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Division 4
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AN
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              EPITOME

                     OF THE


AMERICAN  ECLECTIC  PRACTICE


             OF  MEDICINE,


 SURGERY, OBSTETRICS, DISEASES OF WOMEN AND CHILDREN,
           MATERIA MEDICA AND PHARMACY,
DESIGNED A8 A
TEXT BOOK FOK PHYSICIANS, AND STUDENTS OF MEDICINE.
/
         WILLIAM PAINE, M. D.,
                      (i*
PROFESSOR OF THE PRINCIPLES AND PRACTICE OF MEDICINE AND PATHOLOGY IN TBE
    KCLECTIC MEDICAL COLLEGE OF PHILADELPHIA, AND PRESIDENT OF THE
       ECLECTIC MBDICAL ASSOCIATION OF PHILADA., LECTURER ON
           CLINIC MEDICINE AND SURGERY IN THE KC-
                LECTIC COLLEGE, ETC., ETC.
          PHILADELPHIA:
WILLIAM PAINE, 931 AND 933 ARCH STREET.
                1863. 
Pl47e.
 1563
       Entered, according to Act of Congress, in the year ]Rf>.0.. ]>y

                     WILLIAM PA1NK.

in the Clerk's Office of the District Court of the United Slates for the Eastern
                   District of Pennsylvania.
PRINTF.D BY WM. ,S. YOUNi 
                         To
Reuben Boovell, Levi Butliff, Esq., Qeo.JK. Tuttle, Esq.,
                         and
             Hon. Judge JJLilton butliff,
In consideration of their early  and continued friend-
         ship, this work is most respectfully
                  inscribed by the
                                        JiUTHOIi. 
J 
PREFACE.
  In  presenting the third, and  very much  enlarged edi-
tion of the Epitome to the profession,  we expect it to re-
ceive  the ordinary criticisms.
  While we are conscious of its  imperfections, we flatter
ourselves that we have introduced a sufficient amount of
new and practical matter, relative to  the  management and
treatment of diseases, to warrant it a place in the library of
every physician who desires to keep pace with the  progress
of medicine, and to treat disease with the greatest possible
success.  The work, as its title implies, is  designed to be an
Epitome of the American Eclectic Practice of Medicine in
all its branches; and although it could  hardly be expected
that we should treat as elaborately upon  many subjects as
may be  desired by some, yet we  apprehend that  but few
works of this character will  be  found to  discuss a greater
variety of subjects, or to  give more complete details of the
treatment of disease.  In the preparation  of the depart-
ment of Surgery we have to acknowledge our indebtedness
to Professors McClintock and Livezy, for their  valuable 
vi                    PREFACE.
contributions.   In the  department of Toxicology and Anti-
dotes to Poisons, to Professor  Gauntt; and in  the depart-
ment of Practical Medicine, we are indebted to many of
our most prominent practitioners for kind suggestions.        J
  If the work subserves the purposes of humanity, aids the
student of Medicine in the acquirement of a knowledge of
the profession, and assists the practitioner in his arduous
duties,  it will gratify the highest ambition of the
                                         AUTHOR.
  Philadelphia, June, 1863. 
      Iltsr, ^rngrMB, ml ^radical ^rinriplja
                        OF THE

AMERICAN ECLECTIC SYSTEM
                          OP

          MEDICINE AND  SURGERY.
  Soon after the  settlement of this country by Europeans, it
was discovered that the aborigines were in the habit of using a
large number of remedies for the removal of disease.
  The early white settlers not being well supplied with physi-
cians, were induced to resort to the same means, and the bene-
ficial influence of  the medicines soon introduced them into ge-
neral use.                        i
  The exposures and privations incident to the rapid settlement
of the country induced  many diseases, which were easily con-
trolled by the use of indigenous remedies.  The increasing con-
fidence in these medicines led many persons to devote themselves
to the cure of diseases through their agency.  This class of in-
dividuals were mostly ignorant of anatomy,  physiology, patho"
logy, chemistry, and surgery; and although in many instances
remarkable cures were performed, at other times an amount of
ignorance was displayed which was truly lamentable, often
proving most disastrous to the health and lives of the people.
  Notwithstanding these facts, the inefficiency of the Allopa-
thic treatment increased the faith of the people in the efficacy
of native remedies; so  that, in many sections of the United 
10
RISE AND PROGRESS OP
States, no other class of physicians could get employment. And
notwithstanding the most  stringent laws  were enacted, prohi-
biting  all persons from practising as  physicians or surgeons,
except regular Allopathic graduates, the use of native remedies
continued to increase; and at length many of these obnoxious
laws were repealed by overwhelming majorities.
  About the year 1810, a native  of New Hampshire, Samuel
Thomson, a  strong-minded and sagacious man, observing the
faith of the American people in the power of native remedies
to remove disease, took advantage of the fact, and attempted
to establish a new botanic system of medicine.  He compounded
several valuable remedies, and arranged them in numbers from
1 to 6, for which he obtained a patent in 181:5, thus monopo-
lizing the exclusive right  to prepare  and prescribe the very
remedies which had been so extensively used by the natives, aa
well as many practitioners  among the whites.   From the time
that Dr.  Thomson obtained  his patent until 1820, he and his
followers had almost the exclusive control of the Botanic prac-
tice.  After taking the most extensive and  impartial view of
Dr. Thomson's  system, it is quite difficult  to decide whether
his labours were really of more value than  detriment to the pro-
gress of American medicine ; as, while he presented his claims
with vigour, his entire ignorance of general medicine led him to
reject many of the most valuable remedies which had formerly
been used by the Botanies,  and to  recommend others  as uni-
versal  panaceas, which  had only  limited virtues.  Dr. Thom-
son's entire practice, when stripped of the  bold pretensions with
which he advanced and defended it, will be found to be nothing
more than the original Botanic system to which I have alluded,
together  with a few formularies, and the more extensive use of
vapour baths.
  The system of Thomson was soon very materially modified,
and rendered more rational and beneficial  by Dr. Morton How-
ard, a native of North Carolina, who wrote and published a very
much improved system of Botanic practice in Columbus 0.  in
1833; and by Morris Mattson, who published in 1845  a verv 
AMERICAN  ECLECTICISM.
11
elegant and  elaborate work upon the principles and practice of
the Botanic system, which included not only what was known
by Dr. Thomson, but nearly all the  essential and reliable facts
relative to the Botanic practice, of this country, up to the intro-
duction of Thomson's system.   It is also due to Dr. Alva Curtis,
of Cincinnati, 0., and Dr. W. J. Comfort, of  Philadelphia, Pa.,
to say, that their writings have been essential improvements on
the writings of Thomson, and  have  in no small degree contri-
buted to the advancement of the  American  Eclectic practice.
Before dismissing  this portion of the subject, however, I will
state that very many of the  Botanic and Thomsonian practi-
tioners had  acquired a large  amount of experience, and used
the native vegetable remedies with decided skill in the manage-
ment of many  diseases;  yet there were no systematic organiza-
tions, nor was the scattered and  detached  medical  knowledge
of physicians so arranged  and presented by any of the writers,
as to constitute a scientific system of medicine.
   In 1825, Wooster Beach, M. D., a graduate of the  University
of New York, an Allopathic  school, obtained from  Dr. Jacob
Tid, of  New Jersey, a noted Botanic, a full knowledge of the
virtues  and curative powers of the  native remedies, as far as
they were known at that time.
   The information thus obtained enabled him to cure many cases
and diseases which hitherto had baffled the skill of the Allopa-
thic profession.   In 1827, Dr. Beach, in connexion  with some
friends, established a large infirmary, for the purpose of more
extensively  testing the merits of the indigenous remedies of
America in  the cure of disease.  In  one  year he treated about
two thousand one hundred patients with such remarkable suc-
cess, as  to attract the attention of  many of the  leading minds
of that time;  and the subject of establishing schools, in which
the medical resources of our country might be studied in addi-
tion to the ordinary curriculum pursued in medical colleges, was
contemplated.                                 ^
   Accordingly, in  1829, initiatory steps were taken, and in 1830
a permanent organization was effected by an amendment to the 
12
RISE AND  PROGRESS  OF
charter incorporating the Worthington Literary College of Ohio,
thus connecting with it a medical department.
  The first systematic course of lectures in this institution, was
held in the winter and spring of 1830.   The Faculty were com-
posed of medical  gentlemen of the  first order of talent, all of
them graduates of Allopathic colleges.  The teachings  em-
braced all the branches usually pursued in medical colleges : to
wit,  Anatomy,  Physiology,  Pathology, Surgery, Theory  and
Practice of Medicine, Obstetrics, and Diseases of Women  and
Children, Materia Medica, Pharmacy, and Chemistry.  In ad-
dition to which a  full  knowledge, as far as  was known, of the
curative powers of indigenous  remedies, together with the me-
dical resources of Homoeopathy, Hydropathy,  &c, was taught
with a view of appropriating  all that  science and  experience
proved to be valuable in the treatment of disease.   Hence they
applied to their teachings and school the term Eclectic ; which
means, "to choose, to select."
  The prosperity of  the school was almost unparalleled.   The
graduates met with great encouragement,  and their  practice
with remarkable  success; so much so, that other  schools in
different sections of the  country were subsequently  organized;
yet, owing to the  difficulties of prosecuting  a  medical college
in a small inland  town like Worthington, the  Faculty decided
to abandon it, and re-organize in Cincinnati, which they accoi'd-
ingly did in 1842. In 1845 they obtained  a charter from the
Legislature of Ohio, incorporating  the  Eclectic  Medical Insti-
tute  of Cincinnati.  They immediately  organized, and the fol-
lowing gentlemen  were appointed its Faculty:
  B. L. Hill, M.D., Professor  of Anatomy.
  T. V. Morrow,  M. D., Professor  of  Physiology, Pathology,
and Theory and Practice of Medicine.
  H. Cox, M.D., Professor of Surgery.
  L. E. Jones, M.D., Professor of Materia  Medica, Therapeu-
tics,  and Medical Botany.
  A. H. Baldridge, M.D., Professor of Obstetrics, and Diseases
of Women and Children. 
AMERICAN  ECLECTICISM.          13
   J. Oliver, M. D., Professor of Chemistry and Medical Juris-
 prudence.
   The first course of lectures was commenced  in March, and
 continued until the 1st of July, 1845.   An event in the progress
 of this school, which contributed very materially to its prospe-
 rity, was the  appointment, in the  spring of 1846, of Joseph  R.
 Buchanan, M.D.,  of Louisville, Ky., to the chair of Physiology
 and Medical Jurisprudence.  Dr. Buchanan entered upon his
 duties in the fall of 1846 :  and bringing his great philosophical
 power to the  aid of Dr. Morrow's indefatigable zeal,  energy,
 and perseverance, a more scientific arrangement was effected of
 the vast amount of practical medical knowledge previously ac-
 cumulated.   He  also  brought much weight and influence  to
 bear in the  successful defence of the  cause against the attacks
 of a bigoted, sectarian foe.  Drs. Morrow and Buchanan, aided
 by their colleagues, directed  their efforts with remarkable suc-
 cess to  a permanent  establishment of the  institution, and the
 American Eclectic Reformed  Practice. '  The names of Morrow
 and Buchanan will ever be held in grateful remembrance by  all
 true lovers of humanity, as pioneers in the cause of medical  re-
 form.
   But the progress of these co-labourers was not destined to be
 long unimpeded.   In July, 1851, Dr. Morrow, care-worn and ex-
 hausted  from a life of incessant labour and anxiety for the be-
 nefit of  mankind, sank beneath the  overwhelming pressure  of
 duties involved upon him, aided by an attack of dysentery, and
 yielded up his  great soul  to the Cod who gave it.  He sleeps
 beneath  the mighty  pyramids  of benevolence and  goodness,
 which, while living, he created, and  that will ever stand a vast
. monument to his greatness.
   After  the death of Dr. Morrow, difficulties occurred in the
 faculty,  which resulted in a division,  and the organization  of
 another  school, called "The  Eclectic College  of Medicine."
 The jealousies existing between these schools, together  with
 the bickerings of those who occupied prominent positions in the
 reform movement, disgusted Prof. Buchanan, and caused him
                             2* 
14         "rise  and progress  of
to retire to private life in Kentucky, where he now enjoys  the
quiet associations of the domestic circle, and the gratitude of all
true lovers of medical  progress for his gigantic efforts towards
the establishment of true American Eclectic medicine.   After
several years of strife and contention between the medical schools
of Cincinnati, they re-united in the winter of 1859 and '60, under
the protection  of  the  Eclectic  Medical Institute.  The best
wishes of all true Eclectic medical  reformers  are with them;
and for the good of the cause it is to be hoped  that the future
faculty may emulate  the characters of  their  illustrious  prede-
cessors, of which we have  spoken, and  rising above all merce-
nary considerations, devote their labours to  the upbuilding of
the cause, and the  welfare of suffering humanity.
   While medical reform was  thus  progressing in the West, its
friends in  other parts of the country were by no means idle; as
in the mean time the Eclectic  medical  colleges  were chartered
by the  legislatures of New York, Virginia,  Indiana, Tennessee,
Kentucky, Ceorgia, Pennsylvania, and Massachusetts.  As early
as 1848 a  society was formed, called  " The Middle States  Re-
form Medical Society," having for its object the permanent esta-
blishment of an Eclectic Medical College in  Philadelphia.   In
1850 they organized a school,  but did not obtain a  charter,  and
lectures were given to small classes by members of the Society.
  In 1853 this Society succeeded in obtaining a charter, grant-
ing all  the rights and privileges of  Allopathic colleges.  A full
board of instructors was organized,  and the school put into ope-
ration.   The want of a  suitable building, and a medium through
which to bring the school and its  principles before the people
and profession, together with the unhappy  appointment of  am-
bitious, but incompetent men  to the position of teachers, ren-
dered the  enterprise comparatively unsuccessful, until the year
1859, when the school  was re-organized, and a  new faculty ap-
pointed, a large and commodious  college building obtained, a
museum furnished, and the school  put into full working condi-
tion, from which period it has  been one of the most flourishing
and prosperous institutions in  the United States.   The classes, 
AMERICAN  ECLECTICISM.          15
which had previously been small, soon became large, and  the
graduates command most influential and prominent positions as
physicians and surgeons.   That there is a necessity for a change
in the practice of medicine and  surgery, we infer from the fact
that the present state of society is admitted to be one of great
intelligence, and as such demands a thorough revolution in all
those systems which ignorance has originated, and self-interest
kept alive.  The supporters and advocates of such systems not
only assume to  be wise, but condemn every thing which  is op-
posed to their prejudices and inherited  opinions.  This is now
the case with the Old School, or Allopathic system of medicine.
This system is a thing of the past, a product of the dark ages,
and bears upon its face the ancient date of its birth.  Its great
object and aim  are secrecy;  and when scrutinized by the light
of the science  and intelligence  of the nineteenth century,  its
fallacies, deformities and imperfections  make a most unseemly
exhibition.  Its advocates, notwithstanding, assume the preroga-
tive of infallibility, and, like  the priests of old,  are doing all in
their power to  keep the world in ignorance, not  only as to  the
real nature of  their system  of medicine, but of all  other  sys-
tems; and in this they have too  well succeeded for the good of
mankind.  All other cognate sciences  are  presented to an in-
telligent people in harmony with the progressive  spirit of the
age, elucidated  and explained in  a manner calculated to impress
the mind with all the facts brought to light by modern researches
and discoveries.  The Allopathic system of medicine,  on  the
contrary,  stereotyped in notions  the  most fanciful, dreamy,  and
unreasonable, in dogmas the most  crude and speculative, is
kept in monkish seclusion, as if  far beyond  the comprehension
of  ordinary mortals—as if none  but those who have stood the
test of initiation, and received the holy sanction of the fathers,
could at all understand.   Instead of courting investigation by
teaching its doctrines in plain language, every  thing has been
wrapped in obscure and unmeaning  language.  As the result
there exists at this time the most complete and universal igno-
rance respecting their principles  and practice of medicine among 
16          PRACTICAL  PRINCIPLES.
 all classes, except those who have learned from the reform lite-
 rature and practice of the day.  A strange anomaly in the his-
 tory of these Allopathic professors and practitioners is, that an
 individual  after having gone through a regular and prescribed
 course of medical studies, and that, too, under the strictest Al-
 lopathist, and having been declared by a board of examiners to
 be  thoroughly qualified to practise medicine, and  having ob-
 tained a diploma as a guarantee to the public of his competency
 to discharge the highly responsible duties of physician to the
 sick, must  be branded as a quack, and that, too, for no reason
 other than that he has added to his medical researches a know-
 ledge of other systems of medicine, as Homoeopathy, Hydropa-
 thy, Botanicism, Thomsonianism, &c.  Humiliating  and dis-
 graceful  as this is, it is  nevertheless true that  these medical
 bigots, actuated by a spirit of intolerance, no sooner learn that
 one of their practitioners has adopted  the Eclectic system of
 medicine, than they raise  the  cry of imposture and quackery.
 Every physician has a right to form an opinion of his own; but
 before passing judgment  on others, he should  make himself
 thoroughly acquainted with their  doctrines and principles.   In
 our medical colleges we review all  the  doctrines and medical
 resources of the different systems; and whenever we find a well-
 attested truth, a reliable item of knowledge, no matter to what
 department of medicine it belongs, we at  once ingraft it  into
 our system of practice.   Do the other  systems of medicine do
this ?  Do they understand and teach the specific medical powers
 and invaluable utility of the  hundred new and potent  remedies
introduced by the Eclectic profession?  Are their students  as
impartially taught Eclecticism as  Allopathy or Homoeopathy?
 Their entire ignorance of our remedies and  principles of cure
most conclusively show that  they  are not.  Eclectic physicians
have discovered, and are using remedies, which enable them  to
 cure a large per cent, of cancer, hydrophobia, epilepsy, tetanus,
 scrofula, consumption, necrosis, &c, all of which are regarded
 as incurable under other systems of practice.   Besides, we cure
 all diseases, both acute and chronic, in a much less time  and 
PRACTICAL  PRINCIPLES.
17
with far more certainty than any other system.  No fact is better
established than that the Eclectic system of medicine possesses
means to cure dysentery, typhoid fever, pleurisy, pneumonia>
inflammation, &c, &c, almost immediately; and that, too, by
remedies which, while they act specifically in removing disease,
leave no constitutional injuries.  But, like every other discovery
which is calculated to promote the happiness of mankind,  Eclec-
ticism is destined to receive from  medical bigots  criticisms si-
milar to every new discovery and  essential improvement.
  Abelard, for  maintaining the right of free inquiry, was  con-
demned in solemn council.   Farel, Lefevre, Hutton, Melanc-
thon, Luther, Zwingle, Calvin, and a host of others, for  lifting
up the standard of independence, rejecting the infallibility of the
Papacy, and condemning the unmeaning ceremony and legalized
licentiousness of the  church, were hunted down by the merce-
naries of the Pope, and menaced by the horrors of the Vatican.
It was wrong  for the human mind to assert its independence,
and attempt to break loose from the restraints which had held
the church and  the world in  darkness and degradation for  cen-
turies !
  Socrates taught the Athenians  the existence of a Supreme
Being, the source of all good, and the only true object of adora-
tion.  For this he incurred ihe vengeance of those who should
have rendered him gratitude, and was  condemned to drink the
juice  of hemlock.
  When Descartes taught the doctrine of innate ideas, he was
declared an atheist.  The University of Paris became alarmed
for the  being of a God, and the purity  of philosophy, and with
all laudable zeal valiantly ordered the pestiferous works  of the
infidel author to be burned.   It was but a short time, however,
till this same infallible University adopted the very doctrine it
had combated so lustily; and when Locke and Condillac attacked
it, the cry of materialism  and  fatalism was turned against them.
The teachings of Aristotle were held for many ages to be as per-
manent as the rock of truth itself.  Francis I. passed a  decree
against Peter Raums, interdicting him under pain of corporeal
punishment from uttering any more slanderous invectives against 
18          PRACTICAL  PRINCIPLES.

Aristotle, and other ancient  authors, received and approved.
About a century after the Parliament of Paris passed a decree,
prohibiting any  person, under pain of death, from holding or
teaching any maxim at variance with the ancient and approved
authors, especially  the*infallible  Aristotle.   When Columbus
made application to the sovereigns of Europe for assistance in
his project of Western discovery, he met with cold neglect and
repeated repulse.   The earth was as flat as a board, and how
could he get to the East Indies by sailing west?  And as to
finding land, that was  only the day-dream of a visionary mad-
man.  All the  philosophy of the past was  not to be capsized,
to suit the fantasy of  an adventurer.  When the persevering
Fulton proposed to make steam  a mighty agent in the propul-
sion of vessels, his capacious-minded, far-seeing  countrymen,
laughed at him.  Steam had never propelled vessels; therefore,
it never could.  The  conclusion was as  natural as to look to
the past for all wisdom;  and Fulton was nonplussed, ridiculed,
and  neglected, and at  last died in indigence.  Galileo followed
and  espoused the views of Copernicus.  He was reported to his
holiness the Pope,  who called him to an account.  The theolo-
gical censors condemned  the system  " as absurd in itself, false
in philosophy, and formally heretical, because opposed  to  the
sacred Scriptures."  Galileo was commanded to  renounce his
heretical opinions, and thenceforth to refrain from teaching or
defending them  in any way.  But the philosopher transgressed,
and was again brought before the same faithful repositories and
infallible judges of truth.  He was declared to be " vehemently
suspected of heresy,"  for holding an opinion declared  and de-
fined  as contrary  to sacred Scriptures.   "Good Galileo" re-
 canted, and  thereby proved himself a worthy Christian, and a
sound  philosopher. All popedom rejoiced that a heretic  had
 been reclaimed, and the heavens set right again.
              "The man is thought a knave or  fool,
                 Or bigot plotting crime,
               Who for the advancement of his kind,
                 Is wiser than his time.
                For him the hemlock shall distil,
                 For him the axe be bared, 
PRACTICAL  PRINCIPLES.          19
              For him the gibbet shall be buiJt,
                For him the stake prepared.
              Ilim shall the scorn and wrath of man
              Pursue with deadly aim."
  The present cultivators of medical science are regarded by the
advocates of Old Physic as innovators and fanatics; and when,
by superior success in the treatment of disease, they demon-
strate the superiority of Eclecticism over Old Physic, they, like
             " A base pack of yelping hounds,
                Who wish their betters to annoy,
              If a stray cur transgress their bounds,
                Will bruise, and mangle, and destroy;
              So they will on some plan unite,
              By which to vex him and to spite:
              His very virtues they will use
              As pretexts for their foul abuse."
  Notwithstanding this opposition, those engaged in the enter-
prise have calmly pursued their labours, most cautiously inves-
tigating the various systems of medicine, culling from each all
that science  and experience proved to be valuable.  We have
so instructed the people relative to their destructive system of
mercurialization, and blood-letting, and other injurious and  poi-
sonous  agencies, that Allopathists have been compelled to very
essentially modify their treatment.  Formerly both water  and
fresh air were denied their patients.   Now they are compelled
to acknowledge them as indispensable agents.  Formerly they
bled and  blistered  for every trifling disease.  Now the  people
will not tolerate the  practice, and they are compelled to aban-
don it.  Formerly they gave large doses of mercury, producing
salivation, ulceration, and destruction of the tissues of the mouth,
liver, stomach,  lungs, &c, &c. Now, by the superior intelli-
gence of the people, they are compelled to use less of the poison.
  Thus, while they refuse to acknowledge our claims, and adopt
our improvements,  they have  been compelled to abandon many
of the most destructive features of their practice, as the result
of our  labours and influence;  and we have the most sanguine
hope that the time is not far  distant when all the evils of their
system  will be supplanted by the more rational practice of Ame-
rican Eclectic medicine. 
20           PRACTICAL  PRINCIPLES.
   We are satisfied that by a cautious and scientific selection
 from the present systems of medicine, with industrious research
 in the yet hidden medical resources of the vegetable, animal,
 and mineral kingdoms, together with  the vast amount of new
 and practical contributionsof the Eclectic profession, one grand
 system of medical practice may be established  and perfected;
 as—
        "All are but parts of one stupendous whole,
          Whose body nature is, and God the soul;
          That, changed through all, and yet in all the same,
          Great in the earth, as in th' ethereal frame,
          Warms in the sun, refreshes in the breeze,
          Glows in the stars, and blossoms in the trees;
          Lives through all life, extends through all extent,
          Spreads undivided, operates unspent;
          Breathes in our soul, informs our mortal part,
          As full, as perfect,  in a hair as heart;
          As full, as perfect,  in vile Man that mourns,
          As the rapt Seraph that adores and burns;
          To Him, no high, no low, no great^ no small;
          He fills, He bounds, connects, and equals  all."

  Harvey, who discovered the circulation  of the blood,  was
called the circulator, in derision.  He was deprived of the right
to practise his profession in his own country; was  threatened
with banishment, and was finally compelled to leave his  native
land, to escape the obloquy that was heaped upon him, and died
without realizing the benefit of his labours.
  In 1522, Ambrose  Pare first introduced the ligature, and
tied  the artery, instead  of plunging  the limb into  boiling tar,
as was practised  by his cotemporaries.   He was  denounced,
with the most reckless violence, for daring to  suspend the life
of a man  upon a mere thread.  In  1638 the  Countess of Cin-
chon, wife of the ex-king of Peru, was  labouring under a fever,
from which she was unable to obtain relief.  The  Governor of
Loxa, having learned from  the natives the curative powers of the
Cinchona, advised her to employ it.  After much hesitation she re-
solved to try it, and was by its use restored to health.  Ten years
afterwards, a Jesuit of Rome endeavoured to introduce the, Peru- 
PRACTICAL PRINCIPLES.
21
vian Bark into Europe; but his efforts were unsuccessful.   The
profession proclaimed at once that it was a Papish remedy, and
proceeded from  Quacks, who  created all  manner  of disease.
Protestant England  called it a  Papish remedy, saying that it
proceeded from the father of all  Papists, the Devil.  It was not,
until in spite of all  opposition, its utility was demonstrated,
that physicians availed themselves of its curative powers.
  Lady Mary Wortley  Montague, while in Turkey,  observing
the wonderful effect of inoculation for small-pox, to mitigate the
severity of that much dreaded disease, determined to  introduce
the practice into her native country.  But no sooner did she make
known her purpose, than the medical faculty arose at once and
predicted the most  disastrous  consequences.  The clergy de-
Bcanted from the pulpit on thus seeking to take events from the
hand of Providence.  In order to  satisfy the profession and the
people of the great utility of inoculation, she resolved to experi-
ment upon her own daughter, and government appointed four
of the best medical men to observe its progress. Lady Montague
Btates, that they not only manifested the greatest  incredulity as
to its success, but  also such an unwillingness to have it succeed,
that she was absolutely afraid  to leave her daughter in their
hands, lest she should suffer from their interference.
   In 1790, Dr. Jenner, of Gloucester, remarked that the disease
known in the western  part of England as cow-pox, communi-
cated to those who milked the cows, precluded those who became
thus affected from being infected with small-pox.   This strange
fact suggested to him the idea of  inoculating  children  with
virus directly from  the  udder  of the  cow, which  he accord-
ingly did, and in the course of four or five  days he saw pustules
developed at all  points where  the  skin  had been  punctured,
similar to those of cow-pox;  when the pustule broke, the  pus
dried, forming a  thin  scale or  crust, which, falling off,  left a
cicatrice.  There  was little or no fever, the children continuing
to eat and play as usual.  After repeated experiments  of  this
kind, Dr. Jenner  became satisfied of its being a preventive of
small-pox, as not  a single  child thus inoculated  was attacked
with it.   But how was the discovery received by the illiberal
and dogmatical portion of  the profession ?  With ridicule  and
contempt, like every other proposed improvement.  Jenner was
       3 
22
PRACTICAL  PRINCIPLES.
persecuted, oppressed, and  driven from  his country ;  even re
ligion and the Bible were made engines  of attack against him
and his invention.  Errhman, of Frankfort, attempted  to prove
from Scripture that vaccination was the anti-Christ.  At that
time small-pox was the scourge of the human family,  and, but
for the discovery of Jenner, would have remained such  until the
present time.
  In 1315, Mondini  dissected two human bodies, and shortly
after published his Epitome of Anatomy, illustrated with wood-
cuts.  At this  time, and for a long time afterward, it  was cus-
tomary to demonstrate anatomy upon the hog and other animals.
The  act  of Mondini was considered heresy.   The persecution
of Mondini, together with  the prejudice  existing upon  the sub-
ject  at the time, prevented any other dissection of a human
subject for more than a century ; and Mondini, in his experi-
ments, dared not open the dead for fear of committing a mortal
sin.  It  was not until the  commencement  of the sixteenth
century  that dissections for  anatomical purposes were made,
and then they were performed by the authority of the Pope, and
not at the instigation of the medical profession.
  The  natives  of Brazil first taught the medicinal qualities of
ipecac; but, owing to the opposition with which it was met by
the medical profession, it was more than a quarter of a century
before  its virtues were appreciated.  A Mexican soldier, more
than half a century ago, demonstrated the styptic properties of
the Matico, and its entire control over  the bleeding vessels of
the body ; but such is the tendency to oppose every new remedy
that, as yet, it is never employed by the  mass of the profession.
Dr.  Samuel  Thomson  discovered  and proved  the  valuable
medical properties of Lobelia; but on modestly making known
his discovery to the profession, it was not only denounced, but
he  was  persecuted and imprisoned.  At this  time  we find
medical men using it in disguise, and at the same time  denounc-
ing its discoverer.  In 1823, an association of  scientific medical
men, from different parts of the country, met in  New York city
and made preparation for organizing a reform medical college:
when, by the indomitable  energy of Dr. Beach, the first reform
medical college in the world was organized.
   The object of this oi'ganization was to break the shackles of 
PRACTICAL  PRINCIPLES.
23
Hunkerism;  to  open the science  of medicine  to all bold  and
thorough investigators;  to  enlarge  and improve  the materia
medica; to  investigate more fully and clearly the nature and
character of disease peculiar to the country and  climate, and
to place the entire profession upon a more liberal and scientific
basis.   But no sooner was the object and aim of this institution
announced,  than a majority of the profession  commenced an
attack upon it, denouncing, violently,  all who were  indentified
with  this philanthropic movement.   Dr. Beach, its  founder,
although a man of  learning, and a graduate of one of the first
allopathic colleges  in  the country, was assailed with terms of
insolence and reproach, and all  those who had the courage to
participate in the work shared the same fate.   To  all who  are
in  any considerable degree acquainted  with  the  history of
medicine, it is obvious that this  conservatism, which has long
been a characteristic of the professon, has had a most disastrous
influence upon its progress.
   The conservative, always ready to apologize and  explain  the
reasons for  his ungenerous course, with all complacency affirms
that to talk of improvement is but a dream ; that the fathers of
the profession have left us their knowledge as a choice legacy,
which we should keep in grateful remembrance ; that the pro>
fession has already attained a position which  entitles it to  the
highest respect.
   Yet the positive  uncertainty of medicines is  manifested in  a
striking degree, as  we trace the history of particular remedies,
recommended by those who  are  reverenced as almost divine
authority by the conservative.   What differences of opinion —
what  an array  of alleged  facts directly at variance with each
other — what opposite results of like experience—what ups and
downs, glorifications and degradation, confidence and despair—
arose in treating the same disease with the same remedies.  To
be satisfied upon this point we need only refer to the history of
one or two prominent diseases,  viz : pneumonia and syphilis.
Mercury, antimony and blood-letting  have been regarded as
specifics in these diseases by many authors, while others of equal
pedantry and learning have rejected them as useless and injuri-
ous.   Such has  been the uncertainty of practical medicine, that
even the conservative  portion  of  the profession, if they become 
24
PRACTICAL  PRINCIPLES.
in the least ^lightened, omit the  heroic and  adopt the expect-
ant or tentative mode of practice.  The foregoing facts  disclose
a lamentable state of things, but not a state to be despaired of;
Jiuch less is it one to be concealed.  It is our duty as guardians
of the lives and health of our fellow-beings, to  unmask, not only
the virtues, but the faults  of the profession.  The course of our
subject will now lead us to attempt to disclose in what the de-
fects  of the allopathic system of  practice mainly  consist; the
cause of these, and  the means which seem best  calculated to
remove  them.  Also  the  principles  which  govern the Young
American Physic.  In order to fully understand why the allo-
pathic system of practice is not more successful in removing
disease, it will be necessary to  enter more fully into its princi-
ples of cure and therapeutic resources. For the investigation of
these, it will be necessary to enter  somewhat into the history of
medicine.  Pliny states that, if there exist any nation in which
at any epoch  of its  history  physicians  were not found, there
is none in which traces of medicine were not visible.  It is pro-
bable that medicine  has  existed,  either as an art or  science,
from tka earliest period; and that  the practice of medicine had
its existence in the natural tendency of the soul to resist death,
together  with benevolent impulses  towards the sufferings of
others.
  The earliest and  most authentic  account  we  have of the
practice of medicine, is that given of Centaur Chiron, a prince
of Thessaly, who went out  in the expedition against Troy.  From
all accounts we have of his practice, it was exceedingly empirical,
and consisted  in the external application of a few remedies to
wounds, &c, together with incantations and ceremonies to affect
the imagination.  Chiron  transmitted his profession, according
to  custom, to  his son  iEsculapius, and iEsculapius to  his  two
Bons, Machaon and Podalirius.
  Fifty  years after  the  destruction  of  Troy, a  temple was
erected at  Titanus, a city of the Peloponnesus,  in honor of
iEsculapius, who was  worshipped as a god.  The worship of this
god very soon  spread  throughout Greece and  passed  into Asia
Africa, and Italy.  Multitudes of temples were consecrated to
him, among which those at Epidaurus in the  Peloponnesus at
Pergamos in Asia, on the island of Cos, and at Cyrene  a city 
PRACTICAL  PItlNCIPLES.            25
of Libya, were particularly famous. In the temple at Epidaumua
there  was  a statue  of colossal size  representing  the god of
medicine, under the  figure of an old man, seated on a throne,
holding in one hand a sceptre, and resting the other on the head
of a large serpent; a dog, the emblem of vigilance, rested at his
feet.  The statue was of gold and ivory, and was the workman-
ship of Grasymedus.   Socrates, it is said, in  his last discourse
with his friends, requested them to  offer for him a cock, as a
sacrifice to iEsculapius ;  whence we infer that this bird was
sacred to the god of medicine.
  The priests attached to this worship were named Asclepiades,
or descendants of iEsculapius. They regarded all the knowledge,
relative to disease and medicine, as sacred, their laws forbidding
it to be revealed to the non-elect, lest their god should be angry ;
strangers were not admitted  to this knowledge until they had
been subjected to certain ceremonies called the tests of  initia-
tion.
  These temples were erected in the midst of the most delight-
ful  scenery; no  pains were  spared to furnish them with the
most agreeable and healthful diversions; they breathed a pure•
air, were subjected to a wholesome regimen, and every possible
means was used to affect the  mind and imagination agreeably;
thus exercising a healthful and happy influence upon the con-
stitution.   Fasting and prayer were strictly  enjoined upon the
patients, also abstinence and sacrifices, before they were admitted
to receive the response of the oracle.  Those who were benefited
went  to their homes  blessing the  author of their  recovery, and
those who were not benefited redoubled their efforts to propitiate
the god in their favor. Besides these means, remedies were used,
not unlike those now in vogue, consisting in bleeding, purga-
tives, vomiting, friction, mineral water, &c.
  There existed in the country, about Epidaurus, serpents  of a
yellowish brown color, whose  bite was not poisonous, and  which
were easily tamed.
  These were employed by these priest-doctors to more effectually
impress the minds of their patients with wonder  and astonish-
ment at their supposed power, which, from all accounts, had the
desired effect.   Aurelius  Victor relates,  that during the year
350 of the foundation of Rome, that city was scourged by a terrible
                            3* 
26
PRACTICAL* PRINCIPLES.
pestilence ;  the Senate sent six deputies to consult the oracle at
Epidaurus.
  On  arriving at the temple, suddenly an  enormous  serpent
issued from beneath the  pedestal.   The sight of it filled  every
mind  with veneration more than with terror.  He moved tran-
quilly through the crowd and entered the  vase of the Romans
in the chamber of Ogulnius, the chief of the ambassadors.  The
serpent was sacredly borne  away, and when the  ambassador
was approaching the city of Romulus it sprang  into the waves
and swam to an island in the Tiber, where a temple was imme-
diately erected to iEsculapius, and the pestilence ceased.
   It  can hardly  be doubted that the priest-doctors of these
temples were endowed with strong natural powers of mind; that
they understood the  influence of mind over  matter ;  and that a
strong belief in their ability to  cure, contributed in a very con-
siderable  degree  to their  success.   The  teachings in these
temples were  confined  to  the  family of iEsculapius for some
eight or nine hundred years.  After a time they became more
general, assuming more of the character of the medical colleges
of the present day.  Their  means  of teaching was confined
mostly  to  tablets  hung upon  the walls and columns of the
temples, showing the name of the patient, the disease, and the
manner in which  it was treated.  One of these tablets, found on
the island  in  the Tiber,  the site of the ancient yEsculapian
temple, bears the following inscription in Greek characters:—
Lately  a certain  Caius, who was blind,  came to  consult the
oracle.  The god required that he approach  the sacred altar to
perform certain adorations ; at  once he passed from the right to
the left, and having rested his fingers on the altar, he raised his
hands and applied them to his eyes,  whereupon he recovered
his sight immediately  in the sight  of  all  the  people,  who
rejoiced to  see such marvels  performed  in the reign of our
august Antoninus.  Upon the same tablet is the account of one
Julin, who had pleurisy, and the gods ordered that the ashes of
the altar be put into wine and  applied to his side, which being
done, he was immediately cured.  Another man, Valerius Aper
was blind,  and the gods ordered an ointment of the blood of a
white cock and honey to be applied to his eyes, which was done
and his sight restored.  The  only  principle which  guides  these 
PRACTICAL  PRINCIPLES.            27
priest-doctors in the administration of medicine for the cure  of
disease, was, that remedies, which  have once cured, will cure
again under .similar circumstances.
  The practice  of medicine, in the temples, was continued until
about the commencement of the Christian era.  Pythagoras, who
was  born in the  year  500, B. C,  at Samos, one of the most
flourishing islands in the iEgean sea, having one day heard a
lecture on the  immortality of  the  soul by Pherecydes, was so
charmed that he renounced  every  other  occupation to devote
himself to philosophy.  He travelled among the most enlight-
ened  nations, obtaining extensive knowledge in every art and
science  cultivated at  that  early period, and that of medicine
among others.   It was Pythagoras  who first introduced  the
practice  of visiting patients  in  their own houses;  he also
rejected all theories in medicine, and contended that experience
was the only safe guide  to a successful medical practice. Hip-
pocrates, who was born on the isle of Cos, 460 B. C, was one
of the first reformers in medicine we have any account of.  He
was one of the direct  descendants of iEsculapius, and received
his education at  Cos, which  contained a temple dedicated to
iEsculapius,  and  a medical  school; thus his advantages for
acquiring a medical  education were very favorable.   He was
not satisfied, however, with this instruction, and extended his
researches into the principal  Greek cities of Europe and Asia,
taking a survey of the art of  medicine as it then existed, which
was in a state sadly deficient and imperfect;  the ideas of dis-
ease, and principles of cure, being of an exceedingly vague and
uncertain character.  He consequently commenced a series  of
experimental investigations into  nearly every department  of
medicine.
   He opened an earnest warfare upon the superstitious cere-
monies of the iEsculapian priests,  and advocated the custom,
introduced by  Pythagoras, of visiting patients  at their own
houses.   He also  classified  and arranged diseases and remedies
in a much more systematic manner than  had hitherto existed,
and introduced a  variety of new-remedies, which proved  exceed-
ingly valuable  in the treatment  of disease.   His  system  of
Therapeutics was, however, similar to his predecessor; depending
in his choice of remedies upon those which experimental observ- 
28
PRACTICAL  PRINCIPLES.
 ation had proved  beneficial in removing disease.   To show the
 reader how slightly the treatment of disease, twenty-two centuries
 ago, differed from  that of a class of practitioners at the present
 time, I will here introduce the treatment for pleurisy, given by
 Hippocrates, as translated by Renouard.
   " It is  necessary to examine, in the  following  manner, the
 peripneumonic and pleuritic affections; if the fever is acute; if
 there is pain in one or both sides of the chest; if the  patient
 suffers during expiration; if he coughs, and the  expectoration
 is rusty or livid, or thin and frothy, or of a blood-red — if, in
 fine, it  differs at all from that which  is natural, the  following
 course must be pursued: the pain extending above and towards
 the clavicle, or towards the vein and the arm, the  internal  vein
 of the arm  on that  side  should be  opened.  The quantity of
 blood drawn should  be proportional to the  constitution of the
 body, the season of the year, the age  and color  of the patient;
 and if the pain is acute, the bleeding should be boldly pushed to
 syncope ;  afterward an injection is to be administered.
  " If the pain occupies the inferior region  of the  chest, and is
 very great, you should prescribe for pleuritics a mild purgation;
 but the patient  must taste nothing else whilst the medicine is
 operating.  After  the  purgation they should have an  oxymel.*
 The purgation should not be administered until  the fourth day;
 during the first three  days injections should be  employed ;  but
 if they are not sufficient, the  purge  should  be  given, as  above
 said.   He must be watched until the  fever ceases, and  the
 seventh day is attained;  after that, if he appears out of danger,
 he may take a little barley-water, sweetened with honey.  If the
 convalescence progresses  and the respiration  is good, the tisane f
may be given twice a day, and be gradually increased in  quan-
tity and strength ; but if the convalescence is  slow  the  drink
must  be lessened, and a  small quantity of weak tisane  for
nourishment, once  a day.   It should be given when the' patient
is in the best condition, as may be known by the appearance of
the urine.
  " To those who  approach the close of the disease,  it is  not
necessary to give the tisane before you see thecoction manifested
in the urine or expectoration ; nevertheless, if, when purged, the
  * Decoction of barley.         f Oxymel, honey and vinegar syrup 
PRACTICAL  PRINCIPLES.
29
patient  has abundant evacuations, it is  necessary to give the
tisane, but in less quantities and weaker, otherwise the empti-
ness of the vessels would allow him  neither to sleep, nor to
digest, nor to await the crisis.  With this exception, the crude
humors should be liquefied, and whatever has been the obstacle
should be ejected:  then nothing  prevents alimentation.   The
expectoration is perfectly concocted when it appears like pus:
the urine, also, when  it has a red sediment like brick-dust.
  " As to the pain in  the side, nothing contra-indicates the use •
of fomentations and wax-plasters.  The  legs and arms should
be  jubbed with  warm oil  and  then  anointed  with  fat.   The
hypochondria should be covered as high as the breast with a flax-
seed poultice.  When  the peripneumonia has reached its height,
nothing can be accomplished without purgation : it is bad if the
patient has dyspnoea, or if the urine be thin and acid, or  there
be  sweats around the neck and head.  These  sweats indicate
danger in proportion to the violence  of the disease, which  is
known  by the suffocation and  rattling,  which  increases and
produces  death, unless there  supervene an  abundant flow of
viscid urine, or of concocted  sputa.   Whichever of these two
phenomena supervenes, it indicates resolution.
  "An eclegma is prescribed for peripneumonia, with galbanum
and grains of pine seed, in Attic-honey.  Other expectorants are
employed, such  as worm-wood {Artemisia abrotanum, Lin.), and
pepper in oxymel; purgatives—boil black hellebore (Helleborus
orientalis, Lin.), and  give it as a drink to pleuritics  at the com-
mencement and while the pain  is felt.  A useful remedy in
affections of  the  liver,  and  in  pains  proceeding from the
diaphragm, is a drink of opoponax (Pastinacce opoponax, Lin.),
boiled in oxymel and  strained.   In general, a remedy that is to
act on the stools, or urine, should be given in wine and in honey
if to act on the stools alone, it should be given in a much large
quantity of diluted oxymel."
  It will be seen, by comparing the treatment  of Hippocrates
with that of Dr. Eberle, given  in another part of this work, that
there is no essential  difference.   The bleeding and purgative
plan is still adhered to.
  At the death of Hippocrates, which  occured when he  waa
about one hundred years  of age, his two sons, Thassalius and 
30
PRACTICAL  PRINCIPLES.
 Draco, together with his son-in-law Polybius, cultivated the art
 of medicine, and transmitted the knowledge of their father by
 teaching in a public manner his doctrines.  Hippocrates and his
 sons were the first authors of any note upon the subject of medi-
 cine.
  The foundation of  the Alexandrian Library, about the  year
 320 B. C, had a happy effect upon some departments of medicine,
 as Anatomy, Physiology, &c.
  But from the statement of Galen, who had examined all the
 contents of this library relative to medicine, it appears that the
 only knowledge  it  evinced of therapeutics was merely experi-
 mental.   The Alexandrian Library is  said to  have  contained
 about  600,000 volumes  or rolls, which were  equal to about
 200,000 modern bound volumes.  This library contained all the
 valuable  information of those  times in every  department of
 science and art.   It was burnt by Caliph Omar, A. D., 640, who
 gave as his reasons that, if the books agreed with the Koran, they
 were  of  no use,  and  if they disagreed they contained  heresy,
 and should be burnt.   Thus far in the history of medicine, the
 only therapeutic  axiom  was  this: When a treatment was suc-
 cessful in one case, it was always employed in analogous  cases
 without inquiry whether it acted upon one principle or another;
 although Hippocrates and his disciples suggested some diseases
 were  cured by their  opposites, and others by similars; while
 again diseases have been cured  by remedies which appear  to be
 neither similar nor  contrary to the nature of the disease.
  It is not my purpose to enter in  any considerable degree into
 the consideration  of the theories, which prevailed in those ancient
 times relative to disease, yet I can hardly present to the reader
 any thing like an  idea of the comparative condition of medicine,
 without noticing in  a brief manner some of the more prominent
 notions relating to it. The Asclepiades, of the isle of Cos, regarded
 disease as a series of phenomena, resulting from the  efforts of
 nature to remove the cause of the disease.  They regarded nature
 as competent to accomplish, her purpose in many instances  but in
 others medical interference  become  necessary.   They  also
regarded disease as having critical days and a certain  duration.
Pythagoras states that the  number of  days which bring about
tb? cure or death  of a patient, regulates the crisis, of fevers.  In 
PRACTICAL  PRINCIPLES.            31
remarking upon the observation of these  critical periods  and
daily phenomena of disease,  he says  that  a physician who
neglects  nothing  that  may  contribute to the patient's health,
must observe carefully  what passes each day.
  Among those days of even numbers the  most important are
the fourteenth, the twenty-eighth, and the forty-second.  Who-
ever carefully observes the phenomena of disease, as described
by these ancient authorities, will see ah aphorism of Prof. J. J.
Jones  verified:  That  all diseases  are  more  or  less  periodic.
Following the doctrine of  crisis is that of the four elements,
Heat, Cold, Dryness and Moisture; and the four cardinal humors,
blood, bile, atra-bile, and phlegm.
  Empedocles was  the first to  introduce this doctrine of the
elements.  He says the human body  is  composed of  blood,
phlegm,  and two sorts of  bile — yellow and  black;  and that
their condition  determines the state  of health; that perfect
health consists  in  a due proportion of each; that disease is
caused by an excess of any one of these, or if any one  lacks its
due proportion, or is evacuated without being properly  mixed—■
for when it  is thus evacuated, they  claim  that not  only the
region where the admixture took place must be affected, but the
organ, through which it passed off, must suffer and become dis-
eased.  Another theory of those times was, that all  disease was
caused by cold, which  they explained as follows: — Colds cause
the  condensation of the tissues and veins of the head; if the
cold strikes them when they are heated, they contract, and the
humors  contained  in them are expelled.  All the tissues are
obliged to pour out their fluids when they contract.
   Fluxions  are also caused by the tissues  becoming heated,
which rarefies them, enlarges  their pores; the humors they con-
tain are attenuated, so that it  flows easily  when compressed.
This theory of  fluxions is regarded  as being  anterior to Hippo-
crates.   For  a long time after Hippocrates, we have no writings
from which we  can  learn any progress in the practical resources
of the profession.   From  all we can gather,  if would seem that
little, if any, progress  was made in  the principles or practice of
medicine for many  centuries.  Herophilus is mentioned by some
as  a reformer  in medicine, and as  having introduced quite a
large number of medicines;  but what they were, history fails 
32            PRACTICAL  PRINCIPLES.

to tell us.  Dioscorides states that the medicines used by him
had the power to dissolve stone in the bladder; to consume the
spleen ;  to  prevent conception in females; of making children
black-eyed, &c.; also, that they would prevent the various mani-
festations  of  mental  emotions and  passions.    The  modus
operandi of medicines, as explained by the ancients, was that
they acted upon the system- according to the degree of heat or
cold, dryness or moisture, of the system.  A principle not very
dissimilar to that advocated by the modern Samuel Thomson,
which was that heat was  life, and cold was  death; and that
medicines acted beneficially or otherwise, according to the degree
of heat they contained.
  iEtius, who lived at the commencement of the sixth century,
and was the  first physician of eminence  who embraced the
Christian religion, dispensed with most of the ceremonies, magic
and incantations, that originated in the iEsculapian  school; but
instituted others almost equally superstitious.  In his directions
to use certain medicines, he recommended that the following
words be repeated in.a low voice: May  the God of Abraham,
the God of Isaac, the God of Jacob, deign to bestow upon this
medicine the  necessary  virtues, &c.  In extracting a  foreign
substance from any part  of the system, he recommends, in con-
nection with proper means used, the following words: As Jesua
Christ  caused Lazarus to come forth from the  sepulchre,  as
Jonah came  out of the whale's belly, come thou out.  In his
practice he  made  free use  of  the cautery, and introduced a
number of new ointments.   He also claimed to have introduced
to the materia medica several new remedies, but did not tell us
what they were.  His principles of practice were the same aa
his predecessors.
  Rhazes, an Arabian physician, although  a strict  imitator of
the  Greek practice, offered  one or two  suggestions worthy of
remembrance.  Among other considerations, he says: " study
carefully the antecedents of the man to whose care you propose
to confide all you hold most dear in the world —that is to say
your life and health, and the life and health of your wife and
children.  If the man is dissipating his time in  frivolous "plea-
sures ;  if he cultivates with  too much zeal the arts  that     f
reign to the profession, such as music and poetry; still more 'f h 
PRACTICAL  PRINCIPLES.            33
is  addicted  to  debauchery, refrain from committing  into his
hands a trust so precious."
  Hally-Abas, Avicenna, and Albucasis,were also Arabian physi-
cians of some note, and lived in the eleventh and twelfth centuries.
They added to the resources  of the Greeks several articles of
some value, such as cassia, senna, and manna.   They also added
several ointments and  syrups  to the pharmacy.  In the princi-
ples of treating diseases, however, they made but little, if any,
advancement.
  On examining the progress  in the principles and  practice of
medicine, from its commencement to the close of the seventeenth
century,  we find that the principal improvements were made by
the descendants of iEsculapius, Hippocrates and Galen ; that the
Arabians, Turks,  and Jews, did little,  if any thing, more  than
teach it as it had been taught by Hippocrates.  Even after the
discovery of the art of printing by Guttenberg and others, in
1424, physicians appeared to be entirely satisfied in translating
the writings of ancient authors, and in commenting upon what,
it would  appear, they thought a fixed science.
  In the year 1700, John Fernel, who wrote quite  extensively
upon the materia  medica, re-examined the therapeutic axiom of
Hippocrates, that, all  diseases are cured by  contraries.   He
stated that every disease must be  cured  by contraries; for, says
he, " a remedy is  that which  can drive out a disease, and that
which  drives acts violently.   That which uses violence is in
opposition, therefore the  remedy  is always opposed to the  dis-
ease, and no healing can  take place except in virtue of the law
of contraries.  We  call contraries not only those things which
are endowed with opposite elementary  qualities, heat and cold,
dry and wet, but also things which differ among themselves in
any way, as to  quantity, number, quality, &c.  Thus  the hard
and the soft, the dense  and the  diffuse,  the great and the small,
that which is in excess  and that which is deficient; the high  and
the low, the pure and the impure,  are all examples of contraries.
These are the views of  Fernel relative to the therapeutic action
of medicine, although he carried them further than Hippocrates
and Galen, and entirely rejected their experimental knowledge
of therapeutics, and claims the law of contraries to be impos-
sible.
       4 
34
PRACTICAL  PRINCIPLES.
  Paracelsus,  a native  of Einsiedeln,  a village  of  Switzer-
land,  lived in the latter  part  of  the sixteenth  century,  and
although a man of neither integrity of purpose, nor stability of
character, obtained almost universal sway over the medical pro-
fession.  He  claimed to have made great discoveries in thera-
peutics and pathology. He stated that the human body, like the
great world of which it is an image, is composed of four elements,
fire, air, earth and water.  The fire  in man is the soul ; the earth
is represented by the dry parts ; the water by the liquids ; the air
by the vacuum.   These four elements cause disease.  But if we
leave  this high analysis to get at the more immediate elements,
the body of man is composed of mercury, the liquor  of sulphur
and salt.  And now we see how this is demonstrated by alchymy.
There are, in the first place, in  the body liquids; these are the
mercury; then the  solids, which  may  be burnt; the portion
which burns  is sulphur, while  the residue or the ashes is salt.
It can hardly be imagined how a man  can embody, in so few
words, such  an amount of ignorance, and,  what is still more
wonderful, is, that a system,  thus  founded in the grossest igno-
rance, should exert such an influence on the medical profession.
The additional element of mercury, which he added  to the four
elements of the ancients, enabled him to found a new system of
therapeutics,  and in a measure  to introduce new principles of
cure.   Mercury, he tells us, being in close relation to ordinary
quicksilver,  produces, by its  volatility, many  affections of
the ligaments, as  tremblings, &c. If it becomes excessive, or if it
be joined to acrimony, mania, phrenzy and madness  occur.  On
the contrary, if the mercury is  chilled,  it causes trembling of
the hands and feet, lethargy, erosions of the mouth, &c.  Sul-
phur  causes various kinds of fevers, jaundice, &c.  Salt causes
gravel, gout,  sciatica, and, when it becomes dissolved, it causes
diarrhoea; if it coagulates, constipation  ; if it volatizes too soon,
it causes ulcers,  itch, erysipelas, cancers, herpes,  &c.  For the
purpose  of removing all these  diseases, he introduced into the
system antimony, gold, mercury, copper, and some other metals.
He discarded many of the remedies of Hippocrates as being in-
effectual and unable to control the elements of the body and
pretended the principle upon which  mercury  removed disease
from  the body was a profound secret, peculiar to himself   It 
PRACTICAL  PRINCIPLES.
35
was  a  combination of these  metals  which  composed what he
called his elixir vitce, or universal remedy for all diseases.   One
attempt which he  made  to explain the modus operandi of his
medicines,  will suffice to show  his entire  ignorance  upon the
subject.  It was as follows : —"As antimony purges gold only,
and consumes all other metals, it is  the proper agent to purge
the human body, and no other ;  for in regard to perfection and
forces, man has a great  similitude to gold ; whence it  follows,
that antimony brings man and gold to a supreme degree of per-
fection  and purity,  while it  destroys,  consumes and exempts
every thing else.  The nature of antimony is a purgative, though
it does not produce  evacuation of faeces and other excrements;
but, above  all other remedies, which  act insensibly, it drives out
that which renders man  impure, and having purged  the  cause
of disease, brings him to a supreme  degree of health."   It will
readily be perceived from the above quotation, that in the adminis-
tration of medicine, he was guided for less by correct principles
than his predecessors in  the profession.   Paracelsus  was the
first physician who used mercury and the other violent  mineral
poisons.  Andrew Libanius, a physician, chemist and  director
of the gymnasium at Cobourg, and  cotemporary of Paracelsus,
informs us that the latter cured very few of his patients ; that he
killed a great many, and that  many others were horribly tor-
tured by the use of his medicaments.  As ignorant and unskillful
as was Paracelsus, he is the founder of the present  system of
Allopathy  ; and  the very remedies  of which he composed his
quack elixir, are still insisted upon as being the almost universal
panacea for bodily ills.  It is true that men, eminent in the pro-
fession, have labored for a more rational system of practice ; have
minutely investigated the cause and nature of disease, and have
very materially jmproved the condition of  pathology.  But not-
withstanding all this, it must be acknowledged that their thera-
peutic resources are essentially the same as those of Hippocrates
and Paracelsus.  By referring to the compendium of Dr. Eberle'a
Practice, ?n another part of this work, we can  learn what the
resources  of the Allopathic  portion  of the profession are.  T„
be sure, every article is not there enumerated which has been
recommended by that branch of the profession :  but,  he being a
late author, and  having enjoyed the confidence of the profes- 
36
PRACTICAL  PRINCIPLES.
 eion as such for nearly a quarter of a century, it is probable he
 as fairly represents his party in medicine as any author I could
 select.   According  to all their authors, bleeding,  blistering,
 mercury, antimony, &c,  are their  principal therapeutic  re-
 sources.  With these are they successful in accomplishing the
 only purpose for which medicine is cultivated?—that of healing
 disease.  The first of these resources, in  order, is bleeding.  Is
 bleeding of service in the treatment of disease ?  Is it  produc-
 tive of more good than evil ?   These are questions which should
 be solved before venturing upon so active a measure in changing
 the normal condition of the human organism.
  To assist us in the solution of this question, we may first  in-
 quire, what are the purposes of the blood ? what part does it
 perform in the economy of human  life.   Scripture tells us that
 the blood is the life of the flesh.   Physiology tells us that the
 blood is the histogenic material, out of which all the organs of the
 body  are formed,  and by which they maintain  their  normal
 integrity.  Pathology,  still further, informs  us that a large
 majority of all disease that afflicts  the human family is depen-
 dent upon, or is caused by, a deficiency in the whole, or in certain
 constituents of the  blood.  Physiological pathology informs  ua
 that the blood is a medium through which all the disintegrated
 or waste portions of the old tissue  are removed from the body;
 that it watches diligently over every  tissue, and carefully supplies
 every deficiency.  Still the question is, does it remove disease!
What are the facts?  The following  remarks  of Dr.  Samuel
Dickson, formerly an officer of the British staff,  now of London,
will  show some facts  upon  the  utility of .blood-letting in the
treatment of disease. "A medical officer of one of her majesty's
regiments, serving  in  India, couched  a woman for cataract.
 The next day  the  eye  having  become inflamed, according to
received practice,  he bled the  patient;  but scarcely had  he
bound up her arm, when she fell as if she had been  shot, and
lay, to  all appearance, dead ; with the  greatest difficulty  he
succeeded in recovering her from this state ;  but it was  not till
four long hours had passed that he felt he could safely leave her
with attendants; for during the greater part of that time, when
he ceased to chafe her temples, or otherwise call up the attention
of the brain, by the  application of stimulants to the nose mouth 
PRACTICAL  PRINCIPLES.            37
&c, she relapsed into a death-like swoon.   More  than once he
was obliged to inflate her lungs  to keep her from dying.   But
in this case, gentlemen, blood-letting did not cure the inflamma-
tion ;  for the next  day the eye was more painful and inflamed
than ever, and the poor woman, after all the blood she had lost,
— and who will say that  she was not  bled? —did not  recover
her sight.   It is  now many years since that case came under
my sight, and it made an  impression on my mind I shall never
forget.  Had the woman  died, would  not  every one  have  said
that the gentleman who  bled her had killed her?  and very
justly, too."
         " Religion, Freedom, Vengeance, what you will,
           A word's enough to raise mankind, to kill—
            Some party-phrase by cunning caught, and spread,
            That Guilt may reign, and Wolves, and worms be fed."
   "The first resource of the surgeon is the lancet — the first
 thing he thinks of when  called to an accident, is, how he  can
 most quickly open the flood-gates of the heart, to pour out the
 stream of  an already enfeebled existence.  Does a man fall from
 his horse, or  a height, is he not instantly bled? has he been
 stunned by a blow, is not the lancet in requisition ?  Nay, has
. an individual fainted from over-exertion or exhaustion, is it not
 a case offts — and what so proper as venesection ?  You can-
 not have forgotten the fate  of Malibran — the  inimitable Mali-
 bran ; she who so often, by her varied and admirable perform-
 ances, moved you  to tears and smiles, by turns.  She was playing
 her part upon the stage ;  she entered into it with the whole of
 her soul, riveting  the audience to the spot by the very intensity
 of her acting.  Just as  she  had taxed the powers  of her  too
 delicate frame to  the utmost, she fainted and fell; fell from very
 weakness.  Instantly a medical man leapt upon the stage, — to
 administer a cordial ? No, to bleed her! to bleed a weak, worn,
 and exhausted woman ! and the result?  She never rallied from
 that  unfortunate  hour.   But, gentlemen, Malibran was not  the
 only intellectual person  of the thousands and tens of thousands
 who  have prematurely perished by the lancet.  Byron and Scott,
 those master-spirits  of their age — those  great men, who, like
 Ariosto and Shakspeare, not only excited the admiration of
 cotemporary millions, but whose genius must continue, for  gen- 
38             PRACTICAL PRINCIPLES.
erations yet unborn, to delight the  land  that produced them —
they, too, fell victims to the lancet —they, too, were destroyed
by the hands, which,  however friendly and  well-intentioned,
most undoubtedly dealt them  their death-blow.   Is not this a
subject for deep reflection ?  To the cases of these great men we
shall recur in the course of this lecture; but, for the present,
we must turn to other matters — to events that have just passed
before our  eyes.  The affair of Newport, in Wales, is still tho
topic of the hour.  You must therefore remember it to its min-
utest detail — the  attack  of the rioters upon the town;  the
gallant and successful stand made by Capt. Gray and his little
detachment of the 35th regiment— the  prisoners captured and
the investigation which took place afterwards.  In the course
of that  examination a prisoner, who was under examination,
fainted.  What  was  done with him?  he was  carried out of
court and immediately bled.  On  his return  an extraordinary
change had come over his countenance; from being  a man of
robust appearance, he had became so  wan  and haggard, so
altered in every lineament, the spectators could scarcely recog-
nize him as the same prisoner.  Yet, strange to say, not one of
the many journals that reported this case, spoke a word in  con-
demnation of the uncalled-for measure which  brought  the  man
to such a state; so much  has  custom blunted  the sense  of the
public to this, the most dangerous of all medical appliances.
  Gentlemen, a coroner's inquest was held on a person who  died
suddenly.  Mr.----, surgeon, stated that he was called upon to
attend  deceased,  and  found him  at the point of death.   He
attempted to bleed him, but ineffectually, and in  less than a
minute from  witness'  arrival, deceased  expired.  Witness not
being able to give any opinion as to the cause of death from the
symptoms that then exhibited themselves, he afterwards, with the
assistance of Dr. llidge, 37 Cavendish Square, made a post-mortem
examination, and found that a large  tumour, attached  to a large
vessel of the  heart, containing blood, had bursted, and that was
the cause of his death.  So that, while the man was actually dying
of inanition from internal bleeding, the surgeon, utterly  igno-
rant, according  to  his own confession, of the nature of  the
disease, proceeded  to open  a  vein.  How  happens it that the
lancet should be so invariably the first resort of ignorance. 
PRACTICAL  PRINCIPLES.             39
  " In every case of stun or faint, the employment of this instru-
ment  must be a superadded injury; in all, there is a positive
enf'eeblement of the whole frame, evidenced by the cold surface        ',
and weak but imperceptible pulse ; there is an exhaustion, which
loss of blood, so far from relieving, too often converts into a state
of utter prostration.  True, men recover when treated in  this
manner—but these are not cures, they are escapes.  How few the
diseases which loss of blood may not of itself produce! if it
cannot cause  the  eruptions  of small-pox, nor  the glandular
swellings of plague, it has given rise to disorders more immedi-
ately fatal than either.   What think you of cholera asphyxia-
Asiatic cholera?   Gentlemen, the symptoms of that disease are
the symptoms of a person bleeding slowly away from life.   The
vomiting, the cramps, the sighing, the long gasp for breath, the
leaden and livid  countenance which the  painter gives to the
dying in his  battle-pieces;  these are equally the  symptoms of
cholera and loss of blood.  Among the numerous diseases which
it can produce, Darwin  says, ' a paroxysm of gout is liable to
recur  on  bleeding.'   John  Hunter  mentions 'lock-jaw  and
dropsy' among its injurious  effects — Travers,  'blindness  and
palSy' — Marshall Hall,  ' mania' — Blundell,  'dysentery' —
Broussais, 'fever  and convulsions.'   'When an animal loses a
considerable  quantity of blood,' says John Hunter, ' the heart
increases in its frequency of  strokes,  as  also  in its violence.'
Yet these are the indications  for which professors  tell you to
bleed.   You  must bleed in every inflammation, they tell you.
Yet is not inflammation  the  daily effect  of the  loss of blood?
Magendie mentions pneumonia as  having been produced by it,
completely confirming the evidence of Dr.  Hume  upon  that
point.   He further tells  us,  that he has  witnessed among its
effects the  entire  trains  of what people are pleased to call in-
flammatory phenomena ; and mark, he says, the extraordinary
fact, that this inflammation will have been produced by the very
agent that is  daily used to  combat  it!  What a long dream of
false  security have mankind  been dreaming !  they have  laid
themselves down on the laps of their Mentors,—they have slept
a long sleep ;  while these, like the fabled vampire of the poets,
taking advantage of a dark night of barbarism and ignorance,
have thought it no sin to rob them  of  their life's blood during 
40            PRACTICAL  PRINCIPLES.
the profoundness of their slumber!  Gentlemen, the long shiver
of the severest  ague, the burning fever, the severest lock-jaws,
the vomiting, cramps, and asphyxia of cholera, the spasm of
asthma  and epilepsy, the pains of rheumatism, the palpitating
and tumultuous heart, the most settled melancholy and madness,
dysentery, consumption, every species  of palsy, the faint  that
becomes death,  these — all these — have I traced to the loss of
blood!
  " Lord Byron called medicine the destructive art of healing.
How truly it proved to be so in his  own case, you shall see when
I give you  the  details of his last  illness: —'Of all his preju-
dices,' says Mr.  Moore,  'he declared the  strongest was  that
against  bleeding.  His mother had obtained from him a promise
never to consent to be bled ; and, whatever arguments might be
produced, his aversion, he said, was stronger than  reason.  Be-
sides, is it not, he asked, asserted by Dr. Reid, that less slaughter
is effected by the lance than by the lancet— that minute instru-
ment of mighty mischief!'  On Mr. Millingen observing  that
this remark related  to the treatment of the nervous, but not of
inflammatory complaints, he  rejoined, in an angry tone, ' Who
is nervous if I am not? and do not those  other words of his  (Dr.
Reid's)  apply to  my case, where  he  says  that drawing blood
from a nervous  patient, is like loosening the cords of a musical
instrument — whose tones already  fail for want  of sufficient
tension ! Even before this illness, you  yourself knew how weak
and irritable I had become; and  bleeding, by increasing this
state, will inevitably kill me.   Do with me what else  you like,
but bleed me you shall  not.  I have had several inflammatory
fevers in my life, and at an age when robust and plethoric; yet
I got through them without bleeding. This time, also, will I  take
my chance.'    After much reasoning  and  repeated entreaties,
Mr. Millingen succeeded in obtaining from him a promise,  that
should  he feci  his fever increase at night,  he would  allow Dr.
Bruno to bleed him. On revisiting the patient early next morn-
ing, Mr. Millingen learned from him that, having passed on the
whole, as he thought, a  better  night, he  had not thouo-ht it
necessary to ask Dr. Bruno to bleed him.  What followed I shall
in justice to Mr. Millingen, give in his own words: 'I thought
it my duty now to  put aside  all consideration of his feelings 
PRACTICAL  PRINCIPLES.
41
and to declare, solemnly, to him how deeply I lamented  to see
him trifle thus with his life, and show so little resolution.  His
pertinacious refusal had already, I said, caused much precious
time to be lost; but few hours of hope now remained ; and, un-
less he submitted immediately to be  bled, we could  not  answer
for the consequences.  It was true he cared not for life, but who
could assure him that, unless he changed his resolution,  the un-
controlled disease might  operate  such  disorganization  in his
system as utterly and forever deprive  him  of  reason !   I had
now hit  at  last on the  sensible  chord ; and  partly annoyed
by our importunities,  partly persuaded,  he cast at us both the
fiercest glance of vexation, and throwing out his arm  said,  in
the angriest tone, ' There you are,  I see, a d—d set of butchers,
take away as much blood  as  you like, but have  done with it!'
We  seized the moment (adds Mr.- Millingen), and  drew  about
twenty ounces. On coagulation, it  presented a strong buffy coat,
yet the relief  obtained did not  correspond to the  hopes  we had
formed, and during the night the fever became stronger than it
had  been hitherto, the  restlessness  and  agitation increased, and
the patient spoke several times in an  incoherent manner.   Surely
this  was  sufficient  to convince the  most school-bound  of the
worse than inoperative nature of the measure. Far from it. On
the following  morning, the 17th of April, the bleeding  was re-
peated twice, and it was thought right also to apply blisters  to
the soles  of his feet!  Well might  Mr. Moore  exclaim,  'It  is
painful to dwell on such details.'   For our present purpose it is
sufficient to state, that although the rheumatic symptoms had
been completely removed,  it was at the expense of the patient's
life.   His death took place upon  the 19th, that  is, throe days
after he was first bled.
   " M. Capeman, in 1845, gives the statistics of the bleeding and
non-bleeding practice  in apoplexy.  'In 1836, when I first re
pudiated the lancet in this disease, the statistics were all on one
side, the only cases of the non-bleeding  side of the argument
being my own.'   The following is from Mr. Capeman's table:
    Number bled............120......Cured.........51......Died.........18
   JNumber not bled...... 26......Cured.........18......Died......... 8

Showing that, in the cases where bleeding was practised, nearly 
 42            PRACTICAL PRINCIPLES.

 two out of three died; whereas, in the cases  treated without
 blood-letting, more than two out of three  recovered!   What is
 the worth of general assertions in the face of such evidence?
   " In the army hospitals I had an opportunity  of studying dis-
 ease both at home and abroad.  There I saw the fine tall soldiei
 bled, for relief of a symptom, to fainting;  and what is fainting?
 A loss  of every organic perception —a death-like state, only
 difioring from death in the possibility of a recall.  Prolong it to
 permanency and it is death.  Primary symptoms were, of course,
 got over by such measures ; but once having entered the hospital
 walls, I found that soldier become familiar to me;  seldom did
 his pale countenance recover its former  healthy character.  He
 became the victim of consumption, dropsy, or  dysentery.  Ilia
constitution was broken  by the first  depletory measures  to
which he had been subjected."
  In connection with these  cases, reported by Dr. Dickson, we
might mention that of our own Washington, who, after escaping
the perils of war with its engines of death, fell a victim to the
lancet.  He was attacked with quinsy — bled to an enormous
 extent,  three times within a few days, and  died with all the
 characteristic symptoms of fatal hemorrhage.
  Andral recently reported one hundred cases of pneumonia
 treated by blood-letting; one hundred treated by antimony and
 mercury,  and one hundred by diet  and  rest. Of the  cases
 treated by blood-letting, 27 died;  of those treated by antimony
 and mercury, 21 died; by diet and rest, 7 died.
   To the candid and impartial  observer  of facts,  the general
 fatality accompanying this practice  is conclusive on this point.
 Within my own experience I could enumerate hundreds who,
 while in the bloom of health, upon  some  trifling ailment have
 submitted themselves to be bled, and thus offered up their livea
 upon the altar  of this  murderous  practice.  These are a few
 among the many facts which lead us to condemn the use of the
 lancet.   Another therapeutic  agent in  the allopathic materia
 medica which we reject, is  mercury with all its  preparations;
 for ample experience has shown, that the allopathic axiom  that
 medicines which will produce one train of morbid  phenomena
 will remove an already existing disease,  is not successful  in
 combating disease; but, on the contrary, has greatly  enlarged 
PRACTICAL PRINCIPLES.
43
 the biHs of mortality, and increased the  amount of human suf-
 fering.   It is not true that two diseases will not manifest them-
 selves in the  human organism  at  the  same  time, as common
 observation will show.  It is  true that while patients are laboring
 under the specific influence of mercury, they, at the  same time,
 suffer  from the  ravages of other  morbid influences  equally
 disastrous  to  the  life  and  health  of the patient.  Nothing is
 more common than to  see  patients die of idiopathic  fevers,
 syphilis, small-pox, phthisis, pneumonia, pleurisy,  inflammation
 of the  brain,  stomach,  bowels, &c, while under the  specific
 influences of mercury.   Statistics show that a much larger por-
 tion  die, when thus treated, than when left to the unaided efforts
 of nature.  This fact was fully appreciated by Lord Byron after
 recovering from a very severe attack of fever.  He stated that
 after a week of half delirium, burning skin, hot headache, hor-
 rible sensations, and no  sleep, by  the blessing of  barley-water,
 and  refusing to see his physician, he recovered.
  Lord  Byron was not the only one  who realized the inefficiency
 of the allopathic method of  treating disease.   A large majority
 of the most intelligent  people have felt, for the last two-thirds
 of a  century, the  importance of  an entire revolution  in our
 therapeutic resources.  The  following are the preparations of
 mercury most  in use :
  The blue-pill, which is  a preparation of quicksilver, rose-leaves
 and honey.
  Bichloride of mercury,  or corrosive sublimate.
  Chloride of  mercury, or Calomel.
  Ammonio-chloride of mercury, or White Precipitate.
  Red Oxide of mercury, or Red Precipitate.
  Bicyanide of mercury.
  Sub-sulphate of Peroxide of mercury.
  Nitrates of mercury.
  Iodide of mercury.
  The symptoms of large doses of Bichloride of mercury, as
 described by Taylor in his Medical  Jurisprudence, page 87, aro
nausea,  with vomiting of long stringy masses  of white  mucus,
mixed with blood, followed by profuse purging.
  The pulse is small, frequent, and irregular, being scarcely
perceptible as the  disease advances.  The tongue is white and
v 
44             PRACTICAL  PRINCIPLES.
shriveled, the skin is cold and clammy, the respiration difficult,
and  death is commonly preceded by fainting, convulsions, and
insensibility. The mouth is swollen and the urine is suppressed.
The  symptoms  produced by corrosive sublimate, in the first in-
stance, resemble cholera.  The quantity necessary to destroy life,
according to Taylor, is from three to five grains.
  Chloride of mercury, or calomel, is poisonous in doses similar
to corrosive  sublimate.   A  case is  reported in the Medical
Gazette (18 vol., p. 484), in which  a boy, aged fourteen,  was
killed by one dose of six grains of calomel.
  It  is stated, by Mr. Taylor, that no salivation was produced in
this case.   Pereira mentions a case of a lady who was killed by
a dose of twenty grains of calomel.   Sobernheim states that  a
girl,  aged  eleven,  took  eight  grains of calomel in twenty-four
hours, for croup, and died in eight days from inflammation  and
ulceration of the mouth and fauces.
  Dr. Taylor mentions a case, which occured at Lesser, where
fifteen grains of calomel produced similar effects, and the patient
died  in eight days.  Dr. Christian mentions a case in  which two
grains of calomel destroyed life by the severe salivation induced,
as well as by the ulceration of the throat.  Taylor, in his Medi-
cal Jurisprudence, page  80, mentions a case, where  two-thirda
of a  grain of calomel was given to a boy, aged eight years, pro-
ducing violent salivation and necrosis of the  bones.
  In another instance, a little girl, aged five, took daily, for three
days, three grains of mercury and chalk-powder.  Her mouth
was  severely affected ;  sloughing ensued, and she died in  eight
days.  In a third case,  a boy,  aged eleven  years, took three
doses of this powder — one of six grains on  the 14th, a similar
dose on the 17th, and four grains  on the 20th, making altogether
sixteen grains.   The most profuse salivation ensued, slougbino
commenced in both cheeks and rapidly extended through  them!
The  boy di'-d in four days.  Previously  to  the exhibition of the
mercury .e had recovered from an attack of  fever.  In a fourth
case, three grains of blue pill, given twice  a day, for three days,
making eighteen grains, were ordered for a girl, aged nineteen^
who complained of a slight pain  in her  abdomen.° Severe 8ali-
vation supervened, the teeth separated, and she died in twelve
days.  Dr. Craigie says the great objection to the  employment 
PRACTICAL  PRINCIPLES.
45
of any preparation  of quicksilver in the cure of renal disease,
consists in the fact, that the use of the mineral is known to
render the urine albuminous, to increase the inflammatory state
of the system, and to induce the disease, the effects of which, it
is expected, to remove.  Another evil is that, in persons laboring
under symptoms of granular kidney, a very  small quantity of
mercury induces salivation, and renders the mouth  tender and
most painful.  (Practice of Physic,  ii., 1148.)
  Prof. Z. Freeman reports a case, in the August number of the
Eclectic Medical Journal, 1854, p. 345, of a girl who took  calo-
mel and jalap for a cathartic.  It was followed by severe saliva-
tion, gangrene and necrosis  of the jaw bone.  He  states, that
himself and Dr. Newton took from the jaw  four pieces of bone,
each over an inch in  length and three-fourths of  an inch in
thickness, including a number of  teeth.  The jaw was anchy-
losed and the mercurial bone fcetor was very offensive in this
case.   He mentions another case which came before him while
he was lecturing in Memphis, in which the jaw was necrosed,
and the features horribly mutilated, as the effects of mercury.
I knew a case of a lady, treated by a homoepathic physician for
remittent  fever, who took corrosive sublimate,  as admitted by
the physician, one grain a day, for three days, producing violent
salivation and ulceration of the  mouth, with  a strong tendency
to gangrene, followed by persistent vomiting, prostration, and
death in the course of five or six weeks.  Upon making a post-
mortem examination, the mucous membrane of the stomach, and
upper portion of the bowels, were found entirely disorganized by
the effects of the mercury.
  Dr. Norris, surgeon in the Pennsylvania Hospital,  stated, in
a recent clinic, that he had not prescribed  mercury in cases of
syphilis for the  last twenty years,  and that patients did much
better  than  before.  Dr. Dick, of Calcutta, states, in a letter to
Dr. Sanders, that chronic liver attacks frequently  follow the
long continued use of mercury.   Dr. Nichols, surgeon in the
British army in India, states that most of the  soldiers, who were
treated for venereal disease with mercury, were exceedingly liable
to inflammation of the liver.  Dr. M. Dessuelles, that from his
experience in the treatment of one thousand three hundred and
twelve cases  of primitive and secondary syphilis without mer-
       5 
46
PRACTICAL  PRINCIPLES.
cury, that the average  duration of the disease was  only thirty-
two  days, while  those  treated with mercury were not only
subject to a much longer period of the disease, but a  far less
number recovered.  Prof. J. G. Jones  stated, in his lectures, that
he had not used a grain of mercury  for twenty years.  And it
is well known that  he treated every variety  of disease with
almost uniform success.
  Dr. Pulte, in his Homcepathic Domestic Physician, states that
mercury causes the  following diseases and symptoms.  Hence
he recommends it to cure the same, upon the principle described
by Shakspeare.
       "Tut, man ! one fire burns out, another's burning;
           One pain is lessened by another's anguish :
         Turn giddy and be helped by backward turning ;
           One desperate grief cures with another's languish;
         Take thou some new infection to thine eye,
         And the rank poison of the old  will die."
  Swelling and inflammation of the glands ; inflammatory fevers,
with disposition to perspire profusely; rheumatic, or catarrhal
headache ; scrofulous rheumatic ophthalmia;  syphilitic ophthal-
mia; rheumatic prosopalgia and tooth-ache; dysentery;  mucous
or bilious diarrhoea ; influenza.
  Symptoms: — Enlargement, inflammation, and ulceration of
the glands, with pulsative and shooting pains.
  Copious and Colliquative sweats.
  Vertigo, principally on getting up.
  Itching,  tickling and burning in the eyes.
  Tearing, stinging and drawing pains in the ears.
  Bloatedness and swelling of the face.
  Tearing, stinging,  or pulsative pains in  the carious teeth.
  Putrid smell from  the mouth.
  Stinging pains  in  the  throat and  tonsils, principally  when
swallowing.
  Acid and mucous taste ; dislike to all food.
  Violent empty eructations; excessive tenderness of the stomach
and precordial region.
  Loose and dysenteric evacuations.
  Frequent, copious emissions  of urine, like diabetes.
  Catarrh, with febrile shivering. 
PRACTICAL  PRINCIPLES.
47
  Difficulty of respiration, with attacks of suffocation at  night.
  Obstructions and inflammatory swellings of the glands  of the
neck.
  Sharp pains in the shoulders and arms.
  Sharp and piercing pains in the hip-joints.
  We have given some of the reasons why we reject the use of
mercury  and all its  preparations in the treatment of disease.
We urge the same objections against the medicinal use of copper,
antimony, arsenic, lead, zinc, tin, in short, against all minerals
not found as a component part of the organic  structure  of thf
human body.  And if our limits would permit, we could produce an
array of facts, proving, beyond a reasonable doubt, that the use
of all these mineral substances is absolutely disastrous to  health
and life.   The mineral substances, which are constituents of the
human organism, and can be used with benefit in the treatment
of disease, are the following : *
  Lime, or its base, calcium, is combined with  the  carbonic or
phosphoric acid, in the bones and teeth.
  Magnesia, in the sebaceous matter of the skin.
  Alumina, in the  enamel of the teeth.
  And iron in the black pigment of the various  parts, and in the
blood.
  Metallic bases of  earth : — Calcium,  magnesium, silicium,
aluminum.
  Phosphorus, sulphur, chlorine, and fluorine.
  Metals ; iron,  manganese,  titanium.
  Water, found  universally,  composed  of hydrogen and oxygen.
  Carbonic acid, found in urine, blood, and sweat.
  Carbonates, or salts of carbonic acid and a base.
  Carbonate of soda, in serum, bile, mucus, sweat, saliva, tears,
cartilage, &c.
  Carbonate of lime, in cartilage, bone and teeth.
  Carbonate of magnesia, in the sebaceous matter of the  skin.
  Phosphate  of  soda,  in serum,  saliva, in sweat, bones, mus-
cles, &c.
  Phosphate  of lime, in  bones, teeth, cartilage, and the  sandy
concretions of the pineal gland.
* Wilson's Histology. 
48
PRACTICAL  PRINCIPLES.
  Phosphate  of  soda and ammonia, in urine and blood ;  but
probably only for the purpose of being excreted or thrown off
as unfit to constitute a part of the animal body.
  Phosphate  of iron, in blood, gastric juice, and urine.
   Chlorine and its compounds:—
  Hydrochloric  acid, in gastric juice and in  the fluid of the
caecum.
  Chloride of sodium, in blood, brain, bone, muscle, cartilage,
pigment, and gastric juice.
  Chloride of potassium, in blood, gastric jjuice, milk and saliva.
   Chloride of ammonium, in sweat and gastric juice.
   Chloride of calcium, in gastric juice.
   Sulphuric acid and its compounds:—
   Sulphate of potassa, in urine, gastric juice, and cartilage.
   Sulphate of soda, in sweat, bile, and cartilage.
   Sulphate of lime, in bile, hair, and cuticle.
   Sulpho-cyanide of potassium, in  the saliva.
   Fluoride of calcium, in the enamel of the teeth.
   Silica and  oxide of manganese, in the hair.
   Alumina, in the enamel of the teeth.
   Oxide of iron, in blood, black pigment, lens and hair.
   Oxide of titanium, in the capsulae renales.
   The above  minerals, and their compounds, being constituents
of the animal organism, necessarily play an important part in
the  great  drama  of organic life ; and disease of  any of the
tissues may, and frequently does  occur, from  a  deficiency of
some of the elements of the parts.  The blood may become dis-
eased  from a deficiency of iron, sodium, or potassium; in this
case a proper administration of  these articles may be beneficial.
A lack of sulphur  and soda in the  system may cause a defi-
ciency of bile ;  in which case a supply of them may restore the
liver to its normal condition, and the bile to its natural quantity.
Thus while all minerals, which constitute a part of  the organic
structure,  not only become  assimilated and assist in restoring
the abnormal conditions of the  system to a healthy state__all
minerals which  do not enter into the  organization of any of the
various tissues, when introduced into the system^  act as foreign
agents, and  prove a constant source  of irritation,  disease and
death. Having  hinted at what we conceive to be some  of the 
PRACTICAL PRINCIPLES.
49
facts relative to the past and present  condition of Medicine, we
now proceed more directly to consider  some of the principles
which guide the great American movement for the reform of the
medical profession.
  1st. A determined effort to ascertain more precisely than has
been done hitherto the natural cause and events of diseases.
Or, in other words,  the  fatality  of disease  when left to  the
unaided efforts of nature.
  2nd. A determination  to  understand  more  fully the  modus
operandi  of  medicines,  and to  ascertain their real curative
powers.
  3rd. To continue our researches in the vegetable, mineral and
animal kingdoms for the purpose of developing resources for the
removal of disease.
  4th. To introduce into the profession a spirit of liberality and
progression;  to dispense  with all  creeds  and cliques, and to
overcome all party prejudice among the different members of the
profession.
   5th. That it is the  duty of every physician to investigate  each
system of medicine,  and  make its valuable resources available
for the relief  of the sick.
   6th. That both  science  and experience have demonstrated that
the use of mercury, lead, zinc, arsenic, and the entire catalogue
of minerals, incompatible with the  organic tissues, is a fruitful
source of disease, and dangerous to life.
   7th. That blood-letting is  one  of those  dangerous practices,
which experience  has found to be  positively  injurious in  all
cases.
   8th. That the pharmaceutical method of compounding a  great
variety of medicines  into syrups, powders, pills, &c, not  only
prevents  the physician  from ascertaining their  real curative
 powers, but the action of each is frequently neutralized, and the
 object defeated for which it was given.
   9th. That it is  far  better to leave the disease to the unaided
 efforts of nature,  than attempt to remove it with  medicine, un-
 less its indications are demonstrated by  observation and science.
   10th.  That investigation  and  research  into the nature and
 cause of  disease should be encouraged, and all new  facts  rela-
 tive to medical soienoe should receive due attention.
                              5* 
50
PRACTICAL  PRINCIPLES.
  11th. That neither Allopathy, Homoeopathy, nor Hydropathy,
as an exclusive system of medicine, has arrived at any consider-
able degree of perfection, as shown by the fact that neither very
materially lessens the natural fatality of  disease;  although,
occasionally, each of these may prove successful, as  shown  by
the power of cold water to allay inflammation, which  is Hydro-
pathy;  by nitrate of silver for aphthae of  the  mouth, which
is Allopathy; or by rhubarb for diarrhoea, which is Homoeopathy.
Each of these systems of medication being  occasionally appli-
cable in removing disease,  they  should be  understood  by the
physician, and adopted as indicated.
  12th. To discourage, by every  honorable  means, the baneful
practice of constant drugging for  all trifling diseases.
  13th. To investigate and adopt  the physiological and hygienic
methods of curing and preventing disease by a proper  regulation
of the  diet, temperature and  purity of the air,  by bathing,
friction, proper clothing, occupation, mental and physical train-
ing, &c.
  14th. That the practice of physicians, of spending  their time
in idle conversation, electioneering  and otherwise, in pursuits
foreign to the  profession, disqualifies them for practice; and that,
to be a skilful physician, the whole  energies of body and mind
should be devoted to the profession.
  15th. To avoid adopting any set  of  dogmas in medicine  as
infallible ;■ bearing in mind, that a constant change  of opinion
relative to the  fundamental practical principles of the  art, shows
that what men supposed to be true at one time, have been proved
to be entirely erroneous at another, and that the only means of
advancing medicine  to the rank  of an  exact science, is by the
constant rejection of old errors and the reception of new and well-
attested truths.
  16th. To combine the two extremes  of the profession__the
ultra-conservative and the fanatical reformer.  As conservatives
we would pay  due respect to the labors and discoveries  of our pre!
decessors in  the  profession, and adhere with commendable zeal
and dignity to those doctrines which long usage, and extensive ex-
perience and science have demonstrated to be true.  As  reformers
we would extend cur researches in every direction which promised
accession  to the already existing stock of medical knowledge 
PRACTICAL  PRINCIPLES.
51
 paying no homage to the aristocracy and learned pedantry of
 the profession, only so far as it has contributed to the advance-
 ment of science.  Finally, that we adopt and adhere to the facta
 of the conservative, and  enter into the labors  of  the reformer,
 with equal cordiality.
   17th. To use every practical means to inform the public upon
 the subject of medicine  in all its departments, that they may
 understand the true merits of the different systems of medicine,
 and be prevented from trusting their  lives and  health in the
 hands of men ignorant of the principles  and practice of the
 profession.
   18th. To cultivate the spirit of true Eclecticism, liberality and
 progression ; and to show the positive necessity that every phy-
 sician or student of  medicine, who  would  acquit himself with
 honor and with  fidelity to  his practice,  should not only pass
 through the ordinary and preliminary course of study, but that
 his whole time and attention should be  devoted to  the investiga-
 tion of all the  therapeutic resources of  every school of the pro-
 fession, selecting from each that whic'a science and experience
 has proved beneficial in the treatment of disease.
   It will be seen from the foregoing,  that the principles laid
 down as the basis of the American Medical Reform, cover every
 department of  the science.  That they propose to annihilate the
 boundaries of  party limits; to break  the  shackles which bind
 the conservative to his dogma ;  to reinvestigate existing symptoms
 of medicine,  and study anew all the  laws of life and health ; to
 ascertain  to what extent  health  may be promoted and  disease
 prevented.   This is the  work which has  been commenced  by
 American Medical  Reformers, and  to the completion of which,
 they will  consecrate their future labors.    They desire to esta-
 blish  a practice based upon scientific  principles and inductive
 experience.   They claim that, as a man is composed of the com-
 mon elements of  matter, that  to understand his organism in its
 physiological, pathological  and  therapeutical  relations,"is to
 understand his material structure and forms, with their various
 movements and forces, and cause of forces, which necessarily
 includes an intimate knowledge of the great branches of Physi-
 cal Science, vegetable, animal, aed  mineral, with  all the laws
and forces which  control them-, as electrical, magnetical, chemi- 
52             PRACTICAL  PRINCIPLES.

cal, dynamical,  and physiological or organical.   The  fallacies
of all former  doctrines in medicine have, in a great measure,
arisen  from  a  want  of this  important  knowledge.    The
allopathist,  in establishing his system  of medication, that all
diseases are cured by medicines that  alter or change the struc-
ture or physiological forces  of diseased parts, entirely omitted
the chemical,  organic and vital dependencies of matter, as the
very disease which he intends to remove, by altering the organic
tissue,  may  depend upon  deficiency of  carbon, nitrogen, hydro-
gen or oxygen.  As these substances alone possess the power of
combining and forming the basis of all the  elementary tissues,
a deficiency of either of these elements  may give rise to a series
of pathological changes that  no allopathic alterative could over-
come, the only remedy being to introduce into the diseased organ-
ism its original elements.
  Suppose the gastric fluid to  be imperfect, as it frequently is,
owing  to  a  deficiency of oxygen to  unite  with  the chyle and
blood, out of which it is formed. Any attempt to re-establish the
normal quantity by alteratives would prove as effectual as an
attempt to  reorganize water, after the oxygen is  set free, by
adding alteratives.  A deficiency of the carbonates may cause a
disease of the liver, lungs, cartilage, bones  or muscles.  It is a
fact that carbon, united with  soda, constitutes a large portion of
bile; that, combined with lime, it forms one of the elements of
the teeth,  bone, &c.;  that  it unites with oxygen in the  lungs  to
maintain animal temperature.  Let us inquire, of the allopathist,
how many  doses of  mercury, how much  alterative  influence,
from bleeding and blistering, will compensate for this deficiency.
It must be borne in mind that the human system is an extensive
organic chemical laboratory, in which is manufactured germ-
cells, epithelium, mucus,  muscle, nerves, brain,  gastric juice,
saliva, chyme, chyle, blood, lymph,  tears,  hair,  nails, cuticle,
cartilage,  bone, &c.   The  object of this extensive manufactory
is to furnish  material  for the constant  demand made by the
human body, that it may  maintain its integrity and perpetuity.
This constant demand arises  from the fact, that not only all the
inorganic, but the organic elements, which come in contact with
the human organism, tend to unite with it  and form  new  com-
pounds, structures and forces, thereby disturbing the natural 
PRACTICAL  PRINCIPLES.
53
relations and  dependencies of the human  organism upon its
organic elements, causing disintegration  and destruction of the
old tissue, which is supplied by these newly-manufactured pro-
ducts.   Any excess or deficiency in the supply is disease.   And
the only  philosophical  method of  curing  or removing  such
abnormal conditions  is  to supply elementary deficiencies, pre-
vent excesses,  and maintain the natural relation of elementary
principles to the human organism.  What is true of Allopathy
is equally true of  Homoeopathy.  Who, after a moment's reflec-
tion,  would suppose that chlorosis, which every pathologist
admits  is dependent upon a  deficiency of iron in  the blood,
could be  removed by infinitessimal doses of charcoal, oyster-
shell, mercury and  arsenic.   Or who would suppose that the
same remedies would remove disease of the bones, caused by a
deficiency of lime  and carbon in the  system.  But, what is still
more ridiculous and  absurd, in this hair-brain theory of Hahne-
mann and his  followers, is, that  their remedies,  as mercury,
arsenic, belladonna, &c, are capable of causing, and consequently
of curing, fifty or sixty diseases each.  Jahr, in his Manual  of
Homoeopathy, vol. i., p. 563, states that sulphur will both cause
and cure the feeling  of  despair of eternal salvation.   Lachesis
(p. 310,  Jahr's  Manual) produces, and  hence  should  cure
absence of religious  feeling and fear of approaching death; a
small dose of  gold, taken internally, produces excessive scruples
of conscience,  and despair of one's self and others; veratrum
produces  extraordinary taciturnity, with oaths on the slightest
provocation, and raving about religious matters. Aconite (p. 3)
produces  an irresistible  desire to  blaspheme and  swear, and a
sensation as if the mind was separated from the body.  Ana-
cardiuni (p. 33) produces the  same swearing symptoms and
absence of all moral and religious feelings; (vol. ii., p. 155) a
dose  of common  colocynth  (an ingredient in allopathic pills
which most people  have repeatedly swallowed) produces (says
Jahr,  p.  189)  want of all  religious  feeling, &c,  &c, &c.
Lycopodium  (club-moss) possesses  the same power (p. 319)  as
6ulphur, i. c. the feeling  of despair of eternal salvation.   Pulsa-
tilla causes, and will cure, despair of  eternal happiness, with
eontinued prayer and devout aspects (Jahr, p. 468).
   Thus, while Homoeopathy is equally  unphilosophical in  its 
54             PRACTICAL  PRINCIPLES.

general principles, it has advanced some of the most extravagant
notions relative to the action of medicine ever advocated by any
sect  in the profession  since  the magic incantations  of the fol-
lowers of iEsculapius.   If  it were  true  that these remedies
would produce  such terrible conditions of body and mind, the
effects would be still more, disastrous.
  In this case,  a patient, who was curing himself for itch with
sulphur, would be seized with despair of eternal salvation ; also,
according to  Pulte's Homoeopathic Domestic Practice, p. 516, he
would contract  periodical and intermittent head-ache; obstruc-
tion of the ears, with humming and redness ; inflammation and
ulceration of the nose; profuse perspiration day and night; con-
gestion of blood in the head ; heat in the face ;  tooth-ache ; sore
mouth;  dislike  for sweets ; pain  in the  abdomen; constipation
and piles.   We can readily conceive how a  person, who was
suffering under the influence of the above disease, would be will-
ino-  to endure many inconveniences to obtain relief, but, that he
would exchange it for such .a catalogue of ills is quite doubtful;
and yet, if the homoeopathic doctrine be true, and their notion8
of the action of remedies correct, such would  be the case; and
while one morbid condition  of the human organism was being
corrected, several hundred others  would make their appearance.
It is frequently claimed, by the  disciples of this system, that
although the law of similia similibus curantur cannot be  esta-
blished by appeal to the philosophy of medicine, still experience
teaches it to  be true in practice, and they have observed cases to
recover while under its influence.   This may be true, and yet it
may not follow that the  medication contributed in  the least to
the  result; as it is now a well-attested fact that, without medical
interference, the average mortality of all disease in this country
does not exceed seven per cent.   Hence, to ascertain the useful-
ness of any system of  medicine, it is  necessary not only to
 observe  that some  recover, but also  how many the profession
 loses: if above seven per cent., it may be inferred  that medica-
 tion increases the mortality of disease.  The limits of this work
 will not permit me to  enter into a full  investigation  of these
 different systems of medicine, and show what I conceive to be
 true relative to all their principles.   But in  accordance with the
 principles of American Eclecticism, while we would reject every 
PRACTICAL  PRINCIPLES.
55
hypothesis not founded  upon science, we would  gladly adopt
whatever Homoeopathy, Hydropathy or Allopathy contributes to
the real advancement of medicine.
  The therapeutic principles which guide us, then, are neither
exclusively Homoeopathic, Allopathic, Hydropathic, Antipathic,
Physiological, nor Hygienic; but, by an intimate knowledge  of
the laws of life and organic elements of the different tissues,
with a correct view of  all the causes and  influences brought to
bear upon the human  organism, together with a knowledge  of
all  the physiological and  pathological changes connected with
disease, we are enabled to  adopt  such principles of cure as the
nature of the case may indicate.  In the choice of our remedial
agents, we claim equal independence and liberality, selecting
from all systems  such as science  and enlightened experience
prove to be beneficial  to the afflicted, having formed no definite
boundary to  our researches; for, as yet, no theory of medicine,
as  an independent system, has  been able to stand the test  of
scientific  analysis and experience.  -The  following remarks  of
Thomas Jefferson, in a letter to  Dr. Worcester, are to this point.
He says:—" I have lived, myself, to see  the disciples of Boer-
haave, Cullen, Stahl, and  Brown,  succeed each  other like the
shifting figures of the magic lantern," and the practice predicated
thereon, of course as evanescent and as  changing as its sister
theory ; and we, of the present time, have, most of us, witnessed
one entire revolution  in theory and practice of disease; while
we are at this very moment, on the last quarter of the full moon
glory of a fast fading system.  Where  is the practitioner so
wedded to the past, so tenacious of early practice, and so un-
compromising of change as to  risk his reputation or the  lives
of his patients, on the practice of twenty years ago ?  It is  more
 than probable that before  another  half century has passed, the
present system of  Hydropathy, Homoeopathy and Allopathy,
like  the  systems of Hoffman,  Boerhaave, Cullen, Stahl, and
Brown, will  be remembered only as a relic of the past.  The
well-attested truths of each will, no doubt, be treasured up by
the  American democratic or   Eclectic   cultivator of  medica]
science, to contribute to that perfection in medicine, which will
enable it to take rank  with Chemistry, Geology, or Mathematics.
To accomplish this is the object of American Eclecticism. 
56
DIAGNOSIS.
                    DIAGNOSIS.
  The methods  resorted to for the  purpose of estimating the
condition of the  various organs and tissues of the body, are—
1st. Inspection, which comprises a complete examination of all
portions of the  body.  On inspecting the chest, observations
should be made as to its  configuration; whether it is deformed
in any way by disease, or whether the deformity is congenital.
The motions of the chest should also be  examined, as a forced
inspiration indicates spasmodic asthma; and a partial inability
indicates pleurisy, &c.  2d. Palpation.  By palpation is under-
stood the application of the hand, or tips of the finger to the va-
rious  portions of the body, so as to ascertain whether there  is
fluctuation, diminished or increased sensibility, &c.  3d. Men-
suration.  This  consists  of various measurements of different
parts of the  body, in order to learn  the alterations, motions,
size, &c.  4th. Percussion.  The sounds produced by percus-
sion, according to Mr. Bennett, are those occasioned in the solid
textures of the organ percussed.  The different density and elas-
ticity of these textures will, of course, more or less modify the
number and condition of the vibrations, and give rise to different
sounds.
  M. Piorry considers  that nine  elementary sounds  are thus
formed; which he has designated, from the organ or part which
originates  them,  "femoral, jecoral,  cardial, puimonal,  sto-
machal, osteal, humorique, and hydatique."   I consider  that
all these sounds  may be reduced to three elementary ones; that,
in point of fact,  there are only three  tones occasioned by per-
cussion, and that all the others are  intermediate.  These three
tones are, respectively, dependent—1st. On the organ's contain-
ing air; 2d, on its containing fluid; and 3d, on its being formed
of a dense, uniform, parenchymatous tissue throughout. These
tones, therefore,  may be termed the  tympanitic, the  humoral,
and the parenchymatous.  Percussion over the empty stomach
gives the best example of the  first kind of sound; over the dis-
tended bladder, of the second; and  over the liver,  of the third.
Certain modifications of these  sounds occasion the metallic and
cracked-pot sound. The latter is made audible  over the chest
under a variety of circumstances, by  percussing with the mouth 
DIAGNOSIS.                   57
open.  The terms jecoral, cardial, pulmonal, intestinal, and sto-
machal, however, may be used to express those modifications
of sound produced  in percussing respectively the liver, heart,
lungs, intestines, and stomach.
  No description will suffice to convey proper ideas of the va-
rious alterations of tone occasioned by percussing over the dif-
ferent thoracic and abdominal viscera.  To become acquainted
with these, it is absolutely necessary to apply the pleximeter to
the body, and then half an hour's practice with this instrument
and the hammer will be sufficient to render any one conversant
with those sounds which  may be heard in a normal state.
  It must be remembered, however, that the  tones, even then,
may vary according  to circumstances.  Thus, after  a deep in-
spiration, the pulmonal sound will be rendered  more tympanitic,
and, after expiration, more parenchymatous.  In the same man-
ner the stomach and intestines may give out  different sounds,
according to the nature of their contents."  In  the left or right
iliac fossa a clear tympanitic sound will be heard when the in-
testine below is empty; and a dull, parenchymatous sound, when
it is full of faeces.
  A study of the different modifications of sound, which various
organs  thus  produce in a state of health, readily leads to the
comprehension of the sounds which may be elicited in a morbid
state.   Thus, the lungs may occasion a dull or parenchymatous
sound, from  solidification, the  result  of exudation;  or, on the
other hand, become more tympanitic, from the presence of em-
physema.  The abdomen may give out a parenchymatous sound,
from enlargement of the uterus, or "an ovarian tumour; or a
dull, humoral sound, from the effusion of fluid  into the cavity of
the peritoneum.
  Of the Sense of Resistance produced by Percussion.—By
the sense of resistance is  understood  the peculiar sensation re-
sulting from those impressions which are communicated to the
fingers  on striking  hard, soft, or elastic bodies.  It is  of the
greatest service in  determining the  physical  condition of the
organ percussed. The sense of resistance bears relation to the
density of the object struck; hence firm and solid textures offer
more resistance than those which are soft or elastic.  The tho-
        6 
 58                   DIAGNOSIS.

 rax of the child is elastic, whilst that of the adult is unyielding.
 Of all the thoracic and abdominal organs, the liver presents the
 greatest degree of resistance, and the stomach the least.   The
 presence of fluid  in  the  hollow viscera offers  an amount of re-
 sistance between  the parenchymatous organs on the  one hand,
 and  those  containing  air on  the other.  But  air much  con-
 densed, or fluid contained within the rigid walls of the thorax,
 may offer a considerable  degree of resistance.
  The sense of resistance should be as much  educated by the
 physician as the sense of hearing; and it would be difficult for
 an individual, practised in the art of percussion, to say which of
 these two points is the most valuable to him.   Both are only to
 be learnt by practice; and we consider it perfectly useless to
 describe that in words, which may be learnt in half an  hour by
the use of the pleximeter and hammer on a dead body, or the
living subject.
Fig. 1.                              Fig. 2.
  In order to more fully comprehend the location of the various
organs so essential to a more complete understanding 0f the
proper method of percussion, we refer to figs. 1 and 2 which 
                     DIAGNOSIS.                    59

represent the normal extent of dulness.  Notice, on percussing
a healthy individual, fig. 1 represents the anterior, and  fig. 2
the posterior positions;  P P, pulmonary  sound; C, cardial
sound ;  H, hepatic sound; S, splenic sound; G, gastric sound;
E, enteric sound; Co, colic from distended colon; H H, humo-
ral sound over the distended bladder; M, muscular, and 0, os-
teal sounds.—(Piorry.)

                           Fig. 3.
  On percussing  the lung, especial reference should be had to
detecting  the  healthy from the unhealthy, by  comparing the
opposite sides of the chest, and the various sections of the same
lung.  In the  healthy lung, a marked difference in the  reso-
nance is observed from that in which the lung is diseased. Con-
gestion of the lungs, in the first  stage, causes  only slight dul-
ness.  In  the last stage, where the congestion is extensive, the
dulness, is almost complete;  and in partial indurations of the
lungs from apoplexy, or cancerous exudations, the dulness heard 
60
DIAGNOSIS.
will be circumscribed, and always correspond to  the extent of
the diseased  portion.  Cavities in the lungs, when filled with
air, may be detected by the  excessive  resonance, or tympanic
souud.  Cavities may be filled; in which event they will yield
a dulness on percussion.  On percussing the lungs, it is well to
change the posture of the patient; as, in case the dulness is de-
pendent upon a fluid effused  into the pleural sac, the area or
extent of dulness will change with the posture of the patient.
When the  lung  is emphysematous, or  if air be present in the
pleura, the sound elicited will  be tympanitic.   Tympanitis, how-
ever, may be  heard  in other  conditions of the lungs; such as
over-distention of the lungs with air, as  in some cases of pleur£
pneumonia.
  Fig. 3 represents phthisis, atrophied heart and liver.   1, atro-
phied heart;  2, infiltrated tubercles on the left side;  3, the same
on the right side, with the cavity:  4, atrophied liver; 5, spleen;
6, unusual  dulness  over the  abdomen from  prolonged  absti-
nence.—Piorry.
                      AUSCULTATION.
General Rules to be followed in the Practice of Auscultation.
  1. Auscultation may be practised directly  by  applying the
ear to the part, or indirectly  through the medium of a stetho-
scope.  Generally speaking, direct auscultation answers  every
necessary purpose, except when the surface is unequal, or when
it is desirable to limit the sounds to a small region, as during
auscultation of the heart.  In either of these cases a stethoscope
is necessary.   The  instrument is also useful to confirm or nul-
lify the existence of certain fine sounds, which may be detected
by the naked  ear; to remove  the head of the practitioner a re-
spectable distance from the bodies of persons not distinguished
for cleanliness; and lastly, as the most delicate method of aus-
cultating the chest anteriorly in women.  "You should  regard
the stethoscope  merely as a means to an end—that end  being
the right appreciation of the pathological changes indicated by
certain sounds.
  2. In the choice of  a stethoscope, you should  observe—1st,
that the ear-piece fits your  own ear;  2d, that  the  trumpet-
shaped extremity is  not above an inch and a half in diameter, 
DIAGNOSIS.
61
and is rounded so as not to injure the patient's skin when pres-
sure is made  upon it;  3d, that it is light and portable.  The
instruments recently made of gutta percha fulfil all these con-
ditions.
  3. In applying the ear, the body of the patient should be co-
vered only with a smooth piece of linen, or a towel.   But the
stethoscope should be applied to the naked skin, and held stea-
dily above the trumpet-shaped extremity by the thumb and in-
dex finger.  It should be pressed down with tolerable firmness,
whilst with the second, third, and fourth fingers, you  ascertain
whether the circular edge be perfectly applied, which is abso-
lutely essential.
  4. The position of the patient will vary, according to the part
examined.   In auscultating the lungs anteriorly, the erect or
recumbent position may be chosen, the two arms being placed
in a symmetrical position by the side.  If the chest be examined
posteriorly, the individual should lean somewhat forward,  and
cross the arms in front.  In auscultation of the abdomen, va-
rious positions will be required, according as the anterior, late-
ral, or posterior regions  demand investigation.   The  practi-
tioner, also, should  choose such a position as will  prevent  too
much stooping or straining.
  5. Whenever individuals are thrown into such a state of  agi-
tation as to interfere with the action of the heart or lungs, the
examination should be deferred until their fear diminishes, or
the greatest caution should be exercised in drawing conclusions.
Non-attention to this rule has led to many errors.
  6. Before examining patients in a hospital, it is necessary that
you should have made yourselves perfectly acquainted with the
sounds which are continually  going on in  the healthy  body.
Omission  of this rule  not only renders the examination of pa-
tients useless, but betrays great want of consideration; for, as
it is only from the alterations the healthy sounds undergo, or
from their  being replaced by others, that we draw conclusions,
how can this be accomplished if we are ignorant of their cha-
racter in the first instance?   It is expected, therefore, of every
examining pupil, that  he should be familiar with the character
and theory of the various sounds heard in the healthy body be-
fore coming to the bed-side.
                             6* 
62
DIAGNOSIS.
Special Rules to be followed during Auscultation of the Pul-
                     monary Organs.
  1. In listening to the sounds produced by the action of the
lungs, we  should pay attention to three things:—1st,  the na-
tural respiration; 2d, the forced, or exaggerated respiration;
and third, the vocal resonance.   For this purpose,  having lis-
tened to the sounds during ordinary breathing, we direct the
patient to take a deep breath;  and then, still listening, we ask
him a question, and during his  reply judge of the vocal reso-
nance.
  2. You should commence the examination immediately under
the centre of one clavicle;  and having  ascertained  the nature
of the sounds and vocal resonance there, you should imme-
diately listen at exactly the corresponding spot on the oppo-
site side.  The examination should be continued alternately from
one side to the other, in  corresponding  places, until the whole
anterior surface of the  chest is  explored.  The posterior sur-
face is then to be examined in like manner.
  3. When, in the course of the examination, anything different
from the normal condition is discovered at a particular place,
that place and the parts adjacent should be made the subject of
special  examination, until all the facts regarding the lesion be
ascertained.
  4. It  is occasionally useful to tell the patient  to cough,  in
which case we are enabled to judge—1st, of forced inspiration,
as it precedes the cough; and 2d, of the resonance which the
cough itself occasions.

Of the Sounds produced by the Pulmonary Organs in Health
                      and in Disease.
  I am anxious to impress upon you,  that the sounds which
may be heard in the lungs are like  nothing but themselves.
Students are too apt to take erroneous notions from reading on
this subject; and, instead of listening to the sound actually pro-
duced, fatigue themselves in a vain endeavour to hear some-
thing like the crackling of salt, the rubbing of hair,  foaming of
beer, or other noises to which these sounds have been likened.
Preconceived notions frequently oppose themselves to the re- 
DIAGNOSIS.
63
 ception of the truth, and have to be got rid of before the real
 state of matters can be ascertained.  Hence the  great import-
 ance of deriving your first impressions of the sounds to be heard
 by auscultation, not from books or lectures, but from the living
 body itself.
   If you listen through your stethoscope, placed over the la-
 rynx and trachea of a healthy  man, you will hear  two noises,—
 one  accompanying the act of inspiration, and the other that of
 expiration.  These are called the laryngeal or tracheal sounds,
 or murmurs.  If you next place your stethoscope a little to the
 right or left of the manubrium of the sternum, you will hear the
 same sounds diminished in intensity.  These are the  bronchial
 sounds, or murmurs.   If, now, you listen under and outside the
 nipple on the right side, or posteriorly over the inferior lobe of
 either lung, you will hear two very fine murmurs.  That accom-
 panying the inspiration is much more distinct than that accom-
 panying the expiration.  By some, on account of  its  excessive
 fineness, it is stated  that there  is  no expiratory murmur in
 health; but this is incorrect.   These sounds, then, are the ve-
 sicular respiratory murmurs.  All these sounds become exag-
 gerated during forced respiration, but in a state of health they
 never lose their soft character.  Again, if you listen in the same
 places, whilst the individual  speaks, you will hear  a peculiar re.
 sonance of the voice, which has been called in the first situation,
pectoriloquy; in the  second, bronchophony;  while in the third
 it  is scarcely audible.  A knowledge of these circumstances,
 and  a capability of appreciating these sounds, are  necessary
 preliminary steps to the right  comprehension and detection of
the murmurs which may be heard during disease.
  I have to suppose, then, that you have made your  ears fami-
liar with  these sounds, and  that you are acquainted with  the
present state of theory regarding their  formation.  This last
may be stated, in  very few  words, to be, that  the respiratory
murmurs are occasioned by the vibrations of the tubes through
which the air rushes, according to well-known acoustic princi-
ples.  Hence they  are loudest  in the trachea, finer in  the  large
bronchi, and finest in their ultimate ramifications.  The  vocal
resonance,  on the other hand,  originates in  the larynx; and di-
minishes  or increases—1st,  according- to the distance of any 
64
DIAGNOSIS.
point from  the  source of the sound; and 2d, according to the
power which the textures have in propagating it.   If now you
examine, in succession, any cases which are labouring under
well-marked  pulmonary disease, you will have no difficulty in
recognising that all the sounds you hear may be classified into
two divisions:—1st, alterations of the natural sounds; 2d, new,
or abnormal sounds, never heard during health.
  1. Alterations of the  Natural  Sounds.— All the sounds of
which we have spoken, and which can be heard in the lunga
during health, may, in certain diseased  conditions, be increased,
diminished,  or  absent;  their character or  position  may  be
changed; and with regard  to the respiratory  murmurs,  they
may present alterations in  rythm or duration with respect to
each other.
  Alterations inlntensity.—Some personshave naturally louder
respiratory murmurs than  others; if  this occur uniformly on
both sides, it is a healthy condition. Occasionally, however, the
Bounds are evidently stronger at one place, or on side,  {puerile
respiration,) and then they generally indicate increased action
of the lungs, supplementary to diminished action in some part.
In  the same manner there may be feeble respiration simply
from diminished action, as  in feeble or old persons; but it may
also be occasioned by pleurodynia, obstructions in the larynx,
trachea,  or bronchi, pleurisy, pulmonary emphysema, or exuda-
tions filling  up a greater  or less  number  of the. air-cells  and
smaller tubes,  as  in pneumonia,  phthisis,  &c. Complete ab-
sence of respiration occurs when there is extensive pleuritic
effusion,  or hydrothorax.
  Alterations  in  Character.—The various respiratory  mur-
murs may, in eertain conditions of the lung, assume a peculiar
harshness, which, to the ear of the auscultator, is a  valuable
sign, indicative of altered texture.  Thus in incipient phthisis,
the vesicular murmur under the  clavicle is often rude, or harsh.
In  pneumonia, the bronchial  respiratory  murmur presents a
similar character.  When a cavity is formed, it becomes  what
is called cavernous, (hoarse or blowing;)  and  in certain cases
of pneumothorax, with pulmonary fistula, it assumes an ampho-
ric character.
  Alterations  in  Position. — It frequently happens that the 
DIAGNOSIS.
65
sounds which are natural to certain parts of the chest, are heard
distinctly, at places, where in health they are never detected.
Thus, in pneumonia, bronchial^ or tubular breathing, as it is
sometimes called, may be evident, where only a vesicular  mur-
mur ought to exist.  This is often well marked with regard to
the vocal resonance, as certain lesions, which occasion conden-
sation or ulceration of the lungs, will enable us to hear either
bronchophony or pectoriloquy, where, under  ordinary circum-
stances, no voice can be heard.
  Alterations in Rythm.—In health, the inspiration is  usually
three times as long as tho expiration.   In  certain diseased con-
ditions  this relation is altered, or even inverted.  In incipient
phthisis we often  find the expiration unnaturally  prolonged.
In chronic bronchitis and emphysema it is three or four  times
longer than the inspiration.
  II. New, or Abnormal Sounds.—These are of three kinds:—
1st, rubbing, or friction sounds; 2d, moist rattles;  3d, vibrating
murmurs.
  1. Rubbing, or friction sounds, are caused in the  pulmonary
apparatus by some morbid change in the pleurae, whereby, in-
stead of sliding noiselessly on one another, they emit a rubbing
sound.  This  may be so fine as to resemble the rustling of  the
softest silk, or so coarse as to sound like the  creaking of a sad-
dle, grating, rasping, &c;  and between these two extremes you
may have every intermediate shade of friction noise.  This va-
riation  in sound is dependent on the nature of the alteration
which  the pleuras have undergone.  If covered with  a softened,
thin exudation, the murmur will be soft;  if it be tougher and
thicker, the sound will be louder; if hard, dense, and rough, it
will assume a creaking,  harsh, or grating character.  These
noises  are heard in the various forms of pleurisy.
  Moist rattles  are produced by bubbles of air traversing or
breaking in a somewhat viscous fluid.  This  may occur in  the
bronchi, when they contain liquid exudation, mucus, or pus, or in
ulcers  of various sizes.  They may be so  fine as to be scarcely
audible, (when they have been called crepitating;) or so coarse
as to resemble gurgling or splashing, when they have received
the name  of cavernous.  Here, again, between these  two ex-
tremes, we may have every kind of gradation, to which auscul- 
66
DIAGNOSIS.
tators have attached names, such as mucous, submucous, sub-
crepitating, etc., etc.   With these names you need not trouble
yourselves; all that it is important for you to determine is, whe-
ther or not the sound be moist, and you will easily recognise
that the rattles are coarse or large, in proportion to the size of
the tubes or ulcers in which they are produced, and the amount
of fluid present.  These rattles may be heard in pneumonia,
phthisis pulmonalis, bronchitis,  pulmonary apoplexy, etc., etc.
  3. Dry, vibrating murmurs arise when the air-tubes are ob-
structed, constricted, or lose their elasticity, and become en-
larged, whereby the vibrations into which they are  thrown by
the column of air, produce sounds or tones of an abnormal cha-
racter.  Hence murmurs may be occasioned by a fine, squeak-
ing, {sibilous murmur,) or of a hoarse, snoring character, (so-
norous murmur;') and between the two extremes there may be
all kinds of variations, to which ingenious people have applied
names.  These only cause confusion; all that is necessary is to
ascertain that the  murmur is dry, and you will readily under-
stand that the fineness or coarseness of the sound will depend
on the caliber of the tube or cavity thrown into vibrations. They
are usually heard in cases of bronchitis and  emphysema.  Oc-
casionally they present a blowing character, as  when ulcers are
dry, a condition which  often occurs in phthisis.
   The vocal resonance, besides undergoing the  changes already
noticed, in intensity, character, and  position, may give rise to
abnormal sounds.  Occasionally it presents a soft, reverberating,
or  trembling noise", like the bleating  of  a goat, (eegophony.)
The value of this sign, as indicative of pleurisy, was much over-
rated by Laennec.   At present it is little esteemed.  Sometimes
the resonance  gives rise to a metallic tinkling,—a noise similar
to that  caused  by dropping a shot into a large  metallic  basin,
or  the note produced by rubbing a wet finger  round the edge
of  a tumbler, or glass vessel. This is often best heard  imme-
diately after a cough in certain cases of chronic phthisis.  M«o-
phony is supposed to be produced when a thin layer of  serous
fluid between the pleurae is thrown into vibrations.   The cause
of  metallic tinkling has created great discussion, and is not ^et
ascertained.—{Bennett.) 
DIAGNOSIS.
67
            Diagnosis by the Aid of a Microscope.
  In order to obtain a full benefit from  the use of the microscope,
the practitioner should carefully study the various structures
and tissues of all portions of the body,  both in health and dis-
ease, as well as the texture of all animal and vegetable sub-
stances which constitute the nutriments of the body.
  lat.  Examination of the Saliva.—In order to examine the sa-
liva, a drop  from the tip of the tongue should be placed upon a
glass, and allowed to remain quiet for a moment or two, so that
the bubbles  of air may collect on the  top; they should then be
removed, and  the remainder of  the fluid pressed between two
thin glasses  ; then, by applying a magnifying power of two hun-
dred and fifty or three hundred diameters, you will observe sa-
livary corpuscles, which are colourless, spheroid bodies, varying
in size, containing a nucleus, occupying about one-third of the
cell.   The balance of the cell is filled with molecules and gra-
nules.
  The epithelial scales are derived from the mouth, and are va-
riously shaped, but are usually oblong or squarish.  The saliva
may present various  alterations,  depending on diseases of the
mucous membrane of the mouth.  Thus, where there is ulcera-
tion of the mucous  membrane, there is an increase of the mo-
lecular, granular, and epithelial matter.  In some cases inflam-
mation of the mucous membrane gives rise to morbid growths.
These are found mostly upon the borders of aphthous or ulce-
rated portions  of the mucous surface.
Fig. 4.
                           Milk.
  On  examining a drop of milk, we observe a number of milk
corpuscles floating in a clear.fluid: these bodies, in healthy milk, 
68
DIAGNOSIS.
are perfectly spherical, with dark margins.  The globules con-
sist of a delicate envelope of caseine, enclosing a drop of oil or
butter.   The act of churning  consists in  liberating these  fat
corpuscles, which  accumulate  in  a mass, and constitute the
butter.  The richness of the milk  is determined by the quan-
tity of the globules; the various adulterations of milk are de-
termined by the number and character of the corpuscles.  Wa-
ter separates the globules.  Flour exhibits the large starch cor-
puscles, which are  changed blue by the action of iodine.   Chalk
shows numerous irregular  mineral particles.   Brain  substance
can  be  distinguished by large oil  globules, mixed with nerve
tubes.  Healthy milk may be recognised by the uniformity and
size of the globules.  In some cases milk is mixed with pus and
blood, in which event it can be distinguished by the characteris-
tics of these substances.

                         The  Blood.
   On examining a drop  of blood, there will  be  seen a large
number of bi-concave discs, rolling in the field of the microscope,
which soon exhibit  a  tendency to turn upon their  edge, and
arrange themselves in rolls, like rouleaux of coins.  These rou-
leaux, by crossing one another, dispose themselves in a kind of
net-work, between which may be seen a few colourless spherical
corpuscles,  having a molecular surface,  and  a few granules.
The coloured blood-corpuscles vary in size from the one-five-
thousandth to the  one-three-thousandth of an  inch—according
toGulliver, one-three-thousand-two-hundredth of an inch.  Owing
to their  bi-concave form, they present a bright external rim,
with  a  central shadowed  spot, or  a  bright centre and  a dark
edge, according to the focal point in which  they are viewed.
If the blood be exposed to the  air a little time before examina-
tion, or if it be obtained by venesection, the edges of the cor-
puscles may often  be observed to have lost their smooth outline,
and  to have become irregular, notched, serrated, beaded, etc.
Long maceration in serum, or  other circumstances, frequently
cause them to diminish in bulk half their natural size, and to
present a perfectly spherical, coloured body.   On the addition
of water, the blood discs become  spherical, and lose their co-
lour.   On adding syrup, they become flaccid  and  irregular, 
DIAGNOSIS.
69
Strong acetic acid dissolves them rapidly ;  and very weak acetic
acid does so slowly, or diminishes their size by one-half.
  The colourless corpuscles of the blood are spherical in form,
and vary in size from  the one-two-thousand-five-hundredth to
the one-two-thousandth of  an inch in diameter.  Their surface
presents a molecular or dotted appearance, almost disappearing
on the addition of water, when  they swell out by endosmosis.
Acetic acid renders the  acetic cell-wall  very transparent, and
brings the nucleus into  view, consisting  of one, two, or three
round granules.
  The examination of the blood by the microscope enables us
to determine certain pathological conditions of that fluid, which,
though few in number, are by no means unimportant.
  In  certain internal  hemorrhages the blood-corpuscles break
down, or become partially dissolved.  When the external enve-
lope  is seen very  transparent,  the shadowed spot disappears,
and there is found in their interior one or  more granules.  The
liquor sanguinis also contains an unusual  number of granules.
Fig. 5.
  Blood-corpuscles, drawn from the extremity of the finger.  On
the left of the figure they are isolated, some flat and on edge, some
having a dark  and others a light centre, according to the focal
point in which they are viewed.  On the right of the figure several
rolls have formed.  Two colourless corpuscles and a few granules
are also visible.
  The same change is occasionally observable in the blood ex-
travasated below the skin in scurvy, or purpura hemorrhagica.
  In a woman who died  of cholera, Dr. James M. Cowan ob-
served a remarkable alteration in  the blood, which he was so
good  as to show me.  It consisted in the coloured corpuscles
being paler than usual,  and the colourless  ones normal, but
       7 
70                    DIAGNOSIS.

mingled with these were others varying in shape and size.  They
were generally circular; but some were oval, and a few caudate.
They had a well-defined external  smooth border, having one or
two bright, refracting granules, generally situated in the exter-
nal membrane, and occasionally projecting from it.  When
seen edgewise, they were flattened, and existed in the propor-
tion  of one to seven of the coloured corpuscles.  Their long dia-
meter varied from  the one-one-thousand-two-hundredth to the
one-two-thousandth of an inch, and their  transverse diameter
from the one-two-thousandth to the  one-four-thousandth of  an
inch.  The addition of acetic acid caused them to swell out, dis-
solved their external wall, and liberated the granules.  Aqua
potassae rendered the whole structure paler; and a solution of
muriate of soda rendered them more distinct, and of smaller size.
   We have seen that, in a healthy condition, the blood possesses
very few colourless  corpuscles; but there  is a certain state of
that fluid which I was the  first to describe in 1845, and have
since called  "Leucocythemia," or white-cell blood,  in which
they are very numerous, and generally associated with enlarge-
ment of the spleen, or other lymphatic glands.

                           Fig. 6.
  It has been affirmed that the colour and number of the cor-
puscles  of the blood undergo a change in plethora, fever, jaun-
dice, dropsy, cholera,  etc.;  but exact observations are wanted
to confirm  the  statement.  I  have  never  been able to satisfy
myself that any such  changes were observable in these diseases
by means of the microscope.  In chlorosis the number of the
blood-globules  is undoubtedly diminished; but this is  deter-
mined  by the size of the  clot, rather than by microscopic de-
monstration. 
DIAGNOSIS.
71
  Occasionally the serum of the blood presents a lactescent ap-
pearance; and, on being  allowed to remain at rest some hours,
a white, creamy pellicle forms on the surface.  This consists of
very minute particles of  oil, which resemble the smaller mole-
cules found in milk, and  in the chyle.

                           Pus.
  Normal, or good pus, when examined under a microscope, is
found to consist of numerous corpuscles, floating in a clear fluid,
the liquor puris.  The corpuscles are globular in form, having
a smooth margin, and finely granular surface.  They vary in
size from the one-two-thousandth to the one-one-thousand-two-
hundredth of an inch in diameter.  In some of them there may
be generally observed a  round or  oval nucleus, which is very
distinct on the addition of water, when also the entire corpuscle
becomes distended from endosmosis, and its granular surface is
more or less diminished.   On the addition of strong acetic acid
the cell-wall is dissolved,  and the nuclei  liberated in  the form
of two, three, four, or rarely five granules, each of which has a
central shadowed spot.  If, however, the  re-agent be weak,  the
cell-wall is merely rendered transparent and diaphanous, through
which the divided nucleus is very visible.
  Occasionally  these bodies are seen surrounded by another
fine  membrane, as in fig. 7.   At other  times  they are not per-
Fig. 7.            Fig. 8
Pus corpuscles, as seen in healthy pus.
The same, after the addition of acetic acid.
fectly globular, but present a more  or  less irregular margin,
and are associated with numerous molecules and granules. This
occurs in what is called  scrofulous pus, and various  kinds  of
unhealthy discharges  from wounds and granulating  surfaces.
In gangrenous and ichorous sores we find a few of these irregu- 
72
DIAGNOSIS.
lar pus corpuscles associated with a multitude of molecules and
granules, and with transformed and broken-down blood globules,
the debris of the involved tissues, etc., etc.—(Bennett.)
  In serofulous affections the pus corpuscles present an irregu-
lar and disorganized appearance.  (See  fig. 9.)
                           Fig. 9.

                       Vomited matters.
   The first substance observed in vomited matter is the food in
 various stages of decomposition; and  if there is either chronic
 or acute inflammation,  there will be mingled with this portions
 of epithelial lining membrane of the stomach, and other parts
 of the digestive tube.   The new formations which occur in the
 stomach are mostly vegetable fungi, such as iorulce and sarcini
 ventriculi.  In addition to the above the vomited  matters may
 contain pus blood, cancer-cells, bile, &c, &c.

                           Fceces.
   On examination  of the faeces all the elements which enter
 into the composition of the food, and in disease various morbid
 products  will be observed.   In typhoid, and other malignant
 fevers, the fasces will contain large crystals of phosphates and
 carbonates.  They  also contain numerous torulae.

               Uterine  and Vaginal Discharges.
   The menstrual discharge is composed of old and young epi-
 thelial scales and blood globules;  and in cases where the men-
 struation  is connected with disease of the mucous membrane
 of the uterus or vagina,  with pus globules.  The gelatinous dis-
 charge, which is always observed immediately after menstrua-
 tion, consists of mucus, in which are found a large number of
 epithelial cells.  The blood,  which is found in  the menstrual
and leucorrhoeal discharge, is found  altered by exosmosis.   In
leucorrhoea and dysmenorrhcea, in addition to the albuminoua 
DIAGNOSIS.
73
exudation, blood, pus, and patches of epithelial membrane may
be found.   In cases of a cancerous affection of the uterus or va-
gina, cancer-cells will be detected.

                          Mucus.
  The fluids secreted by the mucous membrane are of a gelati-
nous character; and when the membrane becomes inflamed, or
otherwise diseased, the mucous cells become converted into pus
corpuscles.
                     Dropsical Fluids.
  On examining dropsical fluids,  some peculiarities frequently
present themselves;  as, for instance, the fluid collected in the
tunica vaginalis, testes, spermatozoa will frequently be found.
In other dropsical fluids, pus corpuscles, epithelial scales, and
cancer cells are sometimes found.

                           Urine.
  Healthy human urine, when  examined  with a microscope,
is absolutely structureless; but in disease  various substances
may be recognised,  of which  Dr. Bennett  gives  the following
description, (p. 96:)—
   " Uric Acid.— Uric acid crystals are almost always coloured,
the tint varying from a light fawn to a deep  orange  red.  The
general colour is yellow.  They present a great variety of forms,
the most common being rhomboidal.  The  lozenge-shaped and
square crystals are more rarely met with, and are isolated and
in groups.   Not unfrequently they  present adhering masses, or
flat scales, with transverse or longitudinal  markings.  Occa-
sionally they assume the form  of truncated round  columns, with
other structures.
   " Urate  of Ammonia most  commonly assumes a molecular
and  granular form, occurring in irregularly aggregated amor-
phous masses.   This may be  separated from a similar-looking
deposit of  phosphate of lime  by the  action  of dilute  muriatic
acid, which immediately dissolves the last-named salt, but acts
slowly on urate of ammonia,  setting free the uric acid.  Some-
times, however, it occurs in spherical bodies of a bistre brown
colour, varying in size from the one-five-thousandth  to the one-
two-thousandth of an inch in  diameter.  The latter size rarely
occurs.  Occasionally they assume a stellate form,  needle-like
                             7*              .  '         • 
74
DIAGNOSIS.
 or spieular prolongations  coming off from the spherical  body.
 I have seen both these forms associated, and the former  so cu-
 riously aggregated together as to assume the appearance of an
 organic membrane, for which by some observers it was mistaken,
 until it was found  to dissolve  under the action of dilute  nitric
 acid.
   "Triple Phosphate of Ammonia—Phosphate ofMagnesia.—These
 crystals are very commonly met with in urine, and are  gene-
 rally well defined, presenting the form of triangular prisms, some-
 times truncated,  at others having terminal facets.   If an excess
 of ammonia exist, or be added artificially, they present a star-like
 or foliaceous appearance, which, however,  is seldom seen  at the
 bed-side.
   " Most of the  forms of urate of. ammonia are associated with
 the triple phosphate.
   " Oxalate of lime most commonly appears in  the form of octa-
 hedra, varying in size, the smaller aggregated together in masses.
 Once  seen, these bodies are readily recognised.  Very rarely
 they present the  form of dumb bells, or of an oval body, the cen-
 tral transparent  portion of which presents a dumb bell  shape,
 while the shadowed dark portion fills up the concavities.
   " Cystine takes the form of flat, hexagonal plates, presenting
 on their surface marks of similar irregular crystals.  Occasion-
 ally their centre  is opaque, having radiations  more or less nu-
 merous,  passing  towards the circumference.
   "In addition to the various salts  found in  the  urine, there
 may occasionally be  found different organic products, such aa
 blood  and pus corpuscles, spermatozoa, vegetable fungi, exuda-
 tion casts of the  tubes, or  epithelial scales from the bladder or
 mucous  passages.  Frequently one or more of these are  found
 together.
   "  Very rarely casts of the tubes, principally composed of oily
 granules, may be seen, or epithelial  cells, more or  less loaded
 with similar granules, several of which also float loosely in the
 urine.
   " Although these casts of the tubes were at one time confounded
together, they may now be  separated  into at least four distinct
kinds,  namely,—1st, fibrinous or exudative; 2d, desquamative;
3d, fatty; and 4th,  waxy casta.  The inferences  to  be derived 
                      DIAGNOSIS.                    75

from the presence of one or more of these will be especially
dwelt on in the section which treats of urinary diseases.
  " Spermatozoa are occasionally found in the urine, but must
not be considered as of any importance, unless accompanied by
the peculiar symptoms of spermatorrhoea.  The presence of to-
ruloe in considerable quantity is indicative of the existence of
sugar, which  requires,  however, for  its confirmation, the ap-
plication of chemical tests.
  " All the various appearances here noticed are only diagnostic
when accompanied by concomitant symptoms.   Alone, they are
not to be depended on; but, in combination with  the history
and accompanying phenomena, they are capable of affording
the greatest assistance in the detection of disease."

               Cutaneous Eruptions and Ulcers.
  Pus taken from all kinds of eruptions and sores, presents the
same appearance;  thus, the pus taken from eczema and variola
is identical in character.  Squamous  eruptions of the skin  con-
sist of psoriasis, pytyriasis, and ichthyosis.  The dry scales,
found  on the surface in these diseases, consist of flakes of epi-
dermis, more or less aggregated together.  The tumours found.
on  the skin which are  of an epidermic  character, assume the
forms  of callosities, condylomatous warts, and corns.  They all
consist of epidermic scales, more or less condensed.  The favoua

                          Fig. 10.
  Appearance of section of cancerous ulcer of the skin,  a, epider-
mic scales and fusiform  corpuscles on the external  surface; b,
groups of epidermic scales; c, fibrous tissue of the dermis; d, can-
cer-cells infiltrated into the fibrous tissue, and filling up the loculi
of the dermis. 
76
DIAGNOSIS.
crust consists in epidermic scales, lined  with a fine granular
mass, from which millions of cryptogamic plants originate and
fructify.  In cutaneous ulcers of a healthy character the sur-
face is covered with  normal corpuscles.   In  scrofulous or un-
healthy sores the pus is more or less broken down.   In cancer-
ous  ulcers of the skin the fluid obtained from the ulcer will be
observed to be full of cancer cells.   (See  fig. 10.)

                 Chemical Tests in Diagnosis.
   In practical  medicine the most important  chemical tests are
those which detect  the  presence  of  albumen, bile,  sugar, and
chlorides  in  the urine.   To detect  albumen, boil a small por-
tion of urine in  a test tube; and  ifthero be albumen, the urine
will become  thick, and present  the character resembling that
of the white of an egg boiled in water.  To detect bile, add a few
drops  of nitric  acid to a dram or two  of  urine; and if bile be
present, the urine will  assume a greenish appearance.   To de-
tect sugar in the urine, a few drops  of the urine may be placed
on a slip of glass, and  held over a spirit lamp  until the  urine
is evaporated.   If sugar  be present, a dark sediment will re-
main on the glass.   Trommer's test  consists in adding a few
drops of a solution  of sulphate of copper,  which gives the urine
a  pale blue colour.   Liquor potassse  is  then added until the
hydrated  oxide  of  copper thrown  down is again dissolved.
Then boil the solution, and if sugar be present the mixture will
assume a yellowish-red tint.  If  the urine contains  no sugar, a
dark green precipitate will be  thrown down.  To detect chlo-
rides in the urine, add to  urine in a  test tube one-sixth part of
its bulk of nitric acid, and then  add a few drops of a solution
of nitrate  of silver.   If chloride be present, the  chlorine will be
thrown down with silver as a white precipitate.  If none be pre-
sent, the fluid will remain clear.

                  Examination of Patients.
   There are various methods adopted  by various practitioners
for the examination of  special cases of disease.  The method
which I have been in the habit of pursuing is the following —
   1st.  What  is  your name, age,  occupation, and  place of na-
tivity? 
DIAGNOSIS.
77
  2d. What ia the duration of your disease,—and so far as you
can, describe its seat, nature, and cause.  If the disease is ac-
companied with pain, place your hand over the region of its
locality; and describe its  nature, whether acute or severe, or
heavy, dull, and throbbing.
  3d. We proceed to a systematic examination of all the prin-
cipal organs of the body;  and  first, the circulatory system,
includes the heart and all the principal blood-vessels; the situa-
tion of the heart, its rythm, impulses, the locality of the apex.
By percussion we learn its extent, and area of dulness; by auscul-
tation we learn the  character of the sounds; if abnormal, their
position; by palpation and inspection we learn the nature and
character of the arterial pulse, the existence of aneurism, &c, &c.
  4th. You proceed to an  examination of the  respiratory  sys-
tem; the nares; its discharges ; the voice, natural or altered in
quality, hoarseness; difficulty of speech,  aphonia; epiglottis;
tonsils and  pharynx; the lungs; state of respiration, difficult,
quick or slow, equal or unequal, laboured, painful; dyspnoea;
odour of breath; character of expectoration;  hemoptysis; co-
lour, appearance, and amount of blood discharged;  cough, rare
or frequent, short, long, or painful, moist or dry; external form of
the chest by inspection; the resonance determined by percussion,
whether increased or diminished; dulness, cracked-pot sound,
&c, &c.  The sounds determined by auscultation, whether nor-
mal or abnormal; their character, position, &c.
  5th. Nervous system:  of the character of the brain, as indi-
cated by intelligence, cephalalgia, hallucinations, delirium, stu-
pidity, dream?, vertigo, idiocy, monomania, coma.   Spinal cord
and nerves: general sensibility,  increased, diminished, or ab-
sent ; pain in the back; special sensibility—hearing, taste, sight,
touch, smell; their  perversion, increase, or diminution; spinal
irritation, as determined by  percussion; trembling, contractions,
paralysis,  rigidity,  convulsions;  motion, natural or perverted,
pain on movement, fatigue.
  6th. Digestive system,—mouth, taste in the mouth, lips, gums,
and  teeth ; tongue—moist  or  dry, mode of protrusion, furred,
fissured, colour,  coated, condition of papillae.   Fauces, oesopha-
gus, tonsils, and pharynx — regurgitation; deglutition, if im-
peded, examine the pharynx with a spatula;  the neck, the  cer- 
78
DIAGNOSIS.
vical glands, &c.  Stomach—epigastric uneasiness or pain, nau-
sea, thirst, flatulence, appetite, swelling, eructations, vomiting,
character of matters  vomited.   Abdomen—hemorrhoids, pain,
distention or collapse, diarrhoea, borborygmi, character  of de-
jections, constipation, tumours; its preparation and measure-
ments.   Liver—the size, as determined by percussion, jaundice,
results  of palpitation, pain, &c.   Spleen—the size, as deter-
mined by percussion.  If enlarged, examine the blood  micro-
scopically.
   7th. Genito-urinary system.  Uterus—amenorrhcea, leucor-
rhoea, condition  of  the menstrual  discharge,  dysmenorrhcea,
&c; uterine or ovarian tumours; if pain, or much leucorrhoeal
discharge, examine os uteri and vagina with a speculum ; diffi-
culty in walking, or in defecation;  pain in the back; functions
of the mammae.  Kidneys—micturition, lumbar pain ; precipi-
tates, as determined by the microscope  and  by chemical teats;
quality and quantity of urine, the  specific gravity, colour;  ac-
tion on test papers;  spermatorrhoea;  stricture; action of heat,
nitric acid, &c.;  discharges from urethra.
   8th.  Integumentary system.  Emphysema; temperature;  ge-
neral  posture;  marks or cicatrices;  anasarca; expression  of
countenance;  emaciation; rough or smooth; morbid growths,
swelling; external surface;  eruptions, (see diagnosis of skin dis-
eases;) colour; oedema; perspiration; dry-or moist.
   9tb.  Antecedent history—parentage,  age, constitution, place
of residence, habits, irregularities in diet, mode of living as re-
gards food and drink, hereditary  disposition, excesses  of any
kind, trade or profession;  exposure to heat, moisture, or cold;
fatigue, epidemics and endemics, commencement and progress of
the disease, contagion and  infection;  mode  of  invasion; in fe-
male cases, whether married or single;  have had children and
miscarriages, previous diseases, &c.; date of rigour or seizure;
previous treatment, &c. 
CONSIDERATION  OF  FEVERS.        79
PHYSIOLOGICAL,  PATHOLOGICAL,
  AND  PRACTICAL  CONSIDERATION
  OF PEYERS.
  Pathological researches have not as yet been as suc-
cessful in  revealing the  seat, nature,  and character of
fevers, as of some other diseases.   This may be owing  in
part to the nature of the investigation.  The investigation
being mostly confined  to  autopsic appearances, while a
correct physiological analysis of the symptoms  manifested
in the progress of the disease,  has been in a great measure
neglected.
  In order to  arrive at a correct idea of the nature of
fevers, a study of the causes,  symptoms, and effects,  pro-
duced by the remedies, and the character of these pheno-
mena, with those of organic  modifications in  a state of
health, with microscopic autopsic appearances,  will enable
us to arrive at a more just conclusion relative to all the
pathological changes connected with fevers.
  The phenomena.of fevers are so numerous  and so dif-
ferent in appearance, that it would be  almost  impossible
to give a minute description  of  them.   There is  not a
single derangement of function, or of  tissue, which I have
not observed in these diseases.  They have then no specific
symptom nor pathognomic sign ; even the hot skin, rigors,
and  accelerated pulse, exist in diseases  when fever  is not
present.  Although  this is true relative to  a single pheno-
menon of fever, there are a series of phenomena, which is
so uniformly present  in  what is termed idiopathic fevers,
that we call the disease  fever,  when the   symptoms are
manifested in the following order : 
80       consideration of fevers.

  1. Nervous depression, characterized by languor,  lassi-
tude, and debility.
  2. Rigors  and chills, connected with  superficial capil-
lary congestion,  an  irregular pulse, and hurried and op-
pressed breathing.
  3. Reaction,  characterized by  a  dry tongue, scanty
urine,  and  loss of  appetite.  When  these  symptoms-
appear in the order in which they  are  here  laid down, we
denominate the disease fever.  Although the above  series
of symptoms must always be present in the above order to
constitute fever,  it by no  means includes the entire number
of  symptoms present in  this disease.  These  symptoms
indicate the disturbance of,  or abnormal manifestation of,
   1.  The nervous  system,  as indicated  by the debility,
lassitude, aversion to mental and  physical exertions, rest-
lessness,  creeping  chills, horripilations, alternations of
flushing heat, and irregular  breathing.
   2.  A  hurried  and irregular  action of the heart and
arteries, dependent upon the  abnormal nervous  manifesta-
tion.
   3.  Immediately following this increased  circulation of
the blood,  is an increased  and  abnormal temperature, a
derangement of  the secretions, as  indicated by the scanty
urine,  dry tongue,  hot  skin, increased  thirst,  anorexia,
&c, giving  unmistakable evidence of the entire inability
of  the nervous  system to  afford  these important organs
the necessary stimulus.   In  thus carefully noting the  series
of  changes  which  manifest themselves  in  all  idiopathic
fevers, we can commence at the derangement of the brain
and nervous system, and follow.the entire series  of physio-
logical and  symptomatical  changes, as arising  from, and
dependent upon, the primary cause of this entire class of
diseases,  i. e., a  derangement of the brain and its append-
ages.
  In  our classification of fevers,  we  have  adopted  that 
          consideration  of  fevers.        81

which appears to us to be the only  one warranted  by the
manifestations of this disease.
  1st.  Ephemeral Fever is the simplest  of  all forms of
fever, yet it manifests the entire series of phenomena ;  but,
owing  to the  mildness  of the cause, it lasts only twenty-
four hours.  The cure  is  effected  by  the  recuperative
powers of the system.
  The next form is that of Intermittent Fever,  in which
so much  of the cause is removed as to relieve the nervous
system for the time, but not entirely relieviug the system        (.
from the  morbid influences.   During the  thermal changes
of the body in rest  and sleep, the poisonous cause makes
a sufficient impression upon the brain and nervous system
to obstruct the proper supply of vital stimulus to the de-
pendent  organs of the body, and the result is a repetition
of  the paroxysm or Intermittent Fever.  If the shock
received  by the brain and nerves, is of sufficient  intensity
to prevent a temporary restoration and reaction, the fever
is called  Remittent or Continued.  When the secretory
and excretory system is so far deprived of the necessary
stimulus  as to produce an entire suspension of these func-
tions, and  the  circulating organs  are exceedingly languid
from the same cause, the fever is called Typhus or Con-
gestive Fever.   When, in  addition  to these symptoms, a
disorganizing tendency is manifested in the glands of the
bowels, the fever is termed Typhoid.

The  condition of the capillary vessels in fevers, as recorded by
  David  Craigie, M.D.,  F.R.S.E., in his Pathological Ana-
  tomy, pp. 156 to 163.
   "In fevers, whatever be  the  form, intermittent, remit-
tent, or  continued,  the capillary vessels are the seat of
disorder.  Nor is the affection confined  to the capillaries
of one region,  of one organ, or of one tissue.   The seat
of fever  is to  be sought neither  in the  capillaries of the
         8 
82        consideration of fevers.

brain and spinal chord, nor  in those of the lungs, nor in
those of the alimentary canal; but it is diffused over  the
minute ramifying communications of the aortic and venous
branches, in whatever part  of the body these communica-
tions are found.   To establish the truth of this statement,
it is requisite merely to consider the phenomena of fever
in the living body, and its traces and effects in the dead.
   " I presume that the  affection of the  capillary system
of the brain, both cranial  and vertebral,  is too generally
admitted  to require being  formally  demonstrated.  In
point of fact, the pain in the head in the beginning of all
fevers, the derangement of thought during their progress,
and the tendency to stupor,  and absolute coma towards
the  conclusion,  are sufficient alone to  prove disorder of
the cerebral capillaries.  But when blood or serous fluid
is found effused  into the ventricles, when the vessels of the
brain are found turgid,  distended with blood, and more
numerous than  natural, it  is  impossible to resist the infe-
rence as to the over-loaded state of the cerebral capillaries
during life.   I am aware that cases of fever are sometimes
adduced, in which neither pain of the head nor deranged
thought are  observed.   I  can  only say, that, among a
very great number of cases which I have observed, though
in a few the patient did not  complain of  headache,  it  was
always  possible to recognize more or less derangement of
thought.
   " In  all cases, pain is felt when the patient coughs or
stoops,  or when the head is slightly shaken ;  and when no
pain is said to be felt, it indicates that the stage of natural
sensation is passed, and that he complains not, because he
does not feel.
   "In  ague, the oppression  of the cerebral cavities may
be so great as  to constitute inflammation (Siriasis JEgyp-
tiaca), or phrenitic ague; or, in various degrees, the  sleepy
quotidian, the  sleepy, lethargic, hemiphlegic, carotic,  and 
CONSIDERATION  OF  FEVERS.        83
apoplectic tertian, and the comatose quartan of practical
authors (Werlhof,  Torti,  Lautter,  Sydenham,  Morton,
&c), the same disease which  has been named by Lancisi,
Baglivi,  and Morgagni, epidemic apoplexy.
   " The disorder of the capillaries of the spinal chord is
indicated by paiu  and weight in various  parts  of the
column,  by the  derangement  in  the muscular motions,
especially local palsy, e.g., of  the arms, legs, &c, by the
tetanic  spasms  and  convulsions  taking place  in  many
fevers.   After  death,  much  serous  fluid flows  from the
iheca; the vessels of the chord are distended and numer-
ous ; in all instances, serous fluid is effused,  and sometimes
pure blood issues from its capillaries.
   " That the capillary system of the lungs is overloaded
and oppressed iu  all fevers, is one of the most certain
points in pathology.   During the ague fit, the respiration
is invariably quicker  than  natural,  sometimes to the
amount of thirty or thirty-six  in the minute; the patient
complains of sense of weight in the breast, cannot breathe
fully, pants, and  has frequent cough.  In continued fever,
the respiration is invariably quicker and more  laborious
than natural; a deep breath  cannot  be drawn easily, and
more or less sense of weight  and  oppression  is felt.   I
have found  the respiration in  continued fever so quick as
thirty-six in the minute, while in ordinary cases, the appli-
cation of the stethoscope  indicates  an embarrassed state
of the circulation in the pulmonary capillaries.  In persons
predisposed, expectoration, streaked with blood (hseinoptae),
is not unfrequent during continued fever.
   " The same conclusion is clearly established, by examin-
ing  the  lungs of  persons cut off  either by intermittent
or by continued fever.  In many instances  of the former,
it induces bronchial  inflammation,  or proceeds  to  actual
peripneumonia or pleurisy,  constituting  the  catarrhal,
pneumonic, or pleuric tertian respectively (Werlhof,  Torti, 
84       CONSIDERATION OF FEVERS.
Lancisi, &c).   In the latter, the bronchial mucous mem-
brane is  always more or less red, sometimes  crimson or
purple, or  of a deep brown color, rough and much thick-
ened; the  sub-mucous tissue is brown and loaded with
serous fluid; and the  minute  vessels are much distended
with dark-colored blood.  The bronchial tubes are very
commonly, in  fatal cases, perfectly filled with thick, viscid
mucus, which adheres to the inner surface of the bronchia
membrane.  The  serous surface of  the  organ is generally
livid  or  marbled  from this cause;  but the pleura itself is
not much changed, save from the bloody serum discharged
into its cavity.   The lungs, in totality, are generally dense,
and firmer than in the natural state.
   "These changes arise from the minute ramifying vessels
at the termination of the pulmonary artery, and the organs
of the pulmonary veins being unusually loaded with blood.
As they are more so  than can be  readily affected by the
ordinary quantity of air admissible  in such a state, imper-
fect respiration and undue change  of  venous blood  con-
tributes  powerfully to the  bad symptoms and the unfavor-
able termination of the disease.  In such a state of  the
organs of  respiration, the bronchial arteries are less able
to counteract the bad effects of  imperfectly respired blood,
in so far as they receive from  the  aorta blood which  has
not been sufficiently arterialized.
   "In the capillary system of the chylopoietic and assistant ■
chylopoietic viscera, traces of the same condition  may be
recognized, both  from the symptoms during  life  and its
appearance after death.  In  these  organs,  two capillary
systems may be distinguished, a primary and a secondary
one.  The  primary is that which consists of the ultimate
divisions of the splenic, gastric,  and  duodenal arteries, and
of the superior and inferior mesenteric arteries,  and their
corresponding  veins, which afterwards  terminate in  the
splenic  and superior and  inferior mesenteric veins.   The 
CONSIDERATION  OF FEVERS.        85
secondary capillary system is  that which results from the
union of the minute extremities of the portal vein, and of
the hepatic artery with those of the vena cava hepatica.
   "It is unnecessary to dwell on the  proofs  of  the loaded
state  of  the  capillary system  of the alimentary canal.  It
is sufficient to remind the student that the furred or brown
tongue, the  thirst, the sense of internal heat, the loathing,
squeamishness, and sometimes  sickness, with weight, op-
pression, and tenderness of the epigastric  region,  suffi*
ciently demonstrate the morbid state of the  capillaries of
the oesophagus, stomach, and duodenum; while the consti-
pation of the bowels at  the  commencement, insensibility
to cathartic medicine throughout, and occasional looseness
at the conclusion, indicate the deranged condition of those
of the intestines.   After death, the minute  vessels of the
whole of these parts are found much distended with blood,
generally dark-colored.
   "In   one  form  of  fever, the abdominal or intestinal
typhus, the ileum and  its mucous  follicles are very  much
affected.  The follicles  become enlarged,  elevated,  and
prominent,  and  swelled in consequence of their proper
tissue being attacked,  and perhaps  their secreting  pores
being obstructed.   The apices become  dead,  and are
thrown  off in the form of sloughs;  and in their place are
left small ulcers, which, in no  long time, enlarge, spread,
and  increase in depth.   These changes may  take  place
either in the  isolated follicles,  or in the aggregated patches,
or in  both orders of glands.
   "In  certain forms of fever,  there are pain, distension,
and uneasy sensations in the  right iliac region ; and when
percussion is employed, the sound emitted is dull, while  a
peculiar croaking noise is heard, and a gurgling movement
is felt beneath the fingers,  as if  produced by air and liquid
moving within the intestine.
   "These symptoms  continue  the  greater part of the
                           8* 
86        CONSIDERATION OF FEVERS.
duration of the fever;  and though they are abated by local
depletion, by means of leeches aud and laxative medicines,
they do not disappear until the fever itself either abates or
altogether retires.
   " The portal vein constitutes, among the vessels of the
digestive  organs, a secondary capillary system, in which
the blood is not less accumulated than in  the primary one.
It may be thought that, as the blood is accumulated in the
first, it ought not so readily to find its way into the trunk,
branches, and ramifications of the second.
   " But this objection will vanish, when  it is remembered
that, at the same time,  both the primary  and secondary
system of capillaries become overloaded.  This state of
the capillaries of the portal and hepatic system is estab-
lished by the appearance of  the liver in persons cut off by
fever.
   " The spleen may suffer so  much from this capillary dis-
tension as to resemble a mass of clotted blood  without
trace  of  organization.  This morbid  and  extraordinary
distension of the primary and secondary capillary  systems
of the  chylopoietic organs, though distinct enough in the
fevers of temperate  countries,  is most  conspicuously de-
monstrated in the agues and  remittents  of warm climates,
and  especially in  the severe and  extreme  form termed
yellow fever.  In the former, great sickness and epigastric
tenderness, with more or less vomiting, are frequent;  and,
in the latter, constant symptoms.   The vomiting, however,
is not bilious, as has  been too generally  imagined.  It is,
at the commencement,  always  a watery fluid, evidently
derived from the capillaries  of the gastric, and, perhaps,
from the duodenal mucous  membrane.   After some time
it begins to be mixed with bile, expressed, no  doubt, from
the gall-bladder by the pressure  of the stomach in the act
of vomiting.  A much more uniform occurrence, however,
if the  disease does not subside spontaneously, or is  checked 
CONSIDERATION  OF FEVERS.        87
by  art,  is  the gradual  admixture  of blood,  somewhat
darkened, with the watery fluid.   This  blood issues from
the capillaries of the gastric  and intestinal tissues by  a
process analogous  to  exhalation  in  the  sound state,  but
differing in  so far as, in the capillaries  from which it pro-
ceeds, a degree of disorganization has taken place.
   "As the blood  escapes  into the  cavity  of the  canal,
originally not highly  scarlet,  it  is rapidly  blackened by
the action of  the carbonic acid and sulphuretted hydrogen
gases, at all  times  present in greater  or  less quantity.
This bloody exudation is at first  scanty, but gradually in-
creases as the disease goes  on,  until  it constitutes  the
greater part of what is discharged both by vomiting  and
by stool.  In the former case, it  forms  the black-vomit or
coffee-ground matter (vomito prieto), so frequent in cases
of  remittent or yellow fever.  In the  latter,  it forms the
dark, tarry, or treacle-like  stools, mentioned  by practical
authors  in  the same disease.  The description now given
is general,  and applies to  this capillary disorganization,
as it takes place both  in bad agues and remittents, and in
yellow fever.   In the  former it is  less frequent, but, never-
theless, takes  place sufficiently often.  In the latter, it  is
seen in its most aggravated form, and is almost invariable
in fatal cases.   Its origin and formation have been traced
in the most satisfactory manner by repeated dissections.
   " The idea that  black  vomit is morbid or vitiated bile,
deserves no attention.   In some cases of severe yellow
fever,  a  dark  colored fluid  of the  same physical characters
as those found in the intestinal tube,  may be traced coming
down  the biliary and hepatic duct, from  the pori biliarii.
This,  however, instead of  being  bile, is blood which has
oozed from the hepatic capillaries, in the same manner as
that from the intestinal ones.
   " The capillaries of the urinary system are much affected 
88        CONSIDERATION  OF FEVERS.

during  fever.   Both in  intermittents  and  in continued
fever, bloody urine has been discharged.
  "In  the  same manner, the capillaries  of the  muscles,
of the filamentous tissue, and  of  the skin,  are morbidly
distended.   One of the most common symptoms of fever is
pain, soreness, and a sense of bruising in the muscular
parts and  limbs  in general.   In fatal cases, when these
parts are examined by incision, unusual vascular distension
and  extravasation of blood are frequently seen.   The livid
spots and  patches  (molcepes;  vibices  ecchymosata)  are
proofs of the  same state of the  capillaries  of  the fila-
mentous tissue, as petechial eruptions denote this in  the
skin.  In short, there is scarcely a texture or organ of the
animal  body,  the  capillaries of which are not disordered
in the different forms of fever;  and this disorder, instead
of being confined to the capillaries of a  single organ, is
extended throughout the capillary system at large.
  "It is doubtless true, that in individual cases, this dis-
order may  be  greater  and  more  distinct  in one set of
capillaries  than in another.   In one  set of  patients,  the
capillaries  of  the  brain may be most disordered; in  an-
other, those of the lungs; in a third, those of the intestinal
canal; and in a fourth, those of the urinary  organs.  It is
always  found,  however, in  sueh cases,  that the  affection
of one  organ  does  not entirely exclude that  of another;
and  while the  capillaries of the one are very much affected,
though  those  of  the others are less  so,  they are by no
means in the  healthy  state.   In all cases of severe and
exquisite  fever, whether  intermittent,. remittent,  or con-
tinued, the capillaries of the brain,  of the lungs and heart,
of the chylopoietic  organs, of the  urinary organs, of  the
muscles, of  the cellular tissue, and  of the skin, are  affected
nearly in the same degree.
  "An  important question is to decide the nature  of this 
CONSIDERATION  OF  FEVERS.       89
affection.   The  dissections of  Home,  Plocquet,  Mills,
&c, as to  the brain ; those of Schenck, Morgagni, Lieu-
taud, Sarconi, and others,  as to the thoracic organs ; and
those of  Lieutaud,  Petit,  and Serres,  Broussais, Lermi-
nier,  and Andral, Louis, Chomel,  and Bright, as to  the
intestinal canal,  might  favor the supposition that  the
morbid process of fever consists in inflammation.
  "Against  this conclusion,  however,  various facts and
arguments  may be added.
  "1st.  In  fatal cases  of fever, unequivocal  traces of
inflammation are not uniformly or invariably found.   The
proportion in which  these  marks, as albuminous effusion,
suppuration,  ulceration, &c, are observed, is small,  com-
pared with the number in which accumulation of blood in
the capillaries, and  more or less disorganization of  these
vessels, are observed.  2d. In cases of pure, genuine, and
unmixed  inflammation of  the internal  organs, whether
spontaneous  or  from injury,  the concomitant symptoms,
though febrile, are totally different from  those that distin-
guish either  intermittent  or  continued  fever.  3d.  The
marks or effects  of inflammation, which are  found in  the
bodies of persons cut  off by fever, are accidental compli-
cations, and  may almost invariably be traced to  inflam-
matory reaction  supervening on the  febrile process, in
consequence  either  of the  physical  peculiarities  of  the
individual,  the local weakness of the parts, or the influence
of external morbific causes.  4th.  Inflammation is a local
action confined to the capillaries of one  tissue, or at most
of one organ and contiguous tissues;  and while the struc-
ture and functions of  the  organ may be completely  im-
paired, those of others  remain unaltered.   In fever, on
the  contrary,  the  capillaries of all the tissues, and of every
organ are affected;  and while  no individual  organ is much
affected at the commencement, every organ suffers a little
in  the general  disorder of  the  capillary system.   5th. 
90       CONSIDERATION  OF  FEVERS.
Inflammation gives rise to albuminous exudation, suppura-
tion, ulceration, and in certain parts, to  serous, or sero-
purulent effusion.   In fever, the morbid state of the capil-
laries terminates in complete destruction  or disorganiza-
tion  of  their  organic  extremities,  and  the consequont
oozing  of blood,  from  the  surface of the  several mem-
branes and organs.
   In conclusion, though it may be regarded as established,
that, during the morbid process of fever,  the whole capil-
lary system is unduly distended and loaded with an inordi-
nate  quantity of blood,  which  really moves more  slowly
and imperfectly than in health,  we  have  no facts  that
enable  us to  determine what  induces this peculiar  and
excessive accumulation.  Much has  been said lately of
congestion,  and especially  of  venous congestion.   The
state of the capillary system which  I have attempted to
describe is that of congestion or accumulation ; and so far
the hypothesis of congestion is intelligible.  Of the existence
of venous  congestion, however, unless as an effect of  that
in the capillary vessels there is neither proof nor proba-
bility.   It is not a primary, but a secondary, or  rather a
remote consequence."—(Marsh.)

         The Condition of the Blood in Fevers.
   " It is obvious," says Dr. Carpenter, "that increase of
fibrine in the blood does not exist  as the result of fever."
   Dr. Andral has  observed  a marked diminution of fibrine
in the blood in  all  idiopathic fevers ; he also found the red
corpuscles  and serum slightly increased.  It is probable,
however, that the  increase  of red  corpuscle is  relative  ii>
proportion to the amount of fibrine, and not in proportion
to the entire bulk of the  blood.  "In typhoid fever  "  says
Dr. Carpenter, "the decrease in the proportion  of  fibrine
is much more  decidedly marked;  and that it  does not
depend upon abstinence  from food, as, in all  cases, as soon 
          CONSIDERATION  OF FEVERS.        91

as a favorable change occurs in the disease, the proportion
of fibrine is  much  more decidedly marked."   " In malig-
nant forms of fever," says Dr. Simon, " the blood frequently
becomes  so  deteriorated in amount of fibrine as  to com-
pletely lose the power of coagulation."  Another remarkable
change which has been observed  in the blood in Typhoid
and other malignant forms of fever,  is the want of due
arterialization, as indicated by its dark blue appearance in
the veins and arteries, as  well as that of the capillaries.
This  being  a very important one in a practical point, I
will introduce the remarks  of Dr. Cragie upon this subject:
   " What is the cause of these changes ?   It is reasonable
to think  that for the cause we ought  to look in the lungs
chiefly.   The lungs,  I have   already  observed, are in all
cases of  fever more or less  disordered,  their vessels  are
congested and oppressed; their action is impaired; and
there is  proof of great derangement  in the action of  the
bronchial membrane,  imperfect  admission  of air to  the
bronchial tubes  and their membranes, and,  accordingly,
inadequate arterialization, or, it may be, the lowest possible
degree of that function. These may be regarded as matters
of fact, capable of demonstration.   Does this morbid state
of the blood, then,  begin  in  the lungs or in  some  other
organ or set  of vessels?  When we consider the  large
extent of the bronchial membrane; the fact that, upon  it are
ramified the capillary divisions of. the pulmonary artery; and
the fact that through these vessels passes the whole of  the
blood of  the  body;  and the further  fact  of  the manifest
disorder  of  the whole blood  of the system in fever, it is
impossible to resist the conclusion, that it must be chiefly,
perhaps solely, on the blood of the lungs that the cause of
the fever begins to display its primary and initial operation.
   " On the nature  of  this  cause it is not possible to speak
with confidence or  certainty.  But if the  general opinion
that it is a poison diffused through the air, be well founded, 
92        CONSIDERATION  OF  FEVERS.

it is not difficult to perceive at least some traces of its mode
of operation.   Whether that poison be extricated in the
form of a vapor or exhalation from the surface of the earth,
and is telluric in its origin ; or is eliminated from vegetable
matters in certain circumstances of decay  or  change; or
from vegetable and  animal matters conjoined ;  or is given
off as a subtle effluvium from the bodies of living human
beings, in circumstances unfavorable to ventilation  and the
healthy performance of the functions ; or  is the result of
some unknown and inappreciable state of the atmosphere;
— it must equally be inhaled in the air in inspiration, and
thus thoroughly mixed with the blood of the lungs in suc-
cessive acts of the function of respiration.   If it be so
mixed, it  must be circulated with  the circulating blood,
and in this manner distributed  through the whole vascular
system to  every organ  of the body.  In doing so, however,
this poisonous material will  have so  altered  the blood in
the lungs  as to produce in that blood, and in these organs,
a more decided effect than elsewhere.   The  shock first
inflicted on the blood in these organs appears, it is natural
to think, the great cause  of  the loss  of coagulating power
and the impaired  arterialization.   We know that one of
the  great  uses of  the lung, next  to or  along with the
arterialization of the blood,  is to maintain the coagulating
power, and restore it when impaired.   It  is, therefore,
natural to infer, that when the coagulating power is dimin-
ished, it depends  upon some important impediment to the
function of respiration, and that when the function  of respi-
ration is  imperfectly performed, that it should evince its
effects in  a diminished  proportion of coagulating power.
   If these views be well founded, it follows that, when the
blood thus altered  is  circulated, however imperfectly,  it
must operate hurtfully  on the organs to which  it is trans-
mitted.   It must  act,  in truth,  as a poison, and many of
the phenomena of fever are similar, certainly, to the effects 
          CONSIDERATION  OF  FEVERS.        93

of poison, especially a poison  at first irritant,  and then
sedative and narcotic.   This appears to be-the  mode in
which, towards the latter stage of fever, its cause acts on
the brain and spinal marrow."
  The ancients  supposed fever to depend upon a warfare
between the vital  forces of the body and some noxious
element which had invaded the system.
  Hippocrates ascribed the different fevers  to  the  four
humors ; blood, phlegm, and yellow and black bile.  Galen
supposed that the different forms of ague depended upon
the corruption  of the  different fluids.   That  quotidian
arose from the corruption of phlegm, the tertian from the
corruption of yellow bile, and the  quartan from that of
black bile.   He also supposed that, in whatever part of
the body the heat began, it ultimately terminated  in the
heart, causing increased motion of the blood and accelerated
pulse, followed by an  effort of the  vis vitce to  expel the
poisonous agents  from  the  system, and to assimilate the
healthy fluids  to sustain the different organs of  the body.
Sydenham  says,  "that reason  dictates that a fever  is
nothing else than  an  effort of nature to thrust from the
system morbific matter, in order to  restore the patient to
health ; that seeing it has pleased  God, the Governor of
all things, so to constitute  human nature as to be subject
to a variety of diseases ; that these diseases are introduced
into the system in  the form of poisoned  air and otherwise,
and^hat when once introduced into the system they become
so identified with  it that it is beyond  the art of man to
separate it, hence nature has provided for herself a method
and concatenation  of symptoms, so  that she might thereby
expel the poisonous matter which would otherwise ruin the
whole fabric.  Avicenna attributed the phenomena of fever
to the superabundance of the different humors.   Dr. Stahl
maintained that fevers  depended upon plethora or over-
fulness of the vessels,  and a  depraved condition of the
       9 
94        CONSIDERATION OF FEVERS,

fluids.  Hoffman maintained that fever consisted in a spasm
of the capillaries.  He attributed the cause of these spasms
to some  morbid affection of the nervous  system.   Cullen
contended  that  fever  depended  upon certain  abnormal
changes occurring  in the brain.  Dr. Benjamin Rusn, that
all diseases are  a  unit; and that fevers,  as well as other
diseases,  depend upon an irregular action, and this irregular
action, in its turn, is the proximate  cause  of every form
and modification of disease.   Ploucquet  claimed that all
fevers were dependent  upon inflammation of  the  brain.
Broussais that  all fevers depended upon an altered condi-
tion  of  the mucous surface of the stomach and bowels.
That  this  alteration was mostly confined to the mucous
follicles;  and that,  as the disease advanced, they passed into
a state of suppuration.  Relative to the opinion of Brous-
sais, Dr. Andral  remarks  as  follows: "Admitting that
simple or follicular enteritis is the commencement of a
great number of fevers, can everything be explained by
them ? We never  thought so ;  and it has  always  appeared
to us that these fevers never become severe except in con-
sequence of a disturbance which supervenes in the innerva-
tion  and hematosis.   This  has  been very  satisfactorily
proved by Prof. Bouillaud, who has contributed to give
considerable weight to  the doctrine of the localization of
fevers, by placing  this  doctrine on a broader basis, more
particularly by  establishing  the reality of the alterations,
which on the one hand the blood, and on the  othe#the
nervous centres, undergo in  a great number of fevers.  The
part performed  by  these has been also clearly demonstrated
by the valuable observations of M. Chaufford, of Avignon.
  This disturbance of  hematosis  and innervation,  which
gives  rise to the phenomena called adynamic and  ataxic,
or in other words,  to the typhoid  state, may be the result
of several lesions, different in their  nature and in their
seat. 
          CONSIDERATION  OF FEVERS.        95

   First, gastro-intestinal inflammations give rise to it more
frequently than diseases  of any other organ.   Of these
inflammations, some are directed principally to the intesti-
nal follicles,  which become tumefied, and  ulcerate ; others
consist  merely in a simple ulceration of the mucous  mem-
brane  itself.  Other organs  also, however,  though  less
frequently than the digestive tube, may  become the occasion
of that profound disturbance of innervation and hematosis,
a disturbance which constitutes  the adynamic  and ataxic
fever of Pinel.  Thus phlebitis, pneumonia,  particularly in
aged persons,  erysipelas, phlegmon,  inflammation of the
urinary  passages, an abscess developed  in the  prostate,
metritis, several forms of inflammation  of the liver, variola,
acute inflammations of  the  synovial membranes,  etc., may
give rise to  it.   M. Boisseau has clearly proved this in
his physiological  pyretology, and  it has been  put out of
all doubt by several  other  works; by those of Dance, in
particular.
   Thus the ataxo  adynamic, or typhoid state,  may be de-
veloped, in consequence of a great number of affections
widely  differing from each  other: it  is  a collection  of
symptoms identical as to their ultimate seat, but  not as to
their origin.   Thus symptoms,  identical  also  as to their
nature,  differ  only in their greater or less intensity; with
regard to their progress and duration, they are subordinate
to the progress and  duration  of  the  affection, in conse-
quence  of which  the  typhoid  symptoms  have  been  de-
veloped.  If it be a primary alteration of the blood which
gives rise to them, these  symptoms may acquire, in  a  few
hours, their highest degree of development; and, in some
cases, even occasion sudden death.  If the commencement be
in an organ where inflammation is rapidly developed, as in
a lung,  or in a vein, the typhoid  symptoms shall have a
quick course  and  a rapid termination, similar  to this in-
flammation.   If, on the contrary, they are connected with 
96        CONSIDERATION  OF  FEVERS.
an inflammation, which, as that of the intestinal  follicles,
has stages, which it passes through with a certain degree
of slowness, they will be  like the inflammation itself, slow
in their  development,  and  slow  in  their  termination,
whether favorably or fatally.
  This is, we think, all the difference between  a typhoid
fever, which is connected  with  phlebitis,  for  instance,
and  that  which  follows dothiteritis.   There will  be,
however,  in each  of them,  some  particular  symptoms,
which will depend on the local lesion, as the diarrhoea in
the case of follicular enteritis.  We may, no doubt, as M.
Louis has done, reserve  the term typhoid  fever for the
morbid state which proceeds along with the affection of
Peyer's  glands; this,  however,  is  a  distinction  purely
arbitrary; and, besides this mode of proceeding, seems to
us to be  attended with  the inconvenience of thus desig-
nating a  great number  of cases  of  follicular enteritis, in
which the term typhoid affection  has no longer any mean-
ing ; for  all cases  of follicular enteritis, certainly are not
accompanied either with  stupor, or with the different  phe-
nomena of adynamic or ataxic fever; all do  not resemble
typhus :  they are oftentimes mere  inflammatory, bilious, or
mucous fevers, to use for a moment the language of the
Nosographie Philosophique.
   We do not think it right then to retain the term typhoid
fever, because this term  leaves a vagueness  in  the mind,
not consistent with science, and because it often fails in ex-
actness,  with respect to the symptoms which it represents.
We admit as a possible, but never a necessary consequence,
a typhoid state in a great number of diseases ;  that  is  to
say, a state in which there appear some general symptoms
more or  less similar to  those which characterize typhus.
This state indicates that the disease no longer exists in the
organ where it had commenced—it is, in some degree, the
signal that the blood and nervous  centres participate in 
CONSIDERATION  OF FEVERS.         97
 the disease.   Notwithstanding our  objections to the use of
 the term typhoid, I do not feel justified in introducing ano-
 ther term, although it might be equally euphonious, and no-
 sologically more correct, but shall, according to custom, re-
 tain the term typhoid:  in all cases using it in a nominative
 sense, without any regard to its qualifications of typhus.
   By most European writers, typhoid fever  has been, and
 is still considered  the same as typhus; constituting the only
 essential fever not included in the modifications of intermit-
 tent.  In the Encyclopedia of Practical Medicine, published
 in 1833, we find typhus fever " constituting one of the prin-
 cipal forms of continued fever; characterized by the earlier
 and more severe affections of the  brain and nervous system,
 by the more constant changes which the mucous and glan-
 dular systems undergo; and in the advanced stages, by great
 prostration and symptoms of putrescence."  And it is fur-
 ther added, " that it is not uncommon to find fevers  at first
 very mild, assume by degrees the typhoid type."
   And again,  " There can be no doubt of every intermediate
 gradation between  the common forms of intermittent, typhus,
 and typhoid, so that it becomes a matter of nicety  to dis-
 criminate which class any  particular case or number of
 cases belongs.   Sometimes,  indeed,  we find  the one form
 passing into the other; more frequently mild forms lapsing
 into typhus or typhoid." • Dr. Copland, speaking of typhus
 and  synochial  fevers, states that they frequently run into
 typhoid.  Observation has led me to conclude that the fever
 of this country, described by various writers as typhus, ner-
 vous, synochial, continued, putrid, &c, is  a specific fever,
 dependent upon a specific cause; and that  the supposed
 change in the  type of fever is not a change in its nature or
 character, but rather a discovery on the part of  the practi-
tioner  of its true  character.  When we consider the close
resemblance of all fevers in  their initiatory stages, and the
habit of most physicians of treating cases upon general prin-
                           9* 
98
CONSIDERATION  OF  FEVERS.
ciples, we are not surprised that this error in diagnosis fre-
quently occurs.   We have every reason to believe that these
supposed changes in the character of fevers are  erroneous;
for when typhoid fever is closely observed, it will be found
to pursue a definite  course, passing  through regular stages,
spreading by infection, and being marked by a distinctive
rash, presenting all the characteristics of genuine exanthema,
to which class it seems correctly and exclusively to belong.
For several years I  have considered this fever  as  entirely
distinct from the intermittent and  remittent varieties, and
to belong to the same family as scarlatina, rubeola, &c.  I
was led to this conclusion by observing> in nearly every case,
that the initiatory symptoms, as pain in the head, back, and
calves of the legs, wakefulness, &c, subside from the third
to the fifth day,  and  are immediately followed by an  extraor-
dinary redness of the surface of the  body,  which is, in all
cases,  preceded  for  several days by  a similar congested ap-
pearance of the mucous membrane,—so far as it is  exposed
to inspection, as the mouth, rectum, and vagina; and from
the  embarrassed respiration, anorexia, epigastric tenderness,
and irregular condition of the bowels, there is every reason
to believe that the entire mucous surface is affected in the
same manner.  This opinion is further supported by the fact
that nearly all cases of typhoid fever in this country  are pre-
ceded  by more or less catarrhal symptoms, consecutive upon
enteric and gastric irritation.  The eruption is by no means
uniform  in its appearance or duration.  In some cases care-
ful observation  is required to detect it, while in others  it
appears in large, diffuse patches over the  entire body.   The
appearance of this rash depends much upon various condi-
tions;  such  as the severity of  the attack, the power of the
system to repel the eruption from the mucous surface to the
skin, the physical condition of the patient at the time of the
attack, the character of the medication, &c   It  also varies
much in  appearance  at different stages of the  disease.   In 
CONSIDERATION  OF FEVERS.         99
the early stage being very pale, and scarcely  perceptible;
but as the disease advances, and the premonitory symptoms
disappear, it presents a vascular erythematic character.
  As the rash appears upon the surface, the mucous mem-
brane presents more of its normal appearance; but whenever
it recedes from the surface, the mucous membrane again be-
comes red and congested, and all the constitutional symptoms
become aggravated.   There is increased pain in the head
and  back, difficult respiration  and constant gastric distur-        i
bance, which again subside on the  re-appearance of the rash
upon the surface.  This rash very much resembles  that of
scarlatina, except that it is less florid; yet, in several epide-
mics, I have seen the appearance so nearly allied as to lose its
identity until the disease had reached the seventh or eighth
day of its duration.
  At first the eruption  is pustular, i. e., there are small pa-
pillary elevations, resembling very much the papillae of the
tongue, when they become elevated upon a red and congested
base in the more advanced stages of the disease.  The pa-
pillae upon the surface of the body, however, are pale, or of a
darkish purple hue.  The rash usually makes  its  appear-
ance from the third to the fifth day; and as I have  already
remarked,  may be seen  upon  the mucous  surface some
days previously to this.  Its first appearance upon the surface
is  upon  the  bowels, back, and neck.  In more favourable
cases, in  the course of thirty-six hours from the first appear-
ance of the erythema, its papillary character becomes plainly
visible.   In twenty-four or thirty-six hours after it is first
seen, a small white vesicle appears immediately upon  the
apexes of the papillae, which writers term sudamina.   These
vesicles,  being  very  small and transparent, are frequently
mistaken for dry dermoid scales,  which, to the casual ob-
server, they very much  resemble.   They are filled  with  a
thin watery fluid, which very readily escapes on the vesicle
being ruptured.  If the powers of  the system are feeble, and 
 100        CONSIDERATION  OF  FEVERS.

 the fever is of an adynamic character, the vesicles remain
 small, and in the course of twenty or thirty hours after their
 appearance they lose their transparency, and present a faded
 and dingy appearance, and in some cases entirely disappear.
 In this event, not only the sudamina disappear, but the entire
 erythematic eruption recedes to the mucous surface.  I am sa-
 tisfied that the petechiae are an enlargement of the glands of
 the skin, caused by the irritation of a specific poison, and
 that the sudamina are the result of an exudation of particles
 of lymph or albumen from the cutaneous capillaries.  This
 eruption, manifesting itself as it does in the rete vasculosum
 of the chorion, always destroys more or less of the scarf skin.
 Previously to the appearance of the exanthema, the capillaries
 of the cuticle  may be observed  to be  heavily loaded with
 blood, which circulates with remarkable sluggishness  until
 the eruption makes its appearance, when it circulates with
 more freedom,  the skin becoming hot and dry.   Whenever
 the deeper capillaries of the chorion become weakened, either
 from imperfect nutrition, or from lack of nervous influence,
 the rete becomes injected, giving rise to petechiae.  Another
 point of interest in the exanthema is,  that in all cases the
 petechias may be seen  before the bleb or sudamina.  But
 this requires careful  observation, as  in the early stages of
 the disease the  rete has not a red or florid appearance, al-
 though it may be slightly edematous.
   Another important feature of typhoid fever is the tendency
 to metastasis, or recession of the eruption from the surface to
 the mucous membrane of the bowels, lungs, &c.   The transfer
 of disease from one organ  or tissue to  another is of common
 occurrence; but in  exanthema this appears to be especially
 the case.   In scarlatina, rubeola,  and typhoid  fever, the re-
 cession of the erythema from the surface is always accom-
 panied by serious  constitutional disturbances, such as pain
in the head and back, with greater epigastric and precordial
pressure, high-coloured urine, anorexia, and, in many cases, 
CONSIDERATION OF  FEVERS.        101
nausea and vomiting.   There is also a strong tendency to
disorganization of the  mucous membrane, which is always
preceded by a loaded or congested condition of the mucous
capillaries.  The weakened  respiration aud the albuminous
urine are among the first indications of this congested state
of the mucous membrane.   As soon as the erythema disap-
pears, (if its disappearance  is premature,) the  respiration
becomes quick, and  the  atmospheric air  fails to penetrate
the minute bronchia; and hence the blood is imperfectly
supplied with oxygen, and  the effete and waste tissues fail
to be converted into products for elimination.   If this con-
dition continue, the  blood loses its coagulating power, (for
in all cases the coagulating power of the blood is maintained
by healthy respiration.)  It also loses its bright scarlet ap-
pearance in the arteries, and assumes a dark purplish hue,
indicating  that it has become over-loaded with particles of
waste matter from the  body.  If this condition of  the mu-
cous  surface of the body continues for any considerable
length of  time, the blood becomes unfit for  circulation in
the minute capillaries, and the phenomena of life gradually
fade, until the patient  expires.   Or if by a well-directed
course of medication, or by natural active forces of the body,
the erythema again appears upon  the  surface, respiration
becomes natural,—the inspired air penetrates the minute
bronchia, giving off its oxygen to the blood, and the zymo-
tic products become  converted into carbonic acid, urea, per-
spiration, &c, and are eliminated from  the  system by  its
various emunctories.  I am  unable to state the precise time
of the appearance and duration  of the eruption in typhoid
fever.  In many cases of a mild form I have noticed  the
rash to appear on or about the fifth day, to desiccate on the
seventh, and  desquamate on the tenth.   In other cases I
have observed the rash in the very outset, and again it did
not appear until the disease had progressed for twenty, or
even thirty days.   In this event, however, the mucous mem- 
102      CONSIDERATION  OF  FEVERS.

brane becomes seriously disorganized, and in most cases
there is severe hemorrhage.
  Dr. Bartlett, in his work on the Fevers of the United
States, p. 64, remarks:  "The most usual period for the ap-
pearance of the eruption, is during the second week of the
fever.   In  a few rare instances, they are seen as  early as
the close of the first week.  Of twenty-five cases, in which
this point was successfully noticed by Chomel, the eruption
appeared between the sixth and eighth days of the disease
in two; between the eighth and  fifteenth days in thirteen;
between the fifteenth and twentieth days in seven;  between
the twentieth and thirtieth days in four; and  on the thirty-
seventh day in one.  They generally come out successively,
one after another, and after remaining, commonly, for little
more than  a  week, they  successively  and gradually fade
away and disappear."
   The following is Dr. Jenner's description of the rose spots:
" They are slightly elevated.  To detect the  elevation, the
finger  had to be passed very delicately over the surface, as
they had none of the hardness of the papulae of lichen, or
of the  first day's eruption of small-pox.   Their apices were
never  acuminated, never flat, but invariably rounded;  their
bases gradually passed into the  level  of the surrounding
cuticle.  No trace of a vesicle, or white  spot of any kind,
was ever detected on them.   They were  circular,  and of a
bright rose colour, the  latter fading insensibly into the na-
tural hue of the skin around.   They never possessed a well-
defined margin.   They disappeared completely on pressure,
resuming  their  characteristic appearances as soon as the
pressure was removed; and  this was true from first to last,
from their first eruption to their last  trace.  They left no
stain of the cuticle behind; they  never passed into anything
resembling petechiae; the characters they presented on their
first appearance continued till they vanished.  Their ordi-
nary size was about a  line in diameter; but, occasionally, 
         CONSIDERATION  OF FEVERS.      103

they were not more than half a line, and sometimes a line
and a half in diameter.  The duration of each papula was
three or four  days; fresh  papulae  made their appearance
every day or two.  Sometimes only one or two were present
at first, ran  the  course  above described, and then  one or
more fresh ones  made their appearance, vanished in three
or four days, and were  followed  by others to last as  long.
The number of papulae seen at one time on the surface, was
ordinarily from  six  to twenty;  though occasionally there
was only one, and sometimes more than a hundred.
   " They usually occupied  the abdomen, thorax, and back,
but were occasionally present  on  the extremities.  One was
frequently noticed on the thorax, over the cellular interval,
at the upper border of the pectoralis  on either side.  A
very pale and delicate  scarlet tint of the skin sometimes
preceded the eruption of the papulae, but never lasted more
than a day or  two;  the skin  resembling in tint  that of a
person shortly after leaving a hot bath.  Rose  spots were
present in nineteen of the  twenty-three  of the  fatal  cases
here analyzed."   (Dr. Flint found the duration of the  erup-
tion in seven well-studied  cases to be seven days.  He met
the eruption less frequently than some of the authors here
quoted;  that is, in  forty-nine of his  seventy-three cases.
About two-thirds showed it in 1850, less than  one-half in
1851, and all (fourteen) in 1852.)
   Another pretty common eruption consists in transparent
vesicles, to  which  the  name sudamina has been given.
These vesicles are circular, or oval  in  their shape, varying
from that of a small pin's head to that of a split pea.   They
are formed by the presence of a limpid fluid elevating the
cuticle.  Their  most frequent seat is upon the  sides of the
neck, anal about the shoulders and  axillae, though they are
sometimes scattered more extensively over the body.   Cho-
mel  says that he has never seen them  on the face.   They
are most readily seen when  looked at in an oblique direc- 
104      CONSIDERATION  OF FEVERS.

tion.  They appear late in the  disease, being rarely  seen
before the twelfth day.  They usually remain  for several
days,  and gradually disappear.   They were present in two-
thirds of Louis's cases, where they were carefully sought
for, and in the same proportion, whatever was the severity
of the fever.  Dr. Hale attaches much less importance to
sudamina as a diagnostic sign of typhoid fever,  than  Louis
and Chomel.
   The rash, then, may appear at different intervals, or it
may not appear  at all, and I  have seen it in more than one
instance disappear after having been out for a few hours
only.  What is  true in regard to the appearance and  disap-
pearance of  the  rash  in typhoid fever, is equally true in
other exanthematous diseases.   Dr. Rogers  states that the
eruption in measles will sometimes  appear on the second or
third day, or even sooner; while, in other cases, it does not
appear until the seventh or eighth.
   The disappearance of the rash in measles, on the third or
fourth day, caused by exposure to  a cold  current of air, or
by improper treatment, is by no means an uncommon  occur-
rence; and every one of the least experience in this disease,
is familiar with the disastrous consequences of this metasta-
sis.   In scarlatina, it is not  unusual for the efflorescence to
appear and disappear.  In malarial districts nothing is more
common than to have this appearance and disappearance of
rash  assume a.regular periodical character.   With the ab-
sence of rash ip  scarlet fever, every physician is  familiar.
In the anginose form it frequently does not make its appear-
ance at all;  and when it does appear, it many times  is not
seen  until the tenth or twelfth day.  In the malignant form
the  eruption is  always much protracted in appearance, and
in many cases  fails  to appear  altogether.    And when  it
fails  to appear, the erythema being confined to the mucous
surface, as in typhoid fever, the same disastrous consequences
 are produced.  In order to still further support the preceding 
         CONSIDERATION  OF  FEVERS.      1 O :•

facts, and to understand  the  nature  of typhoid fever as it
manifests itself in this country, let us inquire if this disease
is  contagious.  Upon  this Dr. I. G.  Jones remarks: "In
regard to the cause of typhoid fever, a great diversity of
opinion is entertained among the most learned of the profes-
sion.   Some contend with great earnestness that it is  speci-
fically contagious, and cite instances  that it may seem diffi-
cult to explain to sustain the contagious character of the
disease.  Others  again, equally entitled to confidence, from
extensive observations, express themselves without any doubt
in regard to its non-contagious character.  It has always been
a difficult matter to reconcile these  apparently conflicting
facts; and  in view of  the fidelity of  the  statements, made
by individuals standing before the world and the profession,
both unimpeached and unimpeachable, on both sides  of the
proposition, it may be thought impossible to do  it.  But in
reviewing the whole subject, and examining the arguments
and facts adduced by the partisans of  both doctrines, I have
at length, I think, discovered  a satisfactory solution of the
difficulty, by which the facts claimed  by both are readily ex-
plained and reconciled.
   " From its general prevalence,  ' where human beings are
crowded  together, with insufficient or  unwholesome food, in
confined  or vitiated air/ such as hospitals and ill-ventilated
prisons; the densely populated, crowded, and filthy portions
of cities; among  the soldiers of large  armies in camps; and
in the close  and crowded holds of emigrant ships, the gene-
rally accredited opinion is, at  the present time, with  most
members of the profession, both among contagionists and non-
contagionists, that it is caused, in some way, by  the effluvia
arising from the decomposition of animal matter;  or, in other
words, that it results from a poisonous animal.
   " This conceded, it does not matter in  what this effluvia
consists;  whether it  be in the form of animalculae, mephitic
gas, or animal fungi—either of which will explain the facts.
       10 
 106      CONSIDERATION  OF FEVERS.

 But from this statement it will be seen that it may be either
 a contagious or an infectious  disease, and the difficulty is
 not thereby removed.   Let us see,  however, if it cannot be
 reconciled better with one than the other.
   " The laws of contagion are peculiar, and subject to few
 exceptions.  All those diseases  admitted to be  contagious
 have their uniform periods of incubation, or latent periods;
 their regular rise, progress, and decline, without any consi-
 derable variation, unless by some  accidental occurrence they
 are made otherwise; and  they are uniformly propagated by
 exposure.   Such, it may be, is the case with all those conta-
 gious diseases of which we have any knowledge, and we con-
 clude, therefore,  these are the laws of contagion.  In this
 definition we include that class of contagious diseases known
 to be propagated without actual contact; making a distinc-
 tion between those thus communicated, and those requiring
 immediate proximity to the poison to be  taken—such as ve-
 nereal, gonorrhoea, itch, &c, which  clearly are not subject to
 the same laws, and, I apprehend, should not be comprehended
 in the term contagion, in its ordinary acceptation.   These
 latter diseases, though they may be communicated directly
 from one person  to another,  are not governed  by those ge-
 neral laws peculiar to  the  class  of contagious diseases of
 which I am speaking; and, I think, therefore, should be
 regarded as propagated by what may be  styled  limited con-
 tagion, perhaps, with greater propriety, local contagion.
   " How is it with typhoid fever?   Its  latent  period is ir-
 regular and uncertain, varying from twenty-four  hours to
 nearly as many days;  and  its rise, progress, and decline, are
 little more regular or  determined than its period  of incuba-
 tion; in some instances continuing from four to  six weeks,
 in others  terminating  in  a few days; and exposure  to the
disease is not necessary to its propagation, for it often has a
spontaneous origin.  We conclude,  therefore, it is incompa- 
CONSIDERATION  OF FEVERS.       107
tible with the known laws of contagion, and hence cannot be
contagious."
   In making these statements, Professor Jones betrays a lack
of observation relative to contagious diseases, as it is a well-
known fact that small-pox, under Eclectic treatment, is not
only modified in severity, but that nearly all the premonitory
symptoms are completely arrested; besides, there are scarcely
two cases, where the disease is allowed to run its natural course,
in which the symptoms have anything more than a general
resemblance, and even these are symptoms common to most
acute diseases  in the early stage.   Dr. Jones himself, in
giving the symptoms  of small-pox, states, that previously to
the eruption, they are the ordinary symptoms peculiar to re-
mittent fever;  and  that the only peculiar symptoms are the
increased pain in the back and greater irritability of the sto-
mach.  What is true relative to the irregularity of the symp-
toms in small-pox, is equally true of measles, scarlatina, &c.
Not only are these diseases irregular in the manifestation of
their premonitory symptoms, but their entire course is marked
by variations both as  to duration and severity; as in some
cases of scarlatina they are so mild as hardly to disturb the
normal manifestation; while  in other cases the most severe
symptoms are manifested, and result in the most disastrous
consequences.   A moment's reflection will satisfy every per-
son who has been at all familiar with exanthematous diseases,
that the observations of Professor Jones relative to their symp-
tomatic character must have been very imperfect.   Without
entering into a further discussion of the subject at the present,
let us inquire what  are the facts relative to typhoid fever as
a contagious disease.   In 1851, typhoid fever attacked one
of the inmates of a large building, located in a healthy vil-
lage in Western Ohio.  The building was occupied by seve-
ral families, and every individual member had an attack of
the disease. A few  cases  occurred in the immediate vicinity,
otherwise the inhabitants of the village were entirely exempt. 
108      CONSIDERATION  OF FEVERS.
There was but little communication between the inmates of
this tenement and the  citizens of the town.  In 1855,  the
disease appeared in a family in another  town, and a large
number were exposed.   The fever spread until  a general
epidemic was the result.  In  many cases the disease only
manifested itself in the  mildest form; but in all cases  the
characteristic rash made its appearance.  At the same time
the disease spread through the surrounding country, but in
all cases the  patient had been exposed, or lived in a conta-
gious atmosphere.
  Another fact that helped to establish in my mind the con-
tagious character of the disease was, that during the first
three weeks of the epidemic, the wind blew from the north-
west, and the disease spread only in the opposite direction,
unless the patient had been directly exposed to the infection.
On the commencement  of  the fourth week  the wind sud-
denly changed to the south, and continued to blow from that
direction for some days.   In less than two weeks the disease
made its appearance in the opposite direction, and spread
into the adjoining county.   In 1858, this fever  made its ap-
pearance in another town in Ohio.   The first case was in  the
north-east part of the town, much elevated above the main
village.  The wind  blew from the  proper direction to carry
the infectious atmosphere over the town, and the result was
that the disease spread most rapidly, and  a general epidemic
prevailed.  Instances might be multiplied to show with what
uniformity the disease always spreads to  the leeward.  Not
only is the infectious character of typhoid fever proved by
these results, but the almost  certainty of its attack upon
nurses and attendants, unless they enjoy an immunity from
it by a previous attack.  I have conversed upon this point
with many intelligent physicians of extensive  observation,
all of whom  agree with  me, that typhoid fever uniformly
attacks nearly all, if not all, of the unprotected  members of
the family where it makes its appearance. I will relate  one
• 
CONSIDERATION  OF FEVERS.      109
instance only as it occurred in my practice, in illustration of
this fact.  In 1857, a boy of some ten years of age was at-
tacked by typhoid fever.   Before he recovered, his sister, a
few years  older, came down;  and, in two weeks, the father,
mother, and  two  other members of the family,  all with the
 same disease.
  Four families in the immediate neighbourhood were soon
attacked in the same manner, and in the course of two months
it manifested itself to a greater  or less extent on all  persons
who had been engaged as nurses or attendants, not exempted
from  it by a  previous  attack.  I could quote hundreds of
similar cases, which I have observed for. the last few years.
I find my observations verified in other sections  of the coun-
try, in nearly every particular;  so that I have become satis-
fied that typhoid fever, in this respect, manifests all the cha-
racteristics of genuine exanthema.  Although a  second at-
tack of this disease is unusual, yet I have seen all the cha-
racteristic symptoms the second time, and in one instance an
individual had an attack at four different periods.   But im-
munity from a second attack is quite as sure as from any
other form of exanthema.
  Dr. Bartlett also states that " the general opinion has been
that typhoid fever was not propagated by contagion."  Louis,
in his first edition, published  in 1829, says nothing upon
this subject.   Chomel, in his Legons de CUnique Medicate,
published in  1834,  although he himself was inclined to the
opposite opinion, says that not more than one  physician of
a hundred, in France, regarded the disease  as contagious.
Andral says  he  never saw any evidence of its contagious-
ness.   Dr. James Jackson says, if he were to  answer from
general experience, he should  say  that instances occur in
which there  is much in favour  of the doctrine of contagion;
but that,  in  the  very great majority of instances, there is
not any such evidence.  He relates son^e  cases, oocurring
among the hospital nurses, apparently attributable to conta-
                           10* 
110      CONSIDERATION  OF  FEVERS.

gion.   In 1829, M. Bretonneau read to the Royal Academy
of Medicine a paper, intended to show that the disease, as
it prevailed in the country, was often transmitted from one
individual to another.  Leuret, about the same time, adopted
a similar opinion.  The subsequent researches of Gendrof,
Ruef, Putegnat, and others, have confirmed this opinion;
and Louis has adopted it in the second edition of his work,
published in 1841.  Many years, however, previous to these
publications,  Nathan  Smith asserted, in  the most positive
and unqualified terms, the contagious character of this dis-
ease.   His essay was published in 1824.   " That the typhus
fever is contagious.," he says, " is a fact so evident to those
who have seen much  of the disease,  and who have paid at-
tention to the subject, that I should have spared myself the
trouble of saying anything in regard to it, did I not know
that there are some physicians in this country who still dis-
pute  the point;  one  which I think can  be as fully demon-
strated as that the measles, small pox, and other diseases,
universally allowed to be contagious, are  so."  Dr. Smith
then  mentions several instances, which had fallen under his
own  observation, where the  disease seemed to have been
communicated through the medium of  a  contagious prin-
ciple.  From amongst  these, I  select the following:—"A
young  man, a pupil of mine, was attacked with the  typhus
fever, from which he  recovered with some difficulty.   Some
of his family, who lived about forty miles distant, came and
took  care of him during his sickness.   Upon  his recovery
they returned home in good health, but soon after sickened
with the same disease, and communicated  it to others, who
had  not  been  exposed in the first instance.   From  this it
spread to numerous other families in the vicinity, who had
been exposed to the  contagion.   In the whole town where
 this  occurred, there  had been no case of typhus fever for
 many years,  till brought there by the circumstance above
 related." 
         CONSIDERATION OF  FEVERS.      Ill

  During the prevalence of the typhus fever in Thetford,
Vt., a woman went there from Chelsea, about ten miles dis-
tant, to visit and administer to a sister sick of this disease.
Upon her return she was herself attacked by it, and soon
after died.   Others of her family contracted it of her;  and
in about four weeks  there were thirty persons taken down
with typhus, all of whom had been exposed to the  conta-
gion.   Dr.  Samuel  Jackson, formerly of Northumberland,
relates several  striking instances  similar to those  quoted
from Nathan Smith, showing the contagious quality of the
disease.  The memoir  of M. Gendrin upon  this subject, is
very full and elaborate.   He adduces  a great number of in-
stances similar to those above quoted from Dr. Smith, many
of them very striking  and conclusive, to show  the  conta-
giousness of the disease.  He believes  that it is transmissible
by direct and repeated contact; by the presence of the sick,
without contact; that it may be carried from a sick person,
and communicated to another by a third, who does not have
the disease; and also, that it may be contracted from exposure
to infected  clothing, beds, and similar  fomites.   He regards
the first-mentioned mode of transmission as altogether the
most  common.   The indirect transmission  of  the  disease
from one individual to  another, through the intervention of
a third, he thinks does  not often.happen, except where it is
prevailing more or less extensively as an epidemic.   The
disease is most  frequently communicated to those who  are
in the closest and most constant relation to the sick—their
nurses and  immediate attendants."
  Genovese states,  that during the universal prevalence of
measles in 1787, he attended forty-six  cases of both children
and adults, who had already gone through with  the disease
some time before.   Dubosque had occasion to treat several
children for measles that he had previously carried through
the same disease.  Dr. Baillie states that he had  occasion to
treat five children for measles the second time.  Every prac- 
112       CONSIDERATION  OF  FEVERS.

titioner of any  considerable experience  in  scarlatina and
small-pox is familiar with instances of their second  occur-
rence in the same individual.  Dr. Morton states that he met
with a case where the system derived no protection from re-
peated attacks.
  Anatomical Character—The anatomical character of fe-
ver varies with  the  type of the disease.   In intermittent,
autopsy has shown traces of inflammation of the arachnoid
membrane.   The liver is frequently the seat of lesion, and
sometimes undergoes a change of structure. In chronic ague,
it presents the appearance described by Dr. Craigie, caused
by the congested condition of its capillaries.  But of all the
organs of the body, the spleen is the most uniformly affected.
It is not only changed in structure, but becomes very much
enlarged, and in  all fatal cases proves to be the principal
organ on which the disease has spent its force.  In  remit-
tent and congestive  fevers,  the essential anatomical charac-
ter is altered in  the  condition  and structure of the liver and
gall-bladder;  although  other organs, such  as  the spleen,
lungs, brain, and we might add, the entire capillary system,
at times manifest organic lesion and congestion.
  In  typhoid fever  the  principal anatomical characteristic
appears to be confined  to the glands of the bowels.  Dr.
Bartlett  states that " the mucous membrane, exclusive of
the elliptical  plates and the isolated follicles, is, in a majo-
rity of cases, more or less changed in colour.   In many it
is preternaturally red.  The redness is sometimes  continu-
ous, and  extends  through a large portion of the  intestinal
tract;  at other  times,  and more  frequently,  it  exists in
patches or zones.  Occasionally, the colour is grayish; this
is particularly the case when the disease has been protracted
to a late  period."
  The consistence of the membrane, like its colour, is  found,
in a moderate proportion  of cases, quite natural.   Oftener,
however, it is more or less diminished; sometimes so much 
CONSIDERATION  OF FEVERS.       113
so as to resemble an unorganized  pulp, spread, like a layer
of paste, over the subjacent tissue.  This  softening is, in
some cases, quite simple; that  is,  it is  not  connected with
any other appreciable alteration.   In others, the membrane
is, at the same time, reddened or thickened, or both.  It is
the opinion of Louis, that these two forms of softening are
unlike in  their character and causes.  The latter he consi-
ders to be inflammatory; the former, he thinks, may depend
on different causes, but that it is not the result of inflamma-
tion.   In a part, at least, of the cases, he is inclined to re-
gard it as the result of post-mortem, or cadaveric change.
  The invariable and  characteristic lesion found in  the
small intestines, to which allusion has been  made, consists
in alterations, differing somewhat in different cases, of the
elliptical plates,  or Peyer's glands.  The condition in which
these bodies  are found varies with the duration of the dis-
ease, with the distance  of  the plates themselves from the
ileo-ccecal valve, and from other  circumstances, the nature
of which is unknown.  Without entering into so minute and
elaborate a description of the several forms of this lesion, as
has been very properly given in the original researches of
Louis and Chomel, I shall enumerate the principal and more
striking varieties.
  In a small  proportion of cases, consisting of those which
terminate early,  the elliptical plates, together with  the sub-
jacent cellular tissue, are merely increased  in thickness, with
redness and softening.   This increase of  thickness is such,
that the edges of the plates have been known (in rare cases)
to project to a distance of from one to two, or three lines,
above the surrounding mucous  membrane.  Sometimes the
hypertrophy of the plates and of the subjacent tissue is quite
simple, the colour and consistence of the membrane remain-
ing unaltered.   This simplest form of the lesion, that I am
now  describing,  like all the others, which are  more com-
plex, is invariably found most advanced, and most strongly 
114      CONSIDERATION OF  FEVERS.

marked, at  the lower extremity of the ileum.   Each succes-
sive plate, as we go upward along the intestinal tract, from
the ileo-coecal valve, is less and less profoundly altered, till
we arrive at those which are in a natural  condition.   The
number of  plates thus changed is  various;  sometimes ex-
tending to fifteen or twenty, and at others limited to one or
two, and these  always in the immediate neighbourhood of
the ileo-ccecal valve.  Louis says, that in two-thirds of the
cases  the number of plates more or less  altered, is from
twelve to forty.
  The surfaces of the thickened plates frequently present
a granular, or finely mamellonated appearance.   This condi-
tion becomes very manifest when the gland is detached from
its subjacent tissue, and held between the eye and the light.
At other times, the surface  of the thickened membrane
corresponding to the plates, is quite smooth and level.
  In  a great majority of cases, the plates,  instead of being
merely thickened, with or without redness  or softening, are
more  or less extensively the seat of  ulcerations.  These ul-
cerations vary  much in  size  and number.  It  frequently
happens, for instance, that in proceeding from above down-
wards in our examination, after having passed over several
places, we  come to  one of them in which  there is a simple
circumscribed ulceration, with perpendicular edges, extend-
ing more or less deeply into the thickened tissues.  As we
go on towards the termination of the intestine, the ulcera-
tions  become more and more numerous and extensive, till
at last, for  several inches next to the valve, the plates are
entirely destroyed, and we find  only ulcerations, correspond-
ing to their size and shapes, occupying  their places.
  These intestinal  ulcerations are  commonly more or less
regularly rounded, or oval in their shape.   Sometimes, how-
ever,  their  borders are irregularly jagged and angular.   So
their edges are, in most cases, pretty regularly perpendicular
and smooth, but sometimes they are ragged and shreddy. 
          CONSIDERATION  OF  FEVERS.      115

 The  bottoms of the  ulcerations vary, of course, with their
 depths.   They  consist, sometimes, of the cellular tissue im-
 mediately under the mucous membrane; sometimes of the
 muscular coat,  and  sometimes  of the  peritoneal covering.
 Occasionally this covering itself gives way, perforation takes
 place, and the contents of the intestine are discharged into
 the cavity of the peritoneum.   Louis found  this lesion  in
 eight  of  fifty-five cases.   Chomel quotes  two instances  of
 its occurrence in his clinique at the  Hotel-Dieu; in one  of
 which, however, the perforation took place in the large in-
 testine.   The perforation is usually single, small  in diame-
 ter, and  near to the termination of the ileum.   In one  of
 these  cases,  mentioned by Dr. Hale, it was at the distance
 of forty-four inches from the ileo-ccecal valve.  It generally
 takes place at a late period of the disease.  Perforation oc-
 curred in three  of Dr. Jenner's twenty-three  cases, respec-
 tively on  the seventeenth, thirty-first, and forty-second day
 of disease.  " The perforation of all three took  place through
 the floor of an ulcer seated on one of the agminated glands.
 In two of the three perforation occurred in the lower nine
 inches of the ileum; in one, three feet above  the ileo-ccecal
 valve.  In two  of the three the coats of the intestine were
 destroyed through their whole thickness, at another spot
 from that at which the perforation, which proved fatal, took
 place; but the  contents of the bowel had been prevented
 escaping through the aperture first formed by adhesion,  in
 the one case, to  the fundus of the uterus; and in the other,
 to a fold of  the  intestine.   It will be observed that, in one
 of the three cases certainly, the fatal perforation took place
after  the  termination  of the fever."  It is a very singular
fact, that  this fatal accident commonly occurs in the course
of very mild, or  almost entirely latent, forms of fever.  This
was the case in ten  of twelve  instances cited by Chomel.
Chomel suggests that the distention of the intestine by gas
may frequently be the immediate cause of perforation.  This 
116
CONSIDERATION  OF FEVERS.
seems hardly probable, since the greatest distention is usually
confined to the large intestine, while perforation is most fre-
quent  in the  small.  It has occurred to me that the fre-
quency of the  accident in the mildest, and in some degree
latent form of the disease, might possibly be occasioned by
mechanical causes, especially by efforts of the patient while
standing or walking.
   This accident is much less  common in children than in
adults.   Taupin met with it only twice in one hundred and
twenty cases, and Barthez and Rilliet only once in one hun-
dred and eleven cases.
   There  is  another  peculiar appearance of the  diseased
plates, which is found in a certain  proportion of cases;  ac-
cording to Louis, somewhat less than one-third.  This seems
to consist in a morbid change, or transformation of the sub-
mucous cellular tissue.   Instead of being simply hypertro-
phic, with or without redness or softening, as in the cases
already described, there is deposited in the tissue a substance
of a yellowish colour, destitute of any traces of organization,
presenting a surface somewhat glossy when cut, and about
as hard  and friable as crude tubercle.   The  term typhus
matter has been given to this  morbid deposit.   This pecu-
liar condition was  observed in several  subjects, during the
grave  epidemic of 1833, '4, in the city of Lowell;  and, in
accordance with the fact previously noticed by Louis, it was
most frequent and striking in cases which terminated quite
early.   This would seem  to indicate that the alteration in
question is connected with the more severe and rapid form
of the disease.
  Dr. Jenner, after a careful examination and analysis of
these  lesions in twenty-three cases, sums up the results in
the following conclusions:—
  1. That ulceration of the solitary and  agminated glands
may commence in two modes: on the one hand, by soften-
ing of the mucous membrane, abrasion  of the  extremely 
          CONSIDERATION  OF  FEVERS.       117

softened superficial  tissue,  and  then enlargement  of the
breach of continuity thus formed, in  depth and extent, by
simple ulceration; on the other, by sloughing of a portion
of the submucous tissue containing the before-described de-
posit, and of the mucous membrane over it, and then exten-
sion of the ulcer in breadth and width, by the separation of
minute sloughs from the edges of the  breach of continuity,
left after the separation of the slough  first formed.
   2. That when the  whole  of the deposit has sloughed out,.
no fresh deposit is formed;  and that, consequently, as  the
whole of that deposit is seated in the  submucous tissue, de-
struction of the mucous fibres of the  intestine must be the
result of simple ulceration.
   3. That resolution of the disease  affecting the  patches
may, in some cases, occur before ulceration has taken place.
   4. That ulcers, of considerable size, may heal.
   5. That no contraction follows, within a short period, the
healing of the ulcers.
   6. That ulcers dependent for their origin on the presence
in the system of the fever  poison, may, after the fever has
run its course, continue to spread, retard recovery, and even
cause death by perforation.
   7. That while some of the ulcers are undergoing the heal-
ing process, others may be spreading; or, as  Rokitansky
says, may pass into the state of atonic ulcers.
   On summing up the  locality of fevers, we may reasonably
infer that the intermittent form is intimately connected with
a deranged condition of the spleen, while the remittent  and
congestive spend their force upon the liver and stomach,
and  typhoid upon the  bowels.   Yet  it  is contrary to  the
universal  characteristics of all forms of  fever, to  confine
their anatomical and physiological changes to any  definite
boundary, as each  and every organ of the  body is necessa-
rily more or less dependent upon the entire organism, which
constitutes the  whole.   So disease, although local in its in-
       11 
118      CONSIDERATION  OF FEVERS.
cipiency, soon extends its abnormal influence to nearly, if
not every tissue of the body.
  On making post-mortem examinations, it must be borne
in mind that the anatomical changes observed are not always
the result of diseased  action, from the fact that but very
few, if any, fatal  cases of fever occur, without the patient
receiving more or less medical treatment; and  it is  well
known that nearly, if not all the medicines used in the treat-
ment of disease, are susceptible of producing changes in the
various tissues of the body, and that these remedies do fre-
quently play an important part in the organic change of va-
rious tissues, will  hardly admit of a doubt.  Hence, in order
to estimate  the full effect of disease upon the different organs
and tissues of the body, we must take into consideration the
influence of the various remedies used in its treatment.

               TYPHUS   FEYER.
  Typhus  Fever; common  names—Hospital Fever,  Jail
Fever, Camp Fever, Malignant Fever, Putrid Fever, Con-
gestive Fever, Ship Fever, &c.   There is, perhaps, no fever
that is so illy defined,  and  relative to which  practitioners
have so much diversity of opinion, as regards the classifica-
tion, nature, and  character, as  of Typhus  Fever.  A  class
of very respectable writers regards this fever as an idiopathic
affection; while others of equal ability and  notoriety regard
it as a condition,  or one of the  dependencies of  bilious re-
mittent fever.  Among the former are Drs. Gerhard, O'Brien,
John Cheyne, Jenner, Upham, Flint, Bartlett, Wood,  Cop-
land, &c;  among the  latter we may mention Drs. Macin-
tosh, Armstrong, and  I. G. Jones.   Dr. Gerhard, of this
city, has published the history  of an epidemic fever which
prevailed in Philadelphia in 1836, which he regards as iden-
tical with typhus  fever, which  has  been so elaborately de-
scribed by  many  European writers;  and especially of that
which  is described by Drs. Barker and Cheyne as the great 
CONSIDERATION  OF  FEVERS.      119
Irish  epidemic typhus fever which prevailed in 1817, '19.
In the description of the Philadelphia epidemic, as published
by Dr. Gerhard, we cannot discover that the disease differed
in any essential degree from the malignant forms of mala-
rial fevers which have  prevailed so generally  throughout
the United States, when modified by a vitiated state  of the
fluids, a feeble vitality,  and  the addition of animal effluvia.
Dr. Gerhard  mentions  that the  attack of the fever was
usually preceded by lassitude, debility, and loss  of appetite;
that it was ushered in by rigours and chills, and that  during
its progress it was characterized by frequent exacerbations
and declines.   The  only symptoms which appeared  to dis-
tinguish this fever from the ordinary congestive  fever  of
the Western, Southern, and Middle States, were the more
violent symptoms of enervation, such as great nervous pros-
tration, early delirium,  &c.  Of this fever Dr.  Copland re-
marks :—
   " This fever is characterized by phenomena which  distin-
guish it from  the foregoing  varieties, by catarrhal and gas-
tric symptoms early in  the disease; by stupor,  delirium, or
typhomania;  by a peculiar cutaneous eruption; by more
or less evident affection of the  liver, and by the  determinate
course and regular succession of all  the febrile changes.
   il True, or  contagious typhus, has been confounded with
synochoid aud nervous fevers, on the  one hand, and with
putrid or malignant fever on the other.  It has been already
stated that putridity, or malignancy, not  only may charac-
terize a particular form of fever, or certain epidemics, even
at an  early period of their  course; but also, owing  to va-
rious  contingencies, may take place in advanced stages of
any other fever.   As the circumstances  favouring the ge-
neration and spread of  typhus are often such as also to de-
velop those changes which have been usually named putrid
or malignant, and  as these changes are frequently observed
iu the latter  stages of typhus, the symptoms distinguishing 
T 20       CONSIDERATION  OF  FEVERS.

this  fever becoming associated with, or followed by those
indicating the putro-adynamic state, so has  it been often
confounded with other fevers, in which this state has pre-
dominated more or less.  If we refer to the numerous his-
tories of  epidemic  typhus recorded by writers from  the
close of the fifteenth century up to the present time, or even
to the brief abstracts furnished by M. Ozanam, (Hist. Med.
des Maladies Epidermiques, &c,  et seq.,) we shall find, that
although  many of these, owing to the  concurrence of cir-
cumstances  developing a putrid  or malignant disease, were
instances  of fever, either identical with, or very  closely re-
sembling  that which I have described  as  such in the pre-
ceding section; yet many others—or even the majority-
were true typhoids, in which the putro-adynamic state was
either early or prominently developed; the exanthematous
eruption characteristic of typhus being succeeded or accom-
panied by the petechiae indicating the approach of the sep-
tic condition, and being either  mistaken for them, or for
an eruption of malaria.  Owing to this circumstance espe-
cially, typhus, low nervous,  and putrid fevers, have been
very generally confounded together.  The essential charac-
ters  of typhus were first distinctly traced by Sauvages; but
Cullen mixed them up with the  symptoms of those forms
of low nervous or typhoid fever which occur sporadically.
Even among modern writers, comparatively few have made
the distinction, excepting Hildebrand, Foder6,  Naumann,
Peebles, and some others.   True, or contagious  typhus,
has not been epidemic in England for many years; or, if it
have appeared in a few places, it has not extended beyond
them.  In Ireland, however, it was  extensively  prevalent,
particularly in the  years 1817, '18,  and '19; and in some
parts of Scotland since that time.   The fevers  most com-
monly observed in  England, and particularly in London,
have been either synochoid, simple or complicated; or low
nervous fever variously associated, and but rarely display- 
CONSIDERATION OF FEVERS.       121
ing a predominance of putrid or septic character.   During
1836, '7, '8, '9, this fever was very prevalent in London
and in several other places.
  True typhus, although  prone  to assume a septic condi-
tion, especially when  epidemic, and appearing under the
unfavourable circumstances about to be noticed, yet may
run its whole course without petechiae, or any marked pu-
trid  symptom.  It  may, as shown  by Hildebrand, be sim-
ple,  or  variously  complicated;  and, as  remarked  by Dr.
Peebles, it may be benign throughout, or assume a malig-
nant character, according to individual  diathesis, the na-
ture of the prevailing epidemic, or the mode of treatment.
It generally presents  itself  as an  epidemic, is contagious,
and  runs  a uniform course,  unless a predominant affection
of some internal  organ modifies its course, or prolongs its
duration.   It has been shown above that the petechial affec-
tion  consists  of minute stains, or  ecchymoses, caused by
the transudation of blood from the minute  capillaries  of
the vascular rete of the skin, owing  to the atony of these
vessels, and the alteration of the blood;  that it may occur
in the advanced  stage of any fever, even of the more in-
flammatory, or purely eruptive, when converted  into an
adynamic  or  typhoid  state,  by improper treatment, or the
peculiar condition of the patient;  and that it is not, in any
sense of the word, an eruption, as  it has  been very impro-
perly denominated  by some writers.   This change  in the
skin, which has been viewed as one of the chief indications
of incipient putridity, or of a septic tendency, is very dif-
ferent from the eruption  characterizing typhus.  The pe-
techia, or  cutaneous ecchymoses, vary in dimensions from
minute  stigmata to large patches of vibices, and  in the
deepness or shade  of  colour.  They very rarely appear  at
the commencement, even of the  more putrid or malignant
fevers, unless from peculiar  depravity of constitution,  or
from causes affecting more especially the circulating fluids—
                          11* 
122
CONSIDERATION  OF  FEVERS.
as impure air, imperfect nourishment, unwholesome food,
or other injurious ingcsta.
  But the exanthematous eruption attending true typhus
is as  characteristic of it as the eruption of measles or of
scarlatina; and, although observed by numerous writers, it
has been confounded with petechiae, with which it is often
associated in the  advanced stages of the fever,  or with
miliary eruptions.  Hildebrand gave a description  of it,
as it appeared in the contagious fevers prevalent in Ger-
many during the commencement of the  present century;
and Dr. Peebles has  recently described it accurately  and
minutely, and as he saw it in Italy soon after the war.   His
description  agrees  with my own observations  about  the
same  period.  This eruption appears  in the early progress
of a fever produced by human effluvia, when circumstances
occur  to  promote them, or to  prevent  their dissipation.
The animal miasm, whether generated by numbers crowded
in a small space and confined  air, or proceeding from a
person affected by the disease,  should be viewed as a poison
affecting the  human body in a  specific manner, and causing
fever with an eruption of a certain form, which propagates
itself by the diffusion of a morbid effluvium in the sur-
rounding air, or by its retention in various animal produc-
tions, or porous substances, when shut up from the air.
  This eruption usually appears from the third to the se-
venth day of the fever, but it may be delayed till the twelfth
or fourteenth day.  It is  of  a florid, reddish, or reddish-
pink colour;  disappearing on pressure, but soon returning
when pressure is removed.   This circumstance is sufficient
to distinguish it from petechiae.  The more exuberant re-
sembles the measles, and has been mistaken for them;  but
it is more papillar, and  rougher to the touch, being  sensi-
bly elevated to the eye; and, although sometimes grouped
or crowded, it does not coalesce so much as  measles,  but
each papilla is more or less separate.   It is sometimes ve- 
CONSIDERATION  OF  FEVERS.      123
sicular, and followed by desquamation of the cuticle.  It
is occasionally indistinct, and may be then overlooked, and
it sometimes approaches more nearly the miliary eruption.
Hence it has been mistaken for this eruption in such cases.
It is generally confined to the trunk of the body, the arms,
and thighs, but it may cover nearly all the body.  It rarely
extends over the  face or hands.  In children  it  appears
only on the trunk, or parts of it, and often scantily.   It is
sometimes evanescent, disappearing in one part of the body,
and  returning in another.—(Peebles.')   It may be copious
in some  cases,  and scanty in others, even in the same fa-
mily.  Owing to these circumstances, it may escape obser-
vation.   It is not  liable to recede early in its course; but
if it disappear from injudicious treatment, or a faulty state
of the system, malignant symptoms are  apt to supervene.
  In some cases the interstices of the skin between the pa-
pillae are red, or erythematous.   In these there are also in-
creased suffusion of the eyes, redness of the tongue at the
point and  edges, redness of the fauces, as in mild scarla-
tina, and subsequent desquamation of the cuticle.
  The foregoing description, it will be  noticed, almost ex-
actly corresponds with the  description which I have given
of typhoid fever.  The nature, character, and  progress of
the eruption, together with the erythema, closely resembles
the typhoid eruption which I have so  uniformly observed
during the progress of typhoid fever in nearly all sections of
the United  States for the last twenty years, that we can but
conclude that Dr. Copland  has confounded what he chooses
to term typhus fever with the true typhoid of this country;
that typhoid fever becomes essentially modified by the com-
bined influence of animal  and vegetable miasm, we have
the most ample proof.  In malarious districts, where inter-
mittents  and remittents are prevalent, typhoid fever, in ad-
dition to  its ordinary progress and symptoms,  not unfre-
quently manifests all the symptoms  peculiar to aggravated 
124      CONSIDERATION  OF FEVERS.
remittents.  Again, in crowded  cities, hospitals, barracks,
and other situations, where large bodies of people are con-
gregated, the zymotic effluvia may coincide with the typhoid
poison, and so modify the disease as to embrace all the symp-
toms and characteristics which have been so elaborately de-
scribed by Hildebrand, Copland, and others, under the head
of typhus.  Another form of fever, which has been minutely
described by many writers, and which Dr. Armstrong has so
thoroughly investigated, is unquestionably a modification of
congestive or remittent fever, produced by the same zymo-
tic influences.  That Dr. Armstrong, in his investigations,
confined  his observations to the  modifications of remittent
fever produced by this idio-miasmata, we have the most am-
ple evidence in the  following statements:—
   " My former belief was, that typhus fever arose from hu-
man contagion.  But I have lived to feel it a duty incumbent
upon me entirely to alter that opinion.   The following case
affected me deeply, and first led me  to review my opinion
on the subject,—the opinion,  I  mean,  which I then enter-
tained with regard to the origin  of typhus fever:—
   " About six years ago, shortly after I had published  the
third edition of my work on typhus fever, in which I had
strenuously maintained the doctrine of human contagion,
I met with a case  of intermittent fever.   In a few days the
fever became remittent, and in a few days more it  put on
the continued character, and the patient died with  all  the
most malignant symptoms of typhus fever.
  " This case made a powerful  impression on my mind; and
I could not help asking myself whether it was not possible
that the common ague of this country, the marsh remittent
fever, and continued  typhus fever, might be one and  the
same affection, modified by certain circumstances.  I deter-
mined, at any rate, to re-investigate the subject; for I sus-
pected  I might have taken up as  a prejudice, at college, the
doctrine of contagion, and  might have acted on that preju- 
CONSIDERATION  OF  FEVERS.       125
dice as a sacred truth.   Few men have more contemptuous
views of black-letter learning, and the dogmata of schools;
yet the opinion  clung to  me closely, and I parted with it
gradually, if not with regret.  I investigated the  subject
afresh, resolved, if possible, to  arrive at the plain truth,
whatever it might be;  and in six years the result has been,
that I am perfectly convinced that what is commonly called
typhus fever does not  arise from  malaria, or marsh effluvia;
that it is intermittent, remittent, and continued; that it arises
from infection; and that it does  not originate from human
contagion. It should be remembered that infection is not
contagion. It is a state of atmosphere produced by the sur-
face of the earth, and the  air, which is limited to a certain
space; and persons breathing it are subject to certain mo-
difications of a similar disease.
   " It is a very humiliating thing to the human mind to de-
tect  long-established  error; but it has these two advan-
tages :—it gives a man the satisfaction of possessing the truth
at last; and besides this reward, it makes him more cautious
in the admission of prejudices for the future.  Nothing can
satisfy the human mind,  which contemplates the pheno-
mena of nature around it,  but the conviction of possessing
the truth.  The longer I have lived, and the nearer I have
advanced, step by step, to the grave, the more I am convinced
how small is the amount of what I know;  and while I feel
the most  perfect humiliation that I  know so little, I am
bound to make the most public acknowledgment  of the full
extent of my  ignorance.   In  fact, having discovered my
error, the only reparation I can make is by such an acknow-
ledgment.
   " I have often been amused, and sometimes surprised, on
communicating the change of my views to my acquaintances
and friends; several of them have, however, though many
have not, become converts  to my opinion.   If I mention the
subject to one man, he shrugs his shoulders, and seems  as 
126       CONSIDERATION OF FEVERS.

if something had stuck in his throat.   If I speak of it to
another, he cocks his eye into one corner, and smiles sarcas-
tically.   A third shakes his head, and swears that the doc-
trine of contagion is true.  A fourth strokes his chin, makes
a dead stand, and confesses the matter requires farther con-
sideration.  If you will stroke your chins, and make a si-
milar declaration at the end of this lecture, with a resolu-
tion  to follow up  the investigation,  I shall be perfectly
satisfied.
   " I shall now repeat the facts  and arguments which I
have used here for years,  and  which have found their way
into  print, without any acknowledgment of, or allusion to,
the source from which they originated.
   " There are many reasons for supposing that typhus fever
arises not from human contagion, but from malaria, or marsh
effluvia;  and the six following  are, in my mind, perfectly
conclusive:—
   " 1. Typhus fever arises in single cases, at the same time,
in places  remote from each other.
   " This  is the  fact in  London; and not only so, but it is
the fact in the country  also, that typhus fever takes  place
at the same time  in single cases, at  remote situations, in
places, and among persons where, and with whom, there has
been  no  communication or contact, or intercourse of any
kind.
   " Does the doctrine of contagion account for this?  Cer-
tainly not.
   "2. It often attacks  several persons at one time, and in
one place, where it has  not before existed.
   " This  is a very remarkable circumstance.   I have the
history of fourteen cases of typhus fever in a school, where
no such fever previously existed.
   " It attacked  some of the fourteen boys in one day.
   " Two   ladies, sisters, had been in  the country, during
which time their house in London had been shut up.   When 
         CONSIDERATION OF FEVERS.      127

they came to town their strength had become impaired, and
they were both attacked by typhus fever.
  " Does the doctrine of contagion account for this ?   Cer-
tainly not.
  " 3. When several are thus attacked, some cases generally
put on the remittent or intermittent character.
  " Trace the  history of  all the cases minutely backward,
and it will generally be found that the affection in some of
them has put on, in the beginning, the remittent character,
between which there is a  mere shade of differencej for they
have some  characters in common;  and  it is allowed, I be-
lieve .by all, that they have a common origin.
  '' Does the doctrine of  contagion account for this?   Cer-
tainly not.
  " 4.  The intermittent, remittent,  and  continued forms of
fever, with their peculiar symptoms, pass and re-pass into
each other.
  " The intermittent will become remittent,  the remittent
will  become continued, the continued will  become remit-
tent, the remittent will become intermittent.
  " Does the doctrine of  contagion account for this ?   Cer-
tainly not.
  " 5.  Typhus fever prevails most remarkably in particular
places.
  "The common belief is that  typhus  fever  prevails only
in crowded  situations; but this is not true.  It may readily
be shown to be a perfectly erroneous opinion, for typhus
fever exists in some of the most open districts in London.
It prevails  in  one of the best built squares in town.  It
prevails inparts and patches of London.  With  a map of
London before me I could point out distinctly where it oc-
curs; where the earth's surface is filthy, and the drains are
imperfect.  Here it has  prevailed, passing  under various
names; but when the earth's surface has been cleansed, and
the drains have  beeu purified,  the disease has disappeared. 
128       CONSIDERATION  OF  FEVERS.

I could  point  out  places where  the disease  almost always
prevails.  There is one particular district which borders on
two parishes, where typhus fever has prevailed for the last
sixty years, and where it still prevails.  It is so marked,
that on a map you might circumscribe it with a line.  In the
borough typhus fever prevails remarkably.   Some time ago
a family were brought into the Fever Hospital with typhus
fever.   The account they gave of themselves was, that an
individual next door had fever,  and that they visited him
and caught the disease.  Human testimony, however, is not
always to  be depended upon.  The name of the family was
Jay, and they lived in White Square, Clapham.   The case
of fever next door was one of scarlet fever, and had occurred
four months previously.   On farther investigations of the
cases of this family, I found that all but one originated in
intermittent and remittent fever.  Running round the whole
of this square is an open common sewer; and  if typhus fever
occur in Clapham, it is sure to be in that square.
   " Typhus fever  prevails very  remarkably  in another vil-
lage, which is one of the most beautiful in the neighbour-
hood of London.
   " I know two ladies, who had  typhus fever, who were
living in a very airy square.  The house was built on dry
ground; but there were  open sewers in the square, which
rendered the inhabitants liable to typhus fever.
   " I know an old  practitioner, upwards of seventy years of
age; and  in the whole range of his recollection typhus fever
has prevailed in a  certain district, and there it still is pre-
valent.   The earth there is unclean, and the  drains are bad.
   " I was once looking at a house, which I had some thoughts
of taking;  but a medical  man warned me against it, as there
was always typhus fever there, and on that account a family
had just left it.  It was in a very airy district, but malaria
prevailed  there.   I could mention many other parts where
it prevails, but these may suffice. 
CONSIDERATION  OF  FEVERS.
129
  " Is this fact explained upon the doctrine of contagion ?
or can it be explained upon that doctrine?   Certainly not.
  "6. The rise, progress, and decline of typhus fever, are
connected with certain states of the earth and the air.
  " To give a few examples:—Typhus fever has  prevailed
remarkably since April, 1824, in and about London, but
certain places have been remarkably exempt from it; for
example, Islington, Wimbledon Common, and the higher
parts of Kensington; but it has been exceedingly prevalent
in some of the lower parts of Kensington;  and in  all  these
situations which have been exempt from typhus fever, the
soil is dry and gravelly.
  " In one part of Norfolk there is  a  district,  of which
several thousand acres  are sometimes covered by a conti-
nuous wave, and when the water subsides, leaving the  slime
exposed to the sun, then continued, remittent, and inter-
mittent fevers  occur  very remarkably.   In the period I
have  mentioned,  since April,  1824, all these parts  were
under water; and while that was the  case not a single in-
stance of typhus fever occurred.
  " Typhus fever prevails remarkably with  certain states
of the earth and air.
  " I attended a very respectable tradesman, labouring under
a remarkably bad attack of typhus  fever.   It was such a
case  as would have been called plague in  the time of Syden-
ham.   He had  knotted glands, and carbuncles, and black
petechiae.   He was one of four or five individuals who trans-
acted some business in a nobleman's kitchen; he was sick-
ened at the time, and  in common with all the other indi-
viduals had an attack  of typhus fever.
  "A friend  of mine had the  drains in his house cleaned,
and during the operation the inmates were attacked by ty-
phus  fever.  He ordered a dirt-hole in his house to be
cleared out, and himself and three inmates were  attacked
by typhus fever.
       12 
130      CONSIDERATION  OF FEVERS.

  " Two ladies, sisters, (to whom I have already alluded in
this lecture,) went into the country; and during their ab-
sence the house, which is situated in one of the squares, was
shut up.   When they came home, they were both attacked
by typhus fever.
  " There is one house in  the borough, where typhus fever
has prevailed for a series of years.  I have attended three
individuals in that house under  typhus fever; and I was
informed that no family had entered it for some years, part
of which had not been attacked by typhus fever in it.  A
common sewer runs close behind the house."
  After making most thorough researches and observations
relative to the nature  and  character of typhus fever, I can
only reconcile the conflicting opinions by concluding that,
while one class of observers and writers have confounded
typhus with  genuine typhoid, modified by idio-miasmata,
another class have made their observations upon the modi-
fications  of  remittents and congestive fever,  modified  by
the same influence; and that the only systematic division
that can be made of fevers, which is founded in the nature
and  character of  the  affection, is—1st, vegetable, malarial
fevers, produced  by the influence of vegetable miasmata,
which include all  the varieties of intermittent and remit-
tent; 2d, exanthematous fevers, which include small pox,
typhoid fever,  scarlatina,  measles, &c; 3d, symptomatic,
or zymotic fever,  which embraces all the varieties of exan-
thematous and miasmatic fevers, modified by idio-miasmata.

    ERUPTIYE, OR EXANTHEMATIC
                     FEVERS.
  When we take a survey  of fever, we notice a certain form
of disease characterized  by a peculiar exanthemata, and
other symptoms so entirely dissimilar from all the forms of
miasmatic and idio-miasmatic fevers, that  they  require  a
separate and special consideration.  The principal forms of 
CONSIDERATION OF FEVERS.        131
exanthematic fevers are—Typhoid Fever, Small-Pox, Mea-
sles,  Scarlet Fever, Erysipelas,  Vaccina,  Variola, Herpes,
Miliaria, Lichen, Urticaria, Roseola, Erythema, Lepra, Pso-
riasis,  Ichthyosis, Impetigo, Elephantiasis, and  Molluscum.
Among the principal eruptive fevers are Typhoid Fever,
Small-Pox, Scarlatina, Erysipelas,  and Measles.  Typhoid
fever I have already considered, and it now only remains
for me to offer a few suggestions relative to the character
of the other forms  of exanthemata and eruptive fevers in
general.  Small-pox,  or variola, (from the Latin varius,
spotted,) next to typhoid fever,  should demand  the  consi-
deration of the physician.
   " The Greeks and  Romans knew nothing of small-pox.
It is very true that Hahn in former times, and Dr. Willan
and Dr. Baron in our own, have laboured diligently to prove
the contrary.   Mr. Moore, too, has been no less anxious to
convince us that small-pox was known in  China and Hin-
dostan even before  the time of Hippocrates; but I am very
incredulous on these points, and am borne out in this skep-
ticism by the opinions of Dr. Friend, Dr. Mead, and many
other physicians of great learning, and equally indefatiga-
ble in  research.
   " In the writings of Alexander Trallianus, who lived in
the first half of the sixth century,  we have a brief descrip-
tion  of the whole circle of medical science as it existed in
his days.   No allusion to any complaint exhibiting the cha-
racter  of small-pox  is there to be met with.
   " The first notice of a disease that looks like small pox
is to be found in a chapter of Procopius, ' De Bello Per-
sico/ (lib. ii., cap. 22,) where he  describes a dreadful pesti-
lence which began  at Pelusium, in  Egypt, about the year
544, and  spread in two directions, towards Alexandria on
the one side, and Palestine on the other.  This disease, he
says, was accompanied by buboes and carbuncles.  So far it
resembled the Egyptian plague;  but, on the other hand, Pro- 
132        CONSIDERATION OF FEVERS.
copius distinctly states that it raged independently of all sea-
sons; that it spread into Persia and through the whole inte-
rior of Asia, and did not confine itself to the  shores of the
Mediterranean and Red Seas; that it spared neither age nor
sex; that it affected the  whole human race alike; that it
was a new disorder, so little understood by the physicians
of those days, that many recovered whom they had  given
over as hopeless, and many died whom they had pronounced
safe.  It is stated, also, that it was peculiarly severe in preg-
nant women.  All this looks very like small-pox.
  " Whether this  epidemic was  or was not small-pox, may
be doubted; but certainly, within a short time  afterwards,
very unequivocal traces  of small-pox are  to be met with
in the countries bordering on the Red Sea, for we read
of caliphs and caliphs' daughters being pitted.  Mr. Bruce,
the celebrated Abyssinian traveller, wishes to fix the first
epidemic of small-pox  to the  era 522, which corresponds
sufficiently near to the  date of  this  plague  described by
Procopius.
  " Small-pox had certainly been known for several centu-
ries before it was described.  Rhazes (910) is the first author
who mentions it; his description is clear and full, his theory
childish  in the extreme, and his  practice very bad.   Avi-
cenna and Hali Abbas, the Arabian physicians who succeeded
Rhazes, also mention variola,  adding some facts to  those
already described.
  " From the East small-pox travelled to the West, whether
slowly or quickly we have no means of ascertaining.  It
appears to have reached England  towards the close of the
ninth century.   The word variola is to be found in several
Latin manuscripts  preserved  in  the  British Museum, of
date decidedly prior to 900.  Exorcisms to  ward off the
dangers of this new plague are  to be found addressed to
St. Nicase.  The term variola, the diminutive of varus, a
pimple, is obviously of monkish  origin.   The monks were 
         CONSIDERATION  OF FEVERS.      133

the depositories of all the little  medical  learning of those
times.   The term pock is of Saxon origin, and  signifies a
bag or pouch.  The  epithets small in America  and Eng-
land, and petite in France, were added soon after the intro-
duction of the grand or great pox in 1498."
  Small-pox first visited the American continent in 1492.
It made its firs't appearance in Mexico; and in  1666 it
appeared in Boston, and subsequently in all portions of the
United States.
  Inoculation for the small-pox was first  practised in Con-
stantinople about the year 1700; but it was not until Lady
Mary Wortley Montague had  her daughter inoculated  in
1721,  that physicians had  their  attention called to the
improvement, and then, as I have  stated in another part
of the  book, she could not prevail  upon the  profession
to adopt the experiment  until  after the people  had re-
peatedly demonstrated  the  utility of inoculation in mo-
difying the disease.   Inoculation  had a powerful  influ-
ence in modifying the  severity of variola;  and up to the
period in which  vaccination  was introduced by Dr. Jenner
in 1770, small-pox  had become much less  prevalent and
essentially modified  in its character; but it remained for
vaccination to completely disrobe small-pox of its deathly
power.  Vaccination, however, has its evils as it is practised
at the present time.  Most of the virus used by  the physi-
cians is that which has passed through the system of persons
affected with syphilis, scrofula,  cancer, phthisis, &c, &c;
and from the frequency with which persons, previously ex-
empt from these maladies, are attacked with them after being
vaccinated, we have  every reason to infer that the vaccine
virus is contaminated with those poisons; consequently phy-
sicians cannot observe too much pains to obtain either the
genuine cow-pox, or the vaccine  virus  that has passed
through the system  of those who are entirely exempt from
any constitutional contamination.   The symptoms of small-
                          12* 
134      CONSIDERATION  OF FEVERS.
pox are those which mark the four  periods into which the
disease is naturally divided.
  1. The Period of Invasion.—This period  usually occu-
pies about three days, and is manifested by lassitude, languor,
restlessness, gaping, stretching, petulant and sullen disposi-
tion, which are accompanied or soon followed by chills, ri-
gours, and the usual symptoms of the cold* stage of fevers.
Towards evening these symptoms are succeeded by hot, dry
skin, pain  in  the head, and scrobiculus  cordis, which  is
increased on pressure, loss of appetite, nausea, and in some
cases, vomiting and lumbago.  During the second and third
day  the sleep is disturbed with  troublesome dreams and
sudden  startings, with frequent horripilations or creeping
chilliness, which is soon  followed  by heat, fever, flushed
face, occipital headache, and, in children, with frequent con-
vulsions.
  2. The  Period of Eruption.—At the end  of the third
day, or  on the morning of the fourth, a series of small, red,
circular points or papulae, in which form the variolous erup-
tion first presents itself, are not prominent above the sur-
face in which they are seen; but, by passing the finger over
them, they can be  easily  and distinctly felt.   They are  of
the size of a pin's head, are round,  hard, movable and roll-
ing  under the finger, and are evidently situated in the
substance of the skin.  These minute, isolated, tubercular
tumours, increase in diameter and in prominency, advance
upon the surface, become slightly elevated  above it, and
gradually rise into distinct  pimples.  In the course of the
first day,  or by the time they are twenty-four hours old,
they become rather more globular in form, have a  regu-
larly-formed ring of inflammation at their base, and assume
the usual appearance of rising pustules.  They now go  on
increasing in breadth and elevation, and, on the  commence-
ment of the second day,  present light, transparent specks
at their summits.  At  the first inspection these shining, 
CONSIDERATION  OF FEVERS.        135
semi-pellucid specks appear as if they were the effect merely
of the distention of their cuticular covering, caused by the
rising pimple pressing  against it, and thus giving to it a
polished  and glistening appearance; but they are, in fact,
the seat'o'f rising vesicles, for in the course of the second
day, but sometimes not until the third, the eruption loses its
papular character, and becomes visibly and truly vesicular.
The vesicles are at this period, however, confined to the tops
of the pimples, and contain a drop of limpid secretion. During
the eruptive stage  the pimples are painful when pressed;
and when  they have reached their vesicular  state,  they
seem to be planted upon well-defined tubercular bases, which
are perfectly distinguishable by the touch.   The inflamma-
tion attending the disease is of a phlegmonous kind;  and
the redness, both of  the  pimples  and skin, subsides and
disappears under the  finger, and on stretching the surface;
but the hardness and  projection of the  eruption continue to
be felt and seen. The true seat and structure of the eruption,
during the eruptive period, have been accurately ascertained
by dissection.  This has established, what indeed the sense
of touch and other methods of examination had indicated,
that the  small-pox pustule is originally formed in the sub-
stance  of the cutis.   The little tubercles, soon after they
are formed, are discovered, on dissection, to be located in
the reticular tissue of true skin, occupying, as it were, little
cells expressly formed for them. They resemble regularly-
formed bulbs, are reddish exteriorly, of an ash colour inte-
riorly,  and are evidently cellular.   If, on the second or third
day after their appearance, these bulbous tubercles are divided
by incision, and examined by means of a magnifying lens, ami-
nute quantity of a serous fluid maybe discovered in them, re-
tained by small, thin walls, or filamentous partitions; which
havenot, however, as yet the appearance of a regularand sym-
metrical structure.  The febrile symptoms on, and duringthe
appearance of the eruption, subside; and when the eruptive 
136      CONSIDERATION  OF  FEVERS.
process is completed, the patient, particularly if it be a child,
is frequently relieved from all the distress and  uneasiness
which attend the fever.  The pains of the head, back, and
loins, and the increased heat of the system, are much dimi-
nished, and occasionally entirely vanish.   The eyes  and
tongue regain, in some measure, their natural complexion,
the pulse becomes more regular, and the organs of digestion
and  of secretion resume, in a degree, their natural  and
healthy functions.   Patients usually complain of soreness
in the  throat during the whole time occupied by the period
of eruption, and this increases in degree as the pustules in-
crease in size and number. As the eruptive process goes on,
the regions which are  successively invaded by the pustules,
gradually  swell  and  redden; and  in  grown persons the
eruption is very frequently attended by a profuse  and  con-
stant perspiration.   After the breaking  out of the erup-
tion, the pocks, on whatever part  of  the body they  may
exist, all pursue the same march, varying a trifle,  perhaps,
in appearance in different regions, according as  the  tex-
ture of the skin differs in thickness and vascularity, and
by the time  the pocks which first appeared become vesi-
cular, those which succeed them are in different stages of
progress, and the  eruption  consequently presents a varie-
gated and multiform appearance.  The pimples, after having
passed  into the vesicular form,  as  already  described, in-
crease  in  diameter and elevation; and by the  fourth day
the tubercles seem to have emerged  entirely from the  sub-
stance  of the skin, and  are quite prominent above, and are
situated, as it were, upon its surface. Their whole superficies
is now  converted into a vesicle, which fills and  assumes a
rounded or hemispherical form, and soon presents a slight
depression in the centre.  This depression differs in degree
in different pustules.   In some it is quite evident, whilst
in others it is hardly  perceptible, or does  not exist.   It is
usually considerably deep in the eruption on the face, when 
CONSIDERATION OF FEVERS.        137
that on the extremity remains rounded and globular. When
the depression does exist, it is " produced by an adhesion of
the cuticular membranes to the inflamed cutis, in conse-
quence of the effusion of coagulable lymph; which also forms
a cyst to confine the matter, and thickens the rete mucosum
and cuticle."  The pustules, which are now of a  pearl or
ivory  colour, are  surrounded by a red circle, and  measure
from one to two lines in diameter.  They are tender on pres-
sure, and are still distinguished by hard tubercular bases.
They  subside, but do not disappear, on pressure, or by dis-
tending the parts in which they exist.   Their bases, how-
ever,  communicate a hardness and resistance to the touch,
whilst their superficies are comparatively soft and yielding.
These peculiarities, however, are not common to all of the
pustules at this  epoch;  some of them more  readily give
way under pressure, and  are more yielding and elastic than
others,  owing probably in part to a greater comparative
quantity of secreted fluid which distends them, and to some
difference in the compactness of the texture in which they
are situated.  Dissection of the  pustules, on the fifth or
sixth  day of their age, demonstrates that their  structure is
cellular, and that the cells are filled at this period  of  their
progress with a diaphanous secretion, and that they are se-
parated from each other by thin partitions, which converge
to a central point.  This structure is easily recognised in the
superior portion of the pustule, by dividing it by a trans-
verse  incision from  above downwards.  The structure of
the lower or deep-seated portion  of it  is more dense and
compact; but is still cellular, and is of a deeper colour than
the superior portion, and contains a little fluid.  In punc-
turing the  pustules at this  time, the secreted matter will
usually flow out at once; which shows that although it is con-
tained in cells, yet these are not distinct from each other,
but that there is  a free opening and communication among
them.   The pustules vary considerably in size, age, and ge- 
138        CONSIDERATION OF FEVERS.
neral appearance.  When about five days old they are he-
mispherical in shape, are bounded by a red circle, and their
fluid  contents gradually assume an opaque and  turbid ap-
pearance.  Whilst these changes are taking place in the pus-
tules, which are the first to break out, those which succeed
them gradually pass  through the same changes,  and the
parts which are thickly studded with them inflame and
swell, and frequently acquire a damask rose colour.   As the
pustules increase in size, and become filled with matter,, the
intermediate  spaces  inflame, and become infiltrated with
effused lymph, which occasions some  general swelling of the
cutaneous surface.  The eyelids are the parts which first
begin to swell, and they frequently swell to so  great an ex-
tent as to close the eyes, and produce temporary blindness.
In some instances they are so much infiltrated and distended,
that they resemble' shining, inflated bladders, drawn over
the eyes.  The other parts of the face soon swell in propor-
tion, and present a polished and bright red surface.  The
swelling of the face is sometimes so extensive, that its ge-
neral outlines are completely destroyed, and the peculiar fea-
tures of the individual are no longer to be recognised.  Im-
mediately after the face, the hands,  the  fingers, the body,
and the feet swell in proportion to the number of the pocks
which are on them.   The whole head  is at the same time .
tender and painful, and it is with much  suffering  that the
patient raises or moves it.
  Period of  Suppuration. — As soon  as the  suppurative.
process takes place, the surfaces of the  pustules begin to
lose their smooth and  semi-transparent  aspect,  and to grow
rough and whitish.   This is  the first sign of commencing
suppuration.   As maturation  proceeds, the complexion of
the pustules continues to grow more opaque, and to assume
successively a  milky and  light straw, or cream colour.
During  this process small, well-defined,  circular  specks,
darker than the rest of the surface,  appear in the middle 
CONSIDERATION OF  FEVERS.      139
 of most of the pustules.  These little specks on the first
 formation are rendered very apparent by means of a mag-
 nifying lens, and  the  cuticle which  covers them appears
 somewhat dry, and slightly scaly.  They increase in size
 from the centre to the circumference, until the whole super-
 ficies of the pustules assume in a measure the same opaque
 and purulent appearance, and until desiccation actually com-
 mences.   At this period of their progress the pustules cease
 to communicate that resistance to the touch which distin-
 guishes them during their vesicular state;  and, instead of
 feeling firm and hard, they are now  comparatively soft, and
* the matter in them evidently fluctuates under the pressure
 of the finger.   The fever, which subsided on the breaking
 out of  the eruption, re-appears at the commencement of sup-
 puration, and rages with greater or less violence till desic-
 cation  takes place.  It is announced by chills, which are
 succeeded by heat, headache, quick and hard pulse, thirst,
 furred tongue, by a disposition to sleep, coma, and sometimes
 delirium.  The parts which  are the  most thickly studded
 by the pustules, are commonly  the most  swollen,  inflamed,
 and painful.   The hands and feet of children usually swell
 a good deal, even when there are but few pustules on them,
 and adults are  almost  constantly troubled with a free, and
 frequently a profuse salivation.  The secretion  of saliva
 is attended with  hoarseness and pain, and with a peculiar
 and very disagreeable odour.   The urine is commonly high-
 coloured and muddy;  and the dejections are frequent and
 liquid  in children, whilst in adults  they are often sup-
 pressed and hard.   The general symptoms continue with
 varied severity, until  the pustules on the different regions
 of the body become entirely maturated, and begin to dry
 up.  The pustules on the face, or those which first break
 out, are  the first in which suppuration commences, and is
 soonest completed.  Those on  the extremities are the last
 to suppurate.  As the pustules on the different regions, 
140
CONSIDERATION OF FEVERS.
and even on the same parts of the body, do not pass into
their  suppurative  stage  all at the same  moment,  but at
different times and in succession, the eruption consequently
exhibits a variegated appearance at the time that the oldest
pustules are in a state of complete suppuration.  As  soon as
desiccation commences in the pustules the febrile symptoms
abate, and vanish as the process of scabbing proceeds.  The
areolae surrounding the pustules, and  the swelling and tur-
gescence of the parts on which they exist, decline, and soon
disappear.  The scabs fall from the face irom the twelfth to
the fifteenth day after  the appearance of the eruption, and
from the fifteenth to the eighteenth day from the commence-
ment of the febrile attack.  In  the course of two or three
days more, the scabs on the other parts of the body  fall off.
Such are the usual symptoms and appearances of the small-
pox in its distinct form.
   Variola Confluens.—In the other  form of the affection,
however, (which is called "variola confluens,") the pustules
are very numerous, and run together.  The  feverishness is
infinitely more violent, and rather of a typhoid character;
the pulse is not so strong, the patient is exceedingly weak,
and  there is delirium.  There is often so violent an affec-
tion of the head, that it produces coma; and the eruption
not unfrequently begins early, even on the second day. The
pustules are not only far more numerous,  but they are
smaller, flaccid, and not filled as they should be. Their quality,
also, is bad; for, instead of containing a creamy,  "laudable"
pus, the  contents are brown,—perhaps thin and  serous;
and perhaps there is a brownish, ichorous fluid, rather than
genuine pus.   They not only run together;  but, from not
being well filled, they appear more or less flat.
   Attendant Symptoms.—The feverishness, in this  form of
the disease, is very little lessened on  the appearance of the
pocks; and at the  end of the  eruption it is aggravated very
much.  Secondary fever, of a very violent character, comes 
          CONSIDERATION OF FEVERS.       141

on.  The symptoms occurring in other parts, are also very
severe.   There is much more "running" of the mouth, and
much more inflammation of the fauces, than in the distinct
form; and, in infants, there is sometimes violent diarrhoea.
In this latter instance, the lower part of the alimentary
tract suffers great irritation.  Frequently, too, between the
pustules, there are petechiae, vibices,  and ecchymoses;—
there are, in short, red, dark-coloured spots, of various sizes.
Sometimes there  is bloody urine, and sometimes blood ap-
pears in the  evacuations.    The secretions are  very un-
healthy;  and there is  an exudation all over the body, so
that the person emits  a very offensive smell.   Now  and
then, patients labouring under this form of the disease, die
rather suddenly.   The consequences of this species of the
disease, too, are more  severe than in the other form.   In
fact, it is "variola confluens" that, for the most part, leaves
such terrible consequences; such as blindness, phthisis, and
diarrhoea;—the latter of which ends in  ulceration of the in-
testines.
   Complications.—Such are the ordinary phenomena of the
natural small-pox, in its distinct and confluent forms, when
it occurs in persons previously in good health, and of sound
constitution.   But  it must be  remembered that this  dis-
order may attack those who may be labouring, at the  time
of seizure, under some other disease,  such as  pneumonia
hooping-cough, hepatitis, or consumption; and, farther, that
these and other disorders  may  come on, unexpectedly, at
any period,  (early or late,) during the progress of small-
pox.  An infinite variety of accidental  symptoms may thus
be superadded to those regular  symptoms  already enume-
rated.  Besides which, small-pox may occur in  persons of
a weak habit,  or in constitutions exceedingly exhausted,
and unable to cope with a disease of such severity.  It may
occur, for instance, in  those  who have but recently reco-
vered from a severe typhus or scarlet fever.  In these cir-
       13 
142       CONSIDERATION OF FEVERS.

cumstances we observe a  very tardy  eruption;  collapse,
without advance of eruption; or, in a case  somewhat more
favourable, an abundant formation of large  blebs, contain-
ing a thin ichor, with a very tedious and hazardous period
of convalescence.  To this  latter form of the disease the old
writers gave the name of the  " watery, or b'ladder-poek."
   Occurs  only once.—The disease rarely occurs more than
once; and, although we may all see instances of its  secon-
dary occurrence, yet these are  exceptions  to  the general
rule.  Like measles, however, and scarlatina, it may occur
more than once.
   Co-existent with Measles.—It  was a dogma of John Hun-
ter, (an assertion without proof,) that  no two  specific dis-
eases could exist, at  the same time, in the same body; but
this  is untrue.  We see  persons labouring under itch and
syphilis at the same time ; and there are plenty  of instances
on record, of small-pox co-existing with measles  and cow-
pox;  though, in general, one disease runs its course in the
body, and then the other.  It is mentioned in  the " Edin-
burgh Medical Commentaries,"  that measles and small-pox
occurred simultaneously in  sixteen children.  Out of forty-
three children who  were inoculated, sixteen  were at the
time labouring under measles;  and both the diseases went
on together.   This occurrence took place at the Foundling
Hospital in Dublin.
   Effects.—Pustules frequently form around the  eyes, and
on the cornea itself; and there is  often ophthalmia, which
not unfrequently (in the violent forms of the disease) pro-
duces albwgo, or staphyloma.   Formerly a great number of
persons were rendered  blind by the small-pox.  When the
disease is over, it frequently leaves scrofula.  Persons may
have  enlarged glands of the neck, or they may  have en-
larged mesenteric glands, or they may have phthisis.  Fre-
quently it leaves rupia and  ecthyma.  Diarrhoea, too, is not
unfrequently left  after it;  and  the  mucous membrane of
the intestines sometimes falls into  chronic inflammation.
A 
          CONSIDERATION OF FEVERS.       143

  Among the mucous membranes, those of the larynx and
trachea frequently suffer much.   Many children die, from
the upper part of the trachea being blocked up with a thick,
tenacious  mucus, and  much swollen.   I have frequently
examined the larynx of children, who have died  of this
disease, and its state  has  been such  as  to  astonish  me.
There  has been great inflammation;  and so  great an effu-
sion of thick stuff, as very nearly to block it up.
  Morbid Appearances.—The following is a summary of
the  principal results deducible from the  investigations of
Dr. Petzholdt, into the morbid  appearances  found in the
bodies of persons dying of small-pox:—
  " 1. There occurs  softening of the  undermost layers of
the cuticle; and, at a later period, destruction  of the con-
nexion with the cutis.
   "2. Orifices are never observable in the cuticle covering
pocks.
   "3. What is called the ' pit/ or 'umbilicus,'  is produced
by  the retention of the  cuticle  by the excretory ducts of
the cutaneous glands.
   " 4. All pocks have not a pit, or umbilicus.
   " 5. The pit, or umbilicus, never exists in pocks seated •
on the palm of the hand, or sole of the foot.
   " 6. On the  base of the pock, and consequently on the
base of the cutis, the orifice of the gland can be seen; ex-
cept in the palm of the hand, or the sole of the foot.
   "7. The portion of the surface of the cutis  not covered
with pocks, is also in a morbid condition.
   " 8. The vessels at the base of the  pock  exhibit marks
of inflammation; those at its circumference, marks of  con-
gestion only.
   " 9. The (so-called) l wiW-pocks' are by no means empty.
   " 10.  The cutaneous glands  are  generally  swollen in
small-pox.
   "11.  The excretory ducts of the glands, when destroyed,
as well as the hairs that fall out, are regenerated.
i 
144      CONSIDERATION  OF  FEVERS.
  " 12.  The mucous membranes of persons affected with
small-pox, often  exhibit inflammation, with the formation
of vesicles and ulcers.
  " 13.  Vesicles, and superficial excoriation, are met with
on the tongue.
  " 14.  On  the  pharynx, and  back part  of  the mouth,
there are never  pocks; but  the glands  there seated  are
much distended, and have very wide orifices.
  "15.  There occurs softening of the  epithelium of the
oesophagus, rising into pustules.
  " 16.  At  a  later period,  the epithelium is completely
destroyed.
  "17.  Ulcers are met  with in the oesophagus;  but never
with perforation of the proper mucous coat.
  "18.  No  pocks are found in the stomach and intestinal
canal; but there occurs destruction of the papillae of the
mucous  membrane, particularly in the small intestine.
  " 19.  There is often dentritic, vascular injection of the
mucous  membrane of the alimentary canal.
  " 20.  Ulcerated parts are occasionally found in the mu-
cous membrane of the nasal fossae..
  "21.  Vesicles form in the trachea.
  " 22.  Ulcers occur in both larynx and trachea.
  " 23.  The mucous membrane of the  genital organs is
free  from pocks, except at its junction with  the  external
skin.
  " 24.  On  the serous membranes nothing more is (in ge-
neral) to be seen, than what is  found after their inflamma-
tion  in other diseases.
  "25.  In a few cases, an eruption was found on the se-
rous coverings of the spleen and liver."

