WBA 1835 W WW &A&J6 . •*?:!• ISEfi SURGEON GENERAL'S OFFICE LIBRARY. Section,........---------------- A v DOMESTIC GUIDE TO MEDICINE, BT WHICH INDIVIDUALS, BOTH MALE AND FEMALE, ARE ENABLED TO TREAT THEIR OWN COMPLAINTS ON A SAFE AND EASY PRINCIPLE, BY DR. RAirn, Graduate of the University of Edinburgh ;—Member of the Royal College of Surgeons, London; (Lecturer on Midwifery and the diseases of Women and Children,)—&c. &c. &c. TO THIS IS PREFIXED A FEW REMARKS ON THE UNIVERSAL DOMESTIC MEDICINE OF THE AUTHOR, (Formerly the Improved Hygeian Pills ;) SHOWING THAT THIS MEDICINE IS FOUNDED ON THE PREVAILING DOCTRINES OF THE Brit. College of Physicians and Surgeons, London. Xeto ¥orU: Sold by the Author at the General Office of the Domestic Medicine (late Improved Hygeian Pills,) 38 Courtlandt-street; as well as by most of the principal Booksellers in New York and elsewhere. Merchants and Country Booksellers supplied by any of the following Whole- balf. Agents for the Domestic Medicine, on the same terms as at the Gene- ral Office. Sickles & Co. New Orleans;—Graves & Findlev, Charleston;— Woodruff & Co. Mobile;—W. H. Mead, Raleigh, N. C.;—0. A. Strieker, Richmond, Va.;—Wm. Stabler, Alexandria, D. C;—Wm. L\ Pettet, Louis- ville;—Wm. Holloway, Baltimore;—G. W. Carpenter, 301 Market street, Philadelphia ;—and others. ^833. f ^r'.NcRJ-L.V'f" FEB.1--!»02 \MBJt, !- |433o, likewise, in the beginning of every complaint, be it what it may, it is always proper and advantageous to begin the treatment with a suitable and active purging medicine; nay, not only do all com- plaints proceed with greater mildness, but many are cut short at once by a purgative operation ; and much sickness, danger, and perhaps death, is thus prevented. Again, in those complaints called Chronic, such as Dyspepsia, Nervous, &c., as well as those which affect the he,ad, and especially in complaints peculiar to the Female constitution, there is always a connection, more or less, with some disturbance of the organs of digestion; so that by restoring the stomach, the liver, and the bowels, to their healthy and natural condition, the cure of these is more safely and successfully attempted than by any other means. For these reasons, also,—that is, first, because so many complaints are perfectly cured by this Domestic Medicine, alone; and next, be- cause the disorders which need the aid of other remedies, are like- wise essentially assisted by this, the Title of Universal Domestic Medicine, is preferred to its former name, Hygeian. Indeed, with respect to the word Hygeian, it is proper to observe, that since the serious consequences have come to light resulting from the sale of Pills called Hygeian, this name is rapidly sinking into disreputation. And, in addition, there has now arrived from the metropolis of Lon-> 10 don, a fresh supply of speculating Agents of a new description; these, with impostors of every kind, all use the word Hygeian, or Original Hygeian,—so that the very name has become a reproach with men of understanding and discernment. These persons do not succeed in places where their different trades and occupations are known, but in country towns, as well as in the Southern and Western States, they possibly might succeed. In order, therefore, to avoid the con- fusion and serious consequences which might otherwise ensue, it has been deemed advisable to renounce the word Hygeian altogether, and to substitute the more plain and appropriate title of RalpWs Universal Domestic Medicine. It may further be remarked, that it has been the constant object of the author to make this little book as plain and interesting to every class of private and domestic readers as it possibly could be made ; but, there are some particular classes of society to whom he trusts it will prove especially acceptable. To those, for instance, who re- side in country places, away from medical assistance, it must prove a valuable treasure. Not only will such possess a general remedy, but will also understand the nature of disease, and the principle on which its cure should be conducted. For the same reason it will be found a valuable guide to those who go to sea, especially if bound to warm climates, in which the fiver is so apt to be affected. In this little volume their peculiar circumstances of want are carefully anti. cipated and provided for ; so that diseases may be treated as well, and sometimes even better, at sea, than on shore. Certainly, no Captain should leave port without a few packages of these pills in his possession, while the Treatise will give to his medicine-chest a tenfold usefulness. But there is another class to whom this little Treatise, together with the pills, will prove at once a physician and a friend ; we allude to the female sufferers. Many of their complaints are of a nature so delicate as to be far more properly treated by themselves than any other person. To such it will be satisfactory to know, that the hints which are delicately conveyed in these pages are yet suffi. cient to enable them to undertake the treatment of many complaints which it would be painful to mention to another. Now, in what has been said, the author trusts that he shall not be 11 charged with a design of depreciating the usefulness and character of medical men ; very far from this; no man has a higher consciousness of their general merit and integrity ; and those who prefer it, and have the means, he would even advise to consult their friends and physician, in preference to a reliance on this, or any other private guide; and those who are thought to be in danger, should by all means obtain their personal assistance, where it can be done conve- niently. But, on the other hand, there are those who have not the means, nor the opportunity ; and there are many whose complaints are of long standing, and of a chronic kind, and do not stand in need of personal attendance ; and there are also those to whom it is not convenient to submit to professional injunctions, and who themselves prefer to undertake the treatment of their own complaints. To all these, in an especial manner, this little volume is addressed, and while the simple doctrine it sets forth, is true and rational, its practi- cal directions are so plain and efficacious that they cannot be mistaken. With regard to the composition of the remedy to which this Trea- tise continually refers, it is proper to observe, that it consists of two kinds of pills, and these are compounded of imported ingredients of the most genuine kind which London and Paris can supply. At the same time it is cheaper than others, inasmuch as the boxes contain a greater number of pills, and being more efficacious, large doses are rendered unnecessary. In point of fact, therefore, families will find this a convenient and economical method of preserving life and health ; and it is believed that at no distant period these pills will be preferred to any advertised medicine either in public, private, or domes- tic use. It should be repeated that " they contain no mercury, they may be continued for any length of time, and are eminently calculated for general and extensive usefulness." It may be expedient, in conclusion, to guard the public against attempts which may be made to introduce a spurious and deceitful remedy. The cruelty of such an act is evident, for the pills of Dr. Ralph are prescribed in accordance with the essential doctrines con- tained in the domestic treatise'; and with regard to their ingredients, their proportion, and particular composition, these are known only to the author. It should be the care therefore of every one to inquire for and see that he obtains 12 Ralph's Universal Domestic Medicine- late Improved Hygeian Vegetable Pills;' every genuine package of which is signed, on the outer cover, ia the following lawful and particular manner : Jos. Ralph, M. D. Graduate of the University of Edinburgh;—Member of the Royal College of Surgeons, London;—and Lecturer on Midwifery, and the Diseases of Women and Children, &c, &c, fto. 38 Courtlandt Street, New-York. This medicine may be obtained, wholesale and retail, at the general office, 38 Courtlandt Street,—at most of the respectable Drug" Stores of New York,—and many of the cities and principal towns in the United States. Agencies in vacant districts may be obtained, and will be supplied- upon liberal terms, a satisfactory reference being given. Those who experience remarkable cteres, or especial benefit from this plan of medicine, particularly in cases which have long withstood the effects of other remedies, would confer an obliging favor on the author, if they should feel disposed to transmit a statement of such cases to' him or any of the agents. A volume of cases in which the cure of diseases is practically proved by the'experience of others, is thus collect-1 ing ; and he who adds his faithful testimony to this record, will enjoy the satisfaction of having contributed to the cause of suffering humanity. The Plates which follow are illustrative of the organs of Digestion. 14 CHAPTER II. Plates illustrative of the organs of digestion, showing that these with the inteiti. nal canal, are the principal sources of the impuraties which contaminate the blood and produce diseases. Before we begin to explain the process of digestion, and show in what manner its weak and disordered condition supplies the blood with vitiated humors and impurities, it is thought necessary^ first to give a repressntation of these organs themselves, in order to render the subject as clear as possible. This with the aid of two or three plates will be very easily accomplished, and will also give an oppor- tunity of explaining a few professional terms which it will be conve- nient to use in the after pages of the work. The use of the plates, it should be mentioned, is intended chiefly for those who are desirous of obtaining a more particular knowledge of diseases and of the principle on which the Domestic Vegetable Pills are so universally beneficial; by far the greater number of those who take them be^in upon the recommendation they have received from others, but the ground on which they are induced to persevere in using them, is that of their own personal experience,—the best of testimony. These plates, therefore, may be examined or passed over at the rea- der's pleasure. Plate I. presents a view of the digestive organs, sometimes called the first passages ; while the bowels alone are called the Intestinal canal.—These consist of A, the stomach ; B, the small intestines ; C, the large intestine, or Colon ; D, the Rectum ; and E, the liver and Gall-duct. 15 Plate 1. THE ORGANS OF DIGESTION. A. The stomach, in which digestion is partly performed. B. The small intestines, in which digestion is completed. C. The large intestine, or colon, in which the residue of food collects. D. The rectum. E. The liver which secretes, and the gall-duct, which conveys the bile into the small intestines; these are the seat of bilious diseases, &c. 10 Plate II. shows a portion of the small intestines into which the bile and other secretions are conveyed for the purpose of completing the digestive process. It is while in these intestines that the food imparts its nourishment to the body; but if the process of digestion is imperfect, or deranged, then, instead of bland and proper nutri- ment, a mass of crude impurities and vitiated humors is supplied. Further, these intestines are seen to abound with absorbent tubes called lacteal vessels, (A,) which take up such vitiated fluids and convey them through the mesenteric glands (B,) into the blood and circulating system. There is also seen a large supply of blood. vessels, (C,) of which the use will presently be shown, when speak- ing of the operation of the pills in purifying the blood, and carrying off its humors. 17 Plate 2. A PORTION OF THE SMALL INTESTINES. K. Lacteal vessels, having mouths by which they absorb the vitiated matter of corrupt and undigested food. B. Mesenteric glands, C. Large blood-vessels. 18 Plate III. represents the large intestine or colon; from its figure and dimensions some idea may be formed of the quantity of putrid refuse of undigested food which is apt to be accumulated therein. It begins on the lower part of the right side of the bowels, and passing upward, crosses under the stomach, and then passes downward on the left side. This explanation of its direction will serve to account for many of those pains and uneasy feelings which are frequently the subject of complaint, but which are not always suspected to arise from a disordered state of this intestine. It is also to be observed that the colon is divided into little cells, or pouches, by a number of bands which run across it, (A). It is in these cells that the ill-di- gested food accumulates, a..d from which it can not be expelled by the ordinary purgatives in use. 10 Plate 3. THE COLON, A. The cells which collect and retain the hardened refuse of the food, and are die seat of cholic, dysentery, &c. &c, B. The rectum, the termination of the colon, the seat of piles, fistula, thread- worms, &c. &c, These, therefore, are the principal organs of digestion, and the manner in which their important office is performed, is explained in the following chapter. 20 CHAPTER III. the process of healthy digestion explained. Having endeavored in the foregoing chapter to furnish the reader with a familiar description of the form of the various organs of diges- tion, it now becomes an easy task to explain what part each of these various organs performs in accomplishing this process;—it is as fol- lows. The food, being received into the stomach, is there retained for a certain time, and by the action of the gastric juice becomes changed into a soft and uniform mass ; this is all that the stomach has to do, and is termed "the first stage in the digestive process."— The food, as we have stated, being reduced into this pulpy stale during its retention in the stomacb, is now passed on into the small intestines, and undergoes a second change by the action of the bile and other secretions which here mix with it, and when this mixture is perfected the process of digestion is complete. The meaning of digestion is this ; that the nutritious portion of the food, of whatever kind it may be, is, by the means detailed above, converted into a milky fluid, which is intended by nature to supply the growth and wjasting of the body,—the refuse of the food passing on to the colon, (plate III.) In order to convey this extracted fluid to the various parts of the body, which are constantly needing supply, a means of communica- tion must be provided, and thus we find an innumerable quantity of little vessels, whose mouths open upon the inner surface of the intes- tinal passage, and there suck up this fluid, and convey it to the blood, where it becomes fitted for its various purposes. These little absorbent vessels are named " lacteals," and the mesenteric glands, through which they pass, are beautifully exhibited in Plate II. But the nutriment of the food having been extracted, the residue becomes a useless mass, and must be disposed of. For this purpose the colon or large intestine, which is shown in Plate III., is pecu- liarly adapted. It is large, and divided into cells or pouches, and in these the residue of the food collects, and after remaining there a certain period of time, is then expelled by a natural and easy effort of the bowels. 21 CHAPTER IV. The manner in which a weak and disordered digestion supplies the blood with vitiated humors and impurities, and otherwise becomes a perpetual cause and aggravation of disease. The seperate organs of digestion and their natural uses having been so clearly explained in the foregoing chapters, it becomes no difficult matter to understand how universal is the general connection of diseases with a disordered condition of these organs. So long, indeed, as these perform their office in a natural and regular manner, we hear but little of complaint, but as soon as either of them becomes enfeebled or deranged, disease arises as a necessary consequence. Nor can it be expected otherwise, for the digestion of the food being incomplete, the blood is loaded with impure and half-digested parti- cles and humors, and these as they pass through the tender structures of the body, in which the blood must circulate, produce diseases in them. It cannot be forseen at all times, what part will be the seat of such diseases, but whether it be the brain, or the lungs, the skin, or any of the other numerous and delicate structures of the frame, which these humors happen to obstruct and irritate, there disease originates ; and this will be inflammatory, or of any other kind, just as the age, sex, constitution, or some other accidental circumstance shall direct and modify. There are also many instances in which the vitiated humors of the body render those disorders dangerous and fatal which would otherwise be harmless or light. This is remarkably the case in small-pox ; two individuals taking this from the same person ;—one of them shall have but few pustules, with very little fever, and soon get well;—while the other shall be loaded with pustules andcorrup- tion, have a putrid fever, and die of a malignant disease. So again with regard to consumption; two persons having a cough from tak- ing cold;—in one, whose constitution is good, the cough shall cease in a few days, and nothing more be heard of it;—but in another, whose constitution is imbued with scrofula, or other humors, the cough continues, or if it abates, does not go off entirely, and is in- creased on every slight occasion ; at length invited to the lungs by frequent coughing, such humors settle there, generally in the form 22 of tubercles ; these tubercles may now continue in a dormant state for a certain time, but sooner or later they inflame and ulcerate, and their humors thus discharging into the air-cells, are brought up from thence by frequent and long continued fits of coughing, the substance of the lungs themselves being quite consumed. Thus, therefore, while impurities of the blood are shown to be a general source from which disease proceeds, we account at the same time for the great variety in which diseases constantly appear. But not only does disease proceed from the various humors of the blood which a weak and depraved digestion supplies; for, indepen- dently of this, there is a certain disordered action of the intestinal passage, which of itself alone originates, as well as aggravates, dis- ease. For instance, who has not sometimes experienced immediate relief from the operation of an aperient medicine ? now, this is not from having purified the blood,—there has been no time for that;— it has arisen from having carried off a quantity of acrid and offensive material from the bowels, whieh had established disordered action in them. It is a fact which no man disputes, that disorder originating in one part of the body is transmitted through the medium of the nervous system to another, even to a distant part; thus in children, the irrita- tion of the bowels from worms is transmitted to the head, and the child is seized with fits, or has water in the brain.—So also in adults, the irritation of the colon is transmitted to the head, and may terminate in apoplexy ; at any rate it never fails to be a source of aggravation and of danger in those who are disposed to apoplexy from other causes. Innumerable instances of such a kind might be adduced to prove that irritation and deranged action in one part of the body may, and often does, become the cause of disorder in distant parts. The author is the more anxious to be as plain as possible on this sub- ject, because of a very fatal mistake which prevails with some people ; it is the error of supposing that every complaint, without exception, arises from impurities of the blood, and from no other cause whatever. Now, this is quite contrary to the fact;—it is true, as has been clear- ly shown, that the impurities of the blood comprise a very general cause of disease, but it is not true that this is the only one. It is for the same reason that persons who run away with this mistake, never gets thoroughly well of many prevailing and dangerous camplaints ; 23 such is the case With those who are apoplectic, or gouty, or dyspep- tic ; and the same applies to all hysterical complaints, epilepsy, St. Vitus's dance, and all the class of nervous disorders, as well as to many others;—they may, indeed, feel somewhat benefited by purifi- ers of the blood, but inasmuch as they overlook another and co- operating cause, they are never likely to be cured, and are, therefore for ever taking pills or something of the kind. Now, the distinguishing peculiarity of this simple plan of medicine is this,—that it embraces the two principal causes of disease, viz. 1st. the impurities of the blood, and 2d. that disordered action of the or- gans of digestion which supplies those humors that are the founda- tion and support of many obstinate complaints. Thus the operation of the universal domestic vegetable pills is to clear and purify the blood, while at the same time, by correcting the disorders of the stomach, liver and bowels, and restoring the organs of digestion to a natural and healthy state, they cut off the supply of injurious mate- rials, and thus prevent the recurrence of disease, CHAPTER V. On the composition of No. 1, or alterative purgative pills, with directions for their management and doses. The alterative purgatives, or No. 1, compose an active, searching, and deobstruent medicine, which is effectual in carrying off the vitiated secretions from every part of the body. The slime * and bilious humors they separate and bring away from the intestinal canal and liver, are frequently so acrimonious as to give a scalding sensation as they pass by stool. But their operation is not only to purify, and remove obstructions; they have also the effect of regulating the circulation of the blood, by which its impetus is drawn away from distant parts and directed to the bowels ;—hence it is, that in disorders of the head, in apoplexy, fevers, and obstinate tumors in various parts of the body, their effi- cacy has been so much experienced and acknowledged. 24 In many instances a free evacuation of the bowels is all that is required, but there are other cases which call for something more than this in the operation of cathartic medicine; such is the case in fevers, in St. Vitus's dance, and in diseases of a nervous kind : in all these, the great secret of cure consists in keeping up the same purgative action in a moderate degree even after the bowels have been thoroughly cleansed, and this must be continued throughout the whole course and duration of such diseases. For this purpose nothing can be more proper than the purgative pills No. 1, and as they contain no mercury, so no hurtful consequences need be antici- pated from their continuation and repetition. The dose and management of No. 1, or alterative purgative. With regard to the dose of the alterative purgatives, it is usual to begin with 4 or 5, but as these are generally given to produce an active effect upon the bowels, the dose should be increased or dimi- nished so as to produce the desired action. If they are given in continued fevers, nervous diseases, or any of those cases in which a constant impression of the bowels is required; then of course the dose must be diminished, and the interval of time between taking them lengthened, so as to moderate their effect. This interval may be four, six, twelve, or twenty-four hours, as the patient using them may find their operation more or less powerful. If the object is to reduce the quantity of blood, and they are used instead of bleeding, as in apoplexy, or general fullness of the habit, the period between their repetition should be more protracted still; every fourth day, or once a week, may be frequent enough ; and, in such cases, a low diet and a vigorous exercise of body should be subjoined. The best time to take them is on going to bed, as they do not usually operate until the morning at the time of rising; but if they should not operate before breakfast, another dose should then be taken ; and cases may occur of particular constitutions, in which the dose should be repeated continually, at intervals of three or four hours, until the desired effect has been obtained. Another observation may be added ; these pills do not in general gripe, but there are exceptions. Indeed, in some constitutions, thw consequence cannot be entirely avoided; as, for instance, in those patients whose passages are loaded with viscid and obstructing mu- 25 cus, nothing but a searching medicine can be of service in stirring up and purging off such humors, and this will now and then produce a griping pain; this much, however, may be said, that those who have occasionally found them gripe, have thought them of more than ordi- nary service. If these, or any other medicine, should produce grip- ing, the best of all remedies is plentiful draughts of some warm or mucilaginous drinks, such as water gruel, rice milk, panada, &c; a little warm wine and water, with cloves, or any other spice in it, is also very proper; if at any time they should operate too much, a tea-spoonful of paregoric should be added. CHAPTER VI. On the composition of the No. 2, or gentle Aperient Pills, with directions for their management and doses. The gentle aperient pills, or No. 2, are a composition of a different kind from that of the No. 1, their effect being gentle, and their operation slow ; in some cases, indeed, they do not cause the evacuations to be more frequent, but only more free and healthful; and they are therefore taken by many, rather to prevent a costive habit, than to produce an active purging of the bowels. This is a matter of very considerable importance, for there are many persons who have a daily movement of the bowels, and therefore conclude that their action is healthful, although the evacuations are scanty, of a black color, and costive; such persons are laboring under great deception, and little think that many of the complaints they suffer, especially those of the head, arise from this circumstance; the dry and hard masses they pass by stool have always been accumulating in the large intestine or colon for several days, so that the fluid hu- mors with which they were at first charged, have been absorbed and carried to the blood. Few persons are aware of the evils arising from a costive habit of the bowels, or that this is the cause, in their own persons, of many of the complaints under which they suffer. Even apoplexy, and many serious diseases of the head, are among this number; so also 2G is dyspepsia ; and where costiveness is not the only cause of this dis- tressing malady, it is always an aggravating one. The same remark applies to diseases of the liver, the lungs, the kidneys, and urinary passages ; the blood, loaded with impurities, has to circulate through these tender structures, which it cannot do long without producing obstruction and disease in them. It is true that those who labor, and thus support a copious per- spiration, escape, in some degree, these consequences; but those, whose occupations are more sedentary, are subject to perpetual dis- eases from this cause. This is remarkably the case with clerks in banking houses, and other offices ; and still more with tailors, shoe- makers, watchmakers, milliners, and with those of other occupations of the same sedentary character; in these, as the perspiration is scanty, the blood is more readily loaded with impurity. With respect to piles, costiveness is almost the only cause of them, though in a different manner; here it acts by pressure; the harden- ed lumps of stool, which fill the lower bowels, prevent the blood from passing upwards, so that the veins swell, inflame, and some- times burst, thus occasioning what are termed the bleeding piles. But the consequences of a costive habit do not stop here, and it is fit that they should be known in order to be obviated ; an inward and constant fever is often attendant upon an accumulation in the lower bowels or colon; the tongue is foul, particularly in the morn- ing, the sleep is unrefreshing, and the breath putrid and offensive ; the nervous system too, as well as the parts subservient to the pow- ers of intellect, as those of sense and motion, are also greatly influ- enced by torpor of the bowels;—hence it is, that literary people, and nervous and hysteric patients, are so much benefited by the gentle operation of the aperient pills, or No. 2. They will not be sufficient of themselves, in every instance, to clear out the loaded bowels, but when this has been done by a dose or two of No. 1, or the alterative purgative, it is then that their good effects are seen in keeping up that natural action of the bowels, by which a re-accu- mulation is prevented. The dose and management of No. 2, or gentle aperient. The dose of this gentle aperient varies from three to five or six, or more, and these may be taken either at bed-time, in the morning, or night and morning; when taken in cases of habitual costiveness, 27 they should be continued as oflen and as long as the occasion de- mands ; they may, however, be discontinued at intervals, in order to ascertain whether this necessity has been removed. As individual constitutions require different doses, the patient may begin with four pills, and increase or diminish the quantity accordingly, as he finds their operation more or less than is desirable. When they are prescribed for fever and ague they should be re- peated oftener ; as often even as every four or five hours, beginning after the shaking fit is over ;—the more that can be taken between the shaking fits the speedier is the cure, so that in a case of fever and ague, five or six may be taken for a dose, and if this number should prove too laxative, it may be checked by a tea-spoonful of paregoric in a little wine and water, or the number be diminished. In ague, however, it is always best to take them in conjunction with quinine or Peruvian Bark,—and then they never fail to cure. Children require doses large in proportion to their age;—as a general rule, a child of seven years old will take half the dose of either of the pills that an adult would require. In ordinary cases they are taken once a day, either night or morn- ing ;—some prefer them immediately before or after a meal, and this is a good time, when taken as a corrector or sweetener of the blood. It is not often desirable to increase the appetite in cases of dyspepsia, for such persons generally eat more than the stomach can digest; but where the appetite is deficient, and they are used as a dinner pill, they should be taken 15 or 20 minutes before the meal,—in this empty state of the stomach they excite the secretion of the gastric juice and provoke the appetite accordingly. It is observed that the operation of this pill, with most people, is pretty regular, at a certain period from the time of taking them. Many take advantage of this circumstance, and use them at such an hour as to operate at the most convenient part of the day. For the general purposes of health, their operation should take place either in the morning or evening; but in those whose sleep is unrefreshing, it is better to have it in the evening or before bed-time. It is ob- served that a peculiar calm and refreshing sleep succeeds their operation in the evening, while a pleasing calmness and command of thought succeeds to it in the morning following. It may be also justly added, that nothing is more calculated to 28 counteract the effects of over-repletion ; and those who have been tempted to partake too freely at the table of hospitality, should never omit to take a laxative dose of them on going to bed. These aperients are composed of three ingredients, each of which is capable of acting only upon separate parts of the alimentary pas. sages ; the first, being soluble in the stomach, imparts vigor and tone to it; hence its value in cases of dyspepsia, gout, apoplexy, and all the diseases in which a peculiar weakness of this organ is a prominent feature : the second, dissolving in the small intestines, ex- erts its influence on the liver and biliary secretions, and is efficacious in removing all obstructions of the gall-duct, and in the various dis- eases of the liver; the third ingredient operates only on the lower bowels, and having entered with the refuse of the food into the colon, it gently stimulates this large intestine, and thus excites a free and natural evacuation. In this concluding paragraph it may be remarked, that every ne- cessary topic has been reverted to upon the subject of this Domestic Medicine—its composition, properties, and general use and manage- ment ; the leading and fundamental principles on which it is ap- plicable, in one degree or other, in all diseases, have also been explained ; and the manner in which diseases take their origin, and become relieved or aggravated through the medium of the organs of digestion, have likewise been included. It therefore now remains that something more descriptive and particular should be said on those diseases which are of more general occurrence, so that the plainest and most perfect understanding may be attained, with regard to the particular use and management of the Pills in such diseases, individually. This, therefore, leads to the domestic treatise on particular dis- eases,—the catalogue of which will be found in the Index. A DOMESTIC TREATISE On those Particular Diseases for which the Universal Do- mestic Pills are especially intended, and in which are pointed out such other remedial measures as are adapted to the peculiar circumstances of Con- stitution, Sex, &c. &c. so as to give more entire efficacy to this Medicine. It will be observed, that in the following Treatise, the writer has included several diseases in one chapter; the reason for doing this is, that these diseases are so nearly alike in character, although having different names, or require a mode of treatment so precisely similar, that it would only have tended to produce confusion, if he had treated of them separately. 4 30 CHAPTER I. dyspepsia, indigestion, &C. &C- Slnce the first edition of this work, the attention of the author has been more than ever called to the subject of Dyspepsia and Indi- gestion ;—a disorder which he finds to be so exceedingly general and important as to claim every possible endeavor, in order that the nature, cases and cure of this prevailing disease, should be clearly and universally understood ; with this view he has revised the chap- ter on Dyspepsia with more than ordinary anxiety, and he trusts that a little attention to this disease will enable every individual to conduct the treatment of it with more satisfaction and success than has been usual heretofore. It may not indeed be right to promise a perfect cure in every individual case, but even in such as are tedious and inveterate, much may be done by way of alleviation; and, what is still more important, much may be done in the early stages of Indigestion to prevent the disease Dyspepsia, altogether. In proceeding therefore with this object, the author will first endea- vor to show the nature and extent of this serious disorder; for, although many are aware that it is attended with a vast variety of distressing symptoms, both of body and mind, yet but few persons have the least idea of the number and of the fatal nature of many of the diseases which take their origin from it. For instance, who is aware that Dyspepsia is the frequent cause of fatal tubercular con- sumption,—of fatal enlargement and abscesses in the liver,—of fatal diseases of the head,—and of fatal disorders in the organs of genera- tion, both of male and female 1 But such, nevertheless, are facts, and they are such as to admit of satisfactory explanation. We all know that a variety of pains and sensations are frequently felt by dyspeptic persons. There is not a part of the body which may not be the seat of these sensations, nor is there a part in which they may not termi- nate in a permanent disease. Suppose, which is a common occurrence, that a dyspeptic person complains of frequent attacks of pain in the side. These pains are 31 at first nothing more than the effects of the stomach upon the liver, through the medium of the nervous system, and are called nervous affections; they are not relieved by any thing applied to the side itself,— the means whtch relieve these are means which improve the state and condition of the stomach, and none others, so that it is evident they originate in this organ. But, after a time, these pains become continued and are more severe; they are also attended with some fever, and with a tenderness which is felt on pressing the side or taking a deep breathe. This is the first step which Dyspepsia makes to establish a disease in the liver; the pain has now become inflamma- tory instead of nervous, and will sooner or later terminate in what is called liver disease,—the word is used to signify enlargement and hard- ness of this organ, and this state of the liver finally breaks up the constitution. In the history of the progress of dyspepsia, therefore, we may remark three distinct stages. The first is when it produces pain in the liver, which is only felt occasionally, and which is not accompanied with a sense of tenderness on pressing it with the hand; this is called nervous, or sympathetic pain. The second stage begins when that pain becomes more continued, is increased on pressing the side with the hand, and is accompanied with slow pain ; this is in- flammatory, and is called chronic inflammation of the liver. The third stage begins in some persons, very quickly after this, and in others it is some length of time ; sooner or later, however, after this chronic inflammation, it enlarges the organ, and, on examining the side, it is found to bulge out a little, and the liver may be distinctly felt to be larger, harder, and a little more tender than natural; this is the stage which is properly called Liver Disease, and which will terminate in an abseess or a premature close of life. Now all these diseases are observed to arise from Dyspepsia, and the different stages which intervene in its progress towards them, may be distinctly marked. Perhaps nothing will better serve the purpose of convincing individuals that such is the fact, than tracing some of these diseases from this common origin. To begin with the diseases of infants and children. Water in the head is one of their most fatal disorders, and children often labor under this disease when it is not in the least suspected. This disease begins obscurely in the bowels;—it originates from some such dis- turbance of the organs of digestion as inflammation, which in adults we 32 should call dyspepsia. No doubt children have, in this early stage, a series of occasional and nervous pains in the head, but which they cannot express in words. At length, however, these pains alter" their nervous and occasional character and become inflammatory. The poor mother all this time is but little aware of the consequences of this apparently trifling disorder of the bowels, nor does she deem it necessary to adopt the proper measures for relief, until she is alarmed by some fever and restlessness, perhaps some occasional screaming or convulsion. But at this time the mischief has extended to the brain, and has established a chronic irritation or influx there, and which, if not speedily removed by prompt and proper measures, will assuredly issue in that fatal complaint of children, water in the head. The reason why this disorder is so very fatal, is because the remedies are availed of too late, or are not suited to the different stages of it. In the first stage, water in the head is easily cured, or rather prevented, by proper attention to the bowels; but, in the second stage, it is neces- sary to look to the head also, and relieve the irritation there by local means. If this is not attended to, it frequently happens that all other means prove unavailing. It is hardly necessary to detail the different stages which it passes through, for these are exactly similar to those which have already been related. The first is cough ;—it is a simple nervous or sym- pathetic cough;—then comes a cough with some expectoration; and after this, a more alarming cough, with constant uneasiness or pain, and with copious expectoration ; and, lastly, these are fol- lowed by weakness, emaciation, and with hectic fever. Dyspepsia, further, has the same connection with disorders in persons more advanced in life. Apoplexy, the loss of memory, and the failure of sight and hearing, are frequently the consequences of this disease. With respect to apoplexy, it leads to this disorder in adults exactly as it does to water in the brain in children; and the two first stages are just as clearly marked, and as certainly admit of cure. Another class of disorders arising from indiges. tion and dyspepsia, especially in elderly people, is that which affects the kidnies and urinary passages. These are particularly under the influence of the digestive organs, and in most instances the disor* ders of gravel and stone arise from this cause. 