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 HOME PHYSICIAN: 
 
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 L> CO I A NEW AND POPULAR GUIDE *y <g^ 
 
 TO THE J^ W* %> 
 
 Art of Preserving Health and Treating Disease ; 
 
 WITH PLAIN ADVICE FOR ALL THE 
 
 MEDICAL AND SURGICAL EMERGENCIES OF THE FAMILY. 
 
 CONTAINING CLEAR DESCRIPTIONS OF THE 
 
 Structure and Functions of the Human Body ; the Influence of Occupation on Health and 
 Longevity ; the laws of Inheritance ; with new and original chapters on Diet, Stimulants 
 and Narcotics, Air, Sunlight, Exercise, Climate, Electricity, and Nervous Diseases 
 of modern times ; and full directions for the care of the Sick, and the manage- 
 ment of Infants and Children ; with a general description oi recent Medical 
 Discoveries and Improvements ; plain suggestions for the Treatment of 
 Diseases adapted to the wants of the Household, and for those 
 who, like Miners, Sailors, Planters, and dwellers in remote 
 districts, are beyond the ready call of a Physician. 
 
 BASED ON THE MOST RECENT AND THE HIGHEST AUTHORITIES IX THE SEVERAL DE- 
 PARTMENTS, AND BROUGHT DOWN TO THE LATEST DATES. 
 
 By GEORGE M/ BEARD, A.M., M.D., 
 
 Lecturer on Nervous Diseases in the University of New York ; Member of the New York County 
 Medical Society; one of the Authors of "The Medical Use of Electricity," &c. 
 
 WITH NUMEROUS ILLUSTRATIONS. 
 SOLD BY SUBSCRIPTION. 
 
 NEW YORK: 
 
 E. B. TREAT & CO., 654 BROADWAY; 
 
 C. W. LILLEY, CHICAGO, ILL. ; A. H. HUBBARD, PHILA., PA. ; A. L. TALCOTT & CO., 
 PITTSBURG, PA. ; IRA S. BRAINARD, ST. LOUIS, MO. ; J. H. HUMMEL, NEW ORLEANS, LA. 
 
^ 1 v* 
 
 3> 
 
 Entered according to Act of Congress, in the year 1869, by E. B. Teeat & Co., in the Clerk's Office of the District Court of the United 
 States for the Southern District of New York. 
 
 /v 
 
 ^ 
 
 # 
 
 
 The New York Printing Company, 
 
 81, 83, and 83 Centre Street, 
 
 New York. 
 
PREFACE 
 
 The objects of this book are : 
 
 1. To prevent disease, by presenting in a popular form informa- 
 tion concerning the laws of health. 
 
 2. To shorten disease, by enforcing the necessity and the duty 
 of taking bad symptoms in time, and stopping the beginnings of 
 evil. 
 
 3. To diminish the evil and fatal effects of disease, by giving 
 plain advice for all the medical and surgical emergencies of the 
 family, and simple rules for arresting and controlling disease for 
 those who are beyond the ready call of a physician. Its purpose, 
 therefore, is not so much to enable its readers to dispense with a 
 physician, as to teach them how to dispense with disease. 
 
 4. To give popular information concerning the progress of me- 
 dical science, by briefly describing and illustrating the recent inven- 
 tions, discoveries, and improvements by means of which physicians 
 are now enabled to study and to treat disease so much more satis- 
 factorily and successfully than in former times. Although many 
 of the instruments and appliances that are represented cannot, of 
 course, be used by my readers, and may indeed never be seen- by 
 them, yet a general knowledge of their nature and uses cannot fail 
 to be both interesting and valuable to the afflicted of every class, 
 and should have the effect to convince the most sceptical that a 
 profession which has done so much and so nobly for humanity is 
 worthy of the highest respect and most fervent gratitude. 
 
 What is here said concerning the structure of the human body 
 and the functions of its organs ; on diet, stimulants, narcotics, air, 
 sunlight, exercise, bathing ; on the care of the sick-room, the man- 
 agement of infants and children ; on the general laws and history 
 of disease; and on the treatment of accidents and emergencies, and 
 descriptions of familiar remedies, — is designed for all persons and 
 for every household. 
 
 What is here said concerning the special care and treatment 
 of obscure and grave diseases, and the application of powerful re- 
 medies, is designed chiefly for those who, like planters, miners, 
 sailors, travellers, and dwellers in remote districts and on the plains, 
 
IV PREFACE. 
 
 are beyond the reach of skilful medical aid, and must either be 
 treated by themselves or by their friends, or left to suffer, and per- 
 haps to die. 
 
 The work, as now arranged, not only includes all that has ever 
 been attempted in similar works, but also several hundred new siO~ 
 jects in the department of health that have never before been men- 
 timed in any or all of the popidar treatises on m.edical science that 
 have yet appeared.. I have sought to mention and describe every 
 recent medical discovery and improvement that can possibly be of 
 any service to my readers. I have endeavored throughout the 
 work to keep in mind that I was writing for the great masses of 
 the people, who know little or nothing of medical language. There- 
 fore I have aimed to make the descriptions brief, clear, and elemen- 
 tary. There are many methods of studying disease, many hard 
 terms which would only bewilder the general reader, though they 
 are very familiar to physicians. Of such I make no mention. 
 
 My aim has also been to make the work so clear that the wayfar- 
 ing man might not err therein, and yet so thorough and exhaustive 
 that the educated physician should find in it much to perfect his 
 knowledge and refresh his memory. 
 
 It will be seen that the types, phases, and names of diseases 
 have changed wonderfully during the past twenty-five years. We 
 now have less of fevers and inflammation, and more of dyspepsia, 
 neuralgia, hysteria, hypochondria, and other forms of nervous dis- 
 ease. 
 
 In our method of treatment, a greater revolution has been 
 wrought than in the types of disease. Instead of bleeding and 
 calomel, tartar-emetic and low diet, we now give tonics mid stimu- 
 lants — iron and quinine, strychnine and arsenic, cod-liver oil and 
 whiskey, air and sunlight, passive movements, general electriza- 
 tion, abundance of sleep, and a large and palatable variety of nour- 
 ishing food. 
 
 The result of all this scientific progress is, that we are much 
 more successful in the treatment of diseases than formerly. Con- 
 sumption is now much oftener held in check, relieved, and cured 
 than it was twenty-five years ago. Statistics now show that it is 
 much less frequently fatal under the new system of treatment than 
 under the old. Catarrh of the nose and larynx (rhinitis, pharyngitis, 
 and laryngitis), dyspepsia, neuralgia, hysteria, hypochondria, in- 
 sanity, the special diseases of xoomen, affections of the eye, the ear, 
 and the skin — all of which were until recently ignored and neglected 
 by the profession — are now treated with signal success. Among the 
 new remedies and methods of treatment that have been found most 
 
PREFACE. 7 
 
 successful, I may here mention bromide of potassium, carbolic acid, 
 t7ie sulphites and hypophosphites of soda, pepsin, cod-liver oil, strych- 
 nine, Swedish movements, general and localized electrization, podo- 
 phyllin, pyrophosphate of iron, veratrum viride, nitrous oxide, 
 oxygen, phosphorus, glycerine, chlorate of potash. 
 
 ' This work is intended to be a compend of the whole of the pop- 
 ular medical science of our time, so far as it can be interesting or 
 useful to my readers. Under Anatomy I have presented those gen- 
 eral facts in regard to the structure of the body, that every one, 
 young and old, should be acquainted with. Under Physiology I 
 have introduced many recent experiments and researches in this 
 most fascinating branch of science. Under Hygiene I have given 
 in detail important rules for the care of the health and the art of 
 prolonging life. This is a subject to which I have devoted my 
 life, and one to which I call the special attention of my readers. 
 The large portion of the book devoted to the care of the health will 
 be found to contain new, reliable, and interesting facts, many of 
 which have never before been published. The facts and views that 
 I present on the subject of Food, Stimidants and Narcotics, Exer- 
 cise, Sleep, Laws of Inheritance, Influence of Occupation on Health 
 and Longevity, Man compared with other Animals, certain of the 
 nervous diseases, will probably take most of my readers by surprise. 
 This surprise will be all the greater because the people have usually 
 obtained their instruction on these matters from bad or ignorant 
 men, who knew nothing whatever of science. I have tried also to 
 present this department of hygiene in a somewhat attractive and in- 
 teresting style, so that every one into whose hands the book may 
 fall will read them first, even though all other sections are neglected. 
 
 In speaking of the various Accidents, Diseases, and Remedies, 
 I have aimed to be brief, clear, direct, and explicit ; to introduce 
 nothing that would mislead, to omit nothing that can be of prac- 
 tical service to any one. I have tried to draw the lines beyond 
 which patients should never attempt to cross. I have pointed 
 out those conditions in which patients should never allow them- 
 selves to be treated by themselves or their friends, and should con- 
 sult the best medical advice or none at all. 
 
 It will be seen that a large number of diseases which the masses 
 of the people suppose to be incurable are now, under our modern 
 systems of treatment and in skilful hands, susceptible of relief and 
 of cure. All over the land there are thousands of cases of cataract 
 that a skilful oculist might operate on with success ; thousands of 
 cases of deafness which, if taken in time, might be wholly or par- 
 tially cured ; thousands of cases of dyspepsia, neuralgia, paralysis, 
 
VI PREFACE. 
 
 and Dther nameless forms of chronic nervous diseases, that, if they 
 only knew where to go, without falling into the hands of the phi- 
 listines, might be permanently relieved. All about us there are 
 aching heads, weary nerves, that cry bitterly for relief and know 
 not where to find it. This knowledge of the best way to consult a 
 physician, and the best means of treatment, especially for diseases 
 that have been regarded as incurable, I endeavor here to supply. 
 
 There are yet among the people those who have a blind faith in 
 some one school or exclusive system of treatment. To all such, 
 let me say that the wise physician of oar time uses for his patients 
 all things that have been proved to be beneficial. On this principle 
 this work is based. The best physicians of our day are not nar- 
 row or bigoted, as some suppose, bat are on the whole more liberal 
 and progressive than almost any- other class in society. 
 
 I undertake the enterprise with a full appreciation of the re- 
 sponsibilities of my position as a pioneer. Accordingly, I have left 
 no stone unturned to make the work fully represent the best and 
 most recent opinions and experience of the leading authorities of 
 our time in the various departments. 
 
 This book, as now completed, is the work of so many hands, that 
 I might perhaps be more properly called its editor than its author. 
 Of the "Domestic Medicine" prepared by Imray and other able 
 writers, on which the work is based, I have taken of the general 
 descriptions, especially in the department of Anatomy, such por- 
 tions as in their very nature cannot be very progressive, and are 
 therefore of permanent application. 
 
 I have been assisted in the department of the Eye and Ear, by 
 Prof. D. B. St. John Roosa ; in Surgical Accidents and Emergen- 
 cies, by Prof. Benjamin Howard ; in Obstetrics and the Hygiene of 
 Infancy, by Dr. James B. Hunter. In the general revision of the 
 work and correction of the proofs I have received indispensable 
 assistance from my professional associate, Dr. A. D. Rockwell. 
 
 In collecting Vital Statistics I have at various times received 
 invaluable suggestions from those eminent hygienists, Dr. Edward 
 Jarvis and Dr. Elisha Harris, Registrar of Vital Statistics of the 
 New York Metropolitan Board of Health. 
 
 In the sanitary department I have had the benefit of the experi- 
 ence of the well-known sanitarian, Dr. John H. Griscom. 
 
 To each and all of these gentlemen I desire to express my 
 warmest acknowledgments, not alone for special assistance, but 
 for general encouragement in my labors. 
 
 I have quoted extensively from my translation of ToboWs 
 Chronic Diseases of the Larynx, from my works on The Brain and 
 
PREFACE. V1J 
 
 Brain-'Wor'kers, and Hygiene for Students, both of which are now 
 being prepared for early publication ; and also from a work on 
 General and Localized Electrization, by Dr. A. D. Bockwell and 
 myself, which is now in press. To Messrs. Tiemann & Co. my 
 thanks are due for courtesy and promptness in furnishing a number 
 of the cuts of instruments with which the work is illustrated. 
 
 I have consulted and freely quoted the standard works in the 
 special departments of medical science that have appeared during 
 the last few years. A partial list of the more prominent of these 
 writers, with the titles of their books, will be found under a separate 
 heading. 
 
 The task which I have here undertaken is one of unusual diffi- 
 culty and delicacy. To prepare a comprehensive popular treatise 
 on the recondite science of medicine that shall say just enough to 
 instruct, and not so much as to bewilder ; that shall fairly represent 
 the various departments in language both clear and attractive, as 
 well as accurate and instructive ; that shall make broad and plain 
 the boundaries between those subjects which the people can and 
 should know, and those which they should not attempt to know ; 
 that shall treat all this large variety of themes in such manner as not 
 to offend the taste of the best-ordered household, — this is probably the ■ 
 severest test to which a scientific writer can possibly be brought. 
 
 In the absence of any respectable model, I have been compelled 
 to proceed without guide or precedent, and to create my own ideal. 
 Accordingly, it has been my aim to write here in the pages of this 
 book just what I say every day in my office to my patients; just 
 what I have been accustomed to teach in my popular essays 
 and in my lectures before schools and lyceums. 
 
 I say just what the family physician would tell his patients if 
 he had the time and strength to give instruction in science to the 
 families under his charge. 
 
 New York, August, 1869. G-. M. B, 
 
INTRODUCTION 
 
 KEASONS WHY ALL PEOPLE SHOULD HATE SOME 
 GENERAL KNOWLEDGE OF MEDICAL SCIENCE. 
 
 It is one of the most cheering signs of our times that science is 
 being diffused among the masses of the people. 
 
 On every hand we see evidences of an increasing love for scienti- 
 fic truth, even among those classes who formerly had no love for 
 knowledge of any kind. Works on familiar science are now read 
 with considerable eagerness ; and the certain prospect is, that in a 
 few years they will command a much wider circle of readers than 
 they do at the present time. 
 
 The people are beginning to learn that science is for them and 
 not for the few, and are now informing themselves of some of the 
 general principles and facts of astronomy, of geology, and of che- 
 mistry ; and our periodical literature is helping on the good work, 
 oftentimes unconsciously. It is hard to find any prominent and 
 popular newspaper or magazine that does not now and then present 
 some interesting and valuable scientific facts and theories; and there 
 are quite a number of journals which regularly devote a certain 
 space to popular science in all its branches — chemistry, astronomy, 
 geology, and medicine. 
 
 Nor is this all. Quite recently a journal has been established, 
 one of the professed objects of which is to disseminate popular 
 science among those classes who are the most eager readers of fiction. 
 
 These signs of the times are, I say, full of cheer. They give 
 promise of a more generous culture, larger views, and more kindly 
 tolerance in the future, among all ranks of society ; for the tendency 
 of scientific knowledge is always to liberalize. 
 
 The one great cause of the prevailing (but happily diminishing) 
 narrowness in our current theologies, systems of education, and 
 social customs, is ignorance. Ignorance begets prejudice, and for the 
 poison of prejudice the only antidote is knowledge. 
 
 While, then, bidding God-speed to all who, like Agassiz, and 
 
X KEAS0NS WHY ALL PEOPLE SHOULD HAVE SOME 
 
 Huxley, and Youmans, and others, are endeavoring to popularize 
 natural science, I desire here to make a special plea for the popular- 
 study of the Human Body in health and disease. 
 
 There are reasons why, especially at the present time, every one 
 should make it a pleasure and a duty to become acquainted with 
 some of the general facts in regard to the structure and functions 
 of the human system, as well as the rules for preserving health, and 
 checking or modifying disease. 
 
 These reasons are : — 
 
 1. Because the human body is the greatest wonder of creation. 
 Nothing that man can devise, and nothing else that God has created, 
 is worthy to be compared with the complex, wonderful machine 
 which we call man. 
 
 A distinguished theologian truly and eloquently says : " Men will 
 cross the ocean to see a mountain or a waterfall, but there is more 
 of grandeur in the human spirit than in all material nature." 
 
 Now the human spirit is manifested through the material organ- 
 ization — the body; it therefore becomes necessary that we should 
 study the structure and functions of this body before we can well and 
 truly understand the spirit of which it is the agent. The human 
 brain, through which the soul is manifested, is a far more wonderful 
 object than the loftiest mountain or the broadest ocean. It is true 
 that the gigantic and imposing objects of nature, — mountains and 
 oceans, forests and cataracts, — appeal more directly to the uneducated 
 senses than do those objects which are comparatively minute and 
 insignificant. 
 
 The element of size, the grandeur of immensity, the awfulness 
 of height and depth, of length and breadth, can be much better 
 appreciated by the great mass of unthinking and unreasoning hu- 
 manity than objects which, though far more wonderful and sugges- 
 tive, are yet less imposing and pretentious. Humanity the world 
 over is more impressed by quantity than by quality. In proportion, 
 however, as men advance in knowledge, in proportion as reason ob- 
 tains supremacy over imagination, in that proportion will men cease 
 to be impressed by mere size and quantity, and will learn to appre- 
 ciate the beauty and grandeur of nature as revealed in objects that to 
 the untaught mind would not only not be impressive, but would 
 actually be revolting. 
 
 There are those who feel that the study of material substance 
 is undignified and disagreeable. They declare that the study of 
 anatomy suggests the dissecting-room, that the reading of hygiene 
 tends to hypochondriasis, and that all discourses of medicine bring 
 up horrid images of the hospital and sick-room. To all such objec- 
 
GENERAL KNOWLEDGE OF MEDICAL SCIENCE. XI 
 
 tions I reply that knowledge itself is dignity, and in turn dignifies 
 and ennobles that which to the untutored senses is insignificant and 
 revolting. The human body is always small and insignificant in 
 comparison with thousands of other created objects, animate and 
 inanimate, and only in exceptional cases is it attractive or beautiful 
 to the eye; and yet it is the most wonderful and suggestive of all. 
 
 The brain is but a small portion of the human body : its yield- 
 ing and sightless mass can readily be held in the hollow of the 
 hand; but in comparison with it all other wonderful objects of 
 nature sink into insignificance. Place but a minute section of that 
 brain beneath the microscope, and what before, to the unaided 
 vision, was as simple in its structure as a formless mass of clay, 
 reveals itself as a vast congeries of cells, group after group, layer on 
 layer, of every variety of shape, infinite in their number, infinite in 
 their communications, and infinite, too, as we may suppose, in their 
 functions. Subject a fragment of that brain to the tests of chemis- 
 try, and we learn that the elements of which it is composed are 
 substantially similar to those out of which are developed thousands 
 of organized products of nature ; and thence we are forced to infer 
 that the vast superiority in function and capacity over all other 
 created objects must be due solely or chiefly to some subtle and 
 mysterious difference of molecular arrangement, which neither the 
 microscope nor chemistry have yet been able to fathom. 
 
 2. A general knowledge of medical science will aid us in pre- 
 serving health and prolonging life, and thus will add much to our 
 usefulness and happiness. 
 
 The great art in medical science is not so much to cure disease 
 as to prevent it. The great progress that medicine has made in 
 recent times is shown not so much in the actual treatment of dis- 
 ease — although here also we are far more successful than formerly 
 — as in forestalling and preventing it by obedience to the laws of 
 health and wholesome sanitary reform. 
 
 For all that we are, and for all that we do in life, we are depen- 
 dent on the body. The difference between one man and another is 
 the difference in quantity and quality of bodily formation ; for the 
 soul manifests itself through the brain, which is an organ of the 
 body, and is as much dependent on the brain for the character of 
 its manifestations as the digestion is dependent on the apparatus of 
 digestion. 
 
 Strictly speaking, there can probably be no such thing as a dis- 
 ease of the mind without a corresponding disease of some part of 
 the body, and usually of the brain, which is the organ of the mind. 
 In view of this consideration we see that it becomes a liisrh and 
 
Xll REASONS WHY ALL PEOPLE SHOULD HAVE SOME 
 
 solemn duty for every one to obtain some general knowledge of the 
 human system in health and disease, in order to guard against evil, 
 to ward off injury, to intensify and prolong existence. 
 
 It should be remembered that every evil that is experienced by 
 the human system, every pain, every sorrow, every disease, comes 
 by the operations of the great law of cause and effect. Nothing evil 
 or good comes to us by chance. Contagions, epidemics, malarias, 
 the myriad forms of nervous disease, the subtle and saddening 
 phases of insanity and delirium — all these myriad woes of the 
 human races are dependent on definite causes, many of which 
 may be guarded against by those who have the requisite knowl- 
 edge. 
 
 A general knowledge of medical science will help us to fulfil 
 more intelligently and successfully our various duties as members 
 of society. 
 
 Science must not be confined to scientific men. A knowledge 
 of science in its various departments, and especially a general 
 knowledge of the structure and operations of the human body and 
 of some of the laws of disease, will make us better lawyers, better 
 clergymen, better merchants, better farmers, better laborers, better 
 mechanics and artisans, better wives and mothers and husbands 
 and fathers, better citizens, and better in every condition and 
 relation of society. 
 
 The habit of studying and reading on science is important, not 
 only for the facts that we learn, hut on account of the habit which 
 we thereby form of looMng at questions from a scientific point of 
 view. We are all of us too much inclined to form our opinions from 
 prejudice, and from a general impression, without regard to truth 
 or facts. The consequence is that society is filled with error. The 
 consequence is, that even in this enlightened age and throughout 
 this enlightened country, the opinions of masses of people on nearly 
 every important subject are more or less erroneous. On nearly 
 every page of this present work I have been obliged to refute some 
 deeply-rooted, widely-spread error concerning diet, or stimulants 
 and narcotics, or sleep, or exercise, or some form of disease. 
 Erroneous views on medical science confront the physician wherever 
 he turns — in the street, in the store, at public assemblies, in the 
 halls of legislatures and chambers of justice, in the periodical litera- 
 ture and in our standard works of genius, in every family, and by 
 every bedside. 
 
 These are not the results of ignorance alone. They are the 
 results of a deficiency in the scientific spirit, and an excess of dog- 
 matic prejudices in society. 
 
GENERAL KNOWLEDGE OF MEDICAL SCIENCE. Xlll 
 
 The scientific spirit differs from the dogmatic spirit in these 
 respects : 
 
 First. In the pursuit of truth it endeavors to dismiss all pre- 
 judice, all preconceived impressions. It has no theories to prove 
 and no wishes to gratify, except the love of truth. 
 
 Secondly. It never assumes that anything is true until it is 
 proved to be true / and, always holds itself ready and willing to 
 change any views, however dear or long-cherished, as soon as they 
 are proved to be erroneous. 
 
 Thirdly. When it has found the truth on any subject, after 
 careful and patient balancing of all the facts that bear upon it, it 
 eagerly embraces and proclaims that truth, without ever asking for 
 an instant uihether its apparent tendencies may be good or evil. 
 
 The great want of our country at the present time is a wider 
 diffusion of this scientific spirit, so that men will form their opinions, 
 especially on social and political topics, less by their hopes and 
 desires, expectations and fears, and more by the facts. 
 
 When I write on the ignorance of the country on matters of 
 science, I know not where to begin or where to end. This igno- 
 rance is not confined to the lower classes ; it is even more promi- 
 nently observed and far more injuriouslj T felt among the educated 
 and influential. In our country this scientific ignorance is espe- 
 cially to be deplored, because here all men are created free and 
 equal, all have equal voice in the administration of government, 
 and all have equal chance to rise to positions of honor and influ- 
 ence. Our present social, legislative, and judicial systems are so 
 defective, that men who know nothing whatever of science are 
 continually called upon to decide important scientific questions 
 affecting the rights, the privileges, and the duties of those who, 
 perhaps, know far more than t ne Jj n °t only of science, but of every 
 other department of thought. 
 
 Legislatures, not one of whose members can answer the simplest 
 fundamental question concerning the nature or the history of 
 stimulants and narcotics, who do not know and have not thought 
 to inquire whether they came chiefly into use fifteen hundred years 
 before Christ or fifteen hundred after, are yet every year called 
 upon to enact laws to prohibit or regulate their use in society. Is 
 it surprising that their legislation is so absurd and inconsistent? 
 Judges and juries, who have not the faintest conception whether 
 insanity is a symptom of disease of the brain or of the liver — who 
 in all their lives have never given five minutes of consecutive 
 thought to any scientific subject whatever — are compelled, under 
 our present system of laws, to decide on this momentous question 
 
XIV REASONS WHY ALL PEOPLE SHOULD HAVE SOME 
 
 of sanity or insanity, not only in cases of life and death, but also in 
 cases where property even, so much more valued than life, is at 
 stake. Is it surprising that the wicked so often escape and the ir- 
 responsible are so often punished ? 
 