                    TREATMENT.
  In addition to the treatment that I have given in ano-
ther portion of this  book, I would state that after giving 
          CONSIDERATION OF FEVERS.       145

the free purge, if I am called to treat the case in the early
stage,  a  thorough  spirit  sweat should be administered.
This can  be  done  by placing  the patient  on a Windsor
chair,  with two blankets, one  applied  in front, and  the
other to  the  back, a cupful of alcohol  placed under  the
chair, and set on fire, and allowed to burn  until free per-
spiration is produced.   After the sweat, the patient should
be thoroughly sponged, wiped, and placed in bed; and, in-
stead of the  infusion that I was formerly in the habit of
giving, add thirty grains of triturated  macrotin  to a tum-
bler half full  of water, and give  one teaspoonful every half
hour, or hour, during the  stage of maturation.  If there is
fever,  aconite  or veratrum, as  previously  recommended,
should be given.   If inflammation  of  the fauces  should
prove a troublesome symptom, a mild solution of the chlo-
rate of potash  and hydrastus should be used  as a gargle.
In some cases,  where angina is  very severe, in addition to
the gargle, I have found hot packs, applied to the throat,
of much benefit; and where the disease assumes a conflu-
ent and an erysipelatous character, quinine and  muriated
tincture  of iron  are valuable  remedies.  A  prescription
that I  have been in the habit of using,  is the following:—
     R. Muri.  Tinct. Ferri........................3j.
         Sulph. Quinine.............................gr. x.
         Syr. Simplex............... ...............§iij.  ity..
          Sig.—One teaspoonful every two hours.
  During the entire progress of the disease, the body should
be  thoroughly  sponged once a day, and wiped dry; after-
wards  the following application should  be made to all por-
tions of the body, where  there are  pustules or symptoms
of inflammation.   Take creasote,  thirty drops;  olive oil,
one pint.  Mix, and use as directed above.  If the pustules,
at any period, should present a  disk appearance,  and there
should be symptoms of fever, a liberal amount of beef broth,
wine whey, and, in some  cases, quinine, iron, and hydras-
                           13* 
146       CONSIDERATION OF FEVERS.

tin, should be freely administered.  These symptoms are
more liable to occur from the seventh to the tenth day, and
have usually  been described under the head of secondary
fever.   In cases where there appears to be a large amount
of the small-pox virus absorbed, I have found much benefit
from the free use of diuretics, such as barosmin, chimaphi-
lin, &c.   To  prevent pitting, iodide of collodion should be
applied  to all portions of the face, and re-applied as often
as every twenty-four hours.  The iodide of collodion may
be made by  adding  ten  grains of iodine to four ounces of
collodion.  Small-pox is frequently complicated with local
inflammation, such as pneumonia,  pleuritis, gastritis,  hepa-
titis, &c.  When these  complications occur, they should
receive  a special treatment, as described under their respec-
tive heads.  During the  convalescence  the system should
be well  supported by means of a nutritious diet;  and, in
weak and  debilitated cases, by a liberal amount of milk
punch,  malt  liquors, &c.
   In some cases small-pox  ophthalmia manifests itself as
an  obstinate  and dangerous symptom.   In such cases I
have found the greatest benefit to result from the applica-
tion of  ten grains of hydrastin, triturated in two ounces of
glycerine, and  applied to the eyes in the form of an oint-
ment.   In cases where  the mucous membrane  is granu-
lated, small doses of rucine, repeated  at proper  intervals,
will be  found  a valuable  remedy.  If there is  bronchial
irritation, with cough, from one-half to  one teaspoonful of
the acetic syrup of sanguinaria, repeated at proper  inter-
vals, will afford relief.

                  SCARLATINA.
   Scarlatina, from scarlatino,  scarlet.
   The  first well-authenticated  account of scarlet fever is
that given by  Ludovicus  Mareotus and Michael Herodia,
who gave a description of  the fever as it existed in  Spain, 
         CONSIDERATION OF FEVERS.      147

in 1610 and 1612.  Sydenham first described scarlet fever
as it existed  in  London in 1670, and Sir Robert Sibbald
describes the disease as existing in Scotland in 1680.  Of
this  disease Dr. Gregory remarks:—"Scarlatina, taken in
its widest sense, is a fever  sometimes inflammatory, some-
times typhoid, the offspring of a morbid poison  gaining ac-
cess to the body by the mode of infection only,  characte-
rized by a short period of incubation, an eruption rapidly
developed, and  an inflammation of the fauces,  having a
strong tendency to terminate by  sloughing.   In its  mild
form, the disease does  not exist  more  than a week; but
when assuming its aggravated  type, it may be protracted
to a  month,  or  terminate fatally in a few hours.   Such a
disease  does not, like measles, invade a large proportion of
mankind during infancy; but having been undergone, the
susceptibility to future  attacks is  exhausted.   A zuma,
ferment, or poison, must have  access to  the body before
the blood is set in motion,  so as to develop the phenomenon
now  called scarlet fever.   The effects  produced by that
poison may be exerted on the  skin alone, and then the ac-
companying fever is  slight; or it may develop a more se-
rious kind of ardent fever, and then the skin and throat
both exhibit appearances.   It may so seriously  affect the
whole system as to produce intense fever, in which case the
throat receives nearly the whole shock, the skin being alone
partially affected.  Nay, in some extreme cases, the nervous
system  shall be so completely compressed and  subdued by
the virulence of the  miasm, and the mass of blood so tho-
roughly poisoned  and disorganized by it, that  all the ordi-
nary appearances of scarlatina are masked.   Petechiae, co-
ma, and a sloughy state of the throat, alone  appear.   Life
rapidly yields under such an attack.
   " From this  rude  sketch of the effects of the  scarlatina
miasm, you will see  that a gradation exists in  nature from
the mildest  to the most malignant, and that the external 
148       CONSIDERATION OF FEVERS.

appearances vary with the character of the fever.  A divi-
sion of scarlatina into species has been made, but remember
that it is artificial.   Nature creates genera and  individual
cases, but species are the imperfect arrangements of man.
With this reservation, I shall avail myself of the threefold
division now in general use, and shall treat of the two ex-
treme links in the long chain of phenomena, and the inter-
mediate variety; that is, I shall describe to you—1st, Scar-
latina Mitis; 2d, Scarlatina Anginosa; 3d, Angina Maligna."
  To Dr. Gregory's nosological arrangement of scarlet fever,
I add  that which has more recently made its appearance-
Scarlatina Diphtheritis:—•
  " The poison of scarlatina, whatever aspect it subsequently
assumes, has a very short period of incubation.   It invaded
my own family in 1839.   Rigours occurred to one member
of it on the last Saturday in April.  On Sunday, languor
and  lassitude, with dryness of  skin, were the chief symp-
toms.   At  6  o'clock on Monday morning, eruption ap-
peared.  On the following Saturday, at 2 p. M., my eldest
daughter sickened; so that the incubative period could not
have  exceeded seven  days,  and  was probably  only six.
Withering says that he has known patients begin to com-
plain as early as the third day  from exposure to the conta-
gion; and I cannot contradict the  assertion, though I never
saw incubation so rapid as this.   We may fairly state the
incubative period as varying from four to eight days.
   " In the mildest form of scarlatina, it often happens that
the first symptom is the rash.   No febrile disturbance what-
ever  has preceded.   More commonly,  there is a  certain
amount of fever, the symptoms not presenting  any marked
character.   Rigours, heat of surface, vomiting, restlessness,
thirst, languor, lassitude, muscular debility, and headache,
are the chief complaints.  On  the succeeding day the rash
appears.  Some authors would persuade us that the rash
may be delayed to the third, or even the fourth day from 
          CONSIDERATION  OF  FEVERS.      149

the rigour.   These observations, however, made when the
diagnosis of measles and  scarlatina was  yet  in its infancy,
cannot be trusted to.
  " The efflorescence in scarlatina mitis is first perceived on
the trunk, arms, and thighs; very often nothing appears on
the face, when these  parts  are covered with eruption.   In
less than twenty-four hours it spreads over the whole body.
Every thing is rapid about  scarlatina,—rapid incubation—
rapid eruption—rapid course.  Sometimes  the redness is
continuous,  but much more generally it is  distributed in
patches of no definite shape.   The colour is a bright scarlet,
precisely  that of the  boiled  lobster.   When closely exa-
mined,  it is found to consist  of innumerable  small  red
points, or dots.  In the greater number of cases, the finger
passed over  the surface is not made sensible  of elevation or
roughness.   Sometimes, especially on the breast, and parts
kept very warm, the feeling of papulae is given.   This, how-
ever, can only occur when there is fever, and sufficient force
in the heart's action to distend the  cutaneous  capillaries.
In the  mild form of  scarlatina  I am now describing, this
will not often happen.   The redness  of scarlatina, like that
of erysipelas, disappears on  pressure.
  " For twenty-four hours the child is restless, and refuses
his food.  On  the  third  day you will find him sitting  up
with his  toys.   The  rash is  receding.  In  two days more
the little  patient is convalescent.   I  have often examined
the throats  of children affected with the  scarlatina mitis,
and not  seen the slightest trace  of  angina.  The poison,
therefore, may circulate without any throat affection.   Well
might  Sydenham call  this  a disease in name only; it  is,
nevertheless, worthy  your  study, in order  that you may
trace  the steps by which it ascends into the malignant  cy-
nanche.
   " I now come to  the Scarlatina Anginosa, the primitive
type of the  disease, or that from which all the other varie-
L 
150      CONSIDERATION OF FEVERS.
ties diverge.  It is, as might hence be presumed, by far the
most frequent form  in which  the  miasm develops itself.
Scarlatina anginosa is a disease which, more than any other
that I know of, will  call into  play your pathological learn-
ing, and all your therapeutical  skill.  It is a disease which
may be  materially  aided by medical art.   It is a disease, in
the management of which medical men are more apt to differ
than perhaps any other.  It is, lastly, a disease which, from
its rapidity, leaves you little time for reflection.   You must
have studied it well beforehand,  and determined how to
act in cases of emergency.
  " The Angina Maligna are distinguished by other  true
forms, by the irritable state of the stomach and  bowels, vo-
miting,  diarrhoea, precordial oppression, great dejection of
spirits,  small and fluttering pulse, dorsal decubitis, and the
ash-coloured sloughs which early appear on the tonsils, and,
in some cases, delirium, of a fierce and unrestrainable cha-
racter.
  "Angina maligna is unquestionably produced by a con-
centration  of  the  scarlatina  poison upon the  fauces and
glands of the throat; and if it be allowed to remain in that
position, it will  result in extensive disarrangement of its
structure, and the formation of abscesses, or in extensive
oedema.   Either condition will most  essentially  interfere
with the functions of respiration, and produce symptoms to
correspond with the extent of the organic lesion, and imper-
fect arterialization of the blood.  In what  is denominated
scarlatina maligna there is an absence of the angina, which
is so prominent a symptom in  the anginose form of the dis-
ease; and we have every reason to infer that it is produced
by an  accumulation of the zymotic  poison in  the blood,
which, failing to be eliminated, either  through  the skin or
emunctories, produces a disorganizing  influence upon that
vital fluid,  and in many cases  immediate and disastrous  re-
sults.    In this form of the affection the symptoms are more 
          CONSIDERATION OF FEVERS.       151

obscure than in either of the  two previous ones.   As in
scarlatina simplex,  or  angina maligna, the diagnosis  can-
not be very difficult;  as  in the simple form  of the dis-
eases  the albuminous urine and lobster appearance of the
skin are most conclusive evidences of its nature,  while the
anginose form is as easily identified by the peculiar affec-
tion of the throat, and  the allied symptoms are evidences of
its nature."

         THE  SEQUEL  OF  SCARLATINA.
  The sequel of scarlatina  is dropsy,  convulsions, ulcera
tion of the glands  of the throat, neck, and kidneys, and
disarrangement  of  the blood.   The dropsy may  depend
upon  softening of the mucous membrane, or portions of the
kidneys; or it may  depend upon local  inflammation of the
peritoneum, pleura, &c, &c.  Convulsions occur  as the re-
sult of irritating effects of the specific scarlatina poison on
the cerebro-spinal nerves, and as the effect of the disorga-
nizing tendency  of the poison on the blood and  other fluids
of the body.
                    TREATMENT.
  In  addition to the treatment given in another portion of
the work, I would say  that in scarlatina maligna,  and angi-
nosa,  every possible effort should be made to establish a full
and complete re-action in the system during the  early pe-
riod of the disease.   This  should  be accomplished by hot
baths, hot packs, friction, with capsicum, lard, and  pulve-
rized  camphor, in the  form of ointment, to all  portions of
the body.  Hot  jugs of water, and capsicum, xanthoxylin,
and other stimulants administered internally if  required.
The philosophy of this treatment must be apparent to every
one when they consider that scarlatina is a disease dependent
upon  a specific virus introduced into the blood," which acts
as a ferment, and, unless eliminated from the system through
I 
152
CONSIDERATION OF FEVERS.
the skin, lungs, kidneys, &c, will soon  convert the blood
and other fluids of the body into structure identical  with
itself.   That the emunctories may accomplish the important
work of freeing the system from this poison, all the organs
and tissues must be aroused to the full extent of their ca-
pacity.  This is what I understand by re-action.   The fatal
mistake in the  treatment  of eruptive diseases dependent
upon  specific poisons  introduced into the blood, is, that
while the poison acts as an anaesthetic, paralyzing  all the
organs and functions of the body, the physician neglects to
counteract these influences by such remedies as he has at
his command, so as to allow the eliminating organs to free
the system from so noxious an agent.  I have, in cases where
it was important to maintain  active  elimination  from the
system, not only occasionally resorted to stimulating emetics,
such as lobelia and capsicum, but to the alcoholic vapour-
bath, and the frequent application of the camphor and cap-
sicum ointment to the surface of the body, and a large sina-
pism to the  entire  spine.   When the re-action is only par-
tial, and difficult to maintain, I have found the  following
prescription to be most valuable :—
        R.  Keith's Strychnine...............gr. j.
            Macrotin............................gr. iij.
            Sac. Alba.........................^ss.  Mix.
        Ft. pulv. No. xij.  S.—One every two hours.
   In  case the  above, with such other active treatment as
the practitioner may deem  expedient, should not effect a
complete re-action, hot brandy toddy should be given in
connexion with the other treatment.  After  the re-action
is thoroughly established, the only treatment  essential is to
maintain the eliminating process on the cutaneous surface,
to give metastic remedies, as directed in  the other forms
of scarlatina.  The sequel of the disease should be treated
as directed under the head of diphtheritis. 
CONSIDERATION  OF  FEVERS.       153
   DIPHTHERIA,  OR  DIPHTHERITIS.
   As I have already stated, I regard diphtheria as one of
the modifications of scarlet fever.   I came to this conclusion
after the most thorough investigation of nearly every form.
The reasons for these conclusions  are  the striking resem-
blances of the diseases in many particulars, and the still
more  positive evidence that diphtheria frequently assumes
the character of simple  scarlatina;  while, in other  cases,
scarlatina not unfrequently is converted into genuine dipth-
theria.   My attention was first called to this subject some
three years since, while  treating a case of diphtheria in
a family where there were five children.  The  two oldest
had diphtheria.  Some five or six days  after, one  of the
youngest was attacked with scarlatina; and although they had
not been exposed in any way only to the diphtheria patient,
it passed through all the stages of genuine scarlatina.   The
next case was that of the fourth child, who had diphtheria-
The cases so attracted my attention, that I at once instituted
a most careful investigation relative to  the identity of the
two affections, and soon found that the diseases were  not
only closely allied, but that they sprang from the same cause,
and were identical in nearly every particular.
   But, in order to a more full understanding of these hi-
therto supposed independent affections,  let us analyze their
respective  symptoms.   In scarlatina, the child is seized
with  rigours  and chills,  lassitude,  debility, albuminous
urine, quick, wiry pulse, light, furred tongue, a hot, dry,
and pungent skin, and in  the anginose form of the disease,
with congestion of the fauces,  thickening of the lymphatics
about the neck, and, not unfrequently, more or less catarrhal
symptoms.  In diphtheritis the patient first complains of
lassitude, headache, loss of appetite, has rigours and chills,
albuminous urine, active and  quick pulse, a light, furred
tongue, redness of the fauces, enlargement of the lymphatics
       14 
154       CONSIDERATION  OF  FEVERS.

about the neck, a hot, dry, and  pungent surface; and, in
most cases, a copious exudation from the mucous capillaries
of the upper  air-passages.  This  exudation soon becomes
organized; and patches of white, tough, fibrous membrane
may be observed on the uvula, soft palate, and tonsils.   It
will be  observed that the only essential difference in  the
general  symptoms of scarlatina and diphtheritis are those
which relate to the local  affection, or the peculiar inflam-
mation of the throat; and, even in this respect, in the an-
ginose form of scarlatina, the symptoms are almost identical,
with the exception that in genuine diphtheritis  the exuda-
tion becomes converted into fibrous tissue, constituting  the
formation of the false membrane, whilst in scarlatina angi-
nosa it is converted  into  pus  corpuscles, producing a solu-
tion of the  continuity of the  tissue, and the formation of
ulcers.   Even in  diphtheritis the existence  of the  mem-
brane does not always prevent a solution of the sub-adjacent
tissue, as I have seen many cases in  which the membrane
has been perfectly organized, but which became  absorbed
or disorganized in  the  brief period  of  from twelve  to
twenty-four hours, leaving  deep, ragged, purplish ulcers.
Again, as I compare the  sequel of the  two affections, I ob-
serve that in diphtheria the  blood becomes disorganized,
the kidneys granulated,  the muscles soft, the nervous sys-
tem prostrated, together with paralysis,  albuminuria, dropsi-
cal deposits, and a general derangement of  the  gastric and
hepatic functions.  In cases where there is extensive oedema
of the glands  and  tissues of the neck, ulcerations and chro-
nic abscesses not unfrequently constitute a part of the sub-
sequent difficulties.   In  scarlatina anginosa, and scarlatina
maligna, I find all these conditions existing as the result of
the acute form of the disease, and  in the sequel of the
two affections there are still less marks of distinction.
   Cause.—When  I came to examine into the  nature  and 
CONSIDERATION  OF  FEVERS.     155
cause of scarlatina, I observed the records almost uniform in
attributing to it a peculiar or specific miasm; the precise na-
ture and character of which they do not fully understand.
This  materius  morbi, when  introduced into  the blood,
either by endermic absorption or by inhalation, produces a
series of morbid changes in the  fluids, organs, and tissues,
which is denominated scarlatina.  When the poison acts
with moderate  intensity, and the recuperative and the eli-
minating powers are vigorous, the intensity of the poison is
so modified as  to  constitute scarlatina simplex.   In this
simple form  of scarlatina, as I have  previously stated, the
poison appears  to be eliminated through the skin with such
vigour as to very essentially preserve the integrity of the
general organism.   On the  other  hand, scarlatina anginosa
is produced  by a  more intense impression of the specific
poison upon the system by a less vigorous, recuperative, and
eliminative force, and by the concentration of the materius
morbi upon the mucous membrane, lymphatic, and adjacent
tissues of the  throat; whereas,  in scarlatina maligna the
overwhelming  sedative impression of the scarlatina virus
upon the cerebro-spinal centres produces great prostration,
rapid disorganization of the fluids, and death, unless the
intensity of the poison is modified by a most  energetic and
vigorous course of medication.   In  scarlatina diphtheritis,
the specific  poison, as in the case of  scarlatina anginosa, is
concentrated upon the fauces, producing inflammation and
the organization of the exudation.
   Diphtheria assuming the form  of Scarlatina.—A  child
of Mrs. Z., aged three years, was seized with all the symp-
toms of diphtheria.  Upon inspecting the fauces, a white,
tesselated exudation appeared upon various portions of the
mucous  surface of the fauces.   Twenty-four hours after-
wards, on examining the membrane, it was found perfectly
organized, and extending into the lateral, nasal passage and
larynx.  A hot-bath, stimulating friction, hot packs to the 
156      CONSIDERATION  OF  FEVERS.
throat, macrotin, quinine, and acetic syrup of sanguinana,
soon disorganized the membrane, relieved the throat symp-
toms, and produced a diffused scarlatina erythema over the
entire surface.  After this the case was treated as scarlatina
simplex, and had an early and rapid convalescence.
  The history of the above case is but a sample of a large
number of cases, which have occurred in my practice within
the last four or  five years, where, by an  energetic treat-
ment, all the symptoms of diphtheria have been reduced
to those of simple scarlatina.
   Scarlatina converted into Diphtheria.—-While diphtheria
frequently assumes all the symptoms of scarlatina, scarla-
tina, on the other hand, not  unfrequently takes the form
of diphtheria.
   A daughter of Mr. Z. was attacked on the 25th of Novem-
ber, 1862, with chills, fever, lassitude, headache, and loss
of appetite, which was followed by scarlatina  erythema on
the morning of the 26th.  On the evening of this  day an-
gina made  its  appearance, and on the next  morning the
fauces were  completely lined with a diphtheria exudation.
During this period the scarlatina erythema had entirely dis-
appeared, and  the disease presented all  the  symptoms of
general diphtheria.  Upon the administration of metastatic
remedies, however,  the  erythema again made its  appear-
ance, connected with a mitigation of all the throat  difficul-
ties.   What has occurred in this case, has frequently been
noticed to happen in other cases; so that during the preva-
lence of diphtheria in this city, (Philadelphia,) in 1861,
'2, nothing was more common than to witness well-marked
cases of scarlatina assuming all the characteristics  of diph-
theria.   From these  observations,  and other concurrent
facts, I am inevitably led to the conclusion that diphtheria
is only another modification of scarlatina.
   Symptoms.—Diphtheritis* usually commences  with loss
of appetite, lassitude,  general  debility, paiu  in  the  head, 
          CONSIDERATION OF FEVERS.       157

constipation, scanty urine, and fever, alternated with chills.
In some cases the constitutional symptoms are very slight,
and  do not make  their  appearance until  after the throat
symptoms.  The first  manifest difficulty of the  throat  is
slight  soreness, and  difficulty of swallowing.  As the dis-
ease advances, the throat becomes  painful, and  swallowing
extremely difficult.   In the commencement of the disease
there is usually an  extensive discharge  from the mucous
capillaries, of a thick, plastic matter, which is expectorated
with considerable difficulty.  Upon examining  the throat,
it will be found red, swollen, and the capillaries largely
distended with blood.   In  patches there will be found  a
whitish, plastic substance,  so firmly adhering as to be re-
moved with difficulty.   This membrane, as it is  called, is
the result of an  imperfect  organization of  the albuminous
portions of the blood, which has escaped from the diseased
capillaries.  In many  cases this abnormal transformation
occurs before the  blood leaves the capillaries, as upon mi-
croscopical examination of a section of the mucous  mem-
brane before the diphtheritic deposit is- removed, it will be
found  that the false membrane consists  of a semi-fibrous
structure  deeply imbedded in  the capillaries themselves.
While the organizable  portions of the blood are thus  being
converted into adventitious structure, the fluid portion is
making its escape into sub-cellular tissue,  producing oede-
ma, and offering  serious obstruction to  the  respiratory pas-
sages.  Hence the breathing becomes hurried and difficult,
the pulse  quick, and, as a natural  sequence, there is great
restlessness  and  anxiety.  In  some cases the  membrane
forms rapidly, extending to the tongue, and dipping down
into  the trachea, presenting a complication of symptoms
characteristic of angina and pseudo-membranous croup.  In
other cases there is an abortive attempt at"thei formation of
the membrane, the parts increase in redness and  swelling,
and assume the  appearance of erysipelatous inflammation.
                          14* 
158       CONSIDERATION OF FEVERS.

In other cases small aphthous patches make their appearance,
and rapidly extend themselves to  the  sub-cellular tissue,
constituting large and indolent ulcers.   The  symptoms of
these  different forms may vary according to the severity of
the case, and the age and constitution of the patient.   The
majority of fatal cases in the city, so far  as  I have been
able to  learn, occurred where the  membrane extended  to
the trachea, producing  asphyxia.   In a few cases the dis-
ease has terminated in  gangrene  and  mortification, or  in
death from exhaustion.   While in other cases the throat
symptoms  readily gave way to a proper treatment, and to
all  appearance the patient was passing through a favoura-
ble convalescence, yet  the  skin  was  sallow, the bowels
irregular,  and  the  patient  continued  debilitated.   In a
few cases, where these  symptoms manifested themselves,
the patient was  iittacked with paralysis of one or both of
the lower  extremities, together with a general softening of
the entire  nervous system.   In other cases, instead of the
paralysis, a softening of the nervous system appears to pro-
gress slowly, until the patient dies from general inertia; or,
as has occurred in a few cases in my practice, the scarlatina
virus continues to work its disorganizing  influence on the
blood, and other fluids of the body, until the patient either
dies from dropsieal effusion,  or from an absolute disorgani-
zation of the blood.  In a few cases, after these symptoms
had continued for a time, the patient was  seized with he-
moptysis, or hematemesis, and death soon  terminated the
patient's life.   In other cases I have known disorganization
of the kidneys, liver, and lungs, to occur, and a long series
of constitutional symptoms  to exist as the  result of the
disease.
   Treatment.—The treatment of diphtheria does not differ
in many particulars from that of scarlatina.  When called
to treat  the case in  the  early stage, it must  be  borne in
mind that the affection is dependent upon a specific poison,
J 
CONSIDERATION  OF  FEVERS.  v    159
and  that, in order to eliminate  this poison from the sys-
tem, all the emunctories  should  be put into full operation.
This  can be done by giving a  spirit sweat, a thorough
emetic, followed by  an active purge of podophyllin and
anti-bilious physic; after which  the  barosmin or apocynin
should be given, to keep the kidneys in vigorous operation,
and aconite to maintain free perspiration.  To remove the
local affection, flannel cloths, wet in the compound tincture
of myrrh, capsicum, and lobelia, should be applied  to the
neck, over which should  be placed a hot  pack.   The pack
should be  changed as often  as  every  half hour, and ap-
plied as  hot  as the  patient can bear it.   As soon as the
purge has- operated  the  patient should be placed in bed,
and  jugs of hot water placed to the feet, and  metastatic
remedies given for the purpose of diffusing the poison on
the skin.   Among the best medicines for this purpose are
the macrotin and scrofularia.  My method of giving these
medicines is to add to a half tumbler of water one dram of
the saturated tincture of scrofularia. and give  one teaspoon-
ful every hour.  Add to  another tumbler twenty grains of
the triturated macrotin, and give one teaspoonful every hour.
Alternate the medicines, so that one or  the  other will be
given every half hour.  If there is much inflammation in the
throat, a gargle of the hot decoction  of hydrastus Canaden-
sis should be frequently used.  If, after pursuing the above
treatment for twenty-four hours, the  disease should  not as-
sume a favourable aspect, ten grains  of quinine, five grains
of hydrastin, and ten grains of  capsicum,  should be made
into  ten powders, and one given every two hours, in con-
nexion with  the  other treatment.   When the  membrane
has become fully organized, and  shows a disposition to ex-
tend, the acetic syrup of sanguinaria, either alone or  in
combination with other remedies, will prove valuable.  In
a few  cases, where the membrane has proved an incum-
brance to  the arterialization of the  blood, I  have  ap- 
160      CONSIDERATION  OF  FEVERS.
plied a strong solution of the hot sulphate of zinc, by means
of a probang.  In cases where deep aphthous patches pre-
sented themselves on the mucous  surface, with a disposi-
tion to  ulceration, rucine and baptisin, either alone or in
combination, used as a gargle, and  small doses introduced
into the stomach, will  soon  arrest its  progress.   If  the
breathing should be difficult, a free emetic of the acetic tinc-
ture of sanguinaria and lobelia should be given. The surface
of the body should be frequently sponged in hot soda water,
and the patient allowed a liberal  quantity  of soft, nutri-
tious food.   After the active stage of the disease has passed,
the eliminating process should be continued by constantly
stimulating the various  emunctories of the  body, and  the
system freely supported by alnuin, iron, hydrastin, and other
tonics.   If softening of the nervous tissue  occurs, with pa-
ralysis, hypo-phosphoric acid, in  doses of five or ten drops,
in combination with cypripedin, given once or twice a day,
will have a tendency to relieve the difficulty. If paralysis
exist, from the one-sixteenth to the one-tenth of a grain of
Keith's strychnine, in combination with two or three grains
of hypo-phosphate of iron, given three or four times a day,
will prove  of value.  Where the disease produces softening
of the mucous membrane of the stomach, bowels, bronchia,
&c, &c, one dram of the chlorate of potassa added to six
ounces  of  syrup  of hydrastus Canadensis,  and  given  in
doses  of one teaspoonful every three hours, is a valuable re-
medy.  When there is leucocythemia, and  other diseases of
the blood following the disease, I have found the following
a most valuable remedy:—
      R. Leontodin.......................................gr. x.
         Alnuin...........................................gr. xx.
         Iron by-Hydrogen............................."^j.
               Mix.  Ft. pulv. No.  x.  Sig.
One to be  taken four times a day, in a tablespoonful of cod
                        liver oil. 
CONSIDERATION  OF  FEVERS.      161
At the same time allow the patient to take freely of cream,
into which has been introduced a small quantity of capsi-
cum.  In cases where there is granulation of the kidneys,
with albuminuria  and  dropsical  deposits, hot stimulating
baths, together with a proper use of helonin, apocynin, and
ampelopsin, will usually effect a cure.   If, after the diph-
theria deposit  on the mucous membrane is removed, ulcera-
tion should  occur, the chlorate of hydrastin should be used,
both as a gargle, and by means of a probang; and the ex-
ternal surface be kept  constantly stimulated by means of a
hot, stimulating liniment, and hot packs.

RESUME TREATMENT — ADDITIONAL TO  TYPHOID FEVER,
             SMALL-POX, AND SCARLATINA.
   The treatment of typhoid fever  should be proceeded with,
with great caution, especially in  regard to the administra-
tion of active remedies; as all medicines which have a ten-
dency to irritate the  bowels, aggravate, rather than alle-
viate the disease.   Notwithstanding these facts, the same
principles which govern us in the treatment of other exan-
thematous  affections, should be borne in mind, and all the
emunctories of the  body put into full operation, so as to
eliminate, as far  as possible, the specific virus  from  the
system.   This can be done by giving the patient a hot bath,
or rum sweat, a free  lobelia emetic, and warm  water to
cleanse the bowels.   Then the  treatment, as prescribed in
another portion of the book, should be carried  out.  In ad-
dition to which, lately  we have been  in the habit  of giving
ten or fifteen drop doses of the saturated tincture of the
scrofularia  marilandica every two or  three hours, either in
connexion with macrotin or alone, for the purpose of main-
taining  the  eruption on the  surface, as in all cases I have
observed that the severity of the disease depends much upon
the extent to which the poison is  concentrated on the inte-
gument.  In bad  cases, where the typhoid eruption would
recede rapidly, and the disease was connected with a vi- 
162      CONSIDERATION  OF FEVERS.

tiated constitution, I have added twenty or thirty drops of
hypo-phosphoric acid to one-half tumbler full of water, and
given one teaspoonful every half hour, or hour, with much
benefit.   Where the disease is accompanied by great pros-
tration, in addition to the previous treatment I have found
the sulphate of hydrastin, in combination with ferri hypo-
phosphite,  to  prove of the  utmost value.   When  I pub-
lished the first edition of this work, I was in the habit, with
my professional brethren,  of giving  liberally  of beef tea
during the progress of the  disease, especially during its
convalescent stage.  Subsequent observation has led me to
abandon  the  practice  only in such cases where the diges-
tive and assimilating organs are in a healthy state; as under
other circumstances the albuminous nutriment, instead of
being digested, is decomposed  and converted into carbu-
retted hydrogen gas, and only tends to distend the stomach
and bowels, and produces other disorganizing influences of
a most pernicious  character.

                    TYPHUS FEVER.
  In the treatment of typhus fever, the same general plan
should be  pursued that I  have already prescribed  under
the head of congestive or typhus, with the exception that
in the early stage of the disease I have found a good, active
lobelia emetic, and a free rum sweat, to prove of the great-
est value.  Then apply the hot packs and stimulating anti-
periodics previously directed, as with  this additional  sug-
gestion I have proved the  treatment adequate to the cure
of all the cases which have fallen to my lot to treat within
the last four years.

       SMALL-POX, COW-POX, AND VACCINATION.
  Of the treatment of small-pox I have already given the
most essential portion of my treatment, both in  the present
consideration of this disease and in the first edition, so that 
         CONSIDERATION  OF  FEVERS.      163

it only remains for us to speak of the prophylactic treatment;
and this consists of a simple remedy, that is, vaccination.
This should always be  performed as soon as the child is of
sufficient age.   The best period is when the child is from
three  to six months old.  This  should be accomplished by
selecting a pure lymph from a cow-pox pustule, on a healthy
person, when the pox is about four or five days old.   Then
take a sharp lancet, and  make frequent scarifications through
the cuticle, and allow  the arm to be exposed until all the
blood  that will flows from the superficial capillaries; then
wipe the scarified portion with a soft sponge, or cloth, and
apply the lymph by means of the point of the lancet.   If
the pure lymph from the udder of the cow can be obtained,
all the better.  All the after  treatment that is necessary,
is to notice the symptoms; and if there be fever, give a few
doses  of aconite, a warm bath, or such other treatment as
the symptoms may indicate.  The importance of vaccina-
tion should be fully impressed upon the attention of those
who have children in charge;  and in case that this almost
positive use of preventing the disease has not been resorted
to before the adult age, it  should be then.  The  only im-
portant thing to be attended to is to see that  the virus is
of a pure character, free from scrofula, syphilis, and other
infectious and contaminating diseases.

         RUBEOLA,  OR  MEASLES.
   Rubeola, or Measles, the Rougeole of the French,  the
Morbilli of Sydenham  and  other  old authors,  is an exan-
thematous  disease, characterized by the  following symp-
toms:—A fever, with catarrhal  implication, which, at  the
end of seventy-two hours,  throws out an abundant erup-
tion, consisting  of minute  confluent papulae, slightly ele-
vated above the surface of the skin, and subsiding in three,
or at  farthest, in four days; the catarrhal symptoms, in  all
normal  cases, declining on  the appearance of eruption, but 
164      CONSIDERATION  OF FEVERS.
sometimes, especially in severe and  irregular cases, conti-
nuing, or merging into those of pneumonia.  The disorder,
for the most part, occurs to all mankind once in the course
of life; but having been undergone,  the  constitution re-
mains for ever after unsusceptible of the same disease.
   The  leading features of the initiatory fever  of  measles
are, I have said,  catarrhal.   I must  describe them  more
in detail.
   1.  There is sneezing.  I have seen both adults and chil-
dren sneezing every five minutes, and really exhausted by
it.   Sneezing indicates a gorged  and  irritable state of the
Schneiderian membrane.
   2.  The eyes are red and watery.  There is epiphora, the
great diagnostic on which nurses are wont  to rely.  While
the measles are breeding, you will be  sure to find the win-
dow-blinds down, and the curtains of the bed closely drawn.
The slightest ray  of light is painful.  There Is  irritability
of the  retina, sometimes attended by inflammation of the
conjunctival membrane.
   3.  There is a loud, dry, hollow cough, (tussis sicca.)   The
violence of this  cough,  on some occasions,  will astonish
you, as it did me many years ago, while attending a young
Irishman, Mr. Webb, at Islington.   It was not  only loud,
but incessant.  The trachea and bronchi participate in the
same kind of action (whatever be its  nature) which takes
place in the nose and eyes.
  4.  There is hoarseness, (raucedo.)  The larynx is also im-
plicated.  In fact, the mucous structures  generally of the
head  and chest receive  the first impetus of the  poison.
I am not justified in saying  that the  action developed in
them is inflammation.  The membranes are only in a state
of congestion,  with increased irritability—a state which
plethora, bad management, a cold season, or a bad habit of
body, may convert into inflammation. 
CONSIDERATION  OF FEVERS.       165
  The appearance of measly eruption is very characteristic.
It comes forth in a full crop, and rapidly reaches its climax.
In regular measles the face is always first affected.
  When closely examined, the eruption is found to consist
of a congeries of minute papulae, close-set, or confluent, and
for a short time perceptibly elevated above the level of the
surrounding  skin.  This  elevation,  or  roughness,  is most
perceptible on the forehead.  On the limbs it is scarcely to
be detected.   The colour  of the measly eruption is a dingy
red, very different from the bright scarlet  hue of its rival.
Hence the French name rougeole, or  fievre  rouge.   The
difference in colour may  easily be  traced  to the  tracheal
and bronchial complication so generally present in measles,
which, extending partially into the substance  of the lungs,
gives a venous character to the blood.  In  scarlet fever,
on the other hand, the  lungs are unaffected, while  there
is intense arterial action.   The eruption, therefore, partakes
strongly of the character of arterial blood.
  The development of eruption is often accompanied with
a very moist  state of the surface.  This is the normal mode
of development, and of course  always to be desired.  Few,
if any cases,  that  begin thus, end unfavourably.  The same
thing is true of all exanthematic disorders.   In a hot and
dry state of  the  surface  eruption is difficult, partial, and
imperfect.
   On  the second day of eruption, (the fifth from the occur-
rence of rigours,) the eyelids  often  swell, from the exten-
sion of cutaneous  action to the subjacent cellular tissue.
Although I have never seen such a thing,  I have yet heard
of children  blinded by measles during the  space of four
days.  The progress of measly eruption, in all normal cases,
is steadily from above downwards.   On the second day of
eruption the trunk and  upper extremities  are  occupied.
On the third it has extended to the lower extremities, by
        15 
166       CONSIDERATION OF FEVERS.

which time it has nearly disappeared from the face.   On
the sixth day it has faded over the whole surface.
  The sequelae, or dregs, of measles, require from you as
much study as the earlier periods of the  complaint.  I have
described the normal progress of measles  in perfectly healthy
subjects.  I  am now to trace its effects on weakened and
scrofulous constitutions.   Generally, in such habits, some-
thing occurs  early to give cause of uneasiness. The initia-
tory fever has been severe.   The eruption has been retarded
twelve or twenty-four hours.   It has receded and returned.
Epistaxis, or an  epileptic fit, or diarrhoea, has occurred to
interrupt the normal course of the disease, and warn you of
impending danger.  Above  all, in such constitutions  the
catarrhal symptoms do not subside on the outbreak of erup-
tion.  The cough continues.   The child becomes restless.
Careful observation detects dyspnoea.  The stethoscope gives
signs of impeded respiration.   Instead of the febrile symp-
toms  subsiding on the sixth  day, and the child expressing
its desire to get up and have its toys, the little sufferer con-
tinues to  droop.   Its hands  are  hot,  its nights  unquiet.
It is thirsty,  and  the urine is scanty.  Secondary fever has
set in.
  Pneumonic complication occurs both in the progress of
the eruption, and during its decline.   It is a slow, creeping,
insidious form of inflammation, which too often throws the
practitioner off his guard.   No positive complaint is made.
The child droops,  and appears weak and exhausted.  Ima-
gining that the disorder has weakened his patient, the prac-
titioner directs some mild  tonic.  Mean while, pneumonic
engorgement (or pneumonia  in its first stage) creeps  on.
The lungs become more and more congested, and at length
solidified.   A  convulsive fit  now takes place.   Alarm is
taken, but the mischief is irreparable.   Dyspnoea increases.
The child becomes drowsy, the feet cold.  The pulse sinks. 
           CONSIDERATION  OF FEVERS.       167

Fluid effusion now takes place  from the bronchial mem-
brane.   Another and  another fit succeeds.   Rattles are
heard in the throat.  The child dies!
   Ophthalmia.—Ophthalmia of  a very obstinate character
frequently follows measles, and  proves  of a  very  difficult
nature to treat.  It is indicated by an inflammation of the
conjunctiva, which is soon followed by a muco-purulent dis-
charge, and which extends to the adjacent tissues, and as-
sumes  a chronic, and, in some cases,  an ulcerative cha-
racter.
   Phthisis, as an Effect of Measles.—Phthisis, as an effect
of measles, is one of the most common forms of the termina-
tion of the disease.  It is produced by the miasmatic poison,
so contaminating the blood as to cause tuberculous degene-
ration of  its albuminous  constituents, and a general soften-
ing of the mucous membrane, not only of the bronchi, but
of the stomach,  bowels, and  even in some cases  extending
to nearly every portion of the mucous lining.  The soften-
ing of the mucous  membrane of the stomach and bowels
most essentially  impedes  the  healthy digestion, and contri-
butes largely to  the development of the disease.
   When  phthisis  does occur as the effect of measles, the
only distinguishing features  that characterize this form of
phthisis from  most other forms  are the rapid tendency of
the disease towards its fatal results;  and the more marked
dyspeptic symptoms, together with a loss of function of the
entire mucous tissue.   Dropsy, scrofula, dyspepsia, uterine
and other diseases, produced by the contaminating influence
of measles, are developed as  the result of the disorganizing
influence of the morbific virus upon local organs and tissues,
and are amenable to the same general treatment.

                    TREATMENT.
   The treatment of measles, during the early stage of the
disease, should be conducted by giving the patient a warm
./' 
168        CONSIDERATION  OF  FEVERS.
bath, a  mild emetic,  and purge; after which  the patient
should be kept in a warm room, or at least where there is
no danger of taking cold, and the following metastatic remedy
given:—Take macrotin, ten grains; white sugar, one dram.
Triturate, and add to  a tumbler of water, and give one tea-
spoonful every hour or two, according to the  character of
the eruption.  If the eruption is  fully developed on  the
surface, but very little is required.   On the  other hand, if
the eruption is easily repelled, or manifests a faded appear-
ance, it should be given  more freely.   In cases where  the
eruption  does  not appear freely, and  there  are  active ca-
tarrhal  symptoms, one grain of quinine, and one-fourth or
one-eighth of a grain of pulv. lobelia seed, or what is better,
the oleo-resin of lobelia, should be given.   If that does not
allay the bronchial  and pulmonic  irritation,  a  few doses of
the acetic syrup of sanguinaria, either  alone  or in combina-
tion with the quinine and lobelia, will answer  the purpose.
If the above treatment does not produce and maintain the
eruption of the skin,  from five to ten drops of the saturated
tincture of scrofularia marilandica,  in hot milk punch, or if
there be inflammatory symptoms, give in water, and follow
by a hot bath.  In cases  where the constitution has been
debilitated by previous disease, or where there is a scrofu-
lous or  phthisical habit, iron, alnuin, myricin, and frazerin,
in such forms and quantities as the peculiar case  may require.
During the convalescence the patient should  drink freely of
tonic tea four or five times a day.   Order the skin  to be
kept active, the bowels open, and kidneys free, so as to pre-
vent the  accumulation of the rubeola poison in  the fluids.
In cases where the disease has  assumed a chronic form, and
the  lungs, stomach,  kidneys,  or bowels, all the most  vi-
gorous  resources to restore the emunctories should be  re-
sorted  to, and local difficulty  should be combated  with
such remedies as will remove local inflammation, and  re-
store the organ involved to  its   original  condition.   In 
CONSIDERATION  OF  FEVERS.      169
cases where there is evidence of an accumulation of rubeola
poison in the blood,  apocynin, given in half grain  doses
every two or three hours, has  the  effect to eliminate the
virus from the system.  A case which recently came under
my charge, was that of a young lady of a strong phthisical
habit.   She  was  seized with measles,  which  ran a mild
course, and subsided on the eighth  day.   Some two weeks
afterwards she was attacked with  cough and bronchial irri-
tation, accompanied with great prostration, imperfect diges-
tion, and  rapid emaciation.  Upon  examining the sputa, it
was found to contain an abundance of tuberculous granules.
Dulness was  manifested upon percussing the  apex of the
lung, and auscultation indicated rapid infiltration of tuber-
culous matter into the pulmonary  tissue.  The case was
evidently one of phthisis, excited by the depressing  influ-
ence of the rubeola virus  in the system.   I instituted the
following treatment:—
      R.  Apocynin.......................................gr. v.
          Ampelopsin....................................gr. x.
          Ferri Hypo-Phos.............................gr. xx.
              Mix.   Ft. pulv. No. xx.  Sig.
  One every three hourp, in  one teaspoonful of Cod Liver Oil.
A warm friction bath was  ordered  every day, and a nutri-
tious  diet.  Under this treatment  the  symptoms  became
somewhat mitigated, yet there remained an irritable cough,
with copious expectoration, and  great  debility of the  di-
gestive organs.  To remedy which, the  following  was  or-
dered:—
      R.  Prunine.......................................gr. x,
          Alnuin.........................................gr. xx.
          Sac. Alba.......................................gj.
               Mix.  Ft. pulv. No. xv.  Sig.
  One every three hours, in  one teaspoonful of Cod Liver  Oil.
In connexion with  this treatment,  I ordered an ounce  of
the tonic tea, and one dram of carb. ferri, to be added to one
quart of the best  Port wine; and  one wine-glassful  to be
                          15* 
 170      CONSIDERATION OF  FEVERS.

 taken before each meal.   Under this treatment the patient
 rapidly recovered.   When there is known to exist a strong
 phthisical  or  scrofulous habit, during the  early stage of
 measles, every effort should be made to maintain the erup-
 tion on the skin, and support the constitution until the dis-
 ease is entirely eliminated from the system.  In cases where
 measles  has been followed by chronic ophthalmia, in con-
 nexion with the proper internal treatment, take pyrocin, ten
 grains; hydrastin, five grains; glycerine, one dram.  Mix,
 form a paste, and apply to the inflamed portion of the eye,
 by means of a camel's hair brush,  four or five times a day.
 During the treatment of all the forms of chronic measles, a
 nutritious diet, and a well-regulated hygienic treatment, will
 contribute much to the cure.

                INFLAMMATION.
   There is, perhaps,  no  subject connected with  pathology
 of so much interest as that of inflammation, nor is there a
 phenomenon of disease that has been more  carefully stu-
 died; but it is only until  recently that the entire subject
 has  received a thorough explanation.  The theories of  the
 cause and  nature of inflammation which have previously
 existed, based  as they were  mostly upon false hypotheses,
 exerted a most pernicious influence upon the theory and
 practice of medicine.
  Van Helmont ascribed inflammation to a peculiar disturb-
 ance of the vital principle, thus forcing the blood  into  the
 capillaries in undue quantity, and that the irritability of the
 vital principle depended upon the pressure of gases in  the
 blood. The mathematical school of physicians, and especially
 Pitcairn and Des Cartes, attributed inflammation to an error
 loci,  or to obstructions which  they supposed occurred in  the
passage of the  blood from  one portion of the body to  the
 other.   Boerhaave  claimed that the cause of  inflammation
was that  the blood became  more viscid, causing a lentor in 
          CONSIDERATION OF FEVERS.       171

the circulation, especially in the capillaries, and producing
an engorgement of them, and that  the increased action of
the large vessels is for the  purpose of overcoming  the  ob-
struction which  exists in the small ones.   Dr. Haller  ad-
vanced the doctrine that the congestion of the blood in  the
capillaries was due to an irritability of the venous  system,
which was transmitted, to the small vessels.  In the seven-
teenth century Dr. Berlinghiere advanced a doctrine relative
to inflammation quite opposite from  that advanced by all  the
previous writers; which was, that instead of the cause of in-
flammation existing in the blood, or a constricted condition
of the capillaries, the capillaries were in a state of relaxa-
tion and weakness; that as the result of this weakened con-
dition of the vessels, the action of the heart and  arteries
becomes quickened, and a much larger quantity of blood than
usual is impelled into the small vessels.  Drs. Allen  and
Philip,  who have written elaborately upon the subject, and
who embraced  the doctrine of relaxation  and  weakness of
the vessels as the cause of inflammation, made many obser-
vations  with the microscope for  the purpose of confirming
their notions.  They, observing the  feeble circulation of  the
red blood corpuscles, and their alternate stagnation, concluded
that they depended upon the debility of the part inflamed.
Drs. Gorter, Gaubius, and Glisson, considered that inflam-
mation  was  the  consequence of irritation, which increases
the vital action  of the vessels of the inflamed  part, which
by degrees extended to the entire organism.  I might con-
tinue to narrate  the  theories of inflammation, as  they  are
recorded in the history of medicine, but what I have given
will  suffice to show the reader some of the conflicting  no-
tions relative to  the nature and causes of inflammation^   It
appears  to me that the only systematic method  of studying
the phenomena  is that adopted by Dr. Bennett, which is
to observe the condition of the parts during the process of
inflammatory action, together with the consecutive  changes 
172       CONSIDERATION  OF  FEVERS.

which are produced by the morbid process.   These changes
Dr. Bennett has described as occurring during the process
of inflammation; he describes them under the head of exu-
dation, which term  he regards as a much more appropriate
one than  inflammation, because,  as he  remarks, it explains
the phenomena of the disease, as well as the symptoms.
   There are three varieties  of exudation, which, occurring
as they do in one or other of the textures, occasion the great
majority of those diseases we are called upon to treat.  A
knowledge of the manner in which these  are produced, of
the characters of each, of their specific differences and na-
tural progress, constitutes the foundation of modern medi-
cine.  I  propose, then, in the first place, to describe them
to you generally, and  then  direct attention to the  special
peculiarities which they present  in individual cases.
   The term exudation has been introduced  into pathology,
not only to express the act  of the liquor sanguinis passing
through the walls of  the blood-vessels, but also to denomi-
nate the coagulation of the fibrinous portion of the liquor
sanguinis itself, upon the surface, or  in the substance of
any tissue or organ of the body.  The use of this term re-
moves a difficulty which morbid  anatomists have long ex-
perienced;*  and hence it has of late years been extensively

   * Of inflammation, Andral says:—''Created in  the infancy of
science, this  expression,  altogether metaphorical, was  destined to
represent a morbid state, in which the parts appeared to burn, to
be inflamed, etc.  Received into general language without any pre-
cise idea having ever been attached to it, in the triple relation of
symptoms which  announce it, of the  lesions which characterize it,
and of its intimate nature, the expression inflammation has become
so very vague, its interpretation is so very arbitrary, that it has
really lost its value;  it  is like an old coin without an impression,
which ought to be removed from circulation, as it only causes error
and confusion."  On  the other hand, exudation of the liquor san-
guinis  is a demonstrative fact, and  gives rise to a definite idea.
Hence, for all scientific and practical purposes, the expression "exu-
dation" may be substituted for that of inflammation. 
CONSIDERATION OF FEVERS.       173
used to indicate various kinds of morbid deposits.   Thus it
has been applied to all of those  morbid  processes, hitherto
termed inflammatory, tubercular, and cancerous; it may be
associated with every form of morbid growth;  it often gives
rise to concretions, and frequently constitutes  the  soil in
which grow those parasitic vegetations, or cryptogamic plants
of a low type, which communicate essential  characters to
certain diseases.
   Under  the  head of  exudation, indeed, considered as a
morbid process, is comprised the greater part  of organic, as
distinguished  from functional disease;  of lesions  of nutri-
tion, as separated from  lesions of innervation.

               PRODUCTION OF  EXUDATION.
   Exudation is, in every case, preceded by a series of changes
which have taken place in the capillary vessels, and in the
blood contained in them.   These changes, as we are enable'd
to follow them in the transparent parts of animals under the
microscope, are seen  to  occur in the following  order:—
1st. The  capillary vessels are narrowed, and the blood flows
through them with greater rapidity.  2d. The same vessels
become enlarged, and the current of blood is slower, although
even.  3d. The flow of blood becomes irregular.  4th. All
motion of the blood ceases, and  the vessel appears fully dis-
tended.   5th,  and lastly,  the liquor sanguinis is  exuded
through the walls of the vessel; and  sometimes there is ex-
travasation of blood corpuscles, owing to rupture of the ca-
pillaries.
   The first step  in the process, namely, narrowing of the
capillaries, is  readily  demonstrated  on the  application  of
acetic acid to the web of the frog's foot.  If the acid be
weak, the capillary contraction occurs more slowly and gra-
dually.   If it be very concentrated, the phenomenon is not
observed, or it passes so quickly into complete  stoppage of
blood, as  to  be imperceptible.   Although we cannot  see 
174      CONSIDERATION  OF FEVERS.
these changes in man  under  the microscope, certain facta
indicate that the same  phenomena occur.   The operations
of the mind, for instance, as fear and fright, and the appli-
cation of cold, produce paleness of the skin, an  effect which
can only arise from contraction of the capillaries, and a di-
minution of the  quantity of blood they contain.   In the ma-
jority of instances, also, this' paleness is  succeeded  by  in-
creased  redness, the  same result as  follows from direct ex-
periment on the web of the frog's foot, and which constitutes
the  second  step of the process.  In other  cases, the red-
ness  may arise  primarily from certain mental emotions, or
from the application of heat; and in both  instances depends
on the enlargement of the capillaries, and the greater quan-
tity of blood which is thus admitted into  them.*

  * It has been asserted, that instead of contraction of the capilla-
ries, the first changes observable are enlargement, with increased
flow of blood.  To determine positively the question of contraction
or dilatation, I have recently made a series of careful observations on
the web of a  frog's foot.  Having fixed the animal in such a way
that it could not move, I carefully measured with Oberheuser's eye
micrometer the diameter of various vessels before, during, and after
the application of stimuli. The results were, that immediately as hot
water was applied, a vessel that measured thirteen spaces of the eye
micrometer contracted to ten; another that measured  ten contracted
to seven;  a third, that measured seven, contracted to five;  a fourth,
which was a capillary carrying blood-corpuscles in single  file, and
measured five, was  contracted to four;  and another one, of the
smaller size, which measured four, was  contracted to three.   With
regard to the ultimate capillaries, it was  frequently  observed that
if filled  with  corpuscles, they contracted little; but  if empty, the
contraction took place from four to two, so that no more corpuscles
entered them, and they appeared obliterated.   This  was especially
seen after the addition of acetic acid.   It was also  observed that
minute vessels that  contracted from four  to three, afterwards be-
came dilated to six before congestion and stagnation occurred.   The
smaller veins  were seen to contract as much as the arteries of the
same size. 
CONSIDERATION  OF FEVERS.       175
      The variation  in  the  size of the capillaries, and of the
    amount of blood in  them, is conjoined with changes in the
    movement of that fluid.   Whilst the vessels are contracted,
    the blood may be seen to flow with increased velocity.  After
,   a time the blood flows more and more slowly, without, how-
    ever, the vessel being obstructed; it then oscillates, that is,
    moves forwards and backwards, or makes a pause, which is
    evidently synchronous with the ventricular diastole of the
    heart.  At length the vessel appears quite distended with
    yellow or coloured corpuscles, and all movement ceases.
      Again, these changes  in the movement of the blood in-
    duce variations in the relation which the blood corpuscles
    bear to each other,~and  to the walls of the vessel.  In the
    natural circulation of the frog's foot, the yellow corpuscles
    may be seen rolling forward in the centre of the tube, a clear
    space being left on each side, which is filled only with liquor
    sanguinis and a few lymph corpuscles.   There are evidently
    two currents, one at the centre, which  is very rapid,  and
    one at the sides, (in  the lymph spaces, as  they are called,)
    much slower.  The coloured corpuscles are hurried forward
    in the centre of  the vessel, occasionally mixed with some
    lymph corpuscles.  These latter, however, may frequently
    be seen clinging to  the  sides of the vessel, or slowly pro-
    ceeding a short distance along it in  the lymph space, and
    then  again  stopping.  Occasionally  the lymph corpuscles
    get into the central torrent, whence they are carried off with
    great velocity, and  accompany the yellow corpuscles.  It
    has been said that these corpuscles augment in number, ac-
    cumulate in the lymph spaces, and obstruct the flow of blood.
    In young frogs their number is often very great; but then
    they constitute a  normal part of the blood, and in no way
    impede the circulation.   In old frogs, on the other hand,
    all these, and subsequent changes, may be observed, without
    the presence of colourless corpuscles.   When the capillaries
    enlarge, however, the central coloured column in the smaller 
176      CONSIDERATION OF FEVERS.

vessels may be seen to enlarge also, and gradually approach
the sides of the tube, thus encroaching on the lymph spaces.
The  slower  the  motion of the blood, the more the lymph
spaces are encroached on,  until at length the coloured  cor-
puscles come in contact with the sides of the vessel, and are
compressed  and changed in form.   The  vessel is at length
completely distended with  coloured corpuscles, the original
form of which can be no longer discovered, so that the tube
appears to be filled with a homogeneous, deep crimson fluid.
This is congestion.   Fig. 11, an exact copy of the portion of
                         Fig. 11.
the web in the foot of a young frog, after a drop of strong
alcohol has been placed upon it.  The view exhibits a deep-     \
seated artery and vein, somewhat out of focus; the interme-
diate or capillary plexus running over them, and pigment
cells of various sizes scattered over the whole.  On the left     J
of the figure, the circulation is still active and natural.
About the middle it is more slow, the column of blood is
oscillating, and the corpuscles  crowded together.   On the
right, congestion, followed  by exudation, has taken place.
a, a deep-seated vein, partially out of focus.  The  current
i 
       CONSIDERATION  OF  INFLAMMATION.   177

of blood is of a deeper colour, and not so rapid as that  in
the artery.  It is running in the opposite direction.   The
lymph space on each side, filledVith slightly yellowish blood
plasma,  is very apparent, containing a number of colourless
corpuscles, clinging to, or slowly moving along, the sides of
the vessel,  b, a deep-seated artery, out of focus, the rapid
current  of blood allowing nothing to be perceived but a red-
dish, yellow broad streak, with lighter spaces at the  sides.
Opposite c, laceration of the capillary vessel has produced
an extravasation of blood, which resembles a brownish-red
spot.  At d, congestion has occurred, and the  blood cor-
puscles  are apparently  merged  into one  semi-transparent,
reddish  mass, entirely filling  the  vessels.  The  spaces  of
the web, between the  capillaftes, are rendered thicker and
less transparent, partly by the action of the alcohol, partly
by the exudation.   This latter entirely fills up the spaces,
or only  coats the vessel.  If the morbid process continue,
the vessel may burst,  causing hemorrhage,  or  the liquor
sanguinis may transude through its walls, without  rupture,
into the surrounding textures.   This last is exudation.

                THEORY OF EXUDATION.
  It is of the utmost importance in pathological inquiries,
to separate facts from theories.  Our facts may be correct,
although  the conclusions derived  from them are wrong.
This proposition, however generally admitted, is seldom ad-
hered to  in practice;  for in  medical writings and  state-
ments, we frequently find fact and hypothesis so mingled
together,  that it often requires considerable critical and
analytical power to separate the one from the other.  We
are, however, in all cases insensibly led  to theorize; that
is, to  attempt an explanation of the phenomena  observed,
in order that we may derive from them some general prin-
ciple for our guidance.   Such speculation is always legiti-
mate, so long as we  consider opinions to be mere generaliza-
      16
[ 
178    CONSIDERATION OF  INFLAMMATION.
tions of known facts, and  are ready to abandon  them the
moment other facts  point  them out to be erroneous.   The
phenomena of exudation, previously described, may easily
be demonstrated —they  contain the facts.  Let  us  now
examine how they have been attempted to be explained.
In other words, What is theory?
  1. The contraction and dilatation of the capillaries are ex-
plicable, by supposing them to be endowed with a power of
contractility  analogous to that existing in non-voluntary
muscles.  John  Hunter  thought they  were muscles, from
the result of his observations and  experiments; and they
may be known by the histologist  to consist of a delicate
membrane, in which permanent nuclei are imbedded.  Mr.
Lister has recently shown thft much of the contractility is
dependent on fusiform cells, which have  the property of
shortening themselves, and which run  transversely round
the  vessels.   In structure,  then,  they possess elements
closely resembling the muscular fibres of the intestine; and
we know that, like them, they may be contracted or dilated
by emotions  of the mind, (that is,  through  the  nerves,)
or by  local applications,  that is, directly.   The narrowing
of  these  tubes, therefore, may be considered, as Cullen
thought it was, analogous to spasm, or to muscular paralysis.
The recent observations of CI. Bernard and others as to the
effects produced by dividing the large nervous trunk of the
sympathetic  in  the neck, have singularly confirmed this
theory.
   2.  The rapid  and slow movement of the blood is expli-
cable  on the hydraulic principle, that when a certain quan-
tity of fluid is driven forward with a certain force through
 a previous tube, and the tube is narrowed or widened, while
the propelling force remains the  same, the fluid  must ne-
cessarily flow quicker  in  the first case, and slower in the
 second.   It has been supposed, from the throbbing of large
vessels leading to congested parts, that they pump a larger 
       CONSIDERATIONOF  INFLAMMATION.    179

quantity of blood than usual into them. This was called " de-
termination of blood" by the older pathologists, and is now
known not to be a cause, but a result, of the changes going
on in the capillary vessels  and tissues of the affected part.
The oscillatory  movement, seen later  in  the  transparent
parts of the small animals, has not been observed in man,
and probably depends, in the former, on a weakened  power
of the heart.
   3.  It is the stoppage of  the blood, and exudation of the
liquor sanguinis, however,  which it  is most difficult  to ex-
plain; for why,  so long as  there is no mechanical obstruc-
tion,  (and  during this process none has ever been  seen,)
should the circulation  through the capillaries  of a part
cease?  It has been  endeavoured, indeed,  of late years, to
account for this  stoppage by referring it to a mechanical ob-
struction, which is supposed to result from the formation
of colourless corpuscles, which cling in large  numbers to
the sides of the  capillaries, and so cause interruption  of the
stream.   But this hypothesis  is negatived by the following
facts:—1st. In young frogs the vessels may be seen to be
crowded with colourless corpuscles, while the circulation is
in no way affected.   2d. In old frogs, oscillation and gra-
dual stoppage of the stream may be seen, without any co-
lourless corpuscles being present.   3d. The colourless cor-
puscles, as shown by Remak,  are increased, after large ve-
nesections, in  the horse, without ever causing  active con-
gestion.*   And, 4th, in leucocythemia all the vessels are
crowded with colourless corpuscles,  and yet no active con-
gestion  in  these vessels, nor  exudation of any kind, takes
place.  (See Leucocythemia.)

  * Diagnostische and  Pathognetische Untersuchungen, &c, 1845.
He also found that in  man the colourless corpuscles of the blood
were few in number during inflammations, and were augmented
during successive bleedings, so that he concluded the fewer there
are of these, the higher is the  degree of inflammation. 
180    CONSIDERATION OF INFLAMMATION.
  We cannot ascribe the stoppage of the circulation in the
capillaries to venous obstruction, or to mechanical pressure
of any kind, because all observation proves that such causes,
while they induce effusion of serum, never occasion exuda-
tion of liquor sanguinis.   Neither can we suppose it to de-
pend on endosmose, nor on a vis a tergo, as such physical
causes cannot be  shown to apply in all cases.  We are com-
pelled, therefore,  to attribute the vital force producing these
changes, not to anything residing in  the blood, or in the
vessels, but to the tissues which lie outside the vessels.   That
these do possess a power, attractive  and selective, whereby
matters are drawn from the blood to carry on nutrition and
secretion, is now  generally admitted  in physiology.   A mo-
dification of this power, whereby the attractive property is
augmented, and the selective one diminished, at least offers
us an explanation consistent with all known facts, and seems
to be the  only active  agency to which we can ascribe the
approach of the coloured particles to the capillary walls, and
the passage through them of the exudation.
  When the liquor sanguinis is exuded, it generally coagu-
lates, and constitutes a foreign body in the  texture of the
parts affected;  and then it becomes  the  object  of nature,
either to remove  it from the system, or so to modify it that
its presence may  be rendered conducive to the wants of the
economy.  In order to accomplish this, two kinds of changes
take place in it:—1st, the exudation serves as a blastema, in
which new vital structures originate and are developed; 2d,
it exhibits no power of becoming organized, and the exuded
matters,  together with the textures involved  in  them, die.
In the first case, corpuscles spring up in the exudation, which
differ in form, size, constitution,  and power of farther de-
velopment, and give rise to those various appearances and
changes, which, in some cases, have been denominated the
results of inflammation, in others, various kinds of deposits.
In the second case, death of the exudation takes place slowly,
constituting ulceration, or rapidly producing gangrene. 
       CONSIDERATION  OF INFLAMMATION.   181


     VITAL TRANSFORMATION OF THE EXUDATION.
  We find the peculiar constitution of the blood, or the ge-
neral vital power of the organism, exercises a very power-
ful  influence on the development of the  exudation.   This
has been long recognised by pathologists in certain condi-
tions, denominated respectively diathesis, dyscrasia, or ca-
chexia.   I propose, at present, to direct  your attention to
some of the facts connected with exudation as it occurs in
the body during health, as  well as when connected  with
cancerous and  scrofulous constitutions'.   I shall  call the
former simple exudation, to distinguish it from what  may
be denominated cancerous and tubercular  exudation.
   Simple Exudation.—Simple exudation presents four prin-
cipal forms:—1st, as it occurs on serous membranes, where
it exhibits a finely fibrous structure, and  has a strong ten-
dency to be developed into molecular fibres;  2d,  as it oc-
curs on mucous membranes, or in areolar tissue, where it
is generally converted into  pus corpuscles;  3d, when it oc-
curs in dense, parenchymatous organs, such as the brain,
where  it assumes a granular form,  and is  associated  with
numerous compound  granular  corpuscles; 4th,  as  it  is
poured out after wounds or injuries, and  occurs on granu-
lating  sores.   In this last  case  the superficial portion is
transformed into pus-corpuscles, while the deeper seated is
converted, by means of  nuclei and cells,  into nucleus and
cell fibres, which ultimately form a  cicatrix.
  1. On examining the minute structure of the exudation
on a serous surface when recently formed, and when it pre-
sents a gelatinous, semi-transparent appearance, it will  be
found  to be  made of minute filaments mingled with cor-
puscles.  (Fig. 12, molecular fibres and plastic corpuscles,
in  simple exudation on a serous  surface.   The latter,  after
the addition of acetic acid.)  The filaments are not the re-
sult of the development of  either a nucleus or a  cell, but
                          16* 
182    CONSIDERATION OF INFLA M M ATION.
are formed by the simple precipitation of molecules, which
arrange themselves in a linear manner, in the same way as
                        Fig. 12.
they may be seen to form in  the buffy coat of the  blood.
As the exudation becomes firm,  the filaments appear more
distinct and consolidated, varying from one-fourteen-thou-
sandth to one-ten-thousandth of an inch in diameter.   Bun-
dles, or different layers  of them, often  cross  each  other;
and as the lymph  becomes  older, they assume more and
more the character of those in dense fibrous  tissue.   The
corpuscles, when newly formed,  are  delicate  and  transpa-
rent, but in a short time become more  distinct, and are
then seen to be composed of a distinct cell-wall, enclosing
from three to eight granules.   They vary in size from one-
one-thousand-three-hundredth to one-ten-thousandth, and
the enclosed granules from one-fourteen-thousandth to one-
ten-thousandth of an  inch in diameter.   On  the  addition
of water  and acetic  acid,  the corpuscles undergo no change,
although sometimes the latter re-agent causes  the cell-wall
to contract and  thicken; and at others, to be somewhat
more transparent.   In 1842,1 separated these bodies from
pus cells, and called them plastic-corpuscles, from the fre-
quency of their  occurrence in plastic lymph.  Lebert,  in
1845, confirmed my description, and called them pyoid,
from their resemblance to pus. 
CONSIDERATION OF INFLAMMATION.  183
  These  corpuscles, after a time, melt away among the
fibres;  but several of them remain, constituting, as shown
by Dr. Drummond, permanent nuclei.  After a time blood-
vessels grow in the exuded lymph, (see Vascular Growths,)
the surface of which becomes villous.   Into the villi  loops
of vessels penetrate, and by these the fluid,  contained in
the interior of shut sacs, is absorbed.  The fluid thus gra-
dually diminishes, and, when the villous surfaces are brought
into contact, they unite, and ultimately form the dense  chro-
Fig. 14.
 Fig. 15.
 l|lj| ,  .... ■>;■-■
 im^f}}!%


Iv'    i
Fig. 17.
if
nic adhesions so common between serous membranes.  (Fig.
13, a portion of recent lymph from the pleura.   Fig. 14,
another portion of the same, farther developed.   Fig. 15,
portion of firm pleural adhesion.  Fig 16, another portion
of the same, farther developed.  Fig. 17, the last acted on
by acetic acid.)
   2.  Exudation poured out on a mucous membrane, some-
times presents a fibrous mass, as in cases of croup and diph-
theritis;  but more generally it passes into an opaque, unc-
tuous, straw-coloured fluid, long known under the name of
pus.   When poured into the meshes of areolar tissue, and
occasionally into the substance of the brain, the same trans-
formation occurs,  and then forms  an  abscess.  On exa-
mining the  minute structure of pus, it is seen to be com-
posed of  numerous corpuscles floating in a  clear fluid.
These corpuscles  are  perfectly globular in form, and vary
in size from the one-two-thousandth to the one-one-thousand-
two-hundredth of  an  inch  in diameter.  Their surface is 
184   CONSIDERATION OF INFLAMMATION.
finely granular.   They  have a regular, well-defined  edge,
and roll freely in the liquor puris upon each other.   On
the addition of water, they become much increased in size,
and more transparent, their finely granular  surface disap-
pearing.  Weak acetic  acid  partially, and the strong acid
completely, dissolves the cell-wall, and brings into view the
one included body, generally composed of two or three gra-
nules close  together, and rarely four or  five, each with a
central  shadowed spot.  These are usually about the one-
                    Fig. 18.     Fig. 19.
six-thousandth of an inch in diameter.  (Fig. 18, pus cells.
Four cells have been acted on by acetic acid.  Fig. 19, pus
cells containing fatty molecules, after adding acetic acid.)
In some cases the pus  corpuscles now described are sur-
rounded by  an albuminous layer closely resembling a deli-
cate  cell-wall, which I first described in 1847.  Jt is about
the one-ten-thousandth or one-eight-hundredth of an inch
in diameter, and is highly elastic, assuming different shapes,
according to  the degree and  direction of the pressure  to
which it is subjected.   Water and  acetic acid cause it at
once to dissolve, whilst the included pus corpuscles exhibit
the usual body composed of two or three granules.
  In what is called scrofulous  pus, the corpuscles, instead
                   Fig. 20.       Fig. 21.

                 <a>. Kg) w°<
of being round and rolling on  each other, are misshapen
and irregular, and, on  the addition of acetic acid, the gra- 
       CONSIDERATION OF INFLAMMATION.   185

 nular nuclei are found to be ill-formed, or  absent.  (Fig.
 20, scrofulous pus cells, after the addition  of acetic  acid.
 Fig. 21, the same.   In both specimens the nuclei are irre-
 gular, or absent.)
   Pus cells, if  not evacuated  externally, ultimately  dis-
 solve, their walls disappear, the included nuclei and gra-
 nules separate, and are converted into a fluid.  This passes
 into the blood, increases for a time its effete constituents,
 but is at length excreted by the emunctories.  Mean while
 the original abscess, or collection of matter, is said to be
 resolved.
   3. In parenchymatous organs, the exudation  insinuates
 itself among the elementary tissues of which they are com-
 posed, so that, when it coagulates, those are imprisoned in
. a solid plasma, like stones in the mortar of a  rough-cast
 wall; thus constituting a firm mass, and  giving increased
 density  to certain  organs.   This is well observed in the
 lung; where, however, a mucous surface extensively pre-
 vails, and where the exudation is commonly transformed
 into pus.  In the brain, spinal  cord, and placenta, we find
 the exudation deposited in the form of minute  molecules
 and granules, which are frequently seen coating the vessel
externally, and filling up the  intervascular spaces.   (Fig.
22, granular exudation and granular masses, from cerebral
I 
186   CONSIDERATION OF INFLAMMATION.

softening.)  The granules vary in size from the one-twelve-
thousandth to the one-six-thousandth of an inch in diame-
ter.   They always contain among them round, transparent
globules, varying in size from the one-five-thousandth to
the one-three-thousandth of an inch in diameter.   These
are the nuclei of round or oval cells, which may frequently
be observed in various stages of development.   When fully
formed, the cells vary greatly in  size, for the most part
measuring from the one-thousandth to the one-hundred-
and seventy-fifth of an inch in diameter.   They sometimes
contain a few oil granules only, at others they are so com-
pletely filled with them  as to  assume a brownish-black ap-
pearance.  Water and acetic acid  cause no change in them;
although the latter re-agent, on some occasions, renders the
cell-walls more transparent.  They are readily soluble in
ether, and break down into a molecular mass on the addi-
tion  of  potash  and ammonia.  These are granule  cells.
(Fig. 23, granular cells and masses from cerebral softening.)
Fig. 23.
Masses of these granules may be seen floating about, of irre-
gular shape, without  any cell-wall.   They are  produced
either  by the solution of the cell-wall in which  they are
contained, or from the separation, or peeling off of such
masses from the external wall of the vessels, and form gra-
nular masses.   Pressure causes these  granules to coalesce,
or the air to be forced through the cell-wall;  occasionally,
also, the cell-wall is ruptured.
   The granules, masses, and cells just described, are found 
      CONSIDERATION  OF  INFLAMMATION.  187

in the colostrum secreted by the mammary glands;  in the
exudative softening of parenchymatous organs;  on the sur-
face of granulations and pyogenic membranes;  in the pus
of chronic abscesses, combined with cancerous,  tubercular,
and all other forms of exudation; in the tubes  of the kid-
ney, when affected with Bright's disease; and in the  con-
tents  of encysted  tumours.   In fact, there  is no form of
cell growth, whether healthy or morbid, that may not, under
certain conditions, accumulate oil or fatty granules in its
interior, become a  compound granular corpuscle, and  thus
be rendered abortive.   The granule cells in an exudation,
however, are the  results of a vital transformation of  that
exudation, and not of a mere fatty degeneration of the ves-
sels,  as  some have supposed.   In some instances I have
seen  them in all stages of development coating the blood-
vessels, as in fig. 24.  (Fig. 24, two vessels coated with  exu-
                         Fig. 24.
dation from softening of the  spinal cord.  Granular  cells
may be seen forming in it.)  That softening from the forma-
tion of granules and granular cells may occasionally disap-
pear, and the new structures be absorbed, is rendered pro-
bable  by the history  of several  well-recorded cases; but
the changes thereby produced, especially in  nervous tex-
tures, have  not  hitherto been made the  subject of special
investigation.
  4. If a recently-formed granulation on the surface of a 
188   CONSIDERATION OF INFLAMMATION.

healing sore be examined, numerous cells will be observed
of various  shapes, and in different stages of development.
Some are round, others caudate, spindle-shaped, elongated,
or splitting into fibres, as originally described by Schwann.
(Fig. 25, vertical  section of a  granulating sore.   Exter-

                        Fig. 25.
nally, pus corpuscles, deeper fibre cells in various stages of
development into fibre.   The looped blood-vessels are seen
enlarged at their extremities, magnified one hundred diame-
ters linear.  On the left, the cells are magnified two hun-
dred and. fifty diameters linear.)  In many cases there may
be seen  a number of free nuclei  imbedded in a slightly
fibrous blastema, elongating at both ends, becoming fusi-
form, and splitting up the  surrounding exudation, as de-
scribed by Henle.  Not unfrequently the nuclei may be
seen developing themselves into elastic fibres, in the same
exudation which contains cells  that are passing into white
fibres.  Indeed, the  process of cicatrization in its various
stages, and in different tissues, offers the best means of stu-
dying the manner in which nucleus and cell fibres are re-
spectively formed.  As these fibres are developed in the
deeper layers of the exudation, a villous, vascular basis is 
      CONSIDERATION  OF  INFLAMMATION.  189

formed, and  the  superficial pus  corpuscles,  after having
served to protect  the more prominent growths, are thrown
off in the form of discharge.  When the fibrous structure
becomes more consistent and dense, the amount of pus di-
minishes, and a greater tendency is manifested by the exu-
dation to pass into permanent tissue.   At length pus ceases
to be developed;  the whole  remaining exudation is trans-
formed into fibres; a new surface is produced, which, after
a time, contracts and forms the permanent cicatrix."
  From the foregoing remarks of Dr. Bennett it will be per-
ceived that the liquor sanguinis escapes from the capillaries
during the process of inflammation, and consolidates on the
outside of the vessels, constituting more or less solid exuda-
tion.  The serum which escapes during the exosmosis is prin-
cipally absorbed, although portions of it remain and consti-
tute a blastema, which assists in the  organization  of the
exudation.   The  character  of this  organization depends
upon the locality of the  inflammatory process; as, for in-
stance, exudation occurring on the  mucous  surface has a
strong tendency to be converted into pus cells.   The only
exception to this  rule is in pseudo-membranous croup and
scarlatina  diphtheritis.  When exudation occurs on a se-
rous surface,  as in pleuritis, peritonitis, &c, the tendency
of the exudation is to become organized and converted into
fibrous tissues, constituting various forms of adhesive in-
flammation, while that which occurs in the solid  parenchy-
ma usually assumes a granular form.   The general  excep-
tions to the rule of the transformation of these exudations,
are in cases  of cancerous  and tuberculous affections;  in
either of which the exudation maintains its peculiar cha-
racteristics.   Of  the cause  of exudation Dr. Bennett re-
marks :—
  " Of the ultimate cause producing this difference in the
formative power of  the exudation we are ignorant; but le-
gitimate reasoning  leads us to the conclusion, that these
       17 
190   CONSIDERATION OF INFLAMMATION.

changes and  effects depend, not upon the vascular system,
which is the mere apparatus for the production of exuda-
tion ;  nor upon the nervous system, which conducts impres-
sions  to or from  this apparatus; and not  on the texture,
which is the seat  of the exudation, as that varies whilst the
cancerous or tubercular formation is the same—but upon the
inherent composition, or constitution of the exudation itself.
On this point most pathologists are agreed, and hence the
supposed existence of various kinds of dyscrasiae, which ori-
ginate in the blood, and as it is imagined,  explain the dif-
ferent results produced.  And here pathologists pause,—
having  traced  the disease back to the  blood, they are  con-
tent;  but they have not sufficiently taken into considera-
tion,  that the blood itself  is dependent for its constitution
on the  results  of the  primary digestion in the alimentary
canal on the one  hand, and the secondary digestion in the
tissues on the other.  Yet it must be evident to every phy.
siologist, that if  it be the  constitution of the blood which
determines  the constitution of the exudation, the  causes
which produce the latter must be sought in  those circum-
stances  which operate on the composition of the former fluid.
   " Numerous facts render it probable, that while the blood
is normal in simple exudation, it contains  an excess of nu-
tritive  materials  in cancerous, and a deficiency of them in
tubercular exudation; but these are points which can  only
be established after examining instances of such exuda-
tions  in detail.   But it must not be forgotten, however, that
as the blood is continually undergoing changes, and is re-
ceiving and giving off new matters, it can scarcely remain
the same for  many hours  together.  An exudation at one
time  may be very different from  what it was at another;
abounding in elements at one  period which do not exist in
it at the next.  Hence, therefore, it may often happen, that
a concurrence  of circumstances is necessary to occasion a
certain  result.   A cancer  once formed, may remain  local 
      CONSIDERATION OF INFLAMMATION.   191

until such a concurrence of events arises,  comprising, first,
the phenomena leading to and producing an exudation; se-
condly, the occurrence of this exudation in  some other tissue
or organ sufficiently predisposed for the purpose; and thirdly,
a peculiar  constitution of the blood.  Hence  the histolo-
gist continually finds many varieties of intermediate forma-
tions  between the three leading kinds of exudation; and
even when the constitution is thoroughly cancerous or tu-
bercular, simple exudations may be  poured into  tissues as
the result of recent wounds or injuries.  But, whilst a recent
cancerous or a tubercular exudation may be found  to ac-
company, or alternate with,  a simple exudation, the two
former are seldom met with together—a circumstance which
still farther points out the wide difference  between the con-
stitutional causes producing them.   The termination of all
kinds of exudation may be the same, but each has its  pecu-
liarities.   We have  noticed the tendencies of simple exu-
dation to be transformed into pus or fibres, according to its
seat.  In the one case the pus cells break down, and are
re-absorbed in a disintegrated  and fluid condition into the
blood; in the other, permanent fibrous tissue is produced,
constituting chronic adhesions, cicatrices, &c.   The cells of a
cancerous growth  may also degenerate or decay, but this
rarely takes place throughout the whole structure.   But it
is not uncommon to find in certain encephalomatous tumours,
yellow matter, either in masses, or reticulated through its
substance.—(Cancer Reticulare  of Miiller.)   This is gene-
rally owing to fatty degeneration of the cancer cells.   The
fibrous structure of cancer may also increase, so as occasion-
ally to produce cicatrization.  Tubercle possesses no such
fibrous stroma, but is infiltrated among the elements of va-
rious  organs, the vascularity of which it tends to destroy.
This, indeed, is the reason why a cancerous tumour increases
by growth, which a tubercle cannot be said to do; the former is
vascular, the latter is not: in the one, cells are formed which
have  the power of re-development; in the other,  no re-pro- 
192   CONSIDERATION  OF INFLAMMATION.

ductive cells are produced.  In cancer, the morbid matter,
whatever it be, circulating in the blood, is concentrated or
attracted to the cancerous part; and  even should no such
matter be present, the healthy blood is made subservient to
the purpose of nourishing a foreign growth.   In  tubercle,
successive fresh exudations only occur, which, by their ac-
cumulation, augment the volume or amount of the morbid
product.  All these forms of exudation may be  rendered
abortive, the animal matter of them being broken down and
absorbed, while the mineral matter remains, constituting a
cretaceous or calcareous concretion.  This is not unfrequently
seen as the result of simple exudation;  it rarely happens in
cancerous, but is very common in tubercular exudations.
   " During the disintegration of simple, cancerous, and tu-
bercular exudations, the animal matter broken down is again
rendered fluid, re-passes into the blood, and then constitutes
that excess of fibrine detected by chemists.   The quantity
of this will, of course, vary according to the amount of the
exudation  and the activity of the disintegrating process.
In the blood this effete matter undergoes a series of chemical
changes, preparatory to its excretion by the different emunc-
tories, especially by the kidneys,  in the form of various se-
diments.  The resolution of simple exudation is generally ac-
companied by the presence of urinary sediments,  whose na-
ture indicates  in what way the exudation, after it has passed
through the  phases of development described, is  at length
discharged from the body.  In the same manner the amount
of these sediments frequently points out the  extent of ab-
sorption going on in cancerous and  tubercular exudations.
  " Another theory has been advanced regarding the various
products of exudation as we have described them,  viz., that
instead of being  new formations  in an exuded blood plas-
ma, they are only modifications of pre-existing texture.  Ac-
cording to this view, pus cells are only altered  epithelial
ones, cancer cells are an increased development, and tubercle
corpuscles are adegeneration, or "necrosis," of glands or other 
     CONSIDERATION  OF  INFLAMMATION.   193

cells.   The fallacy of this theory, though it has many facts
which seem to give it support, is easily demonstrated.   For
instance, pus cells may occur in tissues where there are no
epithelial  cells, as among muscles;  and cancer, pus,  and
tubercle, are all found in the white substance of the brain,
where no cells have been demonstrated to exist, capable of
increasing on the one hand,  or degenerating on the other."

    MORTIFICATION, OR  DEATH OF  THE EXUDATION.
  During an active inflammatory process, it is not uncommon
for a large amount of liquor sanguinis to escape  from  the
diseased capillaries; and in case they become ruptured, blood
corpuscles will be  found  mixed with  the exuded  product,
in which case a complete obstruction may occur to the cir-
culation, and the  pressure so paralyze the nerves as to pre-
vent the formation of new structure, or the ordinary changes
in the exudation.  In  which event the  corpuscles break
down and become disintegrated, their haematosine dissolves
and colours the serum, forming a rusty-coloured or blackish
mass, producing what is known as moist gangrene, or morti-
fication. During this decomposition an acid matter is formed,
which acts upon the surrounding tissue, producing disorga-
nization, and evolving carburetted hydrogen gas.   (See fig.
                        Fig. 26.
26, which represents mortification following compound frac-
ture.—Liston.)  As the tissues become broken  down  and
dissolved  in this acid product, they are discharged in the
form of ichorous pus.  In mortification the vitality of the
                          17* 
194  CONSIDERATION OF INFLAMMATION.

exudation is lost, and, instead of passing into organization,
it becomes subject to the chemical laws  of  dead matter.
Senile, or dry mortification, may occur as the result of ob-
struction of the blood-vessels, of debility, or some peculiar
crasis of the blood.
                      ULCERATION.
   Ulceration, although somewhat similar  to  mortification,
is of a more  chronic character, and does not result in the
entire  death of the  exudation; as, while portions of the
exuded product still  possess its cell-formative power, other
portions become disintegrated and converted into granular
matter, mingled with the serum, constituting that form of
pus known as unhealthy, or ichorous.  This form of ulce-
ration  almost always occurs in vitiated  constitutions.  In
recent sores and ulcerated patches connected with a healthy
constitution, the regular pus corpuscles will form a plastic-
like substance, which- covers and protects the  fresh gra-
nules during their process of development and organization.
   Of the symptoms of inflammation I have already given
an account in another portion of the work.
             TREATMENT OF  INFLAMMATION.
   In addition to  the treatment I have  already given, I
would  state that the various  applications of the cold and
hot packs constitute a valuable auxiliary in the treatment
of active exudation.  Where  the disease is connected with
a vitiated constitution, the system should  not only be sup-
ported by means of alnuin, hydrastin, iron, and other active
tonics,  but the part inflamed should be stimulated by means
of the  alcoholic tinctures of hydrastus,  baptisin, &c.   A
pernicious error that exists relative  to the treatment of lo-
cal inflammation in  scrofulous and tuberculous constitu-
tions, is in the application of weakening  and debilitating
poultices,  instead of applying supporting and strengthening
remedies,  as  is demanded by  the  nature  and character of
the disease.   For farther consideration of the treatment,
the reader is  referred to special inflammatory diseases. 
               AN  EPITOME

                       OF THE

AMERICAN  ECLECTIC  PRACTICE  OF  MEDICINE.
                  EPHEMERA.

  Ephemera is a fever which lasts but  one day.  Its
symptoms  are  chilliness and anorexia  or  indifference to
food, followed by a hot skin, flushed  face,  with hard  and
frequent pulse.   In the course of from  sixteen to twenty-
four hours, these symptoms yield to a gentle perspiration,
which lasts one  or two  hours, leaving  no  trace of fever
save slight debility.  It is mostly confined  to  children,
and may be considered the simplest form  of fever, requiring
only mild treatment.
                   treatment.
  Give a  warm  bath  by immersing the patient in warm
water, or by sponging the surface frequently in warm  sal-
eratus water.  If the head is hot, apply  a towel wrung out
of cold water, and change often.
  If the fever is persistent, add ten drops of the Tinct. of
Aconite to ten tablespoonfuls of pure water, and give one
teaspoonful every half hour  until  the fever subsides.   If
the  bowels  are confined, give a warm water injection.
Warm  or cold  packs  may be resorted to in case of local
congestion.
                                         (195) 
196         INTERMITTENT  FEVER.
 INTERMITTENT  FEVER,  OR  AGUE.
                    SYMPTOMS.
  Febrile paroxysms occurring at regular intervals  of
longer or shorter  duration.  But mostly recurring every
twenty-four, forty-eight,  or seventy-two hours.  The
twenty-four  hour type is the Quotidian, the forty-eight
hour the Tertian, and the seventy-two hour the Quartan.
The interval between the paroxysms is called the Apyrexia.
The period  from the commencement  of  one paroxysm to
the end of the next is called the revolution.  Either type
of this fever may appear in a double form.  Thus, Quo-
tidian frequently  occurs  twice  a day, producing double
Quotidian.   The Tertian and Quartan, when occurring in
a double form, produce a double paroxysm every second
and third day.   The double daily paroxysms  have some-
times been  ascribed  to  the double Tertian.   And their
occurrence  at different hours on  alternate days, together
with the difference in the severity of  the paroxysms, have
been described  by Prof. Jones as diagnostic symptoms of
double Tertian.   But having frequently observed the Ter-
tian type manifesting itself in  double  paroxysms every
other day, with a perfect immunity from the disease on the
Apyrexial day,  I am led to infer that  the double  daily
paroxysm,  ascribed to  the double Tertian, is only one
modification of double Quotidian.   This fever is generally
preceded by languor, pain in the  bones, irregular bowels,
and alternate changes in the urine, which characterize  the
type of  the  approaching disease by occurring at the same
regular  intervals,  and lasting the  same  length  of  time.
These changes  in  the urine are from a light limpid to a
dark yellow appearance.  The  tongue  becomes covered
with a white thin  coat, and from one  to two hours before
the chill, the spleen yields a peculiar elastic  resonance, 
             INTERMITTENT  FEVER.          197

and becomes considerably increased in  size.  About this
time distinct rigors or chills  are  felt, passing up the back
and  down the legs;  the teeth chatter, the nails become
purple, the  skin has the appearance of goose-flesh (cutis
anserina) with Horripilations.  If the chill lasts for any
considerable length of time, there  will be oppressed breath-
ing, with precordial pressure.
  In the course  of from fifteen  to thirty minutes these
symptoms gradually subside,  and at first a mild fever suc-
ceeds, which continues to increase until  the  skin becomes
dry and hot. The pulse increases in fulness and frequency,
beating from  100 to 120 per minute.   There  is violent
throbbing  of the carotid artery, severe pain in  the head,
with dryness of the secretions, producing thirst, and scanty
and high-colored urine.  There is also much restlessness
and uneasiness throughout the entire Pyrexia.
  These symptoms, modified in  different  individuals and
localities, last from one to  six hours, when they become
mild, and terminate in the sweating stage.  The skin now
becomes covered with a profuse perspiration,  the pulse
becomes soft and  natural, the respiration easy,  and the
patient feels as if almost restored to a state of health.

                    TREATMENT.

  On the approach of the cold  stage, the feet  should  be
placed in warm  water, and  the  patient  caused to drink
freely  of  some  warm  tea.   After  which  he should  be
placed in bed, with covering of  hot  flannel, and jugs  of
hot water to the feet.   As soon  as the fever appears, the
extra covering should be removed, and  from one to ten
drops of the Tinct. of Veratrum Viride  should  be given
every half  hour  until  the  fever subsides.   Cold  packs
should be  applied to the head, and hot  sinapisms to the
feet.  The  body  should be  frequently sponged in warm
broke water, to which may be added a little whiskey. 
198
INTERMITTENT  FEVER.
  During the Apyrexia, the following compound may be
given for the purpose  of interrupting and preventing the
return of the paroxysm :
     R Eupatorin.......................................... gr. xx.
       Cornine............................................. gr. xx.
       Citrate of Iron................................... gr. x.
Mix,  divide  into  six  powders, and give one every three
hours, or oftener if it  is necessary, in order to have them
all taken before the return of the paroxysms.

  If  the  paroxysms  return, the same treatment may be
pursued as at first, during the cold  and hot stages.
  After which, give the following compound :

      R'Viburine............................................ gr. x.
        Rhusine............................................ gr. x.
        Salicin.............................................. gr. xxx.
Mix,  divide  into  six  powders, and give one every three
hours, or oftener as the case may require.

  Or,
      R Bebeerine.......................................... gr. xx.
        Quinine............................................ gr. x.
        Phosphate of Iron............................... gr. x.
Mix,  divide into six powders, and give as above.

  Or,
      R Quinine............................................. gr. xx.
        Bitartrate of Potassa........................... gr. xxx.
Mix,  divide  into  six  powders, and give one every three
hours.
  Or,
      R Chinoidin........................................... gr. xx.
       Capsicum.......................................... gr. xx.
       Santonine.......................................... gr. xx.
Make ten pills, and give one every two hours. 
REMITTENT FEVER.
199
  Or,
     R Syrup of Bone Set................................. Oss.
        Chloride of Sodium (Common Salt)........... %j.
Mix, dose 1 oz. every hour during the revolution.
  3j of pulverized  Sassafras  Bark, taken at intervals of
one or two hours during the revolution where the stomach
will  tolerate it, is generally sufficient to interrupt the pa-
roxysms.   Also  a  strong  infusion  of  Strawberry  root,
taken  freely  during the interval,  will generally  effect a
complete intermission.
  After the paroxysms have been entirely interrupted, a
radical cure  should be attempted  by giving the patient a    '
mild  alterative,  such as Euonymine, one or two  grains,
three or four times  a day.   If the bowels are costive, and
do not yield readily to the Euonymine, add £ or £ of a
grain of Podophyllin, and  give  sufficiently often to main-
tain them  in a soluble state.
  If the spleen continues permanently enlarged, Diuretics
of Marshmallow and Cream  of  Tartar should be  drunk
freely.
  On  the  seventh, fourteenth, twenty-first, and  twenty-
eighth days succeeding the last paroxysm, one of the anti-
periodic compounds should be given as at first.
  If the patient resides in an ague district, daily baths of
warm  lye water, together  with  a  free use of  Cream of
Tartar and Marshmallow, will have a tendency  to prevent
a recurrence of the  disease.
                 REMITTENT  FEVER.
        Remittent  Fever,  like  Intermittent, is  generally  pre-
     ceded by lassitude and yawning, with soreness and stiffness
     of the muscles, especially those of the neck and calves of
     the legs.   The tongue is covered with a light yellow coa-t


1 
200
REMITTENT FEVER.
The  countenance is  shrunken, pale, and of a leaden hue.
The  conjunctiva presents  a congested  appearance.   The
urine is thick and of a dark yellow  color.   The bowels
are costive.   The liver is  congested, and yields flatness on
percussion.
  There is sense of weight in the Hypochondric and Epi-
gastric  regions.  Creeping  sensations of  cold  are suc-
ceeded  by flushes of heat, the taste in the mouth is me-
tallic, the  skin is sallow, and sleep is disturbed by alarming
dreams.  These symptoms increase in  intensity,  until the
attack of  the disease is established.   As the hot stage be-
comes developed, much  of  the pain  about the  legs and
back frequently abates, although  it often returns  at the
next exacerbation.   Frequently,  there is  a  sensation  of
chilliness, lasting from ten minutes to one hour, during
which there is excessive thirst,  nausea,  and vomiting,
mostly  rejecting the fluids and medicine  taken.   There is
intense fever with  much tenderness of  the  Epigastrium
and right Hypochondrium, which becomes painful upon
pressure.   The countenance is flushed, the eye has  a wild
expression, with a violent pain in  the head,  and in some
cases delirium.   The pulse is frequent, beating during the
fever from 120 to 130 per minute.   It is sometimes small
and irregular,  at others  full and forcible.   The tongue is
mostly brown,  with  a dry streak through the middle. The
bowels are costive,  but, when acted  upon, the discharges
are  black or yellow.   The urine  is  scanty and muddy.
These symptoms usually continue from six to ten hours.
   The  febrile paroxysm is superseded  by a gentle perspi-
ration  on the  head and  shoulders, rarely extending over
the  entire body.  There  is  now a mitigation of all  the
paroxysmal symptoms; yet there is by no means a perfect
A pyrexia.  The pulse is still quick and  irritable, with
Tinnitus Aurium, lassitude and much debility.  This state
is called the remission, and  lasts from one to three hours, 
REMITTENT  FEVER.
201
when  the  febrile symptoms recur, and  gradually increase,
until they acquire  their former intensity, and do not sub-
side until after a period longer than that occupied by the
first  paroxysm.   In  the  subsequent  exacerbations,  the
symptoms all become  aggravated, except the chill, which
generally becomes less marked each succeeding paroxysm.
These exacerbations generally occur in a double Quotidian
form,  although I have frequently observed  them, both  of
single and double Tertian, and Quartan.

                   TREATMENT.
   This fever, if timely treated, yields  with much readiness
to mild  antiperiodic, and alterative  remedies.   As  for
instance,  in  the  forming  stage, combine thirty or forty
grains of  Cornine with equal  parts of Euonymine  divided
into six powders, and give one  every two or three hours,
until a full antiperiodic and  alterative impression  is pro-
duced.   This, with rest, and  free  bathing, will generally
arrest the disease.
   During the cold stage the  patient should be placed in
bed, and a hot pack be applied to the bowels, and  also to
the regions of the liver  and spleen.  Hot sinapisms should
be placed along the spine and the  calves of the legs,  ex-
tending to the ankles  and  feet.   As  soon as  the fever
makes its appearance,  the sinapisms  should be  removed,
and the packs changed to tepid ones.  The body should
be freely  sponged in warm lye water, every hour  or two,
as long as the fever lasts.   The  head should be packed in
towels wrung out of cold water, and from  ten to  twenty
of the Intermittent drops be administered every half hour.
   These drops are composed of equal parts of fluid Ext.
of Lobelia, Cypripedin and Scutellaria.
   If  the  stomach will  not tolerate them, from one to  ten
drops of the Tinct. Veratrum Viride  may be given every
fifteen or twenty minutes, until the same effect is produced.
       18 
202
REMITTENT  FEVER.
After  the  remission is fully  established, the  following
antiperiodic compound may be given.
     R Quinine............................................. gr- xx-
       Phosphate of Iron.............................. gr. x.
       Ferrocyanide of Potassium................... gr. j.
Mix,  divide  into six  powders, and give one every two
hours.
   Or,
     R Bebeerine.......................................... gr. xx.
        Salicine............................................ gr. xx.
        Viburin............................................ gr. xij.
 Mix, divide into six powders, and  give one every three
 hours.   If the  exacerbation  comes on before the powders
 are all taken, give one eighth of a grain of Veratrine with
 each alternate powder, till the remission becomes distinct.
 Or give Tinct.  of Veratrum in quantity sufficient to sub-
 due the fever.   If this antiperiodic should not completely
 arrest the disease, before repeating it,  the bowels should
 be moved by giving  one gr. of Jalapin, one half gr. of
 Phytolaccin, mixed with thirty grains of sugar,  and given
 in three  doses at intervals of one hour.   If this should fail
 to  produce Catharsis, give one  teaspoonful of the fluid
 extract of Antibilious physic every half hour, accompanied
 with  warm water injection until the bowels  move freely.
 After which, give  one  of  the above  antiperiodic  com-
 pounds as before.   Or if the stomach become irritable,
      R Quinine............................................. gr. xx.
        Cream of Tartar.............................. gr. xxx.
        Simple Syrup.................................... gij.
 Mix, and give one teaspoonful every hour until all is taken.
 If the stomach still continues irritable, thirty drops of the
 Tinct. of Gelseminum, and one grain of Morphine, may be
 added to the above mixture.
   When the  paroxysms are very severe, and accompanied 
CONGESTIVE  FEVER.
203
by congestion of some of the vital organs, and the natural
increased  intensity of the next  exacerbation would  prove
disastrous  to the  patient,  a large  and full dose of some
antiperiodic, in connection with an intermittent, should be
administered at once.   As for instance,
     R Quinine............................................. gr. xx.
        Scutellarine...........................,........... gr. x.
        Cypripedin.................,...................... gr. x.
Mix, divide into three powders, and give  one every hour
until all are taken.   Or if the approaching exacerbation
is near at hand, they may be given at still shorter intervals.
   When the paroxysmal  form of the fever is removed,
little remains to be done, save to repair the local and con-
stitutional injuries  produced  by the  disease.   To  restore
the deranged functions  of the liver, one or two grains of
Euonymine may be given night and morning.
   The  tone  of  the  stomach  may be restored  by adding
fifteen  grains of Hydrastin to  one half pint  of Simple
Syrup, and one eighth of a pint of gin, of which one or two
teaspoonfuls may be given before each meal.   If there  is
a tendency to relapse, or if the  disease assumes an inter-
mittent form, as it frequently  does, the antiperiodic altera-
tive, and tonic course,  should be pursued until the parox-
ysms are arrested, and the causes removed.
 CONGESTIVE  OR  TYPHUS FEVER.
  Much diversity of opinion exists relative to this disease.
Some regarding it as a Continued Fever, of a highly con-
tagious character, while  others consider it as  one of the
modifications of malarial fever, belonging to the intermit-
tent family.
  The limits of this work not being sufficient to admit of a
thorough investigation of this subject,  the reader  is re- 
204           CONGESTIVE  FEVER.
ferred to  the  American Eclectic Practice, by Jones and
Morrow, for a more minute description of this disease.

                     SYMPTOMS.
  It is  preceded by  languor, headache,  disturbed  sleep,
loss of appetite, followed by chilliness, swollen tongue, and
great debility.   The bowels are costive, the urine scanty
and high-colored, the countenance is dingy and heavy, the
eyes watery, with congestion of the  conjunctiva,  which
often extends to the nasal fossa and  larynx.  There is
ringing  in the ears, with Epistaxis,  and sense of fulness in
the Epigastrium.
   These symptoms continue for two or three  days, when
the  teeth become  covered with dark  sordes,  the  pulse
becomes compressible, and the countenance is of a flushed
appearance.
   The debility becomes more marked from the tenth to the
twentieth day, and the symptoms are all more aggravated.
   There is  incoherent  talking, and delirium ;  the tongue
becomes dark and dry, with tremor  of the hands, and
Subsultus Tendinum.   The evacuations  become involun-
tary, with retention of the urine, and interrupted breath-
ing.   The surface  is covered with cold sweat,  and the
patient  expires.
   This  fever lasts from  ten to  thirty days.  It is frequently
confounded  with Typhoid Fever, from  which, however, it
may be  distinguished,  by the absence  of petechia?, the
costive  state of the  bowels, and swollen condition of the
tongue.    Also, it usually assumes a more intermittent or
remittent type.
  Where  congestive fever is about to terminate favorably,
the symptoms  are much milder than those  described above,
and from the tenth to the twentieth day there is a diminu-
tion in the severity. 
CONGESTIVE  FEVER.
205
                    TREATMENT.
  There is  generally more local  congestion in  this than
any of the previous forms of fever, with almost a complete
suspension of the assimilating functions.   To remove  the
congestion,  and restore  the assimilating  functions, is  the
prominent indication to be fulfilled.  In the early treat-
ment  of this disease, hot  packs should  be  applied to all
parts  of the body involved in the local congestion, except
the head, which should be kept  cool.   For the purpose of
restoring the  assimilating functions  of the  stomach, pro-
ducing intermission, and interrupting the paroxysmal cha-
racter of the disease, the treatment should consist of those
remedies possessing intermittent,  antiperiodic, and stimu-
lating powers,  such as the following compounds :
  No.  1.  R Quinine.........................................  gr. xx.
          T. Xanthoxylin..............................  gr. xx.
          Capsicum......................................  gr. x.
Mix,  divide into six powders, give one every three hours.
   Alternate each  powder with  ten  or fifteen intermittent
drops.
   Or,
  No.  2.  R Quinine........................................  gr. xx.
          Capsicum......................................  gr. xx.
          Veratrin.......................................  gr. ij.
          White Sugar.................................  gr. xx.
Mix,  and divide into ten powders, and give  one  every two
or three hours.
   Or,'
  No.  3.  R Camphor.......................................  gr. v.
          Quinine........................................  gr. xx.
          Viburine.......................................  gr. x.
          White Sugar................................  gr. xx.
Mix,  and divide into twenty powders, and give one every
two or three hours.
                          18-* 
206           CONGESTIVE  FEVER.
  Or,
  No. 4.  R Eupatorine.................................... gr. ix.
          Alnuin......................................... gr. xx.
          Aconitine...................................... gr. lss.
          White Sugar................................. gr. xx.
Mix, divide into  six powders, and give one  every two 01
three hours.
  Or,
  No. 5.  R Scutellarine.................................. gr. xx.
          Chinoidin.................................... gr. xx.
          Oil Capsicum............................... gutt. iij.
          White Sugar................................ gr. xx.
Mix, divide into eight  powders, and give one  every two
or three hours.
   To act as an alterative after the fever is broken :
     R  Euonymine........................................ gr. xx.
        Podophyllin ...................................... gr. ij.
        White Sugar...................................... gr. xx.
Mix, divide into ten powders, and  give  one every three
hours.
   The bowels should be  kept open, during the treatment of
this disease, by giving small doses of neutralizing mixture
and Euonymine,  and the body should be freely sponged
with, lye water and  whiskey.  In cases where there  is  evi-
dent derangement of the stomach,  with costive state of the
bowels,  an emetic and cathartic should be given, previous
to  the  administration of  the antiperiodic powders.   A
teaspoonful  of common  emetic acetic   Tinct.   in* warm
ginger tea, may be  given every ten or fifteen  minutes, until
(he  stomach  is  thoroughly  evacuated.   This  should be
followed by small  doses of Podophyllin  and neutralizing
mixture, until  free  catharsis is produced.   In cases where
there are severe  paroxysms,  and the local  congestion is
likely to prove disastrous to  the  patient,  the antiperiodic 
CONGESTIVE  FEVER.  '          207
Bhould be administered  first,  and the emetic and cathartic
should follow.
  But, whether the emetic and  cathartic, or the powders
be given first,  if they fail to arrest  the  paroxysms, there
should be a repetition of the antiperiodic powders after
two  or three  days.    During  the  interval, the  patient
should drink freely of some mucilaginous preparation, as
marshmallow,  flaxseed,  or slippery elm.  At the  same
time, if the skin be dry, from five to ten drops of Tinct.
of Veratrum may be given to produce moisture.   If, after
pursuing  the  above course of  treatment  a week or  ten
days, the fever still  proves persistent, the following com-
pound may be given :
      R Ferri Ferrocyanide............................. gr. xx.
        Quinine.......................................... gr. xx.
        Piperine.......................................... gr. x.
        Gelsemin......................................... gr. ij.
        White Sugar..................................... gr. xxx.
Mix, triturate,  divide  into  ten powders,  and give  one
every two or three hours.
   If, during the progress of  the disease, there  is  trouble-
some Epistaxis, a snuff of Matico leaves may  be  used, or
an infusion of them  may be injected into the nostrils.   If
there is much restlessness and inability to sleep, one-eighth
 of a grain of  Hyosciamin, with Cypripedin and Scutel-
laria, each  one grain, given two or three times a day,  will
control the symptoms   Where there is tendency to  syn-
cope :
      R Carbonate of Ammonia....................... gr. v.
        3um Camphor.................................. gr. v.
        Capsicum........................................ gr. x.
        Pulverized Acacia............................. gr. xxx.
 Triturate,  mix,  and  give  one as often  as   indicated.
 During the treatment of this disease, the patient's strength
 should be  maintained  by  a free use of beef  tea, boiled 
208             TYPHOID FEVER.
rice, and such other nutritious food as the stomach will
tolerate.   During the convalescence, a mild alterative and
tonic  course  should  be pursued.

  Thus far we have  been treating of fevers which  are ad-
mitted to have their  origin in marsh misasm,  or are pro-
duced by exposure to  damp  atmosphere contaminated by
noxious gases, and decomposing vegetable matter, mostly
affecting the spleen,  producing Intermittent; or, the spleen
and liver,  producing Remittent;  or, the spleen, liver and
nervous  system,  producing  Typhus or Congestive fever.
But we now come  to the  treatment of a  disease which  is
supposed to have its  origin in both animal and vegetable
miasm.  And to confine its morbid influence mostly to the
small glands of the bowels, producing more or less exten-
sive ulcerations.   This is called

              TYPHOID  FEVER.
   This is  a  fever which has received quite a number of
names.  Such as  Enteric  fever, Continued fever, Bilious
fever,  Bilious Continued  fever, and Nervous  fever.  But
the name by  which it  is most commonly known is that of
Typhoid Fever.
                     SYMPTOMS.
   Few diseases are so remarkably insidious,  in their ap-
proach,  as this  fever;  its  commencement being almost
imperceptible.   Its  incubation generally  lasts from three
or four days to as many weeks.   The patient  feels  at first
slight debility, with a  dull and "heavy feeling  in the head,
which continues to increase, terminating in violent frontal
headache.   By  the  time  the  disease  becomes fully de-
veloped, the limbs are weak, with  lameness, and  in some
cases, rheumatic  pains.  The bowels  are at  first slightly
constipated ; but in the course of a few days, there is  a
strong tendency to  diarrhsea.  The pulse is  accelerated, 
TYPHOID  FEVER.
209
and a creeping chilly sensation is  felt, commencing in the
back, and passing over the entire body.   The chilliness is
soon followed by  a slight increase  of all the  symptoms,
together with  a  dry and warm state of  the  skin.  These
partial paroxysms, frequently follow each other in rapid
succession ;  but sometimes there is  an interval  of several
hours.  The tongue is but slightly  coated, and the appetite
remains nearly natural until the disease becomes fully de-
veloped.  Indeed, in a large number of  cases which have
come under my observation, there is no  anorexia during
the entire progress of well-marked cases of this  disease.
   About  this time, there may be observed  a number of
small white  vesicles or  sudamina?, at first mostly confined
to the abdomen, but afterwards extending over  the entire
body.   These sudamina?, although frequently appearing in
other fevers,  are  more generally  present in this.  These
vesicles,  unless carefully observed, will  escape  notice, as
they are frequently so small  as to be scarcely perceptible
to the naked eye;  being seldom larger than half the head
of a pin.  To the casual observer, they might easily be
mistaken for partial, detached,  dermoid scales.   But when
pricked with the point  of a needle, a small  quantity of a
thin white fluid may be seen to escape.    On the fifth  day
from the  appearance of the .sudaminse,  another eruption
appears which is diagnostic  of this disease.   It is small,
red, or purple spots or eruption, resembling flea-bites.
   At first they are very small, so  small  that without the
aid of some magnifying power the larger portion of them
cannot be seen.   They are at  first perceptible just above
the  ileo-cascal valve, or about one and one half inches
above the crest of  the ileum, and  extend over all parts of
the  body;  but are mostly confined to  small  patches of
akin corresponding to  the ulcerated  parts of the bowels.
These spots are called  petechias.   They  are small circum-
scribed red  spots when  fully developed.   They may be
L 
210             TYPHOID  FEVER.

distinguished from most other forms of eruption, by dis-
appearing on pressure, but returning again the moment
the pressure is  removed.   They come and  go, appearing
and  disappearing; but their presence or absence during
the active stage of the disease, is a sure index to the state
of the bowels.   As when the bowel symptoms  are aggra-
vated, the petechiae  disappear;  but when  they  become
ameliorated,  are again visible.   This leads me to infer
that Typhoid Fever, like Scarletina, is an eruptive disease,
and that to maintain the eruption on the surface, is a very
important indication to be fulfilled in its  treatment.  When
the disease becomes fully developed,  and in some cases, in
the  forming  stage, the bowels yield a marked tympanitic
resonance on percussion.
   On inspection, a bloated or tympanitic condition of the
bowels may  be observed,  and most  marked, beneath the
patches  of petechiae.
   About this stage of the  disease, the nervous symptoms
become  aggravated, amounting in many cases to delirium,
and in others  producing great  pain  in  different parts of
the  body,  as the  knees, hips,  abdomen,  side  and  head.
These pains  are mostly transitory, or appear in the  form
of paroxysms.   In a few cases  the  patient  inclines to
stupor, but generally the opposite is  the case, the patient
being restless  and wakeful.   There is a buzzing noise in
the  head,  very much like that caused by full doses of
Quinine.
   The tongue, by this time, mostly assumes a red appear-
ance,  especially upon  the  tip and edges, and the papillae
become  elevated.   When it is protruded it may be seen to
tremble, and in some cases it is  protruded with much diffi-
culty.   The pulse increases in frequency, but diminishes in
fulness; and in the latter part of the disease it  becomes
very compressible.  The  eyes have  a watery appearance, 
TYPHOID  FEVER.
211
and when the bowels become extensively ulcerated, they
have a vacant stare and remain partly open during sleep.
  The breathing is laborious, the  mouth is half open, and
sordes accumulate upon the teeth.   The urine, which was
somewhat scanty, now becomes nearly suppressed, having
a dark red  appearance, generally containing a large per
cent,  of  albumen.   The  bowels  continue to  bloat, the
evacuations are frequent,  sometimes watery and frothy, at
other times dark and offensive, and mixed with blood ; or,
the entire discharge may  consist of blood amounting to
active hemorrhage ;  being mostly of a dark venous charac-
ter, although I have seen  it  of a bright red color, or of
the appearance of  fresh  arterial  blood.   This symptom,
although alarming  and dangerous  if persistent, is fre-
quently  followed by speedy  recovery.  The  skin is not
as  dry and  hot  as  in many fevers, yet it is frequently
pungent, and has a  husky  feeling.   The pulmonary organs
generally sympathize with affections of the  bowels, and
especially is  it the  case in this disease.   Hence we find
Crepitant Rhonchus, and  frequently a slight  cough.  If
the disease  is  about to terminate  fatally,  the symptoms
will  continue  to increase in severity,  the  patient will
become stupid with low muttering delirium, subsultus ten-
dinum, picking at the bed-clothes, coma, and  death.  Or
frequently the  ulceration  of  the  bowels may terminate
in perforation, followed by  a discharge of  the  contents
into  the  cavity of the  abdomen, producing at first  much
pain,  but soon subsiding, the patient becomes  covered
with a cold  clammy sweat, the pulse  ceases at the wrist,
the bowels evacuate involuntarily, and the patient  sinks
into the arms of Death.
  Or what is more frequently the  case, where mischievous
medication  has been avoided, the symptoms will  continue
in a somewhat modified form  from fourteen to twenty-one
days,  when  they  gradually become ameliorated,  and the 
212
TYPHOID  FEVER.
patient  recovers.  The average mortality of this disease
is  only about 10 per cent, or from 15 to  20 per cent, less
than it is under Allopathic treatment.

                    TREATMENT.
   In no disease  is there more mischief  done by an im-
proper course of medicine than in this.
   The practice of giving active purgative medicine in th(
commencement of a fever, with the notion  of puking and
purging it from the system, has increased the mortality to
an alarming extent.   For  after a drastic purgative, it is
almost  impossible to cure Typhoid Fever,  no matter how
prudent your after course may  be.  First, in the treatment
of this  disease, the  skin should be thoroughly bathed  in
warm lye water and whiskey.   The patient should then  be
placed in bed,  when, if the bowels are costive, they should
be moved by warm water injections.  If the stomach con-
tains indigestible food, or if there  should be a marked  in-
dication for an emetic,  one-eighth of a grain of Lobelin
may be given in a wine-glass of warm ginger tea every ten
or fifteen minutes, until the  stomach is thoroughly evacua-
ted.  After this the patient should drink freely of beef tea
and rice gruel.  When the stomach becomes settled, or the
effect of the emetic has passed off, give from one to five
drops of the Tinct. of Aconite in a tablespoonful of water
every half hour, until the pulse becomes  less frequent and
the  skin moist.   At  the same time apply  warm lye poul-
tices to the bowels,  made by  adding one  teaspoonful  of
mustard-seed to  ten  tablespoonfuls of slippery elm, wet
with strong saleratus water.   These  poultices should  be
changed as often as three  or  four times a-day, and con-
tinued as long as the bowel symptoms prove troublesome.
   When the pulse becomes  controlled by the Aconite, the
next thing is to interrupt the periodicity of the disease,  by
giving the following antiperiodic. 
TYPHOID  FEVER.
213
      R Quinine.......................................... gr. xx.
        Hydrastin...........,........................... gr. xx.
        White Sugar.................................... gr. xxxx.
Mix,  divide into six powders, and give  one every three
hours until all are taken.
  At the same  time, give freely of mucilage,  such as a
cold infusion  of pulverized marshmallow, acacia, or flax-
seed.   Also apply water  to  the head.   If  the patient is
of a bilious temperament, and full habit, the water should
be cold.   If of  a nervous temperament, with low vitality,
the water should be tepid, and mixed with a  little whiskey.
The feet  should be kept warm, and  the patient  remain
quiet in bed.. At  the same time give a sufficient quantity
of  Aconite to  control  the  fever, and  to  maintain the
petechiae upon the  surface.  If there should be diarrhsea,
small doses of equal parts of Erigeron and Rhusine should
be given two or three times a-day.   If the patient be rest-
less and unable to sleep, from the sixteenth to an eighth
of a grain of Morphine  may be mixed with one or  two
grains of  Cypripedin,  and  given at  bed-time.   If the
diarrhaea proves persistent, in  addition to the Rhusine and
Erigeron, injections should be given two or  three times a-
day, composed of from four to six ounces of starch-water,
half a grain of Morphine, and from five to  ten grains of
Tannin.   If the Aconite, fail to maintain  the  petechia?
upon  the surface, one half grain of  Macrotin  should be
given in connection with it.   If, after pursuing the above
treatment for six or seven days, the disease  should not be
arrested, the antiperiodic  should be repeated by giving the
following compound :
      R Phosphate of Iron.............................. gr. x.
       Quinine............................................ gr. xx.
        Rhusine........................................... gr. xx.
       White Sugar.................................... gr. xxxx.
Triturate, mix, and divide into six  powders,  and give one
every  three hours until all are taken.
      19 
214
TYPHOID  FEVER.
  At the same time, the Aconite and anti-diarrhaea medi-
cines should be given if indicated.   If the bowels should
become persistently tympanitic, with extensive ulceration,
the Tinct. Bryonia  should be substituted for the Aconite,
and the patient prohibited from assuming the upright pos-
ture,  as in all such cases there is great  danger of perfora-
tion.   Where there is much debility, a permanent tonic
may be given in connection with Chalybeates, such as the
following compound :
      R Iron per Hydrogen........................... gr. xx.
        Hydrastin....................................... gr. xx.
        White Sugar.................................... gr. xxx.
Triturate and mix,  divide into ten powders-, and give one
every two  or three hours, during the interval between the
antiperiodic  medicine.
   During the entire course  the  patient's strength should
be  maintained by a free use of the Essence of Beef, made
by adding one pound of beef to one quart of water and one
half pint of  vinegar.   Boil  the  beef till the liquid is one
half evaporated.  Then strain ;  add one pound of White
Sugar and eight ounces of rice flour, boil fifteen minutes,
strain again, add  one half pint of best Old Whiskey, one
tablespoonful of salt, and bottle for use.  Give  the patient
from one half to one wine glass full four or five times a-day.
Also Porter or Scotch Ale,  toast, or broiled beef may be
allowed when the stomach will tolerate it.   In the event
that  the medicine already prescribed fails to maintain the
petechia? upon the  surface, the Tinct. of Scrophularia may
be given to the amount of twelve drops three or four times
a day.   If necessary to restore  the eruption, hot brandy
toddy may be given  in connection  with the above.  If
symptoms  of softening of the brain appear, from one to
five drops of Tinct. Phosphorus may be  given two or three
times a-day in a large quantity of mucilage.   If dangerous
hemorrhage  from the bowels occur : 
YELLOW  FEVER.               215
     R Nitrate of Silver................................  gr. j.
       Pulverized Acacia...............................  gr. xxx.
Pulverize, mix, make  sixteen pills, and  give one every
hour until all are taken, or until the hemorrhage  is con-
trolled.  Or give from ten to fifteen grains  of Matico every
three  or  four  hours.   If an  alterative is  indicated, small
doses of Leptandrin may be given three or four times a day.
Where the disease is firmly established, much care must be
observed relative to the administration of  medicine, never
giving any,  unless some marked  indication demands it;
frequently all  the medicine  necessary is a few drops  of
Aconite two or three times a-day, with  a  liberal quantity
of mucilaginous drinks, one or two courses  of antiperiodics,
and  a liberal  supply of food.   Yet  where  there  is  a
decided indication for treatment, it should be met with
promptness.   During convalescence, small  doses  of Hy-
drastis in connection with  Chalybeates,  should  be  ad-
ministered.
     YELLOW  FEVER,  OR  TYPHUS
                  ICTERODES.
   This  disease prevails endemically in tropical climates,
but only appearing at the North as  an epidemic.   It is
generally  supposed to have  a compound  origin  arising
from the effects of animal  and vegetable miasm.

                     SYMPTOMS.
   The premonitory  symptoms very much resemble those
of Typhoid Fever, except that, they are more rapid in their
course.   The  skin is hot and dry, the face flushed,  the
respiration hurried, the eyes are red and watery, and there
is nausea and vomiting.   As  the disease  advances, these
symptoms all become  aggravated,  and the diagnostic
symptoms make their appearance. 
216              YELLOW  FEVER.
  The countenance assumes a peculiar cadaverous expres-
sion, and is of  a bright saffron color.   The tongue is soft
and swollen, and there is pain in the Epigastrium. During
the progress of the disease, the symptoms  are variable in
different individuals and localities, sometimes running an
exceedingly mild course, with little more severity than ordi-
nary Remittent Fever,  while in other cases the disease is
marked with great prostration.  In the first  stage the pulse
sinks, there is nausea, and vomiting of a dark frothy fluid;
the respiration is exceedingly difficult and hurried.  There
is also  low muttering  delirium.  The  alvine evacuations
are large and  dark, the patient rapidly sinks,  and death
soon relieves him, unless the  disease is arrested by timely
treatment.
                     TREATMENT.
   The first thing to be done in the early stage of the dis-
ease is to give  a stimulating emetic :
     R Pulverized Lobelia .............................gr. x.
           "     Bloodroot ..........................gr. xij.
           "     Capsicum...........................gr. xx.
Mix,  add  one  gill of warm water,  steep fifteen or twenty
minutes, and after giving the patient  three or four wine-
glasses full of warm ginger tea, give one teaspoonful of the
mixture, and repeat  until a  thorough evacuation  of the
stomach is produced.
   Immediately after the emetic,  give a spirit vapor-bath
by placing a blanket about the patient and chair, and burn-
ing a cup of alcohol beneath it, to produce a copious per-
spiration :   at  the  same time give the patient freely of
weak salt and water to drink.  After the sweat, a thorough
bathing and rubbing will prepare the patient for bed.  The
following compound may then be  given :
     R Quinine  ........................................... gr. xx.
        Chloride of Sodium............................  gr. xxx.
        Capsicum ........................................gr. x. 
                  YELLOW  FEVER.               217

Mix, divide into eight powders, and give  one every three
hours until all are taken.  At the same time, warm poul-
tices should be applied to the abdomen and stomach, and
hot sinapisms to the feet and calves of the legs,  and a
warming plaster along the spine.
  When the antiperiodic mixture has been taken, the fever
and circulation should be controlled by the use of Aconite,
and rest should be induced by giving Cypripedin and Scu-
tellaria or by small doses of Morphine.  The bowels should
be moved by the following alterative :
     R Euonymin ....................................... gr. x.
        Jalapin........................................... gr. ij.
        Xanthoxylin .................................... gr. x.
        White Sugar ....................,............... gr. xxx.
Triturate, mix, divide into six powders, and give one every
two or three hours.
  If there is  much  nausea and  vomiting, the following
compound may be given :
     R Vinegar............................................, Oss.
        Common Salt ....................................... ej.
        Capsicum ........................................... gr. xx.
Mix, and give one  teaspoonful every ten or fifteen minutes,
as the  symptoms may indicate.  If the disease should not
yield  to the above treatment, within the course of three or
four days, the following antiperiodic should  be adminis-
tered :
     R Salicine.......................................... gr. xxx.
        Quinine .......................................... gr. xv.
        Iron by Hydrogen............................ gr. xx.
        Capsicum ....................................... gr. x.
Mix, divide into six powders, and give  one every three
hours.   At the same time give the patient freely of Ess.
of Beef as directed under Typhoid  Fever.   Once or twice
a day the patient  should be bathed with warm  lye water
and  allowed  to  drink  of porter or good ale, whenever
                         19* 
218               INFLAMMATION.
the active fever does not contra-indicate.  Local congestion
or inflammation should be relieved by hot or cold packing,
as the case  may require.  During the convalescence, altera-
tive doses of Podophyllin, with  Hydrastin as a tonic, may
be given once or twice  a day, together with  a free and
generous diet.  If there  should be symptoms of a relapse,
the antiperiodic remedies should be repeated.
               INFLAMMATION.
   Inflammation  is always located in the capillary vessels.
 Hence, tissues destitute of these vessels are never capable
 of taking it on, as the hair, nails, cuticle, and enamel.
   Filamentous tissues, on the other hand,  as  the liver,
 lungs, and mucous and serous membranes, are very liable
 to inflammation.   The first step towards the inflammatory
■process is an  accumulation of blood, which is congestion.
 This accumulation may occur either from too  slow venous
 or too  rapid arterial circulation.   Or it may arise  from
 debility of the capillary  vessels, or from all these causes
 combined.   The .congestion may disappear by a diminu-
 tion in the afflux, together with a restoration of the normal
 functions  of the capillaries.  Or.it may terminate in inflam-
 mation by the  blood beginning to  oscillate in the vessels,
 adhering  at different points until finally it stagnates.
   The blood failing to be converted into venous blood, its
 coagulability is increased  so that the globules  coalesce and
 form minute clots.  New vessels  or  canals are formed by
 globules of blood bursting the vessels and passing into the
 adjacent parenchyma, reaching another vessel, thus form-
 ing  new passages through  the areolar tissue, which ulti-
 mately become capillary  tissue.   Or the corpuscles may
remain in  the adjacent parenchyma, producing swelling by
effusion.   In active congestion, the contractile powers of
the vessels are lost by over-distension, the blood stagnates. 
INFLAMMATION.               219
the coats of the capillaries become diseased and  ruptured,
resulting in extravasation or effusion of blood, coagulable
lymph, and serous or muco-purulent fluid.

                   THE SYMPTOMS
   Are redness, swelling, pain,  and increased heat.   The
redness is  owing to an increased accumulation of blood in
the part.   The swelling to infiltration, to accumulation of
blood and pus, and to  oedema of the lymphatics.   The
pain is produced by the tension, and the  pressure made on
the nerves  of the parts, with the increased sensibility.  The
heat  is caused by  oxydation of effete matter and  adipose
tissue, and retention of natural  animal heat.
   The termination of  inflammation is  1st, resolution; 2d,
suppuration ; 3d,  mortification.
   Resolution may be preceded  by Metastasis, as in mumps
or rheumatism.   The symptoms which precede  resolution
are increased perspiration, diarrha?a, changes in the urine,
and hemorrhage.   In effusion,  we  have formation of  false
membrane, as in croup.   Suppuration is  the conversion of
coagulable  lymph into  pus.  Mortification,  Gangrene, or
Sphacelus, is the complete death of the part.

                    TREATMENT.
   The first indication to be fulfilled in the treatment of
inflammation, is to equalize the  circulation, and restore
the lost functions of the capillaries.
   Veratrum, Aconite, and Gelseminum,  with the ligature,
will  enable us to control  the  circulation.  While Podo-
phyllin, Jaolapin, with  Bitartrate  of Potassa, will relieve
the vessels of the plethora, if that should be a cause of the
disease.
   But as the treatment of inflammation depends in a great
measure upon its locality, the remedies will be given under
the head of inflammation of the different tissues. 
220                 PHRENITIS.
 PHRENITIS, OR ENCEPHALITIS,  AND
                  MENINGITIS;

 (OR INFLAMMATION OF THE BRAIN AND ITS MEMBRANES.)

                     SYMPTOMS.
   A  vague uneasiness of  the  mind, defective  appetite,
 dizziness with vertigo.  The pulse is hard and bounding,
 the eyes have a wild and anxious expression.  The patient
 complains  of  great debility, and  a  sense of numbness  in
 one side of the body ; the numbness  being on the opposite
 side from the  location of the disease, and the patient lies
 mostly on  the back.   There is ringing in the ears, which
 very much  increases as the  disease advances.   In the early
 stage of the disease, the pupil of the eye is preternaturally
 contracted; but  in  the latter stage,  the pupil is  much
 dilated, and light becomes  intolerable.
   As the disease advances,  there are convulsive  muscular
 movements, with  more  or less delirium.   The respiration
 is irregular, the  skin hot,  there is nausea and  vomiting,
 the bowels are confined, and in  most cases there is obsti-
 nate costiveness.   These symptoms may all become aggra-
 vated, terminating in subsultus, picking at the bed-clothes,
 stupor,  coma, suppression of the urine, colliquative sweat,
 stertorous respiration, and death.
   Or the symptoms may all become  ameliorated, and the
patient recover.
                      CAUSES.
   1. Accidents.   2. Intemperance in eating and drinking.
3. Metastasis  of inflammation  from  other   parts.   4.
Mental  excitement.  5. Exposure to atmospheric vicissi-
tudes.   6.  Animal and  vegetable misasm. 
PHRENITIS.
221
                   TREATMENT.
  After  due attention to  the  cause  of the disease,  the
bowels should  be thoroughly  evacuated,  by  giving  the
following compound :
     R Podophyllin....................................... gr. ij.
       Jalapin............................................. gr. j.
       White Sugar...................................... gr. xx.
Mix, divide into eight powders, and give one every hour
until they act as a liberal purgative.   At the same time
apply ligatures to the legs  and  arms by placing a bandage
around them sufficiently tight to prevent the return of the
blood by the veins, but allowing it to pass into the limbs
through  the arteries.   Care should be taken not to pro-
duce complete syncope;  but the ligatures should  be used
sufficiently to deplete the brain and  thereby  relieve the
distended capillaries.   The ligatures should be tightened
or loosened according to  the emergency of the case  and
the indication to be  fulfilled.   In removing them, much
care should be taken to  loosen them one at a time, and at
sufficient intervals to allow the blood to return  to the body
by degrees.  At the same time cold packs should be ap-
plied to  the head,  and  changed  sufficiently often  to keep
them cool.   A warm sinapism  should be placed along the
spine, and the patient  caused  to take Aconite until a free
diaphoresis is  produced.   The  surface should be freely
bathed  in strong lye water two  or three  times a day, to-
gether with hot foot-baths.
   If the disease does not yield to the above treatment, the
purgative should be repeated.
   After which the  following compound should be  given :
      R Digitalin........................................... gr. j.
        Sanguinarin....................................... gr. ij.
         White Sugar...................................... gr. xx.
Mix, divide into eight  powders, and  give one every two 
222                   THRUSH.

or three hours.   If there be periodicity  connected with
the inflammation, give the following compound :
     R Quinine............................................ gr. x.
       Phosphate of Iron .............................. gr. xx.
       Veratrine......................................... gr. j.
       White Sugar...................................... gr. xx.
Mix,  triturate,  divide  into  ten  powders,  give  one every
two  or three hours  as may be  indicated.  During the
treatment, the patient should be  kept quiet,  and in bed,
and  recourse  should be  had to the  ligature,  when the
determination of the blood to the head should indicate it.
The diet should  be principally fluid, and of easy digestion.
 THRUSH,  INFANTILE   SORE  MOUTH.
   This disease mostly occurs in children from one to three
 mouths old.
                       CAUSES.
   Unhealthy  milk  and an  accumulation of effete matter
 and lactic acid, which comes in contact with the mucous
 surface of the  child's mouth, while nursing,  producing
 abrasion.
                     SYMPTOMS.
   Small white specks appearing, either single or in clusters,
 having a dark and inflamed base, which continues to spread
 and coalesce  until the entire mucous surface is involved in
 the disease.
                    TREATMENT.
   Remove the cause.  Bathe the breast frequently in weak
lye water,  and thoroughly cleanse  the  nipple  each time
before the child nurses, and give the following compound:
      R Hydrastin....................................... „r x
       Rhusine.......................................... „r x
       Neutralizing Mixture....................... ?j; 
FOLLICULAR  STOMATITIS.         223
  Give the child from fifteen to twenty drops two or three
times a day; also wash  the  mouth in a weak solution of
Hydrastin.
    FOLLICULAR  STOMATITIS,  OR
         NURSING  SORE MOUTH.
  Symptoms are transparent whitish vesicles on  elevated
salivary glands.  The vesicles break, and the fluid denudes
the mucous surface of the Epithelium, causing inflammation
and ulceration, the  ulcers often extending over the entire
mouth,  and  in some  instances  to the Oesophagus  and
stomach, producing general constitutional disturbance.

                    TREATMENT.
     R Neutralizing Mixture.......................... 2ij.
        Salicine............................................. gr. xxx.
        Rhusine............................................ gr. xx.
Mix, give one teaspoonful every two or three hours during
the day. The mouth should be washed in a strong solution
of Hydrastin both before and after each meal.
  If the disease does not yield to the above treatment, the
following antiperiodic and tonic should be given :
     R Myricin......................................... gr. xx.
        Cornine........................................... gr. x.
        Iron by  Hydrogen............................. gr. x.
        White Sugar.................................... gr. xxx.
Mix,  divide  into ten powders, and give  one every three
hours ;  after  which  give the following mixture:
     R Neutralizing Mixture........................... ?iij.
        Myricin............................................. gr. x.
        Helonin............................................. gr. xx.
Mix, give one teaspoonful three times a day.
  If there is  debility, give the gin bitters of the American
Eclectic Dispensatory in quantities indicated. 
224
QUINSY.
  The surface should be  bathed every day  in  warm  lye
water.  The diet should consist of animal broths;  broiled
beef, rice, bread and milk, &c.
 QUINSY —CYNANCHE TONSILLARIS.
                    SYMPTOMS.
  The parts involved in this  disease are the tonsils  and
adjacent mucous surface.   They appear red  and swollen.
The patient complains of great pain  and difficulty in swal-
lowing.  The  pulse becomes   quick and  hard,  and  the
breathing nasal and laborious.
  These symptoms are generally preceded  by rigors or
chills,  alternated with  flashes of heat.  The tongue  Is
covered with  a  light coat,  the bowels  are  confined, the
eyes are suffused and red,  and the face swollen.   As the
disease advances the swelling increases,  and the patient
expectorates a thin viscid mucus.   The throat, ears  and
eyes become painful,  the  breathing  and deglutition more
difficult,  and the patient is compelled to assume the erect
position on account of the great dyspnoea.

                    TREAT MENT.
  The patient's feet should be placed in hot  water, and, in
the early stage  of  the  disease, a sufficient quantity of the
acetic emetic Tinct. should be given to produce free emesis.
After  which the surface should be  thoroughly bathed in
warm  saleratus water, and the patient placed in bed,  with
 jugs of warm water to the feet, and an onion poultice to
the throat.   If there  is much fever,  from three to  five
 drops of the Tinct.  of Veratrum  should be given from
every half hour to an hour; until the fever subsides.
  At  the  same time  the  throat  should be thoroughly
washed by means  of  a probang, with a weak solution  of 
OTITIS.
225
nitrate of silver and Hydrastin.  The bowels should be
opened by small  doses  of  Podophyllin  and  antibilious
physic.   If the swelling produces dangerous dyspnoea, the
tonsils should be freely scarified with a sharp-pointed bis-
toury, and a strong solution of sulphate of zinc applied by
means of the probang.   Also apply to  the throat, before
the application of  each onion  poultice, a liniment com-
posed of equal parts of Acetic  Tet. of Beef's Gall, Gelse-
minum and Camphor.   The patient should be kept quiet,
and  during  convalescence  the  diet should be light and
nutritious.
   OTITIS,  OR  INFLAMMATION  OF
                    THE  EAR.
                      CAUSES.
  Local injuries, Scarlet Fever  or inflammation of  the
Eustachian Tubes.
                    SYMPTOMS.
  Pain, ringing in the ears, &c.  Diagnosis is easily made
with the Speculum.

                    TREATMENT.
  Remove the cause,  after which apply hot packs to  the
ear, and introduce lint, saturated with equal parts of Tinct.
of Lobelia and Aconite.  If there are constitutional symp-
toms, give a mild purgative of Euonymine and neutralizing
mixture.  If there  is  fever,  give Eupatorin one or  two
grains  three  or  four times a-day;  also  from five to  ten
drops of the  Tinct. of  Gelseminum every two or three
hours until the fever abates.  If there  is ulceration, use a
mild zinc wash;  Compound  Syrup of  Stillingia,  given in
quantities  sufficient  to  act as a mild  alterative,  will
generally be adequate to  a cure.
       20 
226
GASTRITIS.
GASTRITIS,  OR INFLAMMATION  OF
                THE  STOMACH.

                     SYMPTOMS.
  Vomiting, great  thirst, precordial distress, a quick and
hurried pulse, tenderness in  the Epigastrium, with  the
tongue mostly dry and hard and the papillae elevated.  The
skin is hot and dry, the urine scanty, and the bowels  con-
stipated.   As the disease advances, the patient is restless
and peevish, the countenance has a distressed, shivered and
anxious appearance.
  The nausea becomes constant, and every substance taken
into the stomach is immediately rejected.  The appearance
of the rejected contents of the stomach is at first a greenish
mucus, mixed with the  ingesta;  but  if the disease is
about  to  terminate in mortification,  and death, they will
become dark,  and will finally have the appearance of coffee
grounds.
                       CAUSES.
  Worms, irritating substances taken into the stomach, or
as is more frequently  the case, it is one of the local symp-
toms of idiopathic fever.

                   TREATMENT.
  After giving due attention to the cause of the  disease,
the feet should  be placed in warm water, and the entire
surface of  the body thoroughly bathed in broke water and
whiskey.  After  which, from one to ten drops of the Tinct.
of Aconite should be given every fifteen or thirty minutes
until a gentle perspiration is produced.
  At the same  time, the bowels should be  evacuated by
means  of  stimulating  injectious,  and  warm  sinapisms
applied to  the Epigastrium.
  After continuing the  above  treatment for five or six
A 
DYSPEPSIA.
227
hours, if the symptoms do not yield, the Tinct. of Bryonia
may be substituted for the Aconite," and the patient caused
to drink freely of mucilage, as Gum Arabic,  Slippery Elm,
Flaxseed,  &c.
   The sinapisms should be removed after  having caused
irritation, and hot packs applied in their place.
   If, after pursuing the above treatment for ten or twelve
hours,  the inflammation still proves persistent, and  the
cause of the disease has been removed, a thorough spirit-
sweat should be given, and the hot packs continued, and
warm sinapisms applied to the feet.  Also from one to five
drops of the Tinct. Rhus Radicans given every  hour until
the disease becomes mitigated.
   If it assumes an intermittent form, some of the anti-
periodic compounds should  be administered by means of
starch-water injections, sufficiently to arrest the disease.
   The diet should be fluid, but nutritious.
    DYSPEPSIA, OR INDIGESTION.

                       CAUSE.

  Debility of the stomach, and whatever prevents a normal
secretion of gastric fluid.

                    SYMPTOMS.

  Pain  in the  stomach after eating,  palpitation of the
heart, sharp and pinched features, furred tongue, irritable
temper,  wakefulness, a costive condition of the bowels,
dry and husky skin, and debility.

                   TREATMENT.
     R Populin..........................................gr. xx.
        Sanguinarin.................................... gr. x.
        White Sugar....................................gr. xxx. 
228
ENTERITIS.
Triturate, mix, divide  into sixteen powders, and give one
four times a day.  After which,
     R Hydrastin....................................... gr- xxx.
        Syrup of Sugar................................ Oss.
        Muriated Tinct. of Iron..................... %j.
Mix, and take one teaspoonful three times a day before
meals.
   If the above prescriptions do not give relief, the follow-
ing compound may be administered :
     R Neutralizing Mixture......,.................... Oss.
        Aletrin.............................................. gr. x.
        Chloride of Sodium.............................. 5jss.
 Mix,  and give one teaspoonful three times a day.

   A mixture of animal and vegetable diet should be taken
 at regular intervals, and thoroughly masticated.
   A free state of the bowels should be maintained by the
 use of bran-water, salt and water, ripe fruit, etc.; and the
 surface should be sponged  several  times a week in cold
 or warm water, as circumstances indicate.
  ENTERITIS, OR INFLAMMATION OF THE
               SMALL INTESTINES.
  In  simple  Enteritis,  there is deep-seated pain in the
umbilical region, and sometimes in other parts of the intes-
tinal  tubes.  The pain  is more or less constant,  yet it  is
subject to  paroxysmal  aggravations, and is increased by
pressure.   The patient manifests  restlessness by constant
motion of the arms and legs.  As the disease advances,
the pulse becomes hard  and wiry, the skin dry, and some-
times pungent, the tongue  is covered with a dark brown
coat; and  in later stages, there is diarrhaaa and a bloated
condition of the bowels. 
DYSENTERY.
229
                    TREATMENT.
  The stomach should be thoroughly evacuated by Lobelia
and Sanguinaria, in quantities sufficient to produce active
emesis.   As soon r,s this is  effected, give a spirit vapor-
bath,  and wash the patient in strong saleratus water.   A
sinapism should be placed over the  bowels, and Aconite
administered in one or two-drop doses every ten or fifteen
minutes until free diaphoresis is produced.   If the symp-
toms  should not become mitigated in ten or fifteen hours,
the following antiperiodic should be given :
     R Gelsemin......................................... gr. i.
       Sanguinaria ..................................... gr. x.
       White Sugar.................................... gr. xxx.
Triturate, mix, divide into ten powders, and give one every
two or three hours.   At the same time, if the fever prove
obstinate, one or two drops of the Tinct. of Bryonia may
be given between each powder.
  When the sinapism has produced free counter-irritation,
warm packs may be applied to  the bowels.
   If the disease assumes a periodic character, some of the
antiperiodic mixtures should be given.  The convalescence
should be carefully watched, and the diet well regulated.
 DYSENTERY, OR  COLITIS, (AN  INFLAMMA-
             TION OF THE  COLON).
                     SYMPTOMS.
  Acute dysentery  commences with  uneasiness,  soreness,
and sense of weight in the lower part of the bowels, and a
constant desire to go to stool.
  In the course of from five to twenty-four  hours,  the
diarrha?a is  changed  to  mucus  mixed with  blood.   As
the pain and tenesmus  increase, the skin becomes hot and
dry, the urine red and  scanty, and not unfrequently there
is much pain in micturition.
                        20* 
230
DYSENTERY.
  The tongue  is covered at first with a light coat, which
soon becomes heavy  and of  a dark brown  color.  The
pulse varies in frequency and fulness according to the seve-
rity of the  case.  In children, there are more or less brain
symptoms,  which not unfrequently prove the most obstinate
feature of the case.
                        CAUSES.
  In children  the  disease is not unfrequently  caused  by
ascarides in the lower portion of the  rectum.  Also by
anything which tends to obstruct the portal circulation,
and causes a sudden determination of the blood from the
superficial  capillaries to the deep capillaries of the bowels.

                     TREATMENT.
   To  ascertain the cause, and as far as possible to remove
it, are the  first things to be done  in the  treatment of this
disease,  as well as all others.
   If the tongue is coated, and the stomach in a condition
to indicate it, an emetic of Emetine or Lobelia may be
given.   During the  operation, the patient should  drink
freely  of some warm aromatic tea.
   As  soon as the effect of  the emetic has passed off,  the
spirit  vapor-bath should be given ;  after which the surface
should be  thoroughly bathed in warm lye water, and  the
patient placed in a recumbent position in bed.
   If there  is obstruction of the portal circulation from con-
gestion of  the  liver or otherwise, the following purgative
should be  given:
     R Podophyllin........................................ gr. x.
        Neutralizing mixture............................^iij.
        Pulv. Acacia....................................... gr. x.
Mix, and  give one teaspoonful every half hour until free
catharsis is produced.  Afterward give the following anti-
periodic : 
DYSENTERY.
231
     R Chloride of Sodium .............................. £j
       Quinine  ................................ ............ gr. x.
       Oil of Gaultheriae................................. gutt. vi.
Triturate, divide into ten powders, and give one every two
or three hours until all are taken.
  During the administration of the powders, if there is
much tenesmus, injections of starch-water, to  which are
added two or three grains of Tannin, and from  one-fourth
to one-half a grain of Morphine, should be given every five
or six hours.
   If there is frequent pulse, connected with fever, Aconite
or Veratrum should be given in  sufficient quantities to
maintain a gentle moisture of the skin.
   If, after  giving  the  antiperiodic, the  passages should
still be frequent and painful, the following compound may
be given :
     R Neutralizing Mixture.............................^ij.
       Myricin and Rhusin.............................. aagr. x.
       Morphine........................................... gr. ij.
       Ess. of Anise...................................... ^i.
Mix, and give from one-half teaspoonful to a teaspoonful
every two or three  hours,  as the case may indicate.
   Also apply the following liniment to the abdomen :
     R Chloroform.......................................... gjss
       Tct. of  Camphor...................................gij.
       Oil of Olives........................................giij.
Mix, and apply  to the bowels four or five times a  day,
followed by the application of hot dry flannel.
   If the passages should be large  and consist  principally
of blood,  from five to ten  drops of the oil of Erigeron
should be given every two  or  three hours, in  connection
with the above treatment.
   Where brain symptoms  prove  troublesome,  the bowels
should be kept  open, and a free  use made of Capsicum, 
232
ACUTE  PERITONITIS.
and diuretics, in connection with the other remedies.  If
there  is heat in the head, cold packs should  be applied,
also sinapisms to the back of the neck.
  The diet  should consist of beef  tea, boiled rice, soft
ripe fruit, and  such other articles of food as the condition
of the patient may  indicate.  The convalescence  should
be watched with  great care, as  regards both  diet-and
exercise.
 ACUTE  PERITONITIS,  OR  INFLAM-
    MATION  OF  THE  PERITONEUM.

                     SYMPTOMS.
  There is  a sharp pain in the abdomen  over the region
of the part inflamed.   Soon  after the first  attack,  there is
generally more  or less  of a  chill, followed by a  decided
reaction and fever.  The pulse soon becomes quick, wiry,
and weak, and  the tongue is covered with a light brown
coat.   The abdomen is tympanitic, and frequently there is
nausea and vomiting.   The  patient assumes a recumbent
position,  as pressure  causes much  pain.  The  skin  is
hot and dry, the urine generally scanty and high-colored.
As the disease advances, the extremities  become cold,  the
eyes  have  a peculiar  anxious  expression, the body is
covered with a cold  clammy sweat, and the patient  ex-
pires.   Or these  symptoms  may all become ameliorated,
and result in gradual recovery.

                    TREATMENT.
     R Podophyllin......................................... gr. i.
        Ext. of Anti-Bilious Physic..................... 5ji.
Mix,  and give one teaspoonful every fifteen minutes, until
it operates as a cathartic. After which, give the following
antiperiodic : 
PNEUMONIA.
233
     R Quinine............................................. gr. xx.
       Gelsemin........................................... gr. i.
       Capsicum.......................................... gr. xx.
Mix, divide into six  powders, and give one  every three
hours, until all  are taken.  At the same time, if there is
fever, give Aconite sufficient to control  it.   Also apply a
poultice to the abdomen, made of one  pint of oil  meal,
and  one  tablespoonful of mustard, wet  with warm water,
and  change as often  as becomes necessary, to keep up a
gentle irritation of the surface.
  If, after the antiperiodic has been given, the symptoms
still  prove persistent,  the cathartic should be repeated,
followed  by the Muriated Tinct. of Iron, from five to ten
drops every two or three hours until the symptoms abate.
  The above treatment, together with frequent bathing of
the surface, is generally sufficient to control the disease.
PNEUMONIA,  OR INFLAMMATION OF
                  THE LUNGS.

                    SYMPTOMS.
  The most  prominent  is  a cough,  with difficulty  of
breathing, followed by a hot skin, and increased fulness
and frequency of the pulse.
  In the second stage the cough  becomes loose, and the
expectoration free  and copious, having  a rusty appearance
and being at times mixed with blood.
  In the third stage, the Sputa assumes more of a purulent
appearance, and the respiration is sufficiently hurried to
produce more or less Dyspnoea.
  The physical signs  are Crepitant Rhonchus in the first
stage, Tubular or Bronchial Rhonchus  in the second stage,
and when  there is  Hepatization in the third stage, there
will  be  either blowing tubular,  sniffling metallic,  or 
234
PNEUMONIA.
Crepitant Rhonchus, also dulness on percussion.  If there
is  pulmonary abscess, there will  be amphoric tubular, or
crack-metal rhonchus.  The vocal resonance will be either
bronchophonous or pectoriloquous.
   The varieties  of  pneumonia  are  numerous.  At one
time,  it is marked by  highly inflammatory  symptoms; at
another, it  assumes  more of a  Typhoid  character, and
being connected with great debility, the entire phenomena
of the disease resembles that of  incipient Phthisis.
   The prognosis of pneumonia, is altogether dependent
upon the treatment.   The mortality under  Allopathic
treatment being from fifteen to  thirty per cent.,  while
under a judicious Eclectic course, it scarcely amounts to
one half of  one per cent.

                    TREATMENT.
   The  prescriptions for simple sthenic  pneumonia, are
easily indicated ; very few medicines being required.
   The patient should be put upon the Tinct. of Veratrum
Viride, in quantities sufficient to control the inflammatory
action.   In adults of full and plethoric habit, from five to
ten drops may be  given  every half hour, until the inflam-
matory stage has passed.
   A  large  cold pack may also be applied to the chest.
When the inflammation has subsided, expectoration may
be facilitated  by giving  equal parts  of the Syrup of Lo-
belia and Sanguinarin, every two or three hours.
   If  there is  periodicity to the disease,  after the active
stage has passed, Ceracine  and Cornine  may be given in
sufficient quantities to  produce an antiperiodic effect.  At
the same time, continue the syrup.   If the disease should
assume a Typhoid  form,  Capsicum,  in  connection with
small doses  of Carbonate of Ammonia, should be given
Beef  tea, and small quantities of wine, may be adminis-
tered, to maintain the integrity of the constitution, and 
COLIC.
235
the  patient's  strength.   If  there  should  be  bronchial
symptoms, with a persistent cough, twenty or thirty drops
of the  Syrup  of Stillingia should be given three or four
times a day.
  Where there is Hepatization pf any portion of the lungs,
small doses of Sanguinarin and Iodide of Potassium may
be  given.  For  further consideration of  this  subject,  the
reader is referred to  Newton and Calkins  on Thoracic
diseases.
  COLIC,  SPASMODIC,  OR  BILIOUS
                      COLIC.

                     SYMPTOMS.
  It commences with very acute pain about the region of
the navel.   The patient  complains of great thirst, and is
generally costive.  He vomits a hot, bitter, and mostly a
yellow bile,  which at first seems to afford some relief, but
is quickly followed by the same violent pain as before. As
the disease  advances  there is an  increased propensity to
vomit, which  becomes almost continual.  The  natural
motion of the  intestines is  so far inverted as to render an
evacuation almost impossible. If the patient is young and
plethoric, the pulse will be hard and resisting, the surface
will  be  covered with  a cold  clammy sweat during the
paroxysm of pain.  The vomiting will also  prove very
persistent.
  This disease may be distinguished from inflammation of
the bowels by pressure upon the abdomen, which in bilious
colic  always  affords  relief;  but, on the  contrary,  in
inflammation  of  the bowels it increases the pain  and
aggravates all the symptoms. 
236
LEAD  COLIC.
                       CAUSES.
  The causes of this disease may be various, but the effect
is a spasmodic contraction of the muscles of the bowels.

                    TREATMENT.
      R Dioscorine....................................... g1"-  *.
        PulV. Camphor................................. gr.  iij.
        White  Sugar.................................... gr.  xx.
Mix, divide into  ten  powders, and give  one  every fifteen
minutes until  the patient is relieved.  After which,
      R Gelsemin..........................................gr. ij.
        Podophyllin.......................................gr. ij.
        Capsicum..........................................gr. vi.
        White Sugar......................................gr. xx.
Mix, divide into five powders, and give one every hour, in
a teaspoonful of Neutralizing Mixture, till it operates as a
cathartic.
   If the  bowels resist the  action of the  cathartics, they
should be injected with warm water, and  small quantities
of Lobelia Tea.  Also apply a poultice to the  bowels made
of  oil  meal  and  mustard ;  say ten tablespoonfuls of oil
meal to one of mustard.  The patient should be kept warm
and in bed.   During the convalescence the diet should be
of easy digestion and nutritious.
LEAD  COLIC.

   SYMPTOMS.
  This  disease is  preceded by languor,  pallor, general
debility, pain in the  Epigastrium, and  a twisting griping
pain in  the region of the umbilicus. 
SCARLATINA.
237
                    TREATMENT.
     R Sulphuric Acid.............................. gutt. xxx.
        Pure Water...................................  "  ^i.
  Give from ten to twenty drops five or six times a day
for several days.  During the time, a Lobelia emetic, vapor
baths and mild purgatives should be given.

  When the active stage  of the disease has passed off,
vegetable tonics, wine, porter, and a nutritious diet, are all
that will be required to restore the patient to health.
                 SCARLATINA.
   Scarlatina is  divided into three varieties, indicating the
different degrees of severity of the disease, viz :  Scarlatina
Simplex, Scarlatina Anginosa, Scarlatina Maligna.

                     SYMPTOMS.
   The mild form  of this disease is preceded by coldness
and shivering, to which succeed febrile heat, thirst, and an
accelerated pulse.   About the fourth day the face swells,
and irregular patches of a florid red color make their ap-
pearance on different parts of the body.   In the course of
four or five days, the eruption disappears, and the cuticle
falls off in branny  scales.
   The second  variety  is marked by previous  lassitude^
dejection of mind,  pain in the head,  soreness,  and pain in
the muscles of the  neck and shoulders, shivering and fever.
To these succeed nausea, vomiting, difficulty of swallowing,
a hurried respiration, and frequent sighing.   There  is a
quick, weak, and sometimes a hard pulse ; the skin is red,
hot, and dry;  the tongue  is dry,  and  florid  along  the
edges ; and there is great thirst.
   About the third day the redness about the face, neck,
       21 
238
SCARLATINA.
and chest,  becomes more intense, and the glands of the
lower jaw  are painful to the  touch.   In a few hours the
redness becomes diffused over the entire body.  About the
fifth day the  redness  abates, and a brown  color succeeds,
the skin becomes rough,  and falls off in large scales.
   In  the third  variety, in addition to the common symp-
toms, there is great  prostration,  the  surface has  a  dark
livid  appearance; there is nausea and vomiting, a quick
and feeble  pulse, and  laborious breathing.   There are also
ulcerations on the tonsils and adjoining parts, covered with
dark  sloughs, and surrounded by a livid base.   The efflo-
rescence appears about the third  day, but without relief.
It assumes a dark purple appearance.   Delirium, a debili-
tating diarrha?a, and hemorrhage, eusue,  and in a great
majority of cases under  Allopathic treatment, death closes
the scene.
                     TREATMENT.
   But little  treatment is necessary in simple  Scarlatina.
The patient should be kept in bed, and warm.   The skin
should be  thoroughly bathed  in  warm lye water, and the
surface anointed, after each bath, with sweet oil. A warm
bread poultice should be applied to the neck, and from one
to three  drops of the  Tinct. of Belladonna  given five or six
times a day.
   In the Anginose form a more active treatment  is indi-
cated.   A hot  onion poultice should be  applied  to the
throat, and changed  every four or five hours.   Every time
the poultice is changed, the neck should be bathed with a
liniment composed of the following ingredients :
      R Oil of Stillingia .................................... £ss.
        Tinct. of Capsicum...............................gij.
        Oil Origanum....................................... gj.
Mix.
   Bathe the entire body, as in the simple form, with lye
water, but add  to every ounce of the sweet oil  one-half 
SCARLATINA.
239
ounce of  pyroligneous  acid, and anoint  the  surface  as
before.  Add twenty grains t)f  triturated Belladonna to
half a tumbler of soft water, and give one teaspoonful every
half hour.  Also, give the following compound :
     R Capsicum........................................ gr. xx.
       Trit. Hydrastin ............».................... gr. xx.
Mix,  divide into ten powders, and give  one  every three
hours in a teaspoonful of sweet cream.   These medicines
should be continued until the disease  abates. At the same
time keep the bowels in a soluble condition by the use of
warm water injections.
   There  is always  extensive  capillary  congestion in the
malignant form, not only in the  glands  of the throat, but
through the entire system.  To remove this  capillary con-
gestion, and  bring about a reaction, is the first indication
to be fulfilled in this form of the disease.   For this purpose
the following compound may be given :
     R Xanthoxylin..................................... gr. xx.
       Capsicum.......................................... gr. x.
       Hydrastin......................................... gr. xx.
Mix,  divide into ten powders, and give  one every half
hour.  If practicable,  put the patient in a warm bath;
otherwise, apply hot packs to the bowels, back, and extre-
mities ; also, apply sinapisms to the feet and calves of the
legs.  If these measures fail to produce the desired effect
in a few hours, hot rum toddy  may be given in connection
with them in  sufficient quantities  to produce the wished-for
result.  When the reaction is fully established, the patient
should be placed upon  Belladonna, as in other forms of
the fever.   Also, give the following antiperiodic :
     R Quinine.......................................... gr.  xx.
       Baptisin ......................................... n-r. v
       Hydrastin ....................................... gr. xxi.
       White Sugar..................................... gr. xxx. 
240
PERTUSSIS.
Triturate, mix,  divide into ten powders,  and  give  one
every two hours until all are taken.  The  onion poultice
should be applied to the neck, as in the other forms of the
disease ;  also, the oil and acid to the surface.  The throat
should be frequently bathed in a strong solution of Hydras-
tin and Bayberry, and the diet should be highly stimulat-
ing and nutritious.
  PERTUSSIS,  OR HOOPING  COUGH.
  The Hooping  Cough is usually described as a disease
of childhood ; occurring  but  once in the same individual,
usually at some age  before puberty, and propagated by
specific contagion.   It mostly prevails as  an epidemic;
hence, a large number of individuals  are attacked at about
the same time.   The diagnosis of Hooping Cough is,  a
suffocating convulsive cough,  returning in  regular parox-
ysms,  and terminating in  an  excretion  of  thick,  glary
mucus.   The cough is marked by a prolonged  stridulous
convulsive inspiration,  attended by  a peculiar tracheal
rattle, and followed by short efforts of inspiration in rapid
succession.   The long  Hooping inspiration is almost im-
mediately repeated, and thus the paroxysm continues often
for  some  minutes, until there is a discharge  of slippery
mucus,  either by  expectoration or  vomiting,  when the
respiration becomes comparatively easy.
  During the paroxysm,  the  face becomes  much injected
and red, the eyes suffused, and there is violent spasmodic
action of all the muscles of the respiratory organs.
  Hooping cough  is  not  unfrequently  combined  with
bronchial inflammation, and in these cases, there is more
or less cough between the paroxysms.
  The latent stage of the disease,  is  from  eight to  fifteen
days.   The cause of the spasmodic symptoms, is a closure
of the glottis.   When the disease is unaccompanied by
j 
                   ERYSIPELAS.                241

severe  bronchial  affections,  and  is  not connected  with
Pneumonia, Trachietis, or inflammation of the brain, it is
seldom attended with danger.   When it is  thus  compli-
cated, each disease should be treated separately.

                   TREATMENT.
  For the primary disease, take of oil of Skunk Cabbage
berries, from one to three drops, four or five times a  day.
  Or,
     R Pulv. Alum........................................ gr. xx.
       Cochineal............................ ............ gr. x.
       Syrup of Stillingia.............................. &aa-
Mix, and give one half teaspoonful  three or four times a
day.
  Or,
     R Triturated Belladonna........................ gr. xxx.
           "    Sanguinarin....................... gr. xx.
           "    Eupatorin.......................... gr. xx.
Mix, divide into fifteen powders, and give one three times
a day.   Once in five or six days, give from  ten to fifteen
grains of Sulphate of Cinchonin,  divided into six parts,
and taken at intervals of three hours.
ERYSIPELAS —ST.  ANTHONY'S  FIRE.
                     SYMPTOMS.
  Shivering, thirst, pain in the back, limbs, and head, loss
of strength, restlessness,  quick pulse,  nausea,  and some-
times vomiting.  In the course of a few hours, a red spot
appears upon some part  of the face, which tumefies and
spreads rapidly.  It may  confine itself to the skin,  or dip
deep into the adjacent areolar and cellular tissues,  pro-
ducing Phlegmonous Erysipelas.  There is  general fever,
a hard and full pulse, and coated  tongue.  The inflamed
parts become of a dark purple appearance, terminating in
large and extensive abscess, or in gangrene and death.
                         21* 
242
ERYSIPELAS.
  This form of the disease often assumes  a periodic cha-
racter, spreading with great rapidity for a few hours, pro-
ducing dangerous constitutional disturbance, then subsiding
for  from twelve to  twenty-four  hours, when it renews its
attack with more than former violence.
  The prognosis of Erysipelas is always  favorable, under
Eclectic treatment, with good constitutions.

                     TREATMENT.

  The  first thing to  be done in the treatment of this dis-
ease, is to give a  thorough cathartic  of Juglandin and
Menispermin.
      R Juglandin......................................... gr. x.
        Menispermin.................................... gr. x.
        Hyociamin....................................... gr. j.
        White Sugar..................................... gr. xxx.
Triturate, mix,  divide  into  ten powders,  and give one
every hour, until it operates as  a cathartic.
   At the same time, the patient should take a vapor bath,
and the inflamed  part should be thoroughly covered with
 Collodion.  After  the  operation of the cathartic, the fol-
 lowing compound should be  given :
      R Cinchonin.......................................... gr. xx.
        Quinine............................................. gr. x.
        Capsicum......................................... gr. x.
        Gelsemin........................................... gr. j.
 Mix, divide into eight powders, and give one every three
hours,  until  all are taken.   After which,  give from five to
ten drops of  Muriated Tct. of Iron,  every two or three
hours.   The  diet should  be nutritious,  and the  surface
frequentiy sponged  with  warm lye water.  If there  is
 fever, Veratrum or Aconite should be given to control it.
 The  inflamed parts  should  be constantly protected  by
repeated use of the Collodion. 
PLEURITIS.
243
                 PLEURITIS.*

                    SYMPTOMS.
  Acute sthenic pleuritis usually commences with a chill,
soon succeeded by an acute lancinating pain  in  the  side,
cough, short and quick breathing, and fever.
  Each of these will receive particular notice.
  The pain may come-on either before, at the same time,
or a short time after the chill.   In character it is severe,
as if resulting from the thrust of an instrument, and hence
it  is often called a  stitch in the side.   Usually  it is felt
somewhere in the mammary region ;  but sometimes,  else-
where ;  sometimes near the lower margin of the  chest, in
which  case it is, probably,  the  result of inflammation of
that part of  the  pleura which covers the diaphragm.   In
most cases it is confined to one place; but it may be dif-
fused over the surface of the chest,  when it is sudden, very
sharp and severe.
  It is so nearly simulated by the nervous pains in hysteria,
that it  may lead to error in diagnosis.  By  inspiration,
cough and motion, it is increased.   Generally lying on the
affected side,  and pressure  over the  intercostal spaces,
aggravate it.   There is,  a day or two after the occurrence
of the most severe  pain, a greater  degree of soreness ex-
ternally, than  when early in the disease the pain is  most
acute.   As the effusion  increases,  the pain  decreases in
consequence of the separation of the inflamed membraues
by the fluid, and the prevention of  friction.  It is, in some
cases, almost  entirely wanting,  being  perceptible only as
soreness on pressure.
  The cough  is usually  short and  dry, attended with but
little expectoration of mucus or frothy matter.  Sometimes
a  more  copious  expectoration is present.   When  the

                  * Newton and Calkins. 
214
PLEURITIS.
pleuritis is complicated with a  degree of bronchitis, it if
occasionally somewhat bloody.   Severe pain often attends
it, to avoid which, the patient tries to suppress the cough,
and to a certain extent he succeeds by the effort.  In some
cases, however, this  is wanting.   When  such  is the fact,
and there is at the same time no pain, the disease, by some
authors, is called latent pleurisy.
   The breathing, in most cases, is  more  or less difficult.
The pain has the effect of preventing a full, deep inspiration.
The patient  is said to have a catch in his breath.  In
consequence  of this, less air is taken into the lung when
the pleura is  affected, and  the  frequency of respiration is
therefore increased, inversely, as  the quantity  of inspired
air at each inspiration decreases.   The dyspnoea, unlike
the pain, increases as the  disease advances.   The effused
fluid filling up  the  space  usually occupied by the  lung,
causes this symptom.
   The function of one lung is more or less suspended, and
the action of the other is increased beyond  its normal
degree, so that the breathing of the patient becomes pain-
ful and difficult.   This is more particularly the case when
the effusion is both sudden and copious.  When gradual,
the system accustoms  itself to the abnormal condition of
the  respiratory organs.  In the  latter  stage  it is most
severe.
   The decubitus has been  considered as a pathognomonic
sign of  the disease.   Yet  there is much variance among
observers in respect to this symptom.  This results from
the variation  of the decubitus  in the different stages of
pleuritis.  At first the patient cannot lie upon the affected
side, on account of the increase of pain which that position
produces.  At a later stage, when  the effusion separates
the inflamed surfaces, the pain  resulting from  the position
of the two portions  of the pleura becomes less,  and  some-
times is entirely wanting.   When the decubitus is on the 
PLEURITIS.
245
sound lung, the weight of the effused fluid, pressing on
the mediastinum, and forcing this beyond the median line,
preventing the ingress of air into the sound lung, causes
pain from dyspnoea.  And, consequently, at this period of
the  disease,  the decubitus  is most  free from  unpleasant
sensations on the affected side,
   The fever is usually considerable, and attended with the
most common phenomena of febrile affections.   The pulse
is quiok, sometimes  rising to over a hundred  beats in a
minute, hard, full  and tense.  The  skin is dry and  hot,
particularly over the chest, or the seat of the disease.
   The tongue is parched, the urine scanty and high-colored,
and occasionally there  are cerebral symptoms.
   Of the fever there are often daily remissions and exacer-
bations, the  former coming on in  the morning, the latter
in  the  afternoon  or  evening.  In four or five  days  it
moderates considerably.

                    TREATMENT.
   In strong and plethoric  individuals,  where there  is a
marked case of sthenic  pleuritis, the stomach  should be
thoroughly  evacuated  by a Lobelia and Boneset emetic,
followed by an active cathartic of Jalapin  and Cream of
Tartar.  The affected side  should  be  packed with  cold
water, and  the patient caused  to  take  from  five to ten
drops  of the Tinct. of Veratrum Viride every half hour,
until the symptoms of the disease abate.  After which, the
following compound should be given :
     R Asclepin.......................................... gr. xx.
        Gelsemin.........................................gr. ij.
        White Sugar....................................  gr. xxx.
Triturate,  divide  into ten  powders, and give  one every
three hours.  The patient  should  drink freely of some
diuretic mucilage,  such as marshmallow or flaxseed.
   If the case be one of asthenic pleuritis,  the  emetic and 
246
PLEURITIS.
cathartic should be omitted, and hot packs applied to the
side or sides,  and the Tinct. of Aconite given to control
the inflammatory action, say from one to five  drops every
one or two hours.  Also give the following compound:
     R Asclepin..........................................  gr.  xx.
        Sanguinarin.....................................  gr.  x.
        Quinine...........................................  gr.  x.
        White  Sugar....................................  gr.  xxx.
Triturate, mix, divide into ten powders, and give one every
two or three hours.   If the disease is  not subdued, the
following compound  may be given :

     R Eupatorin...................................... gr. xx.
        Sanguinarin..................................... gr. x.
        Apocynin........................................ gr. x.
        White  Sugar....................................gr.  xxx.
Triturate, mix,  divide  into ten powders, and  give one
every three hours.  If there should be extensive effusion,
     R Syrup  of Marshmallow........................ 3jiij.
        Ipdide  of Potassium............................gr. xxx.
Mix, and give' one  teaspoonful four or five times a day.
Where there  is much debility, beef tea, wine, porter,  in
connection with Iron by Hydrogen, should  be  freely given.
The surface should be thoroughly bathed,  and the patient
caused to  remain   quiet  in  bed.   If  expectoration is
difficult, small doses of  Lobelia  may  be  given three  or
four times  a  day.   Where there  is  a tendency of the
disease to  assume a chronic  form, an  irritating plaster
should be placed over the seat of the disease,  and allowed
to remain until  a free  discharge ensues.   The  patient's
strength should  be  supported by vegetable   tonics and
chalybeates. 
CHRONIC  PLEURITIS.
247
          CHRONIC  PLEURITIS.
  This disease being so well described by my colleague,
Prof.  Calkins, in his work on thoracic diseases, I shall
offer no apology for transferring it to these pages.
  "Chronic  Pleuritis,"   says  Prof.  Calkins,  "varies
greatly, both in severity and duration.   It may be acute,
in respect to the degree of suffering and the rapidity of
its progress; it  may be latent in its character, and slow
in the progress of the  successive changes attending  and
consequent upon it.   Between these extremes, the  inter-
mediate grades of morbid  action are almost innumerable.
The term chronic, then, when applied  to pleuritis, seems
to be  more of a conventional term than in respect to other
diseases.   In pleuritis, the transition of the acute  to  the
chronic  state  is so indefinite, and the symptoms  of  the
recent disease sometimes have so little of an acute  cha-
racter, while that of a long duration  occasionally  manifests
so much  greater an intensity of irritation, that the terms,
acute  and chronic, would seem  to  be less  applicable to
pleuritis  than  to  other diseases.   This difficulty arises.
from the  anatomical relations of the pleura.   Being a shut
sac, its acute inflammation is liable to be made chronic by
the retention of inflammatory products; and the chronic
is liable to be changed into the acute by the irritation of
effused fluids.
  "But, notwithstanding these difficulties, there seems
to be  no impropriety in  ascribing  to the  disease, when
highly inflammatory, and until the inflammatory symptoms
seem to arrive at an acme, the term acute.   If, after that
period, lingering fever continues, evidently excited by the
products of previous inflammatory  action, then  the term
chronic may, with as much propriety,  be applied  to  the
disease after,  as acute to the disease before the acme.   In
some  cases, however, such an acme  seems  never  to exist; 
248           CHRONIC PLEURITIS.

and to these the name sub-acute may with propriety  be
applied."
  Pathology. — The  anatomical appearances  caused  by
chronic pleuritis, are very similar to the acute form of the
disease.   Of course, the  influence  of time would tend to
produce certain modifications.
  In  general, we find  the membranes thicker, often com-
posed of several adherent  layers, the  earliest  deposit
being harder than those subsequently formed.   The cha-
racter of the liquid, too,  is subject to various changes in
the onward progress  of  the disease.   It is less limpid,
more  prone to  become turbid with flocculi of a fibrinous
character.  In  some cases, it  even appears in consistence
like jelly.   The quantity  is greater, and consequently, the
displacement of adjacent viscera is much more apparent.
Here  and there, adhesions are often  formed between the
pleura and lungs, which, in somje case's, enclose little sacs
of fluid.
   Under the best treatment, the disease, when uncompli-
cated, will generally advance to a favorable termination.
  But it often is the case, that the morbid products cannot
be  absorbed, and,  consequently, they  remain and  pass
through a series of pathological changes, sometimes ending
in gangrene. Cartilaginous lamina?, bony plates, abscesses,
tubercles, and hemorrhagic effusions, are among the succes-
sive steps in the progress of chronic pleuritis.
  " Sometimes," says Dr. Wood, "the walls of the chest
are forced inward contrary to their elasticity, so that, when
a puncture is made from without, the air rushes in to sup
ply the  vacuity produced by  their resilience.   In some
cases,  secretion  goes on as rapidly  as  absorption, and the
liquid accumulation remains for a  great  length of time.
This is especially the case in  empyema, or collection of pus
in the cavity of the pleura.   Sometimes the pus makes its
way into the substance of the lung,  and a fistulous commu- 
CHRONIC PLEURITIS.            249
nicalioi;  is formed between the bronchi  and the  pleural
cavity through which pus is discharged and air admitted.
   " In other instances the liquid takes an external direction,
and by means of ulceration escapes into the cellular tissue
without the chest, and, travelling  occasionally for a consi-
derable distance,  produces sub-cutaneous  abscesses in va-
rious  parts of the chest, which ultimately open, unless life
is previously  worn out.   In thus travelling, the  pus has
been  known  to occasion caries  of the  ribs and vertebra?.
Sometimes the purulent collection is  found to be connected
with a tuberculous vomica."
   It  is sometimes difficult to determine the causes which
change ordinary acute  pleuritis  into  the  chronic form.
Evidently, in  many cases, too much  depletion, the too fre-
quent use of  mercury, and other  articles making up the
antiphlogistic regimen, tend to  the  production of chronic
pleuritis.   Often, when a case seems to be  cured  by such
means, the impoverished state of the blood, caused by the
use of the lancet,  thus rendering the  system  more liable to
be affected by low grades of inflammation, developes a new
and unwelcome train of symptoms, admonishing the physi-
cian that the  supposed cure was, after all, delusive.
   Dr. Gallup,  defining chronic rheumatism, says that it is
acute  rheumatism half cured.   So,  it  may  be  said with
equal  propriety, that chronic pleuritis  is the acute variety
half cured.
  Diagnosis. — The  general  inflammatory  symptoms  of
acute  pleuritis may gradually disappear ; but, unless the
morbid products of the diseased  action are removed from
the pleural sac, the fever will recur,  and change its type,
now very closely resembling hectic,  now becoming identical
with it.   This recurring fever is one of the most  trouble-
some and  alarming symptoms of chronic  pleuritis; for in
other  respects the patient does not suffer in  proportion  to
the extent or duration of the effusion.
       22 
250
CHRONIC  PLEURITIS.
   Dr. Gerhard observes: "I once saw a patient who had
performed the full  duties of a sailor, going aloft with an
enormous pleuritic  effusion.   When he returned from sea,
it amounted to two or three  gallons.  This is an  excep-
tional case; but it is very common  to find  patients who
can perform many  laborious occupations without much in-
convenience.   This is generally the case if the dyspnoea is
not severe; and we find that some patients  complain of
little difficulty of breathing, with an extent of pectoral dis-
ease, which will give rise to great  distress in other  indi-
 viduals.  The symptoms which  so  frequently characterize
 chronic organic diseases, are extremely variable in this va-
 riety of pleurisy.   These are emaciation, loss of the firm-
 ness of the muscles, harshness and dryness of the skin, and
 slight oedema of the legs.   Sometimes they are nearly as
 well marked as in tuberculous disease of the lungs; — in
 other cases they are very slight; hence they constitute a
 diagnostic  sign of the disease ; and if  we find them well
 characterized, we will  do  right  to  regard the case as one
 probably complicated with tubercles.  If our impression
 be erroneous, we will soon rectify it as the symptoms will
 gradually become  more decided in  the latter case,  and
 slowly disappear if the pleurisy be  followed by recovery."
   The diagnosis of chronic pleuritis, without the aid of
 the physical signs, is often very difficult.*   Its  general
-symptoms  simulate those  of phthisis.   But the physical
 signs are far more reliable. When  these are present, there
 is no difficulty in ascertaining the true character of the dis-
ease.   If it is complicated with tuberculous deposition, the
case should be regarded with much anxiety : for the diag-
 nosis then becomes much more obscure, and the prognosis
more "unfavorable."
* See Empyema. 
CHRONIC  PLEURITIS.
251
                     PROGNOSIS.
   The prognosis of this  disease depends much upon the
extent of the effusion, the condition of the constitution, and
the tendency to hereditary disease.   Also, upon  the  skill
with which the disease is treated.   If the integrity of the
constitution is not too much impaired, and there is not a
marked tuberculous tendency, under a judicious treatment
our prognosis will be favorable.

                     TREATMENT.
   The treatment of this disease depends upon the  constitu-
tion of the patient.  If there is still an inflammatory pro-
cess going on, Aconite,  in connection with Veratrum and
Gelsemin, should be used until it  is controlled.   As for
instance, if the  skin  is hot and dry, the  pulse quick, the
urine scanty,  with more  or  less  dyspnoea,  and  alternate
pyrexia, the following compound may be given :
      R Gelsemin..........................................gr-j-
        Qninine............................................ gr. xx.
        Asclepin........................................... gr. x
        White Sugar ..................................... gr. xxx.
Mix, triturate, divide into ten powders, and give one every
two or three hours until  all are taken.
   If the symptoms should not subside under tnis  prescrip-
tion,  the irritating plaster should  be  applied  over the
entire surface* of the affected side,  and a thorough spirit-
sweat be given ;  after which, the following mixture :
      R Syrup  of Tolu................................... -fiij.
          "     Sanguinarin.......................... ^ij.
          "     Iodide of Iron.......................^ij.
Mix,  dose one teaspoonful every three hours.
   If there are febrile symptoms, from one to three drops
of the Tct. of Aconite should be given  every three hours,
in connection with the above mixture. 
252
CHRONIC  PLEURITIS.
  The diet should be nutritious  and stimulating, and if
there is much debility, a small quantity of Porter or Scotch
Ale should be  taken four or five times a day.   If there is
much effusion,  an attempt should  be made to produce ab-
sorption by the following mixture :
     R Syrup of Iodide of Potassium................. £j.
           "   Apocynin................................ .^ij.
           "   Stillingia............................... 3'ij.
Mix, dose one teaspoonful three  or four times a day.  At
the same time  drink freely three times a day of a  tea made
of equal parts  of Eupatorium, Purpureum and Pipsissewa.
 If the strength of the patient will bear it,  one eighth of a
 grain  of Phytolaccin and five grains of Cream of  Tartar
 should be given.
   The irritating plaster should not be removed until a free
 discharge  ensues, which should be maintained by the
 occasional use of the vegetable caustic,  and a constant
 application  of slippery elm  poultice.  If the absorbents
 should prove  too debilitating to the patient, they should
 be discontinued for a few days, and the following tonic be
 given  :
      R Hydrastin....................................... gr. x.
         Phosphate of Iron............................. gr. xx.
         Prunin........................................... gr. x.
         White Sugar.................................... gr. xxx.
 Mix, triturate, and divide into ten powders, and give one
 every three hours.
   If  there  are   periodical  symptoms  in  connection with
 debility, and  the  above  prescription  should fail  to give
 relief, five drops  of the muriated Tct. of Iron, and two grains
 of Quinine, should  be given four times a  day.   Also a
 liberal supply of beef tea, prepared as directed in  treat-
 ment  of Typhoid Fever.   After recruiting the patient's
 strength for some days, the diuretics and absorbents should
 again be resumed, and persisted  in for  the purpose of pro- 
EMPYEMA.                  253
ducing absorption of the effused fluid.  If the above treat-
ment should  prove  unsuccessful, and  the Empyema likely
to prove  disastrous  to the  patient, the  operation  of
Paracentesis  Thoracis should be  performed as  directed
under the head of Empyema.
                    EMPYEMA
   Is a collection of fluid  in  some part of the body,  par-
ticularly in that of the pleura.  It consists mostly  of a
purulent, sero-purulent or  serous fluid, within the cavity of
the pleura, and is dependent upon chronic pleurisy.  When
inflammation attacks a serous or diaphanous membrane, it
loses its transparency, becoming dull, and in some instances
dry.  These changes  may be observed not  only  in the
Pleura, Pericardium and Peritoneum, but in the arachnoid
membrane, in which it is distinct when  other traces of
inflammation cannot be recognized.  At the  same time,
red vessels appear  in isolated spots over  a considerable
extent.   They are arborescent, and consist of minute  red
lines radiating from star-like points.  These vessels, though
placed in the substance of the membrane,  gradually  ap-
proach the surface as the process advances.  They are not
newly developed, but are the colorless capillaries  of the
sound part, injected with red blood.  After existing for a
longer or shorter time, these changes are succeeded by
others, which are regarded as their  effects.   The first and
most important of these is, the formation of a new fluid at
the free and inadherent surface of the membrane.
  The nature of the fluid  varies according to the stage of
the inflammation.   In the  commencement of the inflamma-
tion, the capillaries begin to deposit  a serai-transparent
fluid, in small quantities, which becomes more abundant as
the disease advances.  It is  straw-colored, of a homoge-
                         22* 
254
EMPYEMA.
neous character, and, as it is effused,  undergoes sponta-
neous coagulation.  This  consists  in  part of  the  fluid
attaining  a solid form  like  a jelly in  layers  of variable
thickness,  with  a honey-comb  surface, and thready  fila-
ments coalescing and quite consistent.   A  small  quantity
of a thin fluid is found in the interstices of these filaments,
oozing from the surface of the coagulated part, and lodging
in the most dependent part of  the cavity.  This process
may continue until a large amount of fluid is accumulated,
or the entire product of the  inflamed surface may be defi-
cient in albumen,  producing an extensive accumulation of
sero-purulent fluid.
   Baillie  and other observers  state "that  this  fluid has
been supposed to be derived immediately from the blood;
but that this is  not correct, as it is the serous or watery
portion  of the morbid  exudations,  from the  surface and
interstices of which it may be seen trickling.
   The red or brown tint is derived from the blood issuing
from the newly-formed  capillaries.  Shreds of lymph  are
found floating in  it when  the accumulation occurs  in  the
pleural cavity.   The sero-purulent is often connected with
albuminous  fluid, from which  it is  separated  during the
process  of coagulation.   It consists  mostly of serous fluid,
with minute granules of albuminous matter, which precipi-
tate to  the  bottom, leaving a chalk-like liquid, which con-
 stitutes  the  majority of the effused fluid in the cavity.   In
this fluid may be seen small particles of lymph afloat.  The
pnriform fluid of serous membranes consists of serous fluid
with small granules of opaque matter, not coagulable, and
is considered as an abortive effort to produce albuminous
exudation.   The puriform  deposit  mostly occurs  in the
 peritoneum.   It is a white or cream-colored opaque fluid.
 [t occurs  mostly in chronic pleurisy and peritonitis.  It has
been supposed that genuine purulent matter was not formed
 unless there had been previous  ulceration of the part.  But 
EMPYEMA.
255
the researches of Baillie, Black,  Hunter, and Millin,  have
amply shown that purulent fluid  may either be secreted by
the inflamed membrane,  or from the  organized  layers  of
lymph, or from both.  In  the first, the  fluid is secreted
directly from the capillaries of the inflamed membrane.  In
the second,  it is  derived from  the organized false mem-
branes which take on the suppurative action.  In the third,
both sets of vessels are concerned.

                     SYMPTOMS.
   The patient either lies on his back diagonally, or on the
diseased side with the  head  slightly  bent forward.  The
voice is weak, and there is a persistent cough, with more
or  less expectoration of mucus  or  muco-purulent matter.
The face is buffy, and semi-transparent; the lips  tumid and
livid.  The pulse is habitually quick and small, and febrile
attacks are frequent, and often connected with chills.   In
recent empyema, the diagnosis may be confounded with that
of pneumonic solidification.   But in  empyema,  vocal fre-
mitus disappears.  In hepatization  of the lung, it is main-
tained, and frequently above the average of health.
   In empyema there is no crepitant rhonchus, nor is there
true tubular sniffling,  metallic respiration ; vocal  resonance
is well or weakly bronchophonic. There is dulness on per-
cussion over the entire  pleural sac, and not unfrequently
effusion becomes so extensive as to force the lung towards
the mediastinum and  spine, compressing it in so  small a
bulk that it appears to  be  destroyed.  Its vessels  are
crushed together;  its bronchial tubes and vessels  closed,
and the whole organ is rendered unfit for respiration.
Unless much care is taken in  diagnosis, this condition will
lie mistaken for atrophy of the lungs.   In other  cases the
heart and mediastinum are carried over to the right  side
and the heart will be found beating on the right side of the
sternum between the third and fourth  ribs. 
256                  EMPYEMA.
  A case of this kind occurred in my practice, where the
effusion,  following latent pleuritis, was so extensive that it
not only carried the lung  forward and  backward towards
the mediastinum, and against the spine, compressing it so
completely,  as to  prevent the  ingress of air; but, the
heart and mediastinum were carried forward, and beneath
the sternum, so as to encroach materially upon  the  right
lung.  In this case, the symptoms  at  first were those  of
latent pleuritis, followed  by  a persistent cough,  with
expectoration of muco-purulent fluid, great dyspnoea, and
inability to  lie on the affected side.   There was great dul-
ness on percussion, which extended  an  inch over the right
of the sternum.
   The only physical signs which were diagnostic of the
disease, were the absence of respiratory murmur on the left
side, and the deviation of the area of dulness upon percus-
sion ; on changing  the position of  the patient, the dysp-
noea and the increased diameter of the left half of the
chest,  which was three and one-half inches greater than
the right.   In this case, absorbents,  diuretics,  and tonics,
only gave temporary relief.  And  in  the  course of two
and one half years, an opening made  its  appearance in
the base of the pleura and diaphragm, where it had  previ-
ously become attached, and the  fluid made its escape into
the  cavity  of the  abdomen,  producing  peritonitis and
death.   The patient refused to submit to the operation of
Paracentesis.   Dr. Hughes reports  a case of thoracic dis-
ease,  where the  patient became much debilitated, with
quick pulse, dyspnoea, and every physical sign of effusion
into the right pleura.  There was no bulging of the inter-
costal  space ; but a flat  fluctuating tumor was observed,
which dilated upon coughing.   A small trochar was intro-
duced, and  twenty-four  ounces of turbid serum  were
drawn off.   Iodide  of  Potassium and  Sarsaparilla were
taken, which afforded partial relief,—yet, he states that he 
EMPYEMA.
257
operated again, in two  weeks, and drew  off  thirty-six
ounces more.   No inconvenience followed, and the patient
appeared much improved.   Some two months afterward,
the tapping was  again repeated,  and  twelve ounces of
fluid were drawn off.  In two months more his health ap-
peared good ; but there seeming to be an increase of fluid,
tapping was  again performed, and thirty-six ounces of
fluid evacuated.   He was tapped  again on the eighteenth
and  twenty-sixth  of November successively, which  was
also  again performed  on the  twenty-first of December.
Finding that repetition of the operation must still be con-
tinued,  the  patient learned  to perform  it  himself,  and
actually did  so twice.   The prognosis was  subsequently
favorable, and  after fifteen  tappings his  restoration  was
complete.
                   TREATMENT.
   The first efforts of the physician should be to  produce
absorption, which can  be accomplished, in most  cases,
where the walls of the sac are in a normal condition.  But,
unfortunately, in many  instances the albuminous exudation
forms a complete  false membrane to  the internal walls of
the sac, which entirely precludes the action of the absorb-
ents  upon the effused fluid.   In this event but  little can
be expected from the  use of  remedies, until the fluid  is
evacuated by means of the trochar.
   The operation  of Paracentesis Thoracis is performed  in
this  manner.   The patient should be propped up in  bed,
and inclined a little to the sound side, so as to separate the
ribs,  as much as possible, on the diseased side.   The skin
is to be divided to the  extent  of one and a half  inches,  in
a direction parallel with the superior edge of the lower rib,
on the intercostal space that is selected for the  puncture.
After dividing the superficial  fascia, and any portion  of a
muscle  of the  chest that may intervene, as well as the
external and internal intercostal muscles, the pleura will 
258
EMPYEMA.
be seen to bulge into the wound.   After being distinctly
felt by the finger, so as to establish the fact that only fluid
is  behind it, a trochar, armed with a  canula, should be
introduced through the sac ;  the  trochar should be with-
drawn, and the canula allowed to remain until the fluid is
discharged.  Or the pleura may be punctured by means of
a sharp-pointed bistoury.  On making an incision through
the integument, the skin should be drawn up from an inch
to an inch and a half above the intercostal space intended
for the internal  opening, so  that after the  evacuation of
fluid, the integument, by passing down over the internal
wound, may exclude  the air from  the pleural cavity, which
is one of the most essential conditions  to be observed  in
this operation.
   If there is a probability that the fluid may be absorbed,
an attempt should be made, by the use  of the following:
      R Corydalin......................................... gr. x.
        Phytolaccin........................................ gr. ij.
        Iodide of Potassium.............................gr. xxx.
        Syrup of Marshmallow......................... ^iij.
Triturate, and mix well  together;  give from one half to
one dram three times a day.
   At  the same  time apply  the  irritating plaster to  the
affected side, until a free discharge ensues.
   The strength of the patient should be maintained by the
use of porter, wine,  beef tea, and such articles of food as
are easy of digestion.  When the above remedy has been
used for two or three weeks, a change may be made  to the
following:
      R Quinine.......................................... gr. xx.
        Digitalin......................................... gr. ij.
        Bitartrate of Potassa........................ 31J.
        Syrup of Stillingia and Syrup of Iodide
          of Iron....................................... aa gij.
Mix,  and give  one  half teaspoonful  three  times  a day.
A 
PHTHISIS.                   259
The  skin should be thoroughly bathed in lye water two or
three  times  a week, and every effort should be  made to
preserve the patient's strength.
  If,  after the above treatment, and such  other  remedies
as seem to  be  indicated, the patient is  not materially
relieved, tapping should be resorted to at  once.   In per-
forming this  operation, much care is required  to prevent
the ingress  of air into the  cavity  of  the  chest.   Other-
wise  empyema would be  removed only by substituting
emphysema.  After the operation, a general diuretic, altera-
tive,  and tonic treatment  should be pursued, for the pur-
pose  of  preventing a re-accumulation of  the fluid.   If
empyema is  connected with organic disease of the lungs,
or  general  tuberculosis,  much  relief may be  obtained
from  the operation of Paracentesis.  Although it may not
effect  a cure,  still  it  will  very materially assist  your
constitutional treatment.
                  PHTHISIS.*
  " The  essential character of  pulmonary consumption
consists in the  deposit of tubercles in the  tissues  of the
lungs.   This deposit may  begin  with local mischief,  or
may evidently be the sequel of  constitutional disorder.
In both varieties  the general disease  is present, although
it may exist in a latent form.  Of this the formation  of
tuberculous  matter is a proof.   It is  evident, however,
that the presence of tubercles does  not  alone constitute
the disease.   One step back, along the chain of causation,
is  a morbid condition,  of which tubercles  are  but  the
effect.  This morbid  condition, whatever is its nature, may
exist a long time before  the formation of tubercle begins.
* Newton and Calkins. 
260
PHTHISIS.
That a change takes place in the blood, which causes or
precedes the deposit and development of tubercles, is well
established.  The  corpuscles are  diminished,  and the
albumen increased in quantity. The fibrin is below, rather
than above the  normal  amount, and, it  may be  inferred,
that it  is also defective in its nature.   Eisner, and some
other analysts, have found the fatty principles diminished.
  Dr. Fricke's  analyses  indicate  an increase  above the
standard of  health,  in  the lime,  and  a decrease in the
phosphates;  while  l'Heritier states, that in scrofula, the
earthy salts  are diminished.   Hence,  the blood may be
stated generally to be degraded in quality, and  endowed
with a low degree of vitality.  Whether these be the real
changes in the blood is not certainly determined.  Physio-
logists  and pathologists are not  fully  agreed as to the
nature of all  the changes which  the  blood undergoes in
the  scrofulous diathesis.   Andral  showed that in phthisis
pulmonalis, the  fibrin was augmented.   The probability
is, that this increase  of fibrin is most frequent, when  inter-
current pneumonitis  is associated with tubercular disease
To  attain to accuracy in this matter is very difficult, on
account of the  variable state of the  blood,  arising from
exercise, diet, time of the day, and other changing circum-
stances.
   The  conclusions to which we may logically come, are
the  following:   1. That from  the earliest invasion, the
sum of  the  vital force  is either  below the standard of
health,  or it is relatively low as respects  the structure and
organization of the  individual.   2.  That this diminution
in the sum of the vital force, is dependent on the imperfect
blastema of the diseased  blood, causing  perversion of the
tissues.   3. That as  tuberculosis advances, the sum  of the
vital force for  the whole system, continues to  diminish.
4. That the nutritive powers of the blood, as respects the
nervous  tissue,  frequently  remains  undiminished;  this 
PHTHISIS.                   261
tissue not requiring for its nutrition, compound principles
identical with it to be introduced into the blood with  the
food,  and having a nutrition  peculiar to itself, differing
from  that of the cellular  and muscular structures.   The
fatal disease tuberculosis may be traced to a primary error
or defect  in  the  blood-making process.  Vitiated air, or
air stagnating  or insufficiently renewed within the chest;
and probably other  anti-hygienic influences,  as a vitiated
or  defective  diet, acting singly,  coetaneously, or  as re-
spects each  other, ancillary, produces  slowly under  ordi-
nary circumstances, but  occasionally with  great rapidity,
some unknown change  in a portion of  the  proteiniform
principle of  recently formed  liquor sanguinis; this change
may consist  in hyper-oxydation; but whether so  or not,
it deteriorates its properties,  rendering it, more or less,
altogether unsuitable as a material for organization.
   At the same time, the oily  principle of nutrition  circu-
lating with  a diminished number of real corpuscles, is in
part converted into a fatty substance of a lower degree of
oxydation.   These modified proteiniform  and oleaginous
principles are exuded in the  blastema, and are either  em-
ployed in the assimilating processes, deranging the  nutri-
tion of the organic structures, and giving  the tuberculous
or scrofulous character to various pathological processes;
or, in the more advanced stages of the morbid process,
they  are  deposited in  particular tissues,  and accumulate
generally in  the  form of tubercle, but  sometimes both as
tubercle and morbid fat, substances for the most part inca-
pable of organization.
   In the present state  of pathological science, confining
ourselves to  its legitimate object,  the study of phenomena,
apart from any metaphysical views of final causes relative
to the powers  of nature, this appears to be the most accu-
rate definition  that can be give'n  of  the most essential na-
ture of tuberculosis.—(Dr. Ancell.)
        23 
262
PHTHISIS.
  But in what manner does tne deposit take place ?   We
possess sufficient evidence that it is derived from the blood ;
that it transudes from the capillary vessels of the part in
which we find it; and that after being deposited, it is liable
to undergo certain further changes.   On the  examination
of incipient  tubercular deposit,  we may always note that
there is congestion in the tissues  immediately surrounding
it.  In the pia mater of  the sylvian fissure, we see an in-
creased redness,  in  which a few vessels are more  promi-
nent than usual;  in the pulmonary parenchyma we may
especially, by the use of the microscope, discover the en-
gorgement of the interlobular capillaries investing the -air-
vesicle into which the tubercle is being secreted.   In the
mucous membrane of the intestines  we  see  the  exquisite
arborescent arrangement of the  congested vessels, tending
from  the  mesenteric attachment  to  the point where we
observe the  deposit, shining  through the mucous surface
from  the  submucous tissue, where it has  collected.  The
first elimination of the morbid  products acts like a mag-
netic point of attraction, and  generally serves as a centre
around which the deposit progressively enlarges by eccen-
tric deposition.
   Tubercles  exist in various  forms ; in fine  points, grey
and yellow  granulations, miliary tubercles, and  grey or
yellow tubercular masses, softened and cretaceous.  Each
of these modifications requires a more particular notice.
   1.  Pulmonary Granulations— Grey Granulations —
Miliary Tubercles.—These various names have been used
by authors  to describe round, small, translucent, shining,
homogeneous bodies, often not larger than a millet-seed,
but varying from this to the size of a pea, which appears
to be the primitive state of tubercles.  Usually they are
of a greyish, but often they are of a reddish or of a brown-
ish color, and in some cases they  are nearly  colorless.
Sometimes they are  isolated, sometimes clustered in small 
PHTHISIS.
263
 bunches, or in aggregate masses.   In the latter state they
 are most  often found  in  the upper  portion of the lung.
 But in the isolated  form they are  scattered sometimes
 thickly through the whole or greater portion of the pulmo-
 nary tissue ; not unfrequently they are found situated be-
 neath the pleura, producing  an irregularity perceptible to
 the touch.   This is more often  the case  in children  than
 adults.
   2.  Grey Tubercular Infiltration.—Laennec  defines this
 as the same kind of matter which forms the granules above
 described, deposited in the cellular tissue of the lungs in
 irregular masses, sometimes one, two, or even three inches
 in cubic dimensions without definite boundaries, or limited
 only by the extent of the lobules.  It is hard, homogeneous,
 translucent, and of a greyish  color,  sometimes darkened by
 the black matter of the  lungs, portions of  which become
 enveloped  in  the masses  as they  are formed.  In some
 cases no traces of pulmonary tissue  can be detected in  the
 masses ; in others they present remains of blood-vessels,
 bronchial tubes,  and cellular  membrane ;  and occasionally
 they are partially penetrated by the  air in respiration.
   3. Crude Tubercle  and Yellow  Tuberculous  Infiltra-
 tion. — The grey translucent matter  constituting the  first
 two deposits above noticed, appears to undergo a gradual
 conversion into what has usually been considered the  pro-
 per tuberculous  substance.   In  the miliary granulations,      *
 the transformation  commences in a small yellowish, white
 spot, which most commonly appears at or near  the centre,
 and  gradually enlarges until the whole granule assumes
 that character.
  In  this  altered state,  the  little  bodies  are now called
crude tubercles.  In the aggregated  granules, the change
commences at several points,  each probably answering to a
distinct granule, and considerable masses of yellow opaque 
264
PHTHISIS.
matter result from the extension and ultimate  coalescence
of these central spots.
  The same transformation takes place in the infiltrated
translucent matter, beginning in like manner with isolated
opaque spots, and spreading until  it involves the whole
deposit, which, when thus  altered,  receives the name of
yellow tuberculous infiltration. This may be distinguished
from  the  crude tubercle by an irregular and  angular, in-
stead  of  roundish form,  and by a less  regular  line of
division between it and the pulmonary tissue.  There is no
doubt that both the  crude tubercle and yellow infiltration
are often originally  deposited in this state,  without the
preliminary formation of the translucent matter.
   The next important change in tubercle is that of soften-
ing.   This, in many  authors, is said to begin in the centre,
and to gradually advance to the circumference.  Concern-
ing the truth of this, there is, however,  some doubt.  The
reasons as given by Mr. Carswell upon which such a doubt
is based,  are the following: —Tubercular matter, accord-
ing to his theory, is  contained in the air-cells  and  bronchi.
If, therefore, this morbid product is confined to the surface
of either, or has accumulated to such a degree as to  leave
only  a limited central portion of their cavities unoccupied,
it is  obvious that when they are divided  transversely, the
following appearances will be observed : — 1. A bronchial
tube will resemble a tubercle having a central depression,
 or soft central point, in consequence of the  centre of the
bronchus not being,  or never having been occupied by the
tuberculous matter, and of its containing at the same time
a small quantity of mucus or other secreted fluids:—2. The
air-cells will exhibit a number of similar appearances, or
rings of tuberculous  matter joined together, and containing
in their centres a quantity of the  same kind of fluids.
When the  bronchi  or air-cells are  completely  filled with
tuberculous matter, no such appearances  as those we have 
PHTHISIS.
205
just described are observed,  and hence  the reason why
tubercle, in such circumstances, has been said to be still in
a state of crudity, or in that state which is believed  to
precede the softening process.
  As the softening process advances, the whole tubercle
becomes converted into a soft, pultaceous, yellowish mass,
in appearance resembling pus.  The infiltrated mass, like-
wise, undergoes a  similar change.  Sometimes the  entire
tuberculous deposit seems throughout its whole mass,  to
become suddenly softened, and, in this manner, large por-
tions of the lung are  quickly destroyed.   The pressure  of
the growing tubercle upon the circumjacent  lung, at first
makes it less vascular ; but reaction at length takes place,
inflammation  succeeds,  and  congestion, ulceration and
suppuration follow.   In  some cases the tubercular disease
passes through its various stages without giving rise  to
marked inflammation.  In the majority of cases, however,
the bronchi, air-cells and cellular tissue,  are more or less
affected  by the inflammatory process.   The  succeeding
ulceration  gives rise to  the formation of cavities.  Fre-
quently one large vomica is made up  of several smaller
ones, which,  in the parietes  of  the  large  cavity,  make
excavations of irregular shape,  now winding  and now
crossed by bands of tissue.  The  size of the  cavity varies
from that of a pea to that  of an orange.  Its contents
consist  of a mixture of  pus and  bloody matter,  and por-
tions of pulmonary tissue.  Sometimes they are inodorous,
sometimes fetid.  In children the  vomica? are  less common
than in  adults.   As  the disease advances, a false  mem-
brane begins  to form around the decaying tubercle, at first
thin  and delicate,  and in appearance resembling mucous
membrane.   Large abscesses are  sometimes seen, between
which and the bronchi there is no communication.
  Cicatrization of Tuberculous  Cavities. — That  this  ii
not a very rare occurrence, Laennec  proved in his earh 
266
PHTH ISIS.
researches  into  the termination of  tuberculous disease.
Indeed, from this we learn that phthisis sometimes termi-
nates favorably.  This happens when the deposit is limited
in extent.
   But, sometimes at the apex of the lung, we find an old
adhesion, sometimes a crust of fibro-cartilaginous deposit,
or even a fibrous band  passing  from  the lung to the ribs.
Adjacent to this pathological change, the lung is puckered
and drawn inward.   To the  touch, it feels firm and con-
solidated ;  to the eye, it appears dark,  from  an abundant
deposit of black pigment.   On making an incision,  we
find a cavity lined by grey fibrous membrane, semi-trans-
parent, or thick, whitish,  and fibro-cartilaginous, or soft
and pliable,  like the mucous membrane.
   [In the winter  of 1855, my colleague, Prof. Hollera-
back, and  myself,  made a post-mortem examination of a
female, who  had been laboring under phthisis for the last
twelve years.  In her case the right lung had been entirely
destroyed,  save  a  very  small  portion, just below bifurca-
tion of the bronchi, which was completely  injected with
tuberculous matter.  This portion was  about the size of a
lien's egg, and  completely impervious  to air.   A fibrous
band passed from  this  bunch to the  lower portion of  the
pulmonary cavity,  and was attached to the pleura costalis.
The cavity was filled  with sero-purulent fluid ; but  the
woman had  enjoyed a  respite from the urgent  symptoms
of the disease, save periodical  attacks of dyspnoea, in one
of which she died.— The Author.'}
   Adhesions are almost always present in  phthisis   In
112 cases examined by  Louis, there was only one in which
no adhesion  was found.  To some extent,  their location
corresponds to that of tubercles.  In  rare cases, the entire
surface  of  the lung is bound down to  the costal pleura,
and to that of the  diaphragm.  These  have  the effect to
prevent pneumothorax.   The trachea  and bronchial tubes 
PHTHISIS.
267
often are the seat of  extensive lesion.   Those  are most
often affected which form a way of exit to vomica?.   Their
posterior, more often than their anterior, internal surfaces
are affected.   The larynx and. epiglottis, are sometimes
the location of tuberculous disease.  Among other lesions
attending phthisis,  are partial emphysema of the lung,
dilatation of the bronchi, and enlargement of the bronchial
glands.   This latter  effect is most common in children.
  Appearances in other parts of the body.—The  origin
of tubercles being in the blood, their distribution through-
out the entire system is a necessary result.   But according
to Louis, this general  law is established, that when tuber-
culous deposit exists in other organs, it always exists in
the lungs. " The converse, of this, is far  from being true ;
and the  law  itself  is  occasionally subject to exceptions,
the  occurrence  of  which  is  most frequent  in  children.
Without the  lungs,  the tuberculous depositions  are most
often composed  of the yellow  opaque tubercle.   Grey
granulations  or miliary tubercles, have also been observed
in various parts  of the body.   From  some form  of tu-
bercle, scarcely an  organ  of  the body is  wholly exempt.
They are found in the  liver, intestines, mesentery, prostate
gland, testicles, heart, bladder, uterus, spleen,  and kid-
neys, and in  the membranes and substances of the brain,
It was the conclusion  of Louis, that, of all the cases of
tubercles,  occurring in persons  over the  age  of fifteen
years, one-third had them in the small intestines, one fourth
in the mesenteric glands, one-ninth in the large  intestines,
one-tenth in  the cervical glands, one-twelfth in the lumbar
glands, and  one-fourteenth in the spleen.   The stomach
becomes larger than natural,  more thin, and  is  subject to
chronic inflammation of its mucous surface.  The  glands
of Peyer — those  near the ccecum — become the  seat of
tubercles.  The  mucous glands of the small   intestines,
sometimes ulcerate,  causing perforation, and the  admission 
268
PHTHISIS.
of the fa?cal secretions into the cavities of the  peritoneum.
A similar diseased state of the  large  intestines sometimes
occurs.   The  mesenteric  glands  are  very much enlarged.
In the brain, tubercular deposition  gives rise  to  hydroce-
phalus.

    GENERAL  SYMPTOMS  AND  COURSE OF  PHTHISIS.
   Since  the discovery of the physical signs  by Laennec,
the tendency  of  some  minds has  been to  disregard  the
general symptoms in the formation of a diagnosis.  Among
such, an unnecessary  delay is often caused in  the applica-
tion of remedial agents; for the general symptoms very
frequently are the first indications of  approaching disease.
A diagnosis should not  then be wholly dependent upon
the physical signs in  the first stage ;  for these are seldom
manifest,  until the disease has  so  far  progressed  as to
make a prognosis unfavorable.   Certain general symptoms
are grouped together, and said to  be  indicative  of  the
scrofulous diathesis, or tuberculous cachexia,   What
this condition of the system  is, or what its  influence, in
the development of phthisis, it may be difficult to accu-
rately  ascertain ; and yet the  description of some of its
more important  symptoms, may be of utility in detecting
that first pathological change in which phthisis begins.
   Among the more important symptoms are, a pale, pasty
appearance of the countenance, large upper lip aud aloe-
nasi.  In persons of dark complexion, the skin is sallow ;
in those of fair complexion  it is unnaturally white, resem-
bling blanched wax  rather than a  healthy  countenance.
The veins are  large and conspicuous,  the pupils of the eyes
are large, eyelashes  long, with a fair, florid  complexion.
In persons of  a bilious temperament the skin  is coarse, its
color dingy.   The form of the body is often  destitute of
symmetry.  The trunk is  small,  the  head large, abdomen
tumid, limbs unshapely, the growth of the body is irregular, 
PHTHISIS.                   269
the functions of nutrition  are  feeble and deranged.  The
intellect is often very active; there is  great sensibility to
impressions and acuteness of mind.
   Stages.  •— For  convenience  in description, phthisis  has
been divided into three stages.  Between these no  line of
demarkation  is accurately drawn.   The first stage begins
with the onset of the disease, and ends when the softening
of the tubercle has commenced.
   General Symptoms.—The  pulse is accelerated, espe-
cially after eating, towards evening, or by slight  exercise.
A burning sensation is felt in the palms of the hands  and
soles of  the feet.  Towards  evening   a  slight  chilliness
comes on;  towards  morning, perspiration supervenes.
The febrile paroxysm  is sometimes very slight, scarcely
attracting notice;  sometimes severe,  causing unpleasant
sensations, and exciting  alarm.   Sleep ceases to refresh,
food to give strength and vigor. The aspect of the  patient
chauges;  the countenance is pale, expressive of languor, or
red with  the hectic flush.  The skin  is less elastic; the
muscles less firm ;  menstruation is tardy or entirely want-
ing ; emaciation becomes  evident.  If these symptoms have
appeared  in the spring-time, by the use of proper  remedies, ,
and regimen, they  are almost entirely removed, until the
returning  autumn and winter bring them on with increasing
severity.    Occasionally they seem  to arise from bronchitis,
pleuritis,  pneumonitis, or some  febrile disease.   When
they succeed to measles  or scarlet fever, they frequently
progress with unbounded rapidity.   The  rational symp-
toms are subject to much  variation.   In most cases, how-
ever, a short, dry cough is one of the  first  symptoms  that
excites alarm.   Often very slight, a mere hacking in the
morning,  it steadily increases, and at length is  accompa-
nied with a frothy expectoration of transparent mucus, and
afterwards  of  yellow,  opaque  matter.  Slight  dyspnoea
occurs when the patient exorcists.  About the sides and 
270
PHTHISIS.
shoulders there are  fugitive  pains.   Slight hemorrhage
from the lungs  occurs;  at times it may be somewhat co-
pious,  but often in small quantity.   As the disease pro-
gresses, the  cough increases, preventing sleep, and  some-
times occurring in paroxysms.   The expectoration is cor-
respondingly increased, becoming  thicker,  more yellowish,
or greenish  and purulent.   The other symptoms usually
advance with equal pace.   Sometimes the disease is very
insidious in  its  approach.   Suddenly, without any premo-
nition, a violent attack of ha?moptysis occurs, immediately
succeeded by  all  the appearances of confirmed phthisis.
These  rational  symptoms are intimately connected with the
tubercular deposition.  The tubercles are in a state of cru-
dity.  Softening has not yet commenced.  They are in the
form of small,  roundish, homogeneous bodies, collected in
clusters, or  more  widely disseminated through the lungs
in the  form  of miliary tubercles. Sometimes they are mors
or less firm, of a greyish color, or translucent.
   Physical Signs. —In the nascent state of phthisis, we
cannot derive positive information from physical  explora-
tion.   In order to produce  abnormal sounds on percussion
and auscultation,  the deposit of tubercles must be conside-
rable ;  or there must be in some one  part of the lungs, be
it ever so limited, a deposit sufficiently great  to  interfere
with the pulmonary functions.
   If the tubercles are  small and scattered, the  physical
signs will not be«so sure to  detect  the morbid changes.  If,
on the contrary,  they are  large  and  clustered together,
abnormal sounds are more readily developed ;  so that it is
evident that the physical signs cannot determine the accu-
rate amount of tuberculous deposition;  since the arrange-
ment of tubercles, as well as  their number,  has a modify-
ing influence.   Shall we therefore conclude that the phy-
sical signs are  of no practical utility?   As well  might we
deny the usefulness of the  telescope, because it does not 
PHTHISIS.                  271
reveal all the minute phenomena of the heavens.   Because
no one of the physical signs is absolutely pathognomic, we
should not conclude that their evidence, added  to  that
afforded by the general symptoms, is not of great value.
These  signs,  found at the point most subject to tubercular
disease, the comparative rarity of any other lesions  capable
of producing the same  physical  phenomena, enable us  to
arrive at a degree  of probability which is  almost  equiva-
lent to certainty.   The existence of the  twofold evidence
given by  the  general  symptoms and the  physical signs,
makes the diagnosis far more  sure than  it  could be when
founded only on one class of symptoms.
   Inspection  is  often  a valuable means  of diagnosis.
Prominence of the clavicles,  contraction of the intercostal
spaces, a flatness of the  chest in front, an unequal height
of the shoulders, a depression of the ribs,—all these, when
present in a tuberculous  patient, indicate the  presence  of
phthisis.
   Percussion is usually somewhat dull under the clavicles.
An inequality in its degree on opposite sides of the chest,
and  at points  equally  distant from the  median line,  adds
much more significance to this physical sign, and especially
if the dulness is greater  on the  left side.   In emphysema
and  pneumo-thorax a  similar  inequality of  sound  may
exist.
   In these instances the diseased side is most sonorous;
but the respiration is  most feeble where the  resonance is
greatest, a circumstance  which distinguishes this condition
from phthisis.  An emphysematous condition of the lung
occurring adjacent to  the  location of  solidification  from
tubercles, may cause the percussion to remain  nearly nor-
mal.   Were  this coincidence  common, it  would  certainly
diminish the value of percussion in diagnosis.  But it is of
very rare occurrence.  The  signs derived from percussion
should be sought about the clavicular and acromial  regions, 
272
PHTHISIS.
Obscurity of  resonance being  detected  beneath  one or
both clavicles, or at any  point of the chest near to  the
apices  of the lungs, what conclusion should be  formed as
to the nature of the disease ?   To this question Chomel
replies:—"Obscurity  of  sound,  and feeble respiration
under one of the clavicles,  give  strong reason to  suppose
the existence  of tubercles, for partial  effusions take place
in the immense majority of cases at the  inferior and pos •
teridr parts  of the chest, and it is almost never that chronic
pneumonia  is primitive  and  without  the presence of
tubercles.
   In the early stage,  the slightest difference  of note or
pitch on  opposite sides  of the chest, if confined to  the
clavicular and  acromial  regions, should excite  suspicion.
Although the dulness may be confined to a small locality
over the top of the shoulders and the scaleni muscles, yet
if it be clearly perceptible it is a  very sure indication of
the existence of phthisis.
   Auscultation, in the first  stage, reveals a feebleness of
respiratory  murmur  in  the  sub-clavicular  region.   This
occurs where percussion is  dull,  and at the same time the
resonance of the voice is greater than normal.   While in
one  part of the lung these  signs are heard, in another the
respiration  is blowing.   A slight  difference of  sound in
relative situations  on both sides, does not  necessarily
indicate phthisis.   The  anatomical relations of the lungs
have a  modifying effect.   A sound in the right lung of  a
phthisical patient should not be considered as  indicative
of tubercles,  unless it is  decidedly blowing.   But if the
respiration is more blowing at the  apex of the left than at
that of the  right  lung, there can be but little doubt that
tuberculous  disease is present.   With  the advance of the
disease, the respiration becomes somewhat rough, or even
bronchial, with a prolongation of the expiratory sound,
which is one of  the most striking characteristics of tubei 
PHTHISIS.
273
culous deposition.   Inspiration is at times somewhat jerk-
ing.   The cardiac pulsations are more audible than usual.
Bronchial respiration and bronchophony are heard out of
their natural locality, thus becoming indications of pulmo
nary lesions.
   Second Stage of phthisis may be considered as beginning
with  the softening of  tubercles, and terminating  when
cavities are fully formed, and all the  physical effects arising
from  them  fully developed.  In  other words, it is the
forming stage of vomica?.
   General Symptoms. —Of the general  symptoms collec-
tively, I remark that they are more severe.   The  evening
chills are more constant  and troublesome;  the succeeding
heat is more  intense and  more general, the morning sweats
more regular and copious.   Hectic is more constant, and,
to use the words of another, " hangs out upon the cheek
the red  flag  of death;" the pulse is more frequent, the
respiration quick  and  laborious,  even when the patient  is
at  rest.   Languor and  weakness increase, emaciation  is
rapid, the  muscles are soft and flabby, and the patient
can  no longer endure  his wonted amount of physical  or
mental exertion.   Paleness  of  the  countenance frequently
remains  through the early  part  of the day.  Sometimes
there is a greater tendency to chills shown  by an increased
sensibility to  cold, and the evening  exacerbation brings  on
an increased  heat of the  palms  of the hands  and the soles
of the feet.   The countenance, under the influence of the
morbid excitement, is for a  while more animated, the eye
brightens, and the red  blush of hectic gives to the features
new beauty and loveliness.  When speaking, the lips  of
the patient slightly quiver,  there is breathlessness which
interrupts him in the middle of a  sentence.   Sleep is more
disturbed.  Not unfrequently the mind, even in this  stage
of the disease, is buoyant and hopeful.  The least or most
temporary  amendment in his  symptoms, or the delusive 
274                  PHTHISIS.
promises and boasts of quacks, inspire him with the joy of
hope.  The Physical Signs in this stage are more marked.
As the disease advances, the tubercles soften and becomo
diluted with  a  morbid   secretion   from the  pulmonary
tissues.   Particles of curdy or cheesy matter pass from
their locality,  in the parenchyma of the lungs, into  the
bronchial tubes, and  are  expectorated.  The exit of  this
matter from the lungs gives rise to little vacuities called
caverns, cavities, vomica? or excavations.   A careful  ex-
amination of the chest, at this  time, affords positive  evi-
dence of the internal mischief.   The upper parts  are  less
freely raised during respiration than in the healthy state;
this  phenomenon frequently being  more evident on  one
side  than on  the other.  The  sub-clavicular regions on
both  sides, give a  dull  sound  on  percussion.   To  the
mind, the  ear,  or  stethoscope, when applied to  those
portions  of the chest situated  where percussion is dull,
reveals a slight crackling  noise—the crepitating rhonchus.
   After vomica? are  formed,  the cavernous  rale  or  the
gurgling  is heard,  when  the  cavity is partly filled with
liquid.  Resonance of the voice and cough, and at length
pectoriloquy follow.   If a solidified portion of lung,  en-
closing a considerable bronchus, comes near to the surface
of the chest, then bronchial  breathing and  bronchophony
are heard.   Percussion,  too, will give the  same  sound,
whether the lung be hepatized or blocked up by tubercular
matter.   This  condition  of the  lungs may be present in
one part, while cavities exist in another,  and  therefore,
different parts of the chest will  exhibit different physical
signs; I have  said that the gurgling sound  is heard in
case the vomica?  contains liquid.   But does this sound
necessarily prove in  all cases the existence of cavities 1
Dr. Watson remarks, "tha,t where we hear, during  inspira-
tion, the gurgling rale—called by Laennec, gargouillement
— we  may conclude,  that  there  exists a cavity.   But  the 
PHTHISIS.
275
cavity  will not necessarily be a vomica.   In ninety-nine
cases  out of a hundred,  it will be so ; but in the hun-
dredth, perhaps it will not."
  Dilatation of the  bronchi, sometimes produces a con-
siderable  globular  expansion.    In case  these  cavities,
formed by such an expansion, were filled with a liquid,  the
same sound would be produced, as  that caused by tuber-
cular vomica?.
   Third Stage. — The third stage is  that period, which
commences when  cavities are already formed, and con-
tinues  until the  termination of the  disease.   This  has
been  called the  colliquative stage, from the copious per-
spiration, the frequent  attacks of diarrhaea, and the abun-
dant  expectoration  with which it is attended.   The  feet
and ankles become cedematous; the vital powers gradually
decrease, one after another;  the functions of life fail;  the
body,  by a facilis descensus, falls to the earth, and  the
soul rises to eternity.
   General Symptoms.—The most important of these are,
the colliquative  sweat,  diarrhaea,  extreme  emaciation,
anasarcous swelling  of  the lower limbs, and high  febrile
excitement.   A  sure indication' of approaching dissolu-
tion, is an aphthous condition of the mouth.  This usually
comes  on during the last weeks,  or  days of existence.
The mental faculties,  at  this  period of phthisis,  are more
or  less deranged.   Reason  remains;  but it  is not  the
reason of health.   Slight delirium sometimes  occurs;  the
patient becomes indifferent to what is passing around him,
and to his own state, when a little while  before his atten-
tion was aroused by  every unfavorable symptom.
   Special Symptoms.—The expectoration is very copious,
consisting  of  a heterogeneous  mass of mucus, pus, soft-
ened  and  occasionally  solid tubercle, blood, shreds  of
lymph, rarely portions  of pulmonary tissue, sometimes
very fetid.    The cough and dyspnoea  increase.    The 
276
PHTHISIS.
shoulders  are raised  and brought forward ;  the  chest ia
narrow and  flat.   During   respiration,  the  clavicular
regions are  less moveable than  natural,  and when  the
patient attempts to make a full inspiration,  the upper part
of the thorax, instead of expanding with the appearance
of spontaneous ease, peculiar to  the healthystate of the
lungs, seems to be forcibly dragged up at each respiratory
effort.
   Physical Signs.—The physical signs in the third stage,
are similar ttf'those in the second.   The gurgling rale, the
increased resonance  of  voice, bronchophony, and pecto-
riloquy, amphoric  resonance, and metallic tinkling, may
be present in different cases and at different times.  Some
of these  signs are  more frequently heard  than others.
The  metallic tinkling is oftener present in  a  large than in
a small cavity ; and since large cavities are formed in the
third stage, this symptom  is observed only when the dis-
ease  is far advanced.
   Haemoptysis. — This  is  the most  important  rational
symptom that occurs in phthisis.   In other  diseases and
conditions of the lungs,  it is  so rare that it very certainly
indicates the nature of the case.   Haemoptysis, to be sure,
maybe produced  by other  causes — by certain  forms of
heart disease, by cancer, by cirrhosis of the lungs ; and, in
females, by vicarious menstruation.  But these latter con-
ditions of the lungs are very rare, and therefore haemoptysis
should be considered a strong evidence of phthisis.
   Emaciation.—This is one  of the  cardinal  symptoms of
phthisis.    Frequently  it  precedes  the other  symptoms.
Between the ages of forty and fifty, Dr. James Clark found
it one of the earliest symptoms of this disease.  Indiges-
tion is regarded by the patient and his friends as one of the
principal causes of this atrophy.  It is frequently associated
with  anaemia.   There is many times a peculiar  physiog-
nomy ; the  cheek is  pale  and thin, and the eye bright.
A 
PHTHISIS.
277
 Every organ in the body, except the liver and the heart, even
 the blond  itself,  emaciates.   And this  is often the  first
 symptom noticed.  At length slight disturbance is mani-
 fest— a little dyspnoea, a little chilliness towards evening,
 and  a tendency to cough.  This  symptom, emaciation, is
 not always  progressive.   The patient may gain flesh, but
 he soon loses it again; then  perhaps gains awhile in
 weight;  and so on alternately.  This, however, is observ-
 able :  he seldom  gains as  much as  he loses.   There  is a
 gradual though not a continuous descent.  It is true also,
 that while  there  is  an increase of weight, the tubercular
 disease advances ;  and while  the  patient  and friends art
 elated with  hope  by the apparent amendment, a fatal  ter-
 mination steadily  approaches.   Loss of appetite  and
 diarrhaea very much increase the emaciation.
  Diarrhoea. —The rapidity  of the progress  of consump-
 tion very much depends upon  this.   With  the number of
 evacuations Louis found  that the loss of  strength corre-
 sponded.   This fact should militate against the employ-
 ment of cathartics in  phthisis.  "A tablespoonful of castor
 oil," says Dr. James Clark, "I  have seen  throw a phthi-
 sical patient into an alarming state*of debility."  In those
 who have in health a costive state  of the bowels, incipient
 phthisis ] roduces regularity of  action.  Diarrhaea is usually
 confined  to  the advanced stage of the  disease.   In one-
 eighth of the cases treated by Louis, diarrhaea commenced
 with the  disease,  and continued until  its termination  ; in
the  majority it occurred  in the later  stages;  in others
during the last days  of life ; and in  four out  of one hun-
dred and twelve  cases, it  never appeared.   The distress
attending this symptom   is  often  severe;   before each
evacuation  the pain is  often intense, and immediately after
it there is a  deadly sensation of sinking.    It has an effect
upon the cough and expectoration.
  The severity of these symptoms is  usually in an inverse
                         21* 
278
PHTHISIS.
>'atio to that of the diarrhaea.   As a diagnostic  sign  it Is
not of great value.  The nature of the disease is known by
Other means, before  this becomes fully  developed.   The
cause of the diarrhaea is  the  softening of the tuberculous
matter deposited among the coats of the intestines.  After
death we find ulceration of the mucous membrane, tubercu-
lous deposits thickening  and softening, and enlarged mu-
cous follicles, especially near the termination of the ileum
and in the colon.
   (Edema. — This is  an invariable  attendant of  the last
stage of phthisis.   In young  delicate females it may super-
vene  in the earlier stages.   Generally it shows  itself first
in the lower extremities,  and is confined to thern.  In the
morning there is sometimes  an oedematous  appearance in
the face.   For the diagnosis  this is of no value ; but  it is
a prognostic of approaching death.   Is the suppression of
the menses the  cause of  the  tuberculous disease ?  Some
have thought it might lead to tubercles in the lungs.  The
menstrual suppression is for the most part the effect of that
general debility, that deficiency of the nutritive properties
of the blood which  precedes the  deposition of tubercles.
If this theory is true, then the treatment,  instead of being
wholly directed to the restoration of the uterine functions,
should be   directed   to  remedy  that deficient  nutrition
and  its  consequent  debility, which  cause  the menstrual
suppression, and the tuberculous deposition.   The cessa-
tion of the menses is  sometimes one  of the first, if not the
first,  prominent symptom of phthisis; and a careful exami-
nation of the case will often  discover this to be the fact.
Attendant upon this  symptom there are, in most  cases, a
slight cough, a little  chilliness and fever, and  some of the
physical signs of incipient phthisis.   In general this func-
tion continues, but decreases  in qnantity, during the early
stage of the disease.    From  a great variety of causes, thia 
PHTHISIS.
279
function  is so liable to derangement, that as a diagnostic
sign it is not of much value.
  Duration of Phthisis.—Tuberculous phthisis  is essen-
tially a chronic  disease, the range of its  duration being
considerable.  Cases have been recorded which have ter-
minated  in eleven days, while  others  have lingered for
twenty or even forty years.  These, however, are extreme
cases ;  the majority terminate in one  or  two years,  the
average duration being eighteen months.
  Phthisis in Infancy and Childhood.—Phthisis is more
common in infancy and childhood than was once supposed.
Dr. Guersent, one of the physicians to the Hospital  des
Enfans Malades, an institution appropriated to  the treat-
ment of patients between the age of one and sixteen years,
gives, as the result of  his  observations, that five-sixths of
those who die in that hospital are more or less tuberculous.
Early in  life, its  existence is  manifested  by symptoms
somewhat  different from those  of  adults.  The  cough
occurs  in paroxysms ;   hectic expectoration and  hemor-
rhage from the lungs are not so apparent. The tuberculous
cachexia,  rapid  pulse and  breathing,  emaciation  and
derangement  of the digestive organs, tumid abdomen and
irregular action of the  bowels, at one time constipated, at
another affected with diarrhaea, and  the  pale unnatural
color of the evacuations, point out the nature of the disease.
In children the mesenteric glands are  more  subject  to
disease than  in  adults.  But  the most frequent  seat of
tuberculous affections is the bronchial  glands, and thenext
in frequency is  the lungs.   The relative frequency of
tubercles in the bronchial glands of  children, compared
with the  lungs,  is  not less than five  to  fovr,  which is
reversed after the age of puberty. 
280
PHTHISIS.
               CAUSES  OF PHTHISIS.
   Among the causes of phthisis, hereditary predisposition
occupies the most important place.  And yet this heredi-
tary tendency explains nothing in relation to the real cause
of the disease.  It is the name of a fact, not a cause, which
is sure to produce specific results.   We must, therefore,
in order to arrive at anything definite or practical, seek to
find that in which the fact has its  origin — whether it is a
peculiar state of the blood, or a want of functional power,
—in the digestive organs, or in the respiratory apparatus.
Vitality is the effect of so  many conditional  causes, each
ljable to vary in intensity, and by that variation to influence
the result — the degree of vitality, — that it is difficult to
tell  in what  ultimate change phthisis has  its origin.  But
the nearer we  can ascend to the sources of knowledge, the
more general  and  conditional  that  obtained knowledge
becomes, for all other knowledge  relates to it as species
to genera.   Accordingly, it is evident that if  chemistry
or optics could detect that condition of the blood, whatever
it is, which is most prevalent in the progeny of tuberculous
parents, before deposition  of  tuberculous matter  takes
place,  a general fact would be obtained of more value than
many particulars often spoken of by medical writers.   From
pathology or from  chemistry we  gain no  evidence  that
those wrho are  predisposed  to phthisis have blood essen-
tially differing  from  that of others.   And the existence of
the hereditary tendency has been questioned by some recent
observers.   But because of the non-appearance of an ab-
normal change in the constituents of the blood, except in
rare  cases, or  because the  existence  of  that tendency is
denied, we should not therefore conclude that hereditary
influence  does  not  exist.    It may exist, but not  as an
ultimate cause, ever producing a certain result.
   Occupations of Life.—Concerning the causes of phthisis, 
PHTHISIS.
281
Lombard, of Geneva, has given us some valuable statistical
information.  The result of his researches is thus stated :—
The circumstances which increase the tendency to phthisis
are poverty,  sedentary habits, violent exercise of the chest,
an  habitually bent position of the  body, impure air in
workshops, the inhalation of certain mineral and vegetable
vapors, or air loaded with a coarse or impalpable dust, or
with light, thready,  elastic substances.
   The  conditions which seem to exert a favorable  pre-
servative influence, are easy circumstances, an active life in
the open air, regular general  exercise, the inhalation  of
watery vapor,  and  animal  and vegetable   emanations.
Sedentary habits are  prone to  produce  phthisis.   The
habit of sitting with the  body inclined forward, thus pre-
venting the free expansion of the lungs, and the action- of
the stomach, and other abdominal viscera, is  one cause of
the injurious tendency of a studious life.   Among shoe-
makers and tailors, the proportion of phthisical patients is
very large.
  Dyspepsia. — In dyspeptic diseases,  many authors have
placed one prominent cause of phthisis;  and  with good
reason they have done so.   For since tubercles  depend for
their development upon a want of nutrition in the blood, and
since dyspeptic diseases deprive the blood of its nutritive
properties, there is  every  reasou to believe, that in this
source tubercles have their origin.
  There  are other causes of phthisis, seldom described in
medical works.    Of  these, one is  masturbation, which, by
its debilitating  effects upon the general constitution, tends
in an eminent degree to favor the development of tubercles.
Another  cause  is the use of such  remedial agents in  the
cure of disease, as leave after  their primary effects  have
subsided, secondary  ones, which in the end prove worse
than the original disease.   If this  be  so, and  the  history
of thousands of individuals corroborates its  truth,  then 
282
PHTHISIS.
why may not its action upon the system directly induce
tuberculous disease ?   Indirectly, if not directly, by debili-
tating the system deteriorating the red blood, and inducing
emaciation, it so influences  the  mass of the fluids,  as to
predispose the system to the ingress of phthisis ; it leaves
the territory unguarded by  any vital force, even by that
mysterious one,  "the  vis medicatrix naturae.'1'' A patient,
somewhat  predisposed to phthisis, takes a severe cold in
the autumn.   Febrile symptoms supervene.   There is, ac-
cording to the  opinion of some, an exalted condition of
vital  action ;  and consequently, all the instruments of the
antiphlogistic  regimen  and treatment,  are  immediately
used  to subdue the  inflammation.  After  a number of
weeks,  the patient may slowly recover.  But  his digestive
organs  do not  seem  to  be  healthy.   Strength -does not
return ;  a  slight cough begins, and in from six months to
a  year,  phthisical symptoms are  fully  developed.   Such
cases often occur, and so often, that the more judicious
physicians of all creeds,  even those  standing on the con-
servative platform, now begin to  abandon the use of de-
pressing remedies ; not because as some  often pretend, dis-
eases are now so different in their nature, as not to require
the same treatment, but because the application of science
to the study  of  medicine, has exploded  the idea that it is
necessary to  hazard life, by  the use of deleterious agents,
in order to produce a speedy and complete cure.
   Prognosis. — In those  cases  where the disease is  far
advanced,  the prognosis  is  always very unfavorable.   So
small is the chance of recovery, that  the physician has no
good reason  to encourage either patient or friends.
   But morbid anatomy has .demonstrated, that even in the
last stages, recoveries do take place; the cavities are filled
with  chalky concretions, their parietes contract, and cica-
trices are produced.   What else than the cure of phthisis
do such facts teach ?   On this subject, Dr. Swett remarks, 
PHTHISIS.
283
"I never shall  entirely  despair of  the  life of a  patient,
when I recollect what  I  once witnessed  in this  Hospital.
A patient was admitted with phthisis.  The disease was
perfectly well characterized,  and in  its most  advanced
stage; a large and well-marked abscess  existed under the
right clavicle.   Indeed the signs of this  lesion  were  so
distinct, that I was in the habit of calling the  attention,
of students in attendance, to them, as perfect in their cha-
racter.  On one  occasion, as I approached the bed for this
purpose, I found the patient,  who had been  gradually
sinking, in such  a state that it seemed to me improper to
disturb him.   He was bolstered up in bed, with his head
falling upon  his shoulder, breathing with great difficulty,
bathed in perspiration, and with a rapid and feeble  pulse.
The next day my attendance ceased, and after two months
was  again commenced.   On  entering the ward, the house
physician called my attention to a man, dressed,  and walk-
ing  about  the ward, apparently stout and well, although
somewhat pale   To  my great astonishment, it  was the
patient I had  left two months before, apparently  dying."
The  same author testifies  that  he has known a number of
cases of  patients,  who  have had   all  the evidences  of
phthisis, and  yet have recovered.

                   TREATMENT.
  " The indications to be fulfilled in the treatment of this
disease," says Prof. Calkins in his very excellent work  on
thoracic diseases, "are, first,  to prevent  the further  depo-
sition and development of tubercles ; and, secondly, to pre-
vent  and  to protect, as far as possible, the lungs and other
organs from their injurious results.   The means  both pro-
phylactic and remedial, which can be of any utility for this
purpose,  must be directed to the attainment of this result:
the production of that  state of the solids and fluids  which
is most adverse to the development of tubercles."  Prof. 
284
PHTHISIS.
J. G. Jones says : " The leading indications to be fulfilled
in the treatment of this disease are twofold, to wit: 1. To
change the condition of the blood, and restore the qualities
pertaining to its healthy state.   2.  To prevent the further
deposition  and  development  of tubercles,  give tone and
vigor to the whole system, and in a measure change its dia-
thesis."  Profs. Newton  and  Powel,  in a work  on the
treatment of diseases, make the following  remarks: "In
the treatment of this disease, little  else can be done than
to make use of means  which will enrich the fibrinous por-
tions of the  blood, strengthen  the nervous and  muscular
system of the  patient,  and relieve troublesome and danger-
ous symptoms as they  may appear."  Dr. Walshe gives the
results which  he obtained in the Consumption Hospital  as
follows: "1. Of a given  mass of patients entering the
hospital in all  stages of the  disease, and in every variety
of general condition — between  the  actual  moribund state
and that of but  slight  constitutional suffering—the number
leaving it,  on the one  hand, improved or unadvanced was
more than  double that, on the other hand, leaving  it in a
worse  state or  dying  within its walls  (the exact ratio is
67*84: 32"16).   If the cases  in which death was actually
imminent at the period of admission, were excluded, the
result would be very materially more  favorable than this.
2.  In  4 26 per  cent, of the cases, complete restoration-to
health, not only as regards apparent disturbance  of the
functions generally, but as regards  local evidence of actual
pulmonary disease,  was  effected.   3.  Complete  removal
of symptoms was more frequently effected in the male than
in the female ; but, on the other hand, the results were  on
the whole slightly more favorable in the latter than  in the
former  sex.   4.  All patients who  grew Avorse while they
were in the hospital had  reached the stage of excavation
on  admission; and all patients whose tubercles were  yet
unsofteiied on admission,  left the hospital either improved, 
PHTHISIS.
285
or having had a statu quo condition kept up.   Improve-
ment is more probable than the reverse, even where exca-
vation exists on admission.   5. In a given mass of cases,
the chances of favorable influence from sojourn in  the
hospital will be greater in a certain (undetermined) ratio
as the duration of the disease  previous to admission  has
been greater; in other  terms, natural tendency to a slow
course is a more important element of success in the treat-
ment of the disease, than the fact of that treatment having
been undertaken at an early period.   6.  The mean length
of stay in the hospital, in the most favorable class of cases,
nearly doubled that in the least favorable. 7. The chances
of benefit are most in favor of those whose trades are pur-
sued out of doors  (wholly or partially) than of those who
work wholly within doors.  8. The results did not appear
to be influenced by the laborious or non-laborious charac-
ter of the trade individuals might have pursued.   9. The
age of the sufferers  did  not appear to exercise  any very
material  influence  on the character of the results.   10.
Patients coming from the country have, on  an  average, a
slightly stronger chance of improvement than the residents
of London and its suburbs.   11.  Patients admitted during
the warmer half of the year, benefit by a sojourn at Bromp-
ton, to  a slight extent, more than those received during  the
six colder months."
   From  the above facts, together with the experience of
every intelligent Eclectic physician, it appears that pulmo-
nary consumption  is occasionally  cured, and  sometimes
terminates favorably without medical aid; and perhaps I
might state, in spite of medicinal treatment.   But  when
we consider the irrational treatment which has been relied
upon for the cure  of this disease,  we can  hardly be sur-
prised at its fatality.  Nor that  not only the medical fra-
ternity,  but the community generally, have been led to  be-
lieve that it is incurable.  So much so is this the case, that 
286
PHTHISIS.
a large number of physicians deem it a sufficient apology
for losing a patient in the prime of life, to state that he
died of pulmonary consumption.   I do not expect in this
article to lay down a course of treatment that will always
oure,  irrespective of age, condition of the  patient, and
stage of the disease;  but,  I  do expect  to  explain such
a  course, as will, if properly  applied,  cure  a large pro-
portion, and materially relieve such as cannot be entirely
restored.
   When  a person  exhibits premonitory symptoms  of
phthisis, every exciting  cause  of the disease should be
removed.   The patient should exercise freely in the open
air, and be placed upon a full and  nutritious, diet, such
as beef-steak rare cooked, &c.   He should  also take a
reasonable  quantity of some stimulant, as brandy toddy, or
some malt  liquors,  before each meal.  If this does not
remove those  early symptoms, chalybeates, in connection
with sugar, may be given as follows :
      R Precipitated Carbonate of Iron...............  ^ij.
        White Sugar........................................gvij.
Mix and triturate, take one teaspoonful three or four times
a  day.  Should the beef,  and other  articles of food,  not be
well digested,  on account of a dyspeptic  habit which fre-
quently precedes this disease, slightly cooked eggs and rich
animal soups may take their place.   This course has been
efficient in my  hands in a large number of cases, where the
early symptoms  of  phthisis were developed.   But where
the disease  is farther advanced, with more or less anemia,
cough  and expectoration, with  depression  beneath  the
clavicle, feeble  respiratory murmur, and  dulness* on per-
cussion,  and especially if there is  connected with  this a
tubercular  diathesis, then  much effort will be required to
prevent a disastrous encroachment of the disease.   In this
condition and stage of symptoms, the following treatment
should be instituted. 
PHTHISIS.
287
   A  large  double  flannel cloth, within which has  been
 quilted a liberal quantity of coarse  salt, should  be placed
 over  the  chest and back in such a manner as to protect
 both  the anterior  and posterior portions  of  both lungs.
 This  salt pack should be changed from time to time, but
 should  be worn until the  disease is removed.   And for
 supplying those deficiencies of the blood, which are such a
 prolific cause of pulmonary consumption, give the following
 compound :
      R The white ot eggs................................ xij.
        Iron by Hydrogen................................. gr. xx.
        Phosphate of Lime................................gij.
        Chloride of Sodium.......»...................... giij.
 Mix with one pint  of best brandy, one pound of sugar, and
 one pint of water; dose one tablespoonful three or four
 times a day.   In connection with this, the patient should
 exercise freely in the  open air, and  should make a liberal
 use of warm or cold  baths, as  the case may seem to indi-
 cate.   If there are  chills,
      R Quinine....................................w... gr. xx.
        Phosphate of Iron............................ gr. x.
        Morphine........................................  gr. jss.
        White Sugar.....................................  gr, xxx.
 Mix,  triturate, divide into  fifteen powders, and take one
 every three hours.    If  the first fifteen powders  fail to
 interrupt the chills, they should be repeated from time to
 time,  until they cease entirely.   If there  is troublesome
 cough, with dyspnoea, give the following mixture :
      R Simple Syrup of Stillingia..................... ^iij.
        Syrup of Tolu..................................... 5jj.
        Morphine........................................... crV. ii.
 Mix;  dose, one teaspoonful three times a day, and oftener
if  required.  If there appears to be bronchial  irritation,
from one-eighth to  one-half a grain of Gelsemin should be
taken at bed-time.   If the salt  pack should be removed 
288
p n t ii i s i s.
at any time during the treatment, the chest should be well
protected by oil  silk or flannel.   In nearly all cases  of
pulmonary consumption, there is a deficiency of the natural
covering, the hair.  In  fact,  so  general  is this  the case,
that I have come to regard a deficiency of hair on the
chest as  one of the indications of a tuberculous  diathesis.
For the  hair  is  not simply an ornament, but it serves
to separate certain proportions  of carbon, silica,  sulphur
and other  materials from  the  blood.  As the  disease
advances to the  latter part  of  the  second stage, other
symptoms make  their  appearance, as  diarrhaea, and  a
muco-purulent  matter or pus, constituting the sputa, indi-
cating a breaking down of'the  tuberculous deposit, with
more or less affection  of the glands of  the bowels.  To
 control  the diarrhaea, no medicine  is more  effectual than
the following:
      R  Sub-nitrate of Bismuth........................ gr. xx.
        Quinine............................................ gr. xvj.
        Pulverized Gum Arabic........................ gr. xxx.
Mix, triturate, di?ide into twenty powders, and give one
every five or six hours until that symptom is controlled.
   The  method of treating  this  disease by introducing
medicine into the system by inhalation,  having received
much attention of late, I will quote the remarks of Dr.
Turnbull upon the subject, as they appear to embrace most
of the facts essential to  it.
   " Dr.  Snow has shown, in  a paper on the inhalation of
various medicinal  substances,  that some must be inhaled by
the aid of heat, such as opium, morphia, extract of stramo-
nium, and the gum resins; others with heated vapor, such as
iodine,  camphor and creosote, and a third class  of sub-
stances,  such as hydrocyanic  acid, ammonia and chlorine
at the ordinary temperature.  Mead, in his day, recom-
mended  fumigations with the balsams in  phthisical cases, 
PHTHISIS.                  289
 and Dr. A. T. Thomson (Cyclopedia of Medicine,  Art
 Expectorants) has  stated that he has seen much benefit
 derived from them,  when inhaled in spasmodic  asthma, in
 shortening the paroxysm, and  promoting expectoration.
 Dr. Snow found  that  ammoniacum  gives off a fragrant,
 rather pungent odor, which can be  inhaled very well by
 most persons.  He also found  inhalation of the watery
 extract of opium serviceable in  relieving the oough ; but
 that morphia was the most pleasant and suitable prepara-
 tion  of  opium for inhalation.  Extract of stramonium
 afforded more or less relief in five or six cases of asthma.
   He tried  iodine in eighteen  cases of  consumption  at
 Brompton Hospital; in ten of them it was  continued for
 more than a month; and the conclusion to which he came,
 was that no  benefit could be observed to follow its  use.
 Oil of turpentine appeared  to relieve the cough in a few
 cases, and likewise  camphor.  He used the volatile alka-
 loid conia  in the  quantity of  one  minim, diluted with
 nine of spirit; the cough was usually relieved, and in two
 or three  cases the  breathing also.   It would seem, there-
 fore, from its volatility at the ordinary temperature, to b(
 a remedy peculiarly suitable for  inhalation, if it could be
 obtained more easily.  Dr. Snow also found great relief
 in a few cases of bronchitis with  difficult expectoration,
 from  inhaling ammonia, twenty drops of the strong  solu-
 tion being mixed with two ounces of water  in a Woulfe's
 bottle.   Chlorine has  been used for inhalation ;  it  was
 introduced  for this  purpose in  France, and there is good
 reason to believe that it has proved of material service in
 cases of chronic bronchitis, and even in some of phthisis.
  With  reference to its use in this latter disease,  Dr.
 James Clark has observed,  '' We  have tried  it in many
 instances, and it has in several, apparently suspended the
progress  of the disease."   He also states that it relieved
dyspnoea and cough in  some cases, though in the majority
                        25* 
290
PHTHISIS.
it  procured  no amelioration.   Dr. A. T. Thomson has
likewise stated, that in  cases of asthma, the relief it pro-
duced  was very  striking,  and  that  in  phthisis,  he had
observed the  hectic symptoms abate.
   Of the various remedies now mentioned, it is  probable
that gum resins  and balsams, camphor, conia, and chlo-
rine, are the  most suitable and useful  for inhalation ; but it
does not appear that by inhalation of opium, or morphias,
very decided  advantage has been gained over the ordinary
mode of exhibiting them.
   The vapor of tar was formerly recommended for inhala-
tion, and few  medicines  have  been more used for this
purpose than creosote.  Sir Alexander Crichton, in 1823,
strongly  recommended  tar  vapor in  consumption;  but
Dr. Forbes,  in a report of cases in which he had  tried it,
published in the  Medical and  Physical  Journal,  stated
that he found it injurious in this disease, though of service
in some cases of chronic  bronchitis.  He appears, how-
 ever, to have  used it in cases so far advanced, that no
benefit could  reasonably  have been  expected  from  its
 employment.  Creosote has  now  superseded  the use of
 tar vapor, which does not, from its irritating properties,
 seem well suited for inhalation, though there can be very
 little doubt,  when  we consider the healing power it has in
 external  application, that it  must  exert a similar effect
 upon the lungs, if it could be  used in such a form as to
 obtain its beneficial influence apart from its irritating pro-
 perties.   Creosote is  perhaps more generally used by the
 profession for the purpose of inhalation, than  any other
 remedy ; and I believe  that wlten sufficiently diluted witli
 vapor  of water,  it is  one of the  most  useful    I have
 found  that it has a sedative influence, relieving cough and
 promoting expectoration, whilst it  at  the same time not
 unfrequently lessens the quantity of  this secretion, both in
 consumption and  bronchitis.   I  have already  observed 
PHTHISIS.                   291
that the  pyrogenic bodies act upon  the mucous and cu-
taneous surfaces; and my attention has been directed to
other bodies  of this class, by'tlie  fact that many of them
have  remarkable healing  properties, when  applied  to
ulcers and chronic cutaneous  eruptions, a fact which leads
me to expect that  this class of bodies  may, when  fully
investigated,  furnish a suitable remedy for promoting the
healing of pulmonary ulcers, and  thus  supply the deside-
ratum to which  I have previously alluded.  Many of the
pyrogenic bodies possess such healing  properties in cu-
taneous diseases, in  a greater  or  less degree.   From my
own  experience, I  know that ointments, made with  tar,
creosote,  spirit of  tar, juniper tar oil, and  naphthaline,
have such properties, and are valuable  remedies in the
treatment of skin diseases.
   The inference drawn from these facts, has led me to use
for inhalation, some other pyrogenic bodies, viz : spirits
of tar, juniper tar oil, Persian naphtha, and enpione.  The
spirit of tar  possesses the healing virtues of tar without
its irritating effects; so  much so, that I think it might
advantageously supersede  the  crude  substance as  an
external remedy.  It is more readily volatilized  than creo
sote; and when inhaled,  it  produces generally  a mild,
stimulating, and often rather a soothing  effect upon the
lungs.  In some instances, however,  it has  appeared to
increase the cough and expectoration, and it is not, there-
fore, suited for bronchitis, until inflammatory action has
been subdued  completely; or for cases of  consumption,
until progress has  been made in arresting  the disease.
Without  wishing to speak confidently  of the  remedy, I
may state that it has appeared useful in some cases of the
latter disease, in conjunction with other treatment.  Juniper
tar oil (oleum  codinum), which is a valuable  remedy in
skin  diseases, and  much used  on the  Continent  is less
volatile than spirits of tar,  and is  less  irtitatino- wnen 
292
PHTHISIS.
inhaled.   Persian naphtha and  eupione possess  decided
anaesthetic properties;  the  former,  when  inhaled  along
with the vapor  of water, has in some instances  relieved
difficulty of breathing  in  a very remarkable  and  decided
manner;  and this  fact renders it worthy of trial in spas-
modic asthma.  Eupione has decided sedative properties:
it has relieved cough and difficult breathing,  and  patients
have  slept well after using  it;  but it  is not a pleasant
remedy to inhale,  and  it  has  not  unfrequently produced
sickness afterwards, so  that I should not recommend it to
be used for this purpose.
   I have  used several of the essential oils for the  purpose
Of  inhalation.  Many  of them possess  decidedly  anti-
spasmodic properties, and I have found that they have a
remarkably strong power over difficulty of breathing, a
property which renders them peculiarly  suitable for reliev-
ing spasmodic asthma.   The  oil should be  dissolved in
spirit,  and inhaled with the vapor of water, so as to dilute
its stimulating properties.  The oils of cubebs and copaiva,
which  are hydro-carbons, are mild  in  their action,  and
produce very little stimulating  effect.   The  oxygenated
oils which I have used  appeared to be more stimulating in
their  action on  the air-tubes, and  some  of them  have
stronger anti-spasmodic and expectorant properties.   The
oils of anise and  peppermint are very stimulating, and in
general cause too  much  irritation.   Oil of  spearmint is
milder and antispasmodic, relieving difficulty  of breathing
in asthma,  and  even  in  phthisis.   Oil of fennel is  also
mild.    The oil of origanum is moderately stimulating and
expectorant.   I have also used  the  oils of rosemary and
pimento,  which have  similar  properties.  The hydruret
of benzyle, which is the oil of bitter almonds deprived of
its prussic acid, is very  irritating and much too stimulating
for  inhalation.  Chloroform is  a remedy which has been
much  used by some medical men  for  the purpose  of inha- 
PHTHISIS.
293
lation, not  only  in  asthma, but, in a small quantity,  in
consumption,  in order to relieve irritable cough.  In some
cases I have dissolved the essential oils in chloroform, and
used them in this way for inhalation, their volatility being
thus so much increased that they may be given on a hand-
kerchief,  as  chloroform is usually administered.
   In addition to  the remedies spoken of by Dr. Turnbull,
Carbonate  of Ammonia, Nitrate of  Silver, Sanguinaria
and Yeratrum Yiride have  been quite extensively used by
different physicians, and in some cases to much advantage.
The oil  of  Erigeron, spoken of by Dr. Turnbull, I have
used quite successfully in several cases of haemoptysis, con-
nected with phthisis, but whether it acts more efficiently in
this way than when introduced into the stomach, I am not
prepared to say.   If the inhalation of medicine be resorted
to, the introduction of medicine into  the stomach should
not be neglected.  We can readily conceive how ineffectual
a treatment exclusively by inhalation must prove, since the
well established pathology of this disease shows the local
affection of  the lungs to be only one of the unhealthy pro-
ducts of the constitution.   In this stage of the disease,
much benefit will be derived from the use  of diuretics to
relieve the blood  from the excess of  uric, and other acids,
with which  it becomes overcharged, and also of the dis-
integrated tissue  which accumulates in the system, owing
to  imperfect  respiration.   Among the best diuretics to
accomplish this object is the following:
      R Pipsissewa.......................................... ?j.
       Indian  Hemp.......................................Ijss.
       Marshmallow....................................... Sj.
Bruise all together,  and make  one quart  of  syrup with
white sugar, and  add one half pint of best gin, and let the
patient take from one half to one wine glass full four or five
times a day. 
294
PHTHISIS.
  For the purpose of procuring rest at night,
     R Quinine............................................. gr- x.
       Scutellarin......................................... gr. xv.
       Gelsemin............................................ gr. ij.
       Iron by Hydrogen................................ gr. xij.
Mix, divide into ten powders, and give one every night at
bed-time.
  Where  there  is great  emaciation and  debility in this
stage,  for supplying material  for  combustion, and  for
increasing the quality and quantity of blood :
     -R Cod Liver Oil....................................... Oj.
        Good Brandy.......................................Oss.
        Chloride of Sodium...............................^ij.
        Phosphate of Iron................................. gjss.
Mix, and  shake  well before using.  Dose,  one tablespoon-
ful three or four times a day.    If there is  much bronchial
irritation in connection with tuberculous affection,
      R Syrup of Stillingia..............................^ij.
        Tct. of Veratrum Viride....................... gss.
Mix, and  give thirty drops three or four times a day.
   For the purpose of promoting absorption of the already
existing tuberculous  deposit, Prof. John Fondey, Emeritus
Prof, of Theory and Practice of Medicine  in the Eclectic
Medical College of Pennsylvania, who has had great ex-
perience in the treatment of this class of diseases, places
much reliance on the use of electricity.
   In his treatise upon this subject, p. 68, he thus remarks:
" The electro-magnetic  machine  constitutes  one of the
most powerful  means that we possess, to accomplish the
results so  desirable in the treatment of this disease. What
we want in the remedies which we  employ, is some power
that will excite the contractility of the coats of the vessels,
of the enlarged absorbent glands, as well as of the lymphatic
vessels;  give strength to the magnetic organization of the 
HAEMOPTYSIS.
295
part, and promote the absorption of the deposits that may
have occurred in and around these glands and vessels."
  Dr.  Cartwright,  of  New  Orleans, who has  published
several very interesting articles upon the nature  and treat-
ment of tuberculous affections of the lungs, cites quite a
number of cases where absorption of the tuberculous depo-
sition was effected by the inhalation of the vapor of sugar.
  I have generally obtained the most satisfactory results
in promoting the absorption of tuberculous deposits by the
use of  Iodide of Potassium, in connection with mucilage,
The mucilage prevents the  irritating effects of the Iodide
of  Potassium on  the  bowels.   The  chest  should  be
thoroughly  bathed twice  a day with a liniment made as
follows:
     R Oil of Stillingia ....................................... |j.
        White of three eggs.
        Oil of Turpentine ....................................^ij.
        Chloride of Sodium .................................gij.
Mix, and shake well together.  During  the entire treat-
ment of this disease, the strictest attention should be given
to bathing,  diet,  and  exercise  in  the  open  air.   Every
means should be resorted to  which has a tendency to im-
prove the general health of the patient.  Where the disease
assumes  a periodic character, the greatest benefit will be
derived from administering  a liberal quantity of Quinine
and Iron every seven or eight days.  When the disease is
complicated with other local difficulties, such as leucorrhaea,
spermatorrhaea, &c, they should receive especial attention.
                HEMOPTYSIS.
  By haemoptysis we  understand expectoration of blood.
It may occur from the mucous surface of the bronchial tubes;
by extravasation of blood into the pulmonary tissue, &c,
or from the corrosion of a blood-vessel on the wall of a tuber- 
296
HJEMOPTYSIS.
culous vomica.   It is also said to occur from the granula-
ted surfaces in phthisis.  The most common cause of the
disease in females, when it occurs from the mucous surface
of the bronchi,  is  vicarious menstruation, which  takes
place about the period of the catamenia.   In  these cases,
for some time previous to the attack, there will be observed
a diminution in  the catamenial flow, accompanied by anae-
mia.  Indeed,  we have reason to suspect that, in connec-
tion with the catamenial derangement, there is tuberculous
affection of the lungs.  I do  not recollect, out of a large
number of cases, a single exception, and in quite a num-
ber of oases, it has terminated in acute  phthisis.  When
the blood escapes from the bronchial mucous  surface, it
may be detected by the bubbling  liquid rhonchus in the
bronchi.   The discharge is generally preceded by more or
less constitutional disturbance, such as  constipated bow-
els, furred  tongue, and cough, which is often  persistent,
and accompanied with great dyspnoea.   Where it occurs
from the rupture of corroded blood-vessels, the premoni-
tory  symptoms are quite  obscure, and  the discharge of
blood is  very  sudden,  with  violent cough and dyspnoea.
The physical sign is the  mucous rale.   When  it occurs
from the granulated surface  of the pulmonary tissue, or
from pulmonary apoplexy, a correct diagnosis of  the case
may be made from its previous history, together with the ra-
tional and physical signs.  The general symptoms of he-
moptysis  are dulness, cold extremities, followed by flushes
of heat, and red cheeks.  The discharge from the lungs is
attended  with dyspnoea, pain, and  oppression of the  pra?-
cordia,  a sense of rawness in the throat, and  a  sweetish
taste in the mouth.   The expectoration consists of bright,
frothy, or black and clotted blood,  sometimes  mixed with
mucus.    Says Laennec:  " When the hemorrhage is very
great, it comes on with a moderate degree of cough, and is
accompanied with a convulsive elevation of the diaphragm 
                   HEMOPTYSIS.                297

like that which takes place in vomiting. Auscultation fur-
nishes us with  two signs of  pulmonary apoplexy,  absence
of the natural respiratory sound over a circumscribed space
and crepitant rale around this space.