33 With respect to those complaints which are peculiar to the femalo economy, and are more distressing and fatal after the age of forty-five or fifty, these also are the frequent results of dyspepsia, and are fre- quently to be prevented altogether by attention to the organs of digestion at this critical period of life. But not only are these fatal diseases in many instances, known to arise from dyspepsia, but a vast variety of complaints, which, though not so dangerous, are yet known to spring from this origin ;— such are hypochondriacal affections, melancholy, hysteria, palpita- tion, and the whole tribe of those complaints called Nervous. In- deed, indigestion presents itself in a thousand forms, and there are but few disorders, comparatively, which may not, and often do arise from it. But there is another circumstance which claims to be mentioned in this place, it is this ;—that, among these complaints which arise from any other cause, there are none which can continue any length of time without disturbing the functions of some of the organs of digestion,—that is to say, without inducing temporary dyspepsia ; while on the other hand, there is no complaint which is not aggravated from the occurrence of dyspeptic symptoms. Indeed, this is the basis on which the author first prescribed his universal domestic medi- cine. It is not meant, however, that this single remedy is always sufficient in itself, for the cure of all complaints ; but, that it always formed a safe and useful part in every other plan of treatment; a number of diseases require no other remedy. THE CAUSES OF DYSPEPSIA. There are two immediate eauses which produce dyspepsia,—these are a weakness of the stomach, and a deficiency or depraved con- dition of a fluid called gastric juice. But, besides the immediate causes, there are many which are called remote or occasional; and these are the causes of dypepsia which are to be mentioned here, because it is over these that we have the most control. It may be well first to mention some hurtful practices which are in very common use,—such as chewing tobacco, taking snuff, and 34 smoking. It is acknowledged that many persons enjoy an excel- lent state of health who indulge in these practices ; but they are not indebted to these practices for that excellent health ; all that can be said of such, is, that they enjoy good health, not because they chew, &c, but notwithstanding they do so. The juice and fume of tobacco is a narcotic poison, and no doubt some portion of it passes into the stomach, and, therefore, the practice should be avoided, at least, by dyspeptic persons. The same observations apply to dram-drinking. There is no cause more productive of dyspepsia than this ; nor is there any one which so much aggravates it when it has once commenced. With regard to the pernicious properties of alcohol, these will be stated under the article of Diet;—the practice only is to be mentioned here, and this is entirely condemned. Strong spices, acids, cold ice, and cold or very hot water, and anything which distends the stomach—even if it is only water—is hurtful, and leads to dyspepsia. Another practice, on which the author would lay considerable stress, is the habit of eating too fast. This error is as remarkable and prevalent as dyspepsia itself, and he cannot help associating in his mind these two circumstances as cause and effect. There must be some prevailing and powerful cause for the uncommon propor- tion of dyspepsia which is observed in this country, and it is worthy of enquiry, how far the practice of fast eating may be this very cause. With this view, we are led to reflect on what takes place in the process of digestion. In the first place, the stomach secretes a fluid called gastric juice ; and when the stomach is empty, this stimulates its coats and produces appetite. Next, the mouth is supplied with glands to produce saliva, and also a set of teeth to grind with. Now, the very sight of dinner, and to a hungry person, even the smell or sound of it, will produce an abundant flow of this saliva,— the mouth waters, as they say,—but when he begins to eat, or grind his food, the salivary glands are kept in constant motion, and the quantity of fluid thus produced is very great,—it is half a pint, at least, at every meal. The use which nature makes of this secre- tion, is to mix it with the food, and thus prepare it for digestion. Now, when food thus mixed and softened, passes to the stomach, it 33 readily absorbs the gastric juice already mentioned, by which it is dissolved and properly digested. Also, the gastric juice being now engaged, the sense of hunger immediately abates. The error, and the consequence of eating fast, therefore, must now appear to every one. First, the food is swallowed,without being broken down, and thus deprived of the qualities which saliva give it, and when it passes to the stomach, it cannot absorb or mix with gastric juice so fast as a softer mass would do. The latter, perhaps, is the greatest evil; for a portion of the gastric juice being unengaged, it still acts upon the stomach, and goads the appetite be- yond the limits of digestive power. By way of further explanation, it may also be remarked, that if you are called from dinner before your appetite is half sufficed, and kept away for 10 or 15 minutes, you cannot eat again. This failure of the appetite arises from the thorough mixing of all the gastric juice with the food already eaten,—having had more than ordinary time to do so. The author has prolonged his observations on this subject, from the persuasion that this practice, at least in New York, is a very fre- quent cause of indigestion and dyspepsia ; how far this single cir- cumstance may account for the uncommon prevalence of these dis- orders, he will leave for others to determine. High-seasoned dishes, and a variety of meats, are also hurtful; these, in general, only induce an individual to take more than the stomach should receive. It seldom happens that we take too little food, provided it is suitable and nutritious, but taking too much, is a very common thing. Those whose occupations are of a sedentary kind, should keep this constantly in mind, and not only should they limit themselves in quantity, but should also select the most suit- able and light inquality. Constipation of the bowels, is another cause of dyspepsia, which merits great attention;—this is fraught with various evils, and is always under a person's own control. It is perfectly inexcusable to slight this constant cause of an uncomfortable state of mind and body. Circumstances which depress the spirits, as grief and fear, as well as the harassing anxieties of business, are also causes of dyspepsia. Hot rooms, cold, damp situations, and damp night air, may likewise be added to the number. 36 TREATMENT OF DTSPEPSIA. Having thus far endeavored to explain the nature and the causes of dyspepsia, it now remains to point out the best means of preventing, curing, or alleviating this prevailing malady. This subject, however, seems to divide itself into moral, or do- mestic management, on the one hand, and medical treatment on the other; and, as in many instances in the early stages of dyspepsia, nothing more is required than a little attention to circumstances of diet, bodily exercise, and a regulated state of the bowels ; so there seems a peculiar propriety in beginning with the MORAL AND DOMESTIC TREATMENT OF DYSPEPSIA. It is hardly necessary to remark, that in every case of dyspepsia, as well as in every disorder, it is of the greatest consequence to remove the cause, if it is possible. A dyspeptic person, therefore, will, no doubt, think it worth while to read attentively what has been said on the subject of these causes in order to avoid them; and, next, he will feel the want of information on some of the following particulars. We will begin with DIET. The quantity and quality of food, as well as the frequency of taking meals, are subjects on which dyspeptic persons are con stantly enquiring ; and, indeed, they are matters of so much impor- tance as to merit the most careful and minute consideration. In the following remarks, the author does not pretend to any thing new, for wmilar observations have been made by many others ;—he has, 37 however, the~peculiar satisfaction, after nearly 30 years experience* of knowing that they are correct and true. In general, the diet of dyspeptic persons should consist of animal more than vegetable food. Fat, and even the lean part of meat which has much fat inter- mixed, is difficult of digestion. Mutton and beef, but mutton much more than beef, is easy of digestion. There is nothing, in general, which suits a weak sto- mach better than a broiled mutton chop, rather underdone, with a mealy potatce. Game is easy, hutfish is not so—and when it is digested, fish affords but little nourishment. White meats, such as veal and pork, are not so easy as red meats ; it is true they are not so apt to excite fever, but owing to the quantity of animal mucilage they contain, which is always of dif- ficult digestion, they do not agree with a dyspeptic stomach. Pork and tongues are not proper, on account of the quantity of fat in their substance. Among the poultry tribe, geese and ducks have too much oily fat for a weak stomach ; turkey is light and easier, but fowl is easier still. Next to mutton, perhaps fowl is the lightest animal food that can be taken, and is very suitable to a weak stomach, whether in dyspepsia, or in the convalescent state of fevers, or the like. Venison, especially the lean of it, is very easy of digestion ; so are hare and partridge, but the pheasant of this country is not so light and easy. It scarcely need be mentioned with regard to every kind of meat, that it becomes tender, and more digestible, by keeping. Salt meat, and especially that which was originally tough and hard, as well as dried and smoked meats; also articles fried in a pan, are all heavy, and of very difficult digestion ; and yet, which is a curious fact, a fried rasher of bacon will sit easy and be relished by some dyspeptic persons. This indeed has so often occurred under the immediate observation of the author, that he would fain recommend the trial of it to every dyspeptic person, particularly to such whose stomach is so squeamish as scarcely to relish any thing. Let it be taken in the morning, at breakfast. It may be mentioned in this place, also, that any article of diet, however it may seem improper, if there is a particular longing for it, 38 may be indulged in by way of trial.—It is astonishing to see how many things of this kind, the stomach will digest a little of. Eggs, to most people, are light and easy, but they ought to be soft boiled, and eaten with stale bread. New bread is exceedingly difficult of digestion ; it forms a tough mass of paste in the stomach, which the gastric juice cannot penetrate and dissolve; considerable stress should be laid on this particular remark, as new and even hot bread is too commonly partaken of. Minced up meat, and articles mashed, as potatoes, are not so good as when roughly broken down and prepared with the teeth ; the reason is, as has already been stated, not being mixed up with saliva. Roasting, Boiling, and Broiling, is better than any other cooking, but these should not be carried too far;—a little and good, instead of a little and often, should be the dyspeptic's motto ;—you cannot say that meat can be good and nutritious when every part is cooked away, and nothing but thread and a bundle of muscular fibre left; this is the part of meat which is most difficult to digest, and which, when digested, yields the very least nourishment. Meat should not be cooked farther than is sufficient to coagulate certain parts which are between the fibres, just as you set the white of eggs. Never mind if it looks red,—this is all the better,—you have then the good of the meat, and it digests easier and better. Solid meat should always be given in preference to broth or soups, whenever the stomach is not too weak to bear ever so small a quantity ; one ounce of properly cooked meat is better than a quart of the strongest beef-tea; and, moreover, broth and soups seldom agree with the dyspeptic.—Whenever beef-tea or the like must be had recourse to, be sure you put some little substance in it;—toast bread is the best,—next to this,—rice. Vegetables do not often agree well with dyspeptic persons,—they ferment and generate wind and acidity. Sauce, which includes salt, pepper, mustard, &c.—should be used in moderation ;—they assist in the process of digestion, and enable a weak stomach to exert its powers. Care should be taken lest they excite the appetite to overload the stomach ;—in health this is a very common effect. Those articles of diet which most require- them, are such as have been noticed as the least easy of digestion ;— 30 •as geese, ducks, toasted cheese, fyc, and these are the things with which mustard, pepper, stuffing and sauces, are generally eaten. Butter is very often found to disagree with a dyspeptic stomach ; when this is observed it should be avoided; no habit or persever- ance in its use will surmount this difficulty in such cases; the same may be said of cheese; and the use of either should be determined by experience and observation. Vegetables,—pease, beans, cabbage, and waxy potatoes, are the worst articles of this class ; mealy potatoes and turnips are better;— broccoli is the best of all vegetables. Fruit,—such as melons, cucumbers, and the like, are cold and very bad ; but gooseberries and pears are better ; the best of all fruits, however, are ripe strawberries, peaches, and apples. But there is this exception with regard to fruit, that when any kind is found to agree, it is always safe and proper to indulge in such with modera- tion. Very acid fruits are often observed to disagree ; and with respect to preserves, these are almost always improper ;—even a little lump of sugar in tea or coffee will derange the stomach in some dyspeptic people for many days. The quantity of food to be taken at each meal, is another matter of great importance. Generally speaking, dyspeptic persons, as well as those in health, take too much ; a great variety of dishes, and those of a savory and inviting flavor, lead to this error ; but a far more serious and certain cause of this is to be found in eating too fast. It has been already stated in what manner this effect is thus produced. It will be remembered that the gastric juice is the fluid on which the appetite depends, and when this is mixed and engaged with food more slowly masticated, the sense of hunger ceases ; but, if lump after lump is swallowed with rapidity, there is no time to absorb and neu- tralize this fluid, so that the appetite continues on, and a larger quan- tity of food is taken, than the stomach can digest. There is a certain period at meals, if the food is duly masticated, when the sensation of enough is felt. This should always be attended to, especially by dyspeptic persons, and immediately complied with. One mouthful after this is frequently sufficient, in the weak and deli- cate, to upset the whole digestive process. The frequency of meals is another point to be considered. The advice so often given to eat " a little and often" is not good advice. 40 Two principal meals, at which animal food is taken, ia generally quite sufficient for dyspeptic persons. Whoever will take the trouble of perusing the chapter on the article of digestion, will see the reason why it is so. The stomach is a muscular organ, and is intended to have a time of rest, like other muscles, in order to recruit its strength. And, further, it will there be seen that digestion is a process which is not finished in the stomach; the food, when it passes to the bowels, undergoes another change, and then the process of digestion is completed. Now, if you interrupt this latter stage by a perpetual call of nervous fluid to the stomach, you rob the bowels of that share of energy which is quite essential to complete it. Between these principal meals, however, a lighter kind of food,— as a cracker or toast and tea, or coffee, is very proper, and, in the summer time, the use of fruit should be encouraged. Drinking.—Some have gone so far as to recommend that no fluid at all should be drank at meals ; but this is an extreme, and without reason. Some dry foods absolutely require diluting; and again, the evaporation which is continually going on from the skin and from the lungs, as well as the different secretions of the body, demand a eertain supply of liquid. On the other hand, there is no doubt but too much fluid is often taken at meals, and that this practice is ac« quired from custom. The principal evil of drinking largely at meals is, that it dilutes the gastric juice too much, and thus disquali, fies it for its office. The best rule to follow in this matter is the dic- tate of nature. Persons in health are not much troubled with thirst, and many have no inclination to drink at meals ; if you have no thirst therefore, drink nothing at your dinner; but if you have, it is better to assuage it moderately. It should be mentioned however, that in many instances, a little would suffice where much is taken; this is the point to be observed by dyspeptic persons. But the most difficult question yet remains;—what is the best beverage in dyspepsia 1 Alcohol, or spirit, is the active ingredient in all fermented liquors, whether wine, ale, cider, or any thing else; and this ingredient in any shape, is unnecessary to persons in health ; but, to the dyspeptic, it is peculiarly unfortunate and destructive. If it were asked, which is the least hurtful of the various wines and pleasant liquors, with which the table is frequently supplied, it may be answered, that which 41 contains the least alcohol or spirit;—such as claret and the lighter wines, mild ale or cider. With respect to distilled spirits, such as brandy, rum, &c, there is a remarkable circumstance pertaining to these, which should be known to every one. It has been said that all fermented drinks con- tain alcohol, and that the hurtful property of each is in proportion to the quantity of alcohol it contains ; but, the circumstance to note is this :—that when alcohol or spirit has been separated from any one of these by the act of distillation, it then acquires a new and dele- terious quality, and one which cannot afterwards be corrected. In vain is ardent spirit diluted, and reduced again to the strength of wine, or ale ; it is true, that it is less hurtful in its diluted than its un- diluted state ; but it never loses its new property of poisoning ; and, in any form, is the most enfeebling and unfortunate article a dys- peptic person can determine on. Distilled spirits, therefore, is out of the question, and but in very few exceptions, is never to be thought of. Home made wines are very apt to run into fermentation in the sto- mach, and greatly to oppress it with acidity and wind. Beer is a compound which does not well agree with very feeble stomachs; it best agrees with those who have been reduced by fevers or other causes, and where the stomach is not weaker than other organs. There it is useful as a beverage and medicine, and wonder- fully recruits the strength. But London bottled porter is far to be preferred to every other kind for such a purpose. Cider, provided it is not very sour, is a mild and good article of beverage, particularly in hot weather. Foreign wines generally agree with dyspeptic persons, and none better than good Port, provided, it is not found absolutely binding to the bowels. The reason why Port is not in more general use in America, is, because it is too frequently made up and adulterated with distilled spirits; but, when it is pure and good, nothing is found more generally to suit the dyspeptic. It may be taken alone, or in water, and those who really stand in need of any thing more than water, or toast and water, will find it to be the most grateful and proper beverage they can take. The next to good Port, properly diluted, are the lighter foreign wines, of which none is better than claret. This also may be diluted. But, whatever wine is fixed on, 42 much care will be necessary that it be not carried too far. When- ever it flushes the face, or excites an unnatural flow of spirits, this may certainly be suspected. Green tea, and very strong black tea and coffee, are found by the experience of many dyspeptic people, as well as others, to be hurtful to the stomach. They have some effect upon the nervous system, by which sleep is driven away, and a tremulous state of the nerves is induced. Moderately strong black tea or coffee, is, on the other hand, grateful and refreshing. One great evil which should be noticed in taking tea or coffee, is, in drinking it too hot. Every thing very hot, weakens the stomach. Exercise and air are so well known to befriend the dyspeptic, that it would seem unnecessary to mention them here. It must be observed, however, that exercise may be taken to excess, and that there is a time when, and a time when not, to engage in it. In cases of very great weakness, unsuitable or excessive exercise is to be carefully avoided. Many persons in the convalescent stage of fever are thrown back for many days, by making more exertion than their strength will allow. From this fact we may take a lesson in cases of dyspepsia. Excessive and exhausting excercise, as well as inactivity and indolence, are equally to be avoided. The gentlest kind of exercise is that of sailing, and next to this, is riding in a car- riage ; but, if it can be borne, a still better kind of exercise, is riding on horseback. This has justly been extolled in every age, and it seems to owe its peculiar advantages to the shaking and concussion given to the intestinal and digestive organs. Neither is walking to be held, by any means, inferior for the general purposes of exercise. It is not convenient for every one to ride on horseback; and, after all, it is more than probable that the exercise of walking, being more universal in its effect, and certainly more natural, is better calculated to support a free equal circulation than any other. One thing respecting exercise should not, however, be forgotten ; —it is the time of taking it. Nothing is more common than to hear it recommended before a meal. Accordingly, many persons who have been fatigued and jaded in the banking-house or office, are in the habit of taking a walk or ride, or some fatiguing exercise, just before their dinner. This is quite ill-timed. Such advisers do not consider that in dyspepsia, the stomach is always very weak and 43 feeble. Now, the immediate effect of exercise is to exhaust the gene- ral strength and vigor of the body, but in doing this, the stomach is affected too. Who, then, does not see the striking impropriety of weakening this organ just before a meal,—at the very moment when you call upon it for its utmost vigor and exertion. Avoid fatiguing exercise, therefore, as much as possible, at this hour; and when your time can be commanded, it is better to avoid it also immediately after dinner. In one hour and a half, an ordinary meal is tho- roughly digested in the stomach, and passes to the bowels. There is no time when exercise can better be sustained than now. The same remarks apply, most accurately, to the labors of the mind; and those who wish to husband out their intellectual powers to most advantage, would do well to think of this. Exercise taken in the open air is incomparably better for the pur- poses of health than any other. Indeed in many instances, particu- larly in ladies, the author has been called to witness many serious disorders chiefly originating from the want of exercise in the open air. The occupation of many mothers is very often any thing but indolent or inactive; and yet, because this exercise has been within the house, their health has suffered. Night air is not good, neither is a damp cold day to be chosen for it. A damp cold situation also is unfavorable to dyspepsia. In such circumstances a week or two's change of air is always beneficial, MEDICAL TREATMENT OF INDIGESTION AND DYSPEPSIA. The domestic management of this disorder having been very care- fully and minutely described, the medical treatment will now follow with peculiar advantage. Indeed, in the early stages of indigestion and dyspepsia, and even in those cases which have continued long, provided no other disorder has been induced, the hints which have been already given upon the causes and domestic management of this complaint, will be sufficient, with the aid of very little medicine, to cure or prevent the disorder altogether. It cannot, however, be said, that no medicine at all is required; for so intimately is the dyspeptic stomach connected with a certain state and condition of the intestinal passages, and so frequently does the disorder take its origin entirely from a constipation of the bowels, or 44 eome irregularity which might be easily corrected, that a safe and suitable medicine for these purposes is exceedingly desirable, and forms, indeed, a most important part of its successful treatment. It was a strong conviction of this necessity which originally led the author to compose his Universal Domestic Vegetable Medicine, (formerly called Improved Hygeian Pills,) and the great demand and unexampled confidence it now enjoys in almost every town and vil- lage in the United States and other countries, is a gratifying proof of its value and utility. The various medicines often advertised for these complaints have all their separate objections. Some of them, if useful in one stage of the disorder, are quite injurious in another ; and all of them, without exception, are too weakening in dyspepsia. Moreover, most of them contain mercury, and therefore are by no means fit for private and domestic purposes. One of the peculiarities of this Domestic Medicine, and which relates especially to the milder pills, or No. 2, is, that they may be continued for any length of time, without the slightest weakening effect; indeed, instead of this, the bowels as well as the parts subser- vient to the office of digestion, are strengthened and invigorated by their use. This is a quality of immense importance, for many of the causes of dyspepsia are of a nature which cannot be removed, and therefore require a remedy which may be, if necessary, constantly resorted to. Such is the case, for instance, when constipation of the bowels is the immediate effect of sedentary habits, as in watchma- kers, tailors, milliners, and many others. It is not reasonable to expect that a medicine can so far change the constitution, as to pre- vent the recurrence of that effect, so long as these sedentary habits are continued ; and, as it is not in every person's power to alter or to choose his trade or occupation, so it is of great importance that every one should have the means of obviating those peculiar diseases origi- nating from them. Many are the serious disorders, besides dyspep- sia, which are common to persons of sedentary habits; such as apoplexy, the piles, the gravel, and a multitude of others, but the first step to all of these, is constipation of the bowels; and this immedi- ate effect, it is in the power of every one to obviate with a very little ate trouble and expense,—simply by taking a dose of these mild ape- rient pills, as long as the occasion for them is required. 45 But, it is not meant by this that a dyspeptic person does not occa- sionally require, the assistance of other medicine ; for of this the author is perfectly aware. Such medicines however, are but fewm number, and these he now intends to speak of in the following order ; and at the same'time to mention very carefully those stages of dys- pepsia, and those particular symptoms in which they are most fre- quently required. He will begin with Emetics.—In the early stages of indigestion, some persons recom- mend emetics ; but these are scarcely necessary except in cases where some tough or indigestible article of diet is known to have been taken,—such as is in the following case,—(taken from the author s note book:—" Yesterday was called to see a little boy about 10 years old, who had been troubled for some hours with a pain at the top of his head. This pain was confined to one spot, and which he com- pared to the sensation of moving up and down with every pulsation. Towards night, about ten o'clock, it had increased to an extreme de- gree, so as to become necessary to relieve it. It appeared that this little boy was fond of the liver of fish, and of this he had indulged very freely at his dinner. There was no sickness complained of, nor any circumstance which pointed to the stomach as the cause ; but, knowing that the liver offish contains an oily fluid which is very indigestible, it seemed expedient to relieve the stomach without delay. Twenty drops of hartshorn in a little water was therefore given, and, in less than two minutes afterwards, a large quantity of liver, exactly of the appearance of having just been eaten, and mixed with undi- gested fish and a quantity of a glary fluid, was then brought up. This was at ten o'clock, and his dinner had been taken at one o'clock, so that it had remained nine hours in the stomach without sustaining any alteration from the gastric juice. Immediately after this the pain abated, and he went to sleep, and awoke quite comfortable in the morning." Ether, Eau de Cologne, Spc— This seems a proper place to notice several domestic applications, which are useful in relieving various pains arising out of indigestion ; and, in slighter cases, or where it is not quite so probable that there is any thing in the stomach which oppresses it, these are very useful, and should be tried in preference to emetics. An excellent remedy of this kind, is a little ether, which should bo 6 40 poured into the hollow of the hand, and held to the forehead on the temple until it quite evaporates;—the effect of the ether is to produce a pungent, burning sensation, and often effectually relieves a nervous pain. Eau de Cologne, or hot brandy, used in the same way, or rubbed upon the skin, are remedies of the same nature. Mustard poultices, or a piece of brown paper soaked in hot vinegar and well peppered, are also useful domestic remedies, but these are not so instantaneous in relieving as those just mentioned, though their good effect is more enduring. The :iild aperient pills, or No. 2.—There is not a single stage of dyspepsia, nor a single disorder arising out of it, which does not need a carefully regulated state of the bowels; and, for this purpose, nothing more safe and suitable can be thought of than this mild and gentle composition. In every case it is proper to begin by clearing out the bowels ; and, throughout the whole continuance of dyspepsia, it will be desirable to keep them a little more than naturally open, by the repetition of these pills. Four or five may be taken at bed-time,— they will not operate till the morning, but if they do not then, the same number should be repeated immediately after breakfast. It is supposed that every one will consider what has been said on the subject of the causes of dyspepsia, and avoid such as are in his power. At the same time that the remarks on diet, (none of which have been here advanced without due and anxious consideration,) will be availed of, as circumstances may demand. In this way indiges- tion may be cured before it can assume the more settled form of dys- pepsia ; and thus the possibility of many serious and fatal maladies will be prevented. After this, nothing more will be required than to avoid the various causes which have been mentioned; and, of all things, to avoid a constipated state of the bowels, by the use of No. 2. whenever there be occasion. The more active purgatives, or No. 1, are of the greatest use in those individual cases which require a stronger purgative. It now and then occurs that the bowels are too sluggish to be thoroughly evacuated by the milder pills, but when this is once effected, they are better kept from falling into their former state by the milder pills. On this account, some begin with a dose or two of No. 1. Another use which is made of these, is to give a dose or two if the milder pills become inactive. It is astonishing to see how perfectly they 47 restore the active virtues of No. 2, if at any time they become too mild from long continued use. It is very proper to change aperient medicine occasionally, and these two pills are so arranged as to aid and perpetuate the good effects of one another. Others have found an excellent effect from taking a dose of mild ones over night, and a dose of the stronger ones early in the morning. The evacua- tion of the bowels is, in this manner, very effective without violent action. Lastly, with respect to the purgatives, these are often ex- ceedingly useful also, in the event of diarrhoea, which occasionally comes on. This is always the effect of some undigested or irritating material in the bowels, and which must be carried off before any attempt be made to stop the purging. After this, six or eight drops of laudanum in camomile tea, will generally counteract it;—if this is not sufficient, then half a tea-spoonful, or less, of chalk, may be further added to each glass of the camomile infusion. The ordi- nary dose of the purgatives is about five; but this must be regulated entirely by their effect. Bitters are often useful when the stomach is very weak, but these are to be only of the lighter class. The most suitable articles of this kind are camomile, bitter orange-peel, or quassia. All of which should be taken in the form of tea. Every one knows how to make these. A moderate handful of camomile flowers, or an ounce of dried orange-peel, or one tea-spoonful of rasped quassia-root, is to be steeped in a pint of boiling water till it is cold, and of either of these, a wine-glass full should be taken two or three times a day. Perhaps the camomile tea is the best of all. The stronger tonics, such as bark, are seldom to be ventured on. As to valerian, castor, or the like,—the author has no faith in any of these,—the lighter bitters already mentioned, do all that these can do. Aromatics are also useful in dyspepsia, and, therefore, a little bruised ginger, cloves, or caraway seeds, may be added to the sto- machic infusions above mentioned. Ginger is the best. Alkalies are such things as soda, spirit of hartsJiorn, and magnesia. These are particularly useful when there is acidity in the stomach, which is known by sour risings and eructations of wind. The dose of hartshorn is about 20 or 30 drops, and this medicine is exceedingly supporting to a feeble and dyspeptic stomach. The magnesia is, preferable to the carbonate of soda, only when some opening quality 48 as well as an anti-acid is desirable. The dose of these is about half a tea-spoonful in each wine-glass of either of the bitter infusions. Chalybeates, that is, different preparations of iron. These are justly classed among the most strengthening articles of medicine ; chalybeates, therefore, might be supposed to be often prescribed in dyspepsia,—a complaint essentially connected with so much weak- ness. They are not, however, very often used in this complaint, except when it arises from one particular cause ; but, in that, they prove of most extraordinary utility. The dyspepsia now referred to is that which occurs in delicate females about the age of puberty. Most of the numerous symptoms which then appear are of a dyspeptic character, and are relieved by the same remedies which are availed of in ordinary dyspepsia; but, to these, in this case, the use of chalybeate medicine is superadded. Indeed, the various preparations of this mineral constitute the remedy on which the chief reliance is to be placed with a view of as- sisting nature in accomplishing that important function in the female constitution, on which her future health and happiness depend. This subject, however, will be considered in its proper place ; the only remark which seems called for here, is, respecting the best form or preparation which can be given in this species of dyspepsia. The simplest and the best form of chalybeate medicine is the car- bonate of iron. This is a powder which may be purchased at the druggist's, and a small tea-spoonful of it may be taken in mo- lasses, night and morning, and continued for a month or six weeks; ■—or, the common filings of iron may be taken in the same way. Let it be remembered that this is recommended in the dyspepsia of young women, and that throughout the course, the bowels should be kept in a strictly regulated state by the mild aperient pills, taken at bed time. Those in whom the face is pale and bloated, and the feet are swollen and cold, stand most in need of chalybeates. On the con- trary, those who aro fresh-colored, and of a full plump habit, are not proper subjects for chalybeates ; neither should they be taken at any time when there is any inflammatory pain in any part of the body, or when there is any fever._ Blue pill.—This leads to the subject of mercury ;—an article of medicine which merits every care and consideration. There is scarcely a medicine, perhaps, which has ever been the subject of so 49 much prejudice, or which admits of better use, and, at the same time, more abuse, than mercury; and yet there is none which admits of plainer directions for its use. The property of mercury is to institute a certain determined ac- tion of its own, by which a variety of disorders are entirely cured. This is all we know of many remedies on which the utmost confi- dence is often placed,, and this is all which is necessary we should know respecting mercury in the treatment of dyspepsia. It will be the principal object of the author, therefore, in this place to point out, First, what those stages of dyspepsia are, in which, mercury is required ; and next, the.extent to which it should be carried. The use of mercury in dyspepsia is generally determined by the appearance and color of the evacuations of the bowels. The proper and natural color of the stools, is a deep brownish yellow ; and this color undergoes but very little alteration from the kind of food we take. It is the bile which gives this natural color to them ; and it is only when this secretion is unhealthy or defective, that we have much alteration in the color of the stools. Now, when dyspepsia continues any length of time, it has the effect of disturbing the healthy action of the liver; and, then, the bile is altered, both in quality and color. To remedy this disturbance of the liver, the blue pill is sometimes given, and, therefore, when we want to know if mercury is required in cases of dyspepsia, we have nothing more to do than notice the nature and color of the stools ; and if these are of a brownish yellow color, and have no remarkably offensive odor, then the blue pill is not required, and would do injury. It is much to be regretted, that the blue pill or calomel is often given in dyspep- sia, and other complaints, when it cannot be of any use, and then it never fails to be injurious. But this is the abuse, and not the use, of mercury. In many instances, dyspepsia continues years without disturbing the secretion of the liver, and sometimes it never does so. Neither is it every slight or temporary alteration of the color of the stools, which calls for mercury. Before this medicine is ven- tured on, it is proper to ascertain if the deviation from this natural color has continued long, and whether it may, in any measure, be the effect of food. Some articles are known to produce a change of color ;_spinage will cause them to be very green ; rhubarb very yellow ; and chalybeate medicines will make them quite black ; but 50 all these things are easily ascertained, and, besides, they are only tem- porary and occasional. Upon the whole, therefore, the examination of the color of the motions affords a very plain and easy rule to deter- mine when the use of mercury is, and when it is not, indicated, in the treatment of dyspepsia. But, it is not in every case in which the use of mercury is indicated by the color of the stool, that mercury must, of necessity, be given ; for in many instances, this color of the stool, and that affection of the liver which produces it, are entirely and perfectly removed by a course of the mild domestic pills, No. 2, of the author. The effect upon that portion of the bowels immediately connected with the liver is to pro- duce a healthy action there, and this healthy action is communica- ted to the liver through the medium of the gall-duct,"so that healthy bile and a natural appearance of the stool, are thus effected. There is scarcely a day in which the author is not consulted by persons who are conscious of this effect of his mild aperient pills in their own particular case. It is not, therefore, always expedient to have re- course to mercury, even where it might be proper. This is a fact the more important to be known, because, with some individuals, mercury is a very debilitating medicine; and there are others who have a great aversion even to the name of mercury. When the natural color of the stool is altered in dyspeptic persons, there is still a variety of colors to be observed ; sometimes it is green, or white, or clay-colored,—being destitute of bile altogether. The most frequent variety, however is, black, or a color nearly approach- ing it,—and this is more commonly the case in habitual constipation of the bowels. The stools are also generally more offensive. In addition to these simple and plain directions, it may be mentioned that the tongue is almost always furred, or covered more or less with a whitish or a brownish coat, particularly at its root. In dyspepsia, when the tongue is clammy and more or less coated with this fur, it will be proper to examine the color of the evacu- ations and the bowels, and when these are such as have been de- scribed, it may be known assuredly that the action of the liver is disturbed, and the disease is gaining ground. Under these circumstances then, the question may arise,.—shall I take mercury? to this it is answered no ;—take the mild aperients, for in 99 cases in every hundred, these will prove sufficient to restore 51 the healthy action of the liver and remove these symptoms. The only use to make of mercury then, is in those instances in which the evacuations still continue of this unnatural color, notwithstandj ing aperients have been taken and persisted in for some length of time,—for some weeks at least; under these circumstances mercury may certainly be taken with great advantage. This being then determined on, the next thing to consider is the choice of mercury and the extent to which it should be carried. There are two preparations of mercury chiefly now in use ; the blue pill and calomel; but the mildest of these, and by far the most suitable in dyspepsia is the blue pill; calomel is a rougher medi- cine, and should never be given in this complaint excepting when the bowels are very costive,—it should never be preferred. The blue pill therefore being determined on, it should be remem- bered that it is only given for a particular purpose, so that when this purpose shall be answered, it should be laid aside. It very often happens that this object is perfectly accomplished in three or four doses of this medicine, and the stools from being very dark and unnat- tural, become of a brownish yellow color.