 Clergymen, editors, and public teachers, who know all subjects 
 better than they know the science of life, are expected and required 
 to pronounce upon the right or wrong of questions which do not and 
 should not rise into the sphere of morals until they have first been 
 determined in the sphere of experience. Is it surprising that even 
 our most conscientious public instructors must sometimes put 
 darkness for light and light for darkness on many of these impor- 
 tant themes ? 
 
 Parents and guardians, who have never themselves been properly 
 taught concerning the structure or the functions of the human body, 
 are obliged to train up their children to the same dogmas and pre- 
 judices and erroneous impressions by which they themselves have 
 been inspired. Is it surprising that our children grow up in error? 
 "Would it not indeed be still more surprising if they possessed any 
 true or real knowledge on any question of hygienic or medical 
 science ? 
 
 The truth is, that there is scarcely any important social, political, 
 or religious question of our time that may not be aided in its solu- 
 tion by a knowledge of the leading principles of medical science. 
 The rights and duties of women, the status of the Africans, the future 
 of the Chinese, and many other analogous questions of minor im- 
 portance, would be solved much more readily and more correctly 
 if philanthropy would not so blindly refuse the aid of physiology. 
 But, unfortunately for the cause of truth, only those who have at 
 least some general knowledge of medical science, or who have en- 
 joyed some training in that department, are willing to listen to 
 arguments based on the facts of science, especially when they mili- 
 tate against their prejudices and desires. Prof. Goldwin Smith, in 
 his masterly address on education recently delivered at Albany, 
 said that the voice of physiology should be heard on this great 
 question of the education of woman ; but until the people, both 
 the leaders and the masses, are educated into a scientific spirit, the 
 efforts of physiology will be vain. Though she cry aloud in every 
 language and on every corner of the street, yet her speech will be 
 in an unknown tongue, and her voice will be drowned in the jeers 
 and groans of the multitude. 
 
 It cannot be denied that even at the present time there exists a 
 deeply-seated prejudice against scientific men. They are regarded 
 as the enemies of truth, although their professed object is the pur- 
 
GENERAL KNOWLEDGE OF MEDICAL SCIENCE. XV 
 
 suit of truth. They are branded with meaningless but repulsive 
 epithets, — materialists, infidels, atheists, — and are held up before 
 the people as solemn and impressive warnings. The cure for this 
 unfortunate prejudice lies in the general diffusion of scientific know- 
 ledge. 
 
 4. The study of the principles and facts of medical science is 
 exceedingly pleasurable. 
 
 If the pursuit of knowledge is the highest and most enduring 
 pleasure of life, the study of science is the most enjoyable depart- 
 ment of knowledge. 
 
 The calm and unworried pursuit of science is probably the 
 purest and most enduring intellectual pleasure of which human 
 nature is capable. It is also exceedingly conducive to health. As 
 will be shown in my essay on the Influence of Occupations on 
 Health and Longevity, philosophers and men of science attain a 
 great average longevity. 
 
 Children should be instructed in the interesting and important 
 departments of physiology and hygiene, not only at school, but in 
 the family circle. It is not right nor necessary that the study of 
 these subjects should be made dry and dismal. By the aid of maps, 
 charts, pictures, attractive books, and especially by the exercise of 
 kindly care on the part of instructors, these theories can be made 
 not only instructive but actually fascinating. The commandments 
 of physiology and hygiene should be taught diligently unto our chil- 
 dren, line upon line, precept upon precept, here a little and there a 
 little, in the house and by the way, at their lying down and their ris- 
 ing up. Much of the scientific instruction given to children in 
 early life will not be fully understood in all its transcendent im- 
 portance until after years ; but in time of need they will both re- 
 member and appreciate its value. 
 
 They will remember it when they rise to positions of responsi- 
 bility and posts of honor, and will guide their judgment and inspire 
 their lives by its teachings. They will remember it in the hour of 
 temptation, and will derive therefrom wisdom to direct and 
 strength to resist the force of mastering passions. They will re- 
 member it in the time of darkness and sorrow, and will rejoice 
 in the light of its truths, and find the rarest of consolation in the 
 activity of its pursuit. They will remember it when they them- 
 selves are parents, and in turn will teach it to their children, and 
 they again to their children's children, unto the remotest gen- 
 erations. 
 
II. 
 
 EEASONS WHY THE PEOFESSION SHOULD LABOE 
 TO DIFFUSE A GENEKAL KNOWLEDGE OF MEDI- 
 CAL SCIENCE AMONG THE PEOPLE. 
 
 The duty of the profession to diffuse a knowledge of medical 
 science among the people is rendered imperative by these four 
 considerations : 
 
 1. Because all people everywhere need, and should have, some 
 general knowledge of the human "body in health and disease. 
 
 The time has gone by when it was thought to be necessary that 
 learning should be confined to the few. It is the glory of our century 
 that knowledge of all kinds is diffused among the masses of the 
 people. The time was when theology was confined to the clergy, 
 and was the privilege of monks and cloisters ; religion is now the 
 duty and the joy of the ignorant and the lowly. The time was when 
 all government and law were in the hands of a few aristocrats, and 
 even of some single monarch; in our day and country the people 
 rule, and kings and queens, presidents and senators, are but their 
 servants. 
 
 Science must now follow in the wake of theology and govern- 
 ment. If the masses of the people are to have all the power in 
 Church and State, they certainly must not be left in ignorance. 
 For the ignorance of humanity there is only one antidote, and that 
 is knowledge. Of all departments of knowledge, none is so im- 
 portant as that of ourselves. It is impossible to know ourselves 
 without knowing the structure of the human body, the functions of 
 its organs, and the laws of health. It is impossible to acquire this 
 knowledge without careful study, diligent reading and patient 
 repetition, in all the recognized methods of imparting knowledge. 
 It must be taught to children in the school and by the domestic 
 fireside, and in juvenile literature. It must be taught to parents 
 from the pulpit, the platform, and in the periodical press, and 
 in such works as these. 
 
 The present ignorance of society in regard to anatomy, physiology, 
 and the laws of health are truly appalling. Even the clergy, who 
 are so advanced in general culture, and who should be the teachers 
 of hygiene as a part of morality, are as a profession utterly in the 
 
REASONS FOE DIFFUSION OF MEDICAL SCIENCE. XV11 
 
 dark in regard to the simplest laws of life and health. Theologians 
 and professors, college presidents and pulpit orators, who have learned 
 all important languages, living and dead, who can repeat at call the 
 names of all the imbecile and insane kings of Europe and the dates 
 of their administrations, do not even suspect the nature of the pro- 
 cesses of respiration or of digestion every moment going on in their 
 own bodies ; and even give no reason for the faith that is in them, 
 that the brain rather than the liver is the organ of the mind. 
 
 Even men of general science, who plan great inventions and 
 understand all the machinery of man's devising, know nothing of 
 the most wonderful machine of all — the human body. If these 
 things be done in the green tree, what shall be done in the dry ? 
 If our teachers, and the teachers of our teachers, know little or 
 nothing of themselves, what shall we say of the great masses of 
 the people ? What shall we say of the millions of farmers, 
 mechanics, laborers, and the solid yeomanry of our land, on whose 
 virtue and intelligence the welfare of the republic must ever 
 depend ? 
 
 The profession must exert its influence to introduce the sys- 
 tematic study of hygienic science in all of our colleges and in- 
 stitutions of learning. 
 
 Time was when the standard of scholarship was necessarily 
 estimated by the extent of one's familiarity with dead lan- 
 guages ; when the span of a thousand years — the dark ages of 
 humanity — intervened between the scholar in the cloister and the 
 literary wealth of the world ; when, in short, the student was 
 forced to choose between treasuring up the learning, of ancient 
 times, and knowing nothing at all. 
 
 That necessity has long since gone by, but the system of in- 
 struction to which it gave rise in its leading features lives to-day. 
 Bacon never uttered a profounder or more beautiful thought than 
 when he said that what is called the antiquity of the world is 
 really its youth. If the ancients could be alive again to-day, 
 they surely would be the first to bow at the feet of the nineteenth 
 century. 
 
 When we consider the marvellous scientific progress of the last 
 century — that within that time Geology has arisen out of the dark- 
 ness of conjecture and has developed into a more comprehensive 
 and enduring science; and that by the discovery of hydrogen by 
 Cavendish, of oxygen by Priestley, of nitrogen by Rutherford, and 
 by the labors of Sir Humphry Davy, Liebig, and their followers, 
 the science of chemistry has been as it were created, and all since 
 the year 1766 ; that within less than this time that universal agent, 
 
XV1U REASONS WHY THE PROFESSION SHOULD LABOR 
 
 Electricity, lias revealed itself to man in its effects if not in its 
 nature, — lias indeed deigned to serve him as his fleetest messenger 
 through the air and under the sea, as the faithful and rapid copyist 
 of works of art, as a powerful means of illumination, and as a most 
 effective healer in disease; that within the last fifty years the 
 mechanic arts, in their myriad ramifications, have made more 
 effective progress than other eras have witnessed in twice as many 
 decades ; when we consider that astronomy, the most ancient 
 of sciences, the boast of the Egyptians and Chaldeans — which is 
 indeed in its very essence a study of centuries — has not been with- 
 out its refinements even during the present generation — nay, even 
 within the year that is just passed ; when, I say, we thus consider 
 all that the last fifty years has done for science, — and more than all, 
 when we contemplate the wondrous possibilities of the fifty years 
 to come, and for which we now have but laid the foundation ; and 
 when, on the other hand, we consider how little these branches are 
 taught or even suggested to our undergraduates, we can but wonder 
 that an age which has revolutionized society by its activity in 
 science, has made so little impression on those institutions that 
 ought to be, if they are not, the centres and the repositories of 
 the world's progress. 
 
 It is neither necessary nor desirable that hygienic or other 
 science should supplant the languages. It is the duty of the 
 profession, however, to see that in all our institutions of learn- 
 ing it is placed on the same footing as all other important depart- 
 ments ; that it receives something more than a merely incidental and 
 superficial attention ; and that it is made equally binding with all 
 other recognized studies of the course. 
 
 2. Because physicians are the only class who are authorities in 
 medical science , and who are qualified to give instruction in it. 
 
 Medical science is a large subject, and it takes a lifetime to 
 comprehend it. People look to those whose lives are devoted to 
 this subject to teach them what they ought to know. They have 
 a right to do so. Of those to whom much has been given, much will 
 be required. If we know that which will be of service to onr fellows, 
 we have no right to keep it to ourselves alone. A miser of knowl- 
 edge is even more censurable than a miser of money, because he is 
 more intelligent, and therefore more responsible. It is even more 
 wrong for us to hoard knowledge than to hoard specie, for knowl- 
 edge is more valuable than gold or silver or precious stones. 
 
 Until quite recently the clergy have been the chief instructors of 
 the people in medical science ; but they have unfortunately taught 
 more of error than of truth. The fault, however, is not with the 
 
TO DIFFUSE A KNOWLEDGE OF MEDICAL SCIENCE. XIX 
 
 clergy but with the physicians. The clergyman must first be himself 
 instructed before he can instruct others. The duty of teaching medi- 
 cal science to the clergy devolves upon the physician, because in all 
 such matters he is the first authority and last appeal. It is right and 
 proper and noble for the pastor to teach his flock the laws of health, 
 and to enjoin their observance as a high moral duty ; but he must 
 know whereof he affirms, and the true knowledge on these themes he 
 must learn from the physician. 
 
 3. Because the instruction of the people in medical science has 
 oeen almost entirely in the hounds of ignorant and unprincipled, 
 charlatans. 
 
 This lamentable and well-known fact, which ought long since to 
 have aroused the profession to its great duty, seems to have had the 
 opposite effect, and has deterred them from attempting any syste- 
 matic instruction of the people. There are those even now who fear 
 to write or lecture for the masses, lest they may thereby become 
 classed with the ignorant and villanous quacks who in this country 
 have appropriated this department almost entirely to themselves. I 
 hold to a very different doctrine. I hold that the example of charla- 
 tans, so far from discouraging, should rather stimulate the profession 
 to follow after them and drive them off the track. It is because the 
 enemy have planted tares in the field, that we should enter in and 
 sow the good seed. It is because the philistines have already invaded 
 the land, that we should hasten to take possession. 
 
 The noblest and best part of our mission is not to cure disease, 
 but to prevent it. The true and only way to prevent disease is to 
 diffuse through all ranks of society a general knowledge of the 
 human body and of the laws of health. 
 
 There maybe those who fear lest the profession may lose its dig- 
 nity by coming down from its lofty eminence and feeding the hungry 
 multitude. In the infancy of science, in the darkness of the middle 
 ages, such fear was, perhaps, not unnatural ; but the time for that has 
 now long gone by. When the sun is rising it gilds only the higher 
 mountain tops ; when it mounts to noonday it sends its rays, bright, 
 warm, and abundant, into the depths of the valleys and the darkest 
 crevices of the rocks. Just so when science was first rising upon the 
 world, its light was only seen and its warmth only felt by the philo- 
 sopher, the recluse ; as it is now ascending higher in the sky, it 
 should shine, with wisdom and healing in its beams, on the walks 
 of the humble, the lowly, and the sorrowing. 
 
 Science is no more degraded by ministering to the wants of the 
 people than is the sunlight when it trails its beams along the valleys, 
 or the rain when it falls alike on the evil and the good. 
 
XX REASONS WHY THE PROFESSION SHOULD LABOR 
 
 Jean Paul Richter has somewhere presented in substance this 
 simile, which the disciple of science should ever bear in mind : 
 "Beautiful is the eagle when it soars aloft in the sky and plumes 
 its distant flight towards the sun, but more beautiful still when 
 it descends to the earth and brings food to its helpless offspring 
 in their nest ; so the philosopher is noble when he lives above the 
 world in the cold atmosphere of science, but nobler still when he 
 descends from his lofty heights and brings hope and comfort to the 
 suffering sons of men." 
 
 4. Because the profession will elevate and benefit itself by thus 
 instructing the people in medical science. 
 
 All physicians the world over will agree that ignorant people 
 make the worst patients. The lower classes are proverbially ex- 
 acting and unreasonable, and too often un appreciative. In propor- 
 tion as people are educated — and especially in science — in that 
 proportion do they become considerate towards their physician, 
 obedient to his orders, and grateful for his services. 
 
 The effect of the popularization of medical science will be not 
 to diminish the practice of the profession, but to increase it. Pa- 
 tients are deterred from consulting educated physicians, not by 
 knowledge but by ignorance ; not by their ability to prevent or treat 
 diseases, but their inability to distinguish between those conditions 
 which are beyond all hope, and those which in scientific hands are 
 both relievable and curable. 
 
 "When the people are educated to a full understanding of the 
 wonderful achievements of science in the past, and the vast progress 
 that it is making in the present, and the wide distinction between 
 the physician and the quack, then will they know — what the masses of 
 our country have yet to learn — that the educated members of the 
 profession are not the enemies but the friends of advancement, and 
 that on the average they are as much more successful than the 
 charlatans, as they are more scholarly and more honest. 
 
 It is only by a general diffusion of popular science that the 
 vast army of charlatans — that are now working such ruinous havoc in 
 the best ranks of society — can be successfully combated and dis- 
 persed. The scientific man is pained to his heart's core when he 
 sees — as every day he is compelled to see — the best educated and 
 finest cultured minds of the country — our leaders in literary, pro- 
 fessional, and business life — ruined in health and in purse by the 
 vilest quacks that ever disgraced any age or country. The quack- 
 ery of our day feeds and fattens on the ignorance of the learned. 
 It derives its rich support from the fact that the people know all 
 other things better than they know science. The scientific physi- 
 
TO DIFFUSE A KNOWLEDGE OF MEDICAL SCIENCE. XXI 
 
 cian who long gazes upon this great rush of humanity after quack 
 doctors, quack books, quack medicines — after all forms of error and 
 one-sided "pathies" and "isms," feels much like the philanthropist 
 who, from the bank of a mighty stream, sees his fellow-beings 
 hurried along in the flood and ingulfed in the whirlpool, while he is 
 powerless to save. 
 
 Salvation from quackery will only come from popular instruction. 
 
 Besides all this, it is the duty of the profession, through the popu- 
 larization of science, to make itself & power in society. 
 
 It is our duty in this way to make our influence more widely felt 
 as a ruling force through all the departments of modern activity. 
 
 For all these reasons we hail with joy the recent endeavors of 
 some of our leading physicians to popularize medical science. The 
 system of lectures on science lately attempted by Professors Huxley 
 and Carpenter in London ; the noble example of Professors Willard 
 Parker and E. R. Peaslee in ISTew York ; the recently published 
 essays of Bowditch, Jarvis, Allen, Youmans, Hammond, Flint, Mit- 
 chell, Griscom, Peters, Roosa, Harris, Byford, and other leading 
 authorities in our profession; and the magnificent and success- 
 ful treatise of our eminent countryman, Prof. John C. Dalton — all 
 these are the emphatic protests on the part of the profession that the 
 people shall no longer dwell in darkness, that the medieval age of 
 narrow and selfish exclusiveness has passed away, and that men of 
 science shall hereafter follow in the path of theologians and law- 
 givers, and sow the good seed of truth broadcast through society. 
 
 In order to popularize science it is not enough to provide text- 
 books for the young. "We must sow beside all waters. "We must 
 make the magazines, the daily and weekly press, the pla'tform, the 
 lecture hall, the organizations of philanthropy, the pulpit and the 
 Sabbath-school, channels of communication, through which know- 
 ledge of science shall flow to the uttermost corners of the earth. 
 

 
EXPLANATIONS AND SUGGESTIONS FOR THE READER. 
 
 1. In order to get information on any subject treated of in this book, 
 look in the index. 
 
 Although the departments of Anatomy, Physiology, Hygiene, Descrip- 
 tion of the Principal Diseases and Remedies (alphabetically arranged), 
 Prescriptions and List of Medicines are so arranged that one who is familiar 
 with the book can tell at once where to look for information on any par- 
 ticular theme, yet the surest and easiest way is to consult the index at 
 once. 
 
 2. The subjects of Physiology, Diet, Sleep, Air, Sunlight, Exercise, 
 Stimulants and Narcotics, Influence of Occupation on Health and Lon- 
 gevity, Laws of Inheritance, Influence of Climate, Management of Infancy, 
 and many of the principal diseases, are so treated that they can be read 
 with interest and studied with profit, as well as merely referred to. 
 
 3. The doses of the medicines prescribed in this book are designed for 
 adults. The rule for graduating the dose for children, according to the 
 age, is given on page 460. 
 
 When any remedy is recommended for the treatment of any disease, 
 the dose is not usually given, because it must necessarily vary with the 
 age of the patient. The way to ascertain the dose in all such cases is to 
 refer to the description of the remedy itself, which can be 'found in the 
 index. In those exceptional cases where the dose is given it is designed 
 for adults, unless specially ordered otherwise. 
 
 4. Under the treatment of the diseases, I have given principles of 
 treatment rather than minute and bewildering details. The tendency 
 with patients is almost always to give too much medicine, and to give it 
 in too large doses. It will be observed that the treatment recommended, 
 even for the most serious diseases, is frequently quite simple — consisting 
 chiefly in good nursing, refreshing drinks, thorough ventilation, and the 
 cautious administration of perhaps one or two medicines. 
 
 Those who have been accustomed to indiscriminate dosing with great 
 combinations of drugs, will no doubt be surprised, on consulting this 
 book, to find even some of the most terrible diseases are treated by a few 
 remedies and by simple prescriptions. 
 
 It has been found in recent times, that, with some exceptions, simple 
 prescriptions, containing but one, two, or three substances, are more sure 
 and reliable than those containing a larger variety. As will be explained 
 
XXIV EXPLANATIONS AND SUGGESTIONS TO THE EEADEE. 
 
 under " Prescriptions" combinations of a large number of substances are 
 in certain cases of advantage ; but these combinations should not usually 
 be made by patients, but by competent druggists. 
 
 5. Throughout the work the prevention of disease is kept continually 
 prominent. The laws of health are treated of in great detail, because it 
 is believed that by thoroughly knowing and observing them, much of the 
 disease of the world could be prevented. The power of medicine at best 
 is limited. Most of fevers run their course, and all that medicine can do 
 is to relieve, to mollify, and sustain. The positive efficacy of medical 
 science is most observed in the treatment of those chronic diseases where 
 nature is incapable of effecting a cure, but where various combinations of 
 remedial measures assist her to accomplish tasks to which, without such 
 assistance, she would be unequal. 
 
 Most of chronic diseases, especially of the nervous variety, are best 
 treated by the same methods by which they should be prevented — that is, 
 by obedience to the laws of health. Therefore, in the treatment of all 
 these nervous diseases, referenced are continually made to the subjects of 
 diet, sleep, air, sunlight, exercise, and other important departments of 
 hygiene. 
 
PARTIAL LIST OF AUTHORITIES 
 
 CONSULTED, QUOTED, AND EEFEREED TO Iff THIS WORK. 
 
 Anything like a complete list of all the sources from which the infor- 
 mation in a work of such a character as this is derived, is manifestly- 
 impossible. I have only attempted to acknowledge those authorities that 
 are nearest at hand, and to which I am chiefly indebted. I have also liber- 
 ally consulted the medical and scientific periodicals, American and foreign, 
 and have thereby received indispensable aid in my endeavor to represent 
 the most recent views and experience of physicians of all countries. 
 
 Aitken, William, Science and Practice of Medicine. II. 1868. Edited by 
 Dr. Meredith Clymer. 
 
 Allen, Nathan, Intermarriage of Relations. 1869. 
 
 The Law of Human Increase. 1868. 
 
 Physical Culture in Amherst College. 1869. 
 
 Althaus, Julius, The Value of G-alvanism. 1866. 
 
 Medical Electricity. 1860. 
 
 Annandale, Thomas, Surgical Appliances. 
 
 Anstie, Francis E., Stimulants and Narcotics. 1865. 
 
 Atkinson, E. T., Change of Air. 1867. 
 
 Atkinson, E. T., Physics. 1868. 
 
 Bedford, Gunning S., The Principles and Practice of Obstetrics. 1868. 
 
 ■ Clinical Lectures on the Diseases of Women and Children. 
 
 1862. 
 
 Beigel, Hermann, The Human Hair. 1869. 
 
 Benedikt, Moriz, Elektrotherapie. 1868. 
 
 Bennett, John Hughes, Physiology as a Branch of General Education and of. 
 Natural Science for Students in Arts. 1869. 
 
 Bains, M. A., Excessive Infant Mortality. London. 
 
 Brodie, B., Mind and Matter. 1859. 
 
 Brown-S£quard, C. E., Course of Lectures on the Physiology and Pathology of 
 the Central Nervous System. 1860. 
 
 -^— — Lectures on the Diagnosis and Treatment of the Prin- 
 cipal Forms, of Paralysis of the Lower Extremities. 1861. 
 
 Buckle, Henry Thomas, History of Civilization in England. Two volumes. 
 1868. 
 
 Cazeaux, P. L., A Theoretical and Practical Treatise on Midwifery. 1863. 
 
 Chapman, John, Sea-sickness, and How to Prevent it. 1868. 
 
 Chavasbe, Pye Henry, Advice to a Mother. 1868. 
 
 . Advice to a Wife. 1868. 
 
 Churchill, Fleetwood, On the Theory and Practice of Midwifery. 1851. 
 
XXVI PARTIAL LIST OF AUTHORITIES 
 
 Cock, Thomas F., A Manual of Obstetrics. 1853. 
 
 Cohen, J. Solis, On Inhalations. 1868. 
 
 Condie, D. Francis, A Practical Treatise on the Diseases of Children. 1858. 
 
 Dalton, J. C, A Treatise on Physiology and Hygiene. 1868. 
 
 Dalton, John C, Jr., A Treatise on Human Physiology. 1861. 
 
 Damon, Howard F., Neuroses of the Skin. 1868. v 
 
 Darwin, Charles. The Origin of Species. 1867. 
 
 Animals and Plants. 
 
 Davis, Henry G\, Conservative Surgery. 1867. 
 
 Denman, James L., " What Should we Drink? " 1868. 
 
