i'lV.i.:-' ::!i!;;it^I-|-:'.-;^!f .'jWv-.jjS'-I'UI' ? 919�3853849 I3I03W JO AVVH9I1 IVNOIIVN 3NI3I03W JO A » V D 9 I 1 IVNOIIVN 3 N I 3 I 0 3 W Jl X "' \ & V TIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL II 3I03W JO AoVoSn IVNOIIVN 3NI3I03W JO HVIII1 IVNOIIVN 3NI3I03W JO riONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LI V^X | J%\/ \ 3I03W JO AIVIII1 IVNOIIVN 3NI3I03W JO AIVIIM IVNOIIVN 3NI3IC-3W J< ,-^firx.. « 7t>^; flONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LI 3I03W JO AKV.oil IVNOIIVN 3 N I 3 I 0 3 W J O k » V . S 11 1 V N O I 1 V N 3NI3IC-3WJC \f^\ % r V I 3I03W JO AaVafll IVNOIIVN 3N13I03W JO AIVIII1 IVNOUVN 3N.3.03WJO \/\iMy ATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL II -uQTf IV ■•v NI3IQ3W JO A.V.8I1 IVNOIIVN 3 N I 3 I 0 1 W J O A a V . I 11 1 V N O 11 V N 3NI3I03WJC %-/{ \Jg^ \ NATIONAL LIBRARY OF MEDICINE N A T I O N A L I I B R A R Y O F M E D I C I N E NATIONAL II Wvif?' 2 ^STsV"**^ 3NI3IQ3W JO AHVlian IVNOIIVN 3N.3.Q3W JO A.V.e.l IVNOIIVN 3NI3IQ3WK NAT. oTaL LIBRARY OF MEDICINE N A T I O N A I I I B R A R Y O F M E D I C I N E NATIONAL I JO. N,3.a7w JO ABVBB.l IVNOIIVN 3 N I 3 I C 3 W JO A.V.a.l TVNOUVN 3N.3.03W i I i / §?4 ^ /' NAT. ONAl LIBRARY OF MED, CINE N A T I O N A L L . . R A R Y O F M E D . C . N E NATIONAL WATSON'S PRACTICE, Improved Edition. Lea fy Blanchard have just issued LECTURES ON THE PRINCIPLES AND PRACTICE OF PHYSIC. Delivered at King's College, London, By THOMAS WATSON, M.D., etc. Second American, from the Second London Edition. Revised, with Additions, By D. FRANCIS CONDIE, M.D., Author of a Treatise on the Diseases of Children, etc. In one large octavo volume of nearly eleven hundred pages, well bound. That this volume should have passed to a second edition within so short a space of time, is the best proof of its intrinsic merits, and of the appreciation in which it is held. The present edition will be found preferable in its appearance to the former one, being printed on larger type and finer paper; while the additions of the Editor, Dr. Condie, improve its value as a work of reference and authority for the American physician. Notwithstanding these improvements, it is still among the cheapest medical books before the public. It has met with universal approbation from the Medical press, a few of the testimonials of which the publishers submit, together with a letter from Dr. Chapman, of the University of Pennsylvania. Philadelphia, September 27th, 1844. Watson's Practice of Physic, in my opinion, is among the most compre- hensive works on the subject extant, replete with curious and important matter, and written with great perspicuity and felicity of manner. As cal- culated to do much good, 1 cordially recommend it to that portion of the pro- fession in this country who may be influenced by my judgment. N. CHAPMAN, M.D. Professor of the Practice and Theory of Medicine in the University of Pennsylvania. "We know of no work belter calculated for being placed in the hands of the student, and for a text book, and as such we are sure it will be very ex- tensively adopted. On every important point the author seems to have posted up his knowledge to the day." — American Medical Journal. " In the Lectures ol Dr. Watson, now republished here in a large and closely printed volume, we have a body of doctrine and practice of medicine well calculated, by its intrinsic soundness and correctness of style, to instruct the student and younger practitioner, and improve members of the profes- sion of every age." — Bulletin of Medical Science. " We regard these lecture.- as the best exposition of their subjects of any we remember to have read. The author is assuredly master of his art. His has been a life of observation and study, and in this work he has given us the matured results of these mental efforts."—New Orleans Jhdical Journal. " We know not, indeed, of any work of the same size that contains a greater amount of interesting and useful matter. The author is evidently well acquainted with everything appertaining to the principles and practice of medicine, and has incorporated the stoics of his well-slocked mind, in the work before us, so ably and agreeably, that it is impossible for the iniorestof the reader to flag for a moment. That they are well adapted for such a pur- pose, all must admit; but their sphere of usefulness may extend much be- yond this. Wc aie satisfied, indeed, that nu physician, well read and ob- Watson''s Practice. servant as he may be, can arise from their perusal without having added largely to his stock of valuable information." — Medical E.rtniuner. " In this volume of the ' Principles and Practice of Medicine,' we have before us a mass of information which is rarely to be found within the boards of a single volume. This is the age of condensation. Here is brought to- gether mature views of the present state of the science, by a lecturer, ac- knowledged by all to be of the first order, and that which was spread over 1700 pages of the London edition, we have in about 1100 (of course large pages), and so cheap that no medical reader will hesitate a moment to trans- fer it from the bookseller's counter to his own table, where it should be con- stantly before him."— U. S. Gazette. " In calling the attention of the profession to the elegant volume recently published by Lea & Blanchard —the Lectures delivered at King's College, London, by Dr. Watson — we do not suppose anyone at all conversant with the medical literature of the day to be unacquainted with its general character. Dr. W. delivered these now celebrated lectures during the me- dical session of 1836--7. They have been revised by the author, and those who now study these erudite productions will have them diverted of any ob- jectionable matter that might have formerly crept in through inadvertence. There are ninety lectures, fully written, embracing the whole domain of hu- man maladies, with their treatment, besides an appendix particularly remark- able for its richness in important practical information. We could not<.ive even a tolerable synopsis of the subjects discussed in this great undertaking without materially entrenching on the limits assigned to other matter. * * * Open this huge, well-finished volume wherever we may, the eje immediately rests on something that carries value on its front. We are impressed at once with the strength and depth of the lecturer's views; he gains on our admiration in proportion to the extent of our acquaintance with his profound researches. Whoever owns this book will have an acknowledged treasure if the combined wisdom of the highest authority is appreciated."— Boston JWcdical and Surgical Journal. Also, just Published, A NEW VOLUME OF THE SPLENDID SERIES OF Sir Astley Cooper's Works. THE ANATOMY AND DISEASES OF THE BREAST. With numerous Plates. Bt SIR ASTLEY COOPER, F.R.S., etc. To which are added HIS VARIOUS SURGICAL PAPERS, Note first published in a Collected Form, In one large imperial octavo volume, with over two hundred and fifty figures, on thirty-six large lithographic plates. This volume concludes L. and B.'s beautiful series of Sir Astley Cooper's Surgical Works, and contains the whole of his writings not before republished in this country. This series consists of Cooper on Hernia, with twenty-six plates; Cooper on the Testis, with twenty-three plates; Cooper on the Thymus Gland, with six plates; and the present work, all of which are printed, illustrated, and bound to match, and which, together with Cooper on Dislocations and Fractures, with loo wood cuts and Cooppr's Sui"if—' Lectures by Tyrrel, constitute the whole of his professional work*. PUBLISHED BY LEA AND BLANCHARD. SIBORNE'S WATERLOO CAMPAIGNS; WITH MAPS AND PLANS. L. of the War in France and Belgium in 1815; containing minute details of the Battles f Quatre-Bras, Ligny, Wavre, and Waterloo. By Captain W. Siborne. In one octavo volume, with Maps and Plans of Battles, &c, viz: 1. Part of Belgium, indicating the distribution of the armies on commencing hostilities. 2. Field of Quatre-Bras, at 3 o'clock, P. M. 3. Field of Quatre-Bras, at 7 o'clock, P. M. 4. Field of Ligny, at a quarter past 2 o'clock, P. M. 5. Field of Ligny, at half past 8 o'clock, P. M. 6. Field of Waterloo, at a quarter past 11 o'clock, A. M. ". Field of Waterloo, at a quarter before 8 o'clock, P. M. 8. Field of Waterloo, at 5 minutes past 8 o'clock, P. M 9. Field of Wavre, at 4 o'clock. P. M.f 18th June. 10. Field of Wavre, at 4 o'clock, A. M., 19th June. II. Part of France, on which is shown the advance of the Allied Armies into the Kingdom. " This officer's acquirements in a scientific branch of his profession, of which he has given evi- dence in his models of the ground of Waterloo, entitle his views of that conflict to much higher consideration than those of Mr. Allison. With great respect for his zeal and honesty, and admit- ting that professional knowledge has saved him from the presumptuous blunders which disfigure Mr. Allison's chapters on Waterloo."—Quarterly Review for June, 1845. RUSH'S COURT OF LONDON. Memoranda of a Residence at the Court of London, comprising Incidents Official and Personal, from 1819 to 1825; including Negotiations on the Oregon Question, and other Unsettled Relations between the United States and Great Britain ; by Richard Rush, Envoy Extraordinary and Minister Plenipotentiary from the United States from 1817 to 1825. In one large and beautiful octavo volume, extra cloth. In 1833, twelve years ago, the first series of these entertaining and interesting memoranda ap- peared ; and coming from such a source, were bo favorably received that we have lone wondered at the abstinence which had prevented their being more rapidly followed out. Both for their po- litical aud social maiter, they belong to a class of reading which it is very desirable to cultivate. In the complexion of his mind the author is so moderate and just that his international statements are worthy of perfect credit; while the position he occupied gave him such opportunities of mix- ing with the best informed portions of society, that his descriptions and anecdotes of them are of a most agreeable kind.—London Literary Gazette. MACKINTOSH'S PHILOSOPHY. Dissertation on the Progress of Ethical Philosophy, by Sir James Mackintosh ; with a Preface, by the Rev. William Whewell, M.A. From the second Edinburgh edition ; in one neat octavo volume. HUMAN HEALTH: or the Influence of Atmosphere and Locality, Change of Air and Climate Seasons, Food, Clothiug, Bathing, Mineral Springs, Exercise, Sleep, Cor- poreal and Mental Pursuits, &c. &c, on Healthy Men, constituting Elements of Hy- giene. By Robley Dunglison, M. D., Sec. &c. In one octavo volume. EVERY MAN HIS OWN FARRIER: containing the Causes, Symptoms, and .Methods of Cure of the Diseases of Horses, by Francis Clater and John Clater. From the 28th London edition. By J. S. Skinner ; in one 12mo. volume. THE DOG AND THE SPORTSMAN: embracing the Uses, Breeding, Train- ing, Diseases, &c. &c, of Does. An account of the Different Kinds of Game, with their Habits ; also. Hints to Shooters, with various useful Recipes : by J. S. Skinner. In one neat 12mo. volume, with Engravings. REMARKS ON THE INFLUENCE OF MENTAL EXCITEMENT, and Mental Cultivation upon Health: by A. Brigbam, M.D. Third edi- tion ; one volume, 18mo. RELIGIO MEDICI, AND ITS SEQUEL, CHRISTIAN MORALS : by Sir Thomas Browne, Kt., with Resemblant Passages from Covvper's Task. In one neat I'Jino. volume. PUBLISHED BY LEA AND BLANCHARD. MISS ACTON'S COOKERY. MODERN COOKERY IN ALL ITS BRANCHES, reduced to a System of Easy Practice, for the use of Private Families. In a Series of Practical Receipts, all of which are given with the most minute exactness. By Eliza Acton. With numerous Wood-cut Illustrations. To which is added, a Table of Weights and Measures. The whole revised and prepared for American Housekeepers, by Mrs. Sarah J. Hale, from the second London edition. In one large 12mo. volume. The publishers beg to present a few of the testimonial* of the English press in favour of this work. " Miss Eliza Acton may congratulate herself on having composed a work of great utility^ and one that is speedily finding its way to every 'dresser' in the kingdom. Her Cookery-book is unquestionably the most valuable compendium of the art that has yet been published. It Btrongly inculcates economical principles, and points out how good things may be concoctod without that reckless extravagance which good cooks have been wont to imagine the best evi- dence they can give of skill in their profession."—London Morning Post. " The arrangement adopted by Miss Acton is excellent. She has trusted nothing to other*. She has proved all she has written by personal inspection and experiment. The novel feature of her book, which will greatly facilitate the labours of the kitchen, is the summary appended to each recipe of the materials which it contains, with the exact proportion of every ingredient and the precise time required to dress the whole."—London Atlas. " Aware of our own incompetency to pronounce upon the claims of ihis volume to the confi dence of those most interested in its contents, we submitted it to more than one professor of the art of cookery. The report made to us is more than favourable. We are assured that Miss Acton's instructions may be safely followed ; her receipts are distinguished for excellence. The dishes prepared according to Miss Acton's directions—all of which, she tells us, have been tested and approved—will give satisfaction by their delicacy, and will be found economical in price as well as delicious in flavour. With such attestations to its superior worth, there is no doubt that the volume will be purchased and consulted by the domestic authorities of every family in which good cookery, combined with rigid economy, is an object of interest."—Globe. " We have subjected this book to the severe lest of praelice, and we readily concede to it the merit of being a most useful auxiliary to the presiding gonius of the cuisine. Tho instructions it gives in all that relates to culinary affairs are comprehensive, judicious, and completely divested of old-fashioned twaddle. It contains, besides, some novel features, caleu-lated to facili- tate the labours of Cnokery; the principal of these is the sum nary appended' to each receipt of the exact quantities of the ingredients it contains, and the precise time required to dress the dish. To the practical woman who seeks to combine comfort with economy in the direction of her household concerns, this book will prove an invaluable treasure."—Sunday Times. " We cannot, therefore, too warmly recommend to the notice of our junior brethren this com- pilation of Eliza Acton's, which will prove as useful to young Mrs. and her cook in the kitchen; as Thomson's Dispensatory or Conspectus to the young doctor in the library."—Medico- Cliintr- gical Review. " Mistress Acton writes well, to the point, and like a woman of sterling sense; her preface ought to be primed on a broadside, and taught to all the young ladies at all the-boarding-schools, and all the day-schools, whether boarding or not, in England. "The whole of Miss Acton's receipts, with a few trifling exceptions, which are scrupu- lously specified, ' are confined to such as may be perfectly depended on from having been proved beneath our own roof, and under our personal inspection.' We add, moreover, that tho receipts are all reasonable, and never in any instance extravagant. They do not bid us sacri- fice ten pounds of excellent meat that we may get a couple of quarts of srravy from it; nor do they deal with butter and eggs as if they cost nothing. Miss Acton's book is a good book in every way; there is right-mindedness in every page of it, as well as thorough knowledge of the sub- ject she handles."—London Medical Gazette. a±\ THE DOMESTIC MANAGEMENT SICK-ROOM, NECESSART, IN AID OF MEDICAL TREATMENT, FOR THE CURE OF DISEASES. V ANTHONY TODD THOMSON, M.D.,F.L.S., >*» FELLOW OF THE BOIAI COLLEGE OF PHYSICIANS, ETC., ETC. FIRST AMERICAN, FROM THE SECOND LONDON EDITION. REVISED, WITH ADDITIONS, R. E. GRIFFITH, M.D., &c. PHILADELPHIA: LEA AND BLANCHARD. 18 4 5. I Entered, according to act of Congress, in the year 1845, by Lea & Blanchard, in the clerk's office of the District Court for the Eastern District of Pennsylvania. wy PREFACE OF THE AMERICAN EDITOR. This small volume has appeared to be so well calculated to fulfil the intentions of the writer, and contains so much that is really useful, without that admixture of quackery which has hitherto been considered as a necessary ingre- dient of works on domestic medicine, that it is with much pleasure we present it to the American public. It has been carefully revised, and some additional matter added, which, it is hoped, will be found to increase the value of the volume. It must be always borne in mind, that the inten- tion of this work is not to enable any one to undertake the treatment of disease, but to give such plain directions as will instruct nurses and friends in their duties as aids to the medical attendant, and also to adopt such precautionary measures in the prevention of disease, as to preclude, in many cases, the necessity for the assistance of the Phy- sician. The additions are enclosed within brackets [ ]. Philadelphia : September, 1845. ADVERTISEMENT. The favourable reception of this little volume has been highly gratifying to the Author. In sending forth a second edition, he has endeavoured to add to its value, and to render the text as perfect as possible. He trusts these improvements will render the work still more acceptable to those who have patronized the former edition. 30, Welbeck Street : February, 1845. PREFACE. Such a volume as the present has long been a deside- ratum in the opinion of every Medical Practitioner, whose practice is sufficiently extensive to enable him to observe the almost general ignorance which prevails respecting the domestic management of the sick-room, and to feel the influence of that ignorance on his treatment of disease. The most judicious plan of medical management may be devised, and the plainest directions for its fulfilment may be delivered to the attendants of the sick-room ; but, with- out more information on the subject than is at present possessed by the females of a household, and especially by those whose duty it is to superintend the execution of the orders of the Physician, little benefit can be anticipated to the Invalid. In a period which is characterized by the general ex- tension of knowledge, it is remarkable how little attention has been devoted, in the education of young women, to those duties which are requisite to the comforts of a family, whether in health or in sickness. Woman is fully qualified by nature with intellectual powers equal to fit her as a rational companion to man, and to become an able and a sound instructress to his children ; and also with sufficient strength of mind to share with him all the ills and disap- pointments of a chequered life. But if, in her education, accomplishments form the chief object; and acquirements are cultivated which have no tendency to elevate her cha- racter, to the exclusion of the wholesome and solid culti- vation of the mind ; — if her education qualify her rather 1* VI PRKFACK. for the light graces of the drawing-room than for the matroniy offices of the wife and the mother; —these invaluable properties cannot be looked for : and an act of the greatest injustice is committed to the best and the most interesting part of our species. In sickness, especially, man requires the attentions, the gentle and consolatory offices, of woman. To have his pillow smoothed by one whom he loves and cherishes — to have his wants anticipated by one whose smile has graced, adorned, and thrown a brighter beam of sunshine on his happier hours ; to hear the sympathizing words of endearment and consolation in his sufferings fall upon his ear like the accents of love ; and to find by his side one who is alive to all his feelings, unwearied with watching, forgetful of self, and only anxious for his recovery, — are the greatest blessings which can be bestowed by a bene- ficent Providence upon mortals. But if, with all the desire which can actuate a good woman to perform these duties, she is ignorant of them, how heart-rending must be her feelings ; and how deeply must she deplore her inability. The object of this little volume is to afford the instruction which is essential under such circumstances ; to render the management of the sick-room as satisfactory, as it is a labour of love, to her who is unhappily doomed to watch over it. The author has endeavoured to convey that idea which is essential to aid the medical treatment of disease, not to cure it. That his work may fully answer the inten- tion for which it is written, he humbly trusts ; and he will feel satisfied, should it do so, that the hours he has bestowed upon it have not been vainly nor uselessly employed. A. T. THOMSON. 30, Welbeck Street : December, 1840. CONTENTS. INTRODUCTION. Health and Disease.— Causes of the latter in reference to Air, Food, Exercise, Clothing, Mental Affections, Sleep. — Recognition and Pre- vention of Disease ..... page 13 CHAPTER I. Choice and Furnishing of the Sick-Room, when the disease is likely to be protracted, or is of a peculiar description : — Ventilation, Temperature, Cleanliness, and Darkening of the Apartment.— Qualifications to be looked for in the Choice of a Nurse . . . .81 CHAPTER II. Necessity of Intelligence, Self-control, and Judgment, in the unhired Attendants of the Sick-room. The management of the Invalid illustrated in different diseases . . . . . .101 CHAPTER III. Domestic management in Diseases affecting the Nervous System, and in Diseases of Depraved Secretion ..... 135 CHAPTER VI. Administration of Medicines : — Blood-letting ; — Application of Leeches — Mode of preserving them alive and fit to be reapplied ; — Cupping 171 CHAPTER V. Application of Lotions : Sponging: the Cold Affusion : the Shower Bath: Partial Baths: Douching: General Baths: Fomentations: Stuping: Poulticing: Frictions, with and without stimulating Substances . 192 via CONTKNTS. CHAPTER VI. Management of Counter-irritants; Rubefacients; bmapisms; Suppurative Ointments:-Vesicating Oils; Blisters; Issues; Setons Manage- ment of Dry Heat, by Stomach-plates, Salt-bags, Hot Bucks, Moxas Cauterants. Domestic Management of Accidents — Bandaging . ^o CHAPTER VII. Directions respecting the General Management of Convalescence ; and of Diet in Disease and Convalescence—Fumigations . . 2.J8 CHAPTER VIII. Cookery for the Sick and the Convalescent: Useful forms of Domestic Medicines ..••••• *'° CHAPTER IX. Mental Influences upon the Body in Disease and in Convalescence. Re- ligious Consolation in Disease — the necessity of Discretion and Judg- ment in its application . . . . • .316 INTRODUCTION. HEALTH AND DISEASE.--CAUSES OF THE LATTER IN REFER- ENCE TO AIR, FOOD, EXERCISE, CLOTHING, MENTAL AFFEC- TIONS, SLEEP. -- RECOGNITION AND PREVENTION OF DIS- EASE. Before entering upon the details of the subject of this volume, namely, the management of the sick-room, it will be proper to point out to the reader what really constitutes disease, that it may be recognized on its first appearance, and successfully combated before it has gained sufficient strength to entrench itself securely within the fortress of the constitution ; or, whilst its phenomena are as yet merely the results of disordered functions, and not the consequences of structural changes. With such a knowledge of the aspect of disease, and possessing the means of judging of its earliest approach, we are not only warned to demand assistance to combat it when it is most vulnerable ; but, by anticipation, we are placed upon our guard against its ap- proach, and enabled to shield those naturally predisposed, either hereditarily or otherwise, from its attacks. Health is that condition of the body in which all the functions of life are performed harmoniously, with ease, and with a feeling of well-being. Each organ acts uncon- sciously ; the whole bodily energies seem to play their part together ; and the union is so complete, that wre neither feel nor care to enquire how the machine works; we are only sensible that its movements are simultaneous. Every deviation from this state denotes, in strict language, if not the actual presence, at least the approach, of disease. Thus, when the food, instead of being digested without the con- sciousness of the process, causes uneasiness or pain ; when the appetite is lost, and the sight of food, instead of exciting the desire to eat, induces loathing, or nausea, or vomiting, 14 INTRODUCTION. we may conclude that disease exists ; unless we can trace these circumstances to transient causes, on the discontinu- ance of which they also disappear. When the ordinary bodily exertions cannot be carried on without weariness, languor, or fainting ; when the circulation is hurried ; the skin is hot and dry ; or sweating is excited on the slightest exercise ; when the breathing is embarrassed; when the head aches, or there is a sensation of dizziness: the usual sensibility being either considerably diminished or aug- mented ; the volition impaired ; or the mental faculties disturbed, and under little or no control ; then is disease present. It is not necessary, however, that all, or even many, of these symptoms should exist at the same time; any one of them, occurring and continuing, constitutes disease. The causes of these changes from health are either phy- sical or intellectual: the former depending on the influence of extraneous circumstances connected with the ordinary phenomena of nature : in the atmosphere, on the earth, and in the waters of the planet which we inhabit: the latter, on the influence of that portion of our being to which we owe all those affections that prompt us to action, and by which alone we become conscious 6f our existence, and which we believe to be immutable. But, besides these exciting causes, man is liable to diseases by hereditary transmission; and to changes consequent upon the natural decay and the perishable structure of his bodily frame. Man, also, has produced for himself, by the habits which civilized life has established, many diseases which wrere scarcely known in the early periods of society. Thus the crowded population of towns ; the assemblage of many in- dividuals in a limited space, under cover from the open air, either for amusement or for business ; occupations car- ried on in ill-ventilated or insalubrious places ; migratory habits, and the necessities which lead man to visit climates uncongenial to his constitution ; his ambition of distinction and of power, which enforce sedentary and severe mental study ; the indulgence of either the exciting or the depress- ing passions ; and even-idleness, and the excessive culti- vation and indulgence of the imagination; all contribute, AGENCY OF AIR IN CAUSING DISEASE. 15 more or less, to the production of diseases. Mental slothy also, as much as excessive application, impairs the powers of the mind and those of the body ; and man suffers both for the crime of ingratitude which he commits in neglecting to cultivate that gift of Providence which has placed him above all other created beings on this earth ; and for the error, however commendable the object, which impels him to task his intellectual powers beyond their natural strength. Numerous bodily diseases result; the vital energy in some organ diminishes ; the nervous system gives way ; the ordi- nary incidents of life become sources of irritation, and the mind, reacted upon by the condition of the body, shares in the morbid influences under which they suffer, and either Hypochondriasis or Insanity is the result. In tracing the origin of all diseases, medical men., with much propriety, look very closely into the afflicted indi- vidual's predisposition to receive or to take on disease ; and, perhaps, if they were professionally consulted rather to obviate the tendency to diseases than to cure them when they are present, the sum of human happiness, as far as that depends upon health, would be greatly augmented. In a popular treatise, therefore, upon the duties of the sick-room, I am disposed to think that a greater service cannot be done to its readers, than to point out to them the most pro- bable means of preventing diseases. Regarding man as he is, in many respects, an artificial being, let us briefly enquire what are the general agents, the operation of which, under certain circumstances, is pro- ductive of disease. ' L That one which first demands our notice, because it is that which is most essential to existence, and to the agency of which man and all animals are continually exposed, is the air* In the natural or savage state of the human race, it might be questioned how far the variations in the movements and the electrical conditions of the atmosphere, in its temperature, its dryness, and its moisture, would pro- duce disease ; but there can be no doubt of their influence on civilized man. * The atmospheric air is a compound of two distinct airs or gases,— namely, 21 parts of Oxygen and 89 parts of iNitrogen in every 100 parts. It holds in solution aqueous vapour, Carbonic acid,and other extraneous matter*. 16 INTRODUCTION. It is the diversity in these natural agents which regulate the influence of climate both upon man and the lower ani- mals, not only in respect to health, but to the perfection of the species. Hence, in the most genial regions of the earth, where a medium temperature prevails, we find the human race in the highest state of perfection ; as, for example, in the Caucasus. This diversity, also, in conjunction with other external circumstances of a physical character, namely, surface, soil, exposure, produce, and other influences, are the chief causes which affect the health of the inhabitants of particular countries, as well as that of strangers resorting to them. In the present instance, however, our enquiry is limited to the general influence of atmospheric air in pro- ducing diseases. With respect to the temperature of the air, — when it is high, the weak and the delicate suffer from the relaxation which it causes; consequently they ought to remain as much as possible at rest during the day, and to take ex- ercise either in the morning or in the evening. Even the robust should be cautious in fatiguing themselves by severe exertion of any kind in the middle of the day in sultry summer weather ; a precaution, however, less important in England than on the Continent. " I have seen labourers," says Zimmerman, " returning from the plough, fall down and die."* Violent frenzy is not uncommonly the result of exposure to the noon-day sun in equatorial regions. On this account, the siesta in Spain, Portugal,! and other in- tertropical countries, is not a mere luxurious indulgence ; it is essential to health. Winter is a more healthy season than summer, provided we are well clothed, and that we can afford fires, and enjoy sufficient vigour to take exercise. In Captain Parry's voy- age to the Arctic Circle, the officers walked daily upon the ice when the thermometer was 20° below zero = 52° below freezing.^ The humidity of the air, if considerable, like its high temperature, relaxes, dispirits, and favors disease. But too • Treatise on Experience in Physic, (trans.) v >I. i . p. 93. -j- This term is given to the mid-day sleep which is indulged by the in- habitants of these countries. $ [See Human Health, &c., by R. Dunglison, M.D., pp. 26, et seq.] INFLUENCE OF MOIST AND DRY AIR. 17 dry air is equally hurtful: a proper medium is requisite for the maintenance of health. Cold moist air is more injurious than cold dry air ; hence night air is generally hurtful to all invalids. Warm moist air, within a certain limit, is favor- able to those liable to Pulmonary Consumption ; but, when the heat of the air is great, and accompanied with much moisture, Dysentery, Cholera, and fevers are generated, and the air may be said to be, in every respect, unhealthy. It is the variations in the. temperature of the air, however, that are most hurtful in this climate. When the surface of the body is artificially heated, and suddenly exposed to cold air, both the skin and the respi- ratory organs become affeeted, and inflammatory action is induced. On the other hand, variations less obvious, and which can scarcely be detected by the closest investigation, exert morbid influences upon either the nervous or the vas- cular system, and set up epidemic diseases ; such, for ex- ample, as Cholera, Dysentery, Scarlet Fever, and continued fevers of every type, from common catarrhal Influenza to Typhus, and even Plague. It is true that some fevers are the result of local causes, operating only through the me- dium of the air; as, for example, Ague, and Yellow-fever, and some well-marked endemic diseases:* but the prophy- lactic means to be adopted for shielding the body from the influence of such causes are nearly the same. In this island, where atmospheric changes of every de- scription are so frequent, and where a predisposition to consumption of the lungs so generally prevails,! the strict- est attention should be paid to the condition of the surface of the body. Means should be taken to preserve it, under every change in the weather and of season, in as equable a state both of temperature and of perspiration, as possible ; and nothing is better fitted for this purpose than wearing * Fndemic diseases are those depending upon permanent physical causes pecuh'rt certain localities; as, for cample, JSue, generated by exhala- tlons in 7"h/fi°'^U^ - Great Bri,ai" aie duP t0 C°nSUmp- j- About one-fifth o{ "»*be° , (N E Quart. Jour. Med. & Surg. tion. [Accoril^f°t.U;\"^^un llol in Philadelphia, is 1 in 7003. the average °\*?%*\™*™TU\1. In Baltimore, according to Dr. ^^Un^.^JHun-anHeahh, pp. m. *c] 2* 18 INTRODUCTION. flannel next the skin in winter, and, at the same time, giving tone by the use of the shower bath ; or by sponging, daily, the trunk of the body with water, or with vinegar and water, or salt and water, either cold,or tepid, accord- ing to the season of the year. Many a fatal issue, in those hereditarily predisposed to Consumption, has followed a cough, caused by remaining near an open window in a neated ball-room ; or by standing to converse with a friend at the corner of a street, during the prevalence of east or north-east winds, whilst the body is heated by walking: and many an Asthma, also, has been the result of an au- tumnal evening's expedition in an open boat. It is not easy to guard against atmospheric-electrical variations, and other vicissitudes, which influence the ner- vous rather than the vascular system, and which cause de- pression of spirits, and even a feeling of despondency, in the absence of misfortune, anxiety, or any occurrence likely to produce such a state of feeling. The best method, how- ever, to repel such injurious influences, is to invigorate the body by exercise, proper clothing, and diet; and to with- draw the attention from the personal feelings by occupa- tions which can fully engage the energies of the mind. 2. The causes of many diseases, again, are found both in the nature and the quantity of our food. Under the first may be placed its over-stimulating properties; under the second, its excess or deficiency. It should be fully under- stood, especially by mothers, that strength is not the result of stimulating diet: on the contrary, the use of such food is rapidly followed by exhaustion: this is also the effect of over-feeding; the strength fails in a manner nearly similar to that which is the consequence of too scanty a supply of food. It is difficult to define what is enough in reference to food; but the rule is, never to eat so much at one meal as to cause a sensation of fulness and oppression at the stomach. In maintaining health, not a little depends on diversifying the food; on the regulation of the periods at which it is taken; and the exercise which precedes and follows it. The teeth, as well as the stomach and the intestinal canal, of man, point out that a mixed aliment is that destined for INFLUENCE OF DRY AND FLUID BLOOD. 19 him by Providence. Almost all substances from the ani- mal and vegetable kingdoms, which are soluble in the fluids of the stomach, and contain no poisonous principles, either afford nutriment, or stimulate the digestive organs.* But, in order to nourish the body, the food must not only be dissolved, but it must be converted into an albuminous substance ; hence it may be of easy digestion, and yet af- ford little nutriment to the system. " The further a sub- stance," says a celebrated physiologist, " is removed in its composition from albumen, the less nutritious will it be, and the greater expenditure of the digestive powers is re- quired for its conversion into chyle."f With regard to the diversifying of food, the most con- clusive experiments have established the fact, " that differ- ence and variety of the kinds of aliment is an important circumstance to be attended to in the preservation of health."} I)ry food, if nutritious, although it is the least fitted to add to the bulk of the body, yet, is the best for increasing its vigour. In hazarding this assertion, however, it may be necessary to state, that the degree of the nutritious pro- perty of any article is in the ratio of its containing a due admixture of saccharine, oily, and albuminous principles. Exercise should not be taken immediately after a meal; nor should a person eat directly after taking exercise; under both circumstances, a certain space, at least half an hour, should elapse: in the one case, to permit the process of digestion to be begun and even be somewhat advanced ; in the other, to enable the hurry of the circulation to sub- side before the stomach is excited to exertion. That rest, however, which induces sleep is hurtful; and it should be known that much sleep favors obesity, and diminishes vigour. If excess of diet, improperly timed exercise, and sleep immediately after a meal, be detrimental to health, — ab- * The doctrines of Pythagoras with respect to food are founded on error: but, in England, the proportion of the animal to the vegetable food is too great. Whole tribes — the Hindoos, for example—live on farinaceous substances and milk. f Muller's Physiology, (trans.) vol. i., p. 480. * Muller's Physiology, p. 803. 20 INTRODUCTION. stinence and over-exertion are even more hurtful. Absti- nence in particular, and long fasting, affect both the nervous and the vascular system; and, in the same manner as in excess, vomiting is sometimes excited ; hence the nervous arrangements which are subservient to digestion are dis- turbed, the regular functions of the economy impeded, and diseases excited. Regularity in the periods of taking our meals, therefore, is not only consistent with the proper re- gulation of our domestic economy, but it enables one sup- ply of food to be digested and assimilated before another is introduced into the stomach; and the best indication of the necessity of such a supply is the return of appetite. The intervals between each meal, except during sleep, should not exceed six hours; although there are few men, in the present day, who have any business or profession to occupy their time, who do not fast daily for eight hours. On the contrary, women who can afford to eat luncheon seldom fast more than three or four hours. The first-men- tioned custom is certainly the most injurious to health : it not only tends to produce dyspepsia, but it also favors apo- plexy. It is not easy, however, to lay down any general rules for the number of daily meals : in my opinion, they should be limited to three ; namely, breakfast, dinner, and tea or an evening repast. Breakfast is the best meal for a healthy individual, as it is not indulged in before the last meal which was taken has had ample time to be duly assimilated ; and the natural appetite to return. This is the case in health : but, in weakened states of the habit, the length of time between the evening meal of the preceding day, and the breakfast of the following morning, causes the nervous energies of tue stomach to suffer ; consequently the appetite is weaken- ed, and an uneasy sensation is experienced, different from that of hunger. It is accompanied by a feeling of debility, great depression of spirits, and a defective state of the se- cretions. In this condition of the habit, a draught of cold water, on getting out of bed, affords a moderate stimulus to the organ, and fits it for acting upon the food at break- fast. The appetite is also increased by friction over the stomach, by cold sponging, by the shower bath ; and espe- EXCESS IN DIET DELETERIOUS. 21 cially by exercise, either on foot or on horseback, before breakfast. In health, breakfast should be a solid meal, and a mode- rate quantity of animal food indulged in. This is by no means incompatible with either tea or coffee : on the con- trary, a greater supply of liquid is required than at other meals, to make up for the waste by perspiration and other causes during the night; and liquids are then instinctively desired. Tea, coffee, and weak cocoa, are well adapted for this meal ; but, in dyspeptic conditions of the stomach, these preparations increase that evil: weak beef-tea, pro- perly made,* is preferable, or at least it is much less delete- rious than either tea or coffee. Dinner is, at the present period in the upper ranks of society, not only the most unseasonable meal, from the late hour of the dayf at which it is eaten, but it is also the most unwholesome, from the variety of the dishes and the incon- gruous admixtures which the art of cookery has devised for the gratification of the pampered palates of the luxurious. The abuses and the excesses committed at this meal are in- deed a most fruitful source of disease. It is a mistake to suppose that it is the wine of the festive board, especially the Champagne, which is then handed round, that engen- ders Gout; it is the excess in quantity, as well as the stimulant quality of the viands, which are the source of the evil. To the same cause may be ascribed many of the cases of Apoplexy and Palsy which occur among the higher ranks, and in the class of wealthy citizens. Amongst the latter, indeed, something is due to the late hour of dining, after a long-protracted fast, during which the brain and nervous system have been much excited, and consequently exhaust- ed. The application of an excess of stimulus, under such * See Chapter on Cookery. + The change which has taken place in this matter is confined to the higher and the middle ranks of society. Harrison, in his description of England in the sixteenth century, remarks — " With us, the Nobilitie, Gentrie, and students, do ordinarilie go to dinner at eleven before noone, and to supper at five and six at afternoone. The merchants dine and sup seldom before twelve at noone, and six at night, especiallie in London. The husbandmen dine also at high noone, as they call it, and sup at seven or eight: but out of the tearme in our Universities the scholars dine at ten." Description of England, prefixed to Holinshed's Chronicle, p. 171. 22 INTRODUCTION. circumstances, is sufficient to cause that disturbance, both of the circulating and the nervous system, which induces the fatal diseases to which we have just referred. When luncheon is taken, the late dinner, if it be not heavy, is less objectionable ; as, under such circumstances, dinner may be regarded as a supper, taken at an hour* sufficiently early to permit the food to be well digested be- fore bed-time arrives; and were the present name of this evening meal changed from dinner to supper, the viands would be less heavy, and, consequently, better fitted for so late an hour. Much often depends on a name. It is on this account,that ladies, who all, more or less, indulge in a hearty luncheon, rarely suffer from Apoplexy and Palsy, compared with men, who dine late and eat heartily, after fasting from breakfast to dinner time, a period generally of eight hours. But women, who eat a hearty luncheon and also a dinner, taking, at both repasts, from two to three glasses of wine, and whose exercise is chiefly in a carriage, rapidly become plethoric* It is scarcely requisite to remark, that, if more food be taken than the ordinary waste of the body demands, repletion must follow; and if the excess be continued to a degree to excite the powers of life beyond a certain point, then diseased actions of various kinds are engender- ed ; and whilst the individual is indulging in the supposi- tion that the increase of bulk is the indication of exuberant health, the foundation of a host of diseases of an inflamma- tory character is already laid. But the deleterious influence of the mid-day repast is not solely felt by the higher ranks of society. The hour of dining maybe said to be unexceptionable amongst that por- tion of the middle classes engaged in trade, as well as the labouring class ; but the nature of the food, and the excess in point of quantity indulged in, especially amongst the labouring poor, with the hasty manner in which the meal is eaten, and the exertions that immediately follow it, be- fore the digestive process is even commenced, are the ex- citing causes of many diseases. * Sir Charles Scarborough's advice to the Duchess of Portsmouth is ap- plicable to every woman who can alford to live well: — " You must either eat less, or use more exercise, or take physic, or be sick." INFLUENCE OF EXERCISE ON DIGESTION. 23 Amongst the higher classes, whose occupations do not call for such exertions, an idea prevails that exercise, either on foot or on horseback, is essential to promote ap- petite and aid digestion. The propriety of this custom cannot be disputed, when the exercise is moderate and is taken some time before a meal: but when it is carried to fatigue or when the meal, especially dinner, is taken be- fore the individual has rested, it deranges the function of digestion ; and, when Dyspepsia is present, it tends to aggravate and render that disease permanent. It should never be forgotten that some of the worst and most fatal diseases to which flesh is heir, commence with indigestion.* The more sedentary the occupations are, the less should be eaten, and the less stimulant should be the food. The mental faculties are clearer and more energetic under a temperate than under a full diet. Newton was satisfied with a biscuit and a glass of Canary when he was com- posing his Treatise on Optics. He who feels drowsy after dinner may be assured that he has eaten too much. Persons of a delicate habit of body, in particular, suffer from excess in eating: it causes a sensation of fulness and distension of the stomach, flatu- lence, disturbed sleep, nightmare, dreaming ; and a state of the nervous system which favors apoplexy. The unremitting indulgence, also, in the use of malt liquor, especially new and sweet ale, among the poor and the middle ranks, even amongst the most temperate, to a degree bordering on excess, is a universal cause of dys- pepsia and of many other diseases. Wine, even in mode- ration, when daily used, is equally hurtful: it over stimu- lates, and consequently exhausts the powers of life. That meal which is now almost universally termed Tea, from the nature of the beverage then drank, is beneficial, inasmuch as the food taken at dinner being in a few hours converted into chyme, requires a certain degree of dilu- tion to enable the soluble matter to be carried into the ' blood, where it is to undergo its final change, and to be rendered fit for assimilation into the substance of the body. * Among others, it develops Consumption in those predisposed to tubeF- 1 cular depositions in the lungs. 24 INTRODUCTION. This meal may, consequently, be regarded as an aid to enhance the utility of that which precedes it a few hours, rather than an essential repast. Under such circumstances, little or no solid matter is taken at this time by those who dine late. By those who dine early, it is regarded as a light refreshment between dinner and supper, in the same manner as luncheon is between breakfast and dinner by those who keep more fashionable hours : to the dyspeptic, a cup of warm milk, with a bottle of soda water poured over it, is preferable to tea. With respect to Supper; — the dinner of the present period, amongst the upper ranks, is equivalent to the sup- per of our ancestors, who dined at an hour when many of their suceessors are breakfasting, and supped between five and six o'clock in the evening. The supper of the tradesman and the labourer is not only the heaviest meal of the day, but it is taken just before the hour of rest. Now, although habit has a powerful influence in recon- ciling the animal economy to circumstances which would otherwise prove highly detrimental, and accommodating the system to a state which is unfavourable to the process of chylification, or the conversion of the food into blood, yet, as a general principle, hearty suppers are injurious. The old adage, however, " that there is no rule without an exception," holds good with respect to suppers of a light kind, for those who dine early, and undergo fatigue in the after-part of the day. The period which elapses from tea- time to breakfast-time the following morning is too long to fast: for, if it be an undoubted truth, that abstinence cannot be borne with impunity; that it causes general debility, enfeebles the circulation of the blood, depresses the nervous energy, destroys the power of the stomach, and produces emaciation as its first effects ; then, it is evi- dent that long fasting must be productive of the same effects, in a more limited degree, and therefore cannot fail to prove injurious.* On this account, a light supper is ♦ I trust it will not be thought out of place here to mention some of the general morbid effects of fasting; more especially as the zeal of one set of well-intentioned religious enthusiasts is labouring to restore the fast- ings of the primitive Church as an essential duty. It must be remarked that the effects of fasting necessarily vary in different individuals, and in INFLUENCE OF MASTICATION ON DIGESTION. 25 not only allowable, but it is essential for the maintenance of health in those who dine early and work after dinner; and for those of sedentary habits, and literary men, who work late at night, something light — for example, a bis- cuit or a piece of bread, and a small quantity of water, should be taken before going to bed ; otherwise the nights are likely to be as restless as when the supper is so heavy as to oppress the stomach. A question here arises — is excess in quantity as inju- rious as the improper quality of food which has been men- tioned ? In reply, it is difficult to determine on what ex- cess in quantity depends, or how it is to be determined. I believe that the best guide is never to continue eating until the stomach feels oppressed or distended ; and never to take a single mouthful after the appetite flags. If these natural intimations were always attended to, excess would rarely occur. It is a well-known fact, however, that a change in the nature of the dish will re-excite the appetite ; and excess may be present before the individual is aware of it; but, from whatever cause, excess cannot frequently occur with impunity. The custom of not masticating the food completely is a verv common cause of Dyspepsia. Before the stomach can act "properly on the food, mastication is necessary to break the cohesion of the organic matter, in order to aid its solu- tion in the stomach. It extends the surface of the substance to be acted upon by the juices of the stomach, in the same manner as pulverization aids the action of chemical sol- vents upon common matter. There is also, probably, some different conditions of the digestive organs: but the following may be re. garded as those which result from long fasting. The first are feelings of general debility, which are followed by " fever, delirium, violent passion, alternating with the deepest despondency," the temperature of the body is lowered ; the respiration becomes foetid ; the secretion of the kidney is acrid and burning;" the emaciation of the body is extreme; and, when the fasting has been so protracted as to terminate in death, the stomach has been found contracted. Fasting, it is true, has been often borne for a long time with impunity in disease, especially in Insanity: but. in health it cannot be supported many days without eminent risk to life. The strict observance of the Catholic fasts has often been productive of Dyspepsia: and other enthusiasts, who have regarded abstinence a virtue — for in- stance, according to Pinel, the Brahmins, and Fakirs, and the Anchorites of thcTbebaid,— equally suffered from this cause. 3 26 1NTR0DUCTII0N. influence of the saliva, which mastication mingles with the food, in aiding the solution of solid matters in the stomach, although this is undetermined. At all events, mastication, mechanically considered, assists digestion ; and nothing is more likely to act as an injurious irritant to the alimentary canal than unmasticated food. That the stomach secretes or forms a juice which ope- rates as a solvent upon the aliment introduced into it, is a well-established fact :* but, besides this, much of the effect of the digestive function depends on the influence of the nervous system ; consequently we may daily observe that appetite fails, and digestion becomes imperfect, whenever this part of our frame is deranged by anxiety of mind, or any depressing passion ; whilst, on the contrary, whatever tends to induce a quiet and tranquil state of mind, aids di- gestion and promotes health. These mental affections also influence powerfully the condition of the liver ; the health of which, and the due secretion of bile, are essential ingre- dients in the conversion of the food into chyle; and, conse- quently, in the promotion of the vigour and the health of the body. If good bile be not present in the bowels, chyle is not formed, assimilation is imperfect, and emaciation and disease must follow. 3. Much of the preservation of health depends on the proper timing of exercise, before and after meals. The first part of the digestive process, —namely, the solution, or, as it is termed, the chymification. of the food, — as has been already stated, requires rest: but as soon as this is over, and the soluble part of the chyme, namely, the chyle, en- ters the blood-vessels, exercise is salutary ; and the neces- sity of it, at that time, is demonstrated by the instinctive desire for locomotion which displays itself. But this feel- ing is more frequently abused, than properly taken advan- tage of to promote the object for which it is designed — namely, the mvigoration of the body, by the means of 'ex- ercise, in order to equalise the circulation, to promote the * The gastric juice is a compound of muriatic and acetic acid, with salt* of Potassa Soda .Magnesia, and Lime: and so powerful a solvent is thi fluid that ,t d.ssolves art.cles of food out of the stomach ; and when a pe . son dies suddenly ma state of health, it occasionally dissolves the s.onL \ rtself. During life, the vital principle prevent, this from occurring ! MECHANISM OF WALKING. 27 due performance of the secretory system, and to ensure the perfect assimilation of the nutritive portion of the food. Exercise, however, fitted to induce these beneficial effects, is not to be found in the midnight exertions of the ball- room, and much less in the hot atmosphere of the crowded drawing-room. It is in the open air, and in situations where the mind can be amused with the tranquil pleasures which result from the view of natural scenery, and from social intercourse, that exercise must be enjoyed to be pro- ductive of benefit. The author, however, is no ascetic ; his objection to balls and fashionable evening parties is founded more upon the evils arising from the late hour at which they commence, when the body is already in a half- feverish condition, from the various excitements of the previous day, than even the heat and the foul air generated by the multiplicity of lights, and the over-crowded state of the rooms. With respect to exercise generally, its excess or its defect may contribute to produce diseases. The necessity of vo- luntary muscular motion in all animals is undoubted ; in man, it cannot be neglected without risk ; at the slrne time, its excess is productive of equal danger. To render this more obvious to the non-professional reader, let us briefly examine the nature of the contractile property of muscles; the influence of volition upon it; the sources of the loco- motive power; and the influence of this upon the preserva- tion of health, and the formation of disease. a. Contractility is an essential property of the muscles, although they possess little sensibility. Their contractile property intimately depends on the influence of the blood, and that of the nerves. When the current of blood to any muscle is obstructed, it loses its property of motion. A certain supply of blood is therefore requisite for maintaining the function of every moving organ : this blood must also be of the arterial kind, or that which has undergone the change which breathing is intended to produce in the vital fluid. Persons in whom ■ .the blood is not properly arterialized, owing to a malfor- mation of the heart, — blue persons, as they are termed, — * ''are incapable of any considerable degree of muscular move- 28 INTRODUCTION. ment: and limbs, the principal artery of which has been tied, lose, in a great degree, both their natural temperature and their muscular movements : facts sufficient to prove that a constant supply of arterial blood is necessary for the preservation of the muscular energy. But the voluntary motor power of muscles requires also the influence of the nerves : whatever lowers the excitability of the nerves, therefore, paralyzes muscles, and they cease to be under the influence of the will. The involuntary muscles are also equally influenced by the nerves. It is, however, to the voluntary movements only that our attention is now to be directed. Every voluntary movement of the body depends on an impression of the will on what are termed the spinal nerves, spread out on a certain part of the brain, u and ex- posed," to borrow the language of a celebrated physiolo- gist, " to the influence of the will like the keys of a piano- forte."* How the mind is directed to the particular key, or nerve, requisite to effect the contemplated movement, is beyond our powers of conception ; we only know that the act of volition, necessary to cause motion, is the conscious direction of the nervous principle, in the brain, upon that part of the nervous apparatus destined for exciting muscu- lar movements. A very frequent or constant repetition of the same movements causes, at length, a difficulty in their accomplishment and exhaustion; hence, rest, alternating with action, is requisite to increase power, and to maintain the healthy condition of the muscular system. When action and rest duly alternate, the susceptibility of the muscular fibre is augmented, and the movements of the same set of muscles are capable of being excited by the slightest in- fluence of the will; a fact which is daily demonstrated by jugglers and other performers of rapid movements. On the same principle, walking exercise, or running, becomes more easy and less fatiguing, in the direct ratio of the fre- quency of its employment. The mechanism of walking is regulated by the same prin- ciple of alternate motion and rest. The body is supported * Muller — Elements of Physiology, trans., p. 934. MECHANISM OF WALKING. 29 on the legs alternately. At the time that the one leg a gives the movement which impels the body forward, the other leg b is at rest, and supports the body; and only as the step made by a is nearly finished, does it b proceed to raise the foot from the ground to give the body the fresh impulse, whilst a in its turn becomes fixed, and is the sup- porting agent. It may, however, truly be said that there is a period in every step, except in running, in which both feet rest on the ground ; but it is extremely short ; and does not alter the principle of alternate rest and motion. The trunk of the body also shares in these alternate move- ments ; it is at one moment inclined forward, and at the next raised to the perpendicular, so that the lumbar muscles suffer alternate contraction and relaxation ; and the body rises and sinks at each impulse forwards. In walking, the movement of the arm is always in the opposite direction to that of the leg on the same side ; the arm, on the side which gives the impulse, moves forwards, and that on the opposite side is thrown backwards; movements essential to preserve the equilibrium of the body. Running, except in point of quickened motion, differs from walking only in both feet never being on the ground at the same time. Enough has been said to explain how essential to these movements is the healthy condition of the nervous system; and, as the vigor of the muscular system depends on its adequate supply of blood, how requisite the perfect condi- tion of both systems is for muscular exertion. Exercise in its turn promotes the health of both systems, by equalizing the circulation of the blood, in order to supply that nutri- ment which is essential for their integrity, and to render them adequate to the performance of their functions. A certain quantity of locomotion or exercise is necessary for the preservation of health at every period of life ; with- out it, neither the function of the lungs, nor the due circu- lation of the blood, can be carried on : nor digestion effected ; nor assimilation perfected. On the other hand, too much exercise hurries to excess the circulation, and dis- turbs the functions of life ; whilst the exhaustion which 3* 30 INTRODUCTION. must succeed to violent exertion, both of muscular and nervous energy, when too long continued, is not only likely to impair health, but even to terminate in death. In infancy, vertiginous affections and inflammation of the brain, terminating in dropsy (hydrocephalus) of that organ, have resulted from tossing the child high and catch- ing it again upon the hand ; and, not unfrequently, at a later period, after the child has begun to walk, the same effects may result from swinging it round by the hands. In adolescence, the male part of the species, boys and young men, are most likely to suffer from over exertion; girls and young women from defective exertion. A boy of a delicate habit of body may have the foundation of an in- curable disease of the heart laid by a single excessive effort in running ; and the author has witnessed more than one instance of pulmonary disease, which terminated fatally, from the attempt of young men to walk distances, within a given time, to which their strength was inadequate. Incu- rable diseases have occasionally resulted from young men, even of robust frames of body, over exerting themselves in cricket and in rowing matches; exercises which, in mode- ration, are not only harmless, but salutary. Girls and young women are too much restricted by custom from the free employment of their limbs. Their exercise rarely ex- ceeds a formal walk; and the undue proportion between even this and their sedentary occupations leads to the most serious consequences ; namely, curvatures of the spine, me- senteric affections, cough, and that deposition of tubercular matter in the lungs which constitutes pulmonary consump- tion. In adult age, in both sexes, health cannot be sus- tained, nor disease warded off, without moderate exercise, daily and regularly taken.