                    TREATMENT.
   Where this disease is dependent upon derangement of
the catamenia, the feet  should be placed in warm water,
and hot sinapisms applied to the back and lower portions
of the bowels,  and from five to ten  grains of pulverized
matico  given  every fifteen  or twenty minutes  until  the
hemorrhage ceases.  Or, put one drachm of the oil of Eri-
geron in a pint bottle, fill  it with hot water,  and  cause
the patient to inhale the vapor.  Either of these remedies
will arrest the hemorrhage.   Or,  in  the  absence of other
remedies, a teaspoonful of  a strong  solution of salt and
water taken every five or ten minutes,  will frequently prove
effectual.  As soon as this symptom is removed, the patient
should be put upon a treatment as  directed under the head
of  irregularities of the catamenia.   Where  hemorrhage
occurs from the rupture of large vessels, ligatures should be
applied  to the legs and arms, and the  patient caused to
inhale a  strong vapor of the oil of Erigeron, and at the
same time from five to ten grains of the  matico  should be
given every fifteen or twenty minutes, until it is arrested.
During the active hemorrhage, the ligatures  should be so
adjusted  as to  retain  the main volume of blood in the
extremities, which should only be allowed to  return by
degrees after the bleeding has ceased.
   As  this form of haemoptysis is always connected with
phthisis, the patient should be  treated accordingly.   If it
arises from pulmonary apoplexy, the ligatures should be
used as in the other case.  A hot  sinapism should also be
applied to the chest, and the surface should be thoroughly
bathed  in hot  whiskey and  capsicum, for the purpose of
       26 
298                BRONCHITIS.
diverting the blood from the deep capillaries of the  lungs
to the superficial capillaries.   Also, administer the matico
with small doses of Lobelia and capsicum every fifteen  or
twenty minutes.   The bowels should be moved by a stimu-
lating  injection, and the patient allowed to  hold ice iu his
mouth.
   As soon as the hemorrhage ceases, the circulation should
be controlled by the use of Aconite.  As this form of he-
moptysis is connected not only with phthisis, but also with
pneumonia and scurvy, the primary cause of the affection
should be treated  according to the nature of the case, and
the condition of the patient.
                 BRONCHITIS.

  Inflammation of the  mucous membrane of the  bronchi
is one of the most common forms of pulmonary disease. It
may be either acute or chronic. In the acute form, coryza,
sore throat, hoarseness, and slight  rigors,  are the  first
symptoms.  There is also lassitude with more or less pain
in the limbs.   As the disease advances there  is a sensation
of heat and soreness  or rawness of the bronchial  surface,
accompanied by pain on coughing, and  oppressed breath-
ing.  There is a persistent cough, with an expectoration
of frothy mucus of a saline taste.   In a more severe form
of the disease, the small capillary tubes, as well as those
of a medium and large  size,  are implicated.   In this form
of the disease  the pulse  is  extremely  frequent;  there is
great dyspnoea,  a cyanotic appearance of the countenance,
coldness of the body, difficult respiration, and  a marked
tendency  to asphyxia.  In these  cases the  vital powers
rapidly  become exhausted, and unless  relieved  by timely
treatment, delirium with fatal coma terminates the patient's
existence. 
BRONCHITIS.
299
  Physical Signs.—In certain cases slight dulness on per-
cussion will be detected.  In  protracted cases, a conside-
rable amount of dulness may be observed  at  the  base of
the lung, owing to  the  gravitation of the excreted fluid.
On auscultating the chest, the respiratory  murmur will be
found weakened,  and in  some instances entirely  sup-
pressed.  There is sonorous, sibilant, and mucous rhonchus
in  various  combinations.   The  sonorous and  sibilant
rhonchus is most marked in the early stage of the disease;
the mucous in the second.   But both are frequently com-
bined  in  the second  stage.  In capillary bronchitis,  in
addition to the above signs, there is sub-crepitant rhonchus
at both bases, posteriorly, with a fine mucous rale higher up.
If the fine mucous rale is predominant,  it most positively
indicates inflammation of the capillary bronchial tubes.

                    TREATMENT.
  The surface should  be thoroughly bathed in  hot lye
water, and the patient placed in bed with a warming poul-
tice applied over each lung.   From five to ten drops of
the Tinct. of Yeratrum Yiride should be given every half
hour until -the active symptoms of the disease disappear.
As  soon as this occurs—
     R Quinine..........................................  _
        Iron by Hydrogen.............................. gr x
        Pulverized Acacia............................. gr xx
Mix,  and triturate; divide into eight powders, and  give
one every two hours.  After which, if there are any linger-
ing symptoms,  small  doses of  the Tinct.   of  Aconite
should be  given.   To  relieve  the cough, if any  should
remain, the acetic Syrup  of Sanguinaria should be used
as indicated.  The patient's strength may be maintained
by the use of chalybeates, vegetable tonics, and a nutritious
diet. 
300
CHRONIC  BRONCHITIS.
         CHRONIC  BRONCHITIS.
  This,  like  other  forms  of chronic inflammation, fre-
quently succeeds  the  acute form, although it may occur in
a slow and  insidious manner, without being preceded by
an acute form of the  disease.
  It attacks individuals of all ages ; but is most frequently
met with in the aged, and those who are much exposed to
the inhalation of dust.  When the  disease  succeeds to
acute bronchitis, the febrile symptoms disappear;  but  the
pulse still  remains frequent, and the  cough and difficulty
of  breathing  prove  persistent,  although these symptoms
are materially relieved by free expectoration.   There  are
still nightly exacerbations, and  irregular sleep.  The  ex-
pectoration is copious, opaque, and  in  some instances,
puriform.   Night sweats are frequent, occasioning  great
debility.  If the disease should not be relieved, the cough
will become croupy,  the  expectoration more  copious, the
dyspnoea increases,   there is diarrhaea,  and  death soon
follows.
  Physical Signs.—These are sub-crepitant, mucous, sibi-
lant, and sonorous rales.   It  is  said  by Laennec, that we
frequently have all the sounds in chronic bronchitis quickly
following each other,  which he calls, " cantus omnium
avium"  (the  song of  all the  birds).  If  the disease is
mostly confined to the extreme ramifications of the bronchi,
the sub-crepitant rale will be predominant; if the larger
tubes, the sibilant.   If the larger tubes are the seat of the
disease,  the sonorous rale will indicate it.

                    TREATMENT.
  In the early stage  of chronic bronchitis :
     R Compound Syrup of Stillingia...............
        Iodide of Potassa...............................
Oss.
33- 
EMPHYSEMA.                 301
Mix, and take one teaspoonful every five oT six hours.   A
salt pack should be  applied to the chest, and occasionally
moistened  with  equal parts  of the  Tinct. of Iodine  and
Aconite.   If there are night sweats, and  periodical exa-
cerbations :
     R  Quinine........................................... gr. xx.
        Iron by Hydrogen............................. gr. x.
        Cream of Tartar............................... gr. xxx.
Mix,  triturate, divide into eight  powders, and  give  one
every four or five hours.   If there is much debility,  a
liberal  use should be made  of porter, ale, or brandy, to-
gether with a nutritious animal diet.  Where there is much
irritation   of the  upper  part of the  bronchi, benefit  is
sometimes derived  from  the  use of astringent  gargles.
Also  by inhaling the vapor of Aconite  or Lobelia.
   If  the cough is troublesome at night, a small dose of
Lupuline,  Morphine, and  Prunin, may be taken at bed-
time.    When the disease assumes  a  tuberculous character,
it should be treated as in phthisis.
                       EMPHYSEMA.
         This term applies  to  air in the cellular tissue, all por-
      tions of which are liable to  the affection.  The sub-cu-
      taneous is  the most so ;  but all  the prolongations of this
      tissue  through the  body communicate  with  it by the
      areolar structure.  Thus the air when effused  into the
      cellular tissue may pervade nearly every tissue of the body.
         There are three ways by which air may make its ingress
      into the cellular tissue.   1. By  a  wound  of the integu-
      ment.   This is termed traumatic emphysema.  2. By the
      development of gas  within its  cells.   3.  By  a  fistulous
      opening through the lung, communicating with the pleural
      cavity.
*••                              26*
k 
302                 NEPHRITIS.
  The diagnosis  of emphysema is  seldom difficult.   As
when air accumulates  in the cavity of the pleura, it will
readily be distinguished from  empyema,  by the resonance
on percussion.  And when it  accumulates in the cellular
tissue, the swelling is uniform  and light, and yields a
peculiar  crepitant  sound upon  pressure,  caused by  the
removal of the air from one cell to the other.
  The prognosis will depend upon the cause of the emphy-
sema and the state  of the respiratory organs.
                    TREATMENT.
  In the treatment of this disease the object should be to
arrest its progress by preventing a further accumulation of
air  in the cellular tissue, and to remove that already accu-
mulated.   In  spontaneous emphysema  the only effectual
method of  arresting the disease is  to correct the morbid
state of the system, which gives rise to it.   When it pro-
ceeds from asthemic and typhoid disease, Quinine and Iron
with a liberal  diet will  generally arrest its progress.   By
scarification,  the air which has previously accumulated,
will make its escape.   In emphysema arising from wounds,
by enlarging the wound so as  to give free exit to the air,
the   difficulty  may  be  relieved.  Where it occurs as the
effect of a fistulous opening into the  pleura, the inhalation
of the vapor of nitrate of silver, together with astringents,
will generally  effect a cure.  If there is  tuberculous affec-
tion  of the lungs, it should be treated as directed under
that head.
  NEPHRITIS,  OR INFLAMMATION  OF THE
                      KIDNEYS.
                     SYMPTOMS.
  There is an acute pain in the region of the kidneys, with
some  fever, and a dull pain in the thigh of the affected
side.   The urine is  at first clear, but soon becomes of a 
CYSTITIS.                  303
dark red color.   The  patient feels great uneasiness when
he attempts to walk or sit upright.   He lies easiest on the
affected side.   The pulse is, at first, hard and full, but in
the course of a few days, it becomes small, weak, and quick.
The skin is hot, and the tongue covered with a dark brown
coat.
                   TREATMENT.
  Apply hot wet packs over the region of the  kidneys, and
give freely of the  syrup of Marshmallow, Oliver tea, &c.
Also, give the following compound :
     R Sweet Spirits of Nitre  ..................... §j
        Tinct. of Aconite............................ gutt. xxx.
        Gelseminum.................................. sjii.
Mix, and give fifteen drops every two or three hours as the
case may indicate.  If the  disease should prove obstinate,
a mild  alterative  of Euonymine should be given at  bed-
time, and Digitalis and Cream of Tartar should be substi-
tuted for the Aconite and Gelseminum.  The patient should
keep quiet, and in bed, and the diet should  be of a  light
vegetable character.
   CYSTITIS, OR  INFLAMMATION  OF THE
                     BLADDER.
   Inflammation of the bladder very much resembles that
of the kidneys in its symptoms.  But there  may be acute
pain and tension at the lower part of the bowels, and diffi-
culty of urinating,  with constant inclination  to do so,  and
also  to go to stool.
                   TREATMENT.
   The bowels should be  thoroughly evacuated by Jalapin
and Neutralizing mixture.  The patient should be placed
in bed,  and hot packs should be applied over the region
of the bladder.  The  bladder should be injected with a 
304
HEPATITIS.
luke-warm mucilage of slippery elm, and the patient caused
to drink of  Marshmallow, flaxseed, slippery elm, &c.  If
the inflammation is not thus controlled, give the following
compound:
     R Pulverized Acacia........................... gr. xx.
        Soft Water  ....................................gii.
        Sweet Spirits of Nitre..................... 5;ss.
        Tinct. Veratrum Viride.................... gutt. xx.
 Mix, give one half teaspoonful every half hour  until the
 symptoms are controlled.  Continue the mucilage until the
 patient is completely free from the disease.
  HEPATITIS, OR INFLAMMATION OF THE
                       LIYER.
                     SYMPTOMS.
  The diagnostic symptoms of this disease  are tension of
the right side, under the false ribs, attended with fever,
difficulty of breathing,  anorexia,  thirst, and a pale and
yellow appearance of the skin and  eyes.  When the inflam-
mation is extensive, the pulse becomes quick and hard, and
sometimes  irregular.  The patient is troubled with a dry,
hacking cough, and a constipated condition  of the bowels;
although, in the latter  stage of the disease, and in warm
climates, there is sometimes a diarrhaea with bilious vomit-
ing, great'tenderness in the hypochondrium, and dulness
on percussion.
                    TREATMENT.
  A hot sinapism should be placed over the region of the
liver.  The surface  should be bathed in warm lye water,
and the following compound be given :
     R Euonymin ....................................... gr. xx.
       Sanguinarin..................................... gr. x.
       Bitartrate of Potassa.........................gr. xxx. 
ASTHMA.
305
Triturate,  mix;  divide  into  ten powders, and give one
every three hours.  At the same time, if there is fever, give
from ten to twenty drops of the  Tinct. of Gelseminum so
often  as to maintain a gentle moisture of the skin.
   When the sinapism has produced  irritation of the sur-
face, it should be removed and hot packs  applied instead.
If the disease should  still prove  persistent, the following
compound must be substituted for the first:
     R Muriate of Ammonia........................... gr. xx.
        Irisin .............................................. gr. x.
        Gelsemin .......................................... gr. j.
Triturate, mix, divide into ten powders, and give one every
two hours until all are  taken, or until the disease is re-
moved.   If the disease  should  assume a chronic form, a
pill of the extract of Dandelion  and Capsicum should be
given two  or three  times a day.  If  the  bowels  should
become  constipated from a deficient secretion of bile, give
the following compound :
      R Syrup of Boneset................................. Oss.
       Common Salt...................................... !|i.
       Sulphur............................................gr. xxx.
Mix,  and give one  teaspoonful three times a day, and let
the diet be free and nutritious.
                     ASTHMA.
                     SYMPTOMS.*
   The symptoms  indicating asthma  are various.   Some
of them are premonitory, and, by those who are accustomed
to the affection, are understood as  warnings  of  an ap-
proaching attack.  Among  these  are loss of  appetite,
flatulence,  eructation,  languor, irritability,  drowsiness,
oppression and  chilliness.   Perhaps  he  retires  at night
with a sense of uncomfortableness.
* Calkins. 
306                   ASTHMA.
  It is very common for an attack actually to commence
sometime  after midnight, or about 2 or 3  o'clock in the
morning, and the general signs are much like the follow-
ing :
  Often the person is  aroused from sleep by a feeling of
constriction across his  chest, or inability properly to ex-
pand it.   He  raises himself in bed, and sits bowing for-
ward, perhaps with his  elbows resting on his knees, drawn
up  before  him.   His breathing  is labored, and attended
with  a wheezing noise,  often so  loud  as to be  audible in
another apartment, or at a distance.
   He asks for more air to be  admitted into the room, and
makes a strong voluntary effort to expand his  chest in
inspiration, and to contract it in expiration;  or, if  able,
he rises from his bed, and hastens to a door or window, at
which, however cold the weather, he  often long remains.
The labor of respiration gives warmth to his body, and he
often perspires  freely.   His  extremities, however, are
liable to become cold,   and his  countenance is  generally
distressed, pale  and haggard, though  sometimes it is red
and turgid. Often  the pulse is small,  feeble and  irregular,
though sometimes it is scarcely disturbed.   Sometimes the
heart palpitates, and flatulency becomes troublesome; the
urine becomes copious  and pale, and even the faeces are
passed with the impatient hurry of spasmodic action.  The
speech of the sufferer is interrupted and difficult,  and  there
is a propensity to cough, which  he sometimes favors with
the hope of forcing  away the impediment to his breathing.*

                    TREATMENT.
  In the  treatment of  this disease, the first thing to  be
attained is the relief of  the  excessive dyspnoea.  For this
purpose,  give the following mixture :
* Calkins on Thoracic Diseases. 
               CHOLERA  MORBUS.             307
     R Tinct. of Gelseminum.............................. §j.
          "    Lobelia....................................gss.
Mix, and give fifteen or twenty drops every ten or fifteen
minutes,  till the paroxysm passes off.   After which,  give
the following compound:
     R Quinine................................................ 31J.
       Cornine................................................ 3nJ*
       Compound Syrup of Stillingia................... Oj.
       Phosphate of Lime.................................. £}.
Mix, and give from one half to one teaspoonful three times
a  day, during the interval  between  the paroxysms  of
dyspnoea.   Whenever the paroxysms return, the Gelsemi-
num and Lobelia should be repeated.   But  as soon as
relief is obtained, the alterative and  antiperiodic should be
resumed. Other medicines, such  as Chalybeates and vege-
table tonics, if required to maintain the integrity of the
constitution, should be given.  The  above course, if per-
sisted in, will seldom fail to remove  this very troublesome
disease.
             CHOLERA  MORBUS.
   Cholera Morbus is a violent purging and vomiting, with
griping, sickness, and a constant desire to go to stool.
   It is occasioned by a redundancy of bile, by the fermen-
tation of food on the stomach, such as cucumbers, melons,
sweet-meats, cherries,  and all  unripe fruit.   Also exposure
to damp night atmosphere.

                     SYMPTOMS.
   It is  generally preceded  by Cardialgia, sour  stomach,
flatulency,  and  pain  in  the  bowels.   As the disease
advances, the pulse  becomes  very feeble, and the surface
cold and clammy.  The urine is scanty, and there  is almost
constant vomiting and purging. 
308
CHOLERA.
                    TREATMENT.
     R Neutralizing Mixture.............................. §y-
       Tinct. of Prickly Ash Berries................... §j-
Mix, and give from 30 to 60 drops every fifteen or twenty
minutes,  till the vomiting  and purging cease.  Apply a
hot sinapism over  the  region of the stomach and bowels,
and place jugs of hot water about the patient.   If the use
of the above mixture for a proper time does not afford relief,
give the  following :
     R Pulverized Camphor........................... gr. x.
           "     Capsicum.......................... gr. xv.
        Oil of Peppermint.............................. gutt. iij.
        Morphine........................................ gr- j-
Triturate, mix, divide  into ten  powders,  and give one
every half hour.  At the same time, give the patient freely.
of rice coffee, made by scorching the rice and preparing it as
common coffee.  . If the disease assumes a periodic charac-
ter,  some of the antiperiodic compounds  should be given
for the purpose of interrupting its periodicity.   After the
vomiting and  purging cease,  mild alteratives should be
given, as Euonymine, Hydrastin, &c.  The diet  should
consist  of  rice, dropped  eggs,  broiled  beef, &c.   The
patient  should avoid  exposure to the sun,  and violent
exercise, until completely recovered.
CHOLERA, EPIDEMIC OR  CHOLERA
                  ASPHYXIA.
  This disease began to excite general attention in 1811.
It commenced in Bengal in India, from which place it has
scarcely been  absent since.   In 1818 it passed  on to the
Coromandel coast, and in  the same year to Malabar, the
Burmese Empire, Sumatra  and Ceylon. In 1820 it spread 
                     CHOLERA.                  309

to China, and successively throughout the larger portion
of Eastern Asia, and to the islands of the Mediterranean,
to Arabia, Mesopotamia and Syria.  In 1821 and in 1822
to Persia. In 1831 it appeared in Prussia and in Austria.
In June of the same year it  appeared in St. Petersburg,
in October at Hamburg and London.  On  the  eighth  of
June, 1832, it first made its  appearance on the American
Continent in Quebec, and in  a few days at Montreal.  On
the 24th of  June in New York, on the  3d  of July in
Albany, on the 5th of July in Philadelphia,  on the 30th of
September in Cincinnati, from whence it spread to Madi-
son, Louisville, St. Louis, Maysville, Wheeling, and made
its way  to  most  of  the important  towns  in  the United
States.
   It reappeared in  America in  1848, where  it  has pre-
vailed as an epidemic  or in a sporadic  form ever since.
Its fearful ravages and well-known  fatality, have elicited
on the part  of the medical  profession, the  most anxious
'nquiries, in regard to its cause and pathology.

                     SYMPTOMS.
   Malignant cholera, like most  other epidemic  diseases,
presents a  great  diversity  of symptoms.   Its  attack  is
usually violent and sudden, but mostly preceded by certain
premonitory symptoms, such as a furred tongue,  diarrhaea,
with a complete loss of the digestive powers, and some-
times with headache and ringing  in the ears.  After these
symptoms  have continued for a longer  or shorter  time,
the  patient is  attacked with violent  Cardialgia  or  heart-
burn, soon followed  by nausea and vomiting, with a pro-
fuse  colliquative  diarrhaea.   The   discharges   from  the
stomach and bowels  resemble rice  water.  These  symp-
toms are soon followed by  great weakness and  sense of
exhaustion.
   The powers of locomotion are speedily arrested, and
       27 
310                  CHOLERA.
spasms affecting the whole of the muscles of  voluntary
motion, but particularly those of the arms and legs, come
on.   The pulse becomes small, weak, and accelerated, the
respiration  labored,  the tongue fiat, white,  and  moist.
These symptoms are soon followed by a sense of pain, and
burning  heat  in the  stomach, and great desire for cold
drinks.  The skin becomes cold, corrugated, and covered
with  a clammy sweat.   The lips, limbs,  and at  times the
entire body, have a peculiar livid hue.
   The pulse  decreases until  it  is no  longer  felt at the
wrist, the respiration is slow and feeble, the breath is cold,
the eyes are sunken, and surrounded by a livid circle.  At
this stage there is no secretion of the bile and urine, and
the vomiting,  purging,  and spasms  abate.   The  powers
of the mind seem unimpaired,  for the patient continues to *
answer questions freely ;  but he frequently expires in this
stage suddenly and without a struggle.
   The limits of this work will  not permit me to enter into
the details of the different varieties of this disease; but
suffice it to say, it often runs an entire  course  to a fatal
termination, without vomiting or cramp, but characterized
by the peculiar diarrhaea.  Again the diarrhaea may be
absent, and the vomiting be the principal symptom.  The
rice  water evacuations, together with the excessive pros-
tration, are sufficient to distinguish it from cholera morbus.

                    TREATMENT.
   The indications  to be  fulfilled  in  the  treatment  of
Cholera, are to arrest the diarrhaea and vomiting, and to
produce  reaction,  or  to  equalize  the  circulation, by
inducing the blood from the deep-seated,  to the superficial
capillary vessels.  For  the  purpose  of  arresting  the
vomiting and  diarrha?a,  small  doses  of Camphor, Capsi-
cum, and Morphine, should be given every ten or  fifteen
minutes, in a small quantity of Neutralizing Mixture: say, 
CHOLERA.
311
     R Pulv. Camphor..................................... gr. v.
       Capsicum........................................... gr. x.
       Morphine............................................ gr. j.
Triturate,  mix,  divide  into  ten powders,  and give  one
every  fifteen or twenty minutes in one half to one  tea-
spoonful of  Neutralizing  Mixture, until the nausea  and
vomiting cease.  At the same  time the patient should be
placed in bed  in a recumbent  posture, which should be
maintained during  the  entire active stage  of the disease.
The body should be thoroughly bathed in equal parts of
lye water, and Tinct". of Capsicum. Also apply sinapisms
along  the  spine, calves of the  legs, abdomen  and arms.
They  should be applied hot, made up  of good  ground
mustard, and wet  with  hot vinegar.   If there is thirst,
hot rice  coffee should be  freely given.  Also toast water
and essence of beef, prepared as directed in the treatment
of typhoid fever.   If the nausea, vomiting, and diarrhaea,
do  not yield to  the above treatment, the following com-
pound may be given:

     R Tinct. of Prickly Ash Berries................... ^iij.
       Neutralizing  Mixture.............................. giij.
       Tinct. of Capsicum................................. ^iij.
Mix,  and  give one teaspoonful in hot peppermint sling
every five or ten minutes.   Also inject the bowels with the
following mixture :
     R Starch Water......................................... Oss.
       Tinct. of Xanthoxylin Berries...................^ij.
       Morphine..............................................grs. iij.
Mix, and give six  ounces as an injection after each pas-
sage  from  the  bowels.   If reaction  should  not   follow
these  measures, hot brandy toddy  may be  given in con-
nection with them  every half hour.   If  there  should be
cramp with the vomiting and diarrhaea : 
312
CHOLERA.
     R Gelsemin.........................................  gr. ij.
       Hyosciamin......................................  gr. j.
       Pulv. Camphor...............................  gr. ij.
       White Sugar.................. .................  gr. xxx.
Triturate,  mix, divide into ten  powders,  and give one
every half  hour, or oftener, as the case seems to indicate.
  If  the discharges  continue,  and  the  patient be pros-
trated, the following  compound will  often be successful:
      R Rhusin...........................................  gr. xij.
        Quinine..........................................  gr. x.
        Piperine.........................................  gr. xx.
        Hydrocyanic acid.............................  gutt. iij.
        White Sugar..... ..............................  gr. xxx.
Mix, triturate, divide into twenty powders, and give  one
every thirty minutes.   If the sinapisms produce too strong
counter-irritation,  they should be taken off, and large hot
packs applied in their place.  If the reaction should  be
followed by fever,  Aconite should be given in quantities
sufficient to control  the  circulation, and  maintain mois-
ture of the surface.
   Where the patient has passed into the collapsed state,
the following compound is valuable  :
      R Xanthoxylin ............................ ........ gr. xx.
        Piperine.......................................... gr. x.
        Oil of Capsicum................................ gutt. x.
        White Sugar....................................gr. xxx.
Mix, divide into ten powders,  and give  as often as the
symptoms indicate the necessity.
   Shocks  of electricity, passed  through the stomach and
liver, have been  reputed of much value.   Also highly
stimulating diuretics, such as oil  of  Turpentine, Hemlock,
Wintergreen, &c.
   The following compound  was used with much success
by my colleague, the late Dr.  Hotchkiss : 
SMALL-POX.                 313
     R Chloroform............................................311.
       Tinct. of Camphor .................................. ^ii.
       Tinct. of Opium......................................51.
Mix, and give from  ten to twenty drops  every twenty or
thirty minutes, as the case may be.  As soon as the active
stage has passed off,  the patient should take freely  of fluid
nutriment containing the  elements of the  blood,  for the
purpose of restoring its exhausted condition.   Also, he
should remain quiet and  in bed,  and avoid both  mental
and physical exertions.
        SMALL-POX,  OR YARIOLA.
                     SYMPTOMS.

   The premonitory symptoms of this disease do not vary
much from those of ordinary bilious fever.
   It is generally preceded by more  or  less languor, auo-
rexia,  headache, and  constipation of the bowels.   When
these symptoms have continued for two or three days, the
pationt is seized with violent  pain in the back, increased
pain in the head and limbs, great restlessness; the pulse
becomes accelerated,  and the skin is hot and pungent.
The eyes are suffused, and in some cases the fever is alter-
nated  with rigors or chills.  On the fourth or fifth day of
the disease, small red spots make their  appearance on the
face and ueck, which gradually diffuse themselves over the
entire body.
   The eruption is  at first pustular, but in the course of
eight or  ten days becomes vesicular at  the apex, yet still
remaining, pustular at the base.   The vesicular portion of
the pustule  has a  cupped appearance,  while the base  re-
mains  white and opaque.   Maturation commences from
the tenth  to the  fifteenth day, at which time the pustules
become covered with  a  mahogany-colored scab, terminat-
ing in  desiccation  and desquamation, and  leaving a deep
                        27* 
314
SMALL-POX.
pit.  At this stage the patient generally has a fresh attack
of fever, called the secondary fever.   When the pustules
are very numerous, and run into each other, the disease is
called confluent small-pox.  This is decidedly more violent
than the simple form.
   There is extensive oedema of the face and lower extremi-
ties, and inflammation of the fauces, lungs, and in  some
instances, the  brain;  and the  disease not  unfrequently
terminates in consumption, blindness, and ulceration of the
intestines.
                    TREATMENT.
   In the treatment of small-pox, much diversity of opinion
exists among eclectic physicians ; but the treatment about
to be described has not only proved  universally successful
in my own practice, but in that of several of my colleagues,
who have had  the most ample experience in this disease.
   If called in the early stage, the first thing to  be  done  is
to give the. patient an active cathartic of Podophyllin and
Antibilious  physic.   The  patient  should  then  take a
thorough spirit-sweat, after which the body should be tho-
roughly bathed in hot lye water, and the patient placed in
bed, in a room well ventilated.   The following compound
should  then  be given :
     R Bayberry Bark,  Pulv.............................gss.
        Ginger,  Pulv........................................ §j.
        Macrotys,  Pulv...................................... §ij.
        Capsicum  ............................................. 3J.
Mix, put it in  one  quart of water, steep for fifteen  or
twenty  minutes,  strain,  sweeten, and  give two  or  three
tablespoonfuls  every hour during the  development of the
disease.  If there is fever, give  Aconite to control it, and
small doses of diaphoretic powders at night  to  procure
rest, if necessary.  The surface should be bathed in lye
water and whiskey three or four times a day.
   If the pustules should not fill well, and  the strength of 
MEASLES.                   315
the patient should fail, small doses of equal parts of Hy-
drastin and Quinine should be given three or four times a
day.   Also, give milk punch, beef  tea, and such  other
articles  of  diet as are easy of digestion  and nutritious.
Collodion should be applied as a wash morning and even-
ing, to prevent being marked by the eruption.  If the dis-
ease be of the complicated variety, the constitutional symp-
toms will require more attention.
   If the lungs become affected either by congestion tf  in-
flammation, they should be relieved by Lobelia and  Capsi-
cum.   If the liver is thus diseased, Euonymine and Lep-
tandrin may be used.   If the glands of the bowels  should
become diseased, Hydrastin and  the Nitrate  of Silver pill
as directed under the head of Typhoid Fever, should be
given.
   The fever should be controlled as in the simple form, and
the patient's strength maintained by the  use of beef tea,
wine, porter, vegetable tonics, Chalybeates, &c.
        RUBEOLA,  OR  MEASLES.*
  In  our  humble opinion, this is both  a contagious and
infectious  disease, affecting, in this  climate, children and
adults with  almost  equal severity;  the  disease is inflam-
matory, affecting at once the  skin and  gastro-pulmonary
mucous membrane; in which, after catarrhal fever has
continued  about three days, a rash appears on the skin, at
first in small stigmatized dots,  not unlike  flea-bites, which
presently coalescing, form patches of a crescent  or  semi-
lunar form ;  first on the face, and thence spreading gradu-
ally downwards over the whole body and limbs, at the end
of four days  they disappear by  desquamation of the
cuticle.  In short, the symptoms which  usher in an attack
of measles, are the  symptoms of coryza and catarrh.*
Massie's Practice of Medicine. 
316
MEASLES.
                    TREATMENT.
  In the great majority of cases,  but little treatment is
necessary, save to have the patient confined to  the house,
which should  be  kept of an  agreeable temperature, and
freely ventilated.   The clothing should be changed daily,
and the bowels kept regular by small doses of Neutralizing
Mixture and Leptandrin.
   Should symptoms of Pneumonia, Bronchitis, or Laryn-
gitis make  their  appearance, an emetic of  Lobelia and
Sanguinaria should be  administered,  together with  the
warm bath and laxative  enema.   As soon as the effects of
the emetic have passed off, the following compound should
be given, if a child over eight years of age;  if younger,
in proportion to the age :
     R Triturated Belladonna.......................... gr. x.
        Sulphate of Cinchonin........................ gr. xx.
        Triturated" Leptandrin......................... gr. xx.
Mix, divide into  ten powders, and give one every two
hours ;  also give freely of warm sage tea.
   If there  should be fever,  and  pain in the head,  five
drops of Aconite, added to three  ounces of water, and a
teaspoonful given every half hour,  will soon control it.
   If, as sometimes happens, the patient should be seized
with convulsions, small doses of equal parts  of Lobelin
and Scutellarin,  given  every ten  or fifteen minutes,  will
relieve  them.
   The  surface should be frequently sponged, and if there
is heat in the head, moderately cold packs  should be ap-
plied and continued until the head is relieved.
   The  diet should be light, and taken in small quantities.
If Ophthalmia makes its appearance during the disease or
afterwards, mild  zinc ointment should be used, and  the
eves should be frequently bathed in warm milk and water. 
OHIOKEN-POX — MANIA-POTU.      317
   VARICELLA,  OR  CHICKEN-POX.
   This is a contagious disease, and in its first appearance,
bears some resemblance to small-pox.

                    SYMPTOMS.
   Small, pointed, transparent  red vesicles, some of which
become pustular.   They run their course in from  five to
six days,  without  produoing any very marked constitu-
tional disturbance.
                    TREATMENT.
   The diet should be regulated, and  regularity  of the
bowels maintained.  If fever arises, give Aconite in small
quantities,  and  a gentle purgative  of  Euonymine  and
neutralizing mixture.
     MANIA-POTU,  OR  DELIRIUM
                   TREMENS.
  This disease in some of its symptoms, resembles inflam-
mation of the brain.   It is caused by the use of Alcoholic
drinks.
                    SYMPTOMS.
  Constant  wakefulness, and  motion  of the  hands and
arms, and continual delirious talk.   The whole  body is in
a state  of tremor, wrongs  are imagined, injuries  appre-
hended,  and the  patient constantly  beholds  imaginary
images,  which terrify his mind, producing great  mental
excitement.   This disease  is  easily distinguished  from
Pleuritis,  by the softness of the pulse, the flushed  face,
and the  habits of the patient. 
318         DROPSY  OP  THE BRAIN.
                    TREATMENT.
  In this disease  it is  necessary to continue the use of
stimulants,  in  a moderate degree.  The patient should
take warm whiskey toddy, mixed  with  starch water,  often
enough to maintain a decided influence of the spirits  upon
the brain.   At the same time give freely of beef tea,  wine
whey,  soft boiled eggs,  &c.   If the disease does not  yield
to the  above treatment, give the following compound:
     R Morphine.......................................... gr. ij.
        Capsicum..........................................gr. xx.
Divide into ten powders, and give  one every two or three
hours  till the disease yields.
   Or,
     R Scutellarin.......................... .............. gr. xx.
        Hyosciamin.......................................gr, iij.
        Cypripedin....................................... gr. xx.
Triturate,  mix, divide into  ten  powders, and give one
every hour.  When the disease becomes manageable, the
use of alcoholic drinks should be  discontinued, and the
patient warned  against the use  of a drug, the  effects of
which  are fraught with  so much  evil.   During  the  treat-
ment,  the bowels  should be  kept regular, by the use of
mild  stimulating  alteratives,  and  the  skin thoroughly
cleansed by bathing.
  HYDROCEPHALUS, OR  DROPSY  OF
                   THE  BRAIN.
                     SYMPTOMS.
  When the  disease comes on moderately,  the  patient
becomes peevish and fretful.  If it  is a child, which is
most  frequently the case, there will  be frequent  extension
of the hands  to the head,  and the sleep will  be  disturbed 
DROPSY OF  THE  BRAIN.          319
by  frightful  dreams,  causing  starting,  jumping,  and
Bcreams.
  As the  disease advances, there is  anorexia,  dizziness,
vertigo, nausea, vomiting, and delirium.
  The pulse is soft and quick,  and the tongue is covered
with a light coat.  In the early stage of the disease, the
bowels  are costive ; but  in the latter stage, there  is fre-
quently diarrhaea.  Paralysis and  convulsions often result
from this disease.

                    TREATMENT.
   In the  early stage of this  disease, Aconite should  be
given to control the fever and  inflammation.  After  which,
a purgative of Podophyllin and Jalapin  should  be  given.
Warm water and whiskey should  be applied to the head,
and sinapisms  to  the feet and calves  of the legs.  After
the operation  of  the cathartic, give  the  following com-
pound :
     R Syrup of Marshmallow........................... ^iij.
        Iodide of Potassium...............................gij.
Mix, and  give  one half  teaspoonful every hour.  At the
Bame  time, give two  or  three tablespoonfuls of  strong
Buchu and uva ursi tea, and ten drops of sweet-spirits of
Nitre every three hours.   If there is  much debility, con-
nected with periodical symptoms, the following compound
may be given,  with the above treatment:
     R Quinine............................................ gr. x.
        Ferrocyanide of Potassium....................gr. j.
        Digitalin............................................ gr. j.
        White Sugar....................................... gr. xl.
Triturate,  mix; divide into twelve powders, and give one
every three hours.  The purgative should  be repeated, and
the  strength of the patient maintained by the free  use of
Iron, vegetable tonics, and a nutritious diet. 
320       DROPSY  OP  THE ABDOMEN.
  ASCITES,  OR DROPSY OF  THE ABDOMEN.
                     SYMPTOMS.
   Swelling of the bowels, and  often a  fluctuation which
may be perceived by laying the  hand on one side  of the
abdomen, and at the same time gently rubbing the other
side.  This disease is mostly connected with Anasarca, or
a collection of water in the cellular tissue, indicated at
first by swelling of the feet and  ankles towards night, but
which disappear before  morning.  Pressure of the swollen
parts with the finger in  the evening, produces indentation,
which remains for some time.  The swelling  gradually
ascends to the trunk of the body, the arms and the head.
   At this time the breathing becomes difficult, the urine is
scanty  and high-colored,  the  bowels  are  costive,  the
countenance is heavy and bloated, the skin is dry, and has
a dirty sallow appearance, there  is a dry cough and  a slow
irregular fever.
   When these symptoms have continued for a longer or
shorter time,  there  is  generally a deposition  of  tuber-
culous matter  in  the  lungs, a hectic fever, and unless the
progress of the disease is arrested by  timely treatment,
death is the result.  The use of Mercurials, the suppression
of the Catamenia, Chronic ague, improper diet, &c, are
among the causes of this disease.

                    TREATMENT.
   The first object should be to remove the cause.   At the
same time, means should be resorted to by which the blood
may be restored to  a natural condition,  and at  the same
time relieve the different tissues from their incumbrance of
water.   The  patient  should  be placed  upon  a  strong
nutritious diet, and should freely use beef tea, porter, &c,
and should take the following compound : 
MUMPS.
S21
      R Iron by Hydrogen..............................gr. xx.
        Syrup of dwarf Elder.......................... Oss.
        Cream of Tartar................................ 5ss.
Mix, and give one tablespoonful three or four times a day.
Two or three times a  week the patient should  take  a
thorough spirit-sweat, and  the  body  should be sponged
every morning  in warm or cold water,  as the condition of
the case may indicate.

   If the patient's strength will warrant, a cathartic of
Jalapin and Cream of Tartar may be given once or twice a
week.   When the  above  course has been pursued for a few
days, if the patient does not manifest signs of rapid re-
covery, give the following compound :
      R Digitalin....................................... gr, jjj.
        Cinchonine.................................... gr. xxx.
        Phosphate of Iron.......................... gr. xxx.
        White Sugar.................................. zj,
Mix, triturate ; divide into  sixteen powders,  and give one
four times a day in watermelon seed  tea.

   After these are  all taken, the  syrup  should be resumed,
and the vapor bath continued.
   Every possible  means should  be  resorted to by which
the patient's strength may be maintained.
          PAROTITIS,  OR MUMPS.
   This is a contagious disease, affecting the Parotid gland.

                     SYMPTOMS.
   The skin becomes hot and  dry, the pulse increases in
frequency.  The tongue is covered with a thin white coat,
the bowels are costive, and the urine  is scanty and high-
colored.   These symptoms are followed by a swelling just
       28
i* 
322
EPILEPSY.
below the angle of the lower jaw, sometimes on one side,
at others on  both.   The swelling increases rapidly for
about two days,  when it begins to decline.
  This disease is frequently transferred from the glands of
the neck to the mammary  glands,  in the female, and to
the testicles of the male.

                    TREATMENT.
  If  there  is much fever in  the  active  stage, the body
should be bathed in warm lye water, and  Aconite given in
quantities sufficient to subdue it. The patient should keep
quiet, and in bed.  If the bowels are confined, a mild dose
of Antibilious Physic may be  given.   If there should be  a
metastasis of the disease, a stimulating liniment should be
applied, such as Tinct.  of Capsicum and Myrrh, and  a
mild  alterative  of Euonymine given two  or three times  a
day.
                   EPILEPSY.

                     SYMPTOMS.
  The patient falls suddenly,  and is  seized with convul-
sions.  The features are distorted and  fixed, the senses are
suspended, and the subject paralyzed.  During the struggle,
mucus, commingled with  bubbles of air, issues from the
mouth.   The breathing is generally hurried,  and the pulse
is feeble and  frequent.  These attacks  return at stated
periods, and generally increase in severity as  the patient
grows older.   The disease is frequently developed by irri-
tation from teething,  worms,  suppression of the menses,
blows upon the head, spermatorrhaea,  &c 
EPILEPSY.                  323
                   TREATMENT.
  In the early stage of the disease, but little need be done
save to remove the cause.  But after the disease has become
established, the convulsions will continue,  although the
cause be removed.
  In such cases the intermittent and antiperiodic treatment
is that  only  which has  proved successful in my hands.
While the  patient is  laboring  under the  paroxysms, the
following mixture should be given :
           R  Fluid Extract of Scutellaria,  \
               "    "    of Lobelia,     >• ad libitum.
               "    •'    of Cypripedrin, J
Equal parts.   Mix,  and give from ten to  twenty drops
every ten or twenty minutes, until the convulsions cease.
Then open the bowels by a mild, neutralizing physic, and
the skin by  tepid  baths, after  which  give  the  following
compound:
     R Chinoidin ....................................... gr. xxx.
        Fiburine......................................... gr. xx.
        Quinine .............,........................... gr. x.
Mix, divide into twenty powders, and give one three times
a-day.  Continue the powders between the  first four or five
paroxysms, and relieve the  patient during the paroxysms
by the anti-spasmodic mixtures, followed by the cathartic.
If the above treatment does not interrupt the paroxysms
in the course of eight or ten weeks, the following mixture
may be given between the spasms :
     R Port Wine.........................................Oss.
        Hydrocyanic acid ...............................gutt.  xx.
        Quinine ........................................... gr. xx.
        Iron by Hydrogen .......................".......gr. xxx.
Mix,  and give one teaspoonful  three  times a-day.   The
patient's bowels should  be opened by mild purgatives.
The mind should be kept cheerful, and  the diet should be
nutritious,  and of easy digestion.   The antiperiodic and 
324
APOPLEXY.
intermittent treatment should be pursued until a cure is
effected, which will be the case in the course of time, unless
there is some organic lesion of the brain.
                  APOPLEXY.

  Sanguineous Apoplexy is the effusion of blood into the
substances of the brain.   Traumatic, or Apoplexy caused
by blows on the head, is the effusion of blood into the mem-
branes of the brain.
                     SYMPTOMS.
  Apoplexy is generally preceded by giddiness, pain and
swimming in the head, ringing in the ears, and laborious
respiration.   In Sanguineous apoplexy, if the person does
not drop dead at once, he gradually becomes stupid, until
he passes into a profound sleep;  the face is swollen, the
eyes are fixed, the blood-vessels about the neck beat rapidly
and forcibly, the breathing is sonorous, and it is impossible
to arouse the patient from his state of lethargy.

                    TREATMENT.
  Ligatures should be placed around the arms close to the
shoulder; also, around the  legs at their  connection with
the body.   They should be  so adjusted as to admit of the
passage of the blood through the  arteries, but to prevent
its return through the veins.
  If the patient can swallow, a large dose  of antibilious
physic should be given.   The feet should be placed in hot
water, and cold water applied to the head.   If the circula-
tion  continues to be rapid, Yeratrum should be given  in
quantities sufficient to moderate its action.
  The ligatures should be kept on  until the patient appears
entirely relieved, but should  be  tightened  or loosened
according to circumstances.   If symptoms  indicate hemor- 
                          4
                            2
                 CHOREA — PALSY.             325
rhage to any considerable extent, small doses of Digitalin
should be given three or four times a day, in connection
with Iodide of Potassium,   The bowels  should be kept
regular, and the diet mild.
    CHOREA,  OR ST. YITUS'  DANCE.
                    SYMPTOMS.
  There is a lameness of one leg, which is partly deprived
of its natural motion.   The arms  are next affected, and
are thrown into various contortions.   The muscles of one
side of the face have a  constant involuntary motion.  The
appetite is lost, and the bowels become irregular.
                    TREATMENT.
     R  Scutellarin ....................................... gr. xxx.
        Cypripedin.......................................gr. xx.
        Carbonate of Iron.............................. gij.
        Port Wine........................................ Oj.
  Give  one tablespoonful three times  a day.  The bowels
should be  kept open with  small doses of  Euonymine, and
the surface should be bathed with tepid water every morn-
ing.  If the disease should be caused by suppression  of
the menses, Macrotin should be  given in  connection with
Iron.  If  by worms, Santonine and Podophyllin.   If  bj
ague, some of the antiperiodic compounds may he given.
          PARALYSIS,  OR  PALSY.
  If the palsy  is confined to  one side of the body, it is
called Hemiphlegia.   If to the lower half, Paraphlegia.

                   TREATMENT.
  When  the palsy attacks the heart, lungs, or any other
vital organ, it  soon  terminates  in  death.   But when it
                      28* 
326
PALSY.
arises from injuries of the spine, effusions into or softening
of the brain,  or in a deficiency of nervous fluid, the follow-
ing treatment may he resorted to with hopes of success.
First. The patient should be enjoined to remain quiet in
bed, and if an injury to the spine  is the cause of the dis-
ease,  the  irritating  plaster  should be applied along  the
spine.   The bowels should be acted upon by giving  small
doses of antibilious physic, and a mild current of electricity
should be passed from above the part of the injury through
the paralyzed  parts.  The   diet   should be  sufficient  to
maintain an ordinary degree of health.  A  liniment should
be  applied to the palsied part, composed of the following
substances:
      R Oil of Origanum.................................... gij.
          "  Capsicum.................................... gj.
          "  Stillingia.................................... gij.
          "  Alcohol...................................... Oj.
Mix,  and bathe the affected part three or four times a day,
following the same by brisk friction.  The patient should
take from one to  three drops of the Tinct. of Rhus Toxico-
dendron from  one  to three times a day.   If the disease
occurs  from injuries of  other parts of the  body,  a similar
course  should be pursued, both as regards the electricity
and counter-irritation.   If there should be  softening  of the
nervous centres,  or brain, from one to five drops of the
Tinct. of Phosphorus should be given three or four times
a day,  in  connection  with  chalybeates   and vegetable
tonics.
   This course should be persisted in for some length of
time, unless  the disease yields.  In quite a number of cases
with  which I have been familiar, recovery has taken place
after a lapse of more than a year's treatment. 
         LOCKED JAW — HYDROPHOBIA.      327

      TETANUS, OR  LOCKED JAW.

  This  disease generally arises from wounds, but  occa-
sionally it is a symptom of  other diseases.

                     SYMPTOMS.
  Stiffness in the back of the neck,  difficulty of swallow-
ing, rigidity of the muscles of the lower jaw,  also of  those
of the  spine, and  sometimes nearly all  the muscles of
the body are involved.

                    TREATMENT.
  If this disease is caused by a wound, it should be tho-
roughly burnt with caustic, and a poultice applied until  a
complete discharge is produced.  At the same time the
patient  should take a lobelia emetic, followed by Euony-
mine and Jalapin, until it operates as an  active cathartic.
After which, give the following compound :
     R Dioscorine.......................................gr. xx.
        Scutellarin....................................... gr, xxx.
        Quinine........................................... gr. xx.
Mix,  divide  into ten  powders,  and give one every two
hours until all are taken.   If the disease  is not removed,
the Lobelia emetic should be repeated, and again followed
by the powders.  The skin should be kept cleansed by lye
water baths, and a  free diet allowed.
The above  treatment  has  proved  triumphantly successful
in my hands in several well-marked cases of this disease.
               HYDROPHOBIA.
  This  disease is caused by  the  bite of rabid  animals.
The  wound generally  heals rapidly, and it is  not until 
328
DIABETES
twenty or thirty days  have elapsed that any pain is felt in
the wound.
                     SYMPTOMS
   Anxiety, restlessness, nervousness, loss of sleep,  horror
of water,  and finally convulsive spasms, are the prominent
symptoms of the affection.

                    TREATMENT
   In the treatment of this disease,  much  depends upon
thoroughness and  perseverance.   The wound should be
canterized with caustic Potassa, and caused 'to discharge
freely for five or six weeks.  The patient should take an
active Lobelia emetic, followed by  a brisk Podophyllin
cathartic, and a spirit sweat.   After which, the following
compound should be given :
      R Scutellarin....................................... gr. xx.
        Cypripedin....................................... gr. xx.
        Lobelin............................................ gr. v.
        Quinine........................................... gr. xxx.
Mix, divide  into ten powders, and give one every two
hours until  all are taken.  At the  same time,  a  strong
decoction of Plantain should be drunk freely during the
day.  Lupulin  and Hyosciamin should be given at bed-
time, to produce sleep.   The  emetic and other  remedies
should  be continued until the patient is entirely relieved
from the  disease.
   This treatment has proved  successful in the hands of
several  eclectic physicians.
  DIABETES, OR SACCHARINE  URINE.
This disease has its primary cause in the  stomach. 
DIABETES.
329
                     SYMPTOMS.

   It is generally preceded by debility, anorexia, dry skin,
pain in the lumbar region, and great thirst, with alternate
attacks of chills and fever.   On examining the urine, it is
found  to have a sweetish taste and smell.

                    TREATMENT.

   Give one grain of Aletrine in a tablespoonful of brandy
toddy  three  times a  day,  and  keep  the surface freely
bathed in warm broke water and whiskey.
   In the early stage of the disease, this treatment, if per-
sisted  in  for three or four weeks, will  generally  effect a
cure.    But in the more advanced stage,  where the kidneys
have  become  organically affected, the   irritating plaster
should  be applied over  that region, and  the following
compound given :
     R Xanthoxylin.................................... gr. x.
        Populin.......................................... gr. x.
        Prunin ....*...................................... gr. x.
        Sach.  Alba...................................... gr. xxv.
Mix, divide into twelve powders, and give one every three
hours.   After which, give the following  :
     R Syrup of Sugar.................................... gij.
        Tinct. of Capsicum............................... gij.
        Muriated Tinct. of Iron.......................... gj.
Mix, and  give  one teaspoonful three times a  day.  If there
are intermittent symptoms, some of the  antiperiodic  com-
pounds should  be given, followed by  bitters made  of
Brandy and Aletris Farinosa.

  The  bowels  should  be kept regular,  and  the  stomach
evacuated with Sanguimrin, and Lobelia if indicated. 
330                RHEUMATISM.
                RHEUMATISM.
  Acute rheumatism commences with weariness, shivering,
quick pulse,  restlessness, thirst, and fever.  The patient
soon complains of pains in some of the joints, which in-
crease  by motion.   The  parts  swell, and have a red and
inflamed appeafance, the tongue is covered with a heavy
white coat, the bowels are  costive, the urine  scanty and
high-colored.
                    TREATMENT.
     R Podophyllin...................................... gr. ij.
        Xanthoxylin.....................................gr. iij.
        White Sugar.................................... gr. xxx.
Mix, triturate, and  divide into eight powders.   Give one
every hour until it  operates as a cathartic.   After which,
give the following compound:
     R Sanguinarin......................................... gr. ij.
        Iridin................................................. gr. j.
        Quinine.............................................. gr. x.
Mix, divide  into  ten powders, and give  one  every three
hours.    The body should be thoroughly bathed in  strong
salt  and water, and  the  inflamed joints packed  with hot
cloths.   If the disease does not yield, a pill may be given
composed of the following materials :
     R Ext. Hyosciamus................................. gr. ij.
        Ext. Indian Hemp............................... gr. xx.
        Capsicum.......................................... gr. x.
Mix, form a mass, and make three-grain  pills.   Give one
every three or  four  hours.   If there is fever,  Aconite  or
Yeratrin should be  given to control it.   If the rheuma-
tism is of a chronic  character,  give  the following:
     R White Pine Turpentine....................... gr. xxx.
        Extract of Poke Root........................ gr. x.
        Macrotin......................................... gr. v.
        Apocynin........................................ gr. x. 
CROUP.
331
Mix, form a mass,  and make three-grain pills.   Give one
every five hours.   Animal broths should be taken freely
as a diet.   The kidneys should be stimulated  by mucila-
ginous  diuretics,   and stimulating liniments  should  be
applied to the affected limbs.
   Much care should be taken not to induce metastasis to
the heart;  but if that should  occur, Aconite,  compound
syrup  of  Stillingia, and  Iodide  of  Potassium  are  the
remedies,
 TRACHEITIS,  (CROUP,  OR INFLAM-
      MATION OF  THE  TRACHEA.)
  This disease is divided into two varieties, the spasmodic
and pseudo-membranous.   In the spasmodic form, there is
a sudden contraction  of the Trachea, owing to a slight
cold, or the transmission of irritation to that organ from
the stomach and  gums in teething.  The only treatment
required in this form of the disease, is  some active anti-
spasmodic.  It may be distinguished from  the Pseudo-
membranous variety, by its sudden appearance at  night,
when the child was apparently well during the day, and by
its almost as sudden disappearance on the administration
of a few drops of Tinct.  of Lobelia, and the application
of a wet pack to the neck.
   The  symptoms  of  the  spasmodic  kind, are a sudden
hoarse cough, followed by a whistling and difficult respira-
tion.
   The  symptoms  of  the  pseudo-membranous  kind,  are
very  insidious.   The  child  is  irritable,  restless,  and
peevish, and at times  has a  fever.   He will also be  ob-
served to spit  frequently.   These symptoms, in the course
of from twenty-eight to thirty-six hours, will be followed
by a slight  cough, which increases,  and  the  voice soon
becomes hoarse. 
332
CROUP.
  The disposition to spit also increases, and the sputa, if
examined, is found to be of  an albuminous character, thus
clearly indicating the nature of the disease.
  The symptoms are all  aggravated at  night, the pulse
becoming quick, and  the breathing laborious;  but in the
morning, they are much ameliorated.  In the afternoon,
the symptoms again appear, and are greatly  aggravated.
  The child throws his head back, and frequently grasps
at the neck, the expectoration ceases, the breathing is
more labored, and the pulse more frequent.  He is unable
to speak  above a whisper,  and unless relieved by proper
treatment, soon becomes stupid and expires.

                    TREATMENT.
   The treatment here  recommended, is of a very simple
character,  and  rather belongs to Prof. J. G.  Jones  than
to myself.  And as all other methods with which I have
been familiar have  almost universally failed,  while this has
always proved successful, I  most confidently recommend it
to the profession as the only radical  cure ever offered for
this  hitherto  almost invariably fatal disease.
   In the early stage, a thorough Podophyllin and Cream
of Tartar  cathartic should be  given, the feet should be
placed in  hot water, and a cold wet  pack applied to the
throat.   The pack  should be changed sufficiently often to
keep it cold.  After which,  the patient should be put upon
a mild acetic syrup :
     R Sanguinaria Pulv....................................3J.
       Acetic acid............................................  ^iij.
       White Sugar......................................... ^iij.
Mix, steep for fifteen or twenty minutes, and give one half
teaspoonful every half hour.  This prescription should be
continued as long as any symptoms of the disease remains.
If the treatment is  not  commenced until the disease  is far
advanced,  the cathartic sh >uld be omitted, and the syrup
m 
                      worms.                  333

given at once.  The bowels should be moved by laxative
enema, and the surface frequently sponged in tepid water.
  If the disease proves obstinate, two or three antiperiodic
powders  should be  given during  the  Apyrexia.   The
syrup  should also  be continued.  There  should be no
more of the syrup given than the stomach will tolerate.
  The strength should be maintained by a generous diet,
and all excitement should be avoided.
                     WORMS.

   According  to  the classification  of  the  entozoist, the
following are the different varieties that infest the alimen-
tary canal:
   1st.  Ascaris Lumbricoides, or common round worm.
   2d. Ascaris Yermicularis, or thread worm.
   3d. Tricocephalus Dispar, or long thread worm.
   4th.  Taenia Solium, or common tape worm.
   5th.  Taenia Lata,  or broad tape worm.
   The most common varieties of worms met with in this
country, are the common round  worm, mostly found in the
small intestines, and the  short thread worm, which inhabits
the rectum or lower portion of the bowels.

                    SYMPTOMS.
   The symptoms of  worms are various.  The most com-
mon are frequent flashes of fever, which disappear in  a few
hours; irregular appetite, irritable  temper, symptoms of
irritation about the fauces, tumefaction of the glands, fre-
quent changes in the appearance of the urine,  which  is at
one time scanty, and of a milky appearance; at others,
Qopious and  limpid.  The  irritation will be  so great at
times as to affect the brain, and convulsions follow.  If the
       29 
334
WORMS.
worms infest the rectum,  there will be constant itching and
uneasiness of  that  part, and at  times a  slight  sanious
discharge.
                     TREATMENT.
   For the long round worm :
      R Santonine .......................................... gr. vj.
        Podophyllin....................................... gr. j.
        White Sugar....................................... gr. xxx.
Mix, triturate, divide into twelve powders, and give one
every three or  four hours until they act upon  the  bowels
If this should fail, the following mixture may be given :
      R Neutralizing mixture..............................^iij.
        Essence of Wormwood ............................§j.
        Tinct. of Aloes......................................gss.
        Santonine............................................gr. x.
Mix, and give one teaspoonful three times a-day.
Or —
       R Santonine ......................................gr. x.
          White Sugar...............'.....................gr. xxx.
Triturate, divide into ten powders, and give one every night
on going to bed.   After two or three days, give a mild
purgative.   If the  patient is troubled  with Ascarides, in
addition to the above, injections should be  given :
      R Santonine .......................................... gr. xx.
        Hydrastin ........................................gr. xx.
        White Sugar......................................gj.
        Warm water......................................^iv.
Mix, and give as an injection every morning and evening.
If either variety  of the tape-worm afflicts the patient, the
following mixtures may be given:
    R Fresh Pumpkin-seeds after the shell is taken off ... ^ij.
       White Sugar ..................................................gij.
Bruise and mix.  Give  one  teaspoonful  every half hour
until  all is taken.  After which give a brisk purgative of
Podophyllin.   If the first mixture does not  succeed, it may
be repeated.   Or the following compound may be given: 
CHLOROSIS.
335
     R Oil of Male Fern.................................... Jjij.
        "   Turpentine.................................... §ij.
        "   Red Cedar..................................... 3J.
        "   Worm Seed....................................gij.
       Castor Oil ............................................f iij.
Mix, and  give one teaspoonful  every half hour  until it
operates upon the  bowels.   During the  treatment for the
tape-worm, the patient  should abstain from food ;  and if
the passage of the  worm is commenced, it should be care-
fully wound  around a stick, to  prevent it  from  being
broken.
         ANEMIA, OR CHLOROSIS.

                     SYMPTOMS.
  The symptoms of this disease are paleness of the skin
and mucous surface, and a  peculiar white appearance of
the conjunctiva.   When the  disease has advanced for some
time, the countenance  assumes a sallow and bloated ap-
pearance.  The patient is feeble, and cannot bear much
exertion.   The circulation is irregular and weak ; the re-
spiration, although  natural  when  the patient  is quiet,
becomes labored  on the least  exertion,  and there is fre-
quently violent palpitation of the heart.
  The nervous system  is most  disordered ; vertigo, dizzi-
ness, and feelings of fainting are not uncommon.  At times
there are violent neuralgic pains in the head, back, limbs,
and side.   In females the menses are almost entirely sup-
pressed or altogether wanting.   The blood in this disease
is found to be deficient in iron.

                    TREATMENT.
     R Carbonate of Iron...................................gij.
        Port Wine............................................. Oj.
        Common Salt.........................................^ij.
        Hydrastin ............................»...............3J. 
336
MILIARY  FEVER.
Mix,  and give one teaspoonful three times a day.   If the
patient is a female with partial or complete suppression of
the menses, the following pill should be given:
     R  Senecin............................................ gr. xx.
        Macrotin.......................................... gr. v.
        Vallee's mass .................................... gr. xxx.
        Podophyllin.................. .................... gr. j.
Mix,  form a mass,  and make three-grain pills.   Give one
in connection with  the wine tonic three times a-day.   The
diet should consist  of rich animal broths, and the patient
take  plenty of out-door exercise.  The  bowels should be
kept open by the use of some mild laxative, such as Apo-
cynia and Euonymine.   If the disease does not yield, the
following comp und may be given :
      R Brandy ... ............................................Oss.
        Water..................................................Oss.
        Phosphate of Lime.................................^ij.
        Iron by Hydrogen................................. gr. xxx.
        White Sugar.........................................giv.
Mix,  and give one tablespoonful three times a-day.   The
above treatment, together with  cold  baths, followed by a
reaction, will generally prove effectual.
                MILIARY  FEYER
   Is  characterized by an irregular eruption of round vesi-
cles of the size of a millet-seed, upon slightly elevated and
inflamed patches of cuticle.
   It  mostly commences with rigors and languor, a quick
pulse, hot and dry skin, and thirst.   The eruption gener-
ally appears about the  fifth  or sixth  day from the com-
mencement of the febrile attack.   Previous to its  appear-
ance,  there  is a sense of pricking or  itching of the skin.
The patient complains of great praecordial oppression, but
is soon relieved by a profuse perspiration, and in the course 
MILIARY  FEVER.
337
of from three to five  days the vesicles  form into small
scales, and fall off.
  The eruption is generally distinct, but is sometimes con-
fluent.  It is said rarely to  affect the  face, and different
crops may appear in the same fever.  It is mostly a symp-
tomatic disease, and occasionally appears in the course of
nearly all  low forms of fever; — although it may be idio-
pathic when  it attacks those who have been previously
weakened by fatigue,  or a long  exposure to damp  and
malarious atmosphere ; or who have been for a long time
confined to a bad regimen.

                    TREATMENT.
   As  this  disease  is  mostly dependent upon  constitu
tional debility, caused  by some previous difficulty, it will
be of the  first importance to ascertain  the  cause, and  re-
move it;  after which the skin should be thoroughly bathed
in warm  lye water,  and small doses of Aconite adminis-
tered until a free perspiration is produced.  For the pur-
pose of stimulating the secretions,  and as a mild purgative3
the following compound should be given :
        Euonymin ......................................... gr. iij.
        Irisin................................................. gr. ij.
        White Sugar........................................ gr. xxx.
Triturate, mix, divide into  ten powders,  and  give  one
every hour until  all  are  taken, or until  they act  upon the
bowels.   If the disease does not yield to this mild treat-
ment,  small doses of Quinine and Iron  together, with an
active, stimulating,  and nutritious diet, should be resorted
to.   When the active stage of the disease is passed, the
patient should be  allowed a liberal quantity of  porter, in
connection with vegetable tonics and chalybeates.   If the
disease is connected with a scrofulous  diathesis, the com-
pound syrup of Stillingia, with Iodide of Potassium, should
be given until the patient is entirely restored.
                          29* 
338       ROSE-RASH — NETTLE-RASH.

       ROSEOLA,  OR  ROSE-RASH,
  Is a fever  attended with a rose-colored efflorescence,
and not  contagious.   It has often been confounded with
measles and  scarlet-fever.   It mostly depends upon  indi-
gestion,  and seldom  requires medical  treatment.  The
diet should be regulated, and if the fever is troublesome,
small doses of Aconite, and a gentle  purgative  of  Neu-
tralizing mixture, may be given.
   URTICARIA,  OR  NETTLE-RASH,
   Is characterized by circular elevations of the cuticle, of
a red color, writh a white spot in the centre.
   The  eruption is generally preceded by gastro-intestinal
irritation  and  fever.   There  is  frequently restlessness,
languor, and anorexia.   If the eruption  is  extensive, the
patient suffers much from the itching and heat which it
occasions.   This disease is frequently caused by excess in
eating and drinking, also by undue heating  of the blood.
It may continue  for an indefinite  period,  and reappear
whenever the stomach becomes deranged.

                    TREATMENT.
   The  patient's diet should be well regulated, and  all
excesses carefully  avoided.   The surface should be freely
bathed, two  or three times  a week, and a mild vegetable
alterative and tonic be  given.  If the disease assumes a
periodic character, as it sometimes does, an antiperiodic
should  be  administered, succeeded by the following com-
pound :
     R  Cream  of Tartar............................... gn xxx.
        Leptandrin..................................... gr. xx.
        White Sugar................................... gr. xxx.
Triturate,  mix, divide  into ten powders,  and  give one
three times a day. 
THE  PLAGUE.
339
                THE  PLAGUE.
  This disease is regarded  as nothing more than a malig-
nant typhus fever, attended during its  course, by buboes
and carbuncles.
  Mackintosh gives the following diagnostic symptoms of
the Plague:
  It is ushered in by rigors and  oppression, followed by
heat  of the skin, great prostration of  strength, giddiness
and headache.   The expression of the countenance is be-
sotted, and the eyes have a muddy glistening appearance.
  The intellect  is sometimes cloudy,  at  others there  is
insensibility and fixed delirium.
  Occasionally,  stupor takes place, and in some instances
the functions of the brain remain distinct and clear.   The
patient  in  general  seems indifferent respecting his fate.
The  tongue is at first  moist, although it  is more or less
loaded.   There is sometimes constipation,  at others diar-
rhaea.  The stools are very offensive, and there is constant
nausea  and vomiting.   About  the third  day from the
attack, there is acute pain, followed by redness and swell-
ing in the  arm-pits  and groins, which terminates  in  car-
buncles and  buboes,  unless it  is  immediately relieved.
And unless suppuration  soon takes place, death speedily
follows.  It is stated that  if the patient survives the fifth
day, and the buboes appear well-formed, the patient may
be pronounced  convalescent.   The points  of danger  in
this disease appear  to  be, the  time in which the buboes
ought to appear, and the time of maturation.   For a full
description of this disease, the  reader is referred to the
writings of Dr. James McGregor, who has described it
minutely, as it appears in India and Egypt. 
340          DIFFICULT DENTITION.
                    TREATMENT.

  Cullin condemns both blood-letting  and purgatives in
this disease, and states  that  the  chief object  in the treat-
ment  should  be  to relieve  the spasms of the extreme
vessels.   For this, he recommends the  application  of oil
to the surface, and some antispasmodic internally.   There
can be  no doubt that  this  disease  requires a vigorous,
stimulating,  and  antiperiodic treatment from  the com-
mencement.   From all the  information I  can obtain, I
should  make a liberal use  of hot  alkaline  baths, anti-
periodics, and a free use of Aconite to  control  the  fever.
Also  a liberal use of tonics, antispasmodics,  and stimu-
lants, with a nutritious diet.
         DIFFICULT  DENTITION.
  Few  children pass  through  the  process of dentition
without more or less suffering, and often a variety of com-
plicated symptoms  make their appearance, all depending
upon one general cause, viz : dentition.  It has long been
observed, that  children who pass through  the  period of
teething early, suffer less than those whose teeth are longer
making their appearance.
  The ages at  which children cut their teeth are various.
There are instances of children being  born with full sets
of teeth, as is  recorded of  Richard the Third and  Louis
Fourteenth.  In general,  however,  the  teeth begin  to
appear  between the age of six and  eight  months.  The
two  centre incisors  of the lower jaw,  are  commonly cut
first, and are  soon followed by those of the  unper, after
which  the two lateral incisors of the lower, and then
those of the upper jaw make their appearance.   Between
the twelfth and sixteenth months, the intergrinders of the 
DIFFICULT DENTITION.          341
lower jaw appear, and next in succession are the cuspides
or eye teeth.   The others soon follow, so that  by the age
of two  years,  the  child has its complete set of  teeth,
twenty in number.  The formation of each tooth goes  on
in a membranous and vesicular sack, which is firmly united
to the gum.   It is supposed that in tedious and difficult
dentition, the sack becomes more vesicular, and is materi-
ally  thickened.   This, together  with the pressure of the
teeth upon the gums, is supposed to be the only cause of
the various ills incident to this period.
   The teeth  are composed of Phosphate and Carbonate
of Lime, Fluoride of Calcium and Cartilage.
   On analysis  by Berzelius they were found to be  com-
posed of
          Cartilage and vessels........................28.0
         Phosphate of Lime............................64.3
         Carbonate of Lime............................  5.3
         Phosphate of Magnesia......................  1.0
         Soda with Chloride of Sodium.............  1.1
   According to  Lessaigne,  it appears  that as the teeth
become  older there  is  an increase  of  the Phosphate  of
Lime, and a  corresponding diminution  of the  Carbonate.
From the above facts,  it seems the food should contain
these elements,  to enable the teeth to become perfectly and
timely developed.   The cause of the diseases so frequently
identified with  dentition, is  a lack  of  the proper  histo-
genetic material, thereby causing a  drain upon the other
tissues,  which,  together with the long-continued irritation
of the teeth  upon the nerves, produces a train of morbid
symptoms, which are attributed to anything but their true
source.
   The child, under these  circumstances, becomes restless,
fretful and feverish, the  sleep is disturbed, the  bowels are
irregular, the face is flushed, and in some cases  there is
slight spasmodic twitching of the muscles, and in others
general convulsions. 
342          DIFFICULT DENTITION.
   Sometimes the  child becomes troubled with an irritable
cough,  with  wheezing, a hot skin, quick pulse and scanty
urine, denoting great irritation of the bronchial and pul-
monary tissues.  Cutaneous and glandular affections often
occur.  The  sub-maxillary  glands  are those most com-
monly affected.  Occasionally there is inflammation of the
eyes, causing purulent Ophthalmia.
   The enumeration of the above symptoms will show the
importance of a correct diagnosis in these cases.

                    TREATMENT.
   There is no disease in which  the  ordinary allopathic
treatment proves more mischievous than in this.
   The poor  child has its gums scarified and  mutilated to
no purpose.   In some cases its stomach and bowels are
entirely destroyed by the drastic  doses  of Calomel, Rhu-
barb, Prepared Chalk, and the like;  while in other cases,
Opium, Paregoric, Godfrey's Cordial, Bateman's Drops, and
a  long  catalogue  of irritants and narcotics, tending still
farther  to  depress  the feeble vitality  of the child, cause
Dropsy of the Brain, Tabes Mesenterica, and Tuberculous
Consumption.  Now these medicines have not one particle
of the aliment needed to build up the  structure which is
making such extensive drains upon the  other  tissues, and
causing such derangement of the vital powers.   The scari-
fying of the gums frequently produces an irreparable injury
to the teeth,  by denuding  them of their soft enamel, an
injury seldom  repaired.   Hence the  frequent premature
decay of the teeth.   The proper treatment  consists  iu
administering in small  quantities  those elements  of which
the system is deficient.   For instance :.
      R Phosphate of Lime..............................  gr. xx.
       Carbonate of Magnesia......................... gr. x.
       Phosphate of Iron.,............................. gr. v.
       Simple Syrup..................................... ?iij. 
DIFFICULT DENTITION.
343
Dose, one teaspoonful three or four times a day.  If there
is fever, a few doses of Aconite,  given at intervals of from
half an hour to an hour, will be  sufficient to control it. If
the  disease proves  persistent,  or  assumes  a periodica]
character, Quinine may be given in combination with some
of the other articles, or alone as indicated.   If Bronchial
irritation is the prominent symptom, two or three drops of
the  Tct. of Yeratrum  may  be given every three or four
hours until the symptoms subside.  If there is  diarrhaea,
Neutralizing Mixture,  with  small doses of Geranin,  should
be given.   The surface should  be  frequently bathed, and
the diet should be nutritious and of easy digestion.  The
Lime, Magnesia and Iron should be  continued  from time
to time until dentition  is complete.
   Many cases might be adduced to  illustrate this mode of
treatment,  but one will suffice.
   In June, 1855, I was called to see a  child fourteen
months old, in which the teeth had not made their appear-
ance.
   The Doctor (Allopathic)  had pronounced it  to have
Pneumonia.  It had been afflicted with alternate diarrhaea
and costiveness for three months, and on two  or three
occasions had had convulsions.  Its gums had been  lanced
eight or  ten  times.   I immediately ordered Magnesia,
Lime and Iron, with small  doses of Quinine, and a good
diet, and in three weeks the  constitutional difficulties had
disappeared, and the teeth  had  begun to make their ap-
pearance.   In the course of six  months, by the occasional
use of the above  remedies, the teeth were fully developed,
and the child restored to perfect  health. 
341
03 S 0 P H A GI TI S.
INFLAMMATION  AND ULCERATION  OF  THE
                   OESOPHAGUS.
  There is no structure  in  the human  body more exempt
from disease than the oesophagus; but when it becomes
inflamed, it  is quite difficult  to  detect it  until ulceration
and constriction take  place.
  Inflammation may be  partial, affecting only a small
portion of the  oesophagus, and if ulceration  occurs, there
will be no contraction; but the patient  will  feel  slight
pain, and there will be momentary stoppage of the food as
it passes on to the stomach.  If the whole caliber is in-
flamed, the  difficulty  of swallowing will be much greater,
not so much owing to the stricture of the oesophagus, as
to the  constant tendency to vomit.  There will  be more or
less constitutional symptoms, as debility,  hot skin, scanty
urine,  &c.  Not unfrequently the entire system materially
sympathizes with the  local affection.

                    TREATMENT
  The constitutional  symptoms should be  removed, and at
the same time  an irritating plaster should be  applied to
the throat,  or  the region of the inflamed and ulcerated
parts,  and caused to remain until a free discharge  ensues.
The bowels should be  maintained in a soluble state, and
the skin freely bathed in hot lye water and whiskey as often
as two or three times a week.  And  the  following com-
pound should be administered:
     R Syrup of Marshmallow..........................^iij.
       Syrup of Iodide of Iron........................... ^ij.
       Compound Syrup of  Stillingia.................. gj.
Mix, dose one teaspoonful three times a day.  The diet
should be nutritious and easy of digestion, and every pos-
sible exertion should be made to maintain the integrity of
A 
GASTRODENIA.
345
the constitution.   If the ulceration  proves unyielding, a
strong solution of Hydrastin, to which  may be added a
few drops of the Tct. of Iodine,  may be taken in reason-
able doses three or four times a day.
   If the above treatment should not prove successful, the
application of a mild solution of nitrate of silver may be
made once or twice a week by means of  a probang.   The
above remedies will be sufficient to effect a cure,  provided
the cause of the disease has received due attention.
                GASTRODENIA.
   Gastrodenia is a neuralgic affection of the stomach, and
is closely allied  to dyspepsia, and in some instances  ap-
pearing as one of its symptoms.   Sometimes the appetite
remains good, but  generally it  is  impaired.  There is
gnawing pain  in the stomach,  extending to the  back,
accompanied with anxiety and  sense  of constriction, with
a strong tendency to vomit.  There is constipation of  the
bowels, and more or less pain in the head.  The principal
causes of  this disease are the long-continued use of indi-
gestible food, very warm  or very cold drinks, or the  use
of Alcoholic drinks, schirrous and cancerous affections of
the stomach, &c.
                    TREATMENT.
   If the disease is dependent, either upon irregularities of
eating or drinking, or upon the excess of either, this should
be  carefully avoided.  During the  attack,  much  benefit
may be derived from an emetic.
     R Lobelia Seed Pulv............................... gr. x.
        Bayberry Bark Pulv............................gr. xxx.
Mix, add one half pint of warm water, two tablespoonfuls
of milk, sweeten, steep fifteen minutes, and give a wine-glass
full every fifteen minutes till it operates freely as an emetic.
After which,
       30 
346
H.EMATEMESIS.
     R Lupulin.................„....................... gr. x.
       Scutellarin...................................... gr. xx.
       Leptandrin.................................... gr. xxx.
Mix, triturate; divide into  fifteen powders, and give one
every three or four hours.  If the pain still continues in
the stomach, small doses of Morphine may be taken at bed-
time.   The  constitutional symptoms  should be carefully
attended  to, and if the disease becomes periodical, one of
the antiperiodic preparations should be administered. The
diet should  consist of animal and vegetable broths, and
the body well bathed in warm or cold water as often as
three or four times a week.
               HJSMATEMESIS.
   This disease most frequently attacks women, particularly
those who are of a plethoric habit, and at times when there
is a suppression of the  catamenia.   Each attack is  gene-
rally preceded by rigors.   Pure blood is seldom vomited,
unless caused  by internal violence  or corrosion of the
vessels of the stomach.  The blood seldom coagulates, and
seems to be the product of passive hemorrhage,  or exuda-
tion from the minute vessels of the mucous membrane.
   The diagnostic symptom of hemorrhage  from the sto-
mach is  a sense of weight and  pain in that region,  unac-
companied by cough.   Every part  of the  mucous  mem-
brane of the alimentary canal is  perhaps equally liable to
passive hemorrhagic exudation.
   Occasionally the disease is so general as to give rise to
a sanguineous cholera.   In some instances it is confined to
the bowels, the stomach not participating in  it.   The most
alarming  intestinal hemorrhage  is called melaena, and is
characterized sometimes by full discharges of black blood,
resembling ink mixed with sand ; but at others,  it is more
of a sanguineous character. Hemorrhage from the stomach
A 
HEMORRHAGE.                347
and bowels produces great exhaustion, and unless relieved,
soon  proves fatal.  This disease frequently accompanies
some  form of fever, especially typhoid fever.   When the
hemorrhage is from the stomach, it is a less fatal symptom
than  when  it occurs from the  bowels; yet  it  rapidly
exhausts the patient,  and  frequently  proves  disastrous,
unless timely relief is given.

                   TREATMENT.
  In hemorrhage from the stomach or bowels, an infusion
of matico,  in  connection  with  the ligatures, and hot
turpentine and  mustard  sinapisms, will  generally give re-
lief.   If the patient is  an adult, give  two or three table-
spoonfuls of a strong tea, made of the matico leaves, every
five minutes.  At the same time apply the ligatures to the
arms  and  legs;  also, a sinapism  over the stomach  or
bowels,  as the  case may be,  made  by  taking  one table-
spoonful of mustard, four tablespoonfuls of pulverized slip-
pery  elm, and one of oil of turpentine, mixed with hot
water, and applied as warm as the patient will bear it.  The
matico  tea  should be  continued until the hemorrhage
ceases, or for one or two hours.  If it proves  ineffectual,
a pill may be given, made as follows:
      R  Nitrate of Silver'...... ............................ gr. j.
        Geranin  ............................................... gr. x.
        Pulv. GumArabic  .................................. gr. xxx.
Triturate, and make sixteen pills.   Give one  every half
hour  while  the hemorrhage continues.   After  which the
patient's strength should be well supported by vegetable
tonics,  iron, and  a generous  diet.   If the hemorrhage
should  be  owing to a suppression of the catamenia, the
feet should be immediately placed in a tub of warm water,
and a large  Galbanum plaster  applied along the spine and
across the lower  portion of the abdomen.   Also, ten  or
fifteen drops of the oil cf Erigeron should be given  every 
348
JAUNDICE.
fifteen minutes, until the hemorrhage ceases.  After which
the patient should be treated as directed under derange-
ment of the menses.
      JAUNDICE,  OR YELLOWNESS.
  This appearance is owing to the deposit of the coloring
matter of the bile in  the skin and other  tissues  and fluids.
This  substance must be presumed to exist in the blood of
the jaundiced patient,  and  it is  claimed to be found in
healthy blood.   But the prevalent belief is that  the bile-
pigment  is  absorbed after having been secreted by the
liver: an opinion founded upon  the most  common cause
of jaundice, i. e., the obstruction of the  ductus  communis,
or one or more of the branches of the  hepatic duct, by a
gall stone, or by the  pressure of a tumor, &c.  But among
the most common causes of jaundice is  a deficiency of the
secreting cells of the liver ; consequently no biliary secre-
tion takes place.  Jaundice is considered by some as an
idiopathic disease, but it is mostly a symptom of some spe-
cific   difficulty, and  for which it serves as a  diagnostic
symptom.   It  is a  phenomenon of several fevers, viz.:
bilious remittent and yellow;  also of  different affections
of the liver,  gall-ducts, and stomach.    When it comes on
with  indigestion, slight fever, sluggishness, and  pain  in
the hypochondrium,  it  may be regarded as a functional
disease of the liver and stomach.   But when it follows vio-
lent and spasmodic  pain  in the  region of the  liver, it is
dependent upon the  arrest  of gall-stone  in the biliary pas-
sage.   When it  precedes  delirium or  coma and convul-
sions, it indicates disorganization of the hepatic cells; and
when  it comes on slowly and lasts a long time, and acquires
a dark tinge, it depends either upon organic disease of the
liver,  or  some of the neighboring organs obstructing  the
discharge of bile into the  duodenum.   The symptoms  of 
JAUNDICE.
349
jaundice,  excepting the yellowness, depend much upon the
cause of the difficulty, though in all cases the skiuis husky
and dry ;  the urine partakes of the color of the skin ;  the
fa?ces are  either of a dough or grey-ash color, and in most
cases there is constipation of the bowels.  The other symp-
toms  vary in different cases.

                     TREATMENT.
   The  treatment  of this disease should depend entirely
upon its  cause as  indicated by  the symptoms connected
with  it.   If it depends upon a functional disorder of the
liver, the  following compound may be given :
        Euonymine......................................... gr. x.
        Podophyllin ........................................ gr. ij.
        Gelsemin ........................................... gr. j.
        White Sugar.......................................gr. xxx.
Mix, triturate, divide into six powders, and take one every
two hours.  After which —
      R Phytolaccin ....................................... gr. vj.
        Flour of Sulphur................................. gr. xxx.
        Extract Dandelion ............................... gj.
Make twenty  pills,  and take one four times a day.   The
surface should be  freely bathed, and the diet should be
easy  of digestion.   After the pills are taken, the following
may be given :
      R Cream of Tartar.....................................  gij.
        Sanguinarin ..........................................gr. x.
        Sulphur............................................... gr. xx.
        Iron by Hydrogen .................................. gr. xx.
        Best Gin............................................... Oj.
Mix, and take one tablespoonful three times a-day.  When
the disease  is  dependent upon  the arrest of gall-stone in
the biliary passage,  a thorough  Lobelia emetic should be
given, followed by a spirit-sweat and a brisk purgative, as
follows :
                           30* 
350         DISEASES OF THE HEART.
     R Podophyllin ......................;................... gr. ij.
       Cream of Tartar.................................... gr. x.
       Gelsemin .............................................. gr. ss.
Mix, triturate,  and divide into four powders, and give one
every two hours until it operates as a cathartic.

  If the above  prescriptions fail to give relief, they should
be repeated at  proper intervals.
        DISEASES  OF  THE  HEART.

  The most common disease of this organ is fluttering or
palpitation.  This may be connected with various structural
changes in the organ, yet it frequently exists independent
of any such change.  " The distinction between organic and
functional disease of the heart," says Dr. Walshe, "is far
from being easily made.  Many of the general rules  given
for this purpose  fail clinically."  The inconstancy of func-
tional and the constancy of organic  ailment are strongly
dwelt upon for examples. But all the subjective and many
of the objective symptoms  may  disappear  temporarily in
cases of extensive organic disease. The existence of secon-
dary changes, such  as sub-cutaneous oedema,  congestion
of the lungs, &c, commonly proves the cardiac affection to
be organic, but  not always; for  spanaemia, added to ner-
vous palpitation, may  induce oedema.   If exercise relieves
a disturbed  condition of the  heart,  its  affection is pro-
nounced to be dynamic only;  but if spanaemia exist, exer-
cise  may  be  unbearable.   From  these remarks of Dr.
Walshe, it will be perceived that without much care, func-
tional and organic disease of the heart are liable to be con-
founded.   Indeed, nothing was  more common   than this,
previous to the  discovery of physical diagnosis and their
complete  elucidation by  Laennec.  And now, without re-
peated physical examinations, even an adept in this method 
DISEASES  OF  THE  HEART.        351
of diagnosis may mistake mere irregularity of rhythm for
structural cardiac disease ;  as  it is now universally admit-
ted that palpitation, when  connected with  spanaemia, will
not only produce a basic  systolic murmur, but a systolic
murmur at the mitral apex may be generated by the irregu-
lar action of  the musculi  papillaries,  and  even  the  area
of dulness may be extended temporarily, owing to the dis-
tension of the  cavity of the heart with blood.

    SYMPTOMS OF  DYNAMIC  PALPITATION.
   According to Laennec, the first impression conveyed by
the stethescope is,  that  the heart is not enlarged.   The
sound is not heard  loudly over a great extent, but this de-
pends very much upon the thickness  of the chest.  Laennec
states that in nervous palpitation  of  the  heart, the heat
of the patient is never sensibly  elevated by the increased
action of the heart,  which is the case in organic disease of
this organ.  This may be true as a general rule, but is far
from  being  universally so, as my own  professional expe-
rience has proved.  Dr. Walshe states that in nervous affec-
tions  of the heart, the  area of dulness  remains unaltered;
but that distension to the right of the  sternum may  occur
in prolonged  paroxysms.   He  states   also that the first
sound is too loud and clear at the mitral apex, and some-
what  abrupt and short.  The sound is duller and less click
ing than is natural at the mid-sternal base.  The first sound
may be  loud enough to be audible both to  the patient and
to the bystanders at a distance of some inches from the
chest.   Reduplication of the second sound  at  the base is
common; and a clear metallic ring or a praecardial rub
may accompany the shock at the mitral apex.
   Prof.  Calkins remarks, that in order to form a correct
diagnosis, we should recollect that the character of organic
disease of the heart  is to progress ; that of functional to
occur at regular intervals;  that  active exercise almost 
352
DISEASES  OF THE HEART.
invariably aggravates  organic, but  seldom increases  the
symptoms of functional; that the physical signs generally
are  soon developed, and  remain permanent in  organic,
while they seldom  exist — and  when  they  do,  they arise
from chlorosis — in  functional.   The  rational  symptoms,
which more frequently occur in nervous disease of the heart,
than in functional, are choking in the throat,  precordial
anxiety, with faintness and actual syncope,  or active pains
simulating angina.  The pulse beats with increased fre-
quency, and there is a clammy coldness of the extremities,
with a flushed face.   The fits of palpitation may last for a
few minutes,  or they may last for hours, or  even days.

                    TREATMENT.
   During the paroxysms, the remedies should  be of such
character as to lessen  their intensity, and, if possible, at
the same time to remove the cause. If this cannot be done,
the paroxysm should  be relieved, and an  effort made to
remove the cause afterwards.  For the purpose of relieving
the paroxysm,
     R Gelsemin..........................................  gr. j.
        Scutellarin.......................................  gr. x.
       Cypripedin........................................  gr. xv.
       White Sugar......................................  gr. xxx.
Mix, triturate;  divide into  eight powders, and give one
every hour until the paroxysm is  relieved.   At the same
time, the feet should  be bathed  in warm  water, and the
patient should  avoid  all  mental and bodily excitement.
After which,  if there is spanaemia,
     R Quinine.......................................... gr,  x.
        Iron by Hydrogen............................ gr.  xij.
       Hydrastin....................................... gr.  xj.
       White Sugar................................... gr.  xxx.
Mix, triturate ;   divide into ten  powders,  and give one
three times a day.   The diet should be generous, and the
following tonic should  succeed the powders  :
i 
ANGINA  PECTORIS.
353
     R Scutellarin....................................... gr. xx.
        Precipitated Carbonate of Iron............. gr. xxx.
        Caulophyllin........*............................. 5jj.
        White Sugar..................................... lbss.
Mix, triturate; add to one pint of good  port wine, and
take one tablespoonful three  times  a day before eating.
The bowels should be kept in a free state by the use  of
Leptandrin  and Neutralizing  Mixture,  and  the patient
should avoid all undue exercise.
             ANGINA  PECTORIS.
   This is a disease characterized by paroxysmal pains and
 tenderness in the precordial region, extending to the head,
 shoulders,  arms and legs, and  in  some  cases  producing
 numbness.   The pain is sudden in its onset, but is  mostly
 of a dull character, although in some cases it is lancinating
 or tearing,  producing exquisite torture  and  contractive
 suffocation.   There  may be slight dyspnoea or orthopncea,
 with lividity of the  countenance.   The heart usually pal-
 pitates, the extremities become cold, the urine is passed in
 large quantities, and is mostly of  a limpid appearance.
 The bowels are constipated,  and in most cases  there is
 more or less constitutional disturbance  for some time pre-
 vious to the attack.   If there are cardiac murmurs in con-
 nection with the disease, there is reason to apprehend that
 it is  connected  with some organic difficulty of the  heart.
 This disease may be a pure neuralgic affection of that
 organ, accompanied by hysteria and anaemia, or it may be
 of a periodic character,  of  miasmatic origin, — a mere
 masked  ague — or  it may  depend  upon  some  organic
disease of the heart. 
354
CONGESTION.
                    TREATMENT.
  In this affection, the first object should be to relieve the
urgent symptoms.   For this purpose, the feet should be
placed in hot water, a large sinapism applied over the
region of the heart, and  the patient caused to take one
drop of Aconite every five minutes until the  symptoms are
relieved.  If they are not relieved in the course of half an
hour, the following compound should be given :
      R Lobelin.......................................... gr. j.
        Lupulin......................................... gr. vj.
        Hyosciamin.................................... gr. ij.
        White Sugar................................... gr. xxx.
 Mix, divide  into ten powders, and give  one  every ten
 minutes until relief is  obtained.  As soon as  the severity
 of the paroxysm is relieved, the cause of the  disease should
 be  ascertained, and such a course pursued as  will effect a
 permanent cure.  Antiperiodics should be given where the
 disease  fs  produced by miasm, chalybeates  and tonics
 where it is dependent upon  anaemia, and if it originates in
 organic disease of the heart,  the  proper  treatment may
 be  found under that head.
CONGESTION, OR ACCUMULATION OF BLOOD
      IN  THE CAYITIES  OF THE HEART.
   Congestion, or accumulation of blood in the cavities of
the heart, may occur in consequence of fibrinous  deposits
interfering with the  free movement of  the valves.   This
deposit seems  mostly to  be a  product of endocarditis,
although it may arise from regurgitation during fits of
dyspnoea,  and whenever there is sudden obstruction of the
circulation through the lungs. 
PERICARDITIS.
355
                    SYMPTOMS.
  These are orthopncea, cough, lividity of the countenance,
oppression and anxiety.  The physical signs are extended
area of dulness, irregular rhythm  and a labored  impulse
of the heart.   Dropsical effusions and  anaemia  are  fre-
quently produced by this disease.

                    TREATMENT.

   Give a free  purgative of Podophyllin and Cream of
Tartar, followed by Syrup of Marshmallow  and Iodide
of Potassium.   If the disease proves obstinate, an irrita-
ting plaster should be  placed over the region of the heart,
and allowed to remain  until a  free  discharge  ensues.
Aconite should be given to control  the circulation,  and
the diet should be nutritious.


PERICARDITIS,  OR INFLAMMATION OF THE
                  PERICARDIUM.
   The symptoms of this disease  depend much upon the
state  of the inflammation,  during the  first stage of  the
inflammatory process.   There is more  or less fever,  with
increased frequency of the pulse, cough and  dyspnoea.
The physical sign is a sound  of grating friction.  In the
second stage, which is that of exudation, there is pain in
the region of the heart, irregular pulm, anxiety, dyspnoea,
cough, and  a   tendency  to syncop*.  The features  are
sharp, and  indicate  distress.  There is scanty and high-
colored urine, with alternate fever and apyrexia.
   The physical signs  are  frictional  sound, and valvular
murmurs,  dependent  upon  endocarditis.   In the  third
stage,  bulging  of the  precordial region may be observed,
and if there is extensive effusion, displacement of the apex 
356
PERICARDITIS.
of the  heart upwards.   The  area  of  dulness will  be
changed, and very materially  enlarged.   The  sound of
the heart will be indistinct and muffled.   If adhesion of
the pericardial  surface to  the heart should  occur, the
action of the heart will be tremulous and  unsteady.  As
the  disease  advances, the head is kept elevated, or-
thopnoea is a constant symptom, and the  patient dreads
movement of any kind.  In fatal cases risus sardonicus
often occurs, with tenderness of the Epigastrium, Spas-
modic  dysphagia,  nausea,  and  vomiting, quasimania,
stupor,  and death.   Or the severity of the  symptoms may
gradually yield, and the patient recover.

                       CAUSE.
   This  disease may be caused  by metastasis of inflamma-
tion from other parts, as in pleuritis, pneumonia, rheuma-
tism, phlebitis, &c, and  in some cases it is  said to be
idiopathic.
                    TREATMENT.
   In the first stage  of this disease, the bowels  should be
opened  by full doses of Podophyllin and Cream of Tartar,
a warm sinapism should be applied over the region of the
heart, and the surface thoroughly bathed in lye water and
whiskey.   The  operation  of the cathartic should be fol-
lowed by from  one to five drops of the Tinct. of Aconite
every hour,  until free diaphoresis  ensues.  This  course
will  cOntrol the  a^Mve form  of the inflammation, after
which the  patient smmld  take the following diuretic and
alterative mixture:
      R  Syrup of Marshmallow............................t^v.
        Iodide of Potassium................................jss.
Mix,  and give one teaspoonful  every three hours.  At the
same time,  give from five to  ten drops of the Muriated 
ENDOCARDITIS.
357
Tinct. of Iron every five hours.  If the disease should be
of a periodic character, from five to ten  grains  of  the
Sulphate  of Cinchonin, and  one-eighth of a  grain of
Gelsemin  should  be given  every three or four hours until
that symptom is controlled.   If extensive effusion  should
occur, from one-eighth to one-fourth of a grain of Phyto-
laccin to the Syrup of Potassa and Marshmallow, may be
added.  If, after the active symptoms of the disease, there
should still remain some cardial disturbances, the abetic
syrup of Sanguinaria will generally suffice to control them.
                                           \
               ENDOCARDITIS.
   The symptoms of this disease  are  pain  and uneasiness
in the region of the heart,  with precordial  pressure.   The
decubitis is dorsal.   The skin is hot, the  countenance is
livid, and there is cough,  dyspnoea, and tendency to syn-
cope.  The physical signs  are uneasiness, and increase of
the action of the heart, and a grating accompanying the
bellows sound.  The  normal systolic  murmurs will be
changed, corresponding to  the stage of the disease.

                    TREATMENT.
   The treatment of endocarditis, is  essentially the same
as in pericarditis.   The surface  should be bathed in lye
water,  a warm pack applied over the cardiac region, and
Aconite or veratrum given until the active stage  of the
disease  is  removed.   These  should be followed by diu
retics,  alteratives, and tonics.
31 
358
CARDITIS — ATROPHY.
  CARDITIS,  OR INFLAMMATION  OF THE
         SUBSTANCE  OF THE  HEART.
  This disease is mostly  connected  with endocarditis or
pericarditis, and even when it exists as an idiopathic dis-
ease, its symptoms are so closely allied to them that as yet
the diagnostic symptoms are very obscure.  The treatment
should be the same as of inflammation of its membranes.
       ATROPHY OF THE  HEART.
  In valvular atrophy, says Dr. Walshe, when the chorda?
tendina? of  the  mitral valve are shortened or extremely
thin,  they are  probably  purely  atrophous;  the  large
tongue of the valve is simply defective in size,  without
obvious puckering, or other evidence of past inflamma-
tion :  in either case regurgitation may occur.  The sig-
moid  and pulmonary valves may also  become atrophous,
causing regurgitation in the aorta and pulmonary veins; in
the former producing syncope, in the latter asphyxia.
  The physical signs are regurgitation with bellows sound.
Where there is atrophy of the parenchyma of the  heart,
the area of 4ulness  will  be diminished,  and the diastole
and systole will both be feeble.
  The rational symptoms  are pallor, coldness of the ex-
tremities,  cough,  irregular respiration,  palpitation, pre-
cordial  oppression,  oedema of the  extremities,  and in
females, irregularities  of the catamenia, haemoptysis, and
it frequently terminates  in dropsy and phthisis.   In old
age,  the  valves  of the  heart becoming atrophied, fre-
quently causes pulmonary apoplexy. 
HYPERTROPHY  OF  THE  HEART.      359
                   .TREATMENT.

  The patient  should  avoid all  excesses,  in mental and
bodily exercise.   The  diet should consist  of rich  animal
broths, with a liberal amount of fats  and sugar.   Give the
following compound:
     R Precipitated Carhonate of Iron................. ^j.
       Hydrastin............................................. gij.-
       White Sugar.........................................^iij.
       Port Wine............................................ Oj.
       Water.................................................. Oss.
Dose,  one tablespoonful  three times a day.  If there  is
much irregularity  in the  action of the  heart, one grain of
Myricin, and  one-sixteenth of a grain of Yeratrin, given
twice  or three times a day, will usually  give  relief.   In
old age, much benefit is  sometimes  derived from a mode-
rate quantity of malt liquor once or twice  a day.
  HYPERTROPHY  OF  THE  HEART.
  By this  disease, is understood  thickening  of one  or
more of the cavities  of the heart.   It may exist with, or
without other  affections  of this organ.   The  difficulties
with which  it is  most frequently connected are dilatation
and  ossification of the valves.   It is said that hypertrophy
is mostly confined to the ventricles, and that it is  more
commonly met  with  in  the left ventricle, than the right.
This may sometimes be true, yet, in my practice, it is  far
from being  generally so ;  as in some  thirty cases of  both
complicated and uncomplicated  hypertrophy, the majority
occurred in the auricles.   Hypertrophy of the heart may
be caused by a preternatural  determination of  blood to
the organ, from a latent form of inflammation,  or it may
arise from  a long-continued increase  of action dependent
upon nervous disease. 
360      HYPERTROPHY  OF  THE  HEART.

                     SYMPTOMS.
  The symptoms of hypertrophy of the left ventricle are a
sensible,  constant increase of the action  of the heart;  the
pulse strong, full, and vibrating.   On percussion the area
of dulness is extended ;  and on auscultating the chest, the
sound of the heart will be found very much enfeebled, and
if hypertrophy is connected  with dilatation,  the  diastole
will be materially prolonged.   In this way we may be ena-
bled  to distinguish between  simple hypertrophy and that
accompanied  with increase in the capacity of the cavity.
In hypertrophy of the  right ventricle,  the  signs are very
nearly the same as above,  except the shock of the  heart's
action will be  felt at the  base of the sternum, instead of
between the fifth and sixth ribs,  as in hypertrophy of the
left side.
  In hypertrophy of the  ventricles, the impulse  will  be
much increased, and the  systole shortened in duration,
while the diastole will be  prolonged.  The diseases pro-
duced by these cardiac derangements are : dropsy, haemop-
tysis, asthma, tubercles, phthisis,  and asphyxia.

                     TREATMENT.
  In treatment of hypertrophy of the  whole or different
portions of the heart, all stimulating articles of food and
drink should be avoided, as also the use of tobacco.  To
lessen the action of the heart, and thereby prevent  the
abnormal supply of  nutrition, is  another essential element
of the treatment.  For  this purpose a sufficient amount of
Tct. Yeratrum Yiride maybe given, say from five to ten drops
three or four times a-day.  The pulse should be maintained
at about fifty-five or sixty by the  use  of the Yeratrum.  At
the same time one teaspoonful of the solution of Iodide of
Potassium should be taken three times a-day. If the disease
proves persistent, and should not yield to this plan of treat- 
DILATATION.
361
ment, from one-eighth to one-fourth of a grain of Phyto-
lacca may be given every night at bed-time.   The bowelg
should be moved once or twice a-week, with Podophyllin and
Cream of Tartar, and the patient should avoid all mental
and bodily excitement.
DILATATION,  OR  ENLARGEMENT  OF  THE
           CAYITIES OF THE HEART.

 • Dilatation may be confined to one cavity of the heart, or
it may extend to all.  The cause  of this disease, says Dr.
Bertin, is owing to some obstruction in the circulation of
the blood, as diseases of the  valves,  &c, while Laennec
attributes it to congenital disproportion in the parts of the
heart.   But what is a more common cause of the  disease
in this country is an impoverished state of the blood, pro-
ducing a weak and lax state  of  the muscles,  thus giving
rise to dilatation.
                    SYMPTOMS.
   The patient is often attacked with violent dyspnoea  and
palpitation, followed by a weak and feeble  pulse ;  ten-
dency to syncope, and in some cases nausea and vomiting.
The bowels are mostly constipated, and there is frequently
pain and praecordial pressure.  According to Laennec, the
most constant and  characteristic sign of this  disease is
a swollen state of the jugulaiweins without pulsation.

                    TREATMENT.
   The principal classes of medicines indicated  in this dis-
ease are tonics and  astringents, such as Hydrastin, Macro
tin,  Myricin,  and  Muriated Tincture-of Iron.  The  diet
should be full and nutritious,  and the patient allowed to
drink porter  or ale  once or twice  a-day, with his meals.
The Muriated Tincture of  Iron  should  be  taken  in from
                          31* 
362   PHLEBITIS AND  PHLEGMASIA DOLENS.

five to ten drop doses three or four times a day in a small
quantity of beef tea or starch water.  The Macrotin,  Myri-
cin, and Hydrastin, should be used in the  form of a syrup
two or three times a-day.
  PHLEBITIS  AND PHLEGMASIA DOLENS.
  Phlebitis is inflammation of the inner  membrane of a
vein.   It  may  occur  as the effects  of  blood-letting, the
application of ligatures, pressure upon some venous trunR,
&c.   The pathological effects of inflammation of the veins
vary according to the extent and severity of the inflamma-
tion.  In most cases the affected vein is swollen, thickened,
and indurated to  such a degree as to very much resemble
an artery.  A diffused swelling, connected  with acute pain,
coated tongue, scanty  urine, constipated  bowels, and py-
rexia, are among the prominent symptoms of this disease.
Upon examination, the adipose, cellular, and subcutaneous
tissues are found to  be filled with fluid ;  and when the parts
are laid open, clots of blood and lymph are found adhering
to the inner coats of the veins.  If the  inflammatory pro-
cess continues, the clots of blood and lymph are converted
into purulent matter, rupturing the vessels, and forming a
deep phlegmonoid abscess in the adjacent  tissue.
  Phlegmasia Dolens is an inflammation of the veins of
the leg, mostly caused by  pressure of the gravid uterus,
upon  the  iliac  and other veins, generally making its ap-
pearance on  the  second or third week  after  delivery.  It
occurs for the most part in  one leg, exhibiting to the touch
numerous  irregular prominences under the skin.

                  • SYMPTOMS.
  In the course of two  or  three weeks  after  confinement,
pain and uneasiness are complained of in  the hypogastric, 
    PHLEBITIS  AND PHLEGMASIA DOLENS.   363

lumbar  and inguinal regions.   On examining the limb, it
will be  found tense, elastic and shining, mostly painful to
the touch.   It will also be flexed.
   The skin will be  hot, the pulse quick, with great thirst
and restlessness.   If the disease is allowed to advance, the
tongue will be  covered with a dark sordes, the respiration
becomes hurried, and  delirium, coma, and death, rapidly
follow.   Or the symptoms will continue in a mild form for
weeks, or even months, and the patient recovers, but with
a shattered constitution.
   The above are the  most ordinary  symptoms, yet they
vary exceedingly in  different cases.   Sometimes the pain
commences in the  knee, and is of a sharp darting character,
extending to the groin.   The limb is but slightly swollen,
and cold,  but  has a peculiar glistening appearance.  The
secretions  of  milk  will be interrupted, and  the  bowels
irregular.  At other times the  disease will assume a decided
periodic character.  The symptoms, such as pain, redness
and fever, will  all become  exceedingly aggravated, at a
certain  stated  period, and  remain so for  a few hours,
followed by a distinct remission ;  or  the disease may be
transferred to other organs, as the peritoneum, pleura, or
lungs, producing extensive organic disease of those organs.

                    TREATMENT.
   The  treatment of phlebitis, when it is traumatic, con-
sists  in  the application  of warm emollient poultices, as
slippery elm,  saleratus and myrrh, kept moist with the
Tinct. of  Arnica, and the  administration of brisk purga-
tives of Podophyllin  and Cream of Tartar, or Cream of
Tartar  and antibilious physic, succeeded by a mixture as
follows:
      R Muriated Tinct. of Iron........................... gss.
        Pure Water........................................„  ?yj.
        Sulphate of Cinchonin.............................^ss. 
364
PHLEBITIS AND PHLEGMASIA DOLENS.
Mix, and give one teaspoonful five or six times a day.  If
there  is  fever, Aconite or Yeratrum should  be given to
control it.   The  purgative should be repeated as often as
indicated.   After the swelling is subdued,  the limb should
be  evenly bandaged,  and  kept wet with the  Tinct.  of
Lobelia.
  In  Phlegmasia Dolens, the poultice should be applied
with a bandage  over it.   A purgative  should be given
similar to that in  traumatic  phlebitis,  succeeded by the
following compound:
      R Sulphate of Bebeerine........................ gr. xxx.
        Caulophyllin.................................... gr. xj.
        White Sugar..................................... gr. xxx.
Mix, triturate;  divide into  ten  powTders, and  give one
every three hours.   Aconite may be given to control the
fever, and the back, hips, and lower part  of the bowels be
bathed in a liniment prepared as follows :

      R Oil of Turpentine..................................gj.
        Eggs...................................................v.
        Common Salt......................................  !|ss.
Mix,  and use two  or three times a day.   If the disease
should assume  a  periodic character,
      R Muriated Tinct. of Iron........................^ss.
        Water...............................................^ij.
        Quinine............................................. gr.  xx.
Give one teaspoonful every three or four hours.    The sur-
face should  be thoroughly bathed,  and if practicable, a
spirit-sweat given once or twice a week.   When the active
stage of the disease has passed, small doses of  Carbonate
of Iron, with Euonymine, may be given three  or four times
a day.   If there should be a chronic diseased condition of
the vessels of the limb, the bandage should be continued,
and kept  moist  by vegetable astringents.   The  patient 
BLUE SKIN DISEASE.
365
Bhould also  take  Iodide  of Potassium in connection with
tonics.  The diet should  be full and nutritious, and entire
rest should be enjoined.
CYANOSIS, MORBUS  CJ3RULEUS,  OR  BLUE
                  SKIN  DISEASE.
  This disease is confined to infants.  The symptoms are
a peculiar livid or blue appearance of the skin, frequently
extending to the mucous membrane of the mouth.   There
is constant cough, dyspnoea, and  palpitation.  In  some
cases the dyspnoea becomes so excessive, as to produce
syncope and death.
  The causes of these symptoms have been shown by Dr.
Gintrae, to be as follows:
  In 22  cases, the aorta was  found to arise from both
                  ventricles.
   "30    "    the foramen ovale was open.
   "  14    "   the ductus arteriosus  was open.
   "   4    "    a single heart with one auricle and ven-
                 tricle.
   "   5    "    the ventricular septum was imperfect.
   "22    "    the pulmonary artery was contracted.
   "   5    "    the pulmonary artery was obliterated.
   "   1    "    the aorta was obliterated.
   "   4    "    the aorta arose from  the right ventricle.
  The above table shows that this  disease  is mostly de-
pendent upon congenital deformities of the heart  and its
appendages.
                   TREATMENT.
  But little can be done  in the treatment of this disease,
more than to  give temporary relief.   Where  there is  syn-
cope, the  child should be  placed in a warm bath, and
ammonia or camphor applied to its nostrils.  After which
it should be wiped dry, and wrapped in a  warm  flannel. 
366
HEADACHE.
For the cough  one or two drops of the Tinct. of Lobelia
should be  given in a teaspoonful  of  breast  milk.  The
action of the heart may be regulated by Aconite, and in
some  cases, where  the deformity is  only partial, the child
will gradually recover.
                   HBA'DACHE.
  This  is frequently  a mere  symptom of idiopathic dis-
ease,  yet we  often meet with  cases where the difficulty
constitutes the only perceptible ailment.  Headache may
be caused by a preternatural determination  of blood  to
the brain, by the too frequent use of intoxicating liquors,
by a disordered condition of the stomach and bowels,  by
a loss of balance between the venous and arterial circula-
tion, by an injudicious use of  tea and coffee, undue mental
or bodily exertion, imperfect menstruation,  and the too
frequent use of purgative medicines.  It is also a symp-
tom of  most Idiopathic fevers, as well as most other acute
diseases.
                    TREATMENT.
  When headache is dependent upon over-exertion of the
mind  or body, add one-half grain of Belladonna  to one-
half tumbler full of water, and give one teaspoonful every
fifteen minutes, until the pain ceases.  If dependent upon
constipation of the bowels, mix one  ounce of neutralizing
mixture  and one  grain of  Podophyllin,  and  take one  or
two teaspoonfuls  a-day, or a quantity sufficient to keep
the bowels in a  soluble condition.    If  upon  imperfect
menstruation :
     R  Macrotin.......................................... gr. vj.
        Vallet's ferruginous mass.................... gr. xxx.
Mix, make twelve pills, and take one every night.  Whera
the headache depends upon  eating and drinking more
than nature requires, this  should be carefully corrected. 
CONVULSIONS.                367
CONYULSIONS  IN  ADULTS AND CHILDREN.
  When convulsions oqcur in adolescence, it may indicate
inflammation of the  brain,  plethora, or  anaemia, ossifica-
tion of the arteries of the brain, growth  of tumors on the
inner  table of the skull,  &c.  When they occur in chil-
dren,  although  frequently  arising  from disease of the
brain  and  spinal marrow, they are nevertheless produced,
in a great majority  of cases, from irritation,  transmitted
to these parts, from the digestive organs.

                    TREATMENT.

   When the disease occurs  in adults, the  treatment de-
pends principally upon  the cause.   Although during the
convulsions,  small doses of equal parts  of the  Tinct. of
Lobelia and Scutellaria, should be frequently administered
into  the stomach, if practicable;  otherwise  mixed  with
starch water, and given  in the form of  an  enema.   The
circulation should be equalized  by hot baths, sinapisms to
the calves of the legs, feet, &c.
   When thus relieved, the patient should be  treated ac-
cording  to the cause.   Where children are  seized  with
convulsions,  the first object should  be  to  evacuate the
stomach and bowels.  For this purpose,  four or  five drops
of the compound Tinct. of Lobelia should be given, every
five or ten minutes, until the stomach is thoroughly evacu-
ated.   At the same time,  the  bowels should  be injected
with equal parts of warm water, oil of olives, and molasses.
The  child should be placed in a warm bath during the
action of the emetic and injection.  When  the  child has
been  relieved  by the above course,  all irritating  food
should be carefully avoided, and a weak  tea of Hydrastin
and ginger, well sweetened, should be given occasionally
for the purpose of giving tone to the stomach. 
368                 NEURALGIA.
                 NEURALGIA.

  Neuralgia has alternately been classified under the head
of surgical  and medical  disease.  But from  the  almost
universal failure of  surgical practice to relieve it, this dis-
ease is  now almost generally treated  as belonging to the
medical department.
   There is  yet, however, some difference  of opinion with
respect to its pathology.   Prof. Jones and others regard
it as but a form of ague; while Craigie and  others con-
sider it to have its seat in an inflammation  of the neurilema
or covering of the nerve.  Dr. Mcintosh states that the
cause of this disease  may frequently  be traced  to a dis-
ordered state of the stomach, and  alimentary canal.  Dr.
Elliotson in the 3d volume of the Cyclopedia of practical
medicine, p. 388, states that the nature of neuralgic affec-
tions may  be  evident immediately,  or, not  till after a
lapse  of time;  may  become evident after  death only,
or,  may  never be  discovered.   He  further  states that
inflammatory  conditions  of  the nerves,  and  structural
changes, as well as mechanical causes, may be detected
during  life, if the  seat of these conditions  is within the
reach of  observation; and  symptoms may  be induced,
which clearly point  out the  inflammation  or structural
changes, even if those should be beyond our observation.
   Occasionally, however, the seat and cause of the  irrita-
tion is not only beyond our reach during life, though dis-
coverable afterwards, but no symptoms are produced which
indicate them.   From the above remarks,  and many other
observations which might be made, we perceive that quite
a diversity of opinion exists relative to its  pathology.   In
order to harmonize the conflicting theories,  resulting as
they do from actual observation, we might conclude that
occasionally it has its origin in inflammation of the mem-
branes of the nerves, in spinal  irritation,  in derangement 
NEURALGIA.
369
 )f the stomach and bowels, and in affections of the kidneys ;
 ilso, that it frequently arises as one of the effects of miasm,
 md assumes a disguised remittent  character.

                     SYMPTOMS.
   In the most aggravated form the pain is lancinating or
 tearing, as the patient expresses it.  It is sharper at some
 times than others, and in some instances the  parts become
 red, and assume the appearance of inflammation, although
 this is not generally the case.   When this  disease attacks
 the nerves of the face, it is called  Tic Doloureux.
   All the soft tissues  seem to be liable to this  affection.
 The attacks are mostly sudden, and  last from a few hours
 to several days.  The constitutional  symptoms  connected
 with them are  frequently very slight,  although, in some
 cases, the pulse becomes  quick, the urine scanty and high-
 colored ; a light  brown coat will  appear on the tongue,
 and there will be alternate fever and perspiration.  In other
 cases the paroxysms will commence with rigors and chills,
 followed by fever and perspiration;  in  short, manifesting
 all the essential symptoms of ague.

                    TREATMENT
   As shis disease is decidedly of an intermittent character,
 where there  is no obvious  organic  lesion or perceptible
 cause of the disease, the  treatment should  be commenced
 by giving full doses of antiperiodics, such as the following :
      R Scutellarin ....................................... gr. x.
        Cypripedin ....................................... gr. v.
        Quinine ............................................ gr. x.
        Prussiate of Iron................................. gr. xij.
Mix,  triturate, divide into ten powders, and give one  every
two hours, till all are taken.  At the same time the affected
parts should be thoroughly bathed in a strong, hot solution
       32 
370                  HYSTERIA.
of Ferrocyanide of Potassium.   These applications should
be made in the form of fomentations, and changed as often
as cold. When the  antiperiodic powders are all taken, the
bowels should be thoroughly evacuated by the use of anti-
bilious physic and Leptandrin.  If the above prescription
be not sufficient to remove the disease, give the following:
     R Tinct. of Gelseminum.............................. sjij.
         "      Macrotys Racemosa................... 3J.
         "     Iodine .....................................gss.
Mix,  and give  three drops every  three hours,  until  the
symptoms yield.  If there should be  a tendency to a peri-
odic return of the disease, the  antiperiodic  powders should
be repeated from time to time.  The bowels should be kept
in a natural condition by the use of Neutralizing mixture,
and as often as once or  twice a week, the surface should be
thoroughly bathed.   Where the disease is dependent upon
spinal irritation, in  addition to the above mentioned causes,
an irritating plaster should be placed along the spine, and
remain until a free discharge ensues.   Where there is  de-
rangement of the menses, Senecine and Bebeerine should
also be used  as circumstances  seem to indicate.
                   HYSTERIA.
   This is  a disease  of the nervous system, and  almost
wholly confined to females, although it is said that males
are not exempt from it.   The  invasion of the disease is
sudden and irregular, but in many cases decidedly periodi-
cal.  In slight attacks the patient bursts into a fit of weep-
ing, soon followed by convulsive laughter, which lasts for
a longer or shorter time, and  may be followed by compa-
rative composure.
  In more  severe cases, the complaint is ushered in by a
sharp pain  in the abdomen or chest, which is soon followed 
                    HYSTERIA.                 371

by a sense of suffocation and oppression at the Epigastrium.
The bowels are tense and the surface is  cold.   The coun-
tenance varies ; in some cases it is red  and swollen, in
others it is  pale,  and  the  features  are contracted.   In
some  very severe cases, there is a convulsive affection of
the muscles,  amounting to clonic spasms.  The urine is
mostly discharged in large quantities,  and  has a  light
limpid appearance.
                      CAUSES.
   We seldom meet  with this disease before puberty, or
after  the period of life when menstruation finally ceases,
and as it mostly makes  its appearance during the  cata-
menial flow, it is  supposed to have  its origin mostly in
deranged uterine action.

                    TREATMENT.
   During the paroxysms, the feet should be placed in warm
water, and a hot sinapism applied to the lower part of the
abdomen.  The patient should take equal parts of Cypri-
pedin and Scutellarin, one  grain every half hour until the
paroxysms subside.  If the above is not sufficient to con-
trol the  disease, the compound ginger  and Bayberry tea
may be given freely, followed by ten or  twenty of Beach's
sudorific drops, or thirty or  forty drops of the Tinct. of
Castor, followed by a pill of assafcetida.  After the parox-
ysm, the patient  should  take from five to ten grains of
Bebeerine,  and the  same  amount of phosphate of Iron,
every day for two or three  weeks.
   To remove the uterine affection, Macrotin, Caulophyllin
and Senecin should  be used, as  the  nature of the case
seems to indicate.   When  the disease is dependent upon
indigestion  and constipation  of  the  bowels, tonics  and
laxatives are the remedies.   If upon spinal irritation, the
proper treatment will be found under that head. 
372
MYELITIS.
 MYELITIS, OR INFLAMMATION AND  IRRPTA-
       TION  OF THE SPINAL  MARROW.

   The symptoms  of this disease are a sharp pain up and
 down the back, rigors,  fever,. headache,  and  not  unfre-
 quently delirium and coma.  In some cases dysuria occurs,
 in others  retention of the urine.  Rigidity of the muscles
 of the back and neck is almost a constant symptom.   The
 body may be  bent backwards, opisthotonos,  or forwards,
 emprosthotonos, or there may be a simple rigid state of
 the muscles, and  the decubitis normal.   In other cases
 there may  be tetanus,  convulsions,  or  paralysis.   The
 muscles of  deglutition are often so affected as to occasion
 much difficulty of swallowing.  The  pulse is mostly hard*
 and  quick, the  bowels are  extremely  constipated,  and
 frequently there is nausea and vomiting.   The  respiration
 is slow and irregular,  and occasionally death is suddenly
 produced by asphyxia.

                     PROGNOSIS.
   The prognosis of this disease is usually favorable under
 the eclectic  system, if it receives timely treatment.

                   TREATMENT.
   A sinapism should be applied along the spine, and the
 feet should be placed in warm water.   The patient placed
 upon the Tinct. of Yeratrum Yiride, if of a plethoric habit;
 if otherwise, Aconite should be given, and the following
 cathartic may be administered :
      R Cream of Tartar.............................. gr.  xx.
       Podophyllin.................................... gr.  iij.
       Capsicum....................................... gr.  x.
 Mix, triturate; divide into six powders, and give one every
hour until a cathartic effect is produced.   The powders 
              SPINAL IRRITATION.            373

should be  assisted in .their action by  warm stimulating
enema.   If the "disease  still proves  persistent,  a spirit-
vapor bath should be given, followed by an emetic of the
acetic tincture of Lobelia and Sanguinaria, also repeat the
cathartic and continue the sinapism to the spine.   If there
should be  muscular  spasms,  give the  fluid extract of
Lobelia,  Cypripedin  and  Scutellaria,  equal  parts, from
five to ten drops every half hour until that symptom  sub-
sides.  After the  active stage of the disease is passed, to
prevent disorganization of the spinal marrow  and its
membranes, with its consequences, such as paralysis,  &c,
a full antiperiodic course  of medicine  should  be given,
followed by two  or three drops of  the Tinct. of Phos-
phorus once or twice a day.  The bowels should  be  kept
open, and  the system supported  by the  liberal use of
Hydrastin and Euonymine.
           SPINAL  IRRITATION.
  This  affection might be  more properly designated  as
chronic inflammation of the spinal marrow, and its mem-
branes.   In fact the  various morbid changes  observable
as  the  symptoms of what  is  usually  designated spinal
irritation,  such  as  softening,  effusion,  hypertrophy,  &c,
all  clearly indicate the  previous  existence  of a latent
inflammatory process.

                     SYMPTOMS.
  Says  Prof. J. G. Jones :  " The proteian manifestations
of spinal irritation, and the great  liability that  exists to
mistake some of the numerous  disturbances produced  by
disease  seated in the  spinal nerves, for  other  and more
serious organic affections, remote from the source of trouble,
renders the consideration  of this subject scarcely less  im-
portant to the student of medicine,  than that of  any other
                         32*
L. 
374            SPINAL  IRRITATION.
 topic connected with disease.   Scarcely an organ in the
 body can be found that is not by turns made the scapegoat
 upon which these great nervous  centres play off their fan-
 tastic representations of serious organic or functional dis-
 turbances, and thereby mislead the unsuspecting attendant,
 at  the   expense to  the  patient,  of a  severe  course of
 medication directed to  disease  having  its  real  seat far
 remote  from  the  organ  manifesting embarrassment and
 functional disturbance."   It  will  be perceived by  these
 remarks  of  Prof.  Jones, that  irritation  of the  spinal
 marrow  assumes a great variety of symptoms, which  is
 actually the case.
   Not unfrequently females  who  are troubled  with the
 latent form of spinal affection, exhibit symptoms of uterine
 derangement, heart disturbances,  irritation of the  lungs
, and  bronchi,  irregularity  of the  bowels, neuralgic pains,
 &c, succeeding each other in a rapid  series of changes.
 The  diagnosis  must be made up, in these cases, by care-
 fully examining each organ, thus sympathetically affected,
 by itself; and,  in the absence of any serious organic dis-
 ease, together with the extreme  nervousness of the patient,
 it  will   enable us  to  arrive  at the true source of the
 complaint.  On  pressure  of  the  spinal  processes,  there
 will  generally be found more or less tenderness,  although
 I have seen quite a number of cases of evident spinal irri-
 tation where this symptom was not present.
                     TREATMENT.
   In cases of spinal irritation, the irritating plaster should
 be applied along the diseased part of the spine, and caused
 to remain until a free discharge ensues,  and the following
 tonic and alterative given :
      R Phosphate of Iron ............................ gr. xxx.
        Scutellarin......................................  gr. xx.
        Syrup of Iodide of Potassium .............  ^iij.
        Port Wine......................................Oj. 
HYPOCHONDRIASIS.            375
Mix, and give one tablespoonful three times a day.   The
surface should be bathed in warm or cold water,  as indi-
cated, twice or three times a week; and the bowels should
be kept regular by the use of small doses of Neutralizing
mixture.   When the above course has been pursued for
some time,  and the disease is not  removed, the following
compound may be  given :
     R Valerianate of Quinine........................... gr. xx.
       Cypripedin .......................................... gr. x.
       Sanguinarin .................................  ...... gr. xx.
       White Sugar........................................§ss.
Mix, triturate, and give ten grains four or five times a day.
Also, bathe the surface in a warm solution of Ferrocyanide
of Potassium every morning.   If ihere is  Leucorrhaea con-
nected with the spinal difficulty, Macrotin and Caulophyl-
lin should be given in addition  to the above.
            HYPOCHONDRIASIS.
   The symptoms of this  disease are exceedingly various,
and are both imaginary and real.  The imaginary ones are
numerous, such as want of sleep, constipation of the bowels,
inability to sleep, &c.  Nothing is more common than to
hear the patient state that he has been unable to close his
eyes in sleep for several nights, when the fact is that he has
slept regularly.   Or that the bowels have not moved for
days, or even weeks, when they are perfectly regular.  Or
there may be a  great variety of imaginary difficulties at
the same time.  The complaints of one individual that I
treated for this disease will serve to illustrate the imagi-
nary symptoms of this class of cases :   The patient was  a
male about 45 years of age.   He first  complained of ina-
bility to walk, and accordingly took to his bed.   He was
soon unable  to  speak  above a whisper, and imagined he
was laboring under an attack of acute phthisis, and, as ho 
376
HYPOCHONDRIASIS.
said, had excessive dyspnoea and violent cough, although
he neither  coughed nor apparently had any difficulty of
breathing.   He also complained of an entire loss of appe-
tite,  and inability to  take food, yet he ate three hearty
meals daily.   At times he thought  he was about to die
from an extensive affection of the heart; and also, that his
liver and kidneys were consumed.   In short, he was com-
posed of a congeries of all the  ills  that afflict  the human
family.   He continued  in this state for twelve  years,  only
leaving his bed for a few minutes at a time, and then  with
great difficulty.  During the whole  time,  he  only spoke
above a whisper, except when angry.   He would then be-
come very boisterous, and talk  exceedingly loud, which in
one  or two instances laSted for several days.   But when
the fit passed off, he was as seemingly incapable of speech
as before.   On examination, no apparent disease existed
further  than the natural debility dependent upon  so  long
confinement.   By a proper course of mental and physical
treatment,  he  soon recovered,  and resumed his ordinary
occupation, that of farming. And  although it is now over
ten years, he has enjoyed uninterrupted good health.   Fe-
males who are afflicted  with  this diseased condition  of
the  mind,  often imagine  they  have  some  severe uterine
derangement.  And frequently the medical attendant being
as ignorant of the cause of  the  disease as  herself, subjects
her  to  a very disastrous course of medication.  Another
class of patients afflicted with hypochondriasis have, in
addition to  the  imaginary symptoms, some real organic
affections which require especial treatment.
   Hypochondriasis, no  doubt,  is  induced  by  a want  of
harmonious  action between the different  organs of the
brain.
                    TREATMENT
   The treatment of this malady should consist  principally
in quieting, as far as practicable, the already-excited facul- 
OPHTHALMIA.
377
ties of the brain, and bringing other faculties into action.
The mind should be constantly directed to other subjects
than those to which it has been  previously directed ;  and
those subjects  should be sufficiently exciting to arrest his
former meditations.   The head, should be frequently show-
ered in cold, and the body, in tepid water.   He should be
induced to take as much exercise as his enfeebled condition
will  warrant.  The bowels are to  be regulated  by mild
aperients, and  in  some cases chalybeates and vegetable
tonics will be required.  If the disease is complicated with
organic affections, it should be treated accordingly.
OPHTHALMIA, OR  INFLAMMATION  OF THE
                        EYES.
  The eye is one of the most delicate as well as one of the
most complicated organs  of the body.
  Diseases of the eye have been until recently very imper-
fectly understood.   Thus has the patient been  duped,  not
only in a  pecuniary point,  but too often mourns the  loss
of that inestimable organ.
  Ophthalmia is mostly  described  as a surgical disease,
but considering that a large majority of cases of this class
originate in some  defect of the constitution, the propriety
of treating upon them, in  a work on  practical medicine,
will readily be perceived.
  Inflammation  of the eye maybe divided into external, or
inflammation of the conjunctiva, and deep-seated, or inflam-
mation of the other tunics, including amaurosis, which is
frequently produced by inflammation.  This disease is again
divided into acute and  chronic.
k 
378        .CATARRHAL OPHTHALMIA.
  INFLAMMATION OF THE  CONJUNCTIVA.

  The first symptom complained of, in this form of inflam-
mation of the eye, is a sensation as if particles of sand had
insinuated  themselves beneath the lids, accompanied by
heat, pain,  and increased lachrymal secretion; also, intole-
rance of light.  In severe cases there are headache, nausea,
constipation  of the bowels, anorexia, and more or less
disposition to fever.  The causes of this form of Ophthal-
mia are mostly local—as particles of sand, dust, or insects
beneath the lids, inversion of eyelashes, &c.

                    TREATMENT.
   The first object should  be to remove the cause.  If there
is an irritating substance beneath the lid, the eye should be
thoroughly bathed in cold water while the lid is held open.
If the substance is not removed in this manner, a vial cork
should  be rubbed perfectly smooth with a dry flannel: the
particle may then be removed by touching  it lightly with
the cork.  Particles of iron  or steel may be removed in
this  manner;  also, by means of a  small  magnet.   When
the eye is thus relieved, it may be packed  in cold water,
and the patient's  bowels moved by a dose of anti-bilious
physic.  If the injury be  sufficient to cause inflammation
of the eye, a mild  diet may be adopted for a few days, and
the packs changed as often as necessary to keep them cool.
      CATARRHAL  OPHTHALMIA.

                     SYMPTOMS.
  After exposure to cold, the eyes are noticed to have a
smarting or burning  sensation, and the capillaries to be
sufficiently dilated to admit of the red corpuscles, whereas 
           CATARRHAL  OPHTHALMIA.        379

in a normal condition they only convey white ones.   The
dilated capillaries at first  exhibit a radiated appearance,
but  soon become confluent, and  the entire conjunctiva
assumes  a red and highly inflamed  aspect.  This  con-
dition of the eye is accompanied by chilliness, aching of the
bones, and some degree of fever.  There is also intolerance
to light,  and,  when the disease has become established, a
puriform discharge from the eyes.

                    TREATMENT.
   As this form of inflammation of the eye is dependent
upon exposure to cold ;  in other words, upon a contracted
state of  the  superficial capillaries,  and consequent con-
gestion,  or inflammation, of the deep capillaries,—the first
indication of treatment is to relax the vessels of the surface,
and thus unload the congested internal vessels.   To effect
this the surface should be thoroughly bathed in warm lye
water,  the patient placed in bed, and the following emetic
given :
     R Lobelia seed, pulverized ......................... gr.  xx.
        Ginger Tea .......................................... Oj.
Add the Lobelia to the ginger tea while warm,  and give
one wine-glass full every fifteen minutes, until a  thorough
emetic effect is produced.  The bowels should be opened
by the liberal  use of antibilious physic.  During the action
of the emetic and cathartic, the eyes should be kept packed
in cold,  soft water.   If the disease has assumed  a chronic
form, the pack should be applied  as warm  as the patient
will  bear it, and an astringent wash used once or twice
a day,  such as one gr. of nitrate of silver added to one oz.
of pure soft water, and a small quantity applied to the eye
by means of a camel's hair pencil once or twice a-day ;  or
the eye may be bathed in a strong decoction of Hydrastin
every morning and evening.  All irritating salves and eye-
washes should be carefully avoided, as  they always prove
L 
380      INFLAMMATION  OF  THE  EYES.

injurious.   If there should  be fever, it should be con-
trolled by the use of Aconite.  The  diet should be cool
and bland, the eye precluded  from light, and the patient
kept quiet.
 INFLAMMATION  OF THE EYES OF INFANTS,
         OR PURULENT  OPHTHALMIA.

                      SYMPTOMS.
   The symptoms of purulent ophthalmia of children, are
 somewhat similar  to  those  of  catarrhal ophthalmia of
 adults.  The eyes are kept constantly closed, the  lids are
 red and swollen, and glued  together  by thick  puriform
 matter becoming dry.  The  skin will be  dry,  and the
 bowels irregular.  If this disease is  neglected,  it will
 result in ulceration of the cornea and  loss of the organ.
 The cause of this disease is exposure to cold, damp cloth-
 ing, and injuries in washing the child;  also  the introduc-
 tion of acrid matter, which is  upon the  child, into the eye.

                    TREATMENT.
   In the treatment of this affection,  the eyes should be
 thoroughly bathed in a cold, weak  solution of Hydrastin,
 four or five times a-day.    They should  be kept packed in
 cold soft water, to which is added  a small amount of the
 Tinct. of Lobelia. The bowels should be kept open by the
 use of neutralizing mixture and Leptandrin, and from one-
 half to one  drop of  Aconite, given  every four or five
 hours.  Where   the  eye-lids  become   granulated,  they
 should be  inverted, and  lightly touched with a camel's
 hair pencil, moistened with a solution of vegetable caustic,
 once or twice a-day; but  much care should be taken that
the caustic be all removed  before the lids are closed.  All
poultices should  be  avoided.   Where the disease is of a 
AMAUROSIS.
381
Bcrofulous character, either in children or adults, Muriated
Tinct. of Iron, Compound Syrup of Stillingia, Hydrastin,
Scrophularia, Quinine, Iodide  of  Potassium, Iodide  of
Iron, and a generous diet, are the remedies.
                  AMAUROSIS.
   The term amaurosis is  used to denote a partial or total
loss of vision, affecting one or both eyes.  The causes of
this affection are various.   It may arise from the  inflam-
mation of the sclerotic coat, from inflammation of the iris,
from  inflammation of  the retina, by congestion of the
vessels of the retina, by congestion of the brain, by effu-
sion into the base of the  brain, by the too  free use of
ardent spirits, by  gastro-intestinal irritation, by tubercu-
lous affection of the optic nerve, by  spermatorrhaea, in-
ternal  use  of mercury,  exposure of the eye to too strong
light, &c.
                     SYMPTOMS.
   The symptoms of  amaurosis very  much depend upon
the cause.   Yet the  following  may  be  enumerated  as
generally present in cases of  this kind : imperfect vision,
pain in  the  eye, flashes of light, dark spots  appearing
before the  eyes, and  in some cases the pupil will  be ob-
viously dilated.   The disease is  mostly insidious, and its
progress very slow, although in  some  cases  it is rapid,
destroying the vision  almost at once.

                    TREATMENT.
   If amaurosis is dependent upon any of the inflammatory
affections, a thorough purgative should  be  given at once.
As,
     R Podophyllin...................................... gr. iij.
       Jalapin...............................,........... gr. j.
       Cream of Tartar...............................gr. xxx.
        33
I 
382
AMAUROSIS.
Mix, divide into eight powders, and take one very hour
until it operates.   After which  the patient  should be put
upon  full doses  of Tinct.  of Yeratrum,  the pulse main-
tained at about  fifty-five or  sixty beats  per minute,  and
the following diuretic or alterative given :
     R Syrup of Marshmallow............................ Oss.
            "   Iodide of Potassium...................  3ij.
Mix;  dose,  one teaspoonful three or four times a-day.
The eye should be  kept constantly packed with cold water,
the diet should be low, and the patient should avoid all
exposure of the eyes  to   the  light, and all mental  and
physical  labor.  If  effusion  of  lymph has  taken place
within  the tunics  of the optic nerve, or any part of the
eye,  causing  amaurosis, absorption  can  be produced by
the following pill:
      R Xanthoxylin.....................................gr. xx.
        Iridin.............................................. gr. x.
        Podophyllin..................................... gr. iij.
        Iodide of Potassium........................... gr.  xxx.
        Ext. of Dandelion, in  quantity sufficient
          to make a pill mass.
Make three-grain  pills, and let  three to six be taken per
day.   At the same time, the kidneys should be stimulated
by the  use  of Cream  of Tartar water and vegetable diu-
retics,  as Queen  of the  Meadow, &c.  Where there  is
loss of power  in the nerve, bathing the forehead in strong
Tinct. of Capsicum, three or  four times a-day,  will be
very  beneficial.  The  eyes should be well protected from
strong  light,  and  from three to  five  drops  of Tct. Rhus
Radicans given three times a day.   If this  remedy should
fail to give relief in the course of  a few weeks,  the follow-
ing mixture should be given :
      R Hydrocyanic Acid............................. gtt. viij.
        Quinine Sulph................................... gr. xx.
        Aqua.............................................. |iij. 
DISEASES  OF  THE  SKIN.         383
Mix; dose, one teaspoonful four or five times a day.   The
bowels should be kept  open by the occasional use of a
stimulating  purgative.  Cold baths should be taken as
often  as  every third day.   Where the disease  is of long
standing, indicating paralysis of the optic nerve, the fol-
lowing may be used to advantage :

     R Extract Macrotys............................... gr. xx.
          "   Mux Vomica.......................... gr. x.
          "   Euonymine............................ gr. xxx.
Mix,  and  form a  pill  mass, and  ma£e  two-grain pills.
Dose, from one to three pills, three times a  day.   During
the entire course of treatment, the anterior portion of the
head  should be frequently bathed with a  stimulating pre-
paration.
         DISEASES  OF THE  SKIN.

           HERPES,  OR  SALT  RHEUM.

                     SYMPTOMS.
  Small vesicles grouped  together upon inflamed patches
of skin ; the  vesicles contain a thin,  light,  transparent
fluid, which  is  absorbed  or  evaporated, leaving a  thin
transparent scale.   This desiccation will desquamate and
leave the part,  which will  again become affected in  the
same manner.   There are two other varieties of Herpes
spoken  of by  writers,  viz:  Herpes Zoster or Shingles, and
Herpes  Circinatus or  Ring-worm.   The   symptoms  of
Herpes Zoster  are full and  quick pulse,  dry  skin with
fever, tenderness of the Epigastrium, constipation of  the
bowels;  and  the herpetic  eruption  which generally  com-
mences  on the bowels, and spreading  frequently, encircles
the  body.  The appearance  of  the  eruption,  is  almost
iden tical with  salt  rheum: it  is in fact the  acute form of 
384          DISEASES  OF  THE  SKIN.

it.  The symptoms of Herpes  Circinatus are very simple;
it being only what is known as a ring-worm, no farther
description will be required.

                    TREATMENT.
   As an  external application, an  ointment may be used
made as follows :
     R Iodide of Zinc................................... gr.  xxx.
        Ext. of Phytolocca Decandra............... gr.  xx.
           "   Black Walnut Bark................. gr.  xxx.
           "   Balsam Copaiba....................§ij.
Mix, and rub a small portion on the diseased  part, morn-
ing  and  evening.   Previously,  the  part  should be  well
bathed in a  strong  decoction of  Black Walnut buds or
leaves.  At the same time, the following compound should
be taken internally :
     R Juglandin..............................................  3J.
        Irisin..................................................^ss.
        Sac Alba.............................................  ijiij.
Mix, triturate, and  give  from ten  to fifteen grains twice a
day.   Also  give one teaspoonful  of compound syrup of
Stillingia three times  a day.   If there is tenderness in the
parts after the disease seems to be  removed, they should
be protected  by  liquid  collodion  for a few months, to
prevent a return.   For Herpes Circinatus, or ring-worm,
wash the parts in Saleratus water,  and  cover  with  Col-
lodion.
   In  Herpes Zoster, or Shingles,  the  eruptive surface
should be well bathed in a strong  solution of zinc,  after
which  apply a slippery  elm  poultice.  A purgative of
Juglandin and Cream of Tartar should be  given, and
repeated  from time to time as long as the disease  proves
active.  To control the fever, Aconite or Yeratrum should
be used, and the surface frequently bathed in lye water.
If the disease is periodical, some of the antiperiodic medi- 
                      ECZEMA.                   385

cines should be given.   The zinc wash should be repeated
from time to time, until the active inflammation  is sub-
dued.   Afterwards use the liquid Collodion instead.

                      ECZEMA.

   This is another  form of herpetic eruptive disease, and
like  all  others, it  is  characterized by small blisters or
vesicles.  There are several varieties of this form of  erup-
tive disease, sucli as Eczema of the face,  or crusta lactea,        \
Impetigo, or moist tetter,  &c.  The  causes  of these  cu-        ^
taneous eruptive diseases are as numerous as the varieties.
They  may arise from improper  diet, exposure to  cold,
teething in children, intestinal irritations, &c.  They are
also hereditary.   The symptoms  depend  very much  upon
the cause; but in  all cases, where the disease  is in any
way severe, there  is  more  or  less constitutional  disturb-
ance,  such  as irregularity  of the bowels,  fever,  quick
pulse,  scanty and high-colored urine,  &c.  The limits of
this work will not allow of  a  minute description, of  every
form,  of these eruptive diseases and their symptoms.   But
as the treatment varies only,  as the causes are different,
the descriptions and  symptoms given will be found suffi-
ciently minute for all practical purposes.

                    TREATMENT.
                                                      •
   There is no class  of remedies  more efficacious in skin
diseases, than the  preparations of the Juglans cinerea;
and  the most efficient  of these is the Juglandin.  This
should be used in connection with bitartrate of potassa, in
sufficient quantities to produce a mild  purgative effect.
The best preparation of that kind is the following :
     R Juglandin........................................ gr. xxx.
        Cream of Tartar..........'..................... gr. xxx.
        Pulv.  Cubebs.................................... gr. xx.
                         33* 
386
ITCH.
Mix, triturate, and  divide into twenty powders, and give
one every morning and evening.
  The above may be  given in connection with,  or alter-
nated with antiscrofulous syrup, or  Iodide  of Potassium.
In some cases, iron and antiperiodics will  be  required.
The  external applications should be  tar ointment, nitro-
muriatic acid, zinc ointment, ointment of Baptisin, acetic
Tinct. of Bloodroot, astringent washes, slippery elm poul-
tices, and Collodion.   These different  remedies  may be
used  as the  nature and character of  the disease  seem to
indicate.   In the active  stage, the preparations of zinc
are  the best  adapted to  remove  the disease, while the
others are more efficient in the chronic stages.

                 ITCH, OR  SCABIES.
   This  disease  is caused  by minute white  insects, the
Acarus Scabiei, or   Sareoptis hominis, which  insinuate
themselves beneath the cuticle, and travel  over the differ-
ent  portions of the rete mucosum.   It is said that these
insects travel in  pairs — male and female — and  that the
female  is very much  smaller.  By  the  aid  of the  micro-
scope, they are observed to have a large number of bristles
upon the head or proboscis.   When  they find a soft and
moist portion  of skin, they burrow beneath a small  der-
moid scale,  and luxuriate until a  deposition of  a small
quantity of serum  from the blood warns them, that unless
yiey take their departure, a flood will soon overtake them.
But before taking their final  leave, the female  deposits her
eggs at the point  of  the vesicle ; thus a nidus  is formed
for the complete development of the acarii.
                      SYMPTOMS.
   A vesicular eruption makes its appearance between the
fingers, and in  other soft portions of the skin, accompanied
by an  intolerable  itching.  ,If the  vesicle is opened, a
small  amount  of sero-albuminous  matter will escape, and
if allowed to dry,  will form a light brown scale. 
PUSTULOUS  CUTANEOUS.         387
                   TREATMENT.
  The only remedy necessary in  the  treatment op  this
disease  is  sulphur, and  the reason why this  remedy is
not more  successful,  is  the inefficiency  of its  applica-
tion.  The entire  surface of the patient  should first be
washed  with soap and  water;  immediately  afterwards,
a strong decoction of  sulphur should be  applied to every
portion  of  the body, and allowed to remain  from one-half
hour to  an  hour, when the whole surface  should be wiped
with a towel, wrung out of strong saleratus water.   One
application of  the sulphur, used  as directed above, will
generally remove the disease ;  yet, it is advisable to renew
the application several times.   The sulphur, on coming in
contact with the insect, immediately destroys it.

      PUSTULOUS  CUTANEOUS  DISEASE.
  All the diseases characterized by pustules, may be cor-
rectly classified under the above head.   Willan and Bate-
man specify four varieties of this form of non-contagious
disease, viz : phlyzacium, psydracium, achor, and favus.

                     SYMPTOMS.
  A  greater or less number of distinct tumefied eruptions,
which gradually mature  and become filled with a sero-
purulent matter,  and  having an  inflamed  base.  These
may appear in  small clusters, and disappear in  a few days,
or they may cover a considerable part of the hands,  face,
or other portions of the body, and be  accompanied with
extensive inflammation of the integument, and  extending
in some instances to the adjacent tissues, terminating in
phlegmonoid abscess.  Nearly all  the forms  of tetter come
under this  class, as do also impetigo and  acne.   In some
cases, there are constitutional  symptoms, as fever, quick 
388          PUSTULOUS  CUTANEOUS.
pulse, headache, loss of appetite, &c.   The causes of this
kind of cutaneous disease, are essentially the same  as  of
the vesicular, but they are more apt to be connected with
an impoverished condition of the blood.

                    TREATMENT.
   If this disease appears on the head, it is called porrigo,
or scald head.   The hair should be  shaved close to the
scalp,  and the head must be thoroughly washed  with soap
and water, after which  the zinc and tar ointment must be
alternately applied, morning and evening — the zinc in the
morning,  and the tar in the evening: the patient should
likewise take a full dose of the alterative syrup three times
a day.  This  course, if persisted in,  will remove the dis-
ease.   When  the eruption appears on  other parts of the
body,  the nitro-muriatic acid should  be first applied, and
be followed by the Tar ointment.  A mild purgative of
Juglandin and  Cream  of Tartar,  also  simple  syrup of
Stillingia and  Scrophularia,  equal parts, should be taken
in small quantities  during  the application of the external
remedies.  When the pustular eruption is connected with
extensive inflammation  of  the skin, a slippery elm poultice
should follow the application of the ointment.  Should the
disease prove obstinate,  equal parts  of vegetable caustic
and pulverized  Sanguinaria,  should be  sprinkled over the
parts  before each  application of the  ointment.   If there
are constitutional symptoms, they should be treated accord-
ing to their nature; in  most cases,  iron and  vegetable
tonics will be  required.   The diet should  be nutritious,
and the surface  freely  bathed once or twice  a  day.   Tu
remove the small pustules which appear on the face,  apply
a liniment made of equal parts of ammonia  and sweet oil.
Or, when they first appear, touch them with ammonia, and
cover them with Collodion. 
PURPURA.                  389
                     PURPURA.
    here are several varieties of this disease:  as  simplex,
or petechial scurvy, purpura hemorrhagica,  purpura
nautica, purpura scarlatina.  By the term purpura, we
understand a greater or less number of livid spots on  the
skin from extravasated blood.   In purpura  simplex,  the
effusion is confined  to  the  skin and cellular tissue, mostly
occurring on the arms, legs, and breasts.  The  spots at
first are small, resembling flea-bites,  and are frequently
very numerous.   The countenance is pale, and the patient
complains  of great debility, loss of appetite, irregularity
of the bowels,  and periodic fever.  If the disease  is al-
lowed to progress, it will terminate in  what is called pur-
pura  hemorrhagica, and is described by Dr. Bateman as
follows :
   " The petechia? are often of a large size, and are  inter-
spersed with  vibices,  echymoses,  or livid  stripes  and
patches,  resembling the marks left by the strokes of  a
whip, or violent bruises.   They commonly appear first on
the legs,  and  at uncertain periods  afterwards, on  the
thighs,  arms, and trunk of the body; the hands  being
more rarely spotted with them, and the face generally free.
They are usually  of a bright red color when  they first
appear, but soon become purple or livid;  and when  about
to disappear, they change  to a brown or yellowish hue;
so that, as  new eruptions arise, and the absorption of  the
old ones slowly proceeds,  this variety of colors is com-
monly seen in the different  spots  at the same  time.   The
cuticle over them appears smooth  and shining,  but it is
not sensibly elevated;  in a few cases, however, the cuticle
has been  seen  raised  into a sort of vesicles, containing
black blood.   This more frequently happens in the spots,
which appear on the tongue, gums,  palate, and  inside of
the cheeks  and lips, where the cuticle is extremely thin, 
390
PURPURA.
and breaks from the slightest force, discharging the effused
blood.  The gentlest pressure on the skin,  even such as is
applied in feeling the pulse,  will often produce a purple
blotch, like that which is left  after  a severe bruise.   The
same state of the system which gives rise to these effusions
under the cuticle, produces likewise copious discharges of
blood, especially from the internal parts, which are de-
fended by more delicate coverings.   These  hemorrhages
are often very profuse and not easily restrained, and there-
fore sometimes  prove suddenly fatal; but  in  other cases,
they are less copious;  sometimes returning every day at
stated periods, and sometimes  less  frequently,  and at
irregular  intervals ;  and sometimes there is  a slow  and
almost incessant oozing of blood.   The  bleeding  occurs
from the  gums, nostrils,  throat,  inside  of  the  cheeks,
tongue, lips, and sometimes from the lining membrane of
the eyelids,  the urethra  and  the external  ear; and  also
from  the  internal cavities of  the lungs, stomach, bowels,
uterus,  kidneys, and  bladder.    There  is  the  greatest
variety, however, in different  instances as to the period of
the  disease, in which  the haemorrhages   commence  and
cease, and  as  to the proportion which they  bear  to the
cutaneous efflorescence.
   "This  singular  disease is often preceded, for some
weeks,  by  great lassitude, faintness, and pains  in  the
limbs, which render the patient incapable of any exertion;
but, not unfrequently, it appears  suddenly in the midst of
apparent  good health.   It  is  always accompanied  by
great debility and depression  of spirits; the pulse is some-
times quickened;  and  heat,   flushing,  perspiration,  and
other symptoms of febrile irritation,  recurring  like the
paroxysms  of  hectic,  occasionally  attend.   In some
patients, deep-seated pains have  been  felt about the  pre-
cordia,  and in the chest,  loins, and  abdomen;  and in
others, a  considerable cough  has accompanied the corn* 
PURPURA.                  391
 plaint, or a tumor and tension of the  epigastrium, right
 or left hypochondrium, with tenderness  on pressure, and a
 constipated,  or irregular  state of the  Jbowels.   But  in
 many cases, no febrile appearances have been noticed; and
 the  functions  of  the* intestines are often natural.   In a
 few cases, frequent syncope has occurred.  When the dis-
 ease has  continued  for some  time, the patient  become?
 sallow, or of a dirty complexion, with much emaciation,
 and some degree of  oedema appears in  the lower extremi-
 ties, which afterwards extends to other parts.  The disease
 is extremely uncertain in  its duration ;  in  some instances
 it has terminated in  a few days, while in others it has con-
 tinued not only for many months, but even for years."
   When the disease runs a rapid course and terminates in
 death, it is  generally  dependent  upon  the occurrence  of
 hemorrhage into some of  the vital organs.  Such is  the
 disposition to  hemorrhage in this  stage of the disease, that
 although a patient may appear convalescent on retiring to
 bed in the evening, he may be suddenly seized with violent
 dyspnoea and  orthopnoea,  which  rapidly increases  until
 death ensues by asphyxia.  In such a case, there has been
 a sudden effusion of  blood into the pulmonary tissue, pro-
 ducing pulmonary  apoplexy.
   Or there may be acute haemoptysis, caused by the escape
 of blood into  the air passages.  In this event, the hemor-
 rhage may be controlled,  and the patient recover under
 proper treatment.    The  hemorrhage  may occur  in other
 organs,  as the brain, producing apoplexy and death;  or,
 into  the cavities  of the  chest and  abdomen.  It  also
 occurs  into  the cellular tissue, producing extensive ecchy-
 mosis, inflammation,  gangrene, and death; or the purple
spot will gradually assume a yellow appearance, absorp-
tion of the effused  blood occur, and the  patient recover.
  In purpura  nautica, the purple spot  mostly. occurs at
the roots of the hair, on the gums, and mucous membrane 
392
PURPURA.
of the mouth and pharynx.   In this form of the disease,
the gums become spongy  and  bleed  upon  the slightest
injury, the teeth become loose, and frequently fall from the
gums : there is  great  debility,  a sallow countenance, ir-
regular sleep, and night-sweats, followed by  fever;  the
bowels  are  irritable, and  there is  maelena.   This latter
form of it,  Prof. J. Gr.  Jones has. treated as  a separate
disease, under the head of Scurvy or Scorbutus; and con-
siders it the same as various writers  have described as sea-
scurvy : although he does not favor  the opinion, at one
time very prevalent, that salt water causes the disease; but
states,  that  the cause  is  generally more of a  positive
than a negative character, being the want of such  articles
of food as furnish the system through the medium of the
blood,  with certain elements  indispensable to life and
health.   He is of the  opinion that  these deficiencies con-
sist in the lack of vegetable  acids.
   On comparing the description of scurvy by Prof. Jones,
Mcintosh,  Bateman, and  others, with purpura, as it is
described by various individuals, the  only difference be-
tween what is  known  as sea-scurvy, and  purpura, is the
circumstances under which it makes its appearance ;  both
evidently depend upon the same pathological condition of
the system.
                        CAUSE.
   The  causes  of the different varieties of this disease,
seem to depend upon a deficiency  of vegetable  aliment,
and  long exposure to a damp atmosphere; also, a lack of
due  exercise, an unwholesome  diet, and anything which
tends to an impoverished  state of the blood.   The influ-
ence  of improper diet, in developing purpura,  has been
remarkably exemplified within the past year.   Owing to
the failure of fruit, as well as the potato crop and other
vegetables, bread, butter, and meats have been the princi-
pal articles of diet;  and purpura, which was  hardly known 
PURPURA.                  393
in the  country,  has  become  a prevalent  disease.   So
much so, that the  most trifling complaints  are attended
frequently  by  active  hemorrhage.   On  examining  the
blood, it is found  to be  deficient in fibrine, but feebly
disposed to' coagulate, and very abundant in  serum.

                   TREATMENT.
   When the  disease first makes its appearance  in  the
simple form,  little more is necessary than a liberal diet of
fresh vegetables,  with out-door  exercise,  and a  small
amount  of Muriated Tinct. of Iron,  say from five  to  ten
drops three  times  a  day.   Where the disease assumes  a
hemorrhagic character, the following  may be given :
      R Quinine............................................ gr. xv.
        Citrate of Iron.................................. gr. xxx.
        Capsicum.........................................gr. xx.
Mix, triturate, divide into eleven  powders, and take  one
every three hours.  The patient  should  at the same time
make a free use of lemonade, and take a free diet of green
vegetables, salt meats, eggs, &c.   After  the powders  are
all taken, the following mixture should be given :
      R Port Wine.............................................Oj.
        Phosphate of Lime.....................„...........gss.
        Carbonate of Iron.................................. giij.
Mix, shake well, and take one tablespoonful, three or four
times a  day.   If  effusion has occurred into the  cellular
tissue of one of the limbs, it should  be  carefully ban-
daged,  and kept constantly wet in  a strong liniment of
camphor, whiskey, and spirits of turpentine.   The bowels
should  be  moved once or twice a week, by the use of
Antibilious   physic  and  Cream  of  Tartar.  The  body
should  be  frequently bathed in warm  or cold water as
indicated.
   Should hemorrhage occur into the bowels,  lungs, or any
other organ, the oil of  Erigeron  may be given in  five or
        u 
394         RETENTION OF URINE.

six drop doses every half hour.   If there should be  me-
laena, and the oil of  Erigeron should  fail to arrest it, the
nitrate  of silver pill  may be  given as directed under the
head  of typhoid  fever.  Or  from five to ten grains of
Matico,  may  be  given  every fifteen  or twenty minutes,
until  the hemorrhage ceases.  If there is much debility,
porter, ale, or brandy, should be  given  in such quantities
as the  nature of the case  may indicate.   The patient
should avoid  all active  exercise, and exposure to a damp,
moist atmosphere; let him repeat the  Quinine  and Iron
from time to time, until the disease is removed.
  ISCHURIA,  RETENTION  OF  URINE.
   In this disease, the urine, accumulated in the bladder,
 cannot be evacuated without extreme difficulty, or without
 assistance; when it  cannot be evacuated  without  assist-
 ance, the retention is said to be complete;  and when it is
 evacuated without assistance, but with great difficulty, it
 is said to be incomplete.

                       CAUSES.
   The  causes of retention  of  urine are various;  as  in-
 flammation of the bladder, small  stones or gravel lodging
 in the  urinary passages,  hard faeces lying in  the rectum,
 pregnancy,  stricture of the neck  of the bladder, swelling
 of the  hemorrhoidal veins, paralysis of the bladder, pro-
 lapsus  uteri, inflammation of the mucous  surface of  the
 urethra; it also  occurs in female hysteria,  and  from  in-
 flammation  of the meatus urinarius.

                     SYMPTOMS.
  When the bladder  becomes abnormally  distended with
urine, there will  be a dull pain, in the back, with  sharp
lancinating  pains passing  through the bladder.  As the 
RETENTION  OF  URINE.           395
accumulation of urine goes on, the pain  increases until  it
becomes excruciating, the arterial system is much excited,
and the pulse beats with increased frequency, rising to 100
or 140 beats per minute.  The respiration is hurried, and
the skin litt and dry.   If the uric acid is allowed to be
absorbed into the blood, the brain will sympathize with
the other constitutional symptoms,  producing  delirium,
and as I have seen in several cases, clonic spasms.  Unless
the bladder is  evacuated, it will become perforated, pro-
ducing death ; or death may occur as the result of zymotic
influence upon the blood and nerves.

                    TREATMENT.
   When the retention is dependent upon inflammation of
the bladder, kidneys, or urethra, the bladder  should first
be  evacuated by  means of a catheter; after which the
disease  should  be treated, as directed under the head of
inflammation of these  parts.   If it depends upon a stric-
ture, it can generally be overcome by injecting into the
urethra,  a solution of the  extract of Belladonna or Gel-
seminum :
     R Extract  of Belladonna...........................  gr. x.
        Warm Water.......................................  2iij.
Dissolve the extract in the water, and inject one third into
the urethra.  If this is not soon followed by relief, it may
be  repeated every  fifteen  or twenty minutes.  If,  in  a
reasonable time, relief is not effected, the Ext. Gelseminum
may be used in the same manner.   In my hands this treat-
ment in strictures of the urethra has proved efficacious  in
a large number of cases.  Where the disease is occasioned
by a gravelly deposit in the bladder,
     R Ext.  Eupurpurin..............................gr.  xxx.
       Cream of Tartar..............................gj.
       Apocynin....................................... gr.  xx. 
396         INCONTINENCE OF URINE.

Mix,  triturate;  divide  into  ten  powders, and give one
three  times a day in one teaspoonful of Syrup of Iodide of
Potassium ;  the hypogastric and lumbar regions should be
bathed every morning and evening in equal parts of sweet
oil and  spirits  of turpentine.   Where there is pressure on
the neck of the bladder,  by faeces lying in the rectum, by
pregnancy,  or  other cause, it should be  removed.  And
then,  by the use of Marshmallow, Clivers  or flaxseed tea,
a cure may be effected.   In females, where it is dependent
upon  irritation of the meatus  urinarius,  a wafm elm poul-
tice, applied to the vulva, and melon-seed tea, will gene-
rally  effect  a cure.   If  there should be  debility of the
bladder, with  a tendency to paralysis,  tonics, combined
with  Iron,  should be flsed,  and  the  nerves  of the  back
gently stimulated by the application of the electro-magnetic
current  once or twice a  day.  During  the treatment of
retention of urine, whatever the cause may be, the bladder
should be evacuated every day by the use of the catheter.
    ENURESIS,  INCONTINENCE  OF URINE.
   Incontinence of  urine, like retention, is often associated
with some constitutional weakness.   In  advanced life it is
usually associated with disease of the neck of the bladder,
prostate gland, or with paralysis.   Incontinence of urine,
in children, mostly occurs  in the night only, while asleep;
and, not unfrequently, in these cases the urine  passes off
involuntarily under the influence of a dream.
   It is said that in  such cases  the acid property of the
urine is  the exciting cause, and that there is a strong ten-
dency  to gravelly  deposits.   In young  people, where the
urine passes off  in the night involuntarily,  it is usually
retained, at any time, with much difficulty,  and  will be  of
a very pale color, and far less  serous than  is natural.  In 
HEMATURIA.                397
old people, this  difficulty arises  from paralysis, produced
by injuries of the spine, or over-distension of the bladder,
injuries of the neck of the bladder, &c.

                    TREATMENT.
  In children, where the disease depends upon a changed
condition  of  the  urine, the diet should be  well regulated,
and warm or  cold baths given three or  four times a week.
A syrup  of  equal parts of Hydrastus Canadensis  and
Aletris Farinosa  should  be  given in  teaspoonful doses
three times a day.  Where it depends  upon spinal irrita-
tion, the  irritating plaster should be applied to the spine,
and  from five to  ten  drops  of  the oil  of  Erigeron given
three  times  a day,  with a free  use of cold  baths  and
friction.
  If the bladder is in an irritable state, give the following:
     R Dwarf Elder....................................... gj.
        Indian Hemp...................................... gij.
        Marshmallows..................................... gj.
Make  one pint  of syrup,  and  add one half pint of gin.
Dose,  one teaspoonful three  times a day.  If there is an
enlarged condition of  the  prostate gland,  one  drachm of
Iodide of Potassium should be added to  the  syrup, and
the same quantity taken.
HEMATURIA, OR HEMORRHAGE FROM  THE
               URINARY  ORGANS.
  This  frequently occurs  in  certain  epidemics  of  the
malignant type, as in cholera and  severe remittent and
typhoid fever, in which the spleen and liver are implicated;
also in  Purpura,  Scurvy, and all  diseases in which  the
blood is in an impoverished state.  The exciting cause of
haematuria  may be of a mechanical  nature, that is, a cal-  *
                         34*
L 
398          URINARY HEMORRHAGE.

cuius concretion;  or  it may be from ulcerations of the
bladder, kidneys, or their appendages.  When the hemor-
rhage cannot be traced to some constitutional disturbance,
it  may be  considered  directly mechanical.   This  may
depend upon a calculus, either causing irritation or wound-
ing some blood-vessel; or the hemorrhage may occur from
ulceration of the bladder, by the  irritating  effect of the
urine itself.
                     DIAGNOSIS.
  When the patient is  laboring under no constitutional
disease, that is usually accompanied by hemorrhage, or has
not been afflicted with calculous affections, if he complains
of pain in the urinary organs, and voids blood with the
urine,  mixed with  mucus, and  especially if  mixed  with
purulent matter, a breach of surface must exist somewhere
in the urinary apparatus.   Having ascertained the cause
of the hemorrhage, its seat should be sought for.  When
there are sharp twisting pains along the line of the ureter,
darting to the urethra  and  testicles, accompanied  with
nausea and vomiting,  it may be reasonably supposed that
it depends upon the presence of calculus in the ureter or
kidneys.  On the other hand, when the hemorrhage comes
on after exercise, and  there is occasional retention, accom-
panied by a twinging  pain in the pen-is, there can be but
little doubt that the hemorrhage is caused by stone in the
bladder.  Where  the hemorrhage is from the kidneys, the
first urine that flows  is generally clear, the blood mostly
passing at the close of micturition.

                    TREATMENT.

  The  treatment  of  haematuria  will depend  upon the
cause,  the degree and locality,
  Where the disease is dependent upon scurvy or purpura,
it should be treated as  directed  under that head, with the
addition of astringents, such as an  injection of a weak 
URINARY HEMORRHAGE.         399
solution of Matico into the bladder, and the oil of Erigeron
taken internally.   If occurring as melaena,  the effect of
obstruction of the liver and spleen, give the following :
     R Muriated Tinct. of Iron........................gij.
       Quinine............................................. gr. xx.
       Water............................................... 3»j
Mix, and give.one tablespoonful every four  or  five hours
until the  active stage of the disease is passed.  After which,
the following mixture:
     R Gin...................................................Oj.
        Sugar...............................................lbj.
        Water............................................... Oj.
        Aletrin.............................................. gj.
        Euonymine......................................... 3ij.
Mix, and give one tablespoonful three or four times a day.
The region of the liver and spleen should be bathed two or
three times a  day in a liniment composed of sweet oil  and
spirits of turpentine.  Where haematuria is connected with
a gouty diathesis, a free  purgative of Podophyllin   and
Cream  of Tartar may be given in the commencement of
the treatment, followed by full doses of the oil of Erigeron,
until the hemorrhage ceases.  After which, nitro-muriatic
acid and Euonymine should be given.   If calculus in the
kidneys  is the cause of the disease, a strong decoction of
the Queen of the Meadow will  dislodge it and arrest the
hemorrhage;  after which,  mucilaginous  diuretics should
be given,  such as marshmallow,  flaxseed, &c.   When the
cause of haematuria is  seated in  the bladder, it should be
injected first  with warm water, afterwards with a strong
solution of Matico mixed with starch-water.   The  back
and loins being  thoroughly bathed with a liniment  pre-
pared as follows:
     R Oil of Capsicum................................. gtt.  x.
        Alcohol............................................ Oss.
        Oil of Origanum................................ 3;iij. 
400          UTERINE CONGESTION.

Mix,  and use as heretofore directed.  If there is mn h
inflammation of the bladder, scarify and cup  over that  re-
gion,  and apply hot packs.  At the same time give Aco-
nite or Yeratrum until the symptoms are controlled.  If the
bladder should become distended with a large amount of
coagulated blood, recourse  must be had  to  a large-sized
catheter;  and by the  aid of an exhausting syringe and an
occasional injection of the  bladder with cold water,  the
coagula may be removed.  Should the hemorrhage become
active while thus evacuating the bladder, it may be arrested
by injecting a solution of Matico into the rectum.
  CONGESTION  AND  INFLAMMATION OF  THE
                        UTERUS.
    This disease  is but imperfectly understood;  and more
  frequently than otherwise passes  unobserved both by the
  patient and her medical attendant.  In  a great majority
  of cases it is treated by physicians as prolapsus uteri, ame-
  norrhasa,  dysmenorrhaea, menorrhagia, or leucorrhaea;  the
•  primary cause of the disease is overlooked, and the  symp-
  toms only receive attention.  Hence it is  that but little if
  any benefit is derived from the ordinary course of medica-
  tion in this class of cases.
    The hydropathists have  acquired some reputation for
  treating this class of cases,, and in many instances  they have
  had superior success.   Their success, however, is not de-
  pendent upon a more extensive knowledge of the  affections
  so much as the  remedy upon  wrhich they rely being better
  adapted  to  relieve this peculiar pathological  condition
  of the  uterus,  than the remedies  generally  used for  this
  purpose.
    Congestion of the uterus, like congestion of other organs,
  is a disease of frequent occurrence, and  is caused by the
i 
UTERINE  CONGESTION.          401
accumulation of blood in  the  veins and capillaries.   The
congestion is generally combined with infiltration into the
cellular tissue of the uterus, producing oedema of the ute-
rus, and in some cases the oedema is very considerable.

                     SYMPTOMS.
  On making a vaginal examination of the uterus, a com-
plete  congested appearance  is manifest.   The uterus is
enlarged   and vesicular, and  in places  the  veins have  a
varicose appearance.  In the incipient congestion of the
uterus the appearance very much  resembles  that of early
pregnancy.   The uterus is tender upon pressure, and if the
disease is  of long standing, the broad ligaments and vagina
also present a similar congested condition.   In other cases
there is excoriating granulations,  or ulceration of the neck
of the uterus and its lining membrane.   Congestion  of the
uterus, like the  congestion of other  similar  tissues,  is fol-
lowed by pathological changes, such as  an increased  afflux
of blood to the part; a loaded condition of the capillaries,
the blood  circulating with less and less force until it'finally
ceases, and a complete barrier is formed to the further  cir-
culation of blood in the part.  At this stage  inflammation
is said to commence.  But where  congestion assumes  a
chronic form, as it  mostly does in the uterus, the vessels,
after  having been thus distended for some  time, contract
upon  their own contents, forcing the  more fluid portions
of the blood out of the vessel into the adjacent areolar and
cellular tissues; and in  this  way the parenchyma  of the
uterus becomes extensively infiltrated with the fluid portion
of the blood.  Where the  congestion extends to the vagina
and  inner membrane of  the  uterus,  a similar  exosmosis
occurs from the congested capillaries of the parts ; instead
of being  retained in the  parenchyma, it escapes into the
cavity of the uterus and  vagina, mixing with  the mucus,
and thus constituting what is known as the whites.  In case
L. 
1
402           UTERINE  CONGESTION.

the blood is anaemic, and the patient of a scrofulous cachexia,
the salts of the blood held in solution will make their escape
with the serum, and, mingling with mucus, cause a muco-
purulent or muco-serous discharge.  If there is abrasion
of the uterus or its appendages, the sanious secretion from
the ulcer, mixed with the disintegrated tissues of the parts,
often renders the discharge not only offensive but  exceed-
ingly irritating, denuding the vagina of its mucous surface
and inducing either an acute or chronic inflammation.  The
constitutional symptoms are a sense of weakness,  weight,
or pain in the back ; the patient complains of nervousness,
pains in the head and shoulders, often changing to different
parts of the  body.   The functions of the  stomach  and
bowels become deranged ; the  countenance is sallow, and
the skin has a dry and  husky appearance;  the lips  lose
their color,  and the  eyes their natural brilliancy;  the feet
and  hands are mostly cold,  although in  some cases, and
in some portions of the day, they  are hot  and  burning.
The  menses are mostly irregular either in quantity, quality,
or time of occurrence.  I have observed all these  symptoms
in connection  with congestion of the uterus.  If the disease
is allowed to advance, palpitation of the  heart will occur,
with cough, bronchial irritation and expectoration of mu-
cus.   At this stage of the disease, the increased  weight of
the uterus, together with the relaxed condition of the mus-
cular tissue, causes the uterus to gravitate into the pelvis,
resulting in what is usually known as prolapsus uteri.  The
lower floor of the abdominal cavity thus  giving  way,  ena-
bles  the whole contents of the abdomen and thorax to settle
from their normal position.   The  bowels, stomach, liver,
spleen,  heart,  and lungs, all being  thus displaced, put the
pneumogastric nerve and upper portion of the lung  upon
a  stretch, producing a constant irritation and materially
increasing  the cough, which before was  considerable.  If
this condition of things  is allowed to continue, the blood
j 
             UTERINE  CONGESTION.          403

Boon becomes impoverished,  owing to a defective appetite,
irregular  respiration  and  leucorrhaea, and a  tuberculous
deposition occurs in the langs.   In cases where the uterus
has become impregnated, the symptoms frequently somewhat
abate, although in several cases I have known them to be
very much aggravated, and maintain  an uncommon obsti-
nacy during the entire stage of gestation.  Where the ute-
rus remains thus congested during pregnancy, the  disease
is very liable to terminate in inflammation immediately after
delivery,  proving very  obstinate,  and,  unless  properly
treated, disastrous to the patient.   In these cases there is
acute pain just above the pubes, quick pulse, hot skin, and
retention  of urine, either partial or complete.  The  tongue
will soon be covered with  a dark brown  coat, and many
times there are convulsions.   The bowels are  constipated,
and in many cases there is nausea and vomiting.
   If  the  disease is  not controlled,  delirium,  coma, and
death  ensue.   The inflammation  may be  less acute,  ex-
tending to the peritoneum, causing a tympanitic condition
of the bowels, suppression  of the lochia  and milk, with
violent fever.   There are other points of great interest
connected with this form of uterine derangement, which
the limits of this  work will not allow me to consider.

                       CAUSES.
   There  are a variety of causes which may produce this
condition of the  uterus; such  as  the frequent use  of em-
menagogues,  which  contain  mercury, exposure   of  the
feet to the damp and cold earth by wearing thin  shoes;
the practice of dressing in such a manner  as to compress
the waist, thus  preventing the  return of the venous blood
to the heart by the superficial veins, also obstructing the
capillary circulation ; hence  the blood is forced through
the deep capillaries,  inducing congestion of the uterus.  It
may also  be  caused by repeated  abortions,  by excessive
L 
404
UTERINE  CONGESTION.
venery,  by cold and  exposure; in short, anything  which
will induce it in any of the internal  viscera,  will produce
it in the uterus.
                    TREATMENT.
  In commencing the treatment of this disease, the cause
should be constantly kept in view,  and as far as possible
be removed.   To remove the congestion, a plaster  should
be  applied to the  abdomen over the uterus,  composed of
the following materials :
     R Gum  Galbanum..................................... ^ij-
        White Pine Gum.................................... 3J-
        White Wax........................................... 3JSS-
Melt the gums  and wax together,  add one  drachm of
pulverized blood-root,  and stir until it becomes thickened;
spread a coat  of it upon  a thin piece of leather, large
enough to cover the  uterus,  and apply.  It  should be
renewed from time to time  until relief  is effected.   At the
same time, give the following compound :
      R Gelsemin......................................... gr. ij.
        Bebeerine....................................... gr- xxx.
        Caulophyllin.................................... gr. x.
        White Sugar..................................... gr. xxx.
 Mix, triturate,  divide  into  twelve powders,  and give one
 every  six  hours.  During the  administration of  these
 powders,  vaginal injections of the  cold infusion of Cin-
 chona  should be used two or three  times a  day.   During
 the early part of the treatment, a thorough hand-bath
 should be taken every morning as indicated; also an oc-
 casional  sitz bath.  The above treatment should be pur-
 sued for ten or  fifteen days; the following may then  bo
 substituted :
      R Carbonate of Iron................................... $]•
        Pulv. Queen of the Meadow...................... 3'j-
        Cream of Tartar..................................... §j- 
UTERINE  CONGESTION.          405
       Port Wine.............................................. Oj.
       Sugar................................................... lbj.
       Gin....................................................... Oj.
Dose, one tablespoonful three times a day.  At the same
time:
     R Fol. Jugland Regise, or Fresh Walnut leaves, ^vj.
       Port Wine............................................ Oj.
Make a Tincture, and use a syringe full, as vaginal injec-
tion, once or  twice a day.   The plaster should be removed,
and  a wet girdle  worn around the lower portion of the
abdomen  and back.  During the entire  course of treat-
ment, the bowels should be  regulated by the use  of neu-
tralizing mixture.  If any of the symptoms, described as
dependent upon this disease, should remain after using the
above remedies for a  reasonable length of time :
      R Macrotin........................................... gr. xx.
        Senecin............................................. gr. x.
        Capsicum......................................... gr. xx.
        Vallet's Ferruginous Mass.................... 2j.
Mix, and form a  mass.   Make three-grain pills, and let
one be taken three times  a day,  alone, or in connection
with  other medicines as indicated.   If  there should  be
ulcers upon the vagina or uterus, the speculum should  be
Introduced,  and  the vegetable caustic  be applied,  after
which the ulcer should be covered with powdered slippery
elm.   Much care will be required in making this applica-
tion, to prevent the caustic.from  coming in  contact with
parts not diseased.   If there should be a  scrofulous dia-
thesis, connected with this disease,  Stillingia and Iodide
of Potassium may be used  in connection with  the other
remedies.  The diet in any case should be  free and nutri-
tious.  In  case the congestion should terminate in a latent
form of inflammation, Muriated Tinct. of Iron, Yeratrum
Cinchonine,  and  Cornine,  in  connection with the local
applications, as directed  under the head of congestion
       35
L. 
406      CESSATION OF THE MENSES.

Where  active  inflammation  ensues,  a full  cathartic of
Podophyllin and Cream of Tartar should be given in the
commencement, followed by cold packs to the bowels, and
full doses of Muriated Tinct.  of Iron and Quinine.  If
convulsions are  connected  with the inflammation,  Gelse-
min, Lobelin, and Belladonna,  should  be used in sufficient
quantities until  that symptom is relieved.  During the
inflammatory stage,  the  patient must be kept quiet, but
in the  congestive  form  of the  disease, moderate exercise
should be taken.
     CESSATION  OF THE  MENSES.
   At the period of life when the menses should cease, the
discharge  usually  becomes  irregular;  sometimes being
obstructed for two  or three months  or more.   Among
the symptoms  of this period,  are nausea and vomiting,
swelling of the abdomen,  tenderness  of the breasts, &c.
These  symptoms are frequently mistaken for pregnancy;
connected  with the above,  there  are frequently uterine
pains,  with dragging sensation .in the back and loins; at
times there is fever, accompanied by violent headache,  a
full, strong pulse, a loaded tongue, and symptoms of indi-
gestion.   The  nervous system  generally sympathizes with
the other affections, causing nervous headache, neuralgic
pains,  periodic diarrhoea, and  costiveness.   These symp-
toms may all  be  mitigated by  a sudden return of the
menses, which  may last much longer than is natural, and
also be  more  profuse;  upon their cessation  they may
again return in an aggravated form.
   This period in female life is truly designated  the critical
period ;  and, although this is necessarily the case, owing
to the important physiological changes which occur at this
time, yet it is  frequently made  much more  so, from the
abuse of quack medicines. 
CESSATION  OF  THE  MENSES.
407
                    JRE ATMENT.

  When the symptoms are slight, but  little more will b«
necessary than  to regulate  the bowels and diet, bathe the
surface,  and occasionally to  wear  a pack on the  lower
portion of the  bowels, wet with equal parts of water and
whiskey ; but, where the  symptoms are  severe, in addition
to this, a purgative of anti-bilious physic should be taken^
and afterward the following compound :
     R Aletrin...........................................  gr. xxx.
        Cypripedin.....................................  gr. xx.
        Pterin.............................................  gr. xxx.
        Carbonate of Iron.............................  gr. xxx.
        White Sugar....................................  giij.
Mix, and add to one pint of Port-wine.  Dose, one table-
spoonful three times a day.   Also,
     R Irisin.............................................  gr. xxx.
        Hyosciamin......................................  gr. v.
        Podophyllin.....................................  gr. ij.
        Extract of Dandelion sufficient to make thirty pills.  Let
         one be taken night and morning.
  If neuralgic pains should occur,
     R Belladonna........................................ gr-j-
        Quinine............................................. gr. xv.
        White Sugar...................................... gr. xx.
Mix,  triturate,  divide into eight powders, and take one
three times  a day.   Constitutional symptoms of every va-
riety manifesting themselves during  the  period, should be
met with such remedies as are indicated. 
408       DISEASES  OF  THE  OVARIES.
     DISEASES  OF  THE OYARIES.
  The ovaries are subject  to a  number  of  diseases, as
dropsy, sarcoma, hypertrophy, atrophy,  &c.   Among the
most common is dropsy; hence, I  shall confine this article
mostly to that disease.
                     SYMPTOMS.

  A slight fugitive pain will  be felt in the region of the
ovaries.   The ovary will be  found to  be larger on one
side than on the  other.  This tumor, which  is  but  very
small at first,  gradually increases in size, until  it finally
presses upon the  uterus and  vagina, causing  uterine and
vaginal irritation,  difficult micturition, and prolapsus  ani.
On examination, the tumor may be felt between the vagina
and rectum.   This is particularly the case before it becomes
very much enlarged.   Sometimes  this tumor  ascends into
the cavity of the  abdomen, and  presents  very  much the
appearance of the gravid uterus. The tumor may gradually
increase until it becomes of  an enormous size.
  A specimen is now in the museum of the Eclectic  Col-
lege of Pennsylvania, of a tumor  which grew to such an
enormous size as  to  contain  over three gallons of  fluid.
In  some instances, the fluid  becomes spontaneously ab-
sorbed.  This  occurred  in  a  case which  came under my
observation,  where the ovarian cyst was of a size sufficient
toehold a gallon.         ,;°  r    "'          ri
  In  other eas£s; inflammation occurs in the  cyst, which
may produce death.'   Sometimes the  cyst  adheres to the
parietes of the abdomen, to-the boawels, or vagina; in this
event,  occasionally,  a fistulous opening occurs, and the
fluid makes its escape ; but  as the internal membrane of
the  cyst is so organized as to  constantly secrete this gela-
tinous  fluid,  a discharge will  be  maintained  until death
ensues from exhaustion. 
DISEASES  OF  THE  OVARIES.       409
                   TREATMENT.
  I do not propose to speak of the surgical treatment of
this disease, but to confine my remarks entirely to that
form of medical treatment which has proved successful in
my hands in removing the disease in its early stage.
  In the commencement, a pad should be placed over the
tumor, kept in its place and caused to make gentle pres-
sure upon it, by a bandage passing around the body. The
pad should be wet with the Tinct. of Iodine  before ap-
plying it, and  afterwards  once  or twice a day throughout
the entire treatment.  The bandage should be so adjusted
as to.maintain  a constant pressure.   The patient may also
take the following syrup :
     R Syrup of Iodide of Iron........................ Oss.
        Syrup of Stillingia............................... Oss.
Dose,  one teaspoonful  four or  five times a  day.   The
bowels  should be evacuated once  or twice  a  week with
Cream  of  Tartar and  Podophyllin.   When  this  course
has been pursued for four or  five weeks, substitute  the
following:
     R Syrup of Marshmallow.......................... Oj.
        Iodide  of Potassium.............................. spj-
Mix, and give one teaspoonful four times a day, occasionally
using the purgative as before.
  This treatment  persisted in,  has in  my hands proved
successful in several cases of ovarian dropsy, and in some
where  it was  considerably  advanced.  The pressure,  in
connection with the Iodine,  acts as a constant stimulant
to the  absorbents,  and by the alterative effect of the medi-
cine, the cyst ceases to secrete the gelatinous fluid.
                          35* 
410       EXPLANATION OF PLATE  FIRST.
                   PLATE  FIRST.
                       Division 1.
  Fig. 1.  The  upper part of this cluster of figures  is in-
tended to  represent the  uninflamed follicle; the lower the
commencement and progress of inflammation, and its  termi-
nation in  the formation of matter.   2. The  enlarged  and
indurated tubercles, (A. indurata,)  with matter formed in
their centre, which occur in bad constitutions.   3. Inflamed
and suppurated follicles, forming sycosis on the beard.   4.
The appearance of spots of porrigo, where no fluid secretion
or scab has been formed.   5.  The partially denuded scalp
of long-established cases of the latter, where scabs have been
allowed to accumulate, and  where great irritation prevails,
the remaining hairs insulated by pustules.

                       Division 2.
   Fig. 20.  The two inferior spots representing the first ap-
pearance of the spots of lepra, before  the first  scale sepa-
rates.   The superior large, round, and scaly;  the disease in
a spreading state.   21. Psoriasis.   22.  An enlarged repre-
sentation  of the morbid  and  discoloured cuticle,  forming
ichthyosis.   The  numberless fissures caused  by the crack-
ing of this hard,  dry substance, and dividing it into thou-
sands of pieces, are well represented.

                        Division 3.
   Fig. 11. Porrigo favosa.   12.  P. larvalis, both from cases
of considerable standing.   13. The pimples of infants, some 
EXPLANATION OF PLATE  FIRST.     411
of them surrounded by  considerable inflammation; their
representation in clusters connected by patches of inflamed
skin, (S. intertinctus, &c.,) has been omitted.   14 and 15.
The pimples of adults, termed lichen; the first of these, as
it sometimes occurs on the arms and other parts covered by
the finer kind of hair, each hair occupying the centre of a
pimple; the second as it  appears on other parts.  16. The
pimples of prurigo, the tops of some of them scratched off,
leaving a peculiar, little,  black, bloody scab on  their apices.
17. Two of the common  forms of urticaria.  18. The vesi-
cles of impetigo  in  an  advanced  and partly flaccid state.
19. The carbuncular furuncle.

                       Division 4.
   Fig. 23. The inferior portion, exhibiting  an enlarged
view of the vesicles of impetigo.  The superior, the disease
in an  advanced stage, with the scab partially covering it.
24. The vesicles  and enlarged pustules of the itch.  25.
The appearance of the skin in eczema mercuriale.  26.  The
tubercle of erythema nodosum.

                       Division 5.
   Fig. C.  Petechiae, or purpura simplex.  7. The enlarged
spots  of purpura hemorrhagica.   8. Different stages or de-
grees of the echthymatous eruption.  9. The conical scabs
of rupia.  The similarity  of character between the two latter,
is rendered very distinct.  10. Pompholyx.  The superior
vesicle discoloured by the admixture of blood from the ves-
sels of the surface. 
412
DISEASES OF THE SKIN.
          DISEASES  OF  THE SKIN.
                    CLASSIFICATION.
  There are few diseases in which there is more confusion
relative to their arrangement, than diseases of the skin.  In
the plate representing skin diseases, I have endeavoured to
so arrange them that all the forms could be viewed at a sin-
gle glance.  In  order to do this I was under the necessity
of arranging them under the head of five  distinct divisions,
which, although not  representing all the minute subdivi-
sions of dermatologists, shows every form of skin affection
in some stage of  the disease, which has fallen under  my
notice.
  In the classification of integumentary or skin diseases I
shall adopt  that which has been  arranged  by Willan;  not
that I consider this arrangement free from  objections, but
because it is  that which is ordinarily adopted by medical
writers  and teachers, and  may enable us to  study these di-
visions as well as any other system that we could adopt.
  Diagnosis of  Skin Diseases.—The diagnosis of skin dis-
eases is of primary importance, from the  fact that  no suc-
cessful treatment can be instituted, unless an  accurate dis-
crimination  be made between its different forms.
  In Willan's system, cutaneous diseases are  divided into
eight orders,  characterized by the  form of the eruption,
namely:—
           Papulae,                 Vesiculae,
           Exanthemata,           Tuberculae,
           Squamae,                Pustulae,
           Bullae,                  Maculae.
  The distinctive features of the  eruption, by which these
orders are characterized, he defined  as follows; and here I
may again remark  that his nomenclature and definitions are
still  in use,  and  generally recognised as correct:—
  " Papula, (Pimple.)—A very small and acuminated  ele- 
DISEASES  OF  THE  SKIN.          413
 vation of the cuticle, with an inflamed base, not containing
 a fluid, nor tending to suppuration.
    " 2. Squama, (Scale.)—A lamina of morbid cuticle, hard,
 thickened, whitish, and opaque.
    "3; Exanthemata,  (Rash.)—Red  patches  on the skin,
 variously figured,  in general confluent, and diffused irregu-
 larly over the body, leaving interstices of  a natural colour.
    " 4. Bulla, (Bleb.)—A large portion  of the cuticle de-
 tached from the skin by the interposition of a transparent,
 watery fluid.
    " 5. Vesicula, (Vesicle.)—A small, orbicular elevation of
 the cuticle, containing lymph, which is sometimes clear and
 colourless, but often opaque and whitish, or pearl-coloured.
    " 6. Pus/ula. (Pustule.)—An elevation of the  cuticle,
 with an inflammatory base, containing pus.
    " 7. Tubercula, (Tubercle.)—A  small, hard, superficial
 tumour, circumscribed and permanent, or  proceeding very
 slowly to suppuration.
   " 8. Macula, (Stain.)—A  permanent discolouration  of
 some portion of the skin, often with a change of its texture,
 but not connected with any disorder of the constitution."
   Alibert, in his natural arrangement, considers cutaneous
 diseases to resemble a tree, which he  terms I'arbre des der-
 matoses,  and the branches of which constitute the  various
 divisions or groups, which are subdivided into genera.  His
 primary groups, which are twelve in number, he designates
 as follows:—
   Dermatoses Eczemateuses,     D.  Fe>oleuses,
              Exanthemateuses,   "  Strumeuses,
              Teigneuses,        "  Scabieuses,
              Dartreuses,         "  Hemateuses,
              Canc6reuses,       "  Dyschromateuses,
              Lepreuses,          "  Heteromorphes.
  Biett, the immediate and most celebrated pupil  of Ali-
bert. soon perceiving the difficulties which the complicated 
414          DISEASES  OF  THE SKIN.

system of his nature, though based on the natural affinities
of the various  eruptions of the skin, threw in  the way of
their  successful diagnosis,  forsook  it for  that  of Willan,
which he modified, and so  far improved, that all the artifi-
cial systems of classification which have been proposed since
his time include the  changes made by him.   Viewed ab-
stractedly, it is manifest that a class of diseases of the skin
which, as a natural system is supposed  to do, takes into
account not merely the form, but the essential  nature and
pathological characters of a cutaneous eruption,  should pos-
sess many advantages, both practical and  theoretical,  over
an artificial arrangement which takes cognizance merely of
the alterations of the skin which cause the eruption, or, in
other words, regards solely the apparent changes in the cu-  I
taneous structure of the part  affected.  Consequently, we
find that most modern writers on the subject have bestowed
their atteution on the construction of a perfect natural sys-
tem, but hitherto, in my opinion, without success; amongst
them all there are, I think, two only at all deserving of no-
tice,—that of Erasmus Wilson in England, and of Cazenave
in France.   Wilson adopts, as the basis of his arrangement,
the anatomy  and physiology of the skin,  a groundwork
which, owing to the additions recently made to our know-
ledge  of this structure  by microscopic investigation, and
the  degree of certainty which extended  observation has
stamped upon it, has been well employed by him, and ren-
ders his system of classification justly entitled  to be desig-
nated a natural one.  He constitutes four primary divisions
of the subject, namely:—
   1.  Diseases of the Derma.
   2.  Diseases  of the Sudoriparous Glands.
   3.  Diseases  of the Liviparous Glands.
   4.  Diseases of the Hairs and Hair Follicles.
   Of the first, five secondary divisions are made:—1st, In-
flammation of the Derma;  2d, Hypertrophy of the Papillae 
DISEASES  OF  THE  SKIN.         415
of the Derma; 3d, Disorders of the Vasadar Tissue of the
Derma; 4th, Disorders of the Sensibility of the Derma; 5th,
Disorders of the  Chromatogenous Functions of the Derma.
   The first of these divisions constitutes six groups, namely:
a, Congestive Inflammation, divided into two sub-groups;
the first including those  affections, in which both the mu-
cous membranes and the derma are inflamed, and which are
attended with constitutional symptoms of a peculiar kind;
and the second, those in which the derma alone is engaged,
and in which there are no specific constitutional symptoms;
b, Effusive Inflammation; c, Suppurative Inflammation;  d,
Dcpositive Inflammation; e, Squamous Inflammation;  f, In-
flammation from the presence of Acari.
   Of the second primary divisions, three secondary are con-
stituted, as  the diseases  are attended with—1st, Augmen-
tation; 2d,  Diminution;  3d, Alteration;  4th, Retention  of
Secretion; and 5th, in which the Glands and Adjacent Tis-
sues are inflamed.
   And the fourth constitutes six secondary divisions:—1st,
Augmented Formation; 2d, Diminished Formation; 3d, Ab-
normal Direction of the  Hair; 4th, Alteration of Colour;
5th, Diseases of the Hairs; and 6th, Diseases of the Hair
Follicles.
   M. Cazenave, adopting likewise an anatomical  basis for
his natural  system, arranges diseases of the skin  in  eight
groups:—
   1.  Inflammations.        5. Hemorrhages.
   2.  Lesions of Secretion.  6. Lesions of Insensibility.
   3.  Hypertrophies.       7. Foreign Bodies.
   4.  Deteriorations.        8. Diseases of the Appendages.
   The first  group  contains four orders:—1st, Non-Specific
Eruptions, which  may exist in a chronic state;  2d, Non-
specific Eruptions, always existing in a chronic state; 3d,
Aeute Specific Eruptions; 4th, Chronic Specific Eruptions.
   The second group is divided into three orders:—1st, Le- 
416          DISEASES  OF  THE  SKIN.
sions of the Follicular Secretions; 2d, Lesions of the Epi-
dermic Secretions; 3d, Lesions of the Colouring Secretions.
  The third group, which constitutes but a single order, is
defined to consist in  an abnormal development of the parts
affected.
  The fourth group  contains those  diseases which have a
tendency to destroy the part attached.
  The fifth group is characterized by the presence of blood,
more or less altered, without its proper vessels.
  The sixth group is divided into two orders:—1st, Gene-
ral or Local Hyperaesthesia; 2d, Anaesthesia.
  In  the  seventh group are  placed those diseases which
seem to depend on the presence of parasitical insects,  or
animalcules.
  The eighth consists of two orders:—1st, Diseases of the
Hair;  2d, Diseases of the Nails.
  In order to a more correct understanding of the nature
and treatment of skin diseases, I purpose considering each
affection by itself, and giving a proper treatment for its cure.
  1st.  Erythema.—Erythema consists in an eruption of su-
perficial red stains,  or patches, slightly elevated,  and at-
tended with heat, tingling,  and  sometimes slight pain.   It
is not usually connected with constitutional symptoms, un-
less it  appears as the effect of some  specific poison in the
blood,  as  mercury,  antimony, lead,  &c.   It  may  be  pro-
duced  by  exposure to harsh winds, hot sun, &c.
   Treatment.—The  treatment consists in the  external ap-
plication of equal parts of lime-water and sweet oil, mixed;
or a little glycerine.    In cases where the erythema appears
to be extensive, the  bowels should be opened  by means of
a little neutralizing mixture and anti-bilious physic, and a
low diet prescribed for a few days.
  2d.  Erysipelas. — (Treated on  in another  part of the
work.)
  3d.  Urticaria.—(Also, in another part of the work.) 
DISEASES OF THE  SKIN.          417
  4th. Roseola.—Roseola, or Rose-Rash, consists in very
slightly elevated rose-red patches, of irregular shape, which
may be confined to a small portion of the body, or extend
over the entire surface.  In ordinary cases there are but
few constitutional symptoms; but in a few cases I have ob-
served rose-rash ushered  in by chills, fever, active  pulse,
anorexia, and a disordered state of the bowels.  This dis-
ease may occur at any age, but is mostly confined to chil-
dren.
  Diagnosis.—The only disease with which this is likely to
be confounded, is scarlatina; from which it may  be  distin-
guished by the absence of sore throat, the  bright red ap-
pearance of the eruption, and the less violent constitutional
symptoms generally.
   Causes.—It  may be produced by irritating substances in
the bowels,  such as worms, &c, or by any substance which
may irritate  the  skin.  I have known roseola to occur as
the  result of irritation produced by wearing flannel next
the skin.
   Treatment.—A warm bath, followed by a little lime-water
and sweet  oil  to  the  surface,  together with a little anti-
bilious physic, and cream of tartar  to open the  bowels, a
low diet, and a few doses  of aconite to control the  febrile
symptoms, is all that is necessary in the treatment of this
disease.
  5th.  Eczema, (Scale, or Humid Tetter.)—This disease is
one of the most frequent forms of skin affections met with
by  the physician.  Dermatologists divide it into Eczema
Simplex, Rubrum, Faciei, and Capitis.   Eczema simplex
consists in the appearance of minute, shining vesicles, not.
larger than  the head of a small pin, on different portions
of the body.   They are usually clustered together, and sur-
rounded by red  areola.   In  from thirty-six to forty-eight
hours  the fluid becomes  opake, and in from three to four
days  dries up, and  forms light, thin scales, and desqua-
mates.  In  most cases a fresh  crop appears  as  soon as the
       36
L 
418          DISEASES OF THE SKIN.
first  is matured, which develop and  proceed through the
same  course; in which event yellow crusts form over the
diseased patch, and chronic tetter exists for weeks, or even
months.  In simple eczema there is usually but little fever,
or constitutional disturbance, although the  diseased  part
may  be irritated and inflamed.
  Eczema Rubrum.—This is  a  more violent form of the
disease, in which there is  frequently fever, and other con-
stitutional symptoms peculiar to eruptive diseases.   The
vesicles are  much larger;  and when the  fluid  becomes
opake, they rupture and form large, yellow crusts.
  Eczema Faciei, as the term indicates, mostly appears upon
the face, and  is confined  generally to young children.  It
is frequently accompanied with fever, and assumes the ge-
neral appearance of eczema  rubrum.
  Eczema  Capitis is that form which is confined to the
scalp, and presents the ordinary characters of eczema  on
other portions of the body.
  Diagnosis. — Eczema may  be confounded with herpes,
from which it may be distinguished by the following symp-
toms:__In herpes the vesicles  are much larger,  and the
patches are always well defined.  When it  appears on the
fingers, it is liable to be confounded with scabies, from which
it may be distinguished by the excessive tingling and itch-
ing, peculiar to itch, and the absence of inflammation around
the  vesicles.
   Treatment.—On commencing the  treatment of eczema,
the  bowels should be opened by means of some mild laxa-
tive, the skin thoroughly bathed, and the  patient placed
'upon a well-regulated, but  nutritious diet.   After which,
the  following internal treatment should be instituted:—
       R. Juglandin  ....................................grs. xx.
          Quinine.......................................grs- x-
          Neut.Mixt.............. .....................3ij-
          Syr. Simplex ..............................S'j-
 Mix.  Sig.—One teaspoonful every two or  three hours.   For
            children, one-half the usual quantity. 
DISEASES OF THE  SKIN.         419
   As an external  application, take acetic  tincture of san-
guinaria, quantity sufficient to  keep the part thoroughly
saturated by means of lint.   This treatment, if thoroughly
applied, will most speedily cure all the forms of eczema.
In some cases, where the part is irritable, the patient will
not  tolerate  the lotion.   In that event I have been in the
habit of applying the wash by means of a camel's hair pen-
cil, four or five times a day, and after each application cover
the part with glycerine.   In case the disease should prove
protracted, the quinine and juglandin  mixture  should be
alternated with the following:—Take essential tincture of
scrofularia  marilandica,  one ounce;  simple syrup,  four
ounces.  Mix, and give one teaspoonful every two or three
hours.  In  cases where  there  is great local inflammation,
previously to applying the sanguinaria wash, the inflamma-
tion may be  subdued  by means  of a slippery  elm poultice
applied to the  part, and  kept moistened with the tincture
of lobelia.   In treating eczema capitis of young children, it
is well to remove the hair, so as to enable the medicine to
come in contact with  the diseased part.
   Herpes.—Herpes, by medical writers, has been divided
into Herpes Phlyctenoides, Zoster, and Circinnatus. Herpes
phlyctenoides is characterized by a smarting, burning pain,
on a small patch of the skin, which becomes covered with
small blebs, or vesicles, in the course of twenty-four hours.
The fluid usually becomes opake and  muco-purulent, and
is discharged in the course of two or three days, forming a
dark-brown scab.   This form of the disease very frequently
appears on the lips, especially after a protracted  intermit-
tent or remittent fever, and in females upon the outer lips
of the pudendum.
   Herpes Zoster, or Shingles, mostly appears upon the cen-
tre of the body, and is much more severe than  the previous
form, being usually ushered in by rigours, chills, and fever,
with a burning, smarting  sensation in some portion of the 
420           DISEASES  OF  THE SKIN.
body, frequently about the umbilicus, which becomes red,
tumefied, and, in the course of twenty-four hours, covered
with vesicles, as previously described.  In some cases there
are several of these inflamed patches appearing on different
parts of the body at the same time, which gradually extend
and coalesce until they nearly form a girdle around the body.
In these cases there is frequently loss of appetite, continued
fever, constipation, headache, &c.
   Herpes  Circinnatus, or Ring-Worm. — This derives  its
name from the shape of the group in which the eruption
appears.  It is  accompanied with but few  constitutional
symptoms, and occurs mostly on the neck and face of chil-
dren ; although it may appear on other parts of the body,
and in adults.
   Causes. — But little is known relative to the  cause  of
herpes, as well as many other skin affections.  It has been
attributed to the vitiated state of the system, produced by
over-mental excitement, bodily fatigue, impoverished diet,
friction and  irritation from  clothes, scrofulous constitu-
tions, &c.
   Diagnosis.—The only disease with which it is  likely to
be confounded is eczema,  from which  it may be distin-
guished by the vesicles  being larger, more globular, and
the patches better defined.
    Treatment.—In the treatment of the simpler  forms  of
herpes, but little more is necessary than the application of
some stimulating and astringent lotion, such as the follow-
ing:—Take acetate of lead,  ten grains; pure  water, one
ounce; tinct. of aconite,  one dram; mix, and apply to the
part five or six times a day.  In cases of herpes labialis, the
following paste is almost a specific:—Take sulphate of hy-
drastin, ten grains; glycerine, one ounce; mix, form a paste,
apply six or eight times a day.  In herpes zoster the stomach
should be thoroughly cleansed by the comp. acetic tincture
of lobelia, the bowels opened with small doses of anti-bilious 
             DISEASES  OF  THE  SKIN.         421

physic and podophyllin; and, where it is convenient, the pa-
tient should take a hot bath. If the hot bath cannot be given,
the alkaline  sponge bath should  be resorted to.  The por-
tion of the body covered by the eruption should be bathed
in a solution  of sulphate of  zinc.  Take  sulphate of zinc,
one ounce; water, one pint.  Bathe the parts in this solution
frequently; and  if there is much inflammation, a slippery
elm poultice should be applied after each bathing.  If there
is fever, it should be controlled  by the use of aconite or
veratrum,  and in case the disease proves obstinate, quinine
and iron should be given.  Where the eruption is very se-
vere, I have  used the following ointment:—Take oxide of
zinc,  two drams; sulphate of sanguinarina,  one-half dram;
lard,  one ounce; mix, form an ointment, and apply to  the
part;  followed either by a  hot  pack, or a warm slippery elm
poultice.
   Pemjdiigus, (Watery  Blebs.)—(See plate 1st, skin dis-
ease, division 4th, fig. 23.)  Acute  Pemphigus is ushered
in with  febrile symptoms and general malaise, loss of appe-
tite, and derangement of the secretions, which, on the se-
cond or third day, are followed by an eruption on the thighs
and lower part of the abdomen, of a bright red colour, which
is usually  accompanied with  a smarting or burning sensa-
tion.   In  the centre of this eruption a minute vesicle  ap-
pears, which  rapidly extends until  it covers nearly, and in
some  cases the entire inflamed  patch.   These blisters are
at first round, and of a bright transparency.   In the course
of from  twenty-four to forty-eight hours the fluid contained
in the vesicle becomes  opake, the  bullae break,  the fluid
escapes, leaving a red  and  excoriated surface, which soon
becomes covered with a  yellowish thin scab, which falls off
in from five to six  days.    In some instances several  succes-
sive crops of these  blisters  occur, which pass through the
same process.   Dr. Willan has described two forms of pem-
 phigus,  which are modifications of this—such as pemphigus
                           36* 
422           DISEASES  OF THE SKIN.
pompholyx, where the fever is severe, and  pompholyx be-
nignus, when the fever is mild.   Pemphigus  chronicus is
the name given to the disease by Dr. Neligan, when it is of
long standing.
   Causes.—The causes of pemphigus are always connected
with constitutional derangements.  It is produced by bad
diet, by the long-continued use of poisonous mineral medi-
cines, and, in  short, anything that tends  to debilitate the
constitution, and vitiate the fluids, may develop pemphigus.
   Pathology.—Pemphigus is an inflammation of the super-
ficial layers of the derma, which result in the  effusion of
serum  and the formation of blebs.
   Treatment.—The treatment of pemphigus depends much
upon the cause, which should be carefully sought, and as
far as practicable removed.  The surface of the body should
be bathed, the bowels opened by means of one or two grains
of apocynin, and  the  inflamed surface covered with a slip-
pery elm  poultice, kept moist with the tincture of lobelia.
Where the  constitution is feeble, iron, chimaphilin, qui-
nine, cod liver oil, and alnuin, should be given in such quan-
tities and combinations as the nature and constitution of the
disease may require.  Where pemphigus occurs in children,
it is more frequently than otherwise dependent upon defi-
cient  nutrition;  and in order to successfully treat the ma-
lady, especial attention should be given to the diet and ha-
bits of the patient,—fresh air,  out-door exercise, and fre-
quent bathing, being  essential auxiliaries in  the treatment.

   j^wpia.—Rupia is a small blister, or vesicle, the size of
 a chestnut, which appears upon the inflamed base, and con-
 tains  from  the first  an ichorous, semi-opake fluid,  which
 dries into a dark-brown crust, falls off, and leaves an  indo-
 lent ulcer.   (See  division 5, figs. 9 and 10, plate of skin
 diseases.)   Rupia has been divided into simple  and promi-
 nent;  but as  there is no practical importance  connected
 with this division, we omit it. 
              DISEASES  OF  THE SKIN.           423

   Causes.—This disease is always connected with a vitiated
constitution, and is dependent more frequently than  other-
wise upon imperfect diet; although  chronic  diseases, such
as syphilis, phthisis, dyspepsia, and poisonous medicines not
unfrequently produce it.
   Diagnosis.—The only diseases with which rupia is likely
to be confounded, are pemphigus and ecthyma.  From pem-
phigus it may be distinguished by its seldom having more
than one  bleb, or blister.   In pemphigus they are  nume-
rous.  Ecthyma is an inflammatory pustular  eruption, and
the scabs formed are flat and small.
   Treatment. — As rupia might be  considered  more of a
symptom of some other disorder than an idiopathic disease,
the  principal  indications of treatment consist in removing
the constitutional affection upon which rupia depends, such
as correcting the digestive organs, nourishing and enrich-
ing the blood, &c, &c.   The local applications should con-
sist of emollient poultices, kept constantly moist with the
tinctures of hydrastin, baptisin, and myrrh.   When rupia
degenerates into  an indolent ulcer, in connexion with the
constitutional treatment the parts should be washed once or
twice a day in a weak solution  of sulphate  of zinc, and a
poultice applied, composed of equal parts of pulverized bay-
berry, white pond  lily, and slippery elm.  The diet should
be of a nutritious character, and the system invigorated by
frequent baths, friction, and fresh air.

   Puslulse.—The order pustulse includes those cutaneous
diseases that are characterized by the eruption of circum-
scribed, rounded elevations of the epidermis, which contain
pus, and are situated on an inflamed base.

   Acne.—Acne consists of small pustules, with a hardened
base, which are usually distinct, although sometimes they ag-
gregate together, and form clusters.  The pus usually appears
upon the apex of the acne, while the base is red and pain-
L 
424           DISEASES  OF  THE SKIN.

ful.   Sometimes acne assumes a chronic  and indolent cha-
racter, and small  red pimples or eruptions appear, without
forming pus, which, after existing for a time, become ab-
sorbed, but only to be followed by another crop.  The seat
of the disease is usually in the sebaceous glands, and has been
denominated by Bennett, entozoon folliculorum. Dermatolo-
gists have divided acne into simplex and rosacea. The former
is  that form  of eruption which appears mostly on young
persons, about the face; although it may appear on other
portions of the body; while the latter is that form of erup-
tive disease known as brandy face, or rum blots.
   Causes.—Simple  acne is  produced by an obstruction of
the sebaceous glands, and is the result of high living, and
the want of proper elimination from the body.  In females
it  may occur about  the age  of puberty, and  may be pro-
duced by either retained or imperfect menstruation.  Acne
rosacea, in males, is often  produced by the frequent use of
intoxicating beverages, although it may be produced by de-
rangement of the urinary organs, stomach, &c.   It also occurs
in females  about  the change in life, and is supposed to be
caused by the introduction of zymotic poison into the blood.
   Treatment.—In the treatment of acne, as in other dis-
eases, the causes  should be sought for, and, so far as prac-
ticable, removed.   If produced by a want of proper cleanli-
liness, bathing, &c, baths should be prescribed,  out-door
exercise, and a low diet.  If dependent upon imperfect men-
struation, senecin,  iron, and  gossypiin,  should be given,
in connexion with sitz baths, and a general tonic and invigo-
rating course of treatment should be pursued.  When pro-
duced by the use of wines, brandy, and other alcoholic sti-
mulants, they should be proscribed.  If connected with the
change of life, the eliminating organs should be invigorated
by baths and friction to the skin, leontodin, neutralizing mix-
ture, and chimaphilin, to  disengorge the liver, bowels, and
lymphatics; and barosmjn, and populin, to invigorate the di- 
DISEASES  OF THE SKIN.
425
gestive organs, and facilitate elimination through the kidneys.
As a local application, I have found aqua ammonia applied to
the pustule, when it first appears, then covering  it imme-
diately with collodion, almost a specific, frequently causing
an absorption of the  pustule in a very few hours.   In a few
bad cases, I have removed the disease by first puncturing the
pustule, then applying the muriated  tincture of iron.   The
following  ointment has also been used very successfully:—
Take sulphate of sanguinarina, one dram; lard, one-half ounce;
pulverized camphor, two drams; form an ointment, and ap-
ply two or three times a day.  Where the blood is loaded
with effete matter, and the patient of full habits, benefit will
be derived by administering one or two drams of the com-
pound syrup of stillingia every day.

   Impetigo, (Crusted Tetter.)—Impetigo is a cutaneous affec-
tion characterized by numerous pustules occurring separately,
but which soon become confluent, secreting a lightish-yellow
pus, which breaks, and forms a greenish-yellow crust.   The
pus usually continues to be secreted, and, drying, adds ma-
terially to the  dimensions of the scab.  In time the scab is
forced off by the accumulation of pus which forms beneath,
but is soon re-produced in the same way as the previous one.
The disease frequently spreads by means of  fresh crops  of
pustules, until large  portions of  the  body become involved.
Three divisions of impetigo have been made, viz., Figura-
ta, Sparsa, and Capitis, (see plate,  skin  disease, div. 3d, fig.
18.)  Impetigo Figurata is so named from the pustules ap-
pearing in a circular  or ovoid shape;  while Impetigo Sparsa,
as its name indicates, appears  in distinct pustules; and Im-
petigo  Capitis  is confined to the  scalp, and is the  only dis-
ease of an eruptive character  which  usually appears on the
head, it being mostly confined to children.
   Causes.—It is supposed that the disease is produced by a
scrofulous tendency of the system; and Mr. Neligan states
that it is produced by irritants applied to the skin, especially
ife 
426
DISEASES  OF  THE SKIN.
to the scalp.   It also appears in some cases about the age of
puberty, and is supposed  to  proceed from imperfect men-
struation.
   Diagnosis.—Impetigo is always characterized by  the ap-
pearance of small, semi-transparent pustules.   The only dis-
eases with which it is  liable to be confounded, are  eczema
and ecthyma, from which it may be distinguished by the pus-
tules in impetigo being larger.  The  scab forms are thicker,
and  the quantity of pus secreted is  much greater, than in
eczema or ecthyma; besides, impetigo  is the only  disease
which affects the scalp.
   Sycosis has, in a few instances, been confounded with im-
petigo; but as sycosis  is always  confined to the face, which
is covered with  a beard, and is not of a true pustular cha-
racter, it need not be confounded with impetigo.
   Treatment.—In the treatment of acute impetigo of strong
and  robust children, the bowels  should be opened by means
of small doses of podophyllin and cream of tartar.  A hot
bath should be given; and  if there is fever, small doses of
the  tincture of  veratrum viride given to control it.  As a
local application, take  equal parts of pulverized sanguinaria
Canadensis, or blood-root, and nymphaea odorata, one ounce;
good cider  vinegar, six  ounces;  mix, and let it tincture
twenty-four hours, and apply as a wash with a sponge four
or five times a day.  In cases where there is a scrofulous or
tuberculous tendency, and  the  disease is of a chronic cha-
racter, the following compound will  be found valuable: —
      R. Ferri Hypo-Phosphite.....................jj.
          Juglandin...........«.........................grs. x.
          Quinine.......................................grs. xij.
Mix.  Ft. pulv. No. xvj.  S.—One taken three or four  times a
            day, in a spoonful of Cod Liver Oil.
Also apply the following ointment:—
      R. Glycerine......................................,§ij.
          Baptisin.........................................grs. x.
          Creasote.........................................gutt. x.
Mix, and apply with a camel's hair brush four or five times a day. 
DISEASES  OF THE SKIN.          427
The  parts should  be  thoroughly washed with warm water
and soap between each application of the ointment.   After
the powders have been taken, the following mixture may be
given:—
      R. The Essential Tincture of Cinchona......§j.
         Essential Tineture of Baptisia Tinctora.^j.
         Pyro-Phosphate Ferri........................3.1-
         Svrupus  Simplex...............................^iv.
Mix.  Sig.—One teaspoonful every three or four hours during
                        the day.
   Where the disease proves obstinate, and  especially  if
confined to  the  scalp, the  head should be shaved;  and, in
addition to the other treatment, bathe in a solution of sul-
phate of zine, of the strength of one dram to four ounces of
water.   Dr. Bennett recommends in these cases the tar oint-
ment, and in some cases it may be used with benefit.  Where
the lymphatics are implicated, I have obtained benefit from
the  chimaphilin  given in  one or two grain doses, in com-
bination with iron, three or four times a day.   The diet and
habits of the patient should be well regulated.

   Ecthyma, (or Papulous Scale.)—Ecthyma is an eruption of
phlyzacious pustules on a hardened, inflamed base, commonly
found alone, but sometimes in small groups, terminating in
scabs of a yellowish brown colour.  It is rarely met with
in children, but frequently occurs in adults.   The pustules
appear  chiefly on the extremities, although they may affect
any portion of the skin.   There are two divisions of ecthy-
ma, viz., Ecthyma Acutum, and Ecthyma Chronicum.  The
eruption of acute ecthyma  is preceded by a slight fever;  in
about thirty-six  hours, small, red spots, are seen to appear
on the skin, accompanied  by heat and tingling.   On  the
second  day the centres of  these spots are raised by the pus
contained in them, which  form  the phlyzacious pustule of
the  disease.   This stage  of the disease is accompanied by
much pain.   Maturation occurs from the fourth to the sixth
L 
428           DISEASES  OF THE  SKIN.
day.  The disease terminates usually in about two weeks,
although it may continue for five or six weeks.
   Chronic ecthyma is a common eruptive disease, occurring
more frequently than the acute form, and in weakened con-
stitutions at every age, but  more commonly in very young
children.   The  eruption is  the same as in the  acute  form,
except that there are no preceding symptoms.  The chronic
character of the disease is due to the constant succession of
the pustules.  The appearance of the skin is unhealthy, being
covered with large spots and stains.  The constitution,  espe-
cially in old persons, becomes very much weakened.   This
form of the disease may last five or six months,  or  even
longer,  being connected with other affections.
   The causes of ecthyma are topical and constitutional.   Re-
siding in damp places, wearing insufficient clothing, inatten-
tion to cleanliness, all aid in developing the disease.
   Diagnosis.—Ecthyma is known by the phlyzacious pus-
tules, and their detached manner of development.  The  small
pustules somewhat resemble those of small-pox; but the man-
ner of eruption, and its mode of appearance on different parts
of the body are  sufficient marks of distinction.  The pus-
tules of ecthyma may also be confounded with those of  sy-
philis in the second form, but the latter seldom occurs  ex-
cept in  persons of advanced  age.
   Prognosis.—Ecthyma is not a fatal  disease, except in  its
complicated form.  The chronic form  is of long duration,
which injures the general health.
   Treatment.—In acute ecthyma the  stomach should be
cleansed by a mild emetic, and the bowels opened by a gentle
purge;  after which  the patient should take a warm  bath,
and  aconite, to control the  fever.  The inflamed and pus-
tulated surface should be covered with a warm slippery elm
poultice, kept  constantly moistened with the tincture of lo-
belia.  After the acute inflammation has subsided, quinine
and iron should  be given, followed by small doses of juglan- 
              DISEASES OF THE  SKIN.          429

din and  chimaphilin;  and, instead of  the poultice, the fol-
lowing ointment should be applied:—
      R. Oxide of Zinc....................................3j.
         Sulphate of Sanguinarina....................grs. x.
         Adeps...........;...............................3j.
Mix.  Ft. Unguentum.  S.—Let it be applied four or five times
                         a day.
Wash the part thoroughly previously to  each application.
In the chronic form, the indications of treatment are to en-
rich the blood, regulate the  habits of the  patient, and by
means of local astringents and stimulants restore the affected
surface to its normal condition.   This can be accomplished
by giving hydrastin, alnuin, rumin, chimaphilin, iron, and
quinine.  The following is a valuable preparation:
      R. Rumin...............................................gj.
         Pyro-Phos. Ferri................................gss.
         Syrupus Simplex.......................,........^vj.
  Mix.   Trit.  S.—One teaspoonful four or five times a day.
The following ointment is also valuable:
      R. Myricin.........................................grs. x.
         Baptisin.........................................grs. xx.
         Glycerine.......................................§j.
         Creasotum......................................gutt. x.
               Mix.  Apply as an ointment.
In case  the disease should prove  obstinate, the part  may
be washed  once or twice a day  in  a solution of sulphate
of zinc, and the  patient should be placed upon juglandin
and quinine for two or three days.   The diet should be nu-
tritious, and the patient should be prescribed out-door exer-
cise and  frequent baths.

  Popidse, (or Pimples.)—This group of diseases is known
by the small eruptions on the skin, called papulae, or  pim-
ples.  They are  in  general of a reddish colour, but are
sometimes  found paler than the  surrounding skin,  and
neither contain pus  nor serum, being mostly accompanied
      37
fc. 
430           DISEASES  OF THE  SKIN.
by insufferable  itching.  These non-contagious eruptions
occur in every stage of life, affecting both sexes, but espe-
cially males.   They vary in size, and may be scattered over
the entire surface of the skin, or may be confined to a single
portion of the body.  The number of papular diseases may
be reduced to two, viz., Lichen and Prurigo.
   Lichen.—Lichen consists of numerous small papulae, of
a  reddish hue,  or  of the colour of the skin, collected in
groups, or scattered over the  entire surface.  It may be
divided into three varieties—Lichen Simplex, Lichen Stro-
phulus, and  Lichen Agrius.   Lichen Simplex  is seldom
accompanied by any constitutional disturbance at its  com-
mencement.   The  papulae are small  and numerous, of a
bright red colour, and scattered in closely set groups over
the  skin.  The eruption is attended  with much heat and
tingling, which  remain until the papula? have disappeared.
Lichen simplex may be either acute or chronic; in the
former the disease  continues for about a fortnight; in the
chronic form it may last  for  months, or even years.  In
lichen simplex the size of the papulae varies according to
the portion of the body  on which it appears.  In the  weak
and  aged the eruption  is of a livid colour, frequently ac-
companied with red stains of the skin.
   The papula?,  in lichen  simplex, are in patches, instead
of being scattered over the surface.  In young persons the
itching is sometimes severe, while the papulae are very much
increased in size.
   Lichen Strophulus,  (Gum.)  This  eruption is  confined
mostly to very young infants.   The papulae may be white,
red,  or the colour of the skin.   In strophulus intertinctus,
or red gum,  small, red  pimples appear a short time  after
birth, and mingled with slight erythematous patches. Some-
times the local  symptoms are  excessive, the papulae of a
bright red colour,  appearing  in groups.   This  variety is
termed volaticus, or wild-fire rash;  often remaining a con-
siderable length of time. 
              DISEASES OF THE  SKIN.           431

  Lichen agrius sometimes follows lichen  simplex; but in
most cases its phenomena are seen from the. first, in which
event smart febrile symptoms are seen to occur two or three
days previously, and with such a burning heat as to resem-
ble scarlatina.  As  the rash appears the fever diminishes,
while numerous small and shining papulae are seen in the
skin.   The  itching  is increased  by anything which  adds
to the heat of the skin.  In the advanced stage of the dis-
ease the papules ulcerate, and  discharge a  serous fluid,
which forms into thin scabs;  the skin then becomes thicker
and more inflamed, pustules of acne or impetigo are  seen,
and the skin assumes a livid  aspect, discharging freely a
serous fluid.
   In the mild  cases of lichen agrius the eruption disap-
pears about the twelfth day, the irritation grows less, and
the disease  ends in about a fortnight.  It  may last  for a
much longer  period, in  some cases remaining four or five
years.   This form of the disease  affects particularly special
portions of  the  body.  The  swelling on  the face is much
greater than on other parts—the  eyes becoming, sometimes,
almost  entirely closed.   The influence of heat in producing
lichen agrius may be noticed; thus we see persons affected
particularly in the  warm season of  the  year;  and in  hot
climates this occurs so frequently that it  is  accounted a se-
parate variety, under the name  of lichen tropicus, or the
prickly-heat of the East Indies.
    Causes.—Lichen  may occur  at  any period of life,  but
its different varieties  seem to  be connected with different
ages; thus  lichen  strophulus,  as we have noticed, belongs
 to infants;  lichen agrius occurs generally in old age;  while
 lichen simplex appears to belong to those in middle life.  The
 causes  of this disease are often  difficult  to understand; it
 is  frequently noticed in persons of a nervous disposition.
 It sometimes appears to be caused by the  disorder of the
 digestive organs;  or on  the face  and hands, by exposure to
 hot fires, harsh winds, &c.
k 
432           DISEASES  OF  THE SKIN.
   Diagnosis.—Lichen simplex may be easily known by the
appearance of the erythema.   It is likely to be mistaken for
prurigo^ the first appearance of the eruption being the same
in both; but in prurigo the papulae  are  much  larger than
in lichen.   When  these  begin  to  disappear, the eruption
might be confounded with psoriasis guttata, except that the
scales are thinner  and smaller.  It may be distinguished
from scabies and eczema by the free discharge attending them.
Lichen circumscriptus may be  distinguished from  herpes
circinnatus  and erythema circinnatum by the  character of
the eruption.   The distinguishing features of urticaria and
lichen urticatus are the pale  centres of the elevations, and
the nature of the former to pass quickly away.
   Lichen strophulus may be  distinguished from prurigo by
the white papulae in the former being paler, while the red
forms are of a deeper colour  than those  in prurigo.  They
also  occur at different ages.
   It  is sometimes  difficult to detect a difference between
lichen agrius and chronic eczema;  but  in the  first-named
eruption we  can  readily  distinguish the character  of the
papula?.  In this form, moreover, the serous discharge is less
abundant.
   Lichen is a very frequent form of syphilitic and mercurial
eruption, which I have fully described under that head.
   Prognosis.—The  prognosis  of lichen is almost always fa-
vourable under the  New School treatment; although on old
people, and  mercurial and syphilitic patients, it sometimes
proves an obstinate form of disease.
   Treatment.—The treatment, in the acute form of lichen,
consists in cleansing  the  stomach and bowels by means of
a gentle emetic and a mild purge, after which the following
remedies should be given:—Take the saturated tincture of
scrofularia marilandica, one dram, and add to  a tumbler full
of .water, and let the patient take one teaspoonful every half
hour, or hour.  If there is fever, twenty or thirty drops of 
DISEASES OF  THE  SKIN.          433
the essential tincture of veratrum viride should be added
to another tumbler partly filled with water, and a teaspoon-
ful given  in alternation with the above remedy, every half
hour  or hour, until the fever is controlled.   During  the
treatment the surface should be frequently sponged in tepid
water, and the patient remain quiet in bed.   If the above
treatment should not control the disease in from  twenty-
four to forty-eight hours, the following should be given:—
       R.  Macrotin...................................gr.j.
          Quinine......................................grs. x.
          Hypo-Phosphite Ferri ..................grs. xx.
     Mix.   Ft. pulv. No. xv.   Sig.—One every two hours.
As an external  application, borate of  soda, dissolved in
water, of moderate strength, is all that is required in simple
lichen.   It may  be applied as a  wash three or four times a
day.   In the chronic form of the disease, an active, sup-
porting, and invigorating course of treatment is requisite.
The following compound will be found valuable:—
       R.  Chimaphilin ....................................3j.
          Ampelopsin....................................3SP-
          Pyro-Phosphate Ferri........................3jss.
          Syrupus Simplex.............................,§vj.
    Mix.  Sig.—One teaspoonful every two or three hours.
 At the same time the patient should take a nourishing diet,
 frequent  out-door exercise, in connexion with daily baths,
 and the following local application should be made:—
       R. Oxide of Zinc...................................3J-
          Sulphate of Sanguinarina..................grs. x.
          Glycerine.......................................3 U •
          White Wax ....................................5ss.
 Mix, and  form an ointment,  to be  applied  to the eruption  once
                      or twice a day.
 If there  should be much itching and a burning sensation
 experienced, one dram of the essential  tincture  of aconite,
 added to two ounces of glycerine, and  applied  as an oint-
 ment, will relieve that  symptom.  If the  disease should
•*
L 
434           DISEASES OF  THE  SKIN.
still prove obstinate, ten grains of quinine, and three grains
of juglandin, made into six powders, and one given every
two or  three  hours,  will, under  ordinary circumstances,
control  the difficulty.

   Prurigo, or Itching.—Although prurigo frequently occurs
without the presence of papula?, yet it must be arranged with
the cutaneous diseases, as in some cases the eruption is dis-
tinctly visible, appearing of a larger size than in some other
affections of the skin.  It consists of two distinct forms—
Prurigo Vulgaris,  and Prurigo Senilis.
   Prurigo vulgaris, although often severe, may in some cases
occur in a very mild  form.   The eruption is sufficient to
cause an unpleasant itching on the surface.
   The papulae, in  the outbreak of the  severe form  of this
disease, may or may not occur; but they are generally visible
in  some stage.  The pruritus occasions  the  most  intense
degree of itching,  especially during the night, thus causing
the  skin to be torn by the almost incessant  scratching of
the patient.
   The milder form generally lasts about three weeks, while
the more severe kind may continue a number of months.
   Prurigo senilis  is  confined to persons of advanced  age.
The papulae are always present in this form,  and are of a
larger size than  those of prurigo vulgaris.  The skin being
torn with the nails, small black crusts appear  on the points
of the eruption.   In this form of the disease  numerous pe-
diculi are constantly found on the surface of the skin, espe-
cially on persons in lower life, and those of unclean habits.
The eruption is consecutive, new ones beginning to appear as
soon as others are  removed.
   Prurigo vulgaris may occur on particular portions of the
body, taking its  name from the parts which it affects.
   Causes.—This disease  may occur at  any period  of life,
although it is most frequent in very  old  persons.   It is
especially liable to  occur upon the pudenda in females, about 
DISEASES OF  THE SKIN.           435
the change of life.   In cases where the skin is subject to
frequent irritations from trifling causes, this disease is likely
to be developed.   Dissipated habits, want of cleanliness, un-
wholesome diet, &c, all act as exciting causes of this affection.
   Diagnosis.—The extreme papular eruption is the most
prominent symptom  of prurigo,  together  with  the black
crusts which form on the papula?.  It is liable  to be  mis-
taken for scabies and lichen, as has been before stated.
   Prognosis.—When prurigo has been of long standing, it
is difficult to combat with, especially in those of advanced
life.  Although it is not deemed fatal, yet it, in many cases,
affects the mind, and renders the remaining days of the pa-
tient a burden.  Under  Eclectic treatment,  however, it is
usually controlled.
   Treatment.—In  the simple form  of acute prurigo, the
following application is usually all the treatment required:—
       R.  Oleo-Resin of Lobelia......................grs. xx.
          Aconitin.......................................grs. iij.
          Sulph. Sanguinarina.......................grs. x.
          Glycerine......................................,§ij.
Mix.  Triturate until an ointment is formed.  Apply this oint-
          ment to the  part three or  four times a  day.
   In the  chronic form of the disease, where the constitution
is vitiated, iron, quinine, juglandin, and general tonics, will
be required.   If occurring on the pudendum, I have found
the following  application of great value:—Take iodide  of
potassium, one dram; water,  one ounce.   Mix,  and bathe
the parts three or four times a day.   If there is much in-
flammation connected with the disease, a slippery elm poul-
tice may be applied, moistened with the glycerine ointment
described above.

   Squamsc-.—Squamous eruptions may be said to consist  of
dry, hard scales,  occurring in groups on the surface of the
skin.   Scaly diseases  chiefly affect the extremities, although
k 
436           DISEASES OF THE  SKIN.

they may occur on any portion of the body.   They may be
divided into two varieties—Psoriasis, and Pityriasis.
  Psoriasis, (Dry Tetter, Dry Scale.)—Psoriasis consists in
the production of dry, white scales on the surface of the skin,
which  separate into small layers.   The eruption is scattered
over the surface, in the form of small, round spots, formed
into  groups.   There  are three varieties  of psoriasis, viz.,
Psoriasis Guttata, Psoriasis Aggregata, and Psoriasis Leprae-
formis.
  Psoriasis Guttata.—In this mild form of the disease, there
is a slight degree of itching, with numerous small papulae
appearing at the commencement of the affection.  This form
of psoriasis usually lasts from six  weeks to  two months.
Sometimes the eruption  appears in narrow strips, which are
nothing more than the papulae crowded  together in a small
space.
  Psoriasis Aggregata.—This form, like the  previous one, is
usually developed without much  constitutional disturbance.
The eruption consists of slight  elevations of the cuticle
closely aggregated together, which soon become covered with
a dry,  briny scale, and desiccate and desquamate every day,
and sometimes oftener.
  Psoriasis Leprseformis, (Lepra.)  (See div. 2, fig. 20, plate
on skin diseases.)  This form of psoriasis usually commences
without constitutional symptoms, by the appearance of small,
red stains, upon which appears a silvery white scale.  In
some instances these  patches coalesce and form an extensive
eruption; or they may remain distinct, appearing on all por-
tions of the  body.  The lepra form of psoriasis  is usually
chronic, with but little disposition to a spontaneous ter-
mination.  The scales appear and disappear in this form as
in psoriasis, with the exception of lepra nigricans, in which
the scales are black, instead of a light colour, with a ten-
dency  to accumulate, forming quite an elevation on the skin.
   Causes.—Psoriasis occurs at all ages, and in both  sexes. 
               DISEASES  OF  THE  SKIN.           437

It is said to depend frequently upon hereditary predisposi-
tion.  It is also said to be caused by irritants applied to the
surface,  but is more probably the result of the inactivity of
cutaneous exhalation, and the accumulation of detritus in the
blood.
   Diagnosis. — Yarious forms  of  psoriasis may be distin-
guished  from all other eruptive affections, with the excep-
tion of pityriasis, by the presence of squamae or scales. From
pityriasis, by  the surface being elevated, which is not  the
case in the  former.
   Prognosis.—Under  the New  School treatment, the prog-
nosis is usually favourable.
   Treatment.—As this disease unquestionably depends upon
the  imperfect action of one or more of the  emunctories of
the  body, the  physiological condition of these organs should
be carefully studied.   If the skin be inactive, baths,  fric-
tion, out-door exercise, with a  free use of fresh vegetable
diet, and two  or  three grains of chimaphilin, administered
two  or three  times a day, will  be  sufficient  to  remedy  the
difficulty.   If the  disorder be  dependent upon a  diseased
condition of the kidneys, apocynin, barosmin, and  helonin,
are the remedies.   To  act specifically upon the affection, qui-
nine and juglandin should be given.  As an external appli-
cation, the  acetic tincture  of sanguinaria Canadensis,  ap-
plied five or six times  a day, will be found most beneficial.
In some  cases, I have  derived benefit by applying the wash
during the day, and covering the part with glycerine at night.
During the  treatment the bowels should be kept regular, by
means of anti-bilious physic and neutralizing mixture, and
the  parts kept free from irritating substances.   The above
treatment, if  persevered in,  has been found  ample for the
cure of a very large number of all forms of  psoriasis that
have occurred in my practice.

   Pityriasis.—Pityriasis has been divided into Pityriasis
Diffusa, and Pityriasis Localis.  (See div. 2, skin diseases, fig.
k 
438           DISEASES OF THE  SKIN.
21.)  Pityriasis diffusa is characterized by patches of yellow-
ish, or reddish-yellow colour, covered with fine, branny scales,
and is accompanied by smarting, itching, and burning.   Pi-
tyriasis localis does not differ from the_ other form, the term
only alluding to  its peculiar location.   It may appear on
the face, neck, scalp, and other portions of the body.
   Causes.—The  causes of this form of squamae are unques-
tionably similar to those of psoriasis.
   Diagnosis.—The only disease with which it is liable to be
confounded is  that  of psoriasis, from which  it may be dis-
tinguished by the scales being much smaller, finer, and  the
surface less elevated than in psoriasis.
   Treatment.—The treatment, so far as the  constitutional
symptoms  are  concerned, differs but little from that which
I have already described under the head  of psoriasis.   As
a  local  remedy, I have found  almost immediate relief by
applying a warm  solution of the sesqui-carbonate of potassa,
say, take of the potassa, one-half ounce; boiling water, half a
pint.  Let cloths be wrung from this hot solution, and applied
to the part as  warm as the patient can bear; have  them
changed every  half hour or so, during the day.  At night
cover the part with the following mixture:—Take glycerine,
two ounces; hydrastin, ten  grains; mix, and use as an oint-
ment.  If the  case  should prove  obstinate, and especially
if it  should be confined to  the scalp, the acetic  tincture of
sanguinaria should be used, as described under the head of
psoriasis.

   Hypertrophise.—Under this head I purpose describing all
those diseases of the skin connected with its thickening and
enlargement.
   Iclhyosis.—(Div. 2,  fig. 22, skin diseases.)   Icthyosis, or
fish skin disease,  is characterized by thick, dry, horny scales
appearing on portions of the body.   If the disease continue,
it may extend over all portions of the  body.   The  entire
integument is usually involved, and the  skin  has a hard 
DISEASES OF THE  SKIN.
439
and thickened appearance.   These scales generally dry and
fall off, but they are soon supplied by the formation of new
ones.
   Causes.—But very little is known as to the cause.  In
many instances it is  congenital, while in other cases  it ap-
pears to depend upon a general derangement of the skin and
vitiated state of the fluids.
   Treatment.—A variety of plans of treatment have  been
introduced, but in  most instances with  but little success.
Dr. Banks reports two cases  that he cured by the free use
of cod liver oil, internally and externally.  This fact would
go to show that the disease may be dependent on disordered
nutrition; and in the numerous cases that have  been suc-
cessfully treated  by the New School practitioners, I notice
that the cures  have principally depended upon the correc-
tion of the nutritive functions.   Cod liver oil, alnuin, chi-
maphilin, quinine, and  iron, being the remedies mostly
administered internally; while hydrastin and sanguinarina,
triturated in cod liver oil,  have been  most successfully
used as an external application.

   Mofluscum.—Molluscum is characterized by  the  deve-
lopment on the  skin  of round, slightly umbilicated, soft
tumours, varying in size usually from that of the head  of
a pea  to  that  of a  nut, but described as  occasionally ac-
quiring the magnitude of a pigeon's egg; they are of  a yel-
low, or pinkish-white. colour, sessile, rarely pedunculated,
scattered  irregularly over the surface,  yet occurring not
unfrequently in  small groups, of slow growth, and  unat-
tended with  either  local pain or  constitutional  irritation.
When pressed between the fingers, a  small quantity  of
thick, whitish fluid exudes from the minute aperture that
forms the umbilical apex of each tumour.   They are most
frequently found on the face and neck.  Their duration  is
uncertain, in some  cases ulcerating and  falling off  spon- 
440           DISEASES  OF  THE SKIN.
taneously; in other cases lasting for life, without increasing
or diminishing.
   Causes.—But little  is known  in regard to the cause of
molluscum.
   Treatment.—The treatment that has been  most success-
ful in this disease consists in clipping off the tumours with
a pair of scissors,  and cauterizing the part with a little
caustic potassae;  after which a slippery elm poultice should
be applied.  The constitutional treatment should be of a
tonic and invigorating character.

   Starrhcea.—Starrhoea is a disease of the sebaceous folli-
cles, characterized  by  hypertrophy of the glands,  and an
abnormal discharge of their contents. This disease, although
classed among the skin affections, hardly amounts to a dis-
ordered state of the skin, with the exception of a few cases.
When it occurs as a disease, it mostly exists in the axillary
and  inguinal region, in which  the parts are covered with
a moist,  oily perspiration.  In some  cases  the  discharge
becomes  so copious as to be termed a disease,  there being
inflammation, and in some cases a separation of the glands.
   Treatment.—But little internal  treatment is  required.
The  bowels should be kept open by means of  a mild laxa-
tive, and  the parts should  be  bathed with a decoction of
equal parts of rumex crispus and hydrastus Canadensis.

   Elephantiasis.—There are two varieties of this disease—
Elephantiasis Graecorum, and Elephantiasis Arabum.   The
former is  characterized by the  development  of tumours
upon the integument,  varying  in size from  a  pea to  that
of an apple.  Eventually these tumours ulcerate, and dis-
charge an ichorous pus, in  some cases affecting the bone
and  resulting  in mortification and death.  It  is  a  dis-
ease  principally of tropical climates, and is supposed to be
the true leprosy of the ancients.  Elephatiasis arabum is
characterized by an extensive hypertrophy of  the  integu- 
DISEASES OF THE  SKIN.          441
ment, most usually affecting the lower extremities, the scro-
t um of males, and the pudendum of females.   The affection
usually commences with more  or  less  local inflammation,
and a general  derangement of the constitution; the parts
affected often assuming an enormous magnitude, and when
fully developed, has a rough, lightish-brown colour, full of
deep furrows, which ulcerate, and discharge an ichorous pus.
   Treatment.—As  this disease is produced  by a vitiated
state of the fluids and imperfect action of the integument,
tonics and alteratives should be freely administered, such
as the compound  syrup of stillingia, in combination with
iron, &c.   The parts should be thoroughly bathed three or
four times a day with a strong solution of sesqui-carbonate
of  potassae, followed by slippery elm  poultices.   In cases
where the swelling and thickening of the integument have
become very extensive, painting the part with the muriated
tincture of iron,  followed by  an  astringent poultice, has
been  found very beneficial.

    Clavus, (or Corns.)—Corns consist in excrescences, al-
most always confined to the feet.  They are usually pro-
duced by wearing tight shoes, boots, &c.
    Treatment.—Shave the part as  closely  as possible, with-
out hurting;  then  touch it with a small  quantity of chro-
mic acid.  Avoid pressure until the parts are sound.  The
above treatment, if properly applied, is all that is necessary.

    Condylomata.—Condylomata consist of small, fleshy tu-
mours, which  usually appear  at  the junction of the mu-
cous  membrane with  the  skin.  They are easily removed
by applying caustic of potassae.
   jVivvus, (or Mother's Mark.)—Mother's mark is charac-
terized by discolouration, and more or less elevation of dif-
 ferent parts of the body, easily engorged, and composed of
 loose, cellular structure.  It  usually exists at birth, and
 seldom changes during life.
        38 
142           DISEASES  OF  THE SKIN.
   Treatment,—If but a small portion of the integument is
affected, and so located as to disfigure the patient, it should
be removed; otherwise it should  not  be interfered with.
The best method for removing it consists in inserting through
it a large number of small steel needles, and  so encircling
the needles with the ligature as to interrupt the circulation;
allow these to remain until the  parts slough off.  The sore
will heal by granulation, and usually present  a healthy ap-
pearance.

   Maculse.—Maculae consist of a variety of discolourations
of the skin,  caused  by the  accumulation  of the  pigment
cells of the derma on various portions of the body.  It fre-
quently appears upon the face of pregnant women, and upon
those affected with uterine disease.  It may  exist also as
the effect  of deranged  secretions,  and an impure state of
the blood.
   Treatment. — When  it occurs  in  pregnant  women, it
usually disappears after child-birth; and if dependent upon
uterine derangements,  by removing the cause  the difficulty
will  disappear.  So  in the  treatment of the disease, de-
pendent upon other causes.   The  cause  should be sought,
and  so far as practicable removed.   Bathing the part in
the acetic syrup of sanguinaria, also, has a tendency to re-
move the  discolourations.

   Vitiligo.—Vitiligo is  consequent upon  the want of the
colouring matter of the skin, sometimes occurring in the
hair,  eyes, &c, when it  is called  albinoismus.  True viti-
ligo occurs on some particular portion of the body, at one
time, in small, round  spots,  which afterwards increase in
size.  The surface of  the skin, which is thus  affected, is
not elevated, and is of a perfectly white colour.  The cause
of this disease has not been ascertained; it occurs generally
in middle-aged persons.  It occasions  a great  amount of 
DISEASES  OF  THE SKIN.
443
mental distress, especially when it  occurs  in  young per-
sons; yet it may, by untiring care, be removed.
   Treatment.—The indications of treatment are to enrich
the blood with  tonics, iron,  cod  liver oil, nutritious diet,
out-door  exercise, and bathing.

   Ephelis.—This affection, which is an increased hue of
the pigment of the skin, is divided into three varieties,
viz., Ephelis Lenticularis, Ephelis Hepatica,  and Ephelis
Yiolacea.  Ephelis lenticularis, or freckles, is  caused par-
ticularly by the influence of  the sun's rays upon the parts,
and occurs most usually in females, owing to their fine skin.
   Treatment.—These discolourations can  usually be  re-
moved by an abstinence from animal food, the free use of
fresh, succulent, vegetable matter, and bathing the part in
a solution of lactic  acid three or four times a day.
   Ephelis hepatica appears mostly in patches of a dark-yel-
lowish hue; they at first occasion  an  itching, which  in-
creases on rubbing the part.  It may last for many months,
but generally disappears in a short  time.  It is seen most
frequently in females, especially during  pregnancy.
   Treatment.—The same  as  in maculae.
   Ephelis violacea  is caused by the  long use of the nitrate
of silver, which changes  the colour of the cutaneous sur-
face to a grayish or leaden-hue, and  is considered a perma-
nent disease.

   Lupus, (or Eating Tetter.)—Lupus  occurs  in a variety
of forms, generally upon  the face.   It is an inflammatory
affection, with  more  or less  hypertrophy.  It  commences
by slight thickening and elevation of the skin, usually not
larger than a kernel of wheat, or a half pea.  A thin, hard,
brownish scab appears on its surface.  The scab, if removed,
shows a thickened, indolent, and elevated portion  of the
integument.  The  disease extends  slowly, but gradually,
until, in many cases, it produces  extensive destruction of 
444
DISEASES  OF  THE SKIN.
the integument, which  is followed, in some instances, by
prostration, general constitutional derangement, and death-
Lupus has been divided into Lupus Superficialis, and Lu-
pus Devorans, or noli me tangere.   The  noli me tangere is
the most active form of lupus, and is usually recognised as
that form of cancer which appears about the face, neck, &c-
It is  most destructive in its character, destroying all the
soft parts, and even the bones, in its progress.
   Treatment.—Lupus, in all its forms, should be destroyed
by the. application  of the caustic of potassae; and  healed
under the application of the mild  zinc ointment.   At the
same  time, the compound syrup of stillingia, iodide of am-
monia, and chimaphilin, should be freely administered in-
ternally, for the purpose of purifying the fluids.

   Porrigo, (Scald Head.)—Scald head differs from all other
forms of eruptive  diseases, in the fact  that it appears on
the scalp in  the form of small,  elevated, dry spots, about
the size of a pin's  head.   These little  crusts are usually
perforated by the  hair.  The eruption  gradually spreads,
until, in some instances, the entire scalp is involved in the
difficulty.  It  is usually confined  to children, although it
may exist in adult  persons.
   Causes.—Porrigo is a contagious affection,  and is propa-
gated by contact.  It is supposed that  the nature  of  this
contagion is that of a vegetable parasite.
   Treatment.—The treatment of this disease consists in
shaving the hair, and washing the scalp  three or four times
a day in  a moderately strong solution of sulphate of zinc,
and applying the following ointment:—
       R. Oxide of Zinc...................... ........31.
          Podophyllin ................................grs. iij.
          Adeps.........................................gij.
Mix;  form an ointment.  Let it be applied to the affected  part
                    after each washing.
At the same time  the child's food should be nourishing; 
GLANDERS.
445
and if there are any constitutional  symptoms, they should
be removed by the proper remedies.

   Sycosis.—Sycosis is an affection which is confined to the
face, especially to that portion covered with beard.   It is
an eruptive affection, which  is supposed  to  depend upon
the presence of a vegetable parasite, similar to that of por-
rigo.   It is a contagious  disease, and is confined, of course.
to the male sex.
   Treatment.—To cure this disease the beard should be re-
moved, and a similar course of treatment  pursued as that
recommended  under the  head of porrigo.
                    GLANDERS.
   Glanders is a malignant disease, contracted by man from
glandered  horses.  It is  produced by inoculation, or by a
small portion of the virus, coming in contact with the mouth,
nose. &.c.  It is ushered in by hot, dry skin, rigours, and chills.
Connected with these febrile symptoms, is pain in the joints,
limbs, and other portions of the body, which soon become
swollen,  red, and present the character of erysipelas.   In
the  course of two or three days the face, neck, chest, and
sometimes other parts, are covered with phlyzacious pustules.
They usually appear  in successive crops;  and in some cases,
instead  of going through the ordinary course  of pustular
eruptions of this character, they degenerate into indolent
ulcers.  At other times there are small blebs appearing upon
the part filled with a dark, ichorous fluid, which soon rup-
tures, and  leaves a gangrenous ulcer.   In the course of a
week or ten days, sometimes longer, the nostrils commence to
discharge a greenish,  corroding pus, mixed with blood.  Soon
after the commencement of this discharge, the mucous mem-
brane becomes engorged and inflamed, which frequently ter-
minates in  permanent gangrene.   This disorganization may
                          38*
k 
446
DENGUE.
extend to the fauces, and  produce almost immediate death,
or it may be confined to small patches, and assume a chronic      ■«
character.
                    TREATMENT.
  In the treatment of glanders, the patient should have a
thorough lobelia emetic, followed by an active purge of anti-
bilious physic; after which the following compound should
be given:—
      R. Baptisin............ ..........................grs. x.
         Quinine......................................grs. x.
         Prussiate of Iron...........................grs. xx.
     Mix.  Ft. pulv. No. x.  Sig.—One every two hours.
If there are pain and swelling in the joints, cloths wrung in
hot soda water should be applied, and frequently changed;
or if the pain be violent, previously to applying the hot packs,
a thorough spirit sweat should be given.  If blebs or gan-
grenous ulcers appear, they should immediately be  caute-
rized  with  caustic potassae, and  slippery  elm poultices ap-
plied, kept constantly wet with  the compound tincture of
myrrh and capsicum.  If the ulcers appear in the nose and
throat,  the nose should be syringed, and the throat gargled
with a strong infusion of bayberry and hydrastus.   If the
disease  assume  a  chronic  character, a  similar  treatment
should be instituted, but alternated with  comp. syrup of stil-
lingia, iron, a general  tonic, and an invigorating course of
treatment.
                      DENGUE.
  Dengue  is  a disease  of a febrile character,  connected
with  rheumatic symptoms and  a peculiar  eruption.   It
usually commences with a chill, fever, headache,  loss of ap-
petite, and other symptoms peculiar  to  bilious fever, with
the addition of violent rheumatic pains  in the joints, and
other parts of the body.   This fever  usually lasts from one
to two days, when a gradual  remission occurs,  and  the pa- 
OZiENA.
447
tient feels quite comfortable, although there are frequently
more or less  rheumatic pain and soreness of the  muscles.
In the course  of from two to four days,  the fever gene-
rally returns, and passes through paroxysms  similar to the
first.   Upon  the subsidence of this paroxysm, or about the
sixth day, an eruption makes its appearance somewhat re-
sembling that of scarlatina, and is immediately followed by
a cessation of all the constitutional symptoms.  The erup-
tion usually amounts to nothing more than a fine rash, which
becomes  covered with small scales, and disappears in the
course of one or two days.

                        CAUSE.
   The probable cause of this disease  is that of a concen-
trated  miasmatic poison, acting in concert with a peculiar
epidemic influence.
                    TREATMENT.
   The warm  bath should be ordered, the stomach and bowels
cleansed by means of a mild emetic and purge, followed by
the following prescription:—
      R. Quinine.......................................grs. x.
          Yeratrin.........,............................gr. ss.
          Sacch. Alba...................................grs. xx.
   Trit., mix, ft. pulv. No. x.  Sig.—One every two hours.
If this should  not control the fever,  small doses of aconite
should be  given for that  purpose, and  in a few  days  the
prescription  repeated.   In  cases where the disease is  fol-
lowed  by debility, alnuin,  hydrastin, and iron, should be
given.
 OZiENA,  (CATARRH  OF  THE HEAD.)
  Ozaena  is a chronic inflammation of the mucous mem-
brane of the nostrils.   It is  characterized by a feeling of
uneasiness, heat, and inability to respire  through one  or 
448                    0Z1ESA.
both  of the nasal  passages.  This  disease may be either
acute or chronic.   In the acute form, it is usually accompa-
nied by an abundance of secretion, and a continuance of the
disagreeable symptoms for two or three days, when it gra-
dually disappears.  In the chronic form, there is generally
a secretion of muco-purulent matter, of a very offensive cha-
racter.   If it is confined to the anterior portion  of the nos-
trils, it will be discharged externally.  If to the  lateral pas-
sage,  it will pass into the larynx,  and  produce irritation,
which not unfrequently extends to the trachea and bronchia.
In other cases this  purulent secretion will dry upon the mu-
cous membrane, and form large, thick crusts, which will be
discharged  after having  accumulated  for several days or
weeks.
                    TREATMENT.
  In  the acute  form of the  disease, but  little more is ne-
cessary than to  keep in a warm room, and  inject the nos-
trils occasionally with warm water.   Chronic ozaena, how-
ever,  is a  disease that is very seldom  successfully treated
by the Old School.   The  following  plan,  which I have
adopted within  the last few years, has proved  universally
successful in quite a large number of cases:—Take pulverized
muriate of ammonia, one dram, and place in an iron spoon;
hold it upon a lamp, or gas, and heat it until  the ammonia
is  converted into a smoke or vapour.  Inhale  this  smoke
through the nostrils; continue the process until the ammonia
is all  consumed.  Let this process be repeated two or three
times a day, until  the disease is removed.   At the same
time, give the following mixture :—Take compound syrup of
stillingia, three ounces;  neutralizing mixture, three ounces;
carbonate of iron, one dram; mix, and  let the patient take
from  one to three  teaspoonfuls a day.  The constitutional
symptoms should be attended to, and treated by such  other
appropriate remedies as are indicated. 
gout.                    449
                       GOUT.
  This  disease affects  various parts of the body,'causing
much inflammation and irritation.   It was formerly known
by the name arthritis.   It is most properly divided into three
varieties—Acute, Chronic, and Nervous Gout.   Added to
these is a form of the disease, which, showing symptoms of
rheumatism, is known as Rheumatic Gout, and may be con-
sidered  as a distinct variety.