 Derby, George, Twenty-fifth Registration Report, Mass. 1868. 
 
 An Inquiry into the Influence of Anthracite Fires upon Health. 
 
 1868. 
 Dickson, Henry Samuel, Elements of Medicine. 1859. 
 Draper, John William, Human Physiology. 1868. 
 Druitt, Robert, The Principles and Practice of Modern Surgery. 1860. 
 Duchenne, G. B., L'Electrisation Localisee. 1861. 
 Dunglison, R., Dictionary of Medical Science. 1860. 
 Ellis, Benjamin, The Medical Formulary. 1868. 
 Erichsen, John, The Science and Art of Surgery. 1860. 
 Eyre, Sir James, The Stomach and its Difficulties. 1869. 
 Farr. Registration Reports of England. 
 Ferguson. Robert M., Electricity. 1867. 
 
 Flint, Austin, A Treatise on the Principles and Practice of Medicine. 1866. 
 A Practical Treatise on the Chest, Physical Exploration and 
 
 Diagnosis of Diseases Affecting the Respiratory Organs. 1866. 
 Flint, Austin, Jr., Physiology of Man. 
 
 Gtbb, Duncan George, Diseases of the Throat and Windpipe. 1864. 
 Cray, Henry, Anatomy, Descriptive and Surgical. 1862. 
 G-reenhow, E. H., Chronic Bronchitis. 1869. 
 
 Grindon, Leo. H., Life ; Its Nature, Yarieties, and Phenomena. 1866. 
 Hammond, William A., A Treatise on Hygiene. 1863. 
 
 Physiology and Pathology of the Cerebellum. 1869. 
 
 Harrison, John, Athletic Training and Health. 1869. 
 
 Hartshorne, Henry, A Conspectus of the Medical Sciences. 1869. 
 
 Headland, Frederick William, The Action of Medicines. 1859. 
 
 Hill, Berkely, Essentials of Bandaging. 1867. 
 
 Hoskins, H. T., What We Eat. 1861. 
 
 Hufeland's Art of Prolonging Life. Edited by Erasmus Wilson. 1867. 
 
 Humphry, M. G-., The Human Foot and the Human Hand. 1861. 
 
 Hunt, James, Stammering and Stuttering. 1865. 
 
 Huxley, T., Physical Basis of Life. 1869. 
 
 Huxley, Thomas H., Evidence as to Man's Place in Nature. 1863. 
 
 Johnston, James F., Chemistry of Common Life. 1857. 
 
 Jones, Handfield C., Clinical Observations on Functional Nervous Disorders. 
 
 1867. 
 Laycock, T., Mind and Brain. 1869. 
 Lecky, W. E. H., Rationalism in Europe. 1868. 
 Lewes, H. G-., Physiology of Common Life. 1860. 
 Loomis, Elias, Meteorology. 1868. 
 Mackenzie. Morell, The Use of the Laryngoscope in Diseases of the Throat. 
 
 1869. 
 Mabcet, W., On Chronic Alcoholic Intoxication. 1868. 
 Maudsley, Henry, Physiology and Pathology of the Mind. 1867. 
 Meyer, Moritz, Electricitat. 1868. 
 Moreau, T., La Psychologie Morbide. 1859. 
 
 Morgan, Charles E., Electro-Physiology and Therapeutics. 1868. 
 Morton, George Samuel, Types of Mankind. 1855. 
 Neill and Smith's Compend of Medicine. 
 Nott, J. C, and Gliddon, Types of Mankind. 
 
REFERRED TO IN THIS WORK. XXV11 
 
 Packard, John H., A Manual of Minor Surgery. 1863. 
 
 Page. D., Man; Where, Whence, and Whither. 1867. 
 
 Paget, James, Lectures on Surgical Pathology. 1860. 
 
 Parkes, Hygiene. 
 
 Parsons, S., Toothache. 1868. 
 
 Pettigrew, Thomas Joseph, On Superstitions Connected with the History and 
 
 Practice of Medicine and Surgery. 1844. 
 Piesse, The Art of Perfumery. 
 Porter, Noah, Human Intellect. 1868. 
 
 Report of Medical Society for the State of New York. 1868. 
 Reynolds, Russell J., System of Medicine. 1868. 
 
 Rockwell, A. D., On the Treatment of Paralysis by Electrization. 1869. 
 Romberg, Moritz Heinrich, Manual of the Nervous Diseases of Man. 1853. 
 Seiler, T., De la Galvanisation. 1860. 
 
 Sheen, James Richmond, Wines and other Fermented Liquors. 
 Sims, J. Marion, Clinical Notes on Uterine Surgery. 
 Smith, Henry H., Anatomical Atlas, Illustrative of the Structure of the Human 
 
 Body. 1859. 
 Smith, S., Surgical Operations. 1863. 
 Spratt, G., Medico-Botanical Pocket-book. 
 Spencer, Herbert, Principles of Biology. Two vols. 1868. 
 Stellwag, von Carion, Diseases of the Eye. 1868. Translated by Drs. Hack- 
 ley and Roosa. 
 Stille, Alfred, Materia Medica. 1868. 
 Tanner, T. H., A Manual of the Practice of Medicine. 
 Taylor, Charles Fayette, Infantile Paralysis. 1867. 
 
 Differential Diagnosis in Diseases of the Spine. 1869. 
 
 Thackrah, Influence of Occupation. 
 
 Thomas, T. G-aillard, A Practical Treatise on the Diseases of Women. 1869. 
 
 Tobold, Adelbert, Chronic Diseases of the Larynx. Translated by Dr. G. M. 
 
 Beard. 1868. 
 Toynbee, J., Diseases of the Ear. 1865. 
 Tripier, A., D'Electrotherapie. 1861. 
 Troltsch, Treatise on the Diseases of the Ear, including the Anatomy of the 
 
 Organ. Translated by D. B. St. John Roosa, M.D. 1869. 
 Trousseau, A., Lectures on Clinical Medicine. Translated by Bazin. 1867. 
 Wake, S. C, Chapters on Man. 1868. 
 
 Watson on Cod-liver Oil, and Chapman on Pyrophosphate of Iro^m 
 Watson, T., Practice of Medicine. 
 
 West, Charles, Lectures on the Diseases of Infancy and Childhood. 1860. 
 Wilson, Erasmus, A System of Human Anatomy, General and Special. 1859. 
 
 On Diseases of the Skin. 1863. 
 
 Winslow, Forbes, Light ; its Influence on Life and Health. 1867. 
 
 Obscure Diseases of the Brain and Mind. 1866. 
 
 Wislizenus, A., Transactions of the Academy of Science of St. Louis. 
 
 Wood, George B., and Bache, Franklin, The Dispensatory of the United States 
 
 of America. 
 Wood, George B., Therapeutics. 1860. 
 
 A Treatise on the Practice of Medicine. 1858. 
 
 Wood, Rev. J. G., Insect Architecture, by James Rennie. 1869. 
 
 Youmans, R. L., Prof. Grove, Prof. Helmholtz, Dr. Mayer, Dr. Faraday, Prof. 
 
 Liebig, and Dr. Carpenter. Correlation and Conservation of Forces. 1868. 
 Zikmssen, Hugo, Electricitat in der Medicin. 1866. 
 
TABLE OF CONTENTS. 
 
 PAGE 
 
 Preface 3 
 
 Introduction (Part I.) to the Public 8 
 
 Introduction (Part II.) to the Medical Profession 15 
 
 Explanations to the Reader 19 
 
 List of Works referred to in the preparation of this Work 25 
 
 Contents 28 
 
 List of Illustrations '. 29 
 
 Anatomy and Physiology. — Brief View of the Human Body — Bones — 
 Muscles — Brain and Nerves — Senses and their Organs — Blood — Organs 
 of Circulation — Organs of Respiration — Organs of Digestion — Uterus 
 and its Appendages — Integuments of the Body and their Appen- 
 dages 33 
 
 Hygiene. — Diet — Adulterations of Food — Stimulants and Narcotics — Air — 
 Exercise — Sunlight — Sleep — Clothing — Bathing — Evacuations — Influ- 
 ence of the Weather on Character — Change of Residence — Atmos- 
 pheric Electricity — Management of Sick-rooms — Sick-room Cookery 
 — Cooking for the Convalescent — Animal Preparations — Preparation 
 of Beverages — Influence of the Occupations on Health and Longevity 
 — Longevity of Animals — Man as Compared with other Animals — 
 
 Hereditary Descent — Schools of Medicine 167 
 
 Surgical Accidents and Emergencies. — Bleeding of Arteries — Fractures — 
 Dislocations — Ruptures — Bruises — Burns and Scalds — Drowning — 
 Suffocation — Wounds — Lightning-stroke— Convulsions— Poisoning — 
 
 Cupping — Vaccination — Leeches 399 
 
 Quackery and Quack Medicines 455 
 
 Diseases and Methods of Treatment. — Alphabetically arranged. Con- 
 taining an exhaustive description of over 250 Diseases, and explicit 
 
 directions for their treatment 461 
 
 Pregnancy, Lying-in Room, and Management of Infants 936 
 
 Prescriptions. — Cathartics — Emetics — Diaphoretics — Diuretics — Expecto- 
 rants — Emmenagogues — Anthelmintics — Stimulants — Narcotics — 
 Antispasmodics — Tonics — Astringents — Gargles — Eye Washes — 
 
 Lotions — Injections — Ointments — Liniments — Poultices 961 
 
 Miscellaneous Recipes 1013 
 
 List of Medicines and Doses , 1019 
 
 Glossary 1042 
 
 Index 1047 
 
LIST OF ILLUSTRATIONS. 
 
 PAGE 
 
 Our Home Physician — at Home — at Sea — in the Mines — on the Planta- 
 tion — in the Workshop — in various Emergencies. — Frontispiece. 
 
 Sectional View of the Brain 32 
 
 Skeleton 67 
 
 Nervous System 83 
 
 Sectional View of the Eye 104 
 
 External, Internal, and Middle Ear, with Drum and Little Bones 107 
 
 The Larynx (Figs. 1 and 2) 114 
 
 The Heart and Lungs 132 
 
 The Stomach 139 
 
 The Anterior Viscera of the Chest and Abdomen 143 
 
 The Posterior Viscera of the Abdomen 153 
 
 Skeletons — Man compared with other Animals 160 
 
 Lesperance Ventilator — External View 264 
 
 Internal " 264 
 
 Circulation of Air in a Room 264 
 
 Shower Bath 286 
 
 Hand Bath 286 
 
 Turkish and Russian Baths 287 
 
 Occupations Illustrated. — Artist 350 
 
 Student 351 
 
 Carpenter 356 
 
 Cooper ' 356 
 
 Blacksmith 357 
 
 Butcher 358 
 
 Tanner or Currier 359 
 
 Glass Blowers 361 
 
 Foundryman 361 
 
 Needlemaker 362 
 
 Shoemaker 363 
 
 Tailor 363 
 
 Printer 364 
 
 Miner 364 
 
 Mason or Bricklayer 365 
 
 Druggist or Chemist 366 
 
 Potter 369 
 
 Nurse 371 
 
 Compressing Artery of Leg to stop Bleeding 401 
 
 " " Arm " " 401 
 
 Stopping Bleeding of Leg by twisted Handkerchief 401 
 
 " ' " " by a tourniquet 401 
 
 " " Arm " 401 
 
XXX LIST OF ILLUSTRATIONS. 
 
 PAGE 
 
 Cutting Adhesive Straps 409 
 
 Applying Adhesive Strips to Wounds 409 
 
 Kolling a Bandage 410 
 
 Bandaging the Leg (Fig. 1) 410 
 
 " " (Fig. 2) 411 
 
 Bandage applied to Finger and Hand 411 
 
 Bandages for Head 412 
 
 Irrigating a Wound 412 
 
 Apparatus for Broken Collar-bone 417 
 
 Bandage for Broken Ribs 418 
 
 Setting the Shoulder 423 
 
 Setting a Dislocated Shoulder 424 
 
 " " Jaw 426 
 
 Setting the Jaw 426 
 
 Eestoration from Drowning (Figs. 1 and 2) 436 
 
 Centiped, Scorpion, Mad Dog. Black Spider, Rattlesnake 445 
 
 Poisonous Mushroom (Fig. 1) 449 
 
 (Fig. 2) 449 
 
 (Fig. 3) 450 
 
 The Dynamograph 585 
 
 The Dynamometer 585 
 
 Apparatus for Electrization 601 
 
 JSsthesiometer (Fig. 1) 602 
 
 (Fig. 2) 602 
 
 (Fig. 3) 602 
 
 Section of the Skin, under the Microscope 634 
 
 Abnormal Growth of Hair on the Body 640 
 
 11 " " " Face and Scalp 640 
 
 Hypodermic Syringe 662 
 
 Injection Tube for same 662 
 
 Hypodermic Injection 662 
 
 Ice Bag (Fig. 1) 666 
 
 " (Fig. 2) 666 
 
 Apparatus for Inhalation of Steam. 670 
 
 Laryngoscope 686 
 
 Apparatus for Laryngoscope 687 
 
 Microscope 713 
 
 Movement Cure (Figs. 1, 2, 3, 4, and 5) 722 
 
 Dumb-Bells 723 
 
 Indian Club 724 
 
 Section of same * 724 
 
 Exercises with Indian Clubs (Fig. 1) 725 
 
 " « " (Fig. 2) 725 
 
 " Wand (Fig. 1) 725 
 
 " " (Fig. 2) , 726 
 
 Hand Swing with Rings 726 
 
 Exercises with Dumb-Bells (Fig. 1) 726 
 
 " " (Fig. 2) 727 
 
 " " (Fig. 3) 727 
 
 " " (Fig. 4) 727 
 
LIST OF ILLUSTRATIONS. XXXI 
 
 PAGE 
 
 Exercises with Dumb-Bells (Fig. 5) 727 
 
 " " (Fig. 6) 728 
 
 (Fig. 7) 728 
 
 Hand-over-hand Ascent '. 728 
 
 Horizontal Ladder Exercise 728 
 
 Exercise with Rings 729 
 
 Rowing in Single Wherry , 729 
 
 Nasal Douche 732 
 
 Ophthalmoscope 745 
 
 Pessaries (Fig. 1) 752 
 
 " (Fig. 2) 752 
 
 Conant's Pessary (Fig. 3) / 752 
 
 Hoffman's " (Fig. 4) 752 
 
 Pleximeter 758 
 
 Percussion Hammer 758 
 
 Specula (Figs. 1, 2, and 3) 835 
 
 Sphygmograph (Fig. 1) 842 
 
 Marking Plate of Sphygmograph (Fig. 2) 842 
 
 Sphygmograph (Fig. 1) 843 
 
 " (Fig. 2) 843 
 
 " (Fig. 3) 843 
 
 Stethoscope (Fig. 1) 851 
 
 " (Fig. 2) 851 
 
 Syringe, with Changeable Appendage 872 
 
 Laryngeal Syringe 873 
 
 Posterior Nasal Syringe 873 
 
 Ear Trumpet (Fig. 1). 886 
 
 (Fig. 2) 886 
 
 Elastic Stocking 907 
 
 Worms (Figs. 1, 2, and 3) 923 
 
 " {Trichina Spiralis) 927 
 
YEETICAL SECTION OF THE HUMAN BRAIN. 
 
 (After Meirihold & Sons, Dresden.) 
 
 8. Cranial Bones. 
 
 5. 
 
 Cerebrum. 
 
 6. 
 
 Cerebellum. 
 
 7. 
 
 Arbor Vitse. 
 
 8. 
 
 Corpus Callosum. 
 
 10. 
 
 Mammillary Bodies. 
 
 11. 
 
 Pituitary Glands. 
 
 12. 
 
 Optic Thalamus. 
 
 13. 
 
 Pons Varolii. 
 
 15. Spinal Cord. 
 
 16. Frontal Sinus. 
 
 21. Mouth of Eustachian Tube. 
 24. Tongue. 
 26. Hard Palate. 
 
 29. Epiglottis. 
 
 30. Cartilages of the Larynx. 
 
 31. Windpipe. 
 33. (Esophagus. 
 
 14. Medulla Oblongata. 
 
THE 
 
 STRUCTURE AND FUNCTIONS 
 
 OF THE 
 
 HUMAN BODY. 
 
 ^ « e» «■ 
 
 ANATOMY AND PHYSIOLOGY. 
 
 BKIEF YIEW OF THE HUMAN BODY. 
 
 That we may understand for what purpose the human body is 
 made to consist of such a variety of parts ; why it possesses such a 
 complica tion of nice and tender machinery ; and why there was not 
 a more simple, less delicate, and less expensive frame, it is ne- 
 cessary that we, in our imagination, make a man ; in other words, 
 let us suppose that the mind or immaterial part is to be placed in 
 a corporeal fabric, in order to hold intercourse with other material 
 beings by the intervention of the body ; and then consider what will 
 be wanted for its accommodation. In this inquiry we shall plainly 
 see the necessity, advantage and wonderful adaptation of most of the 
 parts which we actually find in the human body. And if we con- 
 sider that in order to answer some of the requisites, human wit and 
 invention would be very insufficient ; we need not be surprised if we 
 meet with some parts of the body whose use we cannot yet perceive, 
 and with some operations and functions which we cannot explain. 
 We can see that the whole bears the most striking tokens of ex- 
 celling wisdom and ingenuity ; but the imperfect senses and capacity 
 of man cannot reach every part of a machine, which nothing less 
 than the intelligence and power of the Supreme Being could con- 
 trive and execute. 
 
 First, then, the mind, the thinking, immaterial agent, must be 
 
 provided with a place of immediate residence, which shall have all 
 
 the requisites for the union of spirit and body ; accordingly it is 
 
 provided with the brain, and is governor and superintendent of the 
 
 whole fabric. 
 
 3 
 
3i ANATOMY AND PHYSIOLOGY. 
 
 In the next place, as it is to hold a correspondence with all ma- 
 terial external beings, it must be supplied with organs fitted tc 
 receive the different kinds of impressions which they will make. 
 In fact, we see that it is provided with the organs of sense, as we 
 call them ; the eye is adapted to light ; the ear, to sound ; the nose, 
 to smell ; the mouth, to taste ; and the skin, to touch. 
 
 Further, it must be furnished with organs of communication 
 between itself in the brain, and those organs of sense, to receive 
 information of all the impressions that are made upon them ; and it 
 must also have organs between itself in the brain, and every other part 
 of the body, fitted to convey its commands, and to influence the 
 whole. For these purposes the nerves are actually given. They are 
 soft white cords which rise from the brain, the immediate residence 
 of the mind, and disperse themselves in branches through all parts 
 of the body. They convey all the different kinds of sensations to the 
 mind in the brain ; and likewise carry out thence all its com- 
 mands to the other parts of the body. They are intended to be 
 occasional monitors against all such impressions as might endanger 
 the well-being of the whole, or of any particular part ; which vindi- 
 cates the Creator of all things, in having actually subjected us to 
 those many disagreeable and painful sensations to which we are 
 exposed from a thousand accidents in life. 
 
 Moreover, the mind, in this corporeal system, must be endowed 
 with the power of moving from place to place ; for the sake of 
 intercourse with a variety of objects ; of escape, from such as are 
 disagreeable, dangerous, or hurtful ; and for the pursuit of such as 
 are pleasant or useful. Accordingly it is furnished with limbs, 
 muscles, and tendons, the instruments of motion, which are found 
 in every part of the fabric where motion is necessary. 
 
 But to support ; to give firmness and shape to the fabric ; to keep 
 the softer parts in their proper places ; to give fixed points for, and 
 the proper directions to, its motions, as well as to protect some of the 
 more important and tender organs from external injuries, there must 
 be some firm prop- work interwoven through the whole. And in fact, 
 for such work the bones are given. 
 
 This prop-work is not made with one rigid fabric, for that would 
 prevent motion. Therefore there are a number of bones. 
 
 These pieces must all be firmly bound together, to prevent their 
 dislocation. And this end is perfectly answered by the ligaments. 
 
 The extremities of these bony pieces, where they move and rub 
 upon one another, must have smooth and slippery surfaces for easy 
 motion. This is most happily provided for, by the cartilages and 
 imueus of the joints. 
 
BKIEF VIEW OF THE HUMAN BODY. 35 
 
 The spaces between these different organs must be filled up wi th 
 some soft and ductile matter, which shall keep them in their places, 
 unite them, and at the same time allow them to move a little upon 
 one another. These purposes are answered by the cellular membrane 
 or adipose (i. e. fatty) substance. 
 
 There must be an outward covering over the whole apparatus, 
 both to give it compactness, and to defend it from a thousand inju- 
 ries ; which in fact, are the very purposes of the skin and other in- 
 teguments. 
 
 Lastly, the mind being formed for society and intercourse with 
 beings of its own kind, must be endued with powers of expres- 
 sing and communicating its thoughts by some sensible marks or 
 signs, which shall be both easy to itself, and admit of great varie- 
 ty. Accordingly it is provided with the organs and faculty of 
 speech, by which it can throw out signs with amazing facility, and 
 vary them without end. 
 
 Thus we have built up an animal body which would seem to be 
 pretty complete ; but as it is the nature of matter to be altered and 
 worked upon by matter, so in a very little time such a living crea- 
 ture must be destroyed, if there is no provision for repairing the in- 
 juries which it must commit upon itself, and those to which it 
 must be exposed from without. Therefore a treasure of blood is 
 actually provided in the heart and vascular system, full of nutritious 
 and healing particles, fluid enough to penetrate into the minutest 
 parts of the animal, impelled by the heart, and conveyed by the ar- 
 teries. It washes every part, builds up what was broken down, and 
 sweeps away the old and useless materials. Hence the necessity or 
 advantage of thn heart and arterial system. 
 
 "What more there is of the blood than enough to repair the pre- 
 sent damages of the machine, must not be lost, but should be re- 
 turned again to the heart ; and for this purpose the venous system 
 is provided. These requisites in the animal explain the circulation 
 of the blood. 
 
 The old materials which were become useless, and are swept on 
 by the current of blood, mutt b". separated and thrown out of the 
 system. Therefore glands, the organs of secretion, are given for 
 straining whatever is redundant, fapid, or noxious, from the mass of 
 blood ; and when strained, they are thrown out by emunctories, 
 called organs of excretion. 
 
 But as the machine is constantly in action, the reparation must 
 be carried on without intermission, and the strainers must always 
 be employed. Therefore there is actually a perpetual circulation of 
 the blood, and the secretions are always going on. 
 
36 ANATOMY AND PHYSIOLOGY. 
 
 All this provision, however, would not be sufficient ; for that 
 store of blood would soon be consumed, and the fabric would 
 break down, if there was not a provision made for fresh supplies. 
 These, we observe, are profusely scattered around her in the animal 
 and vegetable kingdoms ; and hands, the fittest instruments that 
 could be contrived, are furnished for gathering them, and for pre- 
 paring them in a variety of ways for the mouth. 
 
 But these supplies, which we call food, must be considerably 
 changed ; they must be converted into blood. Therefore are pro- 
 vided teeth for cutting and bruising the food, and a stomach for 
 melting it down ; in short, all the organs subservient to digestion. 
 The finer parts of the aliments only can be useful in the con- 
 stitution. These must be taken up and conveyed into the blood, 
 and the dregs must be thrown off. With this view the intestinal 
 canal is provided. It separates the nutritious part, which we call 
 chyle, to be conveyed into the blood by the system of absorbent 
 vessels ; and the coarser parts pass downwards to be ejected. 
 
 We have now got our animal not only furnished with what is 
 wanting for its immediate existence, but also with powers of protract- 
 ing that existence to an indefinite length of time. But its duration, 
 we may presume, must necessarily be limited ; for as it is nour- 
 ished, grows, and is raised up to its full strength and perfection ; 
 so it must in time, in common with all material beings, begin to 
 decay, and then hurry on to final ruin. Hence we see the necessity 
 of a scheme for its renovation. Accordingly wise Providence, to 
 perpetuate, as well as to preserve his work, besides giving a strong 
 appetite for life and self-preservation, has made animals male and 
 female, to continue the propagation of the species to the end of time. 
 
 Thus we see, that by the very imperfect survey which human 
 reason is able to take of this subject, the animal man must necessarily 
 be complex in his corporeal system, and in its operations. 
 
 He must have one great and general system, the vascular, 
 branching through the whole for circulation ; the nervous, with its 
 appendages the organs of sense, for every kind of feeling ; and a 
 third, for the union and connection of all these parts. 
 
