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A
FAMILIAR   TREATISE
ON
MEDICINE:
                       BY

         JOHX  M.  SCUDPER, M. D.,    (~-^

PROFESSOR OF THE THEORT AMD PRACTICE  OF MEDICINE IN THE ECLECTIC MEPICAL
  ntmrcTE, author or "a practical treatise on diseases of women," "the
     ECLECTIC PRACTICE OF MEDICINE," "THE ECLECTIC MATERIA MEDICA AND
         THKKAPECTICS," " ON THE U8E OF INHALATIONS," ETC.
               VOLUME  I.
Anatomy, Puysiolooy, Hygiene. Domestic Remedies,
     Surgery and  Practice of Medicine, and
               Notes on NrusiNO.
TE3STTI3: ZEZDITIOIN"-
                CINCIN N ATI:
MOORE,  WILSTACII &  MOORE, Printers,
            141 AND 143 RACE  BTRKET.
                     1869. 
S43U
       Entebed accobding to Act of Conqbess, in the teab 1865,
               BY JOHN M. SCUDDER, M. D.,
IN THE CLERK'S OFFICE  OF THE DISTBICT COVBT OF THE UNITED STATES, FOB THE
                   SOUTHERN DISTBICT OF OHIO. 
PREFACE.
  The present volume is offered to the public with
the  belief that  there  is  an  earnest  desire  by
many to  understand more of the  structure  and
functions of their own bodies, and  to qualify them-
selves to  meet cases of emergency,  when a com-
petent  physician  can not  be obtained.   Men  and
women know  less of themselves than they know
of anything else,  and it is not only surprising, but
often humiliating, to witness the  gross  ignorance
displayed on these subjects,  by persons  who are
otherwise well informed.   It  would  seem, some-
times, as  if men's reasoning powers  were in com-
plete abeyance when they or  their  families  are
sick, being as  ready to  employ the merest charla-
tan or nostrum vender, as the educated physician,
and to disregard the plainest rules of hygiene, as
to give the patient good nursing.
  There  must  be some  reason for this state of feel-
ing,  as  it is  certainly very unnatural.   There is
nothing that a man  loves  as he loves life, and life
has  no blessing  like health; why, therefore,  are
people so indifferent to that knowledge  that  will
enable them to prolong the  one, and  preserve the
other?  Men and women should  care to understand
the structure  and functions of their  own  bodies,
and  how to avoid the causes of disease.   So, also 
4
PREFACE.
should  they use a sound discretion in selecting  a
medical  adviser, and avoid ignorant pretenders,
and patent nostrums, using their reason from abso-
lute knowledge,  and not governed by  emotional
impulse, or by novelty or superstition.   The reasons
why they do not, present themselves to me as fol-
lows :  First, physicians in all  ages have* tried to
confine  a knowledge  of medical subjects to their
own profession, and have successfully accomplished
their  purpose by making it a breach of  medical
ethics to write on medicine for the people.   Second,
the public have been instructed to believe  that
these subjects are beyond the  ordinary  powers of
comprehension;  that there is something impure, if
not sinful, in their study, and  that it would  be  a
great breach of  propriety, if nothing worse, to en-
deavor to learn that which has so strenuously been
kept from them.
  The human body is perfect in all its parts, and
adapted  by its Creator to supply  all  the  earthly
wants of the soul, which is placed within it.  Noth-
ing displays the  wisdom and beneficence  of God in
a higher degree; and  we might say, with the  emi-
nent anatomist,  Cruveilhier,  u While contempla-
ting the marvelous organization, in which all  has
been arranged with such  intelligence and wisdom,
that no fiber  can acquire the slightest  addition, or
undergo  the  least diminution,  without the equili-
brium  being destroyed,  and disorder induced —
what anatomist is there who  would not feel tempted
to exclaim with  Galen, that a work on anatomy is
the most beautiful hymn which man can chant in
honor of his Creator?" 
PREFACE.
5
   In undertaking to present that knowledge, which
I consider it the duty of every one to possess, I do
not  wish to be understood as  holding the opinion
" that every man can be his own doctor."   Every per-
son  should know how to avoid disease, how to act
in cases of accident and injury, how to treat simple
cases of disease,  and how to  nurse  and properly
care for the sick.   It is  this knowledge that I have
attempted to give  in the following  pages,  using
plain language that may be understood  by all.
   I am satisfied that no person who will  carefully
read its pages, will be led into injudicious experi-
menting upon their own bodies, or their neighbors,
but  that  they  will be enabled,  in most cases, to
decide  when  simple remedies are sufficient, and
when it is necessary to have skilled advice.
   On the subject of nursing,  I have preferred to
give the  small work of  Miss  Florence Nightingale
complete, rather than write on the subject myself.
Her devotion to the sick and  wounded in the Cri-
mean Avar, placed her foremost in the list of be-
nevolent women,  and gave her a world-wide rep-
utation.   In this small  volume,  she gives the re-
sults of a lifetime's  experience, and, addressed by
a  woman to those who have care of the sick, it
can not but make a good impression.   The lan-
guage is clear and concise, and her deductions are
based on a very large  experience,  and upon  the
facts of science. 
& 
TABLE OF CONTENTS.
Introduction,    ----..-13
Origin of Medicine, -------13
Allopathic Medicine,   ------    19
Homoeopathy, --------21
Eclecticism,........28
The Physician,.......35
The Practice of Medicine,.....37
Quackery,........38
         PART 1.—Anatomy and Physiology.
The Materials of which Man is Composed,     -    -  43
Bone,.........44
The Skeleton,........45
Articulations,.......47
Cartilage,........47
Fibrous Tissue,.......48
Muscular Tissue,   -------48
Nervous Tissue,.......49
Adipose Tissue,    -------50
Origin of the'Human Being,     -    ...    50
Development of the Body,    -----  51
Food,.........52
Hunger, ---------55
Organs of Digestion,......58
The Stomach,.......59
Small Intestines,.......63
Large Intestines,   -------65
Liver,.........66
Pancreas,........67
Spleen,........67
The Blood,........68
Heart and Blood Vessels,.....72
Arterial System,.......73 
8                   TABLE  OF CONTENTS.

Nutrition,.....--.-     75
Secretion,........77
The Skin and its Secretion,  -    -    -    -    -     79
The Urinary Apparatus and Secretion,   -    -    -   80
Kidneys,........81
The Respiratory Apparatus and its Function,  -     -   85
Lungs,.......-87
The Lymphatic System and its Functions,     -    -   90
The Nervous System,......90
The Brain,........92
Spinal Cord,.......93
Cranial Nerves,     __.----   94
Phrenology,     -------96
Laws of Mental Development, -    -    -    -    -100
Example,   --------    104
Value of Perseverance,  ------  107
Self Culture,.......110
The Human Temperaments,  -    -    -    -    -112
The Science of Physiological Marriage,     -    -    136
Vital Tenacity,.......146
Organs of Special Sense,.....149
The Eye,........149
The Ear,    -                       -    -    -    153
The Organ of Smell,     -    -    -    - *   -    -  155
The Organ of Taste,......155
The Sense of Touch,......156
                PART H—Hygiene.
Dwellings,........160
Defective Ventilation, ------    163
Clothing,........165
Food,.........169
Fruit,.........172
Air and Temperature, ------    173
Exercise,     --------  177
Mental Occupation.    -     -    -    -    .    -180
Sleep,.........181
Excretion,  -----.__    183 
TABLE OF CONTENTS.
9
Intoxicating Liquors as a Cause of Disease,  -     -    187

        PART III.—Medicines for Family Use.
Use of Medicines,.......193
Emetics,........195
Cathartics,........198
Diaphoretics,.......203
Diuretics,........210
Sedatives,........213
Narcotics,     -.......215
Tonic?,........215
Stimulants,........219
Alteratives, ---»----    223
Astringents,........225
Antispasmodics,......-228
Expectorants,........229
Liniments, -----    _    -     -    252
Ointments,........233
Emollients,.......-    233
Family Medicine Chest,......236
Dietetic Preperations,......238

PART IV—Management of Accidents and Injuries and
                  Surgical Diseases.
Directions for Restoring the Apparently Dead,   -    245
Treatment to Restore Natural Breathing,      -    -  246
Treatment after Breathing has been Restored,   -    247
Appearances which generally indicate Death,  -    -  248
Poisoning,........248
Sun Stroke,    -    -     -    -         -    -    -  252
Apoplexy,........253
Concussion of  the Brain,.....254
Bruises,    --------    254
Cuts,.........254
Burns,........256
Dislocations,........256
Fractures,........260
Hernia—Rupture,.......261 
10              table of contents.

Hemorrhoids—Piles,......262
Fistula in Ano,.......263
Chronic Disease of the Loins,    -    -    -    -   264
Tumors,.........266
Cancer,........2*>7
Carbuncle,........2^9
Boils,.........2™
Felon,.........2?1
Ulcers,........272
      PART V.—Diseases and their Treatment.
General Disease,    ------- 274
Fever,      -    -     -.......276
Febricula,......-    * 280
Intermittent Fever—Ague,.....281
Congestive Chill,   ------- 283
Remittent Fever—Bilious Fever, -    -    -    -   284
Yellow Fever,.......288
Common Continued Fever,  -----   292
Typhoid Fever,    -     -    -     -    -    -    - 297
Eruptive Fevers,       ------   307
Small Pox,........307
Varioloid,......-    -313
Vaccination,  -    -     -    -     -    -    -    -313
Chicken Pox,    -------   316
Measels,.........317
Scarlet Fever,.......320
Spotted, Fever,.......326
Diphtheria,........328
Rheumatism,  -------- 331
Chronic Rheumatism,  ------   334
Scrofula,      -              .....336
Dropsy,........342
Diseases of the Respiratory Organs,     ... 344
A Bad Cold,  -    -     -                  -   -   347
Quinsy,.........348
Croup,      -    -         .....350
Chronic Laryngitis, ------- 355 
table of contents.
11
Acute Bronchitis,......356
Chronic Bronchitis,.......358
Inflammation of the Lungs,      -    -    -    -   361
Asthma,     -    -    -    -     -    -    -    - 365
Consumption,    -    -    -     -         -    -   366
            Prevention of,                        376
Physical Education of Children,  -    -    -    -   377
Hemorrhage from the Lungs,  ----- 382
Pleurisy,......--   384
Whooping-cough,......- 386
Diseases of the Heart,......388
        of the Digestive Organs,   -                390
Derangements of Dentition,.....390
Toothache,........391
Sore Mouth,.......392
Nurse's Sore Mouth,......393
Dyspepsia,........394
Diseases of the Liver,......401
Jaundice,........404
Diarrhoea,........405
Cholera Morbus,.......409
Asiatic Cholera,.......411
Cholera Infantum,......416
Colic,   -    -    -    -.....419
Dysentery—Flux,......421
Worms,.........426
Diseases of the Urinary Organs,  -    -    -    -   428
Inflammation of the Kidneys,.....429
Suppression of Urine,......431
Retention  of Urine,......432
Diabetes,........432
Bright's Disease of the Kidneys    -                434
Incontinence of Urine,.....435
Inflammation of the Bladder,.....436
Diseases of the Nervous System,  -    -    -    -   438
Inflammation of the Brain,.....438
Spinal Meningitis,......443 
12
TABLE OF CONTENTS.
Epilepsy,........446
Convulsions,.......450
Hydrophobia,......-    - 453
Delirium Tremens,......458
Neuralgia,........461
Hypochondriasis.......463
Headache,........466

           PART VI.—Notes on Nursing.
Ventilation and Warming,   -----    475
Health of Houses,.......485
Petty Management,    ------»   494
Noise,.........502
Variety,........514
Taking Food,........518
What Food,.......524
Bed and Bedding,.......532
Light,........536
Cleanliness of Rooms and Walls    -                539
Chattering Hopes and Advices,  -    -    -     -    546
Personal Cleanliness,     ------ 544
Observation of the Sick,.....554
Conclusion,.....-._ 572 
INTRODUCTION.
              OMIGIX OF MEDICINE.

   The practice of medicine undoubtedly arose from the
wants of the people, who being subject to  pain and dis-
ease, would naturally endeavor to  find some  means of
relief.  As hunger was the first incentive to procure food,
and the vicissitudes  and  inclemency of the weather the
first to cause the building of houses and the manufacture
of clothing, so medicine grew out of the natural want of
means to relieve pain, shorten the course of disease, and
prevent death.
   In the early ages of the world, the history of medicine
is involved in much obscurity.  For centuries there wat-*
no written medicine, and what knowledge of simples they
possessed was handed down  from parent to child, increas-
ing as they learned the value and use of medicinal plants.
We do not learn that there  were  any men who devoted
themselves to the practice of medicine, but in some  coun-
tries when a person was suffering from a severe disease,
he would  sit by the road side and get the advice of the
passers by, as possibly some one would have seen the dis-
ease before, and  be able to tell him  of means that would
give relief.
  If we consult the Bible, we will find that the Jews must
have possessed  considerable  knowledge  of medicine, and
that some men had at an early day devoted themselves to 
14
introduction.
 the care of the sick, and were called physicians.   Thus in
 Jeremiah viii: 22, the prophet says:  " Is there no balm
 in Gilead; is there no physician there? why then is  not
 the health of the daughter of my people recovered."  And
 in Job xiii: 4—" But ye are forgers of lies, ye are  all
 physicians of no  value."  Again  in Proverbs xxvii: 22—
 " A merry heart doeth good like a medicine, but a broken
 spirit drieth the  bones;"  a saying as true to-day as when
 spoken by Solomon.  Jeremiah again speaks of medicine,
 xxx:  13—" There  is none to  plead thy cause, that thou
 mayest be bound  up: thou hast  no healing medicine."
 In the New Testament we  frequently read  of physicians
 and medicine, and  every reference tends to show that the
 art was held in high esteem.  Still the practice of  medi-
 cine must have been in a very rude and imperfect state,
 as they knew but  little  of  anatomy and physiology and
 the kindred sciences, and we are forced to the belief that
 it consisted in a traditional knowledge  of  the action of
 vegetable remedies.
  Renouard  in  his history  of medicine remarks:  "We
 have seen that the  first notices of medicine go back to the
 earliest infancy of society, in all the countries of the world;
 so that we may repeat the statement of Pliny, that if there
 exists any nation which, at any epoch  of its history, was
without physicians, there is not one  in which we do not
find some vestiges  of medicine."
  Greece, which was for so many centuries the center of
 civilization and arts, first developed medicine as an  art,
and had physicians.  Even  here the history of medicine
is clouded with the mythology of the times.  The Centaur
Chiron is said to have introduced the art  of medicine into
 Greece, and rejecting the fabulous accounts of  his com-
pound form, historians consider it probable that he was a
prince of Thessaly,  who lived about the thirteenth centuiy
before the Christian era.  To his pupil yEsculapius, how-
ever, is ascribed the merit of first devoting himself to the
 cultivation of medicine as a science, and of having made 
INTRODUCTION.
15
it a special pursuit.  Hence he is called the god of medi-
cine, and was  deified by his countrymen after his death,
who paid him divine honors, and erected temples to him
in various parts of Greece.
  His pupils and  followers were priests in these temples,
and  took the name of Asclepiades.  The temples were
usually situated on high salubrious ground, near medicinal
or other springs, and  surrounded with groves of  trees,
which afforded shade, pleasant  walks, and that agreeable
variety so beneficial to the sick.  These temples  became
a species of hospitals, to which persons resorted from all
quarters for the relief of the diseases with which they were
affected.   Under the direction of the priests of these tem-
ples  they underwent a variety of ceremonies, the imme-
diate effect of which must  have been on the imagination.
Some,  however, of the practices which were enjoined were
of a dietetic nature, and were directly conducive  to tem-
perance and cleanliness—such as frequent ablution, and
the abstaining from certain kinds of food.
  Hippocrates, who is  called the father of medicine, was
born about 450 years  before Christ, and was the most
noted of the ancient physicians.  He was educated in the
temples  of ^Esculapius, and then  traveled  extensively;
returning to his country rich in the  materials he collected,
he devoted his life to research on disease and its remedies.
His writings, part of which have been preserved, show a
very imperfect knowledge of the structure and function of
the body, but  a tolerably accurate knowledge of the symp-
toms of disease, and the remedies for its cure.
  From this period up  to the establishment of the school
of medicine at Alexandria, some three hundred and twenty
years before Christ, there was but little if any progress in
medicine or its associate sciences.  Up to this time dissec-
tions of the human body were not permitted, and were
looked upon  as a  most heinous sacrilege.   Now  for a
period of nearly one hundred years this study was pursued
with great zest, and we may date  from this a new era in 
 16                  INTRODUCTION.

 medicine.  Galen, who  obtained his knowledge  at this
 place, about the one hundred and fiftieth year of the Christ-
 ian era, was the most celebrated physician of his time.  He
 afterwards resided in Rome, and was the favorite of the Em-
 perors during its most prosperous days.  His works have
 come down to the present  day, and though crude and
 imperfect, they are still far superior to those that had pre-
 ceded him.  For over a thousand years his writings were
 deemed nearly perfect, and were authority for the majority
 of physicians.
  From the time of Galen to the  commencement of the
 fourteenth century, there  was a gradual decline in medi-
 cine, as there was in all sciences, until in the dark ages it
 had sunk almost to its primitive condition.  During this
 period anatomical research was abandoned, and the books
 of Galen obscured by the  comments of ignorant men were
 the only guides.  For a portion of this time medicine was
 cultivated by the  Arabs  with considerable success,  but
 with their decline the most of this knowledge was lost.
  From  about the year 1315, the study of anatomy was
 again pursued by dissections of the human body, and from
this time we discover a slow but permanent advance in
 medical science.
  Paracelsus, who was born about 1506, though a man of
no principle, and considered by his compeers as almost in-
sane, was the father of the mineral treatment.  Though
known before, he introduced into general use, preparations
of mercury, antimony, gold, &c, and claimed that  in them
he had found the  essence of life.   Like many who have
followed  him  in the use  of the same  means, we  are in-
formed that his practice was very unsuccessful, so much so
 that he could not remain  longer than a year in a  place.
 Not only so, but Andrew  Libanius assures us " that he in-
 jured a multitude of people and did not cure them; and
 that he killed a good number, or put them in a worse state
 than he found them."
  Up to the year  1600 medicine  advanced  but  slowly, 
INTRODUCTION.
17
there being but little improvement on the works of Hippo-
crates  and Galen, except in the study of anatomy.  The
circulation of the  blood, which lies at the bottom of all
sound  knowledge in physiology and practice of medicine
was  yet to be  discovered.  It seems singular that for so
many  hundreds of  years  the human body should have
been under the observation of a class of men who devoted
their time to the relief of disease,  without this, the most
important of its functions, having been discovered.  It was
known that the veins contained blood, but supposed that
it proceeded from the liver, which was said to make blood.
The  arteries were said to contain air, which was derived
from the lungs ari% conveyed  by them to all parts of the
body.  In two thousand years no physician had seen blood
issue from a cut artery, yet in these days it is noticed fre-
quently.   William Harvey, a native of England, first made
known the true theory of the circulation of the blood in
1613, though it was not adopted by the profession for many
years, or without strenuous opposition.
  From this period up to the present time medicine  has
made most rapid progress, especially within the present
century.   Anatomy may now be said to be perfect.  Physi-
ology has  advanced almost to the state of a positive science.
Chemistry now ranks as one of the sciences, and the prac-
tice of medicine and surgery, though deficient in  many
respects, possesses a degree of definiteness that  would not
have been deemed possible two hundred years ago.

             SYSTEMS OF MEDICINE.

  From the earliest periods of which we have any know-
ledge there has been more or less diversity* of opinion
among medical men, and at times has resulted  in the or-
ganization of  distinct  systems or sects in medicme.   It
was as much the case among the Grecians, and in the days
of Galen, as at the present time.  Some men would found
a theory  of disease and lend every circumstance  to its
           2 
18
INTRODUCTION.
 proof, and  make all remedial measures  conform  to  it.
 Theory has been the constant clog to the practice of  medi-
 cine, as doctors are  the most stubborn of men  and will
 never give up a theory if it can be avoided.  Not only are
 they noted  for stubbornness, but they have a high regard
 for  authority, and will rarely act unless  they can  find a
 precedent.
   Naturally we would expect to find changes progressing
 slowly, and improvements would have to be well tried and
 stand the test of time before they would be received as a
 part of medical knowledge.  Reform in medicine or the
 propagation of new ideas, is not tolerated,  and he who en-
 deavors to get in advance  of the prelent  state of the
 science will meet with most bitter opposition.  Thus  when
 Harvey discovered the circulation of the blood, he was de-
 nounced as a  charlatan, and the profession were so exas-
 perated that nothing too severe  could be said against him.
 So, likewise, when Jenner published his discovery of vac-
 cination as a  preventive of small-pox, nearly the whole
 profession rose up in arms against him.   He  was de-
 nounced from  the pulpit as  flying in the face of the Al-
 mighty, endeavoring to thwart his  purposes, and the phy-
 sicians accused him of desiring to introduce a horrid dis-
 ease from the animal, which would  render the sufferer
 beastly if it did not maim him for life.   He lost his private
 practice and his good name on this account, and it was not
for some ten or fifteen years that the merits of his discovery
 were recognized.
  So it is in the present day.   Those who twenty  or thirty
years since commenced their efforts to arrest the destruc-
tive  use of the lancet, mercury, antimony, etc., were de-
 nounced as quacks and empirics, and every effort made use
 of to put them down.  They convinced the people that
 these medicines were injurious, and thus effected  a radical
 change in  medical practice.   The most prominent systems
 of medicine in this country at the present time, are the Old
 School or Allopathic, the Homoeopathic and the  Eclectic. 
INTRODUCTION.                    19
             ALLOPATHIC MEDICINE.

  A certain class of physicians claim to be regulars, and
the direct descendants of Esculapius.  They further claim
to possess all the science and literature of the profession,
and to be the physicians par excellence.  To hear them
talk or read their works, it would be supposed that they
were the embodiment of perfection, and that it would be
impossible for any persons outside of their ranks to know
anything of the healing art.  Yet it was these same men
that twenty or thirty years ago gave calomel by the tea-
spoonful, and in e*ery  disease, and that  bled in  almost
every acute affection.
  There has been a very marked  change for the better in
this school.   They have been forced  by public sentiment
to almost entirely discard mercury, antimony and the lancet,
and to adopt other and  milder means of treatment.  It is
true, many hold on to their old errors with great tenacity,
and others have discarded them under protest, and have not
as yet become acquainted with better  means.  But the
change is going on, and they will be forced to complete it.
  It is claimed that the word Allopathic is not an appro-
priate designation, and that they do not practice exclusively
by this method. An allopathic method of cure is one in
which the remedies administered  produce phenomena of
a different character from the disease.  It is a cure effected
by counter-irritation or antagonism; in other words, by es-
tablishing an artificial or secondary disease that shall dis-
place the primary one.  This practice  is based upon the
influence which one disease is known to exert over another;
as for  instance, the supervention of diarrhoea arresting
some other affection, the disappearance of an internal dis-
ease on the appearance of a cutaneous eruption, etc.
  Many of our medicinal measures prove curative by ex-
erting a stronger irritation than exists  at the  location of
the primary disease, the effects of the remedies being pro-
duced  in another part of the system  and in a different 
20
INTRODUCTION.
 tissue.  It is a well established law that the system will take
 cognizance of but one morbid process at a time, and thus
 if an artificial disease is excited of sufficient intensity, time
 is given for the original disease to get well, when the arti-
 ficial one  will subside of itself.
   Though there is no doubt of the correctness of these
 positions,  it may well be doubted whether it is a success-
 ful mode of medication.  Thus it was formerly taught that
 the constitutional  impression (disease) of mercury would
 in this  manner  cure fevers,  inflammations,  syphilis, etc.,
 but experience has proven to us that the mercurial disease
 is worse than  the  maladies for which it was  induced, and
 that it would  have been better for the patient to have left
 the disease to the natural powers of the system.
   All physicians except the homoeopaths, practice to a
 considerable extent on the antipathic method.   This con-
 sists in the use of appliances or  medicines that produce
 effects of a nature opposed to the symptoms of the disease,
hence the axiom, contraria contrariis opponenda.  Hippo-
crates may be regarded as the founder of this doctrine, as
he says: " All diseases which proceed  from  repletion are
cured  by evacuation; and  those which proceed from
evacuation are cured by repletion.  And  so in the rest,
contraries are the remedies of contraries."  Much  of the
practice of the present day is based upon this principle.
Purgatives are given  to relieve constipation;  cold is em-
ployed to  alleviate the effects of burns or Scalds; narcotics
to abate pain, etc.
   Though physicians generally adopt the two methods of
cure above named, they not unfrequently give medicine
that acts  upon the law, similia similibus curantur, or in
 plain English, that like cures like.  They do not claim .that
 either is  perfect, but employ sometimes one, sometimes
 another, as experience dictates, believing that a rational
 empiricism is  the best guide  in the  practice of medicine.
   Our old school brethren are  noted for their  illiberality,
 their self esteem, and their antipathy to change.  Ever ready 
INTRODUCTION.
21
to investigate anything that is stamped as legitimate, born
within  the ranks, and that does not conflict with their
prejudices,  they reject  with  contempt  anything that
comes to them from without.  They have changed greatly
within the last twenty years, and the change is still going
on, and we  hope that the  old  errors will be forsaken in
twenty years more.


                  HOMQUOFA THY.

   The Homazopathic method of practice is that founded by
Dr. Hahnemann upon the maxim " Similia similibus euran-
tur," or in exhibiting  remedies  capable  of producing ef-
fects  similar to  the disease  for the removal of which it is
given.
   A  few  of the many examples claimed by the homoeo-
pathists as evidences of remedial agents producing effects
similar  to those of the disease for  which they were ad-
ministered, and  by their so-called secondary effects prov-
ing  curative, may serve to  illustrate the doctrine which
they maintain to be the only true one.
   They assert that white hellebore has cured patients at-
tacked with violent cholera, and  yet  it  caused  a disease
similar to cholera, when exhibited.  In a disease attended
with  great sweating, which occurred in England,  called
the " sweating sickness," it  was treated  successfully only
by the use of sudorifics.  Purgatives will cure the dysen-
tery ;  tobacco occasions nausea and giddiness, and relieves
the same; senna occasions colic, and is one of the  reme-
dies for this disease; ipecacuanha cures dysentery and
asthma, because  it produces hemorrhage and asthma; bel-
ladonna causes a sense of choking and horror of liquids,
with fixed and  sparkling eyes, and  propensity to bite at-
tendants—in short, a disease  having the semblance of hy-
drophobia, which it is said this agent  has cured. Opium
relieves  lethargy and stupor by  converting it into natural
sleep, and the same agent is a cure for constipation.  The 
22
INTRODUCTION.
 vaccine disease protects  from small-pox upon the same
 principle.   Cold, either in the form of snow, cold water,
 or some freezing mixture, is found to be the best applica-
 tion to frost-bitten parts.  In scalds or burns, relief is ob-
 tained by exposing the part to heat, or by the application
 of heated  spirits of wine, or oil of turpentine.  We  can
 not better  illustrate Hahnemann's views of the action of
 remedies, than by giving the language of Pereira.   " The
 medicine sets up in the suffering  part of the organism an
 artificial but somewhat stronger disease, which, on account
 of its great similarity and preponderating influence, takes
 the place of the former, and  the organism from that time
 forth  is affected only by the artificial complaint.   This,
 from the minute dose of the medicine used, soon subsides,
 and  leaves the patient altogether free from disease; that
 is to say, permanently cured."
   Hahnemann  conceives that the secondary effects of med-
 icines are always injurious, therefore he  recommends that
 no more be given than is  absolutely necessary to cure  the
 disease.  Proceeding  upon this principle, he has reduced
the doses of medicines to  such a minute state of division,
that in many cases no  human intellect is capable  of  ap-
preciating  the  slightest influence  from their administra-
tion.  Many of them, when  exhibited in full or ordinary
doses, produce  effects  scarcely appreciable, and when re-
duced  to  the  millionth, quintillionth, or even decillionth
part of  a grain or drop, (the  usual  dose being large,  say
 one or two drachms of the powdered article, or sixty
drops of the tincture,) how they then can exert any con-
trolling influence over a  disease that is grave, if they do
so, as  is asserted, is a mystery incapable of being solved
 by finite  minds.  To give credence to such a doctrine re-
 quies  a  stretch of imagination that we imagine few pos-
 sess.
   The method  of obtaining these minute doses consists in
 reducing  the solid  to a powder, and mixing one grain of
 it with ninety-nine grains of sugar of milk—this is called 
INTRODUCTION.
23
the first attenuation; the second attenuation is obtained by
mixing one grain of the first attenuation with ninety-nine
grains  of sugar of milk;  and the third by mixing  one
grain  of the  second with the same quantity of sugar of
milk, as before.  In this way Hahnemann proceeds to the
thirtieth attenuation.  Water is the diluent of liquid medi-
cines, and the attenuations  are obtained in the same man-
ner—that is, by mixing one drop of the mother tincture
or liquid with ninety-nine drops of water, and in  this
manner continuing the  dilutions up to  thirty, as in  the
case of solid substances.
  The  annexed table shows the strength of the different
attenuations:
  First  attenuation,—one  hundredth  part  of a grain.
  Second attenuation,—one thousandth part of a grain.
  Third          "     " millionth    "         "
  Sixth          "     " billionth     "         "
  Ninth          "     " trillionth     "         "
  Twelfth         "     " quadrillionth"         "
  Fifteenth       "     " quintillionth "         "
  Eighteenth      "     " sextillionth  "         "
  Twenty-first    "     " septillionth  "         "
  Twenty-fourth  "     " octillionth    "         "
  Twenty-seventh"     " nonillionth   "         "
  Thirtieth        "     " decillionth   "         "
  The  minuteness  of the  dose is carried to the same ex-
treme, as seen by  the  following table, as presented by
Pereira:
    Charcoal, one or two decillionths  of a  grain.
    Chamomile, two quadrillionths       "    "
    Nutmeg, two millionths             "    "
    Tartar emetic, two billionths         "    "
    Opium, two decillionths             "    "
    Arsenious acid, one  or two decillionths of a gr.
    Ipecacuanha, two or  three millionths of a gr.
  Such are the doses of the medicines used by this class
of practitioners.  They are exhibited in the form of pills 
24
INTRODUCTION.
 (pellets or globuli,) each pill being about the size of a pop-
 py-seed.
   Hahnemann asserts that the longer a powder is triturat-
 ed, or the more a mixture is agitated, the greater will be the
 effect of the powder or mixture  upon the system; indeed,
 he found rubbing or shaking develop the inherent virtues
 of medicines  to such an extent, that he says, latterly: "I
 have been forced, by experience, to  reduce the number of
 shakes to two, of which I formerly  prescribed ten to each
 dilution."
   Such are the doctrines, and such  an outline of this far-
 famed system  of infinitesimal practice.
   The principal facts urged against the doctrine, may be
 embraced under four heads:
   1st. Many of our most  certain and valuable medicines
 do not  act  homoeopathically; sulphur does not produce
 scabies,  nor does cinchona, or any of its preparations, give
rise to  intermittent fever;  and  yet these agents are used
with  great  certainty  for the  removal  of the diseases
named,  and  no one  questions their utility.   Andral took
quinia without  contracting  intermittent,—and who has
seen that disease, or one similar to. it, follow the use of
cinchona ?  We have often employed it, without ever wit-
nessing  such results.   It may be urged, however, that  the
diseased state which  previously existed, precluded the  de-
velopment of that disease.   Nor have we ever seen scabies
follow the use  of sulphur; but, perhaps, the homoeopathist
 might say the existence of a previous morbid  state acted
as a barrier to its  occurrence.  Acids and  vegetable diet
 cure the scurvy, but  they never  produce a disease  analo-
 gous to  it.
   2d.  Pereira asserts  that  many homoeopathic remedies
 would increase  the  original disease, as acrids in gastritis,
 cantharides  in nephritis or  cystitis, or  mercury in spon-
 taneous  salivation.
   3d. The doses in  which these agents are exhibited, are
 so exceedingly  small, that it  is difficult to believe they 
INTRODUCTION.                    25
 produce any effect on the system, and therefore we would
 suppose that the reputed homoeopathic cures are clearly
 referable to a natural and spontaneous effort of the sys-
 tem, aided, perhaps, by strict attention to diet and regi-
 men.
   4 th.  Homoeopathy has been put to the test in numerous
 cases, without the least perceptible improvement or change
 in the nature of the disease, and this under the immediate
 inspection of some of the most  eminent members of that
 system of practice. " Andral tried it in 130 or 140 patients,
 in the presence of the homoeopathists themselves, adopt-
 ing every requisite care and precaution, yet in no one in-
 stance  was  he successful."  Recently it has been put to
 the  test, in  some  of the European  hospitals, in a  large
 number of cases ; a given number  of cases being treated
 homoeopathically, and the same  number of cases (all being
 similar) being left to the unaided efforts of the system,—
 regimen and dietetic  rules alone being enjoined,—and the
 results  were not very dissimilar in the two classes  of
 cases.
   If these be facts, the attenuated system of practice adopted
 by Dr. Hahnemann, can not be  one upon which the prac-
 titioner of medicine can place reliance with any degree of
 confidence in diseases of a formidable character.
   Whether we regard the homoeopathic system of practice
 as wholly negative in its effects, or as positively curative,
 it matters not, so  far  as its merit is concerned.  That it
 possesses merit, we do  not feel  at liberty to deny, but
 whether of a positive or negative character, is a question
 about which there is much  dispute.  So far as the rules of
 dietetics, as enjoined by homoeopathists upon their patients
 are concerned, we have never seen any that surpassed,  if
 indeed equaled, those which they  have adopted.  And so
 far, all will admit that their system of medication is posi-
 tively useful and curative;  and may  we not inquire, is not
 much  of the  success which they claim for their practice,
to be fairly and justly ascribed  to this cause ?  Does  not 
26
INTRODUCTION.
that rigid regimen, that scrupulous avoidance of every ar-
ticle  of diet of an oppressive or indigestible character,
leave nature free to  act, and does it not invite her to as-
sert her own prerogative ?—does it  not leave the vis into?,,
the vis  medicatrix naturce unoppressed, unobstructed, and
independent, by which her powers  rally, and she throws
off disease, and  abnormal  action is arrested?   May we
not reasonably account for many cures in this way ?   We
think it is not unreasonable to award much credit to this
system of practice, upon the grounds above named.  Then
if it be not regarded as positively curative in this respect,
so far as a system of medication is concerned, yet  it is
important for the reason  that it leaves nature free to act
and rid  herself  of disease, and is, therefore, to be regarded
as a highly valuable mode of negative medication.  Do we
not daily see febrile and inflammatory diseases relieved in
this way, without a particle of medicine ?  Every  one of
common observation knows this to be an indisputable fact.
How often do we see many of the most obstinate diseases
relieved by the  unaided efforts of the system.  We have
often seen patients recover, who we believed to be danger-
ously  ill, but who, from  an aversion to drugs, a  fear of
poisonous agents, penuriousness, or  some other cause, did
nothing of an  active character.  Then may we not truly
say, nature  is all-powerful in throwing off disease.  If,
then, nature effectually eradicates a vast number of dis-
eases, and  those that baffle the skill of the most experienced
physicians, even when called  at  an early hour in their
course, and aided by the best of care, may we not reason-
ably conclude that recoveries would be very numerous  if
no physician of any kind was called, and no medicine ad-
ministered.
  May we not reasonably and justly conclude, from what
has been  just stated, that the attenuated form of medica-
tion—the  infinitesimal doses, often receive credit when none
should be awarded to it;  that their influence is imaginary,
and not real; that they exercise no positive curative agency 
INTRODUCTION.
27
in many, perhaps  not in any case in which they are ad-
ministered, but in which it is ascribed to them ; that their
effects are negative, and that the powerful influences, bene-
fits and advantages, claimed to follow from the exhibition
of the millionth or decillionth part of a grain of charcoal,
common salt, or of silex or sand (and all other agents when
administered in a form so attenuated), and carried out ac-
cording to the doctrines of Hahnemann, are but an impo-
sition  on the credulity  of the people, which must be ap-
parent to any one who investigates the subject.   Does it
not seem to be practicing upon the expectant plan wholly ?
Does it not seem to be a mere placebo—the  bread-pills, or
colored-water exhibited in a new form ?  To believe that a
dose of the most simple agent, so minute that it is entirely
beyond the conception of the human mind, exercises such
a powerful control over the human system when in a state
of disease, requires an  imagination so acute (it seems to
us) as it falls to the lot of but few mortals to possess.  As
well may we  imagine  that the millionth or decillionth
part of a grain of our daily sustenance, taken three times
a day, will be sufficient to sustain life; that it will support
the  wants of the animal economy, and maintain all the
varied processes  of secretion, excretion and  innervation,
as that a similar amount of salt, charcoal, etc., will effect
great sanative  changes  upon the human body when in a
state of disease.
  Although we can not  repose confidence in the Hahne-
mannian system  of medication as a whole—as a positively
curative system—but must regard it as a negative one, yet
we are fully satisfied it will be of great good to the med-
ical profession, and to  mankind generally.  We have long
since been fully persuaded that too much medicine was
used—that the patient was too frequently and too largely
dosed with drastic, corrosive, or poisonous drugs, without
any definite object or  well-defined reason  in view on the
part of the physician.  Less medicine will be found to be
to the advantage of  patients, and physicians will learn 
 28                  INTRODUCTION.

 from the homeopathic system to administer it in smaller
 quantities, to give it less frequently and with a definite
 object in view, and above all, to  repose more  confidence in
 the recuperative powers of the system, when untrammelled by
 the  use  of nauseous, and often  oppressive and  disease-
 creating  drugs.   In this light  we  view  homeopathy  as
 positively advantageous, and as calculated to bring about,
 or aid in bringing  about, an  important reform in the
 practice of the healing art.
  We regard the principle of " Similia  similibus curan-
 tur" as laid down by Hahnemann in the administration
 of medicine, as true in some  cases, but  not as being an
 infallible or invariable rule, by which the physician is to
 be governed in  all cases.  Disease was treated upon this
 principle long before the day of  Hahnemann; but when
 disease is treated in accordance with this  axiom, the
 remedy, in order to prove effectual, must be given  in
 sensible doses.

                   ECLECTICISM.

  Eclecticism in medicine has prevailed, to a very consid-
erable extent, from  the  foundation of  the Alexandrian
library to the present time.  At  some periods they were
termed Empirics, at others Methodists, at others Eclectics,
 and were always opposed to the Dogmatists.  These latter
 adopted certain  theories  or dogmas, and  made them the
basis  for  their  practice.  These  were,  necessarily, very
 crude, and often possessed not the slightest foundation in
 fact, as their knowledge of anatomy, and especially  of
 physiology,  was  most meager.   Those who would not
 adopt these theories, were forced to take the ground that
 observation  and experience  were the true guides in the
 practice of medicine.
  The term Eclectic, by which a large and  growing class
 of the medical  profession are now designated, is derived
 from a Greek word which signifies to choose; we use  it 
INTRODUCTION.
29
 however, in both  the past and  present tense—we have
 chosen, we are constantly choosing.
   We have chosen, what?   To  answer  this question
 properly  it will be necessary to glance at the medical
 practice of forty years ago, at the time this medical reform
 was commenced.  At that time we find that the principal
 agents  used in  combating disease were calomel, tartar-
 emetic, arsenic, and  the  lancet:  the  theory was that in  all
 acute diseases there was an excess of vitality, and that this
 must be  reduced by depletion before the  patient could
 recover.   The results of this practice, and the theory upon
 which it was based, were very unsatisfactory, especially to
 the people who had to suffer the penalty—in  many cases
 loss of useful lives, in others constitutions broken down,
 the patient being but the wreck of his former self.
   Calomel was the  Samson of medical agents in those
 days, and there was no disease in which it was not recom-
 mended and used.  Thus we find in Mackintosh's Practice
 of Medicine,  published  as late as  1844, this  agent was
 recommended in every disease  named, except six.  Those
 who can recall the practice of even twenty years back,
 know that  when the  doctor  was  called, the first thing
 given in almost every case was calomel and jalap, and very
 frequently it was the last, and in many cases nearly or
 quite all.  In the Southern and  Western  States  it was
 used in moderation, i. e., from  ten grains to a tea or table-
 spoonful at a dose.   Many followed the rule of Professor
 Cook,  of Louisville, that if an apparent effect was  not
 produced by the remedy the first day, double the dose the
 next, quadruple it the third, and so on, until, as we have
 authentic accounts,  one-fourth, one-half, or in one case of
 bilious fever, over one pound had  been  introduced.   To
 thinking minds this indiscriminate use of one agent,  in
 all diseases, should have been evidence of the utter futility
 of employing a  physician; and doubtless  it  would, if
people had  been permitted  to think.  The bad  results
following the use of this agent, and other mercurial prep- 
30
INTRODUCTION.
 arations, are  at this day known to all; in other publi-
 cations their  effects have been  sufficiently  pointed out.
 We have chosen to discard this agent and replace it with vege-
 table remedies  that " never" leave a disease worse than  that
 for which they were given.
   Tartar-emetic, though not resorted to  as frequently as
 calomel, was  guilty many times of manslaughter.   Thus
 in the days that I speak of, it was thought that inflamma-
 tion of the lungs could not be treated without the use of
 this agent.  In proof that it is  clearly chargeable with
 murder,  let us examine  the statement of Dr. Deitl.  In
 order to show the  comparative  value  of treatment, he
 reports three hundred and eighty cases of inflammation
 of the lungs.   Eighty-five were treated  by blood-letting,
 one hundred and six by large doses  of tartar-emetic, and
 one hundred and eighty-nine by diet and rest alone.  Of
those treated by blood-letting, seventeen  or 20.4 per cent.,
died;  of those treated with large doses  of tartar-emetic,
twenty-two, or 20.7 per cent., died; while of those  treated
by diet  and rest,  only fifteen, or 7.4 per  cent., terminated
fatally.   These were cases of a similar character, and yet
we see -that the cases being as one hundred and six tartar-
emetic to one hundred and eighty-nine diet and rest, this
agent is chargeable  directly with  the lives of at least ten
persons.   We  therefore choose to discard this agent.
  Arsenic, though not as  frequently used as the other two,
has yet  a large  amount of  suffering,  and  even life to
answer  for.   Pereira, an  eminent authority,  states,  that
"Small doses  of  arsenious  acid,  continued   for  a  lono-
period,  act as  a slow poison; and if persevered  in, wifl
ultimately occasion death.  The same effects take place in
 a shorter period, from the administration of large  med-
 icinal doses.   Sometimes the digestive apparatus, at other
 times the nervous  system, first show symptoms  of the
 poisonous  operation of   this agent.   Hahnemann  has
 graphically  described the condition  of slow poisoning by
 arsenic, as "a gradual sinking of the powers of life, with- 
INTRODUCTION.
31
 out any violent symptom;  a nameless feeling of illness,
 failure of the strength, an aversion to food and drink, and
 all the other enjoyments of life."  Notwithstanding these
 facts are known to the profession, we find that this agent
 is still employed, two lives, to my knowledge, having been
 lost within the last year by slow medicinal arsenical poison-
 ing.  We choose to discard this agent because of its dan-
 gerous character.
   Blood-Lettlng.—Forty years  ago,  yes, even  twenty
 years ago, blood-letting was the  fashion, and both physi-
 cians and people supposed, that  acute  diseases could not
 be treated without it.  Bleeding was so  common that it
 was customary with some to be bled every spring, some-
 times twice a year, as a preventive measure to ward off dis-
 ease.  " The inveterate theoretical bleeder," says Dr. Tick-
 nor, " will bleed in the most opposite states of the system;
 he will bleed to check the circulation, when it is too rapid,
 and to subdue febrile reaction—when the circulation is de-
 pressed, he  will bleed to restore  it, and to increase the
 heat of the body when it is below a healthy standard—he
 draws blood to subdue reaction, and to  excite it—he calls
 bleeding a sedative, and  again  he says  it is  a stimulant.
 With such  a man  bleeding is a sine qua non—it is almost
 fdod and drink, and is about equivalent to vomiting  and
 purging—it is  refrigerant in summer, and calefacient in
 winter—a hobby  which he  rides either rough or smooth
 shod."  The great majority of physicians, at the time I
 speak of, were just such theoretical bleeders.
   The evil effects of blood-letting necessarily vary with
 the nature of the disease in which it is employed. In fever
 and inflammations it was employed to subdue excitement
 and lesson inflammatory  action, and yet in many cases it
 is  well known that it produced but a temporary effect—re-
 action came on and the disease for which it was employed
was aggravated.   The consequence  of this reaction was,
that another depletion was again prescribed for  its re-
moval ; blood is taken to full syncope—again relief is felt— 
32                   INTRODUCTION.
 again reaction and the local  symptoms return, the practi-
 tioner continues to bleed, and is astonished at the obsti-
 nacy, course and termination of the disease, which under
 such circumstances  generally terminated in dropsical ef-
 fusion, or in convulsions, or in delirium running into coma,
 or in death from exhaustion or one of the foregoing states,
 or in a partial subsidence of the original malady, and pro-
 tracted convalescence.  Dr.  Dunglison, an eminent old-
 shool authority,  says, "The extent to which blood-letting
 should be carried, in cases of violent internal inflammation,
 is often a matter of great difficulty with the discriminat-
 ing, but  of ho difficulty whatever  with the reckless and
 uninformed.  In this state of blissful ignorance the latter
 continues to bleed, and consoles himself, when the fatal
 result has  been hastened—perhaps  mainly induced—by
 his agency, that  the sufferer has fallen a victim to an incur-
 able malady."
   President Jackson was in the habit of relating an anec-
 dote, which exemplified the satisfaction often  felt at the
 exhibition of such energy on the part of the practitioner.
 Traveling from  Virginia toward the North, he rested for
the night at a tavern on the road; soon after his arrival
at which,  the hostess came  in from a neighboring house
with  the females of her family, all  exhibiting  marks ®f
deep  distress. He was informed that they had been wit-
nessing the parting scene of a young friend, who had died
of some acute affection.   " But thank God!" observed the
the contented matron, "every thing was done for him that
was possible, for he was bled seven and twenty times:'
  I  make  the assertion that  the lancet  has  murdered
thousands,  and can prove it from  the best authorities of
old-school  medicine; that it  is inefficient  as an agent in
the cure of disease, is now readily admitted by  a large
majority of the profession.  Eclectics choose to discard the
lancet.
  The theory that there is  an excess of vitality which
needs reduction in febrile and inflammatory diseaso, comes 
INTRODUCTION.
33
very  far  from  being a fact.  We  choose to believe and
teach, that a person laboring under disease is actually de-
bilitated from the commencement—that the disease itself
is an evidence of depressed  vitality.   Practising upon the
first proposition, we would  resort to blood-letting, strong
cathartics, mercurials, etc., to reduce vitality to that point
that reaction could not take place.   Considering the other
to be true, we  carefully husband the strength of the pa-
tient, until by appropriate remedies  we remove the cause
of disease.
  Eclectics started from the common platform of profes-
sional knowledge with a declaration  of dissatisfaction with
the usual  results of the healing art;  of a certainty that a
true therapeutic science  might be discovered, and of the
imperative duty of all practitioners  to  investigate all suc-
cessful systems of practice, and avail themselves of every
successful  agency which has been  or  can be discovered.
The result  has been that  our  materia  medica has been
greatly enlarged by the investigation of the properties of
our  indigenous plants;  many of which are so  valuable
that they are now being used by physicians of all schools.
So great a change has thus been made by new remedies,
new  applications of old ones, new  compounds, and new
principles  of treatment, that four-fifths  of the prescrip-
tions of Eclectic practitioners, in every variety of disease,
are entirely different from those which are usually  made
by our old-schoel friends.  It may be said, therefore, that
the Eclectic system  of  medicine has  wrought a decided
revolution, and presents an essentially new system of prac-
tice, which may be justly styled the American system, as
it has been  developed by the labors of American physi-
cians.
  The peculiarities of the Eclectic practice are too numer-
ous to be learned, except by a thorough course of study.
These peculiarities have  arisen from the gradual adoption
of one improvement after another, until the whole system
of practice  has been essentially changed, and all  those
       3 
34
INTRODUCTION.
 measures which are calculated to impair the vital powers,
 have been substituted by more successful methods.  It
 is a  cardinal  principle of the  Eclectic  system,  that
 no medical treatment should  be allowed which perma-
 nently impairs or injures the vital powers; that no such
 treatment is, in any case, necessary or proper, and that in
 the  choice of remedies, we should prefer those which  are
 safest, and calculated to act most nearly in  accordance
 with the laws of health.
   Hence, we reject, in toto, the most pernicious features of
 old-school practice.  Not that  we consider them entirely
 useless; but because they are so far inferior in their results
 to the measures on which we rely.  The habitual internal
 use of certain intensely poisonous  metals, as mercury, an-
 timony, arsenic, lead, copper, etc., we consider a gross vio-
 lation of the dictates of medical  philosophy and  experi-
 ence—an egregious delusion which has brought millions
 k> a  premature grave, and which, at  the  present time,
maintains an immense amount of human suffering among
the living.  This  delusion has  arisen  from a  profound
ignorance of the true characters of a number of import-
ant medicines, and an indifference to the enormous evils
now arising from the mercurial practice.  It is not known
in the Colleges, that our vegetable materia medica furnishes
far better agents for all the purposes  of the  healing art,
 than these destructive metals; and that every purpose  for
 which it is supposed that  mercury is necessary, can be
 accomplished better without than with its agency.  The
 fancied  necessity  of mercury, for the sake of  its power
 over the liver, is well known by all Eclectic practitioners
 to be a gross delusion; without the use of a particle of
 mercury, and without its dangerous morbid consequences,
 they  produce  much more efficient cholagogue and altera-
 tive action  than mercurial remedies can maintain.  The
 medical profession are aware  of the dreadful evils of a
 mercurial practice, and would gladly get rid of the two-
 edged weapon which cuts  alternately the disease and  the 
INTRODUCTION.
35
patient, if they were informed by the colleges and authors,
upon whom they rely, of the powers of other and better
cholagogues.

                  THE PHYSICIAN.

  To obtain the highest  degree of skill in any art, it is
necessary that it should be studied with  care, and that the
entire time should be  devoted to it.  Hence, in  the prac-
tice of medicine, the most intricate of all arts, it becomes
necessary that those who pursue it, should have  a thor-
ough medical training, in  order to  become skillful work-
ers.  Not only does it require reading, but, as in all other
arts, it  requires that experimental knowledge  which is
only obtained in  well-conducted colleges and hospitals.
Time is necessary  for this; the printer who sets  this type
has served his apprenticeship of three or four years before
he is entrusted with the entire management of his work;
the foreman who places the form on the press, and watches
the action of the machinery as the sheets go through one
by one, has served the same length  of time; it is the case
with the man that builds your house, that makes your
coat or your pants, or that  follows any of the  common
avocations of life.   How much more necessary is it, that
he who takes charge of the  intricate mechanism  of the
body, and undertakes to modify its  action during disease,
and prevent  its  dissolution,  should have  served a suffi-
cient  length  of  time to become thoroughly  conversant
with the entire art of healing ?
  Not only is it necessary that he should have spent years
in the study  of his profession, but  he must also have a
love for it, in order to prove  successful.   " An instinctive
impulse," says Hufeland, " to relieve  a  sufferer, was  the
origin of the healing art.  This pure and noble sentiment
must always prevail,  to make  the practice of  medicine
answer its ideal, and render it a blessing  to both physician
and patient.  To live  for others and not for himself, is a 
36
INTRODUCTION.
 physician's vocation.  He must be ever ready to sacrifice
 nis repose, advantages and comforts, to the end of saving
 the life and health of his fellow men."
   As he is brought  constantly in contact with the family
 in the most intimate relations of life, and exercises  a
 marked influence either  for  good or  evil, it is essential
 that he should be a  moral man, and one whose influence
 and example will be constantly on  the  side  of truth and
 virtue.  Many times the  happiness of single individuals,
 and whole families, lies in his discretion, and he  is fre-
 quently placed in positions in which  a word of advice,
 coming, as is known, from a pure and truthful heart, will
 change the course of an individual's  life,  and prevent
 much misery and suffering.
   In  the  choice  of  a physician,  therefore, always select
 one who has  pursued the study of medicine diligently,
 and for such length of time  as  may reasonably be sup-
 posed to give the necessary knowledge of the healing art.
 Give  preference to those, other things  being equal, who
 have completed a regular  course  of instruction in a Med-
 ical College, as they will almost invariably be found more
 conversant with disease, and understand better its appro-
priate treatment.  It will be observed that certain  physi-
 cians take a very great interest in their profession, and in
 the welfare of the sick  entrusted to their charge.  They
 do not consider any sacrifice of time or  comfort too great
 to be  made,  if  it  conduces  to the  recovery of  their
 patients—are ever ready to render  their services, to rich
 and poor alike, and seem to derive their greatest recom-
 pense from the relief of  suffering  and arrest of disease.
 From such, choose your medical adviser.  If a physician
 is a tippler, a libertine, a profane swearer, or is the subject
 of any vice that you would object to in your family, do
 not employ him, if it is in your power to do otherwise.
   The physician's influence is  very  great, either for good
 or evil, and his example is especially marked by the young
 The truly  good physician will, therefore, prove a  morai 
INTRODUCTION.
37
blessing to a neighborhood, while the immoral one will
continually  be an  evil example, and a  moral pest that
should be got rid of, no matter what may be his medical
qualifications.

          THE PRACTICE OF MEDICINE.

   The practice of medicine is one of the most laborious
callings that man follows.  Passing from years of severe,
unpleasant and exhausting study, he becomes every body's
servant for  a meager compensation.  He can claim no
time as his own, not even the  hours which others devote
to rest, as he is alike liable to be called at night as in day.
He is brought constantly in contact with the dark side of
life's picture, and is a constant observer of all that is most
repugnant to others.  Constant contact with suffering,
disease and  death, attends his daily work, and were it not
for the evidence of suffering relieved, of disease arrested,
and of death warded off, it would be the most irksome,
if not loathsome of all callings.
   Its reward is the consciousness of a  good work well
done, and the gratification that a good man feels when he
is able to minister  to the wants of his suffering fellow
creatures.  The honorable physician  rarely becomes rich,
and not unfrequently he  finds himself unable to lay up a
competence against the  time when  he is worn out and
unable to follow his profession.  It is not generally because
he has not enough  to do, but  because those that  receive
his services soon forget  the  benefits derived,  and fail to
pay him his just dues.  How often have I seen the coun-
try doctor called out of his bed on cold, stormy nights, to
visit a patient some miles distant, without even receiving
a dollar for  his trouble, or hardly thanks; and yet these
persons were able to buy fine clothes and waste their time
in idleness and dissipation.
  If there is one  debt more than another that should be
paid promptly, it is a doctor's bill.  No person, other than 
 38                  INTRODUCTION.

 those who have practiced medicine, can appreciate  the
 severity of the labor, both physical and mental, and surely
 it deserves to be promptly and fully requited.  Pay your
 physician immediately on  the cure of the patient, and
 you will feel better, your bill will not seem  so large, and
 you will  interest the doctor in your welfare, so  that you
 will receive increased attention and skill should you need
 him again.  There is nothing that so quickens and gives
 increased  ability to  the  laborer, as prompt and certain
 payment.
   Never change physicians on trivial grounds,  as  much
 injury to yourself and family may result from it.  No one
 can know the constitution and peculiarities of a person as
 well as the physician who  has known  him long, and
 attended him in previous attacks  of disease.  People differ
 very markedly from  each other,  and in no respect do we
 notice this difference more than in sickness, and in  the
 action of medicine  upon the system.   This is  a strong
 argument not only against change of physicians, but also
 for retaining the same one in a neighborhood as long as
 may be possible.  It  is possibly beneficial to have  a change
 of preachers, of lawyers, of school teachers; but  no  profit
 flows  from a change of doctors.   Select your system of
medicine from careful examination of its merits, and select
 your  physician  with reference to  his moral and profes-
 sional reputation—then stick to him, and  make  him one
 of your family, your counselor in health, and your careful
 attendant in disease.


                    QUACKERY.

   There  is no  calling in life that  is so burthened with
 rogues as the  practice  of medicine.  A certain  noted
 quack who was making his $25 to $50 per day, remarked
 that there were many people who would  be humbugged
 by some body, and he might  as well take  their money as
 any other person.   H is very true that  the public  are 
INTRODUCTION.
39
ready to give credance to almost any statement, and, quite
frequently, the more marvelous it is, the more greedy they
are for it. As before remarked, people know less of them-
selves than they know of any thing else, and the  general
impression is, that the family physician, though a worthy
man, runs in the old ancestral grooves,  and can not know
much  that is  new; in fact, is  a very  slow, mulish, and
stupid individual.   Hence they  p,ro ready to give welcome
to any statement which seems  plausible on  its face, if it
promises to  meet their wishes.
  It is an every-day occurrence in every neighborhood for
persons to consult entire strangers who  have come  to their
knowledge by  flashy advertisements,  and entrust  their
health and lives to their  hands, when on the  same  author-
ity they would  not have purchased a new  variety  of corn
or wheat, or a pint of turnip-seed.  This  credulity is fre-
quently turned  to account by persons who  have no know-
ledge of medicine, except a few old receipts, and who some-
times make  large fortunes by their impositions.
  A very noted character in this line, in New York City,
was sr.pposed  so  ha\e  realized $500 per day from letters
reccr ex from  his dupes, imtil  his career was arrested by
the poKc,.   We haT"e had hvo examples of the same kind
r. thb city, and the papers  :f our country are still flooded
/nth  their advertisements.  Many of them profess to de-
vote their  whole  time  for  the good  of humanity, and
promise  to  send such nrf\vmation as will cure the most
serious  diseases, without fho  or reward.  Many write to
fhem, as it costs nothing, und get their  receipts, with high
lown  panegyrics  on tho advantages  that  have  been or
may be  gained by the  rri idicine.  But on application at
*he drug-stores they find  no such medicines,  and finally
send to the advertiser, "who charges them  round prices for
worthless and somethn jb injurious stuff.
  The patent  meaioi'je and  nostrum manufacturers and
renders fatten  off oi the people in the same way.   They
advertise to cure all curable and many  incurable diseases, 
 40                   INTRODUCTION.

 and furnish certificates signed by ministers and others that
 they can accomplish what they profess.  The result is that
 they sell millions of dollars of worthless trash yearly, that
 in the end does more harm than good.  Immense fortunes
 have been realized in this way, and others are being made
 constantly.  There is no cessation to the demand, though
 the  old  nostrums are constantly being replaced by new.
 No person is now so foolish as to swallow a dollar's worth
 of Townsend's or Guizot's, or Bull's Sarsaparilla a week.
 But they will take an  equal  quantity of Plantation or
 some other kind of bitters,  or some  other person's altera-
 tive.  There seems to be a constant  desire for medicine,
 whenever a person has the slightest ill feeling or ache, and
 there are few who would not put  more reliance in the
 most absurd  nostrum than they would in the curative
 powers of nature.
  I do uot say that all patent medicines are humbugs, for
 I know  that  some of them are prepared with care, and
 can be used  with advantage in some cases.  But I believe
 that it is better in all cases for the person to take such
 remedies as are known  to him, or to put himself under
 the care of a physician.  It is an error that combinations
 of many  different remedies are  better than  a  single one,
 and the best physicians will tell you that a single remedy,
if properly selected, is  much better than a  combination.
Patent medicines are compounded of common, cheap, and
 often inferior drugs, you  do not know what they are, and
 they come to your notice in a suspicious manner, therefore
 it is wise to  purchase from a reliable dealer such indi-
vidual medicines as are desirable for domestic use.
  "The  history of quackery, if it were written on a scale
 that should include the entire number  of  these frauds
 which  may be generally classed under the head of hum-
 bugs, would be the history of all ages and climes. Neither
 the benefactors nor the enemies  of mankind would escape
 mention.  In  the success  that  has in every  century at-
 tended the rascally enterprises of pretenders to the art of 
INTRODUCTION.
41
 medicine is found a  touching evidence of the sorrow,
 credulity and ignorance of the generations that have passed,
 or are passing, to the silent home where the pain and joy,
 the simplicity and cunning, of this world are alike of in-
 significance.  The hope that, to the last, lurks in the breast
 of the veriest wretch under heaven's  canopy, whether his
 trials  come from broken health  or  an empty pocket, or
 wronged affection, speaks aloud in saddest tones, as one
 thinks of the multitudes  who, worn  with bodily malady
 and spiritual dejection, ignorant of the source of  their suf-
 ferings, but thirsting for relief from them, have gone from
 charlatan to charlatan,  giving hoarded money in exchange
 for charms, cramp-rings, warming-stones, elixirs, trochees,
 etc., warranted to cure  every ill that flesh is heir to.
  " The  scene from another  point of view is more droll,
 but  scarcely less mournful.  Look away from the throng
 of miserable objects w'ho press around the empiric's stage;
 wipe out for a brief while the memory of their woes, and
 regard the style and arts of the practitioner who, with a
 trunk full of nostrums, bids disease to vanish, and death to re-
 tire from the scenes of his triumph.  There he stands—a lean
 fantastic man, voluble  of tongue, empty-headed, full of
 loud words  and menaces, prating about kings and princes
 who have taken him by the hand and kissed him in grati-
 tude for his  benefits   showered upon them—dauntless,
 greedy, and so stupid in falsehood  that  his  erazy-tiiued
 brain half believes the lies  that flow from his glib tongue.'
Are there no such men amonerst us now—not standi no1 on
carts  at the street corners,  and selling  their wares to a
rabble—but having their seats  in  honored  places,  and
vending their prescriptions to crowds of wealthy clients?" 
PART   I.
ANATOMY  AND  PHYSIOLOGY.
   A knowledge  of the phenomena of life, or Physiology,
 should be possessed by every one; not only that we may
 know how to preserve our health, but also as  a means of
 moral  and intellectual improvement.  Yet we find com-
 paratively few outside of the  medical profession who can
 describe or account for the  most common functions of
 their bodies.  It seems singular that men and  women of
 intelligence should be content to witness the varied work-
 ings of such a complex and intricate piece of mechanism
 as their own bodies, without the desire of inquiring into
 and knowing something about the different processes by
 which that life, of which they are so tenacious, and which
 they are so loth  to give up, is continued from day to day.
   People  are generally eager  to  acquire  knowledge,
 especially if the pursuit is  entertaining and satisfies  curi-
 osity.  Place a man in one  of our machine shops: he is im-
mediately  interested.   He watches  the action of the large
 engine in the corner, which  keeps the almost endless shaft-
 ing, with the varied and complex machinery,  in  motion;
 he watches with interest the motion  of the piston in the
 large cylinder; sees the automatic machinery by which the
 steam-valve? of the cylinder are opened and shut; in fart,
 in a short time, if he  has ordinary inquisitiveness, he will
 master  a  knowledge  of its workings.  Let him continue
 his observation for a few weeks, and he will have obtained
 a good knowledge of almost  all the processes of the man-
 ufacture of a steam engine.  The same man has observed 
ANATOMY AND PHYSIOLOGY.
43
the workings of his own system for years, and yet will
not be able to tell you what purposes are subserved by the
continued and never-ceasing  action of the lungs, by that
wondrous and continuously-acting  hydraulic mechanism,
the heart, or by the daily introduction of food into his
stomach.  In the  one case his curiosity prompts him to
investigation; while in the other, though constantly placed
in a position to observe and investigate, he yet deliberately
shuts  his eyes, and passes through life knowing less of
himself than of  any thing else.  Why is this the case ? If
I were to account for it, I should say, that popular opinion
has long since decided that this knowledge is private prop-
erty, belonging exclusively to physicians, and in which the
public have no interest, as they pay a class  of  men to
investigate such  matters, and give to them the conclusions
drawn from such  investigation, in  the shape of medicine,
whenever called upon.
   Should this state  of things continue?  I believe  that  a
knowledge of Physiology, Anatomy, and  Hygiene, is just
as important as a knowledge of arithmetic, geography,
history, etc., and that it should form  a part of common-
school education.  The time is coming, and even now some
progress is made toward it, when works on these subjects,
written in plain language, will be placed in the hands of-
every  school-child.  The  objection  to  this is, that these
subjects  are dry, and en a not interest the  young, or even
any one, except the physician.   This is  not the  case.
There is nothing as interesting as the study of the human
body, merely as a piece of complicated but masterly work-
manship ; and how  much  is this interest increased when
we consider it as the dwelling of an intelligent soul, which,
but for  this body, would be  cut off from all intercourse
with things  of earth.
  Man is  composed of six  varieties  of material, which,
variously combined, form  the most  complex structures of
the body, and are adapted to the various functions of life.
These  are bone, cartilage, fibrous tissue, muscular tissue, 
44
BONE.
 nerve tissue, and adipose tissue or fat.   These are contin-
 ually wearing out and being replaced, so that the man of
 to-day has in all probability no single atom of matter that
 was in his body twenty years ago; in fact, our best observers
 conclude  that man is  renewed  about every seven years.
 This renewal is a necessity of his existence, as these vari-
 ous materials possess but a limited vitality, in other words,
 retain their form for but a limited period, when, unless the
 body dies or loses its properties it must be renewed.  This
 renewal takes place, as will hereafter be described, by the
 continued digestion and appropriation of the food we daily
 consume.

                       B ONE.

  The bones form the  frame-work of the body, and give
 shape and support to its various parts, and furnish a mech-
 anism, which, when acted  upon by the muscles, give loco-
 motion and the various actions  necessary to our support
 and well-being.  The bones of the body are 246  in num-
 ber,  divided  into  long, flat, and irregular, which, when
 placed together in their natural order form a skeleton.  The
skeleton  (see Fig. 1,) is divided  by anatomists  into  head,
 trunk, and extremities,  the head being  divided into two
parts, cranium and face,  the extremites into upper and
lower.
  The  cranium  consists of 8 flat bones joined together,
which form an oval cavity for the brain.   The bones of
the face   are 14 in number, mostly  small, and form the
walls of the orbits, nose, and mouth; in addition, the 32 teeth
 are enumerated as bones, and there are 3  small bones in
 each ear.
  The trunk  is composed, first,  of a column of irregular
 bones called the spine  or back-bone, 26 in number, the 24
 superior being called true vertebra, and the last two false
 vertebrae.  The true  vertebrae  are  divided  into  three
 varieties,  according to their situation: 7 cervical, in the
 neck; 12  dorsal, that give attachment to the  ribs; and 5 
BONES.

Fig. 1.
45
                      THE  SKELETON".
  It consists of 246 bones ;  60 in the head ; 52 in the trunk ; 64 in the upper
extremities ; 62 in the lower extremities, and 8 sesamoid bones. 
46                       BONES.

lumbar, in the loins.  Arising from the dorsal vertebras are
12 bones on each side  called ribs, which pass downward
and  forward to  be attached by cartilages  to one bone in
front—the sternum or breastbone.  At  the upper part ot
the neck below the lower jaw is one bone, the hyoid, form-
in o- half an arch,  supporting  the air-tube.   In  all, the
trunk has  51 .bones; 26 of which  forms a column which
supports the head  and  upper extremities,  and 25 form a
bony cavity to contain the lungs and heart.
  The upper extremities have 32 bones  each, divided into
a shoulder, 2 bones; arm, 1; forearm, 2; wrist, 8;  and
hand, 19.   The  lower  extremities have  31 bones  each,
divided into hip,  1; thigh, 1; leg, 3; and ankle and foot,
26.   In addition to  these, there are  in the body  eight
small bones, called  sesamoid.
  Long bones are found  in the upper and lower limbs,
and consist of a  shaft of dense hard bone, and extremi-
ties of spongy bone; the shaft being  smaller in circum-
ferance  than  the extremities,  and. containing a  central
cavity.  The ends of long bones are covered wTith articu-
lar cartilage, which gives them a smooth, glistening sur-
face,  preventing friction  where they play one  upon
another.   A long  bone is usually broken in its shaft, not
because it is weaker there, but because it is not so well
supported  by fibrous  tissue.  Flat bones are found enclos-
ing cavities, and are composed of an  outer covering of
dense bone, and an  internal spongy portion.  Irreo-ular
bones are found where great strength is required with but
little motion, and have an external investment of compact
bone, while their center is spongy.
  All bones have an  external investment of fibrous tissue,
forming a membrane called the periosteum, which  is, to
some extent, the  source of growth and  repair,  as late
investigations have proven  that  a bone  may be repro-
duced if the periosteum is  left entiie.  This membrane
is liable to inflammation, the pain being  very  severe
and in some cases,  as in syphilis, an irritation  is produced 
JOINTS—CARTILAGE.
47
 which causes an increased deposit of bone, and the forma-
 tion of an excrescence termed a node.  Bones receive a
 considerable  supply of blood, though  the  vessels are  all
 small; hence there is never much bleeding.  Their nervous
 supply is limited;  so  that it  is a very great mistake to
 suppose that cutting a bone will give rise to much pain.

            ARTICULATIONS—JOINTS.

   When two bones come  together, there is said to be an
 articulation; and these are divided into two kinds—immov-
 able  and movable.  In an immovable  joint,  the bones
 come  directly together, and, in some cases, are adherent,
 as in the bones of the scull.  The movable may be divided
 into two kinds, in the  one of which the bones are united
 by an elastic tissue, passing from end to end;  in the other
 the bones move one upon another, the surfaces coming in
 contact being free.   In the last variety, the free extremi-
 ties or surfaces of the bones is covered  with cartilage, and
 this again by a delicate, smooth membrane (synovial mem-
 brane), extending  from one  bone  to  the other, which
 secretes the synovia or joint-water, for the lubrication of
 the opposing  surfaces. The bones are tied  together  by
 fibrous bands called ligaments, which pass from one to the
 other in such  situations as to permit of  the necessary
 degree of movement.

                    CARTILAGE.

  Cartilage  (popularly called  gristle),  is found  where a
 considerable degree of strength is required, and it is neces-
 sary that  a part shall maintain a permanent form, and
 still possess a certain degree of elasticity.  "We thus find
 it situated between the bones of the spinal column, and
 so arranged as to form a cushion for them, and thus prevent
 those numerous jars to the body which  would prove  so
 annoying and injurious.  Again, it forms the connecting
medium between bones, and permits a  limited motion, as 
48         FIBROUS  TISSUE—MUSCULAR TISSUE.
 in the cartilages of the  ribs; and lastly, it  forms the
 frame-work of an organ,  as in the larynx, or  organ of
 voice—no other material  possessing the necessary elas-
 ticity with permanence of form.   I might have stated,
 that  all the bones are  first represented by cartilage, the
 bony material being deposited in it, and finally in the adult
 taking its place.

                  FIBROUS TISSUE.

   Fibrous tissue is that dense, white, and tenacious mate-
 rial that forms so considerable  a part of the body.  It is
 placed  wherever  strength is required,  as  at the  joints
 uniting the bones, forming the investment or attachment
 of muscles—tendons.  As  a  connecting medium, uniting
 together all parts of the body, and  in each organ  form-
 ing,  so to  speak, the basket in which other  parts are
 placed, or threads with which they are bound  together.
 It is a component of almost  every organ and  tissue, fur-
 nishing strength and a bond of union.  A variety termed
 yellow  fibrous tissue, possesses elasticity, and is  found  in
 the skin, forming some  ligaments,  and in the  blood-
 vessels.
                MUSCULAR TISSUE.

  Muscles are divided into two kinds—the  muscles of
 animal life, or voluntary, and the muscles of organic life,
 or involuntary.  The first forms the large, reddish masses
 surrounding and situate on  the bones; the second is white,
 and is found within the body as a component of some of
the viscera,  especially forming one of  the  coats of the
 entire  alimentary  canal, and of the bladder and womb,
 and probably of the arteries.  If a muscle, or the lean of
 meat, be examined, it will  be found to  be composed of
 fibers, which pass like threads from  end to end, and if a
 magnifying glass be used, these will be seen to be bundles
 of still smaller fibers—the ultimate fibril being  not  more
 than ,fo part of an inch in diameter.   It is a compound 
NERVOUS TISSUE.
49
 tissue, consisting of muscular tissue proper, and of fibrous
 tissue, which gives an investing sheath to  each fiber, to
 each bundle of  fibers, and  to the  entire muscle.   The
 muscular substance terminating near the extremities of
 the musle, the fibrous tissue continues  on alone, forming
 the tendon,  and giving the insertion to  the  bone.  Each
 muscular fiber is marked by transverse lines at short dis-
 tances, and  it is found that in  action each of these spaces
 are shortened.   The  muscular  fiber of organic life is
 smaller,  flattened, and is  not  marked by the transverse
 stripes, though  capable of contracting; its  bundles are
 white, wdiile those of  animal life are dark red, as in flesh.
   Muscles are arranged in groups, so as to  exert a great
 degree of force  in the principal direction of movement,
 and at the  same  time, from  their varied  position  and
 attachment, give every variety of movement.  Take, for
 instance, the thumb;  its principal muscles are in the palm,
 and form the large fleshy  mass at the  upper and outer
 part of the  hand; five in  number, their united action is
 to  oppose the  thumb to the fingers, but  if we examine
 them  separately,  we find  that each has a separate  and
 distinct action at other times.  The muscular mass on the
 anterior  and posterior surfaces of the  forearm, flex  and
 extend the  fingers, flex and extend  the wrist, rotate the
 forearm, and perform those  varied and intricate move-
 ments so distinctive of man.

                 NERVOUS TISSUE.

  Nervous tissue, like muscular, is a compound tissue con-
sisting of more than one element.  It is divided into  twTo
marked varieties, gray and white; the first consisting of
cells and granules, as  will hereafter be described;  the
second being formed of fibers.  A peculiar form of fatty
matter enters largely into the composition  of the brain
and  spinal  cord,  while fibrous  tissue  surrounding  the
nerve fibers forms a large portion  of the nerve trunks.
         4 
50            ORIGIN OF THE HUMAN BEING.

This will be spoken of more fully when describing the
nervous system.
              ADIPOSE TISSUE—FAT.

  Varying in quantity, we find adeps, or fat, in all parts  of
the body.  In some persons it  fills all inequalities, and
forms a more or less thick layer under the skin, over the
principal parts of the body.   The fat is contained in  an
envelop of fibrous tissue, and this again in a net-work  of
the same; and the same fibrous  arrangement that in one
simply connects the skin to parts beneath, or one organ
to another, will in another be so loaded with fat  as  to  be
an  inch  or  more in thickness.   Fat  is combustible, and
furnishes the larger portion of animal heat,  so that these
deposits of fat  may be considered the storehouses of fuel
for the body.  In  diseases  in which the  appetite and
digestion is much impaired, these deposits are drawn upon;
hence the great loss of substance.

             COMPOSITE STR UCTURES.

  The tissues above named are united in varying propor-
tions to  form complex structures or organs,  having a
specific function or action.  Thus the skin,  which forms
the exterior  covering, has, first, a dessicated, scaly invest-
ment, and is next composed of white fibrous tissue, yellow
and red elastic tissues, blood-vessels, nerves, sweat glands,
sebaceous glands, etc.   The internal  lining of the  body,
or mucous membrane, is  similar to it; while, if we exam-
ine some  of the larger organs, as the liver,  we will find
the same tissues arranged in a still different manner.

        ORIGIN  OF  THE HU3IAN BEING.

  If we examine the ultimate elements  of  the body, we
will find that it is  composed  of oxygen,  hydrogen, carbon,
and nitrogen—four gases—with the addition  of a variable 
♦
               DEVELOPMENT OF THE BODY.            51

amount of lime,  potash, phosphorus, sulphur,  etc.  The
principal part of the tissues is formed of varying propor-
tions of the four elements first named, which is called a
protein  compound.  Such a combination wTe find in eggs,
milk, flesh, bread, etc., which furnish this material to the
body.  The first  three of these,  oxygen, hydrogen and
carbon, are the elements of fat, starch, sugar, alcohol, etc.,
and are the heat producers, or fuel.   These elements, sep-
arately or in varying combination, form the principal part
of the globe we inhabit—water being formed of  a union
of two volumes of hydrogen  and one  of oxygen, while
the air we breathe is formed of an admixture of four parts
of nitrogen,  and one of oxygen.   These materials  are
very plastic, and are molded into  many varying forms by
the vital force, as  wre shall hereafter see.
  Our food contains all the elements of our bodies, in such
a state that the process of digestion fits it for appropria-
tion by the various tissues.  Some  single articles of food
contain all that is requisite, as flesh, milk, eggs, bread, etc.,
whilst others contain but a part, and though they will sup-
port life for a while, at last the body yields from a want of
some material they do not contain.

         DEVELOPMENT OF THE BODY.

  Having thus glanced at the material of which  our bodies
consist, we now wish to learn the processes by  which a
living being is developed from them.  With man, as with
the plant, there must first be a seed or germ. This is fur-
nished by the female parent, and is called the human egg.
It is very minute, but perfect in all its parts, and resembles
very closely the  eggs of oviparous animals.  For the de-
velopment of this it is necessary that a principle of vitality
shall be imparted to it by the male parent, which is also
the case  with the  eggs of oviparous  animals, and  also
with many plants.  (For further description see Vol. 2.)
In the egg thus vitalized a process of growth commences, 
52                      FOOD.
its elements being formed into minute cells, which arrange
themselves to form a membrane,  and this again separates
into different parts, for the production of bone, nervous
system, heart, arteries  and veins, alimentary canal, skin,
etc.  The egg contains ail the elements of growth within
itself, and in the human being, when these are exhausted
it has formed an attachment to the mother, and derives a
further supply of nutritious material from her blood.  We
may take the egg of the common fowl as an example of
this  process.  If vivified by the male bird, and placed in
a situation  where it will receive a continuous supply of
heat, we  will find in  a short time its character is entirely
changed.  A germinal membrane is formed, the heart and
blood-vessels are developed, an intestinal canal, lungs,
bones,  nervous system, and  lastly, skin, feathers, etc., so
that in the course of twenty-one days a chick, perfect in
all its parts, has been developed from  the  contents of the
egg.  A  casual observer would have seen nothing in it re-
sembling bone, or feathers, or even flesh; but they were all
there in a fluid form.   Neither would he suppose that in
our  food were the elements of blood, bone, nerve-tissue,
muscle, and even the hair and  nails.
  In the  human egg, the process of development goes on
in the materal contained within it up to about the fifth
week, when the heart  and vessels having been developed,
it forms  an attachment to the mother, and henceforth re-
ceives its supply of material  from her blood.  It contains
all the elements of the body, in such form as to be readily
appropriated by the child, which, when born, is complete
in all its parts.

                        FOOD.

  Food may be described as anything that can be appro-
priated by the body for the growth and repair of its vari-
ous parts, or for the production of heat.  It may be prop-
erly divided into two kinds, one nutritive or plastic which
contains nitrogen,  and can be  converted  into blood,  and 
FOOD.
53
thence into the tissues of the body;  the other contains no
nitrogen, and is simply combustible material.  Kirkes re-
marks, "That an easier division of foods than this, accord-
ing to their destination, is derived from their origins; for
all consist either of animal or vegetable  substances.   No
substance can offer nutriment, even  though  it contain all
the elements of organic bodies, unless it have all the natu-
ral peculiarities of organic composition, and contain incor-
porated  with its  other  elements, some  of those derived
from the mineral  kingdom, which, as  incidental elements,
are found in the organized tissues: such as sulphur, iron,
lime, magnesia, etc.
   " Man is supported as well by food constituted wholly of
animal substances, as by that which  is formed  entirely of
vegetable matters; and the structure of his teeth, as well
as experience, seems to point out that he  is destined for a
mixed kind of aliment.  In  the case of carnivorous ani-
mals, the food upon which they exist, consisting as it does
of the flesh and blood of other animals, not only contains
all the elements of wThich their own  blood and tissues  are
composed, but contains them  combined, probably in  the
same forms.  Therefore,  little more may seem requisite,
in the preparation of this kind of food for the nutrition of
the body, than that it should be dissolved and conveyed
into the blood in a condition capable of being reorganized.
But in the case of herbivorous animals, which feed exclu-
sively upon vegetable substances, it might seem as if there
would be greater difficulty of procuring food  capable of
assimilation  with their blood and  tissues. But the chief
ordinary articles of vegetable food contain substances iden-
ical, in composition, with the  albumen, fibrin,  and casein,
which constitute the principal nutritive materials in animal
food. Albumen  is abundant  in  the juices and seeds of
nearly all vegetables; the gluten which exists, especially
in corn and other seeds of grasses, as  well as in their juices,
is identical in composition with fibrin, and  is commonly
named vegetable fibrin; and the substance named legumin, 
51                VEGETABLE—ANIMAL.

which is  obtained especially from peas, beans,  and other
seeds of leguminous plants, and from the potato, is  iden-
tical  with the casein of milk.  All these vegetable sub-
stances are, equally with the corresponding ajiimal princi-
ples, and in the same manner, capable of conversion into
blood and tissues."
  It is difficult to determine the amount of food required
by  a man in ordinary pursuits,  as  it varies greatly  as
regards the kind and quality,  and, to a considerable extent,
the habit of the individual.   It is probable that a healthy
man, taking exercise in the open  air, will require  some-
thing near the following amount:.
  Meat,     -    -    -     16 ounces.
  Bread,     -    -    -     19   "
  Butter or fat,    -          3£  "
  Water,     -    -    -     23 fluid ounces, or 3|- pints.
  The following table, compiled from Carpenter's  Phys-
iology, showTs  the relative value of different articles of
food, human milk being the standard of comparison, and
rated 100.				
		VEGETABLE.		
Rice,	_	81	Oats,	138
Potatoes,	-	84	White bread,	142
Turnips,	-	106	Brown bread,	166
Rye,	-	106	Peas,	239
Corn,	100-	-125	Lentils,	276
Barley, -	-	125 AND	Beans, -1AL.	320
Human milk,	-	100	Fish, from	776 to 954
Cow's milk, -	-	237	Pigeon, boiled,	827
Oyster,	-	305	Lamb,	833
Eggs, -	-	305	Mutton, boiled,	852
Cheese,	331-	-347	Yeal, "	911
Pork ham, boiled	5	807	Beef, "	931
  Such a table  must  not be supposed to  indicate the
fitness of different articles for  food, though  correct  as 
HUNGER.
55
 regards the proportionate amount of material capable of
 forming tissue.  For an article that  contains a small por-
 tion, may be so much easier of digestion, that it would be
 preferable.  Some  of those articles of food,  also, which
 contain a small proportion of tissue-making material, are
 vich in material for the production of heat.
   Carpenter remarks, " that the most economical diet will
 be that in which there  is the most perfect apportionment
 of each  class of constituents to the wants of the system;
 and these will vary with the amount of muscular exertion
 put  forth, and the  lowering of the external temperature.
 Thus, for a man of ordinary  habits, and living  under a
 medium temperature, a  diet composed  of animal flesh
 alone is  the least economical that can be conceived; for,
 since the greatest demand for food in his system is created
 by the necessity for a supply of carbon  and hydrogen to
 support  his respiration, this want  may be most advan-
 tageously fulfilled by the employment of a certain quan-
 tity  of non-azotized food, in which  these ingredients  pre-
 dominate.  Thus it has been calculated, that, since fifteen
 pounds of flesh contain no more carbon than four pounds
 of starch, a savage with one carcass and an equal weight
 of starch, could support life for the same length of time,
 during which another, restricted  to  animal  food, would
 require five such carcasses, in order to procure the carbon
 necessary for  respiration.  Hence  we see the immense
 advantage, as to economy of food, which a  fixed agricul-
 tural population possesses over those wandering tribes of
 hunters,  which still people  a  large part of the  old  and
 new continents."

                      HUNGER.

  In every living organism there is  an incessant and re-
 ciprocal activity of  waste and repair.   The living  fabric in
 the very actions  which constitute its  life, is momently
yielding up its particles to destruction, like the coal which
is burned in the furnace; so much coal to so much heat, 
56
HUNGER.
so much waste  of tissue to so much vital activity.   1 on
can  not wink  your eye, move  your finger, or think a
thought, but some minute particle of your substance must
be sacrificed in doing so.  Unless the coal which is burn-
ing- be from time to time replaced, the fire soon smoulders
and  finally goes out;  unless the  substance of your body,
which is wasting, be  from time to time  furnished with
fresh food, life  flickers, and at  length  becomes extinct.
Hunger  is the  instinct which  teaches us to replenish the
empty furnace.  But  although the want of food, neces-
sary to repair  the  waste  of life, is the primary cause of
hunger, it does  not, as is often erroneously stated, in itself
constitute hunger.   The absence  of necessary food  causes
the sensation, but it is not itself the sensation.  Food may
be absent without  any sensation, such  as we express by
the  word hunger,  being  felt; as  in  the case  of insane
people, who frequently subject themselves to prolonged
abstinence from food,  without any  hungry cravings; and,
in a lesser degree, it is familiar to  us all how any violent
emotion of grief or joy will completely destroy, not only
the sense of hunger, but our possibility of even swallow-
ing the food which  an hour before was cravingly desired.
Further, it is known  that the feeling of hunger may be
allayed  by  opium,  tobacco, or  even by inorganic sub-
stances  introduced into the stomach, although none of
these can supply the  deficiency  of food.  Want of food
is, therefore, the primary, but not the proximate, cause of
hunger.  I am using the word hunger in its proper sense
here, as indicating that specific sensation which  impels us
to eat; when the  subject has been more fully unfolded,
the reader will see how far this popular sense of the word
is applicable to  all the phenomena.
  We can now understand why hunger should recur peri-
odically, and with a frequency in proportion to the demands
of nutrition.   Young animals demand food more  fre-
quently than the adult; birds  and mammalia  more  fre-
quently than reptiles  and  fishes.  A lethargic  boa-con- 
HUNGER.
57
 stricter will only feed about once a month;  a lively rabbit
 twenty times  a day.  Temperance has  also its influence
 on the frequency of the recurrence : cold excites the appe-
 tite of wTarm-blooded animals, but diminishes that of the
 cold-blooded,  the majority of which cease to  take  any
 food at the temperature of freezing.  Those warm-blooded
 animals which present the curious phenomenon of " winter
 sleep,"  resemble  the cold-blooded animals in this respect;
 during hybernation they need no food, because almost all
 the vital actions are suspended.  It is found  that, at this
 temperature of  freezing, even  digestion  is suspended.
 Hunter fed lizards at the commencement of winter, and
 from time to time opened them, without perceiving any
 indications of digestion having gone on; and when spring
 returned, those lizards which were still living, vomited the
 food which they had retained undigested in their stomachs
 during the whole winter.*
   Beside the usual condition of recurring appetite, there
 are  some unusual conditions, depending on peculiarities
 in the  individual, or on  certain states of the organism.
 Thus, during convalescence after some maladies, especially
 fevers,  the appetite is  almost incessant;  and Admiral
 Byron relates that, after suffering from a month's starva-
 tion during a shipwreck, he and  his companion, when on
 shore, were not content with gorging themselves while at
 table, but filled their pockets, that they might eat during
 the intervals  of meals.   In  certain  diseases there is  a
 craving for food which  no supplies allay; but of this we
 need not speak here.
   The animal  body  is  often  compared with  a steam-
 engine,  of which the food is the fuel in  the furnace, fur-
 nishing the motor power.  As an illustration, this may
be acceptable enough, but, like many other illustrations,
it  is often  accepted as if it were  a real analogy, a true
expression of the facts.  As an analogy, its  failure is con-
* Hunter—Observations on Certain Parts of Animal Economy. 
58
ORGANS OF DIGESTION.
spicuous.  No engine burns its own substance as fuel: its
motor power is all derived from the coke which is burning
in the furnace, and is in direct constant proportion to the
amount of coke  consumed; when  the coke is exhausted,
the engine stops.  But every organism  consumes its  own
body:  it does not  burn  food, but  tissue.   The  fervid
wheels of life were made out of food, and  in  their action
motor  power  is  evolved.    The difference between the
organism and the mechanism  is this : the production of
heat in the organism.is not the cause  of its activity, but
the result of it; whereas, in the  mechanism, the activity
originates in and is  sustained by the heat. Remove the
coals  which  generate  the steam,  and you immediately
arrest the action of the mechanism; but long  after all the
food has disappeared, and become transformed into, the
solids and liquids  of the living fabric, the organism  con-
tinues  to  manifest  all  the powers which it manifested
before.  There is, of course, a limit to this continuance,
inasmuch as vital activity is dependent on the  destruction
of tissue.  The man who takes no food, lives like a  spend-
thrift on his capital, and can not survive his capital.  He
is  observed  to get  thin, pale, and feeble, because he  is
spending without replenishing his coffers;  he  is gradually
impoverishing himself because life is waste ; for life  moves
along the stepping-stones of change, and change is death.

             ORGANS OF DIGESTION.

  The process by which food  is prepared for the uses of
the body, is  a  most  interesting  and important study,
though much simpler than would be supposed.  Our  food
contains all the elements of the tissues, but in such form
that they can not appropriate it.  Therefore the necessity
of  a  series  of organs for its minute  comminution and
change from a solid or semi-solid form to a fluid.
  The mouth, the first part of this  apparatus,  is furnished
with teeth, firmly inserted in the upper  and lower  jaw 
ORGANS OF DIGESTION.
£S
the latter being moved by strong muscles; the arrange-
ment of the muscles of the lips, cheeks and tongue being
such as to keep the food between the teeth during mastica-
tion.   As the principal articles of food are  more easily com-
minuted by the addition of fluid,  certain glandular organs
are associated wTith the mouth to furnish it.  These are on
each  side,  one  between the lower jaw and the ear, one
beneath the angle of this bone, and one beneath the tongue.
  Food taken into the mouth is carried  under the teeth,
and the process of trituration begun; this excites the sali-
vary glands, and saliva is poured out in quantity sufficient
to  form  the  food into  a semi-fluid mass.   When thus
divided, it  is  carried on to the tongue, which being drawn
backward,  carries the food into the  throat, from whence
it passes through the oesophagus, or gullet, to the stomach.
This  process is usually regarded  as a very unimportant
one, and the  demands of the system for a proper prepara-
tion of the food entirely overlooked.  As a nation, we
are guilty of bolting our food without mastication, and of
wasting  the  saliva  by chewing  and  smoking  tobacco;
hence we are a nation of dyspeptics.  Many  a man and
woman suffers from indigestion, and all its consequences—
broken down health—who may attribute all  their suffer-
ings to not taking sufficient time  to masticate their food;
and others suffer the same consequences by wasting the
saliva in the use  of tobacco.  Numerous cases in  my
experience have been relieved by such change of habits
as would permit the normal performance of the functions
of mastication and insalivation.
  The saliva  consists principally of water, holding in solu-
tion a small  amount of alkaline matter, and a peculiar
principle termed ptyaline, which commences a process of
change in the food, changing its  starch into sugar.   The
amount of  saliva usually secreted  in twenty-four hours, is
from ten to twenty ounces.
  The Stomach.—The  stomach  is  a large, hollow sac,
situated immediately below the septum dividing the chest 
ORGANS  OF  DIGESTION.
Fig. 2.
               DIGESTIVE  APPARATUS.
  1,  Mouth.  2, (Esophagus.  3, Stomach.  4, Large Intestine.  5,  Small
Intestine.  6, Rectum.  7, Gall Bl.iil.icr an>! ?itunt'u:i of tho Liver. 
ORGANS OP DIGESTION.
61
 from the abdomen, its largest portion  being in  the  left
 side and extending across the body to the right.  Its walls
 are about an eighth of an inch in thickness, composed of
 three  layers, a serous, muscular and  mucous, the  last
 containing numerous  minute glands which  secrete  the
 gastric fluid.  Its muscular coat is strong, and during the
 process of digestion keeps the mass of food in constant
 motion.
   Food  taken into the stomach during  a meal, usually
 contains a large amount of fluid,  which must be removed
 by the veins before digestion commences.  Hence, in some
 cases, indigestion is remedied by abstaining  from fluids
 during a  meal,  so that the process  of digestion will
 commence  immediately.   When  the fluids are  thus
 absorbed, the gastric  juice is poured out, and comes in
 contact with the surface of the mass, which being kept in
 constant motion by the muscular coat of the stomach, is
 rapidly dissolved.  The liquid thus formed, called chyme, is
 a milky fluid, of an acid reaction, and is passed through the
 contracted lower extremity of the stomach into the first part
 of the small intestine. In addition to the water, a small
 portion  of the albumen of the  food is absorbed  by the
 veins of the stomach, but the largest proportion  has to
 undergo still further  change to fit it for  the  uses of the
 economy.
   From  two to six hours is required for the  digestion of
 a meal in the stomach, depending partly on the character
 of the food, and partly on the condition of the stomach.
 Thus we find cases in which the process of digestion is so
 slow that a considerable part of the food putrefies, and is
 thus not only useless, but  in  many cases  absolutely inju-
 rious.  When a person is very much exhausted, food can
 not be digested rapidly;  hence, it will almost invariably
 prove injurious, unless taken in  small quantities.   Food
 should be taken sparingly  when a person is feeling badly,
 or when they  have symptoms of approaching  disease.
For the same reasons, I have known cases  in which food, 
62               ORGANS  OF DIGESTION.
taken into the stomach before an attack of  sickness,
remained undigested for days, being a source of continued
irritation.
   An individual by the name of Alexis St. Martin, from
a wound, had an opening into the stomach from the sur-
face, permitting an examination of the process of diges-
tion.  Dr. Beaumont, who performed  numerous experi-
ments with him, gave the following as the time  required
for the digestion of different kinds of food:
    KIND OF FOOD.
  Pigs' feet,      -
  Tripe,.....
  Trout  (broiled),      -
  Venison steak,       -
  Milk,.....
  Roasted turkey,          -
  Roasted beef,  -
  Roasted mutton,     -
  Veal (broiled),
  Salt beef (boiled),
  Roasted pork,  -

  The gastric  juice which accomplishes the transforma-
tion of food into chyme  is secreted by numerous minute
glands, situated in the mucous membrane of the stomach.
It is supposed to amount, in the well developed and healthy
man,  to  between sixty and eighty  ounces, being poured
out only when food or  other  material is taken into the
stomach.   Dr.  Beaumont found  that the  introduction  of
any material, as the bulb of a thermc-meter, would excite
the secretion, so that he was enable  to  collect as much  as
an ounce at a time.  He describes it as a " clear, transp;irent
fluid,  inodorous, a little saltish, and very perceptiblv r.cid.
Its taste  is similar to  that of mucilaginous water, slightly
acidulated with muriatic acid.  It is readily diffusible  in
water, wine, or spirits;  slightly  effervesces with alkalies,
and is an effectual solvent of alimentary material.  It pes-'
HOURS.	MINUTES,
1	00
1	00
1	30
1	35
2	00
2	30
3	00
3	15
4	00
4	15
5	15
 
ORGANS OF DIGESTION.               63
sesses the property of coagulating albumen in an eminent
degree; is powerfully antiseptic, checking the putrefaction
of meat, and effectually restorative of action when applied
to old fetid sores, and foul, ulcerating surfaces."
  At times  the gastric juice is secreted in large quantity,
and possesses an undue degree of acidity, and brought up
into  the mouth by eructation, it  is extremely acrid.  This
acridity is the cause of heartburn.  In addition to the gas-
tric juice, the stomach secretes mucus for its  protection,
like  other mucous membranes; at times this is secreted in
undue quantity, and impairs the appetite and digestion,
causes the tongue to be heavily coated, and  a bad taste  in
the mouth.  It is this mucus, removed by an emetic, which
the Thompsonians call canker.
  Small Intestines.—The chyme, formed in the stomach,
passes into the small intestines, and being exposed to the
action of the bile, pancreatic fluid, and intestinal secretions,
is changed into chyle, a fluid of higher organization, which
is absorbed  by the veins  and lacteals, and thus gains en-
trance into the blood.  It is supposed by a majority, both
in and out of the profession, that the process of digestion
is principally accomplished in the stomach.   This, how-
ever, is  not the  fact, as  recent  experiments have pro'ven,
the  most important part of the process occurring in the
intestines.
  The case of Alexis St.  Martin, who, from a wound, had
a large opening from the stomach through the abdominal
walls, and  the extended  experiments  of Dr.  Beaumont,
which accomplished  so much  to elucidate the physiology
of digestion, has been named.  As that was the first in-
stance of the kind on record, it might be reasonably sup-
posed that centuries would elapse before another opportu-
nity  of like character would occur.  Fully as remarkable
a one, however, has been observed in Germanv, and a series
of very important observations made by Dr. Busch, of the
University of Bonn.
  A  woman, thirty-one  years  of age, from injuries, had 
64
ORGANS OF DIGESTION.
 fistulous  openings, completely separating the  stomach,
 duodenum, and a short fragment of the jejunum, from the
 intestine  below, the upper portion of the jejunum  being
 torn in two.  Not the least communication existed between
 the two portions, and the contents of the stomach and
 duodenum, with the gastric,  pancreatic and biliary  secre-
 tions  were discharged without admixture with the  secre-
 tions from the intestine below.
  When admitted to the hospital the first effects of the in-
jury had passed  off, but the  emaciation was remarkable,
 so that, though considerable improvement had taken  place,
 she only weighed 68 pounds 2 ounces eight weeks after
 admission.  She  devoured  incredible quantities of food,
 and for a length of time, while still eating, the food first
 taken  would make its appearance  in the superior fistula,
 and on being questioned, she would state that, though feel-
ing better, her strong desire for food was not satisfied.  In
fact, though her stomach was filled, she felt an irresistible
desire  for aliments.  The physiology of hunger was con-
clusively shown in this case to be composed of two factors—
the one, the emptiness of the  stomach and  first passages,
which  was   temporarily relived  by  eating;  the other,
more  permanent,  caused  by the  excess of  waste over
supply.
  The main object, at first, was to arrest the marasmus,
 by  furnishing to the system a supply of nutritious  mate-
rial, it  being evident that no matter how much was  taken
into the stomach the exhaustion still increased.   It was at-
tempted to lead the contents of the upper portion into the
lower by artificial means, but this  failing, after repeated
trials, another course of feeding was adopted, with marked
success.  "At first  protein substances were injected into
the lower opening, alternately  with amylaceous, and subse-
 quently eggs  and  meats were stuffed in by the finger.  The
result was most surprising, and admitted no comparison
with the previously adopted  feeding through the mouth.
 Although there was not commensurate increase of the 
ORGANS OF DIGESTION.
65
 volume of the patient, yet the muscles manifested  more
 tone, the features lost their death-like expression, the eyes
 became bright, the voice returned, and the patient  could
 sit up in the erect  posture."
   AVe have here indisputable evidence that the small and
 large intestines do possess the power of digestion in a very
 marked degree—far exceeding the stomach and duodenum,
 which, with  the associate glands, have  hitherto received
 the credit.  The enteric juice, contrary to the experiments
 of Frerichs, was found to be secreted  in small quantity.
 During six  weeks prior to her entering the  hospital, the
 patient had but one alvine evacuation, of the size of a
 chestnut,  consisting, probably, only of mucus and epithe-
 lial scales.  Subsequently, (food being introduced into the
 lower fistula)  she had, every  twenty-four hours, a copious
 one  of ordinary consistence, though  of a grayish  white
 color, on account of total absence of bile.  Most conspicu-
 ous was their  foetid  odor.  Digestion seemed  otherwise to
 be perfect, and the faeces retained no traces of the  nutri-
 ments taken.   These facts, with the steady improvement
 of the patient, would seem to demonstrate the dissolving
 properties of  enteric juice upon protein bodies.
   As before  remarked, the chyle  is absorbed by the veins,
 and  by a series of small vessels termed lacteals, which
 empty  into a larger vessel, the thoracic duct,  and it again
 into a vein on the left side of the neck.  In addition to its
 action in  digestion, we find that the  small intestine is an
 excretory organ, its glands removing foreign material from
 the blood, and passing them into the  tube  to be passed
 from  it as feces at stool.
   Large Intestine.—Whilst the small  intestine is  about
 25 fp.et in length, the large intestine is only about 5 feet;
the small intestine is very loosely attached and movable;
the large intestine,  for a considerable part of  its course, is
firmly attached.   The  large  intestine commences low
down in the right side of the abdomen,  passes upward to
near the  liver, then across  to the left, then down on the
        5 
66
ORGANS OF DIGESTION.
left side to the lower part of abdomen, then to the median
line where it becomes the rectum, terminating at the anus.
It receives the remains of the  food  and the intestinal ex-
cretions, which are formed into feces, and  discharged at
regular periods.
   The Liver.—The liver is the largest organ in the body,
measuring about twelve inches from  right to left, from
four to five  from  before backwards, and weighing about
four pounds.  It is situate in the upper part of the abdo-
men immediately behind the lower ribs, and in contact
with the diaphragm.  The  blood from which its secretion
is  formed is venous,  and derived from the veins of the
stomach  and entire intestinal canal, which, uniting, form
one large vein, the portal vein.  This, passing into  the
liver, divides and sub-divides into minute or capillary ves-
sels,  which  pass to the lobules of the liver, which remove
the elements of bile.  The blood is then received into the
hepatic veins, which convey it to the large ascending vein—
vena cava.  Unlike  all other  secreting organs, the  secre-
tion of the liver is formed  from venous blood, and the ar-
rangement of the  vessels is such that should this organ
become torpid, the flow of blood from the intestinal canal
will be obstructed.  It is from this  reason that torpor of
the liver produces piles, which are simply enlargements of
the inferior intestinal veins,  and sometimes occasions diar-
rhoea, though more frequently constipation.
  The bile is a yellowish or greenish, viscid fluid, with an
intensely bitter  taste, and  peculiar  nauseous  smell.  Its
secretion is supposed to be constant, the gall-bladder situated
on the under surface of the liver, receiving the bile and
pouring it into the intestine when it is required.   The pur-
poses served by the secretion of bile are of two kinds, the
removal of excrementitious material from the blood, and to
aid in the process of digestion.  The first  purpose is quite
important, as  when the elements of bile are not properly
removed from the blood, disease always occurs, as in jaun-
dice.  The second has not  as yet been fully investigated, 
ORGANS OF DIGESTION.
67
 but as Paget remarks, " though the chief purpose of the
 secretion of bile may appear to be the purification of the
 blood by  excretion, yet there is reason to believe that
 while it  is in the, intestines, it serves then in the process
 of  digestion.  In nearly all animals the bile is discharged,
 not through  an excretory duct communicating with the
 general  surface, or with a single reservoir, as most excre-
 tions  are, but is made to pass into the intestinal canal, so
 as to be  mingled with the chyme directly after it leaves the
 stomach; an arragement, the  constancy of which clearly
 indicates that the bile has some important relations to the
 food with which it is thus mixed."   It undoubtedly assists
 in the process of converting chyme into chyle, and render-
 ing it capable of being absorbed by the lacteals.  It is also
 markedly antiseptic, and arrests the putrefactive process
 in the intestine,  and also, as supposed, furnishes a material
 to the blood, which stands in  the same relation to it that
 hops do  to beer.  It is one of the principal agents in the
 digestion  of fatty matter, and  in  the production  of fat
 from the starchy  portions of the food, and  also changes
 the same material into grape sugar.
   The Pancreas.—The  pancreas is a small glandular or-
 gan  about six  inches in length, but  not more than from
 one to one and a half  in width, and about one in thick-
 ness.  Its  duct  opens into the same part of the intestine
 as the duct of the liver.   The secretion closely resembles
 the saliva, being colorless, transparent, and slightly viscid.
 It aids in the process of digestion, but in what manner has
 not been certainly ascertained.
  The Spleen.—The spleen is an oblong, flattened organ
 of a bluish-red color, situated  in the upper and left side of
the abdomen.  It receives  a large supply of blood, and its
vein, which is a  branch of  the portal, is much larger than
the artery.  It is not a gland, and furnishes no secretion,
but is supposed by most writers to serve as a reservoir for
the portal blood when it can  not pass freely through the
liver.  It has also been  noticed that  the red globules of 
68                      BLOOD.
the blood  were more broken  down  in the spleenic vein
than  in  any other vessel, and contained a larger number
of white globules.   Thus  it is considered by some, an or-
gan to break down the worn out blood; by others, a blood-
making organ.  Occasionally it is seen very much enlarged,
as in ague-cake in  severe and protracted agues.

                    THE BLOOD.

  " The blood is the general circulating fluid  of the ani-
mal  body; the source of all nutriment and growth, and
the general material from which all the secretions, how-
ever much they may differ in properties, are derived.  It
also serves the scarcely less important office of removing
and carrying off from the  body principles which are hurt-
ful or no longer required."
  AVhen drawn  from an  artery it is  a bright scarlet-red
fluid; when from a vein, it is purplish-red; heavy, and of
a viscid consistence.  If allowed to stand for some minutes,
it coagulates, becoming  solid like jelly,  but after awhile a
considerable amount of fluid separates, and is called serum,
the clot being more firm.  Blood  has a peculiar, slightly
salty taste, and to many, a disagreeable odor.
  The average proportion of the principal constituents of
the blood in 1,000 parts are:
    Water,......784
    Red. corpuscles,   -                      131
    Albumen,   ----..   70
    Saline matters.....6.03
    Extractive, fatty, and other matters,   -    6.77
    Fibrine,......2.2
  The albumen, saline, extractive  matters, and fibrine, are
held in solution in the water, and form the liquor sanguinis
or serum, in which are suspended  the red globules.
  The albumen is derived from the albuminous elements of
our food, which undergoes but slight change  after diges-
tion, further than  being combined with » minute portion 
BLOOD.
69
of soda.  It furnishes the nutrient material for all the soft
tissues  of the body  except fat, and is  constantly being
drawn  upon as it circulates  through the vessels, and as
constantly replenished from food.
   The  saline  matters comprise  soda, potash, lime, mag-
nesia,  phosphorus,  sulphur and  iron.   They are very
important elements of the solids and fluids of the body—
soda and  potash  of the  blood itself, lime  of the  bones,
phosphorus and sulphur of the nervous system and bones,
and iron  of the red globules,  and the coloring material
of the eye, hair, etc.  If either are deficient, though they
exist in such small quantity, disease is  the  result.  Thus
the difference of half an ounce of iron in the body, is the
difference  between perfect health and that extreme condi-
tion of debility known as anemia, and the absence  of a
few grains of phosphorus  from the  brain, will result in
enfeebled nervous action or death.
   The  extractive matters  we may suppose to be the detritus
of the tissues, which, being absorbed by the blood-vessels,
is being carried to the execretory organs for removal from
the  system.  Fatty  matters exist in the blood  in small
proportion, and are constantly removed either by com-
bustion or by being stored away as adipose tissue.
   Fibrine seems to be the element most  nearly related to
the tissues of the body; as, in blood drawn, it immediately
arranges itself in beautiful fine fibers  interlacing in all
directions.  It is this  element that causes the blood to
coagulate,  and  it may be removed  from freshly-drawn
blood by whipping it with a bunch of  small switches or
wires, when the blood  loses its property of coagulating.
In former years much attention was paid to  this element,
as a  symptom of disease, and as an indication for bleed-
ing.  In all inflammatory and febrile diseases, it was held
to be in excess, the evidence of which was  the firm clot,
cupped, and with a whitish, buffy coat.   The presence of
this,  it  was considered, always  indicated  blood-letting.
The experiments of Magendie, one of the ablest physiolo- 
70
BLOOD.
 gists, proved that in many cases the fibrine was not increas-
 ed in these diseases, but the increase was dependent upon
 the abstraction of blood, and that each successive bleeding,
 instead of lessening,  but  increased the quantity.  It was
 further shown that in confirmed anemia, when the powers
 of life were nearly exhausted, the fibrine was in very large
 quantity;  so that  if this  was an indication for blood-
 letting, then it should be  most  certainly  adopted in this
 last condition.  The absurdity of blood-letting, as a means
 of treatment, is now so generally admitted, that  it seems
 useless to advance arguments against it.  AATith reference
 to  the uses  of fibrine, there is much dispute, some con-
 tending that it is albumen prepared for the formation of
 tissue, while others contend that it is the elements of the
 worn out tissues.
   The red globules, as we  have already seen, form  more
 than  half of the solids of the blood.   They are circular,
 flattened discs, varying in  diameter from 3^ to 4^00 of
 an inch in diameter.  Examined  singly, they  appear col-
 orless, but when  aggregated, they give the red  color to
 the blood.  They consist  of a  cell wall, and  an  internal
 substance  called  hematine, containing iron, which  is,
undoubtedly, the  coloring material.   These  bodies are
highly organized, requiring a considerable time  for their
 development, as we observe in disease, in  cases  of  hem-
 orrhage, and from blood-letting.   They are  the normal
 stimulus of all parts  of the body; as when deficient, we
find imperfect  digestion,  nutrition and innervation.  In
addition, they are the principal  carriers of oxygen  from
the lungs to all parts of the system, and of carbonic acid
gas back to the lungs.   In this view they  resemble small
vessels freighted with  life  from  the lungs to  the tissues,
and carry a return freight  of death from the tissues to the
lungs for its removal.   If  this  carrying power w-is des-
troyed for five minutes, death would be inevitable- and it
has been  supposed by some that some forms of -ridden
death, as from lightning, result  from  this.   TI~>  white 
HEART AND BLOOD-VESSELS.
71
corpuscles are much less numerous than the red, and are
supposed by some writers to be embryo red globules.
   The life  of the blood  is manifested in its coagulation,
and the  subsequent more perfect organization which  it
may  attain when it  coagulates  among healthy  living
tissues.  But, in a higher degree, its life is shown  in its
development and self-maintenance, in its  liability to dis-
ease  and death, and in the purpose  and relation which
connect it with other parts.
   The formative power by which the blood maintains itself,
is, perhaps,  inherent in its whole substance, as we observe
that the glands through which the chyle passes, is abund-
antly supplied with arterial blood.  There are  no blood-
making organs, but the materials  of digestion are formed
into blood by contact with the blood itself.  It possesses a
large vitality, sufficient for its formation and preservation,
and for the  various purposes of the body.   Though this is
the case, no other part of the organism, as Liebig well
remarks, can be compared to the  blood, in respect to the
feeble resistance it offers to external influences.   It is not
an organ which is  formed, but an organ in the act of
formation;  indeed, it is the sum of all the organs which
are being formed.  The chemical force and the vital prin-
ciple hold  each  other in  such perfect equilibrium that
every  disturbance, however trifling,  or  from  whatever
cause it may proceed, effects  a change in the blood.  In
fact, it possesses  so little permanence, that it can not be
removed from the body without  immediately suffering a
change, and can not come in contact  with any organ in
the body without yielding to its attraction.

          HEART AND  BLOOD VESSELS.

  The heart is situated near the center of the chest between
the lungs, though to the left of the median line; the junc-
tion of the fifth rib with the breast-bone, marks its exact
position.  A very common error, is to suppose it situated im- 
72
HEART AND BLOOD-VESSELS.
 mediately  below the breast-bone, or to the left under the
 false ribs, and attribute symptoms to it which arise from
 derangement of the stomach.
   The heart is  a hollow muscle, divided into four com-
 partments, two on the right and two on the left side.   The
 compartments are called auricles  and ventricles,  the  first
 being  situated above and having thin walls, the second
 below, arie-  having thick walls.   The circulation of the
 blood  depends upon the contraction of the heart, which
 acts as a force pump to throw the  blood to all  parts of the
 system.  If wTe examine  it  carefully  we  will see that all
 the venous blood in the body is gathered into two large
 veins,  the  ascending and descending vena cava. These
 empty into the right auricle, which,  contracting, forces
 the blood  into  the  right ventricle, and its  contraction
 throws it into the pulmonary artery which conveys it to
 all  parts of the lungs.  A very  important change  now
 takes place in the blood,  it gives off its carbonic acid gas,
 and receives a supply of oxygen, which changes  its color
 from the purplish-reel of venous blood, to the vivid scarlet-
 red of arterial blood.  The blood is received from the
lungs by four veins called pulmonary veins, which convey
it to the left auricle; this contracting forces it  into the left
ventricle, which  throws  the blood through the aorta into
 every part  of the  body.   The different  openings in the
heart are closed by strong membranous valves which pre-
vent the backward  passage of the blood when the heart
 contracts.
  The  blood propelled from the heart is distributed to the
body  by vessels  called arteries, from  the belief  of  the
 ancients that they contained air, being always found empty.
 These  vessels  are  cylindrical  tubes  composed  of three
 coats—an  external dense fibrous, a middle elastic, and an
 internal  lining membrane.   The  veins possess the  same
 structure, though  their walls  are much thinner, and they
 are supplied with valves to prevent a reflux of blood.
 Owing  to the elasticity of the arteries, their walls yield  at 
HEART  AXD BLOOD-VESSELS.
Fig. 3.
                     ARTERIAL  SYSTEM.

  1, Temporal Artery.  2, Carotid Artery.  3,  Vertebral Artery.  4, Subcla-
vian Artery.  5, Aorta.  6, Abdominal Aorta.   7, Iliac Artery.   8, Axillary
Artery.   9,  Brachial  Artery.  10, Radial Artery.  11, Femoral Artery,  12,
Anterior  Tibial Artery.  13, Posterior Tibial  Artery.  14, Peroneal Artery.
15, Dorpalia Pedis Artery. 
74
HEART AND BLOOD-VESSELS.
each impulse of the heart, and contract when it has passed,
hence the pulsation of all arteries are synchronous with the
beats of the heart.
  AVe wish to study the situation of the principal arteries
with reference to injuries, that we  may know when to
apply pressure to arrest a flow of blood.   The large artery
arising from the heart is called the ascending aorta, passing
upward, and  to the right about three and a half inches;
thence curving to the left and backward, the arch of the
aorot, then downward on the  anterior surface of the
spine to  a point just posterior to the umbillicus or naval.
In this course it sends off, first, two large vessels which go
to the right side of the head and right arm, and next two
others, which go to the left side of the head and left arm.
By examining Fig. 3, the course of these arteries and their
distribution may be readily seen.  Passing downward, the
aorta gives branches to the walls of the  chest, next to the
diaphragm, then to the stomach, liver, spleen, small  intes-
tines, kidneys and large intestines, finally dividing into
two  large trunks which supply the  organs in the pelvis,
and pass down, the lower extremity.
  The system of arteries may be compared in its arrange-
ment to  the trunk and branches of a tree, except that
very frequent communications exist between these branches,
so that by a continual sub-division and inosculation, then
distribution comes  more  and more to resemble the  capil-
lary net work in which they terminate.  (See Fig. 3.)  "Al-
though the diameters  of the  branches,  at each sub-di-
vision, together, exceed that of the the trunk, yet there is
but little difference in their respective areas; what differ-
ence  does exist, however, is  usually  in favor of  the
branches."
  The minute vessels  in  which the arteries terminate, are
called  capillaries.   They vary considerably in size, their
average diameter being  about 3^ of an  inch, and  the
spaces between them does not exceed, and in many situa-
tions is much less  than the size of the vessel.   So closely 
NUTRITION.
75
are they situated that the finest pointed needle can not be
introduced into any tissue  without wounding them and
causing a  flow of blood.   Looking  at  it  in  this light,
almost one-half of our bodies are composed of blood-ves-
sels.  It is from  these minute vessels that  the tissues
derive their  nutrient matters, and when a vessel carry-
ing red globules would  interfere with the function of a
part,  the vessels are so minute as only to carry the color-
less portions  of the blood, as is the case in the transparent
structures of the eye.
   The veins receive the blood from the capillaries, and con-
vey it to the  heart.  As before remarked, their walls are
thinner, and  their course more  tortuous, and a retrograde
movement of the blood  is prevented by the presence of
valves.  The heart  furnishes the principal motive power
to the blood  in the veins, though this is doubtless increased
by the action of the muscles.
                    NUTRITION.
   Very closely associated with digestion, the structure,
composition  and circulation of the blood, is the formative
process by which  the various parts of the body renew
their substance.  Among the most familiar  examples of
nutrition and growth, may be cited the nails and hair.  I
take these as examples, because they are visible and read-
ily appreciated.  The nails and hair are cut frequently,
and are observed to grow, and become as long  as ever.
This growth, in the one case, takes  place by the continued
formation of nail at its root or matrix, and in the other in
the hair bulbs.  If, now, we should examine these parts
with a  magnifying glass, we would find that minute cells
are constantly being formed, and that as  they grow they
abstract from the blood the material for nails and hair.
As this  formation continues, those which were  developed
yesterday, are pushed further from  the blood-vessels that
supply  them, and, in a  few days more, have  become
elongated, and  lose their fluid and form a part of the nail
or hair. 
76
NUTRITION.
  So it is in all parts of the body.  Each structure  and
tissue possessing vitality  sufficient to live, possesses the
power of producing formative cells.  If a part loses  this
property, it  soon becomes worn out, or loses its function,
as we witness in old age.  These  cells  are  microscopic,
from the ,fo to the y^ao part of an inch in diameter.  Its
wall is apparently structureless, and it is filled with protein
compounds, in the case  of the tissues;  bone in bone cells,
and fat, in the  case of  adipose  tissues.  AVe have hereto-
fore noticed, when describing the formation of the human
being, that the egg from which the process of  develop-
ment  commenced, was  a cell, and that the germinal mem-
brane from  which the  body was  developed, was formed
by the growth of cells in the egg.
  Each  tissue and part has its own peculiar cells, capable
of abstracting material from the  blood for the nutrition
of that  part.  The tissue is the parent of the cells, and it
is a law in nature that  offspring possesses all the general
characteristics of parents.   Thus fibrous tissue produces
fibrous  cells, muscular tissue muscular cells, bone  tissue
bone cells, etc.   In the  young this process of cell growth
is very rapid, so as  to  increase the size  of the part.   In
middle age it is just sufficient  to  maintain the part in a
normal  condition, while in old age it gradually ceases, and
the part finally dies.
  Associated with the process of nutrition, is the wearing
out and constant removal of the tissues.  The material of
which our bodies are formed is not very substantial, and,
at farthest, can last but a few years;  hence the necessity
for its replacement.  Certain portions are being worn out
every day, and have to be removed to give place to the
new.  It becomes soluble, is  absorbed by the blood-vessels,
and removed from the blood by the excretory organs.   If
this process of breaking down  be interfered with, the
parts  become old, and in the same ratio lose their func-
tions.  " The duration  of life in each particle, is, however,
liable to be modified;  especially  by the exercise  of the 
SECRETION.
77
function of the part.  The less a  part  is exercised the
longer do its component particles appear to live;  the more
active its functions are, the less prolonged is the existence
of its individual particles."
   The  conditions  necessary to nutrition are:  " 1st. A
right state and composition of the blood, from which the
materials for nutrition  are  derived.  2d. A regular  and
not far distant supply of such blood.  3d. A certain influ-
ence  of the nervous system.  4th. A natural state  of the
part to be nourished."
                     SECRETION.
   Secretion  is the separation of some material  from the
blood, either  for some use in the body, as  the  secietion
of saliva, bile, etc., or for removal, as the secretion from
the skin, kidneys and bowels.  The, first is termed  a
secrementitious, the last  an excrcmentitious secretion.  For
the production of  a  secretion a  special  apparatus  is
required, which is always  alike in its minute  structure,
however it may differ in its general detail.  The simplest
form of  a  secretory  organ consists  of  a minute  simple
tube, closed at one  extremity, and receiving a very free
supply of blood.  This  tube posseses  the power of form-
ing cells with great rapidity, and these of abstracting from
the blood the  material for the secretion, whether it be
gastric  juice, bile, sweat, etc.  AVhen it has filled itself from
the blood, it has served its purpose, is ruptured, and dis-
charges its contents into the tube.  A small gland consists
of but  one  such tube or duct, as  is the case  with the
gastric  follicles and  others.  A large gland is  simply a
combination of such tubes, no matter what its shape or  size.
  Xormal secretion, both  secrementitious and excremen-
titious,  is necessary to health; hence it will  be  profitable
to notice the circumstances  ivfluencing secretion, which I
will quote from Kirkes :
  " The influence  of  external conditions  on  the  functions
of glands is manifested chiefly in alterations of the quan-
tity of secretion, and among the principal of these  condi- 
78
SECRETION.
tions are variations in the quantity of blood, in the quan-
tity of the  peculiar  materials for any  secretion it may
contain, and in the conditions of the nerves of the glands.
   " In general, an increase in the  quantity of blood  tra-
versing a gland, coincides with an  augmentation  of its
secretion.  Thus,  the mucous membrane of the stomach
becomes florid  when, on  the introduction of  food,  its
glands begin to secrete.   The mammary gland becomes
much more  vascular during lactation, and it appears that
all circumstances which  give rise  to an increase  in  the
quantity of  material secreted  by an organ,  produce, coin-
ciclently, an increased supply of  blood.  In  most  cases,
the increased supply of blood rather follows than precedes
the increase of secretion.
   " Glands  also secrete with  increased activity when the
blood contains more than usual of the materials they are
designed to  separate.  Thus, when an excess of urea is in
the blood, whether from  excessive  exercise, or from des-
truction of one kidney, a healthy kidney  will excrete more
than it did before.  It will, at the same time, grow larger:
an interesting fact, as proving both the  identity of  secre-
tion and nutrition in glands, and that  the presence  of
certain  materials in the blood may lead to the formation
of structures in which they may be incorporated.
   " The production of secretions often appears, also, to be
influenced by the condition of the  nervous  system.   It is
not possible to say, with  certainty, whether the  secretion
of a gland would be  arrested  by the  division  or destruc-
tion of  all the nerves  distributed to it, for the branches of
these nerves are largely spread over the blood-vessels, so
that their destruction can not be effected without serious
injury to the  vessels.  The most distinct instances  of
nervous influence are shown in cases of secretion of the
earthy  phosphates, by the  kidneys,  after  injury of  the
spinal cord.   AAQiatever, within  certain limits, excites the
nerves of a gland, is followed by an increase in the quan-
tity of its secretion." 
THE SKIN  AND ITS SECRETION.
79
THE SKIN AND ITS SECRETION.
   The skin is not only the  investing  membrane  of the
whole body,  but it is also  one of the  most important
excretory organs ; in this respect being essential to life.  It
is composed of two  parts—an internal layer, thick and
strong, formed of fibrous and elastic  tissue, called  the
derma, or true skin, and an  external layer, composed of
dessicated cells, which overlap each other like the scales
of a fish, are horny, and afford it efficient protection.  On
examining  the true  skin, it will be found  covered with
minute elevations, termed papillae, in which the  sensitive
nerves are distributed.
                  Within the skin we find the  sudorifo-
                rous,  or  sweat  glands, sebaceous follicles,
                and  hair bulbs.   The first  secrete  the
                sweat, and are very numerous, being esti-
                mated .at about 417 to the square inch,
                or from 600,000 to 700,000 in a full grown
                man.  Each of these glands consists of a
                convoluted tube passing through the entire
                thickness of the  skin, and abundantly
                supplied  with   blood.  The  estimated
                length  of these  tubes  in the body is  28
                miles; an immense amount of  drainage
                for a small surface.
                  Perspiration,  or  sweat,  is composed
                principally of water, holding in solution
                a small proportion of effete material, sup-
                posed to amount to about one  hundred
                grains, or nearly one-fourth of an  ounce.
                Not only does the perspiration carry off
                this effete matter, but it also removes any
                excess of heat, a very important function.
It has been "proved by  experiment that if the  skin was
hermetically sealed up,  as by the  application of collo-
dion or other  material, an animal would die in five min-
 SUD0RIFER0US GLAND.
Magnified 30 diameters.
  a, convolutions of
duct beneath the skin;
b, b, under surface of
the skin; c, c, fatty tis-
sue; e, the duct; d, its
opening on the sur-
face. The three layers
of which the  skin is
composed, are  shown. 
80       THE URINARY APPARATUS AND SECRETION.

utes.  And  even where but five-sevenths were occluded,
death took place at a longer interval.
  The sebaceous glands are usually situated at the root of
a hair, and furnish an oily secretion for the lubrication of
the skin.  The hair follicles, are  depressions in  the true
skin,  profusely supplied with blood, which,  furnish the
cells that are formed into hair.   So long as these follicles
are healthy, hair  will be produced, but if destroyed by
disease,  the loss of hair will be permanent.
  Examining the skin with reference to its functions, we
must  realize that the maintenance of the normal condi-
tion of this very extensive and  highly sensitive tissue, is
of primary importance in the preservation of health.   This
is satisfactorily proven by the morbid conditions so fre-
quently and so speedily induced by the suppression of per-
spiration or  by derangement  of its  normal functions.
AVIien we take into consideration the extent of the  cuta-
neous tissue, the innumerable sudoriferous glands, the  ducts
of which penetrate it and empty upon its surface, through
which much  of the effete matters of the system should
escape, and  through which they do  escape in a state of
health, we can not be insensible to the  important office it
performs.   We can also readily understand the influence
which it is capable of exerting upon the whole system if
its normal functions are arrested, and also the very salu-
tary influence which may be exerted  upon  it and through
it upon the entire  system in  subverting morbid action in
disease.

THE URINARY APPARATUS AND  SECRETION.

  The urinary apparatus consists of the kidneys, two in
number, which secrete the urine; of two tube ureters,
which convey it away; of a hollow  organ, the  bladder,
which serves as a  receptacle for it; and of a second  chan-
nel, the urethra, through  which  it  is removed from the
body. 
         THE URINARY APPARATUS AND SECRETION.       81

       Fig. 5.          The kidneys  are situated in the
                     posterior part of  the abdomen, on
                     the right and left side, and perfectly
                     protected from  injury by the struc-
                     tures surrounding them.   Each kid-
                     ney is about  four  or five inches in
                     length, two  and a half in breadth,
                     and a  little more  than  one inch in
                     thickness, weighing from three to
                     five ounces.   In shape it very much
                     resembles a bean, the depression in
                     one border  receiving the large renal
                     artery, and giving exit  to the renal
vein, and containing the pelvis of the kidney which is the
dilated upper portion  of the ureter.  If we cut it in two
from  above, downward,  we will  find  it presenting the
appearance of Fig. 5, consisting of numerous  cones, with
their base outward, and their apex toward the pelvis of
the kidney, and of  a second structure darker colored, and
about half an  inch in thickness, and investing the entire
kidney.   The  cones are composed  of small tubes, called,
tubuli uriniferi, which  empty into  the pelvis,  and pass to
the  outer vascular coat.  The external or vascular coat
consists of small red  globular bodies, formed  of a dilata-
tion of a  uriniferous  tube containing a tuft of capillary
blood-vessels, of minute convoluted uriniferous tubes, and
of arteries and  veins.  The water of  the secretion is poured
out in the funnel-shaped expansion  of the tube, whilst the
solid elements of the secretion are removed by the convolu-
ted walls of the tube, in the  manner  heretofore  named,
when speaking of secretion.
  The ureters pass from the  kidneys to the bladder, and
are membranous tubes about the size of a goose-quill, and
some  eighteen inches in length.  The bladder is a hollow,
muscular organ, situated within the pelvis, and capable of
containing from one to two pints of  fluid.  It is composed
of three coats, an external serous, derived from the serous
       6
 
82       THE URINARY APPARATUS AND SECRETION.

membrane of the abdomen, a middle muscular, which haa
an attachment in front to the bones of the pelvis, and an
internal mucous lining.  Its function is simply to  receive
and contain urine  for a suitable  period, and then expel it
from the body.   The urine is expelled, partly by the con-
traction of  its  own muscular tissue,  and  partly  by the
muscles of the  abdomen.  The  urethra is the canal that
conveys the urine from  the bladder out of the body, and
is about two inches in  length in the  female, and about
nine inches in the male, and has an average diameter of
about three-eights of an inch.   It consists  of  a  mem-
branous portion, lined by a mucous membrane, the latter
of which is very delicate and sensitive.  Closely connected
with the  urinary  organs, is  the sexual system of both
male and female, which will be fully described in Yol.  II.
  The urine is a yellowish, amber-colored fluid, possessing
a strong,  disagreeable  odor, and a  bitterish saline taste.
The average quantity of urine passed in twenty-four hours,
is estimated at thirty ounces  in  summer, to forty ounces
in winter, the solid matters varying from 20 to 70 parts in
1,000, amounting to from 600 to 700 grains, the  remain-
der being water.   According to Golding Bird, the solids
of the urine in man in twenty-four hours is as  follows:
                                                 Grains.
Urea,........270.
Uric acid,.......7.6
Fixed salts,.......150.
Organic matters and vegetable saline combinations, 176.

  In a physiological view, the urine may be regarded  as
arising from three general sources, each acting alike  in
preserving the equilibrium  of the delicately-adjusted bal-
ance of  the secreting  and  depurating functions of the
body.    The effects of copious  aqueous  potations pro-
ducing a  free  discharge of pale urine, at once indicates
one source of the great bulk of the urinary secretion, and
demonstrates one of the most important functions of the 
        THE URINARY APPARATUS AND SECRETION.       83

kidneys in their pumping off any  excess of fluid which
may enter the circulation.  A second great duty of these
organs is shown in the physical and chemical characters
of their secretion after the digestion of food is completed.
Here it is no uncommon  circumstance to detect the pres-
ence of some  traces  of the elements of an  imperfectly
digested meal; and in unhealthy and irritable  states of the
digestive  organs, to  discover some  abnormal  constituent
in the urine arising from  the incomplete assimilation of
the recently digested food.  Of the  former of these states,
the peculiar odor and color of the  urine, after the inges-
tion of asparagus, seakale and rhubarb, afford an exam-
ple ; and a good illustration of the latter is met with in
the  copious elimination  of oxalic  acid from the  blood
shortly after a meal  in some cases of irritative dyspepsia.
It is, indeed, a general law, that  any substance which has
entered the circulating mass, and not being required for
the nutrition of the body, nor  forming a normal element
of healthy blood, always escapes from the system by way
of  the kidneys, providing it exists in a state  of complete
solution.  Hence these most important emunctories have
the duty of  removing any imperfectly assimilated ele-
ments of the food which have been absorbed, while travers-
ing the small intestines, and entered the circulating mass;
as well as excreting the often noxious results of unhealthy
digestion.  The third function of the  kidneys  is their
serving as outlets to evolve from  the animal organism
those elements of the disorganization of  tissues which
can not perform any ulterior process in the economy, nor
be got rid of by the lungs or skin.
  " It is well known that our bodies are always in a kind
of transition state; that during each moment of our exist-
ence, every atom of the frame is undergoing some change
or other;  the old matter is absorbed  and thrown off at
one or the other of the excretory outlets of the body, and
new matter is deposited from the blood to take its place
The-old and effete atoms of the  animal structure are no* 
 84        THE BOWELS  AS  EXCRETORY ORGANS.

 excreted in the form of dead tissue, but becoming liquefied
 they re-enter  the circulation, their elements  being re-ar-
 ranged;  one series of combinations thus produced, rich in
 nitrogen, is  excreted by the kidneys, while those products
 which contain a preponderance of the inflammable ele-
 ments, carbon, hydrogen and sulphur, are called upon to
 perform, chiefly  through  the  medium of  the liver, an
 important office, previous to their final elimination from
 the system."—Bird.
   The principal  constituent of the urine  is  eminently
 poisonous if retained within the blood, giving rise, if in
 small quantity, to disturbance of the brain and nervous
 system, and of the stomach; whilst if in large quantity it
 produces stupor, coma, convulsions and death.  An entire
 arrest of the secretion for twenty-four hours would prove
 fatal, though  a  person  might  five for  several days with
 but partial suppression.

     THE BOWELS AS EXCRETORY ORGANS.

   We  have already considered the intestinal canal with
 reference to  its principal function—the digestion of food—
 but it has another and important one as an excretory or-
 gan.  The material  discharged from the bowels daily as
feces, consists in part of the debris of the food, but princi-
 pally of material thrown off from the  blood through the
 intestinal wall.  There seems  to  be no proper secreting
 structure  for  this purpose, and  it is  possible that it is
 effected by the mucous membrane alone.  The quantity of
 fecal  discharge  from the bowels daily, averages about six
 ounces, but  at least 75 per cent, of this is water, so that
 the solids do  not amount  to  more  than one-and-a-half
 ounces.
   Torpor of the bowels deranges the process of digestion,
 and induces disease.  In this condition, digestion is im-
 perfectly performed, and frequently  food is retained in an
 imperfectly  digested condition, much longer  than the laws 
THE RESPIRATORY APPARATUS.            85
of health will tolerate.  While retained, it is mingled with
the various products  of secretion eliminated from the
blood through the wall of the canal.  This heterogeneous
mass  becomes  more irritating, and we may add, disease-
creating,  in  proportion  to the time it is retained in the
bowels.  The more liquid portions  are re-absorbed into
the blood, contaminating  that fluid, causing  sick head-
ache,  pain in the back and limbs, loss of appetite, fever, etc.

  THE RESPIRATORY APPARATUS  AND ITS
                     FUNCTION.
  The respiratory apparatus consists of the nose, pharynx,
larynx, trachea, bronchial  tubes and lungs.  (See Fig. 6.)
The nose is an organ of special sense, and will be described
hereafter; we notice it now, simply  as the passage by
which the air gains the lungs; air may enter through the
mouth but this is not common.   The pharynx is the mem-
branous sac immediately behind the tongue, and forms the
principal part of what is generally spoken of as the throat,
forming  part of both the air passages, and the passage for
the food.
  If the tongue is depressed, and we look into the mouth,
we will  notice  a constriction at the posterior  part of the
tongue, called  the fauces,  and situated at this  point, two
almond  shaped glands—the tonsils.  Hanging from the
roof of the mouth at this point, is  the  soft palate, with a
smaller depending portion—the uvula—and posterior to,
and below the tongue, a  reddish substance projecting up-
ward—the epiglottis—the first portion of the larynx.   Be-
hind all these we notice a somewhat large cavernous space,
which is  the pharynx, the part first spoken of.   These vari-
ous parts assist  in the acts of delutition, respiration, and
modulation of the voice, and their change by disease is very
unpleasant, and  sometimes gives  rise  to  serious conse-
quences.
  The larynx  is situated  immediately below the tongue,
and not only forms a part of the air passages, but is especially 
86
THE RESPIRATORY APPARATUS.
interesting as the organ of the voice.  It is composed of
a frame-work of seven cartilages, articulated together by
as perfect joints as the knee or elbow.  These cartilages
are moved by several small muscles, which varies the size
and form of the passage  through it.  If we examine its
cavity, we will find it divided by two prominent elevations
of the mucous  membrane on each side, which are caused
by two bands of fibrous tissue that  pass from behind  for-
ward, and  are called the vocal cords.  The cartilages of
the larynx  and muscles are so arranged that these cords
can be made  tense  or relaxed, brought near together to
diminish the aperture, or  drawn apart to relax it.  Hence
the great range of the human voice, commanding two or
three octaves.  Modulations of the voice take place in the
throat, nose and mouth,  and  articulation  by the tongue,
teeth and lips.
  The trachea is the continuation of the air passage down-
ward from the larynx.  It  is a cylindrical tube about one
inch in  diameter, formed  of a skeleton of cartilaginous
rings,  covered by fibrous  tissue  and  lined  by  mucous
membrane.   These rings do not come together by one-
fourth to one-third of an inch behind, as  is also the case
with the bronchial tubes; the  interspace being  filled by
muscular fibre, the diameter of the tubes can be greatly
lessened, as  is the case in  the act of coughing and sneez-
ing, and  the cause of the difficult breathing in asthma.
  As just remarked, the bronchial  tubes very closely resem-
ble the trachea.  They commence by a bifurcation of the
air passage immediately below the third rib, and pass one
to the right, and one to the left lung, distributing branches
to all parts  of them.   AA^ien they become very small, the
cartilaginous rings are replaced by plates of cartilage, and
at last these cease,  and the tubes  consist simply of fibrous
walls.  Each minute bronchial tube  forms a miniature
lung; dividing into intercelhdar passages, these are studded
with air cells, like  grapes upon  a stem, and so numerous
that they are estimated at  600,000,000 in a grown man. 
THE RESPIRATORY APPARATUS.
87
Each lobule receives a branch  of the pulmonary artery,
which is distributed  in  minute capillary vessels on each
air cell, the blood being  received by the pulmonary veins
and carried back to the heart.   The air cell is composed
of a very delicate membrane, and the  carbonic  acid  gas
passes freely through it  from the blood to the air in the
vesicle, and  oxygen passes in the opposite direction from
the air cell to the blood.   It is in this manner that venous
blood is changed into arterial.
                                The lungs are formed of
                              an aggregation of these lo-
                              bules, the bronchial tubes
                              which convey the air, the
                              pulmonary arteries   and
                              veins, the bronchial arteries
                              and veins for the nutrition
                              of its tissues, nerves,  and
                              lymphatic vessels.   These
                              various parts are united to-
                  <l)|fv      sgether  by delicate fibrous
                            ^tissue, and the whole cov-
                              ered with  a  complete in-
                              vestment of  serous mem-
                              brane called  the  pleura.
      lungs and heakt.      The lung is  thin in front
and below, and small as it passes up to the root of the neck,
the largest portion being situated in the posterior- part of
the chest, on each side of the spinal column.  The point
where the bronchial tubes and blood-vessels enter, is called
the root of the  lung.
  The serous membrane that invests the lung is reflected
from it, and lines the walls of the chest, the  pleura form-
ing a shut sac.   Owing to this arrangement  a vacuum is
formed between the mng and the walls of the  chest, which
adhere together, as does the glass to the receiver of the
air-pump, or a boy's sucker formed of damp leather, when
he presses it with his foot upon a stone.   It is this attach-
 
88
THE RESPIRATORY APPARATUS.
me nt of the lung to the walls of the chest that .gives them
motion, as they possess in themselves neither the power
to dilate nor contract.
  The cavity  of the thorax, as we  have already seen, is
formed of twelve ribs on each side,  which arise  from the
dorsal  portion of the spine,  and pass backward, then for-
ward and downward.   Their direction is such that if their
anterior extremities are raised, the diameters of the cavity
of the  chest are increased.  The muscles of the chest are
so arranged as to accomplish this.   The inferior wall of
the chest  is formed  of a single muscle, which, arising
from the margin of the ribs, passes  upward in the  shape
of a  basin or funnel, the  concavity being downward.
When  it contracts, its apex is drawn down, and it becomes
level.  The respiratory function consists, then, in an ele-
vation  of  the  ribs, and  drawing downward of the dia-
phragm ; the lungs being attached to the  walls of  the
chest, as  already  described, the air  is forcibly drawn in.
The abdominal muscles acting, the  ribs  are drawn down,
and the diaphragm thrown back, and the air is forced out
of the  lungs.
  The  lungs always contain  a considerable amount of air,
which  is proved by portions  of them floating after death.
This fact is made use  of to determine whether  a child is
still-born, or has been murdered; as  in the first case, if the
child has  not breathed, its  lungs are solid, and sink in
water,  while, if it  has  respired but once, they will float.
The capacity of the lungs is indicated by the quantity of
air which a person can expel from his lungs by a forcible
expiration after the deepest inspiration he can make, and
averages about  225 cubic inches in  a full grown, healthy
person. Though the lungs  have this capacity, it is sup-
posed  that not more than from 20 to 25 cubic inches of
air are changed in ordinary respiration.  From sixteen to
eighteen  respirations  are made  per  minute,  and  the
amount of air respired in twenty-four hours amounts to 
THE RESPIRATORY APPARATUS.
89
 between three and four thousand gallons, containing about
 three-fourths of a pound of carbon.
   Taking these facts as data, we will readily understand
 the importance of large sleeping apartments, school-rooms
 and public buildings.  Experience  seems to have fixed
 800 cubic feet as the minimum of air that can be safely
 assigned  for each  individual, except when extraordinary
 provisions are in  operation for its constant  renewal by
 ventilation.
   Carpenter draws the  following conclusions from an
 extended series  of observations:  " In all climates, and
 under all conditions of life, the  purity of the  atmosphere
 habitually respired is essential to that power of resisting
 disease,  which,  even more  than  the  habitual state of
 health, is a measure of the real vigor of the system; for,
 owing to the extraordinary capacity  which  the  human
 body possesses of accommodating itself to circumstances,
 it not unfrequently happens that individuals continue for
 years to breathe a most unwholesome atmosphere, without
 apparently suffering from it; and thus, when  they at last
 succumb to some  epidemic disease, their death is  attrib-
 uted solely to  the latter—the previous preparation of
 their bodies for the reception  and development  of the
 zymotic poison being altogether overlooked.   It is impos-
 sible, however, for  any one who carefully examines the
 evidence  to hesitate for a moment in the conclusion, that
 the fatality of epidemics  is almost invariably in  precise
 proportion to the degree in which an impure  atmosphere
 has  been  habitually  respired."   That  an  atmosphere
 loaded with putrescent exhalations will furnish a material
 capable of receiving and propagating the seeds of disease,
 is  proved by  all our observations, and that  the  rate of
 mortality, severity and number of diseases, may be enor-
 mously  decreased,  by strict  attention to  the means of
promoting atmospheric purity, is equally evident. 
90
THE NERVOUS  SYSTEM.
THE LYMPHATIC SYSTEM AND ITS FUNCTION.

  In addition to the arteries  and veins, we have another
system of vessels, distributed minutely through the entire
body, carrying a whitish fluid called lymph.  Unlike the
other, these do not become much larger as they approach
the center of the body, but  the  principal channels are
more numerous.  Associated with these vessels are certain
bodies  called lymphatic glands, which are  formed by the
division into several branches of one or more lymphatic
vessels, and the  convolutions  of these.   They receive an
abundant supply of blood, and the various parts are con-
nected together by  fibrous tissue, and the  entire gland
receives  an investment of the same.   These glands are
found principally in the neck on each side, under the
arms, in the groins, and within the  cavities  of  the body.
Enlargement and disease of these  glands is the  principal
manifestation of scrofula.
  It is supposed that the lymphatic vessels gather up any
material  in the tissues that may be further used in the
body, and  convey it back to the general circulation.  It
is true, that  the function of this circulation is not fully
understood, but  from the  character of the  lymph,  this
seems to be the most reasonable supposition.  The lym-
phatics of the intestinal canal are called lacteals; they ab-
sorb the chyle and carry it  to the large lymphatic trunk—
the thoracic duct, which empties it into the  venous system.

              THE NER VO US  SYSTEM.

  The  nervous system consists of central nervous masses
in which nerve force is  generated, and nerve trunks that
convey it to all parts of the body.   The nervous system
is  divided into two  distinct parts, one of which controls
the functions of digestion,  assimilation, the circulation of
the blood, nutrition and secretion, and  is properly termed
the vegetative system; the other controls the functions of 
THE NERVOUS  SYSTEM.
91
 animal life, is under the direction of the will, and called
 the cerebro-spinal system.
   If we carefully examine the nerve centers, we will find
 them  composed of nerve cells, nerve granules, and nerve
 fibers.  Nerve cells and granules are always of a grayish,
 ashy color, as are also some of the nerve fibers, and in the
 brain, forms the outer gray layer, as well as the grayish
 matter internally, the  gray substance of the spinal cord,
 and of the sympathetic ganglia.  Nerve cells are very
 minute bodies, shown by the  microscope  to be composed
 of three or  four cells one  within another.  Owing to this
 structure it has been surmised that nerve force is generated
 in the same  manner as  is  electricity in a Groves' cup.
 Passing from this cell is  a gray nerve fiber, which usually
 goes to a nerve granule, from which the white nerve fibers
 arise.   All the white nerve structure  of the brain  and
 spinal  cord, as well  as  the nerve trunks, is composed of
 minute nerve fibrillse from the 3^ to y^ of an inch in
 diameter.  They possess but little consistence in the nerve
 centers, and are in consequence, traced with difficulty, but
 in the nerve trunks they receive an investment of fibrous
 tissue  which  gives  them great strength.  A nerve  fibril
 commences at a nerve cell, and passes to its termination at
 the surface of the body  without  change of size; a nerve
 trunk  being  composed  of multitudes  of these fibrils, is
 said to send branches to various parts, but the single fibril
 passes directly from its origin  to its termination.
   In the cerebro-spinal system, nerves are divided into two
 classes, nerves  of sensation, and nerves of motion.  The
 first convey impressions  from  without  to the brain, while
 the second carry the commands of the brain to the various
 muscles of the body.
   The brain is the large  nervous mass  contained within
the cranium,  weighing from  two and a  half  to  three
pounds.  It is invested by three membranes—an external
dense fibrous membrane  called the dura mater; a middle
serous  membrane, composed  of two  layers,  forming a 
92
THE NERVOUS SYSTEM.
shut sac, the arachnoid, and an internal vascular, consist-
ing principally of blood-vessels, which penetrate the brain
in all directions.   It is ovoid in form, somewhat flattened
at its base, which is marked by several depressions, some
of which are caused by  the configuration  of the bones
of the cranium, while  others mark its division into differ-
ent parts.  Passing from  before, backward, is  a  large
fissure of considerable depth, which divides it into two
hemispheres.  It is, in fact, two brains connected together
by nerve fibers.
           Fig. 7.              The brain is divided into
                                      a superior portion
                                      called the cerebrum,
                                      a posterior portion
                                      the cerebellum, and
                                      several parts at the
                                      base termed senso-
                                      ry  ganglia.   The
                                      cerebrum seems to
                                      be composed  of a
                                      nervous mem-
             the  brain.             brane  folded  to-
A section in the median line, showing the structure  Cfefher  the  folds
           of one hemisphere.               ° m    '
                                      being called  con-
volutions, which are distinctly marked.   The external sur-
face of the convolutions is  composed of °t?.^ substance  the
internal of white. The two hemispheres of the cerebrum are
connected together by a large mass of white substance—the
corpus callosum—beneath which are several cavities called
ventricles.   The  cerebellum is situated under the posterior
part of  the cerebrum, and seems to be formed in a similar
manner, though the convolutions are much smaller.   The
sensory ganglia consist of two nervous masses, of gray and
white substance, on each  side  of  the median line, at the
base  of the brain.  Fibers  of  communication  can  be
readily traced from them to the cerebrum above, and two
 
THE NERVOUS SYSTEM.
9h
large  bundles of  fibers  pass  downward  to  the medulla
oblongata, and are termed the crura, or legs of the brain.
The cerebellum also communicates with the medulla  at
the same point.   This brief and imperfect description  of
a very intricate  organ, must be assisted and interpreted
by the acccompanying cuts.
  The spinal cord  passes downward from  the  medulla
oblongata through  the entire  length  of the spinal canal,
sending nerves in this course to all parts of the body.  It
is composed of white nerve fibers passing from the brain,
and of gray nerve substance from  which other nerve
fibers arise.   It is thus, in part, a mere nerve trunk, and in
part a nervous center, in which nerve force is generated.  It
also has  three envelops,  or cOats, like the brain, though
the interna], instead of being vascular, is fibrous.
  AVe wish, now, to briefly consider the function of these
various  parts, a subject of  no little difficulty.  Kirkes
remarks, that, " taking together all the parts of  the cere-
bro-spinal nervous system, except the  cerebral hemi-
spheres, they appear to include the apparatus, 1st, for the
direction and government  of all the  unfelt and involun-
tary movements of the parts  which they supply; 2d, for
the perception of sensations; and  3d, for the direction  of
such instinctive and habitual movements as do not require
the exercise  of judgment,  deliberation, memory, or any
other intellectual act.   The medulla oblongata and spinal
cord have their office in none but involuntary and uncon-
scious movements; but above the  medulla, the pons, and
other organs, appear capable of such  conditions as the
mind may perceive, and of being, by the will, excited to
the production of orderly and voluntary movements.
  " As regards the cerebral hemispheres, they are those of
the organs by which the mind, first, perceives those clear and
more  impressive sensations which it can retain, and judge
according to; secondly, performs those  acts of will, each
of which requires a deliberate, however quick, determina-
tion ;  thirdly, retains impressions  of  sensible  things, and 
94               THE  NERVOUS SYSTEM.

reproduces them  in  subjective  sensations  and  ideas,
fourthly,  manifests  itself  in  its higher  and  peculiarly
human emotions and feelings, and in its faculties of judg-
ment, understanding, memory, reflection, induction and
imagination, and others of the  like class.  The cerebral
hemispheres appear thus to be the organs in and through
which the mind acts, in all these its operations, which have
immediate relation to external and sensible things."
  Kme pairs of nerves arise from the brain, and thirty-
one from the spinal  cord.  Of those from the brain, the
first and second, a branch of the fifth, and part of the sev-
enth, are  nerves of special sense, and are distributed to
the nose—olfactory; to  the  eye—optic;  to the  tongue—
gustatory; and to the ear, auditory.  The  third and fourth
nerves pass to the muscles of the eye; the fifth, or trifacial,
is  the  sensitive nerve  of the face; the  sixth passes to a
muscle of the eye ;  a part of the  seventh is distributed to
the face; the eighth is  composed of three nerves, glosso-
pharyngeal, distributed to the throat and tongue, pneumo-
gastric, which governs the action  of the respiratory appa-
ratus, and sends branches to the  heart and stomach, and
spinal accessory distributed to the neck.   The ninth pair
of nerves, or hypoglosal, are distributed to the muscles of
the tongue.   The thirty-one spinal nerves  supply all the
voluntary muscles below the  head, and  furnish sensitive
nerves to all parts of the system except the face.
  The sympathetic or organic system of nerves, consists of
two nervous cords, situated on the anterior surface of the
spinal column, and which have certain enlargements upon
them  termed  ganglia.   These ganglia are thirty-three in
number on each side, and are composed of nerve cells and
granules, doubtless furnishing the nerve-force for this sys-
tem.  As before remarked, the  sympathetic nervous sys-
tem supplies the organs of digestion, secretion and excre-
tion, the blood-vessels, and undoubtedly control the nutri-
tion of the  body.  The  sympathetic  nerves  are  very
intimately connected  with the  spinal cord, by fibers of 
THE  NERVOUS  SYSTEM.
95
Fig. 8.
                    NERVOUS  SYSTEM.
  1, Cerebrum.   2,  Cerebellum.   3,  Facial  Nerve.   4, Spinal  Cord.   5,
Brachial Plexus.  6, Internal Cutaneous Nerve.  7, Median Nerve.  8, Uln.ir
Nerve.  9,  Intercostal Nerves.  10, Lumbar Nerves.   11, Sciatic Nerve.  12,
Peroneal Nerve.  13, Posterior Tibial Nerve.  15, Anterior Tibial Nerve. 
96
PHRENOLOGY.
communication;  hence the intimate sympathy between
the two.
                   PHRENOLOGY.

 • Before leaving this  subject it will be  expected that I
give an opinion upon the " science  of the  mind," about
which so  much has  been said of late years.   That the
principles  of phrenology are true there can be no doubt,
and they are admitted by all educated men.   But the de-
tails of it, as the  mapping out of the various minute or-
gans upon the skull, and proposing to determine them by
the elevations and  depressions of bone, is most certainly,
to  some extent, a humbug.   It is very difficult to separate
the true from the false, and when truth is burthened  with
falsehood, the probabilities are that at first it will be rejected.
Phrenologists can determine the general charater of an in-
dividual, but they do it by the general configuration of his
head, rather than from bumps.
         Fig. 9.            Figure 9, from  a phrenologi-
                         cal work, illustrates the opinion
                         I have just expressed; it  pre-
                         sents  six divisions,  each of
                         which can be distinctly defined,
                         not  by  any  perceptible eleva-
                         tion, but  by its proportionate
                         dimensions   compared   with
                         other parts.  The first division,
                         embracing the forehead imme-
                         diately above the eyes, contains
                         the  perceptive faculties, and its
size  and prominence is a pretty accurate index of the in-
tellect.  The division immediately above, forming the up-
per part of the forehead, is determined to be the seat of
reason. The upper and anterior division embraces the moral
sentiments, and gives elevation to character.  Immediately
below  this,  we have a group  of faculties that might be
denominated,  semi-intellectual  sentiments.   Still, below
 
PHRENOLOGY.
97
 this, and surrounding the ear, we find the selfish propen-
 sities.   The posterior division  embraces the domestic pro-
 pensities;  and the last division at the upper and posterior
 part of the head, the selfish sentiments.
   Whilst  I doubt the possibility of making those minute
 divisions that are  described by phrenologists, we must ad-
 mit that the brain contains  all the organs they describe,
 if not more.  The only difficulty I see, is the determining
 of them by  perceptible  elevations or depressions  of the
 bones of the  cranium.   There is no doubt that the bones
 are moulded by the brain beneath,  and  that they change
 their  form as it  changes its shape, but as yet I have not
 been able to see  the  minute  elevations and depressions
 mentioned.  The  following from Chambers' Information
 for the People, will give the principles of phrenology in
 brief:
 " THE PRIMITIVE FACULTIES OF MIND, AS CONNECTED WITH THEIR
                  ORGANS IN THE BRAIN."
   " Alind, which was considered by the metaphysicians as a
 single thing or essence, was said by them to be capable of
 being in  different states, in each of which state it made
 one of its various manifestations, as memory,  judgment,
 anger, etc. In no particular  does the phrenological hy-
 pothesis differ  more from the metaphysical than in this.
 The phrenological doctrine is, that the brain, the organ
 of the  mind, is divided  into  various faculties,  each of
 which has its  own mode of acting.  It is held—
   " First. That by accurate observation of human actions,
 it is possible to discriminate the dispositions and intellec-
 tual power of man, such  as love, anger, benevolence, ob-
 servation, reflection, etc.
   " Second. That the true form of the  brain can be ascer-
 tained  from  the  external form of the» head; the  brain,
 though the softer substance, being what rules the shape
of the  skull, just as a shell takes its form from the animal
within.
  " Third.  The organs or parts into which the  brain , is
           7 
93
PHRENOLOGY.
divided, all  of which organs are possessed by every indi-
vidual except in case of idiocy, appear on the brain's sur-
face in folds or convolutions, somewhat like  the bowels or
viscera of an  animal, but have  a well ascertained fibrous
connection through the whole substance of the brain with
one point at  its base,  called the medulla oblongata, which
unites the brain to the spinal cord.  The organs have thus
each a  conical form from  the  medulla oblongata to the
surface; the whole being not inaptly compared to the stalks
and flower  of  a cauliflower.
  " Fourth. The brain is divided into two equal parts called
hemispheres; on each side of the  fosse or division between
these hemispheres the same  organ  occurs;  all the organs
are therefore  double,  in analogy with the eyes, ears, etc.
But when the  term organ is used, both organs are meant.
The organs which are  situated  close to the middle line
drawn vertically  on the head, though close to each other,
are nevertheless  double;  for  example, Individuality, Be-
nevolence, Firmness, etc.
  " Fifth. Besides the  brain  proper, there  is a  smaller
brain, attached to the hinder part of the base of the brain,
called the cerebellum.
  " Sixth. The brain, including the cerebellum, is divided
into the  anterior,  middle, and posterior lobes.   The cerebel-
lum forms part  of the posterior lobe.  The anterior lobe
contains  all the  intellectual faculties; the posterior and
lower range of the middle lobe are the regions of the an-
imal propensities; while  the moral sentiments are found,
with a sort of  local pre-eminence, to have their organs de-
veloped on the top or coronal surface  of the head."
  Figure 10 represents the  location of the  various facul-
ties of the mind,  as designated by phrenologists, and time,
which proves all things, has given conclusive evidence of
its  general correctness.  Some persons claim to have that
skill in manipulation, and delicacy of  touch, that they can
determine the  exact character of an individual by the con-
tour of each  individual organ.   AftThilst  doubting this, I 
PHRENOLOGY.
99
readily admit that a person  skilled in phrenology can de-
tect the general character and intellectual standing of most
individuals.
                        Fig. 10.
**
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26
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Ms,
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131
*3
No. 1, Animal Sensibility. No. 8, Yitativeness.
"  2, Muscular Motion.
"  3, Amativeness.
"  4, Pneumativeness.
"  5, Alimentiveness.
"  6, Hydrativeness.
"  7, Sanativeness.
 9, Philo-ancestry.
10, Philo-progenitiveness.
11, Inhabitiveness.
12, Adhesiveness.
13, Gregariousness.
14, Combativeness. 
100
PHRENOLOGY.
No. 15, Destructiveness.	No. 33, Individuality
" 16, Acquisitiveness.	" 34, Form.
" 17, Secretiveness.	" 35, Size.
" 18, AVatchfulness.	" 36, Weight.
" 19, Cautiousness.	" 37, Color.
" 20, Resentfulness.	" 38, Order.
" 21, Approbativeness	" 39, Number.
" 22, Self-Esteem.	" 40, Eventuality.
" 23, Firmness.	" 41, Locahty.
" 24, Conscientiousness.	" 42, Time.
" 25, Submissiveness.	" 43, Melody.
" 26, Hopefulness.	" 44, Plan.
" 27, Benevolence.	" 45, Comparison.
" 28, Imitativeness.	" 46, Casuality.
" 29, Marvellousness.	" 47, Method.
" 30, Perfectiveness.	" 48, Harmony.
"' 31, Common nouns.	" 49, Analogy.
" 32, Proper nouns.	" 50, Suggestion.
	" 51, Evidence.
  There is nothing more  clearly established  than that
every function of the brain may  be increased  or dimin-
ished by exercise, or want of use.  This is in accordance
with  the general law, that any part that is continually
called into action, receives a  more  abundant  supply  of
blood, its nutrition is increased, and it becomes larger.
The brain is  no exception to this rule, as it increases in
size and density in proportion to its use; and any portions
that are called into action more frequently than others,
obtain a proportionately greater development.  AA"e have
heretofore seen that a group of muscles would increase in
size by use, of which we have very marked  examples  in
the arm of the blacksmith, and the legs of public dancers.
And  it is a  well known  law  of our being, that parts
increase  in size and strength to meet all  legitimate de-
mands upon them.  Conversely, we find that parts dimin-
ish in size, and lose their function by want of use.  Thus 
PHRENOLOGY.
101
 we have reported instances in which  Eastern Fakirs, by
 retaining their arms in one position for years, would finally
 lose the use of them.
   AVe have very marked examples of this natural law, in
 the  occasional development  of the  special senses.  A
 sailor is  able to see a ship in the distance, and even deter-
 mine its size, character and nationality, when a landsman
 would be unable to perceive any object, or, at least, very
 indistinctly.   A musician has  so developed his organ of
 hearing,  that he is enabled to detect the most  minute
 variations in sound;  and the Indians, and even white
 hunters, so cultivate this sense  that they are enabled to
 hear  sounds  that are entirely inappreciable to the unedu-
 cated ear.
   The various functions of the brain may be increased or
 diminished;  and this is a matter of very great interest to
 parents,  educators, and to each individual.   Each person's
 destiny is, to some extent, in his own  hands, and he has
 the power of development in an  almost unlimited extent.
 Does  he  wish to  be learned—continued  exercise  will
 develop  observation, the reasoning faculties, and memory,
 almost as far  as may be desired by the most sanguine.
 Does he wish to influence the  people by oratory—careful
 cultivation and exercise will, as was the case with Demos-
 thenes, give power and freedom of speech.
   Exercise not only gives increased power to an organ or
 function, but as this depends  upon  an increase of struc-
 ture, it is, to a very considerable extent, permanent.  Thus
 the boy  who continues  to  give way to, or, as we might
 more properly  say, cultivate  his  evil propensities,  will
 invariably become a bad man, and if this is continued up
 to the age of forty or fifty, a reformation will be almost
 impossible.   Even at a much earlier age it will be found
 very difficult to break off bad habits, and the evil disposi-
 tion will  continue to  annoy the individual as long as he
may live.   On the contrary, if the moral faculties are cul-
tivated, they  become stronger year by year, until they so 
102
PHRENOLOGY.
predominate that the man  is a good man almost in spite
of himself.
  Spurzheim remarks  that, "in the greater number of
persons, the lower faculties  are the most active, and  sev-
eral of them more so than others.   This explains the great
activity of the  animal nature of  man.  Again, single
individuals, each of the sexes, the  inhabitants  of certain
provinces, and whole nations, possess individual faculties
more  active than  others.  These  primitive  dispositions
must first be  studied, and each power cultivated in har-
mony with the dictates of general morality.   Any feeling
that is naturally  too  active, should  never be exerted.
Hence, in those children, and nations, whose  character is
strongly marked by the  love of approbation, this feeling
should never be nourished by education; for, if predom-
inant, it becomes the  cause  of great mischief, and it is
evidently a great fault  to encourage it continually, and to
hold out approbation and glory as the  principal  reward
of any action.
  " On the other hand, no strong feeling can be overcome
at once; its activity will appear in  one way or another,
and the object of the  teacher or parent ought to be, to
make the  best use  of  it.  The love of approbation,  for
instance, may lead to war or peace, to idleness or industry,
to vice or virtue, according to the object approved by the
directors.  It is  the same with any fundamental power.
Has not  every  crime been committed, and  every virtue
exercised, under pretence of glorifying God, or of obeying
God rather than men ?
  " The faculties proper to man being given to govern
every where, are to be cultivated incessantly, and in every
one, while the powers common to man and animals, should
be encouraged only in so far as they  contribute to  the
great  end  of the satisfaction  of  the properly  human
nature,  or to general  happiness.   The animal faculties
may be  employed  as  means, but not any  one should
become the  aim of our  existence.  They may do good, 
                     PHRENOLOGY.                  103

when subordinate, but they produce much evil, as soon as
their gratification becomes the aim of life.  It is remark-
able, that all institutions, true Christianity excepted, are
founded on  selfish principles, and that by far the greater
number of the motives, which they propose to mankind,
originate in  the animal feelings."
  Youth  is  the proper time for the commencement of
proper mental  training, and  for the development of the
higher faculties, and repressing, by the influence of the
will, the baser  passions.  It  should  be  firmly impressed
upon the young that they hold their destiny in their own
hands, and that they have  the power, inherent in  them-
selves, of almost unlimited development.  They can now
so strengthen the will and reasoning powers, that it will
be sufficient to regulate the mind through  life.   Con-
versely, they should understand that the animal passions
and instincts may obtain such preponderance, if they now
give way to  them, as will render this  life  a  failure, and
entirely unfit them for happiness in the life to come.
   There are no persons but what may become good men
and women, as there are none but what  might sink to the
level  of the  brute, or  become devils in human form.  In
each  case the development is strictly in accordance with
natural laws of growth by exercise, and if we had none
other, this would be sufficient  evidence of the truth of
Holy AVrit.   AVIiile, then, we should set before the young
the fact that their success in life is wholly in their own
hands, they  should be impressed that they are developing
characters that endure through all eternity.  The spiritual
man  has form and  size  like the natural man; and its
development and growth is going on day by day, by the
exercise of the mind in  this life.  If the better principles
of our nature are exercised, they increase in strength; if
the animal passions  are exercised, they  also increase—in
the one case forming a  character that  will do good, and
get good, in this world  and the world to  come; and in 
104
EXAMPLE.
the other that will do evil, and get evil, and fit the person
for the society of evil spirits.
EXAMPLE.
   Example  is  one of the  most  potent  of instructors,
though it  teaches  without a  tongue.  It is  the practi-
cal school of mankind, working  by .action, which is al-
ways more  forcible  than words.  Precept may point to
us the way,  but it is silent, continuous example, conveyed
to us by habits, and  living with us, in fact, that carries us
along.  Good advice has its weight; but without the ac-
companiment of a good example, it is of comparatively
small  influence; and it will be found  that the common
saying of " Do  as  I  say, not as I do," is usually reversed
in the actual experience of life.
  All  persons  are more or less apt to learn through the
eye,  rather than the  ear;  and, whatever is seen  in  fact,
makes far deeper impressions than anything that is  read
or heard.  This is especially the case in early youth, when
the eye is the chief inlet of knowledge.  Whatever child-
ren see they unconsciously  imitate; and  they insensibly
become like to those who are about them—like insects
which take the color of the leaves they feed on.  Hence
the vast importance of domestic training.  For whatever
may  be the efficiency of our schools, the examples  set in
our  homes must always be of vastly greater influence in
forming the characters of  our future men  and women.
The  home  is the crystal of society—the very nucleus of
national character; and from that source, be it  pure or
tainted, issue the  habits, principles  and maxims, which
govern public as  well as private life.  The nation comes
from the nursery; public  opinion itself is for the most
part  the outgrowth of the home; and the best philanthropy
comes from the  fireside.  -To  love the  little platoon we
belong to in society," says Burke, "isthe germ of all  pub-
lic affections."   From this little central spot, the human 
EXAMPLE.
105
sympathies may  extend in an ever-widening circle, until
the  world is  embraced; for, though true philanthropy,
like charity, begins at home, assuredly it does not end there.
   Example in conduct, therefore, even in apparent trivial
matters, is  of no light moment, inasmuch as it  is con-
stantly becoming inwoven with the lives of others, and
contributing  to form their characters for better  or  for
worse.  The characters of parents are thus constantly re-
peated  in their children; and the acts of affection, disci-
pline, industry and self-control, which they daily exemplify,
live  and act when all else which they may  have learned
through the ear has long been forgotten.   Even the mute
action and unconscious look of a parent may give a stamp
to the character which is never effaced;  and who can tell
how much evil has been  stayed by the thought of some
good parent, whose memory their children  may not sully
by the commission of an unworthy deed, or the indulgence
of an  impure thought?  The veriest trifles  thus become
of importance in influencing the characters of men.  "A
kiss from my mother," said AVest, " made me a painter."
It is on the direction of such seeming trifles when children,
that the future happiness and success of men mainly de-
pend.   Fowell Buxton, when occupying an  eminent and
influential station in life,' wrote to his mother,  " I constantly
feel, especially in action and exertion for others, the effects
of principles early implanted by you in my mind;" and
Lord Langdale, looking back upon the admirable example
in life set him by his  mother,  declared,  "If the  whole
world were put into  one  scale, and my mother  into the
other, the world would kick the beam."  Mrs. Schimmel
Pennick, in her old  age, was accustomed to call to mind
the personal  influence exercised by her mother upon the
society amid which she moved.  When she entered a room
it  had the effect of  immediately raising the tone  of the
conversation, and as if purifying the  moral atmosphere—■
all seeming to breathe more freely, and stand  more erectly.
" In  her presence," says the daughter, " I became for the 
106                    EXAMPLE.

time  transformed into another  person."  So  much does
the moral health depend upon the moral atmosphere that
is breathed, and so great is the influence daily exercised by
parents over their children by  living a life before their
eyes, that perhaps the best system of parental  instruction
might be summed up  in these two words: " Improve thy-
self."
  There is something solemn  and awful in the thought,
that there is not an act nor thought in the life of a human
being but carries with it a train of consequences, the end
of which we may never trace.  Not one but, to a certain
extent, gives a color  to our  own life, and  insensibly in-
fluences  the lives of  those about us.  The good deed or
thought will live, even though we may not see it fructify,
but so will the bad ; and no person is so insignificant as
to be  sure that his example will  not do good on the one
hand, or evil on  the other.   There is, indeed, an essence
of immortality in the  life of man, even  in  this world.
No individual  in the  universe  stands alone; he is a com-
ponent part of  a system of mutual dependencies; and by
his several acts, he either increases or diminishes the sum
of human good now and forever.   As the present is rooted
in the past, and the lives and examples of our forefathers
still to a great extent influence  us> so  are we by our daily
acts contributing to form  the condition and character of
the future.  The living man is a fruit formed and ripened
by the culture of  all the foregoing centuries.  Generations
six thousand years deep stand behind  us, each laying its
hands upon its successor's  shoulders, and the living gene-
ration continues the  magnetic current of action and ex-
ample destir ed to bind the remotest past with the most
distant future.  No  man's acts  die utterly; and though
his body may  resolve into dust and air, his  good or his
bad deeds will still be bringing forth fruit after their kind,
and influencing generations of men for all time to come.
It is in this  momentous and solemn fact that the great
peril and responsibility of human existence lies.—Smiles. 
VALUE OF PERSEVERANCE.
107
           VALUE OF PERSEVERANCE.

  It is not accident, then, that helps a man in the world,
but purpose and persistent industry.  These make a man
sharp to discern opportunities, and turn them to account.
To the feeble, the sluggish and  purposeless, the happiest
opportunities avail nothing ;  they pass them by, seeing no
meaning in them.  But if we are prompt to seize and im-
prove even the shortest intervals of possible  action  and
effort, it is astonishing how much can be accomplished.
Watt  taught himself chemistry and  mechanics  while
working at his trade of a mathematical instrument maker;
and he availed himself of  every opportunity to extend his
knowledge of languages, literature and the principles of
science.  Stephenson taught himself arithmetic and men-
suration while working as an engineman during the night
shifts, and he studied mechanics during his spare hours at
home, thus preparing  himself for the  great work of his
life—the invention of the passenger locomotive.  Dalton's
industry was the habit of his life.  He began in boyhood,
for he  taught a little village  school when he was only
about twelve years old, keeping the school  in  winter, and
working upon  his father's farm  in summer.  He would
sometimes urge himself and  companions to study by the
stimulus of a bet, though  bred a Quaker; and on one oc-
casion, by his satisfactory solution of a problem, he in this
way won as much as enabled him to buy a winter's store
of candles.  He went on indefatigably, making his mete-
orological observations until a day or two before  he died,
having  made  and recorded  upward of 200,000  in the
course of his life.
  With perseverance, the very odds and ends of time may
be worked up into results of the greatest value. An hour
in every day withdrawn from frivolous pursuits would, if
profitably employed, enable any man of ordinary capacity
very shortly to master a complete science.  It would make
an ignorant man a well-informed man in ten years.   AYe 
108
VALUE OF PERSEVERANCE.
 must not allow the time to pass without yielding fruits,
 in the form of something learned worthy of being known,
 some  good  principle  cultivated, or  some  good  habit
 strengthened.   Dr.  Mason  Good translated  Lucretius
 while riding in his carriage in the streets of London, going
 his rounds  among  his patients.  Dr.  Darwin  composed
 nearly all his works in the same way, while driving about
 in his "sulky" from house to house in the  country, writing
 down his thoughts on little scraps of paper, which he car-
 ried about with him for the purpose.  Hale  wrote his'
 " Contemplations" while  traveling  on  circuit.  Dr.  Bur-
 ney learned French and  Italian while traveling on horse-
 back from one musical pupil to another in the  course of
 his profession.  Kirke  White learned Greek  while walk-
 ing to and  from a  lawyer's  office; and we personally
 know a man of eminent  position in a northern manufac-
 turing town, who learned Latin  and  French  while going
 messages as an  errand-boy in the streets of Manchester.
  Elihu Burritt attributed his first success in self-improve-
 ment, not  to  genius, which he disclaimed, but simply to
the careful  employment of those invaluable fragments of
time, called "odd moments."   While working and earning
his living as a blacksmith, he mastered some  eighteen
ancient and modern languages, and twenty-two  European
dialects.  Withal, he was exceedingly modest, and thought
his achievements nothing extraordinary.  Like another
learned and wise man, of whom  it was said that he could
be  silent in  ten  languages, Elihu  Burritt  could  do
the same  in forty.  " Those who  have  been acquainted
with my character from my youth up,"  said he, writing to
a friend, "will give  me  credit for sincerity,  when  I say
that it never entered  into my head to blazon forth any ac-
quisition of my own.  *  *  *  All that I have accom-
plished,  or expect, or hope to  accomplish has been  and
will  be  by that plodding, patient, persevering process of
accretion which builds the ant-heap—particle by particle,
thought by thought, fact by fact.  And if  ever  I was 
VALUE OF PERSEVERANCE.
109
actuated by ambition, its  highest and warmest aspiration
reached no farther than the hope to set before the young
men of  my country, an example in employing those in-
valuable fragments of time called ' odd moments.'"
  Daguesseau, one of the great Chancellors of France, by
carefully working up his odd bits of time, wrote a bulky
and able volume in the successive intervals of waiting for
dinner;  and Madame de  Genlis  composed several of her
charming volumes while waiting for the princess to whom
she  gave  her daily lessons.   Jeremy  Bentham in like
manner disposed of his hours of labor and repose so that
not a moment should be lost, the  arrangement being de-
termined on the principle that  it is a calamity to lose the
smallest portion of time.   He lived and worked habitually
under the practical consciousness that man's  days  are
numbered, and that the  night cometh  when no man can
work.
  AATiat a solemn and striking  admonition to youth is
that inscribed on the dial at All  Souls, Oxford—"periunt
et imputantur"—the hours perish, and are  laid to  our
charge; for time, like life, can never be recalled.  Melanc-
thon noted  down  the time lost by him, that  he might
thereby re-animate his  industry and not lose an hour.  An
Italian scholar put over his door  an inscription intimating
that whosoever  remained there,  should join in his labors.
"AYe are afraid," said some visitors to Baxter, " that we
break in upon your time."  " To be  sure you do," replied
the disturbed and blunt divine.   Time was the estate out
of which these  great  workers,  and all  other workers,
carved  a rich inheritance of thoughts and deeds for their
successors.
  The mere drudgery undergone by some men in carrying
on their undertakings has been something extraordinary,
but the  drudgery they  regarded  as the price of success.
Addison amassed as much as three  folios of manuscript
materials  before  he began his  "Spectator."  Newton
wrote his " Chronology " fifteen times over before he was 
110
SELF-CULTURE.
 satisfied with it; and  Gibbon  wrote out his "Memoir"
 nine times.  Hale  studied for many years at the rate of
 sixteen hours a day, and when wearied with the study of
 the law, he would recreate himself with  philosophy and
 the study  of the  mathematics.  Hume   wrote  thirteen
 hours  a day  while preparing his " History of England."
 Montesquieu, speaking of one part of his writings, said to
 a friend, " You will read  it in a few hours;  but I assure
 you it  cost me so much labor that it has whitened my
 hair."
  The  practice  of writing down thoughts  and facts for
 the purpose of holding them fast, and preventing  their
 escape into the dim region of forgetfulness, has been much
 resorted to by thoughtful and studious men.   Lord Bacon
 left behind him   many  manuscripts,  entitled " Sudden
 thoughts set down  for use."  Erskine made great extracts
 from Burke; and Eldon copied Coke upon Littleton twice
 over with his own  hand, so  that the book became, as it
 were, part of his own  mind.   The late Dr.  Pye Smith,
 when apprenticed  to his father as a book-binder, was ac-
 customed to make copious memoranda of  all the books he
 read, with  extracts and criticisms.   This  indomitable in-
 dustry in collecting  materials distinguished him through
life, his biographer describing him  as " always  at work,
always  in  advance, always accumulating."   These note-
books  afterward proved,  like  Richter's  " quarries," the
great store-house from which  he drew his illustrations.—
 Smiles.

                  SELF-CULTURE.