* * Although the following quotation from Dr. Parry's Elements of Pa- thology is perhaps too strongly expressed, yet it contains truths which should be generally known. " With regard to riding on horseback, it is usually a mere apology for the want of that exercise which Providence evi- dently intended that man should take by means of his own limbs, and not those of another animal. Accordingly we find that, exclusively of the positive diseases which spring from this mode of gestation when violent, those who trust to its moderate use, and mor« especially those who substi- DEFECTIVE EXERCISE PRODUCTIVE OF DISEASE. 31 A man whose occupations are sedentary, and whose mind is also much engaged, should rise early and take walking exercise before breakfast, to an extent adequate to counterbalance the period which he is destined to sit during the day. When this canuot readily be accomplished in winter, or from the individual being an inhabitant of a town which affords no opportunity for such exercise, fric- tion should be used over the body generally, either with a flesh-brush, or with horse-hair gloves.* The same danger results from excessive exercise in manhood as in adolescence ; and the more sedentary the habits of the individual, the more likely is risk to occur. A gentleman came to town from Woolwich to dine with a friend ; and, having some business to transact in the fore- noon, he brought his dressing-case with him. On arriving at Charing Cross, whilst paying the coachman his fare, a stranger offered to hold his dressing case, and ran off with it. The gentleman pursued the thief at the height of his speed, as far as the other end of Westminster bridge before he overtook him. This effort brought on palpitation of the heart, which became permanent, and terminated fatally in six months. On the other hand, too little exercise lays the foundation of numerous diseases; among which we may enumerate Dyspepsia, Hemorrhoids, Apoplexy, Tubercular Consump- tion, and Dropsy. If with sedentary habits mental study is conjoined, the individual usually becomes dyspeptic, flatulent, subject to Diarrhoea, and a variety of nervous affections, accompanied with sleepless nights, which bring on Hypochondriasis, and not unfrequently Melancholy. Rousseau remarked that literary men are generally sickly and unhappy : but although this opinion is not literally correct, yet there are few very studious men who are not more or less hypochondriacal. Sedentary occupations, even amongst the labouring classes, lead to disease. Shoemakers, weavers, and others, who follow trades requiring a sitting posture, often become dyspeptic ; and sensitive, in a high tute it for accustomed bodily labour, are at least as subject to dyspepsia' gout, dropsy, hemorrhage, the whole train of nervous affections, mania, hysteria, epilepsy, paralysis and apoplexy, as those who lead the most indo- lent lives." Vol ii., 31, 2. * Gloves for this purpose are sold in almost all the drug stores. 32 INTRODUCTION. « degree, to every change of temperature or of weather. On the same account, many of the employments of women tend to generate nervous affections. There is one descrip- tion of exercise too little attended to, but which is, never- theless, of great importance in warding off pulmonary dis- eases ; namely, the exercise of the chest. Nothing is more essential for the preservation of health, than the full expan- sion of the lungs, so as to maintain the free passage of the air, to the minutest tubes and all the air-cells, to promote the pulmonary circulation ; and to favour that complete change in the blood for which the respiratory function is intended. Nothing tends more to produce this beneficial effect than recitation, or reading aloud, if it be not carried to excess ; or taking full and repeated inspirations,'succes- sively, throwing back the arms and shoulders, so as to ex- pand the chest, but with sufficient precaution that the exer- tion do not hurry too much the action of the heart, nor quicken to excess the respiration. It should never be car- ried so far as to prove distressing to the individual, nor to leave behind it a sensation of great languor. It would be impossible, in a work of the nature of this volume, to enter into any minute details respecting the influence of mental affections, and consequently of educa- tion, as a cause of disease. The subject, however, is one of the utmost importance. The influence of mental impressions on the circulation of the blood is too well known to require any comment. The act of blushing; the instantaneous pallidness of fear; the turgidity of the face caused by violent anger ; are daily and obvious illustrations of mental influence : whilst the quickened breathing of surprise and joy ; the sighing, and the acute feeling of pain in the chest, which follow sorrow and other depressing causes; equally display the power of the passions over the respiratory function. The palpitations, the tremors, the faltering speech, and the dumbness, as well as the most extraordinary increase of muscular power, which various states of the mind induce, also strikingly demonstrate the power of the mental part of our nature over the moving organs; whilst its influence, even on the glandular system, is rendered obvious by the tears whicl follow sympathetic feelings; the perspiration that accom- INFLUENCE OF MENTAL AFFECTIONS. 33 pafiies alarm; the eruptions; the sudden change of the hair to grey,* and the complete loss of appetite, and the powers of digestion, which are the result of the depressing passions. " Violent and long-continued exertions of the mind fatigue the body." It is a well-known fact that excessive mental application in young persons, especially in those of a delicate frame of body, of both sexes, has frequently brought on that state of inflammation of the membranes of the brain which has terminated in dropsy of that organ ; and if the boy or the girl escape this too fatal disease, their future life is rendered miserable by dyspeptic and scrofu- lous affections. When the exertion is the result of emula- tion in the young person, it should be checked, if the con- stitution be delicate ; " otherwise," as has been justly re- marked, " that which confers honor on the pupil, may be purchased at the risk of health, and even of life."f Great students have generally extreme susceptibility of nerves; consequently much irritability of temper: they are neces- sarily more liable to the attacks of disease, and their com- plaints are also more difficult of cure, than those of others less emulous of distinction. Over-study, besides, often defeats its object: it causes a kind of atrophy of the brain ; and, as Rousseau remarks, " returns man to his original stupidity."| The exciting passions, when in excess, give rise both to spasms and convulsions : the depressing passions relax the whole muscular system ; the feet and legs are incapable of supporting the body, the features hang as if lifeless, and are devoid of expression, and the voice is rendered either feeble, or it suffers a temporary extinction. The power of volition in both cases is weakened ; in the first, the distor- tion cannot be counteracted : in the second, the relaxation * Stahl, a celebrated medical writer, mentions that a young man of high family, being condemned to death for a penal crime, became grey in the space of a single night. f Cooke on the Mind and the Emotions, p. 9. t Many instances, ancient and modern, might be quoted in proof of the evil of over-study in reference to health. Cicero was dyspeptic, and almost a skeleton: Pliny's life was rendered miserable by constant heart-bum ; Bayle died a martyr to his unremitting application; and Sir Isaac Newton fell into a deep melancholy, which, for a long time, deprived him of the power of thinking. 34 INTRODUCTION. cannot be braced up by any effort of the will. The dis- turbed state of the action of the heart during inordinate mental emotions of either excitation or depression, is a striking proof how far the influence of mind operates upon the vital energies of the habit, and, consequently, how far health is under the influence of education. Many facts might be adduced to illustrate the fatal in- fluence of sudden, great excitement, such as occurs in joy or in anger. In the latter especially, the blood-vessels fill to turgidity, the heart acts violently, and the head sutlers pain ; and if the heart or its valves be in a state of disease, or the vessels of the brain be weakened, a paroxysm of anger is most likely to become an instrument of death. It causes Hasmorrhage, Epilepsy, Jaundice, or some vessel of the brain gives way, and a fatal Apoplexy result. The daily newspapers teem with instances of this fact. But it is not necessary that the excitement should be of the high description which occurs in violent transports of the mind. Long-continued irritation, like accumulating poison, undermines the health, and ultimately induces organic affections of the brain, the heart, or the liver; which, although the effort be not sudden, yet, produce an equally fatal issue. It is not in one organ, nor in one functional derangement only, that mental influences of the opposite kind display their injurious effects. Protracted anxiety, or mental de- pression of any kind, often produces not only habitual func- tional derangement of the circulating and the nervous sys- tems, but it leads imperceptibly to structural or organic changes, either of the stomach, the liver, the lungs, or the heart; and even to incurable alterations in the brain or the spinal cord. In the poems of Mallet, is the description of a maiden who actually died of a broken heart, in the literal sense of the term. Neither this, nor " the green and yellow melancholy" of her " who never told her love," is to be regarded as a metaphorical or poetic fiction. The pining, which leads to tubercular Consumption, is of every-day occurrence ; and several cases, besides that one quoted above, are recorded, in which the heart has actually burst, from the surcharge EDUCATION A CAUSE OF DISEASES. 35 of blood thrown upon it by the influence of sudden, abject grief. In this condition of the mind, the surface becomes cold ; perspiration is absent, owing to the imperfect and languid state of the circulation ; the breathing is embar- rassed, and sighing is required to assist the transmission of the blood through the lungs. The vascular and the ner- vous lymphatic systems equally suffer, and a low inflamma- tory state is set up in various organs ; hence Liver Diseases, Asthma, Consumption, Hypertrophy or enlargement of the heart, Epilepsy, Apoplexy, and Mania, are apt to super- vene. The depressing emotions, also strongly predispose to epidemic fevers, and lay the body open to the influence of infection. It is true that mental impressions rarely act violently on the frames of those who enjoy robust health ; but when the vital energy is already somewhat impaired, not only the daily incidents of ordinary life, but even the social inter- course of society, and the most common depressions, ope- rate as causes of disease. In the education of young women, too little attention is given to subdue the imaginative faculty, and to moderate sensibility : on the contrary, they are generally fostered ; and, instead of a vigorous intellect and healthy condition of mind, we find imagination and sentiment predominant over the reasoning faculties, and laying the foundation of hysterical, hypochondriacal, and even maniacal diseases. The truly frivolous occupations of fashionable life, and that affected refinement which debars natural and active exer- cise, also nourish these tendencies. They become predis- posing causes of every form of nervous disease, which is awakened into activity by causes that, in a sounder state of body, would pass on unnoticed. When a tendency to Hysteria exists, the utmost care should be taken to avoid exposing the individual to the influence of imitation, and especially to that of terror. Many a thoughtless frolic has awakened an excitable state of the nervous system, which has terminated in augmented Hysteria, or Epilepsy, or other convulsive diseases, or in loss of reason, or even of life. The hazardous influence of sudden grief upon the brain 36 INTRODUCTION. cannot be more forcibly illustrated than by the following anecdote related by Dr. Cooke. A young medical man, who " was elevated to the distinguished post of tutor to Prince George of Cambridge, and was pursuing his duties to his royal pupil, in Hanover, highly to the satisfaction of the paternal Duke, was informed that his twin-brother had died in London. Although means were adopted to ensure a delicate and guarded communication of the event, they were unavailing. He was thrown into agitation; the brain received a shock which it could not sustain, and mind was immediately lost. His language, pre- viously so appropriate, now became idiotic:—' he is not dead' —' my brother is not dead,' — were the sentences he was frequently or continually uttering during a few days, when his earthly career terminated.*! It is an easy transition to pass from the morbid effects of mental emotions to those which result from that extra- ordinary condition of our existence in which we daily lose all consciousness, and in which the mind seems to sus- pend its influence over the body, and either lies for a time quiescent, or operates independent of it—namely, Sleep. "Half our days," says Sir Thomas Brown, "we pass in the shadow of the earth, and the brother of death extracteth a third part of our lives. It is unnecessary for our purpose to inquire into the nature of sleep: we have only to investigate its influence as* regards its perfect or imperfect nature, and the quantity essential for the preservation of health. That sleep is the most refreshing which is the most opposite to the waking condition, or, in or- dinary language, is the soundest; in which all conscious- ness, all memory, all volition, are suspended, and no ner- vous impressions are received sufficient to excite ideas or dreaming ; sound sleep, indeed, is that state in which there is an apparent absence of every mental function. From this condition the person awakes, nourished and refreshed, and ♦ Mind and the Emotions, in relation to Health and Disease, bv Wm Cooke, M.D, F.R.C.S., p 17. » J ■ f [See the excellent observations of Dr. Brigham in " Kemarks on the Influence of Mentr.l Cultivation, &c, upon Health.] SLEEP —ITS INFLUENCE ON HEALTH. 37 fitted for the performance of all the duties of the succeed- ing day ; and, when suffering under disease, he opens his eyes with a consciousness of improvement, and an antici- pation of returning health, which, as it inspires hope and confidence, is of the utmost importance in forwarding the accomplishment of that anticipation. Whatever tends to prevent sleep is necessarily produc- tive of disease. Strong emotions of the mind, long-pro- tracted intellectual exertion, and some narcotic substances, as, for instance, green tea and strong coffee, may be ar- ranged among the causes of wakefulness. Great anxiety to procure sleep, in one lying awake at night, is pre- ventive of it, on the same principle that it is opposed by any urgent train of thought. Another cause of wake- fulness is the codition of the alimentary canal; thus we suffer a sleepless night after a full supper, and this is one cause of many of the restless nights in the present period, the hour of dining being brought so closely upon that of sleep. It would be even less hurtful to sup immediately before retiring to rest, than to indulge in the full meal which is now taken four or five hours only before going to bed. The digestion at this time is so far advanced as to require the aid of exertion rather than of rest to com- plete it.* The late and heavy dinners of modern times are, indeed, very common causes of restlessness, dreaming, and night- mare : they may truly be said to -----------make sleep a pain, And turn its balm to wormwood. Every source of irritation of the intestinal canal which can operate during sleep should be avoided ; hence it is injudicious to take tonic or stimulant medicines at bed- time ; and, on the same principle, purgative medicines should not be taken in the evening. Many individuals, however, are in the daily habit of taking a purgative pill at bed-time : but such persons always dream — a circum- stance which never occurs in sound sleep. * The old adage is applicable to the present habits of the higher classes, if the dinner receive ita proper appellation — supper. " After supper, walk a mile." 4 86 INTRODUCTION. It is extremely difficult to estimate the quantity of sleep best adapted to preserve health ; much depends on the con- stitution of the individual, and as much on the nature of the sleep enjoyed. The oldest man whom the author ever personally knew, a man aged one hundred and eight, informed him that he had rarely exceeded four hours sleep in a night, at any period of his life. From six to eight hours sleep may be regarded as the best propor- tion for a healthy adult: and, undoubtedly, as much mis- chief may arise from too much as from too little sleep. If much sleep be indulged, the brain is brought into a condi- tion unfavourable to its healthy functions, and favourable to apoplexy and coma: on the other hand, too little sleep, by wearing out the powers of the brain and the nervous system from protracted stimulus, may cause the same dis- eases. The indulgence of the propensity to ex'end the hours of sleep increases the desire for it sometimes to an alarming degree. I knew a young man who, from such indulgence, required sixteen hours' sleep in the twenty- four, and at length suffered from a stroke of palsy. RECOGNITION AND PREVENTION OF DISEASES. With regard to the recognition and prevention of dis- eases, it is not the intention of this work to point out either the forms of diseases, or their causes, or their treat- ment ; but merely to indicate the means of recognising their approach : and the best method of preventing or warding off diseases of common occurrence, and especially those which, at some previous period, have attacked the same individual. By the possession of the knowledge ade- quate for these purposes, many diseases of the most serious character might be either checked at once, or rendered mild in their progress ; others, the seeds of which may be said to be laid in the constitution, rendering it predisposed to their attacks, might never be permitted to break out; and the fatal issue, even of severe and incurable diseases, might be removed to a distance far beyond that at which it usually occurs, were the eyes of friends and relatives opened to the danger that threatens the fated victim of the malady. The remarks upon each disease shall be as con- densed as the nature of the subject admits. RECOGNITION AND PREVENTION OF DISEASES. 39 I. GENERAL DISEASES. a. Fevers constitute an extensive class of diseases which are generally preceded by a change from the ordinary con- dition of the person about to be affected. Languor ; lassi- tude in muscular power, accompanied with an expression indicative of some inward distress ; and an aversion and inability to every exertion, either of mind or of body, usu- ally denote the approach of fevers. Irregular chills and heats, with great restlessness, and a general sensation of soreness, succeed ; with flushing of the face, increased heat of the skin, especially in the hands and feet; a quick pulse, and headache, or a disturbed condition of the mental facul- ties, demonstrate that the fever is already formed, and that medical assistance should be obtained. When fever, espe- cially of the continued kind, is present in a family, the anxiety which naturally is awakened in the near relatives of the patient tends to strengthen its infectious influence, if it possesses any ; and, at all events, to place those attend- ing the patient in such a condition as will awaken a sus- ceptibility or predisposition to the disease. Whatever tends to impair the health, operates, indirectly, as a predis- posing cause of that condition which renders the habit sus- ceptible of infection ; hence the necessity of supporting the vigour of the system by an adequate supply of proper and wholesome food. On the other hand, nothing like over- repletion should be indulged ; although the food, in mode- rate quantity, ought to be of the most nutritious kind. The moderate use of wine, also, contributes, not only during attendance on infectious fevers, but during the prevalence of epidemic fevers, to obviate the predisposition to their reception ; but, on the same principle that excess of food is hurtful, the undue use of wine, or of intoxicating liquors of any kind, is injurious, and indeed increases the suscepti- bility to infection. The same is the result of bodily fatigue, protracted watching, little or disturbed sleep, and fear or grief; whilst fortitude and equanimity of mind are as certain safeguards. The occurrence of fever more than once in the same in- dividual displays a tendency to the disease which should not be overlooked. Such persons should never sleep in the vicinity of stagnant water ; nor in houses in which any 40 INTRODUCTION. foetid effluvia arise from drains or cess-pools ; nor in the neighbourhood of burial grounds. It is no unusual cir- cumstance to find those living in the vicinity of church- yards with sallow countenances, febrile states of the habit, and labouring under dejection of spirits. Exposure to sudden alternations of atmospheric tempe- rature is always most cautiously to be avoided by those liable to fever; hence currents of air ; coming out of hot rooms into the cold evening air; or passing from it into heated rooms ; — and too soon throwing aside flannels which have been worn through the winter;—are all ex- citing causes of fever in such individuals. At one season of the year, that epidemic form of fever, which has been named Influenza, prevails in this country ; it appears suddenly, and leaves behind it debility to a great degree, independent of the mortality which it inflicts. Hitherto, the cause of its occurrence has remained an un- resolved problem ; but, as far as my own experience can be relied upon, I am disposed to refer it to the prevalence of easterly and north-easterly winds. Whatever may be the causes of Influenza, it generally attacks the delicate ; and there is, also, a liability to the recurrence of the dis- ease, which long remains in the constitution. The disease itself is always accompanied with extreme depression of the vital powers. It seem to attack most particularly the mucous membrane lining the air passages, indicated by in- flammation of the throat, cough, and general irritation of the windpipe : the necessity, therefore, of keeping within doors, and guarding the mouth from the influence of the prevailing wind, need not be insisted upon. As the dis- ease, however, is one of debility, food and regimen, calcu lated to restore the depressed vigour of the system, inde- pendent of medicine, are requisite ; and by improving the tone of the habit, we not only take the most effectual means of combating the liability to the recurrence of the disease, Which is so peculiar to those who have once suffered it, but we also shorten the period and lessen the severity of the convalescence. In some states of fever, an eruption, termed Miliary* * The name originated from the vesicles in minuteness and form resem- bling a millet seed. RECOGNITION AND PREVENTION OF DISEASES. 41 spreads over the skin, consisting of minute vesicles upon inflamed bases. Formerly, when febrile affections were improperly treated, and long-continued sweating was kept up, this eruption was by no means uncommon : it is now noticed chiefly with the view of cautioning against the error of keeping persons in diseases of any kind in an over- heated atmosphere, or loading the patient with bed-clothes, or administering hot and stimulating drinks. Miliary fever may, indeed, be regarded in almost every instance as a symptomatic affection ; and the only means to prevent it are free ventilation, cooling drinks, and a strict attention to those rules which the physician will necessarily point out, should the disease actually appear. Those fevers which are attended with eruptions on the skin, and are infectious, seldom occur but once in a life- time. They require but little notice in this place, unless it be to point out the means of arresting the extension of the affection, and limiting the sphere of its action. Scarlatina, in all its forms, is powerfully infectious ; hence the utmost caution is requisite in permitting the re- turn home of any member of a family who has lately had the disease at school, or elsewhere ; especially if the family consist chiefly of daughters between the ages of fifteen and twenty, at which period the habit is most susceptible of the infection. This caution may be lessened, when those in the family have had the disease ; but it cannot wholly be set aside; for instances have occurred in which a second and even a third attack has taken place ; but these are fortunately rare. It is requisite to notice here an erroneous popular idea which prevails, that Scarlatina and Scarlet-fever are dis- tinct diseases, The mildest and the most malignant forms of this fever are mere varieties of the same disease, depen- dent, in some degree, on the state of the habit of the affect- ed person at the time of receiving the infection ; and, also, on certain unknown epidemic conditions of the atmosphere. It has been asserted by the homceopathists that the ad- ministration of minute doses of Extract of Belladonna* will * Three grains of the Extract are to be dissolved in one ounce of distilled water, and two drops (one-eightieth of a grain) of the solution are to be given twice a day, to a child one year old, and one drop more for every year above that age ! 4* 42 INTRODUCTION. act as a safeguard against the action of the infection of Scarlet-fever ; but, at least, this is highly problematical. After the disease is over, the frequent use of the warm bath tends greatly to aid the desquamation of the cuticle, which should be completed before the patient is permitted again to mix in society. The body linen, worn during the dis- ease, should either be destroyed, or it should be put into a vessel hermetically closed, and subjected to the heat of boiling water for three or four hours. For the mode of purifying the apartments of the patient, see fumigations. Measles is readily recognized by the inflammation of the eyes, the swelling of the eyelids, the discharge from the nostrils, and the sneezing with a teasing dry cough which precedes the eruption for seven or more days. When these symptoms appear, medical advice should be obtained. This disease is nearly as infectious as Scarlatina ; consequently similar cautions are requisite. It should, also, be under- stood that it is infectious before the appearance of the erup- tion. In no case should the disease be treated domesti- cally; but, it may be important to inform our readers, that, if the eruption does not come out in what is usually regard- ed a proper manner, nurses are very apt to give the chil- dren stimulants, such as sulphur in brandy and water, punch containing saffron, and syrup of saffron, all of which are injurious; consequently, under such circumstances, nurses should be closely watched. The custom of discharging the medical attendant immediately after the disease has run its course, and the patient is apparently well, is also im- proper, as the sequel of Measles is often as hazardous as the disease itself. The influence of vaccination in protecting the human system from the infectious influence of Small-pox, or mo- difying the disease so as to render it devoid of danger, is now generally admitted. The infection of the small-pox is communicated through the air, at some distance, even out of doors ; nothing, therefore, is more reprehensible than sending children labouring under Small-pox into the streets or squares of a town, or into the fields in the country. Every one who has not been vaccinated, or not had Small- pox, is susceptible of the infection at every period of life ; RECOGNITION AND PREVENTION OF DISEASES. 43 and the risk is not lessened by the fact that the person had been previously exposed to the disease, and had resisted it. A person may resist it at one time, and yet be suscep- tible of it at another. A full and plethoric condition of habit predisposes the person, not only to receive, more readily, the infection, but also to suffer more if he is at- tacked by it; hence the necessity of those who have neither had Small-pox, nor have been vaccinated, living sparingly, and refraining from the use of malt liquor, when Small-pox prevails as an epidemic; but, at the same time, although temperance is requisite, yet the opposite condition to ple- thora, namely, one of emaciation or debility, is equally injurious. As a general rule, Small-pox occurs once only in life to the same person; but every medical practitioner knows that there are exceptions to this rule. I have known four cases in which the disease returned a second time. In one case, the patient had been inoculated, and had the dis- ease severely at that time, as well as on its recurrence. Various means have been proposed to prevent the for- mation of those cicatrices, named pits, which so frequently disfigure the faces of persons who have suffered from con- fluent Small-pox. Among other means, M. Nenat* has given a most favourable account of the influence of the compound mercurial plaster, a remedy which appears to have been suggested by MM. Serres and Gariel.f It ap- pears to check the suppuration of the pustules, when it is applied early, and to convert them into solid tubercles, which terminate in a furfuraceous desquamation, without leaving any scar. I have found olive or almond oil equally efficacious as any other application ; and I believe that the benefit depends on guarding the pustules from the action of the air.| Chicken-pox is distinguished from small-pox by the ab- sence of a firm base to the vesicles and vesicular form of the eruption. The vesicles, instead of suppurating, burst * Gazette Med. de Paris, July, 1839. | Archives Gen , vol. viii, p. 468. * [From recent observations, it appears that protecting the skin from the action of light, will, in a great measure, prevent pitting, and hence that the use of a black silk mask, as soon as the pustules begin to form, will avert any disfigurement of the face.] 44 INTRODUCTION. on the third or fourth day, and form puckered crusts. It is so mild a disease, and generally so free from all sympa- thetic constitutional disturbance, that it demands no parti- cular notice. Erysipelas, in its most usual form, is a febrile disease, exhibiting a certain degree of swelling of the parts which it affects, with a red, almost scarlet, blush spread over them, and causing a sensation of heat and tingling. Vesi- cations sometimes occur; but before these appear, medical advice should be obtained. The disease is, in many cases, fnfectious; but, like every other malady which is capable of being communicated from one person to another, it only attacks those predisposed to reeeive the infection. What condition of body causes this predisposition is not well un- derstood ; but it is probably connected with derangement of the digestive organs, or, in other words, an irritable state of the stomach and bowels. On this account, indi- viduals who are exposed to the infection, or who are liable to the attacks of disease, should be careful in diet, avoiding indigestible and irritating food, not indulging in excesses of any kind, and sedulously relieving the bowels; but at the same time avoiding the too free employment of pur- gatives. When Erysipelas appears in a house, the sick person should be separated from the healthy inmates; and, after the termination of the disease, whether that be favourable or otherwise, the bedding and bed clothes should be washed and fumigated ; the room, after fumigation, white-washed and painted. So infectious is Erysipelas, that even this system of cleansing is sometimes insufficient to check the extension of the disease. In one of the wards of the In- firmary of Montrose, notwithstanding all the patients were removed, and fumigations and white-washing were adopt- ed, the disease continued to attack every fresh patient who was placed in it; so that it at length became necessary to phut up the Infirmary for a considerable time. When Erysipelas has once made its attack, few diseases are more apt to recur. The best mode of guarding against this;susceptibility, is to invigorate the body, without in- ducing plethora. I have seen the tepid shower bath most RECOGNITION AND PREVENTION OF DISEASES. 4fj useful in such cases. A moderate quantity of wine may be taken, but malt liquors should be avoided. The best topical application is a solution of Nitrate of Silver ; but people have objected to the face, when attacked with Ery- sipelas, being painted over with the solution of Nitrate 01 Silver, because it blackens the skin : they should know that this blackness is not deeper than the cuticle, which soon peels off. JVettle-rash (Urticaria) is a non-contagious, general dis- ease, accompanied with an eruption of wheals, very closely resembling those caused by the sting of a nettle. The eruption is most troublesome on rising from bed in the morning, and generally makes its appearance wherever the skin is rubbed or fretted. It depends in a great measure on the condition of the digestive organs. In many in- stances, indeed, it originates from certain articles of diet operating in a manner not usual, owing to a peculiarity in the habits of those subject to attacks of the disease. Thus, white of egg,* cheese, shell-fish, as mussels, lobster, crabs; some other fish, especially the coloured fish, as salmon, mackarel, pike, tench, carp, and barbel; honey, sugar, cucumbers, mushrooms, bitter almonds, potatoes, some fruits, vinegar, and some kinds of wTine, occasionally are exciting causes of nettle-rash. Whatever may be the cause, nothing should be doae to repel the eruption ; as in- jurious results have followed such attempts, when they have been made in the absence of medical advice. The offending substance should be detected if possible, and avoided in future ; and this may generally be effected by leaving off one substance of diet after another, and noticing the results. Scrofula. — It is not the object of this volume to enter into an investigation of the nature and medical treatment of diseases; consequently I refrain from making any remarks respecting the Protean character of Scrofula, and the mul- tifarious forms which it assumes. The preventive mea- * Singular as this may appear, the truth of the remark was demonstrated in the person of the late celebrated Professor James Gregory of Edinburgh, the author of the Conspectus Medicinx. The smallest morsel of white of egg caused an erupton of nettle-rash over his body a few minutes after it had been swallowed. 46 INTRODUCTION. sures which we possess, for arresting the disease in* earlv progress, are numerous; and to these only have 1 to direct the attention of my readers. This is the more im- portant, as the disease is hereditary, and the germs of it are laid in the constitution before birth. The chief object, whether the disease is hereditary only on the mother's side, or is derived from both parents, is to correct the tendency to it by changing the first nutriment of the infant. Instead, therefore, of being suckled by the mother, or being brought up by hand, the child, at birth, should be consigned to a robust, healthy wet-nurse, with an abundant supply of milk : and on the breast milk alone should it be nourished for the first seven months of its life, or until the first teeth are cut; after which, a little beef tea, with pounded, good biscuit, boiled to a pulp in water, should be given once a day. The child should be warmly clothed ; but it should from the first wear no cap. It should be daily sponged with cold salt and water, followed by friction over the whole body ; and be as frequently carried into the open air as possible. The nursery should be at the top of the house, well ventilated, spacious and lofty. As the child advances in age, the same principle should regulate its management, namely, that of imparting tone. A plain animal diet, with a moderate share of well boiled vegetables, avoiding pastry and sweets ; employing warm Clothing, especially flannel next the skin, which should not be too soon left off' in summer, and should be resumed early at the approach of winter ; the use of the tepid or the cold salt water shower bath every morning throughout the year ; well ventilated rooms, and moderation not only in study and business, but also in the pursuit of pleasure, with strict temperance, comprise the best means of preventing the development of the disease in those predisposed to it, and protecting those not so predisposed from its approach. The moral management is not less essential than the phy- sical ; whilst, in the dull and apathetic, the mind should be roused, precocity should be opposed, and whatever can awaken sensibility in those naturally sensitive should be strenuously withheld. In a word, every means should be Recognition and prevention of diseases. 47 adopted which can aid the improvement of the constitu- tion. Rickets may be almost regarded as one of the forms which scrofula assumes. When the disease appears early, it is usual to advise that the child should be weaned sooner than might otherwise be necessary, as protracted suckling disposes to the disease ; but this is an error. The infant should be continued at the breast until the process of teething is nearly over. After the weaning, the diet should be such as will support strength without quickening the cir- culation of the blood, or generally stimulating. The cloth- ing should be warm, and the greatest care taken to avoid damp ; the sleeping apartment ought to be well ventilated ; and, during the day, the child should be constantly in the open air. When the child is carried, it should be on either hand, changing alternately; but it should never be held in the hollow of the arm, as is too often practised by lazy nurse maids. Another affection, namely, Mesenteric disease (Tabes me- senterica), has so intimate a connection with scrofula, that I prefer mentioning it here, rather than under diseases of the bowels. When it appears, the bowels enlarge, and the extremities waste, especially the legs. The skin assumes a sallow hue, is dry, and harsh ; whilst the muscles waste and feel soft and flabby. It is most likely to be prevented by good country air, in proximity to the sea, and daily ex- ercise to the limit of fatigue ; or, when this cannot be taken, by friction twice a day over the belly and along the spine. Flannel should be used next the skin throughout the year, and the diet ought to be of the most nutritious kind. When the child is very young, a protraction of the period of lactation, by means of a succession of good healthy wet nurses, has been judiciously advised.* AFFECTIONS OF THE BRAIN AND NERVOUS SYSTEM. In no disease cart the attention of friends more effectually operate than in Hypochondriasis, either in warding it off, or in lessening its miseries. This unfortunate malady arises more frequently from mental than from physical * Dr. Joy, Cyclopaedia of Pract. Med., vol. iv., p. 159. 48 INTRODUCTION. causes. The nature of civilized society tends to augment greatly those cases depending on the first set of causes: they are, indeed, often the result of anxiety respecting schemes of ambition, disappointments in pecuniary specu- lations, and excessive and long continued intellectual ex- ertions, combined with sedentary habits. Their frequency, from the last mentioned cause, has led to the remark that Hypochondriasis may be regarded as the " morbus litera- torum," the disease of the learned. But men of all ranks, and of every degree in point of intellect, whose occupa- tions are sedentary, from the Lord Chancellor on the wool- sack to the Cobler in his stall, are equally liable to the dis- ease. The physical causes are often secondary to moral affections ; but, nevertheless, the disease may be truly re- garded as an affection of the brain and of the nervous sys- tem. It sometimes seems to depend solely on digestive derangements from improper diet; more particularly the abuse of tea, coffee, and other warm diluents. The latter are the most common causes among the lower classes, in which Hypochondriasis more frequently attacks women than men. Whatever may the primary cause of the dis- ease, as soon as it actually displays itself, there can be no doubt that the brain and the nervous system are more or less affected. When the disease is actually present, the aid of the phy- sician must be called in ; but his prescriptions will be of little avail without the co-operation of the friends or the relatives of the patient. When the attack has arisen from moral influences, — change of scene, travelling, or some other means capable of arresting the attention, and reversing those influences which have ;nduced the disease, should be resorted to: and, perhaps, much of the benefit which certain mineral springs and watering places have conferred on hypochon- driacs may be ascribed to arresting, by new objects, the attention, and consequently abstracting the train of ideas from the bodily feelings. But such influences should be often renewed, in order to prove permanently successful. When circumstances prevent travelling being resorted to, exercise should be strongly urged ; and all the usual studies RECOGNITION AND PREVENTION OF DISEASES. 49 and habits must be changed. The clothing should be warm, but light. Indulgence in bed should be prevented, and the patient ought never to be left alone. Nothing is so much to be condemned, in such cases, as ridiculing the whims and the caprices of the patient: the mind may be diverted from them; but ridicule only fixes them more deeply, and favours a tendency to despondency and me- lancholy. Indeed, when the disease is fairly established, the patient should be removed from his relations, who seldom appreciate correctly his excessive sensibility ; and are constantly offending his already over irritated feelings. The great difficulty is to withdraw the attention from the morbid sensations which so wholly absorb it, and to shift it to external objects ; but, wThen that can be accom- plished, the medical management of Hypochondriasis be- comes easy, and recovery more certain. In the educated, nothing tends more to subdue the misery of the hypochon- driac, and to turn his attention from himself, than literary composition ; and next to this, drawing, or any branch of the fine arts. Although Wakefulness is not strictly regarded as a dis- ease, yet, when it exists, it indicates the absence of health; hence it is an important object, in reference to health, to prevent the habit of it, which, if once established, is most difficult to overcome. It is difficult to determine the quantity of sleep requisite for health : much depends on age, temperament, constitu- tion, habit, and occupation. Children require more sleep than adults ; but between infancy and adult age there are some differences, which should not be left unnoticed. The infant, for example, requires from fourteen to sixteen hours ih the twenty-four to be passed in sleep ; the boy generally about ten ; the young man or young woman eight, and the adult from four to six. Much, however, depends on habit; but when a person who has been accustomed to enjoy six hours of sleep is reduced to three or two hours, he then suffers, and is justly regarded as wakeful. Sleep, also, may extend to the usual period, and yet be restless and unsound. When Wakefulness occurs, independent of any specific disease being present, the best means of obviating 5 50 INTRODUCTION. it is a tepid bath, taken just before bed-time ; but when this cannot be obtained, the hot foot-bath'will often answer the same purpose. There is a variety of nervous irritation, commonly called Fidgets, which always more or less cause wakefulness. They are generally accompanied with hot hands and a dry skin, indicative of irritative fever. The Wakefulness, in this case, is best counteracted by placing the hands in cold or in tepid water, for five or ten minutes; or wrapping the end of a towel dipped in cold water round one hand, and allowing the other end to hang over the side of the bed. If the weather be mild, nothing so effectually destroys wakefulness as rising from bed, walking about the room for a few minutes, then returning to bed. It is sometimes, also, overcome by sipping a tumbler of cold water on re- 1 tiring to rest. Sensitive persons, who suffer from wakefulness, should refrain from exposing themselves to any causes of excite- ment for a considerable time before going to bed. They should not drink coffee, nor green tea, at a late hour; for, although these substances do not influence the circulation to any morbid extent, yet, they act on the nervous system in a manner unfavourable to sleep. In many instances, when Wakefulness has long continued, the physical habits of the sufferer should be changed : thus, instead of dining late, and taking no supper, he should dine early, and sup just before going to bed. The custom, also, of taking purgative pills at bed-time is unfavourable to sleep ; the irritation which they induce, if it does not wholly prevent sleep, at least tends to disturb its tranquillity. Sensitive persons should, in the evening, always endeavour to turn the current of thought from the subject which has been pre- viously engrossing the mind during the day. The bed of the wakeful should be ample ; furnished with a firm, elastic mattress placed over the feather bed ; and the thick coverlets, which are usually found on beds, should be thrown aside. The curtains should not be drawn, and every means of admitting air to the bed should be adopted.* Hysteria is purely a disease of the nervous system: few * [Vide Dunglison, Human Health, Chap, vi J RECOGNITION AND PREVENTION OF DISEASES. 51 diseases are more unmanageable, and few reflect so little credit on the physician. The disease is one of a Protean character; but the fol- lowing are the most obvious symptoms of what is termed an hysteric fit, or paroxysm. It is preceded by a feeling of general uneasiness and oppression, followed by the sen- sation of a ball rising in the throat, coldness and stiffness of the limbs, noise in the ears, vertigo, and loss of volition; so that the person either is motionless, or is violently agi- tated with involuntary convulsive movements in almost every part of the body. During these struggles, the face is flushed and the skin hot; and the afflicted person either breathes by sudden impulses, or sobs, or sighs, or laughs immoderately. A feeling of suffocation is often present, causing the throat to be forcibly grasped ; and the arms to be bitten, as from excess of suffering. These symptoms, however, vary ; and the disorder simulates almost every disease to which the body is liable. There is, also, a most extraordinary disposition in hysterical persons to deceive9 without reference to any moral turpitude. In the prevention of Hysteria, much may be effected by judicious and moral treatment. It is a disease peculiar to the female sex, although some men have been attacked with symptoms closely resembling it. In both sexes, the disease may be referred to the brain and nerves, which are affected in a secondary manner. Hysteria sometimes attacks young women about the age of puberty ; but its most common appearance is at that age in which women begin to feel that they are no longer young, and that the chance of any matrimonial alliance is more than doubtful. The moral education of the sex forces them to subdue the most powerful of the passions, whilst their sensibility by such an effort is rendered more acute ; hence the nervous system is easily excited ; and mental causes, which, under other circumstances, would have little in- fluence upon it, operate powerfully, and excite those con- vulsive motions which are the most striking features of the hysterical paroxysm. In every individual predisposed to Hysteria, imitation has a powerful influence : a fit in one person may be pro- 52 INTRODUCTION. ductive of fits in twenty, or any number of persons, under certain circumstances ; even whole schools have been thus attacked. The representation of agitating passions in the drama has, often, been productive of a similar effect.* Hysterical females, or those of delicate, susceptible nerves, should never be exposed to such exciting causes. During the paroxysm, care must be taken to prevent the patient from hurting herself; and, as the tongue is apt to be bitten, a napkin should be placed between the teeth. The powers of self-control in the patient should also be endeavoured to be roused. All tight ribbons, or handker- chiefs around the neck, should be loosened. If the convul- sions be severe, the face and the chest may be sprinkled with cold water; but dashing a pailful of water over these parts should not be attempted, except under the authority of a medical practitioner. Burnt feathers, salts, or the vapour of heated Assafoetida, may be freely applied to the nostrils. As a preventive measure, when plethora or ful- ness of habit is present, a diminished quantity of animal food is essential. In the intervals of the fits, also, the patient should not indulge in soft and warm beds : walking exercise daily, or pony exercise, should be strictly enjoined ; but carriage exercise is not only useless, it is injurious, by inducing a ■determination to the head. The tepid shower-bath, or the tepid sea-water bath, and exercise taken after it, is an excellent mode of strengthening the habit and warding off the fits. The residence of hysterical females should be high and dry; moisture and warmth are both hurtful: and the en- joyment of the cool and pure air of morning is preferable to all the nervous medicines in the world. Ease and in- dulgence and the nurture of sentimental and romantic feel- ings aggravate the disease. When it can be effected, travelling, or, as it is termed, change of air, by abstracting the attention from the condition of the body, is always use- ful in warding off Hysteria. The influence of the engage- * When Mrs. Siddons first appeared in Edinburgh, hysterics were so common amongst the female part of the audiences, that young men attended the theatre to carry out the affected; " a service which," Dr. Gregory used f.o state, " was called carrying off the dead." RECOGNITION AND PREVENTION OF DISEASES. 53 ment of the mind, even in times of danger, has been often strikingly illustrative of the benefit resulting from it. In the American* and the French Revolutions, and in the Scotch and Irish rebellions, ladies, who were suffering under Hysteria, were readily cured by the events of the period. " They forgot," says a writer on the subject, " their hysterical affections." Even reverses of fortune are sometimes useful in-warding off hysterical attacks. Dr. Frank has remarked that " the wives of merchants become hysterical in flourishing times ; but, when reverses come, they have no time to be ill." When Hysteria has once appeared in young women, nothing is so likely to foster its return as the debilitating habits of fashionable life, in what is called the season in London. Not only does the constitution suffer from hot and crowded rooms, late hours, and stimulating suppers, but the spirits are often broken by wounded pride and dis- appointed anticipations. By such causes the sensibility is morbidly augmented, and Hysteria engendered. These evils are not now confined to the higher circles ; they have descended to the middling ranks of society ; health is ne- glected, and happiness sacrificed on the altar of Dissipation. Epilepsy has been justly regarded, in many instances, as an hereditary disease, and always more or less connected with a scrofulous state of the habit; consequently, when one of a family is affected, we may anticipate the proba- bility of an attack in some other of its members, whether brother or sister. On this account, it is of great importance to be aware of the occasional or exciting causes, so that, by warding them off, the disease may be kept at bay. If the patients be young, indulgence of every description is injurious ; every excess in diet is likely to bring on the disease ; and nothing more so than the use of malt liquor in boyhood, if the smallest predisposition to Epilepsy exists. High temperatures, prolonged sleep, over-exertion, the re- pulsion of skin diseases, and some of the exciting passions, such as excessive joy, and anger ; too intense application to study or business ; watching ; inanition from any cause ; purging; masturbation, and some depressing passions ; for * Dr. Rush, Medical Inquiries and Observ , vol. i. 5* 54 INTRODUCTION. example, great disgust, grief, and terror, are incidental causes of Epilepsy. The sight of any one in the paroxysm of the disease is, also, very likely to induce it in the pre- disposed. Nothing is more likely to produce an attack of Epilepsy than indulgence in what is termed the pleasures of the table ; hence nothing is more essentially requisite to ward it off than the strictest adherence to temperance in diet as far as relates to quantity, and to plainness with re- gard to cookery and the quality of the food. Breakfast should not be taken for an hour after the morn- ing walk of the Epileptic : it should consist of a small por- tion of animal food plainly cooked, and a moderate quan- tity of toasted bread, and only one cup of tea or coffee, with much milk. Dinner, which should be taken at two, or at three o'clock, should be moderate in quantity, and consist of mutton, or poultry, or game, plainly cooked, with well-boiled vegetables. The drink of the epileptic should be toast-water, or seltzer water and milk. When the dinner hour is early, some supper is requisite ; but little, if any, animal food should be taken at that time: a small proportion of bread, and a cup of milk and water, are preferable to animal food. Exercise, especially walking to any extent within the limits of fatigue, is essential for warding off the paroxysms of Epilepsy : but it is preferable to divide the exertion, and not to confine it to one daily effort. A walk of three or four miles every morning before breakfast should be taken, previously fortifying the system with a slice of toast and a cupful of milk. If the disease have already made its attack, the sufferer should not walk out alone, nor should he be permitted to ride, or to drive a carriage : indeed, if he can afford to have a constant attendant, he should never be alone. Although rest after meals is requisite, yet sleep at that time is hurtful to the epileptic. The epileptic should never indulge in much sleep ; consequently, at whatever hour he retires to bed, he should rise early. His sleeping-room should be large, and without a fire. His hair should be closely cut, or shaved; a very light hat worn; and the tepid shower-bath, with friction on the scalp, should be daily used. RECOGNITION AND PREVENTION OF DISEASES. 65 When the paroxysm is present, the patient should be laid on his back, and merely prevented from hurting himself, until a medical man can be sent for : but no attempt should be made to make him swallow, unless it shall be ordered by the medical attendant. Paralysis, the loss of voluntary power over one or more members, or one side of the body, is another disease in which the treatment of the physician is often of less avail than the management of diet and regimen. If any form of the disease has occurred, either partial or general, that is, in one member, or in the whole of one side, or in both upper and lower extremities, the use of all stimulating aliments, solid or fluid, must be rigidly ab- stained from, and air and exercise, to the extent to which the patient is capable of taking the latter, should be daily enjoyed. Mental serenity and relaxation from the cares and vexations of business are indispensable ; and much advantage may be derived from a frequent change of scene, such especially as is calculated to withdraw the mind from the feelings of the body. With regard to the paralytic limbs themselves, much good may be effected by friction with a flesh-brush or the hair-glove, and sponging with tepid salt and water. Many who have suffered from palsy have long survived the attack; and, by observing proper caution in diet and regimen, have warded off a re- newal of the attack, and enjoyed for many years a comfort- able share of health. The tendency to Hydrocephalus, or Water in the brain, to pass through families, is well known to the profession ; and it too often happens that, from ignorance of the pre- monitory symptoms, the disease advances too far before medical aid is sought for, and means are adopted which, at an earlier period of its progress, might prove success- ful in warding off the disease. The principal premonitory symptoms are a capricious or defective appetite ; and the bowels irregular or torpid. The urine is high-coloured and scanty ; the skin, harsh ; and the complexion faded and unhealthy. Languor and frequent drowsiness are often present, with disturbed sleep ; there are, also, occasional attacks of giddiness, and headache. The child loses its 66 INTRODUCTION. spirits, and becomes taciturn and grave. When such symptoms display themselves, although the little patient makes no complaint, but, on the contrary, says that no- thing ails him, when he is closely questioned, yet, imme- diate medical advice should be resorted to. The disease has already set in, when, in addition to these symptoms, the child has alternate chills and flushing, and walks with a tottering and unsteady gait. It only remains to be mentioned that every appearance of precocity of intellect in the children of a family in which Hydrocephalus has occurred should be checked; and parents ought to be fully aware of the hazard of too early, or too long-continued, mental application in such cases. The vigour of the body should be cherished, and the powers of the intellect left at fallow until the strength of the constitution is established. The utmost care must be taken to support the tone of the habit by mild nutritious diet, daily exercise, and good air. Nothing is more important, in the management of chil-- dren of a hydrocephalic tendency, than the daily examina- tion of the alvine evacuations. When these are pale, slimy, offensive, or in any respect unusual, the child should be immediately purged ; and, if that does not produce re- lief, medical advice should be instantly obtained. In a family in which three children, successively, died on arri- ving at a certain age, the next child and all the other chil- dren of the family were saved by unremitting attention to this circumstance. In children, also, predisposed to this disease, caps ought not to be worn, either in the night or by day; and the hat should be as light as possible. The vanity of the mother must be sacrificed to the health of the child. TheTcutting of the teeth should be facilitated by the frequent employment of the scarificator. It should be generally known that the cicatrix formed by this opera- tion is more easily absorbed, to admit the protrusion of the tooth, than the sound gum. DISEASES OF THE HEAD AND FACE. Bleeding from the nose depends upon so many circum- stances, that, except in young people, it should never be RECOGNITION AND PREVENTION OF DISEASES. 57 neglected ; and medical advice should always be resorted to directly it occurs in adults. To check the flow of the blood, in the mean time, the person should be kept in the erect posture, with the face freely exposed to a stream of cold air, and cold water should be applied to the face and the back of the neck. The common practice of putting alarge cold key down the back is serviceable ; but the appli- cation of ice between the shoulders is better. If the flow of the blood be alarming, the nostrils may be plugged with a piece of lint, or of sponge. Headache may arise from a variety of causes; conse- quently the preventive measures vary according to the na- ture of the attack. When it is of that kind which is de- pendent on rheumatism, and which affects the muscles, ex- tending often from the forehead to the back, and some- times involving the temples, the patient should be as much 1 as possible in the open air, and should use the shower- bath every morning. When the form of headache is ac- companied with tenderness of the scalp, and acute pain on pressure, indicating an affection of the immediate - covering of the bones, or periosteum, — besides exercise ! in the open air, the head should be shaved ; and washed 1 twice a day, namely, morning and evening, with cold • water; and afterwards gently rubbed with a towel for ten u or fifteen minutes. The residence of the patient should be in a dry, somewhat elevated situation; and quietude of mind should be maintained. When the pain in the forehead and the back of the head is obtuse, and accompanied with a sensation of torpor and 5 oppression ; and when this occurs in weak and irritable per- sons, besides the necessary medical treatment, which ought a" not to be neglected, all mental application should be sus- l pended, and cheerful society cultivated ; the diet should be ;i: moderate, and the utmost attention paid to the condition of ;; the bowels. Exercise and the shower-bath are as essential i! in this as in the other varieties of headache. Lastly, in what is usually termed sick headache, denoted by either acute or dull pain over the left temple, with some tenderness of the part, throbbing, and an incapacity at the if time for any mental exertion, the whole arising generally re: 58 INTRODUCTION. from indigestion, or some error in diet, previous to the occurrence of the headache, it is scarcely necessary to say that prudence in diet, both with respect to quantity and quality, should be observed. Long fasting, excess of wine or any stimulant, protracted sedentary occupations, hurry of business and anxiety, should be known to be exciting causes ; and, consequently, as far as possible, avoided by those predisposed to sick headache : in a few words, the duty of the head and the feet should be equally balanced. Proper diet and exercise, cheerfulness of mind, and agree- able social intercourse, will do more to regulate the stomach and bowels, in those predisposed to this form of headache, than any plan of medical treatment which can be suggested. Should it, however, become periodical, as frequently hap- pens, medical advice must then be taken, and the rules laid down strictly observed. DISEASES OF THE CHEST. There is little difficulty in recognizing diseases of the chest; but it is important to distinguish between a cough, which confinement to the house and spare diet may remove, and inflammation either of the lining membrane of the breathing tubes or the substance of the lungs, or of their covering membrane, or of that membrane (pleura) which lines the cavity of the chest: all of which demand the im- mediate aid of the physician. When cough is accompanied with fever, pain in some part of the chest, increased on drawing a deep breath, and causing embarrassment of breathing, with viscid, rusty- coloured expectoration, inflammation of the substance of the lungs [Pneumonia) may be suspected. In such a case, medical assistance should be immediately procured. In no disease is attention to the orders of the medical attendant so essential for insuring the safety of the patient. In the convalescence, also, from few diseases are pro- phylactic measures more necessary than in that after in- flammation of the lungs. Whatever can protect the patient from the exciting causes of the disease is important; hence, clothing in flannel next the skin ; avoiding exposure to cold ; refraining from singing, or from much speaking ; and RECOGNITION AND PREVENTION OF DISEASES. 