                   ACUTE GOUT.
   This  form generally affects persons in middle life, and of
vigorous habits.  The principal seat of this form of the dis-
ease is the great toe.  It is often very severe, the part affected
having  the sensation  of being torn by an instrument, or
pierced.  The joint soon commences to swell, becoming so
intensely sensitive that the slightest motion occasions the
most extreme pain.  The pain,  after remaining from six to
twenty-four hours, diminishes, while the swelling augments.
The  febrile symptoms commence  at  about the  same time
with the other affections;  also continuing for a similar pe-
riod, and both leaving before the appearance of the swelling.
At this time the patient is frequently troubled with looseness
of the bowels, or a free discharge  of the urine.   Gout may
occur, however, in other forms.  The patient may be affected
 with slight preliminary attacks, before the disease fairly sets
 in.   The symptoms are almost identical with those of nervous
gout, and will be described under that head.  It is seldom
 that the patient is released with one attack of acute gout.  It
 generally re-appears in about one year, although the interval
 may be prolonged to  a  much longer  time.  These  inter-
 vening periods "shorten, while the length of the  attacks in-
 crease.  During these attacks the patient may be affected
 with inflammation in  the bowels,  stomach, brain, heart, &c,
 when the disease  is said to have passed from the acute to the 
450                     gout.
 chronic form.  When this  form passes from the  outward
 surface to the anterior organs, without any  visible signs
 of its  Existence,  it is termed misplaced gout.   It maybe
 caused by the application of cold to the affected part.
   Gout may appear in two  forms  in the stomach; the in-
 flammatory, and the nervous.  The symptoms of the former
 are similar to those of acute gastritis.  In  the nervous, or
 functional form, the  burning pain of the former is absent,
 while  there are either nausea and vomiting, or a severe
 convulsion, depending upon the seat of the  irritation.
   When the bowels are the  parts affected, it occasions colic,
 or diarrhoea.   Although the heart is seldom the seat of acute
 gout, sharp pains, an  oppressive feeling, and swooning may
 occur.  Should the lungs be affected, there will be a feeble
 pulse,  difficult respiration,  and bronchial  congestion.   In
 affections  of the diaphragm, the symptoms  are the same as
 those  of  rheumatism of this  part.  The  liver  is affected
 when there is  a superabundance of bile, causing bilious vo-
 miting, &c.
   The kidneys are more generally acted upon than the other
 internal organs.  There being an abundance of uric acid in
 the urine, symptoms of gravel appear.  In some instances
 the disease settles upon the  urethra and mucous  membrane
 of the bladder, producing symptoms analogous to gonorrhoea.
 At other times the disease attacks the brain, producing apo-
 plexy.
                  CHRONIC  GOUT.
   Chronic gout is but a continuation of the acute, of long
 standing;  or it may be denominated chronic when the gouty
 symptoms appear, unaccompanied with fever.  In this form,
 as well as  in the  acute, the  disease may fix upon a certain
joint;  or it may be migratory, changing from joint to joint.
 In the majority of cases, however, it locates  upon a single
joint, and  produces permanent enlargement, which consists
in extensive chalky concretions. 
GOUT.
451
                 NERVOUS  gout.
  Nervou3 gout, although in some instances distinct from
that affecting other parts of the body, is usually connected
with it.  AY hen it  is of a purely nervous character, it is
manifested in the form of neuralgic pain in different parts
of the body.  It is usually accompanied by a marked  dis-
turbance of the circulation, and of the secreting organs.
Another form of gout  that has been described by many
authors, is rheumatic gout.  This form usually manifests
itself by symptoms  analogous to those of acute rheumatism.
                       CAUSES.
  It is supposed that gout is  more frequently than other
diseases, of an  hereditary character.  It may also  be  pro-
duced by  high living, excessive use of alcoholic stimulants,
and a want of sufficient exercise.
                     DIAGNOSIS.
  The only disease with which gout is likely to  be  con-
founded is acute rheumatism, from which it may be distin-
guished by the more extensive disorder  of the digestive or-
gans, and  its existence in patients of indolent and plethoric
habits.
                    treatment.
  The primary  object in the  treatment of this disease, is
the regulation of the patient's habits.   His diet should be
of a simple character, and composed largely of vegetable
matter.   Out-door  exercise, and  daily  baths, should  also
be enjoined where  the circumstances will permit it.   The
constitutional treatment should consist of a free lobelia
emetic as  often as  once or twice a week, succeeded by the
following  compound:—
      R.  Apocynin...................................grs. xx.
          Quinine......................................grs. xv.
          Chimaphilin...............................gr?. xx.
          Sacch. Alba................................gj.
Mix.  Ft. pulv. No. xxv.  Sig.—One every three or four hours, 
452
RHEUMATISM.
If there is much pain, let the patient take the one-sixteenth
portion of a grain of aconitin, and the one-eighth of a grain
of hyoscyamin once or twice a day.  At the same time let
the following liniment be applied:—
      R. Chloroform.........................................3>j-
         Tincture of Aconite..............................3'j-
    Mix, and apply to the part by means of a small brush.
If there  are  febrile symptoms,  let the patient take small
doses of the  tincture of veratrum viride  as often as it is
necessary to  control it.  If the gout  assumes a chronic
character, let from one-half pint to a pint of the strong in-
fusion of queen of the  meadow and pipsissewa be drunk
during the day.   If there are  nervous symptoms, a pill
composed of  one  or two grains of lupulin and cannabis sa-
tiva, taken three or four times a day, will usually relieve
it;  and if there  is enlargement of the joints, a  liniment
composed of equal parts of the compound tincture of myrrh,
capsicum, lobelia, and  oil of hemlock, rubbed on  three or
four times a day, will be found beneficial.  Where the
gout partakes of  the nature of rheumatism, either the sul-
phate or chlorate of potassa should be  freely administered,
in  combination with eupatorin purpurin,  barosmin, and
other diuretics.  If the disease is of a periodical character,
and especially  if it returns at stated intervals, the attacks
should be anticipated by the free use of quinine and podo-
phyllin.   During the  treatment the entire body should be
sponged in a hot alkaline bath as often as once or twice a
week.
                 RHEUMATISM.
  In  addition to what  I have written  on rheumatism in
another part of this work, I purpose to offer a few observa-
tions  relative to the nature  and character of this disease,
inasmuch as it is an affection of common occurrence, and
resists the ordinary course of treatment. 
RHEUMATISM.
453
                     SYMPTOMS.
   Acute  rheumatism is generally ushered  in  by a quick,
bounding pulse, a hot, dry skin, foul tongue, loaded urine,
and more or  less severe  pain in different portions of the
body.   In many cases these symptoms are preceded by ri-
gours and chills, followed by a fever, which in a short time
subsides,  and  a sour perspiration takes its  place.  In the
course of a few days the pain fixes upon one or more of the
joints, which become red, full, and  painful.  Unlike  ordi-
nary inflammation, the  pain frequently changes  from one
joint to another.  The inflammation of the  joint is not al-
ways, although sometimes, accompanied by  exudation and
infiltration of liquor sanguinis into the cellular  tissue.  In
many cases, when the disease is transferred to  a distant
portion of the body, all traces of inflammation in the pre-
vious site disappear in a very few hours.   This,  however,
does not occur as a general thing, when the inflammation
is accompanied by an exudation into the tissue.  In  some
cases the disease appears  to  be confined to the synovial
membrane, and  an exudation  occurs  within the sac, pro-
ducing hydrops  articulse.   The disease may run its course
without involving any of the vital organs, or it may locate
upon the pleura, peritoneum, pericardium, and  other  por-
tions of the serous  tissue.  In this event  the symptoms
will become more complicated, and the disease of a more
dangerous character.   This  acute form  of rheumatism,
when not  involving the  vital organs, under  favourable
treatment, terminates by  critical evacuations, such as co-
pious acid perspiration, diarrhoea, or large deposits of urates
in the urine.   In other cases this disease  terminates  in
chronic rheumatism, which consists in permanent enlarge-
ments of one or more of the large joints, accompanied by
much swelling, pain, and a general thickening and consoli-
dation of the  articulating tissues, together with all the es-
       39 
454
RHEUMATISM.
sential characteristics of gout, as I have already previously
described.
                      CAUSES.
  It is a prevailing opinion  that rheumatism is, in some
way, the effect of cold,  exposures, dampness, &c, and that
these exposures and influences result in an inflammation of
the serous tissues, especially those of the joints.   That the
inflammation connected with  rheumatism is  of a very dif-
ferent character from ordinary inflammation, requires but
little observation  to confirm.  Who  ever heard of an ordi-
nary inflammation changing its  locality almost instantly?
And  yet this is  a most  ordinary occurrence, during the
progress of inflammatory rheumatism.  Nothing is more
common than for a rheumatic  inflammation to leave one
joint, or section of serous tissue, and appear upon another,
within the space of three or four hours, and that, too, with-
out leaving any traces  of the disorder in the tissues where
it was previously located.   Besides, rheumatic inflamma-
tion seldom, if ever, pursues the  same course as that which
characterizes the ordinary inflammatory process.  Ordinary
inflammation, it will be remembered, is always accompanied
with exudation, and a variety  of consecutive changes in
the exudation, such as the  formation of pus, abnormal tis-
sues, or  the death of the exudation.  All these are most
essentially different from  those changes  which occur in
rheumatic inflammation.   Again, it is not  those who are
most exposed to cold, fatigue, and dampness, who  are the
most frequent subjects of  rheumatism.  In the  Western
country, during its early settlement, I had ample opportu-
nity to observe the effects of colds and every variety of ex-
posure, especially those which are supposed to be most pro-
lific  in  producing  rheumatism; yet, not only did these
causes fail to produce the disease,  but, when rheumatism
occurred, which was seldom, it was far  more amenable  to
treatment than when it occurs among those who  enjoy all 
RHEUMATISM.
455
the luxuries and comforts of life.  Indeed, it is among this
latter class that we find  rheumatism most prevalent and
most violent.  Hence, in consideration of all the facts con-
nected with this disease, I must infer that  rheumatism is
produced by other causes than those which ordinarily con-
tribute to inflammation, and that it must depend upon some
specific poison, or materies morbi existing in the blood.   Of
the characters of this poison, Drs. Todd  and Prout state
that in the blood of rheumatic patients a superabundance
of lactic acid is found.   Dr. C. J. B.Williams, in his Prin-
ciples of Medicine, remarks that rheumatism is probably
produced  by a specific  poison in the blood, and suggests
that this may be lactic  acid.  That  this substance should
contribute to  this disease, when existing in the blood in
large quantities, is no more unreasonable  than that other
foreign acids and substances, when circulating in the blood,
should contribute  to special inflammations.

                    TREATMENT.
   Basing my treatment upon the hypothesis that lactic acid
is  the principal cause of rheumatism, my first efforts are to
cut off this supply to the  blood.  Lactic acid, it must be
remembered,  is generated to the amount of twelve or thir-
teen pints in the stomach during twenty-four hours.   But
during healthy digestion  it is neutralized by the ingester.
If the digestion becomes disordered, instead of this acid  be-
coming neutralized, it may be taken up by the absorbents,
and thus  the  blood becomes loaded with  this agent.   To
prevent this, our first purpose should be  to correct the di-
gestive  organs;  for which purpose a free lobelia  emetic
should be given, followed by frequent doses of  chlorate of
potassa, in combination with diuretics.   It must be remem-
bered that lactic acid is transformed  into  uric and lithic
acid during its passage through the kidneys.   Hence  the
value of diuretics.   In addition to this, one or two hot alka- 
456
GLOSSITIS.
line baths should be given every day; and where there is
local inflammation,  the  parts should  be kept  constantly
packed in cloths wrung from  a strong solution of potassae.
The above, in addition to the treatment I have  previously
given in another portion of the work, has proved most effec-
tual in the speedy cure of this disease.
  GLOSSITIS, OR  INFLAMMATION  OF
                  THE  TONGUE.
   This is a disease which often makes its appearance suddenly,
characterized by some or all portions of the tongue becoming
red, painful, and swollen.   In some instances, in the course
of a few hours, the inflammation extends through the entire
organ, and it enlarges so as to  fill the whole mouth, and the
patient is unable to articulate a single word.  The system
usually sympathizes, and the pulse becomes quick and strong,
the skin hot and dry, and other symptoms of general inflam-
matory excitement occur.   The  inflammation  may termi-
nate in resolution, in suppuration, or  in mortification and
gangrene.
                       CAUSES.
   Glossitis may result from the usual causes of inflammation,
although it is more frequently produced by injuries, by the
introduction of too hot drinks in the mouth, or by mineral
poisons, especially the mercurials.
                   TREATMENT.
   Where glossitis originates in the  ordinary causes of in-
flammation,  the stomach should be evacuated by means of a
free emetic,  the bowels opened by means of anti-bilious phy-
sic and podophyllin, and the patient placed upon full doses
of veratrum viride.   After the  action of the physic the
skin should  be bathed in hot lye water, and the mouth fre-
quently gargled with warm water.  If the disease  is pro- 
ANGINA.
457
duced by scalds or injuries, in addition to the above treat-
ment the patient  should hold  glycerine in his mouth.  If
produced by mercury, after the bowels  have been opened
by the purge, and the  fever controlled by  veratrum, the
following powders should be given:—
      R. Sulphur.........................................3j.
         Quinine.........................................grs. x.
         Baptisin......................................grs. x.
    Mix.  Ft. pulv. No. xv.  Sig.—One every two hours.
At the same time the mouth should be frequently washed
with equal parts of lime-water and sweet oil.  If there are
symptoms of gangrene,  a gargle of  cinchona and baptisin
should be used.  If  an abscess form on  the  tongue, it
should be opened by a bistoury.
 ANGINA,  OR  INFLAMMATION OF THE
                      FAUCES.
   Under the name of Fauces are included the Yelum Pen-
 dulum, the half arch of the Uvula, the Tonsils, and upper
 portion of the  Pharynx.  Common  inflammation of  the
 fauces, or  sore throat, is indicated by a bright red colour,
 more or less oedema, and  in the  advanced stage, the  ap-
 pearance of whitish patches upon different portions of the
 mucous membrane.   The  patient has a sense of heat and
 dryness  in the  throat, which becomes  painful upon swal-
 lowing, and in conversation.  After the disease exists for
 a short time, an exudation of liquor sanguinis occurs, which
 is expectorated  in the form of tough, viscid  matter.  In
 many cases this disease runs its course without much con-
stitutional  disturbance; whilst in others there is a  hot, dry
 skin, irritable pulse, and general febrile action.  This dis-
 ease may terminate in resolution, or in chronic angina.
                          39* 
458
A N G 1 N A .
  Dr. R. B. Todd, of London,  describes a variety of an-
gina, which he considers erysipelatous.
  The inflammation, in ordinary cases, runs on for several
days, and then gradually declines, terminating almost al-
ways in resolution.   In some rare cases, suppuration takes
place in the substance of the uvula, or soft palate, and gan-
grene may occur  in  persons of debilitated and unhealthy
constitutions.  The tonsils sometimes inflame, and the ex-
ternal parts participate in the disease; the jaws becoming
stiff and painful, and the absorbent glands swelling.   The
most unpleasant ordinary result, however, is the travelling
of the inflammation downward into the larynx, and even
into the lungs;  and, in some persons, severe bronchitis is
very apt to follow an attack of  simple angina, if not early
arrested.   Not unfrequently the Eustachian tube partici-
pates in the inflammation, and partial deafness results from
its  closure.  This may be ascertained by causing the pa-
tient to close firmly the mouth and nostrils, and then en-
deavour to expire forcibly; or,  as suggested by Mr. Toyn-
bee, simply to perform the act of deglutition.  If the tube
is open, the air will readily enter the tympanum, otherwise
not at  all, or with difficulty.  Another method, suggested
by Prof. Richter, is to auscult over the ear, with the carti-
laginous portion  pressed down, so as to cover the external
meatus.   If the tube is open, the sound of the breath and
voice is heard; otherwise not.

                CHRONIC ANGINA.
  Inflammation of the  fauces sometimes assumes a chronic
form; in which event the fauces remains permanently con-
gested, thickened, and, in places, small ulcers make their
appearance.  In  some cases  this chronic inflammation is
accompanied by a copious exudation; while in  other cases
the fauces remains red, swollen, and dry.   This form of in- 
        INFLAMMATION OF THE PHARYNX.     459

flammatlon is frequently of long standing, and is liablo  to
extend to the trachea and bronchia, resulting in bronchitis.

                      CAUSES.
  The causes of both acute and  chronic angina are, a vi-
tiated condition of the stomach, colds, scrofulous and tuber-
culous constitutions, spermatorrhoea, and other causes which
tend to debilitate and exhaust the system.

                    TREATMENT.
  The treatment of acute angina consists in removing the
cause, cleansing the stomach, frequent baths,  hot packs to
the throat, and frequent gargling with hot water.  Chronic
angina should be treated by first cleansing the  stomach and
bowels, then invigorating the  system with  quinine, iron,
hydrastin,  cod liver oil, and chimaphilin, and  gargling the
throat frequently with a hot decoction of hydrastis Cana-
densis and  rumex  crispus.   If the disease should prove
obstinate, the throat should be packed once or twice a week,
for  ten or  twelve hours, with hot water.  In the gangre-
nous form  of the disease, the treatment should be analo-
gous to that recommended under  the head of  diphtheritis.
   INFLAMMATION  OF  THE  PHARYNX.
  Inflammation of the pharynx is  a disease of much less
frequency than angina.  When it occurs, it is characterized
by tenderness upon pressure on the outside, the absence of
the alteration of voice, and frequently from enlargement,
and the accumulation of pus in the cellular tissue.

                    TREATMENT.
  When accompanied with the accumulation  of pus,  it
should be treated the same as  angina; but when abscesses
form, they should be opened with a sharp-pointed bistoury,
L 
460      STRICTURE OF THE  03SOFHAGUS.

and touched, by means of a probang, with a hot solution of
sulphate of zinc.
   STRICTURE  OF THE  (ESOPHAGUS.
  Stricture of the oesophagus may occur as the result of
chronic inflammation, producing  hypertrophy of the mu-
cous membrane; or it may be produced by granulation,  or
cancerous infiltration.
                     SYMPTOMS.
  The symptoms of stricture of the oesophagus are a diffi-
culty in  swallowing, a hot  and burning  sensation  as the
food passes over the constricted point, and in case of can-
cer of the oesophagus, weakness, and general constitutional
debility.
                    TREATMENT.
  Ordinary stricture of the oesophagus,  produced  by in-
flammation, may be successfully treated by giving the pa-
tient principally a fluid diet, and the free use of menisper-
min and  muriate  of ammonia,—say, take  menispermin,
twenty grains; muriate of ammonia, ten grains; white su-
gar, one dram; mix, and make twenty powders; dose, one
every three hours.   If the disease should prove obstinate,
a probang, moistened in a tolerably strong  solution of ni-
trate of silver, may be applied once or twice a week.   In
very obstinate  cases, a bougie of sufficient  size  to put the
parts thoroughly  upon  a stretch, should  be  introduced
every two or  three days.  In case of cancerous affection
producing the obstruction, it may be mitigated by the free
use of compound syrup of stillingia and iodide of potassa?,
and the  application  of a solution of sulphate of zinc,  by
means of a probang, once a day.
 SPASMODIC STRICTURE OF THE (ESOPHAGUS.
  Spasmodic stricture of the  oesophagus may occur as the
result of nervous irritability, or of chronic inflammation. 
CHOLERA INFANTUM.
461
                    SYMPTOMS.
  The symptoms of spasmodic stricture of the oesophagus
are the same as those of permanent stricture, with the ex-
ception that it occurs in paroxysms.

                   TREATMENT.
  It may be temporarily relieved by the administration of
an ounce  of lobelia, and permanently cured  by removing
the nervous irritability or inflammation upon which it de-
pends.
           CHOLERA  INFANTUM.
   Cholera  Infantum is a complaint which usually attacks
children between the ages of two months and three years.
It is a disease peculiar to the warm season, commencing in
the first heat of the summer, and usually terminating with
the cold weather of autumn; is confined mostly to cities,
and prevails most extensively in its most populous portions.
                     SYMPTOMS.
   The attack is usually preceded with  a diarrhoea, which
lasts from  a few days to several weeks.   During its pro-
gress  the stomach becomes  irritable,  and active vomiting
and purging  occur.   In the more violent form of the dis-
ease, the vomiting and  purging occur without any premo-
nitory symptoms, and, in some cases, are so active as to  de-
stroy the life  of the patient in a  few hours;  while in others
it is protracted for weeks, and even months.  The abdomen
is  usually flat when the disease  first commences; but after
it has existed for a short period, it more ordinarily becomes
full and tense.  The discharges, both  from the stomach
and the bowels, are  of a yellowish, thin, liquid character,
although in some cases  it is of a  rice-water appearance.
The pulse  is feeble;  the skin,  although occasionally hot
and dry, is usually cold and  clammy. 
462           CHOLERA INFANTUM.
                       CAUSES.
  The causes of cholera infantum are,  probably, the hot
weather, the impure air of cities,  and a lack of proper nu-
trition.   This deficiency of nutrition  may consist in  a want
of proper nutritive material in the breast milk of the mo-
ther; or the cow's milk, upon which the child  is fed; or it
may be owing to a want of proper nutriment in other forms.

                    TREATMENT.
  When called to treat  the case  in the early  stage of the
disease, small doses of neutralizing mixture should  be fre-
quently administered, until the diarrhoea and vomiting are
 arrested.  Or if this fails,
      R. Leptandrin....................................grs. v.
          Bi-Carbonate of Soda.......................grs. iij.
          Pulv. Camphor............... ..............gr. j.
          Sacch. Alba..-...............................grs. xx.
Mix.  Ft. pulv. No. xii.  Sig.—One every half hour, or hour,
                 as the case may require.
If this  should be rejected, and fail to arrest the vomiting,
the stomach and bowels should be thoroughly  packed with
equal parts of hot water and  whisky; and  ten or fifteen
drops of spirits of camphor, added to a tumbler half full of
water, and one teaspoonful given every five or  ten minutes.
As soon as the vomiting is arrested, the following powders
should be given:—
      R. Quinine......................................grs. x.
          Frazerin......................................grs. vj.
          Xanthoxylin.................................gr. j.
          Sacch. Alba..................................grs. xx.
        Mix.  Ft. pulv. No. x.   Sig.—One every  hour.
The diet should be carefully prepared, and be administered
in such quality and quantity as the stomach will contain it,
and will best nourish the  system.   If there  should  be a
diarrhoea following the disease, from one-half teaspoonful 
LYMPHADENITIS.
463
to a teaspoonful of the dysentery mixture should be given
every two or three hours.  If there be fever, it should be
controlled by aconite, and the stomach and bowels strength-
ened by means of alnuin, hydrastin, and frazerin.
INFLAMMATION  OF THE  ABSORBENT
     GLANDS, OR LYMPHADENITIS.
  Inflammation of the absorbent glands may occur wherever
these organs exist.  The  more frequent occurrence, how-
ever, is in the regions of the groin, neck, and axilla.

                    SYMPTOMS.
  The affected gland becomes swollen, hard, and painful.
The inflammation usually extends to the sub-cellular tissue;
not unfrequently several glands  are inflamed when the tu-
mour becomes very much enlarged.  If the disease is of an
acute character, in the course of  from one to  two weeks the
tumour will become soft  and fluctuating.  The skin at
length becomes absorbed,  and the abscess is opened spon-
taneously.   If it be  a simple inflammation of one or more
of the lymphatics, unattended by constitutional symptoms,
the abscess, after  discharging, will very frequently heal;
or if it does not heal spontaneously, it is  easily made to do
so by the use of proper remedies. The chronic form of the
disease  is usually connected with a scrofulous or tubercu-
lous constitution; and  instead  of the tumour depending
upon ordinary inflammation  and infiltration  of liquor san-
guinis  into  the gland, it  is  characterized by  tuberculous
and scrofulous deposits.  In these  cases the swelling is
usually more gradual, and the gland  presents a  hard and
indurated appearance.   In the  course of time not  unfre-
quently the glands suppurate; but instead of healthy pus,
a thin ichorous discharge  occurs, and  continues for a long 
464
GANORiENA ORIS.
period.   In some cases the swelling degenerates into an in-
dolent ulcer, which manifests but little disposition to heal.
The  constitutional symptoms  are  usually those connected
with  scrofulous or tuberculous patients, such as pallor,
feeble digestion, and a weak and exhausted state of the  sys-
tem generally.
                    TREATMENT.
  The treatment of acute  inflammation of the lymphatics
consists  in applying to the  tumour hot packs, changed
every fifteen  minutes, until the swelling disappears; or if
it cannot be controlled by packing, constitutional treatment
should be  given, such  as chimaphilin, quinine, and iron,
followed by a brisk purge of anti-bilious physic.
  If this does not discuss the tumour, warm emollient poul-
tices  should be applied, and suppuration induced.   After
the gland suppurates, it should be injected with a mild so-
lution of sulphate of zinc once or twice a day, and  the
emollient poultice continued.   Where there is chronic in-
flammation of the gland, it should be treated as the acute
form until the inflammation is controlled.   Afterwards the
tumour should be painted with a strong tincture of iodine,
and%constitutional treatment instituted,  as directed under
the head of phthisis and scrofula.  If suppuration occur,
the mild zinc ointment should be applied to the ulcer, while
the remaining portion is kept painted with the iodine.
              GANGR.ENA ORIS.
  The synonyms of Gangrsena Oris  are  " Cancrum  Oris,"
" Sloughing Phagedsena of the Mouth,"  " Water  Canker,"
" Stomacace Maligna," "Norma," "Necrosis Infantilis."
  Gangrene of the mouth is a disease  commencing with
that loss of vitality, which in inflammatory mortification is
the last of a series of morbid  changes. 
GANGRyENA  ORIS.
465
                     SYMPTOMS.
  The first symptom is usually an indolent swelling of one
cheek, without heat or  redness, hard to the touch, but so
little tender or painful, that the patient seems hardly con-
scious  of it;  and but for the enlargement being obvious to
the eye, the  disease would  probably not  be noticed in its
early stage; and as it is, it may be mistaken for less serious
affections.
  The principal phenomena of the first stage are a peculiar
glossy  appearance of the  skin of the  cheek, a whitish or
ash-coloured eschar in the mouth, without any inflammatory
redness of the surrounding membrane, with the gums pale
and spongy.   The general health frequently does  not ap-
pear deranged, though there may be slight feverishness or
languor.  As it goes on the interior of the cheek and lip
slough, and the gums become affected.   Saliva at first clear,
but afterwards mixed with a sanious matter of a very offen-
sive  smell, flows  rapidly.   A white, livid spot appears on
the outside, soon resulting in complete mortification.   The
teeth become loosened, and are thrown off with portions of
the alveolar processes.  The corrosive quality of the saliva
sometimes produces new mortification in  the angles of the
mouth, and on the lower lip.   Both sides of the face in the
same individual  have been  known to  be attacked, and  in
some cases all parts of the face, the  upper maxillary bones,
the palatal, the nasal, and even the ethmoid.  This disease
is attended with a weak, but frequent pulse, bowels at first
confined, but towards the close very much relaxed, and with
great diminution of heat of the extremities.  Gangrsena
oris is  commonly met with in children between the ages of
two and five years, debilitated habit, low, marshy locations,
and  rainy seasons, seeming  to  aid in its development.  It
is also  frequently one of the consequences of exanthema-
tous  fevers.
     40 
466
GANGRiEN A  ORIS.
                    PATHOLOGY.
  We  consider gangraena  oris an idiopathic disease, any
inflammation found about  the  part being only secondary,
and not the cause of the gangrene.  The swelling is caused
by the circulation in the capillaries being retarded, and by
the extravasation of the liquor sanguinis into the tissues,
which  is the reason why there is no attendant pain or red-
ness in the beginning, the  pressure destroying the vitality
of the central portion.  The pressure of the diseased tis-
sue upon the capillary circulation necessarily affects the con-
tiguous parts, and thereby extends the mortification, though
if there be sufficient vital action, inflammation and suppura-
tion may only occur;  but  it often happens that being in-
fluenced by the same state of general health, the lesion as-
sumes the character of the adjacent part.

                    TREATMENT.
   The treatment of gangraena oris should be commenced
with an emetic,  followed  by a brisk  purge of podophyllin
and cream of tartar, after  which the following tonic  mix-
ture will be found valuable:—
   R. Essential Tincture of Cinchona...........................§j.
              "          Hydrastus Canadensis...*,.....£ij.
       Simple Syrup................................................§ij.
       Carbonate of Ferri..........................................3ss.
Mix.  Dose, from one-half to one teaspoonful four or five times
                          a  day.
   When the gangrene is confined to the soft parts, the
mouth should be frequently washed in a strong decoction
of baptisia tinctoria and comptonia asplenifolia.  If the bone
is affected, a solution of sulphate of zinc, of the strength of
one dram of zinc to two ounces of water, should be applied
as a wash, or injected  on  the diseased bone two or three
times  a  day.   In marshy districts much benefit may be  de-
rived  by the occasional administration of quinine and iron. 
DYSENTERY.
467
Where the digestive organs are weak, cod liver oil, in com-
bination with tonics, will be found  of service.   In  a bad
case of this disease, I derive much benefit by touching the
parts two or three times a day with a probang, moistened in
a solution of muriated tincture of iron, of the strength of
one dram of the iron to one ounce of water.   The patient
should have plenty of fresh air, and a soft, nutritious diet.
The surface should be bathed two or three times a week in
alkaline water of moderate strength, followed by brisk fric-
tion.  In some bad  cases benefit has been received from the
administration of small doses of myrrh, capsicum, and bap-
tisin, and washing the parts with pyroligneous acid.
                  DYSENTERY.
  The symptoms of this disease are severe pain in the ab-
domen, straining while at stool, accompanied by bloody eva-
cuations.  There is also great inflammation of the mucous
membrane of the colon and rectum.  The disease is divided
into Acute and Chronic.

              ACUTE  DYSENTERY.
  The symptoms which precede this form, are dull pains in
the abdomen,  loss  of appetite, a feeling of weariness, and
costiveness, or diarrhoea, accompanied generally by fever,
although in some mild cases this may be absent.   In some
instances the  disease runs a mild course, unaccompanied
with fever, and lasting only for a few days;  whilst in others
it may be one of the most violent forms  of disease with
which a patient can be afflicted.   These different varieties
may  depend upon  various  causes, as the degree in which
the disease occurs—whether simple or complicated.  In
simple dysentery there are frequent discharges from the
bowels, which  somewhat relieve the pains in the  abdomen. 
468
DY SENTER Y.
These discharges are not less than ten or twelve in the course
of twenty-four hours, although they frequently exceed that
number to a very great degree.   They have at first scarcely
any odour; but as the disease advances  this increases, be-
coming very offensive.  There is, generally, much tender-
ness in the abdomen, the extent of which may be known
by the pain experienced on pressing the parts.   The patient
will have a feeling of hollowness  in the stomach, with a fee-
ble pulse, and sometimes attended with  vomiting, although
in the  simple form this is not often  the case.  Generally,
the disease changes favourably from the sixth to  the tenth
day;  but the system  may be so affected, as not to recover
entirely.
   Should the disease  continue  longer than a week or ten
days, there is generally much danger to  be apprehended;
and should the patient recover, the disease is liable to be-
come chronic.
              BILIOUS  DYSENTERY.
   The secretion of the bile is generally diminished in this
disease; but in some instances the liver and stomach be-
come disordered at the outset, when it  is known  as bilious
dysentery.  In  this form vomiting is more frequent; while
the skin, tongue, and urine, assume a yellowish appearancej
and the disease is  accompanied by a high state of fever, and
delirium.
            ADYNAMIC  DYSENTERY.
   This form of the disease  is more  liable to  attack those
living in camps, vessels, and besieged cities, where they are
compelled to subsist upon unwholesome food, suffer fatigue,
&c.  In such instances we find  symptoms of  a  malignant
character, as  great thirst, a foul, black, dry tongue, a dis-
coloured skin, often   covered with  dark spots,  the stools
black and very offensive, with depressed spirits, delirium,
etc., while the  sufferer seems  to be struck with death  in
the beginning of the  disease. 
DYSENTERY.
469
INTERMITTENT AND REMITTENT  DYSENTERY.
  It is not uncommon, in marshy districts, where these fe-
vers rage as epidemics, to find  dysentery connected with
them.   They may occur at the same time, or at intervals;
and may be distinguished from the simple form by the ten-
dency to paroxysms, at which time there is more pain  in
the head, delirium, and nervousness.

             TYPHOUS  DYSENTERY.
  Dysentery is occasionally  attendant upon typhous fever.
The only essential difference in  this from other forms of
dysentery,  is that it is connected with an adynamic state
of the system.
           RHEUMATIC DYSENTERY
  Differs from other forms in its mode of attack, the irrita-
tion passing from some part  to the large intestines.

             EPIDEMIC  DYSENTERY
  Is sometimes  regarded as a distinct variety of the dis-
ease; but I have observed that it may appear as an epide-
mic in any form.   There is, however, one mark of difference;
which is, that in epidemics  of this disease, the symptoms
are usually malignant.
                    PROGNOSIS.
  Should the disease take a  favourable turn,  the  pain gra-
dually diminishes, the discharges  occur less frequently,
leaving nothing but a slight  diarrhoea.   The most  unfa-
vourable symptoms are coldness of the skin, distention of
the  abdomen, the absence of griping pains, delirium, stu-
por, hiccough, &c.  If the  disease continue  without a fa:
vourable change longer than the fourteenth day, the. danger
is to be regarded as very great; inflammation extending
alon°- the entire length of the pqlon, is to be considered un-
favourable.
                          40* 
470
DYSENTERY.
           ANATOMICAL  CHARACTERS.
   When  death results from  dysentery, there is always in-
flammation of the mucous membrane of the rectum, and the
lower  portion  of the  colon;  and ulcers frequently exist,
which, combined with mortification, often occasion  the  re-
moval  of  a  part of the membrane.   We find, in some cli-
mates, this disease affects the liver.

                       CAUSES.
   Dysentery may be  caused by heat increasing the excita-
bility of the mucous membrane, thus predisposing the sur-
face to diminished action.  It also attacks persons, who, after
the heat of the day, expose themselves to the damp air of eve-
ning.  It is frequently occasioned by eating unripe fruits, ve-
getables not easily digested, acid drinks, &c.   While unripe
fruits,  and all other substances capable of irritating the ali-
mentary canal are liable to produce dysentery,  it is a mistaken
idea that ripe fruits, when indulged  in in proper quantities,
contribute to  this affection, as the most ample  experience
has demonstrated.  In the Western country, previously to
the  cultivation of fruits, when the people subsisted mostly
upon fresh  and salt meats, with but  sparing quantities of
vegetables, the most violent and malignant forms of dysen-
tery frequently occurred.  Again, after fruits were culti-
vated,  several seasons in which they were destroyed by an
early frost,  the people suffered  most extensively from  this
disease.   Again, I observed that those families who obtained
an abundance of ripe fruits from a distance,  enjoyed almost
a complete immunity from it.

                    TREATMENT.
  The treatment of dysentery has hitherto been of the most
empirical  character.   Bleeding,  emetics, cathartics, mercu-
rials, opium, acetate of lead, sulphate of copper, sulphate  of
zinc, nitrate of silver, leeches, blisters, nux vomica, and qui- 
DYSENTERY.
471
nine, have  each, in turn, been regarded by Old Physic as
specifics for dysentery; yet the most ample experience has
shown  that these remedies, both alone and in combinations,
are not only incapable of curing the affection, or in any es-
sential degree mitigating its severity, but, on the contrary,
in the  great majority of cases, aggravate it.  Among all the
modern improvements, there is none, perhaps, which has con-
tributed so much to the relief of suffering humanity as that
introduced by the Eclectic profession for the cure of dysen-
tery.   I have now reference to gelsemin.  If there is  any
one remedy capable  of producing a specific  impression on
disease, it is this.   It is now over seven years since  I  first
called  the attention of the  profession to the almost specific
power  of gelsemin to control dysentery.  At that time I put
this medicine to a most thorough  test in one of the most
malignant  and  fatal forms of dysentery I ever  witnessed.
After  having treated quite a large number of cases, with
what was then considered the  most approved Eclectic plan,
and finding it quite  unsuccessful,  I determined  to try the
effects  of gelsemin.   I found that it acted with almost magic
power; and during that entire epidemic, although I treated
six hundred  and  three cases  with this remedy, I had no
difficulty whatever in managing the disease, with the excep-
tion of two cases; and in those I did not consider the fault
so much in the remedy, as in the  circumstances which  sur-
rounded  them.   The treatment for dysentery, as practised
at this  time,  in addition to that prescribed in another por-
tion of this work, consists in the confinement of our patients
in bed, in a recumbent posture, with large, hot packs  to the
abdomen, frequently changed, and the administration of gel-
semin.   Previously to giving the  gelsemin, the  stomach
should be cleansed by an emetic, the bowels opened by means
of large doses of neutralizing mixture and leontodin, after
which  from ten to fifty grains  of triturated gelsemin should
be added to a tumbler full of water;  one teaspoonful  of the 
472
DIARRH03A.
solution should be given every ten or twenty minutes, until
the disease is controlled, or its full constitutional impression
produced.  The constitutional effects of gelsemin are double
vision, photopsia,  and ptosis.  If the disease does not yield,
antiperiodics and  other remedies, as previously prescribed,
may be given, although the influence of the gelsemin should
be maintained.   In chronic and other forms of dysentery,
the treatment will necessarily be somewhat modified, yet the
general treatment is the same.
                   DIARRHCEA.
  Diarrhoea is a looseness, or flux from the bowels.   This
is  a very common disease, characterized by frequent and
urgent demands to evacuate the bowels.
                     SYMPTOMS.
  Diarrhoea, when produced from whatever cause, is usually
preceded by a sense of indigestion, fulness of the stomach,
flatulency; and, usually, more or less  colicky pains.   The
pain, however, usually subsides after the evacuation of the
bowels, but returns as an indication of another discharge.
The nature of the evacuations varies; as,  in some cases,
they are thick, and consist mainly of the ingesta; while in
others it is more watery, or of a rice-water appearance, and
in some cases  consisting  of disintegrated mucous mem-
brane, blood, and bile.
              BILIOUS  DIARRHfflA.
  Bilious diarrhoea is a very common disordered condition
of the bowels, characterized by frequent discharges, com-
posed of serum, highly coloured with either yellow or green
bile.  It is supposed to be produced, either by the  secre-
tions from  the  liver becoming vitiated, and irritating the
alimentary canal, or by a discharge of a superfluous quan-
tity of bile into the duodenum. 
DI ARRHCE A.
473
              MUCOUS  DIARRH03A.
  Mucous diarrhoea consists in discharges of a semi-transpa-
rent character, which  at  first is mixed with ingesta, but
afterwards composed principally of mucus.   It is produced
by colds, and catarrhal affections generally.

              SEROUS  DIARRHCEA.
  Serous diarrhoea is  characterized by  heavy evacuations
of a thin, watery character,  varying in chemical and physi-
cal  constituents, as it is mixed with blood, bile, ingesta, &c.

                       CAUSES.
  Diarrhoea may originate  from any cause which disturbs
the normal condition of the digestive  canal, such as im-
proper diet, either in quantity, quality, or period.   In some
constitutions, certain articles of food, as milk, cheese, cab-
bage, onions, &c, produce this disease.  It is also produced
by a weak state of the stomach; the food not being properly
digested, ferments  and generates irritable gases and acids.
Diarrhoea may also  exist as a  symptomatic disease, as  in
children who are  teething, from over-mental labour, great
fatigue, and a weak, debilitated state of the system.   It is
also produced by the improper use of irritating remedies.

                    TREATMENT.
  In  the treatment of diarrhoea the  cause should be tho-
roughly studied, and, so  far as  practicable, removed; after
which the bowels should be opened by means of small doses
of leptandrin and neutralizing mixture.  If it is connected
with  fever  and  catarrhal symptoms, the patient should be
placed in bed, the surface bathed, and hot packs applied to
the abdomen, and small doses of aconite or veratrum given
to control the fever.  If the bowels are in a weak and relaxed
condition, the patient should be allowed to drink freely of
a decoction of comptonia asplenifolia.  If it is connected
L 
474
CONSTIPATION.
with intermittent and remittent fevers, as it frequently is
in marshy and ague districts, quinine and hydrastin should
be given, in connexion with small doses of opium.   If it is
a bilious diarrhoea, leontodin, neutralizing mixture, and the
compound tincture of camphor [and opium will soon control
it.  If the diarrhoea assume the chronic form, the following
is a most valuable remedy:—
      R. Chlorate of Potassa?........................grs. x.
         Myricin.......................................grs. v.
         Quinine........................................grs. x.
     Mix.   Ft. pulv. No. xij.  Sig.—One every two hours.
If connected with children who  are  teething, small doses
of geranin and neutralizing mixture, in connexion with the
teething mixture, will usually  control it.  If the diarrhoea
assume a cholera character, it  should be treated according
as I have prescribed under that head.
                CONSTIPATION.
  By constipation is understood a collection of excremen-
titious matters in some part of the intestinal tube.

                     SYMPTOMS.
  Constipation is marked by the infrequency of the eva-
cuations of the bowels, and by the occurrence of fulness and
tension in parts of the abdomen.  Constipation has usually
been considered as of two forms; the one in which the pa-
tient was of a lax and weak habit of body,—the other that
in which the disease was produced by rigidity of the mus-
cles and irritable temperament.   The first form of consti-
pation is characterized by a costive, or more consistent state
than usual of the fecal excretions, with less frequent calls
for evacuations.  The constitutional symptoms are pain in
the head, fulness and tension of the abdomen, a foul tongue, 
f
                  CONSTIPATION.               475

loss of appetite, and listlessness, together with an undefina-
ble sense of oppression.
                       CAUSES.
   One of the first causes of constipation is that of a debility
of the muscular coat of the intestines.  It may also be pro-
duced by the secretions concerned in the process of alimen-
tation becoming vitiated, either in quality or quantity.   It
may also depend upon imperfection of the diet, such as in-
troducing into the stomach food which can be only imper-
fectly dissolved in the gastric secretions; also by food which

                         Fig. 27.
  (Fig. 27. Remarkable displacement of organs, in conse-
quence of intestinal obstruction,  a, Caput Coli; b, Ascend-
ing portion of Sigmoid Flexure; c, Descending portion; d,
Gravid Uterus turned a little down.) 
476              CONSTIPATION.
lacks the proper quality of nutrition.   Constipation is also
a very common occurrence as the result of a morbid state of
the brain and nervous system.  The nerves and brain, when
diseased, fail to dispense to the bowels that amount of nerve
influence essential to their healthy condition.  Again, con-
stipation may be produced  by irritating medicines, and the
constant use of drastic purgatives.  It may also be pro-
duced  by excessive  secretions from  other portions of the
body; as elimination is carried on from the body by the va-
rious emunctories, and when there is an excess of elimina-
tion from one, it is proportionately diminished in another.
Mental emotion, grief, anxiety, &c, also produce constipa-
tion.  It may also occur as the result of stricture of the
rectum, or other portions of the bowels.  A remarkable case
is shown by Mr. Easton, in which there was an accumula-
tion of fecal matter in the ascending colon.   (See fig. 27.)

                     TREATMENT.
   In the treatment of constipation of the bowels,  the cause
 or causes of the difficulty should be carefully studied.  If
 dependent upon a weak and lax state of the  muscular fibre,
 hydrastin  and  iron are the remedies, say,  let  the  patient
 take one grain of hydrastin, and two of iron by hydrogen,
 five or six times a day.  For the  present  relief, the bowels
 may be opened with the compound podophyllin granule once
 a week.  If dependent upon vitiated secretions of the liver,
 stomach, &c, tonic tea should be drunk freely during the
 day, and two or three grains of frazerin, and  one grain of bi-
 carbonate of soda, taken  every night at  bed-time; and  to
 maintain a soluble state of the bowels, the patient  should
 eat unbolted bread, and freely of fresh fruits.  Where it is
 produced  by spinal and  cerebral difficulties, the nervous
 affection should receive especial attention, while the bowels
 should be kept open by means of euonymin, in combination
 with cypripedin.   Ten grains of euonymin, and five of cy- 
             INFLUENZA — CATARRH.          477

pripedin, divided into two  powders, and  one morning and
night, will usually accomplish this purpose.  The  surface
should be frequently bathed and rubbed with a coarse towel,
and the patient should attend to the demands of the bowels
every morning.  Where the constipation  is dependent upon
stricture of the rectum, the bowels should be moved by
means of large stimulating injections,  and the stricture re-
moved by proper treatment, such as the introduction of the
bougie, the  use  of menispermin, gelsemin, muriate of am-
monia, &c.  Where the constipation is owing to a nervous
and irritable habit, the following mixture is most valuable:—
      R. Essential Tincture of Scutellaria............§j.
                            Cypripedin. ..........gij.
                 "          Leptandria  Virg.....^iij.
         Simple Syrup.....................................^vj.
   Mix.  Sig.—One teaspoonful three or four times a day.
The diet and habits of patients labouring under constipation
of the bowels should be well regulated, and all drastic and
irritating purgative medicines carefully avoided, as they tend
to debilitate the alimentary canal, and  in other  ways to de-
range the system.
          INFLUENZA—CATARRH.
  We have  numerous epidemics of  catarrh  throughout
America, and it is  not  confined to the human  race; for
horses, dogs, and cats, are subject to it.  There  is a great
difference of opinion respecting its  contagious character;
many facts connected with the disease would lead us to in-
fer that it was.
                     SYMPTOMS.
  The symptoms of  influenza are  soreness throughout the
body, connected with stiffness of the muscles.  In some
cases  there is chilliness,  and more or less inflammation of
the air-passages.  The mucous membrane of the throat  and
       41 
478                   MEDINA.
  nasal passage is in a state of congestion, and in a few cases
  results in inflammation.   During the existence of the con-
  gestive stage the mucous  lining is covered with abundant
  secretion of liquor sanguinis, which is discharged with the
  greatest freedom from the  mouth and nose.   The constitu-
  tional symptoms of influenza are most various, frequently
  producing nervous  irritability, headache, loss of appetite,
  hot and dry skin, together with general febrile irritation.
                      TREATMENT.
    The treatment for influenza consists in  a  hot bath, fol-
  lowed by brisk friction.  The bowels should be opened with
  neutralizing mixture and leontodin, and the  febrile symp-
  toms controlled by small doses of aconite.  If the influenza
  is of an epidemic character, the following compound should
  be given:—
        R. Quinine........................................grs. x.
           Rhein..................................,.......grs. v.
           Sacch. Alba..................................grs. xx.
      Mix.  Ft. pulv. No. xij.  Sig.—One every two hours.
  If there are very much inflammation and  discharge from
  the mucous membrane of the nose and pharynx, the patient
' should  be allowed to inhale the burning fumes of camphor,,
  or muriate of ammonia.   The patient should keep in a warm
  room, avoid violent exercise, and subsist upon a sparse diet.
MELAENA,  OR  HEMORRHAGE  OF  THE
                     BOWELS.
  Hemorrhage of the  Bowels, when it occurs as an original
functional disease, usually assumes the form of Melaena, the
blood assuming'the black appearance characteristic of that
affection, by changes  in, or after the act of extravasation.
The name  melaena is  improperly employed, as in its most
extensive sense  it includes  all black discharges from  the 
MEDINA.
479
bowels, whether of altered blood, or vitiated bile; and if
applied to hemorrhage alone, it is inadequate, as there are
many instances of intestinal hemorrhage in which the dis-
charges are not black.
                     SYMPTOMS.
  The evacuation of  blood  in  intestinal hemorrhage is
usually preceded by symptoms of some well-known disease,
such as enteritis, dysentery, enteric fever, scurvy, purpura,
&c; but often by those less definite, as oppression in the
abdomen, pains in the hypochondriac region, a furred tongue,
disordered appetite, constipation or diarrhoea, sallow or dingy
complexion, dejection of spirits, languor, and more or less
disorder of the circulation, indicating visceral disorder and
impaired digestion.  The patient is suddenly attacked with
griping pain, nausea, increased paleness, depression of the
pulse, coolness of  the extremities, attended by an offensive
discharge  of black-coloured  blood from  the  bowels.   In
some instances the diarrhoea, with part or all of  the  same
symptoms, may continue for several  days without the he-
morrhage being noticed; but in others the hemorrhage may
be the first obvious sign of the disease, in which case there
is sometimes  extreme depression, which may prove  fatal.
There may be no evacuations, and sudden death occur from
intestinal hemorrhage, which may be suspected if there has
been previous partial  congestion or organic disease of the
bowels; and if tumefaction, with dulness on percussion is
discovered, which did not before exist.  The quantity and
quality of the blood are various; the quantity, in some in-
stances, being very small, and in others amounting to pints,
or quarts.   The  colour is  sometimes  bright red,  but often
very dark.  In consistence  it may be fluid, grumous, or
tar-like.    It may be pure, or it may be mixed with bile or
intestinal  secretions.  The character  of tbe disease  may
often be  determined by the nature of the evacuations; as
the blood coming from the large intestines is usually a bright
k 
480                   MELiENA.
red colour, and from the small intestines dark red, copious,
and pure.  If issuing from membrane, disorganized by inflam-
mation, or malignant ulceration, as in fevers and cancer of
the bowels,  it has  the  appearance  of coffee-grounds.   If
there is a small discharge of bright blood, mixed with mu-
cus, active inflammation, as in dysentery, may be suspected;
and when the evacuation is  black and tarry, with both a red
and bilious tinge, it may have come from the liver.
   The course of this disease is uncertain.  It may prove
fatal, but rarely, unless complicated with  serious  organic
derangement of  the bowels, or other viscera, though after
cure predisposition may lead to a return.
                     DIAGNOSIS.
   It is not always easy to decide, in case of bloody evacua-
tions from the bowels, whether intestinal hemorrhage really
exists or  not.  Discharges of dark and altered blood  are
often a mere attendant upon haematemesis,  and  may be the
result of it even  when there is no vomiting, or they may be
derived directly from the mucous membrane, and there still
be vomiting of blood, as the causes of haematemesis act with
nearly as much energy upon the bowels as on the stomach;
and in another case vomiting and purging  may both exist,
though the seat  of  the hemorrhage be in the bowels exclu-
sively.  In deciding whether the stomach  or bowels is the
source of the hemorrhage,  we must judge according as the
symptoms point more directly to one than the  other, or as
they  embrace both.  Hemorrhages may be distinguished
from  bile by diluting them, or by adding common salt, in
either of which  cases  the blood will assume its proper red,
and  the  bile its  yellow hue.  True melaenotic  matter may
be mistaken for  hemorrhage, but may be distinguished by
its wanting the redness of blood.
                       CAUSES.
  Whatever is capable of producing irritation,  congestion,
inflammation, or  ulceration  of  the intestinal mucous mem- 
        HEMORRHAGE  FROM  THE RECTUM.     481

brane, may occasion this form of  hemorrhage.  In cases of
predisposition, drastic  cathartics  are  liable to bring on an
attack.   Inflammation and ulceration of the mucous coat,
cancers, aneurisms, organic diseases of the heart, suppressions
of the menses, malignant fevers, purpura, and scurvy, are
all occasionally attended with hemorrhage from the bowels.

                    TREAT MENT.
  After having discovered the nature and character of the
hemorrhage, it may be necessary to relieve the discharge at
once.  If it occur from the mucous membrane, either as the
result of exudation from  the weakened capillaries, or from
the  rupture  of large  vessels, as in cases of ulceration, can-
cers, and other affections of the bowels,  it may usually be
controlled by injecting into the bowels a strong decoction of
matico.  This  should be  done by inserting a long catheter
into  the bowels, and pumping through it from one to two
pints of  the  decoction while the patient  is  lying with his
hips slightly elevated.
  If this should not  control the hemorrhage, take tannin,
geranin, and trillin, of each one  dram; thick mucilage of
gum Arabic, six ounces.  Rub well together, and inject the
bowels as directed above.   If this should  fail after a proper
trial, the patient should be put under the influence of the
nitrate of silver  pill,  as  directed under  head of  typhoid
fever.  After having arrested the hemorrhage the patient
should be  placed upon such treatment as will remove the
cause of the difficulty.  Where the  hemorrhage is active,
and followed by great prostration, the ligatures should be ap-
plied, and so adjusted as to prevent the excessive loss of blood.
   HEMORRHAGE FROM THE  RECTUM.
  Hemorrhage from the Rectum may depend on the same
pathological conditions as  other  hemorrhages, but is most
frequently connected with  piles.
                          41*
I 
482     HEMORRHAGE FROM THE  RECTUM.
           SYMPTOMS,  COURSE,  ETC.
  Before the appearance of blood there is usually uneasi-
ness in the region of the sacrum, with heat about the anus,
indicating congestion of the mucous membrane; but there
may be no premonitory symptoms.   It is usually the accom-
paniment of hemorrhoidal tumours, but occasionally it comes
in a full stream with no explanatory circumstances attend-
ing it.  The quantity is sometimes large, or it may be very
small.  The colour is various, accordingly  as it comes from
a vein or artery.
  The hemorrhage is generally quite irregular in its occur-
rence, but is sometimes periodical; and in females occasion-
ally comes on monthly, and does sometimes assume the same
periodical character in men.
  When tumours can be detected, the bleeding may be sup-
posed to depend upon piles.  When the blood is pure, and
there has been previous uneasiness in the sacrum, it is pro-
bably from the rectum; but if tar-like, it very likely pro-
ceeds from some higher position.
  Hemorrhage from the rectum is  sometimes  dangerous)
but rarely so, being sometimes even beneficial.

                      CAUSES.
  The causes of hemorrhage from the rectum are whatever
occasions irritation, congestion, or inflammation of  the mu-
cous membrane of the rectum, also suppression of the menses,
and other  habitual discharges,—aided, of course, by a he-
morrhagic  state  of the circulation, but  the most  frequent
source is in hemorrhoidal tumours.

                    TREATMENT.
  The immediate hemorrhage from the rectum may be con-
trolled by the same  means  as those prescribed  for hemor-
rhage of the bowels, with the exception that where a more
active remedy than the matico, tannin, &c, is required, ni- 
PNEUMOTHORAX.
483
trate of silver may be injected into the rectum, or the fol-
lowing ointment may be used:—
      R. Red Styptic Powder............................gss.
         Oxide of Zinc......................................9j.
         White Wax........................................gj.
         Lard...............................................3>j-
Melt the wax and lard together, and when cool add the other
ingredients, stirring it until cold.  This ointment may be ap-
plied by means of a little lint, after which the disease should
be treated  as prescribed under  the head of hemorrhoids;
although this ointment, in combination with mild laxatives,
has cured many bad cases of piles. If the hemorrhage is pro-
duced by cancerous affections of the rectum, sulphate  of
zinc,  or the solid nitrate of silver may be used to arrest  it.v
                    PNEUMOTHORAX.
        This is not, properly speaking, a disease, as it may depend
      upon various other affections.  It may be defined an affec-
      tion, in which the air is confined in the  pleural cavity.
        Pneumothorax maybe divided into three varieties:—1st,
      that form in which the cavity of the pleura has no commu-
      nication with the air; 2d, that in which  the communication
      is through the walls of the chest;  3d, that in which it com-
      municates with the air through the bronchial tubes.

                           SYMPTOMS.
        This disease is characterized by a difficult breathing, which
      is the most  prominent symptom of the  affection,—the dis-
      tress depending upon the quantity of air in the pleura, and
      also on the condition of the opposite lung.   If the accumu-
      lation of air is slow, the degree of pain  is lessened, owing
      to the adaptation of the lungs to the new condition; but its
      most common mode of appearance in the cavity is violent,
<-      occasioning  severe pains in the side, and sometimes causing
k 
484
PNEUMOTHORAX.
discharges of pus.  When there is a communication between
the lung and the cavity of the pleura, there is a painful
cough  attending  the dyspnoea.  If the air should be be-
tween the lung and ribs, the sound produced by percussion
is much clearer than in healthy portions of the body.  If
there is liquid in the cavity, it^occasions a dull sound.  We
can determine many things by auscultation, which otherwise
could not be discovered; as the cavernous breathing, and
cavernous sound of the cough and voice.   When the quan-
tity of the liquid is very considerable, a peculiar sound, as
of splashing, is heard, especially when the  patient is moved
suddenly.  Another sound, occasioned by coughing, resem-
bles the noise made by the  striking of a hammer.  The
progress of this disease varies.  In some instances it proves
fatal in a few hours; at other times it remains for months,
and even years.
                       CAUSES.
   Pneumothorax is most frequently occasioned by a tuber-
culous abscess of the lungs, and we very often find it in con-
nexion with  phthisis.  Such attacks are sudden.
   The disease sometimes results from a gangrenous abscess
of the lungs, and  rarely from a cancerous ulceration.  Where
there is empyema, a communication is formed from the lungs
into the pleura,  the pus passing into the  bronchial tubes,
and there is released.  Sometimes, instead of passing into the
lungs, it proceeds along the external wall of the chest, form-
ing a communication with the air-passages.  Pneumothorax
may be  caused, also, by the fracture  of a  rib, injuring the
lung, or by a forcible compression externally, causing a rup-
ture of  the  pleura and  air-cells.  Occasionally the liquids
contained in the pleural cavity decompose, and  send forth
gaseous  matter.  Sometimes air is forced from the pleura,
without any apparent injury.   In this disease the nature of
the gas is dependent somewhat upon the cause of the affec-
tion, being sometimes extremely offensive; at others having
scarcely any odour.  Sometimes the lung is very much dis- 
PNEU MOTHOR AX.
485
placed; but the degree of compression varies, at times being
scarcely perceptible, at others the size being very much di-
minished.  Pneumothorax is, in most cases, a fatal disease;
although the patient may recover, even though  it is  con-
nected with phthisis.
                    TREATMENT.
  When called to treat a case of pneumothorax, if there is
great dyspnoea,  a hot sinapism should be applied to the
chest, and from one-eighth to one-quarter of a grain of opium
should be administered.  The feet should be placed in hot
water; and if there is pleural inflammation or irritation, as-
clepin and oleo-resin of lobelia should be given.
       R. Asclepin. ...................................grs. x.
          Oleo-Resin of Lobelia....................grs. ij.
          Sacch. Alba................................grs. xxx.
Mix.  Ft. pulv. No. x.  Sig.—One  every hour until relief is
                         afforded.
If there is extensive accumulation of air in the thorax, and
it threatens  immediate  suffocation, it should be evacuated
by means of a trocar and cannula.  The operation should
be  performed as directed under the head of empyema.  It
should be resorted  to,  however, only in  cases where there is
great danger.   In  cases where the atmosphere enters the
pleural sac, through an  opening made in the bronchia and
section of the lung, as the result  of vomica, I  have known
benefit to be produced  by  inhaling the burning fumes of
muriate of ammonia.  Where the atmosphere passes through
an external opening, pads and bandages should be supplied,
so as to prevent the farther ingress of atmosphere; and re-
medies given to combat the inflammatory symptoms, such as
aconite, veratrum, &c.   Where it is produced by the decom-
position of fluids, the  effect of pleuritis, benefit may be de-
rived  by administering  one  teaspoonful of carbo ligni, in
combination with small doses of anti-bilious physic and qui-
nine, four or five times a day.
L 
486       AFFECTIONS  OF  THE  LUNGS.
YARIOUS  ORGANIC AFFECTIONS OF
                  THE  LUNGS.
  In  addition to those affections which have already been
mentioned, the lungs are subject to various others.   Extra-
neous substances  entering the larynx frequently lodge in
the bronchia, occasioning  much suffering,  and sometimes
speedy death, although cases are on record in which a num-
ber of years have elapsed before) the foreign substance was
extracted, and the patient relieved of the troublesome cough
occasioned by its presence.
  We frequently find bony,  calcareous,  and cartilaginous
tumours, after death, in the upper portion of the lungs of
aged persons. They are generally small; hence they may be
present during life for a considerable length of time, while
the patient is unaware of their presence.
   Serous cysts and  hydatids have been  known to exist in
a few instances.   The latter  may grow to such a size as to
disturb the action  of the lungs.   Small cysts have occa-
sionally been expectorated, thus showing  that the affection
was present;  but in most instances its existence is not known
until  after death.   It may sometimes be  difficult to distin-
guish it from pleurisy, but the following symptoms are suffi-
cient  to readily discern the one from the other:—frequent
pains in  the affected parts; difficult breathing, which some-
times terminates  in  death; dulness on percussing; alack
of constitutional symptoms;  the absence of sound, occasioned
by breathing, &c.  Should the  tumour  be pierced by  a
grooved  needle, and  colourless liquid exude, mingled with
small pieces of membrane, which is not rendered turbid with
nitric acid or heat, it may be considered  a sure test of  the
existence of hydatids.
  We sometimes find malignant tumours in the  lungs, as
well as other parts of the body.  The medullary and fibro-
plastic diseases are sometimes  met with.   They may consist 
AFFECTIONS OF THE LUNGS.       487
of either encysted or non-encysted tumours, which appear to
soften, and thereby form a cavity.   They are characterized
by difficulty in breathing, and a slight cough, which increase
until they assume the form of constitutional symptoms.  The
breath, in this stage, is frequently very offensive.   We find
by auscultation and percussion that the lungs are sometimes
consolidated, and sometimes  cavities are formed.  The  tu-
mour sometimes crowds upon the blood-vessels, oesophagus,
&c, causing numerous disorders.  The most positive indica-
tion  presented by this disease, is a similar affection in  other
portions of the body. Cirrhosis of the lungs is a wasting away
of the cellular tissue of that organ, followed  by a hard, white
structure.   The disease may affect the whole, or a small por-
tion  of the lung.  The opposite lung, the heart, &c,  are
forced into  the diseased portion of the thorax, the wall of
which is also pressed down.  The symptoms are, rapid pulse,
cough, with a discharge of mucous, fetid matter, etc.   By
percussion we discover a tubular, and sometimes a cracked
metal sound; by auscultation we find all the appearances of
alung solidified, and containing cavities.   It may be dis-
tinguished from phthisis  by the  absence  of hectic, by  its
slow advancement, its restriction to  one lung, and displace-
ment of the heart.  Cirrhosis of the lung, in some respects,
might be confounded with pleurisy, but may be distinguished
from it by the turning of the ribs inwards, while the dis-
turbance of the system is greater.   The disease usually  ad-
vances slowly, but  always proceeds to a fatal termination.
In some cases, instead of the  purulent and other discharges
from the  lungs, which  I  have noticed, the sputa become
loaded with dark, pigment matter;  yet the symptoms are
those of  true  pulmonary phthisis.  This  is owing to the
degeneration of the tuberculous exudation into pigment
granules.  The  progress and effects of the disease are the
same as those of ordinary phthisis.  In some cases of pul-
monary affections the bronchial glands become involved, and 
488      DISEASES  OF  THE  LIVER,  ETC.

become loaded with pigmentary, melaenotic, and tuberculous
matter.  They may be detected by  dulness on percussion
above the clavicle, and a correspondent enlargement of the
lymphatics of the axillary and other portions of the body.

                    TREATMENT.
  The treatment of these affections must depend altogether
upon their  extent, nature, and  character.  Foreign  sub-
stances may frequently be removed from the bronchia by an
active  lobelia emetic,  and  cancerous  degeneration of the
lungs may be mitigated by an active, tonic, and supporting
course of treatment.
 DISEASES OF THE  LIYER, BILIARY
       DUCT, AND  GALL BLADDER.
  There is, perhaps, no organ in the body, the anatomical
character and function of which has been more carefully
studied than that of the  liver.  This has arisen, in part,
from the important relation it holds to the digestive appara-
tus, and in part to the supposition entertained by both an-
cient and modern practitioners, that whatever malady affected
the human organism, the liver participated  largely in the
difficulty.
  Nothing is more  common at  this time than to hear phy-
sicians attribute all the common maladies and indispositions
of their patients to a derangement of the liver.  In fact, it
is supposed to be an ample apology for the doctor's ignorance
to  denominate the case a bilious affection.  This universal
hepatic pathology has had its  corresponding therapeutics;
hence blue mass, a calomel pill, or a mercurial purge, is the
universal panacea with a certain class of practitioners.   Not-
withstanding these absurd notions and extravagant methods
of treatment, the liver is liable, to a variety of disorders, and,
when affected, exerts a marked influence on the organs and
tissues of the body.   Among the most common affections of 
        DISEASES  OF  THE LIVER, ETC.      489

the liver,  is that of inflammation, or hepatitis.   Inflamma-
tion of the liver may be confined to the peritoneal covering,
or it may involve the entire substance of the liver.  It is, in
many instances, a difficult matter to decide whether the in-
flammation involves the structure of the liver, or is confined
to its covering.  This we think, however, can usually be de-
termined by a careful analysis of the symptoms.  If the in-
flammation be confined to the peritoneum, there will be
sharp, acute pain, which is very much aggravated by deep
inspiration;  but there is no increase of dulness on percus-
sion, nor is there hypertrophy or enlargement.   If the in-
flammation is extensive, it is usually connected with a short,
irritable cough, and  a pleuritic pain  in  the left shoulder.
If the inflammation extend to the substance  of the liver, it
is soon manifested by an increase of bulk,  a marked derange-
ment of its function, and more extensive  constitutional dis-
turbance.   The season and climate, also, contribute much to
a correct diagnosis, as inflammation of the substance of the
liver  seldom occurs, only in tropical  climates, or in a tem-
perate climate during the hot  season, while peritoneal in-
flammation of the  liver occurs in cold climates,  and in the
cold season.  Again, the  character of the pain may serve
as an important diagnostic symptom; as the pain connected
with  the inflammation of the substance of the  liver is of an
aching, disagreeable character, while that connected with its
membrane is always acute and harassing. Inflammation of
the membrane, or substance of the liver, may terminate either
in resolution, chronic inflammation", or separation.   Where
it terminates in resolution, the symptoms gradually subside,
and  the organ is restored to its natural function.  When it
terminates in chronic inflammation,  there is  usually more
or less hypertrophy, or enlargement  of  the liver, which is
indicated  by increased dulness upon percussion, and the
extension of the liver beyond its normal boundaries.  There
are also  derangement of the  stomach and bowels, and  a
       42 
490      DISEASES  OF  THE  LIVER,  ETC.

sense of weight and uneasiness in fne right hypochondrium,
with dry skin, high-coloured and scanty urine.  Chronic
inflammation of the liver, however, may occur without the
existence of the acute  form; in which  event it  usually oc-
curs  insidiously, but is  characterized by the symptoms above
described.   Both the  acute  and  the chronic variety may
terminate in suppuration; in which event there is a sallow
and  dingy appearance  of the skin, nausea,  and sometimes
vomiting, loss of appetite, high-coloured urine, hectic fever,
dull, aching pain, and  great  tenderness over the region of
the abscess.   A case  occurred in my practice, where acute
hepatitis terminated in  suppuration, and involved nearly one-
half of the liver.  I opened the abscess by dissecting through
the parietes of the abdomen, and evacuated upwards of one
quart of  pus; after which the case proceeded to a favourable
termination.   Nothing is more common than to  observe se-
veral abscesses in different portions of the liver,  on inspect-
ing that  organ, after death, from  hepatitis.
                       CAUSES.
   Among the most common causes of hepatitis is  that of
exposing the body to a high  temperature for a long period;
also  sudden  exposures to heat and cold, humid and mias-
matic atmosphere, the  habitual use  of mercurial medicines,
high living, sedentary habits, finally anything which con-
tributes to inflammation in other parts of the body, may give
rise  to hepatitis.
                    TREATMENT.
   In addition to the treatment I have already given  in ano-
ther portion of the work, after applying the mustard sina-
pism to the side, hot packs  should be applied, and protected
by means of oiled silk,  and changed  as often as they get cold
for ten or twelve hours,  and in bad cases even longer.   If
it is \nflammation of the peritoneum, asclepin, in combina-
tion  with the essential tincture of corollorhiza odontorhiza,
will  be found most beneficial.  If the  inflammation  assume 
         DISEASES  OF  THE LIVER, ETC.     491

 a chronic form, leontodin  and neutralizing mixture, given
 in  small  doses, and repeated at  short intervals, is a  most
 valuable remedy.  Where abscesses form on the liver, benefit
 maybe obtained by administering the following compound:—
       R. Menispermin.................................grs. x.
          Leontodin.....................................grs. xx.
          Muriate of Ammonia.....................grs. xv.
          Sacch. Alba..................................gj.
    Mix.  Ft. pulv. No. xx.  Sig.—One every three hours.
 In connexion with these powders, the irritating plaster should
 be applied, and be continued until free separation occurs.

        HYPERTROPHY  OF THE LIVER.
   Hypertrophy of the  Liver is simply an overgrowth, de-
 pendent upon an increase  of its  structure, without any in-
 flammatory appearance.  It may affect a part, or the entire
 liver.  Where it is simple hypertrophy, it does not amount
 to disease, but may produce ascites by pressing upon the
 large abdominal veins.

           ATROPHY  OF THE LIVER.
  This is the reverse  condition,  and is usually dependent
 upon defective nutrition.   It does not amount to disease,
 unless the atrophy is so extensive as to impair its function.

         INDURATION OF  THE  LIVER.
  Induration may occur as the result  of hardening of the
 parenchyma, and is usually one of the symptoms of other
 affections of  the liver.

          SOFTENING  OF THE  LIVER.
  This is usually the result of some long-continued fever,
or it may occur as the result of inflammation.

                   FATTY LIVER.
  Fatty Liver may depend upon a quantity of oil secreted
in the hepatic cells.  Fatty degeneration of the  liver  has
L 
492      DISEASES OF THE  LIVER,  ETC.

been observed to be very eommon in drunkards, and is sup-
posed to be produced by the introduction into the system
of a large quantity of carbon, in the form of spirits.  Fatty
liver is also common in pulmonary diseases, and other cases
where the  respiratory functions are interfered with.

                    TREATMENT.
  The treatment for fatty liver consists in abstaining from
alcoholic drinks, and  other carbonaceous  substances,  in-
creasing the activity of the respiratory organs, and other
emunctories of the body, administering small doses of  po-
dophyllin and leontodin, and the free use of succulent  ve-
getables and fruits.

           CIRRHOSIS  OF  THE LIVER.
   Cirrhosis of the  Liver  consists in a development upon
the surface, and through the substance of the liver, of small
corpuscles, varying in size from a pin's head to a pea.  The
colour of the  corpuscles is mostly yellow.   According to
Dr. Carswell, this disease is essentially atrophy of the lobu-
lar structure, originating in inflammation.  According to
the observations of Mr. Bennett, the hepatic lobules undergo
pigmentary degeneration, and the hepatic cells become filled
with  a fatty or waxy matter.
   The symptoms of this condition of the liver are local and
general dropsy, jaundice,  hemorrhage  from the stomach,
bowels, and other portions of the body, together with irre-
gular bowels, dry and sallow skin, capricious appetite, mo-
rose and irritable temper.
                    TREATMENT.
   Treatment for  cirrhosis has generally been unsuccessful,
although much may be done to palliate the disease by re-
gulating the diet and habits of the patient, slightly stimu-
lating the  liver with small doses of podophyllin and leonto-
din, and applying the irritating plaster, and maintaining a
free discharge. 
         DISEASES  OF  THE  LIVER, ETC.      493

                   WAXY  LIVER.
   Waxy liver is the result of a peculiar degeneration of the
hepatic substance.  The liver usually becomes enormously
enlarged, and connected with scrofulous and syphilitic pa-
tients.   It is probably the result of the poisonous influence
of mercury.
                 NUTMEG LIVER.
   This name has been applied to the liver, when it pre-
sents an appearance like that of a nutmeg.  It is probably
the result of a degeneration of the hepatic substance.

              TUBERCULOUS  LIVER.
   Tubercles are frequently found in the liver, as well as in
other parts of the body, and are the result of albuminous de-
generation.
           HYDATIDS OF THE  LIVER.
   Hydatids, or cysts, containing  a yellowish, watery fluid,
are often found in various sections of the liver.
   The liver  may also  be the seat of cancerous affections.
The diagnosis of these various  morbid conditions of the
liver, is frequently a most difficult matter during life.  In
cancerous affections of the  liver, however, the disease may
sometimes be detected by the peculiar discharges from the
bowels, together with the leaden appearance  of the  skin,
and the general  malignancy of all the symptoms connected
with the affection.

FUNCTIONAL  DISEASES  OF  THE  LIVER—
                   NEURALGIA.
  The liver is frequently the seat of hyperaesthesia, and is
characterized by a heavy, dull pain in the right hypochon-
drium.   Sometimes, however, the pain is sharp, acute, and
of an intermittent character.
                          42*
h. 
494      DISEASES  OF" THE  LIVER,  ETC.
                       CAUSES.
  The causes of neuralgia of the liver are the same  as
those which produce the disease in other portions of the
system, although it is more commonly connected with gouty
and rheumatic patients than others.

                    TREATMENT.
  Treatment for neuralgia of the liver consists in the ad-
ministration of  quinine, in connexion with leontodin, scu-
tellarin, and cypripedin.   In case the disease should prove
obstinate, the following compound has proved of value:—
       R. Prussiate of Iron...........................grs. xx.
          Aconitin.......................................gr. j.
          Salicine.......................................grs. xx.
          Sacch. Alba.................................grs. xx.
     Mix.  Ft. pulv. No. xv.   Sig.—One every two hours.
   Benefit  may  also  be derived  from bathing the part in
chloroform liniment.

  CONGESTION,  OR  HYPEREMIA OF THE LIVER.
   This disease  consists in a preternatural  fulness of the
blood-vessels of the liver, and is characterized  by weight,
oppression, and tension in the region of the liver.  There
is also constipation or looseness  of the bowels, loss of appe-
tite, furred tongue, yellow appearance of the eyes, skin, and
urine.  These  symptoms are  not all present at once, but
usually occur in some form modified according to the seve-
rity of the case.   Upon percussing the liver there will be
increased  dulness. and it will be observed to be increased
in bulk.
                        CAUSES.
   Whatever excites irritation of the liver, may produce
congestion.  Hence it is very  frequently produced by a
continued use of mercurials, and other hepatic irritants and
stimulants. 
        DISEASES  OF  THE  LIVER,  ETC.     495

                    TREATMENT.
  The treatment of  active congestion of the liver consists
in giving warm baths, and  otherwise exciting the functions
of the skin and  kidneys, the application of hot packs over
the region of the liver, and the liberal use of veratrum to
control the  circulation.  If the  bowels are costive, small
doses of leptandrin  and neutralizing mixture should be
given.  If the disease is  of a chronic character, an  irri-
tating plaster should be applied over the region of the liver,
the patient should have frequent warm baths, followed by
friction, the kidneys should be stimulated by means of ba-
rosmin and apocynin, and  the liver with small doses of le-
ontodin and euonymin.

  DEFICIENT SECRETIONS IN THE LIVER.
  Deficient secretions  of the liver are recognised by con-
stipation of the  bowels, light or  clear-coloured stools,  dys-
peptic habits, and imperfect nutrition.
                       CAUSES.
  The causes of imperfect secretions of the liver may be
owing to a want of activity in that organ, or a deficiency of
bile element  in the blood.
                    TREATMENT.
  When it is dependent upon a want of energy in the liver,
leontodin, irisin, and leptandrin, given in proper  quanti-
ties, will usually remedy the difficulty.  When owing to a
deficiency of bile element  in the blood, the following com-
pound should be given:—
       R.  Sulphur............................................3j.
          Chloride of Soda................................gj.
         Carbonate of  Ferri.............................3ss.
          Soda Hypophosphite.........................3j.
         Syrupus Simplex......".........................§iv.
    Mix.  Sig.—One teaspoonful every two or three hours. 
496
ACUTE SPLENITIS.
The diet should  be nutritious, and  composed  largely of
fruits.

   BILIARY CALCULI,  OR  GALL-STONES.
  Biliary Calculi are concretions formed in the hepatic, or
biliary ducts.   They vary in size and position, and consist
of a single stone, or a large number.   They are usually of
a yellowish, or reddish-brown colour, and of various shapes.
They consist of cholesterin and the colouring matter of the
bile.  They may exist in the gall-bladder, or in the ductus
communis.  When they exist in the gall-bladder, they may
remain  there for a long time without  producing any dis-
agreeable  symptoms:  but if they attempt to pass the duct,
it is usually accompanied by violent spasmodic pains, which
occur mostly in paroxysms.   If the stones should remain
in the duct for any considerable length of time, it will  pro-
duce inflammation, jaundice, and other  symptoms of.active
congestion of the liver.

                    TREATMENT.
  When it is determined that gall-stones are passing through
the gall-duct, a free lobelia emetic should be given.   If the
emetic does not facilitate their passage, and relieve the pa-
tient, a belladonna plaster should be applied over the  seat
of the difficulty, and neutralizing mixture and small doses
of podophyllin should  be  given at short intervals, until a
free action of the bowels  is  produced.  If this does not
give relief, hot packs  should be applied,  and the emetic
repeated.   This  course of  treatment,  when persisted in,
will usually relieve the  difficulty.
              ACUTE  SPLENITIS.
  In Acute Splenitis inflammation may occur either on the
peritoneal coat, or the parenchyma of the spleen, or both at 
ACUTE S PLENITIS.
497
the same time.  The symptoms differ in some degree, though
it is  sometimes difficult to detect them during life.

                     SYMPTOMS.
  This  disease is marked by pains in the left hypochon-
drium, which are increased by pressure, coughing, &c.  At
times they are sharp and lancinating; at others, dull and un-
defined.  In some instances the pain is absent, and the pa-
tient experiences only a feeling of oppression.
  In the chronic form of this disease the patient is attacked
with a  chill, which  is usually followed by fever.   Some-
times there is a feeling of disquiet above the region  of the
stomach, with vomiting, &c.   Generally the bowels are con-
stipated, although diarrhoea may occur as the result of irri-
tation.   The  system,  at such times, may  be  vigorous, or
destitute of all  activity; in which latter case the disease is
mostly symptomatic.   Usually the simple form of the dis-
ease  terminates favourably, but in some instances death may
occur in a week or ten days.
  Splenitis may often be mistaken for  diseases of various
other organs with which it is connected, as inflammation of
the stomach, colon, kidneys, &c.   The disease whichjs most
frequently confounded with it is pleurisy, the  symptoms
being very similar; but the absence of aegophony, the rough
sound of the  pleura, heaviness towards the abdomen, &c,
mark the distinction sufficiently.

           ANATOMICAL  CHARACTERS.
  After death the spleen is found to be much increased in
size, and of a dark-red colour, yielding under pressure, &c.
When death  has not occurred until  in the advanced stage
of the disease, quantities of pus are observed in cavities, or
extravasated through the structure of the viscus..  The ab-
scess (when only one occurs) is very much enlarged, in some
instances occupying the entire spleen. 
498            CHRONIC  SPLENITIS.
                       CAUSES.
  Sudden emotions of the mind, suppression of the menses,
great muscular exertion, and external injury, may  all oc-
casion  acute  splenitis.  Inflammation of the  spleen is also
a frequent accompaniment of intermittent and remittent fe-
vers, and is of more frequent occurrence in miasmatic dis-
tricts than in other localities.

                    TREATMENT.
  The treatment of splenitis should be commenced by ap-
plying hot packs  over  the  spleen, and changing them  as
fast  as they get cold.  If the stomach is vitiated,  a mild
lobelia emetic should be given; after which one-half dram
of the essential tincture of veratrum viride should be added
to a  tumbler half full of water, and one teaspoonful given
every ten or fifteen minutes, until the active inflammation is
controlled.  In miasmatic districts this treatment should be
followed  by quinine and iron.

              CHRONIC  SPLENITIS.
  In this disease I consider those enlargements of the spleen,
which are attendant upon intermittent fever.

                  SYMPTOMS,  ETC.
   The most important indication of this  affection is an in-
creased size of the viscus, which may sometimes be observed
by the slightest examination.  It causes difficulty in walk-
ing,  and an inclined position in standing; also pressing upon
the surrounding organs, and thus occasioning imperfect di-
gestion, irregular  action of  the heart, cough, &c.   It also
affects the action of the liver  and kidneys, and occasions a
sallowness of the skin, almost amounting to a greenish hue.
  This disease may continue for a few months, or its dura-
tion  may extend  into a long number of years; in which
event the person will observe no inconvenience by  its pre- 
CHRONIC  SPLENITIS.
499
      sence, unless excited  to  action by a severe blow, or  some
      other outward injury.
        Chronic splenitis occurring in miasmatic countries, is fre-
      quently accompanied by a vitiated  constitution, with a cor.
      rupt state of the blood.   When it affects the constitution the
      skin becomes pale, dry, and sallow; with languor, weakness,
      and  depressed spirits; in the female, suppression of the
      menses, pain in the limbs, &c.  The spleen, when enlarged,
      generally extends beyond the ribs into the region of the sto-
      mach and loins, and sometimes occupies nearly the whole ab-
      domen.   It  then assumes the form  of a  hard, oblong tu-
      mour, rounded on the outside, and extending downward.
                         DISSECTION.
        The  size of the spleen is  often so much increased  as to
      weigh from ten to  twenty pounds; portions of "the coating
      of this  organ  may be of the character of bone or gristle,
      while the parenchyma presents a variety of  alterations in
      form.  In other  cases, portions of the spleen  will be found
      softened, or  even converted into  pus; in which event ab-
      scesses  will be found  in  portions of  the  organ.   In  a few
      cases the peritoneal coat of the spleen  becomes attached to
      a section of the stomach or bowels, where a fistulous opening
      is formed, and the  contents of the abscess are discharged
      into  these organs.   A case occurred  in my practice, where
      the spleen became enormously enlarged.  After a protracted
      intermittent fever, an abscess formed, and the spleen became
      attached to the stomach, an opening occurred, and upwards
      of two quarts of  pus were discharged  from the stomach and
      bowels.   Every  eight or ten days this abscess would fill,
      and again discharge its contents into  the stomach, as in the
      first instance.  But after an energetic  and somewhat pro-
      tracted  course  of treatment, the patient recovered.
                            CAUSES.
        Chronic splenitis is most commonly occasioned by inter-
s,     mittent  fever; it may also succeed  the bilious  remittent
i. 
500
CHRONIC SPLENITIS.
fever, or may be  the  result of imperfect or retarded men-
struation.
                   TREAT MENT.
   Where the disease is not of long standing, and  has oc-
curred as the result of intermittent fever, the enlargement
is usually owing to an exudation of liquor sanguinis into the
parenchyma of the spleen, and may be removed by giving
iodide of potassium, menispermin, and apocynin.  The fol-
lowing compound has provea most efficient in some very
obstinate cases:—
      R. Apocynin...................................grs. x.
          Menispermin...............................grs. xx.
          Iodide of Potassae.........................3j.
          Syrupus Simplex.........................gvj.
Mix, triturate.  Dose, one teaspoonful every two or three hours.
In case  there is  permanent enlargement of the spleen, an
irritating plaster  should be applied over the entire tumour,
and the following compound administered:—
      R. Eupatorium  Purpurium........................^ij.
         Chimaphila Umbellata..........................§j.
         Chionanthus Virginiana.......................§j.
Mix, pulverize.  Add to  one quart of boiling water, make an
       infusion, and give one-half teacupful every hour.
Benefit will also  be derived by occasionally giving  the fol-
lowing:—
      R. Quinine......................................grp. x.
         Anti-Bilious Physic.......................3j.
     Mix.  Ft. pulv. No. x.  Sig.—One every two hours.
   Where the spleen is indurated, it may be relieved by the
proper use of irisin, menispermin, and podophyllin.   If an
abscess form  and  open into the stomach or bowels,  its eva-
cuation may  be facilitated by means of gentle emetics, or
mild laxatives.   The constitution should be well supported,
and the diet of a  nutritious character. 
DISEASES OF THE  SPLEEN.        501
NON-INFLAMMATORY  DISEASES  OF
                  THE  SPLEEN.
                     CONGESTION.
  Congestion may be present without the appearance of
inflammation.   When the spleen becomes irritated, it be-
comes engorged with blood.   The symptoms are somewhat
similar to those of acute splenitis.   Sometimes  the spleen,
by constant distention, is ruptured; when the blood, rush-
ing into the  abdomen, causes instant death.   Congestion
of the spleen may occur in the cold stage of fevers, or in
fainting.   Anything that interferes with the circulation of
the blood, will also occasion  congestion.  Upon dissecting
the spleen, we  find it very much enlarged, engorged with
blood, and of a dark-brown colour;  and in cases where the
disease has been of long standing, scars and small sacs have
been met with.
  This disease  is not a fatal one.

                   SOFTENING.
  Acute inflammation will soften  the spleen, but it  may
also lose its degree of hardness when there are no traces of
inflammation.   The degree of softening varies.  The affec-
tion may occur in the  course of various diseases, but is
usually an attendant  upon typhoid fever.  The nature of
the softening has not been thoroughly investigated, but it
is apparently dependent upon a diseased condition of the
blood.
        HYPERTROPHY  AND  ATROPHY.
  The spleen may either become enlarged,  or  waste away
without producing any change in its formation.   The former
may be  caused  by irritation.   The  causes of the latter are
unknown, but it is thought  to result from  contraction of
the membranous sac of the spleen.
      43 
502        DISEASES  OF  THE  HEART.
                    TUBERCLES.
  These scrofulous  deposits are  rarely met with in the
spleen, and  the  same may be said of  cysts and  hydatids.
Among other affections  sometimes  observed in  this con-
nexion, are  fatty and waxy degenerations,  cancer, calcu-
lous concretions, melanosis, &c.   When hemorrhage occurs,
death is liable to follow very quickly.

                    TREATMENT.
  The treatment for congestion of the spleen consists in
equalizing the circulation.   This can usually be done  by
giving a warm bath, keeping the  patient in a warm room,
and administering small doses of  aconite.   If the  conges-
tion is violent, hot packs should be applied, and frequently
repeated.
        DISEASES  OF  THE  HEART.
   Previously to describing diseases of the heart, it may be
well to enumerate some of the  prominent points which
should guide the practitioner in the diagnosis of these affec-
tions.
   1. In health the cardiac dulness on percussion commences
immediately below the nipple, and extends two inches across;
and any increase from this extent of dulness either indicates
an  enlargement of  the  heart, or distention of  the  pericar-
dium.
   2. The apex of the heart is between the fifth  and  sixth
ribs, immediately below, and a little to the inside of the  left
nipple.
  3. Friction murmur, corresponding with the heart's move-
ments, indicates pericardial exudation.
  4. A bellows murmur, with the  first sound heard loudest
over the apex, indicates atrophy of the mitral valves. 
DISEASES OF THE  HEART.         503
  5. A bellows murmur, with the sound heard loudest at
the base, indicates aortic insufficiency.
  6. A murmur, with the second sound loudest at the apex,
indicates aortic disease, or a roughened, auricular surface of
the mitral valves.   A murmur, with the first sound loudest
at the base, and propagated  in the direction of the large
arteries, indicates  an altered condition of the  blood, as in
anaemia.
  The general symptoms of diseases of the  heart are those
which  are indicated by the irregularity of the pulse, which
depends on the contraction  of  the  left ventricle.   If the
parietes of this cavity contract freely, the pulse will be feeble.
If it contract spasmodically, the pulse will correspond. Dysp-
noea is also a frequent accompaniment of heart affections.
It may depend upon nervous excitement, mechanical inter-
ference with the functions of the lungs, or  an  interference
with the pulmonary circulation.
  Pain in the heart may also indicate a diseased condition
of the organ;  but as this  is  experienced when there is no
organic affection,  it should be  regarded as a  symptom of
heart disease only  when there are other indications.
  There are many other symptoms that may be connected
with heart affections, such as dropsical deposits, haemopty-
sis, &c.
  For farther descriptions of symptoms of  diseases  of the
heart,  see cardiac affections in another part  of the work.

        CHRONIC  VALVULAR DISEASE.
  The morbid changes in the valves, or their orifices, are
of common occurrence.   They  may  be merely thickened,
without any alterations in their structure.  Their edges may
be united so as to narrow the aperture through which the
blood passes, or they may become attached to the surround-
ing tissue.  In either case the orifice is not accurately closed.
The valves may also undergo a change of structure,  and be
converted into fibro cartilage, or bone. 
504         DISEASES  OF  THE  HEART.
  Fungous excrescences are  sometimes formed upon the
valves, thus interfering with the closure of the orifice.
  Atrophy and hypertrophy also occur in the valves.
  Disease of the  aortic valve may be distinguished by the
abnormal sounds heard over the site of the valves, which ia
upon  the  sternum, opposite the lower margin of the  third
rib.   The  regurgitation  accompanies the diastole of the
heart.   The sounds of the pulmonary valves are heard about
two inches up the  aorta.   The regurgitation of the mitral
valves is loudest near the  apex of the heart, and somewhat
near to the right of the nipple.   In diseases of the tricuspid
valves the morbid  sounds are heard above the apex of the
heart, a little to the right, and  over the sternum.   In dis-
ease of these valves there is almost  always a distention  of
the jugular veins, and a visible pulsation, which is synchro-
nous with the murmur of  the right ventricle.

                       CAUSES.
  The causes of vajvular difficulties of the heart, are inflam-
mation, and diseased condition  of the blood, together with
long-continued nervous irritation.

                    TREATMENT.
  The treatment of valvular diseases of the  heart, where
there are inflammatory symptoms, consists in such reme-
dies as will control the inflammation, such as veratrum vi-
ride, laxative  doses of podophyllin, counter-irritation over
the heart, (by means of some chafing plaster or liniment,)
and such other means as will restore the  circulation, and
stimulate  the emunctories of the body.   Where there are
adhesions of the valves which interfere with their function,
one or two grains of menispermin, with an equal quantity
of muriate of ammonia, given  two or three  times a day,
and persisted in for some  time, will usually relieve the diffi-
culty.   If there is atrophy, or  degeneration of the valves, 
LEUCOCYTHEMIA.
505
collinsonin is the remedy.  From two to three grains should
be given  three or four  times a day.  If the degeneration
should depend upon an  impoverished state of the blood, as
in scrofulous or phthisical patients, a strong, invigorating,
and tonic course should be pursued.
             LEUCOCYTHJEMIA.
  When the human blood is examined under the microscope
of two hundred and fifty diameters, it will be observed to
be composed of two sets of small, round  bodies of different
colours.  These are the white and red corpuscles.  (See fig.
28.)  The  small, round bodies, which  are aggregated to-
gether, and arranged in rows, are the red  corpuscles; and
the small bodies which are separate, and appear to be filled
with granular matter,  are the white ones.  Fig. 29 is the
                Fig. 28.             Fig. 29.
same after the addition of acetic acid.  In the normal state
the number of red corpuscles is very large, in comparison
to those of the white, about the proportion as represented
in fig. 28.   In leucocythsemia  the  white blood-corpuscles
become abundant, while the red blood-corpuscles either re-
main stationary, or are diminished  in number.  It is now
generally considered by physiologists that the coloured cor-
puscles are formed from the colourless ones; but Mr. Ben-
nett, in connexion with  some others, is of the opinion that
the coloured blood disc  is merely the liberated nucleus of
                          43* 
506
LEUCOCYTH MMIA .
the colourless cells.  Of the mode of transformation he re-
marks,  that the colourless cells may  frequently be seen,
on the addition of acetic acid, to have a single round nu-
cleus; but more commonly the nucleus is divided  into
two, each half having a distinct  depression presenting a
shadowed spot in the centre.  Occasionally, before the di-
vision takes place, the nucleus becomes oval, and sometimes
bent, and even of a horse-shoe form.   (See fig. 30.)   Fig.
                      Fig. 30.

         ®®0@(D@@


        @®(J)(D(D@©
30 shows the colourless blood-cells, as observed in leucocy-
thaemia, arranged in  the order of the development of the«
nuclei.   (See fig. 31.)  Fig. 31 shows the development of
                      Fig. 31.
the nucleus in colourless blood-cells; a, as found in  the
lymphatic vessels;  b, increased development.  Mr. Bennett
regards the formation of white blood  nuclei as dependent
upon the  aggregation of granules in the chyle; and that in
the lymphatics, or blood-glands, which consist of the spleen,
thymus, lymphatics, thyroid, and supra-renal capsules, they
undergo still farther development.  (See fig. 32.)   Fig. 32

                      Fig. 32.




                       o° 8 0 o o
shows the order of the development.   He also claims that
the liberation of the nucleus, and its transformation in  the 
LEUCOCYTHEMIA.
507
lungs, constitutes the red corpuscles.   Fig. 33 shows the
nuclei of the blood-cells after the addition of acetic acid.
(See fig. 33.)  From this hypothesis or theory of the deve-
                        Fig. 33.
(§)©©
lopment of the formation of blood, Mr. Bennett infers that
many of  the  most important pathological changes of that
fluid depend  upon a disordered condition  of the blood-
glano*s^ and in leucocythaemia his  observations appear to
be confirmed, as it has been shown in this disease that the
blood-glands are the primary seat of the difficulty.  He ex-
plains the disease by  showing that when these organs are
diseased  the cell elements of the white blood-corpuscles cir-
culate in the blood without undergoing transformation into
red blood-corpuscles,  thus  producing a superabundance of
white  blood-cells, and a corresponding  diminution of the
red blood-corpuscles.
                     SYMPTOMS.
   This disease usually commences very slowly, frequently
continuing for years previously to manifesting  its fatal
symptoms.  The first indications of its approach are slight
dyspeptic symptoms connected with disordered respiration,
which frequently amounts to more  or less  dyspnoea.   In
connexion with these symptoms there is a peculiar, light-
sallow complexion.   As the  disease advances, the spleen,
liver, kidneys,  and lymphatics will be found enlarged, and 
508       ODONTALGIA,  OR  TOOTHACHE.
otherwise disordered.   These symptoms  are usually fol-
lowed by dropsical deposits in various organs and tissues.
They generally increase, and  become more malignant until
death occurs.
                    TREAT MENT.
  The treatment for leucocythsemia has not been very suc-
cessful.  A case that I have at this time under the follow-
ing treatment appears to be improving.  He is taking chi-
maphilin, one dram; ferri  hypo-phosphite, one-half  dram;
alnuin, two drams;  cod liver  oil, six ounces.  A  mixture
is formed by trituration, and one teaspoonful taken every
three hours during the day.  In connexion with this treat-
ment, hot friction baths are given, and the patient ordered
a nutritious diet.  In a few  cases that I have treated, in
connexion with the above remedies I have found a free lo-
belia emetic, administered  every two or three weeks^to be
of advantage.
    ODONTALGIA, OR  TOOTHACHE.
  Toothache is usually produced by an inflammation of the
periosteum, or of the inner structure of the tooth.   It may
be caused  by a cold, by caries, by an inflammation of the
gums, or it may be a neuralgic affection.

                    TREATMENT.
  Where it is dependent upon inflammation of the gum, pe-
riosteum, pulp of the tooth, hot packs should be applied to
the face, followed  by a  hot foot-bath, and the  free use of
aconite  until perspiration is produced.  If it is caused by
caries, the  cavity may be cleaned and filled with lint, moist-
ened with aconitin and chloroform.  This will usually afford
temporary relief; but the only permanent relief is in killing
the nerve,  which can be done with the dentist's arsenical
paste. 
       DISEASES  OF THE  NERVOUS SYSTEM.    509

                SEA-SICKNESS.
  Some persons, when riding or sailing, are liable to symp-
toms of vertigo, which is soon temporarily relieved by nausea
and vomiting.   The relief obtained, however, is usually but
temporary, as it is soon followed by a renewal of the vomiting.
                    TREATMENT.
  Previously to exposing to the cause, the stomach  and
bowels should be evacuated by means of a mild dose of neu-
tralizing mixture  and anti-bilious physic.  When the  first
symptoms appear, suck freely of fresh lemon juice.   This
method proves almost universally successful against sea-sick-
ness.  If it should fail, one or two drops of the essential tinc-
ture of belladonna may be taken every half hour, or hour,
until relief is obtained.
    CARDIALGIA,  OR  GASTRALGIA.
  This disease  consists of sharp, violent pains in the sto-
mach, and is usually known as heart-burn.  It is caused by
the generation of gases in the stomach, or the accumulation
of an excess of acid.   It  may also be produced by irritating
ingesta.
                    TREATMENT.
  It can frequently be relieved by a small draught of pep-.
permint sling, in which has been dissolved a small portion of
bi-carbonate of soda.  If  this does not relieve the affection, a
cupful of warm soda water should be drunk, and sufficient
lobelia taken to produce slight emesis.  If the disease should
return, it should be  treated  according to  the nature  and
causes upon which it depends.     •
DISEASES OF THE NERYOUS  SYSTEM.
                 HYPERESTHESIA.
  The character  which these  affections have in  common,
is exalted irritability, and  increased irritation of the sensi- 
510   DISEASES OF THE NERVOUS SYSTEM.

tive or centripetal nerves.  The expression of this irritation
is either physical, one of consciousness, a sensation,—or mo-
tor, a reflex movement—or both at the same time.
  The sensation varies according to the peculiar sphere of
the affected nerve.  Hyperaesthesia of the  cutaneous nerves
is manifested by pain in its various modifications; that of
the nerves of special  sense by phantasms.   The part taken
by the brain  as the psychical organ, in sensation, is not only
receptive, but also re-active.   If the imagination-dwell upon
the sensation, the latter becomes more intense and more de-
fined;  the power of imagination  may create sensations, as
proved by the feeling of nausea  or prurigo, and a morbid
condition termed hypochondriasis.  Dreaming and insanity
differ from unfettered consciousness, in their interpretation
of centripetal action, by an absence or estrangement of self
in the  perception of sensations;  evidence of this is presented
to us in nightmare and hallucinations.
  The second manifestation  of exalted irritability of the
centripetal nerve takes place by reflex action upon the motor
apparatus; in which case  sensation may be absent, or it may
continue.   In the former case the absence  of accompanying
sensation increases the difficulty of forming a correct judg-
ment, but we may satisfy ourselves of the  real character of
the affection  by observing that the gentlest irritation of cen-
tripetal nerves, which  in ordinary conditions would produce
no effect, at once rouses re-action amounting to violent spas-
modic  action, such as we  see in poisoning by strychnine, in
tetanus, or hydrophobia.  The combination of sensation and
reflex action, as often exhibited in hyperaesthesia, of the ce-
rebrospinal,  and more particularly  in the sympathetic  sys-
tem, allows of a  more easy interpretation.   Thus in ciliary
neuralgia, or photophobia, the eyelids  are  closed by reflex
action, communicated  by the  sensitive fibres of the trige-
minus  to the motor fibres of the facial  nerve.   In sciatica,
pain occurs  in combination with  cramps in the calves  and
J 
       DISEASES  OF THE NERVOUS SYSTEM.    511

spasmodic  action of the  leg.  In  the case of prosopalgia,
with neuralgia of the tongue, which will  be  detailed in a
future chapter, reflex action was communicated to the hy-
poglossus, and in consequence of this the tongue was thrown
about.   Numerous instances  present themselves, in  con-
nexion with  hyperaesthesia of  the  sympathetic.   Under
this head I class disturbance of the rythm of the heart's ac-
tion from cardiac neuralgia, intestinal spasm, and ischuria
accompanying mesenteric neuralgia.  Nor is it only in the
muscular tissue that hyperaesthesia is manifested by reflex
action,—the same is the  case in  other contractile tissues,—
but it is a subject  to which  hitherto little  attention has
been devoted.  Thus it may show itself in the skin;  for it
is not unusual for the hair  in hemicrania to be  elevated at
certain painful parts.  A farther relation between hyper-
aesthesia and  motor action  is  exhibited in the aura epilep-
tica;  phantasms, vertigo, and especially abnormal  sensa-
tions  of a  current  of air, or  more frequently  of tearing,
dragging pains, which mount up from some point of the
trunk or extremities to the  head or adjoining parts, where
they seem to be cut off,  and are immediately followed by
spasms.  Epileptic attacks most frequently, and not unfre-
quently hysterical paroxysms, are introduced in this man-
ner.   Even tetanic  and  hydrophobic spasm occasionally
commences with an aura at  the seat of injury.   In hyper-
aesthesia we find that not only the irritation is increased,
but that also the  irritability of the nerves of sensation ge-
nerally is exalted, both during the paroxjsms as well as in
the intervals.  During the paroxysms it shows itself by the
extent of the sympathetic  action, such as takes place, for
instance, in the hyperaesthesia  of the sympathetic nerve,
and in hysterical affections.   In the  intervals it manifests
itself partly by a derangement of  sensibility, as in tender-
ness or numbness of the neuralgic parts,  partly by the ab-
normal re-action  to  external  stimuli, or to irritation  pro- 
512    DISEASES  OF THE NERVOUS SYSTEM.

ceeding from the organism.   Thus neuralgic patients exhi-
bit an unusual sensitiveness to atmospheric influences of an
electric or hygrometric character, whose approach they are
thus able to foretell.  Hugh Ley has made the observation
that leech-bites induce erythema and ulcers in the skin of
neuralgic subjects.   I may also quote, in proof of my posi-
tion, the trifling nature of  the  cause  which  occasionally
gives rise to the paroxysms,  and  the contrast in the effects
produced by these  causes  in different  individuals.  It is
this exalted sensibility, upon which the change in the rela-
tions of the organism in hyperaesthesia depends, that distin-
guishes morbid processes from mere  physiological activity
of a stimulated nerve.  Our acquaintance with these phe-
nomena is not as yet sufficiently extensive, but their study
will be advanced by accurate observations of the free inter-
vals occurring between the paroxysms.
   If we turn from the physiological to  the nosological fea-
tures of hyperaesthesia, we observe that the following cha-
racters are applicable to the  entire class:—1.  Periodicity,
the alternation of paroxysms and intermissions.  2. Uni-
formity and persistence of the symptoms, however long the
duration of the disease.  3.  Absence of danger to life.  4.
Freedom of early life from the disease.

HYPERESTHESIA OF  THE CUTANEOUS NERVES.
   The expression of this variety  of hyperaesthesia consists
in a sense of pain, itching, formication, and heat; pain is
the most frequent symptom, and  for  this reason the term
neuralgia has been used to designate it.  These sensations
come on in paroxysms, and are confined to the distribution
of one  or more cutaneous nerves—of one, or occasionally of
both sides of the bod}7.
   Injuries  of the  nerves  may serve as  types of this affec-
tion, because they may, as surgical operations generally, be
looked upon in the light of experiments  which afford a more
distinct interpretation of simple conditions. 
       DISEASES  OF THE  NERVOUS SYSTEM.   513

  Neuralgia from injury of a nerve may be known by the
pain commencing at a definite point in the course of a nerve,
by its distribution  to  the peripheral terminations of the
nerve, by excitement or exaltation of the pain by the slight-
est touch of the injured part,  and by cessation of pain when
compression is applied above the seat of injury.   Sooner*
or later  sympathies in other nerves, not only in the vici-
nity, but also  at a  distance from the  original  seat, show
themselves; and if the pain continue for a long time, a
constitutional  disease is developed.
  Punctured wounds, cuts, bruises, and foreign bodies are
the most frequent causes.  The pain occurs in  paroxysms,
and is produced or  increased by change of weather, affec-
tions of the mind, and errors in diet.
  The purest form of neuralgia is  seen  when the injury
affects very sensitive  nerves, such  as  the sub-cutaneous
nerves; becomes blended with symptoms of a  motor cha-
racter, when those causes are seated  in a nerve containing
sensitive and motor fibres.

           NEURALGIA  ISCHIATICA.
  The chief feature of this malady is pain in the distribu-
tion of the cutaneous branches of the sciatic nerves; it va-
ries according to the seat and number of branches affected.
If the posterior, middle, or lower cutaneous nerves, as often
happens, are the seat of  neuralgia, the  posterior or lateral
surface of  the thigh is the suffering  part, the pain extend-
ing to the popliteal space and the calf of the leg.   The su-
perficial  branch of the calf  of the  peroneal nerve is less
frequently affected; in this case the pain extends down the
external  and anterior surface of the  leg, and along the ex-
ternal and inner half of the dorsal surface of the foot.  The
Ions: cutaneous branch of the tibial nerve is more often in-
volved, the pain then shows itself at  the external malleolus
and  the  outer  edge of the foot.  The  plantar nerves are
       44 
 514    DISEASES  OF THE  NERVOUS SYSTEM.

 rarely affected, excepting the external tibial nerve, which
 supplies the heel.
   The  pain darts through these parts with the rapidity of
 lightning, up and down, cutting, tearing, and burning, with
 extreme violence, increased by  slight contact, or gradually
^becoming permanent with a gouging or crushing character.
 At the same time the patient often complains of an oppres-
 sive, painful  sensation in the vicinity of the tuberosity of
 the ischium, not far from the seat of the sciatic nerve, and
 of pains  in the  sacrum.  At times the sciatic  pain  rivals
 that  of facial neuralgia.  Lentin mentions  a patient  in
 whom the ball of the right foot was the seat of pain;  a slip
 of paper falling upon the ball, though covered  with the
 stocking, excited the pain for several hours.  The pain is
 most violent  in  plantar neuralgia, of which I  have  lately
 seen an instance in  a woman of fifty-four years  of age; her
 sufferings quite  equalled those of tic douloureux.  Hugh
 Ley  quotes two similar cases;  and  Descot communicates
 one observed by Richerand, in which the application of the
 actual cautery to the sole of the foot proved effectual.   The
 latest edition of Bell's works contains a case in which ago-
 nizing pains occurred in the sole of the foot, against which
 the most powerful  remedies  were of no avail.   Bell exa-
 mined  the  patient a few days before  his death, and disco-
 vered a hard tumour  in  the  popliteal space lying in the
 tibial nerve, and originating in  external injury.  In addi-
 tion  to the cutaneous pain, the patients  frequently  com-
 plain of other abdominal sensations, such as a sense of cold,
 heat, itching, horripilation, or cold affusion.
   Sciatica occurs in paroxysms varying in duration, with a
 remittent, but rarely, with an intermittent type.  At the
 commencement of the disease they are  more crowded to-
 gether, later ikey are separated by longer intervals.   The
 attacks occur  towards evening, and  at the  beginning  of
 night; the intermissions occur in the morning hours.  There
J 
       DISEASES  OF THE  NERVOUS SYSTEM.    515

is  frequently a persistent dull pain, or numbness, in the
intervals, with tenderness on pressure, especially at those
parts where the skin immediately invests  the bone, as at
the knee, the head of the fibula, or the ankle.

CERVICAL AND INTERCOSTAL NEURALGIA.
   The lower cervical nerves bear to neuralgia of the arm
a similar relation to that  existing between the upper, (espe-
cially the second and third, from which the  occipital nerves
branch off,) and neuralgia of the posterior surface of the
head.  The pain extends from the upper cervical vertebrae
to the  vertex, the  external  ear, and the mastoid process;
occasionally it remains limited  to a few small spots, but
may be complicated with painful sensations in the face, or
of the  lower jaw, if the upper cutaneous nerves of the neck
are affected.  The pain occurs by jerks and starts, as in
other  neuralgic  affections, both while  the  head  is at rest
and during its movements, which the patients avoid during
the attack.
               ARDOR AND  ALGOR.
   The perception of physical warmth is also conducted by
the cutaneous nerves of sensation.  This  power does not,
according  to Bell's observation, appertain to the sensory
nerves of the muscles;  for when these are exposed in sur-
gical operations they exhibit sensitiveness on the applica-
tion of hot or cold water, but are stated to be incapable of
appreciating a change of temperature.  It follows that ardor
and algor occur as cutaneous hyperaesthesiae; they are ma-
nifested by a sense of heat and  cold, which does not cor-
respond with the indications of the thermometer.
   A common form  is ardor volaticus s. fugax; it  is charac-
terized by  a hot flush passing over the forehead and chest,
especially the face, and occasionally accompanied by the
appearance of a thin perspiration.  After a few minutes
this  phenomenon disappears as  rapidly as it appeared.  I 
516   DISEASES OF  THE NERVOUS  SYSTEM.

have generally met with it in females about the climacteric
period, and after the cessation of the catamenia;  it is asso-
ciated with mental excitement and great  restlessness; and
though it often obstinately resists all the  remedies tried, it
may, after a few years, yield of its own accord.
   The chilliness accompanying the numbness of  the limbs
forms a contrast with the hyperaesthesia just spoken of; I
shall advert more fully to it in the chapter treating of anaes-
thesia, as well as of the sensation of cold confined  to a small
spot, algor circumscriptus.  The individuals are  almost al-
ways females with an hysterical diathesis.   The symptom
generally occurs on the scalp, and occasionally on the skin
of the abdomen;  it appears in paroxysms, and  again va-
nishes, together with the other hysterical symptoms.  I shall
Speak of the aura as the forerunner of epileptic attacks when
I  examine into the nature of this disease.

                      VERTIGO.
   The sensation of illusory movement generally attacks the
individual suddenly,  and without premonitory symptoms;
consciousness is unaffected, and it is  referred by him, either
to himself or to surrounding objects.    He feels as if he were
going to  fall, or were turning round, or  as if every thing
else were doing so.
   This  sensation  is invariably  preceded, accompanied,  or
followed by  another  symptom, the  sense of disturbed ba-
lance.
   Those patients  who complain of  the illusory movement
and the disturbed balance,  prove by doing so,  that their
consciousness is unaffected;  accordingly, the will continues
to be active.  They try to secure themselves against the
abnormal sensation, which threatens  to carry the body away
with it, by means  of movements which require some force
for their execution, as by stretching out their arms, by plant-
ing the feet firmly, or by pressing the trunk against a sup-
port. 
       DISEASES  OF THE  NERVOUS SYSTEM.    517

  Among the causes of vertigo, the state of the blood occu-
pies an important position, and we find that both an increase
and diminution in the supply of blood are followed by ver-
tigo.   Thus it commonly accompanies diseases of the heart,
and especially hypertrophy of the  left  ventricle.   On  the
one hand,  we find vertigo induced by suppressed hemor-
rhoids, menstruation, epistaxis, or the omission of habitual
extraction of blood; on the other, hemorrhages, whether un-
developed or intermittent, arthritis, or trichoma, pregnancy,
and the pressure of tumours in the abdomen, are to be classed
in this category;  not unfrequently the affection is caused
by injury and diseases of the brain, and especially of the
cerebellum, or by epilepsy, for the paroxysms of which ver-
tigo is not unfrequently  substituted.
 HYPERESTHESIA OF  THE OPTIC NERVE.
   Hyperaesthesia of the Optic  Nerve is manifested by lu-
minous and chromatic sensations.   It is usually preceded
by  headache, a sense of tension in the eyes, loss of appetite,
and general debility.  It  generally runs a chronic course,
and is usually produced by congestion of the brain, optic
nerve, and structure of the eye.
          ACOUSTIC  HYPERESTHESIA.
   Increased sensibility of the auditory nerve is characterized
by tinnitus aurium, melodious  chants, or noises resembling
the human voice or the cries of animals.  These sensations
of  sound  occur whether the ear be open or closed.   This
affection of  the nerve may be produced by violent  explo-
sions, continued loud noises, diseases  of the brain, and in-
flammation of the nerve.
        OLFACTORY  HYPERESTHESIA.
   Olfactory Hyperaesthesia  is recognised by an increased
sense  of smell.
        GUSTATORY  HYPERESTHESIA
is an increased sensibility of the nerves of taste.
                          44* 
 518   DISEASES OF THE NERVOUS  SYSTEM.

  HYPERESTHESIA OF THE  CARDIAC  PLEXUS.
   Hyperaesthesia  of  the  Cardiac  Plexus is recognised as
 Angina Pectoris, which is described  in another portion of
 the work.

   HYPERESTHESIA  OF  THE SOLAR PLEXUS.
   Hyperaesthesia of the Solar Plexus is recognised by vio-
 lent, contracting pains at the pit of the stomach.  It is usually
 preceded by a sense of oppression.  The hands and feet are
 cold, and the pulse feeble.   The stomach is usually distended,
 and tender on pressure.   It occurs in paroxysms, and lasts
 only a few minutes.

 HYPERESTHESIA OF THE MESENTERIC PLEXUS.
   Hyperaesthesia of the Mesenteric Plexus is characterized
 by sharp, twisting pain, extending from  the umbilicus to
 the lower portion of the abdomen.  It occurs in paroxysms
 and is of a most excruciating character.  The patient is rest-
 less,—hands, feet, and  cheeks are  cold, the pulse is small
 and hard.   The abdomen is tense and distended;  obstinate
 constipation, and usually nausea and vomiting occur.  The
 fits usually last from a few minutes to several hours.  This
 disease is generally recognised as colic; and when connected
 with vomiting of  bilious  matter,' it has been denominated
 bilious colic, and has been mistaken for inflammation of the
 bowels.   It is a pure neuralgic affection, and  amenable to
 the same  treatment as hyperaesthesia in other  parts of  the
 body.
   Hyperaesthesia of the spermatic plexus, and other nerve
 ganglia, and sections or portions of the nervous  system, may
 occur.   In  short, all portions of the nervous  system,  in-
 cluding the brain, spine, and entire sensitive nervous system,
may become subject to hyperaesthesia, or increased nervous
sensibility; and, when attacked with  this disease, manifest
 the same general symptoms.  All the forms of hyperaesthesia, 
       DISEASES OF  THE NERVOUS  SYSTEM.    519

including the complicated varieties of neuralgia, may be
distinguished from inflammatory diseases by their peculiar
periodicity, and the systematic order  in which the parox-
ysms of pain are repeated.

         CAUSES OF  HYPERESTHESIA.
   Hyperaesthesia  may be produced by specific poisons in-
troduced into the blood, such as lead, mercury, arsenic, and
all the poisonous minerals; it may also be produced by scro-
fulous or tuberculous diseases, by a debilitated state of the
fluids, by local irritants, long-continued nervous excitement,
zymotic  and vegetable miasms, together with other agents
which irritate, debilitate, and exhaust the nervous system.

                     TREATMENT.
   The treatment of hyperaesthesia may be divided into pal-
liative and radical.  The palliative treatment consists in the
administration of anaesthetics, such as chloroform, sulphu-
ric ether, aconitin, hyosciamin, cypripedin,  belladonna, can-
nabis indica, cannabis  sativa, opium, morphine, lupulin,
cicuta, and other  anaesthetics.  These remedies may be ap-
 plied either locally, or introduced into the system internally-
 When taken into the stomach they reach the nerves through
 the medium of the  blood;  when applied  externally,  they
 may come directly in contact with the nervous tissue.   In
 either case their influence is the same.  Among  the  most
 potent anaesthetic agents, are chloroform,  sulphuric ether,
 aconitin, and the opiates.  A most valuable  anaesthetic for
 external applications, in case of active neuralgia, is the fol-
 lowing:—
       R.  Chloroform ...................................^ij.
           Aconitin........................................grs. ij.
           Sulphate of Morphine.......................grs. x.
 Mix, and  apply to the part by means of  a little lint, or a
 small pad of cotton.   Another very valuable preparation is 
520   DISEASES OF THE NERVOUS SYSTEM.

to take ten grains of aconitin, and ten of the extract of bel-
ladonna.   Form an ointment with one dram of lard.   Let
this be applied to the  affected part with friction.   Any of
the  above remedies may be introduced into the system, in
proper doses, and  at sufficient intervals to subdue the pain.
After the pain is controlled with anaesthetics, antiperiodics
should be given to interrupt the periodicity of the disease.
For this purpose the following will be found most valuable:—
       R. Quinine........................................grs. x.
          Prussiate of Iron............................3ss.
          Lupulin.......................................grs. xx.
     Mix.  Ft. pulv. No. xx.   Sig.—One every two hours.
As  soon  as  this antiperiodic has been taken, the cause of
the  disease should be sought, and, if possible, removed.  If
the  paroxysms should return during the radical treatment,
the  pain should be again subdued with anaesthetics, and the
periodicity of the disease with antiperiodics, when the ra-
dical treatment should be persevered  in until the disease is
permanently cured.  During the treatment the body should
be frequently bathed, a nutritious diet  prescribed, and every
practical means resorted to  for the purpose of invigorating
and  strengthening the system.

                   ANESTHESIA.
   By Anaesthesia is understood loss of the energy of the
sensory nerves.
ANESTHESIA  OF THE  CUTANEOUS  NERVES.
   The characteristic symptom of this variety of anaesthesia,
is diminution or loss of the  normal sense of the skin, in its
simple or modified condition.  Cutaneous anaesthesia gives
rise  to a diminution, or a loss of the sense of warmth  and
cold, as  well as of tactile  sensation.   English physicians
have published a few accurate observations on the change
of the sense of temperature in  anaesthesia.  In one  case,
in which anaesthesia had  affected the feet half up the calves, 
       DISEASES  OF THE  NERVOUS SYSTEM.    521

and the hands, the patient experienced no feeling of tempe-
rature when brought into contact with solid bodies, not even
if ice were  applied; water at every temperature appeared
lukewarm.  Another patient, himself a physician, (Dr. Yieus-
seux, of Geneva,) whose right side was anaesthetic, called
hot things that were applied to it cold, or lukewarm, and
cold things hot.   When lying in a cold bed, it seemed hot
to the right side, and cold to the left.   In a hot bath the
water appeared hot to the left side, and neither hot nor cold
to the right.  Yery cold water produced a sense of warmth to
the right side.  If he touched a substance which was neither
hard nor polished, such as  the hand  of  a  friend, he was
unable  to determine its  temperature, and  he was forced to
call in the aid of the left hand.

ANESTHESIA OF THE NERVES  OF SPECIAL
                        SENSE.
              AMAUROSIS, (GUTTA SERENA.)
   The  individual  affected with it sees  objects indistinctly,
even when they are lit up by a bright light; they appear
surrounded by a fog or mist, and no effort nor the employment
of artificial means increases the distinctness.  The outlines
of objects appear not only indistinct, but  also broken, and
thus disfigured.  The flame of the candle  appears rent;
while  reading,  the patient misses single  syllables,  words,
and lines, and he  is forced  to follow  them  by moving his
eye, his head, or his entire  body.  At times the upper or
lower,  the right or left half, the  circumference or centre
of the object only is  seen;  at  others  the loss of vision is
still more partial, and is confined to different spots of small
extent, and with differently shaped outlines.   Instances also
occur  in which the object  only  is seen,  when  it bears a
definite relation to the eye, and it vanishes on the slightest
movement of the eye or head.  The faculty of distinguish-
ing colour is often lost. 
522    DISEASES OF  THE NERVOUS  SYSTEM.

  When the disease is at this stage, it is termed amblyopia;
when vision is entirely lost, it is called amaurosis.
  An attack of amaurosis is often preceded by phenomena
of optic  hyperaesthesia,  (photopsia, chromatopsia,) which,
in many  cases, accompanies the disease when completely de-
veloped.
  Among  the  causes predisposing to  optical anaesthesia,
we have to enumerate  hereditary taint, the middle period
of life, in the female sex the  climacteric, and the develop-
ment of pigment;  amaurosis is rare in gray and blue eyes,
as compared with the liability of dark irides.   Among the
specific substances which suppress the activity both of the
ciliary and the optic nerves, I must mention belladonna and
hyosciamus.   Lead  poisoning, especially  by an atmosphere
filled with lead dust, occasionally gives rise  to amaurosis,
either in combination with other  nervous affections that
precede or are associated with it, such as  colic or saturnine
epilepsy, or, though rarely, by itself.   It generally super-
venes suddenly, runs a rapid course, lasting only a few hours
or days; or in exceptional cases, extending  over a longer
period.  Both eyes suffer at the same time, and in an equal
or different degree.  The pupil is dilated, unequal, varia-
ble.   Tanquerel des Planches has observed twelve cases of
the affection.
            ACOUSTIC  ANESTHESIA.
  This anaesthesia may be defined as the absence or loss of
the  power of the  acoustic nerve to perceive impulses of
solid bodies, or vibrations  of  the air, as  sound, owing to a
diminution or loss of the conducting power, or excitability
of the acoustic nerve.
  In acoustic anaesthesia the loss of hearing generally com-
mences in  one ear, gradually and almost  imperceptibly; it
rarely affects both organs at the same time.  At first distant
sounds only are indistinctly perceived.   There is a difficulty
in following a general and animated conversation, the sounds 
       DISEASES OF THE NERVOUS  SYSTEM.    523

becoming confused.   After a time the opposite ear suffers,
and the deafness increases.  Sooner or later tinnitus aurium
supervenes.   It is at first indistinct;  but as the disease
increases, becomes loud and sonorous.   This noise not un-
frequently extends from  the ear to the entire head.   Cer-
tain circumstances exert an undoubted influence upon the
improvement or increase of the affection.  It is augmented
by mental fatigue, depressing emotions, by damp, stormy,
or  cold weather, or  debilitating discharges; while  light-
heartedness, a hopeful frame of mind, and a dry, mild atmo-
sphere relieve the patient, though but temporarily.  The
same applies to loud noises in the vicinity, driving in a rat-
tling carriage, the ringing of a bell, the beating of a drum,
&c.  Anaesthesia of the acoustic nerve either remains per-
manently at this stage, or complete deafness ensues, to such
an  extent that hearing can no longer be excited by any sti-
mulant.   In this case the tinnitus generally ceases.
   The causes of deafness must.be divided  into such as de-
stroy the conducting power of the peripheral, or of the cen-
tric tract of the auditory nerve.   Among the former we
must enumerate sudden, violent concussions of the acoustic
 nerve, by loud explosions, thunder, &c, or  by concussion
 of  the cranial bones, (or by a vigorous box on the ear,) in-
 jury or laceration accompanying fractures  of the cranium,
 compression by tumours seated in the petrous bone, and  at
 the base of the brain.  Among the central causes, disorga-
' nization  of the brain is the most frequent, whether idiopa-
 thic, or resulting from destruction of  the  petrous bone by
 osseous  tubercle.  In  the  cases  that have hitherto been
 placed on record, the cerebellum, though not exclusively
 affected,  has generally been found to be the seat of the dis-
 ease, together with  the scrotum.
 'anesthesia  GUSTATORIA,  (ageustia.)
    What  I include under the above term is the loss of taste,
 owing to th$ conducting power of the nerve of taste having
k. 
524   DISEASES OF THE NERVOUS SYSTEM.

been destroyed.  This distinguishes the affection from an
impairment of the sense of taste, resulting from conditions
which prevent the action of a rapid substance upon the
nerves, as dryness of the tongue.

                    TREATMENT.
   The general treatment in anaesthetic diseases consists in
removing the cause  or causes  of the  difficulty, so far as
practicable, in toning and invigorating the system generally,
and in the use of anti-anaesthetic agents.  Among the most
reliable anti-anaesthetic remedies, are  nux vomica and its
preparations,  ignatia, viburnin, and  rhus radicans.   In
cases of anaesthesia of the  optic nerve, I have found the
following prescription most valuable:—
       R. Viburnin......................................grs. x.
          Iron by Hydrogen.........................grs. xx.
          Sacch. Alba..................................3j.
     Mix.   Ft. pulv. No. xij.  Sig.—One every two hours.
At the same  time let  the  patient take from three to five
drops  of the  acetic tincture of rhus  radicans four or five
times a day.   During the interval between the administra-
tion of these  remedies, hydrastin, iron, and quinine, with
cod liver oil, should be given for the purpose of invigorating
the general system.   In hyperaesthesia  of the auditory
nerve, nux vomica frequently serves the most valuable pur-
pose.   The following prescription may be used :—
       R. Essential Tincture  of Nux Vomica..........3j.
         Ferri Hypo-Phosphite..........................£ij.
         Syrupus Simplex................................§vj.
    Mix. Sig.—One teaspoonful three or four times a day.
The ear should be frequently  syringed with warm water,
for the purpose of removing  all foreign substances, dry
wax, &c.; and the peripheral nerves may be stimulated by
rubbing around the ear with a liniment, composed  of the
equal parts of myrrh, capsicum, and nux vomica.  In some 
       DISEASES  OF THE NERVOUS SYSTEM.    525

cases of anaesthesia, much benefit may be derived from dry
friction, or a gentle current of electricity.  The constitu-
tional treatment should be such as would produce a normal
condition of the emunctories generally.

            NEUROSES  OF MOBILITY.
   A Neurosis of Mobility is that vital process in which the
"activity of the centrifugal  nerve, owing to a  change in its
excitability, deviates from the normal condition.       t
   The activity of the centrifugal (motor)  nerve, is mani-
fested by the contraction of the muscular fibres supplied by
it; and this manifestation, when abnormal, may be exalted,
or depressed, and  extinguished.  In the  former case we
have to do with hypercinesis;  in the latter,  acinesis.
   Consequently, there are two organic elements, the motor
nerve, and the contractile fibre, whose mutual action is ne-
cessary, and to both of which we must pay special attention.
The integrity of the muscular fibre is an essential condition
of contraction;  the nerve loses all  power  as soon as the
muscular tissue has undergone alteration, though only of a
microscopic character; the  contractile tissue and the inner
coat of the vessels, though dependent upon nervous stimu-
lation, play a subordinate part in the theory of these  neu-
roses.
   The antagonism, the balance, and the  co-ordination  of
movements depend upon  this.   The unsymmetrical, but
harmonious movements of  seeing eyes afford a proof that,
notwithstanding the existence of symmetrical nerves and
muscles, the movements are guided by an equilibrium de-
pendent upon sensual impressions.

          HYPERCINESIS, (SPASMS.)
   The  character common to this class of affections is, ex-
alted irritability, and increased  action of the  motor nerve.
   This activity is  evidenced  by muscular  contraction oc-
          45 
526    DISEASES  OF THE NERVOUS SYSTEM.

curring with quick changes, or enduring, as clonic or tonic
spasm; the latter does not, however, originate in a persist-
ent influence exerted upon the motor nerves, but as Edward
Weber's experiments with the rotary apparatus have shown,
in a succession of shocks communicated to the motor nerves.
He states that if the galvanic shocks, communicated to a
muscle or its  nerve, be  repeated  so  rapidly that the con-
tractions which ensue, in spite of their short duration, fol-
low one another in such immediate succession, that the suc-
ceeding one commences before the preceding one has ceased,
the contraction of the muscles becomes persistent, and so
perfectly continuous, that even with the microscope we are
unable to perceive the movements  and tumours of indivi-
dual muscular fibres.
   The muscles of animal life, which are under the domi-
nion of the cerebro-spinal nerves, and the muscles of orga-
nic life which  are  controlled  by the sympathetic system,
exhibit the  peculiar type of their  movements in the spas-
modic contractions not less than in the healthy movements;
and in the former we see the muscular fibre at  the same
time uniformly and contracted throughout its extent, while
in the latter we  find successive contractions in wavelike
progression.  Although, however, the fundamental type is
preserved, we meet with deviations in  duration  and loca-
lity;  in spasmodic action of the heart  the  ventricles con-
tract  several times before a contraction of the auricles takes
place, and the rythm of the contraction itself is irregular.
   The cycle of spasmodic labour-pain is different from that
occurring in normal  labour;  the  pain attains  its climax
suddenly, at which it remains for a considerable time, and
then  subsides quickly.   The contraction of the  uterus is
effected partially and irregularly.  In intestinal spasms the
waves of the movement very often recede, and cause anti-
peristaltic action.  The organs possessed of a sphincter are
not unfrequently attacked with spasms, in which the normal
antagonism to their contractions is removed;  thus we  find 
       DISEASES OF THE NERVOUS  SYSTEM.    527

 a desire to micturate in combination with ischuria, and te-
 nesmus associated with a desire for defecation.

                       CAUSES.
   1st. Spasms resulting from irritation of the motor nerves,
 as conductors.  2d. Spasms from irritation of the central
 organs, the sympathetic ganglia and plexuses, the spinal
 cord and the brain.
   We possess but  few observations  on the alterations oc-
 curring in muscles in consequence of spasm.  Bowman is
 the first who has investigated  the subject accurately.   He
 found some muscles in tetanus perfectly healthy, whilst others
 presented  a  peculiar pale-gray  appearance  in many parts,
 like the flesh of fish, doubtless  owing to the blood having
 been squeezed out of the vessels.  In other parts, again,
 they  had almost lost  their fine filamentous structure, and
 presented a soft, spotted mass, which easily tore, or retained
 the print of the finger.  Extensive  ecchymoses were fre-
 quently met with, which contrasted with the  pallor  of ad-
 joining parts.

 SPASM  IN  THE  RANGE  OF  THE  MOTOR
   NERVES  OF THE INFERIOR  EXTREMITIES.
   The seat and cause of the affection induce various modi-
 fications in the phenomena accompanying it.
   Among the muscular nerves  of the thigh,  the branches
 of the first and second lumbar  nerves, which are distributed
 to the flexors, the psoas and iliacus, are the more frequent
 seat of the spasm,  and cause the spasmodic contraction of
 the hip, the diagnosis of which disease has been determined
 by  Stromeyer's investigation.   The  extremity is bent at
 the hip-joint, and is incapable of being extended. Attempts
 at extension excite violent pains in the knee.   The tendons
 of the psoas and iliacus, and the muscles themselves, pro-
ject in dense ridges;  touching them  increases the pain in
 the knee.  The hip is drawn up by the action of the qua- 
528   DISEASES  OF THE  NERVOUS SYSTEM.

dratus lumborum  and the abdominal muscles, so as to in-
duce an apparent shortening of the extremity, from the tip
to the affected foot, only touching the ground in walking.

                   TREATMENT.
   The treatment of spasms may be divided into radical and
palliative.   The radical  treatment consists in ascertaining
the cause, and introducing such general or local treatment
as to remove it.   The palliative  treatment consists in the
administration of anti-spasmodics, among the most reliable
of which we find the following:—gelsemin, lobelia, valerian,
castor, scutellarin, cypripedin, musk, veratrum viride, and
camphor.  To relieve the spasms, these remedies  may be
given either alone, or in such combinations as the nature
and circumstances of the case may indicate.  The spasms
of children may be relieved by an injection of the tincture
of lobelia, and a warm bath.  In adults, where it  can be
accomplished, gelsemin  and  lobelia should be introduced
into the stomach.   In cases of permanent hypercinesis, as
epilepsy  and chorea, they should be treated as directed
under the head of those diseases.

           ACINESIS, (PARALYSIS.)
   The definition of Paralysis  is, weakness or cessation of
the muscular contraction, by diminution or loss of the con-
ducting power or stimulation of the motor nerve.
  This gives us  the means of distinguishing paralysis from
every other  immobility of the muscle, with which it is often
confounded.  I shall  not enter into a consideration of that
variety  of  immobility which arises from disorganization
of the muscular and fibrous tissue, and from other  morbid
processes; but I deem it necessary to dwell upon those va-
rieties of immobility which originate in an absence of the
normal stimuli of the muscular fibre.
  Among the sjmptoms of paralysis,  those  manifested in
the muscular and contractile tissue generally are the most 
       DISEASES  OF THE NERVOUS SYSTEM.   529

marked.   The loss of all tension in contractile fibres is most
conspicuous in the paralysis of the facial  nerves.  In one
case I found that all the furrows of the affected half of the
face and forehead had disappeared within ten minutes after
the malady had supervened.   The skin becomes flabby and
faded, the cheek  is pendulous, and when  an attempt is
made  to blow, is distended more  easily than the healthy
cheek.   In an unmarried  female,  who was paralytic,  I
found that the abdominal parietes hung down like an empty
bag.   There is another symptom of muscular paralysis,
which we should meet with more frequently if we did not
neglect to examine the naked body,  and which I have seen
in several instances; I allude to the oscillation of the mus-
cular fasciculi, similar to the play of the voluntary muscles
in animals whose spinal  cord has been destroyed.  Not less
characteristic than the arrest of movement in the paralyzed
muscle is the contraction of its antagonist, or of the sym-
metrical muscle of the healthy side; paralysis of the facial
muscle, of the muscular nerves of the eye, of the nerves of
 the respiratory muscles  of the trunk, and of the nerves of
 the extremities, afford sufficient examples of this.  Distor-
 tions and disfigurements result, which often at first sight
 indicate the seat of the paralysis,  and offer  a point of phy-
 siological interest, by giving a proof that even in a state of
 repose a constant current of  the  motor power passes from
 the central apparatus to the muscles by nervous conduction,
 and that the symmetrical  balance must be looked upon as
 one of those adaptations by which  the manifestation of those
 otherwise visible  and  sensible  movements is  prevented.
 We not unfrequently  meet with contractions  in the  pa-
 ralyzed muscles, whether of a permanent or temporary cha-
 racter.
    The causes of paralysis are only partially  known.  Every
 period of life is liable to them, from  the foetus to the last
 stao-e of existence.  There is a  congenital, and a connate
                           45* 
530    DISEASES OF  THE NERVOUS SYSTEM.

form of paralysis; of the latter we have an instance in the
histrionic paralysis  caused  by pressure  on the  forceps.
During the period of dentition paralysis occurs frequently,
both in the lower extremities and in individual limbs, whe-
ther convulsions have preceded or not, and they may per-
sist during the whole term of life.  Infancy and advanced
age are more subject to cerebral, the middle period to spinal
palsies.  To  the latter, especially in the shape of tabes dor-
salis, the male sex are  much more obnoxious than the fe-
male.   An hereditary tendency is observed less frequently
in paralysis than in other nervous diseases.  Paralyses differ
from convulsions in their etiological relations by being less
frequently based upon  anaemia, whilst the continuance of a
stronger current to the central organs affords an etiological
moment of  consequence.  It is  thus that hypertrophy of
the left ventricle favours the origin of cerebral paralysis in
itself,  and not only by  the cerebral hemorrhage it may in-
duce.   A change in the constitution of the blood is  more
rarely followed by paralysis than by spasms.  Lead, arsenic,
woorari, and tobacco, are substances endued with a specific
paralyzing power.   Among  the  pathological processes the
rheumatic is the  most productive of paralytic affections;
and it frequently occupies the first position, both in regard
to its immediate and its consecutive effects.  The interrup-
tion and suppression of the cutaneous secretion, by a draught
or from getting wet, either paralyze instantaneously or gra-
dually.  Instances of the former  mode of action are pre-
sented to us in facial paralysis, or paralytic aphonia; sup-
pression of the copious and peculiar  perspiration of the
feet, less frequently of the palms of  the  hands, to which
many  individuals are liable, affords examples of the latter.
In the latter cases there is not so much a metastatic process,
as the older school assumed,  as a coincident affection of the
motor and sensitive  nerves, a change in their condition of
excitement which gradually re-acts upon the central organs.
   Rheumatism is also of  importance in connexion with pa- 
       DISEASES OF THE  NERVOUS SYSTEM.    531

ralytic affections, by the secondary alterations produced in
the fibrous tissues, along and through which motor nerves
take their course.   The internal periosteum of the cranium,
the dura mater, plays an important part in this way, it being
either primarily affected, or secondarily to  a similar malady
of the pericranium; it acquires a still farther importance by
accompanying the cranial nerves.
   Rheumatic exudation within  the sheaths of the nerves,
though often spoken of, has  not hitherto been met with in
the dead subject.  The exudation of the cellular tissue of
the skin, which Froriep terms a rheumatic  node, and which
he states to be accurately limited  to  the  distribution of a
nervous branch,  or an  entire nervous trunk, has not been
confirmed  by cadaveric investigation,  nor  have I met with
it during life, although numerous cases of facial paralysis
from rheumatism have come under my notice.   Syphilitic
and scrofulous processes induce  paralysis, by their influence
upon the osseous and membranous envelopes,  by  producing
morbid growths, and by causing tumefaction of the glands
lying in the vicinity of nerves.
                     TREATMENT.
   The treatment for  paralysis does not, in many respects,
essentially differ from  that  of  anaesthesia, with the excep-
tion that the nervous system is  usually more  involved,  and
the blood more generally disorganized.  The  specific reme-
dies for the treatment of paralysis are the same as those enu-
merated under the head of anaesthesia.  For  paraplexia, or
hemiplegia, in addition to the treatment that I have  given
in another part of the work, where the disease is dependent
upon an affection of  the  spine,  an  irritating plaster should
be placed over the diseased part, and  remain  until a  free
discharge is produced.   The plaster should be removed and
re-applied every eight  or ten days, for five or six weeks.
During the application of the  plaster, and the administra-
 tion of the  anti-anaesthetic agents, the blood should be  tho- 
532    DISEASES OF  THE NERVOUS  SYSTEM.

roughly enriched by  means of tonics, such  as alnuin, hy-
drastin, iron, cod liver  oil, and a nutritious diet; and  the
nervous system thoroughly invigorated by means of cypri-
pedin, hypo-phosphite of iron, soda, and lime.  Baths, fric-
tion, and  cheerful company, have also a most beneficial in-
fluence in diseases of the nervous system.

                     MYALGIA,
   There are but few subjects connected with medicine that
have been so imperfectly studied  as diseases of the muscles.
These important organs  of locomotion constitute a large bulk
of the soft tissues of  the body, and perform a most import-
ant function, and, like  other tissues, are subject to import-
ant changes, especially during  active excitement.  There
are but few who have not experienced the fatigue and sore-
ness of muscles in various parts of the body.   For instance,
a man take%a long walk, and overtaxes the muscles of the
legs and hips.   He experiences  fatigue, and in some cases
severe pain, which he attributes to rheumatism or neuralgia,
when the truth is, that  this lameness and fatigue are pro-
duced by a disordered condition of the muscles.  Females,
who are not in the habit of sweeping, after exercising with
the broom for a short time, experience soreness and pain in
the muscles of the arm,  breast, and back.   This is especially
the case if the patient be of a scrofulous or phthisical habit-
Mechanics, of feeble muscular development, are liable to
attacks of myalgia in  the muscles constantly exercised; and
in some instances the pain becomes so severe and harassing,
that it disqualifies them for their business.  If they apply
to a physician, their disease  is pronounced rheumatism, and
they are subjected to a-course of drastic and debilitating treat-
ment, which invariably renders their condition worse.  There
are but Jew physicians of experience who have not encoun-
tered numerous cases of this kind.   The pain in  the shoul-
ders, so frequently attributed to diseases of the liver, as well
as the lumbago, or pain in the back, which  is supposed to 
       DISEASES OF THE NERVOUS SYSTEM.    533

depend upon prolapsus uteri and other female disorders, is
nothing but pain  produced by fatigue and the exhausted
state of these muscles.
                    PATHOLOGY.
  Upon examining  the  minute  structure of muscles, by
means of a microscope, after violent exercise, many of the
fibres  will  be found ruptured, the muscular  striae sepa-
rated, the capillaries ruptured, and the blood extravasated
into their substance.
                     SYMPTOMS.
  The symptoms of myalgia are  heavy, aching pains expe-
rienced in various portions of the body.   These pains are
always aggravated upon exercising the muscles, and subside,
to a greater or less  extent, after rest.  There are usually
but few constitutional symptoms  outside of a sensation  of
languor, lassitude, and general debility.
                     DIAGNOSIS.
  The diseases with which myalgia is  liable  to be  con-
founded, are  rheumatism and neuralgia.   From the  former
it may be distinguished by its being confined especially to the
muscles, whilst rheumatism is a disease of the serous tissues
of  the joints.  From the latter it may be  distinguished by
the persistent character of the pain, whilst  neuralgia always
occurs in paroxysms.
                     TREATMENT.
  The treatment of myalgia consists in rest of the muscles,
and such tonic remedies as are known to give strength and
power to these organs.   A  patient afflicted with myalgia of
the back, shoulders, breast, abdomen, or limbs, should be
ordered to avoid  all exercise which tends to fatigue the
muscles diseased, and as  often as  every hour recline  upon a
sofa,  bed, or  lounge, for  ten  or fifteen minutes,  for the
purpose of giving these organs  rest.   -At the same  time 
534    DISEASES  OF THE  NERVOUS SYSTEM.

hydrastin and iron should be administered  internally, and
the painful muscle frequently bathed in pure alcohol.  There
is no remedy in the materia medica which exerts so power-
ful an influence  over the  muscles as  does hydrastin.  It
gives  tone, vigour,  elasticity, and strength to these organs,
in a most  remarkable degree.  My plan of administering
this remedy consists in triturating one dram of hydrastin
with one dram of iron by hydrogen, making twenty powders,
and giving one three or four times a day.  If the myalgia is
dependent upon a scrofulous  or tuberculous  habit, as it fre-
quently  is, in  addition to the treatment for myalgia, the
patient should be treated as directed under the head of these
respective diseases.
  Young females, about the age of puberty, are frequently
subject to myalgic pains, especially in the back, abdomen,
and limbs, which are frequently mistaken for symptoms of
the return of the catamenia.   Such cases are easily cured
by rest, nutritious diet, iron, and  hydrastin.  I  have  also
frequently seen confirmed cases of constipation of the bowels,
and dyspepsia, dependent upon a weak state of the muscles
of the intestines and stomach, and have cured  them with
iron and hydrastin, when all other means have failed.  A
lady, who was  recently under my treatment, was subject
to violent spasms of coughing, after taking exercise.  Anti-
spasmodics and anaesthetics only afforded temporary relief.
Judging the case to be myalgia of the respiratory muscles,
I ordered bathing the chest with alcohol two or three times
a day, frequent rest, and the liberal use of hydrastin and
iron.   The treatment was soon followed by permanent relief. 
SCROFULA.                  535
                   SCROFULA.
  Scrofula, says Ericksen, is a peculiar constitutional con-
dition,  either hereditary or acquired, that leads to  the
formation of, and  in  its full development  is characterized
by  the  presence of tubercle.   It is, however,  only when
fully developed that scrofula gives rise to the local deposit
of tuberculous matter.  The constitutional condition that
tends to this is sufficiently characteristic;  but although we
may recognize its existence, and speak of the individual
possessing  such  a constitution,  as having a scrofulous
tendency or diathesis, he can  scarcely be  considered to
labor under the  fully formed disease, unless tubercle  be
deposited in some of the tissues  or organs.   The  scrofu-
lous  diathesis is  a peculiar constitutional state that is
often erroneously confounded  with general debility.  It
may and often does  co-exist with this, but is by no means
synonymous with  weakness of constitution.  Debility often
exists without any scrofulous tendency or taint, more par-
ticularly in  individuals of the nervous temperament; many
delicate people, though weak, being perfectly healthy, and
showing no disposition to this  peculiar affection;  on the
contrary, the scrofulous tendency is often conjoined with
much muscular power and  mental  activity, no  weakness
being manifested  in  either of these respects.   Scrofula is
invariably conjoined  with  debility and a perversion of the
nutritive functions of the organism.  This is especially mani-
fested in certain tissues, such as the  mucous and cutaneous,
and in  those organs the  vitality of which  is low, as the
lymphatic glands, the bones and joints. In these, scrofula
is especially apt to influence the products of nutrition and
of  inflammation,   more  particularly during the  earlier
periods  of  life, when these actions  are  most energetic, in
such a way  as to render its  existence evident to the sur-
geon.   It is this  tendency to the occurrence of particular 
536
SCROFULA.
diseases, and to the engrafting of special characters on
affections of certain tissues,  that  may  be considered as
specially indicative  of the  scrofulous  diathesis,  of  that
condition which, in  its fulness  of  development, gives rise
to deposits of tubercle in the organs and tissues.
   The existence of this diathesis is marked by the presence
of  a  peculiar temperament,—by  special  modifications
of the seat, form, and products of inflammation, and, lastly,
by the development of tubercle.
   The scrofulous temperament  assumes  two distinct forms,
and each of  these presents two varieties.   The most com-
mon, is that which occurs in persons with fair, soft, and
transparent skin, having clear blue eyes, with large pupils,
light hair, tapering fingers, and clear white teeth; indeed,
whose beauty is often striking, especially in early life, being
dependent rather on roundness of outline, then  grace of
form; and whose  growth is  rapid and  precocious.  In
these individuals the  affections are strong,  and the  pro-
creative powers considerable ; the  mental  activity is great,
and is usually characterized  by much delicacy and softness
of feeling,  and vivacity of intellect.  Indeed, ijb would ap-
pear that  the  nutritive, procreative, and mental powers
are rapidly and energetically developed in early life, but
become proportionably  and prematurely  exhausted.   In
another variety of the fair scrofulous temperament, we find
a coarse skin, short and rounded features, light grey eyes,
crisp and curling sandy hair, a short and somewhat ungainly
stature, and  clubbed fingers;  but not uncommonly, as in
the former variety,  great  and early mental  activity,  and
occasionally much muscular strength.
   In the  dark  form of the  scrofulous  temperament, we
usually  find  a  somewhat  heavy,  sullen,  and  forbidding
appearance ;  a  dark, coarse,  sallow, greasy-looking skin;
short, thick,  and harsh curly hair; a  small stature, but
often a degree of torpor or languor of the mental faculties* 
SCROFULA.                  537
 though the powers of intellect are sometimes remarkably
 developed.    The  other  dark  strumous  temperament is
 characterized by clear, dark eyes,  fine hair, a sallow skin,
 and by mental and physical organization that pretty closely
 resembles the first-described  variety of the fair strumous
 diathesis.
   In  all these varieties  of  temperament, the digestive
 organs will oe found to be weak and irritable.   This con-
 dition, which I believe is invariably associated with struma,
 and the importance of which has  been pointed out by Sir
 James Clark, must be regarded as one of the most essential
 conditions connected with scrofula, and as tending greatly
 to  that impairment of  nutrition which  is  so frequent in
 this state.   This gastric  irritability is especially charac-
 terized  by the  tongue,  even  in  young  children,  being
 habitually coated towards the root with  a thick wliite fur,
 through which elongated papilla? project, constituting the
 pipped or strawberry tongue; the edges and tip, as well
 as the lips,  being of a bright-red color.   This state of the
 tongue is aggravated by stimulants, high  living, and  the
 habitual use  of  purgatives.   In  the fair varieties,  the
 bowels are usually somewhat  loose ; but in the dark forms
 of  struma,  there  is  a torpid condition  of the intestinal
 canal.  In  all cases the action of the heart is feeble,  the
 blood is thin  and watery, and there is a tendency to  cold-
 ness and often to clamminess of the extremities.
  One of  the most marked  characteristics of struma,  is
 certainly  the  peculiar  modification   that inflammation
 undergoes, whether we regard the course that it takes, the
 form that it assumes, its products, or its seat.  The course
 of  inflammation in  strumous  subjects  is  always slow,
 feeble, and ill-developed, the more active and sthenic con-
 ditions being rarely met with.   In its form,  it is  either
 ulcerative, congestive, or suppurative,  and in its products
it is characterized  by little tendency  to  adhesion, by the
      46 
538                  SCROFULA.
production of  thin, weak,  blue,  and ill-developed cica-
trices, and by the formation of thin, curdy pus, with much
shreddy corpuscular lymph.
  The seat of  strumous inflammation varies greatly;  the
peculiar modifications of its  course, form, and products, are
assumed,  according to the part that it affects.  The tissues
implicated by.it,  are  chiefly the  skin and  mucous mem-
branes,  the joints,  and  the  bones;  occasioning a great
variety of special diseases, according as  one or another of
these structures is affected.   It is as the result  of, or in *
connection with, these  local affections,  that the general
symptoms of struma become most marked.  Whatever the
temperament may  be,  the  individual becomes emaciated,
sallow, cachectic, and debilitated, and at length  falls into
a state of hectic or marasmus.
   When affecting the  skin,  scrofula declares itself under a
variety of cutaneous  eruptions,  especially the  different
forms of eczema  of the  scalp,  and various ulcers on the
surface, usually weak  and largely granulating, with con-
siderable  swelling of surrounding  parts,  and a tendency to
the formation of thin, blue,  and glazed cicatrices.
   The  mucous  membranes are commonly extensively
affected, and often present  the  earlier forms of scrofulous
disease in childhood;  this is more especially the case with
those of the  eyelids and  nose.  The conjunctiva becomes
chronically  inflamed,  with  perhaps  ulceration  of  the
cornea; the mucous  membrane  of the eyelids may be
permanently  congested and  irritated, with loss of eyelashes,
constituting  the  different forms of psorophthalmia.   The
mucous membrane lining the nostrils becomes chronically
congested, red, and swollen, giving rise  to habitual sniff-
ling of the nose, and to a sensation as of a constant cold.
Occasionally the lining of the antrum  becomes  irritated,
and may  then  occasion  an  enlargement of this cavity, or
the discharge  of unhealthy pus  into the  nostrils.   The 
SCROFULA.
539
 tonsils are often found chronically enlarged and indurated,
 with occasional tendency to  fresh inflammation ; and the
 larynx may become the seat  of various forms of aphonia,
 dependent on  congestion of  its  lining membrane.  The
 state  of the  gastro-intestinal mucous  membrane,  has  al-
 ready  been  described when  speaking of the  state of the
 tongue;  and  that  of the genito-urinary  organs  is also
 marked by a  tendency to debility and irritation,  indicated
 by  the occurrence  of discharges from the  urethra, under
> the influence of very slight exciting causes, and that are
 often very permanent in their character.   The occurrence
 of  calculus  in the bladder, especially in children, may
 also occasionally be attributed to the scrofulous  diathesis.
    Perhaps the most important local diseases arising under
 the influence  of this agency, are  those of the bones and
 joints.  The bones are liable to the occurrence of various
 forms  of  caries and  necrosis; more especially those that
 are spongy in their texture, as the short bones of the foot,
 and the articular ends of the long bones.   The joints are
 liable to that  large class of affections that  are commonly
 known as white  swellings, and which consist of thicken-
 ing, disorganization,  ulceration,  and suppuration of the
 synovial membranes and cartilages.
    Lastly, some of the glandular organs  are  peculiarly
 prone to  scrofulous disease.  Enlargement  of  the lym-
 phatic  glands, more particularly those at the side of the
 neck, and the  glands of the  jaw, is of such  frequent oc-
 currence,  and is usually so early a sign, that the surgeon,
 in determining whether an individual is scrofulous or not,
 commonly passes his hand over the glands in these situations,
 in order to ascertain their condition and size ; these glan-
 dular  enlargements are especially  apt to run  into un-
 healthy and  chronic  suppuration.   The testes  and  the
 mamma? are  occasionally affected;  and  other  glandular 
540
SCROFULA.
 structures, though sometimes  implicated, are by no means
 so commonly found diseased,  as those just mentioned.
   The occurrence of tubercle must be looked upon as the dis-
 tinctive characteristic of scrofula, and when it occurs it may
 be considered a sure sign of this affection, which has then
 reached its ultimate development.   In those cases in which
 the scrofulous diathesis exists without having given rise to
 this product, it must be considered as  not having been
 called into  full and active operation, having merely mani-
 fested itself  in the minor  forms  of the disease,  such as«
 ulceration of the skin and mucous surfaces.
   Tubercle, though sufficiently well marked  by its appear-
 ances  and progress, cannot be looked  upon as a  specific
 affection, but must be considered to be a perverted or un-
 healthy  development of  the  nutritive  materials,  destined
 for the repair of the body and the restoration of the blood.
 According to Mr. Simon, it consists of the  lymph or nas-
 cent blood.  It is a "dead  concretion," a " fibriniform
 product, insusceptible of development."  "The scrofulous
 diathesis," says Mr. Simon, "consists  in a  peculiarity of
 blood  development, under which the nascent blood tends
 to  molecular  death by  superoxydation."   According to
 Dr. Williams,  tubercle is  a  degraded condition  of the
 nutritive material from which the old textures are renewed,
 and the  new ones  formed, and it differs from fibrine or
 coagulable lymph,  not in kind, but in degree  of vitality
 and capacity of organization."
   " Tubercle essentially occurs in two forms,  as semi-trans-
 parent grey granulations,  smooth  and  cartilaginous in
 look, somewhat hard,  closely adherent, and accumulated
 in groups, often with a good  deal  of inflammatory action
in  the  surrounding tissues.  These  grey  granulations,
 usually about the size of a small pin's head, appear to con-
sist of a modified exudation of matter.  They have a tendency
to run into  masses, and to form the true yellow tubercle, 
SCROFULA.
541
which is met with in opaque, firm, but friable concretions,
of a dull whitish or yellowish color, homogeneous in struc-
ture, and without any appearance of vascularity.
   The microscopic characters of tubercle present no very
specific appearances.   We find that this  product presents
under the lens, a homogeneous struma, which chiefly occurs
in the grey  granulations, a granular matter  which is  prin
cipally met with in yellow tubercles, drops of molecula.
oil, and, lastly, considerable quantities of imperfectly de-
developed   exudation  cells,  more  or  less   disintegrated,
stationary or degraded.
   The progress of tubercle  is most commonly to disinte-
gration and liquefaction,  at the same time that it  gives
rise, by its  irritation, to inflammation and  suppuration in
the surrounding tissues;  hence  it commonly leads to ab-
scesses, the pus of which is always curdy  and shreddy.  In
some cases  tubercle may become indurated,  and undergo a
species of calcification.  The causes of scrofula, unless this
be of an hereditary character, though very various in their
nature, are usually such conditions as influence injuriously
the  nutrition  of  the  body.  The  hereditary nature  of
scrofula is well known, both to  the public  and to the pro-
fession, for although the disease is not  commonly connate,
yet the tendency  to it is, and the characteristic nature of
the affection often manifests  itself at an early  period, not-
withstanding every effort to prevent its development.  That
a parent may develop a  tendency to malnutrition, to mis-
development of the blood, just as he may  a peculiar feature
or mental condition, is undoubted.  It is  by the hereditary
transmission  of peculiar  combinations  and modifications
of action   in the  organization, that hereditary diseases
develop  themselves at certain periods in  the  life of the
offspring, when the injurious results of the  morbid actions
that have been transmitted, have had time to be produced.
There are  certain  conditions which,  though not scrofulous,
                          46* 
542
SCROFULA.
are supposed to have a tendency to develop this disease in
the offspring to which they are transmitted ; thus dyspeptic
parents are said,  and I believe with reason, to have stru-
mous children;  so, also, the offspring of very old or very
young people, often  exhibit  a proneness  to  scrofulous
affections.   The influence of intermarriage is still a matter
of doubt, though I believe it exerts but little influence in
this respect, and it is commonly stated that the inhabitants
of little communities, who intermarry closely, such as those
in the isles of Portland and Man, are not more liable to
scrofula  than other individuals.   The most potent cause
of.scrofula, and that which  in  civilized  countries is like-
wise most frequent, is  mal-nutrition, arising either from
want of food,  or the use of inferior food by the  poorer
classes,  or  from  over-feeding,  and  over-stimulation   of
the  digestive  organs  in  the  children  of  the  wealthier
orders of society,  thus inducing  chronic  irritation   of
the  mucous membrane of the  stomach,  interference with
the  digestive powers,  and   consequently with  nutrition.
The influence of  food that  is  insufficient in quantity, or
innutritious in quality, has been shown by Mr. Phillips, in
his excellent treatise on  scrofula, to be the more  immediate
cause of this disease ;  and when conjoined with  the injuri-
ous atmosphere of large towns, of close and over-crowded
rooms, and want of  light and exercise, may be considered
as sufficient to occasion the disease in those cases in which
no  predisposition to it  exists,  and greatly to develop  any
tendency to it in the system.   It is to the conjoined influ-
ence of agencies such  as these,  that we must attribute  the
prevalence of scrofula amongst the  lower orders of town
and rural populations.
   Scrofula is often  called into immediate  action  by  the
debility induced  by  previous  diseases,  such as measles,
scarlatina, hooping cough, &c.   It usually develops itself
at an early age, though seldom before the  child has reached 
SCROFULA.                  543
its second year.  It is most  commonly about the period
of the  second dentition that the disease declares  itself,
and  it is rare to meet with it, for the first time,  after the
ages of twenty-five or thirty-five.
  According  to Phillips, when it is fatal  it  generally
proves so before  the fifteenth year; 60 to TO per cent, of
the deaths  occurring before this age.   Sex does not ap-
pear materially to influence this disease, though according
to the same authority, the deaths of males from  scrofula,
exceed those of  females in  this country by 20 per cent. If,
however, we are to regard phthisis as an allied  affection,
people  who are  scrofulous  in  early life,  often having
phthisis  developed at a later period, these numbers  may
require correction.
                    TREATMENT.
   The treatment of Scrofula  may be divided  into preven-
tive  and curative.   The  preventive treatment consists  in
so regulating the diet, as to supply all deficiencies  in the
histogenic material of the different tissues.  The digestive
and  assimilating organs should  receive  special attention,
every possible  effort being made to  increase their tone.
The surface should be bathed  three or four times a week
in warm or  cold water, as best  agrees with the constitu-
tion.   A liberal amount of exercise in the open air  should
be taken, and the  patient should avoid all excesses, both
physically and mentally.   When these means  fail  to arrest
the tendency to scrofula, a moderate amount of stimulants,
in combination  with  small  quantities  of Iron, may be
taken  before each  meal.   When the  disease has become
fully  developed,  whether in the skin, lungs,  bones, liver,
stomach, uterus, kidneys,  or any other part of the system,
the constitutional treatment should consist in a thorough
tonic and alterative course.  In case the disease appears
in the form  of herpes or pustules, the  treatment  has been
fully described  under  that head.  Or, if in  the  form of 
544
SCROFULA.
phthisis, the treatment  has already  been given.  When
scrofula manifests itself in the form of ulcers, of an indo-
lent or irritable character,  the  constitutional  treatment
should consist of the following remedies :
     R Scrophularin...................................... gr. xx.
        Bitartrate of Iron............................... gij.
        Chloride of Sodium............................. 3J-
        White Sugar...................................... §iij.
Mix, triturate, and take one teaspoonful three times a day.
The diet should consist of rich animal broths, ripe fruit,
&c. ; and  a wine-glass full of malt liquor should be drunk
with each meal.   The  ulcer should be stimulated by the
occasional  application of a mild solution of sulphate of
zinc, or vegetable caustic.  The limb should be bandaged
with moderate tightness, and the ulcer covered with a soft
slippery elm  poultice.   After  the'  above treatment  has
been pursued for about two weeks, it should be changed
to  the following:
      R Compound Syrup of Stillingia.................. Oss.
         Syrup of Apocynum............................... Oss.
         Syrup of Iodide of Potassium................... 3ij.
 Mix;  dose, from  one teaspoonful to one tablespoonful
 three times  a day.  This treatment should be pursued for
 two or three weeks,  when it should be omitted,  and the
 following  substituted :
      R Phosphate of Lime................................. ^ss.
         Cnrbonate of Iron.................................. giij.
         Phytolaccin.......................................... gr. xv.
         White Sugar......................................... lbj.
 Mix, triturate and  add to one pint of  water, and  one  pint
 of best gin. Dose, one tablespoonful three times a day. If
 the ulcer  should still prove  indolent, it may be  touched
 with caustic of potassa, followed by a poultice of  slippery
 elm, wet with Tinct. of Arnica.  Where the disease appears
 in  the form  of caries or necrosis of the bone, the dead por- 
               M E R C U R I A L D I S E A S E .            515

tion should be  destroyed by the sulphate of zinc, or caustic
potassa.   The  sore should be stimulated  as in ulcer of the
soft parts, until it becomes healthy.  After  which collo-
dion,  or a mild ointment, may be applied, until union takes
place.   In no case, however, in disease of the bones, should
the ulcer be allowed  to heal until the  necrosed portion  of
bone has been  entirely exfoliated, and the ulcer healthy  in
every respect.
   Where scrofula attacks the glands of the axilla, groin,  §r
breast, causing enlargement and irritability of these parts,
absorption should be promoted, if practicable, by the use  of
Iodine ointment and  moderate pressure;  if this fail, suppu-
ration may be induced by the application of a poultice of equal
parts of gum-myrrh, capsicum, and slippery elm   In such
cases, Phytolaccin, Iodide of Potassium,  Apocynin, in con-
nexion with the compound alterative syrup, are the reme-
dies to be used.   In the treatment of this disease, the sur-
face should be frequently bathed, the diet should be nutri-
tious, and consist  of  both vegetable and animal food.   The
sleeping apartments should be freely ventilated,, and the ha-
bits of exercise well regulated.
           MERCURIAL  DISEASE.
  There is no disease more formidable in its attack  upon
the organic tissues  than this; not  only in its tendency to
develop a great variety  of  pathological conditions, but in
the peculiar  obstinacy with which it  resists  the  efforts of
the physician  to  arrest its progress.   Mercurial diseases
manifest  themselves in  periodic  rheumatic  affections of
the joints,  in  enlarged  and indurated  condition of the
various glands  of  the  body,  in the  form  of dropsies,
anaemia, phthisis,  palpitation of the heart, dyspepsia, blind-
ness, deafness, loss of teeth, convulsions; in  fact, there is
no form of disease that  is  not occasionally represented by 
546           MERCURIAL  DISEASE.
the disastrous influence of  mercury.  When once  intro-
duced into the system, the manner in which mercurial pre-
parations  affect  the different tissues, is as yet a matter of
some dispute.  Although it is claimed  by those who  still
persist in its  use, that it possesses the power to change the
morbid condition of the part affected into another morbid
state, which is far less dangerous to the life of the patient
than the primary affection ; that it acts as a stimulant to
tne liver,  and a purgative to the  bowels;  in short, it is
claimed by those who still adhere to  the  dogmatism of
allopathy,  that it is essential to the successful treatment of
nearly all inflammatory, as well as chronic diseases.   But
in what way it stimulates the liver, or how it arrests fever,
or subdues inflammation,  they are unable to tell us beyond
mere conjecture.
   It certainly cannot be owing  to its power to increase
the histogenetic  material  for  the  reparation  of injured
organs, nor  to  its tendency to reorganize the  blood, or
other fluids, as the  most minute chemical  analysis  has
failed to  detect  the least  trace of mercury  in the organic
tissue,  unless it had been first introduced into the stomach,
and then always acting as a foreign agent, and in no  way
identified  as an  element  of the human organism.   The
only way by which the modus operandi of mercurials upon
the organic tissues can be explained, is that by which we
explain the  inability of  all  foreign  agents to produce
disorganization, unless the quantity be sufficient to over-
power the vis-vita?  of the part with which it comes in
contact.   When a foreign body is  introduced into the ex-
ternal  soft tissue, the vitality of  the part is  at once sum-
moned to  remove  the intruder, consequently a  deposition
of lymph  occurs around the foreign body, which soon be-
comes  organized in such a way as to cut off all communi-
cation  between the  foreign body and  the  adjacent tissues.
Inflammation and  suppuration are  the agents used to 
MERCURIAL DISEASE.           547
expel the body, so when mercury is introduced into the
system, it acts as a foreign body to every tissue with which
it  comes in contact,  and an effort  is made to expel it.
When mercury is combined with chlorine,  as in  calomel, it
may entirely dissolve the tissues, such as the mucous mem-
brane of the stomach, bowels, lungs, &c.   But whether
we are able or not to  account for all the morbid conditions
produced by this agent,  we have the most positive assu-
rance, that in the whole  catalogue of predisposing causes
to disease, there is none more prolific than this.  Allo-
pathists themselves are beginning to observe this fact,  in
confirmation  of which, I will  introduce  the remarks of
W. Porter, M. D., F. R. C. S. I., &c, as published in the
Dublin Medical Press of Feb.  10, 1847.
   Dr. Porter  observes :  "I think that mercurial diseases,
properly so called, that  is,  such as arise  from mercury
alone, admit of subdivision into two classes, according  as
they seem to be products of a small or a large dose of the
poison ;  when taken  in small quantities, it appears to be
determined to  the tegumentary structure  of the skin, the
mucous  membranes and analagous tissues, such as the  con-
junctiva of  the  eye,  and therefore bowel complaints,
cutaneons  eruptions,  and  superficial  inflammations are
generally met  with at  an early period,  and  before the
specific  effects  of  the medicine ought  to be expected  to
appear ;  when taken in large quantities, the nervous system
is  most likely  to suffer,  and that too  where the specific
effects have not been developed at  all,  which is the  case
most pregnant  with danger, or that being present and  in
full operation, they have been  suddenly  checked, or other-
wise interfered with, by improper or incautious  exposure.
Some few cases occur whilst patients are  under complete
salivation ; but it is so difficult to say that  such may not
have been  guilty of some irregularity,  that  they may be
placed within the latter  category, and at all events they 
548           MERCURIAL DISEASE.
are of rare occurrence. Such is the arrangement I propose
to follow  in  considering these  affections; not, however,
without being conscious  of its imperfections, and  that
numerous diseases arise, or seem to arise, from the irrita-
tion of mercury, that run  a wild and unbridled course,
which it would be impossible in the present state of our
knowledge to subject to this or almost any other classifica-
tion.   Persons,  for  instance,  whilst  taking  mercury, be-
come deranged: the examples  of this which I have  seen
were all maniacal, and the symptoms such as might be
expected  from inflammation of the  brain and its mem-
branes ; these patients all  died.  Whether such an event
was the effect of too sudden exposure to wet or cold—
whether it could be regarded as a  kind of metastatic trans-
fer of  the mercurial irritation to  the brain,  or whether it
had any direct  connection  with the  mercury at all,  I am
unable  to prove, but certainly at  the time  when  each
occurred, I  could not help placing  the mercury  and the
madness in the relation of cause and effect.   Again,  per-
sons whilst taking mercury have become paralytic.  When
I  was in college, a young  friend of mine,  slightly under
the influence of  the medicine, was exposed to an incessant
shower of rain for nearly two hours ; he went to bed, where
he had a rigor,  but fell asleep, and awoke perfectly para-
lytic on one  side;  he lived many years afterwards, but
never recovered the  use of his limbs.   A young clergyman
who had taken mercury for a liver complaint, and had
apparently nearly recovered from its effects, incautiously
fell asleep on the grass; he awoke  paralytic,  and nevei
recovered, although he lived to  more than middle  age.
Perhaps it may be said that these are not  fair specimens
of  the  morbid  influence of mercury upon  the  nervous
system ; perhaps it  may be doubted  whether mercury had
any relation to such  cases at all, inasmuch as persons  have
become paralytic from exposure,  who have never taken a 
MERCURIAL DISEASE.           549
grain of the medicine.  I know not how this may be.  My
opportunities  of investigation have been too limited to
enable me to speak with confidence on a matter of so much
obscurity ; but my experience in many instances has led me
to believe that mercury may prove eminently mischievous in
this particular manner.  But suppose we acknowledge that
mercury may and does act injuriously on the nervous system
in all its parts and in its various ways, how are we to account
for its prejudicial influence on other systems and structures,
particularly as to its production  of an hemorrhagic ten-
dency ?  Several years ago, when investigating the patho-
logy  of aneurism, I remarked the frequency of that disease
in persons who had  been  subjected to protracted courses
of mercury, and I  then  hazarded  an opinion that this
fearful and dangerous  affection might be occasionally thus
induced ;  since  then, I have paid great  attention  to the
subject, and have observed different kinds of hemorrhage
so frequently ensue after  mercury had been  extensively
used, that I feel convinced of its injurious influence in this
respect.   Almost all the aged people treated  with  mer-
cury  for syphilis, have, according to my observation, died
shortly afterwards of  haemoptysis,  or else of apoplexy ;
nor  are  such casualties confined  to the aged, for  I  have
seen several instances of young persons under  similar cir-
cumstances, being seized with spitting  of blood, and dying
rapidly of consumption.  It  may be imagined that I am
presenting the possible injurious  effects of mercury in too
strong colors, and that my apprehensions on this subject,
as being derived from the  experience of a few cases, are
little more than visionary ; be it so ; but having remarked
the fact, I think it my duty to state it, and leave it to be
established or contradicted by future experience.
   " The tendency of mercury  to  produce a hemorrhagic
condition, is readily explicable by the effects of the mineral
upon  the fibrin of the blood."  W. H. Ranking, M. D.
       47 
550           MERCURIAL  DISEASE.
  Mercurial erythema is sometimes preceded by symptoms
resembling those  which  usher  in  erysipelas,  shivering,
nausea, foul tongue, thirst, headache, cough,  and pains
about the praecordia, and these febrile symptoms, not only
continue throughout, but in severe cases become daily ag-
gravated ; sometimes it occurs without any premonitory
notice,  except a harsh dryness of the skin; and  I  have
known it to appear suddenly the day after the administra-
tion of three or four grains of calomel as a purge.  It may
be  a consequence of administering mercury in any of its
forms or preparations, but seems more frequently produced
by  its administration internally. I have, however, seen an
exceedingly well marked case of  it from  dressing a sore
with the  red  precipitate.   It appears as a dark red blush
at  some of the folds of the body,  the seat of the scrotum,
the  groin, axilla?, or  anterior  parts  of  the elbow,  from
which .it spreads with a greater  or less degree of rapidity,
according to the severity of the case.  This is distinguished
from ordinary erysipelas, by its surface being slightly rough
to the touch—by its edge not being distinctly defined—by
its  intolerable itching, which  is  the local inconvenience
chiefly  complained of  in the first  instance — and by its
vesicular appearance when viewed through a magnifying
glass.   Whenever the surfaces  of the body lie in opposite
contact, such  as in the perineum, the inside of the  thighs,
or  between the folds  of the nates, these vesicles break
almost as soon as formed, the parts become abraded, and
there is a constant oozing of a serous fluid, foul and abomi-
nably fetid.   In modern  times, the  disease  seldom pro-
gresses beyond this, which is termed the  first stage; but
suppose it neglected, and the use of mercury still perse-
vered  in, the febrile symptoms become exasperated, the
eruption  spreads,  and  may  so  extend as to occupy the
entire  body,  and  the vesications,  or rather vesicles,  run
into each other and break.  Where surfaces are opposed, 
MERCURIAL DISEASE.
551
the discharge increases in quantity,  assumes a puriform
character,  and becomes, if possible, still more offensive;
when they  do not, a branny scurf or scale is formed, which
falls off, and is renewed so abundantly, that after the night,
or even after a few hours, a great quantity may be found in
the patient's bed.  In  general, this desquamation of the
skin is  attended  with febrile  symptoms, and the  patient
slowly recovers;  but if  otherwise, if the disease has  been
more than usually malignant,  or if the medicine has  been
still persevered with, the parts engaged (and these  may be
the  entire  body)  swell,  apparently by  the formation  of
thicker scabs or crusts, which  are deeply cracked or fis-
sured (not inaptly compared to the scored skin of  roasted
pork), discharging sometimes  sanies, sometimes blood, and
so  sore and painful that the  patient can scarcely  bear to
turn himself in bed.  I am not quite sure that I ever saw
a fatal case of mercurial erythema.  About five years ago
a poor Scotchman was  brought into  the hospital covered
with a scurfy eruption, and in a miserable state of debility,
who attributed his illness to having taken some medicine,
which he believed to have  been corrosive  sublimate, for
the cure of clap,  in despite of the treatment, he died (as
several thought)  of this disease ; but if it was so, there was
a symptom here present not described hitherto  as  apper-
taining to  it, namely : a discharge of purulent  matter as
foul and offensive as that from a glandered horse,  from
every raucous outlet of his body, mouth, nostrils, eyes,  ears,
anus and urethra.  I know not, I say, whether this was a
specimen  of the  disease or not;  but without passing to
such  extremity,  the description given by those  who had
witnessed the latter stages  of the malignant erythema, is
sufficiently appalling.   The  cough  becomes very  severe,
and is accompanied by  great soreness of the  chest; the
matter expectorated is sometimes highly tinged with blood,
which is so  coagulated  as  to threaten  suffocation.  The 
552           MERCURIAL DISEASE.
pulse is frequent and irregular, the surface of the body is
intensely hot and sore, the  thirst becomes unquenchable,
the tongue becomes parched and black  in the centre, and
the urine is high-colored, small  in quantity, and without
sediment.  Wretched,  indeed,  is  the   situation of the
patient in this stage of the disease ;   without the enjoy-
ment of one moment's repose, afflicted in body with the
most excruciating anguish,  and depressed in mind to the
lowest state of despair, he  soon falls beneath these com-
plications of wretchedness.   Diarrhaea  and  low delirium
speedily supervene, the pulse sinks, the  body  mortifies,
and a state of insensibility at length announces the termi-
nation of a complaint that at once exhibits a distressing
proof of the inefficiency of  medicine, and the insufficiency
of human skill."
   Before I speak of the treatment, allow me to revert for
a moment to the history of  this disease.   Alley states,
"that before the nature of  this disease was known, it was
considered as  a more  virulent form of Syphilis.   In
proportion, therefore, as the  disorder  advanced, mercury
in  some form or other was  exhibited in greater  quantity;
the fever, consequently, was soon found to be increased to
an alarming degree, by the  action of the  mercury thus
heaped upon an already overloaded system ;  and lest the
patient should sink too rapidly under  the oppression of
this fever,  recourse  was had to  tonics and stimulants.
Among these the bark and wine were resorted to, without
any regard to  symptoms and  appearances.   It  is almost
unnecessary to add, that the disease was in almost every
instance  dreadfully  aggravated, and  that  very few  re-
covered."  Now,  recollect that all this  happened in a
Lock  Hospital, and  at a time when all cases of venereal
disease were treated with mercury.  The patient was sur-
rounded  by, and actually  breathing   a mercurial  atmo-
sphere, and you can easily understand why medicine and 
              MERCURIAL DISEASE.           553

medical skill were  inefficacious  and insufficient.   It was
useless to  prescribe purgatives, and acids, and antimonials,
andv other cooling  medicines, the cause of the fever re-
maining  ever present; it was  in vain to  endeavor to
support the strength by bark, and wine, and opium,  while
the tendency to putrescence was constantly on the increase.
At present the disease is known  to be mercurial.
   Mercurial Erethismus. — Mr. Pearson tells us, that in
the course of two or three years after his appointment to
the Lock  Hospital, he observed  that in  almost every year,
one or two cases  of sudden death  occurred among the
patients ;  that these could not be traced to any ostensible
cause, and  that the subjects were those who had nearly
and sometimes entirely completed their mercurial course.
He consulted  Messrs. Bromfield and  Williams  on  the
subject, and they were unable to  give him any information,
more than that they had carefully examined the bodies of
many who had thus died unexpectedly, without being able
to  discover any morbid appearances.  On watching the
effects of mercury on the  patients,  he ascertained that
these deaths were  attributable to the mineral acting  as a
poison on the system, and  that  its deleterious effects were
neither in proportion to the inflammation of the mouth,
nor to the actual  quantity of mercury  absorbed  into the
body."

                    TREATMENT.

   The treatment  of mercurial disease is usually less suc-
cessful than the treatment of most other  diseases; although
much good may frequently be done by a proper course of
medication.
   If mercurial disease is manifested  in a  mild form, the
patient should  be  caused to take a gentle purge of Podo-
phyllin, the surface should be freely bathed in  salt water,
a mild course of tonics should be. commenced and pursued,
                       47* 
554
MERCURIAL DISEASE.
and a generous diet should be  allowed.   This course will
frequently remove the most troublesome symptoms.
  In  more severe cases, as  much  of the  mercury should
be extracted from  the  system as possible, by recourse  to
the galvanic battery.   After which,  Compound Syrup  of
Stillingia, in connection with small doses of Sulphur, will
be required.   The surface  should be  frequently bathed in
Saline water, and Iron and Hydrastin given in doses suffi-
cient to maintain the patient's  strength.  Where the dis-
ease appears to confine its poisonous action chiefly to the
skin, much benefit will  frequently be derived  from the use
of an ointment made of equal parts of tar and sulphur.

    IMPORTANCE OF CERTAIN SYMPTOMS IN DIAGNOSIS.
   In order to form a correct opinion of  the nature, cha-
racter, and identity of disease,  it is  necessary to take a
general  survey of  the  physical  characteristics of the
patient: as his weight, height, temperament,  age, whether
his  constitution is of a strumous  or scrofulous diathesis,
whether  of temperate  habits, and  whether he  has been
subjected to a mercurial course of medication.
   Every possible item  of information relative to the dis-
ease, should be obtained from the patient and nurse, which
will in the least assist in forming a correct diagnosis of
the case.   If the  heart, lungs, liver,  or spleen  are impli-
cated, auscultation, percussion, palpation,  and  mensura-
tion, should be practised, for  the purpose of forming  a
correct opinion  of the  true  nature of the disease.   Some
of the special symptoms which should engross  our atten-
tion, are  the  appearance of the tongue,  the  appetite,
respiration, circulation, sleep, the skin and secretions, and
state of the intellect.   Pain  is the result  of some impres-
sion made upon the nerve, and  transmitted to the brain •
the  pain  may be  remote from the impression,  as  in  hip
disease the pain is generally in the  knee ; the irritation 
DIAGNOSTIC  SIGNS.            555
 causing pain in the head, may be in the stomach ; or pain
 in the shoulder may occur, as the  result of congestion of
 the liver.   The amount of pain suffered by different indi-
 viduals from the same disease is  various, owing to the
 different sensibilities of the persons, and dependent upon the
 temperament.   Hence the amount of the pain experienced
 by the patient, is indicative of the  amount of the  disease,
 ceteris paribus.  A dull heavy pain generally indicates
 congestion, effusion, or the pressure of some tumor ; fugi-
 tive pain  indicates  a stretch of some part;  lancinating
 pain is characteristic of cancer, rheumatism, pleuritis, or
 neuralgia; a heavy, throbbing pain, indicates the collec-
 tion of pus;  itching pain is mostly confined  to  the skin
 and mucous membrane ;  on  the skin it is caused  by erup-
 tive diseases, and on the mucous surface by ascarides in the
 rectum, &c. When pain suddenly ceases, followed by cold
 clammy sweats, weak  pulse,  and sunken  countenance,  an
 attack of the affected  part by gangrene is indicated.
   The tongue affords  many important indications of dis-
 ease of the digestive organs.   When the tongue is thickly
 furred, and of  a white or brownish color, it indicates a
 derangement of the mucous membrane of the  stomach.
 If, in addition to the above, it  should have a red appear-
 ance at the end, it indicates the mucous membrane of the
 stomach  to be in  a high state of irritation or inflamma-
 tion.   A dry red tongue also indicates the  same state of
 the stomach.  A cracked and swollen tongue, indicates an
 extensive irritation of the nerves of the stomach,  and also
 that the brain is involved.  When the tongue is tremulous,
 great nervous prostration is indicated.  A dry, furred, or
 red  and  tremulous  tongue,  is often present in typhoid
p fever.   A light, flat  tongue,  is  characteristic  of most
 forms  of  intermittent fever. •  Much information, relative
 to disease, may be obtained by a thorough knowledge of the
 circulation, as  indicated by the pulse.  The conditions of 
556            DIAGNOSTIC SIGNS.
the  pulse, indicative of  disease,  are  various.  The in-
creased frequency of the pulse is one of its most common
varieties,  and  may  exist in  a great  many pathological
conditions of  the  system.   The number  of beats  per
minute, constituting an increase of pulse, varies much in
different individuals, and  also  at different periods of life.
In infancy, the normal pulse is  said to be from 78 to 180
per  minute.   Between  the  age of two and  six months,
from 100 to 120 per minute.  Between  the age of two and
seven years, about 110 per minute.  From  seven years to
twenty-five, from 80 to  85.   From twenty-five to sixty-five
years, the average pulse per minute is about 70 to 75.   In
females it will be  found  to be  somewhat  faster:  the
number of pulsations per minute is greater during the day
than night;  and  more  frequent just  after  a meal  than
before.   From the above  statement, it will be perceived
that a  great variety of circumstances must necessarily be
considered, in order to  derive much benefit  from this con-
dition df the circulation in diagnosis.   When the pulse is
slow, or  much less  than the usual number of beats per
minute, it  frequently indicates disease of the  brain ; it is
also characteristic  of  other diseases.   An  intermittent
pulse indicates either a disease of the brain,  or extreme
exhaustion of nervous energy.  A  weak and  feeble pulse
indicates  anaemia  and debility.  Hope states, that when
the  pulse is jerking, quick,  hard, and  strong,  and stops
abruptly, it indicates a deficiency in  the semilunar valves
of  the  aorta.  In inflammation of the peritoneum,  the
pulse is mostly small and quick,> but  quick and hard in
inflammation of the  lungs and pleura.   When the pulse is
easily compressed under  the finger,  it indicates a  feeble
condition of the heart.   When  the pulse ceases to be felt
in the  extremities, it indicates great danger, unless  it is
merely temporary.   The appetite is another symptom of
much importance  to be  observed in  disease.  In most 
DIAGNOSTIC  SIGNS.            557
diseases, the appetite  is defective, indicating inability of
the stomach to digest food, and loss of assimilating power.
Under these circumstances, food introduced into the stomach,
acts as a foreign substance,  and is  the cause of  much mis-
chief.  In some diseases the appetite is not defective; in
these cases, the powers of the  stomach,  as well as the
assimilating functions, remain unimpaired.  In some forms
of phthisis,  the rapid  exhaustion of  the nutritive material
increases the demand for food beyond its normal amount.
In chlorosis, the appetite is frequently capricious, craving
lime, clay, slate, stones, &c.  This kind of appetite indi-
cates a lack  of proper histogenic material, as well as a
deficiency in  the  salts  of  the  blood.  In children, the
appetite frequently craves sugar, fats, &c., which indicates
a deficiency of the combustive material, and a consequent
loss of temperature.
   There may also  exist a variety of morbid appetites,
such as a craving  for stimulating liquors, opium, tobacco,
ether,  &c, all of which indicate a diseased condition of
the  stomach or brain.  Respiration should also be care-
fully noticed in forming a diagnosis of disease.  If respira-
tion is increased in  frequency, it denotes obstructed circu-
lation through the  pulmonary tissue.  It may also indi-
cate irritation of the lungs  or bronchial tubes.   There are
a  variety of  conditions, which  may  tend to increase the
functions of respiration.  The respiration may be irregular
and imperfect, as  in tuberculous condition of one or both
lungs, or from a valvular disease of the heart and inflam-
mation of the pleura.
   The menses are deranged in many diseases.   They may
be scanty or they  may be profuse.  In some instances they
are  entirely suppressed.   They  are  at times  changed in
quality, and the period of their return may be  irregular.
When the catamenia is scanty, it either indicates a diseased
condition of the ovaries or deficient nutrition.  Suppression 
558             DIAGNOSTIC SIGNS.
of the menses may indicate a variety of opposite conditions.
It may depend  upon pregnancy,  upon  nursing, or upon
age.  It may exist in any of these cases without inducing
disease.  The menses  may be suppressed  by the  extreme
exhausted condition  of the  system, as in the last stage of
phthisis, dropsy, &c.   Or they may be suppressed by sud-
den exposure to cold or damp during the catamenial flow.
The menses may also be vicarious, making their exit from
the system through  the  lungs,  stomach, bowels,  &c.   A
change in the quality of the menses denotes disease of the
uterus, or ovaries, or a scrofulous diathesis.  Excess of the
menses indicates a chronic  inflammation of the lymphatic
glands of the uterus, spermatorrhaea, &c.

             SIGNS FROM  THE  URINE.
   Healthy urine,  when  recently voided, has  very nearly
the temperature of the body; it is of a light yellow color,
emits  a peculiar aromatic  odor,  has a bitter saline  and
pungent taste,  and  a slight acid reaction ;  its specific
gravity is about 1.018.   From 90 to 93  parts to 100 of
healthy urine is water, the remainder is made  up of  uric
acid,  saline and organic matter.
   About 21- oz. of solid  nitrogenized and uric matter is
thrown off from the  kidneys every twenty four hours.   If
the urine be  acid,  it  will redden blue litmus paper; if it be
alkaline, it will turn red litmus paper blue ;  if neutral, it
will have no effect  on the color of  either.   If the urine
contains albumen, heat or nitric acid will  cause it to  co-
agulate, and give  the urine a thick milky appearance.   If
the urine contains blood, heat  or nitric acid  will cause it
to lose its transparency.  If it contains'bile,  nitric  acid
will turn it green ; if it contains uric acid, nitric  acid will
cause it to look dark, and precipitate a brownish sediment.
If it contains sugar, it may be ascertained by  evaporating
a small quantity to the consistency of molasses, which will 
DIAGNOSTIC SIGNS.
559
have  a sweet taste.   A milky appearance may be  caused
by mucus,  albumen, or ammonia.   If it contains ammonia,
nitric  acid will cause  a  brisk effervescence; if it contains
mucus or  albumen, nitric acid will cause  it to coagulate.
Dr. Bird states,  that if  the  sediment of morbid  urine  be
white, and the urine acid, it consists mostly  of  urate  of
annnouia ;  but if it should disappear by heat, it is phos-
phate  of ammonia.  If a deposit be made of any color  in-
clining to dark pink, or red, it is  almost  sure  to  be urate
of ammonia, unless visibiy  crystalline, in which case it
consists  of uric acid.   When the urine contains  albumen,
it indicates granular degeneration of the kidneys, or Bright's
disease,  unless it is connected with low forms  of fevers, or
in certain forms of heart disease. If the urine contains sugar,
it indicates mal-assimilation or diabetes mellitus.  A gritty
sediment denotes a tendency to some of the forms of gravel.
Mucus in the urine is usually owing to the  enlargement of
the prostate  gland.   Pus in the urine indicates  abrasion
of the bladder, kidneys, or urethra.   Bile in the  urine  in-
dicates a re-absorption of the bile from  the liver, or that
the liver fails to  secrete the bile  from the blood.    This
symptom is  present in  most forms of intermittent  fever,
jaundice, disease of the liver, &c.
    THE  FJECES AS  INDICATING  DISEASE.
   The inspection of alvine evacuations is of great import-
ance  in  making up the diagnosis of disease.   Where the
bile is deficient, they are of a light ash color; if there is
an excess,  they are quite yellow.  A red appearance of the
stools  indicates passive congestion ; if red and thin, they
indicate  hyperemia.   If they are of a bloody  mucous cha-
racter, inflammation of the colon is indicated.   When the
stools  are bloody in typhoid  fever,  they indicate ulceration
of the glands of the  bowels.   When  the  faeces  are very
thin, and of  a rice  color, deep capillary congestion is indi-
cated,  as in cholera, cholerine, &c. 
560
DIAGNOSTIC  SIGNS.
  The condition  of the  mind  should also be taken into
consideration in diagnosis.  To what extent the mind con-
trols or influences the morbid tendencies of the  body, is
difficult to determine; but, that it has a powerful influence,
not only in increasing the severity of morbid phenomena,
but also of controlling it, is a fact too apparent to every
observing physician to need comment.  The conditions of
mind,  however, which contribute to the  amelioration or
increase  of organic  disease,  are  as yet  but imperfectly
understood.  Kossuth stated,  in  one  of his addresses
before the American people, that while lying very low with
fever, not having been out of bed for a considerable length
of  time, he  received  very  important  intelligence, upon
which  he arose, and entered  at  once upon active duties,
without feeling any further embarrassment from his disease.
   Instances are of almost  daily occurrence, in which  pa-
tients,  who have for a long  time  labored under some  low
chronic disease, hear of a  new  remedy, which, if taken,
is sure to  remove it; and  if taken  at the time when the
mind is most positive, for a  time,  at least, all the symptoms
undergo improvement.
   There are other instances of the most violent mental and
physical agonies being relieved by the supposed virtue im-
parted to a glass of water or a bread-pill by a clairvoyant,
or so-called spiritual medium, magnetic passes, &c. These
things may appear to the  novice in observation,  absurd;
yet they are living facts which must be met and should be
investigated.   This  class of cures is not confined to the
nervous and weak alone ; but  the athletic are frequently
the passive subjects of these mysterious  operations of the
human mind.   Even infants, whose minds are not suscep-
tible of imaginary  impressions, are  said  by the  best of
authority, to have disease controlled by the action of other
minds.  A circumstance was  related to  me to-day by  a
gentleman of undoubted  veracity, of a child while laboring 
DIAGNOSTIC  SIGNS.
561
under a protracted brain affection, being relieved in a few
hours by one who claimed to be a spiritual medium.  He
magnetized  a glass of water, as he stated, and by giving
a teaspoonful every  five minutes,  the child was  relieved.
Another instance was related, of a similar glass of water
acting as a cathartic  in fifteen minutes, although there was
obstinate costiveness  at the time.   Mental impressions, as
affecting disease,  have  been  noticed  from the  earliest
history of medicine until the present time.
  The mystic ceremonies of the Esculapians, the  incanta-
tions  of Galen, the  rites  and  ceremonies  of  Avicenna,
were another mode of producing  the same results.   The
effects  of  Indian charms,  the supposed power of the
seventh son, of men born  with a caul  over the  face, of
touching a  dead body for the  cure of  cancers, of taking
water, in which  sugar pills have been  placed,  are  all
examples of the effect of the mind over the diseases of the
body.
  While the mind may be  thus beneficially directed upon
diseased organs of the body, it frequently has an  opposite
tendency.  It is a familiar fact, that nearly every disease
that affects the  human  family, may be, and is occasionally
induced by a perverted action of the mind upon the body.
Fevers are frequently caused by a long continued  exercise,
or by powerful  emotions, of the mind.
  Phthisis is frequently induced in persons of a consump-
tive tendency, by constantly anticipating it.   Cholera  is
not only induced, but its  fatality increased, by  the  des-
pondent mind.   Disappointments  cause loss of appetite,
fever,  changes  of the urine,  &c.; diarrhaea, pains in the
head,  &c,  may be  caused by mental impressions.  One
of the most remarkable instances  of  the  influence of the
mind  over the  body, in  producing morbid changes, is re-
lated by Dr.  Cheyne, of Col. Townsend, who could at any
time produce all the  phenomena of death, not only arrest-
                       48 
562
DIAGNOSTIC SIGNS.
ing circulation, respiration, &c, but would remain in this
state for  hours, and then by an effort of the will, be re-
stored to his natural condition.
  He  carried his  last experiment too far, and it resulted
in actual death. The limits of this work will not allow me
to enter further into the investigation of the subject.  The
above facts are sufficient to give some idea of  the influ-
ence  of  the mind over  matter, and  the physician who
would treat disease skilfully, must seek to investigate such
facts, and as far as possible, to  understand their cause and
study their effects.  The condition of the  mind, whether
diseased  or healthy, with all its manifestations,  should  be
taken into account.  The condition of the skin, the tempe-
rature of the  body, the temperament of the patient, his
peculiar idiosyncrasies, together with his  habits of living,
occupation, external influences, &c, should be considered,
before he assumes the responsibility of administering medi-
cine, for the removal of disease. 
SURGERY.                  563
PART  II.
THE PRINCILPES AND  PRACTICE  OF
                    SURGERY.

          INFLAMMATION AND ITS  EFFECTS.
  In another portion of the work I have given a full ac-
count of the general principles of inflammation, as well as
many of the morbid changes which occur during the inflam-
matory process.   It now remains for me more fully to con-
sider the effects of the disordered  actions that have imme-
diate relation to surgery.

               MORBID GROWTHS.
  On making a minute examination of the structure of mor-
bid growths, we find them composed as follows:—1st, Mole-
cules and Granules;  2d, Nuclei;  3d,  Cells; 4th, Fibres;
5th, Tubes,  (especially vascular ones;) and 6th,  Crystals,
or irregular masses of mineral  matter.  Now no  combina-
tion of these  elements  will serve to characterize morbid
growths, such as fibro-molecular, fibro-nucleated, fibro-cel-
lular, fVo-vascular, etc., for the simple reason  that tu-
mours, very unlike in their external characters and natures,
may be composed of the  same elements.  For  instance,
cystic, glandular, cartilaginous, and cancerous growths, are
all fibro-cellular.  It is not, then, from its showing the ex-
istence of one or more elementary structures, but from its
pointing at their mode of arrangement, that the  microscope
is destined to be of infinite  importance in  pathology and
diagnosis.  Neither will chemical  composition  furnish us 
564
SURGERY.
with trustworthy means of distinguishing morbid growths,
as many of them contain albuminous, fatty, pigmentary,
and mineral principles conjoined, although in variable pro-
portions.  The best classification, therefore, is one founded
on our knowledge of the compound textures of the growths
themselves—assisted, as far as varieties are  concerned, by
their  similitude  to  well-known objects, which  have long
been  received in pathology as standards of comparison.
Thus  the following  arrangement appears to  me capable of
embracing all the known classes of primary growth:—
  1st.  Fibrous growths,
  2d.  Fatty growths,
  3d.  Cystic growths,
  4th. Glandular growths, .
  5th. Epithelial growths, .
  6th. Vascular growths,  .
  7th. Cartilaginous growths,
  8th. Osseous growths,
  9th. Cancerous growths, .
  All these primary divisions are susceptible of being sub-
divided according to the presence of particular substances,
or to fancied resemblances which  have received names.
Thus the varieties of the above kinds of growth have long
been determined by their  substance presenting greater or
less  similitude  to well-known  objects, such as water, lard,
flesh, brain, etc., as follows:—
Fibroma, or Inoma.
Lipoma.
Cystoma.
Andenoma.
Epithelioma.
Angionoma.
Enchondroma.
Osteoma.
Carcinoma.
1.	Like water,	Hygroma.
2.	" black pigment,	Melanoma.
3.	" green pigment,	Chloroma.
4.	" blood,	Haematoma.
5.	" glue,	Colloma.
6.	" lard,	Steatoma.
7.	" gruel,	Atheroma.
8.	" honey,	Meliceroma.
9,	" cholesterine,	Cholesteatoma.
 
SURGERY.                  565
1.0.	Like flesh,	Sarcoma.
11.	" nerve,	Neuroma.
12.	" brain,	Encephaloma.
13.	" marrow,	Myeloma.
14.	" marble,	Scirrhoma, etc
  It is easy to understand  how varieties may in this way
be multiplied, and how new names may be scientifically given
to rare forms of tumour, for instance Syphonoma, or tubu-
lar growth, described by Henle;  Cylindroma, by Billroth;
Heteradenoma, by Robin, &c, &c.
  Farther varieties have been made to express one or more
combinations of these elements, and hence the terms Fibro-
cystic,  Fibro-cartilaginous, Fibro-Sarcoma, Osteo-Sarcoma,
and so on.   Indeed, this kind  of nomenclature admits of
farther extension, and such terms as Fibro-epithelial, Angio-
cystic,  Cystic-adenoma,  Osteo-fibrous, and so  on, might be
employed with advantage.   When, also, growths  have a
certain resemblance to,  or largely partake of  the character
of the structures  and substances referred to, while thgir
real nature  is  not  absolutely or  altogether the same, the
words  Fibroid, Cystoid, Adenoid,  Chondroid, Osteoid,  Col-
loid, Hrmatoid, Fungoid, Encephaloid, Myeloid, Cancroid,
etc., have been employed.—(Bennett.)
  Besides the formation of these abnormal  structures as
the result of inflammation, we have the degeneration of the
exudation into pus, and the formation of abscesses.
                     ABSCESS.
  The term  Abscess,  (from abscedo,) denotes,  that  parts
which were in contact, have become separated; and, in pa-
thology, implies a collection of pus in any tissue of the body.
Abscesses are divided by surgeons into eight varieties, viz.:
acute and  chronic, hot and cold, lymphatic, diffused,  me-
tastatic, and  puerperal.  They are formed by the secretion
of purulent matter from inflamed capillaries, confined by a
                          48* 
566
SURGERY.
wall formed by the effusion of coagulated lymph which con-
solidates the surrounding tissues, and prevents  a diffusion
of pus.
                     SYMPTOMS.
   In  acute or phlegmonous abscess,  the part will be  in-
flamed  and swollen, with a throbbing, pulsating pain: as
the pus accumulates and  approaches  the surface, the part
becomes soft  and fluctuating.   As the abscess  advances,
some  portion of the swelled surface becomes more promi-
nent, and more or less livid.  In the majority of cases, sup-
puration takes place,—giving exit to the hitherto confined
pus.   In rare cases, the swelling disappears by the pus  be-
coming absorbed.
   Chronic abscesses are formed by some gland, or some por-
tion of the subcutaneous  cellular tissue becoming irritated,
and frequently with not very prominent constitutional symp-
toms—except swelling.  They soften and discharge a curdy,
puriform fluid, or they frequently extend along some fas-
cia, or burrow deep into the adjacent  tissue, and remain a
lofig time without opening.  The cold, or lymphatic abscess,
mostly occurs in persons of a scrofulous habit, and appears
in the iliac, fauces, groin, or axilla.   The patient usually
feels  but little uneasiness, and does not suffer much pain,
but suddenly finds a large, fluctuating tumour in some of
the parts mentioned above, which, in some cases, opens, but
more frequently remains  indolent, and manifests but little
disposition to suppurate.   If opened,  it will be found to
contain a large quantity of thin,  unhealthy pus.
   A  diffused or puerperal abscess occurs mostly  in women,
after confinement, in  various parts of the body,—commonly
in connexion with  phlebitis, or inflammation of the  veins.
They may be from  a  pin's head, in size, to an abscess capa-
ble of holding a pint or more of pus.   These abscesses may
form  in any part of the body, but are most numerous  where
there is the greatest number of absorbent glands.   The pus 
SURGERY.
567
formed in these abscesses is liable to gravitate and accumu-
late in the more dependent portions of the body, producing
disturbance  of the circulation, &c.

                    TREATMENT.
   The indication to be fulfilled in the treatment of abscess,
is to  prevent the formation of pus—to  evacuate  the  pus
when formed, and to heal the parts, so as to prevent farther
secretion of pus.   To prevent the formation of pus, all irri-
tating substances  should  be removed, such as pieces of dead
bone, &c.; cold packs should be applied, with alkaline baths,
to the surface, followed by brisk friction.
   The bowels should be moved freely by a purge of anti-bi-
lious  physic, and cream of tartar, or podophyllin; tonic and
alterative syrups  should be given, and there should be a free
use of diuretics, such as marsh-mallow,  clivers, eupatorin
purpurin, &c.  If, notwithstanding these means, it is  evi-
dent  that pus is about  to  form, the  treatment should be
changed.
   Warm  flax-seed or elm poultices, wet with the tincture of
arnica or  lobelia, should  be applied to the  part, and  changed
frequently.   The patient should take of equal parts of the
syrup of  chimaphilin and  balmony, one tablespoonful four
or five times a day—also, small  doses  of  precipitate carbo-
nate  of iron and lupulin, three  or four times a day.   The
surface should be frequently sponged in warm lye-water, and
the diet should be nutritious and easily digested.
   When  pointing occurs,  the  pus should  be discharged.
There are  three ways by  which this may be accomplished,
viz.: by  incision, by tapping with the trochar, by making
an aperture in the cyst with caustic.   In acute abscess, the
incision is  preferable.   It should be made either at  the
point where fluctuation  is  most distinct, or at the  most de-
pendent  position of the abscess.  It  should be made by
passing a sharp-pointed  bistoury or lancet into the tumour a 
568
SURGERY.
sufficient depth to reach the pus.   After the abscess is eva-
cuated, it should be injected with warm soap-suds, followed
by a strong solution of myrrh and tincture of arnica.
  In chronic abscess, the opening should be made by means
of caustic potassa.   Should the bone be diseased, the  ab-
scess should be injected with a strong solution of phosphate
of lime,  alternated with sulphate of iron, and sulphate of
zinc.   The patient should take phosphate of iron, chloride
of soda,  and quinine.  If the abscess occur in the extremi-
ties, and is connected with a scrofulous diathesis, the part
should be  supported by a bandage, frequently wet with a
strong solution of salt and water, and the system should be
well supported by tonics and antiseptics.
   A valuable syrup in these cases, may be made as follows :—
Take chimaphila umbellata, or pipsissewa, two ounces; cha-
momile  flowers, one ounce; rock-rose,  two ounces.   Make
one pint of syrup,—add ten drops hydrocyanic acid.   Dose,
one tablespoonful three times a day.
   As to the treatment of chronic abscesses, Druitt remarks,
 if  the abscess is so large  that  the exposure of its  cavity
 would lead to the  evil consequences that have been enu-
 merated, or if it is connected with disease of the spine, or
 other bone, (as in case of psoas abscess,) the following plan
 should be resorted to with a view of inducing a contraction
 of the sac, and of diminishing the danger from a permanent
 opening: should  one be established subsequently, a small
 puncture should be made at the most depending part of the
 tumour.  It may be made valvular,  by drawing the  skin a
 little to one side before introducing  the  bistoury; but this
 is not of much consequence.   As  much matter as flows
 spontaneously should be permitted to escape, and then the
 puncture should be carefully closed by lint and plaster, and
 the patient be kept at rest till it is healed.   During the
 flow of  the matter the greatest care  ought to be taken to
 prevent the admission of  air into  the sac.  At the  expira- 
SURGERY.
569
 tioii of ten days, or a fortnight, when it is nearly re-filled,
 a second puncture should be made,  (but not too near to the
 former,) and should be healed again in like manner.  This
 operation should be repeated at the proper intervals, taking
 care never to let the abscess become so distended as it was
 before the previous puncture,—and using  moderate  sup-
 port and bandages in the  intervals.  Thus,  in  fortunate
 cases,  these  repeated, partial  evacuations, combined with
 proper constitutional measures, will cause the abscess gra-
 dually to contract, so that it either becomes completely ob-
 literated, or degenerates into an insignificant fistula.   This
 method of treatment was introduced by the late Mr. Aber-
 nethy.   He, however, recommended as much as possible of
• the matter to be evacuated at each operation, instead  of
 allowing it to run spontaneously; which latter method  is
 much better calculated to  preclude the admission of air,
 and avoids all irritation of  the cyst by rough handling  or
 squeezing.
    But if air have  gained admission into the  cavity of the
 abscess, and the pus  have  become putrid, and prostration
 of strength, and dry, brown tongue show their influence  on
  the system,  then the indications plainly are, to make free
  openings and  counter-openings,  so as to prevent all lodge-
  ment of  the putrid pus; and to wash out the sac occasion-
  ally with injections of warm water, containing a very little
  of the solution of chloride  of soda.  At the same time the
  general treatment of typhoid fever must be re-adopted, and
  the strength be supported by wine, nourishment, opium, &c.
     Previously to giving the  detailed treatment of the farther
  processes and  changes  produced by inflammation, as well
  as the removal of various heterologous structures, as  re-
  ferred to in the classification  and arrangement of tumours,
  I purpose to proceed  to the consideration of operative sur-
  gery,  and the apparatus essential in this department, 
570                   SURGERY.
                   DRESSINGS.
  By most authors Surgery is divided into Minor Surgery,
including all the lesser operations; and Major Surgery, which
includes all the capital operations.  This division, which has
been  long maintained, is purely arbitrary, as there  are no
natural divisions  whereby minor surgery  can  be  distin-
guished from that of major.   Without attempting, however,
to discuss this subject, I propose to offer a few suggestions
relative to the duties of the general surgeon; among the first
of which is a thorough knowledge of the applications and
dressing of injuries.
   The  principal object of all dressings is  to afford relief
to the injured parts.   The  articles, or means used  for the *
purpose, are known as " Apparatus for Dressing."  These
may be divided into two  parts:—1st. The  instruments for
dressing.   2d.  The materials used  as the  dressing.  The
instruments used for dressing injuries are usually those con-
tained in  the ordinary pocket case, which should consist of
ring  forceps,  simple forceps, scissors,  probes,  directories,
spatulae, bistouries, male  and female catheter, porta? caus-
tic, curved needles, ligatures, tenaculum, and abscess  lances.
Towels, razors,  basins, sponges,  buckets, and such other
things as  are necessary for the removal of all previous dress-
ings,  and facilitating the operation of the present one, may
also be included under the head of instruments.
  Under  the second head, materials  used for dressings con-
sist of lint,  charpie, cotton, tow, compresses, Maltese cross,
shields for amputations, poultices, plasters, adhesive strips,
ointments, collodion,  cataplasms, emollient, strengthening,
astringent, fomenting,  and narcotic  poultices, water dress-
ings, bandages or rollers, splints,  and a great variety of other
apparatus.
  Lint.   Lint is  a delicate   tissue,  or mass,  prepared by
scraping soft old linen.  There are  two  kinds; one called 
SURGERY.
571
domestic, the other patent lint.  The latter can be pur-
chased at most drug-stores.  The former may be made at a
moment's warning, by scraping old linen with a sharp knife.
   Charpie is a substance much employed by surgeons, espe-
cially the French.   It is made by collecting the threads torn
from four to five inches square.   The linen from which char-
pie is  to be made  should be new, as it is said that that
which  is made from new linen absorbs pus, blood, and sup-
purative matter, more readily than that which is made from
old linen.   This dressing is used principally to  keep open
sinuses, fistula, and as outer dressings.  Charpie and lint
are made into various forms, which  have received various
names, such  as the pledget, roll, tent, mesh, bullet, tampon,
etc., etc.
   The pledget is composed of several layers of charpie formed
by collecting the threads, and laying  them parallel to each
other, with ends folded underneath, the whole being flattened
between the palms of the hands, or arranged in other shapes,
according to the requirements of the application.
   The roll is a mass of  charpie,  or lint, made  by rolling its
fibres longitudinally between  the hands, so as to make an
oblong mass,  which may be tied in the centre; the ends
being brought together, it forms a sort of a cone; used mostly
for arresting hemorrhages of  deep-seated vessels, pressure,
etc., etc.
   The tent is a conical mass of  charpie, or lint, twisted by
the fingers, so as to give it a spiral form, of which the base
is  the part at which the fibres are doubled on themselves,
used also for similar purposes as that of the roll.
   Btdlets are little balls made by rolling charpie, or lint, until
it  acquires a round  form.  They are  used for the purpose
of absorbing the pus in deep  wounds.  When several are
used for  arresting hemorrhage, they are called tampon.
   Pellets are  large bullets, surrounded by a piece of soft
linen, the edges of which are brought together  and tied;
also useful as a compress. 
572                   SURGERY.
   Cotton and tow are usually employed as an outer dressing;
they are inferior, however, to charpie or lint, but used on
account of their cheapness.
   Compresses have received several names, such as square,
oblong, triangular,  cribriform, Maltese cross, half Maltese
cross, single  and double splint compress; perforated  pyra-
midal compresses.  These names have reference to the form
of the  compress, and  each form has its use  and advantage
in the treatment of differe»t surgical cases.
   Retractors.  Retractors are of two kinds; two tails, and
three tails.   The two-tail retractor is made  by splitting an
oblong piece of  muslin, used as  a shield to the soft part
in amputations, etc., etc.   The three-tail retractor is made
by splitting a piece of thick muslin into  three slips.   It is
used in amputations,  where there are two  bones to be di-
vided, as in the forearm, leg, etc.
   Adhesive strips are  pieces of  linen, upon which some ad-
hesive  plaster is spread.  [The adhesive plaster  spoken of
in the Eclectic Medical Journal, prepared by Collins & Co.,
I regard as superior to any  I have seen.]
   Collodion, or liquid adhesive plaster, is a preparation  of
gun cotton and ether, first introduced by Dr. Maynard, of
Boston, Massachusetts, used  in many cases in place of adhe-
sive strips.
   Cataplasms, or  plasters, are made of  various  kinds  of
substances.   Emollient poultices are made by wetting suffi-
cient slippery elm,  flaxseed, or comfrey, in warm water, and
stirring it until it is of a proper consistence.  They should
never be  applied too thick or too warm.  The warmth  of
the poultice should be the same as that "of the part to which
it is applied.
   Astringent poultices  are mostly used where there is exten-
sive sloughing, and where there  is great weakness  of the
part caused by an extensive  injury.   An excellent astrin-
gent poultice is made by taking equal parts of pulverized bay- 
SURGERY.
573
berry and geranium maculatum, boiling  it in sweet milk,
and stirring in sufficient slippery elm and flaxseed to form
it into a poultice.   There  are also  other  astringents which
may be used.   Stimulating poultices may be made by add-
ing a small amount of podophyllum peltatum, or sanguinaria
Canadensis,  to a small  quantity of pulverized flaxseed or
slippery elm.  These poultices are  valuable where the parts
are indolent, and where suppuration is desired.
  Fomenting Poultices,  which aue  useful  in hastening sup-
puration, may be made by stirring pulverized  slippery elm
into brewers' yeast, or in the event of its absence a strong
decoction of hops thickened by means of slippery elm and
flaxseed.  It forms a very soothing fomenting  poultice, and
is useful in  hastening suppuration, and where  there is dan-
ger of gangrene or mortification.
  This poultice, in connexion with equal parts of pulverized
charcoal, frequently wet with equal parts of alcohol and wa-
ter, forms a most valuable antiseptic fomenting poultice.  In
cases where  there is a tendency to mortification of the part,
a strong decoction of comptonia asplenifolia, or sweet fern,
should be thickened  with equal parts of charcoal, gum,
myrrh, and bayberry, applied warm and frequently changed.
It has  been  known to arrest gangrene almost immediately.
   Compound Poultices.—In some cases it will  be found ad-
visable to apply the  compound poultice, especially where
there is a great amount of pain and tenderness, or deep-
seated injuries,  liability to gangrene, mortification, &c, or
where  pus is forming in the deep-seated tissues, and is pro-
ducing severe constitutional disturbance.
  Compound poultices are such as include the  properties of
fermenting astringents and  anodynes.  An  excellent  poul-
tice of this class may be made by making  a strong decoction
of hops, polygonum punctatum, or smart weed,  comptonia
asplenifolia,  or sweet fern,  and thickening it with  equal
parts of pulverized slippery elm, gum, myrrh, and bayberry
       49 
574                   SURGERY.
bark.  The poultice should  be frequently wet with equal
parts of tincture opium and  lobelia, and  changed as often
as indicated.  This poultice has many advantages over sim-
ple poultices.  It prevents mortification, allays pain, hastens
resolution, and promotes a healthy condition of the surround-
ing tissues.
   Mustard Poultices.—Mustard poultices are made by wet-
ting a sufficient  quantity of pulverized mustard with equal
parts of water and vinega*, mostly used for  the purpose of
producing re-action, &c.   To be applied  to  the spine, epi-
gastrium, calves of the legs, feet, etc., etc.
   Water  dressings, or irrigation, may be of a  great many
varieties,  such as the application of hot or  cold packs to
the  part;  ice water,  applied in the form  of a pack,  fre-
quently changed; cold or warm water running constantly on
the  part,  by means of the syphon, etc., etc.
   This form of dressing wounds has  become very general,
and is well adapted to a great variety of injuries.   Hot water
is mostly applied where the parts have been severely injured,
and followed  by great debility.  Cold water is used where
there is too violent a re-action of the  part, for  the purpose
of subduing inflammation, and preventing an extensive sup-
puration, &c, &c.
   Bandages,  or Rollers.—Bandages,  or  rollers, consist of
flannel, linen, muslin, calico, gum elastic, or other substance,
of various widths, rolled upon itself in a firm mass.  Band-
ages may be divided into two kinds:—First, simple;  second,
compound.
   The simple bandage is prepared from a  slip of  muslin,
of the requisite length  and  width, by tearing it from the
piece,  and then winding it  into the form  of a cylinder;
which may be done by the  hand, or by a machine.  When
intended  for the body, it  should be fourteen  yards long, and
about three and a half inches wide; when for the extremi-
ties, it should be ten  yards long, and two and a half inches 
SURGERY.                  575
wide; when for the head, six yards in length, by two inches
in width.   Rollers are made into what is called single and
double-headed.  The single-headed roller is rolled from one
end exclusively.  The double-headed roller is made by roll-
ing from  each end.   The single-headed  roller, when ap-
plied  to any part of the body, should be  held  between the
thumb and fingers of either  hand, and pressed by the fin-
gers firmly against the palm, so as to prevent  the  cylinder
from slipping out of the hand as it unrolls, as it is apt to do
when the internal surface is the part first applied.  It should
be retained on the part by pressure of  the fingers, until one
Fig. 34.
or two turns are made around the part to which the bandage
is  applied, and  until  it is firmly fixed; after which the
roller may be  properly carried up  the  limb,  as seen in
figure 34. 
576
SURGERY.
   Bandages have been divided into circular, oblique, spiral,
 figure 8, spica, recurrent, uniting, dividing, expulsive,  re-
 taining, etc.
   The circular bandage is one which is formed by the ho-
 rizontal  turns of the roller, each turn of which  partially
 overlaps the one which preceded it.  The oblique bandage
 turns gradually as it ascends the limb, and passes obliquely
 to the axis.  The  recurrent bandage is  one  in which the
 folds run back to  where they first started.   The uniting
 bandage is  one which is used  for  the  purpose of uniting
 wounds.  Dividing bandages are those which are used to
 prevent  the formation of cicatrices,  in the  treatment of
 burns or wounds attended  with  great loss of substance.
 Compressing  bandages are those used in cases where there
 is great swelling.   Expelling  bandages  are those used to
 expel pus from deep-seated abscesses; retaining bandages,
 to retain dressings, etc.
   Dr. Hennen remarks:—" Dexterity in the application of
 bandages is so necessary, that no  physician  can  properly
 apply  them, unless he has  had much practice;" and he
 thinks that  unless  the  bandage is properly applied, it had
 better be omitted altogether.   He also  remarks, that " the
 practitioner's reputation is  liable  to considerable injury;
 and that he will be sure to suffer  from the  judgments of
 those around  him, if he shows ignorance of this important
 duty." Referring to the application of bandages, he says:—
 " The majority of persons are very attentive to the mani-
 pulations of any workman, and can soon judge, and judge
 correctly, whether he is acquainted with the business; con-
 sequently they do not hesitate to exercise their criticism to
 its fullest extent in the case of the surgeon; and when their
 opinion of his ignorance is confirmed by the patient's con-
 tinued suffering, they are  ever  ready to  disseminate it
 widely."  " On the contrary, when a bandage lies smooth
 and  regularly on the limb,  when  the  patient is  relieved
from previous torture,  and the part assumes the neat ap- 
SURGERY.
577
pearance that always follows  the visit  of an experienced
dresser, the confidence of friends is raised, and  his subse-
quent visit is looked forward to with confident anticipations
of relief."   " Surgeons who from want  of practice cannot
produce the neat appearance of a well-applied bandage, are
frequently  induced, in order to escape the remarks so often
made on this point by those around the patient, to resort
to the wetting of the roller, in order to cause it to adapt
itself to  the part more readily.  But this practice should
never be permitted, except in  the treatment of dislocations,
unless we would wish to expose the patient  to the risk of
mortification, as  it is impossible for any one to calculate
how much a wet roller will shrink in  drying, and conse-
quently how great a degree of pressure it will make on a
part after we have left it."  Great care  should be observed
in the application of bandages, whether  wet or dry, that
they are not applied too tight, as the  one  applied in the
first instance may not be  so tight as to interfere with the
circulation, but will when left a short time  become so.
Great mischief has been done by the improper application
of bandages; the circulation being interfered with, the vi-
tality of the limb destroyed, and its amputation rendered
necessary,  and  in many cases the life  of the patient has
been sacrificed.   The practitioner should ever bear in mind
that the object of the bandage is for the purpose of main-
taining the apposition, and supporting  the parts.   Where
there is any doubt with regard to the tightness of the band-
age, or its  liability to produce pain and interfere with the
circulation, it should be frequently examined, and in such
cases removed and re-applied.

DIRECTIONS FOR APPLYING THE SPIRAL
                     BANDAGE.
   This bandage is the  one most frequently employed in the
treatment of affections of both extremities, and the chest;
                          49* 
578                  SURGERY.
its turns ascend  the  limb slowly, and  are close together,
covering the part most effectually, and  rendering valuable
support, as well as most  thoroughly protecting dressings.
Each turn of the spiral bandage should cover from one-third
to one-half of the preceding turn.   In its application to a
limb, which is of a conical shape, in its passage from the apex
to the base one edge of the bandage is liable to rest firmly
on the limb, while the other edge is loose.  To obviate this
the roller should be  half folded on itself; or  a doubling
made, which is called a reverse.  To prevent uneven pres-
sure, which would occur from bad  reverses,  much  care
should be taken that the reverse be short, and as smooth as
possible.  Dr. Smith  gives the following rules for these re-
verses:—" Hold  the roller in the position in which it is ge-
nerally applied;  that is, either by  its body or  its two  ex-
tremities, the hand being in a  state of supination.   Apply
the initial extremity to the limb,  and  continue  to make
simple spiral turns until you approach the enlarged portion
of the limb; then apply  a finger of  the free hand to that
portion of the bandage which is already in contact with the
limb, not to assist in forming the reverse, or to hold it
down, but simply to prevent the turns already applied from
slipping, or becoming relaxed  while the reverse  is being
made."  He also states  that  " no more of the  bandage
should be unrolled than will enable you to separate the cy-
linder  a short  distance, say four or six inches from  the
limb.  The portion of the  bandage which is between  the
fingers should be perfectly slack; then turn the hand hold-
ing the cylinder, from supination into  decided pronation,
by a simple motion of the wrist alone, without moving the
fingers from the  cylinder, taking special  care not to make
traction, or  to sink the cylinder below the level of the limb,
till the fold or reverse is made, when it again may proceed
up the limb, it  being  recollected  that each turn should be
spiral,  and only cover about one-third of that which  pre- 
SURGERY.
579
cedes it, keeping each turn and each reverse parallel with
its fellow."
   The Crossed, or Figure of Eight Bandage.—This band-
age is useful  in covering joints, and other portions of the
body, where considerable pressure is required.  They may
be either single or double-headed.
   Barton's Bandage, or Figure of Eight Bandage of the
Jcmo.—This bandage is named after  Rhea Barton, of Phila-
delphia, who  first used it with  much success in the  treat-
ment of fractures of the lower jaw.   It is formed by a sin-
gle-headed roller, from five to  eight yards in length, and
from an inch and a half to  two inches in width.   It may be
applied in the following manner:—The initial extremity
should be placed just below the prominence of the  occiput,
or back portion of the head, and then continue the roller
obliquely over the  centre  of the parietal  bone across the
junction of the coronal suture, and over the zygomatic arch,
and under the chin.  Carry the bandage in the  same direc-
tion, and over the same points on  the opposite side, until
you reach the point where  you commenced, and then pass
the bandage obliquely  around  and parallel to  the base of
the lower jaw, carrying it over the chin,  and continue the
same course  on the other side until it ends where you com-
menced.  A pin should be placed in the bandage at the
vertex, and  the  number of layers should be repeated in a
similar manner, until the bandaging is complete.
    The Figure  of Eight Bandage, for the posterior portion
of the chest, requires a roller about six yards long, and two
and a half to three inches  wide.  It may be applied to the
patient sitting.  Carry the initial  extremity of the roller
around the  superior part  of one arm, say the right arm,
and make three or four spiral reverse  turns, from before
backwards, and from within outwards from this shoulder,
passing obliquely over the  back to the left axilla, the shoul-
der being well forced backwards; ascend in front, and over 
580
SURGERY.
the shoulder; pass over the back to the right axilla, over
the front of the axilla, and around the back, and over the
left axilla,  over the front to the back, over the back to the
right axilla.   This course should be continued until the
roller is nearly or quite exhausted, when a few turns directly
around the body should be made.  The anterior figure of
eight bandage is applied in a similar manner, and both of
these bandages  are valuable for the purpose of retaining
compresses, dressings, etc., etc.
   The Spica, or Figure of Eight Bandage vf the Pelvis.—
This bandage requires a single-headed roller, ten or twelve
yards long, and about three inches wide.  It is mostly used
to retain dressings,  compresses, etc., etc.  It may be ap-
plied by placing the  initial extremity of the bandage over
one of the  iliac creases, and making  two or three horizontal
turns around the pelvis, in  order to fix the point of the
bandage; turning from right to left, and from before  back-
wards, if for the right groin, and the  reverse if for the left;
arriving in front of the pelvis, descend to the inside of the
thigh,  and turn around the back part; ascend on the out-
side, to cross the first turn, and  then to the ilium, across
the back, and around the pelvis, to follow the same course,
until  the cylinder is mostly exhausted.   When the whole
may be fastened by a circular turn around the pelvis, where
it is necessary to apply the spica bandage to both groins;
it may be done by means of a double-headed roller applied
to the front of the abdomen in a line with the crest of the
ilium, and  each  head be carried so as to cross behind the
back to  the crest, and then  let  each  head  descend and
pass under and behind, and on the outside, to run—one  to
the right, and the other to the left iliac crest, and thence
around the back,  following the  same course.  The  spica
bandages are of the most convenient kind, and are used for
retaining dressings, &c, to nearly all portions of the body.
  Knotted Bandages.—These bandages have received  their
1 
SURGERY.                   581
 name from their having knots, like packers' knots, and are
 formed by  double-headed  rollers.  They are intended to
 make firm  compression on the  principal  portions of the
 body, and especially upon bleeding vessels  of the  head.
 The knot bandage of the head is frequently applied for the
 purpose of arresting hemorrhage from the temporal artery.
 To apply it, take  a  double-headed roller, five yards long,
 and two inches wide; place the body of the bandage over
 the  compress covering the wounded artery, and  conduct
 the  two heads—the one before, the other behind, to  the
 opposite temple, where they should  be reversed, in order
 to return to the point of departure;  and then give them a
 turn once or twice, so as to enable one to pass over the sum-
 mit of the head;  the  other underneath the chest, to the
 sound side, when they may be reversed, and from thence
 conduct them in the same  course upon the wounded vessel;
 repeat  these turns of the bandage two or three times, and
 knot them firmly each time; let each knot be placed behind
 the one first  formed; the  bandage being then conducted,
 one  head over the vertex,  the other underneath the chin,
 and is terminated by a  few circular turns of the head and
 occiput.
   Recurrent Bandages.—Recurrent bandages are formed by
 convolutions and recurrent turns, which make a kind of cap
 for the part to which they are applied.  These bandages,
 though occasionally used, are very liable to become loosened,
 and they are not so valuable on that account as many  other
 forms  of bandaging.  They may be made of either single
 or double-headed rollers.

            COMPOUND BANDAGES.
   These forms of bandages include a variety of most im-
portant appliances for the retention of dressings, &c.
   Single T Bandage.—The single  T bandage is so  named
from its shape.  It is composed of a horizontal strip, which 
582                  SURGERY.
  passes around the part to be covered, leaving enough to tie
  a bow knot, and a perpendicular piece.  The perpendicular
  piece should be half the length of the horizontal one, and
  firmly sewed to it.   Each portion should be rolled  into
  round cylinders.  The T bandage, if designed for the head,
  ear, or thighs, must be composed of sufficient length to al-
  low each portion to  pass  several  times around  the parts.
  The double T bandage is made like the single one, with the
  exception that there  are two horizontal pieces,  instead  of
  one.   The  perforated  T is  constructed as the single T band-
  age,  with the  exception  that  the perpendicular  strip is
  much wider, and has several  holes perforated through it,
  for the purpose of inserting the fingers, toes, &c.
     The Slit Bandage.—The slit bandage is composed  of a
,  roller three or four yards long, one inch  wide, rolled into
  two heads, and of two  small  compresses, which are to be
  placed on the cheeks  near the angle of the mouth.   This
  bandage should be applied by placing the body of the roller
  on the back portion of the head, about the occiput; carry-
  ing each  cylinder under the lower part of the ear over the
  malar bone, and over the  compresses, make a slit in one
  bandage  large  enough to  pass the other cylinder through
  it.  Continue  this process until  the  parts are sufficiently
  protected.
                        SLINGS.
    Slings  are formed of pieces of muslin, of various lengths
  and widths, with the ends slit into two or more  pieces, ac-
  cording  to  the purposes  for which they are used.  They
  are used  for the purpose of retaining  poultices  and appli-
  ances to  the various  parts of the body,  when  but  little
  pressure  is  required.  They are  also used for suspending
  the arms and legs, in  cases of  fractures and other injuries.
    Suspensory Bandages.—They are composed of small pieces
  of cotton, formed into a bag of sufficient  size to contain a
i 
SURGERY.
583
part or the whole of organs, which they are designed  to
support.
  Lace bandages, stockings, &c, are also used in the place
of the  roller, for the purpose of protecting and compressing
various portions of the body.
  Handkerchief Bandages.—M. Mayor  has introduced a
method of applying a square piece of cotton to the various
parts of the body  as a substitute  to the various forms of
bandages, which I have already enumerated.  He claims
for his method of applying the handkerchief, or piece of
muslin, that it serves all  the purposes for which all other
bandages are applied, and that it is superior, inasmuch as
the material is always at hand, and can be applied by per-
sons of less experience than is required in the application
of  the ordinary rollers.  M. Mayor makes four modifications
of the handkerchief:—1st, the oblong, or cravat-shaped; 2d,
the triangular; 3d, the cordiform;  and fourth, square.
   The first application of the handkerchief bandage is that
which is applied to cover the entire head, and is  called the
square cap  of the head.   This is to be applied so as to draw
the ends down the side of the face, and tie them under the
chin.   Draw the other two ends backwards, and tie at the
occiput.  This is used for the purpose of  securing dress-
ings.   M. Mayor goes on  to enumerate some fifty or more
methods of applying this  form of bandage to various inju-
ries in all  portions of the body.   But as the application
 consists in  adjusting the handkerchief to the parts, and  se-
 curing it by tieing the ends, it is not essential to enter into
the details  of  the various  applications as described by Dr.
 Mayor.
INSTRUMENTS  USED IN  MINOR SURGERY.
   The instruments used in minor surgery consist of those
which are found in the ordinary pocket-case, such as  the
various  kinds of bistouries, scalpels, tenaculums, (see figs.
35—4(i,) scissors,  silver probes, directories, artery forceps,
catheters, caustic-holders,  needles, silk, silver wire, bull-dog 
584
SURGERY.
forceps, exploring  needle,  exploring  trochar, spatula, ca-
nula, etc., etc.
    Fig. 35.  Fig. 36. Fig. 37.  Fig. 38.  Fig. 39.   Fig. 40.

                  1
Fig. 41. Fig. 42. Fig. 43. Fig. 44.  Fig. 45.  Fig. 46.
 
SURGERY.
585
   Incisions.—Ordinary incisions are made with the scalpel
 or  bistoury.   For this purpose the instrument should be
 held  as  a pen in writing,  or  it may be grasped  by the
 thumb, first and second fingers, with the  handle of the in-
 strument resting in the palm of the hand; or the index
 finger may be applied to the back of the handle,  by a
 slight depression of its extremity.  The bistoury may be
 substituted for the scalpel, and used in the same manner.
 It  is commonly used where the director is required; the
 director  being first introduced, and  the instrument passed
 along the groove.  This is especially useful in laying open
 sinuses, and in minute dissections.   Incisions may be made
 from without inwards, or from  within outwards.   They
 should be made  along the course  of vessels, nerves, and
 muscles.
    Union of Wounds.—To secure the union of wounds, the
 edges should  be  brought firmly together, and  maintained
 by  means of adhesive strips or sutures.   Sutures  should
 not be used when the parts  can be maintained in apposition
 by  the strips.
   Sutures.—For the application of sutures, the needle and
 thread are used.  The best needles, for this purpose, are
 those which are about  two  inches long, and straight two-
 thirds of their way—the balance being gently curved, with
 two cutting edges.  A variety of  other  shaped needles,
 however, has been recommended and used by different sur-
 geons.
  Materials for Sutures.—The materials used for sutures ,
 may be either of  animal, vegetable, or metallic substances.
 The most reliable suture, however, is that which is  known
 as dentists' silk.  The silver wire  and  cat-gut  suture are
 frequently used.
  Interrupted Suture.—An interrupted  suture is made by
passing a needle, armed with a ligature, from without in-
wards through the right lip of the wound, about one-third
       50 
586                   SURGERY.
of an inch from its  margin.  Being continued, it should
enter the left lip from within, about the same distance from
the edge, and  pass outwards, at exactly the opposite point
of insertion in the right.  All the sutures should be intro-
duced  before  any are  tied,  after which they are  all to be
tied with  the  common  reef  knot,  and  the  ends closely
clipped.
   Continued Suture.—This  suture is made by passing the
needle diagonally through the lips  of the wound, leaving
the thread uninterrupted.   It is mostly used in wounds of
the intestines.
                         Fig. 47.
   Quill Suture.—This suture is formed by passing it double.
through  the  lips of the wound, as in interrupted suture,
but at a greater distance.  The  ends are tied over a quill,
or some other substance which serves the same purpose.
   The Twisted Suture.—This suture is made by inserting 
SURGERY.
587
steel or silver needles through the wound, and twisting the
suture around it in the shape of a figure eight.
  Hemorrhage.—To prevent hemorrhage, previously to and
after operations, ligating the vessels, and pressure are used;
manual pressure may be made by pressing the fingers firmly
on the artery above the point of hemorrhage, or some hard
substance may be caused to compress the vessel.   The tour-
niquet, however, is the instrument most generally used for
compressing the  vessels, and the  arrest  of hemorrhage.
(See fig. 47.)
  Twisted handkerchiefs, or strips of muslin, are also some-
times used.for this purpose.  During the operation the he-
morrhage is most promptly controlled by pressure from the
assistant's finger, or the arterial clamp  may be used.
Fig. 48.
  Ligatures.—The ligature is also used for the purpose of
controlling arterial hemorrhage.  It can be applied by hook- 
588
SURGERY.
ing up the artery with the tenaculum, or a pair of arterial
forceps.   (See fig. 48.)  The arteries should be separated
from the surrounding tissues, and the end secured by means
of the surgeon's knot.  Cold and styptics are also used for
the purpose of arresting hemorrhage.

                 ANAESTHETICS.
   The only anaesthetics in common use are chloroform and
sulphuric ether.
   Chloroform is  frequently found in the shops adulterated
with alcohol, oils, and ether.   Oils are detected  by adding
a few drops of sulphuric acid, which gives the chloroform a
yellowish appearance.  If it contain alcohol, it will turn a
milky colour  upon the addition of water.  In order to ob-
tain the full benefit  of chloroform, it is essential that it
should be administered in its pure state.  Sulphuric ether
is also found adulterated with volatile oils, sulphuric acid,
&c.  It can be purified by washing it with lime-water.
   The best method of administering chloroform, is first to
empty the stomach by means of a  mild emetic;  second,
loosen  the clothes about the neck,  chest, and  abdomen;
third, see that the patient is provided with fresh air during
the  inhalation; and, provided the patient be of a feeble
habit, a  tablespoonful of brandy  should be administered.
The patient being thus prepared, he should be placed upon
the  table, and instructed  to empty his lungs.   A napkin
should be  impregnated  with a dram or so of ehloroform,
and held over the nose at the distance of from two to three
inches,  and gradually brought  nearer until it  is within
about half an inch, beyond which  it should not be carried.
The  napkin should  be frequently wet, and  the assistant
most vigilant  in  observing that the  patient  has plenty of
air.  As soon  as  sensibility has  entirely disappeared,  the
operation should  be commenced.
  In the administration of sulphuric ether a bell-shaped
sponge should be used, with  an aperture at the  base suffi- 
                      SURGERY.                   589

cient to admit air.  It should then be saturated with ether,
and held firmly over the patient's mouth and nose, and the

                         Fig. 49.
process continued until sensibility is lost, as in, the case of
chloroform.
  Resuscitation.—Resuscitation  can be  produced  by rc-
                          50* 
590
SURGERY.
moving the anaesthetic, allowing the patient plenty of fresh
air, dashing cold water on the face, chest, and  spine, and,
if necessary, volatile  stimulants, electricity, and chafing
friction, may be had recourse to.

           WOUNDS  OF  ARTERIES.
   Wounds of arteries may occur, either with  or without'
an immediate destruction of their coats.   An artery may he
wounded  by a sharp or blunt instrument, when its coats
will be either cut or torn; or it may be so injured by con-
tusion as  to destroy the vitality of its coats, and a solution
of its continuity will occur by degrees.  In either event
hemorrhage will  occur.  In  the first  instance the hemor-
rhage will be of an active character, and occur immediately
after the injury; in the  latter it will be secondary, and will 
SURGERY.
591
not occur until after the arteries have become disorganized.
If the wounded artery is in the extremity, the hemorrhage
                        Fig. 51.
may be first controlled by means of pressure.  Afterwards,
if it continue to bleed, the wounds should be enlarged, and
a ligature be applied.   Whenever a main artery of a limb 
592
SURGERY.
is essentially injured by a musket ball, or  otherwise, mor-
tification is very liable to occur; yet no hasty operation

                        Fig. 52.
should be resorted to, but every possible  means to invigo-
rate the limb, such as stimulating liniments, friction, wrap-
ping the part in hot flannel, &c.  If, after all these efforts
have been made, mortification should occur, amputation is
the only remedy.   Where punctured wounds injure the
deep-seated  arteries, the hemorrhage may be controlled by
pressure.  This is  especially the case where the pressure
can be made in such a way as  to secure the wounded ves-
sel between the compress and the bone.   Dr.  Stephen Smith
has given the following special rules for the treatment of
wounded arteries:—
  1. When  the internal carotid is wounded through the
mouth, Mr. Guthrie advises that a ligature be placed  above 
SURGERY.                  593
and below the opening made into it; the rule which gene-
rally obtains among surgeons  is to apply a ligature to the
common carotid.
   2. When any one of the branches of the external carotid
has been wounded,  it ought to be tied at both ends, at the
part wounded;  if the surgeon cannot do this, and the he-
morrhage demand it, the trunk of the external carotid is
the vessel on which the ligature should be placed, not that
of the common  carotid.
   3. The internal  carotid artery, when wounded near the
bifurcation of the common carotid, is to be secured by two
ligatures.
   4. A ligature may be placed on the internal or external
carotid, close to the  bifurcation,  with safety; but if the
wound of either vessel should encroach on the bifurcation,
one  ligature should be applied on the common trunk, and
another above  the  part wounded; but as neither  of these
would  control  the  collateral circulation  through the unin-
jured vessel, whichever of the  two it might be, a third liga-
ture should be  placed on it above the bifurcation.
   5. The error of placing a ligature on the  subclavian ar-
tery above the  clavicle, for a wound of the axillary below
it, should never be committed.
   6. Punctured wounds of the arteries of the arm and fore-
arm ought to be treated by pressure applied  especially to
the part injured, and to the limb generally; but when the
bleeding cannot be restrained in this manner, a ligature
should be applied  above and  below the part injured,  whe-
ther the artery be radial, ulnar, or interosseal.
   7. When the ulnar artery is wounded in the hand, which
is a comparatively  superficial  vessel, two ligatures should
be placed upon it;  when  the opening is small, pressure
may be tried.
   8. When the radial  artery is wounded in the  hand, in
which  situation it  is deep seated, and the bleeding end or
ends of the artery can be seen, a ligature should be placed
i^. 
594                  SURGERY.
on each.  If this  cannot be done, search should be made
by incisions through the fascia, as extensively as the situa-
tion through the tendons and nerves in the hand will per-
mit.   The bleeding point should be fully exposed,  all coa-
gula removed, and a piece of lint, rolled tight and hard,
of a size only sufficient to cover the bleeding point, should
be laid upon it;  a second and larger hard piece should then
be placed over it, and so on, until the compresses rise so
much above the level of the wound as to allow the pressure
to be continued  and retained on the proper spot, without
including the neighbouring parts; a piece of linen, kept
constantly wet and cold,  should be applied over the  sides of
the wound, which should  not  be closed, so  as to allow of
any blood being freely evacuated.
   9.  The anterior tibial artery is to be tied at that part of
its course at which it  may be wounded.   A case has been
supposed, in which a  knife, a  sword, or  other narrow in-
strument, having penetrated the upper part of the leg, has
wounded the anterior tibial artery just  after it has been
given off from the posterior tibial, behind the  interosseous
space or ligament.  The bleeding is free, and from the
wound in the front of  the  leg, although the  artery cannot
be secured,  from the narrowness  of the space  between the
tibia and the fibula, behind which space it is situated.  This
very  peculiar injury,  which may, however, occur at any
time, cannot be known until an incision has been made on
the fore part of the  leg, and  the bleeding  point  seen so
deep between the bones as  not  to admit of two ligatures
being placed on  the artery above and below it.   In such a
case, an incision is to  be made through the calf of the leg,
when the artery can be secured without difficulty.
   10. The posterior tibial, or the peroneal artery, or both,
if wounded  at the same  time, are to be tied through a free
incision in the calf. 
                      SURGERY.                  595
                                              i.
   11. The popliteal  artery is never to be secured by liga-
 ture, unless wounded and bleeding.
   12. An instrument penetrating the thigh two inches be-
 low Poupart's ligament, and wounding the superficial femo-
 ral artery, will necessitate the application of two ligatures,
 one above  and the other below the wound  in  the  vessel;
 but as the profunda under  ordinary circumstances is given
 off posteriorly at this spot,  it is possible the upper ligature
 may be placed on the main artery a little above the bifur-
 cation.   The result might,  and would probably be, on some
 sudden movement of the  patient, a recurrence of the hemor-
 rhage by regurgitation from the  profunda into the main
 trunk below the ligature;  and  thus through the wound in
 the artery, the lower ligature  assisting by the obstacle  it
 offers to the passage of  blood  through it.  In such a case
 the wound should be re-opened, and the profunda sought
 for and tied.
    13. When a wound of the femoral artery or its branches
 occurs, and the bleeding cannot be restrained by a mode-
 rate but regulated compression in the trunk of the vessel,
 and perhaps on the injured part,  recourse should be had to
 an operation, by which both ends of  the wounded artery
 may be  secured  by ligature;  and  the impracticability  of
 doing this should be ascertained only  by the failure in the
 attempt.   If  the  lower  end of the artery cannot be found
 at the time, the upper only having bled, a gentle compres-
 sion maintained  upon the track of the lower may  prevent
 mischief;  but if dark-coloured blood  should flow from the
 wound, which may be expected to come from the lower end
 of the  artery, and compression does not suffice to suppress
• the hemorrhage, the bleeding end of the vessel must be ex-
 posed, and secured near  to its extremity.
    14.  Wounds of the sciatic and internal  iliac should be
  treated by a ligature applied  to  both  cut extremities, and
  not to the arteries at their origin.      • 
596                   SURGERY.
         j
  The instruments used to ligate an artery are scalpel, for-
ceps, the common aneurism needle, director, spatula, and
ligature.
         WOUNDS  OF  THE VEINS.
  Veins may be wounded similarly to the arteries, but there
is much less liability to hemorrhage.
  The vena cava and subclavian veins,  when  lacerated, are
usually followed by fatal hemorrhage.   The hemorrhage oc-
curring from wounds of the smaller veins is easily controlled
by pressure; while that from  the  larger veins  may be ar-
rested by the ligature, in the same manner as that described
for ligature of the arteries.
   Varicose Veins.—Various methods have been suggested
for the purpose of treating varicose veins.  A plan that I
have found successful in some  instances is, to compress the
vessel  by means of a roller or a lace  stocking, and bathe
the part once or twice a day in a solution of muriated tinc-
ture of iron, of the strength of one part of iron to four parts
of water.  Another method is, to  pass a needle under the
vein, another through  it,  and  ligate the vein so as to de-
stroy the  main trunk.   Still another method is to lay the
vein open, and apply compresses and  bandages.   Dr.Vel-
peau recommends a  complete  section  of the vein with a
straight bistoury.   Dr. Home treats it by ligating the main
trunk.  Cauterizing  the vein with caustic  potassae, inject-
ing the veins  with  powerful astringents, by means of the
hypodermic syringe, have  proved successful in many cases.
Per-chloride and the per-sulphate of iron, diluted with water,
have been very successfully employed.

                 AMPUTATIONS.
  Amputations are performed through  the shaft of the
bones,  or through the joints.   In  the former, it is said to
be in the continuity; in the  latter, the  contiguity.  We 
SURGERY.                   597
copy the following very excellent remarks on the considera-
tion of amputations in general from Dr. Erichson:—

       " GENERAL CONSIDERATION OF OPERATIONS.
   " Manual skill and dexterity are  necessarily of the first
advantage to a surgeon, and he should diligently endeavour
to acquire the art of using his instruments with neatness,
with rapidity, and with certainty; but, desirable as it doubt-
less may be to be able to remove a limb, or  to cut out a
stone,  in so many seconds; important, in a word, as  it is to
become a dextrous operator, it is still of far greater import-
ance to become a successful one.  The object of every ope-
ration  is the removal of disease, that  either threatens  the
life, or that interferes with the comfort and utility of exist-
ence;  and the more certainly  a surgeon can  accomplish
this, the better will he do his duty to his  patients, and the
more  successful will he be in his  practice.   Success, then,
in the result of an operation, whether that result be  the
preservation of life, or  the  removal of a source of discom-
fort, is the  thing to aim at.   To this, dexterity and rapidity
in operating are in the highest degree conducive; but there
are various other considerations equally or still more neces-
sary, the solution of which can only be afforded by an inti-
mate general acquaintance with the science of  surgery and
of medicine.  The diagnosis of the  nature, and the  extent
of the connexions  of the  local disease, have to be  made;
lurking visceral affections must be detected, and, if possi-
ble, removed.   The constitution of the patient must be pre-
pared for the operation; the best time for its performance
seized; and, after its  completion, the  general health must
be attended to in such a way as shall best carry the patient
through the difficulties he has to encounter, and any sequelae
or complications  that arise must be met  by, and must be
subjected to appropriate treatment.  These, as well as  the
simple  performance of the operation, are  the duties  of  the
       51 
598
SURGERY.
operator; and on the manner in which these are performed,
as much, or even perhaps more, than on the mere manual
dexterity displayed in the operation itself, will the fate of
the patient depend.   It  is well known that  the result of
operations differs much in the practice of different surgeons
of acknowledged dexterity, and this variation in the propor-
tionate number of recoveries cannot be accounted for by the
difference in the degree of manual skill displayed in the ope-
ration itself;  but must rather be sought in the greater at-
tention that is paid by some surgeons to the  constitutional
treatment of their patients before and after the operation,
and to their  more  perfect acquaintance with the general
science and practice of surgery.   Indeed, success in opera-
tive surgery depends  greatly upon the selection of proper
cases.  The practice  of  operating in notoriously hopeless
cases, with the view of giving the patient what is called the
last chance, is much to be deprecated, and  should never he
done.   It is by operating in  such cases, especially in  can-
cerous diseases,  that much discredit has resulted to surgery,
for in a great number of instances the patient's death is has-
tened by the procedure; which, instead of giving him a last
chance, only causes him to be despatched sooner than would
otherwise have  happened.
   " The condition of  a patient that  principally determines
the result of an operation, is the state of his general health.
Indeed, the state of the patient's constitution influences the
success of an  operation far more than the mechanical dexte-
rity with which the surgeon  performs it.   It is no uncom-
mon circumstance  to  see patients  sink  after the most dex-
trously performed operations for hernia, stone, the ligature
of arteries, &c, owing  to  some  morbid condition of the
blood  or the  system  that disposes to diffuse  inflammation;
whilst, on the other hand, some patients will make the most
remarkable and rapid  recoveries after they  have been muti-
lated with but little skill.  Persons of an irritable and anxious 
SURGERY.                   599
mind do not bear operations as well as those of a more tran-
quil mental constitution.  Those also of a feeble and irrita-
ble habit of body, especially nervous and hysterical women,
with but little power of circulation, cannot bear up against
severe surgical procedures,  being  apt to  become depressed,
exhausted, and to sink without rallying.   The condition of
the patient's heart should also be carefully looked to before
an  operation is undertaken.   Fatty degeneration of this
organ, as indicated by its feeble action, by irregularity and
want of power in the circulation, by breathlessness, and by
a distinctly-marked arcus senilis,  should make the surgedn
careful in undertaking any operation  attended with much
loss of blood, or shock to  the nervous  system; though it
need not be an absolute bar to its performance, if the dis-
ease  for which it  is to be practised  would  otherwise be
speedily fatal.   Disease of  the  lungs, of a phthisical cha-
racter, when active or advanced,  is incompatible with the
success of an operation; but under certain circumstances, as
will be explained when speaking of diseases of the joints,
and fistula in  ano, an operation is justifiable and proper,
even though the patient be  consumptive.   Perhaps the
most serious constitutional affection, and the one that more
than any other militates against the success of an operation,
is a diseased state of the kidneys, with albuminuria; in this
condition,  the  inflammatory action that  is  set up is apt to
run into a diffuse and sloughing form, and this is especially
the case in all operations about the genito-urinary organs.
The contamination of the patient's system by malignant dis-
ease must always prevent our operating, as a return to the
affection will  most certainly  speedily take place.   And,
lastlj, no operation, save of the most urgent necessity, and
to rescue the patient from immediate death, as for the sup-
pression of arterial hemorrhage, should  ever be performed
whilst he is  labouring under  erysipelas, phlebitis, or any
diffuse inflammation;  and even during the epidemic preva- 
600
SURGERY.
 lence of these affections, operations that are not of imme-
 diate necessity, as for the^removal of simple tumours,  espe-
 cially about the head, should be postponed until a more fa-
 vourable  season.  Operations  in very old people, if of a
 severe character, and attended by much shock of the  sys-
 tem, are commonly fatal; thus  amputations in individuals
 above the age of seventy are very rarely successful.
   " The causes of death after operation are partly dependent
 upon the operation itself, but in the great majority of cases
 they  are more connected with the  constitutional  condition
 of the patient, and with the influences by which he is sur-
 rounded, than with the local injury inflicted during the
 operation.  How often  do we see patients carried off by
 fatal  diseases supervening on the most trifling operations,
 as the removal of a finger or toe, or of small  encysted tu-
 mours of the scalp, from some condition of the system that
 is unconnected with the injury that has  been inflicted; a
 condition that only required the local  disturbance of the
 operation to call it into activity.
   " The conditions that are most to be dreaded by the sur-
 geon, and that most commonly tend  to a fatal result after
 operation, are shock, hemorrhage, and surgical fever, with
 its local complications.
   " The  shock of an operation may prove fatal in various
 ways; from  the  severity of the mutilation, as in a case of
 double amputation;  from the nervous centres  being impli-
 cated, as  in  the  removal of large  tumours from the face,
 that have connexions with the base of the skull; or from
 the state of nervous depression in which  the  patient has
 previously fallen, causing  him  to feel  the influence of an
 operation disproportionately to its severity.  These various
 effects of shock  have, however, been much lessened since'
 chloroform has been generally administered in  operative
 surgery.
   "Hemorrhage,  if very copious, may destroy the patient
by inducing  syncope, that  may be immediately  fatal; or, 
SURGERY.
601
 by increasing the influence of the shock, so that he cannot
 rally; or it may be attended by serious after-consequences,
 such as the supervention of hemorrhagic or irritative fever.
 When occurring a few hours, or a day or two after an ope-
 ration, it usually proceeds from the  imperfect  ligature of
 the vessels, or from arteries bleeding after the setting in of
 re-action, which had not furnished blood whilst  the patient
 was under the influence of the shock of operation.  Under
 these circumstances it is of  far less  moment, and less fre-
 quently fatal, than when occurring at a later period, arising
 from some morbid condition of the wound or system, and
 usually associated with a typhoid condition, in consequence
 of which the proper  formation of plastic matter is  inter-
 fered with.  During the performance of the operation, he-
 morrhage  should, as much as  possible, be prevented;  the
 operation itself is a cause of depression, and any great loss
 of blood would only greatly aggravate this.
   " Surg iced fever, of an irritative type, associated with ce-
 rebral symptoms, may set in with unusual violence; but it
 never, I believe, proves fatal without  the  manifestation of
 some local  inflammatory mischief.   These local inflamma-
 tions are, indeed, the  most frequent  causes of death after
 operations; they are all of a confused congestive, or adyna-
 mic character, and are  frequently connected with a pre-
 vailing epidemic  constitution at the time.  They are of two
 distinct  kinds; the first, taking their origin from a wound
 as from a central starting-point, are the various forms of ery-
 sipelas, diffuse inflammation of the cellular tissue, inflamma-
 tion of veins, and absorbents, hospital gangrene, and diffuse
 suppuration of bone.   The others are those secondary  affec.
 tions which fall upon some internal organ, as for example, the
 lungs, liver, brain, or gastro-intestinal mucous membrane.
The most frequent and fatal of these various complications
is congestive inflammation of the lungs; which is an almost
invariable accompaniment, if not a cause of death in surgi-
                          51* 
602
SURGERY.
 cal fevers.   The membranes of the brain, in other instances,
 are found inflamed; and more rarely the gastro-intestinal
 mucous surface is affected.  Internal organs may also have
 been so injured by the accident or disease that necessitates
 the operation, as to be unable to recover themselves, and fall-
 ing into a state of inflammation or gangrene, may destroy
 life.  This we see happen in the intestines in cases of her-
. nia, and in the brain in injuries of that organ."
    For the instruments used in amputation, see figs. 47—51.

                      OPERATION.
    Amputation may be  performed in two ways, with nearly
 the same facility.   One method is called the circular, the
 other the flap.
    The circular operation consists in first fixing the tourni-
 quet on the main artery, a considerable distance from the
 place of operation, sufficiently tight to entirely interrupt the
 circulation.   After which, if the arm is the limb  to be ope-
 rated  upon, as represented  in fig. 53, the  patient should
 either be placed on a table, or seated on a chair, one assist-
 ant supporting the  arm, while another grasps it with both
 hands, and  forces the integument back as far  as possible.
 The surgeon at the same  time passes  his hand  and knife
 under the arm, as represented in the figure, bringing his
 knife  completely over the arm, and by commencing to cut
 with the hilt, it should be firmly brought  around to the
 point from which it started,  separating the integument  and
 superficial fascia, after which a small scalpel should be used
 to loosen the skin and fascia upon the arm for two or three
inches, and  by means  of a  split  bandage the  integument
should be retracted as far as possible.   This  is done for the
purpose of leaving a good stump.  A second incision should
now be made as far up  as the skin is  retracted,  separating
all the soft tissues to the bone.  The muscles are  now sepa-
rated from the bone by a scalpel, and  held back by a strip 
SURGERY.
603
of strong muslin, (called  a  retractor,) slit so as to pass on
each side of the arm.  The  covering of the bone or perios.
                         Fig. 53.
teum is next divided by a circular sweep around it with a
small knife.  The next step is to saw off the bone, which
should be  done with much  care, so as not  to fracture or
shiver any portion of it.   When this is done, all  the sharp
edges should be  trimmed  off with a pair of bone forceps.
The brachial artery should then be tied, and  the tourniquet
removed.   All the small  arteries which are now observed to
bleed, should be well secured with the ligature.   When the
arteries are all tied, and the veins have stopped bleeding, the
stump should be  thoroughly cleansed with cold water, and
the flap brought together in an exact horizontal line across 
604
SURGERY.
the middle of the stump, and fastened by means of adhesive
strips, four or five inches in length, and one-half inch wide.

                        Fig. 54.
The stump should then be covered with lint, and secured by
a bandage tightly applied, and kept wet with cold water.
When the ligatures are applied  to the artery, they should
be tied in what is called a surgeon's knot, with ends of suf-
ficient length to hang beyond the edge of the wound.  The
dressing should be carefully removed every two or three days,
but no attempt should be made to remove the ligatures under
eight or ten days; and it should not be done then, unless it
can be effected by gentle pulling.
  In the flap operation, as shown in fig. 54, 
SURGERY.
605
  The knife is thrust into the limb at the point where am-
putation is to be made, until it reaches the bone, and then
by a gentle rotary motion it is passed back of the bone, so as
to make the posterior flap first.  The incision is now made
downward and outward, so that the knife will emerge from
one-and-a-half to four or five inches from the point of inser-
tion.   The knife is again introduced at the point where it
first entered, making an incision forwards and  upwards, so
as to form a flap corresponding with the first.  The flaps
should now be brought back, the periosteum  separated,  the
bone divided, and the operation completed as directed in the
circular operation.
  A mputalion of the leg* may be  performed in two situa-
tions, according to the seat of the disease, and the position
of the patient in life.  In those individuals who can afford a
well-constructed artificial limb, and in whom the disease will
admit of it, the amputation may be performed in the lower
part of the leg.   In those, on the other hand, who will be
obliged to wear  a common wooden pin, a long leg  stump
would be  highly inconvenient and much in  the way; and
here the operation usually leaves the best result, if performed
just below the tuberosity of the tibia.   If, however, the dis-
ease be confined to the ankle, amputation, even among the
poorer classes, may be advantageously done below the calf;
the  patient afterwards wearing a  short wooden pin, in the
socket of which the stump is fixed in the extended position,
as recommended by Fergusson.
  The flap operation of the leg may be performed in the fol-
lowing way.   The tourniquet having been applied to  the
artery in the popliteal space, the assistant, whose  duty it is
to retract  the  flap, takes his stand in this, as in all amputa-
tions of the lower extremities, opposite to the surgeon.  In
the left limb the knife is entered at the posterior edge of the
tibia, carried forwards for a distance of one-and-a-half inches,
* Erichsen. 
606
SURGERY.
then across the anterior part of the leg to the posterior bor-
der of the fibula, up which the incision is made to extend to
a corresponding distance; on the right leg the incision com-
mences on the  fibular side of the limb,  and terminates on
the tibial.
   The flap thus formed, which should  be  broad  and well
rounded, is next dissected up  by a few touches of the point
of the knife, and transfixion of the limb made by passing the
blade across behind the bones from one angle of the incision
to the other.   The posterior flap is then formed by cutting
obliquely, downwards and  backwards, and  should be about
three inches long.  The bones are next  cleared by a double
sweep of the knife, and the interosseous soft parts divided by
carrying  the instrument in a figure of eight way, between
the bones.  In doing this, especial care must be taken not to
direct the edge upwards, so as to split either of the tibial ar-
teries, more particularly the anterior: for as these vessels re-
tract above the membrane, its  ligature, when divided  too
high, is  no easy matter.  In sawing  the  bones, the fibula
should always be cut first, as otherwise it will be pretty sure
to be splintered.   This bone may be best divided on the left
side by sinking the hand  below the level  of the limb, and
using the heel of the saw: and on the right, by holding the
hand above the limb, and cutting with the end of the instru-
ment.  If the limb be very muscular, a large pad of the mus-
cles of the calf will be left in the flap; this will usually be a
good deal in  the way during treatment, may slough, and
thus interfere with proper union.   In order to avoid this,
the best  operation consists in such cases as these, in form-
ing skin flaps on the anterior and posterior aspects of the
limb, and then making a circular cut through the muscles.
In this way the ends of the bone receive but a thin covering;
but this matters little if the operation  is  performed just be-
low the knee, for the patient bearing upon the anterior face
of the stump exercises  no pressure upon its cicatrix when
an artificial limb is adapted to it. 
SURGERY.
607
  Amputations of the thigh are commonly required both for
accident and disease; they may be performed in three situa-
tions : immediately above the knee, in the middle of the limb,
or in its upper third.   In  the  amputation in the lower and
middle third, a tourniquet may be applied high in the limb;
but when the operation is performed  in the upper third
there is no space for the application of this instrument, and
the surgeon must then trust to an assistant compressing the
artery as it passes over the brim of the pelvis.  This is best
done by grasping  the great trochanter with the* fingers of the
right hand, and then applying the thumb firmly over the ar-
tery.  Upon this,  the other thumb is then pressed  as firmly as
possible, and thus all  chance of letting the vessel  slip is pre-
vented.
   Amputation  above the knee, or Vermale's operation, is
best done by lateral flaps.  In performing this operation, the
outer flap should always be made  first.  The point of the
knife being entered in the middle  of the thigh, about three
inches above the border  of the patella, is close round the
bone, and brought out round the centre of the ham; the flap
is then cut downwards and outwards; the knife being entered
again in the upper angle of  the incision, is carried close
round the bone to its inner side, and the inner flap made by
a sweeping cut.  Unless  the  blade be kept in contact with
the bone in this situation, the femoral artery is very apt to be
split; the flaps being then retracted, the bone  is then cleared
by two sweeps of the knife, and  sawn about four  inches
above its articular surface.  In the middle and upper third
of the thigh, the  antero-posterior flap operation is to be pre-
ferred.  In ordinary cases the anterior flap may first be made,
and the posterior one subsequently  fashioned  by  transfixion.
   If, however, the patient be very much emaciated, it is dif-
ficult to get a good cushion from  the  anterior part  of  the
thigh in this way, and it is consequently preferable to follow
the plan recommended by Mr. Luke, " of making the pos- 
608
SURGERY.
terior flap first by transfixion, and the anterior  one after-
wards by cutting from without inwards.   If the patient be
excessively muscular, and the operation be a primary one, I
think it is better to make a skin flap by a circular incision
through  the subjacent soft parts.  In this way the large,
gaping, fleshy stumps are avoided,  which commonly run iuto
unhealthy suppuration and sloughing, and lead to the death
of the patient.
   Amputations  in the Contiguity.—The  method  of ampu-
tation already described may be employed in the disarticula-
tion of limbs.  The instruments required are a single knife,
having a narrow blade, to enable  it to move more  readily
over the irregularities of the joint, with a thick back to give
it firmness, and an artery forceps.  The  chief points to be
considered by the operator are thus concisely stated by Mal-
gaigne, (Operative Surgery, American Edition:)—
   " The operator has three special objects in view:—I.  To
well recognise the articulation before commencing.   2. The
flesh being divided, to traverse the articulation without hesi-
tation, destroying all its means of attachment.   3. To pre-
serve flesh and integument enough.   Whence the following
rules:—
   " To  Recognise the Articulation.—The  surgeon  should
have the disposition of the articulation so fixed in his mind,
that he could, without having it under  his eyes, trace it
out exactly.   In this way, recognising one part of the arti-
culation, he is sure of the others,  neither the blood  nor the
soft parts causing the knife to deviate.  He must also know
the direction of the ligaments, to  attach them more  surely;
their length, to  cut them between their attachments;  their
breadth, to divide them completely.
   " 1.  The  surest guide in finding the joints, are the osse-
ous projections.  It  is with them you must  first  occupy
yourself.  To find them, you place the limb in a position
that causes  them to project; seek them on the side where
they are most prominent;  put aside by careful pressure the
J 
SURGERY.
609
 soft parts, fat, or oedema that mark  their projections; and,
 lastly, seek them by starting  from a known  point;  for ex-
 ample, passing the finger along the shank of a long bone
 till you reach its extremity.
   " 2.  The second indication consists in the folds of the skin,
 sometimes placed immediately  above  the joint, sometimes
 some way from it.
   " 3.  You may, as a third recourse, cause to be prominent
 to the sight and touch the tendons which are inserted near
 the  joint.   To effect this, cause  the  muscles to contract;
 this is usually sufficient;  or  you  may render their projec-
 tion greater by opposing the movement of the limb, which
 their contraction tends to execute.
   " 4.  If all  these trials  fail,  you  may  assist yourself by
 the neighbouring tuberosities, whether or not they be in the
 same line, provided their distance and connexions are well
 determined beforehand.  It is  objected  that the relations,
 and especially the distance, vary  in different subjects;  conse-
 quently, they can only give us  a tolerably close indication;
 but certainly there is never more than some lines difference,
 and it is better to have such approximation than none at all.
   "5.  If these means  do not  suffice, seize  the limb with
 the right hand, and seek the joint with the left, moving the
 limb  slightly, and  thus try to mark out the two diameters
 of the joint, or, in other terms, the point of entrance and
 exit of the knife.
   " 6. Lastly,  supposing  that all  these  indications do not
 afford a certain result, incise  the  skin in the most suitable
 direction, and, after having raised  it, assure yourself by the
 touch of the articular line.  If the touch does not point it out,
 place the knife in the angle of the wound nearest yourself,
 its heel perpendicular to the  horizon, and the edge perpen-
 dicular to the  bone, and thus  niOve  it along the bone with
a sawing, sidelong  movement,  without taking it off, and
the pressure will cause the knife to enter  the joint when it
reaches it
     52 
610
SURGERY.
  " To Traverse the Articulation.—1. The articulation  re-
cognised, or at all events  presumed  to  be so, as we have
directed, the index finger and  thumb should rest applied
on the two extremities of the articular diameter until the
knife replaces them.   If this  search has  been made with
the right hand, substitute the left hand for it, before seizing
the knife.   In this way you mark the  point  of entrance
and exit of the knife.
  " 2. If you attack the joint by its dorsal surface, semi-
flex the limb, to extend the parts and enlarge the articular
line.   Without this precaution you often fall on the neigh-
bouring joint, as happens on the foot and hand.
   " 3. The knife should not generally be carried into the
joint, without having first cut its principal means of con-
nexion, which should be divided from without inwards.
   "4. In joints with several projections and interlockings,
commence by the internal or external side.   As the knife
opens  one part, do not push it in there, but go on dividing
and  opening farther.   In this way the  ligaments are not
put out of the reach of the knife, or  shielded by bony pro-
jections.
   " 5. An important fact.  An articulation, that offers to
the anatomist a surface equal  to one inch, presents to the
operator at least four.  So long as  the ligaments are  di-
vided  between their attachments, it is of slight importance
whether during their division the knife fall on the articular
line, or at  the side of it.
   " 6. The dorsal and lateral ligaments  being cut, we can
generally engage all the blade  of the knife between the ar-
ticular surfaces; but if there are interosseous ligaments,
they must  be first divided.  Carry the point of the  knife
directly on them; as they are divided, the joint  opens.
   " 7. To  destroy these ligaments, you  must know the in-
terstices between the  bones through which they may best
be attacked.   In general, on the hand and foot, the bones,
very compact on their dorsal surface, leave  between them
i 
SURGERY.
611
on their palmar and plantar surfaces intervals which lodge
these ligaments.   Carry the  knife  under these intervals,
inclining the handle towards  yourself, and making it form
an angle of forty-five degrees  anteriorly; then raise it up to
a right angle.  The  ligaments  divided by this movement
allow the articulation  to be opened sufficiently for the knife
to enter it.
   " 8.  It is useless to luxate; it strains the parts very pain-
fully; and  if you separate the parts very much on one side,
you apply those of the other  together.   If, in cases of diffi-
culty, you  have recourse to this means, luxate downwards
as far  as half the dorso-palmar  diameter,  and then  vice
versa.   But it is better to separate the parts by slight trac-
tion parallel  to the axis of the  stump; this ordinarily suf-
fices.  The heel and point of the knife should always move
in the same line.  If, in bringing the knife out of the joint,
you dread jagging the integuments, push them gently aside
with your left forefinger and  thumb.
   " To Preserve Sufficient Flap.—1. The  proceedings vary
according to  the method, and often even in each method.
   " 2.  In the circular, you can generally count only  on the
skin to cover the surface of the wound.   Make the incision
at a sufficient distance from the joint, and dissect  back the
skin as a cuff.   If there are muscles under it, you may cut
them obliquely on the plan of Alanson, or divide them per-
pendicularly on a level with  the joint.
   " 3. The oval method is ordinarily performed by tracing
on the  dorsal surface a V incision reversed, the ends of
which are  joined by a semicircular incision round the pal-
mar surface.   When  there are any large vessels, leave them
in the  portion to be divided  last, as in the method of flaps,
so as to be able  to compress  the artery before dividing  it
beyond the part compressed.
   "4.  In most of the oval proceedings, the second incision
is made to  join the first at its point of commencement.  A
loss  of substance  is the consequence; or, if the V  termi- 
612
SURGERY.
nates on a level with the articulation, there is a considerable
difficulty in getting the knife to act in disarticulating.   I
lay down  here as a general rule, Expose the joint to be de-
stroyed by a longitudinal incision passing half an inch, at
least, above, and one inch below it.   The two branches of
the V, which fall on the inferior part of the incision, leave,
as it were, two small flaps at the upper part, which do not
hinder immediate  and linear union, and which perfectly
cover the osseous prominences left by the disarticulation.
   " 5.  The methods by one  or  two flaps are executed in
two ways.   Sometimes the flaps are made first, before touch-
ing the joint; but most  usually a simple incision is made
first, or the least important flap, and the second is not begun
till after the disarticulation.
   " 6.  The  knife having traversed all the joint, when the
bones are  large and uneven, as in  the foot and hand, the
instrument must be withdrawn, and its point placed horizon-
tally in the extremity of the joint next the hand operating,
and its way cut by pressing from right to left.
   " 7.  To avoid terminating the flap by a point,  the knife
must be held horizontally close to the  bones, and kept so
to the required extent, cutting freely.
   '•8.  It is well, before you terminate your flap, to apply it
to the part to be covered, to see if it is  long enough.
   " 9.  If there remain any tendons beyond  the bleeding
edge, cut them off with a scissors.
   " 10. If you fear  too much retraction of the skin, do not
divide it until the muscles have retracted.
   "11. You  may cut your  flap from engorged tissues, so
long as the engorgement is  not malignant.
   " 12. You may operate when there is  not enough  skin to
make a flap; a cicatrix will be formed on the articular sur-
faces."
  Instruments.—The instruments used are the cutting knife,
metacarpal saw, scalpel, tenaculum saw,  bone forceps, artery
forceps, needles, and tourniquet. 
SURGERY.
613
  AMPUTATION OF THE  UPPER EXTREMITIES.
  Amputation of the fingers may be performed at the first
phalanges, where they articulate with the metacarpal bones,
or at any of the joints of the fingers.   Amputation of the
fingers may also be done through the phalangeal bones.  It
may be performed by the circular or flap method. In either
case, it should  be done as  directed for other long bones.
The following is Lisfranc's  method for disarticulations  of
the phalanges:—
  " The Joint is opened on its Dorsal Surface.—If you would
remove the  last phalanx, pronate  the  hand;  an  assistant
holds away the sound fingers, and at the  same time turns
back the skin of the diseased finger, and  retains it in posi-
tion.   The operator seizes the phalanx with the thumb and
index finger of the left hand placed across it, on its palmar
and dorsal surfaces, and bends it to an angle of forty-five
degrees.  There are  three ways  of recognising the line of
the joint:—1.  There is on its dorsal surface  a well-marked
fold in the skin; the  joint is half  a line below it.  2.  If
you cannot find  this, assure yourself of the  dorsal projec-
tion formed by flexion, and  cut half  a line  beyond  it.
3. Seek the termination of the fold; you will find the joint
half a line below it.   Then take  a  straight bistoury in the
third position, and, applying its heel perpendicularly on the
recognised part of the articular interline, cut from  left  to
right a very small semicircular flap, which terminates at the
other extremity.   You should divide the  capsular ligament
in this cut;  if you have  not, seek it by the indications
given.   Then,  without entering  the joint, cut the lateral
ligaments.  For the  ligament situated on the left of the
surgeon, carry the bistoury  on this side perpendicularly to
the axis of the last phalanx; the handle  nearer the opera-
tor  than the  point., and the edge  also slightly turned to-
wards the operator.  In this way, the incision is perfectly
suited to the articular surface, and  the  ligament is divided
                          52* 
614                   SURGERY.

at the first cut.  Bring back the bistoury to the other side,
and attack the second  lateral ligament in the same manner;
only here the handle of  the bistoury is turned downwards,
and farther from the operator than the  blade.  When the
surgeon is well practised, these three steps are comprised in
one; and in the same cut, the skin, the left lateral ligament,
the dorsal ligament, and the  right lateral ligament are di-
vided. In whatever way you  attain this point, after having
widely opened the joint, seize the phalanx by its sides, and
by degrees extend it; while the bistoury, entering the arti-
culation, divides the  palmar  ligament, passes round  the
head of the phalanx, slips parallelly under  it, and  at the
same time cuts a semicircular flap  large enough to cover all
the solution of continuity.  If you would remove the last
two phalanges, the proceeding is the same, only the dorsal
incision should start on  each  side on a level, with the termi-
 nation of  the palmar  fold in the skin.   In performing this
proceeding, inexperienced  operators are frequently misled.
It has  also another inconvenience in  unpractised  hands,
viz.: the base of the  flap is cut and jagged in dividing the
lateral ligaments, but  a little practice gives all the necessary
precision in this respect."