—It is astonishing to see how constantly the tongue will sympathize with this healthier action of the liver, becoming clean and moist. This medicine is generally put up in pills of five grains weight, in each. The best way of managing it, is to take one of these pills every other night for three or four times, and then leave them off for a few days, and observe the effect produced. They may be taken with the aperients at the same time ; or, if the bowels are too relaxed, the blue pill may be taken one night and the aperi- ents the next, alternately. In cases of great weakness, or whenever the pill is thought to weaken, the bitter infusion of camomile should be taken twice a day, at the same time, and the soda or drops of hortshorn may be added, if required. If, which is very unlikely, in this mild and cautious way of taking mercury, any tenderness of the gums should happen, it should be instantly laid aside. This effect is not required and never need be suffered. Thus has the proper use of mercury, in dyspepsia, been plainly and particularly pointed out;—it is a valuable medicine in its proper place, but it is too often taken when it is not required ; and, at other times, 52 continued after all its purposes have been answered. If it were only taken in the cautious manner here directed, it would not meet with so much prejudice and opposition to its use. But, there is another and very important circumstance yet to be mentioned with regard to mer- cury ;—it is its use in that affection of the liver called liver disease, for this is a very frequent termination of dyspepsia. Hitherto we have considered the use of mercury only in that slighter affection of the liver in which the bile is simply altered, and in this we have en- deavoured to prevent the more serious disorder now alluded to ; but, when that opportunity has been neglected, and the vitiated bile has been suffered to continue for a length of time, the disease advances a step farther, and the liver becomes enlarged and hardened.—Now, this is a disorder whose nature and treatment should be understood by every one suffering with it, and this subject may be made so plain that every one of common understanding may easily comprehend it. It would, however, greatly assist the reader, if he would give himself the trouble of a slight inspection of the natural situation of the liver, with the space it occupies in the body; and, with this view a colored plate is given in the following page, exhibiting the natural situation of the liver and other important organs. 7 54 Plate IV. shows the size and situation- of the liver, &c. The letter A points out the lungs, often the seat of disease in dyspepsia; B—the situation of the heart; C—the liver. This chiefly oc- cupies the right side, running towards the left. It is situated under the lungs, so that in a deep breath the lungs press down upon the liver, and, when pain is felt on doing so, we know that it is the seat of inflammation. But the most useful part of this plate is in showing where, and how much, the liver descends below the ribs, so that you can tell where to press it with the fingers. Below the ribs and on the right side, and in the pit of the stomach, it will be seen that the liver is unpro- tected by any bony structure, so that it can easily be felt. It is of the utmost consequence to know when the process of inflammation begins in this organ, and nothing is more easy. It often happens, that slow or chronic inflammation is going on, in an internal organ, without actual pain; but, on pressing such parts, a sense of tender- ness is instantly discovered. This, therefore, is the rule with regard to the inflammation of the liver, and the proper places where such pressure may be made, is rendered clear to every one by the plate. D—further shows the gall-bladder, E—the stomach, and F—the beginning of the first intestine, or where the second stage of the digestive process is completed. 55 Plate 4. SITUATION OF THE LIVER, AND OTHER ORGANS. A. The lungs. B. Situation of the heart. °'ribst Ac0" °f the liver'~showing the Part which may be felt below the D. Gall-bladder. E. Stomach. F. Beginning of the first intestine. 56 LIVER DISEASE. In liver disease, there is not only a sense of tenderness and pain on pressure, but there is often so much hardness and enlargement of this organ as to be felt distinctly with the hand. This is best as- certained in spare, emaciated people, and in such the liver may some- times be seen to bulge out, or to give the right side a greater fulness than the left. With respect to the use of mercury in that stage of dyspepsia called liver disease, nothing which the author could now write, would be more clear and explicit than what is stated on this subject in ano- ther place, and he will, therefore, abstract the following paragraph or two. " Having mentioned that this enlarged and hardened state of the liver is frequently the result of previous disease, hot climate, or hard drinking, and is a mark of a broken down state of constitution, in which little is to be done beside upholding the remaining strength and yigor of it, it should also be mentioned, that it does occasionally come on from other causes, and may be seen in young and healthy persons. In this case great good is to be done, and the treatment is to be varied accordingly. It is in these instances of liver disease, that mercury is beneficial, but it should be given in a very different way from that in which it usually is. Those large quantities which salivate and weaken the constitution are often hurtful; while very small doses, and these continued for a certain length of time, are exceedingly beneficial and curative. " The quantity of mercury should be so small as to produce no sen- sible effect, so that the patient should hardly feel that he is taking mercury. The blue pill is by far the best and safest preparation. Even so small a dose as two grains of blue pill, taken every night, if it be continued for a month or two, or until the disease is found to be removed, will be quite enough ; and if this should by chance, in the least degree, affect the health, it may be discontinued for a day or two. If calomel be preferred, it should be given in doses of half a grain, rubbed up with a few grains of chalk, or with three or four grains of the extract of hemlock. The bowels should be kept open 57 by taking with each dose of the blue pill, the aperients, No. 2, if necessary ; or every other morning, a tea-spoonful of epsom salts in half a pint of water, either warm or cold. A large warm plaster should be continually worn upon the right side, over the region of the liver. This is a plan which has been found wonderfully effica- cious in such cases as are not connected with a shattered state of constitution ; and if it be happily adopted early, and followed up in a due and persevering manner, the best possible chance of success will be secured." Leeches, or cupping.—The necessity, on some occasions, for the abstraction of a little blood, (generally from the side,) arises out of one of the most important changes which can happen to the dys- peptic person; and whenever this necessity is slighted, the disorder becomes involved in on; of those fatal terminations which have been already pointed out. A most important question, therefore, is, when, and in what manner, should it be accomplished ? We have already mentioned, that in dyspepsia, there is scarcely a part of the body which may not be affected with occasional pains; but, that there are some parts more frequently the seat of pain than others. These pains, however, may not be of such a kind as to be increased on pressure, or be connected with any degree of fever ;— such are nervous pains and do not require bleeding. But, there is a pain which is increased on pressure, and is connected, more or less, with fever; this is the pain we speak of now, for this is inflamma- tory pain, and requires the assistance of a little bleeding, or some local remedy to remove it. We will suppose the liver to be the seat of inflammation; if this is acute or active, then pain will be complained of, and there will be fever in proportion to its seve- rity ; but, if it is slow or chronic inflammation, pain will scarcely be complained of, but may be readily ascertained by pressure. The plate will direct you that under the ribs on the right side, and about the pit of the stomach, is the place to press upon the liver. When you do this, also, direct the person to hold in his breath, when the liver will resist the pressure, and the pain will then be felt. The liver does not become permanently enlarged or thickened immediately on the occurrence of inflammation ; but, if this be con- tinued Ions, or frequently returns, this effect will be produced, 58 This is the stage, therefore, when a few leeches to the pit of the stomach will be of most essential service, or when a few ounces of blood may be taken by the cupping-glasses. If, however, there is acute pain and fever, blood should be taken from the arm, and the diet should be low. The blue pill should be also given, as before directed, and in the morning half a tea-spoonful of epsom salts, in half a pint of water, as an aperient. Let it always be remembered, that there is seldom any strength to spare in cases of dyspepsia, and, therefore, bleeding should be very limited. Blisters, or warm plasters, to the side.—These are of use in the same circumstances as those just mentioned, and are recommended in milder cases, or when there is some objection to the bleeding, such as extreme bodily weakness. A warm plaster is always a safe, and very often useful application; and one that can never injure. Warm fomentations are also useful. Dover's Powder.—This is the last remedy it is thought necessary to mention in the treatment of dyspepsia, and this is useful in con- sequence of a weak and irritable state of the bowels, which some- times happens. The cause of this is generally some offensive material that should first be carried off by the aperients, No. 2 ; but when this is done, it is sometimes necessary to allay the irritation, and nothing answers this purpose better than Dover's powder;—it should be made into pills of 2J grains, and one, two, or three, may be taken for a dose. If the blue pill should happen to purge too much, one of these pills might be taken with each dose, or one with every dose of the bitter strengthening infusions. In conclusion, and byway of presenting to the reader a short and definite idea of the nature, causes, and treatment of dyspepsia, it is proposed in as clear a way as possible, to repeat some of the remarks which have now been made. First,—it has been observed, that dyspepsia is a disease which begins with indigestion, but proceeds by certain stages, well defined, to terminate in some of the most distressing and fatal maladies to which human nature is exposed. It has been further shown, that the causes of dyspepsia are gene- 59 rally of such a nature as to be completely in the power of any per- son to avoid. Then, with regard to the treatment of dyspepsia, it appears, that, in the early stages, that is, in indigestion, the cure consists, partly, in avoiding such causes, (and these have been carefully and minutely pointed out,) and partly, by mild and simple remedies which strengthen the stomach, and regulate the bowels. But, the disease proceeding, and sometimes in an early stage, ano- ther circumstance occurs;—this disturbed condition of the stomach spreads to the liver, and alters the secretion of the bile, and, then, an additional remedy is recommended. This remedy is the blue pill, —the mildest preparation of mercury ; and the occasion for its use is always indicated by the color of the evacuation of the bowels. Mercury, however, is not to be used in the promiscuous and unguarded manner in which it frequently is. The natural color of the stools, it has been stated, is a yellowish brown; and as soon as this color is restored, the occasion for it ceases, and it should then be discontinued. Moreover, even in this condition of the.stools, it is not absolutely necessary that mercury should be administered ; for, the mild aperient pills of this Domestic Treatise are abundantly suf- ficient, in a great majority of cases, to restore this healthy color and condition of the stools. Again ;—from the very commencement of dyspepsia, and during its whole continuance, it is a common thing to hear of occasional pains in various parts of the body, as the head, the chest, the side &c.; these, it has been stated, are only nervous pains at first, and are best relieved by remedies which are strengthening to the sto- mach ; and a regulated diet. But, after these nervous pains have been frequently repeated, they change their nature, and, instead of being nervous, they become inflammatory. This is the most eventful period of dyspepsia, for it is now that the foundation is lay- ing for all those dangerous and incurable maladies which have been mentioned in a former page. The utmost stress has, therefore, been laid upon the particular changes which are now taking place ; and, in order to enable every person to detect such changes as soon as they are about to happen in the liver and other organs, a colored plate is given, which makes this subject so plain, that none can fail to understand it. 60 The treatment also differs here, and local remedies are now re- quired,—such as blisters, warm plasters, and the like; also, occasional bleeding by leeches or otherwise, and a lower kind of diet. Further, a mild and gentle use of mercury is often now required in this, which may be termed the second stage of the disease. At length, however, and after long continued pains and inflamma- tion, the part in which these have occurred, beeomes enlarged and hardened. This part most frequently is the liver, which has given rise to the term, liver disease. The treatment of this affection is also carefully attended to, and the proper use of mercury, or the blue bill, has been defined. But it should still ho added, that the same effect which dyspeptic inflammation has upon the liver, it also has upon every other part in which pain or irritation happens. It would not have been consis- tent with the limits of this chapter, to detail the symptoms and the treatment of all these varied affections, especally as these are given in other pages of the Domestic Guide ; but as some may see this treatise who possibly may not possess the Guide to Medicine, it is proposed to mention some of these, and give a general hint or two upon the subject of their treatment. Apoplexy is one of these.—It is seldom that a fit of apoplexy happens without premonitory symptoms, and these affections of the head generally arise from some disorder of the intestinal passages, the cause or consequence of dyspepsia. Water in the head.—With respect to this complaint, it almost always is the consequence of some dyspeptic condition of the bowels, and may generally be prevented. It requires only to see the intimate connection between these two diseases, and to note the symptoms which point out its inroad on the brain, to stop the increase of this frightful malady. The purgatives, No. 1, are chiefly to be relied on in the origin of this complaint. Dyspeptic consumption.—This also is a consequence of indiges- tion spreading to the lungs instead of the more common organ—the liver. It is frequently cured, but much more frequently prevented, 61 by the remedies and management proper for dyspepsia. The blue pill is to be carried to the-length of some soreness of the gums, and the bitter infusions may be used ; but small bleedings, and a blister to the chest or side, can seldom be dispensed with, and the diet should be free from every thing stimulating. Indeed, this kind of consump- tion should be treated as other cases, with the addition of the use of the blue pill. The strength also should be more carefully pre- served than in ordinary cases, so that even local bleeding, whenever it is proper, should be small in quantity. Stricture of the rectum and piles, are also a frequent consequence of dyspepsia; but with regard to piles, it is next to impossible for those who take this mild aperient medicine ever to be afflicted with them. Many other disorders might be mentioned here, particularly those of females, most of which take their origin from, and are afterwards aggravated by, dyspepsia ; these, however, must be left to the judg- ment and good sense of the reader to perceive. CHAPTER II. GOUT. The domestic medicine, late improved hygeian pills, is found to be the most convenient and efficacious remedy for gout, that has ever been contrived, and this disease, which has generally been con- sidered an incurable constitutional malady, is now experienced to be as certainly prevented, relieved, or cured, as many other diseases which are peculiar to advancing life. Under every former plan, it is well known, that when once the gout appeared, uniformly its attacks became more and more fre- quent, and every repetition more severe, until, at length, an interval of perfect ease was scarcely ever enjoyed. But, under a proper use of this medicine, with a due attention to the hints which are sub- joined, the returning fits of gout become less and less frequent, and each attack generally less severe. 8 a - 62 And not only is there now a better remedy at hand for gout, but the disease itself is better understood. It is not, however, said that there is nothing left to be discovered of its nature, but that its con- nection with the derangement of the organs of digestion, is better understood than formerly, and its treatment on this principle more rational and effective. Indeed, the word hereditary having been applied to gout, seems to have precluded every rational investigation of its nature, and certainly quite forbidden every expectation of re- lief; so that persons laboring under the tortures of a gouty fit, could obtain but little more assistance, than that which nursing and patience could administer. Now, with regard to its hereditary nature, it is true, that if an individual of a gouty family indulge in habits of intemperance of any kind, whether it be in eating or drinking, or in intellectual pur- suits, he will probably have the gout himself; but these habits will also bring it on in many other persons, in whom no hereditary claim to this disease can possibly be traced. Is it not, therefore, certain that it depends on something more than hereditary constitution 1 Again, in every instance of the gout, a train of symptoms clearly pointing out derangement of the organs of digestion, appear first, and these continue for a certain time before the gout is seen. Further, it is observed that when a fit of gout abates, the symptoms of dyspepsia also disappear at the sams time, and the digestive organs are restored, in some measure, to a healthy state. It was in reflecting on these truths, that the writer first conceived the propriety of letting the question of the hereditary nature of the gout quite alone, and was led to inquire whether this disease could not actually bo prevented, even in gouty families, and cured or modified in others, from what cause soever it had sprung. This, as might be supposed, he attempted by means calculated to restore the organs of digestion to a healthy state, and keep them so; and he may safely add, that the result of his practise has amply proved these views to be substantially correct. This also further led to a better practice in the treatment of dys- pepsia itself; for he found that the ordinary means of securing a diurnal movement of the bowels, so essential in dyspeptic persons, were, for the most part, weakening;—the very thing to be avoided ; and it was under this impression, together with the conviction that 63 the essential nature, both of gout and dyspepsia, was a state of weak. ness, that he composed his alterative aperient pill, for the properties of which see page 25. From what has been said, it will be perceived that the object of the writer is to prevent the gout, or to prevent its gaining on the constitution of any individual when it has ones appeared, rather than to produce any great effect upon any single gouty fit, when it has actually commenced. For the purpose of shortening, and very materially lessening the agony of gout, there are powerful means ; but as these are of a nature altogether unsafe for private and domestic hands, he thinks it better to omit the mention of them entirely. With a view therefore of preventing the gout, or with the inten- tion of saving an individual from that faulty state of the constitution from which a fit of gout bursts forth, the aperient pills, or No. 2, are chiefly to be relied upon, and their management is so precisely the same as in dyspepsia, that it will be requisite to say but very little on this subject. It should be remembered that they are not to purge, but rather to prevent a costive state, or to prove a little lax- ative. If at any time the general habit has become too full, a dose or two of No. 1, is to be preferred, which may be repeated at inter- vals of a few days. Many persons take their daily dose of aperients, just before or after meals. In this case, they are hardly considered to be a medi- cine but rather as a part of food. They do not, indeed, nourish the body; but by mixing with the food, they give it that strengthening and recruiting quality, which it does not possess without. In this manner, their operation also, as aperient, is pretty regular, and many take advantage of this circumstance so as to procure an evacuation towards evening ; for, the sleep which follows upon the emptying of the colon before bed-time, is always more refreshing and tranquil. No person need apprehend the slightest evil from their continued effect; indeed, such is the general comfort of body, and serenity of mind which accompanies their continued and habitual use, that many persons are not disposed to leave them off at all. With regard to food, the same remarks which were made upon dyspepsia are applicable here, but those who are most disposed to gout, are commonly persons who indulge too much in eating, and fall 64 into habits of inactivity. These habits, at a certain period of life, are inseparable from that weakness which engenders this disease, and it must therefore be stated, that those who wish to avoid, or to cure the gout, must strictly regulate themselves in these two parti- culars. Without a regulated plan of diet and bodily exercise, the gout may be greatly benefited by this plan of medicine, but not en- tirely cured. There is also an intemperance in the exercise of mind which oftener leads to gout than many are aware of. This disorder, espe- cially in its more irregular forms, is very common to literary and studious persons. When literary people are troubled with undefined and irregular complaints, they should be aware of this, and relax in their pursuits; in the meanwhile, they will find that nothing in the form of medicine is more suited to relieve the effects of mind upon the body, or to bring the powers of the body to react upon the jaded faculties of mind, than these aperient pills. Should an absolute fit of gout come on, two or three doses of the fever purgatives, or No. 1, should be taken,—the affected part should be kept cool, (not wrapped up in flannel,) and the diet should be low. These means will greatly lessen the pain and fever, and shorten the fit materially. CHAPTER III. RHEUMATISM, LUMBAGO, AND RHEUMATIC GOUT. These most commonly arisa from cold, or irregular clothing, and are more of an inflammatory nature ; still the utmost good is ob- tained by an attention to the digestive organs, and by guarding against a costive habit. For this purpose, the aperients, No. 2, should be taken for a week or two together, and now and then a dose of No. 1. By this plan, in conjunction with a due regard to clothing, the most obstinate rheumatic affections are removed. Rheumatic gout is nothing more than rheumatism engrafted upon a gouty constitution, and should be treated as the gout. 65 CHAPTER IV. APOPLEXY, GIDDINESS, HEAD-ACHE, CONFUSION OF MEMORY, AND OF THE SENSES OF SIGHT AND HEARING, ALSO FEELING OF NUMBNESS IN VARIOUS PARTS OF THE BODY. These are complaints of the utmost danger, and the safety of every one afflicted with them, depends much more upon the patient's own knowledge of their real nature, than on the skill of his physi- cian. For this reason, it will be an object of much care to make this subject as plain as possible, and it will be no small encourage- ment to those to whom it may relate, to be assured that these dis- eases are greatly under the control of proper management. Apoplexy is not that sudden complaint which many suppose it to be ; on the contrary, it is slow and very deceiving in its approach. Even in those sudden and fatal strokes we hear of, there are always premonitory symptoms, and these, if they were but known and pro- perly treated, would generally lead to measures of relief and safety. The complaints at the head of this chapter, are of this premonitory kind ; they are all of one nature, and under different circumstances lead to apoplexy. In this disease it is essential to keep in mind two things ;—first, that there is a certain weakness in the blood-vessels of the head; and next, that too great a quantity of a rich and heavy blood is cir- culating through them. The plan of cure is therefore plain and rational;—it is, to strengthen the vessels, and to reduce and purify the vital fluid. Now, every one agrees to this, but every one is not acquainted with the means by which it is best accomplished. In all these complaints, for instance, the common practice of repeat- ed blood-letting is adopted, but nothing can be more unfortunate than such a practice. This is not the way to lessen circulation,— it increases it. That the practical effect of bleeding is to increase the quantity of blood, is known to every grazier. On this account it is, that he always bleeds his cattle once or twice before he puts them up to fatten for the market. He does not always know the 66 reason why it is so, nor is it necessary here to point it out, but he knows the fact. In apoplectic symptoms, therefore, except in circumstances threat- ening an immediate stroke; and in all diseases in which too much blood is a principal cause,—bleeding is a dangerous remedy, and very often fatal in its consequences. In all these cases, the repeated operation of the alterative purgatives, or No. 1, is decidedly to be preferred. By these the blood is diminished in quantity, as well as purified in quality ; and this is brought about by means that do not lead to its re-production, which bleeding always does. In all the cases we have mentioned above as circumstances of an apoplectic tendency, the proper use of the purgatives No. 1, is, therefore, to supply the place of blood-letting; and these, in con- junction with the rules which are to follow, will relieve many an anxious sufferer from the fear and risque of sudden death. The importance of this subject is felt to be very great, and the writer would fain endeavor to impress it on the minds of all who have an interest in it, by another word or two. If any one should doubt the truth, that the proper use cf the pill No. l,can lessen as well as purify the blood, he is requested to turn to plate the 2d, and observe the prodigious size and number of the blood-vessels which ramify over the inner surface of the intes. tinal passage. Now, over all these vessels this pill exerts a full command, and by their judicious use the quantity of blood can be reduced as certainly as by the' lancet. But this is not all, for the reduction thus made is gradual, and, therefore, permanent; while the effect of general bleeding is to arouse the system to a fresh supply of blood, and when this habit of re-supplying Llood has once become established,,an increasing fulness of the vessels is a constant consequence; so that the danger of a rupture of the vessels in the head is increased, instead of being diminished, by repeated bleeding. It may not be improper just to mention in this place, that the same remark applies to those distressing cases of palpitation which fre- quently occur in elderly people, particularly in those who are inclined to corpulence, and in whom the little vessels on the face are of a bluish cast. Such persons are very apt to fall into this error, but it is a dangerous and very often a fatal one, and therefore cannot be too plainly pointed out. It is certainly true that those who G7 adopt this practice, most commonly find relief to be the immediate result; but this is the more to be regretted ; for it is that circum- stance which leads to a repetition of a practice which directly involves the dangerous consequences already stated. Depend upon it, if no other means can be devised,—none which have a more per- manent effect in lessening the quantity of blood in constitutions of this kind, (which are called plethoric;) such individuals live from day to day upon a very slender tenure. But, in returning to the treatment of apoplectic constitutions, it may be further added, that while the quantity of blood is certainly and permanently reduced by the operation of this purgative pill, its current and determination is likewise altered by the same means. In the apoplectic, not only is the blood too abundant in quantity, but the proportion of it which circulates through the vessels of the head is also too great. There is a certain irritation in the blood-vessels of the head, in apoplectic subjects, which perpetually invites the cir- culation to the brain. It has been shown already whence this arises, and to what extent the diseases of the stomach, the liver, and the bowels, especially accumulates in the colon, produce and maintain this irritation ; and the reader who is desirous of further information on this subject, is referred to what has been said on the composition of the aperients No. 2, chapter VI. In this place it is only necessary to mention this additional advan- tage of the pills, and to show that while their immediate operation is upon the bowels, and the circulation is determined to this part in consequence, so it is diverted from the head in the same proportion, and those vessels are allowed to recover their natural tone accord- ingly. The use and management of this medicine is the following : It will be observed there are two kinds of pills; the first is pre- scribed with the intention of reducing and regulating the circulation of the blood, and must therefore be had recourse to just as the system stands in need of absolute depletion or reduction, and of course must be continued and repeated according to the emergency and the effect which is seen to be produced. One person, for in- stance, will require a repetition of the pills every second or third day, and will find his strength, both of body and mind, greatly improved in consequence;—while another might feel weakened by such fre- 63 quent doses, and should therefore repeat them but once a week. Again, one individual will be found to require a greater number for a dose than another, so that the dose must be regulated on the score of their activity. From three or four to six or eight evacua- tions of the bowels can generally be sustained, but the dose may be so regulated as to act as may be found desirable. Let three or four pills of No. 1, be taken to begin with, and this quantity may be increased agreeably to the end proposed. When the habit of the body is found to be reduced, and the un- comfortable sensations of the head, and the premonitory symptoms are relieved, then leave them off, to be returned to only in the event of a relapse. The second kind of pill, or mild aperient, is also of great utility in every stage of these complaints. In the first place, their mild effect is called for on the intervening days between the more active doses of No. 1, and when the occasion for the stronger pills has ceased, nothing will more contribute to preserve a healthy state of the organs of digestion, and of the colon in particular, than their occasional and judicious use. With regard to diet and exercise,—much which has been said upon this matter, both in dyspepsia and gout, is applicable here. Bodily exercise, however, is still more called for, and if the habit is gross and corpulent, it must be carried on so as to promote a free and copious perspiration. It should also be as regular as can be commanded. The diet too, should not consist so much of animal food ; and if the constitution be still disposed to become plethoric, the diet must consist almost entirely of vegetable articles. A life of regularity and temperance is known by all to be absolutely called for. 09 CHAPTER V. INTEMPERANCE,--ITS EFFECTS AND REMEDY. The object of the following paragraphs is to point out a remedy for some of those effects which render it so difficult to abandon the use of intoxicating liquors when once established. Many an individual has made attempts to conquer this habit, alike destructive to health and happiness, but in these endeavors he has had to contend with such a host of disordered feelings, the effects of long continued inebriety, that he has given up the task, under the impression that he could not live without stimulating drink. The habit of intemperance, in many cases, is begun without the slightest suspicion of impropriety or danger ; even moral persons of the highest intellectual order, have been seduced unconsciously by this species and deceitful agency. For instance, many of the complaints for which the pills would prove a certain remedy, are attended with a languor and depression of the spirits, for which the use of wine or something which exhilarates, proves, unfortunately, a temporary soother; this may even be in the form of medicine, such as a few drops of the red spirits of lavender, upon a lump of sugar ; but, in what form or shape soever it be taken, its temporary relief is very soon dearly paid for. The first effect of this unhappy practice, is to quicken the returns of languor and depression ; but these return not under the same circumstance as at first; for they now require a greater force of stimuli, or a more abundant supply to counteract them. Invariably, the consequence of habitual wine or spirit drinking, is to increase in its demand upon you ; and the climax of the drunk- ard's scale of graduation, is generally the strongest brandy, and every hour or two the usual interval between its repetitions. But, the various diseases which await the intemperate can scarcely be enumerated ; yet there is not one for which this medicine, if rightly managed ; is not a remedy. The first conspicuous effect is gener- ally on the stomach, in the form of indigestion; then follows either 9 70 emaciation, or a bloated fullness, unsteadiness of the hands and limbs, headache, loss of memory, and a state of dejection. There is usually, also, a peculiarly irritable state of temper, even in those who for- merly were amiable and patient; hence the meal becomes embittered, the social tie is weakened, and the very basis of domestic happiness at length is broken up. But, if the symptoms which have been enumerated are not enough to serve as warning, then there will soon follow, pain in the right side, extending to the shoulder ; jaundice ; occasional bleedings from the nose, the intestines or other parts ; dropsy of the belly and legs; and delirium. Under all these circumstances, how important is it to know that the habit may be discontinued 'all at once.' It is a great mistake to think it is to be attempted by degrees. The popu- lar advice, to add a drop of sealing wax to your glass after every dram, and thus gradually lessen the measure, is bad advice;—it has more of wit than wisdom in it. If this advice be ever appli- cable at all, it' is in those cases only in which the constitution is broken down by long indulgence. With the exception of such a case, I know of none in which a total and sudden abstinence from every kind of spirituous potation, is not the safest and the easiest method to be adopted. In every instance of disease from drinking, the stomach and organs of digestion are first affected, and this is the only medium through which the constitution can be repaired and re-invigorated. On this principle it is that these pills are recommended and relied on. If they are taken as directed, although the languor and craving of the accustomed stimuli should return, they will be of short duration ; while those false and spurious feelings of vigor, excited for a few moments by exhausting stimulants, will be succeeded by an abiding energy of mind and body, such as health alone produces. The aperients, No. 2, are chiefly used in these cases,—and, for the manner in which they operate, the reader is referred to page 25. Let from three to four of the mild aperients be taken every night, or every morning at breakfast time, and these should be continued until the appetite and general strength of body is established. It is best to increase the dose, if they should not happen to be gently lax- ative ; for it is worthy of remark, that those who suffer least from habits of intemperance, are they who are subject to moderate loose- 71 ness of the bowels, similar to that produced by the pills, which serves to carry off, in some degree, the poisonous effects of what is swal- lowed. CHAPTER VI. FEVER AND AGUE, BILIOUS AND REMITTENT FEVER, YELLOW FEVER, SCARLET, TYPHUS, NERVOUS AND COMMON FEVER. Although there is something peculiar to each of the febrile diseases above enumerated, and a great difference in some of them with re- gard to their rapidity and danger; yet there is a striking similarity in their general treatment; and it will be found, that that part of the treatment of fever which is of more importance than any other, is requisite and necessary in them all, without exception. The most essential point in the treatment of fever, consists, first, in evacuating the intestinal canal of all its putrid contents and hu- mors, and afterwards in maintaining a certain action of the bowels, by which the regeneration of such putrid humors is prevented. For the first purpose the composition of No. 1,—the febrile purga- tive,—possesses the most specific virtue ; while, for the remaining purpose, the same pill in smaller doses, or repeated at longer inter- vals, is most remarkably adapted. Fevers, therefore, as it would appear, have much of one common nature, which is peculiar to them all; and it is the vitiated humors of the body, and the state in which the intestinal canal is found, which make the principal difference in them. Indeed, by far the greatest number of fevers, arise spontaneously from the disordered condition of the intestinal canal alone, and then become nervous, putrid, or malignant, just as these vitiated secretions happen to de- termine ; very generally, those which arise from any other cause ; as from cold, would speedily go off if they were not fed and con- cocted into different kinds from this common source of pestilence and disease. But, when this very general cause of fever is so fully stated, it is not pretended that there is no other cause of fever whatever. It is fully acknowledged that there are other causes which give rise to 72 fevers, and those of peculiar and malignant character; and it is a knowledge of this truth which has given occasion for considering fever under the various names which are given at the head of this chapter. One observation, however, may be made, and should excite peculiar gratitude, viz. that while the dangerous and pestilen- tial kinds of fever are few in number, comparatively, by far the greatest number of febrile diseases are of a milder character, and are aggravated by causes which it is in our own power to regulate and remove. It is proposed, therefore, to consider the subject of fever in the order already stated, and to point out what other means of treatment are required, in order to give the utmost degree of usefulness to the fever purgative, as well as to show the proper use of the mild aperi- ent, in each disease. FEVER AND AGUE. Every one knows this form of fever by the perfect intervals of all the symptoms which occur between the fits. This interval may be a day or two, or even three days, and the fever is termed accord- ingly, a second or a third day ague. The best way to attack this disorder, is to wait for the usual time of the returning cold fit, and the moment it is found to be coming on, then take a vomit. Thirty grains of ipecacuanha powder is a very good one, but it does not matter greatly what the vomit is ; half a table spoonful of the flour of mustard, in a pint of warm water, is as good as any, and very safe and certain. Two or three hours after this, begin with the fever purgative, or No. 1,—and after the bowels have been unloaded, then begin with No. 2, which must be repeated and continued until the disease is cured. The dose of No. 2, in this disorder, is from three to five, or more; and these must be repeated every four or six hours. The more that can be taken between the usual period of the shaking fit, the more certain and quicker is the cure. If it should happen that these large doses excite the bowels too much, a lea-spoonful of pa- regoric in a little wine and water, once or twice a day, will check it, or the dose may be lessened. 73 This is the course which is to be pursued for several days, or un* til the ague ceases to return, when the pills are to be diminished by degrees, and in a day or two more may be laid aside. It is remark- able that fever and ague, which has continued long, is liable to return at the period of the changes of the moon ; and on this account it is desirable that a dose or two of the pills should be taken, before and after the first or second lunar changes. If it should happen that a sufficient quantity of pills cannot be taken for the cure of ague, in consequence of the laxative effect, this inconvenience must be remedied by taking them in conjunction with the quinine, or the Peruvian bark. It is known that there are many cases of fever and ague, which resist the efficacy of the quinine or bark alone ; but it has never yet been known that the fever and ague has ever resisted the efficacy of the quinine or bark, when taken in conjunc- tion with these pills. By this means, those obstructions which pre- vent the curative operation of the bark, are removed by the pills, and no fever and ague, however obstinate, can withstand this com- pound. In such cases the following will be found to be the most conve- nient and efficacious method of combining them. To one bottle of Madeira or Malaga wine, add sixty grains of sulphate of quinine, or one ounce and a half of Peruvian bark may be used in lieu of the quinine. Shake the bottle, and take of this, two or three table-spoon- fuls, or a wine-glassful, every two or three hours,—having first cleared the stomach and the bowels as before advised. With each dose, take two or three of the pills, No. 2, or just as many, and as often, as may be necessary to keep the bowels moderately relaxed. It will seldom be necessary to continue this plan beyond a day or two, so that the quantity may be diminished, and by degrees the use of the medicine left off. It is found very useful to continue a mild dose of the aperients for a week or two after, both with a view of re- cruiting the general strength and health, as well as preventing a re- turn of the ague fit. BILOUS AND REMITTENT FEVER. What is meant by this fever is indeed expressed in the name. It means a fever in which the symptoms come on and run high at some 74 particular period of every day, and after some hours' duration, abate, but do not go entirely off. If the symptoms were to go off entirely, and return on the next day, or day after, then it would not be a remittent, but an intermittent fever, or fever and ague, which we have just been speaking of. The difference then between re- mittent fever, and intermittent ague is this; that in remittent fever the symptoms only very much abate for a time, while in intermittent or ague, they go entirely off. In both cases the symptoms return pretty regularly at a certain hour on the following day ; but, while the remittent returns regularly every day, the intermittent or ague, sometimes returns only every second or third day. The common remittent fever then will be known by the daily abatement of all its symptoms. It is very often a mild disorder, and is more commonly seen in persons of a weak and delicate form, and those of sedentary occupations, and is very apt to prevail in the fall of the year. This fever is almost always preceded by a costive state of the bowels, or some irregularity of the intestinal passage, and often by dyspeptic symptoms. There are some cases in which these symptoms do not at first appear, but in those they never fail to show themselves in the course and duration of the disease, and always prove a cause which continues and greatly aggravates it.