59 from excesses in diet; at the same time, regulating the exercise so as to insure the daily movement and evacua- tion of the bowels, must be strictly observed. A wash- leather waistcoat worn over a flannel one has been much recommended ; but I am of opinion that a moderately thick, knit, woollen waistcoat is preferable, as it is a worse con- ductor of heat than leather. This lion-conducting property is that which aids in maintaining the temperature of the body. These remarks apply to both sexes ; and it is scarcely ne- cessary to condemn the bare necks and the exposed chests, which fashion imposes on Jadies in evening visiting, in indi- viduals who have had an attack of inflammation of the lungs at any period of life. Sponging the chest every morning with tepid vinegar and water, gradually lowering the temperature and employing friction with hair gloves or a rough towel, are most advantageous. Those who are very liable to repeated attacks of the dis- ease should either confine themselves to the house during the winter and spring, or should change their residence at these periods of the year to a milder climate. When expense is no object, the best places for such in- • valids are Madeira, the island of Bermuda, Lisbon, Malta, r or the Barbary coasts of the Mediterranean : but for those who cannot afford to visit such distant climates, some, although not the same, advantages will be obtained by passing the winter at Torquay, in Penzance, at Under Cliff in the Isle of Wight, or Cove near Cork.* When spitting of blood (Hcemoptysis) occurs, and has been checked, the treatment is not to be regarded ; for it is as requisite to prevent the return of the bleeding as to sup- j press it when it is present. The medical treatment in this , case does not require to be mentioned here ; but the pro- phylactic measures not of a medical character are of much . importance. These are change of residence to a milder , situation, when the hsemorrhage is one of activity of the cir- ji< * [To consumptive patients from the United States, the best places of re- -sort are the West Indies, or Florida ; and that to be preferred, in every re- spect, is the island of St. Croix, as combining a delicious climate, good ac- 1 commodations, and those attentions so necessary to the invalid.] ': 60 INTRODUCTION. culation, or to a colder when it is passive, from debility ol the habit. In both, a tranquil state of the mind, with light diet, are essentials. When Croup (see Chap, ii.), has attacked any member of a family, the probability is that it may return, and again attack either the same child or some of the other children: prophylactic or preventive measures are, consequently, of great importance. Such children should be regularly sponged with cold salt-water, or vinegar and water, every morning; they should not be over-clothed, although flannel next the skin is essential for them in winter and in early spring ; and, although they should not be out of doors during east winds, yet they should not be wholly Confined to the house, nor inhabit hot rooms. Their diet should be nutritive, but of a light kind ; and no fermented liquors allowed. When the breathing of such children be- come affected, or when any symptoms of croup present themselves, an emetic should be immediately adminis- tered ; and the medical attendant instantly sent for, with* out waiting to see the result of its administration. The prevalence of Consumption of the lungs (Phthisis), and the numberless victims which sink under it yearly in this country, render the consideration of measures for its prevention a matter of paramount importance. Long observation has fully established the hereditary nature of the disease ; but, notwithstanding this fact, it would be a visionary idea to suppose that a knowledge of it, widely diffused, would check intermarriages with con- sumptive families, when we find that even the frightful in- crease of insanity from this cause has no influence in checking such alliances. It has been supposed that the intermarriages of the consumptive with the healthy would have a tendency to diminish the evil; but, admitting this, they would not altogether remove it; for it is a well-known fact that a consumptive mother is capable of entailing the disease on the children of a healthy father. But, although the efforts to check the extension of consumption, by re- commending an inquiry into the health of the family with whom a matrimonial connection is about to be formed, is not likely to prove effective, yet it is a matter of duty to RECOGNITION AND PREVENTION OF DISEASES. 61 proclaim the truth, that " intermarriages among the colla- teral branches of the same family tend more than anything else to fix, to multiply, and to aggravate hereditary predis- position."* * As children must therefore be born with a predisposition to Consumption, our object should be to make the best of such constitutions, and to place the children in circum- stances calculated to keep the disease, if possible, at bay. If the mother be of a consumptive habit, a young, healthy nurse should be procured for the child ; but the rrurse should live in the family, and her habits should be regu- lated, both in reference to her own health and that of the infant. Nothing is more injurious to an infant thus situ- ated than an attempt to bring it up by hand ; on the con- trary, the period of lactation should be extended to twelve or even to eighteen months. During this period, any ad- ditional food, when the nurse is a stout and healthy woman, should not be given to the infant until after four or six teeth have protruded; and, even after this time, the diet should consist almost solely of milk and farinaceous matters. The quantity should never exceed that which the stomach can properly digest, the criterion of which is the healthy condition of the alvine evacua- tions. The nurse requires almost as much care as the infant. Her diet should be nutritious, but not stimulant. When a nurse is highly fed, the digestive function suffers ; especially if she does not take sufficient exercise daily in the open air, or if she is permitted to ^ad the indolent life so commonly followed by the pampered females who hire themselves out as wet-nurses. All infants, especially those predisposed to Consumption, should have the extremities, the shoulders, and the chest warmly clothed. The function of the skin must be kept in a healthy state by baths ; which should be tepid when the child is young, and gradually cooled as it advances in age. In summer, indeed, the child should be plunged into cold water, after the body has been well rubbed with a coarse * Dr. Mason Good; Studv of Medicine, vol. v., p. 35. 6 62 INTRODUCTION. flannel glove. No child predisposed to Consumption should sleep in a bed with curtains, or in small or lll-ven- tilated rooms ; and in summer, if too young to walk, he should be curried out; or if older, be made to take ex- ercise in the open air, before breakfast. As he grows, the nature and quantity of the food should be regulated according to his digestive powers. Animal food should not be given until he has teeth to chew it, and then care must be taken that it is well masticated. If physical exertion be of much benefit to all children, it is most essential to those of consumptive parents ; and, until ten or twelve years of age, no distinction in the kind of exercise should be made in reference to sex. The same unrestrained freedom of play admitted to boys should be encouraged in young girls. In both sexes, at this time of life, book education should not be pushed, nor the mind worked even to the extent of its powers. In consumptive children, the intellect is often precocious; but, on this account, it should be restrained. The sedentary nature of the education of young girls is peculiarly injurious : the extremities are chilled, conges- tions take place in the chest, and the seeds of Consump- tion are sown, when no hereditary predisposition exists. The time devoted to accomplishments, especially music, in the present system of female education, is too great; and every excess in this respect produces a correspond- ing deficiency in that bodily exercise which is not only conducive to health, but essential for preserving it. Be- sides the influence of over-study# in abridging the ne- cessary bodily exercise in young females, there are circum- stances connected with dress equally adverse to the free- dom of that degree of muscular action which is so requisite to preserve health and to ward off Consumption. Stays, tight lacing, and a constrained, stiff, erect position, are all alike injurious; and the consequences are sufficiently obvious: the individuals, instead of acquiring vigour, and firmness of body, at the age of puberty, are pale and thin ; the pulse is feeble, the tongue furred; the bowels are torpid or irre- gular in their action ; the skin is dry and harsh, and the breathing hurried and embarrassed on the least exertk)" RECOGNITION AND PREVENTION OF DISEASES. 63 In such a condition of habit, if the slightest predisposition to Consumption exists, the disease may be lighted up by exposure to cold, or to over-exertion, or any other of its well-known exciting causes. Such are the most prominent precautions to be observed in the physical education of those predisposed to Consumption : attention to them, and avoiding those circumstances likely to awaken latent tuber- cles* into an active state, are the only means of prevent- ing the disease.f It has erroneously been supposed that public speaking, or reading aloud, is injurious to those who have a ten- dency to Consumption ; on the contrary, by giving move- ment and, as it were, exercise to the lungs, it tends to ward off the disease. It is only after Consumption has, to a certain degree, produced organic changes on the sub- stance of the lungs, that speaking or recitation proves hurt- ful. The object of this volume, as I have already more than once stated, is not to enable its readers to act as their •• own physicians, when disease is present; but, in the case of Consumption, I feel authorized to break through this in- r tention, to a certain extent, and to recommend the fre- , quent use of a Sulphate of Zinc emetic,J in the morning, t whenever the disease displays itself, however slight the . symptoms may be. As it is not intended to point out the distinctions between diseases resembling one another, the characteristics which separate Palpitation connected with a highly nervous state ,'. of the habit, and Palpitation depending on organic diseases, ; must be left to the physician. When the former is the cause, the medicinal treatment will be greatly aided by the shower-bath friction, mild unstimulating diet, cheerful : society, and change of scene : when the heart is suffering j * Tubercles are small, round, flattish, grey or yellow, somewhat trans- 1:" parent bodies, deposited from the blood, on mucous and serous membranes. tr They enlarge and soften; and destroying the structure of the part where fc they are deposited, cause ulceration, with all its accompanying evils. I"' f [This subject is most judiciously treated in Dr. Brigham's work on Men- c tal Excitement, and the evils of over-stimulating the mental faculties of the young, fully pointed out] ;• * The dose for a man is half a drachm ; for a woman, a scruple; for chil- dren under sixteen years of age, fourteen grains. 64 INTRODUCTION. from some organic affection, *the quantity of food should be greatly diminished ; and it should be of the least stimu- lating description, chiefly vegetable and farinaceous. In the last case, after the Palpitation is overcome, all corpo- real exertion beyond the most moderate limit should be avoided. Although affections of the Spine are regarded as alto- gether within the province of surgery, yet they are often the consequence of general disease ; and, when they occur, they often are the predisposing causes of affections of the chest. Whenever the smallest indication of their presence is obvious, the strictest attention should be given to the diet and regimen of the patient, and every step taken to improve the general health and to augment the tone of the habit. Friction, gentle exercise, sea-bathing, and the use of the tepid or the cold shower-bath, according to the na- ture of the peculiar case, are the means most likely to prove effectual in warding off the attack. AH mechanical props and supports are hurtful; and although the patient should lie down, when at home, yet daily exercise should not be neglected. Young girls ought not to stand long, nor be forced to sit long at a time at the pianoforte. Whatever can augment strength, must be adopted. AFFECTIONS OF THE DIGESTIVE ORGANS. When that state of the digestive organs, which is termed Dyspepsia, has once occurred, it is most likely to display itself again, if the exciting causes be not avoided ; namely, indolence, much indulgence in sleep, sedentary occupations, hot rooms, the too frequent employment of the warm bath, and the habitual use of narcotics, spirits, and malt liquor. The period of taking food, in those who have suffered from, or are predisposed to, Dyspepsia, should be regular, and the intervals between the meals not too long protracted. Constant attention to keep the bowels free from costiveness is essential. _ But, for warding off Dyspepsia, attention to the condi- tion of the mind is of as much importance as to that of the body. It should be kept tranquil; for nothing is so likely to bring on a recurrence of the disease as a fit of passion, RECOGNITION AND PREVENTION OF DISEASES. 65 or anxiety, or ewn intense study, especially soon after a meal. The influence of the mind on the digestive organs indeed, has been generally observed: Shakespeare has taken advantage of the fact when he makes King Henry the Eighth, in giving Wolsey the schedule of his ill-gotten wealth, express himself thus — —■---- Head o'er this (giving him papers), And after, this ; and then to breakfast, with What appetite you may. Those predisposed to Dyspepsia should avoid exposure to a cold and moist atmosphere. Some details with respect to food, as a preventive of in- digestion, will be found in the chapter on diet; it is only necessary to mention here, that the quantity of the food should be proportioned to the power of digestion, even when the appetite is craving. In certain conditions of the stomach, pain, flatulence, and general uneasiness, almost always succeed a meal. As it is not my intention to lay down rules for curing the disease, it is only necessary to state here, that nothing tends more to produce a morbid condition of the stomach than over-stimulant diet. Nearly the same effect results from a deficiency of food, and pro- tracted fasting. Dyspepsia has also been induced by the mistaken idea that vegetable food is unsuited to a weak stomach, and the consequent exclusive use of an animal diet. This error has often led to more serious diseases of the stomach than Dyspepsia can ever engender. If a mixed diet cannot be borne, the stomach must be regarded in that condition which demands medical attention. Exercise is not less important than attention to diet in warding off Dyspepsia: but it must be that kind of exer- cise in which every part of the body shares, equal to the strength of the individual, and it should be continued long enough to excite perspiration, although not to cause fatigue. It should be taken before breakfast and before dinner: and, whatever may be its kind, it should be out of doors, and connected with some pursuit which can interest the mind, such as botany, natural hist iy, gardening, hunting, cricket, or any other amusement. It should always precede a meal; but a sufficient time should be allowed to intervene, be- 6* 66 INTRODUCTION. tween it and the meal, to take off' any sensation of tatigiie before eating. In winter, when the morning walk cannot be taken, friction with a hair-glove over the body should be substituted, exercising especially the arms. The studi- ous should relax their application to study for some time after a meal. The hours of sleep should be diminished, and the patient should rise in the morning the moment he awakes, and sponge the body with cold vinegar and water, or use the shower-bath. Whatever may be the form which Gout assumes, it is always more or less connected with disease of the digestive organs ; and, assuredly, in no disease is the preventive management so essential and productive of so much benefit as in gout. The primary object, even should there exist a predisposition to the disease, is to withhold all redun- dance of nutrition ; but at the same time to sustain the vigour of the habit; and to avert, as much as possible, any tendency to inflammatory excitement. This assuredly is the best method of correcting the strong hereditary predis- position which often exists.* Too spare diet, and exces- sive or fatiguing bodily exercise, are not only unnecessary, but they often prove as injurious as the opposite extreme. The object is to prevent that condition of the habit which is termed plethora, and to obviate it as soon as it displays itself. To prevent plethora, every tendency to fulness from diet must be shunned : animal food should be mode- rately taken, and all fermented liquors most sparingly in- dulged in, if at all allowed. The proportion of both must be moderate, in the ratio of the bodily exertion, or of the exercise daily taken. No error is so hurtful as the idea that wine, in gouty subjects, is necessary to keep gout from the stomach. As wisely might a man set fire to the floor of his room to warm himself. Exercise in the open air should be daily taken ; sufficient to promote, at least, both the appropriation of the nutritive, and the excretion of re- dundant matters, as well as to maintain the due balance of the circulation. When these are attended to, little assist- ♦ Dr. James Gregory was hereditarily predisposed to gout; his f>dnitiiii which is carried downwards, rapidly, by the aid of the diluent. When the Cathartic is given in the form of pill, the operation is always long of commencing ; in which case, diluents are not required until after the first evacuation. In every case of acute disease, the evacuations should be preserved for the inspection of the Physician ; but not in the sick-room. I have, occasionally, witnessed nurses and attendants in the sick-room giving only half the dose of the purgative prescribed, under the idea that the strength of the pal '.»«• Was inadequate to a fujl dose. But it should be known that a specific action is intended by the administration of a large dose, and less hazard is likely to result from its in- fluence where a full evacuation is required, than from the irritation excited by a small dose. If the Physician cannot be trusted to regulate the dose, he is inadequate to the treatment of the case. [Injections. —This mode of purgation is now very gene- rally employed in our large towns, but a great prejudice still exists against its use, among many persons from a fas- tidious delicacy. In consequence of the improved apparatus now made and to be procured at all the surgical instru- ment makers, the administration of these, remedies is at- tended with much less difficulty than formerly, and hence much of the objection to their use is obviated. They are of almost indispensable utility where it is desired to open the bowels as speedily as possible, or where the stomach will not bear the administration of a purgative by the mouth, where it is of importance to make a direct application to the lower bowels, as in dysentery, colic, &c. In cases where it is wished merely to open the bowels, an injectio' of tepid water will be found sufficient; where a more active purgation is required, the addition of table salt and sweet oil to the water will, in most cases, induce a full operation. In all cases a patient should be directed to retain the injec- tion as long a time as possible, and not to endeavour to ADMINISTRATION OF MEDICINES. — DILUENTS. 181 empty his bowels immediately after the reception of the medicine. Where a large injection is to be given, the self- supplying syringe should be employed for obvious reasons.] Demulcents, prescribed in cases of Catarrh, are usually ordered to be taken ad libitum. They should be slowly swallowed ; for much of any beneficial effect which they produce arises from their lubricating the throat and the gullet; and this soothing effect is communicated by sym- pathy to the lining membrane of the pulmonary tubes, with which the mucous covering of the throat is continuous. When cough is present, they should be taken after coughing; for, as that spasmodic effort throws off the acrid secretion formed on the inflamed mucous surface, the condition of • he. membrane is then more likely to be benefited by their influence than at any other time. Diaphoretics, medicines calculated to cause sweating, re- quire their effect to be kept up by the free administration of tepid fluids or diluents ; hence the day-time is suited for their employment; but, as there is always a tendency to spontaneous perspiration early in the morning, that is the best time for their administration. The system is also then more easily excited, and the surface more readily relaxed. During their action, confinement to bed is essen- tial; but the bed-coverings should be light blankets, as these are the best non-conductors of heat; and heavy cover- ings tend to check perspiration. The shirt of the patient should also be either flannel or calico. No cold liquids should be drank when the perspiration is flowing ; and tepid diluents should not be acidulated when James'spowder or antimonials are prescribed. When it is proper to mode- rate or to check the sweating, the invalid should be moved from the moist bed, covered with a dry blanket, and then dried with soft warm towels ; whilst every exposure to cold air must be carefully avoided. , Diluents are required in all acrimonious states of the con- tents of the alimentary canal, whether arising from diseased bile or other acrid secretions, such as accompany fevers ; and in diseases of the urinary organs. Water is the best of all diluents, as it is the basis of all of them ; the tempe- rature should be different according to the condition of the 16 182 CHAPTER IV. patient, when diluents are prescribed as adjuncts to dia« phoretics ; when they are intended to aid diuretics, they should be cold. Water between 60° and 70° Faht. merely dilutes; I.<•- tween 45° and 60° it affords tone to the stomach ; between 70°, and as high a temperature as it can be drunk, it stimu- lates. When the stomach is irritable, the temperature of the diluent should be about 70° ; and, when heartburn is present, it should be taken as hot as it can be drunk. In all febrile affections, especially those accompanied with eruptions, diluents may be used at the discretion of the Invalid. Diuretics. — When these are prescribed, the surface of the body of the Invalid should be kept cool ; otherwise they are apt to operate as Diaphoretics, and cause sweating, instead of augmenting the secretion of urine. On this ac- count, the patient should be kept out of bed, and the diu- retic medicine administered only during the day-time. Their influence will be also increased by exercise and by friction within the limits necessary to cause perspiration; and, during their administration, the free use of cold diluents, of which soft water is the best, is essential. Emetics. — When Emetics are ordered, friends and at- tendants frequently interfere, and beg that the Emetic may not be too strong. Now it should be known that, unless the dose of the Emetic substance be sufficient to cause full vomiting, the effect will not take place ; but simple nausea, great anxiety and restlessness, are likely to follow its ad- ministration. After the emetic has been swallowed, the patient, if able, should walk about until the first act of vomiting takes place ; after which, but not till then, a large draught of tepid water should be drunk ; and the same should be repeated after each successive act of vomiting, until the water comes clear off the stomach. Some caution, however, is requisite not to carry the supply of water to excess ; for, when the stomach is oppressed with fluid, the muscles essential to effect full vomiting are not called into action ; and the stomach is in danger of laceration, if any disease exist in it. The quantity of tepid water for an adult should be two-thirds of a pint at a draught: and, ADMINISTRATION OF MEDICINES.—EXPECTORANTS. 183 when the stomach is weak, some bitter infusion—'for in- stance, that of Chamomile flowers, or a few drops of solu- tion of Ammonia — in the water, will render the action of the Emetic easier and safer. When the operation is com- pleted, a dessert-spoonful of Brandy, in a wine-glassful of cold water, will rapidly check any nausea which may re- main. But if the vomiting continue obstinate and severe, a tea-spoonful of Magnesia in a glass of Sherry wine ; or the common effervescing draught; or two or three minims of Creosote in a glassful of water, may be given.* Emetics should be administered at the time ordered by the medical attendant; but, when there is no immediate urgency, or when the period of the day for their adminis- tration is left to the choice of the patient, the evening is the best time. This will be readily understood, when we re- flect that the body is always more or less exhausted by the operation of an Emetic, and that the disposition to sleep, which necessarily follows such exhaustion, may then be in- dulged. Expectorants, or Pectoral Medicines, are supposed to pro- mote the expulsion of mucus from the air tubes, in dis- eased conditions of the lungs. It is of little consequence to examine whether this opinion is correct; or to explain the distinction between those substances wdiich operate topi- cally upon the diseased membrane, and those which pro- duce their effects by a nauseating or a sedative influence upon the system. It is too common to prescribe this class of medicines, in Coughs and in Catarrh, without consulting the Physician ; but, as many of the articles contained in it, especially those frequently employed as domestic medicines, are stimulants, much mischief may result from their indiscriminate use. When Expectorants are prescribed, the following rules * [These directions for calming the stomach are applicable in but few cases in which an emetic is required, and if followed might produce mischief, where there is a previous irritation of the stomach, which is, of course, in- creased by the action of the emetic; in all cases, a warm poultice to the pit of the stomach, or if this is not found sufficient, ;i spice plaster, or even a mustard poultice, will be found fully adequate to restrain the vomiting, and to calm the stomach, without the administration of the stimuli ordered in the text.] 184 CHAPTER IV. should be observed in their administration. 1. The sur- face of the body ought to be kept moderately warm, even in a breathing perspiration. 2. The use of fluids, or what- ever can excite the kidneys, should be refrained from. 3. The use of Purgatives must be avoided, expectoration being invariably checked when purging occurs. Excitants, or Stimulant Medicines, are usually prescribed in low conditions of the habit, when a sudden and power- ful impression is required to be made upon the brain and nervous system. They are, however, too apt to be re- sorted to on every occasion of flatulence or of pain in the bowels; and they are also not unfrequently employed where tone or strength is required to be given, but where excitement would prove injurious. But it should be un- derstood that action is not strength. There is, indeed, no class of medicines which requires more decidedly the authority of the Physician for their administration than Ex- citants ; and, when they are prescribed none require to be given so regularly according to the direction of the pre- scriber. Narcotics.—When Opium, or any other article of this Class, is prescribed, the exact dose ordered should be given ; otherwise, instead of causing sleep, if the dose be diminished, a stimulant effect only will be obtained; or, if a larger dose than that prescribed be ventured upon, a poisonous action may ensue. No medicines are so much modified in their action by custom and idiosyncracy as Narcotics ; both of which should be always noticed to the physician. Thus, when they have been long and frequently taken, they lose their influ- ence in disease ; and if this custom be not mentioned to the prescriber, it is not likely that the dose of the Narcotic pre- scribed will be productive of benefit. But, by mentioning it to the prescriber, he may order another Narcotic which will produce the desired effect; the inefficiency of one Nar- cotic, arising from custom, not extending to other Narco- tics. Any singular influence of a Narcotic upon the system of the Invalid should always be mentioned to the medical at- tendant. In some persons, furious delirium, in others, con- ADMINISTRATION OF MEDICINES. — TONICS. 185 vulsions, follow the administration of Opium ; hence these effects should be made known to the prescriber. With respect to the period of the day for administering Narcotics, if they are intended to allay pain, they may be given at any time, and repeated at short intervals, without risk, whilst the pain continues ; but as soon as it abates, their continued administration would prove highly inju- rious, if not dangerous. The author has administered up- wards of eight hundred drops of Laudanum in twelve hours, during the passage of gall-stones, without any other effect than that of relieving the excruciating pain under which the patient was suffering ; and much greater quantities have been administered by others in similar cases. In prescribing Opium, or its preparations, as Soporifics, it is customary to order the dose to be taken at bed-time ; but, if there is no reason for strictly following this direction, the later in the night the opiate is given, the more likely is it to procure sleep, and the less likely to operate as a stimulant. Sedatives differ from Narcotics in their action, by depress- ing the nervous energy without inducing any obvious, pre- vious excitement. The greater number of them are too powerful medicines to be intrusted to the discretion of the attendants of the sick-room. Tonics, as far as refers to the business of the sick-room, are generally prescribed to restore the tone and vigour of the body, after the disease which has caused the debility is removed. Those which are of a mental character, namely, Hope and Confidence, are in the hands of the attendants of the Invalid, and should never be lost sight of in the ma- nagement of disease. A cheerful countenance and a con- fident manner have a powerful influence in assuring the mind of the Invalid, and, consequently, in confirming his returning health. When antiperiodic Tonics — for example, Cinchona Bark or any of the salts of Quinia, or the Arsenite of Potassa — are ordered in agues, it is during the intermissions that they prove most useful. One dose should always be given about half an hour before the anticipated return of the cold stage of the paroxysm. In Remittent-fevers, if Tonics be neces- 16* 186 CHAPTER IV. sary, they are properly directed not to be given until the remission is complete ; but the attendant in the sick-room should be able to ascertain this fact, or much mischief may follow their administration. A remission may be recognized by the skin feeling cooler, and being covered with a mode- rate perspiration; the pulse becoming softer and less fre- quent ; and nausea or vomiting, if either accompany the fever, abating ; whilst the mind becomes rational and tran- quil. The more decided, and the longer this state conti- nues, the more properly may the Tonic be administered. I have already endeavoured to enforce the necessity of adhering strictly to the directions of the Physician or medi- cal attendant; but, at the same time, some discretionary power, respecting the administration of medicines, must be reposed in the attendants of the sick-room. In exer- cising this power, however, any change which maybe made, as well as the reasons for making it, should be reported to the Physician at his next visit. If, for example, a medicine should excite vomiting, and this effect, which was not anticipated in prescribing it, should continue, nothing would be more improper than persisting in its administration ; hut if, either from the taste of the medicine being disagreeable, or the caprice of the patient, a medicine be discontinued, it would display a defect of that firmness of character which every good nurse or efficient attendant in the sick-room should possess. In every sick-room, the medicines only which are ac- tually in use, or to be used during the day, should be left on the table of the Invalid ; and no medicine should be poured from any phial which is not labelled. The same spoon or the same glass maybe employed in administering the same medicine during the day ; but every new or different medicine should be given in a clean spoon or a clean glass ; and every spoon and glass placed upon the medicine-table should be cleaned in the morning, although no change in the medicines is ordered. After pouring out the dose of medicine fron a bottle containing more than one dose, the lip of the bottle should be wiped ; and the bottle corked, before it is replaced upon the table. These little attentions are necessary, not only on account of the neatness and ADMINISTRATION OF MEDICINES. 187 order which should always prevail in the sick-room, but also to prevent the evaporation of any volatile ingredient in the medicine, or any change in it from taking place owing to the action of the atmosphere. To illustrate the necessity of this precaution, let us suppose that a medicine contains in each dose four minims of Prussic Acid, and that the bot- tle is left uncorked for four hours, the interval between the administration of the doses. In such a case, the next dose would most probably contain little more than two minims of the acid; hence the effect intended could not be produced; and the Physician, being unacquainted with the cause of the failure of his anticipations in prescribing this powerful medi- cine, might be induced to order an increase of the dose greater than the condition of the Invalid can admit with impunity. Again, if a bottle containing a mixture of a solution of Sulphate of Iron and Bicarbonate of Soda, form- ing a Protocarbonate of Iron, which is an active and power- ful Antispasmodic and Tonic, be left open, the active Pro- tocarbonate will be decomposed, whilst a Sesquioxide of Iron, which is nearly inert, will be formed, and the efficacy of the mixture be diminished, if not altogether destroyed. In almost every acute disease, the Physician derives much information from the character of alvine and renal evacuations; these should, therefore, be kept for his inspec- tion ; but they ought not to remain in the sick-room. The urine may be preserved in a glass goblet, which should be extremely well cleaned every time it is used, as very little tends to alter the appearance of that secretion. In pulmo- nary affections, the sputa or expectorated matters should also be kept in a clean vessel, such as is made for the pur- pose, and of which there should be always two in the sick-room. The importance of inspecting the expecto- rated matter is greater than is generally supposed : its character not only assists the physician in determining the nature (diagnosis) of the affection of the chest, but it is highly instructive, also, as a prognostic guide. Besides the proper administration of internal medicines, much of the business of the Sick-room, and much of the benefit to be derived from the skill of the Physician or the Surgeon, depend on the assistance which he receives in the 188 CHAPTER IV. employment of topical means ; namely, in Blood-letting and Cupping ; the application and management of Leeches, Lo- tions, Sponging, the Cold Affusion, the Shower Bath, other Partial Baths, and General Baths ; Fomentations, Poultices, the application of Frictions, simple and with the aid of dif- ferent substances ; Sinapisms, Blisters, Issues, and Setons; Rubefacients, Cauterants, and Bandages ; the mode of ap- plying and using all of which should be understood by nurses and by every attendant in the sick-room. When [Hood-letting is ordered, every thing required for the operation should be at hand. The ligature for tying the arm, so as to obstruct the flow of blood in the veins below it, should be broad tape, or a soft old ribbon ; and the same may he employed for securing the pledget over the orifice, when the flow of the blood is to be stopped. The pledget or compress should be either a piece of lint or linen, folded into a square form, about an inch in dia- meter, and comprehending three or four thicknesses of the material. It is always proper to use a graduated basin for receiving the blood ; but, besides this, there should be one or two cups, to demonstrate the influence of the bleed- ing on the aspect of the blood. If the invalid be bled in bed, he should sit erect; if he be up, he should be placed erect in a chair. When the Surgeon is dexterous, there is little or no necessity for guarding either the bed or the clothes of the patient from the blood ; as the pressure of the thumb of the operator, placed below the point where the vein is to be punctured, should not be relaxed until the utensil for receiving the blood be conveniently placed for that purpose. A basin with a little tepid water, and a clean, soft towel, should be ready for washing and drying the arm, before the compresses and the bandage for pre- venting the further escape of the blood be applied. When a nurse or an attendant is not fully instructed in her duty, there is always considerable anxiety displayed to provide smelling salts and other means to obviate fainting. But, in many cases, much of the benefit of blood-letting de- pends on the fainting which it causes ; and the propriety of checking that effect should be left entirely to the Surgeon. No person should be present at this operation, nor should LOCAL BLOOD-LETTING. 189 any one attempt to hold the basin for receiving the blood who is apt to sicken or to faint at the sight of blood. The arm should not be used for several hours after the operation ; but, after twenty-four hours the bandage may be removed. If the bandage has been applied too tight, so as to arrest the return of the blood to the heart, the arm will swell and be in pain, in which case it should be slackened ; but it is preferable that the Surgeon should be sent for to remedy the evil. On removing the ban- dage altogether, if, instead of the opening being closed, the lips of the orifice appear swelled and red, or if any unusual appearance of the part present itself, the Surgeon should also be immediately informed of the circumstance. The same preparations are requisite when the blood is to be abstracted from the jugular vein ; but, besides the compresses and a bandage, a piece of adhesive plaster should be provided. Local Blood-letting is performed chiefly by Leeching and Cupping. Leeches are seldom properly applied or managed. The part to which they are intended to be applied, should be washed with a little soap and warm water, then with simple cold water, and, lastly, it should be well dried. If the part be hot and inflamed, the leeches should be put, for a few minutes, into tepid water; and this should be done, also, when they are to be applied in the mouth, or to any part of the body warmer than the general surface ; but, at all times, before they are applied, they should be dried be- tween the folds of a clean, soft towel. The easiest and best mode of applying them, is, first, to place the number to be used in a hollow made with the points of the fingers in a towel folded like a napkin ; then, so to turn the towel and the leeches upon the part where it is intended they should fix, that the towel will cover them. The hand must be kept over the towel, to prevent their escape, until they all bite, which usually happens in a few minutes: after which, the towel may be removed. By this method, twenty or thirty leeches can be applied more rapidly and with less trouble than two, when each leech is separately applied. If this plan, however, cannot be pursued, owing to the nature 190 CHAPTER IV. of the part to which they are to be applied— as, for exam- ple, the inner or outer angle of the eye — then the simplest method is to scratch the skin with the point of a needle, and to apply the leech to the spot moistened with blood. WThen they are to be applied within the mouth, or any open cavity, each leech should be put into a large quill, with its head towards the open end of the quill, which should be applied to the part, and retained upon it until the leech is fixed, when the quill may be gently withdrawn; but a thread should be tied round the tail of the leech when it is to be applied within the mouth, to prevent it from being swal- lowed—an accident which has occasionally happened, and has been productive of serious consequences. Leeches should never be forcibly detached, as their teeth* are apt to separate, and, being left in the wound, to cause an erysipelatous inflammation on the part. They should be permitted to drop spontaneously, which being the result of a temporary suffocation (asphyxia), all muscular energy ceases in the animal, and, the teeth shrinking, it drops off entire. A bread-and-water poultice, not too hot, should then be laid over the bites, to encourage the bleeding. The invalid should be kept warm in bed, when it is necessary to abstract a large quantity of blood. In general, the bites soon cease to bleed ; but, in some instances, a copious flow takes place ; and therefore, to prevent exhaustion, the poul- tice should be frequently examined. This exhaustion is more likely to occur in children than in adults; and, for the same reason, leeches should not be applied upon chil- dren late in the evening, unless they are very urgently required. It is also proper, in young patients, to select for their application a part which admits of pressure; for ex- * The teeth of the leech are attached to three liltle inflatable gums ; they are sharp, horny points, with which the skin is perforated. After the teeth are carried into the wound, the gums are inflated by the will of the animal; and, thus dilating the wound within, they form an instrument capable of supporting the weight of the body of the leech, even after it is gorged with blood. It is this endorsement, opposed by the definite dilatabihty of the outer skin, that obliterates the breathing vesicles of the animal, which are arranged on each side, between the stomach and the skin ; and the conse- quent compression of which causes suffocation ; and that destroying the muscular energy and volition of the animal, necessarily forces it to lose id hold and drop on". CUPPING. 191 ample, a part over a bone or any other resisting medium, as it is often very difficult to staunch the bleeding when the leeches have been applied to the abdomen or any unresist- ing part. W7hen leeches are ordered to be applied to young infants, the bleeding should be watched, and the bites in- stantly closed on observing the least appearance of sinking from loss of blood: the neglect of this caution has, in some instances, been followed by death from exhaustion. It should be generally understood that leeches will not bite, and are apt to fall off'after they are fixed, if any pecu- liar odour be diffused through the air of the room : as, for in- stance, that of the vapour of hot vinegar ; or that from lighting a candle with a sulphur match ; or from blowing out a candle; ortobacco smoke : neitherwill they bite if the per- son has been taking sulphur internally. Leeches are often applied, without surgical advice, to swellings of the breast during nursing: but they are in such a case, of little use. Indeed, as a general rule, leeches should not be applied in any case without the authority of the medical attendant. In order to preserve leeches for re-application, very litt'e salt should be used to make them disgorge the blood ; ard they should be immediately afterwards thrown into clean water, which ought to be repeatedly changed, at least three or four times. Instead of salt, a Tittle vinegar and water may be used ; or the leeches maybe merely stripped through the fingers, and then thrown into clean water. In order to preserve them, th" vessel should be only half full of water ; but the water ought to be changed once in eight days. When Cui)')'t commonly used warm. The most important and useful of these are the Hip-bath, the Foot-bath, and the Warm Douche or Douse-bath. a. The Hip-bath is intended to influence chiefly those organs which are contained within the pelvis, or bony frame at the lower part of the trunk of the body ; it is there- fore fashioned to admit only the hips; but at the same time to afford sup- port to the back (see cut). It may be employed with either cold or warm water. In either case, it should be recollected that the quantity of water should be only sufficient to fill a little more than one third of the capacity of the Bath; for, when more is used, the water rises when the bather sits down in it, and flows over the Bath, MANAGEMENT OF THE FOOT-BATH. 203 When this Bath is employed to soothe pain, the tempera- ture should not exceed 90° Fahrenheit; but the bather should remain half an hour or longer in it. When it is required to excite the womb to greater activity, when the monthly secretion is defective, the heat of the bath should be as high as it can be borne ; but the time of remaining in it should not exceed fifteen minutes. The evening is the best time for using the Hip-bath. b. Foot-bath. The Foot-bath is chiefly intended to cause derivation ; consequently it should be used as hot as itcan be borne, and always sufficiently hot to redden the skin of the parts immersed. The vessel should be deep enough to permit the water to reach nearly to the knees (see cut); and either woollen stockings should be drawn on immediately the limbs are taken out of the Bath and dried ; or the bed should be warmed, to ensure the full effect of the derivation which it causes. Salt, sometimes Mustard, is added to the Bath in cases of threatened Apo- plexy, or when a more than usual derivative effect is re- quired. In torpid states of the liver, a mixture of Nitric and Hydrochloric acids, in equal proportion, may be added to the water, which should be of a lower temperature than usual. The best proportions of the mixed acids are two fluid ounces for every gallon of water. The hands may be immersed in a similar Bath at the same time. When the Foot-bath is intended to assist perspiration, the legs should remain in it until the invalid feels faint. If the difficulty of breathing in affections of the heart (Hypertrophy) is considerable, the Foot-bath is frequently ordered for its relief. In using it, a blanket should be thrown around both the patient and the bath,'to promote perspiration ; but, at the same time, fresh, cool air should be admitted to the apartment, to satisfy the craving of the labouring lungs. If antispasmodic or anodyne medicines are ordered in such cases, the best time for administering them is whilst the patient is thus employing the Foot-bath. c. Hot Douche-bath, or Douse. An excellent Douche-bath 204 CHAPTER V. may be formed by pouring from a height, hot water from a tea-kettle, or through a tube about an inch and a half in dia- meter, so as to cause the fluid to strike forcibly upon the affected part of the body, whilst, at the same time, percussion is employed ; or in other words, the part is beaten by means of an India rubber bottle, stuffed with wool (see cut b), and affixed to a cane handle (a). The action of the natural Douche- baths, such as those of Aix, in Savoy, and some other continental watering places, which combine the influence of heat and percussion, is well imi- tated by this simple apparatus. A temperature of 1C0° is readily borne in douching. When the dis- ease is chronic Rheumatism, or when deep-seated pains are to be removed, the douching should he continued for either half or three quarters of an hour at a time ; and the patient should be afterwards placed in bed, between blankets, in order to encou- rage sweating. I have seen the most decisive ad- vantage, in enlarged, stiff, and painful joints (Nodosity of the joints), result from this mode of douching. The last mentioned disease has a close affinity to Gout, but differs from it in some particulars. In one case which came under my care, the patient was able, to throw away the crutches, which be had been forced to use for several years, after two month's employment of this mode of douching. In cases of complicated fevers, and in some other dis- eases in which inflammation of the brain occurs, the Cold Douche is frequently ordered. The mode of applying it has been already described : no percussion is required to aid its influence. It usually causes a most uncomfortable feeling at first; but the relief is so quickly experienced, that its repetition is generally requested by the Invalid. 3. General Baths. — When an order is given for the employment of a Bath, the medical Practitioner, too fre- quently, mentions merely the name of the kind of Bath which he wishes to be used ; it is, therefore, necessary that the patient, or his friends, should know7 the temperatures of the different Baths chiefly in use. A temperature of MANAGEMENT OF THE WARM DOUCHE-BATH. 205 from 60° to 70° Faht. constitutes the cold bath : from 75° to 85°-------------the temperate Bath; from 85° to 96°-------------the tepid bath ; from 96" to 98°-------------the warm bath; from 98° to 108°------------the hot bath ; The Vapour-bath produces effects equal to the Not breathed. Breathed. tepid, when the temp, is 96° to 106° 96° to 100° warm,---------------10C7 to 120° 100° 1o 110° hot,-----------------120° to 1G0C 110° to 130° a. The Cold-Bath, when it is ordered to be employed, is never so advantageous as when it is used in the open air, and especially in the form af sea-bathing ; but, when this cannot be obtained, a large Plunging-bath of salt-water, either natural or artificial, is an excellent substitute. The form of the bath is of little consequence, provided it be large, and the apartment in which it is placed be airy. As the intention of the Cold-bath is reaction, it is sel- dom that the constitution of an Invalid is sufficiently vigor- ous to admit its being used before breakfast, unless exer- cise, adequate to accelerate the circulation without exci- ting perspiration, be previously taken. But if the exercise cause a sensation of fatigue, the Cold-bath must not be em- ployed at that time. After breakfast, the habit is generally fortified to a degree sufficient to insure reaction. On en- tering the Bath, the trunk of the body and the head should be instantly submersed, and as much motion be maintained whilst the bather remains in the water as the size and the form of the Bath will admit; but the period of remaining in the water should not exceed five or six minutes; for, when this time is exceeded, the animal temperature is greatly lowered, and reaction is prevented. In such a case, dano-er may ensue ; and it is always to be dreaded when a long-continued chill follows the use of the Cold-bath. b. The Temperate-bath excites less reaction than the Cold- bath ; but the shock to the system is less ; consequently, it is better suited for delicate individuals; and it is also a useful preparation for the use of the Cold-bath, especially when, with delicacy of constitution, the Invalid dreads the shock 18 206 CHAPTER V. of the colder bath. It is also better suited to infancy than the Cold-bath. Some discrimination is necessary in judging of the pro- priety of using these Baths ; hence, even as a luxury, they should not be employed without the advice of the physi- cian. They may be regarded as hazardous for plethoric per- sons who have any tendency to bleeding at the nose, spit- ting of blood, oc where there is a predisposition, natural or acquired, to Apoplexy. Those, also, who have affec- tions of the heart, chronic affections of an inflammatory nature of the bowels, or loaded states of these organs, ought not to use them ; neither ought they to be employed in any instance in which, from delicacy of constitution, reaction cannot be anticipated. The authority of the Physician should, also, be obtained before using the Cold-bath in nervous affections, although in such cases it is, usually, clearly indicated ; and the same may be affirmed, in refer- ence to the use of the Cold-bath in the intervals of the Paroxysms of Asthma, in which it is always productive of the greatest benefit. Nothing is so serviceable, as a pro- phylactic in a tendency to affections of the skin, as the use of the temperate Shower-bath. c. The Tepid and the Warm Bath. — In disease, the Warm-bath should not be employed unless when ordered by a competent Practitioner ; but it is as often employed as a prophylactic or preventive agent as a remedial one. In perfect health, neither the Warm nor the Hot-bath should be resorted to as an indulgence : but, for the purposes of cleanliness, the Tepid-bath at 95° may be employed; and it is preferable to use it at noon, after the first process of digestion is over ; and, immediately afterwards, to take brisk exercise, in the open air if the weather be favourable. It will be found, also, extremely refreshing, employed in this man- ner, when a person is suffering fatigue from long-continued muscular exertion, or after travelling. In many individu- als a journey of several successive days is productive of febrile irritation, and derangement of the nervous system. Under such circumstances, the Tepid, or even the Warm bath, if the skin be unusually dry, and accompanied by rigors, may be regarded as the best means of warding off any sen- MANAGEMENT OF THE TEPID AND WARM BATH. 207 ous consequences. To the man of sedentary habits and in- tellectual exertions, and even to the proselytes of fashiona- ble dissipation, the Tepid-bath is equally serviceable. In such cases, the Bath, whether tepid or warm, should not be employed immediately after a meal, or when the person is much excited by wine. After using muscular exertion, also, the heat of over-exercise should be permitted to pass off; or, if the mind has been much excited, its tranquillity should be restored before using the bath. In some diseases, the use of the Warm-bath may be left to the direction of the friends or attendants of the patient; and it is often important to have recourse to it before the practitioner can arrive. This is particularly the case in the convulsions of children, whether depend- ing upon affections of the head, or on sympathetic irrita- tion in teething. It not only relaxes spasm, and relieves at the moment, but soothes nervous irritation. When the convulsions are very severe, cold water maybe applied to the head whilst the patient is in the Bath. Sprinkling cold water on the face of the child, while he is in the Bath, often tends to cut short the fits. In some diseases of adults, the same discretion maybe permitted ; for instance, in Lumbago, Sciatica, Colic, and all spasmodic affections unaccompanied with inflammation : but, whenever inflam- mation is present, nothing should be undertaken without proper medical advice. In one disease of frequent occurrence — namely, Dys- pepsia — the Tepid or the Warm bath, is, at all times, a safe auxiliary to other and more active measures. It must, however, be recollected that, in Gout, which is the at- tendant of Dyspepsia, when the patient is of a full or an apoplectic habit, the Warm-bath may prove deleterious ; and therefore it should not be unadvisedly employed. It is too generally supposed that the Warm-bath may be always safely used by those labouring under diseases of the skin; but this is, also, an error; and, instead of proving bene- ficial, there is much chance of mischief following its in- cautious employment. This is most likely to be the re- sult when these diseases occur in persons of full, gross habits. In pregnancy, much caution is also requisite, 208 CHAPTER V. whatever may be the apparent object for using the Warm- bath. Management of Worm-bathing.— Whatever description of Bath is ordered to be used, if no specific medical di- rections be given, it must be regarded as an invariable rule, that the original temperature be maintained during the whole time that the patient remains in the Bath. At the end of ten or fifteen minutes, therefore, the heat of the water should be tested by the thermometer, and, if requi- site, hot water added : and it must be recollected that no- thing is a more fallacious test than the sensations of the patient. The medium period for remaining in the Bath is twenty to twenty-five minutes; and this may be regarded as the rule, when no specific directions are given by the Doctor. In cases of infantile convulsions, the time must be regu- lated by the effect produced. Whether the Warm-bath is employed as a luxury, or as a preventive disease, the addition of salt to the water is alwrays serviceable ; but, in disease, neither salt nor any foreign impregnation should be used, without the order of a medical man. The simplest Warm-bath is one which the author in- vented some years since. It consists of a hammock (a) of an India rubber cloth, which is extended upon two long poles (6 6), passed through a broad seam on each side of the hammock, and kept asunder by the cross pieces (c), which are attached to the poles by the thumb screws (d d d). At one end of the hammock is an air pillow, U.-.E OF THE HOT AND VAPOUR-BATH. 209 which can be readily blown up ; and below it is a flexi- ble tube (f), made of the same material as the hammock, by which any water it may contain can be readily drawn off. When the poles are fixed, as in the above figure, and the open end of the flexible tube twisted round one of the thumb screws, the Bath is ready to receive the water. It may be supported upon two chairs, or upon folding tressels (e e). The advantage of this Bath is, that it requires a very small quantity of water, compared with that demanded for other Baths ; — that it requires no sheet for the bather to rest upon ; and, when the bathing is completed, the poles and the folding tressels can be placed aside in a small closet, or in the corner of a dressing room, and the hammock, when dried, put into a drawer. d. The Hot-bath. — This bath, being a most powerful stimulant, should never be unadvisedly employed ; and in using it, under any circumstances, it should always be recollected that, as the object is to arouse the nervous energy and the general vital action, the bather should never remain long enough in it to produce exhaustion. The average time for using it is from ten to fifteen minutes. e. The Vapour-bath. — More latitude may be permitted in the use of the Vapour-bath than of the water baths already noticed. It is applicable to all the cases for which the tepid and the warm bath are ordered ; and, when the Vapour is breathed, the extension of the heating medium to the lungs greatly augments its influence in procuring perspiration. The simplest and most useful of all Vapour-baths is that employed by the native inhabitants of Hindostan. The bather, stripped naked, is seated in an armchair; and a lar«-e, deep, earthen-ware jar, or a bucket, filled with boil- ing water, is placed at his side : the body of the bather, the chair, and the water vessel, are then enveloped with a blan- ket which is thrown over his head when the vapour is to be breathed ; or pinned under his chin when the vapour is not to be breathed. The body is soon involved in the warm vapour, and a copious sweat flows. Two bricks should be in the'fire ready to be thrown into the water, to renew the evolution of the hot vapour, should it be necessary to 18* 210 CHAPTER V. protract the continuance of the patient in the bath. Fric- tion may be employed whilst the Invalid is in the bath. This Vapour bath may be used in a sick-room without the risk of wetting the room or rendering it damp ; for, as the blanket involves both the bather and the hot-water vessel, it is folded up as soon as the operation is concluded, and carried out of the room. FOMENTATIONS. These may be regarded as a species of local bathing. Although the decoctions usually employed, such as those of Chamomile Flowers and Poppy-heads, are useful in aiding the warmth, by their soothing or sedative influence, yet they are secondary objects in the application of Fomen- tations, the intention being to convey heat, combined with moisture, to the part fomented. Flannel cloths, wrung out of boiling water, by means of two sticks turned in Opposite directions, form the best Fomentations. If they be shaken up, and laid lightly over the part, they involve a considerable quantity of air, which, being a bad con- ductor, retains the heat in them for a considerable time. In every process of fomenting, there should be two flan- nels, each three yards long, with the ends sewed together, to admit of the boiling water being wrung out of them ; and the one flannel should be got ready whilst the other is applied. The fineness or the coarseness of the flannel is not a matter of indifference : the coarser it is, the less readily does it conduct heat; and it retains its warmth longer; therefore, it is more efficient for fomenting. White flannel also retains the heat longer than coloured flannel. a. Stuping is a variety of fomentation useful in many cases, but especially in affections of the eyes. The Patient should be his own operator. He should sit up in bed, and should place, in the hollow of his hand, a small piece of flannel, wrung out of boiling water, and hold the hand at such a distance under the eyes that the vapours may rise to them, changing the flannel as often as it ceases to give out warm vapour. If narcotic or sedative additions are directed, a drachm of Tincture of Opium, or of Henbane, MANAGEMENT OF POULTICES. 211 or of Hemlock, should be poured hot upon the flannel each time it is changed. POULTICES. These are modifications of fomentations. They are made either of Bread and water ; or of Oatmeal and water; or Linseed-meal stirred into boiling water; or of Carrots mixed with Yenst; or of mashed vegetable matters, namely, Onions, Digitalis, Conium, Marsh-mallows, or similar sub- stances. . a. The Bread and Water Poultice, to be applied hot, is made by pouring boiling water over a thick slice of a wheiiten'loaf, from which the crust is taken, and which is placed in a hollow dish. It is softened by bruising it with the bock of a spoon ; after which it is spread upon a piece of rao-, and applied to the sore or the affected part. 6 °The Oatmeal Poultice is made by stirring, gradually, Oatmeal, added in small quantities, successively, into water kept boiling in a pan, until it is adhesive, and of a sufficient consistence ; that is, until it is thick enough not to run on the rag by which it is to be applied. [The Indian-meal Poultice is made in the same manner, and is an excellent substitute for it.] To the foregoing poultices, the addition of a little lam is useful, if the poultice does not require to be frequently changed. When the object, however, is to promote sup- puration, the poultice should be frequently renewed, in which case the addition of the lard is unnecessary. c The Arrow-root Poultice is made by mixing two or more table-spoonfuls of Arrow-root with a little cold water, in a basin, till it is all united with the water; and then adding boiling water, until the who e becomes a thick gelatinous paste. This poultice is admirably adapted for irritable, tender sores, where a soothing application is essentia^ ^ .)