  Self-culture  includes the education  or  training of all
parts of a man's nature, the physical and moral, as well
 as the intellectual.  Each must be developed, and yet each
must yield  something to satisfy  the claims of the others.
 Cultivate the physical powers exclusively, and you  have
 an athlete or a savage; the moral only, and you  have an
 enthusiast or a maniac; the intellectual only, and you have 
SELF-CULTURE.
Ill
a diseased oddity, it may  be a monster.  It is only by
wisely training all three together, that the  complete man
can be formed.
  The ancients laid great stress on physical training, and
a sound mind in a sound  body was the end which they
professed to  aim  at  in their highest schools of culture.
The Greek teachers were peripatetic, holding that  young
men should  only  learn what they could learn standing.
The old English entertained a similar idea, embodied in
the maxim, " The field in  summer, the study in winter."
Milton described himself as  up and stirring  early in the
morning—"in winter, often ere the sound of any bell
wakes man to labor or devotion; in  summer, as oft with
the bird that first rouses, or not much tardier, to read good
authors, or to cause them to be  read till the attention  be
ready, or memory have its  full fraught; then, with clear
and generous labor, preserving the body's health and
hardiness,  to render lightsome, clear, and not lumpish
obedience to the mind, to  the  cause of religion, and our
country's  liberty."  In his  Tractate  on  Education,  he
recommends the physical  exercise of fencing to  young
men, as calculated to " keep them healthy,  nimble, strong,
and well in breath, and also as the likeliest means to make
them grow large and tall, and inspire them with a  gallant
and fearless courage," and  he further  urges that they
should " be practiced in all the  locks and grips of wrest-
ling, wherein Englishmen were wont to excel."
  In our day such exercises have somewhat fallen into
disrepute,  and education  has  become more  exclusively
mental, very much to the detriment  of the bodily  health.
The brain is cultivated at the  expense of the members,
and the physical  is usually found  in an inverse ratio  to
the intellectual appetite.  Hence, in this age of progress,
we  find  too  many stomachs weak as blotting-paper—
hearts indicating " fatty degeneration"—unused, pithless
hands, calveless legs and limp bodies, without any elastic
spring in ,them.  But it is  not merely health that  suffers 
 112           THE HUMAN  TEMPERAMENTS.

 by neglect and disuse of the bodily organs.   The mind
 itself grows sickly and distempered, the pursuit of know-
 ledge itself is  impeded, and manhood becomes withered,
 twisted, and stunted.  It  is, perhaps, to  this  neglect of
 physical exercise that we find among students so frequent
 a tendency toward discontent, unhappiness, inaction, and
 reverie, displaying itself in a premature contempt for real
 life, and disgust at the beaten tracks of men—a tendency
 which in England has been called Byronism, and in Ger-
 many Wertherism.  Dr. Channing noted the same growth
 in America, which led him to make the remark that " too
 many of our young men grow up in a school of despair."
 The only remedy for this green-sickness of youth is abun-
 dant physical exercise, action, work, and bodily occupation
 of any sort.—Smiles.

          THE HUMAN TEMPERAMENTS.

  For two thousand years the temperaments have been a
 subject of study with  physicians  and  educated  men,
 though but little  progress had been made from the days
 of Hippocrates up to the present century.   My  friend, AY
 Byrd Powell, M. D., who has made this his study for over
 a quarter of a  century, has kindly furnished me with the
 following description, which is  not only interesting to the
 general reader, but should be thoroughly studied by every
 man,  woman  and child, as  it embraces  subjects of the
 greatest importance to our race :
  Hitherto the importance  of  a  knowledge of the  tem-
 peraments was thought to be with exclusive reference to
the practice  of medicine, and that a knowledge of them
 is  highly  inservient in  this relation, no one probably
 doubts, and hence it is much to be lamented that they are
 so little understood as they are by physicians generally.
  But  the great value of a knowledge of the tempera-
ments  is in relation to  the institution of marriage, the
most important known to our species, because a marriage
contracted in  contravention of their laws, is  invariably 
THE HUMAN TEMPERAMENTS.
113
 attended with either sterility, imbecile, epileptic or scrofu-
 lous children.
   With reference to medical practice, a knowledge of the
 temperaments is of great importance to physicians only,
 and their knowledge should be more than descriptive, it
 should embrace a knowledge  of their dynamic  influence
 over the constitution; but  with reference to marriage, it
 is the duty  of every individual,  without distinction of
 sex, to have a descriptive knowledge of them, and  this
 can be achieved by every  clever  Miss or Master of ten
 summers.
   As, with reference to the science of physiological mar-
 riage, a descriptive knowledge of the temperaments is,
 alone, requisite at present, therefore, I will confine myself
 to a description of  them.  With this introduction I  pro-
 ceed with my subject.
   That system of the temperaments which I adopt, with
 one important modification, is known as  the Hippocratic,
 in  honor of  its founder, Hippocrates, who lived in  the
 fifth century before our era, and to the shame of the med-
 ical profession, the  subject has been, comparatively,  but
 little advanced since his time. Hippocrates  treated of
 four conditions or temperaments, as being in  their nature
 elementary, namely, the sanguine, the bilious, the lympha-
 tic,  and the melancholic.   But the  two latter are  not
 strictly elementary.
  AYhat is temperament ?  As I prefer my own definition
 to any other I have seen, I will  respond  in the  language
 of it.  It is  a sui generis mode of  human life compatible
 with health  and longevity.

           I.—The Sanguine Temperament.
  The altitude of the men of this class  may  be said to
 range between five feet ten inches and six feet four inches.
 The flesh is firm and strong.  The  locomotive movements
are graceful, but not particularly supple.  This  tempera-
ment is further distinguished by light hair, fair skin  and
          8 
114
THE HUMAN TEMPERAMENTS.
grayish-blue eyes.   The nose  is rather large, and gener-
ally, to some  extent, it is aquiline, but sometimes it is
straight on the dorsum, or has the Roman form.  But
with the females, generally, it  has the Grecian form—
straight on the dorsum, delicate in size, and beautifully
formed.  The  lips close handsomely in both sexes, and
are of medium thickness; the superior one  is more full
and prominent than the inferior.
                                indicate the highest de-
gree of this temperament; but this, I am sure, is an error.
  Note.—Aristotle  has stated it as a law that parties of
the respective sexes having light hair, fair  skin and blue
eyes,  should not marrry,  because sterility  will be  the
result.  This is satisfactory evidence to  me that he knew
as little  about this subject  as physiologists generally do.
Now the truth is, our species presents four  temperaments,
which are  respectively distinguished by light hair,  fair
skin and blue eyes, and yet, in constitution, they are very
different.  Consequently, some of the most  fruitful  and
physiological marriages obtain among them.   Is it, how-
ever, a law, that when the respective parties to a marriage 
THE HUMAN TEMPERAMENTS.
115
are sanguine, sterility will be the result; and as an illustra-
tion of this law I may cite Washington and his wife, who
respectively were sanguine and sterile.

            II.—The Bilious Temperament.
                              In this temperament the
          Fig. 12.           men, generally, are neither
                            so tall nor heavy as those
                            of the preceding  tempera-
                            ment.  The person and fea-
                            tures of this  variety  of our
                            species  are  angularly  and
                            harshly defined.  Of  this
                            temperament we have  two
                            varieties; one is distinguish-
                            ed by black and coarse hair,
  OUBTAVUB ADOLPHUS.    ^^  br0WQ  eyeg?  and  ft
dark or brownish complexion.  The other variety  is  dis-
tinguished by red  and  coarse hair, a florid  complexion
and grayish-blue eyes—in this variety  the  skin,  when
excluded from the light, is  very fair.  In both of these
varieties the skin is coarse on the breast, arms and legs of
the men, and covered with coarse hair.
   With this temperament, without  distinction of variety,
the forehead recedes and  contracts  laterally as it rises
above  the temples,  and the brain in general is developed
obliquely upwardly, and backwardly, the flesh is  very
firm, and the locomotion is  quick  and supple, but not
graceful.  The nose,  usually, is above the average size,
and very frequently aqueline  in form, but occasionally it
has the Roman form, and occasionally the Grecian;  this
last form is the most common to the females.  The supe-
rior lip is more full or prominent than the inferior.
  As I have stated in connection with the sanguine, so of
this, there are in our species four  dark  complexioned
temperaments.   The bilious forms a  compatible marriage
with the opposite sex of either of the other three;  but
 
116
THE HUMAN TEMPERAMENTS.
when both  of the parties to a marriage are bilious, ster-
ility is  the  consequence;  and as  an illustration of this
law I may cite Gen. Jackson  and  his wife, who, respect-
ively, were bilious and without children.
          III.—The Lymphatic Temperament.
  This temperament has no distinguishing complexion, it
may be either fair or dark, some physiologists to the con-
trary  notwithstanding.  It is  distinguished, however, by
a large  and globular head, fine hair, an exceedingly full
habit of the body, which is soft or flabby, and so amorph-
ous as  to defy  description, but  imagine the  skin of a
short and corpulent man filled with water, and you will
have a pretty fair idea of the external appearance of this
constitution  when fully developed.   The cheeks are large
and ponderous, the eyes have a sleepy appearance, the nose
is pugged, the lips are thick, and the locomotive move-
ments are slow and waddling.
  Holland and China are the countries in which this tem-
perament  obtains  its highest development.  I think  it
very probable that  no one of my readers will ever see in
this  country a fully  developed individual of this  class.
This temperament, in combination  with those of which I
have treated, the sanguine and the bilious, forms combi-
nations  which are both various and numerous, and withal
useful  and reputable;  although the  lymphatic tempera-
ment is  thought to be  a disgusting sack of humors.  In-
deed I doubt whether the highest order  of human genius
can obtain without some participation of this constitution.
This temperament, though  never  brilliant, will compare,
favorably, with any other for a safe and practical judg-
ment.
  This  temperament is very rarely, if ever, found highly
developed, except in countries having  a humid atmosphere.
          IV.—The EncepJiaZic Temperament.
  This  temperament, like the  preceding,  has no dis-
tinguishing  complexion; it is, however, distinguished by 
THE HUMAN TEMPERAMENTS.           117
a relatively large  cerebrum and  a small  cerebellum, and
consequently a feeble and  tardy manifestation of all the
vital functions.  The thorax  and abdomen are small and
contracted, the muscles slender, stringy and  flaccid, the
locomotion  faltering and dragging.  The person is very
spare, the neck long, the forehead is massive and superiorly
expanded,  the cheek  bones sharp  and  prominent,  the
cheeks  sunken and thin, the nose small, slender and re-
curved, the lips thin, the chin pointed, and the countenance
is thoughtful or even gloomy.  Representatives of this
class  are but rarely to be seen  in any country.   But in
combination with the other temperaments very frequently
obtains.  People of this class feel and think  profoundly
but never powerfully.
  Though this temperament may not be as disgusting as
the lymphatic, yet  it  is as powerless, and in the abstract
of as little use.  People of this class are so liable to mon-
omania that they are probably very rarely entirely exempt
from it.
  This temperament I discovered in 1852.   The fourth
temperament of the ancient physiologists, and denominated
the Melancholic, is thought by modern physiologists to be
a pathological rather than a physiological condition,  and
therefore discarded it.   The condition presented by Pro-
fessor  Gregory, and denominated the  nervous,  is also
thought to be pathological; at all events, it is not an ele-
mentary condition,  but one that is not in all of the tem-
peraments.
  I am very confident that I have given this subject more
observation and study than any other individual ever  did,
or even all others; and thus have become convinced that
humanity is distinguished by four sui generis peculiarities
of constitution, and that they are those I have described.
  The discovery of the  fact that  certain constitutional
conditions or temperaments are so incompatible as to ren-
der marriage very frequently sterile or productive of im-
becile or scrofulous children, must render a knowledge of 
118
THE HUMAN TEMPERAMENTS.
the temperaments of paramount importance.  If there be
any who doubt that such  discovery has been made, they
have but to  exercise a little  observation to become con-
vinced that the fact not only exists, but is most  dis-
tinctively prevalent  in  all parts of  our country.  The
signs of the times  indicate that the  time  is not distant
when public opinion will not tolerate professional igno-
rance of  this subject.  Medical students, therefore, who
possess a laudable ambition and a prudent foresight, will
include  this  subject in their professional studies, and be
prepared to respond to the demands of the public.

         The Origin of Human Temperaments.
  This inquiry is not only interesting, but useful, inasmuch
as  married  parties who are incompatible may frequently
effect a compatibility by knowing how to do it, and those
who are compatible may keep themselves so.
  The four preceding or elementary temperaments do not
probably comprise  more than two per cent, of the popu-
lation of  any civilized country; the remaining ninety-eight
per cent, consist of combinations of the four elementary
ones.  If, therefore, we  understand  the origin of these
four physiological conditions of humanity then of course
we  shall  understand the origin of their combinations, for
it is assumed that  no respectably  intelligent person is en-
tirely ignorant of the laws of reproduction.
  For the sake of convenience and simplification in treat-
ing this subject, I divide the four elementary tempera-
ments into two classes, which I respectively  denominate
the vital and the non-vital.  The sanguine and the bilious
temperaments constitute the first or  vital class, and is so
denominated because observation has  forced upon me the
conviction that without the agency of one or the other of
them, there can be no transmission of life—no re-produc-
tion.  The Lymphatic and the  Encephalic temperaments
constitute the  non-vital class, and is  so  denominated be-
cause as frequently as I have  found the parties to a mar- 
THE HUMAN TEMPERAMENTS.
119
riage to be, respectively, as much as two-thirds or more of
these temperaments, as frequently have I found three-
fourths of their children to have been dead-born, and the
other fourth to have died within the first year of their ex-
istence respectively.
  As I have found  no cause  to be productive of the san-
guine or the bilious constitution, and  as there  can be no
reproduction without the agency of one or the other of
them, so I infer that they were originally founded  in  the
constitution of humanity, and therefore primitive.  But I
am far from being sure that both of them had their origin
in the same species of the race which I regard as a genus.
The two constitutions  are alike in but one respect, and
that is, they are equally reproductive; they are unlike in
their therapeutic relations, they are mentally unlike, and
they are unlike  in  terrestrial relations.   The  sanguine
being especially adapted to high latitudes and the bilious
to the low.  These facts strongly incline me to  the opin-
ion, that the sanguine and bilious temperaments had their
origin in two different, but  allied species of the genus
homo.  I am  disposed to think that  the sanguine condi-
tion had its origin with a  truly white  species, and which
probably originated in Northern Asia, and that the bilious
condition had probably its origin, in or with the Iberian
species, which, in the  opinion  of ethnologists, had  its
origin in Africa, and that  the two  species  emigrating to
more temperate climes, met  and amalgamated, and  that
the present population of Europe and  the United States
descended from this  amalgamation, and  so thorough and
extensive was  this amalgamation that the resulting popu-
lation had a  medium  adaptation, and, therefore,  less
adapted to either extreme of latitude.
  Germany, perhaps more than any  other country, fur-
nishes  an excess  of the white species, and Spain of the
dark.  In Spain, more certainly, perhaps, than any where
else, can still be found  descendants of the Iberian species.
  Physiologists have even regarded the lymphatic tern- 
120
THE HUMAN TEMPERAMENTS.
perament as being both elementary and primitive, but I
can concede neither, for it is compound and  secondary,
having originated in causes which are incidental to civil-
ization.
  I assume, because  universally conceded,  that wealth
results from civilization, and it is  well known that ease,
idleness and  luxury result from wealth or  a  prosperous
condition of society, and that these generate lymph in a
vital constitution, but much more rapidly in a humid than
an arid atmosphere.   I have been  an unceasing observer
in this relation, for thirty-five years, and have known both
sanguine and bilious men, who had given themselves up
to ease, idleness, and their attendant indulgences, become,
in a few years, very obviously, lymphatic.   I do not mean
an obese  condition, but a lymphatic one, for  to me the
difference is unmistakable, but hitherto unobserved. With
the obese condition  the head  does not change in either
form or size; but with  the lymphatic, as lymph accumu-
lates  in  the brain, the  skull loses its  angularity  and
becomes more globular, and the cause of this difference is
easily  explained.   The brain,  equally  with  the  body,
becomes  lymphatic or watery, but  it does not with the
body  become obese.   This lymphatic condition is very
rapidly acquired by  some people, particularly those on
whom was entailed a lymphatic diathesis.  A diathesis to
this condition is entailable, and hence, when a  people  are
prosperous, or in easy circumstances, this condition is not
only produced, but rapidly multiplied.
  With reference to mental activity and enterprise gener-
ally, the lymphatic  condition is greatly preferable to  the
obese; the latter obtuses every faculty.  Those physiolo-
gists err who attribute the  supineness of some  European
potentates to  their lymph;   it is attributable  to  their
obesity.  Fat people  are feeders, but the lymphatic are
drinkers, and those who have  a lymphatic diathesis, and
desire to  avoid a lymphatic  repletion of  the body, must
reduce their fluid ingesta. 
THE HUMAN TEMPERAMENTS.
121
  Some physiologist, name not remembered, has  repre-
sented the Esquimaux as a lymphatic people; but this is
an error of such magnitude that I am ashamed of  it.  A
lymphatic man could not live in that  country, he would
freeze to death about as readily as any other sack of water.
The Esquimaux are a fat people, and fat is  an essential
condition of animal  life in that latitude.  I have five
crania of that people, and  they are all very  similar in
form and size, and as  angular as the  crania of other sav-
age people, and withal have the bilious form.  If  a lym-
phatic man were  to  emigrate to that country, and could
obtain food enough,  he  would, as is common with the
bear, have his lympth replaced by fat in six months, with
the exception of the  brain.  Nevertheless, the obese and
lymphatic conditions are but modifications of the same
fundamental condition, as I infer  from the fact that in
marriage they may replace each other; fat  replaces the
lymph of the bear every  year.
  Finally, the  lymphatic condition is not only secondary
but  adjunctive—a mere addition of  lymph to a primitive
condition—the sanguine  or the bilious.  It should be
remembered that the mere presence of lymph does not
constitute the  lymphatic temperament — the  lymphatic
repletion must be so great as to obliterate all the indices
of the fundamental condition, except the complexion.  If
the lymphatic repletion be on  the bilious element or con-
dition, the  complexion will be  dark; but if  on the  san-
guine, fair.  As the lymphatic repletion imparts no color,
it is  now explained why this temperament has no  distin-
guishing complexion, and  why individual cases may be
either fair or dark.
  The encephalic temperament, like the lymphatic, results
from influences which are  also  incidental to  civilization.
Care, responsibility and mental activity, generally develop
the  cerebrum  or larger  brain, and  sedentary habits or
inactivity of the muscular or respiratory  systems reduce
the cerebellum  or smaller brain, and thus the encephahe 
122
THE HUMAN TEMPERAMENTS.
condition results.  I have observed sanguine and  bilious
men having responsible and sedentary positions in bank-
ing and commercial houses, to become considerably ence-
phalic in, comparatively, a few years.  I have never found
this condition in primitive  peoples, as our Indians.  The
necessity which their condition imposes on them for mus-
cular and respiratory action, as hunters, maintains a high
endowment of the cerebellum;  and their  relations  to
society and property are too few and feeble to develop the
cerebrum.  Hence, that life which distinguishes the wild
horse, the buffalo and the lion, about equally distinguishes
man in his primitive  condition.   Furthermore, the ence-
phalic temperament does not obtain with our frontier pop-
ulation except by emigration and entail.
  As a mere increase of one portion of the brain  to the
neglect  of another  can produce no  modification  of the
complexion, the fact is explained why this temperament
has no diagnostic complexion.   Nevertheless, it is some-
times fair and sometimes  dark, but this circumstance is
referable to the fundamental element which is sometimes
sanguine and sometimes bilious.
  As the lymphatic  and  encephalic temperaments are
founded on either the sanguine or the  bilious, it follows
that neither of them  is an exclusively elementary condi-
tion.  But as the lympathic has always been so esteemed,
and as the encephalic is equally entitled to the  same esti-
mation, and as both of them, in their respective combina-
tions with other conditions, obey the elementary law, and
as this  estimation of them promotes simplicity in their
application, I deem  it best  to  nominally regard them  as
elementary conditions; for, at most, it matters but little
how they are nominated, provided we understand them.
But for the vital condition  that  underlies these tempera-
ments respectively,  married parties of  them could not
procreate; and as it is, their procreations are  invariably
dead-born, imbecile, or die in infancy of scrofulous forms
of disease. 
THE HUMAN TEMPERAMENTS.
123
  The  vital  element on which these  conditions  are
respectively founded  is but feebly developed in  them;
hence  the lymphatic and encephalic  constitutions  are
greatly powerless both mentally and  physically, and  yet
they greatly promote  civilization  by combining with  the
vital temperaments, provided they do not enter too exten-
sively into the compounds.
  Although I have no authority for the preceding views
on  origin of the temperaments, yet I am confident that
they correctly represent nature, and, therefore, I respect-
fully submit them to the observation of my readers.

            The Compound Temperaments.
  To the extent of my  information, I am. the first and
only pioneer in this  department of the  subject.  Some
physiologists have thought it to be a very  useless waste
of time and labor to treat of those constitutional  condi-
tions which result from the combination of two or more
of the  preceding or elementary temperaments.  The inter-
est the subject  promised led me into this  investigation
thirty-five years ago.  I do not  remember that I promised
myself any ultimate advantage from  the  investigation,
nor could I anticipate any that would  be likely to result;
from it.  But if I have not been remunerated for the  toil
and time thus expended,  my species has by  the discovery
of the hitherto unsuspected truth, that the most physiolo-
gical and healthy parties  of our respective sexes are, very
frequently, in the marriage  relation,  so  physiologically
incompatible as to be sterile, or entail on their progeny
mental imbecility or a  scrofulous  diathesis.  I  do  not
regard this as the greatest discovery ever made in human
physiology, but it is confessedly the most important.
  In the  mass of the population of any country,  those
having an elementary temperament are exceedingly few—
so few  as not to produce one per cent, of the incompatible
marriages.   Hence, as ninety-nine  per centum  of those
marriages which are productive of sterility, imbecility and 
124
THE HUMAN TEMPERAMENTS.
scrofulous constitutions, result from  the  compound tem-
peraments, it follows that an effort, at least, should he
made to distinguish the compound  temperaments.  In-
deed, the happiness of society, the strength and prosperity
of States, and the perpetuity of the species  demand it.
In this  relation I can assure my readers that  the subject
involves no  more difficulty than is attached  to the ele-
mentary temperaments.  It is true that an attempt to treat
of every conceivable combination  of the  temperaments,
would  be a  fruitless task, but the science of  physiolo-
gical marriage makes no such demand; it only demands
that we shall be able to  distinguish  the  binary, ternary,
and quarternary combinations,  and to this  extent the
subject is as  the descriptive department of any portion of
natural history.   But our old  and fossilized medical minds
think the subject to be so occult  as to  render it about
impossible for any one to diagnose the compound temper-
aments even to  the above extent, and hence their aston-
ishment at seeing me do it by an  inspection of denuded
crania.

  The  Binarily Compound  Temperaments.—These are
those which  consist of a  union in the  same constitution
of two of the elementary temperaments.
  5. The Sanguinely Bilious Temperament.—This tem-
perament is of equal value with the sanguine or the bilious
with reference to the reproductive function of the species,
and may therefore be compatibly substituted for either of
them.  A priori, it would  be  reasonable to infer that this
compound might and would more  likely than  otherwise
result from a sanguine and a  bilious progenitor; but this,
I think, is never the fact, but if it ever be, the progeny
never lives to be old enough to evidence the fact; the
cause, no doubt, is this:  the sanguine and bilious temper-
aments are incompatible in marriage.  This temperament
results, therefore, from other  progenitors between whom
the two elements obtain compatibly. 
the human temperaments.
125
Fig. 13.
ALFRED THE  GBEAT,
   This temperament is distinguished by brown hair, darkly
 grayish blue eyes, with  a fair complexion when excluded
 from the light, but under exposure to the light it  acquires
 a tan color.  As this condition is the most dense known
 to the  species, the head consequently is a little less than
 the average.   The flesh, also, is more  dense in this than in
 any other, and therefore less developed.   In proportion to
 weight, therefore, this is the ' most muscular constitution
 known  to the  species.   In  altitude this  temperament
 ranges between  five  feet eisdit inches and  six  feet.   In
this class the forehead  recedes  a little, but  less usually
 than in either of its constituent elements, and like them it
becomes more narrow as it rises.  The nose  is straight on
the dorsum, but if either of the  constituent  elements
predominate the nose  becomes larger and  elevated on the 
126
THE human temperaments.
 dorsum, or aquiline, the lips are usually less than the aver-
 age in thickness.
   The  bilious element  frequently so predominates as to
 render the hair of crow blackness and the eyes of a deep
 blue.  On the other hand the sanguine element frequently
 so predominates as to bring the hair to a very light brown.
 When  the bilious element is of the  xanthous variety, the
 above indices are modified, the degree of darkness of the
 hair will  be replaced by a corresponding degree of red-
 ness, the  eyes will be brighter and the  complexion more
 florid.
   The respective components of this temperament unite
 in all conceivable proportions respectively, and yet all the
 combinations of those  constituents  are. equivalent with
 reference to marriage.
  Note.—AYith  reference to the science of  marriage, and
 it is my present object, it is necessary to treat of the tem-
 peraments as far  as relates to their visible appearance.
 But if I were treating of them with reference to medical
 practice, then it would be requisite to indicate their  dy-
 namic influence, respectively, over the constitution.  And
 if I were treating the subject with reference to mental
philosophy it would be requisite to indicate their dynamic
influence respectively, over the mental manifestations.  In
this treatise, therefore, I will  confine my pen to the first
object, not only because it is of the most importance,  but
because it is at present my only purpose, and  for more
than  this I  have neither the  time nor the inclination at
present.
  6.  The Sanguine-Lymphatic Temperament.—This tem-
perament is distinguished by light hair, fair skin and lightly
grayish blue eyes, the  temples are broad   and full,  the
head is considerably  globular, less  than the  average in its
occipito-frontal diameter  and greater  in its lateral.  The
person  is broad and full, the flesh  rather  soft, the fore-
head is  broad but not particularly  elevated, the   nose  has
less  than the  average length, is straight  on  the dor- 
THE HUMAN TEMPERAMENTS.            127
Fig. 14.
 sum, but  is  occasionally a  little  aquiline,  and occa-
 sionally a little pugged, or recurved.  The lips are of more
 than usual thickness.  The great fairness and translucent
 delicacy  of the  skin  of the  young women of this class
 render them  particularly handsome.   I have not seen a
 well-defined representative  of this temperament  in  the
 western  or south-western country, but they numerously
 obtain in  Maryland and Pennsylvania.  It is proper to
 add  that the  forehead  has more breadth at the brow or
 from temple to temple than it  has at two-thirds of its ele-
 vation.   Representatives of  this  class never, perhaps,
 reach an altitude of six feet; an altitude of five feet seven
 or eight inches is usual with the men.  I have seen them
five feet ten inches.  The locomotion of this class is more
 or less waddling. 
128           THE HUMAN TEMPERAMENTS.

                       Frn.15.
  7.  The  Sanguinely-Encephalic  Temperament.—This
temperament is distinguished by light and rather fine hair,
lightly grayish blue  eyes  and  fair skin.  The  person is
spare, the muscles are more or less flaccid, the altitude of
the person is usually four feet eight or ten inches, but oc-
casionally it reaches six feet  two or three inches.  The
head  is  of  average  size and most generally flattened on
the sides.  The  forehead is more  than usually  vertical,
and has also more than usual elevation, and at the eleva-
tion of about two-thirds of its altitude it is more full and
broad than at the temples.  Of all the compound tempera-
ments this is probably the most feeble, physically. 
THE HUMAN TEMPERAMENTS.
129
             Fig. 16.                 8. The Biliously-
                                   Lymphatic Temper-
                                   ament.—This   tem-
                                   perament is  usual-
                                   ly distinguished by
                                   brown  and  rather
                                   fine hair, brown eyes
                                   and a  rather  dark
                                   complexion.   The
                                   habit of the body is
                                   full, the flesh  con-
                                   siderably soft.  The
                                   head is  considerably
                                   globular, the nose is
                                   usually  straight on
       thomas  nelson.       the dorsum, but oc-
 casionally it is pugged,  recurved or  aquiline, the lips are
 more than of average thickness.  In health the complex-
 ion is enriched by a glow of the rose.  Many  of the bru-
 nette beauties of southern climes are of this temperament.
 The  forehead is broad at the temples but becomes less so
 as  it ascends.   AYhen  the bilious element is  of the  xan-
 thous variety, instead of the brown color of  the hair, the
 color will  be yellow or some shade of red, and the com-
 plexion florid and the  eyes  a light gray.  As to altitude
 this class is similar to  the sanguine-lymphatic, but I have
 seen it more than six feet.
  9. The Biliously-Encephalic Temperament.—This tem-
 perament is usually distinguishd by brown and rather fine
 hair, brown eyes and a dark or bilious complexion.  The per-
 son is spare, the flesh of tolerable firmness, the altitude of
 the person ranges  from five feet eight inches to six feet.
 The head has usually a little more than average size and
usually  flattened on the  sides with depressed temples.
The forehead is elevated and has usually more breadth at
two-thirds of altitude than at the temples;  that is, it is
superiorly expanded and inferiorly contracted.  Some of
           9
7357 
130            the human temperaments.

                       Fig.  17.
the brunette beauties of southern climes are also of this
constitution.  In this class the nose is usually straight on
the dorsum, but occasionally it is aquiline, and the lips are
of moderate  thickness.   AYhen  the bilious temperament
in this compound is of the florid variety the complexion
is changed, as with the preceding or bilious-lymphatic tem-
perament.
  Note.—It may be  useful to remark here that the pres-
ence of the encephalic temperament, in all of its combina-
tions, is indicated by an expansion of the superior third
of the forehead;  and in  proportion to  the extent of its
presence, will there be a fullness in the  manifestation of
the vital  functions. 
THE HUMAN TEMPERAMENTS.
131
   Ternarily Compound Temperaments.—This class com-
prises  four  species, and their respective varieties are in-
finite or as nearly so  as  the human mind can conceive.
These species are respectively compounded of three of the
elementary temperaments.  I do not deem it necessary to
the science of physiological marriage to treat of more than
one variety of each species, viz:  that variety in which the
compounding elements are respectively about equal. To
this extent it is indispensable that everybody who aspires
to  a practical acquaintance with  the science of physi-
ological marriage  should be familiar  with the tempera-
ments.
                                10. The Sanguine-Bil-
                             ious Lymphatic Tempera-
                             ment.—This temperament
                             is distinguished by  a full
                             habit  of the  body; the
                             head is,  usually,  a little
                             above the average size, but
                             more particularly in its in-
                             ferior or  basilar  portion,
                             the  hair is  brown  and
                             coarse, the eyes are darkly
                             bluish   gray,   the   skin,
                             where exposed to the light
    Stephen a. douglas.    has, to some  extent, a tan
color, but otherwise is very fair.  The nose is of ample
size and occasionally has the Roman form, but most gene-
rally it  is Roman-pugged.  The forehead is broad at the
base but gradually becomes more narrow as it rises, the
cheeks  are  ponderous  and the lips thick.  This species, I
think, never produced  a beautiful woman, and yet in this
species many very fine  looking representations  of human-
ity, of both  sexes, are to be seen.  AVTien the bilious ele-
ment of this compound is'of xanthous variety, the hair is
yellowish  red or sandy, complexion florid, and the eyes
brightly bluish gray, and this  is true of all the combina-
 
132
the human temperaments.
Fig. 19.
                 J  G 8PURZHETM. M. D
tions with the bilious when it is of the florid vaiiety, and
this fact should be remembered.
          Fm- 20-             11. The  Sangulne-Bil-
                            ious-Encephalic Tempera-
                            ment.—The complexion of
                            the hair, eyes  and skin of
                            this  temperament is  pre-
                            cisely that of the preced-
                            ing,  and  that of both  is
                            the  same  as  that  of the
                            sanguine-bilious  tempera-
                            ment.   This temperament
                            can  be confounded, only,
                            iwith the  sanguine-bilious,
                            and  such  a mistake might
                             result  in  serious mischief;
JOHN BELL. 
the human temperaments.
133
Fig. 21.
but such an  error  can happen  through great negligence
only; they are similar in person and complexion and fre-
quently in their features, but between their foreheads there
is a marked  difference.  With the sanguine-bilious the
forehead is much  more contracted  near the top than at
the base, but that  of  the  sanguine-bilious-encephalic is
more expanded near the top than at the temples.  In this
class the muscular system is less  dense and enduring.  In
this temperament the head is of full average size, but less
developed inferiorly than superiorly. 
134
the human temperaments.
  12. The Sanguine-Encephalo-lymphatic Temperament.
This temperament is distinguished by light hair, fair skin,
lightly grayish blue  eyes, and a full habit of the body.
The head has more than an average size and elevation,
the forehead is  tall  and broad, more especially near the
top; the nose is of ample size, and usually straight on the
dorsum, but occasionally it is aquiline;  the lips are more
than usually thick.  This is not a muscular class, and
hence  it  is  not adapted to the rugged pursuits of life.
The only temperament for which this might be mistaken
by a careless observer, is the sanguine lymphatic; but this
mistake would be attended with no material mischief, but
such a mistake  should not be made, for in the latter the
forehead is only about two-thirds as high as in the former,
and becomes more narrow  as it rises, but in the former it
becomes  more expanded.
  13.  Bilious Encephalo-lymphatic Temperament.—This
temperament is distinguished by a full habit of the body,
by fine and darkly brown hair, dark brown  eyes, and a
dark complexion.  The head is above the average in size,
the forehead is tall and superiorly expanded.   The nose is
amply developed, straight on the dorsum, a little recurved
and pugged, or aquiline.  The  only temperament  with
which  this  can be confounded, is the  bilious-lymphatic,
but in marriage no  mischief would result from  the mis-
take, because in.all cases in which either could be a party
to a physiological marriage, so would the other; but neg-
ligence is the only excuse  that can be offered for such an
error, because in  the latter the  forehead is less  elevated
and less expanded superiorly.  Of all the brunette beau-
ties of any  country, those of this temperament are the
most magnificent or splendid.
          [see illustration on opposite page.] 
THE HUMAN TEMPERAMENTS.
135
Fig. 22.
   14.  QUARTERNARILY  COMPOUND  TEMPERAMENTS.--This
 class comprises but one species, but the varieties are innu-
 merable.
   15. The Sanguine-bilious Encephalo-lymphatic Tem-
 perament.—The  indices of this temperament are those of
 the sanguine-bilious lymphatic temperament, with  the
 exception of the forehead; and hence it is the only one
 with which this can be  confounded.  Both have the same
 complexion of the hair, eyes and skin, and the same habit
 of the body;  and in alliances in which either would con-
 stitute a physiological marriage, so would the  other—and
yet between the  two there is a marked difference. The
sanguine-bilious  lymphatic  excels in muscular strength
 and endurance.  In this  class  the forehead is  superiorly 
136
PHYSIOLOGICAL marriage.
 contracted;  but  with  the  sanguine-bilious-encephalo-
 lymphatic, the  forehead is superiorly expanded.  This
 temperament  is, therefore, more highly endowed  with
 mind than the other.   There is another marked difference.
 This is occasionally productive of a beautiful woman, and,
 in both sexes, the  highest order of human capacity; and,
 as illustrations of  this fact, I may cite the first and third
 Napoleons, and also the beautiful and gifted Miss Harriet
 E. Hosmer.

 THE SCIENCE OF PHYSIOLOGICAL MARRIAGE.

  The human temperaments are the elements of this sci-
 ence, and having treated of them to the extent demanded
 by their relation to this subject, I proceed to their appli-
 cation.
  I divide the elementary temperaments into two classes,
 the vital and the non-vital;  the  former  embraces the san-
 guine and the bilious temperaments, and is so denomina-
 ted because observation has forced upon me the convic-
 tion that without the agency of one or  the other of them,
 there can be no transmission of life.  The latter embraces
 the lymphatic and the  encephalic temperaments; and is
 so denominated, because, -as frequently  as I have observed
 the respective  parties to a marriage to be as much as two-
 thirds  of these temperaments, so frequently  were three-
 fourths of their children dead-born, and the  other fourth
 did not, respectively, live one year; and this  I hold to be
 a law in this relation.
  This science resulted from a discovery which I made in
 1844, namely, constitutional similitude between the respec-
tive sexes of our species  renders  them incompatible in
relation to the procreative function, causing sterility, or an
entailment  of a scrofulous diathesis  on  their children,
imbecility,  blindness,  deafness, or some other abnormal
condition.
  Regarding the reproductive function as the most  im-
portant incidental  to the race, my reflections on this dis- 
PHYSIOLOGICAL MARRIAGE.
137
 covery, and the fact that the evils above-named do obtain
 very frequently from  the constitutional similitude of the
 sexes, forced upon me the inference that the discovery of
 the  physiological laws  of marriage  and their  indices,
 would  constitute  the  most  important  discovery  ever
 announced to man, because it involves not only the perpet-
 uity of the  human species, but all the human capacities
 for either usefulness or the enjoyment of life.
   The  fundamental fact of this  science,  the one from
 which it  resulted, I discovered in two days by a method-
 ical course of observation, thus:  In 1844, I was traveling
 in the State of Mississippi, and met with a married couple
 who  were as physiologically  sound and  healthy as any
 couple I ever saw; they were  very comfortable livers, and
 in a very  healthy district of country.   They had six child-
 ren, of which three had died  of  scrofulous forms of dis-
 ease, and the remaining three were fated to die  in  the
 same way in a few months.
   The physician  of this family, who had known them for
 many years, could form no conception of the cause of the
 scrofula  of their  children;  there was no consanguinity
 between  them, their  respective progenitors were yet liv-
 ing and  in good health, and were  very confident that
 scrofula in no form had ever  been an  heir loom in their
 respective ancestors.   Finding no cause for the scrofula
 of these children, I was  forced to the suspicion that the
 remote cause was  some constitutional peculiarity of the
 parents; and if it were, I thought it might be discovered
 by  a sufficiently extensive course of obseiwation  upon
 parents and children,  and I resolved to  make the discov-
 ery if possible.
  As a preparation for such an effort, I may remark, that
at this time I was, probably, more practically familiar with
the human temperaments than any other physician is or
ever was.  The temperament of these parents was, respect-
ively, sanguine bilious-lymphatic.  I  made a memoran-
dum of this family.   My observations were  confined to 
138
PHYSIOLOGICAL MARRIAGE.
those families on whom I called for the accommodations
incidental to travel. I took them as they came; the second
was at my dinner hour;  the parties were respectively bil-
ious  encephalic, sound and healthy, had  three  children,
one  was imbecile, the other  two  scrofulous; the  parties
were  not consanguine.  The  third family I saw  in the
evening, when halting for the night.  The husband was
sanguine bilious, the wife bilious  lymphatic.  They  were
sound and healthy, had  seven children, and  all of them
had a sound and viable appearance.
  The fourth family I  saw the next morning at breakfast.
These parties were, respectively, sanguine encephalic and
healthy; had had seven children, but all of them  died in
infancy, of scrofulous  forms of disease.
  The fifth family I saw when I halted for dinner.  The
husband was bilious  and the wife was sanguine bilious
lymphatic.  Both were healthy, and had three  promising
children, and had lost none.
  The sixth I observed when I halted for the night.  The
host  was sanguine  bilious lymphatic, and  the hostess was
sanguine bilious encephalic;  they had had six children,
but all  of them died  in infancy, of scrofulous forms of
disease.   When I halted the  next morning for breakfast,
I observed the seventh family.  These parties  were, re-
spectively, bilious encephalic, healthy;  had been married
more than twenty years,  but had had no children.   I had
now  made seven  observations, and,  upon  generalizing
them, I found that between the first, second, fourth,  sixth
and  seventh parties, respectively, there  was a strongly
indicated similitude of constitution, and they, respectively,
had  been progenitally unfortunate.  That  between the
third and fifth parties, respectively, there was a strongly
indicated dissimilitude of constitution, and that they had
been progenitally very  fortunate.
  To the extent that seven cases could warrant an infer-
ence, it  must, of necessity, be  that constitutional simili-
tude between the respective sexes renders them incompat- 
PHYSIOLOGICAL  MARRIAGE.
139
 ible with reference to the reproductive  function; and  the
 observation of many hundreds  of cases during  a  period
 of eighteen years, has thoroughly sustained this inference.
 And  although this fundamental principle was discovered
 in forty-eight hours after I resolved to discover the remote
 cause of the scrofulous diathesis; yet it has required of
 me eighteen years of observation and  study to reduce it
 to an availably practical science.  A practical knowledge
 of this science, which has  cost me eighteen years of toil,
 can be acquired  by any intelligent lady or gentleman in
 less than a month.
  The fundamental principle of this science appears to be
 founded in an instinct of humanity, which is made mani-
 fest by the fact that when people seek a matrimonial alli-
 ance, they prefer the complement  of themselves respect-
 ively—at least a  contrast.   This science does not oppose
 our instincts, but guides them.  The laws of this science
 are few and simple.
  Law I.   AYhen the  constitutional similitude  of  the
 respective sexes is such that a qualified observer can  not
 detect an appreciable difference, sterility will be the result
 of  their marriage.  Illustration: Washington  and  his
 wife were,  respectively, sanguine, and it is known that
 sterility was the result.  Between General  Jackson and
 his wife there was a nominal difference  of constitution;
 he was bilious sanguine, and she  was bilious:  neverthe-
 less they were physically the same, both being exclusively
 vital, and it is known that  sterility was the result. The
 first Napoleon and Josephine were, in person, greatly dif-
 ferent, and in constitution they were nominally as differ-
 ent, and yet there was no  physiological difference.   He
 was sanguine encephalo-bilious lymphatic, and  she was
 bilious encephalic; consequently  they were, respectively,'
 compounded of equal varieties of  vital and non-vital con-
 ditions, and it is known that sterility was the result of
their alliance.
  Law II. AYhen the constitutional similitude of the  re- 
140
PHYSIOLOGICAL  MARRIAGE.
spective sexes is less than complete, or is appreciably dif-
ferent, progeny will result, but it will be dead-born, imbe-
cile, scrofulous, deaf, blind, or in some otherwise imper-
fect.  Illustration : I can furnish three hundred examples
of this law, but  as they  are not historically known,  they
would be of no value in this relation.  I can  cite one,
however, which is historically known, viz: the first Napo-
leon and his second wife.  Her temperament was bilious
encephalo-sanguine, and his temperament I have indica-
ted.   There was between  them an  appreciable difference
of constitution, and the result of this difference was one
son ;  but the  difference was too small to secure  to him a
normal viability, for he died of a scrofulous affection of
the lungs, at the age of eighteen years.  It is most indis-
putably the fact, that a considerable difference of constitu-
tion must obtain between the  respective parties to a mar-
riage, to secure to offspring a soundly viable constitution.
To discover the  least difference consistent with a physio-
logical marriage was indispensable, but before discovering
this the conviction became forced  upon me that my dis-
covery could not become of  general utility without the
discovery of a law of universal  application.  By a great
amount of observation and study, I succeeded in discover-
ing the desired law, and it is of easy application,  and will
universally secure a physiologically  legitimate offspring,
and the greatest possible happiness to the parents.  Those,
therefore, who make  domestic  happiness, and  a really
useful progeny, conditions of  marriage, must observe the
following law:
  Law III. One of the parties must be exclusively vital—
that is, must be either  sanguine,  bilious, or sanguine-
bilious (the last being a compound of the two former, is
also vital), and the other party must as certainly be more
or less non-vital, that is, more or less lymphatic or ence-
phalic.  All  marriages, in contravention of this law, are
physiologically incestuous, and the consequences will be
vicious in proportion to the delinquency. 
PHYSIOLOGICAL MARRIAGE.
141
  Law IY. The greatest dissimilitude of constitution that
can obtain between the sexes, when they are respectively
of the same species, is that which obtains between a vital
and a non-vital temperament—and this is the most favor-
able to progeny.   But marriages of this  character are
greatly impracticable in any country.   It is a very remark-
able fact in  the physiology of human procreation, that a
high degree of constitutional dissimilitude is about equally
unfavorable to progeny.  It has  been seen that a high
degree of similitude entails a scrofulous  diathesis, and a
high degree of dissimilitude, as  when one party  is white
and the other negro, the progeny is invariably  scrofulous,
I believe.
   The preceding  exposition of the  science of physiolo-
gical marriage is amply sufficient to enable  any physician
to make  a practical application  of it to all parties of the
respective sexes who  are  even tolerably well defined, pro- •
vided he be as well informed in relation to the tempera-
ments as  any clever Aliss of ten summers can become in
two hours.  I greatly regret to  add that my observation
for thirty-five years  has induced me to believe that not
two per cent, of our  physicians are  so well informed  in
this relation.  I  strongly suspect that it is  this ignorance
and consequent inability  to judge of this discovery, that
induces my professional brethren generally to denounce it
as a vain pretension, and myself as humbug, but more par-
ticularly the old fogies.  But when has it been otherwise?
Did they not  similarly treat mesmerism, phrenology, the
discovery of  the  sanguiferous  circulation,  and vaccina-
tion ?  I can not  avoid regarding it  as  disgraceful, that
those who should lead in  the investigation of all discove-
ries embraced by the  medical sciences, should very gener-
ally continue  in the  rear till driven  forward by public
opinion, or the want of bread and butter.
  It is exceedingly cheering to find an exception to this
professional stupidity or laziness.  I have found one, and
the fact is an oasis in the barren waste of professional 
142
PHYSIOLOGICAL MARRIAGE.
fogyism.   E.  H. Dixon, M. D., one of the most  accom-
plished physicians and  surgeons known to the profession,
as soon as informed of  this discovery, subjected it to the
test of observation, and not only found it to be  true, but,
in the January number of the  New York  Scalpel, for
1859, he  presents the evidence of its verity which he had
observed, and in conclusion says: " Dr. Powell presents a
claim to  the gratitude  of the race by the announcement
of this great discovery, that will be acknowledged long
after his  memory only will be cherished, as the discoverer
of the most important  truth ever announced in physiolo-
gical science."
  As this is a discovery about which no properly-constitu-
ted member of society,  male or  female, can feel indiffer-
ently, I think it proper  to present a few illustrations of its
practical applicability:
  Case I.  In 1860, a young lady in Wisconsin sent me
through the mail a photograph of herself and of her affi-
anced, and solicited my opinion in relation to their phys-
iological  compatibility.   I informed her that he and she
were  incompatible, and that  if  she  were  unwilling to
become  the mother of imbecile  and scrofulous children,
not to marry him.   She submitted my letter to the perusal
of her physician, a fogy.  After reading it, he said to her:
" Miss, your correspondent is a presumptuous d----d fool,
for how can he, better than any one else, tell what a child
will be before he sees it ?"  A wise doctor!  She did not
adopt my counsel, but married the gentleman, and in due
time became a mother, and then informed me that her
physician said, " my babe is  an idiot; it may be so, I
can't  judge of it yet,  it is too  young."  The  physician
could not judge of it even after he saw it, for I am confi-
dent that these parties  could not produce an idiot. Her
babe must have been an imbecile.
  Case II. In 1861, a lady called on me, from a neighbor-
ing State, with  a daguerreotype of her husband, and re-
quested   my opinion of her marriage.   I responded, " It 
PHYSIOLOGICAL MARRIAGE.
143
  has been unfortunate, for if you have had children, which
  is barely probable, they were  either imbecile, died in in-
  fancy of  hydrocephalus, or  of a  scrofulous variety of
  brain fever."   She rejoined, "I have had three children;
  the first is living, but my physician and the neighbors say
  that  he is an idiot, but you  said imbecile; what, if you
  please, sir, is the difference ? " I explained.  She rejoined,
  "Then, sir, he is^an  imbecile  and not an idiot."  She re-
  sumed, " Have I nothing better to hope for from my mar-
  riage than I have had ?"  I responded, " Nothing, I think,
  madam, unless you would prefer sterility, of which there
  is a probability.
    Case HI. In 1862, a  legal  gentleman from the interior
  of Kentucky called on me with a  daguerreotype  of his
  wife, and said, "Professor, I have learned that you have
  made a great  discovery in physiology; that if you see a
  married couple or  their  portraits  you can tell whether
  they are fit for progenitors or not; is  it true, sir ? "  I re-
  sponded, " It is,  sir."   He   answered, " I have  always
  thought it to be reasonable to suppose that humanity pos-
  sesses the elements  of the science  of its  most essential
  function, but not having learned through the literature of
  the day that such a science had ever been imagined as be-
  ing possible, and much less as having been discovered and
  developed into a practical science, consequently I was not
  prepared  to believe the information I had of you;  and
  therefore consulted my physicians about it; they thought
  your pretentions to be an impossibility and you a humbug.
  But, sir, as  I had business here  I concluded to bring my
  wife's daguerreotype with me and try you, provided you
  permit such trials.  I rejoined, "I do, sir, and  am pleased
  to  have them, because they furnish me additional facts."
  He rejoined, " Well, sir, are my wife and I fit for progeni-
  tors ?"  I responded, " As you and she have the indices
* of sound  constitutions  and good health, it is my opinion
  that you are, in the abstract, favorably constituted for pro-
  genitors, but in  relation to each other you are not."  He 
144
PHYSIOLOGICAL MARRIAGE.
 rejoined, "Why not?"  I answered,  "Because your con-
 stitutions are incompatible, which causes a scrofulous con-
 stitution to be entailed  on your children, a majority of
 which will probably die of scrofulous forms of disease be-
 fore attaining  the age of puberty,  respectively, and the
 others will not, I think, live to the age of thirty-five years,
 respectively, but will die of consumption.
   He continued, " I am satisfied, sir, that you are a master
 of the most important  science ever addressed to the con-
 sideration of man. My wife, sir, has brought me sixteen
 children, and  nine of them died of scrofulous diseases,
 under  the age of puberty.   Of my living children the
 oldest is in his thirtieth year, and his physician informs
 me that he  is in  the forming stage of consumption, and
 hence, there is a strong probability that your opinion will
 be fully verified."   He continued, "My  physicians  insist
 that scrofula must at some time have been in the family of
 either my wife  or myself, but  I have  never believed it;
 what, if you please, is your opinion ? " I responded, " Your •
 physicians may possibly have been correct, sir, but  I can
 not  conceive any necessity  for it, because the physiologi-
 cal incompatibility that  obtains between you and  your
 wife satisfactorily explains the loss  of  your children by
 scrofula."  He  rejoined, "As you  know  nothing of my
 family in  any  relation, beyond  what you can infer  from
 seeing me  and the daguerreotype of my wife,  and yet
have manifested a clear understanding of the consequences
of our marriage, I can not doubt that your opinion is en-
tirely worthy of my confidence.   Do physicians generally
understand this subject?"   I responded, "They do not,
nor is there any probability that they will pay any atten-
tion to it till I have  been  dead half a century.   They
must, at least, be permitted to denounce me as a humbug
while I live, and  the  application of my discovery an im-
possibility."  He resumed,  "Suppose I had consulted you *
before  I married, could you have given me the informa-
tion you have given me?"   I answered,  "The same, sir." 
PHYSIOLOGICAL MARKAIGE.
145
  He continued, " You have certainly made an incalcula-
  bly important discovery, and as the people have a right to
  require of their physicians a  knowledge  of this subject,
  and as I am a member of the Legislature of this State, I
  will  have the attention of our  physicians directed to this
  subject.   If their professional pride will not urge them to
  do it, the  reduction  of their bread and butter will—pre-
  vent them from collecting their fees by law."
    Case IY.  A few months since, a married couple called
  on me; they appeared as rough  and hardy as pig-iron, and
  desired my opinion as to what their " luck" in regard to
  children had been ?  I answered, " If you have had child-
  ren, three-fourths of them were born dead, and the others
  lived  but a few months, at most."  The wife rejoined, " I
  have had seven children, and five of them were dead-born
  and the other two lived but a little while.  These  parties
  were  sent  to try me by an old  fogy who knew them, and
  thought it impossible for me to indicate the consequences of
• their marriage.  He was probably  silly enough to suppose
  that I operated by guessing.
    Note.—The parties to  case 1 were respectively bilious-
  encephalic, case 2 were the same, case 3 one  was bilious-
  lymphatic, and the other  sanguine bilious-lymphatic, case
  4 were respectively bilious encephalo-lymphatic.
    Professional ignorance of the remote cause of the scrof-
  ulous diathesis caused  it to be denominated the "oppro-
  brium medicorum."  Fortunately this   epithet can no
  longer be cast at the profession, for I have discovered it:—
  it is  physiologically  incompatible marriage.   It did not
  operate extensively in our western country till within the
  preceding forty years, but  the want of space dose not per
  mit me to furnish an explanation of this fact, for  such it
  is, I  doubt  not.   If the same  cause shall continue  to
  operate for another  century as it did through the latter
  half of the preceding, our country will be as scrofulous as
  Holland.   A scrofulous diathesis  obtains now in at least
  five-sevenths of American society, and is increasing, and
        10 
146
VITAL TENACITY.
the time is not remote when it will be almost impossible
for any one to contract a physiological marriage.
  Some of our States have by law prohibited the marriage
of cousins.  The least that can be  said of this law is, it is
founded in ignorance, for it is not  known that  consan-
guinity renders  the sexes incompatible.  They are occa-
sionally incompatible, just as other parties are, and for the
same  cause.  My observation teaches that when cousins
are physiologically compatible their children are as promis-
ing as those of other physiological marriages.

                 VITAL  TENACITY.
  It has long been observed that some persons who seem-
ingly  had but little vitality, and of feeble appearance,
would  resist attacks of disease, and  recover  when there
seemed but little  hope,  and live until they were worn out
by age. Whilst others who seemed  strong  and healthy,
and gave every  promise  of long  life, would succumb to
slight  attacks of disease,  having apparently no power to
rally when assailed.  I  have been deceived in this way
many times.  Persons who it seemed to me could not pos-
sibly recover, and who  had  been given up by physicians
and friends, would live,  despite all  adverse circumstances,
and finally get  well; whilst others who  did  not present
any alarming symptoms,  would  die in spite of all that
could be done for them.
  We  find some  families remarkable for their vital tena-
city and longevity, whilst others seemingly as healthy, die
young.  This is especially  noticeable in children.  In some
families they will live in spite of the most adverse circum-
stances and severe diseases, whilst  in others it is with the
greatest difficulty they are raised, or they die in infancy.
Physiologists have never been able to account for this, and
up to a recent period, we have had no means of determin-
ing between these classes.  Now,  however, thanks to Dr.
Powell's investigations,  we are enabled to designate those
of great and those of feeble vital tenacity. 
VITAL TENACITY.
147
Fig. 23.
  He came to the conclusion from long continued observa-
tion that the size of the base of the brain was the index
of vital tenacity; that when this was large the persons have
great power to  resist disease; and when small, that they
would readily succumb to but slight affections.   To de-
termine this, we draw a fine from the prominence of the
frontal bone at the outer angle of the eye to the prominence
at the posterior of the head on the occipital bone, as shown
in  the  accompanying cuts.  The space between this and
the opening into the ear, (external auditory meatus,) de-
termines the size of the base of the brain, and the amount
of vital tenacity.
                                 AYhen this  space
                               measures  three-fourths
                               of an inch and upward,
                               the person has great vi-
                               tal tenacity, and will re-
                               sist  and recover  from
                               diseases, and  five  to an
                               advanced age.  Fig. 23
                               is the skull of  a crim-
                               inal named Loper, who
                               was  hung  for murder.
                               The  line from  A to B
                               marks the  exact  point
                               of  measurement,  and
                               shows a very great vital
                               tenacity.  Fig. 24 rep-
                               resents the  skull  of a
                               man who was about as
                               old as the  former, but
                               who  died of  consump-
                               tion.  It will be observed
                               that the  line  runs very
close to  the opening of the ear;  it measures  but one-six-
teenth of an inch, while in the former case it was a full
inch.
Fig. 24.
 
148
VITAL TENACITY.
  The first marked example of the truth of this discov-
ery that  came under my notice, was the  case of my own
child.  She had  been suffering from  summer complaint
for two  months, and became so  reduced in flesh and
strength  that no person supposed it possible she could live
through the summer.  I mentioned her case to Dr. Pow-
ell, and he desired that I should make the measurement
and give him the result.  I did so, telling him that there
was full three-fourths of an inch between the line and the
auditory  meatus.  He immediately remarked  that  I need
not have the slightest fears for the  child, as she would not
only recover from this sickness, but would, in all  proba-
bility,  out-live either of her parents.  She  did recover,
and is a strong, hearty girl, nine years of age.   Since then
I have applied the test frequently, and have not known it
to fail.
  A very marked example occurred in our College while
Dr. Powell was lecturing  to the classes.  A healthy, vig-
orons young man called on the Doctor for his opinion in
this respect.  He advised him to  live industriously and
temperately  in  all respects, and   to  avoid unnecessary
exposure at all seasons, for under no circumstances  would
he probably live to be an old man.  A few days afterward
his  seat was  vacant  in the lecture  room, and he was re-
ported slightly ill—nothing  serious—but in nine days he
was dead.   In  another case he gave the same opinion.
In a short time the  person had an attack of measles, re-
covered, had a relapse, and died suddenly.
  If this measurement proves reliable in all cases, as I
doubt not it will, it will be  of very great advantage, not
only to the physician, but to the people.  It is true,-there
are but few who would wish to know that their days were
but few, but it would cause such  persons to  take better
care of their health, and give them time to set their house
in order, while yet enjoying health. 
ORGANS OF SPECIAL SENSE.             149
           ORGANS OF SPECIAL SENSE.

   We are brought into  relation with  the  outer world,
chiefly, by means of the organs of special sense and gene-
ral sensation.   Deprived of these, man  would be entirely
shut out from the universe; his only functions being those
of vegetation.   The wisdom of the Creator, so manifest to
the observant in all the works of nature, is especially dis-
played in the adaptation of these organs to the  ends in
view, and whilst we regard them as among the most per-
fect works of the Creator, we can not but admire the sim-
plicity  of the structures by which such wonderful results
are obtained.   The  organs of special sense are, the eye,
the ear, the nose, and the tongue; general sensation is a
function of the entire cutaneous envelope.

                       The  Eye.
   The eyes are situated in two bony cavities called orbits,
on each side of the nose; these cavities being filled princi-
pally by fatty tissue which forms a bed for the eyes.  Six
muscles pass  from the posterior  part of the orbit, and its
borders to be inserted into the globe of the eye, and are so
arranged as to move it  in all directions, and thus give a
very  wide  range  to vision. The eyes  are protected in
front by the two lids, formed of a plate of cartilage covered
by the skin externally, and a mucous membrane internally.
They are still further protected against substances falling
from the forehead by the eye-brows, and against all extra-
neous matter by the eye-lashes.  The  anterior surface of
the eye, the orbit and the under surface of the lids, are in-
vested by a delicate mucous membrane called the conjunc-
tiva.  This  is  kept constantly moist  by the secretion of
tears, which are furnished by the lachrymal gland situated
at the  upper  and outer part of the orbit.  The secretion
of this gland is poured out through  several minute ducts
which  open through the outer part of the upper eyelid; 
150             ORGANS OF SPECIAL SENSE.
the tears pass across the eye between it and the lid, to the
internal junction of the lids, where they are received by
two small canals, and conveyed to the lachrymal sac, which
is just beneath the  internal extremity  of the  lower lid,
and from thence by the nasal duct to the nose.   The tears
are prevented from running  over the  eyelids by an oily
secretion furnished by small glands along their edge.

                       Fig. 25
SECTION  OP THE EYE.
1, Cornea.  2, Sclerotic Coat.  3, Aqueous Humor.  4, Crystalline Lengi
              5, Vitreous Humor. 6, Optic Nerve.

  If we  examine the eyeball removed from the orbit, of
which Fig. 25 is a section, we  will find that it is  nearly
spherical in  form, consisting of an anterior third, clear
and  transparent, and  a posterior two-thirds, white and
opaque.  The first  is  called the cornea,  the second the
sclerotic coat—and these form the first investment, or tunic
of the eye, of which there  are three.  If, now,  we open
the eye, we will find a second coat, which only invests its
posterior two-thirds.   This coat is blaek, and  is intended
to absorb such rays of light as pass through the  retina.
The third coat is in immediate contact with this, and is
formed by an expansion of the optic nerve, which  pierces
the eyeball behind.   Passing across  the eye, at the point 
ORGANS OF SPECIAL SENSE.            151
of junction between the cornea  and sclerotica, and divi-
ding it into two parts, is the iris, which has an opening in
its center called the pupil, which admits light to the inter-
nal parts of the eye.  The iris is partly composed of mus-
cular fibers;  hence the  pupil dilates  and  contracts,  to
admit more or less light, as  occasion requires.  The cen-
tral parts of the eye are filled  with three  humors—the
aqueous  humor,  crystalline  lens, and  vitreous  humor.
The first is water, situated in the anterior part of  the eye,
covered by the  cornea;  the second is  a double convex
body, of considerable tenacity, situated immediately  be-
hind the pupil; and the third is a fatty-like transparent
substance that fills the posterior part of the eye.
  Phenomena of Yision.—" The  essential constituents of
the optical apparatus of the eye may thus be enumerated:
A nervous expansion, to receive and transmit to the brain
the impression of light; certain  refracting media for the
purpose of so disposing of the  rays  of light traversing
them as to throw a correct image of  an  external body on
the retina; and  a contractile diaphragm with a central
aperture for regulating the quantity of light admitted to
the eye.
                      Fig.  26.
  " With the help of the subjoined diagram (Fig. 26), rep-
resenting a vertical section of the  eye from before, back-
wards, the mode in  which,  by means of the  refracting
media of the eye, an image of an object of sight is thrown 
152            ORGANS OF SPECIAL SENSE.

on the retina, may be rendered intelligible.  The rays of
the cones of light emitted by  the points A B, and every
other point  of an object placed before the eye, are first
refracted—that is, are bent toward the axis of the cone,
by the  cornea G C, and the aqueous humor contained
between it and the lens.  The rays of each cone are again
refracted,  and bent still more  toward its central ray, or
axis, to the anterior surface of the lens E E; and again
as they pass out through its posterior surface into the less
dense medium of the vitreous humor.  For a lens has the
power of refracting, and causing the convergence of the
rays of a cone of light, not only on their entrance  from a
rarer medium into its anterior convex surface, but also at
their exit from its posterior convex surface into the rarer
medium.
  "In this manner the rays of the cones of light issuing
from the points A and B, are again collected to points at
a and b; and, if the retina F be situated at a and b, per-
fect, though reversed, images of the points A  and B, will
be perceived; but if the retina be not at a and b, but
either before or behind that situation—for instance, at H
or G—circular luminous spots, c and/, or e and o, instead
of points,  will be seen;  for, at  H the  rays have not yet
met, and at  G they have  already intersected  each  other,
and are again diverging.  The retina  must, therefore, be
situated at the  proper focal distance from the lens, other-
wise a  defined image  will  not be formed; or, in other
words, the rays emitted by a given point of the object will
not be collected into a  corresponding point of focus upon
the retina."—Kirkes.
  Two deviations from normal  vision may be noticed and
have to be counteracted by the use of glasses, or artificial
refractory media.  Myopia or short sightedness is caused
by anything, as undue convexity of the cornea,  which in-
creases  the  refracting power of the  eye, and causes the
image to  be formed  anterior  to the object as at H;  this
defect is remedied by the use of concave  glasses.  Presly- 
ORGANS OF SPECIAL SENSE.
153
opia, or long sightedness is the reverse, and is caused by
the flattening of the cornea, or other causes that would
diminish the  refracting power of the  eye,  and cause
the image to be formed at a point behind the retina, or G;
this defect is remedied by the use of convex glasses.
                     Tlie  Ear.
  The ear, or organ of hearing,  is  composed  of three
parts—the external, middle, and internal ear.   The exter-
nal ear is composed of a frame-work of cartilage attached
to the bones of the side of the head, and covered by the skin;
and a tube about three-fourths of an inch in length which
passes inward. The configuration and position of the ear is
such as to  collect  the waves  of sound and transmit them
inward.  The passage to the middle ear is called the ex-
ternal auditory meatus, and is  formed partly of bone and
partly of cartilage, covered by the  skin which is reflected
inward.  It  is closed internally by  a membrane  which
separates it from the middle ear—the membrana tympani.
Fig. 27.
          THE  EAR.
1, The External Ear.  2, Auditory Meatus.
   3, Middle Ear. 4, Internal Ear.
The meatus has numer-
ous glands which secrete
a peculiar yellowish, bit-
ter,  semi-fluid material
called cerumen or ear-
wax, and which serves to
keep the structures soft
and  protect  them from
injury.  The middle ear
(drum of the ear,) is a
small cavity  not  more
than  five-eighths of an
inch in its longest diame-
ter, and three-eighths in *
its smallest. It is lined by
mucous membrane, and
has but one communica-
tion with external parts, 
154
ORGANS OF SPECIAL SENSE.
and  that is  with the throat, through a  passage called
the eustachian tube.  It contains three small bones articu-
lated together, and moved by muscles, which form a com-
munication between the membrana tympani, and the in-
ternal  ear.  The internal ear is  excavated in solid bone,
and consists of a series of cavities as represented in Fig. 27.
In these cavities the minute fibrillar of the auditory nerve
are so placed in fluid,  that the slightest vibration of air in
the external ear, will, through the membrana tympani, and
chain of bones, produce sensation of sound.
  Hearing.—Sound is produced by the more or less rapid
vibration of the particles of matter  in which the sound is
produced, and is propagated to the  ear by the continued
undulations of the medium through  which it is transmit-
ted, until they strike the  membrane, closing the auditory
meatus.  " Sound is perceived when an impulse of a cer-
tain  force and suddenness is mechanically given to matter
in communication with the nerve of hearing.  Such move-
ments as the  slow moving of a rod through the air, do
not give rise to appreciable sound; hence a certain degree
of force  and suddenness  is required, as instanced in the
cracking of a whip.  Although air  is the usual medium
through which sound  is  conveyeH  to the ear,  any solid,
liquid, or aeriform matter suffices for this purpose.
  " When the impulse is single, or when one impulse fol-
lows another in very slow, irregular succession, the sound
perceived is  called noise;  when they reach sixteen  in a
second, continued sound is  produced; and when they suc-
ceed each other at regular  intervals, and reach thirty-two
in the same time, a musical note results.   The pitch  of a
musical note ascends  from grave to sharp, as the number
of impulses or vibrations  in a  given time increases, and
consequently as  the breadth of the sonorous wave dimin-
ishes.   Thus, if the lowest note of an octave is made up
of thirty-two vibrations, each succeeding note will  contain
more, until the eighth octave will have twice as many.
   " The waves  of sound  travel at an average rate  of 
ORGANS OF SPECIAL SENSE.
155
nearly eleven hundred feet per second in air; four times
faster through water, and from  eigfct to  seventeen times
faster in solids.  They diverge in all directions, and hence
the intensity of a given sound decays in receding from its
origin as the square of the distance increases."
  The small bones of the ear, with the muscles attached
to them,  constitute  an  apparatus for listening.  Thus,
when the mind is directed to the ear, in the act of  listen-
ing, these bones are acted on  so as to render the mem-
branes closing the  outer and  inner ears tense, when slight
vibrations are conveyed to the nerve of hearing.  On the
contrary,  the  ear is protected from  injury by intense
sounds, as the  firing of a cannon, by the power possessed
by the individual, of causing  a relaxation  of those parts.

  The Organ  of Smell.—We have already  partially de-
scribed the  cavities of the nose, as a part of the  respira-
tory passages;  we have now to examine them as an organ
of special sense.   These cavities are quite extensive, ex-
tending  from  their  anterior openings to the throat, and
from the roof of the  mouth  upward to the superior por-
tion of the external nose.   These cavities are lined with
mucous membrane; and to  this the olfactory, or first pair
of nerves  are distributed in a similar manner to the nerves
of the skin.  How these nerves appreciate odorous bodies,
is more than we are  able to  tell.  They serve a very im-
portant purpose, however, in standing guard at  the en-
trance of  the air passages to protect the lungs and system
against the ingress of any noxious matter.

  The Organ of Taste.—The tongue is supplied with a
special nerve; the  gustatory, which gives it the power  to
distinguish between various sapid substances.  The  mode
of action of the substances  which excite taste, probably
consists in the production of a change in the internal con-
dition of the gustatory nerves, and, according to the dif-
ferences of these substances, an infinite variety of changes 
156
ORGANS OF SPECIAL SENSE.
of condition, and consequently of tastes, may be induced.
The matters to be taged must either be in solution, or be
soluble in the moisture covering the  tongue; hence insol-
uble substances are usually tasteless, and produce merely
sensations of touch.

  The Sense of Touch.—The  sense of touch is not con-
fined to  a special organ, as is the  case with  the other
senses, but is extended to the  entire surface  of the body,
Some parts, however, possess it in a much higher degree
than  others, as is the case  with the  skin  covering  the
palms of the hands  and fingers, tongue, lips, etc.   It
results from the minute distribution of the nerves of com-
mon sensation in the papillae of the  skin, sensation being
most  acute where these papillae are most numerous and
most highly developed. 
                PART   II.


                   HYGIENE.


  Health is the greatest of human blessings, and its pres-
ervation should therefore engage  the attention of every
person.  It is true that we attach the least value to those
things that seem to be ours by right,  as life, health and
friends,  and have less interest in their preservation than
we have in the pursuit of objects of far less or no impor-
tance.   Every person  of.sane  mind values his life above
all earthly  things, and yet a majority seem to think that
so far as death  is concerned  it is  far distant from them.
In like manner, though health is an inestimable blessing,
it is not regarded until lost, very frequently  by open dis-
regard of its  plainest laws.
  " A sound mind in a sound body," was a Roman maxim
two  thousand years ago.   Without strength of body, all
social, intellectual, and moral  virtues  lose much of their
value.   Manners  the  most refined and dignified, mental
qualities cultured and commanding, moral traits worthy of
all praise and imitation, if associated with a  feeble physi-
cal constitution,  a frail and sickly body, though of high
worth in themselves, are little better than useless as means
for promoting the demanded improvement in human so-
ciety.   The will and the heart demand strong  arms for the
execution of their purposes.
  No  one, observant  of human condition, can doubt the
idea that feebleness of body is more general at the pres-
ent day  than  it was half a century ago.  This truth is so
frequently  affirmed, and  so seldom  disputed, that it de- 
158                    hygiene.
mands little of proof or argument in its  support.  And
to such an extent  has physical deterioration progressed,
as justly to alarm  every thoughtful mind, every philan-
thropic spirit.  Few fathers, at the present day, deem their
sons able to perform the labor and endure the hardships
which they themselves performed and experienced thirty
years ago.  And scarce a mother can be found who does
not know that her daughters are less strong and vigorous
than she was in the  days  of her girlhood.
  Miss Beecher, authoress of a valuable work upon physi-
cal education, says:
  "The children of  this country are every  year becoming
less and less healthful and good-looking. , There is a great
change in  reference to this  matter within the last forty
years.  In former times, the children in  school-houses, or
on Sunday  in the  churches, almost all of them had rosy
cheeks, and looked full of health and spirits. But now,
the children in churches and schools, both  in city and
country, a great portion of them either have sallow or
pale complexions, or look delicate or partially misformed.
  " The children of  the former generation could go out in
all weathers, were not harmed by wetting their feet, would
play on the snow  and ice for  hours without cloaks or
shawls, and never seem to be troubled with the cold.  And
the tender  parents of these days would be  shocked to
see how little clothing was worn in the bitterest cold of
winter.
  " But now, though parents take far more pains to wrap
up  their little  ones to save them from the cold and wet,
the children grow less and less healthy every  year.  And
it is rare to find a school-room full of such rosy-cheeked,
strong, fine-looking  children as were  common thirty years
ago.
  " Every year more  and  more  complaints are made of
the poor health that is  so very  common among grown
people, especially among women.   And  physicians say
that this is an  evil that is constantly increasing, so that 
hygiene.
159
they fear, ere long, there will be no healthy women in the
country.
  " At  the  same time, among all classes of our land, we
are constantly hearing of the superior health and activity
of  our  ancestors.  Their  physical  strength, and their
power  of labor  and endurance, were altogether beyond
any thing witnessed in the present generation.
  " Travelers, when they go to other countries, especially
when they visit England, whence our ancestors came, are
struck with  the contrast between the appearance of Amer-
ican women and those of other countries, in the matter of
health.   In this nation it is rare to see a married woman
of thirty or forty, especially in the  more wealthy classes,
who retains the fullness of person  and the freshness of
complexion  that mark good health.  But in England, al-
most all the  women are in the full perfection of woman-
hood at that period of life.
  " Now, it  is a fact, that the health of children depends
very much  on the health  of their parents.   Feeble  and
sickly fathers and mothers seldom have strong and healthy
children. And when one  parent is well and the other
sickly,  then  a part  of the  children will be  sickly and a
part healthy.
  " Thus, the more parents become unhealthy, the more
feeble  children will  be born.  And when  these  feeble
children grow up and become parents, they will have a
still more puny and  degenerate  offspring.   So the case
will go on,  from bad to worse,  with  every generation.
What then,  if these  things be true, are the prospects  of
this nation,  unless some great and  radical  change is  ef-
fected?"
  Though these  facts must be apparent  to all, we notice
but little effort on the part of our public instructors to
bring the matter before the people in such a light as will
arrest their attention.   Every man, woman and child, in
this country,  should  be instructed in  the laws of their
being, of the danger of violating the laws of life, and of 
160                   DWELLINGS.
the certain consequences  that will result  to themselves or
their offspring.  A man may have the right to  do many
acts that produce but temporary injury, but he has  no
right to  permanently impair  his health, shorten his life,
and especially to transmit enfeebled  constitutions to his
children.  As he has no right to do this,  it is his manifest
duty to study hygiene for himself, and, so far as  it is  in
his power, see  that the rising  generation  is  properly
instructed.   Harpers, of New York, have done much  to
improve the character of a  common school education,  by
introducing readers, that, while they teach  reading, also
give such knowledge of  nature  and nature's laws as will
prove of life-long service  to the learner.   May such books
soon take the place of those vapid school books that have
but the one idea—reading.
  It is not valid reasoning to say that these matters per-
tain exclusively to the practice of medicine, and should
not be meddled with by  the people.  A man's life is his
own, his health is his own, and in the preservation of both
he has more  interest than any other person.   The know-
ledge that should  guide  him  is  obtained without  much
difficulty, and the facts are so plain and easily understood
that no one need go astray.  While I thus  advocate the
diffusion of this knowledge among all  classes, I do not
wish to be understood as recommending  that each person
should be his own doctor, or that he should turn his entire
attention to his body, watch himself live,  and  thus become
a hypochondriac.

                    DWELLINGS.
   The dwelling, or, as I  much prefer to call it, the home
of a family, has much to do with its health, both physical
and moral.   Of course, our habitations will vary with our
means and tastes, or we may be forced  by circumstances
to occupy houses that  are objectionable; still, a few plain
rules may guide us if we have  the power to select a resi-
dence. 
DWELLINGS.
161
  In the country, other things being equal, the  house
should be built on ground  that is sufficiently rolling to
permit rapid  surface drainage.  If no  such  ground is
found, make an artificial elevation.  The  reasons for such
choice are obvious—it prevents dampness of the ground
adjacent to the house, insures to some extent dryness of
the walls, and gives better cellars.  If the soil is naturally
wet, especially if clay, money will be saved by putting in
tile drains.
  In both city and country, a  house is healthier by hav-
ing cellars under it, providing  those cellars are  kept dry,
well ventilated and free from decaying vegetable  or animal
material.  Damp cellars are fruitful sources of disease, and
this is greatly increased  by allowing the  remains of veg-
etables to  decompose within them.  Numerous instances
have come to my  knowledge, where  serious and long-
continued sickness, and in some cases death, have resulted
to one or more members of a family by  neglect in these
matters.   To secure ventilation, the house should be ele-
vated  from one to two feet  above the surface of the
ground, and the windows so  placed that the prevailing
winds in  spring and summer  may blow through them.
Dampness is best  avoided by a drain passing to lower
ground, but if this is impossible, have a  well-hole  dug in
the center of the cellar, and filled with sand, being careful
that it does not  become a  depository for the offal  of the
cellar.  Weeds,  grass and shrubbery  are sometimes the
cause of dampness; if so, cut them down, at least in such
situations as will allow the sun  to strike the walls with
the greatest effect.  Whitewashing cellar  walls sometimes
answers an excellent purpose in removing dampness and
noxious effluvia.
  Dampness of the walls of a house, whether it be stone,
brick,  or  wood,  renders a house unhealthy.   It  occurs
most frequently  upon tough clay ground, and when the
house is not  sufficiently  elevated.  In  brick or stone
houses, it may be prevented in every case by  placing a
           11 
162
DWELLINGS.
layer of sheet-iron in the cellar wall above ground, which
prevents capillary »passage of water upward.  Whatever
the material of which the walls are composed, they should
be protected against absorption of moisture by painting;
or, if this is too  expensive, by whitewashing.  In build-
ing a house, barn  or stable, always have an over-jutting
roof of from eighteen inches to two feet, as a protection
to the walls of the house below.  Many a good house is
spoiled by the poorly-constructed eave-gutters, which are
so shallow, or have such slight inclination, that  the water
does not run off freely.   They are wet for a considerable
time after a rain, and not unfrequently the wall is kept
damp by overflow.
  As regards the internal arrangement of a dwelling, we
have but little to say in this place.  Of paramount impor-
tance is it  to have the rooms, in which the housework is
done, on one  floor, and water and wood handy.  The
mother has sufficient to do in  the care and work of the
house, and raising of a family, without having her vitality
impaired by stairs or unnecessary work.   The husband
who does not pay attention to  these matters, if  he thinks
at all,  is a brute, and if he has not thought  until this
reaches his eyes, let him look around him and see how he
may lighten the cares of his hard-worked wife.
  If possible, every room in the house should  have the
windows and doors so arranged that the air can pass freely
through, hinged  transums  over the  doors being very
important for  this purpose.  Not only is  it necessary to
have a circulation of air, but, if possible, the living and
sleeping rooms should be so placed that the sunlight will
pass into them at some period of the day.  Air loses, to
some extent, its vital properties if not  impressed  by sun-
light ; and  it is a fact well proved, that cachetic  diseases
of children, as scrofula,  summer complaint, and finally
consumption, are produced from neglect in these matters.
Magendie proved conclusively, by numerous experiments,
that rabbits, and other animals, would soon become tuber- 
DWELLINGS.
163
culous if confined in cellars or dark  places; and that we
might as well expect  to raise vegetables in the dark, or
away from sunlight,  as  healthy children.   In the Paris
hospitals it has been found necessary, in some cases, to
have the patient conveyed out in the open air, as the only
means of saving life.

                  Defective Ventilation.
  Defective ventilation, or  insufficient change  of the air
of dwellings, might be considered to readily suggest its
proper remedy by the feeling of suffocation  induced; but
it is not such a deficiency of oxygen,  or excess of carbonic
acid, as induces a stifling sensation that does most harm;
it is  rather the scanty supply of fresh air that stints the
vital -processes without suddenly disturbing them; and
the gradual  accumulation  of foul  effluvia, that  slowly
poisons, without exciting  alarm. Persons are gradually
brought to endure without  complaint the impure air of a
close room, which, to any one entering it from the open
atmosphere, seems quite suffocating.  Thus, in the hab-
itations of the poor, especially in densely-populated towns,
it is not  rare to find ten or fifteen crowded  into one small
room, without any other supply of air than that which
comes through the floor  or window, or when the  door is
accidentally open.
  Insufficient ventilation is by no means  confined to the
dwellings of  the poor. In modern days, when  workman-
ship of houses is  more complete than it  was in  olden
times, there are no  longer  the latticed casements, chinky
floors, ill-fitted doors, and,  above all, the roaring pile in
the spacious hearth, that supplied abundant  ventilation to
the houses of our forefathers.   Now, in proportion  as
houses are " well  built," every  crevice is so thoroughly
stopped that our rooms, when closed, are well nigh  air-
tight, and their occupiers are inclosed in an atmosphere
which is deteriorating in proportion to the number assem-
bled.  Add to this the vitiating effect of  artificial lights 
164
DWELLINGS.
and of fires, the smoke of which may not freely escape for
want of a due supply'of air, and it will appear how mod-
ern houses  often  comprise the conditions calculated to
produce this cause of disease.   In public  offices, schools,
hospitals, churches, theaters, and other places where great
numbers are collected together, the cause is  still more fully
in operation; and it is quite certain  that not  only is the
public health much injured thereby, but much of the
useful and agreeable objects of such assemblies is defeated
through  the discomfort produced by the closeness and
foulness of the air.
  The habitual want  of pure air, especially, exercises an
unfavorable influence  on the state of the  blood, and the
functions of circulation and nutrition, causing pallidity of
the surface, poorness of blood, imperfect development of
the fibrous principle, which, instead of contributing to the
nourishment of the muscles, degenerates  into scrofulous
or tuberculous matter, the deposition  of which, in the
internal organs or glands, is favored by the weakness of
the circulation.
  Fresh air  is a  cheap  commodity,  and one very easily
obtained;  all you have to do is to make an entrance for it.
A large fire-place  always gives good ventilation—in fact,
is the best ventilator.   If you use a stove, or a grate, fix
the windows so you can lower the upper sash an inch or
so.  If the windows are on opposite sides  of the room,
you will have good ventilation, the cold air  passing in at
one  and settling  down to  the floor, while the heated
impure air will pass out  at the other.   If you have not
windows, cut a hole  in the wall—it is  better to freeze a
little, than to breathe impure air.
  As we have  previously noticed, an individual requires
eight hundred  cubic  feet  of air for  normal  respiration;
and sleeping apartments  should always be  proportioned
to this.  Thus, a room eight feet  square and  ten feet in
hight should never contain but one  person, unless it has
very free communicaton with out-door  air, or other very 
DWELLINGS.
165
 large apartment.   A room eight by sixteen feet, will give
 a sufficient supply of air to two persons, and one sixteen
 feet square will accommodate four.
  Lastly, endeavor  to  beautify your homes with  trees,
 shrubbery  and flowers, as the best means of retaining a
 contented mind, without which, health can not be enjoyed,
 or  in many cases retained.   The earth is full of beauty,
 and we need but a restoration of that inward sense which
 takes  cognizance of the good—the beautiful, to perceive
 it;  this we can obtain only by cultivation.  Make  home
 beautiful; look at the  homes of our  country, how few
 come near the standard?  In the country, a house situated
 in  an open  field,  or on a barren hill-side—no  trees,  no
 shrubs, no flowers;  externally all is dull, gloomy, deso-
 late—a sacrifice to the god of mammon;  how very often
 do we find the inside corresponding, and the hearts of the
 dwellers therein withering, drying up.  We love our homes
 notwithstanding  this—a  merciful provision of the Al-
 mighty for our happiness.  How  much more should we
 love them if we could  associate with  them  thoughts of
 beauty, of pleasant prospects, of the well-kept lawn, of
 the neat walks, the  shade of trees, the budding flowers,
 the twining rose  that  almost curtains our windows, the
 honeysuckle  trained  on the  old porch, shutting out the
 burning rays of the  summer's sun, and  perfuming the
 air  with its  fragrant odor.   Such thoughts are recalled
 with pleasure throughout the journey of life, a green spot
 in the memory which nought can efface.  Beautify your
 homes,  then, if not from  any  delight  you  take in it, at
 least for your children's  sake; to them  it  may  prove of
 more service than your hoarded wealth, a constant safe-
guard against many of the sins of this untoward genera-
tion.
                     CLOTHING.
  The acknowledged purpose of clothing, as a  means of
preserving the health, is  to maintain as  much as possible
such an equal warmth  of the surface and extremities of 
166
CLOTHING.
the body, as may conduce to the comfort of the feelings,
and promote a free circulation, with sufficient perspiration
and innervation in all the external parts of the body.  But
the healthful action of  clothing is not confined to its prop-
erty of retaining warmth.  It is useful also in protecting
the body against the injurious influence of external heat,
dryness, moisture and electricity; and varied modifications
of the clothing will best  answer these  several ends under
different circumstances.
  The lower animals exhibit many interesting facts, show-
ing instinctive or natural provisions for changes in their
clothing to suit  variations in season and weather, from
some  of which we may derive useful instruction.  The
change of coat in horses takes place in spring and autumn,
and depends  much on  the character of the season;  the
thick winter coat being slow to come off in a cold spring,
but soon changing in continued warm weather;  so, like-
wise,  cold weather in the autumn accelerates the thicken-
ing of this   coat, which in  horses left to nature we find
abundantly  provided before the severity of the weather is
established.  Sheep change  their wool only once in  the
year; but its rapid increase before the winter sets in, and
its tardiness in loosening  and falling off", until June, when
all  the  cold winds of the spring have passed by,  afford
useful suggestions as to the propriety of  anticipating the
cold by the protection of dress, and of patiently awaiting
its  subsidence before we remove that protection.   Birds
moult their feathers early in the autumn, at which period
the new plumage thickens  in down and feathery expan-
sion as  the winter  sets in.   In the spring, many of the
downy feathers drop off, and are by many tribes appropri-
ated  to the lining of their nests ;  and through the sum-
mer the feathers continue to get thinner until the moulting
season, when all give place to  the new plumage.
  It is now generally admitted that woolen underclothing,
at least during eight months of the year, is conducive to
health.   The  low  conducting power  of woolen goods, 
CLOTHING.
167
serves  to  retain the heat of the body, so as to maintain
an  equable temperature, while its  porosity permits  the
escape of the  insensible  perspiration.  Experience would
seem to prove that light woolen clothing is also better for
the  heat  of summer, especially for those who labor, per-
mitting, as it  does, the escape of perspiration, without
becoming wet like cotton, and preventing the rapid cool-
ing  of the  surface  during periods of rest.   Laborers on
public works, in foundries  and iron-works, wear woolen
Bhirts the year round, and consider them the coolest  and
most comfortable.  Our  soldiers in the field could not be
persuaded to change their woolen for cotton clothes, even
in  summer, and in  a Southern  latitude,  not  only on
account of their comfort,  but  because experience  has
shown that they greatly aid to prevent malarious disease.
Especially should woolen clothes  be worn in malarious
regions in the  fall,  when such diseases prevail, as tending
more than  any other means to  prevent attacks of ague
and fever.
   Children of  feeble  constitution should  wear woolen
clothes the  entire year, the garments being loose in sum-
mer.  In my practice I have witnessed a  very marked
change in such patients suffering from summer complaint
and similar diseases, by change  of clothing.  Children
should  be warmly  clothed,  as in infancy the body is not
capable of resisting rapid changes of temperature, except
at the expense of its vitality.  The Germans, as  a people,
are  especially noted for keeping their children warmly
clad and still; hence, the nutritive powers of the child are
not impaired by the continued draw for  combustion,  and
waste by undue exercise.  Infancy is essentially a state of
vegetation;  hence, all undue exposure and exercise should
be avoided.
  That most absurd fashion of exposing the child's breast,
arms and knees, should be especially avoided, as no matter
what fashion may dictate, common sense would say that
children look better fully clothed.  How often do we  see 
168                    CLOTHING.
a mother, especially a young mother, with  her child but
half clad, its arms, breast and part of its  legs exposed,
when she is warmly encased in  woolens and furs.   Such
mothers should not be surprised that their children die
early, or that their constitutions are impaired for life, and
learn that it is the hight of impiety to attribute it to
the dispensations of Providence.
  " Under  particular circumstances or conditions of the
system,  additional  warm  clothing  is  necessary; for
instance, in infancy  when the calorific power  is low; in
old age;  in  convalescence from acute  diseases; during
fatigue and other states of weakness ; in organic diseases
of the heart, when the circulation is feeble; in cases of
privation of food; during the operation of purgatives or
diaphoretic medicines;  and when  circumstances prevent
the use of a proper amount of exercise.  Under the influ-
ence of these conditions, a feeling of chilliness arises, par-
ticularly on the surface  and in the extremities; and this
is an indication of the need of more clothing; and if this
be put on to  prevent the sensations of cold, it will  often
counteract such disturbances of the circulation  and inter-
nal congestions  as the weakened body is liable to at the
time, which  too often lay the foundation  of future dis-
ease."
  Fashions are  to be disregarded only when they conflict
with comfort or health.  All desire to look well and dress
well, and the desire is laudable.  The old fashion of tight
lacing and stays was most abominable, not only for the
discomfort that  it must have induced, but also for the
serious injury to the health.  Respiration  is of absolute
importance to life and health, and in proportion as it is
impaired, the health suffers, and life is shortened.  No
woman, with tightly-laced stays, could breathe freely, and
in many cases only the upper parts of the lungs could be
used.  Hoops were advantageous, inasmuch as they took
the place of  the  immense weight of skirts which  before
were  used  to give size, and which, hung upon the hips, 
FOOD.
169
 gave rise to  many diseases of  the lower part of  the
 abdomen.
                 Take Care of the Feet.
   Proper attention to the feet is  of much greater impor-
 tance, as a means of preserving the health, than most
 persons  imagine.  Many of  the minor  diseases which
 render life disagreeable, as well as some of the more seri-
 ous affections, result  from carelessness in this  respect.
 Exposure of the feet to cold  and moisture, for want of
 sufficient covering, by suddenly checking secretion of the
 skin, and driving the circulation from the extremities, is a
 common cause of disease.  Protect the feet, therefore, by
 wearing good stout leather boots or shoes; or, if from
 affected gentility, such should hurt your feelings, and  you
 must wear paper  shoes, get  a pair of rubbers, lined with
 canton-flannel, to  draw on when you  have occasion to
 expose your feet to the cold or wet.
   Cold feet is a  very  common annoyance with  a  great
 many, and directions how to  keep the feet warm would
 not be inappropriate.  Make it a rule to wash them once
 a day in cold  water, rubbing them briskly afterward until
 warm, then drying them carefully by the  fire, is a certain
 preventative,  if proper covering is  worn.  As  regards
 stockings, in some cases woolen will  be preferable, but in
 others we think  cotton the best.  Thus, where the  feet
 sweat, rendering the stockings damp, a good stout pair of
 cotton  ones  will  sometimes  prove warmer than  the
 woolen.   The writer always suffers from  cold  feet when
 wearing  woolen,  but finds it easy  to keep them warm,
 even in the coldest weather, when wearing cotton.

                       FOOD.

  The proper food for the infant up to the end of the first
year, is  the mother's  milk, and  if the child receives an
abundant  supply  of this, no other food  is  necessary or
proper.  Children very generally  suffer from disregard of 
170
FOOD.
one of nature's plainest laws, that they need no other food,
until the organization is so developed as to appropriate it.
" Wanting faith in the sufficiency of God's arrangements
to effect his  own purposes, both medical men and mothers
used  to  advise the addition of gruel, arrow-root, or some
other farinaceous food, almost from  the first month; and
the common results were, impaired digestion, and a greater
liability to convulsions and other diseases of irritation,
especially during  the time of teething.  But now, abetter
acquaintance with the laws of  the animal economy, joined
with a more implicit reliance on the wisdom and benevo-
lence of the  Creator, has  at  last convinced  us that the
more closely we adhere to the path which God has marked
out for us, the more successful shall we be in rearing the
young.  If,  indeed, we bear in mind that  the great mor-
tality in infancy is not a part of the scheme of Providence,
but arises chiefly  from removable causes, and has already
diminished as our knowledge  has  advanced, we shall be-
come more  and  more anxious to discover and fulfill the
laws of the infant organization, as the surest way of bene-
fiting and preserving the child."—Combe.
  When  additional nourishment is required for the child,
fresh cow's milk will prove the best; if the child is  under
four months of age, it will be better diluted with one-fourth
part of water, and slightly sweetened with loaf-sugar;  if
over this age, give the milk alone.  Occasionally arrow-
root,  farina, or  corn-starch  may be used with advantage,
but as a general rule the milk will be preferable.  Yrhen
the child  has gained its teeth, it can eat  with advantage
such food as it can masticate.  Farinaceous food seems to
answer a better purpose  than animal, though an appro-
priate diet would be  composed of both.
  The child  as well as the adult should have its food at
regular  periods,  and eating between meals  should  be
avoided as much as possible, as the stomach requires those
intervals  for rest.   Give a child as much good, wholesome
food as it can digest, but if you love your children keep 
FOOD.
171
them from eating pastry, cake, nuts, and candies; but in-
stead, furnish  them with ripe fruits.  Candy or sugar is
the least objectionable of any of the  articles named, and
would not be injurious in moderate quantity, if it did not
impair the appetite for substantial food.
  A mixed diet is the healthiest for the adult, letting ani-
mal food  overbalance in winter, vegetable food and fruits
in summer.   Common experience is the best guide as re-
gards articles of food,  and there are but few articles but
what can be taken in moderation without injury. liarely
do we find a person who changes his habits of life or food
from some  peculiar  notion  or whim of his own, and is
markedly different from the people around him, but what
comes to grief.  Sooner or later, even he will be forced to
admit, that the experience of thousands of years, as man-
ifested  in the general  habits  of a people, can not be dis-
regarded with safety.
  Avery common source of disease, is improper cooking
or preparation of food, by which it is rendered indigestible
or  its  nutritive properties are  impaired.  I have seen a
beefsteak fried in lard, until  it resembled, and was as in-
digestible as a saddle-skirt; when, if it had been broiled on
the coals or stewed in a very small quantity of water, it
would  have  been palatable and easily digested.  Or the
piece of beef is  put in water and  boiled for hours, the
water being thrown away, and the tough fibrous tissue of
the beef served up.  So with bread—one will have it solid
and tough, a  second light but sour, and a third but half
cooked, while  it is somewhat rare to  find the " staff of
life " properly prepared.  I do not propose to write a cook-
book, but simply desire to call the attention to the neces-
sity of a proper preparation  of the food as necessary to
good health.
  As a general rule, people eat too  much, and by over-
loading the stomach they at last so impair its powers that
it is with difficulty it will digest sufficient for the wants of
the system, and that with much suffering on the part of 
172
FRUIT.
the patient.  A  very good  rule to follow, is, to eat until
you feel the first  sensations of having sufficient for the
wants  of the system, but never until you have lost your
appetite, or until the taste is no longer pleasurable.

                       FRUIT.

  Nothing promotes health of body  and mind more than
plenty of ripe fruit during the summer and fall; and yet
how many do we  find living in the country, with plenty
of ground to spare, who do not raise enough of any one
kind for home  consumption.  It requires some labor to
set out trees and vines;  but  when once started, they are
but little trouble, and repay a hundred  fold  for the time
and labor expended. Again, all  this  may be done at
times when but little else could be accomplished.  For in-
stance:   the  farmer, who  complains  so  much  about
" want of time " to  set out fruit trees, by investing five dol-
lars in apple, pear, peach, and cherry trees, and in grape,
raspberry, and strawberry vines, either  in fall  or spring,
when business calls him near a nursery, taking them home,
putting them in the cellar,  carefully covering  the  roots
with earth, will have a stock to commence with.  Then
devote odd time to setting them out, if  no other place  can
be found, in the fence corners; and in the  space of two
or three weeks they will all be planted and ready to grow.
Continue this plan for two or three years, and he will have
fruit enough, and of the  best kind,  to  supply his family.
Continued ten years, and if near a railroad or river, the
fruit crop will  pay in   silver dollars double the amount
which  by  any other means could be obtained from the
farm.  No farmer should be  without fruit of all kinds. In
the city we can not live without it; and though it is  fre-
quently very dear,  yet  it is cheaper to buy peaches at a
dollar a peck than pills at two dollars a box; the peaches
taste better, without any company, than the pills with the
very pleasant company of the doctor. 
AIR AND TEMPERATURE.              173
            AIR AND TEMPERATURE.

  Impure air is one of the most common causes of disease,
and should be  carefully guarded against.  Impurities of
the atmosphere arise  most frequently from gaseous exha-
lations from decomposing animal or vegetable material,
and though its effects are generally confined to near the
locality where the poisonous matters are generated, yet at
times they extend to a considerable distance in the direc-
tion of the prevailing winds.   A badly-arranged privy
vault, imperfect drainage or removal of the slops of the
house, decaying vegetation near the house, or even a rank
growth of weeds or grass in the yard allowed to decom-
pose, is sufficient to give rise to most serious disease—diar-
rhoea, dysentery, autumnal fevers, or typhoid fever.
  It has frequently been noticed that a house will prove
unhealthy that is situated so that the winds blowing  over
a swamp, or piece of  low land, will strike it.  So, also, is
it the case when  the house is built so that the prevailing
winds blow over newly-opened ground toward the house.
In  a new country, a family is  protected against malarial
disease by building the dwelling in the forest, and clear-
ing the land on the opposite side to the direction of the
prevailing winds; and on the  prairies, by  leaving the
ground about the house unbroken.
  As regards  deficient drainage, it has  heretofore been
spoken of as rendering a house  damp, but we must  now
consider it as  rendering the atmosphere impure.  Dr.
Williams remarks,  "that the deleterious operation of
effluvia arising from  this may stop short of a  directly
poisonous effect, and yet, by adding to  the unwholesome-
ness of the atmosphere, it may gradually undermine the
health.   The soil which drains from habitations, contains,
in addition to  excrement, dirty water, the washings  and
remnants of vegetable matters used  as  food, and other
offal.  All these are mixed together, and stagnant, in the
corrupting slough  that  is  retained  in cess-pools  and 
174
AIR AND TEMPERATURE.
privies, or that is carried into sewers.  The stench which
exhales when these receptacles are opened, gives some
idea of the deleterious influence they originate, and the
fearfully poisonous  nature  of the  emitted gases, is often
proved by the  sudden faintness  and sickness, nausea,
vomiting and diarrhoea, which attack persons engaged in
emptying them.   *  *  It is no wonder, then, that every
ill-drained house has a Pandora's box ready to pour forth
its evils  whenever occasion offers; and always  oozing
them out in degrees sufficient for the  impairment of the
health  of the inhabitants, and the gradual excitement of
cachectic and other chronic diseases."
  Dryness of the atmosphere is promotive of health, and
I have  heretofore adverted to the  importance of keeping
the cellars and walls of the house dry.   A very dry air,
however, is injurious, as wTe observe in the winter in stove
rooms.  It causes dryness and irritation of the respiratory
mucous membranes, excitation of the system, and disor-
dered innervation.  A stove used to heat a room,  does it
by  heating  the surrounding air,  having but very little
tendency to produce circulation of it or ventilation; it
causes  extreme dryness and undue expansion of the air,
thus unfitting it for respiration.   The consequence is, a
sense of fullness of the head, irritation of the respiratory
passages, debility of the skin, and feeling of languor or
listlessness.   When warmed by  an open  fire-place,  or
large grate, which heats the room by radiation, a free cir-
culation of air is produced, the temperature is not unduly
increased, nor is the air deprived of its moisture or other
vivifying properties.   Sitting in stove-rooms we  believe
to be  one  of the most frequent  predisposing  causes of
consumption and other diseases of the lungs.
  A damp or moist air has less vivifying  power than dry
air, as  it contains less pure oxygen, and is also  objection-
able from the facility with which it sets up processes of
decomposition and infection.  Warm, moist air is very
relaxing  and  debilitating  to most persons,  while cold, 
AIR AND TEMPERATURE.
175
 damp air  is proverbially  unhealthy—checking perspira-
 tion, chilling the surface, giving rise to colds, diseases of
 the lungs,  rheumatism, etc.'
   " The invigorating effect of fresh air may be partly
 referred to its  superior purity, more perfectly adapting it
 to  the work of respiration ; but  some  of its refreshing
 power is due to a direct influence exercised on the nerves
 and  capillaries of the surface of the body,  and through
 them on the functions generally.   This  is exemplified in
 the reviving power which a  current of fresh air or fan-
 ning exerts over persons in a  state of faintness;  and this
 result is the more  remarkable when the air is cool and
 the body has been  previously weakened by heat and con-
 finement.  The less marked  but more enduring benefits
 of  fresh air are  experienced  in  rides,  drives,  and other
 out-door exercises,  passive or active, which  are univer-
 sally acknowledged to be essential to the  maintenance of
 the bodily health.  To obtain the greatest  amount of good
 from  these airings, it is advisable  not only  to resort to
 localities where the air  is most pure and free  from con-
 tamination, but also to vary its qualities in other respects.
 Thus the  inhabitants of valleys derive  benefit from the
 air of hills—those  of inland places from that of the sea—
 and  residents on the  sea-coast find advantage in drives
 inland.  For a similar  reason, great improvement often
 results to the health from  continued traveling by land or
 sea;  and  although this comprises other hygienic  influ-
 ences, beside change of air,  experienced  teachers rarely
 fail to distinguish  this as  being of sensible efficacy, and
 exercising  a marked effect on the vital  functions."— Wil-
 liams.
  Physicians are frequently consulted in regard to change
 of  climate for  persons suffering from  chronic  disease,
 especially consumption, and there has been much diversity
of opinion  on the subject.  It is now pretty generally ad-
mitted, and, I believe, conclusively proven by experience,
that southern climates are  rather deleterious than other- 
176
AIR AND TEMPERATURE.
wise, to a majority of persons suffering from consumption.
The warm, moist atmosphere in winter and spring, though
of itself tending to relieve irritation of the lungs, debili-
tates the system, and does not give that vivifying influence
that is so characteristic of northern climates.   So that,
though the sufferer may seem improved for a few weeks,
at last  the vital powers fail as rapidly as  if he  had re-
mained at home.  Much  benefit is obtained in many of
these cases, by a residence in the north, as at St. Anthony's
Falls, St. Paul,  etc., and I am satisfied by experience that
a summer or  even a  winter  residence there will be at-
tended with better results than  in the South, or the vari-
ble  climate of the Middle States.  A voyage to California,
and residence for some time in that State has been  strongly
recommended in some cases, and attended with most grat-
ifying results.
  In very many cases all the  benefit to be experienced by
change of climate, can be obtained at short distances from
home.   One  of the main  objects  is change of scene; a
second, change  of habits; and the third, exercise  in the
out-door  air.  If these  are obtained it makes  but little
difference where the person goes, always choosing  a sec-
tion of country that has pure air, and in the case of dwel-
lers in  low grounds, an elevated country.
  As regards temperature, that most conducive to comfort
and health, is about 65°  Fahrenheit, and It must be an ex-
ceptional case that requires that the air of a room should
be  heated above this.  " The advantages of keeping the
atmosphere of apartments considerably  cooler than the
body itself, consists, not only in the greater amount of oxy-
gen that is then contained in a given bulk, but also  in the
greater force with which the warm,  foul air of respiration
is carried away from the breathing  passages, and a pure
medium supplied to them in consequence of the difference
of temperature maintaining a current.  Overheated  rooms
are  peculiarly oppressive,  for the converse reason,  unless
the air is continually changed by efficient ventilation; and 
EXERCISE.
177
 rooms warmed by stoves or heated air, cause a feeling of
 closeness which does not result  from open fire-places, be-
 cause these latter communicate  heat chiefly by radiation,
 and leave the atmosphere  comparatively cool.  The ani-
 mal body being naturally much warmer than the surround-
 ing air, operates as a ventilator for itself, by the same con-
 summate adaptation of pneumatic laws as that which sup-
 plies a flame or fire with a continued current of fresh air;
 just as a fire burns brighter and clearer in frosty weather,
 so an animal breathes a purer, denser air at the same time,
 which, if not injurious by its cold, is refreshing and invig-
 orating to the body."— Williams.

                     EXERCISE.

   In order to keep the body in a healthy condition, it is
 necessary that all parts be called into action.  Exercise
 facilitates the breaking down of the worn out structures
 of the body, and their  replacement by new material.   It
 gives a  normal stimulus to the respiratory function, and
 to the  circulation of the  blood, increases the excretions,
 and improves the appetite  and  digestion.  Those who
 lead sedentary lives have their bodies formed of old and
 partially worn-out material, and of course, can not enjoy that
 joyous feeling of elasticity and health that belongs to those
 in whom the nutritive powers are active.
   It is a law in physiology, that a part grows in propor-
 tion to the demand on it for action; a wise provision of
 Providence  to  adapt man  to any situation in which he
 may be placed.   Not only does it increase in size,  but in
 still  greater  ratio  in strength or capacity to perform its
functions.  Thus  we notice  that  the  arms of the black-
smith, and  especially the right arm with which he wields
the hammer, is increased in size, the muscles are hard and
firm, and its strength  is greatly increased.   The ballet-
dancer has the muscles of her legs remarkably developed,
whilst the person who sits the greater portion of the time,
          12 
178
EXERCISE.
 finds himself with legs possessing neither size nor strength,
 Not only may single groups of  muscles be increased in
 size and strength, but the entire muscular system may be
 equally developed in the same manner.   As an example
 of  this we might  instance those trained to athletic per-
 formances who exhibit themselves through  the country,
 or Dr. Winship, of whom nearly  all have heard, who by
 a systematic course  of training was enabled to lift over a
 ton in weight.
  Not only is  the muscular system susceptible of growth
 and improvement, but all parts of our bodies are governed
 by the same laws.  Do we wish to go bare-footed ? after a
 time the skin of the feet  is so thickened and protected
 that we can do so with comfort.   Do we  wish to employ
 our  hands  at  severe labor, as cutting wood ? nature pro-
 vides a thicker and tougher envelope for the  palms, suffi-
 cient to  withstand  the friction.   It is a well known fact,
 that the brain  of the scholar increases in size  and density,
 that the capacity of the lungs is increased  by exercise,
 that if one  kidney be destroyed by disease, the  other will
 become much larger and fulfill the functions of both, etc.
  These facts should learn us, that if it is desirable to in-
 crease  our  muscular power, the only way in which it can
be done, is by a continuous and judicious exercise of the
 entire  body.  Do we wish to increase the power of any
particular muscular part? we call these muscles into ac-
tion day by day until the purpose  is accomplised.   Do we
 desire  a  larger and better  pair of lungs ? we  adopt a con-
tinuous course of  exercise for them, and the development
is almost certain to follow.  Thus  I very frequently have
 occasion  to recommend to persons with weak lungs and
 thoracic  muscles, that they increase the  capacity of the
 chest by frequent  full inspirations, and the  strength of
 the respiratory muscles, by dumb-bell or similar exercise.
 The system of free gymnastics that is now being intro-
 duced into our public schools, is a most excellent plan for
 the development of  the  muscular  system, the  only trouble 
EXERCISE.
179
 being that the teachers do not seem to be impressed with
 the fact that time is necessary to develop increased nutri-
 tion and strength.
   Those who labor in the open  air have no occasion for
 gymnastic exercise, their only trouble being to avoid ex-
 cessive action which weakens instead of giving strength.
 To those engaged in sedentary employments, the cultiva-
 tion of a garden, sawing the wood,  or other useful out-
 door employment may give the necessary  out-door exer-
 cise.  It is recorded of Dr. Lyman Beecher, that he not
 only sawed his  own wood to obtain the necessary exercise,
 but would gladly aid his neighbors for the same purpose.
 If you can not  be suited in this way,  have a swing made
 in your shop or office, of a couple of pieces of rope firmly
 attached to the ceiling, and a stout piece of  round hickory
 at such a hight that you can just reach it with your hands,
 grasping this, the act of swinging will call into action all
 the muscles of  the  body.  A pair of  dumb-bells will  an-
 swer a very good purpose if associated  with considerable
 walking.
   Though exercise is so essential  to health, it is necessary
 to avoid carrying it to excess, as serious injury might fol-
 low. In adopting any course of  exercise it must be com-
 menced with moderation, and never carried to exhaustion.
 Day by day the capacity for exercise will be increased,
 and the time can be prolonged with safety, until a normal
 amount is obtained.  There is no use of exhausting vital
 power in swinging by the hands, or using a pair of dumb-
 bells ; all that we desire by their  use, is to give  normal
 nutrition and strength.
  In the case of feeble  children,  a systematic  course of
 physical education,  will, in many cases, yield a strong and
 robust body, when, without it, the child  would have sunk
into  a premature grave.   So in many diseases, by calling
into  moderate action the parts  affected, or those closely
associated with  them,  we sometimes accomplish wonders. 
180               MENTAL OCCUPATION.
              MENTAL  OCCUPATION.

   Mind has great influence  over matter, and we nowhere
have better examples of it than in our bodies.   An occu-
pied, contented  mind conduces  to health, the  reverse to
disease.   No  better  proof of this proposition is  needed
than the evidences of our observation on  persons  around
us; the restive, anxious countenance, indicative of cares or
an ill-spent life,  most surely tells the story of future physi-
cal ailments, while  the busy and  contented, other things
being equal, rarely have need for the physician.
   Over activity of  the mind  from study or business, or
caused by cares or misfortunes, is exhaustive of vital
power, prevents normal  action and nutrition of other
organs and parts, and thus destroys  the harmony that
should exist in our  bodies.  Ask your physician, and he
will tell you the most  difficult cases of diseases  he meets
with, are in persons of this class;  and he sometimes finds
it impossible to give the patient relief in cases  in  which
otherwise he would find but little trouble.
  A hale gentleman of ninety-four, had one evening con-
tributed largely to the entertainment of a social party, by
his performances on the violin.   After his departure, the
remainder of the company set themselves to  speculating
on the causes of the good health  and soundness of con-
dition, which  he continued to  enjoy at so advanced an
age.  After many theories had been discussed, one gen-
tleman, who happened to be a near relative of the vener-
able violinist, told his companions that "he believed they
were all  wrong, upon good grounds  of observation; it
was his conviction that Mr.----owed his singular length
of days and good health to nothing else than  his playing
on the violin.  He had been a player on that instrument
for the last seventy-eight years, had during that time played
more or less every day, enjoyed it keenly, made  others
happy by  the  strains, and derived happiness from  seeing
them happy; lively music had  been the very salt of life 
SLEEP.
181
to him—he scarcely ever knew what it was to be dull or
in low spirits.  As there was no other special circumstance
in his condition, it became apparent that Mr.----had
reached an unusual age, in unbroken health and strength,
solely by playing on the fiddle!"   The  company was
startled at first,  but  after a little reflection, they fully
admitted that in all probability the right  explanation had
been given.
   And  it undoubtedly  was so.  It is now quite settled
among physiologists, that cheerfulness sustains, and care
depresses, health, and that a  certain amount of happy
sensations is necessary to the prolongation of life.   The
doctrine works out its verity in  a striking manner, wher-
ever there are large bodies of men concerned, as in mili-
tary or  naval expeditions.   That  officer,  it is acknow-
ledged, is sure to have the healthiest regiment or ship's
crew, who best can sustain  their  cheerfulness,  or keep
them in merriment;  and for this reason, it becomes  a
matter of serious concern to encourage the men in getting
up plays and sports  among themselves.  This was done
with the best effects by Captain Parry during his compul-
sory wintering in the Arctic regions.  We  will, on  the
same grounds, pledge  any reputation we  may have for
wisdom, to the conclusion that, in two families of young
children, brought up in circumstances otherwise identical,
and starting with equal advantages  in point of constitu-
tion, that will be  the  healthiest, and come to the most
satisfactory set of men and women, which has been in the
hands  of parents of cheerful and kindly dispositions;
which has been  most encouraged, under decent bounds,
to laugh, to play, to dance, to  sing; has been the least
frowned at, awed down, and frightened;  which, in short,
has been made the happiest.—Chambers' Journal.

                       SLEEP.
  Sleep is the normal restorative of the body, giving rest
to the various organs and tissues, and time for their nutri- 
182
SLEEP.
 tion.  Especially is sleep of importance to the nervous
 system, as during it there is complete  suspension  of the
 cerebral and sensorial  functions, and when  this necessary
 rest is obtained, the mind again acts with vigor.  During
 sleep, every function is in abeyance, except the vegetative,
 hence waste  of the tissues is arrested, and the vitality of
 the body can be concentrated  for its own repair and pro-
 tection.
   The young require a great amount of sleep—the infant
 almost the entire time except when nursing, as its func-
 tions are purely vegetative; and the child of two to four
 years, ten  or twelve hours at night, and its mid-day nap
 of two or three hours.  It must not be supposed that this
 arrangement can be broken into with impunity, as disease
 will in very many cases result  from neglect in these par-
 ticulars.    The  adult  requires  at least eight hours of
 refreshing  sleep; some need  more, while others  can do
 with less, but this seems to be the average.
  " The influences which prevent or disturb sleep are, any
 undue excitement, or sensation of body or mind, whether
 of  a painful or  pleasurable nature; strong, sudden, or
 startling impressions  on the  senses;  uneasy postures;
 extreme fatigue  or exhaustion;  oppressed  or imperfect
 breathing;  palpitation of  the  heart;  hunger,   thirst,
 nausea, flatulence,  and various other (often undefmable)
 sensations in the viscera ;  extremes of temperature; cold-
ness of the extremities; irregularity in the habits of seek-
ing repose.
  " The loss of rest is  so seriously  detrimental to health,
that it is of the utmost importance in a hygienic point of
view, that this result should be  obviated;  and  beside
avoiding, so far as may be possible, the  several causes of
wakefulness just specified,  bad  sleepers should  strictly
attend to the following directions for their regimen, rather
than resort too hastily  to hypnotic drugs, which, although
sometimes useful and  necessary as  temporary expedients,
lose  their poAver by habitual  use,  and  produce other evil 
EXCRETION.
183
consequences which render their long  continuance  im-
proper.
   " Bad sleepers  should make a  regular practice of early
rising.  It may cost them some effort at first; but if they
desire to have sound rest, they should seek it at the nat-
ural time, and not late  in the morning, when the excite-
ments of the day begin.  Their hours for meals and exer-
cise should also be early and very regular, both in order
to promote that  state of health  most conducive to ease
and freedom from suffering, and also to secure the accom-
plishment  of the processes  of digestion, and consequent
excretion or eructation  before night, which is the proper
period for repose.   Exercise should be taken freely in the
open air as the strength will  permit,  without causing
lasting fatigue; and if walking or riding can not be borne
without such result, driving or sitting out in the  open air
several hours in the day, may often be  resorted to as an
efficient substitute.  As the hour  of retirement for  rest
approaches,  every description of  excitement should be
avoided."

                    EXCRETION.
   Care of the person, so as to promote excretion from the
body by the skin, kidneys and bowels, is among the most
important  of hygienic measures.  We have already seen
that the broken down elements of our bodies are removed
by these channels, and that their retention invariably pro-
duces disease.
   The skin is not only a very important  excretory organ,
giving exit to about half an ounce of  deleterious material
daily, but it is also, to  some extent, a respiratory organ,
and is very intimately  associated in  sympathy with  the
vascular and nervous systems. Yery many acute diseases
arise  from sudden  arrest of this  secretion, which would
not occur if proper attention had been habitually given
it, so as to  give it tone and  strength.   As a general rule,
bathing for the  purpose of  cleanliness is  all  that  is 
184
EXCRETION.
 required, but in some cases special baths are appropriate.
   Quite a large number of persons seem to have as great
 a  horror of water, locally applied, as  if they had been
 bitten by  a mad dog; and  for years  their bodies have
 never received  a thorough cleansing.   Such  fossils  are
 passing away, and the rising generation better appreciate
 the  usefulness  as 'well  as luxury of a bath.  Children
 should be habituated to the use of the daily bath in sum-
 mer, and two or three  times a  week  in winter.   In early
 life the water should be tepid, but  after the age of three
 or four years, it can usually be  used cold.   Occasionally it
 should be employed warm, with soap, for  the  better
 removal of the oily secretion of the skin.
  Every house should have appliances for bathing.   They
 need not be costly, and do not  require much skill in their
 preparation.  When it is not convenient to have a bathing
 tub, an India rubber bathing cloth, costing six dollars, and
 lasting for years, will answer an admirable purpose.  If
 this  is not readily obtained, purchase a yard and a half of
 common oil-cloth, and  sew a half inch rope in its borders
 to keep the water from  running  on the  floor.   Spread
 either of these  on the carpet, and with a basin of water, a
 sponge, and crash towel, the luxuries of a  bath may be
 enjoyed in perfection.  If a person is of feeble constitu-
 tion, use tepid water, or if it is desired stimulating, add
 salt,  but if reaction is readily established,  employ cold
 water.
  The habitual use of the cold sponge-bath, is the most
 efficient  means of preventing colds, and the  entire series
 of acute diseases which arise from them.  A woman applies
to me, remarking that she can not put her hands in water
 or expose  herself to  change  of  temperature,  without
having ague in the breast.  I advise the daily use  of the
cold bath,  commencing with tepid water,  and gradually
lowering the temperature, and she ceases to be troubled
with her annoying complaint.  Another is  troubled with
a harassing cough through the winter, and  is continually 
EXCRETION.                    185
 taking cold.   The same advice followed out, gives almost
 entire exemption from cold or cough.   A child has fre-
 quent attacks of croup, to the great distress  and annoy-
 ance of the parents; the habitual use of the bath is found
 to  arrest this tendency.  It may be laid down as a  gen-
 eral rule, that the best prophylactic to colds, is the use of
 the cold sponge-bath.
   In very many cases  of commencing cold arising from
 exposure, the use of the hot foot-bath  will  re-establish
 secretion from the skin and prevent disease.   The general
 tepid, or warm bath,  is frequently of much advantage
 in  the  same  cases, and also  after exhaustive mental  or
 bodily exercise,  especially if followed  by brisk friction.
 The warm or cold head-bath will be found very useful in
 obviating excitations of the brain, and the many evils that
 flow from it.
   The  kidneys are generally  supposed to be able to take
 care of themselves, and no attention is paid to  their secre-
 tion.  As we have heretofore noticed, it is the most im-
 portant excretion of the body, and life itself is dependent
 upon its continuance.   Irritation  of the nervous system,
 headache, dizziness, derangement of the stomach, etc., flow
 from its  partial arrest.  As water increases the quantity
 of  urine,  it will, in these cases, be found  advantageous to
 take  a tumbler  full of cold water before breakfast, and
 such  exercise as, while it calls the muscles into play, will
 not excite perspiration.
  In the summer, the secretion of urine is decreased, and
 the secretion of the skin increased; in winter it is the re-
 verse.  If, therefore, a  sufficient quantity of water is not
 passed through the kidneys to wash away the solids of the
 urine, it  is of advantage to increase the amount  of fluids
taken, and lessen the excretion from the skin by the use
of the bath.
  The urine should be regularly voided,  and not allowed
to accumulate  in the bladder.  Want of attention in this
respect may produce but little difficulty in the young, but 
186                   EXCRETION.
in after life it may occasion very annoying diseases of the
urinary organs.  Especially is the habit of long retention
of urine on  the part  of woman  to be deprecated, as it
changes the position of the pelvic  organs, and gives rise
to such relaxation as produces the various displacements
that prove so deleterious to the woman's health.
  Regularity of the bowels is essential to perfect health, not
only because the secretions should be promptly removed,
but more especially because torpidity of the intestines im-
pairs digestion.  A very little attention on the part of the
young will establish habits of  regularity that will last for
life, and in a large majority of persons, observance of the
following rules will overcome habitual constipation.
  Some regular time should be selected for this excretion,
and  punctuality to the minute,  should be attended to.
This, like many other functions, is  naturally periodical,
and when, again, a definite periodicity is established, no
further trouble  will be  experienced.  If  the bowels are
sluggish and will not move at these times,  an injection of
cold water will accomplish the desired object. With persons
whose bowels act regularly, the feculent matter is ready in
the rectum for expulsion at the proper time; but in those
of a lax and  sluggish  habit,  and who have torpid bowels,
time is required to  effect the object.  Yiolent straining is
injurious at all times.  " Repeated gentle and sustained ab-
dominal contractions, assisted, if  necessary, by kneading
pressure or  friction downward in the left iliac region, in
the direction of the sigmoid flexure, with  occasional vari-
ations in the position of the body, are the safest and most
efficient means for accomplishing the object, but they re-
quire the sacrifice  of  a  few minutes of time, and  if the
end  were  not worth the sacrifice, I would not trespass
upon the delicacy of my readers by this allusion to so dis-
gusting a subject." 
INTOXICATING LIQUORS.             187
      Intoxicating Liquors as a Cause of Disease.

   The abuse of intoxicating drinks  is almost invariably
 followed by disease, and it is well to know why this is the
 case, so that if we shorten our lives in this way, we may
 at least have the satisfaction of not doing it ignorantly.
 Alcoholic liquors are soon absorbed, their stimulant action
 being speedily exercised on distant parts, especially on the
 vascular and nervous  system.  Being absorbed by the
 veins, they pass by the portal vein into the liver, the func-
 tion and structure of which are peculiarly apt to suffer
 from excesses, especially when spirits have been freely in-
 dulged in.  So, too, the kidneys, which  are the natural
 emunctories  through which such extraneous matters are
 eliminated from the system, are often over-stimulated, and
 are injured in their secreting power, and ultimately in their
 structure also.   The heart and vessels are over-excited at
 first, and  afterward, lose their tone, and the processes of
 digestion and nutrition become modified.  The nervous
 system is an especial subject of the disordering influence
 of intoxicating liquors.  A large quantity taken at a time
 is a narcotic poison, inducing a short period of cerebral
 excitement  or intoxication,  followed by insensibility, in
 which the functions of the brain are more or less complete-
 ly impaired, and in extreme cases those of  the spinal mar-
 row suffer; and if the influence be insufficient to stop
 respiration, yet it may be imperfectly performed, and con-
 gestions are formed in the brain and other organs.  Hence
 apoplexy, palsy, phrenitis, or delirium tremens may follow,
 and the whole frame may  suffer from the effects of the
poison.   Even when  less excessive  quantities  are taken,
and  their first  effect is mere intoxication, the headache,
sickness and  inappetency, and the  feelings of wretched-
ness and depression wh:*ch often ensue, sufficiently prove
that  disorder  has beer, produced, and that such artificial
excitements can  not be abused with  impunity.
  The habitual indulgence in strong drinks causes further 
188
INTOXICATING LIQUORS.
varieties of disease, which  are so prevalent as to deserve
notice.  When taken  only or chiefly with food, not as a
substitute for it, but as a constituent of general "free liv-
ing," they contribute to  the production of an  abundance
of ill-assimilated, over-heated  blood, which either finds its
vent in eruptions on the surface, or in local hemorrhages
or fluxes,  or causes various functional disorders, such as
palpitation of the heart, vertigo, stupor, dyspepsia, bilious
attacks, etc.;  or may  tend to the production of a fit of
gout or gravel.  The latter results are promoted by such
beverages as contain much free acid as well as an abund-
ance of spirit; such as port wine, rum-punch,  and hard,
strong beer.  The less  acid  malt  liquors, ale and porter,
tend rather to induce liver  disorders, and an abundant de-
position of fat in the body.  All  these consequences  will
be much favored by sedentary habits and deficient excre-
tions;  active exercise  carries  off much of the  spirit and
superflous aliment, by an   increased  elimination  of the
acids of respiration and perspiration.
  The most disastrous  consequences of intemperance are
exhibited  by  the  habitual drunkard,  who, in  proportion
as he  indulges in liquor, loses his appetite for food, and
his power of digesting it.  He  then drinks and starves,
and the disease which  ensues comprises the exhaustion of
inanition  with the more  direct  effects  of the alcoholic
poison. Thus, in  delirium tremens,  the drunkard's dis-
ease, together with the permanent restless excitement of
the irritated nervous  system, which adds more and more
to the  exhaustion, the  weakness of  mind and body, is
fearful, and in bad cases affect even the organic functions,
so that the pulse is very weak  and frequent, the excretions
scanty and depraved, and the respiration is too imperfectly
performed by  the involuntary powers to permit sleep to
ensue.   This  exhaustion must soon terminate in death,
unless  prevented by appropriate treatment.
  Again,  we find that the habitual use of intoxicating
liquors increases the severity of acute diseases, and renders 
INTOXICATING LIQUORS.
189
them less  amenable to  treatment.  In  epidemics it  has
been found that intemperance, or even what  some term a
moderate use of stimulants, predisposes to an attack.  Thus
in the  epidemic of cholera in this city in  1849-50, the
drinking  of liquor,  instead of proving prophylactic, as
some fondly supposed it would, increased the predisposi-
tion to the disease, and greatly aggravated its malignancy.
  These reasons, if  there were  not  others  of a  much
stronger nature, should prove sufficient to cause a man to
live temperately.  Total abstinence, however, is preferable,
because it is morally easier to practice; the faculty of re-
straining an appetite, after it has been once formed, being
possessed by few. 
               PART   III.


    MEDICINES  FOR  FAMILY   USE.


  Medicines for family use  should  be few and simple,
and such as will  tend^ to favor  nature's processes of
cure.   The harsher and more violent means of treatment
should always be left in the hands  of the physician, as it
is not to be supposed that the unprofessional person can
have such knowledge and experience, as  will render their
use safe and beneficial.   Medicine  should be used only
when there seems to be absolute need  for it,  and in all,
but the milder cases of disease, under  the direction of a
well educated physician.  Still, there are many minor ills
that may be appropriately treated by the family, and in
many  cases it  being impossible to obtain a physician,
even severe cases, will for a while, remain under domestic
management.
  In order to understand more fully what may be ration-
ally accomplished by medicine, we will notice how nature
relieves the  system, premising that  this is the only safe
method, and that when medicines are used, they should be
employed to stimulate and control these natural processes.
Let it be recollected that a large proportion of the sick
will recover without the aid of medicine if careful atten-
tion is paid to  nursing and  diet—say  as much as 80 per
cent, of bilious or even typhoid fever;  85 per cent, of in-
flammation of the lungs, and similar  proportions of other
diseases.  There can he no mistake about this matter, as
it is the result of most carefully conducted experiments.
It is said that nature relieves these cases.
  "Thereis," says Dr. Williams, "in  organized beings, a 
               MEDICINES FOR FAMILY USE.            191

certain  conservative power, which opposes the operation
of noxious agents,  and labors  to expel them when they
are introduced,  The  existence  of this power has long
been recognized, and in former days it was impersonated.
It was the archceus of Yon Helmont; the anima of Stahl;
the vis medicatrix naturaz of Cullen.  But without suppos-
ing it to be  ought distinct from the attributes of living
matter, we see its frequent operation in the common per-
formance of excretion; in the careful manner in which the
noxious products of the body, and offending substances in
food are ejected from the system; in the flow of tears to
wash a grain of dust from the eye; in the act of sneezing
and coughing to discharge irritating matters from the air
passages,  and  in  the  slower, more complicated, but not
less obvious example of inflammation, effusion of lymph
and suppuration, by  which  a thorn or other extraneous
object is removed from the flesh.
   " This vis  conservatrix is alive to the exciting causes of
disease, and in  persons of full health it is generally com-
petent  to  resist  them.  How  it resists them will depend
upon  what they  are.  For  instance, is cold the cause?
This throws the blood inwardly, which, by increasing the
internal secretions and exciting the heart to increased ac-
tion, establishes a calorific process which removes the cold.
Is the cause improper food ?  The preserving  power ope-
rates by discharging this speedily by vomiting or by stool.
Is it a  malarious or contagious  poison ?  It is carried off
by an increase of some  of the secretions.   But if this re-
sisting power be weakened, locally or generally, or if the
exciting cause be too strong for it, then the cause acts, and
disease begins."
  It has already  been  stated, that in many cases, the
natural powers of the system are sufficient for the restora-
tion of health, and, also, that the physician or other per-
son who proposes to  benefit the sick should understand
and carefully assist these efforts of nature.  The question
now comes up, how docs nature remove disease ? 
192
MEDICINES FOR FAMILY USE.
   In general  diseases, as fevers and acute inflammations,
we find that this  is accomplished by a  concentration of
the  vital  force, and an increased  secretion  from  those
organs that normally eliminate  noxious materials circula-
ting in the blood.   Of these organs  the kidneys, skin
and glandulse of the intestinal canal are the principal.  In
all of this class of diseases we find that  one or more of
these organs  are  inactive during its progress; but their
activity and  the  quantity of the  excretion  is greatly
increased  in the decline of the disease.   The  opinion is
very prevalent among physicians, and is taught by many
teachers and the majority of text books, that this increased
excretion  is not a necessary process in the removal of dis-
ease—that it is mainly the result, and not the cause  of the
cure.  We will also find that these same authorities never
allude to  the fact, that  the system will, in a majority of
cases, relieve itself of disease.
  Any  one  who carefully  examines the properties and
action of  all the most prominent articles of the materia
medica, can not fail to  be convinced  that  a very  large
majority of  them owe their beneficial effects  either to a
direct or indirect  action in increasing excretion and the
elimination of morbid materials  from the system.   Thus
the classes of diaphoretics, diuretics, and cathartics, act directly
in this way, and are administered for this purpose.  The
entire class of alteratives, also, undoubtedly owe their ben-
eficial influence  in most  part  to  their eliminating action.
Emetics not only act directly as  eliminatives, by causing
the  evacuation  of morbid secretions from  the stomach,
but  also indirectly by their sedative and relaxing effects
upon the system when under  a  high state of excitement,
this  relaxation  being almost invariably followed by  an
increased  action of the  skin, kidneys,  and  bowels.  So
with the prominent class of sedatives, though not directly
affecting the secretory apparatus, yet by their controlling
influence  over the  circulation, high vascular  excitement is
subdued, and secretion is the natural result. 
MEDICINES FOR FAMILY USE.
193
  If we trace the course of any general disease where no
 treatment has  been pursued, we will find that increased
 secretion and consequent elimination always precedes a
 change for  the better; and the same is true when even
 the  most opposite remedies have been used.  Without
 this increased elimination does take place, death is inevit-
 able.   Acting  on these views, Eclectic physicians have
 been very successful in treating the  common acute dis-
 eases of this country.  Their attention has been especially
 drawn to the importance of due attention to these emunc-
 tories, and a large portion of the  treatment is directly to
 stimulate  elimination in  this way.   In addition to this,
 the  fact generally recognized  by them, that in disease
 there is always a depression of the vital force of the sys-
 tem, and that this should be kept up by tonics and stimu-
 lants, has also added materially to their success.
  That nature is able to cure almost  all curable  diseases,
 is clearly proved by the results of homoeopathic treatment.
 There are but comparatively few who have  any faith in
 their attenuations  and dilutions, and yet we find that more
 favorable results are obtained under this plan  than under
 the old depletive system.  This  wTell-known fact  is suffi-
 cient evidence  that the sick will get  well  without medi-
 cine, and that medicine said to be scientifically adminis-
 tered, is responsible for no small per centage of deaths
 under regular treatment.
  If this  be so, you might well ask me, what is the use
 of physicians, or medicine ?   The province of  medicine is
 undoubtedly to place the system in such condition that it
 can resist disease, remove  such material as may endanger
the integrity of its structure, and repair such lesions of
structure as may be produced.  As examples: the  stom-
ach has been overloaded with crude, indigestible material,
its function is  impaired, the entire system sympathizes,
and the person  is sick ; nature will sometimes  remove the
offending material by vomiting, at others, by the  bowels;
art steps in, gives an emetic, and  the disease is  at once
           13 
194
MEDICINES FOR FAMILY USE.
arrested.  The bowels become torpid, secretion is arrested,
and the material remains  to  some  extent  in the  blood,
impairing the functions of the entire body; the natural
powers  of the system will be sufficient  in a very large
majority of cases to  re-establish the secretion, but days
may be  required; art gives a cathartic, and the secretion
is at once restored.   The person has been exposed to veg-
etable malaria.  The  blood is poisoned, and fever  is the
result.   In a very large majority of  cases, nature is suffi-
cient to remove the disease, but weeks may  be required to
effect it;  art steps  in,  and by  the  use  of remedies to
restore the excretions, and  quinine to restore innervation,
and for  its antagonistic action to the malarial poison, the
disease  is arrested  in two or three  days.  In  continued
fever, as we have already seen, the disease will be removed
by the natural powers of the system in  eighty per cent.
of the cases, but a period  of weeks  will be required; art
furnishes a special sedative which quiets the excitement
of the  circulation, and  relaxes the  system, and remedies
which re-establish the secretions, and thus  in a few days
the fever poison  is removed.   We do  not in  these cases
save life in but few  instances, because but  few  would die
if left to the natural powers of the system.  We do, how-
ever, shorten the period of sickness twTo-thirds or three-
fourths, save  much  suffering,  and prevent that  great
exhaustion and  impairment  of vitality which would fre-
quently  result.  In doing this, we rest our claim as bene-
factors of humanity.
  In other cases we set up  a  different action in the sys-
tem, which is but temporary, and unattended with danger,
to relieve  disease of some important organ or part.  We
thus give stimulant  cathartics in  inflammation  of the
brain and other  organs, diverting determination of blood
from the  part originally diseased to  the bowels, and thus
lessening or arresting the inflammatory action.  For the
same reasons we use the sinapism, blister, cups, or irrita-
ting  plaster. 
EMETICS.
195
  In  others  again we  are enabled to employ a specific,
which acts directly upon the diseased structure, restoring
its healthy function, or neutralizes the poison which is the
cause of the diseased manifestation.   As examples of this,
we may instance the employment of the tincture of muri-
ate of iron in erysipelas, the use of belladonna in scarlet
fever, the drosera  in  whooping-cough, and the cough of
measles, the bromide of ammonium in  some  cases of
epilepsy,  etc.  It  is  true,  doubtless, that in the strict
acceptation of the term, we have no specifics in medicine,
but it is only, as I believe, because our knowledge  of dis-
ease and the action of remedies is imperfect.
   In other cases we  stimulate  the  various organs  to a
better performance of their functions, and furnish  to the
body the material for increasing its tonicity and repairing
the  waste of structure.  For  this purpose we use the
bitter tonics, iron, phosphorus,  sulphur, the alkaline bases
of the blood and tissues, acids, and fatty and  albuminous
material that is  easily appropriated.
   In all that we  do, we keep constantly before us the
physiological action of the  different  organs or parts, and
the  normal  action of the body as' a wdiole, and as far as
possible, bend  every means to get  such  normal  action.
And finally, we carefully husband our patient's vitality
and resources, and prevent their unnecessary expenditure or
their direction in a wrong channel.  This, it seems to me,
is the  line of duty for the physician, and the only one in
which his efforts will be attended with success.
  The medicines most appropriate for family use, may be
classified under  their usual heads of emetics, cathartics,
diaphoretics,  diuretics,  sedatives, narcotics,  alteratives,
tonics, stimulants, astringents,  anti-spasmodics,  expecto-
rants and emollients.

                     EMETICS.
  An  emetic is a  remedy which, when taken  into the
stomach, will produce  an expulsion  of its contents, or 
196
EMETICS.
vomiting.  Some remedies of this class, as lobelia and
ipecac, produce nausea, and a feeling of prostration, while
with others, as mustard, no such effect is produced, or it is
but temporary.  The first class of agents  are  absorbed
into the blood, and act from it, hence the nausea; while
the last  causes emesis by irritation of the mucous mem-
brane of the stomach.  Yomiting  may likewise  be  in-
duced by taking large quantities  of tepid water, the dis-
tention  of the stomach being the  exciting cause, or by
passing the finger down the throat, and  thus irritating a
branch of the nerve that is distributed to the stomach.
  Emetics are most commonly used for the following pur-
poses :  1st, to remove any agent or material that is likely
to produce injurious  consequences, as in cases of poison-
ing ; 2d, to remove the morbid or vitiated  secretions of
the stomach, and undigested food, and stimulate a normal
supply of blood and nerve force to it; and 3d, to produce
relaxation, and an equal circulation  of blood in all parts
of the system.
  The  indications  for the use  of an emetic are usually
very plain, and, if carefully observed, there is little danger
of going astray.  An emetic may be used with advantage
when a person suffers with pain or cramp in the stomach
produced by green, indigestible food, or by taking food
in too large quantities; or in  any case where it is evident
that the contents of the stomach are producing irritation.
In the  commencement of disease, an emetic is  indicated
by a foul tongue, bad taste in  the mouth, and feeling of
weight and oppression in the region  of the stomach.
  1. Tepid Water as an Emetic.—A very good  action
may be obtained from simple warm water in  the second
and third cases just spoken of.  It is mild and efficient in
its action, easily obtained,  and if properly used it can do
no injury.  To get its emetic  action, take  from  one to
four pints, drinking it continuously but slowly, so as  not
to produce  too  rapid distension.  Then pass  the finger
down the throat once or twice, and efficient  vomiting will 
EMETICS.
197
follow.  If necessary, repeat it two or three times until
the stomach is thoroughly freed.
  2. Common Salt.—Salt will act as an emetic if taken in
considerable quantities, and sometimes answers an excel-
lent purpose.  Add  a teaspoonful of salt to a common
tumbler of warm water, and if it does not excite vomit-
ing, repeat it in ten or fifteen minutes.
  3. Mustard.—Mustard is an excellent emetic in many
cases, acting very kindly, and without the slightest danger.
We always use it in poisoning by laudanum, or  other
preparation of opium ; and frequently wjhen it is necessary
to remove irritant material from the stomach, as in colic,
cholera morbus,  etc.   Add  a  teaspoonful of ground mus-
tard to a common tumbler of warm water and drink it at
once, repeating in a  short time if necessary.  In cases of
cramp of the stomach,  colic, or cholera  morbus, arising
from indigestible food, it will be found to answer an excel-
lent purpose.
   4. Boneset—(Eupatorium Perfoliatum).—This very com-
mon and well-known plant may be used  as  an emetic in
cases of cold, commencing inflammation, and when it is
desirable to produce free perspiration.   Its  action, how-
ever, is in some  cases quite disagreeable, acting slowly and
with difficulty, and producing great  nausea and prostra-
tion.   Add a small handful to a pint of boiling water; let
it stand in a covered vessel until tepid, then give a wine-
glassful every ten minutes.  Its action may be aided, and
unpleasant effects avoided, by drinking ginger tea or other
gentle stimulant.
  5. Ipecacuanha.—Ipecac is one of the most certain and
efficient of the true emetics, and may be employed in any
case in which an agent of this  character is needed.  From
fifteen to  twenty grains of  the powder may be taken and
repeated  every fifteen minutes, until the desired action is
obtained.   Some stimulant infusion should be given with
it, as every remedy of this class acts more kindly if taken
with a large quantity of fluid. 
198
CATHARTICS.
  6. Emetic Powder.— We employ  a  combination  of
lobelia, ipecacuanha,  sanguinaria, and ictodes,  of each
two ounces; capsicum,  half an ounce.   Pulverize  and
mix.   It is the most thorough and efficient emetic that I
have  ever employed  in  acute affections,  as  fevers  and
inflammations.   It first  produces  nausea,  the  patient
becoming very sick, relaxation of the entire system, an
equal circulation of blood, and complete evacuation of the
stomach.  Add a heaping teaspoonful of the powder to
three-fourths of a teacupful of boiling water; let it stand
fifteen minutes, when it will be ready for use.  Give it in
tablespoonful doses every five or ten minutes until it ope-
rates  freely; an abundant  supply  of warm water, or
gently stimulating tea being taken to render its  action
easy.   Its administration  may be continued  for half an
hour, or hour, or until the necessary effects are produced.

                   CATHARTICS.

  Cathartics are remedies which  cause evacuations from
the bowels,  and are divided into five classes—laxatives,
mild cathartics,  cholagogue  cathartics, hydragogue cathartics,
and irritant cathartics.   The first produce a gentle action
on the bowels;  the second act thoroughly, but  without
irritation or prostration; the third act on the liver, stimu-
lating increased secretion of bile; the fourth produce large
watery discharges;  and the fifth act with very great vigor
and intensity.
  The objects to be obtained by the use of cathartics, are
the removal of  irritant accumulations in the 'bowels, and
obtaining increased secretion and consequent elimination.
As  heretofore remarked, the bowels should be attended to
in such manner that they will act  regularly without the
use of medicine, and let cathartics be employed only when
there seems to be absolute necessity for them.  The indi-
cations for a cathartic are, sluggish  action  of the bowels,
with constipation, loss of appetite, coated tongue,  and 
CATHARTICS.
199
headache.  In these cases a gentle cathartic will frequently
remove all the unpleasant symptoms.
  Are You Bilious? — Few persons  pass  through this
world  of ours, without having asked or answered'the
above question,  if Liver complaint," though not quite so
common as it was  a few years back, is yet in many sec-
tions the prevailing disease.  A person has the headache—
some kind friend informs him  he is bilious; his appetite
has become impaired by eating late suppers and  drinking
schnapps—" he is bilious;" he has not, in any particular,
observed the  laws  of health, for, may be, ten, fifteen, or
twenty years, he feels bad at times in consequence—of
course he is bilious; he  has made it a rule of life, never to
get up from table as long as he can introduce more food;
the stomach is constantly  over-worked, and finally shows
symptoms of rebelling—then he is bilious.   Bilious peo-
ple are the rage in this  age of fast living and over exer-
tion.
   The doctors, too, kind souls, have  also taken up the
cry; in fact, we might  say for  the last fifty years, it has
been  their " harp of a thousand strings."   If called to a
patient,  and they could not readily diagnose the disease,
of course he was bilious, or had liver complaint.  In fact,
nothing  could be said that would impress the patient with
greater confidence in the physician's skill, than to tell him
he was  bilious, that being readily comprehended by all,
and being perfectly satisfactory.   Even where the physi-
cian had better names for disease, it would not do to use
them, as the patient or  friends knew it was liver disease,
and if the doctor did  not coincide, they would employ
some one that would.
  Again, remedies for biliousness were plenty; the bilious
person could find in any shop or store,  half a dozen varie-
ties— "anti-bilious pills," "liver renovators,"  "chola-
gogues,"  " blood purifiers," etc., all warranted to  work off
the offending  bile, and give  certain  relief.  Or,  being
somewhat afraid of quack medicines, could keep  ready 
200
CATHARTICS.
prepared a lump of blue mass, or bottle of calomel, to be
taken as occasion required—a certain panacea for all the ills
of life.  The physician, too, how handy it was  for  him
that patients were bilious,  as  for that, if for nothing else,
he had a specific in blue pill, calomel, mercury and chalk, etc.
Eclectics, too, like others,  are sometimes bilious, and have
their anti-bilious remedies, in the shape  of podophyllin,
leptandrin, etc., but we are happy  to  believe it  is not a
common complaint with them.
  If I have any advice to  give, it is to beware of bilious-
ness ; live temperately, keep the skin  in good condition,
by the use of a daily, at least a weekly bath, accustom the
bowels to  move, as regularly  as you  eat  your breakfast;
above all things, eschew the taking of anti-bilious medi-
cines, and  my word for it, you will soon  outgrow being
bilious.
  If cathartics have to be  employed, choose those that act
mildly and efficiently,  and leave the bowels in good con-
dition, as very many leave them  more obstinately consti-
pated than before the medicine was taken.   Use them as
seldom as possible, and after their action  take especial
pains to regain a habit  of regularity.
  7. Compound Powder of Rhubarb—(Neutralizing Physic.)
—This is made of equal parts of rhubarb, bi-carbonate of
potash and peppermint herb, finely  powdered.  It may be
used in  any case as a  gentle  laxative, in doses of twenty
to thirty grains, but is  more especially applicable in cases
where a diarrhoea has resulted  from accumulations in the
bowels.   It is a most excellent  remedy for children, when
the bowels are lax, and the stools look green and frothy,
or are light clay colored. It is also  one of the best rem-
edies to check irritation of the stomach, nausea and vom-
iting, and undue  acidity  and heartburn.   We prepare it
for children, by adding a teaspoonful to half a teacupful
of boiling water, straining when  cold and sweetening;
the dose for a child two  years  old, will be a teaspoonful
every one or two hours. 
CATHARTICS.
201
   8. Compound Powder of Jalap.—This is formed of equal
parts of jalap, senna  and ginger, and is one of the most
efficient of the mild cathartics.   It is thorough in its ac-
tion upon the entire intestinal canal, and does not produce
nausea or griping, and leaves the bowels in good condition.
If it were not for its unpleasant taste and bulk, it would
be preferable to any other agent for family use.  In cases
of wind  or bilious  colic, it is  almost a specific, giving
speedy and permanent relief  The dose is  about thirty
grains, or an even teaspoonful, mixed  with cold water.
   9.  Seidlitz Powders.—Seidlitz powders consist of two
drachms of Rochelle salt, put up in a blue paper, and half
a drachm of tartaric acid in a white  one; they are dis-
solved in water in separate tumblers,  which being mixed,
is drank in  a state of effervesence.  They are very gentle
in their action, and sometimes answer a useful purpose.
   10. Solution of Citrate of  Magnesia.—A solution of
citrate of magnesia  is  put  up  in  bottles holding about
twelve ounces, which is pleasant to the taste, and a mild
effectual cathartic.
   11. Castor Oil.—The most nauseous, but one of the best
cathartic medicines for family use, is the castor oil.  The
dose for a child, one year old, is a teaspoonful; four years
old, two teaspoonfuls, and for an adult, one or two table-
spoonfuls ; combined with turpentine it forms a very good
vermifuge.
   12. Podophyllin Pills.—We form a most excellent pill •
out of half a grain of podophyllin, and one grain each of
leptandrin and  extract  of  hyosciamus;  the pill being
sugar coated when dry.  It  acts on the liver with greater
certainty than any preparation of mercury, and is a slow,
though  thorough cathartic, leaving the bowels in good
condition.  The dose varies from  one to three pills on
going to bed at night.
  13. The  Butternut—(Juglans Cinerea)—If you  live
where the agents  above named cannot be obtained, a most
excellent laxative and cathartic may be obtained from the 
202                   CATHARTICS.
 butternut.  Take of the inner bark a  sufficient quantity,
 put it in a tin vessel and cover with boiling water; keep
 it on  the stove  or fire, where it will keep hot for one or
 two days, adding water  as it evaporates.  Then  strain
 through a strong towel, using  considerable pressure, then
 put the  liquor in  a vessel with  one-half the quantity of
 molasses, and evaporate with gentle heat to the necessary
 consistency.   It will be quite  pleasant to  the taste;  the
 dose being a lump about as large as a cherry.
   14.  May Apple—(Podophyllum  Peltatum.)—The  dried
 root of the may apple is a very active cathartic if  taken
 in large doses, and  in almost all cases, its action is attended
 with griping.  Still, if used in small doses, it will stimu-
 late the entire intestinal tract, and answer an  excellent
 purpose.   The dose is from  ten to twenty grains, com-
 bined  with ginger,  cloves or other aromatic stimulant.  An
 extract may  be  formed  in the  same manner as named
 above, and an excellent preparation obtained.
   15.  Enemata.—Enemas or injections may be frequently
 used to promote  an action of the intestinal canal,  when
 cathartic medicines would prove injurious, and are  some-
 times  necessary  to facilitate  their  action.  The syringe
 used for the purpose, may be the old fashioned pewter in-
 strument, holding  half a  pint, but a  much better  one is
 the rubber pump  syringe.  Every family should possess
 one of these,  as it may  be  needed at times  when it would
. not be possible to  obtain one, and occasions for their use
 not unfrequently arise.
   The material for the injection is  always  prescribed by
 the attending physician,  and his  directions should be
 strictly followed.  If acting without  advice,  a  pint  of
 moderately cold, or warm water will be found to answer
 in many cases.  A teaspoonful of salt, one of lard, and a
 tablespoonful of  molasses to a pint of water, is frequently
 used;  or  a weak soap-suds will be cleanlier and answer the
 same purpose.
   In all cases, let the syringe be  used with care, so as not 
DIAPHORETICS.
203
to injure the soft parts, and  retain the injection for some
minutes with a towel or napkin.   If it passess away with-
out causing an action of the bowels, or if retained, repeat
it in a reasonable length of time.

                  DIAPHORETICS.
  Remedies  that increase secretion  from the skin, are
among our most important weapons to combat disease, and
a majority of the simples used in  domestic  medicine will
be classed  under this head.   We have already noticed, at
considerable  length,  the  importance of maintaining  a
healthy action of the skin, not only on account of its se-
cretion, but also, because it is the waste-gate for the extra
heat of  the body, and has a  very intimate sympathy with
other important parts of the system.  Twenty-eight miles
of drainage is necessary to keep our bodies in a healthy
condition, and this extensive apparatus is under the in-
fluence  of remedies to free us from disease.
   A large number of the more common acute affections
arise from arrest of the cutaneous secretion, and in the
early stage, they may be arrested by means to restore this
secretion.  A person has been exposed to a cold, damp at-
mosphere, draughts  of air, or sudden alterations of tem-
perature, and as the result, has a dull headache, running
at the nose, poor appetite, constipated bowels, chilly sen-
sations, and feels bad  all-over.  We  say he has caught a
bad cold, and experience teaches us  that in some cases
this will eventuate in fever, inflammation of the lungs or
other serious  disease.   Arrest of the cutaneous secretion
has been one of  the  first  causes, and if we now restore
this secretion, in all probability the disease will be arrested.
  The character of the remedy used to produce sweating,
will vary in different cases.   Thus, if  the skin is cool, soft
and flabby, with cold extremities, a stimulant diaphoretic
as ginger  or  composition tea, with a hot stimulant bath,
will be the best. If, however, the surface is hot, dry and con-
stricted, an  agent that will produce relaxation, will be best. 
204
DIAPHORETICS.
  16. Pennyroyal—(Uedeoma   Pulegioides.)—This  very
common herb is a favorite of mine, and can be  recom-
mended as a very certain and pleasant, gently stimulating
diaphoretic.  Make a strong infusion and drink it hot, at
the same time bathing the  feet in hot water.  It is one of
the best remedies known in arrest of the discharge after
child-birth, a proof of its power and utility in other affec-
tions.
  17. Catnip—(Nepeta Cataria.)—Catnip is a gentle  and
soothing diaphoretic, especially applicable in the treatment
of children.  It is used in  infusion, taken  freely.
  18. Sage—(Salvia Officinalis.)—Sage  is  another  very
good remedy, especially when the bowels  seem affected;
it is used in infusion, the tea being  drank freely.
  19. Ginger.—No better diaphoretic can  be found in
many cases of cold, than a  strong infusion of ginger.  Es-
pecially is this  the case, if from recent exposure the sur-
face of the body becomes cold, with a feeble circulation of
blood.  It acts as a gentle stimulant, improves the circu-
lation, and excites the skin to action.
  20. Composition.—The old fashioned composition pow-
der is an excellent remedy in cases requiring a stimulant
diaphoretic.  An infusion may be made of one tablespoon-
ful of the powder to a pint of water, and taken freely.
  21. Water-Pepper—(Polygonum   Punctatum).— The
water-pepper,  or smart weed, is another excellent remedy,
much better than many that are imported from a distance.
It is given in  infusion, in cases of cold,  arrest  of the se-
cretions, etc.
  22. Pleurisy Root—(Asclepias Tuberosa).—Of  all the
remedies employed to increase the action of the skin, this
is my favorite.   I prepare  it by infusing  one ounce in a
pint of water, giving a wine-glassful as a dose.  Should it
be necessary to produce relaxation, half the quantity of
the lobelia herb may be added.  This remedy is especially
applicable when the respiratory apparatus  is affected, and 
DIAPHORETICS.
205
in diseases  of children, as it exerts a soothing influence
upon the nervous system.
  23. Diaphoretic Powder.—This is a remedy much used
by physicians, and is made of opium, half an ounce;  cam-
phor, two ounces; ipecacuanha, one ounce; bi-tartrate of
potash, six ounces.   It quiets irritation of the nervous
system, induces sleep, and  causes free perspiration when
given  with warm teas.   The  dose is from two  to  five
grains for the adult; for a child a year old I usually add
five grains to four tablespoonfuls of water, sweeten, and
give in doses of half a teaspoonful as often as required.
In the latter case it is employed to relieve pain, quiet irri-
tation  of the nervous system, and produce  sleep.
  24. The Warm  Foot-bath.—This important means, so
frequently recommended by the physician,  is hardly ever
carried out as it  should  be.   The  objects to be  accom-
plished by it, are, first, by the application  of continued
heat to cause determination of blood  to the extremities,
thus removing congestion of internal organs, and equal-
izing the circulation; second, to cause relaxation of the
skin, and  promote perspiration, wdiich it  does  in a very
efficient manner.  These objects, it will be noticed, are
important ones, and yet  I have  frequently found wdiere
there was the greatest need for its influence, that it was so
inefficiently used as to aggravate, rather than mitigate the
disease.  Thus the feet would be placed in a shallow basin
of warm water, kept  there for  a few moments, and when
taken  out left wet,  being in a short time  colder  and
less freely supplied with blood, than before the use of the
bath.
  When a  foot-bath  is recommended, heat a  sufficient
quantity of water to fill a large wooden bucket, or other
utensil, that will bring the  water  nearly  to the  knees;
have it as hot as  the patient can bear his  feet in it, and
keep up the temperature by additions of hot water every
few minutes.  It should be used in  this wTay from fifteen
minutes to half an hour, or until the desired influence is 
206
diaphoretics.
obtained, which may be known by the soft, moist condi-
tion of the skin.  When the  feet are taken from  the
water, they should be thoroughly dried,  and  a pair of
woolen stockings drawn on.   When it is used  to counter-
act determination of blood, as to  the  brain, or in  acute
inflammation, an addition of mustard to the water is fre-
quently of  great service.
  25. Common Yapor Bath.—The vapor  of water  is a
most excellent means of inducing perspiration, and reliev-
ing disease that is caused by its arrest.  Having made up
your mind  to use a vapor bath, put two or three bricks or
irons on the fire to heat; set a bucket  partly full of boil-
ing water under a wooden-bottomed chair, and, divesting
the patient of his clothing, sit  him on it, with  a blanket,
investing both  him  and the chair, and closely fastened
around the neck. Now take the hot brick or iron in a
pair of tongs, and slowly immerse it in  the water, to pro-
duce the required quantity of steam.  It  may be contin-
ued until the patient  perspires freely, giving  him at the
same time some diaphoretic  infusion, and  having his feet
in hot water.  When the  desired effect is  produced, rub
him dry, and pack warmly in bed.  No means of treat-
ment will be found more effectual than this in many cases.
  If the patient can not sit up, as in case of rheumatism,
the vapor bath may  be used  in a different  way.  Heat
three bricks, so that they will vaporize water, but not burn
the clothes; wrap them in  flannel cloths wrung out of
vinegar  or water;   place one near the  patient's feet,
another  near the hip, and  the third  near the opposite
shoulder. Have the bed-clothes loose  over the  patient,
but tucked in around the  neck to prevent the escape of
the vapor.  This can be continued as  long as may seem
necessary, and will be found a most effectual way of estab-
lishing secretion from the skin.
  26. Spirit Yapor Bath.—This is a  favorite  means of
inducing perspiration with many physicians and families,
but it  must be used with care to prevent burning  the 
diaphoretics.
207
patient.  Sit the person on a common wooden-bottomed
chair,  surrounding him with  a blanket to prevent the
escape of heat, and put his feet in hot water.   Pour two
or  three ounces of alcohol, seventy-six per cent., in a
saucer, and put under the chair, and set it on fire with a
match or paper-lighter; when  it is burned out, if neces-
sary, withdraw the saucer, and add an additional quantity
of alcohol,  and proceed as before.  It is called a vapor
bath, but is, in fact, a hot-air bath, and bears a very close
relation to  the Turkish bath, so much talked of.
   27.  The Warm Bath.—Warm water  is used as a par-
tial or general bath to induce perspiration, equalize the
circulation, and lessen irritation.  If a child is restless  or
feverish, I  very frequently direct that it have  an entire
bath from  fifteen  minutes to  half an hour, in water  as
warm as will feel pleasant to the hand.  Any vessel suffi-
ciently large to receive the child, will answer as a bathing-
tub.
   28.  Blanket Pack.—When  there  are  no conveniences
 for  bathing, I would direct, in case of an adult, that a
 blanket be wrung out of water, as warm as the hands can
 bear, wrap it closely around the patient, and pack him  in
 bed, covering warmly.   From half to  one hour is the
usual time for the person  to remain in the pack, when he
may be rubbed dry, or  in  some cases sponged with cold
water.
  29. Wet  Sheet Pack.—The wet sheet pack is employed
to restore secretion  from the skin, and is a most excellent
remedy in  many cases.  The  object is, by applying cold
water, to establish reaction, relax  the skin, and by the
vigorous circulation induced, establish secretion from the
entire sudoriferous glands  of the body.   It may be safely
used with such persons as  have sufficient power of reac-
tion to become warm in a  few minutes  after its  applica-
tion, and is  contraindicated in those of feeble  reactive
powers, and who have organic disease of internal organs,
as of the lungs, heart, etc.  I have used it to a considera- 
208
DIAPHORETICS.
ble extent, and, from  my  personal  experience, would
prefer it to any other means, to remove a severe cold  and
the feverish symptoms that attend it.
  The pack is  easily applied—wring a sheet out of mod-
erately cold water, wrap it closely around the person, put
him in bed, and cover warmly.   The  first sensations of
chilliness are very unpleasant, but in a few minutes they
are succeeded by an agreeable warmth  of the surface; the
irritation of the nervous  system produced- by disease dis-
appears, and not unfrequently the patient sleeps.  At the
end of an  hour, wipe the person dry with a coarse towel,
using brisk friction, and put on dry clothing.
  30.  Sitz  Bath.—The sitz  or  hip bath may  be  used
either warm or  cold, and will be found very efficient in
diseases of the  pelvic viscera  and bowels.   I very  fre-
quently direct the warm sitz bath in dysentery and diar-
rhoea, and in painful and difficult menstruation.
  31.  Local  Baths.—Local baths  may consist either in
immersing the part  in water of proper temperature, or in
applying the water to the part by means of several thick-
nesses of cloth.  They are employed principally  in local
diseases, for the relief of pain and inflammation, but they
also exert  a marked influence upon the general system.
As  examples of their use, we may cite  the case  of colic,
or other pain in the bowels, in which relief is most effect-
ually given by the application of a towel wrrung out of
cold water and  applied; a case of sore throat, in which
a towel  wrung out of cold water, and applied to the throat
at night, gives relief before morning.   Yery many times
the local application of cold water  in  this way, the part
being covered  to prevent evaporation, will give  very
marked relief,  and no injurious consequences can result.
It is often far preferable to the use of costly liniments.
  32.  The Hot Fomentation.—Hot fomentations are fre-
quently ordered in acute inflammation, and other painful
affections.   Sometimes  no   other  influence than  that
derived from the heat  and moisture of the fomentation is 
DIAPHORETICS.                 209
desired, at other times narcotics are used to deaden sensi-
bility, and at others special agents which  exert a favora-
ble influence in modifying inflammatory action.
   The hop  fomentation  is frequently prescribed.   It is
made by taking a  sufficient quantity of hops to cover the
part, simmer them in equal parts of vinegar  and water
enough to wet  them, then stir in corn-meal  to give it
consistence.
   The stramonium or jimson-weed  fomentation, is one of
the best that can be used in inflammatory and  other pain-
ful affections.  In  the summer and fall, it may be made
of the green leaves; in the winter and spring, of the dried
leaves.  Bruise the leaves with a hammer; put,them in a
shallow vessel over the fire, and moisten with water or
whisky; place in  a bag  of thin muslin or mosquito bar,
and apply hot.
   Other agents are formed  into fomentations in the same
way, as  the tansy, hoarhound, catnip,  lobelia, etc.  Again,
we  frequently use simple water, or equal parts of water
and vinegar or whisky.   Sometimes with the  addition of
tincture  of stramonium, lobelia, veratrum viride,  opium
or other agents.   In  this case the liquid is placed by the
tire where it will keep hot, five or six thicknesses of flannel
or heavy  muslin, of sufficient size to cover the part, being
wrung out of it and applied hot.  A good plan is to take
two thicknesses  of flannel, and quilt between  them suffi-
cient cotton wadding to make it, say one inch thick.
   In using the fomentation it should always be recollected
that continuous  equable heat is of  the  greatest impor-
tance.   Hence  sufficient should  be  prepared  to form
two, so that while  one is applied, the other may attain the
requisite  heat.  Fomentations, as a general rule, require
to be changed every five  or  ten  minutes, and when so
changed,  the  nurse  should always  be careful  to do it
speedily, and not expose the surface of the  patient's body
to the air.  Upon the proper  fulfillment of these direc-
tions, the value of fomentations  as  medicinal measures
          14 
210
DIURETICS.
depend, and where they are not  carried out, this means,
which in many cases is of the utmost importance, instead
of doing good, actually aggravates the disease.

                    DIURETICS.

  Diuretics are remedies  that  increase the  secretion of
urine, and may be very properly divided into two classes—
those that increase the amount of water  discharged, and
those that increase the solid constituents of the urine.  It
might be supposed that any agent that would increase the
amount of urine passed, would  at the same time increase
the solids of  the urine  w7hich represent the excretion,
but this is  not the  case.  All  the vegetable diuretics
increase  the amount  of the urine, but very few  of them
increase  the urea  or other solid elements.  Increase of
the solids is best  obtained by  the  administration of the
diuretic salts, and these are the  only agents that will prove
effectual, when disease is  produced by retention, of these
materials.
  As we have heretofore  noticed,  the kidneys  remove
about an ounce of exceedingly deleterious material from
the body every twenty-four hours.  It can not be retained
with safety, even in small  quantities,  and its elements, cir-
culating in the blood, give rise to many morbid symptoms.
Whenever disease terminates in health, we invariably find
that the secretion of urine is  very markedly increased,
and experience tells us that the  progress of disease may
be arrested by such  agents as will re-establish the secre-
tion.  In some cases, all we desire is to increase the quan-
tity of water,  with  such increase of the  sohds as it will
naturally wash away; hence we employ vegetable  diu-
retics.
  The secretion of urine may  be suppressed to a greater
or less extent,  the kidneys failing to perform their func-
tion, in which case remedies are indicated that  favor such
secretion, or remove the cause of the arrest, if this can be 
DIURETICS.
211
 Known.  In other cases the urine is secreted, but retained
 in the bladder, in which case  remedies that will promote
 its evacuation, and not increase the quantity, are the ones
 needed.                            -
   33.  Watermelon Seed—(Cucurbita Citrullus).—Water-
 melon seed made into an infusion, by adding a couple of
 tablespoonfuls of the bruised  seed to a pint of water,  is a
 very efficient and mild diuretic.   It may be drank freely,
 and will increase the amount of water passed.  It is  some-
 times beneficial in irritation of the urinary passages.
   34.  Parsley—(Apium Petroselinum).—The root of the
 common parsley, made in  infusion, is a mild, unirritating
 diuretic, increasing the  flow of  urine and lessening its
 acridity.
   35.  Marsh Mallows—(Althos Officinalis).—Marsh mal-
 lows is one of the simplest and best  diuretics  for family
 use, being demulcent and  soothing to the stomach, and
 also to the urinary organs.  It is given to increase  the
 quantity of water when  the urine is scanty, and to lessen
 irritation in cases of burning or pain in passing water.   It
 is used in infusion, one  ounce being added to a pint  of
 boiling water, and drank freely when cool.
   36.  Mullein — (Verbascum  Thapsus).—The  leaves of
 the mullein made into an infusion will prove diuretic, and
 may be  used in a similar manner to those above men-
 tioned.
  37.  Spearmint — (Mentha  Viridis).—Spearmint is  an
 excellent diuretic  in  cases of scanty secretion of urine,
 with pain  in  the  loins or region of the bladder, and  in
 cases  of burning and difficulty of passing water.  It is
used in infusion, being steeped in boiling water, and drank
cold.
  38.  Uva Ursi.—The uva  ursi is a tonic and astringent
diuretic, and is employed in cases of debility of the kid-
neys, and when there  is mucous discharge from the urin-
ary passages.   Cases where it  is indicated will usually be
under the charge of a competent physician. 
212
DIURETICS.
  39. Honey Bee—(Apis Mellijica).—In cases of retention
of urine, we do not wish to increase  the secretion of the
kidneys, which would but add to  the distention of the
bladder,  but desire to increase  the power  of the latter
organ to expel its contents.  Add twelve honey bees to
half a  pint of boiling water, and when cool give a table-
spoonful every five minutes.
  40. Sweet Spirits of Nitre.—This  remedy is, perhaps,
more widely known and used than any other diuretic.  It
increases the  amount of water  secreted, and but slightly
the solids.   In some cases, it acts as a febrifuge, and
relieves irritation.  The adult may take it in doses of from
one-fourth of a teaspoonful to a teaspoonful;  a child two
years old about ten  drops, repeated  every one, two  or
three hours.
  41. Acetate  of  Potash.—As  a remedy to increase the
amount of solids removed by the urine, there is no better
agent  than this.   It does  not generally increase the
amount of water to any great  extent, but the amount of
urea is frequently doubled.  It is one  of the best reme-
dies in persistent headache with which  I am  acquainted,
and among our most efficient agents in the  treatment of
fever and inflammation.  I also claim that it is one of the
best alteratives, sometimes curing  scrofula and similar dis-
eases when  other  remedies fail.  Add half an ounce of
acetate of potash to four ounces of  water, and take a tea-
spoonful every two or three hours.  If you are far from a
druggist or physician, and can not obtain it, take a table-
spoonful of saleratus, and  add  enough cider vinegar  to
render it slightly acid, and the water to make four ounces;
you will have a very good  preparation, and may use it in
the same doses.
  42. Cream of Tartar—(Bi- Tartrate of Potash).—Cream
of tartar may be used as a diuretic in place  of acetate of
potash, though it is not so good.  Add half an ounce of
cream of tartar to four  ounces of water, and take a tear
spoonful every two or three hours. 
sedatives.
213
  43. Hot Applications.—In cases  of suppression  of
urine, a large flannel cloth, four or  five thicknesses, wrung
out of hot water, and applied to the back across the loins>
will  start the secretion when all internal remedies fail.  I
am positive in making this  statement, as I have seen its
beneficial effect in a large number of cases.  In young in-
fants who have not passed water, or who do not pass it
freely, there is generally retention in the bladder.   In these1
cases the warm cloths  are applied over the lower part of
the  bowels and urinary organs.   If there is retention of
urine in the adult, we  employ the hot sitz bath,  or cause
them to sit over the vapor of bitter herbs, as hops, tansy, etc*

                    SEDATIVES.    *

  Sedatives are remedies that control irritation of  the*
nervous  system to some extent, and lessen the force  and
frequency of the heart's action. In fever and inflammation,
if the finger be placed over the artery on the  anterior  and
outer  side  of the wrist, it will be noticed to beat more
frequently and with greater force.  The blood is  circulat-
ing  with greatly increased rapidity, and as long as it does
so, fever will  continue.  Sedatives are medicines which
will lessen  the frequency of the pulse, and  diminish the
momentum of the blood; and as they do this, they relieve
the  principal  febrile symptoms, rapid circulation and in-
creased heat, and  place the system  in such condition that
secretion can  be  established from the skin,  kidneys  and
bowels.
  They are  very strong medicines, as  we should suspect,
from the parts on which they act, and should be employed
with care; if so, their  use  is no  more  dangerous than
more simple things.  In fact, all medicines must be  em-
ployed with  care,  knowing what we are  doing, and  it
would be well  if it could be generally  impressed upon the
people, that  they  are dangerous things  to tamper with.
I will only name two of this class,  and will here  remark, 
214
SEDATIVES.
that when  kept in the  house, they should be so promi-
nently marked that they can never be  mistaken for any
thing else, and always used in the exact way they are rec-
ommended.
  44.  Tincture of  Aconite Root.—Aconite when taken
in sufficient quantities is an irritant poison, and even when
administered in the ordinary doses of the books, it does not
possess any valuable properties.  We give it in very small
doses  to  obtain its most  marked effect, and in these it is
impossible to produce injurious results.   We use it in all
cases of fever and inflammation, and though its action is
slow, it will most certainly control them.
  In using it, take a common tumbler of cold  water, one-
fourth of a pint,0and  add ten drops of the tincture for a
child two years old, twenty drops for a  female or delicate
person, or thirty drops for a stout adult; the dose being a
teaspoonful every one or  two hours.
  45.  Tincture of Yeratrum   Yiride.—Yeratrum pro-
duces an influence very similar to the aconite, and may be
used in its stead.  If given in large doses it produces nau-
sea, vomiting,  and  irritation  of the stomach; in  small
doses  it lessens the frequency and force of the pulse, and
the heat  of the skin,  quiets irritation of the nervous sys-
tem, and favors secretion from  the skin and kidneys.  I
direct its use in the same manner as the other remedy.  To
a tumblerful of cold water, add thirty to sixty drops of
the tincture, and give a teaspoonful every hour until the
desired effect is produced.  To a child two years old ten
drops to  a tumbler  of water, in doses  of a teaspoonful,
would be the proper quantity.
  In  describing the family medicine case, equal  parts of
these are combined to form a febrifuge.   Of all the reme-
dies in the materia medica I prize these the most, and in
recommending them for family use in slight, simple fevers,
where a physician would not be called, I believe I am do-
ing a  great service to the people. 
NARCOTICS.
215
                    NARCOTICS.
  Narcotics are remedies that lessen or arrest pain and in-
duce  sleep.  There  is but one true narcotic—opium—
though there are many agents  that will quiet pain by re-
moving the cause, and by  lessening  pain and  irritation,
will  induce sleep.  As a general rule, opium and its pre-
parations, should be given only  under the direction of the
family physician, as much injury may result from its im-
proper use.  Though one of the greatest  boons to suffer-
ing humanity, its injudicious use in the form of  Godfrey's
Cordial, Bateman's Drops, Paregoric, and various cordials
and quieters recommended for  children, has carried mil-
lions  to  an untimely grave. Never, under any circum-
stances, give your  child any  preparation that contains
opium, if it is possible to obtain medical advice.  Though
it may have passed unscathed ten or even a hunderd times,
you have not the experience that would determine when
it would prove injurious.
  To  relieve pain  and  irritation, and  induce sleep  in
infancy, some  mild stimulating diaphoretic, as catnip or
spearmint tea,  often  answers  a good  purpose.  I have
frequently prescribed—1^ Tincture of lobelia, one drachm;
compound  tincture  of  lavender, two  drachms;  simple
syrup, two ounces; in doses of  half a teaspoonful as often
as necessary.  Another very good  preparation, is ^  Oil of
anise,  twenty drops;  chloroform, forty drops;  alcohol,
half an ounce; simple syrup, one  and a half ounces; the
dose being half a teaspoonful every half hour or so, until
relief is obtained.  Quite frequently  the use of  the  warm
bath will answer the  purpose,  and at  other times  a hot
flannel cloth applied to the limbs or  back, will relieve the
restlessness.

                      TONICS.

