' jM.EPICJ pJ E BENJAMIN BUSH.M.D. The Father or American Medicine. A COMPENDIUM OF DOMESTIC MEDICINE, AND HEALTH-ADVISER: CONTAINING A Statement of the Modes of Curing the Diseases to which Man is liable; and Directions in case of Accidents on the Road or at Sea; WITH A full Account of Epidemic Cholera, of Dyspepsia, and of Sick-IIeadache; their Causes, Cure, and Prevention; AND A Popular Description of the Human Teeth; their Formation, Diseases and Treatment. * BY HENRY MCMURTRIE, M. D. in PHILADELPHIA: T. ELLWOOD ZELL, Nos. 17 & 19 South Sixth St. 1871. Entered, according to Act of Congress, in the year 1871, by T. ELL WOOD ZELL, in the Office of the Librarian of Congress at Washington. PREFACE. The practice of medicine should be conducted on those general principles, which are drawn by sober experience, from a careful observation of the effects of remedies upon the human body, in its different stages of disease. These great leading principles are few, short, and easily understood; they are applica- ble in every disease to which the human body is subject, although they may not always prove equally successful. It is the judicious use of them which con- stitutes the great merit of the enlightened physician. In a matter of such immense importance to every individual, it would seem necessary then, that these principles be as widely disseminated, and in as plain words as possible, in order that every one may know and understand them. To do this, is every man's duty, as well as interest; for, independently of his own life, which is frequently jeoparded by the want of such knowledge, that of his neighbour is often by accident placed in his hands. To some particular sections of our extensive coun- try, and to travellers especially, this consideration is of the utmost importance. 1 have known a consider- able district in one of our western states, which con- tained but one doctor, and him I have met on his way to his patients by eight o'clock in the morning so drunk, as to render it necessary to lift him into his gig! Sometimes there is no physician of any kind to be obtained; or if there be, after waiting until the complaint has got to a height that baffles all reme- dies, he arrives in a state similar to that described! What becomes of the sick, under such circumstances 1 3 4 Preface. It was on some such occasion, that the necessity of a cheap, plain work, like the present, first sug- gested itself to my mind. Those books that have been intended for like purposes, seem to me too bulky, too learned, or too expensive. In this work, I have endeavoured within a small compass, and in as plain a manner as possible, to lay down such rules and give such directions, as will enable every one who reads them to adapt to his (or his friend's) case, the plan of treatment most proper for it. As these pages are intended exclusively for the use of men, no diseases peculiar to women or children are treated of in it. To the various writers to whose works I am in- debted, I have made no reference; I have, however, made free use of the most valuable of such as are considered authorities, and in some instances have adopted their very words. The Publisher has issued " The Lady's Med- ical Companion" - intended as a companion to the present work. See advertisement of title and contents at the end of this volume. cv, cervical vertebrae, sc-cl, scapula and clavicle, h, humerus. Iv, lumbar vertebra;, p, pelvis. u, ulna, r, radius, c, carpus, me, meta-carpus. ph, phalanges, fe, femur, t, tibia, f, fibula. ts, tarsus, mt, metatarsus, ps, phalanges. cv. sc-cl h Iv p II. r c me ],h fe- t f. ts mt ps SKELETON OF MAN. CONTENTS. PART FIRST. Introduction . . . . • .15 1. General Rules for Treating Diseases . 15 2. Hints to Travellers in Health . . 17 3. Hints to Invalids Travelling . . 21 Division of Diseases .... 23 (Chapter E. Of Fevers. Of the Pulse 25 Of Fever 26 Simple Inflammatory Fever . . .27 Intermittent, or Fever and Ague . . 28 Remittent Fever 30 Bilious Fever 30 Typhus, or Low Nervous Fever . . 32 Putrid Fever 34 Hectic Fever 36 Chapter EE. Of Diseases, commencing in, and chiefly confined to, particular parts. Inflammation of the Brain 37 Headache 38 Inflammation of the Eye 38 Dimness of Sight 39 5 6 Contents. Night Blindness 40 Inflammation of the Ear 40 Bleeding from the Nose 41 Polypus .41 Cancer of the Lip .... .42 Mercurial Ulcers in the Mouth . . • .42 Ulcers and Pimples on the Tongue . . .42 Cancer of the Tongue 43 Venereal Ulcers 43 Enlargement of the Uvula . . . .43 Swelling of the Tonsils 44 Inflammatory Sore Throat 44 Putrid Sore Throat or Diphtheria . . 45 Strictures in the Throat 46 Catarrh, or Cold 47 Asthma 47 Pleurisy 48 Spitting of Blood 49 Consumption . . .... 49 Palpitation of the Heart 50 Dropsy of the Chest . . ... 51 Inflammation of the Stomach . . .52 Cramp in the Stomach 53 Hiccoughs ....... 53 Heart-Burn 54 Indigestion 54 Vomiting of Blood 56 Inflammation of the Liver 56 Jaundice . 57 Ague Cake 59 Inflammation of the Intestines . . . .59 Cholera Morbus, or Vomiting and Purging . 60 Dysentery 61 Diarrhoea ... .... 63 Colic . 64 Painter's Colic 65 Worms: the White Thread Worm-the Round Worm-the Tape Worm . . . 66 Inflammation of the Kidneys . . . .68 Gravel 68 Contents. 7 Inflammation of the Bladder . . . .70 Difficulty of Urine 70 Suppression of Urine 71 Incontinency of Urine 72 Stone in the Bladder 72 Diabetes, or an Immoderate Flow of Urine . 73 Dropsy of the Abdomen . . . .73 Tympany 75 Gonorrhoea 75 Gleet 76 Involuntary Emissions 77 Strictures 77 Syphilis 77 Cancer of the Penis 78 Venereal Warts 79 Mercurial Disease 79 Dropsy of the Scrotum . . . . .79 Enlarged Spermatic Vein 80 Cancer of the Testicle 80 Impotency 81 Gout 81 Inflammatory Rheumatism . . . .82 Chronic Rheumatism 83 Hip-Joint Disease 84 Dropsy of the Knee Joint . ... 84 White Swelling ....... 85 Pieces of Cartilage in the Joints . . .85 Scrofula, or King's Evil 86 Inflamed Glands .... .86 Scirrhus 87 Cancer 87 Goitre 88 Fainting 88 Apoplexy 88 Stroke of the Sun 89 Epilepsy 90 Palsy ......... 91 Tetanus, or Cramp 91 Locked-Jaw 92 Painful Affection of the Nerves of the Face . 93 8 Contents. Angina Pectoris 94 Dance of St Vitus 95 Scarlet Fever 95 Erysipelas, or St Anthony's Fire . . .96 Mercurial Erysipelas 98 Measles 99 Chicken-Pox 100 Cow-Pox 100 Small-Pox 101 Itch ... 103 Herpes 103 Scald Head 104 Ring Worm 105 Nettle-Rash 105 Blotched Face 106 Scurvy 106 Of Tumours 108 Of Ruptures: Reducible-Irreducible-Stran- gulated 108 AneurismIll Tumours: Fleshy-Steatomatous-Encysted . 112 Ganglion . . 113 Boils 114 Carbuncle 114 Whitlow, or Felon 115 Piles: Blind-Bleeding 115 Of Abscess 116 Psoas Abscess 117 Of Fistula . . 118 Of Ulcers: Inflamed-Fungous-Sloughing-In- dolent-Carious-Scorbutic-Scrofulous- Venereal 119 (Cljaptct EJHL Of Accidents. General Directions 122 Of Contusion 123 Of Sprains 124 Concussion of the Brain 124 Contents. 9 Compression of the Brain . . . • 125 Of Wounds 125 To Stop the Bleeding . . . .125 Incised Wounds 127 Punctured Wounds 129 Contused Wounds . . . 129 Poisoned Wounds, from Bites of Mad Dogs, Rattle-Snakes, &c 130 Stings of Bees and Wasps, Bites of Mosqui- toes, &c - . 131 Wounds of the Limbs, &c. . . . .131 Of the Ear, Nose, &c. . . • 131 Of the Scalp . . . • • 131 Of the Throat ' .132 Of the Chest 132 Of the Abdomen 132 Of Joints 133 Of Tendons ....... 133 Of Fractures 134 Of the Bones of the Nose .... 134 Of the Lower Jaw 134 Of the Collar Bone 135 Of the Arm .... . . 135 Of the Bones of the Fore-Arm . . .136 Of the Wrist, &c. . . . .136 Of the Ribs .... . . 136 Of the Thigh 137 Of the Knee-Pan 137 Of the Leg 138 Of the Bones of the Foot .... 138 Of Dislocations 139 Of the Lower Jaw 140 Of the Collar Bone 140 Of the Shoulder 140 Of the Elbow 141 Of the Wrist, Fingers, &c 141 Of the Thigh ...... 142 Of the Knee-Cap 142 Of the Leg 142 Of the Foot 142 10 Contents. Of Compound Occidents 143 Of Amputation 143 Of Suspended Animation 143 From Drowning 143 From Cold 145 From Hanging 145 From Foul Air 145 Of Swallowing Poisons 146 Acids 146 Alkalies ... ... 147 Mercury 147 Arsenic 147 Copper 148 Antimony 148 Salts of Tin 148 Salts of Bismuth, Gold and Zinc . . 148 Lunar Caustic 148 Salt-Petre . • . . ... 149 Sal Ammoniac 149 Liver of Sulphur .... 149 Phosphorus 149 Spanish Flies 149 Powdered Glass 150 Lead 150 Opium, or Laudanum 150 Mushrooms 151 Tobacco, Hemlock, Night-Shade, Spurred Rye 151 Poisonous Fish 151 Foreign Bodies in the Throat .... 151 Of Burns and Scalds 152 Of Mortification 153 Directions for Bleeding 154 Directions for Passing Catheters-Bougies 154, 155 (Chapter ED. Prescriptions referred to in the work. Prescriptions156-160 Mixtures, Saline-Effervescing.... 156 Contents. 11 Wine or Vinegar Whey 157 Scudamore's Lotion for Gout . . . .159 Poultices of various kinds 160 Clysters of various kinds 160 Hartshorne's Decoction of Spanish Flies in Spirits of Turpentine . ... 160 PART SECOND. EPIDEMIC, or ASIATIC CHOLERA . . 163 Causes 164 Predisposing and Exciting Causes . 164 Prevention 165 Symptoms 167 1. The Stage of Diarrhoea . . .167 2. The Stage of Spasm . . .168 3. The Stage of Commencing Collapse 168 4. The Stage of Confirmed Collapse . 169 Treatment in the different Stages . 169 DYSPEPSIA, or INDIGESTION . . .174 Causes 175 Symptoms ... ... 178 Prevention 180 Treatment .... . . 181 1. Costiveness 183 2. Flatulence 185 3. Violent Pam of Stomach and Bowels 185 4. Nausea and Vomiting . . . 186 5. Constant Soreness and Pain of the Stomach 186 General Remedies 187 1. The Warm Bath and Frictions . 187 2. Mr Halsted's Method . . . 188 3. Mineral Waters . . . 189 4. Tonics and Bitters . . .189 Conclusion . ... 190 12 Contents. SICK-HEADACH 191 Symptoms 192 Medicines . . .... 193 Diet .196 Drinks 203 Exercise . • .... 206 Change of Air 207 Other Cautions 207 Treatment of an Attack of the Complaint . 210 THE TEETH . ... .212 Structure, Number, Form and Articulation 2J3 Formation of the Teeth .... 218 1. Formation of the Milk Teeth . . 218 2. Formation of the Permanent Teeth 220 Shedding the Teeth 220 The First Dentition 223 Diseases attending Difficult Dentition . . 226 Diseases of the Teeth 229 Caries or Rottenness .... 230 Diseases of the Fangs of the Teeth . 233 Toothach 234 Tartar, or Scurvy of the Teeth . . 236 Diseases of the Alveolar Processes . . 238 Diseases of the Gums 240 Inflammation and Sponginess of Gums 240 Gum-Boils ... . . 241 Tumours of the Gums . . . 241 Cleaning the Teeth 242 Excellent Tooth Powder . . . 245 Operations on the Teeth .... 245 Extraction of the Temporary Teeth, when Diseased .... 245 Lancing, or Cutting the Gums, at the time of Teething .... 246 Filing or Sawing the Teeth . 248 Filling Teeth with Gold or other Metals 249 Scaling the Teeth, or Removal ofTartar 250 Extracting Teeth 250 Artificial Teeth 252 14 13 12' 11 10 8" 7" 6- ' 15 ■16 -17 •18 ■19 -20 ARTERIES OF THE HUMAN BODY. 6. Iliac.-7. Sacral.-8. Renal.-9. Intercostal.-10. Aorta. 11. Subclavian-12. Carotid.-13. Vertebral.-14. Tem- poral.-15. Curvature of the Aorta.-16. Axillary.-17. Brachial.-18. Coeliac.-19. Mesenteric arteries.-20. Radial. PART FIRST. A STATEMENT OF THE MODES OF CURING THE DISEASES TO WHICH MAN IS LIABLE; AND DIRECTIONS FOR HIS CONDUCT IN CASE OF ACCIDENTS ON THE ROAD OR AT SEA. XIII INTRODUCTION. GENERAL RULES FOR THE TREATMENT OF DISEASES. All diseases might, with great propriety, be arranged under three heads, viz. Inflammatory diseases, or those attended by in- creased action, as shown by a quick, full, hard or strong pulse,-great thirst and neat,-white, or red tongue,-flushed face,-bloodshot eye, &c. &c. Diseases of debility, accompanied and marked by a small, soft, feeble, slow, or intermitting pulse,-a shining white or dark tongue,-languor and weak- ness,-cold clammy or burning skin, and an internal sense of sinking. Diseases either of increased or diminished action, producing particular effects, and requiring peculiar remedies. Although I have not thought proper, (for reasons presently to be mentioned) to adopt this arrangement, I have been induced to glance at it, as giving rise to those great leading principles or rules, which should govern us in the management of all diseases, and which, if attended to, will be followed by conse- quences as beneficial as the nature of the circum- stances will admit RULE I. In every complaint, whatever it may be called, if you find the pulse quick, hard, full, and strong,-the head ache,-tongue foul,-skin hot, or those marka 15 16 Compendium of Domestic Medicine. which denote it of an inflammatory nature, reduce it by purging,-low diet,-drinking plentifully of cold water and lemonade, - rest, <fcc. If on the contrary, the pulse be small, soft, feeble and intermitting,-the tongue dark, and great debility or weakness is evident, reverse the whole plan; the diet must be generous and nourishing,-the bowels opened with gentle laxatives,-and the strength sup- ported by bark, sulphate of quinine, wine and tonics of various kinds. RULE II. RULE III. If in addition to those symptoms mentioned in the second rule, the tongue be covered with a black coat, -foul dark looking sores form about the gums and insides of the cheeks,-the breath be offensive, &c. the same class of remedies is to be vigorously em- ployed, with a free use of acids and other antiseptic articles Severe local pains, as in the bead, side, <fcc., re- quire sometimes the use of purging, and blisters to the part. RULE IV. Incessant and earnest entreaties on the part of the sick, for any particular article of diet, if steadily per- severed in, may be safely indulged, whether the use of it agrees or not with our preconceived ideas on the subject RULE V. In all fevers, where the pulse is quick, full and strong,-the skin burning to the touch, and there is RULE VI. General Rules. 17 no perspiration, dash cold waler over the head and shoulders of the patient, wipe him dry and put him to bed. If in consequence of this, a chill be experi- enced, and the pulse sink, give warm wine, &c. and omit the waler for the future. Should a pleasant glow, over the whole frame, follow the affusion, and the patient feel relieved by it, repeat it as often as may be necessary. RULE VII. Observe carefully, the effects of various articles of food, as well as physic, upon your own body, and choose those which experience proves to agree best with you. It is a vulgar but true saying, that " What is one man's meat, is another's poison." RULE VIII. Keep a sick room alw ays well ventilated. Plenty of fresh air is an important remedial agent in all dis- eases. HINTS TO TRAVELLERS IN HEALTH. The sudden changes of weather, which so particu- larly characterize the climate of the United States, render a supply of flannel to be wom next the skin a matter of much consequence to the health and comfort of the traveller, who is more exposed than others to the morning and evening damps, as well as the meridian heat. As a general preservative of health, I know of no habit more valuable than this; the disagreeable irri- tation of the skin it occasions at first, soon wears off FLANNEL. 18 Compendium of Domestic Medicine. and it then becomes pleasant. The objections to it during the summer months, are more specious than solid. Accustomed to be cased in it from head to foot, in the East and West Indies, as well as in the southern parts of America, I have uniformly had oc- casion to remark that I suffered less from the heat than such of my friends as wore none. This is now generally admitted to be the consequence by scien- tific men, and is easily accounted for on principles, with which my limits do not permit me to meddle. I merely mention the fact, and again seriously recom- mend every one who wishes to preserve his health in this climate, to have immediate recourse to flannel, and never to leave it off. A phial of laudanum, one of strong essence of peppermint, with a bottle of brandy, and a box of vegetable cathartic pills, should always have a corner in every traveller's trunk: they take up but little room, and should he proceed without thorn, a few days, perhaps hours, may give him serious cause to regret it. While in a high healthy country, there is no abso- lute necessity for observing the following rules, which become indispensable while in a low, marshy, and consequently a sickly one. Never leave your sleeping place in the morning, until the fog and damp have been dispersed by the sun; if, however, you are not master of your own movements, and cannot avoid it, always endeavour to have a cup of coffee and a crust of bread before you set out; this can generally be had, by speaking to the landlord the preceding evening. If you are disappointed, a glass of wine with a few drops of peppermint and a little sugar in it, will an- swer; and in default of the wine, spirits of any kind prepared in the same way, with or without bitters. By these means your stomach will be fortified, and one great avenue to disease be blocked up, always MEDICINES. Hints to Travellers in Health. 19 recollecting that it is as a medicine you are to take it, not to gratify your palate. The practice is unfor- tunately too apt to be continued, when all necessity for it has ceased, and mint juleps, like some other good things that are abused, nave wrecked many an honest and good man; coffee should always be pre- ferred if it can be obtained. BEDS. To mention the propriety of examining closely, the beds you are to sleep in, may at first sight seem su- perfluous, to say nothing more of it. It is not, how- ever, the refreshing luxury of clean sheets, that is the principal inducement to caution, but the great risk you run of contracting disorders by sleeping in dirty ones. I have known a want of care in this point, punished by a severe disease. Many trouble- some and disgusting diseases of the skin, are com- municated in this way, without any idea being enter- tained of their origin. For my part, a great coat and a clean plank, a sofa or three chairs, would be pre- ferred to running any risk whatever. Every one should carry towels and soap with them when travelling, for the simple reason that at many stopping-places no soap is to be found, and towels are so scarce that many persons use the same; which is a pernicious habit, as many con- tagious diseases of the skin and eyes have been transmitted in this way. TOWELS AND SOAP. Change of water is very apt to produce some little disturbance in the bowels, and this to a stranger is one of the sure marks of being in a lime-stone eoun WATER. 20 Compendium of Domestic Medicine. try. If it act gently, it need not be minded, if other wise, mix wine, porter, or brandy with it, or omit the use of it altogether, for a few days, when it may be gradually resumed; in this way its effects are dimin- ished. COLD. To prevent as much as possible any danger from frost, while travelling in excessively cold weather, having well cased your whole body (and feet in par- ticular) in warm clothing, avoid approaching the fire, and the use of spirits, or hot drinks of every descrip- tion. When you stop on the road, instead of seating yourself by the chimney and calling for liquor, walk about in the open air as rapidly as possible, and if you are thirsty, take a glass of cider or cold water. Three men (with one of whom I am personally ac- quainted) set out from Boston for Upper Canada, during the middle of a very severe winter, each one driving his own sleigh; two of them were in the habit of stopping at every tavern they came to, warming their feet and drinking freely of hot toddy. The other never entered a house, except for his meals or to sleep; while his horse rested, he stretched his legs, and when he was thirsty he partook of the same element with his beast. The consequence of this was, that out of the three, he was the only one who arrived at his journey's end uninjured. One of his companions had his feet so badly frost-bitten, that he lost them both, and the other was taken out of his sleigh, at the door of a tavern, where his horse natu- rally stopped, frozen to death! If, notwithstanding all your care, you become much affected by the cold, beware of going to sleep: no matter how strong the inclination may be, resist it for your life-it is the sleep of death! NIGHT AIR. On retiring, it is well to close the window over the bed. One of the most fruitful sources of sick- Hints to Travellers in Health. 21 ness, is found in the night air, that is generally damp, and loaded with poisonous vapours, and which, from the relaxed state of the body during sleep, is more apt than at any other time to produce the most mis- chievous effects. 50" Never let false delicacy, or any other cause, pre- vent you from emptying the bladder as often as you feel the inclination: a painful and lingering, some- times an incurable disease arises from neglecting this call of nature. Although the preceding directions apply to all tra- vellers, they should be more particularly studied and observed by invalids who, while travelling by land, either for the restoration of their health, or from ne- cessity, in stages or carriages, will find an advantage in observing the following rules. HINTS TO INVALIDS TRAVELLING. Never commence your journey in the morning until vou have breakfasted and emptied the bowels, or endeavoured to do so. To obtain the wished for result, make it a regular practice to solicit the evacua- tion directly after your meal. RULE I During the summer, never pursue your journey, if you can avoid it, in the heat of the day: it is better io borrow an hour or two from the morning, and one from the evening, than to risk the excitement liable to be produced by a broiling sun. RULE IL RULE III. Make short stages; always remembering that exer 22 Compendium of Domestic Medicine. cise should never be pushed to fatigue-the latter is as injurious, as the former is beneficial. RULE IV. Be careful to have no ligatures about your body-wear your cravat and garters loosely tied, and let all your clothing be easy. The flannel shirt is indispensable. Always have an ample cloak in the carriage; early in the morning and in the evening, even of summer days, you may find occasion to use it with pleasure and profit. Always have a complete suit of winter clothing in your trunks, although you be travelling in the month of July : if the weather becomes cool, on with your woollens,-stockings included. Inat- tention to the simple rule of adapting the clothing to the temperature of the air in its extreme changes, kills hundreds yearly. RULE V. RULE VI. Never hesitate a moment to comply with the calls of nature; much mischief is occasioned by deferring these evacuations. It is better to be accused of a want of delicacy, than to have a suppression of urine or a fever and headache. RULE vn. This is the golden rule, and is of high authority. Keep your body open, your feet dry and warm, and your head cool! ! A COMPENDIUM OF DOMESTIC MEDICINE. DIVISION OF DISEASES. It is a matter of no consequence with what par- ticular complaint we begin, since each one is to be described. All systems are artificial and liable to objections, but for the purpose of enabling every one to find out his ailment, and to refer at once to its mode of treatment, I have adopted the following plan. In some points of view it may be exceptiona- ble, but it suits the purpose I intend it for,-the con- venience of my reader, who may possibly care as little as I do, whether the arrangement be scientific or not In the first place, there are such diseases as produce a general disturoance, that is visible through- out the whole body. These are found in fevers. Simple Inflammatory Fever. Intermittent, or Fever and Ague. Bilious Remittent Fever. Typhus or Low Nervous Fever. Putrid Fever. Hectic Fever. Next we have those whose effects, though extended to the whole body, commence in, and are chiefly con- fined to, particular parts, such as diseases incident to 23 24 Compendium of Domestic Medicine. 1. The Head, 2. Throat, 3. Chest, 4. Stomach, 5 Liver, 6. Intestines, 7 Kidneys, 8. Bladder,. 9. Genital Organs, 10. Joints, 11. Nerves, 12. Glands, 13. Cellular Membrane,* 14. Skin, including Tu- mours, Ulcers, &c. Lastly, under the title " Of Accidents," will be con- sidered all those unfortunate occurrences, which are daily thinning the ranks of society, which human prudence cannot always prevent, and to which all who travel by land or water are more particularly exposed. * This is a kind of fatty net-work, lying immediate ly under the skin, and covering the whole body ARTERIES OF THE HUMAN EXTREMITIES. 1. Tarsal.-2. Perennal.-3. Posterior tibial-4. Anterior tibial.-5. Femoral.-21. Ulnar. CHAPTER I. Of Fevers: or those diseases which produce a general disturbance throughout the whole body. OF THE PULSE. The pulse is nothing more than the beating of an artery.* Every time the heart contracts, a portion of blood is forced into the arteries, which dilate or swell to let it pass, and then immediately regain their former size, until by a second stroke of the same or- gan, a fresh column of blood is pushed through them, when a similar action is repeated. This swelling and contracting of the arteries then constitute the pulse, and consequently it may be found in every part of the body where those vessels run near enough to the surface to be felt Physicians look for it at the wrist, from motives of convenience. The strength and velocity of the pulse vary much in different persons, even in a state of perfect health. It is much quicker in children than in adults, and in old men, it grows more slow and feeble, owing to the decreased energy of the heart The pulse is increased both in strength and velocity by running, walking, riding, and jumping; by eating, drinking, singing speaking, and by joy, anger, &c. It is diminished in like manner, by fear, want of nourishment, melan- * There are two kinds of blood-vessels in the body: arteries and veins. The arteries carry the blood from the heart to the extremities of the body, where they are connected with the veins which bring it back again. An artery pulsates or beats; a vein does not 25 26 Compendium of Domestic Medicine, choly, excessive evacuations, or by whatever tends to debilitate the system. In feeling the pulse then in sick persons, allowance should be made for these causes, or what is better, we should wait until their temporary effects have ceased. A full, tense and strong pulse, is when the artery swells boldly under the finger, and resists its pressure more or less; if, in addition to this, the pulsation be very rapid, it is called quick, full, and strong; if slow, the contrary. A hard, corded pulse, is that in which the artery feels like the string of a violin, or a piece of tightened cat-gut, giving considerable resistance to the pressure of the finger. The soft, and intermitting mdses, are easily known by their names. In cases of*extreme debility, on the approach of death, and in some particular diseases, the artery vibrates under the finger like a thread. In feeling the pulse, three or four fingers should be laid on it at once. The most convenient spot to do this, as already mentioned, is the wrist, but it can be readily done on the temple,-just before, and close to the ear,-in the bend of the arm,-at the under part of the lower end of the thigh, among the ham-strings, -and on the top of the foot. OF FEVER. Fever is, by far, the most common complaint to which the human body is subject It may be briefly described as a combination of heat,-thirst,-loss of appetite,-weakness, and inability to sleep. It makes its appearance in two ways: either suddenly and vio- lently, or gradually and gently. When it comes on in the first manner, a cold shaking, attended with sickness at the stomach, or vomiting, marks its access; the cold is more severe than in the latter, as is also Fever. 27 the pain in the head, and other symptoms. When its attack is gradual, a feeling of soreness over the whole body, such as is experienced after a hard day's work by one not accustomed to it, shows its approach. Nausea, pains in the head, chills, and more or less heat and thirst soon follow. As these symptoms vary infinitely in their degrees of violence, the vigour of the treatment to be pursued, must differ accordingly. Thus the same directions that are given for simple inflammatory fever, must be adhered to, in one whose symptoms are lighter, though similar, only there is no necessity for pushing them to so great an extent. SIMPLE INFLAMMATORY FEVER. Symptoms. Chills,-flushed face,-skin hot,- eyes re<4-pulse quick, full, strong, and regular,- great thirst,-tongue white,-urine high-coloured and small in quantity,-bowels costive,-breathing quick, &c. Causes Cold,-violent exercise, while exposed to the heat of the sun,-intemperance,-the indul- gence of unruly passions. Distinguish it from Typhus, by the strength and hardness of the pulse,-white tongue and high-co loured urine. Treatment.-Open the bowels, if constipated, with Epsom or Glauber salts, and give some Hoff- man's anodyne, or nitre in water. Soak the feet in hot water containing a little salt and mustard or vinegar. If there be great pain in the head, apply cloths wrung out of iced vinegar or cold spring water frequently, or place a bladder par- tially filled with broken ice on the head; and the diet should consist of plenty of cold water, rice water, or lemonade. If the heat of the body be 28 excessive and burning to the touch, and there is no perspiration, give a table-spoonful of spirits of Mindereri every two hours in some warm tea. If this does not produce free perspiration, then sponge the whole body freely and quickly with cold water, wipe dry, and replace in bed, and cover well with blankets. There should be no fear of bad consequences from this sponging, as it has been found one of the best and very quickest methods to set up reaction and break a fever. All these remedies are to be repeated, until the disease is overcome. If there be intense pain in the head or side, apply a blister. The saline* mix- ture No. 1, will be found useful throughout; and to promote perspiration, five or six grains of Dover's powder, taking care not to drink any thing for some time after it. A purge at the very onset, sometimes cuts short the disease. The room should be kept quiet, cool and dark, every source of excitement being removed. Compendium of Domestic Medicine. INTERMITTENT, OR FEVER AND AGUE. Of this fever, there are several varieties, which differ from each other only in the length of time that elapses between their attacks. There is one called quotidian, in which it comes on every twenty-four hours; another named tertian, in which it arrives every forty-eight hours, and the third quartan, be- cause the interval lasts seventy-two hours. Symptoms. The symptoms of fever and ague, are, unfortunately, too well known among us, commenc- ing with yawning, stretching and uneasiness; this is succeedefl by slight chills or shiverings, that end in a violent or convulsive shaking of the whole bodv. This is the cold fit, and is immediately followed by * See prescriptions, post, pages 156 to 160 Fever and Ague. 29 the fever or hot fit. The pulse rises,-the skin becomes hot,-pain in the head,-tongue white, and all the marks of fever, terminating in a pro- fuse sweat, which gradually subsiding, leaves the patient in his natural state, though somewhat weakened. Causes. Is supposed to depend upon the influ- ence of malaria, a poison emanating from decaying vegetable matter in low marshy localities, and is frequently developed in previous healthy localities by turning up the soil, and clearing the lands of new countries. Water absorbs and transmits this miasmic poison to the system, and it is more abundant during the night. Treatment. This consists first in the prevent- ive, by maintaining of as near a standard of health as possible, by a properly regulated diet and pro- tection from the night air. Sleeping in the upper stories of houses in malarial districts, and the closure of doors and windows on the side exposed to marshes or stagnant ponds. As soon as there are symptoms indicative of the approach of this disease, give at once a large dose of sulphate of quinine: to adults 10 to 20 grains, to children 4-6 years old 3 to 5 grains, and from 10-14 years 6 to 7 grains. When the fever comes on after the rigors and chills, soak the feet in hot water with a little mustard in, place in bed, cover lightly, and give some sweet spirits of nitre; tr. aconite, largely diluted, or a saline fever mixture. If the fever is very high, sponge the spine and whole body with tepid water. After the fever has passed off, renew the dose of quinine to prevent the return of the disease. If, however, it is not cut short by these means, and the quinine has no effect, combine it 30 Compendium of Domestic Medicine. with opium and cinchonia. Jfc. Of quinine 5 grains, sulphate of cinchonia 5 grains, with | grain of ext. opii, three times daily. If this still has no effect, give Fowler's solution of arsenic combined with opium, and very minute doses, l-60th grain of strychnia. Of the Fowler's solution give 5 to 6 drops, three times daily to an adult. REMITTENT FEVER. This is a kind of fever which occasionally abates, but does not entirely cease, before a fresh attack comes on, so that the patient is never completely free from it. The symptoms are of three kinds. When bile preponderates, it is called Bilious Remittent or Bilious Fever, which in a highly aggravated state is the true Yellow Fever of the United States and West Indies.-This constitutes the first kind of remittent. The second is marked by debility, when it is called typhus or low nervous fever. The third exhibits all those marks of debility and putrescency, which constitute putrid fever. BILIOUS FEVER. Symptoms. In this disease, all the marks of great excitement and a superfluity of bile are visible; the skin is hot,-the pulse tense and full,-tongue white in the commencement, changing to brown, as the fever increases,-breathing hurried and anxious,- itowels very costive, and skin of a yellowish hue. In bad cases, there is pain in the head,-delirium,- the patient picks at the bed clothes,-a convulsive jerking of the tendons at the wrist,-tongue black and furred,-a deep yellow skin,-vomiting of a dark matter, that looks like coffee grounds,-hiccup and Bilious Fever. 31 death. When the latter symptoms prevail, it is called yellow fever. Causes. A -p'eculiar poisonous vapour from ponds, marshes, and decaying vegetable matter. Treatment. This must be conducted on our general principles. As the inflammatory and bilious symptoms are the most prevalent at the commencement, the first step is to cleanse the stomach with an emetic, which having operated, open the bowels with citrate of magnesia, Glauber salts or cremor tartar. If, after the emetic is given, the vomiting continues, give neutral mix- ture with laudanum, and pieces of ice on the tongue; if the pain in the region of the stomach is great, make warm narcotic fomentations there- on. If, after four or five days, the fever returns, renew the emetic and open the bowels again with the citrate of magnesia, and let the patient drink cold lemonade, currant-jelly water, &c. Should the skin be very hot, and great thirst and rest- lessness prevail, dash cold water over the body 2 or 3 times a day for 8 or 10 minutes long at a time; after each douche put the patient in bed and give 3 to 6 grains of Dover's powder. The diet should consist of rice-water, lemonade, <fcc., taking care to keep up a discharge from the bowels by gentle purgatives, during the whole of the disease. If, however, in spite of all endeavours to the contrary, the complaint seems advancing to the putrid form, give at the same time that the cold douche is applied, the acids, as sulphuric, phos- phoric, muriatic, inwardly. If diarrhoea should set in, give sulphate of iron. As soon as symptoms of putresoency make 32 Compendium of Domestic Medicine, their appearance, no purgatives should be given internally; on the contrary, bark, wine, acids, <tc. are necessary to support the patient, who should be kept clean, cool and comfortable, excluding all noise. The extreme irritability of the stomach, which is frequently found in bilious fever, may be overcome by the effervescing draught No. 4, and in the latter stage of it, when the pulse flags, and the system appears sinking,* the quinine mixture has been found extremely useful. Blis- ters and mustard poultices may also be applied, in this case, to the ankles, thighs and wrists. There are, in fact, two distinct stages in this disease, that require two different plans of treat- ment. The first, is bilious and inflammatory, and should be met by antiphlogistics, as purging with citrate of magnesia in solution, <fcc., and the affu- sion of cold water. The second, is putrid and bilious, and must be treated by wine, brandy, the quinine mixture, sound porter, and the peculiar plan recommended in putrid fever, <kc. TYPHUS, OR LOW NERVOUS FEVER. Symptoms. Languor,-debility, dejection of mind, -alternate flushes of heat and chills,-loathing of * Rubbing the body freely with the decoction of Spanish flies in turpentine, and the internal use of the quinine, are invaluable, remedies in all such cases, and should never be omitted. Typhus Fever. 33 food,-confusion of ideas. These are succeeded by vertigo,-pain in the head,-difficulty of breathing, -frequent,weak,and sometimes intermitting pulse, -the tongue dry, and covered with a brown fur,- the teeth and gums being encrusted with the same,- the forehead is covered with sweat, while the hands are dry and glow with heat: the patient talks wildly. Causes. Contagion; grief; whatever tends to weaken the system; a poor diet; living in close, filthy apartments; inordinate venereal indulgences. Distinguish it from putrid fever by the attack coming on more gradually, and by the greater mild- ness of the symptoms,-by the want of those putrid marks mentioned in the former, and by the absence of vomiting. Treatment. If the bowels be costive, give some gentle laxative, as rhubarb, or six or eight grains of calomel with as many of jalap. As soon as this has operated, or even before, (if the weakness of the pa- tient seem to require it) exhibit wine as freely as the stomach will bear, not only as a drink, but mixed with his food, which should be sago, tapioca, panada, jellies, &c. If no wine is to be had, brandy, and por- ter (an important article, when good) are to be freelv employed, always remembering, that if the strength of the patient be not supported by these means, he will die of debility. Dashing cold water over the body, is a remedy in this disease of great value. If delirium or insensibility come on, shave the head and apply a blister to it, or cloths wrung out of iced vinegar and water. If a purging ensue, it must be stopped, or it will prove fatal; this may be done by the mixture No. 5, and by opium, which should be given through- out the disease in liberal doses, every night. The Cayenne mixture No. 6, musk mixture No. 7, and the camphor mixture No. 8, will also be found useful. Great reliance is now placed upon the sulphate of quinine, which may be taken in doses of two or three grains, four times a day, dissolved in a little gum arabic tea, or in pills 34 Compendium of Domestic Medicine. The order of remedies then, in typhus fever, is, to open the bowels with laxatives, to use wine, brandy, porter and opium freely, to dash cold wa- ter over the body, to give beef tea, jellies, tapioca, sago, &c., to check purging, to keep the room cool and clean, use the quinine mixture, one or all of the different mixtures of camphor, musk or Cay- enne pepper, to give opium every night, and if de- lirium come on, to apply blisters to the head. Bleeding, the old sheet-anchor of the past, is now obsolete and should never be allowed, particularly in typhus fever, wherein nine times out of ten it is sure death to the patient. PUTRID FEVER. Symptoms. Severe chills,-astonishing and sud- den loss of strength,-countenance livid, and express- ive of horror and anxiety,-the skin sometimes burn- ing to the touch, at others the heat is moderate,-the pulse is quick, small and hard,-vomiting of bile.- violent pain in the head,-redness of the eyes,-low muttering delirium,-the tongue is covered with a dark brown or black looking crust,-blackish sores form about the gums,-the breath is very offensive, and in the latter stage, the urine also, which deposits a dark sediment,-in extremely bad cases, blood is poured out under the skin, forming purple spots, and breaks out from the nose, and different parts of the body,-the pulse flutters and sinks, hiccup comes on and death closes the horrid scene,. * Causes. Contagion,-the same that produce typhus. Distinguish it from typhus, by the greater se- verity of all the symptoms,and by their putrid nature From inflammatory fever, by the sudden weakness, -by the black tongue,-the quick, small and hard, yet not strong pulse, and by the marks of putrescency. Treatment. As severe cases of this disease are Putrid Fever. 35 apt to run their career with fatal rapidity, no time should be lost; bleeding is not admissible, the loss of a few ounces of blood being equivalent to a sentence of death. A gentle emetic is the first medicine to be given, which having operated, should be followed by a mild purgative; 6 or 8 grains of calomel, with as many of jalap, answer the purpose. This being done, resort immediately to the cold water, which should be dashed over the body, as already directed. If the weakness of the patient be such, that fears are en- tertained of his sinking under the shock, sponge him with vinegar and water. When employed early in the complaint, this practice produces the happiest results. As soon as he is wiped dry, and has taken the wine if chilled,* give 10 drops of muriatic acid, with 8 or 9 drops of laudanum, in a wine glass of the cold infusion of bark, every four hours, gradually in- creasing the quantity of the acid to twenty drops or more at a dose. Wine and water should be liberally given in this disease, as soon as the putrid and typhus symptoms show themselves; like every thing else that is used, it should be taken cold. The sulphate of quinine in the same doses as mentioned m typhus, is a valuable remedy. Yeast is much used in putrid fever; the dose is two table-spoonsful, every two or three hours, or it may be mixed with porter or beer, and taken in small quantities very frequently. As a wash for the mouth, nothing is better than an ounce of alum dissolved in a pint of water. Rest at night must be procured by opium, provided there is no delirium. If, towards the end of the complaint, there arise a gentle looseness, accompanied with a moisture on the skin, it should not be meddled with; but if it be a violent purging, it must be stopped by astringents, No. 5. As this is a highly contagious disease, all unnecessary communication with the sick should be forbidden. The chamber should be kept cool, clean and frequently sprinkled with vinegar, 36 Compendium of Domestic Medicine. and all nuisances Tae immediately removed. Much advantage will result from taking the patient, on the very commencement of the attack, into a new and healthy atmosphere HECTIC FEVER. This is never a primary disease, but is always found as a symptom of some other one, as consumption. Symptoms. Night sweats,-bowels costive at first, then loose,-alternate chills and flushes,-a circum- scribed spot on the cheeks,-a peculiar delicacy of complexion, and emaciation to so great a degree tliat the patient sometimes looks like a living skeleton. Causes. The absorption of matter from abscesses, os in consumption and scrofula. Treatment. Remove the cause, by curing tl>e disease of which it is a symptom. CHAPTER II. OJ those diseases, whose effects, though extended to the whole body, commence in, and are chiefly confined to, particular parts. Symptoms. Intense pain in the head,-the eyes incapable of bearing the light,-delirium,-face flush- ed,-oppression at the breast,-the pulse hard, and very rapid,-tongue, at first of a fiery red, then yel- low, brown or black. Causes. Exposure to excessive heat of the sun,- blows on the head,-intense application to study,- intemperance. Distinguish it from inflammatory fever, by the pulse, which in the one is full, strong and regular, in the other, hard, quick and corded, and by the raving delirium. From typhus, by the two latter marks. Treatment. The bowels should be freely opened with Epsom or Glauber salts, the head shaved, and a blister, or cloths dipped in iced vinegar and water, or pounded ice, be applied to it, and the room kept perfectly cool, dark, and quiet, and no company be admitted. Rice water, lemonade or cold water, is to be the only diet. Should the violence of the disease not give way to these remedies, repeat the blistering, &c. as often as may be necessary. The most vigorous measures to reduce the inflammation are required, or death will be the consequence. If much nervous irritation is present, here and there a dose of morphium is good. When morphium is not at hand, give laudanum. INFLAMMATION OF THE BRAIN. 37 Compendium of Domestic Medicine. 38 HEADACH. Causes. Some particular disease of which it is a symptom. Indigestion,-a foul stomach,-tight cra- vats or shirt collars,-exposure to the heat of the sun, -a rushing of blood into the head. Treatment. This will vary according to the •rause. If it arises from indigestion, that must be attended to. A foul stomach is one of the most usual causes of headach: such is the connexion between these parts, that the one is seldom out of order, with- out notice being given of it by the other. In this case,an emetic should always be administered, whieh. at a day's interval, is to be followed by a purgative. If from the beating of the artery in the temples and a sense of fulness in the head, we suspect it to originate from an undue determination to that part, apply ice bladder or cloths dipped in cold water to it. Pains in the head frequently originate from old venereal complaints. They are also very often caused by gout or rheumatism ; for such cases, see those complaints. When it arises from acidity of the stomach give five or six grs. of bicarbonate of potash in dilute camphor water three or four times daily. See Sick-Headache, post, page 191. INFLAMMATION OF THE EYE. Symptoms. Pain, heat and swelling of the parts, which appear blood-shot,-the tears hot and scalding. -fever,-intolerance of light,-sometimes when the lids are affected, the edges become ulcerated. Causes. External injuries, as blows,-particles of sand, &c. getting into them,-exposure to cold,-a strong light,-intemperance. Treatment. If tne complaint is caused by foreign A, Lens. B, Aqueous humor. C, Vitreous humor. D, Retina. E, Iris. F, Choroid G, Sclerotica. H, Cor- nea. I, Optic nerve. K, Ciliary process and muscle. THE EYE. Inflammation, of the Eye. 39 bodies, they must be removed with the point of a hair pencil, or the end of a piece of wire cov- ered with lint, or washed out by injecting warm milk and water into the eye, with a small syringe. If particles of iron stick in it, they must be re- moved by an oculist. From whatever circum- stance it may originate, the inflammation is to be subdued by ice or cold applications, and bleed- ing from the neighborhood of the eye, by a dozen or more leeches. The bowels should be freely opened with Epsom salts, and a cold-water poul- tice, enclosed in a piece of thin gauze, be laid over the part. The room should be perfectly dark, and the diet extremely low. Any of the lotions No. 9, may be used. If the pain is very severe, a small quantity of equal parts of bella- donna and water may be dropped into the eye. If the eye-lids are ulcerated, touch them with the white vitriol ointment. Bathing the eye fre- quently with clear cold water is a refreshing and useful practice.* DIMNESS OF SIGHT. Symptoms. The patient imagines he sees par- ticles of dust, flies, and cobwebs, floating in the air, and cannot distinguish clearly any object, either near or at a distance. Though the pupil sometimes does not contract, the eye is to all ap- pearance unchanged. Causes. Pressure on the optic nerves, within the scull, by tumours, or other causes, or an error or defect in the formation of the nerves them- selves,-drunkenness,-blows on the head,-apo- plexy,-excessive venereal indulgences. * The best plan in all affections of the eye, whether inflammation, dimness of sight, &c., is to consult an oculist, as the least improper treat- ment may cause complete loss of sight. 40 Compendium of Domestic Medicine. Treatment. Blisters, issues, or a seton to the back of the neck. Electric sparks passed through the forehead, and drawn from the eyes, if perse- vered in for a considerable time, may prove effec- tual. As many causes of this disease are seated in the intestines and stomach, a light emetic may be first given, and then a succession of purgatives for several days or weeks. NIGHT BLINDNESS* Symptoms. The sight is perfectly clear and dis- tinct during the day, but completely lost at night. Causes. Prolonged exposure to extremely bright light,-general debility and exhaustion. Treatment. The treatment must be directed to strengthening the general health by tonics and a generous diet; give quinine, iron, and cod-liver oil. At the same time keep in a darkened room, going out only when there is no sun, and even then with the eyes protected by dark glasses and a shade. INFLAMMATION OF THE EAR. Symptoms. Pain in the ear, which at last either gradually ceases, or matter is discharged through the opening. Causes. The accumulation of hard wax,-in- sects getting into it,-injuries from blows, <tc. Treatment. A little warm olive oil, with an equal part of laudanum, dropped into the ear, and * There are many other diseases incident to the eyes, but none that can be managed by any but an oculist. When, therefore, any alteration in the structure of the eye is perceived, no time should be lost in having recourse to one. CAVITY OF THE TYMPANUM, OSSICULA AUDI- TUS, AND THEIR MUSCLES. (Magnified.) a a, cavity of the tympanum, b, membrana tympani, or rather the osseous circle to which it is attached, c, handle of the malleus, resting on the middle of the membrana tympani. d, head of the malleus, articu- lating with the incus, e, long handle of the malleus, passing into the crenoidal fissure (the anterior mus- cle of the malleus is attached to it), f. internal mus- cle of the malleus, g, anvil, b, lenticular bones, t, stapes, k, musculus stapedius. retained there by a piece of wool or cotton, will frequently procure almost instant relief. If it be caused by hard wax, inject warm water or glyce- rine to soften it, and then, with care, endeavour to extract it, when the oil and laudanum may again be employed. In cases of great severity, a blister may be applied behind the ear. A tem- porary deafness frequently results from this com- plaint, and sometimes, when matter is formed, the bones of the organ are destroyed and hearing is lost for ever.* Bleeding from the Nose. 41 Causes. Fullness of blood,-violent exercise,- particular positions of the body,-blows, <fcc. Treatment. Keep the patient erect, or sitting with his head thrown a little backwards, take off his cravat, unbutton his shirt collar, and expose him freely to the cold air; apply ice or cold vine- gar and water to his testicles, and the back of the neck. If these are not sufficient, moisten a plug of linen with brandy, roll it in powdered alum and screw it up the nostril. A piece of cat-gut may, also, be passed through the nostril into the throat, drawn out at the mouth, and a bit of sponge be fastened to it and drawn back again, so as to make the sponge block up the posterior nostril. In doing this, it is necessary to leave a piece of the cat-gut so as to be got hold of, in order to withdraw the sponge. It is seldom, how- ever, that the first remedies will not answer the purpose. BLEEDING FROM THE NOSE. The nose is subject to two species of this tumour. The pear-shaped or pendulous polypus, and a flat- POLYPUS. * There are many affections of the ear which cannot be mentioned; however, in all cases, it is best to apply at once to an aurist. 