 Besides these primary and general systems, he requires others 
 which may be more local or confined ; one for strength, support, and 
 protection, the bony structure ; another for the requisite motions of 
 the parts among themselves, as well as for moving from place to 
 place, the muscular system ; another to prepare nourishment for the 
 daily reoruit of the body, the digestive organs ; and one for the con- 
 tinuance of the species. 
 
 In taking this general survey of what would appear originally to 
 
BRIEF VIEW OF THE HUMAN BODY. 37 
 
 be necessary for adapting an animal to the situations of life, we 
 observe, with great satisfaction, that man is accordingly made of 
 such systems, and for such purposes. He has them all ; and he has 
 nothing more, except the organs of respiration. Breathing it would 
 seem at first difficult to account for ; we only know it from observa- 
 tion to be essential to life. Notwithstanding this, when we see ail 
 the other parts of the body, and their functions, so well accommodated 
 for, and so wisely adapted to their several purposes, there can be no 
 doubt that respiration is so likewise ; accordingly the discoveries of 
 Dr. Priestly, and of later inquirers, have thrown light upon this 
 function also, as will be shown in its proper place. 
 
 Of all the different systems in the human body, the use and 
 necessity are not more apparent than the wisdom and contrivance 
 which have been exerted in putting them all into the most compact 
 and convenient form ; in disposing them so, that they shall receive 
 helps from one another ; and that all or many of the parts shall not 
 only answer their principal end or purpose, but operate successfully 
 and usefully in a variety of secondary ways. 
 
 If we consider the whole animal structure in this light, and com- 
 pare it with any machine in which human art has exerted its 
 utmost skill ; (suppose the best contrived ship that ever was built ;) 
 we shall be convinced beyond the possibility of doubt, that intelli- 
 gence and power have been exerted in its formation far surpassing 
 anything of which men can boast. 
 
 One superiority in the animal economy is peculiarly striking. In 
 machines of human contrivance there is no internal power, no prin- 
 ciple in the machine itself, by which it can alter and, accommodate 
 itself to any injury which it may suffer, or remedy any mischief 
 which admits of repair. But in the animal body this is most 
 wonderfully provided for by the internal powers of the system ; many 
 of which are not more certain and obvious in their effects than they 
 are above all human comprehension as to the manner and means of 
 their operation. Thus a wound heals by a natural process ; a broken 
 bone is made firm again by a deposit of new bony matter ; a dead 
 part is separated and thrown off; noxious juices are driven out by 
 some of the emunctories ; a redundancy is removed by some sponta- 
 neous bleeding ; a bleeding naturally stops of itself ; a great loss of 
 blood from any cause, is in some measure compensated by a contract- 
 ing power in the vascular system, which accommodates the capa- 
 city of the vessels, to the quantity contained. The stomach gives 
 information when the supplies have been exhausted ; gives intima- 
 tions, with great exactness, of the quantity and quality of what is 
 wanted in the present state of the machine ; and in proportion as it 
 
38 ANATOMY AND PHYSIOLOGY. 
 
 meets with neglect rises in its demands, and urges its petition in a 
 louder tone, and with more forcible arguments. 
 
 For the protection of the animal amidst the fluctuations in the 
 heat of external bodies, a power of generating warmth has been 
 Drovided ; and to prevent its undue accumulation in a heated atmos- 
 phere, or its excessive loss in a cold one, the quantity carried away 
 is regulated with wonderful nicety to its wants ; so that an equal 
 temperature is preserved in all the range of climates, from the 
 extreme point of habitable existence near the poles, to the intense 
 heat of the equatorial regions. 
 
 A farther excellence in the natural machine, and if possible still 
 more astonishing and more beyond all human comprehension than 
 that of which we have been speaking, is the capability individuals 
 possess of reproducing beings . like themselves, which are again 
 endued with similar powers for producing others, and so of multiplying 
 the species without end. 
 
 These are powers which mock all human invention or imitation. 
 They are characteristics of the Divine Architect. 
 
 OF THE BONES. 
 
 BONE AN ORGANIZED SUBSTANCE. 
 
 The bones, constituting, as was before observed, the basis and 
 support of the body, are necessarily its most hard and solid parts ; 
 appearing to superficial observation to be merely inorganic compounds; 
 resisting for ages the test of time ; and remaining impressive memo- 
 rials of the decay of past generations. Hence, some have been led to 
 think they were without organization, and consequently not liable, 
 like the soft parts of the body, to disease and death. But this erro- 
 neous opinion is refuted by minute dissection, which discovers the 
 internal structure of bones, traces their numerous vessels, and shows 
 them to be supplied with blood like the softer parts ; and also, that, 
 like these parts, they have their periods of growth and decay, and are 
 liable equally with them to internal diseases, and to derangement 
 from external injuries. 
 
 If, for instance, the vessels of adult bone be injeoted with red 
 colored wax, and the earthy particles be dissolved by a mineral acid, 
 the bone will be reduced to a membraneous state, but a jelly-like 
 substance, full of vessels, will remain ; and these vessels will now 
 appear as numerous as in the fleshy parts, a proof that they were 
 before concealed only by the earthy portion of the bone. 
 
 Before birth all the bones of the foetus are of a cartilaginous 
 
OF THE BONES. BONE AN ORGANIZED SUBSTANCE. 30 
 
 character. This cartilage is not, as was erroneously supposed, 
 hardened into bone ; but is absorbed and carried away by one set of 
 vessels, while another set is employed in depositing, in its room, 
 matter for forming the new bones. This process is effected in the 
 following manner. 
 
 The transparent vessels of the cartilage first begin to dilate to re- 
 ceive the red blood ; at this time an artery can be observed penetrating 
 towards the middle of the bone ; this artery is soon accompanied 
 by others, all forming a sort of net- work, and conveying red blood ; 
 and now ossification may be said to have commenced. Gradually 
 the cartilage grows opaque and brittle, and will no longer bend. The 
 bony centre spreads according to the dimensions of the bone ; and 
 may be known by its hard feel, when examined by a sharp instru- 
 ment ; similar points of ossification are now found and in a like 
 manner, in other parts of the bone, till its whole body becomes opaque ; 
 and now the vessels, stretching from the centre towards the extremi- 
 ties, having penetrated the cartilages which separate the heads from 
 the body of the bone, enter these heads, when ossification commences 
 here also. From this mode of process it will be seen, that the heads 
 and body are at first distinct bones, formed separately and connected 
 only by cartilage, and they are not united till the age of eighteen 01 
 twenty years. 
 
 Thus the formation of bone is effected by the action of its blood 
 vessels, which may be seen entering in one great trunk into the body 
 of each bone, and spreading thence towards both extremities. It is 
 by this action all the parts of the body are evolved ; it forms the blood 
 as is seen in the case of the chick, which has no other way of receiv- 
 ing this fluid but by forming it within its own body ; and from the 
 blood are all the solids constructed by the same action of the vessels. 
 All animals have the power of assimilating their food, and with the 
 assistance of air, of converting it into blood ; and as by the action of 
 their larger vessels they can thus elaborate fresh supplies of red blood, 
 so the action of particular vessels is intended to prepare particular 
 parts. Thus some add to the solids to assist growth, others for sup- 
 plying the continual waste ; while more are employed in effecting 
 the different secretions within the body, one of which is the forma- 
 tion of bone. In this manner then is ossification accomplished ; the 
 arteries of the transparent cartilage of the foetus, beginning at length 
 to receive the red blood, commence their deposition of earthy matter. 
 This at first appears in numerous specks, which spreading, afterwards 
 meet, and at last constitute perfect bone. But, while these arteries 
 are thus employed in depositing bone, there are other vessels, (called 
 absorbents, from the nature of their function) busily engaged in re- 
 
40 ANATOMY AND PHYSIOLOGY. 
 
 moving the cartilage, modelling the new bone into its proper form, 
 shaping out its cavities, and also hardening it into due consistence. 
 
 This organization of arteries to deposit bone, and of absorbents 
 to convey away the cartilage, which was necessary to its formation 
 and growth, is also essential to the life and health of the full formed 
 bone. Indeed, the latter depends on the regular deposition and 
 reabsorption of the parts ; for by varying the degree of action in 
 either of these operations, bone may be made to inflame and ulcerate 
 like the softer parts, or to become too brittle by an over secretion oi 
 earth, or too soft from its excessive absorption. It is this earth which 
 constitutes the hardness, and, indeed, all the serviceable properties 
 of bone. It lies dead in the inorganic interstices of the mem- 
 brane, and is united with animal mucilage to give it consistence and 
 strength. 
 
 That the bones, in common with the rest of our frames, undergo a 
 constant renovation of parts, is proved by the following experiment. 
 If madder be given to animals, then withheld for some time, and 
 afterward given again, in twenty-four hours after it had been first 
 given, all their bones will become tinged ; and in two or three days 
 the color becomes very deep. In a few days after the madder has 
 been discontinued, the red color disappears ; but on its being again 
 given to the animals, their bones become a second time tinged. 
 Further, the absorption of bones, is also proved by the disappearance 
 of a carious or dead bone, even before the skin is opened ; and by 
 the destruction of a bone, merely from the pressure of a tumor against 
 it ; in which cases the bone must have been taken up by the absorb- 
 ing vessels and conveyed away ; and lastly, this absorption is placed 
 beyond all controversy, by the fatal disease called "mollities ossium;" 
 (softening of the bones;) which in a short time dissolves and carries 
 off, by an excessive action of the absorbents, the bony system ; dis- 
 charging the earthy matter by the kidneys, and gradually rendering 
 the bones soft, till they bend under the weight of the body and may 
 be cut with a knife. 
 
 But this vascular nature of bones not only sustains their health 
 by constantly removing and carrying off their wasted and unsound 
 particles, and furnishing them with new ones ; but also, by extend- 
 ing to them the circulation in common with the other parts of the 
 body, it enables those useful organs to repair their injuries by uniting 
 such as may be broken. And here we cannot help admiring the 
 beneficence as well as wisdom of the Creator, who thus kindly inter- 
 weaves, not only with the soft parts of the human machine, but also, 
 with its most hard and solid substances, the means of supplying their 
 waste and of repairing their injuries. 
 
OF THE BONES. — BONE AN ORGANIZED SUBSTANCE. 41 
 
 If, for instance, a bone be fractured, its broken ends will unite in 
 the following manner ; first, the arteries discharge a thin mucus, 
 which afterwards thickens into a transparent jelly and becomes 
 vascular, by the elongation of vessels from the neighboring parts ; 
 those vessels soon begin to secrete the osseous matter, till the whole 
 jelly becomes one bony mass, and thus the fractured ends are com- 
 pletely united. That this desirable result may be the more cer- 
 tain, the formation of new bony matter is not confined to any one 
 part or to particular vessels in the bone ; but is generously bestowed 
 upon its entire system ; for not only will the vessels of the periosteum, 
 (the membrane covering and lining the bones) produce fresh osseous 
 matter ; but so also will those of the bone itself ; as will likewise 
 the vessels of the marrow, which is contained within the cavity of 
 the bones. Thus, if by puncturing the bone of an animal we destroy 
 the marrow, the old bone decays, and a new one will be formed from 
 the periosteum ; and, should the creature soon afterwards die, and 
 the bone be inspected, it will be found to be a secretion from the 
 inner surface of the periosteum, bearing all the characteristics of true 
 bone, and containing within it the old bone, dead and black. But 
 if this experiment be reversed, and the periosteum only is destroyed, 
 preserving the nutritious vessels of the bone ; in this case the new 
 bony matter is formed by the medullary vessels, and the old bone 
 surrounding it, will become black and dead. Lastly, when the 
 knee-pan, where there are no medullary vessels, is fractured, the bro- 
 ken parts are united by the intervention of a callus, secreted from 
 the vessels of the bone itself. 
 
 Again, if a bone is injured by blows or other accidents, which 
 derange its economy and damage its structure, the circulation soon 
 repairs the mischief in the following manner. First, inflammation 
 takes place, as in the soft parts of the body ; next, a swelling and 
 spongy looseness with a fulness of blood ensue ; suppuration and 
 ulceration soon follow ; and finally, the diseased bone becomes com- 
 pletely dead, and is discharged from the system. 
 
 Bones, besides arteries, veins, and absorbing vessels, have also, 
 like the soft parts, their nerves. These may be discovered entering 
 like small threads into the body of the bone, in company with its 
 nutritious vessels ; and yet, notwithstanding we can trace the course 
 of some of these nerves, a bone appears to possess no sensibility. 
 Thus, rasping the periosteum, and even scraping it from the bone> 
 produces no pain. In amputation bones are cut without exciting 
 particular feeling. Even the application of the actual cautery 
 formerly in use, was known to produce only a kind of heat along the 
 course of the bone, not unpleasant to the patient. But it must not 
 
42 ANATOMY AND PHYSIOLOGY. 
 
 be supposed from these facts that bones are wholly insensible, tney 
 are in reality otherwise ; but their sensibility being fitted to their 
 functions, is so regulated as not to appear under the generality of 
 those circumstances, which produce it in the soft parts of the body. 
 Hence the shocks from running, leaping, and other violent exercises, 
 cause no sensation in the bones ; and which, if otherwise ordered, 
 must have subjected them to almost continued pain, from the nu- 
 erous blows and other accidents they encounter. The same wise 
 provision is extended to the cartilages, ligaments, and other parts 
 composing the joints, and for the same reason ; namely, to prevent the 
 occurrence of pain on every uneasy motion or concussion which these 
 parts are liable to endure. 
 
 But though bones exhibit this inaptitude to sensibility, in their 
 healthy state, and on ordinary occasions; this is far from being the 
 case when they are diseased. Injuries will produce inflammation in 
 the bones as well as in the soft parts, and now their hidden sensibility 
 becomes roused, and even surpasses that of the latter, though excited 
 from a like condition. This is also the case with the cartilages, liga- 
 ments, and all the other parts in which sensibility appears dull 
 during health. "Thus the wound of a joint is certainly less painful 
 at first, but inflammation coming on, the sensibility of the injured 
 parts rises to an excruciating degree ; and no pains are felt to equal 
 those arising from bones and joints. 
 
 Thus it will be seen that ossification is a process of a truly 
 animal nature ; and that bone is a regularly organized substance, 
 whose form subsists from the first. Bone partakes by its vessels 
 of the general changes with all the other parts of the body ; the 
 absorbents removing the old wasted parts, while the arteries are 
 constantly depositing new ones; and thus it Lives, grows, and is 
 enabled to repair its injuries. Ossification is at first rapid ; advances 
 slowly after birth ; but is not completed in the human body till 
 the twentieth year ; it is forwarded by health and strength of con- 
 stitution ; and is retarded by weakness and disease. In scrofula it 
 is imperfect ; and so children become rickety, the bones softening 
 and swelling at their heads, and bending under the weight of the 
 body 
 
 The structure of bones, as may be seen by breaking those old and 
 decayed ones which are found in church-yards, consists of plates 
 made up of fibres, and those plates connected by other fibres; by 
 which formation a great number of interstices or cells are to be 
 met with in the heads of the long bones, while their sides have a 
 more dense, and firm construction. 
 
THE PERIOSTEUM. TEE MARROW. 4:3 
 
 THE PERIOSTEUM. * 
 
 The bones are covered with a membrane, called on that account 
 periosteum. It adheres closely to their surface, by small points, 
 which dive into the outward substance of the bones, so that it may 
 bear the pulling of the great tendons, which are fixed rather into the 
 periosteum than into the bone. It is also connected with the bones 
 by innumerable vessels, which are transmitted to them through the 
 medium of this membrane. The periosteum is not itself vascular, 
 and appears to be merely condensed cellular membrane. If, however, 
 it be hurt by injuries, the outer layers of the bone die, because the 
 vessels which nourished and sustained their health, are now destroyed 
 or prevented from continuing their function, by the injury of the 
 membrane through which they passed into the bone. But the inter- 
 nal layers will now set about repairing the mischief. These, being 
 fully nourished by the internal arteries, inflame, swell, become po- 
 rous and spongy, and form granulations. These granulations, push 
 off the mortified plate, and form themselves into new bone, which 
 supplies its' place. 
 
 The uses of the periosteum appear to be, to nourish, by the vessels 
 which pass through it, the external layers of the bone ; to afford 
 a convenient origin and insertion to several muscles and tendons 
 which are fixed into this membrane ; and to prevent, by the loose- 
 ness of the external surface, friction, in the sliding of the muscles 
 over the bones. 
 
 THE MARROW. 
 
 The marrow is an oily secretion from the blood, and is lodged in 
 membraneous vesicles or cells, which fill up the larger and smaller 
 cavities within the bones. These minute bags are formed from the 
 membrane which lines the cells within the bones. 
 
 The precise use of the marrow is not yet ascertained ; but its 
 consistence varies in different periods of life. In infancy it is thin 
 and tinged with blood. It thickens as we advance in life. 
 
 The destruction of the marrow, as we before observed, produces 
 the death of the bone in which it is contained ; and from the same 
 cause, that injuries of the periosteum will be the means of destroy- 
 ing the external plates, namely the destruction of the vessels ; for as 
 the periosteum is the medium by which the external vessels are con- 
 veyed to the bone, so the internal ones are conducted to its substance 
 by the membrane containing the marrow, and lining the inside of 
 the bone ; whence the marrow being destroyed, the channels for con- 
 veying nourishment are cut off, and the bone dies. 
 
41 ANATOMY AND PHYSIOLOGY. 
 
 LIGAMENTS. 
 
 The bones are connected to each other by ligaments, which are 
 strong, white, flexible substances, and but little elastic. They are of 
 two kinds, the round or cord-like ligament, which grows from the 
 head of one bone, and is inserted into that of the other, tying the two 
 bones together ; and the capsular ligament, which encloses the whole 
 joint as in a purse or bag, and has numerous arteries opening upon 
 its internal surface, for the purpose of keeping it moist, and of dimin- 
 ishing friction. 
 
 CARTILAGES. 
 
 But the more effectually to preclude friction and concussion, all the 
 bones forming moveable joints, have their ends covered with plates 
 of cartilage, which being of a solid, smooth, elastic nature, renders 
 all the motions of the joints easy and free from shocks in running, 
 jumping, &c. ; and to increase this effect, there are also moveable 
 cartilages interposed between the ends of the bones, in some of the 
 joints. • 
 
 THE SYNOVIA. 
 
 Besides the fluid which the capsular ligament throws out, there 
 are small fringe-like bodies placed within the joints, for securing a 
 constant and copious supply of moisture. They secrete a singularly 
 glairy and slippery liquor called synovia, for lubricating the different 
 surfaces of the joint, and preventing friction in the various motions 
 of the body. After the synovia has performed its office, it is re- 
 absorbed by the absorbent vessels, which arise by open extremities 
 from all the cavities of the body. 
 
 OF THE SKELETON OF THE HUMAN BODY. 
 
 The bones of an animal connected together, after the soft parts 
 have been removed, is called a skeleton ; and is said to be a natural 
 one when they are kept together, as in the living state, by their own 
 ligaments ; but artificial if they are joined with wire, or any other 
 substance, foreign to the animal. 
 
 The human skeleton we shall divide, for the purposes of descrip- 
 tion, into the head, the trunk, the superior and inferior extremities. 
 
 OF THE HEAD. 
 
 By the head is meant all that part which is placed above the first 
 bone of the neck. It therefore comprehends the bones of the skulJ 
 and those of the face. 
 
THE SKULL. SUTURES. 45 
 
 THE SKULL. 
 
 The skull or brain-case consists of eight bones, which form a 
 vaulted cavity for lodging and defending the brain ; this great cavity 
 is proportioned to its contents, which is the cause of such variations 
 in its size in different persons ; while its roundish figure is chiefly 
 owing to the equal pressure of the contained parts, as they grow and 
 increase, before the skull is entirely ossified ; and to the management 
 of the head during this period is to be attributed the difference of 
 shape observable in different nations. Hence from the use of the 
 turban, the head of a Turk assumes a round figure, greatly different 
 from that oblong shape, which characterizes those nations, with whom 
 the turban is not in use. 
 
 A more striking instance of the degree in which the human head 
 may be modelled by national customs, is found among the Caribbee 
 Indians, who by flattening the forehead in early infancy, produce 
 a hideous deformity of aspect. 
 
 Some of the Faquirs of India are well known for the cone-like 
 shape to which they mould their heads. 
 
 The bones of the skull are composed of two tables, and an inter- 
 mediate lattice-work, nearly of the same structure and use, as that of 
 the other bones. The outer table or plate is the thicker and stronger 
 of the two, being more immediately concerned in warding off injuries 
 of the head. 
 
 The eight bones of the skull are the frontal-bone, which forms the 
 whole fore-part of the skull ; the two parietal-bones forming its upper 
 and middle part ; the two temporal-bones composing the lower part of 
 the sides ; the occipital-bone making the whole hinder part, and 
 some of the base ; the ethmoid-bone, placed in the fore-part of the 
 base of the skull ; and the sphenoid-bone in its middle. 
 
 SUTURES. 
 
 These bones are joined to each other by what anatomists call su- 
 tures, which are indented or dovetailed seams ; their uses are not 
 well understood. Some have supposed that they were intended to 
 limit the extent of fractures in the skull ; others, that they enable 
 the dura mater, or membrane lining the inside of the head, to sus- 
 pend itself more firmly, by insinuating its fibres through those sutures, 
 and communicating with the membrane on the outside. But these 
 opinions, with many others, are contested and admit of doubt ; and, 
 perhaps, it is more reasonable to believe that sutures are merely a 
 consequence of the mode in which the ossification of the skull takes 
 place, rather than a formation, designed for certain uses. We see 
 
46 ANATOMY AND PHYSIOLOGY. 
 
 the bones of the skull ossify from the centre towards their circui nfer- 
 ence, their fibres spreading and extending on every side, till at last 
 those different bones meet, and shooting in between each other, form 
 the suture or serrated line of union. Nature, in the formation of all 
 bones, hastens their ossification, by beginning the process in many 
 points, and she observes this law in healing a broken bone, as wel] 
 as in forming the skull. Had the process of ossification in the head 
 been confined to one point, it must necessarily have been slow and 
 imperfect, and the brain would have continued a long time exposed 
 to injuries from without. Instead of this, we find a distinct system 
 of ossification going forward at the same time in each of the bones 
 composing the skull, all spreading from their centres, and approach- 
 ing each other to make one whole, perfect, bony case for lodging the 
 brain. But it should be observed here, that this ossification is not 
 complete for a long time after birth ; the bones not having yet suffi- 
 ciently grown for their edges to meet. The imperfectly ossified state 
 of the skull appears to be better suited to the growing and increasing 
 condition of the brain during this period, than if its ossification had 
 been quite complete ; as in this case the flexibility of the skull must 
 be less, and its capacity not so easily enlarged by the increasing bulk 
 of the brain. One beneficial consequence results from the imperfect 
 ossification of the skull at birth, which is too important to omit, and 
 which, perhaps, was the principal aim nature had in view, in adopt- 
 ing this peculiar structure ; namely, the opportunity it affords of 
 contracting the size of the head in child-birth. It is almost constant- 
 ly found that the bones overlap one another very considerably, and 
 lessen the head in both its diameters to a surprising degree. 
 
 BONES OF THE FACE. 
 
 The face is the irregular pile of bones composing the fore and 
 under part of the head. It constitutes the bony portion of some of the 
 organs of sense, affording sockets or orbits to the eyes, an arch to the 
 nose, and a support to the palate ; it also forms the basis of the 
 human physiognomy, and enters into the composition of the mouth. 
 Anatomists, in their description, commonly divide the face into the 
 upper and lower jaws. 
 
 It consists of six bones on each side ; of a thirteenth placed in the 
 middle, and having no fellow ; and of sixteen teeth. The thirteen 
 bones are, viz. the two nasal ; two ungular ; two cheek-bones ; two 
 maxillary bones ; two palate bones ; two spongy bones of the nose ; 
 and the single bone, called the vomer, and which divides the nose. 
 The two nasal bones form the roo* and arch of the nose. 
 