  Tonics are medicines that increase  the appetite, improve
digestion, and favor  better nutrition, thus increasing the 
216                    TONICS.
tone  and strength of the body.  In  a majority of cases
they are bitter substances, and some have  even supposed
that all bitters would  prove tonic, but this is  an error.
Another class of agents that are with  difficulty distin-
guished from tonics, are termed restoratives, as  they add
some material to the body that is  deficient.  Iron is the
type of this class, and is one of the  principal agents used
to increase the quantity of the blood, it being a constitu-
ent of  that fluid.
  In general terms, it may be stated that any agent that
will increase the appetite and power of digestion, will prove
tonic.  Thus remedies, that remove  causes of disease,
would  be indirectly tonic in their action, as an  emetic in
cases of morbid accumulations  in the stomach, cathartics
in constipation of the bowels, diaphoretics  and the use of
baths when the skin is at fault, etc.  It will not always do
to take it  for granted that because persons have a poor
appetite and imperfect digestion, they require bitters.  In
very many cases, they not only do not need them, but the
tonic and stimulant are absolutely  injurious.  The cause
of the  imperfect appetite should be ascertained by a com-
petent  physician, and medicines prescribed accordingly.
  In some cases, however, bitter tonics can be taken with
advantage without previous  preparation.  They are those
in which there is no perceptible disease of any part of the
body;  the bowels are  regular, there is good excretion of
urine,  and normal action of the skin, but  the appetite is
poor and digestion difficult.
  46.  Yellow Root — (Hydrastis  Canadensis).—Yellow
root is  one of our best bitter tonics, improving the  condition
of the stomach, giving the patient an appetite, and facilita-
ting the digestive process.  Under its use the patient eats
more, digests his food sooner and better, and improves in
strength and  flesh.  A very good bitters may be formed
by adding one ounce of finely pulverized hydrastis to four
ounces of whisky and twelve of water.  It should be well
shaken, and taken in doses of a tablespoonful three times 
TONICS.
217
a day.  If  iron is needed, add to the preparation  one
drachm of carbonate of iron.
  47. Dogwood—(Cornus Florida).—The dogwood bark
is a very good tonic, and may be used  either in infusion
or a tincture made with alcohol  or whisky.
  48. Wild Cherry—(Prunus Virginiana).—Wild cherry
bark is another agent that may be used  with advantage in
some cases.  It  is employed in  the same manner as the
preceding, usually  in combination with other articles of its
class, and especially in cases where the  lungs are affected.
  49. Poplar.—The bark of both the white  and yellow
poplar possesses tonic properties, and  frequently form a
constituent of home-made bitters.  The three agents last
named may be used in equal proportions, and will  some-
times give good satisfaction.
  50. Collinsonia.—The collinsonia is my favorite remedy
in many  of the cases requiring an agent to increase the
appetite and digestion.  Its action is gentle, but persistent,
not only increasing the tone of the stomach, but strength-
ening the  nervous system, and  improving secretion from
the skin, kidneys and bowels.  I direct essential tincture
of collinsonia and simple syrup, equal parts, a teaspoonful
four times a day.
  51.  Compound Collinsonia Tonic—Take of  essential
tincture of collinsonia and simple syrup, equal parts, seven
ounces; tincture of phosphorus, half an ounce;  essential
tincture of leptandra,  one and  a half ounces; citrate of
iron, one drachm.  This possesses, in addition to its tonic
properties, phosphorus in a soluable form, for the nutri-
tion  of the nervous tissues, and iron to increase the red
globules of the blood.
  52. Quinine.—The active principle of Peruvian bark is
the remedy that is principally used  by  all classes of phy-
sicians to arrest periodic disease.   It has been used many
times without either reason or common sense, and in com-
bination with many  deleterious  medicines, and  hence, in
many sections of the country, it has fallen into disrepute. 
218
TONICS.
 In my practice, in not one case out of a hundred, does it
 produce any unpleasant symptom, not even ringing in the
 ears.  The patient is always prepared for its  use by get-
 ting the stomach and bowels  in  good  condition, and
 arresting the excitation of the vascular system by seda-
 tives, and means to  promote secretion from the  skin and
 kidneys.   Employed in this way, its  action is certain, as
 mild as any other agent, and it  has  entirely passed from
 the  system in twenty-four hours.
   As before remarked, diseases which  manifest periodi-
 city, are  those  in which  it is  indicated, and in which
 it proves a specific—as ague,  bilious fever, intermittent
 neuralgia, and similar affections.  As a general  rule, the
 system being prepared for its administration, from twelve
 to fifteen grains will arrest the  disease.
   In the fevers of children, and typhoid fever, we employ
 it in small doses, after the action of the sedative, in order
 to stimulate  the nervous  system.   Take  quinine, five
 grains;  aromatic sulphuric acid,  twenty drops;  simple
 syrup, two ounces: the dose  being  a teaspoonful  every
 three hours to a child two years old.
   53. Iron.—Iron, though in small quantity, serves a very
 important purpose in the animal economy.  The red cor-
 puscles possess but a minute quantity of this mineral, and
 yet  without this they would  lose their vital properties,
 and  no longer give  a normal  stimulus  to the body.  In
. order to their  formation, a certain quantity of iron is
 necessary, and experience has proven that if this is added
 to the blood in many cases,  the red corpuscles will be
 increased in quantity; hence iron is the  most efficient
 medicine in all cases of anemia.  But a small quantity is
 necessary, and it may be taken in any of the many effi-
 cient forms in which it is found at  drug stores.  The car-
 bonate of iron is its  most common form, and this, added
 to Catawba wine, in the proportion of two  drachms to
 the  pint, will furnish the  iron and an agreeable stimulus, 
stimulants.      *            219
                   STIMULANTS.
   Stimulants  are  medicines which produce a temporary
increase of one or more  of the vital functions.  They act
entirely upon the nervous system, and in some cases seem
merely to call forth  the force  of the  system, leaving it
subsequently  exhausted.   In  others, however, they seem
really to  increase nervous force, for if they  did  not, we
would  always have, as a result  of their use, a depression
corresponding with the primary excitation—which is not
the  case.   Again, we may maintain  a certain degree  of
stimulation for an indefinite period, by continuing the use
of the stimulant, which we could not do,  if it merely ex-
pended nervous force  without causing a reproduction of it.
   We must, however, carefully  distinguish  between  ner-
vous and vital force; for nervous force may exist in excess
when the vital force, or that power that  preserves life, is
depressed.  When there  is failure in vital energy, no
stimulant will serve to prolong life, for it can not commu-
nicate  vital  power.  But death may  be occasioned by
more or  less sudden arrest of nervous  force, the body
retaining all its capacity for living; in such  case  a stimu-
lant calling forth the  necessary nerve force to continue the
different functions, will save life.
   The first effect of a stimulant  is that of topical excitant.
When  first taken into the stomach, they  stimulate the
mucous membrane and muscular coat to increased activity,
and the food is more  readily digested, and chylosis facili-
tated.  This  local stimulating influence  is  extended  to
every portion of the  body by sympathy, and the whole
system  participates in the  excitation.  Absorbed into the
blood they act directly upon the nervous system, and call
forth increased innervation.  As the result of this, the
contractions of the heart are increased in force  and fre-
quency ; the pulse becomes more energetic and frequent;
respiration is  accelerated;  animal  heat augmented; the
countenance is enlivened, and the intellectual and physi- 
220            *      stimulants.
cal powers increased.  They produce a temporary exhilara-
tion of mind, and revive  and elevate the spirits—in a
word,  the  phenomena  of  health are  active  when the
system is under  their influence, unless overpowered by
disease.
   This influence may be continued for  some time, if the
agents are  used with care,  and in  many cases the system
will have had time to regain its normal condition; if not,
the vitality, or organs and  parts acted on and stimulated,
will gradually become  exhausted, requiring  a  constant
increase in the quantity of the stimulant to produce the
desired effect, until  at  last they cease to respond to its
action at all.  Taken in excess, this effect is  observed at a
mueh earlier period,  and in addition we have the inflam-
matory condition of the stomach, and  some other parts,
produced by the topical stimulation.
   54. Alcoholic Stimulants.—As a general rule,  alco-
holic stimulants should  only be employed as continuous
medicines,  under the advice  of  a physician.  In some
cases they  answer an admirable purpose, increasing the
appetite and digestion, and  stimulating better innervation,
circulation,  secretion and  excretion.   Still,  as  we  have
already noticed, their influence will at length be exhaustive,
as the  organs and entire system will  require larger and
larger quantities, until at length their influence  is almost
entirely lost.
   As a temporary remedy  in eases of exhaustion, Bour-
bon whisky or brandy may be given in such quantities as
will restore normal action  of the nervous system and cir-
culation  of the blood.  When  they are to  be continued
for a greater length  of  time, ale, porter and beer will an-
swer a better purpose, and in many eases I prefer catawba
wine, with  the addition of sufficient simple sirup to ren-
der it pleasant.   These stimulants may be used when there
is  no apparent  structural  or  functional disease, further
than an enfeebled circulation and innervation.   If the de-
bility is the  result of disease of any  organ or  part,  of 
stimulants.
221
 course the proper course of treatment would be to remove
 such disease.
   55. Camphor,—Camphor  is a  nervous stimulant,  and
 may be employed when a  temporary  influence  of this
 kind is desirable.  Smelling a strong tincture will some-
 times relieve nervous depression, giddiness, faintness and
 pain in the head, as will also bathing the face, head and
 neck with the same.  A half teaspoonful taken internally,
 will relieve  cramps in  the  stomach, colic and choleraic
 diarrhoea.  As a local application, it may be applied in
 sprains, bruises, frost-bites, and whenever a local stimulant
 is desired.
   56. Tincture  of Prickly Ash—(Xanthoxylum  Fraxi-
 neum).—Tincture of prickly ash is an excellent stimulant,
 especially when the  bowels  are debilitated.   It is used
 with advantage  in cramps  of the stomach, colic, cholera
 morbus, and Asiatic  cholera, and in congestive diseases,
 as congestive chill, remittent fever, etc.   The dose is from
 half to one  teaspoonful in  sweetened water  as often as
 necessary.
   57. Capsicum.—Capsicum  is a powerful local stimulant,
 to whatever part it may be applied.  Taken  internally it
 produces a feeling of warmth in the stomach and bowels
 which is very persistent. Applied locally, it produces a
 feeling  of warmth, and the part becomes red, full  and
 warm, showing increased capillary circulation.  It is one
 of the best agents that can be used in  habitually cold ex-
 tremities, bathing the parts  once a day  with the tincture
 pure, or diluted  with one or two parts of water,  being
 sufficient  for the purpose.
   58. Compound Tincture  of Cajeput—(Life Drops).—
 Take equal parts of oil of anise, oil of cajeput, and oil of
 cloves, one drachm, alcohol two ounces, mix.   This is the
most valuable internal stimulant  in exhaustive discharges
from the bowels with  which we  are  acquainted, and  one
of the most efficient in all cases where a prompt, diffusible
Btimulant is  necessary.  It is almost a specific in cholera 
222
STIMULANTS.
morbus, one of the best remedies in Asiatic cholera, and
answers an admirable purpose in congestive chill and sun-
stroke.  In cholera morbus and cholera we give it in tea-
spoonful doses every  few  minutes,  until reaction com-
mences, when the dose is lessened.  It quiets irritation of
the stomach, and checks vomiting.
  59. Arnica.—Arnica is a very valuable local remedy for
family use, but its internal administration should be under
the care of a physician.  We use arnica locally in all cases
in which a part has had its vitality depressed by accident
or disease.  Bruising or contusion of the flesh, from what-
ever cause, demands its employment.  It is generally used
diluted  with  one  or two  parts of water, and applied by
means of cloths kept saturated  with it.
  60. Mustard.—Mustard is a very valuable topical stim-
ulant, and relieves internal pain and disease, by producing
determination of blood and  nerve  force  to the part to
which it is applied.  It is used  with advantage in almost
all cases of internal pain, applied in the form of the mus-
tard plaster immediately over the part.
  The Mustard Plaster.—I have  frequently  heard the
remark, " Oh! anybody can make a mustard plaster," but
my experience is  that everybody  does not know how.
Thus in a very serious case, where I wished a speedy ac-
tion from the mustard, I found, after waiting patiently for
half an hour, that the patient had not felt the application.
Upon questioning the  nurse who was positive as to her
ability to prepare the plaster, I. received the answer: " an'
docther dear, an' didn't I  mix  it with  flour,  it  was so
strong, and didn't  I cover it with a cloth to keep it from
sticking."  And sure enough it had been made as  dry as
possible, so that it had not moistened the cloth interposed
between it and the patient's body.
  To make a mustard  plaster right, take a sufficient quan-
tity of ground mustard, make it into a thin paste, with cold
or warm water, spread it  on thin  muslin so that it satu-
rates it, lay another piece on top, and apply the wet side 
ALTERATIVES.                  223
to the patient.  This will produce rubefaction in from two
to five minutes; then remove, and if desirable, repeat when
the burning sensation ceases.  A  speedy action is best, I
think in all cases, hence I never direct additions of corn-
meal or flour, except when treating children.

                  ALTERATIVES.

   Alteratives are defined to be agents which change, in
some inexplicable  and insensible way, certain morbid ac-
tions and conditions  of particular organs, or of the gene-
ral system.  They are administered to counteract certain
morbid habits of  the body, or cachectic states of the con-
stitution, and to  re-establish the healthy functions of de-
ranged organs.
   We  suppose, from their  known effects, that alteratives
may act in the following ways:  1.  They may change the
condition of the blood by a  direct influence exerted upon
it after the  absorption of the remedy.  2.  They may in
some manner effect  the removal of the worn-out tissues,
and favor the process of nutrition.  3. They may  neu-
tralize or change the character of decomposing or noxious
agents that exist  in the system, as the result of some path-
ological process, or that may have  been introduced from
without.  4.  They  undoubtedly  favor  elimination by
stimulating the excretory organs to increased activity.
   In many morbid conditions of the system, in which this
class of agents is indicated, in  addition  to medicines, a
change of air,  diet, habits,  scenery, employment, society,
etc., will tend in  a very marked manner to improve the
mental  and physical condition  of the patient,  and co-
operate with the medicinal measures employed in restoring
him to a state of health.  The cold shower-bath, douche,
alkaline or salt hand-bath, the medicated vapor-bath, etc.,
by keeping the skin  in a healthy condition, and by their
influence upon the nervous  system, also become valuable
auxiliaries to the remedies under consideration.   In addi- 
224
ALTERATIVES.
 tion to these measures, especial attention should  be paid
 to the regimen of the  patient.  A diet mild and unirri-
 tating in its character,  easy of digestion, and nutritious, if
 taken in moderate  quantities, will greatly  contribute to
 the restoration of health;  it furnishes the necessary quan-
 tity and quality of chyle for the formation  of the blood,
 and thus acts as a healthy excitant to the vascular and
 nervous  systems, furnishing healthy  materials  for  the
 nutrition or renovation of  impaired organs.
  61.  Compound Syrup of  Stillingia.—This is one of the
 most efficient vegetable alterative compounds that can be
 used.  It stimulates  normal  action of all  the  excretory
 organs, improves the appetite, digestion, and assimilation.
 It may be taken in doses of from a teaspoonful to a table-
 spoonful, three or four times a day.
  62.  Compound Tincture  of Corydalis—(Scudder's Alter-
 ative).—This is prepared of equal parts yellowdock, turkey
 pea, tag  alder and may apple.   It is  an excellent altera-
 tive in scrofula, secondary syphilis, and other diseases of
 like character.  The dose is one or two teaspoonfuls four
 times a day.
  63.  Compound Syrup  of  Sarsaparilla.—This  is an offi-
 cinal preparation, and is far superior to that furnished by
 patent medicine men.  Its action is  similar to the ones
just named, taken in doses of a tablespoonful three  times
 a day.
  64. Yellow Dock, Burdock—(Rumex Crispus,  Arctium
 Lappa).—Both  of these agents  are very good  vegetable
 alteratives, and may be employed in cases in which such
 agents are indicated.   The root is the part used, and it
 may be taken in infusion, syrup, or tincture, in doses of a
 wine-glassful of the first, and a tablespoonful of the others.
  65. Elder—(Sambucus Canadensis).—An infusion of the
 flowers of the common elder forms a very pleasant and
 effectual alterative for  children, in scrofulous or skin dis-
 eases.  They are slightly  diaphoretic  and  laxative, and
 improve the appetite and digestion.   The bark  may be 
ASTRINGENTS.
225
employed for the same purpose in the adult, but must be
used with care, as it is a cathartic.  The bark of the root
is a powerful diuretic, and may be used in dropsy.
  66. American Ivy—Five Fingers—(Ampelopsis Quin-
quefolia).—The bark  of this vine is  one of the  most effi-
cient alteratives we possess, both in  scrofula and diseases
of the respiratory apparatus.  In old ulcers and chronic
and obstinate eruptions upon the skin, the infusion taken
internally and applied to the ulcer or surface, two or three
times a  day, effectually removes  this  disease.
  67. Black Cohosh—(Cimicifuga Racemosa).—Black co-
hosh is  not only used as an  alterative, but is also one  of
the best remedies for acute and chronic rheumatism, and in
female  obstructions.  The tincture is generally employed,
and  may be given in  doses of half a teaspoonful four  or
five times a day.
  68. Iodide of Potassium.—This  remedy is  used to a
very great extent by physicians  in  scrofula, syphilis, dis-
eases of the skin, and, in fact,  all  diseases in which an
alterative is indicated.  In doses of from two to four
grains,  four  times a day,  it improves  the  appetite and
digestion, and is a specific antidote to the poison of lead.
To  obtain its full alterative effects, it is given  in doses of
ten  or  twenty grains, in solution in water, or combined
with alterative syrups or decoctions.
  69. Syrup of Iodide of Iron.—This remedy possesses
both alterative and  tonic  properties,  and  is  especially
adapted to delicate  and feeble persons.  The dose is a tea-
spoonful four times a day.

                  ASTRINGENTS.

  Astringents are remedies which, when brought into con-
tact with any portion of the body, cause a contraction  or
condensation of the tissues. Their use is confined principally
to the arrest of excessive morbid discharges, and to weak-
ened and  relaxed conditions of the system.  They are
          15 
226
astringents.
used to arrest hemorrhage from  any part of the body, to
check diarrhoea, and excessive mucous discharges.
  70. Tannic Acid.—Tannic acid is the astringent principle
of all the vegetable astringents, and may be obtained from
any  of them.   It is used in  diarrhoea, and hemorrhage
from the stomach  and bowels,  in  doses of five or ten
grains.
  71. Gallic Acid.—This remedy is very closely related
to the one just named, but differs from it in not  being
a topical astringent, but readily soluble in the secretions
of the  stomach, from which  it  is  absorbed and carried
into the blood.  It is one of the best remedies in cases of
hemorrhage that we possess, though  worthless to check
diarrhoea.  It  may  be given in doses  of five  grains, as
often as seems necessary.
  72. Oak  Bark.—The various  species of oak bark are
decidedly astringent, and may be used  for this purpose in
many cases where other agents can not be obtained.  It
is prepared for use  by adding  two  tablespoonfuls of the
bark (white oak is best), to a teacupful of boiling water;
when cold, it may be  given in doses  of a tablespoonful
every one or two hours.
  73. Crane's  Bill—(Geranium Maculatum).—This is a
mild but efficient astringent,  and  may be employed to
check diarrhoea, and in  hemorrhage.   One ounce of the
root is added to one-half pint of boiling water, strained when
cold, sweetened, and given  in doses of half a wine-glass-
ful every one or two hours.
  74. Catechu.—Catechu will be found prepared in the
shops in  the form of tincture, which is frequently used in
diarrhoea, in doses  of a teaspoonful every one  or two
hours.
  75. Logwood—(Hcemotoxylon).—Logwood is a mild, un-
irriting astringent, and adapted  to  diarrhoea and dysen-
tery.  An infusion of the bark may be made and  taken
in doses  of a tablespoonful, or one drachm of  the extract 
ASTRINGENTS.
227
may be dissolved in half a teacupful of boiling water, and
taken in teaspoonful doses every one or two hours.
  76.  Blackberry — (Rubus Villosus).—Blackberry root
made into an infusion, cordial or syrup, is a pleasant and
mild  astringent, and  is used  to check diarrhoea.  The
leaves of the red raspberry may be used for the same pur-
pose, and will be found an excellent remedy with children.
  77. Wild Indigo—(Baptisia  Tinctoria).—This agent  is
but slightly astringent, and I speak of it here more espe-
cially as a  remedy to  check fermentation in the bowels,
and relieve irritation.  It  is one of  the best,  if not the
best,  remedy  for sore mouth in  children, especially  if
there is ulceration; it will relieve those cases of diseased
stomach in which the tongue is heavily coated,  the breath
fetid, and the appetite and digestion poor.  Add a table-
spoonful of the bark to half a teacupful of boiling water,
strain when cold, and give in doses of a teaspoonful every
one or two hours.
   78.  Neutralizing  Cordial.—This is prepared by taking
the  compound  powder of rhubarb, heretofore  spoken of,
eight ounces; oil of cinnamon and erigeron, equal parts,
one fluid drachm; alcohol, half a pint; water,  two  pints ;
sugar, two pounds.  Infuse the powder in the water (boil-
ing), express and strain, then heat the liquor, dissolve the
sugar in it, and,  while cooling, add the  alcohol and oils
previously mixed.
  I introduce  this here, not because of its direct  astrin-
gent action, but  because it is one of the best remedies that
can  be kept in the house  for common diarrhoea and
derangement of the  stomach and bowels.   The' dose for
a child three years old would be about a teaspoonful- every
one or two  hours; for an adult, a tablespoonful.  It should
be continued until the stools become dark, resembling the
color of the medicine; afterward give in small doses. 
228
ANTISPASMODICS.
                ANTISPASMODICS.

  Antispasmodics  are remedies which counteract spasm,
by relieving the conditions upon which it depends.  Spas-
modic action depends upon irritation of the nervous cen-
ters, either from excitation  and determination of blood to
them, or  from some irritation of a  distant part of  the
body, which is transmitted by the nerves to their origin.
Thus, in one  case, we will have convulsions from disease
of the brain  and spinal cord, in another from teething,
irritation of the stomach, or worms.
  Of course,  as  the  cause of spasm differs in different
cases, the  remedies used to combat  it will differ.   Thus,
if spasms are induced by eating too freely of green fruit,
an  emetic will be the  surest remedy; if from worms, we
give vermifuges, and if from determination of blood to
the brain  and spinal cord, we use such  means  as will ar-
rest the irritation.  I will  name  but three agents of this
class:
  79. Assafgstida.—This fetid gum-resin is a stimulant to
the stomach and bowels, relieves pain and flatulence, and
quiets irritation of the  nervous system.   It may be given
in the form of a pill  to the adult, but the child will take
the tincture  best, the  dose being from one-fourth to  one
teaspoonful as often as  necessary.
  80. Lobelia.—Lobelia is a powerful antispasmodic, pro-
ducing  relaxation of the entire system, and quieting ner-
vous irritation.  We usually  employ it in the form of the
antispasmodic tincture, a tincture of equal parts of lobelia,
capsicum  and ictodes.   To a child two years old, I would
give  one-third of a teaspoonful in sweetened water every
five or  ten minutes until the spasms  had  ceased; if it
could not be  taken by mouth, add two teaspoonfuls to half
a teacupful of warm water and use it as  an injection.
  81. Gelseminum.—Gelseminum  is a powerful  relaxant
and antispasmodic, and should be  used with  great care.
I employ it principally to prevent the occurrence of spasms 
EXPECTORANTS.
229
in diseases  of  children.  If  I notice twitching of  the
mouth  and fingers, or extreme restlessness  and contrac-
tion of  the face, I order tincture of gelseminum, ten drops
every one or two hours to  a child two years old, and feel
confident it will give speedy and certain  relief.  It may
be employed for the relief of convulsions in the same doses
every few minutes.

                  EXPECTORANTS.

  Expectorants are remedies that increase or facilitate ex-
pectoration of mucus from the air passages, and thus re-
lieve cough, difficult breathing, and other symptoms that
attend  disease of the respiratory  apparatus.  They may
do this by allaying inflammation of the mucous membrane,
which, in its first stages, always diminishes the normal
secretion of mucus, or by stimulating this membrane when
relaxed, causing  an increased flow of blood to it, and in-
creased  action  of the mucous follicles, by  rendering it
thinner and less viscid, enabling the patient to bring it up;
or lastly, by exciting an action of the respiratory muscles,
causing an  evacuation  of mucus already secreted, as in
the act  of coughing or vomiting.
  Expectorants may be divided into three classes: those
that produce nausea and relaxation, and increase the se-
cretion  of mucus—nauseant expectorants; those that quiet
irritation of the nerves  distributed to the air passages—
demulcent and narcotic expectorants; and those that stim-
ulate the mucous membrane and check its secretion—stim-
ulant expectorants.
  If cough, pain, or difficult breathing is attended by dry-
ness  of the  mucous  membrane,  or scanty secretion, the
first class of agents are appropriate.  If there is  a tickling
sensation  in the throat or any part of the  air-passages
producing cough, there being sufficient secretion, we would
use the  second class.  But, if  considerable quantities of
mucus was raised, and the cough seemed for the purpose 
230
EXPECTORANTS.
of removing it, then the third class of remedies, that di-
minish the secretion, should be used.
  82. Compound Syrup of Lobelia.—Take of lobelia herb,
four ounces; bloodroot, two ounces, and macerate them in
two pints of vinegar for one week;  then strain with pres-
sure.  Take pleurisy root, four  ounces; Solomon's  seal,
two  ounces; cover with boiling water and  keep  hot one
day, adding water so that when  strained, two pints shall
be obtained.  Put both in a vessel, bringing the liquor to
a boil, and add three pounds of loaf sugar.
  This will make a more efficient expectorant of the first
class than can be obtained at the stores.   It relieves cough,
and is very efficient in croup, and in all  cases where it is
desirable to increase secretion  from the air passages.   It
is  also an  excellent diaphoretic, and may be used in all
cases of cold.
  Any of the nauseant  emetics  may be used  as expecto-
rants, as the ipecacuanha, lobelia, sanguinaria, eupatorium,
etc.;   and temporary preparations may be made by com-
bining their tinctures or sirups.
  83. Compound Tincture of Oils of Stillingia and Lo-
belia.—Take oil of lobelia, one  drachm; oil of stillingia,
oil of cajeput,  equal parts, two drachms; alcohol, 98 per
cent., two ounces, mix.   This is the remedy, par excellence,
for  mucus  and spasmodic croup, and  should be kept  in
every family where the children  are predisposed to this
disease.   We give  it internally, one  drop on a lump  of
sugar every quarter, half, or one hour, and at the same
time  apply it freely to the throat externally.  In chronic
bronchitis, laryngitis, and many chronic coughs, it will be
found a  most  excellent  remedy in doses of one or two
drops on sugar, every  three or four hours.  It should be
taken without  water or other fluid, letting the sugar dis-
solve in the mouth and swallowing slowly.
  Almost any   demulcent will  quiet   cough,  when  it
depends upon irritation of the nerves.   Thus,  we make a
solution  of gum-arabic, or isinglass, sweeten  it with loaf 
expectorants.
231
sugar, and slightly acidulate with lemon juice or vinegar,
and let the patient take it frequently;  or, we direct equal
parts of vinegar, sugar  and butter, with boiling water, to
make a stew.   Sometimes a portion of liquorice, dissolved
in  boiling water,  and  sweetened  with sugar or honey,
answers an excellent purpose.
   84. Syrup of Elecampane.—Take of elecampane, spike-
nard, equal parts, two  ounces ; sun-flower seeds, bruised,
one ounce; macerate them in boiling water  for twenty-
four  hours, strain with pressure, to make one  pint, and
add sugar to form a syrup.  This may serve  as the type
of the second class of expectorants, and if desired it may
be rendered slightly narcotic by the addition of paregoric,
one or two  ounces.   The dose is  from a tea to a table-
spoonful, ?.s often as may seem necessary.
   85.  Stimulant Expectorant.—Take syrup of senega,
syrup of  squills, syrup  of  balsam tolu, glycerin,  equal
parts, one ounce ; mix.   This may be taken as a type of
this class  of expectorants, and will possibly answer as well
as any other  combination.   The dose would be a  tea-
spoonful every two or three hours.
   86. Inhalations.—Inhalation of the vapor of various
articles has been  much used  lately in the treatment of
diseases of the lungs.   With the  exception of two, they
should always be used  under the care  of  a reputable
physician, as a person's lungs are equivalent  to  his  life,
and too important to be tampered with  by  quacks  and
mountebanks.
   In cases of dryness of the air passages, constriction,  and
difficult breathing, much benefit will be experienced by
inhaling the vapor of boiling water, water and vinegar, or
vinegar alone.  In the early stages of all acute diseases of
the air passages, this will prove very effectual, but is espe-
cially beneficial in croup.   The inhalation is easily used.
Place a covered tin vessel on  the stove or fire, and bring
the water or vinegar to  the boiling point, take it  to  the
bedside, and let the patient hold his head over it at a rea- 
232
LINIMENTS.
sonable distance;  throw something over the person's head
and  the  vessel to retain the steam;  then lift the  cover
and let the vapor escape.  It may be continued for a con-
siderable length of time by slowly immersing  a hot iron
in the  fluid.

                    LINIMENTS.

  Almost every family makes more or less use of liniments
for bruises, sprains, pains in various parts of the body, etc.
I wTill give formula for such preparations as I deem best
for domestic use, premising that all the liniments and pain
killers  that flood the market are tinctures of essential oils,
or stimulants.   You  could hardly go  amiss in making a
liniment, if you would  take one or more of oils of  sassa-
fras, hemlock, origanum, cloves, pepper,  mustard, etc.,
using sufficient alcohol to cut them.
  87. For Internal  or External Use.—Take oil of hem-
lock, oil of sassafras, oil of cloves,  each  two drachms;
camphor, half an ounce; alcohol, 76 per cent., one pint;
mix.   This will give you a valuable stimulating liniment,
and an excellent internal stimulant in cases of colic, cramps
of the stomach, cholera morbus, etc.  A teaspoonful would
be an appropriate dose internally.
  88. Chloroform Liniment.—Take equal parts of chloro-
form, tincture of aconite and tincture of opium, 5j; mix.
It is the  best  local  application for neuralgia  that can be
employed, and may be used in all cases of acute pain. It
is an excellent remedy in toothache, applied to the cavity
on a pledget of cotton.
  89. Volatile Liniment.—Take strong aqua ammonia,
one  ounce; olive oil,  two  ounces;  mix.  An excellent
stimulant application in cases  of rheumatism, or pain in
any part of the body.  It should be applied by wetting a
flannel cloth with it,  and covering to  prevent evaporation.
It soon produces redness of the skin, and will sometimes
vesicate. 
ointments.—emollients.
233
                    OINTMENTS.

   90. Mayer's Ointment.—For common use in families
 Mayer's Ointment will answer a better purpose than any
 other.  It is an excellent  application  to  ulcers, inflamed
 breasts, sore nipples, and  as  a discutient  in  scrofulous
 swellings.
   91. Elder Ointment.—In the country I should  advise
 the preparation of this ointment to take  the place of all
 similar  preparations.  Take of  the inner bark  of the
 common elder a sufficient quantity, cut it fine, and put in
 a  tinned vessel;  cover  the bark with fresh butter, and
 keep hot for six hours; now strain, and add pulverized
 camphor, one ounce to each pint of ointment.  Nothing
 will be found  to equal this preparation in milk scall, sores
 behind the ears, and on the neck of children, as a dressing
 for ulcers, boils, sore  nipples, and in any case where a
 gently stimulating and soothing application is needed.

                    E3IOLLIENTS.

   Under this head  we may include all those external ap-
 plications that are  employed for the purpose of softening
 and relaxing  the part to  which they are applied.   They
 diminish the tension of the tissues, and soften and render
 more flexible  the  solid parts of the body.  When oils,
 ointments, lard, etc., are  applied to parts that are  tense
 and resisting, they  lessen  cohesion, soften and  relax the
 tissues, and  many times prove very valuable.  The same
 may be said of poultices, which soothe irritation,  relieve
 inflammation, and are of great utility in relieving pain and
 promoting resolution.
  Poultices are very important local applications in bruises,
 sprains, injuries, painful tumors, superficial or deep-seated
inflammations, painful  ulcers, etc.  In the early stage of
 circumscribed  inflammatory affections, these remedies are
 found to be of the greatest utility in effecting a dispersion 
234
EMOLLIENTS.
of the diseased action, and thus preventing suppuration
and  destruction of tissues.  If,  however, the period  has
passed during which they can prove beneficial as resol-
vents, they will still be found valuable, to relieve irritation,
lessen pain, soften  and relax the  tissues, and promote sup-
puration and an early discharge  of the purulent material.
Their action depends  in  great  part, upon  the moisture
they contain, and  upon their  shielding the  surface from
the action of the air.
  Water  as  a Poultice.—Water  properly employed,
forms one of the most efficient  and cleanly of  these  ap-
plications, and  as  it  may be  medicated to any extent, it
may be  employed  in almost  all cases when a poultice is
desirable.  I direct its application in the following way:
Take a  soft  towel, or cotton flannel folded several thick-
nesses, wet  it  in  tepid or warm water, and  apply to  the
part,  covering  with oil-silk,  oil-cloth, or two or three
thicknesses of flannel, to prevent evaporation. It may be
renewed from time to time without removal, by removing
the external wrappings, and  wetting it with warm water.
We  derive  all the advantage  from it that we could from
any simple poultice, inasmuch  as it keeps the part contin-
uously moist, and  excludes  the  atmosphere.  The  main
recommendations are, that it is cleanly, is easily prepared,
easily renewed, there can  be no  decomposition, no reten-
tion of matter in contact with the skin, and an avoidance
of all unpleasant odors.
  As already remarked, this application may be medicated
with any remedy that  is  deemed  desirable.   If we wish
to use stramonium  or jimson-weed, we boil the leaves,  and
employ the decoction; if we wish a hop poultice, we make
a decoction  of hops,  and use  in  the same way, and so
with  other  agents.  Or, we may medicate the water by
the addition of a suitable quantity of a tincture to it, as
of opium, aconite, arnica, belladonna, stramonium, hops,
etc.   Usually  from one to four ounces of these tinctures
to a pint of  tepid water, will be  the proper proportion. 
EMOLLIENTS.
235
   Bread and  Milk  Poultice.—This is a very good appli-
 cation in  minor cases, in boils, felons, inflamed wounds,
 etc.  Take of soft, dry bread, a sufficient quantity, crumb
 it fine, and  add milk slowly, stirring it all the time, until
 it  is of proper consistence.  As decomposition  of the
 bread and milk takes place very rapidly, it should be re-
 newed every three or four hours.
   Slippery  Elm  Poultice. — Take  of  finely  powdered
 slippery elm  a sufficient quantity to  form a poultice at
 least half an inch in thickness; mix with  tepid  water       €
 until it forms a thin  paste, but not so that it will run when
 spread on a cloth.   It should be renewed sufficiently often
 so that it will not become dry  and adhere at the edges,
 which is very unpleasant  in many cases.  If powdered
 elm can not be obtained, take the  green or dried bark,
 and macerate with hot water until it forms a thick muci-
 lage, which may be  spread on  a  cloth and applied, or it
 may be thickened with flax-seed,  wheat-bran or flour.
   Flax-seed Poultice.—Take of ground flax-seed a suffi-
 cient quantity, and mix to the consistence of a paste, with
 hot water.  It does  not  become dry, like other poultices,
 and hence is preferable  when it can not be frequently
 changed.
   Hop  Poultice.—Take  of hops a  sufficient  quantity,
 cover them  with  boiling water, and  let the vessel stand
 where it will keep hot for an hour, adding  more water as
 it evaporates.  Now strain through  a coarse towel with
 considerable  pressure, and  thicken  with  wheat-bran or
 corn-meal.   It may be applied hot or cool, as may be indi-
 cated, and is an excellent soothing application in all cases
 of inflammation.
   Dogwood  Poultice.—Take of  dogwood bark  a suffi-
 cient quantity to make a strong decoction,  add boiling
water, and  let it stand where  it will  keep hot for two
hours.   Now strain  through a stout towel, and thicken
with wheat-bran.   It is one  of  the best applications that
can be made to an abscess when it is discharging; to ulcers, 
236              FAMILY MEDICINE CHEST.

erysipelas, and  in any case where we wish to obtain the
influence of a poultice, and at the  same time increase the
tone and vitality of a part.
  Onion Poultice.—Onions form an excellent poultice in
diseases of the  chest, croup, inflammation of the bowels,
and other cases of deep-seated disease in  children.  The
onions may be either stewed or roasted until they are soft,
and then beat to a pulp and applied.
  Potato Poultice.—Take of large, fully ripe potatoes, a
sufficient quantity,  boil them with the skins on until they
are mealy; remove the skins, mash  them, and give the
proper consistence by the addition of milk or warm water.
It forms the best poultice I have ever used, in all cases of
skin disease, where a remedy of this kind is  needed to
remove irritation.

            FAMILY MEDICINE CHEST.

  Every  family should keep such remedies in the house
as will answer in trivial cases, and in the more severe
ones, if a physician can not be obtained.   The herbs and
crude medicines that I have described, should be gathered
in the summer and  fall, carefully dried and put away in a
cool, dry place, having each one properly marked.  It is
very little trouble to obtain a supply of pennyroyal, cat-
nip, boneset, etc.; or even the rarer roots, yellowroot, may
apple and bloodroot.  In addition to these, a  few reme-
dies, carefully prepared by a  competent pharmaceutist,
properly labeled, with  a small graduated glass, marking
drops, should be obtained.  It will be found much cheaper
to keep such remedies in the house, and know how to use
them properly, than to be continually taking patent  med-
icines.  Though I  should  always advise  sending for a
physician at the commencement  of a disease, still many
persons will doctor  themselves as long as they can to save
expense; such  should  carefully study the symptoms of 
FAMILY MEDICINE CHEST.
237
disease, to  know when a physician was necessary, and
when he could be dispensed with.
  I propose a medicine case of two sizes, large and small,
to contain the following articles; the numbers refer to pre-
vious description of the agents:
                     SMALL CASE.
45.  Febrifuge—Tincture of Aconite and Yeratrum, equal
      parts, one ounce.
81.  Antispasmodic—Tincture of Gelseminum, one ounce.
    Prophylactic  for scarlet fever, etc.—Tincture of Bel-
      ladonna, half an ounce.
83.  Tincture  of Oil  of Stillingia and Lobelia, half an
     ♦ ounce.
58.  Life Drops, one ounce.
 7.  Compound powder of Rhubarb, one ounce.
12.  Podophyllin Pills, one-fourth of an ounce.

  The above remedies can be put up in a neat box with
small graduate, for $4.00, and will last a common sized
family one or two years.
  For a large medicine case, I would propose to  double
the amounts of each of the remedies named for the small,
and would add:
                     LARGE CASE.
41.  Saturated Solution Acetate of  Potash, -  two ounces.
 6.  Emetic Powder,........two ounces.
 8.  Compound powder of Jalap,    -   -  -   two ounces.
23.  Diaphoretic Powder,......one ounce.
50.  Tincture Collinsonia,......two  ounces.
67.  Tincture Black Cohosh,.....two ounces.
70.  Tannin,.........half an ounce.
77.  Wild Indigo,.........one ounce.
52.  Quinine Pills,........half an ounce.

  This would cost, with neat box,  lock and  key, and two
graduated glasses, $10.00, and  would be all the medicine
needed  for domestic practice, for  a great length of time. 
238
DIETETIC  PREPARATIONS.
            DIETETIC PREPARATIONS.

  Good nursing for the sick is of as much, if not of more
importance than taking medicine, and  one of the impor-
tant parts of good nursing is careful attention to the diet.
If a physician is in attendance, he will, in all probability,
give directions as to the kinds of food proper to be admin-
istered; and yet, if these are improperly prepared, they
may do more harm than his medicine does good.  Unfor-
tunately, however, many physicians do  not know, and
can not, therefore, give intelligible directions for the diet
of the patient, and it  is left entirely to the  discretion of
the nurse.
  Food is necessary in all diseases, to supply the materials
for the repair of the tissues, and the production of animal
heat.  If no food is taken, the sick person will starve to
death as soon, if not  sooner, than if it was withheld in
health.  Few persons  look  at it  in this  light,  and even
physicians wonder that their patients die  when they have
kept their stomach and bowels in  such  condition that no
food could be digested for two or three weeks.   Though
food is necessary, there are  times at which it can not be
given with advantage, and in all cases it must be selected
with reference to the  condition  of the  patient, and given
in such quantities as may be easily digested.
  It is difficult to lay  down strict  rules for the guidance
of the nurse with reference to the kind  and quality of the
food to be given, and the proper period of the day when
it is best appropriated.  The following  general  rules will
serve to guide the nurse to some extent, but much will be
left to the good judgment of the medical  attendant:
  1. Solid food should rarely be  given during the progress
of an acute  disease, as the stomach and  digestive organs
are not in a condition to furnish the fluids necessary for
its proper  comminution, and hence it does not digest,
but decomposes, giving rise to irritation and other annoy*
ing results. 
DIETETIC  PREPARATIONS.
239
  2. As  a general rule, the severer the disease, and the
farther  the system  is  from  a condition  of health, the
lighter and more diluted should be the food.  Thus, in a
high grade of fever or inflammation, we would give whey,
toast-water, thin farina or tapioca, weak chicken or mut-
ton broth, etc.
  3. In  states  of great  exhaustion, the food should be
concentrated, very nutritious,  and yet  deprived, as far as
possible, of all  material that can not be appropriated by
the stomach.  Thus  we would give beef essence, concen-
trated chicken  or mutton tea, farina, with milk, etc.
  4. In  all febrile  and inflammatory  diseases,  the food
should be given at that period of the day in which there
is least vascular and nervous  excitement,  and it should
never be forced on the patient when suffering from high
fever.
  5. Never give food when the patient is  suffering from
severe pain, as at  such times it is  impossible  for the
digestive organs to appropriate it.
  6. If the tongue is heavily coated with a yellowish coat,
a bad taste in the mouth, and a feeling  of weight and
oppression at the stomach, it is better not to give food, or
at least give it in a fluid form  and in small  quantity.
  7. Never force food on a patient when his stomach re-
volts at it,  or  if it  produces  nausea, oppression or pain.
It is much better to wait until  medicine or time has placed
the  stomach in  condition to digest it.
  8. When the digestive powers are much  impaired, and
it is  important to give food to sustain the strength, it
should be given  in small quantities, and at regular inter-
vals like medicine.
  9. If there is  an  absolute  demand for nourishment to
sustain the strength of the patient, and it cannot be given
by mouth, it is  sometimes an excellent plan to administer
it as an injection.
  10.  Much care is necessary  during  convalesence from
disease, that the patient does  not eat  too  much, or that 
240
DIETETIC PREPARATIONS.
 that is indigestible.  The digestive organs are now enfee-
 bled, and if over-worked, there is  not only  an excess of
 imperfectly elaborated material taken into the system, but
 the  exhaustion is extended to the entire system, and im-
 pairs the functions of other organs and parts.
   Gruel.—Thin  corn-meal gruel is an excellent diet drink
 in many diseases, but especially in small-pox and the erup-
 tive fevers, and in acute disease of the respiratory appara-
 tus.   Put a pint of water on the fire, sliglitly seasoned
 with  salt, and when boiling briskly, sprinkle in two table-
 spoonfuls of corn-meal, stirring it continuously until done,
 usually about  five  minutes.   It is best when  warm, and
 should be made frequently.  Oat-meal gruel may be made
 in the same manner, and used in similar cases.
   Toast and  Water.—Cut a large slice  of wheat bread,
 toast it evenly, and nicely brown, and  put  in a covered
 earthen-ware vessel and cover with boiling water.  It will
 be ready for use in half an hour' and forms  a very light
 and acceptable drink in acute diseases.
  Jelly Water.—Stir a tablespoonful of  currant or other
jelly into  half a  pint  of water, keep it cool,  and  give as
 occasion requires, to remove the bad taste from the mouth.
 It answers an  excellent purpose in fevers, being very grate-
 ful to the sufferer.
  Barley Water.—Wash clean two  ounces of pearl bar-
 ley, put it in a  vessel  with a quart of water, and boil
 slowly to one-half.  It may be seasoned to suit the fancy
 of the patient, with  lemon peel, catawba wine and sugar,
 spices, etc.
  Gum-Arabic Water.—To an ounce of gum arabic, add
 a pint of boiling water, and stir until dissolved.  In many
 cases  it. is permissible  to render  it  slightly acid  with
 lemon, and to  sweeten with loaf sugar.   It is an excellent
 drink in acute diseases when the soothing influence of a
 demulcent is desired.
  'Whey.—Whey is very readily formed of fresh milk, by
 the  addition  of  rennet water, catawba wine or vinegar. 
DIETETIC PREPARATIONS.
241
Stir it in, set it in a warm place till the curd is formed,
land has  separated from the whey beneath;  remove the
curd carefully and the whey is ready for use.   There is no
better drink for the sick  than this, when it is  not deemed
necessary to give warm  fluids, as it  is well borne by the
stomach, refreshing to the patient, and  affords considera-
ble nutriment.
   Apple  Water.—Take three or four large, juicy apples,
cut them in quarters, and bake  them until  thoroughly
done and soft.   Put them in an earthen pitcher, and pour
on a quart of hot wrater, then let it  stand where  it  will
keep hot  for half an  hour, when it will be fit  for use.  It
may  be  sweetened with  loaf sugar if  necessary, and if
admissible flavored to suit the  taste of the  patient.  It
Bhould be given cold.
   Farina Gruel.—Heat  a sufficient quantity of water,
and when boiling sprinkle in sufficient farina to  give it
the desired consistence.   Sweeten it with  sugar, and if
desirable  add a small portion of brandy, rye whisky or
wine.  It is an excellent light diet in acute diseases,  and
in the diseases of children.
   Tapioca.—Take three  heaping tablespoonfuls of tapioca
and wash it well in cold water; drain it, and pour on
sufficient  water to cover  it, and let  it soak for four
hours.  Now add as  much more  water and boil it until
it looks quite clear, and flavor it to suit the  taste of the
patient, always having reference to the character of the
disease.   Sago may be prepared in the same way.
  Sago, Mazina, or Tapioca Pudding.—Add three  table-
spoonfuls of sago, mazina  or tapioca to  a  pint of milk,
and boil it until quite soft, adding gradually three ounces
of white sugar.  Now set it aside to cool, and having beat
up  three  eggs, stir them by degrees  into it, flavor with
nutmeg, and bake in a deep dish.
  Egg and Milk.—Take a fresh egg and boil for one min-
ute ; break it into a tumbler, and add half a teacupful of
hot milk,  and stir briskly until they are thoroughly mixed
           16 
242
dietetic  preparations.
Seasoned with salt, this forms a  most excellent, light and
easily digested  food  in many forms of disease, but espe-*
cially during convalescence.
  Egg Wine.—Break a fresh egg into a tumbler, and beat
it until  smooth and thick.  Now  add a teaspoonful of
sugar and  an  ounce of  Catawba wine, and  one or two
ounces of boiling water.   This forms an excellent stimu-
lant and restorative in cases where wine is  indicated, and
where the egg can be digested.
  Brandy and Egg.—Take a fresh egg, break it in a shal-
low dish, and beat it  until smooth and thick.  Now add a
table spoonful of brandy, and four  tablespoonfuls of boil-
ing water, and  mix thoroughly.   This forms one of the
most valuable preparations that can be used, in  cases of
great prostration, as it furnishes a concentrated article of
food in a pleasant form, and at the same time the necessary
stimulant.
  Bran Gruel.—Take of new wheat bran one pint, add
six  pints of boiling water, boil to four pints, strain, and
add sugar, sirup, honey, lemon juice  or aromaties to render
it agreeable to the taste.  Tt is demulcent and nutritious,
easy of digestion, and useful in colds, and febrile and
inflammatory affections.
  Malt  Gruel.—Take  ground malt one  pint, boiling
water three pints. Infuse the malt in the water for two
hours, strain and sweeten, adding lemon juice or aromaties
if desired.  It is valuable in fevers and inflammations, as
a diluent, and is a mild, unirritating and nutritious article.
  Rice Gruel.—Take of ground rice half a teacupful, add
water two  pints, boil for one hour, strain, and add nut-
meg, cinnamon or wine and sugar to suit the taste.  This
forms an excellent diet drink in acute diseases, and in cases
of great exhaustion  when stronger food cannot be taken.
  Panada.—Take two or three slices of dry wheat bread,
toast it slightly and crumb it into a bowl.  Season it with
nutmeg, cinnamon or other spice to suit the taste, and pour
on  it a pint of boiling water, and  if not objectionable, a 
                DIETETIC  PREPARATIONS.             243

tablespoonful of  best brandy or whisky.   It forms an
excellent and pleasant diet for the wreak and prostrate
patient, and digests easily and quickly.
  Flour Gruel.—Make a linen or muslin bag holding a
pound of flour, fill it with wheat flour and boil for several
hours or until it forms a hard mass.  Of this two  or three
tablespoonfuls may be grated into half a pint of new milk
and the same of water, or into water alone if the milk is
objectionable, and let it boil for a  few minutes.   It  may
be seasoned with any spice, and forms an excellent substi-
tute for arrow root, tapioca or sago.  It is a good diet in
the bowel  complaints of  children, chronic dysentery and
diarrhoea, and in many weakened  and irritated states of
the stomach and bowels.
  Beef Tea.—Take of lean beef, freed from fat, a pound;
put it in a vessel over a slow fire and pour in it two pints
of boiling water.   Let it boil for half an hour, removing
any scum that arises, add the necessary salt and pepper,
and strain off the liquor before it gets cold.
  Another.—Take of nice beef  steak  cut thin, half a
pound, put it on the gridiron over coals, and broil until
each side is slightly roasted.  Now place  it in a tin vessel
and pour on  it half a pint of boiling water, cover it and
let it stand where it will keep  warm for half an hour.
  I prefer the latter method of making the beef  tea, but
either will give an excellent preparation, highly nutritious
and easy of digestion.   It is  employed in low states of
the system before solid food is admissible, and is of great
value  in the advanced stages of many diseases.
  Beef Essence.—Take of lean beef, without fat, cut it in
small  pieces and put in a stout glass bottle.   Suspend it in
a vessel of water and boil for four hours, then strain off*
the liquor and season with salt.  This furnishes the largest
amount of  nourishment in  the smallest compass, and  is
employed in  low  forms of  fever, and other  diseases
attended with great prostration.
  Mutton Broth.—Take two pounds of neck of mutton, 
244             DIETETIC PREPARATIONS.

cut it in pieces, and cover it in the vessel with three pints
of water.   Boil it till the meat is in rags, strain off the
liquor and season to the taste.  It is an excellent prepara-
tion for the sick, especially in diseases of the bowels.
  Chicken Broth.—Take of the dark  meat of a chicken,
the wings, legs, thighs and neck, pour on them a pint of
water, and boil gently for thirty minutes, seasoning with
salt only.   It is lighter than either of the  preceding, and
may frequently be eaten with stale bread.
  Oyster Soup.—Take half a dozen oysters, cut out the
gristle, and put them  in a stew pan with a teacupful of
equal parts of  milk and water, boil  for five minutes and
strain off the liquor, seasoning with salt, and pepper if
admissible. 
               PART    IV.

MANAGEMENT  OF  ACCIDENTS AND INJURIES,
           AND  SURGICAL DISEASES.
   Every person should be  so well acquainted  with the
 anatomy of the body, that he will be  enabled to deter-
 mine the nature of the more common accidents, and adopt
 such  treatment as  may be necessary, before a physician
 or a  surgeon can be obtained.  This knowledge is given
 in the chapter on anatomy and physiology.  In addition
 to this, presence of mind is requisite to bring to bear this
 knowledge, and adopt such rational expedients as may be
 demanded by  the case.   I have often been  surprised at
 the extreme ignorance manifested in such cases,  whereby
 great  suffering or loss of life was entailed upon the suf-
 ferer.  A person  receives a cut, and is allowed to bleed
 until  almost  exsanguined, the  persons near trying to
 staunch the blood with flour, sugar, etc.,  or in other cases,
 applying a ligature  to the limb so tightly,  as  to arrest
 the venous circulation, and almost  endanger its vitality.
 A limb is broken, and often  times the sufferer is moved
 considerable distances without any support to the limb,
 the broken extremities of bone  piercing and tearing the
 flesh at each movement.  In all such cases, I would advise
 you to keep cool, and use your common sense and judg-
 ment until better assistance can be obtained.

     Directions for Restoring the Apparently Dead.
  I. If from Drowning or other Suffocation, or Nar-
cotic Poisons.—Send  immediately for medical assistance,
blankets and dry  clothing; but  proceed to treat the pa-
tient instantly,  securing as much fresh air as possible. 
246         restoring the  apparently dead.
  The points to be aimed at are, first and immediately, the
restoration of breathing; and second, after breathing is
restored, the promotion of warmth and circulation.
  The efforts to restore life must be  persevered in until
the arrival of medical  assistance,  or until the pulse and
breathing have ceased for at least an hour.

        TREATMENT TO RESTORE NATURAL BREATHING.
  Rule 1.—To Maintain a Free Entrance of Air into the
Windpipe.—Cleanse  the mouth  and  nostrils; open the
mouth; draw forward the patient's tongue, and keep it
forward: an elastic  band over the tongue and under the
chin will answer this purpose.  Remove all tight clothing
from about the neck and chest.
  Rule 2.—To Adjust the Patient's Position.—Place the
patient on his back on a flat surface, inclined a little from
the feet upward; raise and supportthe head and shoulders
on a small, firm cushion, or folded article of dress placed
under the shoulder-blades.
  Rule 3.—To Imitate the Movements of Breathing.—Grasp
the patient's arm just above the elbows, and draw the
arms gently and  steadily upward until they meet above
the  head (this is  for the purpose of drawing  air into the
lungs), and keep the arms in that position for two seconds.
Then turn  down the patient's arms, and press them gently
and firmly for two seconds against the sides of the chest
(this is with  the object of pressing air out of the lungs.)
Pressure on the breast-bone will aid this.
  Repeat these measures alternately, deliberately, and per-
severingly, fifteen times in a minute, until a spontaneous ef-
fort to respire is perceived, immediately upon which, cease
to imitate the movements of breathing, and proceed to
induce circulation  and  warmth (as below.)
  Should a warm bath  be procurable, the body may be
placed  in  it  up to the neck, continuing to  imitate the
movements of breathing.  Raise  the body  in twenty 
            RESTORING THE APPARENTLY DEAD.        247

 seconds in a sitting position, and dash cold water against
 the  chest and face, and pass ammonia under the  nose.
 The patient should not be kept in the warm bath longer
 than five or six minutes.
   Rule 4.—To Excite Inspiration.-r-Durmg  the employ-
 ment of the above method, excite the  nostrils with snuff
 or smelling salts, or tickle the throat with a feather.   Rub
 the chest  and face briskly, and  dash cold and hot water
 alternately on them.
   *£* The above directions are chiefly Dr. H.  R. Silvester's
 method of restoring the apparently dead or drowned, and
 have been approved by the Royal Medical and Chirurgi-
 cal Society.

 TREATMENT AFTER NATURAL BREATHING HAS BEEN RESTORED.
  Rule 5.—To Induce Circulation and Warmth.—Wrap
 the patient in  dry blankets, and  commence rubbing the
 limbs  upward,  firmly and  energetically.   The friction
 must be continued under the blankets or  over the dry
 clothing.
  Promote the warmth of the body  by the application of
 hot  flannels, bottles  or  bladders of hot water, heated
 bricks, etc., to the pit of the stomach, the armpits, between
 the  thighs, and to the soles of the feet.  Warm clothing
 may generally be obtained from the bystanders.
  On the  restoration of life, when the power of swallow-
ing  has returned, a  teaspoonful  of warm water, small
quantities of wine, warm brandy and water, or coffee,
should be  given.  The patient should be kept in bed, and
a disposition to sleep encouraged.  During re-action, large
mustard plasters to the chest and below the shoulders, will
greatly relieve the distressed breathing.
  H. If from  Intense Cold—Rub the body with snow,
ice, or cold water.  Restore warmth by slow degrees.  In
these accidents it is highly  dangerous to apply heat too
soon.
  HI. If  from Intoxication—Lay the individual on his 
248
POISONING.
 side in a bed with his head raised.  The patient should bo
induced to vomit.   Stimulants should  be avoided.
  IV. If  from Apoplexy or Sun-stroke.—Cold should be
applied to the head, which should be kept well raised.
Tight  clothing should, be removed from the neck and
chest.
     APPEARANCES WHICH GENERALLY INDICATE DEATH.

  There is  no breathing or heart's action; the eye-lids
are generally half closed; the pupils dilated;  the jaws
clenched; the fingers semi-contracted ; the tongue appear-
ing between the teeth;  and the mouth and  nostrils are
covered with a  frothy mucus.   Coldness and  pallor of
surface increase.—Royal Humane  Society's Instructions.

                     POISONING.

  Occasionally persons are poisoned  accidentally or by
mistake, but  most frequently  it is taken  for the  pur-
pose of suicide.   Those who take  poison  are rarely  in
a condition to determine the most  efficient agent, or the
appropriate quantity to  destroy  life;  hence they either
take too much or too little;  and a large majority recover
to learn the folly of attempting to deprive themselves  of
life.  It may be  laid down as a general rule, that persons
who attempt to  commit suicide,  are laboring under tem-
porary insanity, and in many  cases it is proper to put
them under judicious restraint.
  Opium.—Opium is  resorted to for the  purpose of sui-
cide more frequently than any other  agent, and is most
commonly taken  in  the  form of  tincture — laudanum.
Fortunately, in many cases, that which is sold to the pub-
lic, is only from one-half to sometimes not more than the
one-tenth of its officinal strength—so  weak, in fact, that
what seems a large quantity, will  not produce death.
  The symptoms  of poisoning by opium,  or any of its
preparations,  are,  unnatural stupor  and  disposition  to 
POISONING.
249
 sleep, with a very marked  apathetic countenance.  The
 person does not like to be disturbed, and would rather die
 than live.  When they can not be aroused by shaking or
 dashing cold water in the face, there is danger, and espe-
 cially if the breathing is  stertorous or snoring.
   Treatment. — Uncover  the person's breast,  and  dash
 cold water on the  face, neck and breast, shaking them
 sturdily until they are partially aroused.   Now mix a tea-
 spoonful of ground mustard in half a tumblerful of tepid
 water, and force the person to swallow it, and repeat the
 dose every ten minutes until vomiting is induced; imme-
 diately place  the person on his feet, and with an  assistant
 under each arm, keep him constantly moving, giving an
 occasional  dash  of  cold water, if it seems  necessary.
 Keep the person constantly in  motion,  so as to prevent
 their  sleeping for six or  eight  hours, and he will be out
 of all danger.
  Arsenic—The next most frequent poison is  some of
 the preparations  of arsenic, most usually white  arsenic, or
 arsenious acid.   Nausea  and faintness are the first  symp-
 toms, to  which succeed a burning pain  in the stomach;
 obstinate vomiting, which, if it  does cease for a moment,
 is immediately excited by any kind of drink;  a sensation
 of dryness, heat  and tightness in the throat;  diarrhoea,
 accompanied  with straining;  bowels tense and  painful;
pulse  small,  quick and  feeble;  the  surface  cold and
clammy; delirium, convulsions, and death.
  Treatment.—In cases of  poisoning by arsenic, imme-
diately beat up two eggs and give the patient, and follow
with an  emetic  of mustard, if they are  not thrown up
without.   Send at once to the  nearest drug store for the
hydrated  sesqui-oxyd of iron, and give it  in tablespoonful
doses  every ten  or fifteen minutes.   If this can not be
obtained, take any rusty piece of iron, wash the rust off,
and give  the sufferer.  A niustard plaster may be applied
over the stomach, and extended  down over the bowels, if
there is much pain. 
250
POISONING.
  Mercury.—The bi-chloride of mercury, or corrosive sub-
limate, is the preparation most frequently used, and is one
of the most deadly of the metallic poisons.  It gives rise
to a harsh metallic taste; burning pain in  the stomach;
vomiting and purging, frequently  of bloody matter; irri-
tation of the urinary organs; tightness and burning in the
throat, occasionally  so  great as to prevent speech; ten-
dency to doze, stupor, convulsions, and death.
  Treatment. — In cases of poisoning by mercury,  albu-
minous  substances, as white of egg, milk,  a mixture of
wheat flour, etc., should be immediately and freely admin-
istered.   This does  not prevent,  but  only retards the
absorption  of the poison, and  consequently its constitu-
tional effects will be  liable  to be produced.   The  inflam-
mation, salivation, etc., will be  treated on general princi-
ples by a physician.
  Copper.—Poisoning by  copper is rare, yet occasionally
a case is met with where it is accidental, as  by getting
the verdigris off of old copper.   The symptoms are head-
ache,  cutting pain in the bowels, cramps in the legs and
thighs, the  pulse being small, quick and feeble.
  Treatment. — In poisoning by copper,  administer the
whites of eggs, and  evacuate the  stomach by  an emetic.
Afterward  the  treatment will be for the irritation cf the
stomach and bowels.
  Lead.—Lead is rarely taken as a poison, and if  it were,
the symptoms  and treatment  would  be similar to the
agents above named.   Most  usually, lead poisoning is
chronic and accidental, as by taking water, food or liquors
impregnated with lead, and in persons working in the
metal, as painters, plumbers, white lead manufacturers, etc.
  The symptoms of chronic lead  poisoning are, loss of
appetite and power  of digestion;  constipation, the stools
being light-colored, small and  hard; lead colic;  want of
power over the  voluntary muscles, especially manifested
by  dropping of the wrists, and a peculiar  bluish, leaden
line on the margin of the gums. 
POISONING.
251
   Treatment.—Remove the person  from the influence of
 the lead poison.  Then give iodide  of potassium in doses
 of three grains, four times a day, keeping the bowels open
 with some mild cathartic.
   Strychnia.—This agent is frequently used for the pur-
 pose of suicide, and  is very  prompt  and  certain in  its
 action.  The first symptoms are a feeling of weight and
 weakness in the limbs, with  unnatural rigidity or slight
 spasms, when motion is attempted.  When its  effects are
 fully  developed, there  is  frequently  recurring   tetanic
 spasms, the entire body  being convulsed, and the  person
 suffering  intense pain.   These continue to increase  in
 frequency and  intensity, until it would seem impossible
 for the sufferer to live, and finally death ends his misery.
   Treatment.—Give the sufferer freely of any  fatty mat-
 ter, sweet oil, lard,  lard oil, etc., a pint at a time,  having
 it ejected each time by passing the finger down the  throat.
 After repeating this two or three times, give equal parts
 of tincture of camphor and  gelseminum, in teaspoonful
 doses every half hour.
  Prussic  Acid.—Prussic acid is a most deadly poison.
 The symptoms are, an extremely bitter, unpleasant taste in
 the mouth; a  sensation of faintness  and giddiness, suc-
 ceeded  by convulsions and insensibility.  Its influence is
 very rapid, and its effects soon pass off, so that the  person
 will either die, or recover within the hour.
  Treatment.—There is no antidote to  this poison, but the
treatment should be that recommended for the recovery
of persons drowned.  Let a physician be immediately sent
for, who will adopt the necessary treatment, if it is taken
in too small quantity to prove fatal.
  Belladonna,   Stramonium, Hyosciamus. — The  symp-
toms of poisoning by these agents is  very nearly alike.
There is dryness of  the throat and fauces, dilatation of
the pupil and insensibility to light, delirium, stupor, coma
 and death.
  Treatment.—Give  at once the mustard emetic until free 
252
sun-stroke.
vomiting  is produced, then  give  a decoction of  young
Hyson tea freely.
  Rhus—(Poison Vine).—Persons are frequently poisoned
by coming in contact with the different varieties of poison
vine, and not unfrequently the symptoms are  very severe,
and in some cases dangerous.  Usually a crop of pustules
make their  appearance upon the part exposed, it being
also  swollen, inflamed  and painful.  They may be very
persistent, coming out in successive crops for  eight or ten
days; or,  in rarer  cases, a severe  erysipelas  results, and
the case becomes one of danger.
  Treatment.—Take the bark of the  common elder, boil
it in buttermilk and apply the  decoction to  the part
affected.   If this can not be  obtained, use equal parts of
tincture of camphor and milk, or equal parts of lime-
water and linseed oil.  Bi-carbonate of soda, or common
washing  soda, is one of the best remedies that  can be
used.  Add  sufficient water  to it to  form a paste,  and
apply thoroughly once or twice a day to the part poisoned.
It will usually kill it in from two to four days.

                   SUN-STROKE.
  Coup de soliel, or sun-stroke, is usually caused by pro-
longed exposure to the direct rays of the sun, but in some
cases exposure for a very short time  will cause k.  The
first  symptoms are a feeling of weight and tension  in the
head, with intolerable heat of the  surface and  dizziness.
Very soon the patient feels unable to command his limbs,
and sinks down in a state of more  or less complete uncon-
sciousness.
  To prevent sun-stroke, wear a hat that permits the air
to pass through, and have the top lined with one thickness
of flannel, or  keep a silk pocket handkerchief  in the
crown.   Persons who feel the . symptoms above  named
should immediately get in the shade, and bathe the head
in cold water; exposure to the sun  on  the same day would
in most cases be very imprudent. 
apoplexy.                   253
   Treatment.—When a person is sun-struck, have him
 immediately conveyed to the shade, in a cool place, where
 there is  free circulation of air.  Bathe the head freely
 with cold water, and if the extremities are cold rub them
 warm with the hand  or  dry mustard.   As soon as he is
 able to swallow, give internally tincture  of camphor, or
 other stimulus  in small  quantity.   If he is unconscious
 and breathes with difficulty, pursue the plan recommended
 for restoring the apparently  dead.

                    APOPLEXY.

   Apoplexy is caused by sudden congestion of the brain,
 or rupture of some of the small blood vessels and forma-
 tion of a clot within it.   In  all cases there is compression
 of the structure  of the brain, and  sudden arrest of its
 function.  In many cases the person has no warning of
 the attack; in  others he has  a feeling of dizziness and
 partial loss of consciousness and command over the vol-
 untary muscles, which continues but a  few minutes, and
 recurs at intervals for several days.
   When the  attack comes  on he loses  his consciousness
 suddenly, and  falls  down in any place where  he may be
 situated.   The breathing is slow, labored and snoring, the
 pulse full, slow and oppressed, the body  remaining in one
 position without convulsive movement.
  Treatment.—Let the person be immediately placed  in
a comfortable position on  his back, with his  head and
shoulders elevated.  Bathe the head with cold water, and
have the lower extremities  rubbed with mustard, be-
ing careful that the by-standers do  not crowd round so  as
to obstruct  circulation of air. Apply  a  large  mustard
plaster to the  stomach, and if it is a  bad case, use an
injection of a teaspoonful of ground mustard, one of salt,
and one of lard to a pint of water.   Give nothing inter-
nally, but send immediately  for a physician.
  Persons predisposed to apoplexy should  live very tern- 
254
BRUISES.—CUTS.
perately, avoiding rich, stimulating food, and all kinds of
liquors;  The cold bath with rubbing should be used two
or three times a week, and exercise taken in the open air.
As excessive mental exercise predisposes to the disease in
some cases, it is well to keep the mind as free from excite-
ment as possible.

           CONCUSSION OF THE BRAIN.

  Persons falling from a distance may suffer from concus-
sion of the brain, especially if they fall upon the head,
and the same effects  may result  from severe blows upon
the head.   The symptoms are entire loss of consciousness,
slow  and difficult breathing, and slow, oppressed  pulse.
The management  of such a case would  be the same as in
apoplexy, sending immediately for a physician.

                      BRUISES.

  When a part is struck and  injured, the vitality of the
tissues are  impaired, and blood is exuded from the vessels
into the tissues.   Purplish  discoloration results, and the
part is said to be bruised.
  Treatment.—The most efficient treatment in these cases
is the application  of the tincture of arnica, diluted with
-from one to four  parts of water.  It should be applied
with cotton cloths, and the part kept continually wet.  If
you cannot get this agent, use tincture of camphor in the
same way, or even tolerably strong salt water.  The appli-
cation of a poultice  of Solomon's seal will speedily re-
move the discoloration of a "black eye."


                        CUTS.

   When a part is  cut, the first thing that  causes alarm to
 the person and by-standers is the flow of blood.   Every
 person seems to be fearful of blood, and but a small loss 
cuts.                     255
occasions alarm.  If there is but oozing of dark colored
blood, no matter if there seems to be a large quantity lost,
there is no danger, and the bleeding will stop of itself.  If
the blood is dark colored and flows in a constant stream,
a vein is injured, and compression should be made upon
that side of the wound farthest from the heart.  If, how-
ever, the blood flows in jets and is bright colored, an artery
is wounded, and if the stream  is of considerable size, the
person is in danger, and the flow of blood should  imme-
diately be stopped by compression.
  By refering  to Fig. 3 descriptive of the blood vessels,
the course of all the arteries may be traced.  Now, if you
have leisure, follow the course of all these vessels on your
own body, as  you can tell the situation of an artery by
its pulsation.   In a very short time you will have learned
the situation of every important artery in the body, and
this  knowledge, in time, may be the means of saving
your own or some other person's life.   Arteries when cut,
bleed from that end next the heart, and all you have to do
to  arrest the hemorrhage is to apply pressure to the artery
on that side.  For a temporary purpose, apply your thumb
above the wound, making pressure  toward the bone;  the
arrest of the flow of blood will  tell you  when you have
it  over the  artery.  Now  have  a bystander get you  a
block of wood, or a pebble an inch  in diameter, and place
it immediately where  you have your thumb, pass a hand-
kerchief around the limb  over it, and  twist sufficiently
tight to check the flow of blood.
  Unless a large trunk is cut, which is  not common, the
flow of blood soon ceases, and the wound may be dressed.
If  gaping, take a  common stout needle, thread it with
silk, and pass it through first one and then the other edge
of the  wound, tieing it sufficiently tight to bring the edges
together; this is called a suture,  and as many  of  them
may be taken as necessary.  Now take common  adhesive
plaster, cut it in strips half an inch wide, and heating
them over a candle or tin vessel of  hot water bring them 
256
BURNS—DISLOCATIONS.
 over the  wound cross-wise, so as to bring it perfectly to-
 gether.  If the  wound does not gap much, the adhesive
 plaster will answer without the stitches.  No other appli-
 cation is necessary, unless the  part  becomes swollen and
 painful, when cold water should be applied to it.

                       BURNS.
  Burns are the same, whether  produced by a hot solid,
 or by hot fluids.  They vary in character according to the
 length of time the body is exposed to their influence, and
 the extent of surface involved.   If one-seventh of the en-
 tire surface of the body is  scalded so as to destroy the  skin,
 it is claimed by some authorities that the patient will not
 recover; some persons, however, will  get well if even a
 much greater surface is burned.
  Treatment.—When a person is burned or scalded, im-
 mediately wrap the part up in cloths wrung out of com-
 mon cider vinegar, keeping them continually wet,  or if it
 can be obtained, the fire extractor of our  dispensatory may
 be applied.  The old-fashioned remedy  was equal parts of
 lime-water and linseed oil, and a very good remedy it was
 in many cases.   Some direct that the parts should be im-
 mediately covered  with flour, others prefer slippery  elm;
 both of these are objectionable, as they stick to the burned
 part, and can with difficulty be removed if any  other ap-
plication has to be resorted to.   It  is very  important, if
 a limb  or the neck is burned, that it be kept straight during
the process of healing, as contraction of the cicatrix is
very likely to occur, producing  serious deformity.

                  DISL O CA TIONS.

  By a dislocation we understand  the  forcible separation
 of the bones at their point of articulation, the  extremities
 of the bone being thrown out of joint.  It is usually the
 result of falls or blows, and is manifested by pain, deform- 
DISLOCATIONS.                 257
 ity of the joint, and imperfect motion.  Any person who
 will carefully examine the same joint upon  the  opposite
 side of the body will be able to determine the character of
 the injury.  We determine it from a fracture by  carefully
 pressing the fingers against each bone that enters into the
 joint from one end to another; this  can be  done, as the
 muscles yield to pressure;  and in almost all cases the ex-
 tremities of the bones can be felt in an unnatural  position.
   The  most  frequent  points of  dislocation  are  the
 shoulder, wrist, hip, ankle, in the order in which  they are
 named.   In dislocation of the shoulder the  arm can be
 moved forward and backward,  and to a limited extent,
 elevated, and the  hand contracted  without pain.   But on
 elevating  the  limb it  becomes  painful,  and before  it is
 brought to a right angle  with the body its movement is
 arrested.   As  will  be seen by the cut, dislocation of the
 wrist produces marked deformity, and  the  ends of the
 bones can be readily felt.   The hand may be thrown
 either forward or backward.   Dislocation of the hip most
 generally gives rise to shortening of the limb, as  seen in
 Fig. 32, though in some cases the head of the bone being
 thrown  downward, the limb is elongated.  Dislocation of
 the ankle is almost always accompanied by fracture of the
 outer bone of the leg, fibula, and presents the appearance
 seen in Fig. 30.
  Treatment.—If it is possible, obtain  a good physician
 as soon as you can, in the meantime if the joint swells
 and  is painful, keep it perfectly still and apply cloths
wrung out of cold water.  If a physician or surgeon  can
not be obtained, make up your mind to set the limb you r-
self,  observing the following rules.
  In case of dislocation of  the lower jaw, the injury will
be so apparent that it can  not be mistaken.   The mouth
is wide open, and it is impossible to shut it.  Place two
fingers of  each hand in the mouth upon the molar teeth,
 and the thumbs  against the under surface of the chin,
 draw the bone  downward  with  the fingers  pressing  the
      17 
258
dislocations.
   Fig.  28.
Dislocation of the Lower Jaw.
Fig.  29.
Fig. 30.
Dislocation of Shoulder.
Dislocation of Ankle. 
DISLOCATIONS.
259
chin upward with«the thumbs, and press it backward; it
will go into position with a very marked snap.
  In case of the shoulder, let the person  he down upon
the floor;  take your boot off  of that foot that corresponds
to the injured limb; sit down by the  side of the sufferer,
and put the heel of your foot in his  armpit; now grasp
his hand, and make steady, slow but powerful traction on

                       Fig. 31.
Reduction of Dislocations of Shoulder.
the arm, and in nine cases out of ten you will be gratified
by hearing the bone return to its place with a  perceptible
snap.
                       Fig. 32.
  The wrist can usually be set with but little difficulty, all'
that is necessary being to make continuous traction until
it goes into place. 
260
FRACTURES.
Fig. 33.
  The hip is not so easily set, as
it  requires  the  manipulation of
a skilled surgeon,  and  I  should
not  advise  it to be undertaken
if  it is  possible to obtain  the
necessary assistance.  If this can-
not  be  obtained,  recollect  that
continuous, powerful traction  will
draw  the bone out  of its  false
position,  and if you  know  its
true one, you can press  the  head
into the socket.
FRACTURES.
                         Bones  are broken by falls or
                       blows,  either  transversely across,
                       obliquely, or into several pieces-
  Dislocation of Hip.       comminuted.   The  injury is at-
 tended by more or less acute pain in the part,  especially
 when it is moved, shortening of the limb, and in a major-
 ity of cases by almost entire loss of motion.  If now the
 fingers are carefully pressed  along the bone, the seat of
 fracture will be detected, and the sharp extremities of the
 bone felt.  In  very  severe  and bad  cases, one or both
 broken extremities are driven through the flesh and skin.
   Treatment.—Place the sufferer in an easy position, and
 the broken limb on a pillow in  as comfortable a position
 as possible—which will almost always be to lay it straight
 —and send  for a surgeon.  If the person has to be moved
 any distance, it  is well to apply two straight pieces of
, board on each  side of  the limb, straightening it out to its
 full length if possible, and tying them fast with strips of
 muslin two inches wide.
   If  a surgeon can not be obtained  soon,  say during the 
HERNIA.
261
same day, adopt the following plans:  If the injury is of
the lower extremity, and when  the  bones are set, they
immediately draw-  back,  place the patient on a single  bed
or lounge, and elevate its foot,  say eight or ten inches;
now attach a bandage  three inches wide to the foot  and
ankle, so that it will hold it without  making too great
pressure, and firmly fasten it to the foot of the bed;  put
a pillow under the  limb, and the work is done.  The
inclination of the bed  being such that  the patient  will
elide toward the  head of the bed, and the ankle  being
fastened to its foot, the leg will be drawn out and set itself.
  The same plan may be adopted with the  arm, but in a
majority of cases, if it is drawn out to its full length,  and
two straight boards or splints applied, the  bones will be
retained in position until the surgeon can give it a proper
dressing.

                      HERNIA.

  Hernia, or rupture, is the  escape of a portion  of  the
intestine  through  the  abdominal walls.   This  usually


                       Fig. 34.
Inguinal Hernia. 
262                  HEMORRHOIDS.
occurs at two points—first, at the inguinal canal just above
the groin, as  seen in Fig. 34.   This is most frequent  in
males.  Second,  at  and just  below the groin.   This  is
most frequent in females.  Rupture is most usually caused
by heavy lifting, straining, or  injuries, though some per-
sons seem to be naturally predisposed to it, the abdominal
walls being weak at these points.
  Hernia is  usually recognized with ease—the passage of
the intestine causing a feeling  of pain or weakness, and a
peculiar puffy swelling  is observed  at the spot.   When-
ever a rupture is discovered, it should be  carefully put
back by pressure, and a  bandage and compress worn until
a properly adjusted  truss can be procured, which should
be worn constantly, putting it on  in the morning before
getting up, and taking it off on going to bed.
  Sometimes the intestine  comes down, and the sufferer
can not return it, and it  is then called strangulated hernia.
In this case let him lie down upon his back, and for half
an  hour apply warm applications;  now  let pressure  be
made upon the tumor, gradually working  it back a part
at a time.  It is best  to  send for a physician immediately
on finding that the intestine  can  not be returned by the
usual means.  If the case is likely to be a difficult one, it
will be better to apply a fomentation of tobacco leaves for
half an hour before the  physician is expected, to produce
relaxation.

                  HEMORRHOIDS.

  Hemorrhoids, or piles, is a very  unpleasant  affection,
sometimes giving rise to such suffering and inconvenience,
that life is rendered a  burthen.  They are divided into
two varieties, internal and external—the one being within
the  rectum,  and  covered  with mucous  membrane, the
other being outside  and covered with the skin.   Internal
piles, when large, come dowrn when the patient goes to
stool, and have to be returned after the evacuation of the 
FISTULA IN ANO.
263
 bowels.  They also bleed very frequently, and are some-
 times called bleeding piles.
  Both internal and external piles result from enlarge-
 ment of the veins of the rectum, winch, as we have here-
 tofore seen, form part of the  portal circulation, the blood
 passing through the liver on its way back to the heart.
 Any  cause tending to induce congestion of these veins,
 will give rise to the disease.   At first the pile-tumors are
 soft, and vary in size, at times being large, and then pass-
 ing nearly entirely away, but  at last they become more or
 less solid and are permanent.
  Treatment.—In the early  stages of the  disease, it  is
 amenable to  medicinal means, but when  it has continued
 for years, the better plan is to have the piles removed by
 an operation.  As the first and most important  part of
 the treatment, the bowels should be kept regular, moving
 every day.   If this is not attended to, it is useless to do
 any  thing  else.  The Butternut Extract, No. 13, will be
 found a very  good remedy for this purpose, and it may be
 aided, if necessary, by the Podophyllin Pill, No. 12.  As
 small a quantity of these should be used as will answer
 the purpose, and the dose should be lessened each day
 until the bowels act without  medicine.  As a local appli-
 cation, I would strongly recommend lavements, and small
 injections of ice-cold water.  Or, take tannin, one drachm;
 lard, one ounce; mix to form an ointment, and apply to
the tumors  two or three times a day.
  A permanent cure, even in  bad cases, can sometimes be
accomplished without an operation, as I have seen  numer-
ous  times in my practice.   If not,  the removal of the
tumors is neither very painful nor difficult in competent
hands.

                FISTULA  IN ANO.

  Fistula of the anus is always the result of a small abscess
 or boil near the rectum.  This being improperly treated,
 the matter burrows in various directions, finally opening, 
264
CHRONIC DISEASE  OF  THE BONES.
in many cases, both externally and into the bowel, form-
ing a false  passage  for the escape of its  contents.   The
walls of  the fistula become  hardened and callous,  and
constantly  discharge matter,  there being  no tendency to
heal up.   It is a very loathsome  and annoying  disease,
often severely affecting the general health.  No domestic
treatment will do any good—apply to a skillful surgeon,
who prefers the ligature to the knife, and a cure can be
effected in a short period.

       CHRONIC DISEASE OF THE BONES.

  Diseases of the bones are among the slowest and most
stubborn that we have  to contend  with.   Sometimes the
shaft of a long bone is the seat of the disease; at others
the extremities of the bones, and consequently the joints
are implicated.  The commencement of  disease of the
bone may  be  known usually by  its slow progress, the
deep-seated pain, and the attachment of the swelling to
the bone.   In the case of the joints, slight  swelling, weak-
ness, and  pain  in certain movements, are the symptoms.
Do not regard  these symptoms lightly, but as they con-
tinue longer than  any  common affection, consult some
competent authority, and pursue a  regular course of treat-
ment.   All domestic remedies must  do harm,  as they
waste time, and not unfrequently aggravate the disease.
  Very many  cases of  stubborn  disease  of  the bones,
attended with  fistulous  openings, and  continuous  dis-
charge, are relieved by removing the dead bone that acts
as a constant  irritant.   The prospects  of  cure  in  all
cases,  are sufficient to induce  the consultation of good
surgical authority. 
Diseased Bone.
M

P




QO
Section of bone showing enlargement, the result of inflammation.
l-H

&


co
CO
Inflammatory disease of the shaft of the femur.
bo
as 
TUMORS.
Fig. 39.
     Extremity of diseased bones, showing the projecting spicula.

                       TUMORS.

  Tumors may form in any part of the body, either inter-
nally or externally.  There are  very many  varieties, but
they may be  divided into two prominent classes, the
benign and the malignant.   The first, though  it may attain
a very large size, is  not destructive  to  life,  further than
from its great size, and the injurious pressure of it upon
other organs or parts.   The second seems to have an inde-
pendent vitality, and fastening itself upon the body, it not
only appropriates the nutritive materials  of the tissues,
but it destroys those with which it comes in  contact, until
finally death results.

                        Fig. 40.
Tumor of bone.
• 
CANCER.
267
   A  benign tumor may consist entirely of fibrous tissue,
 or of an outer wall of this, and contain  a watery or fatty'
 material, or it may be formed of numerous sacks contain-
 ing fluid.  Its growth may be  rapid  or slow, but it does
 not give rise to  any pain  or uneasiness, except that pro-
 duced by pressure upon the skin  or internal parts, unless
 when developed within  or in connection with  internal
 organs.  I have removed many of them that only became
 troublesome when they had become very large.  The only
 sure  plan  of treatment is their removal with the knife,
 an operation attended with but very little if any danger.

                      CANCER.

   Cancer is the most fearful disease to which humanity is
 subject, as  its  commencement  and progress are so insid-
 ious as to cause but little alarm, until, when his attention
 is strongly drawn to it, most physicians regard his doom
 as sealed.   Three forms  of the  disease may  be  distin-
 guished—first, that which is at first confined to the skin,
 though at length extending deeper,  lupus; second, that
 which  commences as a  slow, hard, nodulated tumor,
 gradually embracing  adjacent  tissues, schirrus; and third,
 that which grows  rapidly, is somewhat  soft and  fluctua-
 ting,  and passes  rapidly  to a fatal termination, fungus
 hematodes.   Their  mlignancy is in  the  order in which I
 have  named them, the lupus least, and the fungus hema-
 todes the most virulent.
   Lupus, or cancer of the skin, commences sometimes by
 a  slight  itching sensation of the  skin, as  if a  fly was on
 it, and frequently  the hand will be raised up to brush it
 off.  If closely examined now, it will be found but slightly
 discolored and roughened.  But after  a few  months a
small  sore  is formed, which is continually forming and
throwing off a scab, the skin gradually becoming thick-
ened,  and the  ulcer increasing  in depth, until the fully
formed disease is developed. At  other times it will com- 
268
CANCER.
mence as a small wart, which becomes irritable, is picked
off, grows again, and at last exhibits its malignancy.
  Schirrus usually commences as a small, hard tumor, situ-
ated immediately beneath the skin.   It is movable under
the skin, and gives rise to but little unusual sensation, ex-
cept that of stinging or pricking of the part.  It is the last-
named feature that calls attention to it, but as it is so small,
and occasions no inconvenience, it is not deemed necessary
to say any thing about it.  But it keeps growing, some-
times slow, at others pretty fast.  It becomes nodulated
or rough ; forms an attachment to the skin, and to parts
beneath; is now quite large, the skin ulcerates, and a foul
sore is the result.  Now the adjacent lymphatic glands
become enlarged, and the system becoming contaminated,
there is no earthly help for the sufferer.
  Fungus hematodes commences  as a tumor under the skin,
but it seems to have an attachment  below.   It  grows
rapidly, soon forms an attachment to the skin,  and in
some cases obtains an enormous  size before it ulcerates.
At other times ulceration  occurs early, and a  large gran-
ular mass grows from the  surface.
  Treatment.—The treatment  of cancer, if  it is  to be
successful, must be commenced at an early period.   "While
the disease is entirely local, the  adjacent glands not being
affected, nor the skin much implicated, a cure is almost
certain if proper treatment is adopted;  but if it is allowed
to progress until the lymphatics are involved, and the sys-
tem impregnated with  the cancerous poison, there is no
known means of curing even a single case.  If, then, you
have a suspicious growth, have it examined by a physician
competent to determine  its character, and have it imme-
diately removed.
  Various plans of treatment have been adopted, and
they may be resolved into the  removal  of the cancerous
mass with the knife, or its extirpation with caustic.  The
knife has been brought into disrepute by the way in which
it has been employed.   As we use it, we remove  tho 
CARBUNCLE.
269
growth and the skin covering it, and then, by the use of
remedies, keep up  suppuration from the wound until the
last vestige of morbid growth is extirpated.  If  caustics
are employed, they must be so used  as  to  destroy the
entire  growth at once, for if they do not, they set up
inflammatory action, and the cancer grows  more rapidly
than if nothing had been done for it.  Some cases can  be
removed by a painless  application,  though  it,  as most
other-means, is most successful with  those who have had
large experience in the treatment of this disease. Beware of
quacks and cancer doctors, and  trust rather your family
adviser, or some physician who does a legitimate business,
than one you do not know, and  who possibly has no fur-
ther interest than to obtain your money.

                    CARBUNCLE.

   A carbuncle is a malignant boil, and manifests but little
tendency to natural recovery.   It commences as  a small,
hard,  and  painful swelling of the skin, similar to a boil,
though much more irritable.   It enlarges slowly,  but,
contrary to the expectation of the  sufferer, it does not
suppurate.   In four or five days  it  will have obtained
considerable  size; it looks red and angry, is intensely
painful, and presents two or three yellowish spots on  its
top that indicate matter.  If these are punctured, but a
drop or two exudes.  As it progresses it involves the adja-
cent skin, and more of these yellowish spots are seen, and
on examination they are found to be the external orifices
of canals which pass through the mass in all directions.
Continuing further, portions of tissue die and are thrown
off, until at the end of the  second or third week,  the car-
buncle has attained the size of a hen's egg, or  a  small
saucer, with a central, foul, sloughing ulcer.
   Treatment.—There are  but two ways  of treating car-
buncles successfully—they must either be freely incised to
their base  in two  or three directions, or they must be 
270
BOILS.
burned out with caustic.  Both  operations  are  painful.
In the first, the surgeon takes a sharp knife and passes it
through the  tumor from side to side,  dividing it to its
base, and again in the same manner from above down-
ward.   I much prefer the use of the caustic.  Take  of
sesqui-carbonate of potash, or if this can not be obtained,
carbonate of potash, a sufficient quantity; pour a sufficient
quantity of water on  it to dissolve it, and, wTith a small
glass syringe, inject it  into every  external opening.. The
pain is intense at first, but in a  short time  it is  almost
entirely  relieved.  This should be  repeated  once a day
until the growth of the  carbuncle is arrested, drawing it
in the meantime with any simple  ointment.   After this it
will heal kindly.

                       BOILS.
  A boil is an inflammation of the skin, and is commonly
supposed, but without  any very good grounds, to indicate
impurity  of  the blood.   They  commence  as a  small,
round,  painful tumor  in  the skin, which day by day
increases in size and impairs  the  movements of adjacent
parts.   Usually, by' the  sixth or eighth day, the pain
becomes tensive and throbbing, indicating the presence of
pus or  matter, and in  two or  three days more they break
and  discharge their  contents, when the part  heals up.
They vary much in size, sometimes being small,  and of
very little consequence, but  at  others  they are  large,
numerous, and very painful.
  Treatment.—In a majority of cases all the  treatment
that is necessary, is, to poultice them  with slippery elm,
and  when matter has formed, have them  opened.  If
they still  remain painful, and will not heal, use the injec-
tion named under the head  of  Carbuncle.  Sometimes
they may be driven back by painting the skin with strong
tincture of iodine. If a  person  is continuously troubled
with them, an alterative will be useful, as No. 61, 62, or
63;  or he may take  a tablespoonful of lime-water in a 
FELON.
271
 glass of milk three times a day, which is said to be a cer-
 tain means of arresting them.


                       FELON.

   A  felon is a deep-seated  inflammation of the fibrous
 tissues covering the  bones of the fingers   It is generally
 supposed to  arise from  a bruise or injury, but in many
 cases no such cause has been noticed.  The first symptoms
 are a feeling of deep-seated  pain and  soreness, and ten-
 derness on pressure.  This  increasing, the part becomes
 very tender and swollen, and in two or three days is  so
 painful that it  can not be used.  The pain of a felon  is,
 in many cases,  extreme, so much so that the sufferer can
 get rest neither day or night.   Suppuration occurs in from
 four to ten days', but as the tissues are so dense,  it requires
 a considerable length of time for the pus to reach the sur-
 face.
   In some cases, especially if improperly treated, the bone
 becomes affected, and passes away in small pieces with
 the matter, the finger being a most unpleasant  looking
 sight.
   Treatment.—At the commencement of the  disease, it
 may be arrested in many cases.  Take of common yellow
 clay,  finely powdered, a sufficient  quantity to  make a
 poultice for the finger half an inch thick; wet it with
 vinegar until it is about the consistence of brick or pot-
 ter's clay; now put it  around the  affected finger, and  tie
 it  on with a strong bandage of cotton cloth.  When it
 dries it  will form a strong case for  the finger, which will
 prevent swelling.  It will be quite  painful for the first
 day, but after that the pain will gradually cease, and  in
three or four  days the finger will be well.  The  applica-
tion should not be removed until all the pain and soreness
has disappeared.
  If too late  for this, apply  a poultice of slippery elm,
 bread and milk, or flaxseed, until pus is formed, then have 
272
ULCERS.
it opened.  Wool  soaked in lard is a good  application to
cause it  to suppurate, though it is  very painful.   If the
felon has been a bad one, have it injected with the potash
solution named under the head of carbuncle.
                      ULCERS.

  An ulcer  is an open  sore in the skin  of variable size,
and with but little tendency to get well without assistance.
They are  sometimes the  result of injury of the part; at
others, they are  caused by varicose  veins, and at  others
they  are  produced by a scrofulous, mercurial or  other
cachectic condition of the system.  They may be divided
into three kinds: the irritable ulcer, which is  painful and
very annoying; the corroding or eating ulcer, which man-
ifests  a continued  tendency to enlarge;  and the indolent
ulcer, the  name expressing its general character.
Fig. 41.
Application of Bandage.
   Treatment.—An  ulcer  in its
early stage, if on one of the ex-
tremities, may almost always be
healed by the application of cold
water, and the careful use of the
bandage,  see Fig. 41.  Apply to
your physician and let him instruct
you  how  to apply the roller pro-
perly, for if not used  so as to pro-
duce equal pressure, it is rather a
detriment than a benefit.  In some
cases the ointments Nos. 90 and 91,
answer an excellent  purpose, and
will sometimes heal the ulcer, with-
out the use of the bandage.  If
the person is of a scrofulous or
cachectic  habit,   an  appropriate
general treatment should be adopt-
ed to remove this condition and re-
store the general health. 
                 PART    V.

      DISEASES AND THEIR TREATMENT.


                     DISEASE.

  Disease we define to  be any change from the normal
structure or function of any part, or of the entire system.
If the  disease embraces the entire body, we say that it is
a general disease, but if confined to any organ or part, we
call it  a local disease.  Disease always involves a change
of structure, either in the fluids or solids, even in those
rare cases in which it originates in, and seems to be con-
fined to, the nervous system.
  Before considering local and general disease, it will be
well to take a glance at  the  forces which act upon the
materials of which the body is composed, producing  all
the varied actions of the system  both in health and disease.
In the  human body, as well as in  all living organisms, we
recognize two separate and distinct forces, which are an-
tagonistic to each other; these are the vital, and the chem-
ical forces.
  The  vital force is that power which from  the single
cell builds up the entire organism; separates from the nu-
tritient materials  furnished it, those portions which  form
the different organs of secretion, excretion, and innerva-
tion ; supplies the waste of the  tissues, and tends to  keep
the body intact.
  But  in the chemical  force, we recognize the cause of
the waste  of the  body, the disintegration of the tissues,
the change of matter from a higher to a lower grade of
organization, and  all the  retrograde  tendencies in the
body—from a state of health to disease and death.
          18 
274
GENERAL disease.
  Health then consists in  the maintenance of the propel
equilibrium between the vital  force  which builds up the
system, and the chemical force which causes disorganiza-
tion.  Life itself is  a  forced  state of being caused by a
preponderance  of vital force; every atom of the body
having a constant  tendency to revert back to its original
elements.   This change taking place  in  the entire body,
produces death;  in but a portion  of the body, it produces
disease.

                GENERAL DISEASE.

  There can be  no doubt that the seat of general disease
is in the fluids of the body, and that all the phenomena
that is manifested by it, grow out of changes which are
primarily produced in the blood.  This  will  be more ap-
parent when we reflect that it furnishes nutritive material
to all parts and tissues, and that its  stimulation is neces-
sary to the performance of all the functions of the body.
No other  part  of the organism can be compared to the
blood, in respect to the feeble influence it offers to external
influences.  " The blood," says Liebig, " is  not an organ
which is formed, but an organ in process of formation; in-
deed it is the  sum of all the organs which are being
formed.  The  chemical  force and  vital principle hold
each other in such perfect equilibrium, that every disturb-
ance, however trifling,  or from whatever cause it may pro-
ceed, effects a change in the blood.   This liquid possesses
so little permanence, that it can  not  be removed from the
body without immediately suffering a change, and can not
come in  contact  with any organ in the body  without
yielding to its attraction.
  " The slightest  action  of a chemical agent upon  the
blood exercises an injurious influence; even the momen-
tary contact  of the air  in the  lungs, although effected
through the medium of cells and membranes, alters the
color and  qualities of the blood.  Eveiy chemical action
propagates itself through the mass  of the blood; for ex- 
GENERAL DISEASE.
275
 ample, the  active chemical condition of a body undergo-
 ing  decomposition,  fermentation, putrefaction  or decay,
 disturbs the equilibrium between the chemical force  and
 the  vital principle  in the  circulating  fluid.  Numerous
 modifications in the composition  and conditions of the
 compounds produced from the elements of the blood, re-
 sult from the conflict of the vital force  with the chemical
 affinity,  in  their incessant  endeavor  to  overcome  one
 another."
   Diseases of the blood may consist either in an excess or
 defect in  the normal  constituents  of that fluid, in a
 change in the composition of some of its  elements, or in
 the presence of a morbid matter, either generated within
 the system or introduced from without.
   Excess of the normal constituents of the blood is rarely
 a  cause of disease, without, indeed, we  should consider
 the increased quantity of fibrine in inflammatory diseases
 an instance of this kind; or the constituents  of the urine,
 urea,  uric  acid, etc., as elements  always  found in the
 blood.
   Defect of some of the  constituents  of this fluid is of
 common occurrence; thus we may have a defect in the
 quantity or quality of the red globules, the  albumen, fib-
 rine or the salts.  A defect either in the quantity or quality
 of either of these materials is disease, and being located in
 the fluid that  furnishes nutritive material for the entire
 system, the  entire system suffers in proportion to the im-
 portance of the constituent  affected, and the  change in
 quantity or  quality that it has undergone.
  The presence of a morbid  material in the  blood is the
most  frequent  cause of  general disease.  This morbid
material  may be either generated within  the body,  and
retained, or it may be introduced into the circulation from
without.   What are we to understand by the term morbid
material? We may define it to be any substance of a
lower decree of organization than  the  blood—an organ-
ized body which has already begun to decay, such  a body 
276
FEVER.
as we know will  act like yeast in the blood, effecting  a
similar destruction in every particle of it that has not suf-
ficient vitality to resist the change.

                       FEVER.

  Fever is a disease characterized  by a rapid circulation
of blood, increased heat of the surface, arrest of the secre-
tions, and an irritable condition of  the nervous system.
  Authors have divided it into two principal classes, idio-
pathic and symptomatic fever.   In the first, there is no local
disease at its commencement, all parts of the body suffer-
ing alike;  therefore, it must be  a disease of the blood and
the nervous system, as these only are generally distributed
through  the body.  The second is preceded  by infiamma'
tion  of some part, the  inflammation being  the  cause of
the fever, as will be hereafter described.
  Causes op Fever.—1. It may be induced by  a sudden
shock  of the nervous  system, as  is  sometimes witnessed
from the depressing emotions, fear, grief, etc., and in some
few other cases from great excitation.  In these  instances
the nervous system is  exhausted, and consequently there
is a feeble circulation of  blood, and  imperfect excretion,
effete material being retained within the blood.  During
epidemics it has long been noticed that those who suffered
from fear or mental excitement, were very likely to have
the disease.  2.  Suppression  of the  excretions is a very
frequent cause of fever.   As we have  already  seen, the
excretions are composed  of the worn out tissues of the
body, and in all cases  are poisonous to it.  Now if such
material as is removed  by the skin, the kidneys or bowels,
is retained in the blood by arrest  of secretion, disease
must result, and  new processes must  be set on foot to
remove  the offending material.  3. Causes inducing con-
gestion  or a sluggish circulation  of blood, will cause
fever.  In order to retain its vital properties, it is neces-
 sary that it continues in active circulation.  If it stops but 
FEVER.
277
 a short length of time in any organ or part, it loses its life
 to a considerable extent, and becomes effete material.  4.
 Morbid material introduced into the  blood from without,
 as  gaseous exhalations from decomposing animal or veg-
 etable material, which gains entrance into the circulation
 through the lungs; or decomposing animal matter, which
 may be  absorbed from the skin, mucous  membranes, etc.
  A very good example of the action of a blood poison,
 is afforded us  by inoculation with small-pox  virus.  The
 smallest quantity of virus, if placed where it can be read-
 ily taken into the blood, is as potent  as a larger one. At
 first, there is no disturbance of the system, the quantity of
 the poison being too small.   But it increases day by day,
 and in time a gradually increasing depression, manifested
 by  listlessness, languor,  loss of appetite, morbid innerva-
 tion, and arrest of secretion.  Finally  the  depression
 becomes so great that there does not seem to  be  power
 enough  in the system to circulate the blood, the result
 being a chill of variable duration.  If this  continues, vital-
 ity will be destroyed ; hence, in a longer or shorter time,
 we find the energies  of the system concentrated to over-
 come it.  The result  is febrile reaction, which ceases  only
 when the material introduced has been entirely removed.
 In this case it is principally  thrown upon  the surface as a
 pustular eruption, but we notice that  the  poison has been
 wonderfully increased, as each pustule contains possibly
 a hundred or a thousand times the quantity introduced.
 This virus has been produced from the blood by the action
 of the original minute portion of virus on it.
  As another instance, take a person who has been exert-
ing himself more than usual; this exertion has caused a
greatly increased disintegration of tissue, which partially
disorganized material remains in the blood.  The exertion
has been attended with increased excretion from the kid-
neys and skin, the  last being especially manifest by free
perspiration.   At this time the person ceases his exertion,
and sits down  in a  damp place, or in a draft of cold air, 
278
FEVER.
the effect being to stop the  secretion from the skin, and
the material that would have  been thus  removed, is re-
tained within the circulation.   Not only so, but the blood
is  driven from the surface to internal parts of the body,
embarrassing the action of the internal excretory organs.
Now if  vicarious excretion  does not occur from the kid-
neys or  bowels, the result will  be  fever, or inflammation
of some structure of the body accompanied by it.  What
are the  phenomena that follow?  There is first a torpor
of all the functions of the body, followed by a chill, and
this by  febrile reaction, which  terminates only when free
secretion is re-established.
  Phenomenon  of Fever.—A fever  is composed of four
stages:  1st.  A stage of incubation, of variable duration;
2d. A cold stage;  3d. A hot stage;  and 4th.  A stage  of
excretion, or, as it is generally called, a sweating stage.
These follow one another in the order in which they are
named,  and each one  may be  considered  as  the natural
sequence of the  one which preceded it.
  1. The stage of incubation is that  period between the
exposure to  the  cause  of  the fever, and the  commence-
ment of the chill, and during this time the fever poison is
acting in the blood.  It is of variable duration—nine  to
twelve days in  smallpox, six  days  in scarlet fever, and
from  two or  three days to  as  many weeks  in other
fevers.  The symptoms are those of depressed  vitality,
languor, listlessness, torpor of all  the functions, feeble
circulation, etc.,  which increases daily until the period of
chill.
  2. Cold Stage.  With the continued impairment of the
blood, we have  such  depression of the nervous  system
that there is no longer power to circulate the blood; con-
gestion  of parts near the center of circulation ensues,
there is  deficient oxygenation and capillary circulation in
the skin, the result being constriction, coldness and invol-
untary movements or tremors.  If the vital  force  is  so
depressed that reaction cannot  take place, these symptoms 
FEVER.
279
 increase,  and  the  patient dies during  the chill, as we
 sometimes witness  in congestive chill.
   3. Hot Stage. We recognize in organized beings a certain
 conservative power which opposes the operation of nox-
 ious agents and labors to expel  them when they are intro-
 duced.  During the preceding stages this power has been
 in abeyance, but now, in order to prevent death, it is con-
 centrated to circulate the blood. The result is increased
 action of the heart and lungs, giving  rise to the frequent
 pulse, return of capillary circulation  to the surface, in-
 creased oxygenation, and consequent increase of tempera-
 ture.  The rapid circulation and oxygenation of the blood
 causes excitation of the nervous system;  and the concen-
 tration of vital force to the circulation of the blood accounts
 rationally for the arrest of secretion.
   4.  Sweating Stage.  If the  hot stage has  been  propor-
 tionate  to the others,  equal  circulation throughout the
 body having been established, and the deleterious material
 fitted for excretion, it terminates by the establishment of
 secretion from  the  skin, kidneys and  bowels, and conse-
 quent return to health.  It may take hours or days for the
 accomplishment of this end, but if the patient recovers it
 is accomplished.  In intermittent fevers we may suppose
 that the stage of  excretion is  not completed;  that the
 blood is not entirely freed from the cause of disease.  In
 such case, after a certain length of time, we would have
 such  increased generation  of the morbid material as to
 reproduce the fever.  In remittent fevers, the object being
 but partially accomplished by one revolution of the  dis-
 ease,  there is but remission in the febrile reaction.
  Division of Fevers.—Fever may be divided into three
 classes—-febricula or slight  fever; periodic fever, and con-
tinued fever.  The first  is that evanescent disease that so
frequently follows arrest of secretion, and disappears in a
few hours or days without trouble.   The second is charac-
 terized by  distinct  periodicity,  and is divided into two
 forms, intermittent and remittent fever. And the third is dis- 
280
FEBRICULA.
tinguished by there being no  break in the fever from its
commencement until its end; it is divided  into four vari-
eties, sthenic or  inflammatory  fever, common  continued
fever, typhoid fever, and typhus fever.
  To these  we  would add  the  exanthematous fevers, as
small-pox, measles, scarlet fever, etc., which are produced
by the absorption of a  specific virus, which reproduces
itself in the blood, and  is finally determined to the skin.

                    FEBRICULA.

  The definition of the  word febricula, is  little fever, and
we use it to designate the evanescent form of the disease,
which is produced by exposure to cold, sudden change of
temperature, or other cause that would impair the circu-
lation of the blood, and check secretion.
  The symptoms  are very  plain—the person feels badly
for  a day or two, has slight chills, headache, pain in the
back and  limbs, poor appetite, constipation of bowels, and
loss of strength.  After the  chill, the surface becomes hot,
the pulse increased in frequency, the  nervous system is ir-
ritable, and  secretions checked.  The fever may come on
and go off several times during the day, or it may remain
constantly for two, or three, or  five days.   Any person
accustomed  to  sickness  will see  that the patient is not
very ill.
  Treatment.—In many cases, all that is necessary is to
bathe the  patient's feet in hot water, and give some  mild
diaphoretic infusion freely, placing him in bed and cover-
ing warmly  to produce perspiration.   Or we may use the
spirit vapor bath  No. 26; common vapor bath, No. 25;
blanket pack, No. 28; or wet sheet pack, No.  29;  either
of which  will restore secretion  in  these cases, and thus
speedily remove  the fever.   A  simpler plan, and a very
successful one is, to add tincture of aconite, twenty drops
to a  tumblerful  of water, and give a teaspoonful every
hour; the foot bath  and diaphoretic may be used with it. 
INTERMITTENT FEVER—AGUE.
281
         INTERMITTENT  FEVER—AGUE.

  A majority  of the profession concur in saying that in-
termittent fever is  produced by  the absorption  of  the
gaseous  exhalations of decomposing vegetable matter, or
marsh miasmata.  In proof of this, it is shown, that this
form of fever is endemic  in those sections where vegeta-
tion is profuse,  and the conditions for rapid decomposition
generally exist, and  that  iu sections where these condi-
tions do not exist, it is not found.  It is further proven by
the fact,, that in those sections where it is endemic, if the
season is remarkably wet or dry, so as to prevent vegeta-
ble decomposition, there are but  few if any cases of the
disease.  Any cause which will depress the vital power of
the system, will predispose the patient to the action of the
malarial poison.
t Symptoms.—For a few days preceding the  first chill,
the patient feels languid  and bad, and has more or less
pain in the back and limbs, with sometimes headache and
derangement of the stomach.  The cold  stage makes its
appearance with a desire to  yawn  or stretch, purplish ap-
pearance of the nails, and increased thirst.  The patient
becomes cold, the skin shrinks, chilly sensations pass over
the body, and in many cases there is shivering or trembling
of the muscles, sometimes to  a very great degree.  This
chill continues a  variable length of time, from  fifteen
minutes to four or  five hours, and is succeeded by febrile
action.  This is usually in inverse  proportion to the chill,
as regards duration and intensity.  The skin becomes hot
and dry, the pulse frequent, the mouth is  husky and dry,
urine scanty,  with considerable pain in the back and head,
restlessness, and sometimes delirium.  The fever will last
for from two  or three hours, to nearly the  entire day, and
is  succeeded  by the  sweating stage.   The skin growrs cool,
perspiration is established, urine becomes free, and the
pain and restlessness pass entirely off.
  The fever, in some cases, occurs  every day, when it is 
282
INTERMITTENT FEVER—AGUE.
called a quotidian; in others, every other day, when it is
designated a tertian, and in others, every third day, and
is called a quartan.   In some cases it occurs at an earlier
hour each day, and is then termed anticipating ague, usually
a stubborn form of the disease; or it  may recur at a later
hour  each day, when it is called deferring ague, which is
usually the mildest form of the disease.
  If an ague continues  for  a  long period,  the skin be-
comes sallow, the digestive organs are impaired, the spleen
enlarges, forming ague-cake, and the nervous system, and
in fact  the  entire body loses its tone.   These cases are
difficult to manage.
  Treatment.—In a simple case of intermittent fever, we
endeavor  to get the  system in  good condition, and then
administer a sufficient  quantity  of some anti-periodic to
arrest the disease.  Thus, if the person has a foul stomach,
give an emetic, as  No. 5 or 6.   If the bowels are torpid,
give a dose  of podophyllin  pills, and if the  skin is  inac-
tive, use an appropriate bath.  Then give, in  the intermis-
sion, from twelve to fifteen grains of quinine to an adult,
and a proportionate quantity to  children, in two or three
doses, so that the last may be  taken at least one hour
before the expected  chill.   This will arrest  the  fever in
nineteen out  of twenty cases;  if it  does not, repeat  it
again, paying more attention to the means first named.
  To keep it  off, use the bath to keep the skin in good
condition; keep the bowels regular,  and take internally
a solution of acetate of potash, No. 41; half an ounce to
four ounces of water;  a teaspoonful four  times a day.
For three or four days after the chill is broken, take two
or three  grains of quinine  daily, and every seventh day
thereafter, until the system is entirely free, five grains of
quinine.   The disease has a tendency to recur at periods
of seven days, and this must be especially guarded against.
No person need fear any injurious  action from quinine,
above  recommended, as  it can  not  possibly  do injury.
The consequences that have  been attributed to it, have 
CONGESTIVE CHILLS.               283
been produced  by other agents with which  it has been
combined.
  There are many cases that are very stubborn and per-
sistent, and  require the skillful  observation of the physi-
cian, and in others some complications exist which require
an experienced eye to detect.  Therefore, if the case is a
serious one, or has been  protracted, consult  your family
physician.

               CONGESTIVE CHILL.

  This is one of the most serious diseases  that we meet
with in the West and South, sometimes proving fatal in a
short time,  unless  promptly combatted.   Every  person
who lives in a section of country where it prevails, should
be able to recognize it at once, and be instructed as to its
proper management, for in some cases the  patient would
be beyond the reach of medicine before a physician could
be obtained.
  Symptoms.—Congestive chill  commences  like any other
ague, only the depression and loss of strength is much
more marked.   The  surface of the body  becomes very
cold, the nails  and lips are purplish, and  the skin of a
leaden color;  the pulse is very  feeble, hardly perceptible
at the wrist, and the respiration somewhat difficult; the
patient is unnaturally torpid, and if he complains, it is of
giddiness, heaviness, and a sense of weight in the head.
He  does  not seem to realize his condition,  or the anxiety
of his friends, and would almost as soon die as live.
  As the disease advances, stupor comes on;  he lies upon
his back, with tendency to slip  dflwn to the foot of the
bed; the breathing becomes more difficult;  the  pulse is
small, weak and fluttering, or  is intermittent, trickling
under the fingers like drops  of water, and at  last  can not
be felt at the  extremities; a cold, clammy perspiration,
sometimes  fetid, covers the body;  the face assumes a
leaden, cadaverous hue; the lips are contracted over the 
284        REMITTENT FEVER—BILIOUS FEVER.

teeth, and the  patient  dies, reaction  not having taken
place.
  Treatment.—The object of treatment in this case is to
produce  reaction, and all- our means will be  directed to
this end.  Give the patient immediately  a vapor bath, as
named in No. 25, or a  hot  blanket pack, as  at No. 28,
with bottles of hot water, hot bricks and stones, surround-
ing him, to give all the heat that is possible. If you have
in the house  any strong stimulant, as life  drops, No. 58;
tincture  of  prickly  ash,  or the stimulating liniment,
No. 87;  give it  internally, in full doses, every few min-
utes,  until symptoms of  reaction occur.  If  you have
none of these, make a strong ginger, red pepper, or black
pepper tea, and give it as freely as the sufferer will take it.
  If a physician can  not be obtained, procure  early four
or five doses of quinine, ten grains each, at the nearest
place, and as soon as they  arrive,  administer one portion,
and repeat every fifteen or  thirty minutes, until decided
signs of reaction are  manifest.   You might give the
patient a half an ounce without  injury, if the chill con-
tinued, but in almost all cases, two or three doses of the
size named will be sufficient.
  It must not be considered that the patient is safe because
he has recovered from one chill—it is as liable to recur as
any other ague, and must  be met with treatment to keep
it off.  This  will be the same as named for simple inter-
mittent  fever,, with the exception that  the quantity of
quinine will have to be increased.

     REMITTENT FEVER—BILIOUS FEVER.
  Remittent fever differs from intermittent, in  that there
is but one chill, the febrile reaction lasting from its com-
mencement  to its termination, but having distinct remis-
sions recurring periodically.   Like intermittent fever, it is
caused by what is generally termed marsh malaria, though
there is  no  doubt but that sudden atmospherical  vicissi- 
            REMITTENT FEVER—BILIOUS FEVER.         285

tudes and changes of temperature, by arresting secretion,
impairing nutrition, and lessening the vital  power of the
individual, may form a  cause of the disease.  It occurs
principally in the fall, though many cases are seen in the
summer, and even the entire year.  It also differs much in
its character, being mild in high and temperate  regions,
and severe in low, marshy and warm countries.
  Symptoms.—The forming stage usually occupies  some
days, the symptoms being gradually developed.  At first
there is nothing  but  a feeling of  weariness, especially
upon slight exertion.  This  languor increases, and  is ac-
companied with listlessness, or indisposition to make any
exertion; the appetite becomes capricious, with a bad or
bitter taste in the mouth; tendency to nausea, with, some-
times, vomiting; the bowels are costive, and skin dry,and
more or less pain and heaviness  in the head, with, fre-
quently, pain in the back and limbs.
  Cold Stage.   The attack is  sometimes ushered in by a
well marked chill or rigor,  closely  resembling the  cold
stage of an intermittent.   Frequently the chill is very
slight, and  again  merely a sense  of coldness; or slight
chilly sensations pass over the body, which, after a short
time, are succeeded  by flushes of heat; these alternate,
the chills becoming less and less marked,  until, finally,
febrile reaction is set up.  In some cases, especially those
in which the chill is marked, nausea comes on, and finally
vomiting, about the time  reaction  sets in.   Sometimes
there is  some pain in the back and limbs during this stage
of the disease.   The cold  stage  usually lasts  but a short
time, one or two hours, but is occasionally protracted.
  Hot Stage. When reaction ensues, the pain in the back,
head and limbs increases, being  in some cases extremely
severe.   The temperature of the  surface  is markedly
increased, the skin being  dry and constricted, the face
flushed and turgid, and the eyes red and suffused*  The
pulse is  full and frequent, rarely tense, and the respiration
hurried  and uneven.  The tongue is covered with a yel- 
286         remittent fever—bilious fever.

lowish-white fur, with frequently a disagreeable taste in
the mouth, and more or  less nausea, with oppression and
pain in the  epigastrium, and in many cases severe and
protracted vomiting of bilious matter.   All the secretions
are checked—the bowels costive, and the urine scanty and
high colored, sometimes loaded with bile which gives it a
yellow tinge.  The nervous system in many  cases is con-
siderably deranged, the patient  being  watchful  and very
restless.  There is rarely delirium in the first exacerbations,
more frequently a marked dullness and torpor.
  These symptoms continue from eight to twenty hours,
when they gradually pass off; the heat of the surface is
diminished, with frequently slight perspiration about the
neck and face;  the pulse is not so frequent, the  pain in
head and back ceases, and the patient feels comparatively
comfortable, and sometimes takes a refreshing sleep.  This
constitutes the period of remission, which, in a majority of
cases, occurs once  in twenty-four  hours,  usually in the
morning, though in some there are two per day, in others
a more complete  remission occurs every second or third
day.
  This remission varies greatly in  its  duration and com-
pleteness in different cases; in some it is long and amounts
almost to  an intermission, in  others it is  short  and the
febrile symptoms but slightly abated.   Following it, the
febrile  symptoms reappear with all their  first  intensity,
and the hot stage continues to the end of the  disease, in a
succession of exacerbations and remissions.
  In some cases of this fever, we do not observe that the
febrile reaction becomes more intense as it progresses, but
in others,  each succeeding exacerbation is more  marked,
the remission shorter and less  noticeable, until finally the
fever is nearly or quite continuous.   The irritation of the
stomach continues often for two, three or four days; in
some cases through the entire disease, if not  arrested by
remedies.
  As might be supposed, the patient's strength  fails day 
           remittent  fever—bilious fever.        287

by day, innervation and secretion become more and more
impaired, until by the seventh or eighth day we find him
in one of two  conditions.  The fever having lost its orig-
inal type, has become an adynamic continued fever, with
typhoid symptoms.  Or, the patient's strength having be-
come greatly  exhausted, we  observe a  want of reactive
power, there is a tendency to congestion during the remis-
sions, at which time the surface becomes cool, sometimes
covered with  a  clammy perspiration, the  pulse is small,
weak, intermittent, and respiration short, quick and cliffi
cult;  coma makes its  appearance, the  patient  lies upon
his back, slips toward the foot of the bed, there is a jacti-
tation, picking of the bedclothes, and after one or more
unsuccessful attempts  at reaction, the  patient dies.   In
this last case, the disease terminates fatally as a remittent;
this,  however, is a rare termination, for  if not arrested
during the first week, it generally  assumes a  continued
form, and presents all the symptoms  of a continued fever.
  Treatment.—In this, as well as in  other diseases, it  is of
the first importance that any derangement of the stomach
and bowels  should be  immediately  corrected.  If, there-
fore, we find our patient suffering from nausea, with inef-
fectual efforts  to evacuate the stonfach, we would admin-
ister a thorough and efficient emetic of compound powder
of lobelia and capsicum.  If there  is redness of the tip
and edges of the tongue, with tenderness on pressure over
the epigastrium, counter-irritation, with agents to quiet
irritation of the stomach, would be indicated; as an infu-
sion  of peach  tree bark, or that and dioscorea, equal parts,
or an infusion of compound  powder of rhubarb and  po-
tassa, with sometimes the  addition  of  small portions  of
morphia.  I have found the irritation of the stomach and
bowels yield  in some cases to the  essential tincture  of
asclepias, and  small doses of veratrum.
  The next thing to be accomplished is to reduce the force
and frequency of the pulse, and induce a better remission for
the administration of anti-periodics.  For this purpose we 
288       ""~        YELLOW FEVER.

use  tincture of  aconite  and  veratrum, of  each thirty
drops to four ounces of water, giving a teaspoonful every
hour.  In the course of a day we will find the fever going
down, and  the remission will  be much more  marked.
Now, during the remission, we give quinine to arrest the
fever.  The  quantity required will be from ten to fifteen
grains divided  into two or three powders,  the first to be
taken as soon as the fever commences to decline, the last
one an hour previous to the time when it rises.
  Great relief is often experienced by sponging the body
frequently with broke-water, or water to which saleratus
has  been  added  so  as to render it a little slippery. If
there is much nausea, or  constant thirst, a towel wrung
out of cold water and applied to the stomach answers an
excellent purpose.   If the patient is restless and irritable,
especially if the  head is  hot, bathe it and the face with
warm water, allowing it to evaporate.   In this, as well as
all other fevers, the patient's clothes should  be frequently
changed, and  the  bedclothes  and  everything about the
person should be kept  scrupulously clean.   A person suf-
fering from fever  wants  but little to eat, but that little
should be well prepared.   Corn meal gruel,  or thin farina,
tapioca or corn starch* answers  an excellent purpose, and
instead of these, nice chicken  broth or beef tea  may be
given.

                 YELLOW FEVER.

  Yellow fever is a disease of warm climates, prevailing
principally in the torrid,  and southern part of the north
temperate zone. It is evidently closely allied to remittent
fever, as it prevails in those sections, and those only, which
are regarded as malarious. It makes its appearance in an
epidemic  form in the latter part of  the  summer,  and
ceases its ravages with the first frosts.   For its production
it  appears to  be necessary, that the causes of vegetable
malaria shall exist with intensity; that there shall be more
or less decomposing animal matter, with a  high range of 
YELLOW FEVER.
289
heat for many days consecutively.   Certain sections of
country appear to possess all the elements for the genera-
tion of the disease, and hence it makes its appearance with
great  regularity  at such period of the year, as gives the
necessary high and long continued heat for decomposition.
   Persons who  have long  resided in those sections have
usually an immunity from the disease, which is  doubtless
owing to  such gradual change in the constitution as ena-
bles it to throw off the  malarial poison;  such persons are
said to be acclimatized.  Persons from the  north, or sec-
tions free from these malarial poisons, residing in a country
where yellow fever prevails, are most liable to the disease.
It is generally admitted that it is not contagious, at least
not  more so than other fevers where  decomposition is
speedily set up after death, or even before dissolution, as
in typhus, and some cases of typhoid fever.  There  can
be no  doubt that the emanations  from such persons are
poisonous to those wmose vitality has been impaired, and
that if  absorbed they will give rise to adynamic fever.
   Symptoms.—Yellow fever may be divided into three
stages, wThich in many epidemics are well marked, but in
others are indistinct.  These are, first, a stage of primary
fever, lasting from thirty to seventy hours; second, a stage
of remission; and third a stage of collapse.
  First Stage.—This stage is sometimes preceded for some
hours or days with the usual prodromal symptoms of fever.
Languor, listnessness, failure of appetite, and more or less
pain in head, back, and limbs.  Chilliness precedes febrile
reaction in a majority of cases, though a well marked cold
stage is rare.  With the development of febrile  reaction,
the skin becomes hot, dry and harsh; the urinary secre
tion is arrested, and the bowels are obstinately constipated.
The patient  suffers severely with pain in the back, limbs
and head, and  is  extremely restless  and uneasy.  Much
irritation of the stomach exists from the first, with pain
and sense of oppression in the epigastrium;  in a majority
of cases vomiting speedily comes on, and continues through
        19 
290
yellow  fever.
this  stage—the retching and  ejection from  the stomach
being painful and difficult.  The  eyes  are generally suf-
fused, reddened, and very sensitive to light, presenting the
appearance that would  follow exposure to wood smoke;
this has been looked upon as almost a  pathognomonic
symptom by  some.  The pulse varies greatly in different
cases;  in many, it is hard, quick and irregular; in others,
small, corded and oppressed; and  in  others  not different
from what it  would be in a simple remittent.   The tongue
hardly ever  presents  the  same appearance; sometimes
clean, again broad, flabby, and covered with a thin, white
coat; again reddened at tip and edges, pointed and coated
in the center; and again presenting a thick yellowish, or
yellowish  brown coat.   As before remarked, this stage
varies in duration, and there is just as much variation in
its intensity.
   Second Stage.—The febrile action gradually abates; the
vomiting ceases, or is  less constant; the  pains are much
ameliorated;  the skin becomes softened, and frequently
covered with perspiration.   The  patient feels compara-
tively well, though exceedingly debilitated, and has hopes
of speedy recovery, and yet, even  now, may be noticed
that yellowish discoloration, manifesting itself in the con-
junctiva, and the  skin of the forehead  and breast, the
precursor of  that third  stage,  from wmich it is so difficult
to recover.   This  remission, sometimes  so  complete, can
hardly be  noticed at  others, but the first rapidly  passes
into the third stage, or collapse. It  is always of short
duration, not more than from two to ten hours.
   Third Stage. — In  this  stage the  pulse becomes very
feeble, and the prostration is excessive; the yellow appear-
ance of the  skin, which gives the disease its name, be-
comes plainly  visible,  and continues to deepen  as the
disease advances.  The  irritability  of  the stomach  is
excessive ; nothing can be retained, but the vomiting now
is easy.  The material  ejected from the  stomach is pecu-
liar, being very dark colored, and hence known by the 
YELLOW  fever.
291
name of black vomit: this dark colored material has been
determined  to be  broken  down blood.   Diarrhoea  fre-
quently ensues, the discharges from the bowels resembling
that ejected from the stomach.  The respiration is hurried
and difficult, with  frequent sighing, and the patient com-
plains  of an  intolerable  oppression and  distress  at the
prsecordia.   The powers of life rapidly fail;  slow delirium
or coma comes on, and death soon eases the patient from
his intolerable suffering.
  Treatment.—With the commencement of the disease,
bathe the patient's feet thoroughly in hot mustard water,
wring a sheet folded out of cold  water, and  wrap around
the bowels  and cover warmly in bed.  Now, give small
doses of podophyllin and cream-of-tartar, about one-fourth
of a grain of the  first, to ten  grains of the second, every
two hours until  it operates.  If there  has been consider-
able nausea  and vomiting, give a thorough emetic before
using the means named.  An infusion of  peach-tree bark
may be employed to check irritation of the stomach, and
warm diaphoretic teas to produce sweating.  As soon as
a remission in the disease occurs, quinine should be given,
about fifteen or twenty grains at two doses, with tincture
of gelseminum in half teaspoonful doses every two or three
hours.
  After this  the treatment will  have to be conducted on
general principles, meeting the indications as they arise.
The stomach  must be kept quiet, diarrhoea arrested if it
appears, the patient's strength kept up by the judicious
use of stimulants and nutritious  but easily digested  food,
and  especially must normal circulation in the skin and
extremities be maintained, and  free secretion  from the
kidneys.   Convalescence is slow, and  must be managed
with great care;  any indiscretion  in  regard to  diet or
exposure tending to produce a relapse. 
292
common continued fever.
          COMMON CONTINUED FEVER.
  This  form  of fever occurs  in  persons  of moderate
strength of constitution, and when there has been no pre-
vious cause acting on the system to lower the vitality, or
permanently derange the excretory organs, and the con-
stitution of the blood.  At its  commencement we notice
no  symptoms of great impairment of the fluids, though
should the disease continue long, such change in the blood
will occur as to give rise to  typhoid symptoms.  This is
the disease which in the majority of cases, has been desig-
nated as  typhoid fever, because if allowed to progress,
such  symptoms become manifest; but more  frequently
because popular opinion regards the last named fever as
an exceedingly dangerous  disease, and  physicians like  to
claim the credit of curing it.   I use the term typhoid in
its  literal meaning, " resembling  typhus," and apply it  to
those cases exhibiting marked  loss of vitality, and com-
mencing necrsemia.   If it wras strictly used  in this sense,
we  could understand better, perhaps, the treatment neces-
sary to its arrest;  at least, wre  would  be able to attach
some meaning to much that  is written about typhoid
fever.
  Causes.—The predisposing  causes of this,  as well  as
typhoid fever, are all such as  occasion temporary exhaus-
tion and want of power in the system to  react and expel
disease.  The  exciting causes are numerous : as an arrest
of secretion, and retention of  excrementitious material;
the absorption of exhalations from vegetable  and animal
matter  undergoing  decomposition; animal miasms,  as
from healthy persons or animals crowded together, or con-
fined in imperfectly ventilated situations, and without due
regard to cleanliness; from persons laboring under disease
of any kind in ill-ventilated apartments.  " Every popu-
lation," says  Mr. Chadwick, "throws  off  insensibly an
atmosphere of organic matter,  excessively rare in country
and town, but  less rare in dense, than  in open districts; 
common continued fever.
293
and this  atmosphere  hangs over cities like a light cloud,
slowly spreading, driven about, falling, dispersed by the
winds, washed down by showers.  It is not vitalis halilus,
except by origin, but  matter which has lived, is dead, has
left; the body, and is undergoing decomposition into  sim-
pler than organic elements.  The exhalations from sewers,
church-yards,  vaults, slaughter-houses, cess-pools,  com-
mingle in  this  atmosphere;  and, notwithstanding  the
wonderful  provisions of nature for the speedy oxidation
of organic matter in  water and air, accumulate, and the
density of the poison (for in the transition of the decay it
is a poison), is sufficient to impress its destructive action
on  the living,  to receive  and impart  the processes of
zymotic  principles, to convert by a  subtle, sickly, deadly
medium, the people agglomerated in narrow streets and
courts, down which no wind blows, and  upon which  the
sun seldom shines."   I have never as yet  seen a case of
this  or typhoid fever, but what I could discover in the
present or  previous location of the  patient, the presence
of decaying animal matter, to account partially, at least,
for the character of the disease.
  Symptoms.—The stage of incubation is generally of some
days duration, though when  the cause is intense, it may
be brief.   The patient complains of languor, indisposition
to exertion, loss of appetite, irregularity of bowels, dry-
ness of skin, and more or  less pain in head or back, and
soreness  of muscular tissue.  These symptoms increasing,
at last a tolerably well marked chill comes on, the patient
feels cold, especially at the extremities, and chilly sensa-
tions  pass over  the body.   These are shortly alternated
with  flushes of  heat, which  become more and  more
marked,  until  febrile reaction  is established.  In  rare
cases, the cold stage is as well marked as  in an intermit-
tent, amounting to a rigor; in many the  patient hardly
notices the cold stage, it is so slight.
  With the development of reaction, the skin  becomes
hot and  dry, the urinary secretion  scanty, high colored, 
294
COMMON CONTINUED FEVER.
and does not deposit a sediment, and the  bowels are con-
stipated.  The mouth is dry, and the tongue coated with
a slightly yellowish-white  coat, or in some cases a heavy
yellowish coat on base, with a bad taste in the mouth and
slight nausea; in others, the  gastric mucous membrane
being irritable, it is elongated, the tip and  edges reddened,
but coated white in the center;  there is thirst, but not so
intense as in the preceding form of fever.  The pulse is
frequent, full, sometimes hard, especially if there is irrita-
tion of the mucous  membranes, or cerebro-spinal centers,
but rarely bounding.  In some cases there is nausea and
even vomiting;  but if so, the tongue will either be found
heavily  coated at base, with a  disagreeable taste in the
mouth,  and  sense of oppression in the  epigastrium,  or
pointed, with reddened tip  and edges, and  tenderness on
pressure over the stomach.
  The condition of the nervous system is  variable: some-
times the patient is  restless, uneasy, and watchful, the
special senses being painfully acute, so that  the patient
can not bear a bright light, and is disturbed by the slight-
est  noise; at others,  he lies torpid, does not appear to
appreciate his condition, is but slightly affected with  what
transpires around him, and lies quiet in one position.  In
either case there may be headache; in the first it is acute,
the face being  flushed, and  eyes reddened, evidencing
determination of blood ; in the last it is  generally dull, a
disagreeable sensation of heaviness and oppression.
  The symptoms above named increase in intensity to
the third or fourth day, after which the fever exhibits but
little change, if uncomplicated, except the increasing de-
bility, until after the  seventh day; when, if it  does not
terminate by the establishment of secretion, either natur-
ally, or by the aid of medicine, we observe symptoms of
deterioration of the blood, and  prostration, making their
appearance,  and after  a variable length of time a low
typhoid condition ensues,  and we have in fact to treat a
fever of the next varietv. 
COMMON CONTINUED FEVER.
295
  Complications.—This form of fever is frequently com-
plicated with local disease, most generally of an inflam-
matory character; yet, as the fever is fully  developed
before the local  disease commences, the symptoms of the
latter are often very obscure.
  Treatment.—I believe that this fever can be arrested,
in a majority of cases, at any period of its course, previous
to the development of low typhoid symptoms, and in this
I differ from a majority of the profession.  I might  have
said I know it, for such has been the result in my practice
too frequently for it to have  been accidental.  In giving
the treatment, I will here only give the abortive plan, and
refer the reader  to the next form of fever for other treat-
ment, for if not stopped, there  is nothing  more certain
than that it will assume that form.
  There are three principal and well defined indications
for  the arrest  of this.disease, and if by medicinal means
they  can be  accomplished,  the  fever will be arrested.
First, to produce arterial sedation, and its attendant relax-
ation, and a diminution of the heat of the body.  Second,
to establish excretion, and eliminate the  broken  down
elements circulating in the blood.  And third, to restore
the tone and integrity of the nervous system.
  To accomplish the first, we have the direct and indirect
sedatives.  I prefer the direct sedatives, but might here
remark that unless properly used, they are  frequently
inefficient, and sometimes  even  harmful.   The influence
desired is gradual but  permanent sedation,  without pros-
tration, and I hold that this can only be obtained in a
majority of  cases by small  doses frequently repeated, giv-
ing sufficient time for the accomplishment of the result,
say from one to three  or four days, according to the con-
dition of the patient.   In  my practice, I use the tinctures
of veratrum and aconite, largely diluted with water, giv-
ing from one to two drops  of the first, and half the quan-
tity of the second, every half hour, with the  frequent use
of the sponge bath.  The influence is very gradual, but it 
296
COMMON CONTINUED FEVER.
is permanent, and  as sedation increases, hour by hour, I
find increased  strength of pulse, a greater equality in the
circulation, and better innervation.
  As soon as sedation is effected, the patient feels com-
paratiyely comfortable;  the skin is cool, and it  is evident
that mild means will now establish secretion from the skin
and kidneys.  The mild diaphoretic infusions will be suffi-
cient to excite an action of the skin, whilst we act upon
the kidneys by giving a weak solution of acetate of pot-
ash, (see No. 41.)   If from the symptoms we judge there
are accumulations in the bowels, producing irritation, we
administer a mild cathartic, not otherwise.
  As soon as the skin and kidneys commence to act, it  is
necessary to stimulate the nervous  system, so that these
critical evacuations may not fail for want of innervation.
For this purpose I employ a preparation  like the follow-
ing : Take of quinine, ten grains; aromatic sulphuric acid,
one drachm; simple syrup, two ounces ;  and give a tea-
spoonful every three hours.  Or  give equal parts of qui-
nine and hydrastin, one grain of each for a dose, every
three hours.
  In those cases  in which the tongue is heavily loaded,
with nausea and oppression at the  epigastrium, all treat-
ment must be  preceded by a thorough emetic.  In this
condition, no remedies will produce a favorable influence
until the morbid  accumulations  in the  stomach are re-
moved,  and if not  done, the prostration will be rapid, and
typhoid symptoms speedily manifested.  If there is irri-
tation of the stomach, this must be first subdued.  Coun-
ter-irritation to the epigastrium and extremities, with the
employment of those agents known to relieve gastric irri-
tation, should be used here.   Frequently the employment
of stimulant enemata, by stimulating to action the lower
intestine, and producing free evacuation, will greatly aid
the other measures.  The enteric disease should  be con-
trolled,  as named under typhoid fever.
  Though I have here given the treatment in full for this 
TYPHOID FEVER.
297
 disease, as I will for the next, it is not to be expected that
 the family will take the management of such a grave case.
 It will indicate to them the proper course to be pursued,
 and thus favor a  rational treatment, as opposed  to  the
 harsh  medication  so  frequently adopted, and which  de-
 stroys more patients than the disease itself.   The manage-
 ment of the sick will be the same as described  under  the
 head of bilious fever, and the next variety of the disease.

                 TYPHOID FEVER.

   It will be recollected that any fever, either idiopathic or
 symptomatic,  will  assume a typhoid character, if it con-
 tinues sufficiently long for the blood to become engaged
 in a process of decomposition.  Now, in all  such diseases
 we notice that there is more or less rapid breaking down
 of the tissues, and the excretory organs  being in such
 condition that it cannot be freely removed, the detritus of
 the body remains in the blood.  This material is undergo-
 ing retrograde  metamorphosis, and it is  a well ascertained
 fact that in certain conditions of the system this decom-
 position  is propagated in the blood.  If these be facts, we
 can  readily see how  a patient may be poisoned by  the
 breaking down and retention of his own tissues.   Thus,
 says Dr.  Williams, " In several cases  of the early stage of
 the severest form of Bright's disease, in which  the urine
 was very scantily secreted and highly albuminous,  I have
 seen typhoid  symptoms  of the  worst character  ensue,
 accompanied by a breaking up and partial solution of  the
 coloring matter of the blood, with the appearance  of pus
globules in it."
  There are causes producing fever which affect the integ-
rity of the blood at the beginning, setting up within it a
process of decomposition,  which is  more or less  rapid,
according to  the degree of vital power in  the system.
 Such causes would produce typhoid fever, and if the vital
 power  of the patient was depressed at the time of expo- 
298
TYPHOID FEVER.
sure, the symptoms would be evident from the commence-
ment.
  Causes.—The predisposing causes  of typhoid fever are
all such as  greatly depress the vital power of the system,
either  temporarily or  permanently, and we might say,
with truth, that  no  person, unless  originally of feeble
vitality,  or laboring under some  cause that produces
depression  at  the time  of exposure, can have primary
typhoid  fever.  It is true that if the cause  acting  upon
the system was very intense, the disease might be rapidly
developed.  Animal miasmata is the exciting cause of the
disease, and by this we understand animal matter in a state
of decomposition.  Liebig says, "An animal  substance in
the act of decomposition, or a substance generated from
the component parts  of a living body  by disease, commu-
nicates its own condition to all parts  of the system capa-
ble of entering into the same state, if no cause exists in
these parts by which the change  is counteracted or de-
stroyed."   Thus,  exposure to gaseous  exhalations  from
animal  matter  undergoing  decomposition,  or  arising
from persons suffering from low typhoid disease,  the ma-
terial gaining entrance into the blood through the lungs,
will, if there is not sufficient resistance  in the  system, set
up  a process  of  decomposition, which continuing, will
give rise to the  phenomena we observe in this form of
fever.   Thus, in those cases in which decomposing animal
matter is introduced into the system by a dissecting wound,
we observe, first a chill, then  febrile  reaction  with  great
depression, and finally, evidence of complete death of the
blood, all the symptoms  of reaction  being  of a  typhoid
character.
  This form of fever may be either endemic, sporadic, epi-
demic or contagious; if endemic, we'will find  a more or
less intense local  cause; if sporadic, the miasm may have
been speedily generated  and  dispersed; if  epidemic, we
have to look to the condition of the atmosphere, as regards
moisture and  temperature, for the rapid propagation and 
TYPHOID FEVER.
299
spread of the miasm.   That in certain conditions the dis-
ease is contagious, I believe few will deny.  Thus, from a
person suffering from low typhoid fever, there  is continu-
ally given off in the excretions, and from the lungs, mat-
ter in a state of decomposition, and if proper attention is
not paid to ventilation and  cleanliness, these exhalations
assume a degree of intensity that will unfavorably impress
all that come within their reach, and will give rise to the
same form of fever, in those predisposed to disease.
  Symptoms.—The stage  of incubation is frequently  of
considerable duration in this disease, the symptoms being
those  of depression.   The  patient complains  of languor
and debility, with giddiness,  dullness,  and confusion  of
intellect; the appetite  is impaired; uneasiness at the epi-
gastrium, and sometimes slight nausea;  a general sense of
soreness and stiffness, with more or less  pain in the back
and limbs, is not unfrequent.   These symptoms increasing
for two or  three days, the patient complains of slight
chilly sensations, with coldness of extremities, which be-
coming more marked, are alternated with flushes of heat.
This chill lasts from  six to eight hours, but sometimes is
prolonged to one or two days.
  With the development  of reaction, the pulse  becomes
frequent, full and open, or  soft and weak, in  some cases
soft and easily compressed, or if of a nervous character,
quick and sharp.  The tongue is generally loaded with a
dirty  mucus, and is  broad, soft, flabby  and moist, but
sometimes coated in the center, but with reddened tip and
edges; there is considerable thirst.  In some cases the
tongue is heavily loaded, especially at  the base, with bad
taste  in the mouth, and feeling  of oppression at the epi-
gastrium, indicating morbid accumulations in the  stomach.
The urine is  slightly diminished  in quantity,  appears
turbid and frothy, but does not deposit a sediment; the
bowels are  frequently natural as  to  frequency, but ex-
tremely susceptible to the  action of medicine; the dis-
charges being thin, pale and frothy.   The temperature of 
300
TYPHOID FEVER.
the surface varies greatly, sometimes it  is intensely hot
and pungent, but more frequently, but  slightly increased,
with tendency to coldness of the extremities.   The coun-
tenance is dull, pallid and shrunk, or transiently flushed;
the eyes heavy and devoid of luster, and the head heavy,
confused and giddy.  The patient sometimes  exhibits
great uneasiness, and is  restless, changing his  position
frequently, but at others is torpid, careless and unimpressi-
ble.  The respiration is frequently but little affected the
first  two or three days, but sometimes frequent and sus-
pirous.
  By the fifth to the eighth day we find that the head has
become more affected, and the mind is  confused, the
patient reasons with difficulty and answers slowly. Some-
times, even at this early period, we have  a  partial devel-
opment of that dreamy delirium termed typhomania. The
respiration  has now become affected, and is short and
quick, or labored and suspirous.   In many cases symptoms
of enteric affection begin to manifest themselves; the bowels
are irregular, two, three or four evacuations in the  twenty-
four hours, watery, yellowish,  clay-colored, frothy and
foetid.  The urine is but little diminished in quantity, but
is pale and frothy, resembling whey or  new made  beer.
The patient, in  many cases, now begins to complain of
tenderness of the bowels,  and it will be found that pressure
produces pain.
  By the tenth or twelfth day, the bowels have  become
quite loose, the operations frequent and difficult to arrest,
with increased  tenderness on pressure, and flatulent dis-
tension of the abdomen.   The coating of the tongue has
been  gradually  changing its  color, and is  now coated
brown, somewhat fissured, or sometimes the coating has
disappeared and the tongue is dry, red  and glossy; sordes
commence to appear upon the teeth and lips.  Typhoma-
nia has now become fully developed, the patient appears
half-asleep, his mind wanders, he talks to himself of his
business, his pleasures, or, reveling  in the chambers of 
TYPHOID fever.
301
memory, he appears to be living his past life over. Some-
times this typhomania is replaced by coma-vigil, the patient
appears to be in a profound stupor, but is aroused by the
slightest sound, to immediately sink back into his former
condition.  About this time, though sometimes as early
as the fifth day, the rose-colored eruption makes its appear-
ance upon the  breast and neck; this eruption manifests
itself in  small  rose-colored  spots  about the size of the
head of a pin; the color disappears upon pressing the finger
over them, but returns wdien  the  pressure is removed.
Milaria sometimes makes its appearance at this time, in
the shape of minute vesicles, filled with limpid serum.
The patient has now become so prostrated that he requires
assistance to get up in bed, or change his position.
  From this to  the twentieth day, the diarrhoea becomes
worse, the discharges being dark, foetid and very offensive,
and the abdomen very much distended; the coating upon
the tongue becomes almost black, and the teeth and lips
covered with a  dark, offensive sordes.  The prostration is
extreme, and the  stupor  profound.   Frequently the heat
of the surface sinks, the extremities being kept warm with
the greatest difficulty; and sometimes there is foetid per-
spiration.  Petechia? sometimes make their appearance in
the shape of small, purplish-red discolorations, not effaced
by pressure; these extending, form vibices.   The posture
is constantly supine, with tendency to slip  down to the
foot of the bed.   The faeces and urine are now discharged
involuntarily, or  in  some cases there is suppression of
urine, which, if allowed to continue, will cause great dis-
tension of the bladder, with  rapid prostration and  death.
Subsultus tendinum comes on, with  picking at the bed-
clothes, and finally jactitation.   At last, the vitality of the
patient is so far exhausted that there  is no  longer  power
to circulate the  blood, and the patient dies.
  Treatment.—The  object  of  treatment at first,  is the
arrest of the fever, and this can be accomplished, in many
cases, by the seventh day, and before  the severer  symp- 
302
TYPHOID FEVER.
toms make their appearance.   The abortive treatment is
the same as in the preceding disease, but I will repeat it.
  First, if there  is evidence of morbid accumulation, in
the stomach, this must be removed, or all treatment will
prove unsuccessful.  I know  from personal observation,
that where the stomach is thus oppressed, typhoid symp-
toms rapidly supervene, and the probabilities are that the
patient will die; and farther, that such accumulation in
the stomach, proves the cause of the rapid  development
of the enteric disease in many cases.  In  this case, an
emetic precedes  all other treatment, the  acetous  emetic
tincture, or compound  powder  of lobelia  and capsicum
being my favorite agents; if there is great  prostration, a
stimulant should be combined with them.   The action of
the emetic  should be prompt  and thorough, and aided by
warm  stimulant diaphoretic infusions,  which should be
continued afterward to produce  diaphoresis, aided by the
hot mustard foot-bath, and warmth  applied to the body.
As soon as the emetic has ceased acting, the special seda-
tives  should be  administered in doses just sufficient to
continue the influence produced by it.  If, in the early
part of the disease, the bronchial mucous  membrane or
lungs  become affected,  the same treatment should be
adopted, with the addition of counter-irritation.
   In other cases we commence with the use of the special
sedatives, veratrum and aconite, giving them as heretofore
recommended.   Add thirty drops of tincture of veratrum,
and twenty drops of tincture of  aconite, to four ounces of
water, and give a teaspoonful  every hour.
   If the skin is hot and pungent, the alkaline  sponge
bath should be employed, three or four times a day, but if
there is deficient  capillary  circulation, with tendency to
coldness of the  extremities, a sufficient quantity of tinc-
ture of capsicum, added to  water, to give  the necessary
stimulation, should be employed in its stead.   The extrem-
ities must  be kept warm, or the entire treatment will fail,
because, if they are cold, with deficient capillary circular 
TYPHOID FEVER.
303
tion in the skin, there is stasis of blood in internal organs,
which suffer as well as the blood, and  if sedatives are
now  administered, these conditions  are increased, and
though the pulse is diminished in frequency, it is also
decreased in strength, with still further congestion.  Some-
times I find it necessary to order the  frequent application
of tincture of capsicum, or other strong stimulant, to the
extremities, with the  constant  use of  bottles of  hot
water, etc.
  The dose of veratrum named, is about the medium
quantity; where  there  is evidence of congestion it will
have  to be smaller, if the  febrile  reaction is vigorous, it
may  be  increased.   I do  not desire  marked sedation
under twenty-four hours, and many times not before forty-
eight, or  seventy-two  hours.  We will notice, that the
above remedies, used in this way, gradually decrease the
frequency of the pulse, but it becomes more full, stronger,
and especially better in parts far from  the heart,  with
better innervation.  At last, the pulse  coming down to
eighty or ninety beats per minute, we observe  evidence of
commencing secretion.   Now, diaphoretics and diuretics
may be advantageously employed, the sedatives being con-
tinued in  doses just sufficient to maintain its effect.  The
preparation of asclepias, above mentioned, I use, first, for
its gentle  stimulant and soothing influence, upon the ner-
vous system, and because it tends to  stimulate circulation
to the surface, but now it may be continued as  a diapho-
retic,  or other gently stimulant agents used in its place
As  a  diuretic, I employ a weak solution of equal parts of
chlorate aud acetate of potash,  the medium dose of each
being about five grains every four hours.
  When secretion has commenced, but not before, we resort
to quinia  to increase innervation; I  generally employ it
in the following  combination:  Take  of  quinine, hy-
drastin, each,  one-half drachm;  mix,  and divide  into
fifteen powders, the dose being one  every three hours,
being governed as was mentioned in the preceding disease. 
304
TYPHOID FEVER.
If it seems  necessary, stimulants  may  be  employed  in
addition.
  Then, if the patient shows no tendency to sleep, about
nine or ten  o'clock in the evening, when every thing has
become quiet, a sufficient dose of opium should be given
to induce sleep.
  During  this time, the patient should be freely supplied
with diluents, and such light food as  the appetite craves,
and we think can be easily digested.   Every thing in the
room and  about the  patient should be kept scrupulously
clean, and the apartment thoroughly ventilated by admit-
ting air from the sunny side of the house, and keeping an
open fire in the room.  Few persons should be in the
room at a time, and the patient's mind kept calm; espe-
cially should care  be used not to excite expectant atten-
tion  in  the  patient by secret  movements, whispered con-
versation,  or by failure of attention at the time expected.
More depends upon* this, than is  generally admitted by
physicians.  We can not " kick nature out  of doors, and
depend upon the materia medica,"  as has been advised by
a somewhat prominent physician.
  When the disease has progressed  for some days, and
the blood  becomes seriously affected, we may not be able
to arrest it, at least, not speedily, and we must adopt addi-
tional treatment to meet the development of low typhoid
conditions.
  When tenderness  of the bowels is first noticed, the use
of dry cups, followed by the application of tincture  of
arnica, and turpentine, to the  abdomen, will be found
beneficial.   Sometimes warm stimulant fomentations pro-
duce a good effect.   If, at this time, there is  torpor of the
bowels, with indications that  retained faeces  are producing
irritation, a mild cathartic, carefully administered, will  be
advantageous; under no other circumstances should cathartics
be employed.  The  diarrhoea may be controlled at first,  by
the employment of any of the mild astringents, frequently
the  tris-nitrate of bismuth in solution with peppermint- 
TYPHOID FEVER.
305
water  and turpentine, acts  admirably in doses of three
grains of the first, one or two drachms of the second, and
ten  or twenty drops of the third.  An infusion  of the
bark of the young limbs of  the peach tree, in teaspoonful
doses,  with a small quantity of tincture of xanthoxylum,
and one or two grains of geraniin, is one of the best means
of  arresting  it.   Tympanitis  is relieved  by  the local
application of turpentine, demulcent enemas containing the
same, and its internal administration with tincture of xan-
thoxylum.  Dr. Stokes strongly recommends enemata of
yeast  and asafcetida, as the  most efficacious  means  of
removing this condition.
  The prostration of the nervous system is combated with
quinia, bitter tonics, stimulants, and the regular adminis-
tration of small quantities  of nourishment, as beef tea,
etc.  When manifested by typhomania, or coma vigil, the
ammoniated tincture  of valerian, with camphor, tincture
of cypripedium, or serpentaria, may be used with advan-
tage.  If there was imminent danger to the patient, and
especially if the discharges from the bowels were copious,
I would  administer opium, with camphor and warm aro-
matic  spices, the  dose of the first being large enough to
induce sleep, say from one to two grains.
  To control the septic condition of the blood, acid drinks
should be freely given, when desired by the patient.  The
chlorate of potash, combined with hydrochlorate of am-
monia, is  often useful.   When the diarrhoea is profuse,
the chlorinated soda, or Labarraque's solution, is probably
the best  of the chlorides;   its administration should  be
commenced in doses of fifteen drops, in aromatic water,
every three or four hours, increasing it as the disease pro
gresses, to thirty  or forty  drops.  Yeast has  been em-
ployed wdth advantage in  doses of two tablespoonfuls
every three hours, with an  equal quantity of camphor
mixture.   It is said by Dr. Stokes " to correct the morbid
contents  of the alimentary  canal, and  the consequent
symptoms of putrescence,  petechise, and black tongue,
       20 
306
TYPHOID FEVER.
being more effectually removed by it than by any other
means."
  With the exception  of quinia, I doubt  much whether
any  advantages result  from  the administration' of the
bitter tonics.   Stimulants additional to those named are
required  in  the advanced  stage  of the  disease, but they
must be  administered with care; small  quantities, fre-
quently repeated, so as  to keep up a continued influence,
are beneficial,  but under no circumstances  should the S}rs-
tem be over stimulated by large doses, and the  stimulant
then stopped, for the prostration  ensuing might be fatal.
Small quantities of bland, nutritious food should be regu-
larly administered, and bland,  mucilaginous or acid  dilu-
ents  sufficient to satisfy  the patient's thirst.
  The patient's position should  be frequently changed,
and the bed shook up beneath him, and the cover straight-
ened out.  This is necessary to prevent injurious pressure
on any part, which  might  give rise to bed sores; if any
part  becomes tender, with dark discoloration, or blanched
white appearance, dilute tincture of arnica and means to
remove the pressure from the part should be employed.
If bed sores form, they  should be washed with a solution
of sulphate  of zinc, from  ten to twenty  grains, to  the
ounce  of water, and a dressing  of mild  zinc  ointment
applied, the pressure being removed.  This  is generally
sufficient for a cure.
  If the disease exhibits a tendency to yield during the
latter period of its progress, excretion should  be aided by
mild  diaphoretics and diuretics, though under no circum-
stances must an additional amount  of heat be applied to
hurry  their  action.  As soon as secretion  commences,
quinia may be  given in increased doses  with advantage.
Convalescence  must  be managed with great care, when
the patient has been thus prostrated. Nourishing food of
easy digestion, taken in small  quantities, with gentle  stim-
ulants and  tonics,  pure  air, light and  sunshine,  are
required.  As convalescence becomes  established, animal 
SMALL-POX.
307
 broths, with easily digested solid food, may be taken, but
 strictly prescribed by the physician, as to kind, quantity,
 and frequency.

                ERUPTIVE FEVERS.

   This class of diseases is propagated by a specific contagion,
 which, gaining access to the blood, generates  the  same
 specific virus, and is then thrown upon the surface in the
 form of an eruption.   These diseases are most frequently
 contracted by the inhalation of  gaseous exhalations from
 a patient suffering from the disease, or from the discharges,
 and also by personal  contact, the morbid material being
 absorbed from the skin.   The most of them may likewise
 be  communicated by inoculation, or  the introduction of
 the  virus, or even the blood of a patient suffering  from
 the disease, under the epithelium by puncture, or from any
 part of the body, if there is an  abrasion.   They are not
 only contagious, but they sometimes become epidemic,
 which is undoubtedly occasioned by some change in the
 constitution of the atmosphere, inappreciable to us, but
 which favors  the spread of the specific poison. These
 affections differ from all  other forms of fever, in that an
 attack protects the individual from ever having the dis-
 ease again, even though  being exposed to  the cause; to
 this there are  some rare exceptions.

                    SMALL-POX.

  Symptoms.—The  symptoms  depend much upon the
constitution of the patient, the intensity of the cause, and
the state of the atmosphere, whether epidemic or not.
The disease has been divided into several varieties by au-
thors, according to its intensity;  Ave need notice but  two:
the discrete  and  confluent; the  first mild, the points  of
eruption being distinct and  separate, the second severe,
the eruption being profuse, and so closely  situated  as to 
308                   SMALL-POX.
run into one  another.  In describing the course of the
disease, the symptoms of the discrete will be first named,
and followed by the confluent.  We divide the disease into
three  stages:  1st, of incubation;  2d, of maturation; and
3d, of decline.
  Stage of Incubation.—This  comprises the period from
exposure to the  cause, to the  development of the chill,
and may be from seven to  sixteen days, usually  about
twelve days when the disease is contracted in the natural
way.   At the time of  exposure the patient  may feel
unpleasantly impressed by  the morbid  poison, yet fre-
quently no notice is taken  of it.  Generally about the
sixth or  eighth day the disease begins to manifest itself
by a sensation of  weariness, languor, and irregular  appe-
tite and excretion. These symptoms  increase until the
day preceding the chill, the patient now feeling so bad
that he can not follow  his usual  employment.   In addi-
tion to the symptoms named, the patient now complains
of soreness of  the muscular tissues, pain in the  back,
weight and heaviness in the head, and more or less nausea.
  The chill varies in intensity,  sometimes it is but slight;
chilly sensations pass over the body,  which after some
time are attended with flushes  of heat; more frequently
there is well marked coldness of  the surface, and again a
well developed rigor.  The chill varies in  duration from
two to four, or even more hours.  During this period the
pain in  the back  and limbs becomes more marked, and
there is sometimes nausea and vomiting.
  With  the development of febrile  reaction, the skin
becomes hot, the  pulse accelerated, the bowels constipa-
ted, the urine scanty and highly colored, pain in the head,
with greatly increased pain in back and limbs; sometimes
the pain is so intense that the patient can not get rest in
any position.  In the mild or discrete form, the fever may
be about as high as common continued  fever, though in
mild  cases,  it  is  sometimes  very slight.  In the  severe,
confluent form  of the disease, the fever is generally intense, 
SMALL-POX.
309
the pain severe, and  the patient extremely restless;  fre-
quently delirium makes  its  appearance on the second or
third day.  In some fearfully intense cases there is marked
torpor of the nervous system from the beginning, which
is speedily succeeded by low delirium or stupor; the skin
being  hot, pungent, turgid,  and dusky, or the heat con-
fined to the trunk, the extremities being cold.
  At the end of forty-eight hours from the chill,  the
eruption usually begins to manifest itself  in the form of
minute,  reddened papulae, at  first  on the face,  wrists,
breast, and where the skin  is thin and delicate, gradually
extending over the  entire surface,  becoming  complete
about  the end of the third or fourth day.   When the
fingers are passed over these papulae, they feel like small
tubercles in the true skin, about the size of a pin's head;
a minute vesicle forms on the apex  of each within twelve
or twenty-four hours after its appearance, which, enlarg-
ing, forms the small-pox pustule.   In the discrete form
of  the disease, these  papulae  are  not very  closely set
together, sufficient room  existing  between them for their
full development; they  are  usually grouped  together in
threes or fives, with considerable space between the groups.
In the confluent form they are closely set together, being
very numerous, so that when developed they press against
one another, giving rise to erosion of their walls and final
coalescence.   In the mild form, the fever becomes much
mitigated upon the  appearance of the eruption; but in
the other there is frequently little or no  decrease in the
fever, delirium being present in many cases.
  Stage of Maturation.—This stage embraces the period
from the appearance  of the eruption to its full develop-
ment and rupture, usually eight or nine days.   The course
of the eruption is as follows : The small vesicle  increases
in  size as it fills with a clear whey-colored fluid, and is
bound down in the center, giving it an umbilicated appear-
ance.   About  the fourth or fifth day of  the  eruption,  a
red areola appears around the base of each vesicle; com- 
310
SMALL-POX.
mencing intumescence of the skin may be noticed, and
shortly the tissue that held down the center gives way,
and the  eruption becomes pustular, and of a somewhat
conical  form.  From  the  fifth to the  eighth  day the
pustule  maturates, the surface becoming rough and yel-
low, and the cuticle breaking allows a portion of the con-
tents to ooze out, which desiccating, forms  the scab. At
the commencement of maturation  the tumefaction of the
skin increases; in the confluent form, the swelling being
so great as to close the eyes and efface all the features.
The desiccation of the scabs is complete from the eleventh
to the sixteenth  day of the eruption, when they  com-
mence to fall off.
  During the period  of maturation the symptoms vary
greatly.  In the mild  or discrete form, the  fever is never
very  intense, though it may be  continuous, frequently
being intermittent, appearing only in the after part of the
day.  In  the  confluent form, the fever is more or less
intense and continued; frequently there is continued rest-
lessness or delirium.  In  severe cases there is stupor or
delirium; the skin is  hot,  dry and hard; the eruption
comes out on the mucous membranes of the mouth, nose,
pharynx, and sometimes larynx or bronchii, attended with
tumefaction.  This  gives rise to  difficulty  in deglutition
and respiration, which is increased by the  secretion of a
tough, viscid and ropy mucus, requiring  a constant  exer-
tion on the part of the patient to  keep the passages free.
If this affection of the mucous membrane is severe, we
notice symptoms of gradual asphyxia, lividity of the lips,
duskiness of the countenance, and sometimes of the entire
surface, with rapid prostration.
  In some extreme  cases, in addition to  the symptoms of
prostration above  named, the  papulae,  when they first
make their appearance, become dusky, the  skin livid, the
pulse  sinks, extremities become cold, and the patient dies
before the formation of the pustules.  In other cases, the
areola becomes purplish and livid, and instead of normal 
SMALL-POX.
311
maturation, the pustules are filled with a sanious fluid, or
blood, petechia? make their appearance between the points
of eruption,  symptoms  of prostration ensue, and  the
patient speedily dies.
  On the eighth day of the eruption, or the eleventh of
the fever, secondary fever ensues.  This, in the  discrete
form, is not very severe; but in the confluent is generally
as high as it was at first.  In the last case, it usually lasts
from two to four days, when it gradually declines; during
this time there is frequently delirium.   In some cases, this
secondary fever is extreme, accompauied  by low delirium,
a  rapid, weak pulse,  and  great prostration, when  the
patient is in imminent danger.   Sometimes complications
arise during this secondary fever, as inflammation of some
part of the respiratory apparatus, the brain, mucous  mem-
brane of the bowels, etc., which  greatly aggravate it, and
may prolong it for an indefinite time.
   Stage of Decline.—The fever  gradually  disappearing,
secretion is established from the skin and kidneys.   The
tumefaction goes down, and desiccation of the  scabs pro-
gresses.  About the fourteenth  day of the eruption the
scabs begin to be  detached, but are not entirely thrown
off for two or three weeks.  If there has been  no ulcera-
tion of the skin, the site of the pustule is of a dark, pur-
plish  color, giving the skin a mottled appearance; this
gradually fades away and disappears in six to eight weeks,
though  upon  exposure to cold they can be noticed  fre-
quently for six  months.  In  many cases, at the time of
the rupture of the pustule, ulceration  is established at its
base in the true skin, which causes a loss  of structure,
and there are pits left in the skin marking the site of the
pustule.  As a general rule, the severer the disease the
longer the convalescence, which presents  similar symp-
toms to that of other fevers.
  Treatment.—This disease has a  determinate course to
run, and therefore can not be  arrested.   There is  no
doubt, however,  but what  it may be modified by  treat- 
312
SMALL-POX.
ment, and rendered comparatively mild, and its  duration
shortened.   If the doctrine of contagion heretofore ad-
vanced  is true, means that would lessen the intensity of
the febrile exacerbation, would prevent an increased gen-
eration of virus, and the same would be accomplished by
so keeping  the surface that the eruption could readily be
thrown  out. Now,  whether these are  facts or  not, I
know that  when this is accomplished,  the  eruption  is
comparatively light.
  Before the eruption, as we have no positive means of
determining that it  is small-pox, we would  treat it the
same as any other fever.   For instance: if there was nau-
sea, with indications  of  morbid material in the stomach,
an emetic should be employed; if there was constipation,
a mild  cathartic.  The  special sedatives should be em-
ployed to lessen the  febrile reaction, assisted  by the fre-
quent use  of the alkaline sponge bath.   The patient
should not  be  kept too  warm,  neither should  heating
remedies be employed to cause determination to the skin.
If there is  much restlessness, sleeplessness, and delirium,
opium may  be used with advantage.
  If such course is  pursued, few severe confluent cases
will be  met with.  All heating and irritant applications to
the skin, and internal remedies calculated to produce determi-
nation to  the surface, will increase the eruption and aggravate
the disease.   When  the  eruption makes its  appearance,
we  continue the same treatment, though the sedatives
will now be used in small doses.  The sponge bath, two
or three times daily, should  still be used, and continued
until maturation is  complete;  Castile  soap  and  warm
water is the best that  can  be used.   Those who have
never adopted this plan would be surprised to see the in-
fluence  that is exerted  upon the system by keeping the
skin thoroughly cleansed.  To prevent pitting, the room
should be kept dark,  and the face not exposed to the ac-
tion of  heat and light; in addition, all that is required is
the free but gentle use  of soap and water, and the appli- 
SMALL-POX—VACCINATION.
313
cation of sweet oil, when  the  pustules commence to rup-
ture, to keep the skin soft.  During  the  period of  matu-
ration  the patient needs  constant support,  and should,
therefore, have  a light and  nutritious  diet;  corn-meal
gruel is the best  article  that I have ever employed.  If
strict cleanliness has been  observed, there  will be  but
little secondary fever.
  In those cases in which marked lividity of the surface
presents itself, either before or  at the time  of the erup-
tion, with great  nervous  prostration, an emetic should be
administered, and the warm  bath  prescribed.   When
there are indications of serious lesion of the blood, those
antiseptic agents, named under the head of typhoid fever,
should  be resorted  to.   If any  complication  arise, it
should be treated  as named under  the  particular  affec-
tion, as the treatment will not generally  interfere with
that for the eruptive fever.

                    VARIOLOID.

  This  is but a modified form of small-pox; the system
having  been partially impressed by the vaccine disease,
the variolous affection is very mild.   The  symptoms are
those of  the mildest form of the  discrete small-pox,
though  its  course is shorter  and more irregular.   The
treatment should be the same as for variola.

                   VACCINATION.

  Vaccination, as  a  preventive  of small-pox,  was  dis-
covered by  Dr.  Edward  Jenner  about  the year  1775.
Dr. Jenner first noticed, whilst studying medicine, that in
the dairy districts  of Gloucestershire there was a current
opinion that certain persons who had contracted a pustu-
lar  disease from the cow were exempt  from small-pox.
His mind was strongly  impressed by the fact,  and he
commenced its investigation.  It was not until 1796, how- 
314
VACCINATION.
ever,  that  he became sufficiently convinced  to  attempt
the propagation of the disease by inoculation.  His first
case was entirely successful; the disease was transmitted,
and two months afterward, upon being inoculated with
small-pox virus, it was found not  to  have the slightest
influence.  He published the results of his investigations
in 1798, but they were received with  incredulity  by the
mass  of the profession,  and met with  the most bitter
opposition  from  many.   The  evidence, however,  soon
became so  strong, that vaccination was  adopted  with
eagerness as an invaluable boon, warding  off, as it did,
the most fell disease of that period.
   Cow-pox in the  Cow.—The  disease in  the cow is of
rare occurrence, and  hardly  ever manifests itself except
where cattle  are  collected together in herds.   It was
stated by Jenner that the disease  of  the cow originated
from the grease of horses, being communicated from the
heels  of the horse to the udder of the cow, by those hav-
ing; the care  of them.  Whether this was the cause or
not, it is a  well-proven fact, that the disease of the horse
can be propagated to the cow, and thence to man, pro-
ducing the vaccine  disease; and,  farther,  that  inocula-
tion with the matter from the horse will prove a prophy-
lactic, if it is not the same disease.   The  Edinburgh
Journal  of Medical Science states: "  That the matter in
use at Vienna, from  1799 to 1825,  was partly  British
vaccine and partly originated from the grease of a horse
at  Toulon, without  the  intervention of  a  cow.  The
effect was so similar in every respect, that they were soon
mixed; that is to  say, after several generations, and in
the hands of innumerable practitioners, it was impossible
to  distinguish what was  vaccine and what was  equine."
According to Dr. Jenner, the  true  cow-pox  shows itself
upon the nipples of the cow, in the form of irregular pus-
tules.   At their first appearance they are commonly of
a palish-blue  color, or rather of a  color approaching to
livid, and  surrounded by an erysipelatous  inflammation. 
VACCINATION.
315
They frequently degenerate into phagedenic ulcers, the
animal appears indisposed, and the secretion of  milk is
much lessened.  The  cow is subject to  other pustular
sores on  the  nipples, which are of the nature of common
inflammation, and possess no specific quality.  These are
free from all bluish  or  livid tint, and no erysipelatous in-
flammation  accompanies them.   They desicate  quickly,
and create no apparent disorder  in the animal.
  Vaccination.—This  is an extremely simple operation,
and  yet, from want of care on  the part of the practi-
tioner, failure to introduce  the lymph is  of quite fre-
quent occurrence.   Vaccination may be performed with
the lymph taken from the vaccine vesicle from the fifth
to the ninth day, and this is, probably, the most effectual
way of transmitting the disease.  It is generally effected,
however, from the  scab, it being macerated with water,
and thus introduced; or a minute portion  of the  scab is
inserted  under the  skin;  and being rendered soluble by
the fluid of  the part, is thus absorbed.   In performing
vaccination  with the  lymph or macerated  scab, we dip
the point of the common lancet in the matter;  and hav-
ing exposed the arm to the  insertion of  the deltoid, we
make a number of  small punctures, just sufficient to ele-
vate the epithelium, when an additional quantity of the
virus can be  applied and pressed into the  punctures with
the lancet; a piece of adhesive plaster should then be ap-
plied to  protect the part.  In  introducing  the scab, the
lancet should make an incision so as to elevate the epi-
dermis in the form  of  a flap; the piece being introduced,
it can be retained with adhesive plaster.
  Preservation of  Vaccine  Matter.—Vaccine matter is
extremely liable to  spontaneous decomposition, and can
not be kept  longer than  from two to six months under
the most favorable  circumstances.  The  lymph  may be
preserved for several  days,  by placing it between  two
pieces of ground glass, fitting each other  accurately; or
by cutting pointed pieces of quill and dipping the points 
316
chicken-pox.
in the lymph two or three times, allowing  it to become
dry each time, and keeping them from the action of the
atmosphere; in  this case vaccination is performed by
making a  small  puncture with the lancet, and inserting
the pointed extremity of the quill, which should remain
in the puncture ten or fifteen  minutes.   The scab is best
preserved by taking two flat pieces of white wax, excava-
ting upon their surfaces a sufficient cavity for the reception
of the scab, and then applying them closely  together; in
order to render  the  protection more effectual, a warm
iron may be passed  around  the edges, and  afterward
three or four coats of collodion, or even glue, may be ap-
plied.

                   CHICKEN-POX.

  Symptoms.—This is the mildest of the eruptive fevers,
rarely, if  ever, endangering life, and requiring  but the
simplest treatment.  Like the  other diseases  of this class,
it is propagated by specific contagion, the  period of incu-
bation being from six to nine  days.  The disease is fre-
quently associated with the epidemic prevalence of small-
pox, and hence has been supposed by some to be a modi-
fication  of that  disease.  It usually  commences with a
tolerably well-defined chill; fever succeeds of a more or
less marked character, and continues with remissions for
twenty-four or forty-eight hours before the appearance of
the eruption.  With its appearance the fever abates, and
the little patient feels  quite comfortable.
  The eruption appears at  first as small, red, slightly ele-
vated spots, usually of an  oblong figure, with  a flat and
shiny surface;  in a  few  hours a transparent vesicle is
formed upon this, which  upon the second  day is  filled
with  whitish lymph, and  upon  the third, has obtained
its full size, about one-fourth  of  an inch in diameter,
straw-colored.  Many of them are ruptured by the fourth
day; those which continue  become puckered at their mar-
gins, and the lymph concreting, a brownish scab is formed, 
MEASLES.
317
 which is detached the seventh or eighth day.  Many times
 there are successive crops of eruption, so that the  disease
 may be observed in all its stages  in the same individual,
 and the time is consequently prolonged.
   This affection is distinguished from small-pox, the  only
 disease with which it could be confounded, by the forma-
 tion of the vesicle the first day of the  eruption, no de-
 pression  in the center, and their rapid maturity.
   Treatment.—Chicken-pox  needs but  little treatment.
 We sponge the little patient thoroughly with the alkaline
 wash, use the hot  foot bath, and cover  them warmly in
 bed.   Internally we  would give  an infusion  of some
 of the milder diaphoretics, as sage,  or asclepias, a  dose
 of mild  physic to open  the bowels,  and if the fever is
 high, tincture of aconite as heretofore recommended.  The
 child should be washed once or twice daily, its diet should
 be  light and  farinaceous, and  exposure to cold avoided.
 When the eruption comes  out freely, there is usually no
 occasion for medicine.

                     3IEASLES.

   This is said to be a disease of childhood, but experience
 teaches us that the adult is just as liable to contract it, and
 that it is dangerous in proportion  to the age of the pa-
 tient.  Like the other eruptive fevers, it is  propagated by
 contagion, and one attack gives  immunity from the dis-
ease ever afterward.  The  period of incubation is from
seven to fourteen days.
  Symptoms.—Measles  usually commence with a chill,
sometimes slight, sometimes amounting to  a rigor;  to thi3
succeeds  catarrhal fever;  there is  frequent  sneezing, with
stuffing of the nose, redness, watering and turgidity of
the eyes,  sensibility to light, hoarseness, and dry, trouble-
some cough.   The appetite is lost; tongue coated white,
 and loaded at base; unpleasant taste in the  mouth; some-
 times nausea  and vomiting;  and general arrest  of the 
318
MEASLES.
secretions.  The fever is sometimes intense, with  severe
pain in the head, back and limbs, and great irritability;
it is remittent in its character, the exacerbation being in
the after part of the day.
  Upon the third or fourth day from the first commence-
ment of the disease, the eruption  makes its appearance;
first, on  the face, neck and breast, then on the arms, hands
and abdomen, and last on the lower extremities.  At this
time there is marked turgidity of the countenance, partic-
ularly of the  eyes; the tip and edges of the tongue are
red, its center and base loaded with a  dirty fur, and the
fauces exhibit reddened  patches, resembling the cutaneous
eruption.  The eruption at first resembles very much the
bites of fleas; as they become  developed, they are elliptic
and irregular in form, slightly elevated  above the skin,
of a crimson  or lively red color which is gradually shaded
off into the adjacent skin, and  slightly rough to the touch;
when pressed by the  finger they momentarily lose their
color, which returns rapidly upon  removing the pressure.
The more acute the fever, the greater the eruption, and
the more intense the disease.
  With the appearance of the eruption, the cough is many
times markedly increased, and becomes very troublesome.
There is more or less difficulty of breathing, which some-
times depends upon determination to or congestion of the
larynx, at others, of the bronchial  tubes, and again of the
parenchyma of the lungs.  During the period of efflores-
cence, the"  fever usually  continues unabated; indeed, in
many cases, all the symptoms become aggravated  as the
disease progresses.
  On the seventh or eighth day from the commencement,
the eruption begins to decline, and the febrile symptoms
to disappear,  with re-establishment of secretion,  and fur-
furaceous desquamation of the epidermis.
  Measles are severe in proportion to the extent of involve-
ment of the  respiratory  apparatus, and hence  constant
care in the examination of these  complications  is neces 
MEASLES.
319
 sary.  The sequela, which are so much dreaded, are chronic
 inflammation of the larynx and bronchii, or irritability of
 the  pulmonary  tissue, causing determination  of blood,
 and eventuating in phthisis.  The  disease undoubtedly
 affects the constitution of the blood in many cases, the
 reparative or reproductive powTer being so injured that the
 patient is feeble and liable to any cachectic disease.
   Treatment.—It some cases of measles the treatment is
 but a small matter.  All that the child needs is to be kept
 in the house  and kept  warm.   In  a majority of  cases,
 however, more is  needed than this.   Wash the patient
 thoroughly  in  saleratus  water, or with soap and water,
 and rub dry, putting woolen clothing next the skin. Bathe
 the feet in mustard and water thoroughly, put him in bed,
 and cover sufficiently for comfort.  Now give  internally
 an infusion of equal parts of boneset and asclepias,  using
 an inhalation of vinegar and water as described at No. 86,
 if there is much difficulty of breathing or a severe cough.
 After the eruption comes out, stop the  medicine  and give
 simple cornmeal gruel, thin, so that the patient can drink
 it freely. Be very careful about  exposure  to  cold, espe-
 cially for eight  or ten days, though it will be better to
 watch the patient carefully for three or four weeks.
   If the child  is very sick, with high fever and stupor,
 the eruption being tardy in coming  out, I would use  the
 hot  blanket pack, No. 28, adding  mustard to the  hot
 water to  render it stimulating.  If it is a very bad case, I
 employ an emetic of compound powder of  lobelia, No. 6,
giving it so as to  produce free  vomiting.  The  same
treatment is applicable if the  above  symptoms should
come on  at any time during the progress of the disease, the
eruption going back, or becoming dusky.
  If the cough  is very severe, with pain in the breast,
and  difficult breathing, apply a mustard plaster, and fol-
low it with the hot hop  fomentation, and give internally
the compound  syrup of lobelia, No. 82.   Of course, in
these cases, if a physician can be obtained, the family will 
320
SCARLET FEVER.
not undertake the treatment, as it becomes a serious dis-
ease, attended with considerable risk.

                 SCARLET FEVER.

  This is essentially a disease of childhood, and few per-
sons will take it after the  age  of  twentj\  Unlike  mea-
sles, it is also milder, as the patient is older.   It is propa-
gated by specific contagion, either  by inhaling the exha-
lations,  or contact  with the clothes of the patient.  In
some seasons it becomes epidemic; doubtless because the
poison is so intense as  to be propagated readily and at a
considerable distance, and the condition of the atmosphere
is  favorable  to  the ready  spread of a zymotic disease.
Scarlatina  has been divided into three forms:  S.  Sim-
plex, S.  Anginosa, and  S. Maligna, differing in their in-
tensity,  severity  of symptoms, and fatality.   In some
seasons the disease will present the character of the first
exclusively, in others it will be  of  the anginose form, and
again every case will be malignant.
  Symptoms.—From six to eight  days  elapse after expo-
sure before the disease  makes  its appearance, and it  is
usually ushered in with a chill.   In scarlatina simplex the
chill is  not very well marked, and lasts but a short time.
The fever following presents the common symptoms, in-
creased  heat of skin, arrest of secretion, frequent pulse,
loss of appetite, etc.  In the course of from six to twenty-
four hours, the eruption  makes  its appearance in the
shape of patches of efflorescence upon the face and neck,
then extending to the body.  If the eruption is minutely
examined, it will be found to consist of  an  infinite num-
ber of small  red points, the rose-colored  ground being
simply the base upon which they  stand.  Soreness of the
throat,  with  slight difficulty  of  deglutition, appears  at
the commencement, though not usually severe, or accom-
panied  with  tumefaction.   For nineteen  to  forty-eight
hours after the appearance of the  eruption,  the fever con- 
SCARLET FEVER.                321
tinues as before, but  then rapidly abates, and  in  from
three to five days the redness disappears, and is followed
by branny desquamation of the cuticle.
  In scarlatina anginosa, the chill is usually marked, there
is nausea and vomiting, pain in the head and back, thirst,
etc.   The fever which  follows4 is intense, the skin is dry,
husky, and  burning, the  eyes dry and  painful, the face
congested and tumid, bowels constipated, urine is  scanty,
frequently voided,  and high-colored, and marked irrita-
bility of the nervous  system.  Soreness of the  throat,
with  difficult deglutition,  is complained of  from  the
first, and on examination we find the fauces tumid and
red,  and the tonsils somewhat  swollen.  The nares are
frequently implicated with the angina, and there is conse-
quent stuffing of the  nose, with difficult respiration, and
consequent  increased  restlessness.  The eruption some-
times makes its  appearance  during the latter part of the
first day of  fever, but more  frequently not until the sec-
ond  or  third day; about the third or fourth day it has
reached  its  hight.  At the commencement there appears
slight tumefaction  of a  portion  of  the surface, which
gradually assumes a rose-red color, and the minute red
points are  developed.  These patches  increase  in size
until the greater portion of the surface is involved.  Dur-
ing the  eruption there is an expression of  anxiety and
suffering; the child is restless and uneasy, and sleepless-
ness, which  resists the  usual means of rest, is caused by
the heat and stinging  of the surface and soreness of the
throat.
  The throat affection  is here the most prominent feature;
the soreness increases, the mucous membrane and subja-
cent tissue is engorged  and tumid, and the secretion from
the mucous  follicles and  salivary  glands  so viscid  and
tenacious as to cause great distress.  In some cases, ulcer-
ation commences by the fifth or sixth day of the disease,
and the  secretion is difficult  of removal and  exceedingly
offensive; occasionally the ulceration assumes a phagedenic
          21 
322                 SCARLET  FEVER.
form, and  speedily terminates the life  of the patient.
Frequently enlargement of the cervical lymphatics com-
mences  from  the  third  to  the sixth day, and if not
promptly treated, terminates in inflammation and suppu-
ration.  The fever, under appropriate treatment,  com-
mences to abate when the eruption has made its appear-
ance, and disappears entirely by the fourth or sixth day,
when desquamation commences.  As this progresses, the
surface becomes paler, the epidermis exfoliating in whitish
scales, or  in large pieces when it is thick;  sometimes
desquamation  is retarded for two or three weeks.
  Scarlatina maligna might be divided into two kinds, the
distinctive  symptoms  being  marked.   In the one case
there is marked evidence of prostration from the com-
mencement.  The  chill is greatly prolonged, and the child
seems dull and stupid, the countenance vacant or besotted.
Febrile reaction comes up slowly, the body becomes hot,
the heat being pungent, but the  extremities are cold; the
pulse is frequent, but  soft and fluent, or else small and
wiry.  Frequently there is nausea and  vomiting, some-
times diarrhoea.  The tongue is broad, flabby, and covered
with a foul, dirty mucus, and the patient has difficulty in
controlling its movements.  The eruption makes its ap-
pearance slowly, the  redness  being more  or less dusky.
The throat* affection  possesses the same characteristics;
there is difficult deglutition and respiration, the mucous
membrane presenting a dusky, tumid appearance.  Ulcer-
ation is of frequent occurrence, the  surface  being foul,
the edges ragged, and a  strong tendency to phagedena.
Enlargement  of the cervical  lymphatic  glands is very
common, with a strong tendency to the formation of «a
diffusive abscess, and, if the patient lives, to the formation
of secondary  abscesses.  As  the disease progresses, the
symptoms  are all of a typhoid character; there  is the
dark tongue, sordes on the teeth, feeble pulse, great oppres-
sion of the nervous  system, tendency to diarrhoea and
tympanitis, etc. 
SCARLET FEVER.
323
   Tn the second case, the disease exhibits but few, if any,
 premonitory symptoms.  The child is attacked suddenly;
 the chill lasting but a quarter  or half an hour, is not well
 marked, and  is succeeded by the  most  intense febrile
 reaction.  The skin is  intensely hot, dry and husky ;  the
 mouth parched and  dry; the  eyes  injected, dry, brilliant
 and painful.  The patient is  either delirious, or suffers
 such intense pain as to be almost unconscious  of what
 passes  around  him.  There is nausea and vomiting,  the
 irritation being sometimes  so  severe that  nothing can be
 retained on  the stomach.   In these cases the patient is
 frequently exhausted by the reaction, and  dies before  the
 appearance of the eruption, or during the time that nature
 is trying to throw it on the surface.
  In the two last forms of the disease, and sometimes in
 the simple form, we  observe a  want of power upon the
 part of  the system to determine the  eruption to the sur-
 face.  In such case, the skin appears tumid and dusky,
 there is tendency to  coldness of  the  extremities, and
 marked oppression of the nervous system.   In such  case,
 prompt measures must be taken to bring the eruption  to
 the surface, or the patient  will die.  Again, we  observe
 cases in which the  eruption comes out, but from some
 cause it retrocedes; in this case the same alarming symp-
 toms manifest themselves.  In  other cases, the anginose
 affection is so severe,  that it seems that the patient has not
 sufficient power to carry on  respiration;  sometimes the
 difficulty depends upon the secretion of a viscid, tenacious
mucus.
  Sequel^.—Among the most frequent of the sequelae of
scarlet  fever, are diseases  of the kidneys, consisting  of
simple  exhaustion and want of power to secrete, chronic
inflammation and albuminuria.  In  the  first we notice a
marked dullness and hebetude, the appetite is poor, the
bowels irregular, marked debility  and tendency' to cach-
ectic disease, the blood  being greatly impaired.  In the
second, the  pulse is hard and frequent, the  dryness and 
324
SCARLET FEVER.
huskiness of the skin continues, there is pain and soreness
in the back and loins, the appetite  is poor, the tongue
dry, whitish and fissured.   In the third, dropsy makes its
appearance when the child is supposed to be convalescing.
Continued disease  of the  throat, and  irritability  and
enlargement of the cervical lymphatic glands is sometimes
observed.  Ozoena,  with weakness and  irritation of the
eyes, and chronic disease  of the ears, attended  by puru-
lent discharge and partial deafness, is not unfrequent.
  Treatment.—If a child has been exposed to the conta-
gion, give it tincture of belladonna, twenty drops; water,
four ounces; a teaspoonful every four hours.  Let its diet
be light; bathe it with castile soap and water every day,
and keep its bowrels regular.  Even  when  the disease is
prevailing in a severe form, this will frequently render it
mild; at least it will be shorn of its dangerous features.
  We prefer, however, that our children shall  not have
scarlet fever, if it is in  our power to prevent it, as there
are none  but fears the  malady.   Great  care should
be used by  parents visiting  houses in which the scarlet
fever prevails, not to come in contact with the bed or the
child, or any clothing that has been used about it, as the
poison can be carried in the clothes for a considerable dis-
tance, and will remain in  them some time.  Even the air
of the room, if ventilation is not cared for, becomes  so
infectious that it will poison the clothing of those remain-
ing in it for some  time.   If  a  sense of duty  calls you to
visit cases of  scarlet fever, it would be better for you to
change your outside clothing, and wash thoroughly, before
seeing your own family.
  This  must  not be  considered as a  light  matter, for I
have  known  many instances in which the fever poison
was conveyed, as above named, and in  one  instance an
entire family of five children were lost by neglect of these
precautions, the mother carrying  the disease home with
her.  As a prophylactic or preventive of scarlet fever, I
place great reliance upon  belladonna.  It must be used in 
SCARLET fever.
325
small doses, as, add twenty drops of the tincture to a com-
mon tumbler of water, and give  a teaspoonful four times
a day.
  The mild form of scarlet fever requires but little treat-
ment further than good nursing.  At its commencement
bathe the child well in saleratus water, rubbing dry; bathe
the feet in hot mustard water, and give some simple  dia-
phoretic tea, as  sage, pennyroyal, catnip, etc.  The bella-
donna, as  named above, may  be given  every two hours,
and if there is much fever,  add ten drops of the tincture
of aconite to the  mixture.   For the sore throat, wring a
flannel cloth out of good cider-vinegar, and put round the
throat, with a dry one over it, changing it as often as every
half hour or hour.
  Never attempt to manage a case of the severer form of
the disease, if you can  avoid it.   If you can not obtain
competent medical advice, I would recommend the follow-
ing course: Use the bath as heretofore named, repeating
it as often as may be necessary to keep down the heat of
the surface, bathing an arm, a leg, or  a part of the body
at a time, keeping the  remainder well covered up.  Give
internally, tincture of aconite and tincture of belladonna,
of each, twenty drops; water,  four ounces; a teaspoonful
every hour  to  a  child four years old.  In addition, add
hydrochlorate  of ammonia, two  drachms, to water  four
ounces, and  give a teaspoonful every three or four hours.
  If the bath does not seem to agree with the child, rub
it with a piece of fat bacon  once a day, wiping off as much
as possible.  If the  eruption is tardy in making its ap-
pearance, or if, having come out, it goes back, and danger-
ous symptoms  should  arise, use  the  hot blanket pack,
adding the mustard, and if the child  is very  bad, give a
thorough emetic.
  The  throat disease  is  often  the  severest  part,  and
requires the most attention.  I employ the cold  vinegar,
as heretofore named, externally, and if it  irritates  the
skin, I substitute a bacon rind.  Use an inhalation of equal 
326
SPOTTED fever.
parts of vinegar and water, every two or three hours (see
No. 86); and as a gargle, employ a strong decoction of the
wild indigo.  Various measures  have been recommended
in addition to these, but I would prefer to trust  those I
have just named, and would  advise that  no  change be
made to suit the whims of neigh bora who  each have their
favorite treatment.
  In scarlet fever it is very  essential  that the room be
thoroughly  ventilated, and no matter what the  time of
year, a fire in an  open fire-place is very desirable.  Keep
the windows sufficiently open to have a  free circulation of
air, and let the patient be covered so as to keep pleasantly
warm.   Keep  the patient, the clothing, and all  the  sur-
roundings, scrupulously clean, as many a  child has been
lost  by lying  in a contaminated atmosphere.  Let the
diet of the child be light, but give it all it wants of appro-
priate nourishment.  Corn-meal gruel is excellent; farina,
or tapioca, or mazina, furnish good food, but I  prefer new
milk to any other article, and give it freely when it agrees
with the stomach.