42 tened irregular excrescence, which is extremely pain- ful, and is of a cancerous nature. As soon as any affection of this kind is suspected, apply to a surgeon. Compendium of Domestic Medicine. This kind of cancer always commences in a small crack, which, after a while, becomes exquisitely pain- ful. If closely examined, this crack is found to be seated in a small hard tumour, which soon ulcerates, and if not checked, extends the disorder to the throat, thereby endangering life. Treatment. The knife is the only remedy for this as well as every other species of cancer, and no time should be lost in resorting to a surgeon. CANCER OF THE LIP. MERCUPJAL ULCERS IN THE MOUTH. Large, dark looking ulcers in the mouth, are a common effect of the use of mercury. They may be known by the horrid smell of the breath, by the teeth being loosened from the gums, and by a coppery taste in the mouth. Treatment. Omit all mercurial preparations, wash the mouth frequently with sage tea or a solu- tion of one drachm of chlorate of potash in five ounces of water, and taking a table-spoonful of the same mixture inwardly three times daily. ULCERS AND PIMPLES ON THE TONGUE. Small pimples are occasionally found on the tongue, which at last form ulcers. Sometimes they are oc- casioned by the rough and projecting edge of a bro- ken or decayed tooth: when this is the cause, the part must be rounded by a file or the tooth extracted, when the sore will heal without further trouble. Whitish looking specks, which seem inclined to spread, are also met with on the inside of the cheeks and lips. They are easily removed by touching their 8urliic.es with burnt alum or borax. Ulcers on the Tongue. 43 Cancer of the tongue commences like that of the lip, being a crack or fissure in a small, hard, deep seated tumour on the side of the tongue. Treatment. No time should be lost in useless attempts to cure it by medicines. The only safety for the patient is in the knife, and that at an early period. CANCER OF THE TONGUE. VENEREAL ULCERS. See Syphilis. ENLARGEMENT OF THE UVULA. The uvula is that little tongue-like appendage that hangs down from the middle of the fleshy curtain which divides the mouth from the throat. It is very subject to inflammation, the consequence of which is, that it becomes so long that its point touches, and sometimes even lies along the tongue, which creates considerable uneasiness, and is now and then the cause of a constant cough, which finally ends in con- sumption. It is commonly called the falling of the palate. Treatment. Strong gargles of vinegar and water jr a decoction of the black oak bark, or a watery 44 Compendium of Domestic Medicine. solution of alum, will frequently cure the complaint It happens very frequently, however, that in conse- quence of repeated attacks, it becomes permanentlu lengthened, and then the only resource is to cut oft the end of it If you are near a physician apply to him, if not, the operation is so simple that any man of common dexterity can perform it, particularly as little or no blood follows the incision. All that is requisite, is to seat the patient, seize the part with a hook, or a slender pair of pincers, draw it a little for ward, and snip off its point with a pair of scissors SWELLING OF THE TONSILS. The tonsils are two glands situated in the throat one on each side, which are very apt to swell iron, inflammation by colds. They sometimes become s< large as to threaten suffocation. Treatment. In the commencement, this is the same as directed for Inflammatory Sore Throat, which see. If it does not succeed, apply to a sur- geon to take them away. Symptoms. Chills, and flushes of heat succeeding each other,-fever,-inside of the mouth, the throat and tonsils much inflamed,-swallowing is painful, -hoarseness,-heat and darting pains in the throat. Causes. Cold,-sitting in damp clothes,-wet feet, -excessive exertions of voice. Distinguish it from, putrid sore throat by the fever tjeing inflammatory, &c. Treatment. An emetic, taken at a very early stage of this disorder, will frequently prevent it from forming. If the bowels are constipated give Epsom INFLAMMATORY SORE THROAT. VERTICAL SECTION OF THE MOUTH AND THROAT. 1. Pendulous palate; 2. Base of the cranium; 3. Phar- ynx: 4. (Esophagus; 5. Nose; 6. Tongue; 7. Salivary- glands; 8. Lingual bone; 9. Thyroid gland; 10. Tra- chea or windpipe. Inflammatory Sore Throat. 45 salts, if not, give citrate of magnesia, a little at a time. A mustard poultice or blister to the throat, is an invaluable application, and should never be neglected. The room should be kept cool and quiet, and the diet consist of barley or rice water. The throat may be gargled several times in the day with No. 10; inhaling the steam of hot water, from the spout of a tea-pot, is of use. If symptoms of putres- cency appear, treat it as directed in putrid sore throat. PUTRID SORE THROAT, OR DIPHTHERIA. Symptoms. All the marks of typhus,-on the se- cond day a difficulty in swallowing,-respiration hur- ried,- breath hot,-skin dry and burning,-a quick, weak and irregular pulse,-scarlet patches break out about the lips, and the inside of the mouth and throat is of a fiery red colour. About the third day blotches of a dark red colour make their appearance about the face and neck, which soon extend over the whole body. U pon examining the throat a number of specks, between an ash and a dark brown colour are ob- served on the palate, uvula, tonsils, &c. a brown fur covers the tongue,-the lips are covered with little vesicles or bladders, which burst and give out a thin acrid matter, that produces ulceration wherever it touches. In bad cases, the inside of the mouth and throat become black, and are covered with foul spreading ulcers, when all the symptoms that cha- racterize putrid fever ensue. Causes. A peculiar contagion. Distinguish it from scarlet fever, by the fever being a typhus and not inflammatory, by the sore throat, dark tongue and putrid symptoms: From measles, by the absence of cough, sneering, watering of the eves, &c. Treatment. Bleeding in this disease is absolutely forbidden. The same may be said of active or strong purgatives. The bowels, however, should be kept open by mild laxatives or clysters. If towards the close of the complaint there is any obstruction, a few grains of calomel and rhubarb may be given. Cold water dashed over the body is one of the most power ful remedies we can employ; it should never be omitted; and as soon as the patient is dried and in bed, hall' a pint of strong mulled wine should be given to him. This practice, boldly followed, fre- quently puts an end to the disease. Emetics are used in the beginning with advantage, but the great and evident indication, is to prevent and counteract the disposition to putrescency, and to support the strength. For this purpose the cold infusion of bark, or quinine, with ten or twelve drops of muriatic acid, and eight or nine drops of laudanum, should be taken frequently, and beef tea. Cayenne pepper is a valuable article; it may be taken in pills, or as recommended by Dr Thomas in No. 6. To cleanse the throat, gargle frequently with No. 11. Any looseness of the bowels must be checked by powerful astringents, as No. 5. The diet should consist of arrow root jelly, panada, tapioca, and gruel; and the drink, of wine whey, wine and water, &c. increasing the quantity of the wine ac- cording to the weakness and age of the patient. The greatest cleanliness is to be observed in the chamber. As this disease is undoubtedly contagious, all unne- cessary communication with the sick room should be prevented, and those who are compelled to be with them, will do well to take a spoonful of the Cayenne mixture from time to time, by way of prevention. It is asserted to be a sale-guard. 46 Compendium of Domestic Medicine. STRICTURES IN THE THROAT. Symptoms. The first mark of an obstruction oi stricture in the throat, is a slight difficulty in swal- LUNGS AND TRACHEA IN MAN, showing the position of the windpipe and bronchial tubes, relatively to the lungs. A, Larynx and superior extremity of the trachea; B, trachea; C, division into bronchi; D, one of the lungs; E, bronchial ramuscules. Strictures in the Throat. 47 lowing solids, which continues increasing for months, or until the passage becomes so contracted that the smallest particle of food cannot pass, but having re- mained an instant at the strictured part, is violently rejected. If the obstacle is not removed, the patient starves. Treatment. Meddle not with the complaint your- self, for you can do nothing to relieve it, but apply with all speed to a surgeon, and remember that your life is at stake. Symptoms. A dull pain in the head,-swelling and redness of the eyes,-effusion of a thin acrid mu- cus from the nose,-hoarseness,-cough,-fever, &c. Causes. Cold or damp air,-exposure to wet. Treatment. If the symptoms be extremely vio- lent, give twenty drops of hartshorn in half a pint of warm vinegar whey. (See No.l2.)Hoarhound and boneset tea taken in large quantities, are very useful. The patient should be confined to his bed, and be freely purged. If there is great pain in the hreast. apply a blister to it. To ease the cough, take two tea spoonsful of No. 13, every fifteen minutes, or till relief is obtained. The influenza is nothing more than an aggra- vated state of catarrh, and is to be cured by the same remedies. No cough or cold is too light to merit at- tention. Neglected colds lay the foundation of con sumption, and every year send thousands to the grave. CATARRH, OR COLD. Symptoms. A tightness across the breast,-fre- quent short breathing, attended with a wheezing, in- ASTHMA. 48 creased by exertion and when in bed. It comes on in fits or paroxysms. Causes. iSpasm of the lungs. Treatment. If the cough be violent and fre- quent, with great pain in the breast, breathe the smoke from burning paper saturated with salt- petre, or the fumes of burning dried stramonium leaves. The tincture of digitalis is highly recom- mended in asthma. It should be taken in doses of a very few drops at first, and cautiously in- creased. If the pulse sinks under it, or giddi- ness, Ac. is produced, it must be laid aside. In fact, it is hardly prudent to take this active and dangerous article, except under a physician's care. The Indian tobacco may be safely used in place of it, in doses of a tea-spoonful of the tinc- ture,® every half hour till relief is obtained. The dried roots of the thorn apple and skunk cabbage, are sometimes smoked through a pipe for the same purpose. Asthma is a disease that is seldom completely cured by art; nature, how- ever, occasionally affects it. Compendium of Domestic Medicine. PLEURISY. Symptoms. A sharp pain, or stitch in the side, increased upon breathing,-inability of lying on the affected side,-pulse hard, quick and corded, -tongue white. Causes. Cold-all that produce inflammation. Treatment. Apply at once 6 or 8 wet cups, or place a large blister over the side and give a full dose of Epsom salts. Repeat the cupping as often as the pulse seems to demand it, and if expec- ® Take a sufficient quantity of the leaves, stem and pods of the plant, put them into a bottle and fill it up with brandy or spirits, and let it remain for a few days. Pleurisy. 49 torntion does not come on, apply another blister close to the first one. All the remedies for the reduction of inflammation, must be actively employed. The patient should be confined to his bed, with the head and shoulders a little elevated, and a warm decoc- tion of the common hemlock* taken frequently, and in liberal quantities. The diet should always consist of rice or barley water. SPITTING OF BLOOD. Symptoms. Blood of a bright red colour, often frothy, brought up by coughing. Causes. Consumption and its causes,-a fullness of blood,-rupture of a blood vessel from any cause. Distinguish wfrom vomiting of blood, by its bright colour, and being brought up with coughing. Treatment. Give the patient at once a table spoonful of common salt, and direct him to swallow it. Apply cold to the chest. The sugar of lead has much reputation in this complaint; 2 or 3 grains of it, with from a half to a whole grain of opium, may be taken every 3 or 4 hours; and in se- vere cases, where the blood flows rapidly, 5 or 6 grains, with two of opium, may be taken at once. The most perfect rest should be strictly enjoined, and the diet consist of cold mashed turnips or cola rice water. Symptoms. A short, dry cough,-languor and gradual loss of strength,-pulse small, quick, and soft,-pain in the breast,-expectoration of a frothy CONSUMPTION. * Twigs and leaves of the tree. 50 matter, that at last becomes solid and yellow,-the breathing grows more anxious and hurried.-the emaciation and pain increase,-hectic fever.-night sweats and a looseness of the bowels come on, and the patient, unsuspicious of danger, dies. Causes. Receiving a disposition to the disease from father or mother,-a flat chest,-spitting of blood,. -neglected colds,-dissipation, &c. Distinguish it by the long continued dry cough, -pain in the breast, and great emaciation,-by the matter thrown up being pure pus. Treatment. In a confirmed state of consumption, nothing that art has hitherto been able to do, can arford us any solid hopes of a cure. When once the disease is firmly seated in the lungs, all that is possi- ble, is to smooth the passage to the grave, and per- haps for a while to retard it. If, however, the dis- ease is taken in its very hud, much may be done by a change of climate, a milk diet, vigorous and dai y exercise on horseback, and by carefully avoiding cold and all exciting causes. A removal to a dry cli- mate should be the first step taken, if practicable; a cold, dry climate is better than a warm, moist one. A complete suit of flannel, worn next the skin, is an indispensable article for everyone who is even inclined to this most fatal disorder. I Compendium of Domestic Medicine. PALPITATION OF THE HEART. The symptoms of this complaint most be obvious from its name. When it arises from a diseased state of the heart or its vessels, nothing can be done to cure it. The patient should be careful to avoid a full habit of body, and abstain from violent exercise and sexual indulgences. He should live low, and keep as quiet and composed as possible. A fit of anger, or anv imprudence, may cost him his life. There is a milder kind of this disease resulting THE HEART, (right side.) Palpitation of the Heart. 51 from debility, which must be remedied by restoring the strength of the general system. It is also symp- tomatic of other diseases, and must be treated ac- cordingly. DROPSY OF THE CHEST. Symptoms. Great difficulty of breathing, which is increased by lying down,-oppression and weight at the breast,-countenance pale or livid, and ex- tremely anxious,-great thirst,-pulse irregular and intermitting,-cough,-violent palpitation of the heart,-the patient can lie on one side only or cannot lie down at all, so that he is obliged to sleep sitting, -frightful dreams,-a feeling of suffocation, &c. Causes. Debility,-all those producing dropsy in general. Distinguish it by comparing carefully all the symptoms together. It is most liable to be confounded with a diseased state of the heart and its vessels. Treatment. This is another of those diseases that mock the art of man. To say it is incurable, would be hazarding too much, but as vet, it has nearly al- ways proved so. All that can be done is to follow the same plan that is laid down for the treatment of dropsy in general, which consists of purging, dia- phoretics and diuretics.® When the water ap- pears to be confined to one cavity of the chest, and the oppression cannot be borne, some relief may be obtained by a surgical operation. * Substances that act on the kidneys, producing an increase of urine. 52 Compendium of Domestic Medicine. Svmptoms. A fixed burning pain in the stomach, -small, very quick, hard pulse,-sudden and great weakness,-the pain in the stomach increased on the slightest pressure,-vomiting,-hiccup. To these are sometimes added an erysipelatous inflammation, ex- tending from the mouth to the stomach,-tainting, clammy sweats, and death. Causes. Cold suddenly applied to the body or stomach,-drinking largely of cold water while very warm,-the striking in of eruptions,-poisons,-gout, -rheumatism. Distinguish vrfrom inflammation of the bowels, by the seat of the pain, which is just below the breast bone, in wbat is called the pit of the stomach, the burning heat and pain there,-by the hiccup and vomiting. Treatment. If from an overloaded stomach, or indigestible food therein, give an emetic; but if by examination it is found that the food has passed out of the stomach into the intestines, give no emetic, but a purge of senna leaves with mag- nesia. A day or two afterward, to remove the acidity of the stomach, give 6 to 10 grs. of bicar- bonate of soda or soda water. If, however, the inflammation is from general debility, give no emetic or purgative, but beef tea, wine, quinine, <fcc., and place warm emollient poultices on the stomach. If from cold, give no meat, but farina- ceous diet; 6 to 10 grs. of bicarbonate of soda 3 or 4 times daily, and keep the bowels open with calcined magnesia and senna. Use no spirituous liquors, but drink freely of ice water. If there is much pain, give besides the warm poultice in- wardly neutral mixture, with sulphate of morphia every 1 or 2 hours. When the inflammation is reduced, and the sto- mach will bear it, a grain of solid opium may be INFLAMMATION OF THE STOMACH. 1 2 6 3 4 10 12 1 5 *1 - 9 - 11 -10 CAVITY OF THE ABDOMEN. 1 Diaphragm. 2. Gall-bladder. 3. Right lobe of liver. 4. Duodenum. 5. Great end of stomach. 6. Pyloric end of stomach. 7. Spleen. 8. Omentum. 9. Pancreas. 10. Great intestine, (colon.) 11. Small intestine, (jejunum.) 12. Small intestine, (ilium.) Inflammation of the Stomach. 53 given occasionally with advantage, combined with some bitter tonic, as tincture of cardui benedicti, extract of absynthi. If the disease has been brought on by poison taken into the stomach, apply the remedies directed in such cases, as oleaginous substances, to neutralize the poison; if, however, there is beginning paralysis, give an emetic and put sinapisms on the stomach. If mortification ensues, death is the inevitable consequence. CRAMP IN THE STOMACH. Symptoms. Violent spasmodic pain in the stomach, which is so severe, as nearly to occasion fainting. Causes. Cold,-gout,-rheumatism, &c. Ac. Treatment. Give 50 or CO drops of laudanum, in a tea spoonful of ether, with a little hot wine. Apply bladders or bottles filled with warm water to the stomach and soles of the feet, or put the patient into the wvtn bath. If the first dose of laudanum does not relieve the pain, repeat it. HICCOUGH. Symptoms. A spasmodic affection of the stomach and diaphragm,* producing the peculiar noise which gives rise to the name. Causes. Some peculiar irritation. Treatment. When hiccoughs occur at the close of any disease, they may be considered the harbin- gers of death : they, however, frequently arise from acidity in the stomach and other causes. A long * A large, broad muscle that closes the chest be- low, dividing it from the belly. It is one of the agents in respiration. 54 draught of cold water, a sudden surprise or fright, puts an end to them. A blister over the stomach may be applied for the same purpose. I have succeeded in relieving a violent case of hiccoughs that resisted every other remedy, by the oil of amber, in doses of five drops every 10 minutes. It may be taken in a little mint water. Compendium of Domestic Medicine. HEART-BURN. This common and distressing affection is most ge- nerally connected with indigestion. To relieve it for the moment, magnesia, soda or seltzer water, and water acidulated with sulphuric acid, may be em- ployed. To cure the complaint, requires the diges- tive powers to be strengthened by tonics, bitters, and the different preparations of iron, &c. as directed for indigestion. The application of a blister over the stomach may be of use. The white oxide of bismuth in six grain doses, three times a day, taken in milk, has been found of service. INDIGESTION. Symptoms. Want of appetite,-low spirits,-pains and fullness in the stomach,-belching,-a sour water rising in the mouth,-heart-bum,-the bowels are irregular and generally costive,-weakness and ema- ciation,-pulse small and slow,-pain in the head,- skin dry,-great uneasiness after eating. Causes. All those which induce debility,-ex- cessive indulgence in the pleasures of the table or intemperance in any way,-chewing tobacco,-a sedentary life, or want of exercise,-a diseased liver. Treatment. In every case of indigestion, the first thing the patient should do, is to abstain from what- Indigestion. 55 ever may have tended to produce it. Chewing and smoking tobacco, occasion a waste of the saliva that is necessary to the digestive process-they must be abandoned. The diet should consist of animal food that is light, nourishing and easily digested. Roasted mutton is perhaps preferable to any other. Country air and constant exercise on horseback, are invalua- ble remedies in this disease, which, as it is generally occasioned by a departure from natural habits and employments, must be relieved by a return to them. Flannel should be worn next the skin and care taken to avoid cold or exposure to wet. A wine glass of the cold infusion of bark and quassia,* with ten or twelve drops of the elixir of vitriol, should be regu- larly taken three times a day, for months. The bowels are to be kept open by some warm laxative, as rhubarb, and the whole frame braced by the daily use of the cold bath. Pepsin in ten to fifteen gr. doses with bismuth just before meals is of much use in the complaint of which we are speaking. Weak spirits and water, or a single glass of sound old Madeira, may be taken at dinner, but all malt liquors should be avoided. Much benefit has been found to result from a long continued use of the wine of iron,+ a glass of which may be taken twice a day. But see post, page 174, fbr a much fuller account of Indigestion, or Dyspepsia. * Made by placing one ounce of powdered bark and one of ground quassia in a close vessel, to which is added a quart of boiling water-to be kept simmer- ing near the fire until the whole is reduced to a pint. + Take of iron filings four ounces, and pour on it four pints of Madeira wine, let it stand for a month, shaking it frequently. 56 Compendium of Domestic Medicine. Symptoms. A flow of dark blood from the stomach, preceded by a sense of weight and oppression in that organ. The blood is generally mixed with particles of food, &c. Causes. Tumours pressingon the liver,blows,&c Distinguish it from spitting of blood, by its dark colour and being mixed with food. Treatment. If the accompanying symptoms be inflammatory, use some cooling purge: if other- wise, try thirty drops of the muriated tincture of iron in a glass of water, every hour till the bleed- ing ceases. If the cause be a diseased liver, or tumour in its neighbourhood, treat it accordingly. VOMITING OF BLOOD. Symptoms. A dull pain in the right side below the rib, which is more sensible on pressure.-an inability to lie on the left side,-pain in the right shoulder,*- a sallow complexion. Such are the symptoms of an acute attack of this disease. There is another species jf it, called chronic, in which its approaches are so gradual that it is a difficult matter to determine its nature. It commences with all the symptoms of in- digestion, and ends in jaundice or dro|>sy. Causes. Long continued fever and ague,-inflam- mation,-acrid bile,-drunkenness or a free use of spirituous liquors is a very common cause,-injuries from blows, &c. Distinguish it from pleurisy, by the pain not be- ing so severe; and by its extending to the top of the shoulder,-by not being able to rest on the left side. Treatment. If from injury, apply leeches, and INFLAMMATION OF THE LIVER. * This is owing to the course of the phrenic nerve. THE LIVER. A, right lobe. B, left lobe, a, depression for colon. 6. depression for right kidney and capsule, cc, coronary ligament, inferior layer, dd, surface uncovered by peritoneum, t, gall-bladder, ff fissure for gall-blad- der. g g, transverse fissure, h, lobulus quadratus. i, umbilical vein. j, hepatic duct. k, hepatic artery. I, ductus venosus. m m, fissure for ductus venosus. n, vena portae, o, lobnlus caudatus. p, lobulus Spigelii. q, inferior vena cava, r, fissure for inferior vena cava. s s, longitudinal fissure. Inflammation of the Liver. 57 afterward ice over the part. If from other causes, warm emollient and narcotic poultices are better, and antiphlogistics and calomel are dangerous. The bowels should be opened by Epsom salts or calomel and jalap. If this does not abate the symp- toms in a few days, give a calomel pill of one grain every five hours, or rub a drachm of the strongest mercurial ointment into the side until the gums are found to be a little sore, when the frictions or pills must bo discontinued until the mouth is well, and then again resorted to as before. If an abscess points outwardly, apply bread and milk poultices to the tumour, omit the mercury, use wine, bark and a ge nerous diet. As soon as matter is to be felt within it, open it at its lowest and most projecting part with the point of a sharp lancet, and let out its contents very slowly, taking care not to close the wound till this is completely effected. The nitric acid in doses of ten or twelve drops, three times a day, gradually increased, and steadily persevered in, will sometimes produce a cure. The mercurial plan, however, is to bo preferred. Symptoms. Languor,-loathing of food,-a bitter taste in the mouth,-vomiting,-the skin and eyes of a yellow colour,-the stools clayey, and the urine giv- ing a yellow tinge to rags dipped in it. There is a dull pain in the right side, under the last rib, which is increased by pressure. When the pain is severe, there is fever,-the pulse hard and full, &c. Causes. An interruption to the regular passage of the bile, which is carried into the blood,-bile be- ing formed in too great quantities. The first is occa- sicned by gall-stones, a diseased liver, &c. Intem- perance is a very common cause, hence tipplers are more subject to it than others. JAUNDICE. Compendium of domestic Medicine. 58 Treatment. Place in a warm bath, and allow to remain there some time; when removed to bed, a grain or two of opium may be given every few hours until the pain is relieved. Bladders partly filled with warm water, or cloths wrung out of hot decoctions of herbs, may also be applied to the seat of the pain. If the stomach be so irritable as not to retain any thing on it, try fomentations and the effervescing mixture, or a blister to the part. As soon as some degree of ease is obtained* by these means, purgatives must be employed, and steadily persevered in; calomel ana jalap, or Epsom salts, in the ordinary doses, answer very well. The diet ought to be vegetable, and should the disease have arisen from a neglected inflammation of the liver, it must be treated accordingly. Diaphoretics and resolvents should be given to remove the bile from the blood and the discoloration of the skin; for which acetate and muriate of ammonia,rhubarb, dandelion root, andchelidonium are recommended. Turpentine is particularly good if there be gall- stones or hardening of the liver. (See Inflam- mation of the Liver.) If putrid symptoms show them- selves, meet them with the remedies already directed for such cases. Regular exercise (on horseback, if possible) should never be neglected by persons sub- ject to this disease. * If, however, this cannot be done, and from the pain being very acute at one particular spot, there is reason to suppose that a gall-stone is lodged there, the fidlowing remedy may be tried, of which one-fifth or a little less may be taken every morning, drinking freely of chicken broth, flaxseed tea, or barley water after it. Ether three drachms. Spirits of turpentine two drachms. Mil them. Ague Cake. 59 AGUE CAKE. This is the vulgar appellation of an enlarged spleen, and expresses with much brief meaning, the cause of the complaint, as it generally results from ill-treated or obstinate intermittents. It is, however, not productive of much uneasiness, and frequently disappears of itself. The plan of treatment must be governed by the cause: by in- termittents, quinine; by chlorosis, iron with qui- nine; by anaemia, quinine with sulphur, auratum, iodide of iron; by syphilis, mercury, &c. INFLAMMATION OF THE INTESTINES. Symptoms. Sharp pain in the bowels which shoots round the navel, and which is increased by pressure,-sudden loss of strength,-vomiting of dark coloured, sometimes exc.rementitious mat- ter,-costiveness,-small, quick and hard pulse,- high coloured urine. Causes. Strangulated ruptures,-cold,-accu- mulations of hard feces in the bowels,-colic, Ac. Distinguish it from colic, by the pain being increased by pressure, whereas in colic it is re- lieved by it. Treatment. Consists in warm narcotic appli- cations to the abdomen; olive oil and laudanum on a thick piece of flannel applied very warm is good; warm baths, oleaginous drinks and emulsions, as oil of sweet almonds with gum arabic; strict diet, ipecacuanha and opium in powder, J gr. each, every 1 or 2 hours,-calomel and opium, castor oil, Ac. If there is sweating, then warm baths are contraindicated. Compendium of Domestic Medicine. 60 The diet should consist of small quantities of barley or riee water only. If in the latter stages of the disease, when the inflammation has some- what subsided, an obstinate costiveness be found to resist all the usual remedies, dashing cold water over the abdomen will sometimes succeed, or better still to place ice in a bladder over the abdomen. Remember that this complaint frequently rune its course in a day or tro. and that, unless the proper treatment be at once employed, mortification and death mill ensue. If a strangulated rupture occa- sion the disease, attempts at reduction must be tried, or operation at once. Great care must be taken in trying to reduce the rupture if it be the cause. It is beet to call a physician. CHOLERA MORBUS. OR VOMITING AND PURGING. Symptoms. A violent vomiting and purging of bile, preceded by a pain in the stomach and bowels, -quick, weak and fluttering pulse.-heat-■thirst.- cold sweats.-hiccups, and sometimes death in a few hours. Cacses. Exposure to sudden changes of weather, -not wearing flannel.-unripe fruit.-acrid matters of any kind in the bowels.-cold moist air, Arc. Treatment. Wash out the stomach and bowels with copious draughts of chamomile tea. barley or chicken water, Arc. and inject clysters of the same articles. Bladders or bottles containing hot water, should be applied to the feet, and flannel cloths wrung out of hot spirits, be laid over the stomach. When from the quantity of barlej' wa'er, &c. that has been taken, it is supposed that the stomach is sufficiently cleared, give one-half grain of powdered opium, and repeat it every few hours as the case may require.* If the powder will not remain in the stomach, give SO or 90 drops of laudanum, in a table-spoonful of thin starch, by clyster, and pieces of ice on the tongue. Fifty or sixty drops of laudanum in a small quantity of strong mint tea, or the effervescing draught, will frequently succeed in allaying the irritation. If all these means fail, apply a blister to the stomach. When the violence of the attack is over, give castor oil or the oil mix- ture, No. 14, to carry off the bile that may remain in the bowels. To complete the recovery and to guard against a second attack, a complete casing of flannel is requisite, with the use of vegetable bitters and tonics. Persons subject to this disease should be cautious in their diet, and avoid exposure to moist cold air. See Asiatic, or Epidemic Cholera, post, p. 163. Cholera Morbus 61 DYSENTERY. Symptoms. Fever,-frequent small stools, accom- panied by griping, bearing down pains, the discharge consisting of pure blood or blood and matter, some- times resembling the shreds or washings of raw flesh, -a constant desire to go to stool,-vomiting. Causes. Moist cold air,-unwholesome, putrid * If the weakness be very great, and the spasms so alarming as to cause a fear of the immediate re- sult, the quantity of opium may be increased to 6, 8 or 10 grains at a dose. Compendium of Domestic Medicine. 62 food,-noxious vapours from marshes, <tc.,-a peculiar and unknown condition of the atmos- phere. Distinguish it from a diarrhoea or lax, by the fever, griping pains, and the constant desire to evacuate the bowels,-by the discharge itself being blood, or matter streaked with blood, &e. Treatment.* In case the dysentery should be caused by hardened feces or something in the intestines, give at the first onset of the disease a dose of castor oil with 20 drops of laudanum, and then the following day begin the remedies to cor- rect the looseness of the bowels. If there is blood diarrhoea, colic pain and tenesmus, give Dover's powder or an emulsion of oil of sweet almonds, nitrate of soda with laudanum. Make warm fomentations on the abdomen. If this does not cure, give every 2 hours small doses of calo- mel and opium, and in the evening 5 or 10 grains of Dover's powder,-and morning and evening a clyster of nitrate of silver, 2 gr. to 5 oz. water, with 10 drops of laudanum therein. The diet should consist of gum arabic dissolved in milk, arrow-root jelly, barley water, <tc. Clysters of the same articles, with the addition of an ounce of olive oil, and twenty drops of laudanum, may be likewise injected several times in the day.- If severe tenesmus (or constant desire to go * I have known several cases of dysentery, when taken in the very beginning, cured in one or two days by a free use of the common black- berry syrup. Dysentery. 63 to stool) remains, anodyne clysters will be found use- ful, or what is more effectual, a couple of grains of opium placed just within die fundament. The vari- ous astringents which are proper fbr dysentery in its latter stages, are found in Nos. 15, 16, and 17, which may be used with port wine and water, as a drink. DIARRIICEA. Symptoms. Repeated and large discharges of a thin excrementitious matter by stool, attended with gripins and a rumbling noise in the bowels. Causes. Cold,-suppressed perspiration,-acrid matters in the bowels,-unripe fruit, &c. Treatment. If the disease arises from cold, a few doses of the chalk mixture, No. 18, will fre- quently put an end to it. It is, however, sometimes necessary to begin with an emetic of twenty grains of ipecacuanha, and then open the bowels by some mild purgative, as castor oil or rhubarb. Bathing the feet in warm water, and copious draughts of boneset tea, will be found of great benefit, if it ori- ginate from suppressed perspiration. For the same purpose also, from 6 to 10 grains of Dover's powder may be taken at night, being careful not to drink any thing for some time after it If worms are the cause, treat it as directed. When it is occasioned by mere weakness, and in the latter stages of it (proceed from what it may), when every irritating matter is expell- ed, opium, combined with astringents, is necessary, as in the similar period of dysentery. The diet should consist, in the beginning, of rice, milk, sago, Ac. and subsequently of roasted chicken. Weak brandy and water, or port wine and water, may accompany the chicken fbr a common drink. Persons subject to complaints of this kind, should defend their bowels from the action of cold by a flannel shirt; the feel and other parts of the body should also be kept w arm. Compendium of Domestic Medicine. 64 COLIC. Symptoms. Violent shooting pain that twists round the navel,-the skin of the belly drawn into round balls,-obstinate costiveness,-sometimes a vomiting of excrement. Causes. A cold,-indigestible or acrid food,- wind in the bowels,-poisons,-gout,-rheumatism, -worms, &c. &e. Distinguish it from inflammation of the bowels by the pain being relieved by pressure, and from other diseases by the twisting round the navel,-the skin being drawn into balls, &c. Treatment. The first thing to be done in this disease, is to give a large dose of laudanum in a little peppermint water or warm brandy, and apply a mustard poultice below the navel. Fifty, sixty or seventy drops of laudanum may be given at once, as the pain is more or less violent, and the dose be repeated in half an hour, or less time, if ease is not procured, while some warm fomentations on the abdomen will afford much relief; when this does not help, try ice. During this time, if the first doses of laudanum are found ineffectual in re- ducing the pain, and it is very great, eighty or ninety drops may be given as a clyster in a gill of gruel, or warm water. One great rule in the treatment of colic where the pain is excessive, is, to continue the use of opium in such increased doses as will relieve U.'-When this is obtained, castor oil by the mouth and clyster must be employed to open the bowels. In bilious colic when there is a vomiting of bile, the effervescing draught, with thirty drops of lauda- num. may be taken, to quiet the stomach, to which flannels wrung out of warm spirits may be applied. When the vomiting has abated, the oil mixture. No Colic. 65 14, or the pills, No 19, should be taken until a free discharge is procured, if, notwithstanding our en- deavours, the disease proceeds to such an extent as to induce a vomiting of excrement, the tobacco clys- ter* must be tried, or an attempt be made to fill the intestines with warm water. This is done by forcibly injecting it in large quantities, at the same time the patient swallows as much as he is able. In this way, with a proper syringe, two gallons have been successfully introduced. In all cases of colic, when there is obstinate costiveness, an examination of the fundament should be made with the finger If there are any hard, dry pieces of excrement there, they may be removed either by the finger or the handle of a spoon. Those who are subject to colic, should avoid fer- mented liquors, and as much as possible, vegetable food; be always well clothed, and take care not to expose themselves to cold and wet. The bowels should never be allowed to remain costive. PAINTER'S COLIC. Symptoms. Pain and weight in the helly,-belch- ing,-constant desire to go to stool, which is inef- fectual,-quick contracted pulse,-the belly becomes painful to the touch, and is drawn into knots,-con- stant colic pains,-the patient sits in a bent position, -after a while palsy of the whole body or a part. Causes. The fumes of lead, or the handling of its different preparations. Treatment. This disease is but too apt to end in palsy, leaving the hands and limbs contracted and useless. In every case of colic, whose symptoms resemble the above, if the person has been exposed * See Clysters. 66 to lead in any of its shapes, all doubt on the sub- ject vanishes. If from the violence of the attack an inflamma- tion of the bowels be feared, give hourly a table spoonful of castor oil. Give laudanum in large doses, and rub the belly well with warm spirits, and place him in a bath as hot as he can bear it. As soon as he is well dried, and has rested in bed a few minutes, take him up, and dash a bucket of cold water over his belly and thighs, or mix an ounce of calcined magnesia in a pint of milk, and give a wine-glassful every half hour, until ease is obtained. If this, with castor oil by the mouth and in clysters, will not produce a stool, apply a large blister to the belly. As soon as the symptoms are somewhat abated, castor oil or laxative clysters may be resorted to for the pur- pose of keeping the body open; and to guard against a return, small doses of opium should be taken from time to time. Bitters, the different preparations of iron, bark, Ac. are necessary to restore the strength of the system. According to modern times, let those who work in lead or paint, drink of skimmed milk with their meals, and lead or painter's colic will be warded off'. Compendium of Domestic Medicine. Symptoms. Intolerable itching at the nose, some- times at the fundament,-disagreeable breath,-• grinding of the teeth and starting during sleep, -hardness of the belly,-gradual emaciation,-- colic, and sometimes convulsions. Causes. Unknown. Treatment. This will vary according to the kind of worm that is to be destroyed. They are of three kinds ; WORMS. THE WHITE THREAD WORM Worms. 67 Resembles a small piece of white thread, and is usually found near the fundament, at the lower end of the guts, where it produces a contraction of the fiarts, and a most intolerable itching. Clysters of ime water will frequently bring whole nests of them away, and procure instant relief The tincture of aloes, No. 20, however, is by far the best remedy known, for not only this, but the round worm. THE ROUND WORM Occupies the small intestines, and sometimes the stomach. It is of various lengths, from 3 to 8 or more inches. If the tincture of aloes fail to remove it, the pink root may be taken in decoction, or in powder, in doses of 60 or 80 grains, to be followed after three or four days by ten or fifteen grains of calcmel. Cowhage in molasses or honey, with a dose of castor oil every third day, has been very highly extolled. In cases where all other means have failed, tobacco leaves pounded with vinegar and applied to the belly, have produced the desired effect.* THE TAPE WORM Inhabits the whole of the internal canal, and fre. quently defies all our efforts to get him out of it. Large doses of spirits of turpentine, from one to two ounces, in barley water, have been advantageously employed for this purpose, and are the very surest remedy that we possess. A remedy formerly much celebrated, is that of Madam Nounler, the basis of which is No. 21; after two doses of which, 15 or 20 grains of jalap with 8 or 10 of calomel should be taken. If the spirits of turpentine be tried, large * All the prescriptions, No. 22, may be tried in suc- cession. 68 Compendium of Domestic Medicine. quantities of gruel or borley water should be used with it, in order to prevent its irritating the stomach and kidneys. By whatever means these troublesome guests are got rid of, the patient should he careful to strengthen his system and bowels by a course of hark, bitters, wine, &c. and to use a great proportion of animal food in his diet. INFLAMMATION OF THE KIDNEYS. Symptoms. Deep seated pain in the small of the back,-urine high coloured and small in quantity, sometimes bloody,-sickness at the stomach,-vomit- ing- Causes.. Gravel in the kidneys,-Spanish flies,- straining the back,.-hard exercise by riding, walk- ing, &c.,-cold,-intemperance. Treatment. This will depend upon the cause. If it proceed from gravel, the plan to be pursued will be detailed under that head. If it arise from any ol the others,, place warm emollient narcotic fomen- tations over the region of the kidneys, or put him into a warm bath. Twenty grains or more of the uva-ursi, with half a grain of opium three times a day, accompanied by small quanti- ties of warm barley or rice water, is one of the most valuable remedies we are in possession of. The diet during the attack should consist of muci- laginous drinks only, which must be frequently taken, notwithstanding they may be rejected by vomiting. GRAVEL. Symptoms. A fixed pain in the loins,-numbness of the thigh,-constant vomiting,-retraction of the VERTICAL SECTION OF THE KIDNEV. a, supra-renal capsule, h b, cortical substance of kid- ney. c c, medullary substance of kidney, e e e, the sinus or pelvis. /, the ureter, proceeding to the bladder. testicle,-urine small in quantity, voided with pain, and sometimes bloody. As the gravel passes from the kidney into the bladder the pain is so acute as to occasion tainting, &c. &c. Causes. The formation of a peculiar acid in the kidneys. Treatment. Chloroform inhalation, or put him into a warm bath, where he should remain some time. Meanwhile an emollient and anodyne clyster should be got ready, which must be given to him as soon as he leaves it. Cloths wrung out of decoctions of herbs or warm spirits and water, should be ap- plied to the part, and small quantities of warm gum arabic tea or barley water be taken frequently. A grain of opium every two hours, will be found useful. Strong coffee, without sugar or cream, some- times acts like a charm in soothing the pain: twenty drops of the spirits of turpentine taken on a lump of sugar every half hour, is said, by high authority, to do the same. If the irritation of the stomach is very great, the effervescing draught, with 30 or 40 drops of laudanum, may be tried. When the pain, &c. is somewhat abated, the bowels should be opened, either with castor oil or Epsom salts. The uva-ursi, as be- fore mentioned, is one of the most valuable remedies in all diseases of the kidneys that we have. Blisters in all such cases are never to be applied. Persons sub- ject to this distressing complaint, should be careful to avoid acids and fermented liquors of all kinds, in- cluding the red wines, beer, pickles, &c. For a com- mon drink, soft-water, or the seltzer and soda waters are to be preferred. When any threatening symp- toms are perceived, recourse should be had to the uva-ursi, in small doses often or twelve grains, with half a grain of opium three times a day, to be con- hnued for weeks. Gravel. 69 70 Compendium of Domestic Medicine. INFLAMMATION OF THE BLADDER. Symptoms. Pain and swelling of the bladder,- the pain increased by pressure,-a frequent desire to make water, which either conies away in small quantities or is totally suppressed. Causes. Inflammation of surrounding parts,- stone in the bladder,-suppression of urine. Treatment. Make warm application of water and narcotics over the bladder: put him into the warm bath. Inject mucilaginous and laxative clysters, and pursue the exact plan of treatment that is recommended for the cause from which it may proceed. See Suppression of Urine, <kc. DIFFICULTY OF URINE. Symptoms. A frequent desire to make water, at- tended with pain, heat, and difiiculty in doing so,-a fullness in the bladder. Causes. The urine having been retained too long -Spanish (lies taken internally,-gravel,-blisters, and all the causes of inflammation of the bladder,- inflamed prostate gland, &c. Treatment. If it arise from simple irritation by blisters, &c. plentiful draughts of warm liquids, as gum arabic or barley water, will be sufficient to re- move it. If from any other cause, a bladder half filled with warm water, or cloths wrung out of a warm decoction of herbs, should be kept constantly applied over the parts, and mild clysters of thin starch be frequently injected. The. Ureters, running from the. Kidneys to the Bladder.- a Aorta b Bifurcation, c Abdominal muscles turned down, d The rectum cut and tied. e. Bladder. //Ure- ters. g g Kidneys. Suppression of Urine. 71 Symptoms. Pain and swelling of the bladder,- violent and fruitless attempts to make water, attended with excruciating pain, &c. Causes. The same as in a difficulty of urine. Treatment. As a total suppression of urine is always attended with considerable danger, there should be no delay in endeavouring to remove it. Chloroform the patient to relieve the spasms, or he should be placed in the warm bath. While he is there a laxative and anodyne clyster must be got ready, which is to be given as soon as he leaves it, and fre- quently repeated. In the mean time the warm fomentations, and a bladder of hot waler must be kept applied, and No. 23 be taken every three or four hours. If there be any difficulty in procuring it, twenty drops of laudanum in a little warm barley or rice water, or a decoction of the dandelion will an- swer in stead. Warm sweet oil or milk and water may be injected up the urethra, and 6 or 8 grains of camphor in a little milk be taken every hour. If no relief is obtained by these means, apply snow or ice to the bladder, or make the patient stand on a cold brick, or stone pavement, and dash cold water over his thighs, and if this fail, try the tobacco clys- ter, which sometimes succeeds after every thing else has been resorted to in vain. If a catheter* can be procured, try to pass it into the bladder while in the bath. If the patient himself cannot do it,t let a handy friend attempt it; if foiled in one position, try another, -success is of the utmost imjiortance, for there is nothing but an operation, in the event of its not being obtained, that can save life. In every case of suppression of urine, the order of SUPPRESSION OF URINE. * An instrument used by surgeons to draw off the water from the bladder. + See directions, &c. for passing it 72 Compendium of Domestic Medicine. remedies then are, anesthetic,-the warm bath,- laxatives and anodyne clysters-fomentations, or bladr ders half filled with warm water over the lower belly, camphor and milk every hour, or No. 23, every three hours,-passing the catheter,-dashing cold water over the thighs and legs, or applying snow or ice to the blad- der, and lastly, the tobacco cl lister. INCONTINENCY OF URINE. Symptoms. An involuntary dribbling or flow of urine. Causes. A relaxative or paralytic affection of the bladder,-excessive venereal indulgences,-a dis- eased state of the bladder,-stone in the bladder. Treatment. If it arises from a relaxation or weak- ness of the parts, use the cold bath daily, apply blis- ters between the fundament and the bag, and have recourse to bark and the different tonics, as iron, &c. recommended in indigestion. Twenty or thirty grains of the uva ursi, twice or three times a day, with half a pint of lime w'ater after each dose, may also be tried. If the disease is occasioned by a palsy of the parts, the tincture of Spanish flies may be of service. If a stone in the bladder is the cause, apply to a sur- geon to cut it out. In the mean time, some kind of vessel should be attached to the penis, to receive the urine, in order to prevent it from excoriating the parts. STONE IN THE BLADDER. Symptoms. A frequent desire to make water, which comes away in small quantities at a time, and is often suddenly interrupted, the last drops of it oc- casioning pain in the head of the yard,-riding over a rough road, or any irregular motion, or jolting Stone in the Bladder. 73 causes excruciating pain and bloody urine, accom- panied with a constant desire to go to stool,-itching of the fundament,-a numbness in the thighs, &c.