— It is on this account that the treatment of bilious and remittent fever, is so simple and successful. Nothing is really necessary but to un- derstand the proper use of the purgatives, No. 1, by which you first unload the intestinal passage, and afterwards continue them at cer- tain intervals, until every symptom disappears. It is proper to be- gin with three or four, and these should be repeated every four or six hours, until the intestinal contents are thoroughly dislodged.— When the evacuations of the bowels cease to be unnatural and of- fensive, or become thin and watery, the first object is then obtained, and now the use of the medicine should be moderated, but must not be wholely discontinued. It is upon a judicious repetition of the same pill, that the removal of this disease depends, and by which healthy secretions of the liver and bowels will be re-established. The dose of the pills may be the same, but the intervals of their re- petition may be 6, 12, or 24 hours ; and at this time it will be necessary to supply the patient with chicken or beef-tea, arrow- root, panada, and the like bland and supporting things, and to these 75 it is often very proper to add a little wine or any other cordial.— Under this plan of treatment, sooner or later, this fever will abate and convalescent symptoms return. With a view of accelerating this return of strength and health, the mild aperients will produce the best effect. From three to four or five should be taken either at night or morning, and, now and then, a dose of the former medi- cine, or No. 1, should be substituted in their place. It should also be observed, that throughout the whole course of the disease, the freest ventilation of fresh, cool air, should always be insisted on. This is of more consequence than persons are gene- rally aware of. It is also very useful to enjoy the advantage of change of air, when the convalescent stage begins ; and if the fever has continued long, and much general weakness has been the con- sequence, this will be greatly advantageous, only care must be taken that too much fatigue and exposure be not allowed. If any form of fever and ague should follow this disease, and that is not uncommon when it happens in the fall of the year, then take the quinine or Peruvian bark, as directed in that disorder. THE YELLOW FEVER. This is a disorder which is frequently so rapid and fatal, that it would always be advisable to obtain the personal assistance of a physician, when it can be done. For the benefit of those, however, who have not the opportunity, and with a view to public good in case the yellow fever should ever become again epidemic in this country, or any other, the most simple and successful kind of treat- ment shall now be given. This fever, like the former, is also of the remittent kind; but, owing to a great degree of heat and certain other circumstances, it now and then assumes this peculiar and malignant character. In this disorder there is always great debility, and the liver becomes so exceedingly irritable as to produce an overflowing quantity of bile ; it is this which gives the skin and surface of the body, its yellow color. In the beginning of the fever there is always, more or less, a high degree of inflammatory action; and therefore, whenever it can be had recourse to, a free and copious bleeding is the first step which 76 should be taken in its treatment. Those physicians and surgeon* who have had the most experience in this disorder, either in this country, the West and East Indies, or in those parts of Europe in which it has ever been an epidemic, are all agreed on the propriety of bleeding. The quantity of blood which should be taken, or the repetition of it, are points which can only be determined by the high degree of heat and fever which are present, and the natural strength and fulness of habit of the individual patient. As a general rule it may be observed, that the bleeding should be bold and copi- ous,—not sparing. When the patient has been blooded, or, in cases where no person is at hand to perform this operation, then immediately begin with me- dicine. Take three or four of the fever purgative pills, or No. 1, and repeat the dose every three, six, or eight hours, so as to keep the gall-duct and intestinal passage free from accumulations of every kind. Both the liver and intestinal glands are under the im- mediate influence of this disease, and are continually pouring forth acrid and malignant humors. Now, the most important point in the treatment of the yellow, as well as of other fevers, consists in car- rying off such morbid secretions as fast as they are formed, and no better means on earth can be devised for this purpose than the fever purgative pill, or No. 1. There is, however, one circumstance to be mentioned in connection with their use in this disease: it is, that an irritable state of the sto- mach and bowels sometimes presents itself which causes them and every thing else which is taken, immediately to be rejected by vomit- ing ;—or, if they pass into the bowels, they do not remain there long enough to produce their good effect upon the liver and intestinal glands. To allay the vomiting, and obviate these effects, some opi- ate or other quieting ingredient should be given with them ; and the most convenient and excellent form of medicine for this purpose, is the paregoric. In such cases, therefore, let a tea-spoonful of this be given in a little water with every dose, or every other dose of the pills, as it may be required. If this should not succeed, an injec- tion of 40 or 50 drops of laudanum in a tea-cupful of starch, is a sovereign remedy. The next object in the treatment of yellow fever, is to subdue the raging heat of the body as much as possible. For this purpose no- 77 thing is better than spunging the limbs and surface of the body with cold water, or vinegar and water. This must never be omitted.— Let a person sit by the bed side, and continue his work steadily.— First begin with the feet and hands, then go up the limbs, and then over the whole surface ; afterwards begin again with the feet, or where the heat is greatest, and do the like. It is astonishing how much the heat is to be subdued by this simple means, and how grate- ful and supporting it is to the suffering patient. It is also the best of all means to bring out a perspiration. This salutary action cannot take place under great febrile heat of body ; but if you can reduce this heat to a certain point by any means, then sweating will break out to the great relief of the patient. Sleep also is brought about by reducing the heat of the skin ; and the author has often known a calm and refreshing sleep to succeed this cooling process, (espe- cially in children with the scarlet fever,) when no medicine could procure it ; he, therefore, lays great stress on this simple means. Another and co-operating measure which must always be insisted on, is ventilation. The importance of a free current of fresh, cool air, cannot be told. Every contrivance for this purpose is invalu- able. Let the bed be removed to the coolest room in the house, and so placed between the door and windows as to make the utmost of the change. If ever yellow fever should become again an epidemic in this country, it will be'found that removing every patient as soon as possible to an encampment formed on this principle, will prove the happiest means of saving life and extinguishing the raging pes- tilence. The beverage also should be cold ; cold water, or water acidu- lated with lemon juice, or any kind of acid, may be drank without measure or limitation,—the more the better. When the fever abates, and marks of convalescence begin to appear, a light and nourishing diet, just as in the convalescence of other fevers, will be demanded. Bark and cordials are sometimes called for. The treatment of yellow fever, then, whenever it occurs, maybe condenssd in a few words. Bleeding at the onset, if it can be done; repetition, of the fever purgative pills, or No. 1, assisted with the paregoric, when vomiting and irritation of the bowels are present; sponging the surface of the body, and free and constant ventilation. 10 78 SCARLET, TYPHUS, NERVOUS, AND COMMON FEVER. It is not necessary to say much on the treatment of the fevers above mentioned, as one common principle is applicable to them all, and this has been plainly described in what has been already said. If a common fever continue in a person whose constitution is suf- fering from impurities of blood, disorders of the digestive organs, anxiety of mind, bad diet, impure air, or any such cause,—then it becomes a low fever, or what is called nervous ;—or, it may become lower still, when it is called typhus, or putrid. Now, in all these, a like treatment is required, and this consists in a well regulated use of the fever purgative, or No. 1, just as it has been pointed out in speaking of yellow fever. The object is to clear the constitution of humors and vitiated secretions, and then continue their use in such a manner as to maintain a certain moderate action on the bowels. Thus a link is broken in that chain of morbid action, on which the existence of disease depended ; the resources which supplied ma- terials for its typhus character, are quite destroyed ; while the ner- vous system is left at liberty to exert the powers of nature in the re-establishment of health. The same remarks which have been made upon the utility of the cooling process, are equally correct in fevers of every kind ; but as the heat does not run so high, and the danger is not so great, such measures are not often required to the extent which has been men- tioned in the previous article. The means of cooling the body, how. ever, by sponging or otherwise, is proper in all fevers, and when the heat arises above the ordinary standard, and the patient is sensi- ble of it, it can never in any instance be hurtful, and scarcely ever can be useless. With respect to scarlet fever, too much cannot be said to urge the practice of sponging the body. Indeed, the author, for many years, has laid a greater stress upon cooling ablutions in the scarlet fever, than on any other means, and not without the happiest results. With regard to other remedies, but little may be said ; for, if the proper use of the fever purgatives be secured, and the heat of the body be reduced by the united efforts of sponging, and constant ventilation, but little else will be required. 79 In the "course of fevers, however, of any kind, local symptoms will sometimes happen. The brunt of the fever in such cases seems to fall in the form of inflammation, on some one or other part of the body, and this is known by great heat and pc.in in such part. These local affections must always ba treated on the common prin- ciple of inflammations, and sometimes a general blood-letting is required. When this part happens to be the brain, or lungs, or any part of the belly, it must never be neglected. The head must be shaved ; clothes wet with cold water, or vinegar and water, applied, and leeches to the temples,—sometimes a blister to the nape of the neck. If it happen in any part of the belly, which is known by the pressure of the hand, then leeches, warm fomentations, and afterwards a blister, will be necessary. These are always safe s^ps, and, in some cases, absolutely required. A blister to the throat in scarlet fever is always safe. With regard Jo beverage and supporting regimen, this must be regulated by the low or typhus symptoms which appear. Every fever differs in the degree of weakness or prostration of the vital powers, and therefore calls for different degrees of supporting beve- rage. Wine and water is the general and most proper drink. This is only called for on the score of support, and therefore is only necessary when symptoms of debility, or putrescence are seen,— such as a dry brown or blackish tongue, the teeth covered with adhering humors, and the breath and evacuations offensive. In such cases, wine alone, and even wine and brandy, are required, and must be given liberally. 80 CHAPTER VII. SCROFULA, KTNG'S-EVIL, TUMORS IN THE NECK, ENLARGED JOINTS, ULCERS, ERUPTIONS ON THE SKIN, PIMPLES IN THE FACE, SALT RHEUM, NETTLE RASH, PRICKLY HEAT, BOILS, ITCHING OF THE SKIN, CUTANEOUS DISEASES, &C. &C. The whole of the above diseases are so much of the same class, that they may be advantageously spoken of in the same chapter, more especially as the method of treatment which is proper for one, is proper for the whole. All of them are complaints in which the blood is poor as well as foul, and great mischief is constantly done by injudiciously purging to excess with calomel and weakening drugs, while the diet allowed is frequently too poor and scanty. It is certainly proper to begin in all these cases with a briskly operating purge,—say with a dose of No. 1 ;—but when the bow. els are once cleared, they should then be only gently, though con- stantly, moved by No. 2. It will sometimes be necessary to give a dose of these pills every day, and sometimes every other day, and where the habit is very gross and full, No. 1 may be repeated once or twice a week. It is, however, the No. 2, or gentle aperients, that must be relied upon for sweetening the blood ; and by their use the digestion will be so much improved, and the appetite so sharpened, that the strength, activity, and spirits will become abundant; and it is only in propor- tion as this result is obtained, which is a proof of general health, that all these eruptions, tumors, swellings, and ulcerations, will heal and disappear. The diet, also, is to be a matter of your care; it should consist of good animal food twice a day, under-done, with a little wine, or beer; pure air and moderate exercise are absolutely necessary. The clothing, too, must be adapted to the change of weather. Many of these complaints are seen in weak ;;nd delicate young persons ; and those parents who have lost their children under simi- lar affections, will be astonished at the health, strength and pre- 81 servation of life, which will ensue from the treatment here laid down. Children that cannot be induced to swallow pills, may have them powdered and dissolved in boiling water, and made a syrup of,—or which is a better way to avoid the taste,—break them with a hammer into little pieces ; and give them with jelly or preserves. CHAPTER VIII. CONSUMPTION, THREATENING COUGH, DIFFICULTY OF BREATHING, AND ASTHMATIC DISEASE. To prevent consumption n those affected with a threatening or suspicious cough, and as a remedy for all the various affections of the lungs mentioned above, it may be confidently affirmed that no medicine will be found more safe and efficacious than these pills. There is not a more insidious and fatal evil than a trifling cough, which sometimes improves, but never goes off entirely. If a cough continues much over a week, there is a sufficient ground for care and watchfulness ; and if there should happen to be a taint of scro- fula in the constitution, or a vitiated state of the blood from indiges- tion, or an inactive state of the bowels, especially at the growing stage of life, the danger multiplies exceedingly. In such cases the humors seem attracted to the lungs, by the frequent irritation of coughing, and are there deposited in the form of tubercles. This is the origin of tuberculated lungs ; these tuber. cles continue to enlarge on every slight occasion, such as change of weather, &c, until at length they suppurate by continual inflam- mation, and the matter and corruption they contain escapes into the air-cells, and is thence expelled by expectoration. This is a state of things more easily prevented than cured, and in a great majority of cases this fatal termination of the disease might have been obviated by the timely use of proper measures. The treatment which is recommended under the circumstances which have just been detailed, is the following:— 82 In a common cold accompanied by a cough, there is generally a little fever;—begin therefore with the No. 1, or purgative pills, and repeat the dose in. a day or two. If there are slimy and offensive materials in the bowels, they will be certainly removed; and if not, the blood will be cleansed, and its circulation determined to the bowels, and thus the irritation and obstruction in the lungs will be relieved. If pain about the chest with considerable fever should attend the cough, a moderate bleeding from the arm is advisable ; and it may be laid down as an axiom, that a blister, or mustard poultice upon the chest, is always a safe and advisable application in severe affec- tions of the lungs. The diet should at the same time be low, and the patient must avoid unnecessary exposure to cold and all exces- sive bodily exertion. In long continued coughs, in shortness of breath and asthma, the aperients, No. 2, are more particularly useful. These should be taken as in dyspepsia, with now and then a dose of No. 1, to purge away the accumulated humors from the system, and so prevent their disposition to settle on the lungs. CHAPTER IX. CHOLERA, OR CHOLERA MORBUS. The disease which is to be the subject of this section, having so lately raged in this and many other countries, in the form of a severe and very fatal epidemic, it seems a matter greatly to be desired that every individual should be so far instructed with regard to the na- ture and treatment of this awful malady, as to be able, from his own knowledge, immediately to attack it where and whensoever it may make its appearance, and to conduct its cure upon some plain and correct principle. There is no particular reason to apprehend that this disease will again return in the same rapid and fearful form in which we have so lately seen it; yet such an event is by no means impossible; and, moreover, we are at all times liable to the milder attacks of cholera ; and, indeed, in the months of July and 83 August, as also in the fall of the year, this disease is very apt to be- come more or less an epidemic. For this reason, as well as that the life of the sufferer very often depends upon the prompt and decisive measures which are adopt- ed, the writer is anxious to render this disease and the treatment of it as plain as possible; and with this intention he proposes to ar- range the remarks he has to make upon the subject of cholera, in the following order: The nature of the disease termed cholera, or cholera morbus. How to distinguish cholera from disorders which in some degree resemble it. The causes of cholera. Objects to be aimed at in the treatment of cholera ; also, a list of materials which should be kept in readiness for their accom- plishment. On the different kinds of cholera;—the symptoms which mark them ;—and the particular manner of administering the reme- dies already mentioned in each variety of the disease. Bilious cholera, or cholera morbus. Flatulent cholera. Spasmodic, or Asiatic cholera ; its symptoms and treatment. The treatment of the premonitory symptoms of cholera. Means for securing general health during the prevalence of cholera. THE NATURE OF THE DISEASE TERMED CHOLERA, OR CHOLERA MORBUS. It is to be remarked, that in this complaint, the liver is the organ which is always first affected, and from this source proceeds every circumstance which is observed subsequently to take place. In what this altered state of the liver consists, has not hitherto been ascertained ; but the consequence of it is, that the secretion of this organ, that is to say the bile, becomes of an irritating and poisonous quality. In common cholera morbus the bile is generally very much increased in quantity, but this is not the case in all the varie- ties of cholera ; on the contrary, in some it is even deficient, and again at other times, though not deficient, it is nevertheless shut up 84 by spasm in the liver and gall-duct, so that there is no appearance of bile in what is thrown off by the stomach and bowels. With regard to the color of the fluid evacuated, this also varies ; in the milder and common cases of cholera morbus, this is yellow and looks like an overflowing of pure, unmixed bile ; but in the more severe forms of this disease, the evacuations both of the stomach and bowels are watery, or like water in which fresh meat or rice has been washed. Further, we observe a striking tendency to spasm. Cramp in the limbs, with spasmodic affections, more or less universal, and which sometimes extend to every organ of the body ; is a peculiar charac- teristic of this disease. Much of this spasmodic affection may be ac- counted for on the principle of the irritating acrimony of the bile, occurring in a weak and excitable condition of the body; but, inde- pendently of this and other causes, there is in cholera a tendency to spasmodic affection which is peculiar to the disease. It does not seem that there is any essential difference in the nature of cholera, under whatsoever form it appears ; and if we examine and compare the common cholera morbus with those severe and fatal cases of spasmodic cholera which occurred in the late epi- demic, it will be seen that the difference consisted more in the violence and rapidity of the circumstances attending each, than in any peculiarity in the nature of the disease itself. In every case the liver is the seat and centre of all that follows, while the violence and fatality of every attack depends chiefly on the following cir- cumstances :—the concentrated poisonous quality of the bile; the ease or difficulty with which it is carried off from the body ; and the natural resources of each individual to supply the exhausting vital power. With regard to the nature of cholera, therefore, it may be stated in few words ;—it is a disease in which the liver is disordered, and secretes an acrid and poisonous bile ; this quickly disturbs the sto. mach and intestinal passages, and through them the nervous system;— hence, vomiting, purging and spasms. Such are the symptoms which are characteristic of cholera, and they are violent and fatal in pro. portion to the intensity of the disease of the liver. In the most severe attacks, the spasm is so extreme and universal, as to shut up the poisonous bile in the liver, and the gall-bladder, and the vital 85 power becomes most rapidly exhausted; when this takes place, the patient is said to be in a state of col lapse, and death is then generally near at hand. Some severe cases have thus proved fatal in less than six hours. HOW TO DISTINGUISH CHOLERA FROM OTHER DISORDERS WHICH IN SOME DEGREE RESEMBLE IT. During the panic of mind which prevails at the time of an epide- mic, almost every disorder which occurs, especially those which relate to the state of the stomach and bowels, are construed into such a case, and much confusion and unnecessary alarm is frequently the consequence. The disorders which are most likely to be mis- taken for cholera, are, dysentery, cholic, and common diarrhoea, or summer complaint; but if what has been said on the nature of cho- lera, be kept in mind, it will generally be an easy matter to distin- guish it from these disorders. For instance, dysentery may be known by the stools being slimy, not bilious or watery, and often streaked with blood. Further, these evacuations are generally mixed with portions of common stool, and in the intervals of griping, there is more or less of a constant pain, about the fundament. These symptoms, together with the absence of cramp and spasm, will be a sufficient guide to distinguish the disease of dysentery from that of cholera. In cholic, and particularly in the painters' cholic, it is true that there is frequently a copious vomiting of bile, while the bowels always remain obstinately costive ; nothing whatever can be made to pass by stool; and this striking circumstance will afford a distinctive mark between the cholic and the cholera. In diarrhoea, or common summer complaint, the evacuations are more or less watery, but they are not bilious. Neither is there fever, vomiting, or cramp and spasms. THE CAUSES OF CHOLERA. With regard to the remote cause, or the reason why the cholera should sometimes become an epidemic,—this is a matter perfectly unknown to every one. Certain circumstances, such as heat alone, 11 86 or heat combined with moisture, seem to favor its appearance ; but there is something more than these, and that which no person has yet been able to detect, which gives existence to the epidemic form of cholera. It has prevailed even in cold and dry, as well as in hot and swampy districts. As to the question of its contagious nature,—that is to say, whe- ther the cholera is communicated from person to person, or only by the agency of some peculiar, but unknown state of the atmosphere, this has been a subject of much debate. Those who have seen most of the disease, and are therefore by far the most capable of judging, are decidedly of opinion that cholera is not contagious, and in this opinion the writer perfectly agrees. In his judgment the disease cannot be taken by any one, in consequence of attending upon, and nursing those that are affected with it, and those who withhold their personal assistance from their friends or neighbors on this ground, are under a delusion. But, if little or nothing is known with regard to the nature of the cause which gives the cholera an epidemic character, this cannot be said of the immediate causes which produce it. Much that is im- portant and very practical is known on this subject, and it is the duty of every individual to become acquainted with such causes, and carefully to avoid them. Amongst the most important of this kind, may be mentioned,—intemperance, and irregularities of any kind ;— perspiration suddenly suppressed, particularly by cold and damp applied to the feet, as by long standing on cold, damp bricks or stones ;—cold drink, especially if taken when heated by exercise ;— cold, indigestible fruits, as unripe apples and pears, cucumbers, melons, &c.;—also any violent purgative medicine ; a state of cos- tiveness ;—a neglected bowel complaint, or such a state mistreated by laudanum or astringents. Fear also may be considered to be a cause, as well as every thing which has a tendency to depress the spirits and exhaust the strength of the body. OBJECTS TO BE AIMED AT IN THE TREATMENT OF CHOLERA, AND ALSO A LIST OF MATERIALS WHICH SHOULD BE KEPT IN READINESS FOR THEIR ACCOMPLISHMENT. The objects to which your endeavors are to be directed in the case of an attack of cholera, are to dilute, evacuate, and wash out 87 the acrid bile from tho passages, both by the stomach and bowels;— to moderate the vomiting and purging;—to allay the cramp and spasm ;—and to prop up and support the sinking powers of life. Now, to effect these purposes, especially in the time of cholera, every one ought to have in his house, or carry with him on a jour- ney, the following articles :— 1st. Some pearl barley, oatmeal grits, or some gum arabic, or all of these. 2d. A box of five grain calomel pills. 3d. A bottle of castor oiL 4th. A two-ounce bottle of laudanum. 5th. A box of one grain opium pills. 6th. A packet of Dr. Ralph's Domestic Pills. 7th. An instrument for giving an injection, or a common glyster pipe and bladder. On the different kinds of cholera, the symptoms which mark them, and the particular manner of administering the remedies already mentioned, in each variety of the disease. There are three kinds or species of cholera,—the bilious, com- monly called cholera morbus,—the flatulent cholera,-'-and the spas- modic or Asiatic cholera. BILOUS CHOLERA, OR CHOLERA MORBUS. This is the first species, and is the mildest. It is the common cholera of our summer months. At such times it frequently becomes more or less an epidemic, but it seldom gives occasion to much alarm, being usually mild and tractable. The manner in which this disease comes on, is as follows :—a person complains, perhaps for a day or two or more, of uneasiness about the stomach and bowels ; he is flatulent and feels some griping pains ;—at length he is suddenly seized with vomiting and purging, and after the first few evacuations, the discharges consist of pure yellow bile, both upwards and downwards. To this pretty quickly succeeds cramps in the legs and arms ; this is sometimes rather severe, and at other times very slight, but there is almost always cramp or spasm in 68 some degree or other. In mild cases the vomiting and purging abate in a day or two, and the patient gradually recovers his full health. In this form of the disorder, that is to say, in common cholera morbus, there is always free vomiting and purging, and it would not be proper, therefore, to irritate the stomach further by emetics and purgatives. The more rational object of anxiety is to dilute and bring away the acrid bile, and to defend the passages from its irrita- ting properties. For this purpose it is recommended to drink freely and repeatedly of warm gruel, barley or rice water, or water in which gum arabic has been dissolved. These are soon prepared, having the ingredients already at hand, and it often happens that nothing else is necessary. These drinks cannot be taken to excess in this stage of the complaint. If the vomiting or purging be excessive, or when they continue from weakness after the flow of bile has considerably diminished; then, these drinks should be exchanged for mint tea, or strong toast water, or strong green tea, and if these be not sufficient to check the ineffectual efforts to retch and purge, then twenty or thirty drops of laudanum may be given and repeated two or three times, at intervals of half an hour or more. If this should not succeed, then give one of the opiate pills, and repeat this as the urgency of the case may demand. A pill of solid opium will often remain upon the stomach when nothing else will. If all these means should fail to soothe and moderate the irritation of the stomach and bowels, then an opiate glyster should be administered. Sixty drops or more Of laudanum in a tea-cupful of water, is an excellent form of glyster ; and this has often been found to allay a constant vomiting, hiccough, and constant calls to stool, when every other means has proved un- successful. In the form of outward applications, draughts, warm bath, or bottles of hot water to the feet;—fomentations of hot brandy and laudanum to the stomach and bowels, and even to the head, will very often be found soothing and supporting remedies. If the symptoms which have been already detailed, should be- come still more severe, and their exhausting effects upon the consti- tution be alarming, this failing condition of the vital principle will be known by the following circumstances :—there will be every mark 89 of great weakness,—peculiar anxiety of countenance,—severe cramp, and repeated hiccough,—small and irregular pulse,—cold and clammy sweats. These symptoms will call for a bolder and quick- er repetition of the means already mentioned, particularly for opiate injections. Chicken broth, also, with a dose of laudanum in it should be injected, and wi-ne and water with spice, and any thing of a na- ture calculated to uphold the sufferer's strength, will be proper at such a time. In every case in which the symptoms abate, and hope begins to dawn, these means must be diminished, both in repetition and dose» but must not be altogether suddenly withdrawn. FLATULENT CHOLERA. This differs from common cholera morbus, principally in the quan- tity of bile, which is rather lessened in this species than augmented. The distressing and dangerous symptoms are not, however, mode- rated by this circumstance ; on the contrary, they are generally more severe;—the concentrated condition of the bile, seems to excite a still more violent action of the intestinal passage and of the nervous system. In this case, therefore, the painful retching and the fruit- less efforts to discharge the contents of the bowels, are more painful and exhausting, while the cramp and hiccough is always more con- stant and severe. The general treatment of this species, called flatulent cholera, is the same as in the common cholera morbus, with the exception of the use of purgatives and emetics. In this case it is proper to be- gin with an emetic. A tea-spoonful of flour of mustard in half a pint of warm water, should be taken, and after this a dose of purg- ing pills. Four or five of the No. 1 improved domestic pills should be given an hour or so after the emetic, and repeated every third or fourth hour, until some evident effect upon the bowels is produced. After this the different opiate means which have already been di- rected in the treatment of bilious or common cholera morbus, are to be strictly followed. The diluting drinks, also, such as barley water, &c. are to be freely administered, and the same outward ap- plications to be made use of. 90 THE SPASMODIC, OR ASIATIC CHOLERA,—ITS SYMPTOMS AND TREATMENT. The disease which is now about to be considered, is the epidemic cholera as it appeared in this and many other countries in 1833 ;—it is a severe, rapid and fatal disorder, and one that requires the most prompt and decisive treatment. The most remarkable and peculiar symptoms of this species of cholera, are the following :—"Watery stools ; retching and vomit- ing of whitish fluid; spasms successive and violent, often extending to every organ of the body; great despondency of mind, and pros- tration of strength." To this is added, pain at the pit of the sto- mach ; giddiness ; thirst; a pulse at the wrist so weak as scarcely to be felt; the surface of the body and the breath cold ; the tongue also is so cold as to give the sensation of icy coldness to the touch. It is also observed that there is neither bile nor urine, these secre- tions being suspended by the universal spasms; the general weak- ness is so great that the voice fails or sinks into a whisper ; the skin becomes of a bluish color, and is shrivelled up about the feet and hands; the belly feels like a doughy mass; the eyes are glazed, and the countenance expresses great anxiety, exhibiting the appear- ance of great advance of age. Such altogether is the peculiar and distressing aspect of one who is suffering under an attack of genu- ine spasmodic cholera, that those who have once beheld a case, can never be at a loss to recognise the disease in every other instance. To this it may be added, that "the watery stools" are of a dingy color, resembling water in which fresh meat or rice has been washed. It is remarkable also, that the faculties of the mind are often unaf- fected, so that the patient is able in his latest moments to answer questions clearly and correctly, although only in a whisper, or in short sentences. The preceding description is a short portraiture of the character and symptoms of that dreadful malady, the epidemic spasmodic cholera. This form of cholera varies in its mode of attack ; in some instances it comes on suddenly, within an hour or two of its first indications ; and in other cases, it may be introduced by mild and premonitory 91 Symptoms, for a day or two before its full developement takes place;—- but whether it comes on preceded by mild and premonitory symptoms, or bursts forth suddenly in its terrific form,—the following is the treatment to be employed. The moment the existence of the disease is ascertained, begin with bleeding. Even if the pulse be so small that you can hardly feel it, you must attempt to bleed. Sometimes it is with great diffi- culty that you can get the blood to flow, but by rubbing the arms, or opening another vein, a little may be obtained, and this generally so much relieves, as to lead to a better circulation and freer flow of blood. It cannot, however, always be accomplished, but it is a most important point gained, when it can be done. The quantity of blood to be taken, may be from sixteen to twenty ounces, but this should be determined by the prior strength and general statev and constitution of the individual. At the same time, or immediately after the bleeding, begin with the calomel and the opium pills. Three of the calomel with one of the opium pills should be given together, and be repeated every four, three, or two hours, according to the emergency of the case. If the retching and urgent calls to stool be not abated, then increase the opiate, and give two of the opium with two of the calomel pills. Sometimes nothing can be made to stay on the stomach for a moment, not even pills, which always remain when any thing at all will;— in this case have recourse to opiate injections. Two tea-spoonfuls of laudanum in a tea-cupful of any soft, warm fluid, may be injected by the instrument, or by the glyster-pipe and bladder, which was recommended to be kept in readiness,—and this may be repeated in half an hour, or an hour or two, as circumstances seem to require. It is astonishing to witness the good effect which an opiate thus ad- ministered, will often have upon the painful retching and griping stools. As a remedy in these incessant vomitings, ice also has been found an excellent assistant. Small portions may be swallowed every few minutes, and the stomach has often been known to be wonderfully calmed and comforted by it. Chicken-tea, beef-tea mint-tea, strong toast-water, cold or warm, as may be seen to answer best, are also found to be useful remedies; they are to be given as directed in a case of common cholera morbus. While this is going on, let the pit of the stomach, the belly, and 92 the limbs, and any part affected with the cramp and Spasms, be well rubbed with equal parts of brandy and laudanum, made hot. A cloth soaked in this mixture, should also be laid on the pit of the sto- mach, and often replaced. When the violence of the symptoms begins to lessen, then the means which have been directed are to be withdrawn,—but not at once. The calomel pills may be altogether omitted, but the opiate pills should be continued, though at longer intervals and in smaller doses. One pill every four or six hours may be sufficient, and this gradually discontinued ; in the meanwhile a mild and nutritious diet should be directed. In the convalescent stage the state of the bowels will require par- ticular attention, and the aperient pills, No. 2, will be called for, both as a gentle laxative, and also as the best means for aiding in the re- covery of general health and strength. From three to six of these it would be advisable to take every night and morning, for some time after the patient has got about, confining their operation to a natu- ral relief of the bowels, which otherwise might become overloaded and occasion a relapse. THE TREATMENT OF THE PREMONITORY SYMPTOMS OF CHOLERA. During the late epidemic, when the spasmodic cholera did not burst forth suddenly and unexpectedly upon an individual, but be- came developed in a milder and more gradual manner, the symp. toms which preceded the attack were similar to those which indicate a disturbance of the digestive organs, and which are called dyspep- sia. These, however, were attended with a more sudden and re- markable degree of weakness than is usual in dyspepsia, and almost always with a disposition to diarrhoea, or laxity of the bowels. These premonitory symptoms chiefly were a sense of chilling languor, im- paired appetite, and some slighter form of common summer com- plaint ; to this sometimes were added pain about the stomach, tight breathing, sighing and vomiting, with occasional slight cramp. Now, when these symptoms appeared in any one during the pre- valence of the epidemic, they were a proof that such individual had been exposed to some of the causes of cholera, and that the disease was just ready to break out in its peculiar and rapid character ; in- 93 deed, they went further than this, for such symptoms were a part of the disease itself, and were therefore a proof that the cholera had actually begun. In this early stage, however, the disease was almost always very curable; for, those who adopted proper measures for these slight complaints, very soon safely got well ; while those who used improper measures, especially such as suddenly stopped the diarrhoea, as soon became involved in all the misery of this frightful malady. It becomes, therefore, a matter of great im- portance, that the proper treatment of these symptoms should be plainly stated. The essential object to be effected under these cir- cumstances, is a removal of the contents of the stomach and intesti- nal passages; but this must be done by gentle, and not by rough and active, means. If there is an inclination to vomit as well as purge, it is proper to begin by giving a gentle emetic. A tea- spoonful of flour of mustard in half a pint of water is soon procured, and this the author has always found to answer exceedingly well. But if there be no sickness, then begin with two or three of the calomel pills, and in four hours a dose of castor oil should be taken, with the view of quickening the effect of the calomel, and causing it to operate with more effect and moderation. The feet should be bathed in warm water, and the patient keep his bed,—bottles of hot water to the feet, if any chilling is felt, are also very useful. Great attention to habits of regularity, and to diet, will always be indispensably necessary. Raw fruit, vegetables, and every kind of indigestible food, must be carefully avoided. If the premonitory symptoms should have continued too long, and the treatment above recommended should not be followed by return. ing health, and particularly a more natural appearance of the stools, then, another dose of calomel