                 SPOTTED FEVER.

  A peculiar form of fever  has made  its  appearance in
various parts of this country during the  last two years,
and on account of the eruption that attends it, it has
received the name of spotted fever.   It has been supposed
to be a new disease by those not conversant with medical
literature, but  in fact  it has been known and described
since 1505, when it first appeared in Europe.  During the
sixteenth, seventeenth and eighteenth centuries  it appeared
several times, and prevailing  over extensive tracts of
country, proved very malignant and fatal.  It sometimes
followed  the course  of large armies, and was therefore
called  the war  pest or war plague, by the Germans.  It
first made its appearance in this country in 1806, at Med-
way, Massachusetts, and from this time up to 1817 it was 
SPOTTED FEVER.
327
met with at different times and in different places through-
out the United States, being as fatal then as it has proven
this time.
  Symptoms.—The symptoms vary in  different cases, and
also in different localities, but generally they are about as
follows: For two or three days the patient is listless, dull
and stupid, the face is somewhat flushed and dusky, eyes
tumid, some pain in the head and back, loss of  appetite,
tongue dusky-red and coated with a  dirty white mucus,
skin dry.  He is still able to go around, but feels  badly.
On the second or third day there is a tolerably well marked
chill, lasting for two  or three hours, and  attended with
marked prostration.   Following this, we have febrile re-
action, sometimes high, at  others not very well  marked.
In the one case the surface  becomes  intensely  hot and
flushed, the pulse 120 to 140, sharp and hard, with  great
irritability and restlessness, though there is marked dull-
ness of the intellectual functions; the urine is scanty, and
the bowels constipated; frequently there is difficult respi-
ration, some cough, and  sibilant rales.  In from two to
six days an eruption  appears upon the surface, very closely
resembling  measles, but  more  clearly defined; if the
patient recovers, they commence fading out by the end of
the first twenty-four hours, but  do not disappear entirely
for some  days;  if the disease  progresses they become
dusky, and at last  livid and  associated with vibices. As
their  color becomes  darker,  the nervous  system of the
patient becomes  more oppressed, his mind wanders, and,
becoming livid, he sinks into a stupor, from which he
cannot be aroused, and which in a short time  terminates
in death.
  In the second  case there is but little reaction, the  pulse
coming  up to 90 or 100, and oppressed ; tendency to cold-
ness  of  the  extremities, the  skin being dry and  harsh.
The eruption appears the first, second or third day, and is
a dusky red, not readily  effaced by pressure.  There is
marked dullness and  hebetude  from the commencement, 
328
DIPHTHERIA.
and frequently the  patient is almost entirely unconscious
a few hours after the appearance of the eruption.  It runs
a very rapid course in most instances, terminating fatally
by the third to the sixth day.   The eruption becomes
dusky and livid, petechias appear, the  tongue  is  dry and
brown, sordes on the teeth, urine and faeces very offensive,
coma or low muttering delirium, and gradually increasing
difficulty of respiration.
  Treatment.—In order to prove successful, the treatment
of spotted fever must be prompt and decided.  If there is
very marked prostration, or evidences of morbid accumu-
lations in the stomach, manifested by a foul tongue, give
a thorough emetic of emetic powder.  Follow this with
the hot blanket pack, making the water strong with mus-
tard ; cover the patient warmly in bed, and put bottles of
hot water, hot bricks and irons around his body to increase
the heat.
  Now give internally one  ounce of good brandy, and
from two to five grains of quinine every two  hours until
reaction comes on.  Continue it in doses just sufficient to
keep up the influence, giving the patient a nutritious diet,
and  recovery is almost certain.  This is one of the dis-
eases in  which a large  number of remedies may be and
have been given, but in which but a few do any good, and
experience has proven that the above is a very successful
treatment.

                   DIPHTHERIA.

  Much  has been written  about this, the latest epidemic
of our country, and the majority have adopted the opin-
ions  I expressed in regard to it  in ,the  Eclectic  Medical
Journal  of June, 1861.  I  hold diphtheria to be a gen-
eral as well as a local disease, as is proven by the languor,
listlessness, torpor of the nervous system, and derangement
of the excretory organs, which, as a  general rule, precede
the local  disease—all being symptoms of perversion of 
DIPHTHERIA.
329
the blood, and almost invariably indicating the establish-
ment of febrile reaction.
  Symptoms.—Usually  diphtheria  commences  with  a
slightly-marked  chill,  lasting from two to  six hours,
though sometimes  it  is quite severe.   Following this,
febrile reaction  comes  up; sometimes slowly and not
very well marked, at others quite acute.  A very marked
feature in  this affection, in  a majority of cases, is the
slow development of the fever and its want of intensity
for the first two or three  days.   About the  fourth day
of the disease, if not modified by medicines, the fever has
assumed a marked  adynamic character;  the pulse  is
feeble, soft, and easily  compressed, or  small  and  hard;
there is marked  stupor  of the  nervous  system; pungent
heat  of the surface, with dry  and husky  skin; tongue
dry and covered with brownish fur, and entire  loss of ap-
petite.  Subsequently the fever runs  the course  of  a
common typhoid fever, unless life  is  terminated by the
disease of the throat extending to the respiratory pas-
sages.
  At the commencement the patient complains of sore
throat, difficult, deglutition,  and some difficulty  of breath-
ing.   On examination, we find more or less tumefaction
of the mucous membrane of the fauces, tonsils, and pha-
rynx ; sometimes of a  bright  red color, at others dusky
or livid, and at others blanched.   Upon some of these
parts we .find the peculiar exudation characteristic of the
disease, in the shape of patches of an ashen-gray lymph,
situated on the surface of the mucous membrane. As the
disease progresses this  exudation spreads, forming large
patches, and  sometimes covering all the mucous mem-
brane visible, extending up to the nares and downward to
the pharynx.   By the fourth or fifth day portions of this
become detached and are thrown off, leaving  a foul se-
creting ulcer; there is also a secretion of muco-pus, alto-
gether forming  a very unpleasant, foetid  discharge  in
large  quantity.   Occasionally the affection of the nares  is 
330
DIPHTHERIA.
       such that respiration through  them  ceases; and, again,
       the muscles  of deglutition  are  so  paralyzed, that if the
       patient  attempts  to swallow, the  ingesta  is returned
       through the  nose,  giving  rise sometimes to imminent
       danger of suffocation.  If the disease extends to the lar-
       ynx, pseudo-membranous croup  is the result, presenting
       all its characteristic symptoms, and attended with its danger.
         Treatment.—What are the indications of  treatment in
       such a fever ?  Plainly they are: first, to reduce  the  ra-
       pidity of the circulation, because we well know that the
       change  in the blood, spoken of above, progresses much
       slower when the frequency of the pulse is reduced; inner-
       vation is improved,  and the system placed in such condi-
       tion that we can get an action from the excretory organs;
       second, to get secretion from  the skin, kidneys, and bow-
       els, as it is  through these organs that the morbid mate-
       rial circulating in the blood  must be eliminated; third,
       to increase innervation, for reasons that must be obvious
       to the reader; fourth, to  employ such  antiseptic agents
       as will counteract the septic tendency of the blood; and
       fifth, to  sustain the strength of the patient
         Have  the  patient first thoroughly bathed  in mustard
       and water; or, if  the case is  a serious one, use the vapor,
       or spirit-vapor bath, cover him warmly in bed, and give
       an infusion of pennyroyal or smart-weed.  Wring a flannel
       cloth  out  of cold vineger and apply to the throat, cover-
       ing it with a  dry one, and changing  it every half hour.
       In addition  to this, let the patient inhale the vapor of
       vinegar  as directed  in No. 86, as often as every half hour
       or hour.
         If there is  much fever, give the aconite and veratrum,
       as heretofore  directed, twenty drops of the tincture of
i       each  to four ounces of water, a tea-spoonful every hour
       until the fever goes down—then in smaller doses.  Now
       give a mixture—of  quinine, ten grains; aromatic sulphu-
       ric acid, one drachm, to simple syrup  two ounces—a tea-
       spoonful every two  or three hours. 
RHEUMATISM.
331
  As a gargle for the throat, use a  solution of* chlorate
of potash, as strong as water will dissolve it; or of hydro-
chlorate  of ammonia, two  drachms  to  four ounces of
water.  To alternate with these, make a strong decoction
of wild indigo, and use as a gargle, and give internally in
doses of half a tea-spoonful every three hours.
  The inhalation of vinegar I consider one of the most
important means, and  it should be used  thoroughly.
After the first day the entire person should  be sponged
once or twice with the alkaline wash; and if  there is any
tendency to  coldness of  the  extremities, they should be
bathed with tincture  of  capsicum.   The  diet should be
plain as in other fevers,  and the same attention must be
paid to ventilation and cleanliness.

                  R HE UMA TISM.

  Rheumatism has been  variously classified—sometimes
as a disease  of the  blood, at others as involving princi-
pally the nervous system, again as arising from  deficient
secretion, and lastly, from an imperfection in  the process
of digestion and assimilation.   Undoubtedly all of these
elements aid in making up the disease, as we have now
sufficient evidence that it depends upon some material
(lactic acid), generated during digestion in some cases, and
in others produced during the breaking down of tissues;
that this impairs the quality of the blood, and unfits it for
the performance  of its proper functions; that its non-
removal by the excretory organs is dependent  upon their
impairment;  and lastly,  that these  associated, produce
disordered innervation, and when the material is deposited
in the tissues it  sets up a peculiar form of inflammation
which we term rheumatism.
  Four forms of rheumatism maybe distinguished, though
they run into one another, and sometimes rapidly change
from  one to another.  They are, rheumatic  fever, acute
inflammatory  rheumatism,  sub-acute  rheumatism  and 
332
RHEUMATISM.
chronic rheumatism.  The causes of rheumatism are, cold
from sudden changes of temperature—arrest  of secretion
from other  causes, imperfect digestion, and  causes  that
depress the nervous system.
  Symptoms.—Rheumatic fever usually makes its  appear-
ance after exposure to cold, followed by sudden arrest  of
secretion.  It is ushered  in with a marked chill or rigor,
lasting from one to six hours, during which time the pa-
tient not only complains  of being cold, but of pain in the
back and head, and a dull aching and soreness in all parts
of the  body.  The fever  that follows is usually high; the
skin is hot, but frequently slightly moist; the pulse hard,
and from 100 to 120 beats per minute; the tongue coated
white;  appetite lost;  sometimes nausea and  vomiting;
bowels  constipated,  and urine scanty and high-colored.
These symptoms usually increase up to the second or third
day, when the fever is very intense; after this it continues
without change up to the fifth, seventh, or, in some cases,
the fourteenth day.  There  is more or less pain in all
parts of the body, and sometimes we find it locating tem-
porarily in the joints of the  fingers, wrists, elbows, knees
or feet, sometimes continuing very steadily in one or two
places, but rapidly changing  in others.  Usually the swell-
ing in these cases is not very marked, but sometimes the
contrary is the case when the local affection resembles
the next form of the disease.   Occasionally the fever runs
so high as to produce delirium, which is followed by pros-
tration, and a low typhoid condition.
  Acute inflammatory rheumatism usually commences with
a chill, which is followed by considerable fever, continu-
ing" for  three or  four  days, or sometimes for a week or
more.   The local disease generally makes its appearance
with the fever, the joints being its most  frequent seat,
though other parts are at times affected.
  If a  joint is the seat of the disease, it becomes swollen,
red, hot and painful; the pain being most acute,  tearing,
burning, gnawing, tensive or lancinating.  It is not usu- 
RHEUMATISM.                   333
ally constant  as  to intensity, but  comes on in  exacerba-
tions, in which the intensity of suffering is so great as to
make the patient cry out.  In other parts, the swelling
seems to be a mere puffiness of the  part, though usually
the part  is exquisitely  tender.   The local lesion  is  so
severe, that the part is rendered entirely useless, the slight-
est movement aggravating the pain,  and the patient can
not bear the slightest  pressure, even of the bed-clothes.
In some rare  cases the part does  not seem red, but more
or less blanched.              ^
  The  disease lasts a variable length of time;  in some
cases it may be  arrested in three or  four days, in others
from the seventh to the fourteenth day;  and if allowed to
run  a regular course without interference, saving good
nursing, it will terminate usually from the second to the
sixth week; and in severe cases it may run this  long  or
longer, under the best of treatment.  During its progress
we may expect  great variation in the general as  well  as
local symptoms; the fever at times becomes more intense,
and  is attended with disturbance  of  the nervous  system,
sometimes amounting to delirium.  The disease gradually
declines, the fever passing off, and the pain, swelling and
redness slowly leaving the parts affected.
  In sub-acute rheumatism, there is usually but little fever;
the pulse may be increased five or ten beats per minute,
and  be more full  and bounding, or hard, the skin harsh
and  dry, the  tongue coated, the  appetite  somewhat im-
paired, bowels constipated, and urine scanty and  deeper
colored.  These  symptoms follow  instead of preceding the
local affection.   One or  more  parts may be affected, the
larger joints  suffering  most frequently, the smaller ones
next, and the aponeurotic expansions and  muscles least.
When  a part is attacked, it commences  to swell and
becomes hot  and painful, though in  many  cases it is not
reddened.   The  pain, as in the preceding  case, is gnaw-
ing, tearing, tensive and contusive, or lancinating, though
usually not so severe as in the acute form.  It does not 
334
CHRONIC RHEUMATISM.
change its position  so  frequently, but still a metastasis is
not uncommon.  It is full as  stubborn as  the more acute
malady, and in fact  I prefer to treat the more acute forms
of the disease.
  Rheumatism very frequently shifts its position from one
part to another in a short period of time.  Thus  it will
change from the right knee to the left in a single night,
or from the knee to the elbow.   This is called a metastasis
of  the  disease.  Rheumatism not  unfrequently  attacks
the heart in this way, being by far the most serious feature
of the disease.  It is evidenced by the feeling of oppres-
sion in the region of the heart, pain of a lancinating, tear-
ing character, faintness, more or less difficulty  of breath-
ing, anxious countenance, and a small, rapid pulse—symp-
toms which  can  not very readily  be misunderstood. It
may affect the eye, producing  rheumatic ophthalmia, or
the structures of the ear, the  brain, the membranes of the
spinal  cord, the  sheaths of the  nerves, and, to some
extent, the stomach and intestinal canal.

             CHRONIC RHEUMATISM.

  It most frequently affects the articulations, they being
swollen, tender and painful; one or more  may be affected
at the same time, usually not  more than two, and the
amount of  swelling, discoloration and  pain, varies in
different cases; sometimes the  tenderness and pain are
exquisite,  at others it is not very marked; the articulation
is in some cases entirety useless, motion or pressure giving
rise to severe suffering; at others, though lame, it may
still be used.   In some cases it takes the form of synovial
dropsy, it being  very evident that the  enlargement  is
almost  entirely dependent upon effusion into the joint.
At others the enlargement seems to be dependent upon
material within the  synovial  membrane, but it  is not
nearly so mobile as before.  In other cases  there is marked
enlargement of the articular  extremities, or a dull, heavy, 
CHRONIC RHEUMATISM.
335
gnawing pain, with great tenderness, when the bones are
placed so as to give rise to pressure on their extremities.
In other cases the deposit is  undoubtedly outside, involv-
ing ligaments, tendons and muscles, that pass between the
two bones, causing relaxation in some cases, contraction
in others, thus giving rise to deformity.  In some cases
this is very marked, bones being dislocated, or tendons so
shortened as to produce unnatural flexion or extension, or
to change the position of the bones, as in the case of the
knee joint, the articulation of the tibia being so changed
as to produce knock-knee, and turn the toes outward; or,
in the case of lumbago, or rheumatism of the dorsal or
lumbar portions of the spine, giving rise to spinal curva-
ture and other distortions.  If it attacks a group of mus-
cles, we may find  them gradually shortening,  until a limb
is rendered entirely useless, as in the  case of contraction
of the ham-string muscles, and flexion of the knee, and
finally terminating in the almost  entire  change  of the
muscular structure.
   Treatment.—Rheumatism in many  cases  is a difficult
disease to manage, and various plans  of treatment have
been recommended for it.   In a large majority of cases,
if normal  secretion is established, the local  disease will
readily yield, but in some forms it still persists.  In slight
cases of the disease but a few days will be  necessary to
effect a cure,  but in  the  more aggravated  cases  it will
require from two to six weeks.
   In  rheumatic fever, give the  patient the special seda-
tives as heretofore recommended, using the hot foot bath,
spirit vapor bath, or hot blanket pack.   After one  or two
days,  give a solution  of acetate or nitrate of potash; half
an ounce  to four ounces  of  water; a  teaspoonful  every
three  hours; and half  teaspoonful doses of tincture of
black cohosh at the same intervals.
   The same treatment may be  adopted in inflammatory
rheumatism,  but in addition  we will  require some local
application to the parts affected.  Common coal-oil makes 
336                   SCROFULA.

almost as good a liniment as I have ever used.   Bathe the
part freely with it every two  or three  hours, and keep it
wrapped up in new cotton. The liniments named under the
head of medicines Nos. 87, 88 and 89, may be used for
the same purpose.
  In sub-acute and chronic rheumatism, I would recom-
mend the following:  Take iodide  of potassium, extract of
conium,  equal parts,  one drachm;  tincture  of  black
cohosh, one ounce;  simple  syrup, three ounces; and give
a teaspoonful every three hours.   In some  cases a simple
solution of acetate of potash will be all the internal med-
icine necessary.
  Especial attention should be paid to the skin  in chronic
rheumatism, the. patient having his daily bath, with brisk
friction, and having the affected parts well rubbed with
some of the preparations above named.  If the spice bush
grows in your section of country, gather the berries, press
the oil from them, and use it; it is one of the best reme-
dies.  But if you can get the advice of a good physician,
it will generally be found the cheapest  and best in the end.

                     SCROFULA.

  Scrofula, or king's evil, is one of the most common dis-
eases met with, and may be regarded as an evidence of feeble
vitality.  It is one of the most serious of diseases, though it
does not always prove fatal.  The causes that tend to produce
scrofula  are  all such as tend to depress vital power, and
impair vital resistance.  Thus Magendie found that this
state could be produced by confining animals in the dark,
and in ill-ventilated  places, and by feeding them innutri-
tions food.
   Scrofula is said to be hereditary;  and so it is in this,
that the child inherits a defective vitality, which  mani-
fests itself in imperfect elaboration of the  blood, and en-
feebled vitality of tissues and organs.   Such persons may
live for  years without any manifestation  of the disease, 
SCROFULA.                   337
simply because there has been no cause acting to further
depress vitality, or determine scrofulous deposit.  Finally,
however, from arrest of secretion or other cause, the sys-
tem is depressed, and an irritation of some part being set
up at the same time, we have full  manifestation of the
disease.
  If we have correctly stated the pathology of the disease,
what  measures may be adopted to remove this predispo-
sition ?  Some contend that  it can  not be removed; but
we  have evidence  sufficient  to show that it can be en-
tirely eradicated.  To  accomplish this we resort princi-
pally  to hygienic measures, such  as will stimulate healthy
digestion, secretion, and innervation.  Remove  the  child
to the country, let it  have plenty of out-door exercise,
with accompanying light and sunshine—give it nutritious
food,  and eschew condiments, pastry,  and sweet-meats,
and the entire constitution of the child will undergo a
change.
  Scrofula  manifests  itself in various ways;  very fre-
quently the deposit commences in the lymphatic glands;
sometimes in the viscera, as of the lungs, liver, brain, etc.;
again in the  bones, in the muscles, in the skin—in fact,
in all  the tissues of the body.   The determining cause of
the deposit is  undoubtedly an irritation of the part,  caus-
ing determination of blood.
  Symptoms.—The symptoms of a scrofulous constitution
are  not well marked, though it has been frequently de-
scribed  as  if  it were.   It is true, that it occurs most fre-
quently in children  of  fair skin, blue eyes, light hair, and
regular features;  but it is so often  met with in persons
of dark skin,  hair and eyes, irregular features, and rough
development, that it is impossible to say, by a child's ap-
pearance, whether it is  scrofulous or not.  There is, how-
ever, in very many cases, such manifest imperfection in
assimilation, circulation, and nutrition, and feeble vitality,
that we are enabled to recognize the scrofulous constitu-
tion.  Usually, the previous  history of the  family will
      22 
338
SCROFULA.
throw some light on the matter;  but, as Prof. Powell has
well demonstrated, the  scrofulous constitution may be,
and is, often developed in  children by incompatibility of
the parents.
  Scrofula  manifests itself when, from  any cause, the
vitality of the system is so  depressed that the blood is not
properly elaborated, or the detritus of  the  system is not
removed, either by an imperfection in the process of ret-
rograde  metamorphosis, or by failure  of the  excretory
organs.  The situation  is determined, in all cases, by the
existence of a local irritation or inflammation in or adja-
cent to the parts affected.   Thus, we observe scrofulous
deposit,  and disease  of the  cervical  lymphatic glands,
from disease or irritation of the mouth or throat; involve-
ment of  the axillary glands, from  disease of the arm or
breast;  of the inguinal glands, from disease of tbe lower
extremity, or genital  organs; of  the mesenteric  glands,
from disease of the bowels;  of the lungs, from irritation
produced by cold ; and in the muscles and bones from the
same causes.  It  might be divided into two forms, as  it
occurs in the lymphatic glands, or as a deposit in the
form of tubercles in the structure  of a part; but no prac-
tical benefit would grow out  of such distinction.  As we
have in  other  places described scrofulous  or  tubercular
affections of the principal organs, we will confine our-
selves  here  to a description  of it as it affects the lym-
phatic glands.
  In many cases  the irritation, giving rise to the develop-
ment of scrofula, is very manifest, and occasionally demands
treatment;  but  in  others  it is very slight.  The superfi-
cial  lymphatic   glands  are   then observed to become
slightly  enlarged and hard,  so as to be very perceptible
when the finger is passed over them.  This occurs fre-
quently, in scrofulous children, in the superficial cervical
glands, without  further development,  and  is  considered
by many as the best indication  of a scrofulous constitu-
tion.   When the disease is fully commenced, one or more 
SCROFULA.
339
 of the glands continue to enlarge, a low form of inflam-
 mation sets in, and deposit  takes place  in the adjacent
 tissues, which  become swollen  and hard.  Now the in-
 flammation becomes more or less acute, the part  is red-
 dened, painful, hot, tender on pressure, and the swelling
 increases rapidly.  Continuing in this way for a longer or
 shorter time, suppuration commences, and the deposit is
 gradually changed into pus, which in time makes its way
 to the surface, and  is  discharged.   This occupies a varia-
 ble period of  time, sometimes  passing  through  all its
 stages in eight or ten days, and at others occupies as
 many weeks.   In  some cases the inflammation  is acute
 and the pain severe, but in others  it progresses without
 much redness, heat, or pain.
   The pus forms slowly in many cases, and  there is  but
 little  tendency to its discharge;  and in others weeks pass
 over,  the part  still continuing hard: and, at  last,  when
 our patience is nearly exhausted, suppuration  occurs rap-
 idly.   Sometimes the  pus is well  formed and healthy,
 and  when discharged, the  part heals  readily;  but at
 others it is watery, of a  greenish-brown color, or  clear,
 with  more or less flocculent material  mixed with it.  Oc-
 casionally the  abscess  exhibits no tendency to point, but
 the pus  burrows in the tissues for a long time, unless it
 is opened.  In other cases, when the pus *is discharged,
 the abscess does not  heal, but  continues to discharge a
 dirty, flocculent pus; and if  we  examine it, we will find
 the walls ragged, and often a chain of lymphatic glands
 dissected out, and lying at the bottom.
  The constitutional disturbance varies greatly.   Some-
times  there is quite  brisk febrile action when inflamma-
tion first comes up, with loss of  appetite, arrest of secre-
tion, and much prostration.   In  these cases, suppuration
is frequently marked with a  chill or  rigor, and occasion-
ally attended with  hectic fever and night sweats.  In
other  cases, there is no constitutional disturbance further
than loss of strength, and some derangement of secretion, 
340
SCROFULA.
languor,  and  a peculiar  pallid appearance  of the sur-
face.
  Treatment.—When children are predisposed to scrofula
a judicious hygienic plan should be adopted to strengthen
the constitution, by improving the functions of digestion,
assimilation and nutrition.  Such children are said to be
tender, and hence they are kept in the house a considera-
ble part of the time for fear of colds and sickness, and
being weakly they  are petted, and their appetites pam-
pered; and not spending their time in play, as they should
do, their minds are precociously developed at the expense
of their bodies.  Instead  of this, such children should be
accustomed to the open  air from an early age.   As with
plants, the human species cannot be robust and stout
without fresh air  and sunshine.   As soon as they com-
mence walking they should  play in the  open air when-
ever the weather is suitable.  In this way the constitution
is  strengthened, and the  liability to colds by  alternations
of temperature much reduced.   Sleeping rooms should in
all cases be large, well ventilated, and exposed  to the direct
rays of the sun during some portions of  the day.  Up  to
the age of eight or ten years, the child's occupation should
be out of doors, and whether it was  play or work, it should
be of such a character as to bring into action all the mus-
cles of the body.   Before this age the child should not be
required to study, neither should it be sent to school, there
being sufficient time after this for all laudable educational
purposes.   Regular meals of good, hearty food, with fruits
in their season, with  a  sedulous avoidance of all cakes,
sweetmeats, etc., are of the highest importance.  An ob-
servance of these  rules, the  children being raised in the
country, will almost invariably result in a complete change
of constitution, and such  increased vitality that not only
is the predisposition to this disease  removed, but the child
becomes  a vigorous, hearty man or woman, instead  of
dropping into a premature grave from phthisis or some
kindred affection. 
                      SCROFULA.                   oil

  In the treatment of the disease, the  indications  are to,
1st, improve the quality of the blood,  and raise it above
the point at which scrofulous material  is effused, and  2d,
to promote the absorption and elimination of such mate-
rial as may have been deposited.  To accomplish these
indications various means are resorted  to, according to
the condition of the patient.  Alteratives are relied upon
to a very great extent, and various agents of this class are
employed.  By some the compound sirup of stillingia and
iodide of potassium are considered the  preferable agents,
and are used to a very great extent. My experience has
not been favorable  to  these  remedies, and I have been
compelled to select others.  I now use the rumex crispus,
alnus serrulata, scrophularia, podophyllum, corydalis, and
some two or three other agents, sometimes singly,  or two
or three combined, to suit the indications of the case.
Acetate of potassa is my main dependence  to  promote
absorption and elimination by the kidneys.  I believe it
to be as much more efficient than iodide of potassium, as
this is over epsom salts;  at the same time employing the
bitter tonics, iron, the hypophosphites, and cod-liver  oil.
  Very much depends upon getting proper action of the
three principal emunctories—the  skin,  kidneys and bow-
els.  Great care is necessaiy, however, in the severer cases,
not to over-stimulate and  exhaust these organs.   To re-
store the secretion of the skin I employ—if it is dry and
husky—oleaginous frictions, followed by thorough wash-
ing  with  castile  soap  arid water;  if  soft, relaxed and
flabby, I use the  bitter tonic baths; if there is  deficient
capillary circulation, with  coldness of the extremities,  a
sponge-bath of dilute tincture of  capsicum.
  As a local application to promote resolution, I have used
equal parts of tinctures  of belladonna and stramonium,
and glycerine, or if there is much fever, an equal  part of
tincture of aconite.  In other cases, a wash of equal parts
of tincture of muriate of iron and glycerine may be used,
or the  part may be painted with the iron, and  then fol- 
342
DROPSY.
lowed by the lotion  named.  In  some cases we obtain
good results from the use of the Mayer's ointment or the
black salve; finely pulverized Indian turnip, made into a
poultice, is an  excellent application.  If there is much
heat and redness, we may use fomentations of stramonium
leaves, or a poultice of a decoction of dog-wood and wheat-
bran.  If it is seen that resolution cannot be effected, we
will employ poultices to facilitate suppuration, and if pus
has formed to any extent, instead of permitting it to bur-
row, we will immediately open the abscess.  The poultice
may be continued for a few days longer, until the inflam-
mation has passed off, when it may be dressed with Mayer's
ointment, or other stimulant application, until it heals.  If
it  does not discharge well, and looks ragged,  it will be
best to use a solution  of sesquic'arbonate of potassa until
suppuration becomes free.  And in those cases in which
the healing process  is slow and the discharge thin and
watery, it may also be  employed with advantage.

                      DROPSY.
  Dropsy is an effusion of water into the tissues of the
body,  and is  most usually symptomatic of some other
affection.  In its mildest form it is  called  oedema, and is
most usually seen  in the lower extremities, the feet and
legs being swollen, of a waxy pale color, and pitting on
pressure.  Dropsy of  the  cellular tissues connecting the
skin to  other parts, and  these one to another, is called
anasarca. And the third form of dropsy is that in which
the fluid is effused into the serous cavities—the abdomen,
the chest, the brain, etc.
  Dropsy may be active or passive, in the  first  case being
attended with more or less fever, in the  second without
fever, the tissues being generally relaxed.   The first form
of dropsy is most frequently met with after scarlet fever,,
or during some disease of the kidneys.  The second most
usually occurs as the result of some  local or general de-
bility, and especially of some change in the condition  of 
DROPSY.
343
the blood.  Any cause that depresses the vitality of the
system, lessens the plasticity of the blood, and  causes re-
laxation of the tissues, favors passive dropsy.
  It may result from  disease of the kidneys, they failing
to remove the  excess of water from  the body, or as  in
Bright's disease, removing  a constituent upon  which the
free circulation of  the blood depends.  It may  arise from
disease of the heart, some structural lesion preventing the
free circulation of  the blood, and proving an impediment
to its  return from the veins.  Dropsy not unfrequently
has its origin in disease of the stomach, liver and spleen,
though we can not  see any connection, other than the
effect that prolonged disease would have upon  the blood.
  Dropsy is very frequently curable, and it often sponta-
neously disappears, if the cause producing it is removed.
If, however, it arises from heart disease, or structural dis-
ease of the kidneys, or any of the abdominal  organs, it
will likely prove fatal.
  Treatment.—-It  is not probable, as it would not be wise,
for any person to undertake his own treatment if suffering
from dropsy,  unless it was but temporary.  The  first thing
to be done is to determine  the cause, if this is possible,
and  remove  it.  Thus, if  the  kidneys are at  fault, the
remedies would be directed to them, or if the stomach and
other viscera, they should receive attention,
  In all cases we obtain much advantage from  the use of
a tonic and stimulating bath, and from the internal use of
tonics and nutritious food, and moderate exercise in the
open air.  To remove the accumulations of water, reme-
dies are used  that  carry it  off by way of the bowels and
kidneys.   Thus, if there was nothing to prevent, we might
give cream of tartar, one drachm, and jalap, ten to twenty
grains, two or three times a day, to  produce large watery
operations  from   the  bowels.  As  soon  as  these are
obtained, use  the more active diuretics, as an infusion  of
dwarf elder, or the root of the common elder, or queen  of
the meadow, to induce a free discharge of urine. 
344       DISEASES OF THE RESPIRATORY ORGANS.
  DISEASES OF THE RESPIRATORY  ORGANS.

  The organs of respiration,  as we  have already seen,
consist of the larynx, trachea, bronchial tubes, parenchyma
of the lungs, and the serous membrane that envelops them,
the pleura.  Each  of these may be  the  seat  of disease
either acute  or  chronic, or two or more parts  may be
involved at the same time. As the function of respira-
tion is one  of the most important to life, so are diseases of
these parts serious, as they  interfere with this function.
  We determine disease of these  organs by the general
symptoms  which  they give rise  to,  and by a physical
examination of the thorax and organs contained within it.
The general symptoms arise from change of  function pro-
duced by disease, and the influence it  exerts upon the
system.   They are never constant, and in some  diseases
never entirely sufficient  to  determine the character and
exact seat of the malady.  A physical examination deter-
mines palpable evidence of disease, in  alterations of shape,
movement, and sound, and is always positive in its nature.
  Physical Examination.—The well educated physician
determines the character and situation of diseases of the
chest, by its form, movement, resonance, and the  sounds
produced by the action of the organs within.  As a gen-
eral rule, the healthy thorax presents a marked uniformity
in the contour of each side, the outlines being rounded
and smooth.  The slightest variation in  shape is recog-
nized  by the educated eye, and is used as evidence in
determining the trouble.  The extent and freeness of the
respiratory movement,  determines, to some degree, the
capability of the lungs to properly perform their function.
Variations  from normal action indicate disease, and be-
come  important when associated  with other signs  and
symptoms.
  Cough.—Coughing arises from an irritation of the sen-
sitive  nerves distributed  to the various parts of the respi-
ratory apparatus.  The  purpose fulfilled by the  act of 
DISEASES OF THE RESPIRATORY ORGANS.        345
 coughing, is the removal of irritating matter which may
 be in the air-passages, and in a majority of cases it directs
 our attention to this part of the system as the seat of dis-
 ease.   It  may,  however, be  sympathetic,  arising  from
 disease of the stomach, liver, and other abdominal viscera.
 As the tone  or special character of the cough varies,
 according to the condition  of the  organs by which it  is
 produced, this change in its character becomes an element
 in diagnosis.   A hollow  or barking cough makes the im-
 pression on our mind, that there is lack of expulsive power
 and  want of tonicity in the respiratory  organs.   It  is
 heard in  the last  stages of consumption, bronchitis, and
 sometimes in nervous affections.  When sharp or ringing,
 it is  dependent upon disease of the larynx.  A hoarse
 cough is dependent upon some relaxation, with increased
 secretion,  in  the larger  air-passages.  It is  observed in
 incipient catarrh, croup, chronic laryngitis, and  anginose
 affections.  In asthma the cough is wheezing; in certain
 diseased conditions of the larynx it is belching; and par-
 oxysmal in whooping-cough and hysteria.  It may be dry,
 indicative of want of secretion;  or humid and moist,
 showing that secretion has taken place.
  The character of the sputa may be studied with refer-
 ence  to quantity, quality, consistence, form, composition,
 color, and odor.  The sputa is scanty in the first stages of
 active inflammation  of the  lungs,  bronchii,  larynx,  pha-
 rynx, and posterior nares, and is frequently entirely want-
 ing.   It is also scanty in some cases of  chronic disease—
 as bronchitis,  laryngitis, phthisis,  etc., the  cough being
 dry and rasping. It is more copious toward  the close of
 acute disease, and  very abundant  in many  chronic dis-
 eases  of these organs—as in broncorrhcea, where a pint or
 quart of mucus is thrown off in  the course of twenty-four
hours. In consistence it is serous or watery in the form-
ing stage of bronchitis, pulmonary  congestion, and vesic-
ular  emphysema.  It is  mucous and more or less viscid,
a? tfie result of acute  inflammation of the mucous lining 
346      DISEASES OF THE RESPIRATORY ORGANS.

of the air  tubes, as we see in bronchitis, pneumonia, and
laryngitis.  It is purulent as seen in the third stage of
pneumonia and phthisis pulmonalis; or a muco-pus, as in
some cases of bronchitis.  It sometimes contains small
roundish masses, either tubercles or desiccated mucus—
the difference being determined by the cheesy consistence
of the first, and  the  tenacity of the second when  rubbed
down with wTater.  Blood, either fresh, bright, and fluid, or
dark, clotted, or  broken down, is  frequently a constituent.
  Percussion.—Percussion, popularly known as " sound-
ing the lungs," is employed to determine  the extent  to
which air enters the lungs.  A vessel or body, containing
air, gives a certain degree of  resonance when struck—de-
pending upon the elasticity of its walls, and  the amount
of air contained within it.  A drum is very resonant, be-
cause it possesses these in the highest degree;  a barrel is
less resonant, because its walls are not so  elastic.  Now,
if we fill the drum with sponge, the  resonance will  be
greatly diminished, but it will still exist; but if now we
fill it with water, the sound will be  flat and dull, and
without resonance.   This represents, to some extent, the
thorax; its walls are elastic, and usually the lungs con-
tain a large  quantity of  air, and the  resonance  is very
marked when the walls of the chest  are struck; but in
proportion  as the lungs  become solid from  disease, the
sound becomes dull, until, at  last, it is flat like striking
on the fleshy part of the thigh.
  Auscultation.—In health, the  passage of the  air into
and out of the lungs during respiration, gives rise to two
very marked sounds.  One produced  in  the bronchial
tubes is called the bronchial sound; the other, arising in
the air cells, is called the respiratory murmur.  As these
sounds will vary according to the condition of the part
in which they are produced, so this variation  tells us the
condition of the organ.  Not only so, but adventitious or
abnormal sounds are developed, and are indications of
certain changes  of structure. 
DISEASES OF THE RESPIRATORY  ORGANS.      347
   To the  physician who has thoroughly studied this sub-
 ject, disease of the lungs is as easily determined as if he
 could be  permitted to  remove  and inspect  the  organs.
 Not unfrequently this knowledge becomes a means of
 saving life, by determining a diseased condition in its
 early stage, whilst it may be arrested by medicine  and
 hygienic measures.
   A Bad  Cold.—A cold is the most frequent of com-
 plaints—in  fact,  there is no  one  but  what  has  one or
 more attacks, light or severe,  during the year.  What is
 a cold, and  how is it taken?  Cold  is a partial arrest of
 the secretions, and a sub-inflammatory condition of the
 internal lining of the  body—the mucous membranes.
 The causes of colds are all such as tend to arrest secretion
 from  the  skin, and drive the  blood to internal organs.
 Thus, a person who has temporarily exhausted his vital-
 ity by active exercise, sits down on the damp ground, or
 in a draught, or  takes  off  part of his clothes, and gets
 cool suddenly, and the next day finds that he has " caught
 cold."  Wet feet  is a frequent cause of cold, as  is also
 damp or  insufficient clothing, change from thick to thin
 clothes, and sudden changes of temperature.
   The common symptoms of cold  are usually a stopping
 up of the  head, a dull, heavy headache, pains in numerous
 parts of the body, dry skin, constipated bowels, and some
 loss of appetite.   At times it affects the lower air passages
 to a greater extent, and the person feels an oppression and
weight about the chest, slight difficulty of respiration, and
has more or less cough.  In the first case the more marked
symptoms disappear in two or  three days, leaving nothing
but a disagreeable running from the  nose,  a hawking of
mucus, with sometimes slight headache.  In the second,
the cough  continues for  some days or weeks, with expec-
toration of a whitish-yellow mucus.
  Treatment.—In many cases, at the very  commence-
ment, all that will be necessary is to  have  the feet thor-
oughly bathed in the evening in hot mustard water, drink 
348
QUINSY.
freely of warm ginger, composition  or  pennyroyal tea,
and cover up warmly in bed.   If the bowels are costive, a
couple of podophyllin pills may be taken.  If the cold is
more severe, use the :^irit vapor bath, or blanket pack, or
wet sheet pack, with the diaphoretics named, and follow
the succeeding day with small doses of tincture of aconite,
or a  solution  of acetate of potash.  When the  difficulty
of breathing  and oppression  of the chest is very marked,
I would advise a thorough emetic, using the emetic pow-
der No. 6.

                       QUINSY.

  The tonsils in some persons appear to be predisposed to
inflammation, and from the action of cold upon the sys-
tem  and atmospheric vicissitudes, they suffer frequently
and  severely from this affection.  The predisposition  to
return is the worst feature of the  disease, and  the most
difficult to remove.   Both  tonsils  are usually affected  at
once, or  in succession, but sometimes the disease is con-
fined to one.
  Symptoms.—Quinsy  usually manifests  itself  first, by
soreness and stiffness of the throat, with difficult degluti-
tion, and more or less derangement of the digestive func-
tions ;  occasionally it is ushered  in with a marked chill,
followed by febrile reaction.  There is always some fever,
dryness and constriction of the skin, and general arrest of
secretion.  In a few hours  the patient complains of pain,
and a sensation as if some  foreign  body were present  in
the throat, with  heat  and  constant desire to swallow.
When fully developed, deglutition becomes so difficult and
painful as to occasion extreme suffering, and in some cases
it is  impossible.   A guttural  cough, with frequent desire
to remove the secretion  from the  throat; a hoarse and
difficult respiration, and confused whispering, and guttural
articulation, or sometimes entire loss of voice is observed.
In the severer cases it becomes impossible for the  patient 
QUINSY.
349
to lie down, and  in  many but little  rest is obtained, in
consequence of the difficult respiration when the will is
in abeyance.  If we  examine the throat in this disease,
we will find the tonsils enlarged, and reddened; some-
times so large as to entirely close the opening of the
fauces.
   An attack of quinsy continues for  a variable  length of
time, usual!}' from four to twenty days, and terminates
sometimes by resolution, at others by suppuration.  When
it terminates the last way, the  gland rapidly  enlarges;
there is a dull, throbbing pain  or aching, and a yellowish
color near where  the pus points; usually it  readily comes
to the surface and discharges without assistance, but some-
times it is very slow  and requires the lancet.
   Treatment.—In the first stage of the disease, we direct
the hot foot bath with the free use of a nauseant diapho-
retic, as the eupatorium, small doses of lobelia with infu-
sion of pennyroyal,  sage, etc.  At  the  same  time  the
patient should inhale frequently the vapor of vinegar and
water, of  camphor and  vinegar, or of equal parts of vin-
egar and water holding  in solution a considerable portion
of nitrate of potash.  As a local application to the throat,
the tincture of veratrum, applied with a  probang, two  or
three times daily, or oftener, is the most  efficient remedy
I have ever used  during the first day or two.  Gargles are
not very serviceable  in this stage  of  the  disease, but the
throat may be  cleansed with  dilute  vinegar, solution  of
nitrate of potash, or muriate of ammonia and mucilage.
Warm fomentations  are very frequently resorted to, but
without favorable results; I prefer the simple cold vinegar
pack, or the application  of a cold terebinthinate embroca-
tion.  A brisk cathartic in the early stage is often of  ben-
efit, and occasionally it is necessary to repeat it.
  In the asthenic forms of the disease, occurring in persons
of feeble health, or in those in which  the structures have
been  permanently impaired by its frequent recurrence, a
stimulant and astringent local treatment is better.  Thus, 
350
CROUP.
we direct a gargle of alum, of solution of tannic acid and
capsicum, as heretofore  named, strong  tar water, pyro-
ligneous acid, sulphate of zinc, etc.   In these cases inhala-
tions of camphor, myrrh, pyroiigneous acid, tar, etc., with
vinegar, will be found useful.  Here we find the cups to
be the best external application, followed by warm fomen-
tations of lobelia, hops, etc.
  If the disease continues, after sufficient time has elapsed
to produce resolution, it is better to resort to warm fomen-
tations or poultices, with the  internal  use of demulcents
to favor suppuration.

                      CROUP.

  Croup is a disease of the larynx, or  upper part of  the
air-passages, and is one of the most common diseases of
children.  Though  generally occurring in childhood, we
sometimes see  it in the adult, and occasionally even in  old
age.   It is  divided into three  forms—the mucous, pseudo-
membranous and spasmodic.  All forms  of croup excite
fear  and dread in the minds of parents, and while some
are among the  severest diseases we meet with,  others are
attended with  but little danger.  Spasmodic croup is  the
mildest form,   is of tolerably frequent  occurrence,  and
rarely attended with danger.  Mucous croup is the most
frequent variety, and though a severe disease, it is gener-
ally  managed  with ease, if taken  in  time,  and treated
properly.  Pseudo-membranous  croup is a fearful affec-
tion, and has been attended with a greater mortality than
almost any other disease.
   Symptoms of Mucous Croup.—This form of the disease
is frequently  preceded  by  well  marked  symptoms of
coryza, and sometimes a  stuffing up of  the breast, slight
difficulty  of respiration,  a  cough, and  a general "bad
cold."  The attack  of croup generally comes on at night,
the little patient being restless and  uneasy, and the respi-
ration rough  and  whistling.   Soon  it  awakes with  a 
CROUP.
351
 hoarse  croupy cough  and sensation of choking, appears
 frightened, breathes laboriously, and continues the cough
 until a portion of mucus is raised, when the spasm passes
 off,  and it breathes freer.  In a short time  respiration
 becomes permanently difficult,  and there is  a peculiar
 whistling and gurgling as the  air passes  through the
 larynx.
   The  cough is hoarse, shrill, gurgling, with a  marked
 ringing metallic sound.  The voice  is changed, becoming
 shrill and piping, and at last sinks to a whisper, even the
 cry being whispering at first, terminating in a shrill piping
 sound.  If the child  sleeps, mucus accumulates in the
 throat, the breathing becomes more and more difficult, and
 at last  the  child  awakes  with symptoms  of imminent
 asphyxia.  At first the skin is dry, its temperature slightly
 increased, and the pulse full and hard ;  but as the respira-
 tion becomes  more difficult, a cold, clammy perspiration
 breaks  out, the extremities become cold, and the  pulse
 frequent and  feeble.   The difficulty of  breathing, and
 other symptoms continuing to  increase, the disease termi-
 nates fatally  from twelve  to  forty-eight  hours  from its
 commencement.
   Pseudo-Membranous Croup.—This form of the disease
 comes on slowly and insidiously; the first symptoms being
 a  dry  whistling inspiration, a slight metallic cough, and
 some alteration of the  voice.   These symptoms  continue
 to increase  for two, three, or  four  days, or  more, before
 the final paroxysm, the child meanwhile appearing toler-
 ably wTell, with the exception of the symptoms  named.
 The day previous to the final attack, these symptoms fre-
 quently become so marked as to excite notice, and mild
measures are used for its relief.
  Finally, the respiration becomes  very laborious,  both
inspiration and expiration being hard and whistling.  The
cough is hoarse,  dry,  ringing and  metallic.   The voice
sinks to a  whisper, is shrill  and stridulous.   The ear
applied  to the larynx detects at once  the  evidence  of 
352
CROUP.
stricture, and the want of secretion.   As the disease pro-
gresses, the child is attacked by fits of suffocative cough,
the  lips become  livid, the  countenance congested, the
extremities cold and clammy, coma makes its appearance,
and the child dies.
  Spasmodic  Croup.—This is the  most frequent form of
the disease, and is dependent, doubtless, on slight inflam-
mation, giving rise to spasmodic contraction; cold and
sudden  atmospheric  changes being  the  most frequent
causes.  Like mucous croup, it usually comes on at night,
though  the breathing may have been  difficult, with a
croupy cough and voice, through the preceding day. The
child is usually awakened by  difficulty of breathing, a
hoarse,  ringing, metallic cough, and  a  shrill whispering
voice or cry.  In some cases  there is  slight secretion, but
in others none  at all.  The  difficulty of respiration  in-
creases for a few minutes, or in some eases for an hour or
two,  then  gradually  passes  off;  sometimes there are
marked exacerbations and remissions occurring every few
minutes.  There  is but little derangement  of the secre-
tions  or circulation, and it is not difficult to detect the
spasmodic character of the affection.
  Treatment. — In mucous   croup I  generally employ
equal parts of acetous  tinctures  of lobelia and sanguina-
ria, and simple  syrup, giving  it in teaspoonful doses suffi-
ciently often to produce and  keep up continuous nausea.
Continuing this until, from  the peculiar  loose, gurgling
sound of the respiration  and cough, we  know that the
secretion is less tenacious, we  carry it to thorough emesis.
Sometimes this ends the disease, but at others it is  neces-
sary  to  still continue  the  remedy, and repeat the emetic
two,  three, or  more  times.   As  an adjuvant, though a
very important  part of the treatment,  we use applications
of water and vinegar to the throat,  as hot  as it can be
borne, and renewed frequently;  or the compound stillin-
gia liniment, heretofore spoken of; or a  plaster made by
sprinkling snuff on a cloth spread with lard, or, in  quite 
                        croup.                    3o3

young children, the emetic powder used in the same way.
Counter-irritation to the  spine, with the hot mustard
foot-bath, and the general sponge bath, if the skin is dry
and constricted, are very useful.  Inhalations of vinegar
and water, or of vinegar, tend to relax the parts, and thus
give temporary relief; and by rendering  the mucus less
viscid, they aid the permanent cure.
  In the  pseudo-membranous variety, the  indications are
to produce relaxation, and thus prolong the patient's life,
and give  a longer time for the action  of medicine  to
cause effusion  beneath the false  membrane, and break
down its  plasticity; and  having thus caused  its partial
detachment,  to cause  its removal by an  act of emesis.
To fulfill the first indication, we direct the continuous ap-
plication of flannel cloths, wrung out of hot water, to the
throat, the use of the stillingia liniment; or, if the case is
urgent, the oil of lobelia applied freely.   In addition, I
have found inhalations of vinegar of marked importance,
and in some cases I have added the extract of belladonna
and the tincture of gelseminum.   Cups  to the throat
prove  very serviceable in  many cases; but  rubefacients
should  not be used.  The hot mustard  foot-bath  and
counter-irritation to the spine are also useful.
  Internally, I employ acetous tinctures  of lobelia  and
saniruinaria, each one  fluid ounce; molasses, one ounce;
chlorate of potash, finely  powdered, one  drachm; mix,
and give to a child, two or three years old, a teaspoonful
every five or  ten  minutes, until nausea is  induced—then
less frequently.  If there is much constriction of the skin
and excitation of the  pulse, I  add the veratrum in suit-
able doses.  The  remedy above named should be given
without any fluid either before or after  it, as we desire
its local influence  as it is swallowed, as much as its gen-
eral influence when taken  into  the stomach; in no case
should it  be allowed to produce vomiting until we  have
direct evidence, in the gurgling and flapping  sound of
respiration, that the false membrane is becoming loosened.
       23 
354
CROUP.
If the tendency to vomiting should be strong, I direct the
sin&pism to the stomach, and an infusion  of peach bark
with the nauseant, as an anti-emetic.   A  variable length
of time will elapse  before  the pseudo-membrane will be
loosened sufficiently to be discharged—sometimes five or
six hours; in one case that I treated, sixty hours.   Wben,
from the sound, we are satisfied the detachment is  suffi-
cient to permit the evacuation of all or part, we induce
speedy emesis, usually with an infusion  of our common
emetic powder, as preferable to the agents we have been
using.   The more thorough  and effective  the emetic, the
greater the  chance of safety, though in some  cases we
find the false  membrane thrown up in shreds by cough-
ing, without any indication for an emetic at all.   Usually
the lobelia and sanguinaria, used as above directed, and
continued for  so long a time, act upon the bowels, some-
times giving rise to great irritation ;  in such case, agents
to obviate this must be  employed.  The treatment is
brief,  but nothing  can be  added to it  in our present
knowledge of the  materia  medica,  and  there  are  no
agents we can substitute for those named, and no prepa-
rations of the agents but the acetous tinctures.
  Spasmodic croup is easily treated;  very frequently the
compound tincture  of oils of lobelia and  stillingia, here-
tofore  named, freely applied externally, with  the internal
administration of a drop, every half hour or hour, on a
lump  of sugar,  answers  our  purpose;  or the  warm
onion  poultice to the  throat, with the internal use of
almost any  nauseant, succeeds.
  The  compound of lobelia, named  under the  head of
mucous croup, is very efficient; in fact, the  entire treat-
ment  named  there may be adopted in this case.   Gen-
erally, however, the milder the  measures for relief, the
better it will  be for the patient, as the stronger  agents
so  change  the  action of the bronchial mucous mem-
brane  as to prove a source of difficulty. 
CHRONIC LARYNGITIS.              355
              CHRONIC LARYNGITIS.
   Symptoms.—Chronic laryngitis usually comes on slowly
 and insidiously, the patient  being hardly aware that he is
 suffering from a serious disease, until it is confirmed.  The
 first symptoms are soreness of the throat when speaking,
 with constriction, slight alteration  of  the voice,  cough,
 and expectoration, which comes on after slight exposure,
 or  over-exertion  of the larynx.   These  symptoms  are
 ameliorated in a short time, and the  patient thinks it but
 a. slight cold, from which he is  recovering.  As time
 advances, however, the attacks become more frequent, last
 longer, and do not so nearly disappear.   The disease being
 fully established, there  is a constant uneasy  sensation in
 the region of the larynx, the voice  is  seriously altered,
 and there is  a constantly  annoying cough, with expecto-
 ration.  The expectoration is at first scanty  and mucus;
 but, as the disease advances, it is muco-puriform, sanious,
 concreted  into lumps,  or  consists  of almost pure pus.
 Hemorrhage occurs in the latter stages, sometimes in very
 large quantity.  If the throat is examined, we notice the
 evidence of chronic inflammation of the fauces, pharynx,
 and epiglottis, and we reasonably suppose that the mucous
 membrane  of the larynx corresponds in  appearance; with
 the laryngoscope we are enabled to view the internal sur-
 face of the larynx, and  determine its condition tolerably
 accurately.
  The impairment of the general  health is  usually in
 direct ratio to the severity  of the local affection.  At  the
commencement, the patient  complains simply of debility,
with some failure of the digestive organs, and sometimes
torpor of the  secretions.  When it has progressed for some
months, he is unable to attend to business; there is  loss of
flesh and strength, marked impairment of the digestive
 functions and of excretion.  Now, frequentljr the system
becomes so depressed that tubercles  are deposited  in the
lungs, the symptoms of phthisis are developed, and the
 disease runs a rapid course to a fatal termination. 
356
ACUTE BRONCHITIS.
  Treatment.—Under no circumstances should a person
undertake to treat himself for this affection; better go a
hundred miles and get the advice of a good physician.

               ACUTE BRONCHITIS.

  Bronchitis is a disease of tolerably frequent occurrence,
and, as its name implies, is an inflammation of the bron-
chial tubes.   We may divide it into  two varieties, ca-
tarrhal and  sthenic bronchitis, the first being a mild and
the other a very severe disease.
  Symptoms.—Catarrhal bronchitis commences as a common
cold, the patient feels dull and languid, frequent chilly sen-
sations alternated with flushes of heat, increased secretion
from the nose, dry skin, constipation of the bowels  and
headache.  In a short time  the  patient complains  of  a
sense of dryness and  roughness, and makes  frequent at-
tempts to clear the throat.  A  hard, dry cough, more or
less hoarse, is soon developed, and seems to be rendered
much worse by tickling in the fauces.   The voice is fre-
quently hoarse, there is a sense of tightness and constric-
tion of  the thorax, with slight pain and soreness in cough-
ing or drawing a long breath.  In some  cases the febrile
reaction is quite marked for the first two or three days.
By the second or third day the patient commences to ex-
pectorate a thin glairy fluid, ■which, rising  to the  glottis,
greatly increases the desire to cough.   By the fourth or
fifth day the secretion has increased in quantity, is  yel-
lowish and opaque, and  is  raised with  greater freedom.
The constitutional symptoms now disappear, though the
cough may continue for several days, and the patient soon
recovers.
  Sthenic bronchitis is frequently  preceded for a short time
by  coryza, oppression of the chest, languor, listlessness,
arrest of  the secretions,  etc.  In a short time  marked
chills or rigors are noticed, sometimes the chilly sensation
will continue for twelve or  twenty-four hours, not very 
ACUTE BRONCHITIS.
357
severe, but annoying to the patient.   The chill is followed
by fever, generally remittent in character, being the high-
est in the afternoon and evening; the skin is hot, dry and
husky, the pulse frequent and hard, the mouth dry, tongue
coated white and contracted, bowels constipated, and urine
scanty and high colored.  With the first appearance of
febrile reaction, a hard, dry and deep cough makes its ap-
pearance, the respiration becomes laborious, and there is
dyspnoea and oppression of the  chest.  Generally within
the first  twenty-four hours a dull pain is experienced on
coughing.
  Expectoration commences from the third to the sixth
day.  At first it is a clear,  transparent mucosity, secreted
in small quantity, and raised with difficulty.   In a day or
two it is a tough, glairy mucus, resembling white of  egg,
and in most cases streaked with blood.  As a general rule,
it may be stated, that the  greater its tenacity, the more
intense the inflammation of the mucous membrane secre-
ting it.   This mucus is expectorated with difficulty; it ac-
cumulates, gives rise to cough, which is much protracted,
lasting sometimes for minutes before the  adhesive mucus
gives way.  The physical signs have not yet changed ma-
terially, though the sibilant rhoncus has become modified,
and as mucus accumulates previous to coughing, is chang-
ed to a mucous sound.  The febrile symptoms are still in-
tense, and the difficulty of respiration and oppression of
the chest as great.
  From the fifth to the eighth  day a marked change  is
noticed  in the  mucus expectorated; it  now contains
opaque, yellowish, greenish or white masses, suspended in
the  glairy mucus.   These increase in quantity as the dis-
ease  progresses,  until the entire expectoration possesses
these properties.  With this change in the expectoration
the fever gradually abates, the secretions are restored, the
appetite returns, the patient rests at night, the cough not
being so troublesome, and the breathing becomes easy.
The amendment continuing, by the eighth to the twelfth 
358
CHRONIC BRONCHITIS.
day the patient is convalescent.   This may be said to be
the natural course of the disease; but these changes can
be very much accelerated by medicines, and the disease
made to run a much shorter course.
  Treatment.—The treatment of catarrhal bronchitis will
be nearly the same as that laid down for cold, further than
it will be well to apply hot fomentations to the chest, and
give the aconite and veratrum.  In the severer cases, com-
mence with the  use  of the spirit vapor bath, common
vapor bath, or blanket pack, giving freely an infusion of
boneset, or similar agent to  produce sweating.   Put the
patient in bed and give of an infusion of the emetic pow-
der,  a tablespoonful every hour, or sufficient to induce
nausea, and  continue  it until the patient commences to
expectorate freely.  In addition to this, add tincture vera-
trum thirty drops, tincture  of aconite twenty  drops, to
four ounces  of water,  and give a  teaspoonful every hour
or half hour to control the fever.
  Much benefit is obtained from the use of the hot fomen-
tation, or a poultice of bran or cornmeal applied to the
chest.  In some cases we use dry cups.  We also  use the
alkaline bath sufficiently often to keep down excessive
heat of the skin.   When expectoration commences, or
even at first, we may use the compound sirup of lobelia,
No. 82, to control the cough, and  facilitate expectoration.
If expectoration becomes abundant, use the stimulant ex-
pectorant, No. 85.

              CHRONIC BRONCHITIS.
  Chronic inflammation of  the bronchial mucous mem-
brane is  of frequent   occurrence, and may result from
many causes.  A badly treated acute bronchitis may ter-
minate in the chronic form, or an inflammation of the
lungs may set up a subacute bronchitis which will  con-
tinue after the original disease has subsided.  The most
frequent cause is  doubtless the neglect of catarrhal bron-
chitis ; the acute  symptoms ceasing, the  patient pays but 
CHRONIC BRONCHITIS.
359
 chitis; the acute symptoms ceasing, the  patient pays but
 little attention to  the cough, and the persistent chronic
 disease is the result.  In many cases  the progress of the
 disease is slow and insidious, in others  quite rapid.  In
 the first  case  the  patient is troubled with cough during
 the winter and spring months whenever exposed to the
 cold, but which passes away  with the  return  of  wTarm
 weather.  The next winter he seems  to catch cold easier,
 and the cough is  more  persistent, and does not entirely
 disappear during the summer.  With the return of cold,
 changeable  weather, all the  symptoms are aggravated,
 and the  general health  suffers, the disease being perma-
 nent.  Thus one,  two,  or more years may be required
 for its development; in other cases it follows "the cold
 in the chest,"  or the acute attack.
   Symptoms.—In  chronic bronchitis, we have both  local
 and general symptoms.  Cough seems to  be at once the
 most characteristic as well as troublesome feature.  The
 cough is persistent and annoying, generally of a  deep
 bronchial character, but  sometimes short and hacking, at
 others, asthmatic.   It is dry  or moist,  depending  upon
 the  amount  of  secretion from  the bronchial mucous
 membrane.  Sometimes  it is  attended by a dull, heavy,
 aching pain, or sense of soreness on coughing.  At others
 the chest is entirely free  from pain.
  Expectoration varies greatly  as regards quantity and
 appearance.   Sometimes it is very  scanty, the cough being
 dry and harsh; at  others there does not  seem to be any
 great accumulation in the  bronchial tubes, though expec-
 toration in moderate quantity attends each  paroxysm of
 cough; lastly, we observe cases in  which expectoration is
 profuse, the  patient being obliged to cough to remove the
 accumulations from the  chest.  We thus divide chronic
bronchitis into two marked varieties: bronchitis with deficient
secretion, and bronchitis with profuse secretion.  The material
expectorated varies from  a thin, transparent, adhesive mu-
cus, to a yellowish or greenish opaque mucus or muco-pus. 
360
CHRONIC BRONCHITIS.
  Treatment.—The treatment of chronic bronchitis may
be properly divided into general and local, and as much
importance attaches to the one as the other. Of course the
general treatment will have to be varied according to the
complications;  but the following points deserve especial
attantion: The appetite  and digestion  being frequently
impaired, it is necessary to administer such mild tonics as
improve  the  tone  of the digestive  apparatus, and at the
same time improves the quality of the blood.   Frequently
these can be selected with reference to their action, either
direct or indirect, on the pulmonary  mucous  membrane.
The bitter tonics,  the mineral  acids, hypophosphites and
nux vomica, are found important curative means.  The
excretions must be restored, and to accomplish this the
milder agents are  of greatest utility. The bowels being
constipated, mild laxatives are indicated.   The secretion
of the kidneys affected, those  agents termed alteratives,
that are  known to facilitate this secretion, are the best
adapted.  The  skin demands our especial  attention, from
the  intimate sympathy existing  between  this membrane
and the  mucous lining  of the  body.  If it  is dry and
harsh, the  use of the  alkaline sponge-bath, with brisk
friction,  seems to be of much benefit; if there is imperfect
capillary circulation, with coldness of the  extremities,  the
capsicum bath is important; and if there  is much relaxa-
tion, the addition  of an infusion of some bitter tonic, or
astringent.  Iron is useful in oases of anaemia or imperfect
nutrition, the hypophosphites, sulphur, and quinia, when
there is deficient innervation, and  nux vomica or other
permanent stimulant when the patient exhibits an apathy
not accounted for by the symptoms of the disease.
   Those cases in which the expectoration is scanty, or in
which the cough  is dry and harsh, are benefited usually
by the employment of nauseant expectorants, to increase
secretion.   The lobelia,  sanguinaria, ipecacuanha,  etc.,
can be employed for this purpose with advantage; and it
is generally a good plan to combine with  them a demul- 
INFLAMMATION OF THE LUNGS.
361
cent, to relieve the dryness and irritation of the throat and
fauces, and a narcotic to allay the morbid irritation of the
nervous system.
  In many cases the compound tincture of oils of lobelia
and  stillingia, in drop  doses every three hours, is  an
effectual remedy for the cough.  In other cases I would
recommend compound  syrup of lobelia, No. 82, or the
compound syrup of elecampane, No. 84.   Sometimes  in-
halations  of various kinds will prove advantageous; but
they will have to be used under the care of a physician.

        INFLAMMATION OF THE LUNGS.

  Inflammation of the parenchyma of the lungs is a dis-
ease of frequent occurrence; and involving, as it does, so
important a structure, its effect upon the general system
is  proportionately severe.  The  extent of the inflamma-
tion varies in different cases; sometimes but a portion of
one  lung is involved;  at others, one entire lung; and,
lastly, both  lungs may be involved in the disease.   If the
inflammation is confined to one lung, it is termed single;
if  it affects both, double pneumonia—the last being a very
severe disease.
  Pneumonia is, in a large majority of cases, produced by
cold; in the exceptional" cases, by  irritant  materials in-
haled, or as the result of injury.  The action of cold upon
the system, and its influence in producing  disease, has
been already considered, and it is only necessary to notice
here that previous exhaustion, and  sudden arrest of the
cutaneous secretion, are almost invariably noticed.
  Symptoms.—Generally the  disease is  preceded for a day
or two by premonitory symptoms, as—oppression of the
chest, quickness and shortness  of breathing, quick, short
cough, dullness and languor, occasional sighing, and more
or less chilly sensations  and coldness  of the extremities.
The inflammation is usually ushered in by marked  chills
or rigors, continuing from one to two or more  hours. 
362          INFLAMMATION OF THE LUNGS.

There is now an increase of the symptoms before named,
general uneasiness,  and a dry and  suppressed  cough.
With the disappearance of the chill, febrile reaction comes
up, the pulse is frequent and hard, the skin dry and hot,
appetite impaired, tongue  coated white, bowels  consti-
pated, and  urine  scanty.  Respiration is more short, fre-
quent, anxious  and difficult, and attended with unusual
expansion and elevation  of the chest; there is a frequent
short cough, and increased warmth and moisture of the
expired air.  Upon auscultation we find that the respira-
tory murmur is replaced  by the crepitant rhoncus, there is
no bronchial sound, and no dullness on percussion.  Dur-
ing this period the cough has been dry; or, if any expec-
toration, it is thin, transparent, or frothy.
  By the third  or fourth day, we find that the patient is
unable to  take a deep inspiration, respiration being per-
formed principally by the diaphragm and abdominal mus-
cles.  He  lies, in preference, upon the affected side, or, in
double pneumonia, upon  the back.   There is a constant
feeling of  uneasiness rather than pain in the chest, with
anxiety, sense of  constriction,  weight and fullness,  and of
internal heat.  In some cases there is constant restless-
ness, with  frequent  attempts to elevate the  head  and
shoulders.   Now, the crepitant rhoncus disappears, and is
replaced by a mucous  rhoncus; percussion gives increas-
ing dullness over that portion of the lungs  involved in
the inflammation.  This indicates  hepatization,  which,
increasing,  gives  rise to  extreme dullness on percussion,
and to a remarkable clearness  of the bronchial sound, and
to broncophony.
  The  cough, which has generally increased up  to this
time, is now attended  with expectoration of an opaque
mucus,  which becomes characteristic about  the fifth or
sixth day.   The sputa is  of a  yellowish, reddish, or more
frequently,  rusty tinge,  semi-transparent, tenacious and
globular; when discharged into a vessel, it runs together,
forming a  single mass, so tenacious  that the vessel may 
INFLAMMATION OF THE LUNGS.
363
be inverted without detaching it.  The rusty sputa has
been considered as pathognomonic of pneumonia.
  By this time the dyspnoea is much increased, the inspi-
rations being obviously short and  quick.  If the disease
is extensive, the  oppression  becomes  urgent,  and the
sense of weight  and  anxiety are extreme.   About the
fifth or sixth day, in favorable cases,  the disease com-
mences to decline, the inflammation terminating by reso-
lution.  The cough becomes looser and less  distressing;
the expectoration less viscid and rusty-colored, and more
abundant, resembling  the sputa of bronchitis, the pain
and  dyspnoea are gradually relieved, the febrile  symp-
toms  disappear, and the patient is convalescent at about
the seventh to the ninth day of the disease.
  Otherwise, the hepatization goes on, the dyspncea is in-
creased, and so urgent is the call for  breath,  where a
large portion of the lung is involved, that the patient has
to have the head and  shoulders raised, and call  into ac-
tion the external  inspiratory muscles.   The  inspirations
are short, forced and rapid, sometimes from forty to sixty
per minute.  The cough is persistent and extremely an-
noying, the viscidity and color of the sputa corresponding
to the intensity of the disease.  The general symptoms
correspond with the local, the pulse is  increased in fre-
quency to a hundred  and twenty,  or even a hundred and
forty  beats,  per minute, and  is small  and hard, or soft
and fluent;  the skin  is  hot, dry and rough;  the tongue
is heavily  coated with a brownish, offensive mucus, which
becomes darker as the disease advances, sordes appearing
around the teeth.   The patient becomes delirious, at first
but partially, and for a portion of the day; but finally it
becomes continuous, and sinks into a low, muttering de-
lirium, or  into  coma.  The symptoms above named ex-
tend over a period of one or two weeks, sometimes com-
ing  on rapidly,  in  others  very  slowly;  the  disease
terminating  fatally in  some by the twelfth day, in  others 
364
INFLAMMATION  OF  THE LUNGS.
in three or four weeks; or the patient recovers after this,
having worn the disease  out.
   Treatment.—Inflammation of the lungs does not gen-
erally require very active treatment, mild measures seem-
ing to answer a better  purpose.  It has  been proven  by
numerous experimenters  that  a very large proportion of
cases would recover with but simple diet  and rest, without
the use of medicine.  As an instance, Dr. Deitl  gives the
results of 380 cases of inflammation of the lungs, of which
85 were treated by blood-letting, 106 by tartar emetic, and
189 by diet and rest alone.   Of those  treated by blood-
letting,  17, or  20-4  per  cent., died; of  those treated  by
tartar emetic, 22, or  20-7 per cent., died; whilst of those.
treated  by diet and rest alone, only 15, or 7*4 per cent.,
terminated fatally.
   These are facts, and not only show that inflammation of
the lungs will  get well without medicine, but it proves
conclusively that the old fashioned practice  was wrong,
and justly chargeable  with a large per centage  of the
deaths;  that instead of being of any service, doctors were
chargeable with killing  every other man that  died with
the disease.  This is a  pretty strong statement, but it is a
true one, and is fully borne out by many of the best wri-
ters on medicine.
   The treatment named for bronchitis might be adopted,
but I should prefer simple medication.   Have the  person
frequently bathed with the alkaline wrash, to prevent un-
due  heat  of the skin, and apply a poultice  of bran  or
cornmeal to the chest, changing it twice a day, keeping
the patient well covered.  Give internally, tincture vera-
trum one drachm, tincture of aconite twenty drops, water
four ounces, a  teaspoonful every hour  until the fever is
subdued, and  then  in smaller doses.   On the third  or
fourth day  add a solution of acetate   of potash in the
usual doses.
   The patient's bowels should be kept regular, but active
physic should  be  avoided.  If the  cough proves very 
ASTHMA.
365
severe, give a sufficient dose of opium to give the neces-
sary sleep.  Let the patient's food be light and nutritious.
Keep  the room well  ventilated, and everything scrupu-
lously clean.

                     ASTHMA.
  Symptoms.—The symptoms of asthma are so marked
that an extended description is unnecessary.  In some
cases the attack is preceded for a day or more by a loaded
tongue, some pain and weight in the head, and a feeling
of languor, but in others there are no premonitory symp-
toms.  The disease is sudden in its  onset, the patient be-
ing aroused at night by a feeling of impending suffoca-
tion, or forced to  throw open the windows and doors in
order to get breath.  Usually it comes on gradually, at-
taining its  greatest violence in  two, three or four days,
and as gradually disappearing.   We find a patient suffer-
ing from an attack of asthma with the head and shoulders
raised and thrown forward, the breathing remarkably dif-
ficult, wheezy, laborious and prolonged, and anxiety and
evidence of imperfect aeration of the blood, proportioned
to the severity of the disease.
  Sometimes there is markedly increased secretion, the
air-passages seeming to  be loaded with  mucus, at others
the respiration is  shrill and whistling.  Cough is present
in nearly all cases, sometimes very severe and prolonged,
giving rise to very great difficulty of breathing, and ag-
gravating the patient's suffering, at  others short, and oc-
curring at unfrequent intervals.
  The duration of the paroxysms is very variable, some-
times but  a few hours,  at  others  days or even  weeks.
Their recurrence, too, varies  greatly even in the same
cases; in some the patient is hardly  free from the  disease
from autumn until summer.  Rare cases are met with in
which the one attack having been arrested, the patient is
not predisposed to its recurrence, but in a large majority
the disease becomes constitutional, and an attack of asth- 
366
CONSUMPTION.
ma is the result of any indiscretion, or sudden change of
weather.
  Treatment.—The treatment of asthma is very properly
divided into the palliative and curative, or treatment for the
relief of the paroxysm, and that for the radical removal
of the predisposition to asthma. To relieve the paroxysm
many means have been made  use  of.   One of  the most
efficient is the lobelia, which may be given in the form of
the tincture, from half to one  teaspoonful for a dose, or
the emetic powder in  infusion, in  quantities sufficient to
produce nausea.  Ipecacuanha in nauseating doses, with
small portions of opium, sometimes answers the purpose.
Powdered lobelia herb, stramonium or jimson weed, and
the mullein, have been recommended in asthma, smoked
in a common tobacco  pipe, and I have known them to be
used with good results.  Nitrate of potash or saltpetre is
one of the  best remedies I  have ever  employed; dis-
solve  it in boiling water as long as the water  will take
it up, and then  saturate common brown paper with it, let
it dry, and during the attack burn it in the patient's room,
letting him inhale the smoke.
  It is very difficult to remove the predisposition to asth-
ma, and in some cases it is impossible.  Various means
have been recommended as specifics, but  so far they all
have failed.   The treatment must be conducted on gene-
ral principles, determining, if possible, the cause, and re-
moving this.   It  would be  useless  to name, individual
remedies for asthma in a work of this  kind, as they would
be used wrongly twice where they would be used properly
once.
                  CONS UMPTION.

   Of all the diseases to which mankind  are  subject, none
makes such  ravages  as consumption.  It spares neither
the high  nor the  low, the rich nor the poor—from  all
classes of society it gathers  its  victims.  How many
hearths have been darkened by this fell destroyer the past 
CONSUMPTION.
367
year—how many bright hopes crushed to the earth; and
still, how many have the dark shadow thrown over them
at present!   It  is an  insidious  disease,  stealing on  the
doomed unawares, flattering him with  false hopes, sooth-
ing him with illusory amendments,  until, finally, he is
placed beyond the reach of aid.   Most other diseases cast
their shadows  before;  their  influence is  evident, their
symptoms sufficient to arouse the sufferer to a sense of his
danger before  serious  change  has taken place.  This
almost always  gives little alarm; there  is but little  suf-
fering ; a gradual sinking of vital power, a  gradual depos-
ition within the substance of the  lungs of a material which
will finally destroy them, the mind still remaining bright
and clear,  as if  it had  no connection  with  the  gross
materials of which our bodies  are composed.  What is
most strange of consumption,  is,  that though it  is all
around us, though it has  entered our  own houses, taken
its victims from our  own firesides, robbed us of friends
and relatives, yet we  do not seem  to  have a wholesome
fear of it—a fear that would lead us to inquire into its
nature, its causes, or the  means by which  we may ward
off its attacks.
   What  is consumption ?   It is the generally received opin-
ion that consumption, or  phthisis pulmonalis, is  a disease
affecting the lungs exclusively,  having there its  primary
seat, and only  incidentally affecting  the general system.
Not only is this the  generally received theory, but  the
practice of many is based upon  it.  Medicine is given for
the influence it produces upon the lungs, and very  many
times for no other purpose.  I will endeavor to show that
this opinion is  not correct; that consumption  or disease
of  the lungs is  a secondary  affection, being  invariably
produced by deficient vitalization of the blood; that it is
principally a disease of the blood; and that  the  removal
of this diseased  condition is  the  principal object  to be
accomplished.
  The blood is composed of  red globules, albumen, fibrin, 
368                  CONSUMPTION.

salts, and  water; so long as these elements are properly
elaborated and exist in normal proportion, it is impossible
for any of them to be deposited in the structure of organs
as tubercle.   And why?  Tubercle is composed of albu-
men and fibrin derived from the blood; and an examina-
tion of this shows that it has been imperfectly elaborated.
We also find, even in the first stages of consumption, and
previous  to  the commencement of the  disease, marked
symptoms  of an imperfect vitalization  of  the  blood.
Lastly, we may cause the deposition of  tubercles  in the
lungs and other parts of the body of animals, by placing
them in such conditions as prevent  the  proper formation
of this fluid.  Rabbits confined in a dark, damp room, and
insufficiently fed, or obliged  to  live on  food  difficult  of
digestion,  invariably  have  a deposition  of tubercles  in
some part of the body, the blood being scanty in quantity,
watery, pale, and imperfectly formed.  Of seven dogs con-
fined for twenty-six days in a cellar imperfectly ventilated
and dark,  and fed exclusively on vegetable food, five had
tubercles  deposited in  the lungs; in all, the blood was
deficient, both in quantity and quality.  Numerous exper-
iments, similar to  the above, are on record, and the results
in all are the same.
   We find, upon examining into the previous history of
consumptive persons, that there was invariably a depressed
condition of the system, arising from impoverishment of
the blood, deficient innervation, and imperfect digestive
power.  This deficiency of vital force  may  have been
hereditary, or it may have been produced by some depress-
ing cause, as previous disease, sedentary habits, living  in
ill-ventilated houses, improper  food, privation,  severe
mental exertion, the depressing  emotions, etc.   We used
to hear of persons " going into a decline;" and it will be
found that this decline precedes the deposit of tubercles  in
the lungs in  all cases, though in some it is much better
marked than in others.   To state the case fairly, then, we
believe it is conclusively proven that there must be a 
CONSUMPTION.
369
 change in the blood before  tubercles can be deposited  in
 the lungs;  that this change consists in a  want of due
 elaboration  of the fibrin and albumen—in fact, a want of
 due vitalization of this fluid.
   In  addition  to this  change in the constitution  of the
 blood, there must he some cause to  determine the deposit
 of this devitalized albumen in the substance of the lungs.
 This cause is some irritation of these organs, which would
 determine an increased circulation  of blood  in them; as,
 for instance, a protracted cold in the chest, chronic bron-
 chitis, irritation of the  nerves, producing chronic cough,
 etc.   Without  this  irritation, the  lungs will not be the
 seat of the deposit of tubercle.  Thus we find that where
 this depression of the system and want  of elaboration  of
 the blood exists, but no irritation of the lungs, tubercles
 may be deposited in other places; as where there is great
 irritation of the bowels in childhood, it will  be deposited
 in the  mesenteric glands, producing tabes mesenterica, or
 abdominal  consumption; or  if  there is irritation of the
 liver, the spleen, the  brain, etc.,  the  tubercles will be
 deposited in those organs.
   " The following," says Dr. Copeland, an eminent author-
 ity in  medicine, " may thus be inferred  as the successive
 or morbid  phenomena  resulting from the action of the
 causes of phthisis, wThether occurring singly,  or in various
 combinations, or in succession:  1st.  Depression of the
 organic, nervous or vital power of the frame,  or an imper-
fect development of this power, owing to hereditary or
congenital, or to more immediate or direct causes opera-
ting in  early or advanced  epochs  of  life.  2d. Morbid
states of the circulating fluids, especially of the chyle and
blood, commencing with the  slow or imperfect develop-
ment of the chyle globules, and followed by a  slow or
impaired metamorphosis of these and of the blood glob-
 ules, or of the former into the latter—the plasma or liquor
sanguinis, with its fibrin, being  deficient in vital endow-
ment.  3d. A wasting or diminution of the red  globules,
         24 
370                  CONSUMPTION..
and an  impairment of the vital  endowment  of the blood
by excessive secretion and excretion from the lungs, skin,
and bowels."
  Causes of Consumption.—The causes of  consumption
may be divided into two classes, predisposing and exciting.
By a predisposing cause, I mean one that has a tendency
to lower the vitality of the body, and  prevent  that due
elaboration  of the  blood, upon which good health de-
pends.  By an exciting cause, one that will produce irrita-
tion  of  the lungs, cause determination of blood to them,
thus causing  deposit of tuberculous matter within their
structure.  The share  which these two  classes of causes
have in the  production of tubercle, varies  in  different
cases.   When the person is little exposed to the exciting
causes, the constitutional predisposition may be long pres-
ent without  any local  affection, while  continued expo-
sure to exciting causes may determine  the  local disease
when the  morbid state of the constitution exists  in a
slight degree.  We have examples of the former among
the wealthy classes of society, where we see  the tubercu-
lous cachexia prevail for  a considerable time without the
actual development of tubercles,  because the person is
little exposed to  the  usual exciting  causes,  and  even
sedulously avoids  them;  and wre meet with instances of
the latter among the poor, when engaged in occupations
in the exercise of which the lungs are peculiarly exposed
to irritation, by which a  diseased state  of the bronchial
mucus membrane, and  ultimately tuberculous disease, are
produced.  The most striking examples of  consumption
which have been adduced, as the  consequence of pulmo-
nary irritation,  occur in persons who  are  at the  same
time exposed to some of the most powerful causes of tu-
bercular cachexia, such as  sedentary occupations carried
on in a confined and  deteriorated atmosphere, and very
often also to  excessive indulgence in the use of ardent
spirits; so that they are exposed to the causes of the con-
stitutional and local disease at the same time. 
CONSUMPTION.
371
  Hereditary Predisposition to Consumption.—That chil-
dren inherit a predisposition  to  consumption from  their
parents, is a well-established fact.  Thus, wTe rarely see a
family where the father or mother has died of this disease,
but what the children  exhibit  evidences of the tubercu-
lous constitution.  We also find that where, from chronic
disease, or from  excess of any kind, the health  of either
of the parents has  suffered greatly, the children will, in
many cases, be  deficient in vitality, and predisposed to
consumption.  Dr.  Powell,  in writing  on this subject,
says : " The amount of disease and premature death that
is  entailed upon society by the marriage of  unhealthy
persons, is such as to demand, on the part of society, the
enactment  of  some  protective ordinance.  If the conse-
quences were confined to the parties themselves, or  even
to their children, the evil would be comparatively small;
but the multiplication of it is so rapid, that, in a few gen-
erations, a very large extent of country becomes similarly
afflicted.  Because  a man  or woman has acquired a pre-
disposition to consumption, or some other form of disease,
it does not follow that the privilege should exist to entail
it upon others.
  "There is scarcely an individual in society who has
not witnessed the  deplorable consequences of the  mar-
riage of those who have had entailed  upon them a pre-
disposition  to consumption, to  insanity,  to  aploplexy,
etc.; then what should we  think of those, who,  know-
ing themselves,  by what they know of their ancestors,
to exist with  such  predispositions,  place  themselves in
such  a  situation as to visit the mischief upon unborn
hundreds, perhaps thousands ?"
  It is easy to  account for  this hereditary predisposition
to disease.  We find, as  a  never-varying law of nature,
that where deterioration of the  parent, whether auimal
or vegetable, has taken place, the succeeding generation
will show marked  evidence of this.  Thus, the farmer
would not  expect good  sound crops from seed that was 
372
consumption.
unsound, or the  product of unhealthy plants;  he would
not select grafts for his orchard  from trees affected with
the rot, or where there had been marked deterioration in
the quality of the fruit; neither would he expect to raise
fine stock  from  parents  that  were unsound.  There is
little use to argue a question like this, as the evidence of
the truth of the proposition is so abundant, that one has
but to open his eyes to see it.
  Predisposing  Causes acting during Early Life.—Of
these causes  there are many, but we will here consider
those that  are most  apparent.  Many parents appear to
pursue, from choice, the very course best adapted to pro-
duce  the tuberculous constitution.  Thus, some are con-
stantly over-feeding  their  children, or, what  is  worse,
pampering their appetites with sweets,  cakes, candies,
pies,  tarts, etc., the best  possible means in the world to
destroy the tone of the digestive  apparatus, to produce an
elaboration of poor blood, and consequent maZ-nutrition.
How can we  expect strong, robust men and women under
such  circumstances?   Others,  again,  constantly  fearful
that their  children will take  cold, or get sick, keep them
almost constantly in the house, deprived of fresh air, ex-
ercise, and very frequently of light.  We might just aa
well expect to raise our garden vegetables in the cellar, aa
expect  to  raise children  in this way.  Did you ever no-
tice a plant kept from light and air—how pale, slender,
and puny it  appeared, having  hardly strength enough to
support its own weight ?   So with children raised in the
house, they are  pale  or sallow,  debilitated,  no strength,
and unable  to  resist the  slightest exposure.   A third
class,  the  votaries of fashion, when they do take their
children out, have their feet  cased in paper shoes, their
knees bare, and the chest and arms poorly protected, or
not protected at  all against the cold; the result is croup,
bronchitis, inflammation, and other disorders of the lungs,
which  frequently prove the seeds of consumption in the
future. 
CONSUMPTION.
373
   At the  age of six or eight years, sometimes sooner,
 other causes  are  brought to bear against the child—it
 must be schooled, and frequently this schooling is but the
 advancement of the mind at the expense of the body.
 The child's mind is forced; it is conning lessons when it
 should be at play;  it is increasing the activity and size of
 the brain, at the  sacrifice of future health and strength.
 Not only so, but it is too much confined to school-rooms,
 with heated,  impure air, absence of sunshine, and  want
 of exercise.  Defend us, good Lord, from the precocity of
 this untoward generation!
   At the age of puberty, say from the twelfth to sixteenth
 year, we find as a general rule that the emotions are culti-
 vated at the  expense of the  body.  Boj7s  and girls are
 reading novels, not representative  of actual life, but  filled
 with characters whose sole aim in life appears  to  be cen-
 tered in  love—not  the affection, mind  you, that is based
 upon the understanding, and which forms the happiness
 of married life, but the animal or sexual instinct.  If we
 were to sum up all the predisposing causes of this disease,
 we believe  that not one of them could compare with this.
 In this school of masked vice, the sexual passions attain
 an unnatural preponderance, and attain it, too,  at the ex-
 pense of life.  Reader, if you are a father or mother, ban-
 ish this trashy stuff misnamed literature from your houses,
 fear it as you would the Evil One, for its  reading not only
 involves a waste  of time, but gives a misconception of
 life,  and in the young risks the wreck not only of virtue,
 but also  of health.
   Children and young persons subjected  to the causes
 above mentioned, become delicate and sickly.  The vital
 endowment and the structural development of the several
 organs  and textures, are  impaired  or arrested in their
 progress.  Like plants growing excluded  from the  sun
 and wind, their vessels often extend rapidly in  the direc-
tion  of their axis;  but the walls of the vessels  and their
lateral branches are thinly or  weakly formed, are sur- 
374
CONSUMPTION.
rounded by lax cellular tissue, and both the organic nerves
and the animal fibers are  imperfectly constituted.  The
formative processes seem arrested before they are comple-
ted.   The circulating fluids present a superabundance  of
the serous and albuminous constituents, and a  deficiency
of fibrin and red globules.  While the blood is defective
in its constitution, the blood-vessels are impaired in their
tone, and the venous and  lymphatic systems  are more
manifestly or prominently developed.
  The predisposing causes of consumption in adult life are
many, as society is organized, and yet there are but few
which  cannot be avoided.
  Sedentary employment might  be named as one of these,
especially if carried on in a confined workshop. In such
cases  there is want of air, light and exercise, the three
most important influences in preserving health, and we
should reasonably expect that with  deficiency of these
there  would be  deterioration of all the  functions  of the
body, and  the  elaboration of poor blood.  Its injurious
effects may be counteracted by free ventilation, good ex-
posure of the workshop to light, and plenty of exercise
after working  hours. In these cases  a gymnasium  is
worth the services of  a hundred doctors.
  The fashionable follies  of the day have to  answer for
the loss of thousands of  lives by consumption.   Thus we
daily see women who, the larger part of  the time, confine
themselves in close, heated rooms, appear upon the streets
with but little if any  clothing to protect the upper part
of the chest and arms from cold.  We see them frequent-
ing the ball-room and other places of amusement,  clad  in
the same manner, exposing the over-heated body on their
return home to the chill  night  air.   Can  we with  justice
say that in these cases consumption is an  inscrutable dis-
pensation of Providence?
  Overworking the brain is a fertile cause  of consumption
in this  fast country.   Our business men are constantly
grasping after wealth, and in addition to  an overworked 
CONSUMPTION.
375
 mind, we find them neglecting the most  common means
 of preserving the health.  They succeed in their object,
 but  in the  race they become  prematurely old, and may
 succumb to this dread disease before they reach the prime
 of life.
   Want of exercise is the most common of the predisposing
 causes of consumption.  Moderate and sustained exercise
 in healthy air, as in walking, riding on horseback, and in
 various  occupations  and pastimes, excites  into activity
 most of the functions of the body, especially the circula-
 tion and respiration, or  those  intimately connected with
 these, the secretions  and animal  heat, and  provided the
 fatigue or exhaustion resulting from this excitement be
 adequately removed by sufficient rest and sustenance, the
 functions gradually gain vigor by their activity, and the
 structures exercised acquire a  fuller and healthier devel-
 opment.   The  muscles,  especially, including  the  heart,
 manifest an increase of strength and firmness;  the blood-
 vessels are improved in tone, by which they distribute and
 equalize  the flow  of blood through them, and prevent
 partial congestions  and  obstructions;  and  the blood,
 actively carried through the organs and  textures, under-
 goes the  complete series  of changes from nutrition, puri-
 fication,  arterialization, by which its  integrity is  main-
 tained, and it is adapted in its  turn to sustain the several
 functions of the body.  The appetite, the digestive  pow-
 ers, the intestinal action, the warmth of the surface and
 extremities,  the spirits and temper, are generally all im-
 proved by the habit of regular exercise.  Want  of  exer-
 cise  induces torpor  of  all the  functions  of  the  body,
 deranges the secretions, impairs digestion, and predisposes
 to impoverishment  and deficient elaboration of the blood,
which we have  seen to be one of the main causes of tuber-
culosis.
  Of the direct causes of consumption in adult  life, we
might name but the single one, a neglected cold, which still
further reduces the  vitality of the blood, and by  the irri- 
376
CONSUMPTION.
tation kept up in the lungs causes debility of their struc-
ture, constant determination of blood, and finally deposit
of tubercular material in them.
  Prevention of Consumption—Marriage.—I have stated,
in the  preceding pages, that the  health of the  child
depends, in a great degree, upon the constitution of the
parents,  and that  when one  or both parents  were  in
feeble health, lacking in vital power, their children could
not be healthy.  No fact in medicine is better proven than
this.  Were  parents convinced that the health of their
children depended  upon their own,  a  beneficial effect
might be produced  among the more reflecting part  of
mankind, and especially among  families of a scrofulous
habit.   If more consideration were bestowed upon matri-
monial alliances, and a more healthy and natural mode of
living were adopted, the predisposition, which is so often
entailed upon their offspring, might be checked, and even
extinguished in  their family in two or three generations.
In the  present  state of society, the reverse of this very
commonly happens; and from the total disregard of the
precautions  alluded to, the third generation often termi-
nates the race.
  The children  of dyspeptic persons generally become the
subjects of dyspepsia, in a greater degree, and at an ear-
lier period,  than their parents; and if they marry into
families of a delicate constitution, their  offspring become
highly  tuberculous, and die  of consumption  in  early
youth, or even in childhood.
  This extinction of families  may be prevented by judi-
cious intermarriages  with  healthy persons.   Families
already predisposed to  tuberculous disease, should at least
endeavor to avoid matrimonial alliance with others in the
same condition; but above all, they should avoid the too
common practice of intermarrying among their own im-
mediate relations—a practice  which is  at once a fertile
source of scrofula, a sure mode of deteriorating the intel-
lectual and physical powers, and eventually the means of 
CONSUMPTION.
377
extinguishing the  degenerated race.  We are well aware
that the mass of mankind do not regard the propagation
of the species as one of the great ends of marriage; there
are some, however, upon whom these facts will not be
thrown away.  It must not be forgotten  that  this is not
merely a question  which has reference to private feelings
and social happiness, but one of great public importance,
involving at once the well being of society, and the moral
as well as physical character of the nation.
  Physical Education of Children.—Where there is any
predisposition in  a  family to consumption,  great  care
should be used to place the children in the most favorable
circumstances as  regards nourishment,  air, exercise, etc.
As a general rule,  the  mother's milk  is the  best  nourish-
ment for the infant;  in cases where the children are of a
scrofulous or consumptive habit,  if  this  disposition  is
derived entirely from the father, and the  mother's health
is good, she should nurse her child.  But if the mother is
in feeble health, or of a scrofulous or consumptive consti-
tution, it is much  better that  the  child  should derive its
first nourishment  from the breast of a stranger, or even
in some  cases " raised  by hand."   When the child com-
mences to eat, its food  should  be nutritious  and easily
digested, carefully avoiding sweetmeats and pastry.
  The dress  of all infants should  be  carefully suited to
the season.   The whole  surface, particularly the  extremi-
ties, should be well protected  during cold weather.   The
notion that children may be hardened by exposing them
to the air in a half-covered state, is false in the case of all
children, and leads to pernicious consequences  in those of
a delicate constitution.
  Much has been said and written in  favor  of  cold bath-
ing, and  writers who have laid down rules on this subject,
have adduced in support of the practice the customs of
savage nations, altogether  overlooking the difference in
the condition of children in civilized  life.   The  object of
washing  and bathing children is two fold: the first  and 
378
consumption.
most important being that of cleanliness, especially in the
tuberculous infant, in whom it is essential that the cutane-
ous functions should be maintained in a state of healthy
activity.   At first the infant should be washed with warm
water; and a bath every night, with  the  view of thor-
oughly cleansing, will be beneficial.  The second object
in bathing being to  brace and strengthen the child, it
may, as its age  increases, be sponged in cold water,  or
even plunged  into it every morning during the summer
with advantage.   The judicious  adoption of this  plan,
along with subsequent friction of the  body, with flannel
or the hand,  is,  we  believe, one of  the most  effectual
means of strengthening children, but  its effects  must be
carefully watched, as all children will  not be equally ben-
efited by cold bathing, and the  health of some may even
be injured by it.
  Tuberculous children should be accustomed to  the open
air from an early age; as with plants, the human species
can not be robust and stout without  fresh air and sun-
shine.  As soon as they  commence walking, they should
play in the open air whenever the weather is suitable.  In
this  way the constitution is strengthened, and the liability
to colds by alternations  of  temperature much  reduced.
Sleeping rooms should in all cases be large, well ventila-
ted,  and exposed to the direct rays of the sun during some
portion of the day.  The occupation  of dark, ill-ventila-
ted  rooms, with  their  necessarily impure atmosphere,
would produce consumption in many cases where  there
was  but little predisposition to it.
  Up to the age of eight or ten years, the child's occupa-
tion should be out  doors;  and whether it was play  or
work, it should  be of such a  character as to bring into
action all  the  muscles of the body.   Before this age, the
child should not be required to study, neither should it be
sent to school, there  being sufficient time after this, for
all laudable educational purposes.  Regular meals of good,
hearty food, with  fruits in  their season, with a sedulous 
CONSUMPTION.
379
avoidance of all sweetmeats, cakes, etc., are of the high-
est importance.  If these almost  self-evident rules for
strengthening  the  constitution during childhood  were
adopted and carried out, I believe that one-half of those
dying of consumption, might live to a good old age.
   Symptoms of  Consumption.—Consumption usually comes
on slowly and  insidiously, and  considerable time  elapses
before either the sufferer or his friends can believe that he
has the disease. Previous to its commencement there is
more or less failure of the general health, though the per-
son  complains  but little, and attends  to his business as
usual.   A bad  cold is then contracted  which affects the
chest, giving rise to a  cough.   This, though  not  bad, is
very persistent, and week by week it may be noticed that
there is slight failure of the general health, marked by
loss of strength and flesh, pallid skin, and enfeebled cir-
culation.  This may be called  the first stage of the dis-
ease.
   The second stage presents marked evidence of  serious
disease, but even yet the sufferer cannot believe that he
has consumption.   The cough is persistent and harassing,
there is pain in the chest, slight difficulty of respiration,
and  frequently hemorrhage of  the lungs.  The patient is
very feeble, has a poor  appetite, soon  becomes tired, has
slight  fever  in  the evenings, and commencing night
sweats.
  In the third and last stage, we find the lungs breaking
down and being thrown up with the  tubercular deposit.
The  cough is very severe and harassing, hectic fever is
marked, and the  night  sweats  exhausting.  The patient
expectorates large quantities of  a muco-purulent material,
and if hemorrhage occurs it is severe.  They are now very
thin in flesh, and their strength is so exhausted that but
little exercise  can be taken.   In addition to the night
sweats, there is  not  unfrequently a colliquative diarrhoea,
which greatly increases the debility.  Continuing thus for
a considerable  period of time,  gradually losing strength, 
380
CONSUMPTION.
they  die  without any considerable  increase of  symp-
toms.
  Treatment.—As heretofore remarked, the treatment of
consumption should be preventive, and the necessary hy-
gienic measures should be adopted in early life.   There is
no doubt but that the predisposition to consumption can
be removed, but when such predisposition  exists, the dis-
ease when fully developed can never be cured, and it is
folly to attempt it.  In the first stage  many cases can be
cured, in the second stage a  few will recover, but in the
third  not one.  No one need expect a cure, however, un-
less he firmly determines that he will  use  every available
means to  live.
  The cure of consumption does not depend upon medi-
cine, though this is sometimes very important, but it de-
pends upon an aggregation of all  the  influences that will
improve digestion, assimilation, the quantity and quality
of the blood, and the nutrition of textures.  The medi-
cines applicable in this case are those that lessen irritation
of the lungs and quiet cough, and those that improve di-
gestion and the quantity and quality of the blood.  Cough
medicines do not  cure  consumption, but they will lessen
irritation, and thus prevent increased deposition of tuber-
cle.^  These remedies should always  be  prescribed and
taken under the direction of a physician, as even a medi-
cal  man  would not take the responsibility  of  treating
himself in such cases.       4
  There is much, however, that the patient  can  do him-
self.  His habits must all be regular, with avoidance of all
depressing influences, a  cheerful mind and fixed deter-
mination  to get wTell if possible being very important.
The clothing should be warm, and such as  will protect the
body from injury by sudden changes of temperature, and
against changes of weather while taking exercise.  Flan-
nel should be worn next the skin, and in fall or winter the
chest should be additionally protected by some  light fur
worn next the under-clothing, as rabbit, squirrel  or  cat 
CONSUMPTION.
381
skin.   The boots or shoes should be heavy, have cork in-
Boles, and be water-proof, and a rubber poncho used when
taking exercise out-doors  in damp weather.
  All this  is preparatory to the most  important part of
the treatment.   The person who recovers from consump-
tion must, as a general rule, live in the open air.  Mode-
rate exercise in the open air is absolutely indispensable to
life in these cases, and should  be taken at all  seasons of
the year, and at all times unless when raining.   I do not
speak from the book, but  from large  experience, and can
most positively assure any one suffering from this disease,
that this is the  only chance of safety.   Though placing
such reliance upon out-door exercise, I wish it understood
that it  is to be proportioned to the strength of the patient,
and must not be carried to exhaustion.
  Normal action of the skin  is  of great  importance, as
the sympathy between it and the lungs is very intimate,
the skin being in fact, to some extent, a respiratory appa-
ratus.   We employ baths of various kinds, cold, tepid and
warm water, stimulant baths, tonic  baths, oleaginous fric-
tions, etc., which will be adapted to the case by the physi-
cian in charge.
  As regards the diet, it should be nutritious and  easily
digested, and taken in moderate quantities.  All innutri-
tious articles should be rejected, or  used in very small
quantities, simply as appetizers.  Fatty matters have been
found very important, as furnishing material for combus-
tion, and saving the protein  elements  which require so
much  vitality for their elaboration.  Thus, cod-liver oil,
cream,  beef suet, etc., have gained great reputation as
curative remedies in consumption.  The blood  is the life
of the  body, and the deposit of tubercles in the lungs de-
pends upon imperfect organization of this fluid.  Hence
the great importance of obtaining a normal quantity and
quality of this fluid by strict attention to diet and regimen.
  The  proofs that  consumptive persons  do  recover are
positive, and should be sufficient incentives to every per- 
382           hemorrhage of the lungs.
son to make the necessary effort.  Hundreds of cases are
recorded, of examinations of the bodies  of those dying
of other diseases, but who have had symptoms of con-
sumption in previous years, and in which there was per-
fect recovery.   In some cases  chalky material was depos-
ited in the tubercles, in others they were partially absorbed
and  organized, and  in  others  still the  cicatrices  in  the
lungs have shown where the tubercles have been removed
by expectoration and the ulcers healed up. It may be that
you  are so  predisposed  to the disease  that there is no
chance of recovery, but still if you are able to pursue the
course designated above, your life is worth the effort.

       HEMORRHAGE FROM  THE  LUNGS.

  Hemorrhage from the  lungs is a very rare disease, ex-
cept as the result  of tubercular deposit; and though fre-
quently made light of, I know of  no  symptom so certain.
It is not, as popularly supposed, caused by the  rupture of
a blood-vessel, or, as some in the profession think, by
their erosion during the breaking  down  of  tubercle; for
blood-vessels are  not easily ruptured, and they yield to
the ulcerative  process so slowly, that obliteration of their
cavity takes place some time previously.   Hemorrhage is,
in a large majority of cases, an  exudation from the blood-
vessels, and its probable cause is compression of the veins
by the tuberculous deposit, thus preventing the free return
of blood to the heart.   We  have a similar  instance in
hemoptysis from disease of the heart, the free  passage of
blood from  the lungs  through the left auricle  and ven-
tricle being obstructed.
  Symptoms.—Evidences of debility, and frequently of dis-
ease of the lungs  precede hemoptysis.   There may be no
seeming cause  for it in some cases, coming on when the pa-
tient is sitting or lying still, or sometimes  when asleep; but
usually it is  after exertion, or  a fit of coughing.  Varying
in quantity, we find it  sometimes raised by an  act of 
HEMORRHAGE of the lungs.
383
coughing;  at others it seems  to flow to the upper part of
the larynx, and into  the pharynx, and is simply spit  out
The blood  is florid and somewhat frothy, differing mate-
rially from that in hemorrhage from the posterior nares
and stomach.  A small quantity of blood mixed with the
secretions from the mouth and throat makes a very large
show, especially when spit on cloths, or into a vessel of
water, so that frequently there is  not the cause for alarm
that there  might seem  at first sight.
  Sometimes the hemorrhage is preceded with chilly sen-
sations,  and  a feeling of faintness,  with occasionally a
sense of oppression in  the  chest, and some dyspnoea.
With its  commencement the  patient  usually  becomes
much alarmed, which is increased by the  excitement of
those about, and this is usually the cause of the excessive
prostration noticed.  In  but few cases is the hemorrhage
in such quantity as  to  destroy the patient.  Dr. Heber-
den  states  that, in sixty years practice, he had never lost
a patient of it, and others testify to the same.  The quan-
tity of blood lost varies from  a few drops to  as much as
ten pounds, the average quantity, possibly,  being from
one  to ten ounces.  When very  free, it occasions much
dyspnoea, and requires continuous  efforts to free the upper
air passages from it.
  Treatment.—The patient should be immediately placed
in the recumbent position, w7ith  the head elevated, and
all physical and mental excitement  avoided.'  But  few
persons should be in the room, which  should be well ven-
tilated and cool.  If the feet are cold, a hot mustard foot-
bath is  very useful, and the  warmth subsequently con-
tinued wdth a  jug of hot water.
  If no other remedy is at  hand, a  half-teaspoonful of
common  salt  may be given every  half hour;  and if
palatable,  a small portion of grated nutmeg added to
each dose.
  Gallic acid, in from  two  to  five-grain doses, is  one
of the best remedies in this  case, and may be given as 
384
pleurisy.
often as  it seems necessary.   The lycopus virginicus has
proven  very successful, and  may be depended  on.  It
is  administered in infusion, one ounce to six ounces of
boiling water; half an ounce of the infusion every half
hour.  Ipecacuanha has been highly recommended, and I
am satisfied it  exerts a  marked influence; it may be
given in  doses of from three to five grains every fifteen or
thirty minutes, until nausea is induced.
   Sulphate  of magnesia in half-drachm doses, with di-
luted sulphuric acid,  has been used with  advantage, as
has also  alum, in doses of from two to five grains, with
gum tragacanth, every half hour.   If  hemorrhage is
feared, oil of turpentine may be used in  doses  of  from
twenty to sixty minims, every three or four hours.  The
oil of erigeron, in doses of ten or fifteen drops, is relied
on by many, and  I have no  doubt will answer  the pur-
pose in many cases.

                    PLEURISY.

   The serous membrane, enveloping the lungs, is not un-
frequently the seat of inflammation, which, when occur-
ring without disease of the lungs, is called  pleurisy.  A
milder form sometimes occurs with pneumonia.
   Symptoms.—Sometimes  pleurisy is preceded for a short
time by languor, headache, loss of appetite, and derange-
ment of the secretions; but usually there are no evidences
of disease  until  the commencement of the chill or  pain.
A marked chill usually ushers in the  disease; sometimes
it  is preceded by pain, at others it is not; fever follows,
and is generally high.  The pain is  sharp  and lancina-
ting, increased when  the  thorax is moved, much easier
when kept perfectly quiet.  In consequence  of this pain,
we find  the respiration short and hurried, and principally
abdominal, as  anything like  a full inspiration produces
excruciating suffering.  A dry, hacking  cough  attends
the disease, and is a source of great annoyance to the pa- 
PLEURISY.
385
 tient.  Pleurisy is characterized by a hard, small, frequent
 pulse, running sometimes from a hundred and twenty to
 a hundred and forty beats  per minute; the skin is dry
 and harsh,  the urine scanty, tongue  coated white,  and
 bowels constipated.
   These symptoms continue without change for from one
 to three days, unless arrested by treatment, when effusion
 taking  place, the  pain is lessened;  but the difficulty of
 breathing and other symptoms are increased.  The fever
 now is  markedly lessened, the pulse is still frequent, but
 has lost its hardness; the trunk is hot, but there is ten-
 dency to  coolness of  the extremities, the secretions are
 yet checked, there is  still cough, and sometimes expecto-
 ration, the patient feeling very much prostrated, especially
 after a paroxysm of coughing. The difficulty of breath-
 ing is  sometimes  so  great  that the patient can not lie
 down; in such cases there is abundant  effusion.
   The disease may terminate fatally in the first or second
 stage.   If in the first, the fever is very  high, and the pain
 excruciating;  the  pulse  is wiry and  quick;  respiration
 rapid, sometimes  fifty per minute; delirium ensues, and
 the patient  succumbs, usually within  forty-eight hours.
 After effusion we find  the patient losing strength, day by
 day—a low form of remittent fever is present, respiration
 is difficult, the patient has no appetite, and is generally
 worn out by the disease.
  Treatment.—The objects of treatment are to lessen the
rapidity and equalize  the circulation,  and, by different
means of derivation, check the flow of blood to the pleura.
We can accomplish this  in different ways—thus, one will
have an infusion  of  the compound  powder of lobelia
made, and give it freely until nausea is induced;  and
after this has relaxed  the system  and mitigated the pain,
give it to produce thorough  emesis.  It would seem, at
first sight, as  if the  patient could not  bear the  severe
movement of  the  chest necessary in vomiting, when the
hacking cough produces so  much disturbance;  but  we
    25 
386
WHOOPING-COUGH.
find  the  nausea to  so check the  pain  that the vomiting
does not occasion  additional suffering.  Others, again,
would  arrive  at the same result by  inducing  profuse
diaphoresis with the spirit-vapor bath, and the free ad-
ministration of an active  diaphoretic,  as  the  compound
tincture  cf Virginia snake-root.
  It will be noticed that these means  are powerfully re-
laxant,  indirectly sedative,  and  thoroughly  revulsive,
and  will sometimes  check the disease at once.  I have
seen it  treated  by podophyllin,  in  doses of from  half
to one grain  every three hours, Until emeto-catharsis was
induced; and  am satisfied, in my own person, that it is
very effective, though extremely unpleasant.
  A much more pleasant treatment is  to give the patient
tincture of veratrum, in doses of from three to  five drops
every hour  until partial sedation is induced, and then  add
the tincture of asclepias in half-drachm doses.   It is well
to get an action on the bowels with the podophyillin  pill,
heretofore named, and in some cases add sufficient opium
to mitigate the distress.  Cups  to the affected part, fol-
lowed by hot fomentations, or a warm  poultice of wheat-
bran, assist very materially.  A sinapism, followed by
hot  hop or stramonium  fomentations, may be used in-
stead;  or  the cold water  bandage,  recommended  by
some, may occasionally be found useful.

                WHO OPING- CO UGH.

  Whooping-cough is a  contagious  disease, like measles
and  scarlet fever, being propagated from  one  to  mother
by inhaling the breath, or emanations from the body of a
person suffering from the disease.  Sometimes, however,
the poison  seems to contaminate  the atmosphere so  that
persons take it when at considerable distance  from those
who have it.
  Symptoms.—Whooping-cough manifests itself at first as
a simple catarrh, the cough being  gradually developed. 
WHOOPING-COUGH.
387
Some clays elapse before there is any thing distinctive in
it; and it is not usually well marked under from two to
four weeks.  The cough  differs  from  others in that it
seems  to  arise from  an obstruction to respiration, and
forcible inspiration is taken, and  then there is a series of
short expulsions until the air is all expelled; the tendency
to cough still  continuing, produces  great  distress, and
more or less evidences of impaired respiration are noticecL
The whoop is developed when the cough becomes intense,
and is  the shrill sound formed as the air is drawn through
the yet contracted larynx in the forcible inspiration suc-
ceeding the cough.  The cough is paroxysmal, the parox-
ysms recurring at  longer or shorter intervals, in propor-
tion to the severity of the disease.
  There  is a secretion of glairy mucus  in most  cases,
which  is raised  at the  latter  part of the  cough, and fre-
quently seems to increase the suffering.  If the disease is
very severe,  and  sometimes when  mild,  there is  a free
yellowish expectoration.  There is, necessarily, some fever
at the commencement of the disease, and  it may occur
during its progress.
  Writers divide  pertussis into three stages — the first,
lasting from five to fifteen days, presents the symptoms of
ordinary catarrh;  the  second, lasting  from three  to  six
weeks, presents the peculiar whoop, which gives name to
the cough; and the third, of variable duration,  is the
period of decline.
  It is during the  second stage  of the disease that the
symptoms become  so aggravated  as  to  demand  relief.
We sometimes see the paroxysms of cough so severe that
the little patient  will  turn purple  in the face, gasp  for
breath, and even for some time afterward exhibit marked
evidences  of imperfect respiration.   Occasionally bron-
chitis sets in  and is very troublesome; sometimes there is
marked congestion  of  the lungs; at others, the frequent
and severe paroxysms of coughing prevent necessary rest,
deranare the functions of the  body,  and wear the patient 
388
diseases of the heart.
out.   In some cases  there is tendency in the disease to
recur, for months after it has  ceased, on exposure to cold,
though almost always in a mild form.   Instead of impair-
ing the strength of the lungs in feeble children, it seems
rather to have  increased it, and  may  sometimes  be
regarded as of marked advantage to the child.
  Treatment. — In a majority  of cases  of whooping-
gough, but little treatment is necessary, as the disease has
a regular course to run.  Where treatment becomes neces-
sary from the severity of the cough, any nauseant expec-
torant may be employed with advantage.  The compound
syrup of lobelia will prove an excellent remedy, as will
the tincture of oil of lobelia  and  stillingia.   Belladonna
is a favorite agent with many.  I order it in the  following
manner:  Take  tincture  of  belladonna, one   drachm;
alum, one drachm; simple syrup, six ounces; and give in
teaspoonful doses every three or  four hours.   Nitric acid
is also employed in this disease; add two drachms to six
ounces  of simple syrup, and  give a  teaspoonful every
three hours.  Another excellent remedy in some cases, ia
a strong infusion of  red clover hay, sweetened, and give
one  or  two teaspoonfuls every two hours.   Tincture  of
drosera, two drachms, to water four ounces, a teaspoonful
four times a day, has proven a specific in  other cases.

            DISEASES OF THE HEART.

  The heart, like all  other structures of the body, is liable
to disease; in fact, we may say it is  liable to all diseases
that affect other  parts.  Thus, it may be the seat of in-
flammation, acute or chronic, of  rheumatism,  of change
of structure, and of  functional disease.
  Inflammation and rheumatism of the heart are so similar
in their symptoms that  it is  almost impossible to  distin-
guish one from another.   The symptoms are usually very
severe,  the oppression  and  pain in  the region  of the
heart being  very great,  a  very  rapid  pulse,  and dif- 
DISEASES  OF THE HEART.
889
ficult respiration.   If, during the progress of rheumatism,
such symptoms should set in, send immediately for your
physician, for it requires prompt and energetic treatment.
  The treatment named for rheumatism may be  adopted
until advice can be had, using the  hot-blanket pack, and
mustard over the part affected.  If you are near a cupper,
send immediately and have from four  to  eight  dry cups      •
applied over the region of the heart.   It is the most pow-
erful and certain  means that can be adopted  in most
cases.
  Chronic structural disease of the heart can only be deter-
mined by a physician skilled in auscultation, its symptoms
resembling very closely those of functional disease.   But
very little can be done for it, except to moderate the more
urgent symptoms, yet the patient may live for many years,
or he may die suddenly at any moment.  It  is true  that
in some cases of this kind, if the disease is recognized
early, the trouble can be entirely removed  by a judicious
and long continued course of medicine and hygiene.
  Functional diseases of the heart are  of far more  frequent
occurrence than structural disease, and, as before remarked,
the symptoms in the one case will  closely  resemble those
in the other.   It  may be dependent upon many causes,
though in all cases the nerves  distributed to the heart are
especially implicated.  Thus I have seen a number of cases
of what seemed to be serious heart disease, dependent
upon irritation of the stomach, and  consequently of the
pneumogastric  nerves; others were  dependent upon de-
rangement of the kidneys; others upon  disease of the
spinal  cord and brain; wThilst in  some the  disease was
confined exclusively to the nerves of the heart.
  If, now, it was dependent upon disease of the stomach,
a removal of such disease would pave the way for a cure,
so of the bowels, kidneys and other parts.   Then we have
remedies that relieve irritation of these nerves, and they
prove important curative means.  Others  strengthen the
entire body, and especially the heart, and we use these 
390           DERANGEMENTS OF DENTITION.

when the trouble is wholly or partly dependent upon de-
bility of the organ.
  If you have palpitation of the heart, irregular action,
a sensation of weakness and smothering in that region,
difficult respiration and  sensation of sinking, do not be-
come alarmed and think you are going to die, or that you
have an incurable disease, but consult a physician capable
of determining the  nature of the difficulty.  In two  out
of every three cases  the  disease is remediable, when a
proper course of treatment  should be adopted.  In the
other case a man knows what he has to depend upon, and
can make preparation to die, though he may live for years.

     DISEASES OF THE DIGESTIVE ORGANS.

  The digestive organs, as will be  recollected, consist of
the mouth,  throat,  stomach, small  and large intestines,
with the associate glands, the  liver, the  spleen, and  the
pancreas.  The function of these organs is, to prepare the
food for the use of the body, by minutely comminuting it
and fitting it for absorption  into the blood.  Diseases of
the digestive organs affect  this function, besides giving
rise to other disturbance of the economy by sympathy, by
deranging the circulation of the blood and nervous force,
and by exhausting discharges.


        DERANGE3IENTS OF DENTITION.

  Dentition or teething is a physiological process, and not
a disease, as many imagine.   If the body is in a normal
condition, and not warped to too great an extent by cus-
toms called civilized, then the process  of cutting the de-
ciduous teeth is painless  and without unpleasant  conse-
quences.  But if the  converse, then the  eruption  of the
teeth  may  be the source of irritation which will cause
disease of various  parts.  We  can readily see how this
may be if we examine other parts:  for instance,the tunc- 
TOOTHACHE.
391
tion of sight is performed with pleasure and advantage to
the  eye, if in a healthy condition; but  if diseased, it is
sometimes the source of great irritation.
   Occasionally we find that the gums become very tender,
or the child  is continually working with its mouth, and
desiring to bite something; it is irritable and fretful; there is
some fever, increased heat of head, or sometimes pallor, and
dilatation of the pupils.  It is true, that many times these
symptoms will pass off' without  danger to the child; but
often they do not, giving rise to a low form of fever, disease
of the brain and convulsions, or derangement of the bowels.
   The treatment of this condition is comprised in a mild
sedative  as  tincture of aconite, ten drops, to water four
ounces, in doses of a teaspoonful every hour or two; and if
the child is nervous, and exhibits evidences of convulsion,
the addition of tincture of gelseminum one to two drachms,
for a child one year old.  If the bowels are constipated, a
dose of castor oil, or compound powder of jalap and  senna
in infusion is indicated, and the general bath and  hot foot
bath should not be neglected. If there is diarrhoea, it should
not be suddenly checked, but the neutralizing cordial, or
compound powder of rhubarb in infusion,  administered
until it produces one operation, and afterward  in smaller
doses; or the infusion of epilobium may  be used.

                    TOOTHACHE.

   The teeth fulfill a very  important  place  in  digestion,
grinding  and comminuting the food, and thus fitting it
for the action of the gastric  and other fluids.  If for  no
other reason  than this, they should be well taken care  of.
But when they become diseased, they become  the nu-
cleus for  unpleasant  secretions, and their diseased action
is extended  to  other parts  of the system.  Thus, I have
had several cases in which  the removal of decayed teeth
and  cleansing the  mouth, was  the principal  means  of
curing long-continued and serious disease.  If your teeth 
392
SORE MOUTH.
are decaying, consult a competent dentist, and have them
filled, removing all those that are  of no further use for
mastication.
   Toothache is one of the most painful affections to which
our bodies are subject, and as common as it  is painful.
It most generally arises from decayed teeth, though some-
times it is  a deep-seated inflammation of the  roots of a
tooth.   If  the  tooth is  decayed, the  pain may be fre-
quently arrested  by the use  of oil  of cloves,  or  other
stimulant,  applied on  cotton.  Tincture  of aconite  is
another excellent remedy, as is also  equal parts of alum
and salt, or the chloroform liniment, No. 88.  The last
may also be applied to the face over the tooth, if there  is
tendt dcy to neuralgia.

                   SORE MOUTH.

  Theit, are many forms of inflammation of the mouth—
from the simple form in which there is but slight redness
and burning, to that in which extensive ulceration occurs,
and destroys its structures, and sometimes the life of the
sufferer.
  In simple sore mouth it will be found red and inflamed,
and the patient will complain of pain and scalding;  very
frequently  some  derangement of the stomach  will be
found associated  with it.  We usually give  an infusion
of compound  powder of rhubarb to correct acidity and
irritation of the stomach, and use a wash  of an infusion
of sage  privet, or  yellow-root,sweetened, adding  a  small
portion  of borax in the severer cases.
  In ulcerated sore  mouth the suffering is much greater,
and frequently the appetite is impaired, and the breath
and secretions from the mouth are foetid.  In this case I
would  recommend a strong decoction of the wild indigo
for a mouth wash,  and  that  it be given internally in
doses  of a teaspoonful every hour  or  two, to  a child
four years  old. 
NURSES'  SORE  MOUTH.             393
              NURSES' SORE MOUTH.

   Some  years  ago a sore mouth prevailed extensively
 among  nursing females; of late it  has become  rare in
 this section, though in some parts of the country it is still
 prevalent.   It  usually commenced some days after con-
 finement, but  occasionally made its appearance in a mild
 form  during the last period of gestation.   It was fre-
 quently  preceded  by heart-burn,  or pyrosis, sometimes
 during the entire progress of gestation.   The first indica-
 tions  of it  were a feeling  of heat  in  the  mouth, with
 slight tenderness, and increased secretion of  saliva, which
 seemed to irritate the inflamed surface.
   On examination the mouth would be found reddened,
 the mucous membrane  tumefied, and where the  disease
 had become severe, small vesicles  terminating in ulcera-
 tion would make their appearance;  commencing on the
 lips or tongue, it would  gradually pass back until it in-
 volved the  entire  mucous membrane, and in some cases
 extend to  the  pharynx, the oesophagus, and finally pass
 through  the entire intestinal canal.
   In  these  cases, as the disease advanced, it would pro-
 duce marked irritation of the parts invaded, of  the stom-
 ach and of the bowels, occasioning great prostration from
 arrest of digestion.  It would sometimes last during the
 entire period of nursing, and only cease when the child
 was weaned.
   Treatment.—To relieve  irritation  and arrest acidity of
 the stomach, I employed  the compound powder of rhu-
 barb in  small doses, and gave  the chlorate of potash, in
 doses  of a teaspoonful of  the  saturated solution, every
three or four hours.  The  iodide of potash, in doses of
five grains  every four hours, answered a good purpose
in some  cases,  but in others it failed.   Occasionally an
 infusion  of  equal  parts  of  alnus, rumex  and quercus
 rubra, administered internally, and also  used as a wash, 
394
DYSPEPSIA.
would cure the disease when other means failed.  As a
local  application, the  chlorate of potash was used wTith
marked advantage; but  in some cases  its influence was
not permanent; all the milder mouth washes heretofore
named were employed with but  temporary relief.  Some
practitioners  used a  solution  of nitrate of silver,  from
twenty to forty grains to an ounce of  water, and spoke
highly of it.   After trying various means, I finally dis-
carded all mouth washes, using the general treatment
above named, and recommending the smoking of tobacco
three or four times a day.  This,  though an unpleasant
treatment, was  uniformly successful, the disease  in some
cases being radically  cured, but  in others requiring a re-
sort to the remedy every few days or weeks.

                   DYSPEPSIA.

  Under this head we may group the entire class of func-
tional disorders of the stomach, which are  primary in
their origin, and not dependent upon structural change.
  Difficult or imperfect digestion, is one of the most fre-
quent ailments we meet with in  practice, and requires
great discrimination  for  its  successful  treatment.   This
will be more  apparent if  we notice those  conditions that
are necessary to  healthy digestion.  They are: l*t, A
proper quantity  and  quality of ingesta;  2d, Thorough
mastication and insalivation; 3d, Normal action of the
muscular  coat of  the stomach,  giving  the food proper
motion; 4th, A proper quantity and quality of the gastric
juice, and of  the pancreatic  and biliary fluids; 5th, Nor-
mal innervation, and healthy condition of the blood;  and,
6th,  A reciprocal  action of the intestinal canal.  Dyspep-
sia may be the  result of  a failure of any  of  these condi-
tions, or a partial failure of two or  more of them, so that
very different causes may give rise to a similar result.
♦ Habershon classifies the causes of dyspepsia, as:  " 1st,
From abnormal condition of  the mucous  membrane and 
DYSPEPSIA.
395
 its secretion; 2d, From the muscular movements being
 impeded; 3d, From the state of the vascular supply; 4th,
 From the condition  of the  nervous system; and  lastly,
 From the character  and changes  that take place in the
 food.  Several of these causes of dyspepsia may be com-
 bined ; some lead to disease of a very transient form, oth-
 ers are irremediable."
   The mucous  membrane  may be affected in various
 ways. Thus, we may have atrophy,  especially of the
 follicles,  the change at last becoming so great that  diges-
 tion can  not be accomplished, and the patient necessarily
 dying of marasmus.
   Again, we  find other cases  in which  there  is undue
 activity  of the mucous glands, and of course deficient
 action of the gastric  follicles; hence we have two condi-
 tions, either of wmich, if considerable, would materially
 interfere with digestion.   This  condition  is frequently
 observed associated with  chronic disease, as in anaemia,
 chlorosis, chronic bronchitis,  and  other chronic affections
 of the mucous membranes.   As an independent affection,
 the symptoms are a feeling of weight and tension  in the
 epigastric region; a bad taste in the mouth; foetid breath;
 occasional  nausea; sometimes vomiting, when considera-
 ble quantities  of  vitiated mucus may be raised; a heavily
 loaded tongue, especially at the base, and in the early
 part of the day; sometimes there is a disgust  for food,
 and for several hours after it is taken, there are unpleasant
 eructations; at others the appetite  is  craving, but the
patient feels uncomfortable after eating.  The bowels are
usually constipated,  but there  are  occasional attacks  of
diarrhoea, in consequence of imperfect digestion of the
food.
  The reverse of this  condition  may  exist.  There  is
scanty mucous secretion, with normal or slight excess of
gastric juice, the result being  a continued irritation of the
 stomach,  from want of its natural protection.  In  these
 cases we have heartburn, both after eating and when the 
396
DYSPEPSIA.
stomach is  empty.  There  is a feeling  of soreness and
rawness when distended with food, and  a disagreeable
gnawing  and feeling of contraction when  it is empty.
Digestion is not impaired to such an extent as it  is found
in some other cases, yet the symptoms are exceedingly
unpleasant.
  The gastric juice may be increased in quantity or defi-
cient, or may be changed in quality, being too active, or
not active enough.  In the first instance, though normal
in quality, the excess impairs digestion, and by its acrid
properties irritates the  stomach and causes  pain and
unpleasant sensations.   It is this excess that gives rise to
pyrosis or water-brash.  It may be  excessive simply by
too great dilution; the  excess may be at the period of
digestion, or in the interval when the stomach is empty;
in the  first case, there are  acid  eructations with more or
less of the partially digested food; the last is attended by
severe heart-burn.
  If deficient, the causes of imperfect digestion would
seem to be evident, but  this is not  the case, for the defi-
ciency may be only in one element, as  of an acid, or of
water, or of pepsin, or it may be deficient  on account of
the intense acridity of the secretion  irritating the stomach
and checking its formation.   In these cases the symptoms
are  varied, but there is evidence of imperfect digestion,
and more or less unpleasant sensations at the epigastrium.
  The secretion may be irregular, giving rise to a  craving,
with pain at the stomach, cramp, heart-burn, etc., in the
intervals between meals, and sometimes nausea and vom-
iting, or a burning sensation, and unpleasant eructations,
two or three hours after eating.  This irregular secretion,
if it continues, causes great irritation, sometimes disorgan-
ization of the mucous membrane, and may cause its diges-
tion if its innervation  is enfeebled by injury or severe
shock  to  the  system.   Impaired action  of the muscular
coat will undoubtedly derange the process of digestion, as
it depends, to a considerable extent, upon  the continual 
DYSPEPSIA.
397
movement  and attritioti of the food.  The general symp-
toms are those common to the other forms of dyspepsia,
but there is an absence of pain, and, in  consequence, gas-
eous accumulations and uneasiness from distension.   *
  The general sluggishness of the system, especially the
torpor of the  nervous system, and slow  action pf other
organs,  with obstinate  constipation of the  bowels, are
additional indications.  The reverse of this is productive
of fully as serious consequences, as  the  food is forced
through the pyloric orifice before stomachic digestion is
complete.   The result is diarrhoea, with imperfect nutri-
tion, great loss of strength and flesh, and, if it continues,
death from exhaustion.
  Changes  in  the  circulating  fluid may give rise to dys-
pepsia, but they more frequently intensify it by preventing
normal  nutrition of the stomach.   All have observed the
intimate relation  existing between the blood  and the
stomach in acute  diseases; hence,  in  fever,  though the
appetite may demaud food, yet digestion is slow and im-
perfect ; though usually the appetite  disappears with the
power to digest.  In many diseases in which the blood is
loaded with impurities, we find that all means directed  to
the stomach are  inefficient;  we  must first  remove the
detritus from the blood, and having secured a normal cir-
culating fluid, though small in quantitj^, digestion can be
again established.   Torpidity  of the bowels, and  inactiv-
ity of the skin, doubtless  affect the stomach in this  way,
in addition to  the  extension of the  derangement  by  con-
tinuity of structure and sympathy.
  The most  common of  these causes of dyspepsia, and
one that should be carefully watched for in all these cases,
is  derangement of the urinary  secretion; I have  seen
cases  in which all  other means having been exhausted, a
treatment directed to  restore this  secretion, has radically
cured the dyspepsia.   That this is the  fact, is proven con-
clusively, when we observe that in every derangement  of 
398
DYSPEPSIA.
the kidney of any considerable  duration, the  function of
the stomach is one of the first impaired.
  Like all other functions, perfect digestion depends upon
normal innervation ; and in this case it is dependent upon
the normal condition of three parts of the nervous sys-
tem.   The great  sympathetic nerve seems to be the gov-
erning power in a state of  health; the pneumo-gastric
nerve  is  distributed to it  to connect  it with the heart,
lungs and brain, and it is connected with the spinal cord
by communicating filaments to the sympathetic ganglise.
Disease of any of these sources of innervation may give
rise to dyspepsia, and conversely, disease of the stomach
may give rise to derangement of these different parts of
the nervous system.
  Derangement  of innervation manifests  itself  in  two
principal forms—irritation  and  atony.  The first, as  we
have  already noted, may arise in and be confined  to the
stomach, or it may be the result of distant lesions.  In
the first place, we have irritation of the peripheral nerves,
with  determination of blood, derangement of secretion,
and other  results that follow.   In  the last, we have the
same  effects, but the cause is distant, as in irritation of the
stomach from disease of the brain and spinal cord. The
severest cases of irritation we  ever witness, are from this
cause, as in some cases  of  cholera infantum.  We again
see cases in which the irritability of  the stomach depends
upon  disease of  the spinal cord; and cases in which  we
are convinced that the lesion is one of the sympathetic
nervous system, though we are unable to prove it.
  Derangement  of the stomach reacts on the nervous
system, and organs supplied by the same system of nerves.
Thus, we have hypochondriasis, hysteria, irritation of the
spinal cord, cough, expectoration, and seeming disease of
the lungs, palpitation and other disordered action of the
heart, as its result.
  The character of the  ingesta is very important as an
element of dyspepsia.  Food may be  taken in too large 
DYSPEPSIA.
399
quantity, or the quality may be such as to overburden the
stomach;  hence its continuance gives  rise to imperfect
digestive power.  Abnormal changes taking place in the
food, may not properly be considered a cause of dyspep-
sia, but rather a result, and  yet serve to perpetuate it.
These may be divided into putrefactive decomposition and
the formation of sulphureted hydrogen; simple fermenta-
tion giving rise to carbonic  acid; fermentation  forming
lactic or  butyric  acids, and  the formation  of  sarcenia
ventriculi.
   Symptoms.—The principal symptoms have been named
as we considered each lesion, but we may reconsider them
with advantage.  Dyspepsia,  as we before remarked, is
imperfect digestion, and from this  we have  feeble  and
imperfect nutrition, and  the results that flow  from it,
derangement to a greater or less extent of all the func-
tions of the body,  and  loss of  flesh and strength.  Un-
pleasant sensations  in  the  region  of  the  stomach are
always  present in  some degree, but vary as  regards its
•condition; pain, burning, sense  of soreness, tension, full-
ness, weight, tenderness  on pressure, are  the principal
ones, and for the diagnostic bearing of them I would refer
to the preceding description.
   Treatment.—As  will  be gathered from the lengthy de-
scription of the disease above given, the treatment of dys-
pepsia wall have to be varied to meet the wants  of each
individual case.  In some the treatment will be mainly di-
rected to the nervous system; in others the skin or kidneys
are principally at  fault, and we will have  to determine
the character of these diseases, and cure them, in  order to
remove the dyspepsia   It  is only  those, therefore, in
which  the  disease  is  strictly confined to  the stomach,
that can be managed by  an unprofessional person.
  In all cases in which  there  is pain in the region of
the stomach, and tenderness  on pressure,  counter-irrita-
tion is one  of the  most useful  means.  In simple cases
the repeated  use  of the mustard  plaster  will  answer, 
400
DYSPEPSIA.
 or we may direct  a flannel  bandage, wet with  cider
 vinegar, to be continually worn,  or used  only at night.
 In the  severer  cases, the irritating plaster will be the
 most useful remedy.
   If  there is  much  irritation of the stomach,  especially
 if attended with nausea, use the  peach-tree  bark tea.
 It is  made by taking the young  limbs of  the  present
 year's growth, scrape the bark off,  and cover with boil-
 ing  water; the  dose will  be  from a tea-spoonful to a
 table-spoonful, four  or  five  times  a day,  or oftener.
 There is no  other  agent with which  I am acquainted
 that  exerts a  better  influence  upon the  stomach than
 this,  and I have known many persons radically cured
 by its use.
   The collinsonia is another excellent remedy, and one I
 very  frequently employ.  Take equal parts of essential
 tincture of collinsonia and simple syrup, and give a tea-
 spoonful four or five times a day.  The hydrastis,  or yel-
 low-root, is  another excellent  remedy.   Add half  an
 ounce of the finely-pulverized root to six ounces of water
 and two of alcohol; let it be well shaken, and  taken in
 table-spoonful doses, three or four times a day.
  In all cases  strict attention  should be paid to the skin,
 using a bath  every day, or every other day, with brisk
 friction.  The bowels must be kept regular, by strict at-
tention to the periods for their action, using injections or
mild  cathartics if they should  become  necessary.  The
food should be carefully selected, and taken in  moderate
 quantities, so  as not to overwork the enfeebled stomach.
 Those articles which  are found  easy of digestion, and at
the same time  nutritious, are the best.  This is one of the
most important points in the treatment; for if the stom-
ach is gorged  with food  three times a day, in quantities
that  it can not dispose  of, we  need not expect it to get
 well, any more than we would a sore on the surface, if we
 kept rubbing it or breaking it open. 
DISEASES  OF  THE LIVER.
401
            DISEASES OF THE LIVER.

   The liver has played so important a  part in medicine
for the last few  hundred years, that it  would look like
sheer neglect to  pass it by without a word;  and yet we
will find that  its  diseases are few in number,  and of rare
occurrence.  Physiologists  have hardly as yet  determined
the function  of the liver, further  than that nature seems
to  have made every provision for  its taking  care  of
itself.
   In  former years almost every disease was attributed  to
the liver.  Did a man have a headache,  his liver was in-
active ;  if his mouth  was foul, and stomach in bad condi-
tion, his liver was torpid, and  needed stimulation; if he
had wandering pains in his body;  if he was nervous and
irritable; if his food  did not digest; if he had constipa-
tion or diarrhoea, fever, or imperfect circulation, it was all
the same—the liver was  deranged.  If a person felt  bad,
and did not  know what was  the  matter with him, espe-
cially if it continued  for some time, all his friends would
decide that he had liver  complaint, and the doctors would
ratify the decision.  Some physicians never get further in
the study of medicine than the liver; and no matter what
the pain or  ache,  or what its location—the liver was
affected.   All the  physical ailments  seemed to spring
from it, as from some  foul  spot—the gehenna  of  the hu-
man body.
   It was a pleasing delusion for both doctor and  patient,
as there seemed such  a certainty in it, and especially such
certainty in the selection of medicines to  remove it.  The
liver being affected, of course medicines must be taken to
act on it; there was but  one such medicine—mercury—
hence it became applicable in all cases, and even the dull-
est mind was capable  of comprehending this much of the
science of medicine.
  A remarkable change, however, has come over the pro-
fession and the people  in regard to this delusion, and it is
    26 
402
DISEASES  OF  THE LIVER.
now well known that the liver plays a very unimportant part
in the diseases of the body, and  that what seemed such a
pleasant practice has destroyed  more victims than any
war, pestilence or famine that ever prevailed.
  Inflammation of the  liver is  of very rare occurrence, so
rare that I do not think I have met with but one case  in
three years.   The symptoms are  similar to other forms of
inflammation, pretty high fever of a remittent type, and
deep seated  pain in the right side under the false  ribs.
The pain is dull and obtuse, and is the  characteristic
symptom, though there  are evidences  of arrest of func-
tion in the constipation, and clay-colored stools, when ob-
tained  by medicine.  The disease sometimes runs on  to
suppuration; inducing  very  marked  prostration, with
hectic  fever  and night  sweats.  The abscess may dis-
charge externally, or into the bowels, and in some  rare
cases it passes through the diaphragm, and  is discharged
through the lungs.  The treatment of  inflammation  of
the liver will not differ from that proper for other inflam-
mations, further than the local applications will be to the
seat of the pain.
  A condition of chronic inflammation or irritation of the
liver was  formerly of frequent occurrence, owing  to the
profuse use of blue-pill and calomel, but  now it  is rarely
met with.  The symptoms were those of deranged diges-
tion, irritation  or atony  of  the  stomach, torpor  of the
bowels, pain in the right shoulder and back, headache,
with sallow, yellowish  skin,  loss of  appetite, etc.  If I
should meet with such a case now, I wrould  use the alka-
line bath  thoroughly, stimulate the liver and bowels  to
action  with  the podophyllin pill, and give a tonic, as the
collinsonia  or  hydrastis.  If there  was  tenderness  on
pressure in  the region of the liver, the  irritating  plaster
would be an excellent remedy.
   Excessive  action of the liver occurs as the  result of irri-
tation, and congestion of blood.  The bile being an irritant
to the intestinal canal, will, if poured into it, give rise to 
DISEASES  OF  THE LIVER.
403
 diarrhoea, the stools being yellowish, brown or green.   In
 some cases bilious vomiting also occurs, and at times there
 is considerable pain  in the bowels, like colic.  If the bile
 is not poured into the intestinal canal, it will be absorbed
 and produce jaundice.
   In these cases I wTould have the bowels freely evacuated
 with the compound  powder of jalap, or similar  remedy,
 and then give  an infusion  of the  compound powder of
 rhubarb, with from one to three grains of opium at night.
 Bathe the patient thoroughly, use the hot foot bath, apply
 a mustard plaster to  the side, and if necessary give a spe-
 cial sedative.
   Torpor of the liver  is of more frequent occurrence than
 any other functional  derangement, and is probably, due in
 a  majority  of cases  to  disease of  adjacent parts of the
 intestinal canal.   It is frequently associated with  dyspep-
 sia, and  hence  the prominent symptoms of that disease
 were  formerly attributed to the liver.
   The treatment recommended for dyspepsia  will  be
 appropriate for this disease, adding a sufficient quantity of
 podophyllin and leptandrin, to gently stimulate the liver
 to action.
   Gall-stones are sometimes  formed in the liver, or gall-
 bladder,  and, passing thence  to the intestine, they give
 rise to very severe pain.  The pain usually comes on sud-
 denly, in the right side; is sharp and lancinating, but in a
few moments it  passes off, leaving a dull, heavy aching.
In a short time it comes on again, and continues longer,
and the succeeding intervals  of ease are very short.  At
last the  paroxysm is so  excrutiating that the  sufferer
bends himself double, or rolls about the floor, at the same
time pressing his  hands against the pit  of  the stomach,
which eases the pain.  Thus  it continues  until the con-
cretion has passed, which may be but a few minutes, or it
may be hours.
  The best treatment in this case is to put the patient in
a hot bath, or use the hot blanket pack, giving some warm 
404
JAUNDICE.
diaphoretic infusion.  If the pain is very severe, a full
dose of opium may be given, or the patient put under the
influence of chloroform.

                     JAUNDICE.

  Symptoms.—The  symptoms  of jaundice  vary very
greatly, depending  upon the cause,  the extent of disease
of the liver, and its complications.   Usually, there is dis-
turbance of the bowels, colicky pains, constipation, the
fceces being clayey, pale, and scanty.  The mouth is dry,
has a bad taste, tongue coated, and sometimes nausea and
pain in the head.  The yellow tinge usually  makes its
appearance in the eyes, and gradually extends to all parts
of the body, the color being deepest in the  folds and
wrinkles of the skin.  Usually the skin is harsh and dry,
and the urine high colored, at first  yellowish, but after-
ward saffron-colored, frequently coloring the clothing that
it comes in contact with.
  In some cases febrile action is a marked feature of the
affection, the  fever being remittent or  intermittent in its
character, and attended with weight and tenderness in the
right side, and marked derangement of the digestive func-
tions.  These cases are generally acute.  In others it comes
on slowly, with symptoms of marked  cachexia and prostra-
tion.   The skin changes its  color very gradually, but at
last, after weeks, or sometimes months,  becomes of a
yellowish-green or bronze color.  In this  case the disease
will be found to depend on serious structural lesion of the
liver.  In others, the symptoms are developed with rapid-
ity; the skin becomes  intensely yellow, or  yellowish-
green;  there is great  prostration of strength, languor,
listlessness, great depression of the  nervous  system, and
finally delirium or  coma, the disease frequently termina-
ting fatally.  Or, it may come on very  slowly, the  skin
gradually gaining a  dull yellowish  tinge, the  symptoms
being those described under the head of deficient secre- 
DIARRH03A.
405
 tion or torpor of the liver.  In this case the jaundice is
 from retention of the materials of the bile in the blood.
   Treatment.—As jaundice depends upon such  diverse
 conditions, no course of treatment could be given  that
 would correctly guide  the inexperienced.  The  stimulant
 treatment of the liver, which would prove curative in one
 form, would greatly aggravate the disease in another.  If,
 therefore, I was to recommend any course in this case, it
 would be to use the warm or vapor bath, and take inter-
 nally a solution  of acetate  of potash, to  stimulate the
 removal of the coloring  matter by way of the kidneys.
 This is one of the most successful  plans of treatment in
 all cases, and will not produce injury in any.

                    DIARRHOEA.

   Diarrhoea is frequently symptomatic of other affections,
 or indicative  of  disease of the small intestines, as in the
 cases just noticed; but it is also, in many cases, an ido-
 pathic disorder.  We may divide it wTith advantage  into
 the following forms: 1st, From irritation of the intestinal
 canal;  2d, From increased  secretion of bile; 3d, From
 atony  of the intestines;   4th, From congestion  of the
 portal  veins, and determination of blood; 5th, From in-
 crease  of mucous secretion; and 6th, From imperfect di-
gestion.
   Symptoms.—Diarrhoea, arising from irritation, may be
caused by acrid and irritating ingesta, or result from ex-
posure to cold, or from  the arrest of  other secretions.
The  operations are copious  and feculent, sometimes pre-
ceded by griping pains, and occasionally attended with an
urgent desire to go to stool.  The tongue is usually loaded,
an unpleasant  sensation at the stomach, loss  of appetite,
and frequently a tendency to headache.   As the diarrhoea
continues the strength is materially affected, though there
is no febrile action at any  time,
  Bilious  diarrhoea results from hyper-secretion of  bile, 
406
DIARRH03A.
and may arise from the causes  named above.   It is rather
a common form of the disease in the summer, and in  hot
climates,  and in intemperate  persons.   The  evacuations
are at first feculent, but green, or  greenish-yellow, and
pultaceous; but as the  disease advances, are more pro-
fuse and watery.  If it continues for some time, they fre-
quently contain  more or less  mucus, sometimes in loose
pieces, at  others in  thin, glairy, and  gelatinous pieces.
There is sometimes a  feeling of tension in the right side,
and soreness on pressure; and there is considerable griping
pain  attending and preceding the discharges  from the
bowels.  The  skin is dry and harsh in many cases, and
the urinary secretion scanty and high-colored; the tongue
coated, a  bitter taste  in  the mouth, and loss  of appetite,
with sensations of nausea and disgust.
  Atony of the intestinal mucous membrane gives rise to
diarrhoea,  by the relaxed  vessels  allowing their contents
to escape.  In  all  diseases  attended with  great  loss of
power, we have examples of such profluvia, as  in asthenic
bronchitis, the oedema of local  debility,  etc.   In this case
the operations are large  and watery, or, in  some cases, a
watery mucosity, unattended with pain or suffering of any
kind.   The discharges pass so freely that the patient has
sometimes but little notice  to  prepare  for  them, or they
pass almost involuntarily.  There is loss  of  appetite to
some  extent;  the skin  is  cool,  pale, soft, and relaxed,
with  perspiration;  the urine  light-colored and of  low
specific gravity.   The debility is marked.
  Determination to the intestines, accompanied by partial
congestion, gives rise to a diarrhoea, attended by large and
fluid evacuations.  There is more or less soreness of the
bowels and griping pains preceding the operations.  The
stools are  of every shade  of  color, from pale clay to a
greenish, or brown color, and are sometimes preceded  by
nausea.   The  skin is usually  dry  and harsh,  the pulse
hard,  the  tongue coated, the appetite gone, urine scanty, 
DIARRHCEA.
407
some headache, with tumid bowels, and some pain  or
soreness on pressure.
  Increased mucous secretion gives rise to that form of
diarrhoea termed catarrhal.   It occurs more frequently in
old persons and children, though it may affect all ages.
The stools consist of mucus, with  a small proportion of
feculent  matter, sometimes  large,  thin, and  gelatinous,
looking like semi-transparent mucilage; at others, thick
and white, or colored by the fieces.  At first it gives rise
to but little disturbance;  but as it continues, the strength
fails, the skin becomes  dry and harsh, the appetite much
impaired, with great loss of strength and emaciation.
  Diarrhoea from imperfect  digestion is known by  the
name of lientery; it is  most frequently observed in chil-
dren, and rarely in adults.   It is undoubtedly owing to
imperfect action  of the stomach, and increased peristaltic
action of the bowels.  The evacuations consist  in part of
fseces, and  in  part of food,  which is discharged from the
bowels  in  nearly the same  condition  in which it passed
into the stomach.  Sometimes there is pain attending the
operations, but  at others none, except a feeling  of raw7-
ness and soreness of the rectum; if it continues, the pa-
tient soon  exhibits the effects  of arrest of digestion, in
a marked  marasmus, terminating  in stupor  and death
by exhaustion.  During  the  entire period the appetite is
usually good, sometimes voracious, and there is no  mani-
fest lesion of any other function.
  Treatment. — Common feculent   diarrhoea   frequently
requires  no treatment, as when the irritating matters are
removed,  it  ceases  itself.  If,  however, there is  much
griping, with colicky pains, the  compound powder of ja-
lap  and senna  may be  administered in  scruple  doses
every four hours, until  there is a  free evacuation  and
a cessation of the  pain. Following  this,  if  necessary,
we  may give  compound  syrup  of rhubarb and potash,
one and a half ounces; paregoric, half an  ounce; mix;
a teaspoonful  every  hour  or  two;  or,  if  necessary 
408
DIARRH03A.
an astringent, as the tincture of catechu, kino, or gera-
nium.
  In bilious  diarrhoea, I  usually employ leptandrin, di-
oscorin, geraniin, ten  grains  each; opium, five grains;
mix, and divide into ten  powders, of which one may be
given every two hours; or, essential tincture leptandra;
essential tincture dioscorea, each half an ounce;  com-
pound syrup  of rhubarb and  potash, two ounces; in
doses of a  teaspoonful  every two hours, until the dis-
charges are changed, when we may substitute  an  astrin-
gent if necessary.  If there is  much febrile action, or the
skin is dry and harsh, the hot mustard foot-bath, with a
bowl  of hot pennyroyal  or sage tea, will be beneficial;
and if considerable  pain or griping, a mustard plaster to
the bowels.
  Diarrhoea from atony should be  treated with  stimu-
lants and astringents.  I have  used the aromatic tincture
of guiacum, with and without tannic acid, in doses of a tea-
spoonful every hour, with the most marked success; or,
oil of cajeput, oil of  anise, each one drachm; alcohol, one
ounce;  syrup of rhubarb and potash, two fluid ounces;
mix, and give in the same doses;  or, leptandrin, ten grains;
capsicum, opium, each five grains; mix, and  make ten
powders, of which one may be given every two hours; in
mild cases the common astringents will prove sufficient.
  In diarrhoea, the result of determination and congestion,
if severe, I  order  cups  to the  abdomen, followed by
warm  fomentations,  the  hot  mustard  foot-bath,  and
in some cases the  spirit-vapor  bath,  with the internal
administration of leptandrin,  and a demulcent;  or, we
may use the white  liquid physic in this case with advan-
tage, following it with the syrup of rhubarb and potash.
In some of these cases I alternate the leptandrin with the
sub-nitrate of bismuth, in doses of five grains; if symp-
toms of atony result, with loss of strength, the stimulants
first mentioned should be employed.
  In  mucous diarrhoea, we  frequently find it advanta- 
CHOLERA MORBUS.
409
 geous to clear the bowels by a mild purgative; for this
 purpose, castor oil and turpentine, or the white  liquid
 physic, or  the  compound  powder of  rhubarb, or leptan-
 drin  and jalap, with small  doses of  podophyllin, thor-
 oughly triturated with loaf sugar,  may be used.   This
 should be  accompanied by the hot  foot-bath, and com-
 pound powder  of ipecac and opium; and if there is any
 tenderness of the bowels, a sinapism, with  hot fomenta-
 tions, the  hot sitz-bath, or the wet bandage;  after the
 bowels are evacuated, the syrup of rhubarb and potash,
 with  essential  tincture leptandra, will usually be suffi-
 cient ; if not, it may be alternated with one of the vege-
 table  astringents.  In some  cases,  the  stomach  being
 much deranged,  it is  advisable to commence the  treat-
 ment with an  emetic of ipecacuanha.
   Lienteric diarrhoea should be treated by the  use of the
 bath, with  brisk friction, the vinegar  bandage  to the
 lower part of  the  trunk,  or  some  stimulant  embroca-
 tion ; bland and  easily-digested food, and exercise in the
 open  air.  Internally I use  the hydrastin  and leptan-
 drin, with a solution of chlorate of potash and carbon-
 ate of ammonia.  The white liquid physic will be found
 a good remedy, as will also the dilute nitric acid, with
 simple  syrup.  Quinia, with hydrastin, seems sometimes
 to answer  an admirable purpose, and, with the  mineral
 acids, is sufficient for the  relief of the disease.

                 CHOLERA MORBUS.

  Cholera morbus is usually caused by acrid or irritating
 ingesta, or  from  long continued torpor of the intestinal
 canal, the secretions being  thereby retained,  or from sud-
 den changes of temperature, or arrest of secretion in the
warm months of the year.  It usually comes on in the
 summer and autumn, and  in  some  years more than in
others.
  Symptoms.—It usually makes its appearance with pain 
410
CHOLERA MORBUS.
about the umbilicus, and a feeling of nausea and prostra-
tion, and desire to evacuate the bowels.  In a short time
a diarrhoea sets in, the discharges being large, fluid, and,
to some extent, feculent;  usually, the nausea soon passes
to vomiting, the attack coming on with the disposition to
go to stool, and being long  continued, and attended with
much straining.   The pain  in  the bowels varies greatl},
in some  cases being  extremely intense,  at  others  but
slight; the stools vary in character, in some cases }'ellow,
or yellowish brown, and accompanied by vomiting of bile,
at others becoming lighter and lighter in color, until they
seem nothing but water with  whitish flocculi in it, like
the rice-water discharges of Asiatic cholera.  The first
variety has  taken the name of bilious  cholera;  in  other
cases, the bowels seem  to  be distended with  gas,  the
patient passing considerable flatus at stool. This is termed
flatulent cholera.
  As the disease progresses, the patient's strength becomes
exhausted, the vomiting  or retching is  more severe, the
discharges from the bowrels  more  frequent, and  the pain
severe and less easily borne.  Now, the spasmodic action
of the muscles of the lower extremities  frequently ensue,
and sometimes of the abdominal muscles; the cramps are
exceedingly painful, and cause the patient to cry out with
pain when they come on.  The pulse is now small and
fluent, the extremities cold,  and the surface bathed in  a
cold, clammy perspiration.  If not  arrested, we  find that
the sufferer's strength is gradually exhausted, the mind
wanders, and the patient  dies.
  Treatment.—Though a severe disease, the treatment is
the simplest  possible.  We  administer  at first the  com-
pound tincture of cajeput, in doses of a teaspoonful  every
fifteen minutes, until the patient feels a sensation of agree-
able  warmth in  the stomach, and then at less  frequent
intervals.  This  almost invariably checks the vomiting,
and in a large majority of cases, the diarrhoea.  Another
very efficient remedy is the aromatic tincture of guiacum, 
ASIATIC CHOLERA.
411
given in the same doses.   If the nausea is not controlled
by  these means, we may give  an infusion of peach tree
bark, or of the compound powder of rhubarb, in small
doses, or of sub-nitrate of bismuth, or morphia.  Usually
these means are not required.
  A sinapism to the epigastrium, and extended over the
entire surface of the bowels, and followed by hot foment-
ations, afford marked relief in some cases.  I prefer, how-
ever, the application of a towel wrung out of cold water.
The hot  mustard foot  bath may be used with advantage,
and in  some cases the vapor  bath.   If the  cramps are
severe, friction with mustard will give  relief; or, in worse
cases, we use the compound tincture of cajeput.  In very
severe cases, the surface being cold, and  the pulse hardly
perceptible at the wrist, the patient may be wrapped in a
blanket wrung  out of hot mustard and water.

                ASIATIC CHOLERA.

  A disease, having some semblance to cholera, was par-
tially described by the  Greek physicians, which was prob-
ably our cholera morbus.   Again, in 1689, Dellen described
a disease very much like it.
  It was not until  from 1774 to 1790,  that the disease we
kimw  as Asiatic cholera, made its appearance, and was
then confined to India, though  committing great ravages
in the Bengal army, it  is  still  believed by many that even
this was cholera morbus.   The  descriptions are so imper-
fect that it is difficult to  determine the  character of the
affection, and as it was so much  milder than the cholera of
the present century, we may consider it  as  not being a
variety of this disease.
  In August, 1817, the terrible disease known as Asiatic
or spasmodic cholera,  made  its appearance  at Jessore,
about a hundred miles north-east of Calcutta.   It reached
the  latter  place early  in September,  having  destroyed
thousands of the inhabitants in its course.   It  gradually 
412
ASIATIC CHOLERA.
passed over the Indian peninsula, and had, by 1823, ex-
tended itself in one direction, to the shores of the Caspian
Sea, and in another as far as the Mediterranean and the
borders of Russia; during this time it counted its victims
by millions, nearly depopulating certain sections of coun-
try.   In 1831, it again made its appearance in Russia, and
extended over Europe, reaching England in October of
this year.  It  appeared on this continent at Quebec, on
the 10th of  June, 1832, and at New York on the 24th of
the same month.  Its spread in the United States was
rapid, and its  mortality fearful, and it did not entirely
cease until 1834.
  Its second appearance in this country, and  the third
choleraic pestilence that we have accounts of, occurred in
1849.  As before, it spread rapidly, and the mortality was
very great.  It seemed to be confined to no age or condi-
tion,  but attacked  the population  indiscriminately.   It
recurred in  1850, 1851, and  in  a sporadic form in 1852,
having thus lasted four years.  The causes of cholera are
not known; many ingenious speculations have been made,
but we are no nearer the truth than we were  at the com-
mencement of the first epidemic.  It undoubtedly depends
upon some peculiar constitution of the atmosphere, which
once generated in  India, was  gradually propagated over
the entire globe.
  Cholera is generally believed to be contagious, and'its
epidemic progress, and extension along traveled thorough-
fares, and its appearance on the sea-board only when a
vessel has come from an infected port, is urged as proof.
We grant these are facts, and further that many cases  are
known, in which the  commencement of the  disease in a
place immediately succeeded the introduction of a person
laboring under cholera from a place where  it  prevailed.
Or, that it  appeared first in a  person coming from an
infected district, possibly to escape the  malady, and after
two, three or more days had elapsed; and that the disease,
where it  once  appeared  in a house, was rarely satisfied 
ASIATIC CHOLERA.
413
with one victim.  Admit all this, and yet we see evidence
sufficient to disbelieve  its contagiousness.   Those who
were most with it, who nursed in it, who took no precau-
tion to avoid it, other than temperate living, rarely had
the disease.  It was  more apt to attack those who seclu-
ded themselves  from fear of the  disease, and who used
undue precautions to  avoid it.   The poison is an atmo-
spheric one, and though the seeds of the disease are prop-
agated along traveled routes, yet where once dissemina-
ted in a place, the mere contact  with a person having
it,  is not likely to increase  the danger.  We may well
compare it to the virus of small-pox,  the most minute
portion being as potent, when introduced  into the blood,
as the largest quantity.
   Symptoms.—In some  cases, the attack  of cholera wras
preceded by a  serous diarrhoea, for two, three,  or four
days, but in a  majority of cases  there were no premoni-
tory symptoms up to the day of attack.  Usually, the first
evidence of the disease was a feeling of  great prostration,
and a copious evacuation from the bowels.   With the first
diarrhoeal discharge, in many cases, the patient was com-
pletely prostrate, and would sometimes pass into the col-
lapsed stage with but two  or three. At other times the
discharges from the bowels were very frequent and large,
and from their peculiar appearance, looking like the water
in which  rice had been boiled, denominated rice-water
discharges.  Nausea, with  prolonged retching and vom-
iting, frequently came on with the  first discharges from
the bowels, or during  the progress of the  disease.  With
the full establishment of  the  affection, the  extremities
were  cold; and  cold, clammy perspiration made its ap-
pearance on every part  of the body, sometimes it was so
great  as to stand in  drops, seeming to  be glutinous and
sticking to the hand.  The pulse was slow and feeble, the
artery easily  compressed,  and the circulation arrested;
gradually, as the disease progressed, it failed more and
more, until in the stage of collapse it could not be felt in 
414
ASIATIC CHOLERA.
the extremities.  With the full development of the dis-
ease, spasmodic action of the muscles, or cramps, would
come on, usually at first  in  the lower extremities, but at
last affecting all parts.
  The muscles would contract into hard, rigid knots, the
patient suffering excruciating  pain, which  was best re-
lieved by  compression and brisk  friction.  A marked
change was now noticed in the appearance of the patient;
he seemed  to have lost flesh as much as he would in two
or three weeks' sickness; the eyes were sunk in the head,
the countenance pinched and contracted  and of a ghastly
white color, the lips and mouth of a leaden purplish hue.
The disease  continuing, it  soon passes  into the stage  of
collapse, the entire surface being cold and covered with a
clammy perspiration, a remarkably cadaverous appearance
of the countenance, and a  shrunk  and shriveled  skin.
The pulse at the wrist is very feeble, and seems very much
like drops of water trickling under the finger, and at last
is not  perceptible.   The  discharges  from the  bowels.are
now involuntary,  consisting of simple  water, with the
whitish flocculi heretofore named.  The  cramps  still con-
tinue, frequently with increased severity.   Sometimes the
patient's mind wanders, but at others it  is clear and com-
posed to the last.
  The disease is of variable  duration, sometimes termina-
ting fatally in an  hour or two, most  generally within
twenty-four hours, though in some rare cases it  lasts two
or three days.  If it terminates favorably, we find that
much care  is necessary during convalescence, as  the bow-
els are so feeble, and there has been such a severe shock
to the system.  A low grade of fever  not unfrequently
sets  in after  it, continuing several days, and requiring
careful management.
  Treatment.—The treatment I adopt in a case of cholera
is such as will support the flagging powers of life, by strong
stimulation.  It may not be successful in all cases, but I
feel satisfied that it will be attended by as good results as 
ASIATIC CHOLERA.
415
ai> j other.  If there is  irritability of the stomach, with
continued vomiting, so that remedies will not remain upon
the stomach,  I  administer an emetic of the compound
powder of lobelia, or of salt and mustard.  In a majority
of cases,  however, wre have nothing  better to settle the
stomach than the compound tincture of cajeput, or Hunn's
Life Drops.   It should be administered in doses of a tea-
spoonful  every five or  ten  minutes,  until the  vomiting
ceases, and there is returning warmth to the  extremities,
and feeling of heat when the medicine is taken, when  it
may be given less frequently.  To aid its action, I  direct
flannel cloths, wrung out of hot mustard and water, to be
applied over the entire abdomen, or, if this seems impos-
sible, we  may use strong salt water cold, or equal parts  of
turpentine and tincture of camphor.   If the case was ap-
proaching collapse, I should wrap the patient in a blanket,
wrung out of mustard and water, as hot as could be borne,
or, if there were no facilities for getting this, I wTould use
the cold  wet  sheet pack, the water being pretty strongly
impregnated  with salt.  One application, I am satisfied, is
as serviceable as the  other; in  fact, I should prefer the
last, if it were not so unpleasant, and objected to  by the
friends.
   The cramps are an exceedingly troublesome feature of
the disease, and are best removed b}7 friction  with dry
mustard.  This is also recommended to bring the circula-
tion back to  the surface, but without the slightest effect,
until the internal remedies commence to affect the system.
The compound tincture of cajeput is much the best local
application, if it were not so costly.
  The treatment named  above seems very meager, and
yet it is the best  that  I have tried  myself, or witnessed
with others.  Other remedies possessing similar properties
might be substituted for the compound tincture of cajeput,
but I doubt  their  being  equal, if as good.  Those  that
Beemed to exert the best influence were the tincture  of
xanthoxylum, aromatic tincture of guiacum, and camphor 
416
CHOLERA INFANTUM.
              CHOLERA INFANTUM.
  Cholera infantum, or summer complaint, is a disease of
very frequent  occurrence, and  one of the most difficult
that we are called to treat.   It occurs usually during the
second summer, or the period of first dentition, but may
come on as early as the age of  six or eight months, or as
late  as the third or fourth  year.  It is difficult to deter-
mine why at this time the child should be so susceptible
to gastro-intestinal irritation.
  Many have urged dentition as the cause, but as  that is
a physiological process, except when disturbed, we would
expect to find the disease only in  cases of dental irrita-
tion, whereas we find it in children who have no teeth, who
are not cutting teeth at the  time the disease  commences,
who have all their deciduous teeth, except the four last
molars, or who show no swelling, tenderness or irritation
of the gums.  We would rather conclude that at this pe-
riod there  is  a  change  in  system consequent upon  the
change in  the  food  of the  child,  and its being no
longer  dependent   upon  its  mother   for  sustenance.
If the child is of vigorous  parents, robust  and healthy,
this change is effected without disease, but  if of feeble
vitality, cholera infantum is  almost sure to result.
  It occurs during the summer, usually making its appear-
ance in June  and July, and in the severer cases  lasting
until frost and cool nights in the fall.  A continuous high
temperature has much to do in bringing  it on, and it is
more frequent in seasons in which  this  is the case.  As
the weather becomes cool in the fall it is mitigated, and
with the appearance of frost it  ceases, though we find that
the sudden changes to cold  during the summer are rather
injurious than otherwise.
  Cholera infantum usually makes its appearance at first
as a simple diarrhoea, which gives  little uneasiness  and
seems not to affect the health of the little patient.  After
continuing thus for a week  or two, it is noticed that the 
CHOLERA INFANTUM.
417
child is becoming very thin in flesh, its appetite is im-
paired, it is very thirsty, and when the  stomach is  over-
loaded' there is nausea and vomiting.   As the disease pro-
gresses, the desire  for  drink becomes more  craving, the
evacuations from the bowels more frequent, and the little
patient wasted to a mere skeleton of its former self. The
discharges from  the bowTels vary much in character in dif-
ferent cases, and even in the same  case at different times.
Sometimes they are  yellowish, with  more or less stringy
mucus mixed with them, showing disease  of the mucous
follicles; at  others they  are greenish, and  have a sour
smell; at others, clayey; again, almost white, and rarely a
dark-brown or black.
  In febrile cholera infantum the  skin is  harsh, dry and
constricted, in some cases seeming to be drawn upon the
patient like parchment.  There is great irritability of the
nervous system, the patient being restless  and uneasy,
never  satisfied,  always  changing its  position, wanting
everything, satisfied with nothing, and especially  restless
and wakeful at. night.  The child seems to be worse in the
after part of the day and  evening, and frequently  every
other day.   When the disease becomes very severe, it  is
almost impossible to keep the  child in bed  at night, the
heat seems to torture it, and it is only satisfied wh%n laid
where it can turn freely about, or when carried from place
to place.
  In the non-febrile form, the skin is  soft, relaxed and
flabby, the extremities cool, the bowels distended or pen-
dulous, the tongue broad, flabby and coated, and the pulse
small, soft and fluent.  The child is not so restless  as in
the preceding case, seems stupid and dull when nursed or
in a comfortable position, but wants its own way.  In both
cases the appetite is alike impaired, there is the same nau-
sea, the same desire for drink, and the same prostration of
strength.
  We sometimes find the brain seemingly affected in these
cases, when there is a continued moving of the head from
      27 
418
CHOLERA INFANTUM.
side to side, the  child sleeping with  its eyes partly open,
and rolling the eyeballs upward.  If the pupils are some-
what dilated and do not contract  freely upon exposure to
light, I am satisfied there is congestion with  effusion, and
consider the patient's prospects very poor.  Occasionally
determination to the brain sets in, the  head  is  hot, there
is  throbbing  of the carotid  arteries, contraction  of the
pupil, and intense restlessness and uneasiness.
  Treatment.—The first thing to be accomplished in the
treatment of cholera infantum is to quiet the irritation of
the stomach.   For this purpose I would  strongly recom-
mend the peach-tree bark tea, heretofore spoken of.  Take
the young sprouts, and scrape the bark off until a sufficient
quantity is obtained, cover it with  boiling water, and when
cold it  will be  ready for use.  Give it to the child in doses
of half a  teaspoonful  every half hour, or a teaspoonful
every hour.  If this does not answer the purpose, employ
an infusion of the compound powder  of rhubarb, No. 7,
using it the  same  w7ay.  The neutralizing cordial will
sometimes answer the same purpose, at others I use chlo-
roform one drachm to simple sirup two ounces, a tea-
spoonful every hour.  Sub-nitrate of bismuth thirty grains
to spearmint water two ounces,  in  teaspoonful doses, is
sometimes very good.
  With the arrest of the  sickness  of the  stomach the
worst difficulty is over, for though we may not control the
diarrhoea at once, w7e will have placed our patient in such
a condition as to give us time.  In many cases the admin-
istration of an infusion of the compound powder of rhu-
barb in teaspoonful doses every hour, until it changes the
character  of the evacuations, rendering  them  dark like
the medicine, and then in less  frequent  doses, answers a
good purpose.  If the stools are light or clay-colored, lep-
tandrin and geraniin are the appropriate remedies, or small
doses of the white liquid physic may be given.  In other
cases the sub-nitrate of bismuth may be administered with
the most marked advantage, especially if there is  a ten- 
COLIC.
419
dency to dysentery, or tenesmus attending the discharges.
At other times the common vegetable astringents may b&
used,  as  in  cases  of common diarrhoea.  If the skin  is
harsh and  dry, I  administer tincture of aconite twenty
drops to water four ounces, in doses of a teaspoonful every
hour, until the surface  becomes moist  and natural, and
then follow with quinine in doses of one grain every two
hours, until two or three doses are taken.
  The epilobium is a most excellent remedy in some  of
these cases; a strong infusion is prepared and  given  in
doses of  a teaspoonful every hour.  The neutralizing  cor-
dial alone, or with the addition of one drachm of chloro-
form to two ounces, sometimes answers  an excellent pur-
pose to check the diarrhoea.
  The bath is an  important agency in  the treatment;  it
may be used cold,  tepid  or warm, according to the indica-
tions, and may be  medicated by the addition of salt, bi-
carbonate of potash, capsicum, or a decoction of bitter
agents.   The food will vary in different  cases.   If the
child nurses, it may be restricted to the  mother's milk,  or
if this disagrees, cow's milk will sometimes be appropri-
ate; in other cases, farina, sago, etc., seem to answer best;
but frequently I have seen the best results from gratifying
the child's  appetite for meat, especially fat bacon, ham,
dried beef, beef suet, etc.; fatty matters, when they agree
with the stomach,  answer an admirable  purpose.  Stimu-
lants  may be employed, as the brandy with epilobium,
already referred to, but the best  is undoubtedly Catawba
wine, which sometimes seems  to  act as  both  food and
medicine.

                       COLIC. •

  The general features  of  colic are griping pains  in the
bowels of a more   or less   constant  character, constipa-
tion, and absence  of inflammatory or febrile symptoms.
It may be dependent on various causes, as acrid ingesta,
irritating secretions, gaseous accumulations,  spasmodic 
420
COLIC
contraction  of  the  muscular coat from irritation of the
•ympathetic and spinal nervous  systems, structural dis-
ease of the intestinal canal, and disease of the blood.
  Symptoms.—The common form of colic is produced most
frequently from irritating ingesta, or acrid secretions.  It
commences with a  severe griping pain in the region of
the umbilicus, though  somewhat wandering  in its  char-
acter, changing its  position from one  side to  the other,
and from above to  the lower portions  of the  abdomen.
It is not constant, but remittent, giving  the patient a mo-
ment's ease, then recurring  with increased severity.  In
some cases it seems  to be confined to the stomach, as if it
was contracted upon itself, (cramps of  the stomach,) but
more frequently involving the entire intestinal canal.
  There is no  tenderness on pressure, but frequently re-
lief is afforded  by  it;  the skin  is cool, the pulse regular
and not increased in frequency, and there are no symp-
toms of febrile action.   The bowels are  usually consti-
pated, though if produced by irritant ingesta, there may
be watery evacuations from the bowels.
  It generally lasts  but a few hours, though if not prop-
erly treated, it sometimes becomes very severe.
  Tbeatment.—The treatment is simple.   If the pain is
confined principally to the  stomach, or upper portion of
the abdomen, and we have the evidence that the patient
has been lately eating unripe fruit or  other articles diffi-
cult of  digestion, we would immediately give  an emetic.
Thirty grains of ipecacuanha in warm  water, will answer
the purpose admirably, or we may use a teaspoonful of
mustard in  half a  tumblerful of warm water, or give  an
infusion of compound powder of lobelia.  In  other cases,
the most effectual and  quickest remedy is the compound
powder of  jalap and  senna, in doses of twenty grains
every hour, until the pain is relieved; or, if the patient
objects  to taking it by the mouth,  two drachms mixed
with warm  water, and  used  as an enema, will answer the
purpose admirably. In lieu of this, almost any of tha 
DYSENTERY—FLUX.
421
aromaties may be employed, or equal parts  of compound
tincture of lavender, and syrup  of rhubarb and potash;
or a tincture of the oil of anise, of peppermint, or of caje-
put;  or  a teaspoonful  of ground  pepper,  tincture of
camphor, etc.  A sinapism  applied to the  abdomen fre-
quently gives relief, though I prefer a towel wrung out
of cold water.

                D YSENTER Y—FL UX.