- retraction or drawing up of the testicle. Treatment. Apply to a surgeon. DIABETES, OR AN IMMODERATE FLOW OF URINE. Symptoms. Frequent discharges of large quanti- ties of urine, which is sometimes of a sweet taste,- skin dry,-bowels costive,-appetite voracious,- weakness, and gradual emaciation of the whole body. Causes. A shattered constitution,-immoderate venereal indulgences,-spirituous liquors,-cold,- suppressed perspiration. Treatment. The principal remedy for the cure of this disease, consists in confining the patient to a diet composed exclusively of animal food. Blisters may, also, be applied over the kidneys and kept open with the savine ointment. The prescription No. 24,* has proved eminently successful. The carbonate of ammonia, in doses of 11 or 12 grains three limes a day, is strongly recommended, upon high authority. In addition to these, opium in liberal doses, exercise on horseback, the flesh-brush, and flannel next the skin are not to be neglected. The bowels should be kept open by rhubarb. DROPSY OF THE BELLY. Symptoms. A swelling of the belly, from water contained in it, preceded by a diminution of urine,- dry skin, and oppression at the breast. * Of Dr Ferriar, of Manchester, England. 74 Compendium of Domestic Medicine. Causes. Diseases of various kinds,-intemper- ance,-a dropsical disposition. Distinguish it from tympany by the absence of the rumbling of lhe intestines, belching, colic, and hollow sound which characterize the latter: From other diseases, by placing one hand on the belly, and gently striking it on lhe opposite side with the other, when a wavy or tremulous motion will be fell, resembling that occasioned by the agitation of water in a basin. Treatment. One of the most valuable remedies for dropsy is found in the elaterium, (the dried ex- tract) one fourth of a grain of which is a dose. As it is a most active article, it is proper to begin with one sixteenth of a grain daily, which may be cautiously increased to a fourth, or till it is found to exert its full powers by bringing away large watery stools. From an ounce to an ounce and a half of cream of tartar, dissolved in waler, and taken daily, has frequently succeeded in removing the complaint. As objections are sometimes made to the quantity of this latter arti- cle it is necessary to use in this way, half an ounce of it, with one or two grains of gamboge, every other day, may be substituted for it. Six grains of calomel, with one or two of gamboge, taken twice or three times a week, have cured the disease. Bathing the feet before going to bed, and taking immediately after 20 grains of Dover's powder, by producing copi- ous sweating, has had the same effect. Dropsy is, notwithstanding, a difficult disease to cure. It must be attempted, however, by the use of such Articles as we have mentioned, beginning with the first, and if it fail, proceeding to the next and so on. If lhe swelling increases to such an extent as to be absolutely insupportable, send for a surgeon to draw off the water. At the decline of the disease, the strength must be supported and restored by bark, wine and lhe tonic plan recommended fbr indigestion Tympany. 75 Symptoms. The symptoms of tympany or a col- lection of air either in the intestines themselves, or in the cavity of the belly, are more or less gradual in their approach. When the disease lies within the intestines, it commences with wind in the stomach and bowels, which keeps up a constant rumbling, belching, &c.-colic,-costiveness,-diminution of urine,-want of appetite, &c. When it is in the cavity of the belly and outside the intestines, the swelling is much greater, and very elastic, when it is struck, giving a hollow sound like a drum,-there Is no belching, &c. Causes. Weakness of the bowels,-intemperance, -a vegetable diet Distinguish it from dropsy, which see. Treatment. If the complaint is within the intes- tines, keep the nozzle of a clyster pipe up the funda- ment, to permit the wind to pass through it, in order to diminish the pressure on the bowels. Warm mint tea, ginger, horse-radish, ether, Cayenne pepper, spices and essential oils, with laxative medicines and clysters, should be freely used, with a moderately tight broad bandage round the belly. If these means do not answer the end, warm and active purges must be resorted to, such as the compound tincture of senna, or jalap, or any of the Nos. 25,26, or 27. If no rehefis obtained and the costiveness continues obsti- nate, apply pounded ice to the belly. Rubbing .t with turpentine may, also, prove useful It is very apt to terminate in death. TYMPANY. GONORRIICEA. Symptoms. A tingling sensation at the end of the penis,whichswells, looks red and inflamed, followed 76 Dy a discharge of matter that stains the linen, first of a whitish, then of a yellow or green colour,-a scald- ing pain in making water,-involuntary and painful erections. Treatment. There are two kinds of this affection, the mild and the virulent. The first is of so trivial a nature, that plentiful draughts of any soothing liquid, as barley water or flaxseed tea, with a low diet, are sufficient to remove it. The second produces effects more or less violent on different persons, and occa- sionally resists for months, every remedy that can be thought of If the disease resist the low diet, &c. apply to a surgeon, and beware of trusting to the recipes of friends, or of employing their injections. Strictures and other horrid consequences are the most probable results of tampering with this disorder. If at sea, however, you may use an injection composed of five grains of sugar of lead and eight or ten of white vitriol, dissolved in half a pint of soft water. Compendium of Domestic Medicine. Symptoms. The weeping of a thin glairy fluid, like the white of an egg, from the penis, caused by a long continued clap. Treatment. A gleet is exceedingly difficult to get rid of, and frequently defies every effort that is made for that purpose. It must be attempted, how- ever, by the daily use of the cold bath, and 30 drops of the muriated tincture of iron, taken three times a day, for months, in a glass of the cold infusion of bark. N. B. This complaint if let alone or badly treated is apt to end in an exhausting and incurable disorder. You had better seek the best medical advice within your reach. GLEET. Involuntary Emissions. 77 Symptoms- An involuntary emission of semen during sleep, inducing great emaciation and debility. Causes. Excessive venery,-onanism,-every thing that weakens the seminal vessels. Treatment. Abstain from all sexual indulgence and lascivious ideas or books,-sleep on a hard bed, -use the cold bath daily, with a generous and nourishing diet. Chalybeate water and all the dif- ferent preparations of iron, with the cold infusion of bark and elixir of vitriol, as directed for indigestion, should be freely employed. INVOLUNTARY EMISSIONS. Symptoms. A difficulty in passing water, which, instead of flowing in a full stream, either dribbles away, twists like a corkscrew, or splits and forks in two or three directions. They are occasioned by strong injections,-longcontinued or ill treated clap. The cause, however, is not always to be satisfactorily ascertained. Treatment. Apply to a surgeon: you can do no- thing to rid yourself of the disease but this,-terrible are the consequences of meddling with it yourself. STRICTURES. SYPHILIS. Symptoms. Chancres and buboes are among the first symptoms of this dreadful malady, which, if not checked, goes on to cause an ulcerated throat, nodes, a destruction of the bones and cartilages of the nose, and the palate. The voice is lost,-the hair falls off, -foul spreading ulcers show themselves all over the 78 Compendium of Domestic Medicine. body, the stench of which is insupportable, and be- fore he dies, the miserable victim to it becomes a loathsome mass of corruption. A Chancre at first resembles a pimple, with a little pit or depression containing matter, which soon becomes an ulcer, with an irregular thickened edge, covered with a tough, ash-coloured matter, the basis of which is hard and surrounded by inflammation. It is generally found on the foreskin or head of the penis. A Bobo is an enlargement of a gland in the groin, beginning in a small hard lump, not bigger than a bean, and increasing to the size of a. hen's egg. A Node is a hard tumour formed on a bone. Treatment. N.B. Apply to a surgeon on the first indication or even suspicion of this most horrible disease,-if taken at an early period, and properly treated, it is soon cured,-but if neglected, or impro- perly attended to, its consequences are loo dreadful to be detailed: a lingering death, and a putrescent body, are what you may expect. Give no confidence to the recipes of friends, but apply to a physician at once. CANCER OF THE PENIS. Symptoms. A small tumour like a wart, upon the head of the penis or foreskin, followed by inflamma- tion and ulceration, which discharges a thin dis- agreeable fluid,-after a time, a cancerous fungus is produced, attended by a most intolerable burning and darting pain. Treatment. Apply at once to a surgeon, who will amputate it. Death is the only alternative. Venereal Warts. 79 Crops of these animal mushrooms sometimes spring up round the head of the penis, or on the foreskin. If flat, they may be destroyed by caustic; if mounted on a stem or foot-stalk, by tying a piece of thread lightly round it. VENEREAL WARTS. This is a complaint whose symptoms nearly re- semble the secondary ones of pox, consisting of blotches on the skin,-pains at night,-ulcers in the mouth, &c. &c. Owing to the liberal use of calomel, it is now a very common disease, which is frequently confounded (even by medical men) with genuine syphilis. Treatment. Abandon every mercurial prepara- tion,-use the decoction of guaiacum and sarsaparilla, -the warm bath, and a mild nourishing diet. If possible, remove to a healthy situation in the country. It is also necessary to take an occasional purgative of the flowers of sulphur or of rhubarb. MERCURIAL DISEASE. Symptoms. A collection of water, which is first perceived at the bottom of the scrotum, increasing in size as it advances upwards, and forming a tumour of the shape of a pear. If examined as directed for dropsy of the abdomen, the wavy motion may be felt, and if a candle be placed behind it, i* becomes partly transparent. Distinguish it from a rupture, by the tumour not DROPSY OF THE SCROTUM. 80 Compendium of Domestic Medicine. swelling when the patient coughs,-by the tumour having commenced at the bottom of the scrotum, <fcc. f rom a diseased testicle, by its softness,-the natu- ral- colour of the skin,-absence of pain,-transpa- rency, &c. &c. Treatment. When it is first discovered, attempt to disperse it, by bathing it frequently with No. 28. The only certain cure is an operation, for which, as there is no pressing danger, apply to a surgeon. ENLARGED SPERMATIC VEIN. Symptoms. A hard knotty and irregular swelling of the vein, which sometimes increases to a large size. When lying down, the swelling diminishes, which distinguishes it from a dropsy of the parts. Treatment. Suspend the testicles, or keep the patient on his back,-apply the lotion No. 28, to the parts,-the cold bath. Symptoms. The testicle is enlarged,-hardened, -craggy and unequal in its surface,-painful on be- ing handled, with irregular pains shoot uig up the groin, into the back, without any previous inflamma- tion, disease, or external violence. Treatment. Apply immediately to a surgeon. Castration, and that at an early stage of the disease, is the only remedy that can save life. Be careful, however, to distinguish it from simple swelling of the testicle by inflammation, blows, die. Wliich see CANCER OF THE TESTICLE.' Impotency. 81 IMPOTENCY. This is of three kinds. The first arises from ar. original defect in the organs of generation. The second, from local debility of the parts, brought on by excessive venery, onanism, or some preceding dis- ease: while the third originates from fear, excess of passion, or want of confidence at the moment of coition. The first is incurable. The second must be treated by the general principles and remedies already pointed out for restoring the strength of the system, consisting of the cold bath, preparations of iron, bark, elixir of vitriol, generous diet, exercise, and by steadily avoiding the causes which may have produced it. The remedies for the third, must be sought for, in calm- ing excessive agitation, and acquiring, by habits of intimacy, that confidence they are sure to produce. GOUT Symptoms. Pain in the small joints, generally tn the ball of the great toe,-the parts swollen and red, -the attack coming on in the night. Such are the striking symptoms of this disease, and generally the first that are noticed. It is occasionally, however, preceded by all those attendant on indigestion. In the advanced stages chalky lumps are formed in the joints. Causes. A too free use of the good things of this world,-a disposition to it from parents. Distinguish it from rheumatism, by the pain, &c. being in the small joints, &c. Treatment. If the patient be young, vigorous,- having the disease for the first time, give citrate of magnesia, confine him to a low diet, and treat it exactly as an inflammation arising from any other 82 cause. To procure sweating, Dover's powder may be taken on going to bed. As soon as the inflam- mation, by these means, is reduced, use the cold bath, and take strong exercise on foot, daily,-avoid high, seasoned food, feather beds, wine, acids and fermented liquors, for the remainder of your life ! Gout is the child of indolence and intemperance, and to avoid it, the above means must be em- ployed, and steadily persevered in. It; however, the patient is old or infirm, and sub- ject to regular fits of it, he must not be handled so roughly. The most perfect rest should be observed, and the parts lightly covered with fleecy hosiery, and flannel cloths wetted with the lotion No. 29, made milk-warm. The bowels should be opened with some warm laxative. In a regular fit of the gout, this is all that can be done. The degree of warmth that is applied to the part, must be regulated by the feelings of the patient, who if weak, may use a nour- ishing diet, if strong, a more abstemious one. If from any cause, the disease leaves the extremi- ties and flies to the stomach, apply mustard poultices and blisters to the soles of the feet and ankles,-give large doses of ether and laudanum, hot wine, brandy, <fcc. and endeavour by all such means (including the 1 ot bath) to send it back again. If the head be the part it is transferred to, and apoplexy is produced by it, take away 15 c. 20 ounces of blood immediately, and give active purgatives, as 10 or 15 grains of calomel, followed by senna tea, or Epsom salts. If in a few hours, the patient is not relieved, the head continuing confused and painful, and the pulse full and throbbing, apply cold vine- gar and water constantly to the part. Compendium of Domestic Medicine. INFLAMMATORY RHEUMATISM. Symptoms. Pain, swelling and inflammation in Inflammatory Rheumatism. 83 some one (or several) of the larger joints. The pain shifting from one part to another,-all the symptoms of fever,-pulse full and hard,-tongue white,-bowels costive and urine high coloured. Causes. Cold,-suppressed perspiration,-wear- ing damp clothes, <tc. Treatment. If fever is present, reduce it and the acidity of the urine and system by doses of 5 to 8 grs. of bicarbonate of potash. If consti- pation be present, give a saline purge. After the fever is removed, give 5 grs. of iodide of potas- sium and 10 drops of tr. colchicum 3 times daily,-if much pain is present, add a | to J of a grain of sulphate of morphia. If there are pe- riods of intermission in the disease, give large doses of quinine, 20 to 30 grs. in 24 hours. Lemon juice and sugar, half ounce hourly, has been found to be good. If the heart becomes affected, give 5 gr. doses of the iodide of potassium mix- ture with tr. of digitalis, and apply cups over the region. Symptoms. A chronic rheumatism is nothing more than one of long standing. It is unaccom- panied by fever, and makes its attacks on every change of weather, on getting wet, &c., Ac. It is frequently caused by inflammatory rheumatism, and sometimes seems ,to exist as a primary affec- tion. Treatment. I have found no one plan of treat- ment in this species of the disease, so effectual as the following: purge with senna and salts, every other day,-rub the parts well with the liniment No. 30, apply a blister of the parts affected, or paint with tr. of iodine, and on going to bed 30 drops of laudanum, with a tea-spoonful of the tincture of CHRONIC RHEUMATISM. 84 Compendium of Domestic Medicine. guaiacum. It is to be recollected, that this is applica- ble only to chronic cases; if there is fever, &c. it will do much damage. The best safeguard against the complaint is the use of flannel next the skin, winter and summer. HIP-JOINT DISEASE. Symptoms. Excruciating pain in the hip-joint and knee,-the leg becomes first longer, then shorter than its fellow. When lying down the foot rolls outwards, the buttocks appearing flatter than usual,-lameness, -after a while abscesses in various parts of the thigh, -hectic fever, &c. Causes. Scrofula. Treatment. This should be treated carefully and constitutionally; the limb must be kept at rest, and put into a proper machine. Cod liver oil and tonics must be given freely, with all the remedies necessary for the treatment of scrofula. A generous diet of good food, beef and wine, must not only be allowed, but insisted on. Reducing the system by purging or bleeding should never be allowed, as the system of all scrofulous patients should be built up and not reduced if a cure is wished to be arrived at. DROPSY OF THE KNEE JOINT. Symptoms. The joint swells, the skin remaining of a natural colour. By placing the hand on one side of it, and striking it gently on the other, the wavy or fluctuating motion is perceptible,-steady pressure on one side will raise the other above its natural level. Causes. A dropsical disposition,-debility,-rheu- matism,-scrofula,-syphilis. Treatment. Keep a perpetual blister on the joint, Dropsy of the Knee Joint. 85 or make a caustic issue below' it, on the inside of the leg,-cold water from the spout of a tea kettle, is a useful application. Camphorated mercurial oint- ment to the knee, and mercury taken internally have sometimes been of service. WHITE SWELLING. Symptoms. Deeply seated pains in the knee, un- attended at first by swelling, which at last comes on with increase of pain. After a while the joint en- larges,-matter is sometimes discharged,-hectic fever follows, and cuts off the patient. Causes. Scrofula,-blows,-inflammation from any cause. Treatment. If from scrofula, use the general remedies directed for that disease, and apply a blister to the part, which must be kept open by the savine ointment, for months: if from blows, apply the blister as before, keep up the system with tonics, and give a good generous diet. If in spite of these pre- cautions, the disease continues to advance, amputa- tion is the only resource. PIECES OF CARTILAGE IN THE JOINTS. Portions of cartilage are sometimes formed in joints, where they act like any other foreign body of a simi lar texture. While in the hollows of the part, they give no uneasiness, but as they frequently slip if. between the ends of the bones, causing excruciating pain, it is sometimes necessary to cut them out. Foi this purpose apply to a surgeon. As all openings into the cavities of the joints are attended with much danger; unless the pain be insupportable, it is better 86 Compendium of Domestic Medicine. to endure the inconvenience than to run the risk of the operation. SCROFULA, OR KING'S EVIL. Symptoms. Hard and indolent swellings of the glands of the neck, that when ripe, instead of matter, discharge a whitish curd. It mostly occurs in per- sons of a lair complexion, blue eyes, and delicate make. In had cases, the joints swell with great pain, -the limbs waste away,-the ligaments and bones are destroyed, when hectic lever soon relieves the patient from his misery. Causes. Inheriting the disease from parents,- moist cold air,-a poor diet, Ac. Treatment. Sea-water is a great remedy in scrofula. It is to be used daily as a bath, and a small portion of it taken internally. Made milk- warm, it forms one of the most excellent local applications that we have. Against the enlarge- ment of the glands, paint with tr. of iodine and give iodide of potassium inwardly. The diet should be mild and nourishing. Scrofula is sel- dom, if ever, cured. If the glands become perma- nently enlarged, and by no means can be reduced, then apply to a surgeon for their removal if un- sightly or troublesome. INFLAMED GLANDS. Every gland in the body is subject to inflammation. Whenever one of them is perceived to be in this state, which may be known by the swelling and pain, measures should be taken to reduce it, for fear of its proceeding to what is called scirrhus, and finally to cancer. Leeches, blisters, and all the remedies directed lor such purposes, should be actively em- GLANDS. Inflamed Glands. 87 ployed, among which tr. iodine and a good diet must not be neglected. SCIRRHUS. Symptoms. A hard tumour, unequal on its sur- face, and not very sensible, giving but little or no pain on being handled. Treatment. Apply to a surgeon without loss 01 time for fear of a cancer. CANCER. Symptoms. A tumour, differing from tne preced- ing one by being surrounded with enlarged veins. It is, also, more painful, the skin being sometimes discoloured and puckered. The whole tumour is particularly heavy, and at last breaks into a malignant ulcer or sore, whose edges are raised, ragged, un- even, and curl over like the leaves of a flower,- white streaks or bands cross it from the centre to the circumference. Acute and darting pains accompany Doth this and the preceding stage of the disease. Treatment. There is but one remedy that can be depended on for the cure of this painful and in- veterate complaint, and even that should be resorted to early, in order to ensure success. All the diseased parts must he cut out. Arsenic, corrosive sublimate, phosphate of iron, and a thousand other articles, have been recommended, both externally and internally, but without any effectual advantage. To relieve the pain, opium may be taken in large doses. A very low diet (such as is barely sufficient to support life} of milk and vegetables, will produce the same effect. The sore should be defended from the air, by some mild ointment. Powdered chalk, scraped carrots, 88 fresh hemlock leaves, and powdered charcoal, may be used for the same purpose. Compendium of Domestic Medicine. GOITRE. Symptoms. A tumour in the fore-part of the throat seated in a gland close to the projection called " Adam's apple." Causes. These are not ascertained. They are supposed to consist of some peculiarities in the water of those places where it is common. Treatment. Goitre is incurable. When taken at the very beginning of the complaint, however, and in young persons, it is said to have been dispersed by a course of mercury, joined to frictions of the part with strong mercurial ointment FAINTING. Causes. Sudden and violent emotions of the mind, -bleeding,-diseases of the heart and its great vessels. Treatment. Lay the person on the back, and raise the feet, then open the doors and windows, and sprinkle cold water in the face. Smelling salts may be held to the nose. Symptoms. Falling without sense or motion,- profound sleep,-face livid or flushed,-eyes wide open or half closed, and immovable,-breathing low labouring and irregular. Causes. A rushing of blood to the head, excessive (at in persons with a short neck,-gluttony,-violent APOPLEXY". exercise,-intense heat,-anger,-hearty meat sup- pers,-blows on the head,-intoxication, &c. &c Treatment. If the pulse remain full,-the face flushed, &c. take away twenty ounces or more of blood on 1he spot, remove the cravat, unbutton the shirt collar, and place the patient in bed, with the head and shoulders a little elevated. The windows and doors must be thrown open, and no more persons than are necessary, be allowed to remain in the room. The head is to be shaved and cupped, a blister ap- plied to the back of the neck and the head, and mus- tard poultices to the feet, An active purgative* should always be administered, as soon as the patient is bled, and its operation assisted by repeated clysters. If by these means, the breathing is not easier, and the pulse softer, bleed again, and again. If, however, the patient is old and infirm, and the attack has come on more gradually, if the pulse is weak, and the face pale, do not bleed, but give immediately a warm purgative, apply the blisters, &.c. If it arises from swallowing vegetable poisons, give an active emetic, as 30 grains of white vitriol, and act as directed in cases of similar accidents. In this second kind of apoplexy, stimulants, as hartshorn to the nose, &c. may be used; in the first, they are very injurious, and should never be employed. Apoplexy. 89 STROKE OF THE SUN. This proceeds from exposure to the sun's rays, and exhibits the same symptoms as apoplexy, commencing with vertigo, loss of sight, ringing in the ears, &c. and must be treated by large and repeated bleedings, and in every other respect as directed for apoplexy. * If the patient cannot swallow pills, try liquids; if neither, have recourse to a strong purgative clyster 90 Compendium of Domestic Medicine. Symptoms. A fit, in which the patient falls to tne ground in a convulsion,-the eyes are distorted and turned up,-hands clenched,-foaming at the mouth, -convulsions,-the whole ending in a deep sleep. Causes. Sudden fright,-anger,-injuries done to the nerves,-unknown. Treatment. Keep the patient from hurting him- self, by holding his hands, legs, and particularly his head, which he is apt to dash violently against the ground or surrounding objects. A piece of soft wood should be placed between his teeth, to prevent his tongue from being bitten. This is, in general, all that can be done during the fit. Give twenty gr. doses of bromide of potassium three times daily. EPILEPSY. CATALEPSY. Symptoms. A sudden suspension of the action of the senses, and of volition, the body and limbs preserving the position given them, while the action of the heart and lungs continues. Treatment. Electricity, cold douches, chloro- form inhalation, and irritation of the skin during the spasm. In the intervals, if from intermittents, quinine, if from cold, warm and sulphur baths, if from hysteria or catamenia difficulties, anemia, Ac., use the general remedies recommended therefor. Palsy. 91 PALSY. Symptoms. A partial or complete loss of the powers of motion, and the sensibility of particular parts of the body,-the pulse soft and slow. Causes. Apoplexy,-pressure on the nerves, from blows, wounds, Ac.-the fumes of lead, mercury, Ac. Treatment. The treatment must be according to the cause. By the idiopathic and pure nervous palsy, attention must be called to the spinal column as the seat of the disease, for which nux vomica, zinc, stramonium, steel baths, cold baths, and moxas down the column, are of service. Magnetism down the back, from the back of the head to the end of the back-bone, is often of use. It is well always in the use of electricity to begin with a weak current. The continual electrical stream upon the limb has produced cures. After the misuse of mercury or mercurial preparations a palsy of the limbs takes place, for which opium or morphium is recom- mended ; also electrical baths. If occasioned by pressure on a nerve or by the misuse of too strong coffee, tea, or tobacco, the cause must be removed. TETANUS, OR CRAMP. There are several very long and very learned names affixed to this disease. When it is confined to the muscles of the neck and jaws, locked-jaw is the common and expressive term for it. The affec- tion, however, is always the same, requires similar treatment, and consists in an involuntary contraction and stiffening of a part of the muscles, the senses remaining perfect. 92 Compendium of Domestic Medicine. LOCKED-JAW. Symptoms. A stiffness in the back of tne neck, which renders it first painful, and at last impossible to turn the head round,-difficulty in swallowing,- pain in the breast shooting to the back,-the lower jaw becomes stiff, and gradually closes. Causes. Wounds,-robust habit of body,-local irritation of a nerve. Treatment. If the disease is supposed to arise from a wounded nerve, or from an injury done to tendinous parts, by a pointed instrument,* enlarge the wound with a sharp lancet, or penknife, and pour laudanum or turpentine into it, as directed for similar accidents. Blood-letting in this disease has been en- tirely given up in modern times, instead of which it has bean found that to chloroform the patient was best. This being done, give 2 or 3 grains of opium at once, and repeal it every tw'o hours, increasing the dose, according to the violence of the symptoms and the effects produced by it, without, regarding the auantitu that has been taken. Cases are on record, wnere 66 grains (a drachm) of solid opium have been taken at once, and with the happiest effect. This, however, is a large dose, and should never be ventured on. but under the most desperate and alarming circum- stances. Active purging with castor oil and senna tea, must not be omitted, and if the power of swal- lowing be lost, laudanum, &c. must be given in clys- ters. Drawing a tooth, is generally recommended by physicians in those cases where the jaws are firmly closed, for the purpose of transmitting medi- cines and food to the stomach. This has always ap- peared to me every way calculated to increase the evil. If no opening exists between the teeth, access to the bowels can always be obtained by clysters, and in this way nourishment and remedies may be * As by running a needle into the foot, &c- DISTRIBUTION OF THE FACIAL NERVE AND OF THE BRANCHES OF THE CERVICAL PLEXUS. 1, The facial nerve at its emergence from the stylo mastoid foramen. 2, temporal branches communicating with (3) the frontal branches of the fifth or trifacial nerve. 4, infra-orbital branches, communicating with (5) the infra orbital branches of the fifth nerve. 6, maxillary branches communicating with (7) the mental branch of the fifth nerve. 8, cervico-facial branches. 9. the spinal accessory nervte giving off a branch to the ti'apezius mu&Itfs. Locked-Jaw. 93 injected. It is alw'ays proper, however, when the disease is perceived to be coming on, to place two small pieces of soft wood between the grinders of the upper and lower jaw, one on each side, so that they may be kept asunder. Madeira wine, in doses of a wine-glassful every hour, continued for several days, and combined with the internal use of mercury and the warm bath, has been found of great service. Cold water dashed freely over the patient, every two or three hours, may likewise be tried. After every affusion, he should be well wiped, and put into a warm bed, when a large dose of laudanum in warm Madeira wine, should be given, and the parts rubbed with the liniment No. 31. The tobacco clyster* has sometimes succeeded when every thing else has failed. During the relaxation which it occasions, opium, wine, &c. must be freely administered. Blistering the whole length of the spine, and caustic issues on its sides, as nearly on a line with the parts affected as possible, are strongly recommended. PAINFUL AFFECTION OF THE NERVES OF THE FACE. This disease also called tic-doloureux, neuralgia, &c. is of very rare occurrence. As it is, however, sometimes met with, it is proper to notice it. Symptoms. A very severe pain darting in particu- lar directions, not lasting more than a second, but * Although a valuable addition to our means of cure, the tobacco clyster is not to be employed lightly, or on common occasions. It should always be re- served to the last moment, never using it until every thing else has failed. The prostration of the system, and other alarming symptoms it sometimes causes, render this caution necessary. 94 very rapidly repeated, and excited by the slightest touch,-during the intervals, there is no pain what- ever. There is no inflammation or swelling of the cheek, as in toothach, nor does the pain seem so deeply seated. Treatment. Blisters, leeches, mercurial oint- ment, opium and Fowler's solution of arsenic, with many other remedies of the same class, have been ali recommended and used for the cure of this most painful of all the affections to which the human body is subject. Where the pain is so excessive as not to be borne, two grains or two grains and a half of the extract of belladonna, may be taken every three hours. When the pain is somewhat relieved, this quantity must be diminished. Sulphate of qui- nine in large doses has often been found a most excellent remedy, particularly if combined with morphium and aconite. If this fails, apply to a skilful surgeon, who will divide the nerve. Compendium of Domestic Medicine. Symptoms. An acute pain at the lower end of the breast bone, shooting into the left arm,-great diffi- culty of breathing,-anxiety,-palpitation of the heart, -a feeling of suffocation. It usually comes on while ascending a hill, or going up stairs. Causes. The vessels of the heart being turned into bone,-an accumulation of blood in the heart and its vessels. Treatment. During the fit, let the patient in- hale sulphuric ether. If fainting, dash cold water in his face. Should this not rouse him in a few minutes, apply a blister to the chest. Strips of linen, moistened with the solution below* applied several ANGINA PEGTORIS. * Tartar emetic, one drachm. Spirits of camphor half an ounce Boiling water, one pint. Mix. Angina Pectoris. 95 times a day to the breast bone, for a month, are said to have effected complete cures. They act by pro- ducing a crop of pimples, on the appearance of which, the disease declines. Persons subject to this complaint, should avoid all fermentable food, and excess in eating or drinking, taking care to live quietly, and to keep the bowels open. Saline purgatives, followed by opium, to lessen the spasm, with the warm bath, and a per- petual blister or plaster of the tartar emetic ointment to the chest, are perhaps the best remedies that can be employed. DANCE OF ST VITUS. Symptoms. Irregular and convulsive motions of the limbs and head, generally of the arm and leg of one side only. It varies, however, in different per- sons, and is frequently counterfeited by beggars. Causes. Weakness of the nerves,-worms,-poi- sons,-fright, &c. Treatment. The daily use of the cold bath, with the Peruvian bark, has often succeeded in curing the complaint in young subjects. In addition to these, any of the preparations of iron, No. 41, combined with large doses of musk, opium, camphor, &c. may be tried. Active and long continued purging sometimes produces the happiest results. Symptoms. Chills,-heat,-thirst,-headach,- the skin is marked with large red or scarlet patches, which at last unite, disappearing in a few days in a kind of branny scurf,-sore throat. Causes. A particular contagion. SCARLET FEVER. 96 Compendium of Domestic Medicine. Distinguish it from measles, by the spots coming out on the second day of the fever (in measles they seldom appear until the fourth day); by their colour, which is that of a boiled lobster, whereas in measles it is of a dark red. Treatment. An emetic (ipecacuanha) should be given on the first appearance of the disease, to be followed by a dose of salts, then give ten to twenty grains bisulphite of soda every two hours. If the pulse is full and strong, the head aches, and the heat great, and no eruption, sponge cold water over the. body very freely and frequently. There is no disease in which the advantage of cold affusion is more striking. In order to reap the full benefit of it, however, it must be freely employed, that is, as often as the heat, <fcc., seem to require it, or eight or ten times in the twenty- four hours. The saline mixture, No. 1, is of great use. If there is any soreness of the throat, the gargles recommended for that complaint, should be used, and a mustard poultice be applied to the parts. If symptoms of putrescency appear, have recourse to the plan recommended for putrid sore throat* As scarlet fever is undoubtedly contagious, the usual precautions should of course be adopted. ERYSIPELAS, OR ST ANTHONY'S FIRE. Symptoms. Fever,-delirium,-vomiting,-pulse strong or weak, as the fever inclines to the inflam- * Writers on this subject generally consider scarlet fever as consisting of three kinds, viz. the simple fever, the fever with sore throat, and the fever with putrid sore throat. The treatment of the first should be like that of any other inflammatory fever; that of the second has been detailed in speaking of inflam- matoiy sore throat; and the last is precisely that of putrid sore throat. <S7 Anthony's Fire. 97 tnatory or typhus kind,-on the fourth day, sometimes on the second on third, the skin in some one part becomes red and inflamed, which is soon extended to others,-the parts affected being swollen and of a bright scarlet. If the face is attacked, it spreads «tself on the scalp, and the eyelids sometimes swell so as to prevent the patient from seeing,-after a longer or shorter period, the eruption ends in small watery vesicles or blisters, or in branny scales. At this period, the fever sometimes abates, at others, drowsiness or delirium comes on, which increases it, and destroys the patient by the eleventh day. Causes. Cold,-excessive heat,-intemperance,- acrid bile, or other irritating matters in the stomach and intestines. Treatment. This disease is of two kinds. One of which is principally confined to the skin, while the other affects the whole system. If the accompanying fever is inflammatory, purging will be proper, other- wise, not. This operation is to be cautiously em- ployed in erysipelas, as it sometimes runs into typhus. If, however, the patient is robust, his head aches, and great marks of fullness and inflammation are evident, which is generally the case in this country, gentle purging with salts, and cooling drinks should be employed, to which, also, may be added, Dover's powders, boneset tea, Ac. to produce sweating. The room should be kept cool. If, on the contrary, the fever is a typhus, or unaccompanied by general in- flammation, and (as before observed) the patient is of a weak and irritable habit of body, purging should never be resorted to. Iron, wine, bark, elixir of vitriol, and decoctions of the snake root, as recom- mended for typhus, are necessary in this case, to guard against mortification, which sometimes ensues. As local applications, bathing the parts with lauda num, or lead water, or dusting them with rye meal or wheat flour, are the best. Should the disease evi- dently be confined to the skin, the application of a blister will sometimes put an end to it If abscesses 98 Compendium of Domestic Medicine. form, large openings must be made to let out the mat- ter and dead parts. When the first or inflammatory kind prevails, the diet should be barley, sago, panada, &c. wilh lemonade,* tamarind water, &c. for drink. If, on the contrary, when the second, or typhus form of it (especially if accompanied by putrid symptoms,) shows itself, a more generous diet, with a moderate quantity of wine, &c. must be employed. MERCURIAL ERYSIPELAS. Symptoms. Heat,-redness and roughness, com- mencing either in the groin, bag, inside of the thigh, or bend of the arm, which slowly and gradually ex- tend over the whole body, which becomes slightly swollen, is tender to the touch, and itches dreadfully. The roughness is occasioned by small vesicles or blisters containing a fluid, which at first cannot be seen without a glass, but if not disturbed, acquire the size of a pin's head. When they are broken, the matter corrodes the skin wherever it touches, so that at last, the patient is almost raw from head to foot. It sometimes occasions the loss of the hair in every part of the body. Causes. The excessive use of mercury. Treatment. Omit all mercurial preparations,- keep the Ixtwels gently open with Epsom salts,-use * It may not be useless again to observe, that in the United States, erysipelas, nine times out of ten, calls for reducing and cooling measures. Among the vari- ous articles which are employed in this, as well as all inflammatory diseases, none ranks higher in my mind than lemonade, which should always (if possible; be made from the fresh fruit. When taken cold, and in liberal quantities, it is not only delicious to the palate of the patient, but tends powerfully to cure his complaint. Mercurial Erysipelas. 99 the warm bath frequently, take opium at night, and dust the parts with flour or starch. If symptoms of putrescency appear, meet them with bark, wine, &c. Symptoms. Inflammatory fever,-dry cough and hoarseness,-sneezing,-watering of the eyes, which itch,-a running from the nose,-great drowsiness. On the fourth day, small red points break out, first on the face, and then gradually over the body. They are in clusters, and on passing the hand over them, are found to be a little raised. On the fifth or sixth day the vivid red is changed to a brown, and the eruption goes off Causes. A particular contagion. Distinguish it from small-pox and all other dis- eases, by the dry cough and hoarseness,-by the ap- pearances of the eyes, which are red, swollen, and loaded with tears. Treatment. The patient must be confined to a low diet, and kept in bed, with as much covering (but no more) as may be agreeable to his feelings. The room should be cool, and if there is much fever and pain in the head, bleeding is necessary. Should there be pain and oppression at the breast, apply a blister. The bowels may be opened by salts. The mild form of measles ought to be treated like any other inflammatory complaint, taking care, however, not to repel the eruption by cold. If this happens, place the patient in a warm bath, give him warm wine, &c. internally, and apply mustard poultices and blisters to the feet and ankles. There is another and more dangerous kind of this disease, which may be known by the fever being a typhus, and by all the symptoms showing a putrid tendency. The moment this is perceived, have re MEASLES. 100 course to bark, wine, muriatic acid,&c. &c. as directed in putrid fever. Compendium of Domestic Medicine. CHICKEN-POX. Symptoms. Fever,-inability to sleep,-pain in different parts of the body,-a crop of small pimples or points on the back, which by the second. day are changed into little blisters, which are ripe on the third and disappear before the ffth day, without forming true pus or matter, and leaving no marks or pits behind them. Distinguish it from small-pox, by the eruption coming out on the back,-by the mildness of the fever,-by the fluid contained in the vesicles or blis- ters not being true pus, and by the whole falling off in scales on the fifth day. Treatment. Confine the patient to his bed,- keep him cool and quiet, and give him a dose of salts. This is all that is necessary. COW-POX. Symptoms. A pimple at the spot where the mat- ter was inserted, which gradually undergoes certain regular changes, that characterize the complaint. CHANGES OF GENUINE COW-POX. On the second day, or sooner, from the time of the operation, a small speck of inflammation is to be per- ceived, which, on the fourth day is a pimple, sur- rounded by a circle of inflammation. On the fifth, this pimple changes to a vesicle containing a thin fluid. On the sixth, this vesicle is more perfect, its margin forming a regular circle; it is also a little fiat- Cow-Pox. 101 tened on the top, the centre of which is of a dark colour. On the eighth or ninth day, slight chills, flushes of heat, &c. are sometimes felt, accompanied by swell- ing of the pustule, and pains shooting up into the arm pit, the glands or kernels of which occasionally swell. On lhe tenth or eleventh day, the pustule is sur- rounded by a circular, vivid, inflammatory blush that is very beautiful. This is regarded as a decisive proof of the presence of genuine cow-pox. On the eleventh day, the centre of the pustule begins to grow of a dark colour, which gradually increases to a brown or mahogany one by the end of the second week, when it begins to leave the skin, from which it is finally separated. Treatment. If the pain, inflammation and swell- ing, are excessive, reduce them by cold applications, a dose of salts, low diet and rest. SMALL-POX. Symptoms. Inflammatory fever,-drowsiness,- pain in the pit of the stomach, increased by pressure, -pain in the back,-vomiting,-on the third day the eruption breaks out on the face, neck and breast, in little red points that look like flea-bites, and which gradually appear over the whole body. On the fifth day, little round vesicles, filled with a transparent fluid, appear on the top of each pimple. The erup- tive fever now declines. On the ninth day the pus- tules are perfectly formed, being round and filled with a thick yellow matter, the head and face also swelling considerably- On the eleventh day, the mat- ter in the pustules is of a dark yellow colour, the head grows less, while the feet and hands begin to swell, 'rhe secondary fever now makes its appear- ance. The pustules break and dry up in scabs and crusts, which at last fall off; leaving pt/s, which suffi- ciently mark the cause 102 Compendium of Domestic Medicine. Such are the symptoms of the distinct or mild small-pox, but it frequently assumes a more terrible shape, in what is called the confluent. In the latter, all the symptoms are more violent from the beginning. The fever is a typhus,-there is delirium, preceded I y great anxiety,-heat,-thirst,-vomiting, &c. The eruption is irregular, coming out on the second day in patches, the vesicles of which are flatted in, neither does the matter they contain turn to a yellow, but to a brown colour Instead of the fever going qff on the appearance of the eruption, it is increased after the Ji/tA day. and continues throughout the complaint The face swells in a frightful manner, so as to close the eyes,-sometimes putrid symptoms prevail from the commencement. Causes. Contagion. Distinguish it from chicken-poi, which see. Treatment. Place the patient in a cool airy room, and let him be but lightly covered with bed clothes. Purge him every other day with salts, and give him twenty or thirty drops of laudanum every night. The diet should consist of panada, arrow root, &c. and his drink consist of lemonade or water. If from any cause, the eruption strikes in, put him into the warm bath, give a little warm wine-whey, or the wine alone, and apply blisters to the feet. Obstinate vomiting is to be quieted by the effervesc- ing draught, with the addition of thirty drops of laudanum. In the confluent small-pox, the treatment must be varied as it inclines more or less to the inflammatory or putrid type. If it inclines to the first, act as directed for the distinct kind, if to the last, employ all those means directed in putrid fever. If the eyes are much affected, it will be necessary to bathe them frequently with warm milk, and to smear the lids with some simple ointment Itch. 103 ITCH. Symptoms. An eruption of small pimples between the fingers, on the wrists, and over the whole body, which form matter, and are attended with an intoler- able itching. Causes. Contagion. Treatment. There are several varieties of this troublesome complaint, as the rank, watery, pocky, scorbutic, &c. A very bad kind of it is contracted by touching dogs that have the mange. The remedy is sulphur. It should be used internally with cream of tartar, so as to purge freely, and at the same time be applied externally, in the form of an ointment. Equal portions of white vitriol, flour of sulphur, and laurel berries, made into a thin liniment with olive oil, is highly recommended as a local application. The following practice is said to be effectual. Take of flour of sulphur two ounces, and mix it well with two drachms of nitre, throw the mixture into a warm- ing pan containing live coals, and pass the pan be- tween the sheets in the usual manner. The patient, stripped to his skin, now gets into bed (taking care not to let the fumes escape), when the clothes should be tucked in all round him. Repeat the process ten or twelve times The diet in all cases should be very low. Symptoms. Broad itchy spots of a reddish or white colour, breaking out in different places, which at last run into each other, forming extensive ulcers,-after a time they become covered with scales, which fall off leaving the surface below red,-while the dis- ease heals in one part, it breaks out tn another. HERPES. 104 Causes. Want of cleanliness,-low diet,-living in low damp situations,-a peculiarity of constitution. Treatment. The ointment of the oxide of zinc, is a very common application. Washing the parts with a solution of corrosive sublimate in water, one grain to the ounce, is, however, to be preferred, 'rhe citrine ointment may also be tried. If these fail, apply a strong solution of blue vitriol to the ulcers, and take a grain of calomel morning and evening. The decoction of sarsaparilla and guaiacum, may be used with them. If the disease resists the mercury, try Fowler's solution of arsenic, in doses of five drops three times a day, to be cautiously increased as directed for intermitting fevers. The warm bath should never be neglected in cutaneous complaints. Compendium of Domestic Medicine. SCALD HEAD Symptoms. Inflammation of the skin of the head which ends in a scabby eruption that extends over the whole scalp. Causes. Want of cleanliness,-putting on the hat, -using the comb, or sleeping in the bed of a person who has it. Treatment. Shave the head close, wash it well with warm soap and water, and cover it thickly with fresh powdered charcoal. One or two of the pills No. 32, should be taken every night, on going to bed. The bowels must be kept open by magnesia or Epsom salts. If this fails, try the citrine or tar ointment to the parts, with a liberal use ot the compound decoc- tion ol sarsaparilla. The diet should be wholesome and nourishing, avoiding spirituous liquors and salted meats. The warm bath should not be neglected Ring Worm. 105 Symptoms. An eruption running in curved lines, -generally in a circle, that itches when rubbed or when the body is heated. Treatment. Into one ounce of water, throw more blue vitriol than it will dissolve, so as to form what is technically called a saturated solution. Touching the ulcerated parts with this liquid several times through the day, will alone frequently cure it. If this fails, apply the citrine or tar ointments. In very obstinate cases, recourse may be had to the pills No. 32, or to the usual doses of Fowler's solution. If it affects the head, shave it. In this as well as all other diseases of the skin, the greatest cleanliness is ne- cessary. RING WORM. Symptoms. An eruption similar to that caused by the stinging of nettles, whence its name. On rub- bing the skin which itches, the eruption will sud- denly appear, remain for a moment and then vanish, breaking out in some other spot. The parts affected are swelled,-at one time presenting the appearance of welts as from the stroke of a whip-lash, and at an- other, that of white solid bumps. Causes. Supposed to be some irritating matter in the stomach or bowels. Treatment. A few doses of Epsom salts, and a little attention to the diet, which should be mild, are generally sufficient to remove it. If it proceed from eating poisonous fish, or any unwholesome food, take an emetic, &c. as directed in such cases. NETTLE-RASH. 106 Compendium of Domestic Medicine. Symptoms. An eruption of hard, distinct tubercles or pimples, generally appearing on the face, but some- times on the neck, breast and shoulders. Causes. A peculiarity of constitution,-irregu- larity or excess in eating or drinking. Treatment. There are a great many varieties of this affection, some of which have been separately treated of by Willan and other writers on diseases of the skin, to whom 1 would refer any one who is particularly interested therein. Notwithstanding all that has been said on the subject, there is no disease more difficult to get rid of than this. Where it arises from suppressed perspiration, high seasoned food, or intemperance, it may indeed be relieved by the warm bath, by sweating, purging, and a low diet; but when it exists in persons who have always led temperate lives, and in whom it seems constitutional, medicine has but little effect on it. In all cases, however, the following plan may be adopted: take a dose of Epsom salts twice or thrice a week, use the warm bath daily, live on plain, mild food, and drink nothing but water. If after a fair trial of several months, this should not succeed, try Fowler's solution, or the pills No. 32. with the decoction of guaiacum and sarsaparilla. The various cosmetics and astringent applications recommended for these affections, are always preju- dicial, tor although they sometimes repress the erup- tion, they occasion more severe and dangerous com- plaints. BLOTCHED FACE. Symptoms. Bleedingof the gums,-teeth loose,- spots of various colours on the skin, generally livid, -debility,-countenance pale and bloated,-pulse SCURVY Scurvy. 