and castor oil should be administered as before directed. After this, should the alarming sensations of increasing spasms threaten a more violent train of symptoms, the means directed for the treatment of spasmodic cholera must be adopt- ed, of which bleeding is the first and most important part. 12 94 MEANS FOR SECURING GENERAL HEALTH DURING THE PREVALENCE OF CHOLERA. Having in the foregoing remarks been anxious to furnish every plain and necessary direction for the treatment of cholera, it seemed expedient to make some further observations upon the subject of a certain general state of health, which affords the best security against the attack of this disease. When speaking on the causes to be avoided during the epidemic prevalence of cholera, it was observed that a neglected state of constipation, as well as the use of improper means to check an unusual relaxation of the bowels, were equally causes of a dangerous kind. Nothing affords more general secu- rity against the cholera than a healthy condition of the organs of digestion ; but these are often known to creep into disorder so gradu- ally and insidiously, that the patient hardly knows that he is the subject of it. It cannot be said, that these organs are in health when the bowels are costive or irregular, the evacuations dark or unnatu- ral in color, and the tongue foul and loaded in the morning. These always denote derangement of the organs of digestion, and are almost always seen together; but it often happens that the individual has never noticed them until they have been pointed out by his phy- sician as the cause of some other subject of complaint. This sub- ject is worthy of great attention, for the writer does not hesitate to affirm, that the disordered condition of the organs of digestion con- stitutes a more general cause of cholera than any other. At such a time, therefore, it is advised that every person should pay a due regard to the regularity of the bowels, the color of the evacuations, and the state and condition of the tongue ; and if these are such as have already been described, depend upon it, he is far more open to an attack of cholera than he is aware of, and it there- fore becomes his duty to remove these disordered symptoms by the following easy and effectual means. Whoever will take the trouble to peruse the remarks which were made in page 25, &c. on the subject of the Universal Domestic Medicine Pills, No. 2, will see the peculiar manner in which they are calculated to effect this purpose. The object is, first, to evacuate 95 the accumulations of the bowels, and then support this healthy and natural action of the intestinal passages. A free evacuating dose of No. 1, should therefore first be given, and then a daily dose of No. 2, should be continued, until the proper color of the evacuations and the regular action of the bowels be established. The only pro- per color of the alvine evacuations, is a yellowish brown, or rhu- barb color ; and it is important to examine occasionally the secre- tions of the bowels, to know if they are of a healthy color and con- sistence. If, on the contrary, there should be a diarrhoea or summer com- plaint,—the same treatment is requisite ;—the offending materials should be carried off with a dose of No. 1,—or a dose of castor oil, and the mild and strengthening aperients, No. 2, be afterwards taken and continued daily. These may appear simple means, but they are not less efficient on that account; it is the duty of every indi- vidual to adopt them, and, inasmuch as it is wiser to prevent than to cure diseases, they may be justly ranked among the most important objects of concern. CHAPTER X. INFLAMMATION, EXTERNAL AND INTERNAL ; INFLAMMATION OF THE BRAIN, OF THE LUNGS, AND OF THE BOWELS ; OPTHALMIA, QUINSY, MUMPS, INFLAMMATORY SWELLINGS, TUMORS, &C. &C. Inflammation, wherever it occurs, is the same disease, and the general principle on which its treatment is conducted, is so exactly similar, that the observations which are about to follow, will be ap- plicable to every inflammatory disorder. The consequences and danger of inflammation, however, vary exceedingly from the situation and structure of the part which is the seat of it; thus, internal inflammations are more rapid, and in- finitely more dangerous, than external inflammations, and therefore require more prompt and energetic means to subdue and remove them. Inflammation of the brain, the lungs, and the bowels, are of this 06 class. These require quick and decisive measures, such as free and repeated bleedings; but in many other inflammatory diseases this is not necessary, and they may be safely left to the operation of milder means. In the following remarks, therefore, the author proposes to point out, first, what those measures are, besides the Domestic Purgative Pills, which are ever necessary in inflammatory diseases ; and next, the proper manner of using such measures in diseases of different degrees of danger. In the first place, rest favors every kind of inflammation. Posi- tion, also, is very often of consequence; if, therefore, the inflamma- tion be in the limbs, the part affected should not be suffered to hang- down, if it can be avoided. If there is inflammation in the leg, for instance, great advantage will be found in laying it on a chair, or on any kind of couch ; and the arm, and other parts may be sustained by a bandage with a very great advantage, on the same principle ; the head, too, should be kept elevated by pillows, when lying down. There is always too much heat in inflammations, as the word itself denotes, and if the part is external, which is the seat of it, much may be done to cool it by outward application. Any thing of a cooling nature may be used ;—cold ice water, vinegar and water, and the like. The best lotion, however, for general purposes, is a mixture of one fourth of brandy and three fourths water. Wet a rag with this and lay it on the part,—as soon as it gets dry, sprinkle it with the same, and, as much as possible, keep it continually moistened. Sometimes, however, this cooling process does not assuage, but rather increases, the pain. In such cases change it for a poultice ; you cannot always tell until you prove it, which will best agree, but it is best to try the cooling lotion first; but whenever an inflamma- tion proceeds to a gathering, and is forming matter, a poultice should always be applied until and after it breaks and discharges matter. The best poultice is the crumb of bread, scalded, with a little butter in it; or equal parts of crumb of bread and linseed meal ;—this hangs together and keeps moist a longer time ;—it should be applied warm, and changed two or three times a day. We hear of a great variety of poultices, but these are seldom necessary; indeed, it is quite unreasonable to lay so much stress on particular kinds of poul- tices. In cases which have run into mortification, indeed, a different kind is required;—the same ingredients should then be mixed with strong beer grounds, or port wine and water. 97 Where poultices are useful, fomentations likewise do good ; or it is even better to soak the part in warm water for half an hour or longer, -—or apply flannel wrung out of hot water, changing the flannel as it becomes cool. Local bleeding does good in every inflammation, though it is not absolutely necessary to have recourse to it in every instance; when it is determined on, leeches should be applied upon the part,—they never do harm, and sometimes are of the utmost utility ;—in case leeches cannot be obtained, cupping is often a good substitute. In every inflammation, external or internal, bleeding from the arm is useful. Where the disorder, however, is slight, bleeding is not often required ; a due attention to the other means render this unne- cessary. But, wherever there is external pain and fever, or where the part affected is very susceptible, as the eye, or other tender parts, —and especially when the seat of inflammation is a vital and in- ternal organ,—such as the brain, the lungs, or the bowels, then gen- eral and unsparing bleeding is absolutely requisite,—as will be men- tioned more particularly in its proper place. Next in importance to bleeding, is the great utility of purging. It has been explained in a preceding section of this work, how greatly we can influence the condition of the blood, both with regard to its circulation and its quantity, by the proper use of purging medicine. To be convinced of this, the reader is again referred to plate the 2d, and when he observes the number and size of the blood-vessels which are distributed on the intestinal canal, he will be satisfied that in many cases where inflammation is not violent, the free and re- peated use of the Domestic Pills, or No. 1, will safely supersede the necessity of bleeding. It should always be remembered, too, that when the superfluous quantity of blood is reduced by purging, the circulation is diverted from the part inflamed, and determined to the bowels, and thus the good effects of depletion are obtained in a two- fold manner. Blisters and draughts are also useful in their proper places, when the inflammation is internal; and, after bleeding and the purgative medicine has been resorted to, blistering is always a safe and very- useful remedy. They are particularly useful after the part has been fomented, and should be applied as near as possible to the part affected,—upon the belly, to the chest, or on the back of the neck, as the locality of the attack may require. 98 Whenever blistering is proper, leeches are also useful, and may be adopted in lieu of blistering, or may be applied first, and the blis- tering after them. These are the principal medicinal means which are relied on in every case of inflammation, but the activity and freeness with which they are to be used can only be directed by the severity of the at- tack, or the importance of the part inflamed. In every case of inflammation the diet must be low, and should consist of fluids,—as tea, toast-water, gruel, lemonade, or chicken- tea. Quietness and freedom from occupation are also to be ob- served. Of all internal inflammations, those which are most rapid and dan- gerous, and consequently demand a quicker and more decided mode of treatment, are the following three,—inflammation of the brain,— of the lungs,—and of the bowels. INFLAMMATION OF THE BRAIN. Inflammation of the brain is known by great pain in the head,— redness of the face and eyes,—tenderness' of sight and hearing, and these often accompanied by delirium. In this complaint, copious bleeding must be had recourse to, and very often requires to be repeated. The quantity must be deter- mined by the fullness of the patient and the severity of the symp- toms, but it should always be free and unsparing. It often happens that when it is unsafe to take more blood from the general system, still a local bleeding is required and cannot be dispensed with. For this reason it is always prudent to apply leeches to the temples, when the first bleeding is not sufficient to give relief,—and to repeat them if required. In severe cases, the head should always be shaved, and the lotion of brandy and water, or ice-water,-be con- stantly applied. Let the head too, be kept elevated, the diet strictly low, and every kind of excitement, such as talking, noise, and even light, be carefully excluded. Blisters also may be applied to the neck, and mustard draughts to the feet. 99 INFLAMMATION OF THE LUNGS. Inflammation of the lungs, or pleurisy,—is known by cough* more or less painful, and by short and painful breathing, with fever. If you are doubtful whether inflammation exists or not in slighter cases, where a cough alone is principally complained of, it may be quickly ascertained if the patient takes a full and deep inspiration or breath. If pain be felt on doing so, there is inflammation, and it is a proper case for bleeding;—if there be no pain, there is little or no inflammation, and bleeding may be dispensed with. Having ascer- tained the necessity of bleeding, it should be done freely, and if the pain is not diminished in four or six hours, another bleeding should be directed. At the same time a blister should be applied to the chest or side, and if the inflammation be at all severe, this should never be omitted. Immediately after bleeding, four or five of the Domestic Pills No. 1, should be given, and repeated every four hours, until a free evacuation by the bowels is effected. After this they must be repeat- ed once in six or twelve hours, and continued throughout the whole course of the disease. If, however, the bleeding and the proper use of these pills be had recourse to, it will not continue long. Very often it will happen that the pain will cease immediately on the bleeding, while the operation of the pills upon the bowels will effect- ually carry off the remaining symptoms of disease. In those cases in which bleeding cannot be commanded, as at sea or in the country, —then the pills must be given in more frequent doses, and their pur- gative effect must be continued longer. The lowest possible living must be observed; toast-water and gruel will be all that should be given until the pain abates. INFLAMMATION OF THE BOWELS. This is a disease which the writer is most anxious should be un- derstood. It is one of extreme rapidity and danger ; it is also of frequent occurrence, and the life of every individual suffering under it depends upon the promptness and propriety of its early treatment. 100 These considerations are in themselves sufficient ground for great anxiety and care in laying down directions for its safe and proper management; but, this anxiety is much increased by the fact, that, in the endeavors that have been and are now making to bring into contempt the various sources of relief which the art of medicine affords, bleeding has also been condemned and ridiculed. In many complaints those who should be so unfortunate as to listen to such ad- vice, would certainly make the sacrifice of life in consequence ; but, in inflammation of the bowels, the omission of bleeding for a few hours only, may prove an error which no earthly means can possibly re- trieve. This disease, although certainly fatal if it be mismana- ged, is yet greatly under the control of proper treatment; an early and free bleeding will almost always put an immediate stop to the complaint, and the patient rendered safe thereby ; but, if this be omitted, whatever else be done, it quickly runs on into mortification, and the patient is lost. This is a melancholy case to witness, espe- cially when it is recollected that a timely bleeding would certainly and speedily have saved the individual. Inflammation of the bowels is known by pain and tenderness of the belly, and it is important to bear in mind that that pain is always increased by pressure. In such a case, therefore, press the belly with the hand in various parts, and ascertain whether such pressure give pain or not. It is not pain alone, but pain which is increased by pressure, which is the mark of inflammation. Along with pain there is constipation of the bowels ; nothing can be made to pass by stool, and the more you irritate the bowels by purging medicine, before you subdue the inflammation by bleeding and other measures, the more the disorder is increased. With constipation there is also vomiting;—conscious that nothing in the form of food can pass the bowels, nature rejects whatever is taken by the mouth. Hiccough is frequently another symptom. There is also fever, and great anxiety of countenance. The disorder which most resembles inflammation of the bowels is cholic,—often the result of improper food. There is great pain in this complaint, but it is more like spasm which goes and comes, and pressure will not increase the pain, but in some measure affords re- lief; while, if inflammation is present, such pressure aggravates the pain. Again, in cholic there is no fevers; and, except in the cholic of 101 those who work in lead, as painters and printers, there is seldom any vomiting. Whenever inflammation of the bowels is ascertained, bleeding should be the first and instant remedy ;—there is no time to be lost. In every case the quantity to be taken must have respect to the na- tural strength of constitution, as well as the severity of the attack and symptoms; the bleeding, however, should be free and plenti- ful ;—an adult should lose at least twenty ounces. If this bleeding do not afford relief of pain, or lead to a discharge of the bowels, in six or eight hours, the bleeding must be repeated, once or twice if needful. There is little or no danger of bleeding too much in this disorder, for where one death has occurred in inflammation of the bowels from bleeding too much, ten thousand have died from bleed- ing too little. Immediately after the bleeding, foment the belly with hot water, and Continue this at least for half an hour, and this fomen- tation should be repeated once every six hours at farthest. After the first fomentation apply a large blister to the belly, for this need not prevent the use of the hot water. If the second bleeding should not succeed in abating pain or opening the bowels, leeches should be applied to the belly round about the blister, and the propriety of fur- ther bleeding should be considered. After the first copious bleeding, give some gentle laxative. Castor oil is a very proper medicine ; if it is thrown off by the stomach, re- peat it again immediately ; a medicine will often stay upon the sto- mach when given immediately after vomiting;—it may be taken floating on a cup of strong coffee. Two or three hours after the oil, give from two to three of the purgatives, No. 1, and repeat them every three hours, until evacuations are procured. This is the great object to be obtained, and when a free dislodgement of the bowels can be effected, the danger is over. Glysters should also be administered ; they assist the operation of opening medicine ;—even if they return without any portion of stool, they are useful and should be repeated. A small tea-cupful of soft soap in a pint of warm water,—or molas- ses, salt and oil, a table-spoonful of each, in a pint of gruel, is a com- mon and very useful form. Such are the means to be pursued in inflammation of the bowels,— the repetition of the bleeding, and the quantity of blood to be taken being determined chiefly by the severity of the disorder. A hiccough, 13 102 frequent retchings, and obstinate costiveness, arc always marks of severity and danger, and will afford a sufficient rule and guide for their timely and prudent management. Further, inflammation of the bowels is a disorder which is very common and fatal to children. The treatment required in them is the same as that in adults ; but, as bleeding from the arm cannot al- ways be effected in children, in consequence of the small size of the veins, an earlier application of leeches to the belly must be substi- tuted for it. It is also more convenient and effectual in this case to use the warm bath instead of the fomentation, and after the removal of leeches, the use of the warm bath is an excellent means of pro- moting the after-bleeding ;—it is on this long-continued bleeding from the bites of leeches that their good effects chiefly depend. Thus it is seen that inflammation, wherever it is seated, is treated on one principle, and the means which are useful in one kind are adapted to every kind. The whole of these measures, however, are not always required in every instance of external inflammation. Bleeding is not required in every case, where the structure of the part affected is not such as to be destroyed, or materially injured by mat- ter forming, or by gathering;—and in other cases where inflamma- tion does not run very high, bleeding may be omitted, and reliance may be placed upon active purging, fomentations, rest, and a low diet. On the contrary, when the part is very delicate, and great injury might result even from moderate degrees of inflammation,—as in the eye,—then bleeding is always proper, and cannot often be omitted with safety. OPHTHALMIA, OR INFLABIMATION OF THE EYE. Ophthalmic inflammation is known by sensations of great pain, redness of the eye, intolerance of light, and fever ;—in this case bleeding is always proper, and after this, leeches to the temples, and blisters behind the ears. The use of the purgatives, rest, and a low diet, are matters of evi- dent necessity. To this treatment it is further useful to add lotions and opiate fomentations. An excellent cooling eye-water is made by adding thirty drops of the extract of lead, to half a pint of rain-water; which may be used 103 by laying a soft rag dipped in this lotion upon the eye, and kept continually moistened with it;—or, to this lotion thirty or forty drops of laudanum may be added, which makes it more soothing. Another good eye-water or collyrium, (as such lotions are often called,) is made by adding half a drachm of alum to half a pint of water, or rose-water. A third is made with twenty grains of sugar of lead, and twenty grains of white vitriol, to half a pint of water, as be- fore. These lotions may be used either warm or cold ;—it is not always known which will best agree, but it is usual first to try them cold. After the bleeding, though the pain abate, a redness of the eye is apt to remain for a few days; in this case, nothing is better than one drop of the wine of opium, dropped from a quill upon the globe of the eye, night and morning. There is a chronic and very troublesome form of ophthalmia, called the blear eye; it is inflammation seated in the edge of the eyelids. An acrid matter forms, which glues the eyelids together in the morning, and by continually wiping over the globe of the eye, keeps it perpetually inflamed and very much endangers the sight. It is easily cured. Obtain from the apothecary a drachm of citrine ointment,—warm it, and with the tip of the finger rub a little_on the edge of the eyelid, every night on going to bed. QUINSY. In inflammation of the tonsils, or quinsy as it is usually termed, if an emetic of a tea-spoonful of ipecacuanha be very early taken, it will cure the disease at once, in nine cases out of ten. Those who have ever had the quinsy, are apt to have it again on every slight cold, and for such, this simple means will be sufficient; it should be followed by a few doses of No. 1, if the pain continue,—and apply a blister to the throat. The steam of vinegar, when inhaled, is a good remedy; place a funnel upside down over a basin of boiling vinegar, and draw the steam into the throat by breathing. 104 MUMPS. The mumps may be fomented with hot vinegar and water; the throat should not be wrapped up in flannel. If any other applica- tion is required, it should be the spirit lotion used with a soft rag, as mentioned at the beginning of this chapter. Free purging with No. 1, is of the utmost utility. INFLAMMATORY TUMORS OR SWELLINGS. ' Inflammatory tumors or swellings on any part of the body, are treated on the same principle ;—fomentations, spirit lotions, active purges, low diet, and rest, are the most proper measures. The early or repeated application of leeches is always useful, and when the in- flammation and fever run very high, bleeding will always lessen the disease, and will sometimes be absolutely necessary to give the ful* and best effect to every other remedy. CHAPTER XI. YELLOW JAUNDICE, LIVER DISEASE, &.C. The yellow color of the skin, which forms a striking feature in the external character of jaundice, is owing to the presence of bile in the blood. The proper direction of the bile is to flow into the bowels only, where it serves important purposes, and is the natural stimulus which keeps them in healthy action ; but, occasionally, from various causes, the bile becomes absorbed in its passage by little vessels which convey it to the blood, instead of the bowels. The bile hav- ing thus found its way into the blood, circulates with it into, every part of the body, and gives to all the surfaces, both external and in- ternal, a yellow color. Those structures, however, which are in- tended to receive only the more fluid and colorless part of the blood, 105 are first and most strikingly affected with it, and therefore, we have the first indication of jaundice in a yellow tinge of the white of the eye, or of the skin beneath the nails,—but this yellowness, in most cases, soon becomes diffused more generally. The obstruction to the proper passage of the bile, as it has been said, arises from various causes, and as the use of the Universal Domestic pills varies a little according to the nature of such causes, it will be proper to be a little more particular on the subject of the treatment of this disease. In the first place, the bile may be obstructed from thick and vis- cid humors filling up the passage. In this kind there is general langor, feeling of sickness, and pain or uneasiness in the stomach. In this and in every kind of jaundice, the evacuations are destitute of bile, and the color of them in general is very light, and they often resemble clay; the urine also is of a deep yellow color, and some- times deposites a substance resembling pitch. In the treatment of this kind of jaundice, it is proper to begin with a vomit;—antimonial wine, or a tea-spoonful of ipecacuanha powder, or any thing else of the same effect, may be given ;—then a brisk purgative medicine should follow, such as five or six of the purga- tives, No. 1,—and they may be repeated every other day for two or three times. The bowels are sometimes moved with difficulty, and the number of pills for a dose, must, therefore, be increased accordingly. When the yellowness goes off, it will be very necessary to keep the passage clear of viscid obstructions, either by the constant use of the mild aperients, No. 2, or an occasional dose of the purga- tives. The milder aperients, however, have the advantage of strengthening the stomach and bowels, as well as keeping them clear of viscid humors, and should be taken for a week or two, either every week, or every other week. A still greater advantage, may be obtained by using sometimes one kind of pill, and sometimes the other. The second kind of jaundice is that in which the bile is obstructed by gall-stones lodged in the passage, in which case there is greater pain, and the attack comes on more suddenly. The treatment of this species is the same as that of the former, with the addition of hot fomentations to the side, or the use of the warm bath. When the 106 pain is violent, an opiate also may be given with great advantage ;— a grain or two of solid opium is the best form. A third kind of j aundice is that which is caused by spasm.— Strong emotions of the mind will bring it on, such as those produced by violent passion, or by fright, jealousy, and the like ; and it is often met with in nervous and hysterical females. It may also be the effect of undigested food remaining in the stomach ; or cold to the feet, &c. It begins with a feeling of sickness, pain at the pit of the stomach, and in the left shoulder, and to these succeed a yellow color of the eye and skin. In the treatment of this kind of jaun- dice, a more moderate use of the purgative medicine is required,— so that after the stomach and bowels have been cleared of any acrimonious materials by a dose or two of No. 1, the following treat- ment should be regulated on the principle of soothing and allaying irritation. On this account, if the patient be in full health, bleeding is often useful;—opiates are especially required ; they should be given in the form of pills, containing a grain or two grains of solid opium, as fluids of every kind are very commonly rejected ;—these pills should be repeated every half hour for two or three times, till the pain abate. Also fomentations to the region of the stomach, and, when it can be procured, the warm bath will be found a valuable means of abating pain.—After the severity of the attack has ceased, a languor of body, and a tawny color of the skin frequently re- main. This is best treated with good diet, cheerful occupation of the mind, moderate exercise, especially on horseback, and above all, the constant use of the strengthening laxative pill, No. 2, taken every night, or night and morning. It should also be observed, that all the species of jaundice which have been mentioned, are very apt to fall into a mild and stationary, or, as it is called, a chronic form. In this case the severity of the symptoms passes away, and perhaps there is no pain or sickness at all; but the bile does not flow freely into its proper channel, but is carried in some proportion into the circulation. The color of the bile, also, as well as its con- sistence, changes, and it may become black or green, and of course will then give a different color to the skin. Such persons feel well enough to go into general society, and about the streets, and it is by far the best that they should, as exercise, a good diet, 107 and a proper and continued use of the aperients, No. 2, are the best means of cure to be relied on. DISEASE OF THE LIVER. Disease of the liver forms a fourth cause of jaundice, which is not of unfrequent occurrence. This organ becomes enlarged, so that it may be seen to bulge out on the right side, and is very often much harder than is natural. There is little or no pain complained of, but if it is pressed upon with the hand, it may be felt to be en- larged, and sometimes such pressure gives a sensation of tenderness and some degree of pain. This state of the liver is very seldom found in young and vigo- rous persons. It is the disorder of hard drinkers, especially in those of hot climates, or in those who have had frequent attacks of fever and ague, and is frequently the mark of a broken-down constitution. The symptoms which attend jaundice arising from diseased liver, are just those of dyspepsia, and the disease itself is treated on a very similar plan. It should be a supporting one, and every thing of a weakening tendency is to be avoided, for the strength and vigor of the whole system is always low. The diet should be good, but not stimulating ; the exercise of body and mind agreeable, and in such proportion as best agrees with the patient's feelings. The mild ape- rient pills are to be taken in such a dose as to operate with mildness and regularity ; not to relax, but merely to relieve the bowels. Having mentioned that this enlarged and hardened state of the liver is frequently the result of previous disease, hot climate or hard drinking, and is a mark of a broken-down state of constitution, in which little is to be done beside upholding the remaining strength and vigor of it, it should also be mentioned, that it does occasionally come on from other causes, and may be seen in young and more healthy persons. In this case great good is to be done, and the treatment must be varied accordingly. It is in these instances of liver disease that mercury is beneficial, but it should be given in a very different wa'y from that in which it usually is. Those large quantities which salivate and weaken the constitution, are often hurtful; while very small doses, and these continued for a certain length of time, are ex- ceedingly beneficial and curative. 108 The quantity of mercury should be so small as to produce no sen- sible effect, so that the patient should hardly feel that he is taking mercury. The blue pill is by far the best and safest preparation. Even so small a dose as two grains of blue pill, taken every night, if it be continued for a month or two, or until the disease is found to be removed, will be quite enough, and if this should by chance in the least degree affect the health, it may be discontinued for a day or two. If calomel be preferred, it should be given in doses of half a grain, rubbed up with a few grains of chalk, or with three or four grains of hemlock. The bowels should be kept open, by taking with each dose of the blue.pill, the aperients, No. 2, if necessary, or every other morning a tea-spoonful of epsom salts in half a pint of water, either warm or cold. A large warm plaster should be continually worn upon the right side, over the region of the liver. This is a plan which has been found wonderfully efficacious, in such cases as have not been connected with a shat- tered state of constitution, and if it be happily adopted early, and fol- lowed up in a due and persevering manner, the best possible chance of success will be secured. CHAPTER XII. SUMMER COMPLAINT, OR DIARRH03A. This is a complaint in which the evacuations of the bowels are more or less too frequent, loose and unnatural, often consisting of what- ever has been eaten, which has scarcely undergone a change in its passage. There is little or no griping. Diarrhoea arises from a variety of causes, and sometimes is a salutary means by which nature mitigates disease, or carries out of the body offensive and hurtful materials ; on this account it is important to know when we should, and when we should not stop a diarrhoea, as well as by what means it should be done. Diarrhoea should not be suddenly stopped so long as the evacua- tions consist of substance and of materials which are offensive and unnatural: but if they are nothing more than unchanged food, and that food is not of an improper and indigestible kind, the case is 109 altered ;—it is manifest in this instance that the discharge is produced by irritation of the bowels, and then of course the diarrhoea should be checked. Neither should diarrhoea be suddenly stopped, when the evacuations are fluid, provided such fluid stools consist of bile, or matter, or are very offensive in smell; but if they are merely watery, and have no particular smell, it is presumed they are continued from mere irritation of the bowels, in which case they are always very weakening, and should at least be checked. Again, whether the stools be of a more solid or fluid kind, if a purging starts up during any disorder, such as fever, dropsy, eruptive complaints, or teeth- ing, and these complaints seem to be benefitted under this state of looseness or purging, by no means stop it; on the contrary, it will sometimes be right to promote and continue it. Under any of these circumstances, however, when the purging is very excessive and exhausting, it may be safe and expedient some- times to check it, and it will be always right to support the patient under it by suitable means of diet, such as arrow-root, rice, good beef tea, spiced wine, or even brandy and water, with toasted bread in it. With these precautions it will now be proper to consider the best means of treating this complaint. In every case of diarrhoea, the natural action of the intestinal canal is increased, and in a great majority of instances, the cause of this increased action consists in some irritating and offensive materials which are retained in the bowels ; so that when such materials are removed by proper means, the diarrhoea ceases. If the reader will examine the large intestine called the Colon, in plate the 3d, he will see how calculated this is, under disease, to retain and lock up such materials. In such cases, the fluid [contents of the bowels will pass over those hardened masses, and thus leave behind the cause which perpetuates the disorder. For this reason, in most cases it is necessary to begin the treat- ment of diarrhoea with an opening medicine. A dose of the purga- tives No. 1, or a dose of castor oil or of rhubarb, will generally an- swer, and after this alone, the complaint will often cease. If it should not do so,—it is now safely controled by soothing medicine. Add half an ounce of paregoric to half a pint of the common chalk mix- ture —and of this a large table-spoonful should be taken immedi- ate.Ureveryli^d motio„ of ,*,„ owe,. Ifthis canoo.boob. 110 tained,—a tea-spoonful of paregoric in a little spiced wine may be substituted ; and if this is not at hand, five or ten drops of laudanum may be used instead. It is not to be forgotten that these directions may be the only guide to many situated back in the country, where a choice of medi- cine cannot be commanded; and therefore the simplest remedies should be mentioned here, and these, indeed, are often the most ef- fectual. At sea there is always a medicine chest of some kind, and paregoric, as well as laudanum, should never fail to be part of its contents. If the complaint should not be abated by these soothing means, it is generally because of some irritating materials which have not been effectually carried off, and therefore a repetition of the purga- tive is necessary. In this case it is proper to give a larger dose of No. 1, and this in conjunction with an opiate. Let four or six pills be taken with a tea-spoonful of paregoric,—this will not prevent the effect of the purgative,—it may delay it somewhat,—but taking off the spasms which retained the irritating mass, these pills will act with more effect and certainty. Some persons always prefer thus to combine an opiate with the pills, or castor oil, or rhubarb, alleging that the purgative, though slower, is always more effectual. It is a safe and proper step to take, and when there is much pain or cholic, it should not be omitted.— After the operation of the purgative, the chalk mixture, or opiate, must be repeated, as may be necessary. In milder cases of diarrhoea, the aperient, No. 2, may be given every second or third night; but wherever the Improved Universal Domestic Pills compose the family medicine, and are taken on the various occasions which have been pointed out, a diarrhoea will sel- dom or never happen. Ill CHAPTER XIII. DYSENTERY, CHRONIC DYSENTERY, BLOODY FLUX, &C. DYSENTERY. The subject of Dysentery properly follows Diarrhoea; but al- though the stools in this complaint are also frequent, the disease itself is ofa very different kind. Dysentery consists of inflammation chiefly affecting the large intestine, called the Colon, and is attended with fever. It is worth while to turnback to plate 3d, page 19, and observe the length, extent, and formation of this large intestine, which is the seat of this complaint. The part immediately affected, is a thin membrane which lines its inner surface, called the mucous mem- brane. The effect of inflammation upon this structure, is, first, to increase its mucous secretion, which r accounts for the quantity of slimy stool;—it then goes on to ulceration, and numerous little sores are formed, mostly on the lower part of it, and from these proceeds a little blood which mixes with the mucous evacuations. There is scarcely ever any portion of natural stool to be seen in that which passes; when any thing of this kind happens, it is gene- rally in the form of small, hard, ball-like substances; but the eva- cuations much more frequently consist of unmixed slime or mucous, often tinged or streaked with blood ;—severe griping and pain about the lower part of the bowels, more or less constant, is also a striking feature in this complaint. These painful feelings lead to a constant desire to go to stool, and to straining efforts, but these are ineffectual, so that the same urgent calls remain, or soon return. Dysentery, therefore, will be known from diarrhoea, by fever, and severe griping, and by painful straining stools which do not relieve that desire ;—also by the evacuations, which are slimy, streaked with blood, and, for the most part, unmixed with any thing like natural stool. This description, however, is not applicable to every stage 112 of dysentery, but is an exact exhibition of the disease, when in its more perfect form. Sometimes it is preceded by costiveness, wind in the stomach and bowels, with heats and chills of the skin, and to these succeed grip- ing pains and slimy evacuations. Also before the slimy stools oc- cur, the evacuations consist of the more ordinary contents of the bowels, and when these have passed off, they become mucous and bloody. Neither are the evacuations always of the latter kind when the disease is fully formed, for they are sometimes frothy as well as slimy;—and at other times watery, with coagulated mucous, like little pieces of cheese; or they may consist of pure blood or mat- ter,—or they may contain purely mucous, without blood or any other admixture or color, Again, this disease may arise out of other complaints, such as fever and ague, scurvy, consumption, or any other which has continued long and enfeebled the constitution. Also, when it has been an ori- ginal disease, the fever with which it began may subside, while the dysenteric state of bowels may remain, and continue in an obstinate and dangerous form. Dysentery, therefore, may originate suddenly and alone, or be the sequel of other complaints ;—it may also be of short or of long duration. The Treatment.