  Inflammation of the large intestines is among the most
frequent diseases of the digestive apparatus.   It occurs at
all ages, and  in  all  climates, though it  is more frequent
aud severe in  southern latitudes.  In  this  country  it  -
usually prevails  to  the  greatest  extent during the fall
months, though  sometimes met wTith during the summer.
Occasionally it becomes epidemic, and is extremely severe,
and at these times it has been claimed by  some that it
was contagious.
  The causes of dysentery are   chiefly sudden  atmo-
spheric changes, or a high range of temperature following
a wet and cold season, over-exertion  and arrest of secre-
tion, the accumulation of morbid secretions in the intes-
tinal  canal, miasmata, and, in the epidemic  form, a zy-
motic poison  in the  atmosphere.
  Symptoms.—Dysentery may very  properly  be  divided
into the  sporadic and epidemic, and the last  we will find
assuming many  different characters.  Sporadic dysentery
is  sometimes  preceded  by  constipation, but more fre-
quently by slight diarrhoea.   The  patient has small mu-
cous  or  bloody  evacuations from the  bowels, attended
with  tormina and tenesmus.  At first they are not very
frequent, but  after a time  they recur as often as, say five
to  fifteen minutes.   Sometimes  the disease  commences
with  a well-marked  chill, but at others  none is noticed.
More or  less  febrile  action will be found in all cases, the
pulse  hard and  increased in frequency, the skin dry and
harsh, the urine scanty and high-colored,  and consider- 
422                DYSENTERY—FLUX.
able restlessness and uneasiness.  Pressure over the colon
will usually detect a soreness in some part of its course.
  Most generally, in  this form of the disease, the upper
bowels  are obstinately constipated, as the discharges con-
sist entirely of mucus, mucus and  blood, or almost pure
blood.   Sometimes, however, it assumes  the  character of
dysenteric-diarrhoea, the  operations having more  or less
feculent material mixed with them, or the dysenteric dis-
charges being alternated  with diarrhceal.  Day by  day we
observe the disease becoming severer,  unless controlled by
appropriate  treatment, until at last  the patient  is very
much reduced, the symptoms  assuming the character of
those of the epidemic form of the disease.
  Epidemic dysentery occurs  in  two  principal  forms,
though there are various  gradations: these are, <^ises with
obstinate constipation of the small intestines, with an ac-
tive grade of fever, and cases where there is an irritability
of the entire intestinal tract, with a low or asthenic fever.
  In the first form, the disease almost always commences
with a well-marked rigor or chill, followed  by high feb-
rile action.  The discharges from the  bowels soon  become
frequent,  are  preceded  and attended by  tormina, the
pains  being of a  severe cutting character.   The tenes-
mus, or desire  to  evacuate the  bowels, is almost constant,
and is very distressing during  the  operation—it seeming
to the patient that the  desire for an evacuation would
never cease.  No rest can be obtained during this condi-
tion, and  as a natural consequence  the patient  is very
fretful and uneasy.  The discharges from the bowels are
sometimes  pure mucus,  at  others  mucus  mixed with
blood,  and again  seemingly almost pure blood, in each
case the material  being unchanged,  not dirty or discol-
ored as  in the next form  of the disease.
  As  it continues, we find that day by day the  disease
becomes seemingly more severe.  The fever is remittent
or  continued, and very  severe, the skin being dry and
parched, the  pulse hard and frequent, pain in the head 
DYSENTERY—FLUX.               423
 and back, the tongue  coated, a  bad taste  in the  mouth
 and loss of appetite, the  urine  scanty, sometimes  passed
 with difficulty, and anxiety and uneasiness from the al-
 most total want  of  sleep  from the  commencement of
 the  disease.  Up  to  the  sixth  or seventh day the symp-
 toms will be  thus  acute;  but  after  that we find the fever
 assuming a typhoid type, aud  the discharges from  the
 bowels  become  discolored and  offensive, as in the next
 variety.
   The  second form frequently commences as above  de-
 scribed, the fever following the chill or rigor being acute.
 The discharges from  the  bowels are small, and composed
 of mucus and  blood, and attended with an  intense tor-
 mina and tenesmus.   But in the progress of the disease
 it is  found  that any cathartic will  start the small intes-
 tines into action, and wre  have the  more or less offensive
 feculent matter passed with the  dysenteric discharges, or
 alternately with them.  When  this occurs, the typhoid
 symptoms  described below soon make their  appearance.
 In other cases  the discharges are  semi-diarrhceal  at  the
 commencement, and we find this irritability of the small
 intestines,  and  sometimes  of the  stomach, continuing
 throughout the progress  of the disease.  This feature of
 the  disease  must  be  noticed;  for  if  we should give in
 this case a  cathartic to increase secretion from the liver,
 and open the small intestines, we would many times  set
 up an irritation that we would find  it impossible to quiet.
 Dr. Copland describes the symptoms of typhoid dysentery
 as follows:  " The patient complains  at first of general  de-
pression, vertigo, violent  headache,  increased sensibility
to light, pains in the limbs and joints, and of gripings and
purgings, followed by anxiety at the  precordia,  stupor,
foul, clammy tongue and mouth, which soon becomes dry
and covered by a brownish coating, a penetrating, offen-
sive odor of the breath,  and intense  thirst.   The pulse
at first  is  very quick and small,  and afterward weak
 and irregular.   The stools are, from the commencement, 
424
DYSENTERY—FLUX.
 very frequent, in small quantity, preceded by tormina and
 tenesmus, and glairy or serous, and contain more or less
 dark blood.  The urine is scanty, thick, and  dark-col-
 ored.  About the fourth or sixth day,  a milliary erup-
 tion  or petechias  sometimes  appear about the  neck,
 breast,  arms, and abdomen;  and  occasionally epistaxis
 occurs, between the fourth and eighth days, in young and
 robust subjects, but without becoming critical.   The in-
 tensity of the tormina and tenesmus generally diminishes
 with the progress of the  disease, and often, about the
 ninth or eleventh day, is  replaced by a colliquative di-
 arrhoea.  The stupor is now attended by delirium; the
 soft solids waste  and become  flaccid;  the surface as-
 sumes a dirty hue, and an offensive, penetrating odor is-
 sues from  the  body and  evacuations.   If not  amelio-
 rated or arrested in its progress, this  form  terminates
 fatally from  the eighth to the twenty-fourth day."
  Many  of these symptoms make their appearance in the
 last stages of epidemic dysentery, and we see cases  that
 run their course as just described.  We again find others
 much more malignant.  By the second, or third, or fourth
 day, the  countenance is sunk, anxious, and cadaveric, the
 tongue covered  with an offensive brown fur, sordes on
 the teeth, fetor of breath,  a small, feeble  and frequent
 pulse, great depression of the nervous system, and want
 of power to control the voluntary muscles.  The evacua-
tions, which were at first of a dirty mucus, with more or
less dark grumous blood, sometimes alternated by a very
foetid feculent matter, now become  reddish and slimy,
resembling the  washings  of meat, or prune juice,  and
excessively foetid  and  cadaverous.   The tormina  and
tenesmus, which at  first were severe, abate,  and some-
times the stools are passed involuntarily, and  attended
with sinking and tendency to syncope.   Soon  delirium
ensues, the patient lies on  the  back, slides down toward
the foot  of the  bed, picks at  the bed-clothes, and after 
DYSENTERY--FL UX.
425
 lasting in this condition longer than it would seem possi-
 ble, finally sinks.
   Treatment.—In the  common  form of dysentery,  the
 first object to be accomplished is to get an action from the
 upper part of the bowels.   The  frequent discharges  the
 patient is having, is the result of the inflammation,  and
 the normal discharges from the bowels are arrested.   For
 this  purpose castor-oil, or  compound powder  of jalap,
 might be given, but the podophyllin pill will be found
 preferable in a majority of cases.   Give just sufficient to
 produce fecal discharges, and it will be found that, for the
 time being, the discharges of blood and mucus will cease.
 If they return, give the cathartic in smaller doses.
   To arrest the pain and constant desire to  evacuate  the
 bowels, let the patient sit in a tub of water, as warm as
 can be borne, and repeat it as often as necessary.  In some
 cases, the use of the hot hop poultice will answer the same
 purpose.  In addition, use an injection of two tablespoon-
 fuls of starch-water and half a teaspoonful of laudanum,
 after each motion.  The injections should be used with
 care, and retained as long as possible.  In some cases the
 use of a large injection of warm  or cold  water, to  the
 extent of a pint, will give great relief.
   Where there is much fever, use the  vapor bath, or blan-
 ket pack, and give the  patient freely of some warm dia-
 phoretic  infusion.   In addition, put  him on the  use of
 tinctures  of aconite and veratrum, as heretofore recom-
 mended, and if  the fever  is periodic, give quinine, as in
remittent fever.
  In the severer cases, where the  entire intestinal canal is
irritated, the cathartic plan of treatment just named will
not answer.  Here we would give sweet-oil in tablespoon-
ful doses  until  the accumulations  in the  bowels were
removed.   Or, we might  use the compound  powder of
rhubarb,  or neutralizing cordial,  for  the  same  purpose.
After this, we give these remedies in small doses, with
mucilage of slippery elm or gum  arabic.   An infusion of 
426
WORMS.
epilobium answers an excellent purpose in this case.  We
use the hot hip bath and the injections, as in the preceding
case.
  In addition to the special treatment for the dysentery,
we  would pursue the same course for the fever as  that
named for  typhoid fever. As a general rule, astringents
are not well borne, but in some cases, when the discharges
become large,  like  diarrhoea, we adopt the treatment
proper for that disease.

                      WORMS.

  Intestinal worms are of very  common occurrence, in
fact there is hardly a person but what has had more or less
of them  at  some period of his  life.   In some sections
of country  every  person  has worms, while in others they
are  comparatively rare.   They are produced in the intes-
tine by the  swallowing of their  eggs or grub, which are
exceedingly minute, and generated in very large numbers.
Thus, in the case of the tape-worm, naturalists have traced
its  development from the cysticercus  of the  hog, which
being introduced into  the intestinal canal, becomes devel-
oped into a fully formed worm.  Each joint of this worm
contains a large number of eggs, which, being discharged
with the  intestinal contents, is eaten by  the hog, devel-
oped into a cysticercus, which may in  turn form a tape-
worm.
  The principal varieties of intestinal worms,  are, the
long round worm, ascaris lumbricoides—the small thread
worm, ascaris  vermicularis—the long thread worm, trico-
cephalus  dispar, and  the tape-worm,  taenia.   The long,
round worm,  inhabits  the  small intestines,  sometimes
passing up into the stomach  or down into the large intes-
tine.  It  varies in length from five to eighteen inches, and
sometimes  is fully half an inch  in diameter.  The small
thread worm is principally found at the lower part of the
bowel, and is  usually not more than half  an inch in 
WORMS.
427
length, and the thickness of a thread.  The long thread
worm, inhabits the stomach and small intestines, is from
one to two inches in length, but very slender.   The tape-
worm varies in length from a few feet to over a hundred
feet.  It  is formed of joints about  the size,  and very
closely resembling gourd seed, which are attached to each
other, end to  end.   These joints are  frequently passed at
stool, and  are the  principal  means  of determining  the
presence of the worm.
  Symptoms of Worms.—The symptoms  of worms  are
very obscure, so much so, that  it is impossible always to
determine whether disease arises from them or  not.   The
principal symptoms supposed to indicate the presence of
the long round worm, and long thread worm, are the fol-
lowing :  The child is  continually picking its nose; its
upper lip swells; there is a white line around the mouth;
the tongue is coated; the breath bad; the  appetite varia-
ble, and there is more or less fever, and irritability of the
nervous  system.   Though these are the symptoms of
worms, yet they may exist from other causes.
  The small thread worm announces its  presence by irri-
tation of the rectum, the itching being  very  severe and
almost unbearable.  It most generally comes on when the
child gets warm  in bed, and is so annoying that it  can
not go to sleep, and at times the irritation becomes so
great as to produce convulsions.  Its presence is known
by its being found  in the stools, and  sometimes crawling
away from the person.
  The symptoms of tape-worm are  not very constant.
The person is usually thin in flesh, but has a voracious
appetite, though it  is variable.  Sometimes there is pain
in the bowels, but  at others there is no symptom what-
ever of the presence of the worm, with the exception of
its joints passing by stool.
  Treatment.—The first  two varieties  may be removed
by any of the common  vermifuges.  The old fashioned
remedy was castor-oil  and turpentine, or a tea of equal 
428        DISEASES OF THE URINARY ORGANS.
parts of pink root and senna.   Worm-seed oil, with castor-
oil, is the basis of nearly all the patent vermifuges, but its
nauseous  taste  renders it objectionable.   Santonin, in
doses of two or three grains four times a day, and worked
off with  any cathartic,  is  the  pleasantest  medicine.
This remedy is frequently combined with sugar to form a
candy, and is  the  principal constituent of all the worm
lozenges.
   The  small thread worm  is easily got rid of.  I direct an
injection of a  teaspoonful of salt to  a teacupful of cold
water,  as an injection, once a day, and in four or five days
the person is entirely free from them.
   Various remedies are used  for the removal of the tape-
worm.   The most simple  one is, to make an emulsion of
four ounces of pumpkin seed, first removing  the  shells,
and take it on an empty stomach in the morning.   Noth-
ing should be eaten during  the day, and  if it does not
operate, it may be  worked  off with a  cathartic.   The
male fern is another excellent agent,-and  is usually em-
ployed in the form  of fluid extract, the dose being from
one to  two teaspoonfuls.  Turpentine, in sufficient quan-
tities to  prove cathartic, about  one ounce, has been em-
ployed with excellent results, though  it should  always be
taken with the advice of a physician.
   In conclusion, let it be distinctly  understood, that worm
medicines are not  required often, and that much  more
harm than  good has  resulted  from their employment,
Let them be given  only when there are good reasons for
supposing that worms  are present, and when  they give
rise to  unpleasant symptoms.

     DISEASES OF THE URINARY ORGANS.

   The secretion  of  urine is one  of the most important of
the functions  of the body, as it is through this channel
that the greater  portion of the nitrogenized wraste of the
tissues gets out of the  system.  Waste or  destruction of 
INFLAMMATION OF  THE KIDNEYS.         429
tissue is just as important in the animal economy as sup-
ply or nutrition of textures;  and we find  that the reten-
tion of this waste is as serious in its results as the want of
material for nutrition.  We  have already seen  that the
urine  contains elements that are poisonous to the human
body, and that when retained in the blood in sufficient
quantity, they exert the same influence that would follow
the absorption of a narcotic poison.

       INFLAMMATION OF THE KIDNEYS.

  Acute inflammation of the kidneys is not of frequent
occurrence, as they are  situated  so deeply, and  so well
protected, as  not to  suffer  from  cold  or atmospheric
changes, or from injury, and  their circulation is so direct
and free that they are not as easily affected by derange-
ments of the general circulation as other parts.  When it
does occur, it is produced by the usual  causes giving rise
to inflammation, as cold, injuries, local irritation, the con-
dition of the  blood, the  sudden  arrest  of accustomed
discharges, too long retention of urine, the extension of
inflammation from the lower parts of the urinary appa-
ratus, etc.  Usually but one organ is affected, but in some
cases both are involved at one time, rendering the disease
very serious.
  Symptoms.—Inflammation  of the kidney usually com-
mences with a well marked rigor, though  sometimes but
slight chilly sensations precede the fever.  The febrile ac-
tion is not high at first, but  frequently becomes very in-
tense  in the course of two  or three days.   With the ap-
pearance of the  chill, the patient complains of a tensive
and tearing pain in the loins, which is but little increased
by pressure.  By the second day this pain has  become a
marked feature, and now extends down to the hypogastric
region, in the course  of the ureter, to the testes, causing
retraction, and sometimes to the penis.  This pain is in-
creased by straining at stool and during micturition. The 
430         INFLAMMATION OF THE KIDNEYS.
urine, at first but little changed, is now small in quantity,
passed with difficulty, and of a dark-red or reddish-brown
color, and frequently tinged with blood.  If both kidneys
are affected, the urine will  be very scanty and high  col-
ored, and passed with  difficulty.  In a later stage of the
disease, if the calyces and pelvis of the kidney are affected,
we will observe more  or less mucus or muco-pus in the
urine.
  The constitutional disturbance becomes marked by the
second day.  There is frequently nausea  and vomiting,
especially when anything in the slightest degree nauseous
or irritant .is taken upon the stomach;  the bowels are ob-
stinately constipated,  and acted  on with  difficulty;  the
skin dry and harsh, the pulse hard  and  frequent, and at
first  great  irritation, restlessness and  entire inability to
sleep;  but if the secretion  becomes markedly scant, as
from disease of both kidneys, coma or  low muttering de-
lirium sooner or later  makes its appearance.  If but  one
kidney is involved, we will find  if the  disease progresses,
without  being controlled by treatment, that the fever as-
sumes a  typhoid or asthenic  character by the seventh or
tenth day, with dark furred tongue, sordes on  the  teeth,
typhomunia, etc.  If both kidneys are affected, the disease
will  terminate fatally before this, if not arrested by medi-
cine.
  Treatment.—Prompt treatment is necessary in this case,
especially if both kidneys are involved in  the disease.  I
should administer immediately  a  full  dose of  compound
powder of jalap  and senna, and bi-tartrate of potash, in
equal parts, and if there were great nausea, I would pre-
mise with an emetic.   We use the cathartic as a most effi-
cient means of derivation, to lessen the quantity of the
circulating fluid, and to remedy in part  the influence oi
defective secretion of urine.  The special sedatives should
also be  employed as  heretofore recommended, with the
addition of full doses of gelseminum, which seems to have
a direct action upon these organs.  I should use it in doses 
SUPPRESSION OF URINE.
431
 of from one-fourth to half a teaspoonful every two hours,
 until its influence upon the system was marked by depres-
 sion of the eyelids and disordered vision.  The essential
 tincture of asclepias, diaphoretic powrder, or other diapho-
 retic, may be used in combination with it.
  To aid the action of these remedies we will find it ad-
 vantageous to use the hot sitz bath, or as I have sometimes
 done, sit the patient in a  tub of hot water, put his feet in
 a bucket of hot mustard water, with a blanket drawn
 closely around the w7hole.  Previous to this, it is well
 enough to apply three or four cups to the region of the
 kidneys, well  drawn  and scarified, and  especially is this
 the case if both kidneys are involved.  Tbe patient being
 placed in bed after the  bath, hot fomentations may be
 assiduously applied until relief  is obtained.  In some rare
 cases, we might find the wet bandage useful, but as a gen-
 eral rule the hot applications are best.
  Until the acuteness of the symptoms has passed off in
 some measure, no diuretic is admissible;  but as  soon  as
 the bowels are freely opened, and the skin is slightly soft-
 ened, they may be  used.  The remedies  should  be  very
 mild and unirritating, as an infusion of althae, verbaseum,
 apium, galium, polytrichum, etc.  As soon as the secretion
 becomes free, we can change these for the tonic diuretics,
 as the hydrangea, agrimonia, collinsonia, uva ursi, etc.  If
 there should be hemorrhage from  the urinar}7 apparatus,
 gallic acid may be given with the greatest confidence.

            SUPPRESSION  OF URINE.

  Arrest of the urinary-secretion  may occur during the
progress of any disease, or it may be the result of inflam-
mation, irritation, or congestion of the kidneys.   In any
case it will be found that the amount passed is very small,
or that it has entirely ceased, and  on examination the
bladder is not distended.   Very frequently the patient will
complain of pain in the loins and back, with sometimes a 
432
DIABETES.
sensation of nausea and debility.  As the amount of urine
decreases, there will be first irritation of the  nervous sys-
tem, followed by stupor and coma,  and if there  is entire
arrest, in a few hours by death.
  Treatment.—In  this case I would advise the applica-
tion of hot  fomentations over the  loins; or, instead  of
this, in some cases,  the hot sitz bath.   If there is nothing
to  contraindicate  it,  open the bowels with  compound
powder of jalap, or other cathartic, and then give a mild
diuretic.   An infusion of watermelon-seed, marsh mallow,
or parsley, will answer a good purpose.

             RETENTION  OF URINE.

  In  this case the urine is  secreted, but is  retained
in the bladder on  account of inability to pass it, either
from  loss of power in the bladder, or stricture of the
urethra.  If the patient is conscious, he will complain  of
a sense of fullness  and distention  in the region of the
bladder,  with a  desire to void urine, but inability  to
do so.
  Treatment.—In many cases hot  applications over the
bladder will  give  relief;  sometimes we use  the  hot sitz
bath, and in  others we  direct that  the patient sit over a
hot decoction of bitter herbs.  An injection into the bow-
els  of a  teaspoonful  of laudanum  to  half teacupful  of
warm water, will sometimes give speedy relief.  In addi-
tion to this, an infusion  of marsh mallow, or parsley, may
be given, though it is better to  send for a physician, if
the means above named are not successful.

                      DIABETES.

  By diabetes we understand a condition in which there
is an excess of urine passed.  It is divided into two varie-
ties, diabetes insipidus  and diabetes  mellitus.  In  the first
the urine is  clear, of low specific  gravity, and tasteless. 
diabetes.                   433
In the second, it is  of high specific gravity, and sweet to
the taste.  The first is not a very serious affection, though
sometimes hard to  manage; while the second is one of
the most grave affections to  which the human  body is
liable.  I will give  the symptoms  of the two, but con-
sider it useless to give the treatment, as it will have to be
conducted by an experienced practitioner.
  Symptoms.—Diabetes insipidus may come on slowly and
gradually, or its advent  may  be  sudden.   The  patient's
attention is directed first to the increased frequency of the
calls to micturate, and especially by having to get up at
night to relieve the  bladder; then, that the urine is passed
in large quantities at a time, and that it is very clear.   At
the same time he feels a sense of  lassitude and languor,
with pain in the back, and  considerable thirst; the appe-
tite is somewhat impaired, digestion  imperfect, the skin
soft  and doughy, or dry and  constricted.   These symp-
toms may make their appearance so as to be marked in a
couple of weeks, or  they may be months in their develop-
ment.   Continuing, it may result  in diabetes mellitus, or,
by enfeebling the system, predispose to severe cachectic
affections.
   Diabetes  mellitus  may  come on slowly or rapidly.  In
some cases  months will  have passed before the patient
thinks his condition so  serious as  to demand the assist-
ance of a physician; but  in a majority, from four to eight
weeks is sufficient for the full development  of the affec-
tion.  It comes on  insidiously, without a pain or an ache,
or any symptom that could be called disagreeable.   The
patient notices that  he is losing  flesh and strength every
clay, and is becoming so feeble that it  is with difficulty
that he  is able to  attend to his business, and at the same
time that he eats nearly as much  as usual. « His attention
is called to the frequent calls to pass water, and especially
that he has to rise during the night, and that the amount
in the vessel in the morning is very large.  These symp-
toms continue to increase  until the patient becomes very
         28 
434
bright's  disease of the kidneys.
feeble and  thin  in  flesh, and is scarcely able to get about,
being confined to  the  room the  greater portion  of the
time—and still there is no suffering.  The thirst is usually
a very marked  symptom, the patient having  an  almost
constant desire  for,  and drinking  large  quantities  of
fluids.
  As the disease progresses toward  a fatal termination,
we  observe hectic  fever  in the afternoon, with  night-
sweats.   The  thirst still  continues, and is  frequently in-
tense; but  the appetite is much impaired and capricious.
Sometimes phthisis sets in and runs its course rapidly; at
others the patient  is  seized  with a colliquative diarrhoea;
and  at  others the  kidneys  fail to remove the necessary
amount of urea, and the patient dies of ursemic coma.

     BRIGHT'S DISEASE OF THE KIDNEYS.

  This, also, is one of the most serious  affections to which
the human body is liable.  It may occur at any age, but
is most frequent in the young adult—say between the ages
of fifteen and thirty-five  years.  It consists of granular
degeneration of the  secreting  structure of the  kidney,
until at  last it  is entirely changed into a granular mass.
One or both kidneys may be involved at a time; if but
one,  the disease will progress slowly; if both,  it runs
rapidly to a fatal termination.
  In this disease albumen is passed with the urine, this
being the characteristic feature.   To determine the pres-
ence of this ingredient in the  urine, put a small portion
in a tin vessel and  boil it;  if albumen is present it will
coagulate, and cause the urine to be cloudy.  Then take
a second portion, and add a few drops of nitric acid, and
the same cloudiness will be observed.
  Symptoms.—There  are  no marked  symptoms  in the
early stage of the  disease to arrest  the attention  of the
patient or the physician.  It is noticed  that the patient is
gradually losing flesh  and strength, and has a cachectic 
INCONTINENCE of urine.
435
appearance.   The skin is dry and  somewhat harsh, and
the patient does  not perspire on active exertion  as usual.
The bowels  are  constipated, or in  some cases irregular,
diarrhoea alternating with  constipation; the appetite is
variable, and there are more or less dyspeptic symptoms
and headache.  These  symptoms and loss  of strength at
last becoming so marked, cause  the patient to consult a
physician, it may be months, or sometimes two or three
years from the commencement of the indisposition.  On
close  questioning, we  will find that  the patient has a
weakness of the back, probably a sense  of fullness in the
loins, and his attention has been drawn to slight difficulty
in passing urine, and some alterations in  its physical prop-
erties.
  As the disease progresses the patient  becomes very
feeble and cachectic, and  frequently dropsical.  The appe-
tite is  poor;  digestion is feeble; the  circulation weak;
there is great emaciation; hectic fever appears in the even-
ing, followed by night sweats; the patient dying of gradual
marasmus, or some other affection that is set up owing to the
enfeebled condition of the system; or uraemia occurs, and
carries the patient off in  a very short time.   Occasionally,
in the  later  stages, the  urine is scanty and but slightly
albuminous, so that there is  some difficulty in determining
the cause of the constitutional disturbance.

           INCONTINENCE OF URINE.
  Incontinence of urine should properly be considered
after diseases of  the bladder, but as we have just noticed
retention, we may  notice it here.  Though not a very
frequent affection, it is  yet met with sufficiently often, and
its symptoms are so disagreeable, as to merit careful study.
It ia of  more frequent  occurrence during childhood, and
may be  in these cases attributed to atony of the  muscular
fibers closing the neck of the bladder,  or to an  irritation
of the  nervous fibrillar distributed  to the mucous mem-
brane of the bladder, which prevents normal distension 
436         INFLAMMATION OF THE  BLADDER.
of that organ.   In the adult it  is frequently the result of
injury, as in cases occurring after labor, or in consequence
of long-continued disease of the urethra or bladder.
  Symptoms. — The symptoms  of  the  affection vary  in
different cases; some being able to partially retain the
urine, while others have no control over it at all.   In the
worst cases it continually dribbles away as it is passed into
the bladder, the patient being unable to retain it.  As the
result of this state of affairs  we find that the person is
rendered filthy, and is debarred society on account of the
disgusting urinary odor that he  can not get rid of.  There
is also more or less  irritation of the genital organs, and
of the adjacent integument, sometimes very severe, result-
ing in  deep foul-looking  ulcers.   In other  cases,  it is
retained to the  amount of a few drachms, and then com-
mences to dribble away, unless the patient has an  oppor-
tunity to void it,  In other cases, the bladder being irri-
table, it is forcibly expelled, after having accumulated  to
a certain extent, the patient having no  power to resist  its
expulsion.   Incontinence  of urine at night is a trouble-
some affection among children, and even the  physician is
frequently  consulted about it; but,  unlike the  other, it
usually arises from  an irritability  of the bladder, which,
assuming control when the will is in abeyance, as  during
sleep, causes the discharge.
  It is  not  necessary to specify remedies in this case, as
they are of such a character that they could not be used
with safety in domestic  practice.   In  many cases the
disease can be radically cured, in  others it can not, but if
it can not, there are appliances  that will obviate the disa-
greeable consequences above named, and permit the suf-
ferers to enjoy life like other persons.

      INFLAMMATION OF  THE BLADDER.
  Acute inflammation  of the urinary bladder is  not  of
frequent occurrence.  It is usually caused by injuries, or
from irritating diuretics  or injections, or  from disease of 
INFLAMMATION  OF THE BLADDER.         43f
adjacent viscera, and  more rarely from cold.  It may be
confined to the mucous coat, or may involve  both it and
the muscular, or extend to the peritoneum.
  Symptoms.—Acute cystitis commences with  pain in the
hypogastric region, of a  sub-acute  character, with  sore-
ness on pressure;   There  is a frequent desire to Urinate,
and these calls are attended With an  aggravation of the
suffering.   From the sympathy existing between the  blad-
der and the kidneys, the urinary secretion  becomes  scant
and high-colored, and its increased acridity gives rise to a
painful burning and scalding sensation when  it  is passed.
When the disease has attained its greatest intensity,  there
is an almost constant desire to  micturate, with an intense
tenesmus, so  that the patient is sometimes obliged to take
hold of something  with his hands when  passing water,
and will frequently bite his lips to keep from crying out
with the severe suffering.
  With the  commencement of the pain  the patient is
usually seized with a  chill *or well-marked  rigor, which is
followed by febrile action, generally of a  remittent  char-
acter, and not very severe.  This disease runs a course of
from six to  twelve days,  and terminates in resolution, or
the chronic form;  or, in some rare cases, extending to the
peritoneum and adjacent fascia, gives rise to the formation
of a pelvic abscess.
  Treatment.—In inflammation of the bladder we would
employ the hot hip bath frequently, and for a considerable
length of time; or, instead of this, we might use the hot hop
fomentation.   Internally,  give a brisk cathartic  of the
compound powder of jalap,  or the citrate of magnesia,
and let the patient drink  freely of an  infusion  of marsh
mallow, mullein, or other mild diaphoretic.  If there is
fever, it will be well to give the special sedatives. 
438          INFLAMMATION OF THE BRAIN.

      DISEASES OF THE NERVOUS SYSTEM.

  The nervous system, as we have seen when considering
its physiology, controls the entire body, though the proper
performance  of its function depends upon a proper quan-
tity and quality of the blood.   The  brain is the organ of
the mind, and furnishes the force by which a very large
portion of the body is brought under the influence of the
will.  The upper  portion of the brain is  especially  the
organ of  thought, and rather detracts than adds to  the
vitality of the person.  The lower portion, or base of the
brain, is associated in action with the spinal cord, and is
eminently a vital part, the tenacity of life  and power of
living depending,  to  a very considerable  extent, upon its
development  and perfect condition.   While  so serious an
injury as  the removal of a considerable  portion of the
front lobes of the brain may be recovered from, the slight-
est injury  of the base of the brain  or spinal cord will cause
death.

        INFLAMMATION OF THE BRAIN.

  The brain and  its membranes, occupying the cavity of
the cranium, is  subject to  inflammation  like all  other
structures. The  disease  may attack and be confined to
the membranes of the brain, cerebral meningitis, or it may
affect the substance of the  brain  itself—cerebritis;  but
very generally affects both to  some  extent.  As it is im-
possible to decide during life whether the  membranes or
the substance of the brain is the seat of the disease, there
is little use in trying  to  draw a distinction between the
two.  Phrenitis may be caused by cold, and other causes
tending to produce irritation of the brain, the state of the
blood, and by injuries.  It is almost  always acute; in
fact, I doubt  if we are able to recognize a chronic inflam-
mation of this organ, unless  it may be of the meninges,
producing chronic hydrocephalus.
  Symptoms.—The invasion of the disease is indicated by 
              INFLAMMATION OF THE BRAIN.          439

a sense of fullness and pain in the head, the integuments
being suffused, and sometimes a marked  sense of heat.
Frequently the patient complains of dullness, with confu-
sion of ideas, and forgetfulness, and  unquiet sleep.  Ex-
treme  irritability and fretfulness, with  indisposition  to
sleep, and  frequent startings  during  rest, the cry being
sharp and quick, as if terrified, are the  precursory symp-
toms  in children.  The disease is usually ushered in with
a marked rigor or chill, continuing  for  an hour or two,
or sometimes for nearly a day.  Following  this, there
is in  most  cases  high febrile reaction, the skin is hot
and flushed, the pulse frequent and  hard, tongue coated
white, bowels constipated, and urine scanty and high-col-
ored.   The head is turgid and hot, the eyes more promi-
nent  and suffused, the pupils contracted and fixed, and
a  deep-seated, heavy, pulsating, and  tensive pain  in the
head.
   As the  disease progresses, the  patient becomes more
irritable and  restless, the  pain  in the head increases, there
is intolerance of light, ringing in the ears, and intolerance
of sound, sleeplessness and delirium.  Up to the third  or
fourth day the fever  is usually continuous, though some-
times there is a slight remission in the forenoon, and the
head symptoms increase  or continue  without  abatement.
A marked change is now observed, the  acute sensibility
gives  way to  torpor,  and the  delirium becomes low and
muttering, or is replaced by coma.   The pulse becomes
fuller, softer or slow,  or in some cases very hard and fre-
quent.  The  head and trunk are still  hot, the face turgid
and of a deeper color, or in some cases blanched an I con-
tracted, the  pupils dilated, the extremities cool, respira-
tion difficult  and sometimes stertorous, and more  or less
involuntary movement and starting of the tendons.  The
coma  gradually  becomes deeper,  and  the insensibility
more marked; all the functions are feebly performed, the
patient lies on his back, slips down to  the foot of the bed,
grasps at  imaginary objects, and thus slowly sinks.  Ac- 
440
INFLAMMATION OF THE BRAIN.
cording to Copland:  " In some cases, particularly those in
which the cerebral  substance is early and generally in-
flamed and turgid, instead of phrenitic delirium, an apo-
plectic sopor, often preceded by convulsions, quickly super-
venes; with  a slow pulse, stertorous, slow  or labored
breathing, turgid or  bloated countenance, startings of the
tendons, involuntary evacuations, torpor of  the senses,
and flaccidity of the limbs."   Here the first stage is very
short, or not  noticed, and  the disease  passes rapidly to a
fatal termination.
  In  children  we  frequently find inflammation of the
brain, making its appearance during the progress of other
diseases.  The head  becomes hot, the face turgid, the pu-
pils contracted, with  great restlessness and constant move-
ment of the head.   Though not very marked on account
of age, the child is  evidently delirious, and the frequent
movement of the head, and putting  the hands up to it>
shows that it suffers  pain.   In other cases, the acute stage
has passed without notice, the face is blanched and con-
tracted, or white  and puffy; the pulse is small and very
frequent, the extremities cool, bowels loose, the operations
being unnatural and offensive;  there  is continued move-
ment of the head  and restlessness, or a deep stupor or
coma.   Sometimes  the  symptoms will continue for three
or four days,  but at other  times the disease will terminate
fatally within forty-eight hours.
  Treatment.—In the  stage  of active determination in
the adult, we would commence  the treatment by the ad-
ministration of a brisk  cathartic, as compound powrder of
jalap and  senna and  bi-tartrate of potash, in doses of one
drachm of each, in a reasonable time, if it should not act.
In  mild cases, the hot  mustard  foot-bath  may be thor-
oughly used; but in the  more  severe, I prefer the warm
bath, and the vapor bath in addition.  With these we
would use a diaphoretic, as an infusion of eupatorium,
salvia, etc*; or of the essential tincture of asclepias, ser-
pentaria,  eupatorium, or  similar  remedies.   To prevent 
              INFLAMMATION of the BRAIN.          441

 determination to the head I use gelseminum, giving it  in
 doses of from twenty to forty drops of the tincture every
 two or three hours until its full influence upon the system
 is obtained.  If there are specific remedies, I should name
 this as  one, its effects  being most'marked in these cases.
 Great care  should be  used, however, in its  employment
 when the stage of excitement is passing into that of pros-
 tration, as it may so paralyze the  brain as to induce fatal
 congestion.   In the second stage of the disease, with coma
 and dilatation of the pupils, it must not be used.
   In many  cases, if we obtain  the action of a cathartic,
 and use the hot foot bath or general bath, the  diaphoretics
 named will induce sufficient sedation without other means.
 If, however, the fever should run high, there  being much
 heat of the head, I would associate with them the special
 sedatives,, tincture of veratrum  and aconite,  in  doses  of
 one drop  of each, largely diluted with water, every hour.
 If the bowels are loose, as is sometimes the case, the gen-
 eral bath will have to be rendered stimulant in order  to
 get the necessary  amount of derivation, cathartics being
 contra-indicated.  In some cases the stomach is  irritable,
 and nausea and vomiting so constant as to  prevent the
 administration of the proper remedies; here I should give
 a thorough  emetic, and expect the  best results from  it.
 The emetic  may also be used in cases where we have rea-
 son  to  suppose  that the  stomach is loaded  with crude
 ingesta, or with vitiated secretions.  As soon  as the bow-
 els are moved, and sometimes before, we  might commence
 the use  of the alkaline diuretics, largely diluted.
  In addition to the means of  derivation already named,
we find  it  advantageous to  apply cups  to the neck, and
even to  the entire length of the spine; in some cases they
should be thoroughly drawn and scarified.  Some use  a
sinapism to the  nape of the neck, but it is too feeble;  if
it is thought preferable, a  blister may be used instead  of
the cups.  Sometimes we find it advisable to use stimulants
to the entire lower extremities, as flannel  cloths wrung out 
442
INFLAMMATION OF THE BRAIN.
of hot mustard water.   The head must be kept cool, either
by the direct application of cold, or the use of evaporating
lotions.  I prefer warm water applied to the head with a
sponge, and  evaporation favored by fanning; sometimes
the water may be used  quite warm  if feeling  grateful  to
the patient, and allaying much of the irritability.
  When the  disease has passed into the second stage, our
treatment will have to be changed, everything looking to
depletion being discarded.  A stimulant purgative, as po-
dophyllin with capsicum and extract of hyoscyamus to the
extent of producing  one  or two stools daily, is  useful.
Stimulant  applications to  the extremities are necessary,
and counter-irritation may be applied  the entire length of
the spine.  I use dry cups to the spine, followed by a sin-
apism, and wet  cups  to the nape of the neck.   When
using the cups and scarificator, it is not our object to re-
move the blood, hence the cupping-glass is never applied
after scarification.   The warm water  applications  to the
head may still be  employed if there  is  heat, or we may
add a  portion of tincture of camphor to the water em-
ployed to render it stimulating;  or in some cases  a weak
tincture of camphor may be used alone.  It should always
be borne in mind that there  is as much danger in keeping
the head too  cool in this stage as in letting it remain too
warm.  Carbonate of ammonia  and brandy are the only
internal medicines that I find any use for, unless  in some
cases  I give quinine, though this  usually comes in at a
later stage.   To an adult the dose would be from half to
one tablespoonful every  hour or two hours;  to a child two
years of  age  about one  teaspoonful.   The  urinary secre-
tion should  be  carefully  watched, for  if suppression  of
urine should  occur, or even retention, our patient will live
but a short time.  If the secretion is deficient, equal parts
of sweet spirits of nitre and essence of juniper will prove
useful, or a small quantity of turpentine may be used with
the nitre.
  Convalescents from this stage of phrenitis must be care- 
SPINAL MENINGITIS.
443
fully watched.  As soon as consciousness returns, we may
commence the administration of quinine, about six grains
in the forenoon, to arrest the obscure remittent fever that
is so generally attendant.  If there are objections to con-
tinuing the brandy, we will  find the nux vomica and hy-
drastin, as heretofore recommended, efficient substitutes.
No continued mental exertion should be allowred, and ex-
citement  should  be studiously avoided, in other respects
the convalescence must be  managed  as  in  other  severe
diseases.

               SPINAL MENINGITIS.
   Inflammation of the meniuges of the spinal column is
not an uncommon disease, though sometimes from the ob-
scurity of its symptoms it may be mistaken for other affec-
tions. It occurs in two forms, as a distinct sporadic inflam-
mation, and as an epidemic or endemic fever, which ow7es its
origin to the spinal cord.  It is in the last named cases that
mistakes in diagnosis are most usually made.  The causes
of this affection are those which give rise to  other inflam-
mations, as cold,  sudden changes of temperature, injuries,
and especially a sudden chilling of  the surface after active
exertion.   It occurs most frequently in the young and
vigorous, and is very rare after middle life.
   Symptoms.—Spinal meningitis usually commences with
a  well marked  chill, lasting  for  several hours,  though
sometimes with a severe  rigor of considerable duration.
I  have seen cases in which  the  chill was of twenty-four
hours' duration, the latter part of it being alternated with
flushes of heat.   Following this, there is marked  febrile
reaction,  with  hot, dry  skin, hard and frequent pulse,
tongue coated white, the edges and tip being red,  consti-
pation oi the bowels, and scanty and high-colored urine.
The patient complains greatly of pain in  the back, which
is  so increased on movement that he dislikes to change
his position for  any purpose; though in some cases, when
not so severe, they are constantly shifting their position to 
444
SPINAL MENINGITIS.
give them ease.  By the  second or third day the  fever
usually becomes high, the pulse running  some thirty or
forty beats higher than in health, the skin being very dry
and constricted, and the irritability and restlessness marked.
These symptoms may be so  prominent as to completely
overshadow the symptoms  of spinal inflammation, the
patient not even complaining of the pain, unless his atten-
tion is directly called  to it.  It will be noticed, however,
that the slightest movement or changing the position of
the body gives rise to pain, and when the attention is thus
drawn to it the soreness of  the  spine will be continually
noticed.   Deep  pressure usually elicits  tenderness, and
sometimes the sensibility is  so exquisite that the patient
cannot bear to be touched.
  As the disease progresses, the fever assumes an irrita-
tive or typhoid type.   The tongue soon becomes brown,
and sordes appear on the teeth.  Typhomania occurs about
the sixth or seventh day, and is  frequently attended with
looseness of the bowels.  Sometimes there is marked irri-
tation of the brain and delirium, at others a  stupor which
soon passes into deep coma.  As the local disease pro-
gresses, it is found that the lower extremities are subject
to involuntary movement, and that the  patient has but
partial command over them;  and that  the  bladder and
rectum is evacuated without the knowledge of the patient,
or there is retention of urine without the power of dis-
charging it.  At last, in severe cases, paralysis of the part
below the seat of inflammation is complete.  The fever is
usually continued, though sometimes remittent, and is in-
variably ataxic, presenting well-marked typhoid symptoms,
with the exception of diarrhoea, by the tenth  to the twelfth
day.  It is usually protracted, lasting from twro to  eight or
ten weeks.
  Treatment.—In many cases it will be advantageous to
commence the  treatment with an emetic, especially if, as
in some cases, there  are  symptoms of morbid accumula-
tions or nausea.  Following this, I  should use the warm 
SPINAL MENINGITIS.
445
bath for an hour or two, or the vapor bath; or if the skin
was hot, I should not hesitate to resort to  the wet  sheet
pack.  The special sedatives may be given from the first,
tinctures of aconite and veratrum being the agents select-
ed, and given  in small doses  and  frequently repeated, as
heretofore recommended; tincture of gelseminum may be
used in full doses until its specific influence is produced, as
its action in preventing determination to the nervous cen-
ters  is more marked  than any other agent.  Associated
with these remedies, we  would direct wet cups to  the
spine, followed by hot fomentations of hops or stramonium,
or in some cases rubefacient applications, as  mustard or
the stimulating liniments.
  We will usually  have to continue the above measures
for two or three days, and sometimes longer, before any
very perceptible influence is produced.  We may add to
the treatment named, a solution of the  alkaline diuretics
about this time, and may also commence the administra-
tion of quinine. The treatment w7ould now be the special
sedatives to the  extent  of  controlling the pulse.   The
tincture of gelseminum in small doses, with a diaphoretic,
as the asclepias, a  solution of the  alkaline diuretics,  and
quinine and hydrastin in the forenoon, the dose being pro-
portioned to the age  and  condition of the patient.   The
frequent  use of the sponge bath gives the patient  great
relief, and aids the action of  our remedies.  The bowrels
should be kept in a soluble condition by the use of some
mild cathartic; I prefer podophyllin thoroughly triturated
with twenty times its weight of white sugar, and with the
addition of cloves  or  ginger to  prevent its griping.  If
the patient seems  much  debilitated, as is  frequently the
ease, brandy or rye whisky should be used to such an ex-
tent as to give the necessary  stimulation, but not to over-
come the effects of the sedatives.
  Quinine has a very  singular influence in some cases; if
given in large  doses it produces marked sedation and ex-
haustion, and if continued this way for a few days, it may 
446
EPILEPSY.
be followed by an irritative fever, with sharp, quick pulse
and dry skin.  For an adult, from  six to ten  grains daily
is as much as will generally be of advantage; and a child
of ten years may usually take from four to six grains.

                     EPILEPSY.

  Epilepsy is one of the most serious of the diseases of the
nervous  system, not  because  of its fatality, for it runs a
very chronic course ;  but because there is  no  tendency to
spontaneous arrest, and medicine has heretofore had very
little influence upon it.   One of the most distressing fea-
tures of  the disease is, that it  gradually impairs the mind,
until the person, once bright and of sound mind, becomes
a driveling idiot or a raving maniac.  The disease usually
commences in childhood, most frequently between  the
ages of six and twelve.
  The causes of epilepsy are various, and not very well un-
derstood.  They may be divided into intrinsic and extrinsic;
in the first case existing in the cerebro-spinal nervous cen-
ters, or their immediate surroundings; and in the second ex-
isting at a distance, and affecting the spinal cord through
the nerves.  Of the  first, we  may instance inflammation
and determination of the blood to  the cerebro-spinal cen-
ters, disease of the meninges and of the bowels, and inju-
ries of the bones,  giving rise to compression, or continued
irritation,  as  by the presence of  a spicula pressing the
nerve substance.   Derangements of the blood may some-
times give rise to  epilepsy, as  in the retention of the solids
of  the urine, and other  changes  that  we are  not cogni-
zant of.   By an extrinsic cause, we understand one in which
the irritation being  set  up at a  distance, is propagated
along the  nerve  trunks to the spinal cord, where, setting
up an irritation, it  manifests itself through the excito-
motory system of nerves.  The most  simple instance of
this action is witnessed in the case  of cramps of the mus-
cles of the extremities from  irritation of the  intestinal 
EPILEPSY.                    447
 canal, as in cholera morbus, and in the case of infantile
 convulsions from teething, or from gastro-intestinal irrita-
 tion.  Epilepsy may in  this way arise from irritation of
 the stomach  from  crude, indigestible  food, from worms,
 from  irritation  of  the  bowels, the  kidneys, bladder, or
 genital organs.  The cause being sufficient to set the dis-
 ease going, may disappear entirely in a few days or weeks,
 and yet the  epileptic attacks continue.   It wrould  seem
 that when  this  abnormal action  is  once set up, the ten-
 dency to its continuance is the same  as in healthy  func-
 tions ; but  why this is, we  know  not, and  neither can we
 give any probable theory.
  As  regards the pathology of epilepsy, we  are much in
 the dark.  In some cases  it would seem to be  dependent
 on a too free  circulation of blood in the nervous centers—
 determination of blood; in other cases, upon a sluggish
 circulation—congestion; and  in  still others, upon  some
 defect  in nutrition.  There are cases  in which it is very
 manifest that the  condition of the  blood  is the exciting
 cause of the  epileptiform  seizure, though we  must still
 imagine an unnatural irritability  of  the  nerve  centers to
 be so impressed. Thus, I  have «seen cases in which every
 convulsion was  preceded  by deficient secretion of urine;
 and so  long  as this secretion could  be maintained in the
 normal  condition, so  long would  the patient be free  from
 its seizure.   Cases in which the disease is dependent  upon
 the amount and character of the menstrual discharge, have
 come under the notice of almost  every one.  Experience,
 however, has  proven to me, that epilepsy is eminently a
 disease of debility of the nervous system, even in cases in
which there seems  to be the  most evident symptoms of
irritation and determination of blood.
  Dr. Radcliffe  has  written a most  interesting paper on
the pathology of convulsions, and draws the  following
conclusions:  "1. The epileptic and epileptiform  parox-
ysm is  not unfrequently preceded by  signs of defective
 respiration.   2d. It  is usually accompanied by a state of 
448
EPILEPSY.
unmistakable  suffocation.  3d. The condition of respira-
tion during convulsion is  one which supports the notion
that the convulsion is connected with  depressed and not
with exalted vital  action.   4th.  In the chronic form  of
convulsive disorders, the  interrparoxysmal condition  is
usually marked  by evident  signs  of  feeble circulation.
5th. The epileptic  and epileptiform paroxysm  is usually
if not invariably, preceded by signs of failure in the cir-
culation.   6th.  In  the  fully-developed  paroxysm, the
pulse is sometimes aroused to a considerable degree of ac-
tivity, not because  the arteries are receiving a largely-in^
creased supply of  red blood, but because  they are then
laboring under a  load of black blood, as they are found to
labor during suffocation.  7th. Convulsion is  never coin-
cident with a  state of active febrile excitement  of the
circulation. 8th. Epileptiform convulsion is a direct con-
sequence of sudden and copious loss of blood.  9th. The
condition  of the circulation during convulsion is one
which supports the notion  that the convulsion is con-
nected with depressed and  not with exalted vital action."
  It is of but little  use to try to study the original  cause
in many cases of epilepsy; for, as  has  been remarked, it
has probably passed away months before our examination.
There is  always, however, an exciting cause, which it  is
necessary to determine, if possible, as  upon its removal
the success of our treatment will in great measure depend.
I have known it to  be a failure of excretion, an imperfec-
tion in  digestion, derangement of the menstrual function,
excessive mental  emotion, and not unfrequently excessive
sexual excitement.
  Symptoms.—In some cases  there are  brief, premonitory
symptoms of the approaching seizure, and rarely the pa-
tient has notice of it for hours.  The sensations differ in
different cases; sometimes  a  sense of weight and oppres-
sion in the head, with giddiness and  loss of  voluntary
power; in others, a coldness passing  from the feet up-
wards, and terminating in the epileptic seizure when  it 
EPILEPSY.
449
reaches the head.  In the  more protracted cases there is
usually a  marked dullness and  hebetude noticed  by the
friends, and the patient feels a loss of consciousness that
is very unpleasant.
  In an attack of epilepsy the  patient becomes suddenly
unconscious and falls to the floor, or wherever he may be
situated.  Involuntary  movement  from spasmodic con-
traction and relaxation is characteristic of the disease, and
may be very  intense or mild.  If severe, the limbs are
thrown in various positions, the trunk contorted, and the
features remarkably changed.  First  one group of mus-
cles contract, and then another, so that parts  are kept in
constant movement.  The lower  jaw and tongue being
also affected, we find that usually the latter organ is se-
verely bitten if means are not taken to avoid it.  The pa-
tient usually froths  at the mouth; respiration is normal
in frequency, and the pulse but little changed,  except that
it is smaller and feebler.  The countenance  is not only
distorted by the convulsion, but in some cases  is turgid
and purplish, or almost black.  Frequently the urine, and
sometimes the faeces are passed  involuntarily during its
continuance.
   The duration  of the  epileptic  seizure is very variable,
sometimes lasting but a few seconds, and at others for fif-
teen or twenty minutes.  The patient may have but  one
attack at a time, or they may succeed one  another at
short  intervals until quite  a large number has passed.
When the attack ceases, the patient  becomes completely
relaxed, and usually falls into a deep, comatose sleep, from
which it is almost impossible to arouse him for an hour or
two.   The frequency of their recurrence varies  in differ
ent cases; in some they do  not appear oftener than once
a month, or even less frequently; in  others, every week,
or almost every day.  Sometimes they are so distinctly
periodic that the return can be closely calculated ;  but at
others  they are  very erratic in their course.  In  many
cases there are slight seizures during the intervals between
       29 
450                  CONVULSIONS.
the principal attacks; in these the patient seems to lose
consciousness but for a moment, and  stares vacantly at
persons present;  passing off, he *has no recollection of it,
nor of the epileptic attack.
  Treatment.—Whilst a considerable number of cases of
epilepsy can  be  cured, a  large  number can not.  Much
depends upon the causes inducing the disease, the time it
has continued, and the condition of the various structures
of the body.  Possibly there is no  affection  that requires
more care to determine an appropriate  treatment for a
cure than this; hence, I would advise that a  physician be
consulted, who has had great experience in its manage-
ment, and that domestic treatment should be avoided.
  The treatment for an epileptic seizure is usually very
simple.  Place the patient in a horizontal position, in such
manner that he will not be able to injure himself.  So  ar-
range things that there will be free circulation of air; and
to prevent congestion, loosen the clothing around the neck
and waist.  This  is all that is  necessary in the majority
of cases;  but if  the  convulsion continues long, give the
remedies named for convulsions.

                  CONVULSIONS.

  Convulsions occur far more frequently during  child-
hood than after puberty, though they may be occasionally
noticed at  all ages.   The  causes giving rise to them are
various.   Sometimes they are produced by disease of the
brain and spinal  cord, as in  determination, -inflammation,
and some obscure structural  lesions; at others they arise
from an external irritation, it being transmitted to the
spinal cord, and giving rise to excited reflex  action.  Ac-
cording to Dr. Marshall Hall, convulsions  are dependent
upon irritation of the true spinal system, and though this
occurs in some cases from causes acting directly upon the
nervous system, it more frequently  depends upon an irri-
tation of some distant part, transmitted to the spinal cord 
CONVULSIONS.
451
 through the nerves.  Thus, we find convulsions arising in
 this way during  dentition, from crude or acrid ingesta,
 from irritation of the stomach or bowels, from the irrita-
 tion produced by worms, and from inflammation of inter-
 nal organs, or disease of the surface, attended with great
 irritation and pain.
  Symptoms.—If convulsions  occur  during  disease,  they
 are generally preceded by tolerably well marked symp-
 toms, by which the  close observer  may  anticipate their
 approach; and  though not always  constant, it is well to
 give them due consideration.  The most marked of these
 is a sudden jerking, involuntary movement of the extrem-
 ities, and quick, grasping movement of the hands.  This
 will be observed as well when the child  sleeps as when
 awake, and is sometimes increased  by motion.  Usually,
 the child sleeps with its eyes partly open, and we observe
 that the globe  of  the eye is drawn upward and rolled
 about, and this  involuntary movement of the eye may he
 frequently noticed when awake.  With these symptoms
 there may be  excitement  of the nervous system, mani-
 fested by restlessness, fits of crying in children, and sleep-
 lessness ; or, we may have the  reverse, the  patient being
 dull, impassible and somnolent.
  The attack is  always sudden, the patient losing con-
 sciousness, and  being to a  great extent  insensible.  The
 convulsion is usually very marked, but in some  cases we
 will find it slight or entirely absent, the patient being rigid
 and remaining in one position.  Respiration is labored, in
 many cases  very markedly so,  and in these the counte-
 nance is turgid and purple, and the features much dis-
torted.  The pulse is very frequent and small, or it is soft,
feeble and small, and but little increased in frequency.  In
the severer cases, deglutition is almost impossible, and from
the falling backward of the tongue respiration is snoring.
 These symptoms may continue  for  a moment or two to
fifteen minutes or half an hour,  in the milder cases termi-
 nating in a  return of consciousness, but  the severer in a 
452                  CONVULSIONS.

deep sopor, from which the patient can not be aroused.
One convulsion may terminate the attack, but in many
cases one succeeds  another for from one to twenty-four
hours.  The interval between the spasms  is  frequently
marked by nothing more  than a relaxation of the entire
system, and a restoration  of the power of deglutition, the
patient being in a semi-comatose condition, and totally
unconscious.  Children having convulsions once, are usu-
ally more  liable to them than others,  and they will fre-
quently come on from slight causes.
  Treatment.—Our primary object is to arrest the spas-
modic movement which is so alarming to the friends, and,
no matter how often seen, to some extent so to the prac-
titioner.   Calmness and  decision  are very important re-
quisites in  this case, as all around the  patient is excite-
ment, and a hundred expedients to benefit the sufferer are
proposed.  Usually, we would give our  patient the com-
pound tincture of lobelia  and capsicum, in doses of a tea-
spoonful every five minutes to an adult, and one-fourth ol
a teaspoonful as frequently to  a child.  We can usually
administer this during the paroxysm by carefully pouring
it into the mouth, and allowing it to pass down the  throat
gradually.   This should be continued until the  convulsion
passes off, nausea being generally induced; or,  if we have
reason to suspect crude  ingesta, we should carry it to free
emesis; or, instead, give a sufficient quantity of ipecac to
evacuate the stomach.  If the  medicine can not be given
by mouth, we would  use  it as  an enema, combining two
or three times the quantity with the necessary  amount of
water, and repeating it as  occasion requires.  The tincture
of gelseminum is the next and most efficient  agent, and
may be given in doses of  from half to  one teaspoonful of
the common tincture to  an adult, or from ten to  fifteen
drops to a child two years old.  It may be repeated at
intervals of ten or fifteen  minutes, or as occasion requires.
Tincture  of asafcetida, or sulphuric  aether,  sometimes
 answers a good purpose,  and occasionally valerian may be 
HYDROPHOBIA.
453
added to the  combination for its arrest.  These remedies
should not only be given during the convulsion, but after-
ward to prevent its recurrence.
  Bathing the feet in hot mustard water for ten or fifteen
minutes, or the use of the hot sitz  bath,  is frequently
attended with benefit.   Occasionally sinapisms to the feet
or ankles are applied, or to the bowels, if there seems  to
be heat or irritation.  If the face is flushed, and the head
hot,  we  would use cold applications, and in some cases
cups to the  neck and spine.  There  are  cases,  as, for
instance, when the skin is hot  and burning, that I would
prefer the wet sheet pack to all other medication.
  If the symptoms  of  convulsions are noticed, we  may
almost always prevent their occurrence by the administra-
tion  of small  doses  of tincture of gelseminum.  So cer-
tain  is  it in  its action in doses of from six to ten drops
every half hour, or  two hours, to a child two  years old,
that I leave it in cases of threatened convulsions, with the
greatest certainty that  it will  prevent their occurrence;
and  in families in  my practice where there  is a tendency
to convulsions during childhood, the remedy is kept con-
stantly on hand;  not only is it a good prophylactic before
the convulsion, but it is also one of our best remedies to
prevent  their recurrence when once  arrested.   Just as
soon, however, as the first convulsion  has passed  off, we
endeavor to learn its cause, so that by its removal we may
avoid any danger of its recurrence.  Thus, if from crude
ingesta,  we  give  an emetic;  if, from irritation of the
bowels, we use the appropriate means to relieve it; and if
from arrested secretions, these should be re-established.

                  HYDR OPHOBIA.

  Rabies is a disease  of great antiquity, and has  been
described by most writers on medicine  from the earliest
ages.  It has its origin in the canine and  feline animals,
but may be propagated to all genera and species. 
454                 HYDROPHOBIA.
  How the disease originates, or what is the character of
the poison, is beyond our knowledge.  Some contend that
from its first commencement it has  been propagated by
contagion, while others reason that the causes which pro-
duced  the first case, may be again set in action and re-
produce the disease.   These suppose that protracted thirst
or hunger, extreme heat, violent excitement or anger, the
sexual heat,  etc., variously associated,  will develop  the
malady independently of contagion.
  When once developed, it is transmitted  from one ani-
mal to another, and  to the human family, by a specific
animal poison found  in  the saliva, and which is usually
introduced into the blood, through a wound made by the
teeth;  though like all other  animal poisons, all that is
necessary is, that it shall be brought in contact with an
abraded surface.
  As regards the physical  properties or character of this
poison, nothing is  known, and neither has it been deter-
mined what part secretes the poison, further than that it
is  furnished  by the  glands- connected with the mouth.
Some writers contend that it is not a disease of the blood,
and urge as evidence the  long  period that  aometimea
elapses from the inoculation before  the disease  is devel-
oped.
  They therefore urge that it must be the nervous sys-
tem that  is affected,  the phenomena being those of a
nervous malady of the  most intense form.
  As  regards the  pathology of the disease; we may as-
sume that the poison of rabies absorbed into the system,
gives rise to a peculiar  irritation of the nervous system,
more especially marked in the true spinal system.  The
symptoms all point to the medulla  oblongata and spinal
cord as the  seat of  the disease, and  the post-mortem
examination  shows these parts  to have been subject to
severe irritation and  vascular excitement.
  The appearance of  hydrophobia in the dog is  indicated
by  a   change in his disposition,  usually  exhibiting  a 
HYDROPHOBIA.
455
marked antipathy to other animals, and rarely becoming
attached to those to whom  he was formerly indifferent.
He seems  also to have changed his habits,  picking up
straws, rags or any  small objects, and licking cold sur-
faces, as stone, iron, etc.  He becomes morose and sullen
in his  disposition,  becomes lonely, has  a  haggard and
suspicious look, and  is constantly thirsty; respiration soon
becomes difficult, and saliva flows from  the mouth, and
forms a viscid foam, and he shows great irritability and
a  disposition  to  snap at  and bite other  animals, though
he may still obey the  voice of his  master.   At  last  he
becomes uncontrollable, and flies at  every creature  he
meets, and having no fear, he is not intimidated by hold-
ing or striking at him with a whip or stick, but  is ren-
dered more savage.  At no period is there  any dread of
water, but the animal  still exhibits strong evidences of
thirst, and runs to it with avidity, and  all other animals,
with  sometimes  the exception of the horse,  drink with
ease.   The disease having continued for several days, the
animal is at length exhausted, and dies in convulsions.
   Symptoms.—The period of  incubation is seldom shorter
than  from thirty to forty  days, or may be  postponed
from  one  to  two years.  The wound seems  to heal as
kindly as it does  in  other cases, and usually  no unplea-
sant sensation is experienced in it.  Sometimes there is
a feeling of constriction in the cicatrix, or slight shooting
pain, but we are  inclined to  attribute this, as well as the
quick pulse and  constitutional symptoms sometimes met
with,  to the effect on the mind of the patient, rather than
to the influence  of the poison.
   The invasion of  the disease is usually marked by a
recurrence of pain at the seat of the injury, which shoots
upward in the course of the nerves, occasionally to the
epigastrium or prsecordia.  Not only  is  there  pain, but
the cicatrix becomes of  a dark  livid red, is irritable,
tumid, and sometimes surrounded by small phlyctenulse,
containing a bluish  fluid, or in  rare  cases the cicatrix 
456
HYDROPHOBIA.
opens and  discharges a watery or ieherous  fluid.   The
patient is now very  anxious and restless, and complains
of drowsiness, chilliness,  flushes of heat, and  sense of
constriction of the throat, and stiffness  of the parts  con-
cerned in deglutition.   The act of swallowing, especially
fluids, is now attended with pain  and distress, and by
spasmodic  action of the muscles  engaged,  so that fre-
quently they are forcibly ejected from the mouth.   The
difficulty of swallowing rapicUy increases, and  the patient
fears to make the attempt, and the sight of fluids  occa-
sions the most distressing spasms of the throat, followed
by sobbing, tremor,  forcible respiration and exhaustion.
  The sufferings now become interne;  the mouth is dry,
parched and clammy, a  frothy saliva being  secreted, and
occasionally forcibly  expelled during the paroxysms; the
thirst is intense,  though the sufferer is not only unable to
take fluids, but the sight or sound of them  gives rise to
uncontrollable convulsions; the countenance is haggard
and anxious, the brow  contracted, the  eyes staring and
wild, and startling in their expression, and the angles of
the mouth  retracted; respiration is hurried, laborious, and
attended with dryness and constriction of the air passages;
and the sensibility becomes so exalted  that  the slightest
touch, or a breath of cold air striking the surface of the
body, will occasion a paroxysm.
  The mind of the sufferer is usually clear in the absence
of the  paroxysms, but when they are on, he  has the
rabid impulse  of biting  or tearing to pieces  whatever
comes in hist way.   These symptoms continuing, the pa»
tient  becomes gradually  exhausted, the  pulse becomes
small and feeble, respiration hurried and difficult, and he
dies suddenly during a violent  exacerbation.   The attack
may last from two days to a week, or in some rare  cases
the symptoms become ameliorated, and quietly wear them-
selves out in  the course of two, three  or four w7eeks. In
these last cases the patient rarely recovers completely, but
has occasional slight returns of the original symptoms. 
HYDROPHOBIA.
457
  Treatment.—Immediately on the receipt of the injury,
it is recommended to wash the wound or wipe it dry, and
suck it with  the mouth for five  or ten  minutes.  Or the
part may be immediately excised, or a ligature applied be-
tween it and the trunk, if of one of the extremities, to
prevent the poison from gaining entrance into the system;
this will be done before a  physician can be seen.  When
the case presents itself to us, we  may excise the part bit-
ten, or apply a cup to it, draining it well, or we may cau-
terize it freely.  I prefer the latter practice, and use a sat-
urated solution of chloride of zinc, bringing it in contact
with  the whole abraded surface.  A deep eschar is formed,
which does not slough for several days, and when thrown
off the wound suppurates freely.  Three cases were thus
treated by  me in 1857, that had been bitten by a dog that
communicated the poison to several  animals which died
of hydrophobia; the cauterization was very thorough and
deep, and not more than half an hour after the injury; not
one of the cases had  any symptoms of the disease.  A
fourth case occurred in 1859, and a  fifth  in 1862, which
were  treated  in the same manner and with the same result,
but in neither of  these was the evidence positive that the
dog inflicting the bite was rabid.  No internal medicines
were  used in  any case.
  When hydrophobia  is  fully  developed, we are  at  a
loss how  to  treat the patient;  some writers  have re-
commended  the   employment  of lobelia to  keep up
continuous nausea;  others to  give Scutellaria  in in-
fusion in as  large doses as  the  patient can bear;  and
others the  narcoties, as the  cannabis indica, belladonna,
stramonium,  hydrocyanic acid, etc.  Each  has been em-
ployed thoroughly, and though they may have so mitiga-
ted the symptoms as to have led tbe attendant to suppose
that under  more favorable circumstances they would have
been followed by success, yet we have no evidence that a
single case has been  cured.  Evacuents have  not  only
failed  to accomplish any good result, but have undoubtedly 
458
DELIRIUM TREMENS.
hastened death.   The anagallis purpura has been highly
extolled, and cases reported cured, but we are not told
whether it was used as a prophylactic previous to the full
development of the disease, or afterward, and  as will be
noticed, very much depends upon this.  If  I had to adopt
a treatment in these cases, it would be the continuous hot
bath, quinine in large doses, and chloroform by inhalation.

              DELIRIUM TREMENS.
  Delirium tremens, in a very large majority of cases, is
the  result of intemperance in the  use of intoxicating
liquors, and usually follows a protracted debauch.  It may
be produced  by the habitual  use of opium, and in rare
cases it may result from excessive emotional excitement in
persons of feeble  health.  As  a general  rule it occurs in
persons who are habitually intemperate, though they may
never have been so intoxicated as to  attract much atten-
tion.  It is claimed by some that delirium tremens is not
the result of excessive excitement, but that it makes its
appearance when  the  person has ceased to drink, either
from inability of the stomach to receive it, or because they
desire to sober up.  Hence they say that  it is the result of
the withdrawal of the stimulant at a time when  the sys-
tem is accustomed to its use.   This would be good reason-
ing, were it not for the fact  that in very many cases it
comes on while  the  person is still drinking  to excess.
How, then, will we harmonize these opinions, or rather
these facts ?   There is only one way, and  that is that there
is  a delirium of drunkenness  following  the debauch im-
mediately, and another that makes its appearance in from
two to seven days afterward.   It may be that this accounts
for the great difference in the treatment  of the disease.
  Symptoms.—Delirium tremens is usually announced by
a marked vigilance and entire sleeplessness, though the
person's mind may as yet  be entirely clear, and free from
the vagaries that are soon to make their appearance.  We
find that there is great irritation of the stomach, frequently 
                   DELIRIUM TREMENS.               459

 thirst, sometimes nausea, and in all cases an entire loss of
 appetite, the patient having usually taken but little if any
i food for several days.  The pulse is generally slow, and the
 hands and feet are cold and clammy;  he is anxious and de-
 jected, sighs frequently, and complains of oppression about
 the prseeordia.  These symptoms  sometimes continue for
 two or three days, at others for  but a few hours.  The
 restlessness and vigilance of the patient are now increased,
 and the countenance has a peculiarly wild expression;
 mental delusions now occur, at first at intervals, and easily
 displaced  by reasoning  with him, but  at last becoming
 fixed and  constant, he sees  curious shapes  and beings,
 snakes,  devils, dragons,  assassins,  etc., and is in continual
 fear of  his fife, or of future retribution.  It  is singular
 that these visions are so generally frightful, and strike the
 poor sufferer with mortal terror, and  yet the cases are
 very rare where it is otherwise.  He sees them on his bed,
 peeping and laughing at him from  behind the furniture,
 grasping at him from the  air, climbing  on his body, and it
 is impossible to displace these fancies.   Occasionally they
 take human shapes, but are still objects of terror, as mur-
 derers, thieves, etc., and he tries various means to escape
 from their clutches, even in some cases to  jumping out of
 the window.   The intensity of this delirium varies in dif-
 ferent cases, the patient being managed with ease in some,
 but in others requiring to be  held down in bed to prevent
 him from injuring himself and others.  During this time
 the skin is harsh and dry, the pulse frequent and small,
 the tongue dry and furred, and the appetite entirely lost.
 The secretions are all diminished, the patient is feeble, and
 there is  an unnatural tremor of the muscles.   Continuing
 in this  way for a variable  period, it may terminate  by a
 subsidence of the  excitement, and by a deep  sleep, from
 which the patient  awakes free from these  morbid fancies.
 In other cases the  delirium becomes more and more se-
 vere, until finally  the system sinks under it, the patient
 dying from the fourth to the twelfth day. 
i60               DELIRIUM TREMENS.

  Treatment.—When the disease is fully developed,we may
occasionally succeed with  opium and stimulants, or with
either of the two, though I do not like the practice.  Dr. I.
G. Jones gave brandy in large quantity, with Hoffman's an-
odyne, and contended that it was not only successful, but
the most successful practice  known.   Opium and stimu-
lants have been employed  by many physicians with  mod-
erate success, though the treatment will not reach difficult
cases.   I have  used the  combination  of gelseminum,
opium, and veratrum  with  good success in cases not
very severe, though  it  fails in the worst  form of the
disease.   Tincture  of  digitalis has been  very highly
recommended, and from  my experience with it, I am
inclined to believe it one of our best remedies.  It is given
in very large doses, from  one drachm to half an ounce,
every three  or four hours, until the patient becomes quiet
and sleeps.
  The warm bath is usually very efficient; and I have
known patients to go to sleep in the  bath, who had been
beyond all control, except by force.   It may be associated
with the other means named.  If there is nausea, and  es-
pecially if the remedies given are thrown up, an emetic
should be administered,  and the  stomach  thoroughly
evacuated.  In some cases  it is well to evacuate  the bow-
els with the compound podophyllin pill, and the  secretion
of the skin may  be started by the administration of tinc-
ure of asclepias, with carbonate of ammonia.   I  have
cured cases  of delirium tremens with the  warm  bath, po-
dophyllin pill, and asclepias and  carbonate of ammonia,
when  opium and  stimulants had failed..   In very severe
cases, we would  place  the patient under the influence of
chloroform, and  continue it until natural sleep was the re-
sult.  When other remedies fail, we are enabled to man-
age the disease with  anaesthetics, until we can get the  de-
sired  action from  medicines.   As the excitement is sub-
dued, it  becomes important to give the  patient food in
such  form  that  it may be  appropriated by the enfeebled 
NEURALGIA.                  461
digestive organs;  animal broths and milk are usually best
adapted to the case, and should be given at first  at regu-
lar intervals if the patient has no  appetite, as is gener-
ally the case.   Yery frequently  the restlessness depends
more  upon a  lack of nutritive material, and consequent
exhaustion, than  it does upon  disease;  and as soon  as
the stomach appropriates the proper amount of nourish-
ment, the excitement subsides and sleep results.  Quinine
and hydrastin  may be given for the purpose of stimulating
the stomach and  inducing a  desire for food, and in the
later stages of the disease is very successful.

                   NEURALGIA.

   Neuralgia is sometimes preceded by a sense of formica-
tion, or numbness, and  sometimes  by soreness  and stiff-
ness.   The pain usually comes on gradually, is at first ob-
tuse and aching, but as it continues becomes sharp, lancina-
ting,  darting  and  lacerating.  Sometimes it  seems  to
be confined to the one spot; but at  others it shoots along
the course of  the nerve, either  in the direction of the
trunk, or the  extremities,  or  seems to dart  through the
part in a direction  opposite to  the course of the nerves.
The pain is usually very intense; so much so, sometimes,
that the patient screams with the agony, and in very se-
vere cases becomes unconscious or  maniacal from the in-
tensity of the suffering.  Occasionally we notice other dis-
turbances of the part, as twitchings  and other involuntary
muscular movements, and derangements of function, and,
in rare cases, seeming paralysis.   The constitutional dis-
turbance varies greatly in different cases, depending upon
the severity of the disease, and its duration.  In common
cases, when it has continued for  twenty-four hours  or
more, we find  an  excitement of  the pulse, dry skin, con-
stipated bowels, coated  tongue and loss  of appetite, the
patient complaining  that the extreme suffering has made
him  sick.  In protracted  cases  the health suffers  very 
462
NEURALGIA.
much, the  patient  becoming feeble and  anaemic,  and
troubled with various functional derangements.
  Treatment.—The treatment  of neuralgia should  be
both  general  and local;  and contrary to the generally-
established practice, we find that the first is far more suc-
cessful than the  last.  In  many such cases, and especially
if indicated by the condition of the stomach, we find that
an emetic will give  the quickest and most decided relief,
and will pave the way for a speedy cure.  I use the  com-
pound powder of lobelia and capsicum in infusion, and
give it so that  a couple  of hours will be occupied in its
action.  The patient should have his feet  bathed in hot
mustard water, and be covered warmly in bed, and take
freely of some diaphoretic  infusion, as of equal parts of
essential tincture of asclepias, and compound tincture of
serpentaria, in doses  of a teaspoonful  every hour, or of
equal parts of diaphoretic powder and asclepin, in doses
of five grains.   Free perspiration is in this way induced,
and the patient often falls into an easy sleep, the first he
has had for several days.  In other cases we may accom-
plish  the same  object by the use of the wet sheet pack,
and the internal use of cold water, and an alkaline diu-
retic.
  The local applications  made use of vary greatly, being
sedative, stimulant, narcotic, emollient, etc.,  according to
the whim of the  prescriber.   Chloroform  and aconite
are probably the most efficient agents we can  use when
the neuralgia is  superficial, as  in the case  of the face.
  I use the agents combined in  equal  parts, and to such
an extent as to produce the peculiar numbness of the
tongue, characteristic of  the action  of aconite upon the
system.  If we  desire a stimulant influence  in addition,
we may add  an equal quantity  of  oil  of sassafras and
alcohol.   If a deep-seated part  is  affected, as in the
case of the sciatic  nerve,  we will find firing, or the ap-
plication  of a hot iron to the  surface in the course of
the nerve, one of the  best applications.  The strong am- 
HYPOCHONDRIASIS.
463
monia liniment applied on flannel, so as nearly to blister
the part, is  sometimes very  successful.   The  extract of
tobacco  has been successfully used as a local application,
as has also  the emplastrum  belladonnse.  The irritating
plaster continued until it produces  suppuration, is very
good treatment in some chronic cases.

                HYPOCHONDRIASIS.

  Among the  most troublesome cases that come under
the physician's  care, are those which may be classed under
the present head ;  though they may vary greatly in their
symptoms, there is that common to all, which gives them
a distinctive character.
  Copeland's definition,  " Chronic indigestion, with lan-
guor, flatulency, dejection of mind and fear, arising from
inadequate  causes;  general  exaltation of  sensibility,  a
rapid succession of morbid phenomena, simulating numer-
ous diseases, or otherwise a real  but variable state of suf-
fering, exaggerated by the morbid sensibility and fears of
the patient, with unsteadiness or variability of purpose,
and distressing anxiety respecting his complaints."   This
in a few words expresses a condition in which, in addition
to a variable amount of physical disease, we have a marked
lesion of innervation, and to some  extent of  the  mind.
Some authorities class it with insanity, and there are cases
sometimes grouped under this head, in w7hich the patient
imagines himself a tea-pot, or a locomotive, or that his
body has so increased in size that he can not get through
the door, or has a morbid dread of thieves, assassins, etc,
which properly belong to that class.
  The causes of hypochondriasis are various, Sometimes
a disposition to it seems to  be  hereditary, making its
appearance after middle age  from slight exciting causes.
It usually  results  from prolonged mental exertion,  or
letting the  mind  dwell constantly  on one subject, and
especially in persons of sedentary habits. 
464                 HYPOCHONDRIASLS.

  " Whatever  exhausts,  or  directly  depresses  cerebral
power, as intense application of the mind to difficult or
abstract  subjects, anxieties respecting  schemes,  specula-
tions, or  objects of ambition;  disappointments, sorrow,
fright or sudden  alarm;  the depraving passions;  severe
losses of fortune, or friends;  indulgence of sombre or sad
feelings;  devotion to  music and the fine  arts; reading
medical books,  etc., and whatever favors  congestion of
the brain, may cause the complaint."—Copland.
  Symptoms.—In a majority of cases we find considerable
derangement of the digestive organs; the tongue is  coated
at the base; there is  clamminess  and bad taste  in the
mouth in the  morning; digestion is attended with flatu-
lence and eructations, and  the  bowels are  constipated.
The secretions  are deranged;  the skin  being dry and
harsh, or soft, pale and  relaxed, with feeble circulation
and coldness;  the urine is usually copious, but deposits
the lithates or phosphates.  There is marked  hyperses-
thesia in many cases, the  sensibility being so exalted that
the slightest suffering is magnified into intense pain, and
there is  constant suffering from wandering  pains in vari-
ous parts of the body.
  Occasionally the  patient  seems  dull  and impassive,
brooding over his troubles and diseases, and seems  to feel
no acute suffering, and is with great difficulty aroused so
as to describe his imaginary diseases, answering that  he
knows them to be such as are incurable by medicine, and
therefore it is  useless to describe them.  In the one case
the patient is always complaining, and evidences of suffer-
ing are well marked;  in the other it is very evident that
the patient is diseased, but he is wrapped up in himself,
and  constantly brooding over his  diseases, rather than
complaining about them.
  In many cases  the patient, notwithstanding the  severe
character of the  symptoms,  presents all the appearances
of sound  health.  "He often complains of violent pains
in the temples, forehead) or occiput, or of a general head- 
                    HYPOCHONDRIASIS.                465

 ache, with dimness of sight, and noises in the ears, or of
 a sense of weight or pressure, more  intolerable than pain
 at the vertex, with giddiness or confusion of mind; and
 sometimes of a constriction or tightness  of the head  or
 temples, or of a morbid sensibility of the scalp and roots of
 the hair.  Occasionally the senses are morbidly acute, and
 intolerant of light  and noise.  Pains resembling rheuma-
 tism, or those  of syphilis, are felt in various situations,
 occasionally with a feeling of burning or heat, and some-
 times  of  coldness,  horripilations, cramps, feebleness,  or
 threatened paralysis  of  one or  other  of the  extremities.
 Weakness of  the  limbs,  unsteadiness in  walking,  or
 feebleness of the joints (in some instances with neuralgic
 pains) and great susceptibility to cold and heat, are not
 unfrequently complained of.  The  morbid sensibility  of
 the  hypochondriac  is generally increased by a cold and
 humid state of the  atmosphere, by easterly winds, and by
 very warm seasons.  His mind is incapable of exertion  or
 prolonged attention, although when aroused, he may be
 lively and acute; but he  soon becomes engaged in his own
 feelings and sufferings.  To these he frequently recurs  in
 conversation, whenever he has an opportunity of doing so,
 although he  seems to suspect that  the subject is unplea-
 sant to those who listen to him, and therefore suppresses
 a part of his complainings.  In some cases there is dysp-
 nea, constriction  of the  chest, with  a dry, short, or  spas-
 modic cough, and  occasionally  a sense of suffocation  or
 constriction is felt in  the throat, with flatulence  and vari-
 ous other  symptoms  resembling those attendant on hys-
 teria.  These phenomena have induced several writers  to
 consider the disease  closely allied to  hysteria,  and the
 severe palpitations, or irregular action of  the heart, fre-
 quently also complained of, have further countenanced the
idea; while they have excited the anxiety of the patient
and  induced  him to believe  himself the subject of irre-
 medial disease of the heart.  Sleep is  sometimes materiallv
 disturbed,  and occasionally the hour  of repose is ardently
          30 
466
HEADACHE.
looked for; but in other cases it is dreaded as aggravating
the distress.  The patient is often tortured with the most
distressing feelings, which are greatly aggravated by his
fears.  He dreads impending dissolution, from the symp-
toms referred to the head, heart  or chest.  His ideas are
concentrated on  himself and his feelings, and he is inca-
pable of attention or mental  exertion, unless by circum-
stances of unusual interest  or moment.  Occasionally ver-
tigo, dimness of vision, and intolerance of light and noise,
are so great as to justify his fears; and  the pains in the
head, or  the sensation of pressure on the head and tem-
ples, are so severe that  the eyes seem starting from their
sockets."—Copland.

                    HEADACHE.

  Headache is produced by many different causes, and
though we can  not tell why they produce this affection, or
even what structure it is that is painful, we are  enabled,
by regarding these causes, to remove, and even to perma-
nently cure the disease.  We might classify headache as
follows: 1st, Headache from  determination of blood; 2d,
from cold; 3d, from derangement of the stomach;  4th,
from deficient urinary secretion; 5th, from malaria; and
6th, sympathetic.
  Headache from determination  of blood is  a very  frequent
form of the disease, and may arise from any cause produ-
cing irritation  of the brain, as  over-excitement, severe
exercise in a stooping position, exposure to the sun, etc.
The symptoms of this form of  headache are, intense  ach-
ing pain in the head of a tensive or throbbing character,
the  head is hot, the face  flushed, the eyes suffused, and
the secretions more or less  arrested.
  We may give a brisk purgative to evacuate the bowels;
use the hot foot bath, and give a warm diaphoretic  infu-
sion, as of the  pleurisy  root, or ginger.  Tincture of gel-
seminum, in doses of from ten to twenty drops, frequently 
HEADACHE.
467
 gives speedy relief;  and if very persistent, we may use a
 solution of acetate of potash.
   Headache from cold is a  frequent form of the disease in
 winter and spring, and will sometimes last for several days
 at a time.  It seems to  be dependent partially upon arrest
 of secretion, but more  especially upon  the sub-inflamma-
 tory condition  of  the mucous membrane of the  nose,
 pharynx, etc.  The head feels full and heavy, and the pain
 is usually dull and aching, with occasional sharp, darting
 pains  just above the eyes, especially on stooping, or any
 continued mental exertion.
   We would treat this  case as we would the bad cold it is
 associated with.  The feet should be bathed  in hot mus-
 tard water,  the  patient packed  warmly in bed, and an
 active diaphoretic used to induce free perspiration.  A
 purgative may  frequently be used  with advantage, and
 sometimes the speediest relief is obtained from the use of
 an emetic.   Tincture of gelseminum, in doses of ten to
 thirty drops  every two or three hours, is a valuable rem-
 edy in many cases, and an alkaline diuretic should follow
 the diaphoretic.  Frequently we would direct a sinapism
 to the back of the neck and between the shoulders, and
 occasionally  in severe cases we may use the cups.
  Headache from deficient action of the  kidneys, is, in my
 opinion, the most common form of the  disease.   It is
 occasioned by cold or any cause that tends to arrest the
 secretion.  In some persons it recurs frequently, and lasts
 for one or two days at a time, so as to become a source of
 great annoyance.  In the milder cases the head feels heavy
 and dull, and there is a dull, aching pain  and feeling of
 soreness in the base of the cranium, sometimes shooting
from side to side, and  at  others from before backward.
In severe attacks, the pain is intense, darting, throbbing,
and tensive, and is aggravated by  motion,  and especially
by noise, or  stooping.   If attention is called to it, it will
be noticed that the urine  was scanty prior to the attack,
and became more free afterward. 
468
HEADACHE.
   We can mitigate this form of the disease by the admin-
 istration of purgatives and diaphoretics, but it is  more
 readily arrested by the use of the saline diuretics.   The
 tendency to the disease may be frequently overcome by
 the employment  of a solution  of acetate of potash in the
 usual doses, whenever the head commences to  feel heavy
 and bad.
   Derangement of the stomach is a frequent cause of head-
 ache, and  especially in persons of sedentary habits, and
 those who have but little exercise  in the open air.  It is
 noticed in these cases that the susceptibility of the nervous
 system is  increased, and  the  digestive and assimilative
 functions weakened.  This form of headache is induced
 by anything that irritates the  stomach, as indulgence in
 improper food, eating late  suppers, overloading the stom-
 ach, too free use of stimulants, especially if not accustomed
 to their use, constipation of the bowels, etc.  An attack
 of this headache usually comes on with a sense of weight
 and tension, with dizziness, and a sharp, lancinating pain
 when the patient stoops.  In an hour or  two the  patient
 frequently feels chilly, and there is a sensation of nausea and
 disgust, wilich not unfrequently terminates in vomiting.
 The pain now becomes severe, is dull, aching and tensive,
 with throbbing in the  temples, and almost  insupportable
 weight; or is sharp and lancinating, darting from one part
to another, and seeming sometimes as if the head would be
torn to pieces with its violence.  It usually commences in
the morning, and does not terminate until the patient goes
to sleep at  night, and in rare cases continues for several
days.
  If called to a case of this kind of headache during the
 attack, I usually administer an  emetic, one that will act
 quickly and kindly being  preferred.  There is  no other
way to check the paroxysm  in a  majority of cases, and
this is  very efficient.  Otherwise, I would have the  feet
 bathed in hot mustard water, a sinapism applied over the
 epigastrium  and  upon the nape  of  the  neck, and give 
HEADACHE.
469
 freely an infusion of sage, spearmint, pennyroyal, or any
 warm,  stimulating diaphoretic.   Quite  frequently when
 the patient has drunk a cupful, vomiting ensues, and it is
 thrown up; if it is now repeated, in  a short time the pa-
 tient will go to sleep, and will awake refreshed.  We can
 generally ward off an attack by the use of the neutralizing
 cordial, or a mild cathartic taken the evening previous, or
 by the  administration of an  alkaline diuretic.  For the
 radical cure, we will  adopt such means as would seem in-
 dicated from the condition of the stomach, some  form of
 dyspepsia being almost always present.
   Headache is frequently periodic,  and is occasioned, we
 suppose, by the same causes that give rise to other periodic
 diseases.  In the most frequent form, it  conies  on in the
 morning, and gradually increases up to noon, and then
 decreases until evening.  It may, however, appear at any
 period of the day, or every other, or every third day.  The
 pain is sometimes dull, heavy and contusive, and at others
 Bharp, lancinating and throbbing; there may or may not
 be sickness of the stomach, or chilly sensations, or slight
 febrile action when the pain is most intense. ^
   In periodic headache we wish first to establish the secre-
 tions, which are almost always impaired, and next to ad-
 minister some remedy capable of controlling the periodi-
 city.  Thus, if the bowels  are costive we  wTould  give a
 podophyllin purgative,  with  a  diaphoretic, as essential
 tincture of asclepias and eupatorium, with tincture of gel-
 seminum, and an alkaline  diuretic.  In some cases  this
 will control the headache, but usually it only prepares the
 way for the administration of quinine, which is given in
the same doses that would be used in  a  case of ague.
Given in this way, quinine always arrests the disease, but
if the system  is not properly prepared for it, it frequently
fails.
  Sympathetic headache  is sometimes called nervous,  and
generally occurs in feeble, debilitated persons, and those of
a sedentary  habit.  It is  almost  always associated with 
470
HEADACHE.
diseases of some other part of the body, and is thus fre-
quently seen in  cases  of uterine disease, especially func-
tional lesions, in derangements of the urino-genital organs,
the bowels, etc.  The pain varies in character, resembling
the two  preceding forms,  and recurs frequently  but  at
irregular periods.
  Having determined the nature of the lesion giving rise
to the headache, we will frequently relieve it either by
curing or palliating the primary disease.   Any  of the
means already named may be employed in addition. 
            PART  VI.

     NOTES  ON  NURSING:
WHAT IT  IS AND  WHAT IT IS NOT.
BY FLORENCE NIGHTINGALE.
  Shall we begin by taking it as a general principle, that
all disease, at some period or other  of its course, is more
or less  a reparative process, not necessarily accompanied
with suffering—an effort of nature to remedy a process of
poisoning or of decay,  which  has taken  place  weeks,
months, sometimes years beforehand, unnoticed, the ter-
mination of the disease being then, while the antecedent
process  was going on, determined?
  If we accept this as a general principle, we shall be im-
mediately met with anecdotes and instances to prove the
contrary.  Just so  if we were to take, as a principle, all
the climates of the earth are meant to be made habitable
for  man, by the  efforts of man—the  objection would be
immediately raised, Will the top of  Mount Blanc ever be
made habitable ?  Our answer would  be, it will be many
thousands of  years before we have reached the bottom  of
Mount Blanc  in making the earth healthy.  Wait till we
have reached the bottom before we discuss the top.
  In watching  diseases, both in private houses  and  in
public hospitals, the thing which strikes the experienced
observer most forcibly is this, that  the symptoms or the
sufferings generally considered to be inevitable and inci-
dent to  the disease, are very often not symptoms of the
disease at all, but of something quite  different—of the 
472
NOTES ON NURSING.
want of fresh air, or of light, or of warmth, or of quiet,
or of cleanliness, or of punctuality and care in the admin-
istration  of diet—of  each  or of all  of  these.  And this
quite as much in private as in hospital nursing.
  The  reparative process which nature has instituted, and
which  wre call disease, has been hindered by some want of
knowledge or attention, in  one or in all of these things,
and pain,  suffering, or interruption of the whole  process
sets in.
  If a  patient is cold, if a patient  is  feverish, if a patient
is faint, if he is sick after taking food, if he has a bed-sore,
it  is generally the fault not of the disease, but of the
nursing.
  I use the word  nursing  for want of a better.  It has
been limited to signify little more than the administration
of medicines and the application of poultices.  It ought
to signify the proper use of fresh air, light, warmth, clean-
liness,  quiet, and the  proper selection and administration
of diet—all at the least expense of vital power to the pa-
tient.
  It has been said and written scores of times, that e\ ery
woman makes a good  nurse.   I believe, on the contrary,
that the very elements of nursing are all but unknown.
  By this I do  not mean that tho nurse is  always to
blame.  Bad sanitary, bad architectural, and bad adminis-
trative arrangements often  make it  impossible to nurse.
But the  art of nursing  ought to include  such arrange-
ments  as  alone make what I understand by nursing, pos-
sible.
  The art of nursing, as now practised, seems to be ex-
pressly constituted to unmake what God had  made dis-
ease to be, viz., a reparative process.
  To recur to the first objection.  If we are asked, Is such
or such a disease a reparative process ?   Can such an ill-
ness be unaccompanied with suffering?  Will any care
prevent  such a  patient from suffering this or that?  I
humbly say, I do not  know.  But when you  have done 
NOTES ON  NURSING.
473
away with all that pain  and suffering, which in patients
are the symptoms, not of their disease, but of the absence
of one or all of the above-mentioned essentials to the suc-
cess of nature's  reparative  processes, we shall then know
what are  the  symptoms  of and the suffering inseparable
from the disease.
  Another and the commonest exclamation which will be
instantly made, is, Would you do nothing, then, in cholera,
fever, etc. ?—so deep-rooted and universal is the conviction
that to give medicine is to be doing something,  or  rather
every thing; to give air, warmth, cleanliness, etc., is to do no-
thing.  The reply is, that in these, and many other similar
diseases, the exact value of particular remedies and  modes
of  treatment  is by no  means  ascertained, while there  is
universal experience as to the extreme importance of care-
ful nursing in determining the issue of the disease.
   H. The very elements of what constitutes good nursing
are as little understood  for the well  as for the sick.  The
same laws of  health  or of nursing, for they are in  reality
the same, obtain among the well as among the sick.  The
breaking of them produces only a less violent consequence
among the former than among the latter—and this some-
times, not always.
   It  is  constantly objected,  " But how can I  obtain this
medical  knowledge ?  I am not a  doctor.  I must leave
this to doctors."
   Oh, mothers of families!  You who say this, do you
know that one in every seven infants in this civilized land
of England perishes before it is one  year old ?  That,  in
London, two  in  every five  die before they are  five years
old ?  and in the other great  cities of England, nearly one
out of two ? *  " The life duration of tender  babies,"  as

 3 Upon this fact the most wonderful deductions have been strung. For a long
time an announcement something like the following has been going the round
of the papers: "More than 25,000 children die every year in London under ten
years of age; therefore we want a children's hospital."  This  spring there
was a prospectus issued, and divers other means taken to this effect: "There 
474
NOTES  ON NURSING.
some Saturn, turned analytical chemist, says, " is the most
delicate test"  of sanitary conditions.  Is  all this prema-
ture suffering  and  death  necessary?  Or  did  nature in-
tend mothers to  be always accompanied by doctors ?  Or
is it better to learn the piano-forte than to learn the laws
which subserve the preservation of offspring ?
  Macaulay somewhere says, that it is extraordinary that,
whereas the laws of  the motions  of the heavenly bodies,
far removed as they are from us, are perfectly well under-
stood, the laws of the human mind, which are under our
observation all day and every day are no better under-
stood than they were two thousand years ago.
  But how much more extraordinary is it, that, what we
might call the coxcombries of education, e. g., the elements
of astronomy, are now taught to every school-girl, neither
mothers of families of any class, nor school-mistresses  of
any class, nor nurses of children, nor nurses  of hospitals,
are taught anything  about those laws which God has  as-
signed to the  relations of our  bodies with  the world  in
which he has put them.   In  other words, the  laws which
make these bodies, into  which He has  put  our minds,
healthy or unhealthy organs  of those  minds, are all but

is a great want of sanitary knowledge in women; therefore we want a women's
hospital."  Now, both the above facts are too sadly true. But what is the
deduction?   The causes of the enormous  child mortality are perfectly well
known; they are  chiefly want of cleanliness, want of ventilation, want of
whitewashing; in one word, defective household  hygiene. The remedies are
just as well known; and among them is certainly not the establishment of a
child's hospital.  This may be a want; just as there may be  a want of hos-
pital room for adults. But the Registrar General would certainly never think
of giving us, as a cause for the high  rate  of child mortality  in (say) Liver-
pool, that there was not sufficient hospital room for children; nor would he
urge upon us, as a remedy, to found an hospital for them.
  Again, women, and the best women, are  wofully deficient in sanitary know-
ledge;  although it is to women that we must look, first and last, for its appli-
cation, as far as household hygiene is concerned. But who would ever think
of citing the institution of a women's hospital as the way to core this want?
  We have it, indeed, upon very high authority, that there is some fear lest
hospitals, as they have been hitherto, may not have generally increased, rather
than diminished, the rate of mortality: especially child mortality. 
VENTILATION and warming.
475
 unlearnt.  Not but that these laws—the laws  of life—are
 in a  certain  measure understood; but not even mothers
 think it worth their while to study them—to study how
 to give their children healthy existences.  They call  it
 medical or physiological  knowledge, fit only for doctors.
  Another objection.
  We are constantly told, " But the circumstances which
 govern  our  children's health  are  beyond  our control.
 What can we do with winds ?  There is the east wind.
 Most  people  can  tell before  they get up in the morning
 whether the wind is in the east."
  To  this one can answer with more certainty than to the
 former objections.  Who is it who knows when the wind
 is in the east ?  Not the  Highland drover, certainly, ex-
 posed to the  east wind; but  the young lady who is worn
 out with the want of exposure to the fresh air, to sunlight,
 etc.   Put the latter under as good sanitary circumstances
 as the former, and she too will not know when the wind
 is in the east.

        I. VENTILATION AND WARMING.

  The very first canon of nursing, the first and  the  last
 thing upon which a nurse's attention  must be fixed, the
 first essential to a patient, without which all  the rest you
 can do for him is as nothing, with which I had almost said
 you may leave all the rest alone, is this: To keep the air
 HE BREATHES AS PURE AS THE EXTERNAL AIR, WITHOUT CHILL-
ING him.   Yet what is so little attended to ?  Even where
it is thought  of at all, the most extraordinary misconcep-
 tions reign about it.  Even in admitting air  into the pa-
tient's room or ward, few people ever think where that air
comes from.   It may come  from a corridor into  wrhich
other wards are ventilated, from  a  hall, always unaired,
always full of the fumes of gas, dinner, of various kinds
of mustiness; from an underground kitchen, sink, wash-
house, water-closet, or even, as I myself have had sorrow- 
476
VENTILATION  AND WARMING.
ful experience, from open sewers loaded with filth; and
with this the patient's room or ward is aired, as it is called
—poisoned, it should rather be said.  Always air from the
air without, and that, too, through those windows through
which the air comes freshest.  From a closed  court, espe-
cially if the  wind do not  blow that way, air may come as
stagnant as any from a hall or corridor.
   Again, a thing I have often seen both in private houses
and institutions.  A room remains uninhabited; the fire-
place is carefully fastened  up with a  board; the windows
are never opened; probably the  shutters are kept always
shut; perhaps some kind of stores are kept in the room;
no breath of fresh  air can by possibility enter into that
room, nor any ray of sun.  The  air is as stagnant, musty
and corrupt  as it can by possibility be made.  It is quite
ripe to breed  small-pox,  scarlet  fever, diphtheria, or any-
thing else you please*.
   Yet the nursery, ward or sick-room adjoining will posi-
tively be aired (?)  by having the  door opened into that
room.  Or children will be put  into  that  room, without
previous preparation, to sleep.
   A short time ago a man walked into a back-kitchen in
Queen Square, and cut the throat of a  poor, consumptive
creature, sitting by the fire.  The murderer did not deny
the  act, but  simply said, " It's all right."   Of course he
was mad.
   But in our case, the extraordinary thing is that the vic-
tim  says, " It's all right,"  and that we are not mad.   Yet,
although we " nose " the murderers, in the musty, unaired,
unsunned room, the scarlet fever  which is behind the door,
or the fever and  hospital  gangrene which are stalking

  * The common idea as to uninhabited rooms, is, that they may safely be left
with doors, windows, shutters, and chimney-board, all closed—hermetically
sealed, if possible—to keep out the dust, it is said; and that no harm will
happen if the room is but opened a short hour before the inmates are put in.
I have often been asked the question for uninhabited rooms, But when ought
the windows to be opened? The answer is,  when ought they to be shut? 
VENTILATION AND WARMING.
477
 among the crowded beds of a hospital ward, we say, " It's
 all right."
   With a proper supply of windows, and a proper supply
 of fuel in open fire places, fresh  air is comparatively easy
 to secure when your patient or patients are in bed.   Never
 be afraid of open windows then.   People don't catch cold
 in bed.  This  is a  popular  fallacy.  With  proper bed-
 clothes and hot bottles, if necessary, you can always keep
 a patient warm in bed, and well  ventilate him at the same
 time.
   But a careless nurse, be her rank and education what it
 may, will stop up every cranny, and keep a hot-house heat
 when her patient is in bed; and if he  is able  to get up,
 leave  him comparatively unprotected.  The time  when
 people take cold (and there are many ways of taking cold,
 besides a cold in the nose) is when they first get up after
 the two-fold exhaustion of dressing and of having had the
 skin relaxed by many  hours, perhaps  days, in bed, and
 thereby rendered more incapable of reaction.  Then the
 same temperature which refreshes the patient in bed may
 destroy the patient  just risen.   And  common  sense will
 point out that  while purity of air is essential, a tempera-
 ture must be  secured which shall not chill  the patient.
 Otherwise the best that can be expected will be a feverish
 reaction.
   To have the  air within as pure as the air without, it  is
 not necessary, as often appears to  be  thought, to make it
 as cold.
   In the afternoon again, without care, the patient,  whose
vital powers have then risen, often finds the room as close
and oppressive  as he found it cold in the  morning.  Yet
the nurse will be terrified if a window is opened.*

 •It is very desirable that the windows in  a sick  room should be such that
the patient shall, if he can  move about, be able to open and shut them easily
himself.  In fact, the sick room is very seldom kept aired if this is not the
 case—so  very few people have any perception of what is a healthy atmosphere
for the sick   The sick man often says, "This room where I spend twenty-two 
478           VENTILATION* AND WARMING.
  I know an intelligent, humane house surgeon, who makes
a practice of keeping the ward windows open.  The phy-
sician? and  surgeons  invariably close them while going
their rounds, and the house surgeon very properly as  in-
variably opens  them whenever the doctors have turned
their backs.
  In a little book on nursing, published a short time ago,
we are told that, " with proper care it is very seldom that
the windows cannot be opened for a few minutes twice in
the day to admit fresh air from without."  I should think
not; nor twice in the hour either.  It only shows how
little the subject has been considered.
  Of all methods of keeping the  patient warm, the very
worst certainly is to depend for  heat on the breath and
bodies of the sick.  I have known a medical officer keep
his ward windows hermetically closed; thus exposing the
sick to all the dangers of an infected atmosphere, because
he was afraid that, by admitting fresh air, the temperature
ot the ward would be too much  lowered.   This  is a de-
structive fallacy.
  To  attempt to keep a ward warm at  the expense ol
making the  sick repeatedly breathe their own hot, humid,
putrescing atmosphere, is a certain way to delay recovery
or to destroy life.
  Do you ever  go into the bed-rooms of any persons of
any class, whether they contain one, two or twenty people,
whether  they hold  sick  or  well, at night, or before the
windows are opened in the morning, and ever find the air
anything but unwholesomely close and foul ?  And why
should it be so ?  And of how much importance it is that
it should not be so.  During sleep, the human body, even
when in health, is far more injured by the influence of foul
air than when  awake.  Why can't you keep the air all
night, then,  as pure as the air without, in  the rooms you

hours out of the twenty-four is fresher than the other where I spend only two,
because here I can manage the windows myself."  And it is true. 
VENTILATION AND WARMING.             479
sleep in?   But for this, you must have sufficient outlet for
the impure air you make yourselves to go  out;  sufficient
inlet for the pure air from without to come in.   You must
have  open  chimneys,  open windows or  ventilators;  no
close curtains  round your beds;  no  shutters or curtains to
your windows; none of the contrivances by which you un-
dermine your  own health,  or  destroy the  chances of  re-
covery of your sick.*
   A careful nurse will keep  a constant watch  over her
sick, especially  weak, protracted, and collapsed cases, to
guard against the  effects of the  loss  of vital  heat by the
patient himself.  In certain diseased states  much less heat
is produced than  in  health; and there is a constant ten-
dency to the decline  and  ultimate extinction of the vital
powers by the call made upon them to sustain the heat of
the  body.   Cases  where this  occurs  should  be watched

  *Dr. Angus Smith's air test, if it could  be made of simpler  application,
would be invaluable to use in every sleeping and sick room.  Just as without
the use of a thermometer no nurse should ever put a patient into a bath, so
should no nurse, or mother, or superintendent, be without the air test in any
ward, nursery or sleeping room.  If the main function of a nurse is to main-
tain the air within the room as fresh as the air without, without lowering the
temperature, then she should always be provided with a thermometer which
indicates the temperature, with an air test which indicates the organic matter
of the air.  But to be used, the latter must  be made as simple a  little instru-
ment as the former, and  both should be self-registering.  The senses of nurses
and mothers become so dulled to foul air, that they are perfectly unconscious
of what an atmosphere they have let their children, patients or charges sleep
in.  But if the tell-tale  air test were to exhibit in  the morning, both to nurses
and patients, and to the superior officer going round, what the asmosphere has
been during the night, I question if any greater  security could  be afforded
against a recurrence of the misdemeanor.
  And oh, the crowded national school, where so  many children's epidemics
have their origin, what a tale its air test would tell.  We should have parents
saying, and saying rightly, " I will not send my child to that school, the air
test stands at' Horrid.'" And the dormitories of our great boarding schools 1
Scarlet fever would be no more ascribed to contagion, but to its right cause,
the air test standing at "  Foul."
  We should hear no longer of " Mysterious Dispensations," and of " Plague
and Pestilence," being " in God's hands," when,  so far as we know, He has
put them into  our own.  The little air test would both betray the cause of
these "mysterious pestilences," and call upon us to remedy it. 
480
VENTILATION  AND WARMING.
with the greatest care  from hour to hour, I had almost
said from minute to minute.  The feet and legs should be
examined by the hand from time  to  time, and whenever
a tendency to chilling is discovered, hot bottles, hot bricks,
or warm flannels, with some warm drink, should be made
use of until the temperature is  restored.  The fire should
be, if necessary, replenished.  Patients are frequently lost
in the latter stages of disease from want of attention to
such simple  precautions.  The  nurse may  be trusting to
the patient's diet, or to his medicine, or to the occasional
dose of stimulant which  she is directed to give him, while
the patient is all the while  sinking from want of a  little
external warmth.  Such cases  happen  at all times, even
during the hight of summer.   This fatal chill is most apt
to occur toward early morning, at the period of the low-
est temperature of the twenty-four hours, and at the time
when the effect  of the preceding day's diet is exhausted.
  Generally speaking, you may expect that weak patients
will suffer cold  much more in  the morning than in the
evening.   The vital powers are  much lower.  If they are
feverish at night, with burning hands and feet, they are
almost sure to  be  chilly and  shivering in the morning.
But nurses are  very fond of heating  the foot-warmer at
night, and of neglecting it in the morning when they are
busy.  I should reverse the matter.
  All these things require  common  sense and care;  yet,
perhaps, in no  one  single  thing is so little common sense
shown, in all ranks, as in nursing. *

  * With private sick, I think,  but certainly with hospital sick, the nurse
should never be satisfied as to the freshness of their atmosphere, unless she can
feel the air gently moving over her face, when still.
  But it is often observed that the nurses who make the greatest outcry against
open  windows,  are  those who take the  least pains to prevent dangerous
draughts.  The door of the patients' room or ward must sometimes stand open
to allow of persons passing in and out, or heavy things being carried in and out.
The careful nurse will keep the*door shut while she shuts the windows, and
then, and not before, set the door open, so that a patient may not be left sit'
ting up in bed, perhaps in a profuse  perspiration, directly in the draught
between the open door and window 
VENTILATION AND WARMING.
481
   The extraordinary confusion  between cold and ventila-
 tion, even in the minds of well-educated people, illustrates
 this.  To make a room cold is by no means necessarily to
 ventilate it.  Nor is it  at  all necessary, in  order to venti-
 late a room, to chill it.   Yet, if a nurse finds a room close,
 sbe will let out the fire, thereby making it closer, or she
 will open the door into  a  cold room, without a fire, or an
 open window in it, by way of improving  the ventilation.
 The safest atmosphere of  all for a  patient  is a good fire
 and an open window, excepting in extremes of tempera-
 ture ;  (yet no nurse can ever be made to understand this.)
 To ventilate a small room  without draughts of course re-
 quires more care than to ventilate a large one.
   Another extraordinary fallacy is the  dread of night air.
 What air can we breathe  at night  but night air ?  The
 choice is between pure  night air from without and foul
 night air from within.  Most people prefer the latter.   An
 unaccountable choice.  What will they say if it is proved
 to be true that fully one half of all  the disease we suffer
 from, is  occasioned by people sleeping with their windows
 shut?  An open window  most  nights in  the year can
 never hurt any one.  This is not to say that light is  not
 necessary for recovery.  In great cities, night air is often
 the best and purest air to be had in the twenty-four hours.
 I  could better understand in towns  shutting the windows
 during the day than during the night, for the sake of  the
 sick.  The absence of smoke, the quiet,  all tend to making
 night the best time for airing the patients.   One of our
 highest medical authorities on  consumption and  climate
 has told  me  that the air  in London is never so good as
 after ten o'clock at night.
   Always air your room,  then,  from the outside air, if
 possible.   Windows are made  to open; doors are made
 to  shut—a truth which seems extremely difficult of appre-
hension.  I have seen a careful  nurse airing her patient's

Neither, of course, should  a patient, while being washed or in any way ex-
posed, remain in the draught of an open window or door.
    31 
482            VENTILATION AND WARMING.

room through  the  door, near  to  which were  two  gas-
lights, (each of which  consumes  as much  air as eleven
men,) a  kitchen, a corridor, the composition of the at-
mosphere in  which  Consisted  of gas,  paint, foul air,
never  changed, full of  effluvia, including  a current  of
sewer air from an ill-placed sink, ascendiug  in a con-
tinual stream by a well-staircase,  and discharging them-
selves constantly into the patient's room.   The  window
of the said room if opened, was all that was desirable to
air it.  Every room must be aired from without—every
passage from without.  But the fewer passages there are
in a hospital the better.
  If we are to  preserve the air within as pure  as the air
without,  it  is  needless  to  say that the chimney must
not smoke.   Almost all smoky chimneys can be  cured—
from the bottom, not from the  top.  Often it is only nec-
essary to have an inlet for air to supply the  fire, which  is
feeding itself, for want of this, from its own chimney. On
the other hand, almost all  chimneys  can  be made to
smoke by a careless nurse, who lets the  fire get low and
then overwhelms it with coal—not, as we verily believe,
in order to spare herself trouble, (for very rare is  unkind-
ness to the sick,) but from not thinking what she is about.
  In laying down the principle that the first object of the
nurse must be to keep the  air breathed by her patient as
pure as  the  air without, it  must not be  forgotten that
every thing  in the room which can give off effluvia, be-
sides the patient, evaporates itself  into his air;  and it fol-
lows that there ought to be  nothing in the room, except-
ing him,  which can give off  effluvia or moisture.  Out  of
all damp towels, etc., which become dry in the room, the
damp, of course, goes into the patient's air.   Yet this " of
course" seems as little thought of, as  if it were an obso-
lete fiction.   How very seldom you see  a nurse who ac-
knowledges by her  practice that nothing at all ought  to
be aired  in the patient's room, that nothing at all ought to 
VENTILATION AND WARMING.            483
be  cooked  at the patient's  fire!   Indeed,  the arrange-
ments often make this rule impossible to observe.
  If the nurse be a very careful one, she will, when the
patient leaves his bed, but not his  room, open  the sheets
wide, and throw the bed-clothes back, in order to air his
bed.  And she will spread the wet towels or flannels care-
fully out upon a horse, in order to dry them.   Now, either
these bed-clothes and towels are not dried  and aired, or
they dry and air themselves  into the patient's  air.  And
whether the damp and effluvia do  him most harm in his
air or in his bed, I leave to you to determine, for I cannot.
   Even in health  people  cannot repeatedly breathe air in
which they live with  impunity, on  account  of its becom-
ing charged with unwholesome matter from the lungs and
skin.   In disease where  everything  given  off from the
body  is highly noxious and dangerous, not only must there
be plenty of ventilation to carry off the effluvia, but every-
thing which the patient passes must be instantly removed
away; as being more noxious than even the emanations
from the sick.
   Of the fatal effects of the  effluvia  from the excreta it
would seem unnecessary to speak, Were they not so con-
stantly neglected.  Concealing the utensils behind the val-
lance to the bed seems all  the precaution which is thought
necessary for safety in private  nursing. Did you but think
for one moment  of the atmosphere  under  that bed, the
saturation of the under side of the mattress with the warm
evaporations, you would be startled  and frightened too!
   The use of  any chamber utensil  without a lid* should

 » But never, never should the possession of this indispensable lid confirm
you in'the abominable practice of letting the chamber utensil remain in a pa-
tient's room unemptied, except once in  the twenty-four hours, i. e., when the
bed is made.  Yes, impossible as it may appear,  I have known the best and
most attentive nurses guilty of this;  aye, and have known, too, a patient
afflicted with severe diarrhoea for ten days, and the nurse (a very good one)
not know of it. Lecause the chamber  utensil (one with a  lid) was emptied
only once in twenty-fo lr hours, and that by the housemaid who came in and
made the patient's bed every evening.  As well might you have a sewer under 
484             VENTILATION  AND WARMING.
be utterly abolished, whether  among sick or well.  You
can easily convince yourself of the necessity of this abso-
lute rule, by  taking one with a  lid, and examining the
underside of that lid.  It will be found always covered,
whenever the utensil  is not  empty, by condensed, offen-
sive moisture.  Where does that go when there is  no lid?
  Earthenware, or, if  there  is any wood, highly polished
and varnished wood, are the only materials fit for patients'
utensils.   The very lid of the old abominable close-stool is
enough to breed a pestilence.  It  becomes saturated with
offensive matter, which  scouring  is only wanted to bring
out.  I prefer an earthenware lid, as being always cleaner.
But there are various  good  new-fashioned arrangements.
  A slop-pail should never  be brought into a sick room.
It should be  a rule  invariable, rather more important in
the private house than  elsewhere, that the  utensil should
be  carried directly  to  the  water-closet, emptied there,
rinsed there,  and brought back.   There should always  be
water and a  cock in every water-closet for rinsing.  But
even if there  is  not, you  must  carry w7ater there to rinse
with.  I have actually seen, in the private sick room, the
utensils emptied into the foot-pan, and put back unrinsed
under the bed.   I can hardly say which is most abomina-
ble, whether  to do this  or to rinse the utensil in the sick
room.  In the best hospitals it is now a rule that no slop-
pail shall ever  be brought  into the wards,  but that the

the room, or think that in a water-closet the plug need be pulled up but once
a clay.  Also take care that your lid, as well as your utensil, be always thor-
oughly rinsed.
  If a nurse declines to do these kinds of things for her patient, "because it
is not her business," I should say that nursing was not her calling. I have
seen surgical "sisters," women whose hands were worth to them two or three
guineas a week, down upon their knees scouring a room or hut, because they
thought it otherwise not fit for their patients to go into.  I am far from wish
ing nurses  to scour.   It is a waste of power. But I do say that these women
had the true nurse-calling—the good of their sick first, and second only the
consideration what it was  their " place" to do ; and that women who wait
for the housemaid to do this, or for the charwoman to do that, when their
patients are suffering, have not the making of a nurse in them. 
HEALTH OF  HOUSES.
485
utensils shall be carried direct to be emptied and rinsed at
the proper place.  I would it were so in the private house.
  Let no one  ever depend upon fumigations, "disinfec-
tants," and the like, for purifying the air.   The offensive
thing, not its smell, must be removed.   A celebrated medi-
cal lecturer began one day, "Fumigations, gentlemen, are
of essential importance; they make  such an abominable
smell that they compel you to open the window."   I  wish
all the disinfecting fluids invented made such an "abomi-
nable  smell"  that they forced  you to  admit fresh  air.
That would be a useful invention.


              II. HEALTH OF HOUSES.*

   There are five essential points in securing the health of
houses:
              1. Pure  air.
              2. Pure  water.
              3. Efficient drainage.
              4. Cleanliness.
              5. Light.
 Without these, no house  can be healthy.  And it will be
unhealthy just in proportion as they are deficient.
   1. To have pure air, let your house be so constructed as
that the outer atmosphere shall  find its way with ease to
every  corner of it.  House architects hardly ever consider
this.   The object in  building a house  is  to obtain the

  * The health of carriages, especially close carriages, is not of sufficient uni-
versal importance  to mention here, otherwise than  cursorily. Children, who
are always the most delicate test of sanitary conditions, generally can not
enter a close carriage without being sick; aud very lucky for them that it is
so.  A close carriage, with the horse-hair cushions and linings always satu-
rated with organic matter, if to this be added the windows up, is one  of the
most unhealthy of human receptacles.  The idea of taking an airing in it, is
something preposterous. Dr. Angus Smith has shown that a crowded railwav
carriage, which goes at the rate of thirty miles an hour, is as unwholesome as
the strong smell of a sewer, or as a back yard in one of the most unhealthy
courts off one of the most unhealthy streets in Manchester. 
486
HEALTH OF HOUSES.
laro-est interest for the money, not to save doctors' bills to
the tenants.  But, if tenants should ever become so wise
as to refuse to  occupy unhealthy constructed  houses, and
jf insurance companies should  ever come  to understand
their interest so thoroughly as  to pay a sanitary surveyor
to look after the  houses where  their clients live, specula-
tive architects would speedily be brought to  their senses.
As it is, they build what pays best.  And there are always
people foolish enough  to  take the houses  they build.
And if in the course of time the families die off, as  is  so
often the case, no body ever thinks  of blaming any but
Providence* for  the result.  Ill-informed  medical  men
aid in sustaining the  delusion, by  laying  the  blame on
" current  contagions."   Badly constructed  houses * do for
the healthy what badly  constructed hospitals do for the
sick. Once insure that the air in a house is stagnant, and
sickness is certain to follow.
   2. Pure water is more generally introduced into houses
than it used to be, thanks  to the exertions of  the sanitary
reformers.   Within the last few years, a  large part  of
London was in the daily habit of using water polluted by
the  drainage  of  its sewers  and  water-closets.   This has
happily been remedied.  But, in many parts  of the coun-
try, well-water of a  very impure kind is used  for domestic
purposes.  And when  epidemic disease shows  itself, per-
s,ons using such water are  almost sure to suffer.
   3. It would be curious  to ascertain by inspection, how
many houses in  London  are really wrell  drained.  Many
people would say, surely all or most of them.  But many
people have no idea in what good drainage consists.   They
think that a sewer  in the street, and a pipe  leading to it

  * God lays down certain physical laws.  Upon His carrying out such laws,
depends our responsibility (that much abused word), for  how could we have
any responsibility for actions, the results of which we could not foresee, which
would be the case if the carrying out of His laws were not certain?   Yet we
seem to be continually expecting  that He will work a miracle—i. e., break
His own laws expressly to relieve us of responsibility. 
HEALTH  OF  HOUSES.
487
from the  house, is good drainage.   All  the while the
sewer may be nothing but a laboratory from which epi-
demic disease and ill health is  being distilled into the
house.  No house, with  any untrapped drain-pipe  com-
municating immediately with a sewer, whether it be from
water-closet,  sink,  or gully-grate, can  ever  be  healthy.
An untrapped sink may at any time spread fever or pyae-
mia among the inmates of a palace.
   The ordinary oblong  sink  is an  abomination.   That
great surface of stone, which is always left wet, is always
exhaling into the air.  I have known whole houses and
hospitals smell of the sink.  I have met just as strong a
stream  of sewer  air coming up the back  staircase of a
grand London house from the sink, as I have ever met at
Scutari; and I have seen the rooms in that house all ven-
tilated by the open doors, and the passages all unventila-
ted  by the closed windows, in order that as much of tho
Bewer air as possible might be conducted into and retained
in the bed-rooms.   It is wonderful.
   Another great evil in  house  construction is carrying
drains underneath the house.   Such drains are never safe.
All house drains should begin and end  outside the walls.
Many people will readily admit, as a theory, the impor-
tance of these things.  But how few are there who  can
intelligently  trace disease in  their households  to  such
causes!  Is it not a fact, that when scarlet fever, measles,
or small-pox appears among the children, the very first
thought which occurs is, " where " the children can have
" caught" the disease?  And the parents immediately run
over in their minds all the families with whom they may
have been.  They never think of looking at home for the
source of the mischief.   If a  neighbor's child  is seized
with small-pox, the first question which occurs is, whether
it had been vaccinated.   No one would under-value vacci-
nation; but it becomes of doubtful benefit to society when
it leads people to look abroad for the source of evils which
exist at home. 
488
HEALTH OF HOUSES.
  4. Without cleanliness, within and -without your house,
ventilation is comparatively useless.   In certain foul dis-
tricts of London, poor people used to object to open their
windows and doors because of the foul smells that came
in.   Rich people like to  have their stables and dunghill
near their houses.  But does  it ever occur to them that
with many arrangements of this kind it would be safer to
keep the windows shut than open?  You can not have
the air of the house pure with dung heaps under the win-
dows.  These are  common all over London.  And yet
people  are surprised  that  their children, brought up in
large, "well aired" nurseries and bed-rooms, suffer from
children's epidemics.  If they studied nature's laws in the
matter of children's health, they would not be so surprised.
  There  are  other ways of having  filth  inside a house
beside having dirt  in  heaps.  Old papered walls of years'
standing, dirty  carpets, uncleansed furniture, are just as
ready sources of impurity  to  the air as if there were a
dung heap in the basement.  People are so unaccustomed
from education  and habits to consider how to make a
home healthy, that they either never think of it at  all,
and take every disease as  a matter of  course, to be "re-
signed  to " when it comes " as from  the  hand of Provi-
dence ;"  or if they  ever entertain  the idea of preserving
the health of their household as a duty, they are very  apt
to commit all kinds of "negligences  and ignorances" in
performing it.
  5. A dark  house is always an unhealthy house, always
an  ill-aired house, always  a dirty house.   Want of light
stops growth, and  promotes  scrofula, rickets, etc., among
the  children.
  People lose their health in a dark house, and if they get
ill, they can not get well again  in it.   More will be said
about this farther on.
  Three out of many " negligences  and ignorances" in
managing the health  of houses generally, I will here men-
tion as specimens: 1. That the female head in  charge of 
                  HEALTH OF HOUSES.               489

any building does not think it necessary to visit every hole
and corner of it every day.  How can she expect those
who are  under her to be more careful to maintain her
house in a healthy  condition than she who is in charge ol
it?  2. That it is not considered essential to  air, to sun,
and to clean rooms while uninhabited; which is  simply
ignoring the first  elementary notion of sanitary things,
and laying the ground ready for all kinds of diseases.  3.
That  ftie window,  and one window, is considered enough
to air a room.  Have you never observed that any room,
without a fire-place, is always close?  And, if you have a.
fire-place, would you cram it up not only with a chimney-
board, but perhaps with a great wisp  of brown paper, in
the throat of the chimney—to prevent the soot from com-
ing down, you say? If your chimney is foul, sweep it;
but don't expect that  you can ever air a room with only
one aperture; don't suppose that to  shut up a room, is
the way to keep it clean.  It is the best way to foul the
room and all that is in it.  Don't imagine that if you, who
are in charge, don't look to all these things yourself, those
under you will be more  careful than you are.  It appears
as if the part of a mistress now is  to complain  of her
servants, and to  accept their excuses—not to show them
how there need be neither complaints made  nor excuses.
  But again, to look to all these things yourself does not
mean  to do  them yourself.  "I always open the win-
dows," the head  in charge often says.  If you do it, it is
by so much the better, certainly, than if it were not done
at all.  But can you not insure that it is done when not
done by yourself?  Can you insure that it is not undone
when  your  back  is turned?  This  is what being "in
charge" means ;  and a very important meaning it is, too.
The former only implies  that just what you can do with
your own hands is  done;  the latter that what ought to be
done is always done.
  And now,  you think these things trifles, or at least ex-
aggerated.  But  what you " think" or w7hat I " think" 
490
HEALTH OF HOUSES.
matters little.  Let  us  see  what' God  thinks  of them,
God always justifies his ways.   While we  are  thinking,
he has been  teaching.  I have  known cases of hospital
pyaemia quite  as severe in handsome private houses as in
any of the worst hospitals, and from the same cause, viz.,
foul air.  Yet nobody learned the lesson; nobody learned
anything at all from it.  They went on thinking—thinking
that the sufferer had scratched his thumb,  or that it was
singular that " all  the servants" had " whitlows," or that
something was " much about this year;  there  is always
sickness  in   our  house."  This  is  a  favorite mode of
thought—leading  not to inquire what  is the uniform
cause of these general "whitlows," but to stifle all  in-
quiry.  In what sense is "sickness" being "always there,"
a justification of its being " there" at all?
  I will tell you what was the cause of this hospital pyae-
mia  being in  that large private house; it was that the
sewer air from an  ill-placed  sink was carefully conducted
into all the rooms by sedulously opening  all the doors,
and  closing all the  passage windows.  It  was that the
slops were emptied into the foot pans; it was that the uten-
sils were never properly  rinsed;  it was that the chamber
crockery was  rinsed with dirty  water; it  was that the
beds wrere never properly shaken, aired, picked to pieces, or
changed.  It was  that the carpets and curtains were al-
ways musty ;  it was that the furniture was always dusty;
it was that the papered walls were saturated with dirt; it
wras that the  floors were never  cleaned; it wras that the
uninhabited rooms were never  sunned, or  cleaned, or
aired;  it was  that the cupboards were always reservoirs
of foul air;  it was that  the windows  were always tight
shut up at night;  it was  that no window  was ever
systematically  opened  even in  the day, or  that the
right window was not  opened.  A person  gasping for
air might open a  window for himself; but the servants
were not taught  to open  the  windows, to  shut the
doors;  or they opened the windows upon a dank well 
HEALTH OF HOUSES.
491
between high wTalls,  not upon the airier court; or they
opened the  room doors into the  unaired halls and  pas-
sages, by way of airing the rooms.   Now all this is not
fancy, but fact.  In  that handsome  house I have known
in  one summer  three  cases of hospital pysemia, one  of
phlebitis, two of consumptive cough—all the  immediate
products of foul  air.  When, in temperate  climates,  a
house is  more unhealthy in summer than in winter, it is
a certain sign  of something wrong.   Yet nobody learns
the lesson.  Yes, God  always justifies his ways.   He is
teaching while you  are not learning.  This  poor  body
loses his finger, that  one loses his life; and all from the
most easily preventible  causes.*
   The houses of the grandmothers and great-grandmoth-
ers of this generation, at  least the  country houses, with
front  door  and back door  always standing open, winter
and summer, and a thorough  draught  always blowing
through, with all the scrubbing, and cleaning, and polish-
ing, and scouring which used to  go on, the grandmothers,
and  still  more the  great-grandmothers,  always  out  of
doors, and  never  with  a  bonnet on, except  to  go  to
church—these things entirely account for the fact so often
seen of a great-grandmother, who was a tower of physical
vigor  descending into a grandmother perhaps a little less
vigorous, but still sound as a bell and healthy to the core,
into a mother languid and confined  to her carriage and

  * I must say a word about servants' bed-rooms.  From the way they are
built, but oftener from the way they are kept, and Irom  no intelligent inspec-
tion whatever being exercised over them, they are almost invariably dens of
foul air, and the "servants' health" suffers in an "unaccountable" (?) way,
even in the country ; for I am by no means speaking only of London houses,
where too often  servants are put to live  under the ground  and over the roof.
But in  a country mansion, which was really a mansion,  (not  after the
fashion of advertisements,)  I have known three maids who slept in the same
room ill of scarlet fever.  "How catching it is," was of course the remark.
One look at the room, one smell of  the room, was quite enough. It was no
longer unaccountable.  The room was not a small one ; it was up stairs, and
it had two  large windows; but nearly every one ot the neglects enumerated
above was there. 
492
HEALTH  OF HOUSES.
house, and lastly into a daughter  sickly and confined to
her  bed.   For, remember, even with a general  decrease
of mortality, you may often find a race thus degenerating,
and  oftener a  family.   You may  see  poor little feeble
washed-out rags, children of a noble stock,  suffering mor-
ally  and  physically, throughout their useless, degenerate
lives;  and yet  people  who  are going  to  marry, and to
bring more such into the world, will consult nothing  but
their own  convenience  as to where  they  are  to live, or
how they are to live.
  With regard to the  health of houses where there is a
sick person, it  often happens  that the sick room is made
a ventilating shaft  for  the rest of  the house.  For while
the house is kept as close, unaired, and  dirty  as usual, the
window of the sick room is kept a little open always, and
the  door occasionally.   Now, there are certain  sacrifices
which a house  with  one sick person in it does  make to
that sick  person: it ties  up its  knocker; it  lays straw
before  it  in the  street.   Why can't it keep itself thor-
oughly clean and unusually well aired, in deference to the
sick person.
  We  must not  forget what, in  ordinary  language, is
called  " Infection ;" *—a thing of  which people  are gen-

  *Is it not living in a continual mistake to look upon diseases, as we do now,
as separate entities,  which must exist, like cats and dogs ? instead of looking
upon  them as conditions, like a dirty and a clean condition, and just as much
under our own control; or rather as the reactions of kindly nature against the
conditions in which we have placed ourselves.
  I was brought up, both by scientific men and ignorant women, distinctly to
believe that small-pox, for instance, was a thing of  which  there was once a
first specimen in the world, which went on propagating itself, in a perpetual
chain of descent, just as  much as that there was a  first  dog, (or a first pair
of dogs,) and that small-pox would not begin itself any more than a new dog
would begin without there having been a parent dog.
  Since then  I have seen with my eyes and smelt with my nose small-pox
growing up in first specimens, either in  close rooms, or in  overcrowded wards,
where it could not by any possibility have been caught, but must  have begun.
  Nay, more, I have seen diseases begin, grow up, and pass into one ancther.
Now, dogs do not pass into cats. 
HEALTH OF HOUSES.
493
erally so afraid that they frequently follow the very prac-
tice in regard to  it which they  ought to  avoid.  Noth-
ing used  to  be considered so infectious or contagious as
small-pox; and people not very  long ago  used to cover
up  patients  with heavy bed-clothes, while they kept up
large  fires and shut the windows.   Small-pox, of  course,
under this regime, is very " infectious."  People are some-
what  wiser  now in  their management  of this disease.
They have ventured to cover the patients lightly, and to
keep  the windoAvs  open; and Ave hear much less of the
"infection"  of small-pox  than we used  to do.  But do
people in our days  act with more Avisdom  on the  subject
of "infection" in feA7ers, scarlet fever,  measles, etc., than
their forefathers  did Avith the small-pox ?  Does not the
popular  idea of "infection"  involve that  people  should
take greater care of themselves than of  the patient?  that,
for instance, it is  safer  not to be too much w7ith the pa-
tient, not to  attend too much to his Avants ?  Perhaps the
best illustration of the utter  absurdity  of this view of
duty in attending on  " infectious" diseases, is afforded by
what Avas very recently the practice, if it is  not so even
noAV, in some of the  European lazarets—in which the
plague-patient used to be condemned to the horrors of
filth,  overcroAvding, and want  of ventilation, Avhile the
medical  attendant A\Tas ordered to examine the patient's
tongue through an operajglass, and to  toss him a lan-
cet to open  his abscesses with ?
  True nursing ignores infection, except  to  prevent it.
Cleanliness and fresh air from open AvindoAvs,  with un-
remitting attention  to the patient, are the only defense a
true nurse either asks or needs.

  I have seen, for instance, with a little overcrowding, continued fever grow
up; and wiih a little more, typhoid fever; and  with a  little more, typhus,
and all in the same ward or hut.
  Would it not be far better, truer, and more practical, if we looked upon
disease in this light ?
  For diseases, as all experience shows, are adjectives, not noun substantives 
494               PETTY MANAGEMENT.
  Wise and  humane management of the patient is the
best safeguard against infection.
  There are  not a few  popular opinions, in regard to
which it is useful at times to ask a question or two.  For
example, it is commonly thought that children must have
what are  commonly called  "children's  epidemics," "cur-
rent contagions," etc.—in other Avords, that they are born
to have measles, Avhooping-cough, perhaps even scarlet
fever, just as they are born to cut their teeth, if they live.
  ISToav, do tell us, Avhy must a child have measles ?
  Oh, because, you  say, we  can not keep it from infec-
tion—other children have measles, and it must take them,
and it is safer that it should.
  But Avhy must other children  have  measles?  And if
they have, Avhy must yours have them too ?
  If you believed in and observed the laAvs for preserving
the health of houses, which  inculcate  cleanliness, ventila-
tion, white-washing, and  other means—and which, by the
way, are laws—as implicitly as you believe in the popular
opinion—for  it is nothing more than  an opinion,  that
your child must have children's epidemics—don't  you
think that, upon the whole, your child would  be  more
likely to escape altogether ?


           III.  PETTY MANAGEMENT.

  All the results of good nursing, as detailed  in  these
notes, may be spoiled or  utterly negatived  by one defect,
viz: in petty management, or  in  other  w7ords, by not
knoAving Iioav to manage that what you do when you are
there, shall be done Avhen you are not there.  The most
devoted friend or nurse can not be always there.   Nor is it
desirable  that she  should.  And she  may give up her
health, all her other  duties, and yet, for want of a little
management, be not one-half so  efficient  as another who
is not one-half so devoted, but who has this art of multi- 
PETTY MANAGEMENT.
495
plying herself—that  is to say, the patient of the first Avill
not really be  so well  cared for as  the  patient of  the
second.
  It is as impossible, in a book, to teach a person in charge
of sick, Iioav to manage, as it is to teach her how to nurse.
Circumstances must vary with each different case.  But it
is possible to press upon her to think for herself.  Noav,
what  does happen during my absence?   I am obliged to
be away on  Tuesday.  But fresh air, or punctuality, is not
less important to my patient on  Tuesday than it was on
Monday.  Or, at 10 P. M., I am  never with  my patient;
but quiet is of no less  consequence to him at 10, than it
was at five minutes to 10.
  Curious as it may seem, this very obvious consideration
occurs comparatively to few, or, if it does occur, it is only
to cause the devoted friend  or nurse to  be absent fewer
hours or fewer minutes from her patient—not to arrange
so as that no minute and no hour shall be for her patient
without the essentials of her nursing.
  A very few instances will  be sufficient, not as precepts,
but as illustrations.
  A strange Avasherwoman,  coming late  at night for the
"things," will  burst in, by mistake, to the patient's sick-
room,  after he has fallen into his first doze, giving him a
shock,  the  effects of  Avhich are irremedial, though  he
himself laughs at the cause, and probably neATer even men-
tions it.  The nurse who  is, and is quite right to be, at
her supper,  has not provided that the washerwoman shall
not lose her way and go into the wrong room.
  The patient's room may always have the window open.
But the passage outside the  patient's room, though provi-
ded with  several large windows, may never  have one
open.   Because it is not  understood that the  charo-e of
the sick-room extends to the charge of the passage. And
thus, as often happens, the nurse makes it her business  to
turn the patient's room into a ventilating shaft for the
foul air of the Avhole house. 
496                 PETTY MANAGEMENT.
  An uninhabited room, a  neAvly-painted  room,* an un-
cleaned closet, or  cupboard, may often become  the reser-
voir of foul air for the  whole house, because the  person
in charge  never  thinks  of  arranging  that these places
shall be  ahvays aired, always  cleaned;  she merely opens
the  Avindow herself "when she goes  in."
  An agitating letter or message may be delivered, or an
important letter or message not delivered;  a visitor whom
it was  of consequence  to see, may be refused,  or one
whom  it was of  still more consequence to not see, may
be  admitted — because  the person  in charge has never
asked herself  this question, what is  done  when I am not
there? f
  At all  events, one may  safely say, a nurse can  not be
with the patient,  open  the door,  eat her meals,  take a
message, all at one and the same time.   Nevertheless, the
person in charge  never seems to look the  impossibility in
the face.
  Add to this that  the attempting this impossibility does
more to increase the poor patient's hurry and nervousness
than anything else.

  * That excellent paper, the Builder, mentions the lingering of the smell of
paint for a month about a house as a proof of want of ventilation. Certainly,
and, where there are ample windows to open, and these are never opened to
get rid of the smell of paint, it is proof of want of management in using the
means of ventilation.  Of  course, the smell will  then remain for months.
Why should it go?
  f Why should you let your patient ever be surprised, except by thieves? I
do not know.  In England, people do not come down the chimney, or through
the window, udIgss they are tliieves. They come in  by the door, and some-
body must open the door to them.   The " somebody " charged with opening
the door, is one of  two,  three, or  at most four persons. Why can not these, at
most four persons,  be put in charge  as to what is to be done when there is a
ring at the door-bell?
  The sentry at a post is changed much oftener than any servant at a private
house or institution can  possibly be.  But what should we think of such an
excuse as this: that the  enemy had entered such a post because A and not B
had been on guard?  Yet I have constantly heard such an excuse made in the
private house or institution, and accepted, viz: that such a person had been
"let in," or not "let in," and such  a parcel had been wrongly delivered or
lost because A and not B had opened the door 
PETTY MANAGEMENT.
497
   It is never  thought that  the patient remembers  these
 things, if you do not.  He has not only to think whether
 the visit or letter may arrive, but whether you will be in
 the way  at  the particular day  and hour Avhen  it  may
 arrive.   So that your partial measures  for " being in the
 way " yourself, only increase the necessity for his thought.
 Whereas, if you could but  arrange that the  thing should
 ahvays  be done, whether you  are there or not, he  need
 never think at all about it.
   For the above  reasons, Avhatever a patient can do for
 himself, it is  better, i. e., less anxiety, for  him to  do for
 himself, unless the person in charge has the spirit of man-
 agement.
   It is evidently much less exertion for a patient to answer  .
 a letter for himself b}7 return of post, than to have four
 conversations, Avait five days, have six anxieties before it
 is off his  mind, before the person Avho has to ansAver it
 has done  so.
   Apprehension, uncertainty, waiting, expectation, fear of
 surprise, do a patient more  harm than any exertion,  lie-
 member, he is face  to face with his enemy all the time,
 internally Avrestling with him, having long imaginary con-
 versations with him.  You are  thinking of something
 else.  " Rid him of his adversary quickly," is a first rule
 with  the sick.*
   For the same reasons, always tell a patient, and tell him
beforehand, A\7hen you are going  out, and when you will
be back, whether it  is for a day, an hour,  or  ten min-
utes.  You fancy, perhaps, that it is better for him  if he
does not find  out  your going at all, better for him if you
do not make yourself" of too much importance" to him

  * There are many physical operations where, eaten* paribus, the danger is
in a direct ratio to the time the operation lasts; and, costerisparibus, the opera-
tor's success will be in direct ratio to his quickness. Now, there are manv
mental  operations where exactly the same rule holds good with the sick'
coeteris paribus, their capability of bearing such operations depends directly on
the quickness, without hurry, with which they can be got through.
         32 
498               PETTY MANAGEMENT.

or else  you can  not bear to give him the  pain or the
anxiety of the temporary separation.
  No such thing.   You ought to go,  we will  suppose.
Health  or duty requires it.  Then say so to the patient
openly.   If you  go  without his  knowing it,  and he finds
it out, he  never will feel secure again that the things which
depend  upon you will be done  Avhen you are away, and,
in nine  cases out of  ten, he will  be right.  If you go out
Avithout telling him  when you will be "back, he can take
no measures nor precautions as to the things which con-
cern you both, or which you do for him.
  If you  look into the reports  of trials or accidents, and
especially of suicides, or into the  medical history of fatal
cases, it is almost incredible how often the whole thing
turns upon something which has happened because " he,"
or still  oftener " she," " was not there."  But,  it is still
more incredible how  often, how  almost always  this is
accepted  as a sufficient reason, a justification; Avhy, the
very fact  of the  thing having  happened, is  the proof of
its not  being a justification.  The person in charge was
quite right not to be "there," he was called away for quite
sufficient  reason, or he was  away for a daily recurring and
unavoidable cause; yet no  provision was  made  to supply
his absence.  The fault Avas not in his " being away," but
in there being no management  to supplement his "being
aAvay."   When the sun is under a total eclipse,  or during
his nightly absence,  we light candles.   But it would seem
as if it  did not occur to us that we  must also supplement
the person in charge of sick or of children, whether under
an occasional eclipse  or during a regular absence.
   In institutions where many  lives would  be  lost, and
the effect of such want of management would be terrible
and  patent, there is less of it than in the private house.*

  * So true is this that I could mention two cases of women of very high posi-
tion, both of whom died in the same way, of the consequences of a surgical
operation. And in both cases I was told, by the highest authority, that the
fatal result would not have happened in a London hospital. 
PETTY  MANAGEMENT.
499
    But in both, let whoever is in  charge, keep this simple
  question in her head (not, hoAV can I always  do this  right


    But, as far as regards the art of petty management in hospitals, all the mili-
  tary hospitals I know must be excluded.  Upon my own experience I stand,
  and I solemnly declare that I have  seen or known of fatal accidents, such as
  Buicides in delirium tremens, bleeding to death, dying patients dragged out of
  bed by drunken medical staff corps  men, and many  other things  less patent
  and striking,  which would not have happened in  London  civil hospitals
  nursed by women.  The medical officers should be absolved from all blame in
  these accidents.  How can a medical officer mount guard all day and all night
  over a patient (say) in delirium tremens?  The fault lies in there being no
  organized system of attendance. Were a  trustworthy man in charge of each
  ward, or set of wards, not as office  clerk, but as head nurse (and  head nurse
  the best hospital serjeant,  or ward master, is not now, and  can not be, from
  default of the proper regulations), the thing would  not, in all probability,
  have happened.  But were a trustworthy woman in charge of the ward, or set
  of wards, the thing would not, in  all certainty, have happened.  In other
  words, it does not happen  where a trustworthy  woman is really  in charge.
« And, in these remarks, I by no meane refer only to exceptional times of great
  emergency in war hospitals, but also, and quite as much, to  the ordinary run
  of military hospitals at  home, in time of peace; or to a time in war when our
  army was actually more healthy than at home in peace, and the pressure on
  our hospitals consequently much less.
    It is often said that, in regimental hospitals, patiente ought to " nurse each
  other," because the number of sick altogether being,  say, but thirty, and out
  of these one only,  perhaps, being seriously ill, and  the other twenty-nine
  having little the matter with  them, and nothing  to do, they should be set to
  nurse the one; also, that soldiers are so trained to obey, that they will be the
  most obedient, and therefore the  best of nurses, add to which they are always
  kind to their comrades.
    Now, have those who say this, considered  that, in order to obey, you must
  know how to obey, and that these soldiers certainly do not know how  to obey
  in nursing? I have seen  these  "kind" fellows  (and how kind they are no
  one  knows so well as myself), move a comrade so that, in one case, at least,
  the  man died in the act.   I have  seen the comrades' " kindness " produce
  abundance of  spirits, to be drunk in secret.   Let no  one understand by  this
  that female nurses ought to, or could  be introduced  in regimental hospitals.
  It. would be most undesirable,  even  were it not impossible.   But the head
  nursesiiip of a hospital serjeant is the more essential,  the more important, the
  more inexperienced  the  nurses.   Undoubtedly, a London hospital ,:sister"
  does sometimes set relays of patients to watch a  critical case; but, undoubt-
  edly, also, always under her own superintendence; and she is called to when-
  ever there is something to be done, and she knows how to do it.  The patients
  nre not left to do it of their own  unassisted genius, however kind and willing
  they may be. 
500
PETTY MANAGEMENT.
thino- myself, but), how can I provide for this right thing
to be always done?
  Then, when anything wrong  has actually happened in
consequence of her absence, which absence wTe Avill sup-
pose to have been quite right, let her question still be (not,
Iioav can I provide against any more of such absences?
AA7hich is neither possible nor desirable, but), how  can I
provide against anything wrong  arising out of my ab-
sence?
  How few men, or even  women, understand, either in
great or in little things, what it is the being " in charge "—
I mean, know hoAV to carry out a " charge."  From the
most colossal calamities, doAvn to the most  trifling acci-
dents, results are often traced (or, rather, not traced), to
such  want  of some one "in charge," or of his  knowing
Iioav  to be " in charge." A short time ago the bursting
of a funnel-casing on  board the finest and strongest ship
that ever Avas  built, on her trial trip, destroyed several
lives, and put  several hundreds  in jeopardy—not  from
any undetected flaAv in  her new and untried works—but
from a tap being  closed which ought  not  to have been
closed—from Avhat every child knows  would make  its
mother's tea-kettle burst.   And  this simply  because no
one seemed to knoAV what it is  to be " in charge," or icho
was in charge.  Nay, more, the jury at  the inquest actu-
ally  altogether  ignored the same, and apparently consid-
ered the tap " in charge," for they gave as a verdict " acci-
dental death."
  This is the meaning of the word, on a large scale.  On
a much smaller scale, it happened, a short time ago, that
an insane person burned herself slowly, and intentionally,
to death, Avhile in her doctor's  charge, and almost in her
nurse's presence.   Yet  neither Avas considered " at  all to
blame."  The very fact of  the accident happening, proves
its own case.   There is nothing more to be said.  Either
they did not knoAV  their  business, or they did not know
how to perform it. 
PETTY  MANAGEMENT.
501
  To be " in  charge," is certainly not  only to carry  out
the proper measures  yourself, but to  see that every  one
else does so too; to see that no one either willfully or igno-
rantly thwarts or prevents  such measures.  It is neither
to do every thing yourself, nor  to appoint a  number of
people to each duty, but to insure that each does that duty
to which  he is appointed.   This is  the meaning which
must be attached to the word by (above all)  those  " in
charge"  of sick,  whether  of numbers  or  of individuals
(and, indeed, I think it is with  individual sick that it is
least understood.  One sick  person  is often  waited  on
by four with less precision, and is really less cared for than
ten who are waited on by one; or at least than forty who
are waited on by four; and all for want of this one person
" in charge.")
   It is often said that there are feAV good servants noAv; I
say there are few good mistresses iioav.  As the jury seems
to have thought the tap was in charge of the ship's safety,
 so mistresses now seem to think the house is in charge of
 itself.   They neither know how to  give orders, nor how
 to teach their servants to  obey orders—i. e., to obey intel-
 ligently, which is the real meaning of all discipline.
   Again, people who are in  charge,  often seem to have  a
 pride in feeling  that they Avill be " missed," that  no  one
can understand or carry  on their arrangements, their sys-
tem, books,  accounts, etc., but themselves.   It  seems to
me that  the pride is rather  in  carrying on  a system, in
keeping stores, closets, books, accounts, etc., so that  any

   Note.—It is often complained, that professional nurses, brought into pri-
vate families, in case of sickness, make themselves intolerable by "ordering
about" the other servants, under plea of not neglecting the patient.  Both
things are true; the patient is often neglected,  and the servants are often
unfairly " put upon." But the fault is generally  in the want of management
of the head in charge. It is surely for her to arrange both that the nurse's
place is, when necessary, supplemented, and that the patient is never neg-
lected—things with  a little management quite compatible, and indeed only
attainable together.  It is certainly not for the nurse to " order about" the
servants. 
502
NOISE.
body can understand and carry them  on—so that, in case
of absence or illness, one can  deliver every thing up to
others, and know that all will go on as usual, and that one
shall never be missed.

                     IV. NOISE.

  Unnecessary noise, or noise that creates an expectation
in the mind, is that which  hurts a patient.   It is rarely
the loudness of the noise, the effect upon the organ of the
car itself, which appears to affect the sick.  How well a
patient will generally bear,  e. g., the putting up of a scaf-
folding close to the house, AA7hen he can not bear the talk-
ing, still  less the Avhispering, especially if it be of a familiar
voice, outside his door.
  There  are certain patients, no doubt,  especially where
there is slight concussion or  other disturbance of the brain,
who are  affected by mere noise.  But intermittent noise,
or sudden and sharp noise, in these as in all other cases,
affects far more than continuous noise—noise with jar far
more than noise without.  Of one  thing you may be cer-
tain, that anything which wakes a patient suddenly out of
his sleep, will invariably put him  into a state of greater
excitement, do him more serious, aye, and lasting mischief,
than any continuous noise, however loud.
  Never to  allow a patient  to  be waked, intentionally or
accidentally, is a sine qua non of all good nursing.  If he
is roused out of his first sleep, he is almost certain to  have
no  more sleep.  It is a curious but quite intelligible fact
that, if a patient is Avaked  after a few hours' instead of a
feAv minutes' sleep,  he is much  more likely to sleep again.
Because  pain, like irritability  of brain,  perpetuates  and
intensifies itself.  If you have  gained a respite of either
in sleep, you have gained  more than the  mere respite.
Both the probability of recurrence and of the same inten-
sity  will be diminished; whereas, both  will be terribly
increased by want of sleep.  This is the reason why sleep
is  so all-important.  This  is the  reason why a patient, 
NOISE.
503
waked in the early part  of his sleep, loses not  only his
sleep, but his power to  sleep.  A  healthy  person  who
allows himself to sleep during the day, Avill lose  his sleep
at night.  But it is exactly the reverse with the sick gen-
erally ; the more they sleep, the better will  they be able
to sleep.
   I have often been  surprised at the thoughtlessness (re-
sulting in cruelty, quite unintentionally) of  friends or of
doctors, who will hold a long conversation just in  the room
or passage adjoining to the room of the patient, who is
either every moment expecting them to  come in, or who
has just seen them, and  knows they are talking about
him.  If he  is  an  amiable patient, he will try to occupy
his attention  elsewhere and not to listen ; and this makes
matters Avorse; for the strain upon his attention, and the
effort he  makes, are so great, that it is well if  he is not
worse for hours after.  If it  is a Avhispered  conversation
in the same room, then it is absolutely cruel;  for it is im-
possible that the patient's attention should not  be invol-
untarily strained to hear.   Walking on tip-toe, doing any-
thing in the room very slowly, are injurious, for exactly
the same reasons.   A  firm, light,  quick step, a steady,
quick hand  are the desiderata—not  the slow, lingering,
shuffling foot—the timid, uncertain touch.   SloAvness is
not gentleness, though it is  often  mistaken  for such—
quickness, lightness, and  gentleness are  quite compatible.
Again, if friends and doctors  did but watch, as nurses can
and should watch, the features sharpening, the eyes grow-
ing almost wild, of  fever-patients AA7ho  are listening for
the entrance from the corridor of the persons whose voices
they are hearing there, these Avould never run  the risk
again of creating such expectation, or  irritation  of mind.
Such unnecessary noise has undoubtedly induced or ag-
gravated delirium in many cases.   I have knoAvn such—
in one case death ensued. It is but fair to say  that this
death was attributed to fright.  It Avas the  result  of a
long-Avhispered conversation, within sight of the patient, 
504                     NOISE.
about an impending operation;  but any  one Avho has
knoAvn the more than stoicism, the cheerful coolness, with
which the certainty of an  operation  will be  accepted by
any patient, capable of  bearing an operation at all, if it is
properly  communicated to him,  will hesitate to believe
that it was mere fear Avhich produced, as Avas averred, the
fatal  result in  this instance.   It  Avas rather  the  uncer-
tainty, the strained expectation as to Avhat Avas to be de-
cided upon.
  I need hardly say that the other common cause, name-
ly, for a doctor or friend to leave the patient and commu-
nicate his opinion on the result of his visit to the friends
just outside the patient's door, or  in the adjoining room,
after  the  visit, but within hearing or knowledge  of the
patient, is, if possible, worst of all.
  It is, I think, alarming, peculiarly  at this time, when
the female ink-bottles are perpetually impressing upon ns
"woman's" "particular worth and general missionariness,"
to see that the  dress of Avomen  is daily more and more
unfitting them for any "mission," or usefulness at all.  It
is equally unfitted  for all poetic   and  all  domestic pur-
poses. A man is noAV a more handy and far less objec-
tionable being in a  sick room than a Avoman.   Compelled
by her dress, every Avoman now either shuffles or waddles-
only a man can cross the floor of a sick-room without
shaking it!   What is become of woman's light step—the
firm, light, quick step we have  been asking for ?
  Unnecessary  noise, then, is the  most cruel absence of
care which can  be  inflicted either on sick  or well.  For,
in all these remarks, the sick are  only mentioned as suf-
fering in a greater proportion than the well from pre-
cisely the same causes.
  Unnecessary (although slight) noise injures a sick per-
son much more than necessary  noise  (of a  much  greater
amount.)
  All doctrines  about mysterious  affinities and aversions 
noise.                       505
will be found to resolve themselves very much, if not en-
tirely, into presence or absence of care in these things.
   A nurse who rustles  (I am speaking of nurses profes-
sional  and unprofessional)  is the  horror  of a patient,
though perhaps he does not know Avhy.
   The fidget of silk  and  crinoline, the rattling  of keys,
the creaking of stays and of shoes, will do a patient more
harm than all the medicines in the world will do him
good.
   The noiseless  step of Avoman, the  noiseless drapery of
woman,  are mere figures of speech  in  this day.   Her
skirts (and Avell if they do not throw doAvn some piece  of
furniture) will  at least brush against  every article  in the
room as she moves. *
   Again, one nurse can not open the door without making
every thing rattle;  or she  opens the door unnecessarily
often, for want of remembering all the articles that might
be brought in at once.
   A good nurse Avill  always make  sure  that no door  or
window in her patient's room shall rattle or creak; that
no blind or curtain shall, by any change of  wind through
the open AA7indow, be made to flap; especially will  she  be
careful of all  this before  she leaves  her patients for the
night.  If you wait  till your patients tell you, or remind
you of these things, where  is the  use of their having a
nurse ?  There are more shy than exacting patients, in all
classes; and many a patient  passes a bad night, time after

  •Fortunate it is if her skirts do not catch fire; and if the nurse  does not
give herself up a sacrifice, together with her patient, 10 be burnt in her own
petticoats.  I wish the Registrar-General would tell us the exact number of
deaths by burning  occasioned by this absurd and hideous custom. But if
people will be stupid, let them take measures to  protect themselves from their
own stupMity—measures which every  chemist knows, such as putting alum
into starch, which prevents starched articles of dress from blazing up.
  I wish, too, that people who wear crinoline could see the indecency of their
own drees as other people see  it.  A respectable elderly woman stooping for-
ward, invested in crinoline, exposes quite as much of her own person to the
patient lying in the  room as any opera dancer does on the stage; but no one
will ever tell her this unpleasant truth. 
506
NOISE.
time, rather than remind  his nurse ever}7 night of all the
things she has forgotten.
  If there  are blinds to }7our windows, ahvays take care
to have them Avell up, when  they are not being used.  A
little piece slipping down, and flapping Avith every draught,
will distract a patient.
  All  hurry or  bustle is  peculiarly painful to the sick,
and  Avhen a patient has  compulsory occupations  to en-
gage him, instead of having  simply to  amuse himself, it
becomes doubly injurious.  The  friend  Avho remains
standing and fidgeting  about while a patient is talking
business to him; or the friend Avho sits and proses—the
one from an idea of not letting the patient  talk, the other
from an idea of  amusing him—each is equally inconsider-
ate.  Always  sit down when  a sick  person is  talking
business to  you, show no signs of hurry,  give complete
attention and full consideration if your advice is wanted,
and go aAvay the moment the subject is ended.
  Always sit within the patient's view,  so that when you
speak to him he has not painfully to turn his head round
in order to look at you.   Everybody involuntarily looks
at the person speaking.   If you  make  this act a weari-
some one on the part of the patient, you are doing him
harm.   So  also  if by continuing to stand  you make him
continuously raise his eyes to see  you.   Be as motionless
as possible, and  never gesticulate in speaking to the sick.
  Never make a patient repeat  a message  or  request, es-
pecially if it be sometime after.  Occupied patients are
often accused of doing too much of their own business.
They are instinctively right.   How often you hear the
person, charged  with the request of giving  the message or
Avriting the letter, say, half an hour afterwards to the pa-
tient, "Did you appoint  tAvelve o'clock ?" or,  "What did
you  say was the address ?" or ask perhaps some much
more agitating  question, thus  causing the patient the
effort of memory, or worse still of decision, all over again.
It is really less exertion to him  to write his letters him- 
NOISE.
507
self.  This is almost the universal experience of occupied
invalids.
  This brings us to another caution.  Never speak to an
invalid from behind, nor from the door, nor from any dis-
tance from him, nor when he is doing anything.
  The official politeness  of servants in these things is so
grateful to invalids, that many prefer, without knowing
why, having none but servants about them.
  These things are not fancy.  If we  consider that, with
sick as  with well, every thought  decomposes  some ner-
vous matter—that decomposition  as well as re-composi-
tion of  nervous matter is  always going  on,  and more
quickly with the  sick  than Avith the well—that to ob-
trude abruptly another  thought  upon  the brain while
it is in  the  act of destroying nervous matter  by think-
ing, is calling  upon it to make  a  neAv exertion—if we
consider  these things,  which  are facts, not fancies, Ave
shall remember  that Ave are  doing positive  injury  by
interrupting, by "startling  a fanciful person," as  it is
called.  Alas!  it is  no  fancy.
  If  the  invalid is forced, by his  avocations, to continue
occupations requiring much thinking, the injury is doubly
great. In feeding a patient suffering under delirium or
stupor, you   may  suffocate  him by giving him his food
suddenly; but  if you rub his  lips gently with a spoon,
and thus  attract  his  attention, he Avill SAvalloAV the food
unconsciously, but with perfect  safety.   Thus  it is Avith
the  brain.  If you offer it  a thought, especially one re-
quiring a  decision, abruptly, you do it a real not fanciful
injury.  Never speak to a  sick person suddenly; but, at
the same time,  do  not keep  his  expectation on  the tiptoe.
  This rule, indeed, applies to the  well quite as much as
to the sick.   I have never  knoAAm persons who exposed
themselves for years to constant  interruption, Avho did
not muddle  aAvay  their  intellects  by it at last.   The pro-
cess Avith them may be accomplished without pain—with
the sick pain gives Avarning of the injury. 
508
NOISE.
  Do not meet or  overtake  a patient who is moving
about in  order to speak to him, or to give him  any mes-
sage  or letter; you  might just as well give him a box
on the  ear.  I have seen  a patient fall flat on the ground
Avho was standing  when  his  nurse came into the room.
This Avas an accident which might have happened to the
most careful nurse; but the other is done with intention.
A patient in such a state is not going to the East Indies.
If you  would  wait ten seconds, or walk ten yards further,
any promenade he could  make Avould  be over.   You do
not know the  effort it  is  to a patient to remain standing
for even a quarter of  a minute to listen to you.   If I had
not seen the thing done by the kindest nurses and friends,
I should have  thought this caution quite superfluous. *
  Patients are often  accused  of being able to " do much
more Avhen nobody is by."  It is quite true  that  they can.
Unless  nurses can be brought to attend to  considerations
of the kind of which we have given here but a few speci-
mens, a very weak patient finds it really much less exer-
tion to  do things for  himself than  to ask for them.  And
he will, in order to do  them, (very innocently and from
instinct) calculate the time his nurse is likely to be absent,
from a fear of her " coming in upon " him or speaking to
him, just  at the moment when he finds it quite as much
as he can do  to crawl from his bed to his chair, or from
one room to another, or doAvn stairs, or out  of doors for a
few minutes.   Some  extra  call made  upon his  attention

  * It is absolutely essential that  a nurse should lay this  down  as a positive
rule to herself, never to speak to  any patient who is standing or moving, as
long as she exercises so little observation as not to know when a patient can
not bear  it.  I am satisfied that many of the accidents which happen from
feeble patients tumbling down stairs, fainting after getting up, etc., happen
solely from the nurse popping out of a door to speak to the patient just at that
moment ; or from his tearing that she will do so.  And  if the patient were
even left to himself, till he can sit down, such accidents would much seldomer
occur.  If the nurse accompanies the  patient, let her not  call upon him to
speak. It is incredible that nurses can not picture to themselves the strain
upon  the heart, the lungs, and the brain, which the act of moving is to any
feeble patient. 
noise.                     509
at that moment will quite upset him.  In these cases you
may be sure that a patient in the state we have described
does not make such exertions more than once or twice a
day, and probably much about the same hour every day.
And it is hard, indeed, if nurse and friends cannot calculate
so as to let him make them undisturbed.   Bemember, that
many patients can Avalk who cannot stand or even sit up.
Standing is, of all positions, the most trying to a  Aveak
patient.
  Everything you do in a patient's room, after he is " put
up " for the night, increases tenfold the risk of his having
a bad night.  But, if you rouse him up after he has  fallen
asleep, you do not risk, you secure him a bad night.
  One hint I would give to all who attend or visit the sick,
to all who have to pronounce an opinion upon sickness or
its  progress.  Come back and look at your patient after
he has had an hour's animated conversation with you.  It
is the best test of his real state we know.  But never pro-
nounce upon him from  merely seeing  Avhat  he does, or
how he looks,  during such a  conversation.  Learn also
carefully and exactly, if you can, hoAV he passed the  night
after it.
  People rarely, if ever,  faint while making an exertion.
It is after it is OArer.   Indeed, almost every effect of over-
exertion appears after, not during such exertion.  It is the
highest folly to judge of the sick, as is so often done,Avhen
you see  them  merely during  a  period of  excitement.
People have  very often  died of that which,  it has been
proclaimed at the time, has " done  them no harm."*

  *As an old experienced  nurse, I do most earnestly deprecate all such care-
less words.  I have known patients delirious all night, after  seeing a visitoi
who called them  " better," thought they " only wanted a little amusement,"
and who came again, saying, " I hope you are not the worse for my visit,"
neither waiting for an answer, nor even looking at the case.  No real patient
will ever say, " Yes, but I was a great deal the worse."
  It is not, however, either death or  delirium of which, in these cases, there
is most danger to the patient. Unperceived consequences are far more likely
to ensue.  You will have impunity—the patient will not.  That is, the patient 
510
NOISE.
  Remember never to lean against, sit upon, or unneces-
sarily shake, or even touch the bed in which a patient lies.
This is invariably a painful annoyance.  If you shake the
chair on which he sits, he has a point by which to steady
himself,  in his feet.  But on a bed or sofa, he is entirely
at your  mercy, and he feels  every jar  you give him all
through  him.
  In all  that we have  said, both here and elsewhere, let it
be  distinctly understood that  we are  not  speaking of
hypochondriacs.   To distinguish between real and fancied
disease forms an important branch of the education of a
nurse.  To  manage fancy patients  forms  an important
branch of her duties.  But the nursing which real and
that which fancied patients require is of different, or rather
of opposite, character.  And the latter will not be spoken
of here.   Indeed, many of the symptoms which are here
mentioned are those which distinguish real from fancied
disease.
  It is true that hypochondriacs very often do that behind
a nurse's back which they would not do before her face.
Many  such I have had as patients who scarcely ate any-
thing at  their regular meals; but if you concealed food
for  them in  a drawer, they would  take it at  night or in
secret.  But  this is from  quite a different motive.  They
do it from the wish to conceal.  Whereas the real patient
will often boast to his nurse or doctor, if these do not shake
their heads at him, of how much he has done, or  eaten,
or walked.   To return to real disease.
  Conciseness and decision, are above all things, necessary
Avith the  sick.   Let your thought expressed  to them be
concisely and decidedly expressed.   What doubt and hesi-
tation  there  may be in your own mind  must never be
communicated to theirs, not even (I would rather say

will suffer,  although neither he nor the inflictor of the injury will attribute it
to its real  cause. It will not be directly traceable, except by a very careful
observant nurse.  The patient will often not even mention what has done him
most harm. 
NOISE.
511
especially not) in little things.  Let your doubt be to your-
self, your  decision to them.  People who think outside
their heads, the whole process of whose thought appears,
like Homer's, in the  act of secretion, who tell everything
that led them towards this conclusion and aAvay from that,
ought never to be Avith the sick.
  Irresolution is what all patients most dread.   Bather
than meet this in others, they will collect all their data,
and  make up their minds for themselves.  A change of
mind in others, whether it is regarding an operation, or
re-Avriting a letter, always injures the patient more than
the being called upon to make up his mind to the most
dreaded or difficult  decision.  Farther than this, in very
many cases, the imagination in disease is far more active
and vivid than it is in health.  If you propose to the pa-
tient change of air to one place one hour, and to another
the  next, he has, in each  case,  immediately constituted
himself in imagination the tenant of the place, gone over
the AAdiole premises  in idea, and  you have tired him as
much by displacing his imagination, as if you had actually
carried him over both places.
   Above all, leave the sick room quickly and come into it
quickly, not suddenly, not with a rush.  But don't let the
patient be wearily waiting for when you will be out of the
room or when you will be in it.   Conciseness and decision
in yonr movements, as well as your words, are  necessary
in  the sick  room, as necessary as absence of hurry and
bustle.  To possess yourself entirely will ensure you from
either failing—either loitering or hurrying.
   If a patient has to see, not only to his OAvn but also to
his  nurse's punctuality, or  perseverance, or readiness, or
calmness—to any or all of  these things, he  is far better
Avithout that nurse  than with her, however valuable and
handy her services may otherwise be to him, and hoAvever
incapable  he may be of rendering them to himself.
   With regard to reading  aloud in the sick-room, my ex-
perience is, that when the sick are too ill to read to them- 
512
NOISE.
selves, they can seldom bear to be read to.  Children, eye-
patients, and uneducated persons are exceptions, or Avhere
there is any mechanical difficulty in reading.  People who
like to be read to, have generally not much the matter
with them;  wrhile in fevers, or where there is much irrita-
bility of brain, the effort of listening to reading aloud has
often brought on delirium.  I speak with great diffidence,
because there is an almost  universal impression that it is
sparing the sick to read aloud  to  them.  But two things
are certain:
  (1.) If there  is some matter which  must be read to a
sick  person, do  it slowly.   People often think that the
way  to get it over with the least fatigue to him is to get
it over in least time.  They gabble;  they plunge and gal-
lop through the reading.   There never was a greater mis-
take.  Houdin, the conjuror, says  that the way to make a
story seem short is to tell it slowly.  So it is with reading
to the sick.   I  have  often  heard  a patient say to such a
mistaken reader,  " Don't read it to me; tell it me." *  Un-
consciously  he is  aAvare that this will regulate the plung-
ing,  the reading with unequal paces, slurring over one
part, instead of  leaving it  out altogether, if it is unim-
portant, and mumbling another.   If  the reader lets his
own attention wander, and then stops to read up to him-
self,  or finds he has read the wrong bit, then it is all over
with the poor patient's chance of not suffering.  Very
few  people knoAV how to  read  to  the  sick; very few read
aloud as pleasantly even as they speak.  In reading they
sing, they hesitate, they stammer, they hurry, they mum-
ble; when  in  speaking they  do  none  of  these things.
Reading aloud to the sick ought always to be rather sIoav,
and exceedingly  distinct, but not mouthing—rather mo-
notonous, but not sing-song;  rather  loud, but not noisy;
and, above  all, not too long.  Be  very sure  of w7hat your
patient can bear.
   * Sick children, if  not too shy to speak, will  always express this wish.
 They invariably prefer a  story to be told to them, rather than read to them. 
NOISE.
513
   (2.) The extraordinary habit of reading to oneself in a
 sick room,  and reading  aloud.to the  patient any bits
 Avhich Avill amuse him, or more  often the reader, is unac-
 countably thoughtless.  What  do  you think the patient
 is thinking of during your gaps of non-reading?  Do you
 think that he amuses himself upon Avhat you have read
 for precisely the time it pleases you  to  go on reading to
 yourself, and  that  his  attention is ready  for something
 else at precisely the time  it  pleases you  to begin reading
 again ?   Whether the person thus read to be sick or well,
 whether he be doing nothing or doing something else
 while being thus read to, the self-absorption and  want of
 observation of the person Avho  does it, is equally difficult
 to  understand, although very often  the   readee is too
 amiable  to say hoAV much it hurts him.
   One thing  more: From the  flimsy manner in Avhich
 most modern houses are built, where every step on the
 stairs, and along the floors, is felt all over the house ; the
 higher the story, the greater the vibration.  It is incon-
 ceivable how much the sick suffer by having anybody over-
 head.   In  the solidly built old  houses,   which,  fortu-
 nately,  most hospitals are, the noise and shaking are com-
 paratively trifling.  But it is a serious cause of suffering
 in lightly built houses, and Avith the irritability peculiar to
 some diseases. Better far put such patients at the top of
 the house, even Avith the additional fatigue of stairs, if you
 can not secure the  room  above them being untenanted;
 you may otherwise bring on a state of restlessness which
 no opium will subdue.  Do not neglect the warning when
 the patient tells you  that he "feels every step above him
 to  cross his heart."  Remember that every noise  a pa-
 tient can not see partakes of the character  of suddenness
 to him ;  and I am persuaded that patients with these pecu-
liarly irritable nerves, are positively less injured by havino-
persons  in the same room with them than overhead or
separated by only a thin compartment.   Any sacrifice to
secure silence  for these  cases  is worth while, because no
          33 
514                     VARIETY.
air, however good, no attendance, however careful, Avill do
anything for such cases without quiet.

                     F.  VARIETY.

  To any but an old nurse, or an old patient, the degree
would be quite inconceivable to Avhich  the  nerves of tue
sick suffer from  seeing the  same walls, the same ceiling,
the same surroundings, during a long confinement to one
or two rooms.
  The  superior  cheerfulness of persons suffering severe
paroxysms  of pain over that of persons suffering from
nervous debility, has  often  been remarked upon, and at-
tributed to the enjoyment of the former of their intervals
of respite.  I incline to think that the majority of cheer-
ful cases is to be found among those patients Avho are not
confined to one  room, Avhatever their suffering, and that
the majority of  depressed cases will be seen among  those
subjected to a long monotony of objects about them.
  The  nervous frame  really suffers as much from this as
the digestive organs from long  monotony of diet, as e. g.,
the soldier from  his twenty-one years' " boiled beef."
  The  effect  in  sickness of beautiful objects,  and  espe-
cially of brilliancy  of color, is  hardly at  all appreciated.
  Such  cravings are  usually called the "fancies" of pa-
tients.  And often, doubtless, patients have "fancies," as
e. g.,  Avhen they desire  two  contradictions.  But much
more often their  so-called "fancies" are  the most valuable
indications of what is necessary for their recovery; and it
would be Avell if  nurses would watch  these so-called "fan-
cies" closely.

  Note.—The effect of music upon the sick has been scarcely at all noticed.
In fact, its expensiveness, as it is now, makes  any general application of it
quite  out of the question.  I will only remark here, that wind instruments,
including the human voice, and stringed instruments, capable of continuous
sound, have generally a beneficent effect; while  the piano-forte, with such
instruments as have no continuity of sound, has just the reverse.  The finest
piano-forte playing will damage the sick, while an air, like "Home, sweet 
VARIETY.
515
   I have seen, in fevers (and felt, when I was a fever pa-
 tient myself), the most acute suffering produced from the
 patient (in  a hut)  not being able  to see out of window,
 and the knots in the wood being  the only view.  I shall
 never forget the rapture of fever patients over a bunch of
 bright-colored flowers.   I remember (in my own  case) a
 nosegay of wild flowers being sent me, and  from that
 moment recovery becoming more rapid.
   People say the effect is only on the mind.  It is no such
 thing.  The effect is on the body, too. Little as we know
 about the way in which we are affected by form, by color,
 and light, Ave do  know  this,  that they have  an  actual
 physical effect.
   Variety of form  and brilliancy of color in the  objects
 presented to patients, are actual means of recovery.
   But it must be slow variety, e. g., if you shew a patient
 ten or twelve engravings successively, ten to one that he
 does not become cold and faint, or  feverish, or even sick;
 but hang one up opposite him, one on each successive day,
 Or week, or month, and he will revel in the variety.
   The folly and ignorance which reign too often supreme
 over the sick-room, can not be better exemplified than bj
 this.   While the nurse will leave the patient stewing in a
 corrupting atmosphere, the  best ingredient of Avhich  is
 carbonic acid; she will deny him, on the plea of unhealth-
 iness, a glass of cut-flowers, or a  growing plant.   Now,
 no one ever saw " overcrowding " by plants in  a room or
 Avard.  And the carbonic acid they give off at  nio-hts
 AA'ould not poison a fly.  Nay, in overcroAvded rooms, they
 actually absorb carbonic acid, and give off oxygen.   Cut-
 flowers also  decompose Avater  and produce  oxygen gas
It is true there are certain flowers, e. g., lilies, the smell of
which is said to depress the  nervous system.  These are
easily known by the smell, and can  be avoided.

 home," or "Assisa a pie d'un salice," on the most ordinary grinding organ
 will sensibly soothe them—and this quite independent of association. 
516
VARIETY.
  Volumes are now written and spoken upon the effect
of the mind upon the body.  Much of it is true.  But I
Avish a little more was thought of the effect of the body
on the mind.   You who belieA'e  yourselves overwhelmed
with anxieties, but  are able every day  to walk up Regent
street, or out  in the country, to take your meals  Avith
others in other rooms, etc.,  you little  know Iioav  much
your anxieties are thereby lightened; you little know how
intensified  they become  to  those who   can  have  no
change; *  how the  very walls of  their sick rooms seem
hung Avith  their cares; hoAV the  ghosts  of their troubles
haunt their beds; how impossible it is for  them to escape
from a pursuing thought without some  help from A'ariety.
  A patient  can just as  much move  his  leg Avhen it is
fractured, as change his thoughts when  no external help
from  variety  is given him.   This  is, indeed, one of the
main  sufferings  of sickness; just as the fixed  posture ia
one of the main sufferings of the broken limb.
  It is an ever recurring wonder to see educated people,
who call themselves nurses, acting thus.  They  vary their
oavu objects, their own employments, many times a  da}r;
and  while  nursing (!) some bed-ridclen sufferer, they let
him lie there staring at a dead wall, without any change
of object to enable him to vary his thoughts; and it never
even occurs to them, at least to move  his  bed  so that he
can look out of windo\v.   No, the bed is to be always  left
in the darkest, dullest, remotest part of the room.f
  * It is a  matter of painful-wonder to the sick themselves, how much painful
ideas predominate over pleasurable ones in their impressions; they reason  with
themselves; they think themselves ungrateful; it is all of no use. The fact is,
that these painful impressions are far better dismissed by a real laugh, if you
can excite one by books  or conversation, than  by any direct reasoning; or if
the patient is too weak  to laugh, some impression from nature is what he
wants.  I have mentioued the cruelty of letting him stare at a dead wall. In
many diseases, especially in convalescence from fever, that wall will appear
to ruake all sorts of faces at him; now flowers never do  this. Form, color,
will free your patient from his painfnl ideas better than any argument.
  il remember a case in  point.   A man received an injury to thf. spine, from
an accident, which, after  a long confinement, ended in death  He was a 
VARIETY.
517
   I think it  is a very common error among the  well to
think that  "Avith  a little  more  self-control"  the  sick
might, if they choose, " dismiss painful thoughts " Avhich
" aggravate their disease," etc.   Believe  me,  almost  any
sick  person, Avho behaves  decently  Avell, exercises more
self-control  every moment  of his day, than you  Avill  eArer
knoAV till you are sick yourself.   Almost every step  that
crosses his room, is painful to him;  almost every thought
that  crosses  his brain  is painful to him: and if he  can
speak  Avithout  being  savage, and  look  without being
unpleasant, he is exercising self-control.
   Suppose you have  been up all night, and instead of
being allowed to  have your cup of tea,  you  were to be
told that you ought to " exercise self-control," Avhat should
you say?  Noav, the nerves of the  sick are always in  the
state that yours are in after you have been up all night.
   We will suppose the diet  of  the sick to be cared for.
Then, this state of nerves is most frequently to be relieved
by care in affording  them a pleasant view,  a  judicious
variety  as to floAvers,* and  pretty things.   Light by itself
will  often relieve it.   The cravings for  "the return of
day," Avhich  the  sick  so  constantly evince,  is  generally
nothing but the  desire for  light,  the remembrance of the

workman, had not in his composition a single grain of what is called " enthu-
siasm for nature," but he was desperate to " see once more out of window."
His nur6e  actually got him on her back, and managed to perch him up at the
window for an instant, to see out. The consequence to  the poor nurse  was a
serious illness, which nearly proved fatal.  The man  never knew it;  but a
great many other people did.  Yet the consequence in none of their minds, so
far as  I know, was the conviction that the craving for variety in the starving
eye, is just as desperate as that of food in the starving stomach, and tempts
the famishing creature in either case to steal for its satisfaction.  No other
word will  express it but desperation.  And it sets the seal of ignorance and
Btupkiity just as much on the governors and attendants of the sick, if they do
not provide the sick bed  with a " view" of some kind, as if they did not
provide the hospital with a kitchen.
  « No one who has watched the sick, can doubt the fact, that some feel stim-
ulus from  looking at scarlet flowers, exhaustion from looking at deep blue,
etc. 
518
TAKING FOOD.
relief which a variety of objects before the eye affords to
the harassed sick mind.
  Again, every man and  every woman has some amount
of manual  employment, excepting a few fine ladies, who
do not even dress themselves, and who are virtually in the
same category, as  to nerves, as the sick.  Now, you can
have no idea of the relief which manual labor is to you—
of the degree to which the deprivation of manual employ-
ment increases the peculiar irritability from which many
sick suffer.
  A little  needle-work, a little writing, a little cleaning,
would be the greatest relief the sick  could  have, if they
could do it; these  are the greatest relief to you, though
you do not  know it.   Reading, though it is often the only
thing the sick can do, is  not this relief.  Bearing this in
mind, bearing in mind that you have all these varieties of
employment which the sick  can  not have, bear also in
mind to obtain for them all the varieties which they can
enjoy.
  I  need  hardly say that I  am  well aware that excess
in needle  Avork, in writing,  in   any other continuous
employment,  "will  produce the same irritability  that de-
fect  in manual employment,  as  one  cause, produces in
the sick.