107 small, quick, and intermitting. In its advanced stage the joints swell, and blood bursts out from different parts of the body. Causes. A long exposure to cold moist air,-a diet consisting exclusively of salted animal food,-want of wholesome nourishment. Treatment. Remove the patient to a new and healthy situation, where the air is dry and pure; give him pler.ty of fresh vegetables, such as spinage, let- tuce, beets, carrots, and scurvy-grass. A small pro- portion of fresh animal food should be taken with them. This, with oranges, lemons and sugar, or lemonade, spruce beer with wine and water, are generally sufficient to cure the complaint. The nitric vinegar* is strongly recommended for the same pur- pose. If there is much pain in the bowels, laudanum must be used to relieve it. If the breathing is diffi- cult, or there is much pain in the breast, apply a blis- ter to it, for on no account should blood be drawn in scurvy. A tea spoonful of charcoal well mixed with half a pint of vinegar, forms an excellent gargle to clean the gums and ulcers in the mouth. Those on the body may be washed with the same, or lemon juice, pure, or mixed with water. The yeast or char- coal poultice, may also be applied to them with ad- vantage. To restore the tone of the system, recourse must be had to the Peruvian bark, with the elixir of vitriol, the muriated tincture of iron, exercise, &c. &c. * It is made in the following manner. Dissolve three or four ounces of nitre (saltpetre) in one quart of vinegar. The dose is from half an ounce to an ounce. If the strength of it occasions any inconve- nience, add a little water, or diminish the quantity of the dose. 108 Compendium of Domestic Medicine. By the word tumour is meant a swelling of any part of the body. They are of different kinds, arise from various causes, and are more or less dangerous according to the nature of their contents and the spot they occupy. OF TUMOURS. Ruptures are tumours caused by the protrusion of a part of the bowels through certain natural openings. They are divided into reducible, irreducible, and strangulated. They mostly occur in men tn the groin and bag. C auses. Straining in any way, as at stool,-vomi t- ing,-lifting heavy weights,-violent exercise, as jumping, running, &c.-a natural weakness of tlie parts. OF RUPTURES. REDUCIBLE RUPTURES. Symptoms. A small swelling, free from pain, and generally soft, the colour of the skin over it remain- ing unaltered. While standing up, the swelling in- creases, on lying down, it decreases, the patient being able to return the parts himself, while in that position. The swelling is also increased by coughing, sneezing, or straining as if at stool. If he is flatulent, a rum- bling sensation may be felt in it. Treatment. The patient should place himself on his back, with his head and shoulders a little ele- vated, draw up his knees to his belly, and (if in this position, the parts do not return of themselves) en- deavour to push or knead them up into the belly through the opening at which they come out, and which, if the tumour be in the groin or bag, is an oval ring or slit, in the groin, at the precise spot where the swelling first appeared. When this is effected, he should remain quiet until a truss can be procured, the spring of which must be passed round his body the pad be applied directly over the spot just men- tioned, and held there with one hand, while the other passes the strap into the buckle and draws it suffi- ciently tighu Having done this, he should get up and walk about. If the swelling no longer appears, the truss is properly applied, if otherwise, take it off, return the parts as before and apply it again; when, if on rising, w alking about, slightly coughing, &c. the parts are found to be well kept up, he may resume nis ordinary business. The truss should be worn night and day, as long as he lives. Reducible Ruptures. 109 IRREDUCIBLE RUPTURES. Symptoms. A rupture in which there is no pain, yet that cannot be returned into the belly, caused by an increased bulk of the parts, or their having formed adhesions, or grown fast to adjoining parts. Treatment. A rupture thus situated must be left to itself. The patient should be extremely cautious in his diet, and in avoiding costiveness, by the use of clysters, or if necessary, laxative medicines. He should also be very careful to protect the tumour from blows, always recollecting that it is in danger of strangulation. STRANGULATED RUPTURES. Symptoms. The first mark of a rupture being strangulated, or of pressure being made on it, is cos- 110 tiveness. The tumour, which before was insensible, becomes painful, ths pain being most severe at the soot where the strangulation or stricture exists, and extending from thence across the belly, which be- comes swollen and hard. The pain resembles that which the patient would suppose to arise if a cord was drawn tightly across it. The pain continues to increase, and is augmented by pressure; sneezing, coughing, nausea and vomiting, first of the contents of the stomach, and afterwards of the intestines ensue, -great anxiety,-restlessness, and a quick hard pulse. Hiccups.-cold clammy sweats,-weakened respira- tion, and a pulse so feeble as hardly to be perceived, announce the approach or presence of mortification. Treatment. Lose not a moment in sending for the best medical aid that may be within reach. In the mean time, having placed the patient as directed for reducible ruptures,apply both hands on the tumour with gentle, but gradually increasing pressure, or grasp the tumour gently but steadily with one hand, while with the fingers of the other you endeavour to knead or push up the parts nearest the ring in the groin, applying the pressure in the same course the parts have taken in their descent. If this fails, seize the tumour between the finger and thumb of the left hand, close to where it enters the be'ly, and carry them downwards, with a mixlerate pressure, so as to dislodge any excrement which may be there, while with the right you endeavour to push in the gut. If you cannot succeed in two or three attempts, place the patient in a warm bath and try it again. If still foiled (you have no time to waste in unavailing attempts), cover the tumour with pounded ice. snow, or any very cold application. Should this fail, let the patient inhale ether or chloroform to perfect narcotism, and when thoroughly under the anes- thetic, seize that moment to return the parts, as before directed. Should the rupture still remain irreducible, there are but two resources left, the tobacco clyster, and an operation One half of the clyster should be in- Compendium of Domestic Medicine. Strangulated Ruptures. 111 jected; if it occasions sickness and a relaxation of the parts, endeavour to return them; if the first half does not produce these effects, throw up the remainder of it, and when relaxation comes on, endeavour, as be- fore, to push up the gut. As regards the operation no one should ever attempt it but a surgeon. Large doses of laudanum allay vomiting, and are otherwise beneficial; in all cases of this kind, they should never be omitted. Ruptures are liable to be confounded with some other diseases, as dropsy of the bag, enlarged sper- matic vein, &c. The modes of distinguishing them have already been pointed out, although it must be confessed that with respect to the latter, considerable difficulty exists. If the disease is a rupture, by plac- ing the patient on his back, returning the tumour and holding the fingers firmly over lhe opening, and then desiring him to rise, the swelling will not appear. Ifi on lhe contrary, it is an enlarged spermatic vein, it will be found to be greater than ever. The latter has also a peculiar ropy feel, as if a bundle of cords were in the bag. REMARKS. Symptoms. A small tumour without pain or red ness, attended by a peculiar throbbing,-it disappears on pressure, and returns the moment it is removed. As lhe tumour increases in size, the throbbing or beating of the artery grows less perceptible. It is generally found in the ham, thigh, neck, groin and arm. It is divided into true and false. Causes of the true are unknown, those of the false are a wound or rupture of an artery. Distinguish it by the beating or throbbing, which ANEURISM. 112 is diminished by pressing on the artery above the tumour, and by the latter disappearing on pressure, and returning when it is removed. Treatment. In the early stage, apply a soft and elastic cushion to the tumour, and bind it tightly over it by a bandage. The diet should in all cases be extremely low, just sufficient to preserve life, and no more. If the patient is of a full habit, it would be well to reduce. This plan steadily and vigorously pursued for a long time, has sometimes effected com- plete cures. There is nothing, however, but an operation that can be depended on, wherefore, as soon as any swelling of this nature is perceived, no time should be lost in procuring surgical assistance. If the tumour is left to itself, it will finally burst, and death be the inevitable consequence. Compendium of Domestic Medicine. Symptoms. Small warty projections, which, as they increase in size, drag down the skin from the neighbouring parts, which forms a kind of stem or foot-stalk on which the tumour hangs. They are hard, full of vessels, and are neither painful nor in- flamed. Treatment. When very small, they maj' be fre- quently touched with caustic, which will destroy them. If large, the ligature or knife must be em- ployed, for which purpose have recourse to a surgeon. FLESHY TUMOURS. STEATOMATOUS TUMOURS. Symptoms. A small, doughy swelling, which gradually increases, and sometimes grows to an enormous size. It is soft and free from pain,-the colour of the skin emaining unaltered. Treatment. These tumours, technically called steatomatous,* are merely inconvenient from their bulk. They can only be removed by the ligature or knife, for which purpose apply to a surgeon. Steatomatous Tumours. 113 ENCYSTED TUMOURS. Symptoms. A distinct, hard, circumscribed swell- ing, gradually growing larger until a slight inflam- mation comes on, when it becomes a little painful, soon after which, a fluctuation is distinctly to be per- ceived. As it progresses the vessels become en- larged,-it seldom exceeds the size of an egg. Distinguish yy from an abscess by the absence of pain and inflammation. Treatment. Pass a seton through the tumour when matter is formed, or apply to a surgeon to dis- sect it out. GANGLION. Symptoms. A small, movable, elastic swelling, with little or no pain, or alteration in the skin, situ- ated under or between tendons or sinews, and gene- rally near to a joint,-it sometimes hinders the mo- tions of the part. Causes. The collection of a fluid within the sheath of a tendon. Treatment. Apply pressure, blisters, or frictions of strong camphorated mercurial ointment to the tu- mour. If these are of no avail, make a small punc- ture in it with the point of a sharp lancet, let out its * From a Greek word which means suet, the con- tents of the tumour resembling that substance. 114 Compendium of Domestic Medicine.. contents and apply pressure to the part, so as to make the two sides of the sack or bag grow together. Symptoms. A hard, circumscribed, inflamed, and very painful tumour, of a conical shape, seldom ex- ceeding tn size a pigeon's egg. Treatment. If the patient is of a full habit, bleed and purge him with Epsom salts. A soft poultice of warm bread and milk, or rye meal, should always be applied to the boil, and frequently changed. If the pain is excessive, a tea spoonful of laudanum may be mixed with each one. In a few days matter will be formed, when it may be let out with a sharp lancet BOILS. CARBUNCLE. A deeply seated, hard, immovable and circum- scribed tumour, which appears generally on the back, shoulders, &c. About the middle it is of a dark red or purple colour, being much paler or mottled round its edges. It is attended with an intolerable itching and burning pain, and at last becomes a kind of sloughing ulcer. Treatment. This will depend upon the state of the constitution. Most generally there is great weak- ness, in which case, the diet must be generous. Bark, with the elixir of vitriol and opium to relieve the pain, are to be frequently employed. As a local remedy, a blister ranks very high. It should be placed directly on the part. After being cut, it may be succeeded by a basilicon plaster. A modern writer strongly recommends the solution of arsenic, as a local remedy in this disease. Pledgets of linen dipped in the liquor, are to be laid on the swelling, and fre Carbuncle. 115 quently renewed. When matter begins to form, apply a bread and milk poultice, and treat it in every respect as a common ulcer. WHITLOW, OR FELON. Symptoms. An inflamed tumour at the end of the finger. It is of three kinds. The first is situated im- mediately under the skin, around the nail. The second in the cellular membrane, the pain and swell- ing of which are much greater than in the first, and the matter much longer in forming. The third lies under the sheath or covering of the tendons of the fingers, and is infinitely more violent, painful and dangerous, than either of the others. Treatment. If of the first description, open the little abscess with a needle and let out the matter, which should be prevented from forming, if possible, by bathing the part with camphorated spirits. The second should be dispersed by purging, and by leeches and blisters. If the inflammation is not reduced by these means, with a very sharp penknife, make an early and free incision in the sides of the last joint of the finger down to the bone. Suffer the blood to run for a few minutes, and then treat it as a common cut The same practice should be followed with regard to the third. PILES. Symptoms. A pain in the fundament when going to stool,-on examination small tumours are perceived to project beyond its verge. They are of two kinds, the blind and bleeding. They may also be ir.ternal and external. 116 Compendium of Domestic Medicine. Causes. Costiveness,-sedentary habits,-aloetic purgatives,-riding on horseback. Treatment. A diet of rye mush and milk, strictly adhered to for a length of time, will very frequently cure the disease. If they project, are swelled and painful, apply twenty or thirty leeches to them, and cold applications. The common gall ointment is a very soothing application. Balsam ccpaiva in doses sufficiently large to purge freely, is also highly re- commended. A radteal cure, however, is only to be sought for in the knife or ligature, for which apply to a surgeon. If the pain is very great, laudanum may be taken to ease it. BLIND PILEb. Treatment. If the bleeding is considerable, inject a solution of alum or a decoction of oak bark, or make pressure upon the vessels by introducing a sheep's gut, tied at one end, into the fundament, and then filling it with any astringent fluid by a clyster pipe. This evacuation is sometimes salu'ary, and it often requires much judgment to know if it should be stop- ped or not. BLEEDING PILES. OF ABSCESS. Symptoms. The formation of matter under the skin, or in any part of the body, preceded by inflam- mation, and marked by a dull heavy weight,-by the pain becoming more acute and darting,-by a pecu- Abscess. 117 liar throbbing,-by the swelling becoming more ele- vated and soft to the touch. If the tumour is not opened it bursts. Causes. Inflammation from injuries, or stimulus of any kind. Treatment. Apply a soft and warm bread and milk, or linseed poultice to the part, and endeavour to hasten the formation of matter. When this is evi- dent, let it out with a sharp lancet. If the patient is weak, let him have a generous diet with wine, por- ter, bark, &c. PSOAS ABSCESS. Symptoms. A weakness across the loins accom- panied by a dull pain. After a while, the pain shifts from the back to the thigh and hip, becoming more darting and severe. The glands in the groin swell, and at last a soft tumour is perceived at the lower edge of the groin, or by the side of the fundament,- the swelling increases to a large size, and sometimes extends itself down the thigh. Causes. Scrofula,-straining of the back,-blows, &c. Distinguish it from a rupture, by the preceding pain in the loins, and by the fluctuation. Treatment. In the early stage, bleed and purge the patient, keep him on a low diet, and apply a large blister over the lower part of the back. Confine- ment in bed is absolutely necessary. When matter is formed, make an opening into the tumour in the following manner-push a sharp lancet first through the skin, then obliquely upwards under it, and then by depressing the point pierce the swelling itself. In this way the abscess is opened without the danger that attends wounds of large cavities. If it is small, the whole of the matter may be allowed to flow aw ay at once; if large, after drawing a pint, close the wound 118 fbr a few hours and then finish the operation. The lips of the wound must be kept together by sticking plaster. As there are many vessels of importance in the groin, care must be taken to avoid wounding them, and if a surgeon can be had, he should always be applied to fbr this purpose. The disease is said to have been cured by blistering the tumour, and keeping it open with the savin ointment. Compendium of Domestic Medicine. OF FISTULA Symptoms. An abscess or ulcer in the neighbour- hood of the fundament, preceded by an inflamed hard swelling, which gives much pain. If there is no communication between the gut and the sore, it is called an incomplete, if there is, a complete fistula. Treatment. As the tumour is often taken for piles, attention should be paid to distinguish them. In all cases apply forty or fifty leeches to the part, keep the bowels perfectly loose by a diet of rye mush, and confine the patient to his bed. If, how- ever, the formation of matter cannot be hindered, the swelling must be opened early and a poultice applied to it, when the disease occasionally heals like any other sore, but nine times out often it forms a callous winding abscess, through which (if it is complete) excrement, &c. often pass. When it ar- rives at this point, nothing but an operation can ever he of any service. There is another species of fistulous opening, which fidlows the obstruction, caused by strictures, &c. in the urinary passage. The water not being able to flow through the natural canal, makes its way out between the bag and the fundament, con- stituting what »is called fistula in perineo. It may almost be called an incurable disease; at all events, none but a surgeon can do any thing to relieve 't. Ulcers. 119 OF ULCERS. By ulcers are meant holes or sores in the skin and flesh, which discharge matter. They are divided into inflamed, fungous, sloughing, and indolent, ulcers in the neighbourhood of carious bone, and those attended by a peculiar diseased action INFLAMED ULCER. Symptoms. The margin of the sore is ragged,- the skin ending in a sharp edge round it. The neigh- bouring parts are red, swelled and painful, the bot- tom of the ulcer is uneven and covered with a white spongy substance. In place of healthy yellow mat- ter, it discharges a thin fluid; the surface of it bleeds on the slightest touch. Treatment. Confine the patient to bed, amend, the general health, and if patient is feverish, give saline purgatives. For local treatment use sooth- ing applications at first, then mild stimulants. When healthy yellow matter is formed, omit the poultice, keep the sore very clean, and apply a plaster of simple ointment. FUNGOUS ULCERS. Symptoms. The presence of large round granula- tions rising above the level of the adjoining parts, or what is commonly called proud flesh, marks this species of ulcer. Treatment. Sprinkle red precipitate over the proud flesh, or touch it with lunar caustic, apply dressings of simple cerate to the sore, and pass a 120 Compendium of Domestic Medicine. bandage tightly over the whole. Burnt alum and blue vitriol may also be used to destroy the proud flesh. Pressure by a bandage will often succeed when all other means fail. SLOUGHING ULCER. Symptoms. The death of parts of an ulcer which mortify and fall off-generally attended by fever anfl pain. Treatment The diet should be generous, lauda- num must be taken to relieve pain, and bark, wine porter, &c. to strengthen the system. The carrot poultice is the best local application. The sore may also be washed with equal parts of a hot decoction of poppy heads and spirits of wine. When the dead portions have all fallen off, treat it as a simple ulcer paying attention, however, to the state of the system. INDOLENT ULCER. Symptoms. The edges of the skin are thick, raised, smooth and shining. The points of new flesh are glossy, and the appearance of the whole ulcer is that of an old one in which the healing process is at a stand. Treatment. Touch the whole surface, sides and edges of the sore with caustic, blue vitriol, or powder it with Spanish flies or red precipitate, and endeavour in this way to rouse the parts to action. If one arti- cle fails, try another. Strips of sticking plaster may be passed over the ulcer, about an inch apart, so as to draw its edges nearer together, and a long bandage be applied over the whole. Ctfrious Ulcer. 121 CARIOUS ULCER. Symptoms. Ulcers situated over or near carious (or dead) bone, are thereby prevented from healing, -they frequently penetrate deep into the parts, forming a canal with hard and indolent sides, that discharges an offensive unhealthy matter. ♦Treatment. Keep the sore clean, repress any proud flesh that may arise, and pay attention to the general health of the patient, taking care that his strength be kept up, if necessary, by wine, bark, por- ter, <fcc. &c. The ulcer will not heal until all the pieces of dead bone are thrown off. This process sometimes lasts for years, in which case, patience is the only remedy, and nature the best physician. SCORBUTIC ULCER. See Scurvy. SCROFULOUS ULCER. See Scrofula. VENEREAL ULCER. See Syphilis. Compendium of Domestic Medicine. 122 CHAPTER III. Of Accident*. GENERAL DIRECTIONS. Whenever, a blow has been inflicted, whether by being thrown from a horse,-out of a carriage,-by falling from a height, or in any other way, the first thing is to examine for any bruised or wounded places or broken bones, and apply ice or cold water cloths over the parts. This rule admits of but one exception, and that is, when the violence has been so great as nearly to extinguish all the powers of life, in which case it is proper to wait for symptoms of returning animation. To hasten these, a little wine and water, or other stimulus may be given. If, in consequence of a broken bone or other injury, the patient is unable to walk, take a door from its hinges, lay him carefully on it, and have him carried by assistants to the nearest house. If no door or sofa can be procured, two boards, sufficiently long and broad, should be nailed to two cross pieces, the ends of which must project about a foot, so as to form han- dles. If in the woods, or where no boards can be procured, a litter may be formed from the branches of trees. In this way a hand-barrow may be con- structed in a few minutes, on which the sufferer may be properly carried. It he has been wounded and bleeds, the bleeding must be stopped before he is removed. Having reached a house, lay him on a bed, and andress him with care and gentleness. If any diili- MODE OF BANDAGING. General Directions. 123 culty arises in getting off his coat or pantaloons, rip up the seams, rather than use force. This being done, proceed to ascertain the nature of the injury. This may be either simple or compound; that is, it may be a contusion or bruise, a wound, fracture or dislocation, or it may be two or all of them united in one or several parts. A contusion is the necessary consequence of every blow, and is known by the swelling and dis- coloration of the skit). Wounds are self-evident. Fractures are known by the sudden and severe pain,-by the misshapen appearance of the limb,- sometimes, by its being shortened,-by the patient being unable to move it without excruciating pain,- but most certainly, by grasping the limb above and below the spot where the fracture is supposed to exist, and twisting it different ways, when a grating will be felt, occasioned by the broken ends of the bone rubbing against each other. If the swelling, however, is very great, this experiment should not be made until it is reduced. Dislocations, or bones being out of joint, are known by the deformity of the joint when compared with its fellow,-by the pain and inability to move the limb,-by its being longer or shorter than usual, and by the impossibility of moving it in particular directions. If slight, bathe the part frequently with cold vine- gar and water for a few hours, and then rub it well wiih brandy, or spirits of any kind. Should it be Very great, or so as to have affected the whole body, which may be known by a general soreness, bleed and purge the patient, and confine him to a diet of rice water, lemonade, panada, Ac. If fever comes OF CONTUSION. 124 Compendium of Domestic Medicine. on, repeat the bleeding, purging, &c. In all cases of this nature, be sure the water is regularly evacuated, for it sometimes happens that in consequence of the nerves of the bladder being palsied by the blow, the patient feels no desire to pass it, though the bladder be full. If a suppression ensues, pass a catheter, if possible, or procure assistance for that purpose. OF SPRAINS. Plunge the part sprained into very cold water, and hold it there as long at a time as you can bear it- for several hours-then rub it well with camphorated spirits If the accident has happened to a joint, as in the ankle, and it remains weak, pour cold water on it from the spout of a tea kettle, held at a distance, several times in the day. The most serious effect, however, resulting from contusion, is when the blow is applied to the head, producing either concussion or compression of the brain. Symptoms. The patient is stunned,-his breathing slow,-drowsiness,-stupidity,-the pupil of the eye rather contracted,-vomiting. After a time he re- covers. Treatment. Apply cloths dipped in cold vinegar and water to his head, and when the stupor is gone, bleed him, and open his bowels with Epsom salts. He should be confined to bed, kept on a low diet, in a quiet situation, and every measure taken to prevent an inflammation of the brain, which, if it comes on, must be treated by copious bleeding, blisters, tec. CONCUSSION OF THE BRAIN. Compression of the Brain. 125 COMPRESSION OF THE BRAIN. Symptoms. Loss of sense and motion,-slow, noisy and laborious breathing,-pulse slow and irregular, -the muscles relaxed, as in a person just dead,-the pupil of the eye enlarged and will not contract even by a strong light,-the patient lies like one in an apoplectic fit, and cannot be roused. Treatment. Open a vein and draw off sixteen or twenty ounces of blood, shave the head, and if possible, procure surgical assistance without delay, as there is nothing but an operation that can be of any avail. Wounds are of three kinds, viz. incised, punctured and contused,-among the latter are included gun- shot wounds. The first step in all wounds, is OF WOUNDS. If the flow of blood is but trifling, draw the edges of the wound together with your hand, and hold them in that position some time, when it will frequently stop. If, on the contrary, it is large, of a bright red colour, flowing in spirts or with a jerk, clap your fin- ger on the spot it springs from, and hold it there with a firm pressure, while you direct some one to pass a handkerchief round the limb (supposing the wound to be in one) above the cut, and to tie its two ends to- gether in a hard knot. A cane, whip-handle or stick of any kind, must now be passed under the knot (be- tween the upper surface of the limb and the hand- kerchief) and turned round and round until the stick is brought down to the thigh, so as to make the hand- kerchief encircle it with considerable tightness. You may then take off your finger: if the blood still flows TO STOP THE BLEEDING. 126 tighten the handkerchief by a turn or two of the stick, until it ceases. The patient may now be removed 'taking care to secure the stick in its position) with- out running any risk of bleeding to death by the way. As this apparatus cannot be left on for any length of time, without destroying the life of the parts, en- deavour as soon as possible to secure the bleeding vessels, and take it off Having waxed together three or four threads of a sufficient length, cut the ligature they form, into as many pieces as you think there are vessels to be taken up, each piece being about a foot long. Wash the parts with warm water, and then with a sharp hook, or a slender pair of pin- cers in your hand, fix your eye steadfastly upon the wound, and direct the handkerchief to be relaxed by a turn or two of the stick; you will now see the mouth of the artery from which the blood springs, seize it with your hook or pincers, draw it a little out, while some one passes a ligature round it and ties it up tight, with a double knot. In this way take up in succession every bleeding vessel you can see or get hold of. If the wound is too high up in a limb to apply the handkerchief, do not lose your presence of mind* the bleeding can still be commanded. If it is the thigh, press firmly in the groin,-if in the arm, with the hand-end or ring of a common door key, make pressu re above the collar bone, and about its middle against the first rib which lies under it. The pressure is to oe continued until assistance is procured, and the vessel tied up. If the wound is on the head, press your finger firmly Compendium of Domestic Medicine. * A lit tle practice on himself or others, would soon enable any one to compress the great arteries in these two situations. And it is well worth the time spent m doing so. Many a man has bled to death before a surgeon could be procured, although surrounded with persons who, by the simple process above mentioned might have preserved him MODE OF BANDAGING. Wounds. 127 on it, until a compress can be brought, which must be bound firmly over the artery by a bandage. If the wound is in the face, or so situated that pressure cannot be effectually made, or you cannot get hold of the vessel, and the blood flows fast, place a piece of ice directly over the wound, and let it remain there till the blood coagulates, when it may be removed and a compress and bandage be applied. INCISED WOUNDS. By an incised wound, is meant a clean cut. Hav ing stopped the bleeding, wash away all dirt, &c. that may be in it with a sponge and warm water, then draw the sides of the wound together, and keep them in that position by narrow strips of sticking plaster, placed on at regular distances, or from one to two inches apart. A soft compress of old linen or lint may be laid over the whole. Should much inflammation follow, apply cold cloths or ice, and purge the patient(who should live very low and be kept perfectly quiet), according to the exigency of the case. If it is plain that matter must form before the wound will heal, apply a soft poultice until that event takes place, when dressings of some simple ointment may be substituted for it. Although narrow strips of linen, spread with stick- ing plaster, form the best means of keeping the sides of a wound together, when they can be applied, yet in the ear, nose, tongue, lips, bag and eye lids, it is necessary to use stitches, which are made in the fol- lowing manner. Having armed a common needle with a double waxed thread, pass the point of it through the skin, at a little distance from the edge of the cut, and bring it out of the opposite one, at the same distance. If more than one stitch is required, cut off the needle, thread it again, and proceed as before, until a sufficient number are taken, leaving 128 Compendium of Domestic Medicine. the threads loose until all the stitches are passed, when the respective ends of each thread must be tied in a hard double knot, drawn in such a way that it bears a little on the side of the cut. When the edges of the wound are partly united by inflamma- tion, cut the knots carefully and withdraw the threads. From what lias been said, it must be evident, that in all wounds, after arresting the flow of blood and cleansing the parts, if necessary, the great indication is to bring their sides into contact throughout their whole depth, in order that they may grow together as quickly as possible, and without the intervention of matter. To obtain this very desirable result, in addition to the means already mentioned, there are two things to be attended to, the [(osition of the patient and the application of a bandage. The position of the patient should be such as will relax the skin and muscles of the part wounded, thereby diminishing their tendency to separate. A common bandage of a proper width, passed over the compresses moderately tight, not only serves to keep them in their place, but also tends by its pressure, to forward the great object already mentioned. If, however, the wound is so extensive and painful that the limb or body of the patient cannot be raised for the purpose of applying or removing it, the best way is to spread the twro ends of one or two strips of linen or leather with sticking plaster, which may be ap- plied in place of the bandage, as follows: attach one end of a strip to the sound skin, at a short distance from the edge of the compress, over which it is to be drawn with moderate firmness, and secured in a similar manner on its opposite side. A second or third may, if necessary, be added in the same way. In all wounds, if violent inflammation come on, reduce it by cold, purging, <tc.; but if there is rea- son to fear locked-jaw, give wine, porter, brandy, opium, and a generous diet. Punctured Wounds. 129 PUNCTURED WOUNDS. These are caused by sharp pointed instruments, as needles, awls, nails, &c. Having stopped the bleed- ing, withdraw any foreign body, as part of a needle, splinters, bits of glass, &c. that may be in it, provided it can be done easily; and if enlarging the wound a little will enable you to succeed in this, do so. Though it is not always necessary to enlarge wounds of this nature, yet in 'hot weather, it is a mark of pre- caution, which should never be omitted. As soon as this is done, pour a little turpentine into the wound, or touch it with caustic, and then cover it with a poultice moistened with laudanum. This practice may prevent locked-jaw, which is but too frequent a consequence of wounds of this description. When matter forms, cover the part with mild dressings, as a common sore. Laudanum may be given in large doses, to relieve pain, and should the inflammation be excessive, bleed and purge. In hot weather, however, bleeding should be employed in great moderation. Wounds of this nature are caused by round or blunt bodies, as musket balls, clubs, stones, &c They are in general attended but by little bleeding; if, however, there should be any, it must be stopped. If it arises from a ball which can be easily found ana withdrawn, it is proper to do so, as well as any piece of the clothing. &c. that may be in it; or if the bal] can be distinctly felt directly under the skin, make an incision across it and take it out, but never allow of any poking in the wound to search for such things • the best extractor of them, as well as the first an« best application in contused wounds, proceed from CONTUSED WOUNDS. 130 Compendium of Domestic Medicine. what they may, being a softbread and milk poultice. Should the inflammation be great, apply ice bladder. Pain may be relieved by laudanum, and if the pat ts assume a dark look, threatening a mortification, cover them with a blister. If the wound is much tom, wash the parts very nicely with warm water, and then (having secured every bleeding vessel) lay them all down in as natu- ral a position as you can, drawing their edges gently together, or as much so as possible, by strips of stick- ing plaster, or stitches, if necessary. A soft poultice is to be applied over the whole. POISONED WOUNDS, FROM BITES OF MAD DOGS, RATTLE-SNAKES, &c. The instant a person is bitten either by a mad dog, rattle-snake, or any rabid animal, or reptile, he should apply a ligature, by means of the stick (see directions to stop bleeding, ante p. 125), above the wound, as tightly as he can well bear it, and without hesitation >r delay cut out the parts bitten, taking along with them a portion of the surrounding sound flesh. The wound should then be freely touched with caustic, or have turpentine poured into it. By these means inflammation will be excited, and suppuration follow which may prevent the usual dreadful consequences of such accidents. As soon as the parts are cut out, take off the ligature. Should the patient be too timid to allow the use oi the knife, burn the wound very freely with caustic, and place in it a tuft of tow or cotton, well moistened with turpentine. The discharge of matter that fol lows, should be kept up for some time. 'rhe only reasonable chance of safety, is found in the above plan, all the vegetable and mineral productions tha have been hitherto recommenced as internal rente dies being of ven doubtful, if of any efficacy Stings. 131 STINGS OF BEES AND WASPS, BITES OF MOSQUITOS, &c. Nothing relieves the pain arising from the sting of a hornet, bee, or wasp, so soon as plunging the part in extremely cold water, and holding it there for some time. A cold lead-water poultice is also a very soothing application. If a number of these insects have attacked you at once, and the parts stung are much swollen, lose some blood, and take a dose of salts. Mosquito-bites maybe treated in the same man- ner, although I have found a solution of hartshorn and water, made very strong, the most speedy and effectual in relieving the pain. Camphorated spirits, vinegar, &c. may also be used for the same purpose. WOUNDS OF THE LIMBS, &c. Wash the parts clean, and draw the edges of the wound together by as many stitches as are necessary. If the part is even completely separated, and has been trodden under foot, by washing it in warm water, and placing it accurately m its proper place by the same means, it may still adhere. OF THE EAR, NOSE, &C. OF THE SCALP. In all wounds of the scalp it is necessary to shave off'the hair. When this is done, wash the parts Well- and draw the edges of the wound together with stick- ing plaster. I f it has been violently torn up m seve- ral pieces, wash and lay them all down on the skull again, drawing their edges as nearly together as possi 132 Compendium of Domestic Medicine. ble by sticking plaster, or if necessary, by stitches. Cover the whole with a soft compress smeared with some simple ointment. Seize and tie up every bleeding vessel you can get hold of. If the wind pipe is cut onlypar//y through, secure it with sticking plaster; if it is completely divided, bring its edges together by stitches, taking care to pass the needle through the loose membrane that covers the wind pipe, and not through the wind pipe itself. The head should be bent on the breast, and secured by bolsters and bandages in that position, to favour the approximation of the edges of the wound. OF THE THROAT. OF THE CHEST. If it is a simple incised wound, draw the edges of it together by sticking plaster, cover it with a com- press of linen, and pass a bandage round the chest. The patient is to be confined to his bed, kept on a very low diet, and to be bled and purged, in order to prevent inflammation. If the latter conies on, reduce it by copious and frequent bleedings. Should it be occasioned by a bullet, extract it, and any pieces of cloth, &c. that may be lodged in it, if possible, and cover the wound with a piece of linen smeared with some simple ointment, taking care that it is not drawn into the chest. If a portion of the lung protrudes, return it without any delay, but as gently as possible. OF THE BELLY. Close the wound by strips of sticking plaster, and stitches passed through the skin, about half an inch from its edges, and cover the whole with a soft com- press, secured by a bandage. Any inflammation that may arise is to be reduced by ice, purging, and a blister over the whole belly. Should any part of the bowels come out at the Wounds. 133 wound, if clean and uninjured, return it as quickly as possible; if covered with dirt, clots of blood, &c. wash it carefully in warm water previous to so doing. If the gut is wounded, and only cut partly through, draw the two edges of it together by a stitch, and re- turn it; if completely divided, connect the edges by four stitches at equal distances, and replace it in the belly, always leaving the end of the ligature project- ing from the external wound, which must be closed by sticking plaster. In five or six days, if the threads are loose, withdraw them gently and carefully. Bring the edges of the wound together by sticking plaster, without any delay, keep the part perfectly at Test, bleed, purge, and live very low, to prevent in- flammation. Should it come on, it must be met at its first approach by applying an ice bladder or cloths dipped in cold water, over the joint, and by a blis- ter covering the whole joint. If a permanent stiffen- ing of the joint seems likely to ensue, keep the liml in that position which will prove most useful, that is, the leg should be extended, and the arm bent at the elbow. Wounds of joints are always highly danger- ous, and frequently terminate in death. OF JOINTS. OF TENDONS. Tendons or sinews are frequently wounded and ruptured. They are to be treated precisely like any other wound, by keeping their divided parts together. The tendon which connects the great muscle form- ing the calf of the leg, with the heel, called the ten- don of Achilles, is frequently cut with the adze, and ruptured in jumping from heights. This accident is to be remedied by drawing up the heel, extending the foot, and placing a splint on the fore-part of the leg, extending from the knee to beyond the toes which being secured in that position by a bandage, keeps the foot in the position just mentioned. The Compendium of Domestic Medicine. 134 hollows under the splint must be filled up with tow or cotton If the skin falls into the space between the ends of the tendon, apply a piece of sticking plas- ter, so as to draw it out of the way. It takes five or six weeks to unite, but no weight should be laid on the limb for several months. The signs by which fractures may be known, hav- ing been already pointed out with sufficient minute- ness, it will be unnecessary to dv ell thereon; it will be well, however, to recollect this general rule: in cases where, from the accompanying circumstances and symptoms, a strong suspicion exists that the bone is fractured, it is proper to act as though it were positively ascertained to be so. OF FRACTURES. The bones of the nose from their exposed situation, are frequently*(brced in. Any smooth article that will pass into the nostril should be immediately intro- duced with one hand, to raise the depressed portions to the proper level, while the other is employed in moulding them into the required shape. If violent inflammation follows, apply ice, and live on a low diet. OF THE BONES OF THE NOSE. This accident is easily discovered by locking into the mouth, and is to hie remedied by keeping the lower jaw firmly pressed against the upper one. by means of a bandage passed under the chin and over the head. If it is broken near the angle, or that part nearest the ear, place a cushion or roll of linen in the hollow behind it, over which the bandage must pass, so os to make it push that part of the bone forward OF THE LOWER JAW. Fractures 135 The parts are to be confined in this way for twenty days, during which tune, all the nourishment that is taken, should be sucked between the teeth. If in consequence of the blow, a tooth is loosened, do not meddle with it, for if let alone it will grow fast again. OF THE COLLAR BONE. This accident is a very common occurrence, and is known at once by passing the finger along it, and by the swelling, &c. To reduce it seat the patient in a chair without any shirt, and place a pretty stout compress of linen, made in the shape of a wedge, under his arm, the thick end of which should press against the arm-pit. His arm, bent to a right angle at the elbow, is now to be brought down to his side, and secured in that position by a long bandage, which passes over me arm of the affected side and round the body. The fore-arm* is to be supported across the breast by a sling. It takes from four to five weeks to re-unite. OF THE ARM. Seat the pat ient on a chair, or the side of a bed, lei one assistant hold the sound arm, while another grasps the wrist of the broken one and steadily ex- tends it in an opposite direction, bending the fore- arm a little, to serve as a lever. You can now place the bones in their proper situation. Two splints of shingle or stout pasteboard, long enough to reach from below the shoulder to near the elbow, must then be well covered with tow or cotton, and laid along each side of the arm, and kept in that position by a bandage. The fore-arm is to be supported in a sling. Two smaller splints may for better security be laid between the first ones, that is one on top, and * By the fore-arm is meant tjiat part of it which reaches from the elbow to the wrist. The arm ex- tends from the shoulder to the elbow. 136 Compendium of Domestic Medicine. the other underneath die arm, to be secured by the bandage in the same way as the others. OF THE BONES OF THE FORE-ARM. These are to be reduced precisely in the same way, excepting the mode of keeping the upper por- tion of it steady, which is done by grasping the ann above the elbow. When the splints and bandage are applied, support it in a sling. OF THE WRIST, &C. This accident is of rare occurrence. When it does happen the injury is generally so great as to require amputation. If you think the hand can be saved, lay it on a splint well covered with tow; this extends beyond the fingers; place another splint opposite to it, lined with the same soft material, and secure them by a bandage. The hand' is to be carried in a sling. The bones of the hand are sometimes broken. When this is the case, fill the palm with soft com- presses or tow, and then lay a splint on it long enough to extend from the elbow to beyond the ends of the fingers, to be secured by a bandage, as usual. When a finger is broken, extend the end of it until it becomes straight, place the fractured portion in its place, and then apply two small pasteboard splints, one below and the other above, to be secured by a narrow bandage. The top splint should extend from the end of the finger over the back of the hand. It may sometimes be proper to have two additional splints for the sides of the finger. When after a fall or blow, the patient complains of a pricking pain in his side, we may suspect a rib is broken. It is ascertained by placing the tips of two or three fingers on the spot where the pain is, and desiring the patient to cough, when the grating sensation will be felt. All that is necessary, is to OF THE RIBS. Fractures. 137 pass a broad bandage round the chest, so tight as to prevent the motion of the ribs in breathing and to observe a low diet. A fracture of this bone is known by the deformity of the thigh, the shortness of the whole limb when compared with its fellow, and by a great swelling at the fractured part. All that can be done in the event of this serious accident, is to send for the nearest physician. The apparatus to reduce it is so complex, that none but a surgeon can apply it. OF THE THIGH. OF THE KNEE-CAP. This accident is easily ascertained on inspection, ft may be broken in any direction, but is most gene- rally so across or transversely. It >s reduced by bringing the fragments together and keeping them in that position by a long bandage passed carefully round the leg, from the ankle to the knee, then press- ing the upper fragment down so as to meet its fellow, (the leg being extended) and placing a thick compress of linen above it, over which the bandage is to be continued. The extended limb is now to be laid on a broad splint, extending from the buttock to the heel, thickly covered with tow to fill up the inequalities of the leg. For additional security, two strips of muslin may be nailed to the middle of the splint, one on each side, and passed about the joint, the one below, the other above, so as to form a figure of eight. In twenty or thirty days, the limb should be moved a little to pre- vent stiffness. If the fracture is through its length, bring the parts together, place a compress on each side, and keep them together with a bandage, leaving the iimb ex- tended and at rest. Any inflammation in this, or other fracture, is to be combated by cold a.pplica tions, 4c. <fcc. 138 Compendium of Domestic Medicine. OF THE LEG. From the thinness of the parts covering the princi- pal bone of the leg, it is easy to ascertain if it is bro- ken obliquely. If, however, the fracture be directly across, no displacement will occur, but the pain, swelling, and the grating sensation, will sufficiently decide the nature of the accident. If the fracture is oblique, let two assistants extend the limb, while the broken parts are placed by the hand in their natural position. Two splints that reach from a little above the knee, to nine or ten nches below the foot, having near the upper end of each, four holes, and a vertical mortice near the lower end into which is fitted a cross piece, are now io be applied as follows. Lay two pieces of tape, about a foot long, on each side of the leg, just, below che knee joint, and secure them there by several turns of a bandage; pass a silk handkerchief round the ankle, cross it on the instep, and tie it under the sole of the foot. The two splints are now placed one on each side of the leg, the four ends of the pieces of tape passed through the four holes and firmly tied, and the cross piece placed in the mortice. By tying the ends of the handkerchief to this cross piece the business is finished. If the fracture is across, and nodisplacement exists, apply two splints of stout pasteboard, reaching from the heel to the knee, and well covered with tow, one on each side of the leg, securing them by a bandage passing round the limb, and outside the splints. OF THE BOWES OF THE FOOT. The bone of the heel is sometimes, though rare]}', broken. It is known by a crack at the moment of the accident, a difficulty in standing, by the swelling, and by the grating noise on moving the heel. To reduce it, take a long bandage, lay the end of it on the top THE DORSAL SURFACE OF THE LEFT FOOT. 1, the astragalus, its upper articular surface. 