    AMPUTATION OF  THE  METACARPAL BONES.
   When a  metacarpal bone  is to be removed, an incision
 should be made on the dorsal portion  of the hand  to cor-
 respond with the portion of the bone to be removed.  The
 soft parts  should be continuously separated from the bone.
 The knife should now  be  passed  under, and by a forward
 cut made  to separate all portions of the soft  parts from the
bone.  If the  operation is on either the third  or  fourth
metacarpal bone, the section should be made with bone
forceps; if the  metacarpal of the thumb is  the  one to be
removed, it should be sawn  perpendicularly to its axis; if
the index  finger section should be made, obliquely from 
SURGERY.
615
without inwards; if the little finger, from within outwards,
the soft parts being retracted as in other operations.
   Disarticulation of the First Metacarpal Bones.—To dis-
articulate the first metacarpal bones, the finger or thumb
should be abducted by an  assistant, and an incision made in
the middle of the commissure between the fingers, the joint
opened, and an external flap formed by carrying the  knife
close  along the side  of the  bone  beyond  the  metacarpal
phalangeal joint.
   Disarticulation of Radio-Carpal Articulation.—The wrist
joint  is composed of the  radius  and  ulna,  above, and sca-
phoid, semi-lunar, and cuneiform bones, below.
   Malgaigne (op. cit.) gives  the following rules for deter-
mining the line of articulation:—" 1. Strongly bend the hand
backwards; the summit of the angle formed by it with the
forearm indicates the radio-carpal articulation.   2. Feel in
front the  transverse  projection of the radius; the joint is
one line  below it, and about half an  inch above the crease
in the skin that separates the  palm of the hand from the
forearm.   3. Determine  the  summit of the styloid pro-
cesses, and draw a transverse line between them; the joint
will  be  two lines and a  half above this  imaginary  line.
4.  Lastly, the styloid  process of the radius being found,
the styloid process of the ulna is two lines shorter, and the
joint is a quarter of an inch above it.
    Circular Method.—The tourniquet being  applied over the
brachial artery,  or  compression  being made,  an  assistant
holds the forearm in a   position  between pronation  and
supination, and strongly  retracts the skin  at the wrist; a
second holds the hand;  the operator, standing upon the
right side of the  limb, makes  a  circular incision  through
the skin, about an inch below the styloid processes, grazing
the thenar and hypo-thenar  eminences; the  skin is  dis-
sected and turned back as high as the joint, a  second  cir-
cular incision just above  the pisiform and unciform bones,
and over the joint, divides all the soft tissues; the joint is 
616
SURGERY.
then entered on one side under the styloid process, and the
knife, held  perpendicularly, is carried along the curve of
the carpal bones  to  the opposite side, completing the  dis-
articulation at a single sweep; the radial and ulnar arteries
are to be tied, the interosseous rarely; the styloid processes
may or may not be removed, and the wound is closed by
bringing together the parts antero-posteriorly.
   Modifications.—Velpeau directs the hand to be flexed
when the incision is made on the back of  the wrist, and to
be extended when it is made in front; it  has been advised
also to direct the assistants to rotate the limb while the in-
cision is made, rendering the movements of the knife more
limited.
   Flap  Method.—Amputation at the wrist may  be  per-
formed with single  or  double flaps, according  to  existing
lesions.  If a single flap is made, it may be taken from the
dorsal or palmar aspect.  If from the dorsum, the hand is
held in a prone position, the integument strongly retracted
by an assistant, the operator grasps the  extremity in the
palm of the left hand, placing the thumb and forefinger on
the extremities of the styloid processes; a semi-circular in-
cision  is then made on the  dorsum,  from just below the
processes, having its concavity  upwards, the skin is  dis-
sected and  turned back, and the joint,  the tendons,  and
radio-carpal  ligaments  divided,  the  lateral ligaments are
next  cut, the  articulation  opened,  and the knife passed
through, forming a palmar flap of two-thirds of an inch in
length; the styloid processes may remain  if desired.   The
double flap  is generally made as follows:—A semi-circular
flap  is made from the  extremity of one styloid process to
another,  but not so low:  first on the  palmar and  then on
the dorsum of the wrist; the ligaments being divided, the
hand is forcibly flexed, and  the  knife carried  through the
joint from the dorsum or from the side, as in  circular am-
putation. 
SURGERY.
617
   uDisarticulation of the Elbow Joint*—The  elbow is a
true ginglymoid or  hinge joint, formed by the lower ex-
tremity of the os brachii above, and the upper  extremities
of the radius  and  ulna, the former on the  outside, and the
latter on  the  inside; the ulna forms the principal  part of
the lower portion of the joint, having a large articular sur-
face of the  projection of  the  olecranon  backwards, and
the  coronoid  process forwards, which  embrace  the  irre-
gular articulating surface of  the  os  brachii; the radius is
merely in contact with  the  os brachii; the articulation has
anterior, posterior, and lateral ligaments.   The  exact  posi-
tion of  the joint is determined  only by careful attention to
the  anatomical relations  of the following osseous promi-
nences  about  the joint:—the epicondyles, or the most pro-
minent points on the condyles of  the os brachii are recog-
nised, the internal more  readily than the external, a line
drawn through the lower points, is, on the outside, a quar-
ter of an  inch above  the interarticular line,  and on the in-
side three-quarters  of an  inch;  the articulation  of  the
radius and humerus is transverse,  that of the ulna  irregu-
lar, and owing to its projections must be entered externally.
   "Malgaigne remarks of the position and direction of the
interarticular  line:—'Two facts result: first, that  the  arti-
cular interline is  very oblique  from without inwards, and
from above downwards; second, that  it is  very much below
the tuberosities of the humerus.  If, then, in cutting your
anterior flap, you extend its base  up  to the level of these
tuberosities, it will almost always  be  too short to cover the
bone, which will  project,  especially on  the  inside  and
downwards. This often happened to Dupuytren, who put in
his knife  transversely at the internal  and anterior  part of
the epitrochlea, to bring it out on the anterior border of
the epicondyle.  You should, on  the contrary, plunge  in
the knife  obliquely one inch  below the middle projection
* Stephen Smith. 
618                   SURGERY.
of the epitrochlea, to bring it out half an inch below the
projection of the  epicondyle.'
   " Circular Method.—The brachial artery being controlled,
the arm is held  in a  supine position, and  the  operator,
standing on the outside of the limb, makes a circular inci-
sion, through the  skin only, around the arm, four fingers'
breadth below the joint;  the integuments are dissected up
to the joint  and reflected backwards;  the muscles in front
are then divided,  the ligaments cut, and the joint entered,
and  disarticulation completed by  dividing the triceps, or
sawing off the olecranon; the brachial  artery is divided be-
fore its bifurcation.
   "Single Flap.—The limb is placed in a supine position,
but  slightly flexed;  the  operator, raising  the  soft parts
from the bone in  front of the joint, enters a straight knife
about a finger's breadth  below the internal condyle;.tra-
versing the limb  close  to  the ulna, it  appears two fingers'
breadth  below the external condyle, to allow for the retrac-
tion of muscles arising from  the humerus, and cuts  an an-
terior  flap about  three  inches in length; this flap  being
retracted, the knife is passed  behind the limb, and the heel
entered on the outside, between the articulation of the radius
and  os brachii, and continued across the  back part of the
joint, dividing all the  tissues to the internal angle of the
wound;  the  anterior ligament and lateral  ligaments are di-
vided, the bones   luxated forwards, the  insertion of the
triceps cut, and the operation completed.
   "Guerin recommends an external flap.  This is made by
transfixing the limb upon the outside, entering the point
of the knife just within the head of the radius, traversing
its neck, and cutting  out a large external  flap; a second
flap is made  from the  inside  of  the arm  by cutting from
without inwards, and from below upwards ; the soft tissues
immediately  covering the  joint are divided, and disarticu-
lation  completed.   A good covering is thus made for the
condyles. 
SURGERY.                  619
  " Oval Method.—Baudens  performed the oval operation,
commencing the incision over the border of the radius, five
fingers'-breadth below the fold of the joint, and passing
around the limb, a finger's-breadth higher, over the ulna ;
the dissection was  then  carried  upwards to  the joint, and
disarticulation accomplished."

         AMPUTATION  OF  THE  ARM.
  Circular Method,—The arm should be carried at right-
angles off the body, the surgeon standing on  the right side
of the limb; then make a circular incision through the in-
teguments, and loosen them from the fascia with the knife;
then let them either be drawn up or rolled up by an assist-
ant, from one inch to one inch and  a half.  Then  let a
second incision be made at the margin of the  reacted
skin,  dividing  the  superficial muscles and laying the bone
bare.   The bone should be sawed through, the brachial ar-
tery secured, and  the wound brought together, from  be-
fore backwards, or it may be closed in the  most conveni-
ent way.

AMPUTATION  AT  THE WRIST.   (SEE  FIG. 55.)
                        Fig. 55.
  Amputation at the wrist may be performed in the follow-
ing way :—Let the skin  be pulled back, and a circular in-
L^ 
620
SURGERY.
 cision then made a little below the  line that separates the
 fore-arm from the  hand.  Then cut through the external
 lateral ligament, and carry the knife across, so as to divide
 the remaining attachments;  or a flap  may be made by
 making  a semi-lunar incision across the back of the wrist.
 The  flap being dissected, the joint is opened behind  the
 lateral ligaments; the ligaments are cut.  The knife is then
 placed between the carpus and  bones of the fore-arm, and
 a flap formed from the anterior surface of the palm.

      AMPUTATION  OF THE  HIP-JOINT.
   This operation is requisite in cases in which the upper
 extremity of the thigh-bone  is smashed, and in which the
 soft parts are so injured  that it is of no use to attempt ex-
 cision.  "No man," says  Mr. Guthrie, "should suffer am-
 putation at the hip-joint when the thigh-bone is entire.  It
 should never be  done in cases of injury when the bone can
 be sawn through immediately behind the trochanter major,
 and sufficient flaps can be preserved to close the wound
 thus made.   An injury  warranting this operation should
 extend to the neck or head of the bone, and it may be pos-
 sible, as  I have proposed, even then to avoid it by removing
 the broken part." *  This amputation is generally accom-
 plished in the flap method, the  flaps  being either anterior
 and posterior, or lateral.   The femoral artery should  be
 first tied or compressed immediately below Poupart's liga-
 ment during the operation, and, if tied, its  cut orifice  be
 tied immediately afterwards.  The patient in  the  recum-
 bent posture, at the  end of the table, and the limb held out
 horizontally, a long knife should  be thrust through  the
 limb, immediately on the  inner  side of the joint, and car-
 ried forwards and inwards, and  made to cut the inner flap
from the adductor muscles.   This flap should be immedi-
ately grasped by  an assistant,  who should compress the  fe^

       * Guthrie, Commentaries,  Sixth Edition, Page 63. 
SURGERY.
621
moral  artery.  In the next  place, cut into the hip-joint
with a short, strong, curved  knife, and sever the ligamen-
tum teres  and the muscles  attached to the digital fossa.
Lastly, putting in the long knife over the trochanter, cut
downwards and outwards to make the outer  flap.
   Of the method by anterior and posterior flaps, a very good
example is afforded by a case of Mr. Tatum's, at St. George's
Hospital, London, in July, 1855.  The thigh having been
Blightly bent and  abducted, the knife was entered  at the
outside, at the junction of the upper and middle thirds of
a line drawn from the anterior superior spine of the ilium
to the  great trochanter.  It was carried obliquely inwards
and downwards immediately in front of  the joint,  and
brought out about two inches below the tuberosity of the
ischium.    "Cutting  my  way out," says Mr. Tatum,  "I
made  a  large  anterior  flap, which  was at  once firmly
grasped,  so as to prevent the possibility of hemorrhage,
and drawn upwards.   The anterior part of the capsular  li-
gament being laid bare,  was easily divided; the head  of
the bone was then partially dislocated by rotating the limb
outwards  and extending  it backwards;  the ligamentum
teres was at once cut  through, and the dislocation of the
thigh-bone completed.  The knife was then carried through
the joint and over the trochanter, and the posterior flap was
made.  In doing this, I took  care to have this flap some-
what small  and  thin, well knowing, by experience, that a
large posterior flap tends, by its weight, to  drag the cut
surface apart in the progress of healing.  As I completed
the posterior flap, dry sponges were stuffed into the wound
by  assistants,  and  thus  all hemorrhage   was  at  once
stopped."   Plenty of ligatures  securing  every bleeding
vessel, including the femoral vein, sutures and plasters com-
pleted  the operation.   The patient, a lad of sixteen, left
the Hospital in a month.
  In this case, as in one  operated on lately by Mr. C. G.
       53 
622
SURGERY.
Guthrie, the entire  thigh-bone was removed, in  order to
give the patient a greater chance of security from the re-
turn of cancer than would have been given by amputation
through the affected bone.   In any such case, the surgeon,
probably, will be able  to plan  his  lines of incision as he
pleases; and the limb  can be moved in any direction to fa-
cilitate his proceedings.   Not so in cases in which there is
extensive destruction of soft parts and smashing of the neck
of the bone.   Here  the surgeon must be guided by the di-
rection in which he can secure the best covering  of skin. *

      AMPUTATION  AT  THE  KNEE-JOINT.
   This operation may be substituted* for amputation in the
lower third of the thigh in cases in which excision of- the
knee-joint is impracticable.
   1.  Syme's  Operation.—A semi-circular incision is made
through skin and fascia over the  patella; next,  the knife
is thrust horizontally across, immediately behind the joint,
and is made to  cut  a long flap  from the  calf of the leg;
next, the anterior flap being filled up, the extended muscles
are severed from the upper border of  the patella;  the re-
maining soft parts are divided, and the former  sawn through
the condyles,  immediately above the joint.   2. If circum-
stances permit it, an anterior flap may be made, including
the patella, by a semi-circular  incision  through the tissues
in front of the joint, beneath the patella, from the posterior
part of one condyle of the femur to the other.   Then the
ligamentum patella is  cut through, the patella lifted with
the anterior flap, the joint opened  by cutting through the
lateral  and crucial  ligaments, and, lastly, a  sufficiency of
under-flap cut from the calf.   The interarticular cartilages
should always be removed, and the surface of the patella,
or femur, if diseased.   The popliteal artery should not be

  * For details of other modes of performing  this operation, see
Guthrie's Commentaries,  and South's Chelius, Vol.  II. 
                     SURGERY.                  623

wounded above the part at which  it is severed.   The pa-
tella should be brought down over  the end of the femur.

           AMPUTATION OF  THE  LEG.
  1.  Oval Amputation through the Calf.—An oval incision
is made in the direction shown in the cut (fig. 56) through
                        Fig. 56.
skin and fat; these are thoroughly drawn back.  The in-
cision is carried upwards, obliquely, through the gastroc-
nemius, to the bones, so as to make a posterior flap.   (Fig.
56.)  This being well pulled up,  the remaining soft parts
around  and  between the bones  are divided;  lastly, the
bones are sawn  through.  The integuments  are  brought
together in  a transverse  line.  2. The flap operation (fig.
57) is performed by Mr. Fergusson in  an elegant and ex-
peditious manner,  thus:—He first places the heel of the
knife on the side of the limb farthest from him, and draws
it across the front  of the limb, cutting a semi-lunar flap  of
skin.   When its point has arrived at the opposite side, it
is at once made  to transfix the limb.   This stage of the
operation is  represented in the figure below;  and then the
posterior flap is  cut.  The surgeon must take care not  to
get  his knife between the two bones.   When the operation
is performed high  up, the popliteal artery will be divided
instead of the two  tibials. The tibia, however,  should ne-
ver  be sawn  higher than  its tuberosity, or the joint will be 
624
SURGERY.
laid open.  If low down, the  tendo achillis will require to
be shortened  after  the flap is made.   The flap is to be
brought forward and confined by a stick or two, the line of
junction being horizontal.   (Fig. 57.)
                  »      Fig. 57.
   Circular Method.—The artery being under command, as
in amputations of the thigh, and the leg being placed ho-
rizontally, one assistant supporting it at the ankle, and ano-
ther holding it at the knee, and drawing up the skin, the
surgeon  makes a circular incision through the skin four
inches below the tuberosity of the tibia.  The integuments
are next to be dissected up for two inches and turned back,
and the muscles  are  to be divided down to the bone by a
second circular  incision.   Then a  long, slender, double-
edged knife, called a  catline, is passed between the  bones
to divide the interosseous ligament  and muscles, and both
bones are sawn through together, the flesh being protected
by a retractor, which should  have three tails.  The spine
of the tibia, if it projects much,  may be removed with a
fine saw  or bone-nippers, and  care should be taken  not to
leave the fibula  longer than the tibia, or it will give much
trouble.   The anterior and posterior  tibial, and peronaeal
arteries,  and any others requiring it, being tied, the  stump
is to be treated as directed after amputation of the  thigh.
The integuments should be put together transversely. 
SURGERY.
625
         AMPUTATION  OF  THE  FOOT.
  1. Amputation of the toes, at any of their joints, is per-
formed in precisely the same manner as amputation of the
fingers.  In removing a single toe from its metatarsal bone,.
the surgeon should take  care, first  of  all, to ascertain the
exact situation of  the joint, which  lies  rather deeply.
Moreover, he should not  remove the head of the metatarsal
bone, as he may the metacarpal, because it is important to
preserve the entire breadth of the foot.-
  2. Amputation of all the toes at their metatarsal joints—
an operation which may be requisite in cases of frost-bite—
is performed by first making a transverse incision along the
dorsal aspect of the metatarsal bones, dividing the tendons
and lateral ligaments of each joint in succession; and then
the phalanges being dislocated upwards, the knife is placed
beneath the metatarsal extremities, and  made to cut out a
flap from the skin on the plantar  surface sufficient to cover
the heads of the metatarsal bones.
  3. Amputation  of the metatarsal bone of the great toe
is performed precisely like the operation for the removal
of the metacarpal bone  of the little finger.  An incision
down to the bone, with a  scalpel, is carried along its dorsum
and round the foot of the great toe.   Secondly, the knife,
which must be kept as  close to the  bone as  possible, is
made to dissect it out from the surrounding parts.  Third-
ly, the bone is cut  through  with forceps.  Vessels are to
be tied, and the wound brought  together.  It may be ob-
served that, in  dividing the metatarsal bones of the great
little toes, or the metacarpal  bones  of  the fore or little fin-
ger, care should be taken not to leave any prominent angle.
  4. Amputation of all the metatarsal bones (Hey's opera-
tion) is  performed in the  following manner:—The exact
situation of the  articulation of the great toe to the inner
cuneiform bone, (to which the tendon of the tibialis anticus
                          53* 
626
SURGERY.
may serve as a guide,) being ascertained, a semi-lunar in-
cision, with the convexity forwards, is made down to the
bone, across the instep, from a point just in front of the
aforesaid articulation, to the outside  of the  tuberosity of
the fifth metatarsal bone.  The flap of skin thus formed be-
ing turned back, the bistoury is to be passed round behind
the projection of the fifth metatarsal bone, so as to divide
the external  ligaments which connect it with the cuboid.
The dorsal ligaments are next to be cut through, and then
the remaining ones', the bone being depressed.  The fourth
and third metatarsal bones are to be  disarticulated in a si-
milar manner, dividing their ligaments with the point of
the knife, and taking care not to let the instrument become
locked between the bones.  The first metatarsal is  next to
be attacked, and, lastly, the second, the extremity of which
being locked in between the three cuneiform, will be  more
difficult to dislodge.  Perhaps it may be convenient to saw
it across.   When all the  five bones are  detached, the sur-
geon completes the division of their plantar ligaments, and
slightly separates the textures which adhere to their under
surface with the point of the knife, and then, the foot be-
ing  placed horizontally, he puts  the  blade under the five
bones, and carries it forward along the inferior surface, so
as to form a flap from the sole of the foot sufficient to cover
the denuded tarsal bones.
   5. Amputation through the tarsus, so as to remove the
navicular and cuboid bones, with all the parts in front of
them, is commonly  called  Chopart's operation.   In the
first place, the articulation of the cuboid with the os calcis,
(which lies about midway between the external  malleolus
and the tuberosity of the fifth metatarsal bone,) and that
of the navicular with the astragalus, (which will be found
just behind the prominence of the navicular  bone in front
of the inner ankle,)  must be sought  for; and a semilunar
incision be made  from one to the other, as in the last de-
scribed operation.  The flap of skin being turned back, the 
SURGERY.
627
internal and dorsal ligaments that connect the navicular to
the astragalus, are to be  divided with the point of the
bistoury, recollecting the convex shape of the head of the
latter bone.  The  ligaments  connecting  the os calcis  and
cuboid are next divided, and  lastly, a flap is to be procured
from the sole of the  foot.   It may be expedient after  this
operation,  to divide the  tendon Achillis, if the heel is
drawn backwards.
AMPUTATION  AT  THE ANKLE-JOINT.
                        Fig. 58.
   Syme's Amputation.—The essence of this operation con-
sists in the removal of the entire foot, and in preserving
the integument of the heel as the most natural pad for the
stump to rest upon.  The incisions employed are different
in the hands of  various surgeons.  The knife is  carried
round down to the bone.  The  ankle-joint is laid  open in
front, and its lateral  ligaments divided.   The  os calcis is
then  dissected out, in which  process, which  is not easy,
the knife  should be  kept close to  the bone, so as not to
wound the plantar  arteries, if possible.  The  malleoli are
cut off smoothly,  and if there is any disease of the ankle-
joint, a thin  layer  at the end  of the  tibia should be re-
moved; the posterior flap is then brought forward and re-
tained by suture.   The skin of the  heel is liable to slou°li 
628                   SURGERY.
 and hence many surgeons make the incision more oblique,
 so as to preserve more skin  from the dorsum of the foot,
 and less from the sole.
   2.  Pirigoffs Amputation.—M. Pirigoff, a distinguished
 Russian Surgeon, proposes  to leave the posterior part of
 the  os calcis,  so  as  to fill  up  the  heel-flap, to make the
 stump larger and better adapted  to bear  pressure, and to
 run less risk of wounding the internal tibial  artery than
 is the case in Mr.  Syme's operation.   The steps of the
 operation  are  the same as in  Mr. Syme's, except, that so
 soon as the astragalus is disarticulated, the os calcis is
 sawn through immediately behind it.  When the operation
 is completed, the cut  surface  of the os calcis is brought
 into apposition with that of the tibia."
   Resections.—Shassaignac  lays  down the  following very
 rational propositions as the basis  of his Nouveau  Systeme
 de Resection:—1. Make but a single integumentary inci-
 sion  in all resections, whatever  they may  be.   2. In all
 cases make a section of bone before disarticulation. 3. Iso-
 late and separately remove each articular extremity, always
 commencing with that which is the most  easily extracted,
 and making it thus an aid to the extraction of the other.
   In the following descriptions of the different operations
 for resections of bones, the  above rules will be recognised
 as correct  in their general application; but various  other
 methods, adopted by eminent operators, will also be given,
 as has been done in the preceding chapters on the ligature
 of arteries and amputations, to enable the surgeon to exer-
 cise his judgment intelligently in  individual  operations.
 Incisions.—Various incisions have been recommended by
 different operators, of which the following are  the princi-
 pal:—The straight,------; the  crucial or -f or X; the
 H; the T; the L; the V; the elliptical, O; the quadrila-
 teral,  |     | ;  the elongated, |----1; the |----,  &c, &c.
 Of these incisions the straight is adapted to the greatest num-
ber of cases, and by many surgeons of great experience in 
SURGERY.                  629
resections is exclusively made.   The straight incision cer-
tainly has the advantage over all  others, of not dividing
the tendons,  and but slightly exposing  the blood-vessels
and nerves to injury.   There are  instances,  however, in
which a combination of the forms given will be found use-
ful, in order  to completely expose the parts to be removed.         ((
The incision should in  general be made as nearly as possi-
ble over  the  bone to be removed, and distant from  im-
portant blood-vessels and nerves; the soft parts should not
be destroyed, except so far as  they  have undergone de-
generation, or  interfere with the  proper  closure of  the
wound.   Injuries to blood-vessels and nerves lying in the
track of the  incision  should be scrupulously avoided by
drawing them aside.   Muscles and  tendons should not be
divided, and  their attachments to bones  should not be in-
cised, but separated to the least  practicable extent with  a
blunt instrument, as the handle  of a scalpel.   Isolation of
the Bone.—The bone being exposed to the desired extent,
the next care of the operator should be to preserve in the
wound, and as far as possible in its original position, the
periosteum of the bone to be removed, in  order to the re-
production of  sufficient new bone to preserve the  func-
tion of the part; in this manner  the lower jaw  may be
completely excised, and subsequently sufficiently repro-
duced to preserve nearly the original contour of the jaw,
and in part, its function.  The periosteum is best preserved
by first incising it to the extent  of the bone to be removed,
and then  separating it with the  handle of the scalpel care-
fully inserted between it and  the bone.   Removal of the
Bone,—The  periosteum being separated,  the bone, if short
or flat, may be  removed with the  forceps; but if a long
bone, it must be divided in its shaft by cutting  forceps or
the saw,  and each portion separately removed, before the
saw is  used,  the soft parts  should be carefully protected
by compresses or a spatula introduced underneath it.  In
removing  diseased bone, Sedillot recommends scooping out 
630                   SURGERY.
the affected parts, and leaving the  cortical  portion in pre-
ference to the removal of its  entire structure; the repro-
duction of bone is much more  rapid  and complete, when
this portion is left, than  when only the  periosteum re-
mains.  Dressings.—If any considerable vessel is divided,
and continues to bleed, it should be ligated, as subsequent
hemorrhage will  greatly interfere with the  process of re-
pair.   When short  or flat bones,  and the  shafts of long
bones  are removed, in whole or part, the wound is gene-
rally at first filled with lint, to  promote granulation from
the bottom; and when the articular extremities are ex-
cised,  and it is desirable  to  obtain subsequent motion or
anchylosis, other dressings are to be  employed.  These
special dressings for individual  cases must be left entirely
to  the direction of the surgeon.   Classification.—Resec-
tions may be divided into resection in the  contiguity, or,
which is more practical, partial and complete resections;
the former term  implies the removal of but part of a bone,
and the latter the extirpation of the whole  bone.   Partial
Resection.—In long bones, partial  resection may be made,
as  of a portion  of the shaft, or of the extremity; in flat
bones,  portions  are removed with  the  trephine or  the
gouge; and, in short bones, processes may be excised, as
in the vertebrae.   Complete Resection.—Total resection, or
the extirpation of entire bones,  has been practised on some
of  the larger and more  important bones in the skeleton;
thus the radius, ulna, tibia,  fibula, clavicle, and scapula,
have been successfully removed, the  patient not only re-
covering from the operations, but in many cases the repro-
duction of bone has been so complete as to restore to a con-
siderable extent the function  of the part. 
SURGERY.                  631
                    FRACTURES.

BY  JAMES M'CLINTOCK, A. M. M. D., EX-PROFESSOR OF
  SURGERY, IN THE ECLECTIC MEDICAL COLLEGE OF PHI-
  LADELPHIA, ETC., ETC.
  In surgery there  are  many subjects that require the
most particular  attention of the student, who aspires to
become qualified to operate upon the living being; while
a young gentleman who designs to be a practitioner of me-
dicine  merely, will pass over these topics lightly.   But, I
commence to-day,  gentlemen, the examination of a subject
which  cannot be slighted, but must be  carefully studied
and thoroughly  understood by every one who assumes'_to
practise physic, whether he calls himself a surgeon or not.
You, no doubt, anticipate me as alluding to the subject  of
Fractures.
  Almost all the bones of the body are liable to be  broken,
and every man practising  medicine will be called upon  to
set a broken bone, as it is  called.  The lesions  are some-
times very simple, readily detected; at other times, they
are difficult to diagnosticate; but, easy or difficult to ascer-
tain, it is  expected certainly that any doctor will  be  able
"to set a broken bone."   You will find, as we go  on, that
the consideration of fractures involves a knowledge  of many
things, and is a topic which, in itself, is very extensive.  I
shall first  examine this subject with reference to its general
bearing, and having considered the various phenomena  of
fractures, means of consolidation, and general treatment, I
shall pass to the examination  of the means to  be resorted
to in the management of particular fractures.  Here I shall
make supposititious  cases.   I will adjust to an imaginary
patient the apparatus, which, in similar cases to those sup-
posed,  I think the best to be adopted. 
632
SURGERY.
   To facilitate your studies, I shall examine this subjeet
 in the following order :
   1.  Definition.
   2.  Varieties:—A. According to severity,   a, simple; b,
                   compound; c, comminuted; d, compli-
                   cated.
                  B. According to direction, a, transverse;
                   b, oblique^ c, longitudinal.
   3.  Bones most liable to be broken.
   4.  Causes:—A. Predisposing.  B. Exciting.
   5.  Symptoms.
   6.  Diagnosis.
   7.  Prognosis.
   8.  Manner of healing:—A. By. callus.  B.  By fibro-
        cartilage.
   9.  Time required to effect union.
  10.  Treatment:—1st. Indication.  To coaptate the parts.
                   2d. To maintain them in apposition.
                   3d. To counteract abnormal symptoms.
   The definition is a simple matter. . I have no doubt you
 all know that the term Fracture  means  a broken bone;
 still,  it is not my business to take it for  granted, but my
 duty  is to infer  that you know nothing about; it, and, there-
 fore,  I tell you  that by the term fracture is understood  a
 solution of continuity in  a bone.   This is more refined
 than  to say a bone is broken.  But as fractures may occur
 in several ways, so as to  occasion simple or severe injuries,
 or as they may happen  in different directions, they have
 been  divided into varieties.  According to  severity of in-
jury,  they are divided into simple, compound, comminuted,
and complicated.  By simple fractures is meant a solution
of continuity in the bony structure, accompanied by com-
paratively slight injury of the surrounding soft parts.   In
all these accidents, the parts which envelop the broken bone
are generally more or less  injured;  but unless the amount
of lesion be very great, the case is called a simple fracture. 
SURGERY.                  633
   The next variety is compound  fracture.   By this term
 we understand that form of solution of continuity which is
 accompanied by disruption of the soft parts, and through
 the opening a communication is established with the cavity
 of the fracture, or the space between the fragments.   There
 may be a solution of continuity in a bone, with  disruption
 of the soft parts, and still the fracture be  not  compound.
 The break may be a simple fracture, with a wound.   It is
 very  important  that  you bear  in mind  this  distinction.
 Either variety of accident is quite severe, but a compound
 fracture is far worse than the fracture with a mere wound.
   Comminuted Fracture is  that  form of injury, in which
 the bone is broken into many pieces.  Complicated Frac-
 ture is that variety, in which, in addition to the breach of
 osseous  matter,  the end of  the  bone is  displaced or  re-
 moved from its articular  connexions, an artery is disrupted,
 a vein is lacerated, a nerve  torn, or very great injury is
 done to the surrounding soft parts.
   The next division is  according to the  direction of the
 fracture.   The bone may be broken transversely to its ex-
 tent, in an oblique course, or parallel to its  length.  The
 first form of  lesion is called Transverse  fracture; the  se-
 cond, Oblique; and the  third is named Longitudinal frac-
 ture.   This last  is a rare injury; the  others  occur fre-
 quently ; and in them the bones are not broken smoothly
 off, but the fractured ends are more or less rough or jagged.
 Although all the bones  of the  body may be  broken, some
 are much more liable to be so than others;  thus superficial
 bones are readily fractured, while  those deeply  covered  by
 muscles are by no means so easily broken.   Bones which are
 levers, or passive organs of locomotion, are more likely to
 be fractured  than those which  form the walls of cavities;
 thus the bones  of the  skull are  not often broken, while
those of the arm are;  and the same remark is applicable to
the pelvis and inferior extremities.
      54 
634
SURGERY.
  The causes of fracture are divided into Predisposing and
Exciting.—The predisposing causes are several, and  they
may be divided into local  and general.   Among the  first,
or local, may be mentioned the position  of the bone, its
functions, conformation, and necrosis, or other local disease.
Of all the bones in the body the clavicle is most frequent-
ly broken.   There are many circumstances which combine
to predispose it to  such an  occurrence:—1st, its position
is superficial and exposed; 2d, its functions and conforma-
tion subject it to many of the causes of fracture; and 3d,
its muscular connexions aid in forming the tendency re-
ferred to.   The same remarks  apply to  the bones of the
forearm, and, indeed, more or less forcibly to all the bones
which form levers, while  the parietal bones are compara-
tively not subjected to the same influences.
  The general predisposing causes  are, season, age, fragi-
litas ossium, and general  disease.   The principal diseases
that act in this manner are said to be scrofula, cancer, and
syphilis.   In former  times it was  imagined that a low
temperature operated directly upon the bony tissue, ren-
dering it brittle, and thus directly predisposed to fracture.
Althoug*h this  is not the proper view, it is nevertheless
true that these lesions are far more frequent in cold  than
warm weather; but the explanation is very simple, when
we remember that falls, and other accidents, happen oftener
in one season than  in the  other.   As life advances, the
bones  break more readily than in  youth or middle  age.
This is readily explained, if we examine  the composition
of bone at the different ages.  According to Berzelius, the
middle-aged healthy  osseous tissue yields  fifty-one  parts
phosphate of lime, twelve carbonate of lime, two of fluate
of lime, one or two  of phosphate of magnesia and  soda,
and thirty-three parts of animal matter in every one  hun-
dred.  In the young  subject the gelatinous substance ex-
ceeds this ratio, while in old persons  the  earthy matter is
in relative  excess; and,  moreover, other changes  in the 
SURGERY.
635
structure occur as life advances, which aid in augmenting
the predisposition.
  By the term Fragilitas Ossium is meant a brittleness  of
bone.  Analysis proves that in persons thus affected, there
is a deficiency of animal, and a redundancy of earthy sub-
stance.   We know the pathological condition, but we can-
not satisfactorily explain its  cause;  although this disease
is said to occur more frequently  in  Europe, in manufac-
turing districts, where there is a want of good food and other
necessaries of life, than in this country.  In some persons
there appears to  be an inscrutable condition of the bony
structure, which renders them peculiarly liable to fracture,
and there is  no external indication to enable you to judge
when this tendency exists.  In 1844 I attended a  girl,
four years old, with the third fracture  of  the clavicle.
Subsequently I learned  she had broken her arm; and still
she seems  to be perfectly healthy,  except this peculiar
tendency.  You will find similar  cases reported by Dr.
Gibson  and  others.   Scrofula, cancer, syphilis, &c, are
supposed to  produce a cachectic condition of the system,
which renders the bones more liable to be  fractured.
  The exciting causes of fracture are  external violence,  or
muscular action, or  as occurs in  many cases, both these
influences operate together.  The  first, external violence,
produces the fracture either by direct application  to the
part, producing a solution of continuity at the site of lesion,
which is generally accompanied by severe injury of the sur-
rounding soft parts;  thus a severe  blow upon the  clavicle
occasions a fracture,  usually transverse, under the spot upon
which the blow was  received.  The same cause frequently
operates  indirectly;  as, for instance, a man falls upon the
shoulder heavily, the force of the  blow and weight  of the
body produce a fracture  of the centre of the clavicle, which
is generally oblique  in its course.  This kind of accident
is not usually accompanied by marks of as much injury to
the contiguous parts as when the cause is  applied directly. 
636                  SURGERY.
In the skull, indirect violence often produces fracture upon
the'opposite side to that upon which the injury is received.
This form of accident is called fracture  by counter stroke.
  Fractures are frequently occasioned by falls, and it often
happens in injuries of the  inferior extremities, especially,
that the break does not occur until after the fall happens.
Mr.  Samuel Cooper, in  his Surgical Dictionary, refers  to
the case of the celebrated French surgeon, Ambrose  Pare,
" who being kicked by a horse, endeavoured to get out of the
way, but instantly fell down, and the two bones of his left
leg, which had been fractured, being impelled by the weight
of the body, not  only passed through the skin, but even
through his stocking and boot."
  Baron Boyer reports a very similar case.  " A young man,
about twenty years of age, who,  in a standing posture, was
struck on the middle of the thigh with  the pole of a car-
riage, which fractured  the femur.  The patient fell down,
and in the fall the upper fragment  was  not only driven
through the muscles and integuments, but also through his
breeches."
  About ten years ago, one of my patients, who was slight-
ly inebriated, was knocked down by a wagon and one of the
wheels passed over his right leg.  He was raised up by a
couple of his boon companions, who, fearing  his limb was
broken, wished to have him carried home; but he insisted
his leg was only bruised, and that if  they would help him
on his feet to the sidewalk, he could and  would walk with
them.  After some difficulty they got him to the pavement,
and upon his feet.  He walked  along for about one hun-
dred feet; but, in attempting to pass a curb stone, his foot
gave way; he fell, and  it was then  discovered that both
bones of the leg were broken.  I saw him very soon  after-
wards; and, notwithstanding his  assertions that the left leg
was the hurt one, I adjusted an apparatus to the right limb,
and after  much difficulty a cure was  effected. 
SURGERY.
637
    Violent muscular action will sometimes produce fracture,
 as in the olecranon, after great  contractions of the triceps
 humeri muscle, or in the patella, under the influence of the
 quadriceps  femoris muscle.   As I have said,  muscular ac-
 tion sometimes produces disruption of a bone, but generally
 this cause operates conjointly with external violence.
    The symptoms of a fracture require a careful examination
 before the surgeon is justified in  speaking positively as to
 the  nature  of the injury.   I know that in this remark I
 differ from  the vulgar notion; but, gentlemen, in the prac-
 tice of surgery, "it is the easiest  thing in  the world to  be
 mistaken;" therefore when you are called to see a case of sup-
  posed fracture,be most careful in your scrutiny and ascertain
 all the facts in the case before you utter your views.   You
 had better be very slow in making up your mind, and then be
 right, than for the sake of gulling the by-standers, affect so
 much smartness as to jump at a conclusion after a superfi-
 cial examination,  in which  case you may express an opi-
 nion which a subsequent proper examination  will prove er-
 roneous ; and to correct which you will be put into such a
 position as  to be obliged  either to make a mortifying ac-
 knowledgment of your blunder, or else give  such contradic-
 tory explanations as" will destroy the confidence of the patient
• and his  friends in  you.   In such cases think well  of the
 maxim,  " Festina  lente,"  before you oracularly  give your
 opinion.
    From  what  I have said, you will understand that the
 signs of fracture are by no means so  certain, or the  acci-
 dent as easy of diagnostication as many persons imagine.
 I wish you to remember that great care is necessary in the
 examination of a  case before you decide upon its nature,
 and commit yourself to an opinion.  The symptoms present
 arc  usually, 1st, pain at the site of injury.   If a nerve be
 near the affected  part, this is sometimes excruciatingly  se-
                            54* 
638
SURGERY.
vere, and in  ordinary cases is liable to exacerbations from
muscular contractions, producing displacement of fragments.
2d. Preternatural mobility of parts.  As a general thing, a
patient has very little power to move a fractured limb, be-
cause of the agony such effort  occasions; but the surgeon
can readily effect more motion than the part is capable of
in a healthy condition.   3d. Swelling of the parts, and
displacement of fragments.
   " Swelling invariably occurs, and is  of three kinds. 1st.
The displacement and overlapping of the. fractured ends
produce  greater or less enlargement of the  part, immedi-
ately after infliction of the injury.  And if muscles be re-
laxed by the displacement, the bulging into which they are
consequently  thrown  will  contribute  to the immediate
swelling.  2d.  The first swelling is increased by extravasa-
tion of blood, which inevitably follows solution of continuity
in the bone, and co-existent laceration  of the  soft parts.  If
any  considerable vessel  have been injured,  this  kind  of
swelling  may prove very great; partly by blood  accumu-
lating around the fracture, partly by its  being  infiltrated
into the surrounding tissues.  3d. The second swelling, in
its turn,  is followed and modified by that which attends on
inflammatory action, beginning to form  after the lapse of
some hours.  The tissues then become infiltrated; partly "
by serum, partly by fibrinous exudation." *
   The displacement of fragments may be occasioned directly
by the violence producing the fracture, as when the arm is
broken by a severe blow, or a piece of the skull  is broken
and driven in by an injury; or it  may be produced by the
weight of the limb dragging down  the  lower or outer piece,
as frequently occurs  when the  acromion or clavicle is
broken.   In oblique fracture, displacement is much more
common  than in the transverse variety.  In the former the
shape of  the fragments greatly facilitates their separation,
* Miller's Principles of Surgery. 
SURGERY.                  639
while in transverse fracture the surfaces are so broad that
they rarely slip, or are drawn past each other; and in many
instances  the parts are  so  locked  together as to form  an
" Impacted Fracture,"  in which there is generally very lit-
tle, if any distortion.
   But of all causes, muscular contraction is the one which
most frequently produces displacement in the extremities.
In these cases the lower  fragment is usually drawn out of
its position by the unnatural action of the muscles which
pass over and upon the  limb.   A strong evidence of the
power of  the muscles in this  way is  found in paralyzed
limbs in which fracture occurs.   Here there is hardly any
displacement, except as it is produced by the original cause
of lesion, or the weight of the limb.
   The direction of the displacement will vary according to
the 'variety of fracture, its location in reference to muscles,
or the weight of  the limb.   The deformity may be angu-
lar, transverse, or in the diameter of the bone; longitudinal,
or parallel to its axis;  and rotary, or in the circumference
of the  limb.
   The most certain sign  of  fracture is crepitation,—a
grating noise made by  rubbing  the  fragments against each
other,  which can  readily be done in  almost any fracture,
except where the parts are impacted.   In the examination
of a suspected fracture, too much  gentleness  cannot  be
shown, nor can an  excess of caution be manifested.  The
remarks of Professor  Miller on this subject are  so practi-
cal and  appropriate,  that I will quote  them entire for
you:—
   "The manipulations necessary to ascertain the nature of
an accident, and which are especially  directed towards de-
tection of crepitus, are to be conducted with all gentleness,
so as not to produce unnecessary pain,  or endanger further
injury to the soft parts, with aggravation of subsequent in-
flammatory action; and  yet with determination  sufficient 
640                   SURGERY.

for fully satisfying the examiner as  to diagnosis.  It is
much better that one thorough examination should be made
at once, painful though it be, than that more gentle move-
ments and inquiries should be made, with frequent repeti-
tion, delaying the means of cure.  Also, let it be borne in
mind, that, at whatever cost  of suffering to the patient, it
is our paramount duty to make such a thorough examina-
tion, for two reasons.  In the first place, in order that the
required repose and treatment of the part may be immedi-
ately instituted; in the second  place, and mainly, that er-
ror of diagnosis may be avoided.   For, suppose that in the
hip insufficient examination has  led to the latter event—
that a fracture is believed to exist, while in truth the in-
jury is dislocation.  The ordinary treatment for fracture
is applied, and continued for  the usual j>eriod.   On finally
undoing the retentive apparatus, the true nature of the case
may be for the first time disclosed—too late to remedy the
evil.  The patient remains a cripple for life; and an unto-
ward event has happened to the surgeon's welfare and re-
putation.  Anaesthesia is of  great advantage here—espe-
cially in  the young, and in those who from any cause are
intolerant of manipulation.   They are  saved all suffering,
and the surgeon, undistracted and in quiet leisure,  delibe-
rately satisfies himself as to the condition of every part—
all the more readily and accurately because the muscles are
rendered pliant and unresisting.
   "The required examination  may,  usually, be conducted
thus :—The patient having been arranged in a suitable pos-
ture, the distal extremity of the injured bone is taken hold
of by  the surgeon's right hand, while his left is placed over
the seat of injury.   With the  right hand the limb is gen-
tly extended, till normal length is nearly or altogether re-
stored; then, while extension is maintained, gentle rotation
is made, and the  fingers of the left hand  are  used coap-
tatingly, so as  to force the broken fragments—if such there 
SURGERY.
641
be—to rub on each other, and emit the expected crepitus.
At  the  same time, by another sign, it is  made apparent
that solution of  continuity exists in the shaft of the bone,
the lower fragment being found to roll in obedience to the
rotating movements of the manipulator, while the upper,
just as plainly, is unaffected thereby.
  "It is obviously of  much importance that the examina-
tion should be made at as early a period as possible; before
spastic  rigidity  of the  implicated  muscles has occurred,
which might oppose the required extension and coaptation,
(if anaesthesia be not employed,) and before concealment of
the relative position of the parts has taken  place, either by
the blood of extravasation, or by the  exudation of excited
vascular action."
   If a deeply-seated bone, or one surrounded by large mus-
cles, be injured, it may  be  difficult, even with the most
careful  and  properly conducted  examination, to ascertain
the exact nature of the lesion.  In such cases, in  addition
to the ordinary means, the stethoscope may be very advan-
tageously employed.
   As I have before remarked, notwithstanding the popular
notion  that  it  is an easy matter to tell  when a bone is
broken, the diagnosis of fracture is frequently attended with
much  difficulty.  This  lesion may be mistaken for bent
bone, or diastasis.  Fortunately, so far as  the treatment is
concerned, such a mistake would be of small consequence.
But sometimes this accident is  closely simulated by dislo-
cation.   Here  an error  of judgment might lead to very.
troublesome consequences for both patient and practitioner.
A proper remembrance  of the symptoms I have  detailed,
and a careful,  thorough  examination of the  case, will,
usually enable the surgeon to detect  the nature of the ac-
cident.
   " I have already spoken of the mistaken notions  of non-
professionals in reference to fractures, and warned you, 
642
SURGERY.
gentlemen, that these lesions are by no means trifling acci-
dents, but that they are frequently of  such a serious na-
ture as to require  the exercise of your greatest skill, and
the closest attention, to conduct them to a successful issue.
In no branch of the subject is more judgment requisite or
care necessary than in  the  formation of  a prognosis, and
the expression  of an opinion as to the result in these  acci-
dents.
   "You will be influenced in your judgment by many cir-
cumstances, and please be careful to give them all the full-
est consideration  before you express your views.   From
some of my remarks, you might also infer that I am over
cautious, or disposed to attach too much importance to the
subject under consideration, but, as I proceed in the  lec-
tures, you will  learn, from the cases I shall detail  to you,
that such is not the fact.   There are few more trying po-
sitions for the physician than in the case of a bad fracture,
and  hence  my anxiety  that  you should  be  thoroughly
posted, and avoid the difficulties  into which some of your
predecessors have plunged.
  "Simple fractures are much more favourable than those
which are compound, comminuted or complicated; a trans-
verse break is less difficult to manage than  an  oblique one;
here, from the shape of the fragments, the ends have a con-
stant tendency to slip or be drawn past each other.   A so-
lution of continuity in the shaft is generally a less severe
accident  than one near to the ends of a bone.  Fractures in
small or superficial bones heal more readily than in larger
bones, deeply-seated, and acted upon by many muscles. As
a rule, fractures in young persons heal more kindly than
in those of advanced age.  In persons of impaired health
these accidents  are not so likely to proceed favourably as in
robust individuals.  Pregnancy is said to retard the union
of bones, and, in some instances, to seriously complicate
the case, but, in my own practice, I have not observed  any
special difficulty: in one or two instances I have supposed 
SURGERY.
643
that union was not so rapidly effected  as in some other
cases.
   "Many other circumstances that I do not now mention
may occur to modify your prognosis, but, if you remember
what has been said  thus far, you will be  fully able to
form a reasonable judgment in any case that may occur to
you.
   "To enable you to understand fully the manner of heal-
ing in fractures, it will be well for us to take a retrospec-
tive view of the condition of things after the occurrence of
the accident.   We will suppose a man has received a blow
on the arm of sufficient violence to occasion disruption of
the humerus.   There is no external solution of  continuity
in the soft parts.  The accident  is a simple fracture.   If
a post mortem examination could  be made  soon after its
occurrence, we would find a disruption of the bone in  one
of the directions I had mentioned, viz.: transversely, ob-
liquely, or longitudinally.   Very likely, however, the so-
lution  of continuity will be oblique in such  a case as  the
one supposed.  There will be observed, also, a lesion of the
periosteum, laceration  of  the cellular tissue and muscles
around the bone, and effusion of blood from these wounded
parts.  The fragments  of the fracture will be seen enve-
loped in  the bloody effusion.   This condition of things con-
tinues for a longer or shorter time,  and  then changes take
place, provided a cure is about to follow.   In the course of
twenty-four or forty-eight hours, there will be a great aug-
mentation of the swelling, which is perceived soon after the
occurrence of the accident.   This increase of size is occa-
sioned by extravasation of blood, coagulable lymph and se-
rum; or, at first, by the  coagulation of the blood alone,
which is soon separated into its constituent parts.  If we
watch its progress from day to day, we will find the swell-
ing gradually diminishes; and if a view could be taken of
all the operations going on, we should see that the red mat-
ter of the blood was  gradually absorbed or taken up,  and 
644
SURGERY.
that its place was supplied by a white plastic matter called
coagulable lymph.   The fibrous structure of the blood re-
mains, and serves to agglutinate the parts disrupted.  This
condition continues for a short period, a week, ten days, or
two weeks, probably, more  or  less, or this  state of things
may last four weeks;  but usually within  two or  three
weeks after the occurrence of the accident,  some matter of
more dense structure is effused into, or  takes the place of,
and ultimately this  matter  increases in quantity, so  as to
form a kind of covering or bark-like investment around the
contiguous broken fragments, and this covering finally as-
sumes  the  cartilaginous  condition, and  the fragments are
held together more or less firmly by this substance.
  To effect this change, weeks may be required.  The cure
is not yet mao>e.   Bony matter is deposited in this cartila-
ginous substance,  and ultimately the  band  of junction
which previously was blood, afterwards coagulating lymph,
and subsequently cartilage, is converted into bone.  When
this  operation is  completed, the fracture  is  said  to be
united.   But union is not yet  effected, although the sur-
geon permits the patient to use the limb.  Thus far there has
been no consolidation of the fragments, no plastic effusion
has occurred between them, whereby they  are tied  to-
gether.   There may have been  formed a bony pin, which
fills up the cavity.   (Please understand I  am explaining
the manner of junction in long bones: a different method
of union is formed in flat bones.)  A cartilaginous pin is
formed in  the medullary canal,  and the exterior of the
fragments is surrounded by a bony ring, which constitutes
the "provisional callus;" or, as it is termed by Paget, the
" ensheathing callus."
  Subsequently, after the lapse of many weeks or months,
and it will require from six to twelve months  to complete
the junction, bony matter will  be thrown out between the
fragments, and they are  agglutinated together,  and then
by a gradual process of absorption or modelling, the  pro- 
SURGERY.
645
visional callus is diminished in size, and made to  assume
somewhat the appearance and condition of the limb.
  The views I have given you, are the result, chiefly, of
the experiments and observations of the  celebrated French
surgeon, Dupuytren. Previously to his time it was supposed
that the blood was the bond  of junction, and this notion
was not far wide of the mark.   Hunter adopted this hypo-
thesis.  Before this it was thought a bony juice was thrown
out.   I do not pretend to speculate as to the manner callus
is formed.  I am satisfied with the opinion that all the tex-
tures contiguous to the broken parts, aid in  forming the
substance by which coalescence of the fragments'is effected.
  I present you here  several fractured bones that have be-
come consolidated; in some  of them very little deformity
is observed,  in other specimens the fragments have not
been so well approximated, and the union is  more or less
irregular.  Here is a  specimen in which you might  infer
that one end of the bone had risen up and been retained in
that position.  This, however, would not be a correct in-
ference.  A rising end of a fractured bone is not so often
met with as many  imagine.  It is said to be often seen in
fractures of the clavicle.  But in this  case, as in  most
others, the risen end is produced by the weight of the limb,
or other causes drawing down the  other  fragment,  pro-
ducing depression of its end when the upper piece maintains
its natural position, and a union is effected,  so that the
outer end of the sternal fragment appears to be above the
acromial piece.  While lecturing upon the  anatomy of the
lower extremity,  I explained to you, that in fracture of
the femur,  just below the trochanter minor, it often  hap-
pened  that the distal end of the  proximal fragment was
drawn upwards and  kept in  that  position  by muscular
action, and this is one of the few cases  in which there is
a "rising end" in broken bones.
  Most fractures  unite in the way I have told you, but
       55 
646
SURGERY.
notwithstanding this is the general method, there are ex-
ceptions  to  the  rule, and you will find these exceptions
within capsular ligaments, and contiguous to joints.   You
will learn that within the capsular ligament of the shoulder
joint  a bony consolidation is  difficult to accomplish;  and
you will  find it much more difficult to effect in fractures of
the neck of the thigh bone within the capsule.   I  think
it a very remarkable circumstance, indeed, to find a bony
conjunction of a fracture of the  cervix  femoris  entirely
within the capsular ligament.  I know many cases of a
supposed osseous union are reported,  but  I apprehend the
fracture  in most of the instances passed to  the outside of
the ligament, so that the lesion was both within and out-
side of the capsule.  These accidents  generally occur in
persons of advanced age, in whom  the  powers of  the  sys-
tem are diminished, and the functions sluggishly performed;
and, therefore, a smaller  amount  of blood passes  to such
parts than is furnished earlier in life.  I do not deny the
possibility of callus junction here, but  I believe the cases
of such union, few  and far between.
  As I have said there are circumstances in which a fibro-
cartilaginous mass ties the fragments together,—and  this
is the second kind of union of which I spoke.  You will
find such junctions in the olecranon process of the ulna;
in the patella, in the neck of the jaw, in the coracoid and
acromion processes of the scapula, in the cervix  femoris,
and under certain circumstances in other situations.   The
general  rule is, that fractures unite by callus  instead of
fibro-cartilage.   This latter kind of union occurs very fre-
quently, and may be a very good junction.   It is  still not
equal  to a  bony union.   In all  instances every possible
effort should be  made to obtain a callus junction.  But, in
the cases referred to, the  probabilities are against it; and,
therefore, you must be particularly careful in your manage-
ment, to  insure a proper coaptation of parts, so as to afford 
SURGERY.
647
every facility for bony formation, and if you fail to accom-
plish  this, a junction may be formed by as short fibro-car-
tilaginous bands as possible.
  I do not inculcate upon you the necessity of daily open-
ing the  dressings and examining the fracture.   On  the
contrary, I beseech you, after a proper dressing, to let  the
parts  alone as much as possible, or until the bandages need
re-adjustment.   Of course I would have you see the case
often  enough to satisfy yourselves the fractured parts retain
their  proper^ relative  positions, as you  should have  left
them  at your first dressing.   I know that patients will ex-
pect you to open the  parts almost daily, to handle them
and see if they are "knitting" properly.   But, gentlemen,
such a course is very bad surgery.  The parts require  rest
to unite.  I trust none of you will ever  be guilty of such
quackish conduct.
  On the subject of union of fractures, you will find some
very valuable remarks in "Miller's Principles of Surgery,"
and in " Paget's Surgical Pathology."   I  advise  you to
study them carefully.
  As to the time required for the union of a fracture, I
cannot speak with positive  certainty; in some cases four
weeks may be a sufficient time to effect a union as I have
explained it, while in others twelve weeks may be required.
But perfect junction rarely takes place under from  six to
twelve  months.   Be careful that  you remember this.  It
may save you much trouble, and possibly a law suit for
malpractice.   Never express an opinion as to the treatment
that has been pursued in these cases.  I will tell  you a
story to show the  necessity of  doctors being very careful
how they express their notions  in reference  to the treat-
ment which has  been pursued in  the management of frac-
tures about joints, or injuries of  bones.  It  so happened
that a Mr. A., accompanied by  judge B., waited upon Dr.
C. of the city of-------.  Dr. C. was a very fashionable 
648
SURGERY.
physician  of twenty-five years' experience.   Mr. A. said
to the Doctor, "I want you, sir, to examine my arm." The
Dr. made the necessary examination, and informed Mr. A.
that his elbow had been dislocated.   "So I thought,"  re-
plied Mr. A.  " Oh, there was no difficulty in ascertaining
that," says the Dr.  " Why,"  continued he, "did you not
have a doctor when the accident occurred?"  " I had one
of the best physicians, as I supposed, in my neighborhood,"
replied  Mr. A.   "He did not know his  business," quoth
the Doctor.   "What did he tell you?"   "He told me  he
had reduced the displacement."   "He told you he had
reduced  the dislocation!  I would sue  such a man for
malpractice."    "You would?"   "Yes,  most certainly."
"Then, Judge B., I think the best  thing I can do, under
Dr. C's. advice, will be to enter suit against the physician."
Who was it?"   "Dr.  C. of------;  it was no other than
yourself; you are  the man,—the accident happened ten
years  ago."   "I set it, and you  did not obey  my direc-
tions,  and the present deformity is the consequence.  You
may begin a suit as quickly as you please !"  After some
farther  conversation,  the  doctor  somewhat modified his
talk, and Mr. A. told  him he had long been satisfied no-
thing  could be done to relieve  him, and as he had not seen
Dr. C. for several years, he thought he would present his
arm, to  see what he said.
  But, suppose Mr. A. had followed Dr.  C's. advice, what
trouble he might have got  into because of his inadvertence.
You must be careful how you promise success.   You will
be asked by the  patients, will the limb be straight?  You
have reason to say, we hope so.  Will it be as strong as
before?   Yes; probably stronger.  It is a fact,  that some-
times  after  a fracture, the part broken  is stronger than
before the accident.  If the fracture  be below or above the
nutritious canal, in the direction of  the course of the ves-
sel, it will be stronger than previously, becaus.e  an  excita-
tion is established in the part—a great afflux of blood fol- 
SU RGERY.
649
lows, and an  excess  of bony matter  is formed, which>as-
sumes, ultimately, the form of the bones  in  the  natural
condition.  We  cannot  determine as to the time that is
requisite for the consolidatien of a fracture.  Fractures of
the superior  extremities are sooner  healed than those of
the inferior  extremities; small bones more  readily than
large  bones; fractures  remote from  a joint sooner than
those near a joint.  If one bone is broken, junction is more
favourable than  if two are fractured.
   There are a great variety of things, in reference to this
matter, as in others  of which I have spoken, to influence
you in the formation of an opinion. . You will refer to the
age of the patient, coaptation of parts, habits, health, &c.
   There are three prominent indications in the treatment of
fractures.   1st.  To coaptate the fragments.   2d. To main-
tain  them  in   apposition.  3d. To  counteract abnormal
symptoms.   As I have  remarked, the first indication is to
coaptate the fragments, reduce the  fracture;  or, in  com-
mon parlance, to "set" the broken  bone.   To enable you
to understand how this is to be done, it is necessary to re-
member the condition of the injured parts, and the muscles
which operate upon them.  I have not yet lectured  upon
 the different fractures,  and I can hardly refer to  the spe-
 cial kinds of derangement which may be present, and to
 the muscles which particularly  operate in the induction
 and  maintenance of the displacement you may  observe;
 but from  the general  observations  I have already given,
 you are aware that when displacement occurs, it  is  gene-
 rally owing  to the removal of the distal fragment, and that
 the part is kept in its abnormal position by the contraction
 of the muscles  which are inserted into it, and, therefore,
 the great cause which we have to counteract, or the great
 operating influence, in,  first, the production of  displace-
 ment, and, subsequently its maintenance,  will be  muscular
 contraction.    Sometimes  the  position  of the fractured
 parts, or the displacement into which they were forced at
                           5.")*
1 
650                  SURGERY.
the* time of accident, will be the cause chiefly complicating
reduction;  but, as a general thing, and it is a rule of  al-
most universal application, you will find that muscular con-
traction  is the efficient cause, first, of the displacement,
and, second, the continued  malposition of the parts.   In
all  the  fractures I shall  show  you, the muscles are  the
principal causes of deformity: the bones have no influence
in producing displacement; they are mere passive levers.
From these remarks you will infer, if you take a proper or
philosophical view of the  matter, that  the natural indica-
tion is to put the limb into as easy a position as possible.
There is no use in resorting to force upon the part until
you have relaxed the principal muscles;  you may pull and
haul until you are tired, and the only effect will  be to ag-
gravate   the mischief, occasion  permanent contraction* of
the muscles, and  induce violent inflammatory excitement.
Therefore I advise that you do not resort at once to active
traction; such a course would increase the symptoms, and
might lead  to  terrible consequences.   But although in-
flammation may be present, it is your duty to try to coap-
tate the  fragments.   If you find  the inflammation is  ex-
ceedingly violent, and the limb  can  hardly  be  touched
without increasing it, let  the  parts alone; do as common
sense would dictate:  reduce the inflammatory action  as
quickly   as possible by the administration  of nauseants,
gelsemin, aconite, or veratrin; or if the lesion be in a supe-
rior extremity, by the use of saline purges in addition, and
by the  local  application of cooling washes, discutient  or
evaporating lotions; resort to every method for the purpose
of subduing the  preternatural action;  and although you
will frequently accomplish the object by these means, it is
nevertheless true that the most efficient course to effect the
result will be to place the  fragments as nearly as  possible
in apposition, then  leave  the case for a few hours under
the treatment I have  indicated, and you will frequently be
surprised to find the broken parts coaptated by the action
of the muscles around. 
SURGERY.                  651
  On this subject I advise you to study carefully the arti-
cle on Fractures in Mr. Abernethy's Lectures on Surgery.
  Do not imagine, gentlemen, that I waste jour time if I
do occupy several hours with this theme.   Should I lecture
half a course on fractures, if you got proper ideas of them,
I would think the time well spent.  Too little attention is
generally given to this subject by students.   Many of them,
I am sorry to say, have the idea that all that is to be done
in fracture of the clavicle, if that be the bone broken, is to
put on Fox's apparatus; in fracture of the arm, to apply
three or four splints and  a roller, or to put on Physick's
Desault's  appliances for fracture of the thigh.   This is a
grand mistake.  The surgeon who  is properly acquainted
with the philosophy of this part  of our science, can treat
fractures  successfully without employing these arbitrary
arrangements.   A  man  may  dispense with  these splints,
and, if he have nothing better, use the bark of a tree, or
an old band-box.  I have been so situated; and before you
are aware of it, you may find  yourselves in a similar pre-
dicament.   I do not  undervalue the  ingenious arrange-
ments of inventors.  As I proceed  I shall exhibit many of
them.   I  will show you many pieces of machinery devised
for the management of fractures.   I will  explain their ad-
justment, and demonstrate very fully the application of
bandages, and  I desire you to give  close attention  to these
practical  instructions; but I wish you to know that  al-
though  arbitrary rules may sometimes be very useful, you
cannot manage these accidents without a  thorough know-
ledge of the anatomy and functions of the parts involved,
and have judgment enough to adapt your  appliances so as
to meet the peculiarities of each case.
   Put the limb in as easy a position as you can, employ the
treatment I have mentioned, and, as I have  said, you will
often be surprised to find  that coaptation  has  occurred in
your absence.   A notion  that great force is necessary to
"set" a broken bone is almost universal among people out 
•    652
SURGERY.
of the profession.  This is a popular delusion; for, as has
.been  explained, gentle means and  proper  treatment  fre-
quently accomplish more than can be effected by the most
vigorous or forcible efforts of the surgeon and his assistants.
In these cases, gentlemen, be like the Indian, do head-work,
instead of physical labour; and then charge a good fee for
your " head-work," rather than for humbugging the people
around you.
   I remember a case of compound fracture that occurred in
my practice a few years ago.   The  man  was injured  away
from home, but very soon after  he was brought there, his
house was nearly filled with people to find out what was the
matter.   The tibia and fibula were obliquely broken, and
there was an external wound communicating with the frac-
ture.   I cleared the room as much  as possible, but still se-
veral persons would remain.   All I did in the case was to
get a common fracture-box, and  put a pillow covered with
oiled  silk into it.  Upon this  I placed the limb as gently
as possible, gradually brought the foot into its natural po-
sition, passed my fingers over the leg, and made slight pres-
sure at the broken spots, put a rag wet in cold water over
the wound, and after fastening the foot, tied up the  sides
of the box, and got ready to leave  as soon as I gave my
directions to the man's wife.  Some of the  people in the
room said  to me, " Doctor, are you not  going to set the
limb ? "  " It is ' set,'" said I.  If I had adopted the method
frequently pursued, I should have grasped  the limb above
the ankle, set my teeth, and made a great hauling over it.
The limb, then, is to be placed in an  easy position; and  if
you find the posturing of the parts is not followed  by coap-
tation, you may run  your fingers over them, and probably
by a little modelling the fragments  will be forced into posi-
tion; but if you find this cannot be effected, and  that the
pieces are separated, or one  pushed over the other, it may
be necessary to resort to  some greater force to enable you 
                      SURGERY.                   653

to coaptate the fragments.   Surgeons call the  power thus
applied, extension and counter-extension.
   Extension is the force which is applied to the distal end
of the bone; the power used on the  proximal extremity is
called counter-extension.  If I had a broken leg, and a man
were pulling at it, he would make extension, and the whole
limb would be likely to  go with him.   To counteract this,
resistance must be  made above the fracture.   A  certain
force has to be applied to antagonize the traction made at
the lower part of the bone.  The inferior fragments should
be drawn away from the upper, which  is to be firmly held
in a natural position, or as nearly so as possible; at the same
time the surgeon ought to apply  his fingers to the injured
parts, and by proper pressure try to place them in a normal
relation.  This is the course that is to be adopted; and not-
withstanding  these means are spoken  of  as  necessary  in
almost all fractures, they are in very many  instances posi-
tively injurious;  for although I tell you that in some cases
their  application  is indispensable, I assure you with great
positiveness that  in many others they are to be avoided.
Suppose, for instance, a  man has fracture of the olecranon.
What is the condition of the parts ?  The olecranon is drawn
up by the triceps extensor cubiti, a great gap exists between
the fragments.   You  pull at the wrist, while counter-ex-
tension is made at  the shoulder.   What is the effect?
Why, you separate the fragments to a greater extent.  The
space is increased between the pieces  more-and more, and
by the time the doctor has worked himself into a free per-
spiration he finds that instead of coaptation being effected,
the gap is far  greater than when he began.   So in fracture
of the coracoid process of the scapula—a rare  accident,  by
the way—the  more you  pull at the arm, the more you sepa-
rate the fragments.  The  coraco-brachialis muscle arises from
this point, so does the short head of the biceps flexor cubiti,
and the pectoralis minor is inserted  into it.   A  man with 
654
SURGERY.
fracture  of this process falls into the hands of a so-called
surgeon  who follows  the arbitrary rules of the books, in
violation of that great gift of Providence—common sense.
He applies extension, and, to his surprise, the  fragments
get farther apart than  before.  The course to be pursued
in these  cases is to place the  parts in  as easy a  position as
possible, so as to relax the muscles about, and coaptation can
be generally  readily more  or less perfectly effected.  The
same remarks apply to fracture of the patella, a bone that
is often  broken transversely.  The greater the  extending
force  applied to the leg, the more the fragments separate.
And why ?   Because  the quadriceps femoris muscle  con-
tracts and draws the proximal fragment upwards, while the
traction  made on the leg pulls  the  distal piece downwards,
and thus increases the gap.   So that, although I speak of
extension and counter-extension as very necessary in many
cases, there are other instances in which they are positively
contra-indicated.   Put the limb in an  easy position, relax
the muscles,  and, as I  have before said, you may find coap-
tation spontaneously effected.
   After  a fair trial of the course I have mentioned to effect
reduction, if you find you cannot succeed, there  is  one
means to employ that will in most instances aid effectually
to accomplish the object.   I  allude to the use of some anes-
thetic.   I prefer pure sulphuric ether to chloroform alone;
but I frequently employ, and very satisfactorily, a combina-
tion of the two, in the proportions of six parts ether to one
of chloroform.   This article, properly administered by in-
halation, will usually  produce  a condition of such  perfect
insensibility  that  the  manipulations necessary  are made
without the induction of irritation or pain, and which could
hardly be borne under other circumstances.
   We pass now to the second indication, which is to main-
tain the  parts in  apposition until  union is effected.  Sup-
pose now you have got the fragments into a proper position, 
SURGERY.
655
what will  you do with the  limb ?  Dr. Dudley, the great
surgeon of Kentucky, taught that it should be enveloped
in bandages, and then let alone.   Dr.  Dudley was  a very
great man, and might have  understood  the  application  of
bandages better than most others; but this is not the course
usually pursued by surgeons.  They will tell you to  put on
bandages and  splints, or  some machinery to answer their
purpose.  A   single  strip of bandage, rolled  tightly,  is
named a roller, or a single-headed roller.  This is the ban-
dage generally employed  to keep parts in apposition.  The
loose end is the tail, the  opposite  extremity  the  head, and
the intermediate part is the  body  of the roller.   If a strip
be rolled from each end,  it is called a double-headed roller.
When the bandage  is cut longitudinally in the centre,  so
that in its adjustment the  ends are passed through the
fissure, it  forms a uniting bandage.  The material  should
be some soft  substance,  generally muslin that  has been
washed  and ironed, in which there are no  seams, no sel-
vedges or  knots.   You may  make bandages of muslin, flan-
nel, or any other substances  presenting the proper charac-
teristics.  They should be as narrow as possible, so as to be
readily adapted to the inequalities of parts, and of sufficient
length to  be  wound properly and fully around the limb.
It is best to avoid the employment of pieces sewed together;
but as you cannot always find long strips, it  is necessary to
know how to  put them together.  If you have a piece two
yards  long, tear it into strips, and place the  ends so as  to
overlap each other;  then sew up and down, so as to make a
flat seam.   In the preparation of a bandage, be especially
careful to  remove the selvedge.  Some  of you may possibly
be candidates  for admission into the medical service of the «
Navy.   When you  go before the examining board—they
are well-informed gentlemen, who from their position can
know  or show no favour—some member  will hand  you a
piece of muslin, and request you to apply  it to a bust on a
table for a supposititious  fracture of  the lower jaw, unless 
 656                  SURGERY.

 they have changed  their course within  a few years.  The
 candidate will look at the muslin, and tear off the selvedge;
 then he should make  a strip an inch and a quarter or  an
 inch and a half wide,  and about six yards long, and form it
 into a roller.  If the  muslin be  new or glazed, he should
 politely say to the examiner, " Sir, this is not the proper
 material; it should have been well washed and ironed to
 remove the glazing, and make it soft;  but I will do the best
 I can with it."  If he make no  explanatory remarks, but
 tries to adjust the bandage, to show  his smartness, he will
 fail most signally, and not reach the desired position.  And
 by the way, if the same bust be presented to you they used
 ten years ago, be sure and apply the bandage devised by
 Dr. J. R. Barton, at the same time respectfully explaining
 that you believe it the  one most readily adjustable to the
 bust.
    "But," you may ask me, "how  is the bandage to  be
 rolled?  By machinery?"   I reply, "Oh yes,  by pieces of
 most extraordinary mechanism, consisting of eight fingers,
 two thumbs, and a  knee."   Double your  bandage so,as to
 form a kind of head  on  which you can  roll, hold the piece
 tightly and roll  away, at the same  time keep  it  straight
 upon your knee.  Be careful to  make  the mass as firm as
 possible, have the bandage tight and the edges as smooth as
 you can get them.  If the  strip be  not tightly rolled, you
 will find it almost imposible to apply it properly to a limb.
    There are fractures to which the ordinary roller cannot be
 applied.  In such cases you will find the bandage invented by
 Scultetus, a celebrated German surgeon, a very convenient
 arrangement.   It is made of several pieces of such lengths as
^ may be necessary to fit the limb,  placed one upon the other
 obliquely,  so that each one covers its predecessor about one-
 third its width.  The application is  commenced with the
 lowest, and the strips are  applied in rotation, so that one
 overlaps the other upon the limb. This manner of adjust-
 ing slips is much  preferable to  the many-tailed  bandage 
SURGERY.
657
previously in use; it can be more neatly applied, and if a
slip get dirty, its place can- readily be supplied with a clean
one, thus:—Spread out the different pieces, pin a clean slip
to the end of the one you wish to remove, have an assistant
press with his hands upon those contiguous, then draw the
opposite end of the dirty piece, and you will gradually sub-
stitute the  clean one in its place, without disturbing the
rest of the apparatus.
   For maintaining the parts in apposition you will generally
require some piece or pieces of a firm material, around which
the bandages may be  applied.   These are called splints, and
they may be made of board, bark, leather, tin, iron, cloth,
pasteboard, or hat felt soaked in  gum shellac.   This, after
heating, can be  readily applied to a limb, and when cool it
retains  the form  it was made to assume while hot.   The
cloth splint is made by dipping the material in a solution of
varnish or gum shellac in alcohol; a very ingenious arrange-
ment of this kind was devised by Mr. Calver, Secretary of
the Board of Trustees of the Eclectic  Medical College of
Philadelphia, a  full account of which you will find in Dr.
Paine's  Eclectic  Medical Journal.  In addition to these, I
should mention splints made of straw; they are " made by
filling a linen bag of  the  size of the splint required, with
unbroken  wheat straw, such  as is used  in thatching; the
straw being cut to the length of the limb, and the open end
of the bag then sewn  up.   This is  both splint and pad in
one, and may often be of great service in country and mili-
tary practice."   And besides  these, gutta  percha may  be
employed, as I shall  explain  more fully when I speak  of
special fractures.  If splints be made of an unyielding sub-
stance, they should be covered with some  soft material, to
prevent abrasion or undue compression.  For this purpose
tow, raw cotton, not wadding, or flannel, is used.  The flan-
nel is the  best.   A splint may be padded with it in this
way:—Cut the flannel into pieces a little  larger than the
splint, place them upon it, and by the proper adjustment of
     56 
658
SURGERY.
a roller they will be kept in position, an equable pad is made,
which does not become lumpy like cotton or tow, but main-
tains its  shape, and  answers the  purpose  well.   In large
limbs the splints may be covered with a pillow, or protected
by bags filled  with bran.   As  substitutes  for splints and
bandages,  some  propose contrivances of leather or  wood,
with straps and buckles attached.
  " How are you to  apply bandages?"   There is an art in
this, as well as in anything else.  You apply a bandage by
circular and reversed turns, and this you can only  learn by
frequent practice upon yourselves or others.  I  may de-
monstrate this matter again and  again, but you will never
know how to do it without frequent  practice of your own;
still, a little instruction will aid you.   For instance, I will
apply a bandage to tLo arm.  I commence by fastening it
to the hand by a few turns, then pass  up the forearm by
circular and reverse applications, making the reverse turns
as I meet inequalities in the limb, then carry it around the
elbow and the arm, and fasten near the axilla with pins, or
a few stitches.  I have not wet the roller,  as is sometimes
necessary; it makes  a prettier bandage, and, under certain
circumstances that I may  mention hereafter, it becomes ne-
cessary to wet it;  and please remember that such a band-
age becomes loose after it dries, and, vice versa, if you ap-
ply it dry, and then  wet it, the roller gets tighter, and the
part be injuriously  compressed.  In making a splint, be
careful that it is of proper size to answer the purpose.  In
some fractures it should be  long enough to pass  above and
below the contiguous joints, and  of  such width  as not  to
compress the injured parts, while in other cases they may
be required short, and so  narrow as to  bind the  limb.  In
some instances splints should be applied before the band-
age; in other cases, afterwards, e. g., in fractures of the
arm, the roller may be applied, and the splints over it, while
in similar  accidents to the forearm, the splints, properly
padded, must  be adjusted before the bandage.  Hereafter 
SURGERY.
659
I will explain the reasons for these different courses. Some-
times it is necessary to apply splints in such away that you
can make fastenings to them for extension and counter-ex-
tension, as I shall  demonstrate in various fractures where
such a course is requisite.  After applying your apparatus
to  maintain the parts in apposition, keep the limb in a quiet
position, and, in favourable cases, the changes which I ex-
plained will go  on until consolidation occurs.   In taking
off the bandage, the practitioner should be careful not to
allow it to drop from  his  hand.  A surgeon  should never
make an unnecessary  fuss in doing any operation  he  may
be called upon  to perform.  If a man has capacity, it will
be found out; if he has  none, all  the noise he can make
will never convince people he has professional merit.
   Besides  the  means  mentioned to accomplish the second
indication in the treatment of fractures, other contrivances
have been suggested.   At one time it was proposed to en-
velop the limb  in a coating  of plaster of Paris, after the
coaptation  of the parts.  It was supposed that after the
hardening of this medium, it would effectually prevent mo-
tion and keep the parts in apposition.   But, although  after
a few trials it was thought  to act serviceably, it was soon
found to be objectionable; it renders the limb cumbersome
and  heavy, and is, moreover, so brittle that it is constantly
liable to be broken. It, therefore, speedily went out of use.
But for a long time previously to the mention of plaster of
Paris, surgeons had applied themselves to the examination
of various materials with the view of discovering something
which  would  be more satisfactory than  the means pre-
viously employed, viz.: the adjustment of splints and band-
ages to the parts affected.   The result of these investiga-
tions has been, that various forms of apparatus have been
devised called immoveable.   One of  the first of which  we
have an account is made  by quilting strips of whalebone,
or pieces of splint, between two Surfaces  of cloth.  The
machine thus made can be applied and accurately adapted, 
660
SURGERY.
it is said, to the  limb;  but this  substitute  did not long
maintain its ground.    Afterwards" other  courses  were
adopted, different kinds  of varnish were used  as applica-
tions to cloths to stiffen  them, and render them efficient for
the purpose desired.   Among the best of these is the
'moulding tablet'  of Mr. Alfred Smee, an English surgeon.
' It is composed of two layers of coarse old sheeting, stuck
together with a mixture of gum-arabic and whiting.   It
is easily prepared  by rubbing very finely-powdered whiting
with mucilage of gum-arabic, till it acquires the consistence
of thick paste, and then spreading this on the surface of
the sheeting, which is  to  be  doubled on itself;  it dries
without  shrinking, and becomes remarkably hard  and
tough, and may readily be softened by sponging it with hot
water, so that it may be adapted with the greatest accuracy.
The appliance now known as the proper ' immoveable appa-
ratus,' was got up since 1830 by Sueten, a French  surgeon,
who served at the siege of Antwerp.  It occurred to him
that by properly  adjusting  starched bandages  and  paste-
board, that broken parts  could be maintained  in a quiet po-
sition, and so kept until coaptation of fragments  resulted.
He supposed this course would possess many advantages
over that usually  adopted, and he  evolved his thought by
the application of starched bandages  and pieces  of paste-
board to broken i limbs.   He found the result satisfactory,
and since his introduction of it, this form of immovable ap-
paratus has been employed  in numerous cases.  It is lauded
by many, and as much condemned by others.   To explain
how it is made, I  will suppose  we  wish to apply a  retentive
apparatus to a fracture of the arm. Two rollers, two inches
to two and a half wide,  and six yards long, are required;
the end of a bandage is to be thoroughly saturated  with pre-
pared starch, its  application is to be commenced  at the
hand, and as it is adjusted by continuous turns, the starch
is freely applied by a bfrush to the new parts of the roller,
so that by the time the  limb is wrapped, the roller is  tho-
I 
                       SURGERY.                   661

 roughly covered with  the starch.  The  roller is still  soft
 and flexible, and may assume any position in which the
 limb happens to be placed.   Over the bandage are placed
 properly conformed pieces of pasteboard, which have been
 previously well soaked in water and dipped in the starch •
 over the boards  the second roller is applied,  and the pre-
 vious dressings are  to be covered with this second bandage,
 which  is to be well  covered with  the  starch also.  In this
 way the limb is  surrounded by two rollers and the pieces
 of starched pasteboard.  After some  thirty to forty  hours
 these will be  fully dried, and the limb be encased in a firm,
 immovable apparatus.   But this  firm drying forms one of
 the objections to the apparatus; for if the dressings be  left
 just as they were applied, the limb will as likely as not as-
 sume an improper position, in which it will be retained by
 the dried apparatus. To obviate this difficulty, small pieces
 of paper are to be laid over the starched bandage, and over
 these firm  splints are placed, and these are maintained in
 position by tapes or strips of bandage.  After a few  days,
 this provisional dressing can be removed, and the parts  be-
 low will be found dry and firm.   In  consequence of the
 difficulty of drying the starched  bandage,  investigations
 have been made to ascertain  if a substitute for the starch
 could be found, and  the result has  been the discovery  of an
 article  of farinaceous  character called dextrine.  It  is so
 named from its power to turn rays of  light to the right.
 It resembles starch,  and a solution of any desired thickness
 can be  made  by pouring hot  water upon it.   It possesses
 the advantage of drying in three or four hours, during
 which time  the parts may be maintained in proper position
 by a provisional apparatus, or by  careful watching.   This
 apparatus, starch or dextrine, appears very simple, and at
 first seems  as though it would  admirably accomplish its de-
 sign, and if we could be certain the limb  would retain ex-
actly the condition  in which we  leave it after  the adjust-
ment of the bandages, &c, it  would be an admirable  con-
                          56* 
662                  SURGERY.
trivance;  but, unfortunately, as is well known to surgeons,
after the application of the retentive means, there is great
reason to fear that the limb will swell; and if it be tightly
cinctured by an immovable apparatus,  which has  been ad-
justed before the swelling appears, the consequence will be
constriction of the limb, and the development of inflamma-
tion and its sequences; so that it has been  demonstrated
that,  although  this  apparatus  is, under  certain  circum-
stances, which I shall presently mention, an admirable con-
trivance, it is not applicable  to  fractures soon after their
occurrence, because  of the  great danger of swelling, and
the risk of inflammation and its effects. Cases are reported
in which mortification followed the application of this "im-
movable apparatus."  One happened  under the charge of
one of  the  most distinguished surgeons in this country, a
Professor in a Southern college.   In this case  sphacelus
occurred within the folds of this dressing—and all this, too^
not from  any fault of the doctor, who, as I said before, is
one of the  best practitioners in this country.  Soon after
its introduction, this  apparatus was very popular, and, be-
cause it was fashionable, many persons  recommended it
highly; but after such accidents as I have  mentioned, they
reprobated it as  much as they had previously praised  it.
I remember a case in  point.   Some years ago, we had  in
this city a very good teacher  of surgery, who, to show that
he was fully posted in all recent matters,  was in  the habit
of lauding everything just out or  fashionable.   He went
off frequently at  "half-cock," forgetting the maxim that
"Everything that was new was  not true, and all that was
true was not new."   Well, one year, in his  lectures, this
gentleman praised the "immovable apparatus," as though
it was a specific, dr everything that was to  be desired  in
the management  of  broken bones;  and the  next year he
railed against its  employment, as though  it  was a piece of
arrant quackery,  without appearing  to  consider that it
might haye  been  employed at the wrong  time.  Notwith- 
SURGERY.
663
standing the accidents that may have occurred with it, the
apparatus is most excellent under certain circumstances, if
properly applied  and at  a suitable time; but  that is not
immediately after the occurrence of the accident, although
it was said by its advocates that it will prevent the swelling
of the limb.   It is not so.   I tell you there is danger in
its application, if it be resorted to at this time.  "Well,
then," say you, "a little while ago you remarked that the
apparatus was a good one. When ought  it to be applied ?"
I reply, as soon as the  inflammatory symptoms consequent
upon  the accident have passed away.  " But," quoth you,
" you have stated this may require months." I do not say,
wait until all the swelling has gone; but when the inflam-
matory intumescence has passed  off, it can be applied.  A
case to which  I was called a few years ago will illustrate
this statement. The patient was  doing well, but his friends
wished a consultation, although they had all confidence in
his physician, who was, and is, one of the best in our city.
I told  the sick man he was  doing well—that so far as I
knew, nothing could then be done to expedite the case—
time was requisite.   When we left  the  case I said to the
doctor: "I suggest that you soon apply the immovable ap-
paratus to this  leg."  He said:  " I  have heard of its use.
Suppose we go  back, and  you apply it?"   "Not now," said
I.   "I will return in a few days, when I have leisure, and
show you how to adjust it.  In the mean time, at your next
visit,  you can remark, 'The swelling appears to be passing
away;  in a short time I wish  to put on a new apparatus, in
the use of which, I have no doubt,  union will occur  more
rapidly than under the old treatment.' "  The doctor acted
upon  my suggestion, and  in a few days I saw the patient
again.   The apparatus was applied;  and as soon as it was
dry, a long sling, reaching from  the foot around the neck,
was arranged, and  he was permitted  to  hobble about  on
crutches, although  within less than two weeks from the
time of accident, and consolidation was effected most fa-
[ 
664
SURGERY.
 vourably.  One of the great objections, as I have  said, to
 this contrivance, is that you hardly know what is going on
 beneath it, and hence the  necessity of hitting the  right
 time for its use.  If you suspect anything, the whole dress-
 ing  should be removed for examination, and not slit  open,
 as is sometimes  recommended, and then re-adjusted,  be-
 cause in this way a ridge will be formed that may produce
 unpleasant effects.  So that,  although I extol the  " im-
 movable apparatus," I most earnestly deprecate its  use un-
 til after the inflammatory symptoms  consequent upon the
 accident have passed away.   It is a most useful arrange-
 ment in other cases than fractures. Hereafter I shall men-
 tion it in connexion with pseudo-arthrosis, dislocations, and
 other accidents.   Whenever there is a necessity to keep a
 joint at rest,  you will  find  it  a  most admirable con-
 trivance.
  In the course of my remarks I have hinted at  the im-
 propriety of frequent dressing, or the  too often repeated
 removal of the bandages.  I cannot too forcibly insist upon
 this  point.   If you shift  the dressings, you certainly pro-
 duce irritation, you move  the  limb, and may separate the
 parts.   Establish for yourselves a line along  the affected
 limb, and by a frequent examination of the parts  to and
 from which you make the line, you will  be able to know
 whether the fragments maintain their proper position or not.
 But  the idea of fingering  a  part, handling it, squeezing it
 for  the purpose  of making the patient  believe you are
 acting  with a great deal  of care to insure coaptation, is
 most reprehensible.   Such a course indicates great  igno-
 rance, or what is  worse, consummate quackery.
  When a doctor meddles  continually with  a fractured
 limb, no coaptation can occur,  because necessarily with the
 removal of the apparatus, there must be displacement of
fragments to a greater or less extent, so that till the appa-
ratus becomes  loose, or until it is too tight in consequence 
SURGERY.                  665
of the increase of swelling, it should not be removed.   I
would not  fix a date for taking off the dressings, but I
should say, let them alone while  the patient is comfortable,
even if a week elapse.  It may be necessary to adjust them
before the  week is out, because  the  movements of the pa-
tient  will  loosen them  a little; moreover,  the  bandages
will stretch, so that the  patient  should be cautioned to be
extremely careful.
   In considering the third indication, I cannot refer to all
the symptoms that may occur, but I will call your attention
to a few that are likely  to happen.  And  first, to  spasms
of the limb.   After dressing, and you have left the patient
a few hours, the first thing he knows the limb is suddenly
drawn up, it falls down  again;  this  movement, occasioned
by the contraction of surrounding muscles, disarranges
the fragments, and  this displacement irritates the muscular
fibres, so that the tendency to jerking is kept up until the
parts are re-arranged, and the system quieted by some ano-
dyne.
   Probably very soon, or within twenty-four hours  after
the adjustment of the fracture, you may be sent for  in a
great hurry to visit the  case again, and you  will  find  your
patient in a state of fever. His system is excitable, and he
complains  that  the limb feels tight and painful.  You will
at once infer that  there has  been extravasation,  and there
is a tendency to inflammation if  this  state be not fully deve-
loped, which occasions  the  general constitutional distur-
bance.  These  symptoms can generally be allayed by re-
dressing the part,  the application of a cooling lotion, and
the administration  of diaphoretics and sedatives.
   In another case  your patient will appear very restless
and  excitable.  He  will complain  that there are several
 snakes in the room, or he will say that a black dog, or some
 other animal, is jumping about  and  trying to bite him.  If
 you are not  aware  of his habits, you will be startled at his
 condition.   If you understand your business, as you should
i 
666                  SURGERY.
do, you will inquire  if he uses alcoholic or malt liquors.
You  may be told he drinks a little.   Be sure to ascertain
how  much he  used in a day, and  you will likely discover
that  the "little" will be from twelve to twenty half gills in
a day, and he now  has delirium tremens, or,  as some  call
it, mania a potu.  In these cases you must  resort to such
general treatment as the circumstances indicate.
  Many other abnormal conditions, as inflammatory,  irrita-
tive  or typhoid fever, may  show themselves, which  you
must treat upon general principles.
  I have  now  concluded the observations I thought it ne-
cessary to give you upon the subject of Simple Fractures,
and we will pass next to the consideration of the much more
serious lesion called Compound Fractures.
            COMPOUND FRACTURES.
  In speaking on the important subject now about to en-
gage our attention, I shall proceed in the  following order:
  1st.  Definition.
  2d. Causes.—A. External violence.
                B. Movements of limb.
                C. Ulceration.
  3d. Dangers.—A. Shock.   B.  Hemorrhage. C. Teta-
                   nus.   D. Mortification.    E. Fever.
  4th. Treatment.—1st. Indication,  to  coaptate  parts.
                    2d. To heal the wound, and  effect
                    consolidation.   3d.  To remove the
                    limb.
  When I lectured on "Fractures" some time ago, I men-
tioned accidents of a very severe nature, which I informed
you were called Compound Fractures.  You will remember
that I then stated these lesions to be solutions of continuity
in the bone,  accompanied by disruption of the soft parts, 
SURGERY.
667
and that a communication was established in this way from
the exterior to the space between the fragments.  I spoke,
also, of solutions of continuity in the bone, with a breach
of the soft parts without this communication.   I remarked,
too, that one variety  of the  injury was  Compound  Frac-
ture;  and  the other,  Fracture with a wound.  Bear  in
mind the distinction,  if you please; it is  very important to
be  remembered.   A fracture with a wound, although a
more severe affair than a simple break of a bone, is by no
means so dangerous an occurrence as compound fracture.
Of all the accidents to which the attention of the surgeon
can be called, there are few of more serious character than
 the lesions now under consideration.
   Compound fractures are occasioned by external violence.
I spoke fully of this cause while examining the more simple
accidents.   You will readily understand that if the force
be very severe in its  operation, that it may, in addition to
 breaking the bone, disrupture the soft parts, and that by
 this breach a cavity or communication is established from
 the exterior to the space between the  fragments.   Com-
 pound fractures are frequently produced by railroad acci-
 dents; the violence which occasions the  break is generally
 sufficiently great to  lacerate the  soft parts,  and  produce
 the  comminution before mentioned.   But, as  I  have
 said, fractures of bones are sometimes occasioned  by mus-
  cular contraction alone.   As a general thing, this cause
 and  external  violence act in  combination.  Still, under
 certain circumstances, muscular contraction will, of itself,
 disrupt the bone ; and in some cases the contraction may
 be so great as  to force one  fragment through  the soft
 parts, and thus occasion  compound fractures.  But, in ad-
 dition to these causes, this lesion may follow a simple so-
 lution of continuity.  Sometimes a bone  is broken, and
 before the patient falls a great deal of weight presses upon
  the fractured  part, and pushes it through the contiguous 
668
SURGERY.
 soft parts.   In this way, although  external violence did
 not occasion the disruption in the soft parts, the bones
 themselves, or some of the fragments, or a piece is pushed
 through the  coverings,  and a compound accident is in-
 duced.   Or  subsequently to the falling  of the patient, or
 after he has been placed  in the horizontal position, the
 movements of the limb may convert the injury into a com-
 pound one.  Possibly  an accident occurs,  and  the patient
 is not seen for several hours; and during this time the
 movements of the  limb, either because of his inability to
 maintain it in a quiet  position, or spasmodic contraction of
 the adjoining muscles, may push a piece or pieces through
 the soft parts, and occasion a solution of continuity of this
 character.
   Compound fracture  may be occasioned by ulcers.   You
 can readily  comprehend, that after the parts have  been
 adjusted, unless they have been accurately adapted, pres-
 sure may be  made so as to  excite inflammation  in  the soft
 tissues; and  as a result of this action ulceration  follows,
 and thus a hole is formed, by which a communication be-
 tween the interior and the  outside  is established.   In all
 these ways compound  fracture may occur; generally, the
 disruption  of the soft parts is a concomitant of the break
 in the bone, the external violence producing fracture being
 usually sufficient to break up and lacerate the soft parts,
 and establish the communication I have explained; or the
 weight of the limb, or the parts above, forces the fragments
 through  the  coverings,  and in this way  the accident is
 complicated.   In whatever  way  occasioned—whether by
 external violence, the  passage of a railroad Car over the
 limb, the  contact of machinery, or  by the violence  of a
 gunshot wound, it is a most hazardous condition  for the
patient.
  It is dangerous, first, because the great severity of the
accident usually produces such an effect  upon  the system 
SURGERY.
669
as to occasion  prostration  of the vital powers, or shock,
which often destroys the life of  the  patient, without  the
supervention of reaction; or, if this occur, it is character-
ized by remarkable symptoms, such as irregular nervous
action, or unnatural determinations of blood, and the con-
sequent development of diseases to which the patient was
not previously subject.   In some of these ways, either from
"shock, irregular nervous action, or unnatural determina-
tions of blood," or by the establishment of some inflamma-
tory excitement, the  life  of the individual may be  de-
stroyed.   But if he pass these  dangers, he has others  to
encounter.   It may happen  that the broken  bone, in its
course to the exterior, will pass through  a vessel, tearing
it open,  and as soon as reaction  is established, the patient
may speedily become dangerously ill, and lose his life from
hemorrhage; or the violence which produced  the fracture
may be of such a nature as to tear an artery, or lacerate a
nerve, and  thus  he may die from  the loss  of blood, or
nervous  irritation.   In  this connexion, I  advise you to
study  carefully the work of Mr. B. Traverse  on "Consti-
tutional  Irritation."   The next danger, is  Tetanus.  On
another  occasion I shall call your attention fully to this
terrible  form  of  nervous  derangement.   But  you  can
readily comprehend that in such accidents, where the hard
parts are broken, and  the  soft parts  extensively torn  up,
how liable the  patient  is to have  his life destroyed by  this
cause.
   But there are  other dangers than  Shock, Hemorrhage,
and Tetanus.  A man  has received a gunshot wound in his
leg, which occasions a  compound fracture.   The fragments
are coaptated; they are well dressed;  and for the first day
or two  there is  every reason to hope that, under proper
care recovery will result.   But at the end of this time the
parts around the injury become hot,  swollen, and painful;
the colour is deepened,  and the secretions  are altered or
suspended;  inflammation  is established.   This action  is
        57 
670
SURGERY.
apt, under such circumstances, to run beyond the point of
resolution, and  the other termination of inflammation is
soon manifested, that is to say, mortification is developed.
And when this  happens,  it is very likely to be very acute,
and run its course quickly, to extend  itself rapidly;  and
unless  the  surgeon is  well informed,  and prompt  in  his
management  of the case, the patient  will probably soon
succumb.
  In many cases  the  dangers I have mentioned  may  not
show themselves, but  the patient has before him  the risk
of Fever.   In one case this will take on the form  of Syno-
cha, or Inflammatory Fever; in another it will be Typhoid;
in a third it may be of irritative character.   Either form
of disease will greatly complicate the case, and  increase the
danger  of  the  case.  Should  the patient avoid  the diffi-
culties I have mentioned, he has still probably to encounter
the risk of Suppuration, which may develop Hectic  Fever.
From this detail  you  will see, gentlemen, that compound
fractures are vastly more dangerous  than simple  solutions
of continuity of a bone.
  Treatment.—In determining upon a course of manage-
ment, there are several  circumstances  to be  considered.
The locality of the injury, the age of the patient, and  the
severity  of  the  accident.  If the lesion be in a limb to
which dressings can be well applied, and the disruption of
soft parts be not very  great, and the age of the patient be
satisfactory, that is to say, if the patient  be under  the
middle age, and over  the period of infancy or childhood,
and be of proper habits and good  constitution, you have
every reason  to prognosticate favourably.  But if  the acci-
dent be a  consequence of gunshot wound, and  there is
much laceration of surrounding  soft parts, disruption of
vessels, comminution of bone, or if the lesion penetrate  the
thigh bone, or pass through  the  scapula and  involve  the
shoulder joint, you will have every cause to fear  an unfa-
vourable result.  The course  of treatment, then, may be 
SURGERY.
671
divided into the method which it is necessary to pursue in
mild, or not very severe, cases, and that which should be
adopted in accidents of a more grave character.
  First,  of the mild cases.   If you are called  to  see  a
patient with a compound fracture, in the leg, for  instance,
in which the bones are broken obliquely, and  you find
there is no comminution, and not much injury of the soft
parts,  the proper course  is to treat the case as though it
were a simple fracture with  a wound.  Approximate the
parts,  put them into proper relations, bring the lips of the
wound together, and maintain them in apposition by any
form of dressing which you  may judge applicable in the
management of the wound to heal it by the first intention.
   If you find bits of broken  bone, pieces of detached bone,
or bits of bone which are merely held together  by pieces
of periosteum, or small masses of cellular  substance, your
better  course is  to remove them.  They will  become de-
tached in the course of the treatment,  and act as causes of
irritation, and hen<*3 you  had better  take them at  once.
If the  end of the bone stick out, you are to resort to ex-
tension and counter-extension,  and manipulation; and, if
 possible, bring it into its natural position.
   By  proper management you may succeed, notwithstand-
 ing the end  does project one or two inches .through the
 soft parts.   Still, though in  some cases you  may be suc-
 cessful, it is right to tell you that you will often  fail.  The
 orifice may be so constricted that you cannot  push the
 pieces back.   You  then take a scalpel and  increase the
 opening, enlarge it so as to loosen  the  constricting part.
 Suppose  you cannot accomplish your object  in this way,
 what method will you adopt?   Will you bring the limb as
 near as possible to the natural position, and allow the bone
 to remain out ?  No.   Failing  by extension and counter-
 extension to effect reduction, and being unable to push it
 back  after the incision, you should take a pair of  bone- 
672                  SURGERY.
nippers, or saw, and remove  the  projecting part.   But it
is  much easier, and much better, if you  can retain the
piece of bone to make an opening, and restore the part to
its natural position.  It  is true,  you run  the risk of ne-
crosis.   If the bone has been deprived of periosteum or
the investments,  there is every  reason  to expect  that it
will die.   Failing to effect reduction, there is no misunder-
standing about the matter;  the  piece should be cut off;
then coaptate the parts.  In  all cases when called to see a
compound fracture, you should say to the patient and his
friends, it is a bad  accident,  it is a dangerous occurrence;
and before resorting to any such  expedient as either of the
methods I have mentioned, you should fully explain to the
patient that such a course, or either of the courses, is ne-
cessary; and, moreover,  you must take care  to have  some
disinterested person by you,  and if you have reason to ex-
pect that there will be  subsequent  difficulty, the proper
course is to write out your notions.   Keep a copy of what
you write, and hand one to the patien^.  It is a  most sur-
prising thing, but nevertheless true, that notwithstanding
the  difficulty physicians encounter  in such cases, they
hardly ever get  paid, and very often are subjected to the
annoyance of a suit for mal-practice, if the case has resulted
contrary to the wishes of the patient or his friends, and if
the precautions I have spoken of have been neglected.
   You will encounter cases of compound fracture more se-
vere than those  to which I  have just referred;  lesions in
which there is not only disruption of soft  tissues, but  a
destruction of  parts,—arteries  are  torn  across,—nerves
are lacerated,—veins are opened,—muscles are torn away,
joints  are entered,  and  bones are severely  comminuted.
Here you have a more severe kind of injury—a severe com-
pound fracture.   In a case  like  this, after having relieved
the patient of the shock, which becomes necessary at once,
or soon  after the  occurrence  of the accident, it becomes
a matter of grave inquiry whether an efl'ort should be made 
                     SURGERY.                  673

to save the limb, or if it should be condemned to the ope-
ration of amputation.  There are circumstances which favor
both views.   If the age of the patient be medium—if the
constitution be good—if the habits have been regular, efforts
may be made to save the limb, which, under other circum-
stances, would be perfectly unjustifiable. I have seen limbs
that suffered  from  compound fracture, in which the arte-
ries were torn across—there had been considerable hemor-
rhage—pieces  of muscles were  removed—bones commi-
nuted, and recovery follow.  I have referred incidentally to
a case of compound fracture from gunshot  wound, that I
saw managed, many years ago, in the Pennsylvania Hospi-
tal, where the wad passed through the calf of the leg, break-
ing  the tibia, fibula,—lacerating nerves and  veins, and
opening the peroneal and  posterior tibial arteries; and still
recovery resulted.  The patient  was a boy  ten  or eleven
years of age, of good constitution.   He was subjected  to
great risk, as irritative fever was developed,  from the long
and  continued drain on the system, and the  extensive sup-
puration which ensued; and parts were carried away by the
injury and  subsequent sloughing, large quantities of pus
were discharged.  The system of the boy was prostrated,
but  by good management he was sustained,  and  finally he
had a fair limb—a much better limb than the stump of the
amputated leg would  have been.  Here is a remarkable
case, one which would have justified  amputation.   I would
say, if called upon  to decide, that a  limb having received
such an accident,  should be amputated.   Still, notwith-
standing,  as  a general rule I should  so decide, it is my
duty to tell you that there are circumstances under which
efforts should be made to save the limb, which are not justi-
fiable under other conditions.  A surgeon is not  warranted
in risking  the life of a patient, without giving  the chance
of amputation.  You may be called to see a person who
has the horror of the knife, and violently objects, and he is
furnished with all the means and conveniences of life—who
                          57* 
674
SURGERY.
can command all the care  that is necessary: under such
circumstances you may try to save the limb;  whereas such
a course would not be safe in poorer persons—on a battle-
field, or in a naval fight.  Suppose you attempt to  save a
limb which has been badly injured, how are you to treat it?
The parts have been  torn away—large vacuities remain on
the limb.   What will  you  do under such circumstances?
The best thing you can do is to adopt the course of treat-
ment  recommended by Dr. John Rhea Barton,  one of the
best surgeons our country has ever produced.  The method
recommended by him consists in filling a common fracture
box with bran, and placing  the limb in the  box, and sur-
rounding it with the bran.  Though a strange application, it
is one that affords equable support to the limb, and moreover
receives the  discharge.  It  is a soft and easy pillow, and
then without disturbing the limb, any noisome matter may
be removed by merely letting down the  sides of the box,
and with a syringe and  warm water, washing away the bran
that has received the discharge.  Clean bran may be dusted
in, and the limb will have remained  undisturbed.   These
are the advantages of the bran dressing.  It makes a good
poultice,  and still affords a sufficiently firm support for the
affected limb.  I say nothing of the apparatus of warm wa-
ter dressing, or  of the  various appliances that  are recom-
mended.   It is  not  necessary to  refer to them.   Those
which are  proper, will  be mentioned  particularly when I
come  to speak of treating the various fractures.
   Suppose, however, you are unable to save the limb. You
find it so badly injured—so torn and broken,  that you
think that to allow it to remain  will jeopard the life  of the
patient, you fear he will not be  able to sustain the recupe-
rative process—that  there is not sufficient vis  medicatrix
naturse to support him, will  you tell the patient,  in a month
you must have your limb off, or as soon as reaction is esta-
blished it must  come  away?  If you speak properly in a
vast majority of'instances, you  will say  the last.  It had 
SURGERY.
675
better  come off immediately after reaction is established;
although success sometimes follows the other operation.  It
has been proved by statistics that the primary operation is
preferable.  Hereafter, when I come to lecture on the sub-
ject of amputation, I shall tell  you that the amputation of
a limb is by no means a trifling operation—that it occa-
sions a shock, from which the  patient may never recover.
I mention this circumstance now, if I have not previously
referred to it, to teach you that it is necessary to inform
your patients of the danger.  Remember, under no circum-
stances, do any operation which will jeopard the life of an
individual, without having previously informed him of the
danger to which he will be  subjected; and as the risk is to
him, give him the opportunity to decide.

    Here end  the very excellent  remarks of  Prof. M'Cliu-
 tock on fractures;  and, to complete the subject, we  intro-
 duce the observations of Dr. Druitt  on the non-union of
 fractures, as  well as those of the treatment of special frac-
 tures.

         PARTICULAR  FRACTURES.
    Fractures  of the ossa  nasi, and of the malar and superior
 maxillary bones, may be produced by  violent blows or falls
 on the face, or by gunshot  injuries.
    Treatment.—Any displacement of the fractured portions
 should be rectified as soon as possible, by passing a  strong
 probe or female  catheter up the nostril, and by manipula-
 tion with the fingers.  A depressed fragment may often be
 conveniently raised by passing one blade of a dressing for-
 ceps up the nostril, and applying  the other externally, so
 as to grasp the fragment between them.  Some practition-
 ers are in the  habit of introducing tubes or plugs of oiled
 lint in order to keep  the fragments in their places; but
 this appears  to be unneccessary, and  is very irritating.   A
 plug  of lint may, however, be requisite to check profuse 
676                  SURGERY.
hemorrhage.   If the fracture is compound, any loose splin-
ters should be carefully removed.   The great swelling, ec-
chymosis, bleeding from the nose, and headache, with which
this injury  is followed,  will require to  be  combated by
bleeding or leeches, purgatives and cold lotions, and spoon
diet;  and if collections of matter  form, they should be
opened without delay.   If there are symptoms of pressure
on  the brain, and the vomer seems depressed, it should be
carefully drawn forward, if possible.
  Fractures of  the lower jaw  may be caused by violent
blows.   Its  most usual situation,  says  Mr. Vincent,  is at
the situation of  one of the eye teeth.   Sometimes in chil-
dren (though rarely) it occurs  at  the symphysis, and  still
more rarely at the angle, or in the ascending ramus.
  Symptoms.—It is known by pain, swelling, and inability
to move the jaw, and irregularity of the teeth, because the
anterior  fragment is generally drawn downwards  by the
muscles arising from the hyoid bone, whilst the posterior
fragment  is  fixed  by the temporal.  On  moving the chin
whilst the hand is placed on the posterior fragment, crepi-
tus  will be felt; and the  gums are  lacerated and  bleeding.
The diagnosis of fracture of the ascending ramus will often
be obscured  by the great swelling, great pain, and difficulty
of motion, and obscure crepitus are the  chief signs.
  Treatment.—A piece of paste-board  or gutta  percha,
softened in boiling water, should be accurately fitted to the
jaw, and  then  a four-tailed bandage  should be  applied.
This is  made by taking  a yard  and a half of wide roller,
and tearing each  end longitudinally, so as to leave about
eight inches in the  middle, which  should have a short slit
in it.   The chin is  to be put into this slit, and then two of
the tails are to be tied  over the crown of the head, so as to
fix  the lower jaw against the upper, and the other two are
to be fastened behind the head.   It is useful  to place a
thin wedge-shaped piece  of cork between the molar teeth
on each side, especially if any of the teeth at the fractured 
SURGERY.
677
part are deficient, in order  to  insure more perfect  adapta-
tion, and to keep the incisor  teeth a little apart.   Some-
times the tooth falls down between  the  broken parts;  a
circumstance which should be looked to, if there is much
difficulty in fitting them together.   (Fig. 59.)
  The patient,  for the first fortnight,  must be fed entirely
with broth, gruel, bread, pap, &c.   The cure generally oc-
cupies five or six weeks.
  Fracture of the clavicle is most frequently situated at
the middle of the bone, and is generally caused by  falls on
the arm or shoulder;  sometimes,  however,  by direct vio-
lence, when  it  is generally situated near  the acromial ex-
tremity.   When fracture of the acromial end of this bone
is  situated between the  coraco-acromial ligaments;  but
when the fracture is external to these ligaments, the acro-
mial extremity  of the bone is apt to turn round at right an-
gles to the sternal portion.
  Symptoms.—The  patient complains  of inability  to lift
the affected arm and support it at  the elbow;  the shoulder
sinks downwards, forwards,  and  inwards;  the distance
from the acromion to the  sternum  is less than it is  on the 
678                   SURGERY.
sound side; and the end of the sternal fragment of the bone
projects as though it were displaced, although  it is  not so
in reality, but merely appears to be so, in consequence of
the sinking of the shoulder and of the outward fragment.
   Treatment.—The shoulder must be raised, and must be
supported in a direction upicards, backwards, and outwards.
The broken parts may  be reduced, either  by putting the
knee between the scapulae and  drawing the shoulder back-
ward;  or, by placing the  elbow close to  the  trunk  and a
little forwards, and then pushing  it upwards.  To support
the parts during the cure, the most common apparatus is
   The stellate, or figure-of-S bandage, (Fig. 60.) In the first
place, a thick wedge-shaped pad must be put into the axilla,
                        Fig. 60.
the large end uppermost; then a long roller must be passed
over each shoulder alternately, and be made to cross on the 
SURGERY.
679
     back.   In the next place, the arm  must be confined to the
     side by two or three turns of the roller; and lastly, the el-
     bow should be well raised by a sling, which is  also to sup-
     port the fore  arm.   It will be noticed that the shoulder is
     kept up by the sling, or by  the pad, and back by the ban-
     dage.   The same rules may  be  gained by means  of  three
     handkerchiefs; one to act as the pad in the axilla, another
     for a sling, and the third to keep the arm close to the body—
     the whole being stitched together.
        Another simple  contrivance, invented  by Mr.  James
     Duncan for the same purpose,  is a strip  of jean about  a
     yard long, of the shape represented in the next figure.  The
     elbow is fixed in the hole; the smaller straps pass back and
r     front of the chest, and are buckled over the opposite shoul-
     der ; and  the broad part is buckled  round the chest, con-
     fining the arm to  the side.   The whole being in  one piece
     cannot slip, and is very available for children.   In ordinary
     cases the patient may be allowed to walk  about in a week
     or ten days, and the cure will be completed in a month or
     five weeks.  The  patient should be informed that some lit-
     tle irregularity is apt to remain.  If, however, there is any
     difficulty in maintaining a proper  disposition, the patient
     must be confined to bed, and some additional apparatus be
     employed.  The simplest  is a  straight splint across  the
     shoulders, to  which they are to  be  bound  by the  figure of
     8 bandage, or a splint shaped like a T, of which the hori-
     zontal part is  bound to the shoulders; and the vertical part
     passed down the back, and is confined by a belt round the
     abdomen.
        Besides these there is the clavicle bandage, which consists
*     of two  loops for the shoulders, attached to two pads resting
     on the scapulae, which are  drawn together by straps and
     buckles.
I 
680                  SURGERY.
         FRACTURES  OF  THE  SCAPULA.
   The body of this bone may be broken across by great direct
violence.   One case is known also in which it was fractured
by muscular action.   The  symptoms  are great  pain in
moving the shoulder and crepitus, which may be detected by
placing one hand on the acromion  or spinous process, and
moving the shoulder of the inferior angle with the other.
   Treatment.—A roller must be passed  round the trunk,
and a few turns be made  round the humerus, so as to  fix
the arm to the  side, and prevent all motion.  Opium  and
quietude, perhaps purging and low diet, will be required to
avert inflammation of the  chest.
   Fracture of the neck of the scapula, by  which is meant
an oblique fracture,  detaching  the  coracoid process  and
glenoid cavity from the rest of the bone,  is a rare accident,
insomuch that some surgeons have doubted its existence.
   The symptoms described by Sir. Astley  Cooper, are the
following: — The  shoulder  appears sunk, and the arm
lengthened; the acromion is usually prominent, and  the
deltoid dragged down and  flattened;  the  head of  the  hu-
merus can be felt in the axilla; and on placing one hand or
one ear on  the acromion, and moving the  shoulder,  crepitus
may be detected.  Crepitus  may also be felt on pressing
the coracoid process, which is situated  deep below the cla-
vicle, between the margins of the pectoral and deltoid mus-
cles.  The accidents with  which  this  fracture is most likely
to be confounded, are fracture of the neck  of the humerus,
and  dislocation of  the shoulder joint;  the symptoms of
which should  be carefully  studied  and compared.  The
existence of crepitus, and the fact that the surgeon can move
the shoulder freely  (although with  great  pain,)  are  the
chief points of diagnosis between this accident and disloca-
tion.
   Treatment.—The  shoulder  must  be  supported  by the
same sling, bandage, and pad that are used for fractures of
the clavicle; but a short sling from the axilla of the injured 
SURGERY.
681
side to the opposite shoulder, should be used in addition to
the long sling from the elbow to the shoulder.   Union may
occur in seven weeks.   Opium, rest in bed, and warm fo-
mentations ; perhaps leeches and purgatives will be neces-
sary for the contusion with  which this fracture is  accom-
panied.
   Fracture  of the acromion is known by a flattening of the
shoulder,  because the fractured portion is drawn down by
the deltoid; and by an evident inequality felt in tracing the
spine of the scapula.   It may be distinguished  from any
dislocation,  by noticing  that the humerus may be  freely
moved  in any direction, and that, on slightly raising the
shoulder, the fragment is restored to its place.  This is also
a rare  accident, and Mr. Fergusson believes that, in some
of the  supposed cases of ligamentous union, the detached
portion was never united by ossification to the  rest of the
bone from birth.
   Treatment.—The same bandages, &c, are to be applied
as for fracture of the clavicle;  but great care must be taken
to raise the elbow thoroughly, so that the head of  the hu-
merus may  be lifted up  against the acromion, and  keep it
 in its place.   Moreover, no pad^must be placed in  the ax-
 illa;  otherwise the broken part will be pushed outwards too
 much.  Union  is almost always ligamentous, owing to the
 difficulty  of keeping the parts in strict apposition.
   Fracture of the coracoid process is a rare accident, caused
 by sharp  blows  on the front of the shoulder.
   Symptoms.—The patient is unable to execute the motions
 performed  by the biceps and  coraco-brachialis; that is, to
 bring the arm upwards and forwards; and motion and cre-
 pitus of the detached  process may be felt by pressing  with
 the finger between the pectoralis major and deltoid, whilst
 the patient coughs or moves his shoulder.
    Treatment.—The humerus must be brought forwards and
 inwards so as to relax the biceps and coraco-brachialis, and
 must be confined to the trunk.
        58 
682
SURGERY.
   Fractures of the  humerus.— Fracture  of the  shaft will
be known at a glance by  the limb being bent, shortened,
and helpless, and by  the crepitus felt when it is handled.
The Upper Extremity of the Humerus may be fractured, 1,
through the anatomical neck; 2, through the line of junc-
tion of the epiphysis; 3, through the surgical neck; 4, the
greater  tuberosity may  be broken off; 5, the head may be
dislocated from the glenoid cavity, and the cervix be frac-
tured likewise.
   Fracture through the anatomical  neck, that is  to  say,
within the capsular ligament, is a rare accident, difficult of
diagnosis; there  being  scarcely any  displacement.   " The
impairment of  the motions of the joint and crepitus,"  says
Dr. Smith, " are  almost the  only symptoms  on which we
can depend."   There is one variety of this fracture in which
the detached head of the bone  is driven forcibly into and
impacted in the reticular tissue of the head of the shaft, be-
tween the tubercles, one or other of which is usually broken
off.   " In this  accident,"  says Dr.  Smith,  " the  arm  is
slightly shortened, the acromion process projects more than
natural, and the shoulder has lost, to a certain extent, its
rounded form;  the upper extremity of the shaft of the hu-
merus is approximated  to the  acromion,  and the entire of
the globular head of the bone cannot be felt. In consequence
of the fracture  of the tuberosity, crepitus can be readily de-
tected, when the  shoulder is grasped with moderate firm-
ness, and the arm rotated.  The absence  of  a  rounded tu-
mour in the axilla, and the impossibility of feeling the gle-
noid cavity, are sufficient to enable us to distinguish  this
fracture from luxation."
   2.  Fracture at the  line of junction of the epiphysis, called
by Sir A. Cooper, "fracture through the tubercles, or  at
the anatomical neck," is a not unfrequent accident in early
life, and is usually caused by great and direct violence.
   Symptoms.—The head of the bone  can be felt in the gle-
noid cavity, (by which  sign  this accident is distinguished 
SURGERY.                  683
from dislocation;) it remains motionless when the elbow is
rotated; there is a striking and abrupt projection situated
beneath the coracoid process, and caused by the upper ex-
tremity of the shaft  of the bone, drawn inwards by the
muscles which constitute the fold of the axilla.   It may be
felt  rounded, smooth, and  slightly convex,  not with the
sharp irregular margin of ordinary fracture;  a slight exten-
sion from the elbow draws the broken point of the  bone
into its natural place,  but  it immediately  projects again
when the extension is discontinued; the axis of the arm is
directed downwards, outwards, and backwards.
   3.  Fracture  of the  neck  (Fig. 61,) presents  nearly the
                        Fig. 61.
symptoms of the preceding variety:  the head  of the bone
felt in the  glenoid  cavity;  the elbow capable  of  being
moved by the surgeon in all directions, whilst  the head of
the bone remains motionless;  the  projection of  the upper
end of the shaft under the peetoraiis muscle; the deformity
removed  by  extension, but returning when the extension is
discontinued.
  There  is one variety of this accident in which the lower
fragment is  driven up and impacted in the cancellous tissue
of the head of the bone, Fig. 6 L.  This complication adds ma-
terially to the difficulty of diagnosis, inasmuch as there is
some deformity, but yet none of the usual signs of luxation, or
of fracture of the neck of the bone.  Crepitus may, however,
L 
684                  SURGERY.
be produced, if the surgeon very firmly grasp the head of
the bone, whilst an assistant rotates the elbow.
  4. Fracture of the greater tuberosity is usually caused by
blows or falls on the shoulder.
  Symptoms.—Great breadth of the injured joint; slight
projection  of the  acromion and  flattening of the deltoid,
though the finger cannot be sunk in the glenoid cavity, as
in the  case of dislocation; the  head  of the  bone drawn
inwards by the  axillary muscles, whilst the separated  tu-
berosity is  drawn outwards by the supra and infra spinatus
and  teres minor;  a deep groove can be  felt  between the
fractured tuberosity and the head of the bone; the latter of
which can  be felt to move  in its socket when  the elbow is
rotated, and the whole limb can be moved in any direction
by the surgeon.
  All of the preceding fractures usually unite firmly  by
bone, even including the fracture of the anatomical neck;
for  though fracture at  this part would seem  likely to de-
prive the head  of the bone of  all vascular connexion and
means of support, yet probably some ligamentous bands,
which are sufficient for the purpose, remain untorn: in cases
of impaction there is no difficulty.  Yet the patient should
be informed that some deformity is likely to remain, and
some loss of motion, though time and use will go far to  re-
store the latter.
  5. In fracture of the  cervix humeri, with dislocation, the
head of the bone can be felt in the axilla, if the arm be raised;
and  it can  be felt not to move when the elbow is rotated.
The  arm is  shortened, and the broken extremity of the shaft
can be perceived to move under the acromion.  In treating
this  peculiar form of injury, it is generally found impossible
to restore the head of the bone to its place; but the broken
summit of the shaft must be brought into the glenoid cavity,
and there be retained by the  figure-of-8 bandage, and  by
keeping the humerus close  to the side. 
SURGERY.
685
   Treatment of Fractured  Humerus.—In all cases it  is
advisable  that the patient be confined  to bed for a week
or a fortnight, and  particularly if the  fracture be  at the
upper  extremity of the  bone; which latter  accident will
probably be followed  by great pain and swelling, and re-
quire leeches, fomentations or cold lotions, purgatives and
opiates.   The hand and forearm must be well and  evenly
bandaged, to prevent oedema, and the fracture be  set, by
steadying the shoulder, whilst the elbow is  drawn  down-
wards.   Next, a long carefully-padded hollow splint should
be placed on the  inner side of the  limb,  bearing well
against the axilla and the internal condyle, a second on the
outer  side from the  acromion  to the  outer  condyle, and
perhaps a third and fourth, shorter, of pasteboard, before
and behind.  These  must  be fastened by bands  of firm
webbing buckled.  Then the arm being placed easily by the
side, a firm board band must be passed round the body, so
as to confine the  elbow to the side, and  a sling  put on to
relieve the weight of the hand and  forearm comfortably,
but not to thrust up the elbow.
   In all  casesrthe  surgeon  should take care to have  the
parts well washed with soap and  water, before the  splints
are put on,  and whenever they are shifted;  otherwise the
confined  perspiration  may  cause an  intolerable  itching,
which tempts the patient at night to loosen the bandages.
No wise man neglects trifles.
   When  the upper extremity of the  bone is the  seat of
fracture  it  is often  difficult to  apply any apparatus that
shall tell upon the fragments, prevent deformity, and keep
the arm at rest.  The author, in such a  case, gets a pur-
chase  from  the opposite axilla, thus: The middle of a long
piece of firm webbing is sown on to the top of the inner
splint, which is well padded on both sides.  This is  crossed
over to the other splint, to the edges of which it is fastened
by a strong needle and thread.  The ends are  then brought,
one before,  the  other behind the neck, to the opposite
                           58*
I 
686
SURGERY.
shoulder, where they cross over a large pad, and finally are
attached to another large pad  over the axilla.  This se-
cures tbe repose of the  entire shoulder, if  the  elbow be
properly secured as well.  Sometimes, instead of the outer
splint, a firm well-setting shoulder-cap  of leather may be
put on, being secured by a strap passing under the oppo-
site axilla, and being likewise buckled round the humerus,
close  under the  axilla.   In  one case,  Mr.  Tyrrell was
obliged to keep the arm at right angles with  the side, by
means of a splint like the letter L upside down; and the
surgeon's ingenuity will often be taxed  to devise  means
suited for particular cases.
   At the expiration of about five weeks,  the patient may
be allowed to  swing the arm  gently backwards  and for-
wards, and gradually to bring it into use.
   Fracture of the lower extremity of the Humerus  may pre-
sent many varieties.  1.  There may be an oblique fracture
above  the  condyles, which  usually  happens to  children.
Fig. 62.—Oblique Fracture of the Humerus.
The radius and ulna, with the lower fragments, are drawn
upwards and backwards as in dislocation; but the natural
appearance of the parts is restored by extension.
  2, Either condyle may be  broken off, and the fracture
m^y or may not extend into  the joint.  (Fig.  63.)   3.
There may be one fracture between the two condyles, and
another separating them  from  the shaft.  All  these inju-
ries may be  distinguished from  dislocation of the elbow 
SURGERY.                   687
by noticing that the motions of the joint are free, and are
attended with  crepitus  above the elbow, and that the
                       Fig. 63.
length of the forearm, measured between the extremities
of the upper and lower extremities of the radius and ulna,
is the same as on the sound  side.   The  patient should  be
warned that it is very difficult to  avoid  all deformity and
loss of motion.
  Treatment,—The fore and  upper arm should be ban-
daged, and a piece of pasteboard, gummed  sheeting,  or
leather softened in water, should be cut to a right  angle,
like  the  letter L, so as to fit the elbow when bent, and
should be applied on the inner and outer sides, and be  re-
tained by another bandage.   Besides this, an angular splint
may be employed.   It  is composed of two pieces joined at
a right angle, one of which is placed behind  the  upper
arm, and the other below the forearm.   But if the injury
were attended with much violence, the patient must be con-
fined to his bed for some  days with  the arm on a pillow,
and leeches and lotions be employed to  reduce the inflam-
mation and swelling.
  6. Fractures of the Forearm.—Fracture of the olecranon
                        Fig. 64.
(fig. 64,) may be caused by direct force, or by violent action
of the triceps muscle. 
688                  SURGERY.
  Symptoms.—The patient easily bends his limb, but has
great pain and inability in straightening it.   A hollow is
felt at  the  back of the joint, because the  broken part is
drawn  from half an inch to two inches up the arm; but
sometimes, when the ligaments are  not torn through, this
displacement may be very trifling, or  altogether absent.
  Treatment.—The limb  should be placed in a straight
position.  Then the forearm having  been  bandaged, the
olecranon, should be drawn down as much as possible, and
the roller, continued from the forearm, should be passed
round  above it, and then back again about the elbow in the
figure-of-8 form.   Then the  whole  upper arm should
be rolled, in  order to  prevent contraction of the triceps;
and  a  splint must be placed in front, so as to keep the arm
straight.  The patient may be allowed to  move the part
gently in three weeks.   Union will be ligamentous, unless
the parts are in the closest apposition.
  If there is much inflammation, it must be subdued by
rest and leeches, before any tight apparatus is put on.  M.
Malgaigne's hooks have  been applied, in  order to  insure
apposition.
  Compound fracture of the  olecranon is  far from an un-
common consequence of violent blows or falls on the elbow;
and  it is followed by protracted disease of the joint.   The
part must be bathed and fomented ;  any loose fragments of
bone be extracted; the wound be closed with bloody lint,
or collodion, if the skin can be  neatly brought together;
the  elbow  must be kept straight  and motionless with a
splint; leeches and fomentations be used to reduce inflam-
mation; and when the wound is healed, and the joint free
from active disease, gentle exercise must be employed  to
restore it to its  proper uses.   If the bones are so exces-
sively comminuted as to render it  probable  that the pro-
cess of reparation  will  be tedious and exhausting, excision
of the joint should be performed;  unless, indeed, the in-
jury is so very severe as to render amputation indispensable. 
SURGERY.
689
  Fracture of the Coronoid Process is very rare.  It is
caused by the action of the brachialis muscle.  Mr. Liston
gives a case of  it which  occurred to a boy of eight years
old, and was  caused  by his hanging with  one hand from
the top of a high wall.
  Symptoms.—Difficulty of bending the elbow, and dislo-
cation of the ulna,—the olecranon  projecting backwards.
   Treatment.—The arm must be bandaged and kept at rest
in the best position.  Union will be ligamentous.
  Fractures of the shafts of the radius and ulna, together
or singly, are known by  the ordinary signs  of fracture—
especially by the crepitus felt on fixing the upper end, and
rotating and moving the other.  The objects in the treat-
ment are to prevent the fractured ends of either bone from
being pressed inwards towards the interosseous space, and
to prevent the upper fragment of  the radius from being
more supinated or everted than the lower.
  Treatment.—The fracture is easily reduced by extension
from the wrist and elbow.   Then the elbow being bent, and
the  forearm placed in a position intermediate between pro-
nation and supination, (that is to say, with the thumb up-
permost;) one splint should be applied to  the flexor side,
from the inner condyle of the humerus to the fingers' ends,
and another from the outer condyle of the humerus to the
back of  the  wrist.  Both  splints should be wide enough,
and should be well padded along their middle, so that they
may prevent the bones from being pressed together.  The
hand should be kept in a line with the forearm.  The cure
is generally  complete in a month or six weeks.
  Fracture of the lower extremity of the Radius, (fig. 65,) 
690
SURGERY.
from half an inch to an inch above the wrist, is now com-
monly called  Collis's fracture, from the name of the  emi-
nent surgeon who first accurately described it.   It deserves
careful study, from its liability to be mistaken  for disloca-
tion.   The carpal extremity of the bone is usually broken
off transversely, and the fragment is drawn backwards and
outwards by the extensors of the thumb and supinator lon-
gus.   Of course, the carpus and metacarpus go along with
it.  Thus: if  the back of the forearm be looked at, there
is seen to be  an apparent swelling, formed by the carpus
and lower  fragment; and, immediately above this, a well-
marked sulcus.   On the  palmar side is a more extensive,
but less prominent, swelling, which seems as if caused by
the flexor tendons being thrown forward; this swelling ex-
tends  about one-third up the forearm, and terminates be-
low, at the anterior  annular  ligaments of the wrist.  The
extremity of the ulna is seen projecting towards the palm
and inner side of the limb. Sometimes it is even dislocated
forwards.   The chief points of distinction between this in-
jury and  dislocation  are, the  facility  with which all de-
formity is removed  by grasping  the hand and making ex-
tension; the return of deformity on ceasing the extension,
and the position of the styloid process of the radius, which
moves with the hand if the case be fracture, but not if it
be dislocation.
  Other varieties of fracture at this part are—
  1. Oblique fracture of the posterior margin of the arti-
cular surface of the radius, with  partial dislocation of the
hand backwards.   2. Fracture of the  lower end of the ra-
dius, with displacement forwards.  3.  Fracture of both ra-
dius and ulna, which may be recognised by attention to the
symptoms presented.
  Treatment.—The  elbow being  bent and  steadied,  the
hand  should be grasped and powerfully extended, and, at
the same time, somewhat adducted. A pad should be placed
along the extensor side  of the forearm, and  the thickest 
SURGERY.
691
part of it should correspond to the  displaced fragment of
the radius, against which it should press, so as to push it
forwards, and  somewhat into  the prone position, as well.
Another pad should be placed on the flexor side, but should
not reach lower than the margin of the  superior fragment.
"An anterior and a posterior splint," says Dr. Smith, "are
then applied,  each  of  which  should be at  least an inch
broader than the forearm; the posterior should extend from
the elbow to the fingers, and  should be curved from  the
wrist downwards to receive the adducted hand.  The  an-
terior need  not descend below the palm of the hand; a
roller is  then to be  carried around the splints in the usual
manner."   Three weeks should elapse for a young patient,
and four or  five for an old  one, before the wrist is moved;
and the  patient should  be informed,  at first,  that  some
months will  elapse before the use of the part  is  restored.
   7. Fracture of the Hand.—The carpus is rarely fractured
without so much other injury  as to render amputation  ne-
cessary.  Fracture of the metacarpal bones, or of the pha-
langes, will be readily  recognised.   With respect to com-
pound  fractures of these parts, we may observe that no
part of the hand should be amputated unless positively ne-
cessary, and even one  finger should be saved if it can be
done.
   Treatment.—For fractures of the carpus, middle, meta-
carpal bones, and first phalanges, it is  a  good  plan to make
the patient grasp a ball of tow or some other soft substance,
and bind his hand over it.   For fracture of the lateral me-
tacarpal  bones, it is better to  support  the hand  on a  flat
wooden splint, cut into the shape of the  thumb and fingers.
If one finger only be fractured, it may be confined by a thin
lath or pasteboard splint.   It must be recollected that  the
palmar surfaces of the metacarpal and digital bones  are
concave.   They must, therefore, be slightly padded before
they are bound to any flat surface, or they will unite crook-
edly.
i. 
692
SURGERY.
  8. Fracture of the Ribs is generally situated in their an-
terior half, and is commonly caused by direct, violence, such
as blows, the bone giving way at the point  struck.  Some-
times, however, it is caused by indirect violence, as, for in-
stance, when the chest is violently compressed between two
points.  In  1837, several people were  crushed to death in
a crowd in the Champ de Mars, in Paris, and many of them
were found  to have several  ribs broken in  this manner.
Sometimes, in old subjects, one or more  ribs are broken
by violent coughing.
  Symptoms.—Fixed lancinating pain, aggravated by inspi-
ration, coughing, or any other motion.  By  tracing the out-
line of the bone, or by placing the hand or the stethoscope
upon it, crepitus may be felt during the act of coughing or
inspiration,  and the  patient be sensible of  it likewise.  If
the fracture be situated near the spine, or if the  patient be
very corpulent, it may  be  difficult to  detect  it with cer-
tainty; but  this is of little  consequence;  for in every case,
when a patient complains  of  pain on inspiration, after  a
blow on the chest, the treatment is the same.
   Treatment.—The indications are—1. To  diminish motion
of all the ribs by passing a broad flannel roller,  or a towel
fastened with tape, round  the chest, so tightly  that respi-
ration may be performed  chiefly by the diaphragm.  The
bandage should have shoulder-straps to keep it up.  The
arms  should be confined  to  the  side, so  as to prevent all
motion of the scapula;  and this latter, in fat women,  is all
that can be  done.   Moreover, there are some patients who
find all bandages intolerable, but  who  do very well by be-
ing kept quiet in bed.  2.  To prevent  inflammation of the
chest,  keep  the respiration easy, and relieve pain or cough
by  rest in bed, by purgatives  and opiates.
  Emphysema—a swelling caused by  the  presence  of air
in the cellular tissue—is an occasional complication of this
fracture.  It is produced in the following way:  The extre- 
                     SURGERY.                  693

mities of the fractured rib perforate both pleurse and wound
the lung.   In the act of inspiration, air  escapes from the
lung into the cavity of the pleura, and from thence through
the wound in the pleura  costalis into the cellular tissue of
the trunk.   Emphysema forms a soft  puffy tumour, that
crepitates and disperses on pressure.
   Treatment.—"The first  object," says  Mr. Vincent, "is
to adapt a firm bandage over the part of the  rib broken, by
which the effusion of air into the cellular tissue under the
integuments is stopped.  The air passing from the wounded
lung is  now confined to the cavity of the pleura, with which
it is filled, compressing the lung.  By this means the wound
which was made whilst the  lung was dilated, is more com-
pletely  closed than would  have  been  done with any con-
trivance of art.  This wound is usually healed on the eighth
day.  At that period the breathing greatly improves," and
the case is soon  reduced to one of simple broken rib.
   9. Fracture of the Sternum.—Symptoms.—Crepitus may
be felt during inspiration or other movements of the trunk,
and displacement (if any) can be detected by examination.
   Treatment.—The same as for fractured ribs.
   10. Fractures of the Pelvis can be caused only  by most
tremendous violence, and are often attended with some fatal
complication,  such as laceration of the bladder or rectum,
or of the great arteries or veins.
   Treatment.—The only thing to be  done  is to place the
patient at perfect  rest, and in as easy a position as possible;
to keep a catheter  in the bladder; to make incisions if urine
is  extravasated into the  perineum,  as it  will be, if the
urethra is lacerated by fractured portions of  the rami of
the ischium  and  pubes, and to  treat  any  symptoms that
may arise.   If it can be borne, a broad belt may be passed
round the pelvis, and another under the nates, which might
be attached to a pulley over the bed, so that the patient may
raise the pelvis without exerting any of the muscles  at-
tached  to it.
        59 
 694                 SURGERY.
           •
   There are some cases of fracture of the os innominatum
 passing through the acetabulum, and caused by falls on the
 hip, which might be mistaken  for fracture  of the cervix
 femoris.  For instance, in some cases related by Mr. Earle,
 the foot was everted, and there was loss of  prominence of
 the trochanter ; but there was no shortening, and the limb
 could be turned freely outwards, which motion is highly
 painful after fracture of the neck of the femur.   In a case
 reported by Dr. George D. Gibb, late of Montreal, now of
 Guilford street, in which the right side of the pelvis was
 literally smashed, the leg was  everted and shortened  an
 inch and a half; the trochanter is nearer the anterior supe-
 rior spinous process than on the sound side.  On rotating
 the  limb, the right trochanter  appeared to move in the
 segment of a smaller circle than the left, and crepitus was
 distinctly felt in the joint.  The diagnosis will be aided by
 the crepitus felt on applying the stethoscope to the ilium,
 and by examination per anum. It very rarely happens that
 the acetabulum and cervix femoris are both fractured.  The
 patient must be kept  on a fracture-bed.    One  of  Mr.
 Earle's cases was cured in eight weeks.   Dr. Gibb's in six-
 teen.
   Fracture of the  os coccygis, or of the  lower extremity of
 the sacrum, may be caused by violent kicks  or falls.  The
 former  may occur during parturition to women who have
 children, after the coccyx is  united to  the  sacrum.  The
 loose portions must be replaced by introducing the finger
 within the rectum.  The patient should keep in bed, and
 the bowels  must be kept relaxed, so  that no  disturbance
 may be occasioned by hard stools.
   11. Fractures of the Femur present many varieties, which
 must be carefully studied, because, as Pott observes, "they
 so often lame the patient and disgrace the surgeon."  We
must, therefore, treat  separately—1. Of fracture of the
neck  of the femur internal to the  capsular  ligament; 
SURGERY                   695
2. Of fracture of that part external to the capsular liga-
ment, (Fig. 66;) 3. Of oblique fracture through the great tro-
Fig. 66.
chanter; 4.  Of fracture separating the epiphysis of the tro-
chanter major; 5. Of fracture just below the trochanter;
6. Of the shaft; 7. of the condyles.
  (1.)  Fracture of the cervix femoris internal to the capsule
is generally caused by indirect violence—that is, by a slight
force acting on the lower%extremity of the limb, as happens
in slipping off the curb-stone.  Sometimes, however, it is
produced by falls or  blows on the  hip.   It is very rare in
persons under fifty;  but very common in old people, espe-
cially old women, because this part of the femur seems to
suffer first, and chiefly, from the atrophy and fatty degene-
ration which all the bones, more or less, experience in ad-
vanced life.
  Symptoms.—After a blow or fall the patient  finds him-
self unable to  stand, and complains of great pain, increased
by motion, and principally seated at  the upper and inner
part of the thigh.  The  leg is shorter than the other; the
foot turned  outwards; the heel rests in  the interval  be- 
696
SURGERY.
tween the ankle and tendo-Achillis of the other leg; crepi-
tus may be detected if  the  hand  or the  stethoscope be
placed on the trochanter, whilst the limb is drawn to its
proper  length and  rotated.  When  extension is discon-
tinued, the limb shortens again.  The trochanter generally
projects less than on the other side, and if the foot be ro-
tated by an assistant, it is felt to move  in a segment  of a
lesser  circle than  natural.  The  limb may generally be
freely  moved  by the surgeon, although with great pain,
especially if it be abducted;  but the patient cannot lift it
from the bed.   The above symptoms are liable to considera-
ble  diversity,  arising from  accidental variations in  the
manner in which the fracture occurs.  Thus (a) the amount
of shortening, (which was stated by Sir A.  Cooper at from
one to  two inches) depends on the  degree to which the
fibrous investment of the neck is lacerated.  If that mem-
brane be not much  injured,  the shortening may  be much
less than an inch:  moreover, it is doubtful, according to
Dr.  Smith, whether the capsular ligament, if entire, would
permit the  limb to  be drawn  upwards for more than an
inch.   Again, if the fibrous investment of the neck be not
torn, or if the fracture be very oblique, so  that the upper
opposes the accident of the lower fragment, or if the lower
be driven into and  impacted  in the upper fragment, there
may be no immediate shortening at all.  (b.)  The time at
which shortening  occurs  may vary.  Sometimes  it is very
slight  at first, but  becomes  very decided in  a few days,
doubtless when the muscles have recovered from the pa-
ralyzing effects of the injury.   Sometimes, in an obscure
case of fracture, the limb  retains  its natural length for a
few days or weeks, and  then suddenly  shortens, whilst the
patient is attempting to walk; doubtless because the at-
tempt has caused the laceration of some untorn fibres of
the periosteal investment of the cervix, which before held
the fractured parts in apposition.   In other cases the limb
gradually shortens to  the  extent of one  or two inches 
SURGERY.
697
during the six months succeeding  the  injury.  This  is
owing to interstitial absorption  of the  neck of the femur.
  (c.)  The position of the limb is sometimes anomalous;
being inverted in a few cases.
  (d.) In some cases the neck of the bone is driven into,
and  impacted firmly within, the cancellous tissue of the
head;  a circumstance which of course renders it difficult
to1 say  whether the injury be one  of fracture or of mere
contusion.   The chief characters of this injury are  those
summed up by Dr. Smith.  "1. Slight shortening of the
limb.  2. Slight eversion of the foot.  3. Absence of cre-
pitus.   4.  Great difficulty in all cases, and in the majority
an impossibility of removing the shortening of the limb by
extension; and, lastly, less loss of power  than in  other
forms of fracture of the neck of the  femur."
   Prognosis.—This  fracture does not unite by bone, ex-
cept in the rare instances of which the broken surfaces are
held closely together by the untorn  periosteum, or by im-
 paction ; or  in which the fracture  is partly internal and
 partly external to the capsular ligament.  In such cases
 there  is no doubt that bony union may occur;  but in the
 majority the fracture either unites by ligament, or, more
 commonly, does not unite at all;  but  the stump of the
 cervix becomes rapidly  absorbed,  rounded,  and covered
 with a smooth porcellaneous deposit, and plays in a socket
 formed by the hollowing and absorption of the head.   The
 capsular ligament becomes excessively thick, and so does
 the obturator externus muscle, so as to support the weight
 of  the body.   The  reason of this non-union is, probably,
 the want of apposition  and of pressure of the fractured
 surfaces against  each other; to which  may be added  the
 a"-e and debility of the patients; the atrophy of the part
 injured;  the  imperfect  nourishment of  the  upper frag-
 ment, and the general indisposition of bones covered with
 synovial membrane to throw out callus.
    Diagnosis.—The surgeon should be aware that a  fall on
                           59* 
698                  SURGERY.
the hip is apt to produce interstitial absorption and shorten-
ing of the neck of the femur, with disappearance of the
cartilage, eburnation of the articular surfaces, and irregular
deposit of bone  around the  cervix  (the same  series of
changes which the part undergoes in  chronic rheumatic
arthritis,) with shortening of the limb, and wasting of the
muscle, with most of the conditions, in fact, that follow a
fracture.   Thus, the patient on recovering from the  im-
mediate effects  of the injury, finding  the limb  lame  and
shortened, may accuse the surgeon of having overlooked a
dislocation or fracture.  Of course, the surgeon  must de-
fend himself by proving the absence of the  symptoms of
these injuries immediately after the accident, and by re-
ference to authenticated  cases in which the same ill conse-
quences have followed  bruises without fracture.
   Treatment.—If the patient  is very old  and feeble, it is
of no  use to sacrifice his  little  remnant of health  and
strength,  and run the  risk of producing sloughing of  the
nates by long confinement to bed, in the hope of procuring
union by bone.  But he should be kept in bed for a fort-
night, till pain and tenderness abate, with one pillow under
the whole length of the limb, and another rolled up and
placed under the knee.   Then  he may get up and sit in
a  high chair, and  shortly begin to  crawl  about with
crutches; and in time  he will  regain a tolerable use of the
limb, especially if not very corpulent.  The sole  of  the
shoe must be made thick enough to counteract the short-
ness of the limb.   It must be added that this inj ury often
proves fatal during the first three weeks from the shock to
the constitution, or from the bruises inflicted on the limb.
   (2.) Fracture external to the capsular ligament is caused
by direct  violence, such  as falls or blows on the hip, by
which  the neck of the  femur is broken off, and driven into
the cancellous structure  of the great  trochanter; and at
the same  time one or  both trochanters are split through 
SURGERY.
699
likewise.  If the cervix be firmly impacted, and the tro-
chanters are still adhering by untorn  periosteum, the di-
agnosis  of this  fracture presents obvious difficulties, for
there is no crepitus; the limb is shortened, but yet cannot
be brought to its natural length by any justifiable amount
of extension, and is not so everted nor so powerless as is
usual in fracture, yet if the distance of the trochanter from
the  anterior superior  iliac spine be measured, it will  be
found less than on the opposite side.  If, however, this
fracture be so comminuted, that the cervix is not impacted
in the shaft, the shortening and eversion are well marked,
and crepitus can be produced  on extension and rotation.
   (3.)  Oblique  fracture through  the  Great  Trochanter.
This accident may  occur at any  period  of life, and is  at-
tended with the following symptoms: The limb is everted,
      Fig. 67.—Impact fracture of the neck of the femur.
but very little shortened, and the shaft of the bone can be
felt widely separated from  the trochanter.  This fracture
unites readily by bone; and the treatment required con-
sists of extension of the limb by the long splint, and a cir-
cular girth with a pad, to support the upper  extremity of
the shaft, and keep the broken surface in apposition.
  (4.)  Fracture of the Epiphysis of the Trochanter Major.
—The trochanter is sometimes broken off from the femur,
at the part where it is united by cartilage as an epiphysis
in youth.  The diagnosis  is generally  obscure;  but we
allude to the accident in order  that the surgeon  may be 
700
SURGERY.
aware of the possibility of such an occurrence.   The part
will unite by ligament.
  (5.)  Fracture of the Femur just below the Trochanters
is liable to be followed by great deformity, because, as Sir
A. Cooper said, the upper fragment is tilted forwards by
the psoas  and iliacus.   Yet Mr. Butcher has shown that
it  is generally the lower fragment which is  drawn up-
wards and outwards.
  (6.)  Fracture of the  shaft of the  Femur requires  no
                        Fig. 68.
observations as to its causes or symptoms.
   Treatment.—For all cases of fractured thigh, including
those of fracture  of  the  cervix, in which the patient's
strength admits of a reasonable effort to procure union, the
long splint is  the  best instrument.  The  common long
splint, known  as  Liston's,  is a  narrow dial board, of a
hand's breadth for an adult, but narrower and slighter for
a young person.  It should be long enough to reach from
below the axilla to four or five inches below the foot.   At
its  upper  end  it has  two holes, and at its lower  end two
deep notches, with  a hollow for the outer ankle.
  First, the splint should be thoroughly well padded with
layers of blanket.   Then the limb  should be  evenly ban-
daged from the toes upwards, and  gently extended to its
proper length and shape.  Next, one fixed point of exten-
sion is made by passing a bandage repeatedly round the
instep and ankle, and  through the notches at the lower
end of the splint.   Next, the splint is-thoroughly secured
to the limb by a bandage carried  upwards.  Lastly, the 
SURGERY.                  701
extension which is to be kept up by the hands of assistants
during this process is to be maintained by means of a peri-
neal band, which  is  passed round the groin, and through
the holes at the top of the splint.
  The improved form of the long splint, employed by Mr.
Haynes Walton, does not extend below the foot, and has two
slits of unequal depth, through which the bandage is passed,
so as to get a thorough purchase from the ankle, (not from
the heel  and  dorsum of the  foot,) and to keep the splint
square with the  leg.   The ankle should be well padded.
For a perineal band, Mr. Walton recommends a fold or two
of blanket, or several folds of flannel, served up in oiled
silk, and having a stout tape tacked to each end.
   In order to prevent the galling of the perineal band, and
its supposed tendency to draw the fractured parts asunder,
Mr. Fergusson had  adopted the plan in some ejses  of
making counter extension  from a strong stay of jean, ac-
curately fitted to  the upper third of the opposite thigh;
from which a band extends back and front to the upper
end of the splint.  This is very comfortable, and obviates
the necessity  of the band round the belly, since it draws
the splint towards the body.   Mr. Fergusson has devised a
modification of the straight splint, consisting of a long iron
bar, of the length of the ordinary straight splint, the upper
half of which  can  be unscrewed and removed so  as to make
it  a  short splint, for fracture below the knee.   It has a
foot-board, which can be adapted to  any length  or thick-
ness of limb,  and  to any portion of the knee or ankle-joint.
   2.  A second plan is that of Post.   It consists  in laying
the patient on the affected side, the thigh at  right angles
to the trunk, and  the knee bent with a many-tailed bandage
and four splints, applied between the pelvis and trochanter
above, and  the knee below.   The disadvantages of this
plan are, first, that the patient soon turns  round on this
rack,  dragging the upper fragment away  from its right
 place; and, secondly,  that the pressure on the great tro- 
702                 SURGERY.
chanter may cause sloughing.  The first evil may be pre-
vented simply by watching the patient, and telling him to
turn round on his belly rather than on  his back, if he
wishes to shift his position.   The second may be remedied
by placing him on his back, at the end of a fortnight, with
his knees bent up, and supported by pillows.
  3. A third plan of treatment is by the Fracture Bed, of
which the best modification is that of Mr. Torry Hester, of
Oxford.   The patient is placed on his back;  the thigh and
knee bent up over a double inclined plane, in which position
they are kept immovable.  But the whole bed is placed on a
sort of hinge, so  that the patient's trunk  can be raised or
lowered without causing any motion of the  hip joint.
  4. The starched bandage may be employed in fracture of
the lower third.
  If both thighs are broken, a fracture-bed may be employed,
if the surgeon has one.
  (7.) Fracture of the Condyle into the knee joint mostly
happens to old persons, and  not unfrequently proves fatal.
  12. Fracture of the Patella may be of two kinds, accord-
ing as it is caused, (1,) by muscular action, or, (2,) by direct
violence.
  1. Fracture of the Patella by Muscular Action generally
occurs thus: A person is in danger of falling, perhaps  from
missing a  step in going down stairs, or from missing his
footing after a leap.   The  knee is bent,  and  the patella
drawn up; and then a sudden contraction of  the rectus
snaps it across.  The symptoms experienced by the patient
are, the feeling as of a blow or sudden snap, and  inability
to straighten the knee.  The surgeon, on examination, finds
a chink between the broken parts, into which he can press
his finger, and which is increased by bending the knee.
  This  as  we have already said, is one of  the fractures in
which it is very difficult to produce reunion by bone in con-
sequence of the difficulty of bringing the  broken surfaces 
SURGERY.
703
into exact apposition.   And not only so, but even when the
patient's recovery is considered complete, the fragments are
apt to be left in a state of very wide separation : the power
of the  extensors, and, consequently, of  straightening the
knee, and of keeping it straight, is lessened or almost lost,
and the patient is not only lame, but in constant danger of
falling, and of again rupturing the connexion between the
fragments, or else of breaking the opposite patella.
   The exact pathology of this accident has been very mi-
nutely studied by Mr. William Adams, who has shown, in
the first place, that the  fragments may  be united by true
ligamentous substance, a firm mass of new tissue, generally
from half an inch to an inch long, and passing between the
broken surfaces.
   This is represented in the diagram  64;  and if the liga-
ment is short, the cure is a good one.
   But, in the second place, Mr. W. Adams has  shown that
in the cases in which  the patient recovers with wide sepa-
ration of the fragments, (and in some cases this is so much
as four or five inches,) there is no ligamentous union  at all;
but the fragments are merely held together by the subcuta-
neous fascia in  a  thickened condition.   So that what is
commonly called a union by a long ligament, is in reality
no union at all.   The conditions under which this failure
of union occurs, are shown in the diagram.   In the  first
place, wide separation  of the fragments renders union very
unlikely. But, in addition, is shown  the tendency the frag-
ments  have to become everted.   Then, if the fascia folds
over, and adheres  to  one  of the fractured surfaces, as to
both, union  becomes physically  impossible; and the fascia
somewhat thickened, is the only, and a very inadequate bond
of union.
   In the treatment there are three indications, First, to place
the patient in such a position that the muscles which tend
to draw  the fragments asunder may be relaxed.  For this 
704
SURGERY.
 purpose, the patient's trunk should be somewhat raised in
 a half sitting position, and the injured limb, with  a well
 padded, long, straight splint behind it, should also be some-
 what raised, but not enough to stretch the ham-string muscles.
   Secondly, to bring  the fractured surfaces  into as close
 apposition as possible.  In some cases there is so little sepa-
 ration, that no apparatus is  required.   In others, it suffices
 to place a simple pad, or strap, or bandage above the upper,
 and another beneath the lower fragment, and to  draw them
 together by longitudinal straps passing between.   The same
 end may perhaps be gained by  a figure-of-8 bandage.  A
 leather strap may be fastened round the limb, first above the
 patella, and a tape  passing  from each side of this may be
 fastened to a slipper on the foot.  Or an attempt may be
 made with a starched bandage, applied from the  foot to the
 middle of the thigh, and passing above but  not upon the
 patella.
   But in all such apparatus there are  two difficulties:  that
 they are liable to cause the  fractured surfaces to be tilted
 up, and that they pull upon the skin, and not the bone, and
 so may pucker  in the skin  between the fragments, and so
 do more harm than good.
   M. • Malgaigne has  devised an  instrument to hold the
 fragments firmly together, consisting of two hooks which
 are fixed into the tendon at the upper edge of the bone,
 and two into the lower, and they can be brought and kept in
 apposition by the screw.   They cannot penetrate the bone,
 nor wound the joint.  They may be kept in six weeks, to in-
 sure bony union.   Malgaigne had treated  (1853,)  about
 eleven patients, producing bony union and no bad results.
   Thirdly, inflammation must be sedulously prevented, if
 possible.   Should it come on, it must be removed by leeches,
 cold lotions, or warm fomentations, and purgatives; and no
 constricting apparatus should be applied during this condi-
tion.
  It has been proposed to scrape off the aponeurotic mem- 
SURGERY.
705
brane which adheres to the broken surfaces, by subcutaneous
section, and then to apply the hooks.
  2. Fracture by direct  Violence is generally comminuted;
perhaps longitudinal.   There is usually much inflammation
and not much separation  of fragments; so that position and
bandages suffice, after inflammation has been subdued.
  3. Compound Fracture of the knee  joint will require
excision or amputation if  the skin is very much torn, or the
bones comminuted; and amputation if the popliteal vessels
are injured likewise.   If the vessels are  entire, the bone
     Fig. 69.
not comminuted, nor the skin torn away, an effort may be
made to save the limb.
  13. Fractures of the Leg, (69 & 70.)  The ordinary frac-
       60 
706
SURGERY.
 tures of the leg may be readily  distinguished by careful
 examination.   There are several methods of treatment.
   (1.)  By the common Splints.—The injured leg being laid
 on its outer side, the fracture is  reduced by extension from
 the knee and ankle.   Then a many-tailed bandage is applied
 by some surgeons, after the manner represented in the cut.
 This bandage is easily made thus:—take a piece of roller,
 long enough to reach from the knee to the foot, and to over-
 lap about one-third of the leg 'besides, cut  another  roller
 into pieces and lay them across  the first at right angles, in
 such a manner that each shall over-lap one-third of the pre-
 ceding one; these transverse pieces, (which  should be half
 as long again as  the circumference of  that part of the leg
 which they are to encircle,) are  to be stitched to the longi-
 tudinal one, and  then the bandage is ready for use.   One
 splint, well padded, should be applied  to the outer side of
 the limb; another to the inner side;  and if there is any
 projection of either fragment, it should be kept in its place
 by a third slight splint to the skin.   The'outer splint should
 have a foot piece, which should be  carefully padded in such
 a manner as to prevent the foot from turning either inwards
 or outwards, especially the  latter.   There is a very useful
 rule, which  should be attended to  in all cases of  injury be-
 low the knee;  it is, to keep the  great toe in a line with the
 inner edge of the patella.
   (2.) By the Macintyre's leg splint, or some of the number-
 less varieties of it in existence, as improved  by Mr. Liston
 and  other surgeons.    It  is  straightened  out by means
 of the screw under the knee, as Mr. Fergusson prefers the
 straight position  in almost all cases of fracture of the lower
 extremity.  Before its  application,  it must be made  to
 correspond to the length of the sound limb, and must be
 well padded.
   (3.) By the very convenient  side-splint of Mr. Fergus-
 son's, described in a preceding page.—This may be applied
either on the inner or  outer, according to circumstances. 
SURGERY.
707
  (4.) By the junks.—This very simple but efficient con-
trivance consists of a piece of old sheeting, with a bundle
of reeds rolled together from either  end.  But it  is more
easy to comprehend it from seeing it once than from  a
page of description.
  (5.) By the starched bandage.—In simple cases of frac-
ture of the leg, the patient may be permitted to leave his
bed at the end of a week, with  the  fracture supported by
the starched apparatus.  When  this has become dry, the
patient may  get  up, and-move  to his  chair or sofa with
crutches, but the foot  must be suspended from his neck by
a sling; and he must be particularly cautioned not to at-
tempt to move it  by its own  efforts.  Lastly, in all  cases
of fracture  of  the leg, it is a good plan  to suspend, or
swing the injured part, by means of Dr. Salter's, or  some
similar, apparatus.   It is  not only  more comfortable for
the patient, but it allows of the  use  of the bed-pan, with
much less risk of disturbing the fracture.
  For fracture of the head of the Tibia into the knee-joint
the treatment is the same as for fracture of the condyles
of the femur.  The limb should be placed straight, so that
the end of the femur may act as a splint, and keep  the
broken parts  in their places.   The whole limb  should be
raised so as to relax the extensor muscles of the knee, and
this should be done  in all cases of fracture of the upper
end of the tibia (for which, consequently, the treatment by
splints, with the knee  bent, is inapplicable.)  Pasteboard
splints and starched bandages should  be applied to keep
the joint motionless; but they should not cover the  front
of the knee.  Passive motion should  be  commenced in
about five weeks.
  Fracture of the  lower  end of the Fibula, about  three
inches above  the ankle-joint, is not an uncommon accident,
and may be caused by twists of the  foot, or by jumping on
uneven ground.
  Fracture  of the  internal  Malleolus  may occur in  the 
708
SURGERY.
same way; and one or the other of these fractures  com-
monly accompanies dislocation of the ankle.
   Treatment.—They may be treated either with the ban-
dage and  two splints, or with Macintyre's  splint, or with
Fergusson's side-splint, or with  Dupuytren's, which is a
diminutive of the long straight splint, represented p.  It
is to be well padded, and applied to  the side opposite the
fracture;  but it is not so easy to keep the foot in a proper
position with this as with the other apparatus.
   The surgeon will often find tme or more bags of sand
most convenient auxiliaries in keeping fractures of the leg
in proper position.  They  may be  used  both  to lay the
broken limb upon, and also to put on either side  to pre-
vent the limb from rolling.  This substance is so ponder-
ous and devoid  of elasticity that it steadily retains what-
ever position is given to it.
   Compound fractures of the leg are to be treated on the
principles already laid down for the treatment of compound
fractures  in general.
   14. Fractures of the foot will often be attended with so
much other mischief  as  renders amputation expedient.
But an  attempt should be made to save part of it;  espe-
cially the ball of the great toe.  Pasteboard splints and other
contrivances must be used to preserve the proper position;
and if matter forms, there should be no delay in freely di-
viding the dense fasciae of the foot, to let it escape.
   The  tuberosity of the os  calcis may be  broken by the
action of the muscles attached to it, in the same manner as
the patella and olecranon, and like these parts will proba-
bly unite  only by ligament.  The treatment must be the
same as that of ruptured tendon Achillis." 
SURGERY.
709
                DISLOCATIONS.
  When any bone is displaced from another without frac-
ture, it is called simple dislocation, but  when  complicated
with laceration of the soft parts, it is called compound and
complicated dislocation.  The re-adjustment of the parts in
either case is called reduction.  In speaking of the treatment
of dislocations, we shall recommend the new school method,
as introduced by Dr. Benoni  Sweet, for  the publication of
which we are much indebted to William A. Foster, M. D.,
one of our former pupils, and a nephew of Dr. Sweet.  This
is the first publication of the  new method of reducing dis-
locations as practised by the  author.
  There are but two theories in the reduction of dislocations
of any practical utility.   One is that of extension and coun-
ter-extension, as practised by the old school, the other the ro-
tary plan of the new school.  Great improvement has been
made in this branch of surgery in past years, which is due to
the science and skill of the new  school.   The principles  and
rules of action upon which this new method is established,
are, that as bones are not pulled out  of joint,  they  should
not he pulled into joint, but that they  axe rolled out of joint,
and, therefore, should be rolled into joint.  The old theory
of extension and counter-extension is arbitrary,  and from
its injurious results and inefficiency in meeting the demands
of all cases it may justly be deemed unphilosophical.  New
apparatus and machines are invented by those who teach
and practise the extension theory to overpower the contrac-
tility of the muscles.   This method is fraught with inde-
scribable mischief, which the  considerate sense of the people
has discountenanced wherever  the new method  has been
understood and practised.
  The new method of reducing luxation operates  by simple
means and reverse laws.  Its  principles require no mechani-
cal  force to facilitate  reduction; nor do  they  countenance
                          60* 
710
SURGERY.
venesection and antimonials as valuable prerequisites, but
reject them as seriously injurious  to  the  health and well-
being of the patient.  The new mode of reasoning is  that
all luxations are caused instantaneously, and effected by a
rotary motion;  therefore,- in  order to reduce  the  luxation
it must be done instantaneously, while the muscles are re-
laxed, |[and  the patient is  unaware of  the  intention  of
the operator.   By  so  doing, there is no muscular  action
or resisting force to overpower,  nor does the operator stand
in that fearful position which the  practitioner of extension
occupies in regard to the "irremediable  disease" that he
fears may arise in  the joint from exercise  after the re-
duction.  After this instantaneous reduction the muscles
are not left in  a weakened state, but, having  their normal
strength and vigour, there is no fear of a second dislocation
caused by proper exercise, nor is  there any time to be  lost
for lacerated ligaments to unite, or sprained parts to  gain
strength.  The difference then between the two modes of
luxation is that the new method requires no depleting or de-
bilitating agents to  facilitate the  reduction, nor any over-
powering or mechanical forces  to accomplish the desired
object; nor is the length of time that is required to reduce
a dislocated bone by distention atall necessary; for according
to the new theory  the length of  time  required to  reduce
luxation, with  one exception,  is five  seconds.   No  con-
finement is necessary after reduction by  the new method,
for it is accomplished in so short  a space of time that the
muscles remain in nearly a normal condition, and all that
is necessary to aid nature in the repair is proper exercise.
   The  following brief description  of  some  of the  more
important forms of luxations, and the  reduction  of them,
will still farther illustrate the new method. 
SURGERY.
711
  DISLOCATION OF THE SHOULDER JOINT
  May occur either downwards, or forwards, or it may be
partially dislocated in other ways.  If it  is thrown down-
ward, the treatment, according to the new plan, consists in
elevating the arm as  much as possible, and  then placing
the knee of the operator or a suitable roller in the axilla,
which must be firmly retained in its position, and then by
using the arm as a lever, and the knee or roller as a fulcrum,
the arm is to be carried downwards and backwards, till the
head of the humerus is raised to the edge of the glenoid
cavity; then  by suddenly bringing the  arm  downwards,
and towards the side of the patient, the  head of the  bone
will easily glide into its proper position.
   If the dislocation is forwards, the head of the humerus
is thrown on the inner side  of the  coracoid  process, and
may be felt under the clavicle.

                    TREATMENT.
   After the patient has been seated in a convenient position,
the operator should stand well back  and to  the  side of
the patient, and grasp the  patient's  wrist  with his left
hand,—if it is the left shoulder that is dislocated, and vice
versa,—and turn the palm of the hand  well up;—at the
 same time,  a firm grasp should be made with the fingers of
 the opposite hand against the head of  the humerus, and
 the thumb  against the  acromion process; then by keeping
 the palm of the hand upwards, carrying the arm upwards
 and backwards, till the elbow is nearly on a level with the
 shoulder, and then by suddenly carrying the fore-arm up-
 wards, and directly behind the head of the patient, the re-
 duction will be easily accomplished.

       DISLOCATION  OF THE HIP-JOINT.
    There are  four principal varieties of this dislocation.
 1st.  The  dislocation upwards,  in which the head of the 
712                 SURGERY.
 femur is thrown on the dorsum ilium;  2d,  the dislocation
 backwards on  the sciatic notch; 3d, downwards into the
 foramen ovale; 4th, forwards on the os pubis.

                   TREATMENT.
   The same plan that is used to reduce the first variety is
 to be employed to reduce  the second; and the  same mode
 that will reduce the third variety is also to be resorted to
 in the fourth.
   The reduction is effected as follows:—If the dislocation
 is either of the first two varieties, let the patient be placed
 in a longitudinal position, and to the side of the bed.  The
 operator should now have an assistant place his hand firmly
 against the head of the femur,  standing well back, or to
 one side, so as not to obstruct the movements of the operator,
 who should now seize the  patient's ankle with one hand,
 and with the other  grasp the limb just above the knee, and
 flex the limb as much as possible, carrying  the thigh  up-
 wards, and across the ilium of the opposite side.   The ope-
 rator should  now tell the assistant  to press  firmly against
 the  head of the bone, while he  suddenly rotates  the limb
 outwards and slightly upwards, i. e., rotate the limb in pre-
 cisely the opposite direction from that in which it was first
 rotated.  By these  simple means the bone will easily be re-
 placed.
   The last two varieties may be reduced on precisely  the
 same plan,  with the exception of the manner of flexing the
 limb.  The limb in these varieties should be flexed upwards
 and  outwards,  and  while  the assistant is pressing against
 the bone, as before, the limb is to be rotated inwards, and
 brought down alongside its fellow.

         DISLOCATION OF THE ANKLE
  May occur  in  various directions,  outward, inward, for-
ward and backward.   The outward and inward varieties are
the most common. 
SURGERY.
713
                    TREATMENT.
  The operator should seize the tarsal portion of the foot of
the patient with one hand, and  grasp the sole of the  foot
with the other, having the thumb of the latter hand press-
ing firmly against the  astragalus just beneath the fibula;
he will  now suddenly rotate, or throw the ankle inwards.
The treatment for the inward variety is the same, with the
exception that the motions and the position of the hands
are to be reversed.

     DISLOCATION OF  THE ELBOW JOINT.
                         Fig. 71.
  Dislocation of the elbow joint is by no means uncommon,
and in many cases  the diagnosis is very obscure.  Espe-
cially is this the case when it is connected with violent injury
of the soft parts.  The most common dislocation is that in
which both  bones are thrown backwards with or without
fracture of the  coronoid process.  In this injury the olecra-
non process will  make a  prominent projection backwards,
and the articular ends of  the  humerus and tendons of the
triceps muscle  can readily be felt.  In cases where the co- 
714
SURGERY.
ronoid process is fractured,  there will  be great mobility
about the joint as well as distinct crepitation.
   When  dislocation of both  bones occurs forward, it is
always connected with fractures of the  olecranon process.
The lateral dislocation is usually only partial, as either the
radius comes in contact with the  internal condyle, or the
ulna with the  external one.  The ulna  or radius  may be
both dislocated, or only one.  When the ulna alone is dis-
located, it alway's occurs backwards, and  in the majority of
cases the  coronoid process will  be fractured.  The radius
alone may be dislocated, either forwards, backwards, or out-
wards, or, as sometimes occurs, the radius and ulna may be
dislocated in opposite directions, the radius forwards, and
the ulna backwards.

                    TREATM ENT.
   The manner of reduction of dislocation of the elbow joint
varies according to  the nature of the dislocation.  When
the injury is connected with a fracture of either of the pro-
cesses, the reductions although much easier than where the
processes  are not fractured, are  more difficult to be perma-
nently cured, owing to their strong tendency to dislocate
again.  When the ulna is dislocated, it may be reduced by
bending the arm over  the knee.   This is done by grasping
the forearm with both hands, and firmly  pressing the bent
knee into the bend of the injured elbow, so as to disengage
the ulna from the humerus,  and restore  the arm to its na-
tural  position.   In dislocation of the radius the reduction
can usually  be  accomplished by extension at the shoulder.
After the reduction is accomplished, a lateral angular splint
should be applied, and if it is the ulna which is dislocated,
a pad should be passed over its head so as to prevent -its re-
dislocation, which is very apt to  occur.  To prevent inflam-
mation from arising, cold packs should  be frequently ap-
plied, the diet should be mild and cooling, the bowels opened
by  a  compound cathartic pill,  and the arm  kept perfect, 
SURGERY.
715
ly at rest. After the inflammation has subsided, gentle mo-
tion should be allowed, and, to prevent stiffness, a liniment
should be used, made as  follows:
     R.—Oil of stillingia,..................................... ^ij.
           "  lobelia......................................... 3j.
             alcohol,........................................ gij.
  Mix, and bathe the arm three or four times a day.
  Where the dislocation is  connected with fracture,  the
fractured bone should be adjusted, and the inflammation re-
duced by the use of hot or cold packs, or fomentations of
arnica or lobelia, lye baths, aconite, &c.

          DISLOCATION  OF THE  WRIST.
  Dislocation of the wrist, although not very common, oc-
curs occasionally.   When it  does, it may be distinguished
from fracture by the absence  of crepitation, and the greater
amount of deformity.

                    TREATMENT.
  The reduction of dislocation of the wrist is very simple
and easy, and the support should be made by the use of an
antero-posterior splint.   Dislocation of the bones of the car-
pus occasionally occurs,  and may be treated upon the ge-
neral plan given above: also, those of the thumb and fingers.
Dislocation of the jaw may  be reduced by placing a cork
between  the teeth, and pressing the jaw upwards and back-
wards, until it glides into its proper position.

      DISLOCATION  OF THE  LOWER JAW.
  Dislocation of the lower jaw may occur as the result of
too widely opening the mouth in  the act of laughing or
gaping, (see fig. 72.)   The signs of this dislocation are  ob-
vious, as the  mouth will  be seen open  without the ability
on the part of the patient to close it.
   Treatment.—The reduction of a dislocation of  the jaw
may be effected thus:—The  surgeon should stand  in front 
716                  SURGERY.

of the patient and place the thumbs, protected by a nap-
kin, upon the  molar teeth, and depress the jaw while he
raises the chin by means  of  his fingers.   In  this way he
                        Fig. 72.
pushes the angle of the bone downwards and backwards, so
as to disentangle the coronoid process from under the zygo-
matic arch, where it is lodged when the jaw is dislocated.
After the reduction, a four-tailed bandage should be  applied,
as in fracture of the jaw; and if the patient should be of a
weak and feeble habit, iron, hydrastin, and other tonics
should be administered.
   Dislocation of the Clavicle.  The clavicle may be dislo-
cated either forwards, backwards, or upwards.
   Symptoms.—The  signs which attend dislocated  clavicle,
are shortening of the shoulder and deformity about the up-
per part of the sternum.   In some cases the displaced bone
may crowd upon the vessels of the  neck and produce dis-
turbance of the brain; or, it may press against the  trachea,
and produce difficulty of breathing.
   Treatment.—The most common form of dislocation of the
clavicle is, that where the bone is depressed forwards and
downwards.   It may be  occasioned by  blows.  The bone 
SURGERY.
717
should be crowded back to its positions, and secured by
means of a pad and figure  of-8-bandage.  The other forms
of dislocation of the clavicle should be treated in a similar
manner..
   Dislocation of the Patella.—Dislocation  of the patella
may occur  in four ways; latterly, upwards,  or downwards.
They may be reduced by extending the limb and crowding
the bone back to its position, when it should be secured by
means of pads or bandages, and the patient  remain quiet
for a week or ten days.
   Dislocation of the knee-joint.  This accident seldom oc-
curs, although it may result from violent blows or falls from
a great distance.  When it does occur, it may be backwards,
forwards, or on either side
   Treatment—Dislocation of the knee joint is frequently
accompanied  by  serious inflammation, and  should receive
most prompt and cautious treatment.  To reduce the dislo-
cation, the  patient should  be  placed  upon  the back, the
thigh placed in a circumflex position, and the leg extended
to its natural length, by an assistant, while the'surgeon, by
proper manipulation, brings the bones into their normal
position; after which bandages and splints  should be  ap-
plied so as to maintain perfect rest and position of the parts,
for at least, four or five weeks.   At  the same  time, the
knee should be kept wet in the diluted tincture of arnica,
and such constitutional treatment instituted  as will prevent
local inflammation.
                     WOUNDS.
  Wounds are divided into gunshot, punctured, lacerated,
simple, incised, and poisonous wounds.
   Gunslwt  Wounds.—Gunshot  wounds  are  a species of
contused and lacerated wounds,  characterized by their pe-
culiar appearance and the extensive injury inflicted to parts
both superficial and deep-seated, iu consequence  of which
     61 
■I
718                   SURGERY.

they may prove immediately fatal.   Gunshot wounds vary
according to the nature of the  projectile; the force with
which it is driven, and the direction in which it strikes.   If
a cannon-ball, at full  speed, strike a part of the body, it is
carried away.   If it be a part of one of the extremities, the
stump will present a level surface of darkly contused, pulpy
tissues.   If the ball be partly expended, the  portion of the
body injured will present more of a lacerated appearance.
If it be  a spent ball, there will be no removal of portions  of
the body, but the part struck will be tumefied and present
the appearance of ecchymosis. Large portions of shell cause
mense laceration of parts, but do not  carry away or grind
as do round shot.   Small projectiles, like  a musket-ball,
make an opening with irregular circular edges, which are
slightly  inverted; and if the ball passes out, the wound  of
exit will be larger,  more torn, and its edges slightly everted.
The number of wounds made by one ball may be  from one
to four; as when one ball  passes  through both  limbs,  or
when the ball splits and makes one hole of entrance and
two  of  exit.    Wounds produced by irregular  missiles,
as small pieces of shell, flattened  musket-balls, &c, produce
more or less laceration, according to the nature and charac-
ter of the projectile.
   Symptoms of gunshot wounds.—A wound  produced by a
musket shot is attended with pain  and swelling according
to the  extent  of the injury.   The shock produced by the
injury depends  upon its  extent.  When  the bones are
fractured and the soft parts are extensively  lacerated, the
shock produced is usually great, and when a ball enters the
body and wounds a vital organ, the continued shock is suffi-
cient evidence of its fatal character.  When a part of the body
is carried away by round shot or shell, the arteries are  la-
cerated, and their middle and inner coats are retracted; the
calibre  of the  vessel is  diminished, and tapers to a point,
near the line  of diversion; the  vessel is plugged by a co-
agulum  of blood, and the cellulo-flbrous investing sheath 
SURGERY.
719
filled with coagulated blood, which forms an outside support
against hemorrhage.
   Treatment. — The  provisional treatment  for gunshot
wounds consists in arresting the hemorrhage, producing re-
action  by means of diffusible  stimulants, and  rendering
such other aid as will contribute to the immediate relief of
the patient.  As soon as this is accomplished and the pa-
tient placed in a hospital or a convenient place for an ex-
amination, the injury should be carefully and thoroughly
examined.   If the injury be produced by a ball, the exami-
nation should be  of such a character, as to enable the sur-
geon to determine  whether the ball is  lodged in the body,
or passed through it.   If there are  two openings, one may
be that of entrance, and the other of  exit; although that
does not necessarily follow, as there may be more than on e
ball in  the  body;  or, it may be a  split ball, making two
holes  of entrance.   Portions of  clothing and other  hard
substances carried in by the ball, should be removed;  after
which  the wound should be examined by means of the in-
dex finger, and if the ball can be  discovered and is accessi-
ble, it should be removed by means  of  the bullet forceps.
If the opening be too small for the removal of the ball, and
an incision can be made without involving vital parts or in-
juring large vessels, it should be done  so as to enlarge the
opening and facilitate the removal of the ball.  Fragments
of shell and other missiles may be removed in a similar man-
ner.   When gunshot wounds are accompanied with  great
laceration, it is necessary,  after removing all the foreign
substances  that can be detected, to adjust the parts and
bring them into their normal position, as near as possible.
Previously to  doing this, however,  the wound should be
thoroughly sponged in warm  water,  and all coagulated
blood  removed;  after which lint or pads of linen  should
be secured by proper bandaging, and kept moistened either
with tepid or warm water.  When suppuration has become 
720
SURGERY.
fully established, the dressing should be frequently changed;
and if the sore assumes an unhealthy appearance, it should
be  stimulated  by applying a  dilute tincture of  myrrh,
lobelia, or arnica.  The constitutional treatment consists in
supporting the system by means of tonics, nutritious diet,
and a strict regulation of the patient's habits.
   Gunshot  Wounds of  the Head,—Mr. Guthrie remarks
that injuries of  the  head  of apparently equal extent, are
more dangerous on the forehead than on the side or  middle
portion, and still more so  than those on the back part—
and that a fracture on the vertex is infinitely more import-
ant than one at the base of the cranium.  The  treatment of
ordinary gunshot wounds of the scalp consists in  cleansing
the  surface  of the wound,  removing the  hair,  applying
lint, moistened in cold water, and  a proper regulation of
the patient's diet.  If the wound is connected with fracture
of  the skull, without depression,  any loose fragments of
bone may be removed, and the wound dressed  as above de-
scribed.   When the wound  is connected with fracture and
depression in the cerebrum, portions of the bone depressing
the brain may  be elevated,  if practicable, or they may be
removed by a trephine.
   Gunshot Wounds of the Face.—If connected with frac-
ture of the bones, they should be treated by adjusting the
fragments as well as possible, and dressing as  those of the
scalp.
   Gunshot Wounds of the Chest.—Gunshot wounds of the
chest may be of the non-penetrating or penetrating charac-
ter.  Non-penetrating wounds,  when caused by large pro-
jectiles, may, by the  concussion produced, be  followed by
active  congestion or  inflammation of vital organs, such as
the heart, lungs, liver, &c.  Penetrating wounds may in-
flict injuries  upon any of the internal viscera, which is fol-
lowed by an extensive shock to the  system, or  hemorrhage
and immediate  death.
  Treatment.—The object of the  surgeon should be to ar- 
SURGERY.
721
rest the hemorrhage, to remove pieces of jagged projections
of bone, and to rally the patient by means of mustard-paste,
stimulating liniments,  and mild  stimulants.   The wound
may be dressed by placing over it folds of linen moistened
in water, and secured by a broad  bandage.
  Gunshot Wounds of  the Neck.—Gunshot wounds of the
neck are by no means as fatal as what might be anticipated
from the anatomical structure of  the part.   If any of the
large vessels  are ruptured, death will immediately ensue.
If not, the wound should be treated as those of the face.
   Gunshot Wounds of the Abdomen.—Gunshot wounds of
the abdomen  are divided into non-penetrating and pene-
trating.
  Non-Penetrating Wounds.—If, although the viscera have
been contused, the injury does not amount to being mor-
tal, the  patient  should  be subjected to perfect quiet, ex-
treme abstinence, and, only when inflammation arises,  to
the necessary treatment  for its  control.  If the parietes
have been much contused, abscess or sloughing may be ex-
pected, and a tendency to visceral protrusion must be af-
terwards guarded against.
  When portions of  the  pelvic parietes are fractured by
heavy projectiles, very  protracted abscess generally arises,
connected with necrosed  bone.
  Penetrating Wounds.—A penetrating wound of the ab-
domen, whether viscera be wounded or  not, is usually at-
tended with a great  amount  of "shock."  The  prognosis
will be extremely unfavourable if there  is reason to  fear
the projectile has lodged  in the cavity of the peritoneum;
and in all cases the danger will be very  great from inflam-
mation of this serous investment.  The liability to accumu-
lation of blood in the cavity, from some vessel of the ab-
dominal  wall being involved  in  the wound, must not be
forgotten.
  When, in addition to  the  cavity being opened, viscera
                          61* 
722
SURGERY.
are penetrated, and death does not directly ensue from rup-
ture of some of the larger arteries, the shock is not only
very severe, but the collapse attending it is seldom reco-
vered from up to the time  of the fatal termination of the
case.  This is sometimes the only symptom which will ena-
ble the surgeon to diagnose that viscera are perforated.
The mind remains clear, but the prostration, the oppression,
anxiety and restlessness are intense—and, as peritonitis su-
pervenes, pain, dyspnoea, diffused tenderness, irritability of
the stomach, distention,  and other signs of this inflamma-
tion, are superadded.
   In ordinary wounds from musket-shot, scarcely any mat-
ter will escape from the  opening of the parietes, the mar-
gin of which becomes quickly tumefied;  but if any escape,
it will probably indicate what viscera  has been wounded.
If the stomach has been  penetrated,  there will probably be
vomiting of blood  from the first.  If the spleen or liver be
wounded, death from hemorrhage is likely to follow quickly.
If the small intestines  have been perforated, and death fol-
lows soon after from peritonitis, the  bowels ususlly remain
unmoved, so that  no evidence is  offered of the nature of
the wound from evacuations; but in any case of penetrating
wound of  the  abdomen, when the opportunity is offered,
steps should be taken—a matter not  unlikely to be omitted
under the circumstances of camp hospitals full of patients—
to isolate and examine all evacuations which may follow.
If the kidneys or bladder are penetrated, the escape of urine
into the abdomen is almost a certain cause of fatal result.
The latter viscus may,  however, be penetrated without the
peritoneal cavity being opened, and  the wound is then by
no means of a fatal  character.  Musket-balls sometimes
lodge in the bladder.   In all such cases it is probable that
the bladder has been penetrated at some part uncovered by
peritoneum, so that the cavity of the  abdomen has not been
opened—or, if otherwise, the foreign body has found its 
SURGERY.                  723
way in by ulceration, after  adhesion  had been established,
and thus circumscribed the openings of communication.
  When the abdominal parietes have been opened by shell
or passage of large shot, protrusion of omentum and intes-
tines will probably be one of the results.   This does not
always happen. Sometimes a wound caused by a large pro-
jectile, which was  at first not penetrating, will indirectly
become  so,  from  the severe  contusion and consequent
sloughing, to such an extent as to denude the viscera. Cu-
rious instances are recorded in which balls have passed di-
rectly through the abdomen without perforating any im-
portant viscus, as  proved by examination after death.
  Gunshot wounds of the colon, especially of the sigmoid
flexure,  appear to be less  fatal, probably from structural
causes, as well as circumstances of position, than wounds of
the small intestines.
   Wounds of the Diaphragm.—Musket-balls occasionally
pass through the diaphragm; and Mr. Guthrie has remarked
that these wounds, in instances  where the patients sur-
vive, only become  closed under rare and particular circum-
stances.   Hence the danger of portions of some of the vis-
cera of the abdomen, as the stomach or colon, passing into
the chest, and thus forming  diaphragmatic herniae, and
of these eventually, from some cause,  becoming strangu-
lated.
   Treatment,—In the  general  treatment  of penetrating
wounds of the abdomen by gunshot, the surgeon can do lit-
tle more than  to sooth and  relieve  the patient by the ad-
ministration of opiates, and to treat symptoms of inflamma-
tion, when they arise, on the same principles as in all other
cases.  The usual directions to attempt agglutination of the
opposite portions of peritoneum by favourable posture, can-
not generally  be carried out,  the attempts  being defeated
by the restlessness of the patient.   The collapse which at-
tends such injuries may be useful in checking hemorrhage,
and the exhibition of stimulants is farther contra-indicated 
724
SURGERY.
 by the risk of exciting too much reaction, should the wound
 not prove  directly fatal.  If the wound be caused by grape-
 shot, or a piece of shell, and intestine protrudes, it must be
 returned.  If the intestine be wounded, sutures are  inappli-
 cable, as in an  incised wound, without previously removing
 the contused edges.  When the bladder is penetrated, care
 must be taken to provide for  the removal of the urine—
 either by an elastic catheter, or, if this cannot be retained,
 by perineal incision.
    Gunshot Wounds of the Perineum and  Genito- Urinary
 Organs.—From the position of these parts of the body, un-
 complicated  gunshot wounds  of them are, comparatively,
 rare.   Perineal wounds are  not unfrequently  caused by
 shells bursting and projecting fragments upwards, but they
 are generally mixed with lesions of viscera of the pelvis, or
 fracture of its structure, or injuries about the upper parts
 of the thighs or buttocks.
   Gunshot Wounds of the  Extremities.—Gunshot wounds
 of the extremities divide themselves into flesh wounds and
 contusions, and those  complicated with fracture of one or
 more bones.   Flesh wounds may  be simple, and these offer
 few peculiarities, whatever their site; or they may be  ac-
 companied with lesion to nerves or blood-vessels, or both,
 and these usually increase in gravity in proportion as they
 approach the trunk.
   Upper Extremity.—Fractures  of the  bones of the  arm
 are very much  less  dangerous than  like injuries in the  cor-
 responding bones of the lower extremity.  Unless extremely
 injured by a massive projectile, or longitudinal  comminu-
 tion exist  to a great extent, especially if also involving a
joint, orthe state of the patient's health be very unfavoura-
 ble, attempts should always be made to preserve the upper
 extremity after a gunshot wound.
   In  these injuries, where  the bone is  much splintered,
 the detached portions, and any fragments which are only 
SURGERY.
725
retained  by very partial periosteal connexions,  should be
removed; projecting spicula sawn  or  cut  off; the wound
being extended at the most dependent  opening, where two
exist, or  fresh incisions being made for this purpose, if ne-
cessary;  light water-dressing applied; the  limb properly
supported;  and  the case proceeded  with  as in  cases of
compound fracture from other causes.  The same general
rules also apply in preserving as much of the hand as pos-
sible in gunshot  injuries.   If the  shoulder or elbow-joint
be much injured, but the principal vessels have  escaped,
the articulating surfaces and broken portions should be ex-
cised.
   The results of excision practised in  the shoulder and el-
bow-joints,  especially  the former,  after  gunshot  wounds,
have been exceedingly satisfactory.  These  operations pre-
sent no peculiarities in mode of performance, or the  after
treatment,  as compared with similar resections  in  civil
practice.
  Lower Extremity.—Gunshot wounds of the lower extre-
mity vary much more  greatly in  the  gravity of their re-
sults, as  well as in the treatment to  be adopted, according
to the part of the limb  injured, than happens in  those of
the upper extremity.  As a general rule, ordinary fractures
below the knee, from rifle-balls, should never cause primary
amputation, while,  excepting in  certain  special  cases, in
fractures above  the knee,  from  rifle-balls, amputation is
held by most military surgeons to be a necessary measure.
The special cases are gunshot fractures of the upper  third
of the femur, especially where the hip-joint is implicated;
for in these the  danger attending amputation itself  is so
great that the question is still open, whether the  safety of
the patient is best consulted by excision of the injured por-
tion of the femur, by simple removal of detached fragments,
and trusting to natural efforts for union, or by resorting to
amputation.  The decision of the surgeon must generally
rest upon the extent  of injury to  the surrounding struc- 
726
SURGERY.
tures, the condition of the patient, and other circumstances
of  each particular case.   If the femoral artery and vein
have been lacerated, any attempt to  preserve the limb will
certainly prove fatal.
  M. Legouest, in a  recent  essay in  the Memoirs of the
Society of Surgery,  at Paris, maintains that  amputation
at the hip-joint  should be reserved for cases  of fracture
with injury to the great vessels, and that where the vessels
have  escaped, resection should invariably  be performed.
He also inculcates, as a general principle, not  to perform
immediate primary  amputation  at  the hip-joint in  any
case; but, even in  the severest forms of injury, to  post-
pone the operation as long as possible.  With regard to
gunshot fractures in  the middle and  lower third of the
femur,  the experience of  the French  and English armies
in the Crimea has tended to  confirm  the doctrine of the
older military surgeons, that many lives are lost which might
be otherwise preserved, by trying to  save limbs ;  and  that,
of the limbs preserved, many are little  better than incum-
brances to their possessors.   In the late Italian battles, the
practice of trying to save lower extremities, after comminu-
ted fractures in these situations  of  the thigh, appears to
have  been abandoned.  In  fractures  of the  leg, where
neither the knee nor ankle-joints are implicated, the results
of conservative attempts have been more favourable. When
the fracture is  comminuted, and implicates the knee or
ankle-joint, opening the capsule, amputation is necessary.
The knee-joint was once  excised  in  the Crimea, but the
patient died; as was the  case in  the only other instance
where this operation  is known to have been performed for
gunshot injury  in  the Sleswick-Holstein  campaign.   In
the treatment of fractures of the leg, where it has  been
determined  to seek union, the same remarks  apply as to
fractures in the upper extremity.  In wounds  of the  foot
it is especially necessary to remove as  early as  possible all
the comminuted fragments of the bones injured, or tedious 
SURGERY.
727
abscesses, and much pain  and constitutional irritation are
likely to ensue."   (Stephen Smith, M. D.)
   Incised Wounds.—Incised wounds are  made with  clean
cutting instruments.  The indications of treatment, are to
check  the bleeding  as  we have previously described, re-
move foreign bodies, bring the divided parts  into apposi-
tion, and maintain them so, and to promote adhesion.   This
can all be done by the various means and appliances that
we have already described.
   Punctured  Wounds.—Punctured wounds are injuries
produced by instruments  which penetrate  the  body, and
have  already been described under the  head of gunshot
wounds.
   Lacerated Wounds.—Lacerated wounds are injuries pro-
duced by substances which tear and comminute portions
of the body.  They have  also been described under the
head of gunshot wounds.
   Poison  Wounds.—Poison wounds are injuries produced
by rabid animals, poisonous reptiles, and dissecting instru-
ments, contaminated with virus from recent  dead subjects.
Wounds of this character should be treated so  as to neu-
tralize the poison and prevent its absorption into the sys-
tem.  When the wound is first  received, whether  it be
that of a poisonous reptile, a rabid animal, or a  dissecting
wound, the blood should all be sucked out, either by the
mouth, or some instrument adapted to that purpose, and
the wound thoroughly cauterized with caustic  of potassae.
If there is danger of the poison being conveyed to the cir-
culation, a tight ligature should be  placed along the  limb
above the site of injury, and remain until after this  pro-
cess.   After  the wound has been  cauterized, a poultice
should be applied composed of equal parts  of yeast,  slip-
pery elm, and pulverized charcoal, and kept wet with the
tincture of lobelia.  If it be a dissecting wound, and  con-
stitutional symptoms should appear, a free  lobelia emetic
should be given followed by an active purge of podophyllin 
728
HYDROP HOB IA.
and  anti-bilious physic, and quinine and  iron.  If it be
from poisonous reptiles, after the lobelia emetic and podo-
phyllin purge, the patient should drink a half teacup full
of a strong decoction of plantago cordata, or water plantain,
every half hour or hour.   Some have advised this decoc-
tion to be made of milk, and think it is much better  than
water.  If this should fail to give relief, a half gill of
whisky should be given every half hour, until free intoxi-
cation is produced.  Both of these  methods have  proved
very successful in the treatment of these wounds.   If it be
a wound produced by a  rabid  animal, and hydrophobia is
the result, it should be treated according to the plan sug-
gested by Prof. Livezey, which is as follows:

                   HYDROPHOBIA.
BY ABRAHAM LIVEZEY, A. M.,  M. D., PROFESSOR  OF SUR-
       GERY IN THE ECLECTIC MEDICAL COLLEGE.
   The painful recital  of cases of hydrophobia, ever and
anon reported in the newspapers, has induced me recently
to examine more closely the views of medical men thereon,
and the treatment employed by Old  Physic in  this terrific
and ever-mortal disease.   This review has, if possible, ex-
hibited to my mind more serious and  destructive errors,
both in theory and practice, than any it has been my duty
to expose in  my  preceding articles; errors so gross and
astounding, as to be almost a matter of surprise to  myself.
   Upon  the completion  of this review, I  ask  a  thinking
public, (for doctors will not think,) to judge, whether  the
regular practice in this frightful disease is  based upon any
sound pathological principle,—or how far  it is calculated
to relieve the  patient, and subdue the fell poison  which is
coursing in  his system, to the certain  destruction of the
unhappy and unfortunate victim; for the "medical faculty "
do not recognise a single  cure of hydrophobia, after that
dreadful  disease  has  declared  itself by its  characteristic
symptoms. 
SURGERY.                  729
  Reports  of cures have, however, time and again, been
made by Thomson and his disciples,—but as they are  not
from a "legitimate source," they are deemed to be not
sufficiently well authenticated, to secure the credence of
the "profession."
  " Post-mortem examinations show an absence of all defi-
nite or constant  traces of organic  change," and  give no
clue to a rational treatment of the disease.  Indeed, with
the new light which Dr. Dickson has  cast upon the world
of medical  science, it is perfect folly  longer  to seek a
knowledge of the treatment of disease in  the dissecting
room,  or  by the oft-repeated  farce  of post-mortem  in-
spections.
   True, there  is "frequent inflammation  of the inner
surface of  the  mucous  membrane of  the  stomach"  ob-
served, which is sometimes softened;  and all authors speak
of the fauces, oesophagus, and bronchial tubes being filled
with a tough, stringy mucus,—and yet the general  fact
above  mentioned, with the " nature of the symptoms, suffi-
ciently mark the disease as belonging, secondarily, to  the
nervous system."  From whence the " excessive nervous
irritability  and  apprehension"—the  "spasmodic contrac-
tion of the muscles of the fauces"—the general " paroxysms
or convulsions"—if a something did  not primarily  exert
an unfavourable influence upon that nervous system?
   With a near approximation to truth,  may we not assert
 that these  symptoms  are  produced by the impression of
 the rabid virus, secreted from the  various follicles  and
 glands, and poured out upon the mucous membrane of the
 alimentary canal, and thence by the reflex action of the
 nervous system, are the spasms produced,—acting as cen-
 tres or sources of irritation, as do teething in infants, and
 indigestible substances in the stomachs of children, both
 of which are capable of exciting spasmodic action and con-
 vulsions in their uninjured organisms?
        62 
730
SURGERY.
f  That the virus is thus  secreted, is  indisputable,—or
whence the  power  of the  rabid  animal to  inoculate his
fellow by  a mere abrasion of the cuticle and a suffusion of
the part with a  little saliva,  or  mucus?  Whence, also,
the "signs of digestive  disorder"—the "difficulty in the
deglutition of liquids"—the coming on  of "singular ner-
vous  paroxysms"—the "sensation of stricture  or oppres-
sion felt about the throat and chest,"—and the  "painfully
embarrassed breathing?"   Whence, also,  the "copious
secretion  of a viscid mucus in the  fauces, which the patient
spits  out  with a sort of frantic vehemence and rapidity,"
or pulls out the "viscid secretion" with his fingers,  which
are " characteristic features  of the disease," as well  as
" one of the most striking phenomena of the case?"—Prof.
 Wood.
   Let us  now examine, for a  moment, the effect upon the
system of a small portion of variolous or small-pox  virus,
introduced by inoculation, and mark the analogy existing
between the action  of the rabid virus  of the small-pox,—
milder in  the latter  case, it  is  true, by reason of the less
degree of virulency  of the poison,—but yet  amply strong
enough to manifest the  striking resemblance.
   In  due  time after inoculation for small-pox, the stomach
becomes disordered, the tongue coated, with general pain
and distress.  Mucus also collects in the fauces and bron-
chial  tubes, giving occasion, not unfrequently, to oppressed
breathing or constriction of the chest, and in children  to
convulsions also.  But in this case,  the system,  in a great
degree, frees itself by the development of a  copious crop
of pustules; whilst the  physician  rationally gives emetics
where indicated, or mild purges to keep the  stomach free
from  an accumulation of foul secretions, whereby the dis-
ease is soon conducted to a favourable termination.
  The whole system, then,  the external surface, and the
mucous membrane, which is  a mere prolongation of the
cuticle, the solids, and the fluids of the body, are poisoned 
SURGERY.                   731
 by a minute speck of variolous matter inserted beneath the
 skin;—or  whence the power to infect others (not pro-
 tected) by the exhalations  from the  body,  from which
 arises  a peculiar and disagreeable odour ?
   In the commencement of the manifestation of hydropho-
 bic symptoms,  "acute pain, or shocks of pain,  are now and
 then felt in the epigastrium," where the poisonous virus is
 most largely effused.   The "tongue  is generally furred;
 often a burning in the throat, with thirst which cannot be
 allayed ;" and, finally the  " skin is covered with  a viscid
 and offensive sweat;"—proving, also, that the whole sys-
 tem, as in  the  case of small-pox, is under the  influence  of
 the  virus.
   In the treatment of small-pox, the  physician assists the
 recuperative powers to throw off the poison, by the removal
 of the  morbid  secretions as they arise; but in the  treat-
 ment of hydrophobia, where there  is tenfold greater need
 of such natural assistance,  he either debilitates the system
 by resorting to blood-letting, or fastens these  poisonous
 effusions within and upon him, by the continued  adminis-
 tration of  opium, morphia, chloroform, and other similar
 agencies.
   More definitely,  then,  what are the  indications  for a
 thorough, energetic, and successful treatment of hydropho-
 bia,  as manifested in the human subject ?
   Wherefore are we recommended  by our standard text-
 books  daily to evacuate the morbid secretions from the
 muciparous and other glands throughout  the alimentary
 canal, in cases  of  epidemic fever ?   Why do  they advise
emetics where  there is oppression  from accumulation of
mucus, or where, by the presence of nausea and vomiting,
there is farther evidence of disordered stomach ?
   This, though, is  rational treatment;  but  wherefore do
they, in a case of hydrophobia, fasten down those more poi-
sonous  secretions upon  the patient, by successively trying
"opium—acetate  of lead—tobacco—mercury—arsenic— 
732
SURGERY.
venesection, ad deliquium animi—cantharides—white helle-
bore—injecting warm  water into  the  veins or solution of
morphia," &c, &c?  In  the  name of humanity and mercy
—in the name of the hecatombs of victims which each gene-
ration has yielded, we ask why this treatment?   The patient
is not only not permitted to die a natural death, but the physi-
cian virtually and actually assists, by such a course, a lethife-
ferous poison  still farther to crush all nervous energy—to
paralyze all vital action.  Would not every case of epidemic
fever, or other malignant disease, terminate fatally, under a
treatment  such as that  to which  the  rabid patient is sub-
jected?
  The nature of the disease, the symptoms manifested, and
the post-mortem appearances, (so far as they are worth any-
thing,) indicate the use of such medicines and means as will
at once, by their diffusive nature, penetrate and cleanse  the
pulmonic and digestive apparatus of the morbid secretions
as fast as they are effused, and stimulate and uphold the vi-
tality of the nervous system.  If these  morbid secretions
are not  removed, but are fastened within and upon the  pa-
tient, they must necessarily act powerfully upon the sentient
extremities of the afferent nerves, and by the reflex action
are conveyed  back to  the  circumference by  the efferent
nerves—the fifth and eighth pairs particularly—to the face,
pharynx, and larynx, and upon this excito-motory system
of Sir Marshall Hall the violent spasms mainly depend.
  Holding it to be a self-evident truth that the hydrophobic
virus is poured out upon the mucous membrane—otherwise
the disease could not be communicated by a bite, or the sa-
liva—the indication in treatment is to remove the cause, and
the effect will  of necessity cease.
  For this purpose we should have prepared the following
tincture;—Myrrh, one pound; capsicum, two ounces; bran-
dy, one  gallon.  Let  these  macerate about ten days in a
warm place; decant, and add to the clear  tincture one-half 
SURGERY.
733
 pound each of lobelia seed, capsicum and valerian.  After
 standing an additional ten days, the tincture is fit for use.
   Administration.—When the undoubted symptoms of hy-
 drophobia, which are known  to every one, manifest them-
 selves, with the paroxysms supervening, let the wound  or
 cicatrix be kept constantly wet with cloths saturated with
 this tincture; use the hot, stimulating foot-bath, or the warm
 vapour-bath; if the surface be cold and cramped, give a
 strong infusion of bayberry and capsicum, with from two
 to three tablespoonfuls of the above tincture, every twenty,
 thirty, or sixty minutes, according  to the severity of the
 symptoms  and the obstinacy of the paroxysms, repeating
 the  same until free vomiting  ensues.  As an adjuvant,  to
 shorten  the convulsions, chloroform may be inhaled, and
 injections of the above tea and tincture may  be conjoined;
 indeed, the case may occur, where the difficulty of swallow-
 ing  is so great, that our whole dependence, for the time
 being, must be upon these  latter means, conjoined with the
 hot  or vapor-bath.  In such cases vitality  is so much de-
 pressed, that these stimulo-relaxant injections are generally
 retained, until they impress the whole system, and produce
 full  vomiting.
   The modus operandi of this treatment will be apparent
 upon a moment's reflection.  In the first place, the astrin-
 gent or "anti-canker" infusion  of  the bayberry, rendered
 diffusive and stimulating by the capsicum, is a powerful de-
 tergent to the fauces and alimentary canal, while it stimulates,
 at the same time, the whole  glandular system, to  a more
 healthy action.   The stimulating foot-baths have a deriva-
 tive  effect;  and the vapour-bath both assists in relaxing the
spasm, equalizing the circulation, and throwing all effete
matters to the  surface,—and thus are these "copious offen-
sive  perspirations" removed; while  the compound tincture
of lobelia, containing, as it  does, the sanative properties of
the myrrh, the diffusive, stimulating, and warming properties
of the brandy  and capsicum, the tonic  and sedative effects
                          62* 
734
SURGERY.
of the valerian upon  the nervous system, and  the  potent,
anti-spasmodic, diffusible, and revivifying properties of the
lobelia, when thus combined, exert a generally recuperative
power by relaxing nervous spasms;  freeing the system (by
emesis)  of all irritating, poisonous  secretions;  by stimu-
lating the organs of vitality to healthy action, and restoring
the whole economy to its wonted healthy play.
  After the bath, the vomiting, &c, the patient will become
tranquil, and pass, perhaps, several  hours  in  a refreshing
slumber,—to awaken, however, to  a renewal  of the pa-
roxysms, dread of water, &c, because  fresh quantities of
poison are secreted and thrown upon the prima vise. These
paroxysms must  be  overpowered, and  the  poison removed
again and again by a repetition of the same course till all is
calm  again;  administering  during  the remissions quinine
and hydrocyanic acid largely, and repeatedly; and by thus
persevering for a  few days, we  shall have  the  pleasurable
satisfaction of witnessing a recovery from  a disease which
is emphatically the opprobrium of medical  science.
  Then would Prof. AVood (and other  learned  authorities)
be  no longer under  the humiliating necessity of declaring
the ignorance of  the profession to the world, in the follow-
ing language:—" The whole magazine of therapeutics has
been  exhausted in the treatment of hydrophobia."  "I do
not pretend," concludes he, " to recommend any course of
treatment, where I can adduce  no sound therapeutical prin-
ciple  in its support!"
   Farther remarks upon hydrophobia, its  nature, &c, and
bites  of venomous serpents, will be cited  hereafter, which
were  cured  by  the • rational principles herein described,
though by different medicinal agencies.
  Now it has been contradicted or  denied that the saliva
of a human being can impart  the  disease  to his fellow,—
yet the  experiment of Magendie and Brischat goes strongly
to prove  its  poisonous nature.   Two dogs were inoculated
with the saliva of a hydrophobic man.  One was seized with 
SURGERY.
735
hydrophobia, and bit other dogs, and the whole lot became
rabid.   Some maintain that this was a mere coincidence,—
but yet we have good reason—by analogy—to believe  that
the saliva of any animal may  impart this disease, for the
saliva is the poison, or a poisonous secretion mixed with it;
and it matters not which it is, as the  results are the same,
and the indication for a sound, rational, hopeful treatment,
is likewise  the same.
  Keeping in view, then", the fact that the virus, though
inserted beneath the cuticle, soon manifests  itself in the
mucus of the mouth, with disordered stomach, it is the duty
of the physician to free the patient from this poisonous agent
as quickly as possible, in the same manner as he would keep
the alimentary tract cleared in  any other  disorder,—and if
he does so, we maintain that the patient in  a vast majority of
cases will be saved.  And in attestation of this truth, I submit
the following cases,  which prove the truth of this assertion:
  Dr. Miller, of South Carolina, relates  the case of a man
bitten by a rattlesnake, and he found him swelled, face black,
tongue enlarged and  out of his mouth, eyes starting from
their  sockets, &c.   Two tablespoonfuls of olive oil were
forced  down him, which produced free emesis and catharsis
in thirty minutes, and the relief was instantaneous.   Now
if  the  "magazine of therapeutics"  advised by Professors
Wood and Gibson had been fired into this patient, he, with-
out doubt, would have been hurried off to the land of spirits.
  Mr. Ireland, surgeon, relates five cases, in all of which
there were violent symptoms present from the bites of very
poisonous serpents, for which he gave them Fowler's solution
in very large (two dram) doses.  In all  it produced severe
vomiting and purging, and cured them;   How?   Not by
fastening  down  upon  the patient the morbid or poisonous
secretions, but by throwing them out of the system.  Had
"opium, mercury,  cantharides, belladonna, arsenic,"  &c,
(which  Professor Gibson "considers  the most  powerful,") 
736
SURGERY.
been used, would they not all have died, or, correctly speak-
ing, been  killed by the doctor?   I leave the answer to any
man possessed of the sixth sense—common sense—to answer.
   Prof. Wood says:   "A poison seems to pervade the sys-
tem, which first damages, and  then annihilates nervous
power."
   Now the "New School" practitioner acts rationally upon
this well-known fact, and removes the poison before it over-
whelms the nervous system.
   I will cite a case, showing what we may expect from the
use of intermittents:
   Dr.  Adams, of Rochester, reports  the  following case:—
H. A., aet. sixteen years, had been bitten by a rattlesnake
ten years previously.  Ever afterwards, towards the  latter
end of each month, he had an  inflammatory attack in his
eyes, with diminished vision, and the  leg, that had been
bitten, would swell  enormously, so as to involve the whole
of the same side of the body.  A kind of mania would seize
him; and though at other times a most peaceable lad, when
under  the influence of the paroxysm he would attempt the
life of any one that offended him.  The  pain was very in-
tense.   He had tried both doctors  and quacks in  vain.
Dr. A. commenced treatment the 20th of the same month,
by  giving him powders of quinine and hydrocyanate of iron.
The next  month the paroxysms were later than usual, and
not half so violent.
  The 20th of the next month he resumed the  powders;
and instead of a paroxysm, he only passed a sleepless night.
The leg was rubbed with tincture belladonna.
  Again: Mr. R. came to me with a hand  much swollen,
attended  with  a burning, itching pain, chills  or rigours,
fever, &c.   This was  the  result of a scratch from a cat,
labouring  under symptoms of hydrophobia.  After  poul-
ticing a few days, the taking of some cooling purgative, diet-
ing, &c, it would subside.   He consulted me for permanent
relief.  Quinine being  then very high, and the  pay poor, I 
SURGERY.                  737
gave  Fowler's solution as  an antiperiodic  and alterative
after  the  inflammation was subdued  by the usual means.
  This was entirely successful, and he never had  a return
of the disease.
  I have  seen several cases of  hydrophobia reported, in
which the fact was mentioned that  there were great collec-
tions  of tough mucus in the throat, or fauces, and  often
ineffectual attempts to vomit.  In one case the patient is
reported as having vomited voluntarily, and relief was com-
plete  for  a time.   Here nature pointed out the treatment
to the attending physician, but the prompting was unheeded;
and as soon as fresh portions of the morbid virus were thrown
out, the brain felt its poisonous influence, and by the reflex
 action spasms again ensued.
   Lastly, I read of another case reported, in which the medi-
cal attendant seeing an effort  to vomit, administered some
tartar emetic, and  gave the  patient great  relief.   But he
adds:—" In a few hours the spasms returned, and the patient
 finally sank."  Of course; for nothing was done to sustain
 him with one hand, and the emetic was never repeated, to
remove the cause of the spasms.  Here we see,  however,
that even a deadly  sedative emetic was very beneficial for a
period; and had  even it been repeated again and again with
 tonics and stimulants ad  interim, the results might have
 been different.
          RETENTION  OF  URINE.
  Retention of Urine is a term that includes things as diffe-
rent from each other according to their cause and state, as
any diseases you can imagine.   It is said, there may be re-
tention of urine in the  pelvis of  the kidney, in the ureter,
in the bladder, and in the urethra.  In the  first two cases,
we, in the first place, are in want of symptoms to point out
their existence distinctly; and in the next place, if we knew 
738
SURGERY.
 perfectly well what was going forward, we could do nothing
 for the sufferer.   There are many causes for the retention
 of urine in the bladder, very different in their nature, and
 requiring very different treatment, when any can avail.  Re-
 tention of urine may exist in the kidneys  and ureter as a
 consequence of retention in  the bladder—an  unfortunate
 patient dying of cancer of the uterus, may have these addi-
 tions to her sufferings, from pressure on the bladder or on the
 ureters themselves.   x\n abscess in the perineum may press
 on  the neck of the bladder, and cause  retention  of  urine;
 the patient, in such a case, may not have  made water for
 two or three days, and yet the surgeon  not hear  any com-
 plaint of a want to make water, or any observation  at all
 upon  the subject, unless he happens to ask the question;
 but generally when you lay open the abscess, and evacuate
 the matter, which in some cases is in considerable  quantity,
 the  bladder  will  act of itself, and discharge its  contents,
 without leaving behind any tendency to  a return of the re-
 tention.   Such a case  will sometimes  give more trouble.
 In like manner tumours forming in the pelvis may  cause
 retention of urine from their pressure.
  Morbid growths in the cavity of the bladder itself,  or en-
 largements of natural structures, as the  uvula of  the blad-
 der, as also calculi and inflammation of the coats of the
 bladder, may be the cause of  the retention  of urine.   The
 bladder may be unable to expel its urine from some fault
 in the  organ itself.  Thus, suppose a man falls from a height,
 and receives a hurt in his spine, paralysis of his lower ex-
 tremities follows, and the bladder partakes  in the paralytic
 affection: here, if we lay our hand over  the  region of the
 bladder above the pubis, we feel the  tumour caused  by its
 distention, and all we have to  do is, to introduce a catheter,
 draw off the urine, and  repeat this every six or eight  hours
 to afford  temporary relief, and  reprieve the  patient  for  a
 short time; but such a  case will never recover—he will die
in from eight to ten weeks.   There is another cause  of re- 
SURGERY.
739
 tention of urine caused by the condition of the bladder it-
 self.   A man advanced in years, of studious and sedentary
 pursuits, and a full habit of body, comes  to you and tells
 you that he has to get up very often during  the night to
 make water,  that he passes  but little at  each time, and is
 obliged to make much effort to get away that little.   Such
 men will often  tell you, that after these  efforts, they had
 still the feel  as if they had not entirely emptied the blad-
 der; they had not the  comfort usual in evacuating a dis-
 tended bladder, and  that they experienced  some  pain  in
 their  straining to pass more;  by and by, this man finds  he
 cannot make any water at all.  Now, this is a case where
 the bladder  is in a less sensible state than natural;  there is
 no inflammation whatever in it.  The first time the patient
 finds he cannot pass his urine, is generally  after a  long
 sleep.   Sometimes  he will remain  five or six hours without
 being able to pass any, but will not send for a surgeon, and
 after this it will begin to come away; not, however, in a full
 stream, but dribbling, what is called stillicidium urinal; yet,
 as in this way, he makes quite as much urine in the twenty-
 four hours, as if it came naturally, neither he nor his friends
 imagine there is such a thing as retention in the case.  Sup-
 pose the man, say  seventy  years  of age—he has  suffered
 very little pain or trouble from the distention of the blad-
 der—he sends for you, and  when  you arrive, he tells you
 he has got an unpleasant complaint, that he can't keep  his
 water, and  just requests you to stop this constant  passing
 of it, and that then he will be quite well;  yet this  patient,
 if not relieved of the retention, will have his  constitution
 become affected with urinary fever; he gets a somewhat se-
 vere rigour;  he then gets into the  hot fit, which lasts about
 half an hour; this is  followed by the sweating stage, which
is extremely  profuse,  and may last for  hours.   It is not a
 partial  sweat, but general over the whole body, and although
he throws off the bed-clothes, he will be obliged  to change
his shirt several times in the night—in fact he lies in a kind 
740
SURGERY.
of warm bath all night, and sheets, bed, and all are drenched.
If a second attack of this fever comes on, there will be some
difference discernible in it from what you observed at first.
In the previous attack the skin of the patient felt cold to
the hand of an examiner, while  the patient was shivering,
but the second time, while the patient himself feels  exces-
sively cold, the skin feels hot to the hand of another person;
it goes on, his head becomes affected, and off he goes.   This
urinary fever is a true intermittent, and'so strongly does it
resemble common ague,  that if you were to come in during
a paroxysm, you might  readily mistake one for  the  other;
but the paroxysms of the urinary fever are very irregular
in their periods of return; in this it essentially differs from
ague, and by it could always be distinguished readily.  Now,
you read that a patient labouring under this fever has a uri-
nous smell from the skin, or even his breath, but there is
no truth whatever in  this; the constant dribbling of urine
wets everything about  him, and diffuses  the urinous odor,
throughout the whole house perhaps, but I never observed a
urinous smell, except where urine was coming away in this
manner.   Some lighter shades  of this  fever will attend
lighter degrees of urinary disease, or they might be con-
sidered as premonitory symptoms that  may or may not
eventually end in the severer form, but, at all events, will
show a disposition in the  patient to become  affected.  He
will  be chilly without  any  very apparent  cause;  his skin
will feel constricted and rough; he will dread any exposure
to a north-east wind, or  even to get between the cold  sheets
at night; and  will have his bed warmed, yet he  may not
have anything like a regular rigour.
   Treatment.—The patient should have a warm bath and
a small dose of aconite, say one or two drops in a little warm
water every half hour.   After the warm  bath hot  packs
should be applied on  the  lower  abdomen, and changed as
often  as  every half hour.   Also  give the following com-
pound. 
SURGERY.
741
      R.—Barosmin,..........................................gr. x.
          Quinine............................................gr. vj.
          Eupatorin Purpurin,...........................gr. x.
          Sacch. Alba.......................................3J-
         tijj. ft. pul. No. xij.  Sig. one every two hours.
  The bladder should also  be evacuated with  the catheter
as often as once in ten or twelve hours.
  There is a cause of retention which you  must carefully
distinguish from the last, in which all you had to do was to
draw off the urine, and administer  a mild treatment.  In
this case a single introduction of the instrument  does irre-
parable and permanent injury.  It is this; an old  man finds
he has repeated calls to make water; at each time he goes
to the utensil, he has to force himself,  and in  the exertion,
experiences some pain; he passes only a spoonful or two at
each offer, and feels satisfied.  You lay your hand over  the
pubis, but there is no tumour there, perhaps, although you
may think you can perceive it, for  there  may be retention
of urine, and yet the bladder be so contracted that it cannot
be felt externally.   Here, if you once introduce a catheter,
that man never makes water again without the aid of one;
he must, as long as he  lives, use a  catheter to empty  his
bladder.
  The treatment for such a case consists in  rest, and a free
use of queen of the  meadow in infusion.  If  that does not
remove the difficulty, apply hot packs over the abdomen, and
give freely of  barosmin, say one or two grains every two or
three  hours.
  There is another kind of retention of urine.  A man for
two or three years, perhaps, perceives that he makes water
more  frequently than his neighbours.  He has been in  the
habit  of indulging in wine or punch, or something of that
kind,—now, if on some occasion, when he wants to make
water, he neglects the call of nature, being, perhaps, loath
to leave his liquor or his company, he  will get retention of
urine.  He goes home, suppose, after drinking a  good deal,
       63 
742
SURGERY.
and after, as I said, neglecting  the  call of nature before,
during the evening, he now tries  to pass water before he goes
to bed, but  cannot pass  a drop.   He does  not  mind this,
however, but goes to bed, and awakes with great pain in the
region of the bladder.   An irritable bladder will get reten-
tion  in  the  same way;  the man is, perhaps, in a court of
justice, and  cannot get out when he wants to  make water.
In these cases you must use the  catheter without any delay
—you have nothing else for it.
  What position is the best to  put  your patient in for the
introduction of the catheter?   Wherever  you  can, make
him  lie  on his back, for as many patients faint as the  water
is coming away, he may fall over you if you put him in an
erect position; and besides this, you have  him favourably
situated to  introduce your  finger  into  the rectum, if it
should be required, which is often  the case.  You should
seize every opportunity that comes across you to practise the
introduction of the catheter into the bladder; there will be
nothing in your future practice  more likely to turn out of
greater importance to yourself and others than dexterity in
this  operation, and this is not to be obtained without that
practical education of your hand which  your opportunities
may daily furnish you the means of accomplishing, if you
sufficiently appreciate the necessity.  Your anatomical know-
ledge of  the urethra will  do something;  your passing a
sound or  bougie in the dead body will add something; but
nothing will make you  feel steady  and dexterous but  the
frequent practice on the urethra of the living man.  When
you  are introducing an inflexible instrument, then  carefully
keep the  open end in the middle line, and close to the belly,
and  draw the penis upon the instrument.  I may just men-
tion  that the secret of  introducing the long instrument,
called Home's catheter, is, to introduce it far before you be-
gin to turn  it.  Should the point of the instrument meet
an obstruction, it may only have hitched  against the trian-
gular ligament of the urethra alone, and  this circumstance 
SURGERY.
743
you  can  know by the simple contrivance of letting your
fingers relax on the instrument, and it will make a half turn
or circle  of itself, if it is impeded by the ligament.
   The catheter is often  stopped  at  the commencement of
the membranous part, and may be thrust through the bulb.
There is  nothing in all surgery so material as being able to
introduce the catheter well.   As to using force, you will not
have to use force in one case out of fifty in the introduction
of a catheter.  Force should never be used when the ure-
thra is sound.  Spasm is mentioned as one of the causes of
resistance to the introduction of the catheter, and it is use-
ful to keep up that notion, as we  cannot sometimes succeed
in passing the instrument when we most wish to do so, and
this without our well knowing why.  In such a case we may
lay the blame on spasm; but for my own part, I have always
felt more resistance from spasm in withdrawing than in in-
troducing an instrument into the bladder.   I have sometimes
certainly felt considerable difficulty in introducing a bougie
or catheter, and by using gentle  friction on the perineum,
and waiting a little, the instrument has glided in easily, and
this in a large urethra, but such a case as this I do not meet
once in a year.   After the introduction of the catheter, it
will often happen that a rigour comes on, but it must not be
imagined that it is always an immediate, or even  a very
quickly succeeding result.   No:  the rigour may come on in
half an hour, or in twelve hours, or even not for forty-eight
after the introduction; and from the length of time which
has elapsed, the  catheter is  often not supposed  to be  the
cause, but it  is notwithstanding.  This occurrence happens
in patients with an irritable bladder, or who have been pre-
viously the  subject of some  disease of the urinary organs.
To prevent the recurrence of this rigour, keep your patient
quiet, and give him a full anodyne draught.  Urinary fever
is one of the dangerous effects that may arise from the intro-
duction  of a catheter; we shall, however, defer saying more
of urinary fever at present. 
744                  SURGERY.
   Bleeding from the urethra is sometimes a consequence
of the introduction of a catheter, even when it is done in
the best manner  and without violence.   When you first
withdraw the  instrument from a canal  disposed to bleed
in this manner, there comes a little blood, which ceases by
degrees, and a coagulum forms  in the  urethra; the next
time the  patient goes to make water, he  finds  great diffi-
culty in passing any, but after straining some time, he ex-
pels the coagulum, and  then comes on the bleeding again.
Sir E. Home  tells us not to make  compression  on  the
urethra to stop this bleeding, because if you prevent the
blood coming out, it will flow into the bladder.  Now, you
are to pay no  attention to  this doctrine, but do the  very
reverse of what it would inculcate.  The  blood has never
been known to go  backwards into  the bladder  under the
circumstances we are considering.   There is no use what-
ever in giving such a patient large quantities of spirits of
turpentine, acids, and other things supposed to have the
property of stopping hemorrhage,  but which often injure
the stomach of those made to swallow them.   You must
compress  the urethra in this way:  get a napkin and roll it
up hard, put it between the patient's  thighs, and press it
up against the perineum for ten minutes, and the bleeding
stops;  but this, however, is not without its inconvenience,
for the next time the patient goes to make water, he can't
pass a drop at all.   This arises from a coagulum which has
formed in the  urethra,  and the patient with some straining
at length expels it, and the inconvenience is removed.  If,
after compressing the urethra and stopping the hemorrhage,
it should return, when the coagulum is removed, from five
to ten drops of the oil of erigeron  should be given every
half hour.  Or the bladder may be injected with  a  mild
decoction of matico or geranin.

                 MAMMARY ABSCESS.
  The various changes that occur naturally in the condi-
tion  of the uterus  are  not  unfrequently accompanied by 
SURGERY.
745
sympathetic affections of the female breast, either natural
or morbid.  Some of the latter may be considered at pre-
sent,  others when we shall  have to speak  of particular
diseases that the breast is liable to in common with  other
parts.
   There is  one affection of the  breasts of women which
mostly occurs after  parturition, but sometimes  before  it,
called mammary or milk abscess;  it generally occurs within
a month after parturition, but you will  sometimes meet it
coming on three months after.   It is  ushered  in with a
rigour, which is  succeeded by heat, sweating, thirst, and
other febrile  symptoms.  There are many circumstances
which may induce a rigour  in a female  at this period, but
if it  is to end in mammary abscess, you will find, on ex-
amining the breast,  that the patient is  able to  point  out
one particular spot which is very painful,  though nothing
at the time  may appear to show what is to follow.  If the
disease be left to itself, it is very slow in its progress—it
will take perhaps a fortnight or three weeks to  come for-
ward.  Even when it bursts the patient says she is better,
and really seems to be doing very well, the painful disten-
tion  relieved,  and the fever generally subsided, you will
have to suffer  the disappointment of finding another ab-
scess forming in some other part of the gland, or even in
the other breast.
   While this suppurative process is going  on,  the  secre-
tion of milk is diminished, the infant's endeavors to obtain
 nourishment give considerable pain, not only in the affected
breast, but even drawing the sound breast is productive of
 much uneasiness, and the consequence is a greater accumu-
 lation of milk, which adds to the distress.
   The contents of these abscesses are  pus, and  often milk
 mixed with pus.  Sometimes the entire of the breast seems
 to be inflamed,  and gets considerably larger and harder
 than that of the opposite  side, and is  accompanied with
                            63* 
746
SURGERY.
high inflammatory fever; the patient suffers much more
than in the preceding case, and its course is generally more
rapid.  .Now, here it is not the substance of  the  gland it-
self that is affected, but the cellular substance between it
and the pectoral muscle, and this form is called an encyst-
ed mammary  abscess.   Occasionally there will be a case
of this kind which will have given  little local or constitu-
tional uneasiness until the matter has come  nearly to the
integuments, and this it  does  by making its way through
the substance  of the gland.  There  are various causes as-
signed for the production  of mammary  abscess.  If the
woman is obliged from her station in life  to use her arm
too much while the breast is distended with milk—if there
be any cause to render her distressed in mind—if she suf-
fers great depression or excitement—if she gets a cold that
produces  a  feverish  condition  of  the system—-if strong
measures be employed to put back  the  milk, particularly
local ones, without proper attention to other treatment, she
will be very likely to get this disease."
   Treatment.—The treatment for mammary abscess in the
early stage consists in keeping the breast  thoroughly wet
with  equal  parts of the  tincture  of arnica and  lobelia.
This can be done by wetting pads of cotton in this mixture
and reapplying them as fast as they get  dry.   The bowels
should be opened by means of small doses of neutralizing
mixture and anti-bilious physic,  and the fever controlled
with aconite.  If the breast should  be very painful, tinc-
ture of aconite or opium may be added to the  mixture for
local application.  If, after the application has been made
for twenty-four hours, there should  still be symptoms of
suppuration, a poultice composed of equal parts of pulver-
ized slippery elm, flax seed, and bayberry, moistened with
warm water to the consistence of a paste,  should be applied,
and kept constantly wet with equal parts of the tincture of
arnica and opium.   As soon as pointing occurs, or an ac- 
SURGERY.
747
cumulation of matter exists in sufficient quantity to warrant
the operation, the abscess should be opened, and contents
discharged;  after which the breast should be injected with
a small  abscess syringe three or four times a day.  The
best preparation for this process is a warm decoction of
hydrastis Canadensis.  The poultice may be continued, and
the breast thus treated until the cure is effected.   Or, if
the abscess should assume a chronic character, it should be
injected once or twice a day with  a mild solution  of sul-
phate of zinc.  The internal treatment should consist of
vegetable tonics, iron, and nutritious diet.

                   PARONYCHIA.
   There is an abscess which is usually found at the ends
of the fingers called paronychia or whitlow, of which there
are some varieties, chiefly owing to their seat.  One de-
scription of whitlow is a mild and  trifling complaint; it is
where a little collection like a spot of milk appears just
under the cuticle.   All that is necessary is to cut the cuti-
cle from about this, or puncture it, and it gets well of its
own accord.   The second variety is where the matter forms
under the whole thickness of the skin.   If it forms under
the nail, the nail will inevitably fall off;  but, after all, this
is the worst that can happen here.  The third kind, com-
monly called the malignant, is a much more serious disease.
A man  will  go to bed quite well, but soon after he feels a
dreadful pain in the top of one of the  fingers, which keeps
him in  torture the whole night.  In the morning, when he
looks at his finger, there is nothing to be seen;  very  quickly
he is seized  with the inflammatory fever, as it is technically
called—that is, where the pulse becomes  much quicker,
but with less strength.  Sometimes the  pain is so  intense
as to cause  delirium, and yet after all nothing is  seen in
the finger itself that could  account for  this disturbance.
So high does the fever go on some occasions, that patients
have died of it and the pain and irritation caused by this 
748
SURGERY,
form of the complaint, and some have been  only saved by
amputation.   Often, if left to  himself, the  patient has a
feel as if the pain and tension were creeping up the arm;
it shifts first to the middle joint of the finger perhaps;
some time afterward he will tell you the pain is alPin the
palm of the hand ; it next passes the annular ligament of
the wrist, and I have sometimes  opened abscesses  in the
middle  of the forearm which began in this way.   When
the pain is in the palm of the hand, an opening made into
that region will give exit to very little matter, and the
relief is but  temporary.    This form of paronychia is  in
the sheath of the  tendons; between  this  strong fibrous
membrane  and  the  periosteum, and it always makes its
way where these sheaths are weakest, as in the cleft be-
tween the fingers.   When whitlow breaks, it heals rapidly,
but with perhaps  the loss of a finger; or the joints may
become anchylosed; or  the hand  itself may become  stiff
and useless; sometimes where the joints of the finger do
not become anchylosed, you can feel the ends of the pha-
langes, grating on each other, being deprived of their carti-
lages, and the bone itself, after a time, appears  to  be  ab-
sorbed ; something extraordinary certainly does take place,
for  you feel  the top of the finger perfectly soft, with no-
thing hard about it,  but  perhaps a  bent, ill-formed nail;
sometimes it will be the  middle  phalanx that will disap-
pear, leaving the extreme one, and quite  movable, as if
only hanging by the integuments.  The first and  second
kinds of whitlow are found generally in those who work
much at their needle; the third variety is  often observed
in sailors and others who are much employed in  pulling
ropes."
  Treatment.—The treatment for the milder form of pa-
ronychia consists in applying a  solution of nitrate of silver
to the part, of the strength of fifteen grains  to an ounce of
water.   The best  method of applying it is, to wrap the
finger in soft lint, and keep it constantly wet in this solu- 
SURGERY.
749
tion.  This application will usually cure the mild form  of
paronychia in  from twelve  to  twenty-four hours.  In the
more  severe form,  where the disease  commences on the
bone or  the periosteum, the finger  or hand should be laid
open by making a long and deep incision to the bone.  As
soon as the bleeding is over, the wound should be injected
with a strong solution of sulphate  of zinc, and kept satu-
rated with equ^l parts of tincture of lobelia and opium.   If
there is much  inflammation, a slippery elm poultice may be
applied, and kept moistened with the above wash.  If there
are constitutional  symptoms,  they should be treated  ac-
cording to their nature and severity.   The practice of ap-
plying rotting poultices to this affection is very objectiona-
ble, as it not only jeopardizes the use of the hand, but, in
some cases, the life of the patient.
       GANGRENE AND  MORTIFICATION.
  Gangrene and mortification may arise from  a variety of
causes, such as intense inflammation, arrest of circulation,
severe contusions, compressions, certain specific poisons, etc.
Gangrene may also occur spontaneously in old people, when
it is called senile, and is usually owing to a disease  of the
coats of the arteries.   Fig. 73, represents this kind of gan-
grene.   See Inflammation and Gangrene in another part of
the work.
                      SYMPTOMS.
  The  symptoms of gangrene and  mortification are both
local and constitutional.   The local symptoms are death of
the part, followed by sloughing and  deep ulceration, unless
it be dry gangrene, represented in the Figure,  which dries
and becomes very hard.   The constitutional symptoms de-
pend much upon the extent and nature of the gangrene.
If it be dependent upon active inflammation, and great de-
bility of the parts,  there will be feeble vitality, loss of appe- 
750
SURGERY.
tite, great prostration, and if the gangrene be internal, there
will be hiccup, vomiting cold sweat, and death.  But where
                         Fig. 73.
the disease is confined to the portions of the body, they cor-
respond with the extent of the injury.

                    TREATMENT.
  Where there is a tendency  to gangrene in any of the in-
ternal organs, quinine, capsicum, baptisin, yeast  and other
stimulants and antiseptics, should be given in such quanti-
ties as  are necessary to  maintain  the vitality of the parts.
In external gangrene, poultices, made of pulverized indigo
weed, sweet  fern, Peruvian bark,  slippery elm and yeast,
should be applied, and changed every hour or two.  If this
does not arrest the gangrene,  wet the poultice with the fol-
lowing lotion:
      R.—Best French brandy,........................Oj.
          Sulphate of zinc,..............................3j.
  Dissolve the zinc in two ounces of water, and add to the
brandy, also, add two ounces of pyroligneous acid, and keep
the poultice wet. 
SURGERY.
751
  Tonics and anodynes should be administered internally.
The following pill I have used to good advantage,
      R.—Pulv. myrrh and capsicum, ...........aa.gr. xxx.
          Prunin and baptisin,......................aa gr. xx.
          Ex. garden lettuce,........................3J.
   Mix, and form fifteen pills; give from three to five per
day.  Give the tonic  wine  bitters, one half wine  glass full,
three  times a day, and if the arteries be affected as in senile
gangrene, small doses of iodide of potassium, in connexion
with  Beach's alterative syrup, will be found  beneficial.
The diet should be  as nutritious as  the patient  can bear,
and the bowels should be  kept regular by means  of mild
laxatives.
               BURNS AND  SCALDS.
  The treatment  of different cases must be varied.  For a
simple superficial burn, involving the cuticle alone, almost
any remedy will be attended with a successful result, so that
one will have a high opinion of cold water, another of warm,
another of turpentine, another of compound  tincture  of
myrrh and capsicum, according as each has applied this  or
that remedy.   In the vesicating burns, the roughened cuti-
cle should be carefully handled, and applications should be
more cautiously applied and removed, lest the cuticle be de-
tached, and the surface beneath be exposed to the air.   In
case there are little blebs, these should be punctured with a
needle or lancet, great care being observed to prevent the in-
gress of air to the surface of the burn beneath the cuticle.
Any application that excludes the air, and is emollient and
tends  to maintain a comfortable and equal temperature, will
fulfil the indications of treatment.   For this  purpose, the
flour of slippery elm dusted over the surface, or warm linen
cloths, wet in warm mucilage of elm, or a thin layer of soft
carded cotton, moistened with diluted whisky, and held by 
752
SURGERY.
a few turns  of the roller, will be useful.   The warm packs
of mucilage  of elm are beneficial, but that application which
excludes the air the most completely and with the least irri-
tation to the part is best.  If the burn  slough, a poultice
of slippery elm  should  be applied until  the slough is re-
moved; if there be fungous flesh, this may be  removed by
the use of pulverized sanguinaria, phytolaccin, or caustic
potassa.  Dr.  W. Beach recommends a poultice of slippery
elm and milk, spread on linen or muslin covered with sweet
oil.  When used, this should be covered with oiled  silk to
prevent evaporation.  After this the black salve.
   A salve which I have found efficacious, is made of the fol-
lowing articles:—R.  Brown diachylon, lb. ss.,  rosin, 5iv.,
beeswax, 5iv., Venice turpentine, 5j.  Melt well together,
and spread on linen  cloth, and  apply.
   Several other  topical applications have been recommend-
ed.  Starch either wet  or dry is  often used.  Acetate of
lead is recommended by some, but  it has no advantages over
the extract  of quercus  alba, the  geranium maculatum, or
the statice limonium.  A solution of borax  is mentioned.
For a simulating application, Dr. B. F. Hill  recommends:
—R.  Spirits of  camphor and tincture  of opium,  aa 5ss.,
spirits of turpentine and tincture of capsicum,  aa  zj, olive
oil, 5iij.  This preparation is most useful  after the inflam-
matory stage has passed away.   It should  be applied once
or twice  a day, and may be  covered with a poultice of slip-
pery elm.
   Rum and molasses is another remedy recommended by
the people of the south.   These substances should be inti-
mately mixed  and applied on  linen,  or  by saturating raw
cotton, or it may be  applied to  the surface by means of a
brush, over  which is placed oiled silk or a  poultice.  Prof.
Gross recommends a mixture of linseed oil and carbonate of
lead, to be applied with a swab.  These various remedies
are referred to in order to show the various opinions  of me-
dical men.   Nothing can better fulfil  the indications than 
SURGERY.
753
the flour of slippery elm made into a paste  with milk or
cream, wet in warm, tepid  or  cold water according to the
indications  of  the  case.   The constitutional  treatment
should be such  in the stage of prostration as will favour re-
action.  Carb.  ammonia, capsicum, wine  whey,—and in
cases where deglutition is lost, injections of the compound
tincture of lobelia  and capsicum, with brandy, should be
administered.   A  small quantity of the same medicine in
the mouth will  tend, by its stimulating effect, to excite deg-
lutition.   If the respiration be deficient, a  sudden shock
to the system by water  sprinkled on  the  bare  breast will
assist much in  the restoration of consciousness.  Galvanism
would likewise tend to  accomplish the same object.  As
soon as the deglutition  and respiration are  established, if
the  patient still remain  weak, the brandy and egg mixture
should be  given.   Thomson's  composition tea,  prepared
by boiling one teaspoonful of the  powder in one pint of
water, a gill of milk, and tablespoonful of white sugar, drunk
freely, will tend to establish re-action and nourish the sys-
tem.  If re-action  is great, and the symptomatic fever ex-
cessive, it should be controlled by aconite.   The  warm, wet
sheet  may be beneficially applied when cutaneous heat is
excessive.  In these cases care  should be taken to properly
nourish the system, for when a large part of the cutaneous
surface of the body has been destroyed, the excretions are
not  removed from the blood so readily, and there is  at the
same time a great demand for fibrin, with which to  repair
the  injured tissues.  The result of this is often the produc-
tion of  typhoid symptoms, delirium  with subsultus.  At
this time the surgeon might be  unable to decide  whether to
 permit the patient to take the egg  and brandy mixture, or
beef-steak, with a view to supply material,  out of which the
system can manufacture fibrin, or to administer aconite and
 other antiphlogisti.es to reduce the fever.
   Prof.  Calvin Newton  in his lectures used  to relate a case
 of this kind.   A young man  had been severely burned, de-
       64 
754
SURGERY.
 stroying nearly half of the skin of the body.  By proper sti-
 mulation, re-action  was restored, and the healing process
 went rapidly on for several days.  At length typhoid symp-
 toms suddenly appeared, and counsel was called.  The ques-
 tion was, whether the typhoid state arose from deficient nu-
 trition with which to supply healing material, or from some
 other cause.   Dr. Newton thought it best to give beef-steak,
 rather than medicine.  This was supplied, and the next day
 the typhoid symptoms all disappeared, and the healing pro-
 cess again commenced.   In common allopathic practice, the
 course pursued is such as  to destroy too much of the nutri-
 tion  of the blood,—there is so much fear of fever and in-
 flammation, that the system does not receive a proper supply
 of matefial for repairing the lesions, and the consequence is,
 that  the patient sinks with adynamic fever.   When much
 tissue is destroyed, the remaining healthy skin has an in-
 creased labour to perform in depurating the blood,—conse-
 quently diaphoresis should be favoured, and likewise diure-
 sis, stimulated so as to prevent the accumulation in the blood
 of disintegrated  tissue.  To accomplish these indications,
 laxatives, leptandrin and euonymin will be necessary to open
 the bowels, cleavers, eupurpurin and marsh mallow to excite
 the kidneys, and asclepin, capsicum, or  the warm bath, to
 promote diaphoresis.   When there are cerebral symptoms,
 these should be met with the appropriate remedies.
   Scalds of the mouth, pharynx and glottis, then occasion-
 ally occur from the drinking of hot water, or the inhalation
 of vapour or flame.  The scald produces inflammation of the
 mouth and fauces, which may produce, by extending to the
 glottis, suffocation and death.   The inside of the mouth ap-
 pears white and scalded, the patient complains of great pain,
 and difficulty of breathing follows, which, if not relieved,
 may terminate in death.
   The treatment should be both local  and constitutional.
 Cool gargles of mucilage of gum acacia, or slippery elm, or
flax-seed  tea should be used, and a warm and relaxing poul- 
SURGERY.
755
tice  should be applied to  the neck, and a  wet compress
covered with oiled silk, to  prevent evaporation.  If fever
arises, aconite should be given in mucilage once in two or
three hours;  the bowels should be opened by means of in-
jections, and if the inflammation is very severe, enemas con-
taining a teaspoonful of tincture of lobelia, to produce  dia-
phoresis, should be given.   When it is  necessary to open
the bowels j jalapin and cream of tartar in mucilage will form
a useful compound,  the quantity being adapted to the age
of the patient.  The operation of laryngotomy or tracheo-
tomy may be necessary in  case  of  oedema of the glottis
arising from inflammation.   But if the treatment above re-
commended is perseveringly applied, and the constitutional
symptoms subdued at the onset, the operation  will seldom
be needed, and even when  resorted to,  its success is  ex-
ceedingly unfavourable, and its performance often difficult
on account of the  shortness of the neck and the small  size
of the trachea.
                     ULCERS.
   An ulcer is defined by Liston to be a solution of conti-
nuity, accompanied by the secretion of pus, or other fluid.
He makes six varieties, viz.:
   1. The simple, healthy, or healing ulcer.          ^
   2. The weak or sluggish ulcer.
   3. The indolent.
   4. The irritable.
   5. The specific.
   6. The varicose.
   These varieties are not  dependent merely  upon  local
causes, but are much modified by the condition of the con-
stitution.  The character of an ulcer is an indication of the
state of the general system.   The characteristics of simple
or healthy ulcer are, a  circular or oval surface, slightly de- 
756
SURGERY.
pressed, studded with granulations, secreting pus, and pre-
senting a  tendency to heal.  The prognosis in this variety
is favourable, and the treatment is simple, consisting of wa-
ter-dressings, and slight pressure with  adhesive strips, or
a bandage.  The indications are to maintain the strength
of the system, and to  remove all local causes of irritation,
such as the contact of air,  or the friction of clothing.   The
black salve of Dr. Beach  forms a good application.   The
ulcer should be cleansed with warm Castile soap-suds, and
cold applications rarely applied.  In the application of ad-
hesive strips, or a bandage, care should  be taken to give a
place of exit for accumulating pus.
   The weak or sluggish ulcer  occasionally occurs, and is
frequently caused  by the continued  application  of  emol-
lient  poultices.  The granulations are  semi-transparent,
high  and flabby, rising in  large,  exuberant,  gelatinous,
reddish-looking masses, above the  surface  of the ulcer.
The granulations readily  slough, having but a feeble vi-
tality.
  The treatment of this variety should consist of consti-
tutional means to invigorate  the system, tonics, stimulants
and nourishing diet, and of the local application of astrin-
gent and  stimulating  compounds, such  as the  tincture of
myrrh,  capsicum and geranin.    An occasional  ablution of
the part in a solution  of sesqui-carbonate of potassa, or ex-
tract of white oak bark, will be found beneficial, or sprin-
kling it with finely pulverized sanguinaria or alum, will be
of service.  Doctor Erichsen highly recommends  the  fol-
lowing  formula:—Sul. zinc, grs. xvi.;  comp. tinct. of la-
vender, and spirits of rosemary, aa. %'u.   Water, 5viii., as
an astringent application.  The limb or  part should be ele-
vated, and gentle pressure should be  made by means of a
roller or adhesive strips.   These should be placed  so as to
leave a space between  them for the escape of pus, and over
them, lint, covered with cerate, and retained by a bandage.
The water-dressing is sometimes used, consisting in the ap- 
SURGERY.
757
•
   plication of a piece of patent lint, of the size of the ulcer,
   dipped in tepid or cool water, to the part, and covering this
   with a piece of oiled silk, somewhat larger, and bound down
   by a roller.
     The indolent ulcer is deep  and excavated, covered with
   irregular and imperfectly formed granulations, which exude
   a sanious pus.  The edges are  hard, irregular and rugged.
   The tissues  adjacent are congested, and firmly adherent to
   the subjacent fascia.  The sensibility of the part is  dimi-
   nished, and pain is seldom troublesome.  This variety is
   caused by feeble capillary circulation, which may arise from
   a local or a  constitutional cause.  It  most frequently  oc-
   curs in men about the middle period of life,  and is usually
   located in the lower extremities  in  the lower third of  the
   leg, just above the ankle.
     The treatment should be such as will tend  to depress  the
   edge, and elevate the base of the  sore.  The means of ef-
   fecting this are stimulation and pressure.  For a stimulant
   a poultice of slippery elm sprinkled with pulverized myrrh
   and capsicum will be  useful.   In many cases, however, this
   will not be sufficient,  and  it will be necessary to destroy the
   diseased edges at once, by nitric acid, or potassa fusa, or
   sulphate of  zinc, and  afterward cover the part with a poul-
   tice of slippery elm, keeping the limb elevated, and sustain-
   ing the strength of  the  patient.   Prof. R.  S. Newton, of
   Cincinnati,  uses the following  formula:—R-. Pul.  sulphate
   zinc, Jij.; pulv. hydrastis, zj.; pulv. podophyllum peltatum,
   3ss.  Mix.   Fill the cavity of the ulcer with this, and let
   it remain  as long as can be well borne, or until it has  de-
*  stroyed the  dead tissue, then apply slippery elm, wash in
   cold water  until the part sloughs.   Then apply  the lead
   plaster, or Beach's black salve, or the emplastrum saponis.
   This treatment, conjoined with proper constitutional reme-
   dies, general tonics, and stimulants and rest, will usually
   effect a cure.  The application  of pressure,  however, will
   often be necessary in cases that cannot be well subjected to
                            64* 
•
758
SURGERY.
the treatment described.  Before this is applied, the limb
adjacent to the ulcer should  be stimulated with the appli-
cation of the comp. tinct. of myrrh and capsicum, and ele-
vated, and steamed over medicated vapour;  then the ulcer
should be filled with the sesqui-carbonate of potassa, letting
it remain for some hours; then wash the ulcer with a weak
solution of tincture of capsicum, say 3J- to  ^j. rain-water.
Then the emplastrum saponis  should be spread on calico,
which should be cut  into strips sixteen to eighteen inches
in length, and an inch and a  half in  width.   The centre of
the strip should be smoothly laid on the side of the  limb
opposite to the sore, and its ends are to be  brought round
the limb and  crossed obliquely over the ulcer. A sufficient
number should be applied to cover  the sore and the  limb
for two  inches  above and below the ulcer.  Each  strip
should overlap about one-third  of the adjacent one,  and all
should be evenly and equally adjusted, so as  to make equal
pressure upon all parts of the diseased limb.  A roller
should then  be  applied  to the limb, from the toes  to the
knee.  The lead plaster may be used as a substitute, or the
adhesive, or emplastrum resinae, although this is thought
by most surgeons to be more  irritating to the ulcer.  The
application of these strips should be renewed every forty-
eight hours,  and, if the discharge  be considerable, holes
should be made in the strips  for the escape of pus.
   The inspissated juice, evaporated to a salve of the  Phy-
tolacca decandra leaves, forms a valuable remedy for pro-
ducing a slough.   Likewise that of the rumex crispus and
of the sanguinaria Canadensis.  These should be applied
on linen cloths, until there  is a line of demarkation be-  *
tween  the diseased and healthy tissue.  The ulcer  may
afterwards be  healed by means  of the black salve.   Pres-
sure may be made upon these ulcers by means of collodion.
It should  be  applied  so as to form a thick  impervious co-
vering; its contraction by means of the evaporation of the
ether produces a degree  of pressure that  is many times
highly beneficial. 
SURGERY.
759
  The irritable ulcer is most often found in females of a
nervous and bilious temperament, about the middle period
of life.  It is usually situated about the ankle or shin, and
is small in size.   Its  edges are not elevated, but are irre-
gular, the surface is grayish, covered with a thin layer, and
discharging a thin sanious  secretion.   It is quite painful,
preventing sleep,  and thus injuring the  general health.
The treatment should first be constitutional.  The alcoholic
vapour bath should be used twice a week, and if the sto-
mach be inactive and digestion impaired, an  emetic of lo-
belia will prove highly beneficial.  This should be followed
by the administration of tonics and  stimulants, the hydras-
tin, and xanthoxylin, and euonymin, are valuable remedies
for this purpose.  If there be evident anaemia, iron should
be  administered.   If the  ulcer appear during  lactation,
especial care will be required in order to sustain the system
by  nutritious diet, tonics, and porter or ale.   The com-
pound syrup of stillingia, or Beach's anti-mercurial syrup,
with the muriatic tincture of iron, will be highly servicea-
ble.  Especial attention should be given to restoring the
secretions of the skin and kidneys, by  baths and  mild diu-
retics.  It is impossible to  cure these  cases unless the ex-
cretions are properly  restored, and the organs of circulation
properly stimulated.   Pure air, good food, and cleanliness
are very important means of cure.  Rest at night should
be  procured by hyoscyamin,  scutellarin, and cypripedin,
cither separately or alone.   These are preferable to opiates,
inasmuch as they do  not arrest the secretions.
   To allay pain and  irritability, a poultice made of equal
parts of  pulverized  lobelia herb  and  slippery elm, with
laudanum, will be useful, or the application of a  thin plas-
ter made  by spreading the inspissated extract of conium on
soft linen, and applied, will relieve the symptoms.   Some-
times dry applications will be better than moist.   These
should  consist  of flour, or finely pulverized  chalk, or the
powder of the lycoperdon  bovista.   But when the ulcer re- 
760
SURGERY.
sists all these means it should be washed in a strong solu-
tion of nitrate  of  silver, followed by  some sedative and
emollient application.  It may be necessary, in some cases,
to entirely destroy,  by means of the chloride or sulphate of
zinc, the ulcerating surface, and then  to apply a poultice
of ulmus and pulverized myrrh to  favour the healing pro-
cess, followed by the use of the black salve of the Eclectic
Dispensatory.   When the granulations are spongy, and dis-
charging watery fluid, it may be necessary  to apply an as-
tringent compound, for which purpose the extract of quer-
cus is  admirably adapted.   Dusting the surface with very
finely pulverized nut-galls will likewise be beneficial.
   The inflamed  ulcer is  sometimes spoken  of  by authors,
though not mentioned in Liston's classification.   It is cha-
racterized by symptoms of inflammation, redness, swelling,
pain and heat.   The discharge is often  thick, and offensive
and bloody.  The treatment should consist of cold applica-
tions, the elevated position of the part, and the use of poul-
tices of ulmus, wet with cold water,  and  frequently changed
so as to keep down  the heat.  At  the  same time, the pa-
tient, if there are symptoms of constitutional excitement,
should  take aconite and veratrin internally, an occasional
warm bath, a cathartic of the fluid extract of senna and
jalap, or of some other effectual purgative.  After the lo-
cal symptoms are reduced, the constitutional and local treat-
ment that is recommended for other varieties of ulcers will
be appropriate.
   The sloughing ulcer is  another  variety not included in
Liston's classification.   It is described as having a great
tendency to spread, a  dusky red blush forms  around the
sore, the edges are sharp cut, the surface is grayish, and is
attended with irritative  fever.  This  is usually found in
persons of a cachectic constitution, and is allied to gangrene,
the vitality of the  part  and the constitution being much
reduced.  The  treatment should consist of a nourishing
diet, the use of quinine and iron, hydrastin and  other ve- 
SURGERY.
761
getable tonics should be given freely, and when the consti-
tutional powers are greatly reduced, the strongest diffusible
stimulants should be used, capsicum, xanthoxylin and car-
bonate of ammonia.   The brandy and egg mixture of the
Eclectic Dispensatory will be  excellent.   The local appli-
cations should be such as will cause  a slough.  Sulphate of
zinc, and  the chloride should be applied on lint, followed
with slippery elm and charcoal poultices, if the tendency to
gangrene be marked.  The carrot and spikenard poultice
will likewise answer a good purpose.
   The specific ulcer has  characteristics dependent upon its
cause, which may be scrofula, fungus, or syphilis.  The par-
ticulars of each should  be described under the  heads  of
their respective causes.
   The varicose ulcer takes its name from its  cause, which is
a varicose condition of the veins in the circumjacent tissues.
The skin gradually undergoes  degeneration, becomes of a
brownish or purple colour, and the veins in the part become
enlarged  and tortuous.   Near  to one  of  these congested
spots the  ulcer forms by breaking down of the softened, and
partially  disintegrated tissue, forming a sore in which the
surface is sometimes irritable, sloughing or indolent.   In
ease the ulcer penetrate one of the tortuous veins, it gives
rise to hemorrhage, which sometimes proves alarming.  The
recumbent posture, elevating the  limb, and  compression of
the part by lint and rollers will speedily arrest the hemor-
rhage.  The causes of this condition of the veins are various.
Phlebitis, by destroying the valves,will produce it.  Pressure
upon the  ascending cava—or upon the femoral or saphenous
veins, or a want of tonicity in  the parietes of  the veins on
account of general  debility—all  these frequently are the
direct causes.   Treatment:—The indications are to remove
the cause, if possible.  The general circulation should be
stimulated, the liver should be excited, if portal congestion
be the  cause.   The heart should receive attention if it be
diseased.   Capillary circulation throughout the body should 
762
SURGERY.
 be increased by baths, and  stimulants  and tonics.  To the
 affected  part, astringents and pressure should be applied.
 The limb should be elevated, and a strong solution of extract
 of quercus mixed with  French  brandy used  for a wash.
 The patient should wear a bandage applied from the toes to
 the knee, or even above, if the  veins  be distended.  An
 elastic, laced stocking will accomplish the same object.   In
 difficult  cases some surgeons recommend passing a ligature
 under the vein adjacent to  the ulcer, then tying it so as to
 cause it to slough.  Care should be taken, in performing this
 operation, not to pierce the vein.   The same object may be
 attained by means of the application of caustic to the vein,
 thus causing an eschar and slough, by which the vessel is
 occluded.   Other remedies may be beneficially used to in-
 crease capillary circulation in the parts.   Tincture of myrrh
 and capsicin, kino, catechu, marsh rosemary, and the various
 astringent remedies will fulfil  this indication.  The tannic
 and gallic acids, containing the essential elements of astrin-
 gents, can be beneficially used in solution as directed by the
 Eclectic  Dispensatory.
   The hemorrhagic ulcer is a sub-variety, known by a dark
 purple sore, occurring  in females, from amenorrhoea, and
 consequently tending to bleed most at the menstrual periods,
 or at those times at which  the female should  menstruate.
 Its cause being constitutional, the treatment should consist
 of the use of tonics  and  stimulants.  Xanthoxylin, macro-
 tin, oil savin, sulphate  iron,  caulophylin, with hip-baths,
 and nourishing diet, and occasional  purges, containing a
 portion of aloes, will  be effectual in restoring the catamenia.
 The local treatment is comparatively unimportant, and should
 generally be the same as that recommended for the irritable
 ulcer.  The general principles in  the treatment of ulcers of
 every variety are to restore the action of the organs of diges-
 tion and assimilation, and the  circulation of the blood, so
that their treatment should be constitutional to a great ex-
tent.   Nothing can be of permanent benefit unless the ge- 
SURGERY.                  763
ncral system is in a proper condition to furnish the healing
material.  The local treatment is such as will aid nature in
hastening on the formation of a slough, and enabling the
system to cure the ulcer quicker than it would do unaided.
Undoubtedly, by means of rest, the  elevated position, and
proper diet, and the  judicious use of water-dressing, the
majority of ulcers can be cured; and, indeed, in many cases
these are almost the only means that can be brought to bear
upon patients  on account of prejudice, or want of faith in
medicines.   Dr. Chapman, of London, speaks very favour-
ably of these water-dressings, which are valuable when the
surgeon  can be in constant attendance, and have  the entire
control of the patient.   But unfortunately this  is seldom
the case in general practice, and it therefore becomes all
the more necessary to use medicines, and  other  means not
hydropathic, in  their treatment.  When scrofula compli-
cates the ulcer—the ampelopsin—scrofularia Marilandica,
phytolaccin, and  the iodide of potassium, and  compound
syrup  of stillingia, will be the best remedies.   If the ulcer
arise from  syphilis, the treatment should consist of stillin-
gia, iodide of potassium, phytolaccin, and iridin,with a gene-
rous diet.  The muriated  tincture of iron will then form a
useful local application.