                VI. TAKING FOOD.

  Every careful observer  of the sick will agree  in this,
that thousands of patients are  annually starved in the
midst  of plenty, from want  of  attention  to  the ways
which alone make  it possible  for  them to take food.
This Avant of attention is as remarkable in those who urge
upon the sick  to  do  what is quite impossible to them, as
in the sick  themselves who will not make the effort to do
what is perfectly possible to them.
  For instance, to the large  majority of very Aveak pa-
tients it is quite impossible to take  any solid food before
11 A. M, nor then, if their strength is  still further ex- 
TAKING FOOD.
519
hausted by fasting  till  that  hour.  For  weak  patients
have  generally feverish nights, and, in the morning, dry
mouths; and, if they could eat with those  dry mouths, it
would be the worse for them.  A spoonful of beef-tea, of
arrowroot  and wine, of egg  flip,  every hour, will give
them the requisite nourishment, and prevent them from
being  too  much exhausted to take at  a  later hour the
solid  food, wdiich is necessary  for  their  recovery;  and
every patient  who  can swallow at all can sAvallow these
liquid things if he chooses.  But hoAV often do  we hear
a mutton-chop, an egg, a bit  of bacon, ordered to a pa-
tient for breakfast, to whom, as a moment's consideration
would show us, it must  be quite impossible to masticate
such things at that hour.
  Again, a nurse is ordered to give a patient a teacupful
of some article of food every three  hours.  The patient's
stomach rejects it.  If so, try  a tablespoonful every hour;
if this will not do, a teaspoonful every  quarter of an hour.
   I am bound to say, that  I think  more patients are lost
by Avant of care  and ingenuity  in  these momentous mi-
nutiae in  private nursing than in  public  hospitals; and
I  think there is more  of the  entente  cordiale  to assist
one another's hands between the  doctor and his head-
nurse in the latter institutions, than between the doctor
and the patient's friends in the private house.
  J£ we did  but  know the consequences Avhich  may en-
sue, in very  weak  patients, from ten  minutes' fasting or
repletion, (I call it repletion when they are obliged to let
too small an interval elapse  between taking food  and
some other exertion, owing to  the nurse's unpunctuality,)
Ave  should  be more careful never to  let this occur.  In
very Aveak patients  there is often a nervous difficulty of
swalloAAring, Avhich  is so much increased by any other
call upon their strength, that, unless they have  their food
punctually  at  the minute, which minute again must be
arranged so as to fall in with no other minute's occupa-
tion, they can  take  nothing till  the next respite occurs— 
520
TAKING FOOD.
so that an unpunctuality  or  delay of ten minutes may
very well  turn  out to  be one of tAvo  or three hours.
And why is it not as easy to be punctual to a minute ?
Life often literally hangs upon these minutes.
  In acute cases, where life or death is to be determined
in a fftAV hours, these matters  are very generally attended
to,  especially  in  hospitals; and  the  number of cases  is
large Avhere the patient is, as it were, brought back to life
by exceeding  care on the  part of  the doctor or nurse, or
both, in ordering and giving nourishment with minute se-
lection and punctuality.
  But  in  chronic cases, lasting over months and years,
where the fatal issue is often determined at last by mere
protracted starvation, I had rather  not  enumerate the in-
stances  which I  have known, where  a  little ingenuity,
and a  great deal  of perseverance, might, in  all proba-
bility, have averted the result.  The consulting the hours
when the patient can take food, the observation of the
times,  often varying, when he is  most  faint,  the alter-
ing seasons of taking  food,  in  order to anticipate and
prevent such times—all this, which requires observation,
ingenuity,  and perseverance,  (and  these really  constitute
the good nurse,)  might save more lives than we Avot of.
  To leave the patient's untasted  food by his  side, from
meal to meal, in hopes  that  he Avill eat it in  the inter-
val, is simply to prevent  him from taking any food at
all.   I have known patients  literally incapacitated from
taking one article  of food  after  another, by  this piece
of ignorance.  Let the food come at the right time, and
be  taken  aAvay, eaten  or  uneaten, at  the right  time;
but never  let  a patient have "something always standing"
by  him, if  you don't wish to disgust  him  of everything.
  On the other hand, I have known a patient's  life saved
(he was sinking for w7ant of food) by the simple ques-
tion put to him by the doctor,  "But is there no hour
when  you feel you could eat?"  "Oh, yes,"  he said,  "I
 could ahvays  take something at —o'clock and — o'clock." 
TAKING FOOD.                  521
 The thing was tried and  succeeded.  Patients very sel-
 dom, hoAvever, can tell this—it is for you to Avatch and
 find it out.
   A patient should, if possible, not see or smell either the
 food of others, or a greater amount of food than he him-
 self can  consume at one time, or even  hear food talked
 about, or see it in the raAV state.   I knoAV of no exception
 to the above  rule.   The breaking of it ahvays induces  a
 greater or less incapacity of taking food.
   In hospital wards it is of course impossible  to  observe
 all this;  and  in  single Avards, Avhere  a  patient must be
 continuously and closely Avatched, it is frequently impos-
 sible to  relieve the attendant,  so that his or her  own
 meals cau  be taken  out  of the ward.  But it is  not less
 true  that, in  such  cases, even where  the patient is not
 himself aware of it, his possibility of taking food  is lim-
 ited by seeing the attendant eating meals under his obser-
 vation.  In some cases the sick are aAvare of it, and com-
 plain.  A case where the patient Avas supposed to be in-
 sensible, but complained as  soon as able to speak, is now
 present to my recollection.
   Remember, hoAvever, that  the  extreme punctuality in
 well-ordered  hospitals—the  rule  that nothing shall be
 done in  the ward  Avhile the patients are having their
 meals—go  far to counterbalance  what  unavoidable evil
 there is in having patients together.  I have  often  seen
 the private nurse go on dusting  or fidgeting about  in  a
 sick-room all the Avhile the patient is eating, or trying to
 eat.
  That the more alone an im7alid can be Avhen takiner
food, the better, is unquestionable; and,  even  if he must
be fed, the nurse should not allow him to talk, or talk to
him, especially about fo5d, while eating.
  When  a person is compelled, by the pressure of occu
pation, to continue  his business while sick, it ought to be
a rule avithout any  exception whatever, that no one shall
bring business to him or talk to him Avhile he is  taking 
522
TAKING FOOD.
food, nor go on talking to him on interesting subjects up
to the last moment before his meals, nor make an engage-
ment Avith him  immediately after, so that there be  any
hurry of mind while taking them.
  Upon the observance of these rules, especially the first,
often depends the patient's capability of taking food at
all, or, if he is amiable and forces himself to take food, of
deriving any nourishment from it.
  A nurse should  never put before a patient milk that is
sour, meat or  soup that is turned, an egg that is bad, or
vegetables underdone.   Yet often I have seen these things
brought  in to  the  sick  in a state  perfectly perceptible to
every nose or eye except the nurse's.   It is here that the
clever nurse appears;  she will not bring in the peccant
article, but, not to disappoint the patient, she will whip
up something else in a few minutes.  Remember that sick
cookery should half do the Avork of your poor patient's
weak digestion.  But if you further impair it Avith your
bad articles, I know not what is to become of him or of it.
  If the nurse is an intelligent being, and not a mere car-
rier of diets to and from the  patient, let her exercise  her
intelligence in these things.  How often we have known
a patient to eat nothing at all in the day, because one meal
was left untasted (at that time he was incapable of eating),
at an other the milk was sour, the third was spoiled by
some other accident.  And it never occurred to the nurse
to extemporize some expedient,—it never occurred to her
that as he had had no solid food that day he might eat a
bit of toast (say) with his tea in the evening, or he might
have  some meat an  hour earlier.  A patient Avho  cannot
touch his  dinner  at two, will often accept it  gladly, if
brought  to him at  seven. But  somehoAV nurses  never
" think of these things."  One w<*ild imagine they did not
consider  themselves  bound to exercise  their judgment;
they leave it to the patient. Noav I am quite sure that it
is better for a patient rather to suffer these neglects  than
to try to teach his  nurse to  nurse him, if she  does not 
NOTES  ON NURSING.
523
 knoAV hoAV.   It ruffles him, and if he is ill he is in no con-
 dition  to teach,  especially  upon himself.   The   above
 remarks apply much more  to private  nursing than to
 hospitals.
   I would say to the nurse, have a rule of thought about
 your patient's diet; consider, remember how much he has
 had, and how much he ought to have to-day.  Generally,
 the only rule  of  the private  patient's diet is Avhat  the
 nurse has to give.  It is true she cannot give him what
 she has not got;  but his stomach does not Avait  for  her
 convenience, or even her necessity.*  If it is used to hav-
 ing its stimulus at one hour to  day, and to-morrow it does
 not have it, because she has failed in getting it, he Avill
 suffer.   She must be  always exercising her ingenuity to
 supply defects, and to remedy accidents which will happen
 among  the  best  contrivers, but  from which the  patient
 does not suffer the less, because " they cannot be helped."
   One very minute caution,—take care not to spill into
 your patient's saucer, in other words, take care  that  the
 outside bottom rim of his cup shall be quite dry and clean;
 if, every time he lifts his cup to his  lips, he has to carry
 the saucer with it, or else to drop the liquid upon, and to
 soil his  sheet, or his bed-goAvn,  or pillow, or if he is sitting
 up, his dress, you have no idea  Avhat a difference this min-
 ute want of care on your part  makes to his comfort and
 even to  his Avillingness for food.

  * Why, because the nurse has not got some food to-day which the patient
 takes, can the patient wait four hours for food to-day, who could not wait two
 hours yesterday? Yet this is the only logic one generally hears. On the other
 hand, the other  logic, viz., of the nurse giving a  patient a thing because she
 has got it, is equally fatal. If she happens to have fresh jelly, or fresh fruit,
 she will frequently give it to UV patient  half an  hour after his dinner, or at
 his dinner, when he cannot possibly eat that and the broth too—or worse still
leave it by his bed-side till he is so sickened with the sight of it, that he can-
not eat it at all. 
524
WHAT food?
                  VII. WHAT FOOD.

   I Avill mention one or two of the most common errors
among women in charge of sick respecting sick diet.   One
is the belief that beef tea is the most nutritive of all arti-
cle.!.  Noav, just try and  boil doAvn a pound of beef into
beef tea, evaporate your beef tea, and see what is left of
your beef.  You will find that  there is barely a teaspoon-
ful of  solid nourishment  to half a pint of Avater in beef
tea;—nevertheless there is a certain reparatiA7e quality in it,
Ave do not knoAV what, as there is in tea;—but it may safe-
ly be given in almost any inflammatory disease, and  is as
little to be depended upon Avith the healthy or convalescent
where  much  nourishment is required.   Again,  it is an
ever ready saw that an egg is  equivalent to a pound of
meat,—Avhereas  it  is not at all  so.  Also, it is seldom
noticed with  hoAV  many patients, particularly  of nerv-
ous or  bilious temperament, eggs disagree.  All puddings
made with eggs, are distasteful to them  in consequence.
An egg, Avhipped up with wine, is often, the only form in
which they can take this kind of nourishment.  Again, if
the patient has attained to eating meat, it is supposed that
to give him meat is the only thing needful for his recovery;
whereas  scorbutic  sores  have  been actually known to
appear among sick persons living in the  midst of plenty
in England, which could be traced to no other source than
this, viz.:  that the  nurse, depending  on meat alone, had
alloAved the patient to be Avithout vegetables for a consid-
erable  time, these latter being so badly cooked  that  he
ahvays left them untouched.  Arrowroot is another grand
dependence of the  nurse.  As  a vehicle for wine, and as
a restorative quickly prepared, it is all very well.  But it
is  nothing but starch  and w7ater.   Flour is  both  more
nutritive,  and less liable to ferment, and is preferable
wherever it can be used.
  Again, milk and the preparations from milk, are a  most 
WHAT FOOD?
525
 important article for the sick.  Butter is the lightest kind
 of animal fat, and though it wants the sugar and some of
 the other elements which there are in milk, yet it is most
 valuable both in itself and  in enabling the patient  to eat
 more  bread.  Flour, oats,  groats, barley, and  their kind,
 are, as Ave have  already said, preferable in all their prepa-
 rations to all the preparations of arroAvroot, sago, tapioca,
 and their kind.   Cream, in many long chronic diseases, is
 quite  irreplaceable by any other  article Avhatever.  It
 seems to act in  the same manner as beef tea, and to most
 it is much easier of digestion than milk.   In fact, it seldom
 disagrees.   Cheese is not usually digestible by the sick, but
 it is pure nourishment for  repairing waste; and I have
 seen sick, and not a few either, Avhose craving for cheese
 shoAved how much it AA7as needed by them.*
   But, if fresh milk is so valuable a food for the sick, the
 least change or sourness in it, makes it of all articles,  per-
 haps, the most injurious ; diarrhoea is a common result of
 fresh  milk  allowed to  become at all  sour.   The nurse,
 therefore, ought to  exercise her utmost care in  this.  In
 large institutions for the sick, even the poorest, the utmost
 care is  exercised.   Wenham  lake ice  is used  for  this
 express purpose every summer, Avhile the private patient,
 perhaps, never  tastes a drop  of milk that  is  not  sour,
 all through the hot Aveather,  so  little  does  the private
 nurse  understand the necessity of such care.   Yet, if you
 consider that  the  only drop of real nourishment in  your
 patient's tea is the  drop of milk, and how much almost

  *In the diseases produced by bad food, such as scorbutic dysentery and
 diarrhoea, the patient's  stomach often craves for and digests things, some of
 which would be laid  down in no dietary that ever was invented for sick, and
 especially not for such sick.  These are fruit, pickles, jams, gingerbread, fat
 of ham or bacon, suet, cheese, butter, milk.  These  cases I  have seen not by
 ones, nor by tens, but by hundreds.  And the patient's stomach was right and
 the book was wrong.  The articles craved for, in these cases, might have been
 principally arranged under the two heads of fat and vegetable acids.
  There is often a marked difference between men and women in this matter
of sick feeding.   Women's digestion is generally slower. 
526
WHAT FOOD?
all the English  patients depend  upon their tea, you will
see the great importance of not depriA7ing your patient of
this drop of milk.  Buttermilk, a totally different thing,
is often very useful, especially in  fevers.
   In  laying  down rules of diet, by  the  amounts of solid
nutriment in different kinds of food, it is constantly lost
sight of what the patient requires to repair his waste, Avhat
he can take and what he can't.   You can  not  diet a
patient  from a book, you  can  not make up the human
body as you Avould make up a prescription—so many parts
carboniferous, so many  parts nitrogenous, will constitute
a perfect  diet for the patient.  The nurse's observation
here will materially assist the doctor—the patient's fancies
will materially assist the. nurse.   For instance,  sugar is
one of the most nutritive of all  articles, being pure carbon,
and  is particularly recommended in  some  books.  But
the vast majority  of  all patients in England, young and
old, male and female,  rich and  poor, hospital and private,
dislike sweet things—Avhile I have never known  a person
take to sweets when he was ill who disliked them when he
was  well, I have  known  many  fond of them when  in
health, who  in  sickness Avould leave off anything sweet,
even  to sugar in tea—sweet puddings, sweet drinks, are
their aversion; the furred tongue almost always likes Avhat
is  sharp or pungent.  Scorbutic patients  are an exception,
they often crave for sweetmeats and  jams.
   Jelly is another article of diet in great favor with nurses
and friends of the sick; even if it could be eaten solid, it
would not nourish, but it  is simply the  bight of folly to
take one-eighth ounce  of gelatine  and make it into a
certain bulk by dissolving it in water, and then to give it
to the sick, as if the mere  bulk represented nourishment.
It is now knoAA7n that jelly does not  nourish, that it  has a
tendency to produce diarrhoea—and to trust to it to repair
the waste of a diseased constitution, is simply to starve the
sick under  the  guise of feeding them.  If one  hundred
spoonfuls of jelly were  given  in the course of the day, 
WHAT FOOD?
527
you Avould have given one spoonful of gelatine,  which
spoonful has no nutritive power whatever.
  And, nevertheless, gelatine contains a large quantity of
nitrogen, Avhich is one of the most powerful elements in
nutrition; on the other hand, beef tea may be chosen as
an illustration of great nutrient power in sickness, coex-
isting  with  a  very  small  amount of solid nitrogenous
matter.
  Dr. Christison says that " every one will be struck with
the readiness  with which"* certain classes  of  "patients
will often take diluted meat juice or beef tea repeatedly,
when they refuse all  other  kinds of food."  This is par-
ticularly remarkable in "cases of gastric fever, in Avhich,"
he says, " little or nothing else beside beef tea  or diluted
meat juice"  has been taken for weeks, or even months,
" and yet a pint of beef tea contains scarcely one-fourth
ounce of anything but \vater "—the result is so striking
that  he asks  what  is its mode of action?   " Not simply
nutrient—one-fourth ounce of the most nutritive material
can not nearly replace the daily wear and tear of the tis-
sues in any circumstances.   Possibly," he says," it belongs
to a new denomination of  remedies."
  It has been observed that a small quantity of beef tea,
added to other articles of nutrition, augments their power
out of all proportion to  the additional amount of solid
matter.
  The reason why jelly should be innutritious, and beef
tea nutritious to the  sick, is a secret yet undiscovered, but
it clearly shows that careful observation of the sick is the
only clue to the best dietary.
  Chemistry has, as  yet, afforded  little insight into  the
dieting of sick.  All that chemistry can tell  us  is  the
amount of carboniferous or nitrogenous elements discov-
erable in  different dietetic articles.  It has given us lists
of dietetic substances, arranged in the order of their rich-
ness in  one or  other  of these principles; but that is  all.
In the great majority of cases, the stomach of the patient 
528
WHAT FOOD?
is guided by other principles of selection  than merely the
amount of carbon or nitrogen in the diet.  No doubt in
this, as  in other things, nature  has very  definite rules for
her guidance, but these rules can only be ascertained by
the most  careful observation at the bedside.  She there
teaches  us that living chemistry, the chemistry of repara
tion, is  something different from the chemistry of  the
laboratory.  Organic chemistry is useful, as all knowledge
is, Avhen Ave come face to face with nature; but it by no
means follows that Ave should learn  in the laboratory any
one of the reparative processes going on in disease.
  Again, the nutritive power of milk, and of the prepar-
ations  from milk,  is very much undervalued;  there is
nearly as  much nourishment  in  half  a  pint of milk, as
there is  in a quarter of a pound of meat.   But this is not
the Avhole question, or nearly the Avhole.  The main ques-
tion is, what the patient's stomach can assimilate or derive
nourishment from, and of this the patient's stomach is the
sole judge.  Chemistry can not tell this.  The  patient's
stomach must be  its own  chemist.  The diet Avhich will
keep the healthy man healthy, will kill the sick one.   The
same beef, which is the most nutritive  of all meat, and
which nourishes the healthy man, is the  least nourishing
of all food to the sick man, whose half-dead  stomach can
assimilate no part  of it, that is, make no food  out of it.
On a diet of beef tea, healthy men on  the other hand
speedily lose their  strength.
  I have known patients  live for many months without
touching bread, because they could not eat baker's bread.
These were mostly country patients, but  not  all.  Home-
made bread or brown bread is a most  important article of
diet for many patients.  The  use  of aperients may  be
entirely susperseded by it.   Oat cake is another.
  To watch  for the opinions, then, Avhich  the patient's
stomach gives, rather  than to read "analyses of foods,"
is the' business of all those who  have to settle what the 
WHAT  FOOD?
529
patient is to eat—perhaps the most important thing to be
provided for him after the air he is to breathe.
  Noav, the medical man who  sees  the patient only once
a day, or even  only once or twice  a Aveek, can not pos-
sibly tell this without the assistance of the patient him-
self, or  of those who are in  constant  observation on the
patient.  The utmost the medical man can tell is, whether
the patient is Aveaker or stronger  at  this visit than he Avas
at the  last visit.  I should therefore  say that incompara-
bly the most important  office of the nurse, after she has
taken care of  the patient's air, is  to take care to observe
the  effect of his  food, and  report  it  to  the medical  at-
tendant.
  It is quite incalculable the good  that would  certainly
come  from such sound  and  close observation  in this  al-
most  neglected  branch  of nursing,  or the help  it would
give to the medical man.
  A great deal too much against  tea *  is said by wise
people, and a great deal too  much of tea  is given to the
sick by foolish  people.   When you  see  the natural and

  * It is made a frequent recommendation to persons about to incur great ex-
haustion, either  from the nature of the service, or  from their being not in a
state fit for it, to eat a piece of bread before they go.  I wish the recommend-
ers would themselves try the experiment of substituting a piece of  bread lor a
cup of tea or coffee, or beef-tea, as a refresher.  They would find it  a very
poor comfort.  When soldiers have to set out fasting on fatiguing duty, when
nurses have to go fasting  in to their patients, it is a hot restorative they want,
and ought to have, before  they go, not a cold bit of bread.  And dreadful
have been  the consequences of neglecting this.  If they can  take a bit of
bread with the hot cup of tea, so much the better, but not instead  of it.  The
fact that there is more nourishment in bread than in almost anything else, has
probably induced the mistake.   That it is a fatal mistake there is no doubt.  It
seems, though very little is known  on the subject, that what assimilates
itself directly, and with the least trouble of digestion with the human body,
is the best for the above  circumstances.  Bread requires two or three processes
of assimilation before it becomes like the human body.
  The almost universal testimony of English men and women who have  un-
dergone great fatigue, such as  riding  long journeys without stopping, or sit-
ting up for several nights  in succession, is, that they could do it best upon an.,
occasional cup of tea, and nothing else.
  Let experience, not theory, decide upon this as  upon all other things. 
530
WHAT FOOD?
almost universal craving in English  sick for their "tea,"
you can not but feel that nature knows what she is about.
But a little tea or coffee restores them quite as much as a
great deal, and a great deal of tea, and especially of coffee,
impairs the little  poAver  of digestion they have.  Yet a
nurse, because  she  sees how  one or two  cups of tea or
coffee restores her patient, thinks  that three or four cups
will do twice as much.  This is not the case at all; it  is,
hoAvever,  certain that  there  is  nothing yet  discovered
Avhich is a substitute to the English patient for his cup  of
tea.;  he can take it Avhen  he can  take nothing else, and
he often can't take anything else if he has it not.  I should
be very glad if any  of the abusers of  tea would point out
Avhat to give to an  English  patient after a sleepless night,
instead of tea.  If you give  it at five or six o'clock in the
morning, he may even sometimes fall asleep after it, and
get perhaps  his only tAvo or three hours' sleep during the
tAventy-four.   At the same time  you should  never give
tea or coffee to the  sick, as a rule, after five o'clock in the
afternoon.   Sleeplessness in the early night is from ex-
citement  generally, and is increased by  tea or coffee;
sleeplessness,  Avhich  continues  to the early morning, is
from exhaustion often, and  is relieved by tea.  The only
English patients I have ever knoAvn refuse tea, have been
typhus cases, and the first sign of their getting better was
their craving again for tea.  In general, the dry and dirty
tongue always prefers tea to, coffee, and will  quite decline
milk, unless Avith tea.  Coffee is a better restorative than
tea, but a greater impairer of the digestion.   Let the pa-
tient's taste  decide.  You will say that, in cases of great
thirst, the patient's craving decides that it will drink a
great deal  of tea, and that you can not  help it.  But  in
those cases be  sure that the patient requires diluents for
quite other purposes than quenching  the thirst; he wants
a great deal of some drink, not only of tea,  and the doc-
tor will order what he is to have, barley water or lemon-
ade, or soda water  and milk, as  the case may he. 
WHAT FOOD?
531
   Lehman, quoted by Dr. Christison,  says that, among
 the Avell and active, "the infusion of  one ounce of roasted
 coffee daily will diminish the Avaste going on in the body
 by one-fourth;" and Dr.  Christison adds that tea has the
 same property.   Now this is actual experiment.   Lehman
 Aveighs the man, and finds  the fact from his weight.   It is
 not deduced from any "analysis" of food.  All experience
 among the sick shows the same thing. *                         *»
   Cocoa is often recommended  to  the  sick in lieu of tea
 or coffee.  But independently of the fact that English sick
 very generally dislike  cocoa, it has quite a different effect
 from tea or  coffee.   It is an oily,  starchy nut, having  no
 restorative poAver  at   all, but  simply increasing fat.   It is
 pure mockery of the sick, therefore, to call it a substitute
 for tea.   For any renovating stimulus it has, you  might
 just as well offer them chestnuts instead of tea.
   An almost uniArersal error among nurses is in the bulk
 of the food, and especially the drinks they offer to their
 patients.   Suppose   a  patient  ordered   four  ounces  of
 brandy during the day, Iioav is he to take this if you  make
 it into four  pints  with diluting it?  The same Avith tea
 and  beef tea, "with arrowroot, milk, etc.   You  have  not

  * In making coffee, it  is absolutely necessary to buy it in the berry and
 grind it at home.  Otherwise you may reckon upon its containing a certain
 amount of chicory,  at least.  This is not a question of the taste, or of the
 wholesomeness of chicory ; it  is that chicory has nothing at all of the prop-
 erties for which you give coffee.  And therefore you may as well not give it.
  Again, all laundresses, mistresses of dairy-farms, head nurses, (I speak of
 the good old sort only—women who unite a good deal  of hard manual labor
 with the head-work necessary for arranging the day's business, so that none
of it shall tread upon the heels of something else,) set great value, I have
observed, upon having a high-priced tea. This is called extravagant.  But
these women are extravagant  in nothing else.  And they are right in  this,
Real tea-leaf tea alone contains the restorative they want, which is not to be
found in sloe-leaf tea.
  The mistresses of houses, who can not even go over their own house once a
day, are incapable of judging  for these women ; for they are incapable them-
selves, to all appearance, of the spirit of arrangement (no small task) neces-
sary for managing a large ward or dairy. 
532
BED AND BEDDING.
      increased the nourishment, you have not increased the
      renovating  pow7er  of these articles,  by increasing their
      bulk—you have very likely diminished both by giving tbe
      patient's digestion more to do;  and most likely of all, the
      patient will leave half of what he has been ordered to
      take, because he can not swallow the bulk with which
      you have been pleased to invest it.  It requires very nice
m     observation and care (and  meets with hardly any) to de-
      termine what will not be too thick or strong for the pa-
      tient to  take, while  giving him no  more than the bulk
      AArhich he is able to swalloAv.

                 " VIII. BED AND BEDDING.

        A feAv Avords  upon bedsteads and bedding; and princi-
      pally as  regards  patients Avho are  entirely, or almost
      entirely, confined to bed.
        Feverishness  is generally supposed to be a symptom ot
      fever—in nine cases out of ten it is a symptom of bedding*
      The patient has had reintroduced into the body the ema-
      nations from himself Avhich day after day and week after
      Aveek  saturates  his  unaired bedding.  How  can it be
      otherwise ?   Look at  the ordinary bed in  which a patient
      lies.
        If I Avere looking out for an example in order to show
      Avhat not to do, I should take the specimen of an ordinary
      bed in a private house :  a Avooden bedstead, tAvo or even
      three mattresses piled up to the height of a table; a var-
      iance attached to the frame—nothing but  a miracle could
      ever thoroughly dry or air such a bed and bedding.   The
      patient must inevitably alternate  between cold  damp
      after his bed is made, and warm damp before, both satura-

        * I once told a " very good nurse" that the way in which her patient's room
      was kept was quite enough to account for his sleeplessness; and she answered
      quite good-humouredly she was not at all surprised at it—as if the state of the
      room were, like the state  of the weather, entirely out of her power. Now in
      what sense was this woman to be called a " nurse?" 
NOTES ON  NURSING.
533
 ted with organic matter,* and this from the time the mat-
 tresses are put under him till the time they are picked to
 pieces, if this is ever done.
   If you consider that an adult in health exhales by the
 lungs  and skin in  the tAventy-four hours  three  pints at
 least  of moisture, loaded with  organic  matter  ready to
 enter into putrefaction ; that in sickness the quantity is often
 greatly increased, the  quality is ahvays  more noxious—
 just ask yourself next where does all this moisture go to ?
 Chiefly into the bedding, because it cannot go anywhere
 else.  And it stays there; because, except perhaps a Aveekly
 change of sheets, scarcely any other  airing is attempted.
 A nurse will be careful to  fidgetiness about  airing  the
 clean sheets from clean damp, but  airing the dirty  sheets
 from noxious damp will never even occur to her.   Besides
 this, the most dangerous effluvia we know of are from the
 excreta of the sick—these are placed, at least temporarily,
 where they must throw their effluvia into the under side
 of the bed, and the  space under the bed is never aired;  it
 cannot be, with our arrangements.  Must not such a bed
 be always  saturated, and be always the  means of re-
 introducing into the  system of the unfortunate patient
 who lies in  it, that excrementitious  matter to eliminate
 Avhich from the body nature had expressly appointed  the
 disease ?
   My heart always  sinks Avithin me when I hear the good
 house-Avife, of every class, say, " I assure you the bed has
 been Avell slept in," and I can  only hope it  is not true.
 What ?  is the bed already saturated with somebody else's
 damp  before my patient  comes to exhale  in  it his oavh
 damp ?   Has it not had a single  chance to be aired ?  !No,
 not one.  " It has been slept in every night."

  *For the same reason if, after washing a patient, you must put the same
night-dress on him again, always give it a preliminary warm at the fire.  The
night-gown he has worn must  be, to a certain extent, damp.  It has now got
cold from having been off him for a few minutes. The fire will dry and at
the same time air it.  This is much mere important than with clean things. 
534
BED AND  BEDDING.
  The only way of  really nursing a real patient is to
have  an  iron bedstead, with rheocline  springs, which are
permeable by the air up to the very mattress (no vallance,
of course), the mattress to be a thin hair one;  the bed to
be not above three and a half  feet wide.   If the patient
be entirely confined to his  bed, there should be two such
bedsteads;  each bed to be " made " with mattress, sheets,
blankets, etc., complete—the patient to pass twelve  hours
in each bed; on no account to carry his sheets with him.
The Avhole of the bedding to be hung up to air for each
intermediate twelve hours.  Of  course there are  many
cases  Avhere this cannot be done at all—many more where
only an approach to it can  be made.  I am indicating  the
idea of nursing, and what I have actually had done.  But
about the kind of bedsteads there can be no doubt, whether
there be one or two provided.
  There is a prejudice in favor of a Avide bed—I believe it
to be  a prejudice.  All the refreshment of moving  a pa-
tient  from one  side to the other of the bed is far  more
effectually secured by putting him into  a fresh bed; and
a patient who is really very ill  does not stray far in bed.
But it is said there is no room to put a tray down on a
narrow bed.  No good nurse will  put a tray on a bed at
all.  If the patient can turn on his side, he will eat more
comfortably from a bed side table; and  on no  account
Avhatever should a bed ever be higher than a sofa.  Other-
wise the patient feels himself  " out of humanity's reach ;"
he can get at nothing for himself: he can  move  nothing
for himself.  If the patient cannot turn, a table over  the
bed is a better thing.  I need hardly say that a patient's
bed should never have its side against the Avail.  The nurse
must  be able to get easily to both sides of the bed, and to
reach easily every part of the patient without stretching—
a thing impossible  if the bed  be  either too wide or  too
high.
  When I see a patient in a room  nine or ten feet high
upon  a bed between four and five feet high, with his head, 
BED AND BEDDING.
535
 when he is sitting up in bed, actually within two or three
 feet of the ceiling, I ask myself, is this expressly planned
 to produce that peculiarly distressing feeling  common to
 the  sick, viz, as if the walls and ceiling were closing in
 upon them, and they becoming sandwiches between floor
 and ceiling, AArhich imagination is not, indeed, here so far
 from the truth ?  If, over and above this, the windoAV stops
 short of the ceiling, then the patient's head may literally
 be raised above the stratum of  fresh air, even Avhen the
 window is open.   Can  human  perversity any farther go,
 in unmaking the process  of restoration which God has
 made ?   The fact is, that the heads  of sleepers or of sick
 should  never be  higher than the throat of the chimney,
 which ensures their being in the current of best air.  And
 Ave will not suppose it possible that you have closed your
 chimney Avith a chimney-board.
  If a bed is higher than a sofa, the difference  of the
 fatigue  of  getting in and out of  bed will just make the
 difference, very often, to the  patient (avIio can get in *md
 out  of  bed at  all) of being able to  take a few minutes'
 exercise, either in the  open air or in another room.  It
 is so very odd that people  never  think of this, or of how
 many more times a patient Avho is in bed for  the tAventy-
 four hours is obliged to get in and out of bed than they
 are,  who only, it is to be hoped, get into bed once and out
 of bed once during the twenty-four hours.
  A patient's bed should always be in the lightest spot in
 the room;  and he should be able to see out of window.
  I need scarcely say that the old four-post bed with cur-
 tains is  utterly inadmissible, whether for sick or well.
 Hospital bedsteads are in many respects very much less
 objectionable than private ones.
  There is  reason  to believe that not a  few of the appa-
rently unaccountable cases  of  scrofula  among children
proceed from the habit of sleeping with the head  under
the  bed-clothes, and  so inhaling air already  breathed,
 Avhich is farther  contaminated by exhalations from the 
536
LIGHT.
skin.   Patients are sometimes given to  a similar  habit,
and it often happens  that the bed-clothes are so disposed
that the patient must necessarily breathe air more  or less
contaminated  by  exhalations from  his skin.   A  good
nurse will be careful  to attend to this.  It is  an important
part, so to speak, of  ventilation.
   It may be Avorth Avhile to  remark, that where  there is
any danger of bed-sores, a blanket should never be placed
under the patient.   It  retains damp  and  acts  like a
poultice.
   Never  use anything but  light Whitney blankets as bed
covering  for the  sick.    The heavy cotton impervious
counterpane is bad, for  the ATery reason  that it keeps in
the  emanations from the sick person, AArhile the blanket
allows  them  to  pass through.  Weak  patients are inva-
riably distressed by a great Aveight  of bed-clothes, which
often prevents their getting any sound sleep whatever.

    •                   IX.  LIGHT.

   It  is the unqualified  result of all my experience with
the sick,  that second  only to their need of fresh air is their
need of light; that, after a close room,  AArhat hurts them
most is a dark room.  And that it is not only light, but

  Note.—One word about pillows.  Every weak patient, be his illness what
it may, suffers more or less from  difficulty in breathing.  To take the weight
of the body off the poor chest, which is hardly  up to  its work as it is, ought
therefore to be the object of the nurse in arranging his pillows.  Now what
does she do  and what are the consequences?  She piles the pillows one atop
of the other like a wall of bricks. The head is thrown upon the chest.  And
the shoulders are pushed forward, so as not to allow the lungs room to expand.
The pillows, in fact, lean upon the patient, not the patient upon the pillows.
It is impossible to give a rule for this, because it must vary with the figure of
the patient.   And tall patients suffer mu-h more than short ones, because of
the drag of  the long limbs upon the waist.  But the object is to support, with
the pillows, the back below the  breathing apparatus, to allow  the shoulders
room to fall back, and to support the head, without throwing it forward.  The
suffering of dying patients is immensely increased by neglect of these points.
And many an invalid, too weak to drag about his pillows himself,  slips his
book or anything at hand behind the lower part of his back to support it. 
LIGHT.                     537
direct sun-light  they want.   I had rather have the poAver
of carrying my patient about after the sun, according to
the aspect of the rooms, if circumstances permit, than let
him linger in a room Avhen  the sun is off.   People  think
the effect is upon the  spirits only.  This is by no means
the case.  The sun  is not only a painter but a sculptor.
You admit that he does the photograph.  Without  going
into any scientific exposition, we must admit that light
has  quite as real  and tangible  effects upon the human
body.   But this is not all.   Who has not observed  the
purifying effect of light, and especially of direct sunlight,
upon the air of a room?  Here is an observation within
every body's experience.   Go into a room where the shut-
ters are  ahvays shut (in a sick room or a bed-room there
should never be shutters shut), and though the room be
uninhabited, though the air has  never been polluted by
the breathing of human beings, you Avill observe a  close,
musty smell of corrupt air,  of air i. e. unpurified by the
effect  of the sun's rays.  The mustiness of dark rooms
and corners, indeed, is proverbial.  The cheerfulness of a
room, the usefulness  of light in  treating  disease, is  all-
important.
  A very high authority in hospital construction, has said
that people do not enough consider the difference betAveen
wards and dormitories in planning their buildings.   But
I go farther, and say, that healthy people never remember
the  difference  betAveen  bed-rooms and sick rooms,  in
making arrangements for the sick.  To a sleeper in health
it  does not signify what the view is from his bed.  He
ought never to be in it  excepting when  asleep, and at
night.   Aspect does not very much signify either (provi-
ded the sun reach his bed-room some  time in every day,
to purify the air), because he ought never to be in his bed-
room except during the hours when there is no sun.   But
the case is exactly reversed  Avith the sick, even should
they be  as many hours out of their  beds  as you are in
yours, which probably  they are not.  Therefore, that they 
»
538                     LIGHT.

Bhould be able, without raising themselves or turning in
bed, to see out of window from their beds, to see sky and
sunlight  at  least, if yon can show them  nothing else, I
assert to  be, if  not of the very first importance for recov-
ery, at feast something very near it.  And you should
therefore look to the position of the beds of your sick one
of the very first things.  If  they can see out of two Avin-
doAvs  instead  of one,  so  much the better.  Again, the
morning sun and the i lid-day sun—the hours Avhen they
are quite certain not  to be up, are of more  importance to
them, if  a choice must be made, than the  afternoon sun.
Perhaps you can take them  out of bed in the afternoon
and set them by the window, where they can see the sun.
But the  best rule is, if possible, to give them direct sun-
light from the moment he rises till the moment he sets.
  Another great difference  between the  bed-room and
the sick-room, is, that the sleeper has a very large balance
of fresh air  to  begin with, Avhen  he begins the night, if
his room has been open all day,  as it ought to be; the sick
man has  not, because  all day he has been breathing the
air in the same room, and  dirtying it by the emanations
from  himself!  Far more care  is  therefore necessary to
keep up a constant change of air in the sick room.
  It is hardly necesssary to add, that there are acute cases
(particularly a few ophthalmic  cases, and  diseases, where
the eye is morbidly  sensitive),  where a  subdued light is
necessary.  But a dark north room is inadmissible even
for these.  You can ahvays  moderate the light by blinds
and curtains.
  Heavy, thick,  dark window or bed  curtains  should,
however, hardly ever be used for any kind of sick in this
country.   A light white curtain at the  head of the bed,
is, in general, all that is necessary, and  a green  blind to
the windoAV, to be drawn doAvn only when necessary.
  One of the greatest observers  of human  things (not
physiological), says, in another language, " Where there is
sun there is thought."  All physiology goes to confirm 
CLEANLINESS OF ROOMS AND WALLS.        539
 this.  Where  is the shady side of deep valleys, there is
 cretinism.  Where are  cellars and the unsunned sides of
 narrow streets, there is the degeneracy and weakliness of
 the human race—mind and body equally  degenerating.
 Put the pale, withering plant, and human being, into the
 sun, and, if not too far gone, each will recover health and
 spirit.
   It is a curious thing to observe how almost all patients
 lie with their  faces turned to the light, exactly as plants
 ahvays make their way toward the light;  a patient will
 even complain that it gives him pain " lying on that side."
 "Then Avhy do you lie on that side ?"  He does not know;
 but we do.  It is because it is the side toward the Avindow.
 A fashionable  physician has recently published in a gov-
 ernment report that he ahvays  turns his patients' faces
 from the light.  Yes, but nature is stronger than fashion-
 able physicians, and depend  upon it, she turns the faces
 back and toward such light as she can get.  Walk through
 the wards of a hospital, remember the bedsides of private
 patients you have seen, and count how many  sick you
 ever saw lying Avith  their faces toAvard the  Avail.

     CLEANLINESS OF ROOMS AND  WALLS.

   It can not be necessary to  tell  a nurse that she should
 be clean, or that she  should  keep her patient  clean—see-
 ing that the greater part of nursing consists in preserving
 cleanliness.  No ventilation  can  freshen a room or ward
 Avhere the most scrupulous cleanliness is not observed.  Un-
 less the wind  be  blowing through  the  windows at the
 rate of twenty miles an hour, dusty  carpets, dirty Avain-
 scots, musty curtains and furniture, Avill infallibly produce
 a close  smell.   I have lived in a large and expensively
furnished London house, where the only  constant inmate
in two  very lofty rooms,  with  opposite windows, was
myself; and  yet,  owing to  the  above-mentioned dirty
circumstances, no opening  of windows  could  ever keep 
540         CLEANLINESS OF ROOMS AND WALLS.
those  rooms  free  from  closeness; but the  carpet  and
curtains having been turned out of the  rooms altogether,
they  became  instantly as fresh  as could  be  wished.  It
is pure nonsense  to say that in London a room can not
be  kept clean.  Many of  our hospitals  sIioav the exact
reverse.
  But  no particle of dust  is  ever  or can  ever be re-
moved or really got rid of by the present system of dust-
ing.  Dusting in  these days means  nothing  but flapping
the dust  from one part  of the room  on to another with
doors  and  windoAvs  closed.   What  you  do  it for I can
not think.   You  had  much better  leave  the dust alone,
if you  are  not going  to  take it  away altogether.  For,
from the time a room begins to be a room up to the time
when  it ceases to  be one, no  one atom of dust ever ac-
tually leaves its precincts.  Tidying a  room  means noth-
ing now but removing a  thing from one place, which it
has kept clean for itself, on to another and a dirtier one. *
Flapping by  way  of cleaning is  only admissible  in the
case of pictures, or anything made  of paper.  The only
way I  know to remove  dust, the  plague of all  lovers of
fresh air, is to Avipe every  thing Avith a damp  cloth.  And
all  furniture  ought  to be so  made  as that it may be
wiped  Avith  a damp cloth Avithout injury to itself,  and
so polished  as that it may be damped without  injury to
others.  To  dust  as it is iioav practised, truly means to
distribute dust more equally OArer  a  room.

  * If you like to clean  your furniture by laying out your clean clothes upon
your dirty chairs or sofa, this is one way certainly of  doing it.  Having wit-
nessed the  morning process called "tidying the room,"  for  many years, and
with ever-increasing astonishment, I can  describe what it is. From the
chairs, tables, or sofa, upon which  the "things" have lain during the night
and which are therefore comparatively clean  from dust  or  blacks, the poor
"things" having "caught" it, they are removed to other chairs, tables, 6ofas,
upon which you could  write your name with  your finger in  the dust or
black.   The other side of the "things" is therefore now evenly  dirtied or dusted.
The housemaid  then flaps everything, or some things, not out of her reach,
with a thing called a duster; the dust flies  up, then re-settles more equally
then it lay before the operation. The room has now been "put to rights." 
CLEANLINESS  OF ROOMS  AND WALLS.         541
   As to floors, the only really clean floor I  know is the
 Berlin lackered floor, which is wet rubbed and dry rubbed
 every morning to remove the  dust.   The  French par-
 quet is ahvays  more or  less  dusty, although infinitely
 superior in point of  cleanliness and  healthiness to  our
 absorbent  floor.
   For a sick room, a carpet  is perhaps the worst  expe-
 dient Avhich could  by any possibity have been invented.
 If you must have a  carpet, the only safety is  to take it
 up tAvo  or three times  a  year, instead of once.  A dirty
 carpet literally infects the room.  And  if you consider the
 enormous  quantity of organic  matter from the feet of
 people coming in, which must  saturate it, this is by no
 means surprising.
   As for walls, the worst  is the papered Avail; the next
 AArorst is plaster.  But  the plaster  can be redeemed by
 frequent lime-washing; the paper  requires  frequent re-
 neAving.   A glazed  paper  gets  rid of a  good  deal  of
 the danger.  But the ordinary bed-room paper is all that
 it ought not to be. *
   The close connection betAveen ventilation  and cleanli-
 ness is shoAA7n in  this.  An  ordinary light paper aa7H1 last
 clean much longer if there  is an Arnott's ventilator in the
 chimney, than it otherwise would.
   The best Avail  noAv extant is  oil  paint; from this  you
 can Avash  the animal  exuvise. f
   These  are what make a room musty.
   The best wall for  a sick-roo'm or ward  that could be
 made is  pure white  non-absorbent  cement  or glass, or
 glazed tiles, if they Avere made sightly enough.
  * I am sure that a person who has accustomed her senses to compare atmo-
 spheres proper and improper, for the  sick and for children, could tell, blind-
 fold, the difference of the air in old painted and in  old papered rooms—
 coeteris paribus.  The latter will always be dusty, even with all the windows
open.
  t If you like to wipe your dirty door, or some portion of your dirty wall
by hanging up your clean gown  or shawl against it on a peg, this is one way
certainly, and the most usual way, and generally the only way, of cleaning
either door or wall in a bed-room ! 
542        CLEANLINESS OF ROOMS AND  WALLS.
  Air can be soiled just  like water.  If you  blow into
water you will soil it Avith  the  animal matter from your
breath.   So it is with air.  Air is ahvays soiled in a room
where walls and carpets are saturated Avith animal exha-
lations.
  Want  of  cleanliness, then, in  rooms and wards,  which
you  have to guard against, may arise in three Avays.
  1.  Dirty air coming  in from without, soiled by sewer
emanations, the evaporation from dirty streets, smoke,
bits of unburnt fuel, bits of straw, bits of horse dung.
  If people Avould but  cover the outside walls of their
houses with plain or encaustic tiles, what an incalculable
improvement would there be in light, cleanliness, dryness,
Avarmth,  and consequently economy.  The play  of a fire-
engine would then effectually w7ash the outside of a house.
This kind of walling would  stand next to paving in im-
proving the health of towns.
  2.  Dirty air coming from  within, from dust, which you
often displace, but never remove.  And  this recalls what
ought to be a sine  qua non.   Have as feAV ledges in your
room or Avard as possible.  And under no pretence have
any ledge whatever out of sight.  Dust accumulates there,
and will  never be wiped off.  This is a certain way  to soil
the air.   Besides this, the animal exhalations from your
inmates saturate your furniture.  And if you never clean
your furniture properly, how can  your rooms or  wards
be anything but musty?  Ventilate as  you please, the
rooms -will never be sAveet.  Besides  this, there  is a con-
stant degradation, as it is called, taking place from  every-
thing except polished or glazed articles, e. g., in colouring
certain green papers arsenic is used.  Noav in the very
dust even, which is lying about in rooms hung with this
kind of green paper, arsenic has been distinctly detected.
You see your dust is anything but harmless; yet you will
let such  dnst  lie about in ledges  for  months, your rooms
for ever.
   Again, the fire fills the room with coal-dust. 
CLEANLINESS OF ROOMS AND WALLS.
543
 * 3. Dirty air coming from the carpet.  Above all, take
care of  the carpets, that the animal dirt left there by the
feet of  visitors does not  stay there.  Floors, unless the
grain is filled up and polished, are just as bad.  The smell
from the floor of  a school-room or ward, when any moist-
ure brings out the organic matter by which it is saturated,
might alone be enough to warn us of the mischief  that is
going on,
  The outer air, then, can only be kept clean by sanitary
improvements, and by consuming smoke.   The expense
in  soap, Avhich this single  improvement would save, is
quite incalculable.
  The inside air can only be kept clean by excessive care
in the ways  mentioned above—to rid the walls, carpets,
furniture, ledges,  etc., of the organic matter and  dust:—
dust consisting greatly of this organic matter—with which
they become saturated, and which is really what  makes
the room musty.
  Without cleanliness, you cannot have all the  effect of
ventilation;  without ventilation, you can have no thor-
ough cleanliness.
  Yery few people, be they of what  class they may, have
any idea of the exquisite cleanliness required in the sick-
room.   For much of what I have  said applies less to  the
hospital than to the private sick-room.  The smoky chim-
ney, the  dusty furniture, the utensils emptied but once a
day, often keep the air of the sick constantly dirty in the
best private houses.
  The well have  a curious habit of forgetting that what
is  to them but a trifling  inconvenience, to  be  patiently
"put up " with, is to the sick a source of suffering,  delay-
ing recover}7, if not actually hastening death.  The well
are  scarcely ever  more than eight hours, at  most,  in the
same room.  Some change they can al\Aray& make, if only
for a few minutes.  Even during the supposed eight  hours,
they can change  their  posture or their  position in the
room.  But the sick man who never leaves his bed, who 
544
PERSONAL CLEANLINESS.
cannot change by any movement of his OAvn his air, or his
light, or his warmth; who cannot obtain quiet, or get out
of the smoke, or the smell, or the dust; he is really pois-
oned or depressed  by what is to you the merest trifle.
  " What can't  be cured must be endured,"  is the very
worst and most dangerous maxim for  a nurse that ever
was made.  Patience and resignation in her are but other
Avords for carelessness or indifference—contemptible, if in
regard to herself;  culpable, if in regard to her sick.

          XI. PERSONAL  CLEANLINESS.

  In almost all diseases, the function of the skin is, more
or less, disordered; and in many most important diseases
nature relieves herself almost entirely by the skin.   This
is particularly the  case with children.  But the excretion,
which comes from the skin, is left there, unless removed
by Avashing or by the  clothes.  Every nurse should  keep
this  fact  constantly in mind,—for, if she alloAV her sick
to remain unwashed, or their clothing to remain on them
after being saturated with perspiration or other excretion,
she is interfering injuriously with the natural processes of
health just as effectually as if she were to give the patient
a dose of slow poison by the mouth.  Poisoning by the
skin is no less certain than by the mouth—only it is sloAver
in its operation.
  The amount of relief  and comfort  experienced by sick
after the skin has been carefully Avashed and dried, is one
of the commonest observations made at a sick bed.  But
it  must not be forgotten that the comfort  and relief so
obtained are not all.  They are, in fact, nothing more than
a sign that the vital powers have been relieved by remov-
ing something that was  oppressing  them.  The nurse,
therefore, must never put off attending to the personal
cleanliness of her patient under the plea that all that is to
be gained is a little relief, which can be quite as well given
later. 
PERSONAL CLEANLINESS.
545
   In  all Avell regulated  hospitals this  ought to be, and
 generally is, attended to.  But it is very generally neg-
 lected Avith private sick.
   Just as  it is necessary to renew the air around a sick
 person frequently, to carry off morbid effluvia from  the
 lungs and  skin, by maintaining free ventilation, so  is it
 necessary to keep the pores of the skin free  from all ob-
 structing excretions.  The object, both of ventilation and
 of  skin-cleanliness, is pretty much the  same,—to  wit,
 removing  noxious  matter from the system as rapidly as
 possible.
   Care should be taken in all the operations of sponging,
 washing, and cleansing the skin, not to expose too great
 a surface at once, so as to check the perspiration, which
 would reneAV the evil in another form.
   The various ways of washing the sick need not here be
 specified,—the less so as the doctors ought to say which is
 to be used.
   In several forms of diarrhoea, dysentery, etc., where  the
 skin  is hard and harsh,  the  relief afforded by washing
 with a great deal of soft soap is incalculable.  In other
 cases, sponging  with  tepid  soap and water, then with
 tepid water and drying with a hot towel wrill  be ordered.
   Every nurse ought to be careful to wash  her hands very
 frequently during the day.  If her face too, so much  the
 better.
   One word too as cleanliness merely as cleanliness.
   Compare the dirtiness of the Avater in which  you have
 washed when it is cold without soap, cold  Avith soap, hot
 with  soap.  You  find the first has hardly removed  any
 dirt at all, the second a little more, the third a great deal
 more.   But hold your hand over a cup of hot Avater for a
 minute or two, and then, by merely rubbing with the finger,
you will  bring off flakes  of  dirt  or dirty skin.  After a
vapour bath you may peel your whole self clean in this
way.  What I mean is, that by simply washing or spong-
ing Avith water you do not really clean your skin.  Take
         35 
546
CHATTERING HOPES AND ADVICES.
a rough  towel, dip one corner in very hot  water,—if a
little spirit be added to it it will be more effectual,—and
then rub as if you Avere rubbing the towel into your skin
Avith your fingers.  The black flakes Avhich will come off
Avill convince you that you were not clean before, however
much soap and water you may have  used.   These flakes
are AA7hat require removing.  And you can really  keep
yourself  cleaner with a tumbler of hot water and a rough
toAvel and rubbing, than with a whole apparatus  of bath
and soap and sponge, without  rubbing.  It is quite  non-
sense to say that anybody need be dirty.   Patients  have
been kept as  clean  by these  means on a long  voyage,
when a  basin full of water could not be  afforded, and
when they could  not be moved out of their berths, as if
all the appurtenances of home had been at hand.
  Washing, however, with a large quantity of water, has
quite other effects than those of  mere cleanliness.  The
skin absorbs the water and becomes softer  and more per-
spirable.   To wash with soap and soft water is, therefore,
desirable from  other points of A7iew than that of cleanli-
ness.

   XII.  CHATTERING HOPES AND ADVICES.

  The sick man to his advisers:
  " My advisers! Their name is legion.    *     *     *
Somehow or other, it seems a provision of the universal
destinies, that  every man, Woman and child, should con-
sider him, her, or itself, privileged  especially to advise me.
Why?  That is precisely what I  want to  know."  And
this is what I have to say to them.  I have been advised
to go to  every  place extant in and out of  England—to
take every kind of exercise  by every kind of cart, car-
riage—yes, and even SAving (!) and dumb-bell (!)  in exist-
ence; to imbibe every different  kind  of  stimulus that
ever has  been  invented.  And this, when those best  fitted
to kno\Ar, viz:  medical men, after  long and  close attend-
ance, had declared any journey out  of the question, had 
CHATTERING HOPES  AND ADVICES.         547
prohibited any kind of motion whatever, had closely laid
down the diet and drink.  What would my advisers say,
were they the medical attendants, and I, the patient, left
their advice,  and  took the casual adviser's?  But the
singularity in Legion's mind is this: it never occurs to
him that every  body  else is doing the  same thing, and
that I, the patient, must perforce say, in sheer self-defense,
like Rosalind, " I could not do with all."
  " Chattering Hopes " may seem an odd heading;  but I
really believe there is scarcely a greater worry which inva-
lids  have to  endure than the incurable hopes of  their
friends.  There  is  no one practice against which I can
speak  more  strongly from  actual personal experience,
wide and long, of its effects during sickness observed both
upon others and upon myself.  I would appeal most seri-
ously to  all friends, visitors, and attendants of the sick, to
leave off this practice of attempting to  "cheer" the sick
by  making light  of their danger, and  by exaggerating
their probabilities of recovery.
  Far more now than formerly does the medical  attend-
ant  tell  the truth to  the sick, who are  really desirous to
hear it about their own state.
  How intense is the  folly, then, to say the least of it, of
the friend, be  he even  a medical man, Avho thinks that his
opinion,  given  after  a cursory  observation, will weigh
Avith the patient,  against the opinion  of  the medical
attendant, given, perhaps, after years of observation, after
using every help to diagnosis afforded by the stethoscope,
the examination of pulse, tongue, etc.; and certainly after
much more obserA7ation than the  friend can possibly have
had.
  Supposing  the  patient to  be  possessed  of common
sense—how can  the favorable opinion, if it is to be called
an opinion at  all, of the casual visitor, cheer him—when
different  from that  of the experienced  attendant?   Un-
questionably the latter may, and often  does, turn out to
be wrong.  But which is most likely to be wrong? 
548           CHATTERING HOPES AND ADVICES.
   The fact is, that the  patient * is not cheered at all by
these  well meaning,  most  tiresome  friends.   On  the
contrary, he is depressed  and wearied.   If, on  the  one
hand, he exerts himself to  tell each successive member of
this too numerous  conspiracy, whose name is legion, why
he does  not  think as they  do—in what  respect  he is
Avorse—what symptoms exist that they know nothing of—
he is fatigued instead of cheered, and his attention is fixed
upon himself.  In general, patients who are really ill, do not
Avant to talk about themselves.  Hypochondriacs  do;  but
again I say, we are not on the subject of hypochondriacs.
   If, on  the  other  hand, and which is much more  fre-
quently the case, the patient says nothing, but the Shakes-
pearian " Oh!" "Ah !"  "Go to!" and, " In good sooth!" in
order to  escape from the  conversation  about himself  the
sooner, he is  depressed by want of sympathy.  He  feels
isolated in the midst of friends.   He feels what a conveni-
ence  it would be, if there were any single person to whom

  * There are, of course, cases, as in first confinements, when an assurance
from the doctor, or experienced nurse, to the frightened, suffering woman, that
there is nothing unusual in  her case, that she has nothing to fear but a few
hours' pain, may cheer her most effectually.  This is advice of quite another
order,  it is the advice of experience to utter inexperience.  But the advice
we have been referring to, is, the advice of inexperience to  bitter experience;
and, in general, amounts to nothing more than this, that you think I shall
recover from consumption  because some body knows some  body some where
who has recovered from fever.
  I have heard a doctor condemned  whose patient did not, alas! recover,
because another doctor's patient, of a different  sex, of a different age, recov-
ered from a different disease, in a different place. Yes, this  is really true. If
people who make  these comparisons did but know (only they do  not care to
know), the care and preciseness with which such comparisons require  to be
made (and are made), in  order to  be  of any value whatever, they would
spare their tongues.  In comparing the  deaths  of one hospital with those of
another, any statistics are justly considered absolutely valueless, which do
not give the ages, the sexes, and the diseases of all the cases.  It does not
seem necessary to mention this. It does not seem necessary to say that there
can be no comparison between old men with dropsies and young women  with
consumptions  Yet the cleverest men and the cleverest women are often heard
making such comparisons, ignoring entirely sex, age, disease,  place—in fact,
all the conditions  essential to the question.  It is the merest gossip. 
             CHATTERING HOPES AND ADVICES.         549

 he could  speak simply and openly, Avithout pulling the
 string upon himself of this  shower-bath  of silly  hopes
 and encouragements ; to whom he could express his Avishes
 and directions without that  person persisting in saying,
 " I hope that it Avill  please God yet to give you tAventy
 years;" or, "You have a long  life of activity before you."
 How often Ave see at the end of biographies, or of cases
 recorded  in medical papers, " After a long illness A. died
 rather suddenly," or " unexpectedly both to himself and
 to others."   " Unexpectedly "  to  others, perhaps, who did
 not see,  because  they  did  not look;  but  by  no means
 "  unexpectedly to himself," as I feel entitled to believe,
 both from the  internal evidence in  such stories, and from
 Avatching similar cases; there  was every reason to expect
 that A. would  die, and he  knew it; but he found it use-
 less to insist upon his OAvn knowledge to his friends.
   In these remarks I am alluding  neither to acute  cases
 which terminate rapidly, nor  to "nervous" cases.
   By the first much interest in their own  danger is very
 rarely felt.   In writings of fiction, whether novels or bi-
 ographies, these  death-beds  are generally depicted as
 almost seraphic in lucidity of intelligence.  Sadly  large
 has been  my experience  in  death-beds, and I can only
 say that I have seldom or never  seen such.   Indifference,
 except with  regard  to bodily suffering, or  to some duty
 the dying man desires  to perform, is  the far more usual
 state.
   The "nervous case," on the  other hand, delights in fig-
 uring to himself and others a fictitious danger.
   But the long  chronic case, who knows  too well him-
 self, and who has  been told by his physician that he will
 never enter active life again; who feels that every month
he has to  give  up something  he could do the month be-
fore—Oh! spare such  sufferers  your  chattering hopes.
You  do  not know  how you worry  and  weary  them.
Such real  sufferers can not bear to talk of themselves, still
less to hope for what they can not at all expect. 
550         CHATTERING HOPES AND ADVICES.
   So also as to all  the advice showered so profusely upon
 such sick, to leave off some occupation, to try some other
 doctor, some other house, climate, pill, powder, or specific.
 I say nothing of the inconsistency ; for these advisers are
 sure to be the same persons who  exhorted the sick  man
 not to believe his own  doctor's prognostics, because "doc-
 tors are always mistaken;" but to believe some other doc-
 tor, because "this doctor is always right."  Sure aiso are
 these advisers  to be the persons to bring  the sick  man
 fresh occupation, while exhorting him to leave his own.
  Wonderful is the face with Avhich friends, lay and medi-
 cal, will come in and worry the patient Avith recommenda-
 tions to do something or other, having just as little knowl-
 edge as to its being feasible, or  even  safe for him, as if
 they  were  to  recommend  a man to take exercise, not
 knoAving he had broken his leg.  What would the friend
 say, if he were  the  medical attendant, and if the patient,
 because some other friend had  come in—because some-
 body,  anybody, nobody, had recommended  something,
 anything, nothing, were  to disregard his orders, and  take
 that other body's recommendation?  But people never
think of this.
  A celebrated historical personage has related the com-
 monplaces  which, when on  the  eve  of  executing a re-
 markable resolution, Avere  showered in nearly the same
words by every one around  successively for a period  ot
 six months.  To these the personage  states that it was
found  least  trouble always to reply the same thing, viz.,
that it could not be supposed that such a resolution had
been taken without sufficient previous consideration.   To
patients enduring  every day for years, from every friend
 or acquaintance, either  by  letter or viva  voce, some  tor-
ment of this kind, I would suggest the same answer.  It
would indeed be spared, if such friends and acquaintances
would but consider for a moment, that it is  probable the
patient has  heard such  advice at least fifty times before,
 and  that, had  it been practicable, it would  have  been 
           CHATTERING HOPES  AND ADVICES.          551

practised long ago.  But of such consideration there ap-
pears to be no chance.  Strange, though true, that people
should be just the same in these things as they were a few
hundred years ago!
  To me these  commonplaces, leaving  their smear  upon
the cheerful, single-hearted, constant  devotion  to  duty,
which  is so often seen in the decline of such sufferers, re-
call the slimy trail left by the snail on the sunny southern
garden wall loaded with fruit.
  No  mockery in the  world  is so hollow as  the adAdce
shoAvered upon  the  sick.  It  is of no use for  the sick to
say anything; for what the adviser wants is, not to know
the truth about the state  of  the patient, but to  turn what-
ever the sick may say to the  support  of his  own  argu-
ment, set forth, it must be repeated, without any inquiry
whatever into the patient's real condition.   "But it would
be  impertinent  or indecent in me to make such an in-
quiry," says the adviser.  True; and how much more im-
pertinent is  it  to give your advice Avhen you can know
nothing about the truth,  and admit you could not inquire
into it.
  To nurses I say, these are the visitors who do your pa-
tient harm.  When  you hear  him told, 1. That he has
nothing the matter with him, and that he Avants cheering.
2. That he is committing suicide, and that he wants pre-
venting.  3.  That he is the  tool of somebody Avho makes
use of  him for  a purpose.   4.  That he will listen to no-
body, but is  obstinately bent upon his OAvn way; and, 5.
That he ought to be called to a sense of duty,  and is fly-
ing in  the  face of Providence—then knoAV that your pa-
tient is receiving all the injury  that  he can receive from a
visitor,
  How little  the real sufferings of illness are  knoAvn  or
understood.  Hoav little does  any one  in good health
fancy him or even Aerself into the life  of a sick person.
  Do, you who  are about the  sick or who visit the sick,
try and give  them pleasure, remember to tell them  what 
552
CHATTERING HOPES AND ADVICE.
will do so.  How often in such visits the sick  person has
to do the Avhole conversation, exerting his OAvn imagina-
tion  and memory,  while you  would  take  the  visitor,
absorbed in his OAvn anxieties, making no effort of mem-
ory or imagination,  for the sick person.  "Oh!  my dear,
I have  so much to  think of, I  really forgot to tell him
that; besides,  I thought he would know  it,"  says the
visitor to another friend.   How could "he  know it?"
Depend upon it, the people who say this are really those
who have little "to think of."  There are many burthened
with business who ahvays manage to keep a pigeon-hole
in their minds, full of things to  tell  the  "invalid."
  I do not say, don't tell him your anxieties—I believe it
is good for him and good for you too; but if you tell
him what is anxious, surely you can remember to tell him
what is pleasant, too.
  A sick person does so enjoy hearing  good news; for
instance,  of a  love  and  courtship, while  in  progress to
a good  ending. If  you tell him only when the marriage
takes place, he loses half the pleasure, which  God knows
he has  little enough of; and ten  to one  but you have
told him of some love-making Avith a bad ending.
  A sick  person  also  intensely enjoys hearing  of any
material  good, any  positive  or practical  success  of the
right.   He has so much  of books and  fiction, of princi-
ples, and  precepts,   and theories; do, instead  of advising
him Avith advice he  has heard  at least  fifty times before,
tell him of one benevolent act wdiich has really succeeded
practically—it  is like a day's health to him. *
  You have no idea what the craving of sick with undi-
minished poAver of  thinking, but little power of doing, is
to hear of good practical action, Avhen they can no longer
partake in it.

  * A small pet animal is often an excellent companion for the sick, for 'ong
chronic cases especially.  A pet bird in a cage  is sometimes the only plef ure
of an invalid confined for years to the same room. If he can feed and o in
the animal himself, he ought always to be encouraged to do so. 
CHATTERING HOPES AND ADVICE.          553
   Do observe these things with the sick.  Do remember
hoAV their life  is to them disappointed and incomplete.
You see them lying there with miserable disappointments,
from Avhich they can have  no escape but death, and you
can't remember to tell them of Avhat would give them so
much pleasure, or at least an hour's variety.
   They  don't want you  to be  lachrymose and whining
with them, they like you to be fresh and active and inter-
ested, but they can not  bear  absence of mind, and they
are so tired of the advice and preaching they receive from
every body, no matter whom it is, they see.
   There is no better society than babies  and sick  people
for one another.  Of course you must manage this  so that
neither shall suffer from it, which is perfectly possible.  If
you think the air of the sick room bad for the baby, why,
it is bad for the invalid too, and, therefore, you  will of
course correct it for both.  It  freshens up a sick person's
Avhole mental atmosphere to see " the baby."  And a very
young child, if unspoiled, will generally adapt itself avou-
derfully  to the ways of a sick  person, if the  time they
spend together is not too long.
   If you know hoAV unreasonably sick people suffer from
reasonable causes of distress, you would take more pains
about all these things.  An infant laid  upon the sick bed
will do the sick person, thus suffering, more good than all
your logic.  A piece of good neAvs Avill do the same.  Per-
haps you are afraid of disturbing him.  You say there is
no comfort  for his  present cause of affliction.  It is per-
fectly reasonable.  The distinction is this, if he is obliged
to act, do not disturb him Avith another subject of thought
just yet; help him to  do what  he wants to do;  but, if he
has done this, or if nothing can be done, then disturb him
by all means.  You will relieve, more effectually,  unrea-
sonable suffering from reasonable causes by telling him
the news, showing him " the baby," or giving him some-
thing new to think of, or to look at, than by all the logic
in the world. 
554
OBSERVATION OF THE SICK.
  It has been very justly said  that the sick are like chil-
dren in this, that there is no propcrtion in events to them.
Noav, it is  your  business, as their visitor, to restore this
right proportion for them—to show  them what the rest
of the world is doing.   How  can  they find it  out other-
Avise?   You Avill find them  far more  open to  conviction
than children in this.  And you will find that their unrea-
sonable intensity of suffering from unkindness,  from want
of sympathy,  etc., will disappear with  their  freshened
interest in the big world's events.   But then you must be
able to give them real interest, not gossip.


       XIII.  OBSERVATION OF THE SICK.

  There  is  no more silly or  universal question scarcely
asked than this:  " Is he better?"   Ask it of the medical
attendant, if you please.   But of whom  else, if you wish
for a real answer to  your question, would you ask?  Cer-
tainly not of the casual visitor; certainly not of the nurse,
while the nurse's observation  is  so little exercised  as it is
noAv.   What you want are facts, not opinions—for who can
have any opinion of any value as to whether the patient is
better or worse, excepting the constant medical attendant,
or the really observing nurse?
  The most important practical  lesson that can be given
to nurses, is to teach them  what  to observe—how to ob-
serve—what symptoms indicate improvement—what the
reverse—which  are  of importance—which are of  none—

  NoTH.—There are two classes of patients which are unfortunately becoming
more common every day, especially among women of the richer orders, to
whom all these remarks are pre-eminently inapplicable. 1. Those who make
health an excuse for doing nothing, and  at the same time allege that the being
ableto do nothing is their only grief.  2. Those who have brought upon them-
selves ill-health by over pursuit of amusement, which they and their friends
have most unhappily called  intellectual  activity.  I scarcely know a greater
injury that can be inflicted, than the advice too often given to the first class to
"vegetate," or than the admiration too  often bestowed on the latter class for
" pluck." 
OBSERVATION OF THE SICK.              555
 which are the evidence of neglect—and of what kind  of
 neglect.
   All  this  is what ought to make part, and an essential
 part,  of the  training of  every nurse.  At  present, how
 few there are, either professional  or  unprofessional, who
 really  know at  all  whether  any sick person they may  be
 with, is better or worse.
   The vagueness and looseness  of the information one
 receives in ansAver  to that  much abused question, "Is  he
 better ?"  Avould be ludicrous, if it Avere  not painful.   The
 only sensible  answer (in the present  state  of knowledge
 about sickness) would be, " How can I know ?   I can not
 tell how he was when I Avas not with him."
   I can record but a few specimens of the answers* which

  * It is a much more difficult thing to speak the truth than people commonly
 imagine. There is the want of observation simple, and the want of observa-
 tion compound, compounded, that is, with the imaginative faculty.  Both
 may equally intend to speak the truth.  The information of the first is simply
 defective.  That of the second is much more dangerous.  The  first gives, in
 answer to a question asked about a thing that has been before his eyes per-
 haps for years, information exceedingly imperfect, or  says, he does not know
 He has never observed.  And people simply think him stupid.
  The second  has observed just as little, but imagination immediately steps
 in, and he describes the whole thing from imagination merely, being perfectly
 convinced all the while that he has seen or heard it; or he will repeat a whole
 conversation, as if it were information which had  been addressed to him;
 whereas it is merely what he has himself said to some body else.  This is the
 commonest  of all.   These people do not even observe that they have  not
 observed, nor remember that they have forgotten.
  Courts of justice seem to think that any body can  speak " the whole truth,
 and nothing but the truth," if he does but intend it.  It requires many facul-
 ties combined of observation and memory to speak "the whole truth!" and to
 say " nothing but the truth."
  " I knows I fibs dreadful; but  believe me, Miss, I never finds out  I have
 fibbed until they tells me so,"  was a remark actually  made.  It is also one of
 much more extended application than most people have the least idea of.
  Concurrence of testimony, which is so often adduced as final proof, may
prove nothing more,  as  is well  known to  those accustomed to deal with
the unobservant imaginative, than that one person has told his story a great
many times.
  I  have heard thirteen persons concur in declaring that a fourteenth, who
had never left his  bed, went to a  distant chapel every morning at seven
o'clock. 
556
OBSERVATION OP  THE SICK.
I have heard made by friends and nurses, and accepted by
physicians and surgeons at the very bedside of the patient,
who could have contradicted every word, but did not—
sometimes from amiability, often from shyness, oftener from
languor!
  " Hoav  often have  the bowels acted,  nurse ?"   " Once,
sir."  This generally means that  the  utensil has been
emptied once, it having been used perhaps seven or eight
times.
  " Do you think the patient is  much weaker than he Avas
six Aveeks ago ?"   " Oh no, sir; you know it is very long
since he has been up and dressed, and he  can get across
the room noAV."  This means that  the  nurse has not ob-
served that, whereas, six weeks ago, he  sat up and occu-
pied himself in bed, he now  lies still doing  nothing; that,
although  he can "get across the room," he can not stand
for five seconds.
  Another patient who is eating well, recovering steadily,
although  sloAvly, from fever, but can not walk or stand,
is represented  to the  doctor as making no progress at all.
  Questions, too, as asked now (but too generallj7) of or
about patients, would obtain no information at all about
them, even if the person asked of  had every information
to give.   The  question  is generally a  leading question;
and  it is singular that people  never think what must be
the  answer to this question before they ask it;  for in-
stance, " Has  he had  a  good night ?"   Now, one patient
will  think he has had a  bad night  if he has not slept ten
hours  Avithout waking.   Another does  not think he has
a bad night if  he has had intervals  of dosing occasionally.
The same  answer has actually been given as  regarded two
patients—one  who had  been  entirely   sleepless for  five

  I have heard persons in perfect good faith declare, that a  man came to dine
every day at the house where they lived, who had never dined there once; that
a person had never taken the sacrament, by whose side they ha 1 twice, at
least, knelt at communion; that  but  one meal a day came out of a hospital
kitchen, which for six weeks they had seen provide from three to Ave and six
meals a day.  Such instances might be multiplied ad infinitum, if necessary. 
OBSERVATION  OF THE  SICK.
557
times twenty-four hours, and died of it, and another who
had not slept the sleep of a regular night without waking.
Why can not  the question  be asked, How many hours'
sleep has------had ? and at Avhat hours of the night ? *
"I  have never closed my eyes all night"—an answer as
frequently made Avhen the speaker has had several hours'
sleep as when he  has had none, Avould  then be less often
said.  Lies, intentional and unintentional, are much  sel-
domer told in answer to precise than to leading questions.
Another frequent  error  is to  inquire AA7hether one cause
remains, and not whether the effect which may be pro-
duced by a great many different causes, not inquired after,
remains.  As when it is asked, Avhether  there was noise
in the street last night; and if  there Avere  not, the patient
is reported, Avithout more ado, to have had a good night.
Patients are completely taken aback  by  these  kinds of
leading questions, and give  only the  exact amount of in-
formation asked for, even when they knoAV it  to be com-
pletely misleading.  The shyness of patien.s is seldom al-
loAved for.
  Hoav few  there  are Avho,  by five or  six pointed  ques-
tions,  can elicit the  whole  case, and  get accurately to
knoAV and to be able to report where the patient is.
  I knew a very clever physician, of large dispensary and
hospital practice, who invariably began his examination
of each patient with, "Put your finger where you be bad."
That man would never Avaste his time Avith collecting in-
accurate information from  nurse or  patient.   Leading
questions ahvays collect inaccurate information.
  At a recent celebrated  trial, the following leading ques-
tion Avas  put  successively to nine distinguished medical

  • This is important, because on this depends what the remedy will be. If
a  patient sleeps two or three hours early in the night, and then does not sleep
again at all, ten to one it is not a narcotic he wants, but food or stimulus, or
perhaps only warmth.  If, on the other hand, he is restless and awake all
night, and is drowsy in the morning, he probably wants sedatives—either
quiet, coolness, or  medicine, a lighter diet, or all four. Now, the  doctor
Bhould be told this, or how can he judge what to give ? 
558
OBSERVATION OF THE SICK.
men.  "Can you attribute these symptoms to anything
else but poison ?"  And out of the nine, eight ansAvered
" No!" without any qualification  whatever.   It appeared,
upon  cross-examination, 1. That none of them had ever
seen a case of the kind of poisoning supposed.  2. That
none of them  had ever seen a case of the kind of disease
to  Avhich the death, if not to poison, was attributable.  3.
That  none of them  were even aware of the main  fact of
the disease and condition to which the death was attribu-
table.
  Surely nothing stronger can be adduced to prove what
use leading questions are of, and what they lead to.
  I had rather not say how many instances I have knoAvn,
where, owing to this system of leading questions, the pa-
tient has died,  and  the attendants  have been actually un-
aware of the principal feature  of the  case.
  It is useless  to go through  all the particulars, besides
sleep,  in which people  have a peculiar talent for gleaning
inaccurate information.  As to food, for instance, I often
think that most common question, Hoav is your appetite ?
can only be put because the questioner believes the ques-
tioned has really nothing the matter with him, which is
very often the case.   But where there is, the remark holds
good which has been  made about sleep.  The same an-
swer Avill often be made as regards a patient who can not
take two ounces of solid food per diem, and a patient who
does not enjoy five meals a day as much as usual.
  Again, the question, How is your appetite ? is often put
when, Hoav is your digestion ?  is the question  meant.
No doubt the two things depend on one another.  But
they are quite  different.  Many a patient can eat,  if you
can only "tempt his appetite."   The fault lies in your not
having got him the thing  that he fancies.   But  many
another patient does not care between grapes and turnips,
everything is equally distasteful to him.   He would try to
eat anything which would do  him good; but everything
"makes him worse."  The  fault here  generally lies in 
OBSERVATION OF THE  SICK.           '  559
the  cooking.  It is not his  "appetite"  which  requires
"tempting,"  it is his digestion which  requires  sparing}
and good sick cookery will save the digestion half its work.
  There may be four different causes, any one of which
Avill  produce  the  same result, viz., the  patient slowly
starving to death from w7ant of nutrition:
  1. Defect in cooking.
  2. Defect in choice of diet.
  3. Defect in choice of hours for taking diet.
  4. Defect of appetite in patient.
Yet all these are  generally  comprehended  in the  one
SAveeping assertion that the  patient has "no appetite."
  Surely many lives might be saved by drawing a closer
distinction;  for the remedies  are  as diverse as the causes.
The remedy for the first is to  cook better;  for the second,
to choose other articles of diet; for the third, to watch for
the  hours when the patient  is in want of food; for the
fourth, to show him what he  likes, and  sometimes unex-
pectedly.  But no one  of these remedies will do for any
other of the defects not corresponding with it.
  I  cannot too  often repeat  that patients are generally
either too  languid to observe these things, or too shy to
speak about them; nor is it well that they should be made
to observe them, it fixes their  attention upon themselves.
  Again, I say, what is the nurse or friend there for except
to take notes of  these things,  instead of the patient doing
so ?*
  Again,the question is sometimes put,is there diarrhoea?
And the answer will be the same, whether it is just merging
into cholera, wlfether it is a trifling degree brought on by

  »It is commonly supposed that the nurse is there to spare the patient from
making physical exertion for himself—I  would rather say that she ought to be
there  to spare him from taking thought for himself.  And I am quite sure,
that if the patient were spared all thought for himself, and not spared all
physical exertion, he would be infinitely the gainer.  The reverse is gen-
erally the case in the private house.  In the hospitals it is the relief from all
anxiety, afforded by the rules of a well-regulated institution, which has often
such a beneficial effect upon the patient. 
560  •
OBSERVATION OF THE SICK.
some trifling indiscretion, which will cease the moment
the cause is removed, or whether there is no diarrhoea at
all. but simply relaxed bowels.
  It is useless to multiply instances of this kind.  As long
as  observation is  so little cultivated as it is noAv, I do
believe that  it is better  for the physician not to see the
friends of  the  patient at all.  They will oftener mislead
him than not.  And as  often by making the patient out
worse as better than he really is.
  In the case of infants, everything must depend upon the
accurate  observation of  the  nurse  or mother who has to
report.   And  how seldom is this  condition of accuracy
fulfilled.
  A celebrated  man, though celebrated  only for foolish
things, has told us that one of the main objects in the
education  of his son, was to give  him a ready habit of
accurate  observation, a certainty of perception, and that
for this purpose one of  his means was a month's  course
as follows:—he took the boy rapidly past a toy shop; the
father  and  son then described to each other as many of
the objects as they could, which they had seen in passing
the windows, noting them doAvn with  pencil and  paper,
and returning  afterwards to verify their  own  accuracy.
The boy always succeeded best, e. g., if the father described
thirty  objects, the boy did 40, and scarcely ever made  a
mistake.
  I have often thought how wise a piece of education this
would  be for much higher objects ; and in our  calling of
nurses  the thing itself is essential.   For it may safely be
said, not that# the  habit  of ready and cortect observation
will by itself make us useful nurses, but that without  it
we shall  be useless with all our devotion.
  I haA7e known a nurse in charge of a set of wards, who
not only carried in her head all the little varieties in the
diets Avhich each patient was allowed to  fix for himself, but
also exactly what each patient had taken during each day.
I have known another nurse in charge of one  single pa- 
OBSERVATION OF THE SICK.
561
 tient, who took away his  meals  day  after  day all but
 untouched, and never kneAV it.
   If you find  it helps you to note down such things on
 a bit of paper, in pencil, by all means do so.  I think it
 more often lames than strengthens the memory and obser-
 vation.   But if you cannot get the  habit of observation
 one way or other, you had better give up the being a
 nurse, for it is not your calling, however kind and anxious
 you may be.
   Surely you can learn at least to judge with the eye how
 much an  ounce of solid  food is, how much  an ounce of
 liquid.  You will  find  this helps your observation and
 memory very  much; you will then  say to  yourself, " A.
 took about an  ounce of his meat to day;" " B. took three
 times in  twenty-four hours about one-half pint of beef
 tea;" instead of saying " B. has  taken  nothing all day,"
 or " I gave A. his dinner as usual."
   I have known several of  our real old-fashioned .hospital
 " sisters," who could, as  acurately as a measuring glass,
 measure out all their patients' wine and medicine by the
 eye,  and never be Avrong.   I do not recommend this, one
 must be very sure of one's  self to  do it.  I  only mention
 it, because if a nurse can by practice measure medicine by
 the eye, surely she is no nurse who can't measure by the
 eye   about how much  food (in ounces) her  patient has
 taken. *   In hospitals those who cut up the  diet give with

  * It may be too broad an assertion, and it certainly sounds like a paradox.
 But I think in no country are women to be found so deficient in  ready and
 sound  observation  as in England, while peculiarly capable of being trained
 to it.   The French or Irish woman is too quick of perception to be so sound
 an observer—the Teuton is too slow to be so ready an observer as the  English
 woman might be.  Yet English women lay themselves open to the charge so
 often made against them by men, viz., that they are not to be trusted in hand-
 crafts to which their strength is quite equal, for want of a practised and steady
 observation.  In countries where women (with .average intelligence certainly
 not superior to that  of English women) are employed, e. g, in dispensing,
 men responsible for what these women  do (not theorizing about man's and
 woman's " mission,") have stated that they preferred the service of women to
 that of men, as being more exact, more careful, and inourring fewer mistakes
of inadvertence.
           36 
562
OBSERVATION  OF THE SICK.
sufficient accuracy, to each patient, his twelve ounces or
his six ounces of meat without weighing.   Yet a  nurse
will often have patients loathing all food and incapable of
any will to get well, Avho just tumble  over the contents of
the plate or dip the spoon in the cup to deceive the nurse,
and she will take it aAvay without ever seeing that there is
just the same quantity of food as when she brought it, and
she will tell the doctor,  too, that the patient has  eaten all
his diets as usual, when  all she ought to have meant is that
she has taken away his  diets as usual.
   Now, what kind of a nurse is this?
   I  would call  attention  to  something  else,  in  which
nurses frequently fail  in observation.  There  is a well-
marked distinction between the excitable and what I will
call  the accumulative  temperament  in patients.   One will
blaze up at once, under any shock or anxiety, and sleep
very comfortably  after  it;  another will  seem quite calm
and even torpid,  under  the same  shock, and people say,

  Now certainly Euglish women are peculiarly capable of attaining to this.
  I remember when a child, hearing the story of an accident, related by some
one who sent two girls to fetch a  " bottle of salvolatile from her room ;"
" Mary could not stir," she  said, " Fanny ran  and fetched a bottle that was
not salvolatile, and that was not in my room."
  Now this sort of thing pursues every one through life.  A woman is asked
to fetch a large new bound red book, lying on  the table by the window, and
Bhe fetches five small old boarded brown books lying on the shelf by the fire.
And this, though  she has " put that  room to rights " every day for a month
perhaps, and must have observed the books every day, lying in the same pla-
ces, for a month, if she had any observation.
  Habitual observation is more  necessary, when any sudden call arises.  If
" Fanny " had observed " the bottle of salvolatile " in the aunt's room,  every
day she was there, she would more probably have found it when  it was sud-
denly wanted.
  There are two causes for these mistakes of inadvertence.  1. A want of ready
attention ; only part of the request is heard at  all. 2. A want of the habit
of observation.
  To a nurse I would add, take oare  that you always put the same things in
the same places ;  you don't know how suddenly you may be called on some'
day to find something, and  may not be able to remember in your  haste where
you yourself had pnt it, if your memory is not in the habit of seeing the thing
there always. 
OBSERVATION OF THE SICK.
563
"He hardly felt it at all," yet you will find him some time
after  slowly sinking.  The same  remark applies to the
action of narcotics, of aperients, which, in  the one, take
effect directly, in the other  not perhaps for tAventy-four
hours.  A journey, a visit,  an unwonted  exertion,  will
affect the  one immediately, but he recovers after it; the
other bears it very  well at the time, apparently, and dies,
or is prostrated for  life by it.  People often say how diffi-
cult the excitable temperament is to manage.  I say how
difficult is  the accumulative temperament.  With the first
you have an outbreak which you  could anticipate, and  it
is all  over.  With the second you  never know where you
are—you never  know  when the  consequences are over.
And it requires your closest observation to know what are
the consequences of what—for the consequent by no
means follows immediately upon the  antecedent—and
coarse observation is utterly at fault.
  Almost all  superstitions are owing to bad observation,
to  the post hoc, ergo  propter hoc; and bad  observers are
almost all  superstitious.   Farmers used  to  attribute dis-
ease  among cattle  to witchcraft; weddings have  been
attributed to seeing one magpie, deaths  to  seeing three;
and I have heard the most highly educated, now-a-days,
draw consequences  for the sick closely resembling these.
  Another  remark: although  there is  unquestionably  a
physiognomy of disease  as well as of health; of all parts
of the body, the  face is, perhaps, the one which tells the
least to the  common observer or casual visitor.  Because,
of all parts of the  body, it is the one most exposed to
other influences  beside  health.  And  people never, or
scarcely ever, observe enough to know how to distinguish
between  the effect of exposure, of robust health,  of a
tender skin, of  a  tendency  to  congestion,  of suffusion,
flushing,  or "many other things.  Again, the face is often
the  last to show emaciation.   I should say that the hand
was a much surer test than the face, both as to flesh, color,
circulation, etc.   It is true, that there are  some diseases 
564
OBSERVATION OF THE  SICK.
 which are only betrayed at  all by something in the face,
 e. g., the eye or the tongue, as great irritability of brain
 by the  appearance of the pupil of the  eye.  But we are
 talking of  casuaj, not  minute  observation.    And feAv
 minute observers  will hesitate to say, that far  more un-
 truth than  truth,  is conveyed by the oft repeated words,
 he looks well, or ill, or better, or worse.
   Wonderful is the way in which people will go upon the
 slightest observation, or  often upon no observation at  all,
 or upon  some saw,  which the world's experience, if it
 had  any, would haA7e pronounced utterly false long ago.
   I have known patients dying of sheer pain, exhaustion,
 and  want of sleep,  from one  of the most lingering and
 painful diseases known, preserve, till within a few days of
 death, not only the  healthy color of the cheek, but the
 mottled  appearance  of  a robust child.  And scores of
 times have  I heard these unfortunate creatures assailed
 with, "I  am glad to see you looking  so well;" "I see
 no reason why you should  not live till ninety years of
 age;"  " Why don't you take  a little more exercise and
 amusement," with all other  commonplaces with  Avhich
 we are so familiar.
   There is, unquestionably,  a  physiognomy of disease.
 Let  the nurse learn it.
   The experienced nurse can  ahvays tell that a person
 has taken a narcotic the night before, by the  patchiness
 of the color about the face, when the reaction of depres-
 sion  has set in;  that  very color which the inexperienced
 Avill  point to as a proof of health.
   There is, again,  a faintness, which does not betray itself
by the color at all, or in which the patient becomes brown
instead  of white.  There is  a faintness of another kind
which, it is true, can always be seen by the paleness.
  But the nurse seldom distinguishes.  She will  talk to
the patient, who is too faint to move, without the least
 scruple, unless he  is  pale, and unless, luckily for him, the
 muscles of the throat are affected and he loses  his voice. 
OBSERVATION OF THE SICK.            565
   Yet, these tAvo faintnesses are perfectly distinguishable
 by the  mere countenance  of the patient.
   Again, the nurse must  distinguish between  the idio-
 syncracies  of patients.  One likes  to suffer out all  his
 suffering alone, to  be  as little  looked after as possible.
 Another likes to be perpetually made much of and pitied,
 and to have  some one always by him.  Both these pecu-
 liarities might be observed  and indulged much more than
 they are.   For quite as often does it happen that a busy
 attendance is forced upon the first patient, who wishes for
 nothing but to be " let alone," as that the second is left to
 think himself neglected.
   Again, I think that  feAV  things press  so heavily on one
 suffering from long and incurable illness, as the necessity
 of recording in words from time to  time, for the informa-
 tion of  the nurse, who will not otherwise see, that he can
 not do  this or that, which he could do a month or a year
 asro.  What is  a nurse there for if she can not observe
 these things for herself?  Yet I have known—and known,
 too, among those, and chiefly among those—whom money
 and position put in possession of every thing which money
 and position could give—I have known, I say, more acci-
 dents (fatal, slowly  or rapidly), arising from  this want of
 observation among nurses than from almost anything else.
 Because a patient could get out  of a warm  bath alone a
 month  ago—because  a patient  could walk  as far as his
 bell a week  ago, the nurse  concludes that  he  can do so
 now.  She has never observed the change;  and the  pa-
 tient is lost from being left in a helpless state of exhaus-
 tion, till some one  accidentally  comes  in.   And this not
 from any unexpected  apoplectic, paralytic, or fainting  fit
 (though  even these could  be expected far more, at least,
 than they are now, if we did but observe).   No, from the
 unexpected, or to be expected, inevitable, visible, calcula-
ble, uninterrupted increase  of weakness, which none need
fail to observe.
  Again, a patient not usually  confined to  bed, is com- 
566
OBSERVATION OF THE SICK.
pel led by an attack  of diarrhoea, vomiting, or other  acci-
dent, to keep his bed for a feAv days; he gets up for the
first time, and the nurse lets him go into another room,
without coming in, a few minutes afterward, to look after
him.  It never occurs  to her  that he  is quite certain to
be faint, or cold, or to want  something.   She says, as her
excuse, Oh, he does  not like to be fidgetted after.   Yes,
he said so some weeks ago;  but he never said he did not
like to be " fidgetted after," when he is in a state he is in
now;  and if he did, you ought to make  some excuse to
go in to him.  More patients have  been lost  in this way
than is at all generally known, viz : from relapse brought
on  by being left for an hour or  tAvo faint, or cold, or
hungry, after getting up for the first time.
  Yet it appears that scarcely any improvement in the
faculty of observing  is being made.  Vast  has been the
increase of knowledge  in  pathology—that  science which
teaches  us the final change produced by disease on the
human frame—scarce any  in  the  art  of observing the
signs  of the change while  in  progress.  Or,  rather, is it
not to be  feared that observation, as an essential part of
medicine, has been declining ?
  Which  of us  has  not heard fifty times, from one or
another, a nurse, or  a friend  of the sick—aye, and a medi-
cal friend too, the following remark: "So A is worse, or
B is dead.  I saw him the day before;  I thought him so
much  better;  there certainly  Avas  no appearance  from
which one could have  expected so sudden  (?) a change."
I have never heard any one say, though one would think
it  the more natural  thing, "There must  have been some
appearance, which I should have seen if I had but looked;
let me try and remember Avhat there was, that I may ob-
serve  another  time."   No; this is not Avhat people say.
They boldly assert that there was nothing to  observe, not
that their observation was at fault.
  Let people who have to observe sickness and death look
back  and try to register in  their observation the appear- 
OBSERVATION OF THE SICK.
567
ances Avhich have  preceded  relapse, attack, or  death, and
not assert  that there were none, or that  there were  not
the right ones. *
  A want of the habit of observing conditions, and an in-
veterate habit of taking averages, are each of  them often
equally misleading.
  Men w7hose profession, like that of medical  men, leads
them to observe only, or chiefly, palpable  and  permanent
organic changes, are  often just as Avrong in their opinion
of the result as those who do not observe  at all.   For in-
stance, there is a broken leg; the surgeon has only to look
at it once to know;  it will not be different if he sees it in
the morning to what it would have been  had  he seen  it
in the  evening.  And in whatever conditions the patient
is, or is likely to be, there will  still be the  broken leg,
until it is  set.  The same  with  many organic diseases.
An experienced physicician has but to feel the pulse once,
and he knows that there is aneurism which will kill some-
time or other.
   But  Avith the great  majority of cases, there is nothing
of the  kind; and  the power  of  forming any correct opin-
ion  as  to  the  result must  entirely depend upon an in-
quiry into  all the conditions in AA7hich the patient lives.
In a complicated state of society in large toAvns, death, as
every one  of great experience knoAvs,  is far less often pro-
duced by any one organic disease than by some illness,
after many other diseases, producing just  the sum of ex-
haustion necessary for death.   There is nothing so absurd,

  »It falls to few ever to have had the opportunity of observing the different
aspects which the human face  puts on at the sudden  approach of certain
forms of death by violence ; and as  it is a knowledge of little use, I only
mention it here as being the most startling example of what I mean.  In the
nervous temperament the  face becomes pale, (this is the only rocognized
effect;) in the sanguine  temperament purple ; in the bilious yellow, or every
manner of color in patches.  Now.it is generally supposed that paleness is
the one indication of almost any violent change in  the human being, whether
from terror, disease, or anything else.  There can be  no more  false observa-
tion.  Granted, it is the  one recognized livery, as I have said—de rigueur in
novels, but nowhere else. 
568              OBSERVATION OF THE SICK.
nothing so misleading as the verdict  one  so often hears :
So and  so has  no  organic  disease—there  is  no  reason
Avhy he should  not live  to extreme  old age; sometimes
the clause is  added,  sometimes  not:  Provided  he  has
quiet, good  food, good air, etc., etc.,  etc.:  the  verdict is
repeated by ignorant  people  without  the latter clause;  or
there is  no possibility  of the conditions of the latter clause
being  obtained; and  this, the only  essential part  of the
whole, is made  of no effect.  I  have heard a physician,
deservedly eminent, assure  the  friends of a patient of his
recovery.  'Why?    Because  he had   now  prescribed   a
course, every detail of which the patient had folloAved  for
years; and because  he had forbidden a  course which the
patient could not by any possibility alter. *

  * I have known two cases, the one of a man who intentionally and repeat-
edly displaced a dislocation,  and was  kept and petted by all  the  surgeons ;
the other of one who was pronounced to have nothing the matter with him,
there being no organic change perceptible, but who died within the week.  In
both these cases it was the nurse, who, by accurately  pointing out what she
had accurately observed, to the doctors, saved the one case from persevering
in a fraud, the other from being discharged when actually in a dying state.
  I will even go further and say, that in diseases which have their origin in
the feeble or irregular  action of some function, and  not in organic change, it is
quite an accident if  the doctor, who sees the case only once a day, and gen-
erally at the same time,  can  form any but a  negative idea of its real condi-
tion.  In the middle of  the  day, when such  a patient has been refreshed by
light and air, by his tea, his  beet-tea, and his brandy, by hot bottles to his
feet, by being washed and by clean linen, you can scarcely believe that he is
the same person as lay with a rapid fluttering pulse, with puffed eyelids, with
short breath, cold limbs, and  unsteady hands, this  morning.  Now, what is a
nurse to do in such a case ?   Not cry, " Lord,  bless you, sir, why you'd have
thought he were a dying all night."  This may be true, but it is not the way
to impress with the truth a doctor, more capable of forming a judgment from
the facts, if he did but know them, than you are.  What he wants is not your
opinion, however respectfully given, but  your facts.  In  all diseases it is im-
portant, but in diseases which do not run a distinct and fixed course, it is  not
only important, it is  essential, that the facts the nurse  alone  can observe
should be accurately observed, and accurately reported to the doctor.
  I must direct the nurse's attention to the extreme variation there is not un-
frequently  in the pulse of such patients during the day.  A very common case
is this : Between 3 and 4 A.  M., the pulse becomes qnick, perhaps 130, and so
thready it is not like a pulse at all, but like a  string vibrating just underneath 
OBSERVATION OF  THE SICK.
569
   Undoubtedly a person of no scientific knoAvledge what-
ever, but of observation  and experience in these kinds of
conditions, will be able to arrive at  a much truer guess as
to the  probable  duration of life  of members of a family
or  inmates of  a house, than  the most scientific physician
to  whom  the  same  persons are  brought  to  have  their
pulse felt;  no inquiry being made into their  conditions.
   In Life  Insurance, and such like societies,  Avere  they,
instead  of haA'ing  the  person examined by the  medical
man, to  have the houses, conditions, ways of life, of  these
persons examined, at  how much truer results  would they
arrive!  W. Smith appears a fine hale  man, but it might
be known  that the next cholera epidemic he runs a bad


the skin.  After this the patient gets no more sleep.  About  midday the pulse
has come down to 80 ; and though feeble and compressible, is a very respect-
able pulse.  At night, if the patient has had a day of excitement, it is almost
imperceptible.  But, if the patient  has  had a good  day,  it  is stronger and
steadier, and not quicker than at midday.  This is a common history of a
common pulse ; and others, equally varying during the day, might be given.
Now, in inflammation, which may almost always be detected by the pulse, in
typhoid  fever, which is accompanied by the low pulse that nothing will raise,
there is no such great variation ; and doctors and nurses become accustomed
not to look for it.   The doctor indeed cannot.  But the variation  is in itsell
an important feature.
  Cases like the above often "go off rather suddenly," as it  is called, from
some trifling ailment of a few days, which just makes up the  sum of exhaus-
tion necessary to produce  death. And everybody cries, Who would have
thought it ? except the observing nurse, if there is one, who had  always ex-
pected the exhaustion to come, from which there would be  no rally, because
she knew the patient had no capital in strength on which to  draw, if he failed
for a few days to make his barely daily income in sleep and nutrition.
  I have often seen really good nurses distressed, because they could not im-
press the doctor with the real danger  of their patient; and quite provoked be-
cause the patient " would look"  either " so much better" or " so much worse"
than he really is "when the  doctor was there." The distress is very legiti-
mate, but it generally arises from the nurse not having the power of laying
clearly and shortly before the doctor  the facts  from which  she  derives her
opinion, or from the doctor being hasty and inexperienced, and not capable of
eliciting them.  A man who really cares for his patients will soon learn to ask
for and appreciate the information of a nurse, who is at once a careful ob-
server and a clear reporter. 
570
OBSERVATION OF THE SICK.
chance.  Mr. and  Mrs. J. are a strong, healthy couple,
but it might be known that they live in such a house, in
such a part of London, so near the river that they will
kill four-fifths of their children: which of the children
will be the ones to survive might also be known.
  Averages again  seduce  us  away from minute observa-
tion.  "Average mortalities" merely tell that so many per
cent, die in this town, and so many in that, per annum.
But whether A-or B will be among these, the "average
rate" of course does not tell.   We knoAV, say, that from
twenty-two to twenty-four per thousand will die in Lon-
don next year; but miuute inquiries into  conditions en-
able us  to  know that in  such a district, nay, in such a
street, or even on one  side of that street, in such a par-
ticular house, or even on one floor of that particular house,
will be the excess of  mortality, that is, the person will die
who ought not to have died before old age.
  Now, would it not very materially alter the opinion of
whoever were endeavoring to  form one, if he knew that
from that  floor of that house, of that street,  the man
came?
  Much more precise might be our observations even than
this, and much more correct our conclusions.
  It is well known that the same names may be  seen con-
stantly recurring  on workhouse books for generations;
that is, the persons were born  and brought up, generation
after generation, in the conditions  which make paupers.
Death and disease are like the workhouse, they take from
the same family, the same house, or, in other words, the
same conditions.  Why will we not observe  what they
are?
  The close observer may safely predict that such a family,
whether its members marry or not, will become extinct;
that such another will degenerate morally  and physically.
But who learns the  lesson ?  On the contrary, it may be
well known that the  children  die in such a house  at the
rate of eight out of ten;  one would think that nothing 
OBSERVATION OF THE  SICK.
571
 more need be said; for how could Providence speak more
 distinctly ? yet nobody listens, the family goes on living
 there till it dies out, and  then some other family takes  it.
 Neither would they listen "if one rose from the dead."
   In dwelling upon the vital importance of sound observa-
 tion, it must never be lost sight of what observation is for.
 It is not for the sake of piling up miscellaneous informa-
 tion or curious  facts, but for the sake of saving fife and
 increasing health and comfort.   The caution may seem
 useless, but it is quite surprising  how many  men (some
 women do it  too) practically behave as  if  the scientific
 end were the only one in view, or as if the  sick body
 were but  a reservoir for  stowing medicines into, and
 the  surgical disease only a curious case the sufferer has
 made  for  the attendant's special   information.  This  is
 really  no exaggeration.   You  think, if you  suspected
 your patient was being  poisoned, say, by a copper kettle,
 you would instantly, as you ought,  cut off all possible con-
 nection between him and the suspected source of injury,
 without regard to the fact that a curious mine of observa-
 tion is thereby lost.  But it is  not every body who does
 so, and it has actually been  made  a question of  medical
 ethics, what should the  medical man do  if he suspected
 poisoning ?  The answer seems a very simple  one—insist
 on a confidential nurse being placed with the patient,  or
 give up the case.
  And remember, every  nurse  should be one who is  to
 be depended upon—in other words, capable of  being a
 "confidential" nurse.  She does  not know how soon she
may find herself placed   in  such  a situation; she must
be no  gossip, no vain talker; she  should never answer
 questions  about her  sick except  to those who have a
 right to ask them; she must, I need not say, be strictly
sober and  honest; but  more  than this,  she  must be a
religious and devoted woman;  she must have  a  respect
 for her own calling, because God's  precious gift of life  is
 aften literally placed in her hands; she must be a sound, 
572
CONCLUSION.
and  close, and quick observer; and she must be a Avoman
of delicate and decent feeling.
  To return to the question of what observation is for:
It would really seem  as  if some had considered it as its
own end, as if detection, not cure, was their  business.
Nay, more, in a recent celebrated trial, three medical men,
according to their  own  account, suspected poison, pre-
scribed for dysentery,  and left the patient to the poisoner.
This is  an extreme case; but in a small way, the same
manner of acting  falls under the cognizance of  us all.
How often the attendants of a case have stated that they
knew perfectly well that the patient could not get Avell in
such an air, in such a  room, or under such circumstances,
yet have gone on dosing him with medicine, and making
no effort to remove the poison from him, or him from the
poison which  they kneAV Avas killing him; nay, more,
have sometimes not so much as  mentioned  their convic-
tion in the right quarter—that is, to the only person who
could act in the matter.

                   CONCLUSION.

  The whole of the preceding remarks apply even more
to children and to puerperal woman than to patients in
general.   They also  apply to the nursing of  surgical,
quite as much as to that of medical cases.  Indeed, if it
be possible, cases  of  external injury require  such care
even  more  than sick.   In  surgical wards, one duty of
every nurse certainly is prevention.   Fever, or  hospital
gangrene, or purulent discharge of some kind  may else
supervene.  Has she a case  of compound fracture, of am-
putation, or of erysipelas, it may depend very much on
how she looks upon the things enumerated in these notes,
whether one or other  of these hospital diseases attacks her
patient or not  If she alloAvs her ward to become filled
with the peculiar close foetid smell, so apt to be produced
among surgical cases,  especially where there is great sup- 
CONCLUSION.                   573
puration and discharge, she may see a vigorous patient in
the prime of life gradually sink and die where, according
to all human  probability, he ought  to have recovered.
The surgical nurse must  ever be on the watch, ever  on
her guard, against Avant of cleanliness, foul  air, want of
light, and of warmth.
  Nevertheless,  let no  one think that because sanitary
nursing is the  subject of these notes, therefore, Avhat may
be called  the  handicraft of nursing, is to be undervalued.
A patient may be left to bleed to death  in a sanitar}7 pal-
ace.  Another, who can  not move himself, may  die of
bed-sores, because the nurse does not know how to change
and  clean him, while he has  every requisite of air, light,
and  quiet.  But nursing, as a handicraft, has  not  been
treated of here for three reasons: 1. That these notes do
not pretend to be  a manual  for  nursing,  any more  than
for cooking for the sick.  2. That the writer, who has
herself seen more of what may be called surgical nursing,
i. e., practical  manual nursing, than, perhaps, any  one in
Europe, honestly believes  that it is impossible  to learn it
from any book, and  that it can only be thoroughly learnt
in the wards of a hospital; and she also honestly believes
that the perfection of surgical nursing may be  seen  prac-
tised by the old-fashioned "sister" of a London hospital,
as it can  be  seen noAvhere  else  in Europe.  3.  While
thousands  die  of  foul air, etc.,  who have this surgical
nursing to perfection, the  converse is  comparatively rare.
   To revert to children.   They are much more suscepti-
ble than grown  people to all noxious influences.   They
are affected by the same things, but much  more quickly
and seriously,  viz:  by want of fresh air, of proper warmth,
want of cleanliness in house, clothes, bedding, or body, by
startling noises, improper food, or want of punctuality, by
dullness and by want of  light, by too  much or too little
covering in bed, or when up,  by want of the spirit of
management generally in those in charge of them.  One
can,  therefore, only press the  importance, as  being yet 
574
CONCLUSION.
greater in the case of children, greatest in the case of sick
children, of attending to these things.
  That which,  however, above  all,  is  known to injure
children seriously, is foul air, and most seriously at night.
Keeping the rooms Avhere  they sleep tight  shut  up,  is
destruction  to them.  And, if the child's breathing be
disordered by disease, a  feAv hours only of such foul air
may endanger its life, even Avhere no inconvenience is felt
by grown up persons in the same room.
  The following passages, taken out of an excellent "Lec-
ture on  Sudden  Death in  Infancy and Childhood," just
published, show the vital importance of careful nursing ot
children:  "In  the great  majority  of instances,  when
death suddenly befalls the infant or young child, it is  an
accident; it is not a necessary result  of any disease from
which it is suffering."
  It may be here  added, that it would  be very desirable
to know how often death is, Avith adults, " not a necessary,
inevitable result  of any  disease."  Omit the word " sud-
den " (for sudden death is comparatively rare in  middle
age), and the sentence is almost equally true for all ages.
  The folloAving  causes of  " accidental"  death in sick
children are  enumerated : " Sudden noises, Avhich startle;
a rapid change of temperature, which chills the surface,
though only for a moment; a rude  awakening from sleep,
or even  an  over-hasty or over-full meal;" " any sudden
impression on the  nervous  system ; any hasty alteration
of posture;  in  short, any cause  whatever by which the
respiratory process may be disturbed."
  It may again be added,  that, with very weak adult
patients, these causes are also (not often " suddenly fatal,"
it is true, but), very much  oftener than is at all generally
knoAvn, irreparable in their consequences.
  Both for children and  for adults, both for sick and for
well (although  more certainly in the case of  sick children
than in any others), I would here  again repeat, the most
frequent and most fatal cause of all is sleeping, for even a 
CONCLUSION.
575
few hours, much  more for weeks and months, in foul air,
a condition Avhich, more than any other condition, dis-
turbs the respiratory process, and tends to produce " acci-
dental " death in  disease.
  I need hardly here repeat the warning against any con-
fusion  of ideas between  cold and fresh  air.  You may
chill a  patient  fatally without giving him  fresh air at
all.  And you can  quite well, nay, much  better, give him
fresh air Avithout chilling him.  This is the test of a good
nurse.
  In cases of long recurring faintness from disease, for
instance, especially disease which affects the organs of
breathing, fresh air to the  lungs, warmth to the surface,
and  often (as soon as the patient can swallow), hot drink;
these are the 'right remedies and the only ones.  Yet,
oftener than not,  you see the nurse or mother just revers-
ing this; shutting up  every cranny through which fresh
air  can enter, and leaving the  body cold, or perhaps
throwing a greater weight of clothes  upon  it, when
already it is generating too little heat.
   " Breathing carefully,  anxiously, as  though respiration
were a function  which  required  all the  attention for its
performance," is  cited as  a not unusual state in children,
and as  one calling for care  in all the things enumerated
above.  That breathing becomes an almost voluntary act,
even in grown up patients who are very weak, must often
have been  remarked.
  "Disease having interfered with the perfect accomplish-
ment of the respiratory function, some  sudden demand
for its  complete  exercise, issues in the sudden stand-still
of the whole machinery," is given as  one process—" life
goes out  for  want of nervous power to  keep the vital
functions in activity," is  given as  another, by Avhich " ac-
cidental" death is most .often brought to pass in infancy.
  Also, in middle age, both these processes  may be seen
ending in death, although generally not  suddenly.  And 
576
CONCLUSION.
[ have seen, even  in middle  age, the " sudden stand-still"
here mentioned, and from the same causes.
   To  sum  up:  the answer  to  two  of  the commonest
objections ujjged,  one by women themselves, the  other
by men, against the desirableness of sanitary  knowledge
for women, plus a caution, comprises the whole  argument
for the art of nursing.
   (1.)  It is  often said by men, that  it  is umvise to teach
women any thing about these laws of health, because they
will take to  physicking—that there  is a great deal too
much of amateur physicking as it is, which is indeed true.
One eminent  physician told me that he had  known more
calomel given, both  at a pinch and for a  continuance, by
mothers, governesses, and nurses, to  children, than  he had
ever heard of a physician prescribing in all his experience.
Another says, that women's only idea in medicine is cal-
omel  and  aperients.  This  is, undeniably, too  often the
case.   There is nothing ever seen in any professional prac-
tice  like  the reckless physicking by  amateur  females.*

  *I have known many ladies who, having once obtained a blue pill prescrip-
tion from a physician, gave and took it as a common aperient two or three
times a week—with what effect may be supposed.  In one case I happened to
be the person to inform the physician of it, who substituted for the prescription
a comparatively harmless aperient pill.   The lady came to me and complained
that it " did not suit her half so well."
  If women will take or give physic, by far the safest plan  is to send for the
doctor every time^-for I have known ladies who both gave and took physic,
who would not take the pains to learn the names of the commonest medicines,
and confounded, e. </., colocynth with colchicum.   This is playing with sharp
edged tools with a vengeance.
  There are excellent women who will write to London to their physician that
there is much sickness in their neighborhood in the country, and ask for some
prescription from him, which they used to  like themselves, and then give it
to  all their friends and to all their poorer neighbors who will take  it.  Now,
instead of giving  medicine, of which you  can not  possibly know  the exact
and proper application, nor all its consequences,  would it not be better if you
were to persuade and help  your poorer neighbors to remove the  dunghill from
before the door, to put in a window which opens, or an Arnott's ventilator, or
to cleanse and limewash the cottages ?  Of these things the benefits are sure.
The benefits of the inexperienced  administration  of medicines are by no
means so sure 
CONCLUSION.
577
But this is just Avhat the really experienced and observing
nurse does not do ; she neither physics herself nor others.
And to cultivate in  things pertaining to  health, observa-
tion and experience  in  women who are mothers, govern-
esses, or nurses, is just the way to do away  with amateur
physicking, and if the doctors did but know it, to make
the  nurses  obedient  to  them—helps to  them instead of
hindrances.   Such  education in women Avould  indeed
diminish  the doctor's work—but no one really believes
that  doctors wish that there should be  more illness, in
order to have more work.
   (2.)  It is often said by women, that they can not know
any thing of the laws  of health, or what to  do to  pre-
serve their children's health, because they  can know noth-
ing  of "pathology," or can not "dissect"—a confusion
of ideas which it is hard  to attempt to disentangle.   Pa-
thology teaches the harm  that disease has done.  But it
teaches nothing more.  We know nothing  of the princi-
ple of  health, the positive of which pathology is the neg-
ative,  except from  observation  and  experience.   And
nothing but observation and experience will teach us the
ways to maintain or to bring back the state of health.   It
is often thought that medicine is  the curative process.   It

  Homoeopathy has introduced one essential amelioration in the practice of
physic by amateur females; for its rules are excellent, its physicking compara-
tively harmless: the "globule" is the one grain  of folly which appears to be
necessary to make any good thing acceptable.  Let, then, women, if they will
give medicine, give homoeopathic medicine.  It won't do any harm.
  An almost universal error among women is the supposition that every body
must have the bowels opened once in every twenty-four hours, or must fly im-
mediately to aperients. The reverse is the conclusion of experience.
  This is a doctor's subject, and I will not enter more into it; but will simply
repeat, do not go on taking or giving to your children your abominable courses
of aperients, without calling in the doctor.
  It is very seldom, indeed, that by choosing your diet, you can not regulate
your own bowels; and every woman may watch herself to know what kind of
diet will do this; I have known deficiency of meat produce constipation, quite
as often as deficiency of vegetables; baker's  bread  much oftener than either.
Home-made brown bread will oftener cure it than any thing else.
         37 
578
CONCLUSION.
is no such thing;  medicine is the surgery o'f functions, as
surgery proper is that of limbs and organs.  Neither can
do any thing but remove obstructions ; neither can cure;
nature alone cures.  Surgery  removes the bullet out of
the limb, which is an obstruction to cure, but nature heals
the wound.  So it is with medicine—the function of an
organ becomes obstructed—medicine,  so far as we know,
assists nature to remove the obstruction, but does nothing
more.  And what nursing has  to  do  in either case, is to
put the  patient in the best condition for nature to  act
upon him.   Generally, just  the contrary  is done.  You
think fresh air, and quiet and cleanliness, extravagant,
perhaps dangerous luxuries, which should be given to the
patient only when quite convenient, and medicine the sine
qua non, the panacea.  If I  have succeeded in any mea-
sure in dispelling  this illusion, and in  showing what true
nursing is, and what it is not, my object will have  been
answered.
  Now for the caution:
  (3.) It seems a  commonly received idea among men,
and  even  among women themselves,  that  it  requires
nothing but a disappointment in love, the want of an
object, a general disgust, or incapacity for other things, to
turn a woman into a good nurse.
  This reminds one of  the parish where a stupid old man
was set to be schoolmaster because he was " past keeping
the pigs."
  Apply the above receipt for  making  a  good nurse, to
making a good servant, and  the receipt will be  found to
fail.
  Yet popular novelists of recent days  have  invented
ladies disappointed in love, or  fresh out of the drawing-
room, turning  into the war hospitals to find their wounded
lovers, and when  found, forthwith abandoning their sick
ward  for their lover, as might  be expected.  Yet, in  the
estimation of the authors, these ladies were none the worse
for that, but, on the contrary, were heroines of nursing. 
CONCLUSION.
579
  What cruel mistakes are sometimes made by benevo-
lent men and women, in matters of business, about which
they can know nothing, and think they know a great deal.
  The everyday management of a large ward, let alone of
a hospital—the knowing what are the laws of life and
death for men, and what the laws of health for wards—
(and wards are healthy or unhealthy, mainly according to
the  knowledge or  ignorance of the nurse)—are not these
matters of sufficient  importance and difficulty  to require
learning by experience and  careful inquiry, just as much
as any other art ?   They do not come by  inspiration to
the lady disappointed in love, nor to the poor workhouse
drudge hard up for a livelihood.
  And terrible  is  the injury which  has  followed to the
sick from such wild notions!
  In this respect, (and why is  it so ?) in Roman Catholic
countries,  both writers and workers are,  in  theory  at
least, far before ours.  They would never think of such  a
beginning for a good working Superior or Sister of  Char-
ity.   And many a  Superior has refused to admit a postu-
lant who appeared to have no better " vocation" or rea-
sons for offering herself than these.
  It is true we make  "no vows."  But is a  " vow" neces-
sary to convince us  that the  true spirit for learning any
art, more especially an art of charity, aright, is  not a dis-
gust to every thing or  something else?   Do  we  really
place the love of our kind (and of nursing,  as one branch
of it) so low as this  ?  What would the Mere Angelique
of Port  Royal, what would our own  Mrs.  Fry have said
to this ?

  Note.—I would earnestly ask my sisters to keep clear of both the jargons
now current every-where (for they are equally jargons); of the jargon, namely,
about the rights of women, which urges women to do all that men do, in-
cluding the medical and other professions, merely because men do it, and
without regard to whether this is the best that women can do; and of the jar-
gon which urges women to do nothing that men do, merely because they are
women, and should be  " recalled to a sense of their duty as women," and
because " this is women's work," and "that is men's," and "these are things 
580
CONCLUSION.
which women should not do," which is all assertion, and  nothing more.
Surely woman should bring the best she has, whatever that is, to the work of
Qod's world, without attending to either of these cries.  For what are they,
both of them, the one just as  much as the other, but listening to the "what
people will say," to opinion, to the voices from without ?  And, as a wise man
has said, no one has ever done any thing great or  useful, by listening to the
voices from without.
  You do not want the effect of your good things to be, " How wonderful for
a woman !" nor would you be  deterred from good  things by hearing it said,
" Yes, but she ought not to have done this, because it is not  suitable for a
woman."  But you want to do the thing that is good, whether it is " suitable
for a woman " or not.
  It does not make a thing good, that it is remarkable that a woman should
have been able to do it.  Neither does it make a thing bad, which would have
been good had a man done it, that it has been done by a woman.
  Oh, leave these jargons, and go your way straight to God's work, in sim-
plicity and singleness of heart. 
INDEX.
                           A.
Acetate of potash......,............................................. 212
Aconite................................................................. ^14
Accidents, management of........................................ -^5
iEsculapius.............................................................  I4
          temples of..................................................  I**
Adipose tissue........................................................  *>"
Ague.................................................................... 281
Air and temperature................................................. 173
Alcoholic  stimulants............................................■••• 220
Allopathic medicine..................................................  19
Alteratives..................•........................."............ 223
Amount of food required...........................................'  54
American ivy.......................................................... 225
Anatomy  and physiology................ .........>..............  42
Antispasmodics...................................................... 228
Apple-water............................................................ 241
Appearances which indicate  death., ...........................   248
Apoplexy............................................................... 253
Arsenic............................................................•.....  30
       poisoning by................................................ 249
Articulations............................................................  4<
Arterial system........................................................  73
Are you bilious........................................................ 199
Arnica .................................................................. 222
Astringents  .............................................  ............. 225
Asafoetida.........................................................;..... 228
Asthma.................................................................. 365
Asiatic cholera........................................................ 411
Attenuations of medicine...........................................  23
                           B.
Barley-water........................................................... 240
Beef-tea........... ....................................................  243 
582
INDEX.
Beef-essence......................................................•••   243
Belladonna, poisoning by............................................ 251
Bed and  bedding...................................................... 532
Bible, account of medicine in.....................  ................   14
Bilious  temperament............................................. 115
Bilious fever............................................................ 284
Blood-letting.........................................................   31
Blood...................................................................   68
      formative power of..........................................   71
      vessels..........................................................   72
Blanket-pack........................................................ 207
Black cohosh.......................................................... 225
Blackberry............................................................ 227
Bladder,  inflammation of the...................................... 438
Bones...................................................................  44
      disease of the............................................... 264
Bowels...............................................................  84
Boneset.................................................................. 197
Boils.................................................................. 270
Brain....................................................................   92
Bread-and-milk poultice........................................... 235
Brandy-and-egg........................................................ 242
Bran-gruel.............................................................. 242
Brain, concussion of................................................ 254
      inflammation of................................................ 458
Bruises.................................................................. 254
Bronchitis, acute..................................................... 356
           chronic. ................................................ 358
Bright's  disease of the kidneys.................................... 434
Butternut............................................................. 201
Burdock................................................................ 224
Burns.................................................................... 256
                            c
Calomel..................................................................   29
Care of  the feet...................................................... 169
Cathartics............................................................... 198
Castor oil............................................................ 201
Catnip............................,....................................... 203
Camphor................................................................. 221 
                          INDEX.                       ^83

 Capsicum................................................................ 221
 Catechu.................................................................. 226
 Cancer................................................................... 267
 Carbuncle.................................... ......................... 269
 Causes of fever....................................... ................. 276
 Chiran...................................................................   14
 Chloroform liniment.................................................. 232
 Chicken  broth......................................................... 244
 Chills and fever....................................................... 281
 Chicken  pox............................................................ 316
 Chronic  rheumatism................................................... 334
         laryngitis.................................................... 355
         disease of the bones..................  .................. 264
 Children, physical education of.................................... 377
 Cholera  morbus....................................................... 409
 Cholera Asiatic....................................................... 411
 Cholera-infantum.................................................... 416
 Chattering hopes and advice....................................... 546
 Citrate of magnesia................................................... 201
 Clothing................................................................*165
 Cleanliness of rooms and walls................................... 539
 Cleanliness of person................................................. 544
 Composite  structures ...............................................   50
 Comparative value of different kinds of food..................   54
 Compound temperaments........................................... 123
 Compound powder of rhubarb..................................... 200
                  of jalap..................................-....... 201
 Composition............................... .......... ............... 203
 Common  vapor-bath...................................-.............. 206
 Collinsonia.............................................................. 217
 Compound collinsonia  tonic........................................ 217
           tincture of  cajeput..................................... 221
           tincture of corydalis.................................. 224
           syrup  of stillingia..................................... 224
           syrup  of sarsaparilla................................. 224
           syrup  of lobelia....................................... 230
           tincture of  oils of  lobelia and stillingia.......... 230
Cordial neutralizing................................................... 227
Copper, poisoning by.................................... ............ 250
Concussion of  the brain............................................. 254 
581                        INDEX.

Continued fever........................................................ 292
Cold................................................... .................. 347
Consumption......................................................... 366
             cases of,.............................................. 370
             prevention of.......................................... 376
Colic.................................................................... 419
Convulsions............................................................ 450
Cranial nerves.........................................................  94
Cream of tartar....................................................... 212
Croup.................................................................... 350
       mucous...................... ................................... 350
       pseudo-membranous.......................................... 351
       spasmodic................•.................................... 352
Cuts..................................................................... 254

                            D.
Development of the body...........................................  51
Defective ventilation.................................................. 163
Derangements of dentition.......................................... 390
Delifium tremens...............................  ......................  458
Digestion, organs of...................................................  58
          in the stomach.,..........................................  61
          in the small intestines..................................  64
Diaphoretics................................................. ........  203
Diaphoretic  powder.................................................. 205
Diuretics................................................................ 210
Dietetic preparations............................. ................... 238
Directions for restoring  the apparently dead.................... 245
Dislocations........................................................... 256
Diseases and their treatment...................................... 273
Disease, general.........................................  ............  274
Diptheria ...............................(................................ 328
Diseases of  the respiratory organs................................. 344
        of the heart..........................................  ..... 388
        of the digestive organs.................................... 390
        of the liver.................................................. 401
        of the urinary  organs.................................... 428
        of the nervous  system...............................  ..... 438
Diarrhoea .......,...................................................... 405
Diabetes................................................................. 432 
                         INDEX.                      585

Dogwood................................................................ 217
        poultice...................................................... 235
Drowning................................................................ 246
Dropsy  .............................................. .................. 342
Dwellings............................................................... I60
Dyspepsia............................................................ 394
Dysentery................................. ............................. 421
                           E.
Ear...........................  ..........................................153
Electicism..............................................................•   28
Egg  and milk...........................................................  241
Egg  wine............................................................... 242
Elder..................................................................... 224
      ointment......................................................... 233
Elecampane........................................................... 231
Emetics................................................................ 195
Emetic  tartar.........................................................   30
        powder........................................................ 199
Emollients.......................... ................................. 233
Encephalic temperament.............................................  116
Enemata.................................................................  202
Epilepsy................................................................ 446
Eruptive fevers..............................................•.........  307
Exercise................................................................  177
Example.................................................................  104
Excretion..............................................................  183
Expectorants........................................................... 229
Excessive action of the liver....................................... 402
Eye.......................................................................  149
    section of...........................................................  150
                            P.
Fat.......................................................................   50
Family medicine chest...............................................  236
Farina gruel...........................................................  241
Feet, care of..........................................................  169
Felon................................................................... 271
Febricula.............................................................. 280
Fever.................................................................. 276
     bilious............................................................ 284 
586                       INDEX.

Fever congestive........................... ........... ..............  283
     continued.........................................................  292
     eruptive..........................................................  307
     intermittent.....................................................  281
     scarlet.............................................................  320
     spotted...........................................................  326
     typhoid.................. ........................................  297
     yellow.............................................................  288
Fistula in ano.........................................................  263
Fibrous tissue............................................-...........   48
Flax-seed. .............................................................  235
Flour-gruel.............................................................  243
Flux...............•....................................................  421
Food..................................................................52,169
     amount  required...............................................   54
     comparative value of..........................................   54
     for the sick.....................................................  524
Formative power of the blood.....................................   71
Fomentations............................................................  208
Fruit........................................................ ...........  172
Fractures................................................................  260
                           G.
Galen.....................................................................   16
Gallic acid..............................................................  226
Gall stones...................  ..........................................  403
Geranium.............................................................•  226
Gelseminum.......................................•••<...............  228
General disease........................................................  274
Ginger...................................................................  203
Gruel...................................................................  240
Gum Arabic water.....................................................  240
                            H.
Harvey..................................................................  17
Headache................................................................ 466
Heart ....................................................................  72
       diseases of  the............................................... 388
Hearing................................................................. 154
Hernia.................................................................. 261
Hemorrhoids.,.......................................t........•......... 262 
                          INDEX.                      587

 Hemorrhage from the lungs.,....................................... 382
 Hippocrates...............................................•••».........   15
 Homoeopathy..........................................................   21
 Honeybee............................................................... 212
 Hops.................................................................... 235
 Hot applications....................................................... 213
 Hot fomentations..................................................... 208
 Human temperaments................>.............................. 112
 Hunger................................................................  55
 Hydrastis............................................................... 216
 Hygiene........................................................ ........ 157
 Byosciamus, poisoning by.......................... ................ 252
 Hydrophobia........................................................... 453
 Hypochondriasis..................................................... 463

                            I.
 Importance of anatomy and physiology..........................   43
 Incontinence of urine............................................... 435
 Injections............................................................... 202
 Inhalations............................................................ 231
 Injuries, management of............................................ 245
 Inflammation of the lungs........................................... 361
             of the liver.......................................... 402
             of the kidneys....................................... 429
             of the bladder....................................... 436
             of the brain..-....................................... 438
Intermittent fever..................................................... 281
Introduction............................................................   13
Intestines, small.......................................................   63
          large......................................................   65
Intoxicating  liquors.................................... ............ 187
Iodide of potassium.................................................. 225
Ipecacuanha............................................................ 197
Iron..................................................................... 218

                            J.
Jaundice................................................................ 404
Jelly-water........................................................... 240
Joints......................................................,..............   47 
588
INDEX.
                           K.
Kidneys.......................................... ......................   81
        inflammation of the..........,............................ 429
        Bright's disease of the.................................. 434
                            L.
Large intestines.......................................................   65
Laryngitis, chronic................................................... 355
Laws of mental development....................................... 100
Lead, poisoning by,................................................... 250
Liniments............................................................... 232
         chloroform................................................ 232
         volatile..................................................... 232
Liver.....................................................................  66
     diseases of the................................................. 401
     complaint......................................................... 401
     inflammation of the.,.......................................... 402
     excessive  action of the....................................... 402
     torpor of the......... .......................................... 403
Light.................................................................. 536
Local baths............................................................ 208
Lobelia................................................................. 228
       Byrup of....................................................... 230
Logwood............................................................... 226
Lungs...................................................................  87
      inflammation  of the......................................... 361
      hemorrhage from the......................................... 382
Lymphatic Bystem.....................................................  91
          temperament...........,................................... 116
                             M.
Mad-Dog............................. .................................. 453
Management of the sick............................................. 494
Materials of the body................................................  43
Management of accidents and  injuries........................... 245
Malt gruel............................................................... 242
May apple............................................................... 202
Mayer's ointment...................................................... 233
Mazina.................................................................. 241
Measles................................................................ 317
Medicine, origin of.................................................   13 
                          INDEX.                       589

Medicine of the Bible...............................................   14
         systems of................................ .................   17
         allopathic...................................................   19
         attenuations of.................... .......................   23
         for family use.............................................  190
         use of....................................................  193
         chest.................  ......................................  236
Membranous croup....................................................  351
Mental  development, laws of.......................................  100
        training, youth the proper time for.....................  103
        occupation..................................................  180
Meningitis............................................................  443
Mercury, poisoning by.........................................  .....  250
Mucous croup..........................................................  350
Muscular tissue............................................. ..........   48
Mustard........................................................ ........  197
         plaster........................................................  222
Mullen...................................................................  211
Mutton broth.........................................................  243

                             N.
Nature  in the cure of diseases.....................................  191
Narcotics................................................................  215
Nervous tissue..........................r .............................   49
         system........................................................   90
               diseases of..........................................  438
Neuralgia.........................  ....................... ...........  461
Neutralizing cordial...................................................  227
Noise.....................................................................  502
Notes on nursing....................................................  471
Nurse's sore mouth...............................,...................  393
Nutrition ............................... .............................   75

                            o.
Oak bark..............................................................  226
Observation of the sick..............................................  534
Ointments..............................................................  233
         Mayer's.........,..........................................  233
         elder..............................,........................  233
Onion poultice.........................................................  236 
590                       INDEX.

Opium, poisoning by..................................................  248
Opposition to reform..................>..............................   18
Organs of special sense................................ .....*.......  149
          smell........................................................  155
          taste,........................................................  155
          touch.....................................................  156
          digestion...................................................   58
Origin of  medicine....................................................   13
          the human  being.........................................   50
                     temperaments..............................  117
Oyster soup......*......................................................  244

                             P.
Paracelsus..............................................................   16
Pancreas.................................................................   67
Panada.................................................................. 240
Parsley................................................................. 211
Pennyroyal.............................................................. 203
Petty management........ ........................................... 494
Personal cleanliness.................................................. 544
Perseverance, value  of.............................................  107
Phenomena of fever................................................... 276
              vision.................................................  151
Phrenology...........................................................   96
Phrenological chart...................................................   99
Physician, the.........................................................   35
Physiological marriage...............................................  136
Physical education of  children..................................... 377
Poisoning by opium...................................................  248
             arsnic...................................................  249
             mercury................................................  250
             copper..................................................  250
             lead...................................................  250
             strychnia......................  .......................  251
             prussic  acid..........................................  251
             belladonna..............................,............  251
             rhus....................................................  252
Piles......................................................................  262
Pleurisy...............................................................  384
        root...........................................................  208 
                           INDEX.                       591

 Pneumonia.............................................................. 361
 Podophyllin pills..................................................... 201
. Poplar................................................................... 217
 Potato poultice........................................................ 236
 Poultices.............................................................. 233
 Practice of medicine.,................................................   37
 Prevention of consumption.......................................... 376
 Primitive faculties of the  mind....................................   97
 Prickly ash............................................................. 221

                            a
 Quackery.......................................... ....................   38
 Quinine.................................................................. 217
 Quinsy...................................................*............... 348

                             R.
 Reasons for discarding  calomel.....................................   18
                       arsenic....................................   29
                       tartar emetic...........,..................   30
                       blood letting.............................   31
 Reform, opposition to................................................   18
 Remittent fever..................................... .................. 284
 Retention of  urine.................................................... 432
 Respiratory apparatus................................................   85
 Rheumatism............,............................................. 331
            chronic.................................................. 334
 Rhubarb^ compound  powder of.  ................................... 200
          syrup  of................................................... 227
 Rhus, poisoning  by.................................................. 252
 Rice gruel............................................................... 242
 Rooms,  cleanliness of................................................. 539
 Rupture ................................................................ 261

                             s.
 Sage...................................................................... 203
 Sago...................................................................... 241
 Salt, as an emetic...................................................... 197
 Sanguine temperament............,................................... 113
 Sarsaparilla........................................................... 224
 Scarlet fever............................................................ 320
 Science of physiological marriage................................. 136 
592                        INDEX.

Scrofula.......................................... ....................... 336
Secretion................................................................  77
        ,of the skin...................................................  79 .
               kidneys.............................................  81
               bowels..............................................  84
Sedatives............................................................... 213
Seidlitz powders................................ .................... 201
Self  culture............................................................ 110
Sick, observation  of the............................................ 554
Similia similibus curantur...........................................  22
Sitz bath..............................................................  308
Skeleton................................................................  48
Skin.....................................................................  79
Sleep..................................................................... 181
Slippery elm........................... ........................  ....... 235
Small  intestines........................................................  63
               digestion in........................................  64
Small  pox......................•........................................ 307
Smell.................................................................... 155
Sore mouth............................................................. 392
           nurse's..................................................... 393
Spasmodic croup.............................................. ........ 352
Spearmint.........  .................................................... 211
Special sense, organs of............................................. 149
Spinal  cord..........  ...................................................  93
       meningitis..................................................... 443
Spirit vapor bath..................................................... 206
Spleen...................................... ...........................  67
Spotted fever........................................................... 326
St. Martin, case of....................................................   62
Stillingia................................................................ 224
Stimulants............................................................... 219
Stomach..................................................................  59
Stramonium, poisoning by........................................... 251
Strychnia      "      "  ................................................... 250
Sudoriferous glands.............................................................  79
Sun stroke........................................................................ 252
Suppression of urine........................................................... 431
Surgical diseases •—............................................................. 245
Sweet  spirits of nitre......................................................... 212 
                           INDEX.                      593

 Syrup of iodide of iron....................................................... 225
         elecampane........................................................... 231
 Systems of medicine............................................................  17

                           T.
 Tannic acid........................................................................ 226
 Taking food......................................................................... 518
 Take care of the feet........................................................... 169
 Tapioca............................................................................... 241
        pudding.................................................................. 241
 Tartar emetic.......................................................................  30
 Taste................................................................................... 155
 Temples of iEsculapius...............................................-......  15
 Temperaments, human....................................................... 112
              bilious ........................................................ 115
              bilious encephalic.................................*......  129
              bilious encephalo-lymphatic.........................  124
              encephalic............•...................................... 116
              bilious lymphatic........................................  129
              lymphatic.....—........................................... 116
              origin of....................................................... 136
              compound....................................................  123
              sanguine......................................................  113
              sanguine bilious................................... 124
              sanguine bilious lymphatic...........................  131
              sanguine bilious encephalic........................  132
              sanguine bilious encephalo lymphatic..........  135
              sanguine encephalic.....................................  128
              sanguine encephalo lymphatic.....................  134
              sanguine lymphatic......................................  126
Temperature .......................................................................  173
Tincture  of aconite.............................................................  214
           veratrum..........................................................  214
           prickly ash.....................................................  220
Tissue, fibrous.....................................................................  43
       muscular.................................................................  4§
       nervous...................................................................  49
       adipose...................................................................  50
       wearing out of......................................................  76
           00 
594                        INDEX.

Toast and water..................................................................  240
Tonics.................................................................................  215
Torpor of the liver.............................................................  403
Toothache............................................................•  391
Touch........................... ....................•.................»  156
Treatment to restore the apparently dead........................  246
Tumors..................................................................  266
Typhoid fever..........................................................  297
                             u.
Ulcers....................................................................  272
Urinary aparatus......................................................   85
Urinary organs, diseases of the....................................  428
Urine, suppression of the........  ,.................................  433
      incontinence of the..........................................  435
Use of  medicine.......................................................  193
Uva ursi...................................,............................  211
                             V.
Vaccination.............................................................  313
Value of  perseverance,................... ..........................  107
Variola..................................................................  307
Varioloid...............................................................  303
Variety............................................. .....................  514
Ventilation.........................  ............................. 475,163
Veratrum ..............................................................  214
Vital tenacity.........................................................  146
Vision...................................................................  151
Volatile liniment...................................................  232

                             w.
Warm bath..............................................................  207
       footbath.......................................................  205
Warming................................. ............................  275
Water as an emetic................................,..................  196
Water  pepper............................ ............................. 203
Water melon seed...................................................... 211
Water as a poultice................................................ 234
Wearing out of tissue...............................................  76
Wet  sheet pack.......................................................  207
What food..................................!..!........!.!!.............  524 
                          INDEX.                      595

Whey................................................................ 240
Whooping cough......................................,............. 38g
Wild cherry............................................................ 217
Wild indigo ........................................................... 227
Worms................................................................... 420

                            Y.
Yellow root.......................................................    _ 216
Yellow dock......................... ..........................     _ 224
Yellow fever.....................................................    _ 288
Youth the proper time for mental training...................... 103 
 
A
FAMILIAR    TREATISE
                ON

MEDICINE:
                     BY

        JOHN M. SCUDDER, M. D.,

PROFESSOR OP THE THEORY AND PRACTICE OF MEDICINE IN THE ECLECTIC MEDICAl
  INSTITUTE, AUTHOR OF "A PRACTICAL TREATISE ON DISEASES OF WOMEN," "THE
    ECLECTIC PRACTICE OF MEDICINE," "THE ECLECTIC MATERIA MEDICA AND
        THERAPEUTICS," "ON THE USE OF INHALATIONS," ETC.
              VOLUME  II.
Midwifery,  Diseases of Women,  and Care  and  Man-
             agement of children.
TEIfTTH  EDITIOIST.
              CINCINNATI:
MOOEE, WILSTAOH & MOOEE, Printers,
          141 AND 143 RACE STREET.
                  1869. 
        Entered according to Act of Congress, in the yeae 1865,
                   BY JOHN  M. SCUDDER,  M. D.,
JN THE CLERK'S OFFICE OF THE  DISTRICT COUET OF THE UNITED STATES, FOE THB
                       SOUTHERN DISTRICT OF OHIO. 
PREFACE.
   A  dcyiii<»tic manual on obstetrics, diseases of womeL
 and the care and management of children, is much needed,
 more so, probably, than a domestic practice.  The ideas
 of even our better  informed class of women, as regards
 their  own systems, and the functions of reproduction and
 child-bearing are very vague and crude, while a large
 number know nothing but what  they have  experienced.
 It is a woman's privilege to know all about herself, and
 any situation in which she may be placed, and to be able
 to take care of her own health, and give that assistance to
 others which is  sometimes  necessary, in an intelligent
 manner.  A specious mock modesty has kept this know-
 ledge from our country women, and  they themselves are
 mostly to blame  for this.   This rejection of books, that
 plainly describe such things  as should be known by all,
 belongs to the same species of  modesty as  that which
 neglects  to  instruct a daughter as regards the  changes
that naturally take place with her, and  the new duties
she will be called  to perform in  wedded life.
  " To the pure mind all things are pure," and it is the in-
tention of the author to plainly describe the various func-
tions of the female, especially with regard to reproduction
 as he  would if he was instructing a wife  or a daughter 
4
PREFACE.
They are  subjects closely connected with our holiest  re-
lations  in  life, belonging exclusively to the home and
family circle, and  should be looked upon in the same
light that we regard any other useful knowledge.
  Many a mother has lost her health by a want of proper
knowledge of the subjects here described, and many young
women  have become unfitted for mothers, or any other
useful purpose  in life, by violations  of  nature's plainest
laws.  As the  health and vigor of  our people  depends
upon  the  health  and vigor of our  mothers, should we
not use all proper means to diffuse a knowledge of nature's
laws, so that each may be able  to live in accordance with
them, and thus add to  their own  comfort and the  well
being of those who are to succeed them ?
  If perchance this volume should fall into  the hands of
those  who will  read it to pander to a prurient  imagina-
tion, the author begs that they will lay it to one side, or
give it to  some person  of  their  acquaintance  who will
make good  use of it;  and if the knowledge contained
within it is turned to  bad purpose, it will be contrary to
the design of the author.
                       98 West Sixth street, Cincinnati. 
TABLE  OF CONTENTS.
                   PART I.
Introduction            ....     9
Female Organs of Generation     -     -         10
Pelvis      ......   17
Menstruation     -     -      -      -          19
Conception      .....     21
Prevention of Conception     -     -      -    -23
Procreation of Male and Female Children at Will  -   25
Signs of Pregnancy  -      -      -      -      -27
Diseases of Pregnancy  -     -     -      -    - 29
Abortion  ------    34
Labor -      -      -      -      -      -.37
Mechanism of Natural Labor  -      -          -  40
Management of Labor  -     -     -          - 44
Difficult Labor  -      -     -     -          - 50
Preternatural Labor  -      -      -          -  54
Complicated Labor -      -      -      -      -   57
Chloroform in Labor     .   -     -     -    .  Qg
Puerperal Fever  -----     65
Phlegmasia Dolens  -      ...      -66 
VI
TABLE OF CONTENTS.
PART H.
Diseases op Women -	- 69
Amenorrhcea -	- 72
Dysmenorrhoea -	- 74
Menorrhagia -	- 76
Leucorrhcea ...	- 78
An Examination -	84
Chlorosis -	86
Hysteria -	89
Chorea - - - -	- 91
Inflammation of the Ovaries -	- 96
Ovarian Dropsy -	- - 97
Cancer of the Uterus -	-. 98
Displacement of the Uterus -	- - 101
Prolapsus Uteri -	- - 102
Anteversion of the Uterus -	- 105
Retroversion of the Uterus -	- 106
Polypus of the Uterus -	- - 108
Diseases of the Breasts -	- - 110
Care of the Breasts while Nursing	- Ill
Ague in the Breasts -	- Ill
Inflammation of the Breasts -	- 112
Tumors of the Breast -	- 114
Cancer of the Breast -	- 115
                    PART III.
Care and Management of Children   -      -     -  118
The Infant Before and immediately After Birth  -  119
Food of Children  -                           -  129
Sleep......-  141
Clothing ------   144 
TABLE OF CONTENTS.
vii
Washing  and Dressing  -      -      -      -  - 153
Ventilation   ---...  156
Exercise  ------     159
Special Diseases of the Child   -       -              166
Fever   -------  167
Affections of the Respiratory Apparatus  -      -   169
Diseases of the Digestive Organs  -      -      -   170
Affections of the Skin  -      -      ...  173
Roseola  -----       .     177
Erythema  --....   178
Erysipelas  -      -      -      -      -      -180
Deformities and Distortions during Childhood  -   -  182
The Infant's Opiate  -      -      -             -   201
Moral Government   -----    202
Earliest Intellectual  Education  -      -           224 
VOLUME II.
  This work has been divided into two volumes in order that
 a more complete description of the anatomy, physiology,
 and diseases of women might  be given than would have
 been proper, if published in one volume.  This is intended
 especially for women, and points out to them clearly the
 various changes that take place in their bodies, and the
 means of preserving the health.

  The functions of menstruation, conception,  gestation,
 and labor, are all explained, and such rules deduced  as,
 if followed, will lead to  regularity and health.   Many
 delicate subjects are here discussed freely, and yet in such
 a manner as not to offend the most fastidious, and all  in-
 formation that can  be of benefit to a woman in any con-
 dition, is candidly given.

  The description of pregnancy, abortion, and labor, and
the management of each,  is full and complete, so that
persons who carefully read it will find themselves posses-
sed of that practical knowledge so often necessary in these
cases.  In addition, the diseases of women and their treat-
ment, is plainly described, as well as the care and manage-
ment of children.  It is  a book that should be carefully
read by every mother in the land. 
DOMESTIC  MEDICINE.
                 VOLUME  II.

MIDWIFERY, DISEASES OF WOMEN", CARE AND
         MANAGEMENT OF CHILDREN.
  Perfect in her organization, woman is fitted for the two-
fold office  of a companion for man and  the mother
of  children.  Her  perceptions are  quick, emotions are
strong,  and sympathy and  love are  the most striking
elements of her mind.  Thus is she adapted  to smooth
the asperities of life, to call our better feelings  into action
and to give that love and care that are so necessary to the
helpless young of  the human species.  Woman is the
center of the  home circle, and on her, to a considerable
extent, depends the physical and mental well being of its
members.   Properly prepared  for her duties, both physi-
cally and mentally, there can  be no doubt  but that she
will enjoy more happiness in this her  proper sphere than
in any other in which she could be placed.
  For one, I am willing to admit all the rights that women
are  inclined to claim.  There  are  some who  cannot  be
contented with home duties and home pleasures, and such
may properly be physicians, ministers, farmers,  mechanics
or whatever may suit their taste. Some women  have mind
enough  for any purpose, and  were  their bodies as well
adapted  to their unnatural vocations as their minds, they
would be well suited. A very large majority, however, 
10           FEMALE ORGANS OF GENERATION.

find their happiness in the vocation nature has designed
for them; the center of a happy home, and the mother of
our future men and women.  So  definitely does nature
point to this in the female organization, that it seems
useless to engage in any discussion on the subject.
  The differences  between the male and female are very
marked : the one is coarse in his organization, the other
delicate; the one large and angular, the other small  and
with  rounded outline; in the  one strength, and in the
other beauty.  The differences are as  marked in mind as
in body; whilst the man has better developed reasoning
faculties, women's perception is quick and her emotions
strong.  These  differences are  developed only with the
development of  the sexual organs; as up to the age of
puberty we observe but very little difference in the sexes.

       FEMALE ORGANS OF GENERATION.
  The organs of generation  in  the female consist of the
sexual opening  or vulva, of a canal  that leads  upward
from  it—the vagina, of the uterus, fallopian  tubes, and
the ovaries.  Associated with  these  are the bladder and
its excretory duct,  the urethra.
  The external parts are supplied with numerous secretory
glands, that furnish a material for  their protection.   If
allowed to  accumulate, it not  unfrequently gives rise to
irritation  and a very unpleasant species of  leucorrhcea,
with  subsequent internal weakness.   Cold  water, or in
some cases  castile soap and water is  all that is requisite
for a cure, and especially as a preventive.
  Pruritus, or itching of these  parts,  is sometimes a very
troublesome affection, being so severe in some cases as to
prevent rest either day or night.  This itching will readily
yield in most cases to an application of—take borax,  one
drachm; morphia, five grains; to water, eight ounces:  use
as a wash .   Or to half a pound of common tar add  one
quart of water: stir it, and  let it stand for two  or three
days and use the water as a wash. 
female organs oe generation.             11

              Fig. 1.
        A Side View of the Viscera of the Female Pelvis.

  1.  The symphysis pubis;  to the upper part of  which the tendon of the
rectus muscle is attached.  2. The abdominal parietes.  3. The collection of
fat forming the prominence of the mons veneris.  4. The  urinary bladder.
5. The entrance of the left ureter.  6. The canal of the urethra, converted
into a mere fissure by the contraction of its walls.  7. The meatus urinarius.
8. The clitoris, with its prreputium, divided through  the middle.  9. The
left nymphae.  10. The left labium majus.   11. The meatus of the  vagina,
narrowed by the contraction of its sphincter.  12. 22. The canal of the vagina
upon which the transverse rugae are apparent.  13. The  thick wall of separa-
tion between the base of the bladder and the vagina.  14. The wall of separa-
tion between the base of the bladder and the vagina.   15. The perineum.  16.
The  os uteri.  17.  Its cervix.   18. The fundus uteri.  The cavitas uteri is
seen along the center of the organ.  19. The rectum, showing the disposition
of its mucous  membrane.  20. The anus.  21. The upper part of the rectum
invested by the peritoneum. 23. The utero-vesical fold of peritoneum.  The
recto-uterine fold is seen between the rectum and  the posterior wall of the
vagina.  24. The reflection of  the peritoneum, from the apex of the bladder
upon the urachus to the internal surface of the abdominal parietes. 25. Tho
last lumbar vertebra.  26. The sacrum.  27.  The coccyx.
  The Vagina is the canal that leads upward to  the womb
and gives it support.   It is formed of fibrous tissue, lined
by  a mucous  membrane, its walls being  about the one-
eighth of an inch in thickness.   They are so  elastic as to
permit of distension to the full size of the pelvis  without 
12
FEMALE ORGANS OF GENERATION.
danger of rupture.   Its posterior wall is' closely connected
with the lower canal or rectum, and its  anterior is  still
more closely attached to  the bladder, and has the water-
passage  or  urethra  excavated within it.  See Fig. 1.   In
its normal condition, the walls of this canal are firm  and
elastic;  when  they  become relaxed,  there  is  always
displacement of the womb and unpleasant sensations.
  Its mucous membrane is very vascular, and abundantly
supplied with nerves and mucous follicles.  Hence, when
diseased, the general  system sympathizes with it to a
considerable  degree, and  there  is  frequently  a profuse
discharge of mucus.
  The Uterus.—TJie uterus or womb is  situated at  the
upper extremity of the vagina, upon which it rests,  and
between the bladder in front, and the rectum behind, as
                        Fig. 2.
The Cavities of the Uterus and Cervix in their Normal Condition. 
             FEMALE ORGANS OF GENERATION.           13

shown in  Fig. 1.  In its  natural condition, it is pear-
shaped ;  about three inches in its longest diameter, two
inches wide, and  one  and a half  inches thick.  It is
divided into a neck, body, and fundus ; the first being the
lower constricted portion; the second, the middle portion;
and  the  third, the  superior portion.   It  contains a small
cavity as seen in Fig. 2, which is  divided into two parts,
the cavity of the body and  the cavity of  the neck.  This
is  lined  by mucous membrane, which is smooth  in the
cavity of the body, and laid in folds in the cavity of the
cervix;  the  latter is  profusely supplied with mucous
follicles, which furnish a secretion to seal up  the womb
during pregnancy, and when diseased, an abundant, white-
of-egg-looking discharge.
  The walls of the uterus  are thick, and as will be  seen
by Fig.  3, are composed of  three coats. The external
              The Tissues of the Uterus.
p The muscular tissue; m mthe internal lining or mucous membrane • o i
                  a tubular gland. 
14           FEMALE ORGANS OF  GENERATION.

one is thin and delicate, and is  derived  from the serous
membrane of the abdomen.  The  middle one is thick,
and composed of muscular fibre; it  is dense and  hard in
the unimpregnated womb, but during gestation it increases
in thickness and  the muscular fibres  are  remarka'bly
developed, so that at the commencement of labor it is
one  of the  most powerful muscles of  the body,  and
capable of forcing the child through the  pelvis and soft
structures below.  The mucous membrane of the cavity
is formed  of tubular glands as seen at o t which  are sup-
posed to furnish the menstrual discharge.
                       Fig. 4.
The Vessels of the Uterus.
  The womb is abundantly supplied with blood-vessels aa
seen in Fig. 4, representing the  organ during gestation.
Owing to this  profuse supply of blood, we can  readily
understand the serious injury that may result to the gen-
eral  system from  a derangement of its circulation  by
arrest of  the monthly periods or  other causes.
  The uterus and ovaries  likewise receive  a very abun-
dant  supply of  nerves (See Fig. 5), derived from two
sources.  The first  are derived  from the sympathetic or
vegetative  system of  nerves, and  associate it with the
digestive and assimilative organs.   This is  necessary  for
the growth and development of the child in the womb, 
FEMALE ORGANS OF GENERATION.          15
Fig. 5.
The Nerves of the Uterus.
and accounts for the morning-sickness and other derange-
ments of the  stomach  during pregnancy, and  for the
diseased condition of the stomach and other digestive
organs  in chronic  diseases  of the womb.  The second
are derived from the cerebro-spinal system of nerves, and
it is thus closely connected with the nerves of sensation
and the mind;  hence the hysterical  manifestations that so
frequently flow from functional or structural disease of
these organs.
  Fallopian  Tubes.—Passing from the upper part of the
uterus on either side are two small tubes, four or five-
inches in length,  which go  to the ovaries.  The  canal
through them is very small, but sufficient for the passage
of the human egg from the  ovaries to the uterus.   Their
outer extremity is  expanded (See  Fig. 6), and furnished
with erectile  fingers to grasp the ovary during ovulation,
and thus prevent the escape of the egg into the cavity of
the abdomen. 
16           female organs of generation.

                        Fig. 6.
The Uterus, Ovaries; Fallopian Tubes and Lateral Ligaments.
  Ovaries.—The ovaries are two whitish flattened bodies
about the shape and size of an almond with its shell.  They
have a strong external fibrous investment, but internally a
spongy vascular tissue in which  the  human egg is gener-
ated.   Upon the external surface  from  ten to thirty
vesicles may be seen  filled with a transparent, coagulable
fluid;  these are  called graffian  vesicles, and contain  the
egg.  One of  them comes to maturity at each monthly
period, and rupturing, discharges its contents into  the
fallopian  tube, whence it is  conveyed into  the uterus.
Thus these small organs furnish  the germ for a future
being,  at each menstrual period.
  Bladder.—The bladder in the female, as will  be seen
by Fig. 1, is situated  immediately in front  of the uterus
and vagina.  It  does not differ from  that in the male
except  that it  is usually  larger.  Its situation  is such,
however, that if allowed  to  become unduly distended, it
will throw  the womb out of place, and sometimes give
rise to serious difficulty.
  The Urethra—In the female, is short, about two inches
in length, and included in the anterior wall of the vagina.
Its external opening will be found immediately under the
bones  of the anterior part of the pelvis, and is usually
marked by a small, cushion-like elevation. 
female  organs of generation.           17
  Muscles of the Pelvis.—The muscles of the pelvis are
so arranged as to give efficient support to the organs here-
tofore described, and to firmly close the outlet of the pelvis.
One pair  arise far within the pelvis and pass downward,
and being broad, they form a muscular basin.  Others pass
from before backward, and from side to side.   As long as
these muscles retain their normal tonicity there can be but
little displacement of internal  organs, and when such oc-
curs, the best means of treatment is to restore  their orig-
inal strength.
  In addition to this the uterus has four ligaments; two
are called broad, and consist of the serous membrane re-
flected from it to the sides of  the pelvis, as seen in figure
6; two  are called round, and pass upward and outward
to be inserted  above  the external genitals.  These liga-
ments were  formerly  regarded  as the structures  that
maintained the womb in its proper position, but it is now
definitely  determined  that they  have but little  to do
with it.

                        Fig.  7.
          Bones of the Pelvis.
2 
18          female organs of generation.
  Bones of the Pelvis.—The pelvis (Fig. 7) is formed of
four bones, two of which are a continuation of the spinal
column, the others  are the hip bones.  The sacrum (2) is
a pyramidal curved bone,  forming the greater part of the
posterior wall of the  pelvis, its curvature  is from above
downward and forward, forming a cavity in front termed
the hollow of the sacrum.  The coccyx (5) is  a small pyra-
midal bone attached to the apex of the sacrum.  The hip
bones, or ossa inominata, one on each side, form the lateral
and anterior walls of the pelvis.  They are divided into
three parts: a superior expanded portion which forms the
hip, an inferior portion, on which  we sit, and an anterior
portion termed the pubis.
  The bones  are firmly bound together by strong liga-
ments, so that no movement is permitted.   The articula-
tions  are termed symphyses, the two posterior sacro-iliac
symphyses, the anterior the pubic symphisis.
  The pelvis  is much deeper behind than  it is in front,
being between five and six inches measured at the sacrum,
and but  two inches at the pubis.   The opening into and
above is called the superior strait or rim  of the pelvis, the
opening below is termed  the inferior strait or outlet, and
the space between, the cavity of the pelvis.   Figure 8 will
                        Fig. 8.
y
M~                  /          *
        Section of the Pelvis.
 
menstruation.
19
  represent a section of the pelvis in its usual position, the
  line from a to b, the plane of the superior strait; the dot-
  ted line c to e, its axis, being the  direction in which the
  child enters the pelvis; the  line / to i the plane of the
  outlet, and the curved line g to k  the course of the child
  through the pelvic cavity.
   The size of the pelvis is  such as to permit the ready
  passage of the child at full time, without injurious pressure
  on  the soft parts, each diameter being from four to  five
  inches.  The  pelvis, in this country, is very rarely de-
  formed so as to offer an obstacle to labor.

                  MENSTR UA TION.

   Previous to puberty we observe but little difference be-
 tween the sexes, except possibly that the female is smaller.
  From the twelfth to the sixteenth year, however, her out-
 line becomes rounder, the breasts  developed, and she be-
 comes more modest and retiring in her disposition,  her
 mind  appreciating the coming change in her condition.
 At this time a discharge of blood occurs from  the genital
 organs, which  is called the  menses, but which is  usually
 designated by women  as the courses, monthly period, or
 monthly sickness.   In the healthy woman  it  occurs every
 lunar  month, or about twenty-eight  days, the discharge
 continuing from three to seven days.   It varies greatly in
 quantity, in some being scanty and  not amounting to more
 than from half an ounce to two ounces at a period, while
 in others several ounces are discharged.
   The menstrual fluid is almost pure blood, the only per-
 ceptible difference being that it has lost  its  power of
 coagulation.  Whenever it is changed from this  bright,
 pure condition, it is evident there is some  disease.
  The menstrual discharge usually appears between  the
twelfth and sixteenth years, but in  some cases it occurs at
a later and in others at an earlier period. It comes on at an
earlier age in the women of warm climates, and residents 
20
menstruation.
 of cities, and later in the inhabitants of cold climates and
 in the country.
  Its first appearance is indicated by the full development
 of the system, and in  many cases by the monthly recur-
 rence  of pain in the  back and limbs, and a feeling of
 weight in the pelvis.   These symptoms may occur at
 regular periods for several months, and should be re-
 garded by the mother as an indication that the discharge
 should appear.  At such  times let the feet be bathed in
 warm mustard and water, at bed-time, and give a cup of
 pennyroyal tea.  If there  is much sensation of  fullness,
 use the warm hip bath.  The  young girl  should  be care-
 fully instructed by her mother preparatory to this change,
 and cautioned against over exertion and exposure at these
 times.  There is no doubt but this is one of the most im-
 portant periods of her life, and if this change occurs nor-
 mally good health may be anticipated; but if arrested or
 prevented  from  coming on, by imprudence, the  system
 may become deranged for life.  Especially should care be
 used during the first years of  menstruation to prevent an
 arrest  of the  discharge, by avoiding exposure, sitting on
 the damp ground, or stones, getting the feet wet, etc.
  Menstruation  continues  regular, except the periods of
 gestation and  nursing, up to the fortieth or fiftieth year.
 This period is termed the change of life, and is looked for-
 ward to with considerable  dread  by most women.  In a
 majority of cases the discharge is irregular for one or two
 years before it ceases, sometimes small in quantity, at
 others profuse, recurring too frequently, and again coming
 on  at  longer intervals.  Though  some  women suffer se-
 verely at these times, and  a few do not pass through the
 change, a majority have comparatively slight trouble, and
 are often-times healthier afterward than before.
  Causes of Menstruation.—The discharge of blood at
the menstrual period is but a  symptom of changes going
on in the internal organs.  Every twenty-eight or thirty
days the ovaries mature   a graafian vesicle, which con- 
conception.
21
 tains a human  egg.   This causes an  excitation of the
 organs, which  also extends to the uterus, and in  conse-
 quence of this there is an increased  circulation of blood,
 which passes off to some extent from the cavity of the
 uterus.  Menstruation does not commence until the ova-
 ries are  sufficiently matured to furnish ovules,  and it
 stops whenever these cease  to be  developed, as during
 pregnacy, disease of  the  uterus and ovaries, and  at the
 change of life.   The monthly discharge may be  taken
 as a sign  of the maturity  of the sexual organs, and a ca-
 pacity for child bearing.


                     CONCEPTION.

   Conception is the fertilization of the egg furnished by
 the female, with the seminal fluid furnished by the male,
 and the retention of the  fecundated body within the ute-
 rus.  As a general rule, the egg is furnished by the female
 only at the period of menstruation, and it  escapes from
 the  uterus between the eighth and  twelfth day after its
 separation from the ovary.  Therefore impregnation oc-
 curs almost universally at the menstural period, or within
 six or eight days after its  cessation.  Thus when it is not
 deemed desirable to have children, connexion should not
 take place for twelve or fifteen days from the commence-
 ment of mensturation.
  The egg having been vivified by contact with the male
 sperm, is retained within  the cavity  of the uterus, by the
 formation of a false membrane, called the  decidua.  In
 some six  weeks it forms an attachment to the uterine
 wall  by the  development of  the placenta, or after-birth,
 and from this time  onward it derives its  sustenance from
the blood  of the mother.   From the commencement of its
growth, the child is surrounded by its membranes,  which
contain a considerable quantity of water in which it floats,
as seen  in figure 9, of a fetus and its membranes  at the
 eighth week. 
22
CONCEPTION.
  At the  fourth week the embryo has the form of a ser-
pent, about half an inch in length, its head being indicated
by a slight swelling,  and its eyes by two black  points.
The arms  and legs appear as nipple-like protrusions, and
the liver and bladder occupy nearly the whole abdomen.
  At two months it  is about one and a half inches in
length, the extremities are developed so  as  to show the
fingers and toes, there are rudiments of the nose and 3ps,
and the umbilical cord and placenta have been  developed.
  At three months it is from two to two and  a half inches
                       Fig. 9.
Ovum at Two Months.
in length, and weighs from one to one and a half ounces,
The head is very large, the eyelids  are developed, and os-
sification has  commenced in the bones.
  At  four months, it is five or six inches in length, the
skin well marked and rosy, the mouth large and open, the
nails begin to appear, and the sex can be determined.
  At  six months it weighs  in the neighborhood  of  one
pound, and is from nine to ten inches in length, face of a
purplish red,  and  hair white or silvery.
  At seven months its weight is from three to four pounds,
and its length from thirteen to, fourteen inches.  The skin
is natural and rosy, but the nails do not yet reach the ex-
tremities of the fingers. 
prevention of conception.
23
   At the  ninth  month its length  is from seventeen to
 twenty-one inches, and its weight from five to nine pounds,
 and it is perfect in every respect.
   A child is capable of respiration between the fifth and
 sixth months, and may cry when born, but it is not capa-
 ble of maintaining a separate existence before the seventh
 month.  It is a common impression that a seven months
 child is more likely  to live than one at eight months, and
 I think that experience goes to prove it.

         PREVENTION OF CONCEPTION.

   There are many women who have their health perma-
 nently impaired,  their happiness destroyed, and sink into
 a premature grave, from too frequent child-bearing.  To
 such, any means  which would prevent conception, would
 be an inestimable blessing.  There are others, who do not
 desire to have an increase in family, because it increases
 their labors  and cares, and confines them  to the  house;
 thus, as they think, preventing that enjoyment of life that
 is their  privilege.  Others, again, desire some means of
 prevention, that they may gratify their desires in an  un-
 lawful manner;  to these, any such means will prove  a
 curse rather than a blessing.
  I can well understand why women should be so desirous
 of means to prevent pregnancy.  The lot of most mothers
 is by no means  easy, and, in  many cases,  their lives  are
 laborious and burthened with cares. A  large family is
 not only a great task on the physical powers in child-bear-
 ing, but the continued care that is necessary in their nurs-
 ing, attention to  food,  clothing, government and  educa-
 tion, is the severest labor that any person could undertake.
 Still, Providence  has  mercifully adapted  the back to  the
burthen, and given strength of body and mind to properly
fulfill our lot in life.   It is no offense, however, to good
morals, to use such means as will not interfere  with duty
 and health, to prevent the having of more  children than 
24
PREVENTION OF CONCEPTION.
can be properly cared for.   The mother whose health ia
broken  down by rapid  child-bearing, can  not give that
vitality to her offspring that they would receive if she was
not thus  exhausted; and  this physical deterioration  of
children is a sufficient argument, in these cases, in favor of
means to prevent conception.
  It may be said, that nature furnishes the proper remedy
in the non-intercourse  of  the  sexes, which  is true, but
without  advantage  to  the mother.   She is  usually not
placed in a position to  have  much choice, the sexual ap-
petite being so  strong as to overcome all prudential con-
siderations.
  As  before remarked, the  menstrual discharge is an indi-
cation of the maturity of the human  egg, which is capa-
ble of impregnation at any period  before  its  escape from
the womb, a period of ten  or twelve days.  The  seminal
fluid  of the male may retain  its  vitality in the  female
organs for two  or three  days.  Hence, it is laid down as a
general law, that conception  takes place from connection
two or  three days prior to, during,  or five  or six days
after  the  cessation of menstruation.   If, therefore, it is
desirable to  avoid having  children, no connection  should
take  place at  this time.   Though this holds good in a
majority of  cases, there are some exceptions in which the
egg is produced  in  the intermediate period  from sexual
excitation.
  As  conception results from the contact of the spermatic
fluid of the male with  the  egg of the female, any means
that will prevent this, will  prevent conception.  For this
purpose the French have devised a sack, called a cundrum,
which is worn by the male, and most effectually prevents
the escape of the seminal fluid.  The same purpose  is
accomplished by using  a piece of soft  sponge, of appro-
priate size, which is  passed up  to  the womb before con-
nection, and withdrawn afterward, a cord being attached to
it for this  purpose.   It is better that it should be wet in
vinegar one part, and water three parts, before using. To 
PROCREATION OF MALE OR FEMALE CHILDREN.
25
render it more certain, an injection of one part of vinegar
to eight of water may be employed.  The injection alone,
using the rubber pump syringe freely, will  often answer
the purpose without any other means, employed immedi-
ately  after the act.  These  things are  some trouble, but
are only named for the prevention of a  far greater one.
   The means above  named are  the only  ones known,
though, to read the advertisements in the public prints, it
would be supposed that they were very numerous, and
easy of use.  I describe them, because I believe I will be
conferring a lasting benefit on many overburthened moth-
ers, though  another class  may use them wrongfully.  It
may seem that such matters should not be spoken of, but
my experience tells me that nine out of every ten women,
have a great  anxiety on this subject, and will be glad to
learn what I have written.


ON THE PROCREATION OF MALE AND FEMALE
                CHILDREN AT WILL.

   This subject, novel as it may appear to some, has  been
for many centuries past, an object of meditation and study;
and extensive experiments  have  been  made  for a great
number of years in several  of the European States, to
hasten its progress;  and foremost among  these we find
England, France, and Belgium.   Those  experiments, at
first made for the advancement of science only, have, of
late years, become objects of speculation, and the knowl-
edge of their results of very great  value to the raisers of
fine horses and cattle.   We could  not in so  short a paper
as this, give the full history of those experiments; a simple
glance at the main points, being, we deem it, sufficient to
derive  the necessary  conclusions  for the design of our
theme.  The governments of the States just  mentioned,
have instituted establishments for the purpose of raising
and improving horses, cattle and other animals, and  men
of science have deduced from close observations, and re- 
26      PROCREATION OF MALE OR FEMALE CHILDREN.

suits  carefully  recorded  for  many years, the following
facts:
  1st.  That the young  obtained  from a mare,  cow or
sheep, etc., when very young,  was generally a male, when
the male employed was of mature age, healthy and strong.
  2nd. When the female is of mature age, strong, healthy
and well fed, the  young is more commonly female when
the male employed  is young, weak or exhausted by too
often repeated copulation.
  3d. That the young obtained from the same when at
mature age, strong, healthy and w«ll fed, was  in  nearly
equal proportion, when the male employed was  in a simi-
lar condition.
  4th.  That the young brought forth, when the female is
old, are  generally males, when the  male  employed is
young and strong.
  5th.  That the young obtained from females, when in
prime, being well fed and young, were  generally females,
when the male was not in pride, or when ill  fed, or ex-
hausted by frequent copulation, or too old.
  6th.  T,hat the young obtained from the same, when ill
fed  and not in pride, were generally  males, when the
male was well fed, young, healthy, strong and in full heat.
  7th.  That if the female was exhausted by labor, or forced
exertion, the young would be generally male, should the
male employed be kept in and well fed.
  8th.  That the young would be female, should the fe-
male be kept at rest, and the  male exhausted by labor or
forced exertion.
  9th.  To conclude—that the offspring would more gen-
erally be male, or female,  according  to their respective
physical  and procreative abilities (age being taken  into
consideration).
  From the preceding statements we derive the following
deductions:  Man being an animal, having physical and
procreative faculties, analogous to those of the brutes, if a
set of phenomena take place among these, the same must 
SIGNS OF PREGNANCY.
27
 necessarily be produced in the human species, and if cer-
 tain conditions of the  physical body affect the offspring,
 the same physical conditions must affect the offspring in
 man.
   To get a male child, the husband should take good sub-
 stantial, and somewhat stimulating food, moderate exer-
 cise, pass his time pleasantly in the gay society of women,
 read lacivious novels, refrain from sexual pleasures for a
 time previous to the procreative connection with his wife.
 During the same time, the wife should live sparingly, par-
 ticularly on vegetables,  fatigue herself every  day, take
 some antiaphrodisiacs, and pass her time in the dry society
 of old women.
   To  have female children, the opposite should be ob-
 served, the woman  should live in the abundance of all
 good things, in the ball-room, etc., but should restrain her
 passion and preserve its whole force for the desired time;
 the male or husband, on the contrary, should reduce his
 physical  abilities by actual labor, and at the same time,
 reduce his procreative propensities by frequent, copious
 cold ablutions.—John E. Van Molle, A. M.

               SIGNS  OF PREGNANCY.

   It is not always possible for a physician to  determine
 the  existence of pregnancy before the fifth month, but
 there are certain signs which, as  a general  rule, are re-
 liable.   These are divided by writers  on obstetrics  into
 rational and sensible, the first being perceptible  to the fe-
 male herself, the second being determined by an  examina-
 tion.
  Arrest of Menstruation is  one of the  most common signs
 of pregnancy,  as in a very large majority  of  cases the
 menses cease when conception takes place.   It is not cer-
tain, however, for this discharge may be arrested by cold,
and occasionally from other causes, and in some rare cases
it  continues  for  three  or four periods after conception 
28
SIGNS OF PREGNANCY.
takes place.   As a general rule, if the arrest depends upon
cold, there will be evidence of disease, as pain in the back
and limbs, weight  in  the  pelvis, with sometimes slight
fever, all the  symptoms recurring monthly.
  Morning Sickness is a common symptom of pregnancy,
though it does not occur in all cases.  It may be but
slight nausea in the early part of the day, or it may be so
severe  as to cause vomiting of the food taken, and in some
cases will prove dangerous.
  A dark ring surrounding  the nipples, with enlargement
of the  follicles, is a pretty certain sign in first pregnancy,
but at succeeding times it is of little value.  Enlargement
of the  breasts about the third or fourth month, is an ad-
ditional evidence.
  Discoloration  of the face, in the form of freckles, is, in
some cases, very good evidence, when taken in connection
with the preceding.
  Enlargement of the abdomen commences about the fourth
month, and is usually regarded  by women as indicating
pregnancy.  Though frequently the  case,  yet  there are
numerous instances in which  the abdomen is  enlarged
from other causes, so that it would not be possible, from
passing the hand over it, to determine what was the cause.
Many an innocent female has suffered from the suspicions
of her  neighbors and friends, when  the  enlargement was
dependent upon ovarian or other disease.
  Quickening  usually occurs at the middle of gestation, or
about four and  a half months, though in some cases it is
not perceived before the fifth,  or even the sixth month.
It is dependent upon the movements of the child in the
womb, and is sometimes  very  marked, at others weak.
Women regard it as a positive evidence of pregnancy, and
so it is in a  large majority of persons; some rare cases
have been observed in which the female was positive in
her own mind that she felt the movements of a child, but
time proved that  she was not pregnant.  If the hand  is
dipped in  cold water, and  applied suddenly over the 
DISEASES OF PREGNANCY.              29
 womb, it will almost always elicit movements of the child
 in the later months.
   Physicians frequently determine the existence of preg-
 nancy in the latter months of gestation, by  applying the
 ear  to the abdomen  to  hear the beating of the  child's
 heart.  Of course it is positive evidence.  It is also em-
  loyed during labor, to  determine whether the child is
 alive,  and is  a very important measure in some cases.
   An examination of the  uterus, through  the vagina,
 gives important evidence of pregnancy.  Month by  month
 we find that the neck of the womb becomes softer,  and its
 mouth more open, so as to admit the finger.  In addition,
 if the womb be struck by the finger the child will rise up
 in the water that surrounds it,  and, falling, will  give a
 decided  impulse to the finger.  This is termed  ballotte-
 ment, and is a positive evidence of pregnancy.
   Taking these as  signs of pregnancy, we may conclude
 that in a large majority of cases, if a woman has  arres't of
 her  monthly periods, morning  sickness,   discoloration
 around the  nipples, enlarged abdomen, and quickening,
 or a majority of these symptoms, she may safely make up
 her  mind that she is pregnant.

            DISEASES  OF PREGNANCY.