}seed_meal voullice combines all the benefit to be expected from the four foregoing Poultices The teste or husk of Linseed contains a large quantity of fixed oil, which is readily procured, by pressure, for the purposes of the arts and of medicine. When these seeds are made 212 CHAPTER V. into meal, the testa being ground with the kernel, the result is a meal containing much oil, mingled with farina; consequently, when the meal is made into a moderately thin paste, by stirring boiling water into it, a poultice pos- sessing the power of retaining heat equal to the others, and at the same time having a sufficiency of oil to keep it soft, is at once formed. [dd. Slippery Elm Poultice is made from the bark of the Slippery Elm, ground into a fine powder, and moistened with hot water. This poultice is excellent in cases of irritable sores, and where a soothing effect is wished.] e. The Carrot Poultice is made by bruising boiled carrots into a pulp, and applying it in the same manner as the Bread and Water Poultice. It is a useful application to old flabby sores, which it cleanses by stimulating them mode- rately ; whilst the saccharine matter of the Carrots, exciting some degree of fermentation in the Poultice, the fcetor of the discharge from the ulcer is corrected. f. The Fermented Poultice is prepared by mixing zpound of wheaten flour with half a pound of yeast, and then ex- posing the mixture to a gentle heat until it swells. It is useful in all foul, foetid, painful ulcers. g. The Onion Poultice is made in the same manner as the Carrot Poultice. It is highly stimulant, and is well calculated to induce suppuration in indolent tumors. An excellent poultice for advancing a blind boil to maturity is a roasted Onion, divided into two halves, and as much of the centre of one half taken out as will cover the torpid boil. It should be applied as hot as it can be borne, and frequently repeated. [gg- Charcoal Poultice. This is to be prepared from recently burned charcoal, reduced to a very fine powder, and mixed with either the Bread and Milk, or Indian-meal Poultice. It is very useful in foul ulcers. It should be frequently renewed.] h. Poultices of Foxglove (Digitalis), or of Hemlock (Conium), should be prepared with the Extract of these substances. Thus a good sedative Poultice may be com- pounded by mixing an ounce of the Extract of Hemlock with half a pint of tepid water, and adding as much Lin- MANAGEMENT OF FRICTIONS. 213 seed-meal as will render the Poultice of a proper consist- ence. These poultices allay the pain of cancerous sores ; but they should not be employed unless ordered by a Sur- geon. Poultices should never be heavy, nor very bulky, but they should be frequently repeated. They are useful, in all cases of inflammation which cannot be backed, to assist the suppurative process and the advancement of the matter to the surface.* After an abscess is opened, the Poultices should still be continued for a few days: but directions for poulticing are usually given by the Surgeon. Poultices may be used, also, as fomentations in Colic, and in Inflam- mation of the Bowels. In such cases, however, as the chief object is to allay pain and to soothe, they should be made with the decoction of Poppy-heads, instead of water. [As warmth and moisture are the principal effects of the simple poultices, an excellent substitute for them is lint, dipped in warm water, and laid over the diseased part; the lint should be covered with a towel, in order to pre- vent evaporation. This mode is much neater and more cleanly than any poultice, and where merely warmth and moisture are required, it will answer all the purposes in- tended.] 5. Frictions, whether simple or conjoined with Lini- ments, are frequently important aids to medical treatment. They are used also as prophylactic measures ; and, as has been already stated, before and after bathing. a. Simple Friction may be performed with the hand, con- stituting a species of shampooing ; or its influence may be augmented by covering the hands with either flannel or hair- gloves, or a flesh brush may be employed. If the friction be well performed — namely, by short, brisk strokes with the tip of the fingers, and with great celerity ;f when the naked hand is the agent; and if it be continued for an hour or upwards, and repeated several times a day — its influence in reducing swelled glands is astonishing. Nothing is re- * The most ancient poultice on record is mentioned in the Second Book of Kings, chapter 20, verse 7. It was employed for the relief of Hezekiah, who lived 200 years before Hippocrates. "And Isaiah said, take a lump of figs. And they took it, and laid it upon the boil, and he recovered." f At least 120 strokes should be made in the space of a minute. 214 CHAPTER L. quired, in such cases, to aid the friction, except a little hair-powder, or flour, to prevent abrasion of the skin. A considerable degree of heat is developed by the operation. It is difficult to determine whether the benefit is the result of the simple attrition, or whether something is not due to electrical influence excited by the friction. When friction is intended to aid the influence of the Tepid-bath, in causing perspiration, it should be used in the bath ; or immediately on emerging from it, after drying and placing the invalid between blankets. Oil or Lard, or some simple ointment, should be employed with the fric- tion.* In some instances, also, where the friction is in- tended to allay deep-seated pains, a Liniment composed of equal parts of oil of Turpentine and Tincture of Opium, or of ten grains of solid Opium dissolved by rubbing them in a mortar with ten drachms of Olive-oil, is a good addition to the friction. This Liniment is mentioned here because it may be employed in chronic pains, independent of the presence of any disease which demands medical attendance. About a dessert-spoonful of either of the Liniments, poured into the palm of the hand, may be used in each friction. In Consumption, the pains of the chest are often tempora- rily relieved by these opiate Liniments, combined with friction. When friction is intended to act as a simple Tonic, it operates chiefly by the warmth which it diffuses over the surface, and, partly, by equalizing the circulation. In order to insure these results, the use of the coarse flannel- glove or the hair-gloves are sufficient, without the aid of Liniments. The operation is most advantageous when per- formed immediately on getting up in the morning. The rubbing, with the palm of the hands, covered with the gloves, should be commenced over the stomach and abdo- men, and gradually extended to the loins and the back, as far as these parts can be reached ; for the Invalid should be his own operator. It should be extended, ultimately, to both sets of extremities. During the operation on the trunk of the body, the Invalid should move briskly about ♦ The Romans had a particular officer attached to their Public Baths. whose occupation was solely to apply ointments to the body on emerging from the Bath — hence he was called Unguentarius. MANAGEMENT OF FRICTIONS. 215 the room ; but, besides being well performed, the friction should be continued for half an hour, in order to render it useful. Friction, when performed in a gentle, slow, and equable manner, by producing a continued repetition of an agreeable impression on the nervous system, acts as a soother of pain, independent of any aid from opiate Liniments : — it also induces sleep. The beneficial influence depends, in a great measure, on its transferring the attention of the sufferer from the seat of pain, and confining it to the mild and agreeable sensation impressed by the friction. In perform- ing it, the operator should sit by the side of the bed, and, introducing the hand under the bed-clothes, rub the legs or the arms gently, with equally lengthened but slow move- ments. I might adduce many instances of the soporific influence of slow and gentle friction. When the Invalid is a child, its influence is more powerful when aided by a monotonous, but a soft tune, which, although it operates upon a distinct sense, yet, by combination, renders the friction more soporific. x When friction is intended to stimulate the surface, it is necessary to aid its influence with Liniments containing Ammonia, or Camphor, or some other excitant or acrid substance : but these should be ordered by the medical attendant. In applying them, the same method should be adopted as when simple friction is employed ; but the hand of the operator must be guarded by a glove from the in- fluence of the acrimony of the Liniment. ' Friction is, also, used to introduce various substances — namely, Mercurials, Iodine, Opium, &c. — into the body through the medium of the skin. The rubbing, in such cases, ought to be brisk, and applied with sufficient force to abrade slightly the cuticle ; and continued until the sub- stance, which is usually in the form of an ointment, disap- pears, owing to the absorption by the skin induced by the friction. In using such frictions, the hand of the operator should be guarded by a glove; otherwise he is likely to suffer salivation, or some other unpleasant result, from the introduction of the medicinal agent into his own system. 216 CHAPTER VI. CHAPTER VI. MANAGEMENT OF COUNTER-IRRITANTS--RUBEFACIENTS — SINAPISMS-- SUPPURATIVE OINTMENTS :--VESICATING OILS --BLISTERS--ISSUES--SETONS. MANAGEMENT OF DRY HEAT, BY STOMACH-PLATES-- SALT-13AGS--HOT BRICKS — MOXAS--CAUTERANTS. DOMESTIC MANAGEMENT OF ACCI- DENTS--BANDAGING. 10. Counter-irritants comprehend Rubefacients, Sina- pisms, Vesicating Oils, Suppurative Oint/ncnts, Blisters, Issues, and Sctons. a. Rubefacients. — These are substances which, in com- bination with moderate friction, redden the skin and excite pain upon the surface by stimulating powerfully the extreme nerves of sensation of the part to which they are applied. Many of them produce only a local action; the influence of other& is extended over the whole system. Something is due to the friction in the application of Rubefacients; consequently, the only instruction necessary for that pur- pose, is not merely to smear the skin with the Liniments, but to rub them into the part. As they are likely to affect the operator as well as the Invalid, his hands should be covered with leather gloves, or the Liniment should be rubbed on the part with a piece of flannel, which should be afterwards laid over it. Some Rubefacients require no friction. Of this descrip- tion is Ether, Camphorated Spirits, and Liniments of solu- tion of Ammonia and Oil. A rag, or, what is better, a piece of lint, dipped in Ether or in Camphorated Spirit, being laid upon the skin, and covered with a piece of oiled- silk, or even with the warm hand kept over it for a short time, to prevent evaporation, will redden the skin, and relieve slight internal inflammation, and nervous headache. The Liniment of Ammonia or Hartshorn and Oil, when used in incipient sore throat, ought not to be rubbed upon the skin of the neck, but should be spread upon a stripe of flannel, about six inches wide, doubled upon 'itself, then put round the neck, and covered with a silk handkerchief. By thus preventing the evaporation of the Ammonia, the Liniment operates as a powerful local stimulant, relieving SINAPISMS. 217 the internal inflammation ; whilst its sympathetic operation upon the nervous system causes perspiration, and abates the fever, which always accompanies sore-throat. An excellent method of reddening the skin, when it is requisite to maintain the counter-irritant effect for many hours, isto sprinkle some finely powdered Sal Ammoniac on a piece of leather, spread with soap-plaster. The Alkali of the soap gradually decomposes the Sal Ammoniac, which is a compound of Hydrochloric Acid and Ammonia ; and, setting the Ammonia free, the skin continues to be stimula- ted by it whilst it is evolved, which is as long as the de- composition goes on. When the effect intended to be produced is not required to be considerable, but to be long continued, a Warm-plas- ter applied to the skin will produce a rubefacient effect, and relieve slight internal pains. It is customary for non-professional persons to recom- mend Rubefacient Liniments in Rheumatism : but their in- discriminate use, in the acute form of the disease, may cause a translation of the inflammation from the part to which they are applied, to the lungs, the heart, the brain, or some other vital organ ; and fatal results may follow. But al- though they are hazardous in acute rheumatism, and ought never to be employed unless ordered by the Physician, yet in old, chronic rheumatic pains, Liniments of Turpentine, or of Ammonia and Opium, often relieve the pains, and sometimes cure the disease. b. Sinapisms. — These are most immediate and most active Counter-irritants ; they are Poultices containing a stimulating ingredient or acrid substance, namely, Flour of Mustard; hence they are termed Sinapisms. They are made by mixing equal parts of flour of Mustard and Bread crumbs or Linseed-meal into a paste, by means of hot Vinegar, if the flour of Mustard be made from the Yellow Mustard ; but with hot water only, if it be the Brown Mus- tard, such as is used on the Continent, which contains the husks as well as the farina of the seeds ; and which con- tains the elements of the acrid oil that is its active princi- ple. Vinegar destroys the acrimony of the brown Mustard. This paste should be spread thin upon a piece of rag, and 19 318 CHAPTER VI. applied, as soon as it is mixed, to the part of the body in- dicated. In a few minutes after it is applied the Sinapism causes a sensation of heat, which increases to almost in- tolerable burning. After some time, the pain subsides, and is followed bya sense of weight and throbbingof the arteries. If the Sinapism be left on, however, the burning pain again returns, and becomes so great, that few persons can bear the action of a Mustard Cataplasm longer than three quar- ters of an hour. In delicate, sensitive people, the Sinapism need not re- main applied above six or eight minutes, as the effect con- tinues some time after its removal. If it remain too long on, Gangrene may supervene : but this cannot happen unless the Invalid be insensible, as too much pain is felt to permit the lengthened application of a Sinapism ; but, in cases of stupor or insensibility, in low fevers, a Sinapism, if left on longer than an hour, may cause both vesication and gan- grene. If the redness only is required, the pain may be moderated by mixing with the paste a drachm of Tincture of Opium, or two drachms of Tincture of Henbane, neither of which, although they allay the pain, diminish the rubefaci- ent activity of the Sinapism. [As a substitute for the mustard Poultice, where mere external irritation is required, the Capsicum or Red Pepper will answer admirably, and it has the advantage of not vesicating : it may be used as a poultice, by mixing the powder with bread and milk, or Indian meal, or as a lotion mixed with warm spirits.] c. Vesicating Oils. — When a more permanent counter- irritant influence than a Sinapism can produce is required, Oils containing irritating substances are ordered to be ap- plied, by friction, until vesicular eruptions display them- selves. The application of these substances seems a simple process ; but, nevertheless, it requires to be done in a par- ticular manner, to insure the results which the irritants are expected to produce. The oil which is chiefly employed for this purpose is Croton-oil, diluted with either Castor-oil or Olive-oil; but both the kind of oil and the quantity is always ordered by the Doctor. In applying it, the part should be first excited SUPPURATIVE OINTMENTS. 219 by brisk friction, with a piece of flannel dipped in strong Vinegar, until the skin is reddened and rendered very sen- sible. The Oil is then to be rubbed upon the reddened surface ; and this part of the operation repeated at intervals of four to six hours, until a crop of small vesicles breaks out; after which, no more of the Oil is to be applied. The vesicles gradually enlarge ; but they never attain to a great size. The part feels, at first, hot and painful; but, in a few days, as the inflammation subsides, it acquires a tight- ened sensation ; after which, the cuticle exfoliates, and the skin recovers its usual sensation and softness. d. Suppurative Ointments. — If an ointment containing Tartar-emetic be ordered as the counter-irritant, more cau- tion is requisite, both with regard to the method of apply- ing it, and to its after-management, than is necessary in using the above-mentioned oily compounds. When the skin is not previously excited by friction, and the ointment only slightly rubbed upon it, it.operates very slowly ; and, after the lapse of a few days, a few large but distinct pus- tules break out: but, if the vascularity and sensibility of the skin be previously exalted, by the means already de- scribed, and the ointment briskly rubbed in, a thick crop of small pustules appears in the course of four or five hours, and they soon become confluent and maturate. As soon as the pustules appear, the use of the ointment must be dis- continued ; its further application causing not only severe and unmanageable sores, but, the Tartar-emetic being ab- sorbed when applied to a raw surface, violent vomiting is induced. The suppuration of the pustules attains its height in twenty or thirty hours ; after which, the pustules shrink, dry, and exfoliate. Tartar-emetic may be applied to produce the same effects in the form of a hot Solution, which should be rubbed on the part by means of a piece of flannel. The solution is required to be hot, for two reasons ; namely, that it may be more concentrated by the augmented solvent influence of the hot water, and that its temperature may render the skin more sensible to the action of the Tartar-emetic. The pustules thus produced are smaller than when the ointment is employed ; but they are sufficient for the effect intended; 220 CHAPTER VI. and, as they leave no pits nor traces of their action behind them, this method of using Tartar-emetic is peculiarly adapted for females. Unless the cuticle be abraded, neither nausea nor vomiting follows this application. If the object be to maintain the counter-irritation for some time, the ointment or the solution may be applied, first upon one side of the chest, and then upon the other when the effect of the first application is on the decline. The repeated renewal of the excitement, in this manner, aids greatly the beneficial effect of the counter-irritation. Should the inflammation run too high, the application of a warm bread-and-water poultice will moderate it, without impeding the progress of the pustules. The morning should be chosen for the application of these counter-irritants; or at least the period of the appear- ance of the eruption should, if possible, be so managed as not to interfere with the repose of the Invalid. They may be applied to any part of the body; but the part is usually indicated by the Physician. e. Blisters are produced by various means, the most usual of which is the common Blister-plaster. The method of applying the plaster, and dressing the blister which it forms, is extremely simple ; but, nevertheless, unless special direc- tions be given by the medical attendants, many persons are entirely ignorant respecting it. A Blister-plaster should never be applied to any part of the skin which is excoriated, or otherwise broken. The part to be blistered should be well cleaned with a little soap and water, and rubbed with a rough towel ; and, after applying the plaster, it should be retained in its place by stripes of adhesive plaster, or by a bandage lightly applied, for much pressure prevents the vesication. In ordinary cases, the Plaster is usually left on until the blister rises: but, if the person be liable to stran- gury, or if he is of an irritable habit, it may be taken off five or six hours after its application; for, if the skin be inflamed, the blister will rise after the Plaster has been re- moved, without any absorption of the acrid matter. This prevents strangury, and the irritant effects of absorption; but it is also customary to guard against these by inter- posing a piece of gauze, or of silver paper moistened with MANAGEMENT OF BLISTERS. 221 oil, between the skin and the Blister-plaster. Both of these customs are preferable to diluting largely with mucilaginous and other fluids, which often defeats the beneficial effects anticipated from the blister. In general, the excitement caused by the first action of a Blister-plaster disposes to sleep ; hence, unless an imme- diate effect be desired, or unless directions are given to apply a Blister-plaster at some particular time, it is usually applied at bed-time. In very sensitive habits, the pain of a Blister causes injurious irritation — an effect which may be prevented by the addition of six grains of extract of Henbane, or three of extract of Belladonna, to the plaster, without injuring its activity. When the immediate effect of blistering is required, a blister may be instantly raised by laying on the part a piece of lint, or a piece of bibulous paper, dipped in strong Vinegar of Cantharides, or in strong Solution of Ammonia, taking care to prevent the fluid from running upon the surrounding skin. A blister may also be raised by directing a jet of steam from a boiling kettle upon the part, covering the surrounding skin with folds of soft paper : or by apply- ing boiling water, blisters are also raised : but these me- thods should seldom be attempted. A more manageable manner of blistering by heat, than steam admits of, is the application to the skin of a piece of polished metal, heated in boiling water. The metal should not be too large, but it should be sufficiently thick to retain the heat for some minutes. [A very expeditious mode of blistering by means of heat is to place a piece of wet blotting paper on the spot in- tended to be blistered and then run a hot flat-iron over it. The steam thus produced will cause an almost immediate blistering effect.] Many persons have a dread of large blisters ; but, when the full effect of blistering is required, a large Blister-plaster is to be preferred to a small one ; for the irritation from the former is not greater than from the latter, and the benefit is more decided. Large blisters, however, depress more than small ones ; consequently, where simple counter-irri- tation is required in weak habits, small blisters are to be 19* 222 CHAPTER VI. preferred. In some deep-seated diseases, blisters are or- dered to be formed by rubbing the Nitrate of Silver on the surface of the skin. In order to raise a blister by this sub- stance, the boundary of the part should be marked out with ink ; and the stick of caustic, moistened, should be drawn across the skin, in lines close to one another, first in one direction, and then in another, the second lines crossing the first at right angles, until the whole is covered with the Nitrate. On drying, it leaves a black stain upon the cuticle, which is raised by the formation of pus beneath it. This blister requires no dressing; but merely to be punctured at the depending part. When a blister has been raised by the usual means, the cuticle should be snipped with a pair of sharp scissors at the most depending part, and the serum evacuated. If the intention is to heal the blistered surface, itshould be dressed, without removing the cuticle, with Spermaceti ointment, spread on the soft side of a piece of lint. But, if a dis- charge is intended to be kept up for some time — or, as the term is, a perpetual blister to be formed,—the cuticle should be removed, either by cutting it round the edge with a pair of scissors or by applying a hot poultice, which carries the cuticle away with it when it is taken off. In dressing the denuded part, in order to make the perpetual blister, the lint or rag upon which the irritating ointment is to be spread should be cut smaller than the blistered sur- face, and always, afterwards, kept of the same size. In every case, whether the blistered surface is to be healed or to be kept open, the ointment for dressing it should be spread upon the soft side of the lint. When the plaster is larger than the blistered surface, it irritates the sound skin unnecessarily, without aiding the discharge. Many persons faint when a blister is dressed for the first time ; but such a circumstance need excite no alarm. It is a mere sym- pathetic effect. [When a blister does not rise well, a hot poultice will, in most cases, cause this effect. In cases of children, where it is feared the blister may not heal properly, the application of the poultice, as soon as the skin is fully red- dened by the blister, will, in most instances, be very suc- cessful.] MANAGEMENT OF ISSUES AND SETONS. 223 In children labouring under dentition, or under remit- tent fever ; and in some peculiar states of the constitution (idiosyncrasy), both in children and in adults ; blistered surfaces, instead of healing, assume the appearance of an eating or phagedenic sore. In such an event, besides pro- per general remedies, the part should be dressed with Oxide of Zinc ointment, spread thick on the soft side of lint, and a poultice applied over the dressing. When gan- grene supervenes, a solution of chlorinated soda should be added to the dressing ; and decoction of Cinchona Bark, or the Salts of Quina, and Wine, administered. But these are cases which demand the management of the medical practitioner. In maintaining what is called a Perpetual Blister, the Cerate of Savine is the irritating substance most commonly employed. In dressing a blistered surface with this oint- ment, the film that soon forms over the raw surface must always be removed ; otherwise the part dries and heals: this is most easily done by a hot fomentation, or a poul- tice, which should be left on for six hours ; and when the film is thus loosened, it must be cleared off before another dressing be applied. f. Issues and Setons form more effectual drains than Perpetual Blisters ; they are, consequently, often employed. Both require care and a peculiar management to keep up the discharge. The Issue is kept open either by the intro- duction of peas, or a piece of lint smeared with the oint- ment of Savine, into the eschar. The peas operate by mechanical irritation ; and, as they swell from the action of the heat and the moisture of the eschar, they tend also to enlarge the wound. The peas should be changed at least once in twenty-four hours. The very irritation, how- ever, by which the discharge is maintained, is apt to cause fungous growths' from the bottom of the wound, which should be kept down; but this must be left to the Sur- geon. g. Setons are made by passing a skein of Silk or a slip of Caoutchouc under the skin, so as to cause a purulent discharge from the part. The edges of the wound are apt, however, after it has been discharging for some length of 224 CHAPTER VI- time, to become callous, and the discharge to cease. When .his occurs, the irritating substance should be smeared with some stimulating ointment; but as such a condition of a seton should always be mentioned to the Practitioner in attendance, I shall say nothing respecting the method of renewing the discharge. It should be recollected that much mischief may result from suddenly suppressing or removing either an Issue or a Seton. If this be, at any time, done without the concur- rence of the medical attendant, purgatives should be ad- ministered, and the discharge of the Issue or the Seton checked as gradually as possible. 11. Heat, independent of Moisture, or in a dry state, operates beneficially in relieving deep-seated pains, affec- tions of the joints, and diseased conditions of the spinal cord, or of the sciatic nerve. The intensity of its action is readily modified by the choice of the vehicle for apply- ing it. The common modes of application are Hot Flan- nels, Stomach Plates, Salt-bags, Hot Bricks, Moxas, and the Actual Cautery. a. Flannel, being of a loose texture, and involving air, is a non-conductor of heat; hence it retains the heat com- municated to it for a considerable time, and yields it up slowly to any part of the body where the heated flannel is applied. It is customary, after heating flannel for reme- dial purposes, to roll the piece tightly together, and then to cover it with a towel: both of which practices are inju- dicious. The more air which can be involved in the flan- nel, the longer it will retain the heat; consequently, in- stead of rolling it into a compact mass, it should be put together as loosely as possible, and applied in that state to the skin. On the same principle, also, the covering of a towel hastens the cooling of the flannel, by augmenting its radiating property ;* linen (the texture of the towel) being * Radiation of the matter of heat (Caloric) is that property which hot bodies possess of emitting their heat, equably in all directions, in right lines, like radii from a centre. 'J'his property is influenced by the nature and cordit on of the surfaces of the bodies emitting the heat; bright polished bodies radiate less perfectly than rough ones ; black bodies better than red; red better than white. The time of cooling of any heated body is more or less rapid according to the degree of its radiating power. APPLICATION OF STOMACH-PLATES, ETC. 225 a much better conductor of heat than flannel. White flannel retains heat much longer than Black or any coloured flannel. b. Stomach-plates, and other solid media for applying warmth to the body, should not be indifferently smooth nor rough upon the surface. The rough surface radiates heat in much greater quantity and in half the time occupied by the polished surface. In cases of spasm of the stomach, when an instantaneous and powerful effect is required, the stomach-heater should be either rough on the surface, or it should be covered with a piece of dark-coloured, rough flannel. If we wish to apply a moderate, but long-con- tinued heat, the heater should be highly polished. Metallic bodies., also, convey a greater degree of heat than the hot water in which they are heated, even when the metal is at a lower temperature than the water. The kind of metal of which the heater is made is also of some consequence, as one metal radiates more powerfully than another: thus, silver is superior in this respect to tin, copper to lead, iron to zinc. A silver jug, filled with boiling water, cannot be held in the hand ; but there is no difficulty in holding a leaden jug under the same circumstances. c. Salt-bags, Hot Bricks, and Foot-heaters, should, on the above principle, be covered with white or coloured flannel, as they may be required to communicate an imme- diate or intense heat, or to convey a slighter but more per- manent stimulus to the part requiring to be heated. They have one advantage over Fomentations, in the facility with which they can be prepared, when an immediate excitant influence is required : for example, in cases of Gout in the stomach, Cramp, and suspended animation from drowning. 12. The Application of Moxas, and the Management of Cauterization. — Moxas and Cauterization are always regarded, by non-professional persons, as cruel and unwar- rantable operations on man. A Moxa is a pastile made of any substance which will maintain combustion, like touchwood, or any similar mat- ter : the best is made by soaking a piece of bibulous paper in a concentrated solution of diacetate of lead, then drying 226 CHAPTER VI. it, and rolling it up into a cylinder about half an inch thick, which should be cut into lengths of an inch. When a Moxa is ordered to be applied, it need not be objected to on account of the pain it excites ; for that is not great; and the benefit which they produce, in deep-seated pains, has been well ascertained. Moxas should be applied, and superintended during their action, by the Practitioner; never by a nurse, nor any non-professional attendant. When the application of the Actual-cautery, or burning with an Iron heated to whiteness, is pronounced to be necessary as a remedial agent, it should not be objected to ; for it is an error to suppose that it is productive of severe suffering to the patient: on the contrary, when managed in the manner which I suggested some years since, it is by no means a painful operation. The greatest pain arising from the white-hot Iron is caused by the radiation of the heat, acting as a powerful excitant on the surround- ing skin, and causing acute inflammation and vesication; whilst, the vitality of the part upon which the Iron itself is immediately applied being instantly destroyed, the sensi- bility is lost, and, consequently, little pain is felt. Indeed, the pain arises from the approach of the hot Iron to the spot, not from its positive application. These inconveni- ences attending the operation, therefore, are prevented by covering the surrounding skin with moistened bibulous paper, from which the water has been moderately pressed^ and which is perforated with a hole a very little larger thUn the bulb of the cauterizing iron. When the operation has been determined upon, the paper should be previously prepared by the nurse or attend- ant of the sick-room; and a phial of spirit of Ammonia should, also, be at hand. Cartridge paper is the best for this purpose. A sheet of it, folded to a quarto size, or so as to form four thicknesses of the paper, should be soaked in clean, soft, cold water, for two hours, then pressed be- tween the folds of a dry towel, until it is freed from all the loose water. In this state, it is easily moulded to the shape of the part which is to be cauterized; and it forms an effectual guard against the scorching from the radiation of the hot Iron. The spirit of Ammonia is usually applied MANAGEMENT OF BURNS AND SCALDS. 227 after the paper is removed, to subdue the pain, which is secondary to the operation. The eschar caused by this operation is rapidly sloughed off, and an issue quickly formed. Its beneficial influence in deep-seated inflammations, as an energetic counter-irri- tant, is much greater than that of any other which I have wit- nessed. It is much less painful than Moxas, or the usual method of forming an issue by Caustic. The pain, how- ever, resulting from the application of a Moxa, may be mitigated by the moist paper, on the same principle which renders it useful in cauterization by the white-hot Iron. 13. Domestic Management of Accidents. — There are many incidental injuries of so slight a nature that the assist- ance of a surgeon is not demanded. In such cases, much evil often results from ignorance ; and injuries, otherwise of little moment, become serious and difficult of manage- ment. On this account, it is important to point out the mode of managing such cases. a. Burns and Scalds, unless they are very extensive, are generally managed without the aid of the Surgeon. Every one has some favourite application to propose in such cases : hence we hear of the infallible success of cold water; of scraped raw potatoes ; cotton-wool (finely carded cotton); oil of turpentine ; spirit of wine ; and many other substances. When the cuticle is scorched and hardened, a poultice, moistened with Laudanum and Oil of Turpen- tine, in equal quantity, is likely to afford considerable re- lief. When it is raised in blisters, either cold water, or vinegar and water, or Goulard's Lotion, will ease the pain; after which, the blisters should be punctured with a needle, and the cuticle left undisturbed, as it forms a scab, which protects the part while healing. When the skin is exten- sively injured, and the cuticle destroyed, the part may be covered either with cotton-wool, or wadding, or with flour, or hair powder dusted upon it. All of these applications soothe the pain, cool, absorb the discharge, and protect the parts from being irritated by the bed-coverings or the clothes. When the cotton-wool is used, it should be soon and ^-eqirsntly changed; but the flour maybe left undis- turbed, as it forms a crust which protects the raw surface, £>6 CHAPTER VI. until it is pushed up by the pus which is formed beneath; after which it is readily removed by a poultice, and the healing process proceeds favourably. When a Burn or Scald, however, is sufficiently severe to produce constitutional disease, the assistance of the Sur- geon ought never to be dispensed with, as the treatment often requires to be opposed to that which the symptoms appear to indicate to a non-professional observer. b. Fcetid Purulent Discharges from the Ear. — Purulent discharges from the ear frequently follow severe cases of Scarlet Fever, and some other eruptive diseases, and con- tinue for the rest of life. But, although this discharge can- not always be checked, yet it may be moderated, and the foetor corrected ; and in this respect it becomes an object of domestic management. The ear should be, every morn- ing, syringed with either tepid water, or tepid lime-water; and, immediately afterwards, two or three minims of a mixture, composed of two drachms of Balsam of Peru and six drachms of fresh Bullocks' Gall, well mixed together, should be dropped into it. Cotton or wool ought to be worn in the ear, to absorb the discharge, and to prevent the injurious influence of cold. c. Slight Sprains. No injury is usually more misma- naged by non-professional persons than Sprains: every old woman has her infallible remedy. " The proper treatment certainly appears to consist in absolute rest and position ;"* which latter implies elevation of the limb. Fomentations of warm water soothe the pain and abate the swelling; and, when the swelling pits on pressure, " gentle friction be- comes advantageous, and uniform support should be afforded by the application of a flannel roller.''! The invalid should preserve the recumbent position, the sprained limb being elevated, upon a pillow, higher than the rest of the body, in order to diminish the flow of blood to the diseased part. When the sprain is very severe, it ought not to be tam- pered with, but surgical advice should be immediately procured. d. Bruises require the same absolute rest and the appli- cation of fomentations as sprains. The common custom of 4 * Liston's Elements of Surgery, 2d edit, p. 757. t Ibid. MANAGEMENT OF SPRAINS — CUTS — SWELLINGS. 229 applying cold water is useless ; and stimulating frictions in the first instance are always injurious, althougth, after a time, they may prove beneficial. For severe bruises, sur- gical advice should always be obtained. e. Cuts or Wounds of external parts, although they rarely prove dangerous, and therefore require' merely do- mestic management, yet, when the bleeding cannot be easily staunched, surgical advice should be obtained. A moderately deep cut may prove more dangerous or trouble- some than a deeper one, owing to the bleeding artery being only partially divided, and thus being prevented from re- tracting, which is the mode adopted by Nature to check the bleeding when the vessel is cut fairly through. When the bleeding is not great, implying the division of small veins or capillary arteries, the wound should be allowed to bleed for a short space of time ; then, gentle pressure being made at a little distance on each side of the wound, the divided edge of it should be cleanly sponged with cold water and applied together, and a compress of lint dipped in cold water bound over the wound. In forty-eight hours, on re- moving the pledget, the edges will be found adhering, and the wound healing, in the same manner as the incision made in the operation of Blood-letting. The bleeding from a wound made by a blunt knife is not so profuse as that from a sharp instrument; but the pro- bability of the edges of the wound adhering, by what sur- geons call theirs/ intention, is much less. f. Scrofulous Swellings of the Glands of the Neck are often treated at home, without the aid of the Physician or the Surgeon, until they suppurate, and are likely to leave scars. When such domestic management, however, is de- termined upon, the Invalid should be allowed a nutritious animal diet, his bowels kept free by exercise on foot, whilst mild purgatives should be given, and the solution of Iodide of Iron, in doses of from ten to sixty minims, or the Syrup of the Iodide, in doses of a tea-spoonful (a fluid drachm, which contains three grains of the Iodide), should be inter- nally administered, in a glass of water, twice a day. The tumors should be treated with fomentations of salt or sea water, and friction employed twice daily for half an hour 20 230 CHAPTER M- each time. If suppuration cannot be arrested, under the improved state of health, then surgical advice must not be delayed until the abscess bursts spontaneously, for an ugly scar is likely to be the result; an event always to be regret- ted, especially in females. g. Decayed Teeth. The glandular swellings, just noticed, as well as many other evils—among which may be men- tioned headaches, ulceration of the tongue and lips, pains of the face, resembling the disease termed Tic doloureux, and some more extended nervous affections, as well as Dys- pepsia from imperfect mastication of the food,—not tin fre- quently depend on decayed or carious teeth. Although 1 am not one who would recommend the extraction of every decayed tooth,—because, after a tooth decays to a certain extent, it often remains stationary for many years, without causing the smallest annoyance, and may answer the pur- poses of mastication almost as. well as a sound tooth,—yet when the cavity of the tooth is exposed, and toothache is experienced, the mouth should be. examined by a good Surgeon, or a well-educated, experienced Dentist. Stuffing teeth is often too long delayed : for if the central cavity of a decaying tooth be exposed, and this state is accompanied with pain, stuffing may be productive of serious evil; in- deed, cases have occurred in which fungous growths have filled the cavity of a decayed tooth, and have given rise to affections of the jaw which have terminated fatally. A tooth which is much decayed, if it causes pain, or is accom- panied by any of the above-mentioned affections, should un- doubtedly be extracted. h. Warts are excrescences of the cuticle, which very com- monly appear on the hands of boys, and occasionally on other parts of the body in adults. They frequently dis- appear spontaneously, wasting and dropping off; but, oc- casionally, they remain for a long time, and become large and troublesome, in which case it is necessary to remove them. They may be repeatedly rubbed with moistened Lunar-caustic ; or a piece of leather, spread with adhesive plaster, perforated with a hole just large enough to admit the wart to pass through it, may be applied over the part; and the wart touched daily with strong Acetic acid. They generally disappear in a few days under this application. ' MANAGEMENT OF ENCYSTED TUMORS. 231 i. Corns appear upon the toes in consequence of com- pression upon the joints with tight shoes. They require to be kept down by paring, after bathing the feet in hot water, and immediately afterwards covering them with soft leather spread with adhesive plaster. If, at the same time, wide easy shoes are worn, the hard nucleus of the corn will some- times be brought out by this treatment. People who call themselves Chiropedists dissect out the nucleus, with a small sharp-pointed knife, and by this means effectually cure the disease. When the operation is cautiously and skilfully per- formed, it causes no pain. k. Encysted Tumors frequently appear on the head, which not only disfigure it, but also prove very incon- venient. It ought to be known, that no local applications nor any general treatment is of the smallest advantage. They can only be removed by a surgical operation ; but, when it is performed by a good Surgeon, it is scarcely pro- ductive of any pain ; a few drops only of blood escape, and no dressings are afterwards required. Such tumors, therefore, should always be removed. WThen they appear upon the eyelids their removal is more difficult; but, unless they are removed, they sometimes attain a great size and press upon the eye. 14. Bandaging.—It has been justly remarked, that *' the most judicious medical treatment and the ablest surgical operation will fail, if not assisted by good band- aging."* In operations, and in cases of extensive ulcera- tions of limbs, it is part of the work of the Surgeon and his assistants ; but, in many instances of minor wounds and sores, varicose or swelled veins, swelled limbs, and many other cases, bandaging is left to nurses and the attendants of the sick-room ; therefore, the principles which regulate the practice of it should be generally un- derstood. The intention of every bandage is either to retain dressings on the part, or to give support to fractured, or wounded, or ulcerated limbs, or to maintain parts of the body in certain positions, or to facilitate operations. For all these purposes, a certain degree of firmness and elasticity are requisite in the material of which the band- * Hennen's Surgical Observations, p. 75. 232 CHAPTER VI. ages are made. Flannel or Muslin is usually preferred. The width of a bandage must be regulated by the pur- pose and the part of the body for which it is intended; but, for general purposes, from two to three inches is sufficient. The web of Flannel or Muslin should be snip- ped on one selvage into the requisite breadths, and then torn across, so as to preserve the elasticity of the strips, which should next be sewed together by their ends till the proper bandage-length is obtained. Every bandage should be firmly rolled into either a single headed roller (a), or a double-headed roller (6) : and, in applying the bandage, the rolled part should be exterior to the part to be applied; for by this means, it, as it were, unrolls itself in its progress round the limb. The application should be equal with reference to the tightness ; and the tightness only sufficient to support the affected part, without impeding the circu- lation of the blood, or inducing pain or inflammation in it. If either of these last-mentioned circumstances should fol- low the application of a bandage, even by a surgeon, it should be immediately loosened ; hence, for this as well as other reasons, it should be so applied that it may be easily loosened. a. Bandaging the leg. In order to accommodate a ban- dage to the shape of the leg, each circumvolution should be so reversed by a half twist, before the next circumvo- lution is made, in passing from a smaller to a larger part, BANDAGING THE FOOT—LEG. 233 as to cause the bandage to apply closely to the calf of the leg, or to any other inequality of the limb, and to assume what is termed a herring-bone appearance. This will be better understood by the representation of a bandage in the course of application to an ulcerated leg. The end of the roller is placed a little above the inner ankle bone at (a) ; thence it is " carried under the heel (b), and round the ankle once ; then passed over the foot, close to the roots of the toes (c), and, by two or three turns, brought up again to the ankle, over the point of the heel- bone to (d), being reversed under each ankle-bone, and then turned round the heel in both directions."* It is next carried upwards, as represented at d ; the turns (cf) being * Liston's Practical Surgery, 2d edit., p 210-11. 20* 234 CHAPTER VI. half twisted in anticipation of its reaching the calf of the leg, where the sore (g) is supposed to be seated. Such are the simple principles for the application of roller-bandages to limbs; but, besides these, there are other bandagings which require to be known. I shall mention only those which are likely to be intrusted to nurses, or to other attendants on the sick. b. Bandaging the head. In injuries of the scalp, arising from blows or other accidents, or in diseases of that part, symptomatic of morbid conditions of the general system, displaying themselves in the form of scabby eruptions, the best means of retaining dressings on the partis a night- cap, with broad tapes to tie on the forehead and beneath the chin (see cut). But if compression be necessary, either on the forehead or on the temples, then the form of the next bandage represented must be used. It consists of a long strip of Calico, divided longitudinally, so as to leave space (a) in the centre, and form two tails (6 6 6 6) at each end. In applying it, the uppermost tails are first past behind the undermost, which are then tied at the back of the head; after which, the uppermost tails are carried upwards, and tied at the top of the head (see cut). When the strip of cloth, of which this description of bandage is made, is six or eight inches, instead of three inches in breadth, it is admirably adapted for confining dressings upon BANDAGING THE HEAD 235 the foie part of the head ; or on the hairy scalp ; or upon the sides of the head ; and it looks neater than the night- cap. In applying it, the unsplit part is placed on the head, and the two posterior tails are carried downwards, and tied or pinned at (a), under the chin ; whilst the anterior tails are carried backwards, and pinned at (6). It thus applies closely over every part which it covers. By re- 236 CHAPTER VI. versing this bandage, it serves in cases of wounds or sores on the back of the head. c. Slinging the arm. In cases of injuries of the arm, the fore-arm is frequently required to be supported in a state of flexion by a Sling, the simplest of whicluis a handkerchief, folded into a triangle : but it is seldom well applied. One end of the triangle should be passed be- tween the arm and the chest of the invalid (a), (see cut), whilst the other (6), carried round the arm, and spread so as to reach from near the elbow to the wrist, should then be taken upwards to the opposite shoulder, carried be- hind the neck, and tied as represented at (c). The Sling should be worn no longer than is absolutely necessary, as the long retention of the arm in the bent position causes a contraction which is extremely difficult to be overcome. d. Bandaging the trunk. For retaining dressings, or blisters which are to be kept open upon the chest, either in front or upon either side, such a bandage as that next represented must be used. It consists of a flannel or a calico Band (a), six or seven inches broad, which goes twice round the body, and is pinned in front, or tied with tapes ; and is kept in its place by two strips (6 6) of the same material as the broad band, pinned to it before, and also behind, as at (c c). When it is employed for retaining a compress over a protruded navel, additional straps are BANDAGING THE TRUNK. 237 pinned to the under margin of the broad band behind. whence they are passed between the thighs, and pinned to the band before. When the operation of tapping is determined upon, a band should be ready prepared for affording pressure dur- ing the flowing of the fluid, and to prevent the faintness which is apt to occur when no pressure is made upon the belly. It should consist of a strip of flannel, a foot and a half broad, with the ends split, and the middle portion made to fix the convexity of the belly, by triangular pieces being cut out, and the cut edges joined. A hole should be made in the centre of the bandage to admit the passage of the instrument which is to be used. Besides the employment of bandages in wounds, sores, and operations, they are sometimes serviceable in general diseases. Thus, in the commencement of Dysentery, a flannel-roller, properly applied on the trunk of the body, has been found very beneficial; but, in order to render it useful, it should be applied in the following manner. One end of the roller being placed obliquely upon the loins, the first turn of it is carried round the upper part of the 238 CHAPTER VII. belly : it is then crossed down to the lower part, and again rolled gradually upwards, so as to produce a firm but equa- ble pressure over the whole abdominal surface. A similar application of a flannel-roller is very useful for females of lax and delicate habits, in whom the abdomen becomes pendulous after the birth of two or three children. It is preferable to any of the numerous forms of stays which have of late years been invented to afford support in such cases. The bandage ought not to exceed five inches in breadth, as, when broader, it does not apply so closely to the convexity of the part which it is intended to cover as the narrower bandage. CHAPTER VII. DIRECTIONS RESPECTING THE GENERAL MANAGEMENT OF CON- VALESCENCE ; AND OF DIET IN DISEASE AND CONVALES- CENCE. -- FUMIGATIONS. In numerous instances, much hazard often exists after dis- ease has disappeared, and when the patient is declared convalescent: and as this period in the removal of dis- eases is left to the management either of the patient him- self or of his friends, some general remarks respecting it, and also in reference to particular diseases, are requisite. In every recovery from sickness, whether external or in- ternal, before the salutary advantages obtained from the treatment be confirmed, the organ or part which has suf- fered must be either left at rest or be used, according to the nature of the case. Thus, if any part have suffered from inflammation, it must not be used for some time after the inflammation is subdued. If the eyes have suffered, the person must neither read nor write, nor expose the eyes to the heat of the fire, nor to a strong light, until some days after every trace of the disease has disappeared. If the arm has been affected, it must be kept at rest; and if the leg, not only should walking be refrained from, but the limb should be placed rather higher than the trunk of the body. If the previous disease has affected the brain, every mental exertion must be avoided; and MANAGEMENT OF CONVALESCENCE. 239 bo on, whatever may be the organ which has especially suffered. Even when the exercise of the organ is re- sumed, it should not be carried to fatigue, nor, on any ac- count, should it be such as to produce excitement. At the same time, it must not be forgotten that, in the treatment of external injuries, when it has been necessary to keep the limb long in a sling, in one position,— as, for in- stance, in fractures, — the muscles which bend the arm ac- quire from the habit a contraction which cannot be overcome by the antagonist muscles, owing to the length of time they have been on the stretch weakening their contractile power. The arm, therefore, should be frequently taken from the sling, and, being rested upon the elbow, a moderate weight should be held in the hand, and friction with oil employed upon the contracted muscles. It is true that Surgeons usually give directions for this operation, before they quit the ma- nagement of the case ; but Surgeons, as well as Physicians, are sometimes dismissed before the convalescence is com- plete ; on which account, arms and limbs have remained contracted for life, from a want of the knowledge necessary to counteract the evil at an early stage. I say nothing respecting the continuance of remedies during convalescence from many diseases, except urging the necessity of regulating the bowels. The most important part of the management of conva- lescence certainly refers to air, exercise, and diet. The errors daily committed, in all of these matters, exert the most powerful influence in retarding complete restoration to health ; and often, indeed, induce evils of a more for- midable kind than the diseases from which the patients have just emerged. 1. Air. In every convalescence, whatever may have been the nature of the disease, if it has been so severe as to wear down the strength of the Invalid, country air is essential. The Benevolent Author of our existence haa made medicinal the hills, the vales, the groves, and all the har- monies of Nature ; and in the repose of these man finds a balm, not only for the wounded spirit, but for his stricken body. When emerging from the bed of sickness, the limbs scarcely able to perform their office, and the mind still 240 CHAPTER VII. looking back upon the turbulence, the noise, and the vexations of business, with disgust; the breath of dewy morning, the sidelong beams of the rising sun throwing the shadows of the trees across the glittering meadow, the music of some neighbouring coipse, mingling perchance with the gurgle of a brattling stream, convey not only more heartfelt delight to the mind than the richest gifts of smiling Fortune ; but they act as the most powerful re- storatives, in reinfusing fresh vigour and energy into the powerless frame. In convalescence, therefore, the choice of a temporary residence in the country is of much import- ance. In selecting a country residence for a Convalescent, care must be taken to ascertain whether any source of Malaria exists in the neighbourhood ; as, in that case, even if all other circumstances be favourable, the place is exceptionable. It has been often supposed that a situa- tion on an elevated spot above a marsh is not influenced by the pernicious vapours from the marsh. Many in- stances might be adduced to demonstrate the fallacy of this opinion: it is only necessary to mention a few. At Neuville-des-Dames, above Chatillon on the Indre, more fevers prevail than close to the marshes which exhale the Malaria: and, at Malta, the Malaria produced on the beach beneath a cliff' causes no bad effect on the spot itself; but it affects a village above the cliff so severely as to produce its occasional abandonment.* It is supposed that this depends on currents of air carrying the concen- trated Malaria to the higher grounds. But, whatever is the cause, the necessity of avoiding such spots is evident. The distance to which Malaria may be conveyed, sufficient- ly concentrated to cause infection, must vary, owing to many causes breaking or obstructing the current; but, on an ave- rage, in Europe, it has been estimated to be 1400 to 1600 feet in elevation, and 600 to 1000 feet in a horizontal direc- tion.! In the West Indies, vessels have been infected 9000 feet from the marshes on the adjoining shore. When abreeze blows over a swamp, the deleterious vapour may be con- veyed many miles. The Convent of Comaldules, which * Macculloch on Malaria. -J- Monfalcon. MANAGEMENT OF CONVALESCENCE. 241 seated on a high mountain, a league distant from the lake Agnano, is often infected by the wind which blows over the stagnant water of the lake. It is a fact which should be known, that the interposition of trees often forms a per- fect safety screen in such cases. If a Convalescent, however, is driven to seek a lodging in a swampy country, as the floors of houses have a strong attractive power for Malaria, the second floor is always more healthy than the first, and the third still more salu- brious than either of the former. The bed of the Conva- lescent should also be elevated from the floor. When the disease has been inflammation of the lungs; and especially if it is apt to recur in cold weather, the win- ter and the spring should be spent in a more genial climate than that in which the Invalid usually resides. If his resi- dence, for instance, be in London, and if he cannot conve- niently go to Madeira, he may winter with advantage at Cove, near Cork, or at Tor, in Devonshire, or Under Cliff, in the Isle of Wight.* 2. Exercise. In convalescence, much caution is requi- site in apportioning the exercise to the degree of returning strength. When the Convalescent is still too feeble to take sufficient exercise on foot, the best substitute for it is riding on a donkey or a poney ; but, as soon as walking can be borne, it should be preferred to either horse or carriage exercise. When walking, however, causes em- barrassment of breathing, or palpitation of the heart, or a sensation of weariness in the loins, it should be discon- tinued : but, when it excites no inconvenience nor dis- comfort, it should be daily increased, and at length con- tinued to the point of fatigue. The morning is the best time for the exercise of the Convalescent. The balmy breath of the new-born day ; the freshness of the dewy fields ; the music of the fea- thered race poured from every shadowing copse; the tiny horn of the wild Bee ; and a thousand other agree- able impressions, incident to the hour, create a buoyancy in the mind, which, added to the renewed vigour of the body derived from the repose of the preceding night, bestow * [See antj, p. 59.] 21 242 CHAPTER VII. an elasticity to the frame, which is experienced at no other period of the clay. 3. Diet. In health, diet may be left, in a great degree, to the inclination or the taste, as far as regards the quality of the food ; and, although diseases occasionally originate from repletion, yet, in general, the appetite may be consi- dered as the best regulator of quantity, when the food is simple, and the appetite is not pampered by high seasoning and rich sauces. In disease, however, a very opposite rule is to be observed : the regulation of both the quantity and the quality of the food is of the utmost importance. The taste is often so perverted as to desire that which would prove injurious ; and were appetite to be the guide of quan- tity, diseases would frequently not only be increased in severity, but life itself would be brought into jeopardy. Many substances, also, wholesome in themselves, are ren- dered unwholesome by cookery ; whilst,"on the other hand, the art of the cook, in many instances, corrects the unwhole- some quality of the food : hence, dietetics and cookery are important matters of consideration, in the management of the sick-room. As soon as solid animal food can be taken with impunity, that which is most digestible should be selected. An opinion has generally prevailed that gelatinous matters, and meats which readily yield jelly — such, for example, as Veal and Lamb — are the most easily digested, and, at the same time, are also the most nutritive. This is a mis- take ; for, with the exception .of poultry, the flesh of young animals is stringy and of a lax fibre, and is even less easily digested than that of too old animals, which presents a great density of texture. The middle-aged animals afford the most digestible food ; and none is so much so as tender wether Mutton of from four to five years old. On this account, Mutton is better fitted for the Convales- cent than either Lamb or Veal, or even Beef, which is of too firm a texture, and cannot be digested so readily by a weak stomach as Mutton, although it is more nutritive than Mutton. Venison is more nutritive and more digestible than Mutton ; but it is more stimulant. Glutinous and gelatinous food is also, in every instance, less digestible than solid meat, even when it actually contains more nutri- DIET IN DISEASE AND CONVALESCENCE. — MILK. 243 trive matter ; hence it is ill adapted for Invalids. Poultry is less digestible, and even less nutritive, than game of a winged kind ; but the latter is not adapted for Invalids' labouring under acute disease, on account of its stimulant properties. Game, hovrever, is well adapted to bring up the strength of convalescents who have been greatly weak- ened by previous disease. Much, nevertheless, depends on the condition of the patient at the time. Nothing tends to lessen the density of the fibre of every kind of animal food so much as keeping it for a certain time before it is cooked. In this case, the tenderness is the result of incipient decomposition or putrefaction ; but the utmost caution is requisite to prevent this from advancing so far as to present the slightest trace of taint, in the food of the convalescent. In the low state of vitality in con- valescence, the change which commencing decomposition (putrefaction) causes, renders animal food, in that condi- tion, a source likely to occasion either a relapse into the disease from which the patient has recovered, or to form a new disease. In examining the relative value of other articles of diet adapted for the sick and the convalescent, the first which presents itself to our notice is Milk. — As milk is the food of almost all young ani- mals, its digestibility appears at once evident; and there can be little doubt that it is very digestible, when it is drank immediately after it is drawn from the udder of the Cow, or that of the Ass, or the Goat, before its components have time to separate. When this separation is effected, either spontaneously by time, or by means of Rennet or other agents, its properties are altered, and its digestibility is lessened.