ANATOMY OF INGUINAL AND  FEMORAL  HERNIA.
   The bowels are  protected by five pairs of muscles and
their tendons.  They consist of the obliquus externus, in-
ternus, the  transversalis, the rectus, and the pyramidalis.
The external  oblique arises from the eight  inferior ribs;
and  after passing over the abdomen  terminate in  an ex-
panded tendon, which splits into two tendons, leaving a
space for the passage of the spermatic cord of the male, and
the round ligament of the uterus in the female.   The upper
column becomes attached  to the symphysis pubis; the lower
column passes under the  spermatic cord, and is fitted to the
spinous  process of the pubis; a process of tendon called 
764
SURGERY.
Gimbernat's ligament passes down, and is inserted into the
linea  ilio-pectinea.   The superficial fascia  covers  the ten-
don of the external oblique.  Behind the tendon of the ex-
ternal oblique the lower fibres of the obliquus internus take
their course, and after passing over the spermatic cord,
terminate in a tendon, which is inserted into the symphysis
pubis.   Between these fascia  the  spermatic cord passes
down to the testicles.  The cone is  composed  of  arteries,
veins,  nerves, absorbents,  vas deferens,  a membranous
sheath, and  the cremaster muscle.  The opening contain-
ing this cord is called  the inguinal  canal, and is composed
of the tendon of the transversalis  muscle, and the  fascia
transversalis.  The only artery immediately connected with
the anatomy of hernia, is the  epigastric.   It  arises  from
the internal  iliac behind Poupart's  ligament.  It passes
upwards and  inwards, and behind the fascia transversalis,
and inosculates with the internal mammary artery.
                     HERNIA.*
  A protrusion of any viscus from its proper cavity, is de-
nominated a hernia.
  The protruded  parts are generally contained  in a bag,
formed by the membrane with which the cavity is naturally
lined.   Several  parts of the body afford  examples of this
disease.   A deficiency in  the bones of the head will some-
times allow the  protrusion  of a portion of the  brain and
its membranes, from the inner to the outer side of the skull,
forming a hernia of this organ.  An imperfect state of the
intercostal muscles may permit a part of the lung, with its
pleura, to form an external  tumour or hernia of the con-
tents of the chest.   rBut the disease most frequently occurs
about the cavity of the abdomen; and on this account, as
                   * Cooper on Hernia. 
SURGERY.
765
well as from its superior importance in a surgical point of
view,  I  shall confine my observations to this species, with
its  several varieties.  Many reasons may be assigned for
the very frequent  occurrence  of protrusions from the ab-
domen.
  First. The viscera of this cavity are numerous, some of
them  very moveable, and others loosely connected by peri-
toneal attachments with the surrounding parts, and they are
constantly exposed to changes of size and relative situation,
from sudden or gradual distention.
  Secondly. The parietes  of the abdomen are composed of
muscles, which, when in action, contract the dimensions of
this cavity, compress the bowels, and thus have a  tendency
to force them from their natural position.
  Thirdly. For the passages of the vessels and nerves, these
muscles and their tendons have various  apertures, which,
naturally, only large enough  for that purpose,  often be-
come  so much relaxed  as to allow the viscera themselves to
protrude.
  Lastly.  The muscles are sometimes imperfectly formed,
and the viscera escape through unnatural apertures.  The
following  are the situations in which abdominal  hernia is
found: —
  First. It appears at  the abdominal rings, generally pass-
ing in the same course with the spermatic cords in the male,
and the round ligaments of the uterus in the female; thence
it is continued  down into  the scrotum in the one sex, and
the labia pudenda in the other.  This hernia of the abdo-
minal ring is known to surgeons under the various appella-
tions  of inguinal  hernia,  bubonocele, scrotal hernia,  and
oscheocele.
   Secondly.  A hernia also penetrates under Poupart's liga-
ments, forming a tumour at the inner and upper part of the
thigh.  In this situation it is called femoral  hernia, crural
hernia, or merocele.
  Thirdly. Another species is formed at the  navel, by a
       65 
766
SURGERY.
protrusion through  the  opening which was formed in the
foetus for the passage of the umbilical cord.  This has re-
ceived the name of umbilical hernia, or exomphalos.
   Fourthly. Similar protrusions take place through the ten-
dinous covering of the anterior part ef the abdomen.   The
linea alba and semilunaris are perforated to transmit ves-
sels passing to the common integument;  when these holes
are either originally of an unusual size, or enlarged during
a relaxed state of body, herniae will occasionally be formed
in them, which are then called ventral.
   Fifthly. Another part at which hernia sometimes appears j
is in the foramen ovale of the pelvis; it then takes the name
of the aperture,  and is termed hernia foraminis ovalis, ob-
turatorea, or hernia thyroidea.
   Sixthly. Sometimes, though rarely,  a hernia is produced
at the ischiatic nerve, under the glutaei muscles.  This takes
the name of the part, and is termed hernia of the ischiatic
notch, or ischiatocele.
   Seventhly. Sometimes, though rarely, a hernia passes be-
tween the bladder and  rectum in the male, and between the
rectum and uterus in the female, appearing in the perineum.
It is then called hernia perinei.
   That species of hernia, which from its frequently ap-
pearing at the time of birth, is called congenital, takes the
same course  through  the  abdominal rings as the inguinal
hernia; but instead of passing down upon the fore part of
the spermatic process, it descends within  the tunica vagi-
nalis  testis, and ought therefore to be named the hernia
tunicae vaginalis.
   The names that  have been given  to  different kinds of
hernia, have  been derived  from  their contents, as well as
their situations.  If they contain only omentum, they are
called omental hernia, or epiplocele; if only intestine, intes-
tinal hernia, or enterocele;  if both omentum and intestine,
entero-epiplocele,—if the stomach be  contained in the tu-
mour, gastrocele; if the liver, hepatocele; if  the bladder, 
SURGERY.
767
cystocele, or hernia cystica;  if the uterus, hysterocele; and
the same of others; for excepting the duodenum and pan-
creas, which are too closely connected with the spine easily
to change their situation, all the different abdominal viscera
have occasionally been found to form the contents of a her-
nial tumour.  However, the viscera usually met with  in
hernia are  the omentum  and the ilium; the next in fre-
quency is the colon, then  the caecum, and lastly, the jeju-
num; sometimes the appendix caeci is the only part of the
intestine found in the hernial sac.
   Of the inguinal hernia there are four varieties :—The ob-
lique, or that which takes the course of the spermatic cord
in the male, and the round ligament of the uterus in the
female;  the direct, which passes  immediately from the ab-
domen through the external abdominal ring, so that  its
direction from the scrotum into the abdomen is not attended
with  that  obliquity  which  characterizes the former;  the
congenital, in which the  protruded viscus is found within
the cavity  of the  tunica vaginalis;  the  encysted hernia of
the  tunica vaginalis, in which an additional membranous
sac is formed within that  peritoneal sheath.
   The oblique makes  its first appearance at the internal
ring  in  the form of a small tumour, situated at about an
inch  and a half to the  outer side of the  external abdominal
ring, in a line extending from the pubes to the anterior su-
perior spinous process  of the ilium.  If its progress be un-
interrupted, it proceeds gradually obliquely downwards and
inwards  in the direction of  the inguinal canal as far as the
external ring.   As long as  it remains within the canal, its
existence is often not  suspected by the patient, because it
requires a careful examination to  detect it; but to a sur-
geon acquainted with the natural feel and appearance of the
parts, it  is  sufficiently obvious.   The length of the swelling
above the ring will be found as the part of the spermatic cord
included between the upper opening  and  the  abdominal
ring; that is, about an inch and a half in the adult subject. 
768
SURGERY.
         STRANGULATED  HERNIA.
  Hernia is said to be strangulated when the omentum that
protrudes is so closely confined that it cannot be  returned
into  the abdomen without a surgical operation, and where
the circulation is cut off, and gangrene or mortification is
liable to ensue.  Strangulation occurs as the  result of con-
gestion of the protruded part, and the spasmodic constric-
tion of the walls of the canal through which the viscus passes.

                    SYMPTOMS.
  When the hernia becomes strangulated, the tumour will
be found increased in size, hard and  tense,  and, in coughing,
the impulse, which is always felt in reducible hernia, is no
longer perceived.  The patient becomes restless, and there
will be obstinate constipation of the  bowels.  The pulse will
be full and hard, the skin hot and pungent, the tumour will
assume a dark purple colour, and be extremely painful, and
if allowed to remain, nausea and vomiting will ensue, toge-
ther  with great  pain  over  the entire abdomen, indicating
active peritonitis.   In the course of a day or two, if the
patient  be  not relieved, the pulse will  suddenly become
feeble, the surface will be covered with cold, clammy sweat,
and dark, effete matter will be ejected from  the  stomach,
passed from the bowels, and death will ensue.

                    OPERATION.
  The patient should be placed upon a table, and should
inhale pure  ether, until complete anaesthesia is produced.
The  bladder should be emptied, and an incision should be
made on the neck of the sac, of sufficient length to  give
the surgeon plenty of room to divide the stricture.   A piece
of skin should be grasped with the  fingers, and having the
back of the  scalpel nearly in contact with the abdomen, the
incision  should  be  made by an upward  motion.  In the
next place, the forceps should be made to grasp the fascia,
and by a similar upward motion it should be divided.  If 
SURGERY.
769
bleeding should occur, the vessels should be secured by the
ligature.
  Much caution will  be required in dividing the  cellular
tissue which covers the sac.  This should be done by pinch-
ing up a small portion with the forceps, making a small in-
cision, and introducing a director, and laying it open upon
this.   If by the first attempt the sac should not be reached,
another portion should be divided as before, and so  on until
the sac is  exposed, which may  always be  known by its
shining appearance  and hard feel.   The sac being exposed,
it should now be opened by raising it up with the  forceps,
(taking care that no portion of the intestine be involved,)
making a very small opening with the point of the bistoury.
A broad director should now be introduced, and upon it the
sac should be sufficiently slit up to  allow its contents to be
examined.   The sac  being opened, the next point  is to di-
vide the stricture.   This should be done by introducing the
finger, and gradually  carrying it between the stricture and
the intestine; then a blunt-pointed bistoury made to pass
along sidewise upon it until it is passed under the stricture,
when the edge of the knife should be turned up, and by a
gentle, sawing motion, the stricture is divided.  When this
is accomplished, the omentum  should be examined, and if
not affected with gangrene, should  be gently pushed back
into the abdomen.   The edges of  the incision  should be
brought in eontact by means of adhesive strips, the patient
placed in bed, and  the  entire abdomen rubbed with equal
parts of water and whisky.  If the  bowels should not move
in the course of twenty-four hours, a small dose of neutral-
izing mixture should  be  administered.
  If symptoms of peritonitis occur, they should be controlled
by aconite, veratrum, &c, as  directed under that head.

            REDUCIBLE  HERNIA.
  In all cases  an attempt should  be made to reduce  the
hernia before resorting  to an  operation.   Every  possible
                          05* 
770                   SURGERY.
effort should be made to reduce the hernia by means of taxis.
This should be commenced by giving from five to ten drops
of the concentrated tincture of gelsemin, repeated every ten
or fifteen  minutes until  the  eyelids  become heavy, which
indicates the  constitutional influence of  the drug.  Then
give a strong lobelia injection,  after which the legs should
be flexed upon the abdomen.  ,The tumour should then be
gently grasped with the left hand, and with a finger of the
right hand the intestine should be gradually restored to the
abdomen.   If this cannot be done, the hips should be ele-
vated, and the parts  should  be fomented  with a strong in-
fusion of  lobelia, after which the taxis  should be again at-
tempted.
  If these efforts aire  not sufficient to reduce the hernia, the
bowels  should be injected with warm water, and  the  sto-
mach thoroughly evacuated  by lobelia.  I once  reduced
strangulated hernia, when all  other  efforts had failed,'by
suddenly  elevating the patient by the feet.  A plaster of
belladonna is used beneficially sometimes in these cases.  I
have also  known electricity  to be used with good effect.
But if all these efforts fail, an operation should be resorted
to, as already described.

      RADICAL  CURE OF HERNIA.
  Various methods  have been adopted for this  purpose.
The following method I have  found effectual, not only in
curing  recent cases, but  those of long standing.  In the
first place, after  reducing the  hernia, it should be kept in
its place by means of a truss  properly adjusted to the upper
portion  of the inguinal ring.  Previously to  applying the
truss, a  small strip of soft leather covered with the irritating
plaster  should be applied  the whole length of the inguinal
canal.   This plaster should be  renewed as often as once or
twice a  week, and continued  until free suppuration ensues.
After continuing the irritating plaster for two or three weeks 
SURGERY.
771
it may be removed, and the common strengthening plaster
applied.  If the first application of the irritating plaster
dees not produce sufficient inflammation to contract the in-
guinal canal, and prevent  hernia, it  should be repeated.
This method I have found very successful in curing many
bad cases of hernia.

  HYDROCELE,  OR DROPSY  OF  THE
                    SCROTUM.
   Dropsy of the scrotum is a collection of water in the mem-
brane which surrounds  the  testicles.   There are a variety
of causes, such as rheumatism, gout, scrofula, &c.  In some
cases the water increases to such an extent, that the tumour
becomes very large.
   It can easily be distinguished from disease of the testi-
cles,  by discovering whether it is opake or  transparent.
This may be done by holding a lighted lamp on the oppo-
site side.
                    TREATMENT.
   Give the patient a free purge of anti-bilious  physic  and
cream of tartar, after which give the following syrup:—
Take queen of the meadow, one ounce; colt's foot, or asarum
 Canadense, one-fourth of a pound;  yellow parilla, one-fourth
 of a pound.  Make one quart of syrup, and  add two drams
 of iodide of potassium.   Let the patient take one table-
 spoonful three times a day.  Pass a strong current of elec-
 tricity through the  tumour  four  or five times a day, also
 give a free purge of podophyllin and cream of tartar three
 or four times a week.   If  this should not  succeed, a sus-
 pensory bandage may be worn; or the water may be drawn
 off by means  of a trochar, and  the scrotum injected with
 the wine tincture of hemlock bark, to prevent return of
 the infusion.   Also give  one or two grains of  apocynin
 two or three times a day. 
772
SURGERY.
  GRAVEL OR  STONE IN  THE  BLADDER.
  Stone in the bladder may be composed of lithic acid,
lithate of ammonia, phosphate of lime, triple  phosphate of
ammonia and magnesia, or, of the oxalate of  lime.
  Symptoms.—Irritability of the bladder, frequent desire
to urinate,  sudden stoppage of the stream during micturi-
tion, pain in  the  neck of the bladder—most severe after
urinating,—a constant desire and effort on the part of the
patient to  relieve the pain by pulling at the end  of the
penis.   The above symptoms, although  nearly always pre-
sent, are not to be relied on  unless the existence of stone
be  demonstrated by means of a sound  into the bladder.
This can be done by  placing the patient on  his back,  and
introducing  the  sound  when  the  bladder  is  free from
irritation, and, if there be stone, the sound will be distinctly
heard  as the  instrument strikes it.
   Treatment.—If stone be present, attempts  may be made
to dissolve it by allowing the patient to  drink liberally of
a strong decoction of  queen of the meadow, in combination
with alkalies, or acids, according to the chemical nature of
the calculi.  If this cannot be done, it should be removed
by lithotrity  or lithotomy,  as directed by Dr. Druitt.

                   LITHOTRITY.
  "Lithotrity is an  operation  for  grinding or crushing
stone in the bladder into fragments of so small a size, that
they may be  readily expelled through the urethra.
  The operation  is performed  as  follows: The  patient is
placed on  a  couch with  his pelvis  well raised, and  his
shoulders  comfortably supported;  the bladder is  then
emptied, and five or   six ounces of warm water injected
with a proper catheter and syringe.   The injection should
be accomplished  with the greatest  possible  slowness  and
gentleness.   The instrument warmed and  oiled, is  now to
be most  gently introduced; and it must be passed fully
into  the bladder,  The  next step  is to seize  the stone. 
SURGERY.
773
But for this purpose, as is well and forcibly stated by Sir
B. Brodie and Mr. Skey, it  is not justifiable to move  the
instrument about in the bladder, or to use it as a searcher;
on  the  contrary, as Mr.  Skey says, the stone must be
brought to the instrument.  For  this purpose, the blades
having been  opened,—in  doing which the same surgeon
observes, the female blade should be pushed forwards to
the same extent to which the male blade is drawn back,—
the blades should be pressed downwards towards the rectum,
by raising the handle;  so  that the bladder may assume a
conical form with the apex downwards.  Into this apex the
stone will most probably fall; if  not, a slight  shake given
to the patient's pelvis will probably make it do so.
   When the  stone is  fairly grasped, the  screw or other
mechanical force employed should be made to crush it;
and here the first operation should generally end, for  the
surgeon must adopt festina  lente  for his motto, and  must
not be eager to do too much at one sitting.  At the  close
of the operation, it must be seen that the blades are entirely
closed, and not choked by detritus; then the instrument
is withdrawn.  The subsequent parts of the treatment are
these.   First,  all pain,  which is often severe, must be
allayed  by opium, administered by the mouth, or in  the
form of enema or suppository.   Hip baths, barley water
and other demulcent drinks, and alkaline  medicines  may
be used with the same  intention.   Secondly, the operation
must be repeated at intervals, till every fragment is  crushed
and expelled.   In favourable cases there is some degree of
scalding and pain, which soon passes off, and allows the ope-
ration to be repeated in three or four days.  In less favoura-
ble cases, there may be severe pain and  spasm of the blad-
der, requiring an interval of six or eight days.
   The third point is the getting  rid  through  the  urethra
of the detritus and  fragments.  After each operation,  and
especially after the  first, the patient should not attempt to 
774
SURGERY.
make water for some hours;  and should remain quietly on
his back for two or three days.  Probably he will not be
able  to make water, from the injury which the neck of the
bladder has received, and  will require the catheter.  After
subsequent operations, the removal of the detritus may be
promoted by injecting the  bladder with warm water through
a catheter with a large eye; or the catheter forceps may be
used.  It may be expedient to make the patient pass water
on his knees, especially if the prostate is enlarged.   If a
fragment become impacted in the urethra and cause re-
tention,  it must either be  gently  pushed  back  into the
bladder, or extracted by the  urethra forceps,  or by probe
or hook; or crushed in the urethra;  or lastly, be cut down
upon from the perinaeum.
   Contra-indications.—The circumstances which render the
operation of lithotrity difficult or dangerous relate, 1st, to
the urethra; for if this be naturally small, as in children,
or strictured by disease, and incapable of being dilated, so
as to admit the  necessary instruments, lithotomy is to be
preferred to lithotrity.   2d. Unconquerable irritability and
contractility of the bladder—especially if already thickened
by disease.   3d.  Very great enlargement of  the prostate,
and  especially of the third lobe, which hinders the manipu-
lation of the instrument and the escape of detritus. 4.
Great size of  the  stone, such  as a greater diameter  than
two  inches, especially if accompanied with great hardness,
and  if there are more stones in  number than two.  If these
be the contra-indications, it will be readily inferred  that
the
   Cases in which Lithotrity may be beneficially resorted to
are those in which, 1st, the patient is an adult, with a full-
sized urethra;  2d. In which  the prostate is not enlarged;
or, at all events, in which,  if the prostate be slightly en-
larged, the stone is small, and other circumstances favoura-
ble;  3d. In which the bladder is free from thickening, ex- 
SURGERY.
775
treme  irritability, and purulent catarrh.  Simple  mucous
catarrh is no contra-indication—in fact, being caused by
the presence of stone, it will be relieved by that which re-
moves its cause.   Lastly, in which the  stone is single, or
in which, at least, there are not more than two, not large,
nor very hard.  The oxalic are the hardest and most in-
tractable of all.
   This operation may be followed by rigours and great con-
stitutional disturbance and debility, or by inflammation and
abscess in the pelvic areolar tissue, which may  prove fatal.
But Sir B. Brodie gives it as his  opinion that, if prudently
and carefully performed, with a  due attention to  minute
circumstances, it is liable to smaller objections  than almost
any other of the capital operations in surgery.   It must be
observed, in conclusion, that  the benefits of lithotrity are
most  fully evinced when patients apply  for relief at the
earliest possible  period after the descent of the stone into
the bladder.
                    LITHOTOMY.
   Definition,—The best definition is the homely  English
 phrase—" Cutting for the stone."
   The indications for this  operation may be defined  to be,
 the presence  of  a stone in the bladder, which it is not
 judged expedient to remove by lithotrity.
   The only contra-indication is the presence of  such serious
 organic disease, and especially of the kidneys  or lungs, as
 would render  the patient  likely to sink from  the  immedi-
 ate effects of the operation.   But the surgeon is not justi-
 fied in withholding a means of relief, if the only one, and
 if the patient desire  it, merely  out of regard to his own
 reputation for success in operations.
   The Preparatory Treatment consists in the  use of such
 measures  described in the last  section for improving  the
 health and  allaying all irritability about the  urinary or-
 gans. 
776
SURGERY.
  There are four methods in which lithotomy may be per-
formed, viz.:  the lateral operation—the bilateral—the rec-
to-vesical, and the high operation,  to which may be added
Mr. Allarton's.   The  lateral is that which  common  con-
sent has decided to be the best,  except in a few rare in-
stances.  There are an infinity  of minute variations in the
manner of performing it, and in the instruments employed
by different surgeons.   In  the  following pages the author
proposes to describe chiefly the method employed by Mr.
Fergusson, which he has had many opportunities of  wit-
nessing at the King's College Hospital.

       1. LATERAL  OPERATION.  (FIG. 65.)
                         Fig. 65.
  The instruments needed  are  the following:—A sharp-
pointed knife; a straight probe-p6*inted knife, if  necessary
to enlarge the internal incision;  a curved  staff, deeply 
SURGERY.
777
grooved; it  should  be large, the groove deep and not ex-
tending more than half way up the straight part of the in-
strument.  Mr.  Fergusson's staff has the groove on the
left side; forceps of various sizes, and scoops for extract-
ing the stone; and  a sound, to make sure that the bladder
is empty after the operation; needles and tenacula; canu-
lae,  and a stone cutter may be at hand in  case of need.
  It is advisable that the  bowels  should  be cleared in the
morning with a simple enema.   The bladder should be mo-
derately full;  and if the patient has  recently emptied it, a
few ounces of water may be injected.
  The surgeon must take care that there is  a good, firm
table for the  operation, about two  feet  and a half high.
When the time is come  the patient should lie down on
this, and be put under the influence of chloroform; then
the staff should be introduced, and be made to act as a sound,
to make clear  the existence of the stone to the operator and
his  assistant.  If the staff does not serve this purpose, a
sound  must be used;  for this is a point about which there
should be no mistake.
  The next point is to place the  patient in a convenient
posture.  He should be placed on his back, with his shoul-
ders resting in the lap of an  assistant, who sits astride be-
hind him.   Then, in order to expose  the perinaeum tho-
roughly, he  must be made to raise and  separate his thighs,
and to grasp the outside of each foot with the hand  of the
same  side, and the hand  and foot  are to be firmly bound
together by a broad garter.  The buttocks should be brought
to the edge of the table;  mean while,  if  not  done before,
the perinaeum  should be shaved.  " The surgeon may," says
Mr. Fergusson, " pass his  left forefinger well oiled into the
rectum, to ascertain the size of the prostate, and its depth
from the surface; he should also explore with  his finger
the surface of the perinaeum, and the position of the rami
and tuberosities of the ischia.
  Every  thing being now prepared, an assistant on each
       66 
778
SURGERY.
 side holding  the  thighs firmly asunder—another being at
 hand to give the surgeon his instruments—and a fourth
 stationed on the left side, holding the staff perpendicularly,
 and well hooked against  the  symphysis pubis—in which
 position he is to hold it steadily from first to last, and keep-
 ing up  the scrotum out of the way, the surgeon places the
 fingers  of the left hand on the right buttock, and with the
 thumb  fixes the integuments of the perinaeum, taking care,
 however, not to draw them  up too  much.  Then he com-
 mences by a free division of the  skin,  with more or less of
 the subjacent tissues; entering his knife just on the  left
 side of the raphe, about an inch and three quarters in front
 of the anus, and cutting downwards with a sawing motion,
 to midway between the anus and the tuberosity  of the left
 ischium.   " The blade of the knife," says Mr. Fergusson,
 " should next be run along the surface of the exposed fat
 and cellular tissue, and then the forefinger  of the left hand
 be thrust  into the wound, about its middle, and directed
 upwards and forwards between the left erector and accele-
 rator muscles."   If  any muscular fibres of the transversus
 or other tissue offers resistance, it may be divided by a touch
 with the knife; but usually they give way before the finger,
 which reaches and feels the groove of the staff in the mem-
 branous part of the urethra.  This is the first stage of the
 operation.   The left forefinger nail  being now well fixed in
 the groove of the staff, the knife is  slipped in over it, with
 its flat surface nearly horizontal;  its point is made to pierce
 the tissues covering the staff, and to enter the groove, and
 to slide along the groove towards the bladder, dividing the
 membranous part of the urethra,  and the edge of the pros-
 tate.  This completes what the French would call the se-
 cond temp.  Now  the knife being withdrawn, the left fore-
 finger is generally insinuated along the staff into the blad-
der with a rotatory kind of motion, dilating the  parts as it
enters, and is made to feel for the stone.   In the next place,
the assistant removes the staff, and the surgeon  cautiously 
SURGERY.                  779
introduces the forceps over the finger into the bladder; the
finger being withdrawn as the instrument enters.   And, at
this  moment, Mr. Fergusson,  with admirable  dexterity,
opens the blades, and catches  the stone as it is  brought
within their jaws by the gush of urine that escapes.   For
it must be observed,  that so closely does the finger follow
the knife into the bladder, that no urine escapes till the
finger is withdrawn.
  If, however, the  stone is not caught in this ready way,
the forceps must be closed and brought into contact with
it—then the blades be opened over it, and be made to grasp
it; if seized awkwardly, it is relinquished and seized again—
then it is  extracted  by  slow, eautious,  undulating  move-
ments.   The forceps  should be held with the convexity of
one blade upwards, and of the  other downwards;  and the
endeavour should be to make the parts gradually yield and
dilate, not to tear them.
  The general maxims to be borne in  mind,  during the
performance of this operation, are—1st, to make a free ex-
ternal  incision, and to bring it low enough down, so that
the urine  may  subsequently escape  freely without  infil-
trating  the cellular tissue;  2d, not to cut deeply too  high
up, nor to open  the urethra too much in front, for fear of
dividing too much of the urethra, and wounding the artery
of the bulb; 3d, not to wound the rectum, or pudic artery,
by carrying the  incisions too low, or cutting too much in-
wards  or outwards; the  left forefinger should protect the
rectum  throughout; 4th, not to cut through the prostate.
  It will be noticed that after the first incision, the use of
the knife is very little limited  indeed;  yet, if the stone is
very large, the  prostate  very hard, or if any muscular or
other tissues resist the forefinger as it passes in, they may
be touched with the edge of the blunt-pointed bistoury. In
fact, the right side of the gland may be divided, equally
with the left.   Also, after the stone has been grasped, the
same may be done if needful. 
780
SURGERY.
  The usual pons of young operators, is the difficulty of get-
ting the finger and forceps into the  bladder, and the pro-
pensity to let  them slip between  the bladder and rectum.
In seizing the stone, if not caught at the first gush of urine,
care must be  taken not to grip the  bladder with it.  The
forceps should have long  blades, curved so as to retain the
stone without undue  pressure.  They may be lined with
linen, which affords a firmer hold, and takes up less room,
and is less likely to crush the stone than the metallic teeth
usually employed.
  The extraction  of  the  stone resembles a problem in ob-
stetrics.  As the os uteri must not be allowed to come down
before the child's head, and get jammed between it and the
pubes, so the surgeon must not drag down the prostate in
front of  the  stone, and jam it against the ramus of  the is-
chium.   " It may be useful," says Mr. Fergusson, " to push
it back over the forceps with the  left forefinger."   More-
over, the extracting  force  must be directed  downwards,
where the interval between the bones is the largest.
  If the stone is so large that it will not pass, there is the
choice of crushing it,  by a huge lithotrite, or by a screw in-
strument invented by Haynes Walton; or of performing the
high  operation.   A surgeon finding himself unable  to ex-
tract  a stone  by the  perinaeum, immediately  cut into the
bladder above the pubes, and extracted it that way.  The pa-
tient recovered.
  If  the stone is adherent, or encysted, the finger nail and
the scoop must be employed to detach it.  If pouched be-
hind  the prostate, a finger in the rectum may lift it  within
reach of the forceps.   If grasped by the bladder behind the
pubes, it may be  brought down  by injecting the bladder
with warm water.
  The varieties  of this operation before alluded to are  as
follows:—Many surgeons direct  the assistant to hold the
staff so that it may project in the perinaeum,  and incline a 
SURGERY.
781
little to the left side of it, and, when they have opened the
urethra, and are about to  incise the neck of the bladder,
they take its handle in  their own left hand, and bring it
down horizontally.    Mr. Key preferred a straight staff.
Again, there are great diversities in the manner  of cutting
into the bladder.   Some  use  a bistouri cache, an instru-
ment containing a blade that protrudes to a certain extent
on  touching a spring.   Sir B. Brodie  prefers a beaked
knife, or, if the stone is  very large, a double-edged  knife,
with a beak in the centre, so as to divide both sides  of the
prostate.  When  the bladder is opened,  he directs  the
wound  to be dilated by means  of the blunt gorget,  which
distends the neck of the bladder, and splits cleanly through
the prostate, without any risk of hemorrhage or mischief.
Many surgeons open the  bladder by means, of the cutting
gorget, the beak of which being put into the groove  of the
staff, held horizontally in the  operator's  left hand, it is
pushed cautiously  on, and  made to cut its way into the
bladder.  If this instrument is employed, every precaution
must be used to keep it  in contact with the staff, and not
to let it slip between the bladder and rectum—an accident
that has been the death of not a few.   The late Mr. Avery
constructed a most ingenious instrument, by means of which
a child might perform lithotomy. A staff introduced into
the bladder contained machinery, through which, by turn-
ing a handle, a trochar was made to pierce the perinaeum
from within, thus making it impossible to miss the bladder.
Lastly, there is a method which was occasionally employed
by Cheselden, and  which is still  practised by a  very expe-
rienced  and successful lithotomist, Mr. C. Mayo, of Win-
chester.  In this method, the operator, after making the
usual external incisions, "cuts into the side of the prostate
as  far back as he can reach, and brings out the knife along
the groove of the staff into the membranous part of the
eurethra," thus making the incision  into the neck  of the
                         *  66* 
782
SURGERY.
 bladder, from behind,  forwards, instead of from  before,
 backwards, as in the other varieties.
   After Treatment.—The surgeon, especially if the stone
 has been crushed, or if there is reason to suspect more than
 one, makes certain by means of the sound, or by syringing
 the bladder, if requisite, that every fragment of the stone
 has been removed.  Mr. Fergusson then introduces a sup-
 pository of morphia, and the patient is removed to his bed.
 The patient should lie on his  back, with his shoulders ele-
 vated ; a napkin  should be applied  to  the perinaeum to
 soak  up the urine, and  the bed  be  protected by oil-cloth.
 Some surgeons introduce a large gum elastic canula through
 the wound into thebladder for it to flow through for the
 first twenty-four hours.   If not,  the surgeon should intro-
 duce his finger, after a few hours, to clear the wound of
 coagula.   Pain must be  allayed  by opium, the bowels  be
 kept  open  with castor-oil, the wound  be kept  perfectly
 clean, the diet be nourishing, and then, in favourable cases,
 the urine begins to flow by the urethra in about one week,
 (sometimes in  three or  four days,) and the wound heals
 completely in four or five.

                 COMPLICATIONS.
   1.  Severe hemorrhage may proceed at the time of the
 operation, or after it, from the pudic or bulbous arteries,
 if wounded.   If the bleeding orifice cannot be secured, it
 must be compressed as  long as may be necessary with the
 finger.   A  general  venous 'or  arterial  oozing  must  be
 checked by filling the wound  firmly with lint or sponge—
 the tube being then indispensable—and by ice applied to
 the perinaeum, or lower part of the abdomen.  Care should
 be taken  that blood does not accumulate in the bladder.
 This may be suspected if the patient is pale and exhausted,
and must be combated by injections of cold water, to make
the bladder contract,  2, Sloughing of  the cellular tissue 
SURGERY.
783
from urinous infiltration—a frequent result of a hasty ope-
ration, and of too freely incising the neck of the bladder—
is  indicated by heat and pain about the neck of the blad-
der, heat  of the skin and  sleepiness, followed by a rapid,
jerking, intermittent pulse, hiccup, the belly tympanitic,
the countenance anxious, and other signs of irritation  or
typhoid  fever.  To  be treated by wine, quinine and am-
monia, by thoroughly opening the wound with the finger,
and, if necessary, laying the wound into the rectum, so
that the urine and fetid discharge may escape.  3. Simple
Peritonitis: pain and tenderness  extending from the blad-
der over the abdomen, must be treated as directed under
the head of peritoneal  inflammation.  4. Pyaemia.—See
Empysemia.
                STONE  IN  WOMEN.
   Stone in women is much less frequent than it is in men,
and when a renal calculus reaches the bladder, it is much
more easily voided.   If, however, there  is a calculus too
large to escape, it must be removed.
   1. The surgeon may employ lithotrity.
   2. The orifice of  the urethra  may be simply  dilated,
which may be effected by Weiss' female dilator, slowly or
quickly, as may be desired.
   3. The bladder may be cut into from the vagina, or the
orifice may be incised.
   4. Incision may be combined with dilatation.  The great
evil is the almost certainty that more or less incontinence
of urine will follow.   Mr. Fergusson recommends that the
dilatation should be  effected very slowly by means of a me-
tallic or some other  dilator, till it is capable  of admitting
the forefinger, when  forceps may be introduced to seize the
stone.   If this should not  answer, and it seems necessary
to make an incision, he recommends that the anterior half
of the urethra—not its whole length into the bladder—
should be divided to  the  extent of half an  inch with a 
784
SURGERY.
probe-pointed bistoury,  after  which sufficient dilatation
might be effected with the forefinger oiled. The outer part
of the urethra, which is the most undilatable part of it,
would be alone divided  by this  operation, and the neck of
the bladder, unless very roughly used, would  speedily ac-
quire its tone and use. '  In this way the eminent surgeon
just quoted has extracted a stone three inches in circum-
ference, and the  patient had  the power  of  retaining her
urine immediately afterwards.

             MEDICAL  TREATMENT.
   The treatment of gravel  should be governed by the na-
ture of the case. If it be of an acid character, (which may
be known by the urine turning blue litmus  paper red,) li-
thontriptics, alkalies  and diuretics should be given for the
purpose of dissolving the stone and expelling it from the
bladder or organ which contains it.  For this purpose the
following compound  may be given:—Take  queen of the
meadow, pulv., one ounce;  Indian hemp, two ounces; bi-
carb, of potassa or saleratus, one drachm; mix, make an in-
fusion,  and let the patient take one-half-teacupful three or
four times a day.   Also, inject a teacupful into the blad-
der once a day, and after it is evacuated, inject the bladder
with  warm flaxseed  tea, to prevent irritation.  For the
purpose  of facilitating the action of the  diuretics, a podo-
phyllin purge should be occasionally given.  The patient
should also be allowed  to partake freely of vegetables, to
 prevent farther calcareous  accumulations.   If the  calculi
be alkaline in  its chemical  nature, (which may be  known
by the urine turning red litmus paper blue,) forty or fifty
drops of nitro-muriatic or sulphuric acid may be added to
the diuretic mixture instead of the saleratus, and adminis-
tered as before.  In  addition to the above, I have used the
aralia hispida or dwarf elder, the clivers, asparagus, horse-
chestnut tree  bark, the  asarum Canadense, or colt's  foot,
&c.  In all cases the diuretics should  be mixed with acids 
SURGERY.                  785
or. alkalies, according to the chemical character of the de-
posit. Where these measures fail, the stone may be crushed
in the bladder by means of an instrument called the lithon-
triptor.   It will then  be  expelled with the urine.  The
operation of lithotomy should be performed by none but the
most experienced surgeons.

DISEASES  OF  THE BLADDER AND  PROSTATE.
                      CYSTITIS.
   This disease, although rare, may be produced by various
 causes, such as wounds, gonorrhoea, the passage of instru-
 ments,  irritation  arising from applying blisters, &c.
   The  symptoms are, very great irritability  in the bladder,
 pain and weight  in the sides and lower part of the abdo-
 men, &c.  The urine is high-colored, frequently mixed with
 blood, mucus  or pus.
   Sometimes an attack of acute cystitis will terminate in the
 chronic form. When it terminates fatally, the symptoms
 will be of  a nervous  character,  the  pulse being rapid and
 weak, the  tongue dry and dark, and the  urine extremely
 offensive.    After  death the  disease will be found to have
 changed from inflammation of the bladder to inflammation
 of the peritoneum, or the formation of abscess.
   The  chronic form  of cystitis  is commonly called the ir-
 ritable  bladder, the symptoms of which are similar to those
 of the acute form, although  less severe.  It continues ge-
 nerally for a long time, usually terminating  in vesicular ca-
 tarrh.  This  form mostly occurs in men,  and frequently
 involves other diseases of the urinary organs.
   The  symptoms  of vesical catarrh are  constitutional debi-
 lity and local  irritation, with a  frequent desire to pass wa-
 ter, which is usually mixed with  a  quantity of mucus.
 Should the urine be left to stand, it will divide into two
 parts, the lower being a thick,  gummy mucus, and having
 the appearance of  pus, while the upper portion remains
 clear.   The  chronic form of  this disease is frequently 
786
SURGERY.
 fatal, terminating,  generally, with symptoms  of typhoid
 fever.
   On examination of the bladder, after death, the mucous
 membrane will be found very much  thickened, the blood
 assuming a black colour  in the veins, which are very much
 enlarged.  Abscesses will also be found, while the mucous
 membrane lies in folds,  which become thick and hard. As
 the disease advances, the organs become covered with sacs,
 which are of two  kinds.   In the first, the muscular and
 mucous coats are pushed outwards. In the second, or most
 frequent  form, the mucous  coat only forms a protrusion
 like hernia.   Pus, mucus,  and sandy substances are fre-
 quently found in these cysts.
   Children of a scrofulous  nature are occasionally affected
 with a peculiar form of  chronic inflammation of the blad-
 der.  The child has frequent desires to make water, which
 occasions much pain, while  the urine is exceedingly offen-
 sive. On sounding the bladder, it will be found rough, and
 containing mucus and a  grinding or sandy matter.   Some-
 times the presence of worms, is noticed.
   Irritability of the  bladder  frequently occurs in women,
 and resembles stone so closely that  it requires the most
 careful investigation to  detect the difference.  It appears
 to depend on a diseased and  extremely sensitive state  of
 the  mucous  membrane  of  the bladder and urethra.  In
 some cases it appears to  be dependent upon a disease of the
 genito-urinary organs, or an affection  of the uterus.  Pro-
 lapsus of  the anterior wall of the vagina will also keep up
 this state.

                    TREATMENT.
   In addition to the treatment that we have given  in ano-
 ther portion  of this work, for cystitis, populin and gelse-
 min, will  be  found valuable remedies.   Populin exerts  a
most  tonic and invigorating  influence over  the  mucous
membrane of the bladder, ureters  and urethra.  Hence, 
SURGERY.                  787
in all cases where there is a weak or ulcerated condition of
the mucous membrane of  the bladder, from  one to five
grains of populin should be given three or four times a
day, and if there be difficulty in voiding urine, with pain
and  burning sensation in the  bladder, from one-eighth to
one-fourth of a grain of  gelsemin may be given with each
dose of populin.  If there are gravelly deposits in the blad-
der, one  or two  grains of eupatorin  purpurin  should be
given two or  three times a day.  Warm irrigation of the
bladder by means of a double  canula may also prove bene-
ficial where there is chronic inflammation.   In diseases of
the bladder of a chronic character, quinine, in combination
with gelsemin or populin, may also prove beneficial.

         TUMOURS OF   THE  BLADDER.
   Fungous growths, or tumours of various shapes, are some-
times found in the bladder.  They may occur  at any time
of life, and generally occasion a great deal of  irritation in
the organ, giving rise to retention of urine and some symp-
toms of  stone.  The growths are usually  of a malignant
character,  and generally connected with like affections of
the  prostate, which,  in  women, may  be closely allied to
cancer of the uterus.  These tumours are sometimes found
covered with earthy concretions which somewhat resemble
a calculus, but from which they may  be recognised by the
impossibility of passing the sound around them.

                   TREATMENT.
   Benefit may be derived in these cases by the liberal use
of iodide of ammonia in combination with compound syrup
of stillingia, populin, &c.  Where  there is much pain and
irritation connected with these  affections, hyosciamin and
gelsemin. given  in small  doses, will afford relief. 
788
SURGERY.
     PARALYSIS  OF  THE BLADDER.
   If the body of the bladder be paralyzed, the patient will
 be affected with retention of urine, on account of the want
 of power in the organ to throw off .the contents, not because
 of any obstacle to the flow of the urine.  When paralysis
 occurs in the neck of  the  bladder, the urine passes away
 without the will of the  patient.
   Loss of tone in the body of the bladder, found in old per-
 sons, is simply occasioned by the want of  muscular power,
 or as an effect of fever.
   When occurring as the result of disease the urine escapes
 in a dribbling manner,  while the patient finds it difficult to
 evacuate the bladder completely.  Should entire retention
 occur, the bladder gradually  enlarges, extending into the
 hypogastric region, often as high  as the umbilicus.   On
 examination, the lower portion of the abdomen will be found
 hard, rounded, pear-shaped, and elastic, having the feel  of
 an enlarged uterus.  On percussion a  dull  sound will be
 heard; while, by tapping above the pubes with the fingers,
 fluctuation may easily be perceived.   When the bladder has
 become distended  a quantity  of urine constantly dribbles
 away, thus causing a large  amount to pass  off, but which
 does not relieve the retention.   This affection is much more
 common in  men than in women.  The  bladder sometimes
 increases to such a size  as to lead to  the supposition of the
 presence of a tumour,—the surgeon  even resorting to tap-
 ping.
   Retention of urine from  paralysis may be distinguished
 from  retention from  obstruction, by  noticing on the intro-
 duction of the catheter (the  patient being  placed  on his
 back) that the instrument may be passed in very easily, and
 that the urine will pass  off in an uninterrupted stream, in-
stead of coming away in jets.  In retention, also, the urine
that escapes will be very high-coloured.    Should  the  dis-
ease  continue  for  a time, the consequences  are  likely  to 
SURGERY.
789
prove fatal.  Sub-acute inflammation  occurs, followed by
typhoid symptoms; and even if the  retention is relieved,
this  state is liable to be present.  The constant dribbling
prevents the ulceration or bursting of the bladder, when
the  retention occurs  from  paralysis  without any obstacle
being present.
   A weakness of the neck of the bladder will give rise to
incontinence of urine, because there is not sufficient strength
to retain  the contents of  that organ.  It may result from
various causes, being most frequent  in  children.  It may
occur in old people as the  effect of debility, and  is usually
accompanied by retention.   It is frequently dependent upon
other  affections, and sometimes upon nervousness.  It is
most liable to be found in  children of scrofulous  natures.
   Hysterical retention and incontinence  may be observed
very often in girls of a nervous temperament.   In  hysteri-
cal retention the frequent  use of the catheter is not advisa-
ble,  as  the patient is apt to depend entirely upon this for
the removal of urine.
   The bladder is frequently affected with severe  pain when
no disease can be discovered, even upon close examination;
the pain will be neuralgic, or else depending upon  the dis-
ease of some other organ not connected with it.   It must be
remembered, however, that irritating urine, or the secretion
of urine, will, in some persons, occasion much suffering, and
any  disease coming in contact with the neck of the bladder
will cause frequent desires to micturate.
   We  sometimes find the anterior wall of the bladder ab-
sent, together with a deficiency in the corresponding wall
of the  abdomen.   In such cases the pressure of the abdo-
minal  viscera behind forces the posterior wall of the blad-
der  forwards, causing the formation  of  a small, rounded
tumour, the surface of which  is red, and papillated, and ap-
parently formed of mucous membrane.
        67 
790
SURGERY.
                    TREATMENT.
  We  have already given the treatment  for retention  of
urine in another portion of the work.  In paralysis of the
bladder, strychnine, viburnin, and electricity, together with
cystic  tonics, such as  populin and helonin, will be found
most reliable remedies.   I have succeeded in curing several
cases of paralysis  of the bladder by giving one-sixteenth
of a grain of strychnine four or five times a day, and passing
gentle  currents  of electricity through the bladder twice a
day.  This  treatment should be  followed by small  doses  of
populin, viburhin, and helonin.  The integrity of the sys-
tem  should be protected by general  tonics, baths,  and nu-
tritious diet.
      DISEASES  OF THE  PROSTATE.
   The prostate may be the seat of various affections, as hy-
 pertrophy, the formation of calculi, acute and  chronic in-
 flammation, and scirrhus.
   Inflammation of the prostate is  generally the result of
 gonorrhoea, usually past the ages of twenty-five or thirty,
 and most frequently in men of middle age.  The symptoms
 are, a frequent desire  to urinate, which act is accompanied
 with severe  pain, heat and weight  in the perinaeum.  On
 introducing  the finger into the rectum, the gland will be
 discovered very much increased in size, and extremely sen-
 sitive to  the touch.
   Abscess of the prostate may be caused by acute inflamma-
 tion, or it may occur when very little inflammation precedes
 the affection.  Idiopathic suppuration of the prostate rarely
 occurs.
   When  abscess  is  a  consequence of inflammation of the
prostate,  it is accompanied by retention of urine, throbbing,
and  rigours.   The abscess frequently gives way into the
urethra,  but it has been known to open externally into the 
SURGERY.
791
rectum or into the  perinaeum.   Frequently, during the in-
troduction of the catheter, the abscess will burst, the matter
escaping through the instrument.
   Retention may occur, in prostatitis, from the formation of
pus, or from the swelling of the gland.
   Chronic,  or  sub-acute  inflammation of the prostate, fre-
quently happens in persons of debilitated constitutions; or
it may be the result of gonorrhoea, or local  irritation.   We
find in this  affection pain in the gland, heat, and tenderness,
with a discharge  of a thick, ropy mucus,  frequently mis-
judged to be spermatorrhoea.   Its continuance occasions a
great deal of irritation of the neck of the bladder, together
with debility of the generative organs.
   Hypertrophy of the Prostate.—This  disease is generally
met with after the  age of fifty—very rarely before.   When
the hair becomes gray, and when  atheroma is found in the
coats of the arteries, the size of the prostate is always en-
larged; then the urethra becomes dilated, and the bladder
thickened.  It  may be produced by any constant irritation
of the urinary organs.
   The enlargement of the prostate is chiefly  dependent upon
fatty degeneration of the gland; the degeneration of which
may occupy the entire  gland, or it may be  confined to the
lateral lobes.   When the  prostate is enlarged, the corre-
sponding portion of the  urethra  also becomes larger than
usual.   The middle lobe of the prostate may  be increased
in size, while  the  lateral  lobes retain  their normal bulk.
These enlargements render it very inconvenient in attempt-
ing to pass water, and may cause retention or incontinence.
The  symptoms  of this disease are,  a straining before evacu-
ating the bladder, and, after an apparently  full passage, an
involuntary  escape  of water in  small quantities.   The pa-
tient is also much longer in evacuating  the  bladder than is
usual.   The urine becomes fetid, and mixed with mucus.
  Retention of urine generally makes  its appearance gra-
dually.   The patient will  find much difficulty, some time 
792
SURGERY.
previously, in passing water, while the greater the effort he
makes the more difficulty he experiences in accomplishing
it.   When the bladder  becomes  expanded  with urine a
small quantity will escape, until the parts about the neck of
the prostate relax and allow it to pass.

                    TREATMENT.
  Where there is acute inflammation of the prostate, the bow-
els should be opened with small doses of jalapin and cream of
tartar; after which the patient should be put upon full doses
of veratrum viride, and the impression maintained until the
inflammation is subdued.  During the treatment the patient
should be kept quiet, and the penis, scrotum, and lower por-
tion of the  bowels, kept constantly packed in warm water.
If the inflammation is of a chronic character, a small irritating
plaster should be applied to the perinaeum, and small doses
of podophyllin and irisin should be given four or  five times
a day.  The quantity of podophyllin given should be suffi-
cient to maintain a mild alterative action on the system, but
not sufficient to produce purging.  If this should not succeed
in subduing the inflammation, one or two warm  sitz-baths
should be given every day.   Where there is hypertrophy of
the gland, and there  is irritable urine caused by an excess of
acids, eupatorin purp. barosmin, in combination with alkalies,
should be used freely. If there is retention of urine, the blad-
der should be evacuated by means of a catheter. The enlarge-
ment of  the  gland can usually be subdued with compound
syrup of stillingia and iodide of ammonia.   Take compound
syrup of stillingia,  six ounces;  iodide of ammonia, one dram;
mix, and  let the patient take  one teaspoonful five  or  six
times a day.  In some cases I have found benefit from paint-
ing the lower portion of the  urethra and perinaeum with
the tincture  of iodine.   If the enlargement of the gland
obstructs the urinary passage, sulphate of sanguinarina may
be applied by means of Lallemand's porte-caustique; in other
cases  nitrate of silver may be applied with the same instru- 
SURGERY.
793
ment, and the prostatic portion of the urethra thoroughly
cauterized. Phytolaccin, corydalin, iodide of potassium, sitz-
baths, electricity, and iodine, have also been used in chronic
enlargement of the prostate to advantage.
INJURIES  AND  DISEASES OF  THE  EYE.
 INFLAMMATION OF THE EYE  GENERALLY.
  The  eye is a delicate and complex organ, composed of
many different structures, and when diseased, each part re-
quires to be considered separately.  It is first necessary to
distinguish between  inflammation of the conjunctiva (im-
properly called ophthalmia) and inflammation of the eye-ball.
The former may be caused by various disorders of the sys-
tem; by the influence of the atmosphere; and by irritating
applications.   It may result in  opacity of the  cornea, but
may be much relieved by local astringents.   Its symptoms
are extreme  sensitiveness to bright lights, a  burning or
smarting pain, &c.
   In inflammation of the eye-balls, the symptoms are a
change in the colour of the iris; dimness of sight; the di-
minished power of the pupil, which is irregular; a neural-
 gic pain; and  great intolerance of light.  When the dis-
 ease becomes chronic, the transparency of the cornea is
 lost, the vitreous humour takes a fluid form, the  lens and
 its capsule become opake, and paralysis of the iris occurs.
   In acute inflammation the  eyelids swell, scalding tears
 fill the eyes, the cornea becomes somewhat  opake, and  the
 affection ends in suppuration.

                      CAUSES.
   Inflammation of the eye-ball may be  either traumatic,
 or idiopathic.  The first is  caused  by wounds, blows, and
 many other injuries.   Persons who are intemperate, render
 themselves more  liable  to  it.   The symptoms are  those
                           67* 
794
SURGERY.
which have already been mentioned, added to which may
be headache, fever, &c.

                     INJURIES.
  In injuries of the eye-lids and eye-brows, sutures, if in-
troduced, should be very small, while care should be taken
that the healing is in no way irregular as to occasion dis-
tortion.   Wounds of the forehead  are sometimes followed
by  a loss of vision, which is probably  the result of the
shock given to the retina.   Blows on the eye usually cause
an unpleasant discolouration of the skin;  and the slightest
stroke on the eye-ball may cause a permanent injury to the
eye,  and even entire loss of sight.  When blood is dis-
persed into the chambers, it may be absorbed in a short time,
if the inflammation be controlled.  The eye may be ruptured
by any very  severe blow.   The  greatest care is  requisite
in order to retain the sight, even  although the contents
may be only  partially lost.
  Dislocation of the crystalline lens may also occur as the
result of injuries.  If it be driven into the  anterior cham-
ber of the eye, and does not prove irritating, it  may be left
for  nature to repair the injury.   If it is  liable to produce
a permanent injury to the eye,  it may be removed by ex-
traction.  This is  almost  always required when  it lodges
in the posterior chamber.

        FOREIGN BODIES  IN THE EYE.
  Foreign bodies  should  be sought for by inverting the
eye-lids and having the patient  turn the eye in different
directions. If the foreign body be found to adhere to the mu-
cous membrane of the cornea or conjunctiva, it can usually
be removed by wrapping a silk handkerchief around a sil-
ver probe and wiping it out.  Or if it be  a piece of steel, it
may be removed by rubbing the end of  a small cork on a
piece of flannel, and applying it to  the substance.   On re-
moving the cork the foreign substance will  be found ad- 
SURGERY.                  795
hering to it.  A magnet has been used for the same purpose.
If lime or mortar should get into the eye, it should  be re-
moved, and the eye washed or syringed with a weak solution
of vinegar and water.   If the eye should become inflamed,
bathe it frequently in warm water, and use an ointment of
equal parts of castor oil and  laudanum.  If a foreign sub-
stance should enter the  anterior chamber of  the eye, it
should be removed, whenever it can be done, without eva-
cuating the aqueous humor.

           PROLAPSUS  OF  THE  IRIS.
  Prolapsus of the iris may  occur as the result of penetra-
ting wounds of the cornea.   A reduction of it may be at-
tempted by rubbing the eye-lids against the cornea so as to
press on the prolapsed portion; and then exposing the eye
to a strong light.  If this is done immediately after the in-
jury, it may prove successful.

     DISEASES  OF   THE  EYE-LIDS.
             HORDEOLUM  OR  STYE.
  Stye is a small painful  pustule on the margin of the eye-
lid,  having its origin in ciliary follicles.  It can usually be
cured by applying aquae ammonia by means of a small steel
needle, puncturing the tumour slightly.  If this does not
remove the inflammation  it may be poulticed with slippery
elm moistened in equal parts of water and tincture of lobe-
lia.
              OPHTHALMIA  TARSI
  Is an inflammation  of  the palpebral mucous membrane
with a disordered condition  of the Meibomian glands.

                    SYMPTOMS.
  The eye-lids are stuck together by a dry mucus  during
sleep.  If there be itching, burning and pain, the disease is
usually acute, as these symptoms do not generally occur in
the  chronic form.  It may lead to ulceration of the hair 
796                   SURGERY.
follicles and loss of the lashes, and sometimes to thickening
and inversion of the eye-lids.
                    TREATMENT.
  In the treatment of this disease the first thing to be at-
tended to is the constitution; and it is almost always con-
nected with a  scrofulous or tuberculous diathesis.   This
condition should be corrected by baths, fresh air, nutritious
diet, alnuin, frazerin, iron, cod liver oil, &c, and the follow-
ing ointment used as a local application.
      R. Muriate of hydrastin,..................... grs.  x.
         Adeps......................................... 3J.
  M. ft. unguentum. Let it be applied by means of a camel's hair
pencil, four or five times a day.
  The eyes should be frequently bathed in a warm  decoc-
tion of hydrastis,  and if the lids are granulated,  they may
be touched once or twice a week with a weak  solution of
nitrate  of silver.

    SYPHILITIC ULCERS OF  THE EYE-LID.
  If syphilitic  ulcers of the eye-lids  occur, they may be
distinguished from other  ulcers by their rapid  progress,
by the patient being otherwise  healthy, and by their cop-
per-coloured appearance.   They yield  to the treatment for
secondary  syphilis.   Trichiasis signifies the growing  in-
ward of the eye-lashes.  It  seems to depend on the thick-
ening of the fibro-cellular tissue of  the eye-lids.   For the
cure of this disease  Dr. Walton recommends an excision
of a portion  of the  lid so as  to give  it an outward turn.
The practice of extracting the  lashes has also been resorted
to with some success.
  Entropion implies inversion  of the eyelids, to cure which
an incision may be made along the  edge of the tarsus, ex-
tending from  one  angle of the lid to the other.   A  second
incision parallel with it should be made  about four or five
lines from it, and joining it at its extremities.   The  ellipti-
cal  piece should  be  elevated  at the end by forceps, and 
SURGERY.
797
dissected  out, down to the cartilage.   The wound should
be closed by sutures and cold water dressings applied.
  Lagophthalmos signifies inability to close the palpebrae.
  Ptosis signifies a falling of the  upper eyelid with  ina-
bility to raise  it.   Both of these affections are usually  pro-
duced by palsy, and are precursors of apoplexy, great de-
bility and extensive disorder of the nervous system.
   Treatment.—If they occur  suddenly, the bowels should
be opened by  an active cathartic, such as jalapin and anti-
bilious physic, after which the following compound should
be given.
      R.—Strychnin,....................................gr. j.
          Ferri hypophosphite,.......................3 ss.
          Sulphate quinine,...........................grs. x.
      M.—Ft.  pulvis no. xv. Sig., one  every two hours.
   After these powders, tonics, chalybeates, mild aperients,
and frequent baths will usually complete the cure.   If the
disease  should prove  obstinate, the powders may be re-
peated and electricity  applied.
   Encyloblepharon, union of the'edges of the lids cured by
incision.
   Symblepharon, a union of the lid to the globe, cured by
dissecting the lid from the globe.
   Tumors of  the Eyelids may be of many  varieties, such
as warts, enlarged cutaneous follicles, cysts of hydatids, &c.
They may be removed by extraction.
   Exophthalmia signifies a dryness of the eyes from a de-
ficiency of tears, cured by glycerine and mild tincture of
capsicum.
   Epiphora signifies  a redundancy of tears.  It  usually
depends upon foreign substances in the eyes, or  upon a
scrofulous or  hysterical  constitution, cured  by removing
the cause.
   Closure of the Puncto-Lachrymalia, when caused by in-
flammation, is of short duration.   If permanent, it may be
remedied  by slitting up the canal  to the mucous surface. 
798                   SURGERY.
  Fistula Lachrymalis signifies a fistulous opening at the
inner corner of the eye communicating with the lachrymal
sac.
  Treatment.—The treatment should consist in  first sub-
duing the inflammation  by local  and constitutional  treat-
ment, and then introducing the style by puncturing the
internal portion of the sac a little below the functum.
       DISEASES  OF THE  CORNEA.
   In Acute Inflammation of the  Cornea, (acute corneitis,)
resulting from neglected injury,  the part becomes red and
opake, with ulceration  or suppuration between the layers,
or abscess of the anterior chamber following.
   In Scrofulous  Corneitis, the cornea is  red, opake, and
very prominent, with the redness extending to the sclero-
tic.   The retina  and iris have also a tendency to inflam-
mation.
   Opacity of the cornea is of two kinds—1st. That result-
ing from adhesive inflammation,  and  that produced by in-
flammation, resulting from the effusion of fibrin between its
layers, and from the effects  of  scrofulous ulcers, which is
generally curable.  This is called nebula,  when of a slight
character, but, when more dense, albugo.  2d. Leucoma,
which is a dense opacity, resulting from a cicatrix of the
cornea.  It may be partially removed  if of recent origin,
but is irremediable if of long standing, and may become the
seat of calcareous degeneration, requiring removal because
of irritation to the eye-lids.  Some cases of opacity seem
to be very near the surface of the cornea, perhaps upon the
anterior  elastic lamma.  Those thus found are often very
opake, and are  sometimes  considered  more serious than
they really are.   A lens, or the point of a needle, will
usually reyeal their true character. 
SURGERY.                  799
   Onyx  signifies a suppuration between the layers of the
cornea, resulting from acute ophthalmia. It is thus named
from the resemblance it bears to the white spot at the root
of the finger-nail.
                   TREATMENT.
   Acute corneitis  should be treated with podophyllin, ja-
lapin, veratrin, blisters  behind the ear and  nape  of  the
neck, low diet, and cold packs to the eye.   The chronic
form should be treated with iron, genuine cod-liver oil,  and
tonics.   Opacity of the cornea may be removed by giving
menispermin,  irisin, muriate of ammonia, and  a weak de-
coction of capsicum, applied to the cornea by means of a
camel's hair pencil.
   Onyx  usually disappears  by giving small doses of podo-
phyllin and diaphoretic powders.
   Ulcers of the Cornea  can  be cured by giving the  patient
tonics and touching the  ulcer two or three times a day with
hydrastin moistened with glycerine by means of a  camel's
hair brush.
   Conical cornea is characterized by the peculiar brilliant
and rounded appearance of  the cornea.  It sometimes can
be cured by tonics and improving the general health of the
patient.
   Iritis.—Inflammation  of  the iris generally involves the
sclerotic.  It  may be diagnosed  by the iris changing its
colour, by intolerance of light, dimness of vision and a burn-
ing and stinging pain in the eye.
        *
                   TREATMENT.
   Cold packs  should be applied to the eye and frequently
changed.  Small blisters should be placed behind the ears,
and the patient given one-eighth of a grain  of podophyllin
and one-half  of a grain of  quinine every two hours, until
it acts freely upon the bowels.   If there is  deposition of
lymph, it should be absorbed by giving small doses of  me-
nispermin and apocynin. 
800
SURGERY
  The following plates (figs. 75, 76, 77, 78, 79, 80, 81, 82,
83, 84, 85, 86, 87, 88, 89,  90, 91, 92, 93,)  show some of
Fig. 75.   76.
83. 
SURGERY.
801
the principal instruments used in the various operations on
the eye:
Fig. 84.     85.     86.  87.
92.
OS 
802                   S U R G E R Y. 1
                         Fig. 93.

                   CATARACT.
   For the description and treatment of this disease, we in-
troduce the very excellent observations of Dr. Druitt:

                   DEFINITION.
   An opacity of the  crystalline lens, or of its capsule, or
of both.
                     SYMPTOMS.
   Before examining  any patient with suspected  cataract,
the pupil should be  dilated with belladonna, and then, if
there be  capsular cataract, there will be seen behind  the
pupil an  opake body, of a gray dead-white; if lenticular
cataract, of a bluish-white, or amber-colour.   The patient
usually gives, as his  history, that his vision  has become
gradually impaired—that objects  appear of irregular out-
line, or multiplied, or  as  if surrounded with a mist, or as
if a cloud were interposed between him and  the eye.   If
lenticular cataract alone  be present, he will say that  the
sight is better in the evening, or in a subdued light, or
when the back is turned to the window, or after the appli-
cation of belladonna—obviously because the  pupil, being
dilated under these circumstances, permits more light to
pass through that part of the lens which is as yet transpa-
rent, or which, though  opake, is thinner,  and,  therefore,
affords less obstruction  to  light than the  centre.  In  the
most confirmed cases, the patient is  yet able to distinguish
day from night. 
SURGERY.
803
   There is also the catoptric test—that is, the mode of exa-
mining the eye by the reflection  of  light, which was pro-
posed by Mr. Sanson.  When a lighted taper is moved be-
fore the eye of a healthy person, three images of it may be
observed—1st. An erect image, that moves  upwards when
the candle is moved upwards, and that is produced by re-
flection from the surface of the cornea.  2d. Another erect
image, produced by reflection from the anterior surface of
the  crystalline lens, which also moves upwards when  the
candle  is moved upwards—and 3d. A very small inverted
image, that  is reflected  from the posterior  surface of the
crystalline lens, and that moves downwards when the can-
dle is raised upwards.   To render this more distinct, the
pupil should be dilated, and the examination be made in a
dark room.   Now,  in lenticular cataract, the  inverted
image is, from the first, rendered indistinct, and soon abo-
lished, and the deep erect one is soon afterwards abolished
also.  In capsular  cataract, from the  first,  only the front
erect image, that, namely, produced by reflection from the
cornea,  is visible.

                      CAUSES.
   Cataract, especially capsular, is sometimes attributed to
inflammation, and  may be  caused in a short space of time
by wounds or other injuries of the  lens and capsule, or of
the eye in general.   But the ordinary cataract of the old
seems to be a mere effect of impaired  nutrition.
   1. Hard  Cataract.—This form is met with in elderly
people  only.   Tt is  caused, according to Mr. Walton, by
grayness or opacity appearing in an already discoloured lens,
and the greater the colouration of the lens, the less  will be
the amount of grayness required to obstruct vision. After
thirty, the lens naturally acquires a yellow colour, and the
hue becomes deeper, till  it is like a piece of amber.  The
amber colour, therefore, the characteristic hue of cataract in
aged persons, is not the effect of disease.   Sometimes the 
804
SURGERY.
colour is as deep as that of dark mahogany, and Mr. Wal-
ton has brought before the Royal Medical and Chirurgical
Society the particulars of a case in which the cataract was
so black that it could not be  detected till the eye was exa-
mined with the ophthalmoscope, or the concentrated light of
a powerful lens.
   The opacity generally commences  in the superficial lay-
ers of the lens, for the most part in the form of streaks or
radii,  converging  towards the  centre,  or, more correctly
speaking, following the course of the natural  divisions of
lens.   Less frequently it commences in the nucleus in the
form  of a cloudy  opacity.  When  the  disease is  of long
standing, the surface of the cataract frequently assumes a
uniform milk or cream-white colour.
   According to Dr. R. Taylor, * the change in such cata-
ractous lenses is two-fold.  The nucleus becomes hard and
dry, to a degree far exceeding what is  ever seen  in the
healthy lens, while the superficial  layers are softened, fre-
quently to the state of a semi-fluid  pulp.  The nuclea lens-
tubes are hard, atrophied and brittle, and are rendered more
or less opake by fine molecular deposit, as well as by lit-
tle cracks and fissures.   Those of  the  superficies are soft-
ened,  and more or less  disintegrated.   They  also  are dot-
ted over with fine molecular matter, which is also  found
floating free in  masses, and filling up and rendering opake
many of the superficial  lens-cells.   This molecular matter
is probably  the  result of the coagulation of the albuminous
blastema, by which the whole of the lens textures  are per-
vaded.
   2.  Soft Cataract.—While hard cataract is seen only in
persons above thirty-five years of age, soft cataract may oc-
cur at any period  of life.  It appears to be due to disinte-
gration affecting the whole substance of the lens, similar to
that which affects the surface alone in hard cataract.  The
* Lancet, Nov. 17, 1855. 
SURGERY.
805
colour in  infancy is bluish-white,  like milk and  water.
Later in life, there is generally less of the blue tint.   The
surface frequently presents an appearance like that of frac-
tured  spermaceti,  or it may be  traversed by radii and
streaks, which glisten like a piece of tendon.  In this va-
riety vision is generally more imperfect than in the hard
kind.  The iris  is frequently pressed upon  by soft cata-
ract, but this may also occur in hard cataract when the su-
perficies are much degenerated.  This phenomenon is pro-
bably due, in the majority of instances, to  the swelling  of
the diseased lens from the  imbibition of moisture, but, in
other instances, the opinion of Mr. Walton is doubtless cor-
rect, that it is caused by unnatural vascularity in the deep-
seated textures of the eye-ball.
   3.  Congenital  Cataract must, therefore, always be soft.
In this variety, vision is generally more imperfect  than  in
the hard kind.
   4.  Capsular  Cataract.—In this variety the opacity may
be general, or may commence partially.  It is almost inva-
riably of a dead or chalky whiteness, scarcely ever shining,
and always showing the same  opacity in whatever position
it  may be viewed.   It is not  unfrequently the result of a
slow inflammation, which may be accompanied with pain  in
the eye.  It may be produced also by inflammation extend-
ing from the iris.   Opacity of the anterior portion may  be
seen immediately behind the  iris.  That of the posterior
appears at some  little distance behind  the  pupil, and pre-
sents a concave striated surface, of a dull-yellowish ap-
pearance.
   5. Capsulo-Lcnticular cataract is very common—in fact,
entire  opacity of the capsule is always followed by opacity
of the lens.
   Treatment.—The cataract must be  removed by opera-
tion.  No other treatment is of any avail to get rid of the
                          6S* 
806
SURGERY.
disease.*   It is, however, a general  rule not to  operate
till the cataract is mature—that is, net whilst the degree of
vision is sufficient for ordinary purposes;  more particularly
if the patient is very old and feeble, or if one eye is already
lost;  because, under these  circumstances, a failure of the
operation  would  entail utter  blindness.    Therefore, the
patient should assist his vision by dropping into the eye
one or two drops of carefully-filtered solution  of extract  of
belladonna 0j. ad. Ij.^) in distilled water, night and morn-
ing, so as to dilate  the pupil, and  defer  the operation till
 despite  of that aid, his blindness is complete.
   Prognosis.—This will be favourable if the patient is  in
 good health and  of temperate habits;  if the iris moves
 freely, and if the retina seems perfectly sensible  to light.
 On the  other hand, it will  be doubtful if there are signs of
 vascular disturbance in the eye; if the iris is  motionless or
 altered  in colour; or if the cataract is  complicated with
 amaurosis, softness of the eyeball, or glaucoma.
   Preparation.—Before operating, the  patient should  be
put into as perfect a state of  health as possible.   The state
of the biliary, and more especially of the urinary excretion,

  * In this we think that Dr. Druitt is labouring under a great mis-
 take,  as we have removed several cases of soft and one or two cases
 even of hard cataract by the use  of the following remedies:
       R.—Menispermin,.............,.........................3J.
           Xanthoxylin.......................................gr. x.
           Muriate of Ammonia,........................ ...gss.
           Sacch. Alba......... ................................3J.
           M. Trit. ft.  pulvis  no. xx.
  Dose, one, three or four times a day.  This medicine should be
 continued until free ptyalism is produced.
  The system should be well protected with tonics, chalybeates and
nutritious diet, and in some cases phytolaccin and podophyllin should
be alternated with the above compound.   The course of time  re-
quired to remove opacity of the lens or of its capsules will be from
six to eighteen months.   Where  this method fails, recourse should
be had to the operations as described by Dr. Druitt. 
SURGERY.
807
should be  examined, and purging, exercise, and low diet
be enjoined, if the habit is  inflammatory.   But no rude
lowering measures, or violent purgation, or sudden change
of diet should  be resorted  to  indiscriminately;  and some
patients require a better diet, with tonics and wine.
   There are three methods of operating:—1, extraction;
2, displacement (or couching;) and 3, solution, or the opera-
tion  for causing absorption.
  I. Extraction.—The object of this  operation  is, to
make an incision through half of the circumference of the
cornea, almost close to the sclerotic; to lacerate the capsule
of the lens;  and then to extract the cataract entire, through 
808
SURGERY.
the pupil.   Its advantage is, that it effectually removes the
cataract; but it is  the  most difficult of all operations for
cataract, and demands,  for  its success, much  knowledge
and  practice.  It is best adapted for hard  cataracts in
elderly people.   But it should  not be attempted, 1st, if
the patient is very  feeble, in case the wound of the cornea
might not unite.  2d.  If the anterior chamber is very small
and the cornea very flat, so that a sufficiently large opening
cannot be  made in it.   3d. If  the  iris  adheres  to  the
cornea, or  if the cataract pushes  it forward  against the
cornea, thus rendering it impossible to incise the cornea
without wounding the iris, or if the pupil is habitually con-
tracted.  4th.  If the eye is sunken, or  if the fissure of the
lids  is preternaturally small.  5th. If the eyes are very
unsteady, or if the patient is subject to habitual cough or
asthma, or is unmanageable  in consequence of infancy or
idiocy.  Some practitioners direct that one eye only should
be operated on at a time, the other being kept as a reserve,
whilst others operate on both together.
   Operation.—In the precise manner of performing this,
there are very many varieties.  Some surgeons incise the
lower, others the upper part  of the cornea; some sit be-
fore,  others behind the patient;  some  are  ambidexter,
others use  the right hand  only.  But referring those who
may wish for fuller information to the various works on
ophthalmia, we  shall  content ourselves  with  describing
one method of  operating, which is, we  believe, most gene-
rally employed at the present day.
  The instruments required  are, 1, a knife having a tri-
angular  blade;  the back  straight and blunt,  the point
sharp, the edge slanting obliquely, the blade increasing in
thickness, as well as in breadth, as it approaches the han-
dle.   The advantages of this shape  are, that it fills up the
incision which  it makes, and  prevents the escape of the
aqueous humour; and that the flap of the  cornea is made
by one simple motion, that is, by pushing the knife on- 
SURGERY.
809
wards.  That used by Mr. Walton measures from the point
to the shoulder .8 inch, and across the broadest part .4 inch.
  2. A curette;  an instrument with a curved needle at one
end, and a small spoon at the other.   Mr. Walton has de-
vised a guarded curette, in which the  hook is concealed
till protruded by a spring.  3.  A secondary knife to en-
large the incision in the cornea  if required.  4. A sharp
hook.
  The patient may be either sitting, or  lying on his back,
with  the head properly supported,  and in a good light.
The  operator, behind him, uses his right hand for the
right, and  his left for  the left eye.  An assistant draws
down the lower lid, and steadies it against the malar bone,
without pressing  on the globe.   The  operator, with the
forefinger of the non-operating hand, raises the upper lid
and locks it under the  edge of the orbit, just resting the
point of this forefinger against  the  upper surface of the
globe, and that of the middle finger against its  inner  sur-
face, so as to steady it.   Then holding the knife lightly with
the thumb and first two fingers of the other hand, and rest-
ing his hand against the side of the face, he commences by
1st. Puncturing the cornea at the centre  of its outer margin,
half  a  line from  the  sclerotica.  (See  fig. 94.)  2d.  The
blade is pushed gently across, parallel with the iris, in such
a way that the point shall  penetrate  the other side of the
cornea, exactly opposite to the first puncture; and that the
edge shall  cut an even  semicircular  flap of the  upper  half
of the cornea.  Just when the incision is complete, which
should be slowly and carefully done, the eyelids should be
dropped, and all pressure discontinued.  3d. Having waited
a few seconds, the surgeon lifts the  upper lid  sufficiently
to expose the cornea, tells the patient  to look towards his
feet,  so that the globe  may be directed downwards; then
introduces the curette, and freely lacerates the capsule of
the lens.   4th. He makes  very gentle pressure on the under
part of the globe, and on the  upper eyelid, till the  lens 
810                  SURGERY.
rises through the pupil and escapes.   Lastly, the eye should
be opened after a minute or two, to see that the flap of the
cornea is  rightly adjusted, and that  the  iris is  not  pro-
lapsed;  if it  is, the  eyes should  be exposed to  a bright
light, so as to make the pupil  contract, and the prolapsed
portion  should  be  gently pressed upon with the  spoon of
the curette.  Then the  operation is finished.
   Complications.—1. Sometimes,  in consequence of the
premature escape of the aqueous humour, the iris falls for-
wards under the edge of the knife.   If  the point of the
knife is completely tangled  in the iris, it is necessary to
withdraw the instrument, heal the wound, and repeat the
operation afterwards.  If, however, a little bit of it should
get under the edge of the knife, when the section is nearly
complete, the operator may push on boldly, since, if a  little
piece of it be cut, it will  be of no  great consequence.  2.
If the opening  of the cornea  is not large  enough, it must
be enlarged with the secondary knife.  3. If a portion of
the lens remain behind, it should be left to be absorbed—
unless it has passed  into the anterior chamber, and can be
removed very easily  indeed.   4.  If the  vitreous humour
seem disposed to escape, the cataract should be hooked out
with the hook.
   After Treatment.—The patient  should be put to bed,
with the shoulders raised, the room darkened, and with a
very soft dry linen rag over both eyes.  The bowels should
be kept open, and everything be avoided which is likely to
provoke coughing,  sneezing, or vomiting.   Mr. Walton
allows the usual diet, at the usual times, only in rather di-
minished  quantity;  and this plan  seems preferable to that
of keeping the patient exclusively on slops.  If all goes on
comfortably the eyelid may be raised on the fifth day, and
then if there be no prolapse of the iris, and the cornea be
united, he may get up occasionally, wearing a shade, sitting
in a darkened room, and walking about a little.   After a 
SURGERY.
811
fortnight the eye may be opened  in  a weak light, and be
gradually brought into use.   But, inasmuch as it remains
weak and irritable, the patient must  take the greatest care
to avoid  exposure  to cold, excess in diet, over-exertion of
the eye,  or exposure of it  to  too strong  a  light.   Oray
spectacles are the best  protectors against too glaring  a
light.  The  patient  will require convex spectacles  for
exact vision, but they must be used very sparingly for some
weeks.   He should have two pairs, one with a short focus
for near objects, and another of long focus for  distant ob-
jects.  The inflammation which may come on after  the
operation may be of two kinds.  If the eyelids are swollen,
and florid, and tender,  and  there is  a thick yellow secre-
tion about the lids,  and the  conjunctiva  is red, swollen,
and ecchymosed, the inflammation is acute, and requires to
be treated  by veratrum and purging.   But if,  as  Mr.
Tyrrell shows, the palpebrae are not much discoloured,  and
the  conjunctiva cedematous, the patient will be benefited
by good broth, carbonate of ammonia and opium.
   II.  Depression  or  Couching.—The object  of this
operation is to remove the cataract from the axis of vision.
It is a clumsy and violent  operation, and adapted only to
those cases of hard cataract, of which the extraction would
be unadvisable, for reasons mentioned in a preceding page.
The disadvantages of it are, that the pressure of the lens
on the ciliary processes and retina is liable to  be followed
by protracted inflammation or  amaurosis; and  that  the
lens may rise again to its old place,  and obstruct vision as
before.   The preparation of the patient, his position during
the operation, as well as that of the surgeon, and the duties
of the assistant, are the same as required for the operation
of extraction.   The pupil should be dilated with belladonna.
   Operations.—1. A curved needle  is passed through the
outer side of the sclerotic, the ^th part of an inch behind
the margin  of the cornea, and in the transverse axis of the
globe.   It is  carried into  the vitreous  humour, upwards 
812
SURGERY.
and forwards behind the iris, and in front of the cataract;
which then  is steadily and  gently pressed upon till it is
carried downwards out of  sight.  It  should be held down
for a few moments to fix it, and if it rise again, it must be
again depressed for a  short  time.   Then  the needle  is
withdrawn.
  2. Egerton's Plan.—The cataract is transfixed through
the sclerotica with  a straight  needle, and  carried down-
wards in  an oblique direction.  The late Mr. Scott  and
Mr. Morgan used to practise this.
  III.  The Operation for producing Absorption  is
very easily performed, and excites  very little inflamma-
tion; but it requires to be repeated several times,  and the
cure occupies several weeks  or months.   It is well  adapted
for soft cataracts, especially the  congenital, but very sel-
dom, if ever, answers with the hard cataracts of old people.
The instruments employed are needles, straight or curved;
which are now made of great delicacy, strength, and hard-
ness.   The pupil must be  freely dilated.
   Operations.—1. The needle  may be introduced behind
the iris in the same manner as  for depression.  Then the
anterior layer of the capsule is to be freely divided, and
the needle, having been passed once or twice through the
substance of the lens, is to  be withdrawn.  Care must be
taken not to dislocate the  lens in this  first operation.  The
cataract will  be more  or  less dissolved by the aqueous
humour, and be absorbed.   After the lapse of a few weeks,
the operation  may be repeated, the capsule may be  lacera-
ted more  extensively, and  the lens be  cut  up into frag-
ments, which, if perfectly soj„,'loaaj be pushed through the
pupil into the anterior chamber, where absorption is more
brisk.  This operation may be repeated  again  and again,
if necessary.  But if a hard fragment  be pushed into the
anterior chamber, it may  probably excite great inflamma-
tion, and require to be removed by operation, so that the 
SURGERY.
813
surgeon had better  avoid  attempting to do too much  at
once.
  2. Or the needle may be introduced through the cornea,
an operation, now styled the anterior operation; formerly
keratonyxis.  It is safer, simpler, less painful, and less inju-
rious to the eye than the first mentioned;  inasmuch, as a
wound of the cornea alone is less serious than one impli-
cating vitreous humour, sclerotic conjunctiva, and perhaps,
retina or ciliary process.   The needle is passed  through the
cornea, about an inch from its margin, and is made to lace-
rate the  capsule  to  the  extent of the pupil, so as to admit
the aqueous humour to the substance of the  lens; but with-
out displacing or cutting into the fragments, or in fact, at-
tempting to do too much.  This operation is liable to be
followed by severe pain and vomiting, if  the cataract be so
fluid that it mixes readily  with  the aqueous humour; or if
portions of the cataract press on the iris:  in the latter case,
the irritation may be so severe as to render it  necessary to
perform  extraction.   The  operation  may require to be re-
peated after two  or three months.
   3. There is a third modification of this operation, which
 Mr. Tyrrell termed drilling.   It is particularly  adapted
for cases of capsular, or capsulo-lenticular cataract, with ad-
hesion of the pupil, caused by  iritis.  It is performed  by
introducing a fine straight needle through the  cornea, near
its margin, and passing it through the  pupil into the lens
to the depth of   about  one-sixteenth of an inch, and ro-
tating it freely.   This operation may be repeated at interval
of four,  five, or more weeks.  It causes the lens to be dis-
solved by  the aqueous humours; and if the  puncture  be
made in a fresh place at each operation, that portion of the
capsule which is behind the pupil may become  loosened and
detached.   This  operation also, according  to  Mr. Tyrrell,
may be occasionally resorted to, to diminish the size of the
 lens, previously to depression or extraction.
       69 
814
SURGERY.
           operations  on  infants.
  Congenital cataracts should be operated on early; within
four months,  if possible, lest the eye, which, when born
blind, habitually oscillates from side  to side, may never ac-
quire the power to be directed to  one particular object.
The pupil being well dilated, the child, narcotized by chlo-
roform to insure quietness, should be placed on  a  table—
the head on a pillow, and rather hanging over it—one assist-
ant holding the legs and trunk, a second the arms and chest,
a third, fixing the head between his two hands, and a fourth,
depressing the lower eyelid with one hand, and  steadying
the chin with the  other.  The operator then, seated behind
the patient, performs the operation for absorption, as before
described.   Care must be taken not to dislocate the lens.
This operation on children, and, in fact, on persons under
twenty, generally  excites  so little inflammation, that both
eyes may be operated on at once, but the bowels must be
kept open, and leeches should be applied if there be  pain.

              CAPSULAR CATARACT.
  When congenital cataract of  the  capsulo-lenticular sort
is left to itself, the lens  often  becomes absorbed, and the
capsule, which is  mostly  tough  or  opake, remains in the
field of vision; and it sometimes happens that an opake
capsule is  left, or that it  becomes opake  after one of the
operations for cataract.  There are three plans of treatment.
1. A needle may be introduced, as for depression; and then
may be made  to  tear through  the  opake capsule,  which
then may shrink and leave the  pupil clear.   2.  The upper
part of the capsule, for four-fifths of its circumference, may
be detached by the needle from  the suspensory ligament,
and then be pushed  down below the  pupil.  3. If no other
plan succeed, an opening may be made in the cornea, through
which it may be extracted by means  of a small hook or for-
ceps.   Mr. Middlemore has proposed a plan for removing
such bodies  through the sclerotic. 
SURGERY.
815
  There is great uncertainty of clearing  the  pupil of cap-
sule by any other mode but extracting it, yet so dangerous
has that operation been deemed, from the escape of the vitre-
ous humour, which is almost sure to occur, when previous
operations have been done within the eye, that  the extrac-
tion is seldom attempted.  To meet this difficulty, Mr. Haynes
Walton has introduced into practice, a peculiar  sort of for-
ceps, for  the removal of the capsule.  The instrument is
no larger than a needle, so that the opening in the cornea
need not be larger than necessary to allow of the exit of the
strip of  capsule, and all the  objections  to  extraction are
overcome.
          DISEASES  OF  THE  EAR.
    FOREIGN  SUBSTANCES  TN  THE  EAR.
  Children frequently put peas, beans, kernels of corn, bits
of glass, &c, into the ear, which, if allowed to remain, will
produce active inflammation.  Hence, they should be re-
moved as  soon as possible.  It may be done  by syringing
the ear with warm water or by means of forceps.  (Fig. 95.)
                        Fig. 95.

   ACCUMULATION  OF  WAX  IN  THE  EAR.  ^
   Wax frequently accumulates in the ear to such an extent
as to obstruct the hearing.   It should  be removed  by fre-
quently syringing the  ear  with  warm water.   If it is not
removed by the first syringing, it should  be  repeated, and
the ear kept packed in the  intervals with pads wet in warm
water. 
816
SURGERY.
                     POLYPUS.
  Fleshy pedunculated growths sometimes occur in the ear.
They generally spring from the glandular  portion of the
meatus.  They should be clipped off at the point of attach-
ment, with a pair of fine pointed scissors, and the wound
touched with a weak solution of sulphate of zinc.

   FUNGOUS GRANULATIONS OF  THE EAR
   Should be removed by syringing with a  solution of  ni-
trate of silver  of the strength of three grains of the silver
to one ounce of water.   Afterwards apply a lint to the ear,
moistened with the following ointment:—
      R.  Glycerine.................................................3J-
         Sanguinarin,.............................................Sr- x-
   njj. Wet small pledgets of lint with it, and apply to the ear twice
 a day.
  NEURALGIA  OF   THE  EAR,  OR  OTALGIA,
   Signifies violent pain in the ear, and is  caused by  local
 inflammation and carious teeth, together with the general
 causes of neuralgia.  Treatment.—If caused by inflamma-
 tion, a warm poultice of slippery elm, moistened in tincture
 of opium, should be applied, and repeated as often as it gets
 cold.  If produced by carious  teeth, the  tooth  should be
 removed.   If  it is a general neuralgic affection, it should
 be treated as indicated under the head of  neuralgia.

                      DEAFNESS.
   Deafness may be caused by a closure of the Eustachian
 tubes, by enlarged tonsils,by anaesthesia of the auditory nerve,
 and by inflammation and ulceration of the tympanum.  It
 may depend upon organic lesion of the brain.  Treatment.
 —When it depends upon  enlargement of  the tonsils, com-
 pound syrup of stillingia and  iodide of potassium should
 be given, internally, and the throat frequently gargled with
 a decoction of equal parts of hydrastus capsicum and  bay- 
SURGERY.
817
berry.   Where it depends upon anasthesia of the nerve,
the following compound may be given:
      R. Prussiate of iron,......................................%'}•
        Keith's Strychnin........................................gr. j.
        Quinine,...................................................gr- x-
        UK ft. pulvis No.  xx.  Dose, one every 4 hours.
   The parts around the ear should be bathed three or four
times a day, in a strong decoction of capsicum, and in some
cases, gentle  currents of electricity may be passed through
the ear to advantage.
INJURIES AND DISEASES  OF ARTERIES.
                 WOUNDS  OF ARTERIES.
  Symptoms. —An artery may be known to be wounded by
the flow of blood, which is in repeated jets, corresponding
to each beat of the pulse, is profuse, and of a florid colour.
  Pathology.—The bleeding from wounded arteries must
necessarily be dangerous, because, from the nature of their
coats, they remain open  and patulous, and do not collapse
as the veins do, and because of the  perpetual current of
blood impelled by the heart.
  There  are  four processes employed by nature for the
temporary suppression of hemorrhage.  First, the divided
orifice contracts;  and secondly, it retracts into the cellular
sheath; thirdly, the blood coagulates in the sheath of the
artery, and in the wound,  and thus  obstructs  the farther
exit of it; and fourthly, the faintness induced by hemor-
rhage both checks the current of blood, and gives it an in-
creased disposition to coagulate.
  These processes will not succeed in stopping the flow  of
blood in large arteries, unless the wound be very small, and
but rarely in arteries of the second order; but if the wounded
artery be  small, the hemorrhage will generally cease spon-
taneously.
       J                  69* 
818
SURGERY.
  Partial division, or puncture of an  artery, is more dan-
gerous than complete division, because contraction and  re-
traction  are prevented.   When an artery is torn across it
contracts almost  immediately,  and becomes  quite imper-
vious.
   Treatment.—For the suppression of hemorrhage by liga-
ture, we have  already  given the treatment on page 290.
The medical treatment consists in the application of styp-
tics, such as geranin, tannin, matico, Beach's styptic pow-
der, ice water, and pressure.  These remedies may be used
in combination or alone, when the nature of  the injury is
such that the ligature cannot be  applied.  Where there is
secondary hemorrhage, or a hemorrhagic diathesis, capsi-
cum, iron, and cod  liver oil, are the  remedies to be used
internally.  The best method is  to give  two grains of cap-
sicum, and  one of iron, in  one tablespoonful of cod liver
oil, three or four times a day.
   Inflammation of the Arteries is of three forms:—1. Sub-
acute Arteritis  is a  local inflammation, producing redness
and thickening of the  artery,  with effusion of lymph into
its cavity, and  coagulation of blood within it.  The symp-
toms are tenderness  and swelling of the  affected part, with
violent pain, numbness, absence  of arterial pulsation, and
tendency to gangrene in the parts receiving blood from  the
affected  artery.
   Acute Arteritis (Encysted ox Effused Arteritis) has a ten-
dency to involve the arterial system generally, and produce
rapid  suppuration.   It may be  idiopathic, or caused by a
wound.  It is known by very violent fever, and great throb-
bing of  the arteries, succeeded  by symptoms of typhoid
fever,  with livid vesications on different parts of the body.
   Chronic Arteritis  may be supposed to be  an occasional
cause  of thickening, softening, ossification, occlusion, and
other forms of  degeneration of the arteries.
   Treatment.—In sub-acute arteritis and erysipelatous ar-
teritis  hot packs should be applied to the aflected parts, and 
SURGERY.
819
changed as often as they get cold.  The bowels should be
opened with small doses of jalapin and apocynin, after which
the patient should  be put upon one-sixteenth of a grain of
veratrin, and from  one to two grains of quinine, every two
or three hours, until the disease is controlled.  The chronic
form of the disease should be treated with compound syrup
of stillingia,  compound syrup of frostwort, iodide of am-
monia, iodide of iron, iodide of potassium, &c.

                     ANEURISM.
   An  aneurism is a  sac  filled with blood,  and communi-
cating with an artery, by the rupture or dilatation of which
it has been produced.
   There are three kinds of  aneurism:—First.   The true
aneurism, which consists of a sac formed by  one or more
of the arterial tunics.  Second.  The false aneurism, which
is formed  after a  puncture of an artery by a  dilatation of
the adhesive lymph by  which the puncture  was united.
Third.  Diffused aneurism, formed when  an artery is lace-
rated by fractured bone,  or ruptured by a blow without a
wound in the skin.
   Pathology.—The formation of an  aneurism is  preceded
by some disease of the artery, and generally commences by
a giving way of its middle and internal coats at the site of
some atheromatous spot,  after which the pressure of the
blood dilates the external or cellular coat  into a pouch.
   Symptoms. — If an aneurism be  seated  in the neck or
limbs, it appears  as a tumour in the course of an  artery,
and pulsating with it; if in the  chest, it will be principally
known by an unnatural pulsation felt by the patient, to-
gether with symptoms of disordered  circulation and respi-
ration; and if  in  the abdomen, it may be felt through the
parietes.
   Diagnosis.—Tumours in the vicinity of arteries  may be
distinguished from aneurisms by the absence  of  pulsation.
Aneurismal tumours are  usually soft, and yield a peculiar
fluctuation upon percussion. 
820
SURGERY.
   Prognosis.—As an aneurism enlarges it usually becomes
strengthened  by the adhesion of its walls to the adjacent
cellular tissue, although its coats  are  thinned by gradual
extension.  The gradual extension of an aneurism upon
contiguous tissues produces their absorption; thus the ab-
dominal and thoracic viscera, the bones, and even the tra-
chea and  bronchia, are not  unfrequently destroyed by con-
stant pressure of aneurismal tumours.  The disease may
result in  a spontaneous cure, by the gradual cessation of
the circulation of blood, the formation  of a firm coagula in
the sac, and  the gradual absorption of the tumour; or it
may prove fatal by the rupture of the sac and hemorrhage,
or by pressure and absorption upon the spinal column, or
other vital parts.
    Situation of Aneurism.—The most common form of aneu-
rism, is that of the aorta; the next, popliteal artery; third,
femoral in  the groin; fourth, carotid;  fifth, subclavian;
sixth, axillary; seventh, external iliac;  eighth, innominata;.
and in other arteries only occasionally.
    Causes.—Aneurisms are produced, first, by predisposi-
tion on the part of the patient to arterial disease; second,
by strong mental emotions, by injuries, great bodily exer-
tions, &c.
    Treatment.—Where an  aneurism is  produced by a ten-
dency to disease of the arteries, the patient should be placed
in  bed and kept perfectly quiet, and put upon cod liver oil,
iron, myricin, chimaphilin, alnuin, and such other remedies
as will impart vigour and tone to  the constitution, and regu-
late the emunctories.   At the same time a sufficient amount
of  veratrin,  or the essential tincture of  veratrum  viride,
should be given to control the circulation.   The pulse should
be  kept at about fifty-five or sixty;  then, if the aneurism is
located so that pressure can be made, folds of cotton  should
be wrung  out of hot water, and applied with a moderate de-
gree of pressure, by means of a bandage.   These packs
should be changed as often as they get cold, and the pressure 
SURGERY.
821
renewed.  I have recently cured  a bad case of popliteal
aneurism by this method, and  arrested the progress, and
nearly dispersed the tumour in several  other  cases.   In a
few cases I have derived benefit by passing gentle currents
of electricity through the tumour.   Where this method does
not succeed, the arteries should be ligated between the aneu-
rism and the heart.  The ligature should not be placed so
near the aneurism  as  to involve diseased  portions of the
artery, or so  far  from it as  to allow the circulation to be
kept up by collateral  branches.   When the  artery cannot
be  tied between  the  aneurism and the heart, it has  been
proposed to tie it on the distal  side, and the  operation has
been performed successfully by Mr. Guthrie, Wardrope, and
others.
  Diffused Aneurism is a wound of the artery by a broken
bone, without laceration of the  skin.
  Aneurismal  Varix  is produced  by puncturing an artery
through a vein, the adhesion of the coats, and a permanent
opening between them.  The ligature is the treatment.
  Fistula in Ano signifies a small cartilaginous opening by
the side of the sphincter ani.  It is called complete fistula,
when it opens into the bowels; and blind fistula, when it
does not open into them.  It is difficult  to cure, on account
of the  constant interference of the sphincter and  levator
muscles.
  Causes.—It is produced by  abscesses near the rectum,
which are caused by hemorrhoids,  ascarides, obstinate con-
stipation, and  injuries and foreign bodies introduced into
the rectum.
  Treatment.—The bowels must be regulated, and any  de-
fect in  the system receive  attention;  after  which three
methods have been introduced for curing this disease.  One
is to introduce a sharp-pointed  bistoury into  the opening,
extending it through  to the  rectum, and introducing the
finger into the rectum, bringing the finger and point of the
knife in contact, and withdrawing them  both at the same
time, so as to separate the sphincter and adjacent tissues. 
822
SURGERY.
   The  second method is to pass a ligature, secured to the
 end of a bent probe, through the sinus into  the rectum,
 and out at the anus,  tying the  ends to a small cork, and
 twisting it every day until it finally cuts its way through.
 Silver and gold wire, and silk and catgut ligatures are used
 for this purpose.
   The  third  method is  that of  introducing a solution of
 sesqui-carbonate of potassa, or sulphate of zinc, of sufficient
 strength to break down the fistulous induration and cause
 adhesive inflammation.  This can usually be accomplished
 by dissolving one dram of sulphate of zinc in one ounce of
 water, and injecting it into the sinus.  It should be injected
 with sufficient force to reach the base of the disease.   Some
 prefer  a  solution  of  sesqui-carbonate  of potassa,  of the
 same strength.   If this method does not succeed  after a
 few months' trial, together with constitutional treatment,
 pledgets of lint, moistened with  an ointment of sanguina-
 rina or podophyllin, may be crowded  into the opening and
 caused to remain until suppuration and sloughing ensue,
 when they should  be  removed, and the parts  injected, as
 previously stated.
   Abscesses about the Rectum.—Abscesses about the rectum
 are characterized by the same symptoms as abscesses in
 other parts of the  body.  They should be treated by hot
 packs, hot sitz-baths, anodyne poultices, mild purges, vera-
 trum, aconite,  and  rest.   When pus  forms, the abscess
should be opened;  and if terminating in fistula, treated as
previously described.
                    TETANUS.
   Tetanus is often the result of wounds, and is a disease
of the spinal cord, produced by  causes at first of a local na-
ture.   The  characteristic symptom  is spasm.   When  the
muscles upon the anterior part of the body contract most,
so as to bend the  body forward, it is called Emprosthoto- 
SURGERY.
823
nos; when those on the back, Opisthotonos; when the body
is bent to one side, Pleurothotonos.   Tetanus may be acute
or chronic, traumatic  or  idiopathic.   The acute and trau-
matic are most frequent, and come most properly under the
care of the surgeon.   This disease occurs most frequently
in hot climates, from  punctured  and lacerated wounds in
tendinous parts.  It is common in military practice, and is
more  often observed in men than in women.  The predis-
posing causes are not  well known.  The period of develop-
ment greatly varies.   Usually, however, it  occurs  in from
one to thirty days from the time of the injury.-  It is a dis-
ease of the excito-motor  nerves.

                     SYMPTOMS.
  At first there is pain and stiffness in the neck and about
the jaw.  The natural antagonism of the facial muscles is
wanting, giving rise to a peculiar ghastly and puckered ap-
pearance.  Thirst and dryness of the fauces, difficult deglu-
tition and mastication, stiffness and  rigidity of the neck,
tonic spasms of the masseter and temporalis muscles, dis-
torted eyeballs, dilated nostrils, pain  shooting through from
the lower end of the  sternum to the back, caused by spasm
 of the diaphragm, are the usual symptoms.   Then succeed
 general spasms of the abdominal and respiratory, and of the
 entire muscular system.   The sphincters are involved in the
general  spasm, the bowels are, therefore, constipated, and
the urine is retained.  There is intense pain and profuse
 perspiration.   The pulse, before full and strong, becomes
 weak.   The intellect is unclouded  until gradual  asphyxia
 and exhaustion bring on the coma of death.
   In the acute form, the disease seldom continues beyond
 a few days.
   The treatment is local and constitutional.
   The local treatment  consists  in  dividing the  nerve by
 making, close to the vessel  if possible, a V shaped  inci-
 sion  down to the bone, so as to divide all  the nervous  com- 
824
SURGERY.
munication between the part and the spinal cord.  The part
should then be enveloped in a warm poultice of slippery elm,
or put into a warm alkaline bath, or fomented, according as
these means produce relief to the patient.   To the  divided
tissues atropin  may be  beneficially applied, to lessen local
irritation.  With a view to produce free sloughing, caustic
potassa is recommended, its use to be followed by poultices
and  fomentation.  The bowels should be  opened by three
grs. jalapin, 3J- cream of tartar.   Divide into three powders,
and give one every three hours.   Then the tincture of lobe-
 lia, and a strong infusion of scutellarin and cypripedin should
be given, at first in small doses, and gradually increased un-
til free and copious emesis is produced.  If this should not
overcome the spasm, a vapour bath should be administered,
and  enemas of lobelia given until every muscle is relaxed,
and  the  respiration  and deglutition  are normal and  easy.
 The use of lobelia is  much safer than that of tobacco, and
 its relaxing effects may be carried to a greater extent with-
 out  endangering life.  The cannabis indica, given in three
grain doses of the extract, repeated every hour or half hour
until narcotism is produced, is highly recommended by Dr.
James Miller.  At the  same time that these powerful seda-
tives and antispasmodics are acting upon the system, espe-
cial care should be observed to sustain the strength by nu-
tritious enemas, and by drinking of  nourishing broth and
gruel, and the administration of stimulants and tonics.  From
one-tenth to one-eighth of a grain of Keith's Strychnin given
every two or three hours, until one or two  grains are given,
has proved effectual.   Of late, the application to the spine
of solid ice, impacted in a large intestine or a bag, has been
highly recommended to  allay inflammation of the spinal cord.
It operates as a powerful sedative, and may be applied so
long as the system is not prostrated by its effects, or so long
as it does not produce syncope, chilliness,  and a feeble
pulse.   Aconite and belladonna, more especially the former,
have been used to considerable extent in cases of disease of 
SURGERY.
825
the spinal  cord.   Opium has been thoroughly  tested  in
these cases, and found not to be well adapted  to the remo-
val of the difficulty.  To procure rest,  hyoscyamin, conium
and lupulin will be found preferable remedies.  Aconite, as
an antiphlogistic, is deserving of high  reputation, although
its antispasmodic  tendency is not so great as that of lobelia.
The tinct. of the cannabis indica is often useful, and should
be prepared from the inspissated extract.  I will here re-
mark that  the strength of this remedy is variable.  In the
Pennsylvania Hospital an article has  been used  so power-
ful,  that one-twelfth grain has been the prescribed dose.  It
is well, therefore, to test the strength  of each specimen of
the  remedy  before administering  the maximum dose, to
which reference is above made.   Chloroform and ether are
thought to be beneficial; but these anaesthetic agents are
not so valuable as the relaxing means above referred to. If,
however, the circumstances should require their use,  after
other means fail, they deserve  a trial.  Counter-irritation
over the spine, with the endermic use of aconitine, atropine,
and morphine, will sometimes prove  valuable adjuncts in
treatment, but will seldom be necessary after the use of the
means already described.  Veratrin, from  the veratrum vi-
ride, is another sedative agent of great power, that is appli-
cable in cases of high sthenic inflammation, and will, there-
fore, be most useful in the  inflammatory stage of this dis-
ease.
   Aside from these remedial measures, the use of hygienic
means is imperative.   A pure air, frequent ablutions of the
surface, perfect freedom from  care,  quiet, and seclusion
from noise and light, and  all intruding visiters, must be
observed.
   A summary of an Eclectic constitutional treatment, adapt-
ed to the cure of this formidable disease, is this:—absolute
rest and seclusion, purgations to cleanse the alimentary ca-
nal, intestinal enemas of a  nourishing and stimulating cha-
racter,  nutritious gruels and broth, given  frequently in
        70 
826
SURGERY.
small quantities, cold applied to the spine so long as agree-
able, and not too sedative; the use  of lobelia, scutellarin,
cypripedin, in infusion, to produce emesis and  relaxation,
with the early administration of tonics and stimulants, on
the first appearance  of prostration.  Under this course of
medication the majority  of  cases will recover, for I feel
confident that this  treatment is much more philosophical
and effectual  than  that heretofore prosecuted by medical
authors of the Allopathic school.
                HECTIC  FEVER.
   When fever arises as the result of the absorption of pus,
it is called hectic fever.   In many  instances, hectic fever
has been known to arise from the introduction of very small
quantities of pus into the blood.
   In surgical practice hectic is very frequently met with
in cases of disease or injury of the joint.  It may occur in
all cases where pus is so  confined as to be absorbed, as in
the last stages of consumption; also, where there is great
debility—especially in scrofulous  and tuberculous consti-
tutions.
                       SYMPTOMS.
   In surgical hectic, the symptoms are never so prominent
as they are in consumptive or scrofulous subjects, yet they
are  sufficiently  so to  indicate the true nature  of  the
disease.
   In hectic fever, one of the first symptoms is usually wan-
dering pains in  the limbs like rheumatism, in some cases
being of the most acute and torturing character.
   In one case of hectic fever which  came under my notice,
caused by the absorption of pus from the uterus, the  pre-
monitory symptom was acute pain in different parts of the
body, of a neuralgic character,  appearing  in regular parox-
ysms, and  lasting four or five  hours. In other cases, the 
SURGERY.
827
pain amounts  only to a mere aching of the bones, accom-
panied by a feeling of  languor and lassitude, very much
resembling incipient ague.  As soon as the fever is fairly
set in, the pains mostly leave.
   "The first symptoms of hectic may be easily, and, in
fact, frequently are,  unnoticed; it  is so irregular in the
occurrence of its paroxysms, that in any six days of its
duration, there will not be three of these days in which the
paroxysm will happen at the same hour.
   "The patient at first only feels a little weakness; he  is
conscious  of not being able to use as much exertion as he
used to do, and his friends remark that he does not look so
well; he rapidly loses flesh, yet his appetite may be as good
as usual, and his functions go on regularly.   It is soon per-
ceived that once or twice a day he gets a change.  About
noon a shivering comes on, and lasts perhaps for half an
hour, during which  he looks  pale, and his countenance
drawn in; after this  the warmth returns, and the heat soon
increases beyond the standard  of comfort, particularly in
the palms of his hands, &c, which have a peculiarly biting,
hot feel.   There  is  nothing in this cold and hot stage of
hectic like the corresponding symptoms of most other fe-
vers.  He may, without arousing any particular attention
in his attendants at the incident, get his chair drawn nearer
to the chimney, have the fire stirred, and have something
wrapped round his feet; by and by he complains that the
fire is too brisk, moves  away from  it, has a  screen inter-
posed, causes the door to be left open, and that's all.  Some-
times the  chilliness returns  during  the hot stage, or there
comes on the  sweating stage,  (which, in hectic, is not  a
general full  perspiration over  the whole body,) and on its
subsidence, leaves the patient pretty well  until  the next
attack, which  usually comes on about six or seven o'clock
in the evening.   The sweating is seldom perfect; it is ge-
nerally over the chest and arms, but sometimes on the lower
extremities  alone; it is not like the sweat in some other
\ 
828
SURGERY.
cases, but a greasy kind  of moisture.   The appetite, as I
have said, remains  tolerably good, and the thirst is  less
than in other fevers.   As it goes on, the patient still loses
flesh and strength, the appetite begins to decline, his tongue
continues clean, but  redder than natural; his  mind be-
comes  easily excited,  his  pulse  is about  ninety—seldom
gets as high as one hundred and twenty; his countenance
changes; his forehead seems larger from the falling off of
his hair; his eyes get a pearly white appearance, and some-
times are peculiarly brilliant; he flushes often, or there is
a circumscribed redness on one or both of the cheeks; his
nose is drawn in, and  his  finger nails  become incurvated.
A colliquative  diarrhoea generally occurs in the morning,
and when this is  the case, he sinks rapidly—not, indeed,
as some imagine, from the consequences of the diarrhoea
itself,  but from the extent to which  the fever has arrived.
He will complain of a slight sore throat, perhaps, and, on
examination, a number of white specks, called aphtha?, are
seen on the soft palate, or perhaps on the tongue, or under
the tongue, or, what is more frequently the case, there will
be seen a large ulcer  in the throat.
   " In the beginning the hectic has intermissions, more or
less perfect, but it soon becomes remittent—that is, never
entirely subsiding.   In  some surgical  diseases, as cancer,
this fever  presents few of its prominent  characters well-
marked, such as you might observe, for instance, in exten-
sive disease of a joint.  In some diseases you will see one
symptom, as the diarrhoea,  almost  alone; in  others the
sweating, and so on—in fact, there is a great variety in its
appearance  and course."
   As the disease becomes  advanced, night sweats usually
take the place  of  the fever, and in many cases the night
sweats are consecutive upon, or may be alternated with it.
Whenever this occurs, the patient usually sinks rapidly,
and, unless relieved, will succumb to the disease in a short
time. 
SURGERY.
829
                   TREATMENT.
  The treatment of hectic  depends much  upon the cause
or causes which give rise  to  it.  When it  is dependent
upon disease of a local character, the local disease should
be treated in connexion with constitutional.   If caused by
confined pus, if the pus be  so situated as to be discharged,
it should be done,  and thus prevent its absorption.
  The internal remedies  consist entirely of antiseptics  and
tonics.  Among the  best  antiseptics used for hectic, is
strychnine, in doses of from one-tenth  to one-eighth of a
grain.   The preparation  of B.  Keith & Co., of New York,
is the  best that  I  have ever used.   Also, one-half to  one
drop of hydrocyanic acid three or four times a day, in com-
bination, or in alternation  with phosphate of lime, or in
connexion with the consumption-pill, or the compound wine
bitters, as recommended  in the formula  of this book.   In
some cases, Beach's wine bitters may be used.  For  the
fever,  aconite  may be used in  connexion with warm baths
and cooling acidulated drinks.   If there are night sweats,
give the following: three tablespoonfuls of strong sage  tea,
and five drops of  nitro-muriatic acid,  every two or three
hours  during the day.  The surface should be bathed every
night in a strong solution of salt and water,  followed by a
cold bath in the morning,  and  brisk  friction, until a com-
plete reaction  is produced.  The patient should be allowed
a liberal amount of brandy, wine  or porter, three or four
times a day, with exercise  in the  open air, and as strong
diet as the stomach will  tolerate.
                    BRUISES.
  Bruises are caused in various ways—by pressure between
two hard substances, by falls  and other injuries that rup-
ture a greater or less number of capillary vessels, nerves,
                           70* 
830
SURGERY.
&c, without tearing, cutting, or absolutely destroying the
continuity of the parts.  Slight bruises, in many instances,
are quite as painful as those which are more extensive, al-
though, from extensive bruises, much more serious conse-
quences are liable to follow.

                     SYMPTOMS.
   A bruise is  usually of a dark-purple colour, (ecchymo-
sis.)  This is owing to the escape of blood from the minute
vessels into the areolar tissue.
   In the course of a few hours after the bruise, the parts
usually become very painful  and swollen.   If the injury
occur to the fingers or toe-nails, they will become blackened,
and the pain will be very severe.  If the bruise is very ex-
tensive,  the countenance will be pale, and there will be
nausea and vomiting, weak pulse, anxious expression of the
countenance, imperfect respiration, dull, heavy pain in the
head, unless the injury be directly to the brain, in which
case  there will be stupor, and, in  some cases, involuntary
discharges from the bladder and bowels.   The surface will
be cold, and covered with a clammy  sweat.  If the bruise
involves the vital organs to any considerable extent, it may
very soon terminate in death.  But where the injury is less
severe, in a short time reaction will  take place, the pulse
will become full, the skin hot and dry, with general fever,
&c, &c.
                    TREATMENT.
   The treatment will depend  altogether upon the  nature
and extent of the injury.  If the injury be slight, but lit-
tle more  is necessary than to wrap the part in cold water
and remain quiet  for a short  time.   But when the bruise
is violent, the patient ought immediately be put to bed, and
the injured part should be kept in a hot pack. At the same
time a warm cordial should be  administered, or some ac-
tive stimulating medicine should be given, as capsicum,
xanthoxylin, &c.  When  reaction  takes place, to  remove 
SURGERY.
831
the fever, aconite or veratrum  should be given, and the
entire surface should be frequently sponged in tepid water.
When  the constitutional  symptoms are controlled, if the
hot packs have restored  the normal circulation to the  in-
jured part, no further treatment will be indicated.  On the
contrary, if the part still  presents a dark purplish appear-
ance, is tumid and painful, the following stimulating poul-
tice will be found valuable : Take pulv. slippery elm, pulv.
indigo weed, equal parts; gum myrrh, one-half part; and
pulv. prickly ash, one-fourth part;  wet with good brewer's
yeast, and apply, changing as often as indicated.  Inter-
nally, from five to ten drops  of arnica, and a  mild anti-bi-
lious purge, will be all that is  indicated, unless the vital
organs are involved, when stimulants and tonics may be re-
quired.
   The old practice of bleeding patients who have received
a recent injury is a very pernicious one, and cannot be too
strongly deprecated.  Its baneful effects  are not unfrequently
exhibited in the consumptive and scrofulous progeny of those
who  have been  the subjects of  this  disastrous practice.
Where the nails  are bruised, and the  blood settles under
them, much relief  will be found by cutting through the
nail, and allowing the blood to escape, afterward applying
hot packs.   For a wash to bathe the parts where the cuti-
cle is not destroyed, tincture of arnica and lobelia will be
found valuable.   In all cases, the  parts should be so tho-
roughly stimulated  as to  prevent gangrene and mortifica-
tion, or  the formation of ulcers, which so frequently occurs
as the result of bruises.

          NECROSIS,  OR  CARIES.
  The bones, as well as the soft  parts, are liable to inflam-
mation, ulceration, necrosis, or death and exfoliation.

                     SYMPTOMS.
  When inflammation of the bones occurs in an acute form,
there is usually pain, frequent and hard pulse, with marked 
832
SURGERY.
derangement of the nervous system.   When the disease as-
sumes a chronic form, the pain is more of a heavy, aching
character than in the acute form.  In most cases where the
disease assumes a chronic character, it is either connected
with a syphilitic, mercurial or scrofulous taint, or appears
in one who has taken a large amount of iodide of potassium,
or it may be the sequel of acute inflammation, arising from
colds, rheumatism, periostitis, &c, or it may be the result
of metastatic, of syphilitic, mercurial or scrofulous diseases.
Necrosis of the bone frequently occurs as the result of de-
ficiency of osseous tissue in the food—hence it is more fre-
quently met with among the  poor and ill-fed than  others.
Wherever necrosis occurs, and whatever cause may contri-
bute to it, exfoliation and discharge of bony matter are its
symptoms.
                    TREATMENT.
   The general  treatment consists  in supplying the system
with plenty of material for bony tissue, and the thorough
cauterization of the  diseased bone.
   The following compound I have found most effectual as
an internal remedy in necrosis.
   Take phosphate of lime, one-half ounce;  common table
salt, one-fourth ounce; carbonate of iron, one-fourth ounce;
the white of six eggs; mix  the white of eggs, lime, salt,
and iron, and  add  one  pint  of best port wine.   Let the
patient take  from one-half to one wine glassful three or
four times  a day.  The bowels should  be  regulated by
neutralizing  mixture and leptandrin or euonymin, and the
surface frequently bathed in  lye water.  The diet should
be  nutritious.   The practice of giving alterative syrups,
with iodine and potassa,  in all cases  of bone disease, I be-
lieve to be fraught with  evil;  unless there  is some  abnor-
mal deposit to be absorbed, it should not be practised. The
object  of the treatment  is not to  increase  the molecular
changes of the part by alteratives, but to prevent such ab- 
SURGERY.
833
normal  changes by the use  of tonics  and  antiseptics
Hence quinine, hydrastin,  oil of tar,  macrotin, cerasein,
pipsisseway, chamomile, poplar bark, balmony, iron, wine
and porter, are among the class of remedies to accomplish
the desired purpose  in necrosis.   The  bone should be
thoroughly cauterized with caustic potassa, or the sulphate
of zinc, followed by the fir and zinc ointment, and stimu-
lating liniments of alcohol, oil of hemlock, origanum, amber,
sassafras, &c, &c.   If the adjacent soft tissue should be in-
 flamed, elm poultices, hot packs, &c, are  among the most
radical means of subduing it.

     HIP  DISEASE, OR MORBUS COXARIUS.
                       C AU SE.
   The cause of hip disease is the  same as of necrosis, of
which it is one variety, viz.: falls, dislocation of the hip-
joint, bruises  of  the joint,  and scrofulous, mercurial or
syphilitic taint.
                    SYMPTOMS.
   Although the symptoms of hip disease are very marked,
 it is  often mistaken for other diseases.
   A  case occurred in my practice of a little girl who  had
 hip disease, but was treated  by an allopathic  professor for
 rheumatism.   This mistake  arose from  the fact that the
 only  complaint the child made, was of pain in the knee.
   In this disease  the  pain is nearly always foreign from
 the real seat of the disease, hence the  patient complains of
 pain  in the thigh, knee, foot, &c.  Deformity of the limb
 is an early symptom, as it will be very considerably turned
 inward, the  knee frequently resting against the  other.
 Very acute pain may be caused in  the hip by pressing the
 thigh bone firmly upwards.   The sleep will be  disturbed,
 the bowels irregular, appetite capricious, and in some cases
 there will be hectic fever and night sweats.  The hip will
 swell, become painful, and  entire loss of  the use of the 
834
SURGERY.
limb will  follow.   In many cases, the membrane  around
the head of the bone will become  so diseased  as  to  pour
out a large  quantity of muco-purulent  matter, or  sero-
purulent fluid, filling the joint, and  causing the  head of
the bone to leave the socket, thereby producing still greater
deformity, as in this  case the limb is  not only turned in-
ward, but is  very much shortened.   In some cases the
soft tissues become red, swollen, and inflamed,  and suppu-
ration occurs near the point of the disease, while in other
cases, the pus, which is  formed around the joints, passes
along the fascia of the thigh, and  makes  an opening down
the leg.   I  have  attended  several cases of hip  disease,
where in this way a large number of openings were formed
along the limb from the  hip  to the knee.   The constitu-
tional symptoms vary according to the nature and cause of
the disease.   In some cases they are very slight, while in
others, night sweats,  diarrhoea, hectic fever, &c, are promi-
nent symptoms.
                    TREATMENT.
   The most effectual treatment in the early stage of hip
disease  is very simple.   A large irritating plaster should
be placed over the entire hip, and caused to remain  until
a  thorough  counter-irritation is effected, and  a discharge
occurs.  When the discharge ceases, the  plaster should be
again applied, and renewed  from time to time until the
disease is entirely removed.   The internal treatment should
consist of mild purges, frequent baths, phosphate of lime,
salt,  iron, and tonic syrups.   Where the disease is con-
nected with a scrofulous constitution the compound syrup
of phosphates, or the syrup of hypophosphites, should be
given in two or three drachm doses three or four times  a
day.   Where the  disease is more advanced, and the  open-
ings have occurred,  they should be thoroughly cauterized,
and covered with  the fir and  zinc ointment.   The entire
 limb should be bathed  with  alcohol four or  five times  a
 day, to which is  added a moderate  quantity of camphor 
SURGERY.
835
and oil of hemlock.  If there is much swelling, a poultice
should be applied, composed of equal parts of slippery elm,
pulv. hemlock, and Peruvian bark, after the liniment and
over the ointment, and changed as often  as necessary to
keep the parts moist and the ulcer clean.   In many  cases
the cartilages and  ligaments become entirely destroyed  by
the ulcerating process.  In this event  the  limb should be
placed in a natural position, and entire rest absolutely  en-
joined;  as the only hope of a cure  consists in inducing a
deposit of bony material around the joint, in quantity suffi-
cient to induce anchylosis.   This can be accomplished  by
administering wine, malt liquors, vegetable tonics, chaly-
beates, and a nutritious diet.   The capillaries of the part
should be excited and stimulated ; for  this  purpose the hip
should be frequently bathed in  the  following liniment;
      R.—Alcohol,.........................................Oj.
         Oil of capsicum,.................................^j.
         Oil of hemlock,.................................gij.
         Crotonoil........................................gutt. x.
   Mix, and bathe frequently.   Also  take  equal  parts of
syrup  of hypophosphites, and  the  syrup of chimaphilin,
three or four times a day.   Dose, one tablespoonful.
   If there are open sores with cicatrized edges, they should
be injected with solution of sulphate of zinc, and filled with
pledgets of lint  smeared with  zinc ointment.  The  limb
should be thoroughly bandaged, and supported with splints.
Where the head of the bone or  acetabulum is decayed, the
following injection will be found valuable :—take sulphate
of iron, one ounce; phosphate of lime, two ounces; water,
one pint; dissolve the zinc and iron in the water, and add
twenty grains of tannin.  Inject with a small syringe three
or four times a day.   Bathe the limb with an  infusion of
bitter herbs in alcohol, followed by brisk friction to keep
up circulation.   As  soon  as the patient can walk, gentle
exercise in the  open air  should be  taken,  and a strict
course of diet and regimen pursued until  entire recovery
is effected. 
836
SURGERY.
    WHITE SWELLING, OR  HYDRARTHRUS.
   White swelling, in its proper  acceptation, occurs most
frequently about the middle period of life, but is, however,
very often seen in children.  There  is a difference in its
approach in these periods;  you will never  see  a case  of
white swelling under the age of puberty, without a devia-
tion from health,  but not always so when it  makes  its ap-
pearance in after life.   Its approach is slow, is accompanied
with pain, the  patient is  only  aware of any thing wrong
by a stiffness in the motions of  the part, and when in the
knee-joint, (which is the most  common seat  of the disor-
der,) the patient walks badly, with the knee bent.
   In  this insidious way it may go on for several weeks,
but on looking  at it, you perceive that the natural points
of the joint are obliterated, that it is swollen, and has be-
come more rounded than the sound one, while the natural
colour of the integument remains unchanged, as the name
of the disease  would  mark as one  of its distinguishing
characteristics.  In some months, or it may be years  per-
haps, an  abscess forms, and may open near the joint or  at
some distance from it, even so low as the middle of the calf
of the leg, and a  quantity of curdy matter is discharged,
without at all reducing the swelling of the joint,  however;
after  a time this  opening may heal,  and another form,
which  will in its turn continue  to discharge.
   White swelling of the knee is  usually of a chronic nature,
but sometimes,  as in morbus coxae, it is acute, when it will
run its course in as many weeks as in the chronic form  it
would have taken months to do.   In  the chronic form, the
joint is swollen before  any pain  is felt, but  in the acute
case, motion  of the limb  produces excessive pain  before
there is any  swelling, except perhaps a little fulness from
an increased secretion  in the joint;  the  fluid poured out
in these cases, does not seem like healthy synovia, but  as
if a mixture of it and serum. 
SURGERY.
837
  White swelling might be confounded with other condi-
tions of  the  joint; sometimes the large bursa above  the
patella, between  the extensor muscles of the  leg and  the
lower part of the femur, becomes inflamed, and  fluid is
poured out by the  sac, and as  this bursa often communi-
cates with the general synovial  cavity of the knee-joint, it
might be mistaken for white swelling of it, but it is very
easy to distinguish them; in the  case  of enlarged bursa,
there is  no pain in moving the femur  and tibia on each
other, and if you make the patient extend his leg by the
action of its extensors, the figure of the  swelling is altered :
there will be a  hollow made in its middle by the pres-
sure of its muscles and patella. Neither of these will be
the case  if it  be  white swelling.  Sometimes after  using a
good deal of  exercise, or taking a  long walk, there will be
a pain  in the  knee and effusion into the joint.   This might
be  mistaken  for white swelling, but the difference in  the
approach of  the two is, that in white swelling the pain
comes  on long before the effusion,  while in the other case
they come on together;—there is  one great distinction be-
tween  white  swelling  of  the knee and  other diseases of
it,—a  symptom  that never fails to point out the nature of
the case  clearly, and it is this—in  white swelling the flexor
tendons  of the leg are not prominent as they naturally are,
but the hollow in the popliteal space is filled up  to their
 level.   In forty-nine cases  out  of fifty,  the position in
which you will find the leg is flexed or semi-flexed on the
thigh, and lying on the  outside,  but in the  fiftieth case,
you will find it extended as straight as possible, and rest-
ing on the head, and the patient cries out with pain if you
 attempt  to move the limb; yet put the patient sitting on
the right side of the bed, or on a table, and you  may not
only flex the limb, but swing it backwards like a pendulum,
 without giving him any uneasiness.
   Patients labouring under  this  disease seldom complain
 of  pain  in the  part, but rather  a sense  of uneasiness—a 
838                   SURGERY.
 feel as if it were tired—as if the bones entering into the
articulation were not rightly bound together; they have,
however, pain in the limb, going upwards towards the ab-
domen, which they call rheumatic  pains, and it  is useless
to try to  persuade  them that they are not rheumatic.
   There  are  cases of white  swelling  met  with, where
neither the patient nor his friends can assign any reasona-
ble cause for its appearance.   Some cases have their origin
in exposure to cold or damp apparently, and several are
found to come on during  convalescence, after  fevers of
various kinds; some are attributed to the sudden recession
of eruptions; but there must evidently be a predisposition
to the disease in the  constitution or the  part, or we  must
discredit many of the agencies said to induce the affection.

                   TREATMENT.
   When  white swelling first makes its appearance,  by a
proper course of medication it may be  arrested at  once.
In the commencement of the disease, bathe the parts in a
liniment  made as  follows:—IJ.—Oil of  hemlock,  four
ounces; dissolve as much camphor gum in it as it will take
up, and add 12 drops of croton oil, and three drachms of
tincture  of iodine.   Bathe  the  limb  thoroughly,  after
which, apply hot cloths wrung from a strong infusion of
equal parts of arnica flowers and  lobelia; change as  often
as they grow cool.   With each change of the cloths apply
the liniment.  The patient  should take a purge of anti-
bilious physic, followed by a free use  of the compound
syrup of chimaphilla and phosphate of iron.  Take of the
compound  syrup  of chimaphilla,  one pint,  phosphate of
iron three drachms.   Dose  three or four tablespoonfuls, a
day.  The patient should be bathed three or four times a
week, in  strong soda water, and  a nourishing diet should
be allowed.  If this course be  adopted, and persisted in, it
will arrest  the disease in the first  stage.  But where the
disease is farther advanced, and openings are formed into 
SURGERY.
839
the bone,  the  openings should be enlarged by means of
caustics and  liniment.  Ointments and  poultices should
be applied as directed in  treatment  of hip disease.   The
constitution should be well supported by means of tonics
and antiseptics.  The limb should remain perfectly at rest,
and the motion of the joint prevented by  means of splints.
In an indolent condition of ulcer, and a discharge of sani-.
ous matter, inject  it with a strong solution of vegetable
caustic, then  take  pulverized  phytolacca  decandra, one
ounce;  scrofularia  marilandica, two ounces;  pulverized
myrrh, two ounces;  flax-seed  meal,  one pound; mix, and
wet with equal parts of soda water, and lobelia tincture,
sufficient  to  make a  poultice, and  apply warm.   The
poultice should be changed, and the ulcer injected as often
as once or twice a day.
   Equal parts  of Beach's alterative syrup, and the com-
pound syrup of helianthus, given  in tablespoonful doses,
three or four times a day, will be found of  much value, in
connexion with iron, hydrastin, ampelopsin, and other re-
medies given as indicated.   Where the bone is diseased, it
may be treated as already directed in  necrosis  and  hip
disease.


PROLAPSUS ANI, OR FALLING OF THE RECTUM.
   Prolapsus of the lower portion of the bowels occasionally
occurs in both adults and children, and is caused  by weak-
ness of the sphincter and other muscles, produced by cos-
tiveness, ascarides of the rectum, dysentery, &c.

                     SY MPTOMS.
   One of the  first symptoms observed of prolapsus ani, is
 the appearance of a large red tumour, after going to stool.
 Unless this be immediately returned, it  will become pain-
 ful,  strangulated,  and  will  produce obstruction of the
 bowels, fever,  and general constitutional disturbance. 
840
SURGERY.
                   TREATMENT.
  In all cases of prolapsus ani, the first indication of treat-
ment is to return the prolapsed bowels, which can be done
by bathing the parts in warm water,  and  then making
gentle  pressure upon them upwards, at the same time dash-
ing a  handful of  cold water in the patient's face.   After
the parts are thus returned, a pad, wet with a strong solu-
tion of oak bark and golden seal, should be applied to the
rectum, secured by a T bandage.   As  soon as this is ac-
complished, the cause of the difficulty should be ascertained
and removed.  If it be  ascarides  or seatworms, an  injec-
tion of aloes  and balmony into the rectum, and  a  free
purge of podophyllin and santonine will usually remove
them.   If the first injection does not succeed, it should be
repeated, followed by injections of cold salt and water, or
ice water.
   If the  muscles of the rectum are weak, the following
ointment may be used:
       R.—Tannin,..........................................gr. x.
          Geranin,..........................................gr. xx.
          White wax,.....................................§j.
          Glycerin.........................................gj.
   Melt the wax,  and mix with the glycerin, and add the
tannin and geranin, while it is cooling.  Apply to the part
four or five times a day.  The bowels should be kept  regu-
lar by the use  of vegetables and fruit, and an occasional
dose of neutralizing mixture.  A case which recently came
under my treatment, was cured by covering the prolapsed
portion of the rectum with pulverized sanguinaria Canadense
whenever it was exposed.  Dr. Beach's pile ointment may
also be used, or the mild zinc ointment.

   BLEEDING  AT  THE NOSE, OR EPISTAXIS.
   This is a difficulty which frequently occurs about the
age of puberty.  It also occasionally  occurs  during the
progress of typhoid and other forms of fever.   It is very 
SURGERY.
841
liable to occur in seasons when fruit and vegetables are
scarce, and the blood is in a scorbutic condition.

                   TREATMENT.
  If the hemorrhage be violent, apply ligatures to the limbs,
bathe the head in cold water, and the feet in  hot water.
If this should not arrest the hemorrhage, give from five to
twenty drops of the oil of erigeron every half hour, and
inject the nostrils with a strong solution of matico.  When
the feet are removed from the warm bath, mustard plasters
should be applied to them, and also to the back.  This
treatment has proved successful, when all other resources
have failed.

              RED NOSE, OR LIPOMA.
   Lipoma is a chronic enlargement of the subcutaneous
and cutaneous structure of the nose, presenting a peculiar
lobulated appearance, and  is usually of a purplish red
colour.
                   TREATMENT.
   Apply a strong irritating plaster  until free suppuration
ensues, and follow with mild zinc ointment, and allow the
parts to heal by cicatrization.   Or the tumour  may be
dissected off,  (care being  taken not to cut through the
nostrils,) allowing the parts to  heal by granulation, keep-
ing them covered with ointment.

                   NASAL POLYPI.
   A nasal polypi is  a soft moist  tumour of a yellowish
colour.  Its structure is very nearly identical with that of
the mucous membrane, to which it is firmly attached.

                     SYMPTOMS.
   One of the first symptoms of nasal polypi is the sensa-
 tion of a stoppage of the nostril, which eventually amounts
 to a nasal respiration.  When this occurs, by inspection  a
                           71* 
842
SURGERY.
tumour may be observed in the nasal cavity, of a shining
grayish colour.  By forcing the breath through the nostril
it will  be noticed to descend, and the reverse by nasal in-
spiration.   As the polypus grows it will press upon the
neighbouring parts, and cause disfiguration of the nose and
face.
                   TRE AT ME N T.
  In  the early  stage of polypus it may be removed by
snuffing equal parts  of pulverized blood-root  and matico.
If the  tumour has become very large, it will be necessary
                        Fig-. 96.
to remove the main body by means  of polypi forceps, and
afterwards use the snuff to prevent further growth. 
SURGERY.
843
  To remove the polypi with the forceps, (see fig. 96,) the
patient's  head should be held by an assistant, and the for-
ceps should be made to grasp the main body of the tumour,
when by a twisting motion it should be removed.   If there
is hemorrhage, it can be arrested by matico.

                    HARE LIP.
  The cure  of hare lip is purely surgical, and  can easily
be effected by a well conducted operation.  The operation
for  single hare lip consists in neatly paring the edges from
one point of the cleft to the other.  After which the edges
should be brought in apposition, and as many fine hare lip
pins inserted as will maintain the parts in their position,
when the twisted  sutures are applied.  At the expiration
of 60 or 70 hours, the pins may be removed, and the parts
kept in apposition by means of adhesive strips.  The opera-
tion for double hare lip is the same as for single.  During
the treatment the patient should avoid violent exercise,
and take  no food that requires much mastication.

TUMOURS  OF  THE  GUMS, 0 R E P U LIS.
  A tumour of a fibrous character often  springs from the
periosteum and edges of the alveolus, springing up between
and loosening the teeth.

                   TREATMENT.
  The  treatment  consists in an entire destruction of the
tumour by means of caustic potassa, followed by a wash of
bayberry and hydrastin.

ABSCESS OF THE  ANTRUM HIGHMO-
                    RIANUM.
  It frequently happens that from inflammation and other
eauses muco-purulent matter or pus accumulates in the ca-
vity of the upper  jaw. 
844
SURGERY.
                    SYMPTOMS.
  In most cases there is a heavy aching in the cheek bone,
pain in the head, swelling of the face, loss of appetite, con-
stipation, and  in  some cases I have known hectic to arise.
If relief be not obtained by exit of the matter, the pain will
be throbbing and very excruciating.   The swelling will in-
crease, and will present a  deep purple colour.

                   TREATMENT.
  In the first  place, any carious tooth in the neighbourhood
of the antrum should be extracted.   Or if there be no cari-
ous tooth, the second molar should be removed, and, most
commonly, pus will escape.  If it do not, an opening should
be made by means of a  small  drill  in  the canine  fossa
through to the antrum.  After the matter is discharged, a
mild infusion  of hydrastin should be injected into the ca-
vity until the  discharge ceases. At the same time the bow-
els  should  be  kept free by means of neutralizing mixture,
and other constitutional symptoms treated as they occur.

   ENLARGEMENT   OF  THE   UVULA.
  Enlargement and elongation of the uvula are frequent
symptoms  of  scrofula, consumption,  and  other  diseases.
When  the  uvula becomes elongated, it proves very irri-
tating, causes  an excessive secretion in the throat and fau-
ces, and sometimes results in inflammation and ulceration.

                   TREATMENT.
  Elongation  of the uvula can usually be remedied by fre-
quently gargling the throat with cold water and the follow-
ing wash:
     R.—Fluid extract rhusin................................ gj.
              "      bayberry............................ sjij.
              "       water................................. ^ij.
  Mix, and gargle the throat three  or  four  times a day.
Also bathe the throat upon  the  outside in  strong salt and 
SURGERY.
845
water.   If constitutional difficulties  exist, they should  re-
ceive attention.  If, after these means have been used, the
uvula still prove troublesome, it  may  be  clipped  with a
long pair of scissors, or an instrument adapted to that pur-
pose.
                 GONORRH03 A.
  Gonorrhoea is a disease affecting the urethra, prepuce and
glans of the male, and the vulva and vagina of the  female.
It is accompanied with a discharge of muco-purulent mat-
ter.  Gonorrhoea is generally considered as a specific, local
and contagious disease.   That it is a specific and infectious
disease, does  not admit of a doubt.   It is  also in  a great
majority of cases local.   Although, in many cases, gonor-
rhoea, when of long standing and in scrofulous constitutions,
affects the fibrous tissues, producing rheumatism, inflamma-
tion of the testicles and sclerotica, which  are followed by
specific symptoms;  it also displays itself upon the mucous
membrane of the throat  and eyes, in the form of chronic
inflammation and ulceration, and  upon  the skin by a spe-
cific eruption.
                     SYMPTOMS.
  In from three to  five days after  exposure, the male sub-
ject will feel  an itching  and burning sensation along the
urethra, with difficult micturation.
  On inspection, the mucous membrane of the urethra will
appear red and swollen, and, by pressure, a small quantity
of muco-purulent  matter will be seen to escape.   As the
disease  advances, the difficulty of  urinating will   be  in-
creased, and the discharge will be very profuse.  In some
cases  the  disease appears  to  extend to the prostate, blad-
der and testicles, in  which event the testicles become  swollen
and very  painful, and the difficulty of urinating is aggra-
vated.  One of the  most  troublesome symptoms of this dis-
ease is  chordee, which consists in the  painful erection of
the penis  at night,  with  a twist downwards.
  In the female, the local symptoms are analogous to those 
I
846                   SURGERY.

of the disease in the male, save the chordee.   The consti-
tutional symptoms in both male and  female consist in the
early stage in slight febrile  reaction, constipation  of the
bowels, headache, and derangement of all the secretory and
excretory functions.

                    TREATMENT.
   In the first stage of the disease, a  free purge of podo-
phyllin and cream of tartar should be given.  At the same
time, the parts should be  thoroughly packed with cold or
hot  water, and mucilaginous injections frequently intro-
duced into the urethra or vagina, as  the case may be.   To
control the inflammatory symptoms after the purge, aconite
or veratrum should be given, until the active inflammation
is subdued, after which, if the disease is not subdued, spe-
cific medication should be given as follows :
     R.—Solidified copaiba......................................  3J.
        Ext. horseradish.......................................  gr. xxx.
        Nitrate potassa............................ ...........  gr. xx.
         Gelsemin................................................  gr. ij.
   Mix,  and  make  thirty pills.   Dose, one every three
hours.  At the same time, the penis or vagina should be
injected   three  or four times a  day with  the following
emulsion:
     R.—Gum Arabic............................................ gij.
         Water................................................... ^vj.
         Sulphur and  sugar of lead......................... aa.gr. xxx.
   Mix, and use for  injections three or four times a  day.
   The following compound has  frequently been used  to  a
good advantage:
     R.—Balsam copaiba........................................  ^j.
         Sweet spirits of nitre................................  gij.
         Oil of cubebs............................................  ^j.
         Emulsion of gum Arabic.............................  31J.
   Mix.   Dose, tablespoonful four or five times a  day.
   Where the disease assumes a  chronic  form, take com- 
SURGERY.
847
pound syrup of chimaphilla, six ounces, and iodide of po-
tassa, two drachms.  Mix, and give one tablespoonful three
times a day.
   The following compound has been very highly extolled
as a specific in gonorrhoea:
    R.—White wax............................................. gj.
        Solidified copaiba...................................... gjj.
        White pine gum....................................... gsa.

   Melt, and form a paste.  While it is cooling, add oil of
juniper and pulverized cubebs, aa. 3J-  Dose, a pill the size
of a pea every two hours.  For other compounds, see For-
mulary.  Where  the discharge is profuse, equal  parts of
hydrastin and tannin as an injection, three or four times a
day, will be found of much value. Where there is chordee,
small doses of camphor and gelsemin will control that symp-
tom.  During the entire treatment, the bowels  should  be •
frequently  opened with  mild purges of  podophyllin and
cream of tartar.   The diet should consist entirely of vege-
tables, and all spirituous  and stimulating drinks should be
carefully avoided.
   In cases  where gonorrhoea has become chronic, and  the
mucus membrane of the  urethra becomes softened or gra-
nulated, I have  been in the habit of applying the following
ointment by means of Lalleman's porte caustique:
    R.—Argenti nitras......................................... gr. x.
        Hydrastin............................................... 31.
        Adeps....................................................  3iv.
   Mix.   Form  an ointment, and apply three or four times
a day.

                    SYPHILIS.
  Syphilis, like gonorrhoea, is a disease which arises from
sexual intercourse, and is transmitted through the medium
of the secretions.  It has been divided into different stages,
as local  or primary, secondary and tertiary. 
848                  SURGERY.
                    SYMPTOMS.
  The first symptom of syphilis is the appearance of a chan-
cre, generally, on the genital organs.  It usually commences
with a little pustule, with a small blister on the apex, which
breaks in a few days, and leaves a red  abraded surface be-
neath.  The sore, which is at first small, gradually increases
in size to a deep rigid-looking ulcer,  presenting a great va-
riety of appearances in different cases.  It has also received
different names, according to jts appearance.   Thus, it is
called simple chancre when its edges are smooth; indurated
or Hunterian, when its edges are indurated; the phageda?-
nic,  or sloughing chancre, when its edges  are ragged and
sloughing.   There may be one chancre, or there may be a
great number.  They may be confined to  the genital or-
gans, or they may extend to all portions of the body, espe-
cially to the nose and throat.  In the first  instance, unless
syphilis is hereditary, it is purely a  local affection, but, if
allowed to  remain for any considerable length of time, the
matter becomes  absorbed, and secondary or constitutional
symptoms appear.   This is indicated by buboes or enlarge-
ments of  the inguinal  glands, which  present a  blue and
hard appearance. A large number of copper-coloured spots
also  appear on the surface.   (See plate on skin diseases.)
If the disease be not removed, large indolent ulcers appear
upon different parts of the body.
  In the tertiary form of the  disease, the serous and os-
seous tissues become  involved, and syphilitic rheumatism,
neuralgia and tertiary ulcers of a most frightful character
make their appearance.   The digestive organs become im-
paired,  the blood impoverished,  and, not unfrequently, tu-
berculous deposits  occur in various organs and tissues of
the body.
                    TREATMENT.
  In primary syphilis, but little more is necessary than ef-
fectually to destroy the  chancre and to heal the parts by 
SURGERY.
849
means of mild dressings. To prevent secondary symptoms,
much care should be taken with reference to the kind of
caustics.  The common practice is to use nitrate of  silver.
Hence the large per cent, of secondary symptoms consecu-
tive upon primary—nitrate of silver forms an eschar, with-
out entirely destroying the virus, and thus the  poisonous
matter is absorbed and carried through the system, causing
secondary effects.
   The pure stick caustic of potassa is the best for this. It
should be  applied sufficiently  thorough to destroy every
vestige of the unhealthy portion of  the chancre.   After
which a flax-seed poultice  should be applied, and allowed
to remain  until all portions of the destroyed  tissue are
sloughed  out.  It should  then be dressed with mild  zinc
ointment, until it is entirely healed.
   During  the treatment, the patient  should abstain from
 all fat meats, spirituous liquors, and excesses of every kind.
 A purge of podophyllin and cream of tartar should be given
 every twenty-four hours.
   If the disease is absolutely in its primary stage, the above
 course of treatment will effect a cure in  a few days.

   TREATMENT  FOR  CONSTITUTIONAL,   OR
              SECONDARY  SYPHILIS.
   The treatment for secondary syphilis is both specific and
 general.
   The general treatment consists in regulating  the  bowels
 with mild purges, bathing the surface with alkaline baths,
 abstinence from stimulating food and drinks, and the obser-
 vance of rest.
   The specific treatment  consists in the use of  such reme-
 dies as exert a specific influence over the disease.
   The following remedies may be used to act specifically in
 secondary syphilis:—Phytolaccin, iridin, iodide of potassa,
 scrofularia, corydalin,  chimaphilin, the  tincture of kalmia
        72 
850
S U R G E R V .
latifolia, or mountain laurel, citrate of iron, potassa, bromide
 of potassa,  quinine, iron, creasote, hydrocyanic acid, meni-
spermin, muriate of ammonia,  ceanothus Americanus,  &c.
In the commencement of treatment the patient should take
a  thorough lobelia and  blood-root emetic, followed  by an
active purge of podophyllin, cream of tartar, and sulphur.
      R.  Podophyllin................................grs. ij.
          Cream of Tartar...........................grs. xxx.
          Sulphur.....................................grs. xx.
   Triturate, mix, and divide into five powders.   Dose,  one
every two  hours until it operates as a purge.  Afterwards
give the patient a thorough spirit sweat, followed by an al-
kaline bath.   When the system has been thus prepared,
one or more of the specific remedies should be given.
      R.  Compound Syrup of Stillingia...............Oj.
          Iodide of Potassa................................gj.
          Phytolaccin..............................„.......3ss.
   Triturate the iodide of potassa and phytolaccin in  two
ounces of glycerine, then add the syrup, and let the patient
take  one  teaspoonful four or five times a day.   After  this
remedy has been used for one or two weeks, it may be omit-
ted, and the following may be used in its place:—
      R. Quinine.......................................grs. xxx.
          Citrate of Iron.............................grs. xxv.
   Mix, divide  into ten powders, and let one be taken three
times a day, in  connexion with five or ten drops of the tinc-
ture of kalmia.  These  remedies may be followed by cory-
dalin, chimaphilin, and citrate of iron.
   If  there is fine  mercurial erythema, as is often the case
in syphilis  after the old school treatment,  the  scrofularin
will remove it.   If there are chancres, or syphilitic ulcers,
they should be  cauterized with nitric acid, and dressed with
mild  zinc ointment and elm poultices.   During the treat-
ment  the patient should retire from  business, and  observe
perfect rest.  The diet should be mostly vegetable and cool- 
SURGERY.
851
in°\   When the  prominent symptoms  have disappeared,
a more liberal diet may be allowed.   The surface should be
frequently sponged, and the bowels kept open.
  In the tertiary form of syphilis the treatment does not
differ essentially from the above, except that the diet should
be more nutritious, and the medication less active.
  Where buboes appear, they may be  dressed with the fol-
lowing:—
      R. Tincture of Iodine..............................3jj-
         Tincture of Arnica..............................3j;g
         Tincture of Scrofularia......................3'iij.
  Mix, and apply by wetting pads of  linen, which may be
secured by means  of adhesive strips.   If this does not dis-
cuss them, they should be caused to suppurate by means of
warm elm  poultices, and healed by means of  mild zinc
ointment.   Where the  bones  have  become  affected,  in
addition to the above remedy, phosphate of  lime should
be frequently used in connexion with quinine.   Where the
patient has been  maltreated with mercury, &c, dilute sul-
phuric  and nitro-muriatic acid will be found valuable in con-
 nexion with compound syrup of stillingia.
   I have cured several eases of the tertiary form of syphilis,
that had been mercurialized until it was difficult to decide
whether mercurial or syphilitic affection was most prominent,
with the following:—
       R.  Nitro-Muriatic  Acid...........................3i\
          Water..............................................•§vj-
 Mix.  Sig.—Forty drops, in one teaspoonful of Compound Syrup
               of Stillingia, three times a day.
 Where the tertiary form of the disease is  connected with
 neuralgia and rheumatism, the following  mixture will  be
found valuable:—
       R.  Lupulin...... ...............................&•
          Quinine......................................%\s- xx.
          Ferri Hypo Phosphite ....................3J-
          Hydrocyanic Acid......... ..............Zat}- xx-
          Syrupus Simplex...........................5VJ-
        Sjo-.—One teaspoonful every two or three hours. 
852
SURGERY.
 The strength of the patient should be well supported; fresh
 air and cheerful company will also facilitate the cure.

                  CASUALTIES.
   Life, when to all appearance lost, may often, by due care
 and energetic attention, be restored.
   Accidents frequently prove fatal, merely because  proper
 means are not used to counteract their effects.   No  person
 should be regarded as killed by accident  or  injury, unless
 some vital organ or structure be  injured to such an extent
 as to be incompatible  with life.  The vital organs may be so
 diseased as to very much disturb  their functions, or, for the
 time, to  entirely suspend them—yet, in many cases, by pro-
 per means, these functions may again be restored, and the
 life of the patient saved.   Hence, in all  cases where  the
 faintest hope of life remains, every means should be used to
 restore it.
          APNC3A, OR  ASPHYXIA.
   Apnoea, or asphyxia, is caused by a stoppage of circula-
 tion through the pulmonary capillaries.  The more common
 causes of this affection are  the inhalation of carbonic  acid
 gas, the  immersion of the body under water, or  drowning,
 the inhalation of chloroform,—in short, all non-oxygenized
 substances which will not support combustion, will cause as-
 phyxia.   It may also be produced by large doses of opium,
 ahd other narcotics, by pressure on the brain, injuries of the
 spine, extreme  cold, frights, convulsions, and in fact, any-
 thing which may interrupt the circulation of blood through
 the heart and lungs.
                    TREATMENT.
  The treatment of asphyxia depends much upon the cause,
 which should be removed, so far as possible.   At the same
time, the body should be kept warm by means  of hot flan-
nel, frictions, &c; and  the  bowels  should be injected with 
SURG ERY.
853
warm water, and  artificial respiration  produced and  con-
tinued so long as the  slightest prospect of resuscitation re-
mains.
  Artificial respiration  may be  produced  by applying the
mouth to one nostril,  while the other is closed, at the same
time making pressure on the  thyroid cartilage backwards
and downward, so  as to  close the oesophagus and allow the
atmospheric air to  penetrate the  bronchia and lungs.   As
soon as the lungs are  filled, gentle pressure should be made
upon the sides, until the air is expelled.  Hot mustard pastes
should be applied  to the spine, and  the patient exposed to
a current of pure air.   In case of asphyxia from drowning,
Dr. Marshall Hall's method is as follows:—
   " 1st. Treat the patient instantly on the spot, in the open
air, freely exposing the  face, neck, and chest to the breeze—
except in severe weather.
   " 2d. In order to clear the throat, place  the patient gently
on the face, with one  wrist under the forehead,  that  all
fluid, and the tongue itself, may fall forward and leave the
entrance into the windpipe free.
   " 3d. To excite respiration, turn  the patient slightly  on
his side, and apply some irritating or stimulating agent to
 the nostrils, as veratria, dilute ammonia,  etc.
   " 4th.  Make the face warm by brisk friction, then  dash
 cold water upon it.
   " 5th.  If not successful, lose no time, but, to imitate  re-
 spiration, place the patient on his face, and turn the body
 gently but completely on the side, and a little beyond, then,
 a-ain, on  the face, and  so on  alternately.  Repeat these
 movements deliberately and perseveringly fifteen times only
 in a  minute.  (When  the patient  lies on the thorax, this
 cavity is  compressed by the weight of the body, and expi-
 ration  takes place.   When he  is turned  on the side, this
 pressure is removed, and inspiration occurs.)
   " 6th.  When the prone position is resumed, make a uni-
i 
854                  SURGERY.
                                                 f
form and efficient pressure along the spine, removing the
pressure immediately before rotation on  the  side.  (The
pressure augments the expiration; the rotation commences
inspiration.)   Continue these measures.
  " 7th. Rub  the limbs upward with firm pressure, and
with energy, (the object being to aid the  return of venous
blood to the heart.)
  "8th. Substitute for  the patient's wet clothing, if possi-
ble, such other covering as can be instantly procured—each
by-stander supplying a coat or cloak, etc.   Mean time, and
from time to time, to excite inspiration, let the surface of
the body be slapped  briskly with the hand.
  " 9th. Rub the body briskly  till it  is dry and warm,
then dash cold water upon it and repeat the rubbing."
  " If the weather be very cold,  and the situation exposed,
it will be obvious that throughout these measures a tolera-
ble shelter should, if possible, be secured, and in extremely
cold weather it  may be necessary to perform  the  rubbing
and rotating movements with the  body loosely covered with
dry blankets, coats, or something of the kind."
  Avoid the immediate removal of the patient, as it in-
volves  a dangerous loss of time—also, the use of bellows,
or any forcing instrument—also the warm bath, and all
rough  treatment.

  CANCERS,  OR MALIGNANT  TUMOURS.
   Cancer usually presents itself in four  or five varieties;
each variety possessing characters  peculiar to itself, viz.,
scirrhous or hard cancer, encephaloid  or  soft cancer,  col-
loid or gelatinous cancer, melanosis  or black cancer.  (Fig.
97 shows the  arrangement of fibrous cancer-cells, as they
occur in the female  breast.   Fig. 98 shows the same, after
the addition of acetic  acid.  Fig. 99 shows  the isolated
cancer-cells from  the same  growth.  Fig. 100 shows the
same, after the addition of acetic acid.)
  The scirrhous variety is hard, firm, and transparent, and 
SURGERY.
855
of a grayish colour.   The encephaloid  is brain-like in its
appearance,  and is of a soft and  hemorrhagic  character.
The colloid resembles glue, or honey in the comb.  The me-
lanosis is of a black colour, and is sometimes soft,  and at
others hard.   Another variety of  cancer  is mentioned by
some authors, called epithelial cancer.
  These various forms may exist separately, or one variety
may be associated with, or take the place of another.  Thus
encephaloid may take  the  place of scirrhous, or  colloid;
melanosis, scirrhous, and colloid, may exist in the same tu- 
856
SURGERY.
mour.  The microscopic character of all  these different
varieties is essentially the same.
  They all yield, by pressure, a turbid fluid, called cancer-
juice, in which are granule cells, pigmentary and fatty mat-
ter.   The cancer cells are spherical, fusiform, and spindle-
shaped, elliptical or caudate, having two or three termina-
tions.
  Mr. Bennett remarks:—"The so-called cancer-cells  may
be  round, oval,  caudate, spindle shaped,  oblong,  square,
heart-shaped,  or  of various indescribable forms, produced
by  pressure on their  sides.   In  size they  vary from the
y^ooth to the -jq oth of an inch in diameter.  The cell wall,
when young, is smooth and  distended; when old, it is more
or less corrugated and flaccid.  Each cell contains  at least
one  nucleus, often  two, and  sometimes as  many as nine.
Most commonly there is only one, which is  round,  or more
generally oval, and contains one or two granules, or nucleoli.
The nucleus also  varies in size, and  may occupy from  one-
sixth to four-fifths of the volume of the  cell.   Between the
nucleus and the cell-wall there is a colourless fluid, which, at
first  transparent,  becomes afterwards opalescent, from the
presence of molecules and granules.  On  the addition  of
water, the cell becomes distended by endosmose, and is en-
larged.  When acetic acid is added, the cell-wall  is rendered
more transparent, and in young cells is entirely dissolved,
whilst the nucleus, on the other hand,  either remains un-
affected, or its margin becomes thicker, and its  substance
more or less contracted."
  The crasis, or condition of the blood which exists in can-
cer, consists in the preponderance  of albumen, and  an ex-
cess  of fat.  And it is evident that the development of can-
cer  is owing to perverted  nutrition, that the healthy blas-
tema as it escapes from the capillaries, by some local influ-
ence, instead of forming healthy tissue, contributes  to the
development of this unhealthy product.
  The cause of this prevented cell-growth  is doubtless the 
SURGERY.
857
result of an injury inflicted upon the part where the future
cancer makes  its appearance.  This injury may be mild,
pressure producing a deformity of the healthy cell, which
deformity is transmitted to the nucleus, and to all the cells
that are developed from  it.   Thus, a series of irregular
cell developments, results in that heterologous tissue, known
as cancer.  The injury inflicted may be violent, producing
speedy  irregular cell development, or it may be gradual,
and the cell-growth only approximating to that abnormal
structure, which by degrees assumes a real malignant  cha-
racter.  All the facts yet observed relative to the nature and his-
tory of this disease warrant this explanation; as all cases of
primary cancer occur on such organs as  are  liable to such
injuries, besides, in a large majority of cases, the cancer de-
velopment may be traced directly  to this cause.
   Also, the unsuccessful treatment of cancers by the use of
the knife, and the successful treatment, by a long continued
course  of sloughing and  caustic applications, most conclu-
 sively proves  that, so long  as one single, irregular, or nu-
 cleated cancer cell remains, so long will the cancer develop-
 ment continue.
   Secondary  cancers may be  developed by the  absorption
 of these cells, and their transmission through the lympha-
 tics and blood vessels, to the organs and  tissues, far  from
 the primitive development.   Thus, cancer of the lungs, &c,
 may be developed from cancer cells, formed in the breast or
 face.   Next to  the female breast and uterus, the cancers
 most common, are 1. the face; 2. the stomach; 3. large in-
 testines; 4.  retro-peritoneal cancer in  front of the spinal
 column;  5. hepatic; 6. bone cancer;  7. cancer of the skin
 and lips; 8. brain; 9. globe of the eye; 10. testes; 11. ova-
 ries; 12. kidneys; 13. tongue; 14. oesophagus; 15. salivary
 glands and parotids. 
858                   SURGERY.
                     SYMPTOMS.
   A small hard tumour most frequently in the breast is the
first indication of scirrhous  cancer.  It is at first movable
and unattached to the integument, but eventually forms
deep and superficial attachments.  It grows slowly—is irre-
gular in shape, and painful.  The pain is mostly sharp, and
lancinating, and is much increased on pressure.
   In the course of time,  the tumour absorbs the tissue be-
neath the skin, and becomes attached to it, which presents
a bluish nodulated appearance.   Ulceration  usually takes
place by the skin becoming absorbed.   As the  sloughing
proceeds the  edges become  ragged and everted, having a
bluish purple colour.  The ulcer discharges a fetid sanious
pus.
   Encephaloid or soft cancer is more frequently met with
in the globe of the eye, testes, nares, &c.  It commences as
a soft, elastic, lobulated tumour,  having a semi-fluctuating
feel.  The skin covering it is loose, and covered with large
dilated veins.   It attaches  itself to the integument, and ul-
ceration occurs.
  In some cases a mass of  fungous flesh called fungus ha?-
matodes is thrown up from the tumour, which bleeds pro-
fusely.   The lymphatic system soon becomes involved, and
general constitutional disturbance is always an early symp-
tom in this form of cancer.
   Colloid or gelatinous cancer usually occurs in the inter-
nal viscera, although it occasionally occurs in the  superfi-
cial tissues.  It consists of cysts filled with  a gelatinous
semi-transparent fluid.  Melanosis or black cancer occurs
in the form  of dark pigmentary matter, mostly upon the
serous membranes.  When ulceration occurs, a dark sani-
ous matter is discharged.

                    TREATMENT.
  The treatment of cancer is both constitutional  and  local.
In the incipient stage it consists in radical  extirpation of 
SURGE RY.                  859
the diseased mass, either with the knife or caustics, and the
sloughing process.   For the purpose of removing the tu-
mour, apply  an  ointment made as follows: Take the ex-
pressed juice of fresh poke weed or phytolacca decandra, ru-
mex crispus or yellow dock, and blood root or sanguinaria
Canadensis, equal parts.   Evaporate the juice by means of
a sand bath to the consistency of tar.   Remove the cuticle
over the  tumour by means of blister plaster, and apply the
ointment, renewing  the application two or three times a
day, washing the part each time with the best French bran-
dy.  This should be continued until the  eschar involves
the entire tumour, when a poultice should be applied, made
in the following manner:  Take pulverized indigo weed, or
 baptisia  tinctoria, Peruvian bark, and slippery elm, equal
 parts, moisten with brewer's yeast, and apply, changing se-
 veral times a day, until the dead mass is entirely sloughed
 out, washing with the brandy before each  application.  If
 there is appearance of any portion of the cancerous tumour
 remaining, renew the application of the ointment, washing
 with brandy, and  followed by the poultice.  During the
 local treatment, the patient should abstain from the use of
 fats and animal albumen,  the diet consisting  mostly of nu-
 tritious vegetables, fruits, &c.
   The surface should be freely bathed daily, and  the pa-
 tient allowed free exercise in the open air.  When  the can-
 cer tumour  is  entirely removed, a mild  sloughing of the
 parts should be produced  by  the use of the following oint-
 ment.   Take sulphate  of zinc, one ounce,  balsam of fir,
 five ounces, white wax, one ounce.  Melt the wax  and bal-
 sam together, and while  cooling, add the zinc finely pul-
 verized, also, add thirty drops of creasote.  Apply the zinc
 ointment  in connexion with brandy, washing in quantity
 and frequency, sufficient  to keep up a mild discharge, until
 every vestige of unhealthy growth disappears.  In ordinary
 scirrhous cancer, if removed before suppuration occurs,  it
 will usually suffice to continue  the zinc  ointment, for  two 
860                  SURGERY.
or three weeks.  In cases of open cancer, where the cancer
cells may have been  absorbed, and passed into the blood,
in addition to the above local treatment, a thorough course
of constitutional medication will be required,  consisting
mostly of tonics and antiseptics, tonics  for the purpose  of
maintaining the integrity of the constitution, and antiseptics
and alteratives to prevent  the formation of cancer cells in
other tissues, and to remove any detached cells that may be
circulating in the blood.  Among the best tonics are hy-
drastin, ceraceine, chamomile, pyrophosphate  of  iron, &c.
These may be given in alternation or combinations, and  in
such quantities as may be  deemed expedient, to  maintain
the strength of the patient.   The following compound will
be found a valuable  one for this purpose   Take  hydrastis
Canadensis or golden seal, English chamomile, and chima-
philum umbellata, or pipsisseway, of each one ounce; pul-
verize, and add to one quart of good port wine.   Give one
wine glass full three or four times a day.
   To prevent the growth of absorbed  cancer cells, the fol-
lowing compound will be found valuable: Take oil  of tar,
two ounces, hydrocyanic acid, ten drops: mix  and let the
patient take from ten to fifteen  drops, four or five times a
day.   To remove the crasial condition  of  the blood, the
compound alterative syrup in connexion with iodide of po-
tassium, or the compound  syrup of stillingia, may be used
in quantity as indicated.  If the caustic application recom-
mended do not prove sufficient to remove the tumour, the
following application may be used.  Take sulphate of iron,
one ounce,  add sulphuric acid sufficient to make a paste  of
the consistency  of  cream.   Surround the tumour  with a
plaster of white wax, and apply the paste to the tumour,  al-
lowing it to remain until a deep eschar is  formed.  If the
first application be not sufficient, repeat it two or three times
a day, until the eschar involves the  entire  tumour.  The
wax  plaster is applied to prevent the caustic from injuring
the integuments surrounding the tumour.  After the life 
SURGERY.
861
of the tumour is sufficiently destroyed, it may be sloughed
out, as recommended  in  the first instance.   A  variety of
other caustic preparations used for the purpose of removing
cancerous tumours, may be found under the head of phar-
macy.
  The object, however, of all these applications is to remove
the diseased mass in  such a way as to effectually prevent
the absorption  of cancer cells.  The reason why caustics are
more successful than extirpation by the knife is, that du-
ring the operation with theknife, the cancer cells are lia-
ble to be penetrated, and conveyed to the  surrounding tis-
sues, and from thence to the blood, forming new  cancer cell
growth in  other  parts of the body, while the caustic de-
stroys the cell  at once, and thus absorption is prevented.
  The above plan of treatment applies equally well  to all
varieties  of the disease, although in some forms  where the
cancerous discharge has produced much exhaustion, a more
nutritious diet should be allowed.   That this treatment will
prove successful in a large majority of cases of early cancer,
if space would permit, the most ample testimony could be
given.
TREATMENT  OP CANCER OP  THE  UTERUS.
  To treat  cancer of the  uterus,  a large-sized glass specu-
lum  should be introduced into the vagina, and so adjusted
as to entirely  cover the portion  of  the  uterus affected.
Then apply with  the probang a moderately strong  solution
of vegetable caustic or of sulphate  of zinc, allowing it to
remain for  several minutes, then removing it, apply a thick
mucilage of  slippery elm, filling  the speculum.  After
which withdraw the speculum, and  allow  the  elm poultice
to remain in the vagina,  and if necessary secure it by a T
bandage.   This application should  be continued until all
traces of the disease  are removed.   Afterwards the parts
should be  dressed with very mild zinc ointment, and fre-
quently cleansed  by the use of antiseptic washes.   The con-
       73 
862
SURGERY.
stitutional treatment should be the same as in other forms
of cancer.
                     TUMOURS.
  The operation  for the removal of tumours consists in
making an incision, rather too long than too short through the
skin and cellular tissue, and dissecting out the tumour by
separating its cellular adhesions.  If the tumour is attached
to the skin, two elliptical  incisions should  be made,  and
such portions of the skin as adhere to it should be removed
with the tumour.   After the removal of the tumour, the
bleeding vessels should be secured  by  a ligature, and the
edges of the wound brought together and secured by adhe-
sive strips.
  Disease of the Muscles, Tendons, and  Bursse.—The mus-
cles may become rigid, producing various deformities  and
displacements of the joints and limbs.   Thus, a long con-
tinued disease of the knee may result in a permanent con-
traction of the flexor muscles  of the leg.

                   TREATMENT.
  Contracted muscles may be relieved by bathing, friction,
and electricity.  A very good liniment  for this purpose is
the following:
      R.—Oil of Lobelia,....................................^j.
             "  Hemlock,..................................3jij.
             "  Olives.......................................|j.
  M. and apply with a great deal of friction, three or four
times a day.   If this should not succeed  in removing the de-
formity, galvanic currents may be passed through the limb
once or twice a day.   If these means should fail, some of
the extension  splints  should  be  applied, and the  leg  put
upon  a stretch.

RUPTURE  OF  THE  MUSCLES  AND TENDONS.
  Violent exertions  sometimes  result  in  rupture of the
muscles and tendons.   These injuries are  best treated by 
SURGERY.
863
perfect rest and such measures as will subdue the inflam-
matory action.
                    ANCHYLOSIS.
  Anchylosis or immobility of the joint is a disease which
frequently  results from violent injuries and disease of the
parts.  It  is  best  treated by stimulating liniments, brisk
friction and local steam baths.

            INJURIES  OF THE SPINE.
  Lateral curvature  of the spine presents  many varieties,
and  may be caused  by debility of the muscles, or by dis-
ease  of portions of the spinal column.

                    SYMPTOMS.
  Elevation of one  shoulder, a projection of one of the
scapulas, and,  on examining the  spine, it will be found to
present a curvature.
                   TREATMENT.
  Attention should be  paid to the position of the patient;
the spine should be frequently bathed in stimulating lini-
ments, and from one to two teaspoonfuls of the compound
syrup of hypophosphites given two  or three times a day,
in connexion with vegetable tonics.   The patient should
indulge in plenty of  out-door exercise, and the diet should
be nutritious.   In  some cases benefit may be derived from
the use of shoulder-straps or other support to the abdomi-
nal muscles.

    POTT'S  CURVATURE OF  THE SPINE.
  Pott's curvature of the spine consists in  an angular cur-
vature produced by caries of the body of the vertebrae, or
ulceration  of the inter-vertebral substance.  It  is mostly
confined to scrofulous children.  It begins with weakness,
and symptoms of spinal irritation, coldness of the extremi-
ties,  twitching and spasm of the legs, which is frequently 
864
SURGERY.
followed by palsy.  If the disease is confined to the dorsal
vertebrae, there will be tightness of the chest and difficulty
of breathing.   If to the cervical, one or both arms may be
paralyzed.
                   TREATMENT.
  Rest and horizontal posture is indispensable in the treat-
ment of this disease;  and the back may be supported by a
bandage  as represented in fig. 101.  An irritating plaster
Fig. 101.
should be applied over the diseased portion, and caused to
maintain a discharge for several weeks.   The body should
be bathed once a day in alkaline water, followed by friction,
and from one  to two tablespoonfuls of the  syrup  of rock
rose;  or the compound syrup of frost work should be given
in combination with one or two  grains of ferri-hypophos-
phite and soda hypophosphite, two or three times a day.
The occasional use of quinine, hydrastin, and chimaphilin,
will also be found beneficial. 
SURGERY.
865
                 PSOAS  ABSCESS.
  Psoas abscess most commonly occurs in the early period
of life, and is mostly connected with diseases of the spine,
and confined to scrofulous constitutions.   It  is developed
either in the sheath or psoas muscles, and  is  preceded by
rigors, chills, lumbago, and general constitutional debility.
It generally presents itself below Poupart's ligament in the
form of a tumour while the patient is in  an erect posture,
which disappears upon lying down.
  The treatment for psoas abscess is that which is  recom-
mended under the head of chronic abscess.

       TREPHINING AND PARACENTESIS.
  Trephining may be  required  for fracture  of the skull,
with depression of the  bone, for  accumulation of blood
under the skull; for suppuration of the  dura mater; and
for diseases of the skull producing epilepsy, &c.  The in-
strument used for this operation is called  a  trephine, (fig.
102.)  The scalp should be shaved, and  an incision in the
                        Fig. 102.
shape of a V or T, and  the  pericranium  shaved off from
the part  of the skull to be perforated.  The  trephine is
                         73*
i. 
866
SURGERY.
then applied, the centre pin forced into the bone sufficient
to steady it, when it should be worked with an alternate
pronation  and supination of the wrist, until a sufficient
groove is made so that the saw will work steadily.   Then
the centre pin  should  be removed.    He then saws on
steadily and cautiously, pausing frequently and  examining
the groove with a probe, to see whether it has reached the
dura mater.  When it has, he introduces the elevator and
removes the circular piece of bone.

             PARACENTESIS  CAPITIS.
  This operation has been resorted to in some  desperate
cases of hydrocephalus.   The operation  consists in intro-
ducing a fine trochar perpendicular to the surface into the
anterior  fontanel.   When the fluid  has been withdrawn
the head  should  be supported  with a properly adjusted
bandage.   The constitutional treatment  should be  that
which is recommended in another part of the work.

                     PHYMOSIS.
  Phymosis is a stricture caused by the rigidity of  the in-
ternal membrane of the prepuce, so that the coronary gland
cannot be uncovered.   This  obstruction prevents washing
the secretions from the corona  glandis, thus  subjecting
the patient to balanitis and gleet, and in the advanced age
to cancer.
                   TREATMENT.
  Phymosis may frequently be relieved by wrapping a hot
pack around the glans  penis, and by compressing the gland
so as to press the blood from the  capillaries  of  the gland,
and then forcing the prepuce back.   If this does not suc-
ceed, the prepuce should be drawn as far on to  the gland
as is convenient, and by means of a sharp-pointed bistoury
the mucous lining should be divided  at several points. 
SURGERY.
867
                  PARAPHYMOSIS
is said to exist when the prepuce is confined back  of the
glans, causing it to swell, &c.

                   T RE AT M E N T.
  Attempts should be made to reduce it as in phymosis.
If unsuccessful, the points of stricture should  be divided
with a bistoury.

ORCHITIS,  or INFLAMMATION  OF THE TESTES.
  This disease may be caused by injuries, but is more fre-
quently  the  result of  badly  treated gonorrhoea.    The
symptoms are, swelling,  great tenderness and pain.

                   TREATMENT.
   Hot packs, purges of podophyllin, and apocynin, fol-
lowed by veratrum.

                   CASTRATION.
   This operation is performed by first shaving the scro-
tum, then grasping the testicle with the hand, and stretch-
ing the skin upon the  testicle.   Then make  an incision
from the external abdominal ring to the lower border  of
the scrotum.   Then dissect  the  cord from the  cellular
tissue, and let an assistant hold it  between his fingers, so
as to prevent it from retracting.   The bistoury should now
be passed under the cord and by gentle motion divided.
 Seize the lower  portion of the cord, and by a few  sweeps
of the knife, relieve the testicle from its cellular  attach-
ment.   The artery should now be secured by a ligature, the
integument brought together, and secured in the ordinary
way.   Cold water dressings are all that is required.  Where
 the testicle is very large, two  elliptical incisions should be
made so as to remove portions of the scrotum. 
868
SURGERY.
                  HEMATOCELE.
  Haematocele signifies an extravasation of blood into the
tunica vaginalis.  It may be treated as hydrocele.

       VARICOCELE, OR  SPERMATOCELE,
signifies a varicose state of the veins of the spermatic cord.
It may  usually  be cured by  laxatives  and purgatives, a
suspensory bandage, and a wash  of dilute, muriated tinc-
ture of iron.   The irritating plaster has  also been applied
and afforded relief in some instances.  Tying the veins and
destroying  them with potash has also been resorted to for
the cure of this  disease.
 CONTRACTIONS  AND  RETRACTIONS
        OF MUSCLES  AND  FASCIAE.
  Under this  head are included a variety of deformities,
such as  wry neck, squint, club-foot, and club-hand.  These
diseases are all dependent upon certain conditions  of the
muscles, which may be  caused  by a faulty position  of the
limb, or by irritation of the nervous system, which  may
produce deformity in  the  muscles by deranging the func-
tion  of  counter groups of muscles.   These deformities we
see in fascial  palsy,  strabismus, &c.  Peripheral, nervous
irritation may  also produce deformities.

         TORTICOLLIS,  OR WRY NECK.
  Under this  head are included all the deformites of the
head caused by a contraction of the muscles.  For  the re-
lief of these deformities, division of the muscles  producing
the deformity  has been resorted to with entire success.  In
the  case of a  boy, where  the head was drawn to the left
side, the ear resting on the left shoulder, connected with the
lateral curvature of the spine, Dr. Warren found the  sterno-
mastoid muscle of the left side to be the one producing the
deformity, for  which the Doctor performed the following 
SURGERY.                   869
                    OPERATION.
  The head being well supported  and carried a little for-
ward, so as to  throw the muscle  outward from  the subja-
cent parts, a puncture was  made with a lancet through the
skin about six lines above the clavicle, between the sternal and
clavicular origins of  the muscle..  A narrow, bluut-pointed
knife (Bouvier's) was then introduced, with its  flat side
towards the muscle, carried behind the sternal origin, its
edge turned towards the muscle, and the section completed
by  a slight sawing motion, the effects being indicated by a
distinct cracking sound, and by the partial restoration of the
head to its natural position.   The  little wound in the skin
being then closed by plaster, a cap  was placed on the head,
to the back of which, opposite the right mastoid  process,
was attached a strap, which, being drawn tight, was secured
over the  breast of the same side.  A stiff stock  was also
subsequently added to the  dressing, and, in the course of a
fortnight, a great change in the  position of the head was
perceptible, though it yet remained somewhat inclined to the
left, the clavicular origin of the muscle having become more
prominent since the  division of its sternal attachment.  To
remedy this, it was,  therefore, decided to divide the  clavi-
cular origin also, which was accomplished as follows:—The
head being well supported, and the muscle sufficiently re-
laxed  by inclining it to this side, the  body of the muscle,
just below the union of its two origins, was readily  seized
between  the thumb and fingers, and completely isolated from
the subjacent parts.  A sharp-pointed knife was  then car-
ried beneath  the muscle, until it  could be felt under the
skin by the finger on the  opposite side, when the patient
being directed to contract the  muscle, its section was readily
accomplished.  In forty-eight hours the wound was healed,
and nine months after the operation the patient's appearance
was so much improved that his former friends could scarcely
recognise him.
   Although the contraction of the  sterno-mastoid  muscle is
i 
870                  SURGERY.
more frequently the  cause  of wry neck than that of any
other, yet in some cases the trapezius is at fault, and has
to be separated in the same way as the sterno-mastoid.

         SQUINTING,  OR STRABISMUS.
  Squinting may be  convergent or divergent.  In the con-
vergent form one eye only is usually affected;  and in the
divergent form, sometimes, but not always, both eyes.

                      CAUSES.
  It may be produced by spasms, scarlatina, measles,  in-
testinal worms, paralysis of the motor nerves  of the eye,
and inflammation of  the conjunctiva and eyelids.

                    TREATMENT.
  The treatment for strabismus  must depend upon  its
cause.   The  cause being  removed by proper remedies, if
deformity still exist,  it must be removed by an operation.

                    OPERATION.
  Bandage the sound eye,  then direct the patient to look
outwards with the affected one.   Then seize a portion  of
the conjunctiva, near the inner  canthus, with forceps, and
separate it transversely with sharp-pointed scissors.   Con-
tinue this dissection until the tendon of the internal rectus
is exposed, which may be seized with the  forceps and cut
across; or a sharp-pointed director may be passed under
the tendon, elevating it and clipping it with the scissors.
During the operation the eyelids should be held apart and
firm by an assistant.   The  wound  should  be dressed by a
small pledget of lint, dipped in cold water, and moistened;
the patient  being kept quiet, and secluded from strong
light for several days. 
SURGERY.
871
            CLUB-FOOT, OR TALIPES.
  Four varieties of Talipes are recognised:—Talipes Equi-
neus, in which the heel is elevated, (fig. 103;)  Talipes Cal-

                            Fig. 103.
caneus, (fig. 104,) in which the anterior part of the foot is
drawn up.   This is a very uncommon variety of club-foot;
and, when it occurs, is almost always congenital.   In order
to relieve this deformity, the tibialis anticus, the extensor
communis, the extensor  pollicis, and the peroneus tertius,
may all require to be divided; after which a straight splint
should be  applied,  and the  foot brought down to it.   For
the cure of talipes  equineus, the tendo-Achilles should be
divided about an inch above its insertion into the os calcis.
The foot should be grasped, and the surgeon extend it until
the tendon is tense.  He then slides  a tenotomy beneath
it, and cuts slowly through it, from beneath upwards, bear-
L 
872
SURGERY.
Fig. 104.
Fig. 105. 
SURGERY.
873
ing the foot up at the same time.  Some prefer to cut from
without inwards.  In this event much care should be taken,
or the posterior tibial artery may be wounded.  As soon
as the operation has been performed and the pain will war-
rant it, some of the modern instruments, as Scarpa's shoe,
should be  applied, and the foot maintained in its normal
position until the deformity is entirely  overcome.

                 TALIPES  VARUS.
   (Fig. 105.)  This is one of the most common forms of
club-foot.  The foot is turned inwards, and the  patient
walks on the outer side of the foot.   To remedy this de-
                       Fig. 106.


                       I     1
formity, the tendo-Achilles, the tibialis anticus and posti-
cus, and plantar fasciae, require division.  In dividing the
       74 
874
SURGERY.
tibialis posticus  tendon in the sole of the foot, much care
will be required to prevent wounding the posterior  tibial
artery, which lies close to it.   The  best way will be  to in-
troduce the tenotome, (fig. 106,) through the sheath of the
tendon directly downwards, and separate it forwards away
from the vessel.  After the operation, and the inflamma-
tion removed two or three days, the foot may be well ab-
ducted by means of splints, or a little shoe.   Mr.  Mutter
recommends an  apparatus prepared by H. K. W.  Board-
man, of Connecticut.  The only use of these appliances is
to keep the foot properly abducted, and in an easy position.

                TALIPES  VULGUS.
   (Fig. 107.) In talipes vulgus the foot is turned out, and
the patient walks on the inner ankle.
  The treatment consists in dividing the tendons of the
peroneus longus and brevis behind the outer ankle, and 
SURGERY.
875
that of the extensor communis on the dorsum of the foot.
An instrument should be applied, and  the  foot brought
into position and supported.

                  WEAK JOINTS.
  The  ankle  and knee joints may become weak and  de-
formed in scrofulous and  rickety children.  They can be
remedied by proper constitutional and temporary appara-
tus which supports the part.

   CARTILAGE  IN  THE  JOINTS  OR
                     BURS^E.
  Loose cartilage may be found  in  the joints or bursae.
They can be felt when they present themselves to the sur-
face; and when they get between the bones,  they produce
sudden and excruciating pain, which is followed by inflam-
mation.   They occur by first being formed on the synovial
membrane, and afterwards becoming  detached.  If it  be-
come troublesome, it should be removed by  pushing it to
the upper part of the joint, on one side of the patella, and
held against the condyle of the  femur; the  skin being
drawn  slightly upwards, an incision is made down to  the
cartilage  by letting it escape.   Mr. Syme proposes to in-
troduce a narrow-bladed bistoury through the integument,
a distance below the cartilage, and carrying  it  up under
the skin,  under the point where the incision  is  to be made
in the synovial membrane, and puncturing it  sufficiently to
allow the cartilage to escape.  The cartilage should then
be squeezed out, and allowed to remain in the cellular tis-
sue until  the  wound in the membrane is healed, when it
should  be removed by making an  incision through the in-
teguments.  In this operation, every  precaution should be
observed  to prevent inflammation, and the limb kept per-
fectly at rest. 
876
SURGERY.
    MASTURBATION,   SPERMATOR-
     RHOEA,  AND  NYMPHOMANIA.
  It can hardly be denied that there are few diseases  that
are more prevalent or pernicious in their effects than those
embraced in the above caption.   There is  scarcely a prac-
titioner of any considerable experience and  observation who
has not observed the frequency in which masturbation has
led to spermatorrhoea and nymphomania, with all their ter-
rible consequences.  From the silence which has been ob-
served by medical writers  and teachers relative to these
diseases, and the extensive practice of it at this  period, we
infer that either the subject has been grossly neglected, or
that masturbation is alarmingly on the increase.  The prac-
tice of self-pollution,  when  at first  resorted to, has but
slight  impression upon the constitution, but, if continued
for a few months, or years, at last, it produces not  only an
abnormal condition of the  sexual organs, which results in
nymphomania or spermatorrhoea,  but  affects the nutritious
functions, and  lays the foundation for scrofula, phthisis,
and insanity, besides so enfeebling  the general forces of
the body as to  predispose the sufferer to many other  ma-
ladies.
                    SYMPTOMS.
   The symptoms of masturbation are, physical and intel-
lectual  debility, irritable  and vacillating disposition, dys-
pepsia,  constipation of the bowels, dry and husky skin,
scanty and high-coloured urine, cold hands  and feet, and an
irregular and capricious appetite.  If the male abandons
this practice in this condition of the system, it will soon be
followed by involuntary discharges of semen.  At first this
will occur  at night  during lascivious dreams, but in time
they will occur during defaecation  and micturition.  In
this event  there will be atrophy  of the testicles, cold and
shrivelled condition of the penis, together  with impotency.
Or if the impotency is not complete, the erections of the 
SURGERY.
877
penis will be feeble, and  almost immediately followed  by
emissions.  In the female,  where the practice is abandoned,
there will be an irritability of the nervous system, a ten-
dency to irregularity of the menses, leucorrhcea, prolapsus
uteri, and, in many cases,  frequent ovarian excitement and
discharges of the ovule.   If the disease be protracted, the
parts become weak, relaxed and cold, and the patient averse
to sexual indulgence.

  SPERMATORRHOEA AND  NYMPHOMANIA.
   As we have already remarked, these affections are more
frequently than  otherwise the result  of  masturbation, al-
though there  are  other causes which may produce them,
such as hemorrhoids, prurigo  labialis, constipation of the
bowels, stricture of the urethra, gravel, excessive venery,
long indulgence in  spirituous  liquors, and hereditary pre-
disposition.
                    TREATMENT.
   The  treatment for masturbation consists in abandoning
the  practice; and, for spermatorrhoea and  nymphomania, in
carefully studying  the disease, ascertaining its cause, and,
so far as possible, removing it.   If dependent  on masturba-
tion, the practice should be abandoned; and if the patient
be a male, he should be ordered aperient medicines to keep
the  bowels regular.   The habits and  diet  of the patient
should be well regulated, and all sexual excitement avoided,
as far as practicable.  If the parts are weak,  the following
compound will be found efficient:
     R.—Tinct. nux vomica.....................................  3J.
         Tinct. cantharides.....................................  sjss.
         Ferri hypo-phosphite................................  3J.
         Simple syrup..........................................  ^vi.
   Sig.  One  teaspoonful three  or  four  times a day.   If
this remedy should fail, one spermatorrhoea pill should be
given night and morning, and the patient ordered  to lie
                           74* 
878
SURGERY.
upon  his  side, or a hard  mattress, and take an  ice-water
enema each night before retiring.
  Where  the disease is dependent upon ulceration or weak-
ness of the ejaculatory duct, or upon irritation of the pro-
static portion of the urethra, it  should  be cauterized by
means of Lalleman's porte caustique, armed with nitrate of
silver.  If the seminal emissions should still continue, gel-
semin  in  sufficient quantity to produce  constitutional ef-
fects may be administered every night.   In some cases of
a very obstinate character, I have found an irritating plas-
ter,, applied to the cervical  portion  of  the spine, and  the
following  mixture, to afford  relief:
    R.—Tinct. ergot............................................. 3J.
        Tinct. gelsemin......................................... ^ss.
        Simple syrup........................................... ^iv.
  M.   Sig.  One teaspoonful  twice or three times a day.
The diet should be nutritious, and baths be taken daily.
  The treatment for nymphomania does not differ essentially
from that of spermatorrhoea, with the exception that  the
clitoris, instead of the urethra, should be cauterized in bad
cases, the strength  of the patient supported, and uterine
tonics and anti-periodics administered.  The constitutional
derangement of these affections should receive especial at-
tention, and every effort be  made to restore the system to
its normal condition. 
PART  III.
OBSTETRICS, AND  DISEASES OF WOMEN
                AND  CHILDREN.
  Obstetrics, (from obstetrix, a midwife,) is that branch
of science which treats of the genital organs of the human
female.
  Parturition,  (from parturio,  to  bring forth.)   The
term is used to designate the act by which  the child is in-
troduced into the world.
  Obstetrical Anatomy concerns the pelvis, its contents,
and the organs of generation.

                   THE pelvis.
  By the Greeks it was denominated rfsfcus; by the Romans,
pelvis; the Italians call it it bacino;  the Spaniards, la pel-
vis;  the French, le basin;  the Germans, das beckens.
  The pelvis  is situated usually about  the middle of the
body, and is an irregular conical cavity.  It contains and
protects  the  abdominal viscera, and affords means of con-
nexion between the  superior and  inferior  portions of the
body.  It is also the  origin and insertion of muscles.   (See
Fig. 108.)
   (Explanation of  Fig. 108.—1. Last lumbar vertebra.
2 2.   Intervertebral substance connecting the  last lumbar
vertebra with the fourth  and sacrum.  3. Promontory of
the sacrum.   4. Anterior surface of the sacrum, on which
its transverse lines and foramina are seen.   5.  Tip of the 
880
OBSTETRICS.
coccyx.  6 6.  Iliac fossae, forming the  lateral boundary of
the false pelvis.  7. Anterior  superior spinous process of
the ilium;  right side.   8.  Anterior inferior spinous  pro-
cess.   9. Acetabulum,   a. Notch of the acetabulum,  b.
                        Fig. 108.
Body of the ischium,  c. Its tuberosity,   d.  Spine of the
ischium seen through the obturator foramen,  e.  Os pubis.
/. Symphysis pubis,  g. Arch of the pubes.  h. Angle of
the os pubis,  i.  Spine of  the pubes; the  prominent ridge
between h and i is the crest of the pubes.   k k.  Pectineal
line of the pubes.  11. Ilio-pectineal line,   m m. The pro-
longation of this line to the promontory of the  sacrum.
The line represented by h, i, k, k, I, I, and m,  m, is the
brim of the true pelvis,  n.  Ilio-pectineal  eminence,   o.
The smooth surface which supports the  femoral  vessels.
p p. Great sacro-ischiatic notch.)
   It is composed, in adult life, of four bones, viz., two os
innominata, the sacrum, and coccyx.
   The sacrum is so called from its being  anciently offered
in sacrifice.
   It is of a triangular  shape, base  above  and apex below, 
OBSTETRICS.
881
and wedge-shaped;  concave anteriorly, convex posteriorly.
It has four foramina, which give exit to the anterior sacral
nerves, which unite to form the sacral plexus.
  The muscle arising from the sacrum  is the pyriformis.
The promontory of the sacrum is formed by the union of
the last lumbar vertebra with the sacrum.  The canal con-
tains the cauda equina.
  It has two horns, or cornua, which unite with the horns
of the coccyx, and form two foramina for  the exit of  the
fifth pair of sacral nerves.
  There are four posterior foramina for the passage of  the
four posterior sacral nerves.
  The grooves on the  outside are filled with  the sacro-lum-
balis and longissimus  dorsi.
  It has  two ligaments—the sacro-sciatic, and the sacro-
iliac.  It is two  and a half inches thick, and four inches
wide.
  The articulation to  the  coccyx constitutes a ginglymoid
joint, which is impaired by age.
   In the foetus it is composed of thirty-four pieces; at birth,
five;  in adults, one.
   It articulates with the vertebrae by interspinous and cap-
sular ligaments.   It  articulates with the  coccyx by liga-
ments and  fibro-cartilage; to the ilium, by  symphysis; to
 the ischium, by ligaments.
   In woman it is shorter, wider, and more curved than in
man.
    Coccyx, Huckle Bone, or Cuckoo's Bill—It consists of
 three  pieces, and in  the young  subject they may be sepa-
 rated.  Altogether, it is about one and a half inches long.
   There are two styloid processes on the posterior surface,
 which rest on the back part of the apex of the sacrum, and
 prevent the coccyx from being pushed  back too far during
 labour.
   The ginglymoid joint becomes anchylosed at from thirty-
 five to forty,  in which case labour is more difficult. 
882
OBSTETRICS.
   The sphincter ani is attached to this bone.
   Os Innominatum, or Haunch Bone.—It is  a quadrilate-
ral-shaped bone;  size, six inches broad, and seven high.
   It is composed of the ilium, ischium, and pubes.
   They all unite in  the acetabulum.
   Ilium, or Haunch Bone.—It is quadrangular, concave in-
teriorly; and the concavity, or iliac fossa,  is partly filled by
the iliacus internal muscle.
   Externally it is convex, and contains the gluteus muscles.
The crest of the ilium is the upper portion of the bone, and
shaped  like the letter F, and  serves as the attachments of
the latissimus dorsi, obliquus  externus muscles, and the fe-
moral aponeurosis.
   To the inner portion the  obliquus internus,  transversalis,
quadratus lumborum, and to its anterior spinous process the
tensor vaginae femoris, iliacus  muscles, and Poupart's liga-
ment, are attached.
   The rectus femoris muscle is attached to the anterior in-
ferior spinous process.
   The ischiatic notch is situated posteriorly, and is con-
verted into two foramina by sciatic ligaments.   The upper
foramen is the largest, and emits the gluteal, sciatic and pu-
dic arteries, and the sciatic and pudic nerves, together with
the pyriform  muscle, where the lower foramen  emits the
obturator internus muscles.
   The Os Ischium, or Seat Bone, is divided into body, base,
spine, and ascending ramus.
   The base forms about two-fifths  of the cotyloid cavity.
   The spine is the inferior termination of the  great sciatic
notch.
   The tuberosity is the inferior extremity of the  bone, and
to it are attached the great sacro-sciatic ligament, quadratus
femoris, adductor magnus, biceps, flexor semi-tendinosus, and
semi-membranosus, the gemellus, inferior  and  great sacro-
sciatic ligament. 
OBSTETRICS.
883
  It unites with the ilium and  pubis in  the  acetabulum,
and to the sacrum by ligaments.
  The anterior planes are converging  and smooth, and give
to the foetal head rotation during labour.
   Os Pubis, or Share Bone.—It is situated anteriorly, and
is divided into a body, two  rami, spine, symphysis, and
crest.
  It forms a part of the cotyloid cavity.  Its  superior and
inner edge forms a  part of the linea ilio-pectinea.
   The gracilis, the transversus perinaei, corpus cavernosum,
the erector, the great sacral ligament, and the tendon adductor
magnus, also Poupart's ligament, are attached to the pubes.
   This  bone  connects in the acetabulum with the ischium
and ilium.
   The angle formed by the rami  in woman is from ninety
to one hundred degrees.
   Obturator  Foramen, or Foramen Ovale, Foramen Thy-
roideum.—It is a triangular-shaped foramen, situated below
the os pubis, and anterior to the acetabulum.
   It is  formed by the rami of the  pubes and ischium.
   It is  filled by two layers of periosteum, and is  the  point
of attachment of the obturator externus and internus muscles.
   Brim of the Pelvis.—It is composed of the ilium, sacrum,
and pubes.
   The articulation  of the  symphysis pubis is fibro-cartilage.
   The ligaments are the anterior pubic, posterior  pubic, su-
 pra pubic, and infra pubic.
   It is said to be covered by a synovial membrane, and to
be moveable.
   The  Sacro-Iliac Symphysis is caused by intervening
 fibro-cartilage.
   Sacro- Coccygeal Symphysis. —It  is articulated by  the
sacro-coccygeal ligament.
                      The Ligaments.
   The  ligaments are  the Great Sacro-Sciatic, Lesser Sa-
 cro- Sciatic, and Sub-Obturator. 
884
OBSTETRICS.
  The great sacro-sciatic arises from the posterior and infe-
rior spinous process of the ilium and posterior tubercles of
the sacrum, inferior margin of the  sacrum, and border of
the eoocyx.
  It is inserted into the tuberosity of the ischium.
  The lesser sacro-sciatic arises from the anterior lip of the
sacrum, and part of the coccyx.
  It is inserted into the summit of the spine of the ischium.
  These ligaments convert the sciatio notch into two fo-
ramina.
  The sub-pubio, or obturator, closes the obturator foramen.

       Divisions of the Pelvis, Greater and Lesser.
  It is separated by the  linea ilio-pectinea.   All above the
line is called the greater, or false; and all below, the lesser,
or true pelvis.
  It is divided into two straits.
  The upper strait is formed behind by the promontory of
the  sacrum, laterally  by iliac fossae, anteriorly by  edge of
pubes.
  The circumference  is fourteen inches; from back to front
it is four inches, and from side to side  it is five inches;
from promontory to acetabulum, three inches.
  The inferior strait is bounded by the inferior part of the
pubis; the tuberosity of the ischium, by  the inferior mar-
gin of the great sciatio ligament, and by the point of the
coccyx.
  Its circumference is thirteen  inches, and is four inches
from  the  coccyx to the pubis; transversely,  four inches;
obliquely, four and three-fourths inches.

                   Arch of the Pubis.
  The angle formed by the descending rami of the pubis,
and  the ascending rami of the ischium,  is from ninety to
one hundred degrees.   At  base it is three and three-fourths
inches broad;  at apex, two inches.   A  line drawn  perpen- 
OBSTETRICS.
885
dicularly to the centre of the planes terminates anteriorly
near the umbilicus;  and  posteriorly, at.union with  upper
two-thirds of the coccyx, and its inferior third.
   Cavity, the space between the superior and inferior straits.
   Dimensions.—Height in front, one and  a half inches; on
sides, three and three-fourths inches.
   It has four diameters, taken  at  centre:—First, antero-
posterior, four  and  three-fourths  to  five  and one-eighth
inches; second, transverse, four  and three-fourths inches;
third and fourth, oblique,  four and  three-fourths inches.
   By dividing the cavity equally by sections at right angles,
two  sets of inclined planes are seen, which  are supposed
greatly to influence  the changes in direction  necessary for
the foetal head to perform its descent.   Some, however, say
that the motion of rotation is executed when the head is
below  the influence of these planes.
   The  anterior planes are directed from without inwards,
from above downwards, and from behind forwards.
                         Fig. 109.
  Fig. 109.   ch. The plane of the superior strait prolonged beyond
the  pubis,   ce.  The plane of the  inferior strait prolonged beyond
the pubis,  cd.  Shows the departure of this plane from the horizon-
tal line.  ab. The axis of the superior strait,  gf. The axis of the
inferior strait.
     75 
886
OBSTETRICS.
   The posterior, from without inwards; from above, down-
wards;  and from before, backwards.

                 Axis of Inferior Strait.
   It is a line from  above downwards, and from behind for-
wards, running from first of sacrum, and falling at a right
angle upon the middle of the bis-ischiatic space.  The axes
of the two  straits  cross in the cavity, forming  an obtuse
angle.
   Axis, or cavity, a curved line parallel to curve of sacrum.

                Other Dimensions of Axis.
   Between the two anterior superior spinous processes, nine
and a half inches.
 Between the highest part of crests of the  ilium,  ten and
a half inches.
   From crest of ilii to tuber ischii of same side, seven inches.
   Symphysis of  pubes,  vertically,  eighteen  lines;  thick-
ness, six lines.
   Base of sacrum,  anteriorly posteriorly, two and a half
inches.
   Base of sacrum,  transversely, four inches.
   Coccyx, in length, eleven to twelve lines.
   From sacrum to pubes externally, seven inches.
   From sacro-iliac symphysis of one  side, to opposite ramus
ischii, five inches.
   From  anterior margin of descending ramus of ischium
to opposite side, four inches.
   Circumference of superior strait, thirteen  to  seventeen
inches.
   From  anterior margin of sacro-sciatic notch to opposite
side, three and three-fourths inches. 
OBSTETRICS.
887
     DIFFERENCES  OF MALE
          Male.
Alse  of ilium more  perpen-
  dicular.

Sacrum straighter.

Coccyx earlier united.
Brim,  long  diameter, ante-
  rior-posterior.
Cavity deeper,  funnel-
  shaped.
Tuberosities converge three
  inches apart;  outlet  less
  capacious.
Arch of Pubes,  seventy to
  eighty degrees.
Foram., thyroid,  oval.
Depth of Symphysis, at least
  two inches.  A line drawn
  from sacro-iliac symphysis
  directly forwards, cuts off
  but little of superior strait.
AND FEMALE  PELVIS.
          Female.
Alse of Ilium larger, wider,
   shorter, lighter; capacity
   greater.
Sacrum shorter, more con-
   cave, wider; not so thick.
Coccyx more moveable.
Brim, long diameter, trans-
   verse.
Cavity more shallow.

Tubera Ischii farther apart.
Arch of Pubes, angle ninety
  to one hundred degrees.
Foram., thyroid, triangular.
Depth of symphysis eighteen
  lines; cuts off much more.
         DEFORMITIES OF THE PELVIS.
  Deformities of the pelvis may be confined  to the whole
or a part of it.
  The deformity may consist either  in  excess or diminu-
tion.  When the pelvis  is too large, the  unimpregnated
uterus is liable to retroversion and prolapsis.
  The impregnated  uterus falls  too low, and compresses
the rectum, bladder,  vessels, and nerves.  Deformities may
occur; first, by projection of the base of the  sacrum, second,
by the turning back  of the ramus of the pubis or by pro-
jection of the pubis itself.
! 
888
O BSTETRICS.
  In  either  of these deformities, the diameters of the
pelvis may be  diminished and labour rendered  difficult.
The inferior strait may be affected by the projecting for-
wards or turning up of the base of the sacrum, also by the
approximation of tuberosity of the ischium.
  The cavity is affected, first, by turning back of the ossa
pubis; second,  by the projecting inwards of the inter-pubic
fibro-cartilage;  third, by the excessive length of the sym-
physis pubis; fourth, by the sacrum being too much curved,
increases the antero-posterior diameter, the head rests too
long, or else the occiput not advancing, produces extension
which results in the  face presentation; fifth, the sacrum
too flat, the head cannot rotate, and  may cause  the death
of the child, or the  great  compression of the soft part of
the mother;  sixth, by morbid  growth, exostoses, fibro-
cartilage, &c.

           CAUSES OF  DEFORMITY.
  The first, and most common cause, is Rachitis or Rickets,
a disease of  early life, in which  the earthy parts of the
bone are imperfectly elaborated;  second, from Malacostion,
(Osteo-malacia, Mollities Ossium,)  occurs later in life; the
earthy matter  is deficient;  third,  exostoses, mal-united
fractures, morbus coxarius, unreduced dislocation, anchy-
losis of sacro-coccygeal articulation from inflammation, &c.

VESSELS CONCERNED IN OBSTETRICAL PRAC-
                         TICE.
  The external pudic artery, a  branch of the  femoral;
course transversely inwards; distributed to labia.
   Gluteal,  a branch  of the  internal iliac; course back-
wards; it emerges from the great sciatic notch.   Vesicle,
a branch of the internal iliac;  Vaginal, a branch of the in-
ternal iliac;  Obturator, a branch of  the  internal iliac ;
emerges from the upper border of the foramen;  Uterine,
a branch of the internal iliac; is very tortuous;  it ascends 
OBSTETRICS.
889
in the folds of the broad ligament;  Ovarian from aorta.
Internal pudic is a branch  of the internal iliac;  emerges
through  the great sciatic notch; re-enters smaller fora-
men, crosses to the ramus ischii; supplies the vagina.
  The Ischiatic, is a branch of the internal iliac;  emerges
from the greater foramen.   Veins, usually accompany the
arteries.   The external iliac vein at the brim lies behind
the artery.  Pressure produces oedema  or varices.
  Nerves concerned in  parturition are the anterior crural,
arises from the second, third, and fourth lumbar vertebrae;
passes outside  of the femoral artery;  distributed to the
rectus, &c.  Pressure on it  produces cramps of the inner
and fore part of the thigh, occurring during gestation.
   Obturator, from the third and fourth lumbar vertebrae;
it emerges from the obturator foramina, distributed to the
abductors; pressure produces cramps of the inside of the
thigh as the head enters the pelvic cavity.
   Sciatic, from the fourth and fifth  lumbar vertebra?, and
the first, second, and  third  sacral; emerges by the side of
pyriformis:  supplies the posterior part of the thigh, leg,
and  foot; is subject to pressure during  parturition, and
cramps are caused in  the calf of  the leg and sole of the
foot; relieved by  pressure  and friction,  sometimes  very
severe.
  The fourth sacral  supplies the bladder and  rectum;
hence pressure produces irritation.
  Pudic, from the third sacral;  supplies  the  clitoris and
external  organs.    Certain  Muscles  are  also interested.
Pressure upon these causes  pain on motion and in defaeca-
tion.
  Levator ani; origin,  pubes below the brim, the spine of
the ischium and  obturator  aponeurosis; direction, by the
side of the vagina;  insertion sphincter ani.
   Obturator internus ; origin, obturator ligament and around
the obturator foramen; direction, tendinous  around the
                          75* 
890
OBSTETRICS.
spine of the ischium; emerges by the small sciatic foramen;
insertion, digital fossa.
   Coccygeus.—Origin,  from the spine of the ischium; in-
sertion, coccyx.
   Transversusperinci.—Origin; tuberosity of the ischium;
insertion, the sphincter ani and  vagina and  into the peri-
neum.
            ORGANS OF GENERATION.
   They are  divided into internal and  external.   The ex-
ternal  are the  Mons  Veneris,  Labia  Majora, and Labia
Minora, Clitoris, Vestibulum, Meatus  Urinarius, Hymen,
Fossa Navicularis, and Fourchette.
   The internal are the Vagina, Uterus, Fallopian  tubes,
and  ovaries.
                   PUDENDUM.
   The term is applied to the whole of the external genitals,
and  vulva.  It includes all parts external  to the vagina
embraced by the Labia Majora.

              THE  MONS  VENERIS
   Is a triangular prominence, situated at the lower part
of the Hypogastrium.   It is composed of adipose tissue,
vessels, nerves, skin, and sebaceous glands.
   After puberty it is usually covered with hair.  It  is
subject to abscesses and excessive growth of hair.

              THE LABIA  MAJORA
   Are two  rounded folds which  bound the orifice of the
vulva; formed externally of skin, and internally of mucous
membrane.   It  is usually well  supplied with  adeps and
vessels from the internal  pudics.  It is also covered with
hair.  Use to protect enclosed parts; in labour they distend
greatly,  subject to excessive development, inflammation,
abscesses, eruption, pruritus, encysted  tumours,  lipoma,
varix thrombus, and oedema. 
OBSTETRICS.
891
THE  LABIA  MINORA, OR INTERNAL LIPS,
           CALLED  ALSO  NYMPHiE,
are two  membranous  folds  lying   between  the Labia
Majora, shaped like  a cock's comb.  They cover the ves-
tibuluni  and  meatus.    They are  composed  of mucous
membrane  externally, and erectile tissue internally;  they
are smooth and rosy  in the young; flaccid and pale in the
old.  They are subject  to inflammation, enlargement, &c.

                  THE CLITORIS
is a small elevation about one-eighth of an inch in length,
situated  at the  union  of the nymphae, and at the lower
edge of the symphysis  pubis.  It is composed of two cor-
pora cavernosa; terminates  in a gland covered by a pre-
puce; contains vessels and nerves from the pudic; subject
to enlargement.
                THE  VESTIBULUM
is a triangular smooth space, bounded  above and in  front
by the clitoris; below and behind by the urethra, laterally
by nymphae.   Length, an inch.

           THE  MEATUS URINARIUS
is a rounded opening situated one inch below the clitoris;
diameter one-fifth  of an inch.

                     URETHRA.
   The urethra is the urinary canal, and  extends from the
meatus  to  the bladder; length  twelve  to  fifteen lines,  is
very dilatable, so much so  as  to permit  impregnation  in
cases of uterus connected with the  bladder.  It is subject
to tumour and prolapsus.

                       HYMEN.
   The hymen is a membrane partially closing the vagina.
It is not peculiar to  the human female.  It is supposed by
some to be a  test of virginity, but is not, as  other causes
besides coitus may destroy it. 
892
OBSTETRICS.
  It may be imperforate, and  may prevent menstruation
and coitus, but in the majority of cases it is absent.

      THE CARUNCULiE  MYRTIFORMES
are two pairs of round red tubercles at the orifice of the va-
gina; supposed to be remains of Hymen.
  They are supposed to increase the capacity of the vagina
in labor.
         FOURCHETTE  (FOURSHATE.)
  This is a sort of bridle forming the posterior  commis-
sure.  It consists of folds of the mucous membrane.
  It is usually ruptured  in the first labour.

                    PERINEUM.
  The perineum is  the muscular floor extending from the
trunk to the anus.
  It is composed  of muscle, adipose tissue, and  integu-
ment.  It has a raphe on the median line.  It is the fre-
quent seat of hernia.

                      VAGINA.
  The vagina is a membranous sheath extending from the
vulva  to  the  uterus.  It is  from  four to six inches in
length; is longest previous to child-birth.
  It is located anterior to the urethra and bladder.
  On the sides of it we find  the ureters, broad ligaments,
sacral plexus of nerves, levator ani and muscles.
  On the back we find the rectum.  Inferiorly where the
hymen exists it is guarded by it.
  Superiorly it embraces the cervix uteri, forming a cul-
de-sac before and behind.
  On  opening, a large number of rugae or folds will be
observed.  It is lined with a mucous membrane  covered
by  tesselate epithelium.  A large number of veins and
other vessels are  found  in the  vagina.   The arteries  sup-
plying the  uterus are from the internal iliac.   The Lym- 
OBSTETRICS.
893
phatics go to the hypogastric plexus.  The vagina is sub-
ject to a  great variety of diseases, viz.: inflammation, can-
cer, &c,  which will be described hereafter.

                      UTERUS.
   The uterus is a hollow viscus, (see figs. 110 and 111.*)
Use, to receive, protect, and expel the foetus.  It is situa-
Fig. 110.                 Fig. ill.
ted above the vagina, below the small intestines, behind
the bladder, and in front of the rectum.
  It is pear-shaped, flattened from before backwards, apex
below and  base  above.   It  is covered  through its  whole
extent with peritoneum.   It is divided into fundus, body,
cervix, and  os.   The fundus is that part above the  orifice
of the Fallopian tubes.   The body is between the fundus
and  cervix.  The part below, about three-fourths  of an
inch in length, is the cervix; the opening through the cer-
vix to the body of the uterus is the os.  It is situated be-
tween the two folds of the broad ligament.  It weighs in
virgins seven to eight drams;  in multipara one and  a half
ounces. A short time previously to menstruation its weight
is increased.  It is from two to three inches in length, two

  * Fig. 110 shows the uterus  previous to impregnation, and fig.
Ill afterwards. 
894
0 B S TE TRI CS.
inches and a half broad, and two-thirds  of an  inch thick.
The superficies is sixteen inches.  The cavity is capable of
containing about a dram of fluid.   It is pear-shaped.   On
the surface are  seen ovula nabothi, which are  muciparous
follicles.   They secrete the fluid that closes the cavity of
the cervix after pregnancy.  The  uterus is composed of
mucous membrane, peritoneum, areolar tissue,  and muscu-
lar tissue.

         FUNCTIONS  OF THE  UTERUS.
   1st. To  secrete mueus.
   2d. To eliminate menses.
   3d. To develop decidua.
   4th. To receive and nourish embryo.
   5th. To expel foetus.
   The uterus  is largely supplied with  arteries,  nerves,
veins, and lymphaties.  It may be wanting and is subject
to a great variety of diseases.   There are two sets  of lym-
phatics;  they develop greatly in gravid uterus.

            THE  BROAD LIGAMENTS
are three quadrilateral folds of the peritoneum, extending
from  the uterus to the sides of the pelvis, dividing  the
uterus into two  compartments.  The upper fold contains
the Fallopian tubes, posterior contains the ovary and liga-
ment of  the ovary; the anterior has the  round ligaments.
   The round ligaments are two in number; they arise on
the front of  the uterus; direction outwards and upwards,
terminating in the mons veneris.  They are from six to
seven inches in length; are composed  of vessels, nerves,
absorbents, areolar tissue and straight muscular fibre.
   Use.—They prevent retroversion.
   The other Ligaments are,—Anteriorly, vesico-uterine,—
Posteriorly, recto-uterine.  They are folds of  the  perito-
neum. 
0 BSTETRICS.
985
                        Fig. 112.

   Ovaries (testes midiebres.)—Two oval flattened bodies,
lying in posterior fold of broad ligament, behind and below
Fallopian tubes, one and a half inches from uterus on either
side, one and a half to one and a quarter inches long, one
half to five-eighths inch wide, one  quarter inch thick.   A
fibrous cord attaches the organ to the uterus; it is one and
a half  inches  long,   Ovary  is  composed outside of peri-
toneum.
  2d. Of Tunica  Albuginea,—It  forms a septum  which
traverses  the organ,  forming cells.  Of the stroma ova
Graafian vesicles  are formed.  Of  these there can be seen
from fifteen to thirty, but,  with the microscope, an innu-
merable number  can  be  seen, the larger on the outside.
The function of  the  ovaries is to supply ova to stimulate 
896                OBSTETRICS.
menstruation.   When the ovaries are removed, the female
loses her sexual characteristics.
  Menstruation is the term applied  to the series of pheno-
mena that attend the rupture of a  Graafian vesicle.   It is
usually said to be a periodical sanguineous discharge from
the female genitals.
  Synonyms, Menses,' Changes, &c,—The appearance of the
menses is an evidence of capacity for conception.  The age
of appearance is usually at fourteen, but varies from nine
to twenty-four years.
  Cold climate delays, and hot hastens it.  It is later with
country girls of simple and laborious habits, while a luxu-
rious life, balls, plays, exciting books, pictures,  and the
use of stimulants, hasten it, and, also, a sanguineous tem-
perament accelerates it.
  Premonitory Symptoms.—There  are inequalities of spi-
rits, headaches, lassitude,  uneasiness,  weight in  loins or
perineum, pain in back, tension in epigastrium, pruritus of
vulva, mucous discharges, pain in the thyroid body, colicy
pains, the skin has a  peculiar odour, and is disposed to
eruptions, congestion  of mucous membrane, epistaxis, and
irritation of breasts.
  Sometimes menstruation commences without precursory
signs.  The first few periods are frequently irregular, as to
time of return and amount of discharge. The manifestations
of the approach of puberty are seen in the development of
the mammae, the expansion  of the hip, the  rounded con-
tour of the body and limbs, the development of hair on the
pubis, the development of voice, reserve takes the place of
forwardness, and the plays of the child are exchanged for
the pursuits of womanhood.
  The duration is  from a few hours  to one week, or even
more.  The average is from four to five days.  The quan-
tity is from four to six  ounces.  Change of climate, from
cold  to  hot, is said  to  produce excess,  and change from 
OBSTETRICS
897
country to city is  said to increase it.   Women of bilious
temperament are said to menstruate most profusely.
  Nature and Colour.—It is blood, mixed with vaginal
mucus and uterine epithelium.  It is thin, and of a dark,
venous-blood colour, with a faint, unpleasant odour. When
discharged from the uterus it is alkaline, and usually  coa-
gulable; discharged from the vagina, it is acid, not usually
coagulable, and contains lactic and phosphoric  acid.
  Mode of Discharge— Guttatim.—On the first day, it is
quite fluid, less highly coloured, and less in quantity.  The
menses return usually every  twenty-eight days.
  The  varieties are,  twenty-two, twenty, eighteen, fifteen,
or thirty-two, thirty-five, and forty days.  The most  im-
portant element is the regularity of return.  Cause.—The
maturation  of a Graafian vesicle.  Menstruation depends
on the ovaries.  The proof is that when these organs are
removed, or even  diseased, if the uterus be normal, the ca-
tamenia are absent, or cease, while, even though the uterus
be absent, the menstrual molimen will give evidence of the
 existence of ovaries.
   Seat.—It is usually from  the cavity of the  body of the
 uterus—sometimes from  the vagina, as  a compensating dis-
 charge.  The proof of its uterine origin  is in  procidentia,
 inversion, and  occlusion of the os by the speculum.
   Source.—The source is the uterine capillaries by rup-
 ture.
   State of the Uterus.—The arteries  and veins are more
 distended, the uterine tissue looser and more  pink, the os
 is more patulous, and the Fallopian tubes are  more vascu-
 lar.   The hypertrophy of the mucous membrane is like de-
 cidua.  Cessation usually takes place at from forty-five to
 fifty years of age.
   The variations are thirty-six, thirty, twenty-six, twenty-
 four, fifty-five, sixty, seventy, ninety-one.  The duration
 of the menstrual life is about thirty years.  The period of
 final cessation  is called change of life, turn of  life, &c.  The
        76 
898                 OBSTETRICS.

evidences are flaccid mammae, cheeks flaccid and wrinkled,
and the skin yellowish.   The eyes lose their brightness—
and sometimes there is a quasi beard.   It is vulgarly sup-
posed to be a critical period, but fewer women than men
die between forty and fifty.
   Varieties in Mode of Cessation.—Sometimes the menses
cease gradually.  They are sometimes excessive, at one time,
and then scanty.  They sometimes cease and return, even
at considerable intervals.   Sometimes they are irregular in
time and quantity, and sometimes they cease  by a mucous
discharge.
   Reciprocal influence of acute disease and menstruation.—
All acute  diseases exert  a pretty similar effect on men-
struation, but this influence  varies  accordingly as the dis-
ease is developed,  during  an  epoch, or  during an interval.
In the first, the menses are usually suppressed completely
or incompletely, and may reappear, after some hours  or
days,  usually  diminished.  In  the  interval,  if the next
epoch is near, menstruation  is favoured by the increased
hemorrhagic  condition of the  organs.  The menses  are
usually  absent,  or  notably diminished, at the periods that
occur during the decline of the disease, or in convalescence,
lasting from one to three months.  The menstrual eruption
in nowise predisposes to disease, and it exerts no appreciable
influence on the issue of acute febrile affections.   No spe-
cial therapeutical indication  in the' treatment of acute  fe-
brile disease is desirable from the state of the menses, and
we must act without reference to menses.
   Disorders of menstruation  occur in four ways— Obstruc-
tion, Suppression, Menorrhagia, and Dysmenorrhea.  Some
add a fifth— Vicarious  Obstruction.  More usually, amenor-
rhea  is applied to cases  in  which there is no catamenial
discharge.
   Causes.—1. Absence of the ovaries.
   2.  Occlusion of the os and vagina.
   Operation for Occlusion of the  Vagina.—Introduce a 
OBSTETRICS.                 899
finger into the rectum, and a catheter into the bladder; the
occlusion may be separated by the scalpel, or perforated by
the trochar.   Use a bandage to the abdomen.   Wash out
the vagina with tepid fluids.  To prevent closure, a care-
ful use of the bougie or cylindrical speculum is required.
Imperfect development of the uterus is irremediable.
   Functional Amenorrhcea is not so much a disease as a
symptom of the constitutional derangement or lesion of the
ovaries.  There  are two forms of functional amenorrhcea—
   1st. Entonic,  or sthenic, or active.
   2d. Atonic, or passive.
   Symptoms.—Headache, active circulation, hot skin, pain
in the back, loins, legs, &c.   It becomes atonic.

                  CHLOROSIS
 '  Is essentially a disease  of the blood.  The red  globules
are reduced from one hundred  and twenty-seven in a thou-
sand  to sixty.  It occurs most frequently in  girls, about
the age of puberty.
   Causes.—Feebly  developed   constitution, unwholesome
diet, residence in damp,  marshy countries, debility of  the
digestive organs,  sedentary occupations, disappointed af-
fections, excessive venery, and masturbation.
   Diagnosis.—Loss of or morbid appetite, green discoloura-
tion of the skin, &c.
   Treatment.—Iron, macrotin, eupatorin perfo., euonymin,
baths, and country exercise, is the best treatment. (See
Chlorosis, in another part of the book.)
   Suppression of  Menses—Acute.—Caused by  wet feet,
iced-water, insufficient clothing,  bathing, &c; fear, grief,
anxiety, drastics, emetics, falls, and coitus  during flow—
also, acute diseases.
   Symptoms.—Weight,  pain in the head  and loins, and
uterine regions, hot skin, apoplexy, epilepsy, vicarious  he-
morrhages, &c. 
900                 OBSTETRICS.

   Chronic suppression may result from  an acute attack, or
gradually, as the  result of some irregularity in the secre-
tions of  the uterus, thus preventing the maturing of the
ova—or it may depend upon organic disease of the uterus
or ovaries.  The  menses may disappear gradually, with a
scanty, painful serous discharge.   Sometimes a painful
monthly  nisus, but no  discharge.   Sometimes persistent
leucorrhoea.
  Symptoms.—Headache, vertigo, muscae volitantes dilated,
pupils, heat and  cold, chills,  dryness,  constipation, urine
abundant and limpid, dyspnoea, palpitation, and depraved
appetite.
   Vicarious  menstruation  is a discharge  from some other
part than the uterus, usually occurring in the  unmarried.
If in the married, conception is rare.
   Nature.—Usually blood, sometimes leucorrhoeal.   It oc-
curs in any part of the skin or mucous membrane, in  the
form of epistaxis, hemoptysis,  &c.
   Symptoms.—Local pain, hysteria.
   Menorrhagia.—Profuse, prolonged, or too  frequent men-
struation, separately or conjoined.  A normal discharge in
one woman may be menorrhagic  in another.  Climate has
an  influence—hot  increases the flow, while  cold  dimi-
nishes it.
   The Active form occurs in early life in the robust, but is
quite rare.
   Symptoms.—Headache,  hot  skin, full  pulse, weight in
the back, hips, and loins, pelvis, &c, are  noticed for some
days.  A discharge produces relief.
   The Passive form is caused by hot rooms, abortions, leu-
corrhoea, falls, excessive venery,  long walks, constipation,
•fee.  In pregnancy, it has  its seat in ulceration of the cer-
vix.
   The health breaks; there is anemia, and often hysteria:
the signs are, pain in the  head, flashes of  heat,  tinnitus
i 
OBSTETRICS.               901
aurium, pain in the left side, palpitation, &c.   Tubercle
often ensues.
  Dysmenorrhea—Painful and Difficult Menstruation.—
The symptoms are those of menstruation, but greatly exag-
gerated.   Sometimes  convulsions  occur.  It occurs most
frequently in single women, and is caused usually by cold
at the  menstrual epoch.   Sometimes by constricted os  or
cervix.
  Symptoms.—Restlessness, heat, flushed face, pain, weight
and heaviness in the head, pain in the back, pubes, coccyx,
and thighs—sometimes so severe, as to produce syncope.
After some  time, the pain  becomes bearing down, and  a
shreddy discharge ensues.  Sometimes a sac is discharged,
being an  exaggeration of  the  deciduous membrane that
occurs normally at the menstrual period.
  But little  effect is produced on the general health of the
young and  plethoric.  In the nervous, the health fails,
and, not unfrequently, phthisis ensues.  All menstrual dis-
orders are apt to awaken phthisis in the predisposed.   Wo-
men subject to dysmenorrhoea after  the  cessation of the
menses, are  liable to cancer.
  Leucorrhoea.—Discharge from  the female genitals—hue
varying from a light to a yellowish-green or reddish brown.
Consistence, from a limpid serum to a ropy substance.
   Treatment for Acute Suppressed  Menstruation.—If the
suppression  is  recent, apply hot  mustard poultices to the
mamma?.  Give a hot foot-bath—also, the following com-
pound :
    R.—Senecin............................................... gr. x.
        Gossypiin................................. ........  gr. xv.
        Apocynin............................................ gr. i.
        Sacch.  alba.......................................... 9J.
        M.  ft. pulv........................................... No. vj.
  Sig.  One every two hours. In bad cases, a hot sitz-bath
should be given during the operation of the  medicine.  If
this treatment do  not succeed,  iron, quinine,  caulophyl-
                          76* 
902                 OBSTETRICS.

lin, senecin, wine, and tonic tea, should be given until the
system is invigorated, and then the above treatment should
be repeated.   The chronic form of the  disease should be
treated by supporting and invigorating  remedies, such as
bebeerine, macrotin, sitz baths, &c.
   Menorrhagia  may  be  treated  with  ceracin,  gelsemin,
trilliin, helonia, female injections  of a decoction of hydras-
tus, matico and cinchonia.   Dysmenorrhoea is treated with
the various preparations of iron, gossypiin, bebeerine, qui-
nine, gelsemin, irritating plaster over the ovary, nutritious
diet,  and general tonics.
   Sometimes several ounces in twenty-four hours.  It is
a symptom of irritation, congestion, inflammation or ulcera-
tion of the cervix.  Frequently a catarrhal affection.
   Symptoms.—At first, itching, heat, weight, sense of ful-
ness, pain during urination, bearing down, &c.
   The Acute form is caused by cold, local irritation, exces-
sive  coitus  or pessaries, hot  baths, too  free living, preg-
nancy, abortion, dysmenorrhoea, &c.
   The Chronic  is a sequel of  the acute form.  The dis-
charge does  not differ in appearance from gonorrhoea in
many respects.
   Treatment.—The treatment for leucorrhcea must depend
much upon the cause.  The cause should first be removed,
then  the attention  should  be directed to the irritation and
inflammation of the cervix uteri and vagina.  This can best
be removed by daily  alkaline  baths to the surface, in con-
nexion with  anti-bilious physic, followed by small doses of
veratrum viride or gelsemin, and rest.  If it is an acute
case,  cold water vaginal injections, or, if chronic, hot water
injections will also assist in removing the congestion or in-
flammation.  After the  inflammation is removed, if the dis-
charge continues, female injections of a strong decoction of
equal parts of golden seal, white  oak bark, and cinchonia,
should be frequently used  during the day, and from one to 
OBSTETRICS.
903
two grains of hamamelin, in connexion with small quanti-
ties of iron, should be given two or three times a day. Cor-
nin, bebeerine, macrotin, caulophyllin, and  gelsemin, are
also used for the same purpose.  Sitz baths, hot packs over
the epigastrium, electricity, and an irritating plaster to the
sacrum, may also be used in some cases of leucorrhcea.
   Ulceration and congestion of the os uteri is the true pa-
thology of the vast majority of cases called leucorrhcea.  It
exists in virgins, the non-pregnant, pregnant, but most fre-
quently in multipara?.
   Causes.—Coitus,  imprudence  during  menstruation,  as
standing, walking, lifting, &c, and, very often, premature
efforts after abortion or  labour.
   Symptoms.—The most frequent is leucorrhcea, varying
•in quality, being mucous, purulent, or starchy; in colour,
milky, greenish, yellowish, or brownish—often tenacious
 masses of mucus, like starch, come away.
    Treatment.—When there is  absolute ulceration of the
 os, a glass  speculum  should be introduced into the va-
 gina, and the  os  cauterized with a solution of nitrate of
 silver, of the strength of fifteen  grains to  the ounce of wa-
 ter.  It can be applied by means of a probang.  After each
 application, and  previously to  removing  the  speculum, a
 small amount of the superfine flour of slippery elm should
 be applied to the os.  The constitutional symptoms should
 be treated according  to their nature.   Vaginal injections
 of a decoction of red raspberry leaves and golden seal will
 also prove beneficial.
    The bowels should be kept  regular by means of neu-
 tralizing mixture and leptandrin, and the  following powder
 should be given:
      R.—Gelsemin............................................. gr- ij-
          Caulophyllin........................................ gr. x.
          Hamamelin.......................................... gr- xx.
          Hypophosphite of soda........................... gr. v.
          Sacch. alba.......................................... gr. xxx. 
904                 OBSTETRICS.

  Mix.  Triturate.   Divide into fifteen powders.  Dose,
one four times a day.
  After  the  inflammation is subdued, give a tonic as fol-
lows:
           R.—Chamomile flowers.
                Eupatorin purpurin.
                Caulophyllin thalyctroides, aa.
                   One half ounce.
                Port wine, one quart.
  Mix.  Dose, one tablespoonful three times a day.  During
the administration of this medicine, the baths and injections
should be continued, the diefopell regulated, and the  pa-
tient allowed to take free exercise in the open air.
  Falling of the  Womb is denoted by pain in the back and
loins, and surpubic region,  heat in the vagina, painful coi-
tus, menses painful  and  irregular, constipation  and diar-
rhoea, bladder irritable, the cervix is  lower than usual, lips
large and tumid, the anterior portion  of the  os is soft,
spongy and hot,  there is a velvety feeling, and sometimes
tenderness on pressure.
  There may be ulcers varying in size from a pea to a half
dollar.  They are bright red, deep red, granular and bleed-
ing, whitish, patchy, with the base  coated,  and the edges
angry.   Authors  divide  them  into  granular, cockscomb,
bleeding, superficial  erosion,  varicose  ulceration,  fissured
ulcer, follicular.
   Symptoms.—All varieties of dyspepsia, hysteria, neural-
gia, cough and dyspnoea.
  Prognosis.—Probably no disease  so severe in its effects
is so easily cured.
   Treatment.—In case of prolapsus uteri, the patient should
observe  perfect  quietude.   The inflammation  should  be
treated  as  previously  described,  after which  the uterus
should be replaced by introducing the index finger into the
vagina, and grasping the abdomen above the pubis, when,
by  a rapid extension of the finger, and  an upward pressure 
OBSTETRICS.
905
of the abdominal parietes, the uterus should be carried up
to its normal position, after which the vagina should be in-
jected with a warm decoction of equal parts of hemlock and
white oak bark—the bowels kept open by means of mild
laxatives, and such  constitutional treatment instituted  as
will restore the patient to her normal health.


DISEASES  OF  THE EXTERNAL  ORGANS  OF
                   GENERATION.
1.  SUPERFICIAL  INFLAMMATION OF  THE
                      VULVA.
   Any part of the external  organs of generation may  be
the seat  of inflammation.  This  inflammation may be  su-
perficial, affecting the skin and mucous membrane only,  or
it may be severe, affecting both the skin and sub-cutaneous
tissues.
                    SYMPTOMS.
f  The skin is reddened and  slightly tumefied, the mucous
follicles are prominent,  sometimes of a pale colour, at others
of a deep red or purplish appearance.  The ulcers will  be
small and oval.
                      CAUSES.
   Generally a want of  cleanliness;  or from the  acrid
character of the vaginal and uterine secretions, or from
causes that produce inflammation in other parts.

                   TREATMENT.
   Frequent bathing with Castile soap and water.

2. PHLEGMONOUS INFLAMMATION OF  THE
                      VAGINA.
   It involves both the skin  and sub-cutaneous tissues; it
occurs most commonly in the labia pudendi, but sometimes
in the mons veneris.   It may occur in  one or both labia,
and sometimes gives rise to great swelling  of the parts. 
906                OBSTETRICS.

                    SYMPTOMS.
   Uneasiness  in  standing, sitting, or walking;  pain, heat,
redness, or swelling.  The inflammation runs a rapid course,
and terminates in suppuration.   When  suppuration  takes
place the patient  complains of throbbing pain in the part.

                      CAUSES.
   A fall or blow  may give rise to it.   Also masturbation,
a first connexion, pressure of the child's head as it passes
the outlet, &c.
                    DIAGNOSIS.
   It  may be  distinguished  from hernia by the  greater
hardness of the swelling, by its circumscribed character, and
by its not being reducible.  It may be  distinguished from
oedema of the  labium by its more circumscribed character,
and darker colour;  and from tumours of the labium, by its
acute course,  and by the  greater degree of heat, redness
and pain.
                   TREATMENT.
   Apply a poultice of equal parts of slippery elm and white
pond  lily.  Keep  it wet in the  tincture of lobelia.   Give
quinine and anti-bilious physic internally.

           COHESION  OF THE LABIA.
   This may be congenital, or the result of accidental dis-
orders.   The cohesion  is seldom complete;  a passage suffi-
cient  for  the  urine  generally exists.   Sometimes,  though
rarely, complete cohesion exists at birth.

                      CAUSES.
   Acute inflammation of the vulva caused by severe labour,
or it may be spontaneously; from a burn, a venereal affec-
tion, a wound  or laceration, or any cause producing inflam-
mation. 
OBSTETRIC S.
907
                   DIAGNOSIS.
  Where the  cohesion is partial and  near  the  posterior
commissure of the vulva, there is an accumulation of urine
and other discharges at that point, which if suffered to re-
main, may produce ulceration, fistulas, etc.

                   TREATMENT.
  Carefully separate the labia by dissection and subdue the
inflammation.

     ENCYSTED TUMOURS  OF THE LABIA.
  These tumours are generally circumscribed and tense,—
forming a round or oval projection  from the vulva,—and
are often semi-transparent.   Some are as large  as a  par-
tridge's egg, others are said to be as large or larger than a
goose egg.  The contents of the cyst are sometimes a yellow
serum;  at others, a viscid fluid, a dark-coloured puriform
matter,  or  a semi-solid lardaceous  matter;  the  cavity  is
always lined with a distinct secreting membrane, the  pro-
per cyst-wall.   These tumours may remain for years  and
give the patient but little uneasiness.   When large, they
cause disturbance, by the tension of the parts.  They rarely
produce pain,  unless by aggravating adjacent organs.

                    DIAGNOSIS.
   This  tumour differs from phlegmonous inflammation by
its slow growth, and the absence of pain, heat, and  red-
ness. It is unlike oedema in  its circumscribed form, being
confined to one labium, and by its  slow growth.   It is un-
like hernia in  these respects.   It swells and  distends while
coughing, and cannot be returned into the abdomen.   To
remove doubt, the exploring  needle may be used.

                   TREATMENT.
   The tumour should be thoroughly cauterized with caustic
potassa?, and the parts covered with a slippery elm poultice. 
908
OBSTETRICS.
The constitutional treatment should be according to  the
symptoms presented.

        OOZING TUMOUR OF THE LABIA,
  Arises in one or both labia, and sometimes extends to
the mons veneris.   Sometimes it covers nearly the entire
labia.  It projects  from a  line or two  to one-third of an
inch  above the plane of the surrounding skin.   The sur-
face consists of slight  depressions and  eminences from
which the liquor oozes in  the form of  a watery fluid, aud
forms drops which run off and keep the surrounding parts
wet.  The adjacent parts are sometimes  oedematous, though
oedema is not found in the  tumour.   This tumour increases
in size, until  the quantity  of fluid is such as to cause much
pain to the neighbouring parts by its irritation in constantly
passing over them.  Thus  there are smarting and shooting
pains on the inside of the  labium with  a general sense of
heat of the external organs, and pain and heat in  passing
water.
                   TRE A T ME N T.  .
  Apply to the tumour the mild  zinc ointment; if that
should not remove it, cauterize it and apply poultices as in
encysted tumour.

            VARICES OF  THE LABIA.
   Characteristics.—Dilated veins from beneath  the skin
and mucous membrane;  lumps more or  less protuberant as
they are  of old or recent date.   The tumours are indolent
upon pressure, of a bluish  colour, and so soft that they dis-
appear upon  pressure, but appear  again as soon as the
weight is taken off.   They  may become the seats of fungous
ulcers difficult to heal.  This is sometimes accompanied by
pruritus.
                      CAUSES.
  Too frequent coitus, the use of instruments in labour,
pregnancy too often repeated, and  any  obstruction of the
venous blood  through  the pelvis. 
OBSTETRICS.
909
                   TREATMENT.
  Bathe the parts with a solution of the muriated tincture
of iron, and if there be ulcer, the treatment should be as
prescribed for varicose ulcers.

THROMBUS, OR  SANGUINEOUS TUMOURS  OF
                    THE  LABIA.
  This consists in extravasation of blood  into the cellular
tissue of the labia, and is caused by a rupture of some ves-
sels of the parts, generally the veins:  these tumours ac-
company parturition, and  occur previously to delivery,
during labour, or immediately after confinement.  One or
both labia  may be affected; the tumour  may extend  up-
wards into the pelvis  or downward  to the perineum;  the
size depends upon the distensibility of the tissues; it some-
times becomes as large as a child's head, it is irregular and
of a livid or black colour, the patient lies  on her back with
her thighs drawn up and widely separated.  She is scarcely
able  to move, cannot even support the weight of the  bed-
clothes.  If the  tumour does  not give way, distention of
the parts causes  great pain.  In some cases its progress is
very rapid,  the  great  effusion  of blood  causing syncope.
In other cases the mucous membrane gives way in a short
time, causing dangerous hemorrhage.   If the labour is com-
pleted without a rupture of the tumour,  it  soon vesicates,
becomes gangrenous, and the contents are discharged.  In
this case the blood is more  or less clotted, and the hemor-
rhage is not so  great.  This tumour has been most  fre-
quently seen during natural labour.  The tumour causes re-
tention of the urine  by pressing against the meatus urina-
rius.  This tumour may be  easily  diagnosed from other
tumours;  it may be distinguished from  hernia by its ir-
regular form, the fluidity of its contents, its colour, and not
being reducible,  nor changed by coughing.
       77 
910                OBSTETRICS.
                    TREATMENT.
   Hot packs should be applied to the tumour  and fre-
 quently changed,  the  bowels  kept open by mild  purges,
 and if there be hemorrhage, pressure should be applied to
 arrest it.   If gangrenous ulcers, equal parts of baptisin and
 sulphate  of  zinc,  followed by emollient  poultices.   The
 patient must be kept quiet, and if there be inflammation and
 fever, anti-inflammatory remedies, such  as  veratrum or
 aconite should be  given internally, and an astringent and
 antiseptic poultices applied externally.

      WARTY  TUMOURS  OF  THE  VULVA.
   These tumours may be developed  upon  any part of the
 external genitals, and have been found in the vagina.  They
 may occur at any age,  and may be single or in groups.  In
 size they vary from a pea to a hen's egg.  There is scarcely
 any difference in  colour between  them and the adjacent
 parts.
                    SYMPTOMS.
   They commonly produce considerable irritation, causing
 a discharge of mucus.  If large, they cause considerable
 inconvenience in walking, sitting, &c.

                      CAUSES.
 f  Want of cleanliness, chronic inflammation of the parts,
 and frequently the sequelae of syphilis.

                   TREATMENT.
   They may be removed by the scissors or ligature.

          DISEASES OF THE  URETHRA.
   Introduction of  the catheter.—In young persons  the ex-
ternal orifice  of the urethra is  immediately below the sym-
physis pubis, and nearly level with its anterior face.  In
those   who have  borne  many  children,  the urethra is
shortened, and the orifice will  be found behind the pubis 
OBSTETRICS.
911
and near its posterior face.  In enlargement of the uterus
the direction of the urethra will change, so that in  the
latter stage  of pregnancy it will  be  found nearly perpen-
dicular, passing "along the inner  surface of the symphysis
pubis, and the meatus will be found behind the pubis and
near its posterior face.
  During labour the direction will  be the same,  but  the
descent of the head into the pelvis compresses the urethra
so that the catheter can with difficulty be introduced.  In
this case the head should  be gently raised by two or three
fingers of one hand, while with the other the  catheter may
be introduced.   After labour much care should be used in
its introduction, as the tissues are much relaxed.

                   URET HRIT IS.
  This affection may be acute or chronic;  the chronic form
always results from the acute.  It may occur at  any age.

                    SYMPTOMS.
  Constant  pain along the urethra, greatly  increased by
passing urine.  There is also bearing down;  the urine is
passed with  great difficulty, and  but a small  quantity at  a
time, the patient having a constant desire to  evacute  the
bladder.  In some cases the urine cannot be passed at  all;
for as soon as it touches the inflamed surface spasms take
place, which prevent  the passage of a drop.  In acute cases
the urethra will be extremely painful to the touch.  If the
orifice be dilated the mucous membrane will  be  seen to be
unusually florid, and it  may be so  swollen as to protrude
from the orifice.  In the  acute form there is no discharge
from the urethra, but in the chronic form sometimes there
are ulceration and a  muco-purulent discharge.

                    TREATMENT.
  If acute, apply hot packs to the vulva; let the patient
drink freely of marsh-mallow tea,  and give one or two drops 
912
OBSTETRICS.
of tincture of veratrum viride every hour or two until the
inflammation is controlled.

         OCCLUSION  OF  THE  URETHRA.
   This  is a congenital affection, and  may  exist indepen-
dently of any malformation of the other genital organs.
   This malformation generally consists of a thin membrane
stretched across  the  orifice of the urethra, though cases
have been reported in which the closure affected  even the
whole canal.   The urethra may be mechanically obstructed
by cohesion of the labia.

                    TREATMENT.
   The membrane should be ruptured by a small catheter;
or if it will not yield  to gentle pressure of the catheter, it
should be punctured by a small trochar.

       FOREIGN BODIES IN  THE  URETHRA.
   Foreign substances in the urethra consist either of sub-
stances  introduced  from without, or of calculi from the
bladder.   These substances, by contact with  the walls, pro-
duce  considerable  irritation and spasmodic contraction,
thus preventing  their farther passage.  Their exact posi-
tion  may be ascertained by the catheter, or  sound.   They
may be  removed by a small pair of  polypus  forceps.   It is
sometimes necessary to relax the  urethra, especially if the
substance be large.   Owing to the great dilatability of the
urethra in females,  very large calculi can be passed.
   A case is recorded, where a stone weighing four ounces,
and another as large as a goose egg, were expelled without
aid by mechanical means, or otherwise.
   The urethra may be dilated by applying gelsemin, bella-
donna, or stramonium. 
OBSTETRICS.
913
      DISEASES OF THE  VAGINA.
             OCCLUSION OF  THE VAGINA.
  This may be either congenital, or the result of disease.
It may occur in any part of the vagina, or involve its en-
tire extent.
            IMPERFORATE  HYMEN.
  This is not likely to be discovered until the commence-
ment of menstruation.   It  may then be  suspected if the
female have all the symptoms which accompany the menses,
without a discharge of the fluid, and if these symptoms
should recur at  regular intervals, accompanied with a sense
of weight and  fulness of the vagina, and especially if an
enlargement is perceptible in the hypogastrium, with pain
and tenderness.
  The symptoms become ameliorated in the course of a few
days, but return at each successive menstrual epoch.   We
may be sure that these symptoms are caused by imperfo-
rate hymen when we can discover between the labia a he-
mispherical tumour, of a livid or bluish colour, soft  and
fluctuating.  In most cases  the membrane has been found
quite  thin, but  it is sometimes from one-fourth  to three-
eighths of an inch thick.

                   TREATMENT.
  Where the hymen cannot be perforated with the finger,
it should  be separated with  a sharp-pointed bistoury, or
punctured with a trochar.

          STRICTURE OF THE VAGINA.
  This may occur  as a natural malformation, or  may arise
as the  result of disease.  Congenital stricture, or narrow-
ness of the vagina, is rarely met with.  In  some instances
the vagina has not been more than half an inch in diameter.
Acquired  stricture  of the vagina is  much more frequent
than congenital.  It may arise from violent inflammation of
                         77* 
914                OBSTETRICS.
the vagina, or from anything that would produce indura-
tion and thickening of its walls, as the  imprudent use of
vaginal injections.
                    TREATMENT.
  Where stricture of the urethra is dependent upon inflam-
mation, or upon prolapsus connected with inflammation, as
it frequently is, the vagina should be frequently injected
with warm mucilage, and the  inflammation  controlled by
means of aconite, gelsemin, or  mild purges.   If the stric-
ture is not overcome in this way, a graduated  bougie should
be introduced, and gradual pressure made until the stricture
is overcome.   If the introduction of the bougie should  pro-
duce much pain, the  pressure should at first  be slight, and
the  effort be  repeated  every two  or  three days  until the
stricture is overcome.

ACUTE  VAGINITIS — INFLAMMATION OF THE
                       VAGINA.
   This affection may  be  confined entirely to the mucous
membrane, or it may extend to the sub-mucous cellular
tissue.  It is attended with pain, swelling, and redness of
the vaginal canal; the mucous membrane is  of a vivid red
colour, and  the rugae are more developed and prominent
than is natural.  At the first stage there is an arrest of se-
cretion;  but after a day or two a  serous secretion sets in,
which becomes purulent,  and of a yellowish or greenish co-
lour.  As soon as  this secretion  is fairly established, the
pain, heat, &c, diminish.  If the sub-mucous tissues be-
come involved, the inflammation may assume a phlegmonous
form, and terminate in purulent  collections, which  empty
into the vagina.
                       CAUSES.
   The disease may arise from  cold, which is the most fre-
quent cause;  also from injuries to the vagina by violence,
excessive venereal indulgence, exertion after  delivery,  high
living, &c. 
OBSTETRICS.
915
                   TREATMENT.
  The vagina should be frequently injected with warm water,
the patient kept quiet, and the inflammation controlled by
tincture of veratrum viride.   The chronic form of the dis-
ease may be treated as under the head of leucorrhcea.

        PROLAPSUS  OF  THE VAGINA.
   This  not uncommon affection has often been taken for
prolapsus uteri.   It is most common in females who have
borne children,  and are past the middle age, though  in
many cases it  has been known  in  the  young,  and before
marriage.  We distinguish  three varieties: prolapsus  of
the anterior wall of the vagina, or prolapsus vesica?, or va-
ginal cystocele, prolapsus of the posterior wall, called va-
ginal rectocele, and prolapsus of the entire  circumference
 of the vaginal canal.-

              VAGINAL  CYSTOCELE
   Is the most common form, and may arise from any cause
 which tends to relax  the vaginal walls, as repeated child-
 bearing, difficult  labours, etc.  This  relaxation causes a
 change in the position of the bladder; there is retention of
 urine,  distending the bladder,  and  forcing it downward
 into the vagina.   The more the bladder is displaced, the
 more  difficulty  there will be  in evacuating it, owing to
 the backward curvature of the urethra; and by its greater
 weight the vagina is forced  still farther downward and for-
 ward.  If this continue, complete prolapsus will be the re-
 sult.
                     SYMPTOMS.
    The patient complains of a constant weight and pressing
 down into the vagina, a sense of uneasiness and  dragging
 in the lower part of the  abdomen, uneasiness and pain in
 walking, great difficulty in  evacuating the  bladder,  the
 bladder becoming paralyzed from retention of the urine,
 and losing its power of contraction; often there is burning 
916                OBSTETRICS.

pain in the base of the bladder, with a sense of distention,
and constant desire  to pass urine.  On examination  there
will be found a soft, elastic, fluctuating tumour of a red or
bluish red colour, covered with the mucous membrane of
the vagina; the surface of the tumour is smooth and shining
when the bladder is  distended; but when the bladder is
empty, it  is thrown  into  transverse folds.   Often  there
is a discharge from  the vagina which  is exceedingly irri-
tating to the labia and soft parts.
                    DIAGNOSIS.

  This affection may  be distinguished from  any displace-
ment of the uterus by observing the following points:—
The tumour varies  in size, in proportion to the quantity of
urine retained; it  may be decreased  by  drawing off the
urine with the  catheter; and if the extremity of the cathe-
ter be elevated, its point may be felt in the most depending
portion of the tumour.   The tumour is soft and fluctuating,
and the finger can be passed posteriorly to  it up to  the os
uteri, which will be found in its natural position.  It may
be known  from vaginal rectocele, by the  fact that it is
softer and fluctuating, and the finger passes into the vagina
posteriorly to  it, while in  rectocele  it can only be  intro-
duced anteriorly.

             VAGINAL RECTOCELE.
  Prolapsus of the  posterior wall of the vagina is less fre-
quent than prolapsus of the anterior; yet  it is not an un-
frequent affection.  The mechanism of this displacement
is the same as vaginal cystocele; the posterior wall becoming
relaxed, the rectum is distended with faeces, and pressed
anteriorly and downward into  the vaginal canal.  The size
of  the  tumour varies, from  a slight tumour projecting
into the vagina to its  extension between the labia.   In its
more aggravated form the uterus  is  frequently dragged
down and displaced. 
OBSTETRICS.
917
                      CAUSES.
  The principal cause of this  affection is habitual consti-
pation.
                    SYMPTOMS.
  Weight in the vagina, dragging sensation in the abdo-
men, increased by walking, habitual constipation, with dif-
ficulty in passing the faeces, a mucous discharge from va-
gina, &c.   If there is much displacement, there will be te-
nesmus, with a frequent  desire to  evacuate the  bowels,
generally fruitless, and accompanied with much pain.   The
tumour increases in size  when the faeces  have not been
passed for some time, and during defecation, and decreases
afterwards.  A globular tumour  may be  felt, occupying
the cavity of the vagina, compressible but not fluctuating :
through its walls cybalae may often be felt.

PROLAPSUS  OF  THE   ENTIRE   CIRCUMFE-
           RENCE  OF  THE  VAGINA.
  This form of displacement is not very rare,  and occurs
as the result of great debility of the lining membrane  of
the vagina.  It resembles  prolapsus ani, inasmuch as mu-
cous membrane and the cellular tissue beneath it being ex-
tremely lax, this cellular structure  is morbidly thickened,
and so increased in weight, that it overcomes the resistance
at the outlet, and prolapsus is  the consequence.  The pro-
lapsus may be either partial or complete;  in  partial pro-
lapsus the mucous membrane  merely forms a  prominence
within the os externum; while in complete prolapsus the
mucous membrane forms a circular tumour, which  projects
beyond the vulva.
                    SYMPTOMS.
  The  symptoms of this  affection  vary  according to the
amount of displacement.   In slight prolapsus  a feeling  of
weight and uneasiness in the lower  portion  of  the vagina,
a dragging sensation in the lower portion of the abdomen, 
918
OBSTETRICS .
&c.  In more severe forms of the disease, these symptoms
become greatly aggravated;  there is a discharge of puri-
form mucus, obstinate constipation, difficulty and  pain  in
passing the urine, etc.  The action  of the urine on the tu-
mour, and  the  friction produced by exercise gives  rise to
excoriation and inflammation.  The tumour has a circular
form, with an aperture in the centre.   On passing the fin-
ger up externally to the  tumour, it  will be stopped by the
cul-de-sac formed between the tumour and the vagina; but
by  introducing the finger  through the central orifice it
will pass up to  the os uteri.

                     DIAGNOSIS.
  It may be distinguished from any displacement  of the
uterus, by the character of the central opening and  by the
fact that the finger can be passed  up through this to the
os uteri.
                    TREATMENT.
  The treatment for  these various  forms of prolapsus  of
the vagina, consists in restoring the system to its  general
degree of health by a  well-regulated course of regimen and
general tonics, such as a  liberal use  of tonic tea, bebeerine,
quinine, hypophosphite of iron, alnuin, helonin, and hama-
melin.   The bowels should be kept open by means of warm
water injections.  If there is inflammation in the tumour,
hot packs should be applied to the vulva and hypogastrium,
and frequently  removed.  As soon  as the constitution has
been  invigorated,  and the  inflammation  removed,  efforts
should be made to reduce the prolapsus by lubricating the
finger, and making gradual  pressure and  other manipula-
tions, so as to force the prolapsed folds back to their origi-
nal  position.  These attempts, if not successful, should be
repeated  two or three times a week, and  after  each effort
a hot wet pad should be applied to the vulva, and secured
by  a T bandage  so as  to make  firm pressure.   If  this
method fail, a large tapering vaginal bougie should  be in- 
OBSTETRICS-
919
troduced; at the same time gradual upward pressure should
be made upon the tumour, when the tumour will be found
to disappear, either all together  or  in  part.   The bougie
should remain for one or two hours,  when it should be re-
moved and the vagina injected with  a strong decoction of
white oak bark and hydrastus Canadensis.  This operation
should be repeated once or twice a  week, followed by pe-
rineal support and injections until the displacement is over-
come; after which the vagina should be strengthened by
astringent and tonic washes, and the system thoroughly in-
vigorated.  Daily  sitz  baths, cornin, iron, tonic tea,  wine
bitters, hydrastis, and cinchonia, will contribute to this end.
The cause of the disease should be carefully avoided.

  TUMOURS,  MORBID  GROWTHS,  &c.
   Tumours, and  morbid growths in  the vagina, are said to
be of rare occurrence.   The cysts met with in this region,
are developed in the cellular tissue, external to the vagina,
and bear a subordinate relation to the latter.  Fibroid pro-
ductions may be  developed in the external layer  of the va-
ginal parietes, and especially at their  posterior surface; they
then project with a larger or smaller  segment, in the shape
of round  tumours, into the vaginal  cavity.   In other in-
stances they are developed in the  cellular tissue, that is
interposed between the vagina and rectum, and  though in
close relation to the vagina in point of origin, project chiefly
into  the rectum, and more or less obstruct its inferior por-
tion.   Warty tumours are sometimes developed from the
vaginal mucous membrane; oftener,  perhaps,  from syphilis
than any other cause; they are generally found  in the ex-
ternal or vulvular portion  of the canal.

                    DIAGNOSIS.
  Encysted tumours of the vagina may be distinguished from
vaginal enterocele, by  its more  circumscribed  form, and
from the fact that  coughing produces no enlargement  in it. 
920                OBSTETRICS.

It may be distinguished from other disease of these parts, by
its circumscribed form, its consistence, and by the fact that its
exact location can be discovered by an examination of the rec-
tum, or by a sound introduced into the bladder.  The diagno-
sis of fibrous tumours maybe the same as that already pointed
out.   It is only to trace their exact size and location, and
the fact that no other disease of the genital  organs exists.

                    TRE ATMEN T.
   Cauterize the  tumours, and apply elm poultices.

       VESICO-VAGINAL  FISTULA,^
   Is an opening between the bladder and  vagina, through
which the urine passes involuntarily.   The passage of the
urine through the fistula, into the  vagina, produces a con-
stant irritation of the mucous membrane and vulva,  exco-
riation, pruritus, &c.  If the opening be small, and toward
the outer extremity of the vagina,  it will  be but mild in
comparison  with those cases where the opening  is large.
In these last cases the urine cannot be retained for a mo-
ment, for as fast as it is secreted it passes down the bladder
and escapes.
                      CAUSES.
   The  most frequent cause is,  the long impaction of the
head of the child in the pelvis during labour, the long con-
tinuous pressure, producing inflammation, which may termi-
nate by sloughing  and  perforation—careless, or improper
use of instruments  during labour—the long-continued pre-
sence of a pessary in the pelvis.
   Retention of urine during labour, or the presence of cal-
culus, will generally involve more or less pressure, and give
rise to subsequent inflammation.  Retention of urine, if it
be excessive, causing the bladder to project into the pelvis,
so as to be pushed before the head of the child, will, most
probably, prevent  delivery, and occasion  rupture of the
bladder. 
OBSTETRICS.
921
  Vesico-vaginal may result  from venereal  ulceration, can-
cer  of the uterus, or vagina, etc.

                     DI agn o si s.
  A careful examination of the vesico-vaginal  wall  should
be made by introducing a sound  into the bladder, turning
its point downward, so that it may be  felt by the finger of
the other hand, introduced into  the vagina, and with  the
finger against the sound, examine the base of the bladder
over its entire extent.  If there  be an opening, the finger
will come in contact with the sound at some point.  If an
opening be found, the vagina should be carefully examined
by the speculum, in order to  detect its true character and
position.  If there be any suspicion of laceration after la-
bour, the fact should be  ascertained as soon as possible, as
the circumstances attending  recent parturition are  all fa-
vourable to  cicatrization.   The vagina  is relaxed and capa-
cious, and, owing to the weight and size of the uterus, having
as yet prevented the return of the parts to their usual height
in the pelvis, any wound of the urethra or vagina will be
far more easily seen, and effectually treated than when  the
torn edges have become separated and  cicatrized.

                    TREATMENT.
  The  treatment for vesico-vaginal fistula  consists  in  the
use of such medicines as will restore the  health of the pa-
tient.   Strict attention to cleanliness, the frequent use of
warm water injections, or, to  prevent the irritating effects
of the urine upon the vagina, a catheter may be introduced
into the bladder, and secured, at the  same  time plugging
the vagina, with lint, lubricated;  cure  has been effected by
this method.  Another method is, to  cauterize the edges
of the fistula; then apply  the  catheter and tampon as be-
fore.  The caustics used, are nitrate of silver and  potassa.
Another plan is, to pare  off the edges of the fistula  and
introduce sutures to approximate the opening edges; intro-
       78 
922
OBSTETRICS.
 duce a catheter, and treat the case as before.   Dr. Sims
 uses  the  clamp suture, which consists of silver  wire, and
 applied like the quilled suture.  Iron, quinine, alnuin, and
 cod liver  oil should be given internally.