  Pregnancy is a physiological, or healthy condition, and,
 as a general rule, women enjoy as good health during this
 period as at other times.  It is true, that in some cases
 morbid sympathies are excited, which prove very unplea-
 sant, and sometimes they can not be avoided.
  When pregnancy is suspected, the female should adopt
 regular habits of living, and  even thinking,  both for her
 own good and the good of her offspring.   The diet should
be nutritious, but not stimulating, and  such articles of
food as are craved, should be taken in moderate quanti-
ties,  if not absolutely injurious.  The feet should be well
protected from dampness, and the entire lower part  of the 
30
DISEASES  OF  PREGNANCY.
body from the action of cold.  Moderate exercise should
be  taken, but excessive exertion and  fatigue should be
avoided.  A daily or tri-weekly  sponge bath  will be of
much importance to women of a delicate and lax habit,
as  it improves the  circulation, increases  nutrition,  and
gives tone to the system.  Labor will be less painful and
shorter, in a majority of cases, if such a course as this is
pursued.
  A well regulated mind not only adds to a woman's hap-
piness, but is of very great importance to the well being
of the child.   There is no doubt but that the state of the
mother's mind exerts a very strong influence upon the
mind of the child.  Instances  of this  are  so  numerous
that any person must have  observed it; if  the mother's
mind is harassed, and she is irritable and fretful, the child
will be cross, and the future  man or woman will  always
feel the  influence to a greater or less extent.  It  is true,
that in many cases it is almost impossible for a wife to be
even-tempered, as she has so much to  irritate and annoy
her, but perseverance in this, as in other things, will work
wonders.
  We hear much said  about mothers' marks; and almost
every old lady has her story to  tell of some  surprising
circumstance of this kind.  It is no doubt  true,  that in
some cases the influence of the mother's mind is mani-
fested in some  physical change in the child.  Sufficient
evidence is before us to make us admit this fact,  and yet
when one child  is marked from such cause,  ten thousand
escape.  In a very large obstetric  practice, not a single in-
stance  has come under my observation, though  I have
been asked the  question a hundred  times, with fear and
trembling, "Is the  child all right?" the mother's fears
having  been excited from some  occurrence during preg-
nancy.
  The  bowels should be kept  regular during gestation,
and this is best affected by strict  attention  to  regular
periods  for their evacuation, only resorting  to mild laxa- 
DISEASES OF PREGNANCY.
31
 tfves, as a seidlitz powder or the citrate of magnesia, when
 it was absolutely necessary.
   Morning Sickness or Vomiting, when mild, requires but
 little attention, as it usually passes off by the fourth or
 fifth month.  Frequently  a cup of  strong  coffee taken
 before, or shortly after getting up, will answer a good pur-
 pose ;  or an  infusion of  peach-tree bark, in doses of a
 teaspoonful every half  hour during the forenoon, will
 answer a good purpose,  as will an  infusion of spearmint
 taken cold.   An infusion of the neutralizing physic, in
 doses of half a teaspoonful frequently repeated, answers
 a good purpose.  The Life drops in doses of ten  drops in
 water may be used, or we may add creosote,  ten drops, to
 sugar one drachm, and water four ounces, and give a tea-
 spoonful every two hours.   A flannel bandage wrung out
 of cold vinegar, and applied around the waist, with  a dry
 one over it, is the best external application.
   A disordered appetite is a frequent attendant upon  preg-
 nancy, but may generally be corrected by care and regular
 habits.  If the  appetite is  impaired,  the Collinsonia
 Bitters recommended in the preceding volume  may be
 used.  If the breath is bad, with  a fonl tongue, use a
 solution of acetate of potash, half an ounce to four ounces
 of water, in doses of a teaspoonful  four times a day.  An
 unnatural longing for crude and  indigestible articles of
 food  can always be  controlled  by judicious  regard to
 variety in the  diet.  It is the popular impression that these
 longings should be gratified, for fear of an injurious  influ-
 ence upon the child, but this impression is rapidly giving
 way, and we rarely find  a case of old fashioned  longing,
 which sometimes extended to a silk dress or a new carpet,
 as well as articles of food.
  Heartburn is a very unpleasant symptom that occasionally
attends  pregnancy,  and  is sometimes very persistent.
Frequently more care in the selection or change of diet is
all  that  is  necessary.   At other  times,  an infusion of
peach-tree bark will prove valuable; and again  an  infu- 
32
DISEASES OF PREGNANCY.
sion of the Neutralizing Physic may be employed.   It is
best to avoid the use of alkalies if possible.
  Headache sometimes proves very distressing;  recurring
from day to day, and being so severe as almost to  drive
the woman crazy.   In some cases it depends upon torpor
of the bowels, and a mild cathartic, and subsequent atten-
tion to keep the bowels regular, will cure it.  At  other
times,  a solution of  acetate  of potash  as above recom-
mended will  speedily relieve  the  patient from  suffering.
If very persistent, a physician should be consulted.
   Toothache occurs so frequently in pregnancy, that by
some it has  been considered a valuable evidence of  that
condition.  As there  is some danger of  miscarriage from
having a tooth pulled, it is best to  check  the pain by other
means  if  possible:  the  remedies  recommended in Vol. 1
will frequently be found sufficient.  If they fail, and the
pain is severe and persistent, have  the tooth removed.
   Unpleasant sensations in the pelvis are of frequent occur-
rence in the earlier months of pregnancy; as of weight,
bearing down, frequent desire to  pass water or evacuate
the  bowels, burning on  passing  water, etc.  These will
usually pass away by the fourth or fifth month, and unless
severe, do not require  medicine.  Attention  should be
especially paid to keeping the bowels regular, which will
obviate much of the difficulty.  When I  prescribe for
these affections, unless there is some decided disease, it is
tincture of staphysagria, one drachm; water, four ounces:
a teaspoonful every four hours.
  In the latter months of gestation, there is sometimes a
very unpleasant sensation of weight and feeling as  if the
lower  parts would give way, which depends  upon  the
weight of the womb, and loss of  power in the muscles of
the  abdomen.   In these  cases,  have a bandage  nicely
adjusted to the lower part of the  body, draw it com-
fortably tight, and suspend it from  the shoulders with a
pair of men's  elastic  suspeuders: it will in many cases 
DISEASES  OF PREGNANCY.
33
 relieve all the trouble, and? the person will feel an agree-
 able sense of  lightness and comfort.
   Under no circumstances should the skirts be suspended
 from the hips, as is frequently the case. The pressure
 thus  made  causes the womb to sink  lower in the pelvis,
 and many times  gives rise  to  the  unpleasant sensations
 above named. Let all the clothing be loose, especially
 such as fasten around the waist, and suspend the  skirts
 by straps from the shoulders.
   Corsets  and tight lacing are always  objectionable, but
 here it should be  entirely avoided from the very first.
 Why any sane person should wish  to  bandage the chest,
 and prevent free  inspiration, is more  than I can account
 for, as  it would be to me a  continued  night-mare.  If
 women will  wear them at other times, let them be  dis-
 pensed  with  during  pregnancy, if they value their own
 health, or care for the welt being of the child.
   Distension  and  pain in the breasts  is sometimes very an-
 noying,  especially in first pregnancies.  In  these cases
 keep the clothing loose, and bathe  the breasts with  one
 part  of tincture  of arnica to  three parts of water, or if
 this can  not be  obtained,  use spirits  of camphor and
 water in the same proportion.
   A distressing itching of the vulva sometimes occurs dur-
 ing pregnancy, and is  very annoying.  It may usually
 be relieved by a wash of morphia, five grains; borax, one
 drachm; water, eight ounces.   Or,  take half a pound of
 tar, and pour  on it one quart of water; stir it, and let it'
 stand for two days, when the water  may be used  as a
 wash.
   Cramps of the  lower extremities are sometimes annoy-
 ing, and in some  cases very severe and  persistent.   They
 depend upon  the pressure of  the enlarged womb, some-
times upon constipation.   They are relieved by keeping
the bowels regular, and by supporting the womb as here-
tofore named.
   Swelling of the feet and limbs  sometimes  occurs, and  re-
        3 
34
AB0RTT0N.
suits frequently from  the  same cause, though at others
from the causes that generally  give rise  to dropsy.  The
woman should be on her feet as little as possible, keep the
bowels regular, and the womb  supported.  If this  is not
sufficient, a physician had better be consulted.
  Displacements of the womb during pregnancy are not of
frequent occurrence, but when  they do happen, give rise
to serious  symptoms.  Previous to the third month the
womb sinks lower in the  pelvic cavity than usual, and
sometimes gives  rise to  unpleasant symptoms.  The suf-
ferer may rest assured, however, that by the fourth month,
this will  cease.  When  the falling of the womb is bad,
and in cases  of retroversion and  anteversion, a physician
must be  consulted.  The  last  two  occur suddenly, and
should never be neglected.

                    ABORTION.

  As before remarked, the child does not become capable
of an  independent existence before the seventh month,
and if labor comes on and it is  discharged before this time,
it is called an abortion.  If labor  comes on between  the
seventh  and the end  of the ninth  month, it is called a
miscarriage, or premature delivery.
  Abortion  may  be  spontaneous, accidental, or  designed
In  the first  case it  is dependent upon some disease, or
weakness of the generative organs, or of the entire system;
and many times there  is such tendency to abortion, that it
is very difficult for the female to carry the child to its full
time.  The accidental causes are falls, blows, over-exer-
tion, lifting heavy weights,  and great mental excitement,
as fear, joy, grief, etc.   Drastic cathartics will sometimes
cause it, as will emetics, or the extraction of a  tooth, or
any thing that gives  a severe shock to the system, or
causes great pain.  Abortion is sometimes  produced by
criminal means, either  medicinal or instrumental, and
the woman placed in great danger. 
                       ABORTION.                     35

   The symptoms of an abortion are, usually, first, a feeling
 of debility and sinking, and a bloody discharge from the
 vagina.  There is pain or aching  in the back, sometimes
 pains in the limbs, and a feeling of weight in the pelvis.
 The discharge of blood continuing to increase, labor pains
 come on, at first slowly and weak, but growing stronger and
 more frequent, until the child and afterbirth are expelled.
 In some cases an abortion proceeds with great rapidity, one
 or two hours being sufficient, but in other cases the pain
 and  hemorrhage  continue  for twelve, twenty-four,  or
 more hours, before the contents of the womb are expelled.
   Up to the third, and sometimes  as late as the fourth or
 fifth  month, the  ovum is expelled entire; that  is, the
 membranes are not ruptured, and the child, afterbirth and
 bag of waters come together without being broken.  Af-
 ter this time, the pains continuing for  a time, the bag  of
 waters break, and this fluid  is  discharged, then the child
 is expelled, and, finally, after considerable time, the after-
 birth passes.  Frequently the  discharge of blood  is  pro-
 fuse,  especially after the expulsion of the child, and before
 the passage of the afterbirth, in some cases proving  fatal
 in a very short time.
   Management of an Abortion.—As  soon as a woman
 feels the first symptoms  above described, she  should im-
 mediately lie down and keep perfectly quiet.   Have some
 friend prepare a good sized  mustard plaster, and apply to
 the small of the back, and take internally half a teaspoon-
 ful of paregoric, or from five to ten grains of diaphoretic
 powder,  No. 20.  In many cases this will be sufficient to
 arrest it, when the female should keep in  bed for at least
 one day, and for several days  should be very cautious  to
 avoid over-exertion or active exercise.
  If the pains and discharge of blood continue to increase
after the treatment named,  it should be discontinued,  as
an abortion will result.  In most cases a physician or com-
petent midwife will  be sent for.  Let the woman keep
quiet, and if there is much hemorrhage or flooding, give 
36
ABORTION.
the essence of cinnamon  in teaspoonful doses as  often as
seems to be necessary, every few minutes, if required; or
if this can not be obtained, equal parts of nutmeg and
alum, about as much as would lie on a ten cent piece, will
answer a good purpose, or the nutmeg may be used alone,
if the alum can not be procured.  If the discharge should
still continue, apply cloths wrung out of cold water to the
lower part of the bowels  and vulva.
  When the pains become severe, let the attendant make
an examination by passing the fore-finger up to the womb.
If the waters have not been  discharged, be very careful
not to rupture the membranes; if they have, the child
may be found entirely or partly within the vagina, when
the finger may be hooked around it, and it thus  with-
drawn.
  The greatest danger is  from retention of  the afterbirth.
If there is but little flooding, there is nothing to be done.
If, however, the  discharge of blood is profuse,  pass the
finger to the  mouth of the womb, as it may be  detached
and situate so that the finger can be hooked over it, and
thus withdrawn.   Give the remedies for hemorrhage that
are named above, and use the cold applications.  If it is
dangerous, and these means  fail of arresting it, and the
woman  has not passed the fifth month, plug the vagina
with a silk handkerchief, or any soft material, put a ban-
dage  around  the abdomen,  with a  compress over the
womb, and get a physician as soon as possible.
  Never be alarmed at these times, as alarm increases the
patient's danger.   Act coolly and deliberately, as there is
very rarely any danger if the above directions are strictly
followed.
  In cases of habitual abortion, always consult some com-
petent physician.
  Producing  Abortion.—Many women, who otherwise
act from conscientious motives, have very  lax ideas upon
the subject of abortion.  Even Christian women seem to
have  but  slight  regard for the destruction of the life  of 
                        LABOR.                      37

the unborn child, and not unfrequently apply to the phy-
sician for means to cause its death and expulsion, as they
would for a medicine to relieve pain.  The  laws of Gocl
and man make abortion criminal; it is murder at any
period of pregnancy, and nothing else can  be  made out
of it.  The life of the unborn child  is as precious as it
would be if one year old, and its  destruction involves the
same guilt.  Any man or woman who intentionally pro-
duces abortion, is guilty of a high crime, punishable in
any of the United  States with imprisonment in the peni-
tentiary.
  Most women suppose  that there  are medicines which
will produce abortion, in the  same manner that a dose of
castor oil will cause evacuation  of the bowels, and  if
the physician would but tell them what it was, they need
never have a child if they did not wish it. This is a very
great mistake, as there  are but very few medicines that
will accomplish it in any case, and none  in a majority of
women.   The agents are all harsh and  drastic, and en-
danger the female's life before a single pain is induced.
  Physicians  induce abortion, only when for some cause
it is impossible for the  female to bear a living child, or her
life is endangered by some disease that is dependant upon
pregnaucy\  So careful are they, that  even in these cases,
they always have a consultation if it can be obtained.  In
such cases  instrumental interference is employed, and in-
ternal medicines are never used.

                       LABOR.

  Gestation, or pregnancy, continues for ten lunar months,
or nine  calendar months and a week, being about two
hundred  and  eighty days.    It may vary from this six,
twelve, or more days, anticipating the time by this much,
or extending over it even  to three hundred days.   Fe-
males count their time  from the last menstruation,  or
monthly  sickness, and expect labor at  its  tenth recur- 
38
LABOR.
 rence, and in which they are very rarely disappointed.  It
 has been remarked in many cases that gestation is shorter
 with females than with males, hence when a woman runs
 over her time, she anticipates having a boy.
   Labor, or parturition, is that process by which the child
 and the afterbirth are expelled from the womb.  This ex-
 pulsion is caused by the contraction of the muscular coat
 of the uterus, which is now highly developed and  power-
 ful, aided by the action of the abdominal muscles.  The
 contraction of the  uterine muscles is  painful, hence labor
 pains is synonymous with uterine  contraction, and  the
 child is said to be expelled by the pains.
   Labor pains vary greatly in character, frequency, dura-
 tion, and intensity.   At first they are grinding or cutting,
 are not frequent, continue but a short time, and though very
 annoying,  they are not  hard.  As labor progresses they
 become  more frequent,  continue longer, are harder, and
 in the last stage, recur every few minutes, or oftener, and
 are very severe and expulsive.
   Stages of Labor.—Labor is divided into three stages.
 The first is the period from the commencement of pain to
 the full dilation of the neck of the womb, and discharge
 of the waters.   It  occupies a  variable period of time,
 sometimes but a few hours, at others, two, three, or four
 days.  Though it may continue long, and the pains prove
 very annoying, yet, as a general rule, the patient is in no
 danger before the discharge  of the waters.  The  second
 stage is the period between the dilation of the mouth of the
 womb  and the  complete expulsion of the  child, and
 though of variable  duration,  is on the average, from two
 to four hours.  The third stage is the period between the
 birth of  the child "and the expulsion of the afterbirth.
  Symptoms of Labor.—A few days previous to the com-
mencement of labor, the womb sinks down in the abdo-
men, the presenting part of the child entering the pelvis.
The respiratory and digestive organs are thus freed from
pressure, and the female feels lighter and more cheerful 
LABOR.
39
 and comfortable than she has for weeks.  So marked is
 this, that she is not unfrequently tempted to assist, or do
 that she would not have  thought of a short time before.
 In  addition  to this, there is  a whitish discharge a short
 time before labor  commences, or at its commencement;
 this is termed the show.
  The first  stage of labor commences  with occasional
 pains, commencing in the back and passing round the
 womb to the front, and down to the groins.  They are de-
 scribed by the woman as cutting or grinding, and she some-
 times suffers as much from them as from the more severe
 pains of the second, stage.  As time passes, the pains be-
 come more severe, last longer, and recur more frequently.
  If the index finger is now introduced into the vagina to
 the womb,  its mouth will be found to dilate or grow larger
 as the pains progress, and a  smooth, round,  fluctuating
 mass fills the opening: this is the bag of waters.   When
 the pain is  on, this will be found pressed down and tense,
 but when the pain is off", it will be relaxed and flabby.   In
 the absence  of pain, if the finger is pressed up through
 the mouth  of the womb, the hard, round head of the child
 may be felt.
  After a  variable time, usually from  eight to  sixteen
 hours, the pains having become  as frequent as every five
 minutes, and quite  hard, the mouth of the womb will  be
 found dilated, and  the head of the child passing through
 it, and the  membranes rupture, and the waters are  dis-
 charged.   This terminates the first stage of labor.
  With the commencement of the second stage the pains
 change their character and  become bearing  down.   As
 time passes they become more frequent and severe, and the
 female wishes something to press her feet against, and to
 pull on with her hands in order to aid the pains.  She
does not complain much more  than in the preceding stage,
except when  a very hard  pain  occurs she is forced to cry
out.  These pains  gradually force the head of the child
 downward  in the pelvic  cavity, and at length it  may be 
40
MECHANISM OF NATURAL LABOR.
felt at  the  outlet,  pressing on the soft parts.   The pains
now become more severe, and at each  one the head is
forced against the soft structures, pressing them out, but
when the pain  passes oft the head recedes.  At  length
one  or more powerful and long-continued pains occur,
eliciting a cry of anguish from the  mother, and the head
is forced through the vulva.   The  next pain  is usually
sufficient to expel  the body of the  child, and  the  second
stage of labor is completed.
  After the expulsion of the  child, a variable period, of
from ten to thirty minutes, elapses in which there is no
pain.  Pains then come on, and  usually, with but  two or
three, the afterbirth is  forced from the womb into the
vagina, from whence it is discharged by the bearing down
efforts of the female, assisted  by the attendant.  In some
cases its expulsion immediately follows the child, and in
others its separation is slow and difficult, occupying sev-
eral hours, unless facilitated by  the skillful physician or
midwife.   This terminates the third and last stage of
labor.
  During the first stage, there is increased secretion from
all the soft parts, and they are observed to gradually relax
and become soft.  In the second stage, these secretions
are  increased, and the parts are  so bathed  and lubricated
as greatly  to facilitate the  passage of the child.  With
the expulsion of the child there is always a greater or less
discharge  of blood,  which  usually increases  while the
placenta or  afterbirth is being  detached,  and afterward
continues under the name  of lochia, or the discharge.  In
some cases the  mother will feel quite  chilly after the
completion of the labor, though this soon passes  off by
increasing the cover.

        MECHANISM OF NATURAL LABOR.

  A natural labor is one in which the vertex, or upper por-
tion of the head presents to the  inlet of the pelvis, and in
which the  labor  progresses favorably, and is completed 
             MECHANISM  OF NATURAL LABOR.          41

within a reasonable period of time.  Three other varieties
of labor are described,  preternatural,  difficult,  and  com-
plicated.  In  the  first, some other part of the child but
the head, presents, and in the  second the  labor is greatly
protracted, and in  the third it is complicated by some
occurrence that renders  it dangerous, as hemorrhage, etc.
  The natural position  of the  child  in  the  womb, is a
state of flexion—the chin on  the breast, the arms to the
sides, the thighs flexed  on the abdomen, and the legs on
the thighs.  In this position it forms an  ovoid body, the
vertex, or upper part of the  head, being the most depen-
dent part.  The child's  head is much  the largest part of
its  body, so that where  it will pass, the  body will  pass
easily.  If  we examine  the head of a child, we will find
its  least diameter to be  transverse, from  ear to ear, and
the next shortest  is its opposite, from the  neck to the up-
per portion of the forehead, as marked by the line from

                        Fig. 10.
Head of the  Child.
3 to 4, in Fig. 10.   These diameters, which give the exact
size of the head as it passes through the pelvis, measure
three  and  three-fourths  inches.  The child's head  then
presents the part marked by 2, and the long diameter of
the head, from 1 to 2, is in  the line of its body.  If the
head was not flexed, this would present to the pelvis, $nd3 
42           MECHANISM OF NATURAL LABOR.

being five  and one-half inches in length, of course  the
labor would be arrested.
Fig. 11.
    Cavity of the Uterus and Vagina at the period of Labor.

  Fig. 11 represents a section  of the female body, with
the cavity of the  uterus, and the parturient canal dilated
to its  full extent.   It  will be seen from this  that  the
uterus, acting upon the child, will  force its head directly
downward to A,  when it will be resisted by the sacrum.
To  make further progress, it will be thrown forward in
the direction of the curved line from  C to B.
  As the vertex  goes first, and is thus  thrown forward
under  the pubic  arch, the chin will  leave the  breast, as
seen in Fig. 12.   As it continues its passage, it will be
thrown still  further forward,  as marked  by the dotted
lines in the same  cut, Fig. 12.   No matter what  the posi-
tion of the head may be, and obstetricians  recognize four 
             MECHANISM  OF  NATURAL LABOR.          43

the occiput, or back part of the head, will be brought to
the pubic arch in a large majority of cases.  By referring
to the cut of the child's head, and comparing it with Fig.
12, it will be  seen that this must be  so, for some part of
the head must escape from the pelvis, in order to permit
of this  flexion, which brings the long diameter of the
head to correspond with the pelvis.

                       Fig. 12.
             Positions of the Head during Labor.

   The child's head having thus passed through the bony
 canal, the  body is expelled in the same line, and being
 smaller and more  flexible, this is accomplished without
 difficulty.
   The position of the child's head is  determined by the
 openings  in it.   If the  head of a newly born child be
 examined, a large square  opening will be found in the
 bones at the anterior part  of the  head; this is called the
 anterior fontanelle.  Passing backward from this, in the
 center of the head, the line of junction between the two
parietal  bones can be readily felt, and is called the sagital
suture.  At the posterior  extremity of this, is  another 
44
MANAGEMENT OF LABOR.
small triangular opening, called the  posterior fontanelle.
Passing from  this laterally, are two sutures, marking the
articulation of the occipital with the two parietal bones.
  If, now, in making an examination,  the finger comes in
contact with the small triangular opening, we are certain
that the vertex presents.  In some cases  this opening is
closed, but even in these  cases the  three lines of  sutures
coming together are readily felt, and the occipital  bone is
pressed under the edges of the parietal during a pain, and
thus becomes very prominent. The direction of the sagital
suture gives us the position of the head in the pelvis.
  It is not necessary to recognize  but two positions, an
occipito-anterior, and an occipito-posterior.   In the first
case,  the  triangular  opening will  be  to the front, and
either the left or right  side; in the second, it will be in
the posterior part  of  the  pelvis, and to the right  or left.
Labor is more difficult in occipito-posterior presentations,
because the head has to rotate  the entire distance  from
the posterior to the anterior part of the pelvis.

            MANAGEMENT OF LABOR.

  The mother will have  every thing prepared and put in
its proper place  preparatory to  her confinement,  leaving
nothing undone that may be required  at such time.  The
binder, or bandage, may be fitted to the body and laced,
but I  prefer a single thickness of drilling or stout  muslin,
about eight or ten inches wide, and hemmed.  Some put
whalebone in it,  to  prevent its wrinkling  up.  Cloths
should be prepared to receive the discharges, and two or
three  old quilts or comforts  to protect the bed.  For the
child, in addition to  its  proper clothing, two pieces  of
stout string, about the size of dress cord, should be made,
to tie the  umbilical cord,  or  navel  string, and a piece  of
soft linen to dress it.  Lard, soap, water and towels should
be placed where they can be readily procured.
  When the pains  come on so as to show that labor  has 
MANAGEMENT OF LABOR.
45
commenced, have the quilts spread on the bed, so that the
one next the female may  be readily withdrawn after the
birth of the child to remove the discharges, and thus leave
the person dry and comfortable.  It is not necessary that
she  should  go  to bed  as  yet, but the physician may be
sent for.  If none is to be in attendance, have the female
lie  down, and make an examination  to determine  how
much the mouth of the womb is open, and, in the absence
of pain, whether the evenly  rounded, hard head of the
child presents.   If it does,  there is no danger, but the
child will be born in due time, and without assistance.
  It is best  for the lady to walk about the room,  as it
renders the time less irksome, and is thought to increase
the pain.  When the pains become frequent and attended
with a desire to lie down, let her remove her clothing and
go to bed.  It is best to  have her under clothing drawn
up, so  as to protect them from the discharges, which obvi-
ates changing the  clothing after delivery.   Now let a
stout box be placed at the foot of the bed for her to rest
her feet against, and attach a  sheet to the footboard, for
her to pull with her hands.   In this way she is able to
assist herself and obtain the greatest advantage from bear-
ing down.
  When the waters break, we  know that the termination
of labor is not far distant.   Physicians now make an ex-
amination to determine  the presentation and position.
Now the head of the child  may  be plainly felt, and the
mother's  anxiety quieted by assuring  her that everything
is right.  As  the pains become more and more severe, she
should be encouraged to keep up her spirits, and not draw
back from the pains, but to bear down and assist them.
Especially should she keep  in one position, the one I
prefer being on the  back, with the knees drawn up  and
separated.
  When the  head commences to  distend the soft parts,
place one hand under the vulva, and gently support them,
making pressure  forward.   As the  child's head distends 
46
MANAGEMENT OF LABOR.
the opening, carry the hand forward with it, and when it
is  born it will be  received on the hand.  Now pass one
finger up the neck of the child  to  ascertain whether the
cord is wrapped around it, and if too tight, draw it down
so as to loosen  it.  Also,  pass  a finger into  the  child's
mouth to remove any  phlegm.  When  the  next pain
comes  on, the body will pass with  considerable rapidity,
and the child should be carried outward as it passes, with
both  hands.   When born, lay it  within the mother's
thighs, at the length of the cord. Now wipe your  hands,
see that the child is breathing freely, and proceed to  tie
and cut the cord.  Take a piece of stout string and tie it
very firmly, two inches from the body of the child,  then a
second piece and tie it an inch or two outward from the
first, and  divide the cord between  them with  a pair  of
scissors.
   Let the child be wrapped in some old woolen material,
and lay it at the  foot  of  the  bed, as the mother needs
further attention.   Place your hand on the lower portion
of her abdomen, and if you feel a hard roundness, the size
of a child's head, you may be satisfied that the womb has
contracted.  If not, gently knead it in various directions
until the womb does  contract into  a hard mass.   If it is
quite small, not larger than the child's head just born, the
afterbirth will  be  found  partly or wholly  within the
vagina; if large, it is probably yet retained. In such case,
in fifteen  or twenty minutes, make pressure on  the uterine
globe, and slight traction on the  cord with the other hand,
telling the mother to bear down at the same  time. If it
passes  into  the vagina, let  the  mother bear down hard,
and withdraw it by pulling upon the cord, twisting it three
or four times round, so as to remove the membranes.  Al-
ways examine the afterbirth, to see whether it is smooth
and round, or if any portion  has been left, as  an  intelli-
gent account of this will sometimes prove a valuable guide
to the physician  if any  unpleasant symptoms  should
arise. 
                 MANAGEMENT OF LABOR.              47

   The afterbirth having passed, apply a folded cloth to
the vulva, to  receive the discharges,  and withdraw the
uppermost quilt  in order to remove the  blood and dis-
charges.  Now apply the bandage, pinning it evenly and
comfortably tight, and if the mother is thin in flesh, it is
well to use a compress over the womb.
   The child is now to be attended to, washed and dressed.
Have a basin  of  warm water, lard, soap, soft towels, pins,
and its clothes placed in easy reach.   Then, with the lard
thoroughly grease the  child from  head to foot, wiping it
oft* before washing with a soft flannel or cotton cloth, to
remove the  greasy secretion  that  covers the  skin.  Now
wash it thoroughly with soap and water, paying especial
attention to the  folds of the arms, groins, neck and legs,
that the skin is perfectly clean.  Have a piece of soft
linen, about six inches square, and fold it with the corners;
and with the scissors cut the point off so as to have a cen-
tral opening to pass the naval cord through, grease it, and
apply, the cord passing through  the hole in the centre.
Lay the cord upward  and to the left  side, and fold the
linen cloth  over it, and apply the bandage.   This had
better be  of cotton in  the  summer, and  woolen in the
winter, and should be pinned evenly  and not too tight.
   The child having been dressed, should be  put to the
breast, in order that its nursing may cause the womb to
contract firmly.   Many nurses wish  to give it something
to take the phlegm out of its throat  and move its bowels,
as urine and molasses, whisky and  molasses, castor oil, etc.
The child does not need anything, and the nurse should
not be allowed to dose i$ under any circumstances.
   The milk first drawn from the breast possesses laxative
properties, and its bowels will move  in the first thirty-six
hours,  passing off the meconium.  If it does  not pass its
water apply hot cloths to the lower part of the bowels.
  The child should be washed  and  dressed  daily,  using
care to prevent  excoriation of the tender skin, and it
Bhould not be allowed to remain  wet  for any length of 
48
MANAGEMENT OF LABOR.
time, as this sometimes produces irritation.  From  the
sixth to the tenth day the  navel  cord separates, and  the
navel should then be covered with  a  soft cloth  spread
with mutton tallow.  If it remains sore for some time, it
may be dressed with the  elder ointment, No. 86.   If its
neck becomes sore,  or behind its ears, the same applica-
tion will speedily heal it.
  The mother should be kept very quiet  in bed  for the
first three or four days,  and not allowed to raise up in the
bed herself.  Her diet should be light, as toast and  tea,
crackers, light soups, potatoes, coffee,  etc   After the third
day she  may be allowed  meats,  and  gradually return to
her usual course of living.   She should not get out of bed
before the fifth day,  and then only to  have her bed made;
after this she may sit up a short time each day, until  she
is able to be up constantly, about  the  ninth to the twelfth
day.  The cloths applied to the vulva should be frequently
changed, and the parts sponged  daily with warm water
and castile soap.  If there is great soreness, they may be
bathed  with one part  of tincture  of arnica to four of
water.                        ,
  By the second or third day, the milk comes freely, and
now the mother will have some fever, with headache.  As
the bowels have not moved up  to this time, it is well
enough to give  a  mild laxative,  which will also remove
the fever.   Castor-oil will  answer, or a seidlitz powder
may be taken, or a dose of the compound powder of jalap
No. 7.
  The lochia is the discharge from the vagina, which con-
tinues from  eight to fifteen days after the birth  of  the
child.   At first it is  pure blood, but in three or four days
it becomes light colored, and by the ninth day is colorless.
The nurse, or mother, should notice  the amount of this
discharge, and  especially any arrest of it.  If it becomes
scanty,  the mother  will be feverish  and  feel  bad, with
pains in various parts  of  the body,  and  soreness in  the
region of the womb.  To  bring the discharge back, or 
MANAGEMENT OF LABOR.
49
 increase it, when deficient, make a strong pennyroyal tea,
 and let her drink it freely; it  is the best remedy known
 for this purpose.  If the discharge  should be profuse and
 weakening, give essence  of cinnamon in doses of half a
 teaspoonful every hour or two.
   Sometimes the breasts become painful, from too great
 distention with milk.   In  this  case let them  be bathed
 with an  ointment composed of camphor, half  an ounce;
 tincture of arnica, one ounce; lard, two ounces. In some
 cases it is best to use it warm.  The breasts should also
 be kept well drawn out, either  by the child, or some other
 person, or with a breast pump; or, what  is  an excellent
 plan, by a young pup, which should be kept for the pur-
 pose until the necessity is over.
   Occasionally the young mother's nipples  are so small
 that the child can not get hold of them, much to its dis-
 gust and annoyance of the mother.   A breast  pump will
 frequently draw them out sufficiently;  or take a  pint
 bottle and fill it with warm water, when as hot as  the
 breast  will bear it, pour the water out and  immediately
 apply above the nipple.
   Very frequently the nipple becomes  chapped and fis-
 sured,  and exceedingly tender and sore.   The child's
 nursing is very painful, and  frequently causes the mother
 to cry out, and brings  tears  into her eyes.  They are dif-
 ficult to cure, as the continued nursing of the child keeps
 them irritated.  In some cases it is  best to get a nipple
 shield from the nearest drug store, for the child to nurse
 through, and  thus protect the  nipples.  If it  refuses to
 nurse through it, as is sometimes the case, fill  the shield
 with  warm milk before it is applied, which will usually
 cause the child to take hold.  The elder ointment, No. 86,
 or the Mayer's ointment, No. 85, will be as  good applica-
tions as can be made, to heal the nipple up.
  Sometimes the child refuses to nurse, and  cries  and
kicks when put  to the breast.  Some care will be neces-
sary' to overcome this.   Always put it to the breast when
          4 
50
DIFFICULT LABOR.
it is in a good  humor, and  let the mother be in propel
position to  give it the breast before it is disturbed.   In
this way it can be got to take hold and nurse.  Under no
circumstances must  it be  fed, as  it may thus refuse to
nurse at all, but starve it until it does take hold.
  After-Pains. — With the second or third child,  the
mother has more or less  pain after delivery, which are
termed after-pains, and are more  and more severe each
succeeding pregnancy.  They are  similar to  the pains of
labor, lasting for two  or three minutes, and then passing
entirely off, to recur in fifteen minutes  or half an hour.
In some cases they are very severe  and annoying, so that
the mother will  say that she would rather suffer from the
pains of labor.  In the milder cases they continue for  one
or two days, but when severe they rarely last less than three
or four days.  They are usually increased when the child
takes the breast.  These pains are necessary to the well
being  of the  mother, and should  never be  entirely ar-
rested, but in most  cases they may be so modified as to
•give the  necessary  rest and  prevent undue suffering. I
generally give the diaphoretic powder, No. 20, in doses of
five  grains, but  if this can  not be obtained, twenty drops
of paregoric may be used in  its stead.  The dose may he
repeated as often as it is necessary until the pains are mit-
igated, but should not be continued to stop them.

                DIFFICULT LABOR.

  A labor may  be difficult or lingering, and yet terminate
unaided  with perfect safety to both  mother and child.
Labor is a physiological function, and the female body is
adapted to  meet nearly any circumstance  that  may pre-
sent in its  progress.  Thus we may say, that in every
hundred labors, nature will be sufficient to accomplish the
delivery of the  child in ninety-nine, the other case requir-
ing artificial assistance.
  As we  have  already seen, the first stage of labor may 
DIFFICULT labor.
51
 be very greatly protracted without danger  to the female,
 if the membranes are not ruptured.  It is very annoying.
 however,  and frequently exhausting, and when possible
 and prudent, means may be used to facilitate its progress.
   Inefficiency of the Pains.—In many cases  the  labor
 progresses slowly, because the pains are irregular or weak,
 or come on slowly.   In these cases a great amount of pa-
 tience must be exercised, and the woman encouraged by
 the certain assurance, that after  awhile the pains  will
 become right.   In  many cases, if she walks  about the
 room in the absence of pain, they will be much increased.
 In others a cup  of warm  ginger tea  may be taken with
 advantage.  Nothing more than this  is advisable until a
 physician is called.
   Rigidity of the Os.—Rigidity of the os uteri,  or mouth
 of the womb, is occasionally a cause of difficult labor.  In
 these cases the  pains are hard, and sufficiently frequent,
 but the labor makes no progress.   If  the finger is intro-
 duced to  the mouth of  the womb, it will be found  hard
 and rigid, and it dilates very slowly as the pains continue.
 In this case we find lobelia to  be  the  most efficient
 remedy.  We emplo}^ the  tincture in doses of half a tea-
 spoonful every fifteen minutes  until  it produces  nausea,
 when the  mouth of the womb will become soft and  yield
 to the pains.
   Toughness of  the Membranes—The membranes con-
 taining the waters are sometimes so tough and unyielding
 as to resist the progress of the child. In this case they will
 be pressed down to  near  the outlet, and will be felt to be
 tough and tense during a pain, and do not  advance.  In
 such case  we scratch or pinch a hole through them with
 the fingers, and permit the waters to escape, when the
labor will  again proceed.
  Rigidity of the Soft Parts.—Rigidity of the vagina and
soft parts closing the outlet of the pelvis, is sometimes the
cause of slowness.  We may rest assured  of one thing in
 these cases, and  that is, that nature is  competent to effect 
52
difficult labor.
their  dilation without assistance, as cases are on record,
where the child passed through  the vagina, that, previous
to labor, would scarcely admit the finger.
  Distension of the Bladder.—This sometimes obstructs
the passage of the child and protracts the labor,  especially
if the bladder is carried down before the head.  In all
cases  it should be borne in mind to keep the bladder free
from  urine, by frequently passing it as the labor proceeds.
When the bladder is carried down before the presenting
part of the child, the female will be unable to  pass her
water, and a physician should be  obtained as speedily as
possible, as it will have to be drawn off with  a catheter.
   Constipation.—The rectum is sometimes so filled with
fseces that it offers an obstruction to the passage of the
child.   This may be determined  on examination, by the
projection and hardness at the posterior part of the vagina.
It should be a rule that the bowels must be moved before
labor comes on.  Therefore, if a woman's bowels are cos-
tive, let her take a good dose of castor oil when the pains
first commence, or instead of this, use an injection to in-
duce  a passage.  During labor, if this is thought to be a
cause of difficulty, let large  injections of warm water be
used until an operation is obtained.
   Small Pelvis.—Disproportion between the head of the
child and the mother's pelvis is  a not unfrequent cause of
protracted labor.  This may arise from a natural smallnesa
of the pelvis, from some deformity of it,  or from the child
having a very large head.   In these cases the labor is very
tedious, protracted  and  painful,  but even  here nature
makes  the necessary provision in many cases.  As the
pains act upon the child, its head is  gradually elongated,
and forced into the shape of a wedge, and finally it is thus
adapted to the size and shape of the pelvis.  The mother
and nurse are frequently surprised and alarmed at the un-
natural shape of the head, but they can be assured that m
a few days it will assume its natural condition.
   Patience is a great virtue in these cases, and time often 
DIFFICULT labor.
53
works wonders.   If the head of the child advances, no
matter how slowly, and the soft parts kept cool and moist,
there is no danger.  On the contrary, if the female be-
comes feverish or exhausted, the soft parts being hot and
dry, interference is demanded, and a competent physician
should be in attendance.
   The means made use of in these, and other cases of dif-
ficult labor, are the use of the forceps, or perforating the
child's head.   The forceps are two blades of steel, jointed
together, and act like a pair of hands applied to  the side
of the child's head.  They are used instead of the hands,
because there is not space enough for them.  In the hands
of the careful physician, their employment is not attended
with danger, and very frequently the labor is speedily and
successfuly terminated by their use.  In the most difficult
cases, when no other means avail, the head of the child
is perforated with instruments, the  brain  broken  down
and removed, and the child is easily extracted.   Neither
the forceps, nor these instruments, are used if they can be
avoided, and are  only resorted to, to save the life of the
child or the mother.
   Labor is more difficult in face presentations, than when
the vertex  presents.   The pains are usually more severe
and distressing and the child passes slowly. Patience is
all that is requisite, however, as nature is sufficient for the
delivery.  We determine a  face presentation  by feeling
the eyes, nose, mouth, chin and forehead.   In these cases
some swelling and deformity of the countenance may be
expected, and the mother should be so informed before
the child is born.
   If the forehead or an ear presents, the labor will be still
more difficult, though in these cases nature will frequently
rectify the mal-position.   A skillful physician will  soon
overcome  the difficulty, and the labor will progress as in
a natural case. 
54
PRETERNATURAL LABOR.
            PRETERNATURAL LABOR.

  A preternatural  labor is one in which some other part
of the child than the head  presents, when there is more
than one child, and in cases of monstrosity.  Next to the
head, the breech presents most frequently, and the side or
shoulder of the child, least frequently.
  Breech Presentation.—A breech or foot presentation
may be determined by the softness of the presenting part,
and the depression between the legs and the genital organs.
Labor is not always more difficult in these cases  than in
natural labor, and in but very few is there much difficulty
in the birth of the child.  The breech is observed to pass
downward under the influence of the pains, in  the same
manner as the head.  The mouth of the womb  dilates,
the bag of waters is formed and ruptured, and finally the
breech appears at the vulva.  As the  labor continues the
body is forced down, and finally the head, the largest and
most difficult portion, is passed from the vagina.
  The  management of a case of this kind does not differ
much from a case of natural labor.  Nature accomplishes
the work in a regular and orderly manner.  The perineum
should be supported  as before, when the  child is passing,
and  as  soon as the  lower part of the body is born,  the
hands should be drawn down.  In all cases the back part
of the  head  of the child must come to  the front of the
pelvis,  and if this is not being done, grasp the body of the
child with the hands, and gradually effect the desired ro-
tation as it passes  down.   The most difficult part of the
labor is the passage  of the  head  of the child from the
vagina, as it is now outside of the womb and can not be
acted on by it.  In such case we elevate  the  body of the
child gradually, and tell the mother to bear down strongly.
If this  is not sufficient, two or three fingers are introduced
under the head and passed  into the mouth.  Now,  the
body of the child being raised, it can be drawn upon, and
force exerted on the mouth sufficient to  extract the head. 
PRETERNATURAL labor.
55
   In these cases, and even in natural labor, the child may
 seem still-born, it  does  not breathe, and the  heart acts
 very feebly, or not at all.   Have some cold water imme-
 diately brought  to  the bedside, and sprinkle it with con-
 siderable  force  upon the face  and breast.  At the same
 time let  the child be turned slowly from its back  to  its
 breast, to induce respiration, or let the plan be adopted
 that we  named  for the apparently dead, in volume 1.   In
 some cases  the  lungs may be  inflated by applying your
 mouth to the child's, being  careful not to produce  too
 much pressure.  In others it will be of advantage to give
 the  child a warm bath.   The umbilical cord should not be
 cut  for some time  in these cases, especially if there is the
 slightest pulsation.   Care and perseverance will  sometimes
 accomplish  wonders in such cases.
   Shoulder Presentation.—A shoulder or side presenta-
 tion is one of the  most difficult and dangerous cases of
 labor.  It is impossible that the. child should be born  by
 the  unaided powers of the system, unless it is a  premature
 birth, and the pelvis is very large.   The early attention of
 a skillful physician will, in this case, save  the fife of both
 mother and child.
   The symptoms of the  first stage of labor do not differ
 in any respect from  natural labor,  further than the womb
 dilates slowly, and the bag of waters is elongated in place
 of globular, and sometimes the arm or hand can be felt in
 it.   When  the  waters  are discharged, the shoulder is
 pressed down into the pelvis, and is the only part that can
 be felt.  If the  child is not  turned,  the  pains are very
 severe, but inefficient, the female's strength becomes  ex-
 hausted,  hemorrhage sets in, and, becoming profuse, she
 dies.
   Such  cases should be recognized before the waters
break, if possible, and when this occurs the child should
be turned.   To the  dexterous physician the child is turned
at this time as  easy  as the operation is described.   The
hand is  introduced  into the womb,  a foot found  and 
56
PRETERNATURAL LABOR.
grasped, and drawn down to the mouth of the womb.
The presentation is thus changed from  a shoulder to a
breech, and the labor proceeds without difficulty.  Where
the waters have been  discharged  for a considerable time,
and the pains  are strong and frequent, turning is accom- ^
plished with great difficulty, and in some cases can not be
done.  Hence it would become  necessary  to  make  an
opening into the side of the child, to permit  its expulsion.
  Twins and Triplets.—In cases of twins, the labor is not
unfrequently as easy and speedy as if there  was but one
child, though in most cases it is slower.  One child usually
presents by the head, the other by the breech, though this
is not always the case.  These labors should be managed
as heretofore described.  When one child is born, tie and
cut the cord and remove it, and wait for the expulsion of
the second and third, which are treated in the same man-
ner.   The afterbirths will  usually be separate, and will
not generally pass until the birth of the last  child.
  Monsters.—In some cases  the  foetus is abnormally de-
veloped, and  in this case is termed a monstrosity.  Some
have two heads, others part of two bodies, and some seem
to be two children joined together.
  We can  hardly  ever determine what the nature  of
the difficulty is, but we may feel  that the natural powers
of the system are sufficient  in a majority of cases to effect
the delivery.   The  Siamese twins, and hundreds of other
cases as difficult, have occurred, and the mother safely
recovered.  In one  case  of this kind the labor was very
severe and  protracted, and the  physician found it impos-
sible to  determine the reasons for it.  In time, however,
one head made its appearance at the vulva and was born;
then the second head came  down and  passed through the
pelvis, and finally the body was born.   Though the mother
suffered severely during the protracted labor, yet she got
up well, and is still living. 
                  complicated labor.                °«

              COMPLICATED LABOR.

  Labor may  be complicated with disease, or accidental
occurrences, that will render it dangerous to the mother.
These cases demand great care and skill in their manage-
ment, and should  always  be entrusted to the physician.
If from any cause, trouble is anticipated, obtain the  ser-
vices of the most skillful physician in this branch that
can be had, and have him in attendance at an early period
of the labor.
  Of these complications, hemorrhage,  or flooding, is of
most frequent occurrence,  and is  usually regarded as most
alarming.  It  may occur previous to, and during the first
stage of labor, after the expulsion  of the child, and after
the birth of the placenta.
  Unavoidable Hemorrhage.—The severest form of hem-
orrhage arises from the attachment of the afterbirth over
the mouth of the  womb, so  that when the os is dilated,
the  afterbirth is more or  less detached, and blood is dis-
charged from  the  open vessels; hence, it is  termed una-
voidable.  In these cases flooding  usually occurs previous
to the coming on of labor, sometimes as early as the sev-
enth month.  It comes on  as well at night, when the
female is asleep in bed, as  it  does when  she is going about,
the first evidence she has being the free  discharge of blood.
Continuing for a time, it  ceases itself,  to again reappear
in two or three weeks.  In this way it  may occur several
times before labor comes on, in some cases producing great
exhaustion.
  With the first pains of labor, hemorrhage  comes on,
and  continues to  increase as the  mouth of the womb
dilates.  Sometimes it is  so profuse as to  exhaust  the
female in a short time, but in others it  is not so marked.
If the womb contract strongly, so  as to force the head of
the child down firmly into the mouth of the womb, labor
may be  accomplished without much risk, but this is very
rarely  the  case.  In  the  majority of  instances,  skilled 
58                complicated labor.

assistance must be at  hand early  in the  labor to save the
life of the mother.
  In  these  cases, if a physician  can not be obtained at
once, saturate  cotton cloths  with a  strong solution of
alum, and gently pass them up to the womb, then filling
the vagina so that the blood can not escape.  Let them
remain  until the physician  arrives, keeping the patient
perfectly still.  If he  can  not be obtained, the labor pro-
gressing, and the  discharge so profuse that it is evident
that she can not survive long, let an attendant pass her
hand into the vagina, detach the afterbirth and  withdraw
it.   This will, in  most cases, stop the flooding, when the
case may be left to nature.  No internal medicines do the
least good, and it is worse than useless to give stimulants
to keep up the strength as long  as the cause of the hem-
orrhage continues.  If the patient faints, it is all the bet-
ter for her, and she should not be aroused, as during the
fainting the discharge of blood ceases.
   Except this, hemorrhage  very rarely occurs before the
birth of the child, except from great exhaustion.  In these
cases, a tincture of the oil of cinnamon, in doses of from
half to one teaspoonful every few minutes, is one of our
most efficient means.   Gallic acid, in doses of five grains,
may be used, and brandy  or whisky given to support the
strength.
   Hemorrhage After the  Birth of the Child.—With
the expulsion  of the child  there is  always more or  less
 discharge of blood, and it usually amounts to from half a
 pint to one pint.   In some cases the flooding is so profuse
 that the mother can feel it running from her, and the bed-
 clothing soon becomes saturated.  It may commence im-
 mediately, or a  short time after the child is expelled, and
 before the expulsion of the placenta.  When very severe,
 the  mother becomes pallid and faint, the pulse being
 feeble; symptoms which at once attract attention.
    Immediately  place the hand on the lower part of the
 bowels, and knead  them with  firm pressure, until  the 
COMPLICATED labor.
59
 womb contracts.  At the  same time make  traction on
 the  cord, to stimulate  contraction and the  expulsion of
 the  placenta.  The  tincture of oil of cinnamon may be
 given internally, and  frequently repeated, or  the  gallic
 acid used; if neither can be obtained, use the  nutmeg and
 alum as heretofore recommended.  Cold applications may
 also be used.
   If the hemorrhage is so profuse as to quickly endanger
 the life of the woman, and  medical  attendance can not be
 obtained immediately, roll up your sleeve and  pass your
 hand into the cavity of the womb.   If you are frightened,
 now wait until  you  recover the use of your faculties, and
 then grasp  the  afterbirth, which will  almost always be
 loose.  Still  keeping your  hand in the  womb, where it
 acts as a stimulant,  and while the arm as a  plug checks
 the flooding, knead the  womb with the other hand until it
 contracts, forcing out both hand and afterbirth.
   Continuing the internal  remedies, let a bandage and
 compress be tightly applied, and  keep the  woman per-
 fectly quiet.   The same means will  be employed in flood-
 ing after the afterbirth is discharged.
   The mother should use great  care after such  a hemorr-
 hage, as exertion, or raising up in bed may bring the flood-
 ing  back.   Careful  nursing, however  and remaining in
 bed  for a longer period will obviate all its effects.   It is
 not best to use  .stimulants  after flooding, except with the
 advice of a physician, and the diet should be  such as will
 digest easily and quickly, and not burthen the digestive
 organs.  I prefer animal broths in these cases, as beef tea,
 or mutton or chicken broth, with crackers or bread.
  Retention of the Placenta.—As  heretofore remarked,
the placenta, or afterbirth, may be retained for an hour or
more, from want of pain, but will at length  be discharged
without trouble.  In many of these cases it  is detached
from the uterine wall and will be found at  the mouth of
the womb, which it covers like a button in a button hole.
The womb may not be sufficient to expel it at all when in 
60
complicated labor.
this position, hence physicians  always" remove it in such
cases.   The cord  is grasped with  one hand  and made
tense, and the finger of the other hand is passed up along
it as a guide, until the edge of the placenta can be felt;
the finger is then  hooked over it and the edge is drawn
down, thus removing it easily as we would unbutton a coat.
  In other cases it passes into the vagina, but this canal is
so relaxed and powerless that all the efforts  of the woman
are not  sufficient for its expulsion.   In this  case twist the
cord three or four times  around the fingers and  make
steady traction, telling the mother to bear down forcibly.
If a reasonable length of time has elapsed, and  it will not
pass, introduce a finger and hook it over the edge, or into
its substance near the cord, and with the bearing down of
the female it  may readily be withdrawn without  much
force.  The same plan should be pursued when the cord
has been broken off.
  There are rare cases in which the afterbirth is morbidly
attached to the uterine wall, and requires the introduction
of the hand into the womb for its removal.   This does not
occur, however, once  in one thousand cases.  In others,
there is  irregular or hour-glass contraction,  and the after-
birth is  retained on this account.
  Recollect, that  in  any case, there is  no  immediate
danger  if the mother is  not flooding, though  she never
can be considered safe until it has passed.   As its detach-
ment and passage  from the womb depends upon its con-
traction, or pain,  stimulating this by pressure  over, or
gently kneading the uterine globe, is one of the most ef-
ficient means.
  Inversion of the Uterus.—In some very rare cases the
womb is turned inside out, after the birth of the child, and
is found  in the  position represented by Fig. 13.  It has
been supposed by many  authorities that it was always
caused by pulling  on the umbilical cord.  It  is now be-
lieved that it depends upon its own irregular contraction,
though  too great  force applied to the cord is the most 
COMPLICATED LABOR.
61
frequent  exciting cause.   The symptoms attending this
accident are profuse hemorrhage and alarming prostration,
the womb being found in the unnatural position repre-
sented.
                      Fig. 13.
Inversion of the Uterus.
   There are few women with nerves strong enough to at-
 tempt to rectify the difficulty, and they should  not at-
 tempt it  if a physician can be obtained in  a reasonable
 time.  If no help can be  had, peel off the afterbirth, and
 in the absence of pain, press the hand firmly against the
 center of the tumor and press it back to its  proper posi
 tion.   Of course the hand will be within the cavity of the
 womb, where  it should be retained until it contracts into
 a globe.
  Rupture of the Uterus.—This is  one of  the  most
dangerous accidents of labor, and is invariably fatal to the
mother, though the child's life may be saved.   It is, how-
ever,  of very  rare occurrence, and hence is  little to be
feared.  The uterus always gives way during a pain, and 
62
COMPLICATED LABOR.
a portion, or all of, the child escapes into the cavity of the
abdomen.  The  symptoms are very plain: the female ex-
periences a sharp cutting sensation, and feels that some-
thing has given way, and in a moment there is very great
prostration, fainting, or even death.  The physician passes
his hand into  the womb, and even through the opening
into the  abdomen, and grasping the child by the feet, ex-
tracts it.
  Rupture of the Perineum.—The tissue  closing up the
space between the vagina in front, and the bowel behind,
is  called  the  perineum,  and this may give way during
labor.  It is usually caused by too rapid  passage of the
child's head, and sometimes by rigidity of the soft parts.
  It may be avoided by properly supporting these  struc-
tures  during the last stage of labor, and  especially by
cautioning the mother against bearing  down while the
head is passing through the vulva.  Much harm is  some-
times done by the attendants constantly telling the fe-
male " to bear down," and insisting that she shall  bear
down harder.   When the soft parts are rigid and unyield-
ing, strict attention should be paid to this matter.
  The results of this accident, when it is  severe, are  very
deplorable, as  the female can  not retain the contents  of
her bowels,  and there is constant tendency to  displace-
ment  of the pelvic  organs.  There  is  one consolation,
however, and that is, that it can be permanently cured by
a surgical operation.
  Puerperal  Convulsions.—The occurrence of convul-
sions  during labor, is  a very serious matter, and in some
cases  will prove  fatal in  spite  of all treatment.   The
causes of puerperal convulsions are obscure, and vary  in
different  cases. In some cases it is undoubtedly depend-
ent upon  deranged action of the kidneys for a  long time
previous, by which the blood is  poisoned.  In others, it
depends upon  an irritation  of the nerves, produced  by the
labor.
  The symptoms  are very marked, and can not be  mis- 
CHLOROFORM  IN LABOR.
63
 taken.   All at once  the  female  becomes entiiely uncon-
 scious, and has more or less violent convulsive movements
 of all parts of the body.   Every function of the body is
 violent, even to the breathing, which is hissing.  The con-
 vulsion may last but a minute, or it may continue for five,
 ten, or fifteen minutes, when it passes off, to  recur again
 in a very short time.  Thus it continues, the paroxysms
 becoming  harder, and the intervals less, until it is arrested
 by medicine, or the sufferer dies.
   Of course, a physician  will be called as speedily as pos-
 sible.  Until he comes, give a teaspoonful of tincture of
 lobelia, every five minutes, in  the intervals  between the
 convulsions, until it produces vomiting, or the convulsion
 passes off.   To assist its  action, use an injection into the
 bowels of three teaspoonfuls of tincture of lobelia, one of
 laudanum, to half a  teacupful of  tepid water, retaining
 it by pressing a towel against the rectum.

             CHLOROFORM IN LABOR.

   "The distress and pain," observes Dr. Denman, " which
 women often endure while they are  struggling through a
 difficult labor, are beyond all description, and seem to be
 more than human nature would be able to bear under any
 other  circumstances."  And, as Dr.  Simpson  remarks,
 " even the amount of agony endured  in most cases  of
 natural parturition, are abundantly severe.  Viewed apart,
 and in an  isolated light, the total sum  of actual pain  at-
 tendant  upon common labor, is  as great, if not greater,
 than that attendant upon  most surgical operations.  It  is,
 I  believe, education and custom, and perhaps the idea of
 its inevitable necessity, which have made physicians look
 upon  the degree of natural pain and physical  suffering
 accompanying  natural parturition, as less  deserving  of
consideration than it actually is.
  " Is it right," says  the same author, " for the physician
to interfere with these fearful sufferings and  agonies, in 
64
CHLOROFORM in labor.
order to save and shield his patient from the endurance of
them ?  Is it proper for him to  exercise the  skill  of his
art so as  to moderate and remove  these  ' intolerable
pains ?'  Would it be fit and meet  in him to use human
means to assuage the pangs  and anguish attendant upon
the process of parturition in the  human mother?"
  These questions present themselves to every physician
and to every mother.  Is it necessary that she  should bear
these pains ?  Not at all, because we have in chloroform
an  agent  that will render her  unconscious to suffering
until the labor is completed.   Some claim that the admin-
istration of chloroform for this purpose is in direct oppo-
sition to the will  of the Almighty, who said,  " In sorrow
shalt thou bring  forth children."   Let these learned doc-
tors bear  such pain for a  few hours, and their religious
scruples would vanish into thin air.
  The important  question with  the mother is, is it safe?
This I can answer in the affirmative, as in my practice I
have never seen the slightest ill  effects, either during the
labor or in getting up.  My partner,  Dr. R. S. Newton,
has employed it in nearly every  case he has attended  for
the last ten years, without a single accident;  and this is
the testimony of Dr. Simpson,  who has administered it
in over a  thousand cases of labor.  Its benefits  are thus
graphically described by the  same writer:
  " The practice of anaesthesia in midwifery not only
saves the mother from the endurance of unnecessar}7 men-
tal anxiety and unnecessary  physical agony,  it saves her
also from  some of the dangers attendant upon parturition,
by husbanding her strength  and warding off the effects of
that exhaustion and  nervous depression which .the pains
and shock of delivery tend to  produce.  In  most cases
the mothers, after delivery, on  waking from their anaes-
thetic sleep, have expressed  their surprise at their  own
feelings of strength and well being; and many who have
borne children previously, have  gratefully declared to me
the great  difference which they  have found between their 
puerperal  fever.
65
 condition  after being delivered under  anaesthetics,  and
 without pain and suffering, and their state of prostration
 after former labors, when they were subjected to  the  en-
 durance of all the  usual' pangs and agonies' of  parturi-
 tion.  Nor does the benefit end here.  By annulling  the
 parturient pains  and shock, and their direct and  primary
 depressing effects  upon the constitution, we ward oft", I
 believe, to a more  or less marked  extent, the chances and
 dangers of  those  secondary vascular excitements which
 are ahvays apt to follow directly upon them.   We  increase
 the chances of a more speedy  and a more healthy conva-
 lescence ; and  both patients and  practitioners have, as a
 general rule, had occasion to  observe, that the period of
 convalescence has been evidently  curtailed and shortened
 by the previous adoption of anaesthesia  during delivery."


               PUERPERAL FEVER.

   The lying-in woman is liable to a severe form of fever,
 which is called puerperal fever. It makes its appearance
 in  the majority of cases before  the ninth  day,  usually
 about the second or third day.   In  some cases it is undoubt-
 edly caused by cold, in  others it results from  the  absorp-
 tion  of decomposing animal matter from the  womb or
 vagina, and in others it arises from epidemic or contagious
 influence.
  'It has not been  definitely determined, as yet, whether
 the disease is contagious or not, yet some circumstances
 go  to  show that it is.   Thus,  an eminent physician  in
 New York, doing a very large obstetric practice, had it to
 occur in every case  that he attended one season, and had
to quit his practice, while others in the  same neighbor-
hood  did not have a single case. Such facts  as these
would go to prove  that it would be very hazardous for a
practitioner who is attending a  case of puerperal fever,  to
continue to attend women in labor.  Mothers  should ex-
               5 
66
phlegmasia dolens.
».         ercise a sound discretion in this  matter, and if the family
          physician was thus objectionable, obtain some one else.
            Symptoms.—Puerperal fever usually  makes its  appear-
          ance with a severe  chill, and pain  and  soreness in the
          region of the womb.  This chill will  frequently last for
          several hours, and is succeeded by a high fever.  The skin
          becomes very hot, dry and  husky, the pulse frequent and
          hard, the tongue dry and parched, the  bowels bound up,
          urine scanty, and the nervous system much excited.  As
          time passes the symptoms become more severe, the lochial
          discharge and the secretion of milk are arrested, and the
          patient is delirious.  By the third or fourth day the symp-
          toms will be very severe, and the most  casual observer
          will observe that it is a very grave case  of disease.
            Passing  on beyond the seventh day, the  strength is
          much exhausted, and typhoid symptoms  are marked.  The
          tongue is brown or black, dark accumulations around the
          teeth, the bowels are swollen and  very tender, and the
          lochial discharge, if not  arrested, is very  offensive.  Day
          by day the patient becomes weaker, and all the symptoms
          more severe, until at length, if not arrested by treatment,
          the patient dies.  In  the main the symptoms are those of
          the severest typhoid fever, and the treatment and manage-
          ment the same.  The patient should be  early under the
          care of a skillful physician, and his  directions as regards
          treatment and nursing should be implicitly followed, using
          that sound discretion which comes from  knowledge, aiid
          which  it has been my object in these two volumes to cul-
          tivate.

                 PHLEGMASIA DOLENS-MILK LEG.

            This is a disease of the puerperal state, and usually oc-
          curs between the fourth day and third week after delivery.
          It may make its appearance in first labor, but in a ma-
          jority of cases it occurs in women who  have borne several
          children, and in those of a delicate  and  lax habit.  The 
PHLEGMASIA DOLENS.
67
 cause of the disease is not well known, though it is sup-
 posed to arise from cold or over exertion.
   Symptoms.—The  disease  is usually ushered in  with  a
 chill of greater or less severity, which is  succeeded by
 fever.  With this the patient complains of  pain  in the
 lower part of the abdomen, loins and groin,  not very se-
 vere, but a source of aching and soreness.  In a short time
 one of  the limbs commences swelling, and there is severe
 pain and tenderness in it.  In the majority of cases, the first
 marked evidence of the disease will  be slight enlargment
 and hardness of the calf of the leg, and when felt of, it will
 seem to be fast to the bone, and pressure on it will pro-
 duce considerable pain.
   The  leg gradually increases in size, and is white, pale
 and shining; it is usually warmer than natural, though in
 some cases it is colder than the other limb.  At the com-
 mencement of the swelling  it will  pit on pressure, but
 afterward becomes so tense that no impression can be made
 upon it.  The entire limb is tender  on pressure, but this
 is especially marked along the course of the femoral vein,
 which may be felt hard and  rolling  under the finger like
 a cord.
   The disease is usually very slow, and the swelling may
 continue for six  or eight weeks,  or longer,  though the
 fever usually subsides by the ninth  day.  In  some cases
 the disease becomes chronic, and lasts for many months,
 or even years.   In others, the inflammation is very high
 and terminates in suppuration, extensive abscesses being
 formed  in the thigh, giving rise  to a great  amount of
 suffering and prostration.
  Treatment.—Always get a good physician if it is pos-
 sible; if not, the following plan may be adopted:   Have
the bowels freely moved with solution of citrate of mag-
nesia, or equal parts of  compound  powder of jalap and
cream of tartar, and keep them moderately open with the
same, through the entire course of the disease.   Add to a
 common sized tumblerful of water  (four ounces)  thirty 
68
phlegmasia dolens.
drops of tincture of veratrum, and twenty drops of tincture
of aconite, and give it in teaspoonful doses every hour,
when the patient has fever, and every two  hours when
the fever has subsided.
  Have a large bucket of water hot, add mustard to  it,
and bathe the feet for half an hour, adding hot water to
keep  it as warm as the patient can bear it, at  the same
time using an infusion of pennyroyal, which may be con-
tinued as a drink throughout the disease.  After the first
three or four days, all the medicine the patient need take
is the sedative, and a solution of half an ounce of acetate
potash to four ounces of water, a teaspoonful every two
hours.
  As long as the pain continues, bathe the lower part of
the bowels, back and loins, with equal parts of tincture
of arnica, tincture of camphor and water.  The best ap-
plication that can be made to the limb is stramonium, or
jimson-weed leaves, bruised  and  moistened  with hot
      Fig. 14.    vinegar and water.  In place of this,
                 smarVweed may be used  in  the same
                 manner.  When the acute symptoms
                 have  passed off, I always   apply  a
                 flannel bandage,  as  shown in the an-
                 nexed Fig., sometimes  wetting it with
                 the arnica mixture above named.
Bandage. 
PAKT   II.
DISEASES  OF  WOMEN.
   Women are liable to the same diseases as men, and, in
 addition, others which  are dependent upon their special
 organization.   These special  diseases  are  divided  into
 functional and structural—the  first being those which are
 dependent upon  deviation from the natural  or healthy
 action of  the reproductive organs;  and the second upon
 changes in their structure. These diseases are of  very
 frequent occurrence, and entail a great amount of suffer-
 ing among women, being in the ratio of about five to one
 of other common affections.
   Nearly  every other woman you meet, has some trouble
 with  these organs, and a very large number have their
 health permanently impaired, and lead wretched lives  in
 consequence.  American women seem to  have a  larger
 share of them than any other nation; and it is not difficult
 to  account for this fact.   As  a general rule, our women
 have less recreation, and take less exercise, than any other
 people. An English woman of the higher class attends
 to her household affairs, sees  to  her gardens,  and takes
 abundant  exercise in the open air, riding or walking.   In
 addition to this, are periods of relaxation with  her family
 and friends, which seem to give variety to life, and greatly
 conduce to health.   Even the poorer classes, though they
have to labor hard, have their periods of relaxation  and
 their open air exercise.
  With American  women, it is a continued and monot- 
70               diseases of women.
onous  confinement to the house; or if they go out they
must be dressed and act  with such precision that they
neither have exercise or  relaxation.  The husband  and
male relations and friends are immersed in business, which
commences  with their getting up in the morning,  and
ceases  only  when they close their eyes in sleep.  They
have no  time for any thing  but business, and are so ab-
sorbed by their  cares, that any thing  that would change
the current of their thoughts, would  be deemed almost a
sacrilege.
  A man will go  poetically wretched, or  morbidly mis-
anthropic, or any  great misfortune will  overthrow him
entirely,  drive him  to insanity, lure him to slip out of
life through  the terrible by-road of suicide; but he rarely
drags on existence from year to year with " nerves," " low
spirits," and the various  maladies of mind and  temper
that make many women  a torment to themselves, and a
burthen to all connected with them.
  Why is this? and is it inevitable?  Any one who could
in the smallest  degree answer this  question, would  be
doing something to the lessening of a great evil—greater
than many  other evils which, being social and practical,
show more largely  on the aggregate census of female woe.
  Most assuredly, however unpoetical may be such a view
of the matter, the  origin of a great  deal of unhappiness
is physical  disease; .or, rather,  the loss  of that  health y
condition of body  which, in the present state of civiliza-
tion, so far  removed  from a state of nature, can only be
kept in any individual by  the  knowledge and practice  of
the  ordinary laws of hygiene—generally  the veiy last
knowledge that  women seem to have.  The daily necessi-
ties  of water, fresh air, proper  clothing, food and sleep,
with the due regulation of each of these, without which
no human being can expect to  live healthily or happil}', are
matters in which the only excuse for lamentable neglect,
k still more lamentable ignorance.
   An  ignorance the worse, because it is generally quite 
DISEASES  QF  WOMEN.               71
 unacknowledged.  If you tell a young girl that water, the
 colder the better, is essential to every pore of her delicate
 skin every morning;  that daily out-door exercise, short of
 extreme fatigue, regular meals, employment and amuse-
 ment, are to her a vital necessity; that she should make
 it a part of her education to acquire a certain  amount  of
 current information  on  sanitary  science, and especially
 on the  laws of her own being, physical and mental: tell
 her this, and the chances are she will stare at you uncom-
 prehendingly, or be shocked, as if you were saying to her
 something improper, or answer  flippantly, " Oh! yes; I
 know all  that."
   " But what good does it do her?—when she lies in bed till
 ten o'clock, and sits up till  any hour the next morning;
 eats all manner of food at all manner of irregular intervals;
 is horrified at leaving her bedroom window two inches
 open, or at being caught in a slight shower; yet will cower
 all day over the fire in a high woolen dress, and put on  a
 low muslin one in the evening.  When she wears all
 winter thin boots, gossamer stockings, a gown  open at the
 chest and arms, and a loose mantle that  every wind blows
 under,  yet wonders  that she  always   has  a  cold—and
 weighs herself down in summer time with four petticoats
 heaped one over the other, yet is quite astonished that she
 gets hot  and tired  so soon!  Truly,  any sensible,  old-
 fashioned body,  who knows how much the health, happi-
 ness and general well-being of this generation—and, aias!
 not this generation  alone—depend upon these charming,
 lovable, fascinating young fools, can not fail to be aggra-
vated by them every day."
  However humiliating the fact may be to those poetical
theorists who, in spite of  all the laws of nature, wish to
make the  soul entirely independent of the body—forget-
ting that if so, its temporary  probation in the  body at all
would  have been quite unnecessary—I repeat there can
be no  really sanitary state  of mind without a sane condi- 
72
AMENORRHEA.
tion of body;  and that one of the first requisites of hap-
piness is good health.

                  AMENORRHEA.

  By amenorrhcea we understand the suppression of the
menstrual discharge when it has once appeared, or its non-
appearance at the period of puberty.  The first we desig-
nate as  suppression of the' menses, the second we call re-
tarded menstruation.
  Retarded Menstruation.—As we have already noticed
when describing the  physiology of the reproductive ap-
paratus, menstruation, or the monthly discharge of blood
in women, usually occurs between the age of twelve and
sixteen years.  It may come on earlier than this, or may not
appear until the eighteenth or twentieth year. Its advent
is marked by the  developenient of the system, from the
girl to the woman.   The organs of generation increase in
development, the breasts become prominent, and the habits
and tastes of the young female undergo a marked change.
In  addition to  this, she usually  experiences, for two or
three periods, a pain in the back and limbs, weight in the
pelvis, and  feeling of langour that is  unusual, before the
discharge comes on.
   If all of these signs of puberty have made their appear-
ance, and the  discharge does  not  come on, and especially
if she exhibits evidence of disease, we  say she has amenor-
rhcea.   The  most common  symptoms  are headache, a
sense of fullness and  weight about the bowels, a florid
countenance, torpor, lassitude, pain in the back and loins,
irregular circulation, and more  or less disturbance  of the
nervous system.
  Treatment.—The non-appearance of the menstrual dis-
charge may be owing to  a want of circulation of blood in
the organs, or to  want  of normal stimulation.  This is
generally the  case  when the girl is of a lymphatic temper-
ment, and sluggish in her appearance and movements. In 
amenorrhea
73
this case laxative doses of aloes, from one to three grains,
twice a day, with the use of the hot foot bath, and an in-
fusion of pennyroyal at night, with sometimes the appli-
cation of mustard plasters to the inside of the thighs,
will  be  sufficient.
  In the second case, there is too much blood sent to these
organs,  and too much excitation.   This is marked by the
pain, weight, and sense of  fullness in the pelvis, flushed
face, pain in the back, etc.   Here we would give a cath-
artic of cream of tartar, citrate of magnesia, or a seidlitz
powder. Bathe the feet well in  hot water, give the pen-
nyroyal tea, and if this does not seem sufficient, let her sit
over the vapor of bitter herbs.
  In the third case, the young girl presents marked evi-
dence of  anfemia.  She is pale and bloodless, poor in
flesh, and feeble, her  appetite is not  good, and  her food
digests  slowly and imperfectly.   In such a case as this we
would give the  bitter tonics  and iron, and with bathing,
proper  exercise, and a nutritious diet, build up the system,
and increase the quantity of blood, when in all probability
the discharge would appear.
  Suppression of the Menses.—The monthly discharge
is most frequently arrested  by cold contracted during  a
menstrual  period, as  by getting  the  feet wet, sitting on
the damp ground, washing the  body with cold water, etc.
Though this is the most frequent cause, yet it may be ar-
rested from severe mental emotion at these times, and
from other acute diseases.   A  long  ship voyage is likely
to cause arrest  of the  menses, as we observe in women
coming from a foreign country.
  The amount of disturbance consequent  upon suppress-
ion of the menses varies very much in different cases.  In
some there is a slight headache, a feeling of weight in the
pelvis, pain in the back and in the limbs, and more or less
feverish symptoms.  These recur at each menstrual period
and  continue for five or six days, when they pass off.  In
most cases  the  general health  suffers to a greater or less 
74
dysmenorrhea.
extent, a cachectic condition of the system being iuduced.
Occasionally  hemorrhage occurs  from some other part
of the body, at the menstrual period, as  from the nose,
lungs, stomach, or from piles; this is called vicarious men-
struation, and sometimes is very persistent.
  Treatment.—The treatment will vary much in different
cases, though if mild means fail, a physician had better be
consulted.  When the discharge is arrested by cold, bathe
the feet thoroughly in mustard water, and drink freely of
a tea made of smartweed, pennyroyal or ginger.  If this
is not sufficient, use the hot sitz bath, continuing it for an
hour at a time, or sit over the vapor of  bitter herbs, as
tansy, hoarhound, hops, etc.  A very mild emmenagogue
pill is formed of aloes, myrrh, sulphate of  iron, and oil of
savin, equal parts, divided into ordinary sized pills.   They
may be taken one every three hours, until they act on the
bowels, then stop, and recommence with them the next day.
In long continued cases, they should be commenced three
or four days  before the  expected period, as that is  the
only time that the discharge can be brought on.

                D YSMENORRHOIA.

  By dysmenorrhcea, we  understand a painful  and diffi-
cult flow of the menses, they being generally  scanty in
quantity; in severe cases containing clots, fibrinous shreds,
or even an  entire false membrane.  In  many women the
menstrual flow is always accompanied and preceded  by
pains in the back, limbs, and in the lower portion of the
abdomen, though it is generally of short duration and not
very severe.   When the symptoms are very severe, dys-
menorrhcea is said to exist.
  Symptoms.—The  symptoms of this  affection  are so
marked that  they can not be mistaken.   Sometimes the
general health of the female is  affected  for two or three
days, preceding the expected period, and there are various
unpleasant sensations in the pelvis.  At  others, the first 
DYSMENORRHEA.
75
 symptom is sharp pain commencing  in the region of the
 womb, and passing to the back.   In  some  cases they are
 intermittent, like labor pains, but in  others they are con-
 stant.  The discharge of blood is very small at first, some-
 times passing but a drop at a time, and attended with the
 greatest  agony.  Occasionally the pains pass down the
 thighs, or  even to the feet, and  the female describes the
 aching in the legs as almost intolerable, so that she hardly
 knows what to do with herself.
   In some cases the pain as above described continues but
 one or two days, when the  discharge becoming free, the
 pain ceases.  In others  it continues without intermission
 from the commencement  of menstruation until its cessa-
 tion.  In others, again, small fibrinous shreds are passed
 with intense pain, which then ceases for some  hours, to
 come on again in the same manner.   And in some cases
 an entire coat of the  cavity of the womb is passed, with
 pain that resembles labor pains.
   Females that suffer severely  with dysmenorrhea, are
 almost always sterile.   It may depend upon disease of the
 womb, or  contraction of its  mouth,  or it may  be  essen-
 tially a neuralgic condition.   Sometimes it comes on with
 the first appearance  of the menstrual discharge, but at
 others it dates from an attack of some disease, or from a
 severe or badly managed labor.
   Treatment.—This is  a very  persistent  disease, and
 usually requires more than domestic  skill for its manage-
 ment.  During the  paroxysm, efforts should  be employed
 to relax the system, and promote the menstrual discharge.
 This may be effected in a majority of cases by bathing the
feet thoroughly in warm water, lying down, and having a
brick heated  hot, wrap it in flannel cloths  wrung out of
vinegar, and put it between  the thighs near the vulva.
The vapor  should not be  allowed to escape; it envelops
the lower part of the body, and will in a majority of cases
give relief.
  I would  not  advise the use of internal medicines, but 
76
MENORRHAGIA.
an injection into the bowels of a teaspoonful of lauda-
num, two teaspoonfuls of tincture of lobelia, to a tea-
cupful of warm water, will give great relief.   In some
cases it  arrests the pain at once, and two or three repeti-
tions is  sufficient to carry the female through the period
with comparative ease.
   For the permanent cure of the  disease, various means
are made use of.  First, it is necessary that any disease of
the  uterine organs that may exist,  should  be removed.
Sometimes  there  is inflammation  of the neck of the
uterus;  at  others, slight ulceration,  and at others a dis-
eased condition of the mucous lining.  Second, the gen-
eral health of the patient must be restored by appropriate
treatment; and it  is not unfrequently a  difficult matter
with those  who have but little experience to determine
accurately what is Avrong.   Third, special  means are used
to overcome the irritable condition  of the nerves distribu-
ted to the uterus.
  For the latter purpose I have obtained good results from
the  use  of the bromide of ammonium, two  drachms  to
four ounces  of water, a teaspoonful four times a day.
The tincture of staphysagria, two drachms to four ounces of
water, a teaspoonful every four hours,   has  also given
good results.  The tincture  of macrotys,  and extract  of
conium and stramonium, are also used, but should always
be taken with the advice of a physician.

                  MENORRHA GIA.

  Profuse menstruation, or flooding  at the monthly pe-
riod, is called menorrhagia.  It may occur at any age, and
either in the plethoric and robust, or in those of a delicate
and exhausted habit of body.   As before remarked, when
describing  the  functions of these  organs, the discharge
varies greatly in different persons,  in some being very
small in quantity, in others being naturally very profuse,
and yet compatible with health. 
MENORRHAGIA.
77
  Excessive menstruation may occur in two ways: either
as regards  the  frequency of its  return, and its duration,
or the quantity lost in a given period of time.  Thus, in
some women, the  discharge would  not be  considered too
large on any day, but it will continue  for from eight to
twelve,  or  fifteen  days, and recur at intervals of two or
three weeks, so that there is but a short time between the
periods. In these cases the long-continued discharge pro-
duces great exhaustion,  and the female exhibits all  the
symptoms  of an impoverished blood ; she is feeble,-thin in
flesh, has  but little  strength, and all the functions of the
body are more  or less impaired.   The disease is sometimes
attended with a profuse white discharge during the inter-
menstrual period, which  increases the debility.
  In the other cases, the discharge  of blood is very pro-
fuse, and frequently it passes in clots.   Occasionally the
flooding is so -severe that the woman will have to take her
bed, and her clothing will be saturated with blood.   In
some cases the flooding is so excessive as  to  prove  dan-
gerous to life, unless prompt means  are used to stop it.
  Treatment.—To check the too free discharge of blood
in either  case,  at the  time,  I would recommend  the
essence of cinnamon, prepared by adding one drachm of
the  oil  to two ounces of alcohol.   The dose would be
from half to one teaspoonful, as often as it seemed to be
necessary.   In place of  this, gallic  acid, in doses  of five
grains  every half hour  or hour, will  almost invariably
moderate the discharge.  Equal parts  of alum and nut-
meg, as much  as  will  lie  upon a ten cent  piece, will
answer  in case  the others can not be obtained.       •
  If the flooding is severe, let the patient go to bed and
stay there until it ceases.  If the feet are  cold apply hot
irons to them, but keep the body  cool.  In very severe
cases, when it  is of great importance to check the dis-
charge speedily, plug the vagina with soft cotton cloth, or
an old silk  handkerchief, as recommended under the head
of abortion. 
78
LEUCORRHEA.
  For the permanent cure of the disease, in the first class
of cases named, I have used a preparation of equal parts
of the  sulphate of beeberina and gallic acid, in doses of
four grains four or five times a day.  The oxide of silver,
in the  form of pill, one grain four times  a day, has  also
given good results.  In  addition to this, she should have
a bitter tonic, and some preparation of iron to increase the
appetite and strength, and improve the quantity and qual-
ity of the blood.   The  collinsonia tonic,  46, would be a
most excellent preparation.

             LEUCORRHOHA— WHITES.

  Leucorrhcea is a whitish discharge from the vagina,  con-
sisting of mucus, or mucus and pus; it is generally known
by the name of whites.  Very many women  have it slightly
at times, and quite a large number have it to such an ex-
tent that it is an exhausting drain upon the system.
  The causes of leucorrhcea are various.  In some cases it
arises from chronic inflammation of*the mucous membrane
of the  vagina; in others, from debility and  exhaustion
produced from other diseases; from  too  frequent child-
bearing, or from prolonged nursing.  In other cases, again,
it is caused by disease of the neck of the womb, and in the
rarer cases it arises from disease of the lining  membrane
of this organ.
  Vaginal Leucorrhea.—In vaginal leucorrhcea, the dis-
charge  may  be white,  but is most generally a creamy
white, or even yellowish.   It is  a creamy fluid, possesses
little4 tenacity and  is opaque.   It may be discharged in
very large quantities, and in such cases the vagina will be
found relaxed and  flabby.  Frequently there are sensa-
tions of soreness and tenderness on pressure, and in a ma-
jority of cases there is a feeling of weight, pressure, and
bearing down, which is very annoying.  Occasionally there
is some trouble with the bladder, with a frequent desire to
make water, pain and burning when it passes, or there is 
leucorrhea.                   79
difficulty in passing it.  There is usually constipation of
the bowels.
  If the disease has continued long, the general health is
considerably affected.   She is weak and feeble, her appe-
tite is poor or variable,  digestion imperfect, with fre-
quently quite severe  dyspepsia.  It would seem strange
how so slight a trouble could produce such serious results,
did we not know the intimate sympathy that exists be
tween these organs and the general system.
  Treatment.—Proper attention to the person will almost
always prevent this disease.   Every woman should have
a rubber pump  syringe, and should use an injection of
moderately  cold water once a day, or at least two or three
times a week, for the  purpose of cleanliness.   The natural
discharges, by being retained, sometimes give rise to irri-
tation and  relaxation, and the discharge  we  are  speak-
ing of.
  In mild cases, the frequent use of cold water alone will
sometimes  be found  sufficient  to  arrest the  discharge.
In other cases, a tea of yellow root may be used as an in-
jection, or a decoction of  white oak bark.   I more fre-
quently prescribe chlorate of potash, one ounce; sugar of
lead, one drachm, to be divided into six powders; one of
these is added to a pint of water and used as an injection.
One drachm of alum to a pint of water will also  answer  a
good  purpose.
  In  using  the  injection,  first wash the  parts  by using
simple water freely, then, lying down, introduce the tube
high up in the vagina, and throw in the medicated injec-
tion.  This  should be retained for five or ten minutes, in
Drder to obtain  its full advantage.  A great many wo-
men, when  directed to use an injection, do it so imper-
fectly, and use  so small a quantity, that no good  results
from it.
  As regards the general treatment, I  sometimes use the
tincture of  muriate of iron, in doses of twenty or thirty
drops, four times a day, with marked advantage.  In other 
80
leucorrhea.
cases, equal  parts  of cubebs and  carbonate  of iron, as
much as will lie upon a ten cent piece, three or four times
a day, exerts a good influence.   In the majority of cases,
however,  the collinsonia  tonic  will be  all the internal
medicine the patient requires.
  Uterine Leucorrhea.—The discharge may come from
the neck of the uterus in rare  cases, or from its  cavity,
and  is then  called uterine leucorrhcea.  In  some cases
there is ulceration of the  neck, in others chronic inflam-
mation of its cavity, and  in  others a diseased condition
of its entire mucous lining.
  The discharge varies in character, according to the seat
and character of the disease  producing it, when the  ex-
ternal surface of the neck of the womb is diseased, as is
shown in the cuts below, the discharge will be a yellowish
or yellowish-green, creamy fluid.   When  the discharge
comes from the cavity of the  cervix, or neck, it is stringy,
transparent, very tenacious, and  resembles white of egg.
When it comes from the cavity of the uterus,  it is gener-
ally thin and watery, looks dirty, and has an  unpleasant
odor.
                       Fig.  15.
            Neck of the Womb in Leucorrhcea.

  Fig. 15 represents the appearance of the neck  of the
womb in a severe case of uterine leucorrhcea.  There was
chronic inflammation, softness and dilation of the mouth,
and several small roundish elevations, as seen in the cut. 
LEUCORRHEA.                  81
  Fig. 16  represents a  case  of similar  character,  the
menses were  abundant and  irregular, and there was se-
vere leucorrhcea.  The neck of the womb was livid, and
covered with small vesicles, and  these,  with the  mouth
of the womb, bled  on pressure, and during movement
of the limbs.
                       Fig. 16.
  Fig. 17 represents a more severe case, there was inflam-
mation and ulceration, the menses being frequent in their
recurrence and abundant, and between the periods there
was a leucorrhceal discharge.  The  patient had  a great

                       Fig. 17.
6 
82
LEUCORRHEA.
amount of pain, which was  increased by pressing on the
womb.
  Fig. 18 represents a case of severe  inflammation of the
neck of the womb, which was enlarged, and had a well
defined ulcer extending into its mouth.  The woman suf-
fered much pain, with a sensation of dizziness and bearing
down; the leucorrhoeal discharge was not in as large quan-
tities as the preceding cases.

                       Fig. 18.
  In uterine leucorrhcea the general health is considerably
affected, especially if the discharge is large.  The patient
complains of a sensation of weight  and bearing down in
the pelvis, soreness  across the lower part of the bowels,
and aching and pain in  the back.   The monthly periods
are almost always irregular, recurring before their time,
and  continuing longer.   The discharge  is sometimes
darker colored, and unpleasant, but in others may be more
or less mixed with the discharges, or may be natural.
  The appetite is frequently  impaired, and digestion is
more or less imperfectly performed—the  patient has dys-
pepsia.  The bowels are constipated, and sometimes there
is a  sensation of uneasiness  and pressure  in the  lower
bowel, and not unfrequently an unpleasant sensation in 
LEUCORRHEA.                   83
passing water  If the disease is severe, the female will in
most cases be sterile.
  Treatment.—It is only the milder cases which will prove
amenable to domestic medication, in others  a physician
should  be consulted.  We  first endeavor to sustain the
general health by appropriate means.   Thus we get the
bowels  regular, by the means named in Vol. I., paying
especial attention to their evacuation at a certain  period
every day. The urinary organs should also be noticed, never
allowing the bladder to become unduly distended.  A daily
bath is of great importance, commencing  with the water
warm enough to  be  pleasant, and  gradually getting  it
cooler, until  cold water can be used.  A basin of  water,
a sponge, and a coarse towel, is all that is necessary for a
bath, sponging the surface and then  rubbing with the
towel until a glow of heat is  experienced on the skin.
The lower part of the abdomen and thighs may be bathed
in salt water, rubbing them thoroughly.
  Internally, I would give .equal parts of tincture of col-
linsonia, No. 45, and compound tincture of corydalis, No.
56.  This would improve the appetite and digestion, tend
to keep the bowels regular, and act gently on  the kidneys
and skin.  If the female is thin in flesh, and exhibits evi-
dences of poor blood, iron may be added.
  We rely mostly upon local applications in these cases, us-
ing the pump syringe.  Let the vagina be thoroughly washed
out with cold or warm water, whichever feels best, and
then use the medicated  injection.  Chlorate of potash,
one ounce, sulphate of zinc, one drachm, divided into six
powders, and one of these added to a pint of  water, is an
excellent  injection.  Alum,  two ounces, and  sulphate of
zinc, one  drachm, divided into six powders, also  answers
a good purpose.   The  yellow root, heretofore mentioned,
and the white oak bark, may also be used.  A very good
injection is made by taking  equal parts of dogwood bark
and yellow dock root, and  making a  strong infusion of
them with boiling water. 
84
AN EXAMINATION.
  When there is m ich irritation and soreness, we some-
times obtain  the mo3t advantage at first from the use of
equal parts of milk and water, warm.   Slippery-elm  or
flaxseed tea may be used in the same cases.  In the severer
and more persistent cases of the disease, it becomes neces-
sary to consult a physician, have an examination made to
determine  the condition of  the organs, and have local
remedies applied to the diseased parts.

                AN EXAMINATION.

  Many  women  suffer for months,  or  even years, until
their health is undermined, and their happiness destroyed,
before they will make up their minds to have an examin-
ation made, to determine the seat and character of their
disease.  There is no doubt but that it is ver}' unpleasant
to have an examination made, yet it must be recollected
that very frequently  it offers the only chance of a restora-
tion of health.  The physician must know what part is
diseased, and the nature of the disease, before he can pre-
scribe intelligently.   Hence, if the sufferer wishes  to  get
well, the earlier she submits to  the  only means that will
tcure her, the  better she will  be off.  There is little use
postponing the time, in hopes that she may get better, for
these cases rarely or never get well  without appropriate
medicine.
  An examination is  not much if  the woman views it
properly.  It is  something that nearly every woman has
to undergo at some period of  her life, and the physician
should  be regarded as a friend, and one conversant with
all that pertains to the human system, and it is his voca-
tion toY  do these things, thereby relieving suffering and
distress.
   In some cases an examination with the finger is all that
is necessary.   The physician having appointed a time to
 meet the lady for this purpose, she should have a female
 friend or acquaintance with her.  Let some lard or oil be 
AN EXAMINATION.
85
placed handy,  with a basin of water,  soap and  towel.
Now let her lie down on the bed, on her back, throwing a
quilt or spread over her.   The physician passes his finger
up to the womb, and by carefully feeling of its surface, its
mouth, and the vagina, he is enabled to determine pretty
accurately what the difficulty is.
  In some cases it is necessary that the parts be seen, and
in those an instrument called a speculum is used, to dilate
the parts, and throw light up to the uterus.  Figures 19
and  20 represent the two  forms of  instruments  used.

                      Fig. 19.
Glass Speculum.
Fig.-20.
Four-bladed Speculum.
Their passage is attended with little or no pain, and their
use is rarely  objected to when the lady believes it neces-
sary, and has confidence in her medical attendant.
  Sometimes it becomes necessary to examine the internal
cavity of the womb, when an instrument called a uterine
sound, is employed.  It is passed through the mouth of the
womb  into the  cavity, and should always  be used with
great care. 
86
CHLOROSIS.
                     CHLOROSIS.

  A peculiar sickness, which sometimes affects young
girls about the period of puberty, is called  chlorosis, or
green sickness.  It is always characterized by anemia of
the system, and a yellow, dirty-green  pallor of the skin.
When a  disease of early youth, it is almost invariably
connected, either  with entire  absence of menstruation,
or with a scanty, painful and irregular performance of the
function; and if a disease  of later life, in addition to these
causes, it may have been preceded and produced by men-
orrhagia or leucorrhcea.
  It is  strictly a  disease  of the blood, and  may occur in
either  males or females,  though  very rarely in males.
When developed in the female, it is nearly always associa-
ted with  some derangement of the menstrual function,
usually  an arrest  of this  secretion.  The blood-globules
are diminished in quantity and the blood  becomes thin
and watery.  In consequence of this  the appetite and
digestion are impaired, the person wastes in flesh, and day
by day becomes weaker.   She dislikes  to take exercise, is
easily fatigued,  is not cheerful, but loves  solitude, and
frequently weeps without  cause.
  Not only is  the appetite impaired, but it  is perverted,
food is  loathed, and  innutritious  substances  desired,  as
chalk, dirt, charcoal, etc.  The bowels  are nearly  always
constipated, the tongue is coated with a  dirty-white fur,
and there is flatulence and  all the  symptoms of indiges-
tion.  The breath is frequently offensive, eructations of
gas from the stomach, headache, palpitation of the heart,
and a quick and easily compressed pulse.
  Treatment.—In very mild cases, the collinsonia tonic
will be the only  internal remedy required,  the  bowels
being kept regular by the  means heretofore recommended.
In the severer cases, the medical treatment will be under
the direction of a physician, and we have only to describe
the hygienic measures and nursing which will be found as 
CHLOROSIS.
87
appropriate for other diseases of like  character, as they
are for this.
   In regard to the hygienic treatment, I can not do better
than to quote from M. Colombat.  He says:  " Whatever
may have been the cause that has brought on chlorosis,
we should remove the patient from all exposure to cold
and humidity; she should breathe a dry, pure, and moder-
ately warm air, and  it is because these  conditions exist
dining the spring and  autumn, that  those seasons  are
more favorable to the cure of the disease.   A dry, breezy
situation, in a sunny exposure, ought to be recommended.
Clothes, which by the nature of their tissue, slightly irri-
tate the skin, are to be preferred to any others.  Flannel
worn next to the skin, and especially alcoholic and aromatic
frictions to the whole surface of the body, should  likewise
be proposed, with the view of exciting the action of the
capillary vessels, of inviting the blood into them, and pro-
moting perspiration.   The food must consist  of roast
meats, fresh  eggs, farinaceous vegetables, ripe fruits, and
bitter and aromatic plants; for example, succory and celery.
As a drink during meals, we may employ with advantage
a mixture  of chalybeate water with wine.  Between the
repasts, the patient may allay her thirst with some refresh-
ing, slightly acidulated  drink.   Nevertheless, though a
careful regimen ought to be strictly observed, it is not well
to be too exclusive; if we meet with  great reluctance in
giving up the injurious articles which the  patients desire,
it  would be  necessary at first, to  respect  their longings,
however strange they might seem, and even to satisfy
them,  unless  they were directed to substances evidently
hurtful.   We should always commence by regulating the
meals, and by forbidding fruit, salad and all crude articles ;
we ought, moreover, to consult the digestive functions, and
wholly proscribe articles well known to be indigestible.
   " Whatever be the  aversion to exercise felt by chlorotic
persons,  we ought invariably to insist upon  its  employ-
ment, regulating it, however, by the strength of the'patient 
88                    CHLOROSIS.
Should  the  muscular debility be  so great  as to  pre-
vent her from walking, we must resort to mixed and pas-
sive  exercises.  Riding  in a carriage, or still better, on
horseback, especially if a man's saddle is used, in open and
elevated places, where the air is pure, are proper modes of
exercise, particularly if pleasant conversation can be added
to the charms  afforded by diversity of views and  land-
scapes.  Boating excursions, which exert a favorable effect
upon all the organs, and  which unite to all the advantages
of exercise, that of being agreeable to young persons, and
of producing a  useful stimulation by the presence  of in-
dividuals of the opposite  sex;  music, which  occasions a
salutary excitation in  lymphatic persons, and finally, sea
bathing, and swimming in  running water, are  different
hygienic means, which it is well to recommend to nervous,
sad and melancholy women, and to those of  great moral
sensibility.  Traveling can  not be  too strongly recom-
mended to persons in whom the disease is  kept  up by
acute sorrow, or by any  moral affection whatever; the use
of mineral water taken  at the springs, offers in this re-
spect, incalculable advantages, not only from the medicinal
action of the waters themselves, but  also, because the pa-
tients enjoy at such places the various charms of a numer-
ous and brilliant  society, and attractions which are con-
stantly changing.
  " The use of  very tight corsets  ought to be forbidden;
sleep should not be protracted beyond eight or nine hours,
and care must be  taken  that the  patient's bed is neither
too warm nor too soft, because such beds  often increase
the feebleness and  constipation of very sensitive women,
especially those in whom  the chlorotic state has been de-
veloped and maintained  under the influence of diappointed
love.  We should  forbid exciting drinks, wine,  highly
nutritious food, vivid emotions, the frequenting of balls
and shows, the reading  of highly-wrought romances, the
examination of lascivious pictures, and lastly, we should,
as far as  possible, suppress  all circumstances capable  of 
HYSTERIA.
89
 disturbing the sensibility, or of exciting the passions too
 strongly."

                     HYSTERIA.

   Of all diseases to which women are subject, this is prob-
 ably  of most frequent occurrence, though usually in a
 very  mild form.  Though  we witness it  in some of its
 forms so frequently, there  are but very few women who
 will admit that they ever had hysterics, though perfectly
 conversant with the disease in others.  It is generally  re-
 garded as an evidence of a weak mind, or as being put on
 for the  occasion, a  species of devilishness that could be
 helped if they  were disposed.  These are mistaken no-
 tions ; hysteria  is as much a  disease as convulsions, or
 paralysis, and belongs to the same class of affections, and
 the woman who is subject to it, either in its mild or severe
 form, is to be pitied rather than condemned.
   It is true, that certain impressions made upon the mind
 will keep  it  off,  or arrest the paroxysm.  In  fac.t the
 female herself, has, to a considerable extent, command over
 it, and can successfully resist it or allow it to come on.
   Symptoms.—The symptoms vary very greatly in  differ-
 ent cases,  being sometimes a  simple  aberation  of the
 mind for  the  time being, and  in others  the severe con-
 vulsive affection  described below.   In  many instances
 it will be slightly  manifested by an unnatural gaiety,
 laughing  when there is nothing particularly  laughable,
 and in many ways  showing a  want  of judgment.  In
 other  cases it will  be the reverse.  She is melancholy,
 mopes, loves solitude, cries without cause, and seems to
 use every endeavor to make herself miserable.  In a third
 class of cases, she is miserable, fretful, and quarrelsome—
 nothing goes right, and no  one does  right, and she feels
 like all the world were her enemies, and occasionally man-
ifests  it by the direst tongue lashings and scoldings that it
is possible for her to get rid of.
   " Most of the disquieting feelings, strange  and way- 
90
HYSTERIA.
ward fancies of nervous females arise from hysteria.   A
paroxysm is usually preceded by general uneasiness, anxi-
ety and oppression ; a sensation of choking, or as if a ball
were rising up from the abdomen into the throat, to which
sensation the appellation of globus hystericus has been given;
stiffness about the larynx, headache  and cramps.   M.
George says: * Hysteric patients in the hospital of the Sal-
petriere, are so well accustomed to take warning by these
precursory symptoms, as never to be seized unexpectedly;
they go to bed, and  are tied down until the fit is over.'
Sometimes the paroxysm  ends here; but more generally
the anxiety  and sufferings increase, extreme depression
of spirits, often weeping, ensues; there is a painful sense
of stiffness and coldness of the  limbs; noise in the ears;
vertigo ; confusion, and to  these rapidly succeed temporary
loss of sense and consciousness, and of command over the
voluntary muscles,  during which,  the   most  vehement
struggles  are  alternated with moments  of repose.   Oc-
casionally there is a tetanic rigidity of the muscles of the
trunk or back, and the  body is thrown up in the form of
an arch, but the limbs are  more  generally contorted ;  the
patient often  beats her breast, tears her hair, grinds her
teeth, bites the tongue or lips, or otherwise injures herself.
The assistants are often struck, bitten or  scratched,  and
have vociferous epithets heaped on them; terrific scream-
ing, sobbing,  laughing  and  vacant staring may rapidly
succeed each  other.  During the  struggling,  the heart
beats tumultuously, the  countenance becomes flushed  and
swollen, and the breathing  laborious.  After a variable
continuance of from a few minutes to some hours or even
days, of repeated  intervals  of struggling  and repose, as
here described, the patient either falls asleep or gradually
returns to a state of consciousness and her ordinary con-
dition, save feelings of fatigue and  soreness, which disap-
pear in a few days.  Such are the prominent features of
the hysteric paroxysm; but it varies greatly in intensity
and duration.  The convulsions may be severe, with lucid 
chorea—st. vitus' dance.
91
intervals, and of frequent occurrence for days, or  a deep,
quiet sleep or coma may fill up the intervals, from which
nothing can  arouse  the  patient.   In  some women, the
paroxysms return monthly, or at  the menstural flow; in
others, at variable intervals, dependent on disturbances of
the physical or mental equability.   It is remarkable that
plumpness of person, roseate hue  of  countenance, and
general  appearance of good health are  not incompatible,
but often attend the worst of sufferers from this affection
through  life, so faithfully is the nutritive function pre-
served amid the many and  frequent storms of nervous
functional derangement.
   Treatment.—The treatment of hysteria requires a great
amount of care, as the hysterical symptoms are only evi-
dence of some  other  disease.   In persons  who seem
strong and robust, some uterine  disease  will be found at
the bottom of the trouble. In those of  a feeble and deli-
cate constitution, means will  have to be used to restore
the general health.
   In a severe attack of  hysteria, we can  almost always
arrest the paroxysm by the administration of  equal parts
of tincture of lobelia and tincture of assafoetida, in tea-
spoonful doses every ten or fifteen  minutes.  The remedy
is unpleasant, but very  certain, in  fact its unpleasantness
is a decided advantage, the  mental impression being as
important as  the physical.  The same general plan  should
be adopted  when the patient is feeble  and anaemic, that
was  recommended under the  head of chlorosis.  But the
treatment for the permanent cure should always be under
the direction  of a physician.


          CHOREA-ST. VITUS'  DANCE.

   This affection, known  commonly as  St. Vitus' Dance,
occurs most generally about the age of puberty, though it
sometimes appears as early as the sixth or eighth year,
and as late as the thirtieth,  and in some cases later than 
92
CHOREA—ST.  VITUS' DANCE.
 this.  It is confined  principally to the female sex, but in
 rare cases it is met with in the male.   Most generally it is
 associated with some derangement of the sexual organs,
 and it is not unfrequently associated with hysteria.  We
 usually find it in persons of feeble health, and precocious
 mental development, but in  some cases, in persons of  the
 opposite character, in which it may be induced by torpor
 of the liver and bowels, deranged secretion  of the skin
 and kidneys, and from close  confinement or  sedentary7
 occupations.
  The modern disease received its name, doubtless, from
 the dancing maniacs of the  middle ages.  The "dancing
 plague," or St. Vitus'  Dance, commenced in Strasburg in
 1418, and is thus described by Burton :  " Chorus Sanctse
 Viti,  the lascivious dance, as Paracelsus  calls it, because
 they that are taken with it can do nothing but dance  till
 they are dead or cured.  It is so called for that the parties
 were  wont to go to St. Vitus for help, and, after they had
 danced  there awhile,  they  were certainly freed.  'Tis
 strange to  hear how long they will dance, and in  what
 manner, over stools, forms, tables;  even  great-bellied
 women sometimes  (and  yet never hurt their childreu)
 will dance so long that they can stir neither hand nor foot,
 but seem to be  quite dead.  One in red clothes they can
 not abide;  music above all things they  love; and there-
 fore magistrates in Germany will  hire musicians to play
 to them, and some lusty, sturdy companions to dance with
 them."
  Another form of the dancing mania, termed St. John's
Dance,  commenced  in 1374,  and  extended  over the
greater portion of Europe.  "At Cologne, the number pos-
sessed amounted to more  than five hundred, and at Metz
the streets are said to have  been  filled with  eleven hun-
dred dancers.  Peasants left their plows, mechanics their
workshops, housewives their domestic duties, to join the
 wild  revels, and this rich commercial  city  became the
 scene of the most ominous  disorder; secret  desires were 
CHOREA—ST. VITUS' DANCE.
93
excited, and too often found opportunities for wild enjoyT-
ment;  and numerous  beggars, stimulated  by  vice and
misery, availed themselves of this new complaint to gain
a temporary livelihood.   Girls and boys quitted  their pa-
rents, and servants their masters, to amuse themselves at
the dances of those possessed, and greedily  imbibed the
poison of mental infection.  Above a hundred unmarried
women were seen roving about in consecrated and uncon-
secrated places, and  the consequences were soon  per-
ceived ; gangs of idle vagabonds, who understood how to
imitate to the life the gestures  and  convulsions of those
really affected, roved from place to place, seeking main-
tenance  and adventures,  and thus, wherever they  went,
spreading this disgusting spasmodic disease like a plague;
for, in maladies of this  kind, the susceptible  are infected
as easily by the appearance as the reality."—Hecker.
  This gives the  origin of the name of the  affection we
are now considering, and though  there  is no  similarity
between the ancient  and modern St. Vitus'  Dance,  the
description just  given  illustrates the ease  with  which
nervous affections of this kind may be propagated.  And
it is a  fact,  proven by numerous instances  in hospital
practice, that attacks of hysteria, epilepsy,  and chorea,
will be excited by witnessing  the malady in another.
  Symptoms.—The first evidences of chorea, are occasional
involuntary movements  of the hands and  facial  muscles,
and an inability to sit quietly in one  position.  Very fre-
quently the fingers are  quickly and involuntarily moved,
and when the patient uses the hands, it is with a quick,
unnatural movement.   As the disease progresses, the in-
voluntary movement  becomes  continuous, some part of
the body being constantly in motion,  and the movements
are now very much exaggerated.  If  the patient attempts
to do any thing, she  seems to have  but partial control
over her muscles, and while  they  are being  directed to
the end intended, they are going through a succession of
movements entirely independent.  So great is this some- 
94
CHOREA—ST.  VITUS' DANCE.
times, that the patient can not sit still, nor keep the hands
quiet for a moment, and her walking is irregular from the
same cause.   The facial muscles are sometimes very much
involved, and the attempt to speak, or give expression to
the emotions, is followed by various contortions of the
countenance, which  would be laughable were they not
connected with so serious a malady.  Sometimes it is
almost impossible for the patient to express herself intel-
ligibly, owing to spasmodic action of the muscles of the
mouth and of the larynx.
  As before  remarked, the general health is usually im-
paired previous to the commencement  of the disease, and
this becomes more marked as  it  progresses; symptoms of
ansemia are of common occurrence, the skin being blanch-
ed, the pulse feeble, the lips and gums pale, variable appe-
tite, imperfect digestion, and constipation of the bowels.
The mind is more or  less affected, the patient being low
spirited, and  desiring solitude,  the countenance being pale,
languid and vacant.  In some instances confirmed chlo-
rosis will be  developed during the progress of the disease.
It will be noticed that the child has no disposition to play
or to take exercise, and  does not desire  to associate with
others, but prefers  rather to get where her infirmity will
not be noticed; the sensitiveness  in  this respect  being
sometimes very great.
  Treatment.—Various  plans of   treatment have   been
adopted,  and many  remedies used as  specifics in this
affection, and as is usual, we  find that where the means
are  so abundant, they  are not very  efficient.  We had
much better  adopt a  rational plan of treatment, by cor-
recting any dyscrasia, and getting  a normal performance
of the various functions of the body, rather than depend
upon any one remedy, no matter how highly it is praised.
Derangement of the digestive apparatus is usually prom-
inent, and its correction  is frequently followed by speedy
recovery.  Thus in many  cases we  will commence the
treatment by the administration  of a thorough emetic, 
CHOREA—ST. VITUS' DANCE.
95
which may in some cases be repeated with advantage once
or twice a  week.  This should  be followed by a mild
cathartic of podophyllin, leptandrin and extract of hyo-
sciamus, in doses sufficient to move the bowels once or
twice daily, until recovery  is complete.   Associated with
this we would give a bitter tonic, as quinia, hydrastin,
each  one-half  drachm;  extract  of nux vomica,  two
grains; extract of macrotys, in sufficient quantity; make
thirty pills, and give one four times a day.  A preparation
of iron is almost always necessary, and we may use the prus-
siate, carbonate or the ammoniated tartrate, which has been
very highly recommended.  In all cases we employ  the
bath to sustain a  normal action of the skin, and for  its
general influence.  I have obtained better results from the
salt  water sponge bath, with brisk friction, especially of
the entire length of the spine, than from any other means.
  If the disease is associated with  amenorrhcea, or irregu-
larity of the menstrual function, this must be attended to.
In some cases the  emmenagogue pill of  the  dispensatory
will prove useful, both as a cathartic and for its action on
the uterus.  The wild ginger is another agent  that will
prove  useful  in some of these cases.  The  macrotys, or
cimicifuga, is  a very valuable remedy, especially in cases
where the patient complains of wandering pains in vari-
ous  parts of  the body,  or pain in the back and limbs.
We sometimes associate it with valerian or Scutellaria, and
sometimes with the bitter tonics.   The extract of Indian
hemp has been  employed with benefit, in doses of half a
grain three times a day, and good results are said to have
attended the administration of small doses of stramonium.
The sulphate and oxide of  zinc have  been  prescribed
oftener, possibly, than any other agents, and  we must be-
lieve, from the favorable reports given, that they have an
action in these cases; these remedies may be given com-
mencing with half grain doses four times a day, and grad-
ually increased until five or ten grains are administered.
  If there is  tenderness on pressure over the spinal cord, 
96
INFLAMMATION OF THE  OVARIES.
counter irritation will often  prove veiy efficient, and the
same will be the case when there is tenderness on pressure
over the epigastrium.   Electricity has been  frequently
resorted to in  chorea, and the reports  of its action differ
materially.  When  passed through the limbs, it is  not
only useless, but sometimes positively injurious, but when
applied to the back alone, it is almost  always beneficial.
The common electro-magnetic machine  may be employed,
the negative pole being applied to the sacrum, and the
positive passed backward and forward over  the spine.
The better plan, however, is to insulate the patient, and
by the old fashioned electric machine, charge the patient
and  withdraw the spark from  the back.   In one case,
lately, I have employed the bromide of  ammonium in ad-
dition to the tonic  treatment first  named,  and seemingly
with marked  benefit, though one case  no  more demon-
strates the curative action of  a  remedy, than that one
swallow makes a summer.
  Very much will depend upon the home management of
the patient.   All causes of irritation must  be carefully
avoided, and  she should be encouraged to take suitable
exercise, and try to control the  involuntary movements.
Out-door exercise, pleasant company,  and something  to
constantly occupy the  mind  with,  exerts  an important
influence, and  it will sometimes be  found that where the
patient is allowed to have her own way, if not decidedly
improper, she will  get along better.   In some cases the
disease results in both male and female, from sexual exci-
tation  and onanism.  This should be looked into, and if
reasonable evidence exists, means should be employed to
put a stop to it.

      INFLAMMATION OF THE OVARIES.

  Acute  inflammation  of the  ovaries is not of very fre-
quent occurrence, but we not unfrequently find a low form
of inflammation, or severe irritation, with determination
of blood, which gives rise to considerable disturbance. 
OVARIAN DROPSY.
97
   In acute inflammation there is  pain  in  the side, low
 down, and marked tenderness on pressure.  There is also
 considerable uneasiness when  the  lady is on her feet; in
 fact in some cases she finds it impossible to get up.  There
 may be a  chill, and generally there is considerable fever
 for two or three days, with a dry skin, scanty  urine, and
 constipated bowels.
   In the milder cases, the lady feels a sensation  of sore-
 ness in the side, which is deep-seated and increases upon
 pressure.   In some cases a slight swelling of the ovary is
 felt; movement produces pain, and when she is much on
 her feet, there is a sensation of dragging and soreness in
 the part, which is very unpleasant.
   Treatment.—In these cases  it is well to free the bowels
 with a dose of podophyllin pills, and if there is fever, use
 the special sedatives, as has been heretofore recommended.
 Bathe the feet thoroughly in mustard and water, and drink
 freely of some  warm  diaphoretic  infusion, as sage or gin-
 ger tea.  Appby a  mustard plaster to the part affected,
 and if the  pain is severe, follow it with a hot hop foment-
 ation.

                OVARIAN DROPSY.

   Sometimes the ovary becomes  diseased, and, as the re-
 sult, a cyst, or  membranous sac,  forms on it, containing
 fluid.   There may be  but  one of these, or they may
 amount to  dozens.  It is supposed by the best authorities
 that they are developed from the graafian vesicles, which
 we have heretofore described as containing the human
 egg.  They grow alike in  persons of good health, and
those who  are feeble, in the  unmarried  as well as the mar-
ried, and occur at  all ages up to the  time  menstruation
 ceases, at the change of life.
   When the growth commences, it is small, and gives but
little trouble.  It continually increases in size, sometimes
very slowly, several years  elapsing before it becomes so
large as to  produce difficulty; but in  other cases it will
        7 
98
CANCER OF THE UTERUS.
obtain an immense development in a few months.  As it
increases in size, it forms a swelling in the lower portion
of the abdomen on one side, but at last it distends it to its
full extent, and occupies all parts of it alike.  So large do
these growths become, that they will contain from five to
ten gallons of fluid.
  The general health suffers greatly when they become
large.  The appetite and digestion are impaired, the  per-
son loses flesh, and all the  functions of  the body are im-
perfectly performed.  Still  she may last for  months, or
even years, a burthen to herself and friends.
  Treatment.—Medicine furnishes no remedy for this af-
fection, no  known remedy having the slightest influence
upon it.  It has been proposed to employ injection to stop
or retard the  growth, but it has not been  attended with
success.  When the accumulation becomes so large as to
render the  breathing difficult, and give  rise to  other un-
unpleasant  symptoms, the water is drawn off  by tapping.
The only cure for the disease is  the removal of the entire
mass by a surgical operation.  Formerly this was deemed
very hazardous, but with the improvements that have been
adopted recently, about three  out of every four perma-
nently recover.  This is a very  good result, as without
the operation death  is certain and not very far distant.


            CANCER OF THE UTERUS.

  Cancer, the most terrible of  all maladies to which the
human body is subject, very frequently attacks the uterus,
It is of most  frequent occurrence in the breast, next of
the face,  and next in frequency we find  it attacking this
organ.  The  previous health  and habits of  the  woman
seem to have but little to do in bringing it on, as it occurs
alike in the healthy and those who  are feeble.  Several
varieties  of malignant disease are noticed in  this region,
all of which prove fatal if not arrested in the early stage.
  The corroding ulcer, Fig. 22, is one form.   It commences 
CANCER OF THE UTERUS.
99
with pains in the pelvis, a leucorrhoeal discharge, and other
symptoms  of uterine  disease.   When  the ulceration is

                        Fig. 22.
Corroding Ulcer of the Uterus.
fully developed there is a  profuse discharge of a  thin
watery, ichorous fluid, and frequent attacks of severe hem-
orrhage.   With  this the health  of the patient rapidly
gives way, and she becomes thin, sallow and anaemic.

                        Fig.  23.
 
100
CANCER OF UTERUS.
  The cauliflower excrescence, Fig. 23, is another form of the
disease, though exhibiting an entirely different appearance,
there being a red exuberant growth in place of ulceration.
The patient's  attention is first excited by a watery, in
odorous  discharge, in large quantity.  In  a few weeks
this discharge becomes  tinged with blood, and after a
longer time profuse hemorrhage occurs.  These exhaust
the woman, she loses her appetite  and strength, and
finally succumbs to the exhausting disease.
  True cancer  commences as a hardening of the neck of
the womb, or  vagina adjacent, which feels nodulated  or
knotty.  There is some leucorrhoeal discharge, and a feel-
ing of weight, uneasiness  and tension in the pelvis.   Oc-
casionally there  are sharp  lancinating, or stinging pains,
lasting but a  few minutes, and occurring several times

                       Fig. 24.
Cancerous Ulceration of the Uterus, involving the Rectum and
                      Bladder. 
DISPLACEMENT OF THE UTERUS.
101
during the day.  Though not absolutely painful, the fe-
male experiences  an unpleasant sensation in that region
most of the time, which gives her considerable annoyance.
  The growth may  slowly increase in size for months, or
even years, giving rise to but few more  symptoms than I
have named.  Finally ulceration commences, when the
discharge becomes free, and is ichorous and fetid.   Now
the female  experiences marked lancinating pains, whi'ch
are sometimes so severe as to  deprive  her of rest. Hem-
orrhage also occurs  occasionally, and increases the prostra-
tion.  The appetite and  digestion become impaired, she
loses flesh, her skin becomes  sallow, and finally she sinks
from the exhausting discharges and the intensity of her
sufferings.   In many cases, the uterus is almost eaten up,
the vagina, the rectum, and  the bladder, are so invaded
that the entire  cavity of the pelvis  seems to be but one
sloughing sore, as seen in Fig. 24.
  Treatment.—There  are many cases of cancer of the
womb, which can be cured  if taken in the  early stage.
But if allowed to progress until the body of the organ and
the vagina is invaded, and  ulceration  has  commenced,
there is no earthly hope for the sufferer.  Bearing this in
mind, never  neglect these affections,  but apply to  some
reputable physician who has  made it a study, and ascer-
tain what the difficulty is.  Under no circumstances at-
tempt to tamper with it yourself, or trust to cancer doctors.


       DISPLACEMENT OF THE UTERUS.

  The womb, as we have already seen,  is  supported on
the upper part of the vagina,  and is freely moveable  in all
directions.   As long as  the vagina, and  the muscles as-
sociated with it  maintain their proper tone, there is little
danger of displacement,  but  when they  become  relaxed
from disease, the  womb may be displaced in any direction.
We recognize three forms of  displacement, 'prolapsus uteri,
or falling of the womb; anteversion, or a  displacement of 
102
PROLAPSUS UTERI.
the upper part of the womb forward; and retroversion, or a
turning of the upper part of the womb backward.

                PROLAPSUS UTERI.

  Falling of the  womb, represented in Fig.  25, is the most
frequent of these derangements, and may exist in a slight
or in a very severe degree.  It always  results from some
disease of the organs, most  generally from  relaxation  of
the vagina, produced by leucorrhcea.  It may be caused
by disease of the  womb, which rendering it  heavier, causes
it to press down  the tissues below; or it may arise from

                       Fig. 25.
Falling of the Womb. 
PROLAPSUS UTERI.              103
 the increased size of the  organ after childbirth, and the
 relaxation of these structures that is found at that time.
   The  symptoms in this  disease vary very much in dif-
 ferent cases.  When it is but slight, unless caused by dis-
 ease  of the womb, the patient has a sensation of weight
 and dragging in the pelvis, which is  increased by being
 long on the feet, or by walking.  As  it increases, these
 symptoms become more marked, there is weakness  and
 pain in the back, sometimes pain  in the legs, and other
 very disagreeable symptoms.  The bowels are usually con-
 stipated, and the straining necessary to produce an evacu-
 ation increases  the difficulty.  The urinary  organs are
 sometimes irritated, and  there is more or less burning and
 unpleasant sensations when the urine is passing.
   The effect of the disease on the general health varies in
 different cases.  Some persons will make but little com-
 plaint, their general health being nearly as good as it was
 before  the displacement, even  in  its worst forms.   In
 others, the digestive organs sympathize with the uterine
 disease; there is disorder of the stomach, loss of appetite,
 dyspepsia, distension of the abdomen, headache, etc.
   Treatment.—In the treatment of falling of the womb
 the same means will have  to be employed as in vaginal
leucorrhoea, for in a majority of cases, this will be found
Fig. 26.
Perineal Supporter. 
 104               PROLAPSUS  UTERI.

 one of the principal troubles.  If the general health is af-
 fected, suitable means will have to be employed to restore
 it, among which the bitter tonics and iron, with means to
 overcome the dyspepsia, will be prominent.  If the womb
 is diseased, this will have to be removed before a perma-
 nent cure can be effected.
   Among  the  most efficient means, the daily use of the
 salt-water sponge  bath to  the lower part  of the body,
 pelvis, and thighs, will be found to yield good results.
 This bath should be accompanied with brisk friction, and
 kneading the muscles of the abdomen and those that close
 the  outlet of the pelvis.  This  increases the strength of
 these parts,  and renders them more  able to hold  the
 womb up.
  For a temporary support, while the treatment is in pro-
 gress, I prefer the perineal supporter, represented in Figs.
 26  and 27.  This consists of  a  well-fitted  abdominal
 bandage  or jacket, made of drilling or stout muslin, and
 furnished with whalebones to keep it from wrinklino-: it
is cut like a corset, lacing in front, and made so that it
will give a  constant and steady support to  the lower and
anterior portion of the abdomen.   From this  jacket ex-

                      Fig. 27.
Bandage and Pad. 
ANTEVERSION OF THE UTERUS.
105
 tends two stout bauds of the same material, or, if preferred,
 elastic suspenders may be used, which pass between the
 thighs, and button or buckle in front.   Immediately under
 the perineum, where these straps cross, a  perineal pad is
 attached, which passes upward between the vagina before
 and the bowel behind, and furnishes a constant and effi-
 cient support.   This pad  may be made about  two inches
 square, and half an inch thick, and covered with oil cloth
 to protect it from the discharges.  In my practice I use it
 altogether, and prefer it to any and all contrivances which
 have been  recommended for the  same purpose.
   I do not like those  supporters which are worn in  the
 vagina, and termed pessaries, as these are never curative,
 and frequently cause more disease by their pressure than
 they advantage the patient.  In  some rare  cases, for a
 temporary purpose, I use  the India rubber bag, distended
 with air or water.  Let it be borne in mind, that all these
 cases can be cured, if  the patient has proper advice, and
 perseverance sufficient to  pursue the treatment.

         ANTEVERSION OF THE UTERUS.

   In this case the womb is thrown forward and presses on
 the bladder, as seen in Fig. 28.  In a slight degree it may
 continue for a long period of time, giving rise to unpleas-
 ant sensations  in the  pelvis, and to  a great  amount of
 irritation of the  bladder, and pain and difficulty in passing
 water.   In some cases chronic inflammation of the blad-
 der sets in, and, in  consequence, the patient suffers very
 much.   In addition to these symptoms, will be those of
 disease of the womb, which almost always come on when
it is long continued.
 , In its severest form, it is generally of sudden occur-
rence coming on from a  sudden jolt or fall on the feet,
when the bladder has  been recently evacuated.   In such
cases,  the  person will feel an  unpleasant  sensation of
weight and bearing down  in the  pelvis, with considerable
pain and uneasiness.   After a time a desire to evacuate 
106          retroversion of the uterus.
                      Fig. 28.
Anteversion of the Uterus.
the bladder  is manifest, but, on attempting it, no urine
can be passed; or it is passed in drops, with much suf-
fering, and medical attendance will have  to  be obtained
immediately.  It would be  useless to describe the treat-
ment,  as it not unfrequently requires  all the skill and
efforts of the most experienced to rectify the difficulty.

       RETROVERSION OF THE UTERUS.

  This displacement is the  opposite of anteversion,  the
upper  portion  of  the womb being  thrown  backward
against the rectum, as seen in Fig. 29.   The  disease usu-
ally comes on slowly, sometimes from too great distension
of the bladder, which presses the womb  backward, and it 
             RETROVERSION OF THE UTERUS.          107

is increased by accumulations of feces above it, and by
straining to evacuate the bowels  and bladder,  both  of
which are difficult.
                       Fig. 29.
Retroversion of the Uterus
   In retroversion, as in other morbid conditions  and dis-
eases of the womb, the accompanying sympathetic de-
rangements or symptoms are, when well marked,  more
or less perfect imitations of the derangements attending
pregnancy.  Dyspeptic and hysterical symptoms are some-
times present, with local neuralgic pains in the breasts, or
some portion of the back, or in the region of the pelvis.
The displaced position of the womb  often gives rise to
mechanical irritations, and symptoms  of the same kind
as if the organ was morbidly enlarged. 
108            POLYPUS OF THE UTERUS.

  Constipation and impeded passage of the stool are  fre-
quent results, caused by the compression of the bowel by
the displaced womb.  Occasionally the bowel is irritated,
and there is discharged from  time  to time quantities of
a mucus-like matter,  resembling flux to some extent.
The bladder frequently  suffers, there being  generally
more or less difficulty in passing water; with  burning or
other  unpleasant sensations, though  sometimes  she finds
herself unable to hold her water, and it constantly drib-
bles away.
  Symptoms of weight and tension,  and bearing down
in the region of the uterus and rectum, are of very  fre-
quent occurrence, and occasion a great amount of suffer-
ing.   They  are almost always increased  by being much
on the feet, by walking, or even by riding in  a carriage,
and they are especially marked at the monthly periods.
  Treatment.—The treatment of these cases is quite diffi-
cult, and beyond  domestic resources. A skillful physi-
cian should  be  consulted, who  will first replace the pro-
lapsed womb, and then advise such measures as will pre-
vent its recurrence.

           POLYPUS OF THE UTERUS.

  Symptoms.—In an early stage of the growth of these
tumors, the symptoms are very obscure, but when more
advanced they assume a  formidable and  dangerous char-
acter.  In many instances, the first symptoms that will be
noticed, are similar to those of  the fibrous tumor, such as
a feeling of weight in  the pelvis, bearing down, pain in
the loins, etc., which are especially aggravated during the
menstrual periods.  The menstrual  function  is usually
first affected;  it becomes more profuse  and protracted,
and occurs at irregular intervals.  At  the commencement
of the growth  there is usually more or  less leucorrhcea;
sometimes the discharge  is principally the normal mucus
of the parts, at others it is fetid and bloody. These symp-
toms may continue for a  longer or shorter time, owing to 
                polypus  of  the UTERUS.            109

the growth of the polypus,  and constitutional peculiari-
ties of the patient.
  As  the growth  advances  in  size,  and in many cases
where it is still very small, the hemorrhages become more
frequent, and increased in quantity.   The loss of blood is

                       Fig. 30.
sometimes  so  profuse as to give the patient a blanched
and bloodless appearance, and to greatly impair the gen-
eral health.  The appetite becomes impaired, the  bowels
relaxed, oedema of the  extremities occurs,  etc., marking
an extreme state of debility from loss of blood.  Another
prominent  symptom in polypus of the  uterus is  nausea 
110
DISEASES  OF  THE BREASTS.
and frequent vomiting;  this is probably  caused, in part,
by the loss of blood, and partly by the dragging down of
the polypus and the expulsive efforts of the uterus.
  The presence of a small polypus does not prevent con-
ception, and even utero-gestation may go on to the full
period.  This, however, is not  common, the irregularity
of the menstrual function caused by the tumor genera-ly
proving a cause of sterility, and  even  should conception
occur, an abortion will most frequently take place during
some period of gestation.
  The presence of a polypus  sometimes proves a cause of
difficult labor, the tumor being extruded before the child
and still  attached to the  uterus, prevents its passage, and
the tumor may require to be removed before the child can
be  born.  It may likewise be  the  cause of  subsequent
danger, by preventing the  contraction of  the  uterus,
necessary to close the open mouths of the uterine vessels,
and by this means give rise to  dangerous, if not fatal
flooding.  Metritis has also been  known to result, where
a polypus was retained in the  cavity of the uterus after
delivery.

          DISEASES OF THE BREASTS.

  The female  breast  is a highly  organized  gland,  abun-
dantly  supplied  with nerves  and  blood vesssels, and
adapted to furnish the appropriate nutriment for the child
in the form of milk.   It is very delicate in its organiza-
tion, and hence liable to  disease, and is very closely con-
nected to the  uterine organs  by sympathy.  Thus we
notice, that with the development of the womb and ova-
ries at puberty, the breasts are also  developed, and with
the changes in the condition of the  uterus  during  preg-
nancy the breasts also sympathize.  This intimate sym-
pathy is best illustrated by the  contraction of the womb
after childbirth, on applying the child to the breast.   Irri-
tation of the breasts  will also  cause sexual excitement, 
               DISEASES OF THE BREASTS.            Ill

and occasionally the menstrual  flow may be brought on
in this way.
   Care of the  Breasts while Nursing.—Though  these
sensitive glands should be well protected from  cold or
injury at all times, this becomes more necessary during
nursing, as they now receive an abundant supply of blood,
and are more liable to  disease.   The breasts should never
be pressed with tight  lacing, and especially with whale-
bone in dresses or corsets.  Many a woman may date the
commencement  of malignant disease, which will finally
destroy her life, from these causes.   They should likewise
be well protected against the action of cold, and if there
is tendency to caking of the breast, or ague in it, a couple
of thicknesses of soft flannel may be constantly worn with
advantage.
   The Nipple.—The nipple is the most sensitive part of
the  breast, and, as we have already seen, it  occasionally
causes a great amount of suffering from soreness when
nursing.  In a majority of cases, the skin of the nipple
may be  hardened prior to labor, by washing it for some
weeks with  a decoction of equal parts of  yellow  dock
and dogwood.  At other times the use of cold water will
be all that is necessary.  The treatment  of sore nipples
has  been  already given.
   Ague in the  Breasts.—Some mothers are very much
annoyed with what is  termed ague in the breast, when-
ever they  are exposed to  cold, from sudden changes of
temperature, or even  from washing the hands in cold
water.  The breasts become hard, full and painful; there
are chilly sensations, followed by some fever, and various
disagreeable feelings.   The attacks  sometimes recur fre-
quently, and  are a source  of great  annoyance.  "
  At the  time, we would  direct that the  feet be bathed
in mustard and  water, drinking a bowl of warm penny-
royal tea, and taking a mild laxative to open the bowels.
If the breasts are very painful have them gently rubbed
with warm oil or lard,  and the milk well drawn.  There 
112
DISEASES  OF THE BREASTS.
is only oue plan  by which this condition can  be avoided,
and that is by the  daily use of a  cold  sponge  bath.
Commence with tepid water, getting it cooler day by day,
until it  can be used cold.  It is troublesome, and some-
times not very  pleasant, but it will  effectually prevent
the person's taking cold, and is thus useful in  other cases
than this.
  Caking of the Breasts.—The breasts not unfrequently
become hard, in a portion  of  the gland, seeming as if
there was a well defined tumor of the part.  It is  more
or less  painful, but  always giving rise to a disagreeable,
uneasy  sensation.   The entire breast is  somewhat dis-
tended, and the child draws the milk with  difficulty, and
does not seem to  remove it all.   Sometimes this is the
first symptom of inflammation.
  Caking of the breasts is  usually removed by gentle
rubbings with warm lard, and  covering them well with
flannel, the milk being thoroughly drawn out.  At  other
times the addition of camphor  to  lard increases  its effi-
cacy, especially if there is a very free flow of milk.  Tinc-
ture of arnica one part, to lard three parts, makes a very
efficient application.
  Inflammation  of the Breasts.—Inflammation  of the
breasts most usually results from cold, injury, or a failure
to keep the milk  well  drawn  out.   Where the breasts
have been  once inflamed,  especially if  abscesses have
formed in them, inflammation is very  liable to recur after
each labor.   In these cases we sometimes find it necessaiy
to dry  the  milk up in  the  affected breast immediately.
This can almost  always be done by frequently bathing it
with warm lard and camphor.
  Inflammation of the breast usually  commences by the
formation of a cake  in  it, which  gradually increases  in
size, and becomes tender and painful.   Several days thus
elapse, in some cases, before the disease is fully developed.
It gradually increases in size, becomes harder, and is the
seat of a constant, deep-seated, aching pain.   After a time, 
DISEASES  OF  THE BREASTS.
113
it  becomes unnaturally warm, there is too much blood
sent to it, the milk  is drawn with  much difficulty, and is
scanty,  and there is great  soreness, with more or less
sharp lancinating pain.  As it continues, the pain becomes
so severe that she can not obtain rest either day or night;
the general  health is more  or less affected, with usually
some  fever.  Finally, suppuration occurs, the matter being
situated in the structure of the gland, sometimes deep, at
others near the surface.  The pain is  now very intense,
usually throbbing, occasionally attended with chills.   The
matter gradually works  its way to the surface, and dis-
charges through  one or more openings.  From one to
three  weeks is usually  occupied in  the progress of the
disease before the breast breaks, and there may be but
one, or several abscesses.
   Treatment.—The main object in treatment at first, is
to check the inflammation, and prevent the formation of
an abscess.   Many plans  have been recommended to ac-
complish this, among which I may name the  following:
When the  hardness is first  felt, apply the lard and cam-
phor,  or lard and arnica, as directed for  caked breast, and
keep it well covered with warm flannel.   If cold has been
taken, bathe the feet well, and drink a cup of warm ginger
or sage tea, going to bed and covering up warmly.   A mild
cathartic should also be taken to open  the bowels, as the
citrate of magnesia, cream of tartar, or a seidlitz powder.
If the body is  still feverish, use the special sedatives as
hereafter recommended.
   If the means above named do not  seem  to answer,
obtain from  the nearest drug-store, equal parts of extract
of belladonna and lard, mixed;  spread  it on soft cotton
cloth  as a plaster, and apply to the inflamed part.  This
should be changed three or four times in the course of
twenty-four hours,  and if the weather  is cool, it should
be warmed before applying to the  breast.  Be very care-
ful when the child is nursing, that  it  does not get any of
the plaster in  its mouth, as it  is poisonous.   Instead of
        8 
114
DISEASES OF THE BREASTS.
this, take a single thickness of tobacco leaf, lay it on a
flannel cloth and moisten it with warm water, and im-
mediately apply to the  breast.   The Mayer's  ointment,
No. 85, is also an excellent remedy when the inflammation
progresses slowly.
  If these means do not arrest the progress of the disease,
apply poultices to favor suppuration and have the matter
discharged as soon  as possible.  Slippery elm, flaxseed,
bread and milk  and many other articles, form good poul-
tices,  and it  makes but little difference which is chosen.
If it is an object  to draw it to ahead speedily, I have found
an application of wool saturated with lard to be the best
application, though it is very painful.
  If properly managed in the first stage, all the symptoms of
inflammation will rapidly subside when the abscess opens,
and in a few days it will heal up kindly.  Sometimes from
want  of  care the abscess does not  heal up kindly, and
numerous fistulous pipes keep discharging, and the breast
continues hard, tender, and more or less painful.   In the
milder cases, if proper attention  is paid to  drawing the
breast, the milk  need not be lost; but when the inflam-
mation is severe  the milk will have to be dried up.  In no
case should the child be permitted to nurse the diseased
breast, until it is  entirely well.
  Tumors of the Breast.—The breast is a very common
seat of tumors, both  benign and malignant, there being
probably no structure of the body where they  occur so
frequently.   This is  no doubt owing  to the delicacy of
their structure, but more to their exposed position.  It is
impossible for the inexperienced to determine whether a
tumor of the breast is malignant or not, and as very much
depends upon ascertaining this fact before it has made much
progress, a physician should he immediately consulted.
  Many of these growths  give  rise to but  little trouble
until they become quite large, though usually there is an
uncomfortable feeling of  weight and uneasiness.   We
designate no less than  eight different kinds of tumors, 
diseases of the breasts.
115
 some of which may be dispersed by appropriate  treat-
 ment, while  others will require an operation for their re-
 moval.   If necessary, the earlier this is performed the
 better, as a growth the size of a common marble is much
 easier removed than one the size of a large apple, or as we
 find in some cases, the size of a child's head.
   Cancer of the Breast.—The breast is a very frequent
 seat of cancer, in fact it occurs here more frequently than
 in any other portion of the body.  It may make its ap-
 pearance at any age, and  alike in the married and single,
 though we find it most frequently between the ages of
 thirty-five and  fifty years.  The cause  of cancer is  not
 known, and neither do we know why it should attack the
 breast more  frequently than other part  of the body.  In
 all probability, it  depends upon their more exposed con-
 dition, and the rapid and great changes which take place
 in its condition during nursing.
   Cancer usually commences as a  small, hard tumor,
 which is freely movable under the skin, though it may be
 deep seated or superficial.  If care is used in its examina-
 tion, a peculiar knotty hardness will be apparent, and is in
 many cases characteristic of the disease.  There is but
 little suffering at first, and sometimes for days the woman
 will  have forgotten that there is anything wrong with the
 breast.   But occasionally there is a sharp stinging sensa-
 tion  as if something was within the breast that should be
 removed.  Occasionally there are  cases in which it is quite
 painful from  the commencement.
  It is observed to gradually increase in size, sometimes
pretty rapidly, at others very slowly, and there is a corres-
ponding increase in the unpleasant symptoms.   Wlien it
has attained  the size of a small hen's egg, it will he ob-
served that the nipple is being drawn in ; and when it has
attained  twice this size, the nipple will in a majority of
cases, he level with  the breast, or sometimes sunken in.
This is one of the most characteristic features of caneer,
and  persons nee4  have no doubt of tfoe  character of the 
116
DISEASES of the breasts.
disease, when,  they observe this  symptom, as it will not
fail to be cancer in one out of one hundred cases.
  It usually commences to be very troublesome about this
time, though there are  many cases in which the patient
suffers very* little.   It has now become attached to the
skin, and to some little extent  to the structures below,
and there is a bluish red discoloration of the surface over
it.  As it increases in  size, its  progress is more rapid.
Ulceration  commences at one  or two points  over the
tumor, and exquisitely sharp, lancinating pains shoot from
these through the mass.  The discharge from these ulcers
varies greatly in  quantity aud character, frequently being
nothing but a bloody matter.  The ulcer increases in size
until it involves a considerable part of the surface of the
breast.  Its edges are hard and uneven, while its  surface
presents an unnaturally red and knotty appearance.
  Sometimes a growth springs from the ulcerated  surface,
and projects some distance beyond the sound skin.   It is
very red,  and looks very much like a  bunch of strawber-
ries, and bleeds  upon  slight pressure.  With the  com-
mencement of ulceration, the glands  under the arms be-
come  enlarged, and  in a longer or shorter time the entire
system is impregnated with the seeds of the disease.
  Now the suffering becomes  intense, sharp, lancinating
pains  pass through  the  breast, and into the shoulder and
back.  The  sensations are sometimes compared to the
gnawing  of an animal, and truly, it resembles to some ex-
tent such destruction.  The entire breast becomes involved
in the disease, as well as the structures adjacent,  and the
person suffers a hundred deaths before death at last comes
to her relief.
   Treatment.—Cancer of the breast can  be  cured, if a
proper treatment be adopted before the constitution has
become affected.  After it has formed attachments to the
deep tissues, and the lymphatic glands are engorged with
cancerous material, there is no hope.   While still small, it
is a very easy matter, to one who understands  it, and  in 
diseases of the breasts.
117
many cases  the cancerous mass can be removed without
the slightest pain, and no danger.  But if allowed to in-
crease in size, the danger of its return is proportionately
increased.  In some cases the knife is used for its removal,
but if depended  on without the employment  of proper
remedies afterward, it is certain to  fail.  My experience
goes to prove  that it is occasionaly the easiest method of
getting rid of the bulk of a large cancer, but in all cases I
leave an open sore, and apply remedies to trace out all the
diseased  structures afterward.  Caustics should never be
applied in these  cases, as they rarely affect a cure, and,
not unfrequently, cause  the tumor to  grow more rapidly,
and cause adhesions to  take place, that will prevent the
proper means from being of benefit.
  If this was a disease  proper for domestic  treatment, I
would give the remedies here, but as it  is  not, and the
remedies require great  skill in their application, I would
advise that a competent physician  be selected.  It is  a
matter of life or death with the sufferer, and it is well to
use a sound discretion. 
PA&T   III.
CARE AND MANAGEMENT  OF  CHILDREN.
         •
  The young of the human being is the  most helpless of
all created things, and entirely dependent  upon its parents
for food, clothing and protection.   While the young of
animals soon have free locomotion, and all the instincts of
self-preservation, the child possesses but the one faculty—
that of taking its food when actually placed in its mouth.
Thus  relying entirely on the mother for that care  and
protection essential to its life, and having so delicate an
organization that but  slight  changes  produce injurious
results, it becomes  important  to parents to know what
experience teaches with regard to the proper management
of children.  It is  true,  that  a love  of  offspring^  im-
planted in the breast of  every mother, and she desires to
do all that will conduce to its comfort and welfare.  Still,
this instinct will not answer in the place of knowledge^
and every woman should learn all that  pertains to the
care and management of  children.
  In this part I will quote freely from a most excellent
little work by Mrs.Barwell, of Scotland, on the treatment
of children.  I do this  because it is written by an educa-
ted mother to mothers, and will thus  have  more weight
My own portion will be  that  pertaining to  the  diseases
and medical treatment of children. 
INFANT TREATMENT.
119
THE  INFANT  BEFORE  AND IMMEDIATELY
                  AFTER  BIRTH.

  The first and most important truth, on this  subject, to
be impressed on mothers, is, that the constitution  of their off-
spring depends on natural circumstances, many of which are
under their own control.
  A child takes its general character from its parents.  If
these be healthy persons, the child will also, in  all proba-
bility, be healthy, provided that no deranging circum-
stance shall take place before the birth of the infant.   If,
on the contrary, the parents are unhealthy, the child will
also probably be  unhealthy.   These principles apply to
the mental  part of  our  organization, as well as to all  the
rest.
  Supposing healthy parents,  still the infant may prove
very much the reverse* if the condition and circumstances
of the mother  during pregnancy be not favorable.   It
therefore becomes important to inquire what is  the condi-
tion, and what  are the circumstances of the mother dur-
ing pregnancy, which are calculated to affect her progeny
for good or  evil ?
  The maintenance of her own health during this period
is of  the  first  importance, as even  a woman usually
healthy,  may be in  such a deranged state during preg-
nancy, as will operate greatly to the  detriment of the
infant.   For the maintenance  of health in ordinary  cir-
cumstances, few people have any other guide than  experi-
ence  and their  own share of  good sense; and these are
guides not to be despised.  It is to be wished, however,
that all whose circumstances Will allow of it, should study
the organization and functions of the  human frame, as,
without that knowledge, there  can be no certain or con-
sistent attention to  the  rules  of health, while* with  it,
attention to  those rules becomes comparatively simple.
  A young  pregnant woman, finding herself perhaps  for
the first time in her life called upon to pay particular atten- 
120
INFANT TREATMENT.
 tion to  the  laws  of health,  will  probably  experience
 some  difficulty in  subjecting herself  to  the  guidance
 of those laws, because she has habits to overcome, and
 perhaps some pleasures  to  forego;  but she will  have the
 aid and stimulus of  maternal  love, which, from the mo-
 ment she becomes  conscious she is to be a mother, myste-
 riously but powerfully possesses  her.   This instinctive
 affection leads to good or to evil, according as the mind is
 informed or ignorant of the conditions which govern the
 health of the parent and  child  during  pregnancy.   If
 informed, the mental and physical powers are directed
 aright; if ignorant, the  nervous sensibility prompts to a
 state of undefined  fears, while physical evils  are produced
 or increased by mistaken treatment.
   That a female in this condition should maintain a serene
 mind, is,  above all things, desirable.   And  for  this end, it is
 in the  very first place necessary that she  should be taught
 to regard her condition  in  its  true  light, as  one perfectly
 natural, and for which all fitting arrangements have been
 made by nature.  The  sickness, nausea,  and disordered
 condition of stomach, which often attend  pregnancy, and
 also the anticipation  of  the pains of labor, are apt to im-
press a different feeling.   But with all such impressions, a
 light-minded woman will successfully contend, if  she be
 truly informed on  the subject.  So far from pregnancy
 being a diseased condition of the system, it is  one in which
 pre-existing disease is often overcome, at least temporarily
 (though  the  contrary is also sometimes the case), and
 during which epidemics are  often  resisted, when  other
 persons not more  susceptible  fall  before them.  Nature,
indeed, seems to have aimed at making the system unu-
 sually strong at this period, as  if to favor as  much  as pos-
 sible an object so important as the increase of the num-
 bers of the species.
  Nausea is most frequently experienced by women of a
 nervous and excitable temperament, or of what are called
 "strong  feelings,"  and  by those  more  particularly who 
INFANT TREATMENT.
121
   have little  to  occupy them.   Those, also, who proceed
   upon the vulgar  error of eating  heartily,  " in order to
   keep up their  strength," are  peculiarly liable to this dis-
   tressing visitation.  There is, however, a certain tendency
   to it in many cases, merely as a result of that increased
   excitement  of the womb, which  unavoidably takes place
   during pregnancy, in consequence of that organ requiring
   and receiving  more  blood at  that  period than at other
   times.  In  all  cases, nausea may be regarded as a means
   provided  by nature for keeping down the  quantity of
   circulating  fluids  at  a proper amount, and thereby7 pre-
   venting a fullness which  might,  in  such  circumstances,
   have fatal effects.
     With respect to labor itself, an intelligent woman will
   find no difficulty, we think, in regarding it under the fol-
   lowing considerations:  It certainly is  a  process which,
   unless in very extraordinary circumstances, can not  take
   place without  considerable pain.   Some, we are aware,
   believe the  reverse.  They allege that, if the females of
   the human  race were to live in a perfectly natural man-
   ner, there would  be no pain or difficulty in labor.  That
   there should be  any natural  process from which pain is
   inseparable, seems also to them a kind of impeachment of
-   Divine wisdom.  We believe, nevertheless,  that pain, in
   some measure, greater or less,  is scarcely avoidable in the
   labor of almost any  female creature, and that to acknow-
   ledge such being the case, is no detraction from Almighty
   goodness.
     Contemplated under such considerations,  the pain of
   labor will be looked  forward to, we think, with firmness
   and without alarm.   It will be regarded only  as pain—a,
   pain imposed with a design, upon the whole, beneficent—
   short in duration, and which there is much to alleviate—
   which, moreover, in the effect which it seems to have of the
   more endearing the infant which has been its innocent
   and unconscious cause, fully repays itself in the tenderest
   of feelings. 
122
INFANT TREATMENT.
  For the preservation of serenity of mind, an exemption from
the severer cares of life is also desirable.  In  many cases this
may be  difficult of attainment, but it is  nevertheless a
point of so great importance, that every reasonable ex-
ertion and sacrifice should be made, in order to bring it
about.  We do  not mean that a pregnant female should
be set aside from ordinary duties, or that she  should  be
allowed  to spend her time in thoughtless langour.  We
only demand that she  should be subjected  to no treat-
ment which will give her great  excitement.   Anxiety
about the illness of a near relative—grief for his loss—the
pain of severe worldly calamity—torment from the mis-
conduct of individuals in whom she is interested—sudden
frights, or excesses of joy—-finally, those  rarer distresses
which a time of public danger occasions—such are the cir-
cumstances which are apt to have a bad effect on females
about to  become mothers.  They also, as a necessary con-
sequence, affect the being about  to be brought into the
world, producing in some instances a general weakness  of
constitution, in others only a certain damage of the mental
organization.  Many of  the  eccentricities  which have
caused the world most to  wonder, or worked it the greatest
woes, have been the  consequence of very simple circum-
stances visiting pregnant females with undue excitements
  The diet  of females during  this  period ought to be simple*
When unenlightened on  this subject, they are  apt to fall
into errors  which may greatly  affect  their offspring.  A
pampering, indolent, and generally self-indulgent mode
of life, is  often practiced, and  many think it necessary that
every casual desire that can arise in ah unregulated mind
ought to  be gratified.  A sensible woman, sincerely anx-
ious for the good of the being  about  to  enter the world,
will be anxious to avoid such  errors.
  The tendency to nausea and vomiting, already alluded
to, may be interpreted  as the  voice of nature proclaiming
that, in the condition of pregnancy, less instead  of more
food than usual  is required.   The perfection  of the child 
INFANT TREATMENT.
123
 does  not depend  immediately on the quantity of nutri-
 ment taken by the mother;  it depends on the supply of
 sound and healthy fluids, for which end  not merely judi-
 cious nutriment, but a healthy action of the whole of the
 functions of the body is  requisite.  Over-eating, or eating
 too nicely, is inconsistent with that healthy action, and is
 therefore to be avoided.  Food too highly concentrated,
 and of too stimulating a  character is unsuitable, as also
 are gruel and Weak broths, for these are not easy of diges-
 tion.   The  mother ought not to depart from her accus-
 tomed diet, whatever  that may  be, provided experience
 has shown that it  is suitable for her constitution and habits
 of life.   Animal food is  not to be systematically avoided.
 Where the digestion is weak, the circulation languid, and
 the muscular frame small, flaccid and puny, this kind  of
 food, of   a tender fibre,  taken in small  quantities at  a
 time  and well masticated, will lighten  present suffering
 and prevent future evil.   The  total want of this kind of
 food tends  to  make the milk weak  and of bad quality.
 Farinaceous and vegetable food, with a moderate portion
 of animal food, and of diluting fluids,  may be generally
 recommended.  Stimulating  liquors are beneficial in very
 few instances.   We present  all of these maxims  on diet
 with some degree of hesitation, for almost every particular
 case requires a treatment more or less peculiar to itself.
  Regular and gentle exercise should be taken every day in the
 open air if possible.   This is one of the principal requisites
 for keeping up that healthy action of the system, on which
 the supply  of  sound fluids depends.  When  the mother
 pursues a contrary course, whether from indolence or from
 positive inability of body, her system necessarily becomes
 much relaxed, its tone is  abated, and the child partakes of
 the same character.  Regard must  of course be paid to
 peculiarities in the general condition of  the mother.   If
 she be very weak, it may be injurious for her to take much
exercise, or to begin to take it abruptly; but still the great
importance  of exercise to her health and that of her child 
124
INFANT TREATMENT.
should  be kept in view, and, if at all practicable or pru-
dent, exercise should be indulged in.   With the healthy, it
is a duty which they will not with impunity neglect.  It
should be practiced from the first, and up to the very last.
As one great inducement to it, they may be assured that
byr restricting an undue and undesirable  growth of the
child, it tends materially7 to lessen their distresses at a par-
ticularly trying moment.
  The ordinary occupations of life should be as little as pos-
sible interrupted.  It may be necessary from the condition
of the expectant  mother, that  she should be kept  very
quiet; it often, indeed, happens  that from peculiar circum-
stances, females are enjoined by their medical attendants
to lie almost continually on a sofa.  But these are un-
fortunate cases.  Where there is a fair measure of health,
to have both mind and  body employed  is decidedly use-
ful, and a female should  be  glad when it is in her power
to enjoy this advantage.  Severe bodily labor is of course
to be avoided, as too trying to the system, and apt to pro-
duce accidents, and great mental tasks are equally7  un-
desirable, as tending to create too much excitement.  But
the every-day matters of life, the domestic arrangements
which make home respectable and attractive, the benevo-
lent and affectionate sentiments exercised in kindness and
service toward  others, the charity which acts rather than
gives, the daily walks enlivened by conversation or obser-
vation, the cultivation of the intellect by reading, the pre-
parations  for the  maternal  office—all these are suitable
means of keeping mind and body in that state of moderate
activity which is required, and such are ever at command.
This moderate occupation is useful in two ways.   It tends
to sustain that cheerfulness and serenity of mind which
have already  been spoken of as so desirable during preg-
nancy.  It is also  useful as a means of keeping  off and
counteracting a certain tendency  to  nervous excitement
which is sometimes experienced by pregnant females, and
which manifests itself in irritability and impatience, des- 
INFANT TREATMENT.
125
 pondency, and listless indifference.   When such excite-
 ment is first felt approaching, it should be met by a vigor-
 ous  determination not to yield to it, and active employ-
 ments will then be found extremely serviceable.  Females
 often act otherwise, and under the notion that such nerv-
 ous  excitement being natural, it ought to be patiently sub-
 mitted to, they resign themselves to it, and expect that
 others should treat it with charitable indulgence.  But in
 reality, it may be successfully contended with in most in-
 stances, and it is the  duty of every one thus to contend
 with it.
   It may here be remarked, that minds being constituted
 differently, all do not find  that the same duties and objects
 serve equally  well for sustaining their cheerfulness and
 keeping off the tendency to nervous excitement.  The
 exercise which is beneficial to one may be irksome to an-
 other; but the main object in all cases is the same, though
 reached  by different paths.  Worldly circumstances are
 also various;  it is therefore  impossible to lay down rules
 for the employment of mind and body, it is easier to point
 out what is to be  avoided, namely, excess, whether it re-
 gards ease or exercise, food or sleep, and the frequenting
 places of public resort, and close private apartments where
 the air is heated and vitiated.  In every situation of life
 there are trials of  temper, alternations of hope  and fear,
 joy and sorrow, pleasure and displeasure; to regulate these
 emotions, to restrain them within  such bounds that they
 shall neither over excite nor exhaust  the nervous energy,
 nor interrupt  the  healthy action of the bodily functions,
 is within the power of every human being, and  is a dis-
 cipline agreeing equally with the precepts of the moralist
 and  the prescription of the physician.
  As yet, we  have  only  considered  those circumstances
which affect#the human being before birth, we are now to
treat of those which conduce  to his weal after  he has
 entered the world.
  The child should  be placed  at  the breast within from 
126
INFANT TREATMENT.
 twelve to eighteen  hours after birth.   When  this is de-
 layed longer, the breasts are apt to be distended with milk,
 and the act of suckling is then attended with pain  and
 difficulty.  In such circumstances, the overloaded vessels
 being imperfectly emptied, inflammation  is excited, and
 milk abscess may ensue.  The milk left too long in the
 breast, if afterward  sucked, occasions pain and disordered
 bowels to the infant, or is rejected from its stomach.   In
 the latter event, the  nourishment is insufficient, and results
 seriously affecting the permanent health of the child may
 be experienced.  It occasionally happens that the  flow of
 milk in the first few days, is greater than the child  can
 take.   If it  do  not flow away, fomentations of warm
 water may be applied, which is a better remedy than rub-
 bing the breasts with spirits;  for they are rendered so
 tender by distension, that they easily bruise.   When the
 abundance of milk  is troublesome, the  mother  should
 drink little, and take opening medicine.
  On  recovering from  confinement, and resuming  her
usual dress, there can not be too much caution in securing
perfect liberty for the breasts.  The waist of the dress
should be loose and  long.  The low, stooping position in
which a woman  sits while  suckling, encourages  an en-
largement of the abdomen, if  not  guarded against;  and
injury  to  the figure, and untidy appearance, have been
urged as reasons  why mothers should not  also be nurses.
 Such  consequences  are by  no means necessary.  The
 dress may be as neatly arranged as at other times, and the
 figure has only to be protected, and such exercise taken
 as will  keep down  the tendency to enlargement of the
 abdomen. There can be no  other permanent increase
 unfavorable  to beauty or utility.  It sometimes happens
 that the nipple is small, or turned into the breast;  a new-
 born infant has scarcely sufficient strength to draw it: in
 such cases it saves much pain to have the breast drawn by
 another child of  about six or eight weeks old.  The  me-
 chanical means often adopted are  very apt to cause sore 
INFANT TREATMENT.
127
breasts.  It is, however, desirable that the infant should
get the first milk, as this has the effect of clearing the
bowels of the meconium, or first evacuations, and gener-
ally supersedes the  necessity of a purgative.  A young
mother is generally awkward in holding an infant; but a
little fortitude and perseverance will overcome the difficulty.
  AVhere there is a decided inability to suckle (which may
usually be decided before delivery), and  a wet-nurse is to
be engaged, there are two  or three points requiring atten-
tion.   The  nurse should  be, as  nearly as possible, of the
same age as the mother, because there  is a relation be-
tween the constitution of a mother and her newly born
babe, and, the more nearly the hired  nurse resembles the
mother in constitutional peculiarities, the more suitable
will she be for rearing that particular child.  A hired
nurse should also have been confined about the same time
as the mother, because  the milk  has a different character
at different stages of nursing, being thin at first, and grad-
ually growing stronger, so that, if a newly born  babe be
put to the milk of a woman any considerable time con-
fined,  it gets too strong or heavy milk, and is thereby
sensibly injured.
  The diet  of a person engaged in  nursing should  be
nutritious, but not heavy.  What agrees  and disagrees in
ordinary  circumstances, will then have  the  same effect.
Diet must also have  reference to constitution.  A person
of full, robust habit, will require  less nutriment, and will
suckle better upon diluting drinks, such as tea, toast and
water, gruel, etc., while a  delicate person of languid  cir-
culation will need more animal food, milk, beer, perhaps
ale or porter.   Wine is not so desirable; it is stimulating
rather than  nutritious;  though, mixed with water, it may
in some cases agree better than beer.
  The quality of the milk chiefly depends upon habits of
mind and body; the quantity varies in different persons, in
correspondence with age, constitution, etc.  In some con-
stitutions the food goes more into nourishment,  and  less 
128
INFANT TREATMENT.
 into milk, than in others.  In those cases, the less food is
 required.  In other constitutions the aliment goes more
 into milk and  less  into  nourishment;  and  a  woman
 so  characterized  requires to  be comparatively  well
 fed.  It is necessary for a nurse who has  a tendency to
 flatulency, to avoid viands  apt to induce that ailment, not
 only on her own account, but that  of her charge, for this
 and other disordered functions tell upon an  infant imme-
 diately, through the medium of the milk.  Where a nurse
 is actually affected by flatulency, her taking  a little pow-
 dered ginger or  carbonate of soda,  makes her milk agree
 better with the digestive powers of  the child.
  A mother who is also a nurse, has a  double claim upon
 her, and a double motive  to stimulate her in the observ-
 ance of the laws which govern  health.  The immediate
 welfare of herself is indissolubly united with that of her
 child;  every  transgression  on her  part inflicts  suffering
 on  her infant, who is the  helpless  victim  of her errors.
 And not only so: unhealthy, ailing  children, bring great
 afflictions upon a family.  In the case of affluent  persons,
they bring disappointed hopes, wounded pride,  and sor-
rowing affections.   A  father  is naturally  disposed  to
regard his offspring with pride, exultation, and hope; but
can he do this when he sees ailing, fretful  beings, incapa-
ble  of  enjoying  or benefiting  by the advantages which
his  abundance and affection procure  ?  In the case of poor
people, the sorrowing affections are aggravated  by the
expense, the household discomfort entailed by illness, and
the prospect of the sickly creatures  around  being hereaf-
ter  incapable of earning their  maintenance at  all, or of
 doing so under the pressure of bodily and mental suffer-
 ing. The faults of the mother  may inflict these disap-
 pointments and difficulties upon the father.   Her respon-
 sibilities are great and  numerous.   Yet there fortunately
 is a present  happiness connected with the maternal duty,
 arising out of mere instinct, which  lightens the  burden\
 beside a  continual  and  increasing reward  springing 
FOOD.
129
from and experienced by  the  higher sentiments of her
nature.

                        FOOD.

  The milk of the mother is to be regarded as the most
appropriate food which can be given to a  newly born
infant.  Where  a mother, therefore, has a sufficiency  of
milk, and is otherwise  able to  perform the duty, she is
called upon by the voice of nature to undertake it.  It is
a duty which may be attended with some degree of incon-
venience ; but this is amply compensated in the delightful
feelings which are developed in the course of the nursing
period, and the consciousness of performing a duty of the
greatest importance to one in whom she  feels the deepest
interest.
  When the mother is  unable  to  nurse, the  next best
course is to  engage a substitute, selecting one  as healthy,
as near in age to the mother, and as nearly the same time
confined, as may be obtained.  It should be regarded as a
sacred duty by parents to  provide a wet-nurse, if their
circumstances will at all permit, for by no other means can
they be  tolerably assured  of the  welfare of their child.
In the next alternative of bringing up a child by the hand,
or giving  it cows' milk and soft food, there is danger of
much physical evil.  The  truth is, no kind of food but
the mother's milk, or that of a well chosen nurse, assimi-
lates with the digestive organs of an infant in the first
few months of its existence.   The evil of the mere unsuit-
ableness  of other  food is  aggravated  when it chances
that too much is given.   While a superabundance of milk
produces no  harm, from its so easily being  discharged
from the stomach, food  can  not be got up without strain-
in o- and  without irritating  the stomach.  Children that
are'dry  nursed vomit less frequently than those who are
suckled; but this is no proof that the food agrees; diges-
tion is difficult, the superabundant food ferments, becomes
very acid, passes into  the  bowels in an improper  state
        9 
130
FOOD.
irritates the  mucous  membrane, and occasions the loose,
green, sour-smelling stools, indicative of what is termed
gripes.  It is a common practice to give an infant a pur-
gative a few hours  after its birth, and to feed it until the
mother has milk for it.  Both these practices are contrary
to nature;  the first  milk causes  a free, natural discharge
from the bowels, very different from the  effect of  medi-
cine, which irritates and enfeebles  the alimentary  canal,
establishing disorders which carry off a delicate child, and
cause a robust one  much suffering.  Whether an infant
be wet or dry nursed, its stomach should be left at rest for
several hours after birth; if there be crying and uneasi-
ness,  they  are likely to arise from other causes beside
hunger.  The sudden change of situation, exposure to air,
the dress with  which it is necessarily encumbered, and
the manner in which it is handled, are  sufficient to ac-
count for uneasiness.  Warmth, quiet and repose  afford
ample solacement for the first few hours of life.
  When there is unusual delay in the flow of the mother's
milk,  or a difficulty in getting the child to suck,  a  small
quantity7  of ass's or  diluted cow's milk  will save the
infant from exhaustion ; but on no account should farina-
ceous food (that is, food composed of any kind  of flour
from grain), be given.  The greatest safety will be  found
in the breast; there are few situations where it would not
be possible to find a mother willing and able to suckle the
new-born infant  until  its natural food is ready.  That thi3
fluid is the proper aliment for an  infant,  is shown  by  its
having no teeth, and by the muscles of the mouth and
jaws being too feeble for mastication, while the structure
of the whole frame is lymphatic, incapable of voluntary
motion, and easily excited.  If a child is to be brought up
by the hand, cow's milk, skimmed, or diluted one-third
with  boiled water, and slightly sweetened, is the only
nourishment that can be safely taken, unless ass's or goat's
milk  can be procured, these being  more  nearly allied to
the milk of a woman.  When we  depart  from the inten- 
FOOD.
131
tions of nature, we always encounter difficulties.   With
some  children, cow's milk  will not agree at all, or only
when mixed  with oatmeal gruel; sometimes the  latter
alone suits best.  Again, in cases of relaxed bowls (a com-
mon disorder  with dry-nursed children), isinglass, highly
baked flour, or arrow root, mixed very thin with milk, are
the best diets; occasionally  weak animal broths are most
suitable.   All  irregularities are better  counteracted by diet
than by medicine.  The application of a flannel bandage
to the lower part of the body is judicious in bowel com-
plaints.   A warm bath soothes irritation and allays pain.
The state of  the  bowels indicates the condition  of the
digestion.   Green, watery, slimy, or  sour-smelling mo-
tions are bad,  as are streaky dark stools.  Two or three
motions in twenty-four  hours are sufficient;  less may be
enough where there is no pain or symptom  of disorder.
Cold produces relaxation.  The  use of the warm bath is
in most cases  highly beneficial.   The facility with which
it is prepared  for an infant, renders it an easy remedy; a
washing tub, and a pailful of boiling water, will be suffi-
cient when  lowered to ninety-six or ninety-eight degrees
Fahrenheit's  thermometer.   There  are  few   disorders
which a bath will not alleviate.  There is an opinion that
it exhausts.  Like all other things, its use requires  discre-
tion.  A very young infant should not remain in it more
than six or eight minutes, and it should not  go in  daily.
The head and loins should be supported by the  hands of
the nurse, so that the whole person may be  at  ease and
entirely immersed, except the head and face; when very
young, an infant  is rarely alarmed  by the water;  but
when there is intelligence, fear is often felt.  A little
ingenuity in floating paper boats, corks, etc.,  amuses and
diverts apprehension;  and, after  a few trials,  the bath
becomes agreeable.
  For the first five or six  weeks,  at  least, the mother is
usually able to support her infant from her breast, and it
will be desirable to continue to do so for three or four 
132
FOOD.
months.  Food is  sometimes required before that time;
but the rule is, that children for the first three months are
better suckled.  At that period, skimmed cow's milk may
be given  safely, when the  natural food is not sufficiently
abundant.  The suckling pot or bottle is the best means
of feeding, for sucking exercises the muscles of the mouth
and jaws, and promotes the flow  of the saliva,  and that
admixture of it with the food which is necessary to  diges-
tion ; while an infant feeding from the spoon only swal-
lows.  The form of the suckling vessel permits but a small
quantity to enter the stomach at a time, and thus another
necessary  law is  obeyed.    Sucking  is  attended  with
healthy exertion and consequent fatigue, and is one  of the
few means of exercise intended for young infants.   Care
and cleanliness are important in using these bottles.  The
sponge or leather soon gets sour and hard, and it is then
distressing to  the  mouth.   After six months, a gradual
approach to solid diet may be made  by a slight addition
of farinaceous food in the  form of boiled or baked flour,
arrow root,  ground  rice mixed  very thin  and smooth,
bread or hard biscuits soaked or boiled, the water poured
away, and the sop beaten till it is wholly free from lumps,
when it may be mixed with milk till it is very thin and
smooth, and slightly sweetened.  Sugar often turns acid,
and should be used sparingly.  The first change of food
sometimes  disorders the system.   Two or three  days
should be allowed for  the  experiment, and, if the diet
does not agree, some other form of farinaceous food may
be tried as likely to prove more suitable.   Should all be
found equally improper, weak chicken, veal, or calf's foot
broth, beef tea freed from fat, and thickened with soft
boiled rice or arrow root, may be tried.  The great point
is to  begin by slow  degrees, giving  a small quantity  of
the thickened food once in the twenty-four hours, and
that in the  forenoon, in  order  that its  effects may be
observed, and the night's rest remain undisturbed.  Food
should always be given about the warmth of the milk as 
FOOD.
133
it  comes from the breast; when too hot, it weakens di-
gestion, and is distressing to the child; and if too cold, it
does not digest so  quickly.
  When infants are fed by the spoon, it is not unusual for
the nurse to ascertain the warmth by putting every spoon-
ful to her own mouth, a habit equally  disagreeable and
unnecessary.   After feeding, the child  should be raised
up, when it will more easily get rid of the air which is
generally introduced   into the  stomach  during eating.
Where there is much  disposition to flatulency, an infant
should be  carefully watched, the accumulation of air oc-
casioning what are called stoppages.  If these occur in
sleep, they may prove fatal to life,  and even when  the
child is  awake they are  dangerous, as when affected by
them it  can not cry out, and  its breath is  for the time
stopped.  The practice of giving caraway seeds, aniseed,
carminatives, or distilled  waters  of  any kind, is decidedly
pernicious.  They irritate the coats of the stomach, and,
though they may give temporary relief, they create future
evil.  They are frequently put into  the food to make it
sit easy on the stomach,  but when food does  not sit easy
we may presume that  it  is of  an improper kind, or given
in too large quantities at a time, or too often.   If  medi-
cine is at any time required, it should be  given as  medi-
cine, and not with the food.  It can not be too strongly
urged, that as the disorders (there is a distinct  difference
between disorders  and diseases) proceed from some mis-
management, they can not  be permanently removed by
medicine, but only by  the adoption  of good management.
Continual recourse to  medicine weakens and irritates the
power of the adult; the  effect upon the tender, excitable
organs and soft frame  of infancy is  even more destructive
to health.
   Over-feeding and improper  diet are the main causes of
the ailments of children. During the first few weeks of
life, infants endure none  but physical evils, they are ex-
empt from anxieties,  from disappointments, from  hopes 
134
FOOD.
and fears; but unfortunately their sorrows, pains, or anger,
are always traced to hunger, and eating is adopted  as
the universal panacea.  This goes on till the child is of an
age to comprehend  and believe  that to eat and drink  is
the greatest happiness and the greatest good.   There is no
doubt that the easiest method of stopping crying is to stop
the mouth,  especially  when  the senses  are not  active
enough to find pleasure from observation.  The means of
relief are then necessarily limited; yet change of position,
loosening the dress, giving the legs and thighs  entire
liberty, chafing them, gentle exercise by the nurse moving
her knees from  side to  side while the child lies  across
them, or walking about the room, and pressing it  to the
bosom, are all of them expedients which may be easily re-
sorted to, and which often have the desired effect.  Rough
jolting and patting on the back, provoke rather than allay
pain.
  It is difficult to lay down rules for the regulation of an
infant's  appetite, since this depends upon rapidity of di-
gestion,  which differs in  different children.   In  two
months the mother may pretty nearly ascertain  how often
her infant requires the breast, and it will  greatly advance
her own convenience and the child's comfort if something
like regularity be established.   Habit very soon  asserts
its influence—so soon, and so imperceptibly, that it is de-
sirable to be governed by its power as soon as the mother
is convalescent.  If a child be  brought up wholly at the
breast, the mother must not be absent at the hour she will
probably be wanted, for  a crying, hungry child offers a
great temptation to a servant to  quiet it  by food.  Every
three hours is the average number of times  a child, from
two to four months  old, requires to suck.   A good  sleeper
may, during  the night, rest as long as six hours together,
but regularity may be attained by night as well  as by day.
Suppose an infant to wake at  seven in the morning, and
to suck; after washing and dressing it will  take another
meal and a long sleep, bringing it to noon, when it is 
                         FOOD.                     135

 again  refreshed, and, if the weather  be warm, carried
 abroad, sleep usually follows upon going into the air, and
 three  o'clock may have arrived before it again requires
 the breast.  From this time until  undressed for the night
 it should not be lulled to sleep, but  if the child be much
 inclined for repose, it should not be prevented.  It is de-
 sirable to give a child the  habit of sleeping  throughout
 the night.   At six, preparations are made for bed; the un-
 dressing and washing produce a certain fatigue, and when
 the child has again sucked,  it will probably fall asleep and
 remain in* that condition four hours.  It is a good plan to
 accustom an infant to suck just before the mother goes to
 bed, and this it will do even if asleep.   Its linen should
 then be changed, and  if  it wake up,  allowing  it to
 stretch its limbs before the  fire, rubbing its loins, thighs,
 legs and feet, give exercise  and refreshment, and prepare
 for another long sleep.   Between this  and seven it will
 wake once or twice again, and require nourishment.
   As the power of observation increases, and  muscular
 strength induces exercise, an infant sleeps less by day, and
 more by night, it  requires the breast less frequentl}7, and
 takes more at a time, the  digestive powers being more
 active, and all the functions stronger.  If a child feeds as
 well as sucks, there  should be a regular time  for both.
 The time of waking  in  the morning, and the middle of
 the  day are  perhaps the  most favorable periods, the
 stomach being then  comparatively empty, and the digest-
 ive power brisk.   Mothers  may in these cases make ar-
 rangements suited to their convenience, without prejudice
 to the infant.  Two circumstances govern the  progress to
 solid and animal food—the appearance of the teeth, and
 the growth of muscular power.  Mastication and exercise
 are necessary  when  strong  nourishment is presented to
the system.  Medical men are of opinion that the time of
weaning should be regulated by the appearance of the
teeth;  but  in  different children this period varies  con-
 siderably.  In the same family, one child has been known 
136                     food-
to cut  teeth before five months, another not till  after a
year.   There may be circumstances rendering it desirable
to wean, even if the teeth have not appeared.  The health
of the child, and the season (winter is a time of difficulty),
will be considerations.  The mother's health should also
be taken into  account.  If the child be strong, and the
mother weak, weaning becomes  unavoidable;  but if all
goes well on both sides, the child should have  every ad-
vantage, and not be weaned, upon the principle that six,
eight, or ten months, are long  enough, but for some good
and sufficient reason connected with  the circumstances of
the mother.  If her infant be  strong and  healthy7, and
likely,  after seven or eight months, to thrive equally well
upon  food,  and if the office of a  nurse prevents the
mother from giving the necessary care to  equally import-
ant duties, she will be justified in weaning.  Under any
circumstances, the general principle must be kept in view,
that the health of an  infant depends mainly  upon the
nature of its diet; and if there be any reason to think
that the loss of the breast will be attended with risk, the
mother will  gain nothing in time or diminution  of care
by weaning.
  It is advised to avoid weaning in severe weather, and to
do it gradually, giving the breast  less frequently, and dis-
continuing  it at night.  The digestion thus gets  accus-
tomed  to the  change, and  the temper is less tried; the
milk diminishes in quantity, and the mother suffers less
inconvenience.  Another advantage  of a  gradual cessa-
tion is, that, should  the infant lose its health, suckling
may be resumed.   Weaning has been considered  a great
trial to mother and child.  The latter suffers when the
privation is sudden and unprepared;  but when it is grad-
ual, the infant healthy, and the food agreeable, it will soon
cease to care for the breast.   The mother naturally regrets
to relinquish so tender an office, and her feelings are the
more distressed when she finds  that  she can not even  be
in the  presence of her infant without giving it  additional 
FOOD.
137
pain.   But it will be well that, at this time, she keeps out
of its  sight, if she be perfectly satisfied as  to  the  trust-
worthiness of those to whom she commits it.  If she can
not rely upon another for attentive and rational nursing,
her child had better be tantalised by the sight of her, than
neglected or  mismanaged.   For  herself, she  will  take
some cooling purgative, and refrain from fluids and stim-
ulating diet.  The following application to the breasts
will assist in drying up the milk :  Three ounces compound
soap liniment, three drachms laudanum, one drachm cam-
phor liniment; or if this be  too  irritating, fomentations
of warm  water,  or  poppy heads and  camomile flowers
boiled  together  in water, give great  relief.  Pressure or
tightness occasioned by the dress must be carefully guarded
against.   The distension  of the  milk vessels occasions
great irritation  and tenderness;  a slight blow, pressure,
or roughness  in  rubbing them, may  produce an abscess.
It is better to get rid of the  milk by its natural absorp-
tion into the  system, than to draw it artificially; for the
latter method keeps up the action of the vessels.  Expo-
sure to cold is dangerous, the system being in an excited
state.
  The  diet  of a child, after weaning, must be regulated
by the strength of the digestive powers, by the teeth, and
by  the muscular condition of the  child.  Upon the prin-
ciple that diet should assimilate with the powers of the
system, the gradual change from the soft lymphatic  forms
of infancy to the firmer condition  of childhood, dictates a
gradual change in the aliment.  If a child thrives on fari-
naceous food,  milk and light broth, there can be no need
of change.   Something  depends  upon  growth.   There
are children whose rapid increase of stature, and incessant
activity,  produce a waste which  calls  not  only  for fre-
quent  supplies of food, but also for food of a more nour-
ishing  quality.   With such, animal  food   once  a  day
(always supposing the teeth are in a condition to masti-
cate it), may be  necessary; but if  a high degree of exci- 
138
FOOD.
tability, a violent temper, and  impatience, prevail, nour-
ishing  food  must  be given  with  discrimination.  The
mother will ascertain whether these qualities are increased
or diminished thereby, and regulate the diet  accordingly.
A lymphatic, fat, white looking child, whose mind and
temper are sluggish and indifferent, should not be fed
wholly upon fluid  or soft diet; more concentrated food
will probably correct the temperament.  In all  cases the
state of the bowels, of the  skin,  and the temper, will
indicate whether the food  nourishes too much or too
little.  Fat is no positive criterion of health; a very active
child, after three years  of age, is rarely very fat, but the
muscles may  nevertheless be large;  their size, compared
with that of the bones, and with the age  and growth,
det^-mines whether the child be  properly nourished.
Emaciation is a certain indication of imperfect nutrition—
a consequence of over-feeding as much  as under-feeding.
If the digestion  be over-tasked by  quantity or  quality,
the chyle is  vitiated, and  nutrition  insufficient, while, if
the supply is not  in  proportion to waste  and growth,
there is a deficiency in  the  formation  of all the tissues,
cne bones remain soft, the muscles  flaccid and shrunken,
the skin covered with eruptions, the  nerves weak, yet  so
excitable that all impressions are painful, and a constant
fretfulness or moping incapacity prevails.   It  has been
ascertained that scrofula and consumption are produced
both by over-feeding and want of sufficient nutriment.
   A soft, clear, pliant skin, accompanies a healthy action
of its functions.   It  is not  transparent  in  all  cases,
because complexion makes a difference  both  in  color and
thickness.  Its condition is better  ascertained by its tex-
ture than by its hue.   A dry, harsh,  scurfy skin, indi-
cates something  wrong in  the  alimentary  canal,  to  be
corrected by the diet,  or  an inactive  state of the skin
itself, to be overcome by exercise and warm baths.  The
temper is a very  sure index  of  health.   Cheerfulness,
mirth, and freedom from anxiety, are  the  peculiar priv- 
FOOD.
139
ilege of  early childhood;  the past and the future are
nothing, the present every thing.  The absence or inter-
ruption of these sentiments denotes deranged health.  It
is true, that what is called a  spoiled child, is troubled by
bad temper; for where there is moral mismanagement,
there will also be physical mismanagement.  The petted
child will have what it desires to eat and drink, will go to
bed only when it pleases, will submit to no regulations,
while the irritation  to which  it is continually subject from
the contradictions  it must encounter, and from its own
unrestrained feelings, wears the nervous system, and ex-
hausts the energy which is required for the healthy action
of all the functions.
  The general rules for diet after weaning, then, are these:
Mild nourishing food  given at  regular intervals of  tiaae,
the quality to be more animalised as the waste of the sys-
tem is increased by growth and  exercise;  observation to
be made of the effect of any new substance, such as  fruit,
meat, etc., that it  may be  discontinued if hurtful,  and
wholly abstained from (for a time) when found  to be so.
Seasoned dishes, fried and  salted meats, pastry, uncooked
vegetables, unripe fruits, wine and rich cake, to be alto-
gether avoided; mastication to  be insisted on, and no
viand to be eaten in large quantities  because it is liked,
while nothing disagreeable should be forced upon the ap-
petite.  Whenever  there  is a disinclination  for food, the
feeling  should  be  indulged, since  it bespeaks  a state of
stomach in which  food would be injurious.  Tempting
the appetite  is physically  pernicious,  while  morally it is
the first  step to needless sensual  indulgence.  Children
require  to eat  more frequently than  adults.  A healthy,
active child of two years, needs  food  every three or four
hours while awake, provided the stomach be not loaded;
but continual eating allows no time for the repose which
the digestive apparatus requires, and  establishes a bad
habit.   Variety is also desirable; not that children should
eat of several dishes at one meal, but they can not be fed 
140
FOOD.
judiciously every day alike.   Farinaceous food is capable
of great variation.  The  animal food  given to  a child
should be of a tender fiber, and  eaten with a due propor-
tion of salt, vegetables, and bread.
   Every thing should be well  dressed.  Good cookery
means the preparing of food in the best way.  However
simple the fare, it should be dressed with  attention to
cleanliness, kept free from grease, neither over nor under
done, neither burned nor dried, the proportions mixed and
flavored  by rule, not by guess work.  An ill-dressed dish
is not only unpalatable, but indigestible.  Bad cookery
causes waste and discomfort.  The dinner of a child, how-
ever simple,  should, for both these reasons,  be carefully
prepared.  Disagreeable food is tossed about  on the plate
and  spoiled, and  thus children  learn to be wasteful and
indifferent to the  true value of food.  They may not per-
ceive its indigestible properties by their taste; but a fit of
sickness or fretfulness is no unfrequent consequence of an
ill-dressed meal.   There is a  natural perception  of good
and bad  food, intended to  save the  stomach and the sys-
tem from injury, quite as much as to insure a reasonable
gratification from  eating.   The sense  of taste  may  be
trained to  discriminate between what is wholesome and
unwholesome  in  cookery, yet no  undue  love of eating
inculcated.
  We would recommend bread  and milk, varied  by  tea
and  coffee, diluted with milk,  as  a good breakfast and
supper.   New bread is decidedly unwholesome; it swells
in the stomach, causing distension and oppression.  Sweet-
meats and  confections, when habitually eaten, turn acid
upon the stomach, and destroy the appetite for plain food.
But,  given  occasionally in  moderate quantities, and of a
good quality, they are a harmless indulgence of the palate,
and  may be  made  the innocent  means of promoting
amusement, and even  intelligence.  Young children  ai^e
delighted to  play  with sugar-plums, and the vaiiety  of
their forms  and colors contributes to their  amusement 
SLEEP.
141
 When the gratification of eating has not been encouraged
 as a chief source of delight, they will be  as much sought
 for the  pastime they afford, as the pleasure of appetite;
 they should not be given as incentives or rewards.
   In training the very young,  it is  to  be remembered
 that natural inclinations and impulses are evil only in their
 abuse, and that the desire for food, like all other desires, is
 intended to be a source of  reasonable gratification.  Eat-
 ing  is made  pleasurable, because it is necessary to life.
 During infancy, the most  ready means of  giving and
 obtaining quiet, is food; a  constant habit of eating, and
 looking to it for comfort, is  one of the earliest impressions
 an infant receives.  A child evinces an  anxiety for any
 viands it may see, and this desire is laid hold of as a bribe
 or a reward.  Eating thus becomes  the chief aim and
 object;  a child learns to eat too much and too  often, is
 satisfied  with mere  animal  gratification,  and  is  most
 attached to those who pamper him the most.   This is the
 abuse of a natural propensity, and the first step to sensu-
 ality7.  But if an infant be fed  only when hungry, instead
 of when uneasy, and as it grows older, eats upon the  same
 principle, with such habitual regard to neatness, order and
 good cooker}7, as shall accustom it to discriminate  between
 what is  fit and what is unfit, wholesome and unwhole-
 some, there will be no undue value attached to food.

