[For the Sunday Morning Atlas.] HINTS TO PHYSICIANS.- Gravity and mystery are the certain indications of medical skill. Gravity is to a physician what gold leaf is to a base counter; a cheap covering often sets out a thing of trifling value. Never smile, or smile like Cassius. Stupidity maybe concealed and dullness maybe pardoned, though apparent; but mirth in a physician is misprison of levity. Worth makes the man- the coat makes the doctor. A new suit of black is indispensable. Leave colors to quacks and apothecaries. If your only black coat is rusty, however, you may wear a blue one. You will be ruined in either case. Be impudent. Never use the words ‘I don’t know,’ shot your discourse with Latin, especially in speaking to ignorant persons. Take men’s understandings by storm. A penny is denied to the prayers of a beggar; but a purse is rarely refused to the pistol of a highway man. Talk in King Cambysess’ vein. Travel for seven years, and let it be understood that you are gone to complete your studies in Paris. When you come back and find that no patient has enquired for you, you will have the satisfaction to reflect that you have lost nothing by your absence! Get notoriety. Manage to be called as a witness before a coroner’s jury. Figure in print. Publish a pamphlet on some prevailing disease. You cannot layout your money to more advantage. Wise men will have little to do with you-luckily, they are but few. It is by the great majority of fools that you must live. Mystify them- Omne ignotum pro magnifico est. Mankind always venerate what they do not understand. Never give a patient a comprehensible answer, or commit yourself by an explanation to anyone. Put few questions to tire sick. Surely you know better what ails him than he does himself. To his friends and relatives you are not bound to give answers gratis. Be not an ominous dyagnosticator. An unlucky shake of the head may frighten a patient to death, and you will certainly gain the ill will of his friends by any intimation of danger, if indeed, you do not lose their confidence. This rule does not hold good, however, where the patient is a rich miser or the old husband of a young wife. After his recovery you may safely and profitably talk of the perils, he has escaped. Flatter your patient and his friends, no matter how desperate the case may be, and you will be sure of their good will and opinion. All people love to be flattered, and you cannot raise or sustain the spirits of the sick with a yard-long visage. The confidence of a patient in his physician works more miracles than the whole Materia Medica. It is no matter how dear you are to the rich, so that you are but merciful to the poor. Every M.D ought to be a gentle man and every gentle man ought to be a Christian; the best evidence of which is best published by constant attendance at some fashionable church. The other tricks of the trade to obtain notoriety are well-nigh worn out; still you may assume a practice though you have it not. Be not familiar with your patients. Physicians should have no familiars. They should measurably follow the example of the Grand Lama. A prophet hath no honor in his own country, and familiarity proverbially breeds contempt. Skill is not a sine qua non; but without manners, all the knowledge of Dupuyuen and Abernethy will do you no good. Never mind what you do; but take heed what you say. Actions are nothing—words, everything. The public always give manners the credit of mind; and if you can talk well on other subjects, it will be supposed that you understand your profession equally well. The extent of your skill will be estimated by the way in which you enter an apartment, and, if you cannot carry the drawing room, you may as well despair of the sick chamber Suavity includes the cardinal virtues of a Doctor. Do what good you can; but look for no gratitude in return. Make up your mind early to encounter detraction, caprice, officiousness of strangers, jealously of apothecaries, unreasonableness at all hands and annoyance of every kind. Above all, never violate the sanctuary of private life or professional confidence in word or thought. Humanity lies bare, helpless and bleeding before you, and you are a villain and a savage if you abuse your power. If you publish what you should but relieve, you are a traitor, unworthy of the name of a physician, and it is to be hoped that there are few like you in existence. There have been such, however, and whenever they are discovered any honest man will sooner approach the leprosy or take a seven years itch into his house than them. Notes From E. Ives’ Lectures Proff Mat. Med. Bolt & Dis of Child Taken in 1825 The influence of medicine consists rather in con trolling the irregular movements, than in repairing the markd alterations of structure in the animal ma chine (Armstrong) Notes of Lectures &c Materia Medica is that part of med ical science which treats of the natures & relations of medicines in the cure of diseases. Thearputies are particularly connected w ith branch of science Botany & Natural History are also conn ected with Mat. Med. Nat. History is capable to a certain extent of affor ding virtues of plants. Those belonging to the same classes & orders have many of the same prop erties. Relations also exist between sensible properties of plants by which we may determine their virtues with some acuracy. Some au thors have taught that an analogy in the Med. virtues existed in those plants which have a sim ilar action on the nerves of the stomach. To the savage who select their remedies on this pr inciple we are indebted for several useful med icines. 2 Lineas taught that plants of the same or simil colors had similar properties. The sciences of Pharmacy is particularly conn ected with Mat. Med. Doct Rush remarkd that young practitioners should be their own apoth ecaries & that good Apothecary would be a good physician. Some rules for collecting & preserving plants m ay be observed here. Wild plants contain more virtues than cultivated. The latter being mo re succulent & nourishing. The properties of every article depends on some of its proximate pr inciples. Every plant plant is to be consider ed as a compound of constituents which act in combination in producing their specific ef fects or separately. The two great divisions in the science h as been Mat. Med. And Mat. alimentaria on a due ballence of the laws animal life health consists. The articles of the Mat. Med. act on the system by increasing or diminishi ng or in some way altering one or more of these actions. The increase of any one of the function of the body necessarily implies the deminish[e]d action 3 some other. To this principle belongs the laws of revulsion. In all prescriptions a particu -lar regard should behad to the relative state of the functions; without which everyone must be ineffectual. To obtain the proximate principles of vegeta -bles, the action of heat & chemic agents are requird The degree of heat must be limited. Some of the pro -ximate principles are obtained by mechanical means as expression + transudation. Proxim principles are also obtained by fermentation. Gum is the most ab -undant of all the proxim principles of vegeta -bles. It is highly nutricious. Resin is usual -ly found in combination with gum sometimes pure. This is insoluble in water & does not combine with oxygen hence us[e]d for varnish. In those where gums & resins are combind we have active articles. Alcohol the proper sol -vent of resins. Extractive matter soluble both in Alcohol & water this is decomposd by exposure to air or heat oil, a proximate principle & not soluble in al -cohol or water 2 kinds expresssd & volatile vol oils contain more hydrogen & less carbon than 4 the fixd. Balsam is a combination of oil and resin. They contain a peculiar acid vir Benzoic soluble in a small degree in water. The odor arrises from the essential oil camph a proximate principle sparingly soluble in water quite so in Alcohol. Contains a peculiar vol oil. A finer kind of camph is found in a tree calld the drobellanops camphor wax when melted unites which fixd oils... Fecula or farina the most nutricious of all the prox mt principles. It is extracted from the seeds or roots by grinding or macera -tion. It is insoluble in cold & soluble in warm water from which it can not be separated insoluble in Alcohol. Albumen. This is capable of pulnfaction yi -elding amonia in abundance. A solution of Albumen in cold water concretes by heat sacharin matter soluble in all kind of fluids particularly calculated for the nourishment of the young. By the action of acids on sugar it is converted to an acid Acids- seven different kinds have a vegetable origin. The tartaric is found in the Rus & juice of grape. The gallic combine with genatlin forms an insoluble precipitate signeous fiber. Us[e]d only as carbon in medicine. The other principles are Aroma Acrid coloring & narcotic... 5 Classification the classificat -ion of Mat. Med. must be imperfect from the imperfect of state of our knowledge. “Medicines operate by stimulating the liv -ing fiber”. Each article has its peculiar specific action i.c. Its exciting power is determi -nd to one part more than another. Doct Murray classd his Mat. Med. according to Brown theory of fever. This how -ever has been considerd imperfect & rejected. Some articles act on the system by in creasing the susceptibility to the action of oth -er articles. I think no article has entirely a specific op eration: all medicine operating in some mea sure according to the state of the system. Great confusion has existed in regard to the use of the term stimulants all those articles which produce on the living fiber a greater ac -tion an action different in kind, or which produce any action at all are stimulants. I think the word remedy is more appropriate 6 Table of Classicfication A General Remedies Diffusith Narcotics Antispasmodics Permanent Tonics Astringents B Local Remedies Emetics Diurotics Siallagogues Cathartics Dirarphoretics Errhines Emenogogues Expertorants Epispastics C Chemical Remedies Escarotics. Antacids. Lethoutriptics Refrigerants D Mechanical Remedies Diluents Demulcents Emolients Anthelmintics The first division are those which act on the system general without any local determin -ation The 2d those which affect particular organs Narcotics The first division act primarily on the nirves of the system increasing both the pow -ers of the mind & body when administ -ered in moderate doses but when given in large doses they prostrate the powers of the system beyond the power of reaction. 7 these are the general effects yet every narcotic has an action peculiar to itself. Some of these articles spend their action more particularly on the circulation. Others on the nerves of the brain Alcohol It is a question whether this should be cl -assd with incitants or narcotics: Its powr being spent as much on the nervous as on the circulating system. It is said this article operates by stimulating the system and that followd by proportionable debility, but this is not correct language. In those cases of di minishd action, as the cold stage of fevers sti mulants act without being followd by pro 8 portional debility. Debility will not follow the use of alcohol when the excitement of the system is below the healthy standard. The older the better loofing by age the “fogo” or empyrumatic oil. The first eff -ect of alcohol is to diminish the sensibility of the system, tending to produce sleep this I explain by its determination of action to the head & blunting the nervous sensibility- that determination to the brain produces sleep we know from the symptoms of apoplexy & other diseases of that kind producing sleep of the m -ost perfect kind. When alcohol is usd in the commencem -ent of fevers it will produce the developm -ent of disease. The common characters of the fever then the alcohol may be witheld and the febrile symptoms attend to . . ... query. What is gaind by that. S. B When from any cause the energy of the stomach has been exhausted & irritable state has suc -ceded Alcohol will act on the stomach when nothing else will. In typhus fever when the symptoms indi cate a change as though the disease had spent itself I have given wine with much 9 advantage of the wines the red contain the most astringency Port Catalonia and Claret. The sapor of alcohol has a salutary effect on the lungs when inhald in the latter stooges of the diseases of those organs. A small quantity of spirits combin[e]d with bitters aloes & c has a favorable effect to prevent the development of worms Porter sometimes succeeds when Alcohol will not suit the stomach. It is one of the best art -itcles to obviate the emaciation of females in n -ursing Current wine contains too much unfer mented saccharine matter the same m -ay be said of metheglin Atropa Beladona night shade The virtues of this somuch resemble strane that I have us[e]d it in similar indications Its effects when given in considerable doses are something like scarlet-fever hence the Germans have given it to displace that disease. Recommended ink rigidity of os.nt. applied in oint. 10 Hyosyamus Niger (Henbane) This grows spontaneous on the seash -ore. It resembles opm. in its action more than any other Narcotic It produces soporific effects when opm will not hence its use in idio syncraces, not constipating. In Col. Piet I have found it a good remedy. In dysentary relieves tenesmus better than open. Dose tinct. Sat. tea to table spoonful. It is said to have specific effects on diseases of the pelvis. I have usd this in crofulous aff -ections and all the obstructions of the lymphatic system. Aconitum Neomontanum (Woolfs Bane) Monks Hood This has a pungent taste & smell this is indicated in Chronic Rheum sometimes cures cases which have for a long time resisted other remedies. The acrid narcotics have peculiar effect in removing chron. affec. Instances are related of its efficacy in Gout 2 grs ext subd into powel with Zu of sugar begin with 10 grs of the mixture of 2 or 3 times a day. Tinct dried leaves 6 times their weight of Alcohol Dose 40 qtr Digitalis Purpurea When the vessels have their action increas[e]d by irritability this will moderate, but if no irritation exists the pulse is quickened by its action. It also increases that action of the absorbents & operates as a diuretic. It has been recommended in inflamatory aff -ections but improperly. 11 Ether This resemble Alcohol in its chemical pro perteis except that it contains more hydrogen The stimulus of ether is not followd by debil -ity like Alcohol. It has been called an an -odyne it equalized exetement by determining to the surface. It is useful for certain chronic coughs It is an expectorant combind with mucilage or amonia. Hoffmans Anodye Liquor is Ether sulph ʒi Alcohol…. ʒii It determines to the surface in typhus fevers & obviates local determin[e]d action It qualifies wine & Alcohol rendering them more diffusible as Aromatics qualifies tonics Doct Rush remarkd that he never sufferd a patient to die with Typhus fever without giving a teaspoonful of Ether every 1/2 hour. It has been usd in strangulated Hernia But I rather depend on injections of warm w- ater of catnip tea. Ether has been usd with much advantage in local affections of the stomach combind with Huxhams tinct. Rx vit. Ether ℥iip Hux Tinct ℥i teaspoonful 3 or 4 times a day. In chronic affections of the kidneys & liver in doses of 15 drops 12 In pulmonary consumption it makes easy the transit by promoting expectoration inhale the vapor. The virtues of paregoric as an expectorant & diarphoretic is increasd by the addition of Ether. It has been usd for worms give zi of Ether in decoction of fern follow by cast. ol. Conium Maculation Hemlock see p 160 This has been incorrectly named cicuta should be gatherd when the plant begins to flowr. The ext made by boiling is good for nothing that which grows in the sun is strongest. and it is best gathered in dry weather the root is strongest part of the plant Doct Storh rubed the milk of the root on his tongue soon become stiff painful & swollen & he lost the powers of speech But by keep ing the tongue moist with lem. juice the symptoms disapp -eard The pain of cancers is much allayd by this . The patient must be kept under the influence in a state of sub intoxication Aplied in poultice on irritable ill condition ulcers usd in enlargement of the OS.Jinc. with pain in the back and loins with much advantage. In obstinate ulcers of the legs Mortification of the toes should be tried when other things fail. I give it in obstructions of the liver & other viscera Prunus Laurocerassus Cherry tree laurel valuable in whooping cough In some dyspeptic cases as the arti cle is swallowed the pain ceased It has been us[e]d with ad vantage in some forms of consumption (worthy of trial) 13 Nitric Ether This diluted with Alcohol formed the sweet spirits of Nitre. The diarphoretic effects of this article is in creasd by the addition of opium Spir Nit Dule. Vin Ant. Elix Paregor. Forms a good expector -ant & diraphorete Acetous Ether This may be combind with Amonia and applied to indolent tumors Muriatic Ether Good in all affections of the skin: As a substitute I have used Alcohol & Muriatic Acid ℥i to ʒi dose from 5 to 20 drops in an ounce of water This is particularly useful when the disease depends on scrofula & laxaty of habit 14 Camphor This is a proximate principle & chief ly found in 2 vegetables natives of the East Indies. Camph. May be made soluble in water by first disolving in sulph Acid. Deleterious to all insects It has been a contested point whether camph is a stimulant or sedative. Doct Alex ander said that camph had no medical properties but his experiments convinced him to the contrary. He took a large dose which like to have killed him. Its action resembles that of Aramatics and narcotics combind. Camph may affect the venereal ap petite when it depends on morbid irritabil -ity. It has but little action on the blood vessels: perhaps it makes the pulse a little fuller & slower. Doct Cullen relates a case when 40 grs were given when a pr ostration of all the powers followd. It was given for Mania but without effect In moderate doses it excites the secretions producing perspiration 15 I am inclind to think it has a peculiar action on the fauces hence its use in chynance & malignant fevers. It has been called a speci cfic in the pustules of small pox given in do ses of from 5 to 20 grs useful in catarrhal fevers & catarrh without fever usd in chronic cough following measles. It is in dispens able in the treatment of Colica pictorum. In the worst forms I have usd it to advantage. I have no doubt but this disease may ar -ise from other causes than lead. Every vir -tue of camp. is calculated obviate all the deleterious properties of lead. It may be given injections & applied to the bowels with E -ther & opium in Hysteria. In Typhus Doct Cullen usd camph. when accompanied with mania. Camph. has been a paliative in the dis -eases which has prevailed with us since 1805 The character of this disease has been typhoid with a determination to the viscera. It may be called the syphoid Intestinal state of fever accompanied with Tympanitis. Whenever this determination has been to the lungs or brain death has speedily followed. Camph. is an old remedy for general & topical inflamation with nitre especially that kind of chronic inflam ation of the stomach & liver of old people. 16 Camph. is a valuable remedy for all diseases within the pelvis if not accompanied with to[o] much action. Puerperal fever Local pains in the head back & limbs have been successfully treaty by camph except such as are gouty. In difficult & painful menstruation camph. powd. with loaf sug ar and Magnesia (10 gr doses) has acted like a charm sometimes the habit is too full & requires bleed -ing. Camph. may be usd with success in mania usd in large doses so as to produce epilepsey 2 or 3 ʒs most indicated in those cases accompanied with pale face & want of febrile action. A powerful remedy in strangury. And a useful paliative in affections of the pros trate gland I have usd it success -fully in ascarided obviating irritability and destroying the worms Camph ʒi Milk ʒs Water ʒiii Dissolve & add the water… Camph ʒi Milk ʒsi Camph. Lin. soft soap ʒi Mix Camph usd to advantage in ulceration with ossified arteries given internally and applied in a past to the part relieving the pain & obstructing ulceration 17 18 Opium In obtaining the juice of this article the incisions should be made only half way through the capsules when a greater quantity of juice may be obtained: perhaps on the principle of half divided arteries The incisions may be repeated after 2 or 3 days. The extract made by boiling the capsules forms a weaker kind of opium less constipating & less stimulant Opium consists of Gm. & resin about 1/4 is a matter not soluble in Alcohol. Wine dissolves it. Sydenham usd it in the following manner Pm. Cpm ℥ii cinnam ℥i Saffron ℥i Cloves ℥i Wine [?i] A solution of opm in Nit Acid has been us[e]d. It is represented to excite perspiration & the secretions profusely hen -ce it has been recommended in dysen -tary. The effects of opm. may be arra -ngd under two heads. First its relat -ion to the system in health. Second in reference to diseases. 19 As sleep is under certain circumstances producd by opm. it may be well to consid er the state of the system inducing sleep When the action of the system is much increasd sleep is prevented So when m uch diminishd, if the action is above the sleeping point sleep will be [illegible] by abstracting stimuted . If be low by adding notwithstanding the di fference of opinion respecting the operation of opm. I am confident that its action is si multaneous on the nerves & flood vessels. As to its use in intermittents, I think it is admissible only in the cold stage. In that kind in which the paroxisms are usherd in with a cough. This I consider as a fever of irritation where opium is the only remedy. Intermittents coming from the north & west are more easily broken up than those coming from the south. In intermittents assuming a Typhus form opm. should be combind with bark camph & serpentaria. Opm sometimes has a peculiar effect on the skin producing itching & eruption. Ant. Ipecac. & Neut. Salts Qualifies the eff ect of opm. It has proved fatal to old per sons subject to chronic cough & expectoration 20 In influenza & catarrhal fever it is inval ual. Sometimes preceding the use of it with an emetic or venesection following Elix As mat. ℥i Vin Ant. ℥i Rad. Glye ℥ii Bran. Tia lbi dose 1/2 pill 3 or 4 times a day In the above prescription a less quantity of opm has to specific effect thany any other form I have sometimes added a small quanti -ty of Acct of Lead: Lead combind wi th camph or opm has its colic effects on the bowels. A good preparation is us[e]d called enegh pill Gm. Amon " Opm a a ℥i Soap ℥ss ol of Anise g.s Pill Opm is good remedy in superlative infla mation. An important medicine in chron. Rheum atism sciatica following Pulv gm gu ac ʒi “ gm. Opm ʒss “ Ipecac ʒii “ gm. Camph ʒi “ Cal. [????] Divide into 20 powds. Give one every 4 or 8 hours Apply a blister to the part affected & keep the patient bed to perspire. This may be used in disease of hip joint. In recent cases I have cupt & scarified the part ap plied a blister cover[e]d the part in wooln clothes rung out in a decoction of cedar tops & ginger 21 When the disease has been considerably advancd I have added muriate of Lime valuable in Diarrhea Rad Rhei Ipecac aa ʒii Gm opm ʒi Mix & Make 60 Pills Grat evening give an enema of starch & laudanum then give Cal 7 grs, Ipecac 2 grs the pa tient usually will rest all night. Those constitutions which cannot receive opm in any other way can use it by injections. Chron. Diarrhea may be treated with opm Cal & Ipecac & astringents. In tetanus opm. must be given till it offe nds the stomach or allays the symptoms Col. Pictonum must be treated with opm camph & ol. May be usd in measles to allay cough & the irritation of the acrid secretions. In passive [hem??] an indis pensable remedy. In those cases of Hys teria which arise from excessive mobility of the nerves & such as are connected with mental affections. Opm. may be used with Ipecac & Antimony in Spasm. Asthma. In painful menstruation sometimes requir[e]d in large quantities. In Palpitation when the case is in the Prim. vie or irritability. Gonorrhea when suddenly checkd may be relieved by injections of starch & Landam into the rectum Samation Bilious cholier when not accompanied with inf- 22 Periodical headache may be relievd in the commencement by a full dose of opm in a cup of tea. This disease probably is amodification of intermittent. Fowlers solution the most to be depended on Chron. Inflamation of the eyes. drop of laud. In retrocedent gout. In parturition opm will change the character of the pains in the forming stage of fever opm. is a pow -erful prophylactic. I consider this as an important principle in medicine. It is evident that fevers are preceded by a pros tration of the powers of the system which may be obviated by the use of opm. In those cases of violent attacks of disease so violent that the system seems incaple of reaction opm is invaluable. In delirium tremens in large doses, I have sometimes usd canths. In this disease In cancerous & venereal ulcers we depend much on opm. 23 Nicotianum Tobacum In small doses this increases the action of the blood vessels in large doses it diminishes. It is said to act as a sedative more by the smoke than any other way. Tobacco has been successf ully usd in dropsy zi to pint of Bol. Wat. add zii of Alcohol give 15 qtr. mixture the effect in this way is diuretic - very obstinct cases have been removd. It has succeeded in hydrothorax given in this way. The use of tobacco suggests to us a principle in the animal economy vie that artificial appetites are stronger than natural ones. Disagreeable impressions often repeated form those hab -its which have the most powers over us. Hence we should chose that which is useful that it may become agreeable by habit. Doctor Baston recommends the applicat ion of the leaves for destruction of worms. It has been usd in Rheum. applied to the part. I think it may be usd advantage in tetanus dose zi of infusing. Humulus Lupulus (Hop) The sat. Tinct forms an anodyne of some value sometimes produce sleep when opm fails The polen possesses the most of the principle may be given to the extent of zii in 24 hours . This acts on the nerves without producing debility. Lactuca Sativa (Lettuce) I have usd this for 211 grs in encysted dropsy visceral obstructions & diseases of female pelvis very useful anodyne & diaphoretic in cases of nervous irritability & agitations of female... 24 Datura Stramonium This article acts more particular -ly on the brain & nerves. Like the other na rcotics this should not be given till deplet -ion. This is one of the most powerful articles we possess, such as arise without any evident cause. (in [illegible] pains) Its action resembles som that of digitalis the accumulated affects appearing sometimes un expectedly. I have usd it to obviate the irrit ability of blisters. I have seen no bad effects from the absorption. In epilepsy give till you see the effect in the eyes then stop a day or two & begin again so carefully keeping the system some time un -der the influence of it. I most commonly precede the use of stram. by bleeding. Epileptic patients must be directed both as to quantity & quality of food. Nit Argent may be combind 1/6 or 1/4 gr stram. is part icularly calculated for those cases which occur at regular periods. The dose may be increasd when the paroxism is expected. Morbid appetite is frequently a symptom of this disease hence the necessity of attending to the food the stomach must not be openpd 25 Sium Latifolium (mater parsnip) This probably possesses vir tues similar to conium. It has narcotic properties and deserves some attention. It has been usd in epilepsy Cohush (come away poppoose) This is a narcotic Tonic. Its action something like that of snake root. It was suppos[e]d by the Indians this article accelerated parturition. Prenanthes Alba (canker root) Habit something like the lettuce this given in decoction & used as a gargle in Angina the root res embles ginseng. Reefs Toxicadendron, radicanus, & varnix (Mercury), poison creeper The action of this poison is particularly determin[e]d to the skin. Persons in a state of perspiration are more likely to be affected than if not. It is said that a tea of marsh rosemary prevents the action of this poison. Also a weak p reparation of Cor. Lub. will do it. The soap of amonia will do it, I use that. Melia Azadarach (pride of Inida) This has been used chiefly as a vermifuge. It is a narcotic & has em. & cath. properties dose zi It has been given in doses of 8 grs to allay irritation and promote expectorate consumption. 26 Thea or Tea I agree in classing this article with narcotics 2 kinds black & green. The former the most ast -ringent. The great use of this article must have some influence on the character of our diseases. The constant use of it has a tendency to effemin -ate the system. By distillation an odorous w -ater is procur[e]d which is a powerful narcotic. Tea drinkers are rarely drunkards. Large doses have produced derangement. Tea is useful to equalize excitement & prevent diseases after exposure to cold & fatigue In some cases of diseases action where opm. & other narcotics will have no effect 2 or 3 cups of strong tea will be of service. 27 28 Coffee Arabica Coffee has medical properties acting chi -efly on the nerves. If cold water is taken previous to drinking coffee it proves cathartic. It quiets nervous irritation, relieves nausea & headache in the morning. It obviates fermentation in the stomach facilitates the process of digestion & removes flatulence & cholic It has been charged with producing palsy Doct Percival recommends coffee in Asthma. It counteracts the effects of opium. Females of delicate habit should not use it for it has a tendency to produce Leucorrhoea. It is improper where there is a turgessence of blood vessels. 