BONES OF TIIE FACE. 47 
 
 The two ungular bones, so called from their resembling the nail 
 of one's finger, constitute the inner angle of each orbit. Each of 
 these bones has a deep perpendicular canal for lodging a part of the 
 lachrymal sac and duct, by which the tears are conveyed into the 
 nose ; and it is this bone which is operated upon in the disease called 
 fistula lachrymalis, which is an obstruction of the duct, by which the 
 tears, instead of flowing off by the nose, trickle over the face. The 
 operation is performed by piercing the bone with an instrument, which 
 opens an artificial communication with the nose, and the tears are 
 conducted through that channel. 
 
 The two cheek bones are the prominent square bones, which form 
 the upper part of the cheeks. They constitute a distinguishing 
 feature in the human countenance, as may be seen by comparing the 
 high cheek-bones of the Tartars, and other northern nations, with the 
 more regularly formed countenances of the people of southern 
 climates. 
 
 The two maxillary bones are the largest, and constitute the far 
 greater part of the upper jaw. They form the most part of the nose, 
 a great portion of the roof of the mouth, and also a considerable share 
 of each orbit ; at their lower edge they afford a base and sockets for 
 containing the sixteen upper teeth. Each of these bones has a large 
 hollow in its body, which is lined with a continuation of the membrane 
 of the nose. It is called the maxillary sinus, has a small opening 
 into the nostrils, and is supposed to be intended for raising and making 
 the voice more perfect, by creating a reverberation of the sounds. 
 Sometimes collections of matter form in this sinus, attended with 
 great pain, inflammation, and swelling of the cheek, and even distor- 
 tion of the face ; in this case the matter is discharged by pulling out 
 the second or third of the grinding teeth, and introducing a sharp 
 stillet by the socket of the drawn tooth, then perforating the bony 
 partition, which is here generally very thin, into the sinus. 
 
 The palate-bones are placed at the back part of the palate or roof 
 of the mouth, and are continued up the back part of the nostrils, to 
 the orbits ; forming part of the palate, nostrils and orbits. 
 
 The spongy bones are four in number, two in each nostril ; they 
 are so named from their porous texture, being rolled into scrolls, and 
 their thin laminae of hone are pierced by many holes, which renders 
 them very light. They are covered with the membrane of the nose, 
 which lines universally all the cavities of this organ. The points of 
 the lower of these bones form those projections which may be felt by 
 the finger, and from the improper practice of picking the nose, very 
 often serious consequences arise ; for in many instances polypi of the 
 spongy bones which are fleshy excrescences and which can be traced 
 
4:8 ANATOMY AND PHYSIOLOGY. 
 
 to injuries of this kind, grow so as to extend down the throat, and 
 cause suffocation and death. 
 
 The vomer, so called from its supposed resemblance to a plough- 
 share, is a thin flat bone ; constituting the thirteenth and last bone 
 of the upper face. It forms the lower and back parts of the division 
 of the nose. Its upper edge is united to the base of the sphenoid- 
 bone, and to the nasal-plate of the ethmoid. Its anterior edge has 
 a long furrow for receiving the middle cartilage of the nose ; and its 
 lower edge is joined to the maxillary and palate bones. This bone 
 divides the nostrils from each other, and like the spongy bones en- 
 larges the organ of smelling by affording greater space for the ex- 
 pansion of the membrane of the nose. 
 
 THE LOWER JAW. 
 
 The lower jaw consists of only one moveable bone and sixteen 
 teeth. It is nearly of the form of a crescent, or half moon, terminating 
 the outline of the lower part of the face, forming the under part of the 
 mouth, and serving as a frame for holding and working the lower 
 teeth. The fore-part of this bone is termed the chin, from this its 
 sides extend back to what are called the angles of the lower-jaw. 
 Here its base ends, and the bone bends upwards at right angles, to be 
 articulated with the head. From these rising branches shoot out two 
 processes or bony projections on each side ; the first is called the 
 coronoid, or horn-like process, and is intended for the convenient 
 insertion of the temporal muscle, the lower end of this muscle being 
 fixed into the whole of that process ; and being placed at a distance 
 before the articulation of the jaw, gives the muscle great power in 
 moving it. The other is the articulating process ; it lies behind the 
 former, is of an oblong shape, and set across the branch of the jaw. 
 These articulating extremities are received into two large cavities, 
 hollowed out in each temporal bone near the ear, and are connected 
 to these bones, by means of capsular ligaments, which extend from 
 one bone to the other, and enclose the joint as in a bag. Not only 
 the surfaces of the bones composing these joints are covered with 
 cartilage, to prevent friction, but, to render their large and numerous 
 motions more secure and easy, a moveable plate of cartilage is inter- 
 posed, which plays between the articulating surfaces, and thus 
 facilitates their motions. It is thin in its centre and thickens towards 
 its circumference, by which contrivance the hollow of the joint is 
 deepened, and the hazard of dislocation is lessened. Such moveable 
 cartilages are generally placed in joints where frequent and rapid 
 motion is required. 
 
 The sockets of the teeth in the lower-jaw are similar to those of 
 
OF THE TEETH. 49 
 
 the upper, but their number and size in both are various, because ol 
 the different numbers, as well of the teeth themselves, as of their 
 roots. As the body grows, the jaw-bone slowly increases in length, 
 and teeth are added in proportion, till the jaws acquire their full size, 
 when the sockets are completely filled, the lips are extended, and the 
 mouth is said to be formed. But, in the decline of life, when the 
 teeth fall out, the sockets are reabsorbed and carried away, as if they 
 had never been ; then the chin projects, the cheeks become hollow, and 
 the lips fall in, the sure marks of old age. 
 
 Fractures of the lower-jaw are more or less transverse, and are 
 known by the falling down of one part of the bone. They happen 
 from blows or falls, but never by pulling teeth, the sockets of the 
 teeth which alone are broken in their extraction, bearing but a small 
 proportion to the rest of the jaw ; and even in children this cannot 
 happen, for in them the teeth have no roots, nor any hold or dangerous 
 power over the jaw. 
 
 OF THE TEETH. 
 
 The teeth of an adult are generally in number sixteen above, and 
 as many below, though some people have more ; others, fewer. The 
 part appearing without the socket, is called the base or body, and 
 those parts within, the roots or fangs. These roots become generally 
 smaller towards the end farthest from the base ; and are nearly coni 
 cal, by which the surface of their sides lessens the pressure made by 
 their bases, and prevents the soft parts, at the small points of the 
 sockets, being hurt by such pressure. Each tooth is composed of its 
 enamel, (an extremely hard substance covering the outer surface of 
 the tooth) and an internal bony substance. The enamel has no cavity 
 or place for marrow, and is so extremely hard, that saws or files can 
 with difficulty make an impression upon it. It is thickest upon the 
 base, and becomes thinner towards the extremities of the roots. Its 
 fibres are all perpendicular to the internal substance, and are straight 
 on the base, but at the sides are arched with a convex part towards 
 the roots, which enables the teeth to resist the compression of any 
 hard body between the jaws, with less danger of breaking these fibres, 
 than if they had been situated transversely. The spongy sockets in 
 which the teeth are placed, likewise serve better to prevent such an 
 injury, than a more solid base would have done. The internal bony 
 part of the teeth is of the nature of other bones ; like them it is sup- 
 plied with blood-vessels and nerves, and like them it is subject to the 
 disorders of other vascular parts. Hence, when the enamel breaks or 
 falls off, and the internal part becomes exposed to the air, it soon cor- 
 rupts, and a carious tooth is produced, perfectly hollow within, and 
 4 
 
50 ANATOMY AND PHYSIOLOGY. 
 
 having only a small hole externally. The vessels and nerves enter by 
 a small opening placed a little to the side of each root, and thence 
 descend to be lodged in canals formed in the middle of the teeth ; here 
 they are employed in replacing the waste constantly made by the fric- 
 tion they undergo in mastication. 
 
 The teeth are commonly divided into three classes, viz : the inci- 
 sores, canini, and grinders or molares. The incisores, so called from 
 their use in cutting the food, are the four teeth in the fore-part of 
 each jaw. The canini derive their name from their resemblance to a 
 dog's tusks. They are the longest of all the teeth, are placed one on 
 each side of the incisores, so that there are two canini in each jaw, 
 which seem to be intended principally, not for dividing or grinding 
 like the other teeth, but for laying hold of substances. The grinders, 
 of which there are ten in each jaw, are so named, because from their 
 shape and size they are fitted for grinding the food. Each of the in- 
 cisores and canini is furnished only with one fang ; but in the molares 
 of the under jaw, we constantly find two fangs, and in those of the 
 upper jaw, three fangs. 
 
 This structure and arrangement of all the teeth displays a wonder- 
 ful degree of art. To understand it properly, it will be necessary to 
 consider the under jaw as a kind of lever, with its fixed points at its 
 articulations with the skull ; that this lever is worked by its muscles ; 
 and that the aliment constitutes the object of resistance to its 
 elevation. Thus it will be seen, that the grinders, from being placed 
 nearest the centre of motion, and from their uneven surfaces, are fitted 
 for the purpose of grinding food ; while the canini and incisores, being 
 placed farther from this point, from the sharpness of their edges, which 
 overlap each other as the blades of scissors do, are particularly adapted 
 to cut and tear the food. 
 
 There are examples of children who have come into the world with 
 two, three, and even four teeth ; but these examples are very rare ; 
 and it is seldom before the seventh, eighth, or ninth month after birth, 
 that the incisores, which are the first formed, begin to pass through 
 the gum. The symptoms of dentition, however, in consequence of 
 irritation from the teeth, frequently take place in the fourth or fifth 
 month. About the twentieth or twenty- fourth month the canini and 
 two grinders make their appearance. The symptoms are more or less 
 alarming, in proportion to the resistance which the gum affords to the 
 teeth, and according to the number of teeth, which may chance to seek 
 a passage at the same time. Were they all to appear at once, chil- . 
 dren would fall victims to the pain and excessive irritation ; but 
 nature has so very wisely disposed them, that they usually appear one 
 after the other, with some distance of time between each. The first 
 
THE BONE OF THE TONGUE. 51 
 
 incisor that appears is generally in the lower Jam, and is followed by 
 one in the upper jaw. Sometimes the canini, but more commonly 
 one of Ihe grinders, begin to pass through the gum first. These 
 twenty teeth, viz. eight incisores, four canini, and eight grinders, 
 are called tempoiary or milk teeth, because they are all shed 
 between the age of seven and fourteen, and are succeeded by what 
 are called the permanent or adult teeth ; and which are of a firmer 
 texture, and have longer fangs. These adult teeth being placed in a 
 distinct set of sockets, and the upper sockets being gradually removed 
 as the under ones increase in size, at length the temporary, or upper 
 teeth, having no longer any support, fall out. To these twenty teeth, 
 which succeed the temporary ones, twelve others are afterwards 
 added, viz. three grinders in each side, in both jaws ; and in order to 
 make room for this addition, we find that the jaws gradually lengthen 
 in proportion to the growth of the teeth ; so that with twenty teeth 
 they seem to be as completely filled, as they are afterwards with 
 thirty-two. This is the reason why the face is rounder and flatter in 
 children than in adults. In extreme age the teeth drop out, their 
 sockets are removed also, and the face again shortens. 
 
 With regard to the formation of the teeth, we may observe, that 
 in a foetus of four months the alveolar process appears only as a shal- 
 low longitudinal groove, divided by minute ridges into a number of 
 intermediate depressions ; in each of which we find a small pulpy 
 substance, surrounded by a vascular membrane. This pulp gradually 
 ossifies, and its lower part is lengthened out to constitute the fang. 
 When the bony part of the tooth is formed, its surface begins to be in- 
 crusted with the enamel. The rudiments of some of the adult teeth 
 begin to be formed at a very early period, for the pulp of one of the 
 incisores may generally be perceived in a foetus of eight months, and 
 the ossification commences soon after birth. 
 
 THE BONE OF THE TONGUE. 
 
 There is a small bone, nearly of the figure of the lower-jaw bone, 
 and which though not classed with those of the head or trunk, yet as 
 being situated near to the head, we shall describe before we come to 
 those of the trunk. This bone corresponds in place with the chin, 
 below which, about an inch, it may be felt, the uppermost of the hard 
 points in the fore part of the throat ; where being placed horizontally, 
 it lies immediately between the root of the tongue and the upper part 
 of the wind-pipe, and carries upon it a valvular cartilage, for shutting 
 the passage and preventing any thing getting down this tube ; while 
 its legs extend along the sides of the throat, keeping the openings of 
 the wind-pipe and gullet extended, as we would keep a bag extended 
 
52 ANATOMY AND PHYSIOLOGY. 
 
 by two fingers. This bone is the centre of the motions of the tongue, 
 for it is the origin of those muscles which compose chiefly the bulk of 
 the tongue ; of the motions of the wind-pipe, for it forms at once the 
 top of the wind-pipe and the root of the tongue, and joins them both 
 together ; of the motions of the gullet, for its legs surround the upper 
 part of the gullet, and join it to the wind-pipe ; and it also forms the 
 centre for all the motions of the throat in general ; for muscles come 
 down from the chin to this bone, to move the whole throat upwards ; 
 others ascend from the breast, to move it downwards ; while different 
 muscles come from the sides to move the throat backwards. This 
 bone is called the os hyoides. 
 
 OF THE TRUNK OF THE HUMAN BODY. 
 
 The Trunk of the Human Body Comprises the Spine, the Pelvis, and the Thorax, ot 
 
 Chest. 
 
 THE SPINE. 
 
 The spine or back-bone is that long chain of bones which extends 
 from the skull to the end of the loins. It consists of twenty-four dis- 
 tinct bones named vertebrae, from the Latin word vertere to turn ; be- 
 cause they perform at certain points the chief turnings and bendings 
 of the body. They also form a tube or canal along the whole length 
 of the spine, for lodging and defending from harm the spinal marrow ; 
 and they support the whole weight of the trunk, head, and arms, 
 without suffering under the longest fatigue, or the greatest load 
 which the limbs can bear. Hardly any thing can be more beautiful 
 or surprising than this mechanism of the spine, where nature has 
 established the most opposite and inconsistent functions in one set 
 of bones ; for their motions are so free as to turn continually, yet 
 so strong as to support the whole weight of the body ; and so flexible 
 as to bend quickly in all directions, yet so steady within as to contain 
 and defend a material and very delicate part of the nervous system. 
 
 The vertebrae are divided into those of the neck, back, and loins, 
 and the number of pieces corresponds with the length of these divi- 
 sions. The vertebrae of the neck are seven in number ; their form is 
 simple, they being almost like rings, their processes scarcely project ; 
 they are very loose and free ; and their motions are the widest and 
 easiest of all fhe spine. The twelve immediately below these are 
 the vertebrae of the back ; they are larger and stronger than the 
 
THE SPINE. 53 
 
 former, ana their processes project obliquely downwards, so as to be 
 laid over each other ; hence one bone is fastened to the other, which, 
 together with their connection with the ribs, renders this the steadiest 
 part of the spine, and allows it only a very limited motion. The 
 vertebrse of the loins are the next and the last ; they are five in 
 number ; they bear the whole weight of the body, and perform the 
 chief motions of the trunk, and with this view, nature has made 
 them the largest and strongest of the entire vertebrse, and given them 
 a wide and free arrangement of their processes. 
 
 The form of each vertebra is particularly calculated for producing 
 the different uses of the spine, and displays at once the astonishing 
 designs and execution of the Supreme Architect. The spine is 
 intended as a support to the trunk, head, and arms ; for this purpose 
 each vertebra is composed of a main part, called its body, which is 
 a thick, spongy, and therefore light bony substance, convex before, 
 concave at the back part, and almost horizontal upon its upper and 
 under sides, when it is joined to similar bodies of the other vertebrse. 
 All these bodies are connected together, like the sections of a large 
 cane, and constitute a bony pillar for sustaining the upper parts of 
 the body. But, besides support, these parts require motion ; hence, 
 this pillar is furnished with all the means of producing it. First, then 
 we see it divided into many pieces ; having a perfectly elastic substance 
 interposed between every two bodies, and which by easily yielding 
 to whatever side we bend, and afterwards, by a powerful rebounding 
 returning to its place in a moment, takes off pressure from the 
 delicate nervous column, and thus preserves it from injury in the 
 violent and sudden motions of the body. During the day this elastic 
 substance is continually yielding to the pressure, so that we are an 
 inch taller in the morning than at night ; we are shorter in old age 
 than youth ; and the aged spine is bent forwards, owing to the 
 yielding of this part. 
 
 Next, we observe projections standing out from the back-part of 
 the spine for different purposes. The first are the articulating 
 processes, of which the body of each vertebra furnishes four. They 
 grow out obliquely, two from the upper and two more from the under 
 part of each body, and incline towards those of the other vertebrae, 
 till they meet to be articulated ; when they serve the double purpose 
 of fastening together, and securing, in conjunction with the interverte- 
 bral substances, the different pieces of the spine ; and also, by affording 
 so many moveable joints, of assisting in its motions. 
 
 From between these superior and inferior articulating processes, 
 the body of each vertebra sends out two arms, which meeting behind 
 form an arch or canal for the spinal marrow ; and from the middle 
 
54 ANATOMY AND PHYSIOLOGY. 
 
 of that aich, and opposite to the body, another process, called the 
 spinous projects. These processes have their direction backwards, and 
 from the sharpness of their points, which form the ridge of the back, 
 give the name of spine to the whole column. They are intended to 
 serve as so many handles and levers for moving the spine ; their size 
 enabling the muscles to take a firm hold, while their length gives 
 those muscles a powerful force in extending and raising the spine. 
 But, beside these, there are other processes, which, from their direc- 
 tion, are called transverse processes, because they stand out at right 
 angles, or transversely, from the body of the bone. They grow out 
 from the sides of the arms or branches which form the arch for the 
 spinal marrow, and are two in number to each vertebra. They also 
 serve as levers, and long and. powerful ones, in moving and turning 
 the spine. 
 
 Thus we see that each vertebra consists of a body and seven 
 processes ; but it must be understood, that this is not the case with 
 all the vertebrae. As we observed before, the vertebrae of the neck 
 are very indistinctly marked, and the first two materially differ from 
 the general character, for the purpose of adopting a most beautiful 
 piece of mechanism. 
 
 The first vertebra of the neck is named atlas, from the globe of 
 the head being immediately placed upon it. Its processes are scarcely 
 distinguishable ; it has no body ; and is simply a ring, through which 
 the spinal marrow passes from the great hole of the skull into the 
 rest of the tube, formed for its reception. The atlas is articulated at 
 two points, one on each side, with the occipital bone of the skull, and 
 these joints being strictly hinge-like, enable the head to move 
 backwards and forwards, but allow it no motion to either side. This 
 motion, called the rotatory, is performed by means of a tooth-like 
 process, which rises from the upper part of the body of the second 
 vertebra of the neck, and which forms the chief characteristic of that 
 bone. This process is about an inch in height, resembling in some 
 degree the little finger ; stands perpendicularly upwards, passing 
 through the ring of the atlas, and serves as an axis, on which this 
 bone, and with it the head may perform all the rotatory motions. It 
 is confined by ligaments, one of which connects its front with the 
 edge of the occipital hole, and the other, extending from one side of 
 the atlas to the other, embraces the tooth-like process, and prevents 
 its injuring the spinal marrow. When this ligament is burst by 
 violence (as has happened) the tooth-like process breaks loose, and 
 pressing upon the spinal marrow, the person dies. 
 
 All the vertebrae conjoined, make a large canal of a triangular or 
 roundish form, for lodging the spinal marrow, and which, as it descends, 
 
OF THE PELVIS. 55 
 
 gives off its nerves to the neck, arms, and legs ; and the whole course 
 of this canal is rendered safe and smooth by lining membranes, which 
 serve the double purpose of connecting the different bones together, 
 and of affording a soft and easy sheath to the marrow. 
 
 Thus we see that a vertebra consists of different parts, all admira 
 bly suited to produce their various purposes. Its body helps to form 
 the pillar for sustaining the upper parts of the frame. The interver- 
 tebral cartilages, which are placed between the different bodies, being 
 of a highly elastic nature, admit motion and prevent concussion ; 
 while the numerous processes, which grow out from the bone behind, 
 act as so many handles and levers, by which the muscles move and 
 work the spine ; and also serve to form the tube or canal for con- 
 taining the spinal marrow. 
 
 OF THE PELVIS. 
 
 To give a steady bearing to the trunk, and to connect it with the 
 lower extremities, by a sure and firm joining, the pelvis is interposed. 
 It is a circle of large and firm bones, standing as an arch betwixt the 
 lower extremities and the trunk. Its arch is wide and strong, so as 
 to give a firm bearing to the body. Its individual bones are large, 
 so as to give a deep and sure socket for the implantation of the thigh- 
 bone. Its motions are free and large, bearing the trunk above, and 
 rolling upon the thigh-bones below ; and it is so truly the centre of 
 all the great motions of the body, that when we believe the motion to 
 be in the higher parts of the spine, it is either the last vertebra of the 
 loins bending upon the top of the pelvis, or the pelvis itself rolling 
 upon the heads of the thigh-bones. 
 
 The pelvis, is constructed, in the adult, of four large bones, viz 
 of the os sacrum behind, the ossa innominata on either side and before, 
 and the os coccygis below. 
 
 The os sacrum or hinder bone is the base, on which the spine, arid 
 consequently the whole body, rests, its upper surface being articula- 
 ted with the under one of the last vertebra of the loins. It is of an 
 irregular triangular shape, broad above for supporting the trunk ; 
 narrow below ; convex behind ; and concave before ; it guards the 
 nerves proceeding from the end of the spinal marrow, and also forms 
 the back part of the pelvis. Within this bone, there is a triangular 
 cavity, which is a continuation of the. canal of the spine. Here the 
 spinal marrow ends, and branching into a great many thread-like 
 nerves, has the form of a horse-tail, and is therefore named cauda 
 equina. These nerves afterwards go out by five great holes, which 
 are on the fore-part of the bone, to be distributed to different parts. 
 
 The os coccygis is a continuation of, or rather an appendage to, 
 
56 ANATOMY AND PHYSIOLOGY. 
 
 the sacrum ; it consists of four bones in the middle age, each bone 
 becoming smaller, as it descends, till the last ends almost in a point, 
 and by bending inwards serves to contract the lower opening of the 
 pelvis, so as to support effectually the viscera within. These two 
 bones, the sacrum and coccygis, are described by most anatomists as 
 parts of the spine, and certainly not without reason. They are a 
 continuation of that chain of bones, and perform some of their func- 
 tions ; supporting, like them, the weight of the body, lodging the 
 spinal marrow, and transmitting some of its nerves ; but as they are 
 precluded motion, and are closely locked in between the other bones of 
 the pelvis, so as to constitute a principal share of this basin, at its 
 hinder part, we think it adviseable to class them as bones of the pelvis 
 in the description. 
 
 The sides and fore-part of the pelvis, as we before observed, are 
 composed of two bones, which correspond in size and figure with each 
 other, but, being of a most irregular shape, are called the ossa inno- 
 minata, or nameless bones. In children each of these bones consists 
 of three separate pieces, which afterwards, when greater strength is 
 acquired, and ossification is become more perfect, are so firmly united 
 as to form but one bone ; still these bones continue to be described 
 as though each consisted of three pieces. 
 
 The os ilium, or haunch-bone, is the highest, constituting each 
 upper side of the pelvis, and has its posterior edge firmly and im- 
 moveable articulated to that of the os sacrum. It forms the flank, 
 and is the largest division of the os innominatum. 
 
 The os ischium, or hip-bone, lies perpendicularly under the former, 
 and is the lowest point of the pelvis, upon which we sit. 
 
 The os, pubis, or share-bone, is the last and smallest piece of the 
 three, forming the fore-part of the pelvis, and completing its brim. 
 
 Each os innominatum has a cup-like hollow for the head of the 
 thigh-bone to move in. It is formed at that part where the three 
 original pieces, which we have described, meet, to form one bone, 
 and is called the acetabulum, from its resemblance to a measure 
 which the ancients used for vinegar. 
 
 The pelvis is intended for many great purposes in the human 
 frame ; first, it is the base for supporting the superior parts of the 
 body ; next, it is so constructed as to receive into its sockets, and to 
 roll upon the heads of the thigh bones, by which means it connects 
 the lower extremities with the upper parts of the frame, without pre- 
 cluding motion ; and, lastly, by forming a kind of basin at the lower 
 end of the trunk of the body, it helps to sustain its viscera ; while its 
 outside surfaces, its ridges, and projecting points, serve as so many 
 convenient places for the origin and insertion of numerous muscles, 
 
OF THE THORAX. THE RIBS. THE STERNUM. 57 
 
 which, having one of their extremities fixed into the pelvis, as into a 
 kind of circular basis, perform, by means of it, with the advantage 
 of a lever, some of the motions of the trunk, and many of those of 
 the lower limbs. The male pelvis differs from the female, in being 
 much thicker, and more rough, and its cavity being less. 
 