        RECTO-VAGINAL  FISTULA.
   This is an unnatural opening between the  vagina and
 rectum, which gives rise to an involuntary discharge of flatus
 and faeces.   They are generally longitudinal in  direction,
 and may  depend on the following causes: from prolonged
 pressure of the child's head during labour, or from the care-
 less use of instruments;  from laceration during  delivery;
 from a recto-vaginal  abscess; from a  pelvic abscess, which
 opens in two directions, perforating the vagina and bowels;
 from stricture or other disease of the rectum; from cancer,
 or  corroding  ulcer of either  rectum  or vagina, and from
 syphilitic ulceration.   This disease, though a source of con-
 stant annoyance, if the opening  be  large, admitting of in-
 voluntary discharge of faecal matter  through the vagina,
 a continuous  irritation is  kept up, which sometimes runs
 into a severe erythematous inflammation.   If the  existence
 of the local injury does not affect the  general health of the
 patient, the distress of mind occasioned by her unpleasant
 condition  is  generally sufficient to  do so.  The  seat and
 character  of  this fistula are ascertained by an examination
 per rectum and vagina.  After the position  of the vaginal
 opening has  been ascertained by means of  the speculum,
 introduce  the finger into the rectum, and pass a probe from
 the vagina, through the fistula, until it can  be felt in the
 rectum; by this means the character of the opening can be
 determined.   If by any means the  probe cannot be passed
 through the fistula, injections  passed through it will enable
 the operator to determine  its course.

                    TREATMENT.
  The same as in vesico-vaginal fistula, and with tonics and
alteratives. 
OBSTETRICS.
923
  LACERATION  OF   THE  VAGINA.
  This may be caused by forcible expulsive efforts  during
labour, or  by the improper or careless use  of instruments.
The  laceration  may  be complete; the whole  of its coats
giving way, and forming an  opening into  the bladder in
front, the rectum behind, or into the abdominal cavity above;
or it may be partial, affecting  only the  mucous  membrane,
or it and the middle  coat.   Either of these  forms may exist
without laceration of the  perineum.  Complete laceration
of the vagina in  front and behind have already been de-
scribed under the head of recto  and vesico-vaginal fistula.
Rupture of the upper portion of  the vagina is  of very rare
occurrence.  This accident would be dangerous, producing
peritonitis, and should be treated  on general principles.   A
laceration may exist when the  medical attendant is not aware
of it, the pain the parts suffer during labour being but little
increased by the parts giving  way.  Careful examination of
the parts should be made  after labour, to  ascertain if  any
lesion exists, as attention to it is of the utmost importance,
while the  parts  are yet soft, and before inflammation super-
venes.
                    TREATMENT.
  The treatment consists in subduing the inflammation and
preventing the vagina from occlusion by adhesion.

LACERATION  OR   RUPTURE  OF  THE
                   PERINEUM.
  This accident, when severe, is one of the most distressing
occurrences attendant upon labour.   Slight laceration often
happens in first labours, but the parts generally heal them-
selves.  Again, the entire destruction of the perineum  may
take place, laying the cavities of the vagina and rectum into
one.   Four varieties of ruptured  perineum  are   noticed.
Where the perineum  is torn to the extent of an inch or
more from the  fourchette,—this is of but little  moment.
Where the perineum is torn  between the sphincter-ani and 
924
0 BSTETRICS.
the constrictor vagina.  Where the laceration occupies the
entire length of the  perineum, but does not penetrate the
sphincter ani.   Where  it extends  so as  to  divide  the
sphincter ani, and even the recto-vaginal septum.

                      CAUSES.
  If the sacrum be too perpendicular, the head of the child,
instead  of  receiving a direction  anteriorly  in  the  line of
the axis of the lower outlet, will be forced downward upon
the posterior portion of the perineum.   If the arch of the
pubis be too  acute, so as to prevent the presenting portion
from  filling the upper part, extraordinary dilation of the
orifice of the vagina will be necessary, and the head will be
pressed with unusual force upon the  anterior part of the
perineum.  A  similar effect  is  said  to  be produced  by
a thickened state of  the perineum and  circumjacent parts
of the pubis.   The too rapid -passage of the head may be
attended with this accident.  Exostosis in any part of the
pelvic cavity, may so act upon the direction in which the
foetal head is propelled, that rupture  of the  perineum is
the result.
                    TREATMENT.
  To remove this difficulty, the surface  should  be made
fresh, interrupted sutures should be applied in  sufficient
number to  bring the parts firmly in apposition.  To main-
tain the parts in contact, and insure union, the sutures may
be  fastened to two  small pieces of bougie, one placed on
each side of the perineum.  After the introduction of the
sutures, cold  packs should be applied, to prevent excessive
inflammation.  The  urine may be evacuated with  the ca-
theter, and the bowels kept quiet with small doses of opium.

PELVIC    CELLULITIS,   INFLAMMA-
  TION  OF  THE  CELLULAR  TISSUE.
  Inflammation, as a consequence of parturition, is liable
to occur in the cellular tissue, between the intestinal, genital 
OBSTETRICS.
925
and urinary canals; between the two folds of the peritoneum,
forming the broad ligaments, and between the fascia pelvica
and parts invested by it.  Though it cannot be said to be
a very fatal affection, yet it is in many instances of long
continuance, and greatly affects the general health.

                      CAUSES.
   It is probably of more frequent occurrence as the result
of labour than  from any other cause, either  as a  conse-
quence of long continued pressure of the child's head on
the tissues of the pelvis, or as the result of puerperal in-
flammation.  It may, however, result from ordinary  labour.
It may occur a considerable time after labour, or  it may
attack these tissues independently of the puerperal state in
married or unmarried women.  In the last case  it may re-
sult from the extension of inflammation of the uterus, Fal-
lopian tubes, ovaries, vagina, &c, or as the result of a fall,
a kick, a blow, etc., or from exposure to cold, &c.

                   TERMINATION.
   This affection after passing through the different stages
of  inflammation, terminates favourably under judicious
treatment, or there may  be organization  of the  inflam-
matory product, and hypertrophy of  the  mass of cellular
tissue; the uterus may adhere to the walls of the  pelvis,
or adhesion may take place between the ovaries and Fallo-
pian  tubes, and the other pelvic viscera, or the walls of
the pelvis.  An abscess is sometimes the result, which may
form  and discharge itself into the vagina, rectum, bladder,
uterus, &c, the pus passing off through the various out-
lets of the several organs.   It seldom discharges itself into
the peritoneum, but if this should occur, severe peritonitis
is the result.   Sometimes the openings which these pelvic
abscesses form  for themselves, become fistulous, and are
difficult to cure.
                           78* 
926                OBSTETRICS.
                    SY MPTOMS.
   The symptoms at first resemble those of inflammation of
 any of the pelvic organs.   There is weakness, pain in the
 limbs, headache, loss of appetite, etc.; the pulse is  acce-
 lerated;  there is thirst, dry skin, and restlessness.   Pain
 extends  in all directions,  from the seat  of inflammation,
 and there is a sense of weight,  and dragging down in the
 pelvis, which  is increased by the upright  position.  The
 irritation extending to  the  bladder  and rectum, or the
 pressure of the abscess upon these organs occasions at times
 great distress  by causing a constant desire to pass water,
 or calls to evacuate the bowels, which is sometimes attended
 with great difficulty.   The disease  may terminate in  reso-
 lution, and gradually diminish, until the tumour entirely
 disappears. Or if it terminates in suppuration, there is
 a throbbing pain, with chills occurring at regular intervals,
 usually in the evening.

                   TREATMENT.
   The bowels  should be opened by an  active purge of po-
 dophyllin and anti-bilious physic.  xVt the same  time the
 entire  pelvis  should  be wrapped in  a hot pack, which
 should be  changed as often as  it gets cold.  After the
 action of the purge, small doses of veratrum viride should
 be given, and repeated until the inflammation is controlled.
 If abscess should occur, it may be treated as directed un-
 der that head.

         OCCLUSION  OF  THE  OS  UTERI.
   This may be  congenital, or  the result of disease, and
partial or complete.  The symptoms do not manifest them-
 selves until after the age of puberty, when, if this  difficulty
be present, there will be no appearance of the menstrual dis-
charge; yet the symptoms accompanying menstruation will
be present at the recurrence of each period.
  Ihe symptoms of occlusion  of the  os  uteri  are weight 
OBSTETRICS.
927
and pain in the loins, and finally the appearance of a tu-
mour  in  the upper portion of the pelvis, resembling the
impregnated uterus.

                   TREATMENT.
  In most cases the occlusion may be overcome by a uterine
sound, which should be pressed through into the uterus.   If
this do not succeed, an opening should be made with a
trochar.
   PHYSOMETRA,  OR TYMPANITIS UTERI.
   This is an accumulation of gas in the uterine cavity, sup-
posed to  arise from the  decomposition of some substance
in the uterus.   This gas is sometimes  retained for several
months, and then  expelled; at other times it is expelled
with a noise many times a day.
                      CAUSES.
   The retention of the membranes after labour, the pla-
centa, a  dead  foetus, or of secretions, as the lochia, men-
strual discharge, etc.
                     SYMPTOMS.
   Distention in the hypogastric region, with pain, extend-
ing from the womb towards the groin, thighs, &c.  Gene-
rally  the menses are suppressed, the abdomen enlarges, and
is tympanitic.   There are sometimes febrile symptoms, and
it is not  uncommon for the breasts to become enlarged, and
to secrete a milky  fluid.  The expulsion of gas at the vulva
gives relief.   It is rare for gas to be retained in the uterus
more  than  five or six months; frequently not so long.

                     DIAGNOSIS.
   It  may be distinguished from pregnancy by the resonance
of the tumour, and the  absence of foetal movement.  Its
resonance also distinguishes it from all other tumours. 
928                OBSTETRICS.
                    TREATMENT.
   To give immediate relief a catheter may be introduced
 into the uterus, and the gas evacuated.  Afterwards the
 cause should be removed, uterine tonics and an invigorating
 course of medication should be instituted.

       HYDROMETRA — UTERINE  DROPSY.
   This is an accumulation of fluid in the uterus; sometimes
 underneath the mucous membrane, sometimes in the uterine
 cavity,  and sometimes in  hydatids.   Cases  are  known of
 both air and water  in  the  organ.   Internal metritis gives'
 rise to this disease by causing contraction of the os internum
 of the cervix, and retention of the secreted fluid, which, in-
 creasing in quantity, a change takes place in the secreting
 surface, by which a colourless, albuminons fluid is exuded.
 This fluid is sometimes evacuated in large quantities.

                       CAUSES.
   Inflammation of the uterus, constitutional debility.

                     SYMPTOMS.
   During the first months the symptoms resemble those of
 pregnancy.  By introducing  a  finger, so as to touch  the
 cervix uteri, and pressing  the tumour with the other, the
 fluctuations of a fluid  are felt.   The menses are  usually
 suppressed, and general constitutional debility will appear
 if the disease continue.   The patient may die from exhaus-
 tion, or  the walls of the uterus may give way from the pres-
 sure of the fluid, causing fatal peritonitis by its escape into
 the peritoneal cavity.
                    TREATMENT.
   The water  may be  evacuated  with a catheter, the cause
of the disease  removed, and a  tonic and hygienic course
of treatment prescribed. 
OBSTETRICS
929
ANTEVERSION  AND  ANTEFLEXION   OF  THE
                        UTERUS.
  The existence of anteversion was first verified by Levret.
Retroflexion was not recognised as distinct  from retrover-
                         Fig. 113.
  Fig 113  Anteflexion.—The womb is seen in the state of com-
plete anteflexion—the second degree, or complete anterior redupli-
cation—it falling into a cavity between the anterior wall of the vagi-
na, and the posterior wall of the  bladder.   The dotted lines show
the position of the body of the uterus in the first degree of anteflex-
ion   Neither the uterus itself,  nor the dotted lines are placed suf-
ficiently low; and the rectum being represented as distended, the
position of the first degree of anteflexion appears to be nearly coinci-
dent with  the normal position of the uterus  Generally in ante-
flexion the uterus is inclined to  one side, and the  bladder to the
other.
82 
930
OBSTETRICS.
sion for  many years afterwards; and even now, by  some
writers, the word retroversion is made to include both dis-
placements.   The distinction is not so indispensable  in a
practical point of view as between retroversion  and retro-
flexion, but should be kept constantly in view.  They are
not any more  than the posterior displacements, merely dif-
ferent degrees of the same thing, and anteversion,  like re-
flexion, most  frequently follows parturition, either prema-
ture or otherwise; while anteflexion is, and even more than
retroflexion, most frequently independent of it.
   1st. In anteflexion the body only of the uterus falls for-
ward, the cervix still preserving its normal  position in the
pelvis; the point of flexion being always at the junction of
the body with the neck.   In anteversion the whole uterus
is displaced forward,  but without any  flexure of the  body
upon the neck; so that it comes to assume an anteroposte-
rior position in the pelvis, the fundus pointing forward.
   We recognise but  two degrees of each of these displace-
ments.  In the first degree of each, the body of the uterus
falls forward upon the posterior wall of the bladder (if some-
what distended,) so that its axis prolonged would fall below
the middle point, between the umbilicus and the symphy-
sis pubis.   In case of anteflexion this would cause a bend
of the body upon the cervix at about a right angle.  In the
second degree of both, the fundus points towards the  sym-
physis pubis.   In anteversion it crowds the posterior wall
of the bladder forwards into its cavity ; while in anteflexion
it falls down between the anterior wall of the vagina  and
the neck of the bladder,  (after stretching the areolar tissue
connecting them,) and thus a complete reduplication of the
uterus anteriorly ensues.  In retroversion, the neck of the
uterus is also  displaced  backward, looking,  in the  second
degree, towards the hollow of the sacrum; while it is not
displaced at all in anteflexion.
   We must, however, admit, as in case of the displacements
backward, every possible grade of malposition between the 
OBSTETRICS.
931
first degree of anteversion, and complete anterior reduplica-
tion.  We also very often find some degrees of prolapsus ac-
companying anteversion, and, rarely, anteflexion also.  In re-
gard to the frequency of the anterior and posterior displace-
ments, in my opinion the latter are the most numerous.  In
those  who have borne children I  have found  anteflexion
more frequent than retroflexion.  Both anteversion and re-
troversion are rare in this class of patients.
  After parturition (premature or otherwise) anteversion is
more common than retroversion or anteflexion, but perhaps
not more common than retroflexion. Retroflexion is far more
common than retroversion in the natural state of the parts.
Anteflexion  is more common  than anteversion, while the
parts  concerned are in their  normal condition, but ante-
flexion more frequently occurs as a sequel of parturition.
  Aralleix found that of 68  displacements, 35 were anterior,
(24 of  anteversion, and  11 of anteflexion,)  and 33 were
posterior, (12 of retroflexion, and 21 of retroversion.)  M.
Boulard finds that, in females who have never borne chil-
dren,  the majority have anteflexion.
  The direct causes of anteflexion  and anteversion include
all  agencies which carry the  body of the uterus  forward
and downward, and may  be either  uterine or extra-uterine.
The former are congestion or inflammation of the body of the
uterus (or of the posterior  wall alone,) a fibrous tumour in
the latter or in the posterior wall,  if large enough to crowd
the whole uterus forward; polypus uteri, and hypertrophy
from previous inflammation, or from arrested involution af-
ter parturition, and early pregnancy, as before explained.
  The  predisposing causes are  relaxation of the broad li-
gaments, or increased weight of the uterus from any cause,
and especially from parturition.
  Of anteversion  in the second degree, the most  common
symptoms are  the following:  Frequent micturition, per-
haps, also, rectal  tenesmus, and especially  during the ca-
tamenial period; a bearing down sensation; pain in the lum- 
932
OBSTETRICS.
bar and inguinal region, and down the limbs; sometimes a
feeling in the rectum from direct pressure against the cer-
vix ; and sonstipation from torpor of the  muscular coat of
the alimentary  canal.  All these are increased during  the
menstrual period, and by standing, and  walking, and di-
minished, while in a  recumbent position.  Generally leu-
corrhoea also exists, and menstruation is abnormal.
  The physical signs of anterior displacements  are  alone
conclusive, as in the case with the posterior.  The first de-

                        Fig. 114.
Fig. 114. Anteversion—Showing the first and second  degree.— 
OBSTETRICS.                933
gree of anteversion or anteflexion may afford no symptoms,
and therefore in most cases escape detection.  In the for-
mer, however,  there  will be found  a backward  displace-
ment of the cervix on making a vaginal examination; but
the sound alone will generally give evidence of the latter.
  In the second degree of anteversion a vaginal examination
shows that the uterus lies horizontally in the pelvis, the os
pointing back towards the rectum, and the fundus forward
towards the neck of the bladder; consequently, the curve
of the vagina is changed, its upper extremity to far back-
ward.   Often the finger may trace the whole length of the
uterus on its  anterior (now its inferior,) surface.   Fre-
quently the os uteri is carried so high posteriorly as  with
difficulty to be  reached, but the sound is very seldom re-
quired to verify the complete anteversion.
   In the second degree  of anteflexion, or complete anterior
reduplication,  the os and cervix are  found in the  normal
position in the  vagina, though the upper extremity of the
latter is often  carried a  little backward, while the  fundus
is felt as a firm, rather tender, rounded tumour, lying be-
tween  the anterior wall of  the vagina  and the bladder.
Sometimes,  however,  the fundus is quite insensible to pres-
sure, and thus might be easily  mistaken for a fibrous tu-
mour in the anterior wall of the uterus: besides, since only
the anterior wall of the vagina intervenes between the cer-
vix and the fundus, the latter may seem at first to be conti-
nuous in structure with the latter, and thus farther  confirm
the suspicion of a fibrous tumour.   Per rectum the  os uteri
may be felt projecting  backward in  the  second  degree  of
anteversion; but no positive knowledge is acquired in this
case of anteflexion.   But if any doubt remain, the uterine
sound decides the diagnosis.
   In using this instrument in case of anteflexion, we intro-
duce it with the concavity upwards, as if the uterus were
in  its normal position, the patient  lying  on the  back, and
     79 
934
OBSTETRICS.
when the bulb is arrested on reaching the point of flexion,
the handle is depressed, and thus the instrument passes into
the proper cavity of the organ.

DIAGNOSIS  OP  ANTEFLEXION  AND  ANTE-
                      VERSION.
   1st. From fibrous tumours in, or inflammations  of the
anterior wall of the uterus.   The  fundus uteri is usually
tender in tumours, usually not so, but the sound decides
in both cases.   This localized inflammation, however, but
rarely occurs.   2d. From early pregnancy.   All the signs
of pregnancy are wanting, therefore the sound being used
decides.  If there be any doubt as to pregnancy, wait; at
any rate, do not use the sound.  Sound  shows the uterus
is in situ, but enlarged,  and its cavity elongated. 3d. From
carcinoma  of the  uterus.    Carcinoma  almost always in-
vades the cervix uteri first; but use the sound. 4th. From
an  ovarian (or other pelvic) tumour.  The sound isolates
the  uterus  from the tumour.   5th. From  extra-uterine
pregnancy.   There again the sound isolates the uterus, if
in its normal  position,  from its extra-uterine mass.   6th.
The anteflexed  uterus  sometimes inclines to one side, and
may be mistaken for a displaced ovary;  the sound decides.

TREATMENT  OF THE  ANTERIOR  DISPLACE-
   MENTS  OF THE UNIMPREGNATED WOMB.
   Of the local treatment of the anterior displacements, the
indications are as of other displacements, threefold.  1. To
remove the cause of displacement, and certain complications,
if still existing, and in action.  2.  To replace the uterus.
3. To retain it in its position.   4. Remove still active caxises
or complications.
   2. Replace the uterus. To effect  this the  patient may lie
upon the back with the pelvis raised, and in  case of ante-
version  the cervix may be brought forward by means of the 
OBSTETRICS.
935
fenestrated spoon, as described by Madame Boivin.   A long
index finger may unaided accomplish this ; or, these means
failing, the uterus  sound, passed an inch into the canal of
the cervix, may bring the os into position.   In case of  an-
teflexion we may, also, sometimes elevate the fundus uteri
to the first degree  of the displacement, by pressing against
it with the index finger in the vagina.  But neither in ante-
flexion nor anteversion, can we, with certainty, restore  the
uterus to its normal position by any other means than  the
use of the uterine  sound.
   3. Maintain the  uterus in its position.  In these displace-
ments, as in retroversion and retroflexion, the womb, except
in rare instances of anteversion, suddenly induced returns,
nearly, if not precisely into the position  it before occupied,
instantly, or at  most a few minutes,  after the sound  (or
other force which  replaced it) is withdrawn.
   In the palliative management of anteversion a simple ring
pessary of tin or gutta percha, large enough fully to distend
the upper extremity of the vagina, and thus pull the os
uteri forward, is to be  used.
   We need not be very strenuous respecting the  precise
form of the instrument used, provided it fits well.   It may,
however, prove valuable  in three ways.   1st, By pulling the
 os uteri forward,  conception  may  occur in a  patient pre-
 viously sterile.  2d, It keeps the uterus  more nearly at rest,
 and thus gives great relief, if there  be irritation from in-
 flammation or congestion.   3d. It relieves the slight degree
 of descent which  often accompanies anteversion, and which
 not seldom is the  main cause  of the patient's suffering.
   In case of anteflexion in those who have never been preg-
 nant, and in whom the  vagina is narrow, and still retains
 its natural  tone, I have  found a more  simple  instrument,
 which is made of  pure silver,  and consists of a stem (a tube)
 21 inches to 3 inches long, and  r3ff  inch in diameter, passing
 centrally through two flattened bulbs.   The smaller of them
 about f of an inch in diameter, is placed about 2.\ inches 
936
OBSTETRICS.
from one  end of the tube; this  free portion of the  tube
being the  stem, or intra-uterine portion of  the instrument,
while the  other bulb, one inch in  diameter, is placed at the
other end of the tube.
  When the instrument  is introduced, the smaller  bulb
supports the os uteri, while the larger (one half inch below
the other) rests on the posterior  wall of the vagina above
the levator ani.  It is  passed into the uterus on  a  staff.
A silk thread is passed into it, so that the patient may re-
move it at any time, if this become necessary.

RETROVERSION  OF   THE  UTERUS.
   Retroversion of the uterus consists in a displacement of
the fundus uteri backward, the cervix being carried forward
against the bladder, the uterus assuming a transverse posi-
tion.
                      CAUSES.
   The causes  of this form of uterine displacement, are a
weakness  of uterine organs, long continued distention of
the bladder, abortions, chronic inflammation of the uterine
organs, violent vomiting,  &c, &c.

                    S YMPTO MS.
   The most common symptoms of retroversion of the uterus,
are such as exist in the early stages of pregnancy, viz., dys-
pepsia, dragging pains in the hip, neuralgia, hysteria, ner-
vous debility, and if the  disease  should continue, bronchi-
tis and consumption often follow.  If retroversion occur
during early pregnancy, in addition to the above symptoms,
there will be  either partial  or complete retention of the
urine, and by manual  examination a tumour will be  felt,
which  is tender on pressure.  Anterior  to  this  tumour
may be felt the cervix uteri.

                   TREATMENT.
   One of the first things to be attended to in the treatment
of this disease, is  the  replacement of the uterus.   To do 
OBSTETRICS.
937
this make a gentle rotary motion with  the hand  upon the
abdomen, and at the same time elevate the uterus and carry
it back into its proper position, when the pad and bandage
should be applied, as directed in the treatment of prolapsus
uteri.  In connexion with these mechanical means, female
injections composed of equal parts of cold infusion  of Pe-
ruvian bark and golden seal  should  be  used frequently
through the day.
  The body should be frequently sponged  in cold water,
followed  by brisk friction with the hand or  towel, and the
following tonic bitters should be administered.  Take one
pint of  best port wine, one drachm of precipitate  car-
bonate of iron,  one half ounce of  pulverized unicorn root,
Fig. 115.—Anteveision of the Uterus.
and one half ounce of life root.   Mix, and allow the pa-
tient  to take  from a table spoonful to one wine-glassful
three  times a day.   Small doses of helonine and rhusin, or
senecine in combination with pyrophosphate of iron, may
be used with the bitters, or instead of the bitters.
                          79* 
938
OBSTETRICS.
  ANTEVERSION  OF  THE  UTERUS.
  By anteversion of the uterus, is understood that  condi-
tion  in which the womb is  so displaced that the fundus
rests against the symphysis pubis, and the cervix against
the rectum.
  By reference  to Fig.  115, it will  be  seen that the os
uteri  is turned  upward  and forward, resting against the
bladder.   In  retroversion of the uterus the position is  re-
verse.
                    SYMPTOMS.
  The symptoms of anteversion  of the uterus, are almost
precisely the  same as those described under the head of re-
troversion of the uterus, and the only difference in the treat-
ment, is in the manipulations to replace the uterus.
  Fig. 116 shows the falling of the womb, pressing the blad-
der forward, and upward,  and pressing the  rectum back
against the bony structure, and the mouth of the uterus to
the lower portion of the vagina, 
OBSTETRICS.
939
      HYDATIDS  OF  THE  UTERUS.
  The formation of small cysts or bladders of water in the
uterus, are by no means uncommon.  They are mostly de-
veloped from the inner membrane, and vary in size from half
a pea to a partridge's egg.  They are usually oval, with a
thin wall, opake, and contain a thin pellucid fluid.  They
may be numerous or few in number.  More frequently, how-
ever, they are in clusters, and numerous.

                    SYMPTOMS.
  The symptoms of hydatids are frequently those of early
pregnancy.  Such as nausea, vomiting, enlargement of the
uterus, fulness of the breasts, suppression of the menses, &c.
In from two to five months the patient feels weight and un-
easiness about the abdomen, which is usually followed by
uterine  pains, hemorrhage, and expulsion of the hydatids.

                   TREATMENT.
  If the flooding be excessive, from five to ten drops of the
oil  of erigeron should be given, repeated every ten or fifteen
minutes, until the hemorrhage is controlled.   If  the pain
should not be sufficient to expel the cysts, a warm infusion
of equal parts of blue  cohosh and cotton root, should be
given in one  or two ounce doses, every twenty or thirty mi-
nutes, until the  uterus seems to be entirely evacuated.  Or
give the following compound.
       R. Caulophyllin,....................................gr. x.
          Gossypium,.....................................gr-  xx-
          Sac. alba..........................................gr- xxx-
   M. Triturate, and divide into five powders.   Give one
every ten or fifteen minutes, until the hydatids are all ex-
 pelled.
   The patient should  afterwards be treated with chalybeates
 and tonics. 
940
OBSTETRICS.
     NEURALGIA  OF  THE  UTERUS.
  By neuralgia of the uterus, is understood a sharp violent
pain in that organ, usually  occurring very suddenly; of a
rheumatic character.  It usually attacks girls shortly after
puberty, and is dependent upon derangement of the uterine
function.
                    SYMPTOMS.
  The patient may be perfectly well apparently, and may be
attacked with violent lancinating pain in the uterus, which
usually lasts for a few minutes only, but soon returns,  as-
suming a regular periodical character.  In some cases it is
connected with hysteria, the patient becoming excessively
nervous, and the pain moves to different parts of the body.

                    TREATMENT.
  A pill made in the following manner, is almost a specific
in the above disease.  Take the extract of garden lettuce,
thirty grains; gelsemin, one and a half grains; dioscorin, ten
grains.   Mix, and form ten pills, and give  one every hour
until the pain subsides.
  To prevent a return of these attacks, one or two moderate
doses of quinine and prussiate of iron should be given two
or three times a day, for eight or ten days.

            PUERPERAL FEVER.
  This  is a very fatal disease, which frequently follows par-
turition.  In certain seasons and districts  it prevails as an
epidemic, and is very fatal in its effects.   During certain
seasons and particular localities it is so uniformly prevalent
and fatal that many  physicians suppose it  to be carried by
the attendant from one patient to another.
  The most minute examinations into the cause and nature
of this  disease have  not been able to detect any condition
or symptom that is not  occasionally found  in cases of ma-
lignant inflammation of the  uterus, peritoneum, and other
internal organs.   The disease then  being of a malignant 
OBSTETRICS.
941
form, the question arises, What are the causes  of the dis-
ease, and why does it prevail as an epidemic ?
  Having had large  opportunities to make observations, I
have to my own satisfaction ascertained what many writers
deem mysterious, viz.: the cause of puerperal fever.

                       CAUSE.
  So far as my own observations have extended, and  so
far as I have been able to learn from others, child-bed fever
in nearly every case attacks persons who are of a scorbutic
habit—or, in other words, those who have been deprived
of a sufficient quantity or quality of succulent vegetables,
for the lack of which the  blood has become vitiated, and
the entire system exhibits that condition which is known
as land scurvy or purpuria, in all cases of which this con-
dition of  the system exists.  The gums become spongy,
the digestion impaired, bowels irregular, urine scanty and
high-coloured, &c.  This condition  of  the system not only
manifests itself in feeble vital and physical forces, but this
crasial state of the blood produces in the venous capillaries
a species of capillary phlebitis, or a diseased condition  of
the minute venous vessels.  During  labour this vitiated and
impoverished blood is forced into the minute vessels of the
uterus and peritoneum, and occasionally into other organs.
The result is that they have no power to unload themselves
when labour  is over, nor has the uterus power to expel or
throw off the effete matter remaining in it.   After the ex-
pulsion of the foetus and secundines, a rapid disorganization
of the congested vessels occurs, and mortification and death
follow.
  That this scorbutic condition  of  the system  exists pre-
viously to, and at the same time that the epidemic of child-
bed  fever prevails, only requires  observation to  confirm.
That child-bed fever will not occur if  this purpural condi-
tion be removed previously to child-birth, can be shown by
the most ample testimony.    This hemorrhagic or purpuric 
942
OBSTETRICS.
condition may be removed by a free  use of fresh vegeta-
bles, fruits, tonics, chalybeates, pure  air, baths, &c.

                    SYMPTOMS.
  The symptoms of child-bed fever are somewhat various,
as the disease manifests nearly every degree  of intensity,
from a very mild sporadic form, to the most severe epide-
mic form of the disease.
  The usual symptoms are,  weight and  soreness in the
lower part of the abdomen, accompanied by lassitude and
debility, capricious appetite, imperfect lochia, spongy con-
dition of  the gums, constipated state  of the bowels, and
scanty  and  high-coloured urine.  These symptoms will
usually continue for two or three days after delivery, when
the patient will be seized with chills and rigours, which may
be so slight as  scarcely to be  observed by the patient, or
they maybe so severe as to amount to a regular ague-shake.
These rigours and chills are soon followed by a hot and pun-
gent condition of the skin, pain in the head, loss of appe-
tite, nausea, and, in some cases, vomiting.  The  pulse be-
comes hard and  quick, respiration  hurried and irregular,
the secretions  are arrested, the urine is scanty and high-
coloured, the tongue  is clammy and covered with a white
coat, and in the course of  a  few hours the pain becomes
concentrated in the lower portion of the  abdomen, and is
very severe.   The bowels are tympanated, or bloated, and
very tender, and the discharge of the lochia and the se-
cretion of  milk are suppressed.  In some cases  the mind
becomes affected, and often there is  delirium.  Especially
is this the  case in the latter stage of the disease.  If the
disease be allowed to continue, symptoms  of great prostra-
tion manifest themselves, and in the course of a few days
mortification and  death close  the scene.   In other cases,
inflammation assumes more of a chronic form, resulting in
effusion into the abdominal cavity,  and terminates as de- 
OBSTETRICS.
943
scribed in another  part of  this work, under the head of
empyema.
                   TREATMENT.
  The most salutary treatment during the first stage of this
disease is to give a free podophyllin and cream of tartar
purge, followed by  aconite or veratrum to control the fe-
ver.  In the selection of the  fever remedy, the attendant
should be governed by circumstances.  If the fever  be of a
high grade, and the patient of a full plethoric habit, vera-
trum is the remedy—but if the vital powers be feeble, and
the fever of an adynamic type, use aconite.  In connexion
with the above remedy, hot packs should be applied to the
bowels, and the vagina should be frequently injected with
warm slippery elm emulsions by means of a female syringe.
If the lochia be scanty or suppressed, a warm mustard  poul-
tice should be applied to the breast, followed by hot packs
covered with oiled silk or flannel.  As soon as the bowels
are evacuated and the other conditions have been attended
to, the patient should take quinine and muriate tincture of
iron, from three to five grains of quinine every two or  three
hours, alternated with from ten to twenty drops of muriate
 tincture of iron.  The quinine and iron should be conti-
 nued for twenty or thirty hours, and  then omitted  for a
 short time, to be repeated in a few days, unless the symp-
 toms become very much mitigated.  During the treatment,
 the patient should  be allowed lemon juice, fresh fruits and
 vegetable soups.
   Where there is tendency to gangrene, in addition to the
 quinine  and iron, one or  two grains of baptisin in a  table-
 spoonful of wine  and yeast may be given three or four  times
 a day—also, charcoal and yeast poultices should be applied
 to the bowels.
   If the mustard  poultice and hot packs applied to the
 breast do not produce a  return of the lochia, one or two
 grains of senecine and a wine glass full of strong infusion 
944
OBSTETRICS.
of cotton root should be given, two or three times  a day.
If there be extensive fetid discharge  following the  use of
these remedies, as there frequently is where the uterine
capillaries are very much diseased, the powers of the uterus
should be supported by bebeerine, macrotin, and phosphate
of iron.  If there be violent pain and nervous prostration,
lupulin and gelsemin are the remedies.  As already stated,
where the disease proves  obstinate, the quinine  and iron
should be  repeated.   The bowels should be kept regular,
and the  skin should  be  thoroughly cleansed from  day to
day with soda water.  The above treatment, together with
such  other remedies as  may be indicated by the complica-
tion  of the disease, has been most triumphantly successful
when  all other remedies have failed.  Although  I  have
treated a large number of cases of both the sporadic  and
epidemic forms of the disease, yet I have  not lost  a  case,
nor have I ever known the treatment to fail in the hands
of others when properly applied.

                     ABORTION.
  Abortion (abortio) signifies the  expulsion of the fetus
from the uterus, before  it is sufficiently developed to main-
tain  independent life.  When the product of conception is
expelled between this period and the full  period of preg-
nancy, it is called premature labour.  The causes of  abor-
tion may be either natural or violent.  Among  the  most
prevalent  causes, are  mercury,  bleeding,  constitutional
syphilis, either in father or mother, small-pox,  sudden and
violent excitement of the blood vessels by surprise, anger,
&c.   Abortion may also  be caused by disease  or death of
the embryo, by disease of the secundines, or by direct vio-
lence to the abdomen, &c, &c.  In addition to these causes,
there is  a variety of medicines used  by professional  abor-
tionists,  such as spurred rye, turpentine, oil of tansy, savin,
&c.   Mechanical means are also resorted  to for the  pur- 
OBSTETRICS .
945
pose of rupturing the membranes.  These means are mostly
used to produce criminal abortion, and  are  not  only dis-
graceful to persons employing them, but criminal in the
eye of the law of our  country,  and of God.   What is
termed the normal cause of abortion is by no  means unfre-
quent in this result.   Dr. Whitehead, in his  treatise upon
this subject,  states that  in  2000 cases, one in seven ter-
minated in abortion.
                    SYMPTOMS.
  When  abortion  occurs in the early stage, the patient
feels languid, uneasy, and despondent, and is  troubled with
chills, alternated with flashes of heat; there is nausea, pal-
pitation, pain in the back, and  tenderness  over the abdo-
men.   The breasts become  flaccid, and there is  more  or
less hemorrhage.  In the more advanced  stage, the pains
are more  severe, and frequently the hemorrhage is violent,
so  much  so  that in many cases,  unless proper  remedial
agents be  employed, the life of  the patient is jeopardized.

                   TREATMENT.
  Females who are predisposed to abortion, should care-
fully avoid every variety of active purgative, and all diu-
retic medicine,  also violent exercise, and should take one
or two cold sitz baths every morning on rising, followed  by
brisk friction, with a crash towel: also take one tablespoon-
ful  of the  mother's cordial  three times a day.  Or if the
cordial is not at hand, take five or ten grains of triturated
aletrin, and one or two grains of triturated  bebeerine  in-
stead.  The patient will also find much relief by placing
a wet pack over the lower portion of the abdomen, securing
it firmly by a bandage, passed around  the body.  Pain may
frequently be arrested by giving one  or two  grains of the
triturated hyosciamin, every  two hours, alternated  with
hamamelin.   To check hemorrhage, give five or ten drops
of the oil  of erigeron,  or  fleabane,  every ten or fifteen
       80 
946                OBSTETRICS.

minutes until it is arrested.  If this should not accomplish
the desired effect, give five  or ten grains of capsicum, in
connexion with one or two grains of matico.  If, in spite
of all these remedies and  such other means as the judg-
ment of  the attendant may devise, the tendency to abort
be still persistent, and the indication  be that the ovum is
detached from the uterus, the patient should drink a strong
decoction of cotton root,  (gossypium  herbaceum;^ every
fifteen or twenty minutes, until the foetus is expelled.  Or
if this should fail, the feet should be placed in warm water,
and  a warm  mustard poultice should be applied  to the
breasts.  After bathing the feet, the patient should take
a warm sitz bath, and drink freely of warm pennyroyal tea,
in connexion with the cotton root.  At the same time, the
oil of erigeron should be given to control  the hemorrhage.
After the foetus is expelled, much care should be observed,
until the placenta is removed.   If this should not occur in
a few days, the treatment  should be the same as for the ex-
pulsion of the foetus, using the same remedies to arrest the
hemorrhage.   During convalescence, the bowels should be
kept  regular, and  small doses of  precipitated carbonate of
iron in connexion with bebeerine  and rhusin should be
given  to maintain the patient's strength, and  to prevent
uterine weakness, which  so frequently results from  this
cause.
      DISEASES  OF THE FEMALE BREASTS.
  During and after pregnancy the mammary glands, which
in the virgin state are small, soon become very much en-
larged by the  new movement of the system, which  always
exists in pregnancy.  In some cases they become inflamed
and  painful.   This also frequently occurs previously to
menstruation, and I have  seen several cases of abscesses
occurring,  in the breasts, both during the earlier stages of
pregnancy and menstruation.   Such is  the relation be-
tween the breasts after puberty and the ovaries and uterus,
that whatever effects  or produces changes  in one, causes
more or  less disturbance of function in the  other. 
OBSTETRICS.
947
  INFLAMMATION  AND ABSCESS  OF  THE
                     B REA STS.
  Inflammation of the breasts does not differ materially
from inflammation of other tissues, save the more general
influence upon the nervous system, owing to the extensive
communication of the breasts with the  great nervous cen-
tres.  In inflammation of the breasts the capillaries become
over-loaded, and the vessels being weak, the blood  accumu-
lates, until finally the inner  coats become diseased, the
blood stagnates, and actual inflammation is said to  exist.

        CONSTITUTIONAL  SYMPTOMS.
  The symptoms of inflammation of the breasts are shiver-
ing, pain in the head, loss  of  appetite, constipation, high-
coloured urine, and quick pulse.
  The local symptoms are swelling, redness, and pain in
the breasts. If the inflammation be allowed to continue, a
deposit  of  sero-purulent fluid will  occur in the cellular
structure, and by its constant  pressure upon the  adjacent
tissue, becomes absorbed, and  an abscess is formed,  which
sooner or later opens and discharges.

                      CAUSES.
  The causes of inflammation of the breasts  are various,
such as  cold during lactation or nursing, accumulation of
milk in the breasts, injuries to them, diseases of the uterus,
scrofulous diathesis, &c, &c.

                   TREAT MENT.
  The first thing to be attended to in the treatment of in-
flammation of the breasts, is to subdue local inflammation,
and to remove constitutional symptoms.  To do this, make
the following local application.  Take one  ounce  of arnica
flowers,  one half ounce of lobelia leaves, and two ounces of
hops.  Make a strong decoction, and  apply cloths  wrung
from it hot as the patient can bear.   Repeat this  operation 
948
OBSTETRICS.
 every fifteen or twenty minutes until  the  swelling disap-
 pears.  At the same time add ten drops of aconite to  one
 half tumbler of water, and give the patient one teaspoonful
 every half hour,  to keep the skin moist.  If there is  con-
 stipation, from one  half to one grain of podophyllin, and
 one drachm of cream of  tartar, may be given to open  the
 bowels.   If there be debility, or if the patient be of a scro-
 fulous diathesis,  the cathartic should be followed  by qui-
 nine and precip. carb. of iron,  and general tonics, such as
 chamomile, Indian hemp, pipsissewa, and precipitate carb.
 of iron, made into bitters by adding wine, or one half wine-
 glassful of Beach's wine bitters, may be given three times
 a day.  If, in  spite  of all efforts,  suppuration  should take
 place, the  breast should be opened,  and the  following
 poultice applied.   Take  pulverized slippery  elm,  pulver-
 ized  hemlock  bark,  and  pulverized arnica flowers, equal
 parts, put  them  in warm  soda  water, and apply to the
 breast warm, and change as occasion requires.
   If inflammation of the breast  occur after  child-birth, the
 following lotion is almost a specific.
      R. Camphor gum,....................................... ^ss.
         Table salt,............................................ ^j.
         Good whisky,............... ........................ Oj.
   Beef's  gall, one  tea  spoonful; mix, and apply to the
 breast as soon  as  the swelling  and pain  commence.

                SORE NIPPLES.
   One of the most troublesome and common  difficulties con-
nected with the breast after child-birth, is soreness of the
nipples.
                        CAUSE.
   The most common  cause of this difficulty is a want  of
cleanliness on the part of the mother and child.  The child
is  frequently applied to the breast before its mouth is tho-
roughly cleansed, and after  nursing, the milk  is too often 
OBSTETRICS,
949
allowed to coagulate and sour upon the nipple, thus proving
a source of great irritation.

                     TREATMENT.
  The treatment of sore nipples  consists of washing with
warm soap and water, after each nursing of the child, and
sprinkling the nipple with superfine flower of hemlock bark.
  The child's mouth  should be washed before applying it
to the breast.
  If this treatment  does not effect a cure, the  following
ointment should be used.
      R. Balsam of fir,..................................... gj.
        White wax,......................................... sjij.
  Melt the wax and fir together, then  add ten grains of
equal parts of tanuin  and bayberry.   Apply this ointment
to the nipple as often as necessary, and wash previously to
each application.   In the absence  of this ointment, the nip-
ple may be bathed in an infusion  of sumach and  hemlock
bark.  Cover the nipple with folds of linen during the in-
tervals of nursing.   A wash of borax and sage has also been
used for sore nipples to good advantage.

              CAKED  BREASTS.
  In some cases where the lacteals or milk vessels are weak,
or from other cause diseased, the milk accumulates in them,
and produces what is  known as milk cakes.  When in addi-
tion to this, the patient  takes cold, this congestion of the
milk vessels produces, or is connected with serious constitu-
tional disturbances, such as chills,  fever,  sweats, loss of ap-
petite. &c.
                     TREATMENT.
  Make two  ounces of thick plaster of bees-wax and lard,
adding ten grains of gelsemin.
  Apply this plaster warm three or four times a  day.   If
this should not give relief in a few days, the following lini-
ment may be used.
                          80* 
950
OBSTETRICS.
      R. Oil origanum,........................................ Si-
         Oil hemlock.......................................... gij-
         Alcohol,............................................. 3U-
  Mix, and apply before applying the plaster.  The stomach
and bowels should be regulated, and the patient  avoid ex-
posure.
                DERMATOZOA.
  The skin may be attacked by  certain animal parasites.
Of these the pediculi or lice are too well known to need de-
scription.  But we here allude to the Acarus Scabiei and
Entozoon folliculorum.
     Fig. 117.            Fig. 118.            Fig. 119.
  Fig. 117, Dorsal Surface of female Acarus Scabiei.  Fig. 118, side
view of the same.  Fig. 119, Abdominal view of the male Aoariea
magnified 100 diameters.

     ACARUS  SCABIEI,  OR  ITCH  WORM.
  This insect has been proved by the researches of M. Bour-
guiguon  to  be  the undoubted cause of itch.   The  male is
al>out one third smaller than the female.
  lie has suckers on two of his hind feet, and possesses on
the abdqminal surface genital organs, all of which  charac-
 
OBSTETRICS.
951
ters are absent in the female.  She, on the other hand, in
addition to her size and the negative marks alluded  to, is
characterized by  three kinds of  horny spines which  are

                         Fig. 120.
  Fig. 120.—Hair and its follicle, in  which may be seen the  ani-
malcules descending towards the roots of the hair and cul-de-sac of
the follicles, magnified 100 diameters. 
952
OBSTETRICS.
scattered over the  back.   The suckers  or ambulacria  are
organs of locomotion; the mandibles enable it to cut  the
epidermis, and extract fluid from the tissues, which passes
through a delicate oesophagus, the  internal termination of
which is unknown, the body of the animal being apparently
filled with an unorganized molecular pulp.   A short deli-
                        Fig. 121.
  Fig. 121.—Cul-de-sac of a sebaceous follicle in different positions,
aud two eggs, magnified 350 diameters.

cate tube  may also sometimes be observed  at the anus—a
supposed  rectum.—No respiratory apparatus can  be dis-
covered, although  the  creatures may be seen  to swallow
minute bubbles of air, which pass down the oesophagus, and,
like the nutritive juices, diffuse themselves  through  the in- 
OBSTETRICS.
953
terior.   At all events animal juices and air are both neces-
sary to the life of the Acarus.
  The disease called  Scabies, or Itch, has been conclusively
shown by  M. Bourguignon to be entirely owing to the pre-
sence of the insect, and to be communicated from one per-
son to  another eight times out of ten by their sleeping
together.
  The female seldom quits her burrow but at night, and if
impregnated, not even then, unless disturbed mechanically,
as by scratching.   Once in motion she crawls  over the sur-
face with great rapidity, and readily passes from one person
to another where the skins are in contact.  Communication
is not readily  occasioned  by holding  the hands of those
affected, or by coming in contact with them during the day.
The disease  cannot be communicated  by inoculating with
the serum of the vesicles, by the pus of the pustules, or by
any principle contained in the dead body of the insect itself;
neither  can the Acarus of one species of animal, as of the
horse or sheep, inhabit the body of a different one.
  Still the disease is not purely local, inasmuch as papular,
vesicular, or pustular eruptions often occur in parts which
the Acarus  had not infested, so  that  they seem to origi-
nate from some cause independently of its mere presence.
  The Acarus has a predilection  for  youth  and a tender
skin, and has a hatred of hair bulbs;—consequently it fre-
quents young  persons  more commonly than  old ones, and
also in  children  it  occurs indiscriminately  all over the
body, while  in  adults it is most often  found between the
fingers and  toes,  inside of the  thighs  and genital organs.
Seventy times out of a  hundred Scabies is confined to the
hands,  and in the other thirty occurs also on the trunk
and genitals.  The  only proof of the  existence of itch is
the presence of the Acarus, and this is  easily to be detected
by a microscope adapted for the purpose by M. Bourguig-
non.  It consists  of a body, with eye piece and lenses mag- 
954
OBSTETRICS.
nifying seventy diameters linear, with a condensing lens,
the whole placed on a moveable arm, with several joints
attached  to a firm stand.   With this instrument the entire
surface of the body may be explored, and the movements
and doings of the insects observed with the utmost facility.
  The associated papules, vesicles, and pustules are, in the
opinion of M. Bourguignon, in no  way  diagnostic.   M.
Biett made a series of experiments at the  Hospital of St.
Louis, to determine what substance would cure itch in  the
shortest possible time.
  He  employed forty different  applications and modes of
treatment.
  The result was that friction with the following ointment
occasioned recovery on the average in the smallest number
of days.   Take of sublimed sulphur, two parts;  of subcar-
bonate of potash, one part; and of lard, eight parts.
  M. Albin Grass endeavoured to ascertain what substances
would most quickly destroy the Acarus just removed from
its burrow.  It survived three hours in water; two in olive
oil;  one  in a solution of acetate of lead;  four-fifths of an
hour in warm water; twenty-one  minutes in vinegar  and
an alkaline solution;  twelve minutes in a solution of  sul-
phuret of potash; nine minutes in  turpentine; and from
four to six minutes, in a solution of hydriodate of potash.
It survived sixteen hours in the vapours of sulphur under
a watch glass;  and one hour in the flowers of sulphur.   Ac-
cording to these researches, therefore, hydriodate of potash
would be the best remedy.   He removed  three living in-
sects from a  patient who had  taken  three  sulphur-baths;
whereas, after a single application of Helmerinch's ointment,
that is, where  sulphur and potash are combined, he  fre-
quently found them dead.  M.  Bourguignon, with his mi-
croscope, watched with great care the effect of the frictions
made at St. Louis with the sulphur-alkaline ointment. After
the first day, in which there had  been two frictions and a
sulphur-bath, the Acari were in  no way disturbed.   In two 
OBSTETRICS.
955
days after four frictions they were still active, but burrowed
deep in their grooves.  In  three days they still lived, but
were unusually  flat, but their eggs could be hatched by
artificial heat, and produced larvae possessing great activity.
In four days the insects in the superficial  parts were shri-
velled  up and dead, the deeper ones, though living, tres
malades.  Many of the eggs now  aborted.  In five days
all the insects were dead, and in six even the eggs had lost
their vitality.  The eruptions, on the other hand, often re-
mained stationary, and, not  unfrequently,  became worse
from the irritation  of the ointment and  frictions, but after
a time they disappear  also.  Hence it  is  common at St.
Louis, after  seven  or eight days' friction, to send  out  the
patients, though still covered with eruption, and  in most
cases they get well.  About three  in ten, however, return
with  the disease again established;—a  circumstance that
 Mons. B. attributes to  the fact, that the frictions which
 were applied to the superior and inferior  extremities had
 not destroyed the insects which were present on the trunk.
   M.  Bourguignon, on  considering the  structure of these
 Acari, and  the  facility with which a poisonous  fluid could
 penetrate  their delicate integument,  was  led  to  make  a
 series of observations to  determine how long they would
 live after the application  of various toxic  solutions.  He
 found those which  possessed the most energetic  action on
 these  creatures, were solutions of the ioduret of potassium,
 and of the ioduret of sulphur, which killed them in eight
 minutes.  A solution of the alcoholic extract  of  staphisa-
 gria was the next  in virulence, destroying  the animals in
 fifteen minutes.  The  hands of an itch patient were im-
 mersed in  a solution of the two former, for two hours, so
 as strongly to impregnate and colour the integuments.  On
 examining the  insects  immediately afterwards they were as
 lively as ever, but on the  next day they were all dead, and
 the eggs destroyed.  The  epidermis was greatly shrivelled, 
956
OBSTETRICS.
and in  three days complete desquamation occurred, carry-
ing with it Acari, grooves, and eggs, and leaving the cutis
raw and tender.  The action on the skin was evidently too
strong.   A bath of a solution of the alcoholic extract of sta-
phisagria was then made, and immediately after a two hours'
immersion of the hands all the insects were found dead,
and, with one  exception, the eggs  destroyed.  So far from
irritating  the  integument, this application  at  once caused
the irritation to cease, and produced such alleviating effects
that M. B. proposes it as a local  remedy for inflammation.
The eruptions also appeared to be rapidly cured by it.  After
various experiments he adopted an  ointment of the staphi-
sagria as the most generally useful preparation, prepared as
follows:—Recently ground staphisagria in powder, three
hundred grains;  boiling lard, five hundred grains.  Digest
for twenty-four hours at the temperature of one hundred
degrees in a sand-bath, and strain.   Four days of friction
with this, instead of seven with sulphuro-alkaline ointment,
not only destroys the insects and their eggs, but completely
cures and  prevents the integumentary irritation and erup-
tions.
           ENTOZOON  FOLLICULORUM.
   This  insect  inhabits the sebaceous follicles of the skin,
and is very common in the face, more especially when the
seat of  acne or small pimples.  In  the follicles of the nose
they are present in the majority of living persons, and, ac-
cording to Simon, are almost universal in dead bodies.  He
frequently found them living six days after the death of the
individual in whom they were found.  The animal measures
from l-135th of an inch to l-64th of an  inch in length, and
from l-155th of an inch to 1.555th of an inch in breadth.
It is composed  of a head,  a thorax,  and  an abdomen.
   The head represents in form a truncated cone, flattened
from above downwards, and directed obliquely downwards
from the anterior  part of  the trunk.  The existence of an
eye has  not been determined.  The head is furnished with 
OBSTETRICS.
957
two maxillary palpi, which admit of extensive motion.  The
thorax is the broadest part of the animal, and is composed
of four segments.   In each of these, on each side, are two
legs, eight in all.   The abdomen varies in length, is annu-
lated  in structure, and admits of certain  movements.   In-
ternally Dr.  Erasmus Wilson  has traced out an alimentary
canal, and its termination in an anus, together with a brown-
ish mass which he considers  to  be the  liver.   No sexual
differences have been discovered in them, and  they possess
no respiratory  organs.
   The animal  is easily found by compressing with two fin-
gers the skin we wish to examine, until the sebaceous matter
is squeezed out in the form of a little worm.   This matter
should be placed in a little drop of oil previously heated,
then separated with needles and examined with  a microscope
magnifying two hundred and  fifty diameters.   Their move-
ments are slow, whilst the conformation of their articulations
only permits them to move forwards and backwards, like
lobsters.—(Gruby.)   They are nourished by the sebaceous
secretions of the follicles.
   They most commonly occupy the excretory  ducts of the
follicles, which are often dilated in the places where  they
are lodged.  Their head is always directed towards the base
of the gland.   When there  are many together, they are
placed back to back, and their feet are applied against the
walls  of the duct.   When very numerous  they are  com-
pressed closely together, and are found deeper in the ducts.
They rarely exist,  however, at the  base of the gland.  In
young persons they vary in number from two to four.  In
an aged individual they may be from ten to twenty.  Though
this entozoon  may occasionally be  associated with  acne, it
seldom gives  rise  to great inconvenience.   According  to
Erasmus Wilson, the difficulty seems to be not to find  these
creatures, but  to find  an  individual with the  exception  of
newly-born  children, in whom they do not exist.
       81 
958
OBSTETRICS.
                    TRE ATME NT.
  We have given the  treatment of this disease in another
portion of the book, which consists in the free use of sul-
phur-baths.
               REPRODUCTION.
   Reproduction comprises  generation, or the formation of
the germ,  fecundation,  conception, gestation, and partu-
rition.  Fecundation is the result of the peculiar influence
of the semen over the matured ovum of the female.  After
coition the semen traverses the Fallopian tubes, reaches the
ovum, and fecundation occurs in the outer third of the
tube.
   The Graafian vesicles are small cysts; shape, round;  con-
taining a fluid; size, varying from a pin's head, (as seen by
the unassisted  eye,) to a large pea, according to progress
towards maturity;  the  largest  are nearest the surface;
number, 15 to 30  to  naked eye.  Negrier  says, they are
found quite early in life; in the old are not seen.  Consists of
two coats, intimately adherent; the outer adheres loosely
to the stroma by soft cellular membrane, to which the ves-
sels ramify;  is called the "tunic of the ovisac;" the inner
is vascular, is called the "ovisac;"  within each vessel is a
layer of granules  covered by a tenacious  fluid; is called
tunica granulosa;  within this layer  is an albuminous fluid;
in this layer, just where it is in contact with the peritoneum,
is the ovule.   The  ovule is rounded  and very minute,  one-
tenth of a  line, consisting  of a vitelline membrane,  yolk
granules, the germinal vesicle, and germinative dot or  spot.
The  vitelline membrane  is an elastic, thick, hyaline struc-
ture; it is  filled by the  vitellus,  a  granular, viscous mass.
The germinal vesicle, discovered by Purkinje, is seen with-
in the vitellus as a clear spot, one-sixtieth of a line in  dia-
meter.  The germinative dot, discovered by  Wagner, exists
usually single, rarely double, within the germinal vesicle. 
OBSTETRICS.
959
  Mammalian ovule, first described by Von  Baer, of Ko-
ningsburg, in 1817.   It appears as a dark sphere, the vitellus
surrounded by a ring, the vitelline membrane.
  Graafian vesicles rupture independently of coitus, and ova
are discharged into the tube, as demonstrated  in  animals,
and very recently by Letheby in two human females.
  When successful coitus occurs, the germ is  fecundated
in the tube, and certain changes ensue; before its arrival in
the uterus, a nidus is prepared for its reception and deve-
lopment.
   In the uterus, at each menstrual period, the  mucous
membrane is hypertrophied and cast off; but on the occur-
rence of conception, the development is greatly exaggerated,
the expulsion occurring subsequent to parturition.  To this
change the title decidua is applied.
  Fig. 122.—The decidua after the arrival of the ovum.   C, the ex-
ternal or uterine decidua.  E, E, the internal  or reflected layer.
D, the cavity of the decidua.  F, the chorion.   G, the amnion.

  Membrana-Decidua, called also caduca, anhistous mem-
brane, is independent of the presence of an ovum, as shown
in extra-uterine pregnancy, though  not invariably.
  The  glandular  utriculares become elongated,  enlarged,
and contorted; their secretion increases; the vessels of the
mucous membrane become larger and more numerous; a
substance composed of  nucleated cells, fills  up  the inter- 
960
OB STETRIC S.
follicular spaces in which the  blood vessels are contained.
The effect of these changes is an increased thickness, soft-
ness, and vascularity of the mucous membrane, which itself
forms the membrana-decidua.
  The structure exists over  the  internal  surface of the
uterus, except the cavity of the cervix, but  extends into
the oviducts.   At an early period of gestation, it is easily
detached ;  as it becomes more vascular, hemorrhage occurs
when it is separated.  It is thickest during first two months.
Its  outer surface, when detached, is spongy and flocculent j
its inner, smooth, with  striae  and depressions which  lead
into canals.
  The ovum enters the uterus, and becomes imbedded in
the soft decidua; by a new action, excited by its presence
at its place of contact, a prominent ring rises over and en-
closes  it, constituting the "decidua reflexa," so called, to
distinguish it from decidua vera.  As the  ovum  grows, a
new structure develops itself between the ovum and the
uterine wall, called " decidua serotina."   In young ova,
examined in the uterus, both  decidua vera  and reflexa are
found; but in aborted ova, this is not the  case; a portion
is retained in utero.  As the ovum grows, both the decidua
vera and reflexa are brought into contact, and  at the  third
month the cavity between them is obliterated.
  To return to the ovum.   The ovarian ovule exists in the
Graafian vesicle, having, in all mammalia, the following
essential parts, viz.:—1st.  The vitelline sac or zona pellu-
cida, a structureless bag, which is seen in  the fowl's egg,
enclosing the  yolk.  2d.  Within this  the yolk, consisting
of fat  globules and nucleated  cells; also, 3d, The germinal
vesicle.  4th.  Within  this vesicle, the  germinative dot,
which is a cell with a nucleus;  in some ova several nucle-
ated cells exist, as in those of fish.
  Lining  the internal  membrane of the Graafian vesicle,
is a layer of nucleated cells, forming a kind of tunic, called 
OBSTETRICS.
961
the membrana granulosa;  this surrounds the ovule.   At
one part the cells are more numerous than elsewhere, form-
ing the proligerous disc.
   About the time the ovum leaves the ovary, the germinal
vesicles disappear, and also  the germinal spot.   The cells
of the membrana granulosa, near  the ovum, become club-
shaped, and subsequently quite round.  The yolk also con-
tracts, and leaves a clear space between it and the zona
pellucida.  As the ovum approaches the middle of the ovi-
duct, an albuminous substance forms on the exterior of the
zona pellucida, into the chorion.
   During its passage along the lower part of the tube,  the
" cleaving of the yolk " occurs, breaking into  two parts, four,
eight, sixteen, thirty-two, sixty-four, &c.  Each segment
contains a transparent vesicle.  The cleaving ceases about
the time of the ovum reaching the uterus, and it now re-
sembles a granulated mass.
   Soon each of these segments becomes surrounded with
a  membrane, and thus converted into a cell; these cells
arrange  themselves into a kind of secondary vesicle,  the
"  vesicula blastodermica or germinal membrane ; this rapidly
becomes thicker, and within its  substance  shortly appears
the first trace of the embryo.
   The time occupied in the transit of the ovum from ovary
to uterus in the human female, is, probably, eight or ten
days.   Coitus, to be successful, must, probably, occur
within this period after menstruation, or else a  few days
before a period.

         CHANGES  BY  IMPREGNATION.
   In  the ovary and  tubes, vascular turgescence; one or
sometimes both tubes firmly embrace their respective ovary,
 and the corpus luteum remains.
                          81* 
962
OBSTETRICS.
             SIGNS OF PREGNANCY.
  One of the first and surest signs of pregnancy is a cessa-
tion of the catamenia.   This  is not, however, an unerring
sign, as it may cease from other  causes.  Nor is the  pre-
sence of  the menses a sure sign  of non-pregnancy, as  it is
a well-known  fact that some females menstruate during the
early months  of pregnancy, and that others never menstru-
ate  except during pregnancy.   Hence any one of these
signs  alone may not be reliable.   But when the  following
series of symptoms exist, we need not be mistaken in diag-
nosis.  During the first and second months, there is tume-
faction and tenderness of the  breasts, unnatural flatness of
the lower portions of the bowels, nausea, and sometimes vo-
miting in the morning, and suppression of the menses. By
examination per vaginam, the uterus will be found slightly
prolapsed, the os uteri closed, and the cervix directed to-
wards the symphysis pubis.   From the third to the eighth
month, in addition to the above symptoms, the tumefaction
of the breasts will be increased, the areola will be disco-
loured, and in many cases a secretion of the milk will take
place.  There will be movement  of the foetus, foetal pulsa-
tion, and increase of the abdominal tumour.

                   TREATMENT.
  The only early symptom of pregnancy which requires
treatment is the morning sickness.  For this, either of the
following remedies  may be relied on:—Take from twenty
to thirty drops of pepsine every  morning before rising, or
from three to fifteen grains of triturated  senecin once or
twice a day.   During the latter stages of pregnancy, if
there be  weakness, the patient should take one teaspoonful
of the mother's cordial two or three times a day.   If there
be pain, with  tendency to abort, one or  two grains of tritu-
rated  helonin, with two or three  grains of  triturated hyos-
ciamin, should be taken at bed-time.   The bowels should
be kept open  by mild laxatives, and violent exercise should
be avoided. 
OBSTETRICS.
963
  CHILD-BIRTH,  OR  PARTURITION.
  If the fortieth week of pregnancy occur at the regular
time of the catamenial flow, labour will  commence; but if it
do not correspond with that time, labour will be delayed
until the next regular period of menstruation.   In  some
cases, labour may be anticipated, and  occur as soon as the
thirty-eighth or  thirty-ninth week.

            CAUSES OF  PARTURITION.
  The cause of  the expulsion of the foetus is the involun-
tary contraction  of the uterus, aided by the abdominal  mus-
cles.  To render the combined action of the  two classes of
muscles  complete, the lungs, by a deep inspiration, are
filled with air, which is  prevented from  escaping by con-
traction of the glottis.  At the same time the ribs are fixed,
and the diaphragm is in a rigid state.   As soon as the ab-
dominal  muscles contract, the intestines are  thrown up
against the  diaphragm, and the entire force of the con-
traction  is made upon the gravid uterus, and its contents
are expelled as soon  as the os uteri becomes sufficiently di-
lated.  The pain experienced  by the  patient is caused by
the pressure which  the uterine nerve  receives during the
contraction  of the uterine fibres.  Hence, as soon as the
fibres relax, the  pain ceases.   As the uterine contraction
is periodical, it  follows that  the pain  is also intermittent.
The first pains are mostly transitory,  occurring at regular
intervals, and are designed merely to dilate  the os uteri,
which is in  a rigid state during the first stages of labour.
The rapidity with which the mouth of the uterus dilates
depends  altogether upon the degree of  muscular rigidity
and the  frequency and violence of the uterine  pains.  In
primiparse,  or females who have never borne children, the
dilatation is usually more tedious  than in those who have
previously borne children. 
964
OB S TETRIC S.
           SIGNS  OF APPROACHING LABOUR.
  A few days previously to labour, the uterus will be ob-
served to settle in  the pelvic cavity, the stomach will be-
come relieved by the removal of the mechanical pressure,
and the patient will feel every way much  better;—to use
her own words, she feels so much better that she expects
to be sick in a few days.   This immunity from nearly all
the inconveniences of uterine gestation appears to be a wise
provision on the part  of the Creator to enable the recupe-
rative  powers of the system to prepare themselves to aid
the patient to endure the labour and pain which is always,
to a greater  or less  extent,  the accompaniments  of this
event.  As labour is about to commence, the patient has a
frequent desire to evacuate the bladder and the  rectum.
At this time there  is usually a discharge  from the vagina
of a mucous character, not unfrequently tinged with blood,
and sometimes  actual hemorrhage occurs.   Accompanying
this discharge  are  slight  premonitory pains, usually very
transitory and fugitive.   As regular labour approaches, the
pains increase in frequency, and instead of commencing in
the lower  portion  of  the abdomen, as they do during the
dilatation of the os uteri, they commence in the back, and
pass  forward and  downward, occurring at regular inter-
vals, and are of a  periodical character.   It is under these
pains that the os uteri becomes fully dilated,  and  if it be
very rigid, the pains are tedious and  extremely  hard to
bear.
   The patient  often is apprehensive  of danger, and  espe-
cially if she has not confidence in her medical attendant.
Her nervous system becomes affected, thereby protracting
the  first stage  of  labour.  When the  os uteri is  fully di-
lated, the first  stage of labour is said to be over,  and the
second stage commences.  In  the early part of this stage
the membrane  which contains  the  liquor  amnii ruptures,
and the liquor  escapes.   At this time the labour  becomes 
OBSTETRICS.
965
more  severe.  The abdominal muscles contributing much
to the expulsion of the foetus, and being under the influ-
ence of the will, the  patient and  attendants  often think
that by a bearing-down effort of the patient the foetus will
be more readily expelled. This is true, provided the mouth
of the uterus is thoroughly dilated—otherwise the effect of
abdominal  pressure might be to rupture  the uterus and
produce serious consequences.  If the mouth of the uterus
be well dilated, the patient should be instructed to hold her
breath as long as convenient, to assist in fixing the abdomi-
nal muscles, thereby aiding the expulsion of the foetus. At
the same time she may very much facilitate the effort by
placing her feet against some hard and firm substance, and
pulling with the hands at some permanent object.  Much
injury may be done at this stage of labour by too violent ex-
tension.  Therefore, extreme caution should be observed
in every effort made by the patient to aid nature in effect-
ing delivery.  In some cases, gentle pressure upon the ab-
domen will assist in fixing the abdominal muscles so as  to
aid labour.  The patient should also  be instructed to bear
the pains with calmness, avoiding nervous or mental agi-
tation, keeping as quiet as possible, although  there is no
objection to her standing upon her feet, walking about the
room, or using the vessel to evacuate the bowels and blad-
der, until after the head of the child passes the pelvis, and
presses against the perineum and vulva, at which time the
patient should remain quiet,  although the pressure  against
the bladder and rectum frequently produces an evacuation
of these organs.  During the passage of the foetus through
the os uteri and vagina to the inferior strait of the pelvis,
the pains are most excruciating, and the patient often gives
vent  to her  feelings  in the  most pitiful groans and cries.
As soon as the head reaches the lower strait of the pelvis,
and pressure is  made  upon the  perineum, the agony and
anxiety of the patient are extreme. 
966
OBSTETRICS.
  The attendant should  place a napkin firmly against the
perineum, making pressure whenever the pains occur, so as
to prevent its rupturing.   Also, direct the head of the foe-
tus  through the vulva with the  other hand.   As soon as
the head emerges from the vulva there will be a short re-
pose, during which the attendant should carefully examine
the neck of the child, and ascertain whether the umbilicus
is around it, and if so, remove it.  The child's head should
also be supported—but in no case in natural labour should
traction  be  made until a pain appears.  Then a gentle ro-
tary traction may be made on the child's head, to assist the
uterus in the expulsion  of the body.  During the progress
of the first stage of labour, the attendant will have occasion
to make examinations to ascertain the position  of the child,
the character  of the presentation, the advancement of la-
bour, &c, which should be done by feeling,  as  gently as
possible, with the finger covered with oil or glycerine, for
the fontanelle, as described under the head of different pre-
sentations.  In  no case, however,  is it justifiable, on the
part of the attendant, to repeat  these examinations oftener
than is absolutely necessary to ascertain the position of the
foetus, as no good, but much injury, may result  from the
constant manipulation sometimes practised by obstetricians.
The position of  the patient during labour should be go-
verned by circumstances.  Some patients find the easiest
position  in  bed, reclining upon  the left  side—others can
only endure the pains by being  on their  knees;  others by
walking  about the room until the  pains  return, and then
kneeling  upon a cushioned chair  until  they pass off, re-
suming the exercises until  another return.   In each  of
these positions I have seen patients complete  their labours
with  equal facility—hence  the attendant should be go-
verned  by circumstances in  respect to the  position of the
patient. 
OBSTETRICS.
967
  With reference to the duration  of labour, the attendant
should be careful not to make the time too short, as thereby
the patient and her friends will be likely to apprehend that
something is wrong, and their confidence in him will be
lost.
  The following facts will be a guide to the length of time
that must elapse from the commencement of labour  until
delivery  is  effected:
  Where the pelvis is large, labour is more rapid than if it
be small: and the first labour is  usually  more protracted
than subsequent ones.   The more relaxed the soft  parts,
the more rapid the labour.   Also where the mouth of the
uterus' is soft and easily dilated, labour usually progresses
more rapidly than where it is thin and tense.   If the pains
be regular and at short intervals, with a well dilated  vagi-
na, labour will usually be short: on the other hand, where
the os is  firm, the  vagina unyielding, and the pains  irre-
gular, the labour will be more  protracted  and  tedious.
The different presentations of the  child's  head to the pel-
vis also have much to do with the period of labour.  These
are the cephalic and pelvic presentations.   The cephalic
positions include the presentation of the face and vertex
and the shoulder, while the pelvic includes the knees, feet
and breech.   When  the vortex or head is  presented, the
labour is  said to be natural, and all other presentations are
said to be abnormal.
  The first three positions of the vertex or head are repre-
sented by the following Figures: 
968                  OBSTETRICS.

  Fig. 123 represents the first position.
                        Fig. 123.
           POSITION  OF  THE  HEAD.
  The head presentation is characterized by the following
six positions:
  1st. Where the posterior fontanelle points to the left ace-
tabulum of the mother.   The posterior fontanelle  is that
part where the two sides, or  parietes, and back or occipital
bones unite just back of the crown of the head, and may
be  recognised by the touch, the bones  not  being quite
united, and the corners  of the bones  not being easily felt. 
OBSTETRICS.                969
Fig. 124 represents the second position.
                       Fig. 124.

The  acetabulum is  the socket  in  which the head of the
thigh bone plays.  The 2d position, is where the posterior
fontanelle looks towards the right acetabulum.   The 3d is
where the posterior fontanelle looks to the symphysis pu-
bis.  The 4th is where the anterior fontanelle  presents to
the left acetabulum.   The 5th is where the anterior fonta-
nelle  looks towards the right  acetabulum.   The 6th is
where the anterior fontanelle will be found to the symphy-
sis pubis.   The anterior fontanelle is  that place in the an-
      82 
970                 OBSTETRICS.
Fig. 125 represents the third position.
                         Fig. 125.
terior of the head where  the frontal and parietal bones
unite, and is known as the open place in the  child's head.

THE DIAGNOSIS OF HEAD PRESENTATIONS.
   The  diagnosis  is usually easy,  especially after  labour
commences.  By examination per vaginam, a round, hard
and uncased body will be felt; and, if pressed backwards,
a large groove will be felt traversing the head, nearly from
one end to the other.  This is the sagittal suture.  At one
end  of  this suture is the posterior  fontanelle, and  at the
other is the anterior fontanelle, which may be distinguished
by the posterior being three-cornered and the anterior nearly
square.   These  fontanelles, as I have already  remarked,
are sure to indicate the position of the child's head during
the second  stage of labour.   The fifth  position, although
more tedious than the first, is by no means an uncommon 
                 OBSTETRICS.

Fig 126 represents the sixth position.
971
Fig. 126.
one.   The sixth position is one of the most difficult ones,
as will be noticed, from the fact that the largest  diameter
of the child's head presents itself to the smallest diameter
of the pelvis.
  In this presentation, an early attempt should be made to
reduce the position to one of the easier ones.  If this be not
accomplished,  the use of the instruments may be required. 
972
OBSTETRICS.
   THE  DUTIES  OF  THE  ACCOUCHEUR.
  Having described the more essential points of what  is
termed natural labour, before giving a description of difficult
parturition, I would  offer a few remarks upon the duty of
the attendant.  When a physician is called to a case of la-
bour, he should obey the summons as soon as possible.  On
his arrival, he should not enter the room until he has been
announced.   In the  presence of the patient he  should  be
modest and gentle, but should make such inquiries relative
to the condition of the bowels, bladder, labour, &c, as will
enable him to obtain  all the requisite information respecting
the condition of the patient.   If the bowels be costive, they
should be evacuated  by means of a warm water  injection.
If necessary, the bladder should be evacuated by means of a
catheter.  If a vaginal examination should be  necessary,
the fact should be made known to a third person, who will
inform the patient.  The hand should  be softened by warm
water and oiled with sweet oil,  and the examination should
never be carried farther than is absolutely necessary to obtain
proper information as to the nature of the presentation.  If
every thing be found as it should be, and the pains are regu-
lar, the pain  should  be allowed to  progress without inter-
ruption,  save an occasional examination to ascertain when
the labour will be  complete.  On the contrary, if the pains
be tedious and the  os be rigid, from three to ten drops of the
tincture of gelsemin  should be given in connexion with five
or ten grains of the triturated caulophyllin every half hour,
until the pains are regulated and the rigidity of the os over-
come.   If these remedies do not regulate the pains, the feet
should be placed in warm water and the patient allowed to
drink a strong infusion of cotton root.   Or, in the absence
of that, a few doses of senecin and quinine may  be given.

          R. Senecin,................................. gr. x.
             Sulph. quinine,........................ gr. v.
            Sacch. alba,.............................gr. xx. 
OBSTETRICS.                973
Mix: divide into ten powders, and give one every fifteen
minutes until the  pains become regular.   If hemorrhage
should occur, from five to ten drops of the oil of erigeron
every ten or fifteen minutes will usually be sufficient to check
it.  If not, five or ten grains of capsicum given in connexion
with it, will control it.  If the warm water inj ection should not
move the bowels, a teaspoonful of fluid extract of anti-bilious
physic may be given.   When the child is born, it should be
carefully examined to see  if the bones are broken, or if any
thing be wrong.   During the entire course, the attendant
should be calm and courteous, and do all in his power to con-
tribute to the wants of the patient.

                TYING  THE  CORD.
   As soon as the child is  delivered,  a ligature should be
placed around the cord, about one inch above the navel, suf-
ficiently tight to prevent circulation in the cord, which may
be known by its ceasing to pulsate.   A second ligature should
be placed  about one inch above the first, and as soon as the
pulsation in the cord ceases, it may be divided with a sharp
pair of scissors, and the child given over to an attendant.

        DELIVERY  OF  THE  PLACENTA.
   After the delivery of the foetus, the pains usually cease for
ten or fifteen minutes, and then returning, are followed by an
expulsion of the secundines.  To facilitate the expulsion of
the placenta, the attendant should make gentle friction with
the hand over the abdomen, at the same time making slight
traction upon the cord.  There should be no pulling upon
the cord, however, as it might cause inversion of the uterus,
or the uterus might be  dragged into  the  lower portion of
the pelvic  cavity.   The former would be  fatal to life, and
the latter to health.  If the placenta be  not immediately
expelled, and the pains do not return, let the patient rest
for a few hours.  The practice of forcing  it away, is a per-
nicious one, as no harm can arise by allowing it to remain
                           82* 
974
OB STETRICS.
for a few hours.  In cases where the placenta has been at-
tached to  the uterus,  I have allowed it to remain two,  and
in one case four days, without any mischievous result.  On
the contrary, it became detached, and was expelled without
artificial means.  Should the pains not return,  however,
and it be  thought advisable to resort to means to expel the
placenta,  it can easily  be  accomplished  by applying  hot
packs to the breast, and giving an infusion of blue cohosh
or a few doses of caulophyllin, repeated at intervals of  ten
or  fifteen minutes, aided by friction over  the  abdomen.
If the placenta should be attached,  the hand may be  intro-
duced into the vagina,  and by introducing one finger into
the uterus, cause it to relinquish its adhesive attachments.
The expulsion  may be assisted by gently pulling upon  the
cord, at the same time moving it to the right and left,  and
up and down in the vagina.  After the placenta is expelled,
several oiled  napkins  should  be folded and  applied  to
the vulva.  The thighs should be brought into proximity,
and an abdominal bandage  of some ten or twelve inches in
width, fastened tightly around the body, the wet clothing
removed,  and the patient placed comfortably in bed.

   After Pains.—When after pains occur, small doses of
hyoscyamin and gelsemin will soon  relieve them.  But, as
these pains are for the purpose of expelling from the uterus
effete matter, which, if allowed to remain, would  be  likely
to produce puerperal  fever, it is not best to interrupt them
unless they prove too exhausting to the patient.

   Lochia.—The  lochia  is a discharge  from the uterus
after delivery, and is  caused by the  escape of bloody serum
from the partially open mouths of the uterine blood vessels.
It usually continues from five to ten days.

   Treatment.—Where the lochia is in excess and produces
debility, a few doses of  the oil of erigeron may be used in 
OBSTETRICS.
975
connexion with  hamamelin, bebeerine and precip. carb. of
iron.
      R.  Hamamelin.................................grs. vj.
          Bebeerine..................................grs. x.
          Precip. Carb. of Iron....................grs. x.
          Sacch. Alba.................................grs. xxx.
Triturate; mix, divide into ten powders, and give one every
three hours.
   If the lochia be suppressed  or scanty, a free purge of po-
dophyllin and cream of tartar should be given, followed by
iron and quinine, or by senecin and quinine.  If this should
not produce a return of the lochia, a warm mush-poultice
should  be applied to the breasts, a hot pack to the bowels,
and a strong infusion of the cotton-root, given in connexion
with  the quinine  and senecin.   The diet, during the first
fifteen or twenty days, should be nutritious and easy of di-
gestion, and the patient should avoid violent exercise and
exposure to inclement weather.


     MANAGEMENT  OF  THE   CHILD.
   Previously to washing the  child, it should be  anointed
with lard, or soft oil.  After washing with soap and water,
the dressing of the navel should be attended to.  The at-
tached  portion  of the umbilical cord should be passed
through a hole cut in the  centre of several folds of linen,
which should  envelop the cord in such a manner as to pre-
vent its coming in contact with the bowels.   An abdominal
bandage should be applied, but not so tightly as to prevent
free circulation; and the child should be dressed in  warm
flannels.  The child's mouth should  be washed with cold
water, and applied to the mother's  breast,—as the first se-
cretion of the breast will move its bowels.  If it be necessary
to give  the child nourishment before the  secretion of milk
occurs in the breast, it should be fed with  milk and  water
sweetened. 
976
OBSTETRI C S.
    PRESENTATIONS  OF  THE  FACE.
   The face presentations may be divided into four positions:
1st. Where the chin points to the right side, and the back of
the child to the left side of the mother.   This position may
be ascertained after the water breaks, by feeling for the  co-
ronal suture, the orbital process of the eyes, the nose, mouth,
chin, and, sometimes, the ears.   The great utility of a cor-
rect diagnosis in these cases, is to ascertain the position of
the feet—a matter of prime importance when it becomes  ne-
cessary to  turn the child.  The 2d  face  presentation  is,
where  the face presents to the left side.   The 3d, is where
the face presents to the sacrum.   The 4th, the chin presents
to the  pubis.   In all  cases of face presentation, the  natural
tendency of labour is to rotate the head  towards the sym-
physis pubis.   When nature fails to do this, art should ren-
der all the assistance in its power.  When the uterus is well
relaxed, the hand may be introduced, and the vertex  pressed
downwards, and the face pressed gradually backwards and
forwards, thus  reducing the face presentation to a  natural
head presentation.  This expedient, however, should be  re-
sorted  to with great precaution, and not until nature has  en-
tirely failed to accomplish her purpose.
   In these cases labour becomes very much protracted, and
instruments must be resorted to,—but not until every effort
has been made, on  the part of the attendant, to effect a  na-
tural delivery.   The system  should be well supported with
tonics,—as  caulophyllin, bebeerine,  hot  ginger  tea, warm
sitz-baths, and an anti-spasmodic injection.


  PRETERNATURAL  PRESENTATION.
       BREECH, FEET, AND KNEES PRESENTATION.
  These forms of presentation are next in frequency to that
of the  vertex.  In  nearly all of  these cases, nature is able
to accomplish the labour without interference.
i 
OBSTETRICS.
977
  Diagnosis of Breech Presentation.—When the finger is
introduced into the os uteri, it will come in contact with a
soft, round tumour, on the side of which will be felt one of
the trochanters.  If the fingers  be passed between these
prominences  on  the upper portion of the thigh-bone, the
anus and organ of generation will be felt.   When the feet
present, there is no difficulty in detecting them; but when
the knees present themselves, all  the different points of the
head should be studied by the sense of touch.   The breech
presentations may assume  four  positions:—1st, the right
sacro-iliac, (fig. 127;)  2d, the left sacro-iliac; 3d, the sacro-
Fig. 127.
pubic, (fig. 128; the spine is behind the symphysis pubis,
and the belly towards the sacrum;) 4th, the sacro-sacral.
The great  importance of these positions is to enable us to
study the positions of the head as it enters the pelvis, as in
all cases where the greater diameter of the head comes in
contact with  the  lesser diameter of the  pelvis, very great
difficulty may be  expected to exist.  It is  in these cases
that  instrumental interference so frequently becomes ne- 
978
OBSTETRICS .
cessary.  The feet presentation may also occur in four dif-
ferent ways, possessing  many practical points of interest,
tending the same as breech presentations to indicate the
degree of the severity of labour.
                        Fig. 128.

      COMPOUND  PRESENTATIONS.
   A compound  presentation is where  one of the  extremi-
ties presents, in connexion with the head. Very fortunately,
these presentations occur where the pelvis is large,—hence
the delivery may be effected without the interference of in-
struments.  In these cases the arm or foot should be pushed
back  into the uterus, in  the absence of pain.   In some in-
stances, to effect this operation, it will be necessary to intro-
duce the hand into the vagina, and, in some cases, into the
uterus, returning  the limb to its original  position,  and
causing it to remain until  the head is so far advanced as to
prevent its return.   But in cases where the limb is so far
advanced, and the condition of the foetus is such as to pre-
clude the possibility of returning, the attendant should wait
until he is satisfied  that nature will not accomplish her  pur-
poses, and then resort to  medical or mechanical interference
as he deems expedient.
   These means, consisting in the use of ether and cranio-
tomy, or of the forceps, all of which will be described under
the head of Instrumental Labour. 
OBSTETRICS.
979
SHOULDER  AND  ARM PRESENTATIONS.
  Diagnosis of shoulder presentation, before rupture of the
membrane, is exceedingly difficult.  But afterwards it may
be determined by the finger coming in contact when intro-
duced into the vagina with a tumour much smaller than
the head—and instead of the fontanelles, the acromial pro-
cess will be felt, and by proper care the finger may be car-
ried into the axillary and down upon the ribs.  The shoulder
presentation may be distinguished from  that of the  elbow
by the olecranon process, and the two condyles of the elbow.
                       Fig. 129.

  TREATMENT  FOR  SHOULDER  PRESENTATION.
  The rectum should be evacuated by warm water injec-
tions, and the bladder, if necessary, by a catheter.   Much
care should be taken not to rupture the membranes.   When
the os uteri is  dilated to the size of a half dollar, and the
vagina and soft parts become yielding, the patient should
be placed upon her back  across the bed, with her hips
slightly elevated,  and  her feet should be supported by two
assistants.  The attendant's arm and hand should be well 
980
OBSTETRICS .
oiled, and he should take his seat between the patient's limbs.
During  a  pain  the  hand should be  gradually introduced
into the vagina, and afterwards, in the absence of pain, into
the uterine cavity.  If introducing the hand into the ute-
rine  cavity should produce  uterine  contraction, the hand
should be opened and made to cover  the body of the child.
The attendant should now rupture the membrane, and pass
his hand over the umbilicus, in the neighbourhood of which
a foot will be found.  If pain  should come on during this
manipulation, the hand should be opened  and allowed to
rest upon the child; after which the foot should be grasped
between two fingers, and search made for the other foot.
(Figs. 130 and  131.)  If the other  foot be found, it should
                        Fig. 130.

be grasped; if not, gentle traction  should  be made  upon
the one already grasped, at the same  time  making gentle
pressure upon the abdomen, until the feet are brought into
the vagina.   Should the pains be severe, a few drops of
laudanum, or a dose of morphine should be given to arrest
them.   After  the operation of turning is  completed, the
hand  should be withdrawn, and labour allowed to pursue
its natural course.
  When the liquor amnii has been discharged, and there 
OBSTETRICS.                 98l
are violent pains, with a rigid uterus, no attempt should be
made to introduce the hand, but the pain should be arrested
by laudanum, the uterus dilated by the use of gelsemin, or
lobelia injections, before  turning is attempted.  If, how-
ever, the uterine contraction should  appear permanent, the
attempt at turning  abortive, the foetus should be removed
by exvisceration.
                        Fig. 131.
 PROLAPSUS  OF  THE  UMBILICAL CORD.
  When the cord is prolapsed, or appears before the pre-
sentation of the foetus, it should  be carried  back into the
vagina, and, if practicable, into the uterus.  If not, it should
be so adjusted in the pelvic cavity as to prevent the pressure
of the foetus upon it, thereby stopping circulation and causing
the  death of the child.

        INSTRUMENTAL  LABOUR.
            APPLICATION  OF THE FORCEPS.
  The  object in applying the forceps is, first, to assist the
uterus in the expulsion of the child; and secondly, to hasten
delivery where there  is threatened danger to the mother or
       83 
982
OBSTETRICS.
child, as in the case of active hemorrhage or convulsions;
in the third place, to assist where there is malformation of
the foetus, deformities of the pelvis—in  short, wherever
there is any obstruction to the expulsion of the foetus by
the efforts of nature.
  The forceps should  not be used where the os uteri and
surrounding soft parts remain in a rigid state, or where the
cord is short, or where it is twisted around the neck.  As a
                        Fig. 132.

general rule, the forceps should not be used when the head
has not escaped from the uterus.
  In applying the forceps the following rules should be ob-
served :—
  " 1st. The patient should be placed upon her back, ex-
actly in the position recommended for turning.
  " 2d. The bladder and rectum should be emptied of their
contents; the first by the catheter, if necessary, the second
by means of an enema.
  " 3d. Before using the instrument it will be proper to 
OBSTETRICS.
983
apprize the patient and her friends of the nature of the ope-
ration, of its probable success, and by showing her the in-
struments prove to her that they are not  calculated, when
properly  used, to injure either her or the child.
  " 4th.  Examine the condition of the soft  parts, which
should be dilated or dilatable.   At the  same time the exact
position  of the presenting part should be  ascertained, if
possible.
  " 5th.  The instruments should be warmed to the tempe-
rature of the patient.  They should also be well greased.
  " 6th.  The forceps may be applied  to the head, where
either the vertex or face presents, or where it remains in
the pelvis after  the body is expelled.   (Fig. 132.)   By
some it has been recommended to apply them over the  iliac
bones in  case of breech presentations;  but this is a doubt-
ful practice, since the form of the part and the delicacy of
these  bones so early in life would  hardly afford sufficient
grasp for the purpose of extraction.
  " 7th.  The concave surface of the blade of the forceps
should be applied, wherever it is practicable, to the sides of
the head in such a way as to grasp it in a line nearly paral-
lel with the occipito-mental diameter.  This is not always
practicable, for in some cases, as we shall see hereafter, we
will be obliged to  apply the forceps, so that the forehead
and occiput shall be  the points compressed.
  "8th.  The forceps should always be applied so as to bring,
at the termination of delivery, the concave edge under the
symphysis pubis.
  " 9th.  The posterior branch is generally the one to be
first introduced.
  "10th. The  male branch or blade is to be  held in the
left hand, and is always to be  applied to the left side of the
pelvis.  The reverse is true in regard to the female blade.
The introduction of the blades should be effected during the
absence of uterine pains. 
984
0 BSTETRICS.
  " 11th.  The hand which is free to be used as the director
of the blade which is being introduced.   (Fig.133.) When
the presenting part is low down, the introduction of one or
two fingers only will be  required, care  being taken to in-
sinuate them between the head and circumference of the os
uteri, so as to prevent the latter from being grasped under
                        Fig. 133.

the blade of the forceps.  When the presenting part is very
elevated, it will be necessary to introduce the whole hand
into the vagina, for the purpose of giving the proper direc-
tion to the blade of the instrument.
  "12th.  The  blades  should be introduced into the poste-
rior part of the pelvis, when they may  by a spiral  move-
ment be gradually drawn round so as to clasp the side of
the head. 
OBSTETRICS.
985
  " 13th.  No force should be used in pushing the blade up
to the proper point; if, as sometimes occurs, the soft parts
of the mother, or the scalp or ear of the child, should pre-
vent the proper application  of  the blades, the difficulty
must be overcome by gentle manipulation, and not by force.
  "14th.  If  when  applied, the forceps should not  lock
easily, they should be withdrawn and reapplied.
  " 15th.  Slight compression must be used, and traction
should be made during the existence of uterine pain.   The
handles need not be tied, and the  compression should be
relieved beween each tractive effort.  (Fig. 134.)
                        Fig. 134.

  "16th.  Before using traction, we should be sure that no
portion of the patient is  within  the  grasp of the forceps.
If any portion of the vagina, vulva or uterus be included,
the least compression will produce  violent pain, and  the
cries of the patient will warn us of the accident.
  " 17th.  Traction should always be made in the direction
of the axis of that part of the curve  (formed by the pelvis
and perineum) at which the head is  successively placed.
  " 18th.  If pains  continue  until  the  head  has  nearly
                           83* 
 86                OBSTETRICS.

passed the  external part, our  traction  may be  suspended,
(though the forceps should not be removed,) so as to allow
delivery to be accomplished by natural efforts  if possible.
In not removing the instruments, but merely  suspending
the traction, there will  be  no  necessity for their re-appli-
cation, if the natural expulsive efforts  should cease before
delivery has been effected.
  " 19th.  The handle of the forceps must be seized with
the right hand, and compressed  sufficiently to give a firm
hold  upon the head, but where the  pelvis is  deformed a
greater amount of compression will be required.   The left
hand must be applied over the joint or lock of the forceps.
When all  this has been arranged, traction may be com-
menced by gradually and  to a moderate extent, swinging
the handle from side to side, at the same time  changing
the direction of our efforts, as the head advances through
the pelvis and over the perineum.  As the head passes over
the perineum, the latter should be  carefully supported  as
in ordinary labours."

                 CRANIOTOMY.
  This operation consists in opening the child's head and
allowing the brain to escape, to admit of  the  delivery  of
the child.  In no  case is the attendant justifiable in resort-
ing to this measure, unless the life of the mother or child
must be sacrificed, in  which case the mother  should  be
saved.  In order to perform this operation, the uterus should
be much relaxed, and the perforator after being well oiled
should be seized  with  the right  hand and  passed along
the two fingers of the  left, previously introduced to the
point where the opening is to  be made in the head.
  The instrument is to  be  pushed into the head up to the
shoulders,  when they should be  spread so as to make the
opening as large as possible.   When this is done, another
incision should be made at right angles with the first, after 
OBSTETRICS.
987
which the instrument should be passed into the brain, and
so far as possible break up the cerebral mass.  After this
the perforator should be withdrawn and the crochet intro-
duced into the cranium, and its sharp points hooked into
the internal tablet of the cranial bones.   At the same time
two fingers of the left hand should be introduced and placed
in such a position as to detect any slip of the crochet, there-
by  preventing injury  to the soft parts.   Gentle traction
may then be made upon  the  crochet, and the mutilated
head thus expelled.  In some cases it becomes necessary
to  remove these bones  by piecemeal,  either  with  the
crochet or with a pair of craniotomy forceps.

      PUERPERAL  CONVULSIONS.
                  SYMPTOMS.
  The symptoms of puerperal convulsions very closely re-
semble epilepsy, and are usually, though not always, pre-
ceded by more or less pulmonary symptoms; such as  pain
in the head, slight vertigo, and load and pressure about the
epigastrium, and in some cases nausea, and vomiting. Also
numbness in the limbs and flashes of light before the eyes
sometimes occur as premonitory symptoms of  the above
difficulty.   In other cases no premonitory symptoms what-
ever occur, and the first  thing observed  is, that the pa-
tient's eyes are set and rolled upwards in the socket, with
rigidity of the muscles, frothing at the mouth, protrusion
of the tongue, &c.   These symptoms frequently disappear
in a few minutes, but  sometimes they continue for an hour
or more.   When these convulsions appear, they are apt to
be repeated until the cause is removed.

                      CAUSES.
  The causes of puerperal convulsions  are various.  But
the more common cause is pressure of the foetus on the sa-
cral plexus nerves during parturition, or an injury inflicted 
988
OBSTETRICS.
resulting in convulsions after child-birth.  Another cause
is congestion of the capillaries of the brain during labour.
They may also  be  caused by irritation  or pressure of the
uterine or vaginal nerves, injuries and  congestion of the
spine, &c.
                   TREATMENT.
  If  convulsions  be  caused by pressure upon  the sacral
nerves, the head of the foetus should be at  once elevated.
In the absence of proper instruments, the head  of a large
spoon may be used for this purpose, placing it  under  the
child's  head, and elevating it until it  passes  the lower
strait  of  the pelvis.   If  this  cannot be done, the child
should be delivered at once by means of the forceps.  At
the same time, give the patient eight or ten of the inter-
mittent drops, until the  paroxysms are  subdued.  If the
convulsions be caused by irritation of the vagina  or ute-
rine nerves, gelsemin and hyoscyamin are the remedies.
If caused by congestion  of the  brain, the ligature should
be applied to the  arms and thighs; at the  same time  the
tincture of veratrum viride should be given in five or ten
drop  doses  every  fifteen  or twenty minutes until  the pa-
roxysms are relieved.  The after treatment should consist
in tonics, baths, &c.

             FC3TAL  CIRCULATION.
  The peculiarities of the foetal circulation consist in the duc-
tus venosus, which connects between the umbilical vein and
the vena cava in the foramen ovale, which exists in the in-
terior auricular space, in the ductus arteriosus, which com-
municates between the pulmonary artery and the aorta, en-
tering the  aorta  on  its transverse arch, in the umbilical
arteries, two in number,  which arise from the hypogastric
or internal iliac.
  The blood passes into the  right auricle,  as  in  adults;
then part of it passes  through the right ventricle, pulmo- 
OBSTETRICS.
989
nary artery,  and ductus arteriosus, into the aorta.   The
other portion passes through the foramen  ovale into the
left  auricle, and  left ventricle, thence through the  aorta
and its left branches.
  Immediately after birth  and upon inspiration the blood
rushes to the lungs, the foramen ovale closes  by valvular
development for  that  purpose.   The  ductus arteriosus  is
useless, and soon becomes obliterated.   The umbilical arte-
ries are also  closed from the fourth to  the seventh day.

                DEATH  OF  FffiTUS.
   Death of  foetus may be known by  cessation of  motion,
flaccid and loose feel of the  abdomen," cold  and weight  in
the lower portion of the bowels, loss of appetite, and feel-
ings of debility. 
PART  IV.
   MATERIA  MEDICA  AND PHARMACY.
   By Materia Medica is understood that branch of medical
science which treats of all medicines which are adapted  to
the removal of diseases in their natural state.  They may
be simple, or  compound, organic, or inorganic.   The for-
mer belong to the animal and vegetable kingdoms, and the
latter to the mineral kingdom.
   By Pharmacy is understood that department of medical
science which  relates  to compounding, mixing,  and pre-
paring all medicines which differ from those found in their
natural state.   The following is Dr. Murray's arrangement
of the  Materia  Medica.
   1. General Stimulants.—These are  diffusible, as narco-
tics and anti-spasmodics, and  permanent, as tonics and
astringents.
  2.  Local Stimulants.—These are emetics, cathartics,
emmenagogues, diuretics, diaphoretics, expectorants, sia-
lagogues, errhines and epispastics.
  3. Chemical.—These are refrigerants, antacids,  lithon-
triptics and escharotics.
  4. Mechanical  Remedies.—These  are anthelmintics, de-
mulcents, diluents and emollients.
  The following is the arrangement of medicinal substances,
according to  their therapeutic properties, by Dr. James
Johnstone:— 
MATERIA MEDICA.
991
  Class I.  Medicines which act upon the alimentary canal.
  Class II. Medicines which act upon the glandular sys-
tem, and upon the secretory and excretory vessels.
  Class III. Medicines which  act upon the heart and ar-
teries.
  Class IV. Medicines which act upon the brain and ner-
vous system.
  Class V. Medicines which act upon the muscular fibre.
  Class VI. Medicines which  act upon  the skin and ex-
ternal parts by application to the surface of the body.
  Class I.  Medicines which act upon the alimentary canal.
  1. Emetics.—Medicines which evacuate the stomach by
exciting vomiting.
  2.  Cathartics.—Medicines which expel the faeces by in-
 creasing the peristaltic motion of the intestines.
   3. Anthelmintics.—Medicines which  destroy intestinal
 worms by expelling them from  the body.
   4. Antacids.—Medicines which  counteract acidity  in
 the stomach.
   5. Demulcents.—Medicines which protect and lubricate
 the coats of the alimentary canal.
   6. Antidotes.—Medicines which neutralize poisons when
 received into the stomach.
    Class II.—Medicines  which act upon the glandular
 system, and upon the secretory and excretory vessels.
    1. Secretory  Stimulants.—Medicines  which  act upon
 the whole glandular  system.
    2. Sialagogues.—Medicines which increase the secretion
 of saliva.
    3. Expectorants.— Medicines which  promote the secre-
 tion of mucus or pus from the bronchial tubes.
    4. Errhines.—Medicines which  promote the  secretion
  of mucus in the nostrils.
    5.  Diaphoretics.—Medicines which excite cutaneous ex-
  halation. 
992
MATERIA MEDICA.
  6. Diuretics.—Medicines  which increase the  secretion
of urine by exciting the action of the kidneys.
  7. Emmenagogues.—Medicines which promote the men-
strual discharge.
  Class III.—Medicines which act upon  the  heart  and
arteries.
  1. Sedatives.—Medicines which diminish the power and
velocity of the circulation by their power  on the heart and
large arteries.
  2. Refrigerants.—Medicines which diminish the heat of
the body, by their action on the extreme vessels.
  3. Tonics.—Medicines which invigorate the circulation,
and thus relieve debility or  atony.
  4. Arterial Stimulants.—Medicines  which  excite  the
circulation.
  Class  IV. Medicines  which act  upon the  brain  and
nervous system.
  1. Narcotics.—Medicines, which by  their operation on
the brain and nerves, diminish sensibility and induce sleep.
  2. Antispasmodics.—Medicines which by their operation
on the nervous system, allay inordinate  muscular action.
  3. Nervous Stimulants.—Medicines  which excite the
brain and nervous system, and  thereby  increase their  irri-
tability and energy.
  Class V.  Medicines which act upon  the muscular fibre.
  1. Astringents.—Medicines which  by inducing contrac-
tion of the muscular fibre, restrain inordinate evacuations
and hemorrhages.
  Class VI.—Medicines which act upon the skin and ex-
ternal  parts, by application  to the surface of the body.
  1. Epispastics.—Medicines which excite external  irri-
tation.
  2. Emollients.—Medicines which  allay external  irrita-
tion, by softening the skin.
  Class VII. Concentrated  eclectic remedies, which mostly
act specifically upon the different organs and tissues of the 
               MATERIA  MEDICA.             993

body, or as direct antidotes to the various morbid elements
producing disease.  Those remedies being most important,
they will be first considered.

     CONCENTRATED ECLECTIC REMEDIES.
   By  concentrated  Eclectic  medicines,  we  understand
those articles which have been manufactured by our phar-
maceutists and  chemists, and  are  denominated essential
tinctures, concentrated  tinctures, active principles, proxi-
mate principles, &c, &c.  These medicines are principally
manufactured from our indigenous plants.  It is not my
purpose to give a detailed account of the various modes of
manufacturing these articles, or to enter into a  discussion
of the importance of these modes, as this is the province of
the pharmaceutist, and he will give you all the necessary
instruction  in this respect.   The  articles which  I  shall
present to you, under the name of  concentrated  Eclectic
remedies, will consist of. solid and powdered extracts,  pow-
 dered resinoids, crystallized alkaloids, oleo-resins, tinctures
 essential, concentrated, and saturated,  and the proximate
 principle of the plant, which includes  the  resin, alkaloid,
 and neutral principle combined.  These articles are manu-
 factured by different pharmaceutists, and each has its re-
 spective merits.   In presenting  these remedies to  your
 consideration, I shall not adopt the old, stereotyped dogma
 of arranging them  under the head  of  alteratives, emetics,
 diuretics,  cathartics, antacids, anthelmintics, &c, &c, but
 shall describe their medical and toxical influence upon the
 various tissues and organs of the body, both in health and
 disease.  It has long appeared to me that this method  of
 studying the influence and medical virtue  of medicines
 possesses superior advantages  over  the old  system.  Ac-
 cording to the old plan of arranging the  materials used  in
 the treatment of disease,  we find  a very  large number of
 them possessing vastly different properties, arranged  under
        84 
994
MATERIA  MEDICA.
some particular head or  classification.  Take the remedies
usually denominated  alteratives : how diversified are their
real properties!  The mercurials are the great, and in the
eye  of  the  alterative branch of the profession, the most
potent of them all; while all the lesser remedies, the medi-
cal properties and curative powers  of which they are igno-
rant, are auxiliaries.  Writers on materia medica seem to
think they have  fully explained every important fact re-
lating to the curative power of a remedy if they have ar-
ranged it  under some  specified caption, as alterative, ca-
thartic, diaphoretic, &c; and then they conclude their re-
marks by  ascribing to the  article the appellations of all
these classifications of it, as  emetic, cathartic, diaphoretic,
diuretic,  alterative, &c, &c.  Thus, instead  of studying
the  modus operandi of  medicine,  as  it affects different
tissues  and organs of the body in health and disease, they
have dealt in  crude generalities, and so befogged the entire
subject of therapeutics and materia medica, that the young
practitioner will  no sooner  find himself at the bed-side of
his  patient, than he will discover  that  these  vague and
confused classifications of medicine do not  enable him to
apply any one of them to his special  case with  any degree
of certainty.  Hence he is left to chalk out his own course;
and  if, after a long experience, he hits upon the remedy to
produce the proper change  in  the  tissue diseased, the  pa-
tient will  recover,  otherwise  nature  must remove  the
disease, and at the same time counter-influence the toxical
impression of the drug.   It is  not  my purpose, to  discuss
this subject, farther than to invite your  attention to a few
of the reasons why I  shall not adopt this  antique and most
miserable classification  of remedies.  I  will  add,  before
dismissing this subject,  that  this arrangement of   the
materia medica is based principally upon  the more power-
ful influences  of the drug upon the human organism; and
what renders it of less value to the profession is, these in- 
MATERIA  MEDICA.            995
fluences are mostly  the poisonous, and  not  the medical
effects.
  You may inquire whether we have any data upon which
we can base our observations relative to  the special  action
of medicines upon special  tissues.   In answer to this in-
quiry I think  I can safely reply that we have abundance
of admitted facts of this character.  Especially is this the
case relative to the toxical impression of medicines.   The
alterations in  the nervous and capillary structure  of the
cervical portion of the medulla spinalis, the effect  of strych-
nine, the ruptured condition of the various muscular fibres
of the uterus after  full doses of ergot, the varicose  con-
dition of  the  hemorrhoidal veins, and  irritation of  the
mucous membrane of the rectum after the use of aloes, the
ophthalmoplegia and ptosis after  the use of  gelseminum,
and urethritis after the use of cantharides, together with a
large number of other  admitted facts relative to  the direct
impression of medicines upon special tissues,  most conclu-
sively demonstrate that medicines do produce specific in-
fluence on special tissues of the body.  This  being the
case, it only remains for  us to study these influences, to
learn the  precise tissues or organs upon which each remedy
manifests its power, together with the character  of the im-
pressions, whether they increase or diminish the vitality
of the part, whether they produce atrophy or  hypertrophy,
consolidation  or softening.  These facts having been ac-
quired, if we fully understand  all the pathological condi-
tions of these organs and tissues in disease and health, we
can so apply remedies as to affect the tissues  diseased, and
correct such pathological conditions as constitute the  basis
of disordered action.
   Before proceeding to  the discussion of the medical vir-
 tues of these medicines, I wish to allude to some objections
which I frequently hear urged by doctors against  the use
of  these  articles.  They do not think them  reliable; they
are not prepared with  a uniform strength; besides, they 
996
MATERIA  MEDICA.
 have tried them, and they do not fulfil  their expectations.
 There may be truth in all these objections, especially in the
 latter, and for the best reasons in the world—the remedies
 not being administered in  proper quantity,  nor for  the
 proper disease.  AVe  have  known persons to administer
 podophyllin as a substitute for  calomel or blue mass, and
 nearly kill their patients with over-doses.   The physician,
 not knowing the virtues of the  medicine, how could he ex-
 pect to cure his patient?  Again, he claims  the  remedies
 are not skilfully prepared.   In answer to this objection, let
 me inquire whether the ordinary physician, with his bowl
 of  hot water and stew kettle, can surpass in pharmaceutical
 skill the  learned chemist  and pharmaceutist, with all  his
 apparatus, in the extraction of the medical virtues of our
 indigenous remedies.  But, says the objector, he is opposed
 to concentrated  medicines.    Does he mean by this that he
 will feed his patient on dry roots, barks, and weeds, or does
 he  mean that he will attempt to  obtain the virtues of his
 medicine  in  the form of teas and  syrups, and thus in a
 crude way to do what the skilled pharmaceutist does with
 entire success?   These objections against the use of con-
 centrated Eclectic  medicines are mostly based upon igno-
 rance, and hardly merit the passing notice I have  given
 them.
  We will now  proceed to  consider the medical properties
 of the medicines.
  1. Aconitin, the  active principle of Aconitum Napellus.
 Aconitum napellus, though  cultivated extensively in this
 country,  is indigenous  to Europe.  Aconitin  is prepared
 from the leaves  and the  root, and is  composed of an alka-
loid, a resinoid, and a neutral principle.  These principles
are  supposed to be the active principle of the  plant.   Fif-
teen years ago I published an article upon the use of the
tincture of aconite  leaves in the  treatment of fevers.  It
 was not used by Eclectic physicians up to that time.   Since 
MATERIA MEDICA.
997
then, however, it has become a general remedy, and there is
now no  Eclectic who treats  fevers  without it.   When I
speak of fevers, I will tell you of its virtues.  I  have now
to do with the active  principle.  I  do  not use aconitin in
inflammatory fevers.   I use the saturated  tincture of aco-
nitum napellus.   Aconitum operates  as  an anaesthetic.  It
is a debilitating agent, and paralyzes nerve tissue.  If you
take a sixteenth portion of a grain, it  will produce  a tingling
sensation through the  nerves.    If there be headache, which
is dependent upon  increased sensibility of the nervous tis-
sue, it will disappear.  A  lady  had facial neuralgia.   She
had been leeched and  blistered, and  had taken all sorts of
mixtures.  I gave  the sixteenth portion of a grain of aco-
nitin at night, when she went to bed.  The neuralgia ceased;
she had none during the  night, nor was she troubled with
it at any subsequent period.   In this case the aconitin ope-
rated simply as an ansesthetic.   I recently used this ar-
ticle in a very peculiar case.   I had a patient, a young man
who had spermatorrhoea; he  was troubled with  noctur-
nal emissions.  You will  find a great many of these cases
in practice.  The  spermatorrhoea was  very persistent; it
was affecting his intellect; he had great prostration and de-
bility of the sexual  organs.  I gave him five powders; each
containing one sixteenth of a  grain of aconitin.   I wanted
to try it in spermatorrhoea.  This gentleman stated he never
had anything to relieve him so quickly and so thoroughly
as did the powders which I gave him.  I have also used it
in case of chordee, in gonorrhoea.   It has operated admi-
rably.  I have also used it in  several cases  of delirium tre-
mens; where that, in connexion with lobelin, soon  put my
patient into a quiet sleep.   I also use it in a class of patients,
where we wish to diminish sensibility of the part.  I have
used a solution of it as a wash to indolent ulcers with bene-
fit.  I have applied an  ointment of it  for herpes, and" a
great variety  of other cutaneous affections of  a  painful
character.   It benumbs the part, and gives ease, without
                          84* 
998             MATERIA  MEDICA.

producing constitutional disturbance or injury of any kind.
There are several instances in which  it may be used where
morphia cannot be.  All the preparations of opium produce
active constipation of the  bowels in nearly all  cases where
there is a debilitated state of the system.   Aconitin does
not do this;  it rather increases the peristaltic action of the
bowels.  I have given it in  irritability of the bladder, and
sensibility of the vagina.   I  recently had a most remarkable
case of prurigo  of the vagina.   This disease occurs in mid-
dle aged females, and there is an exudation which becomes
exceedingly  irritating to the part, together with laceration,
irritation,  subacute  inflammation, and  itching.  Aconitin
will almost invariably relieve the pain at once.   It  should
be applied in the form of an ointment.   I have also used
this remedy  in a large  number of cases  of neuralgia, with
almost instant relief.  In  short,  there is scarcely a painful
condition of the body, dependent upon simple  hyperaesthesia
of the nervous system, in  which I have  not  used aconitin
with marked success.   From these facts we  conclude that
the  specific  influence  of aconitin is upon the gray  nerve
matter  of  the  sensitive nerves.   We infer this from the
fact, that while  it produces almost immediate anaesthesia of
sensibility, it does not interfere with  the nerves of motion;
nor  does it, in doses  sufficiently large to arrest pain, produce
any observable impression upon the action of the heart and
arteries.  From all  the observations  I have made  in the
use  of this article, I believe  it is destined to fill a most im-
portant vacancy in our materia medica.   It appears  to pos-
sess the power of so modifying the sensibility of a diseased
tissue, as to  prevent the suffering without  interfering with
the  functions of other organs and tissues of the body.
   From my brief remarks  relative to the use  of this agent,
you will observe that  the range of the  application of aco-
nitin is very great;  that it may be used in all cases where
there is hyperaesthesia, without interfering with'other reme- 
MATERIA  MEDICA.
999
dies, or their curative influence.   The  dose of aconitin is
from one twenty-fourth to one  eighth  of a grain, repeated
at intervals of half hour or an hour, as the case  requires.
It should be thoroughly triturated in sugar, in the propor-
tion of one grain of aconitin to ten of sugar.   As an external
remedy, it  may be applied as follows:—Mix ten  grains of
aconitin with one dram of lard, and  rub the  painful parts
with it four or five times a day.

                   AMPELOPSIN.
  Ampelopsin is the active  principle of Ampelopsis Quin-
quefolia.  Ampelopsin is a remedy which appears to mani-
fest its influence principally on the lymphatic tissues, or
vessels.  The lymphatics are a class of vessels, which by
anatomists  have been  divided into external and internal.
The external are situated in the subcutaneous cellular tissue,
between the skin and the aponeurotic sheaths of the muscles,
and accompanying the subcutaneous veins.  The deep-seated
layer  of lymphatics is found chiefly in  the  interspaces, and
along the course of the venal and arterial trunks.  These
vessels are  exceedingly numerous,  and converge from all
portions of the body, and  form large  lymphatic trunks,
which open  into subclavic jugular veins, one on each side of
the neck.   The small branches of lymphatics pass through
spherical  bodies, which are termed lymphatic glands, or
ganglions.   It is to  the disordered functions of these vessels
that Cruikshank, Thomas White, Nudo, and others,  have
ascribed nearly every  morbid change  of the human body.
These assertions are  no doubt  extravagant;  yet, accord-
ing to more recent researches of  M.  Alard,  there  can
hardly  be  a doubt, that the lymphatic system, when di-
verted  from its normal condition,  contributes  largely to
a very important  class of  fatal maladies.  In  scrofulous
affections,  angioleucitis, or inflammation of the lymphatic
vessels, is  of  common  occurrence.   It is  to  the  exist-
ence  of this form of inflammation that we ascribe the 
1000
MATERIA  MEDICA.
local determination of this disease in many instances.  From
the intimation I have given you of the extent and influence
of the lymphatic system, you will  anticipate the necessity
of remedies which direct their  energies upon these vessels,
and exert a controlling influence upon the function of this
very important class  of  organs.   In ampelopsin we have
this remedy.
   But you will naturally inquire, How, and in  what way,
does this remedy influence or control the lymphatic system ?
In answer to this important inquiry, I would  remark  that
so far as I have been able to observe its effects, its influence
is of that character which gives tone and energy to these
vessels.  I have arrived  at this conclusion  after frequent
and repeated trials of ampelopsin in nearly every condition
of the lymphatics.   We have a disease, which has been very
accurately described by  Prof.  Bennett as leucocythaemia.
The nature of this disease is that of a peculiar blood affec-
tion, in which the white blood corpuscles are in great excess,
and the nutritive functions are  so feeble as to fail to render
the essential  supplies to  the various organs and tissues of
the body.  From an extensive  observation in this disease
I have concluded that it is dependent upon an unhealthy
condition of the lymphatic  system.   Accordingly,  in my
treatment, I have directed, my remedies to this class of tis-
sues, and have found  the treatment most successful.   The
remedy I have  principally depended upon  is ampelopsin.
It appears to increase the tone of these vessels, and so aug-
ment the nutritive functions as to  restore the blood to its
normal  condition.   Another class  of diseases, in  which I
have regarded the lymphatics as mainly at fault, are those
affections so  common in children, in which there is a ten-
dency to enteric and  gastric  irritation, characterized by
frequent attacks  of  diarrhoea  and ephemeral  fever,  soft
muscles, weak and feeble habits, together with other symp-
toms indicating deficient  nutrition.   In these cases ampe-
lopsin appears to exert almost a specific influence in producing 
                MATERIA  MEDICA.           1001

those salutary changes which impart vigour and health to the
entire organism.   There is still another class of affections,
in which the lymphatic system appears to  be at fault.   I
have reference to an affection which has been denominated
by dermatologists squama, or scale disease.  There is a great
variety of forms of this affection, which are most obstinate
in their power to resist the impression of remedial  agents.
Ampelopsin manifests a most favourable influence in  the
disease, and numbers of cases  have yielded to this remedy
after frequent unsuccessful efforts with other agents.  Ampe-
lopsin has also proved most serviceable in  cases where  the
lymphatic system has been contaminated by syphilis, gonor-
rhoee, cancer, and other malignant affections.  I have  fre-
quently prevented that form of angioleucitis, known as bubo,
by the use of ampelopsin.  I have also known inflammation
and enlargement of the inguinal and axillary  lymphatics,
caused by other  affections, to be prevented and cured by am-
pelopsin.  From these very imperfect observations, you will
notice  that  I regard  the  action of ampelopsin  as almost
exclusively confined to the  lymphatic system, and that its
principal influence is to give tone and energy  to the vessels,
so as to prevent the accumulation of morbid  or  effete mat-
ter within  them.  I have not observed  that  ampelopsin
either  materially increased the quantity or  changed  the
 quality of urine.  When it is continued for any length of
time, in doses of from one-half of a  grain to a grain, four
or five  times a day, it will slightly increase the alvine evacu-
 ations.  It also  increases the quantity of bile in the faeces-
From this fact I have concluded that ampelopsin contributes
to transformations  in the liver.   In  that variety of leucor-
rhcea  dependent upon chronic inflammation and weakness
of the vaginal lymphatics, ampelopsin is  a  most valuable
article.  In short, ampelopsin  is  a  remedy of immense
value in all those cases where the lymphatic system is in
a feeble state, and  requires a gentle stimulant and support; 
1002           MATERIA  MEDICA.

hence the range of its application is very great.   The dose
of ampelopsin  is from five to ten  grains of the triturated
article, or from one-half to one grain of the crude article,
five or six  times a day, taken immediately after each meal.
Medicine given to affect the lymphatics, will be more effect-
ual after, than  before meals.

                      ALNUIN.
   Alnuin is the active principle of Alnus Rubra, or Swamp
Alder, Tag Alder, &c. I have previously informed you that
the old sing song in regard to nearly all medicines is, that
they are alterative, tonic, resolvent, astringent, &c.  Now
the manufacturers of these medicines have adopted the old
tune, and apply to these new remedies  the same properties
that have been transmitted to the crude ones. In this way
they have  done much mischief in  misguiding the  profes-
sion,  and bringing their  medicines into  disrepute.  Mr.
Keith says of alnuin, that it is an alterative, resolvent, to-
nic, and  sub-astringent.   Now who would know anything
about the real medical power of this drug from these vague
terms, or what  physician would even guess the  power of
alnuin to  cure disease from  what he has  said  about it?
Now alnuin is a remedy which, like all other remedies, has
a specific influence  upon special tissues and organs of the
body, both in health  and disease—and the subject of  our
inquiries is,  What  are these  effects, and how are the  tis-
sues influenced by the drug?  If you introduce one or  two
grains of alnuin into  the stomach in the normal state,  one
of the principal sensations experienced is that of hunger,
and, if the  drug be continued for  a  few hours without food,
a peculiar burning sensation  is felt.  This symptom, how-
ever, soon  disappears on  taking small quantities of food.
The uniformity with which this result follows the  introduc-
tion of alnuin has led me to  infer that one of the influences
of alnuin is to excite the gastric glands, and to cause a free
discharge of gastric fluid.   This experiment with alnuin on 
MATERIA  MEDICA.
1003
the healthy stomach has led me to try this article in such dis-
eases as are connected with imperfect digestion, dependent
upon inactivity of the gastric glands, and a consequent de-
ficient  supply of  the gastric fluid.  It is  estimated that
about fourteen pounds of gastric fluid must be secreted
every twenty-four hours, in order  to insure healthy diges-
tion.   Now if the gastric glands fail to furnish this supply,
a species of dyspepsia is the result.  This kind of dyspep-
sia we find prevalent in a large number of diseases, espe-
cially during convalescence.
   It is in this class of cases that the profession have long
felt the need  of  a remedy to  stimulate those  glands, and
hasten those transformations essential  to the production of
gastric  fluid  and healthy digestion.  The  ordinary sto-
machics, while they produce a morbid appetite, do not in-
crease the gastric secretion;  hence they contribute  to, ra-
ther than prevent this peculiar dyspeptic  condition.  Al-
nuin  appears  to supply this  deficiency in the materia me-
dica, and, according to my observations, it exerts a specific
influence upon these organs.  In  the  case of a patient re-
cently under  my charge, the  symptoms  were  evidently
those in which the quantity of gastric fluid was inefficient
to digest food sufficient  to support healthy organization.
The symptoms were a heavy and sleepy feeling after meals,
 together with gastrodynia, flatulency, alternate constipation
and diarrhoea, and other evidences of  imperfectly digested
ingesta.  To test  the effects of alnuin, I gave twenty grains
of triturated alnuin one-half hour before and one-half hour
after each meal.   The beneficial influence of  the remedy
was manifest in a few days, and by the continuation of the
treatment for a few weeks, the patient entirely recovered.
I have also tried this remedy in many other  similar cases,
and in every instance either marked improvement or a ra-
 dical cure was effected.   From all that I can learn of al-
 nuin,  I have  no  doubt that in this class of dyspeptic cases
 it is far the  most  reliable  remedy ever introduced to the 
1004
MATERIA  MEDICA.
profession.   But you must avoid falling into the old error
of regarding remedies as  removing all kinds of dyspepsia
with  equal  facility.   Dyspepsia means a difficulty of di-
gestion, and it may depend upon a  great variety of very
opposite conditions of the  digestive  organs.   In the use of
alnuin I have alluded  to an indigestion  caused by a defi-
cient secretion of gastric fluid, and consequent deficient so-
lution of  the food.   Now dyspepsia may be produced by
ulceration of the  mucous  coat, by chronic inflammation of
the stomach, by cancer, and a great many other causes—
and if you should mistake any of these forms of dyspepsia
for the one in which I  have  recommended alnuin, it is
more than  probable that  your remedy would  fail to give
relief.  Alnuin, in addition to its specific influence  on the
gastric glands, appears to exert a  tonic and invigorating
influence  on the lymphatics and blood  glands generally.
Hence, where there are great  debility, and a  feeble and
impoverished state of  the blood, I am in the  habit of using
alnuin in combination with iron.  A very convenient pre-
scription in  these cases is  the following:—Take  alnuin, one
dram; carbonate of ferri, one and a  half drams; simple sy-
rup, six ounces.   Mix.  Dose—one teaspoonful four times
a day; one after each  meal, and one on retiring.
   You will  remember that all the  concentrated remedies
form a perfect solution in simple syrup after  trituration.
The dose of alnuin, in ordinary cases, is  from one to three
grains of the crude article, or from ten to thirty grains of
the  triturated, three   or  four  times during twenty-four
hours.  I always use  these remedies triturated.

                     APO cy NIN.
   Apocynin is the medical virtue of the Apocynum  Canna-
binum—Black Indian Hemp, &c.
   In the investigation  of apocynin we labour under  the
same difficulty that we do in  the  investigation  of other
.4 
                MATERIA  MEDICA.           1005

agents of this class.  Dr. Jones, in his Materia Medica,
says of apocynin, that "it is said to possess all the proper-
ties of the crude agent;" and that is all he says upon the
subject, except that  "the dose is from one  to five grains."
Of the crude agent he rehearses the old  verbiage that it is
"emetic, cathartic, expectorant, diaphoretic, diuretic,  al-
terative, tonic and errhine."   The merest tyro in medicine
cannot fail to see that the properties ascribed to the crude
article are opposite, contradictory, and do not give the least
idea of its medical  properties, much less of the  concen-
trated preparation.
   Dr. King, in his American  Dispensatory, says even less
relative  to  apocynin than does Dr. Jones,  although  he
ascribes to the crude article nearly the same virtues.  Now
here are two massive volumes, and neither of them  gives
the least information relative  to one of the most powerful
and valuable agents  of the Eclectic materia medica.  What
is  true in relation to apocynin is equally true in relation
to nearly all  the principal Eclectic  remedies.  It is true
that there have been large books compiled about roots and
weeds, which  are much better adapted for the use of herb
gatherers than they  are  for educated  Eclectic physicians.
What physician, now-a-days, would th'ink of discarding
quinine, to drug his patient with ounce  doses of Peruvian
bark?—and yet the idea is no more absurd than that which
appears  to be entertained by those who pretend to manu-
facture Eclectic books  on materia medica.   Indeed,  the
idea of writing an Eclectic  materia medica, and omitting
the Eclectic remedies,  is to  me quite a novel one.  After
taking half a grain  of apocynin every two or three  hours,
for twenty-four hours, the urine will  be slightly increased
in  quantity, and  the specifie gravity materially increased.
In one case, after giving  two grains of apocynin, in half
grain doses, at intervals of three hours,  the specific gravity
of the urine was increased twenty degrees.  In  hundreds

        85                     *____ 
                     *
1006           MATERIA MEDICA.
of cases in which I have tested the urine by the urinome-
ter, after using apocynin, I have  scarcely failed to observe
the increase in the weight of the urine.   The character of
the  solid matter  eliminated by this  medicine appears to
be urate of ammonia, and the earthy phosphates.  A more
careful  observation, however, is necessary, in order to de-
termine the precise character of the solid substances elimi-
nated through the kidneys.
  The next, and what appear to be the secondary effects on
the system, are its peculiar influences on  the brain  and
nervous system.  The first observable impression of the re-
medy on the brain is that of a sense of pressure around the
head, as though a tight bandage were passed  around it.
Next, there will be vertigo, with a swimming sensation, the
pupil of the eyes slightly dilated, and a  decided confusion
of ideas.   If the  remedy be continued,  a sense of nausea
will soon follow, which will  quickly be relieved by vomit-
ing and purging.  The  heart beats slowly,  and if the re-
medy be not discontinued, it becomes irregular in action.
I have never  seen this remedy carried beyond this point,
but presume  it might be pushed  to produce serious conse-
quences.  From these observations relative to the action of
apocynin on the healthy system, we  infer that the specific
tendency of the drug is to the kidneys and nervous sys-
tem, and the use of the remedy in the diseased condition of
these tissues fully  confirms these  conclusions.
  The next part of  our inquiry  is to see if we can ascer-
tain what that action is.  Does it increase the function of
the kidney, and thus hasten those transformations essen-
tial to the production of urine ?   Or does it, by hastening
the liberation of the tissues and elements of which the urine
is manufactured, furnish a greater quantity of these mate-
rials to the kidneys?  Although we may not be able to de-
monstrate the latter theory, I think, from  all  the experi-
ence I have had with  the  use of the remedy, that I am 
MA TERIA MEDICA.
1007
warranted in assuming the conclusion that apocynin has-
tens disintegration, not only of the nitrogenous elements of
the body, but also of the nerve tissue, especially liberating
the phosphates, and probably other agents.   Being in pos-
session of these facts, we  can now study the effects of the
remedy in disease, and, if possible,  ascertain in what pe-
culiar affection or affections the remedy is indicated.   The
principal use I have found for this agent is to remove from
the blood and other organs of the body excesses of the ele-
ments which the medicine eliminates.  Hence, when the
system is overloaded with those poisonous nitrogenous ele-
ments  imperfectly converted  into urine,  this agent serves
a valuable purpose.  Take the case of a marsh fever, when
the teeth are covered with sordes, the nerves paralyzed, and
the brain intoxicated by  the retention  of uric acid  in the
system, one-fourth to one  grain of apocynin, repeated at in-
tervals  of one or  two hours, soon relieves the patient.   In-
deed, it matters not whether it be a  fever or any other dis-
ease, if this condition of the system occur, apocynin will
give relief.  Again, apocynin, in connexion with ampelop-
sin or  menispermin, is an invaluable  remedy to remove
dropsical deposits in the various  cavities of the body.  Am-
pelopsin so excites the  absorbents  as to  rapidly fill the
blood with the fluids  previously accumulated in the cavi-
 ties of  the body, and apocynin soon converts the dropsical
 fluid into products to be eliminated through the kidneys.
 Apocynin is also valuable in  diseases of the kidneys, espe-
 cially in congestion and  granulation, which give  rise to al-
 buminuria.   In  this affection I have  used apocynin with
 marked effect.   It is also a valuable remedy in many con-
 ditions of the brain and nervous system, especially in cases
 of induration and hardening of the  nervous structure.  The
 dose of apocynin is one-eighth of a grain  to one grain be-
 fore trituration,  or from  two to twenty of the triturated ar-
 ticle, repeated at suitable intervals. 
1008
MATERIA  MEDICA.
                     AT R OPIN .
  Atropin is the active principle of Atropa Belladonna, or
Deadly Nightshade.  From the limited experience we have
had with this  article, we infer that its principal influence
is upon the skin and mucous  tissue, and that its action is
to increase elimination from the skin, and transfer eruptive
disease from the mucous membrane to the integument—
hence its use is  principally confined to exanthematous fe-
vers, and other eruptive  diseases.   In scarlatina and ru-
beola, when  the  eruption does not  appear on the skin, one-
half grain of atropin, triturated in twenty  grains of sugar,
and added to  one tumbler of  water, given  in doses of one
teaspoonful  of the solution, proves most effectual. Farther
experiments are necessary with this  article, however, in
order to develop its full medical properties.   The dose of
atropin is from one-fifteenth to one-fortieth of  a grain of
the crude article, to be triturated with ten  times the quan-
tity of sugar.  We hope, at some  future period, to  be able
to give the  profession more full information as to the vir-
tues of this  very powerful drug.
  The next  article to which we invite your attention is one
with which  we are far more familiar, and  have  had a long
and most  favourable experience with.  It is

                     ASCLEPIN,
  The active principle of Asclepias Tuberosa, White Root,
&c.  This article manifests its curative power upon the se-
rous tissue.   You are aware that we have  a  class of mem-
branes which, from their colour, have been denominated dia-
phanous ;  and from  the  peculiar  thin or serous fluid with
which they are moistened, they are called serous. A know-
ledge of the extent and distribution of  this peculiar  mem-
brane is indispensable to the full appreciation of the  cha-
racter  and vital  importance of those morbid changes which
occur in this tissue when inflamed by disease.   A peculi- 
                MATERIA  MEDICA.           1009

arity of these membranes is, that they are hollow sacs,
everywhere closed; hence they have been denominated shut
sacs, sacci occlusi.   These membranes are also so arranged
that one portion is doubled within the other.  The outer
surface is applied over the walls of the regions which  the
serous membrane lines, while the other surface is applied
over the organ or  organs contained in that region.  From
this arrangement  you observe that each organ is covered
with a portion of the serous membrane; not that these or-
gans are enclosed within  this membrane, as I have some-
times  heard  described, but they are  on the outside,  the
main portion  of which is covered by a reflected portion of
the  diaphanous  tissue.  Thus the lungs are on  the outer
surface of the pleura, the heart on the outside of the peri-
cardium.  The stomach, intestines, liver, spleen, and pan-
creas, are on the outside of the peritoneum.   You will also
notice  from this arrangement that the portions of these or-
gans at which the  nerves  and vessels  enter are left unpro-
tected.  I have  stated to you that this membrane was a
shut sac.  The only exception to this  is in the peritoneum
of the female, where  the membrane is  perforated at the  up-
per extremity of the Fallopian  tubes.  The serous mem-
branes are  the seat  of various  morbid processes.  These
changes mostly occur as the  result of inflammation.   As
the inflammation attacks various portions of the serous  tis-
sue, it has been denominated pericarditis, peritonitis, pleu-
ritis, orchitis, meningitis;  and when the viscera which  the
serous  tissue covers are involved, we  have gastritis, ente-
ritis, colitis, mesenteritis,  epiploitis, cystitis,  hepatitis,  lie-
nitis, hysteritis.   As the result of the inflammation of this
membrane,  either acute or chronic, we have empyema,  hy-
drocephalus, ascites, hydrocele, empyocele, and pyrocardia,
together with all the alterations of structure and morbid
growths which are produced by  the  metamorphosed exu-
dations, such as fibroma, liphoma, cystoma, andenoma, epi-
                          85* 
1010
MATERIA  MEDICA.
thelioma,  enchondroma, carcinoma,  &c.  All  these  dis-
eases, and many more, are but the result of those morbid
changes which occur in connexion with the serous tissue;
and when I  tell you that asclepin manifests a most specific
healing power over this very important and vital organ, you
will fully appreciate its utility as one of the articles of the
materia medica.   There is, perhaps, no remedy which ex-
erts a more specific influence over the diseased condition of
the serous membrane than does asclepin.  In cases of pleu-
ritis, after the stomach and bowels have been thoroughly
cleansed by  an emetic and a mild purge, the skin  cleansed
by a bath of warm water and soap, and a hot pack applied
over the seat of  the inflammation, then, by adding twenty
or thirty grains of  triturated  asclepin to  a tumbler of wa-
ter, and giving one teaspoonful of the solution every ten or
fifteen minutes, all traces  of  the pleuritis will disappear,
provided it be given in the  early stage of the disease,  and
the system has been properly prepared for it.   The length
of time required to remove common pleuritis with asclepin
does not, under ordinary circumstances, exceed  four or five
hours.  In cases, however, where the heart's action is  vio-
lent, and the system of full habit, the cure will be facili-
tated by alternating the asclepin with five or ten  drops of
the tincture of veratrum viride, until the heart's  action is
reduced, and slight nausea is produced.  But  asclepin is
not confined to the removal of inflammation from the pleura.
It exerts its salutary influence on all portions of the serous
tissue  with  almost equal power.  In peritonitis,  carditis,
and acute inflammation of other portions of this membrane,
I have noticed the same  specific effects and speedy cures
performed by asclepin.
                    baptisin .
  The next article to which I have to invite your attention
is Baptisin.   Baptisin is the active principle of wild Indigo,
or Baptisia Tinctoria.   Baptisin is an  article which pos- 
MATERIA MEDICA.
1011
 sesses rare and valuable medical properties.  It does not,
 like many other medicines, appear  to direct its influence
 upon special  tissues, but  it manifests its peculiar power
 over all the tissues and organs of the body.   What is this
 influence, then, is our first inquiry.  If we take one or two
 grains of baptisin for several days, when in a state of health,
 the urine will be diminished, perspiration checked, and the
 quantity of carbonic gas  expelled  from the lungs  mate-
 rially lessened.   As the result of these diminished exha-
 lations from the lungs, skin, and kidneys, the blood becomes
 loaded with detritus, and the whole function of the economy
 impaired.  Baptisin exerts a different influence upon the
 system from that usually  ascribed to  it, and experiments
 have  fully confirmed these views.  The  medical properties
 of baptisin, then, consist in its power  to prevent decompo-
 sition of the tissues; hence  its  great value.   In phthisis,
 scrofula, and in fact most chronic affections,  the disordered
 action consists in a too  active  secondary digestion and de-
 ficient primary; that is, disintegration and waste of the tis-
 sues occur more rapidly than digestion, and progressive me-
 tamorphoses supply the organ with newly-formed  tissues;
 hence the soft and thin muscles, the emaciation, expectora-
 tion,  colliquative  perspiration, diarrhoea, chills, and hectic
 fever.  All these, and many more of the distressing symp-
 toms  connected with chronic diseases, are but the result of
 rapid retrograde metamorphoses.  It is in this condition of
 the system that baptisin manifests its most wonderful cura-
 tive power.   You can  hardly imagine my delight in wit-
 nessing the magic power of this medicine over  this here-
 tofore uncontrollable condition of the system.  When the
 conservative powers of the system have lost their influence,
 and the chemical forces are hastening that decomposition,
 which always renders the perpetuity of the human organism
 impossible, baptisin,  with  its magic influence, arrests this
.activity of secondary digestion, and restores the equilibrium
 of the disordered organism.   But I anticipate the inquiry, 
1012
MATERIA  MEDICA.
What are the properties of the medicine?  Is it alterative,
diuretic, diaphoretic, &c, &c?   I have too frequently al-
luded to these terms, and similar unmeaning phraseology
and lumber of the profession, to occupy your attention with
it at this time.  I merely  reiterate  what  I have so fre-
quently said, that these terms, as they are generally used
and applied to medicines, are vague generalities, and have
a powerful influence to embarrass and misguide the student
in his researches into the real nature and properties of me-
dicines.   The inquiry, and  the  only one of importance at
this time, is, What influence does this drug  manifest over
disease, and in what diseases can we rely upon it?  I have
already stated that the power of baptisin to arrest disorga-
nization has been amply demonstrated, not only in disease,
but on  the healthy tissue,  and it would appear as though
all that is required to understand its use is to have  a full
and complete  knowledge of  the condition of the system in
health and disease.  And here I would remind you that it
matters but little how well you may be versed in therapeu-
tics, in  order to be successful in the treatment of disease
you must have a full and critical knowledge of every organ
and tissue,  with  a minute understanding of all the struc-
tural, chemical, and vital changes which occur during the
progress of disease.  As I have already intimated, in  chro-
nic affections  nearly all  the leading  pathological changes
consist in the melting up of the tissues by the chemical
forces of the body, and the most essential  medical interfe-
rence consists in  the arrest  of  this rapid waste.  Baptisin
will do this.   In  phthisis, where great emaciation and de-
bility exist, one or two grains of baptisin administered two
or three times a day, in connexion with a nutritious diet,
and a moderate quantity of cod liver  oil, produces a magic
influence.   You may inquire whether the cod liver oil and
nutritious diet, administered without baptisin,  would not
produce the same result.  In answer  to this inquiry,  I can.
positively assure  you it will not, in the majority of cases. 
                MATERIA  MEDICA.            1013

Allow me to refer  you to one  case as an illustration.   Mr.
E. G., a young man of a strong phthisical habit, contracted
a violent cold, and  the disease  became fully developed.  He
applied  to his physician, who prescribed the ordinary Allo-
pathic  treatment,  together with cod liver oil.   He  grew
rapidly  worse, and in the course of six weeks the disease
became  so far advanced that hectic fever, night sweats, and
oedematous extremities, indicated a near approaching disso-
lution.   Upon consulting me I prescribed one-half grain of
baptisin four times a day, and the cod liver oil and diet to
be continued.  As the result, the night sweats, hectic fever,
and other distressing symptoms, gradually disappeared; and
by the use of baptisin, in connexion with other proper reme-
dies, the young man has entirely recovered.  I might refer
you to many other similar cases, but this must suffice.  I
can assure you that you will find in baptisin a most valuable
auxiliary in the treatment of  phthisis.   It is always indi-
cated when there is great debility, connected with much ex-
pectoration; or when there  are night sweats, copious dis-
charges from the  bowels, and debilitating perspiration, it
will be found most beneficial.   It is also of great value  in
the same condition of the system, connected with scrofulous
affections.  One of the most fatal mistakes made by medi-
cal practitioners, is the administration of alteratives, or such
remedies as hasten retrograde  metamorphoses  of the tissues
in phthisis and scrofula.  The  essential nature of these affec-
tions consists in a deficient nutrition and accelerated decom-
position.  In the  treatment of scrofula, then, instead  of
giving stillingia, corydalin, iodide of potassa, &c, baptisin,
hydrastin, cod liver oil, caulophyllin, chimaphilin, and the
active principles of cinchonia, are the remedies.
  Another important influence manifested by baptisin, is  its
power to arrest gangrene and  mortification.  A case which
recently occurred in my practice, was that of a young man,
with acute gastritis.   He had been treated by one of the Old
School  physicians, and his treatment was secundum artem; 
1014           MATERIA  MEDICA.

hence the vital powers succumbed to the disease and the
remedies, and  gangrene of the small intestines was about
terminating his career.   The  symptoms of the gangrene
were unmistakable.  In this condition I was called, and ad-
vised the use of baptisin, in doses of one-fourth of a grain
every half hour, in connexion with cloths wrung from hot
whisky,  applied to the bowels.   The  effect was salutary.
The vomiting of dark  green matter  soon ceased; and the
pulse, which  was  scarcely  perceptible,  soon became more
full and  regular, and by the use of proper auxiliary reme-
dies the  patient recovered.   I have in many cases observed
like effects from the timely use of baptisin in early gangrene.
Hence, in all cases where there is acute inflammation, which
threatens to terminate in the dissolution of the structure
of the part, baptisin may be used with  good effects.  Not
only is baptisin a  valuable  internal  remedy, but it may be
used externally with equally good results.  In chronic ulcers,
where a  constant solution of the continuity of the  tissue
prevents a union, baptisin sprinkled over the sore, followed
by  a stimulating lotion, is most effectual.   I have also used
it with happy effects as a wash in indolent chancre.   I have
also used a solution  of baptisin  as a  topical application in
diphtheritis and scarlatina anginosa with most  pleasing re-
sults.
  From  what  I have  said  relative to the medical proper.
ties of baptisin, you may infer that it has a wide  range
of applications, and in this you are correct.  I can assure
you, after an extensive use of it in a  very large number of
cases, I have the greatest confidence in its power over dis-
ease, when properly administered.  The dose  is from two
to five grains of the triturated article, and from one-eighth
to one grain of it in the crude state.

                     BARO S MI N.
  Barosmin is  the active principle of the Barosma  Crena-
ta, or Buchu.   There are but few medicines which possess 
MATERIA  MEDICA.
1015
the power to eliminate water from the system, without pro-
ducing other transformations more or less injurious to the
healthy organism.   Barosmin, however, appears to be free
from these objections; as, while it  possesses the power to
produce most extensive elimination of water from the sys-
tem through the kidneys, it does  not  appear to produce
other  essential  changes.   The properties and uses of ba-
rosmin, then, consist in its power to remove from the cavi-
ties and tissues of the body superfluous quantities of liquor
sanguinis, which have been deposited as the result of con-
gestion or inflammation, and in which no essential changes
are required in the  fluid previously  to its absorption and
elimination from the system.
   The diseases for  which we have  found  barosmin most
beneficial  are simple dropsical deposits; such as  ascites,
hydrothorax, oedema, anasarca, &c,  &c.  It must  be re-
membered, however,  in  the treatment of these and all
similar  affections,  that  the dropsical  deposit  is a mere
symptom  of some primary disease, which produces  those
changes upon which exudation and dropsical accumulations
depend.   Hence it must not be inferred  that a remedy
that removes excessive  accumulations  of fluid  from the
body  will produce  radical  cures, as in  the  treatment of
dropsical diseases two indications are to be fulfilled; first,
to remove the dropsical  fluid;  second,  to  remove  those
pathological conditions upon which the dropsical accumu-
lations depend.  Barosmin, when properly administered,
will  fulfil  the first indication,  while  other  appropriate
remedies will be required to fulfil  the second.  Barosmin,
then as a physiological  remedy, is one which may be re-
garded as hastening those transformations essential to the
elimination  of  fluid from  the  body,  without producing
other  pathological or physiological  changes.
   The amount of fluid eliminated from the system  by ba-
rosmin, under favourable circumstances, is frequently most 
1016           MATERIA  MEDICA.

extensive and rapid.  A case which occurred in my prac-
tice, was that of a lady afflicted with anasarca.  The entire
cellular tissue was  distended to its utmost  capacity, not-
withstanding the frequent attempts to remove the fluid by
means of drastic purgatives and  the ordinary  diuretics.
In this case I administered ten grains of triturated baros-
min, in one-half teacupful of tepid water, every hour, and
kept  the surface cool  by frequent  spongings with cold
water.  The effect was most salutary, as the entire cellular
tissue was emptied of its fluid contents in about seventy-
two hours.   Then by the use of proper remedies to remove
the chronic peritonitis, upon which the general dropsy  de-
pended,  the patient was entirely cured.  Many other cases
might be cited, as illustrating the  specific  power  of  this
remedy over dropsical diseases, but this must suffice.  The
dose is from five to thirty grains of the  triturated baros-
min, repeated as often as indicated.

                 CAULOPH YLLIN.
   This article is prepared from the Blue Cohosh, or  Cau-
lophyllum  Thalictroid.es.  There  is  a great  difference  be-
tween caulophyllin and macrotin.   Caulophyllin is a much
more valuable  article for females than for males, although
you will find it of great value in some diseases of the latter.
This  article  acts specifically upon the mucous membrane
of the vagina and urethra; a very important medicine, and
valuable in acute and subacute vaginitis.   Where we have
inflammation of the vagina, it  is one of the most valuable
medicines we possess.   It is adapted to all diseases  con-
nected with the vagina, dependent upon inflammation.  In-
flammation of the vaginal flux, which is a simple exudation
from the mucous membrane;  or  an escape of the liquor
sanguinis, which  is  converted into pus  corpuscles,   and
constitutes what is called vaginal  leucorrhcea.  You  will
find this a common disease in females of all ages.   Caulo- 
                MATERIA  MEDICA.           1017

 phyllin  is very useful  in  those cases also where there  is
 inflammation of the mucous membrane of the urethra;  of
 which there is a great number of cases.   It  is brought
 about by improper  practices.   Young men have it from
 masturbation.  It is also a sequel of spermatorrhoea.   Cau-
 lophyllin is well adapted to these cases.   It seems to stimu-
 late the  mucous membrane, and remove local irritation and
 inflammation.   I  have  also administered  it  in chronic
 bronchitis with good effect.  From the very numerous ex-
 periments I have made with  this article I am satisfied that
 its principal influence  is exerted upon the  mucous mem-
 brane of the utero-genital organs, and gives tone and energy
 to this tissue.  In cases of prolapsus of the  vagina, I have
 found caulophyllin, in connexion with other appropriate re-
 medies, to be most valuable.  In numerous cases of periodi-
 cal vaginal leucorrhcea I have used from five to ten grains
 of the triturated caulophyllin, and had it followed by almost
 immediate relief without any other remedies. You will ob-
 serve, in the treatment of female diseases, that most physi-
 cians are in the habit of presenting a great variety of pro-
 miscuous compounds, without any idea of the specification
 of any one of the remedies used.  This exceedingly unscien-
 tific method of prescribing is but seldom followed with good
 results.  The only reliable method of treating disease consists
 in carefully studying the specific action  of  remedies upon
 special tissues, and then applying those remedies for  the
 removal of the morbid action.  The article that I am now
 presenting to you,  is one to which a great variety of medi-
 cal properties has  been ascribed.   Upon  careful observa-
 tion, however, I am satisfied that  most of  the supposed
 virtues of the remedy are merely its toxical influences on
 the  system itself, and not its  real power to remove disease.
I have already intimated that caulophyllin was a valuable
remedy  in spermatorrhoea.  This  is especially the  case
where the disease is dependent  upon chronic irritability of
      86 
1118            MATERIA  MEDICA.
the urethral mucous membrane.  The dose of caulophyllin
is from three to five grains of the  triturated article, to be
repeated as often as indicated.

                     CERASE IN.
  Cerasein is the active principle of  Cerasius Virginiana,
or Choke Cherry.  Cerasein appears to exert its influence
mainly upon the erectile  tissue.   The  influence which it
produces upon this tissue  is that of a  stimulant; as, after
a full dose of cerasein, the circulation through the capilla-
ries will be  observed more active, and in  case that this
tissue be disordered, and the capillaries  over  distended
with blood,  as occurs in  all intermittent  and  remittent
diseases, as well  as most scrofulous affections, cerasein will
contract the caliber of the capillaries, and restore the  cir-
culation in the tissue, or organ composed of the tissue, to
its  normal  condition.  You may  not  be aware, that this
erectile, or spongy tissue, is the seat of many of the most
essential morbid changes in all intermittents, and some
other  diseases.   This is especially the case in  ague and
spermatorrhoea.  During the cold stage of ague we observe
the spleen to generally enlarge; until, in the majority of
cases, the enlargement is so extensive as to  encroach upon
the stomach, and press the diaphragm against the base of
the lungs and heart, thus  most essentially interfering with
the circulation and respiration.   After  the cold stage is
past we observe the spleen to gradually diminish in size;
until, by the expiration of the entire paroxysm, in ordina-
ry  cases, it resumes its normal condition.  From this  cir-
cumstance we have inferred that any remedy which would
prevent  this periodical  hyperaemia,  or congestion, would
prevent these paroxysms of ague, and repeated experiments
have proved this hypothesis to be correct;  and cerasein is
one of the remedies that we have observed to produce  this 
MATERIA  MEDICA.
1019
effect in a remarkable degree.  The spleen being com-
posed almost  exclusively of elastic erectile tissue, and cera-
sein  exerting such a specific influence upon it, we inferred
that  its principal power was manifested upon this tissue.
Hence the great value of cerasein, as a remedial agent, is
its power to control those periodical  pathological changes,
which are so  prominent in  a large class of affections pecu-
liar to this country.    In intermittent and remittent fevers,
cerasein, either alone or in combination with  quinine, is a
most valuable remedy to arrest the periodicity of the disease.
A dose of cerasein,  requisite to arrest the periodicity  of
these fevers, is from ten to  sixty grains, divided into proper
doses,  and given at suitable intervals during the most in-
termittent  or remittent portion of  the paroxysms.   In
most cases of mild form, in intermittents and remittents,
we have found  cerasein to act as an antiperiodic with  as
much certainty as quinine; but in the malignant forms of
the affection, there is no remedy known  to the profession,
on which we can place so much reliance as an antiperiodic,
as on  the  sulphate  of quinine.  The  value of cerasein,
however, does not cease with its uses in miasmatic fevers,
but it is a valuable remedy in marsh  dysentery, periodical
leucorrhcea, hysteria,  epilepsy, and  spermatorrhoea.   In
the latter disease I have known  cerasein to manifest most
marked curative power, when all other ordinary remedies
had  failed.   The dose of cerasein is from one to ten grains,
repeated at proper intervals.

                      C HE LONIN
  Is the active principle of'cheloneglabra, or balmony.  Chelo-
nin manifests its most prominent influence upon the mucous
membrane of the stomach  and bowels.  It is  one of those
agents that we can trace through all  its  medicinal impres-
sions upon the living tissues.   Chelonin, when introduced
into the stomach, in its normal state, in doses of one or two 
1020
MATERIA  MEDICA.
grains every two or three hours, produces a warm and pun-
gent  feeling,  which is followed  by slight  nausea, if the
remedy be  continued  for ten  or  twelve  hours.   In dram
doses chelonin produces  nausea,  vomiting, and purging;
although in a few cases I have given two or  three drams
without producing any other effect than slight nausea  and
mild  purging.   In one-half to  one grain doses, given  two
or three times a day, it increases the appetite and promotes
digestion, without producing any other sensible impression.
   In disease the power of  chelonin is still more  marked
than  in health.  In all cases where the dynamic power of
the stomach  is  interfered  with,  either by some  specific
disorder, or by some remote affection, chelonin manifests a
most  specific power  to  restore  the stomach to its original
condition.   In cases of dyspepsia, where the indigestion is
dependent upon a feeble condition  of the muscles,  mucous
membrane,  and glands of the stomach, chelonin is most va-
luable.  In cases where patients are labouring under what
they denominate a bilious habit, but which in  reality is im-
perfect digestion, chelonin given in one or two grain doses
not only removes the  present  difficulty, but entirely re-
stores the digestive organs to their natural condition. Che-
lonin  is also well adapted to restore the energies of the sto-
mach after fever and other acute diseases;  especially is this
the case when the patient is of a strumous  or phthisical
habit.  I have frequently prescribed small doses of chelonin
during  the  convalescent  stage  of disease with the most
happy effect.  In chronic affections, such as phthisis, scro-
fula, and other debilitating diseases dependent upon imper-
fect digestion and mal-assimilation, chelonin is of eminent
service.  In numbers  of  cases  of phthisis I have seen pa-
tients improve most rapidly under the influence of chelonin,
in combination with  iron and cod liver oil.  In the case of
a lady who came under my notice, where cod liver oil could 
MATERIA  MEDICA.
1021
not be tolerated, I advised it to be used in conjunction with
chelouin.   The effect was  most salutary, as the chelonin
enabled the stomach to digest and appropriate the oil to the
nutrition of the body.  In a case of diabetes I gave chelo-
nin, in combination  with helonin;  and although the  case
had been under the most  approved Allopathic treatment for
a long time without benefit, these remedies afforded almost
immediate relief.  The remedy had  not been used ten days
before the quantity  of saccharine matter in the urine  had
perceptibly diminished.  It  resulted in entire  restoration
to health.
   Another quality manifested by chelonin is its power to
remove  parasites from the  intestinal canal.   I have fre-
quently observed the almost specific effects  of this reme-
dy as an anthelmintic.   In the case of a girl afflicted with
chorea, where a large variety of remedies had failed to pro-
duce  a  cure, I gave chelonin.  It expelled  from the ali-
mentary tract a large  number of  ascarides  lumbricoides,
which produced  a cure of the chorea.   I have also com-
bined chelonin with santonin with  the most happy effect.
Chelonin may be given alone, or in combination with other
medicines.  A very good method of preparing it is to add
the desired quantity of the medicine to simple  syrup, and
triturate until a complete mixture  is formed.   As a vermi-
fuge I have frequently added thirty grains of chelonin, and
five grains of santonin to four ounces of neutralizing mix-
ture, triturating them until thoroughly mixed.   Dose, one
teaspoonful of the mixture every two or three hours until
it acts upon the bowels.   Where chelonin is given alone,
one or two grains is a dose, repeated at  proper intervals.
Like most of the concentrated medicines, you will find che-
lonin to produce the best effects when thoroughly triturated
with sugar.
                          86* 
1022
MATERIA  MEDICA.
                  CHIMAPHILIN.
  Chimaphilin is a concentrated remedy, derived from the
Chimaphila  Umbellata.   Its common names are Prince's
Pine, Pipsissewa, Winter-green, Pyrola, Ground Holly, d-c;
and the part used is the plant.   Its special influence is on
the lymphatic tissues.   It is a very valuable remedy, there-
fore, in many diseases, such as cholera infantum; in which,
during the development and progress of the disease, the lym-
phatics around the abdomen are replete" with little kernels,
or tumours; in puerperal  peritonitis, because the lympha-
tics are then materially implicated and affected; in  leucor-
rhcea which originates in the lymphatic tissues; in tumours
about the neck; in enlargement of the mammae; and also
in chronic ulcers, where aqueous and serous discharges are
excreted from the lymphatics.   To use chimaphilin  aright,
however, it is necessary to understand thoroughly its "mo-
dus operandi" upon the lymphatic glands.   If taken for a
length of time—by a female, for instance—the mammae gra-
dually become absorbed, and atrophy is the result—the mam-
ma? are softened,  and, as it were, flattened.   In the  male it
causes atrophy of the testicles.  If one dram be given three
or four times per day, the urine will be found thickened.
It does not act as a direct diuretic; no uneasiness about the
stomach is felt, but there is a marked increase in  the so-
lidity of the urine.   If continued for a longer period, there
is a filling out of the constituency of the blood, producing
oedema, leucocythemia, &c.  It is not an  article of food,
making a healthy person more healthy; although it  may be
used for the removal of disease.  In certain maladies  the
lymphatic system becomes loaded with effete matter, and is
thus made the reservoir and source of violent constitutional
disturbance.   An opinion is gaining ground that the lym-
phatics are vessels employed for the manufacturing of blood;
and that, consequently, the health of  the blood,  in  a great
measure,  depends on  the condition  of the  lymphatics.
When  they are in an  unhealthy state,  the glands  of the 
MATERIA  MEDICA.
1023
neck become enlarged, and  the result  is a permanent en-
largement of a scrofulous or tuberculous character.  In
scrofula the tonsils become loaded with effete matter, and
throw out a cheesy substance called tubercles; whilst a bubo
is the product of a venereal poison, generated and termi-
nating in another form of scrofulous affections.  In such
cases, chimaphilin,  operating as a  stimulant, removes the
effete matter, and assists the process  of  elimination.  It
prepares  materials  for the kidneys to work up and work
out, first as uric acid, and next as urate of ammonia.  But
the kidneys  cannot thus  act and manufacture urine, until
this old effete matter is  carried to them;  and the  carrier,
(so to speak,) is chimaphilin.  I was recently called to see
a child, said by its attendant to have the bowel complaint.
I found the  lynphatics loaded  with effete matter; and while
so loaded a cure was a moral impossibility,—the  necessary
changes for  digestion could not occur.  For the two pre-
vious months it had been under Allopathic treatment, and
dosed with opium.  As a specific for this  difficulty, I gave
the child chimaphilin, and it proved a very valuable remedy.
Whenever the lymphatics are  inactive, causing, as the re-
sult, a difficulty in the lungs, the stomach, the bowels, &c,
&c, and producing bronchitis, pneumonia, &c, they must
be  unloaded by the administration of  chimaphilin.  As a
diuretic, however, chimaphilin does not increase the quan-
tity of urine. It is not to be supposed, however, that chima-
philin will remove  all the diseases to  which the lympha-
tics are subject; but it obviously and  invariably exercises
a special  and efficient influence  (which no other  remedy
can do) in diseases  of a scrofulous, tuberculous, and drop-
sical character.
  Chimaphilin, it may also be observed, will increase ex-
halations from the skin, stimulate the liver to manufacture
bile, and produce alvine  evacuations, as well as purge the
system, and  drive out impure lymph through the kidneys.
In  a measure, too, it will  check  the ravages of phthisis, 
1024
MATERIA  MEDICA.
prevent the advance of cancer; and  while thus acting on
the lymphatic glands, it will not, like iodine and potash,
break up the red corpuscles, produce irritability, and dis-
turb the organic actions of the body generally.   The dose
varies according to the  nature of the case and the consti-
tution of the patient; ordinarily  one, two, or three grains.
(triturated with sugar, to avoid local irritation, and to dif-
fuse it more readily into the system, and this applies  to all
" concentrated  medicines,") may be given  three or four
times per day.   This plan I adopted not long ago, in  order
to cure a bubo.   The patient had been mercurialized  to an
Allopathist's heart's content (if possible) for months.  In
a week, or ten  days, I discharged him  fully recovered; at
least as far as the appearance and the existence of a  bubo
are concerned; but when  once a man (and that for months)
is mercurialized, he is  never again  in  perfect health, but
ever predisposed to a variety of aches and pains, &c.   Ten
triturated  grains  (that is, one grain of chimaphilin, and
nine of white powdered sugar) is a sufficient quantity to be
administered at one time  to a child.

                  COLLINSONIN.
   Collinsonin is the active principle  of the Collinsonia Ca-
nadensis, and sometimes termed  Hardhack, Stone-root,  Ox
Balm, Knob-root, Heal-all,  Rich-weed,  &c,  &c.  This re-
medy acts especially, and most beneficially, on the valves
of the heart; though its worth and influence are not limit-
ed to these.  All the serous tissues  and structures of  the
body are subservient to its  therapeutic power.  These se-
rous tissues  possess small capillaries, which, when  disor-
dered and  dilated, suffer  fluids to ooze  out; and this exu-
dation becomes organized, as in inflammation of the pleura,
the endocardium, the pericardium, &c.
   Collinsonin removes the  exuded  organized matter, and
causes the abnormal condition  to disappear.  I, not long
since, had a patient, who was so much oppressed with  a 
               MATERIA  MEDICA.           1025

hypertrophy of the heart, that his friends were obliged to
carry him up-stairs, &c.  He, however, gradually recovered
under the influence of collinsonin, and is now attending to
his business.  Heretofore  physicians knew of no remedy
for the removal of so distressing and so dangerous a malady.
With them it  was all guess work, and it fearfully warned
the afflicted that death was near at hand.   Collinsonin un-
questionably affords relief in such cases, and in most effects
a cure:  it, however, must be administered very cautiously.
An ordinary dose is from one to two grains, three or  four
times per day; in larger quantities, it is a dangerous expe-
riment.   I have given ten grains five times per day; in one
case, thirty grains; but this course is only justifiable under
extraordinary  circumstances.  One dose, I may add, should
always be administered at night.   Collinsonin also acts with
efficiency in cases of chronic peritonitis, especially in those
cases which are accompanied with dropsical accumulation
in the abdomen.  In a case of persistent ascites, where the
ordinary remedies fail to afford anything more than a tem-
porary relief, collinsonin produced a permanent cure.   The
cure, in this case, I attributed to the influence of the reme-
dy in removing the chronic inflammation of the peritoneum,
which was the cause of the difficulty.   I have known this
remedy also to act with much efficiency in removing chronic
inflammation in other portions of the serous tissue.

                   COLOCYNTHIN
   Is a concentrated remedy derived from Cucumis Colocyn-
this, and is commonly called Bitter Cucumber.  It is a hy-
dragogue cathartic, and,  as the term implies, produces wa-
tery evacuations.   Its  effect is peculiar, and it may be re-
garded as a substitute for the lancet; for, by its administra-
tion, a patient is virtually bled without  any venesection,
(that debilitating system  of mal-practice.)  By acting as a
stimulant to the serous tissues,  and by the process of en-
dosmosis and  exosmosis, it is serviceable in the treatment 
1026
MATERIA  MEDICA.
of dropsy, for it evacuates the blood-vessels of their  aque-
ous  particles, and these vessels, in  return, remove by ab-
sorption the dropsical deposits, thus facilitating the desired
cure.  Colocynthin, however, must be  cautiously adminis-
tered, for I have known the twentieth portion of a grain to
cause violent purging and cramps.  Hence, in large doses,
it is a hazardous remedy, producing, for the most part, in-
flammation of the pleura, the periosteum, &c.  It is, more-
over, apt to bring on nausea, causing the  patient to vomit
serous matter, and occasionally generates symptoms of cho-
lera by engendering a diseased condition of the serous ca-
pillaries, as is indeed the usual consequence of all drastic
medicines.  But, in small doses, colocynthin has no drastic
effect, and is found essentially useful in gouty and rheuma-
tic  disorders.
  Rheumatism, I would  here  observe, is  a  very  tractable
disease,  if properly treated—one in which the serous tissue
is affected, and for which the dose is from one-tenth to one-
twentieth of a grain three or four times per diem.   By
thus treating him, I thoroughly cured a gentleman of rheu-
matism, after he had taken, during the  previous ten years,
almost all the advertised remedies, which quacks, to  their
pecuniary advantage, palm off on the credulous public to
their constitutional detriment.   The usual dose is from two
to ten triturated grains.*

                        CORNIN
  Is  derived from Cornus Florida, the  common names of
which are Dogwood, Boxwood, Flowering Cornel, &c.   It
is an astringent and antiperiodic, and as such is often used
as a substitute for quinine, to which, in some cases,  it is
preferable, on account of a tonic property which  quinine
does not possess.  It is specially adapted to certain classes
of diseases, in which the soft, spongy  erectile tissues are
involved; hence it is useful in  neuralgia, epileptic convul-
sions, hysteria,  ague, intermittent, remittent, and  conges- 
MATERIA  MEDICA.
1027
 tive fevers.  It, like quinine, is peculiarly valuable  in  this
 country of periodicity, and in mild cases two to four grains
 may be administered as an antiperiodic.   One dram should
 be given two or three  times within the twenty-four hours,
 (that is, during the intermission,) to break up a fever; and,
 as a general rule, double the  quantity of cornin  is requisite
 to be given that would be necessary were quinine employed.
 It  is serviceable, also, in spermatorrhoea,  and in excessive
 sensual excitement, by administering  two grains every  two
 hours.  By it the gleet occasioned by gonorrhoea may be
 stopped in three or four days; and it  is equally efficacious
 in  leucorrhoea, in weakness of the sexual  organs,  and in
 diseases of the spleen.   In short, it may be considered good
 in  all maladies which come  on  periodically, and even as
 much as ten to fifteen  grains  of  the crude article may be
 given at a  dose.
                    CORYDALIN.
   Corydalin is the active principle of  Corydalis Formosa,
 Turkey Pea, &c.   Corydalin manifests its  greatest power as
 an anti-syphilitic remedy.  There is no fact better established
 than that corydalin, judiciously administered, has the power
 to remove  this  malady from the system.  Within the  last
 few years I have had most ample  opportunity of testing the
 virtue of a great variety of remedies in the cure  of syphilis.'
 The entire inefficiency of the old practice, besides the de-
 structive tendency of the remedies employed, has rendered
 an  inquiry into the  therapeutic  power of innocent drugs
 over this disease of signal importance.  It was  with these
 considerations that I determined to make a most thorough
 test of  the curative power of our concentrated  Eclectic
 remedies;  and, after repeated and extensive  trial  of  co-
 rydalin  in  every form of syphilitic affection,  both alone
and in combination with other agents, I have demonstrated,
beyond  the possibility of a doubt, that corydalin removes
secondary syphilis with as much efficiency and certainty as 
1028
MATERIA  MEDICA.
 any other known remedy, with the exception of phytolaccin,
 and in some cases it operates with even more certainty than
 it.   In many cases of syphilitic chancre I have known them
 to heal most kindly in from ten to twelve days, under the
 influence of from ten to twenty grains of corydalin per diem,
 with no other external application than simple water dress-
 ings.  In many cases, where iodide of potassium and all the
 mercurial preparations had failed to effect relief, I have
 seen most speedy cures follow the free use of corydalin.   In
 bad cases of syphilis, where the  glandular  system has be-
 come much involved, the action of the  medicine  may be en-
 hanced by combining it with chimaphilin, ampelopsin, and
 phytolaccin.  The dose  of corydalin varies from three to
 thirty grains a day, properly triturated, and administered
 in the form of powder, or simple syrup.

                    c YPRIPEDI N.
   Cypripedin is the active principle of  Cypripedium Pubes-
 cens.  It manifests its  power principally upon the gray
 nerve tissue, and appears  to exert a controlling influence
 over the molecular arrangement of this structure.  Hence, it
 exerts a most beneficial influence over diseases  dependent
 upon a derangement of this tissue,  such as delirium tre-
 mens, shaking palsy, nervous and mental debility, &c.   In
 cases of general inertia,  dependent upon a want of nerve
 power, cypripedin seems  to manifest a stimulating and tonic
 influence in a remarkable degree.   In  many cases of both
 acute and chronic affections, where there has seemed to be a
 general prostration  of the  nervous energy, I have known
 two or three grains of cypripedin to remove the difficulty
 almost at once.  In hysteria, epilepsy, catalepsy, and other
 affections of this character, this agent exerts a most bene-
ficial influence. It is also valuable in mental affections, espe-
cially in those cases where the disease is dependent upon
great intellectual exertions, or long-continued excitement.
It appears to impart to the nervous system tone and vigour, 
MATERIA  MEDICA.           1029
without disturbing the other organs of the body.   The dose
of cypripedin is from one to twenty grains, repeated from
three to five times a day.  It may be given alone, or in com-
bination with  such other agents as the nature of the case
may indicate.
                    DIGITALIN.
  Digitalin is the  active principle of Digitalis Purpurea.
This agent seems to manifest its influence principally upon
the genito-urinary apparatus first, and  upon the heart and
arteries second.  Hence its  great value in the treatment
of dropsical, kidney, and bladder diseases, and diseases of
the  reproductive organs.  In  spermatorrhoea, where the
disease is dependent upon weakness of the seminal vessels,
it has proved a very efficient remedy.   It is also valuable in
albuminuria, chronic cystitis, and other diseases of the blad-
der.  It may also be used to advantage in dynamic  palpi-
tation of the heart.  The dose is from one-fifteenth to one-
fourth of a grain, repeated every three or four hours.

                     DIOSCORIN.
   Dioscorin is the active principle of Dioscorea  Villosa, or
 Wild Yam.  Dioscorin is a specific remedy for bilious colic.
It is also used  in other spasmodic diseases.   It operates
most efficiently by being triturated ten grains to the hun-
dred of sugar.  The  dose  of the  trituration is five or ten
grains every five or ten minutes, until relief is produced.
   This remedy has also been used in other forms of neu-
ralgia with remarkable success.

                     EUONYMIN.
   This is the active principle of the bark of the Euonymus
Atropurpureus or Burning Bush.   The Sulphate of Euo-
nymus is much the prettiest preparation, and is of a dark
colour, and on being  exposed  to  light it becomes darker,
and in time will turn entirely black.   Doses given every
       87 
1030
MATERIA  MEDICA.
two  or  three  hours for  twenty-four  hours will bring on
cholera  morbus;  if continued  still longer, there will be
nausea,  and lastly, vomiting of a bilious character.   I have
taken one-half dram and felt no nausea, but at the expira-
tion  of twelve hours  I  have  had nausea, vomiting and
purging with bilious discharges from  the bowels.   If the
liver be engorged, there will be discharged quantities  of
bile.  In weak and debilitated  persons it will cause unea-
siness of the bowels and  abdomen, but no vomiting.
   Euonymin acts on the liver, and its main office seems to
be to manufacture bile  for  the  stomach and duodenum.
It will hasten the formation of bile, as some articles of food
make blood.   You can make bile by this remedy, but there
must be bile material in  the blood.
   To a lady,  a patient  of mine,  who was very weak and
feeble, on whom I tried many of our  most valuable  reme-
dies  without success, and knowing that her digestion was
impaired, I gave  small doses of Euonymin, one-half grain
in pill every night.  She took these for a week, when she
had free evacuations of the bowels.  It does not stimulate
the vascular system, but acts as a stimulant to  the liver,
causing proper action of the bowels, improving  digestion,
affecting the tissues generally, and bringing on  a  healthy
condition of the whole system.
   It will repair diseases of the  bones,—in  necrosis I have
known benefit to result, and in some cases cures have been
made, by giving nourishment or  bone-making material  in
connexion with euonymin.   Euonymin will assist the liver
to perform its functions,  but like all other medicines, will
by long usage lose its effects.   Has  euonymin  any other
virtue?  Is it a tonic? What is a tonic?—something to give
tone  to the frame, to make the heart beat faster, and to pro-
duce a stimulation of the whole arterial system?   If so, it
is not a  tonic.   But if it is to act on the liver, strengthen
the stomach and digestive organs  in general,  then it is  a 
MATERIA  MEDICA.
1031
tonic.  If it is to act on the heart by reducing its action
and lowering the circulation, then it  is a sedative.  This
remedy will make gastric  fluid by action on the coats  of
the stomach specifically.   It arouses the action of the pan-
creas, and relieves the liver.  The dose  is from one-eighth
to one-half grain three or four times a day—of the tritura-
ted, from five to ten grains, one, two,  or three times a day.

                   EUPHORBIN.
   The Euphorbin is derived from the root of the Euphor-
bia corollata.   Common  name, Bowman Root.  The Eu-
phorbin is emetic, cathartic, diaphoretic and expectorant.
It is used in the forming stage  of fever, in dropsy, dysen-
tery and  chronic affections  of  the liver.  As an emetic,
from one to three grains should be added to one-half pint
of warm ginger tea, and one tablespoonful taken every five
minutes until it  produces  free  emesis.  As an  alterative,
it should be triturated ten grains to the hundred of white
sugar, and from two to five grains of the trituration given as
a dose, and repeated three or four times a day.

               EUPATORIN  PURP.
   The Eupatorin Purp. is obtained from the Eupatorium
Purpureum.  Common name, Queen of the Meadow. The
Eupatorin Purp. is resolvent, diuretic  and stimulant. It is
used in gravel, strangury, gout, dysentery, scrofula, necro-
sis, cancer, and in chronic affections of the uterus.   It
should be triturated ten grains to the hundred, and from
three to five grains of the trituration  given as a dose.

               EUPATORIN  PERFO.
   This is  the active principle of the Eupatorium Per folia-
turn.   In large  doses  it is eme to-cathartic,  but in small
doses it acts as a gentle tonic to the stomach  and liver, re-
moving constipation and  imparting vigour and tone to  the 
1032
MATERIA  MEDICA.
digestive organs generally.   Dose of the crude article from
one to three grains.

                     FR A S ERIN.
   Fraserin is obtained from the Frasera Carolinensis, or
American Columbo.   This is more active than the Eng-
lish Columbo.  In medical properties it resembles rhubarb
and rhein; in other respects it  is identical with the Eng-
lish variety.   It acts  upon the  upper portions of the mu-
cous  membrane, particularly that of  the  stomach, in dys-
pepsia where the mucous membrane is engorged.
   I have cured this form of dyspepsia with  it.  It is effi-
cacious in typhoid fever, being  tonic,  and  at the same time
laxative to the bowels;  very beneficial in  female diseases,
as leucorrhcea, inflammation of  the  mucous membranes  of
the vagina, in gleet or in  inflammation of the urethra.  I
have  given as high as two  or three  grains of Fraserin, two
or three times a day.   For inflammation of the vagina sus-
pend  it in some non-stimulating substance, and give an in-
jection.   For  debility  of  the  mucous membrane  of the
stomach, give it  in doses  from one-half grain to  four  or
five.   Triturate with  sugar, and give in simple syrup, and
when indicated give Phosphate of Iron.

                     GELSEMIN.
   Gelsemin is the active principle of the Gelseminum Sem-
pervirens, Yellow Jessamine. There are but few remedies
which appear to possess more specific power, than does the
gelsemin.   It appears to manifest its  influence principally
upon  the capillary circulation of the  mucous surface.  In
this respect it differs  from nearly all other remedies; its
influence appears to be to  diminish the circulation in this
tissue, lessen  exudation, and  bring  about those  normal
changes so  essential  to  the healthy  function of this im-
portant structure.  It is now nearly ten years since I first
demonstrated the power of the gelsemin  over dysentery, 
MATERIA MEDICA.
1033
and during that period my first observations have  been
most extensively verified by the almost uniformity  with
which this remedy controls that affection.  Indeed I think
there is no remedy in the Materia Medica that more nearly
approximates to a specific,  than does the  gelsemin  over
dysentery.   I have seen the most aggravated forms of this
affection speedily relieved by this article.  The method of
using the gelsemin in dysentery is to add fifteen or twenty
grains  of the triturated article to  a  tumbler half full of
water, and give one teaspoonful of the solution every fifteen
or twenty minutes, until the discharges  are  lessened, and
the urgent symptoms controlled.   In bronchorrhoea, leucor-
rhcea, gonorrhoea, spermatorrhoea, and gleet, the  gelsemin
also appears to  exert a most beneficial influence.   It is
also valuable in chronic inflammation of the stomach and
bowels,  especially in those disordered conditions of the di-
gestive  organs, dependent upon a  constant  exudation  of
liquor  sanguinis.  The gelsemin may be combined  with
quinine, hydrastin, iron, or any other remedy indicated by
the nature and complication of  the  disease.   The dose is
from one-sixteenth to one-fourth of  a grain,  and  in  acute
affections it may even be given in much  less  quantities.

                     G ERAN IN.
   Geranin or Geranium is the active principle of the Ge-
ranium Maculatum or Cranesbill.   The  essential principle
is in the tannic  acid which it contains.  All bitter herbs
and  barks  contain tannin  in a great degree.   Merrell's
preparation of Geranin contains more tannic  acid, than any
other one.   It is very valuable where the tissue has be-
come loose and soft, as it seems to  give it tonicity.   Tan-
nin may be given where there is a relaxed and loose state of
the muscles of the system.  In capillary inflammation from
long continued action of the muscles;  where the size of the
capillaries is increased in sores, hemorrhages, hemorrhage
of the  uterus, hemoptysis, and where  an astringent is  in-
                           87* 
1034
MATERIA  MEDICA.
dicated this is a desideratum, also in dilatations of the blad-
der and heart.   It arrests bronchial discharges and diar-
rhoea; it is a reliable astringent, dose from one to ten grains
of the crude article, of the  triturated  one hundred grains.
In chronic bronchitis I give ten grains every three hours.
Small doses have antiperiodic effects.

                    GOSSYPIIN.
   This is the active principle of the  Gossypium Herbace-
um or Cotton Root.   The properties  of this article were
first observed by the slaves of the south;  slave women gave
cotton root tea to produce abortion, and from that time to
this,  it has been given for diseases of  the utero-genital or-
gans.  I think there was no remedy designed to produce
abortion, but there are many used  for that purpose.  This
is good to produce contractions of the  uterus.  It is ex-
cellent to facilitate labour, and five or  ten grains will bring
on moderate contraction of the uterus.   If the uterus is
not yet dilated,  Gossypiin, like ergot,  should not be admi-
nistered.
   Ergot will produce inflammation  of the uterus, puerperal
fever, and uterine inflammation, but  Gossypiin will have
the same beneficial effects without being followed by inflam-
matory symptoms.   It is  an excellent  uterine tonic, valua-
ble in sterility, vaginitis,  leucorrhcea, dysmenorrhea, amen-
orrhoea,  etc., combined  when  proper  with  chalybeates.
Dose  from five to ten grains.

                    HA MA MELIN.
  Hamamelin is the active principle  of the  Hamamelis
Virginica, or Witch  Hazel.  The  hamamelis  appears to
exert a specific influence over the mucous membrane of the
vagina, and  uterus.  In cases of lax, irritable and debili-
tated  condition of this surface, producing leucorrhcea, and
other vaginal and uterine discharges, the  hamamelin re-
moves the difficulty by imparting  tone, and restoring the 
MATERIA  MEDICA.
1035
ussue co us normal condition.   It also exerts a beneficial
influence on the diseased  condition of the mucous mem-
brane of  the bowels,  bladder and  stomach.   Hence it
proves valuable in catarrh of  the bladder, chronic dysen-
tery, and slow ulceration of the stomach.  The dose of the
hamamelin is from one to  five  grains of the crude article,
properly triturated, repeated every two or three hours.

                      HELONIN.
  Obtained from the  Helonias  Dioica, or Unicorn Root,
Starwort, &c.  The helonin is tonic, diuretic, and nervine.
There is no medicine known, which exerts a more salutary
influence over the assimilating powers of the system, than
the helonin.   Hence it is an invaluable  remedy in  the
treatment of diabetes: it is also used in leucorrhcea, and in
all cases where passive congestion of the uterus appears to
be the prominent cause of the ailment.   The helonin should
be triturated  ten grains of helonin to one  hundred grains
of White Sugar.  Dose from five to ten grains.

                   HYDRASTIN.
  Obtained from the  Hydrastis  Canadensis  or  Golden
Seal.   Hydrastin is a pure tonic to the muscles, imparting
great tone and vigour, to both the voluntary and involuntary
muscles.  In dyspepsia, where the indigestion is dependent
upon  a  weakened state of the stomach, hydrastin affords
almost immediate relief.   It is equally valuable in consti-
pation, caused by a weak  condition of the muscles of the
bowels;  and,  in adynamic palpitation of the heart,  pro-
duced by a feeble state of its muscular walls; in myalgia,
and pain and fatigue of the muscles, either from exhaus-
tion by over exercise, or by previous disease, the hydrastin
is almost a specific.  It may be  given alone, or in combi-
nation with iron,  or such  other  remedies as the nature of
the case may indicate.   Dose from one-half to three grains
repeated every two or three hours. 
1036
MATEEIA  MEDICA.
                   HYOSCIAMIN.
  The Hyosciamin is obtained from the Hyosciamus Niger,
or Henbane.   It is  anodyne, antispasmodic, and laxative.
It is used in neuralgia, gout, asthma, phthisis, irritability
of the urinary organs, and nervous affections.  It should be
triturated, one grain to ten of sugar, and from one-half to
one grain of the trituration is a dose.

                       IRISIN.
  The Irisin is obtained from  the Iris  Versicolar, or Blue
Flag.   It is alterative, purgative, diuretic, and anthelmin-
tic.  It is used in syphilis,  chronic hepatitis, scrofula, rheu-
matism, &c.   The trituration of this remedy is ten to the
hundred, and from five to  ten grains is a dose.

                      J A  L API N.
  The Jalapin is obtained from the Ipomoza  Jalapa, or
Jalap.   The  Jalapin  is a  hydragogue  catharthic, and is
used in dropsy, congestion  of the liver, &c.  The dose of
the triturated is from five to ten grains.

                    JUGLAN DIN.
  The Juglandin is prepared  from the  Juglans Cinerea,
or Butternut.   It is cathartic  and alterative.  It appears
to exert most of  its influence  upon the dermoid tissues,
where it is used in cutaneous diseases with very happy re-
sults.   It is triturated the same as the other concentrated
remedies.  Give it in ten or twelve grain doses three times
in the twenty-four hours.

                    LEONTODIN.
   Leontodin  is the active  principle of the  Taraxacum
Leontodin, or Dandelion.   There  are  but  few remedies
which possess more direct  influence over the liver in im-
parting tone and hastening those transformations essential
to the production of bile, than does the leontodin.   In all 
MATERIA  MEDICA.           1037
cases where there is atrophy of the liver, passive conges-
tion, or deficient biliary  secretion,  the leontodin affords
prompt relief.   It is not directly a purgative, but, by its
stimulating and tonic power over the liver, it increases the
alvine  evacuations.   Where a hepatic purge is  required,
nothing acts more promptly than two or three  grains of
leontodin, and  one half grain of jalapin.   Dose,  from one
to five  grains of the crude article, repeated as indicated.

                   LEPTANDRIN.
   The Leptandrin is prepared from  the Leptandra  Virgi-
nica, Culver's Physic, or Black Root.   It is  alterative, to-
nic, and hepatic.  It is used very extensively as  an altera-
tive to the mucous surface, in inflammation of the glands
of the bowels, in chronic diarrhoea, and dysentery.   It is
also used in scrofula and chronic bronchitis.   The  leptan-
drin is to be triturated  ten  to the hundred, and  from ten
to twenty grains given at a dose.

                     LOBELIN.
   The Lobelin  is obtained from the  Lobelia Inflata.  It is
emetic, diaphoretic, antispasmodic and expectorant.  The
lobelin is one of the most valuable medicines in the materia
medica.  It is used in all cases where  a remedy possessing
those properties is indicated.  As an antispasmodic, it may
be used in all  cases of convulsions,  croup, &c; also, in
asthma and spasmodic croup.  As  an  emetic, it may fre-
quently be indicated in the  formative  stage of fevers, dy-
sentery, jaundice, lung fever, &c.   As an expectorant, it
may be used  in chronic catarrh, pneumonia,  &c.   The  lo-
belin should be triturated ten to the hundred of sugar, of
which  from one to ten grains may be  given as an expecto-
rant, from  ten  to forty as an emetic, and from five to ten
as an antispasmodic. 
1038           MATERIA  MEDICA.
                     L U PU LIN .
  Lupulin is obtained from the Humulus Lupulus.  Com-
mon  name, Hops.   The  lupulin  is  tonic, anodyne,  and
anaphrodisiac.   It is used very extensively in all nervous
diseases in the place  of morphine, for which it serves  as a
good  substitute;—it is also used in spermatorrhoea  and
chronic gonorrhoea, for which  it  operates with great  effi-
ciency.  For loss of sleep it serves all the purposes of mor-
phine.  And of late it is becoming quite a popular remedy
for ague, and its power over that  disease leads me to infer
it to be quite a strong antiperiodic.  It may be triturated,
and from five to ten grains given as a dose, and repeated as
indicated.
                     L Y c o pi N .
   Lycopin is the active principle  of the Lycopus Virgini-
cus.  It exerts its  influence mostly on the mucous mem-
brane of the bronchia, and is found most beneficial in bron-
chorrhoea, haemoptysis, chronic bronchitis, and other cases
where there is  a softened  and debilitated state of this por-
tion of the mucous membrane.  It may be used alone or in
combination with  other drugs.   I have found it valuable
in chronic bronchitis, given  in connexion with hypo-phos-
phite of iron and cod-liver oil.   The dose of the lycopin is
from two to five grains of the crude article.

                    MACROTIN.
  Macrotin is the active principle of the Macrotus,  or Ci-
micifuga Racemosa.  The macrotin  possesses most active
metastatic  properties, i. e., the power  to transfer diseases
from the mucous membrane to the integuments.  It is over
fifteen years since I first demonstrated the power  of macro-
tin  to relieve eruptive diseases  of  the mucous surface by
transferring them to the integuments.  In measles,  where
the eruption is  threatening disorganization of the mucous
membrane  of the bronchia, from one-eighth to one-fourth 
MATERIA  MEDICA.           1039
of a grain of macrotin, repeated every half hour, soon trans-
fers the eruption to the skin, and relieves the difficulty. It
is  equally efficacious in scarlatina, small pox and diphthe-
ritis.   In typhoid fever, where the eruption is confined to
the bowels, producing diarrhoea, gastric  and cerebral diffi-
culties of an aggravated character,  relief is soon afforded by
the proper use of the macrotin.  In small-pox, where the
pustules are either  imperfectly developed, or recede too
early, macrotin affords most prompt relief.  In short, in all
cutaneous and eruptive diseases, where the difficulty either
locates upon the mucous  surface, or  is liable to be trans-
ferred to it during its progress,  there  is no remedy  that
meets  the  difficulty  so  promptly as does macrotin.   It is
also used in female  diseases where the  nervous system is
prostrated—also, in  diseases of the serous tissues.   It is
best administered in  cutaneous diseases by adding fifteen
or twenty grains of macrotin to a tumbler half full of wa-
ter, and giving one teaspoonful every  fifteen or twenty mi-
nutes, until the  desired effect is produced.  In female dis-
eases, and rheumatism, from one-quarter to one-half grain
of the crude article  may be  administered and repeated at
proper intervals.
                  MENISPERMIN.
   Menispermin  is the active principle of the Menispermum
Canadense, or Yellow Parilla.   The  menispermin  exerts
its influence principally on the gastric and salivary'glands.
If given in large doses, and continued for any length of
time,  it produces ptyalism and  abnormal discharge of  gas-
tric fluid.  It is found most beneficial in cases where there
is  adhesive inflammation, and where it is necessary to break
up organized deposits and  hasten  disintegration of tissue.
From one to five grains may be given as a dose.

                      MYRICIN.
   The Myricin  is obtained from the  Myrica  Cerifera.
Common name,  Bayberry.   It is astringent and alterative. 
1040
MATERIA  MEDIC.
It is used in scrofula, dysentery and follicular stomatitis.
There are but few remedies which exert a more salutary
influence over a diseased condition of the mucous surface
than this.   It is also used externally upon indolent ulcers.
It should be triturated ten grains to one hundred, of which
from five to ten grains are a dose.   When used externally,
the  triturated  powder should be sprinkled upon the sur-
face, followed by an elm poultice.

                   PHYTOLACCIN
   Is the active principle of the  Phytolacca Decandria.
Common names,  Poke Root,  Garget,  Snake Root, dbc.   It
is alterative, purgative, diuretic, and  antisyphilitic.  This
remedy possesses  almost  specific  power over syphilis.   It
is used in tuberculous affections of the  liver and  spleen—
also in  cancer  and scrofulous cachexia.   It is used exter-
nally for indolent scrofulous  ulcers, necrosis and cancers.
I have found an ointment of this article valuable in obsti-
nate hemorrhoids.  For internal use it should be triturated
ten  grains  to  one hundred of sugar.  In syphilis, from
three to five grains of the trituration should be given three
or four times a day.  If  there should be  chancre, a small
quantity of the untriturated should be spread upon it.   If
this course be persisted in until a  constitutional impression
is made by the phytolaccin, a cure  will generally be effected.
In  scrofulous and hepatic  diseases, one or two grains  of
the triturated should be given two or  three times  a day.

                  PODOPHYLLIN.
  This  is obtained  from  Podophyllum  Peltatum.  Com-
mon  names,  May  Apple, Mandrake.   It is  alterative,
emetic,   cathartic  and resolvent.   The action  of podo-
phyllin upon the  glands is somewhat  like the mercurials.
When given alone, as a cathartic, its  action is very slow,
requiring from six to twelve  hours.  As  an  alterative, it
is  used in all cases of hypertrophy and local congestion
1 
MATERIA  MEDICA.
1041
It exerts a specific influence over  the liver, stimulating it
to increased  secretion of bile.   As a resolvent, it is used
in adhesive inflammation, following pneumonia, peritonitis,
and pleuritis.   It is  used to defibrinate the blood in  altera-
tive  doses, and as a general stimulant to the absorbents.
It should be triturated  ten  grains to the hundred.  From
one to two grains  of the trituration  are used as an  altera-
tive  and from  two to five grains act as a cathartic.

                      POPULIN.                              i
   The Populin is obtained from the Populus Tremuloides,
or  Quaking Aspen.   The Populin is tonic, alterative, ver-
mifuge, and  stomachic.   It  is  used  in dyspepsia, costive-
ness, hysteria,  &c.   It is to be  triturated, and  from three
to five grains given  as  a dose.    It is also valuable in  all
diseases of the bladder.

                       pruni N.
   The Prunin is obtained from  the Prunus Virginiana.
 Common name, Wild Cherry.   It is  a tonic expectorant,
 and  nervous sedative.   The Prunin is a remedy well cal-
 culated  to act beneficially in the early  stage of phthisis,
 and  in chronic bronchitis.  It has been used  lately  as an
 antiperiodic  with good success.   The prunin  should be
 triturated, ten of prunin to the hundred of sugar, and from
 five to ten grains given  at a dose.

                        PTELIN.
   The Ptelin is obtained from the Ptelia Trifoliata.  Com-
 mon  name,  Swamp Dogwood.  The  Ptelin is tonic and
 stimulant.  It is a remedy of much value in diabetes, in
 chronic diarrhoea and indigestion.  It should be triturated,
 ten  parts to the hundred of  sugar, and from  five to ten
 grains given at a dose.
        88 
1042           MATERIA  MEDICA.

                      RHUSIN.
  The Rhusin is  obtained from the Rhus Glabra.  Com-
mon name, Upland Sumach.   It is a valuable  remedy in
purpura, scurvy, and dysentery.  It is also used with good
effect, as an external remedy, in indolent ulcers  and piles.
For internal  use  it  should  be triturated as the other con-
centrated remedies, and from  one to five grains  of the tri-
turation given at  a dose.   As an external remedy for ulcers
or  piles, it should be made  into  an ointment with Balsam
of Fir.
                        RUMIN.
   The Rumin  is obtained  from the Rumex Crispus, or
 Yellow Dock.  It is a remedy  of  great value in consti-
 tutional cancerous affections, and  in  scrofula.  It should
 be triturated, and given in three or four grain doses.

                   S ANGU IN ARIN.
    The Sanguinarin is obtained from the Sanguinaria Ca-
 nadensis.  Common  name,  Blood Root.   The Sanguinarin
 is  one of the most valuable remedies  known, in the treat-
 ment of pseudo-membranous croup.   It has proved as much
 of a specific for  that disease,  as quinine has for  ague.  I
 have  seen it used  in a great number of cases, and have
 never known a single failure.   It is also used in pneumonia
 with good effect.  As a mild  alterative and  sedative, it is
 also  valuable.    Externally, sanguinarin is  used in open
 cancer  with good  effect.  When  used  for  the  croup, it
 should  be made into an acetic syrup,  by adding twenty
 grains of sanguinarin to four ounces of vinegar; steep, and
 add  one ounce of sugar to form a syrup.   Dose, one  tea-
 spoonful as often  as indicated.  As  an alterative and ex-
 pectorant, it should be triturated  ten grains to  the hun-
 dred of sugar, and from three to five grains given at a dose.
 Externally,  for  cancer, it is mixed with the white of an
 egg, and applied in  the form of a paste. 
MATERIA  MEDICA.
1043
        SULPHATE OF  SANGUINARINA.
  The sulphate of sanguinarina is a valuable external ap-
plication in syphilitic, cancerous, and other malignant dis-
eases.   It should be  formed into an ointment by mixing
it with lard.   Internally, it may be used for the same pur-
poses as the sanguinarin, only in much  smaller quantity.

                   SCUTELLARIN.
  The Scutellarin is prepared from the Scutellaria Lateri-
flora, or Scullcap.  It is one of the most valuable nerve to-
nics and antispasmodics.   It is a specific in nervous chorea,
and very valuable in all other forms of nervous affections.
It is one of the ingredients of the intermittent drop.  In the
low stage of typhoid  fever, it allays the nervous  irritation
with great efficiency.  I am in the habit of using the  scu-
tellarin in all cases  where I formerly  used morphine.   It
should be triturated ten  to the hundred, and given in three
or four grain  doses.
                        SENECIN
   Is obtained from the  Seuecio  Gracilis.   Common name,
 Life Root.  The Senecin is one of the  most efficient known
 remedies in irregularity of the menses, and appears to act
 specifically upon the uterus, relieving that  organ  of con-
 gestion  and inaction.   From the efficiency with which the
 medicine relieves  uterine derangement,  its use is mostly
 confined to that class of cases.   The dose of the triturated
 is from three to six grains.

                      STTLLINGIN.
    The St ill ing in is a  concentrated preparation,  prepared
 from the root  of  the Stillingia Sylvatica.  This prepara-
 tion however, does not contain  all the active medical pro-
 perties of the plant.  Hence the crude article is mostly used
 in the form of a syrup.  The  syrup is extensively used in
 syphilis, scrofula,  and  mercurial  diseases.   By those who 
1044
MATERIA MEDICA.
are the most familiar with its medicinal properties, it is be-
lieved to possess  more power over mercurial diseases than
any other.   In order to obtain the best effect, its use should
be persisted in for a considerable length of time.   Dose of
the simple syrup, one teaspoonful three or four times a day.
The stillingin is  valuable in  chronic  bronchitis and diph.
theria.   Dose, one-half  to one grain  every  two or three
hours.
                    STRYCHNINE.
   Strychnine is  the active  principle of the Nux Vomica,
and possesses all  the medicinal properties of that drug in a
highly concentrated form.  It appears to manifest its power
principally upon  the white nerve fibres, imparting tone and
energy to  that tissue, and facilitating the distribution of
nerve power to  all the   organs and tissues  of the body.
Hence it is a remedy of great value in the treatment of all
diseases  connected with debility.   In  low forms of fever,
scrofulous  affections, and tuberculous  diseases, where the
nutritive functions are feeble, strychnine  is most valuable.
It is also a very valuable remedy in the treatment of gleet,
spermatorrhoea, and a feeble state of the reproductive organs
both  of male and female.  It is also valuable in many forms
of palsy.  Dose, from one-twentieth to one-sixteenth  of a
grain.  It should be  triturated as other concentrated re-
medies.
                      TRILLIN.
   The Trillin is obtained from the root of the  Trillium
Pendulum.   Common name,  Beth Root.   The trillin  is
astringent, styptic,  alterative, and  tonic.   It is  used in ute-
rine hemorrhage, leucorrhcea,  and prolapsus uteri.   The
trillin should be triturated, ten grains to the  hundred of
sugar, and from  five to  ten  grains of the trituration  is a
dose. 
MATERIA MEDICA.
1045
                     VERATRIN.
  The  Veratrin  is  obtained from the  Veratrum  Viride.
Common name,  Swamp Hellebore.   It is sedative, diapho-
retic, alterative, diuretic, and in large doses emeto-cathartic.
There are but few remedies by  which  the  heart's action
can be so readily controlled as by this.   Hence in all sthe-
nic diseases, in which there is great increase of circulation,
as in miasmatic fevers, the veratrin constitutes one of the
most important remedies  in  use.  In many eases of inter-
mittent, remittent, and bilious fevers, the vetratrin is the
only remedy needed.   It is also very valuable  in  the treat-
ment  of pneumonia, pleurisy, and bronchitis  of  a sthenic
character.  But where the powers of the system are feeble,
and the  disease of an asthenic character, the veratrin should
not be  given, as  it proves  too  debilitating.   A tincture
made from the fresh root is also  used in the same diseases
as the veratrin.   The  veratrin should  be triturated, ten
grains to the hundred of  sugar, and from one  half to  one
grain of the trituration given as a dose.  Dose  of  the  tinc-
ture is from three  to ten drops.

                     VIBURNIN.
  The Viburninis  obtained from  the  Viburnum O.rycoccus.
Common name, High Cranberry.  It is antiperiodic, tonic,
and alterative.  The  Viburnin is a valuable  remedy in the
treatment of ague and remittent fever.  It is also valuable
in periodic pneumonia and  pleuritis.  While it arrests the
periodicity of pneumonia, it also facilitates expectoration.
This remedy has  proved highly  valuable in obviating the
casualties  of pregnancy.  It is frequently prepared in the
form of a syrup, and given under the name of " Mother's
Relief."  When given  in the form of a syrup, it should be
prepared by adding  one  dram to the  pint of the syrup of
suo-ar.   Dose, one tablespoonful  three times a day.   Dose
of the triturated, from three to ten grains.
                           88* 
1046           MATERIA" MEDICA.

                  XANTHOXYLIN.
  Obtained from the Prickly  Ash.  The Xanthoxylin is
one of  the most powerful diffusible stimulants known  to
the profession.  When given in full doses, it produces effects
upon the nerves as though slight shocks of electricity were
passing through the system.  From its powerful stimulating
properties, it is used in all  low forms of fever, in passive
congestion, in cholera, diarrhoea, and dysentery.   It is also
a remedy of great value in congestive chills.   It should be
triturated, ten grains to the  hundred of White Sugar, and
from five to ten grains is a dose.   A  tincture is made of
the Prickly Ash Berries, by adding an ounce of the berries
to one pint of brandy.  Dose, one  teaspoonful as often as
indicated.  It is used  in the  same diseases  as  the Xan-
thoxylin.


  CONCENTRATED  AND  ESSENTIAL
                   TINCTURES.
   The  Concentrated Tinctures prepared by B. Keith & Co.,
 of New York,  and the  Essential  Tinctures  prepared  by
 Wm. S. Merrell, of Cincinnati, Ohio, are very reliable  pre-
 parations, and represent the medical virtues  of the plants
 from which they are prepared in  a very convenient form.
 In many diseases they may  be used instead  of the concen-
 trated remedies.   A convenient method of using these tinc-
 tures in acute diseases, is to add to them a proper quantity
 of water, and allow a teaspoonful  to be given as often as re-
 quired.
    Oils.—There are several  medicines  of  this  character,
 that have been prepared by our pharmaceutists,  of a most
 valuable character.
    The Oil of Capsicum is a most  powerful,  diffusible sti-
 mulant, and may be given in all cases where such a remedy
 is required, in one or two drop doses. 
               MATERIA  MEDICA.           1047

  The Oil of Erigeron is a remedy of much repute in he-
moptysis and, uterine hemorrhage.   The dose is ten or fif-
teen drops, repeated every half hour.
  The Oil of Populus is a valuable remedy in diseases of
the bladder and  urinary organs, in doses of five or ten
drops, repeated as indicated.
  The Oil of Stillingia is a valuable remedy in bronchitis,
in one or two drop doses, triturated with sugar.
  The Oil of Solidago is valuable in diseases of the kidneys
and bladder.  From three to five drops is a dose.
   The Oil of Xanthoxylin is valuable  in  rheumatism, and
where an active stimulant is required.   Dose, two or three
drops given in  mucilage.
   The Oil of Lobelia is a powerful anti-spasmodic, and va-
luable in epilepsy and other spasms.  From one-half of a
 drop  to one drop is a dose.
   Oleo-Resin of Lobelia contains  all  the active principles
 of the  plant, and is  a  most valuable  emetic.   Dose, from
 two to five grains.
   In addition to the above  remedies, Mr. Merrell has pre-
 pared the Muriate of  Hydrastin,  which is an invaluable
 remedy for  ulcerated condition of the mucous membrane,
 in doses of from one to two  grains; the Sulphate of San-
 guinarina, a valuable external application for cancer, chan-
 cre,  and  indolent  ulcers;  and the Panduratin, a  valuable
 remedy in phthisis, in  doses of from three to five grains.
    There are several other remedies that have recently been
 prepared, and are now being tested,  which will  appear in
 our  next edition. 
1048
MATERIA  MEDICA.
HOW7  TO  PREPARE  AND   USE   CON-
        CENTRATED  MEDICINES.
  The proper preparation of medicine has very much to do
with its  action on the  living organism.   AVe often hear
physicians remark that  concentrated medicines are worth-
less, when we  have every reason to believe that their inef-
ficiency is owing to  the bungling manner in which they
are prepared and administered.  Most  of  the concentrated
medicines are insoluble  in water, and  nearly all the men-
struums  used by physicians and  nurses to administer them
in.   Besides a large  number are comparatively insoluble in
the  stomach.  The  one who prescribes, not knowing this
fact, condemns  the  article either as useless or  spurious.
Suppose  the same individual should  order boiled eggs for
breakfast.  The  cook boils them  thirty or forty minutes,
brings them to  the  table, and they  are eaten, but  instead
of  proving nutritious,  they irritate the  stomach.  Now,
which ought to.be condemned, the eggs, or the manner of
cooking  them?   Every individual .well knows, that how-
ever nutritious and well adapted to  nourish the system  an
article of food may be  in its crude state,  unless it be pro-
perly cooked its purpose will not be  accomplished.   So
with medicines.   It  is not enough that medicines be intro-
duced into the stomach, but they must be so prepared that
when they reach the stomach they pass into the circulation,
and come in contact  with  such diseased tissues as are to be
aflected  by them.   It  must farther be remembered that
the  powers of the stomach during  disease are very much
enfeebled, that the fluids are vitiated, and that the fact that
there is  loss of  appetite, proves  conclusively that the  sto-
mach is not in a condition to prepare either food or medi-
cine for assimilation.  This alone should be a sufficient hint
to the physician to  properly prepare his medicines  before
introducing them into the stomach. 
MATERIA  MEDICA.           1049
  To accomplish this, all the concentrated medicines should
be thoroughly triturated.
  The uniform method which  I have adopted relative to
the strength of the trituration, is to triturate ten grains of
the crude article, in ninety parts  of some  of the following
materials -.—The oleo-resins should  be triturated in glyce-
rine.   Solid remedies should be triturated  either in sugar
of milk, or pure white sugar.   About five grains of the tri-
turation is  usually the strength of  one, or  one and a  half
grains of the crude article.   Or, in other words, by rubbing,
mixing, and subdividing the particles of medicine, they not
only become more readily absorbed, passing into the blood,
&c, through the system, and producing their impressions,
but the more  extensive the  division  of the various mole-
cules of medicine, the  more extensive will be their influ-
ence upon  the system: not only is this the case, but in  very
many  instances, resinoids,  oleo-resins and  other  principles
 of concentrated remedies are so slightly soluble in  the sto-
 mach, that if introduced in their  crude  state, hours and
 even days  may elapse before they will reach the blood.
   In the meantime the local effects are most injurious to
 the coats of the stomach.   This being the case, it may be
 asked why use  the concentrated articles  when  the crude
 medicines  are already triturated and mixed, and are by in-
 fusion so readily diluted?  The reasons are obvious.  In the
 crude state in the majority of cases, the medical properties
 are mixed with substances which are actually injurious to
 the patient, while in other cases the stomach has no power
 to separate or digest the crude material, mixed as it is with
 woody fibre.  It is  enough to remember  that  the  stomach
 is not a chemical laboratory for the purpose of manufactu-
 ring medicine any more than it is a  cooking stove for pre-
 paring food to nourish and sustain the system; and we may
 claim, with as much propriety, that all our food should be
 taken in a crude state as our medicine.  The very physician
 who objects to the use of concentrated medicines, is con- 
1050
MATERIA  MEDICA.
stantly practising concentration in a crude way by steeping
and boiling in water, tincturing  in  alcohol, &c.  In  past
times this was the best  method known.  But when the
science  of organic  chemistry has so much enlarged its re-
sources,  and placed in our  reach so many facilities, it  is
folly to  suppose that a tin cup, a pot, a hot  stove, and an
inexperienced operator can extract all the medical virtues
from our numerous native plants, with  as  much exactness
and reliability as the  experienced chemist in  his laboratory
with his superior knowledge and skill.  It may be  argued
that the concentrated medicines  are not prepared in a  reli-
able manner; but the same objection may be urged against
the crude article, as  it must be properly gathered, dried
and preserved in order to retain its  medical virtues.   In
triturating medicines,  when  sugar  is  used, each  article
should be rubbed for twenty or thirty minutes, then placed
in a well corked vial, and marked triturated.   If glycerine
is used,  the process should  be continued until  every parti-
cle of medicine is dissolved. 
MATERIA  MEDICA.
1051
     CONCENTRATED  MEDICINES.
   The following is a list of the principal concentrated reme-
dies, the amount to be given, the diseases for which they
are nearly specifics, and the frequency with which the dose
should be  repeated until relief is  obtained.   The  dose  has
reference to the triturated article.
DOSE.	RETETITION
5 gr.	Every 2 or 3 hours
3gr.	" 3 or 4 "
1 gr.	" hour.
3gr.	" half hour.
5 gr.	" "
3gr.	" 5 hours.
6gr.	" 3 "
2gr.	" 3 "
5 gr.	.< 2 "
2gr.	« 2 «
5gr.	" 3 "
5gr.	a 3 «
1 gr.	" hour.
^gr.	" 5 hours.
3 gr.	" 10 minutes.
5 gr.	" 4 hours.
1 gr.	" half hour.
3gr.	" 2 hours.
2gr.	" 3 hours.
5 gr.	" night.
^gr-	" half hour.
1 gr.	" hour.
3 gr.	" 3 hours.
3gr.	" 5 hours.
2gr.	" hour.
^g''.	" 3 hours.
3gr.	" 3 hours.
10 gr.	" 6 hours.
2gr.	" 6 hours.
3gr.	" 2 hours.
5 gr.	" 2 hours.
3gr.	" 2 hours.
2gr.	" 3 hours.
3gr.	" hour.
2gr.	" hour.
1 gr.	" 2 hours.
2gr.	" 3 hours.
3gr.	" 2 hours.
5 gr.	" hour.
3gr.	" 2 hours.
ft gr.	" 3 hours.
5 gr.	" 4 hours.
6gr.	" '2 hours.
5 gr.	" 3 hours.
3 gr.	" 2 hours.
5gr.	" 4 hours.
TRIT. REMEDIES.	DISEASES THEV CURE.
Ampelopsin.	Bronchitis, sore throat, and scrofula.
Alnuin .	Indigestion and dehility.
Apocynin.	[Inflammation of the Madder.
Asclepin.	Pleurisy, (Acute.)
Baptisin.	Prevents gangrene.
Caulophyllin.	Excessive menstruation.
Cerasein.	Enlargement of the spleen and ague.
Chelonin.	Strengthens the stomach in dehility.
Chimaphilin.	Enlarged lymphatic glands.
Collinsonin.	Enlargement of the valves of the
	heart.
Comin.	Dehility of the bowels.
Corydalin.	Syphilis.
Cypripedin.	Nervousness.
Diiitalin.	Palpitation of the heart.
Dioseorein.	Bilious colic.
Euonymin.	Inactive liver and costiveness.
Kuphorbin.	Nausea and vomiting.
Eupatorin Per.	Gravel.
Eupatorin Pur.	Kising of food, uterine debility and
	weakness.
Fraz rin.	Night sweats, dyspepsia and con-
	sumption.
Gelsemin.	Dysentery.
Geranin.	Excessive Menstruation.
Hamamelin.	Hypertrophy of the heart, and leu -
	corrhoea.
Helonin.	Loss of appetite.
Hydrastin.	Dehility, a pure tonic.
Hyoscyamin.	Vertigo and sick headache.
Irisfn.	Mercurial diseases.
Jalapin.	Dropsy of the bowels.
Judandin.	Tetter and salt rheum.
Lpptandrin.	Aphthae of the mouth and stomach.
Lupuiin.	Spermatorrhoea.
1.) cop in.	Excessive expectoration of pus from
	the Bronchia.
Macrotin.	Leucorrhcea, rheumatism and erup-
	tive diseases.
Menispermin.	Old adhesions in pleurisy.
Myricin.	Diarrhoea from weakness.
Phytolaccin.	Syphilitic rheumatism.
Podophjllin.	Congested portal circulation.
Populin.	Nervous debility, and diseases of the
	bladder.
Prunin.	First stage of consumption.
Khusin.	Nursing sore mouth.
Rbumin.	Scrofula.
Sanguinarin.	Constipation, croup, and colds.
Scutellari i.	St. Vitus' dance.
Senecin.	Female Irregularity.
Smilac.in.	Enlargement of heart.
Stillingin.	Obstinate tcrofula.
 
1052        MATERIA MEDICA.
DOSE.		REPETITION.
%%T.	Every hour.	
2 gr.	"	half hour.
M5kt.	tt	half hour.
3gr.	"	2 hours.
3gr.	"	half hour.
10 gr.	"	2 hours.
10 gr.	"	5 min.
5 gr.	tt	hour.
1 gr.	"	6 hours.
10 gr.	"	2 hours.
^gr.	«	half hour.
TRIT. REMEDIES.	DISEASES THEY CURE.
Strychnine.	Palsies and epilepsy.
Trillin.	Acute rheumatism.
Veratrin.	All forms of bilious fever.
Viburnin.	Epilepsy.
Xanthoxylin.	Powerful stimulant.
Santonine.	Worms of all kinds.
Emetine.	Emetic.
Quinine.	All periodic diseases, ague, neural-
	gia, &c, &c.
Colchicia.	All forms of dropsy.
Gossypia.	Emmenagogue and abortioD.
Lactuoin.	Wakefulness.
TINCTURES CONCENTRATED AND ESSENTIAL.
REMEDIES.	DISEASES THEY CURE.	DOSE.	REPETITION.
Aconite.	Typhoid, and all forms of debilita-		
	ting fevers.	% to 1 drop.	Every half hour.
Arnica.	Bruises and soreness.	1 to 2 drops.	" hour.
Lobelia.	All spasms, asthma,		
	and cholera.	1 to 2 drops.	" half hour.
Veratrum viride.	All inflammatory fe-vers, hronchitis,		
	pneumonia, &c.	5 to 10 drops.	" 15 or 20 min.
Xanthoxylin.	Cholera infantum.	20 to 60 drops.	" 10 or 15 min.
Capsicum.	Fainting, and great		
	prostration.	40 to 80 drops.	" 20 or 30 min.
Cannabis Indies.	Consumption.	00 to 100 drops.	" 4 or 5 hours.
Matico.	All cases of hemor-		
	rhage.	30 to 40 drops.	" half hour.
Oil Erigeron.	Uterine hemorrhage.	10 to 40 drops.	" 10 or 15 rain.
Tincture of Ignatia	Tetanus, nervous		
Bean.	spasms, &c.	1 to 5 drops.	" 2 or 3 hours.
Rhus Radicans.	Palsy, last stages of		
	typhoid fever.	1 to 3 drops.	" 2 or 3 hours.
Gelseminum sem-	All acute inflamma-		
pervirens.	tory diseases, and all fevers where the brain is not af-		
	fected.	1 to 3 drops.	" half hour.
Oil of Capsicum.	Asphyxia, from drowning, chloro-		
	form, &c.	1 drop.	" 5 minutes.
" Cuhebs.	Gleet.	5 drops.	Three times per day.
" Ergot.	Night sweats, and co-pious expectora-tion in consump-		
	tion.	1 drop.	Every hour.
" Male Fern.	Tape Worm.	60 drops.	" hour.
" Lobelia.	Hooping cough, and		
	infantile spasms.	l4to]4 drop.	" hour.
" Black Pepper	Chronic ague.	5 drops.	Five times a day.
" Stillingia.	Bronchitis.	1 drop.	Every hour.
" Fire Weed.	Piles.	5 drops.	Four times a day.
Valerianate of Am-	Neuralgia, and all		
monia.	nervous affections		
	of the stomach.	1 to 2 drops.	3 or 4 times a day.
Valerian of Iron.	Nervousness where the blood is impo-		
	verished.	}^ to 1 grain.	3 or 4 times a day.
Oil of Skunk Cab-bage berries.	Hooping Cough.	1 to 3 drops.	Every hour or two.
 
MATERIA  MEDICA.
1053
  All the  oils should  be triturated with sugar or gum
Arabic, and the concentrated  tinctures should be largely
diluted with water.
  Of all articles triturated in  glycerine, one drop  may be
considered equal to one grain of the articles triturated in
sugar or gum.
ALPHABETICAL  ARRANGEMENT   OF
        THE  MATERIA  MEDICA.

  Abelmoschus Esculentus, ( Okra.)  The okra is used for
poultices instead of  slippery elm.  The leaves and fruit
are used.
  Abies Bahama, (Fir Balsam.)   Good for dyspepsia and
chronic rheumatism.   Dose, ten to fifteen drops.   Used in
Paine's mild zinc ointment.
  Abies Canadensis, (Hemlock spruce.)   The gum, oil, and
pulv. bark, are the parts used.  Dose of the oil, five to ten
drops; of bark, ten to fifteen grains.
  Abies Excelsa, (Norway Spruce fir.)  The gum or Bur-
gundy pitch may be used externally as strengthening plas-
ter, in rheumatism, &c.
  Abies Larix, (Larch.)  This is  Venice turpentine, and
is used in plasters  and liniments.
  Abies Nigra,  (Double  Spruce.)  A  decoction  of the
boughs of this article is valuable for chronic inflammation
of the bladder and kidneys.
  Abrus Precatorins, (Liquorice bush, Red bean, Love pea.)
  A decoction is good for disease of the bladder and kid-
neys.
  Abutilon Cordatum,  (Yellow Mallow, Sida Abutilon of
L.)   This is a native of Brazil.   It is a species of the cot-
ton plant; is used as a poultice in indolent ulcers, and pos-
sesses emmenagogue properties.
       89 
1054
MATERIA  MEDICA.
   Absynthium  Officinale,  (Artemisia Absynthium,  Com-
mon Wormtcood.)  It is anthelmintic and  tonic—good in
dyspepsia, &c.
   Acacia Arabica,  (Acacia,)  (Gum Arabic.)  One tea-
spoonful to  a tumbler full of water  makes an invaluable
mucilage in typhoid fever.
   Acacia Catechu.   This is an active astringent gum, used
in dysentery, hemorrhage, &c.
   Acalypha Virginica, (Mercury Weed)  The  tincture is
used in Syphilis in  ten  or fifteen drop  doses.  It is  re-
puted to be of great virtue.
   Acer Striatum, (Striped Maple.)   A strong  infusion of
this is regarded as a specific for hemoptysis and other he-
morrhages.
   Acetum, ( Vinegar.)  This is  used  extensively in acetic
tinctures, and croup syrup.
   Achillea  Millefolium,  (Yarrow.)   An  infusion  of the
herb is  almost a specific for night sweats in consumption.
One ounce to one pint of water.   Dose, one half teacup-full
three or four times  a day.
   Achras Sapota, (Sapodil.)  It is  said to be  a valuable
tonic and febrifuge.
   Acidum Aceticum, (Acetic  Acid.)   One dram of this
acid dissolved in  one ounce of water,  is valuable for secon-
dary syphilis, given in ten or fifteen drop doses, three or
four times a day.
   Acidum Aceticum, (Empyreumaticum.)
   Acidum Benzoicum, (Benzoic  Acid.)  Used in rheuma-
tism and gout.   Dose, one or two grains.
   Acidum   Carbazoticum,  (Carbazotic Acid.)   Used  in
dyspepsia,  intermittent  and remittent fever,  and  diseases
of the liver.  Dose, one-half grain, once or twice a  day, in
gum water.
   Acidum  Chromicum, (Cliromic Acid.)  Used in  croup,
bronchitis, and phthisis.  It  is also used as a painless caus-
tic, in cancer, for which it is most valuable.   Dose, inter- 
MATERIA  MEDICA.
1055
nally from one-thirtieth to one-twentieth of a grain, in gum
water.
  Acidum  Citricum, (Citric  Acid.)   It  is used for rheu-
matism, prepared like lemonade, and  drank freely.  Also
useful in scurvy.
  Acidum Fluoricum, (Fluoric Acid.)   Considered valua-
ble in pulmonary diseases.
  Acidum  Gallicum, (Gallic Acid.)  Used as an astrin-
gent, in three or four grain doses for Epistaxis, &c.
  Acidum Hydriodicum,  (Hydriodic Acid.)   Used instead
of iodine, in one or two drop doses.
  Acidum  Hydrochloricum, (Hydrochloric Acid, Muriatic
Acid.)  It  is used  as a  caustic in cancer, &c.  Also  for
night sweats, hectic fever,  &c.   Dose,  from five  to  ten
drops in sage tea, once or twice a day.
  Acidum  Hydrocyanicum,  (Hydrocyanic Acid,  Prussic
Acid, Cyano-hydric Acid.)   Used in the latter stages of
typhus  and typhoid fever.   From one-half to two drops
given in mucilage is a dose.
  Acidum Lacticum, (Lactic Acid.)  Used in dyspepsia.
Dose one to two  drachms  in sweetened water.  Also  for
triturating medicines.
   Acidum  Muriaticum,  (Muriatic  Acid.)    See Acidum
Hydrochloricum.
  Acidum  Nitricum,  (Nitric  Acid, Aqua  Fortis.)  Used
in secondary syphilis, in one or two drop  doses  once or
twice a day.
   Acidum Nitro-hydrochloricum, (Nitro-hydrochloric Acid.)
Used in dyspepsia.  Dose, three or four drops, sufficiently
diluted, three or  four times a day.
   Acidum  Oxalicum, (Oxalic Acid.)   Used externally for
eruptive diseases.
   Acidum Phosphoricum  Dilulum,  (Diluted Phosphoric
Acid.)   Is used in fever and neuralgia, in from ten to fif-
teen drop doses,  two or  three times a day.
   Acidum Sulphuricum, (Sulphuric Acid, Oil of Vitriol.) 
1056
MATERIA  MEDICA.
Used as a caustic in cancers.  See cancer recipe in for-
mulary.
   Acidum Sulphuricum Aromaticum, (Elixir of Vitriol.)
Is  used  in debility of the stomach.   Dose, from ten to
twenty drops, given in a tea of hydrastis Canadensis.
   Acidum Tannicum, ( Tannic Acid, Tannin.)   Used as an
astringent.   Also in diseases of  the  mucous  membrane.
Dose, four or five grains.
   Acidum Tartaricum,  (Tartaric Acid.)  Used in  scor-
butus.  It is also one of the ingredients of Seidlitz  pow-
ders.  Dose, one or two grains in sweetened water.
   Aconitum  Napellus,  (Monk's Hood.)   Common name,
Monk's-hood.  This  is a European plant.  The tincture
of  the leaves is  the preparation  mostly used by eclectic
physicians, in doses of from one to  five drops, repeated at
intervals of from one-half hour to  an hour.  It is used in
all fevers and inflammations of an asthenic character.  It
is an active  diaphoretic and  sedative  to  the  circulation,
and at the same time increases the nervous forces.  There
is no remedy known, which possesses greater power to
arrest typhoid and kindred fevers  in their incipient stages.
In  peritoneal inflammation, the tincture  of Aconite  is of
the greatest  importance, frequently  controlling the disease
in  a very few hours.   It may also be used  in dysentery,
erysipelas, cerebral congestion,  croup, hooping cough, &c.
   Much care should be observed in preparing the tincture,
which should be  made from the  recently dried leaves, in
proportion of two  ounces of dried  leaves to  one pint of
diluted alcohol.   After standing  fourteen days, it should
be strained and bottled for use.  The  active principle of
the plant is the aconitine, which may be used  in all  cases
where the  tincture is indicated.  It should be triturated,
one grain to  ten of powdered sugar, and  one grain of the
trituration is a dose, repeated as  indicated.   The proper-
ties are the same  as the tincture.
  Acorus  Calamus, (Calamus, Sweet Flag.)   Used in fla-
tulency. 
MATERIA MEDICA.           1057
  Ac tea. (Actea Alba, White Cohosh.)   Good  in  female
weakness.
  Aetata Rubra, (Red Cohosh.)  Uterine tonic, and good
in rheumatism.
  Actsea Spicata, (Baneberry, Herb Christopher.)   Active
purgative, used in fevers and bilious affections.
  Actimeris, (many species, all called formerly Coreopsis
Alter nifolia.)  Dr. Eoff states that they cure the ringworm
by rubbing with the leaves.
  Adeps, (Lard.)   One  of the principal ingredients of
ointments, and most  cod liver oil.
  Adansonia Digitata, (Boabab.)  Indigenous to Africa;
used by the  natives in fevers.
  Adiantum Pedatum, (Maidenhair.)   A  decoction is  al-
most a specific for leucorrhcea,  used freely, internally, and
as an injection.
  Adicea  Glaberrima,  (Urtica  pumila.)   (Cool  weed.)
Very common.  A decoction is  used in eruptive diseases.
  JEsculus Hippocastanum, (Horse Chestnut.)  A decoction
of the leaves and bark is a valuable remedy in diseases  of
the kidney and bladder.
  JEther Hydrocyamicus, (Hydrocyanic Ether.)   Used in
nervous affections as an external application.
  Aether  Sulphuricus,  (Sulphuric Ether.)  Used as  an
anti-spasmodic and an anaesthetic.
  JEthusa Cynapium, (Fool's Parsley.)   Used  in  dropsy
and dysentery.
  Agaric, (Touchwood, Spunk, Tinder.)  Used as a styptic.
  Agaricus, (Punk.)  Useful to make the Agaric.
  Agave Virgiuica, (False Aloe.)  One of the principal in-
gredients  of consumptive pill, and  is  very valuable  in
phthisis.
  Agnus Castus, (Chaste-tree.)  This  remedy  is  said to
be a valuable antaphrodisiac.
  Aqrimonia Eupatoria, (Agrimony.)   Used in obstructed
menstruation in the  form of wine tincture.
                          S9* 
1058           MATERIA  MEDICA.
  Ajuga Chamepitys, (Ground  Pine.)   A good diuretic.
  Alchemilla Aljmui, (Ladies' Mantle.)   Equivalent to Po-
tentilla.  Also a diuretic.
  Aletris Aurea, (Yellow Aletris.)   Mix, add harsh bitter
root, used in vinegar for dropsical fevers.
  Aletris Farinosa, (Star  Grass.)  Is used in all female
difficulties as a uterine tonic.  Dose of the powdered root,
from three to five grains.
  Alisma Odorata, Raf. Fl. lud., (Sweet Plantain.)  The
whole plant odorous.  Used for  wounds and bruises.
  Alisma Plantago, ( Water Plantain.)  This is used in a
tea, as a remedy in hydrophobia and snake bites.
  Allium,  (Wild   Garlic, Landlauch.)   Several species.
Used in croup and bronchitis in children.
  Allium Cepa, ( Onion.)  Used  as a poultice, and  in the
form of syrup in coughs.
  Allium Sativum, (Garlic.)   Used as a poultice instead
of onions.
  Alnus Rubra, (Tag Alder.)   One of  the best tonics in
debility—may be used freely.
  Alnus Serrulata, (Black  Alder.)  Stomach  tonic and
antiperiodic.
  Aloe Spicata, (Aloes.)  Used in the form of injection to
remove seat worms.  Ten grains to six  ounces of  water,
used at bed time.
  Alpinia  Cardamomum, ( Cardamom.)  LTsed for children
in colic.
  Ahinc Media, (Chickweed.)   Anti-scorbutic and  pecto-
ral.   May  be eaten boiled  for greens.   Birds  are fond
of it.
  Althaea Officinalis (Marsh  Mallow.)  One of the best mu-
cilaginous diuretics in use.  Dose, one teaspoonful pulv. root
in half a tumbler of water, four  or five times a day.
  Althaea Rosea, (Hollyhock.)   It is valuable in constipa-
tion and female  diseases.
  Alumen,  (Alum, Suljdiate of  Alumina and  Potassa. 
MATERIA  MEDICA.            1059
One  or two grains at night, a useful remedy for inconti-
nence of urine.
  Alumina, (Hydraled  Oxyde  of Alamen.)  Used as an
external application in indolent ulcers.
  Amanita, (Mushrooms.)  With gills beneath, and a cen-
tral  support.  Several are excellent for  food.  The best
are A.  Muscaria,  A.  Deliciosa, A. Edulis, A. Campestris,
A. Albella, A. Aurantiaca, A. Procera, A. Ovoidea, &c.
   Amaranthus,  (Amaranth, Princes' Feather.)  A  decoc-
tion drank freely—valuable in dysentery.
   Amaranthus Hypochondriasis, (Amaranth,  Coxcomb.)
A decoction is good in dysentery.
   Amaryllis Atamasco, (Ground Lily, Stagger   Grass.)
 Said to poison  horses and cattle,  producing the  disease
 called staggers.   Beautiful vernal white blossom.
   Ambrosia Trifula, (Tall Ambrosia, Rag Weed.)  Used
 in  prolapsus  uteri and leucorrhcea.  A  strong decoction
 may be drunk freely.
   Ammonia,  (Ammonia.)  Volatile stimulant.  Dose, five
 or ten  grains  in water.
   Ammonise  Hydrochloras, (Chlorohydrate, or  Muriate oj
 Ammonia.)   An alterative.  Used for diseases of the liver.
 Dose, three or four grains.
   Ammonise  Phosphas, (Phosphate of Ammonia.)  Good
 in nervous debility—from three to  five grains a dose.
   Ammonise  Hypoplwsphite.  Also valuable  in  syphilis,
 and in other  diseases where there is great debility.
    Ammonise Spiritus Aromaticus, (Aromatic Spirit of Am-
 monia.)    A valuable  stimulant,  in  ten  or fifteen  drop
 doses.
    Ammonise Carbonas,  (Carbpnate of Ammonia,  Sesqui-
  Carbonale of Ammonia.)   A  volatile  stimulant  and an-
 tacid.   Dose, one or two grains in  water.
    Ammoniacwn, (Gum Ammoniac.)  Is used in syphilis
 and rheumatism.  In four or five grain doses,  two or three
 times a day. 
1060
M A T E E I A  MEDICA.
  Ammonium Aceticum, (Acetate of Ammonia.)  Also a
valuable stimulant.
  Ammonium Muriaticum, (Muriate of Ammonia.)  Used
as an alterative, and to inhale in ozena.
  Ampelopsis Quinquefolia, (American Ivy.)  Is an inva-
luable remedy in scrofula.  Used in the form of a syrup
for  scrofula.
  Amphicarpa Monoica, (Pea  Vine.)  Good in diseases of
the bowels and stomach.
  Amygdala  Communis, (Almond Tree.)   Used  as a
tonic.
  Amygdalus Glabra, (Nectarine.)   Peculiar  species, and
not a variety of peach.  Properties similar to peach, but
much weaker.  Rare  with us.
  Amygdalus Persica, (Peach.)  Is used for  weak sto-
mach, in infusion—drank freely.
  Amylum, (Starch.)  Used as a nourishment, and for in-
jections.
  Amyris Floridana,  (Florida Balsam Tree.)   Properties
similar to maritima and A. Balsamifera, of the West  In-
dies.  Used for weak eyes.
  Anacyclus Pyrelhrum, (Pellitory of Spain.)  Used in
rheumatism.   Dose, twenty or thirty grains.
  Anagal/is Arvensis, (Reel Chickweed.)  Is said to  be an
antidote  to hydrophobia. It cures epilepsy.  Dose, one-half
pint of the infusion often.
  Anagallis  Phenicea,  (Red Pimpernel.)  Used in scro-
fula and consumption.
  Anamirta, (Cocculus Indicus.)  In from one quarter to
one half grain doses, it is said to cure epilepsy.
  Andira Inermis,  (Cabbage Tree Bark.)  Is used  in de-
lirium tremens.   Five to ten grains, a dose.
  Andromeda, Nitida of Carolina,  (Sour tVood, or Pipe-
stem.)   Equivalent of Kalmia, for the itch.
  Andromeda Arborea, (Sorrel Tree.)  Is a diuretic.   A
decoction of the leaves may be drunk freely. 
MATERIA  MEDICA.
1061
  Anemone Nemorosa, ( Wood Anemone, Pulsatilla.)  One
or two drops of the tincture is almost a specific for cuta-
neous erysipelas,  given two or three times a day.
  Anemone  Virginica, (Windbloom.)   Used in syphilis
and eruptive diseases.
  Anethum Feniculum, (Fennel.)  Mild aromatic.
  Anethum, (Dill, Common Dill.)  Same as above.
  Angelica Atropurpurea, (Purple Angelica, Masterwort.)
A tea  sweetened may  be used instead of paregoric  for
children.
  Angelica Lucida, (Angelic root, Belly-ache root, Nendo of
the Virginian Indians.   White Root of the Southern tribes.
Valuable in pleurisy and fevers.  A decoction may be drunk
freely.
  Angustura Vera, (Angustura Bark.)   An alterative and
stimulant, used in syrups.
  Antennaria Margaritaceum, (Pearl-Flowered Life Ever-
lasting.)   A teaspoonful of the gin  tincture given two or
three times a day is valuable for asthma.
  Anthemis  Cotula.—English name,  Wild  Chamomile;
French name,  Chamomile Puante;  German name is  Stin-
kende Kamille.  Officinal names, Cotula, Camomila Spuria.
Vulgar names, May  Weed, Dog's Fennel,  Dilly, Dilweed,
Fieldweed, &c.   The  May Weed may be used in all cases
in which the officinal Chamomile is used.   It is a valuable
tonic in a feeble  condition of the stomach, and a remedy of
much value  in leucorrhcea, prolapsus uteri, and other dis-
eases dependent  upon a feeble and lax condition of the mu-
cous membrane.   Dose, one ounce made into an infusion
by adding one-half pint of boiling water, and  drank ad li-
bitum.
  Anthemis Nobilis,  (Chamomile,  Roman Chamomile.)
One of the very  best tonics, used freely.
  Antimonium Crudum, (Crude Antimony.)  An  irritant
poison.
  Antimonium  Tartaricum,  (Tartar Emetic.)   Used as 
1062
MATERIA  MEDICA.
an external application, in the form of an ointment instead
of an irritating plaster.
   Apios  Tuberosa, (Indian Potato, Potato Pea.)   Used
in dropsical diseases.
   Apium Graveolens, (Cellery.)   An ointment made of the
tops is said to be a cure for herpes.
   Apium Petroselinum, (Common  Parsley.)  A valuable
diuretic in  the form of a decoction drank freely.'
   Apocynum Androssemifolium, (Bitter Root.)   An anti-
dote to syphilis.  Dose, five or ten grains of pulv. root,
also a good diuretic.
   Apocynum  Cannabinum, (Indian Hemp.)  Is a specific
for neuralgia and lung affections.   Used in tincture, infu-
sion and extract.  Dose of the tincture, from ten to twenty
drops.   Of the extract,  one or two grains.  Of the strong
infusion, from a tablespoonful to a half teacupful, three or
four times a day.
   Aquce Calcis, (Lime Water.)   Valuable antacid; and
used with equal parts of sweet oil for burns.
   Aqua  Picis Liquidse, (Tar Water.)   Drank  freely  is
good for  scrofulous and  lung  diseases.
   Aquilegia Canadensis, (Red Columbine.)  A good tonic.
   Arabis Rhomboides, (Meadow   Cress, Equivalent  of
Water Cresses.,)   The tuberous root edible as well  as the
leaves, similar to radishes, taste like Cochlearia.
   Aralia Hispida, (Dwarf Elder.)  Valuable  in dropsy,
gravel, and  diseases of the kidneys and bladder.  Dose,
ten or twelve grains, or  a  strong decoction may be drunk
freely.
   Aralia Nudicaulis, (Small Spikenard.)  Good purifier
of the blood, used in the form of a syrup.
   Aralia Spinosa, (Prickly  Elder.)  An  active  stimu-
lating alterative.  Used in diarrhoea, cholera morbus, and
cholera.
   Arbutus  Uva-Ursi.  English name,  Bear-Berry.   Offi-
cinal name, Uva-Ursi. Vulgar names, Mountain Box, Red- 
MATERIA  MEDICA.
1063
berry, Upland Cranberry.  The Uva Ursi is a remedy,
which manifests its power principally upon  the kidneys.
It increases the quantity of urine, and acts as a slight
astringent to the urethral mucous membrane.   The most
convenient form of using the uva  ursi is  Merrell's Essen-
tial Tincture.  Thirty drops three or four times a day, or
an infusion may be drunk by adding one ounce to a pint of
boiling water, to be used freely.
  Archangelica, (Lamium Album.)   An aromatic stimu-
lant.
  Arctium Lappa,  (Burdock.)   Used in the  form of a
syrup to purify the blood, used in the form of an infusion
as a diuretic.
  Arethusa Bulbosa, (Bulbous Arelhusa.)  The bruised
bulbs useful  for the  tooth-ache, and in  cataplasms  for
tumours.
  Argenti Chloridum,  (Chloride  of Silver.)  Used as a
caustic.
  Argenti Cyanuretum, (Cyanide or Cyanuret of Silver.)
Also a caustic.
  Argenti Ammonise Chloridum,  (Ammonio-Chloride  of
Silver.)  Used in one-sixteenth grain doses, in ulceration
of the bowels.
  Argenti Nitras, (Nitrate of Silver, Lunar Caustic.) Used
as a caustic.
  Argenti Oxidum, (Oxide of Silver.)   Use the same.
  Argilla Pura, (Pure Argil or Alumina.)
  Aristolochia Serpentaria,  (Virginia  Snakeroot.)  Ex-
pectorant.  Used in  syrups.   Is  good in female and lung
diseases.
  Armoracia  Radix,  (Horse-radish.)   An  extract is a
cure for  chronic gonorrhoea.  Also, good  in rheumatism
and gout.
  Arnica Montana,  (Leopard's  Bane.)  Ten  or fifteen
drops of  the tincture in half  a tumbler of water, and  one 
1064
MATERIA  MEDICA.
 teaspoonful every two hours, good for sore mouth—also,
 for bruises, sores, &c.
   Aronia  Ovalis, (Juneberry, Shadtree, Misascuta of Al-
 gic Tribe.)  A decoction is a good antiperiodic.
   Artemisia Absinthium, (Wormwood.) The tincture is a
 tonic and vermifuge.
   Artemisia Vulgaris, (Mugwort.)  Antiseptic, stomachic,
 detergent, deobstruent, laxative, diuretic, diaphoretic, me-
 nagogue, corroborant, antispasmodic, and vermifuge.  Use-
 ful in hysterics,  spasms, palpitations of the heart, worms,
 obstructions, &c, in tea, infusion or powder.
   Arsenias Ammonise, (Arsenate of Ammonia.)  Used by
 some as an external application  in  cancer.   Is a violent
 poison.
   Arsenice Iodidum, (Hydriodate of Arsenic.)  A violent
 poison,  and should not be used internally.
   Arum Triphyllum, (Dragon Root, or Indian  Turnip.)
 One-half  teaspoonful of the pulverized root, every night,
 is almost a specific for asthma.  Also, good for coughs and
 colds, &c.
   Arum Esculentum, (Eddoes, Tanniers.)   Use same  as
 above.
   Asarum  Canadensis,  (Wild Ginger.)   A strong in-
 fusion drank freely is almost a specific for dropsy of  every
 variety.
   Asarum Europceum, (Asarabacca.)  The pulverized root
is a valuable catarrh snuff.
   Asclepias Carnuti, (Common Silkweed.)   Mild diuretic.
Strong infusion drank freely.
   Asclepias Incarnata, (Swamp Milkweed.)   Its proper-
ties very much resemble the  Cannabis Indica, and may be
used in  all cases as a substitute.   Dose  of the extract, one
or two grains.  Tincture, twenty or thirty drops.
   Asclepias Tuberosa, (Pleurisy  Root.)  A valuable dia-
phoretic.  An infusion drank freely. 
MATERIA  MEDICA.
1065
   Asimina  Papaw, (Custard Apple, Asiminier in  Loui-
 siana.)  An antispasmodic, used in  nervous affections.
   Asparagus Officinalis, (Asparagus.)   A tea of the roots
 is a valuable diuretic.   One pint drank two or three times
 a day is a cure for dropsy.
   Aspidium Felix Mas, (Male Fern.)  A valuable remedy
 for tape-worm.  Dose, twenty or thirty grains three or four
 times a day.
   Asplenium, (Spleenfern.)  Mild astringent, pectoral and
 corroborant,  aperient and diuretic, useful for obstructions,
 gravel, syphilis, to clean the kidneys, hypochondria, &c.,in
 decoction.
   Aster  Puniceus, (Red-stalked  Aster.)  A valuable  re-
 medy for leucorrhcea and prolapsus  uteri.   Dose,  one tea-
 spoonful  of the tincture, or one ounce of the infusion, two
 or three times a day.
   Atriplex Fcetidos, (Orach, A. Laciniata.)  Is refrigerant,
 watery, edible, similar and equivalent to Purslain.  A. Ha-
 lamoides,  Raf, or  Sea  Orach, is similar—also, anodyne;
 useful in gout as a cataplasm, with starch.
   Atropa Belladonna,  (Belladonna.)  Used as  described
 under the head of various diseases.
   Auri Chloridum, ( Chloride of Gold.)   Used in consump-
 tion—one-tenth to one-twelfth portion of a grain.
   Auri et Sodii Chloridum,  (Hydrochlorate or Muriate of
 Gold.)  Used as an eye wash, and for indolent ulcers.
   Auri Iodidum, (Iodide  or Ioduret of Gold.)  Used the
 same.
   Avena Sativa (Common Oats.)  Seeds nutritive, demul-
cent, refrigerant—equal to barley, in fevers, as a gruel.
   Azalea  Procumbens,  (often called Swamp Pink, Wild
Honeysuckle, Springbloom.)  Good in dysentery; a decoc-
tion  may  be drank freely.
   Bacharis Halimifolia, ( Groundsel tree, Pencil tree.)   It
is a mild diuretic.
90 
1066
MATERIA  MEDICA.
  Balota Lanata, (Leonurus Lanatus.)  Good in hysteria
and nervous affections.  A decoction may be drunk freely.
  Balsamodendrin Myrrha, (Myrrh.)  A valuable antisep-
tic.  Dose, five to ten grains.
  Bambusa Arundinacea, (Bamboo cane.)  Young shoots
are edible,  boiled or pickled.
  Baptisia Tinctoria, ( Wild Indigo.)   The most valuable
antiseptic known.  Used in poultices for gangrene and mor-
tification.
  Barii Iodidum, (Iodide of Barium.)  Used in syphilis,
rheumatism, &c, in  one-fourth to one-half grain doses.
  Barosma Crenata, (Buchu.)  A mild diuretic in strong
infusion, drank freely.
  Beeberia, (Bebeerin,  Berberis Canadensis, Berberis Vul-
garis.)   A valuable antiperiodic and tonic.
  Benzoin Odoriferum, (Spicewood.)  A mild diaphoretic.
Used as a beverage  in fevers.
  Berberis Canadensis.  Other names, Pepperidge bush and
Sour-berry.  In the North  the berries are pickled.   A tea
of the bark is used for indigestion, and  an  infusion in wine
as purgative.   The  root and bark, with  alum or lye, pro-
duce a beautiful yellow dye for leather  and cloth.
   Berberis Vulgaris, (Barberry.)  Alterative, tonic and ex-
pectorant.   Used in the form  of a syrup, tincture and  in-
fusion.   Dose,  an ounce of tincture two or three times a
day.  Is  said  to  be almost a  specific for jaundice.  One
ounce of the syrup  three or four times a day is a valuable
tonic in lung disease.
   Beta  Vulgaris,  (Garden Beet.)   Leaves diluent, refrige-
rant—useful in sore eyes, headache, toothache, coryza, &c,
applied on the parts; the best dressing for inflammations, &c.
   Betula Lenta,  (Black Birch.)  A warm  infusion  drank
freely.   Is an invaluable remedy in diseases of the bladder.
Also a  good diuretic.
  Bidens Bipinnata,  (Spanish Needles.) A strong infusion is
a valuable emmenagogue. One gill should be taken on retiring. 
MATERIA  MEDICA.
1067
  Bignonia, (Several species.)  Also an emmenagogue and
diuretic.
  Betrychium Virginicum, (Rattlesnake Fv.rns.)   Mild as-
tringents.
  Bismuthi Viderianas,  (Bismuthum  Valerianicum.)   A
valuable tonic in nervous affections.
  Bismuthum, (Nitrate of Bismuth.)  Used in about two
grain doses for chronic dyspepsia.
  Botrophis, (Add.)  Used for rheumatic pains, diseases
of languor, and scirrhous tumours, in tincture or  decoc-
tion, by the Cherokees and Southern tribes.
  Brayera Anthelmintica, (Kausso, Casso.)   A  good re-
medy for  tape-worm.  Dose, one or two  drachms  of the
flowers, followed by a brisk purge.
  Brasenia Hydropeltis.   (English name,  Watershield;
Officinal name, Gelatina aquatic a, Brasenia; Vulgar names
Frogleaf, Little Water  Lily, Water Jelly, Deerfood. Uses :
Mucilaginous  and  demulcent tonic—may be used instead
of Iceland moss, marsh mallow,  and other mucilages.  Cold
infusion may be boiled into a jelly.
  Brassica Oleracea, (Cabbage.)  Well-known vegetable,
healthy, antiscorbutic,  pectoral  when boiled, raw in cold-
slaw, or pickled, in sourkrout, almost indigestible.
  Brassica Rapa, (Turnips.)   Nutritive,  diluent,  flatu-
lent, aphrodisiac, diuretic.
  Bromelia Ananas, (Pine-apple.)   A delicious fruit, diu-
retic, menagogue and aphrodisiac.
  Bromus Purgans,  (Broom  Grass, Medical Grass.)   Su-
dorific, vermifuge,  laxative, diuretic, &c.
  Brominum, (Bromine.)  A homoeopathic remedy for most
pulmonary diseases.
  Bryonia Alba,  (Bryony,  Zetter  Berry,  Wild Hops.)
Valuable in all granulated conditions of the mucous mem-
brane.
  Bumelia, (Nigra.)  Bark of  several species.  Tonic and
febrifuge.
  Buxus Sempcrvirens, (Box.)   A mild cathartic and al- 
1068
MATERIA  MEDICA.
terative.  Three or four grains of the pulverized wood may
be taken every two or three hours.  Used in syphilis and
rheumatism.
   Cacalia,  (Caraway.)   Many species.   Good in flatu-
lency.
   Cactus.  Almost all kinds have edible fruits, acid and
grateful.
   Cadmii  Sulphas,  (Sulphate  of  Cadmium.)   Used  in
eruptive  diseases.  Twenty grains to one pint of compound
syrup of stillingia.
   Calcaria Chlorata, (Chloride  of Lime.)   Disinfectant.
   Calcaria Phosphorica, (Phosphate of Lime.)  Valuable
in phthisis and diseases of the bones.
   Calendula Officinalis, (Garden Mary gold.)   A good al-
terative  in  scrofulous  and  cancerous affections.   Dose,
one gill of  the infusion—or it may be used in the form of
syrup.
   Gall a  Palustris, (Swamp robin.)  Roots acrid and caus-
tic  like Arum,  yet by  drying,  grinding, macerating and
boiling, a fine meal and bread  is  made in Sweden, very
palatable.
   Callithrice  Verna, ( Water Stanrort.)  A good diuretic.
  Callicarpa Americana, (Sourbush.)  Leaves useful for
dropsies in decoction,
   Calotropis Gigantea, (fMudar or Madar.)  Is an altera-
tive and  sudorific.
   Calycanthus Floridus, (Sweet Shrub, Allspice.)  Used
as an aromatic.
   Campanula Glomerata.  Stated  to be valued in  Russia
as efficacious in hydrophobia.
   Camphora,  (Camphor.)   A  one or two  drop  dose of
the tincture repeated every five or ten minutes, is valuable
in cholera morbus or cholera.
   Canella  Alba, (Cunclla.)  A mild  aromatic stimulant.
Used in infusion.
   Cannabis Sativa or Cannabis Indica, (Hemp.)   A va- 
MATERIA  MEDICA.           1069
luable remedy in all nervous affections.   Used in delirium
tremens, insanity, &c.   Also in lung affections.  Dose,
from one to ten grains of the extract.   Dose.of tincture,
from twenty to sixty drops.   This remedy has been exten-
sively vended as  a quack  nostrum to cure  consumption.
Experience has shown it to be of little value.
   Cantharis  Vesicatoria, (Spanish Fly.)  Used in sperma-
torrhoea and  leucorrhcea in very small doses.
   Caoutchouc, {Gum Elastic, India Rubber.)   An active
astringent.   Dose, two or three grains.
   Capraria Biflora,  (Carib  Tea.)   Astringent and tonic.
   Capsicum  Annum,  (Cayenne Pepper.)  Pure  stimulant-
May be used in all cases where stimulants are indicated.
Dose, from one to ten grains.
   Carbo Animalis, (Animal Charcoal.)  Good  preventive
 of mortification.   Used in poultices.
   Carbo  Ligni,  (Charcoal.)   Good  preventive of mortifi-
 cation.  Used internally.
   Cardamine Pratensis, (Ladies' Smock.)   Equivalent of
 Nasturtium, but more  diuretic, nervine and diaphoretic.
 Root said to be purgative.
   Carex, Crcnaria, (Sedge.)  Edible, stomachic, diuretic.
 Equivalent of Sarsaparilla, Gayac, and Dactylon.
   Carica Papaya, (Papay.)  Milk of the unripe fruit, a fine
 vermifuge,  one dose  said to kill all worms, even the tape-
 worm.  A dose of castor oil is taken next to expel them.
    Carlina  Acaulis,  (Ground Thistle.)  Bitter,  aromatic,
 acrid,  graveolent, sudorific and stomachic; useful in hyster-
 ics and hypochondria.
    Carthamus  Tinetorius,  (Dyer's   Saffron.)   Enimena-
 gogue. An infusion.   May be used freely.
  3 °Carum Carui, (Caraway.)   A mild aromatic.
    Caryophyllus Aromaticus, (Cloves.)  One of the  ingre-
 dients of the anti-bilious physic.
    Cassia Acutifolia, (Senna.)  Five  or ten  grains is a
 rmro-e   One of the  components of the anti-bilious physic.
 1  &  '                    90* 
 1070           MATERIA MEDICA.

    Cassia Fistula, (Purging Cassia.)  One or two drachms
 acts as a purge.
    Cassia Marilandica, (American Senna.) Mild cathartic.
    Cassine  Peragua, (Ilex  Vomitoria.)  Leaves bitterish,
 sudorific and  diuretic,  vomitive and  purgative in strong
 decoctions called black drink by the Indians.   Said to be
 Useful in gravel, nephritis, diabetes, fevers and small pox.
    Castanea Pumilla,  (Chestnut.)   A decoction  of the
 leaves is an astringent and diuretic.
    Castoreum,  (Castor.)   An  antispasmodic.    One  tea-
 spoonful of the tincture is a dose.   Used in hysteria.
    Catalpa Cordata, (Catalpa or Cataba  Tree.)   Leaves
 useful in cataplasms in parturition and nervous pains.
    Caulophyllum Thalictroides, (Blue   Cohosh.)  Used in
 female diseases in the form of tea.
    Ceanothus Americanus, (Redroot.) (Jersey Tea.)   Alte-
 rative.   A  valuable remedy  in  chronic affections  of the
 liver.  Also in secondary syphilis.   Dose, one tablespoon-
 ful of strong infusion four or five times a day.
   Celastrus  Scandens,  (False Bitter Sweet.)   Alterative
 and diuretic.  Good in dropsical affections and  scrofula.
 Dose, one or two tablespoonfuls of decoction two or three
 times a day.
   Celtis  Crassifolia, (Nettle Tree, Hackberry in the  West,)
 (Sugar Berry  in the South.)  Berries useful in dysentery.
   Centaurea Benedicta, (Blessed Thistle.)  It is said to
be a reliable remedy in epilepsy.
   Cephaslis Ipecacuanha,  (Ipecacuanha.)  Emetic in five
or ten grain doses.
   Cephalanthus  Occidentatis, (Button-bush.)    Febrifuge
and diuretic.   Used in  gravel and fevers.  One gill of in-
fusion taken two or three times a day.
   Cera Alba, (White Wax.)   Cera Flava, (Yellow  Wax.)
Used in ointments.
   Cerasus Serotina, ( Wild Cherry, Black Cherry,  Choke
 Cherry.)   An  anti-periodic, (see Ceracein.)
   Cerecisice Fermevtum,  (Yeast.)   Good   preventive of 
MATERIA  MEDICA .
1071
mortification.  Used internally and in the form of a poultice.
   Cesalpina Brasiliensis, (Brazil  Wood.)  Blossoms are
emmenagogue.
   Cetaceum,  (Spermaceti.)  Good in  coughs and colds.
Sometimes used in consumption for cod liver oil, for which
it is a very good substitute.
   Cetraria Islandica, (Iceland Moss.)  Good mucilage in
coughs and colds, drank freely.
   Chamcerops  Palmetto, (Palm  Tree.)   A  decoction  is
good in lung diseases.
   Chara  Hispida, (Water Feathers.)   Said to be anti-
spasmodic and vermifuge.
   Cheirsinthus Cheiri,  (Wallflower.   Called Bitter Root
by the Indians.)   Intensely bitter, used as a tonic.
 '  Chelidonium Majus, ( Great Celandine.)   One of the in-
gredients of celandine ointment.   Five or  ten drops of the
tincture four or five times a day, is a good remedy for piles.
   Chelone Glabra, (Balmony.)  One of the best stomach
tonics—promotes digestion and removes dyspepsia.  Dose
of an infusion of the leaves, one half tea-cup full three  or
four times a day.
   Chcnopodium  Anthelminticum,  (Wormseed.)   A good
remedy for worms.  Three or four grains of the pulv. herb
given at bed time.
   Cherophyllum Sativum, (Chervil.)   Cultivated condi-
ment,  stimulant, diuretic; root, leaves, seeds, oil, and ex-
triot T1S6Q.
    Chimanthus  Amygdalites, (Winter  Laurel, Laurier
Amande in Louisiana.)  Used in constipation, dyspepsia,

    Chimaphila  Umbellate,, (Pipsisseica.)   One  of  the best
 diuretics and antiseptics in materia medica.  May be used
 in an infusion or  syrup freely.  Useful in all cases of de-
bility scrofula, consumption and  cancerous affections.
    Chiococca Raeemosa, (Cahinca.)  This is used for sy-
 philis and  necrosis, or diseases of the bowels  in  twenty
 grain  doses. 
1072
MATERIA  MEDICA.
   Chionanthus Virginica, (Fringe Tree.)   A strong infu-
sion  drank freely through the  day,  is said to break up
ague.
   Chloroformum, ( Chloroform.)   Should only be used in
form of a liniment,  and anaesthetic.
   Chondrus Crispus, (Irish Moss.)  This may be used the
same as Iceland Moss.
   Chrosperma, (Redseed.)   Equivalent to Abalon, a nar-
cotic poison.
   Chrysanthemum  Leucanthemum, (White weed,  Daisy,
Goldens.)  Used for wounds, asthma, phthisis and taenia.
   Chrysophyllum Buranheim, (Monesia Bark.)  A stimu-
lant and tonic.
   Chrysosplenium Americanum, ( Water Carpet.)  Succu-
lent,  acrid, substyptic,  aperient,  corroborant;  used for
coughs, asthma and abdominal diseases.
   Cichorium Intybus, (Succory.)  Used as a diuretic and
tonic.   Dose, one or two drachms of the infusion.
   Cimicifuga Racemosa, (Black Cohosh.)  Used in rheuma-
tism and female diseases.  Five or ten  drops of the tinct.
four  or five times a day, is a  valuable  remedy in leucor-
rhcea.
   Cicuta Maculata.—American Hemlock.  Officinal name,
Cicuta Americana.  Vulgar names, Snake  weed,  Death of
man, Water parsley, Poison root, Wild hemlock, Children's
bane.  This article  is an active, narcotic poison; yet from
one half to one grain doses of the pulverized  leaves have
been used for painful neuralgic affection.   Also,  Scirrhus
and other tumours of a painful character have been bene-
fited by an application of the  Cicuta in the form of oint-
ment and otherwise.
   Cinnamomum Zeylanicum, ( Cinnamon.) A tea of cinna-
mon  is excellent to  allay vomiting.  Also, to arrest morn-
ing sickness in pregnancy.   It is also  used in dysentery.
   Cinchona, (Peruvian Bark.)  Antiperiodic  and tonic. 
MATERIA  MEDICA.            1073
   Circea Lutetiana.  Leaves useful in  decoction and cata-
plasm for piles and condyloma.
   Cirsium Arvense, (Canada Thistle.)   The syrup is said
to be valuable for skin diseases.
   Cissampelos Pareira, (Pareira Brava, Ice Vine.) Diu-
retic and tonic.
   Cistus Canadensis, (Frostwort, Rock Rose.)  Used for
curing scrofula, in decoction and cataplasms.
   Citrullus Colocynthis, (Colocynth, Bitter Cucumber.)  An
active hydragogue purge.
   Citrus Aurantium, (Orange.)  Orange peel is used as a
tonic in debility.
   Citrus  Limonum,  (Lemon)—Citrus  Acida,  (Lime.)
May be used, in the  form of  a  syrup, in scorbutic affec-
tions.
   Citrus Vulgaris, (Bitter Orange,  Seville  Orange.)
   Cladrastis Tinctoria, (Ash, Fustic Tree, Yellow Locust.)
Anthelmintic.
   Claytonia, (Pigroot.)   Antiscrofulous in cataplasms.
   Clematis  Virginiana, (Virgin's  Bower.)    One  or  two
ounces of the infusion once or twice a day is valuable for
impotency.
   Cleome Felina.  Used  in India,  bruised with milk and
sugar, against epistaxis.
   Clinopodium, (Dog-mint.)   Equivalent of Nepeta, much
weaker.
   Clintonia.  Leaves used by Algic Tribes as a plaster for
bruises and old sores.  Applied  wet or bruised.
   Cnicus, ( Thistles.)  Leaves of many hepatic—correct the
bile in decoction or powder.
   Cnidium  Canadensse, (Wild  Chervil.)   Mucilage  and
diuretic.
   Coccoloba Uvifera, (Seaside Grape.)  Fruit causes cos-
tiveness.   Good for diarrhoea.
   Cocculus  Palmatus,  (Colombo.)   Used  as a  tonic  in
bitters. 
1074            MATERIA  MEDICA.