                       SLEEP.

  All young  animals sleep much.  The child partakes of
 this instinct so fully, that there is no necessity to  promote
 it, but only to prevent its disturbance.  Physical  comfort
 is all that is needed; and this is to be  obtained by what-
 ever secures health—namely, proper diet, warmth, cleanli-
 ness, and the fatigue which follows  upon the  exercise
proper to infancy.   During the first few weeks of life, the
sense of hearing is  so dull that noise does not  disturb.
 Sudden noises, however, are sometimes distressing, occa- 
142
SLEEP.
 sioning a weakness of the  nervous system.  But the con-
 tinuous sounds  produced  by talking, the  noises of the
 street, or the voices and sports of other  children, seldom
 rouse infants in the first month or six weeks, and it saves
 much trouble if they become accustomed to them.  Sleep-
 ing in the arms, or on the lap, is, for every reason, to  be
 avoided; no child accustomed to this indulgence v/ill rest
 long in its  bed; neither ought they  to be lulled to sleep;
 they may be early  habituated to  be put into bed  awake,
 and  so left, with the necessary caution  of watchfulness.
  Although  it is not practicable to  adhere strictly  to
 rules at first, there should always be an endeavor to form
 good habits, and this from the beginning—those which
 relate to sleep should be established while the disposition
 for repose  is  strongest. On laying an  infant  down, it
 should be ascertained that the feet,  hands and  face, are
 comfortably warm, that every7  part  of the  body is  sup-
 ported, and the limbs uncramped; the head and shoulders
 being raised a little by the pillow, sloping gradually  to
 the bed.  Blankets  are  better than sheets.   The covering
 should be so arranged that, while  there is sufficient space
 to breathe freely, the face is kept  warm.  It is better not
to take up a child the instant it wakes (particularly  if it
have not been  long asleep), nor if it cries after being laid
 down.  Change  of posture, gentle rocking or slight pat-
ting on the back, should be tried.   If these fail, it should
 be taken  out of bed and quieted in the arms.  Change  of
linen  maybe  necessary; in short, patience, perseverance
and ingenuity, should be put in practice, with a view  to
produce comfort without entailing bad habits.
  In rearing children,  it is well to bear in  mind  that
 present evils ought never to be overcome by wrong means.
 It is best that infants should lie alone, for the air of a bed
 in which one or more grown-up persons  are  sleeping,
 becomes  impure, the child imbibes the perspiration  pro-
 duced  by sleep, and is  in  danger of being overlaid—an
 accident by no means uncommon.  Children, lying alone, 
SLEEP.                     143
sometimes become cold in the course of the night, and it
may then be  necessary,  in  order  to restore warmth, to
take them into bed;  but when warmth has been restored,
they should be again put into their own cot or crib.   It is
difficult to  overcome that natural instinct which leads a
child to lie at the breast; but they sleep alone in the day
for hours at a  time, and ma}7 therefore be trained to do so
at night.  Darkness  is favorable to repose, and it has its
influence upon the young, although not at the beginning of
life.  The object, then, is to cultivate a habit of sleeping
throughout the night.  Mothers must expect their rest to
be disturbed until  the exercise and  fatigue  of the day
increase the necessity and the desire for night sleep.  Re-
freshment and change of linen  are needful  at night, and
these should be given very quietly; no amusement should
be offered, or wakefulness will be encouraged, and a child
will regularly rouse itself for a game of play.
  Every mother  will remember that she has duties as a
wife and the  mistress of  a household, and that in provi-
ding for the comfort of  her child she must not sacrifice
that of her husband and  the rest of the family. A wake-
ful, fretful  child, is a trial to patience, and disturbed rest
is hard to bear.   Every arrangement that circumstances
permit, that can prevent  this infliction, ought  to be made
and adhered to.  After the first three or four months, if
suckled when  the mother retires to rest, as already recom-
mended, the child will wake but once more, provided the
management be judicious.   A child should never be kept
awake when  fatigued, under the idea that it  will rest
better  at night.  Over-fatigue produces general irritability,
pain in the limbs, fretfulness, and restlessness.  For this
reason, however  apparently disinclined, when the fixed
hour arrives, there should be no  delay about preparing for
bed, and  this practice ought to  be  maintained  during
childhood as well as infancy.   The habit of sleeping in
the day is of great service, even during the first four years,
and longer where there is delicacy of constitution or great 
144
CLOTHING.
activity.  Sleep is the only means of giving rest to the
system  of a  child; in health, there is  no repose  except
during  sleep.  In warm  weather, it  is  very acceptable
to active  children of five or six, and frequently  relieves
them from a weariness which assumes the appearance  of
indisposition, or takes  the form of ill temper and  disobe-
dience.   An hour's nap  will be found a safer physical
and  moral remedy, than  a  dose of medicine, or punish-
ment.

                     CLOTHING.

  Warmth is essential  to the health of a new-born infant,
and this is chiefly to be obtained through the medium  of
clothing, for in the first stage of infancy there is no mus-
cular exercise.  What  renders warmth by artificial means
so necessaiy, is the fact  that infants, having a languid
circulation, produce little heat naturally,  and easily part
with what they  do produce; for which reasons they are
liable to suffer far more from exposure than adults.   A
certain degree of warmth  is essential  to the  performance
of all the functions, and protection to the  skin  assists
materially in  maintaining this warmth, which should be
sufficient to keep up the insensible perspiration, yet  not  so
high as to produce continual sensible perspiration. The latter
state relaxes the system, and renders it liable to be affected
by cold  draughts or  changes  in the weather, while  it
exhausts the  strength, and, by increasing the  action  of
the blood on the surface, deprives  other  organs of their
necessary quantity.  Clothing, therefore, must be  regula-
ted by age and by the season.   The sudden change in the
situation of a new-born infant calls for great care  in the
protection of the skin.  This should be entirelv covered
for at least the  first month;  even the face and  hands
should be but gradually exposed.  Lightness, as  well  as
warmth, is requisite in all articles of clothing.  Flannel
and muslin possess these more  than any other material.
But  flannel, even of the finest  texture, may be too irri- 
CLOTHING.
145
fating if worn next the skin, and it is  desirable to give
the infant a shirt of fine linen or cotton  under the flannel
to protect the cuticle.   Another reason for the  use of
linen or  cotton next the skin, is, that flannel can not be
washed often without injury to its texture; and there is
also danger that, as it does not show  the dirt so quickly,
it may be  continued to be worn too long.  Linen  and
cotton take little harm from frequent washing, and are so
much  cheaper than flannel, that a larger stock may be
provided for the same expense.  At no season can flannel
be  dispensed with,  though in hot weather it should be
thinner than in  cold.
  Looseness  is  another requisite in  an infant's  dress;
there should be a free circulation of air  between the skin
and the clothes, as well as a slight friction  upon the sur-
face.   All  confinement distresses, and, when it amounts
to tightness, it may  occasion deformity7,  before the  evil is
suspected.   Full room should be allowed for the increase
which is continually and  rapidly going  on.  For  this
reason, every part should fasten with strings; and in tying
these strings the greatest care should  be  taken  not to
draw them too tight.  It is a good precaution, after every
string has been tied, particularly those under the chin and
round the waist, to  put in the finger, to  ascertain  that it
is not too tight.   In comparison with  strings, buttons
and hooks  and  eyes  are  not to be commended;  they
have  but one  advantage, that  of putting  it out of the
power of a  hasty or negligent nurse to  fix the  dress too
tight, as  may be the case with strings.   It is necessary,
frequently, to ascertain whether a child has outgrown its
clothes.  Growth is so rapid during the first two  years,
that a few  weeks will make enough of  difference in the
relative size to produce pressure  or  restraint;  clothes,
therefore, should always be made so as easily to let out or
enlarge,  particularly round the waist, throat, and arm-
holes, and across the chest  and back.
  It must ever be  kept in  mind, in regard to  clothing,
         10 
146
CLOTHING.
as well as  other circumstances  in the  economy of  an
infant, that the babe can itself give no explanation of the
inconveniencies  which it  suffers.  Bearing this in mind,
and  remembering how continually adults are annoyed  by
trifles which they have the perception to discover, and the
ability to remove, it will readily be  acknowledged that
nothing is too insignificant for  the constant  and regular
attention of a mother.   Articles of dress contract, or oth-
erwise lose their shape; a ruck forms, a hook bends, or a
button turns and presses upon the  flesh.   Any one  of
these accidents occasions pain, and frets the temper of  an
infant.
  The more easily the  dress can  be put on  and off, the
better.  There should be  no other fashion than what is
dictated by  convenience and  comfort.   The fashion  of
long-clothes (such, for instance, as measure a yard or more
in the  skirt), leads to needless  expense, both in material
and  in washing, beside  encumbering  and  overweighting
the child.   There need be no more length than is neces-
sary  to cover the feet, so that the cold will not draw un-
derneath the clothes, and to conceal the under-clothing.
The  change  observable in a child when the  long-clothes
are laid aside, sufficiently proves that the limbs have been
confined and  activity restrained.  The frequent dressing
and undressing which the  use of ornamental  attire neces-
sarily entails, irritates so much, that the slightest sign of
changing the apparel is a signal for crying,  and a habit of
fretfulness, during dressing, is formed, unfavorable to the
tempers of both child and  nurse.  Loose gowns, fastening
in front, are  therefore  preferable to frocks (for the first
two  months),  however less  elegant or fashionable.  All
unnecessary folds should  be avoided, because they may
press painfully upon the muscles or bones;  and the mate-
rials  should be of a soft,  yielding nature.  Harsh seams
and hems, or rough tapes, especially where coming in con-
tact  with the skin, will  be avoided by the  skillful seam-
stress.  Where pecuniary means are  not  abundant, the 
CLOTHING.
147
mother, in making her baby linen, should remember that
quantity is more important than quality, and that cleanli-
ness can scarcely be observed where the stock of clothing
is scanty.
  One of  the most important parts of an infant's clothing
is a band  to support the abdomen, familiarly called  the
belly-band.  This  should be made of soft flannel or muslin,
that is to  say, of material having some elasticity.  It is
intended to give support to the abdomen, especially to the
navel; and it protects the internal  covering of the intes-
tines from any sudden distension.  The umbilical cord is
usually divided at  birth about three inches from the abdo-
men of the infant, close  to  which it is securely tied, or
the child will bleed to death.  The final separation of the
remaining portion of the cord is the work of nature,  and
takes place at various periods, sometimes in five days, or
even less,  sometimes not till the fifteenth day.  The child
is  more comfortable when this is over; the unpleasant
smell alone, which of course attends  the decay  of  the
part, is distressing; but there is always a good deal of ten-
derness, which sometimes amounts to ulceration and pain.
In ordinary cases, as soon  as the separation has  taken
place, a split raisin and a piece of singed linen should be
applied to the part, and changed daily.
  It occasionally  happens  that  after  a few weeks  the
navel  starts;  in   such a case, a  common ball of sewing
cotton, half used,  so that what remains is soft and  yield-
ing, should be laid upon the navel, and confined by strips
of strapping-plaster placed crosswise.   If anything more
serious appear, such as redness, ulceration, discharge, etc.,
medical advice  is  immediately necessary.  The vessels of
the umbilical cord pass through the  abdomen, making a
passage which for the most part closes quickly and soundly
after the separation of the cord; but  unusual size  in  the
opening, indisposition to close, or screaming, straining,
sneezing, or any sudden violent effort, may interrupt  the
natural process, and force the intestines through the open- 
148
CLOTHING.
ing.  A steady protection, which shall gently resist these
efforts yet not compress the cavity of the  abdomen so as
to obstruct the healthy action of the viscera, is required.
The band  affords this  protection.   In putting  it  on, it
must be remembered that there is a distinction  between
support and pressure, the former is indispensable, the latter
dangerous.  If the cavity of the abdomen be diminished,
its  contents are  compressed, and when any action  takes
place that strains the parts, there is no room for the neces-
sary distension, and the  weakest give way.  The action
of the bowels is impeded by compression, occasioning pain
and constipation.   Medical writers  dwell upon the im-
portance of the band, and decide that rupture is frequently
the consequence  of neglect or ignorance in regulating its
use.  It requires to be taken off and  rearranged morning
and night, and a clean one put on every other day, as it
gets rucked, and  so unfitted for use.   It is often  wetted,
and is then likely to create pain and  disturbance of the
bowels, for which reason  the same  should  not  be worn
both day and  night.  With some  children  the  band is
necessary for many months; when it  is discontinued, the
stay or waistcoat, usually  worn as a sort of support to the
rest of the clothing, should reach  two inches below the
navel; it prevents an  enlargement of the  abdomen, and
sustains the child in its attempt to sit up.
  The custom of keeping the head warm is gradually dis-
appearing.  The bones of the skull are not  all united at
birth; the parietal bones are divided, and the soft matter
of the brain on the top of the head is perceptible to the
touch.  This  opening was supposed to give a liability to
cold, and the head was kept very hot; an  injurious prac-
tice, increasing the action of the blood-vessels of the head
to a dangerous extent, and impeding the junction of the
bones.  When a child is to be carried about the 'house,
however securely it maybe clothed, the cold draughts which
prevail even in mild weather, should be guarded  against
by the addition of a light  handkerchief or shawl.  The 
CLOTHING.
149
disorders arising from checked perspiration will thus be
avoided.  On the other hand, a child should never be pre-
sented naked  too near a fire, as a scorching heat injures
the texture of the skin and deranges  its .functions.  Oh
bringing an infant near a fire on any occasion, it may be
well to screen  its face and  hands, in order to protect it
from this evil.
  There is  little doubt that the eruptions to which the
infants of the poor are subject, chiefly arise from want of
cleanliness and warmth.  In this country, where  changes
of temperature are sudden, and continual judicious cloth-
ing  is the  only safeguard,  summer apparel  can not be
safely7 adopted  and laid aside at a  given period, nor can
the same dress be always worn at noon and in the even-
ing.  However warm the clothing, infants should not be
carried abroad in cold weather, their lungs can not bear a
low temperature, and there is no exercise to keep the blood
equally distributed.  Where ventilation is attended to, no
other change of air is wanted but what may be obtained
by moving from room to room.  An  infant  usually falls
asleep when carried abroad; cold increases the disposition
to cto so, and renders  it dangerous, while no good can be
derived from  the external  air, since  common prudence
dictates that the whole person must be completely en-
veloped.  If carried  about  a well ventilated room,  at  a
moderate temperature, the child breathes freely and with-
out risk.  No child can be taken into the open air in very
cold weather with safety, until it is  able to take so much
exercise as shall keep the blood  at  the surface. Before
this period, the  quantity of necessary clothing  impedes
activitv.  This, with the state of  the air, benumbs the
limbs ;"the blood is driven from the surface, and loads the
lungs,5stomach and brain, etc, the child returns  home,  is
brought suddenly into a room with a  fire, and probably
close to the grate, for the sake of restoring warmth ; vio-
lent reaction follows; the harmony of the system is dis-
turbed  and the functions sustain at least  temporary in- 
150
CLOTHING.
jury.  The daily repetition of the disturbance tries the
strongest constitutions  severely, and, where there is pre-
disposition to disease, active disorders follow.  How much
better to put a child into a swing, to  toss him about, en-
courage him to use his voice, throw a ball along the floor
and creep or run  after it, all  of which, and much  more,
may be done in a room  properly warmed and ventilated.
By such means mental and bodily energy is kept up; the
blood is  equally distributed; there is neither stagnation
nor over-action; fatigue follows upon the exercise, and
then comes healthful repose, instead of the torpor which
succeeds the combined effects of cold and inactivity.
  When the period of infancy has passed, the clothing
must still be attended to; if insufficient, children creep to
the fire, and are very unwilling to face the cold or to exert
themselves; if properly clad, weather seems to make little
difference to them.  When a child can run  alone, and ex-
press its wants  and wishes by signs or sounds, it should
(in  cold weather especially) wear loose drawers ; they may
be cut  so as to  be no impediment to activity or cleanly
habits ; if the lower part of the body and the loins are ex-
posed to cold, weakness of the urinary organs is often in-
duced, very distressing and difficult to cure.   The warmth
of a pair of drawers more  than equals that of two  petti-
coats, so that their adoption need  cause  no  additional ex-
pense.
  The care of the feet is for many reasons desirable.   The
practice of keeping them uncovered is not  to be recom-
mended.   There is danger of laceration from the  many
hard and  sharp substances lying on the ground, and ex-
posure is  not favorable to  general health.   Chilblains are
frequent  with  those  whose  feet  are  exposed in  cold
weather.   The only advantage gained  is freedom of gait;
but this is an advantage which the wearing of shoes ought
not necessarily to deprive us of. If shoes were made with
a due regard to  the shape of the  feet, and  a liberal con-
sideration of other circumstances, no  harm would ensue. 
CLOTHING.
151
It is to be observed, that the foot in its natural condition,
as to be seen in a nursing baby, expands regularly from
the heel to the  situation of the smallest toe from which
point it contracts in an oblique direction toward the great
toe.   Shoes are not made in this form, but, after expand-
ing  to a point a little short of the  smallest toe, they con-
tract on both sides equally, thus crushing the outer toes
toward the center.
  It is also to be observed, that the sole is naturally formed
on a perfect level from heel to toe.   Shoes, however, are
formed with an inequality of from half an inch to a whole
inch, or even more (we  allude  to  grown-up persons), be-
tween the heel and the front of the foot.  Thus, the body
is thrown forward from a strong point, the heel, to a weak
point, the toes ;  the limbs are prevented from ever keep-
ing a straight position, and the whole figure and walk are
deranged.  If we were to reflect for a moment on the ex-
quisite adaptations of all things in nature, we should in-
stantly see the absurdity of this conduct; if there had been
any  advantage in making the  heel  somewhat  higher
than the front of the foot, would nature, which has made
every thing so  nicely suitable, have failed to  fashion the
foot accordingly ?  Perhaps it is not to be expected that,
either for  children or adults, shoes without some elevation
behind are to be adopted; but it may at  least be said, that
the lower the heel in all cases, the shoe will  be the better.
Shoes should neither be too roomy nor too tight, though
the latter  is the worse fault.  The  unavoidable results are
corns, bunions, and distorted and turned-in toes, all of them
evils of no small magnitude.  When we are thus affected,
free  motion is impeded ; the foot, instead of being placed
firmly on  the ground, is set down in any way that will
best avoid pain; the whole person droops, the chest is con-
tracted, and, perhaps, worst of all, the temper is rendered
fretful.   A  mother,  sincerely  anxious for the  welfare
of her children, will cause their shoes  to be made of a
proper shape and consistence, to allow of perfect freedom. 
152
CLOTHING.
 When an infant is to make its first advance from woolen
 socks, the best  plan is to cause the shape of the sole of
 the foot when  standing to be traced, and the  sole of the
 shoe to be made from the outline.
   On the general  subject of protection from  cold, some
 remarks may here be made.  There  is an opinion  that
 children should be made hardy from the first, and  that it
 is therefore  proper to plunge them  into cold  baths, and
 otherwise expose  them to  rigors which are obviously
 disagreeable to them.   The practices of savage nations
 are cited in support of these opinions, but no attempt has
 ever been made to show that they are supported by any
 philosophical principle.   When  the practice of a savage
 nation is cited, we should guard against mistaking a pecu-
 liarity of their constitution for a general  principle.  It is
 now known that the  nations  in question do not possess
 nearly the same amount of nervous sensibility as the
 European races, and that this  is the true cause of their
 enduring so many tortures uncomplainingly at the stake.
 What  their infants may not be  affected  by, may greatly
 injure the comparatively tender structure of an European
 infant.   There are certainly differences of the same nature
 among infants in our own country, and some of these
 might be little  the worse of the rigorous treatment  pre-
 scribed.  But there can  be no  doubt that, as  a general
principle, infants require warmth, and ought  not  to be
 unnecessarily exposed.   In them the circulation is languid,
 consequently little heat is generated in  their  bodies
naturally. AVithout being  kept warm, there  can  be no
healthy action of the functions in their case;  and without
 a healthy action of  the functions, the sound formation
 of the various parts of the frame will  be  obstructed.   By
 the contrary treatment, the foundations of glandular and
 pulmonary disease are   often laid.   Infants, therefore,
 should be sufficiently, though  of course  not cumbrously
 clad.   In reply to the argument that  the children  of the
 poor are necessarily exposed, and have the best possible 
WASHING  AND DRESSING.
153
 health, it can only be said they live in spite of the exposure,
 not in consequence of it; those who are accustomed to
 visit the poor testify to the  comparative sickly condition
 of the children, while the bills of mortality show that the
 large proportion of deaths  are those of young children;
 and the  observations of the best informed attest  the fact
 that much suffering, great increase of disease and mortality
 are the consequences of injudicious exposure to cold.

             WASHING AND DRESSING.

  For the health and comfort of an infant, washing- is an
 important requisite.  It should be performed every morn-
 ing and evening, and not in a slovenly, but in a complete
 though  gentle manner.  The physiological reasons for
 such frequent ablutions are these :  The pores of the skin
 convey superabundant  matter from the system, and that
 matter is apt to remain upon the skin so as to clog up the
 pores, and prevent them from performing their functions,
 unless it be washed off.  The pores also act as absorbents,
 and this function likewise  is impeded when the skin is
 not clean.  In the case of an infant, washing is necessary,
 in a more particular manner, for the removal  of impurities,
 the contact  of  which  is  unfavorable for health.   For
 reasons which have been adduced under the head " Cloth-
 ing,"  the water in which infants are to be washed should
 be warmed.   Cold water is further objectionable as  tend-
 ing to drive  the blood inward,  and over-stimulate  the
 organs, the unavoidable consequence of which is disorder,
 and often death.  For the same reason, when the business
 of bathing infants is to be  performed, great  care should
 be taken to  prevent draughts of cold air from  coming
 upon  them.   They  can  only be safely undressed beside a
fire for the first four months.
  A new-born infant is covered with a pasty, greasy sub-
stance, which  must be removed, otherwise it will  irritate
and excoriate  the skin, and occasion a disagreeable smell.
Soap and fine flannel, or sponge, are the best applications; 
154
WASHING AND DRESSING.
every fold of the  skin, the joints, armpits, etc., must  be
carefully examined and  washed.  It is by no  means un-
common to rub a new-born babe with spirits, to prevent
its taking cold after washing; but the stimulus thus given
to the skin is injurious, and  must  be painful, while the
rapid evaporation occasioned by the application of spirits,
tends to  produce instead of to prevent cold.
  On preparing for dressing and washing, every neces-
sary article should  be near at  hand; it is a sign of mis-
management  when a nurse has to rise to fetch  any thing.
The horse, or screen, with the clean linen  conveniently
placed, will keep off draughts.   The  basket, basin, soap,
sponge  and towel, should  be  laid within reach, and  in
such order that there can be  no  confusion, and that the
clothes  shall  not fall into the  water, nor the wet sponge
and  towel find their way into the basket.   The nurse,
being thus prepared, with the addition of a flannel  apron
and a low chair, strips the infant, and having  washed  its
head  with soap,  rubs it dry.   The  face,  throat,  chest,
arms and hands, are then successively sponged  as plenti-
fully as the child  can bear (soap  is not always required),
and tenderly but thoroughly wiped.   The infant is turned
over, and the back, loins and legs are abundantly covered
with water; the left hand holding the child, its legs hang-
ing over the knee, so that the water flows from them into
the basin.  The thighs, groins, etc., require great  atten-
tion  both in  washing and wiping.   The corner  of the
apron should then be turned  up, so that there is  a dry
surface for the child to rest on, while it is carefully wiped.
The  rolls of fat and creases in the neck, arms and thighs,
the bend  of the arms, hamstrings, and  the  ears, must be
thoroughly washed  and dried.   As the friction  between
the parts increases the  perspiration  and the  liability to
excoriation, they should, after  wiping, be slightly pow-
dered with unscented hair-powder or powdered starch.
If occasional heat creates  redness  and chafing, a small
quantity of plain pomatum, or lip salve, is often serviceable. 
WASHING AND DRESSING.
155
  After washing and drying, the skin  should be rubbed
with the hand or a flannel glove; this restores the circula-
tion to the surface, and is agreeable and soothing.  Morn-
ing and  night this washing, from head to foot, must be
repeated, while every  impurity, from whatever cause,
should be immediately removed from the skin during the
day.  If a child throws up its food, or there is much flow
of the saliva from teething, the face and throat should be
washed once or twice during the day.  Before the clothes
are put on, the child should be allowed to kick and stretch
its  limbs upon  the  lap; this affords an  opportunity  of
ascertaining its healthy condition.   At no period of child-
hood  should this attention be  omitted; any little defect
in walking, running, or even sitting, should be inquired
into, and the cause ascertained.
  The clothes of an infant should be made with reference
to convenience and  speed  in dressing, without requiring
any pins for the fastenings.  The  band,  shirt, and back
skirt  or flannel, may be arranged while the infant lies on
its stomach; turning it on its back, they may be fastened
in front, and  the diaper and flannel square folded and
secured.  Raising the child on  its seat, the frock and pet-
ticoat may be  put over its head, the arms put through the
arm-holes of both at once,  the palm  of the right hand  of
the nurse supporting the infant across the  chest, while the
fingers  assist  the left hand.   The  child is then  again
turned  over (if the frock fasten behind),  and the strings
tied.  Putting the arms through the sleeves is a nice part
of the task.  In order to avoid injury  or  pain, the nurse
should ascertain  how  the  joint moves, remembering the
extreme delicacy of the limb  she  directs.   The clothes
which are  taken off should be examined; those that are
not dirt}7,  but moist, should be well dried before  using
them  again, and nothing retained that has an unpleasant
smell.  Where economy is important, the offensive part
may be washed out.
  An infant usually  cries considerably while washed and 
156
VENTILATION.
dressed.   AYhen  not violent  and continuous, crying is
serviceable; it gives the only exercise to the lungs, voice,
and respiration, that infants can bear or take.  As  they
grow older, and  acquire other powers, crying is  dimin-
ished.  Tenderness and dexterity are, nevertheless, in all
cases needful; when  roughly handled,  the sight  of the
basin and the sound of the water are the signals of suffer-
ing and sorrow, and it may be years before a child  can
regard washing as a source of comfort.  This it  is, and
ought to  be; every pains  should therefore be taken to
soften its discomforts to the young and tender.   AVTien
the child is old enough to be amused, a  playful, gentle
manner on the part of the nurse will render the operation
so pleasurable that all painful recollections will fade away,
and agreeable recollections only remain.   As soon as chil-
dren acquire the power of  voluntary motion, they neces-
sarily make themselves dirty; a habit of frequent washing
renders it uncomfortable for them to remain in that state;
but at an early age pleasure in washing mainly rests upon
the way in which  they are handled—if roughly pulled and
twitched,  and wiped with  no regard to comfort,  tears,
rebellion  and dislike, naturally accompany the efforts to
keep them clean.
  Every  kind of clothing  should be aired before  a fire
previous to being  put on; all flannel garments, in particu-
lar, require to be  carefully  dried in this manner.   Either
damp linen or  flannel, dried upon  the person, must of
necessity produce evil consequences, especially where, as
with infants, there is little exercise.  The quantity of clean
linen they require  makes  caution upon  this point  still
more important.

                   VENTILATION.

  The organs of respiration are constructed in accordance
with the nature of the atmosphere, or what is called pure
air.  They are, therefore, deranged, and the blood becomes
vitiated by any departure from this natural order.   As air 
VENTILATION.
157
 that has been frequently breathed is  deprived of its oxy-
 gen, and charged with carbon, and  thus is unfit for respi-
 ration, there should always be a means of admitting fresh
 air, or renewing the  air of an apartment  inhabited by
 children.  To do this  where there is no proper arrange-
 ment for ventilation, without creating draughts, is a diffi-
 culty.   In mild weather, a window may always be safely
 left open during the day; and  if this  be insufficient, or
 the weather unfavorable, opportunities should be taken to
 change the atmosphere by a  thorough  draught of air
 when  the children leave the room.   A window open at
 top, about an inch,  will do something toward keeping the
 air wholesome,  without much  risk, particularly if  the
 window be  so high that a stream of cold  air does  not
 descend at once upon the children.   When the attention
 is directed to the importance of pure air, occasions contin-
 ually offer when rooms may be ventilated without danger
 of cold.   Sleeping rooms are more particularly liable to
 deficient ventilation;  three  or  four  children probably
 sleep in the same chamber, and going early to  bed, the
 air is  perhaps unchanged, or only changed in  a  small
 degree, for ten hours.  It is  scarcely possibly to lay down
 precise rules for preventing such an evil.
   Those who possess  the means, ought to avoid  placing
 several children in the same bed  room;  and those who
 labor under the difficulties of small houses and large fam-
 ilies, will meet the evils of close  rooms  by taking care
 that there is some aperture, either the chimney, or a ven-
 tilator in the ceiling, door, or window, which shall admit
 air with  the  least  possible  draught.  It is a greater evil
 when the same room serves for day and night; but here,
 also, an  exercise of ingenuity  and  care  may  serve  the
 desired end.   Where there  are  difficulties,  let them be
met by that determination which, when springing from
conviction, is generally able  to accomplish  its  object.
Bedding needs daily ventilation.  Every morning, all  the
beds should  be thrown open, and freely  exposed to  the 
158
VENTILATION.
 air until perfectly cool.  The perspiration which is gener-
 ally abundant during sleep, occasions  a necessity for this
 precaution.   Heated impure  air has a  bad effect upon the
 tempers  of young  children; they grow languid,  uneasy
 and fractious;  the  nervous energy is  checked, and  thus
 all the functions, those of the brain  especially,  are en-
 feebled.
   Children  evince  uneasiness by  crying, passive  fretful-
 ness, or active violence, as they are differently constituted.
 A constant  recurrence  of irritating  causes  renders them
 habitually  fretful.  They are, therefore, morally as  well
 as physically injured by breathing an impure atmosphere.
 The mother or nurse being subject to the same influences,
 their tempers are in no condition to soothe the fractious
 little beings around them.  Mutual and increasing irrita-
 bility  prevails,  destructive  of true maternal  and filial
 feeling.  Impure air is not the only cause of this miserable
 state of things, but it is one which aggravates all the other
 evils.
  Considering the defective food and clothing of the chil-
dren of the  poor, and  also the badly ventilated and gen-
erally filthy condition of their dwellings, it is evident that
much of  that health which they possess is owing to their
spending the greater part of their time during the day in
the open air.  This fact, in  itself, ought to impress upon
all mothers the  propriety of preserving a constant fresh-
ness and  purity of atmosphere in the apartments of their
children; at the  same time,  however,  taking care to pre-
vent the rushing of cold draughts from doors or windows,
as these cause colds and other illnesses  perhaps as danger-
ous  as the maladies which may arise  from the want of
 necessary ventilation.
  There are  many  points connected with pure air, which
 require  constant  attention  where there  are children.
 Among these may be  cited  the instant removal of dirty
 hnen,  and  all other offensive  matter; forbearance from
 drying or airing  clothes, bedding, etc., while children are 
EXERCISE.
159
in the room; abstaining from  the use of any clothing,
sheets, blankets, etc., after they require washing;  neat-
ness with regard to utensils; in  short, minute attention to
cleanliness, which is not only essential  to health, but has
its influence  upon morals—for dirt and  indelicacy are fre-
quent  companions, and  a  disregard for the decencies of
life is a step  toward indifference to its virtues.  For these
reasons, as well  as for security to  health, habits of cleanli-
ness and  delicacy should  be formed early; children acquire
or disregard  these in proportion as the manner of  those
associated with them  is  indifferent or careful.  When
their mother or  nurse is  systematic  and reasonable in her
attention  to  the personal necessities of the children, they
feel the  influence of such  habits,  although they neither
reason nor reflect upon them; after a time a sense of com-
fort and self-respect is  associated with the observances to
which they have been accustomed, and a sense of propri-
ety eventually becomes part of their character.

                     EXERCISE.

  Repose is essential to the existence of a new born babe;
the functions of respiration, though regular, are not pre-
pared  for the excitement caused by motion, nor are any
of the animal organs fitted for exercise.   Unless where
there  is  unusual  strength, the fatigue of washing and
dressing  is sufficient for the first three weeks, as is amply
proved by the long sleep which (when all else goes on
well) usually follows upon those operations.
  In the course  of a few weeks, the senses begin to act.
A brilliant object attracts the eye, or a sound the ear, and
a slight movement is the consequence.  This is the begin-
ning of voluntary  muscular motion.  In time, muscular
action  becomes independent of mental impressions, for the
activity of the  body soon outstrips the progress of the
mind, and leaves it behind.
  After  this period, it  may be said that an  infant can 
160
EXERCISE.
 create exercise for itself in the acts of sucking and crying,
 and in slight  movements of the head, hands, and feet.
 For some  time it is not  fit  for any other exertion  of its
 muscular system, and accordingly it should be subjected
 or exposed to  no other.   It  should not be dandled, or in
 any way moved violently about.  It should lie quietly in
 the arms of the nurse, or in  its  crib or bed, carefully sup-
 ported  in  all  parts of its body—head, back, loins, and
 limbs.  The reason of this is, that the bones are at first
 cartilaginous, or gristly, soft, pliable, and elastic, and there-
 fore totally unfit for enduring any strain, force, or weight.
 Great evils may follow from the infant being forced pre-
 maturely into  an  upright position, or from that  position,
 after the child is  in some degree fitted for it, being con-
 tinued too long.  AA^omen entrusted with the charge of
 young infants  out of doors, are perpetually seen subjecting
 them to the  upright posture,  prematurely,  or  too con-
 tinuously,  from  a  natural  but most  fatal wish  to save
 fatigue to themselves.  It should be distinctly understood
 that when the  upright posture  is assumed, the weight of
 the upper part of the body is thrown upon the lower part
 of the spine.   If  that part of the system be sufficiently
 strong, no harm ensues; but  when it is otherwise, it gives
way,  and the  chest is thrown  forward and  downward.
 The double consequence is a curvature of the spine, which
too long neglect may confirm into a settled deformity, and
 a crushing of the  organs on which depend respiration, cir-
culation, and digestion.
  A slow rocking or swinging  motion as the infant  re-
poses  on the lap or in  the arms, is  the  best possible com-
 mencement of exercise.   Sudden jerking on the knee, or
pats on the back, or anything  which  jolts and  shakes,
produce internal pain, and is more  irritating than sooth-
ing.   Gentle motion may proceed to  something  more
 active, as the strength of the limbs (and the  neck especial-
 ly)  dictates.   The power of holding  the head  up, and
 moving it steadily from  side to side, forms a good index 
EXERCISE.
161
of the strength of the spine.  In exercising a babe, nature
must be followed and  seconded,  not directed  and con-
trolled.  When it is desired for the first  time to change
the recumbent position, the whole person of the infant
should be gently elevated as it lies along the arm or lap,
and when the  upright  position is  at  length assumed, it
should be only for a minute or two.  Attention should be
given to the  effect produced upon the breathing by ex-
ercise.  Some infants turn black in the face upon  meet-
ing the  air quickly, and  their breath will be stopped on
being carried rapidly down stairs.  AVhere such symptoms
exist, additional  care  is necessary.   An infant  should
never remain very long in  one position, because the pres-
sure that takes place being confined to one part, free cir-
culation is  prevented, and numbness ensues.   When car-
rying a heavy child, the nurse herself experiences this, and
the child must feel it in a greater degree.  From six to
fourteen months is the  period  which  most taxes  the
strength and activity of a nurse.  The child has muscular
power enough to sit  up, and to bear, and to need, a good
deal of motion, yet is  not sufficiently strong to depend
upon itself.  It still requires to  be so  carried, that its
weight  chiefly falls upon  the  nurse, while its incessant
desire for motion makes nursing really hard  work.  But
when allowed and assisted to take judicious exercise, it
sleeps more soundly and for a longer time at once; it wiH
be  more easily diverted  in  its waking  hours, while its
growing intelligence and  affection render it an object of
deeper interest and amusement.  Thus, the  good nurse
has her reward.
  The spontaneous efforts of a child will never injure it,
if placed in a situation to make  these efforts  securely.
Thus, when an infant is laid on a large soft  cushion  on
the floor, the endeavor to rise is made as soon as the
muscles of the neck have some power, and the head will
be lifted a little, but the effort stops there.  The head can
not be retained in its  position, and it  falls again..  The
      11 
162
EXERCISE.
cushion protects the part; there is no pain, and the attempt
is  made again  and again, till the  fatigue or disappoint-
ment causes a change in the action, or a cry for that as-
sistance which experience has taught it  to expect.   Ac-
customing a child thus early to be left on the floor, or in
bed, is a means of moral  discipline for the mother's con-
venience, and for the furtherance of freedom to the limbs.
When  a child can sit up firmly, tying it  into a chair that
will support the back, into a chair swing, or allowing it
to  sit on the stuffed cushion with the means of amusement
just within  reach, promotes  exercise, and  permits  free
spontaneous exertion. Such and similar resources for the
advancement of physical good ought  never to be adopted
as  a means of punishment; when once this has happened,
they are regarded with aversion; neither ought a child to be
forced to submit to them, if at any time they are disagree-
able or fatiguing.  As with all the other functions, exercise
is a cause and a consequence of strength.   The first indica-
tion of the desire to make the legs bear the weight of the
body, is given by the child itself, by pressing its feet upon
the lap; the  lower limbs are, however, still  incapable of
supporting its weight. The pressure, with the setting of
one  foot before the  other, are  only salutary preparatory
exercises, and should be encouraged and aided by holding
the infant so that it may just place the feet on  a level sur-
face, without bearing its own weight; from this the pro-
gression must be very gradual.
  As the power of walking alone depends upon the
strength of the bones and muscles, the period  at which it
may be acquired is not always the  same;  much, however,
depends upon nursing.  An  infant that is continually on
the lap or in the  arms, does not get the same amount of
healthful exercise which lying  on  the floor and  tossing
about  permits, and is therefore not  so well  prepared to
use its limbs; it is not likely to run alone as early as one
that has been thus  reared, nor as soon as the infant who
has been made to use its feet and  legs by continual fore- 
EXERCISE.                    163
 ing.  The probability is, that  a child too soon forced to
 walk has bent legs or weak ankles; or if it escape these
 evils, it will probably be less strong upon its legs, and less
 active at two years of age, than the  child whose exercise
 has been brought on by more gradual and judicious means.
 Children have been known to run alone at  nine months;
 the average age is between twelve and sixteen months.
   Very fat heavy children should  be carefully managed,
 while a delicate child requires equal  caution, although
 from a different cause.  A notion prevails that it is de-
 sirable to get a child  early to run alone, because it saves
 trouble and time;  yet  as much attention (perhaps more)
 is required when the infant shows  a disposition to walk
 early, as when it walks late.  For many weeks, every at-
 tempt it makes to walk exposes it to the danger of falls
 or blows against furniture.  It has to learu to balance, and
 guide itself, to acquire a knowledge of distances, all which
 can only be done by frequent repetition, during which the
 eye and  the hand  of the nurse are as  needful as ever.
 These are better than her voice: the constant injunction
 to take care, and the exclamations of alarm  which escape
 from the anxious  guardian of a  child learning  to walk
 alone, are seldom beneficial; indeed, where the child is
 naturally timid and cautious, they deter him from making
 serviceable attempts and spontaneous efforts, and encour-
 age a hesitation which  renders  him incapable of  accom-
 plishing those efforts with  the certainty which  makes
 them pleasurable; whereas, if he is heedless, he learns to
 rely upon the warning sounds which greet his ear, and is
 slow  in  acquiring those  perceptions upon which safety
 depends.  An irritable  child is made impatient by them,
 and an obstinate one defies them.
  It is desirable not to bestow too much pity upon  a child
when suffering from a fall or a  blow: practical experience
of the effects of incaution must be acquired by personal
inconvenience; but while  the effects are felt, there should
be neither blame, advice, nor indifference, but quiet assist- 
164
EXERCISE.
ance and moderate sympathy.  A timid,  sensitive  child
requires to be encouraged to endure; a bold one, perceiv-
ing his sufferings to be disregarded, learns also to disre-
gard the pain of others, and  finally, to inflict it.  Some
children are very angry when  hurt; with such it is useful
to discover that you distinguish between the cry of anger
and the cry of pain.
  None of the artificial means  of teaching children to
walk, can be recommended; the leading-strings occasion
all the weight to be thrown upon the chest, while the go-
cart, though less objectionable, forces a child to continue
on its feet too long at a time.   It is a good plan to encour-
age walking, by placing the chairs and tables at conve-
nient distances for the child to support itself by; it then
sits down on the floor when fatigued, and in raising itself
again, acquires power in the right way.   Leading by one
hand ought not to be resorted  to until there is enough of
strength and firmness to walk upright, otherwise the child
is dragged along, swinging upon one arm, with the weight
of the body  suspended by one side  only.   Lifting a child
by both  arms is  dangerous, for  it  strains the ligaments,
and  often occasions injury to  the  collar-bones; beside
which it gives pain.   A child ought to be lifted by placing
the hands round the waist.   A  child  of a year old will
raise itself by its arms, but it never prolongs or forces the
effort to the production of pain.   The only danger arises
from a fall against the furniture.
  As soon as a child  can walk safely and comfortably, it
is only necessary to  provide against walking too much at
a time  when taking out-door exercise.   While  playing
about the room, there is little occasion to guard against
over-fatigue, because the child, guided  by its feelings, sits
or lies down on the floor  at the  first sense of weariness.
This source of rest  it ought freely to enjoy, while its con-
stant change of position  calls  the various bones and  mus-
cles successively into exercise,  so that none are exhausted.
When out of doors, this rest can not be obtained, excepj 
EXERCISE.
165
in warm, dry weather, and in fields or gardens.  At other
times, and in various  situations, the nurse's arms must be
the substitute;  and she must remember that, although the
child can walk, the power is newly acquired, the bones are
still soft, and the muscles delicate.
   Most children are disinclined to proceed along the road-
side with  regularity, and prefer to  sit down or to  stand
still.  On this  account  they must be tempted along  by a
ball, a  rolling  stone,  or  any toy that  beguiles  them on.
Ingenuity must  be set  at  work to devise vaiiety, and
apply that which is fitted for the purpose at the moment
it is wanted.   The exercise thus obtained will be more
serviceable to  the  child, and less irksome to the nurse;
for, even at  this  early age, judicious employment of the
senses promotes a healthy condition of the functions, and
prevents the painful languor which follows upon the mere
mechanical motion  of the limbs.  There are always suffi-
cient objects of attraction, whether the exercise be taken
on the high road, in the fields, or in  a  garden;  but nu-
merous  and interesting as they  are,  the child soon ceases
to observe and to enjoy, if  the notice of his nurse  does
not assure him of her attention and sympathy.  Where
two or three children are together, attention and  sympa-
thy are still to be given.  These  will only have to be
addressed to many instead of one,  and to be adapted to
the nature and  age  of each child.
   Mothers ought, if possible, to superintend the out-door
exercise  of their children.  The  duty  of doing  so is
almost  universally  consigned  to  servants, who,  even
though  well disposed, are not  prepared  by education to
understand  the nature  of  their duties.   Children will
learn much from the occasional example of a mother who
is practically wise.  It is not yet considered a duty among
women  to take daily walking exercise—household occu-
pations and sedentary employments are regarded as more
important.  Yet, surely, the preservation  of health is a
duty.  Want of time is urged in some cases as the obstacle, 
166         SPECIAL DISEASES OF THE CHILD.

want of strength in others.  In most, it is to be  feared,
want of inclination is the real impediment.
  Unless  compelled to remain  within doors by the per-
formance  of some duty which could not be deputed to
servants, mothers  should  make an  exertion to  go  fre-
quently out in company with their children, both  for the
sake of watching over their personal safety, and  calling
their attention to  objects  calculated  to amuse their fancy
and instruct their infant understandings.  The health of
the mother will  in this  manner be as much benefited as
that  of her children.  The prevailing excuse of indisposi-
tion  or want of time is often  deceptious.  Much of the
common feeling of indisposition arises from  neglect of
exercise.  It is necessary to repeat, that the muscles grow
inefficient from want of use; exercise begun in modera-
tion, and  gradually increased,  will  restore  them  to  the
power nature intended them to possess.  And what better
motive for the undertaking than the benefit of the  chil-
dren ? what more delightful and salutary occupation than
to direct and aid that which is  to produce so much moral
and  physical  health  and vigor?  Even  these motives
should stimulate the disinclined to shake off the lethargy
of idleness.  Trees, flowers and animals  are works, great,
indeed, but so simple in their greatness that they are pecu-
liarly fitted to  delight and advance the dawning faculties
of children.  A mother's tenderness and intelligence draw
from these  sources an increase of happiness.  She may
sow  the first  seeds of  religion by   fostering  a love of
nature, which  shall gradually be led   up to the Author of
Nature; while she herself derives the inestimable advan-
tage  of being associated in her  children's minds with all
that  is beautiful, entertaining, good and holy.

       SPECIAL DISEASES  OF THE CHILD.

  If a child is properly cared for, as   has  previously been
described, it will rarely be sick, unless it inherits a feeble
constitution from its parents,  or  has been subjected to 
FEVER.                    167
some undue exposure.  It is true, there  may be some
slight attacks of indisposition, but these pass off with but
little or no medicine.  Exposure or sudden changes of
temperature will, if the child is not properly protected,
give  rise to colds  and diseases of the  respiratory appa-
ratus ; and improper food, or sudden changes of diet, will
cause derangement of the bowels, and disorder of the
nervous system.  The second summer, when the food of
the child is changed from fluids to solids, is very frequently
the  period  of  greatest danger—summer complaint, the
great destroyer of children, prevailing at this time.

                       FEVER.

   Slight fever  is of very common occurrence with chil-
dren, resulting from cold, indigestion,  or any arrest or
derangement  of the excretions.  The child  is fretful and
restless, and dees not  take its food as well  as common,
and even its milk is apt to disagree with it.  This fever-
ish ness  may pass off in a few hours, or it may last several
days.
   In such cases give the child a warm  bath, as has been
heretofore recommended, and  repeat it twice a day, if it
seems necessary. With this you can administer a strong
infusion of pleurisy root, sweetened, in doses of a teaspoon-
ful every half hour, or hour, using some opening medicine.
as castor oil, if the  bowels are bound up.   If the fever is
more severe, I use the aconite,  and for domestic use  I
prefer the small homoeopathic globules saturated with the
tincture, of  which  from two to four may  be given every
hour, until  the fever  passes off.  In place  of these, six
drops of tincture of aconite may be added to  a  tumbler
half full of water, and given in doses of a small teaspoon-
ful every one or two hours, to a  child over six months of
age.
   Children  are liable  to a severe form  of fever,  very
closely resembling the remittent fever of the adult.  It is 
168
FEVER.
usually caused by cold and  arrest of secretion, though it
may be produced by any of  these causes of fever.
  For two or three days  the child will be observed to be
dull and fretful, its rest is broken, and its food is not taken
with  the  accustomed relish, and does  not  digest well.
Following this is a slight chill, frequently not noticed by
the parents,  and this is succeeded by fever.
  The surface becomes hot and dry, the pulse is increased
in frequency, the urine is scanty, and the bowels constipa-
ted.   The child is sometimes very restless and uneasy, at
others it  seems  stupid and drowsy, and  sleeps with its
eyes partly open. The fever is remittent; continuing for
a variable period of time, it gradually abates, to come on
again in  the course  of half  an hour to an  hour.   Thus
there may be one or two, or even a half dozen  parox-
ysms of fever in the course of twenty-four hours.  The
disease continues a considerable  length  of time,  but if
properly  managed,  it  may  be expected to  cease by  the
fifth to the seventh day.
  Treatment. — In  this  case  I should recommend  that
the treatment  be commenced by the thorough use of the
general warm bath; or, in place of this, that the child be
washed with castile soap and water, rubbed well, and then
its feet well  bathed in  warm water  for a  quarter or half
an hour.   Give the  aconite, as just recommended, either
the globules  or in solution in water, and also  the infusion
of pleurisy root.  If the bowels should  move naturally
once  a day, do not disturb  them; but if they do not,
give some mild cathartic, as  sweet or castor oil, magnesia,
etc.
  In  a couple of days of such treatment, the fever will
have abated to a considerable extent, and the child will be
comparatively comfortable.  Now, in order to completely
arrest the fever, we usually give quinine; about two grains
for a child  a year old, will  be the appropriate quantity.
Divide it in three doses, and give them one  or two hours
apart, in  the early part  of the day, when there is least 
THE RESPIRATORY APPARATUS.
169
fever.  It may be repeated for two or three days, and the
fever will be found completely broken up.

AFFECTIONS  OF  THE  RESPIRATORY  APPA-
                       RATUS.

  These have  been considered at some  lens-th in the first
volume,  and they need not  be repeated  here.  As was
noticed there, croup  was of most frequent occurrence.
Next in frequency we have bronchitis  and inflammation
of the lungs, neither of which differ materially from the
same diseases of the adult.
  In the treatment  of bronchitis and inflammation of the
lungs in children, we will find the use  of the warm bath
of much  importance; and, next to  this, proper applica-
tions to the surface of the chest. Moist heat is almost always
beneficial.  Hence we obtain great  advantage  from the
use  of a warm, soft  poultice.   Two  or  three roasted
onions, cut up, moistened with hot water, and spread upon
a soft cotton cloth,  makes an excellent application.   My
favorite remedy is  a  cloth  spread with fresh  lard, upon
which  is  sprinkled the emetic powder, No. 6, so as to com-
pletely cover it.   I  have seen children  recover under its
application who  could hardly breathe, and had been given
up to die.
  As an  internal remedy, I would advise the ipecacuanha
in small doses.   I usually direct it in the following man-
ner: Take ipecacuanha, ten  grains;  white  sugar,  one
drachm; mix thoroughly, and divide into twenty powders.
These may be given as often as one every hour, and should
they produce  too much sickness of the stomach,  each
powder may be  divided into two  parts.   I know of no
remedy or combination of remedies that will  equal this,
and I have frequently treated the severest cases of inflam-
mation of the  lungs in children  with this  alone.  Any of
the  means recommended under  the head of bronchitis, or
inflammation of the lungs, in volume 1, may be used. 
170        DISEASES OF THE DIGESTIVE ORGANS.

    DISEASES OF THE DIGESTIVE ORGANS.

  The digestive organs of the child  are more frequently
deranged than any other part of its system.  Any change
of diet from that which nature provides, is likely to induce
derangements of these organs, and not unfrequently im-
pairment  of  the mother's health  will be attended with
similar results.
  Infantile Dyspepsia.—Children, like adults, suffer from
indigestion, and this in some cases  is  so persistent that it
might be termed infantile dyspepsia.  When nursing, the
child  frequently throws up its milk, if it has been taken
in excess, or if the stomach is not in proper condition  to
receive it.  The shape and position  of the  stomach are
admirably adapted to thus freeing itself  of any material
it can not properly appropriate.
  If this vomiting becomes too frequent,  and especially if
attended with evidences of nausea  and straining, we may
consider that there is something wrong with the stomach.
The trouble is  still more  severe when there is greenish,
frothy stools, and more or  less pain, the child being cross
and fretful.
  In  these cases it is  of importance to look into the
child's diet, and see whether there  is any thing in it that
may account for the trouble.  Even when  the child ia
entirely dependent  upon  its  mother's  milk, we will not
unfrequently  find that the severest forms  of infantile dys-
pepsia are dependent upon errors in her diet.   It is some-
times difficult to convince  a  mother  that  this is the case,
and that what she eats produces so  marked an influence
upon  the child; yet, it is a  fact, and the  sooner  they
become impressed with it, and discard the  objectionable
articles  of diet, and live  on plain  nutritious food,  the
sooner they will get rid of the annoyance of an irritable,
crying child.
  It is sometimes the case that the mother's milk will dis-
agree with the child, no matter how much care she takes 
diseases of the digestive organs.         171
 with her own health, or how particular with  her diet.
 And occasionally  it will become necessary to wean the
 child on this account.   If the child is eating, and suffers
 in this way, change its food until you have selected a diet
 that will agree with it.
   Occasionally, the trouble depends  upon a constant de-
 sire to feed, and an excess of food taken upon the stomach.
 It often happens that the child is  never  satisfied except
 when sucking; and when it has indulged to repletion, it
 seems very uncomfortable until it has disgorged it.  The
 relief thus given  is immediately followed  by a renewed
 desire to suck again, and it is thus constantly overloading
 its stomach, and never giving the overworked  organ time
 for rest.   The remedy in these cases is, obviously, to con-
 trol this species of gluttony, and  not let the child nurse
 too much, or too frequently.
  If it becomes necessary to administer medicine to cor-
 rect this, it will be advisable in most  cases to see a physi-
 cian.  An infusion of peach-tree bark, as has been hereto-
 fore recommended, answers  a good  purpose; and an infu-
 sion of the compound powder of rhubarb, No. 7, will also
 answer in very many cases.
  Colic.—This is a very distressing complaint with young
 children, and is frequently an occurrence of every day.  It
 may be occasioned by a variety of causes, as badly digested
 food, some  derangement  of the  milk of the  mother, or
 from neglect of the nurse to keep the child warm.  It is
 of very frequent occurrence in children who are raised
 on artificial food, and will attend any improper change of
 food, or arise when the food is not well prepared.  The
 mother's milk  may be changed in its properties  by indis-
 cretion  in food, overloading the stomach, and  in  many
 cases from outbreaks of temper—a cross mother almost
invariably making a cross child.
  Flatulence is the result of all these causes, and the dis-
tension  of the  stomach  and bowels  produces pain.   In
some cases colic will occur at any period of the day and 
172        DISEASES OF THE DIGESTIVE ORGANS.
night, and it will be impossible to trace it to any appa-
rent cause.   The  child will  take  the breast and  nurse
freely, and the mother will furnish an abundance of milk
of seemingly good  quality,  but from  some reason the
child's stomach can  not appropriate  it,  it becomes  acid,
gas is generated, and severe colicky pains are the result.
These cases should be treated as named for indigestion.
  Treatment.—In these troublesome  cases, always avoid
giving medicine, if possible.  There is some cause for the
colic, which, if you can  discover and  remove, the trouble
will be at an end.  The mother should pay strict attention
to her diet, and in  a short time she will  be enabled to
determine whether any articles of food she has been using
has given rise to it.  If the child is being raised  on arti-
ficial food, and  cow's milk is given it, institute an exam-
ination into the health and  habits of the cow,  and the
cause of the difficulty may be discovered, and changing
the source of supply  will remove the trouble.   I have had
many cases in my  practice, of children suffering  from
indigestion, colic, fever,  and marasmus, in which  all  med-
icines given for  the  cure, failed  of giving  any relief, but
in which an investigation has shown the cow to be un-
healthy, or fed on  unhealthy food, as decomposing vege-
tables, still-slops, etc.  Changing the milk  in these cases,
obtaining that which was fresh and healthy, has  speedily
accomplished a cure.  In  other cases the vessels in which
the milk was obtained  and  kept, or  the nursing bottle,
would be allowed to become sour, and this would  prove
the cause of all the trouble.
  In  some  cases  it will become  necessary to  entirely
change the child's food.  Thus, if it is nursing, it will
have  to  be weaned  and fed with  milk.  If it has  been
taking milk, some of the other articles of food heretofore
named must be substituted for it.  Proper attention to
these points will frequently obviate the  necessity of giv-
ing medicine, and, without it, medicine is usually  given to
little purpose. 
                      AFFECTIONS OF THE SKIN.             173

         If you determine  that  something  must  be done to
       give temporary relief, prefer external applications to inter-
       nal medicines.  Heat  a flannel cloth and apply it to the
       abdomen, or  the cloth may be wrung out of warm water
       and applied.  A hot flannel applied to  the back over the
       loins, sometimes gives speedy  relief.   Should this not
       answer the purpose, use the warm bath, for five, ten, or
       fifteen minutes.  Internally,  a teaspoonful  of sweet  oil
       every two or  three  hours, until it operates, will sometimes
       be of advantage;  or if  there is much acidity of the
       stomach,  magnesia  may be used in its stead.  An infusion
       of spearmint, sweetened, will be as simple and about as
-j      efficient  as  any thing that can be given;  even catnip tea,
       warm, will sometimes answer the purpose.
         Never,  under any circumstances, give the child  any
       preparation of opium, as it may do the child irreparable
       injury.  Paregoric, Godfrey's  cordial,  Bateman's  drops,
       and all the mother's  cordials, or  other patent medicines
       for  this   purpose, no  matter  what their  names,  contain
       opium, and are all equally objectionable.  It is better to
       bear the  annoyance of a restless  child, rather than give
       that which is  not only dangerous from  its present effects,
       but  may entail lasting injury, not  only upon its physical
       health, but also in its mind.
         Cholera infantum,  or summer  complaint of children,
       was fully described in volume I, as was also verminous
       affections, and the  reader is referred to it for description
       and treatment.

                 AFFECTIONS OF THE SKIN.

         The severe contagious  diseases,  scarlatina,  measles,
       small-pox and chicken-pox, have  been described in the
       previous  volume, to which the reader is referred.  But
       there are  many minor affections which  need to  be recog-
       nized, and a correct treatment understood.   The  skin of
       the child  is very delicate, and more  liable to disease than 
174
AFFECTIONS  OF THE SKIN.
in the adult, and in many cases the constitutional effect is
much more marked.
   Occasionally, diseases of the  skin  seem to answer a
vicarious purpose, and relieve the system of some mor-
bific matter,  which,  if retained, would produce disease.
When we have any reason to believe that this is the case,
no attempt should be made to  cure  them  until means
are instituted to  remove the constitutional disease that
they are connected with.  In other cases, when the erup-
tion  has  been of long duration, it will  not be  safe to
arrest it immediately, but means should be made use of
to increase  the  natural excretions,  and  the  eruption
stopped gradually.
   Mother's Mark.—It is generally supposed, and I think
with  truth,  that certain  impressions  made upon  the
mother's  mind during pregnancy, will  affect the growth
and  structure of the child, and in some  manner  deform
it.  It is true,  that  we can not account, in a  rational
manner, for  any such occurrences, but the instances are
so numerous  that we  can not  dispute  the connection
between  the  impression and the mark.   As heretofore
noticed, there is not more than  one child in a hundred
marked when the mother anticipated it, and we are very
often asked  by the anxious mother whether the child is
" all  right," under the impression that  it will be marked.
   Numerous  instances are  related to  prove the relation
between the  impression on the  mother's mind, and the
deformity of the child.   The severest case of the kind
that  ever came under my knowledge, was a child born
with a hand so completely deformed as to be useless, and
which  was  attributed  to  the mother's  witnessing  the
dressing of a hand that had been crushed in a threshing
machine.  The most common form of mother's  mark, is
a discoloration of the skin, from  an increase of the size of
the blood-vessels.  It may be located on any part,  and
in some  cases increases in size  as the child grows.  If
located upon the  face or neck, it is  sometimes  a very 
                AFFECTIONS OF THE SKIN.            175

great deformity.  Occasionally, it forms a  reddish tumor,
excessively vascular, projecting from  the  surface, and is
not only very  objectionable, from its  appearance, but is
tender, easily injured, and sometimes  the  seat of pain.
  A case came under my care of a child that was thus
marked on the cheek immediately below the eye.   The
mother attributed it  to her  husband's throwing a large
cherry at her, which,  striking upon the same part of the
cheek, bursted, and not only startled her at the time, but
firmly impressed  her mind that  the child would be
marked.  When I saw the little girl, then  two years old,
the mark was about  as large as  a dime, as red as blood,
and  slightly elevated above  the skin.   I removed it with
considerable  trouble, much  to  the gratification of  the
parents.  In another case, the child, then thirteen  years
old, had a mark covering a considerable part of the neck
on  one side.   The mother attributed it  to  fright, from
hearing  of a neighbor who  had cut  his throat.  It had
grown so large that nothing could be done  for it.
  These cases are very difficult of treatment, on  account
of their vascularity; indeed, some children have lost their
lives from hemorrhage during an operation.   The growth
should be removed early in life, if it is  noticed to grow, as
it is  then  much easier accomplished  than if allowed to
become large.
   Shingles.—This disease, technically called herpes zoster,
may attack the young or the adult, though  of most  fre-
quent occurrence about the age of puberty.   It makes its
appearance upon some part of the trunk  in  the shape of
a group of small vesicles,  the  skin  being  reddened for
some distance around.   They  continue to  come out at
new  points,  until  the eruption  has  traveled  half  way
around the body, or in some cases entirely around it.  It
is a popular superstition, that if  occurring on both sides,
it will prove  fatal it they meet, thus encircling the body.
There is no truth in this, as the disease is rarely or never
attended with  danger.  It  is usually attended with con- 
176
AFFECTIONS of the skin.
siderable fever, and the patient feels  badly for several
days.
  Treatment.—But little  treatment is  necessary in most
cases.  The child  should  be bathed daily, and the foot
bath should  be used when there is much febrile action.
Give a dose of castor oil or some mild  purgative to open
the bowels, and if  the fever is troublesome, aconite, and
an infusion of pleurisy root, may be given, as heretofore
recommended.  If there is much irritation at the point of
eruption, dust it with scorched flour, or wet it with  sweet
cream.
  Ring Worm.—This eruption most commonly makes its
appearance on  the face and neck, in  the form of  small
vesicles, situate in  a ring, sometimes quite small, but at
others it will be as large as a  dime, a quarter of a dollar,
or  even larger.  The spot is reddened,  and sometimes
slightly elevated, and gives rise to a troublesome itching.
In many cases it will run its career in a week or ten days,
and this needs no  treatment.  When  it  is chronic, and
lasts for a long time, it  is recommended to paint it with
tincture of iodine.   A simple domestic remedy is to  apply
a slice of onion to it each night.
  Itch—Scabies.—In former years the itch  was quite  a
common disease, and very few families of children were
raised without having more  or  less trouble with it.  At
the present time it is of somewhat rare occurrence, as
more attention is paid to cleanliness, and an avoidance of
the contagion.
  The itch is caused by a small insect or worm, which
burrows in the skin, and is called the acarus scabei, or itch
insect.  The disease is propagated from  one to another by
the transmission of this insect, either  by contact,  or by
the clothing,  beds, or the use of  towels which  have been
used by those suffering with the disease.  It usually makes
its  appearance  first upon the back o$ the hands, between
the fingers, and the anterior part of the wrists, though it
may extend to  all  parts of the  surface where the skin is 
ROSEOLA.
177
fine and delicate.  It comes out first as a slight hardness
and  elevation of the skin, upon  which a  small vesicle
arises.  If these are abraded by scratching, they produce
a yellow, viscid matter, which forms a scab, and this may
be renewed several times  before  the part heals.  When
very bad,  these  crusts or  scabs will become very  thick,
and sometimes cover quite large spaces.
  The disease derived its common  name from the con-
tinued and unalloyed sensation of itching which the per-
son  experienced, and which  in  mild  cases was rather
pleasurable than otherwise.
  Treatment.—The itch is usually a very  stubburn  dis-
ease, when bad,  or when improperly treated, but  if taken
in time it may be got rid of without much trouble.  As a
general treatment, I  would advise the use of a sulphur
ointment: as, take sublimed sulphur, two ounces; bi-car-
bonate of potash, one ounce, and lard, eight ounces. First
wash the parts thoroughly with soft soap and warm water,
and then rub the ointment in thoroughly.   It  is best ap-
plied at  night before going to bed, wiping the surface
well the next morning, and putting on clean clothing.  If
an internal remedy is deemed necessary, sulphur in doses
of five or ten grains, three times a day, will be the best.

                      ROSEOLA.
  Roseola, or rose-rash, is a mild exanthematous eruption,
continuing from one to six or seven days, and attended by
more or  less febrile  action.   The causes are  obscure,
though arrest of secretion  and gastro-intestinal irritation
are the most frequent.  It sometimes occurs as an epi-
demic, especially in warm  seasons, and sporadically, from
over-heating the body, severe exercise, etc.
  Symptoms.—Roseola infantilis, as its name indicates, is
usually met with in young children,  and arises  from gas-
tro-intestinal irritation, or from dentition.  It  comes out
in the form of deep rosy-red patches about one-fourth of
an inch in diameter, and circular in  form.  When severe,
         12 
178
ERYTHEMA.
 they are very much crowded together, so as to give a gen-
 eral red appearance to the surface, but yet each one  is
 well defined.   They may  continue for  several days, or
 vanish and reappear for several days.   Usually the fever
 is but slight, but the child shows symptoms of irritation,
 being cross and fretful.
   Roseola cestiva is  usually ushered in  by marked febrile
 action, and in children delirium or convulsions sometimes
 supervene.  The eruption usually appears about the third
 or fourth day  on the face and neck, and in a few hours
 involves the  greater part of the body.  " The  spots are
 of a deep red  color, more  irregular in  shape than those
 of measles, and their  original color soon passes into a
 light rosy hue.  There is also  present a  considerable
 degree of itching and pain, and often difficulty in  swal-
 lowing."  The disease  runs a very variable course,  but
 the eruption  usually  disappears  in three or four days
 without desquamation.
  Roseola annulata comes out  in  the  form of rose-red
 rings, in the center  of which the skin retains its natural
 color;  it is said to be principally observed on the abdo-
 men and  buttocks.  It is not usually  accompanied with
 much fever,  but  is occasionally very  persistent,  and  is
 usually associated with  gastro-intestinal irritation.
  Treatment.—Give the child a warm  bath, as hereto-
 fore  recommended, or in its stead the child may  be
 thoroughly sponged with the  alkaline wash,  and have a
 hot  foot  bath.   Give  internally, the neutralizing  cor-
 dial, or an infusion of the compound powder of rhubarb,
 in doses of a teaspoonful every two hours until its bowels
 are moved, and, if there is much  fever, the aconite in
 water, as heretofore recommended.

                   ERYTHEMA.
  Erythema^ is one of the  mildest  of  the exanthemata,
and usually is not accompanied with febrile action, though
in the severer cases there is  arrest of secretion and some 
ERYTHEMA.
179
 constitutional disturbance.   It  may be associated  with
 other diseases, and it is thus with intermittent and remit-
 tent fever, gastric irritation  and diarrhoea.   It may be
 produced from mechanical  irritation of the skin, but the
 most frequent causes  are  cold  and arrest of cutaneous
 secretion,  or gastric,  intestinal,  or  menstrual  derange-
 ments.
   Symptoms.—The disease appears in the form of patches
 of variable size, of a light, superficial  red  color, readily
 effaced by pressure, and most frequently on the face, chest
 and limbs.  In some  cases  they spread so as to  cover a
 considerable portion of the  body, but this is not frequent.
 One form, termed erythema nodosum, is preceded by slight
 constitutional disturbance,  and comes  out in  oval, red
 patches, from half  an inch  to an inch  in diameter, most
 generally on  the lower extremities.  AVTien more  fully
 developed, they are slightly  elevated above the adjacent
 skin, and in a few days form small, red, painful  tumors,
 which seem inclined to suppurate, and in  severer  cases
 give a suspicious sense of fluctuation, but at last disappear
 without any change  of structure.   The first form  may
 last but a few hours, or in rare cases it may continue two
 or three weeks; the  second  usually continues  for  from
 three to six days.
   Treatment. — But little  treatment  is needed  in the
 simple form of the disease.   The bowels may be opened
 by equal parts of compound powder of rhubarb, and  com-
 pound powder of jalap, or with the first alone.  The sur-
 face  should be bathed with  a weak solution of carbonate
 of potash, and in  some cases we would use the warm
 foot  bath.  In the second  form  of the disease,  I  have
 usually prescribed  a gentle laxative, with a solution of
acetate of potash, and very small doses of aconite.  The
use of the  alkaline bath gives great relief, and  it  may
sometimes be repeated several times a day. 
180
ERYSIPELAS.
                    ERYSIPELAS.

  Erysipelas  is undoubtedly a disease of the blood, and
should be classed with  the eruptive fevers, though not
contagious, except  in exceptional cases.  It may occur at
any age, though it is niore  frequent in adults than  in
children.  The causes of erysipelas are obscure, though it
is  probably occasioned  by cold, arrest  of secretion, etc.,
as in other forms of fever. It  occurs most frequently in
the spring and autumn, and in persons  of a fine delicate
skin.   Occasionally it becomes epidemic in a  neighbor-
hood or section of country, and  in other cases highly con-
tagious, as in  large  hospitals.  I  have  known  surgeons
that had to suspend all operations, even  the most simple,
on this account, for weeks, as almost every case operated
on would have erysipelas.
  Symptoms.—We distinguish two forms of this disease:
the first  being superficial and affecting the skin  alone,
while the second is termed deep seated.   The first is pre-
ceded, or in other cases shortly followed, by a well marked
chill, to which succeeds febrile action.  In some cases the
fever is slight, but  in others it is as intense as  in the con-
tinued fevers.   With the  commencement of the  chill a
circumscribed redness of some portion of the skin comes
up, and in a few hours becomes slightly swollen, hot and
painful.  The redness is generally  deep, but is affected by
pressure, though from the  exquisite tenderness of the part,
the patient will rarely permit it.  As the disease continues,
it usually extends slowly to adjacent  parts, the advance of
the inflammation being marked by  slight swelling, pain
and tenderness on pressure.   In this  way, commencing as
a small spot on the face, it sometimes extends until it  in-
volves the entire face and  scalp.
  Frequently in the course of two or three days the epi-
dermis is loosened and distended with a yellowish serum,
forming bullae of larger or smaller size, and these ruptur-
ing  pour out  their secretion,  and  sometimes become 
ERYSIPELAS.
181
covered with thin incrustations.   The redness usually
fades, and  the  inflammation commences to disappear by
the fifth or sixth day, leaving the epidermis wrinkled  and
yellowish, and at last it desquamates over the entire  sur-
face.   This form of erysipelas may appear  on any part of
the body7, but is far more frequent upon the face and ex-
tremities.  The fever is in some ctegree dependent on the
extent of the eruption, though  in  severe cases where this
is comparatively slight it will be very severe and of a low
asthenic form;  delirium sometimes occurs  where the  face
and scalp are affected.
  The other affects not only  the skin, but the cellular
tissue, and in some cases, the entire  structure of a part,
and is proportionately more severe.   It results more fre-
quently from injuries, as bruises  or punctured wounds,
but may  be idiopathic; it occurs  most   frequently in
the extremities.   In many cases  the disease is ushered
in with a  chill, to which  succeeds  febrile action.   Oc-
casionally the fever is very intense, the tongue becoming
dark  coated,  the pulse hard, small,  and frequent, the
bowels  irregular,  urine scanty,  high-colored and  foetid,
with low muttering delirum.  The local disease comes up
as in the other case, with heat, pain and redness, but  it is
soon observed  that the  swelling is much  more marked.
AArhen the  disease is fully developed the pain is intense,
and the patient can not bear the slightest pressure on the
part, which seems to be swollen to its fullest extent.   In
the course of from three  to five days, the redness  and
heat subside, and the part gives a doughy sensation to the
touch, and is,  if anything, more swollen and  painful.
Small  purulent  deposits are  now noticed, which upon
being opened, at  first  discharge a healthy pus mingled
withflakes of broken down cellular tissue, and afterward
in some cases, a reddish flocculent material.  AvTien the
disease  has been severe, a  large  portion of the cellular
tissue will have lost its vitality, and will be discharged in
this manner,  recovery being slow. 
182
DEFORMITIES AND DISTORTIONS.
  Treatment.—The  treatment  of erysipelas, though a
very severe disease, is usually very simple.  We first give
a mild cathartic to open the bowels, and afterward keep
them regular every day.  To lessen  the fever, use the
tincture of aconite, ten drops to four ounces of water, a
teaspoonful every hour for a child four years of age.   As
a specific for the disease, I order: take tincture of muriate
of iron, one ounce; glycerine, three ounces, in  doses of
one-fourth of a teaspoonful every three hours, for a child,
and a teaspoonful as the dose for an adult.  It should be
largely diluted with water when it  is given.  The same is
used as the local application, wetting  a piece of  soft cot-
ton cloth with  it, and applying it to the part.    When
there is much irritation of the  skin, a soft cotton cloth,
spread with lard, will form a very good application.
  In deep seated erysipelas, the same  means  may be em-
ployed at first.  Should it become  much swollen, a poul-
tice  made  of a decoction of  dogwood, thickened with
wheat bran, will be found excellent.

DEFORMITIES   AND  DISTORTIONS   DURING
                    CHILDHOOD.

  Some children at birth exhibit deviations from  the ordi-
nary structure of the body.   In some cases  such defects
are capable of cure.  It is the province of the surgeon to
determine what may or what may not be done; but it is
the obvious duty of parents to avail themselves of the
power of art in such cases, and to  sanction any operation
which may promise to relieve their children from awkward
and  annoying peculiarities of form.  The proper period
for such operations  must also be  determined by the sur-
geon.  A mother's apprehensions  are naturally excited,
lest the tender  frame of an infant  should  be unequal to
support the infliction of pain; but  she will be reconciled
to the propriety of early adopting the necessary remedies,
when she is aware that the increasing intelligence of the 
DEFORMITIES AND DISTORTIONS.
183
 infant renders it more sensible to the pain and fear attend-
 ant upon  operations, and that its comparatively passive
 and quiescent state is favorable to the cure of a wound.
   Some children are born tongue-tied, the tongue being too
 much bridled to the bottom of their mouth, by which they
 are prevented from  sucking  properly.  If not remedied,
 this peculiarity will impede  their utterance  in after life.
 It  is the duty of the nurse  to  mention to  the medical
 attendant that there is such  a defect, and he will remove
 it by a slight cut with a pair  of scissors.   Some mothers
 are so heedless as to see their children suffering: for weeks
 and months, and even languishing, from this easily reme-
 died evil, without taking  the trouble to correct it.   In the
 event of children being born with a hare-lip, as it is called,
 or any similar malformation, or with a redundancy in the
 number of fingers or toes, the medical  attendant must be
 permitted  to remedy the defect at the time he thinks
 proper, but,  generally speaking, the  more early that  all
 such peculiarities are removed, the better.
   The deformities and malformations  found at birth, are
 not so frequent as those  which  occur  afterward.   These
 are either the consequences  of predisposition to disease,
 inherited from parents, and increased by bad nursing, or
 are altogether the result of accidents, neglect, or injudi-
 cious management.   Parents are obviously bound to take
 every reasonable precaution, in order to guard their chil-
 dren from  the occurrence of these  inflictions, and, should
 they occur, to endeavor to repair or  subdue them.  To
 possess a perfect frame of body is unquestionably one of
 the greatest  of blessings,  if it were for no other reason
 than  its rendering  us agreeable  objects to our fellow-
 creatures.  The want of it has the contrary  effect, and is
 apt with some natures to lead to moral deformity also.  It
 is  a melancholy truth, that a personal defect, instead of
 exciting  compassion  and kindness, but too  often makes
the individual so  afflicted a mark for ridicule and con-
tempt.  No  one can be  wholly callous to the effects of 
184
DEFORMITIES AND DISTORTIONS.
 such a misfortune.  A man of amiable  temper feels the
 pang inflicted, even if he forgive it.  The mere dread of
 ridicule has irritated many minds into a sentiment allied
 to misanthropy, impelling them to peevishness, pitiless-
 ness, malevolence, and all the peculiarities implied in the
 term bad temper—to splenetic  views  of life, with its
 attendant doubts and dissatisfaction.   The conduct of the
 idiots and deformed beggars who frequent our towns and
 villages, a mark for the gibes and assaults of the ignorant,
 testifies to the  truth of these remarks; while there are
 evidences  among the  educated and the talented  of the
 mental  deformity  caused by  bodily  malformation.  In
 addition to these considerations, it may be observed, that
 deformities very much limit  the  power of self-mainte-
 nance.
   Parents  who  are  themselves afflicted with  hereditary
 disease, or are aware of ancestors and kindred who have
 showed symptoms of such disease, are particularly under
 the obligation to watch  their children, in order that the
 first bad appearances may be met by the proper remedies.
 Scrofula often affects the bones of young children.  From
 other causes there may be a deficiency of the earthy ele-
ments in the bones, rendering them soft, and thereby more
liable to injury.  The  necessity of giving support to the
back and  loins in carrying an infant, and  not allowing it
to put its weight upon  the legs on  first learning to walk,
has been already treated, as well as the danger of forcing
children to use  muscular exertion.   Wherever there is
hereditary predisposition to disease, increased vigilance is
needed,  and increased  attention to the laws which have
been found to  promote health.  The effects of  a want of
pure air, warm unconfined clothing, regular hours, proper
diet and cleanliness, are seen in local weaknesses, as well
as in internal and cutaneous disorders.  The disease called
the rickets, which is  a  modification of scrofula, and may
be productive of distortion of the person and limbs, is to
 be counteracted by peculiar  medical treatment, calculated 
DEFORMITIES AND DISTORTIONS.          185
to invigorate the frame;  and in aid of this, as well as of
simple weakness of the legs,  some kind  of mechanism
may be applied.  AVeakness of the legs, whether proceed-
ing from the poor state  of health  of  the  mother before
the birth of her infant, or from any other cause, must be
carefully watched, so that the earliest opportunity of pre-
venting curvature may be taken. In every case the med-
ical attendant should be consulted; but it is  proper to
state  here  the result of experiments  which  have  come
under our own observation—that if the child whose legs
are bent  be able to walk, and can not be  kept from the
ground, the limbs should  be  subjected to  a constant but
gentle restraint from a steel and leather apparatus, which
generally brings them in a few months, or a  year, to a
perfectly straight condition.  If this  be  neglected,  the
child will, in all likelihood, have bent limbs for  life.
   Children often contract injury unperceived at the time,
or concealed by individuals  immediately  in charge  of
them, and maladies may begin  to affect them, which do
not appear  conspicuously till they have made considerable
progress.  AVhen children are undressed at  night, it is ad-
visable to encourage them to run about the room, stoop,
kneel, sit down, rise  again, etc.  The mother may then
herself observe the action of the muscles and joints, and
so be enabled to detect the first symptoms of any injury,
the marks of any hurt, or the  evidences of any contrac-
tions or distortions, whether they arise from weakness or
bad habits of muscular action.   If the cause can be traced
a  remedy may be more  easily applied. In some cases
suroical aid may be necessary, and  it should be obtained
without  delay;  but if it be clearly ascertained that the
weakness originates in an insufficient  use  of the part, a
o-entle but  steady application of exercise will  probably be
found  a suitable remedy.  The following  fact will illus-
trate our meaning:
   A boy of seven years of age was observed by his father
to.turn in the left knee in walking, so as  to limp slightly; 
186           DEFORMITIES AND  DISTORTIONS.

the child was undressed, and on watching the action of
the limb, it was found that the  boy had, from some cause
or other,  contracted  this habit, and  that he avoided as
much as possible all  use of the  left knee;  the muscles
were consequently weakened,  slightly shrunk, and com-
paratively useless.   An  exercise was immediately adopted
which brought the weak muscles into gentle, continuous
use,  and at the end of  six weeks the limb was perfectly
restored.  It is necessary to add, that the father himself
superintended the exercise.  Had the altered gait escaped
early notice, it is probable that bandages or irons w^ould
have been required as remedies.  This fact will  serve as
an example of the kind  of attention and treatment recom-
mended to parents.  Similar instances could be added to
show that incipient distortions may often be  overcome by
attention, good sense, and perseverance.
  Bad habits, or tricks, as they are called, often produce
distortions during the whole period  of growth.  Before
running alone, infants often creep along the floor; a salu-
tary practice when  the  limbs are  employed  equally.  It
is not unusual to see a child  make use of one leg only to
help itself along, dragging the  other after it, as if it were
useless; the muscles  of  the unused limb consequently be-
come flaccid and weak;  and when  the attempt to walk is
made, a limping gait is contracted, and the weak limb be-
comes  permanently debilitated.   In such a case, creeping
should be wholly prevented, or  at least suspended  until
the injurious habit is  forgotten.  On  first running alone,
a fall may produce slight injury, the pain from which may
be escaped by avoiding the use of the injured  part.  If the
gait  thus adopted escape observation, it becomes a habit,
and the diseased muscles grow weak, while  those  which
receive the additional work become  so strong that they
retain the limb or joint in the assumed position, and thus
lameness is established, to  be  removed only by  severe
remedies.
  Children are apt  to  accustom  themselves  to use the 
DEFORMITIES AND DISTORTIONS.
187
 left hand more readily than the right, and so become what
 is termed left-handed.  Left-handedness is always a mark
 of careless nurture, for no species of imperfection may be
 so easily guarded against.  When the child begins to use a
 spoon, or to handle any object, let care be taken to make
 it use the right hand chiefly, and also accustom it to shake
 hands only by that hand.  By these means it  will soon
 learn that the right is the proper hand  to employ, and in
 this respect will grow up faultless.
   The tricks contracted by children  create  unexpected
 evils.  It  is by no means unusual  for them to stuff sub-
 stances  up their nostrils, or into their  ears, producing
 tumours and  deafness, or rupturing some of the smaller
 vessels of the nose.  All habits which distort  the features
 (as, for instance, over-distension of the mouth by using  too
 large a spoon, or otherwise) are better checked in their
 earliest manifestations; they are not only disagreeable to
 witness, but they confer an  unpleasant  impression  on  the
 countenance.   All persons are influenced by physiognomy,
 and there  can be no  doubt that  the preservation of  the
 graceful forms of feature, so often  found in children, ranks
 among the duties of a mother. The doing this does  not
 cultivate personal  vanity; self-respect  demands a certain
 care of the person, and this care naturally extends  to  the
 avoidance  of ever}- habit destructive of general propriety
 of appearance.
   It is of great importance in  rearing children, to prevent
 all physical calamities; but as this is not always possible,
 the next important step for parents to adopt  is a speedy
 and judicious  employment of remedies.  Mechanical con-
 trivances are found very effective in restoring the strength
 and shape  of the limbs.  Their  application,  though  ap-
 parently distressing to the patient, should be persevered
 in,  upon the  principle that any  suffering they inflict is
 short  and  trifling  in  comparison with the unceasing
trouble, ill  health, and helplessness, entailed by  lameness.
 Steel  and leather bandages present a disagreeable appear- 
188           DEFORMITIES AND DISTORTIONS.
   •
ance, but as the mother knows their utility better than the
child can do, it is her part to set  an example of patient
fortitude.   And while  she soothes the  patient, she must
be careful that her tenderness does not weaken the power
of endurance;  nor must she resign the control which is
not only necessary to the moral welfare of the child, but
to his bodily restoration.
   Curvature of the spine is the most frightful of all distor-
tions.  The danger to which the  spines of infants are
liable, arises chiefly from carelessness  or ignorance on the
part of their nurses.  Hurts from a fall or blow have often
serious consequences, but these are sooner discovered than
the slow but unceasing destruction proceeding from bad
nursing.  A child who is constrained to  keep the same
position  for more than  a few minutes, who falls asleep
while carried erect, who is wearied out by irregular hours,
is always  in  danger of loss of health.  It  depends upon
the nature  of the constitution what form  the evil takes.
Paralytic disorders  of the lower limbs  of children  gen-
erally proceed from some spinal affection.  When disease
of the spine affects a child who  has been able to walk, the
loss of the use of the legs is gradual, though not very slow.
He at first  complains of fatigue, and is unwilling to move
about,  and soon after frequently trips  and stumbles, al-
though there is no impediments in his way.  In attempt-
ing to move briskly, the legs involuntarily cross each other,
and  he  frequently falls;  while in trying to stand erect,
even for a  few minutes, the knees give way and bend for-
ward.  As the disorder  advances, the child can with dif-
ficulty direct his feet to  any precise  point.  Where chil-
dren have not begun to walk, there is debility in the lower
limbs, which forbids their use.
  Two striking instances of  deformity,  occasioned  by
hurts of the spine, have  fallen within our own observa-
tion.  In the first, the child had crept under a pianoforte,
and, on returning  from beneath  it, rose  before he had
cleared the edge of the instrument.  He struck the mid- 
»
              DEFORMITIES AND  DISTORTIONS.           189 '

die of the spine, and in a few years became hump-backed
to a deplorable extent.  In the second case, a child who
had just acquired the power of running alone, was placed
on his feet suddenly and violently by his nurse; he cried
with pain for awhile; in a short time lost the use  of his
legs, and ultimately  became a cripple and deformed.
  Curvature of the spine is not so often found in very
young children as in  girls of six or eight  and upward.
It is  mostly found  to  arise from tight  lacing, sedentary
employment, insufficient exercise and undue mental occu-
pation.  The  disorder  has  hitherto mostly  afflicted the
daughters of the higher classes; but it has been observed
cf late by an intelligent individual employed in making
mechanical contrivances for the correction of distortions,
that curvature of the spine is frequent Avith daughters of
small  tradesmen and  artisans, who, having  only one or
two children, desire  to advance them in life beyond their
own class.   To this  end they laudably and rationally de-
sire to bestow on them what they understand to be a good
education.  The error lies  in  the misconception of the
term.  The girls are spared from active household duties,
and sent to school, with the impression that they must
study hard.   Exercise and fresh air are  neglected.   The
impure atmosphere, the hard narrow benches of the school
room,  and the stooping position assumed in writing, ci-
phering, and needle-work,  together with the long  hours
passed at the pianoforte, add to the probability of injury.
On  leaving  schc-, the  tight lacing  is increased, and this
necessarily  forbids  sufficient  exercise.   In  many cases,
girls on  leaving school  are apprenticed to some business,
where they ply the needle from ten to twelve hours  daily,
with an interval of an hour for dinner, and  half an hour
for tea.  Parents will do wisely to consider  how far the
welfare of their daughters is likely to be  advanced where
the risks of disease are so great.
  A defect, however slight,  should never be regarded as
too  insignificant to deserve attention; neither should ade- 
•
190           DEFORMITIES AND DISTORTIONS.

formity or malformation be looked upon as incurable, till
time and experience have proved every endeavor useless.
It is quite certain that much may be done by mechanical
means, and  it  is equally so that care and attention will
prevent the further progress of a distortion,  even if they
do not remedy  it.  Facts are more convincing than argu-
ments.   A delicate girl of six years of age  falling into
weak health, her parents observed that one of the  verte-
brae of the neck started out beyond  the rest.   This was
attributed to  general debility,  and change of  air, with in-
creased  nourishment,  was  adopted.   Notwithstanding
these measures, the other vertebrae  of the neck gradully
curved outward, the chest contracted, the head leaned for-
ward, and growth was apparently stopped, while the gen-
eral health became so materially worse, that death seemed
inevitable.  The probable effects of mechanical aid had
been overlooked or deemed hopeless;  although four years
had elapsed since the first symptom of distortion was ob-
served,  they were now  resorted  to.  The  child  was laid
upon a  mattrass, with weights attached to the  neck and
around the body, so arranged as to keep the whole person
elongated, and the chest  expanded.  At  the end of five
weeks there was an alteration  of form sufficient  to justify
the hope that if the child's health improved, the deformity
might be greatly, if not wholly,  overcome.   At present,
the general health is in a better state than when  the child
was first placed on the mattrass.
  A premature use of the  brain in childhood is a fertile
source of weakness and disease.  Precocious children gen-
erally die before they attain maturity, or dwindle  below
the ordinary standard of intellectual power.   Precocity is
frequently the  result of disease.  Wherever it is  mani-
fested, parents will do wisely to repress the love  of  study,
and  to  encourage bodily exercise.   The  brain,  during
infancy  and  childhood, is very  soft, and almost liquid
under the finger, yet supplied with more blood in propor-
tion to its size  than at any subsequent period, and conse- 
DEFORMITIES AND DISTORTIONS.
191
 quently  highly  excitable.   The  nervous system is con-
 nected with the  brain, and is  early developed; it  is the
 source of all  vital movement, and gives energy to those
 actions which tend to the growth of the body.   When
 growth is rapid, as in  childhood, there is a great draft of
 nervous  energy upon  the  brain.  If, therefore, the mind
 is worked much  at this time, a deficient supply of this
 energy is sent to the frame, and, as a natural consequence,
 the  progress  of growth is checked.   The  disease  called
 rickets is often  attended by7 a  premature development of
 the faculties;  the brain is particularly active;  and, if such
 activity be not checked, there can be little hope of  recov-
 ery from the  disorder, inasmuch  as the use of the brain
 tends to exhaust  the  vital powers.   The same reasoning
 applies to all other  diseases of the bones,  and plainly
 shows that, to  insure the perfect physical development
 which nature intends to  prepare during childhood  and
 youth, the brain  should have but a comparatively small
 amount  of labor.
   It is the opinion of many men of high medical  celeb-
 rity in this and other countries, that no intellectual  labor,
 no study, should  commence till  after seven  years of age,
 and  that a contrary  course injures the body, while it
 affords  no permanent benefit  to the mind.  Much may
 be learned without study.  As  this subject  will  be re-
 verted to, it is only necessary to  repeat, that, where there
 are original delicacy of health, predisposition  to disease,
 injuries from accident  or undefined causes, the brain must
 be employed sparingly, and never fatigued or excited.
   Healthy children are continually in motion, ever chang-
 ing  their position and  amusements.   A  few minutes'
 steady attention to one object is all that  ought  to  be
 expected until seven years  of age are attained;  and  where
there is  delicate  health, this freedom of mind and body
ought to be continued  longer.   Dr. Arnott observes: " To
the well being of the  higher classes of animals, exercise
of their  various  parts is as necessary  as their nourish- 
192
DEFORMITIES AND DISTORTIONS.
ment;  and if it be withheld by  any cause during the
period of growth, the body is  often crippled, or at least
never acquires its due form and proportion.  The seden-
tary employment of girls, and the unfortunate notion that
all  active sports and exercises are  indecorous, occasion
early weakness of the body, especially iu the back.  To
remedy or prevent this, strong, stiff stays  are put  on at
an early age to support the back, as it  is said, but which,
in reality, by superseding the  exercise of  the  muscles
intended by nature as supports, cause  these to lose their
strength, so that when the stays are  withdrawn, they are
unable to  support the body."
  The constant change of position which children  adopt,
is evidently to give alternate exercise  and repose  to the
muscles.  To sit  still and upright, is really painful to
them;  left to themselves, they rarely carry their exertions
beyond the point of healthy fatigue;  and as soon as they
feel this, they spontaneously throw themselves on the floor
to obtain the necessary repose.   It is not the doing this,
but the way in which it is done, which  constitutes inde-
corum ; and it is this point whereon  a mother's instruc-
tions may advantageously be given.
  The ill  health or temporary  ailments  of children often
prove a source of  moral evil to the sufferers.  Indisposi-
tion renders them fractious and impatient; the indulgence
of violence or  fretfulness necessarily  impedes  recovery;
and to avoid arousing these feelings, parents often  humor
and coax  their children.   Additional  tenderness and un-
remitting attention are necessary from  the mother  or
nurse;  but these  may be afforded without  the  slightest
relaxation of moral discipline.  The control of the parent
is as needful in sickness as in health.  An ailing child is
often a spoiled  child; expecting the gratification of every
whim, and yielding to alternate fits of violence or peevish-
ness.  A sick child is but too often persuaded or deceived
into taking medicine, when he should  be directed by the
calm, honest steadfastness of a parent's authority.   If he 
STAMMERING.
193
once obtain the victory, or has reason to suspect himself
imposed upon, he will become unmanageable, or meet
deceit with deceit.  The observance of the duties of obe-
dience during illness is no source of pain, but produces
that calm reliauce upon the sense, affection and power of
the parent, most favorable to recovery.  To these remarks
we may7 add, that the  severity and coercion necessary to
restore a  convalescent child to the good conduct which
needless indulgence  in  sickness has  disfurbed, produces
more  misery than any rational firmness to  control  the
invalid can inflict.
STAMMERING.
  The  organs  of speech  are, with rare  exceptions,
perfect, and calculated, by proper nurture  and exam-
ple, to perform correctly their assigned  office.   In the
first efforts  to  speak, the  child is a  mere  creature of
imitation, and will acquire a tone and  habit of utterance
in conformity with those of his instructors.   It is, there-
fore, of importance to avoid all improper modes of speak-
ing before children, and in  particular to keep them  from
acquiring the habit of stammering or stuttering.  This
defect in  speech, beside being rapidly caught by imita-
tion,  sometimes arises from  fear,  eagerness, or  violent
passion.   A child whose ideas succeed each  other  very
rapidly, is often unable to express himself quickly  enough,
and utterance is impeded by his own energy.  AVTien the
trick  of stammering has once begun to take place in a few
words, it will  extend  itself to others, and particularly to
all the first words  of sentences, because then the organs
pass in an instant from inactivity to action.  The propen-
sity to stammer, from whatever cause it proceeds, should
be checked on  its earliest  manifestation.   The  person
addressed should refuse  to  attend until the child  speaks
slowly, and with care.  The moment he begins to hesitate,
he should instantly be made to cease from speaking, and
then to recommence with deliberation. If these precau-
           13 
194
STAMMERING.
tions are not sufficient, let the child, for a few minutes at
a time, and frequently in the course of the day, repeat the
vowels in  a  firm, strong voice, and afterward the conso-
nants,  singly, and variously combined  with the vowels,
and occasionally a few sentences fitted to his intelligence.
  Above all things, patience is necessary.  If, as is most
probable, the child is nervous and irritable, any treatment
increasing  these feelings will also increase the propensity
to stammer.   Stammering is  often caught  by imitation.
The means recommended above will best put a stop to a
habit so acquired. To reason with, or forbid the little
mimic, is not likely to quell the active propensity.
  Stammering sometimes arises from any nervous disorder
of the  muscles of speech, particularly a spasmodic affec-
tion of the glottis, or narrow opening  at the top of the
windpipe, by  which the air  passes to  and from the lungs.
It is difficult  to  say  how  far young  children may  be
affected by such  disorders;  but,  however this  may be,
attention should be paid to  strengthening the frame gen-
erally, while every means should be taken to acquire per-
fect  articulation.   It  has been suggested by Dr. Arnott,
that the  glottis,  during common speech, need  never be
closed, and if it be kept open, stuttering is  avoided.   In
humming or droning any simple sound,  like  e in  the word
berry (to do which at  once is no difficulty to an habitual
stutterer), the glottis is opened, and the pronunciation of
any other sound rendered easy.  If, in  speaking or read-
ing, the stammerer joins his words  together, as if each
phrase formed but one long word, or nearly as they are
joined in singing, the voice  never stops, the glottis never
closes, and  there is no stutter.  Stutterers often sing well,
without the  slightest hesitation, for the glottis opens to
emit the tone before  the  words  of the song  are pro-
nounced, and  does not again close.  They  also declaim
and read poetry well, the uninterrupted  tone being almost
as great as  in singing.  Many persons speak in a drawling
tone, and often rest on the  simple  sound of e mentioned 
STAMMERING.
195
above;  saying, for instance, " e, I, e - - -, think, e - - -, you
may, e —;" the sound never ceasing until the end of the
phrase.  A stutterer adopting such a manner, would over-
come his defect, and be no more remarkable than any
other drawling speaker.
  If the simple means first recommended be not sufficient
to check the early habit of hesitation, it may be supposed
that  there  is some spasmodic affection  of the glottis.
With children the cure of stammering must be  pretty
much a matter of imitation; they can not  understand the
causes of their difficulty, nor the  means of removing it,
but if the mother assume the  drawling mode of speech,
recommended by Dr. Arnott to the adult  stutterer, and
the child can be brought to imitate and adopt her manner,
it is fair to presume that the effects will be the same.
  The broken English of infancy is  so  engaging, that
parents are generally unwilling  to correct it.   Mere infan-
tine mispronunciation requires no such sacrifice.  Indeed,
it would be wrong to  attempt to improve  it, since the
child's temper would thereby suffer; but there are errors
which ought to be contended against at first, such as the
hesitation already remarked, lisping, and the inability to
sound the r.   In order to  overcome  these defects, the
mother should first  ascertain by what actions and  posi-
tions  of the  lips, tongue,  palate and throat, she herself
produces the various simple and compound sounds which
constitute the elements of speech; then transferring her
observation to the child, discover how the organs  are mis-
employed.   For instance,  lisping is  chiefly  the substitu-
tion of th for sh, in which case, the tongue is thrust loosely
forward against or between the  teeth, thereby stopping
the transmission of breath through them, instead of being
kept back rigidly in the  mouth, and the breath forced
over  it, through the teeth. The pronunciation of the
letter r requires the tongue  to  be first put  forward, and
then drawn curlingly back, by raising its tip to the palate.
If the latter action be  missed, the necessary vibration is 
196
SQUINTING.
omitted.  R is sometimes pronounced like I, in which case
the tongue goes at once to the palate, instead of  being
first thrust  forward to produce the vibration.  A small
degree  of care on the part of the mother or nurse will
remedy these defects of utterance.
  It is  hardly necessary to offer any comment upon the
importance  of  possessing a  distinct  articulation, free
from  any defects.   The following  passage from an elo-
quent writer will best advocate the cause, if, indeed, advo-
cacy can be needed: " Speech is one of our grand distinc-
tions from the brute.   A man was not made to shut up
his mind in itself, but to give it voice, and to exchange it
for other minds.   Our power over others lies not so much
in the amount of thought within us, as in the power of
bringing it out.  A man of more than ordinary intellec-
tual vigor may, for want of expression, be a cipher, with-
out significance, in society.  And not only  does  a man
influence others, but he greatly aids his own  intellect by
giving distinct and forcible  utterance  to  his thoughts.
Our social rank, too, depends a good deal on our power of
utterance.  The principal  distinction between what  are
called gentlemen and the  vulgar, lies in this: that the
latter are awkward in manners, and are especially wanting
in propriety, clearness, grace, and ease of utterance."   It
is, therefore, for mothers  to lay the foundation  of  the
benefits to be derived  from  this " power  of utterance."
Where the articulation is  faulty, the expression of ideas,
however admirable they may be, will be ineffective, if not
ludicrous.

                     SQUINTING.

  The eyes of an  infant are  for some time  very weak,
and  can scarcely be said to be obedient  to  its will
or inclinations.  The  mind being  yet inert,  the  organs
of vision roll about, as  if by instinctive impulse.   While
in this unregulated condition, the two eyes may occasion-
ally be observed to look different ways, or perhaps both 
SQUINTING.
197
inward toward the nose.  These  affections,  which arise
frequently from  the  desire to look toward the light, or
toward any object which captivates the infantile curiosity,
should be in all cases checked, by simply holding the hand
over the eyes, so as to cause them to shut, and assume a
proper direction on being opened.   So extremely liable is
the child to squint in its vision, that  this will sometimes
require to be performed several times in a day.
  As the strength of a child increases, so  does its power
of vision; nevertheless, the mind being uninstructed, the
eyes will continue for some  time liable to derangement.
Light shining always from  one side, or the  placing of a
knot of ribbon over one eye,  will  lead to a habit of look-
ing obliquely, and therefore  all such causes of derange-
ment should, as  far  as  possible, be avoided.  The infant
must be guided in its efforts  to look, as well as to speak.
It should be held fairly toward the light, or toward any
bright object, and at such a distance  as will accommodate
the focus of its vision, and cause it to use both eyes alike.
The habit  of looking obliquely either with one  eye or
both, is that which has to be  chiefly guarded against, and
corrected when it occurs.  Obliquity of  vision  may arise
from natural  defects, but that is seldom the case; in almost
every instance squinting  is  a result of sheer carelessness
of the mother or nurse.
  AYhen the  child's faculties are advanced, it  may acquire
a habit of looking with one  eye, while the other is kept
shut.   The effect of  such a habit being to strengthen one
eye unduly, and weaken the other in proportion, it should
be promptly checked;  which may be done  by covering
the strong eye,  or  that which is  always employed, and
confirming the use of the neglected eye.  By this means
the muscles  of the latter gain strength, and acquire the
power of directing  and  adjusting the  eye.   The  time
necessary for the cure depends upon  the inveteracy of
the habit, the length of time that  the muscles have been
left to themselves, and their  consequent  weakness—-for it 
198
SQUINTING.
 is with difficulty that  muscles acquire an increased degree  of
 action after having been  long habituated to a more limited
 employment.  Where the habit has been of short duration,
 a piece of gauze, stretched upon a circle of whalebone to
 cover the best eye in such a manner as to reduce the dis-
 tinctness  of vision to an equality, and worn some hours
 every day, has  effected a cure.   Instances are on record
 of a squint being removed by wearing between the eyes a
 piece of thin metal,  which, projecting from the nose, pre-
 vents the  distorted eye from seeing an  object obliquely.
   The  following mode  of curing squinting has been re-
 commended : AAHien the child is of age to observe direc-
 tions, place him directly before you, and let him close the
 undistorted eye, and look at you with the other.  When
 you find the axis of  the  eye  fixed directly upon you, bid
 him endeavor to keep it in  that situation, and open his
 other eye.   You will now see the distorted eye turn away
 from  you  toward his nose, and the axis of the other eye
 will be turned toward you.  But, with patience and repeated
 trials, he will, by degrees, be able to keep his distorted eye
 fixed  upon you, at least for some little time; and when you
 have  brought him to  keep the  axes  of both eyes  fixed
 upon  you, as you stand directly before  him, you may
 change his posture;  setting him  first a little on one side,
 and then on the other.   When in all  these situations he
 can perfectly and  readily turn the  axes of both eyes to-
 ward  you, the cure is effected.
  Squinting is  sometimes the consequence of any severe
illness which has affected the head.   In such cases it will
probably disappear as the strength of the constitution  is
restored.  It is  also  brought on by over-tasking the mind
 with  study, or  by any  cause which  exhausts  the vital
 energy  of the system.   In such cases, no remedy can be
effected unless the  cause be removed.
  The following case is  quite worthy the attention of pa-
rents.   The facts  have  never  before  been  printed, but
their  verity is undoubted: 
SQUINTING.
199
   A healthy boy, when  about four  or five years of age,
 contracted a habit of squinting with one eye, and so sud-
 denly, that his parents at first supposed it was brought on
 by his  having imitated  some  person who  labored under
 the defect.  This, however, could not be ascertained, and
 the habit continued to increase.  Medical men were  con-
 sulted,  and  various  mechanical contrivances applied, but
 with no effect, except,  indeed, that the weak eye grew
 worse,  and the other became affected, though iu a less
 degree.  One surgeon recommended a course of alterative
 medicine;  but as the  general  health of the child  was
 undisturbed, the  parents were unwilling to try such an
 experiment.   The boy  could read  well  for his age, and
 was generally intelligent, but books were now prohibited,
 and he was restricted  from  looking  at  small or  near
 objects,  as the squinting was always  thereby increased.
 The father of the  child, after  repeated  investigations,
 came to the conclusion that the antagonist muscles  were
 not strong enough to keep the eye in its proper position,
 for the sight of both, when  used separately, was  quite
 sound.   The  cure, therefore, could only be effected by
 strengthening these  muscles, and he proposed to confirm
 the whole muscular  system, as well as give power locally.
 To this end a regular  course of gymnastics was adopted,
 superintended by the father himself, and proportioned to
 the age and power of the child; he was well fed, kept a
 great deal in the  air, restricted from study,  but instructed
 orally in subjects suited to  his  age and  capacity.  He
 was also made to shut the eyes alternately, and  to  look
 straight forward  at an  object, and  outwardly, with the
 unclosed eye.  Every morning, on rising, winter  as  well
 as summer, a  pint of the coldest water was dashed upon
 the temples, and in the warm season a shower bath was
 added.  He was also encouraged to catch a ball daily.
  For some time  little or no improvement was percepti-
ble; the perseverance of the parents was unrelaxed,«andat
length a gradual amendment became apparent, but of no 
200                   SQUINTING.
permanent kind, for at the end of two or three days the
eyes would relapse into the original state, and then rally
again.  The plan was not, however, given up or neglected,
although if any accidental omission of any of the reme-
dies (particularly the  gymnastics) occurred, a change for
the  worse was immediately  visible.   If the  child had
cried,  was reprimanded,  alarmed, kept in  the house in
consequence  of bad weather, or did  not go to bed till
after his usual  hour, the squinting invariably and imme-
diately  became worse.  At the  end  of about eighteen
months the boy was capable in some degree of controlling
the action of the eyes; and as he became aware  of this
power his own endeavors to overcome the defect were
added to the energetic attention of his father.   Four years
elapsed before  the defect could be considered cured, and
even after this time, indisposition, mental excitement, par-
ticularly of a painful nature, want of  strong exercise, or
over-fatigue, occasioned a  slight temporary  wavering of
the axis of the  weaker eye.
  Parents will  not fail  to perceive,  from the  instance
above  cited,  that perseverance, and  even  fortitude, are
required on their part, and unremitting personal attention,
in whatever  circumstances of life they may be placed, if
they would overcome the physical defects  of their chil-
dren.  Above all things, it is desirable  they should be im-
pressed with the possibility of a cure, and that the advice
and  attendance  of a medical man, to be  of any  avail,
must be seconded by themselves.  Again,  docility and
intelligence  on the part  of the  afflicted  child will  be
needed, and these qualities mainly spring from the train-
ing it receives.   There is an old notion that, in  order to
effect any cure, the patient must have faith in the remedy.
At  first sight the observation appears to  be founded in
superstition ;  but on reflection it  will  be  seen that faith
not only implies belief, but also the desire to act in accord-
ance with the dictates of belief.  Thus, the patient seconds
the efforts made by others in his behalf, and remedies are 
THE INFANT'S OPIATE.
201
 therefore more likely  to take effect.  To this state  of
 willingness the mother must bring the child, and nothing
 is so likely to operate  advantageously as her own mild,
 patient, affectionate energy and attention.   Example has
 its effect, while the influence which it is the peculiar priv-
 ilege of  a  mother to establish over the  affections  and
 understandings  of her children, strengthens the power of
 her example.

              THE INFANT'S OPIATE.

   You must not give to  babies any opiate—whether it be
 laudanum itself, or opium, Godfrey, or paregoric.  " Drops
 of death " should be upon the label.  You have, no doubt,
 seen a Bible print which  figures " Herod's murdering  of
 the innocents;" mothers  cling in agony around children
 whose breasts are pierced, and infants struggle in the grasp
 of brawny soldiers.  That was a fearful slaughter; yet it
 was mercy when compared with the more fearful murder-
 ing—the  yet more devastating slaughter—among which
 we daily move.
   In Herod's time there was one  day of slaying—in our
 time there is not a day of rest.  Then, death came with
 one short pang,  and mothers struggled to  preserve their
 offspring.  Now, children  perish with the  lingering tor-
 ments of  a  poison, and drops of death are poured  out to
 them by  a mother's hand.  The sale extends through
 every corner of the land.   If you have administered to
 your children these destructive drugs in  ignorance—or
 under counsel different from that to which you now,  I hope
 and pray, are listening—there  can be  no  reproach upon
 your consciences.  But from this day there will be, if you
 refuse now to be warned.   The early death of your own
 children, or the  almost  inevitable sorrows of their after
 life, upon  your  own head be they, if you will not hear
 advice.  According to their constitutions,  or the doses
which your children have received, some who survive will
become idiots; many (reared thus to stimulus from infancy) 
202
MORAL  GOVERNMENT.
will become drunkards; some dull in intellect; all  more
or less broken in constitution, in mind and body; weaker,
and less able to struggle onward in the world than other-
wise they would have  been.   To procure for yourself a
selfish gratification, to still  the crying of an ill-managed
child, instead of seeking to improve your infant's  temper
by increased attention to  the requirements of its health,
you go to the cupboard, you take out the cruel dose.  Of
course the  child is still.  You  sleep the  sleep of health ;
but your child  has not  the  refreshment of repose.  You
have called  death  to  stand  and watch beside its  crib, to
hold his cold, clenched hand over the baby's mouth, and
fix it in a spell for  your convenience, until you wake and
come to  it again.

             MORAL GOVERNMENT.

  During the first few weeks of  life, happiness  is solely
derived  from the healthy operation of the bodily  func-
tions.  Until the senses  begin to act  so^as  to convey im-
pressions to the brain, there can  be  no  pleasure drawn
from external circumstances.  The activity of the senses,
and the enjoyment produced, will be in proportion to the
state of the health.  An infant who is continually in pain,
who is either crying, moaning, or in a state of repletion
or of exhaustion from the consequences of suffering, will
be but little  attracted by the light, sound, or motion which
first engage  the senses of infancy.  In no other instance,
perhaps, are the influences  of the physical condition so
immediate  and  so evident.  An  infant, even of  three
weeks old, will exhibit a haggard, grief-worn countenance,
sunken  eyes and shrunken  face,  painful to those whose
experience tells them what these signs indicate.  But the
fair, plump,  contented look of the healthy babe, speaks  a
language of comfort, prophetic of the approaching dawn
of intellect.   How early does such an infant smile upon
its nurse, fix its eyes  upon her with a look of awakening 
MORAL GOVERNMENT.
203
 intelligence, when she  speaks in accents never addressed
 but to infancy, and reply with the little dove-like sounds
 only  uttered by the  healthy babe!  The  happiness or
 misery of this period  of life is wholly derived from the
 physical  condition, and the dawnings of the sentiments
 and the intelligence are in proportion to the health.
   The general irritability caused by disordered functions,
 renders the impressions upon  the senses even more pain-
 ful  than  pleasurable;  the  disposition for enjoyment be-
 stowed by the feeling  of health  is denied; the  mother's
 voice, her smile, are associated with pain as much as with
 pleasure, and the affections  are imperfectly and tardily
 aroused.   As weeks pass on, habits form, and instead of
 a habit of contentment, there is one of fretfulness.  An
 infant so constituted is either reared with an indifference
 to its  continual crying  and  fretfulness, or with the appre-
 hension which causes its nurse to be continually seeking
 how she may quiet or prevent its cries.  At the age when
 food alone appeases it, the  babe is always eating or suck-
 ing ; as it grows older, sugar, cake, etc., are  superadded,
 with the addition of noises or rough exercise, and but too
 frequently some sedative or composing draught, which
 the  mother believes herself obliged to  adopt in  order to
 procure the child needful repose, or the servant surrepti-
 tiously administers to  relieve herself from incessant fa-
 tigue.   AVhen the time arrives that restraints and guid-
 ance should be  adopted,  the fear of farther irritation by
 contraction leads to a  system of bribes, deceit and coax-
 ino-; all the  lowest sentiments of human nature are ap-
 pealed to; and at two years old we  have a selfish, willful,
 ill-tempered  child, Avith  violence  apportioned  to its
 strength, and intelligence prompted by  ill feelings.  It is
 not  to be  supposed that  these  moral  disorders  belong
 exclusively to bad health.   A healthy child may be selfish,
willful and ill-tempered at two years of age, if injudicious
treatment have cultivated the lower sentiments;  but the
healthy infant is predisposed to receive happy impressions, 
 204              MORAL GOVERNMENT.

 and enjoys the condition called good temper — a term
 which in infancy is  synonymous with good health.   The
 nurse has fewer temptations to  mismanagement, and, the
 affections and intelligence being  more healthful and active,
 moral mismanagement actually produces less permanent
 injury.
   There can not, then, be too much value attached to the
 physical condition of an infant; to the condition  of the
 parent while pregnant  and while nursing, and to the
 regulation of every particular connected with the health
 of  her offspring.   This being  the first  object,  both in
 point of time and importance, the next  consideration is
 the means of developing the moral and  intellectual fac-
 ulties.
   The brain, on which  the  mental functions depend, is
 in infancy the least perfect organ.  Only a  few of the
 simpler instincts, as  the  appetite for  food, are at first in
 any degree  active.   After the child is a few weeks old,
 he  begins to exercise  his senses, and  the first  traces of
 intellect and feeling  are exhibited.  But still, and for
 long  after,  the  brain  is in  a tender  and delicate state,
 calling  for the  gentlest  treatment.  No loud  or harsh
 sound  should therefore  ever reach the  ears  of young
 children; no violent light  should be  allowed  to come
 before their  eyes; they  should always  be addressed in
 the softest tones; and nothing should ever be done in the
 least degree calculated to frighten them.   These are the
 chief particulars of treatment which we are called upon
 to attend to, with regard  to the mental system of children,
 during the first few months.  Opposite  conduct is apt to
produce  serious damage, and  that of  a very  durable
nature.   There are particular cases and circumstances in
which the value  of kind  and gentle treatment  is greater
than usual.  Perhaps the infant may have derived from
nature a constitutional irritability; or he may be acci-
dentally pained  by some derangement of his system.  In
these cases,  caresses, gentle changes of position, and  lul- 
MORAL  GOVERNMENT.
205
ling sounds  and movements,  are of great consequence;
while  all loud  singing, talking, and rough and  sudden
jerks, should be avoided.
  For farther  progress  in the moral management of in-
fants, it is in the first place necessary  to bear in mind
that the mental faculties, in their various degrees of  nat-
ural strength, rest at first  undeveloped, but ready to be
brought into activity in accordance with the respective
circumstances which are naturally calculated to stimulate
them.   All of these faculties are designed for useful  pur-
poses, under  the guidance  of reason and moral principle;
but it may so happen that some of them are naturally in
very strong activity, or are called into great force by the
circumstances with which the individual is surrounded, so
that the character may ultimately be of a very irregular
and uncontrollable kind.   In moral education, it ought to
be the first object of a mother to put the more lively fac-
ulties of her infant under proper regulation, or restraint,
if necessary, and so to evoke and train the rest, that, in
the result, she may have the best character which nature
admits in that case.
   Practically, the circumstances by  which  the infant  is
surrounded, are sufficient to serve the whole end in view,
as far as very young infants are concerned; for it is clear
that, if a  child, for  example, be brought up in  a scene
where angry words  are never heard, and where nothing
of an unduly irritating nature is allowed to visit him, his
own angry feelings, though strong naturally, must be in
a great measure kept out of exercise, and  consequently
weakened; just as the same circumstances, by their sooth-
ing and pleasing nature, are  likely to have an active and
positive effect in bringing out his own kindest and softest
feelings.   In like manner, supposing that  a child  may
have a strong  natural  tendency to secretiveness, and that
he never  witnesses or  hears from  those  near him any
thing  but the  most  perfect candor  and  directness, his
tendency is  just  as  liable  to be kept below the point at 
206
MORAL  GOVERNMENT.
which lying and deception take place, as his opposite
feeling  in  behalf of truth is likely to be positively en-
couraged. t>
  The first duty, then, is for the  mother to be and to  do
on  her  own part, as she would wish her child to be and
to do; and to accommodate all other circumstances, as
far  as possible, to the same end, particularly as regards
the selection of attendants.   She must be  on her guard
against the delusive notion that an infant of a few months
old is not  capable of being affected by the conduct  of
those in whose arms he lives.   Though unacquainted with
words, he is perfectly alive  to what may be called the
natural language  of the feelings, as harsh looks, loud and
sharp tones, or the reverse.   At three months the smile of
his mother  elicits  from him an answering and sympathiz-
ing smile;  and at the same age  an angry  gesture will
frighten him.  And not only is he sensible of language of
either kind addressed to  himself,  but also  of what  is
addressed to others.  An instance is on record  of a child
falling into fits in consequence of a violent altercation
between his nurse and  another person, which took place
in his presence.  An infant may possess such gentle dis-
positions that he will contract no disposition to quarreling
from seeing his elders always doing so; but this is a mere
chance.   The  dispositions may naturally  have  a  strong
bent that way, and he will then be, as it were, in the very
school calculated to make him a thorough quarreler.  The
more perfectly that  the home of infancy  is a  home  of
peace and love, the chances are unquestionably the greater
that the children will grow up creatures of gentleness and
affection.
  The earliest intercourse between a mother and her child
is carried on by  means of the  expression  of the counte-
nance and  the tpnes of the voice.  The first language of
an infant is the language of signs; these are at first invol-
untary,  and indicate his  wants  and  sufferings.   After
some time  he begins to be  sensible of the  existence  of 
MORAL  GOVERNMENT.              207
external objects, and to distinguish his mother's face from
that of all others.   In this face he  reads his first lesson.
The child ascertains that there is one who takes constant
care of him, to whom he can make known his wants and
wishes.  He looks, and she understands; he cries, and she
hastens to his relief.  He improves daily in the use of a
language which he finds is intelligible to her, and becomes
at length a little master of pantomime.  He sees, too, that
she  looks differently at him,  at different times, and that
the  tones of  her voice vary, indicating pleasure, pain,
approbation, and reproof.   Thus, long  before oral lan-
guage is used, the  mother  and child have established a
symbolical language of the countenance  and tones of the
voice, to which, if the  child is sprightly, and the mother
has a tact for it, gesticulation  is added.  The  mother has,
perhaps, used this natural language unconsciously, but she
may do much  to improve and  refine it, and to extend  its
use in the development of the moral and intellectual pow-
ers of her child.  Expression of countenance adds greatly
to the force of speech;  and as it is subject to the will, it
can be cultivated and improved.
  A mother should take care that every feature, look and
movement, corresponds with her feelings, and this without
affectation.  Let her feel as she ought, and then endeavor to
look as  she feels.  Let her, when the occasion calls forth
the corresponding feeling, cast  upon her child a look of
pity, of sympathy, of consolation, of composure, of inter-
est or of playfulness, giving to each a distinct character,
while her habitual  expression  should  bear the stamp of
gentleness, patience, cheerfulness and hope.  AVTien gov-
ernment and discipline are necessary, let the countenance
exhibit authority, decision, firmness,  disapprobation, and
a determination to be  obeyed, mingled, however, with
entire composure and self-possession.
  In infancy and childhood the muscles of the face, which
give it expression, are  exceedingly pliable, and yield  an
almost  involuntary obedience to the emotions and opera- 
208               MORAL GOVERNMENT.
 tions of the mind.  In addition to the care which mothers
 should take to preserve a  command over their own fea-
 tures and tones of voice, it  is important that the same care
 should  be exercised  over  the children  themselves.  By
 these means much may be done to mould the features into
 forms indicative of virtuous emotions.   Habits of expres-
 sion have  a powerful influence upon the internal  feel-
 ings.  A  smile, even if produced  with effort, will assist
 in calming angry emotions.  There need be no hypocrisy
 in this.   We  adopt various methods of self-control, and
 effect that  by  indirect means, which we find by experience
 direct efforts of the will  can not accomplish.  The effort
 to control our features aids us in subchuing internal emo-
 tion.  This principle may be perverted and applied to the
 worst purposes, for all that is good is  subject to abuse.
 The child who is early habituated  to  avoid disagreeable,
 sullen, fretful and unkind looks, and whose affections are
 at the same time cultivated on sound principles, will have
 additional  security  given to the exercise of these affec-
 tions, and a power of subduing contrary feelings,  wanting
to the child over whose features and modes of expression
no such discipline has been exercised.
  Great pains are often taken to  cultivate the manners,
and to give them an air of  courtesy, respect and kindness.
 The tones  of  the voice, articulation, pronunciation, and
modes of speech, are made matter of early instruction.
There is no doubt that all this has an influence in mould-
ing the intellectual and moral  character.  The various
expressions of countenance are  as susceptible of control
and  discipline, and react  on  the mind with  as great  a
force.  They should  therefore be  formed into habits as
well as  the manners or the voice, for there can be no
greater danger of offending against nature and simplicity
 in the one case than in the  other.
  The effect of these principles is fully seen in the change
 which takes place in the  countenance of an uneducated
 deaf mute, after he has enjoyed a few weeks  intercourse 
MORAL  GOVERNMENT.
209
 with  his companions in misfortune in an asylum.  His
 features, expression of countenance, and general deport-
 ment, undergo  a wonderful transformation, and seem  to
 acquire a new power.   Catching by imitation the spirit of
 those around, they become instruments for the expanding
 mind to employ, and have no small degree of influence in
 forming habits of thinking and feeling.
   It is neither  necessary nor desirable to school children
 into studying the expression of their features.   As their
 violent emotions should be repressed, so every expression
 of that violence, whether shown in voice, feature or ges-
 ture, should be gradually checked; not thrown back  to
 be indulged silently and in concealment, but in infancy, by
 the mother's calm expressions of pity, regret or condem-
 nation ;  and in  childhood by the same means, strength-
 ened by rational appeals to  the  good feelings.  A glance
 of the mother's  eye is  often sufficient to  deter  a  child
 from error, a gesture to recall  former  advice, a word  to
 overcome resistance or soften rebellion.   This power must
 have been established from the first.
   However much the  gift  of personal beauty may have
 been misused, and although it  be confessedly secondary
 to moral and mental beauty, yet the charm of an agreea-
 ble and expressive face  can neither be denied nor unfelt.
 Young children generally possess this charm; and if it do
 not remain in after  years, it may be because the indul-
 gence of bad passions or bad habits have marred it.  It is
 obviously the mother's duty to preserve  the best gifts of
 nature, and to endeavor that the pure  affections, lively
 intelligence, and gentle sympathies they seek to cultivate
 in their children, should speak  in  their countenances as
 well as in their actions.
  For some time a child is content to enjoy the sight of
 objects, but growth and increasing strength apparently
inspire the desire to touch and to grasp.  The efforts  to
do this are for months  uncertain and imperfect; there is
no knowledge of distance or size; the infant reaches too
            14 
210
MORAL GOVERNMENT.
far, or not far enough;  too much  on one side or the
other; and when the hand  accomplishes its intention, it
has no power to hold or grasp the object of desire.   Next
comes  the wish for possession.   All who  have observed
the early  manifestations  of  infancy, know that a child  is
not satisfied to touch or take hold—it wants to have.  No
matter how unwieldy  the  object, possession  alone  will
satisfy.   The  gestures  accompanying these desires are
animated  in proportion  to physical strength and energy;
the infant leans forward, stretches out its arms, kicks its
legs about, sometimes with  a little straining scream, not,
however, of anger, but of anxious expectation.  The cry
of auger conies when the object can not  be obtained, or
when it is suddenly removed.
  Disappointment  and vexation being expressed by the
same means as bodily pain or hunger, it is not improbable
that the attention which such  manifestations have pro-
cured, leads the child to expect that crying will obtain all
its  desires.  This impression should be removed,  and a
contrary lesson impressed.   First, the  infant should not
be allowed to  have what it cries for; and as the counte-
nance and manner of the mother have been the means  of
awakening happy emotions, so  they should express con-
cern at the evidences of impatience.  If the child desires
an object which it may touch, the wish should be granted
before it grows into irritability,  yet not in  such  haste as
to preclude a small exercise  of patience and forbearance.
Instant and constant attention to the wants and wishes  of
children renders them exacting,  violent,  or  fretful, and
will even engender a love of command  and impatience  of
control quite inimical to obedience.   Playful notice, while
the child waits, will at first serve to restrain irritable feel-
ings.   It is too much to expect an infant to await its grat-
ification with no other occupation than expectation. This
comes when time and habit have confirmed the certainty
that the mother will attend to the wishes of the  child;
reliance upon her, and  confidence in her love  and truth 
                  MORAL GOVERNMENT.               211

tending to confirm serenity of temper.   The influence of
love fosters  the  best feelings.  Love  is  our  moral sun-
shine.   An infant who is always surrounded by kind looks
and gentle voices, not only imitates what he  sees  and
hears, but all his emotions are of that happy  character
which inspires kindness.  As months  and days increase,
his sources of happiness increase;  he  is prepared by his
own physical comfort and the affection he experiences, to
look upon every new object with confidence and cheerful-
ness ; anticipating nothing but benevolence, he welcomes
every body and  every thing with  gladness.    Constitu-
tional  timidity is checked, and a  habit of contentment
formed.
  An infant, when once  excited, often continues to cry
after the exciting cause has ceased.   To change the nature
of the emotion, should be the  object; and where every
thing is new and unknown, this  is sufficiently easy.  A
pleasing sound, a bright object, will often suddenly put an
end to a fit of anger.   To prevent irritating circumstances
is still more  important.  Uneasiness, however trifling the
cause,  disturbs peacefulness, and it is from peacefulness
that cheerfulness  and  good temper spring.  When the
feelings  are  thus  prepared, trifling annoyances are, after
awhile,  more patiently endured; and  as  intelligence ap-
pears, there is a greater readiness to observe, and to derive
happiness from external objects.  Differences of tempera-
ment are  early manifested;  excitable natures must  be
moderated by calmness and gentleness; sluggish natures
excited,  yet  never with  violence.   A  fat, quiet, white-
looking child, may give little  trouble, and this  condition
is therefore called sweet temper; but it is quite as nearly
allied to insensibility,  which must  be  shaken off by the
activity of the parent; otherwise, selfishness, and a love
of whatever contributes to selfish pleasures, may spring up.
  A young  infant requires constant  attention;  but as
time goes on, enough of this may be given, although the
child be  left (or apparently  left) to itself.   Thus, at a 
212
MORAL  GOVERNMENT.
tender age he acquires a species of independence, namely,
that of finding happiness in himself and for himself.  A
babe of six weeks old, awake in his bed, is preparing  for
this independence;  at ten weeks he will  have fixed  his
eyes upon some  attractive object, perhaps upon  his own
moving fingers, and he  is happily occupied.   At a later
period, when he  can sit in a  chair, or on the floor amidst
his playthings, he will require the watchful glance  of the
mother, and occasionally a word or a little help, to assure
him  of her presence and sympathy.   If the child  be
inactive and dull, then he will need to have his powers of
observation frequently addressed and  kept alive; but an
excitable child is best left to wear out the liveliness of
his impressions upon a few objects, without interruption
or any other stimulus  than  that which is  innate, or
aroused by the objects themselves.  An infant with lively
feelings and quick perceptions, is more likely to be impa-
tient and violent than one of slow perceptions and defi-
cient  sensibility, and will need a counteracting,  rather
than an exciting power.  He should not be hurried from
feeling to feeling, and from object to object, but encour-
aged to dwell upon  one.
  Every office performed for a child should be done with
gentleness and care. When  carelessness pervades the
general management, the child must be continually uneasy;
he consequently gets the reputation of bad temper, and is
deprived of those kind  influences which can alone foster
goodness.   The  close connection  between  physical com-
fort and moral development, ought never to be overlooked.
Perhaps the most difficult part of infancy is that in which the
want  of speech is felt, but without the power of utterance.
The  intelligence is often great;  the sentiments active;
wishes and  wants  are  intensely  felt, but the means of
expression are imperfect, and often  unintelligible.  The
more  intelligent  the child, the greater is  the probability
of violent emotion following the unsuccessful  attempt to
understand  and  be  understood.   This  is  the time when 
MORAL  GOVERNMENT.
213
the mother's influence, and the experience she has gained
of her child's character, will come into use.  A child who
can not make  himself understood, usually screams; it is
in vain to attempt to silence him by giving him something
that he does not cry  for; neither will any good  purpose
be served by talking to him  while crying.   While vio-
lence  is at its hight, calmness and silence are the best re-
proofs.  Beside, Avhen a child is screaming, the  voice of
the mother  must be  elevated to loud or shrill tones, in
order to  be heard; such sounds can  only  be associated
with scolding, or with a noisy mirth, ill fitting the feeling
with which she should witness violence.  The object is to
show  that screaming  is of no avail, and that some better
means must be adopted to express  and obtain its wishes;
there  will be many bursts of anger before this is  effected,
but no evil need be apprehended.   While the mother is
firm and  calm, the child will not  cease to love her, but,
on the contrary, her aid will be felt upon this  point  quite
as much as in matters  of bodily suffering.
  It is not unusual for a child  so  treated,  to soften into
tears of real grief on  finding that his mother's counte-
nance looks sorrowful, and so to forget the cause of his
excitement.   It is always better for the  parent and child
to be alone together during  such  scenes.   A child of a
year old, when crying  with  anger, will often look round
on  his observers with an air of defiance or determined
resistance;  or, conscious that they have  no sympathy,
relapse into stubbornness.  However erring, he should at
no age feel that he has lost his mother's sympathy ; and,
on  the slightest  evidence that  grief has  succeeded to
anger, she must  be ready to encourage and to aid.  A
shake of the head, a firm but gentle no, silence, or placing
the child in solitude,  will sometimes  calm  the passions;
but this  must be  cautiously tried, lest it cause terror or
Greater violence.  It  is an error to  induce  children  to
cease crying by promising them what they want as soon
as they leave off; for if they can understand the words, 
214
MORAL  GOVERNMENT.
" When you have ceased crying, I will give it you," they can
quite as well comprehend, '.' You can not have it, because you
have cried;" but  when anger has subsided,  amusement
must be provided, so that the child shall not  relapse into
fretfulness; the object being, not punishment, but to show
the child that violence will  not obtain its wishes.  It is
difficult to discover how children acquire the power of
interpreting language, but they do so long before they can
use it.   Tone of voice, and expression of face, assist con-
siderably ; strangers, particularly when not accustomed to
children, being rarely understood by them.  It  seems
desirable to accustom a child to listen to a few words from
the mother relating to familiar objects  or persons, or  to
some of his own actions, that  he may be habituated  to
comprehend, or at least to  endeavor to do  so; and he
might be questioned by words and signs, so that he shall
reply by gestures, and by such  sounds as he is able  to
utter.  As the violence of this period of childhood arises
so much from want  of language, pains  should be taken
by the mother to  establish between herself and her child
some means of communication  that will  smooth  the
difficulty.
  Constant warnings, threats, or  entreaties, have  a most
pernicious effect, when the  obedience they would  obtain
is not  insisted on.   The child, becoming accustomed to
them, ceases to regard them, and  imperceptibly discovers
that words  do not  really mean  what  they pretend to
convey, and thus  a  disregard for truth  is first  taught.
When  a  prohibition is given, it should be adhered to; it
will be necessary to repeat it many times,  because  the
tender mind can not be expected to  retain ideas, which
may immediately influence  conduct; but the repetition
must be made seriously and patiently,  not by an  angry
ejaculation  or  reproof  uttered in haste  and irritation.
The oft repeated " let that alone," " be quiet," " don't  do
so," " how naughty you are," only conveys that something
is wrong; no  impression is  made except one, character- 
MORAL  GOVERNMENT.              215
ized by some annoyance felt equally by both parties; and
no fixed and definite experience is obtained.
  A mother should always endeavor to ascertain what
qualities or tendencies are most injuriously active, and, as
far as possible, suppress them by a gentle course of treat-
ment.  At the same time, she should observe what are
the weakest points  of character, and if these  belong to
the good qualities of the mind, let them be cultivated and
exercised with all the diligence which she can  command.
For example, if the child incline to be destructive,  by
breaking toys, killing flies or other small animals, abusing
his  companious, and so forth, it is of importance to check
and suppress this dangerous propensity, and to rouse into
activity benevolence and gentleness of manner in its stead.
If the child show a deficiency in any useful  quality, as
memory, language, power of observation, and so on, these
should be frequently exercised, because  exercise strength-
ens ; and  the  longer that  the exercise is  continued, the
power of performance becomes the more easy and agreea-
ble.   In a word, check bad propensities, encourage good ones,
and in either case with gentleness and moderation, accord-
ing to circumstances.
  It is important to recollect that the vicious or disagree-
able tendencies of children are at first weak, and in most
instances may with little trouble be remedied.  But as the
disease is superficial, the corrective  should be light.  It
should be the object of the mother to prevent rather than
to  cure.   If she keep her  child from  evil  communica-
tions—that is, associating with persons, old or young, who
are likely to sully the infant  mind, and nothing is more
easily done—she will be spared days, weeks, perhaps years
of toil, in eradicating the mischievous tendency which has
been excited.  But in the  worst  circumstances that may
arise  do  not on all occasions oppose and correct.  The
child should not be aware of your intentions to correct it
systematically, for he soon discovers he is to be thwarted,
aud is as ready for combat as his opponent.  In this man- 
216
MORAL  GOVERNMENT.
 ner, injudicious correction has spoiled many children, who
 might otherwise have been the pride and solace of their
 parents in after years.
   Cleanliness, order,  and general propriety of demeanor,
 are to be ranked  among moral virtues, and their founda-
 tion is to be laid in childhood.   Parental  example will do
 much, whether  manifested  in  the  observance of regular
 hours, of neatness, delicacy, genuine courtesy,  and the
 ease Avhich always accompanies  true refinement.  Children
 can not be taught AA7hat is termed manners, Avithout  ren-
 dering them  affected  and insincere, for these are usually
 artificial and conventional; but they  may be practised in
 the true  elements of politeness, namely,  self-respect  and
 a  delicate regard  to the  rights and feelings of others, in
 contradistinction to the mere desire of admiration,  or the
 selfishness which  has  no regard for opinion, and  which
 only prompts to individual gratification.
   It is desirable that children should observe a cleanly and
 delicate method of eating and drinking.  While  they are
 too young to feed  themselves, their food  should be given
 them Avith attention to neatness and comfort.   As soon
 as they can assist themselves, continued care will be  neces-
 sary to accustom them to  the  use of  the spoon, fork  and
 knife, and also to arrange the food on the  plate, so that it
 may be eaten with attention to the method  usually ob-
 served; the meat, vegetable and bread  following each
 other in regular succession, Avith a proper proportion of
 salt.   Drinking or speaking with the mouth full, putting
the fingers into the plate and  mingling the food, should
be checked at first.
   Conduct at table is also worthy of attention.  Children
are often inclined to play A\7ith  the  different utensils, and
so to break  or  overturn  them; this habit, with that of
reaching for what they require, putting their elbows on
the table, sitting awkAvardly, and other uncouth demeanor,
 often  interrupt the comfort of  the  family meal.  A love
 of order is so natural to  some  children, that any change 
MORAL GOVERNMENT.
217
from their customary routine,  or in  the  usual place of
the different objects around them, has been known to
excite them to anger or tears.  There are other minds,
howeA7er, in Avhich a love of order must be created.
  Mutual confidence  should be a governing principle in
the communion between  parent and child.  This can not
exist Avhere the former acts only as  a judge  and law-
giver, who acknoAvledges no compassion, no soitoav, Avho
can not  weep  and hope  Avith the offender.   The  feAV
words, "I am  sorry that you are  angry;" "Try to be
good, and I will help you;" "Wipe away your tears, and
let me hear what vexes you," are more likely to  overcome
error, or turn away wrath, than stern commands  or cold
disapprobation;  for this treatment does not conceal that
there is  error, or disguise its evils, while it  differs totally
from the compassion which fondles or  coaxes, and bribes a
child to  soften  its violence  or withdraw its opposition.
Are there not moments in the lives  of all,  when a confes-
sion of error to a friend Avhose sympathy, consolation, and
encouragement, are certain, lessons the bitterness of self-
accusation and confirms good resolutions ?   Are there not
also moments when the  want of such a friend, or the
reproaches  and cold contempt  of those  who  possess a
right  to condemn, hardens  the  heart, and  converts a
wavering repentance  into dogged perversity?  If, then,
at an early age, when experience and  self-dependence are
so influenced by the denial of sympathy and the admiuis-
terino- of stern reproach, how much  more must the tender
buds&of infantine feeling be nipped and Avithered  by the
chilling  frosts of severity!  Nothing  can be  more beau-
tiful than the conduct of a child reared under the influ-
ence of  love.  It enters among strangers unabashed  and
undismayed, ready to Avelcome and be welcomed, seeking
happiness, and prepared  to  find it in every thing,  and
Avith every body;  so willing to be pleased, that every
gratification, however  trifling, is  prized  and  enjoyed;
habituated to cheerfulness, yet so full  of the sympathy it 
218
MORAL  GOVERNMENT.
 has so largely enjoyed, that, however gay, it does not lose
 sight  of the comfort or  sorrows  of others; however
 amused, there is no selfishness in its enjoyments; the mind
 is active and energetic, and the Avhole character beaming
 Avith intelligence and happiness.
   Reverse this picture, and see the  child who  has been
 governed by fear—a suspicious, timid glance, an endeavor
 to escape observation, no spontaneous prattle, no words or
 actions pouring  out  the  unrestrained thoughts and feel-
 ings ; nothing truly enjoyed, because there is an undefined
 fear of doing or saying  something which  may provoke
 rebuke; or if there be enjoyments, they are  received in
 silence, and in that solitude of heart which leads to self-
 ishness.   Candor is a quality to be encouraged in chil-
 dren ;  indeed, it is natural to them; their helpless, de-
 pendent nature leads them to seek and bestow confidence;
 they have no reasons for concealment but such as fear
 induces.  If it be needful, as  assuredly it is, to learn the
 character of a child's disposition and feelings,  to trace out
 the beginnings of error, to  observe how impressions are
 made,  and Avhat  are  their effects, how can  this be done
 when fear influences the child to conceal, to misrepresent,
 to  affect and to deceive ?  To a young mother  AAdiose
 career  of maternal duties  is but just commenced, it may
 seem unnecessary to  dAvell upon  the  importance  of an
 affection Avhich she believes is already too full for increase;
 but she must look forAvard to  the time when  she will be
 surrounded with  little ones, of different dispositions, the
 novelty of her situation Avorn off, and youthful spirits less
joyous and elastic.   When  pecuniary meaus  are  not so
 equal to the support and comfort of many as of one, when
 cares and anxieties  of all kinds increase, then comes the
 time for the exercise of perfect love,  when it is most poAv-
 erfully taxed, and  when  it is most likely  to give way.
 The active mind is more liable to irritability than the
 indolent; therefore  the best informed, the  most ardent,
 anxious, and Avell-meaning parents, are the most likely to 
MORAL  GOVERNMENT.
219
forget their  previous  convictions,  and in a  moment of
impatience to inspire their children with fear,  and thus to
shake the confidence which the child ought to repose in
its parent.  So true is it, that  before Ave can govern chil-
dren, Ave must be able to govern "ourselves.
  Obedience  from child to parent is justly insisted upon ;
but it is  not sufficiently considered that the means of
establishing  it depends  more upon  the  conduct of the
parent than upon that of  the  child.  Obedience, to be of
any  use  in forming goodness, must be based  upon love,
respect and  confidence.   It is by no means unusual for
children to be told that whatever their parents do or say,
is right;  that  they must be  loved and looked up to as
patterns, and obeyed without hesitation.  Now, instead of
telling them this, it Avould be  Aviser to make them feel it;
and  by the  exercise of kindness and gentleness to all,
industrious attention to duties, strict and universal observ-
ance  of  truth, to earn the love and respect we would
command, and, by  example  and practice, accustom the
young to AA'itness and experience  the effects of the virtues
Ave recommend.  The feelings of children may be sub-
jected to habit  as  readily as -their appetites, and they can
only be habituated to goodness by continually feeling its
effects.  The serenity and happiness produced by  kind
treatment nourished  love  to others; example  shows hoAV
that love may be made active. The  child who sees that
its mother's occupations have a reference to the advantage
or Avelfare  of others, that they contribute  to the comfort
of all, and that she finds pleasure in  these occupations,
has learned a  practical lesson in benevolence; and if  it
seek to act upon what it has learned, its efforts should be
gratefully received.  No matter whether they  are service-
able  or not,  the intention is the  thing to be  valued.  It
exercises  the  benevolence  to employ a  child in  little
services such as fetching an article that is wanted, putting
things in their places, picking  up litter, etc.  When cheer-
fully  executed, they should  be  acknowledged, and,  if 
220
MORAL  GOVERNMENT.
unwillingly performed, thanks are still due;  but the child
might be made to perceive that a willing service is most
prized.
  A mother gains nothing,  and  loses every  thing, by-
making a child fear  her.  Fear may compel obedience,
but it will establish no real goodness, no spontaneous Avish
to do right; on the  contrary, commands Avill be evaded
whenever it may be done with impunity.   There Avill be
concealment  of thoughts, feelings  and actions; and cun-
ning and deceit will take the  place of truth and honesty,
and the mother will neA7er have any influence, nothing but
temporary poAver.  The only fear a child should  feel, is
the fear to  do wrong; not, however, because it  dreads
punishment,  for  this  is  a low,  debasing  motive, but
because it would not pain  those it loves.  The fear of  a
mother's sorrowful countenance will  be a more efficient
check, a more healthy influence to a young child, than the
fear of her angry voice.  Confidence  in a mother is very
necessary to obedience, and can only be obtained by such
a practice of truth and steadfastness on her part, that there
is a perfect  reliance  upon her.  A child has little or no
experience of the consequences of  his actions, nor will he
with the best guidance ahvays consent to fake Avarnings
and  prohibitions upon trust;  but AA7hen  he is  never de-
ceived,  Avhen  promises are never broken, threats never
made in vain, there grows up a faith  in the mother that
leads a child to respect and to  obey.  To gain this faith,
this perfect reliance, the mother must  be consistent, equal
in temper, the same  to-day as yesterday7,  otherwise the
child becomes confused, does  not understand Avhy  the
permission of yesterday is changed into  a denial  to-day,
or Avhy  the smile of affection  is now altered to the  tone
of irritable complaint.
  Falsehoods of a very fearful kind are sometimes uttered
to deter children from errors.   Threats of  old men and
black men,  and  other like terrors,  false and  true, are
resorted to, to frighten them into  obedience.  It is ascer- 
MORAL GOVERNMENT.
221
 tamed that death, fits, idiocy, or insanity, have been  the
 consequences of such inhumanity.  But setting aside the
 probable chance of such calamities, there are other certain
 results.  If the  child discovers  the  falsehoods practised
 upon him, he becomes boldly indifferent to the threats, is
 more  disobedient  and willful than  ever; disbelieves all
 that is  said to him, and, finding no  respect for truth in
 others, has  no regard for  it himself.  What becomes of
 the timid child ?   He lives in a state of fear of—he knoAvs
 not  Avhat.  The sight of  a strange face or a  new object
 fills  him AA-ith terror, for it may  be one of the horrors
 with  Avhich he  has been threatened; his faculties are all
 deceived, and diverted from their proper objects;  he lives
 a  life  of fear and doubt,  unable to  distinguish between
 what is true or false, real or unreal, good or bad.  He loves
 nothing; it is Avell if he does not hate.  But he is not the
 more obedient.
   The exercise of any sort of  cruelty toward children,
 renders them insensible to  the sufferings of others.  And
 this is a reason why they should  not be subjected to per-
 sonahchastisement.  Imitation being one of the strongest
 faculties, the child aat1io is  beaten also uses blows to effect
 his purposes.  There are  many parents who, upon calm
 reflection, would shrink from inflicting a personal correc-
 tion, or encouraging violence, yet  are  continually foster-
 ing  a passion for fighting.  For  instance, a  child  falls
 down  and hurts itself against the  floor or the furniture,
 and is immediately urged to beat them.  This is the first
lesson, practically showing that revenge is to be indulged.
Above all things, let  the mother beware how  irritability
betray her  into a slight pat, a twitch, or a gentle shake;
if  indulged, they inevitably lead to something more, and
personal correction becomes a regular habit.  When once
recourse is  had  to blows, nothing else is left; the child
gets hardened to the sense  of pain,  indifferent to disgrace,
and before committing a fault, does not  consider whether
he is about to do right or  wrong, but Aveighs the chance 
222               MORAL  GOVERNMENT.

of escape, and the proposed gratification against the pain
of a beating.  There is a quality in most minds Avhich
resents injustice and feels  disgrace.  It is a valuable senti-
ment, and gives that self-respect which assists in elevating
the character, and preserving the individual from every
thing base and degrading.  When this sentiment is pow-
erful, a resentful feeling is aroused by violent correction,
not the humility which is necessary to  a sense of error
and  consequent amendment.  AVTiere it  is not  active,
chastisement extinguishes all feeling of self-respect, of
honest and worthy  ambition,  of generous desires,  and
establishes in their stead  a taste for all that is base, low
and sensual.  Every correction that  is inflicted in anger,
bears the appearance of revenge, and seems intended to
gratify the offended  feelings of the parent, not to  amend
the child.   If a parent is angry, she must Avait before she
speaks.   This  will give her time for  reflection, and then
she Avill seldom err.  It is a habit that should be perse-
veringly practised by every irritable  nature.  Many per-
sons act wrong upon impulse, who are right upon reflec-
tion ; Avith such, reflection should always precede  action.
  No man submits to a blow; he considers it the heaviest
indignity that he can receive; AAdiile to strike a woman is
deemed so great an act  of coAvardice, that feAv persons,
however  debased, are found guilty of the  practice.  Her
weakness  is her protection.   How comes it, then, that
children  are subjected to a degradation  Avhich  a  man
revolts from enduring or inflicting ?  The nature of a
blow is not altered by the person on Avhom it  is inflicted,
except that the physical weakness of the one party  reflects
upon the individual  who deals the  blow.   The influence
is, that the parent who inflicts personal  chastisement is
more degraded  than  the child who receives it;  and
though the child can not reason thus, he feels thus, together
with a sense of injury that must break up all filial  respect
and  confidence.  These remarks apply to a later period
than childhood; but the beginning is then, and the parent 
MORAL  GOVERNMENT.
223
must beAvare  of first  steps.  She must guard her OAvn
habits as well as those of her children.
  Some  children early evince a love of cruelty.  They
torture insects ;  they destroy wantonly, and pull in pieces,
break, crush,  and tear, every thing that comes in  their
way.  To cultivate  the opposite feeling,  as  has  been
already mentioned, is  the  mother's part; she must pre-
vent every circumstance that can encourage the propen-
sity, manifesting dislike  at  its exhibition.   No  better
check can be found than occupation, giving  a child some-
thing to do that Avill employ its energies harmlessly.   She
ought  to sIioav  it hoAV animals should be  treated, first
making use of a toy, teaching the child to feed and caress
and protect the  representation  of the dog  or horse, and
taking it aAvay on  the first exhibition of  unkindness.
When the child  can comprehend her, she  should relate
tales of mercy, never of cruelty,  even when the imaginary
delinquent is punished; for where there is a propensity to
cruelty,  the  mind  receives pleasure in listening  to  its
details; indeed, it is  seldom prudent  to  tell children any
stories which illustrate misconduct;  all  their early ideas
should be  of  goodness; their curiosity is often so much
excited, that they are  impelled to do  the things they hear
of, in order to ascertain the facts.   Neither is  it Avise to
excite the  feelings  by tales of deep  sorrow or suffering.
Indifference or  unhealthy  sensibility too often succeeds
such  excitements, and compassion  and tenderness are
exhausted  upon fiction, instead of being exercised  upon
realities.   No child should be allowed to Avitness the death
of trapped mice, rats,  the  drowning  of puppies and kit-
tens, etc.; they  can not be made sensible of the  reasons
for their destruction;  they do  not  know the  nature  of
suffering and  death, but only derive  amusement from the
spectacle, and learn to look upon pain as matter for sport
and  pastime.
  Love, then, should be the impelling reason, the directing
power of education.   AVTiere love influences the parent, 
oo_|.
INTELLECTUAL EDUCATION.
the children of a family will be actuated by the  same
spirit—a spirit subversive of selfishness.  Dissimilar as all
characters are, different as all  intellects are, and different
as all situations are, the great duty of life  is  the same—
the promotion of the welfare and happiness of our felloAV-
men.   There are few errors, perhaps none, Avhich do not
affect the happiness of others as well as of ourselves; each
individual who  improves himself, improves society; and
every mother who rears her child aright, aids the universal
progress toward excellence.

    EARLIEST INTELLECTUAL  EDUCATION.

  The intellectual education of children, until two years
of age, consists in preparing the senses for the reception
of correct ideas of things.   The rudiments  of all learning
are acquired by  means of the  sight, hearing, smell, touch
and taste; as these increase in strength and activity, new
ideas are gained, and neAV impressions made.   The opera-
tions of the senses  are so closely connected, that  correct
notions can not be at first acquired on any  subject by the
action of one sense only.  Touch confirms or  corrects
ideas  of form, texture and substance; and Ave find that
the blind employ this sense to  acquire the knowledge that
can not be obtained by vision, while signs and gestures
are addressed to the deaf, and employed by the dumb, to
express Avhat  speech usually  conveys.  Infants must be
permitted the free  use of the senses, and be furnished
with the best means  for  promoting their  voluntary and
healthful employment.  Direction is  all  that is  needed
from the parent, while  imitation is  the  faculty she Avill
chiefly appeal to, always keeping in  mind the  delicacy
and excitability of the organs.  She will  find that at a
very early age there are decided indications of a prefer-
ence for certain objects; and though she may contribute
to happiness by indulging a predilection, she ought  grad-
ually to endeavor to direct the attention to objects Avhich 
INTELLECTUAL EDUCATION.
225
will  generally employ the faculties.  For example, if a
child sIioav most delight at seeing colors, she ought not to
foster this use of the eye only, but direct it to discriminate
form, dimension, arrangement and numbers.  It is natural
to encourage that which is most easy and pleasurable, but
the object of the first  steps in education is to  prepare all
the powers, not to perfect one.
  Next to bodily health, employment is the source of an
infant's happiness, and one of the means of developing its
moral nature.  The love of employment is an inherent de-
sire or instinct; and it remains to be considered how this
strong desire for occupation may best be satisfied and
directed.  First, objects must  be found  for its exercise
which  are harmless, of no ATalue, or not easily injured, and
which  shall address the eye and the touch.  The inclina-
tion  to carry every thing to the mouth renders it difficult
to provide proper means  of amusement, but which  may
be done by a little  ingenuity.   A colored silk or cotton
handkerchief, for instance, is  to be  met  with in every
house; having vaiiety of color, and being capable of vaiiety
of form, the eye is delighted;  its  softness gratifies  the
sense of touch, while  its yielding nature permits it to be
shaken, twisted, whisked  about, offering  endless excite-
ment for the exercise of the hands and  arms.  As  the
power  of observation grows, the mother may fold  the
handkerchief, Avhich the child  will watch, and next imi-
tate.  A piece of broad ribbon will give a variety of enter-
tainment, and the crumpling and folding of paper changes
its character again.  A bag should be prepared in which
to store every fragment that can delight without hurting
an infant.  There are articles in every house, which, if
gathered up and applied, would spare money, time, and
temper—for  example, feathers, shells, buttons of every
variety, cotton-winders, corks,  cards,  colored beads, bits
of silk, ribbon, and printed  cotton, with many  other
nameless matters.  One  precaution  is necessary—that
every article that can be  swallowed  should  be secured
               15 
226
INTELLECTUAL EDUCATION.
 upon a string, so that they may be moved freely upon it.
 These things will  at first only be turned over, tumbled
 about, shaken, rolled hither and thither, put in and out of
 the bag: as soon as this has become wearisome, and there
 is no more spontaneous application of them on the part of
 the child, the mother may arrange them in certain forms
 or according to  color; in short, make any application of
 them likely to  attract.    Then she may place them by
 number—one here, tAvo there, next three, etc., or she may
 raise cotton-winders,  oorks, or cubes  of wood, one upon
 the  other, or distribute  them  in  squares, columns,  etc.
 All she has to observe is, that she conveys only  one idea
 at a time, that she never insists upon the continuance of a
 pastime one  instant  after  it has become irksome,  nor
 worries a  child from object to object, but  leaves the child
 free to imitate,  alter, or otherwise apply the idea, since
 something may have been suggested which it will benefit
 the child  to work out, and  so raise him above the mere
 imitator.   She has  only to give the direction: suggestion
 is her province  equally with example.
  A book with clofh leaves whereon  to paste prints, is a
 source of unfailing pleasure; it can not be torn like paper,
 and gives the means of associating  things  with their
 names.  Representations of domestic animals, birds, in-
 sects, fruits, vegetables,  utensils and  furniture,  are  the
 most desirable, because they are  seen in their  realities;
 while the  power of cutting out with the scissors is another
admirable means of addressing their faculties, quite worth
a mother's cultivation.  A very rough resemblance satis-
fies a child; and the  use of the pencil and scissors,  or a
 reference to prints,  assists in illustrating a story or  a fact,
 which without such aids  is often uninteresting  and un-
 intelligible.  Objects  that fit one  into another,  exercise
 the hand.and the eye, such as  a box with a sliding lid, a
 piece of wood with  holes, having  corks corresponding in
 size, a basket to'be filled with cubes of wood and carried
 steadily;  these, and such as these, also act  as trials of 
INTELLECTUAL EDUCATION.
227
 patience.  A box with compartments, in which  shells,
 counters,  beans,  beads, cubes, triangles, etc., could be
 arranged according to size, form and color, is a safe  and
 desirable toy when the child has ceased to put every thing
 to the mouth.   It is almost unnecessary to reccommend a
 box of bricks, nine-pins, a  ball, a doll, a cradle, etc.   As
 soon as a toy has ceased to  amuse it should be put away,
 and, if it no longer excites attention, kept  out of sight
 until time enough has elapsed to make  its novelty again
 attractive.  A slate and pencil are usually welcome; chil-
 dren are delighted to  imitate the occupations of older
 persons, and are happy in believing themselves to be read-
 ing or writing.  When children are beginning to articu-
 late  sounds, it would assist them if familiar objects were
 pointed out, and, at the same  time, the name of each dis-
 tinctly pronounced.  The  ear would thus be instructed
 and  the imitation  aroused.  When listening  earnestly, a
 child's lips- and tongue  may often be observed  following
 involuntarily the movements of those of the speaker,  and
 so acquiring the first principles of articulation.   The deaf
 and  dumb are taught to speak by directing their attention
 to the  position  of the lips, tongue, teeth, and larynx of
 the speaker  during utterance.  The same  means may-
 be employed to overcome the difficulty in pronouncing
 certain letters experienced by some children.  Thus, the
 c and k are  often  sounded  like t, as took for cook, tiss for
 kiss.   If at four years of age articulation is not perfect, a
 child ought to be systematically taught to pronounce cor-
rectly.
  A child will not always put a toy to the  purpose for
which  it was intended; but provided he does not destroy
it, this  exercise of invention  is advantageous, and it is for
this reason that fragments are  more  agreeable  than  the
most perfect toy which has but one action.  Children  are
usually fond of destroying and of constructing; if they
have not materials for the  latter, they will  make them
 out of  any thing that first  offers  itself.  Many are called 
228
INTELLECTUAL EDUCATION.
mischievous who are only impelled by their nature to con-
struct, and who, having  no  employment found for their
natural activity, create it for themselves.  The little articles
above enumerated may be made at little cost;  and in this
department of infant training the father may give import-
ant aid.  A child having no experience of its own strength,
does not know Avhat can and can not be broken, • nor
foresee the effect of its own actions;  while the constant
injunction to take  care, the  directions not to do this, and
to beware of that, so perplex, irritate, or alarm, that there
is no enjoyment in the plaything, and the pastime ends in
mechanically looking at  or  moving it  without benefit or
pleasure.  If allowed to  destroy without caution or care,
the first step is taken toward reckless wastefulness.  The
only care to be expected from a young child is abstaining
from direct violence, and  the endeavor to gather his play-
things together, and put  them by in the box,/drawer, or
cupboard allotted to them; and even in this he must  be
assisted, for  when amusement is over, the interest in them
is  over also, and the child can not be expected to  under-
stand the utility of order  till he has had experience of its
advantages.
   We do not mean that children should be taught to play,
or that their faculties should be systematically put to work;
the object is  to furnish  the means of  employing that
activity with which they are  so largely gifted, so  that it
may not be  used injuriously to themselves or others, but
be turned to  the  development of  many of the   mental
qualities.   Neglected children exhibit  melancholy ex-
amples of the misapplication of their early powers.  The
well-worn adage," Idleness is the root of all evil,"  applies
to infants as well as adults; with this difference, that their
idleness is not a matter of choice, and that, intellectually
as Avell as physically, they are dependent beings.
   The playthings of children may be made serviceable in
giving  them  notions  of property.  Furniture, utensils,
books, and the ornaments of a house, offer constant temp- 
INTELLECTUAL EDUCATION.
229
tations to the curoisity and activity of children, and are
often materially injured by them; they are continually in-
fringing positive commands when they meddle with them;
but if provided with proper objects of amusement and ob-
servation, if they be repeatedly shown that these objects
are their own, but not the furniture, the temptation to err
AA7ill be less.  Besides which, there ought to be as scrupul-
ous a regard to  the property of the child, as is required
from him Avith regard to the possessions of others, while
the understanding may be strengthened by reserving some
feAV articles Avhich can  be lent Avhen  asked  for.  These
should be kept apart, and over his own toys there should
be  perfect power, while  they are not applied  to injure
other people.  AArhen there is  a determination to destroy,
no neAV toys should be bestOAved, but it is scarcely fair to
take away7 those already in  possession; an article* once
given  becomes property, which  the OAvner  can not  be
justly made to resign.  No moral law should be infringed,
because a child is  in the  power  of  its parents: if so, the
rule is  admitted  that  authority—superior strength—in
short, AAThatever  constitutes power, may do wrong at  its
pleasure.   Children should  feel  that their parents are
their protectors,  who will not  only rescue them  from the
danger of the moment, but also foresee and prevent evil.
Having felt this  in all that regards  comfort, health, the
allaying of hunger and  thirst, alleviation of pain,  etc.,
they will soon make an instinctive  moral  application of
the protective power and inclination.
  Telling stories is an inexhaustible  fund of  amusement;
and, fortunately, no one, however deficient in invention,
need be at a loss, for the child  is best satisfied  Avith the
simplest narrative, simply because he can understand and
sympathise.  He is delighted  to hear that a little mouse
came out of a hole, and carried some crumbs  from the
floor to his little hungry children at home.   This may be
related in more detail  twenty times in the  same words;
and " tell it again " will follow every repetition.  Tales are 
230
INTELLECTUAL EDUCATION.
 better told than read.   Indeed, there are very few publi-
 cations simple enough for very  little children.   Every
 mother should give attention  to the  accomplishment  of
 telling a story; it is a powerful instrument for the pro-
 duction of good, when wielded  with  discretion.   She
 should not make too much use of the wonderful, none  of
 the terrible, the pathetic occasionally, the benevolent more
 frequently; but she  must not always address  the  senti-
 ments and affections.  Simple  facts illustrative of the
 habits of animals, birds, insects, trifling details of common
 events, such as of the doings of the man while  making a
 chair or painting a house,  or of a little girl who gathered
 Avild strawberries, and running home very fast,  was  quite
 out of breath—such are also very suitable  materials  for
 story-telling,   to be  embellished  by descriptions,  and
 lengthened out by words rather than by too  many or dis-
 similar ideas.   Verse and song should bring  their charms
 also.   Most children are caught by versification, and by
 the melody of rhyme, long before they understand words ;
 the effect of soft vocal music seems instinctively acknowl-
 edged in that maternal lullaby Avhich forms a part of all
 national music.  It is scarcely necessary to remark upon
 the various sentiments  and faculties which  may be thus
healthily addressed, nor that the child may be kept from
 bodily fatigue during the recital of a tale, while the mother
may ply her needle, or pursue other domestic occupations.
  In telling stories, it  is well  to divide  them into those
that have happened, those  that might happen, and those
that  never could happen.   The last should be reserved
till the understanding is advanced enough  to make  some
thing like a distinction between the  possible  and the im-
possible.  A love of truth  is imperceptibly but surely ad-
 vanced by impressing its importance upon the intellect as
 Avell as upon the sentiments.
  Children indulge their imaginations by pretending  to
 be other people, and performing a series of events which
 they have seen or heard  of, or only supposed.   They 
INTELLECTUAL EDUCATION.
231
 readily convert chairs into horses,  houses, etc., and soon
 become so identified with  the  creations of  their fancy, as
 to be greatly disturbed by any interruption which recalls
 them to reality.  When much given to this self-deception,
 they will sometimes defend themselves from the  charge
 of having said or done wrong, by asserting that they were
 then somebody  else.   A mother must never admit this
 defence, hoAvever ingenious, nor allow the slightest appro-
 bation of the ingenuity to escape her.  There can be no
 evil from this exercise  of the imagination, provided there
 is no mischievous intention;  on the contrary7,  the real
 character of the child  will frequently be more perceptible.
 The prevailing sentiments will thus  often manifest them-
 selves ; the benevolent will enact deeds of kindness and
 generosity; the violent will perform deeds of arms, or of
 punishment, or of contention;  the timid will  discover
 their fears, and the hopeful their desires.  Dressing in a
 fancied character is a harmless adjunct to these  sports of
 the  fancy, and in this case taste and  ingenuity may be
 cultivated; but where  the object of the child is  to obtain
 admiration, and  not to excite mirth, or  to increase  the
 reality of his personification, he should find his  failure in
 the indifference of the  bystanders.
   Out-door sports  in  fields  and gardens are dependent
 upon the weather.   Gathering Avild-floAvers, forming them
 into nosegays  and garlands, Avearing daisy chains, and
 stringing berries, the  spade, the barrow or cart, the ball,
 and the hoop, are universally known.  Here, as  in  the
 house, the mother  must occasionally join the sport, sug-
gest, and sympathize.   Playing  in and with the dirt  for
no object, should be discouraged; it leads to nothing use-
ful, and gives a  disregard to  cleanliness.  Digging and
raking may soil the clothes, but, as  the first step to the
cultivation of the earth, the end justifies  the occupation.
In a garden, as in a house, there  are means of imparting
notions of property; and there should be  an endeavor to
give a clear understanding of the flowers which may, and 
232            INTELLECTUAL  EDUCATION.
may not be  gathered, and  the spots which may or may
not be played in.
  A fear of insects and reptiles  is very prevalent among
adults, and  especially females, and may in  most cases be
traced to the impressions made in early childhood; it leads
to much cruelty and needless destruction  of life, while it
depri\7es those who are under its influence of a large share
of delightful and profitable information.   The  innocent
pleasures  to be derived from flowers, trees, and all  else
that adorns  the country, are converted into fear and pain,
by the dread of the insects and reptiles that dwell among
them, and Avhich, in truth,  contribute to their interest.
  A child should be taught to avoid wasps and hornets,
not to handle bees, and not to  sit  doAvn on  ants' nests.
But, at the same time, let  the ingenuity and industry of
these insects be pointed out, so as  to raise emotions of
pleasure in the infant mind.  A little attention in this re-
spect would greatly improve the intelligence and taste of
the child, and, at the least, prevent it from feeling disgust
or aversion in looking upon some of nature's  most inter-
esting works.  To bad training in  infancy, we have to
ascribe the loathing which  is usually felt respecting toads,
spiders, and many other creatures, AAiiose uses, and  econ-
omy ought to be the subject of delightful  contemplation.
We say to all mothers—lose no opportunity of cultivating
in your children a perception of the useful and the beauti-
ful, whether in nature or art, for on  this may be founded
the correct habits and tastes of after  years.
   Telling children they, must attend  and observe, is of no
use Avhatever; they do  not knoAV why they should learn ;
they have no wish to learn, or rather they have no Avish
to study; but Avhen they have continually derived pleasure
from observation, they will observe from inclination.   On
first being put into a SAving, the  child has no notion what
it will feel;  but Avhen it has  ascertained the motion to be
pleasurable, the exercise of  the swing is associated Avith
pleasure.   The use of  the faculties undergoes  the  same 
INTELLECTUAL EDUCATION.
233
process; as soon as the child is conscious of the pleasure
their exercise affords, he voluntarily applies them.
  By endeavoring in this manner to amuse or delight the
tender perceptions of infants, mothers will have performed
an important part of their duty, and further than this, as
respects instruction, they must not  at present go.  Under
two years of age—or even under three or four, according
to circumstances—children should not be incited to acquire
any species  of knowledge which requires a considerable
exertion of  the  intellect.  Attempts to teach very young
children to read, to repeat answers to  catechisms, etc.,
are  highly blameable.  As repeatedly stated, all that is
brought under  the notice  of  the  infant should  excite
joyous conceptions in his tender mind, and gently encour-
age the growth of those habits Avhich are  an ornament in
youth as well as later years.  Children being the creatures
of imitation, should, by all means,  be  reared  only by fe-
male attendants Avho possess an equable temper, and will
study to cultivate  correct sentiments and habits  in their
young charge.   For the same reason, children should not
be allowed to associate with servants who talk coarsely or
indelicately.  In those parts of the country where a vicious
provincial dialect  prevails, female  attendants should, if
possible, be  procured from a district Avhere the language
is more correct; and if  mothers  are unable to incur the
expense of  doing so, they should  endeavor, by7 personal
attendance and  care, to compensate the  deficiency.  Let
mothers be assured that they can not commit a greater
error in the  rearing of their children, than assigning them
to the  charge of incompetent nurses and attendants; for
thus habits are ingrafted which no discipline or education
in after years can altogether eradicate.
  It may be asked, whether there should be any difference
between the mode  of rearing male and female infants.
We answer, none at first.  The mental  faculties  of both
sexes are  radically alike.  It may,  however, be useful to
mention, that boys are usually more difficult to rear than 
234
INTELLECTUAL EDUCATION.
girls.  It is allowed, for instance, that they are more liable
to.convulsion fits; but this  is a point which we leave to
the discretion  and  advice of the physician.  As infants
approach two or three years of age, they will have a tend-
ency to amuse themselves in a manner befitting their sex.
A taste for nursing  seems a strongly planted passion in
females, and will readily demonstrate itself in the fondling
and dressing of dolls.  This is a sentiment which should
be encouraged by the mother or nurse, not only because
it is natural and innocent, but because it leads to careful
and tasteful habits.   Many women will acknowledge that
their taste for neatness in attire was first cultivated by
the attentions which they lavished on their dolls.  But
this matter ought strictly to be treated of in an advanced
work, and it is  only necessary here to make it the object
of a passing hint.  Boys will, in the same manner, exhibit
peculiar tastes and tendencies, which Avill admit of similai
regulation. 
INDEX.
                            A                        PAGE.
Abortion................................... .........................   34
    symptoms of......................................................   35
    management of.................................................•   35
    danger in.................................................... .....   36
    production of....................................................   36
Afterbirth...............................................................   46
After-pains....................................................  .......   50
Afterbirth, retention of.............................................   59
Affections of the respiratory organs............................  169
    of the skin........................................................  173
Ague in the  breast.................................................  HI
Amenorrhea............................................................   72
Anteversion  of the  uterus..........................................  105
Appetite, disordered.................................................   31
                             B
Bandage and pad.....................................................  104
Bad habits in children...............................................  186
Bladder.................................................................   16
    distention of during labor....................................   52
Brain, premature use of.............................................  190
Breasts, ague in..................................■•■ ...............  1U
    cancer of.........................................................  H-5
    caking  of..........................................................  H2
    care of  while nursing...........................................  HI
    diseases of the.......................... ......................>  HO
    distention of....................................................33, 49 
236                       INDEX.
                                                      PAGE.
Breasts, inflammation of............................................  112
    tumors of........................................................  114
Breech presentation...................................................   54
Bronchitis..............................................................  169

                             C
Caking of the breasts.................................................  112
Cancer of the uterus...............................................   98
    of the breasts ...................................................  115
Care and management of children.................................  118
Care of the breasts while  nursing................................  Ill
Cauliflower excrescence..............................................   99
Cavity of the uterus  and vagina during labor..................   42
Child, care  of......................... ........................... ...   47
    refuses to nurse.................................................   49
    food of.............................................................  129
    takes its character from the parents........................  119
Childbirth..............................................................   37
Chloroform in labor...................................................   63
Chlorosis................................................................  86
Chorea.................................................................   91
Clothing after confinement........................................  126
    of children.......................................................  144
Colic....................................................................  171
Complicated labor...................................................   57
Constipation during labor............................................  52
Convulsions, puerperal................................................ 62
Conception...........................................................   21
    prevention of.....................................................   23
Courses..................................................................   19
    suppression of...................................................   73
Corroding ulcer.......................................................   99
Cows' milk as food for the child...................................  130
Cramps................................................................   33
Curvature of the spine..............................................  188

                             D
Deformities during childhood.......................................  182
Difficult labor......... ................................................   50
Diseases of pregnancy.......................,............ .........   29 
INDEX.
                                                      PAGE.
 Diseases, of women...................................................  69
     of the breasts..................................................... 110
     of the respiratory organs...................................... 169
     of the digestive organs......................................... 170
 Disordered  appetite...................................................  31
 Discharges after labor.................................................  48
 Displacement of the uterus.......................................... 101
 Dressing the child................................................... 154
 Dropsy, ovarian......................................................  97
 Duration of pregnancy...............................................  37
 Dysmenorrhea........................................................  74
 Dyspepsia, infantile.................................................. 170

                             E
 Education, infantile.................................................. 224
 Egg, human............................................................  21
 Embryo..................................................................  22
 Erythema............................... ............................... 178
 Erysipelas............................................................. 180
 Examination..........................................................  84
 Exercise of a child.................................................. 159

                             F
 Fallopian tubes........................................................  15
 Falling of the womb................................................. 102
 Feeding with a spoon................................................ 133
 Female organs of generation........................................  10
 Fever, milk.............................................................  48
     puerperal.........................................................  65
     of the child.................................................... 167
 Flooding, in  abortion................................................  35
     during labor..................................... ...............  57
     after the birth of the child.................................  58
     at monthly periods..............................................  76
*Food of the  child...................................................... 129
 Forceps................................................................  53
                             a
 Generation, organs  of................................................   10
 Greensickness..................................................... .   86 
238                       INDEX.
                                                     PAGE.
Headache...............................................................   32
Heartburn...............................................................   31
Head of the child......................................................   41
Hemmorrhage...........................................................   57
    after the birth of the child....................................   58
Herpes..................................................................  175
Human  egg................................... .........................   21
Hysteria................................................................   °9

                            I
Inflammation of the breasts.........................................  112
    of the lungs................................... ..................  1"9
    of the ovaries...................................................   96
Injuries of children..................................................  1"5
Infant's opiate......................................................  201
Inversion of the uterus...............................................   60
Itching  of the external  parts.......................................   10
Itch......................................................................  176

                            L
Labor......... ..........................................................   37
    pains................................................................   38
    stages of..........................................................   38
    symptoms of.....................................................   38
    mechanism of....................................................   40
    natural............................................................   40
    positions of head during.......................................   43
    management of.................................... ..............   44
    difficult............................................................   50
    preternatural.....................................................   54
    complicated......................................................•   57
Leucorrhcea............................................................   78
Lochia...................................................................   48
                                                          •
                            M
Management of labor.................................................   44
Menstruation............... .................... ......................   19
     causes of..........................................................   20
     retarded...........................................................   72 
                          INDEX.                       239
                                                     PAGE.
Menstruation, suppressed..........................................  73
     painful.............................................................  74
Menorrhagia...........................................................  76
Mechanism of labor.............................................___  40
Mission of woman..........................>..........................  90
Miscarriage.........................................................  34
Milk fever. .............................................................  48
Milk leg..................................................................  66
Milk of the mother.................................................. 127
Monthly periods...........  .........................................  19
     non-appearance of.............................................  72
     too profuse.......................................................  76
     too frequent return of..........................................  77
Morning sickness.............................. .......................  31
Monsters..............................  ..............................   56
Mother's mark..................................................... 174
Moral government................................................... 202

                             N
Natural labor .........................................................  40
Nervousness...........................................................  89
Nipple, care of......................................................... HI
     soreness of.................................................. .....  49
     shield..............................................................  49
Nursing the child...................................................■•• 127

                             0
Organs of generation................................................  10
Ovaries..................................................................  1"
     inflammation of...................................................  96
Ovarian dropsy......................................................  97
Ovum...................................................................  22

                             P
Pains after labor........................................................ 50
     feeble.............................................................  51
Painful menstruation.................................................  74
Pelvis...........................................•......................  !7
     section of the......................................................  18 
240                            INDEX
                                                      PAGE.
Pelvis, small..........................................................  52
Perineum, rupture of...............................................  62
Perineal supporter................................................... 103
Placenta, retention of the............................................  59
Phlegmasia  dolens........................ .........................  GQ
Prevention of conception..........................."..................  23
Pregnancy, signs of.....................................  ............  27
    diseases of.....................................................-..  29
    care during....................................................... 119
    influence of the mind during.................................. 120
    diet during........................................................ 122
    exercise during.................................................. 123
Presentation of head.................................................  41
    of forehead.......................................................  53
    of breach..........................................................  54
    of shoulder........................................................  55
    of placenta.......................................................  57
Procreation  of male and female children at will................  25
Producing abortion.................................................  36
Prolapsus uteri........................................................ 102
Preternatural labor..................................................  54
Pruritus of the vulva................................................  10
Positions of the head during labor  ................................  43
Polypus of the uterus................................................ 108
Puerperal convulsions................................................  62
    fever........ ............................................  ........  65

                             Q
Quickening.............................................................  28

                             R

Retention of the placenta...........................................  59
Retarded menstruation................................................  72
Retroversion of the uterus.......................................... 106
Rigidity of the os uteri..............................................  51
    of the soft parts.........................................,........  51
Ring-worm.......................................................'#...... 176
Rose-rash.............................................................. I77
Roseola.................................................................. 177 
                           INDEX.                      241
                                                     PAGE.
Rupture of the uterus................................................   61
Rupture of the perineum...........................................   62

                             L
Scabies.........................................................J........ 176
Scrofula.................................................................. 184
Shingles................................................................. 175
Signs of pregnancy....................................................   27
Sickness of pregnancy...................................-...........   31
Skin, diseases of the................................................... 173
Sleep of children...................................................135,141
Small pelvis............................................................   52
Sore nipples............................................................   49
Speculum.............................................................    85
Special diseases of the child........................................ 166
Spine, curvature of the...................•......................... 188
Squinting......................................................•....... 196
St. Vitus'  dance....................................... ................  91
Stages of labor.........................................................   38
Stammering.......................................................... 193
Suppressed menstruation..........................................    73
Supporter, perineal................................................. 103
Swelling of the  feet..................................................   33

                             T
Toothache...........................................................   32
Toughness of the membranes...............................•.......   51
Tongue-tied......................................................•-••  183
Tumors of the breasts............................................... 114
Twins and triplets....................................................   56

                             U
Unpleasant sensations in the pelvis...............................   32
Urethra.................................................................   16
Uterus..........................•........................................   12
     cavities  of......................................•................   12
     cancer of.........................................................   98
     corroding  ulcer of...............................................   99
     cauliflower excrescence  of...................................   99
     anteversion of..........................*......................... 105
               16 
 242                        INDEX.
                                                       PAGE.
 Uterus, displacements of........................................... 101
     falling of........................................................... 102
     inversion of......................................................  60
     nerves of..........................................................  15
     polypus of........................................................  108
     retroversion of.......,..........................................,  106
     rupture of.........................................................  61
     tissues of..........................,..............................   13
     vessels of...............„..........................................   14
 Uterine leucorrhcea...................................................   80

                             V
Vagina................................................................   11
Vaginal leucorrhoea..................................................   78
Ventilation............................................................  156
Viscera of the pelvis.................................................   11
Vulva, itching of.......................................................   33

                             W
Washing and dressing the child....................................  153
Walking......................... .......................................  162
Weaning..............................................................  136
     diet after.........................................................  137
Wet nurse..............................................................  127
Whites..................................................................   78
Woman's mission.....................................................   9
Womb....................................................................   H
    cancer of.......................................................   98
    displacement of................................................  101
    falling  of.......................................................  102
    falling backward of......  ......................................  106
    falling forward of................................................  105
    inversion of..............................................          60
    polypus of.........................................................  108
    rupture of.............................................           gl
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