29 Segale Cornutum spurd bye This article is chiefly useful on ac -count of its peculiar action on the impregnated uterus. In one case of obstructed catame nia gave ergot in considerable quantities It often in small doses produces vomiting I have seen this article produce spasmodic pains of the uterus with facilitating labor. The lendency this has to destroy the life of the child diminishes its value. This has no effect on the uterus when the patient is much exhau sted. Hence the necessity of rousing the action of the system before giving it. It may be giv -en after the birth of the child to prevent flooding should never be given in bad presentation I think much (from considerable experience) of the usefulness of this article under proper restrictions. First it should never be given till the child is in lower strait of the pelvis with natural formation & condition of all the parts. Second it should never be given till it is ju dgd by the pulse or other symptoms the system is about to flagg in its efforts skillfully usd. I think it is almost wholely a substitute for the forceps. SB 30 Stric Nos Nux Vomica The action which this produces transcends ordina ry inflamatory action & produces death by destroying the vitality of the system. I have given it in doses of 2 grs increasing in paralytic cases. When the affect has been good I have found the disease to depend on nervous affection. In the dispepsia of old people depending on paralyses of that organ I have found it answer a good pur pose Idoffs Hufland gave it dysentery ext Ater an emetic dose 2 table spoons taken every 2 hour & Muc. Arab. ℥i As font ℥i Lyr Al Thea ℥i Injections once or twice a day. Spigelia Marilandica pink This is a useful narcotic of considerable power. This produces a determination to the head. It may be given in spasmodic cough resisting the action of other remedies. Its action is similar to Atropa. In moderate doses it relieves pain & irritation & acts as a stimulant on the bl -ood vessels. I have usd it for cough in consumption where there is much benefit Worms Cicuta Macutala (nild len nel) This has been used in doses of 15grs operates as a diuretic. Children poisond with this have violent someting dilitation of the pupils. Cicuta given 4 grs ever 4 hours in a case of scuralgia where there was gonnorrhoea bosh cured give till diriness then give a dose of sal Eps. (BP. Saats Albany 1841) 31 Antispasmodics Some have doubted the property of this class alleging that the articles which belong to it are only narcotics of the milder kinds. Antispasmodics do not like narcotics destroy life be diminishing its powers in consequence of previous excitement. Doct Murray supposes the difference cons -ists in their being more diffusible in their action. Spasm occurs in that state of the system in which ordinary stimuli produces convuls -ive action. The system may be predisposd by original organization or by a series of causes acting on it for a length of time to take on irritative action. Or it may depend on the action of one part of the system being dis proportionate to that of the other. In cases of general irritability exciting spasm the exit ing causes must be carefully avoided and narcotics & tonics be given. In cases of local irritation counter irritation must be usd. When the spasm arises from unequal excite ment the warm bath &C be usd 32 Musk Moschus This is very uncertain as to its quality hence its efficacy has been disputed. The dose from 5 to 60 grs usd in most spas modic affections. In the opinion of Mr Foth ergil the Musk of the Muskrat is not infer ior to the India. Persons having epilepsy have worn the skin on the stomach see Artificial Musk (Article) Amber Castor This article has been long in use & not without merit. This is particularly cal culated for disease nervous action of the uterus. A pile for many years has sup ported its reputation called Mathews pill Opm Safron Castor It obviates the effects of opium on such cons titutions as opm disagrees with Dose from 5 to 15 grs of the substance. It is given in 33 Rad. Valer decoction with valirian Cast fib Boil. Wat 1 pill close the vessel, give two table spoonfuls of every hour till there is some effect, usd in typhus of the mild kind accompan ied with irritation & low delirium. In examing castor that which is good is of a whitish brown color & breaks with a vitreous fracture. Skunk This has been usd in Asthma in doses of 1 drop of the esential oil. It is curious fact that the disagreeable odors combin[e]d with aromatics becomes agreeable –hence this with some active aromatic would be very fine. An asthmatic patient I directed to use 1 drop on sugar & had no attack for several years. 34 Sucinum Amber I have found this article useful in Hys -teria & other spasmodic diseases dose from 5 to 30 drops. Doct Rush said that it is my shut Anchor in spasmodic disease much usd in spasmodic cough. Usd as an external application in local spasm of the muscles. In convulsions appli -ed to the spine. The artificial musk is much used in whooping cough. A girl 15 years old after the measles with a spa -smodic cough the usual remedies were usd without effect. The oxygenated Amb -er was used successfully. 35 Ambergris Nearly allied to the preceding Article Procurd from the whale those which the fishermen call unhealthy contain the most of it. Petroleum or Naptha Under this kcad I mean to include all Bituminous substances. The British ol. belongs to this class of medicine. It has been made by mixing Barbadoes Jar & spir Turp. Harlem ol. Is probably a sulphuretted pet -roleum. The best kind is that which comes from the west called scucka ol. It should not be used where there is much inflamatory action. It has been usd in coughs pain in the breast indolent tumors, swellings of the Jo -ints & c. It has been usd to prevent chill blains equals parts of sen. ol. of & Bees wax forms a good ointment that may be usd on ulcerated surfaces when other rem edies will not do. 36 Sub. Carb. Potash. I have found this a powerful antis pasmodic. It has been found that potash has the power of exciting muscular excitability hence under that impression I have given alternately alkali & stimulants that the stimulants may have a better opportunity of taking effect. This practice I have adopted when the vital powers are nearly exhausted. In cases of spasm arising from nervous irritation in child -ren & females & delicate habits I have usd pearlash injections with the best success. Also in cases of incontinence of urine from paralasys of the neck of the blad -der. Ferula Assafoetida This excites the secretions of the viscera of the abdomen useful in difficult respiration asthma, sympanites nervous toothache, particularly in that kind of 37 epilepsey arising from hysteria dose from hysteria dose from 5 to 15 grs. It is said to have a specifica -tion on the uterus. It is one of our best expectorants in the latter stages of Pulm. consumper Inject it in paralasys, it is usd in whooping cough & said to increase the appet -ite. It is said to cure the heaves. Rubon Galbanum The action of this article resembles the former in its operation except that it is more heating. Saffron Crocus sativus This usd in affections of the skin. It has some narcotic properties –something like the Hop. Said to have some power of rem -oving obstructions occasioning jaundice usd in the juict of Myrr & Aloes Elix Prop. It has mild tonic properties. 38 Valeriana officianlis Chiefly indigenous in Great Britian said to be also in Ohio. A mild nervine if it can be obtaind without having undergone fermentation. Wild valerian (yellow Daisy) Grows in moist meadow Grounds flowering in June & July Decoctn good for spasmodic cough 39 Malaleuca Lacadendron This plant from which the cajeput oil is obtain resembles the smell of walnuts wh en the buds are pulling forth. It is stimu lant antispasmodic & sedative. I have found much benefit from the use of it in tooth ache & sympanitic states of the bowels It may be usd in the latter stages of Dysentery It may be combind with other substances & used for local affections as gout. Rheum. bruises & sprains Leonurus Cardiacca This sometimes calld Motherwort is an antispasmodic of some use in irritable states of the system in which sleep is obtaind with much difficulty- producing sleep when other things fail. 40 Artemesia Abrotanum This possesses the properties of worm wood c ombind with an aromatic principle Been used in cramp in the stomach All artimesia are probably Antispasmod. Ambrosia Elater Bitter weed Usd for after pains. Possesses the proper ties of eupatorium only more. Antispasmodi Allays pain & irregular nervous action after parturition Chenopodium Anthelminticum This has some virtues as an antispasmodic but is chiefly usd for worms Alium Sativum garlic All the garlics possess Antispasmodic properties they have also expectorant & diaphoretic prop erties. External application Given in decoction & symp 41 Pothos Foetida skunk Cabbage This is an antispasm of considerable power given in Hysteria dose a teaspoonful Leaves a good application to edematous Limbs in Puerperal fever and also to chronic Rheum. Incitants This class of remedies possess the properties of stimulating the system without being follow[e]d with proportional debility. Phosphorus This is an action stimulant its affinity for oxygen will not permit it to be given in substance without destroying the stom ach. It has been usd in the form of pho sphoric Ether ziii of Phosphorus added to zi of sulph Ether stand one week then fit for use. Give from 3 to 12 drops in a liquid indicated in low cases of typhus when the excitability is much worn out. In such 42 cases it has sometimes roused the patient in the article of death. Phos. Acid has been usd for the same indication. I have prepard it by exposing phosphorus to the action of the air in a wide mouthd vial. The acid of the strength of elix vit. may be given in doses of 10 to 30 drops every 2 or 3 hours. It is said to increase the appetite for An food Cantharides this Indicated in those low states of fever when the system is much reducd accompanied with insensibility & involuntary action of the sphinctures said to have been given in that state of the system accompanied with ul cerated surfaces secreting unhealthy puss Canth excites a specific action on the Blood vessels & is usuful in all those cases in Which disease exists in those parts more esent ial life than the blood vessels. If translates the excitement of the nerves to the blood vessels and renders the disease more regular. In dropsy attended with debility canth quickens the pulse. In Typhus with a frequent pulse canth renders it slower. When the system 43 Is overchargd. with Canth the stools will be hysteric remedies Mucilage opm & camph. In all cases of low typhus in which I have usd this so as to effect the urinary pa ssages the patient has got well except one. A man of firm habit attackd with violent acute nervous fever high delirium & profuse perspiration Tonics had no effect Camph & Opm usd . Canths then usd 20 grs till his urine was effected when the delirium went off perspiration ceasd & slept quietly omitted the med. nourishing diet given but after 24 hours the symptoms returnd Canth again given with like effect & so repeated till he seem worn out & died. This is particularly calculated to produce Healthy supuration. It acts powerfully on the urinary system obviating impotency and incontinence of urine from weak disease action useful in malignant Angina with torpor of the system. In Gleet & Gonorrhea and ill conditiond ulcers Robertson gave it in the following manner tinct Canth zii aq. com. zi dose 1 table spoonful 3 or 4 times a day. When the disch -arge becomes thickend & opake stop it A good application for chill blains soak lin 2pts tinct Canth 1pt This is an old remedy in palsy where then is no local determination. 44 45 Anthemis Pyrethrum (Pelitory of spain) This is indicated in all those cases of diseasd action in which a want of power is not accompanied with fever. It has silallagogue properties Tinct. ℥ii to tbj of proof spir. Dose from 14 qtr to a teaspoonful 2 or 3 times a day. It may be given those cases of local palsy arising from no evident cause existing in the nerve Tanthan Fraxineum (Driely Ash) This is useful in palsy the Berries have the most virtues The tinct excites perspiration and increased the vital pow -ers generally. It is usd in Rheum & dyspepsia ʒii to ʒj water decoction Though this is a good substitute for the pelitory it is not the same thing one may succeed when the other will not Arum Triphillium Ind. Turnup This is allied to the pothos Foetida 46 Guaiacum This is a useful article in venereal Disease as an incitant when the system has been much reducd by merc. & the disease. Bals Cohair ʒi Spir Nit ℥ii Gm. Guac. ℥i Useful preparation in Gonorrhea The action of this has some analogy to the pe -ppers increasing the action of the kidneys and bowels Doct Dewes recommended this in painful ministration considering the disease a painful Rheumatic affection of that organ. Indicated in those case -s of irritable stomach in which Canth are recommended. 47 Tonics Lineas taught that the action of Tonic is confind to the muscular system It is known also that they act on the cellular substance. It is said that a long co ntinued use of tonics weakens the powers of life It is not so (doubted) the primary action of tonics on the stomach affecting the n -erves & chang the secretion of that organ & Those organs immediately connected with it those articles of the vegetable king dom which possess litter astringent & arom atics properties are in the best tonics. Repeated full doses of tonics renders the pulse fuller & slower. Cold is an ac -tive tonic though a negative quality. Exercise & amusement the most power -ful tonics also the exciting passions. The Depressing having a contrary effect. Tonics act gradually producing excitement & grad ually diminishes excitability (what kind of an idea is that) I have known persons use the wans root for five years without 48 debility following indeed the system gradually growing stronger. The action of tonics is to induce a healthy & vigorous action of the stomach which is extended to the rest of the system. Iron Iron is the most friendly of all metals to the human system operating as a tonic in all its forms. It acts on the stomach producing healthy digestion inducing healt -hy digestion, increasing the secretions of the Abdominal visera and the force of the circ ulation. I have usd it in enlargement of the os -tince like cancer affecting a complete cure It has been usd in dropsy combind with Myrrh mixture Spier. Rit. Dule & squills. The myrrh mixture has been usd in relax'd mucus membranc preceding consum ption of the lungs. I had rather use the filings or the following P An gustura ℥ts Iron filing Dulv. Cubebs aa ℥ii Mix take a tablespoonful 2 or 3 times a day The tinct. Of Mur. Iron a useful preparation for glandular affecting 49 In cases of bleeding from debility the Mu -riate is usd with much advantage It may be combind with Carb. Acid taking it with effervessing draught. Some consti tutions have idiosyncracees forbiding the use of it In Gout where no inflamatory symptoms are present Iron is good. Much recommended in cancers particularly of the uterus. When the disease has been decided -ly cancerous I have found more benefit from the sulph. of Iron. Some pretend that Canc. has an independent life and that Iron is its poison. But I have not found it a specific This is efficacious in affections of the skin usd in salt Rheum. The phosphate has lately been much usd in Obstructed Catamenia given in doses of ʒi 3 times a day. When pure this article cannot be retain[e]d on the stomach in doses of more than 8 or 10 grs. I have found the following useful in those affections where it was prop -er to use Iron. Crm Tart ℥ii Iron. Filings ℥ss Water 1 gall and drink truly for dropsy. See liquor tem alka line of the Lond. Disp. 50 Zincum This deserves to be rankd among the first of Tonics However of zinc mixd with twice the quantity of Lard dry up ulcerations of the skin Sulph. Zinc This article usually contains a little cop[p]eras & iron which do not injure it I have usd it with great success in inter mittent after evacuations. It will not pro duce local congestions like the bark no debility follows the use of this article. May be usd in the form of Mosely & solution 40 drops in Typhus fever when the bark is ind icated Good remedy in irritable stomachs of children from debility. Usd as a tonic in incipient Angina Pectoris As a tonic in local diseases of the stomach Dyspepsia R Sulph. Zinc ʒi Rad Sirp. ʒii Slocs ʒss Cort Angust ʒii Proof Spir lbi Tablespoonful 3 or 4 times a day Doer Mosely usd this article in dysentery 51 when the violence of the disease had subsid -ed and seems to be kept up by habit- taken So as to prove emetic and cath I have given it in small doses with equal effect The [wh?]. vit. in my hands has been use ful in Catarrhal consumption much usd in hem[?] of the lungs. I think however in violent cases the lead should be relied on It is given in all stages of putrid sore thr -oat by the Physicians of this place. Though a good in Chlorosis probably not sup -erior to iron. In a case of Chlorosis a girl 14 years old I gave it with Geraneum Mac ulatum & though the case was thought to be desperate it was curd. I should nev -er give it in substance as an emetic. A sat. Sol. applied to such tumors as appear to be encysted – may be usd as a wash to ill conditiond ulcers. For an opthalm -ic preparation I have usd the whitr. vit. with a decoction of Popy heads with much advant -age I have given it with much adv -antage in that kind of spasmodic cough succeeding whooping cough Recent Gonorrhea Rx vit. alb. 14 gr Gm. Arab. ℥ii Tinct the b. ʒi Aq. Font ℥viii – In [?leet] vit. Alb. 14 gr Cor. Sub. ii gr Aq. Font ʒviii 52 Cuprum This has been given in epilepsy in doses of 1/2 gr increasing. In large doses it prod -uces similar symptoms to lead. In the putd sore throat it has been usd In this place as gargle & taken into the stom -ach Rx sulph. Cap. ℥vii Gm. Kimo. ℥ii Spts. Reet. Lbj dose 20 to 40 drops. I have usd it for sore legs combind with an gustura Bark valuable Castic The above prescription has much usd in passive eet Hemq i For the debility and irregular action which occurs in females at the cessation of the me nses I have used sulph cup 10 gr Cort. August ʒii Bol. Wat lbss use this to wash ulcers in 3 or 4 times a day 53 Arsenicum Author have plac[e]d this article with tonics but I cannot consider it directly so. The effect of this is like that producd by Cal. & Tart. Ant. It has been questiond whether this is taken into the system by the absorbents or whether the action is merely local or upon the nerves - probably both. Preparation boil the arsenic in water ½ an hour then filter dose from 1 to 10 drops Fols. Solul. Sat. Carb. Potass " 4 gr Arsenic. ‘’ " 4 ‘’ Bol. wat. “ 1 pt In those affections of the liver accom panied with yellow or dark skin I have found it useful . In extreme cases of satr Rheum in which other remedies have faild I have suceeded with this, accompanyi ng the use of it with a wash of glaub. Sar. & then use oxigen. Oint. I have contin ued the arsenic for 2 months without pr oducing any ill consequences. In period. Headache & Tic. dol. When cupping &c. has faild this has suceeded. Sometimes evacuations are required first. As a general rule arsenic is useful in painful periodical affections unaccompanied with inflamtion. 54 Bismuth Oxide This is prepard by dissolving the met -al in nitric Acid & precipitating the oxi -d. The article when first usd was over -rated & since probably been too much n -eglected. In those chronic affections of the Stomach without inflamation it may be usd with advantage especially where there is extreme irritability where there is morbid discharges of that organ. In most of those diseases where caps -sicum is indicated canth. & tinct quaic. Muriate of Lime That which is prep form chalk is the best. This does not excite inflamatory action It has been usd in glandular & scrof ulous affections pulm cousump with Lichen island. It might have been considerd among the desbstru 55 Sulph. Acid In cases of dyspepsia when the alkalies h -ave faild this will succeed in correcting a cidity. This is a useful remedy in diabetis 7 parts of water to 1 of sulph Acid the elix vit is 7 parts of arom -atic Tinct to 1 of sulph Acid Doct Munson depends upon in cases of ob -stinate vomiting depending no very evident cause usd in different stages of consumption to obviate the coliquative sweats. Argil Allumine Alum may be usd in Hemorr[?] 5 grs with 14 grs of Nutmeg Aromatics obviates its tendency to vomit. It enters into the composition of tonic solution & is useful in this form to stop obstinate vomiting. Alum is objectionable in Hemoptisis when ac companied with inflamatory action Moseley sol. diluted with tinct poppy heads – inflammatory eggs 56 Caly or Lime This may be usd in those cases of dise asd stomach where stimulants are indi cated preceding the use of them correcti ng acidity & exciting the natuaral sen sebility to. Acetas Plumbi This article increases the appetite when usd in small doses & diminishes the irrit ability of the system Checks secretions partic ularly from the mucus membrane & dimin ishes the action of the blood vessels It may be given in cases of relaxation of mucus membrane. It will not produce col -ic tile this laxity is overcome In some kinds of dirrhoea following fever it has been verry useful. Tinct of Aromatics with lead 2 or 3 grs a day has curd some obstinate coug hs A man exposd to wet & a catarrhal cough succeeded I directed opm & lead 57 which removd the cough. It is not admiss ible in such cases where there is much ar -terial action or symptoms of congestion. A young man subject to epilepsy treated with v.s. & emetics which increased the dif -ficulty Lead was usd and increasd till 16 grs a day was usd which producd colic worst kind. This was treated with Camph & ols a cath. Operated & the fits did not ret -urn Uterine hem & from the bowels very important as injections operating not by comeing in contact with the bleeding surface by a continuous action. A commanding remedy in lut & Hem This is not proper as a local application where there is a tendency to gangrene A very good application to the sore mouth Of women who nurse Acct Lead x 11 grs Catechu ʒii Boli wal lbs Lead has the power of removing irri Tation something like narcotics but on different principles This may be useful in Hemorrhoids Gm opm 15 grs Camph lb Acct lead ʒss Larrd ʒss Mix in most In water brash this is an excelent reme -dy Acct lead ℥ii Sal Mart ℥i Alcohol 16c Dose from 20 to 40 qtr 58 Sarah Heeler AE 12 afflicted with a cough for several months expectoration purulent, night sweats, sometimes bloody sputa strength failing pulse quick the ordinary remedies usd with only pali ative effect lead & Ipecac & opm. usd successfully in pill recoverd rapid S.B. Ives says, a patient female 16 years old scrofulous, symptoms as the above case took lead inproos for a time at length cough returns & dies with Hectic son of wheeler French AE 10 Pneumonia left with a cough profuse expectoration night sweats bloody sputa food distresses him Emaciated , pulse 120 3 months after the attack of pneum commences with Rx Opium 8 [cross out] grs ipecac 10 Acct lead 2i Mix Make 20 pills 3 or 4 a day Recoverd in 3 weeks & went to school 59 Gold This has been usd in the form of Muriate in bad ulcers in the sequel of ven. disease It is as active as cor Sub. more Lo. Muriate of Barytes, This has been recommended in all cases of scrofula & glandular swellings. Inadmissible in inflamatory action dose 5 to 20 qtr exciting the secretion of the stomach & bowels. It has been con siderd as tonic peculiarly calculated to remove obstructions of the lymphatic system 60 Silver This was a favorite remedy with Boerhave he considerd it a hydragogue & used it in dropsy. I have never experienced any ill effects from it & given it in 1/4 gr doses 6 months. In one patient it producd Catharsis & Epilepsy other caths producd the same effects on that patient. I have usd this in all those spasm odic affections resembling epilepsy with much advantage Safe remedy in cases of relaxation of the ventricles of the heart known by full soft pulse debility & peculiarly of speech When an excess of this article has been given com. salt is the Antidote. An old man threatend with Apoplexy has bled took caths & blisterd &c to no effect I consider the symptoms to arise from relaxation congestion of the the veins & sinuses of the head directed the silv. pile which relievd This more particularly indicated where there is enlarge capacity of the venous sys -tem & relaxation 61 Nitric Acid This is not to be relied on as a cure for ven. disease. It is most useful given after the Merc[?] has removd the vir -us leaving a morbid state of the system A patient who had usd Merc[?] in judiciously took Nit Acid ʒi a day dil uted with 2 tb of water. It has been given with opm. when dia rphoresis is indicated acting like the black drop. Usd to oxygenate lard - this is better than cerates because it is already become saturated with oxygen & will not become rancid Muriatic Acid Mild tonic correcting the secretions of the stomach - Scarlet fever & other low forms of fever – where there is no tendency to inflamation. 62 63 Vegetable Tonics This class of medicine produce a new excitement though they do not ordinarily excite the blood vessels or increase the heat I think they do I. B. Pure bitters act more locally on the stom -ach than when combind with aromatics In cases of weak action recently com menced they have a tendency to obviate the morbid excitement especially in the stomach & subsidary glands Chincona Officialis Long decoction diminishes the powers of the bark. Cold infusion is the mildest prep aration & is retaind on the stomach best First wet the bark with brandy then add the water. Where dropsy & jaundice have followd the use of this evacuations probably have not been sufficiently usd Rhei & salts qua lify the action of the bark when a tendency 64 to congestion exists In that kind of in termittent accompanied with cough I have have usd Cal. & opm Intermittent which prevaild in this state 50 years ago were curd by caths Typhus fever. There may be cases in which bark may be given in the commencement rarely the case with us Typhus being m -ore or less accompanied with congestion. In those cases which occur in jails and hospitals the powers of life are prostrated pr -one the first – without any local determin -ation In all the local dererminations of our climate evacuants are necessary with topical applications. Some have given the bark in inflam Rheumatism but I have treated that dis ease with copious bleeding & evacutions A disease resembling rheumatism pain & swelling of the joints but relaxation of the soft parts here Bark may be given. In consumption with profuse sweats & coligative diarrhoea with great relaxation it may be usd Consumption sometim -es exist with great relaxation & weak diseasd action determining to the lungs this requires bark. Erysipelas may be inflamtory or Typhus when Typhus the bark may be usd with 65 serpentaria & vol. Alkali – In dysent -ery if the evacuations are foetid & Typhus symptoms the bark is indicated A patient of Lax fibre attacked with dysentery stools mucus & bloody. Resemble brine strong smell pulse easily compressd great muscu -lar prostration. Some relievd by emetics took 4 grs ext. every 2 hours 1/2 gr of opm every 6 h. with Alkalies & absorbents. In all diseases accompanied with relaxa -tion & debility of the first passages bark very sucessary 66 Angustura Similar states of the system require the use of this as the bark. It is one of the first rem eddies for debility of the stomach arising without any obvious cause. In that state of the stoma -ch peculiar to pregnant females it is almost a sure remedy. I think it more stimulating than the bark. Cert August ʒii Cubebs ʒii Iron filing ʒi Cert August ʒiii Alocs ʒi P. Bac. ʒan. ℥ss Proof. Spir. bj Something like the above recipe has been very useful to that state the stomach peculiar to laboress in the spring of the year It is useful with other remedies in many of the forms of dropsy. Aristolochia Serpentaria This is a stimulating tonic acting on the skin It is particularly adapted to a low state of Typhus such as has prevaild with us since 1805. It is the practice of the southern physicians to give Tart. Em in a decoction of Serp- 67 Debilitating the stomach much lessen this form Torr Peruv ℥ii Orange peel ℥is Serpentaria ℥ii Her safron ℥i Proof spir ℥ii Hux hams. Tinct Serpent. to ludble In pneumonia Typhoides – the irritation of the stomach accompanying this disease is more readily allayd by this than any thing else & so in similar forms of disease Dorstenia Contrayerva this article possess more astringency & some aromatic properties than jespe. but like it in its general qualities determining to the skin the comp. powd has been muchusd ꝶ R contraer ʒx P carb lime lbss usd in dysinta -ria & all fevers where the powers of life are weak Cascarilla This is like the preceding articles except that the aroma principle prevails in this. I have made much use of it in dispesia with Colomb & white vit. the bark of the tulip may be usd for the same indications 68 Colombo This belongs to the genus menuspermum of which there is a species in this country it contains chinconin & starch. Used in all those states of the system requi ring the use of a tonic bitter Gentiana Lutea I think this has a specific action on the liver It has no astringency & very little aroma usd nervous diseases connected with debility of the stomach Stoughton Bitters following Gentian orange peel proof spir flor. Cam Mint bark colord with cochineal Gentian sometimes operates as a laxative this has done well in chron. affictions of the stomach with torpidity of the bowels Gentians of our country have similar properties 69 Anthemis Nobilis In large doses the operated as a cath.- It is given as an emetic and antimetic in all those Billious remittent accompany -ed with affictions of the stomach it will ev -cuate and leave the stomach in a good state. Useful in all those cases attacking Sudden like colera Morbus Anthemis Catulas (May weed) and Chrysanthum Leucanthemum (wild daisy) have similar properties but les pleas -ant Humulus Lupulus (Hop) In certain cases of chron. affiction of stom. & liver this has been us[e]d with great advantage Polen of the plant the best part made into pills Tinct Hops jvi spirits lbss Tucreum Canadensia This possesses some Narcotic properties but the tonic & Aromatic properties prevail. 70 Quassia Excelsia Strong killer jss to a lbj of spirits makes a strong tinct. It combin[e]d with aromatics This is likely to offend the stomach. Indica -ted in all those diseases in which Colomb is usd Quassia Simarouba Dec. Mon Good tonic in cases of weak action of the stomac -h particularly in gestation in females combind with aromatics venicom root Chrysoplenium Opositifolium brook lime Oct vigin A bitter as powerful as quassia. May be usd as a substitute for the Com. officinal bitters Thorough mort Eupatorum Perfoliatum of all the articles the class of tonics this produces the least congestion. Intermittents where the paroxysms doo not terminate in persp iration this may be used. It increases the secretions of the viscera of the abdomen & perspiration Hoar Hound Eupatoram Pilosum similar Properties as the above (Grows in Peet. Ground) 71 Cornus Florida dogwood The properties of this are more like the bark than any other substance Cornees Serica Red willow more astringent & more pleasant but less so than Cornees Seercinata (Moutain willows) the leaves of this are the largest of th Cornees the stem warty & trunk as big as the thumb or wrist much used in diarrhea & latter stages of dysentery & Chol. Infant In that kind of diarrhea contracted in south ern climates Doct E. U.S.N. in Chron. Affictions of stom. & liver with febricula in the afternoon. Tricostema Dicotoma (wild sage) Found in stuble grounds and light soils qualities much like the garden sage ast ringent Aromatic determining the surface Asculus Hypocastanum Horse chesnut This is a strong though unpleasant bitter it has been usd a substitute for P. Bark. 72 Comon Chesnut this has bitter and astringent properties Maple Accr Rubrum A bitter astringent and deserves some attention as a tonic Agrimoneum Eupatorium This appears something like the geum. I think it particularly indicate in delicate habits where visceral obstruction & irritation of the stomach exists In a case of consumption attended with great debility & irritation of the stomach the common bitters could not be retaind & this was usd with advantage Alnus Serulata Black Alder The bark has some re semblance to pale P. Bark. It is a good ton -ic the flowers gatherd in March are good for bitters & beer. Ceonothus Americanus N. Jersey tea The root is astringent it was usd in the revolution Mar for common tea Bitter sweet Celastrus Scandens this has been usd in chron. Affictions of the liver & stom Much usd for beer 73 Cephalanthus Occidentatis (Dwarf Elder) This has been usd for dropsy. It possess -es some virtues it has some bitterness & astringency. Sold in Guilford for all onogue to cure consumption Artemesia Alsynthium worm wood Comon bitter usd sometimes as an anthelmintic Bruises & the oil made into a paste with aloes & ginger & aplied to the bowels for worms good Cardialgd Colinsonia Canadensis Horse balm grows on the sides of Mountains by the road side height 1 or 2 feet leaf as large as the hand, slightly bitter Aromatic & Astringent usd in consumption as tonic. Liquid Amber Asplenifolia sweet fern usd for beer & eruptions drunk freely Decoction supposed to have a specific action on the skin. Beds may be made of the leaves of this for debilitated persons usd for salt Rheum It is pr obably a deobstruent acting on the liver 74 Dirca Palustris Leather Bark The bark is smooth of a Yellow brown color spotted or checked, stro ng & as easily tied as a strip of leather, this has the power of producing vessication on the skin. One of the mildest tonics & has some mucilaginous properties. I have given this in consumption with advantage It is said that the berries have the stromonium properties Erigenron Canedensis This may be serviceable in Chol. Iref. After evacutions grows in pastures and woods where the trees do not shade too much sometimes colts tail Erigeron Philadelphicum flea bane This possesses diar phoretic & sudorific properties given in gout & gravelly affictions in infusion has a warm aromatic & better taste May be usd in diarrhea & dysentery Hamamelis Virginicum Witch Hazle Flowers in Oct. & perfects The fruit next season It is a bitter as -tringents usd a discutient in the form of poultice 75 Coptis Trifolia gold thread usd in tinct as a tonic, not much inferior to the Gentian the leaf resembles the strawberry except that is smaller Hypericum virginicum (johns wort) The several species of this genera possess similar virtues, bitter, astringent & some aroma has been usd as a substitute for the lesser century. It is a very use -ful tonic in cases of debility of the stomach & in intermittents Hypericum Parviflorum (low century) virtues like the above johns wort Hypericum Sarothea (orange grass) This has the smell of oranges it is usd in coliquative sweats & diarrhea Lysimachia Quadrifolia (Cresswort) A mild bitter & astringent It may be in cases where strong tonics produce con gestion. 