—When called upon in the early stage of this complaint, the best treatment consists in giving a gentle emetic, and after this a dose of the purgative pills. If by this means a quantity of natural stool can be procured, the disease is greatly improved, and another purgative dose on the following day, is often all that is re- quired. It seldom happens that natural stools can be procured with- out active and repeated doses. If griping pain and an urgent incli- nation to go to stool continues after the operation of the purgative, an opiate must be given, a pill of one or two grains of opium should be taken, and if this should not succeed, sixty drops or more of lau- danum, in a tea-cupful of starch, should be injected as a glyster. If a difficulty should be found in getting stool, the purgative should be varied, and a dose or two of castor oil be directed, either alone, or with thirty drops of laudanum. The object to be arrived at is to dislodge whatever may be retained in the cells of the intestines, and with this view the opiates are of great use; they allay a certain 113 state of irritation and spasm; and thus facilitate the operation of the purgative. If calomel be preferred to any other purgative, it may be given in doses of ten or twenty grains, with a dose of castor oil a few hours after it; but the purgative pill, or No. 1, is an efficacious or obstruent purge, and given in large and repeated doses, in con- nection with the opiate, especially with the opiate glyster, has ever afforded all the good effects which could reasonably be expected from purgative medicine. It is proper, however, to add, that the author has frequently assisted them with a dose of castor oil, given about two or three hours after them. Another excellent remedy to soothe the pain, and check the stools, as well as to support perspiration, is the Dover's powder, which may be obtained at the druggist's;—twenty grains of this should be taken at bed time, and five or ten grains two or three times a day, so long as their effect is beneficial or necessary. While these means are followed up with a view of removing ac- cumulations of the bowels, and allaying pain and irritation, they are to be supported by local applications and a suitable diet. Any thing which induces perspiration is useful. Hot fomentation to the belly, and the warm bath, if it can be procured, is an excellent remedy. The pit of the stomach and bowels may be rubbed with spirits of camphor and laudanum, and flannel should be worn as much as possible. The diet should be of that kind which would pass easily through the bowels. Arrow-root, rice in any form, gum arabic in milk, and any thing of this soft and nutritious kind. The same may be injected two or three times a day, adding a tea-spoonful of laudanum each time, and the patient should be encouraged to strive to retain it as much as possible, and to avoid the going to stool as much as he can. In conclusion, the treatment of dysentery may be summed up in a few words; it consists of carrying off accumulations in the bowels by purgatives; but this is most advantageously effected by com- bining soothing medicines with the purgatives, such as opium, or paregoric; after this, allay the irritation of the bowels by the chalk mixture, and by opiates and opiate injections; foment the belly, and keep the surface of the body moist by warm clothing and flannel, and let the diet be of the softest and most nutritious kind. 114 CHRONIC DYSENTERY. Chronic dysentery is another form of the same disorder, but as this is often attended with distressing circumstances, and is by no means of unfrequent occurrence, it justly merits to be treated in this separate manner. The word chronic is used in contra-distinction to the word acute,— one signifying a disease with a great deal of fever,—while chronic means the same disease having little or no fever, but continuing for a great length of time. Every one knows what rheumatic fever is ; —this is the acute form ; but those occasional pains in the joints, which vary from change of weather and the like, and continue in after years, this is the chronic form of the same disorder; and it is not at all uncommon for a disease to begin in the acute form, and when it declines, instead of going off entirely, to settle down into the chronic form. Now, this is exactly what takes place in dysen- tery in the present form of the disease, called chronic dysentery. But chronic dysentery sometimes arises from other causes. It may creep on gradually in those frequently exposed to damp, cold air in a warm climate, or where the bowels have been long and ha- bitually irritated by stimulating food and spirituous drink ; and it will now and then rise spontaneously in those of a very feeble state of body, howsoever induced. In these instances it creeps on so slowly, that it continues sometime before its real nature is detected, and when its duration is very long, it often involves other organs, princi- pally those concerned in the office of digestion; from this cause it is, that the varying circumstances of distress before alluded, to arise. Chronic dysentery is marked by frequent and loose stools, which vary much in their nature and appearance. Sometimes there is no admixture of common stool in them,—at other times they consist of pure blood, either fluid or coagulated,—or they may be purely bilious, or consist of corruption and matter ; but of whatever kind the evacuations are, they are always frequent, and attended with a fretful feeling and desire to go to stool, which is not removed after the stool has passed. Among the organs of digestion which are occasionally affected in chronic dysentery, the liver is one, and when this is irritated, an 115 excess of bile is the consequence, so that the stool may consist almost entirely of vitiated bile. This is called the bilious flux. Abscesses, too, are very liable to form in this organ, and when these burst into the intestines, the matter is discharged by stool, and the evacuations then consist of matter. Sometimes the surface of the bowels, particularly the colon, is so ulcerated, that the larger blood-vessels which supply them are eaten away, and then the stools are chiefly blood;—this is the cause of the bloody flux, so distressing and dangerous a circumstance in dysentery. At other times the smaller vessels only are affected; and then, instead of blood, a watery discharge, or kind of fluid, is passed by stool; and if this disease is milder still, and does not ulcerate the vessels, then an increase flow of mucus only is to be observed, and the stools are slimy. The Treatment.—The object we have in view in this complaint, is to counteract the disordered action seated in the intestines, chiefly the colon, and to restrain the number of exhausting stools. With the first view, the author is again constrained to recommend the use of mercury, but he recommends it only in the mildest doses, such as cannot in any degree whatever enfeeble the constitution, but, on the contrary, will invigorate the system by promoting healthy secre- tions, and counteracting this disorder ; for this purpose, the follow. ing pill, which an apothecary should make up, has proved of almost universal efficacy in chronic dysentery: Take of the blue pill, one drachm, of powdered opium, half a drachm, of tartarized antimony, five grains. This is to be made into sixty pills, and one is to be taken night and morning. This must be continued for some months, unless the disease should disappear, and render their continuance unnecessary. Every few days some opening medicine must be given ; for, if har- dened accumulations are suffered to continue in the bowels, the dis- ease cannot subside. It is best to vary the purgative made use of;— but those articles which are least irritating should be fixed on ;—a dose of No. 1, and the next time No. 2, are well adapted for this purpose;—also castor oil, and sometimes epsom salts, are ^suitable remedies. 116 When the bowels are very loose, or, if after the operation ofa purgative they continue so, they should be checked. The com- pound chalk mixed with paregoric, as directed in diarrhoea, is a very proper remedy for this purpose ; but, nothing answers so well as an opiate injection;—sixty drops of laudanum in a small tea-cupful of starch or gruel, is an excellent form of glyster, given at bed-time, or whenever it is called for. The diet should be soft and nutritious, made up of milk, rice, sago, arrow-root, and the like. When the bowels become more quieted, a cordial, and more strengthening plan of diet and medicine should be entered on. Any of the bitters, as camomile tea, quassia tea, &c. are proper. Flannel and worsted stockings should always be made use of. CHAPTER XIV. DROPSY, WHETHER IN THE CHEST, BELLY, OR EXTREMITIES. In these complaints, the pills No. 1, are mainly to be relied on, and active purgative doses of this medicine are to be repeated according to the strength of the individual. Their mode of operating is to stimulate the vessels which ramify upon the intestines, and so cause them to pour out their watery fluid. The effect of such a stimulant upon these vessels is to rouse the absorbents of the body, by which the fluid is removed from various cavities, or from the legs, and de- termined to the bowels. They likewise provoke the action of the kidneys, which is generally deficient in this disease. In that particular kind of dropsy which frequently succeeds to scarlet fever and measles, two or three doses of the pills, No. 1, as active purgatives, are sure to be successful. In the dropsy which attends a long continued and weakening disease, the mild aperients are most proper; these act by strengthen- ing the vessels, and restoring a healthful tone to the constitution generally. - U7 CHAPTER XV. SEA SICKNESS. It is impossible, in certain constitutions, to prevent the disagree- able sensation of sea sickness entirely ; even Admiral Nelson was affected with it for a time whenever he commenced a voyage, and it is said, never once escaped. After a short period, however, it generally ceases, but not always, for in some cases it continues un- abated, and with great severity, not without some danger. To persons thus affected it will be satisfactory to know what those means are which are best adapted to mitigate and remove this state of suffering. Many remedies are commonly recommended, but the only means by which sea sickness is controled, are those which regulate the bowels. For this purpose the active purgatives, or No. 1, should be taken, and in such a dose, and just as often, as may be necessary to maintain an open state of the bowels. It is astonishing to observe how obstinately costive the bowels ,often become on a voyage, ordinary purgatives having no effect; so that it will be necessary to take a larger dose, in order to insure an ef- fective operation on the bowels. Further, it is universally admitted, that a determination to with- stand the nauseated sensations, and to enjoy the advantages of air and exercise on deck, greatly conduce to surmount these distressing sensations; notwithstanding, it must be repeated, that nothing will succeed without a proper action of the bowels, and therefore, so much stress is laid upon the use of the purgatives, No. 1, which must be taken in such number, and at such intervals, as each individual case may require. 16 113 CHAPTER XVI. PILES, FISTULA, STRICTURE, RUPTURES, &C The two first of these complaints can scarcely ever happen in those who take these pills occasionally ; and no plan can offer a more successful and convenient method of relief or cure in those with whom they have occurred. Pijes are formed by a distension and thickening of the veins about the anus and the rectum, as shown in plate 3d. These vessels can- not carry up the blood, by reason of the hard and bulky stool which is accumulated in the colon, (plate 3d) and presses on them ; hence they swell, and often become inflamed and very painful. Again, if inflammation in this part be not removed, it forms a gathering which bursts, and continues to discharge a little matter; (for, an abscess forming here will not heal as it would in other places ;) this matter continues burrowing into the soft and yielding structure which sur- rounds the rectum, and thus a fistula is formed. It is in this way that tailors are so much affected with this disease, but which might always be prevented. No tailor can ever have a fistula who takes the aperients No. 2, in such a dose as to keep the intestine clean and free from accumulation. Strictures and ruptures are also cured or benefitted on the same principle, but in the case of rupture a proper truss should always be worn in addition. CHAPTER XVII. STONE, GRAVEL, AND DISEASES OF THE URINARY AND GENITAL ORGANS. Some of these diseases do not admit of a cure,—such for instance as the difficulty of voiding the water common to elderly people? winch is occasioned by an enlargement of the prostrate gland; but 119 they all admit of great relief, and some of a total cure ; and this is chiefly to be brought about through the medium of the organs of digestion. . These organs are much more concerned in such diseases than many are aware of; the vitiated nourishment, which they supply when disordered, and the tardiness with which the refuse of the.food passes from the intestines, occasion the blood to be loaded with crude materials. Much of this crude material is separated by the action of the kidneys, and is passed off with the urine; but, in thus relieving the general system, these parts, in their turn, often become over- powered, and not being able to expel all the sediment which enters them, become the seat of diseases of the most distressing kind. From this it will be evident how important it is that the" intestines be kept in a continual healthy state, so as to prevent the further deposition of injurious substances. For these complaints the aperients, No. 2, should be taken, ex- actly as directed for dyspepsia, as the object intended is not to irri- tate, but to remove the causes of irritation, whether they be consti- tutional or local, temporary or of long standing. The relief experienced by preventing the accumulation above the rectum is particularly great, for this is in immediate contact with the prostrate gland, which is often irritated to such a degree as to put a total stoppage to the urine,—a distressing and dangerous condition. By elderly people, therefore, these alterative aperients are high- ly valued, and when the principle on which they operate is consider- ed, namely, that of giving general health, and improving the diges. tive organs, their estimation cannot be too high. But in younger persons also, there are diseases of the urinary or- gans for which they are proved to be a safe and efficacious remedy. Without alluding to the improprieties by which these are frequently contracted, it will be sufficient to observe, that these complaints are known by a sense of heat and scalding in passing the water, a slight discharge.of matter from the part, and often painful swellings. In all these cases, whether male or female, the active purgatives, or No. 1, should first be taken, and repeated daily ;—those evacuate the poison and abate the pain and inflammation. After this, the gentle aperients should be taken to complete the cure;—plentiful draughts of water should also be taken while the pain continues, and the diet should bo uniformly low. DISORDERS OF FEMALES, CHAPTER XVIII. . GENERAL OBSERVATIONS. There are many circumstances both of disorder and peculiarity of constitution which it is the duty of every female, and especially every married woman and mother, to have some general knowledge of. It is not, however, meant that every female should be acquainted, systematically, with all the various circumstances and causes of dis- ease which might ever happen ; but, there are many things with which she cannot remain totally unacquainted, without suffering much unnecessary danger and distress ; and which, on the other hand, is very easily and perfectly understood. Moreover, the delicacy with which many of these circumstances are connected, naturally leads to an injurious reserve upon many of these painful situations and com- plaints. And, in addition to the disorders whieh in a particular manner be- long to this department, there are also certain peculiarities of consti- tution relating to the operation of various articles of medicine, which should be noticed here. One of these peculiarities, for instance, is connected with the use of purgatives, and is the very opposite to what might naturally be ex- pected. Judging from the complex structure and more delicate and tender frame of the female constitution, it might have been reason. ably inferred, that every remedy would have a more powerful effect 121 pn such, and this would lead, of course, to the administering of medi- cine in smaller doses. Experience, however, has taught the very reverse of this in many instances, and in none is this truth more evi- dently shown than in the operation of purgatives in the whole tribe of nervous diseases common in weak and delicate persons. Very often it is seen that the same dose of a purgative medicine which would have produced an effectual operation in a hearty and robust man, will produce little or no operation in a weak and delicate female ; so that in order to produce the same effect from the same medicine, a much larger dose is required in the latter than in the former case. A full knowledge of this fact has many times led the author to a successful issue in treating nervous diseases, after very eminent men had failed ; and, indeed, the unexpected success which frequently attends his treatment of female disorders, and more especially of those called nervous, may be chiefly attributed to his carrying out this practical truth in a persevering and decided manner. Many of those baffling and tedious disorders included in the term ' nervous,' arise entirely out of a certain torpor and condi- tion of the bowels, which nothing but a treatment founded on this principle will ever succeed in removing. It is not denied that chalybeate medicines, change of scene, pure air, and wholesome exercise, have their good effects; but if this prin- ciple, upon which the writer has laid so much stress, be not boldly followed up in practice, and the sluggish torpor of the intestinal pas- sage thoroughly removed, such measures will be in vain ; some slight advantage may indeed be gained, or some nervous symptom mode- rated, but they will soon return, and perhaps in greater force. Another important peculiarity in the nature of female complaints respects the use of tonic and stimulating remedies, and especially in the treatment of nervous disorders. As to the plan of treating such complaints with nervous medicines, as they are called, such as vale- rian, castor, assafoetida, camphor, julep, and the like, the best that can be said of them in most instances is,—that they are useless ; while those of a spiritous kind, such as the tincture of red lavander and the like, are positively hurtful and deleterious ;—many an amiable and unsuspecting female may trace the destruction of her health and happiness from having fallen in with such ill-advised prescrip- tions. 122 There is a languor of body,—a fretful irritability of the nerves, and a certain intolerable sadness of mind in every nervous person, which finds momentary relief from the use of stimulants, only to relapse af- terwards into a state of deeper depression; but, in the more sensitive structure of the female constitution, there is a state of feeling of an order infinitely more delicate and susceptible, and when this is wrought upon, under the baneful idea of allaying such nervous ir- ritation, with spirits, "wine, spirits of lavender, or tinctures of any kind, such morbid feelings increase to an alarming pitch of hysterical excitement, bordering upon, and sometimes terminating in, derange. ment of intellect. It perhaps may be observed, that there are but few chapters on this numerous and important class of maladies ; but it may be also noticed, that these chapters comprehend whole classes of disorders in which the principle of treatment is so precisely similar, that much repetition is hereby avoided, and, at the same time, the approved smallriess of this work, is thus preserved. Moreover, nothing adds so much to the simplicity and plainness of the subject, altogether, as this arrangement. The several chapters following, therefore, contain whole classes of disorders; but such disorders are mentioned afterwards in a proper order of succession, so that an opportunity is afforded for every important remark which each may give occa- sion for. CHAPTER XIX. Directions for treating certain disorders which occur from obstruc- tions at this crisis, and which occasionally return in ofter periods of life. V This interesting stage 'of life is one that is beset with danger. A new order of the female economy is now to be established, and it is not every constitution in which the unassisted powers of nature are adequate to effect the changes which are about to take place. It is well known that the artificial customs of society enfeeble the natural powers, as well as multiply diseases, and it is no wonder, 1*3 therefore, that we are often called to witness her fruitless efforts at this tender age. It is now, also, that every hidden germ of disease is ready to spring up; and there is scarcely a disorder to which the young and growing female is subjected, which is not at this time occasionally to be seen, and very often in a fatal form. It is under these circumstances that coughs become consumptive, and that scro- fula exerts its utmost influence in the constitution, and deforms the figure of the body ; and it is not only that the outward figure is de- formed, but the dimensions of that bony outlet of the female frame is also altered and diminished, on which so much of safety and compara- tive ease depends in childbirth. This, indeed, is the cause of almost every distressing and fatal labor that occurs, and it is at this period of life, chiefly, that such an unspeakable misfortune may be prevented. It is with great confidence that the author's Domestic Medicine is recommended in every form of these complaints. Most of the symptoms which now occur, it will be seen, are those of dyspepsia, for which this medicine has been shown to be peculiarly adapted; but, not only will the symptoms themselves be immediately relieved by a proper course of the pills, but that important function of the female constitution, on which they all depend, will become settled and established by their operation. It is not necessary to be more explicit on the manner in which this change is brought about;—it will suffice to hint, that beside their operation on the larger bowels, they give a certain action to the neighboring parts, to which that due degree of energy and deter- mination of the blood succeeds, so necessary to th? change alluded to. There is, however, yet another remedy to be spoken of,—the use of chalybeates, or preparations of iron. This is of great impor- tance, and in every case of unusual weakness, paleness of counte- nance, and cold feet, the use of chalybeate medicine will assist the operation of the pills in a surprising degree ; and, on this account, the most simple and efficient method of taking this important class of medicine* shall be described. To a quart bottle of any kind of white wine, add a large table- spoonful of the filings of iron, and when it has stood a fortnight, (shaking the bottle frequently,) take a wine-glassful twice a day. , It may be decanted gently, so as to get it clear. Or, half a tea- spoonful of the rust of iron may be taken in a little molasses twice 124 a day ;s—or, (being a third way,) a tea-spoonful of iron filings k equally good. Another and very convenient form for chalybeate medicine, is the muriated tincture of steel; twenty to thirty drops of this in a little water may be taken also twice a day. In any of these forms the use of iron may be continued for a month or two, and they are proper in every case, except where a florid color and a fullness of the habit is conspicuous. They are more suited to the pale, puffy, and sallow complexions, where the feet are cold and inclined to swell. In such cases the complexion soon becomes clear and florid. Difficulty of establishing a certain change of constitution.—In most instances this change occurs without any remarkable complaint, and a new developement of person and of character suddenly bursts forth. Among other changes, the countenance assumes a lovelier aspect, the bosom is enlarged, the mind expands, and the heart be- comes the seat of new and deeply interesting sentiments. But, in other instances, many months, and some years, elapse before this regular and natural function is established ; and all this while the sufferer is more or less afflicted with varions symptoms and com- plaints. The age at which these changes happen, varies in different consti- tutions, and under different circumstances. In temperate climates it is from 13 to 14, but in warmer regions it is two or three years ear- lier, and in cold or northern parts two or three years later; but whether late or early, however, the usual period of its continuance is the same, or aboi t 30 years. To enumerate all the symptoms which may occur at this time would be an useless undertaking ; but, among the most frequent and remarkable may be1 mentioned languor and weakness, with a dis- like to any kind of active employment, a sallow complexion, pale and bloated countenance, shortness of breath, palpitations, costive- ness, flatulence, no appetite, or a craving for strange and indigesti- ble things, such as chalk, slate pencil, and even cinders; also pains in the head, the back, and other parts; a hardness and swelling of the belly, cold and swollen feet, together with almost "all the symptoms of dyspepsia; but these happening in connection with the present cause, they are usually called chlorotic symptoms, or the green 125 sickness. With regard to the treatment of this case, every thing which improves the general health, and which invigorates the sys- tem, is of use, but nothing more so than a course of the Domestic Pills. The usual way of taking these is to begin with No. 1; but, as a peculiar torpor of the bowels is often met with in these complaints, the dose must be large, or increased as the occasion may require. Five or six may be taken at bed time, and repeated in the morning if necessary. These, indeed, should be repeated every night and morning until the bowels become effectually unloaded, and after- ward the bowels should be carefully kept from re-accumulation by suitable repetitions of the pills. There is a natural tendency to an unnatural state of bowels throughout the whole complaint, and it is in overcoming this torpor by repeated doses of the pills, that you take the most important step in accomplishing the object to be kept in view in curing these diseases It has been observed that purgative medicines always have the best effect when they are occasionally changed. The Domestic Pills are admirably calculated for this purpose. If the bowels are very torpid, it is best to take No. 2 at night, and the No. 1 in the morning; but, if not so costive, the No. 2 may be taken for two or nights together, and, then, a dose of No. 1. If any cough, or fixed pain in the side should intervene, so as to threaten consumption, it will be advisable to refer to the remarks which are made upon that complaint; for, if there should be fever and considerable pain, (the signs of inflammation,) a small blister to the chest, and the extraction of a tea-cupful or two of blood, and a mild diet, will be required. Bleeding, however, should always be as sparing as possible, (indeed, the effect of a blister should first be tried,) and as soon as the pain and fever abate, some light and strengthening bitter chalybeate medicine should be given. The same necessity for a regulated state of bowels, will exist. But, instead of an inflammatory state, the very opposite, is gene- rally seen to accompany this, which is called—a chlorotic state ; the face is pale, and the feet are cold, and much inclined to swell, all which indicate weakness; and is the reason why the assistance of a chalybeate course of medicine is so remarkably beneficial. Except, therefore, in those cases where there is some pain and fever, or a florid countenance and a full habit, chalybeates will prove of 120 most astonishing utility. The method of preparing these chaly- beates has been already shown, and the manner of taking them described. They should be continued for several weeks together. In this case, also, exercise of any kind is very useful, but that of dancing is esteemed the best of all, and riding the next to this. Change of air and good and nourishing diet greatly expedite the cure. Obstruction of the period.—This occurs from accidental causes, under two different circumstances,—that is, in full and florid habits, —and in the opposite state. In the former it is often useful to take blood, and promote a moderately purgative state of bowels, chiefly by the use of No. 1. In the opposite state, the milder laxatives, No. 2, with a course of chalybeates, are to be relied on. At the expected usual period, the warm foot-bath often proves of great assistance. If obstruction should take place in consequence of some weakening disorder, as consumption or fever, it would be very useless and hurtful to attempt to reproduce it. If health could be restored,, this change would naturally come about. Bjuinful times.—By some individuals much pain is experienced at each certain period; this is of more importance than it is thought to be ;—the prospect of a family is often ruined by it. Let such take a moderate dose of No. 1, once or twice, a day or two before the time when a change is expected to return ; and, as soon as this occurs, let them be confined to bed, and endeavor to promote a mode- rate perspiration by free and copious drinks of very weak white wine and water made warm. To this treatment it is very useful to add some soothing dose. Nothing has ever proved so useful in the practice of the author, as the tincture of henbane. Two tea- spoonfuls of this should be taken as soon as, or, if the time can be judged of correctly, a little before, the grinding pains come on. Ano- ther tea-spoonful may be repeated in an hour, if the pain is great,— and it may be even taken a third time, in urgent cases of distressing pain. When the tincture of henbane cannot be had, laudanum may be taken in its place ; thirty drOps of laudanum is equal to two tea- spooDfuls of ;h, .Urner tincture. The henbane is preferred, because 127 it does not induce a costive state of bowels, but the contrary, and when laudanum is given instead, this consequence must be obviated by an occasional dose of No. 1. These are simple, but most efficient means of mitigating or totally overcoming this periodical disorder. It may be properly called disorder, for the pain which accompanies this state is a symptom of real organic inflammation. The whole internal surface of the part which is the seat of it is inflamed, and this inflammation often proceeds so far each time, as to form an internal lining of lymph, which is afterwards thrown off, and may be observed in a substance resembling skin. But this is not all, for a repetition of this inflammatory disorder, at length, disturbs the natural functions of this organ altogether, and the capability of having children is lost in consequence. Thousands of married women are childless from no other cause. For this reason it is deemed an impor- tant subject, and one with which every female should be herself acquainted;—the treatment described, is, also, very simple; but, notwithstanding, is the only one to be relied upon, Immoderate discharge.—This should be judged of in reference to its effects ; for, if it should be much greater in one person than ano. ther, and, at the same time, she should enjoy good health, it should not be regarded as a disorder. But, if it proceeds from debility, or if it seems to cause debility, or if there are any lumps or clots of blood, it is then a different thing, and will require attention. This most frequently happens in nervous feeble women, or those who are reduced by sedentary habits, anxiety, or poor living;—but, however induced, it often brings on nervous complaints, with wasting and fever, and may end in a breaking up of the constitution and a pre- mature grave. Whenever these floodings are excessive, they should be treated as usual,—with cooling diet,—cloths wet with cold vinegar and water to the lower belly,—removing them when they become warm,—and with perfect rest. Opiates are always pro. per ; and if any cordial is required on account of extreme languor and faintness, weak port wine and water is the best. Alum-whey also, is an excellent remedy;—put a drachm of alum to a pint of milk, and when strained from the curds and sweetened, it may be drank as the stomach will bear it. Always relieve the bowels either by an injection, or the Domestic Pills. 128 CHAPTER XX. SEXUAL WEAKNESS, AND IRREGULAR SECRETIONS. That which is known in common language by the term '* whites," is sometimes mild and innocent, and needs no other care than the frequent.use of cold and tepid water. In this form it often happens in pregnancy, and in other persons after much fatigue. But this complaint is sometimes very excessive, and lays the foun- dation of serious affections. It weakens the whole constitution generally, so much impairing the female organs as to cause the disappointment of a family. It is proper, however, to know, that this is not the cause in every instance of sterility, though it is a very fre- quent one. This weakening discharge is often brought on by mismanagement after confinement, or by neglect of the bowels ;—and it is sometimes occasioned by little thread-worms, which inhabit the intestinal pas- sage ;—nor can it be concealed that at other times it arises from cer- tain imprudencies, perhaps at a former period of life. It may also occur in opposite states of the constitution, and the most important point to be ascertained in any given case, is, whether it arises from strength and fulness of habit, or from weakness and exhaustion. In the former case, the purgative, No. 1, should be taken freely, the diet should be lessened, and the exercise increased. But in the opposite, that is to say, in the weak and exhausted condition, which is the most frequent, the .aperients, No. 2, should be relied on, and their peculiar property of operating mildly but constantly should be obtained. At the same time, the diet should be good, and wine and beer be allowed; a course of chalybeates as recommended in page 123, will be of great advantage, or any other strengthening or tonic medicine may be resorted to. The cold bath, or the cold shower- bath is also very beneficial. Cold water to the part, and rqund the back should be plentifully applied night and morning. Besides these tonic and aperient means, there are local applica- tions, which are very useful: these may be used as washes, or as more internal applications. For the latter purpose, there is contrived 129 a very useful apparatus, (a female syringe,) which may be obtained at the medical stores. These should be large enough to hold a quarter of a pint. Where internal applications are required, (and they are necessary when the disorder does not yield to other reme-^ dies,) they should be used three or four times a day, and the recum-r bent position will favor their use. Two or three of the best lotions for this purpose shall now be given. Take of alum, three drachms ; warm water, a pint; and a little gum arabic, about one ounce, may be added to it, When these are dissolved and cold, this lotion is fit for use. Another ;—Take of galls bruised half an ounce, boil them in a little more than a pint of water, for half an hour, then strain, and add three drachms of alum to it. One stronger still is made by adding to a pint of the decoction of galls, just mentioned, or of oak bark, two drachms of alum, and one drachm of white vitriol. All these should be used cold. The clothing should be light, and nothing additional worn in con- sequence of the inconvenience of this disorder; the application of cold water by frequent washing should be used instead. Nothing is more important than to avoid heating the body with warm cloth- ing. For this reason a feather bed is very hurtful; horse-hair mattress is better, and the bed clothes should be very light. If any darting pains are felt in connection with this disorder, or if any lump or internal ulceration be suspected; such case would call for individual consideration, and should lead to confidential consul- tation. In these cases the diet should be liberal; good fresh air, and especially a change of air and scene should be adopted ; but bodily exercise should not be carried to any great extent; riding should be preferred to walking, when it can be obtained. 130 CHAPTER XXI. FINAL CESSATION OF REGULAR CHANGES, NATURAL TO LATER PERIODS OF LIFE. In persons arrived at the age of from forty to fifty years and up- upwards, there is a disposition to many diseases, and thes'e are often ofa melancholy character. At this timj., the periodical returns are about to cease, and this often happens in connection with a fulness and a feverish state of body, whieh is favorable to disease. If, how- ever, attention be paid to those changes in the system, which are now occurring, the constitution generally settles down into a long and uninterrupted state of health. At this time the principal object of anxiety should be to keep the system tranquil, and to keep it from increasing fulness. If this be not done, there will happen either occasional and excessive discharges, or some local disease, often in the same organ which had been accustomed to these discharges, or the constitution will become burdened with excessive fatness. All these, however, may be avoided by the use of the purgatives, No. 1. Let them be taken once or twice a week, in a full dose, and the bowels kept in a laxative state in the intervening days, either by a milder dose, or by the aperients, No. 2. The diet must be abridged, and daily exercise, if possible, be .taken. If, notwithstanding all this, the bulk and fulness of the body should yet increase, these means must be carried on to a more severe extent. There is always a good deal of bodily weakness accom- panying this increasing fulness, which leads to inactivity of life. This must never be indulged in ;—it may be a task for a bulky, Ian- guid individual, to force herself to a proper measure of bodily exer- tion, but she will be well repaid for that exertion. If this be not followed up, no other means will be of much avail;—inactivity will favor her increasing bulk and weakness, until it will be impossible to enter upon this plan. The author has seen so much distressing evil arise from a want of determination to pursue a regular" plan of exercise, and so much good result from its spirited adoption, that he gould not omit to press it earnestly. Next to exercise, in utility, i« 131 the proper use of the purgative No. 1. Nothing favors this increas- ing condition of the body so much as costiveness, and of this, there is one degree or other always present. CHAPTER XXII. NERVOUS DISORDERS, ST. VITUs's DANCE, EPILEPSY, HYSTERICAL AF- FECTIONS, PALPITATIONS, AND VARIOUS OTHER NERVOUS FEELINGS AND COMPLAINTS. It has been stated in the chapter of general observations, that a remarkable slowness of the bowels is a very frequent attendant on these complaints, and that the opening medicine employed should always be given in a dose which will prove adequate to arouse the intestinal passage from this torpid condition. It is not always possible to judge the exact dose of purgative medicine in any com- plaint, as constitutional differences are continually to be met with. On this account a considerable latitude should always be afforded ; for, if a moderate dose do not suffice, it is a proof that some pecu- liarity of constitution, or some other circumstance exists which makes a large dose necessary. The proper course in such instances, is to increase the quantity, and thus a knowledge of the suitable dose for every individual win be obtained. These pills are prescribed with the intention of being increased on the ground of individual experience, and it is found much safer that they should be too weak in any given case, than too strong ;—the remedy for the former defect being simply to in- crease the dose. In the cases here before us, supposing the patient to be a weak and delicate female, and the bowels constipated, begin at bed-time with four or five of No. 1, and if these should not operate suffi ciently, another dose is to be taken in the morning. Provided the bowels have only been moderately moved, a dose of No. 1, may again be repeated on the following night;—but, if the evacuations have been very free and copious, then No. 2, may supply their place, and may be continued for several nights, or nights and mornings ia succession. 132 Formerly it was thought, that when the bowels had once been freely cleared of their contents, and all that purgative medicine could do was then accomplished; and no further treatment of this kind was ever thought of. But such a practice only went so far as to remove the effect of disease, while that torpor of the bowels which really constituted the disease itself, was left existing. The conse- quences therefore following were, that these foul accumulations soon returned, and thus the nervous symptoms depending on them, were perpetuated. The great and important secret ever to be kept in mind in the cure of these complaints, is, that the bowels are not only to be thoroughly unloaded, but that they are also to be recovered from that, sluggish, torpid action, which favors and allows of these unnatural accumulations, and that this is accomplished by a perse- vering and judicious use of the Domestic Pills. At this time the author has a patient, whose case will serve to il- lustrate this principle. This individual, had long been subject to ner- vous and hysterical complaints, which during the last year, had much increased upon her, and she was occasionally seized for. many days with faintness, loss of speech, blindness, &c, accompanied with great and distressing irritability of mind. Opening medicine had been prescribed, but the chief reliance had been placed upon the ner- vous, stimulating plan, without, however, any permanent advantage. It was, therefore, thought advisable that she should take a journey of a few hundred miles, which brought her to this city. Being re- quested to visit this patient, and finding that her nervous symptoms were connected with an obstinate and constant torpor of the bowels, the author did not hesitate to give a flattering opinion of her reco- very, nor to explain how much her amendment would correspond with the improvement which a purgative plan of medicine would bring about with regard to the state of her bowels. The first eva- cuating dose of the pills, however, which was given did not operate sufficiently, but this being directly followed by another, a more ef- fectual unloading of the bowels took place, than had ever been ob- served before ; the quantity of offensive stool which passed, was so great as to astonish her attendants, and from that moment she began to recover her health of both mind and body. After this the milder pills were directed to be taken in such doses as to maintain a mode- rate action of the bowels, but this not being so well attended tor,- the 133 bowels became again obstructed, and another of her hysterical at- tacks took place, which very much alarmed the family. This, how- ever only showed the necessity of following up the plan laid down, and upon another dose of the more active cathartic medicine being given, its operation was as effectual as before, and was also followed by an immediate recovery from the hysteric paroxysm or fit. The successful treatment of these complaints, then, it will be seen depends on keeping up a slight purgative action, after the bowels have been once thoroughly unloaded ;—having given, therefore, an effec- tual dose of No. 1,—on the following day, either night or morning, five or six of the No. 2, may be given, and repeated daily. The first dose on the day following the operation of No. 1, may not dis- turb the bowels ; still, however, a certain impression is made, and a disposition to be more readily moved is thus secured; for, a free and natural evacuation is always seen to follow the second dose,—and afterwards the bowels are easily regulated by a daily use of the No. 2* In those cases in which an extraordinary degree of costiveness pre- vails, it will be expedient to repeat the No. 1, more frequently,—per- haps every other night; giving on one night the No. 1, and on the next night the No. 2. In such cases this change of medicine is greatly advantageous, and has much to do with the breaking up of that torpid condition of the bowels, which constitutes the essence of this disease. With respect to the doses, of either one or the other, this must be regulated by each individual case ;—in some instances six or eight of.either pills are required ; there is no possible evil to be apprehended from this quantity. . One thing, however, may be observed, which is, that when the proper dose is ascertained and has been continued for a certain time, the quantity will allow of being diminished rather than require to be increased;—this is contrary to what happens with other medicines of this kind, while the diminu- tion ofthe dose may be taken as the best proof that a radical cure is going on, and a healthy action of the bowels taking place. This therefore is the method to pursue in nervous affections, in which constipation of the bowels is present. Other measures, how- ever, are found greatly to promote and secure the good effect^of pur- gatives,—these are such as strengthen the system. The whole class of chalybeate medicines are admirably adapted for this purpose, and they may be given at the same time as the-purgatives, or after a bet- 134 ter action of the intestinal passage has been established. The best and most simple forms of chalybeates will be found described in page 123 ; a good and generous diet is also necessary; animal food rather underdone should be taken twice a day, and a little wine, or if it agree, 135 to enumerate the symptoms of pregnancy which very generally occur in health ; and, then, to show how far accidental disorders may ocasion them. These circumstances are, obstruction and passing over the period ;—morning sickness and vomiting;—unusual dreams ;—loss of appetite ;—emaciation and a fretful state of temper ; —swelling of the breasts, and a brownish color around the nipple, darker than formerly;—a moving in the belly called quickening, and an increasing size. But all these signs we will now consider more particularly. Obstruction.