* Cream, when intimately united with the other compo- nents of milk — namely, the curd, or the caseous part, and the whey, —is not the same substance as after its separa- tion. In the milk, it is more easily digested, and is the most nutritive part of the milk. But, in its separate state, it is ill adapted either for the sick or convalescent, except * The constituents of Milk are Caseous-matter, Butter, Water, Sugar of Milk, Chloride of Potassium, Acetate of Potassa, Phosphates of Potassa and of Lime, and traces of Iron. 244 CHAPTER VII. in the form of butter, which is not unwholesome, unless it be eaten in excess or be melted.* In the same manner the separate Curd is indigestible ; and Whey itself, although highly nutritive, yet, is flatulent; nevertheless, it is an ex- cellent demulcent in many cases of disease. But none of the components of milk are equal to milk itself. It is often necessary, in convalescence, to dilute with water. With respect to the value of different kinds of milk, that of the Cow is rendered lighter, and less oppressive to the weakened stomachs of invalids, when it is combined with an equal part of barley-wTater, and a small proportion of refined sugar. Asses'1 Milk is heavier than water, being of sp. gr. = 1*023. It contains more saccharine matter than Cow's milk, and it is, consequently, more nutritious; but it is apt to cause diarrhcea in very delicate persons; there- fore, it cannot be taken in the same quantity, nor can it be continued for the same length of time, as the milk of the Cow. The milk of the Goat is still heavier than that of the Ass : its sp. gr. is= 1-036. It abounds with curd, and contains more oily or butteraceous matter than Cow's milk; yet it does not throw up so thick a cream. It has occa- sionally also the disagreeable odour of the Goat. Eggs. — It is not uncommon to hear that the yelk of a raw egg, beaten up with water and sugar, with the addi- tion of a small quantity of white wine, is a light and nutri- tive aliment in convalescence, and even in some states of disease u but Eggs are much less digestible in this form than when they are lightly boiled. In jaundice, however, arising from viscid mucus obstructing the orifice of the common duct, the yelk of a raw egg beaten up with cold water is serviceable. In whatever manner eggs are cooked, they are heating ; and they always more or less favour cos- tiveness, especially when the yelk is rendered firm. Fish, at least the white kind, stimulates much less than the flesh of land animals ; hence it is a proper food for those labouring under some acute diseases ; and also for convalescents, when a sudden return to more stimulating food would prove hurtful. But it is not adapted for conva- * [Although cream is not as digestible as milk, yet it is much less liable to turn acid in the stomach : it id often beneficial to dyspeptics, either alone or diluted with water.] DIET IN DISEASE.—FISH. 245 lescents, when the object is to bring up rapidly the strength of debilitated habits. In such cases, as it leaves more feculent matter in the bowels than animal food, it is apt fb excite intestinal irritation. The least heating kinds offish are Flounders, Whitings, Soles, Haddocks, Turbot, and Cod ; and, of these, the Whiting is the best for Invalids emerging from any acute disease. The Flounder is next in point of digestibility ; then follow in succession the Had- dock, the Sole, the Turbot, and the Cod. All the coloured and the red-fleshed fish, such as the Eel, the Herring, the Mackrel, the Trout, and the Salmon, although more nutri- tive than white fish, yet they are oily and more heating than the white fish ; and consequently, they are not adapted for the sick-room. Raw Oysters have been erroneously supposed to be both easy of digestion and nutritive. The latter opinion is, in some degree, true ; but the former is erroneous. Raw Oysters are less digestible than plainly cooked Oysters. Both are improper for the sick and for early convalescents. Lobsters, Crabs, Prawns, Cray-fish, Scallops, and other shell fish, are still more objectionable. If fish of any kind be admissible, it should be simply boiled: fried fish is even worse for Invalids than the out- side or the brown of roasted meat. It is also true that, as there is more feculent matter left after digestion from fish than from the flesh of land ani- mals, the former is not well suited to cases in which the bowels have been the seat of disease, and remain in an irritable condition ; it may renew the diarrhcea. In reference to vegetable diet, it is only the mildest de- scription of esculent roots— namely, Carrots and Turnips— and a few esculent herbaceous plants, such as the Cabbage, Brussel Sprouts, Brocoli, Cauliflower, Asparagus, and very young Peas, that are fitted for the use of the sick. In pre- paring all of them for the sick-room, they should be well boiled in two distinct waters, until they are soft and very soluble, and in a state not to leave undissolved anything which could act as a mechanical irritant on the intestinal canal. When properly cooked, they are moderately nutri- tive, and free from any stimulant properties; and they are 21* 246 chaptv.r. VII. well adapted for the stomach of the sick, unless in cases in which the torpor of the organ is such as to permit them to run into the acetous fermentation and to prove flatulent.* With respect to Fruits, they produce the most diversified effects : and, consequently, are more or less proper for In- valids, according to circumstances, either connected with themselves or with the condition of the patient at the time. The stone fruits, with the exception of the ripe Peach, or the Nectarine, are to be rejected. The apple tribe, except very soluble Pears, are still less admissible. The Apple, however, when roasted, and when the seeds and the hard central parts, as well as the skin, are removed, is less ob- jectionable ; and, as it possesses laxative properties, the roasted apple is well adapted for the sick, when food is at all allowable, and when the bowels are torpid. The Orange, if fully ripe, is grateful and wholesome to all Inva- lids, and is only equalled in these qualities by the Grape; but, in using the Orange, the pulp should be rejected. Care, also, should be taken not to swallow either the skin or the seeds of the Grape. Strawberries are little stimu- lant, of easy digestion, and more cooling than the other small fruits ; Mulberries are, also, unexceptionable ; but Currants and Gooseberries, and even Raspberries,are notfree from objection for Invalids labouring under acute diseases. With the exception of Oat and Wheaten Bread, all the varieties of farinaceous aliments may be regarded as modi- fications of Starch, containing little nutritive matter, and therefore well adapted for the sick-room. It has been sup- posed that Arrow-root, Sago, Tapioca, and similar sub- stances, are very nutritive, because they form mucilages with boiling water : but this is not the fact; and were they very nutritive, they would be ill adapted for Invalids. Rice, in every case where the stomach is in an acescent state, is preferable to the other farinacese, because it is less fermentable. • [We cannot agree with the author in his remarks on the vegetable food for convalescents. Of those mentioned by him but one, viz., Asparagus, is at all admissible, as the others are without exception liable to create flatulency and indigestion. The best diet for a convalescent beginning to take vegeta- ble food, is Rice, Potatoes, especially if roasted and not boiled, Indian-meal Mush, and afterwards, the Tomato, Okra, plain boiled, and Spinach. The Sweet Potato is not as digestible as the common.] DIET IN DISEASE.—WATER AS BEVERAGE. 247 The farinaceous food, which is ordered in the convales- cence of children from acute diseases, is often made of bread, so as to constitute Pap. No description of food has a greater tendency than this to become sour: a quantity only sufficient for a single meal, therefore, should be made at a time ; for what remains is always sour before the next meal; and even if the quantity be small, and it be mixed with fresh Pap, it communicates its faculty of becoming sour to the whole mass. FLUID ALIMENTS. Water. — The best and the most universal beverage for the sick is Water: but the qualities of water differ, accord- ing to the sources whence it is procured. The fewer foreign ingredients it holds in solution, the greater are its diluent properties. Distilled Water; or rain or river water* filtered ; and that of soft-water springs which fil- trates through silicious strata; are the only kinds proper for the use of the sick-room. Hard-water, under whatever name it is found, whether as Spring-water, or Pump-water, or Well-water,f should be excluded. The impurities of * Rain Water, being the distillation of water taken up from the earth by the solvent power of the air, is the purest of all natural water, if collected at a distance from houses. It, however, tastes vapid, a fault which maybe remedied by pouring it frequently from one vessel to another until it in- volve a considerable quantity of air. It contains portions of carbonic acid, carbonate of lime, and nitric acid ; but the quantity is minute: its specific gravity is not greater than that of pure distilled water. River Water is softened by its exposure to the air in its current, which enables it to deposit its earthy salts; but much of its purity depends on the nature of the channel over which it runs. It is purest when its bed is pebbly, as in mountain rills: but the water of some rivers, as, for example, that of the Thames, although loaded with mud, yet is soft and pure when filtered, and well fitted for the use of the sick, or the convalescent. Soft Spring Water is a mere modification of Rain Water; but it some- times contains, besides the foreign ingredients of the latter, some chloride of sodium (sea salt). The purest springs in Great Britain are —St. Wini- frede's in Holywell, Flintshire; Malvern; and Matlock. The most accu- rate chemicar analysis has detected nothing in them, except a small portion of carbonic acid. The water of all springs welling from compact limestone is usually soft and pure. + Hard Spring Water, or Well II afer, or Pump II ater, as it rises from treat depths, and suffers great compression in its natural bed, has its solvent powers augmented ; consequently, it holds in solution several earthy salts; namely carbonates and sulphates of lime and alumine, as well as chloride of sodium and sulphate of magnesia; hence it does not dissolve soap, and 248 CHAPTER VII. River and Rain Water are merely held in suspension; con- sequently, they are readily removed by filtration. Water itself is aliment ; many individuals, under certain circumstances, have lived for a considerable time upon it alone. Those who live chiefly on animal food require more drink than those who eat much vegetable matter. Water composes the greater part of all the fluids of the body ; namely, the blood and the secretions ; and when it is with- held, these become too acrid, and act almost as poisonous agents upon the nervous system. The influence of water on the animal economy may be regarded in two points of view : 1. As an article of diet. 2. As a medicinal agent. 1. As an article of diet, in health, Water is the beverage provided by nature for all animals, man not excepted. The sensation of thirst is the natural call for fluids, either to assist digestion, or to allay a dry, hot condition of the mouth and the gullet. The consequence of not satisfying this call, is fever of a nervous kind ; and, if it be long re- sisted, inflammation of the air passages. In a healthy con- dition of the body, diluting fluid is requisite to obtund over- stimulant matters, which, without such dilution, tend to induce fulness and an inflammatory condition ; and death soon follows the total abstinence from fluids. On the other hand, too much fluid is injurious; for, although the vital powers of the stomach counteract the tendency which it affords, by over-diluting the gastric fluid, to the fermenta- tion of the aliment in the stomach, yet, when it is in ex- cess, those vital powers languish; hence spontaneous chemical changes in the contents of the stomach take place, and induce Dyspepsia. For all the purposes of dilution, in health, Water is adequate, and it is the only truly whole- some beverage. deranges the digestive organs. If it be boiled and allowed to cool, the cal- careous salts are deposited, and it is then less objectionable as a beverage for the healthy ; but under no circumstances is it proper for the sick or the convalescent. Spring Water, when it has either any obvious odour or taste, even when not sufficient to place it within the class of mineral waters, is unfit to be employed as beverage. BEVERAGES IN DISEASE AND CONVALESCENCE. 249 2. As a medicinal agent, Water is demanded in every disease in which a dry skin and an elevation of the natural heat of the surface, constituting fever, are present. In this case, the desire is for cold water, or cooling fluids ; and it should always be indulged. The degree of temperature, however, must be regulated by the condition of the invalid: but the best medium temperature is between 50° and 60° Faht. ; although even 60° is too low, when the debility of the frame is considerable. As a simple diluent, Water is more effective when it is nearly of the same temperature as that of the body. In fever, the degree of thirst is generally in the ratio of the degree of the fever which is present; and the supply should be adequate to the demand. In a hot state of the body, if the perspiratory function be impeded and the skin dry, the best means of counteracting this, and of inducing perspiration, is a sufficient supply of cold water. This is so obvious, that a learned physician wrote a book to prove that " cold water is the only true remedy for fever."* Thirst is also the result of excessive perspiration, owing to the waste of the fluid part of the blood which that causes; and tepid, bland drinks, in preference to cold water, are then requisite, not only to supply this waste, but also to maintain the perspiratory function now in operation. In such cases, however, tepid water alone is apt to excite nausea ; consequently many kinds of diluents are employed in diseases: but, nevertheless it is the Water which they contain that is the beneficial agent. The qualities of the various kinds of beverages proper, and generally employed, in the sick-room, shotild be known. a. Toast Water, when properly prepared (see Cookery), which it seldom is, forms a useful beverage in the sick- room. It is slightly nutritive, owing to its containing a small portion of gluten, in conjunction with fecula and sugar. It is one of the oldestf and one of the best diluent ♦ In Spain, the Dieta Aquea, the system of the renowned Sangrado, is not yet exploded. Water is there the chief remedy in fever, and it is not uncommon to order from five to ten pints to be taken daily. In this respect, the Spanish doctors anticipated tho Hydropathists: but all excess is capable of doing much mischief. Hydropathy has killed more than it has cured. + It wan recommended by Hippocrates, who wrote an entire book on its use, and that of boiled barley in acute diseases. 250 CHAPTER VII. demulcents ; diluting at the same time that it softens the acrimony of the secreted juices of the stomach, in febrile diseases. c. Gruel, whether made of Groats or of Oatmeal, is less mild and demulcent than Barky water; and it is more likely to undergo the acetous fermentation in the heat of the sto- mach ; a circumstance which is greatly favored by the sugar and butter which is sometimes added to it. Unless Gruel be very thin, it can scarcely be regarded as a diluent; and when thick, it is too heating an aliment for patients labouring under febrile symptoms. d. Tea, in the form in which it is usually taken, is too stimulant and astringent to be a good diluent; and, when it is strong, the narcotic property which it possesses renders it improper for most Invalids, whatever may be the nature of their diseases. As it is, nevertheless, agreeable to most palates, and very refreshing, it may be taken in moderate quantity, provided it be not strong, without any hazard: but it should not be taken soon after a meal, in cases where the stomach is weak ; as it retards digestion, and causes a sensation of fulness. In febrile cases, a cup of Black Tea, with the usual additions of Sugar and Milk, poured into a tumbler of cold water, forms a most agreeable and refresh- ing beverage. Green Tea is extremely apt to cause wake- fulness and nervous feelings in many persons, especially in those labouring under diseases of diminished excitement; indeed, under any circumstances, it is scarcely fitted for the sick-room. Sage, Balm, and Mint Teas are often substituted for common Tea. Each of them undoubtedly allays the irri- tability of the stomach, in some cases ; but, as general be- verages in disease, they are less useful than toast-water. Raspberry Vinegar, Lemonade, Tamarind Tea, Apple Tea, and similar compound diluents, should never be adminis- tered without the consent of the Physician. If a patient be taking an antimonial, they will excite vomiting ; if a mercurial, griping ; and they are equally incompatible with many other medicines, and with many conditions of the stomach in disease. They are a description of beverage greatly recommended and largely distributed by the Lady MANAGEMENT OF DIET IN CONVALESCENCE. 251 Bountifuls in the country, and have frequently been pro- ductive of serious mischief. f. Coffee is more heating, and, consequently, less admis- sible than tea : it may, however, be taken, if it be largely combined with milk. Cocoa and Chocolate are still more objectionable than either Tea or Coffee in the sick-room. I make no comment upon the use of Spirits, nor of Punch, nor of Wine, nor White-wine Whey, as none of them ought ever to be administered in disease, except by the special order of the medical attendant: and this remark applies to Porter, Ale, and all other fermented liquors.* With respect to the number of meals, and the periods best adapted for taking them, it is scarcely requisite to remark, that, although in health, three moderate meals, at proper intervals, are customary, and well adapted for the support of the frame, yet, under the changed condition of the system in disease, it would be improper to take any regular number of meals, or to observe any stated periods for taking them: hence no general rules can apply ; and the circumstances under which nutriment is requisite in disease, are as much within the province of the Physician as the administration of medicines. As a general rule, in the decline of diseases, and on the approach of convalescence, when the desire of taking food returns, the best time for the principal meal, Dinner, is about two hours after noon. If the breakfast be taken at nine o'clock, and the evening meal at seven, the hour of two is the middle period of the day ; so that, when dinner is taken at that time, the intervals between breakfast and dinner, and between dinner and supper, are not only equal, but neither is too short to limit the complete digestion of the previous meal ; nor too long, to injure the powers of the weakened stomach by protracted fasting. There is nothing more important than the regulation of diet in the decline of diseases ; and nothing is more difficult to enforce, as the appetite, when it returns, generally becomes very sharp and importunat •. * [For full observations on Food, &c, see Human Health, by R. Dungli- son, M.D., pp. 179, etseq.] 252 CHAPTER VII. All acute diseases require, more or less, abstinence, especially when the object of the treatment is to lower the system; and, in some chronic affections, abstinence is almost essential. If this be true, the necessity of the strict- est observance of the directions of the Physician on this subject must be obvious. It is one, however, which is not only neglected, but is often combated both by nurses and friends ; and indulgences, which are supposed to be of too trivial a nature to cause any injury to the sick, have often been followed by fatal effects. I have seen cases of con- valescence from fevers suffer most severely from a single improper meal. In one instance, in which the relations of the patient were justly assured that all danger was at an end, a dinner of bacon and beans brought on symptoms which terminated fatally in twenty-four hours. But, although abstinence be requisite during the exist- ence of an acute disease, yet, it is injurious when it is too rigidly maintained, after convalescence is actually esta- blished : it often induces a new train of symptoms, not very unlike those for which it was properly prescribed, and the removal of which it has aided ; namely, acceleration of the pulse, increased impetus of the heart, headache, and even delirium. As health returns, and the functions of the sto- mach are restored, the appetite for certain kinds of food is frequently the best guide which we can follow in the selec- tion of that suited to the circumstances of the patient: but, before indulging it, the acquiescence of the Physician should be obtained. It is, indeed, not more the duty of the Physician to prescribe remedies for the cure of diseases, than to recommend that kind of diet which is the best suited for each individual case ; nevertheless, a few general rules, in reference to the diet proper in certain classes of diseases, may prove highly serviceable when a medical adviser is not at hand to direct it. a. General Dlskases. — Happily, in febrile affections, the appetite of the Invalid is not in a condition to desire food ; and no stronger demonstration can be required of the impropriety of forcing it upon him under such circum- stances. Simple fluids, such as diluents, are all that he desires ; all that the stomach can bear ; and such alone would be administered in fever, before that low condition MANAGEMENT OF DIET IN CONVALESCENCE. 253 of the system, which demands the use of wine or other stimulants, supervenes. In these cases, when the patient desires more nourishment than is usual, animal food ought not to be given, unless by the direct recommendation of the Physician. Indeed, in general, the inclination of the Invalid happily revolts from animal food, as much as ex- perience condemns its administration. I have, never- theless, seen strong animal broths forced upon patients labouring under fever, and have observed much mischief to follow. While febrile symptoms are present, farinaceous matters, little nutritious, such as Barley-water, Gruel, Arrow-root mucilage, or Sago, acidulated with Lemon-juice, and sweetened to the taste of the Patient, are most suitable; but even these should be given in small quantity, and at considerable intervals. The beverage generally most agreeable, and also most salutary, to those suffering un- der fever, is cold water : but a cup of tea poured into a tumbler of cold water is often preferred, and is unex- ceptionable. Ripe fruits are grateful; but they should be taken with caution. No solid matter should be ven- tured upon until the febrile symptoms have abated. In miliary fever, the diet should be purely farinaceous, and somewhat acidulous. In the decline of fevers even, as I have already re- marked, although the severity respecting diet should be relaxed, yet, much danger may result from mistaken kind- ness and over-zeal, in urging animal and stimulant food at too early a period of the convalescence. Indeed, the necessity of caution at this time is greater than during the continuance of the fever ; and the more acute the disease has been, the greater must be the caution in the conva- lescence, especially if the treatment has been of an eva- cuant and lowering description. No error is greater than supposing that debility is always to be removed by nourish- ment and stimulant food, and Wine or other exciting be- verages ; and this caution is more requisite in convales- cence from acute than from chronic diseases. It is much safer to confine the diet, for some time, to vegetable matter only ; and, in the early stage of convalescence, even that 22 254 CHAPTER VIT. should be moderate in quantity ; a rule still more requisite to be observed in the transition to a more substantial and stimulant diet. The first change of diet, in the decline of fevers, should be to another article of the same kind of food which was allowed in the disease ; for example, from simple Arrow- root mucilage to Arrow-root and milk, or to some other of the farinaceous compounds ; whilst at the same time Asses' milk may be given, in small quantity, in the morning. Rice, one of the farinacese, is generally supposed to be astringent; but this is a mistake. It forms an excellent diet in all cases of early, but decided convalescence. It should be well boiled, and mixed either with Broth and Beef-tea; or Gravy, which has been cooled and the fat taken from it. In the transition to animal food, Beef tea, Chicken-broth, and Mutton-broth, and other liquid animal decoctions, should be first resorted to ; then While-Fish, simply cooked; for, although fish is more digestible than animal food, yet it affords much less stimulant nourishment; it is therefore better fitted for the early stage of convalescence. When convalescence is completed, a more generous diet is admis- sible. With respect to beverage, Water, Toast-water, or Lemon- peel-water, is sufficient, until the Medical Attendant declares that a little wine is requisite. The nature of the Wine, both when it is necessary dur- ing the progress of the disease and in the convalescence, is of some importance. The kind and the quantity of Wine, at both periods, is usually fixed by the Physician ; but when this has not been done, in convalescence from fever, it may be assumed that Sherry and sound Claret are pre- - Jj ferable to other wines. The quantity for adults may range from half a pint to a pint, diluted with water, according to the degree of debility. The age of the patient, however, and his previous habits, must betaken into account, in de- termining both the quality and the quantity of the wine. Young persons are more easily excited by wine, and they rally more rapidly from the exhaustion of fever, than adults ; consequently they require less wine in proportion ; and its use may be sooner discontinued. Claret is the best wine DIET IN DISEASE AND CONVALESCENCE. 255 for the' young. Those who daily take from a pint to a bottle of Port-wine when in health require more wine than the temperate, both during the fever and in convalescence. The use of the wine must be gradually withdrawn as the health becomes confirmed. In convalescence from fever, it is an error to permit the patient to get up too soon. He should not leave his bed until his strength be considerably advanced. No danger can result from too strict an observance of this rule; whereas much risk may be incurred by its neglect. In- jury has also often arisen from convalescents venturing out too early, during the cold weather of winter and spring. It has been truly remarked "that many persons, who have struggled through a most dangerous fever, have, from im- prudent exposure to cold, been seized with intense inflam- mation in some organ, which has rapidly destroyed life."* If the head has been much affected, every mental exer- tion should be refrained from during the convalescence; and, according to the degree of suffering in any local or- gan, precautions must be taken to guard that part of the frame against a fresh attack of disease. Eruptive fevers require more precaution, in convales- cence, than general fevers, both as regards diet and expo- sure to sudden alternations of heat and cold. This is more especially essential after Measles and Scarlet fever. Measles are often followed by a distressing cough, and other symptoms of pulmonary inflammation ; or by a ha- rassing diarrhoea, which wears down the strength ; or by inflamed eyes, catarrh, or obstinate toothache. In infants, Canker of the mouth occasionally makes its attack and proves fatal. All these affections, after Measles, might generally be prevented by taking care not to allow too soon a return to the use of animal food ; or too early an expo- sure to cold or to night air. Even in summer, flannel should be worn next the skin for some weeks after the disease has disappeared. Scarlatina is frequently followed by dropsical symptoms ; which, however, might generally be avoided by the same attention to diet and regimen as after Measles. Attention * Cyclopaedia of Practical Medicine, Art. Fever. 256 CHAPTER VII. to the state of the bowels is, also, essential; and the least deviation from their natural action should be reported to the.Physician. The first appearance of dropsy should be reported to the Physician. Small-Pox, when severe, and especially when confluent, is very apt to awaken into activity the dormant seeds of Scrofula, if any hereditary taint exists in the constitution ; hence abscesses, ulcers, and swelled glands, make their ap- pearance. These demand the aid of the Physician, or the Surgeon. But, if the Convalescent be properly dieted, and recourse be had to a change of air as soon as his strength will permit, these evils may be avoided. The diet should be nutritive, but not stimulant; namely, milk, poultry, and mutton plainly cooked, with a moderate quantity of well- boiled vegetables. Erysipelas not unfrequently attacks convalescents from Small-Pox and other eruptive fevers. It should never be entrusted to domestic management. When it occurs, in- dependent of any prior disease, the same attention to diet and regimen is requisite as in other eruptive fevers. The necessity of attention to diet, as a preventive of scrofulous affections, is so well understood, that it scarcely requires to be noticed. It should be simple and nutritious, consisting of a larger quantity of animal food in childhood than would otherwise be required ; and the cookery should be of the plainest description. Every kind of pastry and confections are highly injurious. For scrofulous children who have been lately weaned, milk, in which suet has been boiled, has been found useful. In convalescence from attacks of Scrofula in any of its forms, the diet should be the same as that required to ward t off the disease ; but the quantity should be circumscribed,' and considerably below the demand of the appetite. Convulsions, it is well known, are not unfrequently the result of errors in diet, in individuals with an irritable con- dition of the stomach and bowels. Advice should always be demanded respecting the diet of those who are liable to, and who suffer from, convulsions ; but it must not be supposed that, when they occur in children and have been subdued, a system of starvation is necessary to prevent their DIET AND REGIMEN IN CONVALESCENCE. 257 recurrence. As far as regards convalescence in such cases, it will be proper to bear in recollection the following rules. 1. When the patient is of a full habit, has a short neck, and a tendency to diseases of the head, the diet should be spare. The use of animal food, indeed, in such a habit, should be wholly prohibited in childhood, and very spar- ingly employed by adults ; whilst vegetables, farinaceous matters, milk, and weak broths may be allowed. 2. When the habit of body is spare, and when languor and chilliness are present, the diet, although free from stimulus, yet should be nourishing, and consist of the lighter kinds of animal food ; namely, poultry and fish, with a moderate share of vegetable matters. 3. Under all circumstances, and at every period of life, fermented liquors and wine should be either wholly avoided, or very sparingly used, in almost all convulsive diseases connected with affections of the head. In convalescence from some varieties of convulsive dis- eases, the nature of the diet must depend on circumstances which cannot be judged of by the attendants of the sick- room : hence it should be referred solely to the medical attendant. In St. Vitus'1 Dance (Chorea), for example, although a tonic plan of treatment may have been success- fully pursued, yet the diet may be required to be mild, and wholly free from stimulus. No plan of diet, therefore, even when the convalescence is fairly established, should be determined upon without the advice of the medical attendant. The same precautions are proper to be ob- served in Epilepsy. As a general rule, an abstinence from animal food is, in every case, more or less necessary ; the rule is absolute with respect to fermented liquors, and wine and spirits. Whatever may be the nature of the diet pre- scribed, moderation also, as to quantity, is essential. The necessity for urging attention to this precaution is rendered greater, indeed, from the disposition of most Epileptics to exceed in this particular : nevertheless, no part of the in- junctions of the Physician are so seldom strictly complied with as those relating to diet. "If this cannot be accom- plished," says Dr. Cheyne, in an excellent Essay on this 258 CHAPTER VII. disease, " it would be well that the Physician at once should decline the care of an epileptic patient." Attention to diet in Hysteria is most important. When the disease is connected with indigestion, the meals should be moderate ; and rest in the horizontal posture should be indulged for an hour afterwards, and then moderate exer- cise taken. Fluid food, such as broths and gruel, are im- proper ; yet animal food should be eaten only once a day. Tea and coffee should be very sparingly taken; and the simplest beverages, even water and toast-water, should* be taken in great moderation after a meal, and should not be drunk during dinner. In delicate habits, a glass or two glasses of good Sherry-wine, or a small quantity of brandy and water, may be taken after dinner. Malt liquor seldom agrees with hysterical habits. In convalescence from Hysteria, change of scene and air are absolutely requisite. The mind should be directed to solid studies, and every thing which can cherish morbid sensibility of the nervous system avoided. In every disease of an inflammatory nature, the strictest injunctions of the physician should be observed ; for much depends on the acute or the chronic character of the in- flammation ; the period of its progress; and the probable termination of the attack. When the inflammation is acute, complete abstinence, or at most a very scanty allowance of the mildest, farinaceous diet, may be requisite ; whilst, should it be chronic or sub-acute, not only more nourish- ment, but even a liberal supply, may be allowable. Should it terminate in suppuration, in delicate habits, it may be necessary to prescribe both a nutritive diet and wine: but the Physician or the Surgeon only can determine these points ; and the attendants of the invalid are responsible for strictly carrying into effect his orders. There are dis- eases in which the desire of the patient for food is not to be restrained, nor his inclination with respect to its quality to be opposed ; but inflammatory affections are not of that class. Dropsy. — An opinion was long maintained, that fluids are to be withheld from dropsical patients. No opinion was ever founded on more erroneous principles. Dropsical DIET AND REGIMEN IN CONVALESCENCE. 259 patients, indeed, should be allowed the free use of fluids. With respect to diet, it should, generally speaking, be light and unstimulating: but much depends on the causes of the dropsy. There is, however, less necessity for a rigid ad- herence to low diet in this than in other inflammatory affections. In Palsy, abstinence from all stimulating food, solid or fluid, must be rigidly observed; and the restriction should not be discontinued in convalescence. At the same time, change of air and of scene is always of decided advantage. In every instance, an easy state of mind, and freedom frorn every source of irritation, as well as from the anxieties of business, are indispensable. The confinement of the palsy to any particular set of organs does not alter the necessity for these general cautions; but when exercise cannot be taken, owing to the lower limbs being affected, friction along the spine may be advantageously substituted for it. Gout and Rheumatism. — In no diseases affecting the general habit are abstinence and repose more essential dur- ing the attacks than in the two which head this paragraph, when they assume an acute form. When they occur in weakened or in broken-down habits, it it too often supposed that the opposite plan of diet is to be pursued, and that stimulating food and a liberal supply of wine should be indulged ; but nothing is more likely to prove injurious. As medical aid should always be obtained whenever either disease makes its appearance, it is not my intention to aid, in any degree, the domestic or empirical management of them during the attacks ; and I have nothing to add to what has been already detailed (pp. 66,128). The absurdity of the opinion that those who have frequently suffered from Gout or from Rheumatism should be able to manage them- selves is too obvious to require refutation. An old gouty patient, who thought he knew his own constitution well, mentioned to the Physician the common adage, that " he ought to be able to cure himself, as every man above forty is either a fool or a physician." The Doctor calmly re- plied, " Be assured, sir, you are no physician." When the paroxysm subsides, it is too customary to per- mit the Invalid to glide into his usual habits with respect 260 - CHAPTER VII. to diet'and regimen ; consequently the plethora which ori- ginated the disease gradually returns ; and, the same plan being continued, paroxysm follows after paroxysm, at shortening intervals, until scarcely any interval occurs; and life is sacrificed on the altar of self-indulgence. For some weeks after the paroxysm of Gout has sub- sided, in a young or a middle-aged man, animal food should be sparingly taken, and fermented liquors altogether avoided. The idea of debility is the bugbear which the convalescent is most afraid of ; and, to keep the Gout from the stomach, wine is resorted to ; and a supply of nutritive food, which oppresses the digestive organs and induces indirect debility, more hurtful than that which this errone- ous plan of treating convalescence is intended to obviate, is indulged. There is an aversion in gouty or rheumatic subjects to be convinced of the truth of this doctrine ; and the Physician who would endeavour to enforce its observ- ance, if he depend for his subsistence on the favour of the public, would have little chance of having an attack of Gout himself from over-nutrition. Exercise, as far as the strength can bear it, is as essential as moderation in diet; and it should be taken on foot. No method of manage- ment is so likely to keep within bounds the nutrient, and to favour the excretory, functions. The organs of the body are thus brought back to their natural and healthy condi- tion, and maintained in it by the strict observance of the same plan, after all feelings of disease have disappeared. If due exercise be daily taken, with or without the use of the shower-bath and friction, the bowels will require no arti- ficial assistance ; and the skin wfll be preserved in that condition which is the accompaniment and the safeguard of health. If these rules be necessary after an attack of Gout, in one not hereditarily predisposed to the disease, it re- quires no arguments to prove that their observance is much more essential in those to whom Gout has descended as a patrimonial inheritance. When Gout has become habitual, Invalids often despair of relief; and, regarding their cases as desperate, endea- vour to keep up the vis vita, the constitutional energy, by recourse to artificial stimulants, such as brandy-and-water; DIET AND REGIMEN IN CONVALESCENCE. 261 and, when pain recurs, to allay it with a full dose of colchi- cum. But it should be known that such a plan is like throwing tar-barrels into a burning house ; and that the opposite plan, if it cannot cure a disease of long standing, is likely to mitigate the attacks, to lengthen the intervals, and to ward off disorganizations, which can never be cured. As the open state of the skin is essential for restoring health after an attack of Gout, the tepid shower-bath or the vapour-bath proves highly serviceable in the management of the convalescence. Either should be used in the earlv part of the day, and brisk exercise taken afterwards in the open air; or, when the weather is unfavourable, friction with hair-gloves should be employed. No doctrine is worse founded than that with which gouty patients often console themselves : — " Well, if we occa- sionally suffer, Gout keeps off other diseases !" On the contrary, Gout weakens the constitution, and renders it susceptible to many other diseases which rarely attack a healthy person: nevertheless, there can be no doubt that the gouty paroxysm is intended to relieve a surcharged state of the system. Morbid Corpulency generally originates in causes closely allied to those which occasion Gout. This condition must not be confounded with that extraordinary natural obesity or fatness which occurs in some individuals, and which is neither inconsistent with health nor strength. As illus- trative of this fact, I may notice the case of a German girl, mentioned by Mr. Wadd, in his work on Corpulency, who weighed 1501bs. at four years of age, and 450 at twenty. Her physical strength was so uncommon, that, at six years old, she could carry her mother; and, when she attained to twenty years of age, she thought nothing of carrying 2501bs. in each hand. Her arms measured eighteen inches in circumference, and the rest of the body was in propor- tion. She ate little, but drank a great deal. She was healthy, vigorous, and active; had all the attributes of womanhood at nine years of age ; and suffered from nothing except shortness of breath on ascending a stair or any height. Without alluding farther to such extraordinary growths, 262 CHAPTER VII. we find a cause of morbid fatness in that kind of excess of all the nutritive functions which may be regarded as an excess of health, if such an expression be admissible ; but which, by the deposition of fat loading the organs and im- peding their functions, passes into a state of disease consist- ing of defective strength, torpid bowels, a slow, languid pulse, a white, pasty condition of the surface, a low condi- tion of the irritability of the frame, and somnolency. As this is usually the result of good living and indolence, it might be supposed that nothing is necessary to remedy the evil, except abstinence and activity. But, although these are the best preventives of over-fatness, yet, when it really amounts to disease, medical treatment is as essential as in a fever or a dropsy. When it is fortunately removed, the return to any thing approaching to generous living should be very gradual: much fluid should be sedulously avoided ; active exercise, even violent, must be taken daily in the open air; and the quantity of sleep restricted to four or at the most six hours in twenty-four hours. I may here men- tion, that the idea of reducing obesity by bleeding and purging is founded on mistaken principles : fat people do nor bear the former well, and they suffer from lowness to a degree which could not be anticipated from the latter. Its reduction, however, may be aided by the daily use of Cream of Tartar beverage. Chlorosis, Green Sickness, is a state of the habit which seems to depend on an impaired condition of the blood itself. Its treatment is well understood, and recourse to medical advice should never be neglected ; otherwise it may terminate either in mental derangement or in sudden death. In convalescence from it, the diet should be mild and light, but nutritious ; the exercise should be much within the limits of fatigue, and consist of both walking and horse exercise, daily, in the open air : the body, more especially the lower extremities, should be warmly clothed: the mind ought to be amused ; all sedentary occupations thrown aside ; and confidence placed in the honour of the Physician, who should be made the repository of any mental anxiety, especially connected with the tender pas- sion, which may be preying upon the vital energy of the body. DIET AND REGIMEN IN CONVALESCENCE. 263 Men are, occasionally liable to the disease, or at least to a malady closely resembling it: and, although almost as rarely, yet, it sometimes occurs to married women. In these cases, the same plan of treatment, and a similar manage- ment of the convalescence are requisite, as in delicate single women, or in young girls. b. Affections of the head. — Whatever may be the cause of Apoplexy, no disease requires more prompt and energetic treatment: the alarming nature of the symp- toms is always sufficient to prevent any time from being lost by attempts to relieve the sufferer without medical assist- ance. Should the attack not prove fatal at the time, and should it not be followed by Palsy, still the utmost caution is requisite to prevent a recurrence of the disease. It is scarcely necessary to insist on the strictest adherence to tem- perance, both as to meat and to drink ; and the importance of daily exercise, when the attack is over ; and indeed for the remainder of life. Prolonged study and intense thinking must be given up ; the violent and exciting pas- sions should be subdued ; and even the pleasurable mode- rated. If the Invalid previous to the attack was en- gaged in any occupation likely to impede the circulation of the blood in the brain, by obstructing its return to the heart, it should be given up ; and if he has been a flute- player, that accomplishment must also be foregone, as the voluntary suspension of breathing after a full inspiration is likely to bring on another attack. Much sleep, also, must be avoided. Inflammation of the Brain is one of those diseases which require, as observed respecting Apoplexy, the most ener- getic treatment. When convalescence has fortunately been established, the attention of the Physician is still requisite, durino- several weeks, until complete recovery be fully confirmed ; for the brain, after suffering from inflamma- tion, is very apt to relapse into the same state, from the excitement of too full a meal, or over-exercise, or even slight mental exertions or emotions. On this account, the convalescent must be kept perfectly quiet and completely free from the smallest excitement; and the strictest regi- men observed. His diet should not only be mild and 264 CHAPTER VII. unstimulating, but small in quantity ; for, although circum- stances may exist during the progress of the disease, which require that the strength of the Invalid should be kept up, and even cordials administered, yet, all these cease when convalescence takes place. The dread of debility must altogether be set aside ; and the renewal of strength left to the natural efforts of the constitution, as they gradu- ally regain their powers. In Inflammation of the Brain in children (see Water in the Brain, p. 119), the convalescence is slow. During its progress, the most unremitting attention is required to the condition of the bowels; for which purpose, the alvine evacuations should be daily inspected, and the least devi- ation from their natural state immediately mentioned to the medical attendant of the family. The diet, in the early or active stage of the disease, should be strictly such as conveys little or no nourishment into the system (see p. 121); but, when the disease has run its course, and con- valescence has happily commenced, the farinacea may be changed for Beef-tea, Asses' Milk, and Cow's milk, light- ened by means of a small addition of sugar. Inflammation of the Eyes requires the same caution when convalescence is secured as other inflammatory affections; namely, quiet, great moderation in diet, and avoiding ex- posure either to much light, heat, or cold, or whatever can stimulate the still highly excitable organ. When the dis- ease assumes that virulent form which is termed Purulent Ophthalmia, the reasons for the necessity of a regulated tem- perature and free ventilation, generally enforced by the Surgeon or Physician, should be known to the attendants of the sick-room. Experience has proved that the enclo- sure of the bed-curtains, and immuring the Invalid in a close, dark room, are always productive of the most per- nicious effects. Fresh air and moderate light are essential in such cases ; and, in fine weather, the patient should take exercise out of doors. The diet may be more generous than in simple inflammation of the eye. When Purulent Ophthalmia occurs in infants at the breast, the intervals between the times of suckling should be lengthened ; and when the breast cannot be withheld with- DIET AND REGIMEN IN CONVALESCENCE, 265 out causing much irritation to the infant, a gentle effietie should be occasionally administered, to unload the stomach.- The best emetic for this purpose is the Wine of Ipecacuanha^ which may be given in doses of a tea-spoonful at intervals of fifteen minutes, until vomiting be produced. The eye requires much less clearing than is generally supposed: indeed, the purulent discharge forms a natural protection against the acrimony of the tears. c. Affections of the Chest. —• When convalescence is confirmed after inflammation of the upper part of the windpipe (Laryngitis), the Invalid should for some time be confined to an atmosphere not exceeding 60° Faht. ; he should avoid east and north-east winds, and evening air. The diet should be light, unstimulating, and moderate in quantity. Croup. It is scarcely necessary to say, that, in this dis- ease of the mucous membrane, extending, however, beyond the wind-pipe into the breathing or bronchial tubes, the Same precautions with regard to temperature and diet are essential as in inflammation of the windpipe. In both dis- eases, if the health remains impaired, and the strength is not restored, a change of air has been found very service- able4 The new situation should be low, and sheltered from the east, the north, and the north-east winds. Common Cold. This inflammatory affection of the mu- cous membrane (Bronchitis, or Catarrh) sometimes assumes a low form, and leaves a much greater degree of weakness than the high inflammatory form of disease which consti- tutes Croup. In this case, a teazing, irritable cough re- mains, which rarely disappears until change of air is ob- tained. The same diet and regimen are requisite as in the chronic form of the disease. In chronic inflammation of the lining or mucous mem- brane of the air passages in the lungs (Chronic Bronchitis,, or Catarrh), if the Invalid cannot leave home, he should be confined to an apartment regulated to the temperature of 60° ; and, during easterly winds, which are dry and irritating, the vapour of warm water should be diffused through the room, so as to soften the air as it enters the in- flamed pulmonary tubes. The diet should be mild ; but a 23 266 CHAPTER VII. total abstinence from animal food is not essential. Sudden transitions of temperature should be avoided, long after the convalescence is complete ; and the surface should be kept uniformly warm, by a flannel shirt next the skin, and flan- nel drawers. The removal to a warm climate is often re- quisite after both forms of the disease : but, when circum- stances prevent such a measure, the Invalid should at all events change the air. The change to the distance of only a few miles often proves beneficial. Inflammation of the Lungs (Pneumonia). In convales- cence from this disease, the temperature of the room in which the patient sits should not exceed 60° Faht.; and it should be free from currents of air; but, at the same time, it should not be close. The necessity for continuing the same elevated position of the shoulders when in bed, which is demanded during the existence of the disease, remains even wThen the convalescence is advanced. The patient should be prevented from much talking, and from exerting any muscular motion that can accelerate the circulation. The diet should be of that description which will support the strength without exciting or producing repletion. As the convalescence advances, and exercise is permitted by the medical attendant, it should be regular,, but not hur- ried nor violent; and evening air should be sedulously avoided. When,in spite of these precautions, health does not com- pletely return— but slight relapses recur as the weather becomes colder, or when north or easterly winds prevail— then a change to a mild climate for the winter season must be resorted to: and, when the Invalid cannot go to Italy or to Madeira, no situation is so well adapted for such cases as the Cove of Cork. Pleurisy. — Inflammation of the lining membrane of the chest requires the same attention to diet and regimen during convalescence as the last mentioned disease, except that a greater strictness with regard to abstemiousness in food is requisite; the least deviation being likely to bring on a re- newal of the inflammation. When the disease assumes a chronic character, and when the object is to remove fluid effused into the cavity of the chest, and pressing upon the DIET AND REGIMEN TN CONVALESCENCE. 267 lungs so as to circumscribe their action, the same degree of strictness with respect to diet is not necessary; but, as in this condition of the habit the Physician must continue his attendance, the regulation of the diet devolves upon him. Angina. — In that condition of the habit, which is con- nected with a predisposition to Gout, but in which, instead of a regular paroxysm, the heart and the pulmonary organs become affected, and the disease assumes that form which hasbeen denominated Diaphragmatic Gout (Anginapectoris), the regulation of diet is of vital importance ; and it should be of as low a standard as the constitutional powers will admit. It should not be of a description either to nourish much, or to augment or to cause fulness of habit: mild ani- mal food, in moderate quantity, may be allowed ; but the staple should be of a farinaceous kind ; every stimulant, whether solid or fluid, should be avoided ; and wine and malt liquors regarded as poisons. The Invalid himself should be made aware, that whatever tends to excite or to hurry the circulation is calculated to bring on a paroxysm; nor is it sufficient that he avoids all stimulating viands and beverages ; he should also be instructed that the same dele- terious effects are likely to follow a full meal, even of the most proper and the mildest food. The sams attention to diet, both as regards quantity and quality, is essential in Palpitations depending on organic disease of the heart. In no affection of the chest is attention to diet so import- ant as in Asthma. Sir John Floyer, who himself suffered from the disease, recommends almost a degree of abstinence ; which is correct in reference to quantity ; but the diet, al- though of a light, yet should be of a solid kind. This is especially necessary, when Dyspepsia is present to aggra- vate and excite the disease of the lungs. In Hooping-cough, the diet, whether the patient be an adult or a child, should be of the mildest description ; and, perhaps, no nutriment is so well adapted to support the tone of the body, without exciting it, as milk. In infancy, no- thing but the breast should be given ; the system of the nurse, at the same time, being kept as cool as possible by 268 CHAPTER VII. mild diet, and her mind in a tranquil state. If convulsions occur, these sometimes depend on the nature of the milk; in which case the nurse should be changed. It is still cus- tomary with non-professional persons to consider change of air essential in Hooping-cough; but it is only after the malady has run its course, and convalescence is progress- ing, when the cough remains as a habit, that change of air js really beneficial. It is unnecessary to combat the absurd opinion, that a change even to a worse air is salutary. d. Affections of the Stomach and Bowels. Although acute Inflammation of the Stomach rarely occurs, yet, there js a chronic form of that disease, in which, during its actual existence, and also in convalescence from it, much of the safety of the Invalid depends upon domestic management. Every source of excitement should be avoided; the sick- room should be airy, and its temperature that of summer. The food should be of the blandest kind, and given cold, or iced, and in small quantity ; even when the convales- cence is established, the diet should consist of farinaceous matters, mixed with small quantities of Beef-tea, or weak broths; and this severe diet should be persisted in for a considerable time after recovery. Enteritis. — When inflammatory action extends to, or exclusively exists in, the mucous lining of the bowels, con- stituting this disease, the diet, during the early stage of it, should be confined to cold water, or iced Almond-emulsion; after which, Milk and Barley-water, or weak Chicken or Veal tea, may be given in small quantities; namely, two or three table-spoonfuls, at intervals of three or four hours. Nothing stronger should be ventured upon, unless expressly ordered by the medical attendant. Atonic Dyspepsia, or Simple Indigestion.—During the at- tack, abstinence, to a certain degree, is necessary; but, if this is not essential, the diet should be somewhat stimulant, but simple; namely, a small cup of moderately strong Cof- fee, with little sugar or milk ; or Beef-tea, with a small quantity of dry toast; and, as the stomach begins to retain its tone, a little animal food of easy digestion, such as mut- ton or poultry. More powerful excitants, in the form of condiments, as Cayenne pepper, Mustard, or high-flavoured DIET AND REGIMEN IN CONVALESCENCE. 269 dishes, must be avoided. All condiments, indeed, except salt, are hurtful ; and, unless the person has been accus- tomed to the use of wine, neither it nor brandy-and-water should be taken. If the tongue be moist and clean, this restriction may be relaxed ; but not whilst it remains dry or furred. During the intervals of the paroxysms of Indigestion, attention to diet is of the first importance. As a general rule, the patient should be confined to a spare animal diet, with a moderate share of well-boiled vegetables, and a con- siderable restriction with respect to the use of fluids. Cof- fee, with little milk and sugar, is preferable to tea for break- fast : the bread should be stale or toasted, with a little fresh butter ; but its quantity should be limited. In delicate habits, a small portion of light animal food is allowable ; or a new-laid egg, lightly boiled, may be occasionally taken. For dinner, mutton, venison, poultry, and winged game, are to be preferred ; they should be roasted rather than boiled ; and should never be dressed a second time. Fat meat; gelatinous meat, such as that of the young pig, lamb, and veal ; salted or smoked meats, sausages ; strong con- centrated soup, mushrooms, truffles and morels ; fish, espe- cially the coloured, as Salmon, Mackerel, and Herrings ; fish sauces ; and melted butter ; should be avoided. The best, vegetables are young Brussels sprouts, Cauli- flower, Asparagus, young Peas, French beans, and, very mealy Potatoes. Among hurtful vegetables may be men- tioned, Beans, old Peas, waxy Potatoes, Jerusalem-arti- chokes and Cucumbers.* Rice is an excellent sub- stitute for fresh vegetables ; but all pultaceous matters, pastry of every kind, dumplings, new bread, custards, creams, and cheese, are hurtful. Fruits should not be eaten after dinner, but in the early part of the day, and then in great moderation. The least injurious are Strawberries ; the Mulberry : a ripe, juicy Peach or Nec- tarine ; an Orange, if very ripe, and Grapes. The in- jurious are Figs, whether dried or fresh; Currants, Goose- berries, Apples, Plums, Cherries, Apricots, Melons, Nuts * [We have already stated, p. 246, that we dissent from the author as respects the digestibility of the vegetables noticed by him.] 23- 270 CHAPTER VII. of all kinds, and Almonds, unless they are well masticated. Any fluid, and the best is sherry-and-water, should be taken after the meal is finished, not during the intervals of eatino-. All sweet wines, ale, and mucilaginous and acid fluids, should be scrupulously avoided. When Indigestion is attended with pain, or that condi- tion of the stomach which indicates a very irritable and sensitive state of its internal membrane, the diet must be suited to the sensibility of the organ, as well as to the wants of the system. The food should be of such a nature as to require the least action of the stomach for its digestion, and so soluble as to leave as little as possible behind it to act as a mechanical irritant. It should be partly animal, partly farinaceous, neither too fluid nor too dry ; and the avoid- ance of those substances enumerated as injurious in simple Indigestion must be carefully observed. Milk in all its modifications of preparation, either in its natural state, in conjunction with farinaceous matters, or coagulated as uncompressed curd, is the best diet in this form of Dyspepsia, when it is severe. In milder cases, plain soups, well-boiled, tender vegetables, and mutton or poultry, are admissible. Sherry, Hock, sound Claret, weak Brandy-and-water, alternated with good Porter, in moderate quantity, are proper articles of beverage. The quantity of food should be small, not more than a few spoonfuls at once, and frequently repeated ; and the greatest care observed to masticate the food well. When the condition of the stomach is that which is ac- companied with cramp, and vomiting of glairy, viscid phlegm in the morning, especially in people somewhat ad- vanced in life, and young persons of a cold, phlegmatic temperament, the diet should be of a dry kind, and consist chiefly of the lean of mutton and poultry, and vegetables sparingly eaten. Fish, milk, cheese, eggs, and fruit, should be avoided ; and the quantity of bread limited. The meat should be thoroughly cooked, and always eaten hot: but it is less hurtful in a cold state than when twice cooked. With regard to beverage, coffee is preferable to tea for breakfast, dry wines, such as Sherry or Hock, or Brandy- and-water, in moderation, are allowable ; but malt liquors, DIET AND REGIMEN IN CONVALESCENCE. 