 OF THE THORAX. 
 
 The thorax or chest is that large cavity reaching from the neck 
 to the lower end of the breast-bone before, but extending further 
 downwards at the back, and including all that space which lies be- 
 tween the opposite ribs. It is intended to afford a secure and com- 
 modious residence for the heart, lungs, &c, and is formed, behind, 
 by the twelve dorsal vertebrae of the spine ; at the sides, by the ribs ; 
 and by the breast-bone, before. 
 
 THE RIBS. 
 
 The ribs form the sides of the chest, covering and defending the 
 heart and lungs. They also assist in breathing, being joined to the 
 spine by regular hinges which allow of short motions, and to the 
 breast-bone by cartilages, which yield to the motion of the ribs, and 
 return again by means of their elastic nature, when the muscles cease 
 to act. They are generally twelve in number on each side, though 
 frequently eleven or thirteen have been found. Those whose carti 
 lages are separately inserted into the breast-bone are called the true 
 ribs, and are seven in number, while the five lower ones, whose car- 
 tilages do not reach that bone, but run into each other, and are joined 
 to it by a common cartilage, are designated by the name of false 
 ribs. The low T er edsre of each rib is furrowed alonsr its internal side 
 for the safe passage of the vessels and nerves between the ribs ; and, 
 to the ridge, at each side of this canal, are fixed the double rows of 
 muscles, which lie between the ribs. 
 
 THE STERNUM. 
 
 The sternum, or breast-bone, is commonly composed of three 
 bones, joined together by cartilages. It extends from the upper to 
 the lower part of the breast anteriorily, and has the ends of the ribs 
 and collar bones articulated with it, by which the cavity of the chest 
 is completed, as far at least as the bones are concerned. 
 
 This bone, the ribs, and indeed all the chest, stand so much ex- 
 posed, that d .d w T e not guard them with the hands, fractures must be 
 very frequent ; but, when they are broken and beaten in, they hurt 
 the heart or lungs, and not unfrequently the most dreadful conse- 
 quences en5ue. Often, by a wheel passing over the body, the breast- 
 
5S ANATOMY AND PHYSIOLOGY. 
 
 bone is broken ; its pieces press inward upon the heart, which is 
 sometimes burst ; but more commonly the patient dies a slow and 
 painful death ; for the inflammation, which begins in the place of the 
 wound is extended to the lungs, and propagated still onwards to the 
 heart ; which, being once inflamed, brings on anxiety, oppression, 
 faiotings and palpitations ; then anxious breathing, quick and inter- 
 rupted pulse, still more frequent faintings, and lastly death. But 
 the ribs, covering more properly the lungs, do not always produce 
 death by their fractures, for the wound by the point of a rib is no 
 deeper than just to puncture the lungs ; yet through this small 
 wound on their surface, the lungs breathe out their air into the cavity 
 of the chest, and at last it escapes under the cellular substance of the 
 skin, when the man becomes exceedingly inflated, his breathing 
 more and more interrupted, and, if not assisted, he must die. 
 
 Having now described the bones which form the trunk of the 
 body, we next come to those of the limbs, and first to the bones 
 composing the upper limbs. 
 
 THE SUPERIOR EXTREMITIES. 
 
 Each Superior Extremity consists of the Shoulder, Arm, Fore-arm, and Hand, 
 THE SHOULDER. 
 
 The shoulder includes two bones, the clavicle and scapula. The 
 clavicle or collar-bone is placed at the root of the neck, and at the 
 upper part of the breast. It lies almost horizontally, and extends 
 across from the tip of the shoulder to the upper part of the breast- 
 bone. Its figure is long, round, and curved like an italic S, and 
 serves the shoulder as a kind of arch, supporting and preventing it 
 from falling in and forwards upon the breast, by which the motions 
 of the arms would be confined, and the chest made narrow, which 
 must be the case, were these bones wanting. The collar-bones also 
 make the hands strong antagonists to each other, which otherwise 
 they could not be. 
 
 The scapula, or shoulder-blade, is the other bone of the shoulder. 
 It is a broad, flat, triangular bone placed upon the outside of the ribs, 
 and serving as a base to the whole superior limb. Its under side is 
 somewhat concave, to match the convexity of ribs, yet it is not 
 in immediate contact with them, but is separated from them by 
 several layers of muscular flesh ; so that this bone may glide upon 
 the trunk, and increase the motion of the limb which is suspended 
 
THE SHOULDER. THE ARM. 59 
 
 from it. For this reason the scapula is not jointed with any bi ne of 
 the trunk, or connected to it by ligament, as such connections must 
 impede the freedom of its motions ; but it is securely held to the 
 trunk by those very muscles which perform its movements. The 
 arm-bone is jointed with the scapula, at one of its angles; this angle 
 terminates in a flat surface, not more than an inch in diameter, for 
 receiving the head of that bone ; and, as it is very shallow, dislocations 
 of the shoulder are more frequent than of any other joint. A high 
 ridge called the spine, rises from the back or external surface of the 
 scapula, and traversing its whole length, runs forward to terminate 
 in that high point or promontory which forme the tip of the shoulder 
 and overhangs and defends the joint. This projecting point of the 
 scapula is called the acromion process ; it almost makes a part of the 
 shoulder joint, preventing dislocation upwards ; and is the part which 
 is jointed with the collar-bone. There is also another process which 
 stands out from this angle of the scapula, and is intended to secure 
 the joint, and prevent dislocation likewise. It is a thick, short, but 
 crooked process, and is adapted to defend the joint at its inner side. 
 But the principal strength of this union of the joints arises from the 
 muscles, which, passing from the shoulder-blade over the joint, are 
 inserted into the arm-bone close to its head. These muscles in their 
 passage, closely embrace the head of the arm-bone, adhere to the 
 capsular ligament which encloses the joint ; and, by spreading them- 
 selves over it, thicken and increase its strength. They also bv 
 their contraction hold the arm-bone in its place. 
 
 The shoulder-blade, as we before observed, is not fixed, but moves 
 upon the trunk ; it therefore serves as a moveable intermediate base 
 to the whole arm which hangs from it. For this purpose it is firmly 
 held to the trunk by numerous and strong muscles, which can move 
 it in various directions, and, by a quick succession of these movements, 
 can carry its whole body in a circle, by which greater scope is given 
 to the motions of the arm. This bone also serves to cover and defend 
 the back-part of the chest. 
 
 THE ARM. 
 
 The arm is commonly divided, in the description, into two parts, 
 which are joined with each other at the elbow. The upper part, or 
 os humeri, retains the name of arm, properly so called, and the lower 
 part is usually termed the fore-arm. 
 
 The arm, then, is that division extending from the shoulder to 
 the elbow. It has only one bone, which is long, round, and nearly 
 straight, and which is united at the shoulder by its round head being 
 
60 ANATOMY AND PHYSIOLOGY. 
 
 received into the hollow of the shoulder-blade, and connected thereto 
 by ligaments, which enclose the whole joint as in a bag. But that 
 this joint may have the freest motion, the hollow for receiving the 
 arm-bone is extremely shallow, so that its round head might easily 
 turn in all directions ; and the connecting ligaments, for the same 
 reason, are longer than in other joints. Then, as in all other 
 moveable unions of the joints, not only is the head of the arm-bone 
 tipped with cartilage, but the surface of the cavity into which it is 
 received is also lined with the same substance, for the purpose of pre- 
 venting concussion and friction ; and the more effectually to preclude 
 the latter, an oily fluid is constantly moistening the whole internal 
 surfaces of the joint, and is supplied from the inner side of the capsu- 
 lar ligament, and also from soft, spongy substances, which are placed 
 within the joint. The lower end of the arm-bone is connected with 
 those of the fore-arm, at the elbow, carrying them with it in all its 
 motions, and serving as a base on which they perform their peculiar 
 movements. 
 
 THE FORE-ARM. 
 
 The fore-arm is composed of two bones, viz. the ulna and the 
 radius. The ulna is the longer of the two bones, and is extended 
 from the wrist on the side of the little finger to the point of the elbow, 
 where it assumes a hook-like form ; the concave side of which being 
 fitted to the pulley-like surface of the lower end of the arm-bone, 
 produces the motions of flexion and extension, so that the fore-arm 
 may be bent to a very acute angle, or extended to almost a straight 
 line with the arm. 
 
 The radius is the second bone of the fore-arm. It is but partially 
 articulated (i. e. jointed, or joined) with the end of the arm-bone, and 
 has its position reversed with that of the ulna ; for the ulna, belonging 
 principally to the elbow, has its greater end upwards ; the radius, 
 principally belonging to the wrist, has its greater end downwards ; and 
 while the ulna only bends the arm, the radius carries the wrist with 
 a rotatory motion, and for this purpose it is so articulated with the 
 ulna at the ends, (the only points where these bones meet) that it 
 turns upon it in half circles. The two bones are connected together 
 along their whole length by a strong ligament, which extends from 
 one to the other, filling up the vacant space between them, and ren- 
 dering their position the more secure. The radius is hollowed at its 
 lower end for receiving the bones of the wrist in articulation, but the 
 ulna does not reach quite so far as to come in contact with those 
 bones. 
 
THE HAND. THE THUMBS AND FINGERS. 61 
 
 THE HAND. 
 
 The hand comprehends all from the joint of the wrist to the ends 
 of the fingers. Its back-part is convex for greater firmness and 
 strength ; and it is concave before for containing more conveniently 
 such bodies as we take hold of. 
 
 Anatomists generally divide the hand into the carpus, or wrist- 
 bones ; the metacarpus, or bones that stand upon the wrist, and serve 
 as a basis to the fingers ; and the fingers, consisting, each one, of its 
 three joints. 
 
 The carpus, or wrist, is composed of eight small bones, disposed 
 in two rows. Those of the upper row form an oblong head, to be 
 articulated with the cavity of the radius of the fore-arm, so as to 
 allow motion on all sides ; and, by a quick succession of these 
 motions, the hand may be moved in a circle. The lower row is 
 articulated with the bones of the metacarpus, to which they serve 
 as a solid foundation or centre. These small bones are firmly tied 
 to each other by strong ligaments. There are two in particular 
 which deserve notice ; one is situated on the external, and the other 
 on the internal, side of the wrist, and both not only help to strengthen 
 the parts on which they lie ; but also confine, and serve as smooth 
 lubricated sheaths to the tendons which pass under them. 
 
 The metacarpus consists of four long round bones for sustaining 
 the fingers. They are founded upon the wrist bones ; but, departing 
 from them as from a centre, in somewhat of a radiated form, they 
 allow the fingers a freer play. These bones are connected to each 
 other by plain surfaces, and are tied at their lower ends by ligaments, 
 which prevent their being drawn asunder. Consequently they have 
 not a large motion. 
 
 THE THUMBS AND FINGERS. 
 
 The thumb and four fingers are each composed of three bones. 
 The thumb is placed obliquely with respect to the fingers, and its 
 bones are thicker and stronger than those of the former ; which is 
 necessary, as the thumb is intended to counteract all the fingers. 
 All the bones of the fingers are placed in three rows, called phalanges. 
 The first phalanx is articulated with the bones of the metacarpus, 
 and consists of the largest bones ; the second stands out from the 
 first ; and the last grows out from the second and completes the 
 fingers. These different bones composing the fingers are all regularly 
 jointed with each other, and in such manner as to allow not only a 
 hinge! ike but a* so a rotatory motion. 
 
62 ANATOMY AND PHYSIOLOGY, 
 
 THE INFERIOR EXTREMITIES. 
 
 Each of the Lower Extremities comprises the Thigh, the Leg, and the Foot, and has a gr«a 
 analogy in the structure and distribution of its parts with the Upper Extremities. 
 
 THE THIGH. 
 
 The thigh, like the arm, has only one bone, which is the longest 
 in the whole body, and the largest and strongest of all the round 
 bones. Its upper end inclines inwards, and swells into a large, 
 smooth, round head, to be articulated with the cavity, which is 
 afforded by the side bones of the pelvis. Just below this head the 
 bone becomes small, whence this part is called its neck. The artic- 
 ulation of the thigh-bone with the trunk is secured by strong liga- 
 ments ; the first is almost peculiar to this point, and is called, from 
 its shape, the round ligament. It grows out of the articulating 
 cavity, and is inserted directly into the head of the bone. The other 
 is the capsular ligament, which, arising from the rim of the articula- 
 ting cavity of the pelvis, passes over the whole joint, embraces the 
 head of the thigh-bone as in a purse, and is inserted into this bone at 
 its neck. The body of the thigh-bone continues thick and strong 
 down to its lower end, where it spreads with two great protuberan- 
 ces, called condyles, to be articulated with the bones of the leg. This 
 bone not only serves as a fixed point for performing several motions 
 of the trunk, which it sustains like a pillar, but it also affords a base 
 for the leg to carry on its own motions, and is principally concerned 
 in walking, running, &c. 
 
 THE LEG. 
 
 The leg is composed of three bones ; two long ones, called tibia 
 and fibula ; and a small one placed at the knee. 
 
 The tibia is the long triangular bone at the inside of the leg ; it 
 runs nearly in a straight line from the thigh-bone to the ankle, sup- 
 porting the whole weight of the body, and has its upper end expanded 
 into a large surface for receiving the lower end of the thigh-bone, and 
 forming the knee-joint. This articulation admits flexion and exten- 
 sion, and is secured by very strong ligaments ; to compensate for the 
 weakness of its bony structure, arising from the flatness of the 
 articulating surfaces ; the joint not being protected as in other cases 
 by a ball and socket, by a large head imbedded in a deep cavity, by 
 over-hanging bones, or by hook-like projections, all which were con- 
 trivances ill adapted to its motions. In this instance the strength 
 and complexity of the ligaments are the resources which have been 
 
THE LEG. THE FOOT. 63 
 
 elected. At the sides of the joint the capsular ligament is peculiarly 
 strong. The contrivance of a ligament within the cavity of the joint, 
 and directly connecting the two bones, is improved upon by a strik- 
 ing adaptation to the necessities of the case. Instead of one, there 
 are two such ligaments which cross each other, and hence are named 
 "crucial (or cross) ligaments ;" and by a varied tension of each in 
 different positions of the joint, they check its motions and secure its 
 safety. 
 
 This, however, is not all that is admirable in the mechanism of 
 this curious joint. On the top of the tibia are placed two moveable 
 cartilages of a crescent-like form. Their outward edges are thick, 
 while their inward borders are extremely thin, and they thus form a 
 hollow, in which the protuberances of the thigh-bone play with secu- 
 rity, and with a facility that is much increased by their loose 
 connections. 
 
 Hence, although this joint be the most oppressed by great loads, 
 and the most exercised in continual motions, yet it is less frequently 
 displaced than any other. The lower end of the tibia is articulated 
 with the foot and forms the inner ankle. 
 
 The fibula is a long slender bone placed at the outside of the tibia. 
 Its head is connected to that bone by ligaments, but does not reach 
 high enough to enter into the composition of the knee-joint ; it lies 
 along-side the tibia, somewhat like a splint, increasing the strength 
 of the leg, and like the double bone of the fore-arm, also completing 
 its form. This bone descends to the foot, where it forms the external 
 ankle, and is connected to the tibia, along its whole length, by a 
 broad thin ligament, similar to that which is found between the 
 bones of the fore-arm. 
 
 The knee pan is the third and last bone of the leg. It is a small 
 thick bone, of an oval, or rather triangular form. The base of this 
 triangle is turned upwards to receive the tendons of the great muscles 
 which extend the leg, the pointed part of this triangle is turned 
 downwards, and is tied by a very strong ligament to the upper part 
 of the tibia, just under the knee. The patella, or knee-pan, is in- 
 tended as a lever ; for by removing the direction of the muscles o/ 
 the leg farther from the centre of motion, it enables them to act more 
 powerfully in extending the limb. To facilitate its motions, its 
 internal surface is smooth, covered with cartilage, and fitted to the 
 pully of the thigh-bone, upon which it moves. 
 
 THE FOOT. 
 
 The foot, like the hand, is divided into three parts, viz. the tarsus 
 or instep, the metatarsus, and the toes. 
 
64 
 
 ANATOMY AND PHYSIOLOGY, 
 
 The tarsus or instep is composed of seven bones, firmly bound 
 together by strong ligaments ; and forming a sure and elastic arch 
 for supporting the body. The uppermost of these bones, called the 
 astragalus, is articulated at its superior surface with the bones of tl^e 
 leg in such manner, as to afford the motions of flexion and extension 
 in the ankle joint ; while the sides of this bone are overlapped by the 
 two processes which descend from the tibia and the fibula, to form the 
 internal and external ankles so completely, as to secure the joint 
 from dislocations. The astragalus is joined below to the os calcis, 
 and serves as the immediate base for supporting the bones of the leg. 
 The os calcis or heel-bone is the largest of the seven bones. Behind, 
 it projects, forming a large knob, called the heel, for receiving the 
 insertion of the tendon of Achilles.* It is situated under the astra- 
 galus, with which it is so firmly connected as scarcely to admit 
 motion, but which renders this principal part of our base, which rests 
 on the ground, secure and firm. Its lower surface is pressed flat at 
 the back-part, by the weight of our bodies, this bone being the basis 
 of the whole frame. 
 
 The tarsus or instep is convex above, but leaves a concavity below 
 for lodging safely the several muscles, tendons, vessels, and nerves, 
 that lie on the sole of the foot ; and being composed of several bones, 
 all having slight movements with each other, and firmly tied together 
 by ligaments, so as to prevent dislocation, is well adapted to afford 
 sufficient elasticity for precluding shocks in walking, running, or the 
 other motions of the body ; and also for security against fractures, to 
 which it would have been liable had the tarsus been composed of only 
 one bone. 
 
 The metatarsus is composed of five bones, which correspond in 
 their general character with the metacarpal bones of the hand ; but 
 are longer, thicker, and stronger than the latter. The bases of these 
 bones rest upon the instep ; while their extremities support the toes, 
 in like manner as the metacarpal bones sustain the fingers. When 
 we stand, the fore-ends of these bones and the heel-bone are our only 
 supporters. 
 
 THE TOES. 
 
 Each of the toes, like the fingers, consists of three bones, except 
 the great toe, which has only two bones. Those of the other four are 
 
 * Grecian fable tells us that Achilles, when an infant, was dipped in the river Styx 
 to render him invulnerable. The heel was not dipped because she held him by tins 
 part ; there he was wounded. From this story is derived the name tendo Achillis. 
 
SESAMOID BONES. RETROSPECT OF SKELETON. 65 
 
 distinguished into phalanges. In walking the toes bring the centrp. 
 of gravity perpendicular to the advanced foot. 
 
 THE SESAMOID BONES. 
 
 There are small bones found in different parts of the human body, 
 and which, from their resemblance to the seed of the sesamum, obtain 
 their name. They are nothing more than portions of the ligaments 
 of joints, or of the tendons of muscles become bony by pressure ; and 
 are uncertain both in their number and situation. 
 
 RETROSPECT OF THE SKELETON. 
 
 "When the bones of an animal are connected together, after the 
 soft parts have been removed,, the whole is called a skeleton. Upon 
 its dimensions depend the height, and, in a great measure, the breadth, 
 and strength of the human body. Had this frame been constructed 
 of fewer bones, our actions must necessarily have been rendered 
 constrained, and less convenient. It is therefore wisely divided into 
 numerous pieces, for enlarging the sphere of motion ; while all its 
 divisions are peculiarly and admirably fitted to the various uses for 
 which they have been designed. 
 
 The head, as we have seen, forms a spheroidal case for lodging and 
 lefending the brain within its cavity. In the head, and contiguous 
 to the emporium of sense, we also find organs of sight, hearing, 
 smelling, tasting, and speech ; the more rapidly to transmit informa- 
 tion to the brain, and also to obey its commands. 
 
 From the head, we see descending a large chain of bones, called 
 the spine, or back-bone, and reaching down to the extremity of the 
 pelvis. This bony pillar not only supports the head, and superior 
 parts of the body, but also affords a canal along its descent for safely 
 lodging that continuation of the brain called the spinal marrow ; and 
 being divided into several small bones, connected together by elastic 
 substances, and having a great number of processes projecting like so 
 many small handles, for the muscles to take hold of and work by, it 
 allows the neck, back, and loins, a sufficient motion. 
 
 From the upper part of the spine, the ribs extend out on each side, 
 and meeting at the breast-bone before, they form the cavity of the 
 chest for lodging and defending the heart, and the organs of respira- 
 tion. 
 
 The lower part of the spine, supporting all the parts of the body 
 which are superior to it, is itself received in a wedge-like form, and 
 supported by the bones of the pelvis. These bones are so constructed 
 as to serve at the extremity of the trunk not only as a kind of basin, 
 for sustaining some of its viscera, as the intestines, &c. but also, as 
 
G6 ANATOMY AND PHYSIOLOGY. 
 
 a medium of connection between the body and the lower extremities, 
 affording a firm and safe support to the former, and producing the 
 necessary motion at the hip-joints, by rolling upon the round heads 
 of the thigh-bones. 
 
 In viewing the superior extremities, we observe that the base of 
 each is placed in a situation, the best calculated for the limb to per- 
 form all its motions, and at the same time to defend from injuries 
 the head and chest ; while the muscles which are necessary to work 
 the limb, serve as a defence and covering to the vital parts within the 
 ribs. The division of each extremity into several bones, and their 
 peculiar connection, are intended to produce large motion ; that, at 
 the shoulder, is sufficiently free for describing a circle ; at the elbow 
 the arm may be bent to an acute angle, whilst the wrist is capable of 
 much motion ; as are the thumb and fingers ; the whole limb pro- 
 ducing a collective motion sufficiently great for all the purposes of 
 necessity and convenience. 
 
 The inferior extremities we also see divided into several bones, 
 and for the purposes of motion ; but, serving as two moving columns 
 for the support and carriage of the rest of the body, they are necessa- 
 rily stronger, and their joints firmer and more confined. Hence the 
 thigh-bone has less motion than that of the arm; the joint of the knee 
 is stronger than that of tl. e elbow ; and the motion of the ankle and 
 toes is slower, but more firm than that of the wrist and fingers. 
 
BONES OF THE BODY, 
 
 8 
 
 67 
 
 EXPLANATION OF FIGURE 
 
 HEAD AND NECK. 
 
 1. The Frontal-bone. 
 
 2. Parietal-bone. 
 
 3. Temporal-bone. 
 
 4. Cheek-bone. 
 
 5. Upper Jaw. 
 
 6. Lower Jaw. 
 
 7. Teeth, imbedded in their bony cavities formed 
 by the alveolar processes. 
 
 8. One of the Sutures separating the Bones of the 
 Head ; the Coronal. 
 
 9. Vertebra of the Neck. 
 
 10. The Transverse Projections from the Vertebrae 
 
 for the attachment of Muscles. 
 
 THE TRUNK. 
 
 11. The Sternum or Breast-bone. 
 
 12. The Ribs. 7 true and 5 false Ribs. 
 
 13. Their Cartilages, connecting them with the 
 
 Sternum, and which replace the Ribs, by their 
 elasticity, when they are elevated by inspira- 
 tion. 
 
 14. The Vertebras of the Loins with their transverse 
 Processes. 
 
 15. The tones of the Pelvis; the Sacrum is a broad 
 
 base to the central pillar of the body; the Ossa 
 Innominata, are seated at the sides and the 
 fore-part of the Pelvis: they are divided into a. 
 The Pubis.— b. The Ischium— c. The Ilium. 
 
 UPPER EXTREMITY. 
 
 16. The Clavicle or Collar-bone. 
 
 17. The Scapula or Blade-bone. 
 IS. The Humerus or Arm-bone. 
 
 19. The Bones of the Fore-arm. 
 
 a. The Radius, on which the Arm turns. — 6. 
 The Ulna. 
 
 20. The 8 Bones of the Carpus or Wrist. 
 
 21. The Bones of the Thumb. 
 
 22. The Metacarpus, forming the Palm, the back of 
 
 the Hand, and the Finger-bones. 
 
 LOWER EXTREMITY. 
 