2, its an- terior extremity, which articulates with (4) the sca- phoid bone. 3, the oscalcis, or heel-bone 4, the sca- phoid bone. 5, the internal cuneiform bone. 6, the middle cuneiform bone. 7, the external cuneiform bone. 8, the cuboid bone. 9, the metatarsal bones of the first and second toes. 10, 11, the first and second phalanges of the great toe. 12,13,14, the first, second, and third phalanges of the second toe. Fractures. 139 of the foot, carry it over the toes under the sole, and then by several turns secure it in that position. The foot being extended as much as possible, carry the bandage along the back of the leg above the knee, where it is to be secured by several turns, and then brought down on the front of the leg, to which it is secured by circular turns. In this way the bro- ken pieces will be kept in contact, and in the course of a month or six weeks will be united. Fractures of the foot, toes, &c. are to be treated like those of the hand and fingers. OF DISLOCATIONS. The signs by which a dislocation may be known, have been already mentioned. It is well to recollect that the sooner the attempt is made to reduce it, the easier it will be done. The strength of one man, properly applied at the moment of the accident, will often succeed in restoring the head of a bone to its place, which in a few days would have required the combined efforts of men and pulleys. If after several trials with the best apparatus that can be mustered, you find you cannot succeed, make the patient drink strong hot toddy, of brandy or other spirits, until he is very drunk. In this way, owing to the relaxed state of the muscles, a very slight force will often be sufficient, where a very great one has been previ- ously used without effect. If any objections are made to this proceeding, or if the patient will not consent to it, having your ap- paratus (which is presently to be mentioned) all ready, let him inhale chloroform or ether until com pletely under its influence ; the instant this happens apply your extending and counter-extending forces Another important rule is, to vary the direction of the extending force A slight pull in one way, wifi Compendium of Domestic Medicine. 140 often effect what has been in vain attempted by great force in another. OF THE LOWER JAW. This accident, which is occasioned by blows, or yawning, is known by an inability to shut trie mouth, and the projection of the chin. To reduce it, seat the patient in a chair with his head supported bv the breast of an assistant, who stands behind him. Your thumbs being covered with leather, are then to be pushed between the jaws, as far back as possible, while with the fingers, outside, you grasp the bone, which is to be pressed downtvards at the same time that the chin is raised. If this is properly done, the bone will be found moving, when the chin is to be pushed backwards, and the thumbs slipped between the jaws and the cheeks. If this is not done, they will be bitten by the sudden snap of the teeth as they come together. The jaws should be kept closed t.y a bandage for a few days, and the patient live upon soup. This bone is rarely dislocated. S'houlu it occur, apply the bandages, &c. directed for a fracture of the same part. OF THE COLLAR BONE Dislocation of the shoulder is the most common of all accidents of the kind. It is very easily known by the deformity of the joint, and the head of the bone being found in some unnatural position. To reduce it, seat the patient in a chair, place one hand on the prominent part of the shoulder blade, just aoove the spot where tne head of the bone should be, while with the other you grasp the arm above the elbow and puli it outwards. Should this not succeed, lay the patient on the ground, place your heel in his arm-pit, and steadily OF THE SHOULDER. Dislocations. 141 and forcibly extend the arm, by grasping it at the wrist. The same thing may be tried in various posi- tions, as placing yourself on the ground with him; laying him on a low bed, while you are standing near the foot of it, &c. If this fails, pass a strong band over the shoulder, carry it across the breast, give the ends to assistants, or fasten them to a staple in the wall; the middle of a strong band or folded towel is now to be laid on the arm above the elbow, and secured there by numerous turns of a bandage. The two ends of the towel be- ing then given to assistants, or connected with a pulley, a steady, continued and forcible extension is to be made, while with your hands you endeavour to push the head of the bone into its place. OF THE ELBOW. If the patient has fallen on his hands, or holds an arm bent at the elbow, and every endeavour to straighten it gives him pain, it is dislocated back- wards. Seat him in a chair, let one person grasp the arm near the shoulder, and another the wrist, and forcibly extend it, while you interlock the fingers of both hands just above the elbow, and pull it back- wards, remembering that under 'hose circumstances, whatever degree of force is requ.red, should be ap- plied in this direction. The elbow is sometimes dislocated sideways or laterally. To reduce it, make extension by pulling at the wrist, while some one secures the arm above, then push the bone into its place, either inwards or outwards, as may be required. After the reduction of a dislocated elbow, keep the joint at perfect rest for five or six days, and then move it gently. If in- flammation comes on, apply ice bladder &e. Ac. Dislocations of the wrist, fingers and thumb, are readily perceived on examination; they are all to be OF THE WRIST, FINGERS, &C. 142 reduced by forcibly extending the lower extremity of the part, and pushing the bones into their place. If necessary, small bands may be secured to the fin- gers by a narrow bandage, to facilitate the extension. These accidents should be attended to without delay for if neglected for a little time, they become i» remediable. Compendium of Domestic Medicine. OF THE THIGH. Notwithstanding the hip joint is the strongest one in the body, it is sometimes dislocated. When this accident occurs, which may be readily ascertained by comparing the limb with its fellow, &c. send foi a surgeon as soon as possible. OF THE KNEE-CAP. When this little bone is dislocated, it is evident on the slightest glance. To reduce it, lay the patient on his back, straighten the leg, lift it up to a right angle with his body, and in that position push the bone back to its place. The knee should be kept at rest for a few days. OF THE LEG Procure a surgeon as quickly as possible. The foot is seldom dislocated. Should it happen, however, let one person secure the leg, and another draw the foot, while you push the bone in the con- trary way to that in which it was forced out. The part is then to be covered with compresses dipped in lead water, and a splint appi ed on each side of the leg that reaches below the foot Acc'dents of this nature are always dangerous, an mat can be done to remedy them consists in the speedy reduc- tion of the bone, keeping the parts at rest, and subduing inflammation by cold, low diet, Ac. <fcc. OF THE FOOT. Compound Accidents. 143 OF COMPOUND ACCIDENTS. Having spoken of the treatment to be pursued for a bruise, wound, fracture and dislocation, as happen- ing singly, it remains to state what is to be done when they are united. We will suppose that a man has been violently thrown from a carriage. On examination, a wound is found in his thigh bleeding profusely, his ankle is out of joint with a wound communicating with its cavity, and the leg broken. In the first place stop the bleeding from the wound in the thigh; reduce the dislocation next; drawine edges of the wounds together with sticking plaster: and procure a surgeon as quickly as possible. If, instgid of a wound, fracture and dislocation, there, is a concussion or compression of the brain, a and fracture, attend to the concussion first, the dislocation next, and the fracture the last. OF AMPUTATION. This operation should never be attempted except by a surgeon. If a limb be nearly severed from the body by ac- cident, and hang merely by a slip of skin or muscle, it may be divided with a sharp knife. OF SUSPENDED ANIMATION The common methods of rolling the body of a drowned person on a barrel, or holding it up by the FROM DROWNING. 144 Compendium of Domestic Medicine. heels, &c. are full of danger, and should never be permitted. If a spark of life should happen to re- main, this violence would extinguish it for ever.* As soon, therefore, as the body is found, convey it as gently as possible to the nearest house, strip it of the wet clothes, dry it well, and place it on a bed be- tween warm blankets, on the right side, with the head elevated by pillows. Every part is now to be well rubbed witn flannels dipped in warm brandy, or spirits of any kind, while a warming pan, hot bricks, or bottles or bladders filled with warm water, are applied to the stomach, back, and soles of the feet. During these operations a certain number of the as- sistants (no more persons are to be allowed in the room than are absolutely necessary) should try to inflate the lungs, by blowing through the nozzle of a common bellows, or a pipe of any kind, placed in one nostril, while the other with the mouth is kept closed. An assistant standing at the head of the body should take hold of the arms at the wrists, and raise the arms up to the head, and then throw them forward on the chest, thus dilating and con- tracting the thorax, making artificial respiration. All these operations, particularly rubbing the body and trying to inflate the lungs, should be continued for six or eight hours, and when the patient has come to himself, small quantities of warm wine, wine- whey, brandy and water, &c. may be given to him, from time to time Should the accident occur in winter, and the body feel cold, as if frozen; previously to applying warmth, rub it well with snow, ice, or very cold water. Above all things remember that perseverance for many hours in the remedies pointed out, may give * The seal of the Humane Society beautifully ex- presses this fact. It represents a little boy blowing a coal, the motto iif I mistake not' " a spark may re- main!" Suspended Animation. 145 you the unspeakable pleasure of restoring a fellow creature to life. FROM COLD. Take the body into a room, the doors and windows of which are open, and where there is no fire, and rub it with snow,* or cold water. After a while, fric- tions with flannels and hot spirits are to be used, as in the preceding case, and warmth very gradually ap- plied. The lungs are io be inflated as directed in cases of drowning, and when the patient ir> able to swallow, warm wine, &c. may be given in small quantities. If a limb is frost-bitten, the cold applications should be continued longer, and warmth be more gradually applied than when the whole body is frozen. Care should be taken to handle the parts carefully, so as not to break off the ear, tip of the nose, &c. The remedies for this accident are the same as in drowning, with the addition of taking away a small quantity of blood, by cupping glasses, from the neck, or by opening the jugular vein. FROM HANGING. FROM FOUL AJR. Throw open the doors and windows, or take tnr patient into the open air, and seat him, undressed, well wrapped in a blanket, in a chair, leaning a little to the right side, place his feet or whole body in a bath, and sprinkle his stomach with cold vinegar 01 water, and rub it immediately with flannels dipped in oil. Clysters of vinegar and water are to be in- * If this can be procured in plenty, the patient, with the exception of his face, which should be left out, may be completely covered with it to the thick- ness of two feet. 146 jected, and when animation returns, continue tho frictions, and give warm mint tea, &c. Compendium of Domestic Medicine. OF SWALLOWING POISONS. The first thing to be done when a person is dis- covered to have swallowed poison is, to ascertain what it is he has taken: the next, to be speedy in resorting to its appropriate remedies. If any one of these cannot be had, try some other without loss of time. Oil of Vitriol,-Aqua Fortis,-Spirits of Sea Salt, -Oxalic Acid. Symptoms. A burning heat in the mouth, throat and stomach,.-stinking breath,-an inclination to vomit, or vomiting of various matters mixed with blood,-hiccups,-costiveness or stools more or less bloody,-pain in the belly, so great that the weight of a sheet cannot be borne,-burning thirst,-diffi- culty of breathing,-suppression of urine, &c. Remedies.-Mix an ounce of calcined magnesia with a pint of water, and give a glassful every two minutes. If it is not at hand, use flaxseed tea, rice water, or water alone in large quantities, until the former can be procured. If it cannot be obtained, dissolve an ounce of soap in a pint of water, and take a glassfn. every two minutes; chalk or whiting may also be taken by the mouth, and clysters of milk be frequently injected. If the patient will not vomit, put him in the warm bath, bleed him freely, and apply leeches and blisters over the parts pained. If the cramps and convulsions continue, give him a cup of common tea, with an ounce of sugar, forty drops of Hoffman's anodyne and fifteen or twenty of lauda- num every quarter of an hour. No nourishment but ACIDS. Swallowing Poisons. 147 sweetened rice water is to be taken for several days In these cases never give tartar emetic, ipecacuanha, or tickle the throat with a feather; they only increase the evil. Caustic Potash,-Caustic Soda,- Volatile Alkali. Symptoms. These substances occasion the same effects as acids, producing dreadful convulsions. Remedies. Take two table spoonsful of vinegai or lime juice in a glass of water at once, follow it up by drinking large quantities of sugar and water. Pursue the same treatment as in poisons from acids. ALKALIES. MERCURY. Corrosive Sublimate,-Red Precipitate,- Vermilion. Symptoms. Constrict'an and great pain in the throat, stomach and bowels,-vomiting of various matters mixed with blood,-unquenchable thirst,- difficulty of urine,-convulsions. Remedies. Mix the white, of a dozen or fifteen eggs with two pints of cold water, and give a glassful every two minutes, with as much milk as can be swallowed, and large doses of ipecacuanha. If aftei the egg mixture is all taken, the vomiting does nol stop, repeat the dose, with the addition of more water. Leeches, the warm bath, blisters, &c. are to be used to reduce the pain and inflammation, as be fore directed. Symptoms. These are the same as produced by the mercurial poisons. Remedies. Give large quantities of cold sugar and water, unlil a plentiful vomiting is induced, to assist which, ipecacuanha* may be taken in considerable ARSENIC. * To render it more active, ten grain? of sulphate of zinc may be added to it. 148 Compendium of Domestic Medicine. doses at the same time ;* barley, rice water, flaxseeu tea, milk, &c. should afterwards be employed. Oil is never to be used in this case until the symptoms have considerably abated, or the poison has been ejected. COPPER. The symptoms occasioned by swallowing verdigris, are nearly the same as those of the mercurial poisons- The great remedy is large quantities of sweetened water. In addition to this, use all the means recom- mended for corrosive sublimate, &c. ANTIMONY. Antimonial Wine,-Tartar Emetic,-Butter of An- timony, tyc. Symptoms. Excessive vomiting,-pain and cramp in the stomach,-convulsions, &c. Remedies. Encourage the vomiting by sugar and water, and if after a while it does not stop, give a grain of opium in a glass of the sweetened water, every fifteen minutes. To relieve the pain, apply leeches to the stomach, throat or parts affected. SALTS OF TIN. (Jive as much milk as can be got down, and if it is not at hand, use large quantities of cold water to in- duce vomiting. If the symptoms do not abate, pursue the plan directed for acids. Pursue the plan recommended for arsenic. SALTS OF BISMUTH, GOLD AND ZINC. Dissolve two table spoonsful of common table sa't, in two pints of water; a few glasses of this will in- LUNAR CAUSTIC * Equal parts of lime water and sugared water may also be used. Swallowing Poisons. 149 duce vomiting If not relieved, drink flaxseed tea. apply leeches, &c. as for acids. SALT-PETRE. Pursue the plan recommended for arsenic omitting the lime water. Symptoms. Vomiting,-pain in the belly,-a stiff- ness of the whole body,-convulsions. Remedies. Introduce your finger or a feather into the throat to induce vomiting, and give plenty of sweetened water. To relieve the convulsions give the tea, laudanum, &c. as for acids, or the laudanum alone, and to ease the pain in the belly, apply leeches, &c. SAL AMMONIAC. Symptoms. They resemble those caused by salt- petre. Remedies. Two table spoonsful of vinegar in e glass of water, are to be frequently taken until vomit- ing is brought on, after which, have recourse tc leeches, blisters, &c. LIVER OF SULPHUR. PHOSPHORUS. The symptoms and remedies are the same as by poison from acids. Symptoms. Great pain in the stomach, with obsti- nate and painful erections, accompanied by a diffi- culty or suppression of urine, or if any is passed, it is bloody,-a horror of swallowing liquids,-frightful convulsions. Remedies. Make the patient swallow as much sweet oil as he can possibly get down. Milk ano sugared water are also to be freely used. In addition SPANISH FLIES. 150 to the plan recommended for acids, solutions of gum arabic, or flaxseed tea, are to be injected into the bladder. If no vomiting is induced, put him in the warm bath, continue the sweetened water, and rub his thighs and legs with two ounces of warm oil, in which a quarter of an ounce of camphor has been dissolved. Eight or ten grains of camphor may be mixed with the yolk of an egg and taken internally. If there is acute pain in the bladder, apply leeches over it. Compendium of Domestic Medicine. POWDERED GLASS. Stuff the patient with thick rice pudding, bread, potatoes or any other vegetable, then give him five grains of tartar emetic to vomit him, after which, use milk freely, clysters and fomentations to the belly with the warm bath; leeches, &c. are not to be neg- lected. Sugar of Lead,-Extract of Saturn,- White Lead -Litharge,-Minium. Symptoms. A Sweet astringent taste in the mouth, -constriction of the throat,-pain in the stomach,- bloody vomiting, &c. Remedies. Dissolve a handful of Epsom or Glau- ber salts in a pint of water and give it at once; when it has vomited him, use sweetened water. If the symptoms continue, act as directed for acids. LEAD. Symptoms. Stupor,-an insurmountable inclina- tion to sleep,-delirium,-convulsions, &c. Remedies. Endeavour to excite vomiting by six grains of tartar emetic, or four grains of blue, or thirty of white vitriol. Thrust a feather down the throat for the same purpose. Never give vinegar or other acids, until the poison is altogether or nearly evacu- ated. After't his has taken place, a wine glassful of OPIUM, OR LAUDANUM. Swa'towing Poisons. 151 lemon juice and water may be taken every five minutes, along with a cup of very strong coffee. The coffee, &c. are to be continued until the drowsiness is gone off which, if it continues, and resembles that of apoplexy, must be relieved by bleeding. The patient is to be forcibly kept in constant motion. Remedies. Give the patient immediately, three grains of tartar emetic, twenty-five or thirty of ipe- cacuanha, and an ounce of salts, dissolved in a glass of water, one third to be taken every fifteen minutes until he vomits freely. Then purge with castor oil. If there is great pain in the belly, app'y leeches, blis- ters, &c. MUSHROOMS TOBACCO, HEMLOCK, NIGHT-SHADE, SPURRED RYE. Remedies. An emetic as directed for opium. If the poison has been swallowed some time, purge with castor oil. After vomiting and purging, if the patient seems drowsy, bleed him, and give vinegar and water. Remedies. An emetic. If it has been eaten some time, give castor oil by the mouth and clyster. After these have operated, twenty drops of ether may be taken on a lump of sugar; vinegar and water as be- fo«r mentioned. POISONOUS FISH. FOREIGN BODIES IN THE THROAT. Persons are frequently in danger of suffocation from fish bones, pins, &c. which stick in the throat. The moment an accident of this kind occurs, desire the patient to be perfectly still, open his mouth and look into it. If you can see the obstruction, endea- vour to seize it with your finger and thumb, or a long 152 slender pair of pincers. If it cannot be got up, or is not of a nature to do any injury in the stomach, push it down with the handle of a spoon or a flexible round piece of whale-bone, the end of which is neatly ' wered with a roll of linen, or any thing that may be at hand.* If you can neither get it up nor down, place six grains of tartar emetic in the patient's mouth. As it dissolves, it will make him excessively sick, and in consequence of the relaxation, the bone, or what- ever it may be, will descend into the stomach or be ejected from the mouth. If a pin, button, or other metallic or pointed body has been swallowed (or pushed into the stomach) make the patient eat plentifully of thick rice pudding, and endeavour to prevent him from going to stool for at least twelve hours. Compendium of Domestic Medicine. There are three kinds of remedies employed in ac- cidents of this nature. Cooling applications, such as pounded ice,-snow,-vinegar,-cold water,-lead- water, &c. Stimulants, as warm spirits of turpen- tine,-brandy, or any ardent spirits, and carded or raw cotton. Any one of these articles that happens to be nearest at hand, may be tried, although the preference is due to the turpentine or spirits, which being made as hot as the patient can bear it, is to be applied to all the burned surface (so as not to touch the adjoining sound skin) until some common basilicon ointment can be thinned with spirits of turpentine, to the consistence of cream, in which state it is to be spread on a linen rag and laid over the part, taking care, as before, not to let it touch the sound skin. OF BURNS AND SCALDS. * The small end of a common riding whip answers very well. Burns and Scalds. 153 If, however, (the rule is general) this plan causes great pain and inflammation, it must be abandoned, and one of the others be resorted to, as the pounded ice, which can be readily applied in a bladder. Equal parts of lime water and linseed oil well mixed, forms one of the most soothing of all applications. Should much fever prevail, it is to be reduced by bleeding, purging, &c. but if on the contrary, the sys- *em seems to sink, wine, bark, &c. must be employed. From what has already been stated, it is evident that in treating wounds, &c. as well as diseases, one great and important indication is to repress excessive inflammation, which, if allowed to proceed to a cer- tain point, sometimes produces mortification or the death of the parts. Whenever, therefore, from the violence of the fever, heat, pain, redness and swelling, you are fear- ful of its ending in this way, apply ice bags or cloths dipped in cold water over the part. If, how- ever, the fever and pain suddenly cease, if the part which before was red, swollen and hard, becomes purple and soft, abandon at once all reducing mea- sures, apply warmth over the whole of the parts, and give wine, porter, bark, &c., freely and with- out delay. If the warmth does not put a stop to the disease, and the parts become dead and offensive, cover them with a charcoal or fermenting poultice until nature separates the dead parts from the living, during which process a generous diet, bark, &c., must be allowed. There is a particular kind of mortification which comes of itself, or without any apparent cause. It attacks the small toes of old people, and commences in a small bluish or black spot, which spreads to dif- ferent parts of the foot. To remedy it, place a blister over the vpot, and give two grains of opium night and OF MORTIFICATION. 154 Compendium of Domestic Medicine. morning; taking care to keep the bowels open by- castor oil, and to diminish the quantity of the opium if it occasions any unpleasant effects. In extensive mortifications of the fore-arm, it is necessary to amputate. This, however, should never be done, until by the repeated application of blisters to the sound parts adjoining the mortified ones, they are disposed to separate, which may be easily known by inspection. Tie up the arm, placing the bandage at least two inches above the projections of the elbow joint, and then feel for the pulse at the wrist. If it is stopped, the bandage is too tight, and must be relaxed. Select the most prominent vein, and feel with the tip of your finger if an artery lies near it. If you feel one pulsating so close to the vein that you are fearful of wounding it, choose another. Having set your lan- cet (of course a spring lancet), bend the arm to the precise position it is to keep while the blood flows. Now place the cutting edge of the lancet on the vein, while you depress the handle or frame just as much as you wish the cut to be deep; bv touching the spring on the side with your thumb the business is dene. To stop the bleeding, relax the bandage, press the two edges of the wound together, place a little com- press of linen on it, and bind up the whole with a bandage passing round the joint in a figure of eight. DIRECTIONS FOR BLEEDING. DIRECTIONS FOR PASSING CATHETERS. Take the penis of the patient near its head be- tween the finger and thumb of your left hand (stand- ing beside him), while with your right you introduce VEINS OF THE ARM. Directions for Passing Catheters. 155 the point of the instrument into the urinary passage, its convex side towards his knees; while you push the catheter down the urethra, endeavour at the same time to draw up the penis on it. When you first introduce it, the handle will of course be near the belly of the patient, and as it descends will be thrown farther from it, until it enters the bladder which will be known by the flow of the urine. If you cannot succeed while the patient is on his back, make him stand up, or place hiir. with his shoulders and back on the ground, while his thighs and legs are held up by assistants. If still foiled, place him again on his back, and when you have got the cathe- ter as far down as it will go, introduce the forefinger, well oiled, into the fundament, and endeavour to push its point upwards, while you still press it for- ward with the other hand. Force is never, or. any account, to be used. Vary your position as often as you please, let the patient try it himself, but always remember it is by humouring the instrument, and not by violence, that you can succeed. DIRECTIONS FOR PASSING BOUGIES. Take the penis between your finger and thumb, and pass the point of the instrument (which should be well oiled) down the urethra as directed for the catheter; when it has entered three or four inches, depress the penis a little, and by humouring the bou- gie with one hand and the penis with the other, en- deavour to pass it as far as may be wished. The patient himself will frequently succeed, when ever} one else fails. 156 Compendium of Domestic Medicine. CHAPTER IV. Prescription* referred to in the preceding pages. No. 1. Saline Mixture. R.* Salts of Tartar, 1 drachm,-Water, 4 ounces,-Essence of Peppermint, 3 drops. When the salt is dissolved, add very gradu- ally lemon juice or vinegar, 1 ounce, or till the effervescence ceases. To be taKen every hour. No. 2. R. Sulphate of Quinine, 13 grains,-Gum A-abic powdered, 1 drachm,-Loaf Sugar, J an oun?e,-Water, 6 ounces,-Essence of Peppermint, 5 drops. A table spoonful every hour, shaking the bottle well before it is poured out. No. 3. R. Calomel, 6 grains,-Antimonial Pow ders, 3 grains. To be taken every three hours. No. 4. Effervescing Mixture. R. Salt of Tartar, 20 grains,-Water, 2 ounces,-Essence of Pepper- mint, 2 drops. When the salt is dissolved, add a table spoonful of lemon juice, or good vinegar, and swallow it immediately. No. 5. K Chalk Mixture, 4 ounces,-Tincture'of Kino, 1 drachm,-Lavender Compound, 1 drachm,- Laudanum, 30 drops. A table spoonful every two or three hours, as may be required. No. 6. R. Cayenne Pepper, 6 ounces,-Common Salt, 4 drachms,-Boiling Water, 1J pints,- Boiling Vinegar, pints. Let it remain in a close vessel for an hour, then strain it through a fine linen cloth. * R. stands for Recipe or "Take." The weights used in these Prescriptions are troy or apothecary's -not avoirdupois weight. Prescriptions. 157 Take a table spoonful every hour or two, according ;o circumstances. No. 7. R. Musk, 1 drachm,-Gum Arabic pow- dered, 1 drachm,-Loaf Sugar, 1 drachm,-Water, 6 ounces. Rub up tne musk with th" sugar, then add the gum and pour on the water ve,y gradually, so as to incorporate the whole. Take a table spoonful every two hours. No. 8. R. Camphor, 30 grains,-Almonds blanch- ed, 2 drachms,-Loaf Sugar, 1J drachms,-Pepper- mint Water, 6 ounces. Moisten the camphor with'a few drops of spirits of wine, and reduce it to powder. The almonds and sugar having been beat to a paste, add the camphor, and pour on the water gradually, rubbing the whole well together. Take a table spoonful every two or three hours. No. 9. R. Sugar of Lead, 5 grains,-White Vit- riol, 2 grains,-Laudanum, 2 drachms,-*-Rose Water, 6 ounces. Or, Wine of Opium, J an ounce,-Wa- ter, 2 ounces.--Or, Alum, j a drachm,-Rose Wa- ter, 6 ounces. To bathe the eye frequently. No. 10. R. Barley Water, \ a pint,-Vinegar, 1A ounces. Or, Alum, 1 drachm,-Rice Water, 1A pints,-Honey, 1 ounce. Or, Vinegar, 2 ounces', -Water, 1 pint. To gargle the throat. No. 11. R. Barley or Rice Water, J a pint,- Tincture of Myrrh, A an ounce,-Muriatic Acid, A a drachm. Or, Sharp Vinegar, 1 ounce. Gargle the throat frequently. No. 12. Wine or Vinegar whey. R. Place a sauce pan containing a pint of new milk, on the fire, and while it is boiling add one gill of while wine of half the quantity of good vinegar. As soon as the milk is turned, take it off strain the whey through a cloth and sweeten it to your taste. No. 13. R. Paregoric, A an ounce,-Syrup of Squills, 1 ounce,-Antimonial Wine, 2 drachms,- Water, 6 ounces. Take two tea spoonsful every fif teen minutes, until the cough is relieved. No. 14. R. The White of 1 Egg,-Castor Oil, 2 Compendium of Domestic Medicine. 158 ounces,-Lavender Compound, 2 drachms,-Sugar. A an ounce,-Water, 4 ounces. Incor(>orate the oil and the white of the egg, by shaking in a bottle, then add the water containing the sugar and lavender. Half may be taken at once, and the other half in a few hours, or a table spoonful hourly until it operates. No. 15. R. Chalk Mixture, 4 ounces,-Tincture of Kino, 1 drachm,-Cinnamon Water, 2 ounces,- Laudanum, A a drachm. A table spoonful every two hours, or oftener if necessary. No. 16. R. Tincture of Catechu, 2 ounces. Take two tea spoonsful in a little port wine, every hour, or oftener if required. No. 17. R. Extract of Logwood, 20 grains,-Cin- namon Water, 2 ounces,-Tincture of Kino. 1 drachm, -Sugar, 2 drachms. To be taken at once. No. 18. R. Prepared Chalk, 2 drachms,-Loaf Sugar, 1 drachan. Rub them well together, and add gradually of mucilage of Gum Arabic, 1 ounce,- Water, 6 ounces,-Lavender Compound, 2 drachms, -Laudanum, 30 drops. A table spoonful every hour or oftener if necessary. No. 19. R Calomel, 10 grains,-Jalap, 12 grains, -Opium, 1J grains,-Tartar Emetic, J a grain,-Oil of Aniseed, 1 drop. Make the whole into a mass with conserve of roses, and divide it into five or six pills, all of which are to be taken at once. No. 20. R. Socotrine Aloes, 1 ounce,-Liquorice, 2 ounces,-Coriander Seeds, J an ounce. Digest the aloes'anl liquorice in 1 pint of brandy fora week, shaking the luittle frequently, and add half a pint of a very strong decoction of Carolina Pink Root. Dose, two table spoonsful every morning, fasting. No. 21. R. Powder of the root of the Male Fem, 1 drachm. This is to be taken in molasses early in the morning, and for two days in succession, to be followed with some very active purgative. No. 22. R. Powder of Tin, 1 drachm,-Molasses as much as will envelope it. Repeat the dose morning and evening for three days, and then take some acti ve Pr escriptions. 159 purgative. Or, Bark of the fresh root of Pride of China, 5 ounce:,-Water, 2 pints. Boil it in a close vessel to one piiu Dose, a table spoonful every two hours till it operates. -Or, Bark of the Cabbage- tree, 1 ounce,-Water, 2 pints. Boil to one pint and strain. Dose, a wine glassful or about two ounces. No. 23. R. Mucilage of Gum Arabic, 1J ounces,- Olive Oil, 2 drachms. Mix them well, and add Ether i drachm,-Laudanum, 20 drops. Take at once. No. 24. R. Peruvian Bark, 20 grains,-Uva Ursi 20 grains.-Opium, J a grain. Make a powder, to be taken three times a day with lime water. No. 25. R. Compound Tincture of Senna, 1 ounce -Compound Tincture of Jalap, 2 drachms. No. 26. R. Calomel, 10 grains,-Jalap, 15 grains, -Oil of Aniseed, 2 drops. To be taken in molasses. No. 27. R. Compound Tincture of Senna, 1 ounce, -Wine of Aloes, 2 ounces,-Simple Syrup, 1 ounce, -Water, 4 ounces,-Oil of Mint, 2 drops. A table spoonful from time to time, as may be necessary. No. 28. R. Muriate of Ammonia, J an ounce,- Vinegar, 2 ounces,-Proof Spirits, Bounces,-Water, 3 ounces. Mix them lor a wash. No. 29. Scudamore's Lotion for Gout. R. Alcohol, 3 ounces,-Camphor Mixture, 9 ounces. Render the whole milk warm, by adding boiling water. No. 30. R. Water of Ammonia, 2 drachms,-Olive Oil, 1A ounces,-Laudanum, J an ounce. Shake well. No. 31. R. Opium in fine powder, 2J drachms,- Soap Liniment, 2 ounces,-Spirits of Camphor, 2 ounces. Pour the liniment gradually on the opium rub well together, and add the spirits of camphor. No. 32. R. Sulphate of Quinine, 8 grains,-Syrup of Rhubarb, 2J ounces,-Orange flower Water, 2.| ounces,-Sulphuric Ether, 10 drops. No. 33. R. Muriated Tincture of Iron, 2 ounces. Take twenty drops three times a day, in a wine glass of the cold infusion of bark. Or, Extract of Bark 1 drachm.-Extract of Gentian, 1 drachm,-Greer Vitriol, a drachm.-Myrrh, 1 drachm,-Oil of Ani- 160 Compendium of Domestic Medicine. seed, 10 drops,-Simple Syrup sufficient to make the whole into a mass, to be divided into sixty pills, of which take three twice a day. Or, Rust of Iron, 1 drachm,-Conserve of Roses, as much as will make a mass, to be divided into sixty pills, of which take two, three times a day. No. 34. R. Calomel, J, a drachm,-Tartar Emetic, 15 grains,-Opium, J a drachm. Add syrup sufficient to form a smooth mass, and divide it into sixty pills. Yeast Poultice. R. Into an infusion of malt or beer, stir as much oatmeal as will make it of a proper thickness, and then add a few spoonsful of yeast. Charcoal Poultice. R. To halfa pound of common rye mush, add two table spoonsful of finely powdered fresh made charcoal, and stir them well together. Rye Meal Poultice. R. This is made precisely like rye mush, care being taken to have it very smooth. Emollient Clyster. R. Thin Starch, 1 pint,-Mo- lasses, 1 wine glassful. Or, Molasses, and Sweet Oil, each 1 wine glassful,-Warm Barley Water, 1 pint. Or, Flaxseed Tea, 1 pint,-Milk, }2 a pint. Anodyne Clyster. R. This is formed by adding 40 50, 60, or more drops of laudanum (as occasion may require) to the Emollient Clyster. Purgative Clyster. R. Table Salt and Brown Sugar, each a table spoonful, add half a gill of Mo- lasses, and rub them well together. While you are stirring them, gradually pour in two ounces of Castor Oil, and a pint of warm Water. Tobacco Clyster. R. Infuse 1 dractim of Tobacco in a pint of boiling water for ten minutes. The one naif to be injected first, and if this will not produce the wished for effect in half an hour, throw up the remainder. Hartshorne's decoction of Spanish Flies in Spirits of Turpentine. R. Spanish Flies bruised, 1 ounce, -Spirits of Turpentine, J a pint. Boil for three hours and strain. PART SECOND EPIDEMIC CHOLERA: CAUSES, PREVENTION, SYMPTOMS AND TREATMENT OF EPIDEMIC CHOLERA. DYSPEPSIA, OR INDIGESTION: CAUSES, PREVENTION, SYMPTOMS AND TREATMENT OF DYSPEPSIA, OR INDIGESTION. S1CK-HEADACH: CAUSES, CURE AND PREVENTION OF SICK-HEADACH. THE TEETH: STRUCTURE, FORMATION, DISEASES AND TREATMENT OF THE HUMAN TEETH. 161 ASIATIC, OR EPIDEMIC CHOLERA. As an epidemic, Cholera first made its appearance m Bengal during the month of August 1817. Since that period it has continued to prevail, with scarcely any intermission, up to the present time, spreading itself over nearly the whole of India and the rest of Asia, over a part of Africa, and over a considerable portion of Europe. In 1832 it broke out in the Canadas, and visited successively nearly all the larger cities of the United States. By this terrible epidemic, provinces have been ravaged, and districts depopulated; entire garrisons have been destroyed, and victorious armies arrested in their triumphant progress. Under every point of view Epidemic Cholera claims the attention of every individual, and of every community. Though attended with the most violent symptoms, extremely rapid in its progress, and in relation to the real cause by which it is pro- duced, shrouded in the most impenetrable mystery; yet there are few diseases an attack of which can be so readily and certainly guarded against-while no one is so completely under the control of medicine during its first stages 163 164 Compendium of Domestic Medicine CAUSES. Cholera, like all other epidemics, is evidently dependent upon a morbid change in the condition of the atmosphere. What is the actual nature of this change it is impossible to ascertain. Bv some it is referred to irregularities in the electrical slate of the air; others have presumed that the air be- comes loaded with poisonous effluvia emitted from the earth; while others restrict its cause to a change in the sensible properties of the atmosphere, in other words, to unusual coldness, heat, moisture or dryness •-or to rapid and sudden transitions in these particu- lars. It is certain, that in most places where the cholera has appeared, it has been preceded or accom- panied by violent storms or earthquakes, or by sea- sons unusually disturbed. That the disease is in no degree contagious, that it is not capable of being communicated from the sick to the well, is now established by so many posi- tive facts, that it appears unnecessary to enter here into an examination of this point. Its non-contagious- ness is proved by the disease appearing, at the same time, at points far distant from each other; while in situations intermediate between these not a single case will occur. Physicians, nurses, and attendants upon the sick, are not more affected by the disease than other classes of persons, nor even in as great a proportion; and individuals who were in hos- pitals with other diseases, and were seized with cholera, did not communicate the disease to the other patients in their immediate vicinity. 1st. A vitiated and damp state of the atmosphere. Cholera has always prevailed most extensively and produced the greatest ravages, in those situations ordi- narily the most unhealthy, particularly in the vicinity Predisposing and Exciting Causes. Asiatic, or Epidemic Cholera. 165 of low, wet, and marshy districts-along the low, muddy banks of rivers; in crowded towns and villa- ges, and in the hovels of the poor, where a proper ventilation is neglected, and in which all kinds ol filth are allowed to accumulate. 2d. A constitution broken down by misery, vice, intemperance or fatigue. In every place where Cholera has made its appearance, the great majority of those attacked have been individuals of the lowest classes of the community; those living in the depths of vice and misery; the habitually intemperate; those who were constantly exposed to fatigue, and to the inclemencies of the weather; and those who, from extreme poverty, are obliged to subsist on unwhole- some food, or such as is deficient in nutriment. But few persons in easy circumstances and of temperate lives have been attacked; and in those few, the oc- currence of the disease could very generally be traced either to fatigue, to exposure to wet or damp or to the night air, to fear and anxiety, to improper food, as that which is too stimulating, difficult of digestion or flatulent, to fasting too long, to a consti- tution broken down by disease or a slate of conva- lescency particularly from stomachic and bowel complaints, to the use of impure water, of cold and iced fluidsorof iced creamswhen thebodyisin astate ofijatigue, or overheated.to indulgence in acid drinks, or those w hich readily become sour in the stomach, as the weaker wines, table beer, cider, &c., to the imprudent use of medicine, especially emetics and purgatives, or to prolonged watchfulness To avoid Cholera, therefore, an individual must live temperately on plain, nutritive food, simply cooked. He must avoid rich, high-seasoned soups and sauces, all made dishes and pastry; of salted provisions he must partake in great moderation, PREVENTION. 166 Compendium of Domestic Medicine. salted, dried, and smoked fish he must abstain from, as also pork, geese, ducks, crabs, lobsters, and the like. He must avoid all flatulent vegetables, as cabbages, radishes, green corn, dried peas and beans or those difficult of digestion, as mashed potatoes, cucumbers melons, mushrooms, pickles, &c. and likewise all unripe, decayed, or very acid fruit. He must give up entirely the use of ardent spirits, bran- died wines, &c. as ordinary drinks: indeed, as a general rule, pure water should be his sole beverage. Active regular exercise in a free pure air, not carried so far as to induce fatigue; regular and sufficient sleep; the avoidance of crowded assemblies, of the night air, of wet or damp, or extreme heat, or of ex- posure to cold, without due precaution, are other means essential to be observed, in order to escape an attack of Cholera. Personal cleanliness, and all the other means cal- culated to insure the due performance of the functions of the skin, are likewise all important preventives; hence the use of the warm bath daily, or sponging the entire surface with tepid water, followed by brisk frictions, morning and evening, and a flannel or thick cotton garment next the skin, should never be neg- lected. The possession of that species of moral courage which is intimately connected with a well informed mind ; a reliance upon the goodness and superin- tending providence of the Supreme Being; and a consciousness of having fulfilled, to the utmost of our abilities, our religious as well as social duties (which, while they prompt us to avoid danger by the use of all practicable and rational means, pre- vent all unnecessary terror and alarm when the evil is present), have a powerful influence in guard- ing the system against disease during the prevalence of every epidemic. The necessity of comfortable, clean and well ven- tilated dwellings, situated in a dry, elevated and otherwise healthy situation, must be sufficiently Asiatic, or Epidemic Cholera. 167 evident to all. When, however, an individual is under the necessity of residing in a low, damp, unhealthy situation, much may still be done to pre- vent disease, by a proper attention to ventilation, during fine weather; by strict cleanliness; by closing tti? doors and shutters before night fall; by occupy ing the upper rooms of the house, and, in very damp weather, by fires in the apartments where the family pass the day, and in the bed-chamber. SYMPTOMS. Epidemic Cholera, in regard to its symptoms, may be divided into four stages or periods. 1. The Stage of Diarrhcea. This stage is usually accompanied with griping pains in the stomach and bowels; by a sense of lassi, tude; rumbling of wind in the bowels; frequently, pain and giddiness of the head, and dull pains in the knees and loins. The pulse is various; the tongue is coated with a thin white oryellowish mucus,or thickly furred in the centre and red at the edges. The appe- tite is diminished ; and the thirst increased. There are often shooting pains or stitches through the calves oi the legs. The foregoing symptoms are most usually attended with nausea, with frequent watery dis- charges from the bowels, or with a constant inclina- tion to go to stool without any evacuation taking place, or with only a thin mucous discharge some- times streaked with blood. This stage may last for several days before the symptoms of the ensuing developed; in many cases the symptoms of the latter appear in a few hours. The occurrence of the second and subsequent stages depends greatly upon the constitution and habits of the patient, as well as upon the circumstance of his having, or r.ot. resorted to proper medical aid. In the debilitated and especially the intemperate, the discharges from 168 the bowels are not unfrequently from the first very copious, of the appearance of whey, and giving rise to a sense of extreme exhaustion, ot faintness or even fainting In such cases, in a very few hours, cramps, vomiting and collapse are apt to come on; any im- prudence in eating or drinking, improper exposure, tec. will also accelerate the occurrence of the second and subsequent stages of the disease Compendium of Domestic Medicine. 2. The Stage of Spasm. This stage is characterized by violent pains of the stomach and bowels occurring at intervals; by pain of the head and back; by almost incessant vomiting and purging of a rice-water fluid ; by inordinate thirst and violent spasms, particularly of the muscles of the ex- tremities. The skin still remains warm, but is bathed with perspiration, and has a peculiar doughy feel; the tongue presents nearly the same appearance as in the first stage; the temperature of the hands and feet is reduced; the pulse isoften full and of some firmness ; in other cases it is very compressible; or again, it is small and contracted. The mental faculties are un- impaired ; the countenance is expressive of great suffering or distress. In this stage the secretion of urine is often diminished in quantity or entirely sus- pended. 3. The Stage of Commencing Collapse. In this stage the skin is cold, livid and covered with a profuse clammy perspiration; the tongue is also cold and livid; and the extremities corrugated as if they had been soaked in water; there are frequent crampsof the extremities; the eyes aresimk, the features contracted; there is constant purging, occasionally accompanied with vomiting; there is pain of the stomach, a small, feeble and depressed pulse, and a complete suppress- ion of the urinary secretion. The mental faculties are stib unimpaired. Often considerable heat is felt over the stomach. Great thirst and a constant desire for cool air are almost invariably present. Asiatic, or Epidemic Cholera. 169 4. The Stage of Confirmed Collapse. This stage is marked by icy coldness, and a deep blue or purple hue of the skin, tongue and inside of the mouth; the extremities are corrugated; the whole sur- face is covered with a profuse cold perspiration, which seems to exude in large drops from the pores of the skin. No pulsation can be detected in any of the su- perficial arteries, and the action of the heart is slow and feeble. Involuntary watery discharges flow from the bowels. The voice is low, husky, and almost extinct. The body exhales a peculiar and very dis- agreeable odour. There is a short quick respiration, with heaving of the chest. The patient complains of a burning heat in the region of the stomach, and craves without intermission cold water and fresh air; he is extremely restless, or doses with half open eyelids, the pupils of the eyes being rolled very much up wards. Until the very end, the mental faculties continue unimpaired. The treatment of Cholera differs according to the stage of the disease. 1. In the frst stage, when the patient is young and robust, the skin dry, the pulse frequent ana hard, and the griping pains in the bowels constant or severe; a large mustard plaster over the abdomen, and another on the back, will be found of great service. Bathing the feet in warm water, also the applica- tion of frictions to the whole of the lower extrem- ities, or mustard poultices to the ankles, will also be decidedly beneficial. When the diarrhoea is but trifling, a dose of cam- phor with a few drops of laudanum should be given, and repeated if necessary. If the discharges from the bowels are very co- pious, and of a thin-, watery and unnatural appear- ance, a pill of camphor, rhei and opium, repeated at TREATMENT. 170 Compendium of Domestic Medicine. proper intervals, will often be found very speedily to arrest these discharges, and after a time to pro- cure the evacuation of a very dark, viscid and offensive matter, followed by natural stools. When the griping and constant inclination to stool are peculiarly troublesome, place lumps of ice continually on the tongue, and an injection of thin starch, olive oil and opium will often remove very speedily the disease. The warm bath is a remedy well adapted to this stage when properly managed. Attention to diet and clothing is all-important. The patient should be confined exclusively to gum or rice water taken cold and in small quantities at a time; even after the symptoms of the disease have disappeared, the diet should consist for sev- eral days of well boiled oat meal gruel, thickened milk, or crackers boiled in milk. A very slight impropriety in diet will often bring back the very worst symptoms of the complaint, and render a cure impossible. 2. When Cholera has reached its second stage, there is not a moment to be lost-the least delay on the part of the patient, or timidity in the prac- titioner will be followed by the most fatal conse- quences. Give the patient every five minutes a dose of the following anodyne and cordial tinc- ture: Take of aromatic spirits of ammonia, lau- danum, chloroform and spirits of camphor 1J fluid drachms, creosote 8 drops, oil of cinnamon 2 drops, alcohol enough to make 1 oz. of the tinc- ture. Put a tea-spoonful of this in a wine-glass of ice water, and give one tea spoonful of the so- lution every five minutes until the patient decid- edly improves, then lengthen the intervals of doses till the symptoms all abate. This treat- ment, the result of much experience during the Asiatic, or Epidemic Cholera. 