271 especially Ales, are decidedly hurtful; indeed, they are often the exciting cause of the malady. When the Practitioner in attendance declares the disease to be seated in the first gut or duodenum, the meal, what- ever it may be, should be within the range of the powers of the stomach ; that is, it should not be sufficient to satisfy the appetite. It should be eaten slowly, well masticated, and with the mind completely disengaged. The same kind of food as in the last case should be selected ; and, with respect to beverage, malt liquors are equally objectionable. The proper application of a flannel-roller around the trunk of the body, in addition to the warm bath or fomentations, or other medicinal means, has been productive not only of great comfort to the Invalid, but displayed the most im- portant influence in forwarding recovery. In adult cases, when the skin is cool, the countenance sunk, and the teeth are covered with a dark-coloured fur, and the stools are passed involuntarily, a little diluted wine, or white-wine whey, should be given ; but it should be under the control of the medical attendant. In order to allay thirst, in the early stage of the disease, nothing is more grateful and salutary than small pieces of washed ice, taken into the mouth, and permitted to dissolve slowly : it has never, as far as the author's experience extends, been productive of deleterious consequences. Dysentery, which implies inflammation, acute or chronic, of the same membrane as in Enteritis, but confined to the larger and lower bowels, requires the diet to consist of the mildest farinaceous matters, strictly avoiding all solid ani- mal food. It should be given in small quantity at a time, and the whole allowance for the day should be moderate. The farinaceous food should not be either solid, nor yet altogether fluid : the former may prove injurious as a me- chanical irritant; the latter is apt to excite griping, from the extrication of much flatus. Besides fomentations, and other means likely to be prescribed by the Physician, swathing the abdomen with a flannel roller, not applied so tight as to cause pain or uneasiness, is useful, both in affording sup- port and for preserving the temperature uniform. Diarrhcea. — Much of the domestic, as well as the medi- 272 CHAPTER VII. cal management of Diarrhcea depends on the nature of the attack, and its causes ; but too much attention cannot be paid to the regulation of the diet. It should be both small in quantity, and mild in quality. In the early stage, and the acute form of the disease, Barley-water, Arrow-root made with water, Rice or Grit gruel, and light broths, are proper. In chronic Diarrhcea, Rice, properly boiled and mixed with a small quantity of Beef-tea, forms an excel- lent diet, as it nourishes moderately, and leaves scarcely any feculent matter behind it. After a few days, if the Diarrhcea be of an acute kind, a small morsel of Chicken or Game, or of Mutton, may be added ; but it should be at first given only in the form of Panada; and afterwards roasted, removing the skin before it is eaten. Calves-foot jelly is more irritating to the bowels, and much less nutri- tive, than solid meat. Fish is still more irritating, owing to the large quantity of undissolved excrementitious matter which it leaves in the bowels. In Cholera, convalescence is often tedious; and nothing is so likely to cause relapse as even slight irregularities of diet. For weeks after the feverish symptoms have disap- peared, the diet should consist of a very moderate quantity of vegetable matter only. The feet should be kept espe- cially warm, and the whole body clothed in flannel, to pre- vent that irregular distribution of blood which so strongly characterizes the disease. After inflammation of the lining membrane of the cavity of the belly (Peritonitis) has been subdued, the Invalid should still observe the strictest diet and regimen. He should return very gradually to the use of animal food and wine. The bowels should be moderately and daily opened, the feet kept warm, and the skin maintained in a healthy condition by wearing flannel next to it, for a very consider- able time after every trace of the disease has disappeared. Diseases of the Liver. — In all cases of recovery from these diseases, whether inflammatory or otherwise, every precaution should be taken to guard against the deleterious influence of alternations of temperature and also of damp, by clothing in flannel next the skin, and shunning exposure to a north or a north-east wind. The winter residence MANAGEMENT OF FUMIGATIONS. 273 should be in a sheltered, mild situation; and, when ex- pense is no obstacle, the patient should remove to a tem- perate climate for several successive winters. Errors in diet should be avoided ; and fermented liquors, and stimu- lating beverage of every kind, refrained from. When pains of the side continue, after all the other symptoms of the disease has disappeared, the introduction of a seton, if pre- scribed, should not be objected to ; as the greatest benefit has often followed that mode of counter-irritation. Such are the general principles for the management of convalescence in those diseases which are of most common occurrence. One thing still remains to be considered ; namely, the means requisite, besides ventilation, for pre- venting the extension of infectious diseases, and for de- stroying the virus which may remain in the sick-room after these maladies. I have already insisted on the necessity of preserving the sick-room free from all smells, and in as pure a state as possible: but this is difficult to be done when typhoid fever is present, or when any disease which is under treatment is accompanied with ulcers on the legs or on other parts of the body ; and the difficulty is increased when the complaint is Cancer, or when mortification occurs. In such cases, Chloride of Lime should be sprinkled over the floor of the room ; and dishes containing it mixed with water placed in different parts of the apartment, and frequently reple- nished. Whenever infectious or contagious fevers occur, Fumi- gations are employed to prevent the spreading of the dele- terious effluvia which emanate from the bodies of the Inva- lids, and the extension of the diseases. They are also necessary after these diseases; for the tenacity with which the infectious matter adheres to the substances in the sick-room is scarcely credible. I have already mentioned (p. 44) a striking illustration of this fact in reference to Erysipelas ; and many more, connect- ed with other fevers, might be quoted. It is often, therefore, of as much importance to purify 274 CHAPTER VII. an apartment and its furniture after the termination of an infectious disease, as during its existence. In this case, the Fumigation with Chlorine about to be described should be used after the floor of the room and every solid thing in it have been washed with soap and water ; and all bright metallic substances, such as pokers, tongs, and fenders, have been removed from it. The walls should after- wards be white-washed, or fresh painted or papered, and the room thrown open to the air for some time before it is again inhabited. It may be said that Fumigations are not to be solely re- lied upon ; and that they ought never to supersede ventila- tion or cleanliness. Whilst this must be admitted, it would be absurd to deny their utility ; consequently, their nature and the mode of employing them should be understood. Fumigations of the most varied kind have been sug- gested and employed for this purpose ; namely, Pastiles, Tobacco, Camphor, Vinegar, Ammonia, the Mineral Acids, and Chlorine. a. Pastiles, as disinfecting agents, are utterly useless: they are relics of an ancient custom of burning Frankin- cense, and other odorous substances in vitiated air, to over- come the fcetor which is more or less present. They dis- guise unpleasant odours ; but they accomplish nothing more. The infection remains not only unaltered by the diffusion of the most powerful aromatic vapours, but its deleterious properties are sometimes augmented by them. b. Tobacco. — Although smoking Tobacco is very gene- rally supposed to preserve those in the habit of it from the influence of infection, yet, for the same reasons which should prevent confidence being placed in Pastiles, we may well doubt the efficacy of Tobacco. c. Camphor has more pretensions than either of its pre- cursors to the name of a useful article of Fumigation. It is much employed and confided in on the Continent; but the experience of the author, and of British physicians, does not permit him to acquiesce in the opinion that it possesses any power of destroying infection or Contagion. Nothing is more ridiculous than the custom, which was at one time very general, and which is still continued to a MANAGEMENT OF FUMIGATIONS. 275 certain extent among females— namely, that of carrying a Camphor-bag in the bosom, as a protection against infec- tious diseases. d. Vinegar is, not without reason, regarded as possess- ing some chemical influence in decomposing infectious and contagious matters ; and, consequently, it is almost invaria- bly sprinkled over the floor of the rooms of those suffering under infectious diseases ; or the vapour of hot vinegar is diffused through their apartments. It is thought to be still more salubrious, and a more powerful disinfectant, when it holds Camphor or Aromatic Oils in solution; hence the great popularity of the preparations calls Aromatic Vine- gar* and Thieves'' Vinegar.f - The repute of the latter is founded upon a story, that four thieves, who plundered the dead bodies during the plague at Marseilles, with per- fect security, on being questioned respecting the cause of this impunity, confessed, on the condition of their lives being spared, that they attributed it solely to the use of Aromatic Vinegar. Vinegar, in this state of combination, is extremely agree- able and refreshing, both to the Invalid and the attendants of the sick-room. The benefit which it produces depends upon a certain degree of stimulus imparted to the sensi- tive nerves, which are generally in a low condition in an infectious atmosphere : but, as a chemical agent, its powers are too feeble to be followed by much benefit. It is, how- ever, always refreshing, and is much better adapted for overpowering the unpleasant odours of the sick-room than any of the former substances. e. The most efficacious Fumigation which has yet been proposed is Chlorine. It was first suggested as a disin- fecting agent by the French Chemist Fourcroy, in 1791 ; and it has, since that time, been very generally adopted. Chlorine is extricated from the decomposition of Muri- * Henry's Aromatic Vinegar contains Camphor„and the Oils of Cloves, of Lavender, and of Rosemary. + Thieves' Vinegar, J'iniugre des Quatre Voleurs, contains the volatile oils of Wormwood, Rosemary, Sage, Spear Mint, Rue, Lavender, Calamus aromaticus, Cinnamon, Cloves, Nutmegs, and also that of Garlic, extracted from these substances by macerating them in strong Vinegar. After the fluid is filtered, Camphor, dissolved in Spirits of Wine, is added to it. 276 CHAPTER VII. atic Acid by Peroxide of Manganese ; but this is too ex- pensive a process for ordinary occasions. The best ma- terials, and the proportions of them, for extricating Chlo- rine at a cheap rate was ascertained by Dr. Faraday, in the disinfection of the Millbank Penitentiary : — namely, two ounces of powdered Peroxide of Manganese, mixed with ten ounces of Chloride of Sodium (Sea-salt), and six ounces of strong Sulphuric Acid, diluted with four ounces of Water.* This quantity of materials is sufficient for purifying a room forty feet by twenty. The mixture should be put into a porcelain cup or basin, which should be placed in a pipkin of hot sand. The doors and the win- dows of the room being shut, the fumigation may be left in it for ten or twelve hours ; after which, both the doors and the windows should be thrown open, to admit a cur- rent of air to pass through the apartment and carry off the Chlorine. One objection exists to the employment of the above mode of extricating Chlorine in apartments which are in- habited ; namely, its powerful irritant influence on the lining or mucous membrane of the air tubes in the lungs, and the cough which it excites. In order to obviate these inconveniences, the Chloride of Lime is employed ; which, by attracting the Carbonic-acid of the air, and causing the conversion of the Lime into a Carbonate of Lime, separates the Chlorine in a free or gaseous state. The Chloride of Lime should be mixed with water, in the proportion of one part to forty of the water, in a flat dish or plate, so as to expose a large surface to the action of the air; and the dish holding this mixture should be placed on a table, on the leeward side of the bed of the patient. The floor of the sick-room should be also sprinkled with it; and rags, * In this mixture, the Chloride of Sodium, which is a compound of a pe- culiar metal called Sodium and Chlorine, is decomposed ; the Sodium be- ing converted into Soda (the Oxide of Sodium) by Oxygen furnished fropi the Oxide of Manganese. In this state, it is no longer capable of remaining in union with the Chlorine, from which it separates and combines with a portion of the Sulphuric Acid, another portion of which unites with the re- miining protoxide of .Manganese ; whilst the Chlorine flies oil'in the form of gas. The result of the chemical action is, therefore, gaseous Chlorine, Sul- phate of Soda, and Sulphate of Manganese. The first is the fumigat'ng agent. MANAGEMENT OF FUMIGATIONS. 277 moistened with it, suspended in different parts of the room. The solution of Chloride of Soda maybe employed instead of the solution of the Chloride of Lime. The same chemi- cal changes take place, and gaseous Chlorine is evolved. The solid furniture in the room should be previously washed with hot soap and water, and then with the solu- tion of Chloride of Soda or Chloride of Lime. If the putrid odour in a sick-apartment do not arise from the general state of the system of the Invalid, but from ill- conditioned ulcers and sores, these should be washed and poulticed with the solution of Chloride of Soda, which ope- rates not only by destroying the foetor, but by improving the condition of the sores. With regard to the mode in which Chlorine operates, the most probable opinion is, that it decomposes the infectious matter, which is a compound. One principle of this com- pound seems to be hydrogen ; another, Ammonia ; and a third, a foetid Volatile oil; besides the unknown matter of infection. The Chlorine unites with the Hydrogen, and forms Hydrochloric acid, which combines with the second component of the infectious medium — namely, Ammonia— and forms Sal Ammoniac ; the withdrawing of both of which from the air causes the precipitation of the Volatile oil; whilst the Chlorine also neutralizes the real matter of infec- tion, whatever it may be ; and thus the vitiated atmosphere is purified. Chlorine, even when extricated from Chloride of Lime, or from Chloride of Soda, is apt to excite coughing in those unaccustomed to breathe it. But the nurse should be made aware of this fact; and should so apportion the quantity of the materials on the first introduction of it into the room, that it may cause no such effect : and by afterwards adding to the number of the dishes in which it is distributed through the room, no inconvenience will result; the lungs being Uius gradually accustomed to the irritant impression. I have ascertained that the decomposition and conse- quent development of the Chlorine is much quickened by placing a piece of coarse Calico in the bottom of the ves- sel containin"- the Chloride of Lime or the Chloride of Soda and Water. 24 278 CHAPTER VIII. CHAPTER VIII. COOKERV FOR THE SICK AND THE CONVALESCENT : USEFUL FORMS OF DOMESTIC MEDICINES. The cookery for the sick and the convalescent is confined to the simple processes of boiling, balcing, and roasting. Before entering into the details of Sick-room Cookery, there- fore, it will be useful to offer a few remarks upon the prin- ciples which render these processes serviceable in the prepa- ration of food. 1. Boiling softens the animal fibre, and enables it to be more readily and effectually acted upon by the juices of the stomach; but, at the same time, it robs it of some of those nutritive matters which are soluble in boiling water. Much depends, however, on the slow or the rapid manner in which the process is conducted. If the boiling be too quick, it coagulates the albuminous matter of the meat, ren- ders the flesh on the outside hard, whilst the interior is not sufficiently done; consequently quick boiling diminishes its digestibility. In boiling meat, the water should scarcely be brought to the boiling temperature ; and it should be long kept at a lower than a boiling point of heat, or at that state which approaches more to simmering than to boiling. Every kind of meat for Invalids, except poultry, should be put on the fire with cold water, and very slowly boiled. The nature of the water is, also, of some importance. Beef or mutton boiled in hard water is always more tender and juicy than when soft water is employed ; a fact pro- bably depending on the solvent properties of the water in- creasing in the ratio of its density. Fish, on the contrary, is rendered firm in the ratio of the hardness of the water in which it is boiled. Hence, fish boiled in sea-water, or in water containing much salt, is always firmer and more highly flavoured than that which is boiled in soft water, or water without salt. Vegetables require rain or soft water, with the addition of salt. In general, they are rendered indigestible from being too little boiled. This is especially the case with respect to the Cabbage, the Cauliflower, Brocoli, Turnips, PRINCIPLES OF COOKERY FOR THE SICK-ROOM. 279 and Peas ; which too frequently are cooked rather to please the eye than to afford nutriment. For the sick-room, ve- getables should be boiled in two waters ; when too little boiled, they prove highly injurious. 2. Stewing requires the heat to be kept under the boiling point; and a small quantity of water only is required. It softens the meat, and renders it more readily acted upon by the juices of the stomach than when it is boiled : stewed meat, therefore, is a good form of cookery for the conva- i6sccnt« 3. Theprocessof £a/a'rco-is inadmissible for the preparation of animal food for either the sick or the convalescent: but it may be employed in the preparation of light puddings for the latter. The surface of the puddings, however, should not be browned by the aid of butter. 4. Roasting softens the tendinous parts of animal food better than boiling ; and it retains more of the nutritive principles of the meat; hence, if the meat be neither too little nor too much done, roasted is more nutritive than boiled meat; but it is less easily digested. This fact is demonstrated by the comparative loss which takes place in these two modes of cooking. It has been ascertained that Mutton loses one-fifth and Beef one-fourth of its weight by boiling ; but both lose only a little more than one-sixth in the process of roasting. The digestibility of the meat, however, being in the ratio of the softness of the fibre, that property is increased by slow boiling. It has, of late years, been much the fashion to regard under-done roasted meat well adapted for weak stomachs', but no opinion is more erroneous. The processes otfrying and broiling are wholly incom- patible in Cookery for the sick-room.* The Cookery for those actually suffering under the pres- sure of disease differs considerably from that which is re- quired to repair the ravages of previous illness, and to restore the vigour and the strength of the body in conva- lescence. The following directions are therefore arranged under two distinct heads — namely, 1. Cookery for the Sick-room. 2. Cookery for Convalescents. » Vide Human Health, by R. Dunglison, M.D. 280 CHAPTER VIII. 1. The Cookery for the Sick-room comprehends farina- ceous preparations, animal teas, broths, milk, and drinks. a. FARINACEOUS PREPARATIONS. The whole of these may be regarded as modifications of Starch, more or less pure. They are not capable of con- veying much nourishment into the habit; and being mild, and completely devoid of stimulant properties, they are well calculated for the sick. ARROW-ROOT MUCILAGE. Arrow-root is a white, inodorous, insipid, light powder, procured from the tubers of the Maranta arundinacea, or Arrow-root plant, and manufactured in the East and West Indies, of which it is a native.* The powder is a pure Starch, which, although insoluble in cold water, yet forms a mucilage with boiling water. This Mucilage is made by rubbing the Arrow-root powder with a little cold water in a basin, by means of the back of a spoon, until it is com- pletely mixed with the water ; then pouring boiling water over it, at the same time stirring it assiduously until a soft, gelatinous, tenacious mucilage is formed ; and lastly, boil- ing it for five minutes. A table spoonful of the Arrow-root powder is sufficient to make a pint of the Mucilage. It may be moderately sweetened, and rendered more palata- ble by the addition of a little Lemon-juice : but Cinnamon powder, or any astringent substance, precipitates the starch, and destroys the smoothness of the Mucilage: hence, if wine be ordered with it, Port-wine should not be used. TOUS LES MOIS. This is a species of starch prepared from the rhizomes or tubers of some species of Canna, either C. edulis or coc- cinea, both of which are natives of Peru. It is converted into a mucilage, and used in the same manner as Arrow- root, over which it possesses no superiority. The greaj * In the island of Portland, the farina of the roots of the Arum macula- turn, Cuckow-pint, which grows abundantly there, is manufactured into Starch, and sold under the name of British Arrow-root. Much Potato Starch is also sold as Arrow-root. The fraud, however, is not a hurtful one, as the properties of these Starches do not materially differ. Potato. starch mucilage sooner becomes sour than Arrow-root mucilage. SICK-ROOM COOKERY'. 281 advantage of both, indeed, as articles of diet for the sick, depends on the small quantity of nutriment which they convey into the habit. It is often useful to satisfy the pre- judices of the friends of Invalids, by the appearance of sup- plying nourishment, when it would prove injurious. MUCILAGE OF SAGO. Sago* is the pith of several species of Palms and Cyca- dea3, natives of tropical climates : the best is that made by the Chinese at Malacca, and known in commerce by the name of Pearl Sago. It resembles roundish seeds, of a brownish-grey colour, passing to pearl-white, or brick-red passing into dull-white. WThen soaked in water, at a mode- rate temperature, it absorbs from five to ten times its weight of water, swells, and becomes transparent. It consists of starch, with a small proportion of salt. To make Sago into a proper Mucilage for the sick, an ounce or a table-spoonful of it should be macerated in a pint of water, in a pan placed on the stove, or on a hot plate, for two hours, and them boiled for fifteen minutes, stirring assiduously during the boiling. The Mucilage may be sweetened with sugar, and flavoured with lemon- juice; or milk may be added to it, according to circum- stances. Like other farinaceous mucilages, it affords very little nourishment; and is, therefore, well adapted for Inva- lids labouring under acute diseases. [In preparing Sago, care must be taken that the grains are perfectly dissolved, by long boiling and constant stir- ring ; otherwise it will disagree with a delicate stomach.] MUCILAGE OF TAPIOCA. Tapioca is the pith of the roots of Jatropha Manihot, a native of Brazil, which, although combined with a poisonous principle in the fresh state, yet is easily freed from it by * There are three varieties of Sago known in European commerce ; namely — Sago of the Maldives, in brownish-grey grains, possessing few of ihe chemical properties of starch; 2, Sago of New Guinea, in grains of a brick-red hue, passing to dull white ; it is a nearly pure starch ; 3, Ma- lacca Sago, of which there are ihree kinds — a, in fawn-coloured grains, passing into grey; a pure starch, containing more salt than the other varie- ties ; b, in rose-coloured grains, in chemical characters the same as the former; c, in white grains, a very pure starch. 24* 282 CHAPTER VIII. washing in cold water, after the roots are barked and crushed. The fecula is then dried and granulated. It re- sembles Sago; but it is less coloured and in larger grains. The mucilage of tapioca is prepared in the same manner as that of sago, and with the same proportions of tapioca and water ; but tapioca is more soluble than sago, and, con- sequently, it requires only half the time for its maceration and boiling. It forms a semi-opaque mucilage, which may be sweetened and flavoured in the same manner as sago. MUCILAGE OF SALEP. Salep is prepared from the cormi or bulbs of the Orchis mascula. It is imported chiefly from the Levant; but some is brought from India. It consists of a peculiar kind of gum, termed Bassorin, and Fecula. It is more nutritive than either Arrow-root or Sago, and consequently is better adapted for the convalescent than for the sick. The muci- lage is prepared by dissolving the powdered Salep in hot water, with assiduous stirring, and adding to the solution sugar and milk.* GRIT-GRUEL. Take three ounces of Grits,\ wash them well in cold water, and, having poured off the fluid, put them into four pints of fresh water, and boil slowly, until the water be reduced one-half; then strain the whole through a sieve, to separate the mucilage from the undissolved part of the Grits. OAT-MEAL GRUEL. Take two ounces of Oat-meal, free from mustiness, and a pint and a half of soft water. Rub the meal in a basin, with the back of a spoon, in a moderate quantity of the water, pouring off the fluid after the grosser particles have subsided, but whilst the milkiness continues ; and let this operation be repeated until no more milkiness is communi- cated to the water. Next put the washings into a pan, after having stirred them well, in order to suspend any fecula which may have subsided; and boil until a soft, thick mucilage is formed. * Dr. Percival states that a mixture of Salep and flour makes excelled bread.—Med. and Experimental Essays. t These are Oats freed from their cuticle or testa, and coarsely broken. SICK-ROOM COOKERY. 283 Both the gruel of grits and of oat-meal consist not only of the starch of the oat, but also of a small proportion of gluten; on which account, they are more nutritive than any of the feculaceous mucilages. They may be sweetened and acidulated, or mixed with milk, according to circum- stances. Butter and Honey, which are frequently added to these gruels, are inadmissible in inflammatory diseases. Besides being excellent demulcent articles of diet, these gruels are usually employed as the vehicles for administer- ing substances in the form of Glyster; for which purpose they are better adapted than the purer starches, as they are not so susceptible of precipitation by astringent vegetable infusions and decoctions. Gruel is apt to ferment when it is kept longer than twenty- four hours. MUCILAGE OR JELLY OF ICELAND MOSS. The Iceland Moss is a Lichen, named Cetraria Islandica, which grows on mountains, exposed situations in Iceland; in the north of Germany ; and in many northern countries. It contains a bitter principle, which is useful, as a medici- nal agent, in some diseases; but from which it should be freed, when it is to be employed as diet. This is to be effected by pounding the dried Lichen, and soaking it for twenty-four hours in tepid water containing a small quan- tity of carbonate of soda, and-then pressing it forcibly in a coarse cloth; after which, if any bitterness remain, the process must be repeated. The Lichen, thus treated, is next to be put into water, in the proportion of an ounce to a quart of water ; then slowly boiled down till one half the fluid is evaporated ; and, lastly, strained through a sieve. The mucilage may be sweetened and acidulated; or it maybe mixed with milk, in the same manner as the mucilages already noticed. Any portion of the bitter may be separated by regulating the period of the maceration. When the bitter is not ob- jectionable, it has one advantage ; namely, that of enabling the stomach to digest more readily the Mucilage, by the tone which it affords to that organ. The idea that it pos- sesses any specific medicinal virtue for the cure of Con- sumption is erroneous. 284 CHAPTER VIII. MUCILAGE OF CARRAGEEN --IRISH MOSS. Carrageen is a Fucus, the Chondrus crispus, which grows upon rocks and stones in the sea, and is very common on the Irish coast. It has a tough, horny, flexible, crisp ap- pearance ; it almost wholly dissolves in water during boil- ing. One ounce of it, boiled in a pint and a half of water, is sufficient to form a semi-transparent, moderately consist- ent, nearly tasteless jelly; which, when sweetened and acidulated, or when mixed with milk, forms an excellent diet for Invalids who require to have the strength sup- ported. MUCILAGE OF RICE. Take one ounce of good Carolina Rice, and, having washed it, macerate it for three hours in a quart of tepid soft-water, in a pan placed upon the stove, then boil the whole slowly for another hour, and strain through a sieve. This mucilage may be sweetened and acidulated, or mixed with milk, in the same manner as the other fecula- ceous mucilages. It forms an excellent demulcent diet for the sick, especially in irritable conditions of the intestinal canal, and in diarrhcea; but it is a mistake to suppose that it possesses any astringent property. The soluble part of Rice is chiefly Starch, which it con- tains in the proportion of eighty-five parts in the hundred. The less soluble parts are .about five per cent, of paren- chymatous matter ; an animalized principle, amounting to rather more than three and a half per cent. ; and some phos- phate of lime. It is the animalized matter that affords any nutritive property which the Rice possesses : but this is not taken up by the water in the above preparation; conse- quently, in a nutritious point of view, it is on an equality with the foregoing mucilages. [rice jelly. Take a sufficient quantity of clean Rice, macerate it for some time in as much water as will cover it, boil slowly, adding water as it evaporates, until the rice is reduced to the state of a pap, sweeten and flavour with lemon juice, or vanilla, pass through a fine sieve, into a form. On rooking it becomes a moderately consistent jelly. This SICK-ROOM COOKERY. 285 may be eaten alone or with milk, as may be deemed ex- pedient. It forms an excellent dish in dyspepsia and ir- ritable conditions of the stomach.] GROUND RICE; Take a table-spoonful of ground Rice, a pint and a half of milk, and half an ounce of Candied Lemon-peel. Rub the Rice smooth with the milk, then add the Lemon-peel cut into small pieces; boil for half an hour, and strain whilst the milk is hot. This is an excellent nutritious beverage for the sick, when strict abstinence is not required ; and for early convales- cence. SIMPLE BREAD PANADA. Put any quantity of grated, stale Bread into enough of Water to form a moderately thick pulp; cover it up and leave it soak for an hour; then beat it up with two table- spoonfuls of milk, and a small portion of refined Sugar, and boil the whole for ten minutes, stirring all the time. This may be eaten by the sick, labouring under any disease in which abstinence is not strictly enjoined. [vegetable broth. Take two Potatoes, a carrot, and one onion, all cut fine, boil in a quart of water for an hour, adding more water from time to time, so as to keep the original quantity, flavour with salt and a small quantity of potherbs, strain. When it is thought advisable, a small quantity of mushroom catsup added to this broth improves its flavour very much.] b. ANIMAL PREPARATIONS. HARTSHORN JELLY. Take six ounces of Hartshorn shavings, cut into small pieces ; boil them in four pints of Water down to two pints ; strain, and add to the liquor, whilst hot, two table-spoonfuls of Lemon-juice, six ounces of white Sugar, and two glasses of Sherry Wine. This forms an excellent light nutriment for the sick and convalescent, when Wine is not improper. Without the Acid and the Wine, but with an equal quantity of Milk, it is an excellent substitute for the breast-milk, for 286 CHAPTER VIII. infants who are unfortunately attempted to be brought up by hand. BEEF-TEA. Take half a pound of good Rump Steak, cut it into thin slices, and spread these in a hollow dish ; sprinkle a little salt over them, and pour upon the whole a pint of boiling water. Having done this, cover the dish with a plate, and place it near the fire for an hour ; then throw the sliced beef and the water into a pan, cover it, and boil for fifteen minutes ; after which, throw the whole contents of the pan upon a sieve, so as to separate the Beef-tea from the meat. The quantity of water directed to be used is too little for the strength of the Beef-tea usually proper for invalids; but it is sufficient to extract all the soluble matter of the beef; and the tea can be reduced to the strength required by the addition of boiling water. CHICKEN-TEA. Take a small Chicken, free it from the skin and from all the fat between the muscles ; and having divided it lon- gitudinally into two halves, remove the whole of the lungs, the liver, and everything adhering to the back and the side bones. Then cut it, bones and muscles, by means of a strong, sharp knife, into as thin slices as possible; and, having put these into a pan with a sufficient quantity of salt, pour over them a quart of boiling water, cover the pan, and simmer, with a slow fire, for two hours ; lastly, put the pan upon the stove for half an hour, and strain off the tea through a sieve. Both of these animal decoctions are of a strength proper for any invalid whose condition, during the progress of ac- tual disease, admits of animal diet in its lightest form. When concentrated with some farinaceous additions, and slightly spiced, they are equally useful in convalescence. VEAL-TEA. This maybe made in the same manner as Beef-tea, using a pound of Fillet of Veal, free from fat and sliced, and a pint SICK-ROOM COOKERY. 287 and a half of boilng water, and boiling for half an hour in- stead of fifteen minutes. It may, also, be made with the same quantity of the fleshy part of a Knuckle of Veal. By boiling down the Knuckle-of-Veal-tea, whilst the meat is in it, to one half, and straining, the decoction gela- tinizes; and, when it is poured into small cups, it will keep good for several days. By adding an equal quantity, or more, of boiling water to a cupful of this jelly, a mode- rate quantity of Veal-tea for one individual is prepared in two minutes. MUTTON-TEA. This is prepared with a pound of good Mutton, freed from the fat and cut into thin slices, and a pint and a half of boiling soft water poured over it, in the same manner as for Beef-tea ; but it requires to be boiled, after the macera- tion, for half an hour, before it is strained through a sieve. If the Invalid desires the addition of Barley; an ounce of good Pearl Barley, washed and macerated in boiling water for an hour, may be boiled with the Mutton-tea, and the undissolved Barley separated on straining. TURTLE-SOUP. Plain Turtle Soup, made from the green Turtle, Chelonia mydas, without wine or spices, is sold in pots, and requires only the addition of water to reduce it to a proper consist- ence for the use of the sick and convalescents. It is ex- tremely nutritious, and of very easy digestion : but it should be given only in small quantities, at moderate intervals. In cases of great debility, the consequence of long continued chronic diseases, either wine or brandy may be added to the soup; but the propriety of such an addition, and the quantity requisite in each case, must be left to the judgment of the medical attendant. C PREPARATION OF BEVERAGES. DISTILLED WATER. This, the purest state of water, may be readily obtained by fixing a'curved tin tube, three or four feet long, to the spout of a tea kettle, and conducting its free end into ajar placed 288 CHAPTER VIII. in a basin of cold water, and enveloped with a wet towel. The steam thus condensed is distilled water. The softer the water is, the better solvent it is of all soluble animal and vegetable substances ; and Distilled Water, being free from every foreign ingredient, is necessarily the softest of all water, and consequently the best adapted, not only for diluting in febrile affections, but for pervading the minutest vessels, and improving their secreting powers. Its use is recommended in diseases of the Kidneys, in Gout, Scrofula, Consumption, and Cancerous affections. Distilled Water is mawkish to the taste ; but this is easily corrected by pouring it from one jug to another, succes- sively, for ten or fifteen minutes, so as to involve in it a quantity of atmospheric air. The temperature of Water, when low, is most agreeable to the palate, yet it should approach to that of the body ; and, therefore, when the diluent influence only of Water is required, its temperature should not be under 60°, nor above 70°. When the heat of the body, however, is con- siderable, and the skin dry, in febrile diseases, Water at as low a temperature as it can be obtained in the fluid state may be used. For the Dyspeptic, Water as a drink should be either very cold or very hot. In Catarrh and Coughs, the beverage should be tepid. TOAST-WATER. Toast thoroughly, but not to a cinder, half a slice of a stale quartern loaf, put it into a jug, and pour over it a quart of Water which has been boiled and cooled ; and, after two hours, decant the Water from the bread. A small piece of Orange or of Lemon peel, put into the jug at the same time as the bread, is a great improvement to Toast- water. The toast, in this case, communicates taste and colour to the water, without affecting its diluent properties. The reason for employing water which has been boiled is to bring the fluid as near as possible to the state of distilled water. Toast-water may be used ad libitum in every febrile affec- tion. It diminshes the heat of the mouth, the throat, and the stomach ; and, by sympathy, that of the whole body. SICK-ROOM COOKERY. 289 APPLE TEA OR WATER. Slice two large, not over ripe, Apples, and pour over the slices a pint of boiling water. After an hour, pour off the fluid, and, if necessary, sweeten with a moderate quantity of refined sugar. LEMON-PEEL TEA OR WATER. Pare the rind of one Lemon, which has been previously rubbed with half an ounce of refined loaf Sugar, put the peelings and the Sugar into a jar, and pour over them a quart of boiling Water. When cold, pour off the fluid, and add one table-spoonful of Lemon-juice. If wine be not improper, a glass of Sherry may be added, instead of the lemon-juice. ORGEAT. Blanch two ounces of sweet Almonds, and four bitter Almonds,* beat them in a mortar with a little orange-flower water into a paste, and rub this with a pint of milk diluted with a pint of water, until an Emulsion is formed. Strain, and sweeten with Sugar or Capillaire.f RASPBERRY VINEGAR WATER. This is merely diluted Raspberry vinegar. It is gene- rally made too acid. All of these drinks are good diluents in fever, and may be taken at the pleasure of the Invalid. LEMONADE. Take the juice of two Lemons; add it to a quart of boiling water, having the rind of one of the Lemons in it, in a covered jar, and sweeten it moderately with refined Sugar, or Capillaire. To be moderately drunk as a refrigerant in fevers. * The Bitter Almond, when treated with water, develops a volatile oil, which has the odour of the Peach-blossom, and contains Hydrocyanic Acid. In some individuals, the bitter almond causes an eruption on the skin, closely resembling nettle-rash; consequently this fact should be ascertained in reference to the individual for whom the Orgeat is intended, before it be ordered. + [Barley water will answer better than the milk-and-water ordered above, as the preparation will be much more likely to keep.] 25 290 CHAPTER VIII. BARLEY-WATER. a. Simple Barley-water. Take two ounces and a half of Pearl Barley, and four pints and a half of soft water. Wash first the Barley with cold water, to remove from it every foreign matter ; and then pour upon it half a pint of the water, and boil for fif- teen minutes. Throw this water away; and, having heated the four remaining pints of the fluid, pour them upon the barley, and boil down to two pints, and strain. 6. Compound Barley-water. "Take two pints of simple Barley-water, two ounces and a half of Figs, sliced : five drachms of Liquorice root, sliced and bruised ; two ounces and a half of Raisins, and a pint of soft Water. Boil down to two pints, and strain." These decoctions are not only good demulcent diluents, but, in cases where a very moderate degree of nutriment is not objectionable, they answer the purpose of diet. Simple Barley-water, when mixed with an equal quantity of milk and a small portion of refined sugar, is a good sub- stitute for the breast-milk, for infants who are attempted to be brought up with the spoon. When an ounce of Gum is dissolved in a pint of simple Barley-water, an excellent beverage is formed for cases of strangury from blistering plaster ; and in gravel. ALMOND EMULSION. Take one ounce and a quarter of sweet Almonds, blanch- ed ; five drachms of Sugar; and a quart of soft Water. Beat the almonds with the sugar, in a porcelain mortar, into a smooth pulp, adding the water gradually, and stirring assiduously until the whole of the fluid is added ; then strain through linen. An excellent demulcent in febrile affections. MARSH-MALLOW TEA. Take four ounces of dried roots of the Marsh Mallow (Althoea officinalis); two ounces of Raisins, freed from the seeds ; and five pints of boiling water. Boil slowly down SICK-ROOM COOKERY. 291 to three pints, and when the sediment has subsided, pour off the (dear liquor. This is an excellent demulcent drink in diseases of the kidney with a tendency to gravel. FLAX SEED-TEA. Take an ounce of Flaxseed, not bruised; two drachms of Liquorice root, bruised ; and one pint of boiling soft- water. Place the jug containing these ingredients, covered, near the fire for four hours, and then strain through linen or calico. The mucilage resides in the husk, and the fixed oil in the kernel of the Flaxseed ; and, therefore, the seeds ought not to be bruised. When Flaxseed is boiled, the fixed oil is extracted, and renders the Decoction both nauseous and stimulant. Flaxseed-tea is a useful demulcent drink in Coughs, and affections of the urinary organs; but it should be made daily, as it soon gets ropy, and spoils. [SLIPPERY-ELM TEA. Take of Slippery-Elm Bark, sliced, one ounce, pour on it a pint of boiling water, macerate for some time, and strain. This infusion is nutritious and demulcent, and is useful in coughs, diseases of the kidneys, and bowels.] RENNET-WHEY. Infuse a moderate-sized piece of Rennet* in a sufficient quantity of boiling water to abstract all the soluble matter; separate the fluid ; and stir a table spoonful of it into three pints of Milk ; cover up the mixture with a clean cloth, and place it before the fire until it forms a uniform curd. Divide this curd with a spoon, and, pressing it gently, se- parate the whey. Good whey should be nearly transparent, of a pale straw- yellow colour, and should have a sweetish taste. It con- * Rennet is a production of the inner or mucous membrane of the sto- mach of a Calf. Its action in coagulating milk is not understood. It does not depend on the acid which the Rennet contains ; but on a peculiar sub- stance which has been named Chymosine. The quantity of liquid rennet necessary to curdle 1000 grains of milk is only eight drops : but it requires a heat of 68° Faht.; and its action is aided by the acidity of the Rennet. 292 CHAPTER VIII. stitutes ninety-two parts in one hundred of the milk ; and besides water, contains sugar of milk and some salts. It is an excellent diluent in febrile affections. When boiled down to one half, it proves nutritive as well as diluent. VINEGAR AND TAMARIND WHEYS. A small wine-glassful of Vinegar sweetened with a des- sert-spoonful of Muscovado sugar ; or two table-spoonfuls of Tamarinds, stirred into a pint of boiling Milk, and the whole boiled for fifteen minutes and strained, form these Wheys. They are useful refrigerant drinks in febrile dis- eases. WHITE-WINE WHEY. Take two thirds of a pint of good Milk, and dilute it with as much Water as will make up the pint. Take two glasses of Sherry-wine, or any other good White-wine, and a dessert-spoonful of Muscovado sugar. Place the milk and the water, in a deep pan,upon the fire: and, watching the moment when it boils, which is known by a scum rising to the edge of the pan, pour into it the wine and the sugar, and stir assiduously, whilst it conti- nues to boil for twelve or fifteen minutes. Lastly, strain the Whey through a sieve. This is an excellent mode of administering wine, in small quantities, in low fevers; and in cases which demand a moderate degree of excitement. It may be drunk either cold or tepid, in a wine-glassful at a time. MUSTARD-WHEY. Take half an ounce of bruised Mustard seeds, and one pint of Milk; boil them together until the milk is curdled, and strain to separate the Whey. This Whey has been found to be a useful drink in Drop- sy : it stimulates the kidneys ; and, consequently, augments the urinary secretion. It may be taken in a tea-cupful at a time. MIXTURE OF SPIRIT OF FRENCH WINE. Egg Brandy. Take four ounces of French Brandy, four ounces of Cinnamon water, the yelks of two Eggs, half an ounce of SICK-ROOM COOKERY. 293 purified Lump Sugar, and two drops of Oil of Cinnamon. Mix the yelks of the eggs first with the water, the oil, and the sugar, agitating assiduously ; and then add the brandy by little at a time, until a smooth fluid is formed. This is an excellent mode of administering brandy in the sinking stage of Typhus and other low fevers. ARTIFICIAL GOATS' MILK. Take an ounce of fresh Suet, cut into small pieces, and tie them in a muslin bag, large enough to leave the mor- sels free from compression; boil this in a quart of Cow's milk, sweetened with a quarter of an ounce of white Sugar- candy. This is an excellent article of diet in scrofulous emacia- tion, especially when ordinary articles of food pass through the bowels nearly undigested. It is also useful in the later stages of pulmonary Consumption. It may be used for in- fants who are unfortunately attempted to be brought up by the spoon. ARTIFICIAL ASSES' MILK. Take half an ounce of Gelatine ; dissolve it, by the aid of heat, in a quart of Barley-water ; add one ounce of re- fined Sugar ; then pour into the mixture a pint of new Milk, and beat up the whole with a whisk. It should be drunk warm, and exercise taken after it. It may be, also, prepared by dissolving two ounces of su- gar of milk in one pint of tepid skimmed Cow's milk. These, however, are but poor substitutes for Asses' Milk; which is one of the best,restoratives in convalescence from severe disease. When taken in too great quantity, it is apt to cause diarrhcea. MILK AND SODA WATER. Heat, nearly to boiling, a tea-cupful of Milk, and dis-« solve in it a tea-spoonful of refined Sugar ; put it into a large tumbler, and pour over it two-thirds of a bottle of good Soda-water. This is an excellent mode of taking milk when the sto- mach is charged with acid, and consequently is apt to feel oppressed by milk alone. 25* 294 CHAPTER VIII. BUTTERMILK. When Buttermilk is newly churned, it is a wholesome, delicious, and cooling beverage in fever or any disease of excitement; but, as it cannot be procured in large towns, and not always in the country, the method of making it in small quantities, daily, should be understood. It is readily prepared by putting a quart of new Milk into a bottle which will hold half a gallon, corking the bottle, and covering it with a towel in such a manner, that, by drawing alternately each end of the towel, the bottle can be rolled upon a table. This movement should be continued until such time as all the butter is separated, which is known by its appearing in clots or masses swimming in the milk. Dur- ing the rolling, it is necessary to open the bottle occasion- ally to admit fresh air into it, as that is essential for the formation of the butter. When the process is finished, all the butter should be carefully separated from the But- termilk. Buttermilk may be drunk ad libitum. SAGO POSSET. Put two ounces of Sago into a quart of Water, and boil until a mucilage is formed ; then rub half an ounce of Loaf-sugar on the rind of a Lemon, and put it, with a fluid drachm (a teaspoonful) of Tincture of Ginger, into half a pint of Sherry wine ; add this mixture to the Sago Muci- lage, and boil the whole for five minutes. This is an excellent cordial where acute diseases, not of an inflammatory kind, have left the body in a state of great debility. A large wineglassful may be taken at once, at intervals of four or five hours. II. COOKERY FOR THE CONVALESCENT. This comprehends Farinaceous and Animal preparations of a more nutritious and stimulant nature than is admissi- ble for the sick-room ; but, at the same time, considerably within that which is usual and not improper in a state of health. a FARINACEOUS PREPARATIONS. These are not solely modifications of Starch ; but they SICK-ROOM COOKERY. 295 admit of the presence of Gluten and other components of the Cerealia. They are rendered more nutritive by the addition of milk and other animal substances of a mode- rately stimulant character. BOILED FLOUR AND MILK. Knead any quantity of Wheaten flour with Water into a ball, and tie the whole firmly in a linen cloth ; put it into a pan with water, and boil it slowly for twelve hours. Place it before the fire to dry ; and afterwards, on removing the cloth, separate a thick skin, or rind, which has formed, and again dry the ball. A table-spoonful or more of this, grated, and boiled with a pint of milk, forms an excellent article of diet in convalescence from Diarrhoea, or from Dysentery, and in Emaciations. ARROW-ROOT PUDDING. Take a table-spoonful of Arrow-root powder, rub it with a little cold water in the same manner as in making the mucilage, and add to it, stirring assiduously, a pint of boiling Milk. With this mucilage, mix the contents of one Egg, and three teaspoonfuls of powdered, refined Sugar, which have been previously beaten up together. The pudding, thus formed, may be baked, or it may be boiled in a basin. This is an excellent pudding for the early stage of con- valescence : for a more advanced period, a table-spoonful of Scotch Orange-Marmalade is a good and an agreeable addition to this pudding. ARROW-ROOT BLANCHE-MANGE. Make the Mucilage in the usual manner, using three times the quantity of the Arrow-root powder; then add Milk in a moderate proportion; and, having boiled down the mixture to a sufficient degree of thickness, pour it into a shape to cool and set; after which it may be turned out. In convalescence, this Blanche-mange may be eaten with Currant-jelly, or with Wine or Lemon-juice and Sugar. It is sometimes eaten with Cream ; but such an addition is improper in convalescence. 296 CHAPTER VIII. MILK OR BEEF-TEA ARROW-ROOT MUCILAGE. This mucilage is made exactly in the same manner as the simple Arrow-root mucilage, except that Beef tea, or Milk, is used in the boiling state instead of water; and the Mucilage is boiled for twenty minutes instead of five minutes. Either of these preparations forms an excellent diet in the early stage of convalescence, and for delicate children. FLUMMERY, OR SOWANS. Take a quart or any quantity of Grits, or of Oatmeal; rub the Grits or the meal for a considerable time, with two quarts of hot Water, and leave the mixture for several days at rest, until it becomes sour; then add another quart of hot Water, and strain through a hair sieve. Leave the strained fluid at rest until it deposits a white sediment, which is the starch of the Oats ; lastly, pour off the super- natant water, and wash the sediment with cold water. The washed sediment may be either boiled with fresh water, stirring the whole time it is boiling, until it forms a Mucil- age or Jelly ; or it may be dried, and, afterwards, prepared in the same manner as Arrow-root Mucilage.* Flummery is light, moderately nutritious, and very diges- tible ; it is, consequently, well adapted for early conva- lescence. It may be eaten with milk or with wine, or lemon-juice and sugar. OAT-MEAL PORRIDGE. Sprinkle into a pint of water, kept boiling, small quan- tities of Oatmeal, at short intervals, stirring assiduously, until a moderately consistent mixture is formed ; and con- tinue to boil, afterwards, for half an hour. Oatmeal Porridge, eaten with milk, is a moderately nu- tritive diet, well adapted for early convalescence, when there is no dyspeptic tendency. When the stomach is de- ranged, it is apt to prove acescent, and is improper. RICE AND APPLES, OR SNOW-BALLS. Instead of preparing this dish in the usual manner — namely, cutting the Apples, freed from the rind and inter- * Flummery should not be made in a metallic vessel; COOKERY FOR THE CONVALESCENT. 297 nal seed-cells, into quarters longitudinally, then surround- ing them with Rice, and boiling the whole in cloths—it is preferable to boil the Rice in hot water rapidly, and, after straining off the water through a Cullender, to expose it for ten or fifteen minutes before the fire, and, having stewed the apples separate from the Rice, to mix them together with a very moderate quantity of Sugar. The Rice thus prepared is more digestible, and assuredly much more palatable, than when it is run together into a paste. Too much Sugar is apt to disagree with the sto- machs of convalescents, and induce an attack of Dyspepsia. The butter which is often added to this dish is improper in convalescence. With these precautions, Rice and stewed Apples form a dish well adapted for Invalids recovering from acute disease. BOILED BREAD PUDDING. Grate half a pound of stale Bread, pour over it a pint of hot Milk, and leave the mixture to soak for an hour in a covered basin ; then beat it up with the yelks of two Eggs. Put the whole into a covered basin, just large enough to hold it, which must be tied in a cloth, and placed in boil- ing water for half an hour. It may be eaten with salt or with sugar; and, if wine be allowed, it may be flavoured with a glass of Sherry. SIMPLE RICE PUDDING. Wash two table-spoonfuls of good Carolina Rice, and simmer them in a pint and a half of Milk, until the rice is soft; then add the contents of two Eggs, beaten up with half an ounce of Sugar. Bake it for three-quarters of an hour in a slow oven. In an advanced state of convalescence, two glasses of Sherry to the pudding, before it is baked, is an agreeable addition. MACARONI OR VERMICELLI PUDDING. Take two ounces of Macaroni or of Vermicelli, a pint of Milk, and two fluid ounces (four table-spoonfuls) of Cinna- mon-water ; simmer until the Macaroni or Vermicelli is tender. Next, beat up three yelks of Eggs and the white 298 CHAPTER VIII. of one Egg, an ounce of Sugar, one drop of the Oil of Bitter Almonds, and a glass of Sherry wine, in half a pint of Milk ; and add the mixture to the Macaroni or Vermicelli. Bake in a slow oven. BATTER PUDDING. Take a table-spoonful of Wheaten-flour, a pint of Milk, the yelks of two Eggs, and half an ounce of Sugar. Beat the yelks of the eggs with the sugar, and mix them with the milk and flour. This pudding should be boiled, in a basin tied in a cloth, in boiling water. TAPIOCA PUDDING. Beat the yelks of two Eggs and half an ounce of Sugar together, and stir the mixture into a pint of Tapioca Muci- lage made with milk. Bake in a slow oven. Sago, Arrow-root, or Millet-seed Mucilage may be con- verted into light puddings in the same manner. In advanced convalescence, these puddings may he eaten with wine. MASHED CARROTS AND TURNIPS. Boil the Turnips and the Carrots, peeled, separately, in three successive waters; then press strongly the water out of them, through a clean coarse cloth. Mash them together with enough of new Milk to form them into a pulp, and sea- son with salt. Place them before the fire until the surface seems dry. This is an admirable dish for convalescents who are re- stricted to farinaceous and vegetable diet; and it is one which Invalids get fond of. The author once ate of this dish for dinner daily, in convalescence from a severe disease, for several months; and he now.prefers it to every other kind of vegetable food. PLAIN BOILED VEGETABLES. Almost every kind of Vegetable may be eaten by the convalescent, if it is well boiled. All the Cabbage tribe, Turnips, Carrots, and Onions should be thoroughly boiled in two waters. If salt be added, and the boiling be brisk, in an uncovered vessel, green vegetables do not lose their COOKERY FOR THE CONVALESCENT. 299 color; and, whilst by this means they are well boiled, they remain pleasant to the eye. b. ANIMAL PREPARATIONS. RICE OR VERMICELLI, OR MACARONI SOUP. Make a quart of Beef-tea, in the manner already described, and boil it down one third ; then add to it an ounce of Vermi- celli, or two ounces of Macaroni, which have been previous- ly well boiled in water, and boil down the whole to one pint. The soup may be salted to the taste, and five grains of Cayenne Pepper added to one pint of it; provided the condition of the Invalid does not forbid the addition of so moderate a stimulant. When Rice is used instead of Vermicelli or Macaroni, it should be put into boiling water, and boiled rapidly in a close vessel; then thrown upon a cullender, and slightly dried before the fire. It should not be boiled with the soup, but added after the concentration of the soup, in quan- tity agreeable to the taste of the Invalid. This is an excellent soup for convalescents. CHICKEN-BROTH. When chicken-tea, made as directed at page 286, is boiled down one-half, with the addition of a little parsley or celery, and the yelk of an egg previously beat up in two ounces of soft water, it forms a soup much relished by the convalescent. It may be rendered still more palatable by the addition of some properly boiled Rice, or Vermicelli, or Macaroni; and by the addition of three or four grains of Cayenne Pepper, to a pint of the broth. CHICKEN-PANADA. Take the white meat of the breast and of the wings of a chicken which has been either boiled or roasted, free it from the skin, and cut it into small morsels ; pound these in a mortar with an equal quantity of stale bread, and a sufficiency of salt; adding, by little and little, either the water in which the chicken was boiled, or some beef-tea, until the whole forms a thin, fluid paste : lastly, put it into a pan, and boil for ten minutes, stirring all the time. 300 CHAPTER VIII. A similar panada may be made with a slice from the under side of a cold sirloin of roasted beef; or from a leg of cold roasted mutton. Either should be freed from fat and skin ; and the gravy, kept until the fat is thrown in a cake and separated, may be added to it. This panada is a nutritive article of diet for convalescents and delicate children. RICE AND GRAVY. Take the gravy from a leg of roasted mutton, or from a sirloin of roasted beef; leave it at rest until the fat forms a cake on the surface; remove this; and stir into a tea-cupful of it as much well-boiled rice as will suffice for a meal. This is also a wholesome diet in early convalescence for delicate children. GLOUCESTER JELLY. Take of rice, pearl barley, sago, and gelatine, each an ounce ; simmer the whole in three pints of water until they are reduced to two pints, and strain. When cold, the decoction forms a strong jelly, which may be dissolved in warm milk or in beef-tea, or melted in hot water, and flavoured with wine and sugar. SAGO MILK. Soak an ounce of Sago in a pint of cold water for an hour, pour off this water, and add a pint and a half of good milk, and boil slowly until the sago is well incorporated with the milk. MUTTON BROTH, WITH VEGETABLES. Take a pound of mutton-chops, freed from the fat, put them into a pan with three pints of water and boil them slowly, and simmer them for two hours. Take three mode- rate-sized carrots and the same number of turnips, peel and cut them into dices; boil them for half an hour in a quart of water; then throw them upon a cullender to drain off the water; and, having boiled two onions, sliced, in a pint of water, and also poured off the water, add the turnips, the carrots, and the onions to the mutton liquor, after removing the mutton chops : season with salt and a little celery-seed. Simmer slowly for four hours, then put in the chops again, COOKERY FOR THE CONVALESCENT. 301 and continue the simmering for another hour. The chops may be dished up with the broth. This is a palatable, very nutritive dish for convalescents; and, owing to the long and slow simmering, the mutton is rendered soluble and of easy digestion. TRIPE. Few things are more readily digested than tripe, when it is properly cooked. After partially boiling it in the usual manner, and also after boiling some onions in two waters, both should be slowly boiled together, until the tripe is very soft and tender. A sufficient quantity of salt, and a pinch or a few grains of Cayenne pepper, may be added. SWEETBREADS. These, when plainly cooked, are well adapted for the convalescent. They should be slowly boiled, and very moderately seasoned with salt and Cayenne pepper. FOWL, WITH RICE. Free a young fowl from the skin and the fat between the muscles on the surface of the body, and simmer it in good beef-tea, till it is very tender ; season with salt only; and, having boiled some rice as if for currie, add it to the liquor before the fowl is dished. C. PREPARATIONS OF FISH. WATER-SOUCHY. Take two small fresh Thames Flounders, boil them in a quart of water to one-third, or long enough to reduce the fish to a pulp. Strain the liquor through a sieve, and, having cut the fins off four other small flounders, put them into the above-mentioned liquor, with a sufficient quantity of salt, a few grains of Cayenne pepper, and a small quan- tity of chopped parsley ; and boil just long enough to ren- der the fish proper to be eaten. The fish and the sauce shorId be eaten together. If Flounders are not in season, Soles, or Whitings, or small Haddocks, may be prepared in the same manner. I know few dishes which are so much relished as this is 26 • 302 CHAPTER VIII. by Convalescents from Fever. I have heard Invalids ask for it daily for ten or more days. It is sufficiently nutritive, and very easily digested. In advanced convalescence, the yelk of one or two Eggs may be beaten up with a little soft water, and added to the strained liquor before the Fish is put into it. BROILED WHITINGS. Broil the Whitings without freeing them from the skin ; and when they are sufficiently done, take out the back-bone, and introduce a little cold butter in its place. By cooking Whitings in this manner, the juices of the fish are retained, and its nutritive property augmented. The fish thus cooked is of easy digestion, and well adapted for convalescents. d. PREPARATION OF BEVERAGES. AROMATIC BARLEY WINE. Take a quart of Barley-water, and boil it down one-third; then add to it, while it is hot, a pint of Sherry-wine, a drachm of Tincture of Cinnamon, and an ounce of refined sugar. A wine-glassful, two or three times a day, is a good cor- dial in convalescence attended with much debility. MULLF.D WINE. Take a quarter of an ounce of bruised Cinnamon, half a Nutmeg grated, and ten bruised Cloves ; infuse them in half a pint of boiling water for an hour, strain and add half an ounce of lump sugar ; and pour the whole into a pint of hot Port or Sherry-wine. This is a useful cordial in the low stage of Typhus fever; and in the debility of convalescence from fevers. DOMESTIC MEDICINES. Under this title I have put down those Medicines which may be required to be kept in a family, and which are often administered at the discretion of the Invalid or his friends. In noticing these medicines, however, it is not my in- tention to recommend their indiscriminate employment; or DOMESTIC MEDICINES. 