76 Swamp willow Lythune Verticelate Doct Cullen rank[e]d it a mong the astringents but thought it worth not much notice Podalyra Tinctoria wild Indigo Grows in this neighborhood. It has been used in gangrenous states of fevers supposd to be powerfully anticiptic. In large doses it evacuates the bowels Been usd ex ternally for Gangrene Populus Tremuloides (womans tongue) This is a tonic of some strength rude into woods bitters with Birch bark Populus Dilatata (Lomby Poplar) Exelent tonic cold infusion good For the dryness of the mouth in fevers of a low kind as Billious & Typhus Prinus perticilatus (winter berry) This has been usd a substitute for P. Bark Pyrola Umbelata (Princes Pine) This belongs to the same class as uva -ursi & has similar properties made in to beers. Medicines undoubtedly do well given in this way when they are usd in a fermenting state on account of the carb. Acid which it contains. 77 Pyrola Umbelata (Bean leaf Green winter) The leaves mak a Smosh dressing for ill conditiond ulcers & Cancers. Pyrola maculate spot. winter green This is more acrid than the other species It might blister under fav orable circumstances Smilax Rotundifolia (sasperilla) green leaf Brier Used for scald head and other affictions of the skin in decoction. The leaves are usd for dressing ulcers. Scutilaria Lateriflora (scul Cap) Probably a tonic it may have some anti Spasmodic virtues said to cure Hydrophobia Betula. Lenta spey birck It is a tonic of consider able virtues It has been used for Bitters with poplar Bark Barbaris vulgaris (Barberry Tree) A tinct this sweet apple & wild cherry tree have been used in jaun dice 78 Alcornogue Gmos in S. America It has been much usd in Consumption give infusion 6 or 8 oz in lbii of ag. Pur. Cistus Canadensis (Rock Rose) This has been much usd in scrofula & probably valuable in decoti -on. 79 Astringents The action of these may be considerd twofold first. Chemical precipitating the gellatin on the surface of the membranes & the extremities of the capillary vessels second Physilogically by the action on the vitality of the system producing their peculiar excitement giving a slow & at the same time more vigorous action of the nerves & blood vessels diminishing the orifice of the exhale -ents by exciting them to contraction of their circular fibers & exciting the absorbents to more vigorous action The action is first made on the nerves of the stom -ach & fauces and by association extended to the whole system. Astringents are not carried into the circulation. They are not taken up by absorbtion some astringents check hem[?] before they can be absorbd Those articles are best calculated for interm ittents which combine the bitter astringent and aromat -ic principle. In restraining Hemeg probably act on the vascular System through the medium of the stomach removing irr itability & exciting a new Action, Indicated in passive Hemg ig Acet. Lead alone is admissible in active Hemg[?] Hemg[?] often exists with very unequal excitement when that is the case the excitement should first be equalized sometimes this will be all that is necessary In dysentery with 80 fever astringents should not be usd till the febrile act -ion has been subdued Diarrhea my also require the same treatment before they can be usd. then they should be combind with laxatives or diaphoretics in that diarrhea following dysentery the most active astringents are sometimes required. Fluor Albus is sometimes improperly treated with as tringents even when astringents are admissible the treatment should be preceded by caths or blisters to the sacrum. In a case of enlargement of the uterus & ovarian from sudden surpression of leucorrhoea I directed success fully a blister to the vagina and os. Tince Pyrosis frequently admits the use of astringents Particularly Hin. 81 Quercus Alba (white oak) This is a valuable article of this class alwa -ys at hand - usd in infusion for injections and fomentation the latter in piles – the former in Wt. Hemg – epistaxis & c. Quercus Ceris from this the galls are obtained those are bests which exhibit a blue -ish appearance & are heavy – galls combin[e]d with Aromatic sometimes cures Intermittent when oth -er things fail 8 parts lard & one of galls forms a good oint. for piles – this however may agravate the symptoms when so fomentations & poultices Formentilla Erecta This has connected with its astringency some mucilaginous quality hence its usefulness in di -arrhoea combind with Chalk pearl ash or Cassia in Decoction Hino. . . the best kind is in small pieces of a brighter color & brittle usd in tinct. It acts powerfully on the stomach & uterus altering their secretions – has been much usd by the physicians of this town in UT. Hem. Externally & Internally 82 next to the Acet Lead the most powerful astring ent we have in ut. Hemg is composd of sulph cup ℥viii 1 kino ℥ii Alcohol lbii Dose 20 to 100 qtr ...,, .... Mix This used as a steptic in ulceration of the fances and cases threatning Gangrene I don’t understand you Doct Ives The Camp. Tinct. Vit. is one of the best remedies for Cancer. A single dose often proving effectual. Mimosa Catechu (pappan Earth) Ext. obtaind from a plant varied in quality & strength. Indicated chiefly where kino is useful in sore mouth of nursing women Catechu jii AcetLead 12 grs agua jviii wash several times a day This may be usd in white cancer & plrughy gums log wood Hematoxylon Campeacheamum valuable astringent in the last stage of Dysentary & Diarrhoea Petrocarpis Draco Draggons blood used in Ut. Hemg y formerly. But employd but little at present – soluble in Alcohol not in water Rosa Galica fresh petals made into condem 83 Arbutus Uva Ursi Bears whortuberry This stimulates without increasing aterial action – Intermittent in delicate habits have been successfully treated with this It has a good effect on digestion in dispepsia especially in that kind of dispepsia connected with consumption – Doct Barton says it has never failed to relieve strangury from blisters. It also prevents blists from producing strangury – In old strangury when the parts are so irritable as to prevent injections this has been useful. It is particularly indicated when the blader is relaxd having a peculiar action on that organ – useful in nephrites after eva culations and in Chron calculus 84 Indiginous Astringents Geranium Maculatum Cranes Bill This is one of the purest veg etable astringents we have It should not be calld cr [??os] bill – I think the root in infusion is the best injection for Leucorrhoea Put into the comon white wines Geranium & you have port wine Some of the worst cases of Chlorosis have been curd with this & Lime water – good for the caller stages of Cholera Infant. Good application to relaxd ulcers. Heuchera Americana (Alum root) This is one of the most p -owerful astringents we possess. It is very useful in in those ill conditiond ulcers which have some can cerous action – It may be found in abundance on a bluff of Rock through which the road passes on the bank of Housatonic above Derby Orobanka Virginica (nut all) Used as a gargle in ulcera -ted sore throats usually found under beach trees, the plant has no leaves. Doct Martins Cancer powder was found to be this and Arsenic. 85 Potentilla Simplex I have given this In relaxation of the mucus membrane of the lungs. It is said to prevent abortions in cases of relaxation and debility statica Limonum Marsh Rosemary Flowrs in July & give the Salt Miadows a blue appearance where it grows The root resembles dock root active astringent Vibernum Sertago (snow ball) All the vibernums are astringent It was used sucessfully in a dysente ry which prevaild in Cheshire, after evacuations Quercus Albus (white oak) I have usd this much in relaxation of mucus membrane of the fauces & tonsils & uvula In all relaxation of the mucus membranes of Children I have found it an impor -tant remedy value remedy to relaxd ill con ditiond ulcers in the form of poultice The ext. prepard with molasses in pills 3 or 4 a day good in scrofula & weak diseasd action Doct S used a plaster of wht oak & apple tree bark in relaxd joints and weak action any where 86 Geum Rivale (Evans Root) This is one of the best tonic astringents of the Mat. Med. has been much used as a substitute for Tea & Coffee It has been usd night & morning for ye -ars but without any bad consequences. A pat -ient with severe nervous symptoms tried many Things finally resorted to this drinking it with his meals, soon began to mind & presently recoverd It is of all other tonics least apt to excite congestion It acts more particularly on the nervous system when taken as food ji of Powd. Root one qtr of boil water with mild & suggar persons soon become fond of the taste valuable Palm g Consusup with irritable nerves. A patient of mine entirely recoverd from hectic using this Mur. Lime & Island Moss – It is one of the safest astringents in Hem optises In but Hem. In powd or pill 2 or 4 times a day useful in that kind of irregular action accompanying the cessation of the menses in females and in Dyspepsia Rubus ( Black berry ) Root is the part mostly usd and in strong decoction is an astringent of considerable power in all those relaxations of mucus membra -ne of the first passages after diseases of autumn. 87 Myrica Cerifera (baberry) The vegetable wax obtained from this is procurd by boiling the berry – It is un doubtedly a powerful astringent Spirea Tomentosa (Hard Hack) This is best usd in ext. I have used it with success in diarr hoea I think it determines to the skin – doubted S. B It will agree when no other astringents will rarely Produces vomiting many cases require evacuation before it is given It may be given in Dysentr when it would not do to give any other. Cistus Canadensis (from wood) This is useful in Such cases as require the use of oak bark its Properties being similar 88 Emetics Emetics are those subst ances which excite an action of the stomach suffic -ient to evacuate its contents. During their action the pulse is full & less frequent often irregular – In vomiting the muscels of the dia phragm & abdomen act strongly producing a flow of blood to the head During this the pulse is some -times quicker sometimes slower while it lasts some -times both orifices act together then the effect is dist -ressing the peristatic motion of the Duodenum is sometimes inverted. One important effect ar -ising from the action of emetics is an increased action of the absorbents the whole viscera are acted by the com pression of the muscles The mucus membranes & fol -icles are excited to action. Hence Em are usd for palm Consump arising from Catarrh, Consum -ption from Measles I have treated successfully with meas -les Those Em cs which act most on the absorbents are useful in paroxysms of asthma are useful – Certain fevers of the Typhoid grade as angina pue rperal pneumonia Influenza Diarrhoea are often curd in the commencement by an Em te – Fevers of the inflamatory kind forbid the use of Em te emty in Dropsys have been neglected when other modes of treatment have failed they have been useful Should not be usd during the Catamenial discharge 89 Ipecacuanha The light colord root is the best. Long exposure to the air inj ures it properties In small doses it produces healthy action of the bowels & the parts connected with them. I have given full doses of ipecac in Interm -ittents when the paroxism were expected interrupting their return In the commencement of Typhus in delicate habits it has decided good effects In scarlet fever & ulcerated sore throat Doct W Ethering makes great use of this in the following Specac 6 grs Tart 1 [gr] It is always desirable to Interrup diseasd action in the commencement but if the disease has continued some days it is best to be satisfied with counteracting the urgent symptoms as they rise In Hemg[?] in small doses it is sanctiond by the higest authority in some thing like the following opm 1 gr ipecac 2 gr given every 2 hours – If this is not sufficient resort to Lead In Dearrhoea & Dysentary very efficacious If judiciously administerd It is often well to com mence with large doses if the disease is not of a malignant character The remedy must be stronger than the disease. I was called to prescribe for case standing 4 days Disease mild in its attack Caths. Diluents & Astringents had been given without effect Tenesmus with stools every 1/2 hour. I gave a dose of opm inefficient 90 to check the evacuating & after the opm. 2 grs of ipecac & of Cal & repeated every 6 hours with 1/2 gr of opm The night was passd with rest & with -out stools and the evacuation in the morning wa -s nearly natural. The same symptoms came on in the afternoon when the same course was adopt -ed with like effect 3 days when the patient re -coverd – starch & Laud injections will check sickness of the stomach as well as opm given by the stomach Chronc Diarrhoea requires the same treatm -ent sometimes full vomiting but to have a permanent effects it must be given in small repeated doses. Cal. & opm are necessary aux -iliaries especially if the diarrhea is of long standing The following in dysentery & diarrhea without fever to advantage Rhei 2 grs ipecac 1 gr Opm 1/2 gr 3 pills for a dose Doct Rush usd Injections of ipecac ʒi powed starch ʒii ipecac ℥v hot water Doct Cullen usd it in the same way – Doct Ihas not found so much advantage from it usd in this way – Asthma from 1 to 4 grs repeated every 3 or 4 hours ipecac given in this way changes the morbid condit -ion of the stomach & bowels on which the disease frequently depends In croup when senka & Ant. fail – Opm qualifies its action & determines its action to the skin - the action of Caths will be much kinder when assisted by 2 or 3 grs of ipecac- 91 Scilla Maritama (squills) The emetic qualities of this article is use ful in that kind of disordered secretion of the mucus membrane of infants & old persons where there is much mucus without inflamation. Indiginous Vegetable Emetics Lobelia Inflata Indian Tobacco The fresh plant is more active than the dry 3 grs being sufficient to produce vomiting. Tinct form by adding to oj of spints jii of Lobelia Dose 20 o to teaspoonful useful remedy in As -thma Doct Frisby of N.york that he had subst ituted Lobelia for ipecac & Ant in fevers with m -uch advantage – I think it may be a useful remedy in dropsy particularly Hydrothorax It appears to act on the absorbent system 92 Veratrum Viride W Hellebore ℥ii Boil water may be poured on ʒvi of w. Hellebore & to the strain liquor add ℥vi tinct of the root it forms a good lotion for the itch & other diseases of the skin If to strong dilute, Mix the powd Root with 4 trines the quantity of Com. Cerate This article given freely enough to produce vomiting is hazardous the ancients emp loyd hellebore in visceral Obstructions of Chron -ic character the following recipe for Syd enhams Laudanum Mine of Helebore made by infusing for 10 days ʒiii of the Root in 0jjp of wine then strain & use I use the tinct and Laudanum 20 qtr every hour. Usd as an eroh -ine with powd Lecorice Blood. Root – Sanguinaria Canadensis The root should be prepard by drying suddenly as by the fire or in oven then pulv. & kept in vials – It is an active em -etic & deobstruent I have given it in Amenon ohia in a state of fermentation in the following Jareguin ʒii Red. Ced 9 ops lbii elodes. Feleda lbi Boil in 3 pints of water & Molasses suffice -ent to cause fermentation the bottle for uses. 93 Doct Barton says the seeds possess properties si milar to sttramonium It excites venous absorption hence its use in h -ooping cough Spirea Srifoliata (Indian Physic) This has been given in the same indications as ipecac dose 20 or 30 grs Merits attention Erythronium Dens Canis (Adders tongue) This has the Habit of the lilly flower yellow leaves dark & cloud -ed usd for dropsy proves diuretic and Emetc A patient with encysted dropsy took the comm -on round of remedies. Finally was much rel Iev[e]d by this It may be given in infusion of cider and wine. Phitolacca Decandria Poke R & B This is thought to res emble ipecac 10 grs of the powd root excites vo miting 20 grs operates both as an Emc & Cath seldom produces spasm some stomachs are not acted on till 2 hours then it acts violent ly usd in Rheum Chron. Ulcs Tinct of Berries Doct Smith used in rheumatism dose dose tea or tablespoonful. 94 Mineral Emetics Ant. Tartari’z Nausia when producd by Ant. diminishes & equ alizes arterial action and excites the action of the absorbents. In the commencement of fevers of moderate action nausea kept up some time will completely disapate the disease. Patient should be kept down & warmly covered Ant in nause -ating doses in Pneumonia is indicated in Catarrh with determination to the lungs. A patient with Hemg & full arterial was kept nauseated for 2 or 3 days and curd. Ant. is distinguish for the extent permanency & certain -ty of its operation It acts powerfully on the stomach & connecting viscera during this op peration to the skin & frequently movement of the bowels Glass of Antimony Oxide Ant. I think this article acts more on the bowels than the Tart. And is more objectionable in delicate constitutions James Powder said to be a stronger diaphore tic than any preparation of Ant. 95 Sulphurett of Antimony This has been used to answer the same indications as the other preparations – In white swellings it has been usd externally as an ointment – In puncturd wounds threatning tetanus given internally Bitter & Astringents decompose it. Hydrosulphuret of Antim. Acetas Zinci Doct Munson has usd this as an emetic in Cynanche Maliq. Also in ill conditiond ulcers disposing the m to heal Acetas Cupri and Sub. Sulph. Mer. Unsafe - emetics 96 Vegetable emetics continued from P Colchicum Autumnale This was first brought into notice as a valuable rem edy in dropsy It is not inferior to the imp orted ipecac. I consider this as an invaluable remedy when given to the extent of emesis in inflamat ory Rheum. venesec should be premisa if there is much arterial action. The quality of the article is uncertain especially in tinct or vin. Infus. S. B. Mild ipecac Apocynum Androsemifolium Ind. Hemp This is very good application to eruptions in decoction It is more bitter than ipecac of the shops emetic in dose of 20 grs Aselepias Decumbens Butterfly weed This sometimes calld pleurisy root is used as a diarphoretic in dropsy Aselepias Syriacca Milk weed In large doses of dec oction this produces nausea & vomiting. 97 Euphorbia Specacuanha Grows N. Y. & Pa. emetic And Diarphoretic dose from 5 to 20 grs sometimes produces Hyp. Cath Polygala Senega Seneka Rattle sknake Root Stimulating emetic & expectorant Viola these are all moderately emetic The seneka is a useful article to assist the opperation of Ant. in Croup . Emetics in Croup never do mischief unless with a very great dose the system bearing the use of med icines much better when laboring under disease than at other times. It should not be given where there is much arterial ac -tion 98 Aromatics (proper place afer Tonics) These articles stimulate the stomach and system and are usd chiefly to as sist the action of the other remedies Citron Aurantum (orang Peel) A decoction of this with Camomile & Daisy is good for night sweats Laurus Cinnamomum With chalk & Gm Arab given in Diarrhoea usd to qualify tonics Myristica Moschata nut Meg This has some astringency it is used in dysentery and after parturition Amomum Zingeber (ginger) This root will vegetate long after it has been taken from the ground us[e]d in decoction in slight stomach & bowel affictions and as an external application in fomentations &c. Caryophilus Aromaticus Cloves Cloves belong to hull physic Ginger Cloves ℥ss Aloes ℥i Safe g. 8 Pill 99 Canella Alba This is principally usd with aloes in Piera. A decoction wi th Muslard and ginger has been much used in paralysis Lyriodendron Tulipifera Tulip poplar This may be usd In some forms of chron. Rheum Sciatica &c properties of Can. Alb Peppers. Useful in the last stage of fevers where the disease has run out and exh austd the excitabilities of the first passages as gargles in Angina indicated when gan grene arises from want of action Piper Cubeba Good remedy for Ca -tarrh of the Chronic kind one of the most pleasant tonics for dyspepsia given with Colomb. It excites the stomach to be acted on by perma nent tonics Piper Nigrum Immoderate use of this pro black iep duces of the skin & gout Amomum Repens (Cardamum seeds) A decoction with lesser century often relieves dyspepsia when other things agravate Card. Seeds ʒii Crit. ʒpt. Pearl Ash ʒss Boil wat good in vomiting from irritating 100 Amomum Grana Paradisi This has been used in dyspep -sia spasmodic cough & affections of the kidneys Magnes ʒii Chalk ℥ps gr Pardise ʒi Colomb ʒii dose Teaspoonful before & after eating Pimpinella Anisum anise Best expectorant of all the aromatics in Paregor. in opm with pills in decoctions of senna &c for children Anethum Feniculum fennel Pleasant aromatic in Cath . & bitter Infusions Anethum Graveolens Dill similar Properties to the above . Imperitoria Ostruthium Mast. Wort This and Angelica have similar propertis they have nervine aromatic qualities which render them suitable in the prescriptions of nervous women & delicate children. Leonus Cardiacca Mother. Wort. Usd in debility of stom & bowels with strong nervous action A decoction often prod uces sleep when opm. fails. Mentha Piperita obviates debility of The stomach removes flatulence & increases the heat 101 Lavendula Spica Lavender Salvia Officinalis (Sage) Useful in pain in the Head from nervous irritation Rosemary This is said to be a prophylactic against vegetable poisons parti cularly sumac, Drink freely of the decoction while working among it. Mentha Pulegoides Given in puerperal fever to produce perspiration painful Menstruation Nepta Cataria Cat nip very good in flatulence of children Pyenanthenum Incanum Mount. Mint I recommend this to your attention good in coughs & affections of the chest generally Wild Hysup several species the broad Leafd the best. Claims attention 102 Mentha Viridis spear mint Apply to the epigastrium to stop vomiting Expressd boild skinned & sweetened with sugar I found good for diarrhea of children Myrrhis Dulcis sweet cicily Expectorant substitute for Annise Asaruna Canadensis wild ginger Usd in diseases of the thorax – Quacks have gaind much credit with it Panax Quinquefolia ginseng Mild tonic Acornus Calamus sweet flag This merits the attention of every Physician as peculiarly agreeable & friendly in its influence on the stomach Laurus Sassafras The pith of the twigs forms The smoothest application of any article in Mat Med. agitated with cold water this forms a useful application to irritable eyes when nothing else can be borne Laurus Benzoin spice Bush Used as a diaphoretic drink in fevers Heracleum Lanatum Virtues similar to Master Wort usd for flatulence 103 Origanum Vulgare wild Marjoram Good application to paralytic limbs the Eau De cologne is the essential oil with Alcohol good application to weak eyes not inflamd eyes. A linen cloth wet and applied to the part in chill blains & burns then a cerate made by adding ji of oil to jii of cerate perfume in soap 104 Cathartics The state of the bowels most favorable to health is that in which an eva cuation is produced every 24 hours. Females are most subject to costiveness. Costiveness has an influence in interrupting the calam -enia and producing a determination to the he ad & lungs. A female had symptoms of retention with paroxysms of fever like hec tic with cough. Had been long costive Caths removed the symptoms. Moderate & gentle action of the bowels is accompanied with a sim ilar action throughout the system. Hence Laxatives often produce diaphoresis – strong action of the intestines tends to determine acti on from the brain The state of the bowels much influences the state of the mind The bowels have been said to be physiologically the seat of the passions. In high inflamatory action the use of Caths should be preceded by the use of the lan cet Doct Cullen thought Caths dimin ish the quantity of blood in the head by increasi -ng the quantity in the descending aorta I think the relief depends more on the translation of exc itement than fluids. This infer from the analo gy of Cupping to relieve excitement. In pulm -onic affections Caths diminish the expectoration 105 And if the cough continues alarming sympt -oms my appear. In the Typhoid pneu monia which has prevaild here the primary has been seated in the bowels and Caths were indicated a diarrhoea often relieving the symptoms In Typhus a crisis may be formd by strong caths those affecting the secretions of the liver the best. These must be accompanied by the use of opm. & wine & Diaphoretics given at the same time. Sometimes when the stomach has rejected wine it has retaind it after Caths I the Commencem -ent of puerperal fever with costiveness Cal. & Gal. relive the symptoms much. Patient with puerperal fever typhoid kind Miliary eruptions tongue dark colord extremely low seen by another physician who directed Caths died immediately he had seen the favorable operation of Caths in another case – but did not do in this – the action of Caths produ -ces activity of the absorbents hence their use in Dropsy diuretics will not act as such many times till after the use of Caths. Aloes applid as a plaster will operate – In mild typhus long continued Caths constitute the principle treatm -ent if the disease is malignant strong excitants are indicated Chlorosis Corca Caths should be given to change the secret 106 -ions not merely to evacuate hemoptisis com monly occasiond by an obstructions of the spleen and liver hence the indication as in Chorea for the treatment of Chron. Discases with Caths see hamilton on purgatives Necrosis when a consequence of fever may be tre -ated with Caths Hydrocephalus has for its cause frequently disor -derd bowels Caths usd freely Epilepsy gallap & Gamboge when the intestines are coated with mucus something like rh -eumatism affects children from 6 to 10 grass Caths & diarphoreties may be usd here commences with pain in the hip & leg & sometimes swelling pulse frequent & small sometimes translated to the bowe -ls 107 Fraxinus Ornus usd with senna & seeds for children rarely moves the bowels alone Grays purge once celebrated for Colic Rx Manna Annise seed senna salts & sweet oil united by Means of yolk of egg Cassia Fistula The pulp of the pod a gentle laxative Good Cath in the latter stages of pulm Consum -ption Tamarindus Indica An acidulous laxative in fevers In some cases of dyspepsia acids are indicated in these cases probably an in active state of the liver exists all of the acid fruits are grateful in fevers Ricinus Communis This evacuates the bowels sud denly without exciting the secretions Best Cath. which I have usd for piles is sweet ol & Cast.ol sap onizd with ag am If it is nauseous give it in sassafras Mucilage safe in inflame ation of the bowels when other Caths irritate much used in Dysentary. 108 Sulphur This does not gripe unless it contains Sulph. Acid I think sulph. produces relaxation of the system particularly the parts in the cavity of the pel -vis Hence its use in piles this is useful in Catarrhal affections After using the round of rem -edies without success sulph. will often relieve Townsends cough remedy is sulph. elecampane and licorice root aa ℥i Honey 4 mix and take a piece as large as nutmeg 3 times a day Add to the a -bove ꝶ Camph & Opm. & we have Rodgers pulm. Ast -ringent Sulph Ginger and treacle a popular remedy for mild dysentary. Magnesia ꝶ Magnes ℥fs Carb Soda ʒv pulv R. Colomb. ʒii P. Cubeb.ʒii Pains in the breast Rheum and Gout & Dyspepsia depending on morbid Acidity Cassia Senna When this article is taken with a Large quantity of water griping is prevented Elix. Solutis ꝶ fol. Sen. ℥ii P Rhei ℥ifs sem coriand ℥fs dil. Alcohol lb3 109 Rheum Palmatum Good for irritable bow -els predisposd to diarrhoea Cath properties of Rhei increas[e]d by the addition of ipecac. or Cal. Rx for diarrhoea Rhei 12 grs ipecac 1 gr opm 1/2 gr Soap g.s. to pill repeat every 3 or 6 hours By long decoction Cath properties impaird Croton Tiglium Case of a woman with cra mp in the stomach probably owing to obstruction of the gall ducts from calculi or torpidity 1/2 drop and afterwards 1 drop which opperated kindly uncertain. Convolvulus Jalapi This opperates as a diuretic combind with Crm.Tart. made more action by the addition of 1/2 or 1 gr of ipecac. useful & safe in cold leucophlegmatic habits. Heleborus Niger This has in my hands provd an active emena gogue – In dropsy it is a cath. Particularly cal culated to evacuate serous fluid In dose of 20 to 60 qtr Tinct good deobstruent. 110 Brionia Alba Sometimes sold for galap. It is of a lighter color. Cucumis Colycinthis Dose from 2 to 6 grs. drastic should be given with Gum or farinaceous substance infusion has been recommended in worms Momordica Elaterium One of the best Hydragogues we Possess – used with much success in dropsy & obstinate constipation Ramnus Catharticus Berries have a faint smell & nauseo -us taste – grows heighs 10 or 25 feet used in dropsy Rheum & gout the syrup made by boiling the expressd juice in sugar is much usd in N. H. Aloes Spicata The effect of Aloes in suppressd men -struation is sometimes increasd by adding a grain or two of Cal. Sulph ferri useful in torpid states of the stomach a small qu -antity of aloes taken before dinner opperates more eff -ectually & kindly than any other way Andersons Pills frequently contain nothing but aloes w armed at the fire & made into a pill 111 Elix. Pro. Tinct of aloes & myrrh Picra aloes and CanMa alba Hulls Physic Aloes ℥i Cassia ʒfs Cloves ʒ3 Ginger j2 Head ache pill. Aloes ℥i Cort. Angust. ℥fs Bac junip ℥fs Sulph Zinc jfs Colombo ℥ii add lbj proof spirits & take tablespoonful 2 or 3 times a day. Convolvulus Scammonia This active Cath. should not be gi -ven where the natural mucus of the bowels is deficient in such cases all the Gums irritate and inflame Opperates with Cal. more mild & certain Stalagmitis Gumbogoides Once celebrated in Dropsy given in doses of 1 to 3 grs every 24 hours to excite nau sea & evacuate the absorbents It was a very eff -icient of treating dropsy – Useful in Catarrh al epilepsy A state of fever occurs in dropsy which nurses call inward fever This is a mor -bid action of the mucus membranes this re -quires neut. Salts 112 Neutral Salts These are indicated Indicated in dropsy & inflamations on account of their action on the exhalents Sulph. Magnes. Epsom. Sal. Given in all those affections Ch aracterizd by torpidity in the parts connected with digestion Sulph. Soda Sal. Glanb. Used as an external application In salt Rheum with much heat & irritation on The skin said to be a good application to ill conditiond ulcers small alterative doses good for chron. Eruptions Sulph. Potass Enters into the Comp. of Dov. Powd ipecac & opm aa Sulph potass 8 pts in 10 Sup. Tart. Potass. Good remedy in Dropsy or if the habit is weak Combine with tart. Iron Tart. of Potass particularly calculated For the pneumonia typhoides or Malignant inf -luenza in large doses it opperates as a cath . 