   Coccus  Cacti, (Cochineal.)  From one half to one grain
two or three times a day, in the form  of  simple syrup, is
good for hooping-cough.
   Cochlearia Armoracia, (Horseradish.)   A valuable  re-
medy for gonorrhoea.
   Cochlearia  Officinalis, (Scurvy Grass.)   Antiscorbutic,
acrid, pungent, diuretic, and stimulant.
   Coffea Arabica, (Coffee.)   Used mostly as an  antidote
to opium.  Two or three ounces of strong infusion should
be given and repeated every ten or fifteen minutes.
   Colchicum Autumnale, ( Colchicum.)  Used in rheumatism
and as a diuretic.
   Collinsonia Canadensis, (Stoneroot.)  Ox  balm.  A tea
of the  leaves is an  excellent diaphoretic in fevers.  The
pulv. root sprinkled upon cancers is said to  be very bene-
ficial.
   Collodion, (Ethereal Solution of Gun Cotton.)  Used for
abraded surfaces.
   Colutea Aborescens, (Bladder Senna.)  Leaves purgative.
Dose, one to three ounces in decoction.
   Comandra Umbellata, (Toad Flax.) Used for fevers by
the Algic Tribes.
   Commelina Angustifolia, (Dayflower.)  Root antifebrile.
Leaves eaten by the  Indians as greens—emollient, pectoral
and anodyne.
   Comptonia Asplenifolia, (Sweet Fern.)  A reliable anti-
septic  and tonic.  Used in all cases where there  is a ten-
dency to mortification.  Dose, one or two ounces of the  in-
fusion  three or four  times a day.  An infusion of the leaves
is a valuable injection for leucorrhcea.
   Conium Maculatum, (Poison Hemlock.)  From one-fourth
to one  grain of the extract is used in epilepsy.
   Conocarpus Erecta, (Buttonbush.)   Root  antisyphilitic
in decoction.
   Convallaria Multiflora,  (Giant Solomon's Seal.)  A de- 
MATERIA  MEDICA.
1075
coction used  freely is said to be valuable  for coughs  and
colds.
  Convolvulus  Panduratus,  (Wild  Potato, Man  of the
Ground.)  A  syrup  made  of  this  article,  taken  in
doses of half a wine-glass  full three or four times a day  is
an invaluable remedy for consumption.
  Convolvulus Scammonia, (Scammonyf) An active purge.
One of the ingredients of the compound  cathartic pill.
  Conyza Camphorata,  (Plowmanwort.)  Stimulant, anti-
spasmodic, nervine.
   Copaifera   Officinalis,  (Officinal  Copaiva  Tree.)   A
balsam of  this is  extensively used in gonorrhoea.  From
one half drachm to a drachm three or four times a day.
   Coptis  Trifolia, (Goldthread.)  A wash made  of this
article is valuable  for aphthae, or sore mouth.  It may also
be taken internally for the same purpose.
   Corallina  Officinalis.   Vermifuge and absorbent.
   Corollorhiza Odontorhiza,  ( Crawley.)  This operates spe-
 cifically upon  the  superficial capillaries.  It is  one of the
 most reliable diaphoretics known.  Dose, one or two grains
 of  the pulverized root;  or from ten to thirty drops of the
 tincture.
    Coriandrum Sativum, (Coriander.)   Carminative and
 tonic.  Used in the form of a tea drank freely.
    Cornu Cervinse Ustum, (Burned Deer's Horn.)  One  or
 two grains of  this is said to be a specific  for  uterine he-
 morrhage.
    Cornus Circinata, (Round-leaved Dogwood.)  A strong
 antiperiodic.   It may be used instead of quinine.  Dose, a
 gill of the infusion three or  four times  a day.
    Cornus Florida, (Dogwood.)  Is  used in all cases as a
 substitute for Peruvian bark.  The flowers, tinctured in gin,
 are valuable for leucorrhcea.
    Cornus Sericea, (Swamp Dogwood.)   One or two ounces
 of the infusion is an invaluable remedy for dyspepsia. 
1076
MATERIA  MEDICA.
   Corydalis Formosa, (Turkey Pea.)   One of the  ingre-
dients of the compound syrup of stillingia.  It is a valuable
remedy in syphilis.   Dose, two or three grains of the pul-
verized two or three times a day.
   Corylus Americana,  (Hazelnut,  Filbert.)   Good fruit,
giving relief in nephritis.
   Corypha Gebanga.   The stem is an inferior sort of sago.
Root slightly astringent  and  emollient, used in bowel com-
plaints.
   Crategus, (Hawthorn, Thorn Trees.) Many species. Fruits
of several make  fine stomachic preserves, useful for diar-
rhoea, and anti-emetic;  such as Cr. Coccine, Cr. tomentosa,
Cr. crusgalli.   Leaves and flowers of the last  used as a pec-
toral in coughs, and in hooping-cough as a tea.
   Creasotum,  (Creasote.)  A valuable  antiseptic.   Dose,
from one-half to two drops.  It is used in all  cases of great
debility, and where  there is  a tendency to gangrene and
mortification.
   Creta Preparata, (Prepared Chalk)  Used as an antacid.
Dose, three or four grains.
   Crinum Americanum, (Louisiana Squill.)   Used  as an
expectorant.
   Crocus Sativus, (Saffron.)  Dose, from five to ten grains.
Used mostly as an emmenagogue.
   Croton.   Cr. Eleutheria, Cr. Cascarilla, Cr. Odorifera,
and Cr. Balsamifera.  Bark aromatic, fragrant, smoke musky,
taste pungent, bitter.  Contains resin, volatile  oil,  muci-
lage, and a bitter  principle.   Tonic, carminative, stimulant,
pectoral, eccoprotic, &c, useful in dyspepsia, asthma, fevers,
measles, flatulent colic, diarrhoea, &c.
   Cucumis Colocynthus,  ( Colocynth.)  Dose, from three to
five grains.   An  irritant purge.
   Cucubalus Behen,  (Campion Pink,  Sea Pink.)  Root
anthelmintic, emetic in large doses.
   Cucurbita  Citrullvs,  (Watermelon,)  Cucurbita   Pepo,
i 
MATERIA MEDICA.          1077
(Pumpkin.)  The  seed is the  part principally used.   See
treatment for tapeworm.
   Cubeba,  (Cubebs.)  Diuretic and  astringent.   Used in
chronic gonorrhoea.  Dose, ten grains.
   Cunila Mariana, (Dittany.)  Nervine tincture.   Used
freely is a  valuable remedy for consumption.  Dose, one
wine-glassful three times a day.
   Cupressus  Thyoides, (White  Cedar.)   Infusion of the
wood stomachic.
   Cupri Sulphas, (Sulphate  of Copper,) (Blue Vitriol.)
Used as a caustic in cancer.   Also one of the components
of the  hair tonic.
   Curcuma Longa, (Turmeric.)  Used in tincture.   One
or two teaspoonfuls a dose.
   Guscuta Americana, (Dodder, Devil's Gut.)  Bitterish,
sub-astringent, stomachic, febrifuge, anti-scrofulous; useful
in decoction for agues and scrofula.
   Cycadacea Revoluta affords a kind of sago.   The C. Iner-
mis has much the same properties.
   Cydonia Vulgaris, (Quince.)  A syrup made of the fruit
 is a specific for land and sea scurvy.  The seeds are valua-
 ble  for gonorrhoea.
   Cynanchum Acutum.   Used as a  drastic purgative.  It
 acts violently on the bowels, and causes much pain.
   Cynara Scolymus, ( Garden Artichoke.)  A syrup of this
 article has been known to cure dropsy of the heart.
   Cynodon  Dactylon,  (Dogh  Grass,  Bermuda Grass.)
 Much used in Europe in decoction,  to cool and purify the
 system.
    Cynoglossum  Officinale, (Hound's  Tongue.)   A  strong
 infusion of this will arrest hemorrhage.   It is also used in
 dysentery.
    Cyperus, (Bullrush.)   Roots edible, sudorific, diuretic;
 useful after fevers.
    Cypripedium Luteum.  The  flowers of this fine genus
         91 
1078
MATERIA  MEDICA.
are favourites with the Indian women to deck their hair
I have been informed that in Onondaga, and other western
counties of New York, several physicians rely upon a de-
coction of the roots of C Spectubile as a valuable anti-
spasmodic, which proves an effectual remedy in many cases
when the common medicines have  failed.   Dose, a table-
spoonful of the decoction, made by two ounces of the root
in a pint of water.
   Cypripedium Pubescens, ( Yellow Lady's Slipper.)  Ner-
vine.  A tea of this drank freely will cure nervous head-
ache.  Used in all cases of nervous  affections.  Dose, one-
half gill of infusion three or four times a day.
   Cytisus Scoparius,  (Common Broom.)  The fresh tops
and seeds made into a strong tea, is a reliable remedy in
all dropsical  affections.  Dose, one-half  pint  three or four
times a day.
   Datura Stramonium, (Stramonium.)   The extract and
tincture are used  mostly in epilepsy and nervous affections.
Dose, one-fourth of a grain of the extract, and three or four
drops of the  tincture.   It is also used in ointments.
   Daucus Carota, ( Wild Carrot.)  This is used in infu-
sion for gravel.  Dose, a  tablespoonful three or four times
a day.
   Delphidium,  (Larkspur.)   Many genera blended  here.
Staphisagria,  Consolida, Ajaxia, Plectromis.  LTsed in dis-
eases of the urino-genital organs.
   Dendropogon Useneoides, (Spanish Moss.)   Used in sudo-
rific baths.   The infusion is pectoral in catarrh, asthma, &c.
   Dianthus Caryophyllus, (Clove Pink, Carnation.)  Fra-
grant flowers, cordial,  sudorific, alexitere; used in potions,
conserves, and to give a pleasant flavour and  colour to me-
dical syrups, &c.
   Diclythra,  (Colic Weed, Dutchman's Breeches.)   Root
used for tumours; when  eaten, gives the colic; the decoc-
tion purifies  the blood. 
                MATERIA  MEDICA.           1079

  Diervilla  Canadensis, (Bush Honeysuckle.)   Diuretic,
astringent, and alterative.  Dose of the infusion, one gill,
three or four times a day.
  Digitalis Purpurea,  (Foxglove.)   Used  in  dropsy, and
as a sedative in diseases of the heart.   Dose of the tincture,
from twenty to thirty drops.   Of the powder, from one to
two grains.
  Dioncea Muscipula,  (Venus' Flytrap.)   Irritable, equi-
valent of Diosera.
  Dioscorea  Villosa, ( Wild Yam.)   A specific for bilious
colic.  Also  good in neuralgia.  Dose,  one tablespoonful
of the decoction every ten  or fifteen minutes.
  Diosma Crenata,  (Buchu Leaves.)  Good diuretic, in
infusion, drank freely.
  Diospyros Virginiana, (Persimmon.)  The bark of the
tree is highly recommended for tapeworm.   Dose of the
infusion, one gill,  three or  four times a day.   A  tea of the
fruit is used  as a laxative.
   Dipsacus,  (Teazel.)  Root tonic, aperient; water held
by the leaves deemed cosmetic.
   Dipteracese affords a kind  of camphor.   The Vateria In-
dica furnishes the East Indian Copal, or Gum Anim.
   Dirca  Palustris, (Leatherwood.)   A  tincture of this is
used as a liniment in rheumatism.   Five or ten drops  in-
 ternally, is also a good remedy for chronic rheumatism.
   Dolichos Lacteus, (Cowage,  Cow-Itch.)  D. Lacteus has
 yellow edible seeds, depurative and anodyne.
   Dorema Ammoniacum, (Gum Ammonise.) Good in rheu-
 matism, gout, and syphilis.  Dose, one to three grains.
   Dorstenia Contrayerva,  ( Contrayerva.)  It is a stimulant
 and diaphoretic.  Dose in powder, thirty grains.
   Drosera  Rotundifolia,  (Sundew.)  Deemed  pectoral  in
 South America; a syrup used for asthma.
   Drimys Wiuteri, (Winter's Bark.)  Used in typhoid and
 typhus fever.  From ten to twenty grains of the  pulverized
 bark is a dose. 
1080
MATERIA  MEDICA.
  Echuim Vulgare, (Blue Tliistle.)  Equivalent of Borrago,
pectoral, depurative, antiepileptic.
  Eclipta.  E.  ciliata  is poisonous, smelling like Cicuta,
with a very acrid taste.
  Electro-Punctura, or Galvano-Puncture.   Used in some
cases of palsy.
  Epigcea Repens,  (Trailing Arbutus,) (Mountain Pink or
May Flower.)  Lithontriptic  and diuretic.   Dose, one gill
of the infusion two or  three times a day.
  Epilobium, (Indian Pink.)  Diaphoretic and  diuretic
in decoction.
  Epilobium Angustifolium, (Willow Herb.)  An  astrin-
gent, demulcent and tonic.  Dose, a tablespoonful of the in-
fusion every hour.
  Epispasticus or Vesicants.
  Equisetum Hyemale, (Scouring Rush.)   Diuretic and al-
terative.  Used in  scrofula.   Dose, two or  three ounces of
the infusion.
  Erechthites Hieraeifolius, (Fireioeed.)   The oil is a spe-
cific for piles.  Made  into an ointment, and applied exter-
nally, and four or five drops  taken internally.  It is  also
used in typhoid fever, dysentery, and asthma.
  Ergot, (Spurred or Smut Rye.)   Used in five or ten
grain  doses as a parturient.
  Erigeron Canadense, (Canada Fleabane.)   The herb is
 used in infusion in dysentery.   The oil is a specific for ute-
 rine hemorrhage.  Dose, from five to twenty drops.
  Erigeron Heterophyllum,  (Various  Leaved Fleabane?)
Erigeron Philadelphicum, (Philadelphia Fleabane.)   Pro-
perties same as the above.
  Eriophorum, (Cotton Grass.)  Emenagogue and diure-
tic.
  Eryngium Aquaticum, ( Water  Eryngo.)  Diuretic, sti-
mulant, diaphoretic, and alterative; used in syphilis.  Dose
from twenty to thirty  grains of the pulv. herb. 
MATERIA  MEDICA.            1081
  Erysimum  Officinale,  (Hedge  Mustard,)  astringent.
Diuretic, used for  asthma, cough, ischuria.  The E. allia-
ria is detersive, aperient, incisive and attenuant, used in
dysentery and hysterics.
  Erythoxylon Luberosem.  An aromatic stimulant.  Dose,
from one  to three grains of the pulv. bark, also used in
tincture.
  Erythrina Herbacea, (Coral Bloom.)   Roots sudorific,
flowers pectoral.
  Erythronium Americanum, (Adder's Tongue.)  Used in
chronic dyspepsia.  It makes a cooling and emulcient drink
in fevers.   A decoction may be used freely.
  Esopon Glaucum.  Equivalent of Chicorea.
  Eudistemon, (Pepper Grass.)   A mild tonic, astringent,
diuretic.
  Eugenia,  Pimenta, (Pimento, Allspice, Jamaica Pepper,
Bayberry Tree.)  An aromatic and  stimulant  in  two or
three grain  doses.
  Euonymus Atropurpureus, ( Wahoo.)  An ounce of bark
in a quart of  gin, and a tablespoonful taken three or four
times a day, is one of the best remedies for chronic affection
of the liver.   A decoction of the bark may be used where
a mild alterative and cathartic is indicated.
   Eupatorium Aromaticum, (White  Snakeroot.)   A  de-
coction is used in hysteria.   Dose, one-half teacupful three
or four times a day.
   Eupatorium  Perforatum,  (Boneset.)  A cold infusion
taken in half teacupful doses three or four times a day,  is
an excellent remedy for bilious affections, weakness of the
stomach,  chronic derangement of the bowels, &c.  A warm
decoction operates as an emetic and mild purge.
   Eupatorium Purpureum, ( Queen of the dleadow.) Used
in gravel, leucorrhcea, and prolapsus uteri.  Dose of the
strono- decoction  one-half teacupful three or four  times a 
1082
MATERIA  MEDICA.
   Eupatorium Teucrifolium, ( Wild Horellound.)   Antipe-
riodic and alterative.  A gin-tincture of this article is valu-
able in chronic ague.
   Euphorbia  Corallata (Large Flowering Spurge.)  Eme-
tic, diaphoretic, and purgative.   From eight to ten grains
is a dose of the pulv. root.
   Euphorbia  Hypericifolia (Large Spotted Spurge.)  As-
tringent and anodyne.   Used in infusion.   One ounce taken
every two or three hours to allay pain and nervousness.
   Euphorbia  Ipecacuanha (American Ipecacuanha.) Eme-
tic, and operates in about the same doses  as the English
ipecac.
   Euphorbium Officinale, ( Wolf's  Bane.)   Emeto-cathar-
tic in dram doses.
  Euphrasia Officinalis, (Eyebright.)  One pint of a strong
infusion taken three or four times a-day, is a cure  for epi-
lepsy.
   Euonymus   Atropurpureus,   (Spindlebush,  Wahoo.)—
Leaves pectoral, fruits emetic, decoction or powder equiva-
lent of Sabadilla and Staphisagria for the itch and destroy-
ing vermin.   Also good alterative for the  liver, in five or
ten grain  doses of the pulverized bark.
   Feclia Radiata, (Lamb, Lettuce, Corn Salad.)  Deemed
diuretic and useful for hypochondria.
-   Fel Bovinum, ( Ox or Beef's Gall.)  Beet's gall and vi-
negar, used externally to bathe the neck, is almost a  sure
cure for quinsy.
   Ferri et Pulvis, (Iron by Hydrogen.)   Good  Tonic.
   Ferrum, (Iron.)  The different preparations are used in
all cases where there  is lack of iron in the blood.   The
phosphate, pyro-phosphate, iodate,  acetate,  and  muriate
tincture, are among the best preparations used.   Dose of
the phosphates and carbonates, from one to five grains; of
muriate tincture, from three to ten drops.
  Ferula  Assafcetida, (Assafcetida.)   Anti-spasmodic and
laxative. 
MATERIA  MEDICA.
1083
   Filinguis, (Hart's Tongue.)   Astringent ointment made
with oil for burns and piles; in tea for diarrhoea and dysen-
tery.
  Filices, (Ferns.)  All fragrant kinds  pectoral, anthel-
mintic,  often edible.
  Foeniculum  Vulgare,  (Fennel.)  A tea  is good for wind
colic.
  Fragaria  Vesca,  (Strawberry.)   Anti-periodic,  anti-
septic and diuretic.  From one-half ounce to an ounce of
the pulv. root  given between the paroxysms of ague,  will
usually  prevent the return.   A gin tincture of the root is
almost a sure preventive against renewed attacks.  Take
in doses of one wineglassful three or four times a day.
I have used  all portions of the plant and root in  obstinate
and inveterate cases of  ague, and find it equally reliable
with cinchona or any of its preparations.  Of the infusion,
one or two pints should be taken during the intervals of
the paroxysms.  An extract may be made of the  top  and
root, and administered in the form of a pill.   Dose, a three
grain pill every two hours during the interval of ague.
   Frasera Carolinensis, (American Columbo.)   Mild tonic
and alterative.  Used mostly in the form of bitters.
   Fraxinus  Acuminata, (White Ash.)  The extract is used
mostly for eruptive diseases, in the form of ointment.   A
syrup is used  internally in the same disease.
   Fraxinus Sambucifolia, (Black Ash.)   A decoction is
good in scrofulous diseases.
   Fucus Hefminlho-Corton, (CorsicanMoss.)   Used in tea
for gravel, &c.
   Fuligo Ligni, (Soot.)  Used as an antacid.
   Fumaria  Officinalis, (Fumitory.)   Tonic and alterative.
Used in jaundice.
   Galardia  Amara.  Equivalent of Anthemis Nob.
   Galax Rotundifolia,  (Carpenter's Leaf.)  A good ex-
pectorant in lung diseases. 
1084
MATERIA  MEDICA.
   Galbanum, (Galbanum.)  The gum resin of an unknown
plant.   The extract is used as an irritating plaster.
   Galeopsis Grandiflora.  Sold under the name of Blan-
kenheimer Tea.
   Galipea Officinalis,  (Angustura.)  The bark is warming,
diaphoretic  and tonic.  Used in the form of bitters.
   Galium Aparine, (Cleavers.) A valuable diuretic. Used
in all cases in diseases of the kidneys or bladder.  Dose, a
tea-cupful of infusion two or three times a day.
   Galium Verum, (Common Cleavers, Bedstraw, Cleaver-
wort, Goose Grass, Clabbergrass, Milk Sweet, Poor Robin,
Gravel  Grass.)  Good in dropsy and  diseases of the blad-
der.
   Gambogia, (Gamboge.)   The gum resin of an uncertain
plant.   An irritant purge seldom used by Eclectics.
   Gaultheria  Procumbens,  (Winter   Green.)   Used in
syrups to purify the  blood.
   Gautiera  Repens,  (Mountain  Tea.)   Official  name,
Gaultheria.   Vulgar names, Partridgeberry, Grouseberry,
Deerberry, Spiceberry, Teaberry,  Redberry, Wintergrcen,
Redberry tea,  Mountain lea, Groundberry, Ground Ivy,
Groundholly,  Hillberry, Boxberry,  Chequerberry,  <S*c.
Synonyms, Gaullheria, or Gaullheria Procumbens of many
Botanists, fyc.   Used as  a diuretic and to purify the blood.
Dose, ad-quantum.
   Geastrum Actigea,  (Ground  Star.) Dust  inside styptic,
absorbent, ophthalmic, gastritic, &c.
   Gelseminum Sempervirens, (Yellow Jessamine.) Used as
an antidote to  dysentery  and fevers.
   Genista  Tinctoria, (Dyer's  Broom, Greenwood, Wood-
waxen.)  An active diuretic.
   Gentiana  Catesbei, (Catesbian Gentian.)    Officinal
name, Gentiana  Catesbina.  Vulgar names, Blue Gentian,
Southern Gentian, Bluebells, Bitter-root.
   Gentiana Chirayta, (Chiretta.)  Tonic,  made  in  the
form of bitters. 
MATERIA MEDICA.
1085
  Gentiana Lutea,  (Gentian.)   A  good tonic.   Ten or
twenty grains of the pulv. root, or an ounce of the tincture,
may be taken three or four times.
  Gentiana Uchroleuca, (Ochroleucus  Gentian, Samson's
Snake  Root.)   Dr. R. Johnson,  of Ohio, regards  this as
almost  a specific for prolapsus uteri.  Dose, from five to
ten  grains, two or three  times  a day, of   the powdered
root.
  Geranium Maculatum, (Geranium.)   Active astringent,
used in dysentery and hemorrhage.   Dose, from five to
ten  grains of the powdered root.
  Gerardia Pedicularia, (Bushy Gerardia.)
  Gerardia Quercifolia, (Golden Oak.)  Astringent, used
in dysentery.
  Geum Rivale, Water Avens, Geum Virginianum, ( White
Avens.)  Mild tonic  and diuretic.  Dose of the powder,
from twenty to  thirty grains.
  Gillennia Trifoliata, (Indian  Physic.)  A mild  hepatic
purge.   Dose, from twenty to thirty grains.
  Glandula,  ( Wild Senna, American Senna, &c.)   A ca-
thartic, acting nearly the  same as the India, and  Alexan-
dria.   Dose one-half dram  to a dram of the powdered
leaves.
  Glechoma Hederacea, (Ground Ivy, Alehoof Robin run-
away.)  A tea  is good for the hooping cough.
  Gleditschia  Triacanthus, (Honey Locust.)  Equivalent
of the Ceratonia.
  Glycerina, (Glycerin.)  Used  externally as a liniment;
also used for the purpose of dissolving medicines, and may
be taken internally to fulfil the indications of cod-liver oil.
Dose, one teaspoonful two or three times a day.
  Glycyrrhiza  Glabra, (Liquorice.)   A tea is good for
colds and  coughs : may be used  freely.
  Guaphalium Polycephalum, ( White Balsam.)  A pint of
strono-  infusion  taken in doses of  one-half pint, two or  three 
1086
MATERIA  MEDICA.
times a day, is an excellent remedy for females during the
change of life.
   Gonolobus Hirsutis, (Negro Vine.)   Root drastic, acting
on the bowels like Colocynth.
   Gonotheca Heliemthoides, (Melon Apple Flower.)  Root
tuberous, fragrant, nervine;  Equivalent of Polymnia.
   Goodyera Pubescens, (Net-leaf Plantain.)   Used  in
scrofula in the form of syrup.
   Gardonia Lasianthus, (Swamp Laurel.)   An alterative
used in eruptive diseases.
   Gossypium Herbaceum, ( Cotton.)   Is an emmenagogue
and parturient.   It is used in suppressed menstruation, &c.
   Guaco, (Huaco.)  Tonic, stimulant and diuretic.
   Guaiaci Resina, (Guaiac Resin.)   Used in rheumatism
and diseases of the kidneys and bowels.  One to two grains
a dose.
  Guaiacum Officinale, ( Guaiacum.) Is used in tincture for
rheumatism.   Dose, one-half to  one  teaspoonful three or
four times a day.
   Gunpowder, (Pulvius, Pyrius, Pulvis  Nitratus.)  Used
in poultices for felons.
   Gutta Percha, (Gutta Percha.)  Concrete juice of  iso-
nandra gutta.   Dissolved in chloroform, is an application
for acute erysipelas.   One ounce  of gutta percha to four
ounces of chloroform.
   Gynema Balsamica, (Baume  des  Sauvages of Louisi-
ana.)  A powerful stomachic and sudorific, used  like  tea.
   Habenaria.   Equivalent of Orchis.
  Hsematoxylon Camphechianum, (Logwood.) The tincture
is an  abortant.   Dose, wineglassful two or  three times a
day.
   Hsemospasis,  (Dry Cupping)  Used in internal inflam-
mation.
   Hamamelis  Virginica, (Witch Hazel.)   Five or  ten
grains of the pulverized flowers, taken previous to  the 
Materia  medica.
1087
monthly period, will induce  catamenia.   An  injection of
the decoction of the leaves is also used for leucorrhcea.
  Hamiltonia  Olazifera, (Oil Nut.)  An ointment made of
this is said to be a sure cure for piles.
  Hedeoma Pulegioides, (Pennyroyal.)  A tea drank freely
will produce perspiration.
  Hedera Helix, (Ivy.)   An  ointment  of the  leaves is
valuable for eruptive diseases.
  Helenium Autumnale, (Sneezewort.)  A powder used as
a snuff, is good for catarrh in the head.
  Helianthum  Canadensis, (Frost  Weed.)  An  excellent
remedy for scrofula.   Used in form of a syrup.
  Helianthus Annus, (Sunflower.)  The seed tinctured in
gin, is an excellent remedy for  coughs—good in consump-
tion.
  Helichroa,   Several  species called Rudbickia Purpurea.
(Red  Sunflower.)  A syrup made of the flowers  is an ex-
cellent remedy for bronchitis and lung affections.
  Helicteres Isora.  Root  bitterish, used  for ulcers, exan-
thems and whitlows.
  Helleborus.  Acrid, nauseous, purgative, emetic, vermi-
fuge.
  Helonias Ballata.  Decoction of the peeled root, used in
New Jersey for colics,  &c.
  Helonias Dioica, (Helonias or Unicorn Root.)  Tonic,
diuretic,  and vermifuge.   Dose, of pulverized  root, ten
or fifteen  grains.   Also  a specific for  impotency—one
tablespoonful of gin tincture four or  five times a  day.
  Hemidesmus Indicus, (Indian Sarsaparilla.)  Is said to
be an  antidote to syphilis, and  is used in scrofula.  Dose
of infusion, wine glassful  three or four times a day.
  Hepatica Americana, (Kidney Liver Leaf.)  A strong
infusion drank freely is useful  in chronic affections of the
liver.
  Hepatica Acutiloba, (Heart Liver Leaf.)  Used in hepa-
tic affections.   An infusion may be drunk freely. 
1088
MATERIA  ME D I c a .
   Hepatica Triloba, (Common Liverwort.) Officinal name,
 Hepatica.   Vulgar names, Liverweed, Trefoil, Noble Liver-
 wort.   Synonym—Anemone  Hepatica, &c.
   Heptallon Graveolens, (Hogwort, Bear's fright.)  A de-
 coction boiled in milk  and used  freely, is good for diar-
 rhoea.   It is also used for leucorrhoea and prolapsus uteri.
   Heracleum Lanatum, )Masterwort.)    Good  for cough
 syrup.  Dose, a tablespoonful once in two or three hours.
   Heuchera Acerifola, (Maple-leaf, Alum-root.)   Officinal
 name,  Heuchera radix.   Vulgar names, Alumroot, Sani-
 cle, Ground Maple, Cliffweed, Splitrock, &c.
   Heuchera Americana, (Alum  Root.)   Twenty or thirty
 drops of gin tincture three or foUr times a day is useful in
 diabetes.
   Hibiscus  Moschatus,  (Water  Melon.)   Cold infusion is
 used for coughs, to be used freely.
   Hicorya,  (Hickory tree.)   A tea made of the leaves and
 drank  freely is good for eczema and other skin affections.
 The parts should be  bathed in the same.
   Hieracium Venosum,  (Hawkwood.)  A pill made of the
 extract taken every night on retiring is an excellent reme-
 dy for  spermatorrhoea.
   Hippomane Mancinella, (Machinel Tree.)   Narcotic poi-
 son producing sleep,  tremors, &c.
   Hispidula, ( Creeping Wintergreen.)  Mild astringent and
 diuretic.
   Hopea  Tinctoria,  (Sweet Leaf,  Horse Sugar.)   Root
 stomachic, depurative.
   Hordeum  Vulgare, (Barley.)  Used as a gruel for  nou-
rishment.
   Humulus Lupulus, (Hops.)  Excellent anti-periodic and
nervine.  May be used in ague and all nervous  affections.
Dose, one  gill of infusion three or four times  a day.
   Hydrangea, (Bissum.)  Used  in decoction or powder.
Action mild,  Equivalent to arbutus in gravel, &c.
  Hydrangea Arborescens, (Hydrangea.)   Used as a ute- 
MATERIA  MEDICA.
1089
rine tonic.   Also for gravel.  Dose, tablespoonful of infu-
sion every two or three hours.
  Hydrastis Canadensis, (Golden Seal.)  A pure vegeta-
ble tonic.  May be used in all cases where such a  remedy
is indicated.  Dose  of the pulverized root, from  three  to
ten grains.   Dose of infusion, one tablespoonful repeated
as often as indicated.
  Hydrophyllum  Canadensis.   Used against the bite  of
the rattlesnake.
  Hyosciamus Niger, (Black Henbane.)  Officinal name,
Hyosciamus.  Vulgar names, Henbane, Poison, Tobacco,
Stinking Nightshade, &c.
  Hypericum Perfoliatum, (St. John's  Wort.)  A syrup
of this article is very useful in old ulcers, which should be
bathed in a decoction  of the same.
  Hypogon  Anisatum, (Aniseroot.)   Mild stimulant and
stomachic.
  Hypophosphite of Lime.  Good in phthisis and all other
diseases where an antacid and nerve stimulant are required.
Dose, from five to ten grains.
  Hypophosphite of Potassa.   Good in  lung diseases and
debility of  the nervous system.  Dose—from  one  to two
grains.
  Hypophosphite of Soda.  Ten grains triturated in  six
ounces of simple syrup is an excellent remedy for chronic
dyspepsia.   It is also good in  lung affections and debility of
the nervous system.   A dose of  the pure article ^ from
one to two  grains.  It also constitutes  one of the ingre-
dients of the compound syrup of hypophosphites.
  Hypophosphorous Acid.  A  valuable remedy in typhoid
fever and all other diseases where phosphorus and an acid
are indicated.  Dose, from one to three drops, in water or
simple syrup.
  Hypoxis Erecta, (Star  Grass.)   Root edible, febrifuge,
used in chronic ulcers and ague.
92 
1090
MATERIA  MEDICA-
  Hyssopus Officinalis, (Hyssop.) A warm tea drank freely
produces perspiration.
  lb'eris  Amara, (Candytuft.)   The pulv. seed is used in
epilepsy and hysteria.  Dose, from one to five grains.
  Modes Fcetida, (Skunk Weed, Skunk Cabbage,  Collard,
Itch  Weeds, Stink Poke, Skoka of the  Indians.)   Anti-
spasmodic and nervine.   Good  in hooping-cough,  asthma,
and phthisis.  Dose, from three to five grains of the pow-
dered root.
  Ignatius Amara, (Bean of St. Ignatius.)  An excellent
remedy in  neuralgia, spinal irritation, nervous headache.
Dose, from one-eighth to one grain of the pulv. seed.
  Ilex Opaca,  (American Holly.)   Tonic and febrifuge.
Dose, from five to ten grains of the pulv. leaves.
  Impatiens Pallida, (Jewel  Weed.)  A warm  infusion
drank freely is a good diuretic.  Dose, half a wine-glassful
three or four times a day.
  Imperatoria Ostruthium, (Masterwort.)  Good for sper-
matorrhoea, also catarrh  of the lungs, and debility of the
mucous membrane.   May be used in the form  of a decoc-
tion, ad  libitum.
  Indigofera  Tincturia, (Indigo Plant.)  Used in hoop-
ing-cough, cramps and  spasms.  Dose, from five to ten
grains
  Inula Helenium,  (Elecampane.)   Good for coughs.
  lodidum, (Iodine.) Pure iodine is seldom used by Eclec-
tic physicians, unless as an external application in the form
of a tincture.
  Ipomcea Jalapa, (Jalap.)  An active hydragogue cathar-
tic— one of the  ingredients of  antibilious physic.  Dose of
jalap, from five  to twenty grains.
  Ipomcea Quamoclet, (Cypress Vine—Red Jessamine.)
  Iris Florentina, (Fleur de Luce.)    A valuable alterative
and purge.  Used in syphilis and  diseases of  the liver.
Dose, from one  to three grains. 
MATERIA  MEDICA.
1091
  Iris  Versicolar,  (Blue  Flag.)  Sialagogue cathartic—
valuable in all cases where indolent tumours are  to be ab-
sorbed.   Dose of the powdered root, from five to twenty
grains.
  lanthus Coeruleus, (Blue Gentian.)  Equivalent of Teu-
crium.  Tonic to the lungs and stomach.
  Iva Frutescens,  (Bastard Jesuit Bark.)   Used as a to-
nic in bitters.   Silfc to be antiperiodic and febrifuge.
  Jacobia Aurea, (Ragwort, Liferoot, Anumguah of In-
diana.)   A decoction drank freely is good for female irre-
gularities.
  Jeffersonia Bartonia,  (Common  Twinleaf.)    Vulgar,
Yellow Root, Helmefpod,  Ground  Squirrel Pea.—Good in
scrofula and all diseases where a mild alterative is required.
May be made in a  syrup and taken freely.
   Jeffersonia Diphylla, (Twinleaf.)   Diuretic,  alterative
and antispasmodic.  Dose of decoction, from two to four
fluid ounces.
   Juglans Cinerea, (Butternut.)  A syrup made of  this
article is an excellent remedy for  eruptive diseases, salt
rheum, &c.   Dose, one tablespoonful three or four times a
day.
   Juncus Acutus,  (Rushes.)   Seeds  cathartic—used for
diarrhoea and fluxes.
   Juniperus  Communis, (Juniper.)  Diuretic in dropsy,
gonorrhoea, &c.  The oil  and berries are the parts princi-
pally used.  Dose  of the oil, from  ten to twenty drops.  Of
the infusion of the berries, one-wine-glass full three or  four
times a day.
   Juniperus  Sabina,  (Savin.)    The  oil  of  this  article
is principally used as an emmenagogue.   Dose, from ten to
sixty drops.
   Juniperus Virginiana,  (Red  Cedar.)   The oil is an ex-
cellent remedy for rheumatism, sprains, bruises, &c.
   Kali Carbonicum, (Carbonate of Potash.)  Good in dis- 
1092           MATERIA  MEDICA.
 eases of the bowels  and stomach.  Dose, from one half to
 one grain.
   Kali Chloricum, ( Chlorate of Potash.) Valuable in diph-
 theria, dyspepsia, and phthisis.   Dose, from  one to  two
 grains.
    Kali Hydriodicum, (Iodide of Potash.)  Valuable alte-
 rative used in  connexion with  alterative syrups.  Dose,
 one grain.
   Kali Nitricum, (Nitrate of Potash.)  Febrifuge and di-
 uretic.   Dose, from one to two grains.
   Kali  Sulphuretum,  (Sulphuret  of Potash.)  Good in
 diseases of the bladder and kidneys.   One to two grains a
 dose.
   Kalmia Latifolia, (Sheep Laurel.)  The tincture is  a
 valuable remedy for syphilis.   Dose, five or six drops,  five
 or  six times a day.
    Kino, (Kino.)  An astringent gum used  in  four or  five
 grain doses.
   Krameria Lanceolata.  Perhaps equiv. of valuable  Kr.
 Triandria.
   Krameria Triandria, (Rhatany.)   A  powerful astrin-
 gent used in hemorrhage, dysentery, &c,  Dose of the  ex-
 tract, from one to three grains, two or  three times a day.
  Kuhnia Glutinosa, (Goldenrod  Eupatorium, Three Sj>.)
 Weak eq. of Eupatorium.
   Lachesis, (Leachesis.)  Used by homoeopathies for ery-
 sipelas, in third or fourth trituration.
    Lactuca Sativa, (Lettuce,) Lactuca Virosa, (Strong
 Scented  Lettuce.)  A  mild  anodyne.   Used in nervous
 affections.  Dose, one to three grains of the extract taken
 at bed-time.
  Lantana, (Sagetree,  Blueberry, Cailleau  in  Louisiana,
 2 Sp. L. Floridana, and L.  Undulata.) Used in aphthous
 conditions of the mucous membrane, dysentery,  &c.  A  tea,
may be drunk freely. 
                MATERIA  MEDICA.           1093

  Lapargyrca,  (Silvcrbush,  Hippophse  Canadensis,  L.
Shepherdia.)  Berries,  purgative.
  Larix, (Larch, Tamarack, Hackmatack, two S])., Black
Larch. L. Pendula and Red Larch, L. Mierocarpa.) Used
as a diuretic and astringent.
  Larix Americana, (Tamarac.)   A decoction of this ar-
ticle used freely is a good remedy for gleet.
  Laurus Sassafras, (Sassafras.) One drachm of the  pul-
verized  bark taken every two or three hours during the
paroxysms of ague, will prevent its  return.  As an antipe-
riodic it is about the strength of Peruvian bark.
  Lavandula  Vera, and Lavandula Spica, (Lavender.) A
mild carminative used in wind colic.
  Ledum Latifolium, (Labrador Tea.) A tea drank freely
is an excellent remedy in bronchitis.
  Ledum Palustre, (Marsh  Tea.)  Used as an expectorant   ,
in lung diseases, in the  form of a decoction.
  Leonorus Cardiaea,  (Motherwort.) Nervine antispasmo-
dic.   A decoction drank  freely is  good for  hysteria,  ner-
vous debility,  weak stomach, &c.
  Leontodon  Taraxacum, (Common Dandelion,  Ft:  Pis-
scnlit Commun,  Vulgar, Pissabed, Puff-ball, d-c.)   A good
alterative for  the  liver.  A decoction of this root may be
drank freely.
  Leptandrin Virginianum,  (Cancer Root, Beech  Drops.)
A poultice made of the pulverized root is good for indo-
lent ulcers, cancers, &c.  A decoction used internally is
also valuable in  dysentery and diarrhoea.
  Leptandria Virginica,  (Culver's  Physic.)   Mild purge
in twenty or thirty grain  doses.
  Leskea, (Several Sp.)   Sub-astringent mosses.
  Leucanthemum  Vulgaris, ( White  Weed.)  A decoction is
used in the place of chamomile.
  Liatris  Spicata, (Button Snake  Roof.  Devil's Bite.)  A
uterine tonic  Also exerts a specific influence  over the
                            92* 
 1094            MATERIA  MEDICA.

 stomach and kidneys in diabetes.  In  diabetes two ounces
 of pulverized  root  in  a quart  of best brandy.   Dose, a
 tablespoonful three  times a day.
   Lichen,  (Treemoss,  Rockmoss,  Liverwort,  Livcrmoss,
 Iceland Moss,  Lungwort,  Orchil.)  Mucilaginous  and ex-
 pectorant.  Used in diseases of  the lungs, also for coughs
 and colds.   A diuretic,  sweetened and  flavored  with  le-
 mon juice,  may be taken freely.
   Ligusticum,  (Scoticwm,  Loveage,  Smellage.)   Vermi-
 fuge and anti-spasmodic.
   Lilium Candidum, (Meadow Lily.)   The root boiled in
 milk makes a good poultice for ulcers.
   Limnetis, (31arshgrass.)  Good for bronchial affections.
   Linaria  Vidgaris, (Toadflax.)  Diuretic, purgative, &c.
   Linneusia Borealis, (Twinflower, Ground Vine.)  Good
 in dysentery and diarrhoea.
   Linum Usitatissimum, (Flax-Seed.)   Used externally for
 poultices.   Internally a sweetened tea  is used  for  coughs
 and colds.  Also as  a mucilage in kidney and bladder affec-
 tions.
   Liquidambar Styracifiua, (Srveet Gum.) Used as one of
 the ingredients of poultice in scrofulous ulcers.  Also a good
 tonic in scrofula, consumption, &c.
   Liquor Ammonia, (Aqua Ammonia.)  A volatile stimu-
 lant.  Dose from two to three drops, in water.
  Liquor Ammonia Acetas, (Spirit of Mindererus.)   From
 a tea-spoonful to a table-spoonful given every hour or two.
 Is a good diaphoretic in fevers.
  Liriodendron Tulipifera, (Tulip Tree.)   A decoction of
 the bark drank freely is a good remedy for night  sweats.
  Lithospermum Officinale, ( Gromwell Eq.of Cynoglossum.)
  Lobelia Inflata, (Lobelia.)  A  valuable emetic, antispas-
 modic.  Dose of  pulv.  seeds, one to five grains.   Of  the
tincture, one tea-spoonful repeated every ten minutes until
it operates.  Used in all cases where emetics are indicated. 
               MATERIA  MEDICA.           1095

  Lolium Tremulentum,  (Darnel Grass.)   Seeds narcotic.
  Lonicera Caprifolium,(Honey'suckle.)  A syrup used for
sore throat, &c
  Ludwigia Alternifolia, (Bastard Loosestrife.)   Several
species subastringent.
  Lupinus Perennis, (Lupin, Fingerleaf.)  Diuretic and
diaphoretic.
  Lycoperdon Proteus, (Puff Balls.) Used in epistaxis, to
stop the hemorrhage.
  Lycopus Virginicus, (Bugleweed.)  A decotion drank
freely will cure bleeding  at the lungs.
  Lysimachia Quadrifolia, (Crosswort, Yellow balm.)   A
tea drank freely is good for fevers.
  Lythrum Salicaria, (Loosestrife.)   Used as a mucilage
instead of slippery elm.
  Mabalus Albus, (Lion's Foot.)   The  root  steeped  in
milk is an antidote to the bite of poisonous reptiles.  Dose
one gill every two Or three hours.
  Magnesia, (Magnesia.)  The citrate of magnesia taken.
in wine-glass full  doses every half hour is a cooling purge.
  Magnesia Calcinata, ( Calcined Magnesia.)  In half dram
doses a mild purge and antacid.
  Magnrsisc Carbonas, (Carbonate of Magnesia.)  Used for
acidity of the stomach.
  Magnesige Sulphas, (Sulphate of Magnesia.)  A common
but miserable purge.
  Magnolia Glauca, (Magnolia.)   Used in form of bitters,
a valuable remedy in chronic ague.   A decoction of this ar-
ticle will prevent a love of tobacco.
  Malva Sylvestris,  (Common Mallow.)  Used as a muci-
lage.   Same as slippery elm as a mucilage.
  Mannita, (Sugar of Manna.)  Used with purges as an
anthelmintic.
  Maranta Arvndinacca, (Arrow Root Plant.)  Used in
gruel for nourishment. 
1096           MATERIA  MEDICA.

  Marchantia Polymorphia, formerly used in herpetic  dis.
eases.
  Marrubium Vulgare (Horehound.)  A syrup of this ar-
ticle is an excellent remedy for coughs and colds.
  Martynia Proboscidea, (Double claw.)
  Maruta-Cotula, (Mayweed.)  Excellent tonic,  and may
be used in all cases instead of English chamomile.
  Matias, (Malambo bark.)   Used as a substitute for  cin-
chonia.
  Matico, (Soldiers' weed or Herb.)  A valuable styptic in
all cases of passive and active hemorrhage.
  Matricaria Chamomilla, ( German Chamomile.)  A mild
tonic.
  Matricaria, (Featherfeic.)  Eq. of Anthemis.
  Mel,  (Honey.)  Used in syrups.
  Melilotas  Officinalis, (Meliot Clover.)   An extract of the
flowers,  made in the form of an ointment, is a cure for
piles.
  3/elissa Officinalis, (Balm.)  A tea drank freely on re-
tiring will break up a cold.
  Melothria  Nigra, (Blackberry  Vine.)   A decoction of
the root is an astringent, and good for  diarrhoea  and  dys-
entery.
  Mcnispermum Canadense, (Yellow Sarsaparilla.)   May
be used freely wherever there are adhesions as the  result
of inflammation, as in  pleurisy,  &c.   Dose of decoction,
wine-glassful three times a day.
  Mentha Piperita, (Peppermint.)   Tea  may  be used in
flatulency, &c.
  Mentha  Viridis,  (Spearmint.)   Properties  nearly  the
same.
  Menyanthes Trifoliata, (Buckbcan.)  Used in dropsy, sy-
philis, and necrosis.  Dose,  ten  to  twenty  grains of pul-
verized root  three or four times a  day.
  Mercury Metallic, and  all the  preparations  not used by
Eclectic physicians.   See Poisons and their  Antidotes. 
                 MATERIA  MEDICA.           1097

    Mirabilis Longiflora, (False Jalap, Four o'clock, 3 Sp.)
  Purgative.   Used in dropsy.
    Mitchella Repens, (Partridgeberry.)  An infusion drank
  freely is an excellent remedy for painful menstruation.
    Momordica  Elaterium,  (Wild Cucumber.)   A hydra-
  gogue cathartic used in dropsy.  One gill of the decoction
  is a dose.
  ^  Monarda  Coccinea, (Scarlet Rosebalm;) Vulgar, Moun-
  tain  Mint,  Oswego  Tea,  Mountain  Balm,  Horse  Mint,
  Squarestalk, Red Balm.   A tea drank freely  is a good
  diaphoretic in  febrile diseases.
    Monarda  Punctata, (Horsemint.)  Used for nausea and
  vomiting in infusion.
    Monnina  Polystachya   and  M.  Pterocarpa.   Much
  esteemed.  Their roots useful  in  the treatment  of bowel
  diseases.
    Monotropa  Unifiora, (Iceplant.)  Tea drank  freely is
  good for  St. Vitus' dance and epilepsy.
    Morphise, Acetas, (Acetate of Morphia.)  In  one-eighth
  grain doses a good anodyne.
    Morphise  Murias, (Muriate of Morphia.)  One-sixteenth
  to one-eighth of a grain is a dose as an anodyne.
    Morphise  Sulphas, (Sulphate of Morphia.)  One-eighth
  to one-fourth of a grain is a dose.
    Morus Rubra, (Red Mulberry.)  A mild diuretic.  Dose,
  one gill of the decoction.
    Moschus, (Musk.)  A stimulant and antispasmodic.  Used
  in typhus fever.  Dose, one or two grains.
    Mucuna Pruriens, (Cowhage.)  Used  for worms.  Dose,
  twenty or thirty grains.  Is a bad  remedy, as it is liable to
  produce  mucous inflammation.
    Musa  Paradisica, (Banana, Plantation Tree.)  An an-
.  thelmintic.  The fruit is laxative and diuretic.
    Myrica Cerifera, (Bayberry.) May be used in all cases 
1098           MATERIA  MEDICA.
of scrofula, dysentery, and consumption.   Dose, one table-
spoonful of the syrup two or three times a day.
  Myristica Moschata,  (Nutmeg.)  A good nervine.  Dose,
eight or ten grains.
  Myrospermum Peruiferum, (Balsam of Peru.)   Ten or
fifteen drops of the tincture is a good remedy for gonorrhoea.
  Myrospermum Toluiferum, (Balsam of Tolu.)  A good
remedy for  coughs and colds.   Dose, a teaspoonful three
or four times a day.
  Myrtus Cqmmunis, (Common Myrtle.)  A mild astrin-
gent.
  Myrtus Pimento, (Pimento.)   A tincture  is a good re-
medy for wind colic.  Dose  ten or twenty drops.
  Naphthalan.  Compound, distilled from coal tar.   Ex-
pectorant, and used in  consumption  and other  diseases
of the lungs.  Dose, from fifteen to thirty drops.
  Nectandra Rodioei, (Bebeeru.)   One gill of decoction of
the  bark, drank three or four times a day, is a suj-e cure
for sterility in females.
  Nelumbium Luteum,  (Yellow Nelumbo, Vulgar, Yellow
 Water Lily, Pond Lily,  Water Shield,  Water Nuts, Water
Ch ineapin, Rattle Nitf, Sacred Bean, Lotus, &c.)  The acetic
tincture makes a valuable wash for eruptive diseases.
  Nepeta Cataria, (Catnep.)  An infusion of the leaves is
good for colic in children.
  Nepeta Glechoma, (Ground Ivy, Cliick Weed.)   Makes
an excellent poultice for old sores.
  Nephrodium, (Felix Mas.)  Only used as an anthelmin-
tic.   Best in a fresh state; in two years it becomes  inert.
  Nerium Oleander, (Rose Laurel.)  Poisonous.
  Nymphata  Odorata, ( White Pond Lily.)  Ten or fifteen
grains of the pulverized root, taken in yeast, is a sure cure
for  nursing sore  mouth.  Also used in dysentery, leucor-
rhcea, &c.
  Ocemum  Basilicum, (Sweet  Basil.)   Aromatic, stimu-
lant, cardiac. 
MATERIA  MEDICA.           1099
   Odostemon, (Mountain Holly, Purple Acid Berriesf)   A
decoction is good in dysentery.
   OjJnanthe Phellandrium, ( Water Fennel.)   A  good diu-
retic.  May be drunk freely whenever such a  remedy is in-
dicated.
   CEnothera Biennis, (Tree Primrose.)  A syrup made of
this article and used freely is an excellent remedy in scro-
fula, also an abortant.
   Olea Europa, ( Olive Tree.)  Olives  are a tonic and sto-
machic, produce the best  sweet oil, so  useful for food and
light.  Deemed a panacea in Africa and  Greece for wounds,
sores, colics, tenesmus, cough,  rheumatism,  hydrophobia,
and poison.
   Oleander, (Oleander.)   Mild aromatic.
   Oleum Bubulum,  (Neat's  Foot Oil.)   Good  for  lubri-
cating contracted tendons and muscles.
   Oleum Morrhuse, or Oleum Jccoris, (Cod-liver  Oil.)   A
good nourishment in all cases of debility.   Dose, from one
teaspoonful to a tablespoonful.
   Oleum Petrce, (Stone Oil.)   A good external application
for burns.
   Oleum Ricini, (Castor  Oil.)   Purge.   In  tablespoonful
doses.
   Oleum Succini, ( Oil of Amber.)  Good in liniments for
rheumatism.
   Oleum Terebinthince, ( Oil or Spirits of Turpentine.)  A
diuretic, in ten or fifteen drop doses.
   Oleum Tiglii, ( Croton Oil) In one-eighth to one-quarter
drop doses, is valuable for dropsy.  In one  drop doses, it
•is an active purge.
   Onasmodium Virginianum, (False Cromwell.)  Used m
gravel  Dose, one  tablespoonful of the decoction three or
four times a day.                           ...   ,    A ~
    ^ -, -  7      v,.h-,nvp  (Snakdeaf.}  Emollient used lor
   Ophioglossum Vulgate,  ^na/uitoj.j
ulcers and  sores. 
1100
MATERIA  MEDICA.
   Ophiorrhiza  Mitrcola, (Pink  Snakcroot.)   Equiv. of
Spigelia and Aristolochia for worms and snake-bites.
   Orchis  Mascula, (Salep, Twinroot.)  Good for gravel,
and diseases of the bladder.
   Origanum  Vulgarc, (Origanum  Marjoram)' Makes a
good liniment for rheumatism.
   Omithogalum, (Bethlehem Star Root.) Edible emollient.
   Ornus Europcea, (Manna Tree.)   In drachm doses, is a
mild laxative.
   Orobanche  Americana, (Broomrape, Earthclub, Clap-
wort.)   Astringent, antiseptic, and antisyphilitic; deemed
in the West, a specific for gonorrhoea and syphilis.
   Orobanche  Virginiana, (Buck Drops.)  A poultice made
of the pulv. root is said to cure cancer.
   Osmorrhiza Langystilis, (Sweet  Cicely.)    Useful in
coughs.  A decoction may be drunk freely.
   Osmunda Cinnamomea, (Cinnim Fsrn.)  D3uiile3n'"i ,
subastringent, and tonic.  Boiled in  milk, it yields a fine
mucilage,  which is useful in diarrhoea.
   Osmunda Regalis, (Buck-horn  Brake.)   Half a pint of
strong decoction, drank  on retiring, will remove obstruc-
tion of the menses.
   Ostrya  Virginica, (Iron Wood.)   A half pint of decoc-
tion taken three or four times a day, will cure ague.
   Oxalis Acetosella, ( Wood Sorrel.)   A salve  made from
the juice is  a good remedy for cancer."
   Oxycoca  Macrocarpa, (Large Cranberry, Vulgar, Com-
mon  Cranberry, Mossberry,  Swamp Redberry;  Atoca in
Canada;  Sourberry.)   A poultice  made of the berry is
good for erysipelas.
   Oxyria Reniformis, (Boreal Sourdock,  Vulgar,  Moun-
tain Sorrel, Welsh Sorrel.)   Good  in  scrofulous diseases;
also used as a  poultice in cancer.
  Pceonia Officinalis,  (Peony.)  One or two ounces of de-
coction of the  root is good for nervous affections. 
                MATERIA  MEDICA.            1101

  Panax Quinquefolium, ( Ginseng.)   A decoction may be
drunk freely.
  Papaver,  (Poppy.)  All sp. produce opium.
  Parietaria Heterophylla, (Pellitory.)  Juice or decoc-
tion used as diuretic, &c.
  Parthenium Integrifolium, (Cutting Almond.)  Is a good
diuretic; one tablespoonful of the gin tincture three times
a day, is useful in dropsy.
  Pastinaca Sativa, (Parsnip.)   Root esculent, &c, seeds
aromatic, used in agues; root of wild parsnip, acrid, emetic,
producing sores by handling,
  Peonia Officinalis, Peony, (Cult.  Root, and Seeds Ner-
vine.)   Used in palsy, convulsions, epilepsy.
  Petroleum, (Petroleum.)  Is used for inhalation in lung
diseases, and for liniments.
  Petroselinum  Sativum,  (Parsley.)   Used  in dropsy,
gonorrhoea, and diseases of the kidneys and bladder.   Dose,
one gill of infusion three or four times  a day.
  Phosphorus, (Phosphorus.)   One grain triturated in one
hundred grains of sugar, and one grain given three or four
times a day, is a  cure for impotency.   Also used in the
last stages of typhoid fever.
  Phytolacca Decandra,  (Poke.)  Is emetic, cathartic,
and alterative.  Used in syphilis  and obstinate diseases of
the liver.   Dose of the powdered  root, from one to two
grains.
  Picrcena Excelsa, ( Quassia.)   A bitter tonic used  in the
form of bitters in debility.
  Pimpinella Anisum, (Anise.)   A sweetened  tea is used
for infantile colic, &c.
  Pinckneya Pubens, (Pinckney  Bark,  Vulgar,  Bitter
Bark,  Georgia  Bark, Florida Bark, Fever-tree.)  Good
 tonic.
   Pinus Pendula, ( Tamarac.)  Used in bitters, to increase
 the energy of the stomach.
        93 
1102      .      MATERIA  ME D I C A .
   Piper Angustifolium, (Matico.)  Active astringent. Used
 in all cases of hemorrhage.  Dose, from one  to five grains
 of pulv. leaves;  or from ten to twenty drops of the tinct.
   Piper Cubeba, ( Cubebs.)  Used in gonorrhoea, and dis-
 eases of the bladder and kidneys.  Dose, ten to  twenty   *
 grains of the pulv. article.
   Piper Longum, (Long Pepper?) Piper Nigrum, (Black
 Pepper.)   Four or five  grains act  as an  antiperiodic  in
 chronic ague.
   Pix Burgundica, (Burgundy Pitch.)  Good for plasters-
   Pix Liquid a, (Tar.)   Used in consumption, bronchitis,
 and coughs.  Dose, thirty or forty drops, in honey or simple
 syrup.
   Plantago Cor data, (Water Plantain.)  This  article has
 been  extensively used  in diarrhoea, cholera  morbus, and
 cholera.  Dose, one wine-glassful  of  decoction of the root,
 three or four times a day.
  Plantago Major, (Great Plantain.)  Root, good febri-
 fuge, astringent, vulnerary, used for  tabes,  ulcers, &c.
  Plumbum  Aceticum,  (Acetate  of Lead.)  Astringent;
 used as a local application in inflammation.
  Podophyllum Peltatum, (Mandrake.)  The crude article
 is seldom used, except in irritating plasters.
  Polemonium Reptans, (American Greek Valeria.n.) Ner-
 vine, antispasmodic.  Used in hysteria, photophobia, chorea,
 &c.   Dose, wine-glassful  of decoction every two or three
 hours.
  Polygala Nuttalii,  (Ground  Centaury.)   A syrup made
of this article, and taken freely, is almost a specific for in-
cipient consumption.
  Polygala Paucifolia, (Dwarf Milkroot,  Vulgar, Little
Pollom, Evergreen, Snakeroot.)   Used in  decoction as a
diaphoretic.
  Polygala Bubelia,  (Bitter Polygala.)   Ten  or  twenty
grains is a  mild  stimulating purge.
  Polygala Senega, (Seneka Snakeroot.)   Used as an ex-
J 
MATERIA MEDICA.           1103
pectorant, in the form of a syrup, in coughs, colds, &c.
Dose, one teaspoonful three or four times a day.
  Polygonum  Punctatum,  (Water Pepper.)   An  active
emmenagogue and diuretic.  Dose of the decoction, one gill
three or four times  a day.
  Poly podium  Vulgare, (Common Polypody.)   A  demul-
cent and  anthelmintic.   Dose, of the powdered plant, from
one to four grains—repeated as indicated.
  Polythricium Juniperum, (Hair-cap Moss.)   A powerful
diuretic.   A decoction drank freely, is a very reliable re-
medy for dropsy of the heart.
  Populus Balsamifera, (Balsam Poplar, Balm of Gilead.)
A gin tincture of the buds is an excellent remedy for rheu-
matism.  Dose, tablespoonful three or four times a day.
  Papulus Tremuloides, (American Poplar.)  An excellent
stomach tonic.
  Potassce Acetas, (Acetate of Potass.)  Good in bowel dis-
eases—in five or ten grain doses.
  Potassce Bitartras, (Bitartrate of Potassa,) (Cream of
Tartar)  A cooling diuretic and purge.  Dose, one drachm,
repeated as indicated.
  Potassce Bromidum, (Bromide of Potassium.)   Said to
be good in spermatorrhoea.
  Potassce Citras, (Citrate of Potassa.)  Mild diaphoretic
and antacid.
  Potassce Chloras, ( Chlorate of Potassa.)  Good in diph-
theria  and diseases of the  stomach.   Dose, one  to  two
grains.
  Potassce Cyanuretum, (Cyanide  of Potassium.)
  Potassce  Hydrargyro-iodidum,  (Hydrargyro-iodide  of
Potassium.)
  Potassce Iodidum, (Hydriodate of Potassa.)
  Potassce.  Nitras,  (Nitrate  of Potassa,) (Saltpetre.)  A
paper soaked in a strong  solution, and burnt in the room,
is a good remedy for asthma. ,
  Potassii Sulphuretum, (Sulphuret of Potassium.) 
1
1104 '          MATERIA  MEDICA.

   Potentilla Canadensis, (Five Finger.)  Boiled in milk,
is an excellent remedy for dysentery.  Dose, tablespoonful
every half hour.
   Potentilla Tormentilla, (Tormentil.)   The  dried leaves
pulverized make a good cephalic  snuff.                     I
   Prinos  Verticillatus, (Black Elder.)  Antiperiodic and
tonic.   May  be  used  in  all  cases, instead  of  Peruvian
bark.
   Prunus  Virginiana, (Wild  Cherry.)   A cold  infusion,
dr ank freely,  is a good remedy for chronic dyspepsia, colds
and  coughs.
   Ptelea  Trifoliata, (Wafer Ash.)   Taken  in  the  form
of a gin tincture, is an excellent tonic in all cases of de-
bility.
   Pterilis, Aquilina, Pteris, Brake.   Roots of all edible—
vermifuge.
   Pteris Atropurpurea, (Rock Brake.)  A strong  decoction
is said to be a reliable remedy in spermatorrhoea.   Dose,
one tablespoonful every two or  three hours.
   Pterocaulon, (Blackroot.)   Hinih  of Western Indians.
Root alterative, detergent,  drastic, abortive.
   Pterospora Andromeda, (Scaly Dragon-claw.)   Vulgar,
Dragon  Root, Fever Root, Albany Beech-drop.  Good in
gonorrhoea and gleet.
   Pulmonaria Officinalis,  (Lungwort.)  A  syrup made
of this article is said to be an excellent remedy in pulmo-
nary consumption.
   Punica Granatum, (Pomegranate.)   The bark is exten-
sively used for tape-worm.  Dose, twenty or thirty grains
five or six  times a day.
   Pyrethrum  Parthenium, (Fever-few.)   Diaphoretic  and
mild  stimulant.  A  decoction may be Used  in mild forms
of fever, drank freely.
  Pyrola Maculata,  (Spotted Pipsisseway.)  Vulgar, Win-
lergreen, Whiteleaf White Pipsisseway, Psiseva, Kingcure,
Ground Holly, Rheumatism Weed, &c.  Good in  scrofula.
A decoction may be  drunk freely. 
MATERIA  MEDICA.
1105
  Pyrola Rotundifolia, (Round-leaved Pyrola.)   A decoc-
tion is a metastatic remedy in measles,  scarlatina, and ty-
phoid fever.  Dose, tablespoonful every hour.
  Pyrus Malus, (The Apple Tree.)   Is used as a tonic, in
the form of syrup, in cases of debility, &c.
   Quercus  Albus, (White  Oak.)  Powerful astringent, used
for washes  in old ulcers, &c.
   Quercus  Infectoria,  (Dyer's Oak.)  Used the same as
white oak.
   Quinise Arsenarias, (Arseniate of Quinine.)
   Quiniae Arsenis, (Arsenite of Quinia.)
   Quinise  Citras, (Citrate of Quinine.)
   Quinise el Cinchonix Tannas, (Tannate  of  Quinia and
 Cinchona.)
   Quiniae  Ferrocyunas, (Ferrocyanate of Quinine.)
   Quiniae  Hydriodas,  (Hydriodate of Quinine.)
   Quinise  Lactas, (Lactate of Quinia.)
   Quinise Murias, (Muriate of Quinine.)
   Quinise  Nitras, (Nitrate of Quinine.)
   Quinise  Phosphas, (Phosphate of Quinine.)  (
   Quinise  Sulphas, (Sulphate of Quinine.)
   Quinise  Valerianas, ( Valeriate of Quinia.)
   All the  preparations of quinine are antiperiodic, in doses
 of from one-half to five grains, and may be used in all cases
 where antiperiodics are required.
   Rafflesia Arnoldi.   A decoction employed in Java as an
 astringent.
   Ranunculus Acris, (Acrid  Crowfoot.)  Vulgar, Butter-
 cups, Yellow Weed, Blister Weed, Pilewort, Burwort, Mea-
 dow-bloom, Yellows, &c.   An ointment made of the root is
 good for indolent ulcers and piles.
   Raphanus  Sativus, (Radish.)   Useful  in convulsions,
 asthma, raucedo, ischuria.
   Rhamnus Catharticus,  (Buckthorn.)  Used as an emmena-
 gogue and abortant.   Dose, from one to five grains. 
1106
MATERIA  MEDICA.
  Rheum Palmatum,  (Rhubarb.)  Used as a  purge in
diarrhoea and dysentery.
  Rhizophora,  (Mangrove.)   Bark astringent, styptic, a
bath of it useful for petechial fevers.
  Rhus  Glabrum, (Sumach.)   Powerful astringent and
antiseptic.   Used in  ophthalmia and leucorrhcea.  Dose of
the decoction, one tablespoonful every two or three hours.
  Rhus  Toxicodendron,  (Poison  Oak.)   One  drop of
the tincture three or four times a day, is an excellent re-
medy for salt rheum, erysipelas, tetter, &c.
  Rhus  Radicans,  (Poison  Ivy.)  One or two drops of
the  tincture three  or four times a day is an excellent re-
medy for palsy, amaurosis, &c.
  Ribes Nigrum, (Black  Currant.)  The bark of the root
in strong decoction, is  an  excellent wash in eruptive dis-
eases.
  Robina  Pseudo-Acacia, (Locust Tree.)   A strong de-
coction of the  bark is emetic  and cathartic.  Dose—one
gill.
  Rosa,  (Roses.)   Roots, galls,  buds, and fruits of all
astringent.
  Rosmarinus  Officinalis, (Rosemary.)   An excellent re-
medy in female weakness,  prolapsus uteri, &c.  One table-
spoonful of the  syrup taken three  or four  times a day.
  Rubus  Strigosus, (Red Raspberry.)  R.  Trivialis,  (Dew-
berry,  or low Blackberry.)   R.  Villosus,  (Blackberry.)
Syrup of the bark of the  root  is  a good remedy in dysen-
tery and  diarrhoea.
  Rudbeckia Lancinata, (Tliimble Weed.) A good remedy
in enlargement  of the spleen,  and  Bright's disease.  Dose,
one gill of decoction  three or four times a day.
  Rumex Acetosa, (Sorrel)  The dry extract is used as a
caustic in cancers.
  Rumex Aquaticus, (Great  Water Dock.)  Rumex  Bri-
tannica, ( Water Dock.) Rumex Obtusifolius, (Blunt-leaved 
               MATERIA  MEDICA.           1107

Dock.)   Rumex  Crispus, (Yellow Dock.)  Used in com-
bination  with other  articles, in  the  form of a syrup, for
cleansing and purifying the blood.
  Ruta Graveolens, (Rue.)  A good remedy for seat worms
and round worms of children.  An  ounce to one pint of
gin.   Dose, one tablespoonful at night on retiring.
  Sabbatia Angulatis, (American Centaury.)  Antiperio-
dic, used in fevers.
  Saccharum  Officinarum, (Sugar Cane.)   It is edulco-
rant, relaxant,  pectoral, vulnerary.
   Sagus Rumphii, (Sago.)   It is  nutritive, and easy of
digestion.
   Salicornia Herbacea, (Kelpwort,  Samphire.)  Antiscor-
butic,  gives appetite.
   Salix Alba,  (Willow.)  The catkins of the pussy willow
in gin,  is  an  antaphrodisiac.  Dose, tablespoonful three
times a day.  The bark is used  in fevers instead of Peru-
vian bark.
   Salsola, (Barilla, Stimulant.)  Antacid, diuretic, &c.
   Scdvia Officinalis, (Sage.)  Used for worms  and night
 sweats, a tea drank  freely.
   Sambucus Canadensis, (Elder.)   One of the ingredients
 of the alterative  syrup.   Good in scrofula.
   Sanguinaria Canadensis, (Blood-root.)   Good in croup,
 acute disease of the lungs, bronchia and liver.   Dose, from
 one to three grains.
   Sanicula Marylandica,  (Sanicle, Black-snake  Root.)
 The pulv. root, two ounces added to one pint of port wine,
 and one tablespoonful  taken three  or four  times a day, is
 good for epilepsy.
    Saponaria  Officinalis,  (Soapwort.)  An  excellent re-
 medy in intermittent fever.  One half tea-cup full of de-
 coction taken three times a day.
    Sarothra  Genlianoides,  (Groundbroom,  Groundpine.)
 Diuretic.  Used in scrofula. 
I
1108            MATERIA  MEDICA.

   Sarracenia Purpuria, (Sarracenia.)  Used in nervous
affections.  Dose, five or ten grains.
   Satureja  Hortensis,  (Summer Savory.)   A strong tea
drank on retiring, relieves painful menstruation.
   Saururus Cernuus, (Lizard tail.)   Roots emollient, used
in poultice, &c.
   Scilla or  Squilla Maritima, (Squill.)    Eight  or ten
grains, given three or four times a day, act as a mild purge.
It is also a diuretic and expectorant.
   Scleroticum Clavus, (Ergot.)   Specific as uterine partu-
rient to help parturition in doses of five  to ten grains.
   Scorzonera Hispanica.  Mild sudorific,  &c.
   Scrophularia Nodosa, (Figwort.)   A  syrup made of this
article is an  excellent remedy in fever,  sores,  white swell-
ing, &c.
   Scutellaria Laterifolia, (Scullcap.)  One of the  best
nervines.   Used  in St. Vitus' dance,  neuralgia,  hydro-
phobia, hysteria, &c.   Dose, one gill of strong infusion
three or four times a day.
   Sempervivum Tectorurn, (Common Houseleek.) An oint-
ment of this is excellent for burns.   The tincture  applied
to the part will cure bee stings.
   Senecio Aureus, (Life Root.)  A gin tincture taken in
wineglassful doses, three or four time a day,  will  remove
all female irregularities.
   Sesamum Indicum,  (Benne.)   A  tea of the fresh leaves
drank  freely is a good diuretic.
   Sicyos Angulata,  (Bryony, Wild   Cucumber.)   Used in
granulated condition of the mucous membrane.   From five
to ten  drops of the tincture is a dose.
   Sigillaria Multiflora,  (Multifiore  Scalwort.)    Vulgar,
Solomon Seal, Dropberry.   Good demulcent, used in lung
and catarrhal affections.
   Silphium  Perfoliatum, (Indian  Cup Plant.)  A good
diaphoretic drink in fevers; may be used freely. 
                MATERIA MEDICA.            1109

  Sinapis  Alba, (White Mustard.    S.  Nigra,  (Black
Mustard.)  A teaspoonful of pulverized seeds acts promptly
as an emetic.
  Sisyrinchium  Anaps, (Lily grass, Scurvy grass.)  Root
yellow acrid, decoction purgative, said to be an antidote of
sublimate.
  Smilax Officinalis, (Sarsaparilla.)   Used for scrofula in
form of syrup.
  Smilax Peduncularis, (Jacob's Ladder.)  Good in fe-
male obstructions.
  Sodse Acetas,  (Acetate of Soda.)
  Sodse  Boras,  (Borate of Soda, Borax.)   Ten grains
dissolved in six  ounces of water, injected into the rectum,
will cure impotency, repeated as indicated.
  Sodse  Carbonas,  (Carbonate of Soda.)   Three or four
grains may be used as an antacid.
  Sodii Auro-Terchloridum, (Chloride of Gold and Soda.)
This article is used in syphilis, cancer, necrosis, mercurial
diseases  and tuberculous consumption.   Dose, from one
sixteenth to one eighth of a grain in  simple syrup.
   Sodii Chloridum,  (Common  Salt.)  One fourth tea-
spoonful taken before each  meal  is one of the best known
remedies for chronic dyspepsia.
   Solan urn Dulcamara, (Bitter SweefT)  A tea of this ar-
 ticle drank freely is an excellent remedy for diarrhoea.
   Solanum  Nigrum, (Garden Night Shade.)   An oint-
ment is used for discussing indolent  tumours.   It should
be  made from the fresh leaves.
   Solidago  Odor a, (Sweet  Scented Goldenrod.)   A tea is
 said to be  a valuable remedy for  palpitation of the heart,
 depending upon nervous debility.
   Solidago  Rigida,  (Hardleaf  Goldenrod.)   Tonic and
 astringent.  One gill of decoction two or three times a day.
   Sorbus Pumilus, (Mountain Ash, Service tree.)  Good in
 hemoptysis and uterine hemorrhage. 
1110
MATERIA  MEDICA.
   Sorghum Saccharatum, (Broom Corn, Indian Mdlef, 2
species.)   An active diuretic used in  decoction.
   Soymida Febrifuga.  The bark is a tonic and astrin-
gent, found efficacious as a febrifuge in intermittent and
remittent fevers.
   Spigelia Marylandica, (Pinkroot.)  Five or ten grains
followed  by a dose of podophylla will remove lumbricoid
worms.
   Spirea  Tomentosa, (Hardhack.)  Used for  dysentery
and diarrhoea in children, in the form of a syrup.  Dose,
tablespoonful every hour.          ,  ■
   Spiritus uFtheris  Nitrici, (Sweet spirits of Nitre.)  A
cooling diuretic, used in five or ten drop doses  for fever.
   Spiritus Pyroxilicus, (Pyroxylic Spirit.) Wood naphtha.
An excellent remedy for catarrhal affections  of  the head,
bronchitis and consumption.  It may be inhaled or may be
given internally in fifteen to thirty drop doses,  every two
or three  hours.
   Squilla  Maritima, (Squill,  Sea Onion.)   Emetic  and
expectorant.
   Statice Caroliniana, (Marsh Rosemary.)   Used in leu-
corrhcea, prolapsus uteri, dysentery, and chronic  diarrhoea.
Dose, from ten to  twenty grains.
   Stellaria Media, QChickweed.)  A syrup of this article
is good in  hooping-cough, bronchitis, and  asthma.  Dose,
a tablespoonful three or four times a  day.
   Stercimis Repens.   Diuretic, subastringent, &c.
   Sterculiaca  Tragacantha furnishes  the Sierra Leone
tragacanth;  the S.  terens—a  similar product.  The pod
of S. foetida, employed against  gonorrhoea.
   Stillingia Sylvatica, (Queen's Root.)   Used mostly in a
compound syrup.  Useful in all diseases where  an active
alterative is required.
   Stramonium Daturia, (Thorn Apple.)   An active narco-
tic.  Ten or fifteen drops of the tincture is used in epi-
lepsy and other nervous affections. 
                MATERIA MEDICA.           1111

  Strychjiiae  Ac etas, (Acetate of Strychnine.)   Strychnise
lodas.  Iodate of Strychnine.  Strychnise Nitras.  Nitrate
of Strychnine.  From  one thirtieth to one fifteenth of a
grain is used in palsies.
  Strychnos  Nux Vomica,  (Poison Nut; Nux  Vomica.)
A tincture is used as a tonic and anti-periodic in doses of
from one to five drops.
  Strychnos Ignatia, (St. Ignatius'  Bean.)  An extract is
valuable in spermatorrhoea and weakness of the sexual or-
gans generally.   From one-fourth to one-half grain  is a
dose.
  Styrandra, (Harewort,  Adder tongue,  Natasbuck of Al-
gic  tribes.)  Root diuretic.
  Succus Limonis, (Lemon  Juice.)   Good to prevent sea
sickness and  scorbutic diseases.
  Sulphur.—Used in most acute eruptive diseases.  Dose,
from one to ten grains.
  Sulphuris  Iodidum, (Iodide  of Sulphur.)   Good in
scrofula  and cutaneous  affections.  One to two grains a
dose.
   Suriana Maritima.   Used for sore lips.
  Symphytum  Officinale, (Comfrey.)  Is a good mucila-
 ginous drink in coughs, colds, &c.
  Symplocarpus  Fcetidus, (Skunk's Cabbage.)  The  ace-
 tic tincture  is valuable in  hooping cough and spasmodic
 asthma.   The  pulverized root is also an active anti-spas-
 modic.  Dose of tincture, one drachm; of the powder, ten
 to  twenty grains.
   Tanacetum  Vulgare, (Tansy.)   A  decoction is a valua-
ble emmenagogue.    It  also improves  digestion.    Dose,
wine-glassful three or  four times a day.
   Taraxacum, Dens Leon-is, (Dandelion.)  The extract or
syrup is  an excellent remedy for chronic diseases  of the
 liver.   It may be taken freely.
   Tephrasia Virginiana, (Hoary Pea.)  It is a powerful 
 1112           MATERIA  MEDICA.

 alterative; used in syphilis and  all cases where an altera-
 tive is required.   Dose, from  ten to  twenty grains of the
 pulverized root.
   Thuya Occidentalis, (Arbor Vitai.)  Used in intermit-
 tent fever, chronic diseases of the spleen.  Dose, one-half
 pint of decoction three times  a day.
   Thymelacce  Palustris,  (Leather Wood.)  A good as-
 tringent.
   Thymus Vulgaris, (Thyme.)   A strong infusion, drank
 freely, is a diaphoretic.
   Tiarella Cordifolia,  (Paasmung of Algic tribes.)  Root
 mucilaginous, pectoral.
    Tilia  Americana,  (Linden,  Basswood,   Whitewood,
 Spoonwood,  Lucumug, of Mohegans, Lucuy  or  Wuckopy
 of Algic tribes.)   Antiperiodic and tonic.
   Tinctura Ferri  Chloridi, (Tincture of  Muriate of Iron.)
 Used in erysipelas, puerperal  fever  and  other diseases
 when'there is great debility.  Dose, from  one to five drops.
   Tolutanum, (Balsam of Tolu.)  Expectorant, and a lung
 tonic.
   Trifolium  Pratense, (Red  Clover.)    The  extract  is
 used for cancers.
   Trigonella Fcenumgrsecum,  (Fenugreek.)  Used in ner-
vous and hysterical affections.
    Trillium  Latifolium.    Broadleaf  Bethroot,  Vulgar,
Bethroot,  Rattlesnake  Root,  Wakerobin, Cough-root, In-
dian Balm,  Groundlily, Jew's Harp, Indian Shamrock,
Pariswort,  Truelove.   Used  in uterine  hemorrhage and
leucorrhcea.  From five to ten grains a dose.
   Trillium Pendulum,  (Bethroot.)  An  excellent  remedy
in  low  forms  of  fevers  accompanied  with  hemorrhage.
Dose, five to ten grains.
   Triosteum  Perfoliatum, (Fever root.)   The gin tincture
taken in wine-glassful  doses three or four times a day, is a
good remedy for chronic rheumatism.
i 
MATERIA MEDICA.
1113
  Tropeolum  Majus, (Nasturtium,  Indian  cress.)   Sub-
acrid, diuretic, &c.
  Tussilago Farfara, (Colt's Foot.)   A  decoction of the
root is an excellent remedy in scarlatina and typhoid fever.
Dose, tablespoonful every two or three hours.
  Ulmus  Fulva, (Slippery  Elm.)    Used  as  a cooling
drink, and for poultices.
  Urtica Dioica, ( White Nettle.)   A decoction is good for
sterility, impotency,  and  weakness  of the sexual  organs.
Dose, half gill three  or four times a day.
  Uvaria Triloba, (Pafan or Pawpaw.)  A strong decoc-
tion taken in  gill doses three or four  times a day, cures
epilepsy.
  Uvularia  Perfoliata,  (Bell-wort.)   Nervine,  used  in
neuralgia  and  hysteria.   Dose, twenty or  thirty grains
three or four times a day.
  Vaccinum Frondosum,  (Blue Whortleberry.)   A  syrup
of this is good for gravel.
  Valeriana Officinalis, ( Valerian.)  Nervine, used in all
nervous affections.   A decoction may be drunk freely.
   Valerianum  Pauciflora, (American  Valerian.)   Root
tried in nervous diseases, perhaps Eq. of V. officinalis.
  Veratrum Viride,  (American Hellebore.)   A tincture  is
used in  all forms of  fever and inflammation where there is
a high grade of action.   Dose, from one to ten drops.
  Verbascum   Thapsus,   (Mullin.)   A  decoction  drank
freely allays pain in  mumps and prevents metastasis.
  Verbena  Hostata,  (Vervain.)  Good  in  rheumatism,
gout and piles.  Dose of the tincture, one drachm three or
four times a day.
   Veronica  Beccabunga.    Water  Speedwell,  Vulgar,
Neckwood,  Water Purslain,  Good  diuretic.
  Veronica  Officinalis, (Speedwell.)   A  syrup is valuable
in land  scurvy or purpuria.  Dose,  tablespoonful four or
five times a day.____
       94 
1114
MATERIA  MEDICA.
   Viburnum Opulus, {High Cranberry.)  One of the most
powerful antispasmodics known.  Used in tincture and de-
coction, in fits and spasms.  Dose of decoction, tablespoon-
ful every half hour; of tincture one drachm as indicated.
   Viburnum Prunifolium, (Black Haw.)   A decoction is
good in incontinence of urine.
   Vine a Minor, (Periwinkle.)   Leaves bitter acid astrin-
gent.
   Viola Pedata (Blue  Violet.)  A good poultice in rattle-
snake bites, stings of insects, &c.
   Viscus Flavescens, (Mistletoe.)  Said to be valuable  in
palsy.
   Vitex Agnus castus, (Chaste  tree.)   Leaves discutient,
dispel  swelling of joints and testicles applied warm.
   Xanthorrhiza,  (Yellow Root.)  Is  a tonic  used in the
form of bitters.
   Xanthoxylum Fraxinum,  (Prickly Ash.)   Good  in
rheumatism, cholera morbus, and cholera.  A tincture  of
the berries and bark is used.
   Xerophyllum Setifolium, (Turkey's Beard.)  The Helo-
nias frigida is an active poison.
   Xyris Caroliniana,  (Eyegrass, Headgrass.)  Roots and
leaves  used  against lepra and diseases of the skin by Hin-
dus.
   Zinci Iodidum, (Iodide of Zinc.)   Used as an ointment
for indolent ulcers.
   Zinci Oxydum, (Oxyde  of Zinc.)   Used  as a  wash
for syphilitic ulcers.
   Zinci Sulphas. (Sulphate of Zinc.)   Used as a caustic
in cancers.
   Zingiber  Officinale,  (Ginger.)  A stimulating diaphore-
tic—taken freely. 
PART   V.
                   PHARMACY.

   Pharmacy is the art  of preparing and  compounding
medicines.

   QUANTITY  OF  MEDICINE  TO  BE  USED.
   The quantity of medicine  to be administered must de-
pend altogether  upon  the  age, temperament, constitution,
&c. of the patient.   For the proportionate doses of differ-
ent ages,  the reader is referred  to  the table of doses, as
modified by age, in another part of  this  work.  The time
required for an ordinary dose of triturated medicine to
pass into the circulation is from one to two hours; conse-
quently, if the first dose is not sufficient to accomplish the
ends for which it is given, it may be repeated every one or
two hours until the desired effect is  produced.  Pure soft
water is the best material  in which to mix  the medicine
for administration; all jams and jellies should be carefully
avoided, as they frequently entirely  neutralize the medici-
nal properties of the article.   If the medicine is a tincture,
as aconite or veratrum, it may be largely diluted  in soft wa-
ter asv one half drachm of the tincture may be added to
one half tumbler  of  water,  and  one tablespoonful  given
every fifteen or twenty minutes until the requisite quantity
has been taken.   All the tinctures may be taken in  this 
1116
P II A R M A C Y .
way.   In acute diseases, but one  kind should be given at
once, unless there  is a marked indication for some other
remedy which is compatible with  the one being taken; or,
unless  the medicines possess the  same properties, and one
be mixed with the  other to modify its  action; as quinine
and cornin, both being antiperiodics, when  combined, one
facilitates the action  of  the  other; so with  many other
remedies.
  To make an infusion of any article of medicine.   Take
one pint of warm or cold water, for one ounce of the reme-
dy, much care being taken to  prevent boiling  or overheat-
ing, as this frequently destroys the virtue of  the remedy.

                 ANTIPERIODICS.
  Take  extract cornus  Florida,  two drachms; piperin,
twenty grains; make forty pills.   Dose,  one every hour
for  fifteen hours before the paroxysm.

                     BALS A MS.
                    Balsam of Honey.
      R. Balsam of Tolu (Balsamum  tolutanum)....... ^ij.
         Balsam of Fir (Pinus balsamea,)................. ^ij.
         Opium (Popaver somniferum).................... gij.
Dissolve all these in one quart of alcohol.   Dose, a tea-
spoonful occasionally.  Use —This preparation is also very
useful  in pulmonary diseases.—(Beach.)

                   Pulmonary Balsam.
  Take of the roots of spikenard,  elecampane,  comfrey and
blood root, of the leaves and flowers of  horehound, and of
the bark of wild cherry, each  one pound.   These may all
be  ground and  tinctured  by adding  alcohol, water and
sugar,  sufficient  to make three gallons of syrup.  Or any
portion of the above compound may be tinctured in  suffi-
cient alcohol  to cover them, when the  drugs may  be
boiled  until the strength is obtained, and  the  tincture and 
PHARMACY.
1117
watery infusion  may be  mixed, and a sufficient amount of
refined sugar added to make a thick syrup.   The  Pulmo-
nary Balsam is one of the most valuable cough and expec-
torant  syrups in  use.   It  may be  used in all  eases  of
coughs and colds, also in bronchial  and pulmonary affec-
tions.  Dose is from  one to two teaspoonfuls four or five
times a day.
                      BITTERS.
                   Restorative Bitters.
  Take tamarac bark, six pounds; prickly ash berries, four
pounds;  black cherry bark  and root, three pounds; tansy,
one  pound; pulverize, and to one  and a half ounces add
boiling water, one  pint;  sugar, one  pound;  gin,  one-half
pint.  Mix.   Dose, wine-glassful three times a day.

                       Spice Bitters.
      R. Poplar Bark (Liriodendron tulipifera)......... lb  x
         Bayberry Bark (Myrica cerifera.).............. R).  ij
         Balmony Bark  (Chelone glabra,) .............. lb.  ij
         Golden Seal [Hydrastis Canadensis,).....*... ft),  j
         Cloves (Caryophillus aromaticus,).............. lb.  j
         Cayenne Pepper (Capsicum baccatum,)...... lb. ss
         Loaf Sugar, ....................................... K>.  xvj.
Let  these articles  all be made fine and well mixed.  Put a
tablespoonful of this compound, with four ounces of sugar,
into a quart of boiling water.  Take a wine-glassful three
times  a  day before eating.   This  is a good bitter.  Or a
teaspoonful of these powders, with  one of sugar, may be
taken in a cup of hot  water;  or one ounce may be scalded
in half a  pint of hot water, and put  into a quart bottle,
which may be filled with good Malaga  wine.  Prepared in
this way, it  is  an excellent bitter for weak  patients.—
( Thomson.)
                    Tonic Wine Bitters.
   Take  wild  cherry, gentian, and  black  alder,  each one
ounce; orange peel,  one ounce;  boiling water, one pint;
                           94*
\ 
 1118                PHARMACY.

 loaf sugar, one  pound;  stir.  When cold, add sweet wine,
 four pints; bottle tight.   Dose, wine-glass full three times
 a day.
                      CAUSTICS.
                     Vegetable Caustic.
   Burn  black ash  or hickory bark, and  beech  bark, to
 ashes.  Boil down to a salt.  Keep from the air.

                      Chloropercha.
   Dissolve one  ounce of gutta  percha in  four ounces of
 chloroform.   Useful in all cases where collodion is used.

                     CORDIALS.
                  Anli-Dysenteric Cordial.
      R. Birch Bark (Betula len'a,).....................  Ib.ij.
         Bayberry Bark (Myrica cerifera,)...........  Ib.jss.
         Wild Cherry Bark (Prunus virginiana,)  ...  tb.j.
         Peach Pits (Amygdaluspersica,) ..............  Ibj.
         Water,        Galls............................   ij.
 Boil down to one and a half gallons, after which  add half
 a gallon of good  brandy, and loaf sugar sufficient  to make
 it  palatable.   Dose, a wine-glassful  three  or four  times a
 day.  Use—This preparation forms a very excellent tonic
 and  astringent  for  dysenteries and  diarrhoeas  of long
 standing.—(Beach.)
                    Mother's Cordial,
   Or Compound Syrup  of Partridge Berry, according to
 the  American  Eclectic  Dispensatory.   Take partridge
berry, one pound;  helonias  root,  high cranberry bark,
blue cohosh  root, of each  four  ounces.   Grind and mix
the articles together, place the whole in a convenient ves-
sel, cover them with fourth-proof brandy, and macerate for
three days.    Then transfer the whole to a displacement
apparatus, and gradually add brandy until  three  pints of
spirituous  tincture  have  been  obtained, which  reserve.
Then continue the displacement with  hot water until the 
P H A R M A C Y ,
1119
liquid  passes tasteless, add to this two  pounds of refined
sugar,  and evaporate by a gentle heat to five pints, remove
from the fire, add the reserved three pints spirituous tinc-
ture, and  flavor with essence of sassafras.   This prepara-
tion, says Dr. King, is a uterine tonic and anti-spasmodic.
It may be used in all cases where the functions of the in-
ternal reproductive organs are deranged, as in amenorrhcea,
dysmenorrhoea, menorrhagia, leucorrhcea, and to overcome
the tendency to habitual abortion.   The dose is from one
to four tablespoonfuls three times a day; pregnant females,
especially those of a delicate or nervous system, will find
an advantage in taking one or two doses daily.

                   DECOCTIONS.
                    Diuretic Decoction.
    R. Queen of the Meadow (Eupatoriumpurpureum,).. £\j.
       Milkweed (Asclepias Syriaca,)........................ Sjij.
       Juniper Berries (Juniperus communis,).............. ^ij.
       Dwarf Elder (Aralia hispida,) ... .................... gij.
       Spearmint (Mentha viridis,)............................. ^ij.
       Wild Carrot Seed, (Daucus carota,)................. gij.
Put all into a mortar and bruise.  Make a strong  decoc-
tion.   Dose, half a pint,  to  be taken often through the
day.   Use.—This  decoction  is  strongly diuretic,  and  is
very useful in gravel, dropsy, &c.
                     DIURETICS.
   Diuretics increase the secretion and flow of urine.  These
remedies are often of great value in the treatment of dis-
ease.   They  operate with  the  greatest efficiency when
largely diluted  with warm water, and  the  surface is kept
cool.   Among the best diuretics are marsh-mallow, clivers,
Indian hemp, queen of the meadow, and dwarf elder.

                   DIAPHORETICS.
   These are medicines which lessen the heat, by increasing
the moisture of the  surface of the body.   They are ser- 
1120
PHARMACY.
viceable in all cases of fevers.   Aconite  and veratrum are
among the best diaphoretics.

                        DROPS.
                  Antispasmodic Drops.
  Take equal parts of the saturated tinctures of red pep-
per, lobelia, and  skunk  cabbage  root.  This is a useful
preparation,  in  cramps,  spasms, convulsions, lockjaw,  &c.
Dose, half teaspoonful as  often as required in convulsions
and lockjaw; it must be  poured  into the corners of the
mouth, and  be  repeated as occasion  may require; gene-
rally the effect is almost instantaneous.

                    Bronchitis Drops.
  Take the  fluid  extract  of rumex crispus, rhus glabra,
hyosciamus  niger, uvularia perfoliata, and  cypripedium
pubescens; mix well together.   The Bronchitis Drops are
valuable in chronic bronchitis, laryngitis, &c.  Dose, from
five to ten  drops, repeated  as indicated.

                     Diuretic Drops.
    R. Sweet Spirits of Nitre (Spiritus ce'herii nitrici,).... ^ij.
       Balsam of Copaiba (Cupaifera officinalis,).............. ^j.
       Tincture of Gum-Kino [Pierocarpus erinaceas,)..... Jss.
       Spirits of Turpentine (Pinus palustris,)................ l|ss.
Mix  these together,  and  add  one scruple of  camphor.
Dose,  a  small teaspoonful,  well  shaken, in mucilage of
gum  Arabic, three or  four times a  day.   Use.—These
drops  are  successfully administered in cases of  scalding
of  urine, whether arising from syphilitic  or  other com-
plaints.  In  inflammation  of the kidneys, fluor-albus,  &c,
they give  prompt  relief.   They are superior to all other
preparations for these uses, and particularly in gonorrhoea.
A beautiful emulsion is made  of these drops, by adding
the white of an egg, well beaten up.—(Beach.) 
PHARMACY.
1121
             Thomson's Hot-Drops, or " No. 6."
R.—Spirits of Wine,................................................. gall. j.
    Gum Myrrh, pulverized (Balsamodendron myrrha,)... Ibj.
    Cayenne Pepper (Capsicum baccatum,) .................. gj.
  Put them into a stone jug, and boil it for a few minutes
in a kettle of water, leaving the jug uncorked.   It may be
prepared without boiling, by letting it stand, and shaking
it two or three times a day, for a week, when  it will be fit
for use.  Dose, from a teaspoonful to a tablespoonful, in a
little  hot water, or given in other medicine.  Use.—These
drops are to remove pain, and prevent mortification, either
internally or externally.  They may be used to bathe with
in all cases of external swellings or pain.  It is  an excel-
lent remedy for the rheumatism, in which  case, take a tea-
spoonful;  also, bathe the parts affected.   It will  relieve
headache, by taking a dose, bathing it on the head, and
snuffing it up  the nose.   It is good for bruises, sprains,
swollen joints, and old sores; it will allay inflammation, re-
duce  swellings, ease pain, and produce a tendency to  heal.
There is scarcely a complaint, in which this may not be
used  to advantage.   It is the best preservative against
mortification that I have ever found.—For bathing in rheu-
matism or itch, or for  any other  external  application, add
one quarter part  of  spirits of turpentine;  and for sprains
or bruises, a small quantity of camphor and nerve-ointment
may be added.— Thomson.

                  electuaries.
                 Paine's Pile Electuary.
  Take of cream of  tartar, one ounce; electuary of senna,
one ounce;  flower of sulphur,  one-half ounce; leptandrin,
one drachm; euonymin, two  drachms; simple syrup, one
pint.   Dose, tablespoonful  twice a day, morning and eve-
nino-.   The  above is  designed to be used instead  of the or-
dinary pile electuary.  When used in connexion with pile
ointment, it  is almost a specific for all forms  of prolapsus
ani and piles. 
1122
PHARMACY.
                          EMETICS.
       Emetics are those remedies which evacuate the stomach.
     They are serviceable in the commencement of many fevers,
     also in some chronic diseases, and always when the stomach
     is loaded with some foreign substance.   The best medicines
     for emetics, are lobelia, blood-root, and ipecac.
       Before administering an emetic, the patient should drink
     a moderate quantity of some warm tea, as chamomile, cat-
•    nip, ginger, or Thomson's composition.  If lobelia is given,
     from one-half to one  teaspoonful of the tincture  may be
     taken every five or ten minutes, until it operates as desired.
     The tincture of blood-root and ipecac, may be used in larger
     quantities, say in teaspoonful doses.   The pulverized seed
     of lobelia may be given, by adding one-half  teaspoonful to
     one  teacupful of warm water, and, after steeping ten or fif-
     teen minutes, one tablespoonful may  be  taken  every ten
     minutes, until the desired effect is produced.  Thirty grains
     of pulverized ipecac, and sixty grains of pulverized blood-
     root, may be used in the same  way.

                        Valuable Emetic.
       Take lobelia, two drachms; blood-root, one drachm; skunk
     cabbage, one drachm; ipecacuanha, two drachms; Cayenne
     pepper, half drachm.  Mix, and give a teaspoonful in warm
     herb tea; if  the first dose is  rejected,  immediately  repeat.
     Warm water or tea may be drunk  freely afterward.

                      EMMENAGOGUE.
      Take white turpentine, three drachms;  sulphate of  iron,
     one drachm.   Make a pill of common size.  Dose, one three
     times a day.
                     EXPECTORANTS.
                       Expectorant, Ao. 1.
      Take balsam tolu, two  drachms; balsam  benzoin,  one
     drachm; saffron, one-half drachm; honey, two drachms; hot
     alcohol, one pint; digest seven days.  Dose, a teaspoonful. 
P H AR MAC Y.
1123
                    Expectorant, No. 2.
   Take blood-root, lobelia herb, skunk cabbage root, asara-
 bacca,  (hazelwort,) pleurisy  root, each coarsely powdered,
 one ounce;  alcohol, three pints; water, one  pint.  Let  it
 stand fourteen days,—shake frequently.
   For  croup, hooping-cough, bronchitis  and asthma, this
 is a valuable preparation, and is excellent as  an emetic for
 children, being gentle, safe and certain.   It is also good as
 an expectorant, tightness across the breast, and where there
 is an excess of phlegm.
   Directions.—In croup, for children one year  old, give
 one-half tablespoonful in molasses, and repeat every fifteen
 minutes,  until vomiting is  produced; after which, a tea-
 spoonful  may be  given  every hour  or two, as required—
 the vomit to be repeated two or three times a day.

                  FOMENTATIONS.
   Cloths wrung out of hot water, or an  infusion of any
 medicinal substance, is applied for local congestion or in-
 flammation.   In  these applications,  the adjacent  clothing
 should be protected from moisture by oil-silk.
                     GRANULES.
              Compound Podophyllin Granules.
   R.—Podophyllin,.............................................  giij.
        Capsicum.................................................  gj.
        Jalapin,..................................................  5[iij.
        Gum Arabic and Flower aa, ........................  3J.
Form a pill mass, and  make  sixteen  hundred and  eighteen
granules.   Dose, from three to  six,  as a purge,  once or
twice a day, as  an alterative, for  the liver; much better
than Blue Pill.   (E. E. Tuttle.)
              Compound Leontodon Granules.
     R.—Podophyllin,......................................... 3J.
          Leontodon........................................... gj.
          Jalapin,............................................... gij.
          Capsicum,............................................ gr. xxx.
          Hyoscyamin,....................................... gr. x. 
1124
PHARMACY.
Mix.   Make four hundred and eighty granules.   Dose,
from two to four, as  a purge.   ( V. L. Oliver.)

                    INJECTIONS.
                  Clysters, or Injections.
   When these are used merely to act upon the bowels,
warm water  or flaxseed water may be used.  Any medi-
cines may be thus administered when the stomach will not
tolerate them.
                 Injection for Dysentery.
   Tannin, one drachm;  hydrastin, one-half drachm; mor-
phine, two  grains;  starch, six ounces;  water, one  pint.
Mix.   Make into six ounce injections.  One after every
discharge.
                    LINIMENTS.
                  Concentrated Liniment.
   Take of oil of  origanum, oil of hemlock, oil of cajeput,
gum camphor, of each one pound; African red pepper, half
pound.   Digest  two weeks, express and  filter, and add of
pure white soap sufficient to form  a liniment.   Very use-
ful in painful affections.

               Counter-Irritating Liniment.
   Take alcohol, four ounces; oil stillingia, one drachm; oil
capsicum, ten drops; croton oil, five drops.  Mix.   Apply
with a small sponge.  Good in bronchitis, chronic  rheu-
matism, and  in all diseases where counter-irritation is in-
dicated.  Enough should be applied, two or three times a
day, to keep the surface slightly irritated.

             Goitre Liniment, Dr. D. Ecker.
   Take four ounces of nitrate of potassa, put into one quart
of rain water, let it dissolve, then add two ounces of spirits
of nitre, and one ounce of sulphuric acid, and four ounces
of tincture of opium; then bottle  for use.  Wet the part
affected, two or three times a day,  until cured. 
PHARMACY.
1125
                   Irritating Liniment.
     R.—Spirits of Turpentine, (Pinus palustris,).......gj.
         Croton Oil, (Croton tiglium,)......................^ss.
         Olive Oil, (Olea Europea.).........................gj.
  Add a little origanum or sassafras oil, and mix.
  Use.—One of the best counter-irritants for chronic and
deep-seated pains.   Rubbed in daily, it produces copious
eruptions.  It is good in bronchitis.—(Beach.)

                       Liniment.
  Take tincture capsicum, two ounces;  oil origanum, two
drachms; oil cinnamon, one drachm;  tincture opium, three
drachms; tincture  camphor, one drachm; spirits ammo-
monia, three  drachms; turpentine, one-half ounce.   Mix.
Good for rheumatism.

              Valuable Stimulating Liniment.
  Take compound  tincture of myrrh,  Dr. Thomson's No.
6, one pint; oil of origanum, two ounces; oil of hemlock,
three ounces;  oil  of turpentine, four  ounces;  Cayenne
pepper, one ounce.  Mix and  shake well.  This is  a very
useful application for rheumatism, stiffness of joints, &c.
It may be used with advantage  in erysipelas or black
tongue, by  rubbing  the throat with it frequently.  It may
also  be applied  to  the chest for diseases of  the  lungs,
bronchial affections, &c.  By applying a mullen leaf to the
surface where this liniment has been applied, a blister will
form immediately.
                    MIXTURES.
                   Mixture for Ague.
  Take brandy,  one pint; spirits of camphor,  one ounce;
cloves, half  an ounce;  jalap, half an ounce; Peruvian
bark, two ounces;  Canada snake  root, one ounce; water,
one pint.   Put the  cloves, jalap, Peruvian bark and snake
root in the water, and boil to one-half pint, strain and add
to the brandy.  Dose, one tablespoonful three times a day.
       95 
1126
PH ARM AC Y.
                    Asthma Mixture.
      R.—Ether Sulph......................................... oiJ;
          Lobelia Sem. pul.................................. 3*3'
   Let stand  fourteen  days before using it.   Color with
Cochineal Extract.   To use, put §j. on handkerchief and
inhale.
                  Mixture for Asthma.
   Take glacial phosphoric acid, one half drachm; quinine,
two scruples;  extract cannabis indica, thirty grains;  pul-
verized lobelia seed, twenty  grains.   Make three grain
pills.   Dose, two  every three hours.

                 Mixture for  Baldness.
   The following  is  almost a  specific for baldness,  giving
the hair a smooth, glossy and beautiful appearance.
   Take lac sulphur, one ounce; sugar of  lead, one  half
pint;  sulphate of copper, five grains; pure water, one-half
pint.   Mix all together, and filter through thin  paper;
add to the mixture seven ounces of rose water; essence of
bergamot, cinnamon, jessamine and peppermint, each one
ounce.  Bathe the  head  twice  a day, and give a cold
shower-bath once  or twice a week.   The essences are  for
the purpose of giving it a perfume, and may be omitted,
and pure water added to the same amount.

                Mixture for Gonorrhoea.
  Take copaiba, tincture of cubebs, and syrup of uva ursi,
of each two fluid ounces; gum  Arabic,  pulverized, two
ounces ; cinnamon water, sixteen fluid ounces.   Mix; form
an emulsion, and take one tablespoonful three times  a day.

           Mixture for Hooping-Cough, No. 1.
  Take tincture of the bark of red  root,  ceanothus,  two
ounces; bloodroot, one ounce ; black cohosh, one ounce;
lobelia, half an ounce; mix.  Dose for a child one year old,
fifteen to twenty drops in  cold, sweetened water, and gra- 
PHARMACY.
1127
dually increase.   This is a good tincture for cough; but
should not be used except in  the absence of all inflamma-
tory symptoms.
                 Neutralizing Mixtures.
  R.—Rhubarb and  bi-carbonate of potassa, of each one
pound; alcohol, one half gallon. Tincture the rhubarb in the
alcohol for two days ; then filter and add to the drug one and
a half gallons of water and evaporate down to  one gallon;
then strain and express by pressure.   After which add the
potassa and  six pounds  of white sugar.   Heat until the
sugar and potassa dissolve.  When cool, add six ounces of
good peppermint essence and the alcoholic tincture of the
rhubarb.  Dose, one tablespoonful as indicated.

                Mixture for  Salt Rheum.
  Take molasses, one  pint; sulphur, cream of tartar, one
half pound; rhubarb, one ounce; nitrate of potassa, one
ounce.  Mix.   Dose, tablespoonful.

              Mixture for Typhoid Fever.
  Take new oil of turpentine, two fluid ounces ; bi-carbon-
ate  of soda, one drachm; pulverized gum Arabic and pul-
verized sugar, each two ounces;  compound spirits of laven-
der, one-half fluid ounce; camphor water, four fluid ounces;
peppermint, three fluid ounces.   Mix,  form an emulsion.
Take  a tablespoonful every two hours.
  Tincture  of aconite or tincture rhus may be added  to
this.  Mix,  and give as the case requires.

         Valuable Domestic Mixture for Dysentery.
  Take hot  water, one-fourth of a pint; vinegar, half pint.
Mix, and then continue to add common salt as long as the
solution will dissolve it.  Dose, for  an adult, one  table-
spoonful  every hour until the stools cease to be tinged with
blood, or it operates freely on the bowels. 
1128                PHARMACY.
                     Worm Mixture.
      R.—Populin................................................ 3J-
          Santonin............................................. gr; xx-
          Merrell's Ess. Tinct. of Pink Root............ giv.
          Fluid ext. of Antibilious Physic............... giv.
          Neutralizing mixture............................ Oj.
   Rub the santonin in the neutralizing mixture, until tho-
roughly mixed;  then add the other ingredients.  Good to
remove  worms in  children.   Dose, from thirty  to forty
drops every half hour until it acts upon the bowels  as a
purge.  If the worms  are  not removed, repeat every two
or three days.
                   Discutient Ointment.
     R.—Bark of Bittersweet root, (Celastrus Scandens,)  ^ij.
         Stramonium leaves, (Datura Stramonium,).... ^ij.
         Cicuta leaves, (Conium Maculatum)............. Sjij.
         Deadly Nightshade, (Atropa Belladonna,)...... ^ij.
         Yellow Dock-root, (Rumex Crispus,)............. ^ij.
         Lard.................................................... ft).
   Bruise, and simmer the roots and leaves in spirits;  then
add  the lard, and simmer till the ingredients are crisped.
   Use.—This forms an  exceedingly valuable ointment  in
discussing scrofulous, indolent, and glandular tumours and
swellings.  The parts should be rubbed for about half an
hour at each application,  and then apiece of cotton applied,
secured by a proper bandage.   (Beach.)

                   Mild Zinc Ointment.
   Take hog's lard,  two ounces;   sulphuric  acid, two
drachms.   Mix them in  a glass mortar.   This ointment is
said  to be an effectual cure for the itch.
    R.—White wax............................................  giss.
         Balsam Fir..........................................  tij.
         Pulv. Sulph. Zinc..................................  zij.
Mix.  Form an ointment. 
PHARMACY.
1129
                       Ointments.
  An ointment for the cure of burns may be made as fol-
lows :—Take fresh  butter, one-half pound; yellow dock
root, cut in small pieces, one ounce; fresh raspberry leaves,
one-half ounce; white wax, one ounce.  Melt  the butter
and wax together, add the raspberry leaves and dock root,
simmer fifteen or twenty minutes, and strain while warm.
This is an excellent ointment for burns and scalds.

                     Pile Ointment.
  Take extract of  stramonium and  tobacco—each  one
ounce; tannin, ten  grains.  Make an ointment, and bathe
the parts.
                      Tar Ointment.
  This ointment  is  much  extolled  for removing  tettery
eruptions, and for the cure of scald head.   It  is prepared
by melting equal parts of  tar and  mutton suet, and  then
straining through coarse linen.

                    Antibilious Physic.
    R.—Take Pulverized Senna............................ 1 lb.
        Jalap.................................................. £lb-
        Ginger.............................................. 1 3-
Mix.  This mixture forms one of the most valuable purga-
tives in use.  It is  mild, yet efficient, and is well adapted
to evacuate  the stomach  and bowels, whenever it is indi-
cated.   Dose, five  or ten  grains every two or three hours,
until it operates.
                  White Liquid Physic.
  Take sulphate of soda, half pound; water, one and a half
pints; dissolve, and then add  nitro-muriatic acid, two fluid
ounces;  powdered  alum, one  drachm  and eight grains.
Dose, tablespoonful.
                       PILLS.
  The most uncertain method of using medicines is in the
form of pills, as they frequently become dry and hard, re-
                           95* 
1130
PHARMACY.
quiring a long time to digest.   They also frequently lose
their strength by standing.   Yet it is sometimes advisable
to use  some of the extracts in the form of  a pill.   They
may be made by rolling in  pure starch  or pulverized  li-
quorice, and only as fast as  used.

                     Antibilious  Pills.
    R.—Aloes, pulverized, (Aloe socotorina,)............. gv.
        Dry Castile Soap, fine............................... gss.
        Gamboge, pulverized, (Stalagmitis gambogia,) ^j.
        Colocynth, (Cucumis colocynthis,)................ ^j.
        Extract of Gentian, (Gentiana lutea,)........... ^j.
        Mandrake, (Podophyllum peltatum,)............ ^j.
        Cayenne pepper, (Capsicum baccatum,)......... gij.
        Oil of Peppermint, (Menthapiperita,)........... gss.

Incorporate well together, and form into three  grain pills.
Dose, from  three  to five.
   Use.—This makes one of the best  pills for all ordinary
complaints and purges, without griping or causing debility,
or leaving the bowels in a costive state.  (Beach.)

                  Compound Copaiba Pill,
      R.—Oil of Copaiba, (Copaifera officinalis,) gj. fl.
           Oil of Cubebs, (Piper cubeba,)......... gj.
           Oil of Turpentine, (Pinus palusiris,) gj.
           Calcined Magnesia,.. ..................  gij.
Mix, and  form   sixty pills.  Dose, one  or   two  a  day.
Use.—This has  been recommended as an excellent prepa-
paration.   (Beach.)

              Dr. Morrow's Antidyspeptic Pill.
   Take  extract  podophyllin,  extract  gentian,  extract
boneset, equal  parts,  two ounces; oil of cloves,  twenty
drops;  pulverized lobelia seed  and capsicum, equal parts,
one  ounce;  Castile soap  and gamboge,  equal  parts,  four
ounces; aloes, eight ounces.   Mix.  Form in  pills.   Dose,
one to four. 
PHARMACY.
1131
                      Female Pill.
    R.—Red Oxyde of Iron, (Oxydum ferri rubrum,)... %j.
        Aloes, pulverized,  (Aloe socoiorina,)............. fj.
        White Turpentine, (JPinuspalusiris,)............ ^j.
Melt the turpentine, and strain;  when cold, pulverize and
mix all together, with mucilage of gum tragacanth.  Dose,
three  or  four, twice or three times a day, and drink mo-
therwort tea during the time of  taking  them.   Use.—
This  pill constitutes  an  efficient remedy  in  obstructed
menses.   (Beach.)

                      Female Pill.
       R.—Sulphate Ferri,.......................... £j.
            Senecin, ................................... gr. xxv.
            Gossypiin,................................. 3J.
            Pulv. Aloes,.............................. 3J-
            Gum Arabic,............................ 3J-
            Capsicum,................................ 3J-
            Podophyllin,.............................. 9J-
   Mix, and form  a pill  mass, and  make two hundred and
forty pills.  Dose, from  one to five a day.   Good for ame-
norrhcea, leucorrhcea, female weakness, and all diseases de-
pendent upon debility of the uterus and ovaries.

                     PLASTERS.
   These are made by compounding  medicines with gums,
 resins, &c.
             Adhesive or Strengthening Plaster.
   Take  of rosin,  one-pound;  beeswax,  one  ounce;  Bur-
 gundy pitch, one ounce; mutton tallow, one ounce.   Melt
 them together, and add olive oil, pulverized camphor, and
 sassafras oil, of  each one-sixth of an ounce;  West India
 rum, one fluid ounce.   Stir well together, pour into cold
 water, and form  it into rolls with the hands.   This is an
 excellent plaster in weakness  of the joints, rheumatism,
 weak back, weak chest, ulcers, &c. 
1132
PHARMACY.
              Black Plaster, or Healing Salve.
   R.—Olive Oil, (OleaEuropcca,)........................... qts. iij.
       Common Resin,  (Pinus palustris,)................. ^ij.
       Beeswax................................................. §iij.
   Melt  these articles together, and raise the oil nearly to
 the boiling point; then gradually  add of pulverized red
 lead, two and a quarter pounds, if it be in the winter.  If
 in the summer, two and a  half pounds.  In  a short time
 after the lead is taken up  by the oil, and the mixture be-
 comes brown, or of a shining black, remove from the fire,
 and when nearly cold, add half an ounce of pulverized cam-
 phor.   It should remain on the fire until it forms a proper
 consistence for spreading, which may be known by dipping
 a spatula or knife into it, from time to time, and suffering
 it to cool.   Use.—We have found  this elegant salve supe-
 rior to every other, where applications of  this kind are re-
 quired.  It has an excellent effect in burns, and in  scrofu-
 lous, fistulous, and all other  ulcers.  It should be thinly
 spread  on a piece  of  linen, and renewed  once  or twice a
 day.  (JBeach.)

                   The Irritating Plaster.
   This  is made by using boiled tar, one pound; Burgundy
 pitch, one-half ounce; white gum turpentine, one  ounce;
 rosin, two ounces.  Melt the  tar, rosin and gum together,
 remove from the fire, and  add finely pulverized mandrake
 root, blood-root, poke-root, Indian turnip,  each one ounce.
 This plaster is used extensively in all cases where counter-
 irritation and revulsives  are indicated, as  in  rheumatism,
 neuralgia, and chronic affections of the  liver  and  lungs.
By Eclectic physicians, this is used in many cases  where
blisters are used by the "Old  School," and experience has
shown it to be far superior. 
PHARMACY.
1133
                      POULTICES.
              Sinapisms, or Mustard Poultices.
   These are prepared by adding one tablespoonful of mus-
 tard to three of  flour, mixing with equal parts of vinegar
 and water.  They are beneficially used to attract the blood
 from the deep-seated to the  superficial capillaries.  They
 are also applied to the spine and nape  of  the neck in  in-
 flammation of the brain.

                  Cataplasms, or Poultices.
   May be made  by moistening  bread  crumbs with milk.
 They may also  be made of flaxseed.  Roasted onions, snake-
 root, &c, may be used for poultices.   They are useful in
 nearly all cases of local inflammations.

                       POWDERS.
               Thomson's Composition Powder.
                   (Second Preparation.)
   R.—Bayberry, (Myrica cerifera,)........................... lb. j.
       Ginger, (Amomum zingiber,)........................... lb. j.
       Poplar bark, (Populus balsamifera,).................. lb. j.
       Hemlock bark, (Pinus Canadensis,).................. lb. j.
       Red or White Oak bark, (Quercus rubra—Quer-
            cusalba,)........................................... lb. ss.
       Cayenne Pepper, (Capsicum baccatum,)............ 5jiij.
       Cloves,  (Eugenia caryophyllata,)..................... ^ij.
 Pulverize, and mix well.

                  (Another Preparation.)
  R.—Bayberry, (Myrica cerifera,).........................  lbs. ij.
      Ginger, (Amomum zingiber,)......................... lbs. ij.
      Poplar bark, (Populus balsamifera,) .............. lbs. ij.
      White Oak bark, (Quercus alba,)................... lb. j.
      Cayenne Pepper, (Capsicum baccatum,).......... gij.
       Cloves,  (Eugenia caryophyllata,).................... gij.

  Pulverize, and  mix well.   Dose,  a teaspoonful in a cup
of hot water, sweetened.   Use.—Let either of these com- 
1134
PHARMACY.
pounds be taken for  canker, and to promote perspiration,
the patient being shielded from the air.  This is  for the
first stages and less violent attacks of  disease.   It is a va-
luable medicine, and  may be safely employed  in all cases.
It is good for relax, pain in the stomach and  bowels, and
to remove all obstruction caused by cold.  A few doses of
this, the patient being in bed, with a steaming  stone at the
feet, will cure a bad cold, and  usually throw off disease in
its first stage.   (Thomson.)

                   Diaphoretic Powder.
  R.—Gum Opium, pulverized, (Papaver Somniferum,)....  gss.
       Camphor,  (Laurus camphora,)...........................  gij.
       Ipecacuanha,  pulverized, (Cephoelis ipecacuanha,)  gj.
       Cream of Tartar,  (Potassce bitarlras,)................ 3J.
Pulverize  each article separately,  and then mix.  Dose,
ten grains as often as  may be necessary.  Use.—This forms
a valuable anodyne, diaphoretic, and sudorific.  It is bene-
ficially  administered  in fever, diarrhoea,  dysentery,  and
cholera morbus, and  in all cases where an anodyne, com-
bined with a sudorific, is required.   In these diseases it
should be given  in small doses.  It is also  applicable to
many other affections, such as  rheumatism, gout, &c.  It
promotes perspiration, without  increasing the  heat of the
body, producing a constant moisture of the skin for a great
length of time,  while  it allays irritation; and it is particu-
larly valuable in uterine and other hemorrhages.  (Beach.)

                 Red, or Styptic Powders.
    R.—Copperas, (Ferri sulphas,)......;..................... gvj.
  Submit it  to a red heat in a flame.   A decomposition is
thus  effected, and a  red substance formed.   This, when
pulverized, forms a powder, containing highly astringent
properties. Use.—It is employed in the treatment of piles,
and in hemorrhage.   It may be mixed with a little melted
tallow, and introduced up  the rectum for the  bleeding 
PHARMACY.                1135
piles.  One drachm of this to an ounce of unsalted butter
makes an excellent application for obstinate psoriasis or tet-
ter.   (Beach.)
              Thompson's " Woman's Friend."
  R.-—Poplar bark, {Populus balsamifera,)............... lbs. v.
      Unicorn, (Aletris farinosa,)........................... lb. ss.
      Cinnamon, (Laurus cinnamomum,).................. lb. ss.
      Golden seal,  (Hydrastis Canadensis,).............. lb. ss.
      Cloves, (Eugenia caryophyllata,)......»............. lb. ss.
      Cayenne pepper, (Capsicum baccatum,)............. ^iv.
      White Sugar, (Saccharum alba,).................... lbs. vij.
   Let them all be made fine, and well mixed.  Dose.—A
teaspoonful may be taken in a gill of hot water.   Use.—
This is  an excellent article in female weaknesses, to pre-
vent abortion, and to be used at the cessation of the menses.
 (Thomson.)
                    PURGATIVES.
   Purgative medicines are those which increase the alvine
evacuations, or increase the peristaltic action of the bowels.
This class of  medicines, although of great service in  many
diseases, is also capable of producing very bad effects.
   The constant use of purgative medicines has a tendency
to irritate and  derange the  action of  the bowels.^  They
are mostly useful  in case of obstinate constipation;  in most
brain affections;  in inflammation of  the  peritoneum; and
in some other diseases; but in typhoid  fever, inflammation
of the stomach and bowels,  and in all cases of great debili-
ty they are utterly inadmissible.  Among the best purga-
 tives are Euonymin, Podophyllin,  Iridin,  Neutralizing
 Cordial, and  Anti-bilious Physic.

                     For Cancer Salve.
   Dr. Fell uses this formula for cancer.
   Take blood-root, half ounce; chloride of zinc, half ounce;
water, two ounces.  Mix for use.  Apply on light leather,
 followed  by elm poultice. 
1136
PHARMACi'.
                      SYRUPS.
  In chronic diseases, syrup is often the best form of ad-
ministering medicine, as much benefit is derived from the
sugar it contains; frequently the sugar  is more beneficial
than the medicine.
  Sugar serves the purpose of combustion in the lungs and
extreme capillaries, thereby increasing the animal tempera-
ture, promoting secretion, excretion, &c.   It is stated, upon
good authority, that the negroes on the sugar plantations
become very fat and free from disease during sugar boiling.
And, as I have already stated, in  the treatment of consump-
tion, sugar is of great value.   The best method of prepa-
ring syrup for domestic practice, is to add one pound to one
pint of strong infusion.

        Acetic Syrup of Sanguinaria, or Blood-Root.
    R.—Blood Root in powder,.................................  3J
        Acetic Acid, or Vinegar,..............................j pt.
        Water,......................................................j pt. .
Add the blood-root to the vinegar  and water  mixed, and
steep  for two hours, then strain and add  two  pounds
of white sugar.   Simmer  until a syrup is formed.   This
is the specific remedy for pseudo-membranous croup.  It
is also used  in infantile  pneumonia and bronchitis.   Dose
for  croup is from one-half teaspoonful to one tablespoonful;
but it should not be  given in quantities sufficient to pro-
duce vomiting, unless there is imminent danger of suffoca-
tion;  and then only  sufficient to eject the mucus adhering
to the upper part of the bronchii and trachea.

                    Alterative Syrup.
  Take burdock and  sarsaparilla, each one pound; yellow
parilla, guaiacum, and five leaf ivy, equal parts, three-quar-
ters of a pound; elder flowers, one half pound.  Mix.  In-
fuse, and make into four quarts of syrup.  Dose, wine-glass
full three times a day. 
PHARMACY.
1137
                 Alterative Syrup, No. 1.
    R.—Stillingia Syl. pul.,.................................... gij.
        Podo. Pelt., pul,.......................................gj.
        Scrofularia Mery, pul.,.............................gj.
        Scutellaria Lat., pul.,................................gj-
        Chimaphilla Umb., pul...,...........................gj-
         Make syrup, Oj.  Dose, gj four times a day.

                         No. 2.
    R.—Sarsaparilla, ......................................... ft>s. vj.
        Guiacum Shavings,.................................. ft>s- "j-
        Sassafras Root Bark,............................... lbs. ij.
        Elder Flowers, \ --                    ,.. lbs. ij.
        Burdock Root, /
        Cheap Spirits, >   ................................c    ..
        Aqua Pura,  $
  Boil well and pour off the liquid:  then add water until
the strength is obtained.   Strain and reduce the whole of
the liquid to sixteen pints, and add  twenty-five pounds of
white sugar.   To every pint, half ounce of  iodide of po-
tassium.
  Dose, wine-glass full three times a day.

                    Alterative Syrup.
  Take burdock and yellow dock, equal  parts,  one  pound;
five leaf ivy, scrofularia Marylandica, equal parts, one-half
pound;  blue flag and poke,  equal parts, four ounces.   Make
eight quarts of syrup.   To each pint, one drachm of iodide
of potassium may be added.  Dose, one tablespoonful three
times a day.
                    Alterative Syrup.
  Take sarsaparilla and burdock, each one pound; yellow
par ilia,  three-fourths pound; guaiac shavings, three-fourths
pound;  elder  flowers  and  sassafras,  each one-half pound;
blue flag and dandelion, four ounces; five leaf ivy, three-
fourths pound;  prickly ash berries, one-fourth pound; wild
turnip, one-fourth pound.   Make three gallons  of syrup.
The sassafras and turnip must not be boiled.  Sugar, one
        96 
1138
PHARMACY-
pound to each pint of syrup; spirits, four quarts.   Dose,
tablespoonful three times a day.

                     Syrup of Alum.
    R.—Of Pulverized Alum................................. gj-
        Water.................................................. 1 pint.
Heat the water until the alum is all dissolved, and add one
pound of refined sugar, simmer until a syrup is formed,
strain, and when it is cool, it is fit for use.   The syrup of
alum is very valuable in hooping-cough, in chronic catarrh,
and the early stage of pulmonary consumption.   It is also
used in leucorrhcea and diabetes.   Dose is from one to two
teaspoonfuls three times a day, as often as indicated.

                  Antiscrofulous Syrup,
   As prepared according to the Eclectic  Dispensatory.
Take yellow  dock root, two pounds; bark  of the root of
false bittersweet, one pound; bark of American ivy, ampe-
lopsis quinquefolia, and figwort, of each half a pound; re-
fined sugar, sixteen pounds.  Grind  and mix the drugs to-
gether,  place the whole five pounds in a convenient vessel,
cover them with alcohol of 76 per cent., and macerate for
two days.  Then transfer the whole  to a common displace-
ment apparatus, and  gradually add hot water, until two
pints have  been  obtained,  which  retain  and  set  aside.
Then continue  the percolation, and of the second solution,
reserve so much as  contains a sensible amount of spirits,
and  evaporate the alcohol from it.   Continue the displace-
ment by hot water,  until the solution obtained  is almost
tasteless, and boil  down  this weaker infusion till it begins
to thicken, or until,  when added  to  the balance remaining
of the second portion after  the evaporation of the alcohol,
it will  make twelve  pints.   To these two  solutions com-
bined, add sixteen pounds  of refined sugar, and by heat
dissolve, carefully removing the scum which arises as it
comes to the point  of boiling.  Then, if  it exceeds that
quantity, evaporate  the syrup with constant stirring,  to 
PHARMACY.
1139
fourteen pints, remove from the fire, and when nearly cold,
add the two pints of tincture first obtained, and make two
gallons  of syrup.   Each  pint will contain the virtues  of
four ounces of the ingredients.   It  may be flavoured with
essence  of wintergreen.   It  is used in all cases where an
alterative  is  indicated in  chronic  hepatitis, rheumatism,
syphilis, scrofula, cutaneous diseases, ulcers, white swell-
ing, rickets, necrosis, and every taint of the system.  Dose,
from a teaspoonful to a tablespoonful three or four times a
day.
                      Cough Syrup.
    R.—Syrup of Gum Arabic.............................  Oj.
        Tinct. Prunus Virginiana........................ gij.
        Tinct. Opii..........................................  3J.
        Acetic Syrup Sanguinaria........................  Jvj.
Mix.   Dose, one tablespoonful every two or three hours.

                    Dysentery Syrup.
         R. Turkey rhubarb,..................^
          "  Leptandrin,.......................> aagij.
          "  Super-carbonate  soda,..........)
          "  White sugar,.......................  Ibj.
          "  Hot water,...........................  Oj.
  Triturate  well together.  Add essence of  peppermint
and essence of anise, of each  one dram; tinct. of catechu,
two drams.  For dysentery.  Dose, one teaspoonful every
half hour.
              Compound Syrup of Helianthus.
  Take five pounds of the helianthus  seed, finely pulver-
ized, to which add a sufficient  quantity of water to mace-
rate well;  let this  stand  five days, then  use  a displacer,
having  the mass boiling hot; to  this after being strained,
add three gallons Holland gin, the very best; then add
twenty-four pounds of loaf sugar; take of marsh mallow,
two pounds; pulverized hydrastis Canadensis, two ounces;
peach kernels, eight ounces; water,  one gallon.   Boil and
strain, then mix the residue with the gin  and  sugar; then
boil all  together  until a complete syrup  is formed; while 
1140
PHARMACY.
warm, add sulph. of morphine, in solution  two drachms,
and two pounds gum Arabic.   This makes one of the very
best  stimulating  expectorants  now  in  use, and  may  be
given  in doses of from one  drachm to two ounces three
times a day.   In this combination we have an expectorant,
stimulant, anodyne, tonic, and diuretic.  We  have  used
this in  a very large number of cases in both private and
clinical practice.   The report  of the latter is published in
the Journal monthly.

           Compound Syrup  of Hypophosphite.
   The following  formula  has been  made  in view of the
double purpose to which these salts are  directed  by Dr.
Churchill, the increase of nerve force, and the elevation of
the tone of the several functions concerned in alimentation
and nutrition; and will  afford an agreeable  means of test-
ing practically their merit.   The iron salt is  presented in a
form  well adapted for entering the circulation, whilst the
acid,  besides exerting its solvent power, adds to the agree-
able taste of the preparation.
   Take of hypophosphite of lime, two  hundred  and  fifty-
six grains; hypophosphite of soda, two hundred and ninety
two grains; hypophosphite of potassa,  one  hundred and
twenty-eight grains; hypophosphite of iron,* (recently pre-
cipitated,)  ninety-six grains;   hypophosphorous  acid so-
lution, q. s., or two hundred and forty grains; white sugar,
twelve ounces; extract of vanilla, half ounce; water,  a suf-
ficient quantity.
   Dissolve the salts  of lime, soda and  potassa,  in six
ounces of water; put the iron salt in a mortar, and gradu-
ally add  solution of hypophosphorous  acid  till  it is dis-
solved; to this add the solution of the other  salts, after it

  * This quantity, ninety six  grains of hypophosphite of iron, is
obtained when  one hundred  and twenty-eight  grains of hypo-
phosphite of soda dissolved in two  ounces of water is decomposed
with a slight excess of solution of persulphate of iron;  and the
white precipitate will wash on a filter with water. 
PHARMACY.
1141
has been rendered slightly acidulous with the same acid,
and then water, till the whole measures nine fluid ounces.
Dissolve in this  the sugar, with heat, and flavour the va-
nilla.   Without  flavouring, this syrup is not unpleasant,
being  slightly saline,  and not at all ferruginous.   Any
other  flavouring may  be used,  as  orange  peel,  orange
flower, or ginger.  It is also suggested to physicians that
glycerine may be used,  wholly or partially, in sugar when
indicated, six ounces and a half of glycerine being substi-
tuted for twelve ounces of  sugar.  The  object  of acidu-
lating the saline solution, is to decompose any alkaline car-
bonate which may be  present, and which has been noticed
by the writer in some of  the commercial soda salt.  The
dose of this preparation is a teaspoonful three or four times
a day.  A teaspoonful contains two grains of the lime salt,
one and a half of the soda salt, one of the potassa salt, and
three quarters of a grain of the  iron salt, besides a little
hypophosphorous acid.

              Syrup of  Hypophosphite of Lime.
   Take of hypophosphite of lime, an ounce; water, nine
and a half ounces;  white sugar, twelve ounces; fluid ex-
tract of vanilla, half a fluid ounce.  Dissolve the salts  in
the water, filter, add the sugar, dissolve by aid of heat, and
add the vanilla.  The dose is from a teaspoonful, (3£ grs.,)
to a  tablespoonful (14,) according to the circumstances  of
the case, three times a  day.

                  Syrup of Marshmallow.
      R. Pulv. Marshmallow,  ................................ 3U-
         Warm Water,.......................................... l <&•  '
Add  the marshmallow  to the water and  simmer for half  an
hour, or until the water is evaporated  to  one  pint, then
strain, and  add two pounds of white  sugar and form a
syrup.  This syrup  is mucilaginous and diuretic.  Four
ounces  of  syrup of  marshmallow,  and one drachm  of
                           96* 
1142
PHARMACY.
iodide of potassium,  make  a preparation  of great  value
in empyema, and dropsical effusions.   Dose of the simple
syrup one  tablespoonful every three  or four hours; of the
syrup and iodide of potassium, one teaspoonful three times
a day.
                    Pulmonary Syrup.
      R. Spikenard Root, (Aralia racemosa,) ......... 3XVJ-
         White Root (Asclepias tuberosa,)............... 3xvj-
         Blood Root (Sanguinaria Canadensis,)........ ^"'j-
         Elecampane (Inula helenium,).................. ^viij.
         Coltsfoot (Tussilago farfara,)................... 3VUJ-
         Boneset (Eupatorium perfoliatum,)............ J*™}-
         Poplar Bark {Populus tremuloides,)............ ^iv.
         Seneka Snake  Root, (Polygala senega,)...... gij.
         Lobelia (Lobelia inflata,) ........................ ^ij.
         Slippery Elm Bark (Ulmusfulva,)............ §vnJ-
         Proof Spirits,...................................galls, iij.
Bruise or pulverize all, and  digest in  the  spirits for four-
teen days;  then strain, and add white sugar sufficient to
form  a syrup.  Dose, a spoonful occasionally, in a muci-
lage of slippery elm.  Use.—This is a most excellent re-
medy in all coughs and pulmonary affections.

       Compound Syrup of Sarsaparilla and Stillingia.
  Take of  sarsaparilla, (smilax  officinalis,)  eight ounces;
burdock root,  (lappa major,) eight  ounces; yellow dock
root,  {rumex Britannica,)  eight  ounces;  stillingia root,
(stillingia sylvatica,) six ounces; false bitter-sweet, (celas-
trus scandens,)  four  ounces; dandelion  root,  (taraxacum
dens leonis,) three ounces; juniper berries, (juniperus com-
munis,) three ounces;  prickly-ash berries, (aralia spinosa,)
one ounce; guaiacum wood,  (guaiacum  officinalis,)  two
ounces
  Coarsely  bruise the above ingredients, and moisten them
with alcohol; let them stand two or three days.  Then put
them in a steam displacement apparatus, and pass through
vapour of three pints of strong alcohol.  Continue the  dis- 
PHARMACY.
1143
placement with the steam of water, till  the strength is ex-
hausted; set aside  the  three  pints of tincture which first
passes, and evaporate the  remaining  decoctions  to  one
quart; mix this  with the tincture, add  three  quarts of
sugar-house syrup, and when cold,  add one and a half
ounces of iodide of potassium.
  The diuretic properties acting  directly upon the kid-
neys, and at the same time gently determining to the skin,
greatly promote the efficacy of this preparation in removing
morbid conditions of the system, and restoring  to health !
Not only is the blood, and through it the whole economy
gradually rendered  healthy, but this process is facilitated
by the eliminative qualities of the compound, which cause
a constant excretion of abnormal and effete matters through
the skin  or kidneys according to the temperature surround-
ing the body, thus hastening the cure.  Dose, one table-
spoonful  three times a day.

            Syrup  of Stillingia.
         R. Queen's Root,   ...    3 lbs.
         Prickly Ash Berries,   .    .      l£lbs.
1. Grind and mix the articles together, place  the whole
four pounds and a half  in a convenient vessel, cover them
with alcohol of 76 per cent., and macerate for three days.
Then  transfer the whole to  a  displacement apparatus, and
gradually add alcohol until five pints of the alcoholic tinc-
ture have  been  obtained,  which  retain  and  set aside.
2. Continue the  percolation, and  of this second solution
reserve as much as contains a sensible amount of spirits,
and distil or evaporate the alcohol from  it.   3. Continue
the displacement by hot water until the solution  obtained
is almost tasteless, and  boil down this weak  infusion until
when added to the second  solution after the evaporation
of its alcohol it will make twenty-four pints.  4.  To these
two solutions combined, add thirty-two pounds of refined
sugar, and dissolve it by heat, carefully removing any scum 
1144                PHARMACY.
which arises as it comes to the point of boiling, and if it
exceeds twenty-eight pints, evaporate to that quantity with
constant stirring.  Then remove from the  fire, and when
nearly cold, add  the four  pints  of reserved alcohol  tinc-
ture, and make four  gallons  of syrup,  each pint of which
will be equal to four ounces of the ingredients in medicinal
virtue.  This syrup is one of the most powerful alteratives
known.   It is used  in all cases  of  syphilis, scrofula, mer-
curial and glandular diseases.   Dose, one teaspoonful three
or four times a day.  (This syrup is prepared according to
the formula of the American Eclectic  Dispensatory, John
King, M. D.)  The  above  formula is  the best method  of
preparing the  syrup of stillingia, and  by tincturing and
carefully  boiling, the strength may be obtained, and the
syrup prepared and used as directed.   For domestic prac-
tice,  however,  these syrups can be bought already pre-
pared, as  most druggists keep them for sale.

             Compound Syrup  of  Stillingia.
      R. Take Stillingia Root, Root of Turkey Corn,
          each...............................................2 lbs.
       Blue  Flag Root, Elder  Flowers, and Pipsis-
      sewa leaves each...................................... 1 lb.
1. Grind  and mix  the  articles together, place the whole
seven pounds in  a  convenient vessel, cover  them with al-
cohol of 76 per cent, and macerate for  three days.   Then
transfer the whole  to a  displacement apparatus, and gra-
dually add hot water until four pints of the  alcoholic tinc-
ture have been obtained, which  retain  and  set aside.   2.
Then continue the  percolation,  and of this solution, re-
serve as much as contains a sensible amount  of  spirit, and
distil or  evaporate  the  alcohol from it.  3. Continue the
displacement by  hot water, until  the solution obtained is
almost tasteless, and boil this weaker infusion, until  when
added to  the sound  solution after the evaporation of its al-
cohol,  it will  make twenty-four  pints.  4.  To these two 
PHARMACY.
1145
solutions combined, add thirty-two pounds  of refined su-
gar, and dissolve it  by heat, carefully removing any scum
which arises as it comes to the point of boiling, and strain.
When nearly cold add the four pints of reserved aboholic
tincture, and make four gallons of syrup.  Properties and
use: The  Compound Syrup of Stillingia is one of the most
powerful  and effective alteratives,  and is  extensively used
by Eclectic practitioners in all cases  of  syphilis, scrofula,
osseous, mercurial, hepatic,  and glandular  diseases, or  in
every case where an alterative is indicated.  It is  most
commonly given with one ounce of Iodide of Potassium to
each pint of syrup.  The dose is  a fluid drachm three  or
four times a day (American Eclectic Dispensatory, by John
King, M. D.)
              Compound Spirits of Lavender.
     R.—Lavender flowers, (Lavendula spica.)...........£ij.
           Nutmeg,  (Myristica moschata )..................3'J-
           Mace, (Myristica moschata.).....................3'J-
           Cloves, (Eugenia caryophyllata.)................3'J-
           Cinnamon, (Laurus cinnamomum.)............31J'.
   Pulverize all these  and add a quart of spirits.   Digest
 for a week and then strain off the liquid.
   Dose—One or two teaspoonfuls of this may be taken
 often, in  a little water, with  loaf sugar.
   Use.—This pleasant aromatic"  preparation  is useful in
 debility,  fainting, hysterics,  and all nervous affections; it
 is also  beneficial given  for pain in the  breast, flatulence,
 diarrhoea, &c.   The common method of making this article
 with oil forms a very inferior preparation.—(Beach.)

                    Spirits of Mindererus.
       R.—Vinegar,  q. s.
           Carbonate of Potash, q. s.
    Mix well together.
    Dose.—A tablespoonful three or four  times a day, dilu-
 ted with a little water.
    Use.—This is given as a refrigerant  in fevers, particu- 
1146
PHARMACY.
larly those of a typhoid type.  I add  the sal-aeratus, or
bicarbonate of potash, instead of the ammonia.

                       Tinctures,
  The method of preparing tinctures is to add two ounces
of the green  vegetable  to one pint  of good pure whisky,
and let it stand fourteen days, when  it should  be strained
and bottled  for use.

                 Acetic Emetic Tincture.
  Take lobelia seed, sanguinaria or bloodroot, and skunk
cabbage, each one-half pound; vinegar, two pints. Tincture
for three weeks.  Dose, one tea  or tablespoonful in mint
tea.
                    Golden Tincture.
  Take balsam of tolu, gum guaiacum, gum hemlock,—the
gums to be coarsely pulverized—gum myrrh, of  each, two
ounces; oil of hemlock, three ounces; oil  of wintergreen,
two  ounces; alcohol, one  gallon.    Let  stand  14  days.
Shake frequently.   This preparation is  stimulating, heal-
ing, balsamic, diuretic, touic, antacid, &c.   It  has proved
highly beneficial as  an  internal remedy for rheumatism,
colic,  pains, chills,  soreness, lameness,  flatulence, sour
stomach, languor, depressed  spirits, palpitation, water brash,
and a variety of painful affections.   A tablespoonful added
to a gill of sweetened water, and a draught taken every hour
or two, will be found beneficial for individuals who are ex-
posed to cold, damp, or wet weather, preventing them from
being attacked with colds or rheumatism.  Dose, from one
teaspoonful to a tablespoonful according to the severity and
obstinacy of the case, in  a half glass  of sweetened water, to
be repeated  frequently in  severe  cases, and the  dose in-
creased till relief is obtained.                     J. K.

                    Sudorific Tincture.
  Take ipecacuanha, one ounce; snake root, one ounce;
burdock seeds,  one ounce;  common saffron, half an ounce; 
PHARMACY.
1147
gum camphor, four drachms; Holland gin, one quart.  Di-
gest fourteen days,  then filter.   Dose, fifteen  to  thirty
drops.
               Thomson's Third Preparation.
      R.—Lobelia seeds, pulverized, (Lobelia inflata,)............^ij.
          Cayenne Pepper, pulverized, (Capsicum baccatum,)..gij.
          Nerve Powder, (Cypripedium pubescens.)................§j.
   Put them into a pint of  No. 6, shake them well toge-
ther, and  preserve  it closely corked for use.   Use.—
This is  for  the most violent  attacks  of disease, such as
tetanus or  Icok-jaw, hydrophobia, drowning, fits, spasms,
and all cases of suspended animation.   In  all cases where
the  jaws are set, pour this  into  the  mouth, between the
cheek  and teeth, and the muscles will relax, and the mouth
soon come  open.   It goes through  the system like elec-
tricity, giving  heat and  life to every part.—(Thomson.)

                      Tonic Tincture.
       R.—Old Cider,........ ................................galls, iv.
          White Oak bark, (Quercus alba,)............!|x.
          Horseradish-root, (Cochlearia armoracia,) Ibj.
          Seneka Snake-root,  (Polygala senega,).....gvj.
           Carbonate of Iron, (Ferri carbonas,)........§vj.
          Golden-Seal root, (Hydrastis Canadensis,)..%'w.
          Cayenne Pepper, (Capsicum baccatum,).....§ij.
   Bruise all fine, and add the cider; let  it be shaken up
every  day for eight or ten days.
   Dose.—For  an adult, half or two-thirds of a wineglassful
three times a day; for children, according to their age.
   Use.__A  sure remedy for  intermittent fever,  debility
and an impoverished state of the  blood.   It is also excel-
lent in obstructed menses, and for dropsy, worms,  &c.
   The preceding formula was  communicated by Dr. Isaac
S. Smith, of New York,  a very judicious  physician of re-
formed practice. 
1148                PHARMACY.
                      Tonic Tincture.
       R.—Eng. Camomile,....................................^iv.
           Scullcap..............................................j|ij.
           Pulv. Guiacum Lig........................... .....giv.
           Queen of the Meadow............................^iv.
    Make one gallon of tincture.   Dose, one teaspoonful four
 times a day.   Good in all cases of debility.
       R.—Peruvian Bark, (Cinchona officinalis,).........gij.
           Wild Cherry bark, (Prunus virginiana,)......j|j.
           Cinnamon, (Laurus cinnamomum,)..............zj.
           Cloves, (Eugenia caryophyllata,)................2j.
           Nutmeg, (Myristica moschata,)..................sj.
           Sulphur, (Sulphur sublimatum,).................?j.
           Wine>.......................................................qts. ij.
   Let it stand a sufficient time to extract the strength.
   Dose.—A wineglassful every two or three hours.
   Use.—We have found this tincture an almost infallible
 cure for intermittent fever, or fever and  ague, after suita-
 ble  evacuants.  It removes  the disease  when all other
 means  fail.  Up  to  the present  period, (May, 1850,) I
 find this the best medicine for fever and ague of any with
 which  I  am  acquainted.  In  two  cases which have  oc-
 curred within a few days, this tincture removed the parox-
 ysms, where other remedies had proved of no avail; in one
 instance the patient had been under homoeopathic treatment
 for months.—(Beach.)

                        Tonic Tea.
      R.—Camomile,            -j
          Scullcap,              !   aa
          Queen of the Meadow.  J
   Dose.—One  tablespoonful, added to  one half pint of
water; make a tea and drink  during the day.  A  good
tonic in all cases  of debility.

                    Eye Wash, No. 1.
   Take golden seal, half an ounce; borax,  two  drachms;
sulphate zinc,  ten grains; pure water,  one  pint.  Mix,
(cold) and let it stand  to settle; when clear, decant 
                    PHARMACY.                1149

     Table of Proportionate Dose for Different Ages.
Under \ year,  one-fifteenth of a full dose,  or  4 grains.
  «    1   "    one-twelfth          "       "  5   "
  «    2   "    one-eighth          "       "  7i  "
  «    3   "    one-sixth            "       " 10   "
  «    4   "    one-fifth            "       " 12   "
  «    7   "    one-third            "       " 20   "
  «   14   "    one-half            "       " 30   "
  «   20   "    two-thirds          "       " 40   "
  '•   21   "    the full dose,        "       "  1 dr.
  "   63   "    eleven-twelfths,     "       " 55 grains.
  «   77   "    five-sixths,          "       " 50    "
  "  100   "    two-thirds,          "       " 40    "
  To the above rule there are certain exceptions; thus cas-
 tor oil requires to be given in  larger proportionate  doses,
 while  opium, and the narcotics generally, should be admi-
 nistered in smaller proportionate  doses.
  • Sex, temperament, and  idiosyncrasy, have also a modify-
 ing effect upon the dose, and they should always be kept in
 view in the administration of medicines.
   Females  usually require smaller doses than  males;  and
 persons of  a sanguine  temperament bear  depletory medi-
 cines better than the phlegmatic.

                  Weights and Measures.
   In America, in buying and selling medicine, the avoirdu-
 pois weight is used; but  in compounding medicines, drug-
 gists  use the apothecaries' weight.  This is divided  into
 grains, scruples, drachms, ounces, and pounds:—twenty
 grains make one scruple, three scruples one drachm, eight
 drachms one ounce, twelve ounces one pound.  For mea-
 suring fluid medicines, a small glass is used, called the gra-
 duated measure—the size of which varies from one drachm
 to one ounce.   When fluid measures are to be measured ac-
 curately, the graduated measure should always be used.
        97 
1150
PHARMACY.
        Explanation of Signs and Abbreviations.
  51 Recipe.  Take.
  aa  Ana.  Of each.
  fk  Libra vel librae.  A pound, or pounds.
  5 Uncia vel unciae.   An ounce, or ounces.
  5 Drachma vel drachmae.  A drachm, or drachms.
  5 Scrupulus vel  scrupuli.   A scruple, or scruples.
  0 Octarius vel octarii.  A pint, or pints.
  f 5 Fluiduncia vel fluidunciae.  A fluidounce, or  fluid-
ounces.
  f^  Fluidrachma  vel fluidrachmae.   A  fluidrachm, or
fluidrachms.
  nx  Minimum vel minima.   A minim, or  minims.
  Chart. Chartula vel chartulae. A small paper, or papers.
  Coch. Cochlear vel cochlearia.  A spoonful, or spoonfuls.
  Collyr.  Collyrium.   An eye-water.
  Cong. Congius vel congii.  A gallon, or  gallons.
  Decoct.  Decoctum.  A decoction.
  Ft. Fiat.   Make.
  Garg. Gargarysma.  A gargle.
  Gr. Granum vel grana.  A grain, or grains.
  Gtt. Gutta vel guttae.   A drop, or drops.
  Haust.  Haustus.   A draught.
  Infus. Infusum.   An infusion.
  M.  Misce.  Mix.
  Mass. Massa.   A mass.
  Mist.  Mistura.  A mixture.
  Pil. Pilula vel pilulae.   A pill, or pills.
  Pulv. Pulvis vel pulveres.  A powder, or powders.
  Q. s. Quantum sufficit.  A sufficient quantity.
  S. Signa.   Write.
  Ss. Semis.  A half. 
PHARMACY.
1151
          ANTIDOTES  TO  POISONS.
   The term  antidote had, formerly, a much wider signifi-
cation, and was  applied to the remedies for diseases occur-
ring from natural causes, as well as to the remedies for the
derangement of the functions, arising from the direct intro-
duction into  the system of a known and material poison.
   The selection of appropriate  means  to counteract the
effects of poison  must be determined by a knowledge of the
manner in which  each particular poison acts; but as our
limits will not permit us to enumerate or specify these, some
general rules, only, will be given.
   The first indication is to remove the poisonous substance;
the second, is to prevent or limit its local effects; the third, to
obivate the effects on remote organs, supporting their action
by appropriate measures, till the injurious impression has
subsided.  The first of these is to be accomplished mostly
by mechanical means.   If the poison has been applied to
any external  part, as by the bite of a viper or rattle-snake,
a  cupping-glass, or what will answer as well, a wine-glass,
tumbler, or cup of any kind, from which a part of the air has
been expelled, by holding within it  a lighted candle for a
second of time, should be applied immediately.
   If poison has been taken into the stomach, and is not of
a kind to arrest instantly the action of the heart, its removal
is to be attempted by the stomach-pump, or by exciting vo-
miting.  The stomach-pump cannot well be used without in-
troducing into the stomach a considerable quantity of water
which, by diluting  the poison, lessens its violence, in  all
cases, except  that  of oxalic acid.   But should a stomach-
pump not be  at hand, we must attempt to produce vomiting
by every means  in  our power.   For this  purpose, a table-
spoonful of flour of mustard, which is mostly to be found in
every house, may be put into a tumbler of  warm water, and
given to the patient; or twenty grains of sulphate of zinc,
(white vitriol,) dissolved in a pint  of warm water, and the 
1152
PHARMACY.
disposition to vomit encouraged by tickling the throat with
a feather, and pressing on the pit of the stomach.  Neither
ipecac, nor tartar emetic should be given, as their action is
always preceded by much nausea, during which the absorp-
tion of the poison is often facilitated.
  When the poison is of a corrosive  or irritant nature, in-
stead of losing time in seeking the means of causing vomit-
ing, it is in general advisable to adopt the second rule, and
attempt to prevent or limit its local, and thereby its remote,
effects.   To accomplish this we must ascertain what the poi-
sonous substance was from which the  patient is suffering,
and must  also  know how it acts, as upon this depends the
success of our treatment.  The objects we should have in
view are either to dilute, and so weaken it;  to supply from
an external source  the particular principle which the poi-
son would abstract from the coats of the stomach; or, by add-
ing something to it, so change its nature as to render it com-
paratively or altogether harmless, which last will always be
effected if we can succeed in forming an insoluble compound.
The first may be done by giving plenty of warm water; and
when we know  the  particular poison, if the warm water can
be made the vehicle of an antidote, the second or third object
will also  be insured.  Suppose sulphuric acid (oil of vitriol)
has been swallowed; add to the water,  chalk, magnesia, soda,
saleratus, or soap; the acid will form  with these substances
purgative salts,  and will, by their action on the bowels, assist
in lessening the inflammation caused by the  poison before
its being neutralized.  So when  sugar of lead  (acetate of
lead) is swallowed, by giving  Epsom salts (sulphate of mag-
nesia) we  form an insoluble  sulphate of lead, which will
be discharged by the bowels, operated upon by the magnesia,
which has been freed from the sulphuric acid.  Corrosive
sublimate (bichloride  of mercury) abstracts from the coats
of the stomach the albumen which they contain, by which it
is converted into proto-chloride, or calomel; now if, by giving 
PHARMACY.
1153
 white of egg, which is pure albumen, we supply it with the
 principle which it would otherwise obtain from the coats of
 the stomach, we shall preserve these entire.
   Such means, then, are antidotes, properly speaking; for
 the means by which the secondary or remote effects are to
 be combated, deserved rather to be termed counter-poisons.
 The counter-poisons are of no small value in cases of poi-
 soning by the corrosive or irritant, while they are of the
 utmost importance in the treatment of the sedative and nar-
 cotic poisons.   To administer these appropriately, we must
 know which of the vital organs  the  poison  most speedily
 affects.   When it affects the  heart, the symptoms greatly
 resemble syncope,  (or  fainting;) and  as such poisons are
 the most dangerous agents, which act as rapidly as the poi-
 sons, are alone to be trusted to; such agents are to be found
 among the diffusible stimuli, ammonia, or  its carbonate,
 i. e , smelling-salts, applied to the nostrils, or dissolved in
 water and taken into the stomach, warm brandy and water,
 &c.  Where it chiefly affects the spinal marrow, there oc-
 cur spasms  and difficulty  of breathing; when  the brain,
 there is a partial or complete insensibility,  (coma,) often
 with, at first, full pulse, flushed face, and laborious breathing,
 resembling apoplexy.   In  such a state of affairs, artificial
 respiration, with the administration of  coffee and vinegar,
 greatly contribute to save the patient.

            Antidotes to Vegetable Alkaloids.
  In poisoning  by opium, salts of morphia,  hemlock,  aco-
nite, belladonna, strychnine,  colchicum, &c, take iodine,
grs. iij.;  iodide  of potassium, grs. vj.; water, 16 ounces.
The stomach having been emptied, the mixture is to be
given by glassfuls, still encouraging the vomiting; and  to
be followed (in the case of narcotics)  by strong infusion of
coffee.   Purified animal charcoal absorbs and renders inert
                           97* 
1154
PHARMACY.
the active principle of many vegetable poisons, given in
doses of an ounce or more, diffused in warm water.

              Antidotes to Metallic Poisons.
  The salts of mercury, copper, and lead, are decomposed
by the hydrated proto-sulphuret and per-sulphuret of iron,
and the compounds produced are comparatively inert.  The
antidote for poisoning by  arsenic,  is the hydrated  sesqui-
oxide of iron.   It  may be made  by adding carbonate of
soda to the muriate of iron.  It should be given in the moist
state, mixed with water.   After being  once dried,  it loses
much of its power.
  When given in time, magnesia and chalk are an antidote
for  the mineral acids and oxalic  acid; albumen (white of
egg) for corrosive sublimate and verdigris; bark, for tartar
emetic; common salt, for  lunar caustic; sulphate of soda,
or magnesia, for sugar of lead  and  muriate of baryta; vine-
gar and oil, for the fixed  alkalies.  These substances act
either by neutralizing the  corrosive power of the poison, or
by forming with it an insoluble compound.
  From what has been said upon this subject, the necessity
of an acquaintance with  it must  be sufficiently clear, not
only to insure our doing right, but to prevent us from doing
wrong.   By administering an ill-timed antidote, we may
often hasten the fatal event; as  where vinegar is given
when opium has been swallowed, before it has been  ejected
from  the stomach; and by throwing tobacco smoke into the
bowels of a person apparently drowned, we extinguish the
feeble spark of life,  which might have sufficed to re-animate
him, but for such injudicious  interference.

                         Acids.
  The antidotes for this class of poisons are alkaline sub-
stances, which, by combining  with the  acids, form  neutral
bodies.   For this purpose carbonate of potassa or soda may 
PHARMACY.
1155
be used; also chalk, and magnesia, or its carbonate.  These
latter antacids are especially indicated, when the injurious
influence of oxalic or nitric acid is to be prevented.

              Prussic, or Cyan-hydric Acid.
  Ammonia, or its carbonate, taken internally, and applied
externally;  chlorine, cautiously inhaled, or chlorine water
given internally, or  as  an injection;  cold effusions to the
head  and spine; brisk frictions, sinapisms, artificial respi-
ration, &c.
                        Alkalies.
  For caustic potassa or soda, or their carbonates, also water
of ammonia, administer one of the vegetable acids, as vine-
gar, lemon or lime juice, or solutions of tartaric or citric
acid.   The  fixed oils, as linseed, olive, and castor, by com-
bining with free alkaline bodies, form soaps, by which their
caustic  effects are obviated.

                         Iodine.
   As this substance combines with starch, to form the iodide
of starch, a very insoluble body, any substance containing
fecula should be administered, as common starch, arrow-root,
wheat flour, &c.  They should be mixed with warm water,
by which the solubility of the starch is increased,—a matter
of some importance.
                     Tartar Emetic.
   For  this  salt, and other preparations of antimony, use
astringent infusions, as oak bark, gall-nuts, Peruvian bark,
or a solution of tannic acid, which combines with the oxide
of antimony to form an insoluble  body.   The  efficacy  of
astringent substances in  cases of poisoning by this metal,
depends upon the tannic acid  which they contain.

                Arsenic, or Arsenious Acid.
   Hydrated sesquioxide, or peroxide of iron, should be ad-
ministered  every five or ten minutes, in teaspoonful doses, 
1156
PHARMACY.
until relief is obtained.  The precipitated carbonate of iron
may be used, but it is much inferior to the first-named agent.
If the arsenic is in the form of Fowler's solution, then co-
pious draughts of lime water should be given.

                         Copper.
  The poisonous  influence of the salts of this metal, as sul-
phate  of copper or the blue vitriol, verdigris, &c, may be
prevented by the timely administration of albumen; white
of eggs, beaten up with water, should be freely given;  milk
may also be employed.   When a piece of copper, or an alloy
of this metal, has been  swallowed, the patient should abstain
from the use of vinegar, or any acid  body, which, by acting
on the copper,  would form a poisonous salt.

                         Lead.
  In order to counteract the injurious effects of the prepa-
rations of this metal, as sugar of lead, white lead, litharge,
and red lead, sulphate  of soda, or sulphate of magnesia, or
phosphate of soda may be given for the soluble salts of lead.
For the metal,  or its insoluble forms, dilute sulphuric  acid
should be  given.   The elixir of vitriol  answers very  well
for this purpose.
                      Phosphorus.
  Calcined magnesia  should be  given in water which has
been boiled,  in order to expel the atmospheric air from it. 
TnE
    DIFFERENT  SYSTEMS  OF PRACTICE.


  That the reader may become familiar with the resources,
not only of the American Eclectic System of Practice, but
also with the practice of the  Allopathist, Homceopathist
and Hydropathist, I will here  introduce a list of diseases,
with their remedies, from the most approved authority of
each system  of practice.  The Allopathic treatment  I
have given strictly according to Prof. Eberle, one of the
most popular authors upon that system of practice.   The
Homoeopathic practice  is given according to J. Lourie,
M. D., an author of great popularity among Homceopa-
thists.   The size of the dose and the trituration are given
according to Jahr's  and Gruner's Homoeopathic Pharma-
copoeia. The Hydropathic treatment is given according to
Shew,  Trail,  and other standard authorities.

            ALLOPATHIC  PRACTICE.
  Intermittent Fever. — Treatment: — Emetics,  opium
blood-letting, nitre,  camphor,  sulphuric ether,  magnesia,
calomel and jalap,  cinchona,  quinine, potash, cloves,
leeches, blisters, arsenic,  sulphate of zinc, black pepper
salivation.
  Remittent Fever.— Treatment:— Blood-letting, cathar-
tics, calomel and jalap, ipecac,-nitre,  salivation, epsom
salts,  castor  oil, magnesia, opium,  antimony,  ammonia,
cold water,  leeches, blisters,  balsam copaiva, sinapisms,
warm bath, enemas, lemonade, quinine,  gentian, serpen- 
1158
ALLOPATHIC  PRACTICE.
   Yellow Fever.— Treatment: — Blood-letting,  calomel,
 salivation, enemata, epsom salts, sponge with  cold  water,
 leeches,  blisters, aperients, diaphoretics, quinine,  wine,
 ammonia.
   Synocha or simple continued Fever. — Treatment: —
 Blood-letting, purgatives, soda, magnesia,  antimony, jalap,
 cream of  tartar,  calomel, diaphoretics, nitre,  James's
 powders, digitalis,  salivation, ipecac,  sponging with cold
 water, blisters, cupping, leeches, enemata.
   Synochus Fever.— Treatment: — The same as synocha
 throughout.
   Typhus Fever.—Treatment:—Emetics, ipecac, calomel,
 gentle purgatives, castor oil, enemata, epsom salts, croton
 oil,  salivation,  blood-letting,  effusions   of  cold water,
 diaphoretics, laudanum,  nitre,  wine,  ammonia, camphor,
 opium, quinine, blisters, capsicum, serpentaria, camomile.
   Glossitis, inflammation of the tongue. — Treatment: —
 Blood-letting, leeches, scarifying, incisious  with  scalpel,
 laxative  enemata, blisters on the back  of the neck.
   Tonsillitis, Quinsy.—Treatment:—Blood-letting, scari-
 fying the tonsils, cupping, an active purge, mild aperients,
 calomel,  enemata,  nitre, antimony, ammonia, liquorice,
 blisters,  spirits turpentine, emollient poultices.
   Parotitis,  Mumps.—Treatment: — Keep  the  bowels
 open, diaphoretics, blisters, mercurial  ointment, camphor,
 rubefacient liniments.
   Acute  Gastritis. — Treatment: — Blood-letting, leeches,
blisters, mercurial ointment, mucilaginous drinks, vegetable
 acids, laxative enemata, opium,  calomel
   Chronic Gastritis.—Treatment:—Leeching or cupping,
blisters, tartar emetic ointment, sulphate of iron,  hyoscia-
mus,  morphia,  nitrate of silver, borax, Dover's  powder,
balsam of copaiva, syrup of poppies, purgative enemata.
   Peritoneal Enteritis.—Treatment:—Blood-letting, pur-
gatives,  laxative  enemata, calomel,  castor  oil,  opium, 
ALLOPATHIC  PRACTICE.
1159
spirits turpentine,  blisters,  emollient poultices,  digitalis,
wine.
  Dysentery.—Treatment:—Bleeding, purgatives, castor
oil, calomel, laudanum,emetics, ipecac,  diaphoretics, sali-
vation, mucilaginous liquids, nitrous acid, sugar of lead,
leeches, blisters,  emollient  poultices, balsam of copaiva,
turpentine, enemata, dogwood bark, diet, rice, barley.
  Chronic  Enteritis.—Treatment: — Proper diet, castor
oil, laudanum, leeches,  blisters,  tartar-emetic  ointment,
calomel,  balsam  of copaiva, spirits  turpentine, sulphate
of iron, nitrate of silver, hyosciamus, elm bark.
  Acute Peritonitis.—Treatment:—Blood-letting, leeches,
emollient  poultices, active  cathartics, castor  oil,  spirits
turpentine,  cream  of  tartar,  calomel,  jalap,  blisters,
leeches, salivation,  opium, digitalis, wine.
  Chronic  Peritonitis.—Treatment: — Leeches, blisters,
mercurial  ointment, tartar-emetic ointment, emollient poul-
tices, warm  baths,  castor  oil,  cream of tartar, Dover's
powder.
  Acute hepatitis.—Treatment:—Blood-letting,  mercury,
castor oil, leeches, salivation, blisters,  opium,  antimony,
warm bath,  nitro-muriatic acid, cicuta, tonic bitters, nitric
acid,  extract of conium.
  Chronic hepatitis. —Treatment: —Blood-letting, mer-
cury,  leeches,  salivation, blisters, emollient poultices, blue-
pill,  conium,  laxatives,  epsom  salts, gentian, columbo,
nitro-muriatic acid, white precipitate, setons.
  Splenitis. — Treatment: — Blood - letting,  purgatives,
counter-irritants,  warm bath, leeches, tartar-emetic,  mer-
cury,  setons, hyosciasmus, diaphoretics, antimony, muriate
of ammonia, ipecacuanha, iodine.
  Phrenitis,   phrensy. — Treatment: — Blood - letting,
leeches, cold  water or  ice,  active  purgatives,  calomel,
Benna, blisters, nitre, antimony, digitalis.
  Arachnitis, hydrocephalus.—Treatment: — Laxatives, 
1160         ALLOPATHIC PRACTICE.

calomel, blue-pill, castor oil, blood-letting, leeches, manna,
laxative  enemata, spigelia, ipecac,  salivation,  mercurial
ointment,  blisters, ice, tartar-emetic ointment, James's and
Dover's powder.
   Cerebritis, softening  of the  brain. — Treatment: —
Blood-letting, sinapisms, opium, cold to the head, blisters,
calomel, salivation.
   Peripneumonia. — Treatment: — Bleeding,   leeches,
digitalis,  nitre,  castor  oil, emetics,  cooling diaphoretics,
muriate of ammonia, antimony, calomel, opium, camphor,
ipecacuanha,  expectorants, blisters,  squills, tartar-emetic
ointments, setons, conium.
   Cynanche Laryngea, Laryngitis.—Treatment:—Blood-
letting, leeches, blisters, emollient poultices, emetics, calo-
mel,  sinapisms to  the feet,  lunar  caustic,  alum,  bron-
chotomy.
   Cynanche  Trachealis,  Croup. — Treatment: — Bleed-
ing, blisters, emetics,  warm bath, mercurial purgatives,
antimony, enemata, salivation, ipecac, friction with turpen-
tine, polygala senega.
   Acute  bronchitis. — Treatment: — Blood - letting, ene-
mata,  castor  oil,   emetics,  tartar-emetic, ipecacuanha,
squills, expectorants,  opium,   calomel,  blisters,  leeches,
emollient poultices,  warm bath, columbo, gentian.
   Chronic Bronchitis, Bronchial Consumption.—Treat-
ment:— Bleeding,  leeches, warm climate, tartar-emetic
ointment, emollient poultices, emetics,  digitalis,  antimony,
squills, balsam copaiva, quinine, opium, conium, ipecac,
prussic acid, sugar  of lead, blue-pill,  or calomel,  saliva-
tion.
   Pthisis Pulmonalis.—Treatment:—Blood-letting, digi-
talis, tartar-emetic blisters, issues and setons, gum arabic,
prussic acid, acetate of lead, opium, uva ursi, expectorants,
muriate  of  ammonia,  tartar-emetic ointment,  salivation,
squills. 
             ALLOPATHIC PRACTICE.        1161

  Nephritis. — Treatment: — Blood-letting, cupping  or
leeches, active  cathartics,  calomel,  castor oil, enemata,
emollient poultices, blisters, diaphoretics, antimony, steam
bath,  Dover's  powder,  uva ursi,  opium, conium,  lime
water,  balsam copaiva.
  Cystitis. — Treatment: — Bleeding,  leeches, emollient
poultices,  gentle laxatives,  enemata, opium, introduction
of catheter,  steam bath,  antimony, calomel.
  Chronic   cystitis. — Treatment: — Cupping,   leeches,
blood-letting, castor oil, magnesia, caustic issues on the
thigh,  muriated tincture of iron,  beech leaves, uva  ursi,
ursi, elm bark injected into the bladder.
  Hysteritis.— Treatment:— Bleeding, leeches, emollient
poultices, calomel,  epsom salts, injecting  warm emollient
fluids into the vagina, blisters,  nitre,  antimony, opium.
   Chronic hysteritis.—Treatment: —Blood-letting, cup-
ping,  purgatives,  leeches,  blisters,  emollient injections,
warm bath, mercury, camphor, antimony, balsam copaiva,
muriate of ammonia, liquorice.
  Pericarditis.—Treatment:—Calomel, bleeding, opium,
salivation,  leeches,  blisters, cream  of tartar, diuretics,
squills, pustulation with  tartar-emetic ointment, or a caus-
tic issue over the region of  the heart.
  Acute Rheumatism.—Treatment:—Blood-letting, pur-
gatives, calomel, epsom  salts,  emetics,  antimony, opium,
diaphoretics,  salivation, quinine,  colchicum, magnesia,
stramonium, leeches, blisters.
   Chronic  Rheumatism. — Mercury,  rhubarb,   quinine,
antimony, salivation, sarsaparilla, vapor bath,  sulphate of
zinc, stramonium,  colchicum, arsenic, leeches, cups, blis-
ters, spirits turpentine, capsicum, camphor, warm bath.
   Qout, — Treatment: — Bleeding,  cathartics,   calomel,
emetics,  ipecac, opium, eupatorium perfoliatum, colchicum,
magnesia,  blue  pill, camphor, ginger, savin, laudanum,
sinapisms,  enemata, cupping, leeching.
            98 
1162         ALLOPATHIC PRACTICE.
  Catarrhal Ophthalmia.—-Treatment:—Scarifying, anti-
mony, calomel and jalap, emollient applications, opium,
solution  of zinc,  nitrate of silver, corrosive  sublimate,
ipecac, blisters, lunar caustic, quinine, bark,  arsenic.
  Rheumatic Ophthalmia.—Treatment:—Bleeding, anti-
mony, opium,  calomel, Dover's powder, blisters, cupping,
puncturing the cornea, aqueous solutions of opium.
  Purulent Ophthalmia. — Treatment: — Blood-letting,
leeches, decoction of poppy-heads,  calomel, ipecac, anti-
mony,  castor  oil, blisters,  emollient  fomentations, lime,
nitrate of silver, quinine, nitric acid.
  Scrofulous Ophthalmia.—Treatment:—Leeches, pur-
gatives, calomel, castor  oil, rhubarb, emetics,  antimony,
Dover's  powders,  sarsaparilla, quinine,  barytes,  iodine,
nitrate of silver.
  Syphilitic and strumous iritis.—Treatment:—Mercury,
antimony, jalap,  salivation,  belladonna, precipitate oint-
ment, chalk, quinine,  setons in the nape of the neck.
   Variola, Small-pox.—Treatment:—Blood-letting, pur-
gatives, calomel,  emetics, diaphoretics, nitre,  antimony,
ammonia, cooling regimen, wine, camphor, quinine, opium,
blisters, scarifications, chalk, ipecac, warm bath.
  Rubeola, Morbilli,  Measles.— Treatment: — Mild laxa-
tives, diaphoretics, sage,  elder blossoms, balm, eupatorium,
bleeding, antimony, nitre, warm baths, stimulating friction,
sinapisms,  camphor,  ammonia,  opium, blisters, calomel,
squills, serpentaria.
  Scarlatina. — Treatment: — Gentle  aperients,  cool  or
tepid drinks, emetics, brisk mercurial purges, warm baths,
nitre, antimony,  ammonia,  sulphuric acid, cold water to
the surface, blisters, blood-letting, camphor, calomel, opium,
sinapisms, wine, quinine, capsicum, enemata, serpentaria.
  Erxjsipelas. — Treatment: — Blood-letting, purgatives,
calomel, emetics,  diaphoretics,  antimony,  ipecacuanha,
magnesia, castor oil, warm  bathing, bark, wine,  opium, 
ALLOPATHIC PRACTICE.        1163
camphor, cupping, blisters, enemata, corrosive sublimate,
nitrate of silver, incisions in the inflamed skin.
  Herpes Phlyctenodes.—Treatment:—Gentle aperients,
simple diet,  diaphoretics, calomel, ipecac, warm bath,
bleeding, Dover's powder,  lunar caustic.
  Herpes Labialis.—Treatment:—Fomentations of white
poppy-heads, acetate of lead.
Herpes Preputialis.— Treatment: — A solution of borax,
nitrate of silver, chloride of sodium in solution.
  Pemphigus.— Treatment: — Mild laxatives, rest, tepid
bathing,  bleeding, diuretics,  calomel,  Fowler's  arsenical
solution,  opium, quinine, sulphuric acid.
   Urticaria, Nettle Rash.—Treatment:—Emetics, ipecac,
mild laxatives,  simple diet, cooling drinks, rest, magnesia,
quinine, sulphuric acid, iron,  Fowler's solution, tepid bath.
  Miliaria, Miliary Fever.—Treatment:—Ipecac, emetics,
warm bathing,  diaphoretics,  Dover's  powder, ammonia,
serpentaria, camphor, opiates.
  Lichen.— Treatment:—Tepid bathing, mild aperients,
diluent acidulated drinks,  cream, calomel, unsalted butter,
sulphuric acid,  bleeding, Fowler's solution, laxatives, low
diet.
  Eczema.—Treatment:—Sulphur ointment, tepid bath-
ing, mild laxatives, nitre, tartar emetic, Dover's  powders,
calomel,  nitric  acid,  soda, sarsaparilla, camphor, opium,
stramonium,  borax, cantharides, arsenic,  Fowler's solu-
tion.
  Herpes Zoster.—Treatment:—Gentle aperients, simple
diet, diaphoretics, calomel, ipecac, warm bath,  bleeding,
Dover's powders, lunar caustic.
  Herpes  Circinatus, Ring  Worm.—Treatment:—Alka-
line washes, sulphate of copper or zinc, ointment of narrow-
leafed dock, mild laxatives.
  Erythema.—Treatment:  — Light diet, gentle diapho- 
1164
ALLOPATHIC  PRACTICE.
retics, mineral acids, warm baths, tepid ablutions, borax,
acetate of lead, opium.
   Roseola.-—Treatment:—Rest, mild aperients, acidulated
cooling diluents, simple diet, refrigerant diaphoretics.
   Hemorrhagica Petechialis.—Treatment:—Tonics, cin;
chona,  serpentaria, sulphuric acid, wine, nitrate of silver,
spirits of turpentine, blood-letting, purgatives, calomel and
jalap, oil of turpentine, bathing the  surface with a decoc-
tion of oak bark.
   Hemorrhages. — Treatment: — Blood-letting, digitalis,
cold, blisters,  sinapisms,  warmth, sugar  of lead,  alum,
muriated tincture of iron.
   Epistaxis.— Treatment: — Bleeding, cool drinks, laxa-
tives, nitre,  cold water applied to  the  head,  neck  and
genital organs, sugar of lead, gallic acid, blisters to the
nape of the neck, pediluvium, sinapisms to the feet.
   Haematemesis, bleeding at the stomach.—Treatment:—
Blood-letting, sinapisms to the epigastric and hypocondriac
regions, cupping,  warm  bath,  laxatives,  enemas,  active
purgatives, emetics of ipecac, sugar of  lead, spirits of tur-
pentine, castor  oil, tincture of iron, juice  of the common
nettle.
   Haematuria,  bleeding of the urinary organs. — Treat-
ment:—Bleeding,  warm bath,  opium,  cupping,  sugar of
lead, sinapisms over the kidneys, muriated tincture of iron,
mucilaginous  drinks, alum, ipecac, decoction of  logwood,
cold water to  the  genitals,  inject cold solutions  of the
sugar of lead.
   Hcemoptysis, bleeding at the lungs. — Treatment: —
Blood-letting,  common salt, sugar of  lead, sinapisms to
the  breast,  cooling drinks,  laxative  enemata, nitrate of
potash, opium, calomel, emetics, capsicum, digitalis, caustic
issues,  setons, leeches to  the anus, camphor, ipecac, can-
tharides, warm hip  bath.
   Menorrhagia,  uterine   hemorrhage. — Treatment:__ 
ALLOPATHIC  PRACTICE.         1165
Bleeding, sugar of lead, ipecac, opium,  camphor, cinna-
mon,  alum, nitre, astringent injections into the vagina,
elixir of vitriol,  tampons, emetics, valerian prussiate of
iron, ergot, savin.
  Phlegmasia Dolens. — Treatment: — Blood - letting,
leeches, purgatives, magnesia, colchicum,  antimony,  calo-
mel, opium, ipecac, nitre, frictions with dry flannel, fomen-
tations with hot vinegar and water.
  Apoplexy. —Treatment: — Copious blood-letting, cold
water to the head, fomentations, sinapisms of the tincture
of capsicum to the feet, cupping, active purgatives, calomel
and colocynth, croton oil,  castor oil and  turpentine, ene-
mata, aloes, antimony,  emetics,  zinc, blisters, issues.
  Hemiplegia, palsy of one side; Paraplegia, palsy of
the legs.—Treatment: — Blood-letting,  purgatives,  salts,
aloes, calomel, scammony, colocynth, capsicum, emetics,
blisters to the neck, sinapisms  to the ankles,  stimulating
enemata, friction, stimulating baths, electricity, galvanism,
strychnine, salivation, iodine, warm bath.
   Epilepsy.—Treatment:—Bleeding, cold water in  large
draughts, emetics in large  draughts,  emetics  of ipecac,
calomel, diaphoretics, warm bath, antimony, camphor issues,
setons, emetics, spirits of turpentine, castor oil, oil of tur-
pentine, misletoe,  oxide   of  zinc, nitrate  of  silver, tin,
lead.
   Catalepsy.—Treatment:—Sulphuric ether,  stimulating
applications  to  the feet,  enemata,  bleeding,  purgatives,
galvanism, electricity,  country  air, regular exercise,  tepid
bathing, blue pill, camphor, tepid shower bath, zinc, vale-
rian, musk, castor, opium.
   Chorea, St. Vitus's Dance.—Treatment:—Purgatives,
mercury, quinine, aloes, bleeding, vegetable diet, Dover's
powder, magnesia, valerian  assafcetida, hyoscyamus, cam-
phor, opium, turpentine, warm  pediluvium, blisters,  savin,
                           98* 
1166        ALLOPATHIC  PRACTICE.
iron, leeches and warm bath, sulphur, issues, tartar-emetic
ointment,  &c.
   Convulsive affections of infants.—Treatment .-—Emetics
of ipecac, purgatives,  enemata, infusions  of savin and
spigelia, bleeding, calomel, pediluvium, cold water to the
head, blisters, assafcetida, musk, opium, Dover's powder,
warm bath, setons, issues, sulphur.
   Hysteria.—Treatment:—Bleeding,  sinapisms, emetics,
sulphate  of  zinc, ipecac, opium,  assafcetida, musk, sul-
phuric ether, castor, enemata, warm pediluvium, turpentine,
enemata,  camphor,  valerian,  ictodes-foetida,  antimony,
iron,  mercury, cold shower bath, &c.
   Puerperal Convulsions.— Treatment:—Blood-letting,
sinapisms to the feet, purgative enemata,  cupping, cold
applications to the head, active cathartics, calomel, jalap,
aloes.
   Tetanus. — Treatment: — Bleeding,   leeches,  mercury,
opium, warm  bath,  purgatives, castor  oil,  spirits of tur-
pentine, wine, prussic acid, cold effusions.
   Hydrophobia. —  Treatment: — Local applications  to
the wound, wash  the wound  with warm water, excision,
cautery,  cupping, glysters,  ligatures,  belladonna, water
plantain,  vinegar, cantharides,  mercury,  cold  bathing,
copious bleeding.
   Monomania.—Treatment:—Blood-letting, leeches, pur-
gatives, mercury, castor oil, ;alap,  spigelia, turpentine,
emetics, regimen,  exercise, warm bath,  cold  bath, blisters,
circular swing, music.
   Delirium Tremens.—Treatment: — dpium  the  sheet
anchor, castor  oil,  laxatives,  enemata, cupping,  emetics
of tartar-emetic,  ipecacuanha, cold  and tepid  effusions,
ammonia, assafcetida, camphor, Hoffman's anodyne.
   Neuralgia.—Treatment: — Divide  the   nerve with a
scalpel, quinine, arsenic, carbonate  of iron, stramonium,
frictions with the extract of belladonna, oil of turpentine, 
ALLOPATHIC  PRACTICE.        1167
moxa, leeches, strong magnet, lobelia, zinc, leeches to tha
anus, aloes.
  Amaurosis.—Treatment:—Bleeding, free purging with
calomel,  epsom  salts,  antimony,  salivation,  belladonna,
blisters or setons on the neck, leeches to the temples, blue-
pill,  ipecac, sarsaparilla,  arsenic,  bark,  cold  bath, capsi-
cum, opium, emetics,  leeches around the  anus.
  Asthma. — Treatment: — Blood - letting,   hyosciamus,
stramonium, emetics  of ipecac,  squills, vinegar,  digitalis,
opium, skunk cabbage, lobelia  inflata, galvanism, tonics,
bark, quinine, arsenic, carbonate of iron,  blue-pill,  tepid
sjiower bath, warm bath.
  Asphyxia from drowning. — Treatment: — Artificial
inflation of  the lungs, gradual warmth, friction with a dry
flannel,  mustard  and  capsicum,  stimulating injections,
warm wine,  weak  brandy toddy, infusions of balm,  sage
or catnip.
  Asphyxia, from mephitic gases.—Treatment:—Dash-
ing cold water on  the face and breast, dry frictions to the
extremities,  cold wine, cold shower bath  at short  intervals,
flesh  brush, ammonia, stimulating  injections,  artificial
respiration,  abstraction of blood, warm wine,  galvanism.
  Asphyxia from Electricity.—Treatment:—Cold water
copiously  dashed  over  the whole  body,  frictions with the
flesh-brush.
  Asphyxia from cold.—Treatment:—Gradual communi-
cation of  warmth  to the body, immersion in  spring water
continued forty minutes, gentle frictions  with  flannel, arti-
ficial respiration,  gentle  stimulants,  such as  balm,  sage,
warm -wine,  &c.
  Pneumox-thorax. — Treatment: — Blistering,    tartar-
emetic ointment, cupping, moxa, issues, setons, &c.
  Dilatation of the ventricles.—Treatment:  — Bleeding,
low  diet,  starvation and venesection,  diuretics, squills,
nitre, digitalis,  purgatives,  antimony,  valerian, orange 
1168        ALLOPATHIC  PRACTICE.
 flowers,  cat lint,  mercury,  castor  oil,  blue-pill, tepid
 shower bath.
   Sympathetic  affection of the  heart.—Treatment: —
 Gentle aperients,  tepid  bath,  gentle tonics,  bitters, iron,
 bleeding, warm pediluvium, digitalis.
   Angina-Pectoris.—Treatment:—Bleeding, ether, cam-
 phor,  opium,  hyoscyamus, ammonia,  draughts  of cold
 water, emetics, leeches, sinapisms to the legs,  mild diet,
 blue-pill, tepid or cold bathing.
   Indigestion.—Treatment:—Diet, gentle aperients, mild
 tonics,  regular exercise,  rhubarb, aloes,  soda,   ipecac,
 hyoscyamus, boneset, mild tonics,  alkalies, calomel, gen-
 tian, iron, white mustard seed, mercury, antimony, nitro-
 muriatic  acid bath, opium, ammonia,  nitrate of  potash,
 leeches, blisters.
   Diarrhoea.—Treatment: — Mild  purgatives, calomel,
 castor oil, ipecac,  laudanum, chalk, warm bath, leeching,
 Dover's  powder,  acetate of  lead,  balsam copaiva, sul-
 phate of  copper, injections of mallows,  flaxseed or barley
 water, sulphuric acid.
   Cholera.—Treatment:—Opium, sinapisms to the region
 of the stomach  and liver, free  use of  bland  drinks, fric-
 tions  with  spirits  of  turpentine,  calomel,  warm bath,
 tinct.  of  capsicum  to the extremities, camphor in vitriolic
 ether, mucilages in a warm state, ipecac, columbo, calomel,
ammonia.
   Cholera  Infantum.. — Treatment: — Leeches   to  the
temple,   calomel,  poultices  over  the  abdomen,  blisters
behind the ears, ipecac,  mild  laxatives, castor oil, warm
bath, spirits, Dover's powder, magnesia,  tartrate of iron,
charcoal, wine whey, milk punch, ammonia, common soot.
  Flatulent colic—Treatment: — Rapid friction with the
flesh-brush,  camphor,  laudanum,  vitriolic  ether,  oil  of
 juniper,  emetics of ipecac, essence of  peppermint,  ea 
ALLOPATHIC  PRACTICE.        1169
thartics,  enemata, castor oil, turpentine, laudanum, bleed-
ing, leeches, blisters.
  Bilious Colic.—Treatment: — Emetics, eupatorium, or
camomile tea,  antimony, calomel, sinapisms, or epispastics
to the epigastrium, castor oil, enemata  of castor oil  and
turpentine, opium, salivation, blood-letting, calomel, mag-
nesia, warm bath.
   Colica Pictonum.—Treatment:—Blood-letting, opium,
calomel,  salivation, purgatives,  castor oil with spirits of
turpentine, purgatives, enemata, glauber  salts, flaxseed tea,
blisters, leeches, tartar-emetic ointment, warm bath, senna,
alum.
   Ileus.—Treatment:—Bleeding, cupping, leeches, opium,
purgatives, calomel, castor oil, enemata of warm water,
tobacco,  cold  water, &c, cold effusions, mercury, tincture
of rhubarb, and aloes.
   Constipation.—Treatment: — Proper diet, active exer-
cise,  regular  attempts  at  stool, calomel,  rhubarb, jalap,
aloes, enemata, blue-pill,  aloes  and antimony/ castor oil,
oil of turpentine, salivation.
   Intestinal  Worms.—Treatment: — Spare  and  liquid
diet,  mild  purgatives,  epsom salts, spigelia, followed by
calomel  and jalap, tin filings,  spirits of turpentine, male
fern,  pomegranate root.
   Hemorrhoids,  Piles. —Treatment: — Light  vegetable
diet,  bleeding, sulphur, cream of tartar, blue  mass, nitre,
cupping, sinapisms,  blisters,  injections  of cold water,
acetate of lead, quinine, opium, cinnamon,  aloes, ipecac,
astringents, injections,  excision of tumors, balsam copaiva,
oil of turpentine, aloetic purgatives.
   Jaundice.—Treatment:—Opium, warm bath, leeching,
frictions, emollient applications to the epigastrium, bleed-
ing,  purgatives,  enemata, emetics, ipecac, mercury,  mer-
curial frictions, nitro-muriatic acid bath, proper diet.
   Diabetes Mellitus. — Treatment: — Bleeding, leeching, 
 1170        ALLOPATHIC  PRACTICE.

 cupping, opium, lime water, alum, uva ursi, active exer-
 cise, friction with flannel, carbonate  of ammonia, blisters,
 quinine, exclusive animal diet.
   Diabetes Insipidus. — Treatment: — Tonics,  alkalies,
 opium, quinine, bitartrate  of soda, mercury, ipecac, mag-
 nesia and rhubarb, lime water,  uva ursi, hyoscyamus, cam-
 phor,  gum arabic, mineral acids, quinine, iron, burgundy
 pitch,  galbanum and turpentine to the loins, castor  oil.
   Lithic acid diathesis.—Treatment: — Proper diet, mild
 aperients,  alkalies, bitters, vegetable tonics, calomel, anti-
 mony, magnesia, soda, saleratus,  gentian, columbo, warm
 bath,  opium,  hyoscyamus,  vegetable" diuretics, bleeding,
 cupping, colchicum.
   Phosphatic  diathesis. •—Treatment: — Opium,   tonics,
 mineral acids, cinchona, uva ursi, pitch, soap or galbanum
 plaster to the  kidneys, issues  in the back, hyoscyamus,
 country air, exercise.
   Ischuria renalis. — Treatment: — Bleeding, cupping,
 leeching, warm  bath, blisters, stimulating diuretics,  spirits
 turpentine, castor oil,  balsam  copaiva, juuiper oil, nitre
 and laudanum, mercury.
   Retention  of urine. — Treatment: — Introduction  of
 catheter, canth,  camphor, blisters to the  pubic  region,
 spirits of turpentine, juniper, oil, dipple oil, Peruvian bal-
 sam, cold water to the pubic region, blood-letting, leeching,
 emollient  clysters,  fomentations,  mild  purgatives,  anti-
 mony, warm bath, calomel, opium.
   Dysuria, pain in voiding urine.—Treatment:__Mild
laxatives, flaxseed tea, gum arabic, Dover's powder, castor
 oil, rhubarb, calomel, ipecac, lunar caustic,  borax,  citron
 ointment, zinc or alum  injected into  the vagina, diluents,
opiates, fomentations, anodyne enemata, flaxseed tea.
   Enuresis, incontinence of urine.—Treatment:__Alum,
cantharides, uva ursi, iron,  cold shower bath, electricity,
stimulating frictions, cupping the  perineum, blisters, ano- 
ALLOPATHIC  PRACTICE.         1171
dyne enemata, Dover's powder, stramoniam, tonics, iron,
quinine, oxyde of zinc, spirits of turpentine.
  Ascites. — Treatment: — Blood-letting,  cups,  leeches,
blisters, setons, drastic purgatives, cream of tartar, ele-
terium gamboge, diuretics, squills, digitalis,  acetate  of
potash, nitrate of potash, cantharides, juniper berries, col-
chicum, spirits of turpentine, erigeron, heteraphullum and
parsley, calomel.
  Scrofula. —Treatment: —Diet and regimen, pure air,
calomel,  blue mass aperients,  rhubarb, tonic vegetable
bitters, gentian, quinine, leeches, saturnine solutions, nitrate
of silver, sulphate  of copper, corrosive sublimate,  sarsa-
parilla, conium, antimony, setons.
  Bronchocele,  Goitre. — Treatment: — Iqdine,  burnt
sponge,  calcined  egg shells,  sea water,  squills, kermes
minerals, belladonna, conium, digitalis, mercury, antimony,
blistering, cataplasms, mercurial ointment.
  Scorbutus,  Scurvy. — Treatment: — Fresh  vegetables
and animal food, lemon juice and vinegar, nitre, iron tonics,
cinchona, muriate of lime, lunar caustic.
  Chlorosis. — Treatment:—Exercise, purgatives, aloes,
rhubarb, calomel, ipecac, hyoscyamus, Dover's powders,
diet, sea-bathing, tepid shower bath, tonics, iron.
  Gonorrhoea, Clap.—Treatment:—Blood-letting, saline
purgatives, nitre, antimony, gum  arabic,  warm  fomenta-
tions, opium,  camphor, balsam  copaiva, cubebs, spirits of
turpentine, injections  of sulphate of zine, and sulphate of
copper, nitrate of silver, lunar caustic, cantharides, sarsa-
parilla, mercury.
  Syphilis.—Treatment: — Mercury, emollient poultices,
lead,  sulphate of copper, citron ointment, corrosive subli-
mate, lunar caustic, bleeding, antimony, zinc, nitre, quinine,
opium, hyoscyamus, cicuta, nitrate of silver, Venice  tur-
pentine,  balsam of copaiva,  myrrh,  red precipitate oint-
ment, salivation, warm bath, guaiacum. 
1172       HOMOEOPATHIC  PRACTICE.
  Buboes. — Treatment: — Mercury, frictions,  emollient
poultices, hydriodate  ointment, bleeding, purgatives, anti-
mony, lead water, blisters, opium, sarsaparilla, lead, copper,
corrosive sublimate,  galbanum, cicuta, carrot  poultices,
nitric acid, hyoscyamus.
  Amenorrhcea. — Treatment: — Blood - letting,  opium,
ether,  active  cathartics,  purgatives, enemata, sinapisms,
warm  pediluvium, camphor, ergot, blisters, warm  bath,
antimonials,  iron,  ipecac,  castor  oil, balsam  copaiva,
spirits of turpentine, cantharides.
  Dysmenorrhoea. — Treatment: — Camphor,   Dover's
powder, elder blossoms, or eupatorium tea, opium, ipecac,
warm bathing, bleeding, aperients, blue-pill, ipecac emetics,
antimony, guiacum, sulphur, stramonium.
  Leucorrhcea, fluor  albus. — Treatment: — Bleeding,
purgatives, antimony, blue-pill,  injections of warm water
and sugar of lead into the  vagina,  cantharides, balsam
copaiva, turpentine,  alum,  ipecac, astringent  injections,
such as zinc, copper,  alum, oak bark, sulphuric acid, and
nitrate of silver.
   Cholera  Asphyxia. — Treatment: — Calomel,  opium,
camphor, sulphuric  ether, mild purgatives, rhubarb, or
castor oil, sinapisms, alcoholic vapor bath, blood-letting,
cupping, leeches, frictions with tincture of capsicum, brandy,
ammonia, turpentine,  sugar of lead, mustard, emetics.

            HOMOEOPATHIC  PRACTICE.
   The following are Hahnemann's remarks on the tritu-
rating process of Homoeopathic remedies, as transcribed
from Jahr's and Gruner's Pharmacopseia.
   "All  those homoeopathic drugs which constitute  the
pure materia medica,  are prepared  in the manner pointed
out below.   The  following  anti-psorics come under this
remark:  silica, calcarea carbonica,  natrum carbonicum,
ammonium carbonicum, magnesia carbonicum, baryta carbo- 
HOMOEOPATHIC  PRACTICE.      1173
nica, carbo-vegetabilis, carbo-animalis, graphites, sulphur,
antimonium  crudum, antimonium,  gold,  platinum, zinc,
copper, silver, tin.   Lumps of these metals, not the foil,
are rubbed upon a hard, fine hone, under water, or some-
times under alcohol;  for example, iron.   Of these pulve-
rized substances you  take one grain, mercury may be used
in the liquid state; of petroleum you take one drop  instead
of one grain.  Put  this grain into an unglazed porcelain
mortar, then you take thirty-three grains of sugar of milk,
and mix them with the drug, by triturating the mass with
some force for about  six minutes, by means of a porcelain
pestle ; before you triturate, stir the mass for a little while
with a spatula.  Having  triturated the  mass, you stir it
again for about four minutes,  scraping up that part which
covers the bottom of the porcelain  mortar, and also that
which  adheres to the pestle ; then you triturate again with
great force for about six minutes, without, however, adding
anything new.   This mass you scrape up again for about
four minutes;  then  add  another thirty-three grains of
sugar  of milk,  stir the new compound for a minute with a
spatula, then triturate  it for six minutes with the pestle,
scrape it up for four minutes, triturate  again with great
force for six minutes, scrape up  the mass again four min-
utes, then add  the last thirty-three grains of sugar  of milk,
and with this last added portion proceed as with the two
former.   This powder  you enclose in a well-corked glass
vial, and mark it with the name of the substance,  and the
fio-ure -1-,  to show that  this is the first  potency of the
substance.   In  order to prepare  the degree  TT5^o» y°«
take one grain of the degree Tfo, and add to it thirty-
three grains of the sugar of milk.   Stir up this mass for
a moment with the spatula.   Then triturate  for six min-
utes  stir  it up for four minutes, triturate again for six
minutes, and then stir  up  again for four.   After this, you
         99 
1174       HOMOEOPATHIC PRACTICE.
add the  second thirty-three grains of sugar of milk, pro-
ceed then as before;  afterwards add  the  last thirty-three
grains of sugar of milk,  stir up and triturate again as
before, and  enclose the mass in a well-corked vial, marked
Touo?)> or second potency.
   "To prepare the degree tsvUw or third potency, you
take  one grain of the degree Tqwo>  and go through the
processes of stirring and  triturating  in the  same way as
before, employing upwards of an hour for the preparation
of each different potency.   For the sake of establishing a
sort  of  uniformity in preparing homoeopathic  remedies,
and especially the  anti-psorics, I never carry the tritura-
tion  above  the millionth  degree.   From  this degree,  I
derive the dilutions in their various  degrees  of potency.
For the  process of trituration, a certain force should be
employed ;  not too much, however, lest the  mass adhere
too tenaciously to  the mortar,  to be  scraped up in four
minutes.
   "From the millionth degree of trituration, the dilutions
in the various degrees may be obtained by dissolving these
triturated substances in  alcohol or water.  Chemistry is
not  acquainted with the fact that, all substances, after
having been triturated up to the millionth degree, can be
dissolved in either alcohol or water. Sugar of milk cannot
be  dissolved in pure alcohol;  this is the reason why the
first dilution  should be  composed of one-half water, and
one-half  alcohol.    To  one grain of the millionth, you add
fifty drops  of distilled  water, and  turn the  vial several
times around  its axis ; by this means the sugar of milk
becomes  dissolved: then,  you  add fifty drops  of good
alcohol, and shake the  vial  twice, first  carrying the arm
up and then down.   Only two-thirds of the vial should be
67led  with the solution.
  " This  vial is then marked with the name of the medicine, 
HOMOEOPATHIC PRACTICE.       1175
and the number T£0.   Of this solution you take one drop
and mix it with ninety-nine or one-hundred drops  of pure
alcohol, shaking the vial twice after it  has been corked;
this vial is marked To<Uu-  Of this solution you take one
drop, and mix with  it ninety-nine  or one-hundred  drops
of pure alcohol, then  shake  the vial twice, and mark it
ttjo^tjstj-   Of tn*s potency you again take a drop, and
mix it with ninety-nine or one-hundred drops  of alcohol,
shaking this third  vial twice,  and mark it TT.  In the same
way  you  continue the prepartion, and  marking  of  the
higher potencies, TTJTF TT. tqtsvts tt> ttt> tv, v,  &c.
   " The intermediate vials are put in  perpendicular  boxes
and  kept  in the dark, in  order  not to be  affected by the
light  of day.   In  practice only the full vials are  used.
The  shaking being accomplished by means  of moderate
strokes  with the arm,  it is desirable that the vials  be  of
such  size  that the one-hundred drops will only two-thirds
fill them.   Vials that have contained one medicine,  ought
never to be used for another  even if  they have been pre-
viously  rinsed with great care."
   '' Vegetable substances which can only be had dry, are
triturated in the same  manner.   The millionth trituration
may then  be dissolved, like all the other substances, either
in water or  alcohol.   In this state, they may be preserved
much better and longer than the common tinctures which
easily spoil.
   "Of the juiceless vegetable  substances,  oleander, thuja,
mezereum, you may take one grain and a half, the fresh
leaves, bark, roots,  &c ,  and convert them into the mil
lionth trituration,  with three times one-hundred grains of
sugar of  milk.  Of this trituration  you take one  grain,
and  carry it through the vials, obtaining in this way any
degree  of potency that  may be desired; shake each  vial
twice  first  carrying the arm  up and  then  down.  The 
1176       HOMOEOPATHIC  PRACTICE.
same process of trituration may be resorted  to in  regard
to the recently obtained medicinal juices.   Squeeze the
juice out of the substance,  triturate  one drop with the
necessary quantity of sugar of milk to obtain the millionth
trituration.   Of these you take one grain, dissolve it  in an
equal proportion of water and  alcohol, and then  carry a
drop of  this mixture  through  a series  of  twenty-seven
vials, obtaining in  this way the degree of potency that is
desired.
   "  By triturating the juice first, the medicinal virtues of
the drug are better developed, than  by simply  mixing the
juice with the  alcohol by means of two shakes.  I know
this  from experience.
   " In the beginning of my practice, I gave a small  portion
of a grain of the millionth trituration at a dose.  But the
uncertainty of this mode of exhibiting the remedy, led me
to the discovery of preparing the dilutions, and to  the use
of the globules,  any  definite  number of which may  be
moistened with the  dissolved drug.  Homoeopathy being
based upon  a law of nature, it should  avoid and exclude
all uncertainties.
   "Frequent observations have convinced  me that it is
better to shake the vial twice only, in order to  develop the
medicinal virtue  of the drug just  enough  to affect the
disease  in  a proper manner.   By  shaking  the vial ten
times, as I was in the habit of  doing,  the proportion be-
tween the progressively developed  intensity of action  of
the medicinal properties of the drug, and the degree  of
potency,  were destroyed.   The  object  of the  dynamizing
process,  is to develop the intensity of action  of the medi-
cinal properties of  the drug,  at the  same time  as that
action is reduced to  a milder tone.   Two shakes are suffi-
cient to  establish the  due  proportion  between these two
effects. 
HOMOEOPATHIC  PRACTICE.        1177
Table shoioing the quantity of alcohol or fluid, required to dissolve
  one single grain or drop of a homoeopathic drug (as sulphur,
  aconite, etc.), down into the following homoeopathic attenuations
  or dilutions.— [Dr. Simpson on Homoeopathy, p. 285.]

 1st attenuation.—One grain or  drop in one and half tea-
    spoonful of alcohol.
 2d attenuation. — One grain in twenty-one fluid  ounces
    of alcohol.
 3d attenuation. — One grain in two thousand and eighty
    ounces, or in  one hundred and  four  pints of alcohol.
 6th attenuation. — One grain in thirteen million gallons,
    or in two hundred and  six thousand hogsheads,  or
    in fifty-one thousand funs of alcohol.
 9th attenuation. — One grain in a lake of alcohol with a
    volume of about  fourteen cubic miles, or in a lake  of
    fifty fathoms  in  depth, and presenting two hundred
    and  fifty square miles of  surface.
12th attenuation.—One  grain in a  sea  containing about
    fourteen million  cubic  miles of alcohol, or in a quan-
    tity  of fluid equal to a sea  six  times  the  size of the
    Mediterranean Sea.
15th attenuation. — One grain in an ocean of fourteen bil-
    lion  cubic  miles of alcohol, or in  an  ocean about
    forty-six thousand times greater than the whole waters
    of all the oceans of  the earth.
21th attenuation.—One  grain   in  an ocean of fourteen
    quintillion  cubic  miles of  alcohol,  or in a quantity
    sufficient to make one hundred and forty masses, each
    filling a  sphere extending from limit to limit  of the
    orbit of the planet Neptune.
                          99* 
1178       HOMOEOPATHIC  PRACTICE.
30th attenuation.—One grain in an ocean of fourteen sep-
     tillion cubic  miles of alcohol, or in a quantity suffi-
     cient to make one hundred  and forty billion spherical
     masses,  extending from limit to limit of  Neptune's
     orbit, or in a quantity equal to many hundred spheres,
     each with a semidiameter  or radius extending from
     the earth to the nearest fixed  star.

 List of diseases and Homoeopathic remedies by Dr. J. Laurie.
    The remedies of the vegetable kingdom are the third attenua-
         tion, those of the mineral kingdom of the fourth.
   Typhus fever.—Remedies:—Bryonia,  arsenic, rhus
toxico, croton oil, nux vomica, aconite, belladonna, cam-
phor,  hen-bane,  cocculus  Indicus,  arnica.   The  sugar
globules  are moistened with these tinctures, and five  or
six given every two or three hours.
   Intermittent fevers. — Remedies : — Quinine, arsenic,
ipecac, nux vomica,  antimony,  belladonna,  opium, coc-
culus Indicus, Ignatia  or St. Ignatius'  bean, white helle-
bore, aconite, Cayenne pepper.
   Bilious fever.—Remedies:—Aconite, belladonna, bry-
onia, chamomilla, nux vomica, mercurius, pulsatilla, qui-
nine, digitalis, ipecac, tartar-emetic, arsenic.
   Yellow fever.—Remedies :—Belladonna, bryonia, rhus
toxicodendron, arsenic, nux  vomica, veratrum  album,  la-
chesis, or viper poison, Spanish flies, mercurius.
   Scarlet fever.—Remedies: — Belladonna,  mercurius,
arsenic,  nux  vomica, pulsatilla,  aconite, opium, tartar-
emetic.
   Scarlet Rash.—Remedies :—Belladonna,  aconite, coffea,
sulphur, ipecac, pulsatilla, bryonia, dulcamara, belladonna,
arsenic, phosphorus,  rhus tox,  swamp sumach, cinchona,
conium, mercurius,  capsicum.
   Rubeola, measles.—Remedies:—Aconite, coffea, pulsa-
tilla, sulphur,  nux vomica, bryonia, ipecac. 
HOMOEOPATHIC  PRACTICE.       1179
   Variola, small-pox.-^Remedies :—Coffea, chamomile
aconite, ipecac, tartar-emetic,  bryonia,  rhus, belladonna,
pulsatilla, stramonium, muriatic  acid, mercurius,  sulphur,
lachesis, vegetable charcoal, arsenic, cinchona, phosphorus,
sulphuret of lime, acetate of copper.
   Varicella, chicken-poot.—Remedies :—Aconite, coffea,
belladonna, emetic tartar, mercurius.
   Miliary fever. — Remedies : — Aconite,  coffea,  bella-
donna, veratrum, arsenic,  ipecac, bryonia,  nux  vomica,
carbonate of lime, chamomilla, tincture of sulphur, acetate
of copper.
   Urticaria, nettle-rash.—Remedies : — Dulcamara, aco-
nite, nux vomica, pulsatilla, crude  antimony, belladonna,
sulphuret of lime, rhus,  bryonia,  nettles, sulphur,  nitric
acid, lime.
   Quinsy.—Remedies: — Mercurius, lachesis,  pulsatilla,
eantharides, nux vomica, chamomilla, coffea, ignatia, sul-
phur, veratrum, capsicum.
   Mumps.—Remedies: — Mercurius, belladonna, coccu-
lus, carbo-vegetabilis.
   Indigestion.—Remedies: — Pulsatilla, arsenic, chamo-
milla, rhus toxicodendron, sulphur, ipecac, cinchona, nux
vomica.
   Flatulent Colic.—Remedies: — Cinchona, arsenic, nux
vomica, pulsatilla, carbi>vegetabilis, colchicum, belladonna.
   Haematemesis,  vomiting blood.—Remedies : — Nux vo-
mica, pulsatilla, cinchona, arnica, sulphur.
   Constipation.—Remedies : — Opium, brycnia,  lachesis,
alum, nux vomica, lead, platina, nitro-muriatic acid, silicea,
lycopodium, china.
   Hemorrhoids. — Remedies : — Aconite,   nux  vomica,
sulphur, arsenic,  belladonna,  rhus, pulsatilla,  platina,
ignatia, colocynth.
   Prolapsus ani. — Remedies : — Ignatia,  nux  vomica,
mercurius, sulphur, calcarea. 
1180      HOMOEOPATHIC  PRACTICE.

  Diarrhoea.—Remedies :—Dulcamara, bryonia, cinchona,
chamomilla, mercurius,  rhubarb, pulsatilla, ipecac, nux
vomica, colocynth, arsenic, crude antimony, rhus, lachesis,
nitric acid, phosphoric acid, magnesia.
  Dysentery.—Remedies :—Aconite, chamomilla,  ipecac,
mercurius,  corrosive  sublimate;  bryonia, arsenic, carbo-
vegetabilis, cinchona, cantharides, sulphur.
  Cholera.—Remedies :—Ipecac, veratrum album,  arsenic,
cinchona, pulsatilla, copper, sulphur, carbo  vegetabilis,
nux vomica, ergot, stramonium.
  Cholerine. — Remedies : — Veratrum,  mercurius, pul-
satilla, nux vomica, chamomilla, colocynth, ferrum, Dul-
camara, carbo vegetabilis, cantharides.
  Inflammation of the liver.— Remedies : — Belladonna,
aconite, nux vomica,  chamomilla, mercurius, arsenic, Pul-
satilla, nux vomica.
  Jaundice. — Remedies : — Mercurius,  cinchona, pulsa-
tilla, digitalis, chamomilla.
  Inflammation of the  spleen.—Remedies:—Aconite,
arsenic, cinchona, nux vomica, bryonia.
  Inflammation of the stomach.—Remedies :—Aconite,
belladonna, ipecac, crude antimony, nux vomica, lachesis,
Pulsatilla, arsenic, cantharides, hyoscyamus, arnica.
  Inflammation of the  bowels. — Remedies : — Arsenic,
mercurius, nux  vomica, lachesis, nitric acid, bryonia, pul-
satilla, colocynth, chamomilla,  cinchona, colchicum, phos-
phorus, sulphur, silicea.
  Inflammation of the peritoneum. — Remedies : — Aco-
nite, belladonna, arsenic, chamomilla, lycopodium, colo-
cynth.
  Worms. — Remedies : — Aconite, ferrum, nux vomica,
mercurius,  sulphur,  calcarea,   silicea, pulsatilla,  ipecac,
antimony, cicuta, cinchona.
  Laryngitis. — Remedies : — Sulphur,  burnt  sponge,
Aconite,  lachesis, belladonna, hyoscyamus. 
HOMOEOPATHIC  PRACTICE.       H81
  Hooping Cough. — Remedies : — Dulcamara, pulsatilla,
mercurius, belladonna,  aconite, ipecac, nux vomica,  cha-
momilla and sulphur.
  Croup.—Remedies :—Aconite, sulphur,  burnt sponge,
arsenic, tarta,r emetic, lachesis, caustic, ammonia, bromin.
  Influenza.—Remedies :—Camphor, aconite, mercurius,
arsenic, bryonia, phosphorus, belladonna, pulsatilla, arnica.
  Bronchitis.—Remedies :—Aconite, pulsatilla, bryonia,
sponge, belladonna, nux vomica, lachesis,  mercury, lyco-
podium, stannum, dulcamara, arsenic, ipecac, tartar-emetic.
  Pneumonia. — Remedies : — Aconite, bryonia,  phos-
phorus,  tartar - emetic, mercurius, belladonna, lachesis,
arsenic, antimony, sulphur.
  Pleuritis. — Remedies: — Aconite, bryonia, sulphur,
mercurius, arsenic, arnica.
  Hcemoptysis. — Remedies : — Pulsatilla,  bryonia, nux
vomica,  rhus, arnica,  aconite, ipecac,  iron, opium, cin-
chona.
   Consumption.  — Remedies : — Ipecac,   arsenic,  nux
vomica,  bryonia, pulsatilla,  tartar-emetic,  opium, china,
sambucus, musk, belladonna, lachesis, veratrum, dulcamara,
cinchona, stannum.
  Determination of the blood to the head.—Remedies :—
Aconite, nux vomica, calcarea, belladonna, opium, coffea,
chamomilla,  ignatia, arnica,  mercurius, pulsatilla, lycopo-
dium,  dulcamara, sanguinaria,  cinchona,  sulphur, carbo-
nate of lime, opium, conium.
  Inflammation  of the brain and its membranes.—Reme-
dies :—Aconite, belladonna, bryonia, hyoscyamus, opium,
stramonium, zinc, acetate  of copper, rhus, lachesis,  mer-
curius.
  Apoplexy. — Remedies  : — Aconite,  belladonna, nux
vomica,  opium, lachesis, arnica, pulsatilla, ipecac, carbo-
nate of barytes.
  Paralysis, Palsy.—Remedies :—Arnica, bryonia,  rhus,
sulphur,  electricity, galvanism. 
1182       HOMOEOPATHIC PRACTICE.

   Tetanus. — Remedies : — Belladonna, cicuta,  opium,
arnica, ignatia, stramonium, hyoscyamus.
   Delirium Tremens.—Remedies :—Nux vomica, opium,
aconite, belladonna, lachesis, sulphur, calcarea.
   Epilepsy.— Remedies: — Belladonna, copper, hyoscya-
mus, ignatia,  lachesis, nux vomica.
   Neuralgia. — Remedies : — Belladonna, platina,  lyco-
podium, arsenic, colocynth, veratrum, china,  assafcetida,
spigelia.
   Headache.—Remedies:—Belladonna,  bryonia,  rhus,
sepia,  silicea, pulsatilla.  china, veratrum, lachesis,  mer-
curius, colocynth, chamomilla, sulphur.
   Erysipelas.—Remedies:—Aconite, belladonna, bryonia,
Pulsatilla,  rhus,  arsenic, lachesis, sulphur, copper.
   Carbuncle. — Remedies: — Lachesis,  silicea, arsenic.
   Chilblains.— Remedies : — Nux vomica, pulsatilla, bel-
ladonna, rhus, nettles, arsenic, sulphur.
   Corns. — Remedies : — Arnica,  ammonia, bryonia, nux
vomica, rhus,  ignatia.
   Scabies, Itch. — Remedies : — Sulphur, mercurius, vera-
trum, silicea,  sulphuric  acid, arsenic, dulcamara, pulsa-
tilla.
   Herpes Circinatus, Ringworm. — Remedies: — Rhus,
sulphur, calcarea.
   Scald - head. — Remedies :  — Rhus,  sulphur, arsenic,
dulcamara, bryonia.
   Inflammation of the kidneys.—Remedies : — Aconite,
cantharides,  arsenic, sulphur,  mercurius,  arnica,   nux
vomica.
   Cystitis, inflammation of the bladder. — Remedies : —
Cantharides, pulsatilla, digitalis, arsenic, carbo-vegetabilis,
sulphur, nux vomica.
   Gravel.—Remedies : — Sarsaparilla, nux vomica, gra-
phites, sulphur, cannabis, lycopodium,  calcarea. 
HOMOEOPATHIC PRACTICE.       H83
  Retention of the urine. —Remedies : —Aconite, cam'
phor, arsenic, phosphorus, belladonna, cantharides.
  Difficulty in discharging urine.-—Remedies :—Aconite,
sulphur, belladonna, cantharides, opium, pulsatilla, spirits
of camphor, mercurius, nux vomica.
  Suppression of urine. — Remedies : — Aconite, cantha-
rides, pulsatilla, camphor, belladonna, opium, lycopodium,
  Diabetes. — Remedies : — Veratrum, mercurius, nitric
acid.
  Hematuria.—Remedies :—Cantharides, quinine, pulsa-
tilla,  mercurius, sulphur, ipecac, camphor, carbo-vegeta-
bilis,  arnica, nux vomica, nitric acid, aconite, squills, zinc,
calcarea, petroleum, cannabis, cocculus indicus, capsicum.
  Gout.—Remedies: — Aconite, pulsatilla, arsenic, iron,
nux vomica, bryonia, sanguinaria, sulphur, saffron.
  Rheumatism.—Remedies :—Aconite, bryonia, sulphur,
belladonna,  rhus, chamomilla, ignatia, conium, mercurius,
lachesis,  pulsatilla,  arnica,  mezereum,  euphorbium, pink
root,  digitalis, phosphorus, veratrum, caustic.
  Lumbago.—Remedies :—Aconite, bryonia,  nux vomica,
rhus, belladonna, pulsatilla, mercurius.
  Ophthalmia. — Remedies: — Aconite, belladonna,  nux
vomica, cinchona,  arsenic, euphrasia, ignatia, pulsatilla,
mercurius, sulphur.
  Scrofulous Ophthalmia.—Remedies:—Arsenic, conium,
crude sulphur,  lime, bitter sweet, iron, graphites,  gold,
lycopodium,  indian hemp,  chamomilla,  digitalis, iodine,
mercurius,   corrosive  sublimate,  magnesia,  nitric  acid,
lachesis, cinchona, pink root.
   Ulceration of the cornea. — Remedies : — Nitric acid,
arsenic, euphrasia,  sulphur, calcarea,  mercurius, lachesis,
silicea, nitre.
  Epistaxis.— Remedies :—Aconite, belladonna,  bryonia,
mercurius, carbo vegetabilis, graphites, pulsatilla, calcarea, 
 1184      HOMCEOPATHIO  PRACTICE.
 arnica,  rhus, iron, sepia,  nux vomica, lachesis, bryonia,
 dulcamara, saffron, musk, ammonia, silicea.
   Stomacace.—Remedies: — Mercurius, nitric  acid, nux
 vomica, capsicum, carbo-vegetabilis, sulphur, nitre, borax,
 iodine, lemon juice, dulcamara.
   Scurvy.—Remedies:—Vegetable carbon, mercurius,
 nux  vomica, pulsatilla,  sulphur,  creosote,  belladonna,
 nitric acid, quinine, alum, arnica, chamomilla.
   Ascites.—Remedies:—Arsenic, cinchona, iron.
   Anasarca.—Remedies:—Hellebore, bryonia, mercurius,
 arsenic, phosphorus, iron, colchicum.
   Hydrothorax, dropsy of the chest. — Remedies: — Ar-
 senic, dulcamara, digitalis, pink root, bryonia, aconite.
   Hydrophobia. — Remedies :—Belladonna, hyoscyamus,
 stramonium, cantharides.
   Amenorrhcea. — Remedies : — Nux  vomica,  sulphur,
 opium, aconite, veratrum, pulsatilla.
   Menorrhagia.—Remedies :—Nux vomica, chamomilla,
 sabina, ignatia, platina, veratrum, sulphur.
   Dysmenorrhoea. —Remedies : —Pulsatilla, belladonna,
 nux vomica, coffea, sulphur, calcarea,  chamomilla.
   Turn of life.—Remedies:—Cocculus, aconite, pulsatilla,
 nux vomica, lachesis.
   Leucorrhcea.—Remedies :—Pulsatilla, china,  calcarea.
   Hysteria.—Remedies  :—Calcarea, nitric acid, veratrum,
belladonna, pulsatilla, gold, stramonium.
   Difficult dentition.—Remedies :—Chamomilla, bryonia,
zinc, sulphur.
   Sugar globules  are medicated with these  remedies, in
the third to the sixth potencies. 
HOMOEOPATHIC  PRACTICE.       1185
Method of preparing the sugar globules, from Jahr and Gruner,
                          p. 27.
  These are made by confectioners, and are composed of
sugar and starch ; they can be had of different sizes, from
that of a millet-seed to that of a buck-shot.   The whitest,
dryest, and hardest,  should be selected for medicinal use ;
they should be all of equal size, and not mixed with sugar-
dust.   After having moistened the globules  with the medi-
cine in some suitable vial,  we turn them out on paper with
raised edges, and  agitate them until they cease  to adhere
one to the  other.  Should we afterwards wish to put them
into the same bottle in which we  had moistened  them, we
should take care to dry it  also,  before making use of it.
The complete desiccation of the  globules, before bottling
them, is absolutely indispensable, since, without that  pre-
caution, they fall  into powder in a short time,  and  lose
their medicinal virtues.

A table showing the amount of alcohol required  to form the dif-
  ferent dilutions.  One grain of the millionth degree of tritura-
  tion, is added to 100 drops  of alcohol, and one drop of that to
  100 more of alcohol, making the first dilution.
First attenuation	=	1 =	100 = hundredths
Second "	=	2 =	10,000 = ten thousandths.
Third "	:=	3 =	I = millionths.
Fourth "	=	4 =	100 I = hundred millionths.
Fifth "	=	5 =	10,000 I = ten thousand millionths
Sixth "	=	6 =	II = billionths.
Seventh "	=	7 =	100 II = hundred billionths.
Eighth "	=	8 =	10,000 II = ten thousand bilUonthg.
Ninth "	—	9 =	Ill r: trillionths.
Tenth "	—	10 =	100 III = hundred trillionths.
Eleventh "	=	11 =	10,000 III = ten thousand trilUonths.
Twelfth "	=	12 =	IV = quadrillionths.
Fifteenth "	=	15 =	V = quintillionths.
Eighteenth "	=	18 =	VI = sextillionths.
Twenty-first "	==	21 =	VII = septillionths.
Twenty-fourth "	=	24 =	VTII = octillionths.
Twenty-seventh "	=:	27 =	IX = nonillionths.
Thirtieth "	—	30 =	X = decillionths.
100			
 
1186       HYDROPATHIC PRACTICE.
                   HYDROPATHY.
  By Hydropathy is understood a system of medical prac-
tice, in which  water, in its  various applications, consti-
tutes the  only remedy.   R.  T. Trail, M. D.,  in  his work
on the hydropathic system  of practice, states, that in order
to understand the philosophy of water-cure,  it is necessary
to understand the  physiological relations of water  to the
healthy organism.  These  he states in  the following pro-
positions :
   "1. Water constitutes  the  greater proportion  of the
entire  bulk of the body.
   " 2. Water  composes  more  than three-fourths  of the
whole  mass of  blood, more than seven-eighths of the sub-
stance of the  brain, and  more than  nine-tenths  of the
various colorless fluids and secretions.
   "3. Water is the only medium  through which  waste,
or effete particles of extraneous matter,  are conveyed from
all parts  of  the system to the excretory organs to be ex-
pelled.
   " 4. Water is  the only solvent diluent and detergent in
existence, for animal and vegetable excrementitious matter.
   " 5. Water is the only material capable of circulating in
all the tissues of the body and penetrating their finest
vessels, without vital irritation or mechanical injury.
   " 6. The only morbid effects result from  improper tem-
perature,  and  over-distension  of the  hollow viscera, or
circulating vessels, from excess of quantity — effects never
necessarily unavoidable."
   Hydropathists claim disease to  be the result of the mis-
nse or abuse of some one or more of the hygienic  agencies,
such as bad air, impure light, defective aliment, indolence,
&c.  They still further claim, that  medicinal drugs never
tend  to correct  the functional  disturbances produced by
these morbid influences, although animal organism consists 
HYDROPATHIC PRACTICE.
1187
of true medicinal  elements, and  for the want  of  a due
amount of  which,  disease is  frequently produced.   The
teeth cannot be developed without lime, carbonic and phos-
phoric acids, nor the enamel without fluoride of calcium.
Healthy bile, mucus, sweat, saliva,  tears,  cartilage,  &c,
all contain carbonate of soda,  and if the soda is deficient,
these  fluids  are diseased.   Phosphate of lime is one of
the constituents of serum, saliva, bones and muscles, which
may become diseased by a deficiency of this  material; by
administering  this article  to the  patient, he is restored.
Hydrochloric  acid  is  one of the ingredients of gastric
juice,  a deficiency of which, causes  dyspepsia;  the most
ample experience shows that salt will remedy the difficulty.
Iron  is oue of the ingredients of the  blood,  and without
it the blood is ancemic.   Iron will correct the difficulty.
The above facts, with  many others that might be adduced
to show the  utter fallacy of depending entirely upon water
to correct the abnormal conditions of the system, yet it is
a valuable  auxiliary.   The various  methods  of applying
water for the cure of disease, are the following :
   1. The wet sheet pack :  The mode of applying this bath,
according to Dr. Trail, is  as follows :  Take a sea-grass or
straw mattress, upon which spread from three to five large
thick comfortables, then a soft flannel blanket, and lastly
the wet sheet, wrung sufficiently so  as not to drip.   Two
pillows placed upon the  mattress  are  necessary for the
head.  The patient lying down  on the back is quickly
enveloped in  the sheet, followed by the  blanket and  com-
fortables.  A light feather bed may be thrown over the
top, in which case two less comfortables will be required.
If the feet  remain cold,  bottles of hot water  should be
placed to them.  Headache is  prevented by the application
of cold packs.  In wrapping up the patient, great care
should be taken to turn the clothing snugly and  smoothly
around the neck and feet.  For  very delicate persons, the 
1188        HYDROPATHIC  PRACTICE.
sheet  should first  be wrung out of tepid or even warm
water.   On coming out of the  pack, the  plunge, douche,
rubbing wet-sheet, or towel washing may be employed, as
indicated.
  This bath is used by hydropathists in a  great variety of
diseases,  both acute  and chronic.  In chronic disease it is
used for  the purpose of producing reaction ;  hence the
packing is continued for a considerable length of time, and
a full amount of  clothing is used.   When it is used in
acute diseases to  overcome inflammation  and restore the
superficial capillary circulation, the water is used at a lower
temperature, and the packs are more frequently changed.
This  method of applying water is a  very  favorite  one
among most hydropathists, in typhoid fever, inflammation
of the bowels, lungs,  &c.
                 The Half Pack Sheet.
  The half pack is  the  application of  the wet sheet to a
portion of the body only ; as to the bowels in  Enteritis, or
to the lungs in  pneumonia.   This  bath  is also used on
feeble persons, and in chronic diseases where there is much
debility.   This method of applying  water  is a favorite one
of mine, in  all  cases of  inflammation  of the lungs,  and
bowels, also in most chronic affections of  the uterus.
                  The Douche Bath,
  The douche bath may be applied  either warm or cold.
It is given by allowing a stream of cold water to fall upon
a portion of the body from a height of four or five feet.
The  stream should be from  one eighth to one half of an
inch  in diameter, and should be repeated from time to time
as indicated.  It is used in chronic affections of the liver,
tumors, local rhenmatism,  inflammation of the brain, hip
disease, &c.  When  the vital reaction is feeble,  the water
should be warm, but where it is vigorous, cold water  should
be used. 
HYDROPATHIC PRACTICE.         1189
                   Dripping Sheet.
  The dripping sheet is another  form of applying cold
water.  It is given as follows :  The patient standing in a
tub, the sheet is suddenly thrown around  his body, which
it envelopes from  the head to  the feet,  and the body is
rubbed by the hands  of the attendant, outside the sheet,
for five or ten minutes, when the sheet should be removed,
and the body rubbed with a dry towel.
  This  bath  is used  in the early stage of fevers, also in
most chronic diseases.  I have found this form of bathing
a very convenient  one, not only in removing  disease,  but
when  used  once or twice a  week an excellent preventive.

                The Hip  or Sitz Bath.
  For' the sitting bath, sufficient water should be  placed
in a tub to cover the hips and lower portions of the abdo-
men,  when the patient is in a sitting posture.   The water
may be of  any temperature  to suit the indications.  This
bath is beneficial in diseases of the uterus, as  leucorrhcea,
dysmenorrhoea and prolapsus.  In these diseases the baths
are mostly  used cold.
  This  bath  is  also used  in dysentery, piles, hip disease,
&c.   The  baths should be repeated as often as the nature
of the case appears to indicate.

                     Shalloio Bath.
  This bath is taken  in a tub large enough for the patient
to sit upright with ease.   The water should be from four
to six inches deep.   The  temperature of the water, as in
other forms of bath,  should be warm or cold as indicated.
The shallow bath is used in all cases where the sitz bath is
recommended, and in many cases to much advantage.
                         100* 
1190       HYDROPATHIC  PRACTICE.
                     Plunge Bath.
  This process consists in immersing the whole body up to
the neck in water quickly, where there is room sufficient
for the patient to exercise his limbs under water.  A plunge
bath may be easily constructed where  there is a running
stream.   A box eight or ten feet long, and five or six feet
high, may serve a good purpose for this bath.   This form
of bath is of utility in all cases  where there  is sufficient
vital reaction, except in organic  disease of the heart, and
tuberculous affections of  the lungs.

                      Foot Bath.
  By foot bath  is meant merely placing the feet in warm
water.  This  is a  valuable  auxiliary  in  acute  and most
chronic diseases.   It acts as a revulsive to diseases of the
brain, stomach and bowels. Where there is determination
of blood to the head, stomach or bowels, the bath should
be hot,  and followed by brisk friction.   The benefit of the
bath will be much increased by the addition of lye and
pulverized mustard, in acute diseases.

                     Head Baths.
  The head  bath  may be given in two ways.   By laying
folded towels  upon the head that have been wrung out of
cold water, or by allowing a stream of water to fall upon
the head.   The  most common method in acute diseases is
to wrap the head in wet cloths, and change  as often as
they become warm.  In some violent affections of the brain,
more benefit may be derived from a stream of cold water
falling upon the head from some  distance.

                     Cataract Bath.
  This  bath consists in  two streams of water falling ob-
liquely upon  opposite parts  of the body.   This form of 
            HYDROPATHIC  PRACTICE.        1191

bath may be used for the same pufpose as the douche, as
also  a substitute for the wave  bath or plunge, when the
patient is too weak to take the latter.

             Dry Pack, or Sweating. Bath.
  This is  managed as the wet-sheet packing, except for
the wet sheet a dry blanket is substituted.  In either pro-
cess, wet cloths should be applied to the head, and plenty
of air should be  admitted into  the  room.  This bath is
useful where the patient has not sufficient vitality to render
the wet-sheet pack or other cold applications practicable.
Ague chills  may be  much lessened in their  severity by
this process of sweating.

                  The  Vapor Bath.
  This is valuable in colds  the first stages of fevers, &c.
The  patient may sit on an open chair with a blanket of
sufficient thickness to retain the  steam pinned about the
neck.  A pan of water may be placed under the chair, in
which hot bricks  are immersed to keep a vapor constantly
rising; or a small quantity of alcohol may be burnt beneath
the   chair,  to  produce perspiration.   This  bath may be
continued from fifteen to  twenty-five  minutes.

                   The Wave Bath.
  This consists in extending the body in  a swift current of
water.  It is for the same purpose as the plunge bath.

                    The Rain Bath.
  This  is taken by walking in a brisk shower, dressed in
thin apparel.   This  is  used  for producing reaction;  it
stimulates the glands,  hence it is useful in scrofula.   The
walk should not be  prolonged to produce fatigue;  when
the patient returns, the cloths should be removed, and the
body wiped with a dry towel. 
1192       HYDROPATHIC  PRACTICE.

                Portable Shower Bath.
  This process may be performed by showering the  body
with an ordinary tin shower-pot.

                  The Affusion Bath.
  This consists in pouring water over different parts of the
body, while the patient is standing in a tub.
  This is a favorite method of applying water in fevers and
inflammatory diseases.   Where this  bath is used for cool-
ing the body, it  should be repeated until  the object is
accomplished.
                Towel or Sponge Bath.
  This bath  consists in washing  the surface with a towel
or sponge.  This is the  most convenient of all the baths.
It is  used extensively in fevers.  It should never be neg-
lected in  their treatment, but should be repeated two or
three times a day.   A small amount of saleratus added to
the water is a valuable auxiliary.

                    Wet Dress Bath.
  The patient is enveloped in a dripping night dress, placed
in bed, and treated the same as in  the wet sheet pack.

                      Leg-Bath.
  The leg-bath consists in immersing the legs in a tub of
water.  It is  used  for gout, rheumatism, ulcers, diseases
of the joints,  &c.
                     Fomentations.
  These  are  cloths wrung  out of hot water, and applied
to different parts of the body, as may be indicated.

                    Wet Bandages.
  This is another method of applying cold or warm water
to different parts  of the body.   The cold, wet girdle, is
used to good advantage in prolapsus uteri, and leucorrhcea. 
HYDROPATHIC  PRACTICE.       1193
                    Hand Friction.
  This should be applied after all baths.   It is preferable
to any other kind of friction.   In  all cases  where baths
are made use of to invigorate the  system, friction should
be applied until reaction is produced.
  Temperature of Baths.* — Hot, warm,  tepid, cool,
and cold, are only employed as approximate terms.  Water
that feels hot to one may only be warm to another.  The
sensations  are  generally a better guide for regulating the
temperature  of a given  bath  than the  thermometer;
still the latter  is  indispensable in many cases,  and in all,
convenient.  As a general rule, the more  feeble and deli-
cate the  patient,  the more strictly should we  follow the
test  of his feelings, in administering tepid, warm,  or cold
baths.   When  the circulation  is vigorous, and the vital
temperature  well  developed, we may regulate  any  bath
with  sufficient   precision by the thermometer.   It  is  a
useful precaution, when commencing treatment with very
susceptible patients, to  test their  sensibility to different
temperatures of water, after which the physician or patient
can prescribe them thermometrically.  Some Water-Cure
books seem to  make it an especial point, to be thermo-
metrically exact in directing particular baths for given dis-
eases : as, for example,  sitz baths, at 59°; shallow-baths,
at 63°;  half-bath, 74°, &c.   These nice distinctions are
not  to be  arbitrarily  imitated, but may be  regarded  as
land-marks, to keep us within reasonable bounds.
   Baths may be distinguished into cold, below 65° Fahr.;
tepid,  65° to   80°;  warm,  80° to  98°.   But  a better
division may be made thus :
Very cold,       32° to 40°
Cold,           40° to 55°
Cool,           55° to 65°
Temperate,      65° to 72°
Tepid,         72° to  85°
Warm,         85° to  98°
Hot,           98° to 115°
Vapor,         98° to 125°
* Trail. 
A. The Heart.  B. B. The Lung?.  G. G. Diaphragm,  a. The Trachea,  b. The Vena Cava  C. Th«"
Carotid Artery, d.d. The Jugular Veins, e t. TbeSuhclavian Vfins.  /./. Thoracic Uuct.  g. Traonea
or Wind Pipe /.The Right Auricle. D. The Stomach. E. E.E. The Colon, or the large Intestine. F Tbe;'
Spleen,  j. The Gall Bladder on the under surface of the Liver.  I. I I.I. The Jejunum, the upper-part',
of the small intestines,  m.m.m. The Iliunf. or the lower partofsmall inttRtine*.  r. r. r. A spending I
Transverse, and descending Colon,  p. Arteries and Veins of the t-totnach.  a. SnleiiMtip A r«Urleg aadl
Veins,   e.e.e.e. Valves of the Ileart.  d. Wui^cua o« ■■*'?'.  -  •• •    ■■   • '•  '                 1 
INDEX.
Abdomeri, Dropsy of..............   320
Abortion,............................   944
Abscess  of Antrum  Highmo-
  rianum,...........................   843
Abscess,.............................   565
   do.   Mammary,...............   744
Acarus Scabies,...................   950
Accoucher, duties of,............   972
Acinesis,.............................   528
Acne,.................................   423
Acute Vaginitis,...................   914
iEsculapius,........................    24
After Pains,........................   974
Ageustia,............................   522
Ague,................................   176
Amaurosis,......................381, 521
Ambrose Pare, introduced liga-
  ture,..............................    20
American  Eclectic  Practice  of.
  Medicine and Surgery,.......     9
Amputations,................•......   596
     do    Operation,..........   602
     do. of Upper Extremities,  613
     do. of Metacarpal Bones,  614
     do.  of Arm,................  619
     do.  atWrist................  619
     do.  of Hip Joint,..........  620
     do.  of Knee Joint........  622
     do.  of Leg,.............605'^
     do.  of Foot,...............  625
     do   at Ankle Joint,......  627
     do.  Syme's,.............622, 627
     do.  Pirigoff's,............. 628
     do.  Chopart's,.............  626
Anaesthesia..........................
    do.  of Cutaneous Nerves,
    do.  of Nerves of Special
           Sense,................
         Acoustic,...............
         Gustatoria,............
    do.
    do.
Anaesthetics,.......
Anchylosis,  ........
Anemia, ............
Aneurism,..........
Angina,.............
Angina,  Chronic,.
Angina Pectoris,.
Antiperiodics, ....
Apnoea,..............................
Apoplexy,...........................
Ardor and Algor,................
Arteries, Injuries and Diseases
    of,..............................
Arteries, Wounds of,............
Arteries, Acute and  Chronic,
Articulation, To  recognize,....
Articulation, To traverse,......
Ascites,.............................
Asphyxia, ..........................
Asthma,.............................
Auscultation, Practice of,... 60

                B.
Balsams,.............................  1116
Bandages,...........................   574
    do.   Barton's, for the Jaw,   579
    do.   Compound Single T ,   581
    do.   Directions  for  apply-
           ing Spiral,...........   577
PAGE.
 520
 520

 521
 522
 523
 588
 863
 335
 819
 457
 458
 353
1116
 852
 324
 515

 817
 590
 818
 608
 610
 320
 852
 305
 272 
1196
INDEX.
                              PA.OE
Bandage, Figure-of-Eight,......  579
   do.        do.     for the
           Chest,.................  579
   do.  Handkerchief,..........  583
   do.  Knotted,..................  580
   do.  Lace,......................  583
   do.  Recurrent,..............  581
   do.  Slit,.......................  582
   do.  Spica  or  Figure-of-
           Eight for Pelvis,...  580
   do.  Suspensory,.............  582
Beach, Wooster,..................   11
Biliary Calculi,....................  496
Bitters,............................... 1117
Bladder, Diseases of,.............  785
   do.   Paralysis of,...........  788
   do.   Stone in,................  772
   do.   Tumours of,............  787
Bleeding at the Nose,............  840
Bleeding, Cases of,...............   41
Blood, Examination of,......SiDf,  68
Bowels, Hemorrhage of,........  478
Brain, Dropsy of, Symptoms of,  318
  do.      do.  Treatment of,  319
Breast, Caked,.....................  949
  do.  Diseases of,..............  946
  do.  Inflammation and Ab-
          scess of,..............  947
Broad Ligaments,................  894
Bronchitis,.........................  298
     do.    Chronic,...............  300
Bruises,  .............................  829
Burns and Scalds, '...............  751
Bursae,.................... .........  875
Byron, Lord,.......................   40

                C.
Cardialgia,.........................  509
Carditis..............................  358
Caries,...............................  831
Cartilage in the Joints,.........  875
Carunculae Myrtiformis.........  892
Casualties,........................  852
Cataplasms,........................  572
Cataract,..........................  802
   do.   Capsular,..........805, 814
   do.   Capsulo-lenticular,..  805
   do-   Congenital,............  805
   do.   Extraction of,.........  807
   do-   Hard,....................  803
                              PAOl
Cataract, Operations for, ...808, 811,
                              812
   do.   On Infants,............  814
   do.   Soft,....................  804
Catarrh, ...........................  477
   do.  Of the  Head,...........  447
Cancers,............................  854
Caustics,.......................... 1118
Changes by Impregnation,.....  961
Chicken Pox,......................  317
Child-birth,........................  963
Child, Management of, .........  975
Chlorosis,........................335, 899
Cholera, Epidemic, or C.  As-
  phyxia,...........................  308
Cholera Infantum,...............  461
   do.    Morbus,.................  307
Chorea,..............................  325
Clavus or Corns,..................  441
Clitoris, .............................  891
Club Foot,..........................  871
Coccyx,.............................  881
Colic, Lead,.......................  236
  do.  Spasmodic or Bilious,....  235
Colitis,  .............................  229
Collodion...........................  572
Compresses,........................  572
Condylomata,......................  441
Conical Cornea,...................  799
Conjunctiva, Inflammation of,  378
Constipation,.....................  474
Contagion, Laws of,.............  106
Contractions and  Retractions
   of Muscles and Fasciae,......  868
Convulsions,.......................  367
Cordials,............................  1118
Cornea, Inflammation of,.......  798
   do.   Opacity of,..............  798
   do.   Ulcers of,................  799
Cow Pox,...........................  162
Craige, David, Extract from,..   81
Craniotomy,........................  986
Croup,................  ..............  331
Crusted  Tetter....................  425
Curette,............................  809
Cutaneous  Eruptions and Ul-
   cers,..............................   75
Cyanosis,...........................  365
Cystitis..........................303, 785 
INDEX.
1197
               D.
Deafness,..........................   816
Decoctions..........................  1119
Delirium Tremens,...............   317
Dengue,.............................   446
Dentition, Difficult,...............   340
   do.   Treatment,...........   342
Dermatozoa,.......................   950
Diabetes,...........................   328
Diagnosis, ..........................    56
   do.    by  aid of  Micros-
            cope, ...............    67
   do.    Chemical tests in,..    76
   do.    Importance of cer-
            tain  Symptoms
            in,...... ...........   554
   do.    Indications of  ap-
            petite in,..........   557
   do.    Indications of Men-
            ses in,..............   557
   do   Indications  of Pulse
            in,..................   556
   do.    Indications of  the
            Tongue in,........   555
   do.    Signs from condition
            of mind in,.......   560
   do.    Signs  from  Faeces
            in,...................   559
   do.    Signs from Urine in,   558
 Diaphoretics,......................  1119
 Diarrhoea,.......................277, 472
 Diphtheria,.........................  153
   do.   Treatment of,.........   158
 Disarticulation,...................   615
      do.    Elbow-joint,......   617
 Diseases of Liver, Biliary Duct
   and Gall Bladder,.............   488
 Diseases of  Women and Chil-
   dren................................  879
 Dislocations,......................   709
     do.     Of the Ankle.......   712
     do.     Of the Clavicle,...   716
     do.     Of the Elbow Joint, 713
     do.     Of the Hip  Joint,.  711
     do.     Of the Lower Jaw,  715
     do.     Of the Patella and
               Knee Joint,.....  717
     do.    Of Shoulder Joint,  711
     do.     Of the Wrist,.......  715
 Diuretics,..........................  1119
        101
Dressings,...........................   570
Drops,..............................  1120
Dropsical Fluids,___.............    73
Dysentery,......................229, 467
   do.    Acute,.................   467
   do.    Adynamic,...........   468
   do.    Anatomical   Cha-
            racters of, &c.,...   470
   do.    Bilious,...............   468
   do.    Epidemic,.............   469
   do.    Intermittent    and
            Remittent.........   469
   do.    Rheumatic,..........   469
   do.    Treatment of,........   470
Dysmenorrhoea,....................   901
Dyspepsia,......................227, 281

                E.
Ear, Accumulation of Wax in,   815
 do.  Diseases  of,..................   815
 do.  Foreign Substances in,...   815
 do.  Fungous Granulations of,   816
Eating Tetter,.....................   443
Eclectic Medical College,  Phi-
  ladelphia,.......................    14
Ecthyma,............................   427
Eczema,...................385, 417, 418
Egerton's Plan  for  Cataract,   812
Electuaries,.........................  1121
Elephantiasis,.....................   440
Emetics,.............................  1122
Emmenagogues, .............. ...  1122
Emphysema,....................301, 692
Empyema,..........................   253
Encephalitis,.......................   220
Encyloblepharon,................   797
Endocarditis,......................   357
Enteritis,.........................   228
Entozoon Folliculorum,.........   950
Entropion,..... ....................   796
Enuresis.............................   396
Ephelis,............................   443
Ephemera,..........................   195
Epiphora,..,........................   797
Epilepsy............................   322
Epistaxis,...........................   840
Epulis,...............................   843
Erysipelas,.....................241, 416
Erythema,..........................   416
Exophthalmia,........ ............   797 
1198
INDEX.
                              PAGE
Expectorants,.................... 1122
Exudation, Death of,............  193
    do.    Production of,......  173
    do.    Theory of,...........  177
    do.    Vital Transforma-
             tion of,...........  181
Eye, Foreign Bodies in,.........  794
 do.  Inflammation of,........377, 793
 do.  Injuries and diseases of,  793
Eye-lids, Diseases of,............  795
   do.   Syphilitic  Ulcers of,  796
   do.   Tumours of,..........>  797

                F.
Fallopian Tubes,.................   895
Fevers, Anatomical Character
  of,..................................  112
Fevers, Condition of blood in,   90
  do.    Eruptive and  Exan-
           thematic,........... 130
  do.    Forms,....................  131
  do.    Hectic,...................  826
  do.    Intermittent,............  196
  do.    Miliary,..................  336
  do.    Practical   considera-
          tion of,................   79
  do.    Puerperal,...............  940
  do.    Remittent,...............  199
  do.    Scarlet,............ ......  147
  do.    Surgical,.............601, 670
  do.    Typhoid,.........96, 161, 208
  do.    Typhus, Hospital, Jail,
          Camp,  Malignant,
          Putrid,  Congestive,
          Ship, &c ,..  118, 161, 203
  do.   Yellow,...................  215
Fistula Lachrymalis, ............  798
Flap, Operation,.................  604
  do.   To preserve sufficient,...  611
Foeces, Examination of,.........   72
Foetal circulation,.................  988
Foetus, Death of,.................  989
Fomentations.....................  1123
Fourchette, .......................  892
Fractures,...... ..........'.........  631
    do.    Causes of,............  634
    do.    Comminuted,........  633
    do.    Compound........633, 666
    do.    Crepitation of,......  639
Fractures,	Manner of healing	
		643
do.	Occasioned by Ul-	
		668
do.		675
do.		632
do.		637
do.	Time required for	
	union of,.........	647
do.		633
do.	Treatment of,...649	670
do.	Of the Acromion,..	681
do.	Of the Clavicle,....	677
do.	Of the Coracoid	
		681
do.	Of the Coronoid	
		689
do.	Of the Femur,......	694
do.	Of the Fore-arm,..	687
do.	Of the Hand,.......	691
do.	Of the Humerus,...	682
do.	Of the Lower Jaw,	076
do.	Of the Ossa Nasi,..	675
do.	Of the Patella......	702
do.	Of the Pelvis.......	693
do.		689
do.	Of the Ribs,.......	692
do.	Of the Scapula,....	680
do.	Of the Sternum,...	693
                G.
Gallstones, ........................   496
Gangraena oris,...... ............   464
Gangrene,...........................   749
Gastralgia,........................   609
Gastritis, ...........................   226
Gastrodynia,...................   345
Glanders,............................   445
Glossitis,............................   456
Gonorrhoea, ........................   845
Gout,.................................   449
Granules,...........................  1123
Gravel,..............................   772
Gums, Tumours of,...............   843
Gutta Serena,......................   521

                H.
Haematemesis,....................  346
Haematocele,.......................  868 
INDEX.
1199
Haematuria,........................
Haemoptysis,....................276,
Hare-lip,............................
Harvey discovered circulation
  of the blood,....................
Headache,..........................
Heart, Atrophy of,...............
  do. Chronic  Valvular dis-
         eases of,...............
  do. Congestion of,............
  do. Dilatation of Cavity of,
  do. Diseases of,...........350,
  do. Hypertrophy of,........
  do. Inflammation of,.......
  do. Palpitation of,  ...........
Hemorrhage from Rectum,....
     do.     From  Urinary or-
                gans,..........
     do.     Of Bowels,..........
     do.     To prevent,.....587,
Hepatitis,..........................
Hernia,..............................
  do. Anatomy of Inguinal,
         and Femoral, .........
  do. Radical cure of, .........
  do. Reducible,.................
  do. Strangulated, ............
Herpes, .........................383,
Hip Disease,........................
Hordeolum, .......................
Hooping Cough,..................
Hydrarthrus,......................
Hydrocele, .........................
Hydrocephalus,....................
Hydrophobia..................327,
Hydrometra,......................
Hymen,..............................
  do.  Imperforate,.............
Hyperaesthesia,
do.
do.
do.
do.

do.

do.

do.
do.
Acoustic,.........
Causes  of,.......
Gustatory,......
Of Cardiac plex-
  us,..............
Of   Cutaneous
  nerves,..........
Of   Mesenteric
  Plexus,.........
Of Optic nerve,
Of Solar Plexus,
397
295
843

 20
366
358

503
354
361
502
359
358
351
481

397
478
600
304
764

762
770
769
768
419
833
795
240
836
771
318
728
928
891
913
509
517
519
517

518

512

 518
517
 518
Hyperaesthesia, Olfactory,......   517
Hypercinesis,......................   525
Hypertrophiae,......................   438
Hypochondriasis,......................   375
Hysteria,...............................   370
Ichthyosis, .........................
Impetigo,...........................
Incisions,...........................
Indigestion,.........................
Infantile sore mouth,.............
Inflammation,...................170,
    do.
    do.
    do.

    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.
    do.

    do.

    do.
    do.
    do.
    do.
    do.
    do.
    do.
Influenza,
Injections,
Ipecac, ....
Symptoms of,
Treatment of,. 194,
Of     Absorbent
  glands,..........
Of Arteries,.......
Of Bladder..... ...
Cellular Tissue,..
Chronic,............
Of Colon,...........
Of Conjunctiva,..
Of Cornea,.........
Of Ear...............
Of Eyes, 377, 380,
Of Fauces,.........
Of Heart, .........
Of Kidneys, ......
Of Liver,  ..........
Of Lungs,.........
Of (Esophagus,...
Of Pericardium,.
Of Peritoneum,...
Of Pharynx,......
Prostate,..........
Of  Small  Intes-
  tines.............
Of   Spinal  Mar-
  row, ..............
Of Stomach,......
Of  Testes..........
Of  Tongue,........
Of  Trachea, ......
Of  Uterus,........
Of  Vagina,........
Of Vulva..........
438
425
585
227
222
218
219
219

463
818
303
924
791
229
378
798
225
795
457
358
302
304
233
344
355
232
459
790

228

 372
226
867
 456
 331
 400
 905
 905
 477
1124
  22 
1200
INDEX.
                             PAGE
Iris, Prolapsus of,................  795
Irritation, Spinal.................  373
Iritis, ................................  799
Ischuria,...........................  394
Itch,.................................  386
Itch Worm,........................  950

                J.
Jaundice..................  ........  348
Jenner, Dr.,.......................    21

                L.
Labia, Encysted Tumours of,..  907
   "   Cohesion of,  ..............  906
   "   Majora,....................  890
   "   Minora.....................  891
   "   Oozing Tumour of, .....  908
   "   Varices of,.................  908
   "   Sanguineous  Tumours
         of,.......................  909
Labor................................  964
   "   Instrumental,............   981
Lagophthalmos,..................  797
Leucocythemia....................   505
Leucorrhcea,........................   901
Lichen...............................   430
Ligaments,.........................  883
Ligatures,...........................   587
Liniments,..........................  1124
Lipoma, ............................  841
Lithotomy,..........................  775
Lithotrity,.........................  772
Liver, Atrophy of, Induration
         of, Softening of,......   491
   "   Cirrhosis of, ..............   492
   "   Congestion of,...........   494
   "   Deficient Secretions of,   495
   "   Diseases of,...............   488
   "   Fatty.......................   491
   "   Functional Diseases of,  493
   "   Hydatids of,...............   493
   "   Hyperaemia,   .............   494
   "   Hypertrophy of, .......   491
   "   Inflammation of,.........  304
   "   Nutmeg,....................  493
   "   Waxy, ......................  493
Locked Jaw,........................  327
Lunge, Organic Affections of,..  486
Lupus,.....................,........  443
Lymphadenitis,....................  463
                             PAGE
               M.
Maculae,  ...................... 413,442
Malignant Tumours, ............  854
Mania Potu, .......................  317
Masturbation,......................  876
Materia Medica,........... ......  990
Measles...................104, 163,315
   "     Treatment..........167,316
Meatus Urinarius,................  891
Melaena..............................  478
Meningitis,  .......................  220
Menorrhagia,.................900, 902
Menses, Cessation of,............  406
Menstruation,.....................  896
             Difficult...... ...  901
       "      Disorders of,....  898
       "      Vicarious,........  900
Mercurial Erethismus,..........  553
    "    Disease,..............  545
    "    Treatment  for.......  553
Mercury, Diseases Caused by,   46
    "    Preparations of,......   43
Middle States'  Reform  Medi-
  cal Society,.....................   14
Milk,  Microscopic  Examina-
  tion of,............................   67
Mineral Substances of Human
  Organism,......................   47
Mixtures,...........................  1125
Molluscum.....  ..................  439
Mondini  First Dissector,.......   22
Mons Veneris,.....................  890
Montague, Lady Mary Wortley   21
Morbid Growths,..................  563
Morbus Caeruleus,...............  365
Morbus Coxarius,...............  833
Mortification,..................193, 749
Mucus,..............................    73
Mumps,.............................  321
Myalgia,.............................  532
Myelitis,...........................  372

               N.
Naevus,..............................   441
Nasal Polypi,.....................   841
Necrosis.............................   831
Nephritis,*.........................   802
Nervous  System,  Diseases of,..  509
Nettle-rash,........................   338
Neuralgia.......................368, 493 
INDEX.
1201
  Neuralgia, Cervical and Inter-
             costical,............  515
      "    Ischiatica,.............  513
  Neuroses of Mobility,............  525
  Nursing Sore Mouth,............  223
  Nymphae,..........................  891
  Nymphomania,...............876, 877

                 0.
  Obstetrics,..........................  879
  Obturator, Foramen,............  883
  Odontalgia,................ ......  508
  (Edema..............................  278
  (Esophagus, Inflammation of,..  344
       "     Spasmodic  stric-
               ture of,..........  460
       "     Stricture of,.......  460
  Ointments........................... 1128
  Onyx.................................  799
  Ophthalmia.....................167, 377
       "     Catarrhal,.........  378
       "     Purulent,..........  380
       "     Tarsi.................  795
  Orchitis, ...........................  867
  Organs of Generation,..........  890
     "   "     "   External,  890
     "   "     "  Diseases of,  905
  Os Innominatum,.................  882
   " Ischium,........................  882
   " Pubis, .........................  883
   " Uteri.............................  903
   "   "   Occlusion of,.........  926

                 P.
  Papulae,.............................  429
  Paracentesis,......................  865
       "       Capitis,............  866
  Paralysis, or  Palsy,.............  325
  Paralysis,.............................  528
     "    Treatment,...............  531
  Paraphymosis,........................  867
  Paronychia,..............................   747
  Parotitis,................................   321
  Parturition..........................   963
I  Patients, Examination of,.......    76
'  Pelvic Cellulitis,....................   924
  Pelvis........,..............879, 884, 887
  Pemphigus,...........................   421
■>. Percussion,  Sense of  Resist-
    ance Produced by..............   57
Pericarditis,.........................  355
Perineum,...........................  892
    "     Rupture of,..........  923
Peritonitis Acute,..................  232
Pertussis,.............................  240
Pharmacy,.....................990, 1116
Phlebitis,.............................  362
Phlegmasia Dolens................  362
Phrenitis.............................  220
Phthisis,...............,.............  259
   "   as an Effect of Measles,  167
   "   Causes of,..................  280
   "   Duration of,...............  279
   "   Emaciation in,...........  276
   "   General Symptoms and
         Course...................  268
   "   In Infancy and Child-
         hood.....................,.  279
   "   Treatment of,.............  283
Phymosis,............................  866
Physics................................ 1129
Physoraetra,........................  927
Pills,.................................. 1129
Pityriasis.............................  437
Pleuritis..............................  243
         Chronic,................  247
Placenta, delivery of,............  973
Plague...............................  339
Plasters, ..................... 572,1131
Pneumonia, ......................   233
Pneumothorax,  ..................  483
Polypus,.............................  816
Porrigo, ............................  444
Poultices, ...............372, 573, 1133
Powders,..........................  1133
Pregnancy, Signs of,  ............  962
Presentations Compound,.......  978
     do.      of face.............  976
     do.      Preternatural,...  976
     do.      Shoulder    and
                Arm.............  979
Prolapsus  Ani,....................  839
Prostate, diseases  of,........785, 790
Prurigo ......................,...... 434
 Psoas Abscess.....................  865
 Psoriasis............................ 436
 Ptosis, .............................. 797
 Puerperal Convulsions,......... 987
 Pudendum.......................... 890
 PunotoLachrymalia, closure of 797 
1202                       INDEX.
                             PAGE
Purgatives,........................  1135
Purpura,...................................   389
   do.   Causes of,.................   392
   do.   Treatment of,..........   393
Pus, Examination of,..........71, 184
Pustulae,..............................   423
Pustulous Cutaneous disease,.   387

               Q.
Quinsy,................................   224

               R.
Recto Vaginal Fistulas,.........   922
Rectum, Falling of,..............   839
   do.   Hemorrhage from.....   481
Red Nose,...........................   841
Reproduction......................   958
Resuscitation,.....................   589
Rheumatism,....................330 ,452
Ringworm,..........................   420
Roseola.............................   338
Roseola, or Rose Rash,.........   338
Rollers,..............................   574
Rubeola,.........................163, 315
   do.    Treatment........167, 316
Rupia,......v.......................   422
Rupture of Muscles and Ten-
   dons,..............................   862

               S.
Sacro-Coccygeal Symphysis...   883
 do.  Iliac, ........................   883
Salt Rheum,.......................  383
Salves,...............................  1135
Scabies,.............................   386
Scalds,..............................   751
Scald Head,.......,................   444
Scarlatina.................146,  161, 237
    do.    Converted into Diph-
             theria,.............   156
    do.    Sequel  and  Treat-
             ment of,........151,238
Scrofula,..........................   535
   do.   Treatment of,...........   643
Scrotum, Dropsy of,..............  771
Sea Sickness,.........„...,..........   509
Skin, Blue Disease of,..........   365
 do.  Diseases of,.............383, 412
Slings,.............................   582
Small Pox,...107, 132, 161, 162, 313
                             PAOE
Small Pox, Complications,.....  141
   do.    Morbid   Appear-
           ance of,..............  143
   do.    Treatment of,........141
Sore Nipples,.......................  948
Spasms, .............................  525
  do.   in  range  of   Motor
        Nerves of Inferior Ex-
          tremities,..............  527
   do.   Causes of,...............  527
  do.   Treatment of,.  ........  527
Spermatocele,.....................  868
Spermatorrhoea,...............876, 877
Spine, Injuries of,................  863
  do   Pott's Curvature  of,.....  863
Spirits,..............................  1145
Spleen. Atrophy and Hyper-
  trophy of, .......................  501
Spleen, Dissection of,...........  499
  do.    Non-inflammatory dis-
          ease of,................  501
  do.    Softening of,...........  501
  do.    Tubercles in............  502
Splenitis,  acute,.................  496
   do.    Anatomical Charac-
           ter,  ..................  497
   do.    Chronic................  498
Splints,..............................  706
Squamae,...........................  435
Squinting,.........................  870
Starrhcea,..........................  440
Stomatitis Follicular,............  223
Stone in Bladder, ................  772
Stone in Women,.................  783
Strabismus,........................  870
St. Anthony's Fire,..............  241
do- Vitus' Dance,.................   325
Surgery,............................  563
    do  Instruments used in,  583
Sutures,............................  585
Swelling...........................   638
Sycosis,..........................445, 456
Symblepharon......................   797
Syphilis, ............................   847
Syrups,.............................  1136

                T.
Talipes,............................  871
   do.   Varus, .....................   873
   do.   Vulgus,...................   874
J 
index.                         1203
                              PAGE
Tetanus..........................327, 669
  do..............................  822
Testes, Inflammation of, .......  867
Thomson,  Samuel,................   10
Thrombus...........................  909
Thrush,..............................  222
Tinctures,......................... 1146
Tonsillaris Cynanche,............  224
Toothache,..........................  508
To Recognise Articulation......  608
Tracheitis,..........................  831
Trephining,........................  865
Tumours,...........................  862
Tunica Albuginea,................  895
Tying the cord,  ..................  973
Tympanitis Uteri,.................  927
Typhus Icterodes,.................  215

                U.
Ulcers, ..............................  755
Ulceration.........................  194
    "     of Oesophagus,......  344
Umbilical Cord, Prolapsus of,  981
Urethra,.............................  891
  do.  Diseases of,..............  910
  do.  Foreign Bodies in,......  912
  do.  Occlusion of,.............  912
Urethritis..........................  911
Urine,................................    73
  do.  Incontinence of,.......396, 789
  do.  Retention of, 394,  737,  789,
                              791
  do.  Saccharine,.................  328
Urticaria,.......................338, 416
Uterine  and  Vaginal   Dis-
  charges, examination of,....    72
Uterine Dropsy,...................  928
Uterus,............................  893
  do.   Anteversion and  Ante-
       flexion,  ....................  929
  do.   Cancer of,.................  861
  do.   Functions of..............  894
  do.   Hydatids of,..............  939
  do.   Inflammation of,.........  400
  do.   Causes,................■•■•••  403
  do.   Treatment,...............  0v6
  do.   Neuralgia of, ............  ^0v
Uvula, Enlargement of,.........   844
Vaccination........................  1G2
Vagina,..............................  892
  do.  Inflammation of,.......  914
  do.  Laceration of,...........  923
  do.  Occlusion of,............  913
  do.  Prolapsus of,............  915
  do.  Stricture of,.............  913
  do.  Tumours,    morbid
          growths,...............  919
Vaginal Cystocele,..............   915
  do.   Rectocele,..............  916
Varicella,...........................  311
Varicocele,........................  868
Variola Confluens,.............140, 313
Veins, Wounds of,................  596
Vertigo,.............................  516
Vessels concerned in obstetri-
  cal practice,...................  888
Vesico Vaginal Fistula, ........  920
Vestibulum,........................  891
Vitiligo,.............................  442
Vomited matter, examination
  of,.................................    72
Vulva, warty tumors of, .......  910

                 W.
Washes,............................. 1148
Watery Blebs,.....................  421
Weak Joints,.......................  876
White Swelling,...................  836
Womb, falling of..................  904
Worms,..............................  333
Worthington Literary College,
  Ohio,.............................    12
Wounds, Gunshot,...............  717
  do.    Lacerated,..............  727
  do.    Incised,.................  727
   do.    Poison,..................  727
   do.    Punctured..............  727
   do.     Union  of,...............  685
Yellowness.........................   348
 
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