30S that they should be prescribed in actual disease without the aid of medical advice. Many circumstances, however, are daily occurring in which it is advantageous to have certain medicines at hand, not only for use in cases in which little medical skill is requisite ; but, also, that they may be at hand when the emergency is so great that no time can be lost in administering the remedy, even as pre- scribed by the Physician. The Medicines are arranged Alphabetically for the facility of reference. 1. Acetate of Lead, Sugar of Lead. When pure, it should be in white, semi-transparent, glassy crystals, dis- solving readily in rain-water, or in distilled water; but forming a milky solution with hard water, which is there- fore unfit to be used with it. Sugar of Lead should never be administered internally without the authority of a medical practitioner ; but, as an external application, it may be safely used in solution, in inflammatory affections of the surface of the body. A lotion, made with twelve grains of it, two drachms of Distilled Vinegar, a fluid drachm of Spirit of Wine, and eight ounces of filtered Rain-water, is an excellent eye-water in inflam- mation of the eyes; and, with double the quantity of the Acetate and of Distilled Vinegar, it is a useful lotion for burns and scalds ; or as a gargle in ordinary sore-throat. a. Goulard's Extract — Solution of Diacetate of Lead, has the same medicinal properties as Sugar of Lead ; but it is a more powerful sedative. It has so great an attraction for Carbonic Acid, that a solution of it in distilled water becomes milky, after being exposed to the air for a few minutes. A lotion made with a fluid drachm (a tea-spoonful) of it, a fluid drachm of Spirit of Wine, and twelve ounces of Distilled or filtered Rain-water, may be used in the same manner and for the same purposes as the solution of Sugar of Lead ; but it should not be applied to a raw nor an ulcerated surface. It should be kept in a stoppered bottle. Antimonial Wine. In doses of from ten to twenty or thirty minims, in a table-spoonful of Water or Camphor Mixture, repeated every two or three hours, Antimonial Wine is useful, after bathing the feet in hot water, to ex- 304 CHAPTER V111. cite perspiration and allay fever in slight Colds. The per- spiration should be maintained by tepid, but not acidulated, mild fluids. A tea-spoonful given every five minutes,until vomiting occurs, is a safe means of emptying the stomach, in an overloaded or deranged condition of that organ, in children. If it does not cause vomiting after the adminis- tration of the third or fourth tea-spoonful, its employment should be discontinued. It should be kept in a stoppered bottle. 3. Aromatic Spirit of Ammonia. This is a more grateful stimulant in fainting, languor, flatulent colic, and in Hys- terics, than the Spirit of Hartshorn. It may be adminis- tered in doses of from thirty to sixty minims, in a glassful of water, and repeated at short intervals until relief is ob- tained. It should be kept in a stopped phial. 4. Foetid Spirit of Ammonia. This is more useful than the Aromatic Spirit in Hysterics. It may be administered in the same doses and in the same manner as the Aromatic Spirit. 5. Camphor. A piece of Camphor, the size of a hazle- nut, put into a wine bottle of soft or filtered Rain-water, and frequently shaken, communicates its flavour to the water, in which it is, also, partially dissolved. This solution is equivalent to the Camphor mixture of the London Pharmacopoeia. It forms an admirable vehicle for the administration of the Spirits of Ammonia, and some other medicines. A piece of Camphor, the size of a walnut, dissolved by gentle heat in an ounce of Olive or in Almond Oil, forms a good embrocation in pains of the joints arising from chronic Rheumatism. 6, Castor Oil is a mild, efficient purgative, if the simple evacuation only of the bowels is required. When good, the oil should be inodorous, and not acrid to the taste. Castor Oil often excites nausea ; to prevent which, various means of administering it have been proposed. It may be mixed in warm Milk ; rubbed up with powder of Gum Arabic and Cinnamon water ; or floated upon half a glass- domestic: medicines. 305 ful of cold water, and a tea-spoonful of Brandy floated on the Oil, and the whole swallowed together.* In measuring Castor Oil, the spoon, or whatever instru- ment is used, should be previously dipped in water, to pre- vent the oil from adhering to it. The dose is from half an ounce to one ounce and a half. If the use of Castor Oil be repeated daily, and the dose diminished until a few drops only are taken, it obviates habitual constipation of the bowels. 7. Conserve of Roses. A tea-spoonful, rubbed in a basin with a little hot milk, and then half a pint of new milk poured over it, stirring the whole well together, is an excellent re- storative in cases of protracted convalescence, or in great delicacy of habit. It should be taken daily, about half an hour before getting out of the bed in the morning. 8. Dill Water. A good vehicle for administering Rhu- barb and Magnesia to children, during teething ; or when much flatus is present in the bowels. Half an ounce, a table-spoonful, may be given to a child a year old. 9. Dover's Powder. A useful means for exciting perspi- ration in slight colds, after clearing the bowels, and putting the feet in hot water. The dose for an adult is from five to ten grains : for a boy or girl between ten and fifteen, three to six grains. As it contains Opium, it is an impro- per sudorific for young children, unless in peculiar cases, when it is ordered by a medical practitioner. Acidulous, tepid drinks are not contraindicated for keeping up the perspiration, as when Antimonials are administered. 10. Epsom Salts. Although a common and excellent purgative, yet the mode of administering Epsom Salts is not understood. These salts operate chiefly upon the first gut, the duodenum, where, stimulating the orifice of the common bile duct, they cause a great flow of the bile into the bowels, which operates essentially in aiding the purga- tive influence of the salts. On this account, in prescribing Epsom salts, they should be dissolved in that quantity of water only which is necessary for their solution, and thus swallowed. An hour afterwards, a large basin of warm tea, ♦ [The best method, as before slated, of disguising the taste of this medi- cine, is to mix it with the froth of Porter] 26* 306 CHAPTER VIII. or any warm diluent, should be drunk, which will aid the salts in effectually clearing out the bowels. These salts may be used in the commencement of any acute or inflammatory disease, and in young plethoric people, whenever the bowels require to be moved. The dose for an adult is half an ounce. 11. Gum-Arabic. The simple solution of Gum Arabic in Water, or in Milk, is an excellent demulcent in acrid con- ditions of the bowels. The powder mixed with a little water, forms a better vehicle for administering Calomel than jellies, or honey, or sugar. 12. James's Powder. This well-known, popular sudo- rific should not be administered at all times, without ad- vice, even when fever is present. t If cold has been taken, three or four grains of it may be given after bathing the feet in warm water; and its sudorific effects should be kept up by mild, tepid diluents ; but not acidulated, as acids add greatly to the activity of the anti- monial, and cause vomiting. The bowels should be opened on the following morning. 13. Ipecacuanha Powder. Ipecacuanha only should be domestically employed as an emetic. The dose of the pow- der for this purpose varies according to age and circum- stances ; for an adult, it is a scruple or half a drachm ; for a person under twenty, fifteen grains to a scruple ; and for a boy between six and eight years, ten grains. For chil- dren, it is preferable to use it in the form of an Infusion, made by macerating two drachms of the powder in six fluid ounces of water for an hour, and filtering. Two tea-spoon- fuls, or two fluid drachms, of this Infusion, may be given to a child, and repeated every ten or fifteen minutes until vomiting is produced. 14. Lime-water should be limpid, colourless, inodorous, and have a styptic, slightly acrid taste. It must be kept free from any exposure to the air. It is useful when taken in doses of a wine-glassful mixed with milk, in acidity of the stomach ; and, in larger doses, in worms. Externally applied, in combination with Linseed-oil, it forms a useful Liniment for scalds. 15. Magnesia is a very ready and certain means of coun- DOMESTIC medicines. 307 teracting acidity of the stomach, particularly in children : it forms a purgative salt by combining with the acid in the stomach ; and thus it is carried out of the system. It is also useful, when daily administered, in counteracting a tendency to red gravel or calculous deposits in the kid- neys ; but, in this case, a purgative should be occasionally interposed, to prevent the formation of concretions, which are apt to form in the bowels, when Magnesia has long- been administered, and does not meet with acid in the stomach. The dose of Magnesia for an adult is from a scruple to thirty grains ; for a boy under twelve years of age, from eight to twelve grains : the best vehicle for administering it is milk. Good magnesia should be soft, light, inodorous, tasteless, and readily miscible in water. Henry's is the best.* 16. Nitre is useful as a refrigerant in Fever, and as a diuretic. A small portion of it kept in the mouth, and allowed to dissolve slowly, often checks the progress of commencing inflammatory sore-throat. Eight or ten grains of it, dissolved in half a fluid ounce of Spirit of Mindererus, and a fluid ovmze of Camphor mixture, form an excellent alterative refrigerant in incipient fever. 17. Potassio-tartrate of Iron. —hra general sense, this is one of the best preparations of Iron. It is milder in its effects, has less taste, and is more soluble than any of them, and consequently it is less objected to by children. After the bowels have been cleared by Calomel and Scammony, this preparation of Iron is of the utmost use in worm cases. The dose for a young boy or a girl is from six to twelve grains. a. Iodide of Iron is also a useful preparation of the metal in similar cases ; and for young women of delicate habits, who are irregular in reference to the monthly change. It should be bought in solution, and a spiral of iron wire kept in the bottle. The dose is a tea-spoonful, which should contain three grains of the Iodide. *~ [In mixing magnesia with a fluid, it is better to throw the magnesia on the liquid^ than (as is usual) to add the fluid to the powder, as it forms a much smoother and less disagreeable mixture.] 308 CHAPTER VIII. The author has lately ascertained that this Iodide can be preserved, free from decomposition, for any length of time, when the solution is made into a strong syrup, which should contain three grains of the Iodide in every drachm or tea- spoonful. When sugar is not exceptionable, this is the best form of administering the Iodide. 18. Rhubarb. — The best Rhubarb is the Russian or Turkey : it should present, when broken, a rough fracture, mottled with bright red and white ; should feel gritty be- tween the teeth when chewed ; and taste bitter and astrin- gent, but not very mucilaginous. It should be kept in the lump, and grated when it is to be used. Rhubarb acts either as a purgative or an astringent, according to the dose. In doses of from twelve to twenty grains, combined with the same quantity of Magnesia, and half the quantity of Ginger, it forms an excellent domestic purgative in a dyspeptic condition of the stomach. In doses of five or six grains, combined with any aromatic powder, it operates as an astringent in Diarrhoea from weak bowels. The infusion is a useful addition to chalk mixture, when purging attacks teething children. It is made with a quarter of an ounce of grated Rhubarb and six fluid ounces of boiling water. A dessert-spoonful is a dose for a child a year old. 19. Senna. — The East India, although it is not much employed, is the best of the Sennas. The Infusion maybe made with two drachms (a quarter of an ounce) of the leaflets, half an ounce of Camphor mixture, and three ounces of tepid water. The whole of the active matter of the Senna is taken up by the tepid water, whilst the Cam- phor mixture augments its activity ; and prepared in this manner, the griping property of the decoction is lessened. One half of this quantity, with a tea-spoonful of Epsom Salt, is a good purgative for a boy under ten years of age. 20. Spirit of Mindererus. — This is a solution of Ammo- nia in Distilled Vinegar. It is an excellent refrigerant sudorific, in slight febrile affections, when it is administered in doses of half an ounce, combined with ten or fifteen grains of Nitre and an ounce of Camphor mixture, repeated every third or fourth hour. 21. Sulphur. — Sulphur, combined with Magnesia, in DOMESTIC medicines. 309 doses of from twelve to fifteen grains of each, taken at bed- time daily, affords great relief in piles. When Sulphur is taken alone for some time, it excites fever; on which account, its use should be occasionally intermitted, and a saline purgative administered. 22. Tincture of Aloes, although a very bitter medicine, yet is one of those to which the palate sooner becomes recon- ciled than to many other medicines which are less nauseous. It is a useful, warm purgative in a weakened condition of the digestive organs, accompanied with constipated bowels. It may be taken in doses of half an ounce in a glassful of water, in the morning, or half an hour before dinner. 23. Tincture of Opium, Laudanum.—Although no family can long be without Laudanum in the house, yet it is one of those medicines which require not only to be carefully kept under lock and key ; but even when it is likely to prove useful, it ought to be administered with discretion and judgment. Every pain ,which is suffered is not of a description to be relieved by Laudanum, without detriment to the general system: hence, those pains only, the nature of which is generally well understood, shouldbe domestically treated with Laudanum. Toothache, old chronic pains of Rheumatism, sudden Cramps of the stomach, may be safely allayed with a full dose, namely, twenty minims of Lauda- num for an adult. In those subject to gall stones, the sick- ness and the pain may be relieved in the same manner by a dose of thirty minims, until medical assistance can be procured. The influence of Laudanum increases in the in- verse ratio of the age of the individual; and, on this ac- count, it ought never to be administered to children, nor to infants, without the authority of a medical attendant. Laudanum, as a domestic medicine, is both safer and often more useful when it is applied to the surface, than when it is internally administered ; and it may be rubbed upon the abdomen, in Colic ; upon the spine, in cough; and on the arms to subdue habitual wakefulness. In burns, and in a kind of spreading ulcer which often attacks the fingers in a deranged condition of the habit, a piece of Lint, soaked in Laudanum, and kept applied to the pained'part, and repeatedly moistened with the Laudanum, allays the 310 CHAPTER VIII. pain, and affords great comfort to the sufferer. But be- yond these and similar maladies, Laudanum should never be administered without medical advice. I cannot avoid this opportunity of making a few remarks on the evils arising from the habitual use of Opium ; a vice which is daily increasing in every rank of life. Opium, in moderate doses, and even in large doses when taken by those accustomed to its use, elevates the spirits in the same manner as Wine or Brandy; it is there- fore substituted for these stimulants by many who would be ashamed to resort to the excessive use of either of them. Besides, as Dr. Reid has correctly remarked, "it does not in genera], as wine is apt to do, raise a tumult of the feel- ings, or involve the intellect in clouds." " Instead of low- ering man to a level with beasts, it often invests him, for a time, with the consciousness, and at least fancied attributes of a superior Being ; but he is soon stripped of his shadowy and evanescent prerogative, and is made to suffer all the horrors and the humiliation of a fallen angel."* Many fashionable women, also, attempt to light up their spirits, previousto the reception of aparty,by a dose of Laudanum; " but the mental lustre thus kindled goes out sooner than that of the lamps, and the mistress of the entertainment finds herself deserted by her spirits long before her company is dispersed."! Opium, habitually taken, destroys the di- gestive powers of the stomach, impairs the vigour of the body, and ultimately paralyses the energies of the mind. It causes emaciation, gives a sottish aspect to the countenance, the memory fails, imbecility and old age prematurely creep upon its victims, and they sink into the grave, equally ob- jects of contempt and of pity. Few persons who have indulged in the use of Opium can readily relinquish the custom ; and the sudden disuse of a substance, which acts as a charm in affording a momen- tary happiness, cannot be expected: but the Opium-eate: may be weaned from his seductive poison by a gradual process. I was once consulted by a lady who took a quart of * Reid's Essays on Insanity, &c, p. 105. f Ibid., p 39. domestic medicines. 311 Laudanum weekly. She at length, however, experienced its bad effects so obviously, both upon her health and her purse, that she resolved to overcome the habit, which had proceeded to such an extent, that she could not rise from her bed in the morning until she had swallowed a wine- glassful of Laudanum. I recommended her to purchase two gallons of the poison, and to continue her usual pota- tions ; but for every glassful of Laudanum which she poured from the stone bottle, to pour into it a glassful of water, so that she would at length have a bottle of simple water. She did so ; and she was gradually losing her desire for the se- ductive draught; but whilst I was anticipating a certain cure, she unfortunately received the intelligence that her son was killed at the siege of------. She returned to her poison in its full strength, and soon afterwards I lost sight of her. When Opium is employed for a long time, without any considerable intervals, as a remedy in diseases, its bad ef- fects upon the body and the mind will gradually display themselves ; whilst its soothing and alleviating influence becomes every day less and less obvious. [Laudanum when kept for some time, if not in a glass stoppered bottle, becomes thick, from the evaporation of the spirit. In such a case it becomes much stronger, and chil- dren have been poisoned by doses, which would have been perfectly safe if the tincture had been clear.] 24. Iluxham's Tincture of Bark.— A teaspoonful of this tincture, in a glassful of water, taken on rising in the morn- ing, by those who are liable to periodical attacks of rheu- matism of one side of the head, is the best mode of check- ing the returns of the paroxysm. 25. Vinegar (distilled) is useful as a topical application in burns; and, when diluted, in other cases of inflamma- tion. 26. Vinegar of Cantharides is useful as a ready, almost instantaneous, mode of making a blister. It only requires a piece of Blotting-paper, or a piece of Lint, to be soaked in the Vinegar and laid upon the part to be blistered. This method of making a Blister is extremely serviceable in cases of sudden cramp of the stomach ; and in toothache. The application of the Vinegar is to be made to the sto- 312 chapter vm. mach in the former instance, and behind the ears in the latter. In all cases of deep-seated internal pains it may he employed. In the above list of Medicines, Calomel and many other medicines, usually found in Medicine Chests, have been purposely omitted, from a conviction that nothing is so in- jurious as affording the means of quackery to nurses and to ignorant mothers. Few medicines are so frequently and so injudiciously employed as Calomel; and numerous are the evils consequent upon the practice of administering it in the nursery. The only use of a Medicine Chest is to ha>e the means of affording relief in trifling ailments, and of acting promptly in some sudden attacks, the symptoms of which are so obvious that they cannot be mistaken, and in which every moment is of consequence. In such in- stances, the most serious evils might result before medical aid can be obtained, were nothing done. FORMULAE FOR DOxMESTIC USE. I. MILD APERIENT FOR PILES. Take of Precipitated Sulphur, fifteen grains; Magnesia, a scruple.—Mix. To be taken daily at bed-time, in a glassful of milk or of water. II. EMETIC FOR UNLOADING THE STOMACH. Take of Powder of Ipecacuanha, a scruple; Wine of Ipecacuanha, or of Antimony, two fluid drachms; Water, one fluid ounce. — Mix. III. TONIC IN SIMPLE INDIGESTION. Take of Chamomile flowers, one drachm; Dried Seville-orange peel, two drachms ; Distilled water (cold) one pint. Rub the flowers and the peel with the water, added gradually in a mortar, and strain ; a wine glassful to be taken twice a day. supplement. 313 IV. SEDATIVE LOTION IN THE PRURIGINOUS DISEASES OF OLD AGE. Take of Spirit of Mindererus, two fluid ounces ; Diluted Hydrocyanic Acid, one fluid drachm ; Tincture of Fox-glove, three fluid drachms ; Rose-water, five fluid ounces. —Mix. To be applied to the itching parts, night and morning, by means of a sponge. V. SUBSTITUTE FOR SEIDLITZ POWDERS. Take of effloresced Sulphate of Soda, a drachm ; Bicarbonate of Soda, half a drachm. — Mix, for the Alkaline Powder. Take of crystallized Citric Acid in powder, fifteen grains, for the Acid Powder. Dissolve each of these powders separately ; mix the solu- tions together in a tumbler ; and drink the mixture whilst it effervesces. VI. T00TH-P0WTDER. Take of Powder of Krameria, two drachms; Myrrh, in powder, one drachm; Camphor, four drachms; Charcoal, one ounce; Spirit of Wine, twenty minims. Rub the Camphor with the spirit, and the whole into a fine powder. VII. OINTMENT FOR CHAPPED HANDS. Take of Goulard's Extract, one fluid drachm ; Rose-water, one fluid ounce; Spermaceti Ointment, two ounces ; Melt the ointment, and rub it up with the extract of Gou- lard, mixed with the Rose-water. VIII. LINIMENT FOR PAINFUL JOINTS. Take of Soap Liniment, six fluid drachms; Tincture of Aconite, ten fluid drachms. — Mix. To be rubbed upon the joints at bed-time. IX. APPLICATION FOR CHILBLAINS. Take of Tincture of Capsicum, half a fluid ounce; Tincture of Opium, a fluid ounce. —Mix, ■21 314 CHAPTER VIII. Roll bandages round the affected fingers, sew the ends to keep them on; and dip the bandage fingers in the Tinc- ture two or three times a day. X. APPLICATION FOR EXCORIATIONS, IN BED-RIDDEN PEOPLE. Take of Nitrate of Silver, one drachm ; Diluted Nitric Acid, ten minims; Distilled water, one fluid ounce; Dissolve ; and brush the affected parts with the solution, by means of a camel's hair pencil. [XI. PILLS FOR HABITUAL COSTIVENESS. Take of Powdered Rhubarb, ,, Aloes, each, half a drachm; White Soap, one scruple ; Mix, and divide into twenty pills. Two or three to be taken daily. XII. MAGNESIA DRAUGHT. Take of Magnesia, one drachm ; Simple Syrup, one fluid ounce ; Mix together well by stirring, and pour on the mixture Soda water, four fluid ounces ; To be taken at a draught, previously well shaken. This is an agreeable mode of taking Magnesia. XIII. NEUTRAL MIXTURE. Take of Lemon juice, four fluid ounces ; Oil of Lemon, one minim; Carbonate of Potash, sufficient to saturate ; Water, four fluid ounces. Strain. — Dose, a table-spoonful every hour, or two hours. XIV. EFFERVESCING DRAUGHT. Take of Bicarbonate of Potash, three drachms ; Water, four fluid ounces. Dissolve. — Add a table spoonful of this to the same quan- tity of Lemon juice, previously mixed with a like pro- portion of water, and give the mixture, whilst foaming, every hour or two hours. An excellent anti-emetic in fever with nausea and vomiting. SUPPLEMENT. 315 XV. BROWN COUGH MIXTURE. Take of Powdered Extract of Liquorice, ,, Gum Arabic, each, two drachms; Boiling water, four fluid ounces ; Dissolve and add Antimonial Wine, two fluid drachms ; Laudanum, half a fluid drachm.—Mix. This is an excellent expectorant and anodyne in coughs. XVI. HOPE'S MIXTURE. Take of Nitric Acid, one fluid drachm ; Laudanum,^b/'/i/ minims; Compound Spirits of Lavender, two fluid drachms ; Camphor water, eight fluid ounces. A small wine glassful to be taken every three or four hours. This has been found very useful in looseness of the bowels. XVIl. EPSOM SALTS DRAUGHT. Take of Epsom Salts, one ounce ; Lemon Syrup, one fluid drachm ; Soda Water, six fluid ounces. —Mix. To be taken at a draught. This is a very agreeable mode of taking salts.] DOSES OF A FEW USEFUL MEDICINES. Aloes, five grains. Assafoetida, ten grains. Calumba powder, a scruple. Calomel, two or three grains. Carbonate of Ammonia, five grains. Carbonate of Soda, a scruple. Cascarilla powder, a scruple. Catechu, five grains. Croton oil, one drop or two drops. Disulphate of Quina, two grains. Jalap powder, ten grams. Laudanum, thirteen minims or 25 drops. Magnesia, a scruple. 316 CHAPTER IX. Myrrh, ten grains. Nitre, ten grains. Peruvian Bark, in powder, ten grains. Sweet Spirit of Nitre, half a drachm. Solution of Potassa, fifteen drops. Squill-pill, three grains. Tincture of Henbane, twenty drops. Wine of Colchicum, twenty drops. CHAPTER IX. MENTAL INFLUENCES UPON THE BODY IN DISEASE AND IN CONVALESCENCE:--RELIGIOUS CONSOLATION IN DISEASE— THE NECESSITY OF DISCRETION AND JUDGMENT IN ITS ADMI- NISTRATION. Having endeavoured to present to the reader the method of managing the body labouring under disease, it now re- mains only to inquire briefly into the management of the mind under similar circumstances. But, in the first place, let us examine how far the body is under the influence of mental agency. The influence of the passions of the mind upon the body is a matter of daily observation. This influence is not con- fined to any particular organs ; it acts upon all the organs of the body, — those which are, and those which are not under the control of the will. The vascular and the ner- vous systems are especially under its power. It may be applied either for evil or for good ; consequently, the ex- amination of its effects is an object of importance in an inquiry such as forms the subject of this volume. The heart is an involuntary organ ; its function of giving that impulse to the blood which is requisite for its general diffusion over the habit, is, fortunately, not under the con- trol of the will; its action commences long before birth, and it continues unremittingly whilst life remains. But, whilst this fact cannot be denied, it is undoubted that the action of the heart is influenced by mental emotions. Shame mantles the cheek and the bosom with blood, caus- ing the momentary redness which is termed blushing. MENTAL INFLUENCE IN DISEASE, ETC. 317 Fear blanches the face and renders it bloodless. Anger swells the features, fills the bloodvessels almost to bursting, and suffuses the eyes. The milk of a woman who is nurs- ing becomes, after a fit of passion, indigestible and irritating to the child, and is the cause of convulsions in the infant. Even the direction of the attention to the action of the heart will derange, or quicken, or diminish its beats ; and this altogether independent of any mental emotion, except the exercise of attention to its movements. This influence of mind upon the heart is greatly augmented when the organ is labouring under any irregularity of its function, or is suffering under any organic change in its structure. The influence of the mind on other organs is equally obvious. Thus, sudden alarm may derange the function of the liver, or altogether suspend it. A young man in Paris had a musket pointed at his breast; he became sud- denly deeply jaundiced, for which he was taken to the Hospital La Pitie, and died. But even real organic changes may be created in organs by a morbid intensity of consciousness directed to them. Thus, palpitation, induced and maintained by this cause, has terminated in that organic disease of the heart which is termed Hypertrophy. In this case, as in other instances, where physical alterations in parts occur, the direction of the mind to the seat of disease causes a determination of blood to the part, as well as an increase of nervous sensi- bility in it; and, both operating", produce the changes re- ferred to. But, if the concentration of the mind be thus capable of not only continuing diseased action, but of causing it, we must also admit that the attention may be so abstracted from bodily feelings, by external objects, as to overcome severe sensations of pain, even when the cause of them remains in full force. It is upon this principle that much of the beneficial influence derived from the mental manage- ment of the sick depends. Under some circumstances, this direction of the attention, instead of increasing, diminishes the exercise of the natural function of parts which are even under the influence of volition — a fact which is well illustrated in the efforts to 27* 318 CHAPTER IX. swallow minute bodies, such as a crumb of bread or a pill. The greater the effort to accomplish it, by fixing the atten- tion upon the means, the greater is the difficulty ; whilst no effort is required to swallow a moderate sized piece of bread, owing to its demanding no exertion of the attention. Imagination operates powerfully on the action of the heart. We are told that the Greek rhapsodist in reciting Homer became so excited as to fall into convulsions. I once wit- nessed the metallic tractors cause the most violent palpita- tions, oppression of the chest, and embarrassed breathing. Like the Mesmerism of the present day, they wrought won- ders, gave muscular energy to the paralysed, and ease to the pained; but, unfortunately, they lost their power by the exposure of the deceit. Imagination, when properly di- rected, may be rendered useful in diseases, independent of quackery. Many other proofs of this influence of mind on the body, even independent of the passions, might be advanced; but as it is not intended to offer any explanation of the pheno- mena, these statements of its actions are sufficient. It is enough to know that the nerves ate the organs excited by every act of emotion, or of attention; and, consequently, that every change in sensation, however effected, is pro- duced through their agency. It is not necessary, here, to inquire under what conditions of change in the nervous sys- tem such effects are produced : the examples which have been advanced are intended merely to direct the mind of the reader to the fact, and to impress the practical importance of being aware of it to those attendant upon the sick and the convalescent. Few facts have been better established than that the mind possesses the faculty of withdrawing itself almost completely, for a time, from objects of sense, and of thus preventing the sensations, which usually result from physi- cal causes impressing the organs of sense, from being felt. Thus, a person suffering "under any bodily pain loses the consciousness of it, if he possess the power of abstracting his attention from it by some new or other strongly interest- ing train of thought. Indeed, it has been, with some truth, supposed that the sufferings of martyrs at the stake in the MENTAL INFLUENCE IN DISEASE, ETC. 319 cause of religion, or those of persons put to the torture during political convulsions, have been much less than might be suspected, from the attention of the sufferers being fully occupied with the importance of the cause in which they were" the victims, and from their minds dwell- ing upon the glory or the triumph to that cause, as con- nected with their fate ? The Mohawk does not feel the scalping knife in shouting his death-song. On this principle, therefore, it is of infinite importance to endeavour to direct the attention of an Invalid from the seat of his bodily un- easiness: it not only allays his sufferings, but it also per- mits the energies of the constitution to aid medicines in combating the disease, and restoring the health of the part. But, as few persons have in themselves the power of men- tal abstraction to an extent adequate to the relief of great bodily pain, it should be the first object of the attendants of the sick to endeavour to produce the same effect, inde- pendent of any voluntary effort on the part of the Invalid. By directing the mind into a new channel, the bodily ener- gies have been roused to a most extraordinary degree; even the idea of our own strength gives actual strength to our movements; and, indeed, the " idea that a change is certainly about to take place in the actions of the nervous system, may produce such a change in the nervous energy, that exertions hitherto impossible become pos- sible."* The knowledge of this fact is the secret, in the management of Hysteria, which enables one person readily to cure the disease, although many others fail. It is only requisite to obtain the confidence of the patients; and then to convince them of their capability of exertions of which they have previously supposed themselves incapable. Much caution, however, is requisite in the application of this in- fluence: for, when a person is almost worn out by disease, the effort attempted may be too great, and be followed by fatal effects. Muley Moluc waslying on a bed of sickness, and not expected to live ; but, roused by an important in- cident in a battle between his troops and the Portuguese, he started from his couch, led on his soldiers to victory, and immediately afterwards sunk exhausted, and expired. ♦ Mullcr's Physiology, trans, by Baly, vol. ii., p. 1398. 320 CHAPTER IX. Having offered these brief preliminary remarks respecting the influence of mind upon body, I shall now proceed to the details connected with their practical application in the sick-room ; and, for the sake of perspicuity, I shall arrange them under the following heads : 1. The fact of the influence of mind over body in dis- ease, illustrated by reference to some particular diseases, and the consequent importance of diverting, as much as possible, the attention of the Invalid from his personal suf- ferings. 2. The importance of inspiring Invalids with confi- dence in the means, medicinal and otherwise, adopted in the treatment of their diseases ; and of augmenting the hope of their restoration to health. 3. The importance of religious consolation in allevi- ating the sufferings of the diseased ; but the necessity of exercising the utmost discretion in the attempt to im- part it. 4. It is scarcely necessary to say that the influence of the mind upon the body, labouring under disease, is most ob- vious in those affections which are referred to the nervous system. I have already given a most striking and melan- choly instance of Grief on the general system (page 36), which proved fatal to a person of keen sensibility, previ- ously in good health. It equally affects the vascular sys- tem ; for, to use the words of Melancthon, " Sorrow strikes the heart as with a blow, causing it to flutter, and to lan- guish, with a deep feeling of pain." The influence of mind over the general mobility of the body is strikingly exemplified in convulsive diseases ; and the importance of endeavouring to prevent the patients from yielding to their feelings is well known to the physi- cian. Friends, in such cases, must not display too much sympathy with the patients ; but they should remonstrate with them, mildly, on the necessity of opposing the approach of the paroxysm ; and the probability that it may be warded off, if they resolutely determine to resist it. This is peculiarly essential in Hysteria, a disease which most generally occurs in those who have been imperfectly or improperly educated, whose actions are governed by their MENTAL INFLUENCE IN DISEASE, ETC. 321 feelings, and who have never been taught the value of self- control. In such cases, the moral is not less important than the medical management. The mental irritation which ac- companies and keeps up the disease is often associated with local circumstances, which ought to be discovered, in order that the Invalid may be removed from them, if her moral courage cannot be screwed up to resist their influence. Although sympathy as it were nourishes the malady, yet it must also be recollected that harassing and unpleasant occu- pations should be avoided, and that the imagination of the patient should be weaned from creating fictitious suffering by cheerful and amusing conversation. In Hysteria, when the disease is gradually wearing milder and milder, and when a glimpse of returning health is per- ceptible, a harsh expression may renew all the untoward symptoms, and overthrow the advantages of many weeks' judicious treatment. Hence the paramount necessity of kindness and of delicacy of demeanour towards the unfor- tunate beings who are labouring under the unmanageable disease. In a few words, in no class of disease is a deli- cate, winning manner, accompanied with firmness, more requisite than in affections of the general nervous system. The salutary influence of the treatment which they require depends as much on the mental as on the physical reme- dies. It is not the purpose of this volume to interfere with medical management; but I may be permitted to say, that, in many nervous affections, I have seen the greatest benefit ensue, in a short time, from the custom of sleeping for a few hours during the day. The best period for this siesta is, after moderate exercise, before dinner. This recom- mendation, however, does not imply the propriety of lying in bed : on the contrary, the nervous patient should rise from bed the moment he awakes. To remain in bed, meditating on his bodily and mental feelings, nurtures the malady, and changes the couch of repose and quiet into the cradle of anguish. The most dangerous of all indulgences to the nervous is that of Imagination passing in review before him the melancholy array of the evils, real or fan- cied, which are preying upon him ; and at no time is this 322 CHAPTER IX. more likely to occur than at the period between awaking and rising in the morning, if that be protracted. When serenity is nurtured, it conduces to the restoration of health ; and even where recovery is impossible, kind- ness tends to awaken emotions well calculated to prolong life. The influence of early rising in such cases is thus beauti- fully described in a work which has been too little appre- ciated. " It is in the calm and silent grandeur of the morn- ing that the afflicted man is deeply impressed with the power of his Creator, and feels the sweet balm of his works, and their promises poured into a lacerated bosom. 11 He feels it in the fresh breeze that wafts comfort and strength from Heaven itself on his grief-worn head ; he hears it in the gentle sound of the sheep-bell, in the murmur of the brook, and in the sweet song of the innocent bird which rises aloft to proclaim the beauties of the full-blown morn." — " Let him pass with a troubled, nay, agonized, though not a guilty mind, into those matchless scenes which Nature can unfold to his view, and her own still voice, magnifi- cently eloquent in the morning silence, shall soon clear away his doubts and soothe his sorrows."* From what has been already said, it is evident that few parts of the living frame are so powerfully influenced by mental impressions as those connected with the function of the heart. Care, anxiety, grief, and all the depressing pas- sions, lower the nervous energy, derange the action of the heart, and often lay the foundation of structural diseases of that organ. If this be the case when no derangement of the system is present, how much more is it likely to occur when disease has already weakened the frame, and morbidly augmented the susceptibility of the brain and the nerves. The exciting passions, when carried to a greater than ordi- nary height, are still more hurtful than the depressing; hence, it should be strongly impressed upon the patient, and also upon his relations and friends, that nothing is so likely to cause a sudden, fatal termination to any disease of the heart as a burst of Anger or of Passion. The numer- ous cases of this kind on record prove the great importance * Fletcher's Sketches, &c;, p. 211-12. MENTAL INFLUENCE IN DISEASE, ETC. 323 of preserving equanimity of mind, and a quiet and placid deportment in diseases of the heart. In Hamorrhagies, whether from the stomach, causing Vomiting of blood, or from the lungs, in which the blood is brought up by coughing, moral causes operate powerfully ; and, consequently, the greatest care must be taken to keep the mind of a patient, labouring under either disease, free from every cause which can affect the passions, whether of a depressing or an exciting kind. This is more espe- cially the case in spitting of blood ; as any cause, operating either as a sedative or a stimulant, is equally capable of augmenting the flow of blood. If the exciting passions be roused, the heart is impelled to increased action, and neces- sarily throws an unusual quantity of blood upon the lungs ; if the depressing passions be operating, the diminished impelling power of the heart admits of temporary stagna- tion taking place in the pulmonary vessels; and, in either case, the discharge of blood is renewed if it has stopped, or it is augmented if it has not been suppressed. The importance, therefore, of preserving an equable and tran- quil condition of the mind in this disease requires no comment. The necessity of amusing the Convalescent, and with- drawing his attention from himself, is, under no circum- stances, more necessary than in those cases in which mer- curial remedies have been employed to an extent approxi- mating to salivation. The salivary glands are peculiarly susceptible of being affected by mental emotions. The idea of a savoury dish causes the mouth to water, as the phrase is ; and, when the gums are scarcely affected by mer- curials, painful sensations may be excited by the attention being directed to them. In cases in which salivation has been induced, even when it has been very moderate, a longtime is requisite to remove the tenderness of the gums, in highly susceptible individuals, who have little inclina- tion for reading, and who have no person with them capa- ble of soothing their sufferings by the balm of amusing conversation. I have had many opportunities of seeing this exemplified. A lady was under my care, who had not taken a particle of any mercurial medicine for upwards 324 CHAPTER IX. of six weeks ; nevertheless, she still suffered severely from the tenderness of her gums. Her sisters and mother were out of town, and she had no relation near her, except a deaf aunt; and, never having much cultivated her intellec- tual powers, she brooded over the condition of her mouth, until the pain arose to an almost insupportable degree. What the nature of the physical changes, if any really take place in such cases, may be, it is extremely difficult to conjecture ; but it displays strikingly the necessity of wean- ing the attention from the feelings of the body. The influence of the mind upon the stomach is every day witnessed. It is well known that the excessive exer- cise of mind diminishes the activity of the nutritive pro- cesses. On this account, we frequently observe hard stu- dents lean and shrivelled in aspect. The keen observation of Shakspeare did not overlook this fact, when he wrote the following speech of Caesar — " Let me have men about me that are fat, Sleek-headed men, and such as sleep a-nights: Yond Cassius has a lean and hungry look, He thinks too much."* Any circumstance which will cause a fit of deep anxiety or of misery will suspend the digestive powers for a time, even in a person of the best state of health ; but, when the organ is previously weakened by disease, the injury which is thus inflicted upon the gastric nerves does not disappear with the removal of the exciting cause, but continues long after the mind has regained its usual com- posure. Mental Indigestion, as this malady has been correctly named, is accompanied by confusion and pain in the head, vertigo, palpitations and uneasy feelings about the heart; pains or a burning sensation between the shoulders, with oppression at the chest; a furred tongue, torpid bowels, a feeling of languor after taking food, and flatulence. The temper becomes irritable, and the sensibility so morbidly acute, that a harsh look, or a severe expression, will aug- ment all the sufferings of the Invalid. Like the chords of an overtuned harp, the nervous system, when affliction * Julius Ca-'sar, Act. i., Sc. iv. MENTAL INFLUENCE IN DISEASE, ETC. 325 has once laid his hand upon it, is rendered acutely suscep- tible, and vibrates to the slightest accidental touch ; and even the recollection of what awakened its morbid sensi- tiveness and all its accompanying train of bodily sufferings, raises afresh the evils which for awhile were allayed. In such a condition of the nervous system, even when the disease is on the decline, all the symptoms may return by any mental disturbance, more especially if it be akin to the original anxiety which was the exciting cause of the attack : hence the great necessity that the attendants of the Invalid should refrain from such subjects is obvious. If they are likely to form the contents of letters, these should either be withheld from the Invalid until a fitter opportunity of perusing them presents itself, or until their contents be examined by some relation or intimate friend ; and then they should be cautiously and discreetly communicated. Indigestion, arising from mental causes, not unfrequently merges into Hypochondriasis ; and this is more likely to take place when the stomach has been physically de- ranged by previous disease. Although the ailments under which the Invalid has been suffering have been removed, yet his consciousness that his digestive organs are still inadequate to their office retards his complete recovery, and becomes a source of mental suffering which reacts upon the stomach. Sensations of oppression and pain are experienced, and referred to the stomach; the nervous system again suffers; the irritability, depending upon such a state, is again excited, becoming almost un- controllable; and the poor sufferer then verges into complete Hypochondriasis. Keeping these facts in view, there is nothing more im- portant in the management of convalescence, in such Inva- lids, than the diversion of the attention of the patient from his personal feelings, especially when the stomach has been involved in the disease from which he is recovering. For this purpose, a proper selection of books for his perusal is of primary importance. Their subjects should be of a bustling, stirring nature, but not puerile. Few books are better adapted for this purpose than the Waverley novels. After fevers, in which the brain has been acutely affected, 2y 326 CHAPTER IX. a temporary fit of Melancholy may supervene, under which the closest attention and watchfulness in the attendants are requisite, to prevent suicide — an event which, in such a condition of mind, has too often happened. This is more essential, as this mental affection suffers remissions, and even intermissions, which tend to deceive and throw the attendants of the Invalid off their guard. It is not easy to mistake this state : the haggard, melancholy, anxious ex- pression of the sufferer, displays, most obviously, the bitter anguish in which his soul is steeped ; he sees nothing in the world but misery and suffering; Hope has departed from him ; and he seeks relief where he expects only to find it, in the quiet of the grave. In this case,the previousshock which the brain has suffered is undoubtedly the predisposing cause of the irritable condition in which it exists when this state of mental suffering is present. There are often severe shooting pains in the head, intolerance of light, and many other symptoms, as if the fever which had just ceased had returned. The perceptions of the sufferer are so much ex- alted, that the slightest mental causes affect him: the di- gestive organs soon, also, feel the derangement in the ner- vous system; and, as their function is disturbed, the assi- milative process becomes imperfect, the body falls at length into a state of atrophy, and the mind into imbecility. It is scarcely necessary to say how closely such invalids should be watched. When the previous disease has been fairly subdued, and the Invalid can be safely removed, much benefit may be anticipated from travelling ; but when that cannot be ob- tained, a decided salutary effect may be gained from well- regulated society, even when the Invalid is yet incapable of leaving his room. Great discretion, however, is requi- site in the choice of those who are intended to cheer and to amuse him. The amusement which is supplied must not be such as to fatigue the attention ; the conversation must not rest too long upon one subject, but be occasionally varied in such a manner as to re-excite the attention by the change of the stimulus, before the exhaustion, which must necessarily follow the continuance of the same impressions, be experienced. A hacknied gossip, a professed talker, a MENTAL INFLUENCE IN DISEASE, ETC. 327 conceited punster, a loud laugher, are alike to be debarred from entering the room of such a Convalescent; it is he or she only, who, with a well-stored mind, mild and gentle man- ners, and feelings which can sympathize with the condi- tion of the Patient, and who also possesses judgment to point out the limits to which the efforts to amuse may be safely carried, that is capable of undertaking this important part in the management of nervous convalescence. Under no circumstances should ridicule be employed " to laugh him, as the expression is, out of his malady, because it happens to be nervous."* The taste of the convalescent must also be consulted. Indeed, in every convalescence, this should be consulted ; but, at the same time, some degree of firmness is requisite for enforcing the daily habits of exercise and regimen which the case demands. Thus, in summer, he should be urged to walk or ride before breakfast ; and, to induce his more ready compliance, he should always be accompanied by an agreeable companion, who will never allow his mind to re- flect, nor his attention todwell uponhis past or present suf- ferings. On returning, however, from such exercise, the Convalescent should not breakfast until he has recovered from the feeling of fatigue ; and, after this rest, means should be concerted for agreeably occupying his mind until dinner-time, or until the evening, when, in such cases, the spirits become more composed than at any other period of the day. Butj if attention to the condition of the mind and the state of the feelings be necessary in convalescence from nervous affections, it is equally so during the presence of diseases in which the brain or nervous system is implicated. It is, indeed, scarcely necessary to remark, that mental ex- citement, as it is capable of disturbing all the functions of the body in health, exasperates every symptom of fever: even ordinary mental exertion, if attempted, is hurtful ; and, consequently, it should be restrained. The utmost repose of both mind and body must be enjoined, and all objects which can give rise to mental emotions should be withdrawn. Thus, those connected with the Invalid pro- ♦ Fletcher. 828 CHAPTER IX. fessionally, or in occupation, should not present themselves before him ; nor should any subject connected with his af- fairs be canvassed. This mental repose is still more requi- site in cases in which the brain is specially affected ; as in low, continued fevers of a typhoid character. It is unnecessary to refer farther to peculiar diseases. I shall pointout the necessity of refraining from awakening the passions, whether exciting or depressing; and also of not influencing the imagination of Invalids who are prone to credulity. The exciting passions operate upon the healthy body in the same manner as material stimulants; and, in excess, they are causes of disease in susceptible individuals: the impulse which will kill one man will scarcely excite the smile of another. Under ordinary circumstances, they quicken the pulse, elevate the heat of the body, and rouse the nervous energy: their action,therefore, is followed by col- lapse ; and hence the danger which may result from them to Invalids of suceptible feelings. A joyful eventcommunicated suddenly to such an Invalid may produce a fatal effect. Sophocles, when aged and infirm, was crowned for com- posing a successful tragedy, and died on the spot. Sina- mus Taffurus, the celebrated Jewish pirate, having received intelligence that his son, who was captured and enslaved by Barbarossa, was ransomed; hastening to his aid with seven well-armed ships, was so overjoyed, that he was struck with apoplexy, and almost instantly expired. These are instances of Joy causing fatal diseases in the healthy. The following anecdote illustrates its influence on a habit suffering under disease. A boy of eight years of age, the only son of his mother, was labouring under great debility and Dropsy, the sequel of Scarlet Fever. He was, how- ever, recovering; and the Physician informed the anxious mother that her son was out of danger. She incautiously communicated the intelligence to the over-sensitive boy. "Is it really true, mamma?" said he, ashe ardently threw his arms round her neck—" shall I not be put in the church-yard with Betsy, but play at marbles again with cousin William ?" The warm kiss which in reply she imprinted on the lips of the little fellow was not returned ; his arms loosened from her neck; and he fell back upon the pillow a corpse. MENTAL INFLUENCE IN DISEASE, ETC. 329 The influence of the excitement of anger or impetuosity in disease is still more hazardous than that of over-joy. No unlucky incidents nor events that can cause even a mo- mentary irascible feeling should ever be communicated to an Invalid. The passion which they awaken rapidly ex- hausts the irritability of the nervous system; and faintings, convulsions, and even death, have followed. A gentleman, in an advanced stage of pulmonary Consumption, was visited by a friend whom he had not seen for many years. The conversation turned upon past events ; and an act of ingratitude was mentioned, which roused the indignation of the poor Invalid. He rose from his chair; and, whilst in the act of declaiming against the ingrate, he struck the table with his fist, sank down in his chair, and instantly expired. I have seen an instance in which a wife, neglecting a sick husband, and giving her time and conversation to other individuals, excited the passion of jealousy, which, preying upon the weakened mind of the Invalid, was followed by sleepless nights, wasting of the body, and loss of every apti- tude for the smallest exertion, until he fell a victim to the mental poison which corroded his frame. Nor is this won- derful, when we daily witness its effects on healthy indi- viduals. I may be excused in quoting our immortal Bard's correct detail of its influence on Othello : lago. Look where he comes ! (Othello enters.) Not poppy, nor mandragora, Nor all the drowsy syrups of the world, Shall ever medicine thee to that sweet sleep Which thou own'dst yesterday. The depressing passions operate sometimes as suddenly as the exciting. A gentleman, reading a newspaper in a Coffee-house in Dublin, saw the notice of the death of his only son at the storming of Bergen-op-Zoom, instantly fell from his chair, and expired without a moan, from the rup- ture of his heart. But, in general, the depressing passions, although they operate as fatally as the exciting, in disease, yet operate in a different manner. Their influence is that of direct sedatives, slow but certain in their effects ; con- sequently, nothing which can lead to Despondency or De- spair should ever be allowed to dwell upon the minds of 330 CHATTER IX. Invalids. A person labouring under disease may say to his physician, " Sir, all your endeavours will be useless; I feel that I shall certainly die of this complaint." What is the consequence? If the mind cannot be diverted from dwelling upon such an idea, it produces, in most instances, the accomplishment of the prediction. The body wastes, the countenance becomes pale and dejected, the eye retires within its socket, and the whole powers of life gradually fail, until Death closes the scene. Disappointment, in the anticipation of some expected good, operates nearly in the same manner, in disease, as Despondency. This is peculiarly the case when it is con- nected with the tender passion in young females, more keenly susceptible in disease. In health, it brings on dis- ease, and wears down the energies of both mind and body; especially when the passion has been fostered on one side only; when the mind has long cherished the passion, and then is suddenly awakened to the illusion, to the long, lin- gering, undying pang of disappointed hope — the unlooked for termination of gentle, silent, and devoted love. It is not easy to say how this influence is to be averted or weak- ened in disease. i. The bodily effects of Fear can only be ascribed to its powerful influence on the nervous system. In every disease, Fear increases the danger, disturbs the usual course of the malady, and often brings on new7 and unexpected symptoms — a sufficient reason for always cheering the spirits of the sick, and inspiring confidence in the hope of recovery. Impress a sick man with the idea that the disease may prove fatal, the conviction will verify the impression. The worst of all evils, in sickness, is a belief in fatality. The last remarks which I have to offer respecting atten- tion to mental influences is in reference to surgical opera- tions. Every surgeon knows the blighting and dangerous influence of Fear in such cases; and the necessity for raising and cheering the person who is about to become the subject of an operation before its performance. No in- discreet nor gossiping acquaintances should see the Invalid at that time; since it is impossible often to check their MENTAL INFLUENCE ON SURGICAL OPERATIONS. 331 gloomy forebodings and their ill-selected anecdotes, which are only calculated to awaken imaginative terrors, that sometimes subdue, the resolution of sufferers who can other- wise boast of the strongest moral courage. Those who have witnessed the pulling down of the stoutest heart, during the contemplation of an operation which has been put off for a few days, will join in the necessity of never informing the Invalid of the period when the operation is to take place until an hour at most before the event. If he is of a timid character naturally, he must be cheered and supported, and every idea of despondency or foreboding driven from his mind. When this caution has been ne- glected, men of vigorous constitutions have been taken from bed to undergo an operation ; and, at its completion, have been laid upon it a corpse. This fact of danger at- tending such communications is admirably illustrated in the following melancholy anecdotes: A girl, who was to undergo the operation of amputation, requested to see her mother. After the interview, her mind having been indiscreetly alarmed by the mother, she de- clared that she could not suffer the operation, and would die with the diseased limb on her body. Notwithstanding this declaration, after an interval of some days she was persuaded to submit the limb to the knife of the surgeon. " When she entered the operation-room," says Mr. Fletcher, who details the incident, " she trembled, with an expres- sion of wild alarm, mingled with that of vacancy, on her countenance, indicating the mind lost or distracted with terror ; nor would she have entered the room at all, but for an angry remark of the surgeon, who intimated that she was making a fool of him a second time. This was deci- sive. She sat down confusedly, without being conscious of a question addressed to her, threw a rapid glance round the room, and sighed deeply."* The operation was well done ; but the girl died on the sixth day after the opera- tion. Fear, in this case, was undoubtedly the cause of death. It demonstrates the necessity of discretion on the part of relatives in displaying or expressing their fears to the In- * Fletcher's Sketches, p. 363-4. 332 CHAPTER IX. valid ; and not less the impropriety of performing opera- tions under such circumstances. In general diseases, also, this passion, by lowering the powers of life, so modifies the influence of medicines, as often to baffle the most judicious practice. In one instance, which came under the notice of the author, a person, recovering from an acute disease, sud- denly relapsed, from an alarm excited in his mind respect- ing his condition, which originated in the remark of a visitor, " that he was not yet free from danger." He be- came worse ; the feeling that he musf die took firm posses- sion of his mind, and death soon followed this conviction. The leg of an old, discharged seaman, which was ne- crosed,* was condemned to be taken off, in the Gloucester General Hospital. He was in good health in other respects, and temperate ; " but the day before the operation," know- ing that it was to be performed, he was in unreasonably high spirits, daring and reckless, amounting to wild bravado, and longing for the time to arrive, when he should show the example of a British tar's indifference to bodily suf- fering. " The hour came, and he kept his word. He mounted the stage — would neither be blindfolded nor held — but, with folded arms and a determined eye, surveyed the pre- parations, and flooded the modest and astonished nurse with a torrent of sailor's wit. " When the knife penetrated the skin, he began and con- tinued to sing with more steady coolness than he had hitherto shown, and without the slightest break, the naval song of ' Tom Tough,' until the completion of the opera- tion. " This fine fellow fell altogether as low after the most favourable operation as he had been previously high. He hardly rallied for a moment, but withered away, to sing and fight no more, on the fifth day from the amputation." This result was undoubtedly the consequence of " long-con- tinued over-excitement, or extreme tension or straining of the mind."f ii. The powerful, salutary influence of Hope and Confi- * Mortified at the bone. f Fletcher's Sketches, p. 360-1. MENTAL INFLUENCE ON SURGICAL OPERATIONS. 333 dence in disease is well known to every Medical Practi- tioner. He is well aware that many maladies will yield to no material remedies unless the soul concur ; and daily ob- servation displays to him Hope and fortitude of mind tri- umphant in repairing the debility of the body worn down by physical ills. The more the physician can, therefore, be aided in keeping awake the hopes and confidence of his patient, the more certain is he of curing the disease. Hope, in truth, is not more essential in sustaining the moral cour- age of a man amidst the evils and difficulties which beset his paths of life than it is in disease. Cease, every joy, to glimmer on my mind, But leave, oh! leave, the light of Hope behind ! What though my winged hours of bliss have been, Like angel visits, few and far between ! Her musing mood shall every pang appease, And charm when pleasures lose the power to please.