113 Muriate of Soda Useful in Hemge of the lungs Turpentines usd for the tape worm Balsam Copaiba useful in the torpid -ity of the passages of old people Tobacco Injection of the smoke in obstructions of the bowels Mustard Seed Given more particularly in paralytic affections & torpidity of the first pas sages Guaiacum this will in cases of great torpidity succeed when other things fail dose teaspoonful of the powder Soap In jaundice it is a deobstruent in Chronic affections of the liver it has often given re lief Juglans Cinera Doct Rush says the long use of this article has a tendency to produce Apoplexy Made pleasant by boiling with Molasses & arom atic seeds 114 Phitolacca Decandra Given in tinct. In Rheum[?] A powerful evacuant Platanis. Ceidentalis The powder of the root occasiona -lly used as a cathartic and vermifuge merits at -tention Podophillum Peltatum Mandrake Sure & powerful Cath 5 grains opperates kindly Elders All these are Cath & sometimes di -uretic hence its use in Dropsy made in syrup Triosteum Perfoliatum Dose 20 to 30 grs It has been thought a specific in scrofula It has deobstruent prop -erties Polygala Rubella ℥ii in 1/2 pint of w -ater in one case a teaspoonful of the tinct would opperate as a Cath Eupatorium Perfoliatum Thoroug wort This is laxative diuretic & tonic Verbascum Thapsus (Mullin) Flower. Laxative 115 Asclepias all Laxative Convolvulus Panduratus wild Rhubarb Doct Rush thinks much of this Veronica Virginica (five finger) The root is a drastic purgative usd in decoction & give till it opperates – most seen & powerful Cath we have The Cath properties dep -end on the Cortical part Amigadalis Persica (flowers of peach) A decoction acts efficiently as a Cath I have not seen any of the effects of Prus. Acid Carbo Ligni said to be a Cath it acts proba bly mechanically said to coerce the diarr hoea of maglignant typhus Cassia Marilandica Inferior to the foreign senna but has The similar properties Enemata Usd by the French as prophylactic a gainst disease action of the Intest Canal If these were usd more piles & fistulas would be un -comon For those who ride much in hot weather Enemata are as greatful as to wash the mouth In constipation much may be effected by using warm water 116 Hydrargyrus (Mercury) The combinations of mercury are very active. Ex citing the secretions generally opning the pores of the skin and increasing the irritability of the system acting hence the necessity of combining narcotics In fevers it alters the state of the secretions acting on The liver & pancreas The remedies for an over dose are Caths opm & diar Phoretics. Emetic & Cath in torpidity of the first pas sages produce mercurial action Mercury prob ably acts by sympathy not absorbd as many have supposd the mildest preparations are those which combine with the other articles by sim -ple trituration Sub-Sulphate of Mercury Powerful emetic given in cases of angin a maligna and trachealis doses 3 or 4 grs Nitrate of Mercury This is much used in chro -nic affections of the skin particularly those arising From a Ven. Taint This with lard makes Citron Oint. Muriate of Mercury Cor. Sublimate Powerful – 4 grs once producd fatal Hemorrag 117 A weak solution is said to cure the itch when ot -her remedies fail used for vegetable poisons sa -id to act on the skin more than any other prepa -ration & less apt to effect the Gums. Weak sol. usd for opacity of the Cornea – best remedy for children having ven. disease from the parents Dissolve 1 gr in ji of water give 3 or 4 qtr three or 4 times a day weak sol. also recommend -ed to rub into the Gums to produce speedy sal ivation in maglignant fever Sat. Sol. in Alcohol said to cure corns Sub – Muriate of Mercury In acute hepatitis mer curial action will fall in with the diseasd ac -tion when the excitement is high, hence the necessity of depletion. In Chronic hepatitis it is equal to all other remedies sometimes necessary to use mercurial frictions at the same time. In Pneumonia particularly useful particularly in that calld bilious Pleu risy In Typhys where there is an irrita ble stomach from vitiated secretion of bile In many Cutaneous diseases – In the Com mencement of Dysentary you may 6 grs of Cal & 1 of Tart. Ant. This sometimes however fails of success. Cal. Sometimes is the only remedy where there is continual vomiting & distress about the scrobeculis Cordis with stools not much bloody 118 In the dysentary 20 or 30 grs will sometimes opp Erate more kindly than a smaller quantity after the Cal. Has producd a change in the secretions and suspended the disease then dia rphoretics & Cast. ol. may be given. It has been recommended in Hydrophobia Not sufficient however. A child was bit and kept under influence of Cat. 7 weeks the symptoms came on & the child died, Tarp. Min might have done better. Useful in dropsy arri -sing from affection of the liver white on scrof -ula recommends that whatever treatment m -ay be usd to use occasionally a dose of Cal. Jaundice Cal. More relied on than any other remedy. The deobstruents are more likely to suc ceed after the use of Cal. obstinate costive -ness with irritable stomach should be treated with Cal. tile salivation occurs then other Caths. will opperate chron: affections of the Ut. and overia Cal. usd for some time but not to effect the Gums is useful especially when there is much irritability of the stomach. Consumption useful here only in such cases as are connected with diseasd liver. When Rheumatism assumed the form of Gout Cal. should never be usd. 119 120 Emenagogues The uterus of females is the centre of nervous ex citement its healthy action influences much the other parts of the system A suppression of the menstrual discharge may arrise from too much action of the uterine system or from debility of that organ. The effect of an emenegogue is rather that of equalizing the action of the system than any specific action on the uterus In cases of high action general bleeding will reduce the excitement to that point which will permit the ut. to perform its functions Cathartics act as emenegogues as they ex cite healthy action of the secretions of the aliment -ary canale this being continued to the uterus. In cases of suppression from debility stimu lating tonics are useful. In cases of uneq -ual distribution of blood alterative bleedings or perhaps local bleeding warm bath & the use of those means which determine the action to the uterus ligatures on the lower ex tremities have an effect similar to bleeding 121 Castor This & Asafoetida prove emen agogue by equalizing nervous action Iron Indicated in cases of debility all The preparations are usd Muriate is the best in scrofulous affections Mercury though this has no specific action on the uterus it is indicated in those cases arising from chronic affections of the uterus and Ovaria or of Connecting affections of the Abdomen Aloes One of powerful medic ines as an emenagogue usd as a Cath with Myrrh Veratrum Hellebore sometimes usd Madder If the madder is recent it is one of the most powerful emenagogues ℥i of the root to 2 lb. of water in decoction has a specific action on the viscera of the abdomen analogous to Mercury Deobstruent give an ℥ of the decoction 3 or 4 times a day Sanguinaria Powerful emenagogue usd With Mercury The most powerful article I have usd is a fomenting preparation the following 122 Blood root. Skunk Cabbage Ceder Tops & Celen -dime & juniper Berries. Strong decoction – This succeds when other things fail particularly with want of action The different species of Dock have been recomm ended these like Celenendine & Dandelion are deobstruent & sometimes useful Tanacetum Vulgare This has emenegogue properties I have obs -ervd that women who use this have Leucorrhoea Cold and Warm Bath Cold admissible in cases of equal excitement of unequal ex -citement the warm bath lrictions useful in unequal excitement Cantharides Indicated in cases with want of action acting on all the parts in the Cavity of the pelvis This is an article with which we may command the excitem of the system more than any other. Ergot I do not put much dependence on this Polygala seneka Leonidas Cardiacca Electricity 123 Diuretics These are the most uncertain class of medicines in their opperation Some diuretics act directly on the stomach Their action being extended from thence to the Urinary organs – In cases of inflamation There is too much action for the secretion of urine Hence the necessity of bleeding – Caths when they relieve an anasarcous swellings probably act by stimulating the absorbents those which occasion nausea are considerd best in dropsy On jaundice the deobstruent plants opperate as diuretics The evacuation of urine has important connections with most all dise -ases Diuretics useful to check perspiration Super.Tart.Potass Nitre Muriate of Amonia Acet. Amonia 124 Acet Potash Properties of the preceding Article Carb. And Sub. Carb Potass useful combined with mucilage & ess. winter green Tart. Potass This given as a Cath untill it opperates proves diuretics in dise ases of the kidneys with small secretion I have found this sufficient of itself. Balstown or Impregnated water sure diuretic Scilla Maritma More sure as a Diuretic if combined with calomel – Mixd with Lard and used as an external application [cross out] applied to the epigastric region Better if given with other articles as blood Root &c when dropsy effects full habits Cal. & Neut Salts may be given with digitalis for Digital ʒss LeeCep Bark ʒii Zing ʒss & ℥ of water ℥ss dose 2 or 3 times a day. Hydrothorax ꝶ Rad scille jj gm bal J sapogs 3 a day. Cantharides Doct Chalmers prefers giving this article in substance usd in Retention of urine from Debility of the bladder – In incontinence from debility of the sphicter. Canths are not diu -retic in health I have rarely known them act as such in Typhys fever. Also from want of action in the kidneys Canths will raise the 125 action to the secreting point Dropsy accompanied with weak action ℥viii Cort. Peruv. Rad. Zing. ℥iv P. jalap i Boild in a pint of water till 8 oz remain. Strain & add ʒi of sal. Tart. & 60 or 80 qtr of Camph Tinct & 60 qtr of Tinct Capsicum Give 2 spoonfuls every 2 hours untill It purges the patient – when the swelling has nearly the purgative may be discontinued continue the tonic part untill the strength is restord Horse Radish & Mustard & Chalibea -tes may sometimes be used “- “- In Dropsys & Catarrhal pneumonia when brisk stimulants are requird Doct C. uses ℥i P. Canths & as much Camph. in 1 tlb of old spirits An Ex treme case of Anasarca was effectually removd in one night 6 grs of Cant & ʒss of Camph were made into 6 equal bolus with a little conserves one every 2 hours In the morning the bed was literally floated with water. Spir. Nit. Dule. In synochus I have depended entirely on this dose from 20 qtr to 30 qtr in water Tobacco used in 20 qtr of Tincts in Hydrothorax Solanum Dulcamara Lactuca All the lactesscent are slightly Diuretic 126 Juniperus Prostrata Stimulating Diuretic ℥i in Decoction Bals. Copaiba Anthenum Linare (toad flax) Acteum Lappa B. dock Expectorant diarphoretic & diuretic Bedeus Frondosa (Beggar Lice) Usd in decoction in Cutaneous diseases salt Rheum some Diuretic properties (Horse Raddish) Useful in dropsy with want of action Equicetum Hyemata (Scurvy Grass) Pretty sure as diuretic (Winter Green) In cases of irritation about the neck of the Bladder this with Gm. Arab & Bals.Cop. is very efficacious 127 128 Diarphoretics Those substances which their action on the dermoid system If the circulation is languid perspiration is Excited by increasing arterial action – if much Inflamation it is excited by lessning art. action If great heat on the surface perspiration is exci -ted by a abstracting Caloric and vice versa. An exception to this occurs in Typhus commencing with much sweat. In this case diseasd action of the absorbents is the difficulty some articles which promote the action of the stomach produce perspiration Nauseating medicines act by equalizing excite -ment Sweating is the common mode of treating fevers In the commencement Bleed first when strong Inflamatory action exists see that the perspi ration is general The commencement of all fevers are similar debility preceding this determining to some par ticular part Generally diarphoretics are indi cated in all kinds of epidemics accompanied with regular febrile action The tepid bath is a power -ful diarphoretic operating on the nerves quieting Irregular action & removing impurities from the sur face 129 Useful in all constipation of the bowels particu larly if accompanied with spasm useful in eruptive diseases accompanied with typhus in cases of passage of Bilary Cal culi with much irrelative fever Dysentary is a disease translated from the surface To the intestines hence Diarphoretics indicated External applications not the least important Hot Bricks, bottles, potates, Hemlock Boughs &c. &c. In spasmodic Colic with some inflamatory action the hot bath indispensable in nephritic colic good 130 Amonia This is more properly an incitant – combind with Gm. Arab & Camph in nervous headaches Puerperal fevers & Sympanites In typhus used in the same way or combined with serpentaria The vegetable acids & Carb, Acid combined with am. are pretty Surely diaarphoretic In sick Headache Arising from torpidity of the stomach Carb Am. ʒi Zen Arab ℥i Camph ʒii water oss dose wine glass full. Antimony Almost all the preparations are diarphoretic Opium Useful combind with Ant. ipecac & Ammonia, give in the forming stage of fevers Guaicum Usd in Chron. Rheum. & scrofula jesuits drops ꝶ Jinct. Guac. ℥i Balsbop ℥ss ol. sassfras & spir. ctit. Diarphoretics may be divided into 2 classes such as act on the skin & such as act on the skin to change the action of the Dermoid system 131 Salvea Officinalis Moderately Diarphoretic wine whey Diarphoretic & large doses moderately laxative sometimes cares dysen tary early in the disease Penny Royal All the Aromatic herbs is moderately diarphoretic ipecac. see what was said of this as an emetic Asclepias’ Sulphur Alters the action of the Dermoid System – used in Cutaneons diseases – scald he ad following ꝶ Lard – Sulph – ℥i Am. – ℥ii Mix - 132 Expectorants The primary action of this class is on the mucus membrane of the fauces & stomach three states of the system should be taken into consideration in using expects 1st exces[s]ive excitement 2nd want of excitement 3rd excessive Iritability These may all be obstacles Anstispasmodics sometimes act as expectorants Healthy action of the Lungs is also associated with healthy action of the skin ipecac. Antimony This was a favorite with Caller in Peumonia & Pleurisy If the action is typhoid ipecac must take the place or Blood. Root. Tobacco sometimes smokd with advantage in Asthma 133 Squills Useful in spasmodic cough in the coughs of Children – when irritation of the first passages exists it is sometimes the same is con -tinued to the mucus membrane Senka should not be usd where there is inflamtr action Squills indicated with Children where the fauces are loaded with mucus Gum. Amoniac I have found this to be the most efficacious if dissolvd in the saliva & swallowd It acts on a greater extent of nerves producing a double effect So assafoetida if used in this way would have a greater effect Myrrh Stimulating expectorant in chron. Afections of the liver Bals. Tolou Stim Expect Gm. Arab. Bals Tolou & Elix. Asthmat. Lycopus Hoar Hound This may be combin[e]d with sulph & Lic Orice or & Elecampane as in Townsends Elix Gum. Arabic This is useful in Coughs arising from acrid secretions I have usd it with Toulo & paregor 134 if much relaxation prevails add Tragacanth or Catechu & ol Anise Nearly allied G. Arab. Is sassafras. Slip. Elm. Root of cat tail flag &c. Licoricc Probably much of the virtues of this depends on its dissolving in the saliva & acting as before observed Licopus Virginica Trump weed Much celebrated in affections of the Lungs Lichen Islandicus Mucillaginous and Bitter give large doses Symphytum Officinalis (Comfrey Root) not much usd Ulmus Fulvula Elms Mucilage Nacotics these are expectorant in irrit -ation Warm Water in the form of vapor taken into the lungs one of the best expectorants we have 135 Sialagogues These are divided into those which act on the mucus folicles & those which act on the system producing salivation Mercury Anthemis (Peliton) Used in Odontlgia Arum Nicotianum Tobaccum Ranunculus (Crows foot) Powerful remedy in tooth ache Producing inflamation of the nerve & increasing pain for a few moments Trillium much the same as the Anims Coros. Sublimate Powerful in those diseas -es requiring sudden salivation 136 Errhines I contend that The principles of action in these article is that of Counter irritation These have had some effect in removing head ache Apoplexy tooth ache &c. Arum Veratrum Euphorbium Cephalic snuff mode of this baberry Indian Hemp Helenium Autumnale Ipecac In case of hydrocephalus of children putting chronic form & not yielding to usual remedies errhines may do good 137 Epispasties & Rubefacients 2 states of the system in which these are forb -idden High Action & Gangrenous state of the system may be used in typhus with or without pain they give to diseas[e]d action a centrifugal tend -ency. Cantharides The softer the plaster the better if it does not run In the yellow fever I have seen advantage from covering the chest in the early stage of the fever. Blisters may be us[e]d in some Bilious fevers in the same way A certain state of the system is best adapted to the op peration of blisters In all affections of the throat after depletion blisters may do much good mumps enteritis & gastritis measles with symptoms of con gestion Hydrocephalus – fellows & boils if applied early will sometimes displace the diseasd action In cases of white sur elling where there is not acute inflamation the tinct will answer with child when blist cannot be kept on 138 Mustard This action of this being immed -iate it is used where counter – irritation is ind icated In certain epidemics rection would never take place here the surface of the body may be nearly coverd Excite action [see case] of the dermoid system & you have the command of the disease In cases of tetanus of Hysterical kind irrit ation of this kind will generally remove the disease Case of a woman wounded the hand rigid contraction came on. I usd pow erful stimulants without advantage I direct ed a blister to cover the arm – It unlocked the spasm at once Tart. Em. Refrigerants Vegetable acids by the Oxygen which they aff -ord. Nit. Potass No substances has more refrig erant power A larger doses than 1/2 j reduces the heat of the body so much as to endanger life 139 In ordinary instances a person who has more sensibility to cold than the thermometer ind -icates may be considerd as having some disorder of the stomach. Dose not the stomach perform an important agency in the production of Animal heat? Lythrontriptics Soda – Com. soda water considerd Ante lithic cris supposed these medic -ines opperate by preventing the generation of acid in the stomach & bowels which und oubtedly has much influence on the urin -ary secretions. Astringents We have the best authority that ast ringents act sometimes as Antilithics It is undoubtedly their tonic power Uva Ursi This is indicated in Nephritic com plaints which have agouty oxygen jii to 0j Bol. wat. 140 Escharotics These act Chemically Nit. Silver is the mildest acting only on the Part to which it is applied and healing kind -ly Sulph of Cop. & sed precipt. Demulcents Sago Consists principally of fecula Starch Arrow Root This has the advantage of other articles because it is all fecula much usd in bowel complaints of children Bran has been usd as a substitute Scthyoculas European Oil Combined with Am. good preparation Almonds & all the seeds of plants which contain oil similar properties – bowel & urinary Complaints 141 Anthelmitics Some act mechanically & some as narcot -ics Spigelia Marilandica (Pink) This is narcotic in large doses to man and particularly so to worms Sometimes pink opperates as a Cathe when not something should be given to carry it off Sometimes pro duces Convulsions & death when bad symptoms occur give snake root amonia and loin Melia Azedarach Like spigelia is Narcotic when freely is Em. & Cathe Heleborus Fetidus Valerianus Silvestris Turpentine Camphor Dolichos Pruriens 142 Gout Colchicum not use it until the gout has Become seated say a day or two after the com mencement of the all ack The preparation which I use is the wine of the Root prepard according to the Pharmacopeia & I do not hesitate to declare that I have not known a single case where there has been untoward effect It often cures without any manifest increase of The excretions sometimes perspiration & some -times a diuretic It sometimes will not Purge then I combine a small dose of sulph Magnes with the wine – the formula which I use is a saline draught with Camph Mixt ʒi Syr white popies from 35 to 45 qtrs not more of the wine of the Root at bed time to be repeated in the morning with 25 qtrs only of the wine and ʒss only of syrup popies & ʒi sulph Mgnes It is necessary to repeat these draughts for 3 or 4 successive nights & mornings & follow its use by a pill containing 3 grs of Acetons Ext of Cotch & one or two grs of the Pulv ipecac cough & the same quantity of Ext colocynth comp & terminate the whole by a purgative (Sir N Halfords Essays Page 102) 143 Mixture Terri Comp Secomp[?] prevented ꝶ Myrrh ʒii mix & dissolve [II] Geerb Potup ʒi as Pharmacop Rose water ℥xvss & SRir. Nutmeg ℥i sulph Iron ʒiiss Suggar ℥ii dissolve in ℥iss When required add to ʒvii Rose water of the first ʒi of the latter Extracts from Potter and Calhoun’s Edition of Gregory’s Practice 144 Pill Cocciac Rx Aloes " 8 parts & 8 cammony Colocynth 4 parts Ol Cloves 1 " Sal. & Polycrest. 1 " M. Pill One of the best com. Caths that ever I usd – operating copiously without sickness or griping dose from 3 to 5 pills Counter irritant in Pulmonary Complaints Acid Nitromur ℥ii Ol Terebinth ℥i Axungr ℥v Mix uete the Lard And add the other articles stirring till cold Bost md surg journ Col III P. 581 145 Attention to the nature of the prevailing epidemic necessary This is true not only with re gard to fevers but to all other diseases during an epid emic. Thus Stoll found that dropsy & Abortion requird depletion as well as the prevailing fevers & inflamations The constitution of the year is necessary to be known in order that the remedies may be strong or weak as requird. It has been supposd that more faith is to put in this knowledge than by attention to partic ular symptom And is somewhat true as all diseases partake of the nature of the epidemic These remarks show the necessity of unanimity & harmony among m -edical men that by a free intercours they may in form each other of the results of their experience and the nature of the prevailing epidemic which can be discoverd only by practice and not by symptoms. Fevers may be cut short The idea that a fever cannot be can -not be cut short is one which in general is advocated by feeble practitioners, by men who are averse to all energetic measures and who desire rather to contin -ue in the beaten track than to advance the science by judicious measures 146 Dispepsia the tongue is generally referd to as afford ing evidence of the state of the stomach but it will often be found that the tongue is perfectly clean when the stomach will be most incontestably dis order Scrofulous Inflamation which threaten su -puration as inn the hip disease & diseased verte -brae: free continued & dayly purging with the lowest diet almost bread & water avoiding all stimuli (Doct Physic) Itch Lotion (Hour Dicu) ꝶ Dry Sulphuret of Potass ℥iv Ag. Pur. Tbj Sulph. Acid ʒiv Mix Aply to the pimples thrice a day & the warm bath use at sight Asthma. Acording to the eminent Doct Jackson of Boston Cob Webb in dose of 5. or 6 grs every 4 or 5 hours [Common remedies] he relievd a case of Hereditary Asthma with malfor [Emetics of vingr of sgre?lls] –mation of the chest by administering 20 grs which producd sleep which he had not had for 6 years In other cases bloodletting followd by the flows of zinc Doct Withers observd that if the ox zinc did good at all to persevere when at last it would succeed Begin with small doses 147 Dr. Bra advises the use of Griffiths Myrrh Mixture in the intervals of the paroxysms in debilitated subjects With regards to regimen the Aphorism of Hip ocrates is aplicable here If a man eats & drinks little he will have little or no disease Chorea of 24 cases of this disease only 3 were curd by Caths & here evidently some bilious deran gement existed It is remarkable that Caths will not often cure the disease except they are foll owd by the use of Tonics. Sydenham combind Purging with v.s. on al ternate days with an opiate at night & succeeded with that practice Cold bath has proved a powerful auxiliary and in languid states of the system often acts like a Charm Mr Crampton of the Dublin Hosp usd Leeches to the temples neck & along the spine repeated every few days using the tepid shower bath gradually made cold with a proper attention to the bowels with Nit Silv 1/4 gr ter. dic. Preparations of Iron ferum. Ammonia twice Bark Doct Doucet. Of N. . succeeded with large Doses of Port wine 148 Tetanus where the irritability arises from debilitated states of the system Mercury usd till salivation is produced has succeeded well with me. Ol. Turpentine teaspoonful every 15 min succeeded with Doct Mott Caustic along the spine tell the skin is inflamd Opm. & bleeding Puerpural Hemorrage In almost all cases of flooding after labor where I have had an opportunity of examining the pulse up to the time of the occurrence I have found it remain quick & perhaps full instead of sinking after delivery – this has been so markd in several cases that I now seldom leave a patient where such a state of things occur (Churchill Dublin) Md Chir Rev July 1840 P. 110 149 ℥iv Rx Castor ℥i Ginseng ( said to be famous for Epilepsy) ℥ii P.R. Licorice ℥i Colts foot ʒss Pelitory ʒii Gum boys ʒi Mace I have once succeeded with this recipe in a bad case. Its usefulness undoubtedly consists in the combind influence of the tonic & antispasmodic qualities of the recipe Irish state ʒi Cloves ʒii Nutmeg ʒi Saffron ℥ii Flour Brimstone Gs Ven. Frececle ℥i Black Snake Root ℥ss Asafoet ʒiii ol. Amber Honey to make a bolus 150 Travers’ Theory of fever or the phlogistic diathesis arising from injuries. When a part of the body receives an injury the nerves convey a knowledge of it to the important organs as spinal marrow brain heart stomach &c nature immediately (stops crossed out) commences the restor -ative process by stoping the accustomd secretions; the various outlets being this clos[e]d, the blood collects in quantities in the heart & large vessels which propel it with unusual force to the injurd part giving rise to inflamation in whatever form can best accomplish the desird effect - this is an illustration of the manner in which nature contends for a cure Hence two means follow of reducing irritation 1st Restore the secretions of the different organs & by thus opening the outlets lessen fever 2nd Allay the excitement of the nervous system 151 Result Of Beumont’s Experiments On Alexis St. Martin (Arrangd according to the order of the experiments) 1st undigested portions of food produce all the Phenomena of fever and is calculated to wane as of the danger of excesses 2nd the stomach secretes a fluid which has great solvent powers (Gastric Juice) 3rd Natural temperature of the interior of stomach 100 o Fa[h]renheit disminish from 2 to 4 degrees by damp easterly weather. 4th Gastric juice does not accumulate during fasting 5th Proof of the solvent powers of Gastric juice in its power of digesting out of the stomach at temper ature 100 o 6th vegetables less easing disposd of than Animal 152 7th wine spirits water & other fluids which conduce nothing towards alimentation are neither coagulated nor otherwise affected by the gastric juice. These fluids are not digested and probably enter the circ ulation without much change. 8th Certain degree of heat necessary to the action of the Gastric juice. 9th Minute division necessary to speedy digestion unless the substances are porous so as admit the solvent fluid in the interstices. 10th Milk the best diet 11th Bile necessary the digestion of oily food because it is alkaline 12th when there are indications of disease on the tongue &c the process is retarded because there is deficiency of Gast juice 13th Maceration is a different process from digestion Macera tending to putrefaction & digestion reverse 14th All indigestibles & irritating substances retard digestion & produce disease action of the coats of the stomach peper & salt not excepted 15th Hard solid substances require more Gast juice and longer times for digestion 16th saliva does not posses solvent powers on food nor Antiputressent 17th exercise moderate promotes a flow of Gast juice & inc reases digestion. 153 18th Decoction of Coffee is probably not digested in ab sorb & carried into the system without much change 19th Raw Oysters digest quicker than stewd because cooking hardens. 20th the Gast juice cannot be easily immitated though composed chiefly of free Muriatic acid in solution 21st digestion is retarded by the admixture of bile except there is oily matter in the food 22nd vitiated secretions may take place through the influence of improper articles of food without materially disturbing the general health. 23rd stimulating condiments can only be taken when the stomach is languid and inefficient in its ac -tion without injury to the process of digestion 24th the quantity of food is generally more than the system requires and when this excess is perseverd in some derangement or disease is producd. 