171 visitation of the cholera in 1849, 1850, and 1854, has been found very successful. The limbs of the patient should then be rubbed well with some stimulating liniment: these fric- tions are to be followed by mustard poultices to the ankles, wrists, thighs and arms. In this stage, particularly at its very commencement, bathing the feet in hot water will frequently be followed by a very good effect. Internally the patient should take iced water in small portions at a time ; or when this is immediately rejected by the stomach, a tea-spoonful of powdered ice may be given every fifteen minutes. After the stomach has become calm and is capable of re- taining medicine, the pill of camphor and opium, as directed in the first stage, should be given, and repeated every two, three or four hours according to circumstances. By this treatment, in a very short period, the vomit- ing and spasms will be suspended, and the inordi- nate discharges from the bowels arrested. In many cases a dose of castor oil will now bring away copious stools of a very dark and extremely offensive nature, after which the bowels will return to their natural condition. It is all important in this stage to prevent the patient from drinking too much; which, in conse- quence of his inordinate thirst, he will be very apt to do unless carefully watched. The warm and vapour baths do no good, but rather harm in the se- cond stage of Cholera ; and the most pernicious effects will in general result, if recourse be had to stimu- lants, or to inordinate doses of opium or lauda- num. Occasionally it will be found that there is a ten- dency in this stage to an overloaded state of the vessels of the brain, indicated by drowsiness, dilated pupil, and a dark flushed appearance of the coun- tenance ; here, cups to the temples or back of the 172 neck, with cold applications to the scalp, should never be neglected. 3. When Cholera has reached its third stage, to save the life of the patient will demand great cir- cumspection, judgment, and decision on the part of the physician and attendants. The entire sur- face of the patient should be diligently rubbed either with the hand, or a flannel cloth, wet with a liniment composed of equal parts of spirits of turpentine and a solution of pure ammonia: after the frictions, large mustard poultices should be applied to the arms, wrists, thighs and ankles; and the feet should be enveloped in bags filled with warm bran or sand, and the whole body covered with a blanket. By the treatment just detailed, the reduction of the symptoms is produced gradually : first there is a cessation of the profuse perspiration ; the fea- tures then become more natural, the corrugation of the extremities disappears, and finally the livid colour of the skin is removed and the natural tem- perature of this part is restored. Throughout the third stage of Cholera the pa- tient should be supplied, at short intervals, with small quantities of powdered ice or of iced water. Even greater caution than in the second stage, will be required to prevent him from indulging his inordinate thirst; to guard him against the use of stimulants, and the too free administration of opiates. In the early period of this stage all kinds of food are to be abstained from: when conva lescence has been established, the same remarks in regard to diet will apply as were made in refer- ence to the first stage. Compendium of Domestic Medicine. 4. When the period of confirmed collapse has arrived, little hopes of recovery need be enter- tained. The patient should be carefully rubbed over the whole body with ice, then dried and wrapped in dry blankets outside of which bags filled with warm bran or bottles of hot water may be applied, and internally give champagne and ice, or rum and Selters water, or one gr. camphor every | hour, or spirits of hartshorn one drachm in 6 oz. sugar water, a table-spoonful every | to $ hour. Also rub the body with spirits of mustard, and for the cramps in the calves of the legs rub them with chloroform and camphor spirits. As soon as reaction takes place and has been fully established, the treatment should be con- ducted as in the other stages. In the period of reaction let the patient sleep and perspire freely, and continue giving him Selters water and ice. To arrest the discharges from the bowels, give i gr. calomel every 3 hours with or without opium ; if vomiting should take place, give small doses of morphium 1-15 gr.,-and a mustard plaster over the stomach; if there is a tendency of con- gestion to the head, apply cold iced cloths or leeches. After recovery, the patient must natu- rally be very careful for a long time with his diet. Asiatic, or Epidemic Cholera. 173 174 Compendium of Domestic Medicine. DYSPEPSIA, OR INDIGESTION. There are few complaints more prevalent, parti- cularly among sedentary mechanics and artizans, students and professional men generally, as well as among the indolent and luxurious inhabitants of all large and wealthy cities, than those which have their origin in the stomach and the other organs con- cerned in digestion. The stomach and intestinal canal, parts of a most delicate structure and possessed of an exquisite sensibility, are not only hourly subject to injury from improper food and drinks,or an excess- ive indulgence of the appetite in a diet, which, if taken in moderation, would be altogether whole- some ; but, by the close sympathy which exists be- tween these and all the other organs, they quickly participate in the diseases of other and remote parts. Whether it be the brain, the lungs or the skin which suffers, the stomach cannot remain long in health. Hence, Indigestion is an attendant upon nearly every malady, both acute and chronic, to which the human body is liable. The symptoms of pain and uneasi- ness in the region of the stomach are often indeed the first which direct the attention of the patient to his real condition. On the other hand, the extensive sympathies of the stomach cause the diseases which may originate primarily in the latter to be extended quickly to the liver, bowels, brain, skin and lungs It is this that renders indigestion so complicated and protean a disease-differing in its phenomena accord- ing to the period that it has existed and the constitu- tion, age and sex of the patient in whom it occurs. Dyspepsia, or Indigestion. 175 The causes of Dyspepsia are of two classes. First, those which affect primarily the stomach; and se- condly, those which disorder first some other organ, the stomach being affected secondarily or by sym pathy. Of the causes which affect directly the stomach, the principal are errors in eating and drinking Overfeeding, the use of too rich and stimulating food, of articles difficult of digestion, as fried meats, made dishes, gravies, clams, lobsters, fried oysters, rich soups, fresh bread, and pastry of all kinds; late and heavy suppers, eating rapidly without properly chewing the food, the excessive use of strong tea and coffee, the use of flatulent and indigestible vegeta- bles and fruits, as cabbage, green corn, pickles, cucumbers, melons and the like, and the abuse of spices, are so many causes of injury to the digestive organs, and which, sooner or later, give rise to the train of symptoms characteristic of Dyspepsia. Ex- ercise immediately after eating, or intense occupation or violent excitement of the mind, if constantly or repeatedly indulged in, by impeding the change of the food into chyme, and allowing it to ferment or become acrid, will always, sooner or later, induce Dyspepsia. All drinks excepting water, used as ordinary beverage, whether fermenteu or distilled, malt, vinous or spirituous, disorder the digestive or- gans, and give rise to the very worst kinds of dyspepsia. The tippler as well as the drunkard are almost invariably dyspeptic. Even lemonade, if drank in too great quantities or too frequently, will disorder invariably the stomach. Smoking, chewing CAUSES. 176 and even constant snuffing, very generally produce Dyspepsia, as well by the waste and vitiation of the saliva, as by the narcotic or depressing effect which the tobacco produces upon the nervous system gene- rally, or immediately upon the stomach. When, by any of these causes, the coals of the stomach are rendered morbidly irritable and its vital powers are impaired, the use of even the ordinary articles of food will be a sufficient stimulus to increase the disease, and develope the more aggravated phe- nomena of Dyspepsia. A cause of Indigestion which acts primarily upon the stomach and bowels, of not unfrequent occurrence, though but little suspected, is the imprudent or immoderate use of various medicines. Any indiscretion-whether it consist in excessive in- dulgence in food, an occasional debauch or a too heavy supper-will give rise to certain symptoms termed in popular language bilious. Now the most prudent course would be abstinence for a day or two with the plentiful use of some bland diluent. But instead of this, resource is had to an emetic, to a dose of calomel or anti-bilious pills, followed perhaps by chamomile tea, orsome aromatic tincture or stomachic bitter, or perchance a daily glass of brandy and water; and the slight irritation which exists in the stomach is in this manner not only aggravated but rendered permanent, and Dyspepsia ensues. Of the causes which act indirectly upon the stomach in the production of Dyspepsia, the principal are, the want of sufficient active exercise; exposure to a damp, vitiated and confined atmosphere; seden- tary and constrained positions of the body long in dulged in; close application or anxiety of the mind, together with all the exciting and depressing passions; late rising and prolongation of the occupations or amusements of the day during the greater part of the night; want of cleanliness, or rather inattention to the state of the skin; frequent vicissitudes of the weather; cold and damp; and a neglect to obey the Compendium of Domestic Medicine. Dyspepsia, or Indigestion. 177 regular calls of nature for the evacuation of the bowels-excessive indulgence in venereal pleasures and various unnatural practices. In casting the eye over the above list of causes, the reason will be readily understood why Dyspepsia is of so frequent occurrence among nearly all the classes which compose the population of a large city. The sedentary artizan confined for the greater part of the day and night to a small, close, and often dirty and crowded workshop, his body bent constantly over his task, while his mind perhaps is harass- ed by the anxious thoughts occasioned by the wants of a numerous family immersed in poverty, or the painful reflections to which a view of his own folly may have given birth-The slave of luxury or of pleasure, whose whole existence is spent in listless apathy or in a round of dissipation, who consumes the night amid scenes of riot or of folly, and the morning in unrefreshing slumbers or in entire in- dolence-The industrious mechanic and shop-keep- er, whose minds are absorbed by the cares of exis- tence and their bodies imprisoned within the narrow confines of their respective shops-The enterprising merchant, the ambitious student, the aspiring poli- tician, the man of letters and the members of the various professions, who, in addition to their seden- tary habits, have a thousand causes to vex and agitate their minds, and too often -add to these, errors in diet and indulgence in intoxicating drinks-Finally, the numerous slaves of vice and sensuality pro- duced by the folly, and nurtured by the wealth of every prosperous and crowded city: These all con stitute so many victims to Indigestion, as well as to numerous other diseases. Those most exempt from diseases of the stomach are individuals of temperate habits and. contented minds, whose inclinations or whose occupations carry them abroad into the open air and impose a necessity for active and regular bodily exercise. The emplovments most friendly to health of stomach 178 and of the body generally, are those of the farmer, and the gardener, who at the same time adhere to regular hours and sober habits, and are removed at once from the deteriorated and unwholesome atmos- phere and follies of the city, and the thousand sources of care and anxiety to which its inhabitants are daily subjected. Compendium of Domestic Medicine. SYMPTOMS. The symptoms of Dyspepsia are very numerous and diversified-they differ according as the disease is confined to the stomach and bowels, or has ex- tended to the liver, the brain, the skin, the lungs and other organs. The phenomena by which the disease is most usually accompanied, are a sense of disten- sion or oppression after eating, acrid or sour eructa- tions, flatulence with frequent belching of wind, impaired appetite, vitiated taste, increased thirst, constipation and uneasiness of the bowels, sometimes looseness, coated tongue especially in the morning, loss of strength, disinclination to exercise, and a general feeling of depression and indescribable weariness. When the bowels are moved, the stools are unnatural, being either green, black or very light. Nausea, headach, vertigo and dimness of vision are very generally experienced, and sometimes bilious vomiting; a burning sensation at the pit of the stomach is not unfrequent; sometimes the patient experiences a violent pain of the stomach which ter- minates by a copious discharge, by the mouth, of an insipid or perhaps intensely acid, colourless fluid of a glairy consistency. Palpitation of the heart likewise often attends; with pain in the pit of the stomach or towards the right side, sallowness of complexion, depression of spirits and irritability of temper. The patient is sleepless at night and drowsy during the day, or his slumbers are disturbed by the most frightful ordistressing dreams. Sometimes the body is Dyspepsia, or Indigestion. 179 extremely emaciated, at others it appears fat or rather bloated. The whole of the foregoing symptoms are not, however, present in every case of Dyspepsia; but under whatever form, and from whatever cause the disease has originated, there is always a conside- rable degree of general languor and debility, and a great susceptibility to atmospherical vicissitudes; exercise, or exertion of any kind soon fatigues; the pulse is weak or morbidly excited, the sleep disturbed, the limbs, especially the feet are cold, or rendered so by slight causes; and a sense of distension and oppression, acid eructations, flatulence, nausea, head- ach, irregular bowels, pain in the pit of the sto- mach, sallowness of the complexion and dryness of the skin are pretty constantly present. Frequently there is a good deal of feverish heat, with flushing of the face, dryness of the mouth, thick coated state of the tonpue, pain on pressure at the pit of the stomach, weakness of the knees, wandering pains of the limbs and body, and a dry scurfy slate of the whole surface. In the more aggravated forms of Dyspepsia there is often constant violent pain in the stomach; frequent vomiting of dark matter, the utmost debility and emaciation of body, and extreme despondency of mind. In others there are cough and expectoration, hectic fever, night sweats, and a wasting diarrhoea. Frequent and dangerous mistakes are often made in relation to the seat and real nature of the disease giving rise to the symptoms of Dyspepsia. The bitter taste in the mouth, nausea, bilious stools and sallow complexion, have led many to ascribe them to a disease of the biliary organ-hence it is not unfre- quent to hear dyspeptic patients complain of being bilious or of suffering from liver complaint. But though in very many cases the biliary secretion is disordered, yet for the most part this is a secon- dary and sympathetic affection, dependent upon the irritation or disease seated in the stomach and upper portion of the intestines, and quickly disappears upon 180 Compendium of Domestic Medicine. the removal of the latter The practice resorted to under the supposition of bilious derangement being the chief cause of the symptoms, is highly pernicious, very generally aggravating and complicating the primary disease. Emetics, frequent doses of calomel and other purgatives, and the various irritating reme- dies so generally employed, always do more or less injury to the already diseased stomach. Other patients, paying attention solely to the sense of exiiaustion, the disinclination to exertion, the want of appetite and the sallowness of the complexion, believe the whole of the symptoms under which they labour to be the result of pure debility. Tonics, stimulants, wine, brandy and porter with rich nour- ishing food are resorted to,but without the least good effect. The disease proceeds onwards even more rapidly than before, and the mistaken patient becomes daily more and more weak. The remedies lie has taken have acted like oil thrown upon fire : instead of removing the debility of the system they have merely increased the irritation of the stomach, and secondarily of the other organs. By others again the symptoms of Dyspepsia are supposed to be nervous; and valerian, ether, musk, assafoetida and bark are profusely administered to relieve them, by strengthening, as it is presumed, the nervous system. It is very certain that many of the symptoms from which dyspeptics very commonly Butler depend upon an affection of the nervous system; but the treatment usually resorted to, in order to remove such affection, is altogether impro- per, it keeps up and aggravates the disease of the stomach by which the nervous affection has been produced. PREVENTION. The prevention of stomachic diseases, including Dyspepsia, will depend upon a cautious avoidance of a, oesophagus; b, stomach ; c, cardiac orifice; d. pylorus: e, small intestine; /, biliary duct; g, pancreatic duct; h, ascending colon; i, transverse colon; j, descending colon; k, rectum. ALIMENTARY CANAL. their remote and exciting causes. Let an individual live upon plain wholesome food, cooked in the simplest manner and eaten in moderation. Let him drink nothing but water, and allow to his meals a sufficient space of time, so that he need not eat with haste, and swallow his food without properly chewing it. Let him shun crowded, ill ventilated apartments, and take a sufficient amount of active exercise in the open air daily. Let him retire to rest at an early hour at night, and rise from his bed with the sun. Let him make no use of tobacco in any form. Let him cultivate an even, contented and cheerful frame of mind, and shun as much as possible every source of engrossing care, and of deep depressing emotions. ' Living wisely," as an old writer justly expresses it, " rather in the shade, than risking his happiness upon the smiles and the whims of fickle menlet him fly from dissipation, folly and vice of every kind, and he will seldom be troubled with Dyspepsia. Dyspepsia, or Indigestion. 181 TREATMENT. The first and most important point in the treat- ment of Dyspepsia is to relinquish whatever cause has laid the foundation for or given rise to the complaint, and which continues to aggravate it. This will of itself often be sufficient, especially in its early stages, to remove entirely the disease. If the patient leads a fashionable life, it will be neces- sary for him to forsake at once the haunts and habits of dissipation; to leave the crowded city, to shun luxurious tables, rich wines, strong drinks and late suppers; to renounce his indolence and late hours; and to return to a simple and rational mode of living, lie must seek pure air, engage in active regular ex- ercise and in pleasing out-door occupations, retire and rise early, make use of a simple moderate diet, and court the society of a few cheerful and intelligent friends. The plodding student must in a great mea- 182 Compendium of Domestic Medicine. sure lay aside his books, and extinguish his midnight lamp; the fagging tradesman and merchant will find it indispensably necessary to seek daily, active exer- cise in a pure air; the tippler and the drunkard must give up their poiations. In short all dyspeptics must exercise for several hours each day out of doors; they must rise early and take a sufficiency of sleep during the night; they must seek cheerful conversation; and carefully and constantly observe a moderate, plain and wholesome diet. Among the articles from which the individual labouring under Indigestion must entirely abstain are to be included all species of very fat, salted, dried, smoked or fried animal food; veal in almost any form, rich soups and sauces, spices, pickles, cucumbers, all flatulent vegetables, particularly cab- bage, mashed potatoes, melons, unripe fruit, also sau- sages, fish, particularly salted fish and that which is fried, fresh bread,hot toast, pastry, fried oysters, crabs and lobsters, animal jellies, tea, coffee, malt liquors, wine, ardent spirits, and tobacco whether in snuffing, chewing or smoking. The dyspeptic should never take so much food at one meal as to cause a feeling of fulness or distension in the stomach; and, except under very particular circumstances, lie should confine himself to three meals a day; the last one to be taken at least two hours before going to bed, and to be very light. The best common beverage for a dyspeptic is pure water, or toast and water. It is a common but very erroneous opinion, that persons with impaired appetites and feeble powers of digestion ought to eat little at a time and often. Such a practice is altogether injurious. By taking food in small portions almost constantly, no time is allowed for the proper digestion of that previously eaten, and the stomach is in this way kept in a constant state of activity and of irritation. In- stead of gaining strength, it becomes more enfeeb- led. As a general rule, subject to very few ex Dyspepsia, or Indigestion. 183 ceptions, no food should be taken in the intervals of the meals. Riding on horseback is a highly beneficial exercise for those labouring under Indigestion; it gives a mo- tion to the abdominal organs, w hich is communicated by no other kind of exercise. Daily walking in the open air must not however be neglected. A combi- nation of these two species of exercise is preferable to either alone; for riding chiefly exercises the abdominal viscera, and walking the limbs and thora- cic organs. Exercise should never be taken imme- diately after a meal, nor carried to the extent of inducing undue fatigue. The feet, chest and abdomen of dyspeptics should be especially guarded from cold. If there is consi- derable torpor of the skin and a feeling of chilliness from slight reductions of temperature, flannel should be worn next the skin, during at least the colder and more changeable months of the year. Woollen stockings and a flannel roller around the abdomen are always important articles of dress to the dyspep- tic. At night, the bed clothes should not be more than are sufficient to keep the body comfortably warm, and a mattrass is always preferable to a feather bed. The following are the principal symptoms which seem to demand relief in Dyspepsia. There are few points of greater importance in the management of Dyspepsia than the proper regu- lation of the bowels. They ought to be fully eva- cuated once in the twenty-four hours. To do this, the habit of soliciting a discharge at a regular period of the day by the natural efforts will often suc- ceed. Habitual costiveness in those inclined to indigestion is often caused by neglecting the calls of nature. If this have not the desired effect, a diet composed of laxative vegetables, as well-boiled spin- 1. Costiveness. 184 Compendium of Domestic Medicine. nage, boiled turnips squeezed perfectly dry, well- boiled oat-meal gruel, chicken or veal broth, or some of the summer fruits, perfectly ripe, eaten raw or after being cooked, will very generally produce a free state of the bowels. Let it be recollected that although the articles of food just enumerated maybe highly improper for the ordinary use of the dyspeptic, yet taken occasionally, merely with a reference to their laxative effects, no harm but much good will result from them. Bran bread or crackers, used con- stantly, will often remove costiveness. If costiveness still continue in conjunction with regular active ex- ercise and early rising, frictions over the whole of the abdomen night and morning should be resorted to. The practice of shampooing, rendered some time since very popular in this city by the announcements and publication of Mr Halsted, will not unfrequently succeed in causing regular evacuations by stool, and obviate the necessity of resorting to medicine. This practice will be detailed hereafter. The use of the warm bath should never be neglected. When me- dicines are demanded, they should be of the most gentle kind and not too long persisted in. A combi nation of magnesia, rhubarb and small portions of ipecacuanha is a very excellent purgative in dyspep- tic cases; so are the seidlitz powders, if not too often repeated. A pill composed of the blue mass, soap, myrrh and ipecacuanha, will be in many cases pro- ductive of the best effects The utmost care must be observed, however, not to produce active purging or any considerable irritation of the bowels, in attempting to relieve costiveness-whatever remedy is used, its effects are merely temporary; a regular state of the bowels can be obtained permanently in no other way than by a proper diet and regimen, in addition to the other means calculated to restore to the digestive organs their healthy tone and functions. Dyspepsia, or Indigestion. 185 2. Flatulence. To remove this unpleasant and troublesome symp tom, strict attention must be paid to diet. Food in any degree irritating, acid or fermentable must be abstained from. Active exercise must be taken in the open air, and frictions over the stomach re- peated several times a day. As a palliative, a glass of water in which a few grains of the bi- carbonate of soda have been dissolved, or perhaps what is better with the addition of a few drops of aqua ammoniac, will often be found useful. There is danger however of increasing the irritation of the stomach when this is too often repeated. The cause of flatulence is the disordered state of the digestive organs; when this is remedied the former will cease. We must caution the dyspeptic against the too cus- tomary practice of resorting in cases of flatulence to mint water and various aromatic tinctures, brandy and water, and similar stimulants: from such remedies the most mischievous effects are to be apprehended. In some cases of Dyspepsia the paroxysms of pain are so intense that for their immediate relief opium must be resorted to; the best form for its administration will be in the form of a powder composed of one grain of opium or one third of a grain of sulphate of morphia with ten grains of magnesia and one of ipecacuanha. The relief obtained in this way, however, is only temporary ; and to repeat too frequently the remedy will be productive of mischief. The calm resulting from opiates in Dyspepsia very often leads to their habitual use; but this never fails to aggravate the disease and render its cure more difficult, if not im- possible. Ten grains of pepsin with three grains of the subnitrate or carbonate of bismuth, taken before each meal, will be found of very great 3. Violent Pain of the Stomach and Bowels. 186 Compendium of Domestic Medicine. benefit in these cases. In very many cases the pain of the stomach will be removed by warm fomentations over the abdomen, and by cups to the region of the stomach or along the spine. 4. Nausea and Vomiting. Nausea and vomiting are often distressing symp toms in cases of Dyspepsia. To relieve them, cold toast water, or a draught of soda water taken in a state of effervescence, will very commonly be found useful remedies, in conjunction with a proper atten- tion to diet. When the vomiting is very distressing, a blister should be applied over the pit of the sto mach. 5. Constant Soreness and Pain of the Stomach. Soreness of the stomach, great tenderness under pressure, or constant pain in that organ, is frequently present in protracted cases of Dyspepsia. It is some- times accompanied with burning of the soles of the feet and palms of the hands, or dryness and heat of the entire surface. In these cases the use of all solid food must be abandoned, the patient being con- fined solely to toast water or gum arabic tea; ice bladders or cloths dipped in cold spring water and wrung out, should be applied without delayover the stomach, and repeated if the symptoms be not removed the first time, or if they recur subsequently. The patient should not in such cases make use of any very active exercise. The pain and tenderness alluded to depend upon a greater or less degree of inflammation seated in the lining membrane of the stomach and upper intestine; which, unless it be promptly removed, may produce a degree of disor anization in these important organs from wliich re covery can scarcely be hoped for. 1, aorta; 2, thoracic canal; 3, lymphatics; 4. radicles of the chyle-vessels; 5, intestine; 6, mesentery; 7, lymphatic vessels. CHYLE-VESSELS OF THE MESENTERY. Dyspepsia, or Indigestion. 187 GENERAL REMEDIES. We have next to consider some general remedies demanded for the cure of Dyspepsia. 1. The Warm Bath and Frictions. So intimately connected are the stomach and skin, that one of these parts can scarcely ever be involved in disease without the other suffering likewise. It is important therefore, in all cases of Indigestion, to promote the health of the external covering of the body-by exciting it to a regular discharge of its functions. This is best effected by the use of tho warm bath and by frictions. When properly used, these means seldom fail to prove highly refreshing, to remove many of the symptoms most distressing to the patient, while they aid greatly in bringing back the digestive organs to a healthy condition. From ninety to ninety-six degrees is the best range of heat of the bath for the use of dyspeptics; and the proper time for resorting to it is in the morning, between breakfast and dinner. The patient may repeat the bath three or four times a week, and remain in it from fifteen to thirty minutes, according to his feel- ings, which ought to be comfortable on coming out of the water. A gentle walk or ride should follow the use of the bath whenever the weather is favour- able. When the warm bath cannot be conveniently procured, or when it fails in producing a beneficial effect, which will seldom however be the case, tepid sponging may be substituted. That is, the whole surface of the body is to be sponged regularly every morning with tepid water,or salt and water; the pa- tient immediately afterwards rubbing himself per- fectly dry with a coarse towel. This is a very refreshing and beneficial practice, and one which Sir Astley Cooper considers to have very materially 188 Compendium of Domestic Medicine. contributed to ensure the excellent health which ho so long enjoyed. He uniformly resorted to it imme- diately on rising from his bed. Frictions over the surface with a towel or flesh brush without sponging may also be resorted to with the best effects in the evening, or just before retiring to bed. This is a very effectual means for producing sound and re- freshing sleep, and causes the patient to awake in the morning with renewed strength and vigour. 2. Mr Hoisted's Method. On principles similar to those on which the warm bath and frictions act, in removing Dyspepsia, is to be explained the practice of Mr Halsted, which he recommends as a specific in this disease. The plan of treatment to which we allude is commenced by applying over the anterior part of the abdomen an emollient poultice or cloths wrung out of warm water, and repeating these until the abdominal muscles become perfectly flaccid. The patient being placed in such a situation, either standing or sitting, as shall most completely relax those muscles, the hand of an assistant is to be insinuated deep into the soft parts, in such a manner as that the bowels shall rest in some measure upon the open palm. Then by a quick but gentle motion these parts are to be pushed upwards towards the stomach, and in this manner agitated daily or oftener until an evident change for the better is produced, when the fre- quency of its employment is to be gradually dimin- ished. This is by no means anew plan; it differs but little from that recommended and employed by admiral Henry in 1787. This latter directs the patient whilst in bed, by means of a bone rounded at the end in each hand, to knead the bowels as much as possible, particularly about the navel, causing, " the two in- struments to meet among the bowels as much as they can be forced to do." Dyspepsia, or Indigestion. 189 From frictions and the warm bath diligently per- severed in, all the good effects resulting from the practice just described will be obtained, and with less trouble to the patient and less danger of doing mischief when the stomach or bowels are morbidly tender or inflamed. 3. Mineral Walers. The use of the natural mineral waters has been recommended in cases of Dyspepsia, and instances are related of marvellous cures effected by their agency. The water, impregnated with saline or mineral substances, of many of the natural springs, will, no doubt be found of advantage in some of the forms of stomachic disease, both inwardly and as a bath. But we are persuaded that the good effect frequently ascribed to these waters is dependent equally upon the journey; the agreeable occupation of the mind ; the pure air and daily exercise at the spring, and the breaking ujt for a time the ordinary bodily and mental occupations-the absence, for a season, from the fatigue and anxious cares to which the individual had been previously subjected. In the same manner a sea voyage will often effect a complete cure. 4. Tonics and Billers. We forbear to enumerate the numerous tonics- mineral and vegetable, the bitters and arc matics that have been at different periods, and are still by many writers, recommended lor the cure of Dyspepsia. Un less aided by the treatment already laid down they can do no possible good; with it they are seldom ifever needed. They have in fact produced more injury bj' far than benefit-by being resorted to at an im- proper period of the disease, or continued for too long a period. A light bitter or some simple tonic may, towards the termination of the disease, add tone to 190 the stomach, but by no means so certainly or effectu- ally as will a proper diet, regular exercise, pure air, cheerful employments, and the disuse of the vari- ous injurious agents usually introduced into the stomach. Compendium of Domestic Medicine. CONCLUSION. We may remark, in concluding, that the plan of treatment we have laid down must be persevered in for a considerable length of time before any effectual relief is to be expected: stomachic diseases of any standing cannot be removed in a few days. It is im- portant also that the treatment be uniformly perse- vered in, until the cure is effected and the func- tions of the stomach are completely re-established. It will not do to adhere to the rules laid down for a week or two, and then commit an act of folly or of dissipation, returning afterwards in hope of benefit to a temporary course of prudence and of temperance. Such conduct is more than madness-nothing but disappointment can result from it. Dys peptics, from the desponding state of mind under which they most commonly labour, and an erroneous and exaggerated opinion of the nature of their dis- ease, of its extent and danger; as well as from their want of patience to pursue a long uninterrupted series of gentle remedies, and the false estimate very generally made by the public of the efficacy of diet and regimen unaided by some potent medicine inter- nally administered; render themselves the willing dupes of every needy and impudent empiric. Tempo- rary reliefis often obtained from the pills and panacea of the latter; but the disease, nevertheless, becomes more deeply rooted, and the unfortunate patient for a moment's ease is made to suffer for life. The dys- peptic should always view the empiric as one of nis greatest enemies-the one most to be dreaded. SICK-HEADACHE. This disease is the result of our advanced state of civilization, the increase of wealth and enjoy ments in the power of most people in this country, and of the luxurious and enervating habits in which those in easy circumstances indulge. It is unknown among the natives of our forests, or among those of the frontier inhabitants whose necessities oblige them to live in a manner the reverse of that com- mon among the inhabitants of the Atlantic states, and particularly the residents of our large citiesand towns, among whom the complaint very generally prevails. Some of their habits are indeed of a na- ture directly calculated to lay the foundation of the complaint; but the vigour of their constitutions and daily exposure to pure air, aided by constant exer- cise, are more than sufficient to countervail their bad effects. The stomach is the seat and throne of this disease, and affects the head by means of that sympathetic connexion which it holds with it and every organ of the human body. High living, over-eating, late hours, disposition to acidity in the stomach, partial mastication or long continued use of food of difficult digestion, suppers, indolence, relaxing habits, and the presence of bile in the stomach, are the general remote causes. Our remedies therefore must be 191 192 Compendium of Domestic Medicine. directed to the stomach, and the restoration of its nervous functions, the impaired state of which occa- sions the agony endured by those who labour under the complaint. The desirable change however must be effected by slow degrees; for the stomach gives way slowly, and the means of cure must be gradu- ally applied. The length of time required to re- establish the tone of the nerves of the stomach, will vary in different persons in proportion to the violence of the disease, the fidelity with which the sufferer follows the advice given, and the susceptibility of the stomach to the impression of the remedies, and food prescribed: the object of their exhibition how- ever will be obtained sooner or later. SYMPTOMS. An attack of the disease most commonly forms in the course of the night, and on awaking, a pain is felt in some part of the head, but generally over one or both eyes. More or less languor attends it, with a diminished or total disrelish for food, and great sensibility to light. After continuing for one or two days, and even longer, if no remedy be taken, a nausea sometimes succeeds, which finally ends in vomiting, or this may easily be excited by a draught or two of warm water: in either case, relief is soon obtained from the more acute symptoms, and sleep follows-though a distressing soreness and confusion of the head succeed, which gradually go off and health is restored. In some cases the pain in the head is preceded by a dulness and heaviness of the eyes, and confusion of the brain, which finally ter- minate in the fixed pain. Cold feet sometimes pre- cede an attack, and constitute the first symptoms of its approach. Sick-Headach. 193 MEDICINES. In commencing a regular plan for restoring the tone of the nerves of the stomach, a laxative ought to be the first remedy; as rhubarb, of which twenty, thirty or thirty-five grains, in powder, may be taken early in the morning in syrup, or in the form of pills of a convenient size made with the same material, or, which is preferable, with castile soap, on account of its purgative power. Its activity may be quick- ened, and the object of its exhibition promoted, by the addition of one or two grains of aloes, if no objection to it exist, arising from its effect on the rectum, or from its harsh operation on the stomach or bowels. During the operation of the medicine, several tea cups of thin gruel made of oat meal or com meal, to which so much salt has been added as to be perceptible, should be taken. The breakfast after this prescription, and through the treatment, may consist of a cup or two of weak souchong lea, witn a soft boiled egg, weak coffee, water in which chocolate nut-shells have been boiled, or prepared cocoa, with a slice of dry stale bread. The dinner must be of the lightest kind, of any of the articles hereafter specified. In southern constitutions, an attack of the disease is generally brought on by the presence of bile in the stomach, the removal of which is therefore indis- pensably requisite previous to taking any medicine to relieve the headach, or to the commencement of any regular system of prevention of the disease. An emetic ofipecacuanha, in this case, will be absolutely necessary, of which fifteen, twenty, or twenty-five grains (according to ease or difficulty of being oper- ated on by it) may be taken in half a wine-glass of water. Two vegetable anti-bilious pills will insure its full operation, and the complete removal of the offending cause. The emetic may be worked off by 194 Compendium of Domestic Medicine. a tea cup or two of weak chamomile tea, taken at intervals, after the medicine has operated two or three times. The evening is the most suitable time to take the emetic, after the operation of which sound and refreshing sleep most commonly follows In case the medicine does not operate on the bowels once or twice, the dose of rhuba'b and aloes be- fore mentioned, or twenty or twenty-five grains of jalap or rhubarb, with four or five of calomel (if the bowels are difficult to move), may be taken the following morning or night, and worked off by gruel of corn or oatmeal. Nausea from the calomel is in general prevented by the addition of a few drops of essence of peppermint, or a tea spoonful of compound spirit of lavender. If it come on, it may be relieved by a few spoonsful of a watery infusion of cinnamoi or ginger, or by a little mint water. No fear neec be entertained of the proportion of calomel prescrihec affecting the mouth (unless the system be uncom- monly sensible to its effects), for the quantity added to the jalap and rhubarb insures its passage through the stomach and bowels-whereas a smaller dose might not be removed, and would then touch the mouth; at the worst its effects will only be temporary. This important preliminary being settled, the pa- tient must commence with the following medicine Prepared rust of iron, 1 drachm (60 grains), Colombo root, fresh powdered, 2 drachms, Orange peel, 3 drachms. Mix ami divide into twenty papers: one to be taken morning and evening, in a small quantity of jelly or syrup, and washed down with a wine-glassful of cold water. After taking the above medicine for four weeks, rhubarb, recently powdered, may be substituted for the columbo, ami if it be desired to render it more grateful, cinnamon may be added to the whole. If the dose be inconveniently large, the number of papers may be increased to thirty. After another month's use of this new prescription, the bitters mav Sick-Headach. 195 be omitted for four or five weeks, and the prepared rust of iron used alone. The occasional presence of bile or acid in the stomach, an occurrence that is easily known by the invalid, must be removed, by some anti-bilious pills for the bile : and for the acid, by twenty or thirty grains of magnesia, or dried subcarbonate of soda in the dose of from ten to twenty grains, in pills made with castile soap, three or four of which may be taken in a day. We have known Fowler's mineral solution given with great benefit in this disease: and our confidence in its jiowers, induces us to recommend it in violent cases. When taking it, the patient is not to drink cold water, or take cold. The dose may be from three to five or ten drops at the utmost, in half a wine glass of water, early in the morning, for an adult. If nausea be produced, it may be taken when going to bed, or one or two hours after a meal. The addition of a tea-spoonful of compound spirits of lavender (where this medicine has not previously been added) renders 't more agreeable, and prevents nausea. It must be discontinued, for a short time, when swelling in the face, or a sense of fulness in the eyes, is perceived. After the return of a fit. it may be again commenced. If nausea, or griping follow its use, the dose must be lessened. A tea-spoonful of common salt, dissolved in half a pint of water, and taken frequently in the course of the day, has afforded temporary benefit in a few cases; but we do not recommend it, by reason ol its uncertainty. The use of cider, as a remedy in this disease, was long since highly extolled by Dr N. Dwight of Con- necticut: but we are convinced that the relief ob- tained by it must be only temporary; and we have known many, too many instances of ruinous attach ment to strong drink, from earlv morning doses of tincture of Peruvian bark, and the infusion of other 196 Compendium of Domestic Medicine. vegetable tonics in Port wine, to prevent or cure fever and ague, dyspepsia, or complaints called ner- vous, to permit us to sanction the use of even cider for Sick-headach. DIET. As bread constitutes so large a portion of our daily aliment, and forms a most important item in the articles by which a cure of this distressing com- plaint is to be effected, it demands the first notice. Bread should be light, and none other must be touched. There is no excuse admissible for heavy bread. If corn bread be used, it should be eaten in the form of thin, crisp cakes. I cannot conceive a more injurious article of diet, to a weak stomach, than the hot corn bread of the southern states. No wheaten bread should be eaten, unless twenty-four hours old. Economy and health unite in proscribing fresh bread as an article of diet: for, however palat- able, it is highly injurious to the stomach, and tries its powers more than almost any other of the causes of disease. During the years of youth, when the natural vigour is daily deriving an accession of strength,-or, in constitutions enjoying greater pow- ers of the stomach than are absolutely required for the purposes of digestion, fresh bread may be eaten with impunity for years; but 1 will venture to assert, that every meal tn which it is taken, will detract some little from the powers of that organ, and that, in time, it will show its effects. As an attachment and relish for bread one day old is acquired in a short time, the sooner the former is left off the bet- ter ; indeed a cure must not be expected, so long as the use of fresh bread is indulged in. In cases of severe affliction from the disease, and where a disposition to acidity prevails in the stomach, it is advisable to lay aside raised bread altogether, and to substitute shipbread or crackers, or rice boiled Sick-IIeadach. 197 dry. Where the teeth have failed, biscuits may he soaked in cold water, a short time before they are wanted. Bread made from unbolted wheaten flour, commonly called bran bread, is to be preferred to while bread. That species of animal food which has been found to agree best with the invalid should be eaten, and none else. Wild meats, being more tender, and more easily digested than the flesh of domestic ani- mals must be taken advantage of whenever occasion wtL permit. Our markets annually furnish, in the proper seasons, abundance of venison, which, of all our meats, is the most proper for those afflicted with a weak stomach, or Sick-headach. Gameof all kinds, and rabbits, afford an ample variety of tender food. Beef is an article upon which we can subsist longer without disrelish, than almost any other. The part of the sirloin, containing the tenderloin, should be preferred; though other parts, provided they are tender and juicy, may be eaten. Good mutton may be a standing dish. If either be roasted, the over done outside parts are to be avoided, being difficult of digestion. Beeves' tongues, salted and smoked and corned beef, are equally proper, and even medi- cinal, owing to the stimulus of the salt used to cure them. In general, corned beef is not half boiled by American cooks. Slow, steady boiling, for several hours, is requisite, to render that article sufficiently tender for a deranged stomach. Rapid boiling occa- sions a waste of fuel, dissipates with the steam the volatile and savoury particles of the meat, and thus renders the article less good and palatable The water in w hich meat is boiled, should be kept just at the boiling point. The same rule holds in regard to soup. The lean part of a white fat fillet of veal may be occasionally eaten. The knuckle of veal must never De touched, being very difficult of digestion. Of shell-fish, crabs and oysters are the only spe- cies allowable. The latter should always be accom- 198 Compendium of Domestic Medicine. panied with a due proportion of bread or biscuit, to compel mastication, and prevent over-eating. Lob- sters are inadmissible. There can be no objection to trout, rock (streaked bass), black-fish, sea-bass, sheepshead, perch, flound- ers, and whiting. Boiled fish are generally found more easy of digestion, than when otherwise pre- pared. The use of other fish must be regulated by the effects produced on the individual eating them. Soft boiled eggs, poultry, and ham well boiled, may properly constitute a part of the dinner of an invalid. Pork, unless young, and fed on corn and milk, is too strong; and in any case, the lean part only should be eaten Meat pies are ruinous to the stomach of all subject to Sick-headach. But whatever may be the article of animal food that constitutes the material of dinner, the following rules ought to be constantly observed: 1. If the meat be not salted, it should be kept as long as possible before it is cooked, that it may be tender. 2. Whether roasted, boiled or stewed, meat ought to be done until tender. French cooks pay much more attention to this point than those of America or England. 3. Simplicity in diet is essential to those subject to Sick-headach. The weak stomach revolts at the task of overcoming the difficulty of digesting a din- ner composed of numerous ingredients, and either rejects them, or labours to do the hard duty thus imposed. It may succeed, after a time, though every such exertion tends infallibly to increase the disease in question. The dinner ought to consist of one dish of animal food, and one or two of vegetables, besides bread ; for the stomach is less strained to extraordinary activ- ity, than when several different articles are eaten. Besides, some articles, apparently of the same nature, do not agree when mixed, and may do harm by creat- ing a disturbance in the stomach, the quiet of which Sick-IIeadach. 199 it is important to preserve. The principle of this harmony of aliments applies almost with equal force to vegetables, among which we see agreements and disagreements, almost as great as those we remark in the mixture of two articles of animal food, or of fish and flesh. There are few articles upon which we can live so long without tiring, as beef, potatoes, and rice. These are so innocent, and so well adapt- ed to give tone to the stomach, that they ought to constitute the diet of such as are labouring under a Sick-headach, as long as they can be procured, or taken without disrelish. Much of their excellence, however, depends upon their cooking. It is essen- tiaf that the potatoes be mealy, and that the rice be boiled dry: as this article agrees with most persons, every invalid is urged to use it as steadily as possi- ble. Green peas, carrots, parsnips, and small homi- ny, may occasionally be substituted. 