—This may be the effect of exposure to cold;— it is also frequently the effect of great weakness of body, as in con- sumption. Further, persons who nurse, generally, have not this change to go by, and some pregnant women have a regular period resembling the one alluded to. When, however, the natural change has been regular in a married woman and it ceases at once, without any of the causes mentioned, it affords a ground of strong presump- tion. Sickness and vomiting.—These also may arise from obstruc- tion taking place from any Gause, and are occasioned by many disor- ders. Whenthey are from pregnancy, however, they are generally observed at certain periods of the day,—often in the morning. ' Distressing dreams.—Some stress may be laid on this occur- rence, especially when it is in connection with other signs. Loss of appetite,—proceeds from various causes ; but this serves to strengthen the testimony of other signs. Peevishness,—if unusual and unaccountable, is of still more weight. Enlargement of the breasts,—especially if a little milky fluid ia observed, is another indication; but this is not to be relied upon alone, for this circumstance is known to occur, sometimes, from other causes than pregnancy. A darker color, and a larger circle around the nipple.—This is a circumstance on which a greater dependance may be safely ventured than on any of the early signs of pregnancy. If any doubt arise from the absence of some of the others, this may always, settle the point. But, then, it must be remembered, that it it is not any certain degree of darkness of the color; for this varies naturally with the peculiar complexion of the person ; but, it is a darker color than is natural 138 to the person, and a change sufficiently striking to^be noticed. Again; it answers1 this purpose so remarkably, only in the first pregnancy ;—this change of color is not so striking in future pregnan- cies, because it is apt to remain when once it has been produced. Quickening.—This is a sign which is often waited for in doubtful cases, with some anxiety; and when it happens, is regarded as a decided proof. Ladies who nurse, frequently, have no other intimiation of their situation ; and which, indeed, often occurs much to their surprise. Some persons, however, have mistaken wind for this sensation, for it is at first a little like it; but the motion felt from quickening gradually becomes stronger, and is less to be mistaken. Quickening pretty generally begins about the end of the fourth month, or between the fourth and fifth. Enlargement of the belly.—This varies much in different per- sons, and does not depend entirely on the size of the child. It must be remarked also, that enlargement may take place from dropsy, from tumors, from wind and accumulations in the bowels, and from increasing fatness. The enlargement from pregnancy, however,. is one which gradually increases, after it is first observed ; but, this is not until after the second month; before that time, the belly, is flatter than usual. It is, however, altogether the best rule to judge by in any given case of obstruction, so as to be able to say whether such obstruction arise from pregnancy, or any other cause. In the latter kind, the belly swells almost immediately, and this is a source of much alarm to, some ; but, if it is from pregnancy, the enlargement does not take place for two months more ; indeed, the belly is smaller and flatter up to this time than before. There are many other circumstances which occasionally appear in pregnancy, but' those which have been mentioned are the most common and natural. Even these do not always occur in every case-;__some may be absent entirely, and there is not one which may not exist in so slight a • degree, as scarcely to be recognised at all; and, further, there are remarkable instances in which the signs of pregnancy, taken altogether, are so faintly marked out as to render its existence doubtful up to the very commencement of labor. Besides these external signs, it should be mentioned, there are other means of judging'of the existence of pregnancy, when, in any particular case, it is of great importance to ascertain the fact. 187 Reckoning.—The period of time which nature has assigned to the pregnant state is 40 weeks, or 9 calendar months; and this period is observed with remarkable regularity. There-are, however, exceptions to it, s o that in some rare instances it is prolonged a week or two, or more ; and children in these cases, do not exceed the usual average weight and size. The laws of different countries vary upon this,subject, so that in some countries, a child born six months after the marriage of the mother, or ten months after the death of the father, is considered as legitimate !! But, [in reckoning, taking the natural period to be 40 weeks, or 9 calendar months,] it is usual to date from a fortnight after the last periodica] indisposition ; reckoning, not from the end of it, but from the beginning. This is the best general rule, and may be relied on pretty generally for its accuracy. There is, however, ano;her way, which is called the short rec- koning, (the former being-th long way.) This is, when you rec- ■kon from the time of quickening, and many nursing mothers have no other means of reckoning The feeling of quickening pretty generally happens about, or near, the end of four months, so that by counting four months and a fort- night or a little more from the time when this* was distinctly felt, a tolerably correct opinion may be formed of the time when prepara- tions should be made for lying-in. Disorers of pregnancy.—Respecting the great variety of com- plaints which occasionally appear in pregnancy, these are, many of them, merely the effect of a nervous irritable state, which can only be relieved or moderated by means which preserve the general health. Most of them however arise immediately through the medium of the stomach, so that the remarks which were made on the subject of dyspepsia, will be found very generally applicable in pregnancy. There are, however, positive disorders which arise from other causes, particularly from a certain plethoric state, or fullness of blood, which is peculiar to pregnancy, and which exists even in those who are pinched in the face, and who take very little food. These are the complaints which admit of most relief, and which it behoves every woman to understand the treatment of; and therefore, these will now be mentioned as the subject of the following remarks ; 139 A feverish state.—This is best relieved by the gentle and daily operation of the Domestic Pills, and a lower diet. Take the No. 2, or No. 1, at bed-time as the bowels may require, a stronger or a milder medicine. It is better sometimes to take them alternately, or, the mild ones at night, and if not sufficient, the stronger ones in the morning. None but those who have experienced the fact, can form the least idea of the useful effect of this domestic medicine in every disorder that can occur in the pregnant state. If, however, notwith- standing the duly regulated state of the bowels with a lower diet, this feverish state continues or increases; then, in addition to these, it will be proper to loose a little blood. Soda water or Seidlitz pow- ders are also proper fever med:cines at this time. Vomiting.—This also is greatly relieved by a freely evacuated state of the bowels. It is likewise an advantage to take as little fluid as possible,—as one cup of tea, or half a cup instead of two or three, and the same with other articles of drink. In persons very weak and feeble, some bitter infusion with magnesia is of service, taken and repeated two or three times daily. These infusions have been mentioned in the chapter on dyspepsia, page 30, and may be made and taken as directed there. Sometimes a draught of cold water will abate the vomiting.—If ever there is pain and tenderness at the pit of the stomach, as well as vomiting, a few leeches would be advanta- geously applied. This vomiting, it should be further mentioned, generally happens in the early stages of dyspepsia, and begins chiefly, in the morning. It often goes off after quickening ; but, if it should not or, if it then comes on, it is always proper to lose a little blood, and keep the bowels regularly freed by the use of the Domestic Pills. Heartburn,—is best relieved by the aperients—but small portions of soda, magnesia, and chalk, are useful, and give immediate relief. Nothing will do however, without a constant attention to the state of the bowels. Spasms about the stomach. Jt is proper to relieve this painful af- fection immediately by opiates and a saline injection. Do not hesi- tate to take from 30 to 40 drops of laudanum on the occurrence of this pain about the stomach, and if you have it handy,—in a tea- spoonful of ether and a little water. With respect to the injection, a ta* ble-spoonful of common salt with as much molasses in a pint of warm 139 Water, is soon prepared and should be given directly. If however", there is much pain in the head with a full and flushed countenance, bleeding also, from the arm, should always be had recourse to ; and* afterwards, the bowels kept open with the. domestic pills.—Spasms with vioient pain and throbbing in the head is an alarming occurrence, and might lead on to convulsions. In this case it is more than ever necessary to regulate the diet, which should be done as in dyspepsia* If spasms occur in very weakly persons, the bitters, and even the chalybeates as there directed will be proper. Costiveness.—There is no circumstance in pregnancy which should be more constantly avoided. This state of the bowels not only aggra- vates whatever symptoms arise in pregnancy, but some of them arise entirely out of it;—cholic, piles, spasms, head-ache, convul- sions and abortion, are of this number. An attention to diet alone will sometimes be sufficient to prevent it, so that ripe fruits in their season, as well as figs, prunes, and baked apples, &c, are exceeeingly proper with the intention of avoiding costiveness. The next mildest measure to these is the use of injec- tions. Warm water alone is sometimes sufficient,—or a table-spoon- ful or two of oil may be added, and this may be made more effective still by the farther addition ofa table-spoonful of molasses and one of common salt. But it will be found that Injections in general, can only relieve the lower bowels, while the Domestic Pills will secure a better and more effectual purpose by operating on the upper as well asthe low- er bowels. There is nothing more safe and proper that can be taken throughout every stage of pregnancy ; so that either one or the other of the pills should be taken at bed-time, every, or every other night, and in just that quantity or dose as may prove sufficient for the purpose,—beginning, however, with a gentle dose. Piles,—very frequently attend a state of pregnancy, particularly in the latter months ; and, as a certain bulk or pressure is then the cause, they do not always admit of being cured, but may be greatly re- lieved and moderated by proper means. On the other hand they frequently arise entirely, out of constipation of the bowels, and then they may be cured and thoroughly prevented from returning. The most effectual way of preventing or relieving piles is the use of this Domestic Medicine, but if any other measure is preferred the 140 most gentle laxative articles of physic should be chosen,—the best of which is, sulphur, either alone or mixed with equal parts of cream of tartar ; a tea-spoonful of this, every morning or evening in a little molasses, or, in any other way, is very good. Castor oil is also a safe and mildly operating medicine. When piles are inflamed they are attended with much pain and throbbing. If they should chance to bleed at such a time, which is often the case, do not be anxious to stop it; a moderate bleeding in this way does great good; rather encourage it by warm poultices. In cases of extreme pain, a few leeches is an excellent remedy,—a warm poultice likewise very much assuages the pain and throbbing When Piles are inflamed. Looseness of the bowels,—if excessive, should be treated, first by a dose Of the purgatives, and then restrained by taking a few drops of laudanum, or a tea-spoonful of paregoric once or twice a day. Cramps in the legs, and in other parts,—are more inconvenient than dangerous; these are best paliated by an open state of the bowels, and frequent change of posture in lying, &c, and by rubbing the limbs once or twice a day with warm flannel. If these do not relieve, take twotea-spoonsfullor more of paregoric on going to bed. If there is much tightness from extraordinary bulk, and the habit of body is full, the loss of a little blood js of great service in these cramps. Cholic pains;—demand a more particular attention to diet;—it should be low, and consist of that which is easy of digestion, as rice, light puddings and the like. Particular care should be taken to keep the bowels free from accumulations. If, however, along with cholic pains there is any soreness of the belly and fever, bleeding should never be omitted; or medical ad- vice and assistance should be sought. The method of distinguishing cholic or spasmodic pains, from pain connected with inflammation, has been often and clearly pointed out; but, as it is always an im- portant point to determine it may be excused if they should be men- tioned once more in this place. Sharp pains arise from two very different causes; one is spasm, often called cramp or cholic ; the other cause is. inflammation. In every case of uncertainty always resort to pressure with the hand, or taking a deep breath to deter- mine what kind of pain it is. If pressure increases the pain, it is inflam- 141 matory, and requires bleeding, low living &c.; but, if such pressure does not increase the pain, but rather feels to relieve it,—then it is spasm, and warm and stimulating things are proper. Beside this, in inflammation there is always more or less of fever ;—in spasm very little, and at first none at all. In any doubtful case, however, it is always better to regard it as inflammation, and especially so, as spasm sometimes termipates in inflammation, and a mistake on this side is not of serious consequence. Difficulty in passing water, or inability to hold it;—is often very troublesome in the latter months. They both arise from the bulk which is pressing on the bladder. Change of position often assists in the former case, and a proper bandage made to support the weight by passing over the shoulders relieves in the latter. Such a bandage may possibly be contrived by those who suffer most from this cause. Flooding.—This is generally connected with abortion or miscar- riage, but not always,—every appearance of this kind does not end in this manner; the two latter circumstances however, never can occur without flooding, and this is sometimes so great as to endanger the life of the mother. ' Flooding may occur at any period of pregnancy, and is always a matter which calls for much attention and propriety of conduct. Flooding is not attended with so much, danger in the early, as in the latter months, but it is at all times uncertain as to its consequences,—and when once it occurs, it may afterwards be re- newed on very slight occasions, even from sudden surprise, or a little agitation or fatigue. This will show how necessary it is for such to avoid as much as possible every cause likely to excite it. And, let it also be remembered that, when abortion or miscarriage has hap- pened more than once or twice, it is very difficult to prevent it in future pregnancies, and thus the prospects of a family may be en- tirely ruined. The objects to be kept in mind in cases of flooding are, to keep the body cool, and retard the motion of the blood as much as possible; thus the blood forms clots which plug up the little vessels. Now, the means which favor these objects are, quietness of mind and body,— cool air—a cooling and light diet,—the proper use of opiates and cold applications to the belly. Small bleeding from the arm are also useful in full and florid habits, 18 142 It is scarcely necessary however to give directions on every circum- stance of this kind,—the good sense of every one will best suggest the proper'way of following up these means in the varied situations in which they may occur. It must be evident to every one that a person in a case of flooding should instantly retire to bed, and have but few bed clothes. A horse hair mattrass being cooler is better than a feather bed. Let the room be cool and well ventilated, and the diet be of the lightest kind,— panada and such things. Of course any thing like wine would be very injurious, and whatever is drank should be cold. In young persons who are full habited or are flushed, a bleeding from the arm will be safe and useful; indeed this can never be improper except in cases of great weakness, or where there has been any great loss. Opiates are of great use, except in cases where there is much heat and flus .ing;—from 30 to 35 drops of laudanum should be given as soon or before the lying down on the bed, and the bowels should be evacuated either by a glyster or the Domestic Pills or both. If the flooding continue, in addition to these, a fold of linen wet with cold vinegar and water should be applied to the parts, and over the lower part of the belly, and changed as often as it begins to get warm. But if nothing seems to check the flooding, and especially if the woman is near her time, a medical practitioner should by all means be sent for; in the mean time, the means which have been recommended should be rigidly persevered in. Abortion, or miscarriage, means the passing off of a conception at any time before the seventh month. The circumstances attending abortion are more like labor in proportion as it happens late in the period of pregnancy ;—so that with the flooding there may be pains in the back and belly with regular intermissions, and the discharge of the waters. With regard to miscarriages 'in the earlier months, (which by way ,. of distinction are called abortions, while those after the 7th month are called premature births,)—the management of these is very simi- lar to that recommended in flooding; but, as it is a great object, to avoid any repetitions which might swell this little volume to an un- necessary size, but little need be said on this subject. With respect to any manual assistance, this is very seldom neces- sary, and perhaps never in a case which has not reached the 5th, 143 ' month. It may happen however in rare eases that some assistance with the hand may be afforded. Miscarriage may occur at any period, but it more frequently hap- pens between the eighth and eleventh week, than at any other. In every case of flooding, it is right to put every lump or clot that passes into a basin of cold water, that it may be properly examined. In conclusion, therefore, it may be stated, that soothing the pains with opiates, rest, and quietness, a cooling diet, and laxative injec- tions, comprise the principal means to be relied on. False, or spurious pains.—Towards the end of pregnancy many persons are afflicted with pains about the back and lower part of the belly which very much resemble true labor pains; and these, not only harass the patient, and exhaust her strength and spirits, but frequently induce her to send for her friends and medical attendant in the night, when it turns out to be unnecessary. It is of some consequence therefore to be able to distiuguish between the false and the true labor pains. These false pains are brought on by many causes, but the most frequent are, wind, colic, costiveness, diarrhoea, agitation of mind, and bodily fatigue. False pains ,are known by their situation and shifting disposition, and by their irregularity ; for instance, they aro often felt more in the bowels, and the bearing down which some- times accompanies, and is very apt to deceive, does not increase either in frequency or strength, but is irregular in both these res. pects. Again, they generally come on at night, and instead of becoming quite regular, as the morning approaches they slacken, and the time between them becomes longer instead of shorter. On the contrary, true labor pains, generally, increase regularly, both in their frequency, and in strength. There is not now a short time between, and then a long period ;—a strong pain, and then a slight one ; but on the whole they increase in these respects ; and, after a time, a sense of. bearing down is felt. The water which may accompany, is no criterion, for dribbling water may occur many days before the labor, and that which is sometimes seen in false pains, is not the proper waters we allude to. The period of preg- nancy may also be some guide ; for, if there is a week or two expected, it is still more probable they are false and spurious, and should be relieved. In case of any real doubt, however, a midwife can at all times ascertain the fact. 144 The best way to relieve or prevent these pains, is to give an opiate, and enjoin rest on the bed, and regulate the bowels. Take from twenty to thirty drops of laudanum on going to bed, or in the night when the pain comes on. If there is much weak- ness and nervous languor, these may be taken with twenty drops of spirits of hartshorn in a little water;—or in a little wine and water with spice; and, in the morning, either an injection or a dose of opening medicine. If such pains, however, are accompanied with a feverish state, the loss of a little blood is also proper. And, fur- ther, it should^ be remembered, that if these pains are let alone they are apt to end in real labor,—sometimes a week or two before the time ; and, what affords peculiar satisfaction in this practice, is, that if they really should turn out to be true labor pains, no harm accrues from these measures, but, on the contrary, the patient often has a better time on this account. CHAPTER XXIV. LABOR.--PLAIN AND IMPORTANT DIRECTIONS FOR THOSE WHO MAY BE CALLED UPON, UNEXPECTEDLY AND UNAVOIDABLY, TO RENDER ASSISTANCE AT SUCH A TIME. The utility of the remarks proposed under this head must be evident to every thinking person. It is not proposed to give a minute detail of every peculiar labor and circumstance which might ever happen; nor even very often to give a reason for the direc- tions which are to follow. The persons to whom these observations are addressed, are those who may accidentally be placed in circumstances in which impor- tant services are often called for and required, and the being capa- ble of rendering assistance on an occasion of suchlike urgency and danger must surely be worthy the attention of every mother or female individual. It is impossible to say how frequently these opportunities may occur to any one. Within a very few weeks the author was called at night in great haste to a lady, in Dey street, who nearly lost her 145 life, not for the want of any good intention, but for the want of the very information which these pages are designed to give. She had fainted from one of those circumstances which often happens after delivery,—a sudden and rather larger after-flow than natural. Alarmed at her death-like countenance, her female friends proceeded to do the only two things which, of all others, were likely to increase the danger to a fatal extent,—they propt her up in bed, and kept the room very warm. Now, if instead of this they had kept her lying down, and even taken away the pillow from her head,—and also opened the door and windows, (it was a winter's night) she would have run no risk at all; especially, as further assistance could be readily had. This poor lady was so near dying, (as^her friends well know) that the author could not leave her bed-side for some hours, and he attributes her ultimate recovery only to the ready access to ice and snow which the season of the year afforded. He could mention scores of instances precisely similar, and some, too, which ended in a far more melancholy way. It is true, this kind of information is more valuable to those who live in country places than in towns and cities ; but, it may happen that the family physician sent for may be from home, and sometimes a great deal of time is lost in running about from place to place in the night. Indeed, these cases are of so much danger and rapidity, that if he were at home and in the same street, he might be too late ;—the cases alluded to require the most prompt as well as the most deci- ded measures. It is not that any extraordinary skill is wanted ; it is only necessary to know what are the means and when they should be used ; and, therefore, the rules and directions which will follow, shall be as plain and special as they can be conveyed in words. The first thing to judge of then in such a case, is, whether the pains complained of are real labour pains, or only those spurious pains which, after continuing a certain time, will go off; the rules however for determining this question were given in the concluding part of the last chapter, and to this therefore the reader is referred. If the labor is of a slow and lingering kind, do not mind that, but wait patiently;—such are the safest labors. During this time, how- ever, avoid any thing that would exhaust the strength of the body or depress the spirits. Much company and talking, or a warm room, 140 and especially any kind of wine or spirits would do this ; on the con- trary keep the room cool and quiet, and encourage her to lay down and sleep if she can; let the diet be very light, and it would be well to give a dose of castor oil or something of the kind. If a night Or a day passes on in this way, and no progress is made, and very little Bleep is obtained, give 30 drops of laudanum, and let the patient en- deavor to get some sleep. The waters are apt to break in this case and dribble away ;—this is of little consequence, but if there should be any quantity of pure blood or clots come away, it is then a case which may prove dan- gerous, and skilful assistance should be obtained if possible. If this cannot be had, then the rules which have been given in flooding, are to be followed here. In any case, whether in a lingering on a quick labor, when the pains are strong and are attended with a feeling of bearing down, and there is a bulging of the parts during the time of a pain, then some interference will be called for. The object now is to afford a little pressure or support to the bulging part, in order that it might not pass too quickly, and thereby endanger a tearing, instead of a slow and gradual dilating. This assistance in the language of midwifery is called " supporting the perineum," and is very often all that is ever required in quick and natural labours. It is a simple and very easy thing to do, and as these parts will not often heal when once they are torn, this duty of supporting the perineum should be plainly sta- ted. The patient is supposed to be lying on the bed on her left side,— the knees being drawn up and the feet resting against the bed-post. It is also of advantage to fasten a long napkin or towel to some other part of the bed frame, or to be held by another person, so that she may steadily pull by it during a pain, the usual way of affording »' support to the perineum" is to take in the left hand a folded napkin, and gently hold it against the tumor, which is felt bulging at this time, and when the pain ceases, then you may cease to press or support the part; in this way you sit by the bed-side and proceed until the child is born. Another way is to dispense with the napkin and hold the palm of the hand to the tumor, and this is much to be pre- ferred as it gives an opportunity of using lard or any such thing, which softens and cools the part, and otherwise dees good. A quan- tity of lard, as large as a nutmeg should be placed in the hollow of 147 the hand, and when this liquifies and disappears, another quantity should be taken. Sometimes it is necessary to persevere in giving this support to the parts for some hours, and all this time you cannot safely leave the bed side at all. But, it most generally happens that the head is born before any interference is ventured on, for this is the event which obliges a by-standing friend to interfere. In this case do not proceed to expedite the delivery directly, but simply take hold of the head, and wait for another pain ;—this will soon follow, and then you may give a gentle degree of assistance to help the birth. One more pain after the head is born is generally sufficient for the purpose of completing the birth of the child. After the child is born take care that it be so placed on its back or side as to prevent its being smothered ; and, after this, immediately proceed to take a long napkin or towel, and pin it tight round the belly of the mother over her clothes. Be careful that the lower part of the belly be included ; there is generally a large tumor which rolls about as the patient moves, and this should be secured beneath the napkin. If this bandaging be well done, it is astonishing how much comfort it afords the patient; but, beside the' comfort given by a uniform and moderate pressure of the belly it prevents a flooding also, abates the after-pains, and wonderfully assists the contraction of the parts. Now, after this bandage is well pinned round the mother, you are to think of removing the infant; but, before you seperate the child, the naval cord must be tied, and this you proceed to do in the follow- ing manner. Take a skane of worsted or thread, or a piece of soft strong tape, and pass it round the cord about one inch and a half from the belly; tie it once very tight;—then pass it round again and tie it in a knot, after this pass another string about an inch higher up, artd then with a sharp pair of scissors cut the cord in two, between the two strings, and you will then leave about two inches of cord to the child. This being done you take up the infant, and, wrapping it up in a soft warm flannel petticoat, put it out of the way or give it to the care of some one while you see to the mother. And now it is customary to give a little cordial; not that this is always necessary, but it is a very general practice; and, certainly, where there has been great and protracted exertion, it is a very proper one. The usual cordial is two or three tea-spoonfuls of brandy in a little water, with sugar and nutmeg. To this it is often proper to add an 148 Opiate, and if the la"bor has been tedious, and the after-pains should be strong, this opiate should be repeated once or twice at intervals of two or three hours. From 25 to 30 drops of laudanum is a pro- per dose ; but, if this is to be repeated after the first dose, it should be given in some simple thing,—by no means should the_cordial above-mentioned be repeated. The next thing to do, is to remove the after-birth ; but this must not be done directly,—you must wait for a pain before you attempt it. Take hold'of the cord with a napkin, that it may not slip. Use the right hand while you pass the finger of the left hand as high as you can up the cord. You have then hold of it in two places, and when a pain comes on, use a gentle force by pulling from side to side. It is not proper to use much force, for if it do not come with the first pain, wait for the next. If you can feel the after-birth in the passage, you can assist it with the finger as a hook ; and you may use a little more fores when it is felt to be coming. So manage that it may pass very slowly ; and after it is brought away, apply a warm napkin to the part and leave it there ;—this completes the delivery. It should be mentioned, that if no after-pains come on, and there is no unusual flow to urge it, wait for half an hour or an hour before you attempt to remove the after-birth-, and after this time proceed to do it,—requesting the patient to hold in her breath and force down a little, which will assist you. If, however, there should be considerable flooding, with fainting, you must not wait many minutes for a pain, but proceed immediately to remove it. The labor now being finished, the management of the lying-in woman and her infant will next require attention ;—but this will form the subject of a separate chapter, preferring this place only for a few remarks respecting the proper time, and the manner of removing the mother safely and comfortably into bed. In the first place it'should be mentioned, that it is never proper to change the clothes and remove a lying-in woman immediately after the labor is over. Keep her from being chilly by adding - veral organs. In this place it is only recommended that in every kind of fever, a constant and careful attention be paid to the three parts ofthe body before mentioned, so that the means now to be pointed out, be always quickly resorted to. When fever is about to affect the head, there is great heat to be felt by the hand ; and if the child can speak, pain will be complained of;—neither can noise or light be suffered without pain ;—there is also drowsiness or great restlessness, or short and disturbed sleep, with more or less of delirium, and sometimes convulsions. When- ever these things occur in any kind of fever, it is no longer safe to trust alone to the cooling and purgative plan recommended in the general treatment of fever ; but to this the local treatment of inflam- mation ofthe brain must be added. If, again, the breathing should become short and quick, with a cough,—then it should be regarded as a fever settling on the lungs in the form of inflammation or pleurisy; and if there should be ten- derness ofthe belly (which should frequently be examined by press- 24 190 ing it with the hand,) then it should be treated as inflammation of the belly or bowels; and no time should be lost to relieve this dangerous turn of fever. Water in the head.—This in fact is nothing more than inflamma- tion ofthe brain, or the immediate result of such inflammation. In- flammation ofthe brain is most frequently the consequence of cos- tiveness or some disorder of the bowels ; but it is sometimes also the consequence of fever, as has ju.st been mentioned. The most important fact to be acquainted with, however, is, that from what- ever cause inflammation may arise which terminates in water in the head, it may almost always be removed before it proceeds to this fatal termination, if the proper remedies be but quickly had re- course to. If the limited size of this little work did not prevent enlarging on this subject, I could give many instances from my private case book, which would show the truth of this assertion. I will, however, state two cases with this view ; the one, not having the advantage of immediate local remedies, proved fatal; the other, having an early application of them, recovered. Both of them were under my care, at the same time, only a few weeks ago. The first was a child I was called to see at the Philadelphia Ho- tel, which had just arrived from a distance ; it was about ten weeks old, and had been suffering for several days under a general fever- ish state, with evident symptoms of irritation or inflammation af- fecting the head and chest; but, owing to the necessity of travelling and the want of conveniences on the journey, no local remedies had been resorted to. On the following day the symptoms of the disor- dered state of the head became more clear and positive ; there was stupor, convulsions, squinting, and fits of screaming,—the marks of actual effusion of water on the brain; and, notwithstanding the warm bath, leeches, a cooling lotion to the head, and blisters behind the ears, it died in two or three days. These remedies were ad- ministered too late. The next was a very fine child, 14 months old, at No. 128 Nas- sau street. On the ninth of March I found this child had been fever- ish for a few days, which was attributed to cutting teeth ; but on that morning it was reported to be much worse,—it had become 191 drowsy and stupid, with a constantly changing state of the eye ;— sometimes it had a vacant stare, and then a sudden contraction of the pupil. I did not fail to apprise the mother that these were the frequent forerunners of water in the head, and that they called for immediate relief. The gums were instantly and very effectually lanced; and the Dom.stic Purgative No. 1, was directed to be given every fourth hour until it should operate freely. To this also was added a blister behind each ear. On the following day there was no visible alteration,—the purgative had not been given as freely as directed. (There is often occasion in this complant for powerful and repeated doses of purgative medicine.) A stronger dose was therefore directed, but it was not now deemed safe to trust alone to the operation of the purgative,—a day and night had been already lost,—so that two leeches were also directed to be applied to the temple. Next morning I found the leeches had bled well, and the bowels had been freely purged. The countenance of the child was now' completely altered for the better;—it was also able to recog. nize its mother and partake of nourishment. From this time it amended, and in a few days was quite well. These cases are related chiefly to show the great importance of relieving symptoms which indicate disorder in the head of children, as early as possible. I would not vvish in every instance of suspicion of disorder that the head should be shaved, and leeched, and blistered; for such suspicious symptoms are often removed by freely lancing the gums, and the operation ofa brisk purgative ; but, if after these have been tried, a decided improvement does not take place, or if these symptoms come on suddenly, they cannot be delayed with safety. It is very wrong to postpone these local remedies for a more satisfactory proof that the child really has the complaint which leads to the water in the brain, in order to be quite sure of the ne. cessity of them ; for such a proof is often kept back until the dis- ease is perfectly and fatally formed. In fevers, or in any other complaint, therefore, whenever there is reason to apprehend that the head is threatened, a few leeches should be applied to the temples, an active dose ofthe Domestic Pur. gatives given, and a blister applied behind each ear. If these means are not followed by a satisfactory change in a few hours, the hair should be removed, and a fold of linen, constantly wetted with vine- 192 gar and water, should be applied to the head. The repetition of the leeches must be regulated by the necessity of the case, and the strength and'fulness ofthe child. In situations in the country or where leeches cannot b3 had, the blisters must be substituted, and an ear- lier application of the cold vinegar and water to the head be had recourse to. It has already been stated, that the irritation of the head which leads to water on the brain, more frequently arises from constipation or some disorder of the bowels than any other cause- On this account, it is not only incumbsnt to watch over and regulate the state ofthe bow«ls in children, by the use ofthe Domestic Purgative Pills, but it is always an exceedingly important part of the treat- ment ofthe diseases of the head to carry on the operation of the pur- gatives as far as it can be safely done. So long as the stools are not watery, and do not seem to weaken and exhaust, a repetition of the purgatives is safe and desirable. But it is also worthy of remark in this place, that when symptoms of water in the head come on after a long continued bowel complaint which has weakened and reduced the child, it is not desira- ble to carry on either bleeding by leeches or the purging, to the same extent as when it comes on in fever or in a full habit of body. In such cases the face is very pale, the body is flabby, and the feet and legs are very cold, and there is very little feverish heat. The application of leeches onee, and a moderate use of the purgative medicine, in these instances, is safe and proper ; but the bleeding must not be carried on to the same extent as in the opposite state, nor are leeches to be repeated. In this feeble and exhausted state, it is true that symptoms of water in the head are often seen ; but this arises from weakness, not from irritation or inflammation of the brain, and must therefore be treated on a cordial and supporting plan. A child of twelve months old, for instance, under such cir- cumstances, should have from eight to ten drops of hartshorn in any arreeable drink, or in a table-spoonful of decoction of bark, every three or four hours, and a light and nutritious diet. The bowels should be kept clear of offensive contents by the use ofthe Domes- tic Pill; but, at intervals, if a fretful state of bowels or diarrhoea should be present, this should by all means be allayed, and the best way of allaying it would be by the opiate injection. JqflamwuUion of the lungs, and pleurisy.