25th solid food of a certain texture is easier to digest than fluid 26th the ultimate principles of aliment are always the same from whatever source obtaind 154 A fearful truth for the mortality of Medical Men has been establishd by the table of Mortality of Dr Caspar publishd in the British Review vir: Of 1000 remembers of the Med proffs 600 died before their 62 yr whilst of persons leading a quiet life such as agriculturists theologians the mortality is only 347 in a 1000 If we take 100 person of each of these class 43 theologians 40 agriculturist 85 clerks & 32 soldiers will reach their 70 [??] but of 100 Med. Men only 24 will reach 70. They are the sign posts on the road to health but do not tread in it themselves How emphatical of them “In the midst of life they are in death” 155 156 Dysetery If the pain be constant & severe & the pulse strong or cordy bleed in the first symptoms The employment of purgatives constitutes the most im portant part of the treatment – they must be persisted in till fecal evaculations are procurd & the sensation of load in the bowels removed then not till then desist from the use of Caths Cal 6 grs followed by ℥i sulph. Magnes will answer in some cases the ol. ricin (Gregory)* When there is no pain except on motion & the pulse Is small & corded bleeding may be necessary frequently the character of the constitution requires bleeding thus plethoric youthful & robust. If the symptoms run high bleed to fainting - the bleeding should as often as the pain return till the imflamation is com pletely subdued & till then Em[cs] & purg[tc] are dang -erous in the inflamatory form (Calhoun) The use of tart. Ant. in small doses with a large quantity of water has been much celebrated by senac 1 gr dissolved in pint of water wine glass every hour – I have succeded with this & no other medi -cine It is good for children. Em. medicines have been given by Doct Clarke in injections with great success decoction of ipecac in qt of water down to a pint twice or thrice in 24 hours (C-) Typhus Dysentary treat on the principles of that grade of action abstaining from evacuants 157 Obstinate Constipation (Ed. Am. Ed. Paris) 1825 Charcoal from 1 to 3 tablespoonfuls every 1/2 or hour Give it in any convenient veicle quiets sickness & pain and opperates in 6 or 8 hours * The practice referd too on the opposite page most decided ly incorrect in the epidemic. in the fall of 1839. Bridgept Those cases most clearly doing best where a very spar -cing use of Caths were made & those of the mild -est kind Bleeding scarec at all ad missible – Anodynes after a mild evacu ant perhaps Cast. ol. And a good form was P for given in 3 gr pill every 3 or 4 hours’ In some of the worst case Brandy & astringents after 3 or 4 days became necessary In voluntary Sem. Discharges Injection composd of opm 1 gr Acet Lead 3 grs Mucilage ℥i usd 3 times a day & doubled the strength in 10 days 158 Incontinence of urine in children Ext Nax Vom. Gr VIII Ox Firri Nigri ʒi Pubv Quassia ʒi Syr gri Pill X4 VIII Quassia Tea & one of the above pill 3 times a day 1 with a glass of wine & nourishing diet continued for 3 weeks Dr Ramauge Med Chir Review Apr 1840 Treatment of Apoplexy in aged persons (when not enfebled by some other cause) Drastic Cath sometimes preceded by Emetics where the state of the stomach requires: Ice laid in the head: Blists on the Arms: & Sinapism on the legs Dr Gourdain (French) Med. Chir. Review See Page 143 Part eight Braithwaite & Retrospect. Diseases of Male Org. Gen. Noet. Emiss. Soda Mix with Honey made into Large pills 2 night & Morn I have lately combind the soda with Cubebs & Gm. Ar. Cubeb ℥i G. Arab tbi Wat gallj dose 1/2 pint a day Proffs N. Smith In Plethoric habits precede the treatment with Caths. S.B 159 Treatment of Malignant Ulcers with Cor. Sublim Externally The ulcerated surface or coated with a pinch of the sublimate in fine power Quantity never exceeding 7 or 8 grs A piece of diachalon is then laid over all: when this is applied to the surface of the mouth &c cover with Lint or Cotton An intense burning pain follo -ws & last for several hours & some tumefaction Follows The use of emolients & leeches if nec -essary will speedily relieve these symptoms In cases of superficial cancerous ulceration one application is sometimes su -fficient but generally necessary to repeat it The eschar should be fallen off or removed by scis[s]ors or knife before the 2nd application and so reapplying so long as the Granulations are un -healthy the healing is usually rapid when the diseasd surface surface is all destroyd Case AE 74 Canc . ulcer on the lip 2 years Cor. Sub. applied: much swelling & inflamat -ion followed: subsided in 24 hours under pou -ltices 4th day a eschar was detachd 3rd week the of wound compl -ete Ordinaire French Surgeon Johusous Med, Chir, Review April 1840 p 527 (This practice requires some caution Reviewer) 160 A comparative view of the effects of Conium & Opium Am. Grum. Med science Oct 1841 Conium Opium Brain unnaturally free from blood Brain Gorged by blood Ventricles almost dry Vent full of serum Lungs so full of blood as to run out Lungs empty of blood in a stream on cutting them Stomach & esophagus white Stom & esoph red Intestines active & white Intest inactive red & inflamed Death of the heart Death of the brain I conclude from the other symptom Hence Dr. Gudd considers Conium a powerful remedy in Hypertrophy of the heart & in inflamatory affections of the head after depletion Costiveness may be materially benefited by 2 or 3 grs Ext Conium & the same quantity of blue pill Conium shoud be gather in June when it begins to flower that which grows in rich mudy places in the sun the best Rx Chlorid Lime best 1 Lard - - 4 Mix ung & add Nit Mercury 1 part in 4 or 5 as you wish the strength (in Mort) 161 How does the application of Cold to the feet Produce inflamation of remote organs of the Body? See coopers surg Dictionary Page 112 162 163 164 Notes on Mesmerism by Jowres hend I have labored to prove the mesmeric Condition arise on our actual mode of being and the view which I design to take on the sub ject if it be not this it is nothing. The only method of divesting this subject of its mysticism & opprobrium is to strip it of its false names & the one’s hastily form[e]d on limited observation & under circumstances calculated to impose on the Credulous & deceive the honest sear -cher after truth It is no objection against this subject because some of its phenomena seem to be contra -dictory with themselves or because they may appear to contradict some of the known laws of other sciences Few of the arts or sciences but that have come of their parts or principles seem to be contradictory unt -ill we understand the whole – when all is harmon -ious orderly & consistent. No small difficulty in accurately wei -ghing & analizing the phenomena of Mesmerism is the condition of the investigators own mind How shall he pursue the obscure path of truth 165 and coolly & carefully analyze & systematize facts in such a manner as to come to im pregnable conclusions: when every fact is so mysterious & wonderful as to temper the imm -agination to indulge in its most airy & vision -ary flights of inventions & theory & anticip -ating at the development of every new facts and it may be at the expense of correct con clusions its own [cross out] fanciful results? Name sleep wakeing a species of som nambulism into which one may pass through the influence of his fellow man Cases Conclusions Production of physical sleep while the mind continues awake produced through the influence of another Sympathy of motion & sensation with the Mesmeriser Development of the perceptions though not through sensual organs – but by an in crease of the facilities or qualities of the mind Mesmerism exhibibits the mind as less influenced by the sensual controll of it under which it labors in its ordinary condition from the action of the sensual organs & tenden -cies the Moral tendency & sensitiveness 166 of the conscience being much greater under this than its natural condition invariably presenting the mind in a more exalted & refind condition It improves & increases the power of memory Some instances have the power of discovering the thou -ghts of others and of discovering the true Nature of obscure diseases & the appropriate remed -ies The will of the mesmerised is subject to the will of the mesmeriser Produces a sensibility to influences unknown in the natural condition as to the magnet contact with metals – precious stones – objects which are the property of the Mesmeriser. A faculty analogous to sight is developd in an extraordinary way – receiving impressions of objects when substances intervene not transmissible to rays of light The nature of the influence of the eye & hand On the mind [cross out] of others Few could endure the searching gaze of Napolean see the [cross out] mothers soothing influence of the hand on 167 her infant The apparatus of the senses are contriva -nces for blunting not for heightning sensibility They are masks for protecting the too delicate sensibility of the nervous system from the grosser contanct of the outer world Objections have been raised to Mesmeri -sm because it contradicts the establishd laws of vision – But this instead of contravene -ing any receivd laws of sight goes to show that The mind sees; not the visual apparatus as is shown from the fact that impressions are often made on the visual organs – when the mind is other ways occupied which we do not see & so upon the ear which we do not hear And though the sensual organs are the com -mon channels through which we receive im -pressions from the external world get these are not the only ways by which the mind takes cogni zance and as also appears because impressions made on these are not mental impressions un -less the mind receives or observes Hence there under this subdued condition of the physical system the mind still awake has its own peculiar means of communicating with external objects independent of the organs of sense In the Mesmeric state the 168 the mind takes while in the natural state the mind receives information from external objects theory when the mind acts the brain is agit -ated & these oscillations communicated to the ethereal medium which continued to surround -ing objects acts on the brain & nerves of the m -esmerisd (in its peculiar state) producing corr -esponding agitations or vibrations as light & colors produce their impression on through the medium of the atmosphere on the retina & optic nerve – This ethereal medium being so exceedingly fine & elastic & like electricity pervading alike arriform & solid bodies its vibrations when once set in motion is continued & extended through substances impermeable to light & atmosphere produ cing on the mind vision though [opa??] substances inter vene: and so all the various corresponding emotions of the mind without the usual medium of communications through the aparatus of the sensual organs Why is the mesmerisd more sensible to effects from the mind of the mesmeriser than from others? Because of the peculiar may netic affinity or sympathy exists be troan the troo which does not hold good in relation to any other person. 169 Rx sub Carb soda ℥ss Sasson Durior ℥ss Ward Purte (leav feet Riseris Sipri) ℥ss Ext Gintian ℥ss Mix Make a mass For pills Doct thought for so feet 170 171 172 173 174 174 Notes from Lectures By Nathan Smith M.D. Proffs Surg. & Theory & Practice Of Medicine Yale College New Haven [Conn?]. 1825 and 1826 By S. Beach 176 Lecture 1st The first thing to be attended to in wounds is hemg If there is no considerable artery wounded the hemg will not be troublesome If the Hemgg is profuse and returns often we may conclude the artery is partially divided If this is the case the bleeding the bleeding will be more troublesome than if completely divided I account for this in this way that as the circulation is carried on by capillary attraction as soon as the artery is completely divided then its influence on the artery next the heart is cut off & the blood stops. Jones thinks the above theory is founded on mechanical principles i.e. the length & caliber of the artery is diminishd the latter so as to close the orifice. Some say coagulated blood stops the orifice Others that the blood becomes diffusd into the celular sheath so as to occasion lateral pressure sufficient to close the orifice then I would as how it is that an orifice artery when completely divided stops bleeding? This can be explained upon no other principles than that action of the capillaries is cut off “Th way to stop the bleeding of a small artery is to pass a knife down & divide and the bleeding will stop If an artery is cut off directly at the bifurcation the consequence is the same 177 as a partial division – loath regard to applications to bleeding vessels. The mod. oper. is not mechanical as has been supposed but diminishes the action of the artery If a large Artery bleed it should be tied & care should be usd that none of the integuments are not included for if so the effects will be as though the vessel had been partially divided A division of the temporal artery is generally sufficient to stop the bleeding it may In general it may be considerd bad surgery to fill a wound with lint &c to stop bleeding for these will act as foreign substances hindring the healing. Stiching is a bad practice when adhesive plasters can be usd. When stitching is usd the needle shoud not be carried below the skin & cellular substance – with regard to pressure moderate favors the healthy action of vessels, but more or unequal is injurious simple incisd wounds only require putting in such a condition as that nature may complete the care Therefore no acrid medicines &c should be applied observing temperature & rest If Inflamation follows rest cold applications and Sometimes bleeding. 178 Lecture 2nd Simple incisd wounds will by the first intention Lacerated wounds without contusion will with the assistance of adhesive plaster by the first intention but if much contusion poultice &c for supuration Matt & yeast or honey wheat flour & yeast If blood is extravasated wait & try the action of the absorbents which will generally be sufficient to take it up. but sometimes the extravasation will increase then an opning must be made as when a vein or atery is injurd. The necessity of puncturing may be decided by the tension & inflamation If a wound is indolent you may inject Cor. Sub. to excite healthy inflamation Puncturd wounds The opinion of making These incisd wounds is improper Punctured wounds about the knee joints & in some muscular parts heal with difficulty on account of the motion of the parts hence they must be confind Entire rest is the remedy after dressing with simp. Cerate if inflamation follows reduce the heat with evaporation lotion & if suppuration open freely through the fascia Antiphlogistic means &c Gun Shot Wounds These are not poisond as have been supposd will supurate & should be 179 treated for that purpose - with regard to extracting balls this must be left to the discretion of the surgeon sometimes they vary the direction after they enter the surface & when it requires much cutting the extraction should be abandond .c bleed if the inflamation runs high Wounds of the Scalp when triangular pieces are torn up they should not be cut off but return and carefully return in the place Wounds of the lip usd to be treated with twisted suture but this is not necessary Wounds of the eyelids here stitching must be usd Wounds of the tongue Of the wound is considerable use a ligature and tell them to hold their tongues Wounds of throat Attend first too hemgr If the trachea is partially cut it will not do to use a ligature for this will produce a distressing cough which will prevent the healing but bring the head forward & keep it there close the ext wound with adhesive plast. When the esophagus & trachea are divided you cannot unite them Patient will live till he starves if he does not bleed to death Wounds of the thorax these are dangerous because of the air let into the cavity of the thorax preventing the formation of vacum and obstructing the dilitation of the lungs Any wound which 180 opens any considerable vessel or either of the cavities of the heart the patient dies You can only close the external wound & bandage the body to prevent the motion of the ribs in inspiration keep quiet and avoid inflamation if matter collect in the chest draw it with a Cathr It will not always escape through the cavity but break out below Wounds of the Abdomen Where it is merely through the parietes bring the wound together with a ahesive erup. Sometimes stiching may be necessary when so not include the muscles or peritoneum in the stiches Case A man shot – he was bled freely 3 or 4 poultices on the wound no food allowd supuration followd & the wad came away no Caths or Emc should be allowd quietness & rest strictly observd always bearing in the mind that the improvements in surgery consist in the abolition of supererogation Wounds of the joints Difficulty here consists in keeping the patient still. More subject to inflamation because the parts have so much motion wounds of the joints should never be sewd Bandages especially such as make much pressure do hurt – rest & even temperature, if there is much heat wet a cloth in Laud' & abstract the heat by cold applications When matter thin & ill is dischargd inject Cor.Sub. 10 gr to pint of wat. 181 inflamation is generally extensive & requires the strictest antiphlogistic regimen Lecture III Wounds of the Tendons these are not so liable to be followed by bad consequences as have been immagind – I have known only 1 instance when they have been followd by tetanus, in this case the patient died. The muscles should be immediately relaxd by the position of the limb stitches should never be usd. Wounds of the nerves the nerves are always injurd in all wounds but I now refer to the branches then a paralasys will be the consequence for a certain time Wounds of the veins are frequently attended with bad consequences inflamation appearing & extending to the heart. Ligatures of the veins are to be avoided. Lumber Abscess A collection of matter in some part of the body making its way out at the lumber muscles sometimes appears at the lower part of the Coxcyx & between the anterior spine of the ileum & the last rib but generally appears in the groin Females are more liable than men Comes on with pain the back & loins & weakness 182 with some fever. Hectic not commencing till after the opning – various theories have been adopted in relation to hectic – but I suppose it is because after the opning the matter is secreted much faster Hence some have drawn out small quantities at once allowing the parieties to contract gradually or what is better draw out all the mat. & inject Cor. Sub prevent it forming again If any thing will prevent this disease when the symptoms first appear horizontal posture & perfect rest. The use of bark & Mur. Lime or Iron has been useful even after the formation of matter Put a blister over the surface and give the Mur. Lime & bark if those don’t have effect before long opperate The system is in a better condition after using these remedies than before if they do no other good Case A young man was hurt lifting- pain in the back came on with weakness in the lower extremities I laid him down & felt along the back till I found the sorest place & inserted a set on each side & gave the above remedies & the case was curd without an opperation. 183 Lecture III Hip Disease Peculiar to young persons I had a case begin soon after birth it is discoverd first by some degree of weakness or lameness in walking with a pair about the knee joint As the disease advances the affected leg appears the longest this has been supposd to be occasiond by the head of the femur being crowded out of the acetabulum but I think it is only a twisting of the pelvis upon the vertebre so as to bring one side lower than the other there is no swelling of the hip but if you examine closely you will see a difference in the glutei muscles and raphae. If the disease is in the hip place the patient in a chair & push up the foot then the hurt will be in the hip but if the hurt is in the knee the disease is there At the pain be where it will – The sound ligament becomes dissolved the acetabulum crowded away by ulceration & the muscles acting on the femur draw the head of the bone up on the illeum completely destroying the use of the limb. Treatment Complete rest Caustic issues. The oftener the Caustic is applied the better the application of the pea is not as good as stim. Ung. during These applications attention should be paid to the bowels & you may be using the tonic remedies advisd in Lumber abscess 184 White Swellings the most common seat in the knee joint 2 kinds one commencing in the soft parts the other in the head of the bones. The latter the pain appears in a small place over the head of the Tibia which continues a year when a small tumor appears if this opend the bone appears rough on dissection the bone is soft and spongy . If the pain will not be felt by crowding up the limb or in bearing the weight of the body. It is often difficult to determine the existence of matter – this disease too is more confind to children Treatment Blisters & Counterirritants These remedies will not be successful unless complete Rest is obserod No danger of Anchyloses Lecture 5th Burns & scalds Heated bodies do not do not do injury in proportion to the heat they contain if we apply cold suddenly to a burnt surface the pain is relievd but how? It is because the vitality of the part is so much overcome as to induce a sort of insensibility Hence in the treatment sudden changes may be fatal so with regard to freezing. the first application should be so as to conduct the heat moderately when this principle the Terebinth acts 185 that is the turpentine continues the excited action so that it does not subside too suddenly It is important to promote supuration to relive the violence of the inflamation. It is difficult to prevent the contraction which takes place in the skin in the cicatrices – It is a restoration law in in the animal economy which cannot be counteract'd without intruding upon the healing process Another source of deformity from burns is a fungus which is thrown out from the surface this may be obviated by pressure These should not be cut off or destroyd by excaritics Freezing When a part is partially frozen the application of judicious remedies will restore the part so that the consequence will be only inflamation violent in proportion to the degree of cold but if a whole limb be frozen it cannot be restord, should be kept in view to raise the temperature of the part gradually Necrosis the term signifies the death of a portion of bone Young persons are most subject to this disease Sometimes it follows injuries again sudden change of temperature will produce it A local pain is the first appearance – though not always confind to the diseasd part This disease has been called fever sore because it effects the sanguiferous system more suddenly than inflammation of any other part 186 Generally increasing the force & frequency of the pulse and other febrile symptoms It commences in the periosteum matter is formd under the external lamele Lecture VI Necrosis more generally attacks the long bones when the long bones are effected it commences in the center & seldom extends beyond the epephise I have had to amputate only 2 cases then the affection extended over the joint of the knee Symptoms Pain in the part without tumefaction pulse quick & wiry tongue furrd though not very thirsty countenance like Typhus, some delirium after some days swelling appears & tenderness when the matter has collected the distressing symptoms abate in consequence of the matter breaking through the periosteum The matter spreads through the integuments without any tendency to point When the matter has escapd from the periosteum a new portion of the bone will begin to form the dead part completely enclosing it Treatment Antiphlogistic treatment is unquestionably the most proper but I never have been calld soon enough to get much benefit from Antphogc Means There are 2 periods in which it is dangerous 1st when a great portion of the bone is involvd in the disease & sometimes when 2 bones are affected 187 2d when the disease is sufferd to go on with out interruption the symptomatic fever proving fatal this disease often affects the opposite limb by a kind of sympathy I believe the disease may be arested by making incision down through to the bone when we should probably find a collection of matter – be directed by the appearance when to cut if you find matter under the External lamella of the bone cut with a trephine through to the medullary substance I think there is no danger of wounding the medullary substance dress the wound like any other. If the proper treatment is adopted early enough there will probably be no supuration operation of extracting the sequestra instruments operation round Jaw Hays Jaw strong forceps & pry though there is some injury done to the parts in this difficult opperation the wound will generally heal kindly Lecture VII The bones of young people being more vascular are more subject to vascular disease Another disease of the bones have been confounded with Necrosis I mean Caries this disease of the bones resembles ulceration of the soft parts we do not often find caries with some specific cause as cancers syphilis &c 188 hence a care cannot be effected without a change in the specifc character of the disease Tumors of the Bones Operation Divide the muscles down to the root of the tumor & saw it off with Hays saw & dress the wound as a simple wound The only precaution is to avoid cutting nerves or artery & the muscles should be divided longitudinally Necrosis This consists in an increased vasculanty & size of the bone Attended with periodical pains and sometimes breaks out into sores of the bones & soft parts. The only remedy I have found useful is an eschar of costic in the soft part over the disease & this continued a year or more till the tumor subsides Amputation does not always cure for it sometimes returns. Another kind of affection consists in a complete destruction of the bone & in the place of the bone is left a soft substance Medullary The general diseases of the bones consist in a deficiency of bony matter Phos. Lime rendering the bones more flexible the marks of this disease are first enlargement of the head perhaps a protuberance of the forehead the muscles of the neck seem to be diminishd in size. The abdomen is usually distended & sometimes diarrhoea. It is said the faculties are quicker developed Indications Restore the action of stom. & bowels – cold bath & 189 warm friction. Another affection of the bones is an extreme brittleness by which they break from slight causes – I know of no remedy. Wounds of the Bones of the Head In wounds of the integuments the inflamation is sometimes extended to the bones. Fractures of the skull heal as well as any other parts if the containd parts are uninjured and no necessity of operations when fits occur after injuries of the head I think they arise rather from the concussion than compression Sometimes slight symptoms will go off without an operation When blood is extravasated the consequence follows immediately. But if matter is formd under the cranium the consequences will not appear so soon If a small body is the cause of the injury the brain may be injurd without knocking the person down – so with larger bodies persons may be knockd down with serious injury to the brain the symptoms of injurd brain are paralasys of the organs enlargement of the pupil insensible to light breathing like apoplexy irregular. Slow countenance distorted. In concussion symptoms are different especially pulse quick & small, no operation is required for symptoms of concussion A man fell - senses not injurd at first Case but soon fell into a stupor & symptoms of extravasation Trepand him but he died 190 when matter is the cause of the symptoms they do not appear till the 3rd or 4th day then coma convulsions & death – the younger the subject the better the prospect in injuries of the skull In concussion the patient pukes but not in compression Operate on the skull anywhere the injury requires – be careful about injuring the peri [Hays saw] -cranium with the saw – no bone should be removd if it holds by a small part for the pericranium will convey to it the circulation – If you find the dura mater ruptured Hernia Cerebri may be feard treatment Aply lint over the part: take a piece of pewter hammer it to a shape to sit nicely on the skull bind it on snug but not too tight let it remain 14 days when the parts will be heald. Attend to the state of the system if there is inflamatory diathesis reduce. Lay the patient on a inclind plain to diminish the momentum of blood to the head never bleed when the arterial action is diminishd – the stomach & bowels should be evacated – artificial puking I do not like, if there is a propensity to vomit wait before you give the Cathc. 191 Fractures the theory of the union of bone is that grautations shoot as in the soft parts till they meet the bony matter is deposited The rough edges are absord Amputate a boys leg 3 weeks after the injury Case the ends of the bone shot by & granutations were shooting out on the sides to unite. Complete rest is not absolutely necessary – I set a Colts leg & fixd it firmly in the place & let him go it done well- not absolutely necessary that a fracture should be restord immediately I once set a bone 30 days after the injury done well I have not doubt but that app Application -lications are often too abundant to broken limbs hindring the healing process. In reducing we have only to flex the muscles & moderate extention is sufficient – Do not furthen your limb with bandages & splints Simple & Compound the danger is as much from treatment in compound fract as from the nature of the wound bandages washes &c When the points of bone project & cannot be returnd cut the soft parts to admit the bone to pass back Woolen is best for bandages because it is elastic Fractures of particular bones – Clavicle I see no necessary of the complicated bandage of desaute – bind up the arm to the body & 192 The weight will not displace & union will generally be affected Fracturd Rib bandage the body so as to prevent their elevation Fractures of the Ileum & Pubes keep still & wait for them to heal Arm Support the arm by one splint & confine it to the body – fit the splint to the under surface of the arm the subject of pressure should be well attended to in fractures Thigh In reducing the frac’ of the Femur make a lever of the lower part of the limb & you need not use much force never extend by the foot extension will not affect anything unless it is gradual Dislocations I suppose that the ligamentous structure of the joint must always be rupturd in disloctions. The limb should be us’d as a lever in the reduction which will save the application of much force In dislocation of the jaw – use the thumb as a fulcrum Shoulder Pulling will not reduce this because the scapula is movable. Make a fulcrum of your knee & if all does not answer give tobacco emetic. Bind the arm still if you will keep it 193 There – Remember that gradual extension alone will be useful in reductions I have reduced a dislocation 4 months after the injury Elbow Flex the arm & make extension Hand A splint extending from the elbow down to the fingers bent so as to have the hand partly flexd bend the splint to the limb & rest for a cure Deformity is likely to be the consequence of this injury Don’t encumber the limb with bandages treatment If there is much soreness use some mild ointment or wash Sprains when the inflamation subsides use the limb patients often think they Can’t use friction & urge the use of the limb healthy limbs may be spoild by bandages sometimes a disorderd state of the system at the time of the injuries prevents the healing of sprains Bandages In indolent sores of the legs bandages are useful – An indolent state of the veins seems or to be the cause or an inability to return the blood- Here bandages may be applied to the whole leg Apply so as to have the pressure equal Flanil best because elastic – sometimes the bandage may be left off during the night use some kind of astringent wash make an ointment of aa Helebore & skunk cabbage with 194 Bees wax moderate living & sometimes a dose of salts – Bandage the lower jaw in fracture to prevent motion – varicose veins may be treated with bandages Amputation This is often necessary on account of previous bad treatment – if the veins returning the blood from the limb has been unjurd it is necessary to amputate. In white swelling you should not amputate till all remedies have been usd unless the patient faild suddenly It is said that if amputa is performd immediatly after the injury there is less chance of recovery than if it had been put off till the system had become accustomd to the action of disease. In some cases of contusd wounds there is much reason for immediate amputation If by amputating at the joint we can cut off all the disease that is the best place – Save enough of the soft parts to cover the stump. First thing suppress the hemorgh I think more fear of bleeding is generally indulgd than necessary – I think a good operator may amputate without compressing the artery. Wait 10 minutes after an opperation to see if all the vessels an secure- Fear sometimes suppresses the bleeding. Hernia Is not a rupture but a protrusion through a natural opening – or the fiblers of the muscles may be separated. through which the sack passes. 