4. Slow and complete mastication of food is indis- pensable. The pleasure, moreover, of eating, is very much increased thereby; because the organs of taste are more forcibly impressed than when the food is a shorter time retained on them, by imperfect mastication. Another advantage of slow eating is, 'hat, the stomach being gradually distended, there is less danger of its being overloaded, and it is less sensibly affected by the subsequent relaxation, than if the food be hastily swallowed. When slowly and fully comminuted, the food is also more equally ex- posed to the action of the saliva and gastric liquor, which are designed by nature to dissolve it. The digestion of food is thus promoted. Long intervals between meals render the adoption of this practice very difficult; for the keenness of the sensation of hunger involuntarily forces us to eat quickly. The invalid should, therefore, never permit that sensation to proceed further than to cause a relish for food which should consequently be taken as often as is requisite, without reference to the regular hours of the family meals. Various articles can always be at 200 Compendium of Domestic Medicine. hand. But, on the contrary, unappeased hunger is not less injurious, than adding to the load in the stomach before the previous meal has been digested. The inevitable consequence of this repletion is, that digestion is disturbed, the organ is unduly roused to overaction, and, in the end, evinces the loss of vigour, by the occasional derangement of its nerves, and the production of the distressing sympathetic affection of the pain of the head. The effects of such indiscretion are often shown several days after it has been com- mitted; but most commonly the next day. 5. Moderation in diet must always be attended to. The stomach may be injured, by being over- loaded with simple food, as certainly, though not so speedily, as by other food of improper quality. The invalid should leave off eating, the moment the first distention of the stomach is perceived. Slow masti- cation favours satiety, without inducing undue dis- tention. The dinner should consist principally of vegetables. Most persons in the United States eat much more animal food than is necessary for or con- sistent with health. The rule with respect to butter shall be short. A more innocent article of food is not to be found than pure fresh butter, nor a more injurious one than strong butter The former may, therefore, be safely taken in moderation, provided it be found not to dis- agree with the stomach. This point can easily be settled by the invalid. Many physicians, without consistency or reflection, cry out against fresh butter as noxious, and yet will prescribe repeated doses of castor-oil, without once inquiring whether it is not, as it often is, offensive from rancidity. The most innocent mode of using butter is to spread it cold on bread twelve hours old, or on biscuit previously soaked. Soups of every kind are highly injurious to those troubled with Sick-headach, and ought therefore to be avoided. They suddenly distend the stomach without giving tone, and, in the way usually made, CARTILAGES OF LARYNX AND EPIGLOTTIS, AND UPPER RINGS OF TRACHEA, SEEN FROM BEHIND. (Taken from Todd and Bowman.) a, arytenoid cartilages, b, superior cornua of thyroid cartilage, c, its inferior cornua, d, posterior surface of cricoid, f, epiglottis, with its perforations, b. its left inferior tubercle, t, upper margin of thyroid, t, trachea. Sick-Headach. 201 are injurious, from the grease they contain and which, from the heat they are subjected to, are much disposed to create acidity. The best gravy of all roasted meat is its own liquor. An invalid's stomach is better without any. The ranced fried liquid fat, passing under the name of gravy, is ruinous to the stomach of those subject to Sick-headach. Vinegar pickles must be shunned. They are injurious from the indigestible nature of the solid article, and from the acid used in their pre- servation. But mustard and horseradish may be safely eaten; they are gently stimulating; and in an habitual colic, arising from gout, the latter has been eaten at all hours, with the most marked benefit. Vegetable acids of all kinds, and fruits, are highly injurious. Some of the latter may be more particu- larly hurtful, on account of the difficult digestion of their skins. Cherries in one case, and apples in another, excited severe attacks of the disease. It will be observed that we have said nothing about desserts. We proscribe them ail. There can, indeed, be no objection to plain puddings made of rice, bread, biscuit or potatoes, provided the butter in them is not found to disagree with the stomach, and provided they are eaten sparingly, and alter a moderate dinner. Cal ves-feet jelly, without wine, is equally innocent, and may be taken to the extent of a glass with safety. A plain apple pie, with well baked and very light crust, may also be occasionally eaten, with the same caution as to quantity: but we hold up both hands against rich pastry, and a variety of rich puddings which the ingenuity of cooks have invented to please the palate at the expense of health. They are death to a stomach subject to the derange- ment of nerves producing Sick-headach. The invalid is better without any dessert; for granting that the articles are in themselves innocent, yet they may be injurious by their bulk, and by disagreeing with those constituting the substantial part of the dinner. Besides the stomach acts with most vigour wnen 202 Compendium of Domestic Medicine. employed in digesting the fewest articles; and, therefore, it is wrong to try its powers by undue ex- ertion, or even to risK its derangement by a mixture of food. If any argument be necessary to urge the adoption of this simple diet, and to reconcile those subject to Sick-headach or dyspepsia, to the depri- vation of their usual supposed comforts, let it be re- membered, that the more steadily they submit to the discipline recommended, the sooner the object of it will be attained. Let them also reflect, that in ex- changing temporary sensual gratification, and conse- quent suffering, lor the habits and food that will, in a short time, prove as agreeable as those they have relinquished, they will also acquire light pleasant feelings, elasticity and serenity of mind, and all those sensations arising from the permanent enjoyment of good health, and freedom from pain; and above all, for uninterrupted capacity to discharge the duties which their various situations in life may demand. They must, however, bear in mind that a return to old practices will unquestionably, sooner or later cause a return of their complaints. We can assure .hem, however, that, they will, in a short time, become reconciled to the rational mode of life recommended, and that they will not only afterwards pursue it from choice, but advise others to adopt it. Tea and coffee must be taken in great moderation. In place of them, for breakfast, the articles noted in page 193, or a small portion of some of the varieties of animal food mentioned at page 197, may be sub- stituted; with the addition of sound bottled claret, if the acid of this wine should be found not to disa- gree with the stomach. The claret must be diluted with water. In the evening a cup of souchong may be taken with safety; but it would he better to omit it, and to take a few oysters, or a soft boiled egg or two, an hour at least before bed lime. Regular sup- pers must be wholly laid aside. Invalids should avoid dinner and supper parties. *br they thereby escape the inducement to transgress Sick-Headach. 203 the rules prescribed for their cure, the importunities and remarks upon their forbearance from the thought- less and inconsiderate, and the reflections w hich may prove mortifying to them from seeing others, either in high health, or who set bad health at defiance, eating freelv of what they call the good things be- fore them. Let every one afflicted with the Sick-headach be assured of the fact, of the superiority of water as a diluent, and throw aside wine, spirit, and malt liquors, [n the winter, if the coldness of the water should prove disagreeable, or give pain when taken, these effects may he prevented by pouring boiling water on toasted bread or biscuit, and permitting the tem- jlerature of the water to descend to a degree that may be found pleasant. It may then be taken at meals, or at any other time in the course of the day when required. This toast infusion is far preferable, and more palatable, than that made by infusing a hot toast in cold water. Those who are not blessed with water naturally pure, should, if possible, use distilled water; the benefit of which the late and experienced Dr Heberden, of London, thought might be as great in many chronic complaints of the sto- mach and bowels, as the most famous mineral waters are in other disorders. Dr Lamo says he was cured of a Sick-headach by the use of distilled water, and that he was informed of the same complaint having been relieved in others by using it. particularly by a gentleman more than sixty years of age. The same author relates several cases of the decided good effects of distilled water in various chronic com- plaints, as cancer, gout, obstirate cutaneous erup- tions, <K c. Dr Adair also adds several facts of its me- dicinal powers. If distilled water be used, the first gallon that comes over should be thrown awav. For DRINKS. 204 Compendium of Domestic Medicine. want of it, the water may be boiled; and, in both cases, it should be put into an upright churn, with- out a cover, and agitated for some time, to impreg- nate it with the air which it loses by either operation ar.d, for want of which, it has a vapid and peculiar taste. In places where the water is obviously im- pure, or bad tasted, it ought to be passed through a filtering stone, or, which is better, a filtering appara- tus The water drinker will find, after a short trial, that he will never want the luxury of an appetite; that the sensibility of the organs of taste is increased, and that he will thereby add to the pleasure of eating. But it must be remembered, that a cardinal point in the cure of all diseases of debility in the stomach, or of derangements in its functions, is to take no more drink at meals than is sufficient to promote the solu- tion of the food in its natural solvents, and its passage out of the stomach. Half a pint, or a little more, is enough. The operation of the good effects of the tender modes of cooking, in France, is prevented by the large draughts taken by the people of that country at dinner: and indigestion is known to be a prevail- ing disease among them. During the day thirst must be assuaged, either by plain water, or water impreg- nated with carbonic acid, the method of doing w hich is nowr generally known. Where acidity prevails in the stomach, ten or fifteen grains of the supercar- bonates of soda or of potash, should be added to each glass without syrup. Half a tumbler is enough for one draught. More would cause uneasy disten- tion of the stomach. This drink, taken daily, has, in one case, suspended a severe Sick-headach lor several months. The alkali may be dissolved in a w'ine-glass of milk, and pure water taken after it, if aerated water cannot be procured. The tonic effects of malt liquors on the human body, when not contra-indicated by some circum- stance, would naturally lead those not acquainted with them, to expect that they would be highly be- Sick-Headach. 205 neficial in lhe present complaint: but they are inju- rious, from containing more or less free acid, and must, therefore, be avoided. Attention to lhe state of the bowels is of essential importance in this disease. Costiveness not only dis- poses to its origination, but increases lhe disposition to frequent attacks of it. The bowels must, there- fore, be constantly kept open by the use of occasional doses of medicine, when necessity may require it. The Congress Spring water, at Saratoga, is lhe best laxative for the purpose; for it is the peculiar pro- perty of this admirable water not to weaken like olher purgatives. Three tumblers full, taken early in the morning, are enough at a time. When drank on the spot, a tumbler of the Flatrock water, which is a pure chalybeate, may be taken in the afternoon. Where the Congress w ater cannot be procured, rhu- barb may be substituted, and, to prevent it giving pain, three or four drops of the essence of pepper- mint may be added to the dose; or about thirty grains of the root may be cut up and chewed; lhe effects, when thus used, will be more slow and natural than when a full dose in powder is taken. If there be an aversion to this excellent medicine, castor-oil may be substituted. Spinage, when in season, simply prepared, and slightly seasoned, should be eaten at dinner, when constipation comes on. Where acidity prevails in the stomach, half a drachm to a drachm of calcined magnesia should be taken in milk. It would certainly conduce to the promotion cf the vigour of the body, or, at least, prevent the increase of muscular relaxation, if enervating feather beds were laid aside, and mattrasses of hair, or southern moss, substituted. In summer, a feather bed is an absurdity. Even in winter, a short time will recon- cile the most delicate to mattrasses, when they will invariably be preferred to feather beds. In cold weather, a blanket may be put between the sheet and the mattrass. 206 Compendium of Domestic Medicine. EXERCISE. Exercise is an essential remedy in the cure of the Sick-headach. But under the word exercise, so much is comprehended, that it is necessary to enter into detail respecting it. No species of bodily motion, no variety of the species of exercise commonly used, will have the desired effect, unless under proper regula- tions, and in conjunction with a due observance of the whole system of conduct laid down in the pre- sent set of directions. It is only one of the means prescribed, and may be defeated by, or even interfere with the rest that are essential, by being improperly used, or by inattention to other directions. The ex- ercise must be in the open air, and occasionally be- fore breakfast. If taken in the house, it fatigues without effecting any change in the system. Riding on horseback, on account of the agitation of the in- ternal viscera, is, of al! species of exercise, the most proper; and should be constantly taken, every morn- ing, when the weather will permit. A long journey is much preferable to daily short rides at home, on account of the exhilarating and medicinal effects of the continued change of scene and of air on the system. Occasional stops should be made, and exer- cise on foot taken. Exercise, however, alone, will not cure or prevent the disease, which is known to affect persons of the most active dispositions, and possessing considerable muscular vigour. If it be not convenient to take a long journey, daily rides at home, or walking exercise, may be substituted. Some business, or object of investiga- tion, ought always to be had in view when exercise is taken, as a visit to a friend, the local topography or geology, mineralogy or botany of the country, <fcc. &c. To this must be added gentle frictions from right to left, on the side, and region of the stomach and bowels, with the flesh-brush or flannel, for fifteen Sick-Headach. 207 minutes, every morning before rising, and after meals The benefit of this remedy, though slow, is certain A powerful remedy, in the cure of this disease, is a change of air. The influence of the air of a place, in the production of diseases, is evident from a variety of facts; apd the prevention and cure of them obtained by a temporary change of air, or permanent removal of residence, is no less indis- putable. A striking effect of the change of air in the Sick- headach, occurred in a citizen of Philadelphia, who, from his sixteenth year, had been subject thereto, and in whom, until he had passed his fortieth year, it annually increased in force and frequency, so as to render his life miserable. A few years since he re- moved fr«m the small and confined house, in which he had lived for many years, to one of larger size, having a spacious garden; and the consequence was, that, in the course of two years his headach became much less frequent, and his general health improved. CHANGE OF AIR. OTHER CAUTIONS. Diseased teeth frequently excite this disease. In the commencement of a cure, therefore, all stumps that give occasional pain, and all hollow teeth not to be rendered useful by plugging, should be extracted Slight decays in other teeth must be cut out, and the cavities plugged. Early hours are essential to the cure of the com- plaint. This refers to bed-time and rising, and the invalid should make it a point never to indulge in the unsound sleep that is apt to follow lying in bed in the morning, after being awake some time. The languor induced by a long continued recumbent pos- 208 ture of the body, promotes that torpor of the diges- tive organs which contributes to the origination of the disease, and its continuance. A headach almost in- variably ensues from such practice, with the loss of that refreshing sensation arising from the sound re- pose of the preceding night. Cold feet frequently excite the disease. Care must be taken, therefore, to guard the feet from cold and wet, by cork-soled or Indian rubber overshoes, which are now made with great neatness, and by wearing warm stockings. Flannel socks should also be worn in winter when going to bed, and may be pulled offin the course of the night, when the warmth of the body has become equally diffused. No one subject to Sick-headach should sleep with a fire in the chamber; for the diminution of tempe- rature that often takes place in the course of the night, from the fire going out, or from a change in the weather, disposes the system to catarrh, and every such indis;>osition retards the cure of the dis- ease. This remark does not apply to Canada, or the eastern states, where the severity of the cold renders the preservation of an uniform temperature in the whole house, during winter, an object of unceasing attention; nor to those who have the means of keep- ing up a regular heat in their chambers during the night. The thermometer should not be permitted to rise above sixty degrees. The proper practice is, to have a fire kindled, early in the morning, in a sheet- iron stove, which heats quickly, or to dress in an adjoining room, where there is a fire. Bed-curtains should not be used. If the system feel exhausted by the duties of the morning, and require repose after dinner, to recover its energies, sleep for half an hour may be indulged in, to great advantage, with the body in an erect Compendium of Domestic Medicine. position, or nearly so. A recumbent posture should never be adopted, if a cure be hoped for. The prac- tice, while in perfect health, of regularly going to bed after dinner, for an hour or more, is productive of the most enervating effects, and should never be adopted, by young persons who are desirous to pre- serve or acquire firm muscles, good complexions, or strong nerves. No one who values the preservation of a vigorous state of the surface, or wishes to prevent the gradual diminution of its tone, should ever permit a warming pan to enter the bed. In cases of natural delicacy of constitution, a flannel gown may be used to sleep in. One of the surest methods to invigorate the skin, and to prevent a disposition to take cold, is to rub some part of the body every morning, on rising, with a coarse towel dipped in cold water. The refreshing sensation arising from this practice is so great, that no one who tries it will deprive himself of the grati- fication. The well known sympathy between the surface and the stomach, authorises a belief that the practice would prove a powerful auxiliary to the system recommended for rhe cure of the sick- headach. The passions of the mind must be kept under with especial care. Every mental irritation will add strength to the disease, and retard the wholesome operation of the remedies prescribed for its cure. The common effect of giving way to fretting, peevish- ness, or resentment, is an attack of the complaint. A determination should he made to overcome this disposition. One effect of the system of diet recom- mended for the cure of the complaint, is a happy re- volution in the temper, from great irritability to phi- losophic endurance of the little evils of life, and the power of self-command. The mind and the corpo- real functions are intimately connected and mutually act and react on each other. Every source of do- mestic irritation should, if possible, be avoided. The troubles of life affect the digestive organs very sen- Stck-Headach. 209 210 sibly, and operate with increased force when they are joined to improper food, or other remote causes of the disease. Compendium of Domestic Medicine. TREATMENT OF AN ATTACK OF THE COMPLAINT. If the disease announce its approach, which it sometimes does, by certain premonitory signs, as heaviness of the eyes, or confusion of the head, no time ought to be lost in arresting its progress. If the prevalence of an acid or of bile in the stomach be known, attention must be paid to their removal. If the first be present, twenty or thirty grains of calcined magnesia, or ten or fifteen grains of super- carbonate of soda or of potash, may be taken in a tumbler of artificial mineral water; and if this cannot be procured, they may be mixed with new milk or gum-arabic water: to both, the addition of orgeat, syrup of sugar, or of ginger, all render the draught more agreeable, Bile is to be removed by a brisk purge of com- pound podophyllin pills; after which, if relief be not obtained, fifteen, twenty, or thirty drops of laudanum may be taken in half a wine-glassful of water, with the addition of a tea-spoonful of com- pound spirit of lavender, and sleep encouraged by retiring to bed in a dark room. If, on awaking, the pain in the head should not have disappeared, its removal will be promoted by the person remaining in bed, and repeating the dose. It is better, how- ever, to take enough at first, to insure a sound sleep for several hours; after which it commonly happens that no symptom of the disease remains, except a slight confusion of the head, arising from the effects of the laudanum: but this will disappear in a short time, by taking a cup of clear strong coffee, without sugar or cream. In this way relief from the present symptoms will ne certain; and hy repeating the foregoing process a few times when the attack returns, it will be shortened, and the habit of the disease be broken and by due care to avoid the causes that excite it and the use of the medicines, diet and regimen re- commended, its return may be prevented. Sick-Heudach. 211 212 Compendium of Domestic Medicine. THE TEETH. It is intended in the following treatise, 1. To give, in as few words as possible, a clear description of the structure and formation of the Teeth; and to bring to view those circumstances con- nected with their growth, with which it is important for every individual to be acquainted. 2. To give a brief sketch of the most common dis- eases to which the Teeth are liable; together with such directions, relative to their treatment and pre- servation, as shall enable the reader to take the necessary care of his own Teeth; and, if a parent, to pay proper attention to the Teeth of his children. The reader is aware that the diseases of children are not embraced in the plan of this Compendium of Do- mestic Medicine; but the author, in treating of the Teeth, has found it impossible to avoid some notice of the subject-unless at the hazard of omit- ting much that is interesting and instructive to those to whom this work is professedly addressed. 3. To guard against the injurious practice of igno- rant operators; and to remove some of those popular prejudices which prevent many from adopting the only treatment calculated to diminish the liability to disease in these useful and important organs. A, the separate human teeth as they occur in the half jaw of the adult. B, the human teeth in situ in the upper jaw. a, a, incisors, b. b, canine, c, c, premolars, d, d, true molars. The Teeth. 213 STRUCTURE, NUMBER, FORM AND ARTICULA- TION OF THE TEETH. In order to render the description of the Teeth, and of their diseases, as clear and comprehensive as poss- ible, anatomists have considered a Tooth as divided into three parts or sections; first, the body or crown ; second, the neck ; and third, the root or fang. The whole of that part of a Tooth which is gene- rally exposed to view, when the gums are in a healthy state, is called the crow'n. The part which is immediately embraced by the gums, and to which they are united, is called the neck. The third section, or fang, is all that part which is found buried in the socket, when the bony process, of which the socket is formed, is in a perfect state. The hard or bony structure of the Teeth is described as consisting of two substances; one of a dense bony nature, much harder than that of any of the other bones, and of which are formed all the internal parts of the crowns, the whole of the necks, and also the langs of the Teeth. The enamel, or external cover- ing, is the other hard substance, which, however, forms only a part of the crown. It is of a peculiar nature, possessing a hardness and density exceeding that of any other substance in the whole body, and covers the crowns of all the teeth, but is seldom in any part more than a line in thickness. It is thickest, at those parts which are most exposed to use; and thinnest, at those nearest the gums. The Teeth, like the other bones, are hollow, having a cavity in their crowns, corresponding, in form, to the external part of the tooth, and a canalin each fang, extending from jhis cavity, and terminating by a small opening in the point of the fang. These cavi- ties, however, are not, as is commonly supposed, for the lodgement of marrow, as in the other bones, but to give place to blood vessels and nerves, on which Compendium of Domestic Medicine. 214 the Teeth depend fbr their nourishment and sensi- bility. The dimensions of these cavities are found to vary, according to the degree of perfection attained in the formation of the Teeth; being greatest in those which are very young, and becoming gradually smaller, till their formation is completed. In the Teeth of adults, they become still less, as the individual ad- vances in years, so that in those of very aged persons, these natural cavities are often found to be entirely closed, or filled by solid bone. Of the two sets of Teeth with which the human jaws are successively furnished, the first are called the temporary, infant, or Milk-Teeth; and the second, the permanent or adult Teeth. There is most com- monly a difference in the number which composes these two sets, the first containing twenty, and the second thirty-two. The number in the second set is often found to vary, being in some greater, and in others less: but this variation seldom occurs in the first set. Both sets are divided into classes. In the first set there are, in each jaw, 1. Four front Teeth (Incisore s'), two on each side. 2. Two eye Teeth, or canine Teeth (Cuspidati), one on each side. 3. Four grinders, or double Teeth (Molares), two on each side. The front, and canine Teeth are succeeded, in the permanent set, by Teeth of the same denomination : but the grinders of the first set are followed in the second, by Four double-pointed Teeth, or small grinders (Bi- cuxpides). In addition to which there are tn this set, a fourth class, viz. Six large grinders, or double Teeth (Molares), three on each side; the last of which, on each side, is called wisdom-tooth. The Teeth of both sets, or those of the same class The Teeth. 215 in both, bear a strong resemblance to each other; so that, in many instances, at the period of shedding, the teeth of one set have been mistaken and extracted for those of the other. The roots of all the front and canine teeth, in both sets, are single, and generally straight and tapering; and those in the upper jaw are commonly the longest The fangs of the small grinders (bicuspides') are flatted and thin, often a little crooked and tapering, and generally some of them forked at their extremi- ties. All the double Teeth (molares) in both sets have, in the under jaw, two fangs, and in the upper one, three ; two of these being fixed towards the outer edge of the jaw, and the other towards the roof of the mouth or palate. In many instances, however, the grinders of the upper jaw have four, or even five, fangs; and those of the under jaw, three. And on the contrary, some of these Teeth, which are gene- rally designed by nature to have two or three fangs, are found with but one. The Teeth are connected with the jaws by the means of sockets, which are formed to receive and fit each particular fang, and by intermediate mem- branes, which serve at once for linings to the sockets, and coverings to the fangs; so that the roots of the Teeth are not immediately articulated or joined to the bony sockets, but are united by these membranes. The sockets which receive the Teeth are formed of thin plates or processes of soft spongy bone, w hich, while they embrace the fangs of the Teeth, serve as a support to the gums. These plates of bone, w hich are called alveolar processes, are produced, and in- creased, with the formation and advancement of the Teeth; and there is such a mutual dependence of the teeth and these processes on each other, that a Tooth is no sooner removed, than a wasting of the process commences, and all traces of a socket soon disappear. And on the contrary, when this dissolution and ab- sorption of the processes are first effected, as is often the case m consequence of disease, the Teeth imme 216 Compendium of Domestic Medicine. diately become loose and painful, and the patient is almost constantly afflicted till they are wholly re- moved. Thus it appears, that where there are no Teeth, there can be no alveolar processes, and where the alveolar processes are destroyed, the Teeth can no longer be preserved. These bony sides of the sockets are covered, like the rest of the jaw, by a thick strong membrane, called periosteum, which contributes greatly to support and strengthen them. The gums are next spread over this periosteal covering; and these again are in- vested by a very delicate membrane, which is con- tinued over the lips, tongue and throat, and is indeed the immediate lining of the mouth. All these soft parts, which cover the sockets of the Teeth, are so intimately united by the intermixture of their fibres and vessels, that they cannot be distinctly separated by the knife, and appear, on dissection, like one uni- form and homogeneous substance. These parts, and the membranes which connect the teeth with their sockets, serve for the transmission of innumerable small vessels, which go to nourish the jaws and teeth. Vessels and nerves of conside- rable size enter the jaws, and pass in channels at the deepest part of the sockets, where they supply the fangs of all the teeth with small branches; and in this way the cavities of the teeth are furnished with arteries, veins, and nerves, that enter at the fangs by the small openings in them, which have been men- tioned above. In order to illustrate the doscriptions which have been or may be given, the following print has been drawn and engraved. It consists of a representation of the bones of the face, in which the first and second sets of teeth are so exposed as to show their relative situation in both jaws, as found in a child of six or seven years of age. The preparation from which the drawing was taken had all the flesh removed, and the outer plate of the alveolar processes sawed and cut away in The Teeth. 217 such a manner as to bring to view the fangs of the temporary teeth, and the crowns of the permanent set which were beneath them. Explanation. a. a. a. Three front Teeth of the first set, the other had been shed. b b. The canine or eye Teeth of the first set c. c. c. c. The double Teeth or grinders of the first set, their fangs being partly absorbed. 1. 1. 1. 1. The crowns of the front Teeth of the permanent set, one of which, in the under jaw, is fully advanced, and is in the place of a temporary tooth which has been shed. 218 2. 2. The crowns of the permanent, canine or eye Teeth. 3. 3. 3. 3. The crowns of the double-pointed Teeth, or small grinders of the permanent set. 4. 4. The first large grinder or double tooth of the permanent set in each jaw, the fangs of which are not fully formed. It is owing to the early appear- ance of these Teeth beyond the temporary grinders, that many persons are deceived, and suppose they have never shed all their double Teeth. 5. 5. The crown of the second large grinder, or double tooth of the permanent, set, in each jaw, still deep in its socket, the formation of its fangs not having commenced. The subject was too young to allow of exhibiting the rudiments of the wisdom Teeth, or third large grinders. These are formed still farther back than the others. Compendium of Domestic Medicine. FORMATION OF THE TEETH. When the rudiments of the Teeth are first disco verable, they are small gelatinous or pulpy bodies, enveloped in thin membranous sacks, and arranged in a sort of excavation or groove in the jaw, which at this time is but imperfectly formed. Bony fibres then shoot across this groove, and separate it into distinct cells, each of which contains its proper pulp, or embryo tooth, invested in its membrane. At the time of birth, the formation of the temporary Teeth has generally so far advanced, that the pulps have attained their full size, and ossification has extended over their surfaces in such a manner as to form complete bony shells of the size and figure of the crowns of the Teeth; and the pulp of the first per- manent grinder, on each side of both jaws, has ac- quired a considerable magnitude. After this the 1. Formation of the Milk Teeth. The Teeth. 219 pulps begin to elongate, in order to form the fangs, and the process of ossification is continued for the same purpose till they are completed. While this process is going on at the roots, another is progressing at the crowns, by which an earthy substance is deposited on their surfaces, and gradu- ally formed into that highly polished and beautiful covering, called the enamel. And while these changes are taking place, the Teeth are gradually rising, the alveolar processes which are to support them are increasing in height, and the membranous envelopes are dissolved and taken up by innumerable absorbing vessels, and car- ried into the mass of blood, having effected the pur- pose for which they were formed. After this, the gums, or those parts of them which are situated im- mediately over the Teeth, are also absorbed, and the advancing Teeth are allowed to rise into view. The age at which the Teeth begin to appear, is usually that from the sixth to the eighth month; sometimes earlier, and often much later. They ge- nerally advance in pairs, and in the following order: 1. The two central front Teeth of the under jaw, which are soon followed by the corresponding ones in the upper jaw. 2. The two next front Teeth, or lateral incisores of the under jaw, which are succeeded by the corres- ponding upper ones. 3. The smallest double Teeth, first in the under, and then in the upper jaw. 4. The under canine Teeth, which are followed by the upper ones, called the eye Teeth. 5. The largest double Teeth. These also appear in the same order, with respect to the jaws, first in the under, and then in the upper one. They often pass through the gums at about the same time that the canine Teeth do, and sometimes before them. At other times, the canine Teeth precede even the smaller grinders in their advancement. Though this is the order in which these Teeth 220 generally appear, various circumstances produce the greatest irregularity in this process. The time which is occupied for their advancement varies much, though it is usually a period of about eighteen months, or two years. Compendium of Domestic Medicine. The formation of the second set of Teeth, is one of the most curious and interesting processes which is effected in the development of any part of the human frame. While the temporary Teeth are forming, and soon after ossification has commenced on their pulps, the rudiments of the permanent set may be discovered. They are connected with the membranous coverings of the temporary Teeth, and are contained in the same sockets with them. When the first set advance to their destined situation, this connexion is not de- stroyed, but the permanent Teeth are left deep in the jaw, and bony partitions are formed between the sockets of the two sets. At a certain period after the crowns of the permanent Teeth are formed, the partitions of Irone, which separate them from the sockets of the other set, are al>sorbed, and they gradu- ally rise and occupy the space thus formed. To give place to these Teeth, the fangs of the temporary set are then absorbed; and in this way their crowns are finally deprived of all support, except a slight attach- ment to the gums, and are often removed by the ordinary pressure of the tongue against them. 2. Formation of the Permanent Teeth. The provision of nature for exchanging the two sets of Teeth, is as much calculated to excite our admiration, as the process by which they are formed. And there is no period at which the Teeth of children require more, if so much, attention and care. SHEDDING THE TEETH. If the fangs of the temporary Teeth be slowly ab- sorbed, the permanent Teeth will generally come forward so as to appear as soon as the corresponding ones of the preceding set are shed; and in a majority of cases, without doubt, the whole process is per- formed by nature with such perfect regularity, that the interference of art would be at best but useless. In some cases, it would be detrimental to the forming and rising Teeth; and in others, injudicious and cruel, from the unnecessary infliction of pain. Yet there are so many cases in which irregularity and deform- ity, with tneir usual consequences of disease and suffering, are produced, by the manner in which the permanent Teeth are allowed to advance, that it is highly important that all parents should be acquaint- ed with the situation of the two sets of Teeth in rela- tion to each other, and with the changes which take place within the period of the second dentition. See plate, ante page 217. For it is only by their know- ledge of these, that they can be enabled to judge correctly when it is proper for them to interfere in removing the temporary teeth, and when it may be expedient or necessary to apply for the advice and aid of an experienced and judicious dentist, to pre- vent the evils wnich often result from neglect or ignorance. If the permanent Teeth are discovered to be emerging from the jaw in such a manner that their position will be improper and injurious, or if they are inclined to any irregularity arising from the dispro- portionate growth of the Teeth and jaws, much may be done to prevent it by a seasonable removal of the temporary Teeth; hut this should not be done by any who are ignorant of their liability to do mischief by taking the wrong Teeth, or by extracting them too early, or by removing loose Teeth only, when there may be the greatest necessity for extracting such as are perfectly tight, and in which the process of ab- sorption has hardly commenced. It is a very common opinion that the first Teeth The Teeth. 221 222 Compendium of Domestic Medicine. have no roots, and that they may therefore be ex traded without injury, at any period. But nothing can be more incorrect; for the Teeth of a child have longer and larger roots, in proportion to the size of their crowns, than th' Teeth of an adult; and their connexion with the forming Teeth of the second set, at an early period, is such, that if they be extracted too soon, the violence done to the tender Teeth be- neath them may be so great as to prevent their for- mation from being completed, and they may never appear. Another prevailing opinion is, that the temporary Teeth should always be extracted as soon as they are discovered to be loose; and though this may generally be done without any bad effects, it is not so necessary as has been supposed, and in most in- stances is a useless interference; and exposes children to suffer both fear and pain, which might as well be avoided; for the looseness of these Teeth, as has already been shown, is occasioned by the absorption of their fangs; and there can be no surer evidence than this, that nature is doing her own work in due season, and needs not the aid of art to expedite it, or render it more perfect. It is not by removing Teeth which are loose, but those which are firm, and have their fangs nearly or quite entire, that any advantage is obtained which will favour the regular advancement of the perma- nent set. The best advice, therefore, that can be given on this subject, to parents, and those who have the care of children, is to examine the Teeth fre- quently, about the usual period of shedding (the sixth or seventh year); and if any of the second set begin to make their appearance, or there is an evi- dent swelling of the gums at the part where any of them are expected to appear, a sufficient number of the first Teeth should be extracted to allow a suffi- cient degree of room for the second, which are com- ng forward. From what has been stated, however, it will rea- The Teeth. 223 dily be seen, that when the temporary Teeth have become very loose and troublesome, they may be extracted indiscriminately, and by any person; but when they remain firm, and the Teeth of the second set are coming forward in such a manner as to lap over each other, or appear in a double row, it is of the utmost importance to remove them, whether the process of absorption has commenced at their fangs or not, in order to give room, and restore regularity to the rising Teeth. It should be remembered, with regard to the exami- nation of the jaws and Teeth at the time of shedding, that all the Teeth which are to succeed the first set, if they come forward too soon, or before the tempo- rary Teeth become loose, will be discovered behind them, or on the inner side of the jaw, excepting the eye Teeth, or cuspidati, which will be found advanc- ing on the outer side of the jaw. It sometimes hap- pens, also, that when the temporary grinders have been very early removed, the bicuspides, or small grinders, of the second set, make their appearance on the outer part of the jaw, next the cheek. This is most common with the upper ones. All cases of great irregularity (which may gene- rally be discovered before the teeth have risen far above the gums, and often as soon as they appear) should without delay be placed under the care of an experienced dentist; for the limited knowledge which parents usually obtain, from the few' cases which come under their observation, is not sufficient to en- able them to judge what is proper to be done, with that degree of correctness which the nature of the subject requires. THE FIRST DENTITION. The age at which the first Teeth begin to appear, varies very much in different children. This is caused by various constitutional peculiarities; some- 224 Compendium of Domestic Medicine. times it depends on the general vigour of the system when there is no predisposition to disease of any kind. It may likewise depend on the influence of various morhid principles which have been inherited from the parent, or on that of diseases produced by various external causes. Children of the most robust constitutions do not always begin to cut their teeth earlier, or get through this process in a shorter time, than many others that are of a more sickly and feeble habit; yet the former are much less liable than the latter to suffer from the pains and diseases to which children are exposed during the period of dentition. The common expression of cutting the. teeth, has arisen from an opinion, that the growing teeth make a passage for themselves through the gums by lace- ration ; which certainly is not the case. As the teeth rise, a waste or absorption of the gums takes place, in order to let them pass through. This is often effected so easily as not to occasion any symptoms of pain or uneasiness. The absorption of the gums, to make way for the teeth, is as certain an effect of na- ture as the growth of the Teeth. In many cases, how ever, the rapid advancement of the Teeth, and the changes which must necessarily take place to produce it, produce also much disturbance about the jaws, and in the system generally. The gums appear swollen and inflamed, there is an increased flow of saliva, the infant is restless, cries, and frequently puts its hands to its mouth. From the effects of local inflammation and nervous sympathy, the whole hotly may become dangerously affected; in such cases the most sudden and happy effects have been pro duced by lancing the gums. This operation is a very simple, but not an unimportant one, as will be seen in our remarks (subsequently) on the mode of performing the operation. It is often attended with the most unexampled benefit to the child, and should never be neglected when required Whatever contributes to promote the healthfu' operations of nature, will make Teething easy ; such The Teeth. 225 as frequent bathing in warm or cold water, according to circumstances, friction of lhe body and limbs, good air, exercise, and wholesome food ; and above all, a cool and open habit of body. The gums should be rubbed with the finger, and the child should be al- lowed the use of its own fingers in its mouth. The idea that a child's sucking its fingers will prevent their growth, is a prejudice without foundation in truth. The old and erroneous opinion, that the Teeth, as they grow, cut their way mechanically through the gums, first suggested the idea of assisting them in their protrusion, by the friction and pressure of hard substances; and hence arose the cruel and hazardous practice of scratching the gums through with the finger nail, or with pieces of hard loaf sugar, a prac- tice which has loo often been the cause of severe local and general suffering, if not of death, from the inflammation, fever, and spasms, which it has contribu- ted to excite. Hence also the use of the coral and other hard smooth substances given children to bite ; which are most dangerous instruments put into the hands of children to destroy themselves; for as the Teeth rise, and become slightly elevated above the edges of their sockets, those hard substances press and bruise the gum between them and the sharp points, or edge of the tooth underneath : inflammation and its consequences undoubtedly follow; and in this way, we are fully persuaded, the lives of thousands of children are lost. The second dentition, or protrusion of the perma- nent Teeth, is seldom the cause of any suffering, ex- cept when the last grinders, or wisd<rm-teeth as they are called, are passing through the gum, being at the same time situated farther back than usual, and in such a manner as to present their pointed surfaces towards the cheek; in which case, lhe motion of the jaw in mastication, occasions such a degree of press- ure on the gums and surrounding parts, as to produce much irritation, often a considerable degree of in- Compendium of Domestic Medicine. 226 flammation about the jaw, and even ulceration. These circumstances sometimes render it necessary to extract these teeth, though in most cases they may be preserved, and the troublesome complaints re- moved by cutting away a small portion of the inflamed gum over the teeth, or by other timely and judicious treatment. DISEASES ATTENDING DIFFICULT DENTITION. In infancy, every part of the system is highly sus- ceptible of morbid impressions, and one set of organs readily becomes diseased through sympathy with another. Among the diseases to which children, while teething, are liable, are, general irritation, or fever of an inflammatory kind, eruptions on the skin, diar- rhoea, dysentery, cholera, inflammatory affections of the lungs and throat, swelling of the glands about the throat and neck, spasmodic affections of the limbs, and often convulsions of the whole frame. What has commonly been called the fever of teething children, makes its appearance several times in the course of the period occupied for cutting the teeth; often commencing very suddenly, and marked by a dulness and heaviness of the eyes, rnu- sual heat of the skin, quickened respiration, coated tongue, loss of appetite, and restlessness. When these cases occur, it will be proper for the parent or nurse to administer some mild emetic, or gentle cathartic medicine, and place the little patient for about ten minutes in a warm bath, as high as the waist. But if these do not give relief, and remove the principal symptoms of the complaint, no delay should be allowed in calling medical assistance. The doubtful aid of inexperience should no longer be trusted. When there is an eruption, which has become in any degree troublesome, the parts should be carefullv The Teeth. 227 washed once or twice a day with castile soap suds, or warm milk and water, and covered with hair powder, or dry wheat flour; or smeared with dive oil, and covered with lint. No medicated ointment applied with a view to dry up, or scatter the erup- tion, should he used, or can be used with safety, without previous medical advice. The bowels of infants, while they are Teething, are not unfrequently affected in such a manner as to produce the most alarming consequences in a very short time. Sometimes, however, they remain in a diseased state for several weeks; the child at the same time continuing lively and playful, with a good appetite; so that the sympathetic affection of these parts appears to be but a salutary effort of nature, to relieve the system from other and more serious diffi- culties, or to prevent their occurrence. The very common practice, both of mothers and nurses, of dosing infants that are suffering under diarrhoea or dysentery, with paregoric, anise, burnt brandy, and sugar, and various astringent prepara- tions, cannot be too seriously condemned. It is a practice which but too often serves to drive to a fatal close, a disease which, if it had been treated by a skilful hand, or even left to the kind efforts of nature, misht have been conducted to a happy termination. Concerning most of the other diseases which have been enumerated, few parents possess a sufficient degree of knowledge of them, to be enabled to de- termine what is best to be done; and, indeed, the anxious concern which most parents feel for their suffering offspring, generally unfits them, more than any other circumstance, for a calm and deliberate exercise of their judgment. Delay in giving the attention which is often re- quired by children, when they begin to suffer from teething, is a fault of too common occurrence, and of too inexcusable a nature, to be passed wholly unno- ticed. The various maladies which attend the age of infant dentition, should not be suffered to prev on 228 Compendium of Domestic Medicine. the constitution, while the too often fallacious hope is cherished, that all will be well when the child has finished cutting its teeth; for, changes are not (infrequently produced in the system, which effect a lasting injury, and prevent the enjoyment of perfect health through the remainder of life. It may be asked, does the cutting of the milk-teeth require the aid of the dentist? Certainly not; it is generally a benign operation; but there are cases in which maternal solicitude has need of counsel; and the physician as dentist, or the dentist who is a phy- sician, in this case, will show what is requisite to be done. In almost every complaint attending diffic. It den- tition, the operation of dividing the gums with a lancet over the rising Teeth, is of very great import- ance, and cannot be too strongly recommended; for, in many instances, it prevents the necessity of em- ploying any other remedy, and often exceeds all others in efficacy. In cases of great inflammation about the gums, attended with fever, the operation is often followed by the sudden cessation of pain, and the mitigation of every symptom of irritation ; in diseases of the bowels, by the perfect removal of the most distressing symptoms, and a speedy return of the healthy action of' the parts; and in spasms of the limbs, and general convulsions, by the imme- diate interruption of the paroxysms, and a prevention of their recurrence. Its salutary effects are so power- ful and decisive, that in all painful cases of dentition marked by evident swelling and inflammation of the gums, it should be performed without delay. The prejudices which still exist against the opera- tion, greatly prevent the extension of its usefulness; but it is one which is perfectly simple and safe, when performed by anyone acquainted with the anatomy of the infant jaw, and the relative situation of the two sets of Teeth. The accidents which have been kn< wn to follow it, are among the common fruits ol ignorance and presumption It is so far from being The Teeth. 