-—-The treatment of this 193 complaint in children, as well as the disorder which will follow, is so much like the treatment of the same complaints in adults, that it would scarcely be necessary to mention them but for the pur- pos3 of putting the reader on her guard with respect to the de- ceiving manner in which they creep on in fevers. The fevers of children in general are very seldom dangerous unless inflammation of some vital part creeps on,—such as the brain, lungs, or bowels; and if they are treated on this purgative and cooling plan, they are soon brought to a favorable termination ; but, it happens that fevers which have at first no important form of inflammation, frequently slide into such a state. For instance, there is very frequently a little cough in fevers which arises out of the general excitement of the febrile state, and which is not connected with inflammation of the lungs. Now, being accustomed to this little and irregular cough- ing, many are thrown off their guard when this cough changes by degrees for the cough which indicates inflammation of that organ. The inflammatory cough, however, is harder, and more frequent and regular than that of feverish irritation ; and the breathing is also short and quick. If the child is old enough to speak, and requested to take a deep breath, it will tell you it feels pain in doing so. In- flammation of the lungs, or pleurisy, may be always known by the pain which accompanies it; and especially by the increase of pain which is complained of on each swelling out of the lungs in the act of breathing. But, as inflammation may come on in a case of common fever, so may common inflammatory fever arise out of any sudden attack of inflammation. It matters not, therefore, whether fever comes first or comes after inflammation; as soon as ever a hard and painful cough with short quick breathing is observed, then inflammation ofthe lungs or pleurisy exists, and must be treated in the following way. If the child is old enough to find a vein in the arm, it is decidedly better to bleed in the usual way ; but if otherwise, or the symptoms are not severe, then leeches should be applied to the chest. After the leeches a small blister should be applied. The diet should be very low, and the treatment in other respects should be exactly as in fever. Inflammation of the bowels.—This is a very fatal disorder in 194 children, and it creeps on in fevers, or comes on suddenly, so that the fever follows, just as the former complaint. The means of de- tecting the existence of this disorder consist, chiefly, by pressing the belly with the hand. If the child is old enough to speak, it will complain of pain, and if it is not, by observing the countenance and manner ofthe infant while pressure is made, a pretty correct judg- ment may be formed on this point. There is also a short, quick breathing, as well as some cough in this complaint, but these are not so remarkable as in inflimmation ofthe lungs or pleurisy. If there should be any difficulty in ascertaining whether it is the lungs or the bowels which is the seat of the disorder, this need give no unea- siness ; for the treatment in either case is very much the same, whether inflammation exists in the lungs, pleura, or bowels. Or, if tenderness and pain exist only in the pit of the stomach, or the side, bleeding should instantly be had recourse to, just as directed for in- flammation of the lungs. In inflammation of the bowels, fomenta- tions of hot water to the belly, and the warm bath are exceedingly useful means. With regard to purgatives also, some difference is to be observed. The bowels are often obstinately bound. When this is the case, strong purgatives are not to be given until after bleeding. Where there is obstinate costiveness, if these are given before the in- flammation is removed by leeches and fomentation, they will certainly increase the danger of the disease. Moderate doses of castor oil, epsom salts, or magnesia, may, however, be given early. After the bleeding and fomentation, if the mildly operating medicines do not move the belly, the Domestic Pills, No. 1, may be given in full doses. A free evacuation of the bowels is regarded as a very favor- able circumstance in inflammation of the bowels. Hooping cough.—During the fever attending this complaint,' the treatment is much the same as in measles ;—a proper use of the purgative pills, low diet, and plentiful drink; but, when the fever goes off, there is apt to be left behind a most troublesome, and long continued cough. This cough, however, the author finds to be much relieved, and always very much shortened, by the following plan, and he believes no better can be adopted :— Whether the child is full or spare, apply leeches to the temples, 195 and do it repeatedly. If it be very feeble, only one or two may be applied, supposing it to be five years old, and let them be repeated every third day. At the same time give a moderate dose of No. 1, every other day, and let the child's strength be supported by nou- rishing, but not stimulating diet. What is meant by this, is, that the stimulus of wine or beer is not necessary, unless there should be very great weakness. In addition to this, change the air, if possible, once a week. This may give trouble, but the complaint is some- times so alarming from its long duration and effects, that it is worth any trouble to get rid of it. The author is quite confident with re- gard to the effect of these means, and he has very little opinion of any others, notwithstanding the number of fine remedies that is con- stantly heard of. None of them can do any good, without those mentioned a^ove are also used ; but, if these are not omitted, and such other remedies are of a nature to do no mischief, they may be used also. The famous medicine made of salt of wormwood and cochineal, is one of these innocent things; it is quite ridiculous to think of it in any other light, and it should, therefore, never be used in the place of proper means, though it may be used with them, if it afford satisfaction to any one. With regard to applications to the chest, I have not had occasion to use any thing of this kind since the good effects of repeated leeches came to my knowledge ;—but, as some stimulating application of this kind can do no harm, and in some instances may do good, the following two forms of medicine, which have been long in use, may be acceptable:— Roche's embrocation for the hooping cough.—Take of olive oil, one ounce ;—the oil of cloves, and the oil of amber, of each a quar- ter of an ounce. The next was at one time an exceedingly celebrated nostrum,— it is called Strave's lotion for the hooping cough.—Take of tartarized antimony, one drachm,—dissolve it in two ounces of boiling water —and to this add one ounce ofthe tincture of cantharides (Spanish fly.) These are used by rubbing them well on the chest, night and morning. The latter is the strongest. By the use of this a crop of pimples will appear after a few days;—it must then be left off, and these pimples, which are often very sore, must be dressed with a plaster of spermaceti ointment. When they get well, they are to be produced again by a repetition of the lotion. 196 ' Croup.—It is very proper that every one should know what the croup is and how to treat it, for it often proves fatal very quickly,— even in thirty-six hours from its first attack. It is an inflammatory complaint, seated in the upper part of the wind pipe. The passage for the air at this part ofthe wind-pipe is very small, and it is a pe- culiarity of this kind of inflammation to produce a thick, firm crust or covering on the surface of this, which, at length fills up the pas- sage, and the poor child dies of suffocation. The most common period of life at which this disease appears, is from five months to five or six years ; older children, however, and even adults, are sub- ject to the croup; but as the air passage is larger in them, there is no fear of its filling up, so that the danger is comparatively but little. When adults have this complaint, (and those are most liable to it who have had it when young,) it is generally so mild as to be distin- guished merely by calling it a " croopy cough." This complaint is peculiar to damp and low situations, and a damp atmosphere. In some dry, inland situations, it is not known, and the author has met with eminent and elderly medical men who never saw the disorder in the whole course of their practice. The true croup is commonly preceded for a day or two by a hoarse cough ; but at length at night, there comes on a great difficulty of breathing, which is attended with a peculiar and loud noise ; the cough is then more frequent and hurried, and the noise of coughing is just such as to be compared to the crowing ofa turkey cock. Two fits of coughing generally come pretty quick one after another, and with this there is a tough phlegm, which the child can seldom get out of the throat. When it is severe, the countenance is swelled and flush- ed, and the eyes are bloodshot and watery. There is generally a remarkable paleness around the mouth. Croup, is a very common disorder in Edinburgh, and in one very low and damp part of the old town in that city, chiefly occupied by poor people, this disease was always to be met with after a rainy season. When a student, and before he had ever seen much of that disorder, the author was in the habit of going into any house promiscuously in that neighborhood and enquire for the « child that had the croup ;" and if there happened to be no such child in that house, he was sure to be directed to some neighbor's house in which it was to be seen. 197 In this manner, and profiting by the practice as well as precept of that eminent physician and professor of midwifery, Dr. James Ham- ilton, he had great opportunities of studying the nature and treatment of this disorder. There- is a disposition to sleep; the breathing is laborious, yet food and drink is taken without pain or difficulty. In very bad cases, as the disease advances, the countenance becomes ofa leaden color and the lips are livid, while the paleness around the mouth con- tinues ; there is also much fretfulness during the whole course ofthe disease ; the child however cries but little, from the difficulty it has in breathing. The true croup only occurs in cold damp weather, and it is re» markable that it is apt to attack the healthiest children ; it is not con- tagious. In consequence of two or three children in a family dying of this complaint within a few days of each other, (which is no un. common thing,) the croup was formerly supposed to be a contagious disease, and that impression still remains with some ; but this is not the case. When several children of one family or neighborhood are attacked with croup about the same time, it is from their having all been exposed to one common cause,—a cold and damp state of the atmosphere, in a low and damp situation. If this truth be relied on, it will have two good effects ;—it will prevent unnecessary dread and saperation from families where neighborly assistance is required; and lead to a greater carefulness in guarding against the only com- mon cause of this dangerous disorder,—damp cold air, particularly in the evening. There is a complaint which is called spurious croup, but that is not so dangerous, and may be distinguished from the true croUp by the following circumstances. The spurious croup is not pro- ceeded by a hoarse cough for a day or two, but the distress of breathing comes on suddenly and is very much like asthma. The cough is croupy but there is none of that tough phlegm, as in true crojp. Again, the countenance is not swelled and flushed and livid, as has been described in .the first kind, nor is there the same degree of.restlessness and agitation. But, what is still more remarkable is, that it comes on in any kind of weather,—attacks weakly children, and,—after a few hours, abates or goes gently off; and, in a day 25 198 or two returns again. This disease is not inflammatory, but nervous or spasmodic. The circumstances above mentioned, in most instances, will prove sufficient to distinguish between the true aud false croup ; but (which is a very fortunate thing,) there is no great necessity to be very anxious about this matter ; for, the plan of treatment which is required for the one, is just what is required for the other ;—the only difference being the greater occasion for promptness and decision in the true croup, in consequence of its greater danger. But upon the subject ofthe treatment of croup, I find myself under the necessity again of showing the use ofa medicine, which I have, on a former occasion, endeavored to show the abuse of,—this is calomel; and, as I consider a bold and decided practice in this complaint to be essential to the life of the child, I shall give the treatment of this dis- order in the words of that eminent physician before alluded to, Dr. James Hamilton of Edinburgh. " Immediately upon the attack, the child must be put into a tub of water, heated to the ninety-sixth degree of Fahrenheit's thermometer (that is, to the degree which the hand immersed in it can easily bear,) or must be wrapped up in a blanket wrung out of hot water. Whe- ther the bath or the fomentation be employed, it ought to be contin- ued for at least ten minutes ; and then the child should be carefully rubbed dry, wrapped up in warm flannel, and put to bed." " A dose of calomel is now to be given, and repeated every hour till the breathing be evidently relieved ; when it is to be gradually dis- continued, allowing at first two, then three, and finally four or five hours to intervene between each dose, according to the state of symp- toms. This medicine commonly occasions both vomiting and purg- ing ; and in true croup, the first alleviation of symptoms generally follows the discharge of a great quantity of dark green colored mat- ter (like boiled spinage) by stool; but if the attack have been that of spurious croup, the breathlessness ceases after vomiting has oc- curred." "The dose of calomel is to be regulated principally by the age of the little patient. During the first year it should be from one to two grains; during the second two grains and a half; during the third and fourth years, from three to four grains ; and during the fifth ,and sixth, from four to five grains.. It may be given mixed with a little 199 sugar as a dry powder, or it may be mixed with currant jelly, or honey, or molasses, or pottage, or panada, or light pudding, or with any thing which is thick ; but it cannot be given in drink." During the course ofthe disease, nothing else than liquids ought to be allowed to the child, these should consist of cow-milk, whey, very weak tea, thin barley gruel, fig tea, apple tea, milk and water, t>r toast and water. It may be unnecessary to remark, that if the child be not weaned, nothing but the nurse's milk should be given. The room in which the little sufferer is kept ought to be moderately warm. " When the disease has begun to yield to this treatment nourishment suited to the habits and circumstances of the child is to be exhibited in small quantities and often repeated, In some cases considerable weakness remains after the crouping has ceased, in consequence partly of the violence of the symptoms, and partly of the operation ofthe calomel. Under such circumstances, cordials, particularly weak white wine whey, and a blister to the breast, become necessary. But if proper attention have been paid to the precaution of lessening the number of doses of calomel, whenever the disease is in the least alleviated, the ordinary health of the child will be found restored within a very short time after the symptoms of croup have disap. peared." " For the cure of this formidable disease practitioners formerly trusted chiefly to bleeding, with the use of vomits and blisters as aux- iliaries ; but the result of the. practice was, in the more favorable cases, a very considerable shock to the constitution, and, in the ma- jority of instances, the death of the child. These circumstances ren- dered it fair to make a trial of the practice of giving calomel, first suggested by some American physicians. Accordingly an old pupil recommended it to me about eight or nine years ago, but I was at first unwilling to try it, as he said it produced, in his practice, no other sensible affect than that of curing the disease. After another years experience, his report being still favourable, I agreed to make a cautious trial of it; and having now employed it for seven years, and having most accurately and carefully attended to its effects, I consider myself fully warranted in giving the above directions. I have had the happiness of seeing the disease yield where its violence seemed to threaten almost immediate death; and among the little patients on whom it has been successfully tried, one of five month* 200 old had thirty two grains of the calomel within twenty four hours and another ofthe same age, the infant of an officer of excise, eighty four grains within seventy two hours. A girl, the daughter of a respectable tradesman in College street, seven years of age, had, within little more than sixty hours, an hundred and thirty three grains, and two days after appeared as if she had never had a com- plaint. In every case where it was employed, previous to the oc- currence of lividness ofthe lips, and other mortal symptoms, (amount- ing now to above forty,) it has completely succeeded, both in cu- ring the disease and in preventing any shock to the childs constitu- tion. In three instances where the case seemed desperate it was, thought right to try its effects, rather than leave the patient to his fate. It neither aggravated nor mitigated the symptoms." " It is necessary to add, that I have now seen t*o cases, where al- though all symptoms ofthe croup were removed by the use of calo- mel, the patient sunk from the weakness which followed. One was an infant of nine months, and the other a child of four years old. Both cases were under the care of the same practitioner, and he can- didly admitted, that he had carried the practice too fur. When I was called in, the vital powers could not be renewed by the most pow- erful stimulants; but in another case to which I was called, where the debility was very great, after the use ofthe calomel, the infant was saved by means of a blister and a very liberal use of opiates, and wine diluted with milk. Those cases inforce the necessity for carefully watching the progress ofthe disease, so as to stop the calo- mel whenever the symptoms begin to yield. In a cose where croup occurred after scarlet fever, (the child of a grocer in Richmond street,) along with :he calomel, a decoction of snake root, the favorite remedy of some American practitioners, wine, opiates and blisters, were employed, and the child recovered." Vomiting.—Children that throw off the milk soon after nursing, but little altered, and who at the same.time thrive and do well, are not the worse for vomiting. Indeed if they were not to do so they would Suffer in some way, for this kind of vomiting is the result of taking too much,—so that either, they must suck less or throw off the super- fluous quantity of milk in order to avoid some complaint. If infants vomit from weakness of the stomach, and not over feeding, a soft rag 201 wet with spirits and slightly peppered and applied to the pit of the stomach will greatly assist. If vomiting is the effect ofa disordered state of the bowels then the contents of the stomach are sour and -have an offensive smell, and require correcting with rhubarb and magnesia or the domestic medicine. Costiveness.—This is sometimes the natural state ofthe child, and when it is so, the mother is generally ofthe same constitution. When- ever the child looks well and thrives, it is not desirable to force a contrary state of the bowels, but still, it should not be suffered to go on to any great extent without attempting to correct it by suitable and repeated aperients ; and when this state is accompanied by pale- ness, emaciation, or convulsions, it should be regarded as a disease, and assisted by repeated doses of the domestic pills. Summer complaint, or diarrhoea.—This is a disorder which is both very common and very fatal in this country. Diarrhoea may arisa from various causes, but there are two which are far more fre- quently productive of this complaint than any other, and these too very much under the control of care and management,—they are deficient clothing and improper food. Such are the sudden changes of temperature in this country that it is almost impossible to guard effectually against its injurious ef- fect3 on children, but those who give themselves no trouble to adapt the dress and clothing of their children to these sudden changes, can scarcely expect that they should escape attacks of this disorder. It is no argument against this duty, that, children who are most remarkable for health have the least attention of this kind. The truth is, these children, as well as others, are very frequently af- fected with summer complaint, and if their attacks are not so fre- quently fatal as those alluded to, it is owing chiefly to their natural strength of constitution. In warm weather the circulation ofthe blood is kept upon the sur- face of the body, and if this state of weather continue long, or be- come very hot, the whole system is rendered languid, weak, and irritable. Now, the effect of a sudden change from hot to cold, is, to throw the circulation from the surface of the body upon the internal parts, and as these have been .previously weakened by the summer 203 heat, so the disposition to disorder is increased accordingly. In this manner coughs, inflammations, and bilious fevers, are produced ; and, when it happens to fall upon the bowels, then the summer complaint of which we are speaking, is the consequence. For these reasons, it is strongly recommended, especially to those who have lost children with the summer diarrhoea, that additional clothing be had recourse to on every occasion of a sudden change from hot to cold weather, and that, of all things, the cold damp air of night be avoided. Flan- nel also is .strongly recommended for the summer use of children; nothing is so adapted to these sudden changes; flannel possesses a peculiar property of modifying the effects of cold ; it is called a non- conducter of heat; that is, it does not permit the natural heat of the body to be carried off by the surrounding atmosphere so rapidly as any other article of clothing. We should not see these sudden checks to perspiration and the attacks which follow, if flannel were more generally worn by children. When the heat of the weather renders the use of flannel impossible, then a light domestic muslin must be substituted ; but there is a thin kind of flannel, which, if it can be borne, is decidedly better than cotton. Summer complaint also frequently owes its origin to errors of diet, either with regard-to the quality or quantity of food. There is no period at which diarrhoea is more frequent than at the time of weaning, and this is entirely owing to the quality of the food ; very sudden change of food is likely to produce it, and on this account, it is better to wean a child by degrees. Begin by feeding once a day, as has been observed in a former ehapter, then twice, and let these feedings take the place ofthe breast; do not'feed and give the breast at the same time. By degrees the child may be brought to nurse only at night; then let it sack only once or twice in the twenty- four hours. Be especialy careful not to give too much at a feeding;— this is a very common error ;—in order to avoid it be as long in feed- ing as you can ;—the slower it feeds the better. Unripe fruits, and every thing which has on former occasions been known to irritate the bowels, should be carefully avoided at this time of year by nurses as well as by older children. But beside these two very frequent causes of diarrhoea, there are others which produce it, and which should be removed or avoided if possible;—such as acidity of the stomach,—excess of bile,—the 203 pressure of teeth coming through the gums,—and a previous state of costiveness. Summer complaint is a very serious disorder, and when it does not prove fatal itself, it frequently brings ori other complaints which end fatally. Moreover, the treatment of diarrhoea varies consi- derably under different circumstances, and therefore this complaint merits a more particular detail of its management than many others, and I think some very plain and useful directions may be given on this subject. With respect then to the summer complaint of children, nothing will afford -a more safe and satisfactory guide," than the condi- tion and color of the stools. The evacuations of the bowels must always be a subject of particular attention ; for, it is upon the pecu- liar appearance of these, that the treatment proper to each variety of diarrhoea, is chiefly founded. - The first and mildest kind of summer complaint is,#that in which the stools are of a natural color, and only too liquid and frequent, and without fever. The best remedy for this variety, is small doses of rhubarb and ginger. But, if after giving this a few nights, and then leaving it off, the disorder does not abate, it will be proper to give an opiate at bed time; the best way of giving it, is in the form of an injection, as has before been stated. The next or second variety, is, when the stools are the same as has just been described, but in addition to these, there is some fever. This kind of su mmer complaint is often the consequence of over feeding, or of food which is too rich, generally inducing a full or plethoric habit of body. In this variety some laxative medicine must be given,—such as magnesia, added to the rhubarb,—a dose or two of castor oil,__or a grain or two of calomel at night, and castor oil in the morning. A warm bath in the evening is also very useful. But, the bowels being thoroughly freed from every thing which might cause irritation, if the diarrhoea does not now subside, the soothing effect of an opiate will be necessary. It has been repeatedly stated that no form of this medicine is so safe and certain as the opi- ate glyster,—that is, a few drops of laudanum in half a tea-cupful of starch, made in the common way, and given warm. This should be repeated night and morning, or oftener, if the urgency of the dis- order require it. But the apparatus, or pipe and bladder necessary 204 for giving a glyster, may not be at hand, or, an opiate by the mouth may be preferred. In this case a few drops of laudanum may be given in a little chalk mixture, a little powdered chalk, or in arrow- root, or beef tea, or in any thing most agreeable and convenient. If laudanum is not at hand, paregoric will answer the same pur- pose,—giving ten or twelve drops for each drop of laudanum. But Avhether diarrhoea be caused by teething, by a sudden change of food at weaning, or any other circumstance, this kind of summer complaint should never be neglected. The treatment is the follow- ing :—if there is sickness and vomiting give a gentle emetic of Ipec- ucuana, and after this small doses of calomel. An infant a week old may take a quarter of a grain of calomel rubbed up with a little sugar, to be repeated night and morning for a few days. Older children may take a grain of calomel every night, either with sugar or a little chalk. Calomel is an admirable remedy in diarrhoea attended with green and griping stools, and rarely fails, in a week or so, to bring the evacuations to a healthy state and cure the dis- order. Where there is an aversion to calomel, castor oil or some other laxative should be given every night. If laxatives however do not restrain the number of stools or alter their color for the bet- ter, they should be left off, or given only occasionally, and an opiate, either by injection or the mouth must be substituted for them. Cas- tor oil alone is a good medicine for children, but when made up in an emulsion in the following way, it is much better. Take of castor oil, three drachms ; aromatic spirit of ammonia, one drachm ; cinnamon water, one ounce and a half; shake these well together in a phial until they become a white emulsion ;—then add half an ounce of manna, and of this a tea-spoonful or two may be given to an infant two or three times a day. It should always be remembered, that if laxatives increase the number of stools and gri- pings without improving their color and appearance—they should be exchanged for opiate injections. The injection for an infant a few weeks old may consist of two drops of laudanum in a table-spoonful of starch ;—the calomel however in these cases would prove an excel- lent remedy; or calomel may be given at night, and an opiate injection or a laxative in the morning, just as the bowels may seem to require. When the stools are very frequent and watery, and passed with great force, this state must be stopped directly, even although the 205 evacuations should be dark colored or slimy and very offensive. If these frequent stools were not restrained immediately, the strength of the child would rapidly sink. To do this nothing is so safe and cer- tain as an opiate injection, which should be repeated two or three times a day or oftener if the case be very urgent,—a flannel roller being applied moderately tight around the body. i It is always necessary to support the strength throughout the whole duration of diarrhoea, with beef tea, arrow root and the like. An excel- lent substitute for arrow root, is baked flour ;. let a pound or two be put into an earthern jar and baked in the oven for six hours, frequently stirring it with a stick. This is as good a food as arrow root and far better than inferior samples of that article. If the child cannot take food, glysters of beef tea with arrow root or baked flour, to which must be added a few drops of laudanum, and must be given con- tinually. Five or ten drops ofthe spirits of sweet nitre three times a day is useful when the urine is scanty, or the feet swollen. If drowsiness, or stupor come on—the head should be shaved and cooling lotions applied as in water in the head. Indeed if any inflam- matory disorder is suspected in the lungs, bowels, or elsewhere—this should be treated in the usual way, except that blisters should take the place of leeches. In this variety of diarrhoea, after the frequency of the stool is thus moderated, if the evacuations should remain offen- sive and unnatural these may now be cleared away by laxatives,— chalk or oyster shell powder, or a drop or two of hartshorn, are chiefly useful where acidity is present. In those obstinate cases of diarrhoea, where there is a wasting and flabby state, and which most frequently occur at the time of weaning nothing is so safe and certain as small doses of calomel, or the blue pill, given night and morning, while the purging is kept in due bounds by the occasional use ofthe opiate injection. Haifa grain of calomel or a grain ofthe blue pill may be given at this time, and continued for a week or two or more* In all the varieties of summer complaints opiates, may be used externally as well as internally, by friction on the belly and back, night and morning, and the bowels being moderately compressed, with a flannel roller. The treatment of sum- mer complaint or diarrhoea, then may be stated in the few following words:— t 26 206 In the first place,—remove every cause, either by scarifying the gums or regulating the diet or both. In the second,—clear away any irritating materials from the bow- els, and excite a better action of them by repeated doses of laxatives, as rhubarb, magnesia and castor oil. In the third,—when the stools are green, watery, or offensive,— or where the diarrhoea has been of long standing, small doses of calo- mel or blue pill are required, and they may be given either with laxatives or opiates as the case may require. In the fourth,—always restrain the number of stools when they are excessive, or the strength is sinking, by opiate glysters or by laudanum, either by the mouth or by rubbing it on the belly and back. In the fifth,—support the strength by suitable nourishment and glysters. Worms,—are of four kinds. The large round worm with sharp points at each extremity;—the thread worm which is very small and white, and inhabit the lower bowel or fundament; the short flat worm, and the broad worm with joints, called the tape worm, this last is sometimes many yards long and is more hurtful than any of the others. ' Worms are injurious in many ways, but the two principal effects of them are irritation in the bowels, and a consumption ofthe nutritious part ofthe food. But the irritation of worms is not confined to the bowels,—it sometimes affects the whole system, and then it is called worm fever; or, it may affect the head, or produce many other complaints. It is not easy to give any certain marks by which the presence of worms can be judged of, for the symptoms which occasionally attend them are very numerous, and many of these symptoms belong to other complaints as well as worms,—such as a foul state of the bowels and the remittent feVer of children. The symptoms of all these three disorders are very much alike ; but it is very fortunate that the treatment of each of these complaints is very much the same,— consisting chiefly in the proper use of purgatives. The most com- mon symptoms of worms however, shall be stated; they are the follow- ing, which I have chosen to give from an eminent and valuable author; " an offensive breath; itching ofthe nose and thefundament; especially where thread worms are present; appetite sometimes 207 very bad, and then so great as scarcely to be satisfied; a large hard'belly; pains at the stomach ; sometimes vomiting, costiveness or purging with slimy stools ; irregular colic pains; thirst; dull- nsss ; peculiarly unhealthy and bloated countenance, with a dark hol- low circle round the eyes ; starting in the sleep, and grinding of the teeth." If the complaint has continued long, a fever with a swell and irregu- lar pulse, whitish urine, and a short dry cough, are among the symptoms of worms ; and even convulsions, epilepsy, and palsy of the legs, are produced by the same cause. In the cure of worms we have one of two objects in view ; either to poison or destroy them, or to bring them away by the mere force-of purging ; but some remedies possess the property both of destroying and carrying them off at the same time. All bitter medicines poison them. These are usually given on an empty stomach, two or three times a day for a few days, and then an active purge will carry them off. Worm seed powder, or tansy are of this kind ; articles which do not digest in the stomach, but pass into the bowels and come in con- tact with them, also destroy worms; of this kind are oyster shell pow- der, powder of tin, and of steel, as well as different preparations of mercury. Of all the medicines which I have used in order to de- stroy worms in the bowels, none have more constantly succeeded than the dolichos, which is known by the name of cow-itch. The method I have used is to mix this short hair-like substance, scraped from the pods, with honey or treacle, and give it night and morning for three or four days, and then give an active purge. About 10 or 12 grains of it may be taken by children from 5 to 10 years old. This plan I have often adopted when I have thought it desirable to be quite certain of removing every possibility of worms, for I have found this plan to succeed when others have failed, and if no worms have been brought away under this treatment I have felt quite satisfied, there have been none existing. This plan may be repeated three or four times, constantly examining the stools during its operation. The other means have for their object the removal of worms by the mere force of purging. As a medicine of this kind I am warranted by much experience in recommending the Domestic Purgative medi- cine No. 1, as the best of all remedies of this class, provided it is taken in large doses and properly repeated. 208 It should be remarked, however, that it is not every child that car ' bear the active and repeated purging requisite for the forcing awa^ of worms, and .therefore it will be acceptable to many to point out «. milder plan of management, and one which I have found to be ex- caedingly successful. (For instance, for a child of ten years old,) Take of worm-seed powder, or the rust of iron, ten grains ;—or, of the filings of iron half a tea-spoonful, mix either of them in molasses or syrup, and give it night and morning for three days, then give a fill dose of the Domestic Purgative in the morning, which.will bring away worms ;—repeat this course for two or three times. The rust of iron, or the filings of iron, are preferable where the child is pale and weakly; for, if there should be no worms, this medicine cannot fail to do good. Indeed, these preparations of iron, given with re- peated doses of the purging pills, have a restoring and invigorating effect which is perfectly surprising. Thread worms also are cured by the same plan, but a more immediate effect upon these is produced by an injection of com- mon aloes boiled in milk, and when cool enough, used as a glys- ter, at bed time,—a purging dose being given in the morning. A nourishing and supporting diet should be always allowed during this purging, treatment. Respecting the cure of the tape worm (which formerly was so difficult as to resist the most powerful remedies,) this may now be easily and certainly accomplished by one or two doses of a medi- cine which generally acts with great moderation. This medicine is the common spirit of turpentine. It may appear astonishing that a medicine which has long been used in rheumatism and other com- plaints, in doses of 25 or 30 drops, should now be taken in doses of an ounce, or a small wine-glassful;—but such is the fact. Given in this way it has no effect upon the kidneys, but acts on the bowels as a common purge would do, but with the certain effect of i>ring- ing away the worm. I confess, for my own part, I felt by no means comfortable on the first time of giving this medicine, but the autho- rity with whichft was recommended, and the urgency of the case on which I was consulted, determined me to try its effects. I was quite sure the patient had a tape worm, for he had several times broken off small pieces on going to stool, leaving the bulk of the worm alive in his body, and he had tried many powerful remedies 209 • in vain. On this occasion I gave him one ounce of the spirit ef turpentine, to be taken without any addition the first thing in the morning. On the following day he brought me the worm in a tea-cup, which was nearly full, and oa measuring the worm, it was found to exceed thirteen feet in length. This man assured me that the oil operated on him very comfortably as a moderate purge, but that he felt a little exhiliration soon after taking it,—as if he had taken a glass or two of spirits,—but this soon went off. The length of this worm need not surprise any one, for it is not ofa nature to increase by breeding, but by growth. The worm is quite flat, like a piece of tape, and a large one is made up of hundreds of joints, at each of which there are two mouths; if a piece of the worm occasionally protrudes on going to stool, and if this should be pulled hard, it breaks off, and the portion that is left behind lives to distress the patient with a great variety of symptoms. Since that case I have given the spirit of turpentine, even in larger doses, to many persons, and with unfailing success. I have never known the least harm to arise from it, and where 1 have been quite sure there was a tape worm, it has never in one instance failed in bringing it away. I feel satisfied, therefore, in recommending the spirits of turpentine as a safe and efficacious l'emedy for the tape worm. I have sometimes given it with equal parts of castor oil, and have observed only that it has been more active so than when taken alone. The tape worm is not common to children. A wasting and flabby state of the body, enlargement of the belly, often with rickets and low fever.—This is the last disease to be spo- ken of, but there is none of more consequence. Thousands of chil- dren annually die of it, in this city. Although there is a wasting of the body, the appetite is frequently enormous, but it is no matter what quantity is taken, or how nutri- tious the food, so long as the diseased state ofthe belly remains. This arises from an obstruction in the mesenteric glands, so that the food, much or little, cannot pass through them, and, therefore, cannot nourish the body. Of this any one may be convinced, by turning to plate No. 2, in page 12, and there will be seen the mesen- teric glands, marked B.—while these are thickened and obstructed 210 • no food whatever can pass on to nourish the body, and children are often seen to die of starvation, even when they take more food than would suffice an adult person. In this disease, the pills will prove a sovereign remedy, except in cases in which these glands have proceeded to ulceration. Let the bowels first be well evacuated by doses ofthe purgative No. 1, and repeat them afterwards once or twice a week ; at the same time keep the bowels constantly but gently relaxed by the daily use of the aperients. In this complaint also, it is very useful to give a chalybeate twice a day. Supposing the child to be three or four years old, nothing is better than a tea-spoonful of chalybeate wine, as directed to be made in page 123 ; or six or eight drops ofthe tinc- ture of the muriate of iron twice a day. To this must be added a supporting diet with a little good beer or wine, fresh air and warm clothing. In this course it may be necessary to persevere for some weeks, but it often happens that in a few days an improvement is discernible;—the glandular obstruction being removed, the spirits and activity return, and the limbs resume their former strength and vigor. Do not be tempted to deviate from this plan because of the slow- ness ofthe cure. It sometimes happens that the restoration of health is slow ; but if this plan do not prove successful, depend on it, no other means on earth will save the child. If you can but see the slightest degree of positive amendment,—it is enough,—and with due and proper perseverance you may rely upon recovery. FINIS. *