195 Symptoms A complete interruption of peristatic motion attended with pain felt in the pit of the stomach. Treatment baths should not be given Avoid violence in attempts at reduction in Inguinal hernc use both hand so as to make lateral pressure as well as backward & upward If you cannot reduce in this way apply cold ice. or ether the greatest danger is from the confinement of the part not from the operation – If much inflamation bleed I have known fear a powerful means of reduction Injections of warm water which operates as a warm bath Injections of tobacco smoke I should as live submit to an opperation women are less to this than men they are more liable to umbilical pregnant women sometimes die with it Anurism There is undoubtedly a constitutional disposition to aneurism & hence the cause may not be so often strains &c When anurisms have been continued some time the continuous action of the heart & the extreme part of that artery seems to be discontinued hence often on opening the sack there is not much bleeding What makes the forcible pulsation of the sack? Take care about including any other part with the ligature nerve &c sometimes much mischief is done. 196 Operations on the eye these operations are only call’d for when the lens are the cause of the opacity If the patient cannot distinguish light from darkness there will be no use in operating for there is some disease which an operation will not benefit they sometimes think they can see light when They cannot If the eye is sensible to light we can see the action of the pupil. Or when one eye only is affected the pupil may act by sympathy with the other & not from the stimulus of light – we should acertain that there is no opacity of the cornea the needle should be inserted 2 lines back of the transparent cornea the eye placd in a strong light striking it oblikely so that the operators eye shall be in the angle of reflection - Couching is most approvd in Europe & this country – I have been as successful with children as any other age. [Treatment after operation] Inflamation will not always follow I generally apply a dosil of lint & bandage be cautious not to get it to tight – If symptoms of inflamation appears in 6 or 8 hours apply equal parts of opm & spirits and give laudanum or keep the eye wet in cold water your patient may require bleeding the eye should be kept from the light. Polypus of the Nose Cure by escharotics And ligature & forceps – if bleeding is troublesome inject solution of Galls – if you compress these tumors an hour they will generally die. 197 Foreign bodies in the oesophagus I have us’d an instrument [graphic] successfully Instruments for operating on the eye for ex [Eye] -traction – One to hold the lids open [graphic] another by which you may hold the eye by the cornea [graphic] and a scalpel Supuration sometimes takes place in the globe of the eye & the matter crowds out the cornea so as to give it twice its natural projection [graphic] I have cut off a section of the cornea in such a case the eye then colapses so that the lids shut & cover it from the irritation of light – the operation is simple & the wound ususally heals well. Bronchotomy open through between the cricoid & the thyroid Cartilage transversely this is only calculated for the admission of air the incision should be made longitudenally for the extraction of foreign substances no vessels of any magnitude will trouble you when you arive at the rings of the trachea stop for a moments to sponge away the blood that strangling may not be producd – then cut through the rings with this instrument [graphic] coughing will be produced & the substance thrown out No ligatures should be usd because it may be coughd out of the orifice afterwards 198 When substances get into the throat the epiglotis closes upon it & prevent it being thrown up put down your finger & raise it & it will fly up Stricture this must be overcome by passing the Bougie Diseases of the rectum I have thought the cause of many of these to be indigestible substances have passd down & log’d there acting as foreign substances Symptoms Stricture A difficulty in voiding the feces – the stricture is often higher than the finger will reach bougies also necessary here Sometimes the affecting of the rectum are schirous then we have no remedy. Tumors A tumor implies a change of structure, or a swelling with a structure peculiar to tumors 3 kinds of tumors 1st wens Containing a fluid of curdly appearance do not communicat any mischief to surrounding pts sometimes shoot out fungous then they should be entirely destroyd or let alone – because merely irritating produces a bad ulcer. 2nd Tumors containing a substance like tallow generally produce no other inconvenience but bulk or weight 3rd Tumors containing a pelucid fluid like the white of an egg found on the hand foot &c Difficult to cut them out I have inserted a seton & let them run out 199 Another kind is the Carcinomatous In removing tumors of the neck we do not find them involved in the parotid gland: generally under the platisma moides over the other muscly thuroid gland is sometimes the seat of disease operations should not be performd here. Cancer If the affection is a solitary one there is some encouragement for operating & not without If on examination you find white lines diverging from the center of a tumor or sometimes red the operation is forbidden – these cannot always be discovered without a magnifying glass – circumstances encouraging an operation are soundness of the parts – every part should be removd which is at all diseasd. Remedies without extirpation have not often been successful – A woman Case usd a wash of Sug. Lead. & took Cienta & at the end of 2 years got well - Tumors of this kind are less tenacious of life hence caustics &c act on them destroying while the surrounding parts are not kild Patients do not survive the cure long After the operation use red oxide of iron 3 parts & Cicuta 1 part give in pills so as to use 2 or 3 grs of the mixture at at a time Carb feri also us’d Farinaceous diet important. Hydroceles This may be confounded with diseasd testicle – but little pain is felt on pressure in Hydroceles much pain on pressure if testicle diseasd 200 in hydrocele the swelling begins at the bottom &c. This sometimes has a natural cure when not you have only to destroy the sack. I chose to operate with a scalpel make an inscision through the integuments & puncture the sack with a lancet let a linnen cloth oild be inserted into the wound & a suspensory bandage. Travers on Burns No species of irritation exhibits the symptoms of prostration in a more markd degree than these especially when severe the remedy on which I rely in Burns inducing this state is Brandy & Gruel 1 part of the former to 2 of the laster dose a tablespoonful at short intervals till reaction begins to come on. If much stupor excites & previous costiveness give 10 or 15 grs of the Comp. Scam. & Cal. powder. Opm. in small doses does no good & large ones hurt. Pain good symptom. Local application Turpen. & ol. oil or Turpt. & Cetaceous oint.- subject to such changes as the state of the surface may require Lime water & Milk liniment after supuration has commencd & when it is abundant Calamim or Chalk powd sprinkled over the surface & definded by the same or some simple ointment thinly spread on linen & this latter may be the local treatment for superficial burns 201 Tooth Ache (Paris) Camph - ʒii Ol. Terebin - ℥i Mix Court. Plast Paris 3b1 P Corn Plast av “ - Adhesive Plast av “ - Travers I have known a pill of 5 grs of Cal. 1 of opium stop troublesome vomiting together with a full opiate enema if the bowels are loose or if costive stimulating drastic one when every thing else has faild. Profss. Hnights Hydragogue Recep ꝶ Etaterium gr 1 [HydroThorax] Cal xv Digital fol. Squills aa [?j] Canths grs v Mucelage 2. S- Make Pill No 40 Chap Cal. squells 1 form 2 later & opm if requird 202 Moral Insanity A morbid perversion of the feelings affecting habits without any hallucination or erroneous conviction impressd upon the understanding it sometimes coexists with an apparrently unimpaird state of the intellectual faculty Doct Pritchard Cyclopedia of Medicine He knew a patient in the assylum who would only eat that which was stolen Mrs Drummond a lady of fortune was a person of the highest moral nature insomuch that she devoted herself to a mission to raise money for an infirmary Yet she could not refrain from putting the silver spoons of her friends into her pockets when at their entertainments. Boil Potatoes Boil the water – then throw in the potatoes skin on when Boild 2vss dash in cold water Let be 2 or 3 min 5 & pour off This half remove the pot lid & evaporate over a slow fire till the steam is all gone then pull & use good potatoes thus cookd will always be meal of food. 203 Mercury It was a maxim of a practitioner of great distinction in Philadelphia Doct the Bond that in most cases where other forms of treatment fail. We should resort to it as a [???nier] alternative By pursuing this course he acquired immence celebrity for the no. & variety of his extraordinary cures. Hooker, Sodo Hydrargurett of Postass ꝶ seutiodide of Merc. gr IV Hydriodate of Potass [?j] Aq distill ℥i Dose 5 qtr in water 3 times a day M.ft. sol. Sam2. packson, sol. Iodide of iron ꝶ Iodine - ʒx Iron filings - ʒv Water ℥viijss dose viii to xv qtr 3 or 4 times a day 1851 June 29th Boy 14 years old Lawrence Morrill Head symptoms of low bilious fever increasing on him for a week called this morn early to see him having had a restless night. Some coma rouses after a few moments disturbd sleep crying out in wandering broken & muttering expressions – head hot – pulse Frequent & wiry tongue very dry & very red Bowels evaluating without pain a water discharge whenever he rose or changed the position of the body – not very conscious – answers with much difficulty simple question. In short, having the ordinary Symptoms of the diarrhea accompanying bad forms of bilious fever which had also been an accompanyment of the fever since the commencement and also having the symptoms of cerebral congestion which we find in bad & fatal forms of that complaint morning next direct ext Beladona 1 gr grind with 1 dram of brown sugar and add ℥ jv of water dose teaspoonful every 2 hours Separate, prepare pulv, Coloynth 1 gr & sugar ʒij pulv & incorporate well & give a pinch every 2 hours atternating with the Beladonna Evening visit, delirium & coma all gone had only one or two evacuations skin cool tongue less dry, answers questions correctly looks in his countinance expressive much improved in all the symptoms parents said after the 2nd dose the symptoms all modified & continued to modify through the day Mind better but incapable of much application. Same directions for the night Jun 3rd Improving pulse slower, milder mind improves blister drawn behind the ears & on the nap of the neck – paroxism of fever less destruct – Fretful & restless – occasionally drowsing. July 1st Improving slowly Continue the solution of ext Belladona add weak solution of sul Car potass teaspoonful every 2 hours – Bowels movd 3 times – not very watery. 3 & 4 still very irritable some of the time slightly derangd – Bowels less irritable tongue not so dry – periods of more consciousness. 6-8th slowly improving – conscious but still irritable bowels better continue the ext Beladona omtted one night doubting whether it had any effect but had to return to the use of it to procure rest 209 Case 1st Mrs J Stratford Herling AE 30 Slender, delicate confind with 3d child: natural labor Comfortable till the 4th day: when there was slight chillings followd by Pyrexial symptoms, pulse 110 some tenderness of the abdomen tongue coverd with a loose foul fur: restless & some what thirsty. Direct Cathc of Cal 10 grs followed by Cast. ol. operates 2 or 3 times with much relief till the following 2 or 3 day more fevers hot restless – Cath blue pill 4 grs followed by ol. vic. again relievd: but pulse still small easily compressd & from 110 to 120 – This state of thing continue strength diminishing till 10th or 12th day when there were symptoms of general convalescence: tongue had been redish & rather glossy which is still the case though now looks rather better some appetite – scanty secretion of milk & continues to be so – about this time a light occasional cough which had been at times a little troublesome for a year or two was now rather worse, but easily controlld by anodynes – About the 3rd week after confinement symptoms of phlegmatic Dolens appear in the right leg increasing the general irritation & prostrating the strength, continuing with a rapid small pulse, much pain, tenderness, & tumefaction of the leg which continued for 10 days when it with the general symptoms began to subside 210 but pulse still continues rapid & small appetite partially returns & considers herself improving: when sometime in the 5th week the other leg commences & goes through the same process occupying the same time when about the 7th week again seems improving appetite returns begins to sit up takes tonics, pulse 100 & one or two days down to 90 – Call with Doct Knight he pronounnces her convalescing advises a more liberal use of Quinine or Nit. Silv. 9th week moves into another room had a chill: thinks she took cold has some febrile symptoms again – cough more which for a week or two past had little if any appetite gone, pulse again 115 some pain in the left side & oppression over the sternum expectorly some muco purulent matter: Blisters relieve the pain & oppression, cough & breathing more oppressive till the 5th day after the chill: Rx paregoric Nitre & squills operated profusely as a diuretic relieving all the symptoms so that [Doct Denison Call 6] next day but little cough not much expactoration & but little fever pulse yet 100 or 100 small & but little strength tongue yet smooth & rather red though moist, breaths better seems improving Call Doct Hook & Denison Doct H examines the chest by percussion & stethoscope finds the left [cross out] side sounding very dull Diagnoses extensive disease of the left lobe of the lungs Hepatied – Direct nourishing food occasional anodynes & Nit. Silv. 211 with the to do Hydroqurett of Potass. breathing improves: cough easily controlld by anodynes, little if any expectoration _ sleeps well no regular hectic symptoms _ some appetite says she shall be well soon, but does not gain strength 10th or 11th week the cough almost entirely ceases has faint turns which she calls wind which last but a few minutes & pass off - Is most of the time comfortable but emaciated & weak – pulse & tongue the same 14th week wishes to be raisd up in bed faints & dies Next day friends request Post. mort. examination – Remove the sternum pleura adheres extensively: Left lobe solid impervious to the air heavy air cells all obliterated red, liver color & consistence – right lobe much the same except the upper 1/3 d pervious to the air that being all which had been usd for respiration for some time & that having the air cells much filld with a thin mucus seeming to completely saturate the whole structure as a sponge is filld with water – Heart sound Liver sound – stomach & bowels not examind Could this change of structure have been interrupted by remedial means? May not this have existed previous to her confinement? How can we account for so ambiguous symptoms with such extensive disease? There being no symptoms by which a lung affection could have . 212 been determind except the evidence from percusssion. An attack of searletend 2 years before terminated with much irritation of the Lungs Cough. Oppression & feeble health for some months but at length enjoyed her usual health for a year or more previous to this pregnancy – May not this state of the lunge had its origin in that attack of searletend? Case 2d Mrs Thorp AE 51 spare habit active irritable passionate, subject for several years to much nervous head ache Chronic derangement of stomach & bowels. Winter of 1836 had an attack of subparalasys with an increase of her nerves irritation about the head. But recovered in the course of the winter leaving an obtunded dead state of perceptibilitiy of mind & especially of the moral sensibilities & social relations & obligations. Subject to fits of anger from the slightest causes venting her feelings especially on her own family & thus becoming actually a burden to her friends totally destroying all affection for her & exhibiting in her exacerbations of excitement and anger the furg of madness. Tongue sometimes lightly furd with a compact moist coat apparently mingling 213 mingling with the surface of the tongue: pulse from 80 to 95 small & compressd & usually soft – sometimes a little thready – Countenance rather vacant except when excited then the eyes glassy & vindictive: motions quick: muscular power evidently feeble but would fly at her house wifery (which she always had managed with the greatest tact & skill & neatness) with revenge in every action thus continueing or rather growing worse till June 1838 when after 2 or 3 days of violent excitement on account of some family changes & which she was opposd, 10 oclock PM rose in the bed exclaiming my stomach & vomited several times evacuating the stomach freely & had 2 or 3 alvinc evacuations: when I arrived 11 oclock found her strength somewhat prostrated: a relaxd state of the skin especially about the head & neck hands rather cool pulse about as usual, & vomiting a spoonful or two of mucus looking fluid every 15 or 20 minutes without much retching, having rather a lethargic appearance but easily arousd when spoken to Treatment Mustard sinapisms over the epigastrium and on the feet 30 qtr of Tinct opii soon threw it up, repeated, then retaind it long -er but then threw it up, grows restless, use 1 1/2 gr opm no more vomiting 3 oclock pulse 8 or 10 beats faster, restless left her in the care of her mother 214 3 hours – returnd, found the pulse nearly gone at the wrist, easily felt at the bend of the arm about 100 or 110 hands cold countenance sunken & more lethargic mustard sinps on the legs arms & bowels bathing strong infusion of Capsicum in vinegar hot: brandy slings truly with hot bricks wrapt in flan’cels wet’in vinegar & water continued failing till 11 oclock & died. See Case xxiii q Hunter semitones similar Reflections What occasion death so soon? The vomiting & pain did not seem sufficiently violent for gangreneous inflamation pulse sink in 2 or 3 hours after it began to fail which is not usually the case in gangrenous termination – I suppose the nervous system had been so long under the influence of stimulus of anger that the excitement connected with that state of mind & this lately had been so commonly & habitually so that the capital stock of excitement necessary to sustain life had now become so nearly exausted that the prostration from this attack of the stomac & Bowels was sufficient to use up the remainder or sufficient to prevent any reaction – as in the case of sudden deaths in debilitated habits from Intemperance & Maniacs In some subjects we find anger producing determination to the head with flush Countenance &c while others have pale faces under its influence [Rush] syncope & even asphyxia – which might have been produced in a strong determination to the internal 215 organs in this as her face was pale under that exciement Her stomach had evidently been the seat of more derangement than the brain Apetite always small & for several days at once none – The stomach the seat of much pain and distress both alternating and occurring at the same time with pain in the head. Excessive emotions of the mind a frequent cause of disorderd stomc & Bowels (Gregory Practice) Probably the cause above Mrs Alsop AE 34 Confind with her [Case 3rd] 2nd Child, robust habit natural labor – 2nd day evening taken suddenly with violent pain in the Hypogastrium extending into the left side over the Illeum – usd fomentation freely for 2 hours no benefit much tenderness pulse increasing in force & frequency – venesect 45 oz in an erect position without fainting – feels relievd – stop the blood – in 1/2 hour pain partially returns though not a 10th part so bad Sal. eps. 1 oz operate freely no more trouble with the pain or soreness – recovers fast - in 2 weeks walks 1/4 mile visiting. Remarks I see no way in which the Antibleeding physicians could have got along with this case without inevitably having to see the case go through an extensive inflamation of the uterus or its coverings the Result of which might not have been by any means 216 very safe to the patient – My inference then as in numerous other instances as to bleeding of a similar description is 1st that no theory however good is of universal application. 2nd It is difficult for any man to be a good practitioner who has too many favorite theories to sustain – Let the mind be well stor’d with accurate observation & the opinions & theories of authors that we may rather have them at hand ready for use as the circumstances may require than to be committed to them so as to be obligd to use them to sustain our previous opinions – As to bleeding when judiciously usd & discriminately & appropriately practiced like other remedies of potency & power in controlling the operations of the system it may be resorted to in peculiar emergencies with immence benefit, as well as on the other hand with incalculable mischief – Our general rule however should be that when remedies of the greatest power is not positively indicated or their indication not clearly seen; to eer, if at all on the side of caution rather than experiment. My reasons are in the abundant resources of nature in the human system, which often accomplish more than all beside & put to shame the boasted pretentions of science & art. And which may be seriously maimed & crippled by the untimely & improper use of active medication or interference 217 1838 Miss B Clinton N. York Case 4th arrived in Bridgeport July 1st – Chiefly confind to bed – been an invalid upwards of a year – been through the rounds of medication & finally sent by her Doct to the sea side to be curd by sea air calld to visit her to ascertain whether the sea air would be suitable for her & whether it would be best for her to remain here or return to the interior Countenance pale not very emaciated [symptoms] Always slender habit with a tendency to imflamatory affection with a peculiar sensibility of the whole nervous system – every function of the system in a state of partial derangement except the mind which though effeminate by confinement retaind the balance of its faculties very well – sometimes subject to a little pulmonary irritation with occasional cough but respiration good & little if any pain of the Chest – now rather more disposd to cough with a sense of oppression coming on at evening of the lungs some pain in the side strength not quite as good the inflamatory tendency [pulse small compressd at times n rather obscure handness from 95 to 100] evidently rather increasd – much permanent tenderness the whole length of the spinal Colum spasmodic action immediately produced by the least attempt at counter irritation so that though the protracted nature of the disease may be in some measure attributed to spinal irritation it became necessary to desist from the use of the ordinary means * Blisters seatous &c Cupping (With the state of 218 things it would not be difficult to foretell the influence of the ionicity of sea air – among other things she had never admited the use of tonics, but had several times to be bled & was usually benefited [4th day afer her arrival] by it – Her symptoms especially those connected with the lungs rather aggravated much oppression of breathing – Less strength – wishes Doct Bissel of Norwalk in Council Decision that the pulmonary symptoms would most clearly be agraravated by remaining by the sea exposure – accordingly leaves for the interior the 10th day. Reflections Most diseased states of the system of the chronic character especially [especially] those in which the pulmonary organs are concernd which will not bear tonics or effects of sea air which are much disposd to an irritative sub inflamatory action are injurd or seldom benefited by visit or residence on the sea board – Many persons who have not considerd themselves diseasd subjects who have travel’d from an interior residence on their approach to the sea board have felt oppressd & very uncomfortable & sometimes quite unwell while Case of Doct Fiteh & Doct Bissel] they have been exposd to sea breezes – this probably is more particularly the case with asthmatics The above case after her return to the interior gradually recoverd. 214 1st Case V A. Hubbel AE Slender habit resided in Canton China 3 years – sedentary – returnd in may Latter part of June went to New York on business – found himself capable of enduring but little fatigue felt weak loss of Appetite come home & went to bed lay all next day – Countenance loss of animation cough – hecking dry, tongue light white fur somewhat thirsty pulse 95 rather active sense of tightness about the chest – with general symptoms of membranous irritation of the lungs saline Cathc veget. Diet Tinct Actea [treatment] small teaspoonful doses 3 times a day – rest – stops the cough relieves the oppression & in a week is well [Actea, in Pulmony. Cases] 2nd July C. Bostwick A.E 21 – sanquine Case VI healthy; last winter by exposure contracted a severe attack of pneumonia Bled twice leeched & recoverd – some pain remaind about the side when in July after omiting thick corsets in her dress – pain increased dry cough, breathing labord tongue lightly furd looking rather foul diminishd strength – Cathc saline – bleed, blist. Side Treatment 40 to 80 drops Tinct Actea 3 times a day Cough, stopt – pain better – breathing better strength improves recovers – In the above cases the Actea has Remarks acted like a Charm – It is indicated in subacute action of the irritative kind especially of the Lungs 220 Case VII Mrs W Healthy habit short darkish complexion – Labor. Commences Tuesday pains – slight & irregular Wednes[day] pains harder night partially suspend toward morning increase Thursday diminish. Friday severe enoug [Ergot] to keep up a slight groaning – presentation [Harmless] natural head in the inferior stoait remains through the day Friday night Sat Morn pains subside use Ergot – gave 1/2 teacupful of strong decoction – pains increase constant bearing down about 1 hour when they again subside give 2 tablespoonful more pains increase & in 2 hours after the use the first dose labor completed Child alive! Remarks Here was large dose of ergot usd without [ergot a substitute for forceps] any harm to the child & which evidently savd the necessity of the forceps – If the ergot is poison to the foetus where was its effects? If it kills the Child by compression – the child was here forcibly compressed 2 hours & where was the effects? Doct Hooker thinks from his analasys that the narcotic quality resides in an oily matter which is procurd only by decoction: while the parturient properties may be obtaind by infusion – Hence he says use the infusion & pour off the top of the liquor leaving the sediment which contains the narcotic qualities. See dissertation in Bost. Med. Journal Vol 221 1831 Mrs Ayres A.E 28 sallow. pale. spent Case VIII the winter in Newbern N.C. comes to the N. in the latter part of the 7th mo. Pregnancy. long passage much seasickness Arivd fore part of June much fatigued. Swelling of lower extremeties commences some general fullness: bleed 14 oz better for a few days. Swelling again soon increases till confinement when the skin of lower exts full putting on pressure labor natural. Dull action of the uterus. Child still born 30 min. after the placenta was removd. Convulsions commence violent succeeding in Convulsions paroxysms about once an hour – 6 pm given freely & various means usd to get blood from the arm but could not succeed, no blood appearing to circulate in the cutaneous veins & a remarkable pearly whiteness of the whole skin – Evening opend the Tempe Artery 12 oz no more convulsions occurd till 2 o’clock After bleeding 15 grs Cal given with 2 grs opm sinapism of Mustr extensively applied: in the morning more action on the skin find a vein & bleed 16 oz no more convulsions pulse full strong & quick – General dropsical enlargement Abdomen much distended but little for on the tongue Crm. Tart & galap Caths with infusion of digitalis use 3 days before much effect is producd then 5 or 6 quarts 222 Evacuated by urine in one night – left weak & faint introduce Tonics Tart. Iron swelling much reducd – A spasmodic cough occurs which is subdued without much difficulty by opm Bowels much relaxd though easily controlled by Anodynes 2d week 8 drops of Tinct of Iodine given morning & night as directed by Bost. Med. Journal and Iodine combind with opodeldoc as liniment which reduces the remains of the swelling fast – strength increased appetite returns sits up 4th week, walks 6th week, recovers & returns to the south Case IX Simson B A.E 8 Attack’d with common symptoms of Penmonia subdued without much difficulty about the 5th day, strength, pulse, countenance, cough &c materially improvd some appetite ate a piece of Ginger bread & some preservd Currants 6th day at night after sitting up 1/2 of the day seizd with a relapse violent cough pain & laborious breathing urgent, pulse rapid & passd a very restless night Cal & Ant so as to produce an Em. Cath. Effect Which partially moderated the symptoms 7th day fomentations to the right side the seat of 223 pain, which partly abates the pain but cough and laborious breathing still urgent – continues in this state 8 or 10 days where some fullness is perceivd on the right side over the connexion of the false & true ribs with chills & evident symptoms of suppuration – these continue 2 or 3 days under the influence of poultices & anodynes – when the pain tumefaction & cough begins to subside Appears to be convalescing – appetite returns but lies 3 months without much improvement of flesh or strength at length the cough increases – sound dull of the night side little elevation of the ribs in inspiration – much emaciated: pulse 100 & 120 sits up an hour at once & amuses himself with toys Appetite & bowels natural – Large doses of Anodynes [use Sang. Tart.Em. Ung to the side] are requird to suppress his cough which is rather increasing & wearing him down Concluded to remove to the interior to avoid the sea air – Carried to the steam Bol goes to N. York up the river & out to Clinton some 30 miles from Utica – Improves on the way – had to stop in Skenectady to rest complains of much exhaustion & fatigue, but cough almost entirely subsided – better when he arives at Clinto than when he left Bridgept 2nd week walks about strength much improvd cough none improving rapidly – I conceive 224 Remarks the above to be a case of decided benefit from change of air especially in removing from the influence of sea air – Indeed I have no reason to suppose there would have ever been a recovery while he remaind at Bridgeport The Acted was much depended on in this case for the irritating cough which was one of the most troublesome symptoms in the latter part of the history – and was decidedly beneficial [sometimes increasd to ʒi] this article administerd in ʒss doses 3 times a day in simple irritation has a happy anodyne effect of the most charming character being destitute of the stimulant qualities of opm & also of its constipating qualities – particularly quick to pulmonary irritation – and destitute of the unpleasant effects of most of the other Narcotics when long continued or given in sufficient quantities to exert any controlling influence on the nervous system. Henry Wheeler A.E 25 Hereditary Consumptive Diathesis, cough almost constantly, pain in the side, light white fur on his tongue, light Appetite pulse not much affected Acted directed with success quieting all the irritation as by a charm. 