229 painful or cruel, as is by many supposed, that infants, which a moment before were writhing and crying with pain, are sometimes known to laugh in the face of the operator before he has finished the incision; so sudden, and so great, is the relief which they ex- perience. DISEASES OF THE TEETH. The diseases to which the Teeth are subject, attack them in various ways, and present very differ- ent appearances. In some instances, owing to the peculiar nature of the disease, or the constitution of the Teeth, they are destroyed without causing any considerable degree of suffering, or giving rise to any disease of the surrounding parts; in others, not only the Teeth are affected in the most troublesome and painful manner, but the diseases originating in them, are extended to the gums, palate, tongue and other parts of the mouth, producing fungous and fleshy tumours about the gums and cheeks, deep- seated abscesses, and caries or rottenness of the bones. The Teeth, owing to their particular nature and situation, are subject to some diseases which are peculiar to them, and to others which are of a cha- racter very similar to that of the diseases which affect other bones. They are also, like most of the other bones, liable to fracture, dislocation and other accidents. Hence it must be evident, that in some instances, they will require a peculiar treatment, while in others the same surgical principles must bo adopted, which are observed in the treatment of dis- eases and accidents of the other bones. 230 Compendium of Domestic Medicine. The first disease to be mentioned, and that which is by far the most common, is caries, or rottenness of the Teeth. This commences in different parts of the Teeth, and is produced by several causes. It some- times commences in the internal part of the crown, and gradually extends till much of this portion of the tooth is destroyed. The enamel is rendered thin by the progress of the disease w ithin, and finally breaks by a very slight pressure. In other cases, its first effects are discovered on the enamel, which is dis- coloured, and becomes of a black or brown appear- ance ; its substance is decomposed, and in many cases it cleaves from the bony portion of the tooth, by which the progress of decay is for a long time arrest- ed; but more frequently, when suitable means are not adopted to prevent it, it soon extends from the enamel to the softer and more sensibly organized parts of the tooth. In all cases, black and uneven cavities are pro- duced, which serve to give lodgement to particles of food; and these, mixing with the fluids of the mouth, readily undergo a putrefactive process, and hasten the destruction of the Teeth. By the progress of caries, also, the principal nerves, which supply the natural cavity in the tooth, become exposed not only to sudden changes of temperature, but to pressure from mastication, to the irritating contact of the tooth-brush, tooth-pick and other suo- stances; and hence, pain and inflammation are pro- duced, and the extraction of the tooth very commonly becomes the only means of preventing continued suffering. Causes of Caries.-This affection of the Teeth is the consequence either of internal constitutional causes, or of those which are external and adventi- tious, and very commonly of both. Caries of the Teeth and even that of a peculiar character has Caries or Rottenness. The Teeth. 231 been so often traced through whole families, from one generation to another; that this disease must be considered hereditary, as much as any to which the human system is liable. In numberless cases, caries appears to be the effect of some serious disease with which the individual had been afflicted while the Teeth were in the early stages of formation. With regard to the local or external causes, they are most commonly found to be collections of earthy and other foul substances, which have been suffered to form and collect about the Teeth, and also the use of inju- rious tooth-powders and washes. Treatment of Caries.-Although some Teeth are so constituted as to possess but little durability, and after the destroying power of caries once begins to operate on them, they go on rapidly to decay, in spite of all the aid which science and skill can afford; still, there are comparatively but few instances in which seasonable and judicious treatment will not arrest the progress of disease; and even render Teeth serviceable for many years, which, ifneglected, would soon be entirely destroyed. In the treatment of carious Teeth, it is of the utmost service to remove, by means of suitable in- struments, the whole of the decayed portion in all cases, leaving at the same time as much of the sound part of the tooth as possible. If this be not done, little, if any service is rendered by any operation; and the Teeth go on to decay in the same manner after it has been performed as before. The surface of the tooth, where the decayed part is removed, should be left perfectly smooth, and if excavated, only in such a degree, that by the proper use of the tooth-brush, the lodgementof particles offood and other substances may be wholly prevented. Another mode of treating caries, and which most effectually prevents its increase, is that of filling the excavation, which has been formed by disease, with pure gold, or some other metallic substance. This operation, when properly performed, will generally 232 preserve the Teeth from ten to twenty, and some times even thirty years, in a sound and serviceable state; while at the same time it prevents all those unpleasant and painful occurrences to which a ca- rious and hollow tooth is constantly exposed. The author has witnessed the salutary effects of this practice, in cases where the Teeth had been filled with gold, for twenty and thirty years. In operations of his own, teeth have stood the test of twelve years without any apparent alteration; and cases are recorded, in which the gold has preserved teeth in a perfectly sound and useful state, for a period of forty years. When by caries the natural cavity is laid open, and the principal nerves are exposed, the tooth often becomes too tender to bear the pressure occasioned by mastication, or the sudden changes of tempera- ture, and it becomes painful from the slightest causes After the disease has proceeded thus far, the Teeth may often be saved by filling them with gold, the nerves which supply the natural cavity first being destroyed. This the patient may do gradually, by carefully cleansing the cavity of the tooth of every thing which may be lodged in it, and applying a little lint soaked in some essential oil, as that of cloves or cajeput. which, if renewed two or three times a day, will, tn a short time, have the desired effect. The nerves of such teeth are also sometimes destroyed by the dentist, in a more expeditious manner, by the use of strong mineral acids, or by instruments designed for this purpose. Although, from the time of the earliest writers on diseases of the Teeth, the operations of sawing and filing those which are carious have been recom mended and practised, they are seldom of service, are often injurious, and, in most instances, to say the best of ttiem. are ineffectual and useless. The par- ticular objections to them will be noticed in some subsequent remarks on these operations Compendium of Domestic Medicine. The Teeth. 233 The disease, which has just been described, is .,ne which has its seat in the crown and neck of a tooth ; its progress being almost invariably arrested when it reaches the fang. But there are other diseases which attack this part, and which, though they do not so commonly occur, are not less destructive in their effects than caries. Cases of enlargement of the fangs, owing to an ac- cumulation of bony matter on various parts of them, are not uncommon, by which, not merely a single tooth is sacrificed, but one after another is lost, till, in some cases, the patient is deprived of the whole set, by this formidable and destructive disease. It commences with a dull pain in one side of the jaw, which at times appears to be fixed in some particular tooth. Soon after the Teeth which have been most painful are found to be loose, and the gums and alveolar processes are gradually destroyed or ab- sorbed, leaving the fangs without covering or sup- port; the teeth are thus rendered useless, and too troublesome to be borne, and must be extracted. A disease similar to one which affects the other □ones, and which has been called dry gangrene, sometimes fixes on The Teeth. It commences in the natural cavity of the tooth; the lining membrane and vessels connected with it are destroyed, and the crown of the tooth, before there is much pain, as- sumes a dark blue appearance. A degree of inflam- mation next commences in the articulating mem- brane which connects the fangs with their sockets- the gums acquire a dark red hue, are soft, and easily made to bleed. Matter is then formed about the roots of the tooth, and is discharged by small open- ings produced in the gums by the disease; and in this way the connexion of the tooth with the socket and the gums is destroyed, and the loss of it becomes inevitable. Diseases of the Fangs of the Teeth. 234 Compendium of Domestic Medicine. These diseases, with others of a similar nature, extend in some cases to the bones of the face, so that abscesses and caries of the jaw are often connected with them, particularly as consequences of neglect or improper treatment. The causes of these diseases, though for the most part obscure, are sometimes to be traced to a connec- tion with some constitutional affection, or to blows, falls and various accidents. In the early stage of these diseases, or when they are first discovered by the patient, extraordinary care should be taken to brush and cleanse the Teeth and gums, which should be done two or three times daily. Benefit will also be found from the use of an astringent lotion, of tincture of Peruvian bark and rose water, in equal quantities, or a decoction of marsh rosemary, in the proportion of one ounce of the dried root to a pint of water. When these dis- eases have so far advanced, as to become serious and painful, the patient must not expect to combat them with advantage, unaided by the advice and particular direction of an experienced surgeon, o dentist. And it is of importance that those who may suffer from complaints of the above description, should be cautioned against confiding in the advice of ignorant persons-mere tooth-drawers, and quacks. The former will generally affirm that nothing is to be done but to extract the Teeth, while the latter will be ever ready to apply their infal'ible nostrums accompanied with a profusion of promises to cure all complaints, even those which they are sometimes pleased to call cancers of the mouth. Writers on the subject, have generally mentioned this complaint as a particular disease; whereas, a moment's reflection will show us that it is only a common symptom of disease. Pain in the Teeth or toothach, is an almost invariable attendant on Toothach all the diseases which have been mentioned, and the inode of removing it varies with that of treating the different diseases of which it is a symptom. If it be induced by the exposure of the more sensible part of a tooth, as in case of caries, filling the cavity with gold, or the other methods of defending the nerves from the air, or destroying them, as mentioned above, will be sufficient to remove it. If it arise from in- flammation about the root of the tooth, the same means should be used to subdue it, as in other local inflammations; and hence, in such cases, we find that cold water, or vinegar, cold meal-poultices, or strong irritating tinctures to the face, and a full dose of Glauber or Rochelle salts, are the most effectual in removing the pain. The too common practice of holding hot stimulating substances in the mouth, serves but to prolong the suffering. A momentary relief only is obtained, while the tongue and cheeks are smarting with each renewal of the medicine, but no permanent ease is experienced, till, by long suf- fering, fasting and watching, the patient becomes exhausted, and the paroxysm terminates in sleep. Very severe and almost unexampled suffering is sometimes caused by certain nervous pains to which the Teeth are liable, not only when they are ca- rious, or otherwise diseased, but even when sound. These, however, are generally sympathetic, and may be traced to some change in the habit or circum- stances of the system, particularly those to which the female constitution is liable, or to some disor- dered nerve, or other local difficulty. Toothach from rheumatism, though rare, if the Teeth are all sound, is very apt to occur when any of them are diseased; and the pain is not then cori fined to the diseased Teeth only, but often extends o the sound ones, and even from the Teeth of one side of the jaw to those of the other. Toothach is also a common attendant on a dis- ordered state of the stomach and other digestive organs; and the suffering in these cases is generally The Teeth, 235 236 Compendium of Domestic Medicine. even more severe than when produced by othei causes, and is much less likely to be removed by any application made to the face or teeth only. When toothach is merely symptomatic of disease, or derangement in some other part or organ, it will most commonly yield to those remedies which are calculated to remove the original complaint. If, therefore, it be in consequence of nervous pains about the face, or ear, use some strong irritating tincture, as that of camphor, Cayenne pepper, or Hies, or the volatile liniment, applied externally; giving at the same time a moderate dose of lauda- num, and repeating it if required. Il it be attendant on a sudden atiack of rheumatism, it will often be wholly removed by a full dose of volatile tincture of guaiacum, a warm bath. If derangement of the ordinary functions of the stomach and bowels induce it, an emetic, or a dose of some active cathartic medicine will in general procure relief. These internal remedies, however (as well as most others of a very active nature, which are applicable to the abovementioned cases), should, as much as possible, be administered under the direction of a physician, in order to guard against error, in judging of the nature of the case, and in the choice of medi- cines most suitable. This is a troublesome, and often a very destruc- tive complaint, and one which does much injury to the Teeth, even before those who sutler from it are aware of any danger. It does not originate trom any particular state of the teeth alone, or from a disor- dered state of the gums and alveolar processes, as many are led to suppose; but isowing to an accu- mulation of earthy matter deposited from the saliva. With some individuals, it collects much faster than with others; so that, whereas one will have his Tartar, or Scurvy of the Teeth. The Teeth. 237 teeth completely encrusted with it in a few weeks, if the proper means be not daily used to prevent it, another will pass a long life without any care of his teeth, and tartar will not collect on them at all; so much does its formation depend on the natural, or constitutional state of the fluids of the mouth. The tartar is seen on some teeth of a black or greenish colour, and very hard; on others, brown or yellow, and not so firm in its consistency; but in all cases it is productive of incalculable injury to the Teeth, gums and alveolar processes. When it is first deposited on the Teeth, it is soft, and may be easily removed with a tooth-brush; but if suffered to remain, it soon acquires a stony hardness, and gra- dually increases in thickness about the necks of the Teeth; the gums become irritated and inflamed by it, the sockets are next destroyed, and the Teeth, being left without support, are often pushed out by the ordinary pressure of the tongue and lips. Tartar will in some cases collect to so great a degree on the Teeth of children as to produce a separation of portions of the jaw; and not only bring away the temporary teeth, but destroy those of the second set, which are beneath them. From this, and what has been before stateu concerning the bad effects of tartar on the Teeth, it will readily be per- ceived how important it is to arrest the progress of so mischievous a complaint, in its earliest stage. With regard to the treatment of these cases, if the tartar has been suffered to become so hard as to require much force to remove it, the operation should be carefully performed, and without injuring the enamel, as is sometimes done, by the use of acids and files, practices which cannot be too severely cen- sured. The Teeth should be perfectly cleared of this foreign matter by sharp, cutting instruments, of a suitable form to effect the object without wounding and lacerating the gums. For the purpose of pre- venting the tartar from collecting again (or indeed from forming in the first place), and for restoring the 238 Compendium of Domestic Medicine. gums to a healthy state, nothing more is requisite, generally, than the daily use of a stiff brush, and some suitable dentifrice (post page 245), or the as- tringent washes mentioned ante page 234. Many persons are in the habit of suffering their teeth to go without any efforts of their own for keep- ing them in order, and apply at stated periods to a dentist, to have the tartar removed from them; and this they do, no doubt, from the persuasion that it is all that is requisite for preserving them. But it may be important to state, for the information of those who are thus deceived, that the repeated collections of tartar, and frequent operations, do an injury to the Teeth which is not to be repaired by any sub- sequent care. The gums and alveolar processes are driven from them, they are deprived prematurely of that defence and support which these parts are de- signed to give, and are often lost many years before they would be, were a due degree of care bestowed on them. DISEASES OF THE ALVEOLAR PROCESSES. The alveolar processes commonly share in fhe dis- eases which affect the fangs of the Teeth; but cases in which they are primarily diseased are very rare. A compiaint which is most frequently met with in them, is a gradual decay, or wasting of the bony substance, attended with a certain degree of inflam- mation of the contiguous parts. A little pain, or uneasiness and swelling of the gums, are first expe- rienced; the bone or process after this is very rapidly absorbed; the affected teeth become loose, and ap- pear to be thrust forwards and out of their sockets, so that they are much longer than the rest. These cases, and particularly such as extend to the sockets of many or all of the Teeth, appear often to be caused by, or dependent on, a rheumatic or gouty affection of the whole system In the early The Teeth. 239 stage of the disease the patient should take extraor- dinary care in brushing and cleaning The Teeth daily; and he may also use with advantage, the astringent washes recommended in the preceding chapter; by which, the progress of the disease will be much retarded, and the suffering greatly diminished. Preternatural enlargements of the alveolar pro- cess, or bony tumours, are sometimes found to arise on the jaws. They may readily be distinguished from those of a different nature, by their being much harder, and immovably fixed to the hone. They are not to be dissipated by any application made to the part, or by any internal remedy; and all attempts to do it, are, at best, but useless, and for the most part hazardous. In these cases, as in all others, the interference of quacks cannot be too scrupulously avoided, and the advice of an experienced surgeon should be seasonably obtained. Tumours of this kind do indeed increase very slowly, and if season- ably removed, are seldom injurious in their conse- quences. The fatal effects which they have some- times been known to produce, have been in con- sequence of deferring too long a safe and simple operation. Caries of the alveolar process is a common occur- rence, but it generally arises from some disease which has commenced in the Teeth, and from va- rious accidents to which these processes are liable in common with other parts. The patient has little to do for himself in these cases; they for the most part require surgical aid, and to be treated according to general surgical principles 240 Compendium of Domestic Medicine. Inflammation and Sponginess of the Gums. DISEASES OF THE GUMS. This is the most common disease to which the gums are liable, and which, indiscriminately with that state of the Teeth which is produced by the accumulation of tartar, is often called scurvy. The effects of this disease are, a swelling of the gums, with a dark red, unhealthy appearance, great ten- derness, and liability to bleed. In very bad cases the gums are surprisingly thickened, and rise nearly to the tops of the Teeth. If the gums are suffered to remain for a length of time under the effects of this disease, the sockets of the Teeth are destroyed by absorption and ulceration, and the Teeth them- selves drop out. The ordinary causes of the disease are, collections of tartar on the Teeth, long neglect of brushing the Teeth and gums, even when there is no tnrtar firmed, the use of mercury, and a scorbutic state of the whole system. In order to prevent the ravages which this disease soon makes, if neglected, the gums should be brushed two or three times a day with the astringent washes which have been mentioned above. Powders, con- taining Peruvian bark, are often recommended ; in the worst cases, however, and particularly in those which have been caused by the use of mercury, which renders the gums very irritable, no powders should be used; but alternate mild and astringent lotions, such as warm water, or milk and water, fol- lowed by the application of a decoction of rosemary root, or hyson tea, the tincture of Peruvian bark, or a solution of alum, in the proportion of one drachm to a gill of waler. If the inflammation and swelling of the gums be nroduced by the accumulation of tartar, which is the The Teeth. 241 most usual cause, this substance should be imme diately removed. Gum-Boils. Small abscesses of the gums often appear over the roots of the Teeth, which are commonly called gum- boils. They do not, however, originate in the gum. but are produced by disease in parts beneath, most commonly by ulceration at the fang of a carious tooth. After matter is formed at this part, the inflammation is extended to the gum, and the process of ulceration is continued till the matter is discharged. After gum-boils have been thus produced, they often re-appear from very trifling causes, till a per- manent abscess is formed, from which matter is daily discharged. Although with some individuals these may remain for several months, or even years, with- out producing any serious consequences, particularly if the constitution be perfectly healthy; yet the inju- ries which sometimes result from them show, in a manner too painful and troublesome to be forgotten, that they deserve early and particular attention. It is important in all cases to open these abscesses with a lancet, to allow the matter to be discharged as soon as it is evidently formed; and when a permanent cure is not to be obtained, except by extracting dis- eased Teeth or stumps, this operation should be per- formed without delay. The operations which are required in the treat- ment of these cases, if attended to in season, are most of them too slight to be feared, and all of them much less painful than the extraction of a bad tooth Preternatural enlargements of the gums are not uncommon. They proceed from various causes, but generally from diseased Teeth; and are seldom to be cured till these are extracted. Tumours of the Gums. 242 Compendium of Domestic Medicine. Tumours of the gums are either of a soft spongy texture, or of a more firm and fleshy nature, some- times nearly of the consistence of cartilage. All of them expose the patient to other and more serious evils, by causing a disease of the jaw, more or less extensive. The hard, fleshy, or cartilaginous tu- mours are not so common as those of the opposite nature; but their consequences are much more to be dreaded, if they are not early extirpated. They are sometimes found to be connected with a pre-existing disease of the jaws and Teeth, and at others, arise without any discoverable cause. In all these cases the speedy removal of the tumour (by the use of caustics, the ligature, or the knife) is the only plan of treatment on which we can reasonably depend for success. In some instances, however, the lace- ration produced by extracting Teeth which were enveloped in such tumours, has proved an effectual remedy. CLEANING THE TEETH. Highly important as this operation is to every in- dividual, there are too many who neglect it; and, simple as is the process, there are many who, from habit, prejudice, or want of correct information, fail of performing it in a proper manner. As soon as the crowns of the first four permanent incisors, or front Teeth, have fully advanced through the gums, children should be provided with a suita- ble tooth-brush, and be taught the use of it. There are but few persons, whose Teeth do not require a considerable degree of care to keep them in a heal- thy and sound slate, and more particularly to protect them from the rapid and injurious effects of caries, after they have become affected with this disease. For many, the daily use of the brush and cold water is all that is required to keep the Teeth in perfect order; but most commonly, to effect this purpose, the The Teeth. 243 use of dentifrice of some sort is found to be indis. pensable. With regard to the use of a brush, a moderately stiff one should be employed; for a brush may be too soft to be of any service, or so hard as to irritate firm and healthy gums. The Teeth should be brush- ed both morning and evening, but more particu- larly in the morning, as the causes which favour the accumulation of tartar operate most powerfully during the hours of sleep. Brushing them once a day, however, if it be done faithfully, is preferable to many hasty and imperfect attempts to clean them. Merely to pass the brush a few times hastily over the teeth, is of little service; five minutes or more should be diligently spent in performing this opera- tion. It is also a very useful practice, to brush the Teeth always after eating, particularly if they are very uneven, or affected with caries. The idea that the enamel of the Teeth can be in- jured by brushing, is as false and ridiculous as it would be to suppose that the palms of the hands may be worn out by moderate labour. The brush should not only be passed from side to side of the mouth, on the outer surfaces of the Teeth, but on the inner parts of them, next the tongue and roof of the mouth; also upwards and downwards, from the gums of one jaw to those of the other When the Teeth have been seasonably attended to in the manner above directed, the necessity for using dentifrice or tooth- powder, is very much diminished, if not wholly su- perseded ; and there will be no case in which the use of it will be required oftener than once or twice a week. It should be remembered that it is not by merely spreading the powder over the surfaces of the Teeth with the brush, and then rinsing it off, that it is to have its proper effect; but by faithfully rub- bing it for several minutes on all parts of the Teeth which are exposed to the action of the brush, taking care afterwards to remove every particle of it by the use of the brush and water, because, if left to lodge 244 about the Teeth and gums, it aids the formation of tartar. The water may be used cold or warm, as can best be borne, but cold is preferable. Care should be taken in providing tooth-powder that it do not contain any substance that will act either chemically or mechanically on the Teeth, to injure them. Emery, pumice stone, and various acids are not unfrequently detected in those denti- frices and washes for the Teeth and gums, which are advertised as infallible in rendering the Teeth sur- prisingly white, dissolving and removing tartar, pre- venting decay, toothach, fyc. <fc. These may im- prove the appearance of the Teeth for a day, but in many instances ruin them for ever. Many persons, ignorant and unsuspicious of any evil consequences, are induced to use acids, some- times concentrated lemon juice, but more generally diluted vitriol, because they give the Teeth at once a beautiful white appearance. But few, however, have done this, without having to lament a most serious injury, or the total loss of their Teeth; for in a short time, they become of a dead chalky white, soon turn dark coloured, and be- gin to decay and crumble to pieces, leaving the fangs in their sockets, more generally exposed to pain and inflammation, than if the crowns had been destroyed by any other cause. These baneful effects of acids cannot be too strongly impressed on the mind of every one; for they are so often used by the unwary, even at the present day, that scarcely a week passes, in which the writer has not an opportunity of wit- nessing some new case of the evils sustained by the pernicious practice of cleaning the teeth with an acid lotion of dentifrice. We present to our readers the following recipe for a tooth-powder, which we can conscientiously recom- mend, for keeping the Teeth clean and rendering them white. It is perfectly harmless; and few per- sons will find it necessary to use it oftener than three times a week. Although a little used every morn- Compendium of Domestic Medicine. The Teeth. 245 ing will be found beneficial. Any one can have it manufactured by a druggist from the subjoined recipe:- Powdered Orris Root, 4 ounces, Prepared Chalk, 4 ounces, Powdered Cinnamon, $ ounce, Bicarbonate of Soda, i drachm, Oil of Rose, 2 drops.-Mix. In order lo cleanse and preserve artificial Teeth, the above directions should be carefully observed. It is necessary to add, however, that these Teeth require more frequent attention than natural ones, and that they should always be cleaned with a soft brush, and the mouth be rinsed thoroughly at. least three times a day, particularly after eating. If they are well made and well set, they will bear this treat- ment; and will appear better and last longer in con- sequence of it. OPERATIONS ON THE TEETH. The remarks which I shall offer under this head are not made with a view to describe particularly the various operations which are required in the treatment of diseases of the Teeth, but rather to no- tice some circumstances connected with a few of the most common of them, which it is important should be more generally understood. Extraction of the Temporary Teeth, when Diseased The temporary, or first Teeth, become often very soon diseased, and require an operation, that of plugging, extraction, or the removal of tartar. The importance of the latter will be seen by adverting to the observations on scurvy, ante page 237. With regard to extracting the temporary Teeth, it should be remembered, that a child ought not to be depri- ved of them without due consideration. If at the 246 age of four or five years, the front, or even the ca- nine Teeth, become carious, as they often do, they may be extracted; but much better it would be to have them properly filled, and if, at this early pe- riod, the double Teeth are found to be decayed and painful, it will be advisable to defer extracting them as long as is consistent with safety, and at the same time to employ all suitable means to allay the pain, and to have the Tooth or Teeth cleaned from the decay and filled with gold. If there be inflammation and swelling of the jaw and face produced, the removal of the affected teeth should be no longer delayed; as deep abscesses, which break externally through the cheek, are not unfrequently the consequence; and ulceration, when it takes place, and exists for any considerable time about these teeth, is known even to injure the per manent ones which are forming beneath them. Lancing, or Cutting the Gums, at the time of Teething. The salutary effects of this operation were noticed in the remarks on Diseases of Dentition (ante page 226); and they will be very generally perceived, when it is performed at a suitable time, and in a proper manner. It should never be done, excepting when there is evident swelling of the gums over the expected teeth, attended with undoubted signs of inflammation. These, however, should be ascer- tained by the surgeon, and not by the parents or nurses. Ineffectual and repeated operations will then be prevented; and it will only be requisite that the lancet should be used by some one familiar with the anatomy of the infant jaw. and with the relative situation of the two sets of Teeth at this period. As this treatise may occasionally fall into the hands of physicians, it may not, perhaps, be wholly unim- portant, that we should address to them, a few obser- vations on the above mentioned operation. Nothing, but an essential difference in performing Compendium of Domestic Medicine. rhe Teeth. 247 the operation, could have given nse to the very op- posite opinions, which have been, and still are, entertained by physicians with regard to its utility For, while many are fully convinced of its beneficial effects, some consider it as altogether useless, and others condemn it as injurious. When it is considered advisable to cut the gums, it should be done with a common broad-edged gum- lancet, and the incision made immediately over the Teeth which are about to appear, but over no others. The gum should not merely be scarified, but cut entirely through, as also the investing or capsular membranes, till the lancet is felt to grate against the enamelled surface of the Tooth. Should the edge of the lancet be placed a little too far towards the inner part of the jaw, particularly in cutting for the front and canine Teeth, although we may divide th« gum, and feel that the edge of the instrument is re sisted by bone, it will probably be no other than the internal plate or transverse portions of the alveolar processes, and the objects of the operation will not ne obtained. Some relief may be produced for a little while by the bleeding, but more frequently, the irritation of the pirns will be increased. Besides, by making the incision in this manner, there is dan- ger of dividing or injuring the membranous and vascular connexion between the first and second sets of Teeth, and thereby injuring or destroying the permanent ones entirely. Therefore, in order to prevent any injurious consequences, as well as to render the operation most serviceable, the incision should be made towards the external plate of the alveolar processes, so as to avoid the connecting membranes and sacks of the permanent teeth, par- ticularly those of the incisores and cuspidati. Those of the bicuspides are more easily avoided, on account of the flat and broad surfaces of the temporary grin ders. 248 Compendium of Domestic Medicine. Filing or Sawing the Teeth. This operation is often performed with a view to remove the black and defective parts of carious teeth, and to separate them in such a manner that the excavation formed by the disease may be more ex|K>sed to the action of the tooth-brush; but in a majority of cases these purposes cannot be effected either by saws or fdes, the operation will therefore be unavailing, and the hopes of the patient disap- pointed. The particular objections to the use of these in- struments are : 1. That they do not remove the whole of the decay- ed parts of the Teeth; and it is a fact sufficiently evi- dent to common observation, that the disease of caries is often communicated from one tooth to ano- ther by contact; and it is equally true that while any of the defective part of a tooth is suffered to re- main, the liability of that tooth to decay is much greater than if this part were entirely removed. 2. That in all cases, the effect of sawing or filing is to deprive the Teeth, unnecessarily, of a great portion of their sound enamel, particularly when these operations are performed on the front teeth. 3. That the crowns of the Teeth being broader than their fangs, they often crowd together in such a manner, that, by the repeated operations of filing to keep them separated, one quarter and sometimes one third of each tooth is sacrificed, by the use of these improper instruments. 4. That separating sound teeth with the file or saw (or indeed with any other instrument) is a practice for which there can be no reasonable apol- ogy. The idea that they may be too close, and injure each other by lateral pressure, is altogether errone- ous ; and there are no just grounds for the belief, that, by this operation, they may be prevented from de saying. To these objections we may add, that filing the Teeth always gives them a square and artificial ap- pearance, and is one of the most disagreeable, and often painful, operations that is performed on them to many persons, even worse than that of extraction As a substitute for files and saws, it is now recom- mended to use, in the operations for caries, small crooked knives, and other cutting instruments, which are liable to none of the above objections, and which enable the operator to effect the first, and also the most important objects in the treatment of this dis- ease. The Teeth. 249 Filling Teeth with Gold or other Metal*. This operation, which is called plugging the Teeth, is performed for the purpose of rendering teeth which have begun to decay more lasting and serviceable; and when it is seasonably and properly performed, it is effectual in preserving them for many years, very commonly from ten to twenty, and in some cases even forty years. There are often cases in which the diseased tooth will not bear the pressure which is required to fill it properly with gold; and then an amalgam of mercury and tin may be used in its stead. It is therefore best, in all cases where it is practicable, to use pure gold, which is too hard to be worn away by the ordinary process of mastication, and which will not be changed in its properties, or corroded, by any article of diet or medicine, ex- cepting mercury, when its use is long continued. 250 Compendium of Domestic Medicine. Although every person may prevent the accumu lation of tartar upon his teeth, by the means pointed out in the preceding pages, and may even remove i after it has acquired a very considerable degree of firmness ; yet it is very often allowed to collect for so great a length of time, and to become so hard, that an operation under the hands of the dentist is the only remedy. The doubts that are by some enter- tained concerning the necessity or usefulness of re- moving the tartar, originate in an imperfect know- ledge of the nature of the case, and from accounts of injurious treatment by ignorant operators. The effects which have followed the use of acids and files, to dissolve and remove this substance, have not failed to destroy the confidence of those who have ever submitted to such impositions. The operation, if skilfully performed, is simple, and seldom painful; and will always be of service while the Teeth retain a sufficient degree of attach- ment to their sockets to make them worth preserving. It should be performed in the manner which has been directed at page 237; and the mode of treat- ment there prescribed for preventing the necessity of its repetition, will, if adopted, always be effectual. Scaling the Teeth, or the Removal of Tartar. Extracting Teeth. There is probably no surgical operation which is not of a very serious or dangerous nature, that is so much dreaded as the extraction of teeth. Yet it is not always so much the fear of pain, provided the tooth be well extracted, as that of having it broken, the jaw fractured, or the instrument slip or break in the operation. These are accidents, however, which seldom happen in the practice of a skilful operator; The Teeth. 251 but are generally attributable to ignorance or care- lessness. There are, indeed, circumstances some- times connected with every kind of surgical operation which increase the difficulty of performing it, and which are not in all cases to be foreseen; yet they are extremely rare, and when they do occur, if science and skill be engaged, unfavourable results are often prevented. The accidents above mentioned do indeed too often happen; and they must continue to occur, while the operation is entrusted to persons merely because they have strength enough to extract a tooth, and presumption enough to undertake it. Many are willing to believe a man sufficiently skilled in this operation, because he can make the instru- ments with which it is performed; but who would employ a person to remove a wen, amputate a finger, or open a vein, because he could manufacture a knife or a lancet? An idea is erroneously entertained, by many, that the instruments which are in common use for ex- tracting teeth are imperfect; but this is not the case On the contrary, the Key, the Forceps, the Hook, and the Graver, or what has been improperly called the Punch, though simple instruments, are all very per- fect in their construction; and, in their present im- proved form, are calculated to separate a tooth from its socket with as much safety and dispatch, and with as little pain, as are consistent with the nature of the operation. Much time has been expended, and great ingenuity exerted, to produce an instrument for extracting the double teeth in a. perpendicular direction; but every contrivance of this sort has been calculated to ope- rate by making pressure on one or more of the Teeth next that which is to be drawn. This circumstance has shown such instruments to be in a great degree useless, on account of the frequent unsoundness or looseness of the Teeth on which the required press- ure must be made, or the defective stale of the tooth 252 Compendium of Domestic Medicine. to be extracted. Besides, these instruments are un- avoidably large, and sometimes so complicated, that their application is inconvenient, and the operation necessarily slow and painful. artificial teeth. The early loss of the natural teeth, which is often occasioned by disease, or by various accidents, and the pain and inconvenience which many individuals thereby experience, may be greatly diminished by the use of artificial teeth, provided they are well made and judiciously set Artificial teeth have been in use for many years, and have been formed of various animal and min- eral substances, such as human and animal teeth, ivory, bone, Ac. These have, however, given way in the present day or more modern times to the porcelain teeth, composed of mineral substances, the manufacture of which has been brought to such a high state of perfection that it requires no small degree of acuteness of observation to distinguish them from extremely natural teeth. And they may now be set so firmly as to be very useful, both in eating and speaking, as well as ornamental. Artificial teeth may be set from one to any num- ber required. They may be secured by wooden pivots to the fangs or roots of decayed teeth which are left in the jaw, or to the remaining natural teeth by clasps around them, or be fas- tened to a plate of rubber, silver, gold, or plati- num, which is held in the mouth by suction; and they may be set generally without giving any pain or uneasiness. INDEX. Abdomen, Dropsy of, 73 Abscess, 116 Psoas,117 Accidents, 122 Compound, 143 Affection of Nerves of Face, 93 Ague Cake, 59 Amputation, 143 Aneurism, 111 Angina Pectoris, 94 Anodyne Clyster, 160 Apoplexy, 88 Artificial Teeth, 252 Asiatic Cholera, 163 Asthma, 47 Bladder, Inflammation of, 70 Stone in the, 72 Brain, Compression of, 125 Concussion of, 124 Inflammation of, 37 Beds for Travellers, 19 Bleeding, 154 from the Nose, 41 Piles, 116 Bilious Fever, 30 Blind Piles, 116 Bites of Dogs, Ac., 130 Blindness, Night, 40 Boils, 114 Bougies, 155 Blood, Spitting of, 49 Vomiting of, 56 Blotched Face, 106 Bubo, 78 Burns, 152 Cancer, 87 of Lip, 42 of Penis, 78 of Testicle, 80 of Tongue, 43 Catarrh, 47 Chancre, 78 Cramp in the Stomach, 53 Cartilage in the Joints, 85 Carbuncle, 114 Carious Ulcer, 121 Catalepsy, 90 Catheters, 154 Charcoal Poultice, 168 Cramp, 91, Chest, Dropsy of, 51 Cleaning the Teeth, 242 Chicken Pox, 100 Contents, 5 Colds, 47 Consumption, 49 Cholera Morbus, 60 Colic, 64 Painter's, 65 Chronic Rheumatism, 83 Cholera, 163 Compression of Brain, 124 Concussion " " 125 Contusion, 123 Contused Wounds, 129 Compound Accidents, 143 Cow Pox, 100 Dance of St. Vitus, 95 Diarrhoea, 63 Diabetes, 73 Difficulty of Urine, 70 Dimness of Sight, 39 Diphtheria, 45 Diseases of Alveolar Pro- cesses, 238 Gums, 240 Dislocations, 139 Lower Jaw, 140 Collar-bone, 140 Shoulder, 140 Elbow, 141 Wrist, Ac., 141 Thigh, 142 Knee-cap, 142 Leg, 142 Foot, 142 Division of Diseases, 23 Drowning, 143 Dropsy of the Abdomen, 73 Chest, 51 Knee-joint, 84 Dropsy of the Scrotum, 79 Dyspepsia, 174 Dysentery, 61 Ear, Inflammation of, 40 Eye, « " 38 253 254 Effervescing Mixture, 156 Emissions, Involuntary, 77 Encysted Tumours, 113 Emollient Clyster, 160 Enlargement of Uvula, 43 Enlarged Spleen, 59 Spermatic Vein, 80 Epilepsy, 90 Erysipelas, 96 Mercurial, 98 Extracting Teeth, 250 Fainting, 88 Flannel, 17 Face, Affection of Nerves of, 93 Fractures, Arm, 135 Collar Bone, 135 Foot, 138 Fore-arm, 136 Knee-cap, 137 Lower Jaw, 134 Leg, 138 Nose, 134 Ribs, 136 Thigh, 137 Wrist, 136 Felons, 115 Fever, 26 and Ague, 28 Bilious, 30 Hectic, 36 Intermittent, 28 Low Nervous, 32 Putrid, 34 Remittent, 30 Simple Inflammatory, 27 Scarlet, 95 Typhus, 32 Fleshy Tumours, 112 Fistula, 118 Fits, 90 Foreign Bodies in Throat, 151 Fungous Ulcers, 119 Ganglion, 113 Glands, Inflamed, 86 Gravel, 68 General Rule, 15 Gleet, 76 Goitre, 88 Gonorrhoea, 75 Gout, 81 (turn Boils, 241 INDEX. Hartshorne's Decoction, 160 Headache, 38 Sick, 191 Heartburn, 54 Heart, Palpitation of, 50 Hectic Fever, 36 Herpes, 103 Hiccough, 53 Hints to Travellers, 17 Invalids, 21 Hip-joint Disease, 84 Introduction, 15 Indigestion, 54 Inflamed Glands, 86 Ulcer, 119 Inflammatory Fever, 27 Rheumatism, 82 Sore Throat, 44 Inflammation of Brain, 37 Bladder, 70 Ear, 40 Eye, 38 Intestines, 59 Kidneys, 68 Liver, 56 Stomach, 52 Influenza, 47 Intermittent Fever, 28 Impotency, 81 Incontinence of Urine, 72 Incised Wounds, 127 Indolent Ulcer, 120 Intestines, Inflammation of, 59 Involuntary Emissions, 77 Irreducible Ruptures, 109 Itch, 103 Jaundice, 57 Joints, Cartilage in, 85 Kidneys, Inflammation of, 68 King's Evil, 86 Knee-joint, Dropsy of, 84 Lancing the Gums, 246 Lip, Cancer of, 42 Liver, Inflammation of, 56 Locked-jaw, 92 Low Nervous Fever, 32 Measles, 99 Mercurial Disease, 79 Mercurial Erysipelas, 98 Ulcers of the Mouth, 42 Medicines for Travellers, 18 Mortification, 153 Mouth,Mercurial Ulcers of,42 Nettle-rash, 105 Night-Blindness, 40 Node, 78 Nose, Bleeding from, 41 Painter's Colic, 65 Palpitation of Heart, 50 Palsy, 91 Preface, 3 Penis, Cancer of, 78 Pleurisy, 48 Prescriptions, 156 Piles, 115 Blind, 116 Bleeding, 116 Pimples on the Tongue, 42 Poisoning by Acids, 146 Alkalies, 147 Antimony, 148 Arsenic, 147 Bismuth, 148 Copper, 148 Lead, 150 Liver of Sulphur, 149 Lunar Caustic, 148 Mercury, 147 Mushrooms, 151 Opium, 150 Phosphorus, 149 Powdered Glass, 150 Poisonous Fish, 151 Salts of Tin, 148 Saltpetre, 149 Sal-Ammoniac, 149 Spanish Flies, 149 Tobacco, 151 Polypus, 41 Poultice, Charcoal, 160 Yeast, 160 Rye Meal, 160 Psoas Abscess, 117 Pulse, The, 25 Putrid Fever, 34 Sore Throat, 45 Punctured Wounds, 129 Purgative Clyster, 160 Rash, Nettle, 105 INDEX. Remittent Fever, 30 Reducible Ruptures, 108 Rheumatism, Inflammatory, Chronic, 83 Ringworm, The, 105 Round, 67 Rules, General, 15 for invalids, 21 Ruptures, 108 Irreducible, 109 Reducible, 108 Strangulated, 109 Rye-meal Poultice, 160 Saline Mixture, 156 Scalds, 152 Scald Head, 104 Scaling the Teeth, 250 Scarlet Fever, 95 Small Pox, 101 Strangulated Rupture, 109 Sprains, 124 Spermatic Vein, Enlarged, 80 Spleen, Enlarged, 59 Steatomatous Tumours, 112 Swelling of Tonsils, 44 White, 85 Sick-headache, 191 Symptoms, 192 Medicines, 193 Diet, 196 Drinks, 203 Exercise, 206 Change of Air, 207 Other Cautions, 207 Sight, Dimness of, 39 Simple Inflammatory Fever, Scirrhus, 87 Stings of Bees, Ac., 131 Spitting of Blood, 49 Strictures, 77 in the Throat, 46 St. Anthony's Fire, 95 St. Vitus' Dance, 95 Scorbutic Ulcer, 121 Scrofula, 86 Scrofulous Ulcer, 121 Scrotum, Dropsy of, 79 Scudamore's Lotion, 159 Scurvy, 106 Sloughing Ulcer, 120 Stone in the Bladder, 72 255 256 Stomach,Cramp in the, 53 Inflammation of, 52 Sun-stroke, 89 Suppression of Urine, 71 Suspended Animation, 143 from Cold, 145 Drowning, 143 Foul Air, 145 Hanging, 145 Syphilis, 77 Tape-worm, The, 67 Tartar of the Teeth, 236 Travellers, Beds for, 19 Cold, 20 Flannel, 17 Hints to, 17 Medicines, 18 Night Air, 20 Towels and Soap, 19 Water, 19 Teeth, The, 212 Caries of the, 230 Diseases of the, 229 Formation, 218 First Dentition, 223 Shedding the, 220 Structure of the, 213 Testicle, Cancer of, 80 Tetanus, 91 Throat, Inflammatory Sore, 44 Putrid Sore, 45 Strictures in, 46 Tobacco Clyster, 160 Tooth-ache, 234 Tongue, Cancers on, 43 Pimples on, 42 Ulcers on, 42 Tonsils, Swelling of, 44 Tumours, 108 Encysted, 113 Fleshy, 112 Steatomatous, Tympany, 75 INDEX. Typhus Fever, 32 Ulcers, 119 Fungous, 119 Indolent, 120 Inflamed, 119 Mercurial, of Mouth, 42 " " Tongue, 42 Scorbutic, 121 Scrofulous, 121 Sloughing, 120 Venereal, 121 Urine, Difficulty of, 70 Incontinence of, 72 Immoderate flow of, 73 Suppression of, 71 Uvula, Enlargement of, 43 Venereal Ulcers, 121 Warts, 79 Vinegar Whey, 157 Vomiting of Blood, 56 and Purging, 60 Wine Whey, 157 Whitlow, 115 White Swelling, 85 Worms, 66 White Thread, 67 Wounds, 125 Contused, 129 Incised, 127 Punctured, 129 Poisoned, 130 of the Abdomen, 132 Chest, 132 Ear, 131 Joints, 133 Limbs, &c., 131 Scalp, 131 Tendons, 133 Throat, 132 Yeast Poultice, 160 THE END. A GREAT ATLAS of the WORLD! ISSUED IN NUMBERS, AS A COMPANION TO ZELL'S ENCYCLOPEDIA. THE MOST ARTISTIC, THE VERY BEST, THE MOST RELIABLE, THE MOST RECENT. EACH MAP WILL HAVE WITH IT AN ALPHABETICAL INDEX, Containing every City, Town, County, Diver, Lake, Bay, &c., &c., which occurs upon the Map. 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