 23. The Thigh-bone. 
 
 24. The Patella or Knee-pan. 
 
 25. The Boues of the Leg. 
 
 a. The Tibia.— ft. Tne Fibula. 
 
 26. The Inner Ankle formed by a projection of the 
 Tibia. 
 
 27. The Metatarsus. 
 
 28. The Toes. 
 
GS 
 
 ANATOMY AND PHYSIOLOGY 
 
 OF THE MUSCLES. 
 
 GENERAL DESCRIPTION. 
 
 Those organs which move the bones, and put the whole frame into 
 motion, are called muscles, and constitute all that part of the human 
 body known by the name of flesh. Each large muscle consists of two 
 distinct portions, namely, its belly, which is the only part that is 
 active, and its thin cordy fibrous and shining extremities, or tendons. 
 The only purposes of the last are to fix the muscles to the moveable 
 parts in a concentrated form ; in consequence of which, a greater 
 power is permitted to act, as. laborers are assisted by ropes in moving 
 weighty bodies ; hence they are principally employed in implanting 
 muscles upon bones, and are not discoverable in the heart, stomach, 
 or intestines. Muscles are universally the organs of motions in 
 animals. 
 
 The whole fleshy portion of the human body consists of a great 
 number of muscles, or distinct fleshy bundles, whose surfaces, 
 although in contact, are still separate, sliding over each other, in their 
 alternate contractions and elongations ; and having both ends fixed 
 into the parts which they are intended to move. They are of different 
 sizes and shapes, according to the degree of force required from them, 
 and the form of the part on which they are situated. Hence those on 
 the body are mostly broad and flat, while those of the extremities 
 are of a long, round figure, with tendinous ends. 
 
 Each muscle performs its action by contracting both ends towards 
 the centre, when one of these ends, serving as a fixed point, the other, 
 with the bone to which it is affixed, is necessarily drawn towards it ; 
 and thus, by the co-operation of several muscles, the movement of the 
 limb, and even of the whole body, is effected. As soon as the motion 
 is accomplished, the muscles, which performed it, relax, and allow 
 their ends to elongate to their former position. 
 
 The structure of a muscle appears to consist of a number of long 
 soft fleshy fibres, lying parallel with each other ; and these fibres 
 being enveloped in a thin cellular membrane, are fastened by it into 
 little bundles, which are again tied by some of the same membrane 
 into larger bundles, until the whole muscle is produced ; but, though 
 this is the apparent structure of the muscle, its ultimate division is 
 unknown ; that which appears to the eye to be an elementary fibre, 
 being discovered, by the help of glasses, to consist of a bundle of fibres. 
 
 In this very general description of muscles the form and ap- 
 pearance of those larger ones which cover our bones have been kept 
 
MUSCLES OF THE HEAD. 69 
 
 more particularly in view. But it would convey a very imperfect 
 idea of their extent and importance to confine our observations to 
 them. Muscular fibres, in fact, enter into the structure of almost 
 every organ where motion is necessary, and are adapted in their form 
 and size to that of the parts to which they are attached. The heart 
 and blood-vessels ; the stomach and intestines ; the bladder, &c ; are 
 composed, in a great measure, of very minute muscular fibres, 
 stretching longitudinally, transversely, or obliquely, and sometimes 
 in all directions ; often so small are they that we can only discover 
 their structure by our glasses, and not unfrequently they escape our 
 detection altogether. 
 
 AYe shall now take a rapid view of the different muscles which 
 move the human body ; first, however, observing, that excepting a 
 few, the whole of the muscles on the one side of the frame have cor- 
 responding muscles on the other. If an exact section of the whole 
 human body were made, from the top of the head to the lower end of 
 the trunk, the divided sides would be found similar in structure and 
 parts to each other, the contents of the breast and abdomen only 
 excepted, and which from their nature and situation do not admit of 
 equal division. 
 
 "We also observe, that the end of the muscle, which forms its 
 more fixed point, is called its origin ; while the other end, which is 
 fastened to the bone to be moved, is termed its insertion ; and likewise, 
 that the shape and turn of the part, particularly of the limbs, depend 
 principally upon the size and proportions of the muscles which are 
 situated thereon. Thus we see many of them taper into long slender 
 tendons, where a decrease of size is necessary arid beautiful, as at the 
 small part of the fore arm and leg ; while others swell out in sym- 
 metrical proportion, and give the appearance of fulness and strength 
 to other parts of the frame. 
 
 MUSCLES OF THE HEAD. 
 
 The fore-head is wrinkled and drawn upwards, as are also' the 
 eye-brows, by a broad thin muscle, which rises at the back-part of 
 the skull, and covering the head runs down the forehead, to be 
 inserted into the skin of the eye-brows. 
 
 The eye-brows are drawn towards each other, and the skin of the 
 fore-head pulled down and made to wrinkle, as in frowning, by a 
 pair of small muscles, which rise from the root of the nose, and are 
 inserted into the inside of the eye-brows. 
 
 The ear is moved by eleven small muscles. The first three are 
 called common, because they move the whole ear. The next five are 
 termed proper, and only move the parts to which they are connected ; 
 
70 ANATOMY AND PHYSIOLOGY. 
 
 while the other three are internal, to move the small bones situated 
 within the ear. 
 
 The eye-lids are closed by a muscle, which, rising from the inner 
 angle of the orbit or cavity in which the eye is embedded, covers the 
 under eye-lid, then surrounds the outer angle, and passing over the 
 upper eye-lid, descends to be inserted, by a short, round tendon, near 
 to its origin. 
 
 The eye is opened by a muscle, which (rising from the inner and 
 upper part of the socket) is inserted into the upper eye-lid, to draw 
 it upwards. 
 
 The eye-balls are carried through all their motions by six small 
 slender muscles to each. They arise from the bottom of the socket, 
 and are inserted into the outer coat of each eye-ball at different points. 
 Four of these move the eye upwards or downwards, to the right and 
 to the left ; while the two remaining muscles give oblique directions 
 to the eye, at the same time protruding it ; and all, acting in quick 
 succession, enable the ball of the eye to describe a complete circle. 
 
 The nose is affected by several small muscles of the face, but 
 only one muscle on each side is proper to it. This muscle straightens 
 the nostrils, and wrinkles the skin of the nose. 
 
 The mouth and lips are moved by nine pair of muscles, which 
 arising from the contiguous bones of the face, are inserted into the lips 
 and angles of the mouth ; and from the termination of these muscles 
 a tenth is formed, which surrounds the mouth like a sphincter,* and 
 closes it, by drawing the lips together. It is from the actions of 
 these muscles on the mouth, particularly at its corners, that the 
 emotions of the mind are expressed, and the predominance of partic- 
 ular feelings in individuals is indelibly stamped ; save in those whom 
 nature has gifted with an unimpressible dulness of character, or in 
 whom the more delicate lines are filled up by too great fatness. 
 Perhaps it may be worth while to notice the cause of that distortion 
 of features which is produced by palsy. The muscles on one side 
 then cease to act, while those of the other, contracting with their 
 usual force, the mouth is drawn on one side. 
 
 The lower-jaw has four pair of muscles for pulling it upwards, 
 as in chewing, viz. two pair which are seen upon the outside of the 
 face, and two pair that are concealed by the angles of the jaw. The 
 first pair arise from the sides of the skull, above the temples, whence 
 they are called temporal muscles ; and then descending under the 
 bony bridges of the cheek-bone, are inserted into the lower-jaw near 
 its ends. The second pair arise, at each side, from the under edge of 
 tho bony bridge, and descending along the cheek, are inserted into 
 * A muscle which contracts or shuts an orifice round which it is placed. — En. 
 
MUSCLES OF THE NECK. MUSCLES OF THE TRUNK;. 71 
 
 the angle of the lower-jaw. These four muscles act powerfully in 
 pulling the jaw upwards, and when we bite, may be felt swelling 
 out in the flat part of the temple, and upon the back-part of the 
 cheek. The other two pair of muscles arise from the base of the 
 skull, and are inserted into the lower-jaw internally for enabling 
 this bone to move from side to side, the more effectually to grind the 
 food. The lower-jaw is pulled downwards by muscles, which extend 
 between it and the bone of the tongue, and which also serve to raise 
 the throat upwards. 
 
 MUSCLES OF THE NECK. 
 
 The neck is covered with numerous and complicated muscles. 
 Those on the fore-part or throat extend some between the head and 
 upper part of the trunk ; others between the lower-jaw and the 
 tongue-bone ; more between this bone and the cartilages of the 
 throat ; while numerous other small muscles are situated between 
 these cartilages and the trunk ; and also about the root of the tongue 
 and the back-part of the mouth. 
 
 Their uses are, viz. to bend the head forwards ; to open the mouth 
 by pulling the lower-jaw downwards ; and to move the parts con- 
 cerned in deglutition and speaking. 
 
 The muscles on the back-part of the neck are rather portions of 
 the great muscles, which cover the back, than distinct bundles of 
 fibres ; but, having some of their extremities fixed to the back-part 
 of the skull, and also to the hinder portion of the spine of the neck, 
 are intended to move those parts, drawing them backwards and 
 sideways. 
 
 MUSCLES OF THE TRUNK. 
 
 These are principally the muscles which cover the breast ; those 
 which constitute the fore-part and sides of the abdomen ; and the 
 great muscles that are spread over the back. 
 
 The muscles of the back are numerous and large. They arise 
 from the whole length of the spine or back-bone, having their origina- 
 ting fibres firmly fixed to the numerous processes or handles of that 
 bone ; from the upper and posterior edge of the pelvis ; and also some 
 portions from the back part of the skull ; and from these different 
 organs, they spread over and cover the back of the trunk, and run to be 
 inserted, some into the base of the arm, others into the spine at a 
 distance from their origin, and the remainder into the ribs and back- 
 part of the skull. They consequently not only cover and protect the 
 whole back-part of the body, but also serve to pull the head back- 
 Wards, move the whole arm, assist respiration by acting on the ribs, 
 
72 ANATOMY AND PHYSIOLOGY. 
 
 and to give us an erect posture by extending the spine. These are 
 the muscles which suffer in the barbarous practice of whipping ; 
 and instances have occurred, where from the too great weight oi 
 the whip, or the excessive number of lashes inflicted, the structure 
 of these muscles has been so cruelly torn and destroyed, as to put 
 it out of the power of nature to restore it ; mortification has fol- 
 lowed, and the unfortunate sufferer expired a victim to inhuman- 
 ity or ignorance. 
 
 The cavity of the abdomen is completed at its fore-part and sides 
 by a few broad and thin muscles, which extend from one bone to the 
 other, having their ends firmly fixed to the edges of these bones ; and 
 passing over each other, constitute walls for covering in and con- 
 taining the bowels. These muscles also assist respiration by helping 
 to expel the air from the lungs ; and they contribute to the movement 
 of the body, by bending it forward as in bowing, and by raising the 
 pelvis. 
 
 The breast is covered by a few broad and strong muscles, which 
 arise from the whole length of the breast-bone, and form the fore-part 
 of the ribs, and running from each other over the chest, are inserted 
 into the shoulder for moving the limb forward. 
 
 The ribs are raised, and the cavity of the chest enlarged, during 
 inspiration, by eleven double rows of small muscles on each side. 
 They grow out from the lower edge of one rib, and are inserted into 
 the upper rim of the next. 
 
 MUSCLES WITHIN THE BODY. 
 
 The principal one is called the diaphragm ; it is a broad thin 
 muscle, occupying partly a horizontal position, when the body is erect ; 
 but inclining downwards towards the back, and dividing the trunk 
 of the body into the two great cavities, the thorax and the abdomen. 
 It arises from the lower end of the breast-bone ; from the cartilages 
 of the seventh, and of all the inferior ribs on both sides ; and from the 
 second, third and fourth vertebrae, belonging to the loins, called lumbar 
 vertebrae ; and from these origins its fibres run, like radii, from the 
 circumference to the centre of a circle, to be inserted into a broad 
 flat tendon, which is situated in the middle of this muscle. The 
 diaphragm is the principal agent in respiration, as shall be more fully 
 described under that head. 
 
 The other muscles within the body arise from the sides of the 
 lower end of the back-bone, and from the inner surface of the pelvis, 
 and passing down to be inserted into the thigh-bone, a little below 
 its head, they help to turn the toes outwards, and to bend the thigh ; 
 Dr when the limb is fixed, they assist in bending the body. 
 
THE MUSCLES. 73 
 
 From Professor Dalton's excellent treatise on Physiology and 
 Hygiene* I quote the following remarks on the muscles : 
 
 " If the muscles be examined by the microscope they are seen to 
 be composed of a great number of very small fibres, too minute to 
 be seen by the naked eye, placed side by side, and all running in 
 nearly the same direction. These fibres are ruddy in color, and 
 very elegantly marked by transverse lines or stripes, which run 
 around them in a circular direction. The fibres themselves are 
 united into small bundles, of from 100 to 200 each, which are placed 
 side by side with other similar bundles, but separated from them by 
 a thin layer of loose intervenins: tissue, called Cellular Tissue. A 
 number of these bundles are also united into larger bundles with 
 cellular tissue between them, and these again into still larger. Thus 
 the entire muscle is made up of many bundles of parallel fibres, 
 which can be separated from each other by careful dissection, and 
 reduced to finer and finer divisions, until they become too small for 
 the naked eye. It is this which gives to the muscular flesh its 
 fibrous appearance on close examination. 
 
 " Now the muscles, as we have described them, are endowed 
 with the power of Contraction. By this it is meant that the mus- 
 cular fibres, when they are excited by the influence of the will, can 
 shorten themselves so as to draw together any two points to which 
 their ends are attached. Both ends of a muscle are never attached 
 to one and the same bone, but between their two attachments there 
 is always an articulation or joint, which allows of motion between 
 one bone and the other. 
 
 " In contracting, therefore, the muscle draws the two bones to 
 which it is attached nearer to each other. 
 
 " Whenever a muscle contracts, it swells from side to side at the 
 same time that its fibres are shortened ; and very accurate experi- 
 ments have shown that it increases in thickness in exactly the same 
 proportion that it diminishes in length. It does not become, there- 
 fore, either larger or smaller during contraction, and only changes 
 its shape, but not its size." 
 
 " If we grasp with the fingers the muscles on the front part of 
 the arm above the elbow, we can perceive their contraction when- 
 ever we bend the elbow forcibly upward. At this time two changes 
 in the muscle are distinctly felt. First, it swells, as we have already 
 said, and becomes prominent under the skin ; and, secondly, it be- 
 comes at the same moment harder and more resisting to the 
 touch." 
 
 * I cannot too highly commend this work of Professor Dalton. It should be in every 
 school and family. 
 
74 ANATOMY AND PHYSIOLOGY. 
 
 The muscles act like levers. The action of the muscles of the 
 arm in raising the fore-arm has been likened to a lever of the third 
 kind. The muscle works at a great disadvantage, because it is in- 
 serted so near to the fulcrum. But this seeming disadvantage is 
 really an advantage, for it allows of greater freedom of motion. A 
 careful study of the mechanism of the arm shows us that it is a most 
 wonderful contrivance, and is admirably fitted for the purposes for 
 which it is used by man. 
 
 MUSCLES OF THE SUPERIOR EXTREMITIES. 
 
 These, anatomists divide, into the muscles that are situated on 
 the shoulder-blade, on the arm, on the fore-arm, and on the 
 hand. 
 
 The muscles situated on the shoulder-blade are called muscles 
 of the arm, because, though they arise from the former bone, which 
 serves to them as a base, yet they are inserted into the bone of the 
 arm, to effect its movements. The same observation holds with 
 respect to the other divisions of these muscles. 
 
 The arm, then, is moved by seven muscles, which arise from 
 the shoulder-blade, and passing over the joint are inserted into the 
 arm- bone at its upper and middle parts. These, together with the 
 muscles coming from the back and breast, which are already de- 
 scribed, complete the motions of this part of the limb. 
 
 The fore-arm is moved in flexion and extension by four muscles, 
 which arise from the upper part of the arm-bone ; run down its 
 whole length, and constitute its fulness and figure ; they then pass 
 over the elbow joint to be inserted into the upper ends of the two 
 bones of the fore-arm. 
 
 The hand is moved at the wrist by six muscles ; three of these 
 arise from the upper part of the fore-arm, and descending along its 
 whole length, are continued over the wrist, and inserted into the 
 hand close to this joint ; they bend the hand, and are consequently 
 called its flexors. The three extensors, so called because they ex- 
 tend the hand and bring it backwards, arise from the lower end of 
 the arm-bone, and passing down the fore-arm also, run to be inserted 
 into the back of the hand just beyond the wrist. All these muscles, 
 before they reach to the wrist, become slender tendons, which is 
 the cause of the tapering of the fore-arm from about its middle 
 to the hand. 
 
 Besides flexion and extension, the hand has a circular kind of 
 
MUSCLES OF THE INFERIOR EXTREMITIES. 75 
 
 motion, called pronation and supination. The former takes place 
 when we turn the palm down, as upon a table ; the latter when we 
 turn the palm upwards ; and both motions are produced bj four 
 short muscles which extend obliquely across from one bone of the 
 fore- arm to the other, and roll the radius upon the ulna, carrying the 
 wrist round in circles. 
 
 The fingers are principally moved by two flexors and one ex- 
 tensor. The former muscles arise from the upper part of the fore- 
 arm near the bend, and running down towards the wrist, send off 
 four round tendons each ; which, passing over the palm of the hand, 
 are inserted the one set of tendons into the upper part of the 
 second bone, and the other into the last bone of each of the four 
 fingers. The latter set of tendons pass through slits in the former, 
 which help to bind them down, when the fingers are bent. The 
 extensor muscle arises above the elbow, passes down the fore-arm, 
 and also divides into four round tendons, which can be plainly felt 
 on the back of the hand, and are inserted into all the bones of the 
 four fingers for extending them. 
 
 The other movements of the fingers, and those of the thumb, 
 are performed by muscles chiefly situated upon the hand ; and 
 which, together with those we have described, complete the motions 
 of these parts. 
 
 MUSCLES OF THE INFERIOR EXTREMITIES. 
 
 The great muscles which move the thfgh all arise from the 
 pelvis, or the lower part of the trunk ; covering, and also giving 
 plumpness and shape to the external surface of these parts, they 
 descend over the hip-joint, to be inserted into the thigh-bone below 
 its articulating head. By the action of these powerful muscles the 
 thigh is carried through all its motions. 
 
 The leg is moved by eleven muscles, which arise partly from 
 the pelvis and partly from the upper end of the thigh-bone. They 
 descend along this bone, giving fulness and shape to the thigh, and 
 passing over the knee-joint, are inserted into the bones of the leg ; 
 the extensors into the upper edge of the knee-pan, for extending 
 the leg ; and the flexors into the posterior sides of the long bones 
 of the leg, a little below their heads. The tendons of these muscles 
 form the inner and, outer hamstrings. They bend the leg. 
 
 The foot is moved by three extensors, and by four flexors. The 
 extensors arise, the two first by double heads from the lower end of 
 
76 ANATOMY AND PHYSIOLOGY. 
 
 the thigh-bone, near the bend of the knee. These heads soon after 
 unite into the great fleshy bellies, which, swelling out, form the 
 calf of the leg; "but decreasing where the leg begins to grow small, 
 they each give off a broad thin tendon, which also uniting, form 
 the tendon of Achilles, to be inserted into the extremity of the heel. 
 These powerful muscles extend the foot by bringing it backwards, 
 and are principally engaged in running, walking, leaping, &c. 
 The third extensor of the foot arises also from the lower end of the 
 thigh bone, and descending by a long, slender tendon, is inserted 
 into the heel, to assist the former; but this muscle is sometimes not 
 to be found in the human subject. 
 
 The four flexors arise, the two first from the upper part of the 
 tibia, or principal bone of the leg, and continuing fleshy about half- 
 way down that limb, send off two round tendons, which pass under 
 the inner ankle, and are inserted into the bones of the foot. The 
 other two flexors of the foot arise from the superior part of the 
 fibula or smaller bone of the leg, and seuding off two round tendons, 
 which pass under the outer ankle also, are inserted into the bones 
 of the foot. These assist the former in bending the foot by draw- 
 ing it upwards. 
 
 The toes have two extensors and three flexors. The first extensor 
 arises from the upper part of the leg, and descending to the ankle, 
 separates into four round tendons, which run forward upon the upper 
 part of the foot, where they can be plainly felt ; and are inserted into 
 the four small toes to extend them. The other extensor arises from 
 the heel, and running forward upon the foot, also divides into four 
 tendons, to be inserted into the toes likewise, and to assist in extend- 
 ing them. 
 
 The flexors of the toes arise, the first from the under and back 
 part of the heel, and passing forward along the sole of the foot, sends 
 off' four tendons to be inserted into the second row of bones of the 
 four smaller toes. The second flexor arises from the back part of the 
 tibia below its head, and descending the leg, passes at the inner ankle 
 to run along the sole of the foot, on the middle of which it divides into 
 four slender tendons, which perforate the former in the manner of 
 those which bend the fingers ; and extending beyond them are 
 inserted into the extremities of the last joint of the four small toes. 
 The third flexor assists the two former in bending the toes, and also 
 draws them inwards. Besides these there are other small muscles 
 which are situated upon the foot, and which with those coming from 
 the leg to be inserted into the great toe, complete the movements 
 of these parts. 
 
 Thus we see that the muscles or flesh cover and spread over the 
 
ATTACHMENT AND MECHANISM OF THE MUSCLES. 77 
 
 whole frame of bones; connecting and securing its different divisions 
 and parts ; and not only producing all its movements, but also giving 
 to it fulness, shape, and beauty. We shall now speak of the mo- 
 tions of those muscles. 
 
 OF MUSCULAR MOTION. 
 
 Muscular motions are of three kinds ; namely, voluntary, invol- 
 untary, and mixed. The voluntary motions of muscles are such as 
 proceed from an immediate exercise of the will ; thus the mind 
 directs the arm to be raised or depressed, the knee to be bent, the 
 tongue to move, &c. The involuntary motions of muscles are those 
 which are performed by organs, seemingly of their own accord (but 
 really by their proper stimuli), without any attention of the mind or 
 consciousness of its active power ; as the contraction and dilatation 
 of the heart, arteries, veins, absorbents, stomach, &c. The mixed 
 motions are those which are in fact under the control of the will, 
 but which ordinarily act without the control of consciousness ; as 
 in the muscles of respiration, the intercostals, the abdominal mus- 
 cles, and the diaphragm. 
 
 Motion, as we before observed, is produced by the muscle con- 
 tracting both its ends towards the centre, when one end being fixed, 
 the other is drawn towards the centre of motion, and with it the bone 
 or any other part to which it is affixed ; and thus by the co-operation 
 of several muscles, not only a limb, but even the whole body is put 
 into action. This is the case with all the muscles of voluntary 
 motion ; their fibres contract on the application of the nervous influ- 
 ence, and the whole muscle shortens itself ; and on the same principle 
 the other muscles perform involuntary motion. The heart, for in- 
 stance, contracts from the stimulating properties of the blood ; the 
 arteries do the same, as do the absorbent vessels, by a similar action 
 of their contents, and all those organs and parts which have the 
 power of acting independent of the mind. 
 
 We may define all motion in animals then to be the contraction 
 of the muscular fibre from the presence of some stimulating influence. 
 But whence the muscular fibre derives this contractile power, and 
 what is its nature, remains still a phenomenon that baffles inquiry. 
 
 The following explanations of Professor Dalton are exceedingly 
 lucid and interesting : 
 
 ATTACHMENT AND MECHANISM OF THE MUSCLES. 
 
 " The muscles of the limbs are usually rather elongated in shape, 
 and somewhat thinner at their two extremities than in the middle. 
 At their upper extremities, as a general rule, they are quite closely 
 
78 ANATOMY AND PHYSIOLOGY. 
 
 attached to the bones ; but at their lower extremities they become 
 more slender and tapering, and run into somewhat long and nar- 
 row rounded cords of white fibrous tissue, which are called" sinews " 
 or tendons. These tendons have no power of contraction like that 
 of the muscular fibres, nor can they be stretched like the elastic 
 ligaments of the spinal column ; they are simply very strong and 
 unyielding fibrous cords, by which the muscles are attached to the 
 bones upon which they are to act. When a muscle contracts, ac- 
 cordingly, it draws upon the bone below, by means of the tendon 
 which is inserted into it, exactly as a horse draws a loaded wagon 
 by means of the leathern tugs and couplings of his harness. 
 