225 1838 Case X August A. Hawley A.E 36 Robust farmer After mowing several days in excessive hot weather complaind of his work as going hard, as though the scythe had been dull – left off work & lay about the house feeling rather unpleasant at the stomach with a sense of exhaustion – partial loss of appetite – so continued for a week rather loosing strength untill he lay bed 1/2 or more of the time during this first week pulse or tongue was but very little affected - The latter part of the week however a light frosting of fur was seen mixing in with substance of the surface rather than covering the surface & skin becoming rather husky pulse having a slight thrill of tenseness & at the beginning of the 2d week from 76 to 80 generally rising 4 or 5 strokes at evening The case continues through the 2d week with the same general symptoms – bowels sensible; disposd to Diarrhea with the use of diaphoretics or even soda powers (Effer vess Mixt) skin dry & hot at evening & not very hot in the morning Diaphoresis readily producd by sudorifics but these 14th day soon affecting the bowels had to be suspended – thick white fur on the tongue with clean edges met the paroxisms by sponging cold which kept down the heat of the surface reduced the force of the pulse & afforded peculiar comfort to the patient The 15th no thirst from the first 16, 19th days little if any paroxysm pulse 68 skin cooler - blister the abdomen - drowsy - obtunded faculties - no apparent local affection no pain 226 blister acts well but affects the drowsiness but little if any – direct 2 to the legs 18th day Alvine excretions become natural Tongue from this date to the 25th grows cleaner Doct Simon in Council with a little disposition to eat certain select articles of food, but no improvement of strength less stupid during the fourth week when latter part of the fourth week perspirations commence at first partial coming on in the last of the night & morning after 3 or 4 days passd in this way with a slight excitement in the evening & sweating in the morning which the 4th day becomes general & appears critical but without the expected relief of the general torpidity or of the paroxysm of excitement – since the sweating has come on I have directed stimulant in small doses which seem to suit very well especially Whortleberry Rum for a day or two on the 4th morning the perspiration becomes general & profuse rather reducing him – Direct Quinine in 1/2 or 3/4 gr dose one every 2 hours 4 or 5 was usd perspiration continues till 2 o Clock P.M. when it begins to subside & is followed by the same kind of excitement which in the night & next morning is more than it has 22 day pulse 95 been & continues without perspiration till 3 o Clock P.M. when to break in upon the paroxism of excitement drynes of skin & a cough which unless subdued by large doses of Morphine 227 was very harassing and had now become for 2 hours very much so; materially increasing the pulse & the fatigue we now direct emetic of Ipecac; 3j or more was given in infusion without the least effect on the stomach but the effect on the skin was most completely relaxing bringing out a profuse perspiration & continuing all night & much reducing the excitement some 6 or 8 hours after the administration of the emetic it passd off by 3 3rd day & night 12 oclock next day discharges from the bowels the first rather copious no cough since the use of the emetic quiet & composed asks for bottle cider procurd usd Doct I. directs for the cough Elix Panger Doct Ives in Council Breathing Natural ℥i spir rit ℥ss sulph ether ℥iii & the use of Moseleys Tonic Sol. small doses or ox Bismuth or flos. Zinc or small doses of Quinine acidulated with acid 32nd day Bottle of cider suits: A pyrexial Period with perspiration latter part of the night: sleeps well pulse 80 Direct 10 qtr Moseleys Ton. Sol. 3 times a day. Coughs yet, though the paroxysms not so long 24th day Has a paroxism of excitement commencing at 3 or 4 oclock lasts till 3 or 4 oclock in the Morning Pulse in the paroxism 95 & terminates in a fine general Perspiration with much relief more disposition to eat. Expectorates dark grumous blood which terminates a paroxys of coughing Direct a weak solution of Quinine acidulated with sulph Acid & pills for a laxative 228 Composd of Rhei. Ipecac. Carb. Soda 35th day Less excitement mind more active Appetite increasing Cough yet troublesome Acetea. Directed 38th day Cough diminishing – Convalescing 41st last night coughd more & expectorated some pulse a little excited. Breathing yet natural. Direct Digital & Sang aa 3ii Gen. Arab. 3ss Elix Paregor 3ii pint Bol wat. Desert spoonful every 4 hours 42nd Cough less pulse better strength improving slowly Recovers after 6 or 8 months Remarks The above was a case in which it would be impossible to fix upon any locality as the origin or seat of the disease. Especially the stomach & bowels so that the doctrine of the origin of fever being in inflamation of the the stomach & bowels has no foundation in this case. Whether the primary cause comes through the stomach, lungs, or skin the whole solids & fluids become implicated & continue so untill there is a local renovation: how this renovation takes place whether by Concoction fermentation or reaction it is difficult to say, but the process must be gone through: and the more those organs or functions which seem to suffer most in the progress are vigilantly guarded the better the treatment And indeed this is to constitute the indications & treatment. He who undertakes to controll continued fevers has yet to learn some of the first principles of the laws of nature in their application to this subject the part of the system which seem to suffer most in this case & which undoubtedly 229 was one reason of the protracted character of the case was the nervous system which appeard in the torpor of nearly the whole course of the case the brain & spinal marrow could not have had its usual flow of excitement while all the functions seemd suffering under a partial suspension & especially the mind The insensibility of the stomach to the influence of Ipecac on the 22nd day can hardly be accounted for upon any other principle than that of the peculiar torpidity of the nerves which supplied that organ in common with that which characterizd the case that no inflamatory action of the first passages as [Br??sais] would suppose existed in this case was evident from the state of the alvine discharges which at no time was particularly vitiated: & from the last of the 2nd or beginning of the 3rd week were nearly or quite natural while the other symptoms were not at all abated. Some fevers there are which have much derangement of the functions of the primae vic and are calculated to favor the supposition that their location is there while most of the summer & Autumnal diseases of the class of fevers are according to the views of Hordyce a disease that affects the whole system, the head the trunk & the extremities; the circulation the Absorption & the nervous system; the skin the muscular fibers & the membranes; it affects the body & also the mind it is therefore a disease of the whole system 230 the cough which in the above case has been one of the most obstinate symptoms I have reason to suppose had its primary origion in the condition of the stomach which was of such a peculiarity as to develop that peculiar sympathy which exists between the stomach & lungs. What this condition of the stomach was we have no means of determining from the appearance of the tongue or any other symptom of the case if we except the remarkable insensibility of that organ to the effect of the emetic which was usd. This would lead us to suppose that the whole difficulty consisted in the torpor of the nerves merely which go to the supply of the stomach. The cough in the above case continued through the whole Convalescence – some of the time very afflicting with evident Symptoms of Chronc. Bronchitis this seemd finally to subside (without material influence from any remedial agents) under the influence of a bad boil in the axilla which suppurated & dischargd freely for 3 or 4 weeks It is possible after all that the Bronchitis may have originated from the liberal use of cold ablutions of the extremities which was used for several days which was very grateful & had apparent influence in reducing the paroxysm of excitement Case XI Mrs Tomlinson wife of Hon G. Irritating cough with much oppression about the chest Usd the Actea with blood root - successfull 231 Case XII Mrs. B AE 25 sanguine temperament Second confinement very natural labor 2nd day some tenderness about the region of the uterus occasional pains which the nurse calld after pains but I knew by the action that the pains savord more of that kind of irritability which is a strong predisposition to inflamation in such cases than of that kind of healthy action of the uterus by which remaining coagula are expelld and accordingly directed spirituous fomentations. But the nurse not exactly wanting the trouble & not fully believing in the necessity of doing much omited to use the fomentations. The pain continued & tenderness rather increasing till the third day a chill occurd followd by the common symptoms of highly irritable or inflamatory action of the peritoneal kind Means for shortning the duration of the chill as fomentations warm drinks &c were resorted to but pain & tenderness still continued much increased pulse 120 secretion of milk commencing thirst. restlessness. & anxious countenance Commence the use of Denmans treatment in repeated doses of James Ant. Powder 6 or 8 grs till nausea & vomiting or purging take place Evacutaions afford some relief the effect of the medicine being chiefly purgative fomentations continued. Pains & tenderness rather diminishing under this treatment till the 6th day when tenesmus & suppression of urine with frequent discharges or rather a 232 frequent desire for the stool with but little passing tenderness increasing restless & anxious gave strong infusion of sal eps senna Mannu & seeds 2 tablespoonfuls repeated every hour till operation 4th hour bowels move freely with immediate suspension of the diarrhoea & tenesmus & relief of all the symptoms passes water & has a good night pulse diminish in frequency 8th morning some pain darting about the bowels & somewhat fixd in the right side direct another Cathc of the same follod by a blister 6 by 8 inches Drew well much relief of the remains of pain & pulse 85 convalescing 10th day some appetite. Remarks the practice of bleeding in Child bed where there is pain & tenderness following chills with symptoms of peritoneal inflamation undoubtedly is of the highest importance especially when early resorted to but the above case is evidence of the safety of omitting or substituting a thorough cathc effect with such substances as will not produce any more irritation than is necessary for a full evacuation and thorough fomentation with occasionally a P.Dov. to quiet pain & irritation – The James Powd repeated several times within the space of 6 or 8 hours in as large as the stomach will bear & if necessary followd by saline Caths & injections if necessary 233 answer a good purpose – I suppose where the chill is permitted to run on without proper attention from the nurse much heat irritation & rapid pulse thirst & restlessness following a free bleeding previous to the fomenting & Cathc practice is indispensably necessary The practice in case 3rd P seemd peculiarly requird on account of the great severity of the attack & the peculiarly plethoric habit of the pation & undoubtedly was the only efficient treatment in that or a similar case. 234 Case XIII Alsop AE 28 Sanguine temperament English [?ooler] Catholic Loss of appetite pulse not accelerated perhaps a slight hardness, slight disposition to cough hardly observable, stomach irritable enjecting the food - no appetite - A sort of fullness about the face which has something of the livid about it – perspiration easily excited as he says – but it was probably partial says that he had for 3 or 4 days while about his employment spit a little blood which would be thrown off with a little effort at a few hacks of coughing – loss of strength – lies a bed most of the day – rather restless nights – Tongue not furd. nothing unusual in the appearance of it except perhaps an appearance of approaching fur on the back part of it – a sense of weight – under the lower half of the sternum – sometimes a little pain under the right short ribs [in the right side] Treatment Caths Mustard Ext. Irrits P. Dov 4th or 5th day better Sabbath sits up most of the day has more relish for food – pulse slow 60 Monday goes to the shop 100 rods cold day in Janu Wednesday & Thursday not as well more of the sense of weight precordia more loss of strength cough some – On farther examination learn more of the bloody specta nights breathing a little hurried A large blist over to the sternum with a partial relief of all the symptoms pulse 50 small weak weight gone & cough gone 235 The above case proved to be one of those Remarks obscure lung affections which present but fear of the ordinary symptoms & shows the necessity of a careful examination of symptoms – the case probably would have recoverd under the Cathc treatment with the local counter irritation & rest had he not gone out on Monday but the exposure to the cold air & the effort of walking was sufficient to produce a relapse when the Lung sysmptoms were more fully developd. A blister with Actea Mucilage & a small proportion of sanguinaria would probably have terminated the case sooner & have been the best treatment would not bleeding have done best of all & requird to be followd by few other means? 236 Case XIV Mrs Sherman AE 31 Fair Complexion Sept – 39 Confind natural labor 4 or 5 hours Appetite returnd milkd secreted lochia continued took a Cathc 3rd day because she thought she must – not for fever – operated moderately – passd along to the 5th day took Calc. Magnes no operation 6th took tablespoonful of oil operated moderately – Calld acidentally morning of the 6th day found her sitting up pulse 108 or 10 – advisd her to go to bed & keep still – tongue light fur on it – no tenderness of bowels or thirst in good spirits disappointed because she was orderd to bed – wishd to sit up 1/2 of the day – Calld in hast 5 oclock P.M. to see her, said to be worse – found her with a sub derangement of mind – in rather happy mood but supposing that she was soon going to die – pulse increasd to 120 small & hurried - Cathc previously given had by the assistance of the syringe operated though not Copiously – gave a P. Dov. & had a good night rest next day pulse 110 quiet & fur comeing off next 4 or 5 days fur come on & went off 2 or 3 times leaving the centre of the tongue dry & rather red pulse kept rather increasing in frequency till 12th day 140 small countenance sharp & Cadaverous evacuations from the bowels procurd with some difficulty bowels tympanitic & much ratling as though a profuse diarrhoea was moment threatened yet when discharges was produced by 237 Caths feces natural but thin Cast ol ℥i [Secret?] ℥ii followd by Rhei. Scu. & Suds operated moderately strength low mind failing * pulse rapid Direct evening 12th day pill made of Capsicum Cloves & Alsplice – ung. Merc Camph & Capsicum - ring – rub in bowels thighs freely – give chicken tea, wine whey, takes the tea & whey well next morning looks rather brighter pulse 125 or 30 mind more cheerful centre of the tongue yet dry – 14th Day pulse 115 Countenance improving appetite increasing. Left her in the care of the physician who had Formerly attended the family Improves slowly Slightest causes produces relapse – loose flesh Pulse continues frequent fails with some Looseness of the bowels & about 2 months dies. *not deranged but imbecile & forgetful 238 Case XV Mrs Foster AE 62 Been an invalid for 4 or 5 years said to have a stomach affection supposd to be membranous irritation of that organ seized on Friday evening Dec 6th with severe symptoms of Pneumonia which continued through the night in the morning partially abating: pain which was in the right side & breast less difficulty of breathing less & less restlessness – Calld to visit the patient at 11 oclock of the 7th Countenance anxious occasional cough, sometimes with a small mucus expectoration, sometimes mixd with dark mudy looking blood, Breathing humid, pulse 110 small & not resisting: skin not dry & perspiration easily induced pain which had been severe during the night, now felt only when cough or change of position producd it. From the abatement of the urgent symptoms: the age and invalid constitution of the patient: concluded to defer venesection & Directed fomentations with hot bricks wrapt in flannels wet with water & vinegar with Dovers Powder which produced a copious diarphoresis with some remission of all the symptoms infusion of seneka Licorice & Iceland moss 8th But little cough: breathing slower skin still moist pulse 100, some thirst, rested tolerably well, but the rest partaking rather of the comatose character slight expectoration of mucus with the same Mudy appearance Cath of salts & Senna 9th rested well breathing nearly natural pulse 239 still 100 or more with rather more resistance Dover Powd with Pulv. Ant. Seneka tea continued at evening the pulse faster 120 some more expectoration not quite so dark but little if any pain in the side passd a quiet night 10th symptoms seem to be generally improving except the pulse which is still 120 with light expectoration with but little cough Infusion of sanguinaria taken freely produces more expectoration of peach blossom color & moist skin a sanguinaria continued through the night with a pill of Camph opm & Ipecac 11th More Comatose, skin relaxd, moist, natural temperature Mind rather wandering, sometimes slightly incoherent when rousd up - some cough & a little expectoration, most of the time dark or greenish or sanious – no healthy looking puss or Blist on the chest & neck Mucus – Direct seneka strong infusion with Licorice & Anise seed – Tinct. Canth. 30 drops every 2 hours – 12th Mind more natural takes some interest in things about her – blisters drawn but not well filld – pulse 116 – rather more expectoration but not better in its appearance, take some nourishment suspend the Canth give the seneka less frequent & direct for the night to procure rest a pill composd of opm Camph & Ipecac anodyne 1 gr given at 10 oclock repeated at 2 more quiet sleeps, become Comatose, skin relaxd pulse increase 140 Mind vacant, cough & expectoration 240 expectoration but little & expectoration still sanious 13th through the day in the above condition Direct stimulating applications to the skin mustard & Capsicum – resume the Canth & some wine 14th pulse becomes to active to continue the stimulants some disposition to expectorate 15th direct lqr Scillr & Tinct Sanguin no cough & no expectoration except 2 or 3 times in the course of the day & then dark & Muddy Pulse 140 strength fails, breathing shorter. Mind incoherent though able to answer questions wine & brandy usd freely swallows with difficulty – dies. Remarks Regret that this case was not seen the first night of the attack & bled was not the subsidence of pain the 2 day & the spitting of dark blood (Muddy) evidence of Gangrene or so much injury of the vitality of the vessels on the onset of the disease as to past remedy? Was not this necessarily a fatal case from the time it was prescribd for [cross out] whatever course might ghave been adopted – the evidence of which is in the character of the sputa. This is the 3rd case of Pneumonia which I have attended having dark muddy sanius expectoration all of which has provd fatal. In two cases bleeding was practiced early in the attack – I should consider then a case with such expectoration 241 appearing especially early in the disease necessarily fatal as such appearance in the expectoration must be sure evidence of Gangrenous mischief The use of opium in these case seemd invariably to increase the disturbance of mind the determination to the head & agravate the symptoms Where there are comatose symptoms or any evidence of approaching effusion of the lungs or brain fatal determination to these parts may be inducd by even small doses of opm. Case XVI John Mc. Intyre AE 38 Intemperate habits - had 3 previous attack of delirium tremens – treated successfully with large doses of opium & Morphine – the two last time went 9 & 11 days – After severe drinking (& daily employd about a stable) August 5th attackd with severe gastro enteric Irritation puking & purging - pulse not much excited – profuse sweat on the surface extremities cool but not cold – direct Mustard to the stomach & 2 grs of opium to be taken in a pill which quieted the irritation 242 till the 9th when slight symptom of mental aberation appeard warning us of the approach of the old friend delir~ trem~ attended with severe headache Concluded to adopt Proffs Hookers treatment which is Tinct. Digital. 1 or 1/3d to be usd at evening & repeated every 2 hours till all usd or sleep is producd – this was done but no sleep producd next day pulse 70 no headache use a cath & at night repeat the digital with directions to use 2 grs of Morphine every hour After the Tinct was usd up – but the last 2 or 3 pills was thrown up - then directed ℥i of Sol. Sulph. Morph. double the strength of Sand 10 grs of Morph to be dissolved in the sol. commence with teaspoonful of the strong solution Pulse 120 not diminishd in force by digital every hour till sleep is producd * in the morning of the 11th after scuffling with his brother to get out doors fell back on to the bed comatose & with some spasmodic tendency of the Mustard freely applied muscles: occasionally intermitting pulse & so continued 3 hours: when he was rousd up & again determind to go out, was restraind by force & soon again lay down comatose with suffused adnate pulse 120 (comon strength) but failing with some difficulty in swallowing could be rousd by shaking or calling out alone profuse perspiration comes toward night pulse fails 130 breathing interrupted entirely * Use 3 teaspoonfuls 243 insensible – dies at 10 oclock P.M. Remarks The attack of Col. Morb. which introducd this case probably renderd this case more unfit for the successful use of all means than it other wise would have been For this or some other reason the sanguine expectations of Doct Hooker which he attaches to his digitalis treatment were here not realizd – nothing in the operation of the medicine in this case however seemd favorable but rather to the contrary – the large doses of narcotics seemd here to have exerted their peculiar narcotizing influence without at all controlling the morbid of state of the brain to produce sleep – but exerting some of the peculiar spasmodic influence which are peculiar to an over dose of these articles 244 Case XVII Mrs Alfred Bishop AE 38 Accouchement April 1841 Labor progressd without any unusual Symptoms with severe pains – until examination pr.vag. was made: found the head presenting os.ut dilated half dilated: uterus situated high in the pelvis pains though severe yet but little decending influence seemd producd – About 2 hours after examination was again made & found the labor considerably progressd: head in the pelvis: pains severe & found the funis decending some 2 or 3 inches in advance of the head: no pulsation – attempted to return it back past the head but could not suceed – some time within the hour the labor was completed – Child still born: female Remarks Pressure of the Cord the cause, undoubtedly could it have been return? – after it was discovered or Could the labor have been hasten? : neither If any thing different could have been done It could only be by more frequent examination and an earlier discovery of the advance of the cord when possibly it might have been crowded back: But this from what I know of the peculiarity of the case would have been of uncertain practicability 245 Case XVIII Mrs Fitch wife of Doct F of Oneida Ca N.Y. ae 45 Catamenial change commences disordering all the functions of the system interrupting the balance of action between the secement and absorbent vessels & terminating in dropsical effusion which continued for 4 or 5 years various prescriptions by different physicians without effect finally curd under the following treatment Rx Calamus Aromat ℥viii Crystals of Tart ℥ii Aq. Tont qts 2 Sach Alb g. S Slice Calams. Thin add 2 qts aq. Tont. & Crys & Tart & sugar if necessary – great spoonful as the stomach would bear 3, 4 or 5 a day in 36 hours evacuated water freely Then the use of Tonics & Aromatc as the state of the system requird – brought her up (Related by Doct F, 1841 August) Calamus preservd in Loaf Sug. A valuable excitant in all those weak end Morbid actions of the Membranes lining the first passage is following fevers Diarrhoea sore Mouth of nursing women &c – S. B - 246 Case XIX Mrs Birdsey AE light Complexion Dyspeptic – Costive – Catamenia not wholey regular occasioning however no serious inconvenience in the health – always delicate & easily effected by slight causes & having The usual habits of Complaining of subjects of Such a description In 1835 had an attack of subacute inflammation of the membranous lining of stomach & bowels attended with febrile symptoms lasting 3 or 4 weeks – Recoverd her usual state of health & removed to N. York & there in – 37 had an attack of accute inflamation of the bowels – Recoverd from that & in – 38 returnd to Bridge port – This year first Child born – same year in hastily bending to sit: struck with considerable force the top of a child chair post at the inward curve of the Coccyx occasioning severe Contusion no complaint however was made untill several months after – when application was made for council stating the comon symptoms of a spine affection – pain in the lower part of the back extending down the lower limb, into the bowels, with much tenderness of the Coccyx & lower Lumber vertebrae, without saying anything of the cause of it – the comon prescriptions for spinal irritation were directed: external irritation blister: tarter Em oint: rest anodyne &c symptoms somewhat moderated so that she went about her domestic concerns as usual thought still feeling occasional pain & tenderness about the back – During the next year – 39 accompanied with uterine irritation complaining of the comon symptoms of prolapses uteri – Application was again made for advice when the same remedies were usd as before: Counter irritants to the back rest & anodynes with some benefit though not entire relief But so as again to return to the care of her family. The next year became pregnant: which aggravated all the symptoms at once – much increasing the spinal irritation & also the uterine – so that in the latter part of the pregnancy for the last 3 months pain in the bowels & back frequent calls to stool for water & forces with costiveness & suppression of urine, tenesmus mictirition heat & pain running down the thighs & shooting up the rectum & vagina & occasioning strong expulsive effects whenever the stool was used, sometimes 20 times a day: with frequent disturbances for the same nights Anodynes Laxatives & rest quieted the worst of these symptoms Natural labor came on in July 1841 – terminated in 5 or 6 hours without anything unusual in the progress of it except rather more than the usual keenness & severity in the labor pains Recoverd slow with much complaint of the old spinal & uterine symptoms external irritants preceded by leeches & anodynes were usd & she confind to recumbent posture: symptoms after 4 or 5 weeks slowly improved so that she sat up 1/2 of the day & rode out 2 or 3 times. First of Oct visited by Doct Joes – regarded her condition as extensive derangement of the nervous system from the long continued irritation about the spine directed mix vom Tinct & Ext. oak bark & apple tree applid in plast. to the back. Previous to this the pulse had never been much effected being usually about 80 & small & soft. Saw her one week after the application of the plaster – had that day rode out found her sitting up by the fire with the family complaind of feeling not quite as well found the pulse 120 or 30 with general symptoms of irritation & excitement directed the plaster removd from the back & the Tinct stopt & rest recumbent next day pulse no better strength fails. General symptoms of high nervous irritation & great muscular prostration with an irritable state of mind – expressions all impatient & peevish & still submitting with comparative general composure to her situation 3 or 4 days passes with exceding irritability & restlessness & sleeplessness Directed Ext. Heyosam 20 grs make into 15 pills one morn noon & night. October 5th All the preparations of Opium objectionable Oct 7th more composd - some sleep – Hosam seems answering a better purpose than any other anodyne (Nit. Dule. Teaspoonful 3 or 4 times a day Oct 10th pulse 140 small & somewhat resisting at evening as though there were a paroxysm of excitement & these symptoms attended with excessive heat: though not sensibly increasd to the touch – today find her composd says she is free from pain : & happy in the enjoyment of the consolations & promises of religion manifests a strong desire to converse on religions subjects & expresses relief in being permitted to relieve herself of the burthen of her mind by constant conversation – thinks she shall die soon & converse with the greatest composure on the prospect of death. A lot of vivacity & elasticity however in her conversation which shows that her minds or brain is partaking strongly of the morbid nervous excitement which is the general characteristic of her sickness – but still not amounting to delirium on the 8th found that she had complaind much of pain in passing her water: pain in the urethra vagina thighs &c proposd examination found the urethra enlarged vagina thickened contracted & exceding tender with a circular ring about the inner surface 2 inches from the vulva apparently highly inflamed & tender. Continue the Hyosam. Nitre. Saline Cath Blist on the inside the thighs – fomentations to the pubis & lower part bowels & poultices to the labia – these applications were followed by improvement in the local symptoms of irritation about the vagina. 