* The influence of Confidence is associated with Imagina- tion, with regard to the curative agency of which the his- tory of Medicine is most prolific ; and it is upon this prin- ciple in the mind that the occasional success of Empiricism is based. In looking for illustrations of its influence, the only difficulty is the selection of the facts ; and the author might amuse his readers by the details of the success which has followed its application in every age of society, from the rudest, where it operates on the ignorance and credu- lity of the human savage, to that of the widest diffused knowledge. It holds its sway, not only over the untutored rustic or labouring mechanic, but over the accomplished gentleman, the deep-read scholar, and the philosopher. The Phylacteries of the Jews, the miracle-working relics of the Roman Catholic Church, the Royal-touch of the middle ages were not more confided in than the advertised nos- trums of the present period, by all descriptions of people.f Thirteen hundred years have elapsed since iEtius described * Campbell. f When Louis IX was dying, he sent for the holy man of Calabria, and fill on his knees before him, begging him to prolong his life. The holy phial was sent to him from Rheims, and St. Peter's vest from Rome ; but here Confidence and Faith equally lost their influence. " Ho could," says Commincs, who relates the anecdote, '• command the beggar's knee; but he could not the health of it.." 334 CHAPTER IX. and ridiculed the nostrums of his time, and the extravagant sums paid for them. In the sixteenth century, Paracelsus cured Gout, Rheumatism, Convulsions, and similar dis- eases, by the magnet, a remedy which was again brought forward to work upon the imagination of Invalids labouring under the same diseases, about thirty years ago, in the form of metallic tractors; and a third time, in its original form, a few years since; but its reign was short; and it has given way to the greater absurdity of animal magnetism, the in- vention of Mesmer, a Swiss adventurer. The wonderful influence of Confidence, in the operations of Mesmerism, displayed upon nervous individuals and hysterical women, is perhaps unequalled. In no class of maladies is the influence of Confidence, in supposed remedies, more strikingly illustrated than in those which are characterized by periodical returns, or Agues. Many Agues are, even at this day, cured by charms, by spider's-web, the snuffings of candles, and other sub- stances which can act only through the Imagination. A gentleman, in Sussex, who farmed his own property, was requested to give one of his farm servants a holiday, in order that he might go to Ipswich to be cured of an Ague by a man who could charm it away. As it was harvest time, his master could ill spare him ; and, to satisfy the poor man, he assured him that he himself knew the secret, and could cure him. He made the man turn thrice, for three successive times, and then, mumbling a few Latin words, assured him that he was cured. The man believed ; and the disease never returned. But the fanciful proposals of Empiricism are sometimes equalled by scientific fancies. In the commencement of the present century, a French chemist, having assumed the right to a discovery, made by Dr. Maton several years before, that the Infusion of Galls precipitates Infusion of Cinchona Bark, supposed that this depended on the Bark containing Gelatine, and proposed to employ Glue as an Antiperiodic, or a cure for Ague. In France, in Italy, and elsewhere, numerous cases of Ague were successfully treated with Glue ; and a volume was published by Dr. Giuseppe Gautieri to explain the mode of its action in effect- INFLUENCE OF CONFIDENCE IN DISEASE, ETC. 335 ing these cures : and, to prove that it surpasses Cinchona Bark in efficacy, we are told by the learned Doctor that the Glue diffuses an agreeable warmth over the body, espe- cially the surface of it, and consequently promotes perspira- tion : but, says he, it injures the appetite, depresses power, and procures quiet sleep. The dose of the Glue was five drachms, taken just before the cold fit of the Ague, and repeated in ten or twenty minutes, till the whole was swal- lowed. A London alderman would agree with the opinion of the sapient Physician, that Glue destroys the appetite, as he has often experienced after the third plate of Turtle ; aye, and even produces sleep ; but ho»v far it would serve to remove an Ague from the worthy Magistrate, without a firm faith in its power to make him whole, I shall not venture to pronounce. Although these details are demonstrative of the prop which Confidence or Faith affords to the Impostor, yet, like the dew of Heaven, which falls equally on the just and the unjust, Confidence is not less valuable, when properly taken advantage of, to the scientific physician. It demands two distinct efforts to make it effective : one on the part of the Physician, the other on the part of the friends and attendants of the Invalid. With respect to the first, no medical Practitioner can expect to gain the confi- dence of* his Patient, unless he can impress him with the belief that he is not only duly qualified for the investiga- tion and cure of diseases, but that he is deeply interested in the case ; and he must prove to the Patient that he may rely with security on the measures which he adopts. He is undoubtedly the most successful physician who can most easily govern the mind of his Patient. With respect to the latter, the friends and attendants of the Invalid should second, in every instance, the efforts of the Physician to secure the confidence of his Patient. Every one, who has had opportunities of becoming ac- quainted with the gossiping in the sick-room, must have frequently witnessed the opposite conduct in nurses and the visitors of the sick. " Dr.-------," says the nurse, " would not have given you such a medicine." " I wish," exclaims some female friend, " you had been under dear 336 CHAPTER IX. Dr.-------; he did so much good in a case exactly the same as yours. Yes! he is the Physician 1 shall always recommend." In the weakened condition of the Invalid, is it wonderful that his mind wavers? that his confidence in his Doctor is weakened ? and thus, by taking away the character of the Physician, the disease gains ground, and the anticipations of both Doctor and Patient are frustrated. The cultivation of the Confidence of the sick, essential towards effecting a restoration to health, is most requisite in those maladies which originate in, or are connected with, mental afflictions. In such diseases, the Invalid, brooding secretly upon his miseries, despises the means which are attempted as remedial; he treats his medical ad- viser with pride and distance : but, when his confidence is secured, his reserve is thrown aside, his self-importance is lowered, and he unburthens his mind to his Physician, who thus is enabled to view the malady in a proper light, and consequently to prescribe with the anticipation of a bene- ficial result. As the real character of the patient unfolds itself, hi.° sentiments, tastes, and even his failings, are ex- posed ; and if the Physician possess a sound judgment, he may both morally and physically work upon these materials in a manner adequate to the removal, not only of the exist- ing malady, but completely to oppose its future approach. If this be the point which the Physician ought to aim at attaining, it is surely unnecessary to urge the propriety of every effort on the part of the friends and attendants to aid his efforts in securing that confidence upon which so much depends. To endeavour to reason a Melancholic out of the depths of Despondency, or a Hypochondriac from the dread of death under which he labours, is a vain effort, which will only bring disappointment. The corporeal disease clouds the mental faculties, and especially the power of comparison: but, obtain the confidence of the Invalid, and the battle is already won ; whilst arguments tend rather to rivet the opinions of the Hypochondriac than to convince him of his error. Hippocrates, the father of rational medi- cine, delivers this opinion as an aphorism — " he performs the greatest number of cures in whom most trust." In conclusion, the following may be regarded as a sum- MENTAL MANAGEMENT OF INVALIDS. 337 mary of the rules required to be observed with respect to the mental management of Invalids. 1. No person should be employed as a nurse in the sick- room who has not complete control over her temper; who is of a peevish or irritable temperament; gloomy or super- stitious, yielding belief to forebodings, omens, or any such fancies. A cheerful, pleasing, obliging, patient, and contented disposition, is essential in the character of a sick-nurse. 2. All unnecessary conversation with the Invalid re- specting his feelings should be avoided; but, whilst he ought not to be teazed even respecting his wants, his con- dition should be so studied, that whatever is good for him, whether medicines, food, or drink, should be administered at proper intervals, without inquiring whether he desires it. To do more than this is a cause of irritation, which must always be avoided. 3. No suspicions should be raised in the mind of the In- valid.that his disease is not progressing favourably towards a cure : hence, all whisperings, consultations, exchange of looks, denoting anxiety for his fate, as well as all expres- sions of commiseration respecting his condition, should be carefully refrained from by every attendant in the sick- room ; and caution is requiite respecting every thing that can induce fear, terror, despondency, grief, or any mental depression. 4. Nothing should be said or done to awaken the irri- table feelings or the indignation of an Invalid : even cir- cumstances or events likely to excite too powerfully the pleasurable feeiings should not be suddenly communicated to him. 5. No remarks nor comments should be made respecting the plan of treatment; nor any allusion whatever which can lessen the confidence of the Invalid in his Physician or Medical Attendant. Even when directions, apparently in- judicious, are given, they should be fulfilled, if no dele- terious consequences are likely to result from them. If confidence cannot be reposed in the Medical Attendant another should be procured ; but no interference with the plans of him who is attending should be permitted. If th caprice of an Invalid requires the attendance of any par 3.'M CHAPTER IK ticular Physician, even when the utmost confidence c;ni be reposed in him who is in attendance, the wish of the Invalid should be indulged. 6. In convalescence, idle, gossiping visitors should be debarred from entering the sick-room. The taste and the pursuits of the Invalid should be consulted in selecting his associates, before he is well enough to leave his room and select for himself. 7. In convalescence, every exertion of the mind, as well as every kind of bodily exercise which can cause fatigue, must be refrained from, especially when the disease has been of long continuance. It must always be recollected that the faculties of the mind are exhausted by even mode- rate application, during recovery from disease, and that much mental exertion may induce permanent Dyspepsia, or Apoplexy, or Melancholy, or Fatuity. No mental task to which an Invalid has a reluctance or distaste should be urged during convalescence. Finally, it must ever be borne in recollection that the " soul has a certain empire over the body it animates," and may be so managed as either to cause disease or to fortify health. iii. The inestimable value of the consolations which may be derived from Religion in disease is undoubted. The re- signation which it teaches is a certain source of hope and comfort. But great as the consolations are which it imparts, the impressment of it on a mind weakenedby disease requires much discretion ; and such a season is often the worst adapted for its employment as a corrective to a wandering or hesitating belief. Religion has been justly regarded as the last and firmest hope of the afflicted; but, in imparting its truths to the fractured and over-susceptible mind of the Invalid, gentle- ness, charity, and forbearance are essential; and it is surely unnecessary to say, that those only who possess these quali- ties are capable of imparting efficiently the cheering spirit of Christianity. The object should be to soothe, not to dis- tract. On the bed of sickness, the mind is humbled ; the heart is softened by its humiliation ; it feels its helpless- RELIC. IOCS CONSOLATION IN DISEASE. 339 ness; and is almost involuntarily turned to contemplate a future state of existence : even the infidel, in the restless wakefulness of successive nights of bodily anguish, looks upwards to a superior Being for aid, when he finds that all other is denied him. It is the feelings of such a moment which open the mind to embrace a solid faith, and to rely on the boundless benevolence of the Deity, awakened by the supplication of Him who "felt our infirmity in all things but sin."* But the question may be asked, how is the knowledge of it to be imparted to one who perhaps doubts even the existence of such a Being? When I talk of religious consolation in the sick-room, it is chiefly to Woman I look as the bestower, the instructor, the gentle, yet firm guide ; calculated equally to rebuke, if necessary, the wavering sinner, trembling on the brink of a state of change in which he can see no hope ; and to soothe and encourage him whose eyes are fixed upon the anticipation of a peace which passeth understanding. Who better fitted than Woman to pour into the agonized bosom the healing balm, more salutary from being communicated in the genth'.-t tones of sympathy ? What more cheering, when the hopes of that futurity, upon the confines of which we are about to enter, are held up with the endearing smile which brightens a countenance upon which Providence has bestowed an Angel's impress ? It is Woman only, when engaged in such a sacred duty, who is neither scared by the aspect of misery, however squalid and repulsive, nor deterred by the risk of contagion. It is not in the sick chamber of the wretched and the poor only that the angelic smile of WToraan can impart con- solation, infuse the spirit of resignation under sufferings, and inspire confidence in the promises of divine revelation. The same advantages may be derived from her gentle and kind manner, her enduring attentions, and her forgetfulness of self, to those nursed in all the luxuries of fortune, when laid on the bed of sickness, and seeking the comforts of Re- ligion. Let me, however, caution her whom I have thus described, that, whilst her conscience may lead her to rely on particular creeds, she ought not to press her o*vn creed ♦ •J'.nloi's Holy thing, c. v., § 3. 340 (Tl \PTER IX. too forcibly upon her suffering sister or brother. Let me beseech her to treat with charity opposing religious tenets ; and, if a beam of hope of recovery gleams upon the coming hour, to point out to the Invalid who is about to enjoy it, that no gratitude can be more favourably received by the Divine Disposer of events than the strict exercise of the active as wTell as the passive virtues of a Christian life. Although it must be admitted that no time is more apt than that in which disease aims the dart of the Destroyer, but who delays to strike, for setting, in the sceptical mind, the great truths of Religion ;* when the world to the sufferer is divested of its illusions, and faith illumines that to which he should direct his eyes with the brightest beams of hope ; yet, no time is worse adapted for the purpose of proselytisin. In the buoyancy of health, the majority of men neglect, if they are not really incredulous to, the truth of a retributive state ; but under the pressure of disease, it forces itself upon their notice ; and Conscience too often anticipates a condemnation. The imagination views the future as an in- terminable region of horrors; and the approach of Death, truly to them the King of Terrors, only plunges them deeper into an abyss of doubts and anxieties. In such a condition of mind, nothing is more to be deprecated than holding up the terrors of an offended Deity at the side of a sick-bed. It is as injurious to the mind as it is destructive to the body. The death-bed of an upright man is thus described by Jeremy Taylor: "Then the sorrows of the sickness, and the flames of the fever, and the faintness of the consump- tion, do but untie the soul from its chain, and let it go forth, first into liberty, and then into glory."f The approach to the close of life of a bad man is too painful to contemplate ; all hope struck down; and the future — alas ! the picture is too overpowering. Life, vain life! The bitter and the worthless, wherefore here Do thy remembrances intrude ?$ Weakened by suffering, conscience whispers much neglect * " Certain it is that a mourning spirit nnd an afflicted body are great instruments of reconciling God to a sinner; and they always dwell at the gates of atonement and restitution."—Taylor's Holy Dying, c. ii. § 1. t Taylor's Holy Dying, 12mo. p. 581. $ Miss L. E. Landon. RELICIOUS CONSOLATION IN DISEASE. 341 of duty, if not commission of crime ; the mind of the wretched patient sinks into despair; his nervous system is totally unstrung; and the medicines which, were the mind calm, and the thoughts turned into a salutary channel, might prove successful in the contest with disease, become useless and unprofitable. On the other hand, in such a melancholy condition, much may be effected even by human sympathy, in soothing the troubled conscience to a wel- come serenity, by laying open to the Invalid the consola- tions which a view of the benevolence of the Deity has pro- mised to those who sincerely repent. By such means only can the troubled mind be lulled into tranquillity. Where reproof cannot be avoided, it should be tempered by the mildest wisdom: confidence is thus ensured : and, if the comforter display earnest piety, and demonstrate its influ- ence in his own deportment, there is more to be hoped for than can ever be effected by denunciations and threaten- ings. The task of conversion, as it is styled, cannot, however, be undertaken at a worse moment than when the object of it is stretched upon a sick-bed. At all times, there is no folly greater than that of attempting religious coercion, or endeavouring to produce a uniformity of belief. In the sick-room, the attempt to make converts to a particular faith or sect, by frightful denunciations on unbelief, is cruel, and the worst of tyranny. " Let it be enough that we se- cure our interest of Heaven, though we do not go about to appropriate the mansions to our sect; for every good man hopes to be saved as he is a Christian, and not as he is a Lutheran, or of any other division."* Oh! shall God listen to the meanest prayer That humbly seeks his high supernal throne, And man, presumptuous Pharisee, declare His brother's voice less welcome than his own If Topics of schism exasperate, alter, and impair benevo- lence of character in the healthful; they give an acrimony to temper, and induce an irritability of body highly detri- mental, in the diseased. * Taylor's Holy Dying, c. i\., § 2. + The Dream a poem, by Mrs. Norton. 29' 31-2 CHAPTER IX. Instead of such a mistaken zeal, the essence of Religion consists in attracting the wanderer to the love and practice of truth, and warming his heart with gratitude to the Deity, whatever may be the form in which it is displayed. In- stead of denouncing wrath and everlasting condemnation, the prospect of future and lasting felicity should be opened ; and the pure and forgiving spirit of our Holy Faith, that point of it in which every sect professing Christianity, how- ever exclusive its doctrines, agrees, should, with that most winning eloquence which a conviction of truth always sup- plies, be breathed into the anxious bosom of the sceptical Invalid. The divine Founder of Christianity carne not to destroy, but to save. If the Invalid be truly a Christian, his creed on doctrinal points is of little moment. If he have a sincere belief in the faith in which he has been educated, his mind will enjoy much tranquillity in adhering to it; whereas, what anxiety must be the consequence of any en- deavour, however well intended, to shake that faith upon which the dying man has hitherto rested in security ! In a medical point of view, such misapplied zeal is always injurious, and must be suppressed ; and it is not less the duty of friends, than it assuredly is that of the me- dical attendant, to expel such presumptuous meddlers from approaching the sick-bed. On the other hand, the utmost consolation may be afforded to the sick by pointing out the duty of resignation, and a firm reliance on the merits of our Saviour. Resignation tranquillizes the mind ; calms the agitated emotions ; and, when there are grounds for anticipating recovery, aids the influence of the medical means, and forwards, with the blessing of Providence, the work of the Physician. INDEX. PAGE Accidents, management of - 227 Acetate of lead - - - 303 Actual cautery ... 226 Administration of medicines - 171 Affections of the brain and nervous system - 47 of the stomach and bowels - - 268 Agues cured by charms - - 334 Air, admission into sick-room - 86 in convalescence - - 239 its influence on man - 15 high temperature of - 16 humidity of - - - 17 changes of, a cause of fever 17 Ale, hurtful in dyspepsia - 271 Alimentary canal, diseases of - 68 Almond emulsion, how to make 290 Amputation ; anecdote of a girl who suffered it - - - 331 Anecdote of the influence of sud- den grief 36 Animal Preparations - 285, 299 329 267 179 303 81 Anger, danger of in diseases Angina, convalescence from - Antacids, administration of - Antimonial Wine Apartments of the sick - Apoplexy, management of an at- tack of - management of con- valescence from - description of Apple-tea . - - - Arm-sling - - - - Aromatic Barley-walu - PAGE 304 280 295 295 296 143 267 101 104 343 136 263 135 289 236 302 Aromatic Spirit of Ammonia Arrow-root mucilage pudding blanche-mange with beef-tea or with milk - Articles requisite in the sick-room 82 Asthma, domestic treatment of 142 kinds of - convalescence from - Attendance of relations in the sick-room - Attendants on the sick, calmness of, the essential - Attention ; to be diverted from self, in salivation to the periods of giving medicines, necessary 171 to be diverted from self in convalescence 323 Atrophy, symptoms of - - 155 preventive management of 155 Baking meat, why inadmissible in sickness ... 279 Batter pudding - - - 298 Bandaging and Bandages 231, 238 Bandage in tapping - - 237 in dysentery - - 237 Baths.....199 shower - - - 200 hip - 202 application of and uses of 202 Bath of India rubber cloth - 208 Baths, general warm - - 206 vapour - - - 209 temperature of vapour . 205 344 INDEX. Baths, hot douche - - 203 temperature of - - 204 percussion with - • 204 cold - - - 170, 205 sea-bathing ... 205 temperate ... 205 cautions necessary in using 206 tepid and warm - - 20G use of for children - 207 in Dyspepsia - - 207 management of - - 208 description of - - 208 hot ... 209 Bed, nervous persons should not indulge in - - - 321 description of a - - 85 change of - - 85 Beef-tea, how to prepare - 286 Bleeding from the nose - 56, 133 spontaneous - - 133 vomiting, serenity of mind in, advantageous - 323 Blister, dressing for a perpetual 223 Blisters, management of - 220 immediate - - 231 raised by steam - - 221 large - - - 221 by nitrate of silver - 222 Blood-letting, implements for 188 general - - 188 care of the arm after 189 from the jugular vein and local 189 Blood, spitting of - - - 133 vomiting of - - 134 passing of, by stool - 134 equanimity of mind in, salu- tary - . 323 Boiled Bread-pudding - - 297 Boiling, mode of action in cook- ing .....279 Brain, inflammation of the, ma- nagement of 263 Brain, convalescence from affec- tions of - - - - 263 Breakfast .... 20 Bread, oat and wheaten - 246 Bread-panada ... 285 Broiling, hurtful in cookery for the sick - - - - 279 Broiled whitings - - - 303 Bronchitis, convalescence from 265 Broth, mutton, with vegetables 300 vegetable ... 285 Bruises, care of - - - 228 Burns and scalds, domestic ma- nagement of 227 Buttermilk, how to make - 294 Calomel, administration of - 120 Camphor - - - 274, 304 Canker, management of - 123 Carpet, advantages of a, in the sick-room 84 Carrots and turnips, mashed - 298 Carrageen, mucilage of - - 284 Castor t)il .... 304 Catarrh or cold - • - 125 Cathartics, administration of - 179 Cauterization ... 226 Change of linen in fevers - 111 of bed in fevers - 112 Chest, diseases of - - - 58 Chicken-pox - - 43 Chicken-tea, how to prepare - 286 brolh - - - 299 panada - - - 299 Childbirth, domestic management in 162 mental management in - ^ 163 when unusual events occur in - - 164 Chilblains, applications fur - 313 Chloride of Lime - - 273, 276 of Soda - . - 276 Chlorine, fumigation w ith - 275 Cholera, convalescence from - 27 2 Asiatic - - 160 is it contagious i - 160 of this country - - 1G0 infantum - - . 161 Chymification . . 26 Cleanliness - - - 99 in fever . . 111 Climate, choice of - - 241 Coffee, heating - - 251 Cold affusion - - 199 directions for us ing 199 Cold applications - - - 193 douche - - - - 194 INDEX. 345 Cold douche in inflammation of the brain - 118 in inflammation of the eye '- - 121 Cold, management of conva- lescence from ... 265 Cold water, its uses - - 193 Confidence ; its value in diseases 332 anecdote of its curing an ague - - 334 how to be secured by the physician - 335 Confusion of thought - - 77 Conserve of Koses - - 305 Constipation of the bowels - 68 causes and preven- tion of - - 68 Consumption of the lungs 60, 156 predisposing causes 62 last stage - - 157 deaths from (note) 17, 156 causes of * - 156 domestic manage- ment of - 156 diet for patients in 158 counter-irritation in 157 inhalation of va- pours in - 158 seton in - - 158 morphia on blisters 158 87 106 239 Contagious diseases Continued fevers - - - Contracted limbs, how to ma nage .... Convalescence, what kinds of books proper in 325 general management of - - - 238 influence ofthe coun- try in - - 239 in affections of the head 263 liet in 242 from fevers - 252 Measles 255 Scarlatina 255 Small Pox - 256 convulsions - 256 Chorea 257 Convalescence from Epilepsy 257 Hysteria - 258 inflammatory diseases - 258 Dropsy - 258 Palsy - - 259 Gout and Rheu- matism - 259 Chlorosis - 262 Apoplexy - 263 Inflammation of the Brain 263 Water in the Brain - 264 Inflammation of the eyes 264 of the wind- pipe - 265 265 265 266 266 267 267 Croup - Catarrh Pneumonia Pleurisy Angina Asthma Hooping cough 267 Enteritis - 268 Indigestion - 268 Convalescent, his taste to be consulted - 327 should be urged to walk before breakfast - 241 should not break- fast when fa- tigued - - 327 requires repose of mind - - 327 cookery for - 294 Conversation, management of for convalescents - - 326 Convulsions- - - .137 domestic manage- ment of - - 138 Cookery for the sick-room - 280 convalescent - 326 Corns - - - - - 231 Costiveness, pills for - - 314 Cough ... 58, 78 mixture, brown - - 315 Counter-irritation- - - 216 in consumption 157 346 INDEX. Cream, its digestibility - - 244 Croup - - 60, 78, 125 management of conva- lescence from - 265 Cup for administering medi- cines - - - - - 82 Cupping .... 191 CuU and wounds - - - 229 Darkening of the sick-room - 92 Deafness - 78 Death from sudden grief - 36 Decayed teeth - - - 230 Delirium .... 77 Demulcents, administration of 181 Depressing passions - - 34 Despondency, fatal influence of in disease ... 336 Diaphoretics - - - 181 administration of 181 Diarrhcea - - - 79, 271 diet in - - - 272 involuntary - - 79 Diet in fevers - . - 110 continued fever - 110, 252 measles ... 255 scarlatina - - - 255 small-pox ... 256 convulsions - - 256 hysteria ... 258 dropsy - - - 258 palsy - - - 259 gout and rheumatism - 259 morbid corpulency - 261 chlorosis ... 262 Digestive process - - 26 organs, affections of - 68 Dill water, use of - - - 305 Diluents, administration of - 181 Dinner - - - - 21 Disappearance of swellings - 80 Disappointment, hurtful in dis- ease .... 330 Disease, what it is - - 14 Disease, agents productive of 15 Difficulty of swallowing - 79 of breathing 80 Diseases of depraved secretions 152 Disease of the head and face - 56 Distilled water, use of - - 287 Distilled vinegar - - - 311 Diuretics, administration of - 182 Domestic management of the sick-room - Domestic medicines Dover's powder Douche, cold hot- with percussion Douching hammer Dysentery, symptoms of management of bandage in diet in - Dyspepsia, atonic - exciting causes of Ear, discharge from the Early rising, advantages of Education, causes of diseases - Effervescing draught Eggs, their digestibility Egg Brandy, how to make Electricity, its influence in palsy 137 Emaciation 80 Emetic for unloading the sto mach .... Emetics, mode of action, &c. Emetic Tartar, ointment with Empiricism, extensive influence of..... Encysted tumors - Enteritis - - - 127, 268 Epilepsy, hereditary - 53, 142 Epistaxis - - - - 133 Epsom salts, how to administer 305, 315 Erysipelas in infants - - 117 use of bandages in 117 incisions in - - 116 Erysipelas .... 44 pencilling with Nitrate of Silver - - 117 Escharotic ointments - - 221 Ether, mode of administering 17fi Excitants, administering of - 184 Exciting passions - - 33, 328 Excoriations - - 80,311 Exercise .... substitute for of the chest Expectorants, mode of adminis- tering .... Eyes, inflammation of, manage- 81 - 302 - 305 - 194 - 203 - 204 - 204 - 132 . 271 132,271 - 271 - 268 84 228 322 33 314 244 292 312 182 219 334 231 26 31 32 I S3 INDEX. 347 ment of, in convalescence from .... 264 Fainting ... 72, 79 Farinaceous preparations 280, 294 Fasting, evils of - - 24 Fatality, danger of believing in 330 Fear, its hurtful influence in dis- ease .-- - 330 anecdote of its fatal influence 331 Fevers .... 106 safeguards against - 39 Foetid discharges from the ear 228 spirit of Ammonia - 304 Fever, premonitory symptoms 107 domestic management of 108 continued - - - 106 remittent - - - 112 miliary, diet in - - 253 Fidgets, counteraction of - 50 Fire in the sick-room - - 84 Fish, digestibility of different kinds - - - - 244 Flannel, a non-conductor of heat.....224 Flaxseed tea - - - 291 Flooding - - - - 135 Floor, washing of in sick-room hurtful - - - - 84 Flour and milk, boiled - - 295 Flummery, how to make - 296 Food, nature and quantity of, cause of diseases - 18 general regulation of - 19 excess in - - - 25 Fomentations, intention of - 210 Foot-bath - - - - 203 Foot heaters - - - 225 Formula for domestic use - 312 Fowl, with rice - - - 301 Freezing mixtures - - 193 Fresh Air, importance of - 86 French beds - - - 85 Frictions - - - - 213 in consumption - 214 us a tonic - - 214 as a soporific - - 215 as a stimulant - - 215 to introduce topical me- dicines - - ^ 215 caution? respecting - 215 Fruits, their digestibility - 246 279 273 82 334 123 311 334 326 303 66 Frying and broiling improper in sick-room cookery Fumigations - - - Furniture of the sick-room Gautiere, Giuseppe, Dr. his opi- nions respecting glue Gargles not always useful Gloucester jelly - - Glue, a supposed antiperiodic Gossiping in the sick-room, evils of..... Goulard's Extract Gout, preventive treatment of management of in the young 128 management of in the aged 129 Grief, influence of sudden - 35 Gruel, a demulcent - - 283 grit - - - - 282 oat-meal - - - 282 Gum Arabic - - - 306 Ground-rice Milk - - 285 Haemoptysis - - 59, 133 Haemorrhages ... 132 effects of moral causes in - 323 Hartshorn and oil - - 216 Hair-gloves - - - 201 Hartshorn jelly - - - 285 Headache, varieties of - - 57 Head and face, diseases of - 56 Bandaging of - - 234 Health, definition of - - 13 Heart, diseases of, influenced by the mind - - - - 316 Heat ; its operation - - 221 Heaters .... 225 Hereditary transmission of dis- eases 74 Hiccup 79 Hip-bath, use of - - - 202 Hooping-cough - - 78, 143 domestic treatment of 143 proper diet in . 267 Hope; its importance in the cure of diseases . . . 332 Hope's mixture . . . 315 Hoarseness .... 78 Horse-hair gloves, use of . 201 Hot flannels, mode of applying 210 bricks, mode of using . 225 Humidity, effects of . . 16 348 ,N13 Hydrocephalus, symptoms of 48, 119 precautions against 48 use of calomel in 120 Hypochondriasis, predisposing causes of 47, 325 treatment of . 144 * distinction of, from Insanity . 145 benefit of change of scene in . 145 Hysteria . . . .138 advantage of kindness in 320 a caution regarding . 52 moral influence in . 51 imitation in . .51 treatment of . 52, 140 residence in .52 causes of . .139 to ward off the paroxysm 141 Huxham's Tincture of Bark . 311 Ice and Iced water . . 193 Icliosyncracies . . . 176 Illusions of sight . . 92,107 Imagination; agues cured by it 334 influence of on the heart . .316 Impetuosity; anecdote of its fa- tal influence . . . 329 Indian-rubber hammer . . 204 Indigestion, mental, symptoms of 324 attention to diet in 268 meats to be avoided in 269 vegetables and fruits to be avoided . 269 Infants of consumptive pa- rents 61 directions for suckling 165 dress of . . 165, 169 suckling of . . 165 place of sleeping for . 167 washing of . . 168 weaning of . . 168 management after wean- ing . . .169 should have no caps . 167 exercise of . . 170 Infection, counteraction of . 87 distance at which it operates . . 88 long retention of . 88 definition of . .88 EX. Infectious diseases . . 87 fumigations in . 89 Inflammation of the lungs . ,r>N of the brain . 118 of the eyes . 121 of the tonsils . 122 of the pleura . 124 of the substance of the lung4. 124 of the stomach . 126 of the bowels . 127" Inflammatory diseases . .117 Influenza .... 40 Insanity, hereditary . . 75 displayed at particular times ... 75 most frequent in females 149 celibacy favourable to 149 necessity of separation from friends . .150 education predisposes to 76 qualification for attend- ants on . . • 147 old associations to be broken in . . 150 watchfulness over . 148 anecdote illustrative of 148 after child-birth . 148, 151 probability of recovery in 148 domestic treatment of . 14a necessity of exercise in 151 Intelligence necessary for the sick room . . . .102 Intertrigo, or chafing in infants 72 Iodide of iron, how to keep . 308 Ipecacuanha, powder of . 306 ' Irish moss, mucilage of . 284 Iron, potassio-tartrate of . 307 Issues and setons . . . 223 Itch, treatment of . . .72 James's powder . . . 306 Jaundice .... 159 Jealousy, anecdote of its fatal influence .... 329 Jelly, hartshorn . ., * 285 of Iceland moss . '** . 283 rice . . .' " . 284 Joy may prove fatal . 34, 328 anecdote of its fatal influence 328 King's evil, what (note) . 153 royal touch in lr>:' INDEX. 349 Laudanum, the use and abuse of 309 anecdote of a lady who took it in excess . 310 Lead, acetate of . . 303 sugar of 303 Leeches application of . .189 cautions respecting their application on children 190 affected by odours . 191 mode of preserving . 191 Leg, bandaging of the . . 232 Lemon-peel tea . . . 289 Lemonade, how to make . 289 Letters should not always be de livered to nervous invalids Light in the sick-room . Lime, chloride of water Linen, change of in fevers Liniment for painful joints of ammonia, oil, &c, danger of in rheumatism 130 Linseed tea . . . .291 Liver, diseases of . . 71, 272 prevention of 71 Looking-glass, improper in the sick room .... Lotions, mode (.fusing . Lunatic should be separated from friends . should not be controlled by servants insane ideas should not be opposed attention to be fixed should never be alone . should be allowed exercise 151 Luncheon .... 22 Lungs, inflammation of, conva- lescence from . . . 266 Lying-in room . . .162 conduct of attend- ants in .163 temperature of . 166 preparations for . 165 natural . . . 16i difficult . . . 16< treatment after . 16' Macaroni pudding - - 45' Macintosh's or India Rubber cushions - - - - 120 30 325 92 276 306 111 313 216 83 192 150 151 151 151 151 Magnesia - 306 draught - - - 314 Magnet, a remedy in rheuma- tism, &c. .-- - 334 Magnetism, animal, its absurd- ity . - - - - 334 Malaria, often baneful in high situations Malt-liquor, influence of Marsh Mallow tea Mashed Carrots and Turnips Mastication, necessity of Meals, in disease - Measles 240 . 23 . 290 . 298 - 25 - 252 42, 114 convalescence from - 255 Meats, digestibility of - - 242 Medicines, action of, modified by the imagination 177 domestic administration of Medicine-spoon - - - Melancholy, may supervene after fevers .... Mental management of invalids, rules for affections, influence of Mesenteric diseases Metallic Tractors - - - Mild Aperient for piles - Miliary fever - - - Milk, an article of food in dis- ease - artificial goats' artificial asses' and soda water Mind, its influence in convul- sions ... its influence on the ope- ration of Medicines Minim measure, utility of Miscarriage, precautions against Mixture of Spirit of French Wine Moral management of insanity Insanity result of faulty education - Morbid corpulency Moxas - I Mucilage of Sago - of Tapioca 302 171 174 326 324 32 47 334 312 40 243 293 293 293 320 177 82 73 292 150 152 152 261 225 281 281 350 lNDEV Mucilage of Iceland Moss of Irish Moss—Carra- geen ... of Salep of Rice - Muley Moluc, anecdote of Mulled Wine ... Mutton-tea, how to make Mutton-broth, with vegetables Narcotics .... modified by idiosyn- cracy and custom how to be adminis- tered ... Nervous diseases - Nettle-rash, causes of - Neutral Mixture - Night-nurse, utility of - Nipples, how to treat sore Nitrate of silver in erysipe- las - blisters formed by - - use of in oph- thalmia use of in sore throat Nitre..... Noise in the sick-room hurtful Nurses, difficulty of procuring good - qualifications of age of strength of health of - experienced appearance of - education of - temper and disposition of antipathies of - habits of - Oat-meal gruel, how to make porridge Ointment of Tartar-emetic for chapped hands - time for applying Tar- tar-emetic ointment Operations, effects of fear in - effects of over-ex- citement in 283 Ophthalmia, management in - 121 in children 122 284 Opium - - -184 309 282 Orgeat .... 289 284 Ovarian disease 80 319 Over-study, danger of - 33 302 Over-exertion, caution regarding 30 287 Oysters, raw 245 300 Pallidness .... 78 184 Panada, bread ... 285 chicken ... 299 184 Palpitations ... 63 Palsy, diet and regimen in 137 185 description of - 137 135 Paralysis .... 55 45 Passions, depressing, anecdote 314 of the fatal influ- 84 ence of 329 165 exciting, operate as stimulants 328 117 influence on the body 3'JH Pastiles .... 274 222 Peritonitis, convalescence, from 272 in children - 127 122 Phrenitis .... i;8 Phthisis .... 156 123 Pneumonia, convalescence from 2«6 307 - management of -Position cf patient in bed 124 85 78 Potassio-tartratc of iron 307 93 Poultices, how to make 211 94 of linseed-meal, ar- 94 row-root, oatmeal, 95 &c. 211 95 of bread and water 211 100 of carrots, onions, 96 foxglove, and hem- 99 lock, &c. 212 Pleurisy .... 124 96 Piles, causes and treatment of 70 97 Pills, difficulty of swallowing 175 98 Posset-sago .... 294 282 Preparation of Beverages 287, 302 296 of Fish 301 219 Pregnancy,during consumption 80 313 Prognostics .... Proselytism, ill-adapted for the 77 220 sick-room 341 330 Prussic acid, caution respecting 187 Pudding, bread, boiled . 297 332 simple rice 297 INDEX. 351 Pudding, macaroni, or vermi- Salep, mucilage of 282 celli . 297 Salivation, influence of mind batter . 298 in 323 tapioca . 298 Salt-bags, application of 225 Purgatives 179 Salt-water shower-bath 205 time for administe r- Savine cerate 223 ing . 179 Scarlet fever . . 41 115 Pruriginous diseases of ad- gargle in 116 vanced age 72 symptoms of dan- Purple spots on the skin 79 ger in 115 Putrid sore throat 123 Scarlatina, caution against the Quinsy, domesiic management 122 infection of 41 Raspberry vinegar water 289 precautions in re- Recognition of diseases 38 covery from 41 Religion, consolation of in dis- Scrofula, who most liable to . 153 ease .... 328 hereditary 153 Rennet whey 291 preventive measures in 154 Respirator (note) . 79 causes of 154 Retention of urine 79 domestic treatment of 154 Rheumatism, predisposing causes . 45 of 67 preventives of 46 prevention of 67 Scrofulous swellings of glands 229 exciting causes of 130 domestic manage- use of hot douche ment of 229 in 204 Scalds .... 227 danger of liniments Sea-bathing .... 205 in 131 Secretion, and the diseases of 152 Rhubarb 308 Sedatives, administration of . 185 Rickets 47 Sedative lotion in itchings 313 Rice milk 285 Seidlitz powder, substitute for 313 mucilage of . 284 Self-control in the attendants of jelly 284 the sick-room 104 and apples . . 296 Senna . 308 simple pudding 297 Sensibility, evils of too great . 35 and gravy 300 Serenity, a curative against . 322 soup . 299 Setons . . . . . 223 Rigors 78 Shower-bath, management of 200 Roasting, action of in cookery 279 friction after the 201 Royal-touch in scrofula (note] 153 time for using 201 Rubefacients, definition of . 216 for children 201 application ol Sick-room, furniture of 82 with friction 216 choice of a 81 without friction 216 temperature of the 89 in rheumatism . 217 ventilation of the 86 Running, nature of 29 superintendence ol Saffron, improper in measle s 115 the . 106 Sigc tea . 250 darkening of the . 92 Sago with milk . 281 Sick-headache 57 with lemon juice . . 281 * nurse, her qualifications . 94 mucilage of . 281 Sinamus, Taffurus, died of joy 328 posset . 291 Sinapisms .... 217 352 INDEX. Skin, affections of . - 71 Sleeping during the day some- times useful . . . 321 Sleep, influence of . . 36 quantity necessary in health . . 38,49 more required by young than old . -169 Slippery elm tea . . .291 Small-pox . . . 42, 113 preparation for . 113 to prevent pitting in 43,113 domestic management of 113 Snow-balls of rice . : 296 Soda, chloride of . . . 276 Solution of diacetate of lead . 303 Sophocles was killed by joy . 328 Souchy-water, how to cook . 301 Soups, rice, vermicelli, macaroni 299 Sowans . . . .296 Spine, affections of 64 Spirit of Mindererus . . 208 Spitting of blood . . .133 Spontaneous haemorrhages . 132 Sponging, intention of . .196 discretion in use of 196 as a tonic . .197 times for employing 198 a preventive of rheu- matism . .198 Sprains, management of . 228 Squinting ... .78 St. Vitus' dance . . .142 Stimulants, administration of 184 Stays injurious ... 62 Stewing for the sick-room . 279 Stomach, influence of mind on 324 plates . . . 225 Stuping . . . .210 Sudden disappearance of pain 80 Suicide, tendency to after fevers 326 Sulphur . . . .308 Superintendence of the sick-room 106 Suppurating Ointments . 219 Supper as a meal ... 24 Sugar of Lead . . . 303 Sweetbreads . . .301 Swelled leg, management of . 131 Symptoms of fever in children 112 Syrup of iodide of iron . . 308 Tabes.....~155 Taffurus Sinamus, anecdote of 328 Tamarind whey . . . 292 Tapioca pudding . . . 298 mucilage of . .281 Tapping, bandage necessary in 237 Tartar emetic, its use in fever 219 ointment . . . 219 Tea, as a meal 23 as a stimulant and astrin- gent .... 250 mint, balsam, sage, use of 250 apple, tamarind . . 289 beef, how to make . . 286 chicken, how to make . 286 veal, how to make . . 286 mutton, how to make . 287 lemon-peel, how to make 289 linseed, how to make . 291 marsh-mallow how to make 290 slippery elm . .291 flaxseed . . .291 Teeth decayed . . . 230 Temperature, high . . 16 of sick-room . 89 regulation of . 90 Tepid applications in ophthalmia 121 Tincture of aloes . . . 309 of opium . . 309 Tight lacing, danger of . .62 Toast-water, how to make . 288 Tobacco . . . .274 Tous-le-mois, what its use . 280 Tonics, mental . , .185 in intermittents . 185 Tonic in indigestion . . 312 Tooth powder . . .313 Tripe, how to cook for conva- lescents .... 301 Trunk, bandaging of . . 236 Tubercles, their nature (note) 63 Turnips and carrots mashed . 298 Turtle soup . . . .287 Typhus fever . . .110 Unfavourable symptoms . 77 Unhired attendants of the sick- room . 102 qualifications of 102 intelligence of 102 self-control ne- cessary for 104 Ulceration of the tonsils 123 INDEX. 353 Urticaria .... 45 Vaccination . . 42 Veal-tea, how to make . . 286 Vegetables, digestibility of dif- ferent . . 245 plain boiled . 298 broth . . 285 Ventilation of the sick-room . 86 Vermicelli pudding . . 297 soup . . .299 Vesicating oils . . .218 Vinegar, use of as a fumiga- tion . . . 275 thieves', and aromatic (note) . . .275 as a topical remedy . 311 of cantharides . .311 whey . . .292 distilled . . .311 Volatile medicines, administra- tion of ... 172 Vomiting of blood . 68, 134 Voiding of blood by stool . 134 Walking, nature of .28 Wakefulness ... 49 prevention of . 50 Watchfulness over the in- sane . . . .149 Warts.....230 Warm bath . . .206 plaster . . .212 Washing floor of the sick-room- hurtful . . 84 stand ... 83 Water, an article of diet in health 247 a medicinal . • 249 as a diluent . .182 toast .... 288 barley, simple . . 290 compound . 290 raspberry vinegar . 289 bed . . . .86 bed, caution respecting 86 in the brain . .119 souchy • • .301 cushion . • .194 Weaning, directions for . 168 Whey, rennet, how to make . 291 vinegar and tamarind . 292 white wine . . 292 mustard . . • 292 White-swelled leg . . .131 Whitings, broiled .' . . 302 Wine, bailey . • • 302 in fevers . . .110 mulled . • .302 Worms, treatment of . . 69 Woman, her qualifications to im- part religious consolation . 339 Wounds . . • .229 Zinc, oxide of, ointment, when useful for blisters . . 223 THE END. 30* WOlt-Kf IN THE VARIOUS DEPARTMENTS OP MEDICINE AND SUKGERY: PUBLISHED LEA & BLANCHARD. ANATOMICAL ATLAS, illustrative ■f the Structure of the Human Body ; with Iter Six Hundred Illustrations; the most fcmpleie work of the kind ever issued,— beautifully executed, in One Volume Im- perial Octavo; by II. H. Smith, M.D., un- ftr the supervision of Professor VV. E. Hor- ANATOMY. tology ; 6th edition, much improved. 2 vols 8vo., 1114 pages. WILSON'S Human Anatomy; anew edition (the second) revised, with additions by Dr. Goddard: 207 beautiful cuts. 8vo., 608 pages. WILSON'S Dissector, or Practical and Surgical Anatomy ; with additions by God- HORNER'S Special Anatomy and His- f dard—106 cuts. Royal 12mo., 444 pages. PHYSIOLOGY. CARPENTER'S Human Physiology; j HARRISON on the Nervous System; With notes and additions by Meredith Cly- |8vo.,_292 pages. ner, and over 100cuts—in 8vo., 618 pages. MULLER'S Elements of Physiology DUNGLISON'S Human Physiology ; by Baly, arranged by Bell—8vo., 886 pages. Ihe fifth edition, with numerous additions ROGET'S Outlines of Physiology — Bid 300 cuts—in 2 vols. 8vo., 1304 pages. ; 8vo., 516 pages. PATHOLOGY. ABERCROMBIE on the Brain. Third lition—8vo., 324 pages. ALISON'S Outlines of Pathology. 8vo., !t pages. ANDRAL on the Blood in Disease. 130 Hgrs, 8vo. BELL on the Teeth, with plates—8vo., 150 pages. BERZELIUS on the Kidneys and Urine. ko., 178 pages. BARTLETT on the Fevers of the Inilcd States—8vo., 394 pages. BILLINGS' Principles of Medicine— fco., 304 pages. BRODIE on the Urinary Organs. 8vo., IH pages. BRODIE on the Diseases of the Joints. l*o., 216 pages. CHAPMAN on Thoracic and Abdomi- M Viscera. 8vo., 384 pages. CHAPMAN on Eruptive Fevers, &c. tvo., pages—nearly ready. IIiM'E'S Treatise on the Diseases of the Heart and Great Vessels, with additions by Pennock. 8vo., 572 pages. JONES and TODD on the Diseases of the Ear, edited by Dr. Hays; with numer- ous cuts. 8vo., pages—preparing. LAWRENCE'S Treatise on the Dis- eases of the Eye, with additions by Hays, and numerous cuts. 8vo., 778 pages. PROUT'S Treatise on Stomach and Re- nal Diseases, with coloured plates. 8vo., 466 pages. PHILIP'S Treatise on Protracted Indi gestion. 8vo., 240 pages. RICORD'S Treatise on Venereal Dis- eases. 8vo., 256 pages. WALSHE'S Diagnosis of the Diseases of the Lungs. 12mo., 310 pages. WILSON on the Diseases of the Skin. 8vo., 370 pages. WILLIAMS' Principles and Pathology with additions by Clymer. 8vo., 384 pages WILLIAMS on the Respiratory Organs, I edited by Clymer. 8vo., pages—nearly 'ready. PRACTICE OF MEDICINE. ASH >V ELL on the Diseases of Females, \ CHURCHILL on the Diseases of Fe- V God lard. 1vol. 8vo., pages—near-1 males, including those of Pregnancy and * re.idy. j Childbed; with additions by Huston. 8vo., CONDIE'S Practical Treatise on the )596 pages. Diseaaeaof Children. 1 vol.8vo., 650pagcs. * COATES'PopularModicine. 8vo.5Mpp, JLF.A AND L'LANCHARD'S PI BL1C \T10.\S. DEWEES on lie Diseases of Children. 8th edition; 8vo., £>48 pages. DEWEES on ihe Diseases of Females. S.r . with p'ptes, 532 pages. DUNO'IJSON'S Practice of Medicine.: Second edition, in 2 volumes 8vo., 1322! pages. TWEEDIE'S Librarvof Practical M« dieine. Second edition, revised; in3voli. large tfvo., 2016 p.iges. OCT Any one of the five volumes of thi first edition can be had separate. WATSON on the Principles and Prac- tice ut Physic. 8vo., 920 large pages. SURGERY. COOPER'S (Sir Astley) Treatise on Hernia, with lithographic plates. Imperial Bvo., 428 pages. COOPER (Sir Astley) on the Testis and Thymus Gland, with lithographic plates. Imperial 8vo., pages—nearly ready. COOPER (Sir Astley) on Dislocations and Fractures, with numerous cuts, and a Memoir and Portrait. 8vo., 500 pages. DRUITT'S Modern Surgery. Second edition, with 153 cuts; 8vo., 568 pages. FERGUSSON'S System of Practic* * . Norris, with 246 cut*. 8vo., 630 pa<; Surgery, edited by Norris, with 246 cut! HA RRIS on the Maxillary Sinus. 8vo^ 164 pages. LAWRENCE'S Treatise onRupturi 8vo., 480 pages. MAURY'S Denial Surgery, with n| merous plates and cuts. 8vo., 286 pagnj, ROBERTSON on the Teeth. 8v<% 230 pages. THERAPEUTICS AND MATERIA MEDICA. DUNGLISON'S Therapeutics and Ma- j ELLIS' Medical Formulary, by Mortoi teria Medica; a new work. 2 vols. 8vo., (Seventh edition, Svo., 2u2 pages. 1004 pages. PER EIRA'S Elements of Materia Mei DUNGLISON'S Treatise on New Re- dica and Therapeutics ; edited by Carrol medies. Fifth edition, 8vo., 616 pages. i with 280 cuts. 2 vols. 8vo., 1566 pages.~ ( OBSTETRICS CHURCHILL on the Theory and Prac- j RIGBY'S System of Midwifery, wij rice of Midwifery, by Huston; 116 cuts. J cuts. 8vo., 492 pnyos. 8vo., 520 pages. j RAMSBOTHAM on Parturition, wM DEWEES' System of Midv%ifery, with > figures in lithography, imperial 8vo., 48 dates. Tenth edition, 8vo., 660 pages. s pages. CHEMISTRY, MEDiCaL PHYSICS AND HYGIENE. ARNOTT'S Elements of Physics, with > second edition revised, with additions. 8v»., numerous cuts. One volume bvo., 520 j 161 pages. pages. GRAHAM'S Elementsof Chemistry bj DUNGLISON on Human Health; a J Bridges, with numerous cuts. 8vo.,750pp MEDICAL JURISPRUDENCE AND MEDICAL EDUCATION, CHITTY'S Medical Jurisprudence.— \ TRAILL'S Medical Jurisprudence.- Bvo., 510 pages. \ 8vo., 234 pages. DUNGLISON'S Medical Student; a new edition, large 12mo. DICTIONARIES AND JOURNALS. AMERICAN JOURNAL OF THE MEDICAL SCIENCES; edited by Dr. Laae Hays, published Quarterly at Five Dollars a Year. CYCLOPAEDIA OF PRACTICAL MEDICINE ; comprising Treatises on the nature and treatment of Diseases, includ- ing those of Women and Children, Materia 3ledica, Therapeutics, Medical Jurispru- dence, &c, &c. Edited by Forbes, Twee- die, Conolly and Dunglison. 4 lar^e Su- per-Royal Octavo Volumes. About 300(1 pages in double columns. DUNGLISON'S Medical Dictionary; ;4th edition, containing over 40,000 wotpi ;and synom mes ; birge 6vo., of 772 pag^i ; double cohimus. MEDICAI/NEWS AND LIBRARY. Publi-lied Monthly at One Dollar u Yea* SELECT MEDICAL ESSAYS; l>» Dr.-. Dunglison, Chapman and others.-^ vols, tvo., 1150 pages. Lea fy Blanchard have just issued A NEW AND IMPROVED EDITION OF RAMSBOTHAM'S STANDARD WORK ON PARTURITION. THE PRINCIPLES AND PRACTICE OF OBSTETRIC MEDICINE AND SURGERY, IN REFERENCE TO THE PROCESS OF PARTURITION. Illustrated by one hundred and forty-eight large figures. By FRANCIS II. RAMSBOTHAM, M.D.,etc. A New Edition, from the Enlarged and Revised London Edition. In one large imperial octavo volume, well bound. The present edition of this standard work will be found to contain nume- rous and important improvements on the last. Besides much additional matter, there are several more plates and wood-cuts, and those which were before used have been redrawn. This book has long been known to the profession, by whom it has been most flatteringly received. The publishers take great pleasure in submitting the following testimony to its value from Professor Hodge, of the Pennsylvania University. Philadelphia, August 6th, 1845. Gentlemen:— I have looked over the proofs of Ramsbotham on Human Parturition,— with its important improvements, from the new London edition. This Work needs no commendation from me, receiving, as it does, the unanimous recommendation of the British periodical press, as the standard work on Midwifery; "chaste in language, classical in composition, happy in point of arrangement, and abounding in most interesting illustrations."* To the American public, therefore, it i3 most valuable, — from its intrinsic undoubted excellence, and as being the best authorized exponent of British Midwifery. Its circulation will, I trust, be extensive throughout our country. There is, however, a portion of obstetric science, to which sufficient atten- tion, it appears to me, has not been paid. Through you, I have promised to the public, a work on this subject, and although the continued occupation of my time and thoughts in the duties of a teacher and practitioner have as yet prevented the fulfilment of the promise, the day, I trust, is not distant, when under the hope of being useful, I shall prepare an account of the Me- chanism of Labour, illustrated by suitable engravings, which maybe regarded as an addendum to the standard works of Ramsbotham, and our own Dewees. Very respectfully, yours, HUGH L. HODGE, M.D., Professor of Obstetrics, 8fc. 8fc, in the University of Pennsylvania. Messrs. Lea & Bi.amhakd, " This new edition of Dr. Kaiiisbolhatn's work forms one of the most complete and thoroughly useful treatises on .Midwifery with which we are ac- quainted. It is not a mere reprint of the first edition ; the entire work has undergone a careful revision, with additions. We have already given spe- " Northern Journal of Medicine, July, 1845. Ramsbotham on Parturition. cimens of the work sufficient to justify our hearty recommendation of it as one of the best guides that the student or young practitioner can follow." — British and Foreign Medical Revieic, January, 1S45. "It is intended expressly for students and junior practitioners in Midwifery; it is therefore, as it ought to be, elementary, and will not, consequently, ad- mit of an elaborate and extended review. Our chief object now is to state our decided opinion, that this work is by far the best that has appeared in this country, for those who seek practical information upon Midwifery, conveyed in a clear and concise style. The Milne of the work, too, is strongly enhanced by the numerous and beautiful drawings, by Bagsr, which are in the first style of excellence. Every point of practical importance is illustrated, that requires the aid of the engraver to fix it upon the mind, and to render it clear to the comprehension of the student." — London Medical Gazette. u We feel much pleasure in recommending to the notice of the profession one of the cheapest and most elegant productions of the medical press of the present day. The text is written in a clear, concise, and simple style. We offer our most sincere wishes that the undertaking may enjoy all the success which it so well merits." — Dublin Medical Press. " It is the book on Midwifery for students : clear, but not too minute in its details, and sound in its practical instructions. It is so completely illustrated by plates (admirably chosen and executed) that the student must be stupid indeed who does not understand the details of this branch of the science, so far at least as description can make them intelligible."—Dublin Journal of Medical Science. "We strongly recommend the work of Dr. Ramsbotham to all our obste- trical readers, especially to those who are entering upon practice. It is not eiily one of the cheapest, but one of the most beautiful works in Midwifery." — British and Foreign Medical lleckw. " This is one of the most beautiful works which has lately issued from the medical press; and is alike creditable to the talents of the Author and the enterprise of the publisher. It is a jrood and thoroughly practical treatise; the different subjects are laid down in a clear and perspicuous form, and whatever is of importance is illustrated by first rate engravings. A remark- able-feature of this work, which ought to be mentioned, is its extraordinary cheapness. As a work conveying good, sound, practical precepts, and clearly demonstrating the doctrines of obstetrical science, we can confidently recommend it either to the student or practitioner." — Edinburgh Journal of Medical Science. " Dr. Ramsbotham has treated the subject in a manner worthy of the reputation he possesses, and Ims succeeded in forming a book of reference for practitioners, and a solid and easy guide for students. Looking at the contents of the volume, and its remarkably low price, we have no hesitation in saying that it has no parallel in the history of publishiug."— Provincial Medical and Surgical Journal. "We most earnestly recommend this work to the student who wishes to acquire knowledge, and to the practitioner who wishes to refresh his memory, as a most faithful picture of practical Midwifery ; and we can with justice •ay, that altogether it is one of the be9t books we have read on the subject of obstetrical medicine and surgery." — Mrdiro-Chirttrgical Rcvieio. ANEW MEDICAL DICTIONARY. In one volume, large 12mo., now ready, at a low price. A DICTIONARY 0 OF TEEMS USED IN MEDICINE AND THE COLLATERAL SCIENCES; BY RICHARD D. HOBLYN, A.M., OXON. FIRST AMERICAN, FROM THE SECOND LONDON EDITION REVISED, WITH NUMEROUS ADDITIONS, BY ISAAC HAYS, M.D., EDITOR OF THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES. OPINIONS OF THE PRESS. " We hardly remember to have seen so much valuable matter condensed into such a small compass as this little volume presents. The first edition was published in 1635, and the present inay be said to be almost rewritten, introducing the most recent terms on each subject. The Etymology, Greek, Latin, &c, is carefully attended to, and the explanations aro clear and precise; " We cannot too strongly recommend this small and cheap volume to the library of every stu- dent and every practitioner."—Medico- Chirurgical Review. " We gave a very favourable account of this little book on its first appearance, and we have only to repeat the praise with increased emphasis. It is, for its size, decidedly the best book of the kind, and ought to be in the possession of every student. Its plan is sufficiently comprehensive. and it contains an immense mass of necessary information in a very small compass."—British and Foreign Medical Review. "A work much wanted, and very ably executed."— London Medical Journal, "This compendious volume is well adapted for the use of students. It contains ft complete jloBsary of the terms used in medicine,—not only those in common use, but also the more recent and less familiar names introduced by modern writers. The introduction of tabular riewi of different subjects is at once comprehensive and satisfactory."—Medical Gazette. " Concise and ingenious."—Johnson's Medico-Chirur. Journal. " It is a very learned, pains-taking, complete, and useful work,—a Dictionary absolutely neces- sary in a medical library."—Spectator. CIIEMISTKY FOR STIDKMX Lea Sf Blanchard have just published ELEMENTARY CHEMISTRY, THEORETICAL AND PRACTICAL, Br GEORGE FOWNES, Ph. D., Chemical Lecturer in the Middlesex Hospital Medical School, &c, &c. With numerous Illustrations. Edited, with Additions, Br ROBERT BRIDGES, M.D., Professor of General and Pharmaceutical Chemistry in the Philadelphia College of Pharmacy, &r.., &c. In one large i2mo. vol., sheep or extra cloth. This is one of the cheapest volumes on Chemistry yet presented to the profession. The character of the work is such as should recommend it to all colleges in want of a text book as an introduction to the large and more ud- vanced systems, such as Graham's and others. The great advantage which tpossesses over all the other elementary works on the same subject now before the public, is the perfect manner in which it is brought up to the day on every point, embracing all the latest investigations and discoveries of im- portance. It forms a royal 12mo. volume ol'4(i0 large pages, on small type, embellished with over one hundred and sixty wood engravings. Extracts from a letter from Vmfissor Millington, of William and Mary ('•ollnjr, Va. " I have perused the book with much pleasure and find it a most admirable work, and, to my mind, such a one us is jnst now much needed in Schools and Colleges." "All the books I have met with on chemistry are either loo puerile or too erudite, and I confess Dr. Fowuo's book seems to be the happiest medium I have seen, and admirably suited to fill up the hiatus." Extract from a letter from Professor W. E. A. Aikin, of the University of Maryland. "The first cursory examination left me prepossessed in its favor, and a subsequent more careful review has confirmed these first impressions. I shall certainly recommend it to my classes, and feel sure that they will profit by using it during the session of lectures." " As a judicious compendium, I think Fowne's Chemistry cannot fail to be highly useful to the class of readers for whom it was designated." " Mr. Fownes' work, although consisting of only a single thick l'imo. volume, includes a notice of almost every brunch of the subject, nothing of any impoitance being omitted, and appears to us extremely well adapted us a text book for the pupil attending a course of lectures on chemistry. Indeed, we have no doubt that it will ultimately become the medical student's favorite manual." — Dublin Medical Press. " Having examined it with some attention, we feel qualified to recommend it to our younger readers as an admirable exposition of the present state of chemical science, simply and clearly written, and displaying a thorough practical knowledge of its details, as well as a profound acquaintance with its principles." — British and Foreign Mulicnl Review. "Numerous andusefulas are the works extanton the science of Chemistry, we are nevertheless prepared to admit that the author of this publication has made a valuable addition to them by offering the student and those in geneni whodesireto obtain information,an accurate compendiumof the state of che- mical science; which is, moreover, well illustrated by appropriate and neatly executed wood engravings. * * After what we have stated of this work, our readers will not be surprised that it has our hearty commendation, and that, in our opinion, it is calculated, and at a trifling expense, to spread the doctrines of the intricate science which it so clearly explains." — M/dtro- Chirurgical lircuu: ^T * IT ' K 4XS W^ s ^ NOI1VN 9NI3I01W JO ABVBiM IVNOIIVN IN I3I01W 10 *»»»«M'*jlOll*N !► ICINE NATIONAL LIBRARY OF MEDICINE N A T I O N A I I I B R A R Y O F M E D I C I N E Ni m 7! ^V /vn ' ? V.# MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE N MEOICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE K I3IQ1W JO ABVBBM IVNOIIVN 'iJcS * VNOI1VN IN I 3 10 1W JO ABVBBI1 IVNOUVN IN ID 10 IN JO UVIII1 IVNOIIVN t^m, I jp * MEDICINE N AT ION AL LI BR ARY OF ME Dl C I N E N A T I O N A I I I B R A R Y O F M E D I C I N E i v VNOILVN 3NI3IQ3W JO ABVBBII IVNOIIVN 3NI3IQ3W JO ABVBBII IVNOIIVN CINE NATIONAL LIBRA! MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE ^1X^ i ^^S^ VNOI1VN 3NI3I03W JO ABVBBII IVNOIIVN 3NI3IQ3W JO ABVBBII IVNOIIVN NATIONAL LIBRARY OF MEDICINE NLM Dll^flOM b NLM011938046