20th Nervous symptoms all much improved no irritation about the vagina: sleeps well, takes light nourishment in small quantities mind still chiefly composd & happy & manifesting some of the same morbid excitement & sprightliness – much disposd to converse & wishes to read or hear reading. Nov 14th still improving: tumefaction of the leg subsides pulse Appetite good: sits up an hour at once – bowels move without Caths Nov 24th improving in general symptoms but yet pulse 120 for the last fortnight large inactive boils very troublesome appearing about the nates & thighs continues with slow general improvement through the winter – pulse remaining small and quick – mostly 100 or more – muscular debility – unable to make much exertion but when quiet is comfortable eating & sleeping tolerably well and attending to some care of the family & Children. J. B. Weed AE 48 Resided Several yrs in Charleston for the last 4 or 5 yrs in Connt Building a house assisted his man in laying the turf full corpulent habit – temperate After stooping & working at the turf had a pain about the Crown of the head – severe nights when recumbent – otherwise well – bled 20 oz no relief – cupd – little relief – Cath – still no relief – bled again full bleeding – no special benefit – sleeping deep & heavy nights so as to disturb his wife so that he takes a bed separate – the last 5 days head better - chiefly well – pain contind 3 weeks Nov 30th retired at night feeling well – awoke 12 oclock “one side numb & heavy” – when I arrived hand arm & leg – chiefly helpless pulse small 70 – chilly – no heat or flush of the face – or any other particular evidence of determination to the head – Advise counter irritants Caths. & warm applications to the feet & legs – cold folded wet cloths to the head – blister on the Crown & nape of the neck - & scanty light nourishment Gradually improves under the above course - gains the use of the leg so as in 2 months walks. & rides – in 5 months walks about his yard without help and attends to his business Case XXI L. Sterling AE 39 Active industrious habits – had been excessively employed for 2 or 3 weeks taken suddenly while unpacking Crockery at his store with severe pain in the right side of the chest went home tried to sweat &c, went until next day when I first saw him – found symptoms of pulmonary congestion on the right side – pulse frequent but not full – no cough – strength becoming prostrated – sight brownish fur on the tongue – breathing not much effected – some thirst. Treatment Use active means for promoting perspiration with fomentations to the side – some relief 4th day some tendency to cough dry hard with occasionally a mouthful expectorated dark as chocolate almost muddy, interspersd with occasionally a mouthful perfectly sanious staining the cloth like a discharge from a sanious ulcer Direct sanquinaria ʒi seneka R ʒii Licorice g.s. was 1/2 pint Council Doct [??ight] Double the strength of infusion give every 2 hours – give Cal 2 grs with Dov powd every 2 hours continue 2 days 7th day paroxysm rising restless bled teacupful which checkd the paroxysm & moderated the symptoms stop the Cal & infusion - blist the side – 12 or 13th day mouth becomes thrushy give bark which arests the thrushy tendency pulse moderates rests better improves Appetite returns about the 20th day Recovers April 1842 Case XXII Maria Carlock AE 16 slender, fair, 1842 dark hair, previous health good. Friday 2nd Sept taken with pain over the right hip was partially suspended by fomentations, but return in the night excessively severe, insupportable extending across the bowels – Sat bowels evacuated with salts & senna, pain by turns excessive still Laundanum freely usd, which modified the severity still however, severe by turns bled freely Saturday eveg & Cal 10 grs operated well Sabbath I saw her first with Doct S – restless – tender over the whole bowels & integuments tight some thirst, stomach irritable pulse 130 or 40 Monday Simons left in my charge Direct fomentations frequently renewd pulse 140 Countenance anxious, excedingly restless occasional streaks of severe pain in the bowels found her taking Quinine – suspend & give Pol. Morph – pulse very small & frequent Direct infusion of Len. Rhei seeds to move the bowels with enemata – got down 1/2 teacupful when the stomach refusd fomentations continue, stomach increasingly irritable, refusing sol. Morph. & effer vess Mixt Wednesday the same or worse, stomach worse pulse worse – use various injections, but immediately returnd, polticed on the bowels try a pill of aloes Cal & aromatic: stomach refuses obstinately – Thursday no better direct turpentine injections – could not retain them, failing bowels enlargd very restless – a kind of agony rather than pain, fails afternoon & dies 7 oclock evening – Sept 9th Remarks Case was probably erysipelas inflamation which terminated the first day in gangrene Bleeding in the onset of the disease leeches & fomentations might have saved her & might not but no leeches were at hand Sept 13th today I hear of a similar case under Nashe’s Care Newton Benedict (Fatal) Case XXIII John Hunter AE 6 son of Rev q. H. March 30 1844 1844 11 oclock wakes with pain in the bowels Jany complains an hour or so & says no more of the pain but is thirsty & restless which latter symptoms increase till morning with 3 or 4 times of vomiting. I saw him at 10 oclock 31st skin cold countenance cadaverous & starving, very restless asking constantly for drink & having some blueness in the appearance of the skin & pulseless at the wrist – orderd hot bricks coverd with flanniels sprinkled with water & vinegar mustard sinapisms extensively applied to the surface & stimulants as the stomach would bear stimulants were usd about an hour without any relief when the stomach began eject with a moderate spasm of vomiting – After lying down spoke a word or two incoherent & immediately seemd failing & in 30 min died 10 hours after death examind – the first appearance after laying open the intestines [cross out] was all natural down to the term inactive of the illeum below which the large intestines were highly injectd dark red nearly gangrenny at a point 3 inches above the Caput Colic passd over the Meum a tendinous cord which was a reflective portion of the Mesentery [cross out] inflamd & contracted so as to close its aperture except the size of a small quill in which the intestine intestine was strangulated & inflamd below on separating this band the intestine seemd in its natural place & size Remarks How could death have taken place with so few signs of inflammation? Must this band of the Mesentery [cross out] have been congenital & not have contracted before sufficiently to strangulate because not inflamd? now with more than usual exertion the day before this became irritated inflamd & then contracted so as to strangulate means remedial could avail nothing here onless opium in the very commencement of the symptoms would have quieted the irritation prevented the inflammation & strangulation but all this is uncertain. Case XXIV Doct Bronson Blackman AE 35 1844 April Spare habit black hair & black eyes – the practice New York – About the middle of March complains of pain in the left side chiefly located under the breast of that side – some dispnoea & accelerated pulse becoming more & more for a week unable to attend to business. Applied to 2 or 3 of the faculty in New York who after Auscultation & other examinations told him that there was no evidence of a Lung affection – Applied Cups & blisters & took Catharties without relief, grew more feeble, the pain & dispnoea continue & increase with a slight tendency with much exertion to cough – oblige to relinquish Business & come home to Bridgeport when I took charge of the case Symptoms Countenance anxious & florid especially across the nose & cheek bones A little paroxysm of excitement once or twice in 24 hours sense of stricture across the chest & especially in the left side pain unabated restless when the paroxysm is on; urine scanty & high colord & turbid let’s up part of the time dispnoea increased with exertion dull sound on percussion on the lower left lobe of the lungs pulse 90 with but little excitement. Treatment Keep the bowels open, cup the affected side blister, & use digitalis & dovers powder at night 3 or 4 days passes with the symptoms unabated use Colchicum in small dose as a diuretic. At the end of the first week examine the Lungs more particularly respiration laborious without being frequent percussion now very dull on the affected side up to the upper 1/4 of the Lung where the respiratory murmur could be heard & more correctness in the sound the dullness observable both on the breast & back. Now Conclude the Case to be Cronic inflamation terminating in the effusion – a small bleeding shows the buffy coat on the blood 1 or 3rd walk commence the use of Iodide of Potass continue about a week. Appetite returns pulse moderates; pain in the side abate urine clear, strength slowly increase, 5th week sits up one hour. The upper 1/2 of the affected lung now sounds well much emaciated. Recovers slow with symptoms of adhesion of the Lungs & pleura - Returns to practice in 4 months. 1844 June A case in Charles Burton with the same symptoms of the left Lung impervious prostrated strength, dispnoea, pain in the left breast & side dull sound on the whole of the left side Treated with blister & Iodide of Postass recovers slowly & again after 2 months inflates the lung & breaths well though still fatigue with excercise Case XXV Patric White AE 50 Intemperate March 1844 Complained of cough & dispnoea & purulent expectoration & so complains for 6 months of the general symptoms of Lung Irritation referring them chiefly to the throat & bronchia at length died emaciated With the general appearances of drunkard Consumption Sectio Cadaveris Bronchia above the bifurcation purulent ulcerated contracted to one greater the ordinary size – Lungs tuberculated in some parts absorbd, & in some supurated stomach & esophagus red & irritated Liver & small intestines injected with some inflamd & gangrenous patches. Treated with alterative expectorants & some anodynes with cough Mixtures Tart Em Cint & blisters repeated on the throat – latter part the time took opiates to rest from the constant irritating cough. 1845 Case XXVI Alfred Bishop AE 44 Contractor for the building of the Housatonue R Road Built under much embarrassment as to means, so that the interest of Mr B because involvd occasioning much care & anxiety under these circumstances he becomes dispeptic having frequent attacks of indigestion sickness of stomach pains in the bowels Acidity flatulence sometimes a troublesome irritating cough – headaches costiveness now loss of appetite, now great appetite & always suffering more or lesss from to free indulgence during most of the time for 10 years smokes tobacco more or less sometime excessively becomes fully satisfied that it injures him & has frequent periods of abandoning it & frequently returning to it but for several months has abandond it wholelly In Nov 1844 has an attack of pain & extreme tenderness in the right Hypochondriac region with some enlargement common symptoms of inflamation local but no excitement of pulse or fur on the tongue – but the pain & soreness continue - notwithstanding the use of fomentations Cathartics – blisters. Anodynes &c for 4 or 5 weeks until he commences the use of the brush under which it all disappears - condition of the stomach improves general health improves during the winter & says he has not been so well in 10 years imputes the improvement to the use of the brush - still has great care & much pressure of business – In May 1845 begins to complain of the same kind of pain & soreness about the region of the stomach & liver continues his business for two or 3 weeks in this condition growing thin, weak: sallow countenance loss of appetite – now discovers some enlargement in the region of the stomach soreness so great that he can scarcely go or stand up foment blister take Cathartics &c with little or no benefit Examine find a tumefaction circumscribe as large as the palm of the hand directly on the stomach or upper surface of the liver * very tender Commence pouticing & Leeching 1 doz Leeches applied 3 times a week – with evident relief – this treatment continued for 3 or 4 weeks tumor & soreness subsides intumescences of the whole abdomen subsides appetites returns strength increases countenance improves walks & rides out – recovers – but with a faint weak * Enlargement of the whole abdomen as if there is effusion some appearance of fluctuation Bowels easily movd excretions not unnatural sensation left in the place of the tumor & the tumefaction * not entirely gone – July 1st travel for the west a travelling tour with his wife Debts all paid this embarrassments in his business all disposd of * The tumor turns out to be Hernia Rupture of the fibres of the Rectus muscles & protrusion of some portion of the Omentum or arch of the Colon Bandage & Compress keeps back the tumefaction 1847 Jany No complaint from the rupture indigestion has become common & very troublesome sometimes laxatives relieve the symptoms sometimes the food digests better when stimulants are usd with meal He is now using (without advice) best Cham pain It is difficult to say how much the indigestion may arise from the rupture irritation or whether it may be owing to former gastric irritation entirely independent of the rupture Case XXVII Hon Samc SimonsM. D. AE 55 1847 July 24th from recollection Common symptoms of membranous irritation of the Lungs following a light attack of influenza. Scanty Appetite, slight fur on the not as well after this attack} tongue dry cough with but little expectoration countinance sallow & not having its usual activity but continues about attending to business 3 or 4 weeks with but 2 or 3 days interruption Decemb 13th Chilly, pulse 80, languor, tongue more furd remains in the House today - at evening severe pain through the hips where they connect with the spine affecting the hip and thigh of the left side the most impeding the motion of the left leg, increases under very thorough & active fomentation which produced general perspiration without diminishing the pain until 15th when he took Coletricum vin tinct freely until sickened & affected as a chartartic diminishing the severest of the pain, but remaining still severe some part of the time Directs himself, an anodyne composed of Sulph Morph 2ss Opm Opii 15 grs Ext Hyosam 2i Mix & make 20 pills with the use of these pills one or two in 24 hours He could get some rest – the general symptoms continueing much the same until with the use of fomentations on the return of the pain untill about the 20th pain 20th much diminishd except occasionally with a little paroxysm of excitement in the night would have increased pain. Now a blister is applied to the back side of the left leg above the knee which diminishes the severity of the pain – some thirst & general fever still remains until the 3rd week the 27th when still afflicted with the pain unless some anodynes are usd by his non advice the blist to the back of the leg above the knee is repeated – when it had been on several hours pain suddenly all disappeard from the hip & the stomach became very painful with spasmodic sensation as if contracted towards the diaphragm this sensation continued, occasionally modified by the use of Anodynes through the next 2 or 3 weeks stomach sensitive not bearing the use of nourishment except of the farinaceous kind or liquid: pulse abates after the 4th week to 70 & 80 for several days: some disposition to take nourishment but if more than one or 2 ounces at once are taken distress is felt at the epigastrium & the general symptoms of irritation are increasd tongue appears clean with a slight blush of redness if carefully observd of too high a color sometimes a moisture of the surface appears though not very general & of short duration some tendency to thirst remains this state of things continue through the 5 or 6th week with expectations of recovery by his medical council while he augurs himself a fatal termination: in the early part of the 7th week the pulse grows more frequent the stomach more sensitive strength more feeble countenance sunken voice husky energy of mind abates with periods of aversion to food what he takes chiefly liquid & in very small quantities strength still fails mind fails & becomes comatose in the last of the seventh week – fires up all hope of recovery – has paroxysms of distress in the region of the stomach which he calls sinking or dyeing: the last 3 days becomes more comatose looses his interest in things about him – insensible and on the 40th day from his attack dies Post mortem 30 hours Stomach flabby injected about the lower orifice, lower orifice contracted duodenum highly injected lower portion dark & so thorough most of the jejunum in incipient gangrene under surface of the Liver & the gall bladder somewhat participating in the irritation examination not extended to other organs Pathology Doct S. had been a sick headache subject having the last 3 or 4 years very frequent attacks – and during his residence at Washington & after his return had oppressive business & much mental anxiety increasing the frequency & severity of these attacks untill the parts about the lower orifice of the stomach had become morbidly sensitive – In this condition with a predisposition to invite diseased action from [cross out] other parts of the body he was attackd with this sciatica or Lumbago which was obstinat & became Chronic & under the rise of the local applications particularly the last blister it was repelld to the lower orifice of the stomach & duodenum where it remaind untill the fatal result. Case XXVIII 1850 August Thomas Crowley Ae 30 Laborer Jump’d off the cars Housatonue Train under head way: fell & was struck by the fender of the wheel breaking the right arm at 3 inches below the head of the humerus & injuring the spine so as to paralise the body all below the 5 or 6th dorsal vertebra Some tenderness felt over the above mend vertebra but no verry manifest appearance of displacement Bowels paralizd & torpid Bladder the same use the Catheter – very restless breathing hurried – great thirst entire absence of appetite – pulse not much affected sometimes quickened 8 or 10 beats abdomen tumefied light fur on tongue lower extremities & the whole lower 2/3rd of the body entirely motionless & insensible large quantity of urine evacuated free Cathartics usd the 2 or 3rd day when with the assistance of enemata a motion of the bowels was obtaind after which a sudsy kind of movement was kept up every day without the use of Cathartics 3rd week first visit wishd to lie on the side now lies on his back is emaciated & reduced grow comatose (persons starring always grow comatose probably congestion of the brain) notices but little smells feted tongue looks red flabby & weak adnate of the eyes suffusd Injuries of the spine are fatal according to the distance up the spine where the injury has occurd – those so high up as to include the viscera of the abdomen in the nervous distribution will very soon be fatal. If the injury is in one of the Luber vertebra especially one of lower & the lower extremities only affected death will not soon occur Blanchard case lived 4 or 5 years Learnd the shoe makers trade workd at it & finally died of ulceration of the Nates from setting 1849 Cases XXIX 30- 31 July The dysentery of this summer has peculiar symptoms not before observd Commences with violent irritation of stomach & bowels much tenesmus & pain sunken countenance prostrated strength rapid pulse skin the first 2 or 3 days very hot but soon the extremities become cool moist with some moisture all over the body sometimes appearing as though there would be a favorable crisis but however general the perspiration no relief is obtaind Pulse more rapid discharges not much controlled by treatment countenance more sunken extremities more cold but not themselves at all conscious of the coldness- become comatose & fail in about a week frequent evacuations all through the history of the disease Treatment Laxatives produce fecal mater without any improvement in the disease lerm Tart especially has that effect Dov Powd – opium abates the irritation but does not improve the case Blister no effect astringent no effect active stop passes through in 5 or 6 days discharges becomes less frequent but the system dont rally cold surface comatose - very restless – rapid pulse wandering intellect briny discharges not purulent – seldom any appearance of ulceration – not usually much tenderness on the surface of the abdomen. The above cases George Edwards Fanny Smith – Mr French all cases of impaird constitution from other causes The first dissipation 2nd Chronic gastritis from gormandising the 3rd moderate drinking & age – some other instances occurd in town not under my observation of a similar character & termination several other cases occurd less sever & more manageable Heretofore I have seldom had any difficulty in treating dysentery mild laxatives – anodynes – and anodyne injections persevered in has been sufficient to insure a favorable termination. 1852 Jany 1st Calld to attend at St Ledger Comp Fracture of the Left Tibia & Fibula Bones protrude muscles separated & detached from the bones 3 or 4 inches from the fracture only a small orifice made by the protrusion of the broken end of Tibia through the integuments the fracture was reduced soap plast aplied & the limb below the knew coverd with a many taild bandage & a splint from kee to bottom of the foot with moderate pressure to support either side of the leg while the leg lay on a level soft surface violent inflamation followd with severe constitutional irritation during the first week at the end of which the infflamation became distinctly by erysipelatous & run a severe course involving the whole leg below the knee & extending on the inside nearly to the Groin and terminating in extensive suppuration at the orifice where the Tibia protended on the under & middle portion of the leg & on the upper inside of the knee – At the end of the 3rd week the swelling [cross out] & redness & suppuration abated & there were beginning signs of union of the fraction Appetite returns About the 25th day food was taken too truly gastro intestinal irritation ensued with profuse evacuations great reduction of strength rapid pulse & a return of the erysipelatous inflamation in the limb & great increase of the suppurating discharge at first healthy puss but afterwards various & watery reducing the system & occasioning severe constitutional irritation & great prostration 5th March It was now about the 8th week patient trying to rally from this 2nd attack of erysipelas: tumefaction subsides pulse abates in frequency: takes more nourishment, obtains some rest. Fracture begins to unite – the extensive supuration made it necessary to dress the leg & remove the accumulations once & twice a day which were mostly offensive: for one or two weeks very offensive. On the evening of the 4th of March while visiting a patient with Child bed fever A case of premature confinement 7th month fist unusually fatigued great depression of physical & mental energy uncontrollable disposition to sleep: slight chilliness & headache: next day much cupitude & indisposition to exertion but visited patients through the day with an unusual cruse of fatigue at night pulse 100 Now discover a hang nail on the inside of the end of the finger of the right hand with some pain & irritation commencing at that point and extruding up the inside of the finger – evening of the 10th March attned a confinement Mrs S E. Bridgeport much indisposed languid & whole finger sensitive & painful lay down at eleven & awoke at 12 with a chill at one the labor was completed & went home exceedingly depripd fatigue chilly & restless all night – pulse 112 & finger swelling & increasing in sensibility March 7th head the symptoms of infection developing through the exposd surface under the hangnail & extending up the hand & now occasioning active constitutional irritation loss of appetite reduced strength pulse 120 finger & hand tumefied & painful with diffuse cellular inflamation extending up the hand & wrist. Laxatives anodyne warm washes & poultices to the finger & hand & free leeching reduced the inflammation of the finger & hand general symptoms abated & recoverd so as to resume to business again on the 16th March The case of child bed fever which I attended on previous to my confinement fell into the hands of Doct Nash & the 3 day following ended fatally before a diseased subject with gastro intestinal irritation & as was supposd from the frequent pulse previous to her confinement had some unnatural irritation of the membranous structure of the heart the case attended the last of my business previous to my illness recoverd without any thing unusual March 11th wife of Guikson Guron was in labor whom I attended She had a chronic Bronchitis threatening to carry her off for 2 or 3 years nothing unusual occurd until the 3rd day after confinement when an oppressive Rhmeus seems to be filling the bronchial passages making the breathing very laborious & showing with it general symptoms of pulmonary congestion. Cathartics were usd with partial relief pulse became rapid 120-30 peritoneal inflamation ensued great prostration pulse 140 oppressive accumulation of mucopurulent secretion in the Lungs with no power to expectorate abdomen leechd soreness of abdomen abates but oppressing if pulmonary symptoms increase no milk is secreted & dies comatose on the 14th or 15th day Remarks this case had some symptoms of puerperal peritonitis which might possibly have been the causes of death but the pulmonary symptoms seemd to be the more immediate cause of death. The Child well at first faild & died 3 or 4 days after the mother. William Stephens wife was confind March 22nd Aged 25 healthy full time in labor 8 or 10 hours; nothing unusual healthy Child on the 24th chilly pulse excited 124 no milk secreted lochia diminishing pain in region of uterus & tenderness over the abdomen Direct Cal pulc Antim followd by Sinna & Cas & Oil operates well with no reduition of general symptoms 25th After the physic operates abdominal soreness abates but pulse more frequent great prostration of strength some tumefaction of abdomen Doct Joes calld in Council use turpentine fomentations give turpus & Cast oil – use the Catheter to evacuate the bladder pulse 140 – Ninea wanders 21st Doct Gudson & Doct Bancroft in Council patient fails dies on the 27th. 22nd Barney Farrells wife confind AE 20 light complexion sensitive Abdomen tender previous costiveness labor pain ful but natural. 25 night taken with chill & symptoms of acute metritis & peritonitis arising pains shooting through the Abdomen pulse 130 skin hot great thirst restless, milk hastily secreted abdomen tumefied Bleed 10 ounces & give 10 grs Cal followd by Im & mern & Cast & oil operates well but no relief of general symptoms pain abates becomes comatose dies on the 28th Child dies. Doct Gudson & Nash in Council – William Boyls wife confind 31st March labor natural – 3rd day taken with a chill – same fatal puerperal symptoms follow dies on the 5th – child dies Falconers wife confind April 1st chill on the 3 or 4th day runs with similar symptoms & dies 8th day Mrs Boyl & Mrs Falconer feeble subjects Mrs Sobaell was confind during the above time in the month of March & reverd well but Child died with infantile erysipelas Blackmerus daughter recoverd well May 22nd German E. Brid port confind recovd well dibble wife at Hall recoverd well Brunners wife taken 4th day had the same puerperal symptoms died on the 7th day Harva French s wife confind April 23rd recoverd well Whitstine wife 12th may recoverd John Smith wife confind April 30th recoverd well 3 or 4 Irish women died with the same affection in the hands of Doct Hullard & Doct Bunitt Index Apoplexy 158 Anthelmintics 141 Alcohol Aconite in Chron Rheum & Gout 10 Asthma 146 Antispasmd 30 Amber 34 Ambergris 35 Asafoetida in 36 Asthma Epilepsy Consumpc Alium sativum 40 Arsenic Fowls. Sol. 53 Alum 55 Angustura Rx for Debility in stomach 66 Agrimony Alder 72 Alcornogue in Consumpc 78 Astringents Mod. Oper. 78 Alum Root 84 Adders Tongue 92 Anmatics 98 Aloes [Emenq?] 121 Cathc 110 Amonia sick Hedc 130 Antimony Expectc 132 Adhesive Plast 201 Bark Rhic & Sates quality Cons 64 Bals Tolo Expect Rx Beladona 9 Bitters for worms 9 Buck Thorn 110 Bismuth Chron aff. Stom. 54 Bitter Sweet 72 Birch Barberry 77 Black Berry 86 Baberry 87 Blood Root 92 Butterfly Weed 96 Index Beggar Lice Diuretic 126 Bumonts Experimts 151 Burns Bark Consuption & Dys 64 Camph disolv in wat 14 Cynanche. Col. Pict. 15 Cohush 25 Canker Root 25 Coffee obiates ferment 28 Produce Lucork weak Cicuta C. in Gout 30 Constitution year to Epidemics 145 Chorea 147 Cor. Sul. Cal. 119 Colocynth 110 Crot. Ol. 109 Cassid 107 Cathartic 104 Colchicum (in Gout 142) 96 Catechu 82 Cranes Bill 84 Colts Tail 74 Cresswort 75 Camomile 69 Chesnut Com. 72 Cascarilla Contragerva 67 Colombo 68 Cuprum put. Sore. Throat 52 Caphut ol 37 Cantharides Low fevers 137, 124, 132, 43 Classification 6 Caster Matthews Pill 32 Conium Cancer & ulcers 160 – 12 Constipation 157 Court Plast 2 or 6 om Plast 201 Cases 209 Calamus in Mrs Fitchs case 245 Digitalis in irritability 10 Daisy 69 Dogwood & willow 71 Dragons blood 82 Diureties Conc with all diseases 123 Diarphoritics 128 Demulants 140 Index Dispepsia 146 Dysentary 156 Fern sweet deobstruent 73 Five finger Cathv 115 Fevers May be cut short 145 Ether Sulph qualifies other stim. 11 usd with Hux Tinct Consumption Galbanum 37 also with pareqtr 12 Guac. Ven. dis. Irit. Stom. Ether Nit. Diarphorepc 13 Painful Menst 46 Epilepsy attend to food 24 Gold 59 Elder dwarf 73 Gentian action Liver 48 Evans Root 86 Gold Thnad 75 Emetics Rx in Diarrhoea 88 Gamboge 14 Elaterium 110 Guac. gesuits drops 113, 130 Enemata 115 Gum Amoniac Expt 133 Emenagogues 124 Gout 142 Expectorants 132 Errhines 136 Epispastics 137 Escharotics 140 Hysam. In diserecty 10 Epilipsey 149 Hoffmans Anodyne 11 Hop Hux hams Tinct 69 67 Hour Hound 70 Horse Chesnut 71 Horse balm 73 Hard track 87 Hino ret. Hem. Rx Hellebore 109 – 92 Ulcerated fauces Hulls Physics 110 98 Hydragogues 201 Rx 116 Hoar hound Towns Elix 133 Hernia Cat nep tea 13 Laurel Cherry tree dispep Lettuce Lead Acet 56 Coughs with opm & nt. Hem. Inject Insanity Moral 202 Sore Mouth of nurses how like Narcot 58 Iodide of Merc. & Potass 203 Water brash & relax Mucus Membrane Incitants 41 Leather Bark 74 Iron dropsy Myrr Mixt 48 Low Century 75 Filings with Angust & Canc ret. Lombardy Pop 76 Indigo wild Ironwood 76 Logwood 82 Indian Tobacco 91 Lithron triptics 139 Indian Physic 93 Indian Hemp 96 Itch 146 Incont Urine 148 CompMyrrh & Iron 140 Mercury 203, 116, 25 Musk 32 May Weed Moth nort 39 Johns Woet 75 Mur Acid. Mur Sinu 61 Jallap 109 Maph 72 Juniper Berries 126 Marsh Ros.mary 85 Index Milk Need 96 Pelitory want of action 45 Min. Emetics 94 Prick Ash Magnesia Rx 108 Princes pine 76 Mandrake 114 Polentilla 85 Madder Emenger 121 Pokeoud 93 Mustar Epispas 138 Picra 99 Male org. Gen (disease of) 158 Peach flowers Cath 115 Medical Men Mortality of 154 Pink Anthelminc 141 Mesmerism Notes on 164 Pill Cocciac 144 Pulmonary diseases counter irritate 144 Narcotis 6 Potatoes 20 Nut. Vom. Paralasys 30 Nit Acid 61 Quassia with opm Resembles blc drop Nut Galls 81 Nut All 84 Rose Mary good for poison 25 Rock rose (Rose 82) 78 Rhei 109 Refrigerants 138 Ol Ricini 107 Opium Syd. Land. 18 Opm & Nitin dys. Catc. Fev. 20 Rx with Gem Am. Chron Rheum Smith Lect. 175 Diarrphoretic Rx Tet pass. Hem. Scrofulous Infla 146 Period. Hidach 22 Soda Lythron trip 139 forming stage fever Squills Expect 91 135 Orange Grass 75 Sulph Scald Head Rx 107 131 Sanguinaria Emengan 122 Seneka 97 Index Salts Lent 112 Unicorn Root 70 Scull Cap 77 Ura Ursi 139 Snow Ball 85 Ulcers Malignant 159 Stram. Anodyne 24 Ung Chc Lime & Mercy 160 Spurrd Rye How usd 29 Skunk Callage 41 Saffron 37 Sulph Acid Diabc & Vomc 55 Vomiting 201 Silver Relaxc Ven. System 60 Violet 97 Sage Wild 71 Vomit from irritation Cardamom 201 Saspenilla 77 Valerian Wild 38 Senna 108 Veget. Tonies 63 Scammony 111 Expect in Asthma 132 Wormwood 73 Tobacco Dropsy Tetanus 23 Witch Harte 74 Tea Subotic for opm 21 Willow Swamp 76 Tonics vegetc. How act 63 Womans Tongue 76 Thorough work 70 Winterberry & green 77 Tormentin 81 White Oak 85 Tamarinds (Tooth ach 201) 107 Wine Whey Laxtive &c 131 Trumpet weed 134 Tetanus 148 Travers [illegible] fever 150 Zinc Ion. In stomach affect Rx intermithrt Dispepsice Dysent. Put sore throat Chlorosis ill cond. Ulcers Ponmorrhoea