 "The tendons are usually inserted into the movable part of a 
 limb,* at a short distance below the joint. Accordingly, when the 
 muscles contract, they act upon the limb with great rapidity ; and 
 a small amount of contraction in the muscle will move the farther 
 extremity of the limb over a considerable distance. Thus the hand 
 and arm are raised, in bending the elbow-joint, by the action of the 
 flexor muscles situated on the front of the upper arm, above the 
 elbow, called the biceps flexor and the brachialis anticus (Fig. 5). 
 They arise from the bones of the shoulder and upper arm, whence 
 their fibres pass in a downward direction, their tendons being finally 
 inserted into the bones of the forearm just below the elbow-joint. 
 When these muscles contract they draw the forearm upward, mov- 
 ing it upon the elbow-joint like a door upon its hinges, and thus 
 raising any weight which is supported by the hand or wrist. The 
 greater the weight which is to be lifted in this way, the greater the 
 force which is exerted by the muscles ; and they may be felt, ac- 
 cordingly, on the front of the upper arm, swelling and hardening 
 at the moment of contraction exactly in proportion to the amount 
 of strength put forth. The tendon of the biceps may also be felt 
 at the same time, just in front of the elbow-joint, made tense and 
 rigid like a bowstring by the action of the muscle above. 
 
 " Nearly all the movements of the body and limbs are performed 
 by a mechanism like that just described. Whatever variations occur 
 are mainly due to the different construction of the joints ; for, while 
 some of them, as the elbow-joint and the knee-joint, are so arranged 
 that they can move only backward and forward like hinges, others, 
 such as the shoulder and hip-joints, can be turned in various direc- 
 tions, or even carried round and round in a circle, or rotated by a 
 kind of twisting motion, like the hand and forearm. But in all 
 cases this is accomplished by the action of muscles, whose tendons 
 are inserted into the bones in various directions, and which thus 
 produce by their contraction the corresponding movements." 
 
MOVEMENTS OF WALKING, RUNNING, AND LEAPING. 79 
 
 AND LEAPING. 
 
 " The movements of walking, running, leaping, etc., are per- 
 formed as follows : When the body stands upright, the feet are 
 planted flat upon the ground, bearing at once upon the heels 
 behind and the ball of the toes in front, the weight of the body 
 resting between the two, upon the middle of the arch of the foot. 
 The body is maintained in this position, as we have seen, by the 
 various muscles, which act in such a way as to keep its different 
 parts carefully balanced, and to retain the weight of the whole sus- 
 pended exactly over the ankle-joint. 
 
 "-Now in walking, when a movement is to be executed in ad- 
 vance, the body is first made to lean a little forward, so that its 
 weight no longer remains above the ankle, but is thrown forward 
 so as to rest entirely upon the toes. The heel is then lifted from 
 the ground by the action of the very strong muscles situated on the 
 back part of the leg, called the gastrocnemius and soleus muscles. 
 These muscles, which come down from above, form the fleshy mass 
 which is knowm as the " calf of the leg." They terminate in a 
 strong cord-like tendon, called the " Tendon of Achilles," which 
 is easily felt at the back part of the ankle-joint, and which is 
 attached to the projecting bone of the heel, termed the calca- 
 neum. When these muscles contract, they draw the heel upward 
 by means of the tendon inserted into it, and lift in this way the 
 ankle-joint and the whole body, carrying it upward and forward, 
 its principal weight resting, as already mentioned, over the ball of 
 the toes. 
 
 " The action of the leg and foot, in this movement, is the same 
 as that by wdiich we might lift a weight from the ground with 
 the aid of a lever. Suppose one end of a strong stick to rest upon 
 the ground, and that this stick bears upon its middle a heavy 
 weight. Then, by taking in the hand the other end of the stick, 
 we may lift the weight exactly as the body is lifted, in walking, by 
 the muscles of the leg and the ankle-bones. 
 
 " At the moment that the body is raised and tilted forward in 
 this way, the other foot is lifted entirely from the ground and swung 
 forward, so as to take a step in advance. As soon as the body has 
 been carried far enough in an onward direction, the second foot is 
 also raised in the same manner as before, while the first is swung 
 forward in its turn to take another step. In this w r ay the two legs 
 act alternately, the weight of the body being carried forward first 
 by one and then by the other ; all the muscles, however, upon the 
 
80 ANATOMY AND PHYSIOLOGY. 
 
 two sides combining harmoniously in their action, so as to produce 
 an easy, graceful, and continuous movement. 
 
 " In the act of walking, as above described, one foot is always 
 upon the ground, and the weight of the body is mainly supported 
 in this way by bearing upon the toes ; it is only lifted forward 
 alternately on the two sides by the leverage of the bones of the foot. 
 Consequently no violent muscular exertion is required, and the 
 movement can be kept up for a long time without fatigue. 
 
 " The act of running, however, instead of being a series of steps, 
 is performed by a succession of leaps or springs, in each of which the 
 whole body is thrown clear of the ground, and carried forward by 
 the impetus which it has received. In order to accomplish this, at 
 the moment the heel is about to be raised by the action of the 
 muscles above described, the knee and hip-joints are first bent, and 
 then instantly straightened by the sudden contraction of their exten- 
 sor muscles. The whole limb thus acts like a powerful spring, 
 which, by its sudden extension, throws the entire body off the ground 
 and carries it through the air in an onward direction. The opposite 
 limb is at the same time thrown forward to receive the weight of 
 the body, and to perform, in its turn, and with similar rapidity, 
 the same movements. The speed of the runner depends on the 
 vigor of the muscular contractions, and the swiftness with which the 
 successive motions are performed. 
 
 "The act of jumping is accomplished in a similar way with that 
 of running, except that the same motions are executed by both 
 limbs together, so that each leap is performed by itself, and is not 
 combined w T ith the others in a continuous movement." 
 
 EFFECTS OF NERVOUS INFLUENCE. 
 
 The nervous influence is a stimulus to the voluntary muscles, as 
 blood is to the heart and arteries ; food to the stomach ; or bile to 
 the intestines. It loses its influence over the system sooner than 
 the irritable principle in the fibre fails ; for the irritable state of the 
 muscle continues long after the voluntary motion, or power of ex- 
 citement from the nerves, is gone. If, wmile in perfect health, we 
 are killed by a sudden blow, the irritable power of the muscles sur- 
 vives the nervous system many hours. It is this retention of the 
 contractile power which fixes the dead body in whatever posture it 
 is placed, and preserves freshness in the animal which seemed dead, 
 but which is really dying still ; for the moment this lingering portion 
 of life is gone, the body dissolves and falls down ; and so we judge 
 of freshness by the rigidity of the flesh, and foresee approaching 
 putrefaction by its becoming soft. There is no speedy putrefac- 
 
EFFECTS OF NERVOUS INFLUENCE. 81 
 
 tion in creatures suddenly killed ; in these the body continues 
 fresh and susceptible to stimuli long after death. But if their con- 
 tractile principle, this irritable nature of the muscular fibre, be 
 exhausted before death, or in the moment of death, then does the 
 body fall quickly into the condition of dead matter, passing through 
 those changes which are the only sure indications of death. The fish 
 which is allowed to struggle till it is dead, and which is not instantly 
 killed, as in crimping ; the ox overdriven before it is brought to the 
 slaughter-house; the animal killed by lightning, which suddenly 
 destroys all powers of life; in these the contractile power is effec- 
 tually exhausted; no mark of irritability remains; and putrefaction 
 comes quickly on. So is it also in those who die of the plague, of 
 poison, of some fevers, or of any sudden and violent disease, which at 
 once extinguishes life, in the common sense, and robs the system of 
 that remnant of life which the physiologist could produce to view. 
 In all these cases the body becomes putrid in a few hours. That a 
 body becomes putrid so early in warm climates is not merely because 
 putrefaction is favored by heat, but because heat extracts the vital 
 power ; and often a part of the body has lost its organized power, 
 and is almost putrid, before the whole be dead. We find that we 
 often err in this, that when a body has lost all feeling and motion, 
 we pronounce it dead ; the nerves indeed, have ceased to act and 
 perform their office ; all feeling and consciousness is gone ; but the 
 mere animal power survives the nerves, and through it the whole 
 system may be recalled into perfect life ; as after suffocation or 
 drowning, we can by operating upon these poor remains of life, re- 
 store the circulation, reanimate the nervous system, and recover that 
 life which seemed to have left the body. 
 
 The powers of the nervous system ought, however, to be justly 
 estimated. The perfect animal feels and moves by means of 
 the nerves, which at the same time convey the dictates of the 
 will to the voluntary muscles, and unite every part into a perfect 
 whole. But the muscles themselves are governed by laws of their 
 own. The heart of the chick begins to move before We dare pre- 
 sume that there is any organ for distributing this nervous power. 
 The punctum saliens is the heart of the chick ; it is seen beating 
 while the body of the chick is but a rude, unformed, and gelatinous 
 mass ; daily the active centre increases in strength and power ; and 
 it has a delicate feeling of stimuli, so that it quickly reacts, when 
 they are applied to it. Its motions are excited by increased heat 
 and languish when cold, till at last it dies. Then it ceases to act, 
 but still heat restores it to life ; and again, when we cut out the 
 heart of a grown animal, so as to separate it from the nervous influ- 
 6 
 
82 ANATOMY AND PHYSIOLOGY. 
 
 ence, it will for some time act on the application of stimuli, then 
 appearing to have its power exhausted, it will lie dead for a while, 
 till recovering that power, it will again act. 
 
 Sensibility, therefore, depends upon the nerves ; but motion, 
 upon the muscles. Both are equally admirable and inscrutable ; the 
 one conduces to all the enjoyments, and all the sufferings of life, 
 and to the intellectual faculties of man ; the other is the chief sup- 
 port of animal life, and the source of all the bodily powers. And 
 here we cannot refrain from contemplating this living power. The 
 genius of man has invented pulleys and levers to accelerate motion ; 
 and has enabled him even to anticipate all the mechanical helps 
 which he has found in the mechanism of the human body. But, 
 compared to the lowest creature, animated with the living principle, 
 the proudest works of his hands are but as dead matter. In the 
 most perfect machines no new power is acquired ; if there is any 
 acquisition of force, there is a proportionate loss of time ; while in 
 muscular contraction, which is the immediate source of power in 
 animals, there is a real increase of power without any loss of time. 
 
 THE BKAES" AND NEBYES. 
 
 1. THE BRAIN. 
 
 We now come to those organs which endow the human body 
 with feeling ; cause all the voluntary motions ; and afford a fit 
 residence for the soul. We shall first describe them anatomically, 
 and afterwards speak of their nature and properties. 
 
 The brain is a soft pulpy mass of a whitish color on the inside, but 
 grayish exteriorly. It occupies all that cavity which is formed by the 
 bones of the skull ; and is surrounded by two membranes ; the first 
 or outermost of which is called the dura mater, w T hich lines the inside 
 of the skull, and prevents its eminences from giving injury to the 
 delicate structure of the brain. This membrane also serves another 
 useful purpose ; it helps to prevent concussions of this organ ; for, 
 sending off large folds which enter between the divisions of the 
 brain, it separates the whole mass into portions, which by its parti- 
 tions it supports and protects from pressure, in the different motions 
 and positions of the head. Three of those partitions are considera- 
 ble. The first commences at the inside of the forehead, and run- 
 ning along the roof of the skull, descends to about the centre of the 
 
BRAIN, SPINAL COED, AND NERVES. 
 
 83 
 
 EXPLANATION OF FIGURE II. 
 
 This Plate shows the Nervous System ; consisting of the Brain, Spinal Cord, and Nerves. The brain 
 gives origin to nine pairs of nerves; and the spinal cord, connected with the brain, gives off thirty-one 
 pairs. There are, properly, two brains: the large brain, occupying the upper and front part of the skull, 
 Ind the small brain which occupies the posterior and base of the skull. 
 
 A. A. The two halves of the Large Brain. 
 
 B. B. The two halves of the Small Brain. 
 
 F. F. Spinal Cord, joined to the Large Brain. 
 O. Branches of the Fifth Nerve going to the face, teeth, and eye. 
 E. Fivejierves forming the Brachial Flexus, and going to supply the arms and hands. 
 W. Branches of the Dorsal, or Nerves of the Back. Those near the lower F. are the Nerves of th« 
 Loins. 
 
 H. Sacral Nerves, going to the thighs, legs, and feet. 
 
Si ANATOMY AND PHYSIOLOGY. 
 
 back-part of the head. It divides the upper part of the brain into 
 two great portions, called hemispheres. The second partition runs 
 horizontally, or nearly at right angles with the first, whose termi- 
 nation it receives at its middle ; and, extending itself towards each 
 ear, it divides the brain into the upper and under parts, thus form- 
 ing a floor for sustaining the former. The third fold runs down 
 from the middle of the second, opposite to where the first ends, and 
 separates the posterior part of the brain also into two divisions. 
 This membrane is strong and of a tendinous nature. Like all other 
 membranes of the body, which are only intended to perform sub- 
 servient offices for the living parts, it is insensible ; being like them 
 composed of cellular membrane ; and it may be cut, rasped, or torn, 
 without giving pain. It adheres closely to the inside of the skull, 
 by a great number of filaments, and small vessels, which enter the 
 bones everywhere, and communicate with the membrane covering 
 the skull. 
 
 The second membrane of the brain, called pia mater, is a soft, 
 thin, transparent substance, and full of vessels. It is connected to 
 the former only by the veins which pass between them, and lies in 
 immediate contact with the surface of the brain, not only covering 
 this delicate organ on the outside, but also insinuating itself into all 
 its windings and fissures for the conveyance of vessels, and nourish- 
 ment; to supply the wastings of this active intellectual machine. 
 Between these two membranes there is spread a third, which is ex- 
 tremely delicate, resembling a cob- web ; but it does not dip into the 
 convolutions of the brain. 
 
 Because the folds of the outer membrane of the brain dip deeply 
 into its substance, anatomists pursue this division in their descrip- 
 tion. Hence, although all the parts of the brain unite at the centre 
 of its base, they describe it as consisting of three great portions. 
 
 The first, called the cerebrum, is the largest of the three divisions. 
 It occupies all the space above the horizontal floor of the dura mater, 
 and is separated into two great parts, called, as we before observed, 
 hemispheres. Each hemisphere is again divided into three parts 
 called lobes, and has several winding furrows on its surface. The 
 substance of the cerebrum is grayish on the outside, but is white 
 and firmer in texture within. 
 
 The cerebellum, or second division of the brain, lies under the 
 former floor at the under and back part of the skull, and is also 
 divided into two portions by the third or descending fold of the dura 
 mater. It consists, like the first division, of a grayish and white 
 substance ; and has each portion or half, again divided into three 
 bodies, but lacks the furrows on its surface. 
 
SPINAL COED. NERVES. SENSIBILITY. 85 
 
 The third division is called the medulla oblongata. It lies at 
 the base of the skull, and is a continuation or union of the white 
 substances of the other two divisions ; being like these of a white 
 color, and its consistence more firm than that of the grayish portion 
 of the brain. 
 
 2. SPINAL CORD. 
 
 The spinal marrow, as it is called, is a continuation of this third 
 division of the brain ; it passes out of the head by the great opening 
 of the skull, and running down the canal of the back-bone, where 
 it is safely lodged, throws off nerves, till it reaches the pelvis, where 
 (as was before said, when describing those parts) it separates into 
 numerous thread-like nerves, resembling a horse's tail. The spinal 
 marrow, like the brain, consists of a whitish and a grayish substance, 
 and is covered and protected by a continuation of the membranes 
 belonging to that organ. 
 
 3. NERVES. 
 
 The nerves arise from the brain and spinal marrow. They come 
 out in pairs, and are distributed over the whole body. Forty pairs 
 are counted in all. Of those, nine pairs arise from the base of the 
 brain within the skull; a tenth from the brain, as it passes through 
 the great hole of the skull into the spine ; and the remaining thirty 
 from the spinal marrow. Those arising from the brain pass through 
 holes in the base of the skull, and are distributed chiefly to the organs 
 situated in the head, and to those contained in the chest and belly; 
 while the nerves which arise from the spinal marrow go, partly, 
 among the internal organs of the trunk, to be distributed principally 
 to the exterior parts of the body, and to the extremities or limbs. 
 All the nerves arise, first by medullary (or marrow-like) fibres, 
 which afterwards meet, and form soft, white, pulpy cords. These 
 cords run out in pairs from their origin ; but soon afterwards sepa- 
 rate, and spread themselves over the whole body, by dividing into 
 innumerable branches. 
 
 1. SENSIBILITY. 
 
 The brain and nerves constitute the organs of sensation in the 
 animal machine, and are 
 
 THE SOURCE OF SENSIBILITY TO OTHER PARTS. 
 
 All the other parts of the body derive their capability of sen- 
 sation from the brain, the spinal marrow, and the nerves, being in 
 
86 ANATOMY AND PHYSIOLOGY. 
 
 themselves wholly insensible and incapable of feeling save as they 
 have the nervous branches distributed to them. 
 
 That this is the case, is proved by the fact that if a nerve going 
 to any part be tied, that part becomes immediately paralytic and 
 insensible below the ligature, but will recover its powers on liber- 
 ating the nerve. 
 
 The same thing is also proved by the fact that the degrees of 
 sensibility of the different parts of the body are in proportion to 
 the quantity of nervous branches which can be discovered to belong 
 to such parts. Thus, while in some places we find a conflux of 
 nerves forming the most delicate and perfect sense, and endowing 
 that part with full life, there are other parts of the body, as the 
 bones, cartilages, ligaments, and tendons, which, while they are 
 almost destitute of nerves, are so insensible as to be cut, torn, or 
 even totally destroyed without exciting pain. 
 
 2. SOURCE OF VOLUNTARY MOTION. 
 
 The excitement to all voluntary motion flows from the. brain or 
 spinal marrow, through the medium of the nerves, to those parts of 
 the body which we wish to move. 
 
 That the immediate cause of all voluntary motion is the brain 
 and spinal marrow, is seen by the fact that when the brain is seri- 
 ously injured power of motion in the body is often lost. 
 
 If, for instance, the brain be compressed, either from a rush of 
 blood, or water, or from other mechanical causes, the whole body 
 will become paralyzed, and the power of motion suspended ; but, on 
 removing the compressing cause, this paralysis will cease, and the 
 whole frame will recover its power of sense and motion. 
 
 Compression of the spinal marrow will also cause loss of motion 
 and sense, but only in those parts which receive their nerves from it, as 
 the external flesh of the trunk of the body, and muscles of the limbs. 
 
 And if a nerv r e which conveys the immediate cause of motion 
 from the brain, or spinal marrow, to the parts to be moved, be 
 either cut or tied, or otherwise compressed, the part to w T hich this 
 nerve is distributed will immediately become insensible, and lose 
 its power of motion. Thus injuries of particular nerves produce 
 palsy of the parts to which those nerves are sent ; as loss of voice, 
 hearing, and speech ; but on removing the cause, the disabled parts 
 will recover their functions. 
 
 3. SEAT OF SENSATIONS. 
 
 The nerves are the organs and the brain the receptacle of all our 
 sensations. 
 
SEAT OF SENSATIONS. 87 
 
 That sensation arises from an impression made on a nerve and 
 conveyed by it to the brain, is proved by the following facts. 
 
 If a nerve be in any way irritated, a sharp sense of pain is im- 
 mediately produced. The mind in the brain becomes instantly in- 
 formed of the suffering, and efforts are made to relieve the part. 
 But if that nerve be compressed above the seat of its irritation, so as 
 to cut off the channel of communication between it and the brain ; 
 the mind is then no longer conscious of any irritation that is made 
 below the point of compression ; and the affected parts are reduced 
 to a state of insensibility similar to that of parts which are destitute 
 of nerves, and may be cut or destroyed without exciting pain. But, 
 by removing the compression from the nerve, the parts below will 
 recover their sensibility ; the irritation will be felt anew ; and the 
 sensation of pain again propagated along the nerve to the brain, to 
 inform the mind of the presence of an injury. 
 
 The reader should be here informed that each nerve issuing from 
 the spinal marrow is divided into two distinct parts, or branches ; 
 each of which has its own special office. The anterior branch im- 
 parts motion ; the posterior branch, sensation. Thus the cutting, 
 or compressing by ligature, of the one, will paralyze the power of 
 motion at that point in the system which it is designed to serve. 
 The other, treated in the same manner, will fail of its office of 
 sensation. 
 
 While the power of sensation is destroyed by the one operation, 
 that of motion remains. ' So, while the power of motion is destroy- 
 ed by the operation, that of sensation remains. 
 
 JSTow, pain is only the result of an impression made to excess ; 
 that is, a set of disagreeable sensations, produced by the too forcible 
 contact of bodies with the organs of sense. It is wisely implanted 
 in the human system to guard it against injury; for without it, the 
 delicate structure of our frames would be almost continually liable 
 to destruction from various bodies in nature around us. But as 
 pain is the salutary consequence of excessive, so sensations without 
 pain are the results of a due impression on our sensitive organs, 
 from the objects which are calculated to influence us ; and as long 
 as the body remains in health in all its parts, these impressions will 
 continue to cause sensations in the nerves ; which, on their part, 
 will forward them to the brain, where ideas of the nature and 
 properties of the impressing objects will be instantly formed for the 
 instruction of the mind. Thus the skin and other parts possessed 
 of what is generally called feeling, will be susceptible of touch, and 
 communicate to the mind in the brain, the sensations of the hard- 
 ness or softness, the roughness or smoothness, &c, of such bodies 
 
SS ANATOMY AND PHYSIOLOGY. 
 
 as may be brought in contact with it ; while the organs of the other 
 senses, as the eye, ear, nose, and palate, being differently and more 
 highly organized than the skin (though deriving their sentient 
 powers from the same source as the latter, namely, the nerves), are 
 enabled, by their regular structure, to receive different kinds of 
 impressions, each according to its properties and conformation. 
 The eye will be impressed from light, the ear from sound, the nose 
 from smell, and the palate from taste ; and by those various im- 
 pressions an extensive and varied knowledge will be transmitted to 
 the mind, in the brain, of the nature of the objects in correspond- 
 ence without. 
 
 That the brain not only collects, but also preserves the sensa- 
 tions to an indefinite length of time, is seen in the astonishing 
 strength of the memory of some individuals. 
 
 That the brain is the seat of ideas any one may convince him- 
 self, by shutting his eyes for a moment, to exclude the influence of 
 present objects, when he may figure in his mind the exact likeness 
 of some dead or absent friend, of a favorite horse or dog, or of any 
 other familiar object. 
 
 RELATION OF MIND TO MATTER THE BRAIN THE ORGAN OF THE 
 
 MIND. 
 
 Although the relation of matter to spirit is one that has engaged 
 the attention of philosophers from the earliest ages, it was not until 
 quite recently that we were able to prove even approximately that 
 the brain was the material organ through which the soul acts. In 
 the time of Plato and Aristotle, dissection of human bodies was a 
 crime ; and even within the last twenty -five years, it has been looked 
 upon with disfavor by legislators and by the people. But in spite 
 of prejudices and opposition, physiologists have persevered in their 
 labors, and after centuries of study over the bodies of men and of 
 the lower animals, supplemented by the close and partial researches 
 of modern theorists and microscopists, we are now able to state 
 with positiveness that the brain is the organ of the mind, just as 
 decidedly as that the digestive apparatus is the organ of digestion. 
 Although investigations on this subject have not ceased, are indeed 
 yet in the height of their activity, it is yet sufficiently demonstrated 
 that the mental, moral, and emotional nature of any being depend 
 on the quantity and quality of his brain. 
 
 By quantity of the brain, I mean its weight in pounds and 
 ounces; by quality, I mean the character of its structure — whether 
 fine or coarse, simple or complex, and so forth. Brains that are of 
 
THE BRAIN THE ORGAN OF THE MIND. 89 
 
 the same size and weight may differ very widely in the number of 
 their folds or convolutions, the relative proportion of white and gray 
 matter, the number and shape of their cells or fibres, and in their 
 intimate chemical structure. All these factors taken together make 
 up what I term the quality of the brain. 
 
 The conclusion that the immaterial part of our nature acts 
 through the substance of the brain, and in the character of its mani- 
 festations depends on the quantity and quality of the cerebral sub- 
 stance, is mainly derived from the following arguments : 
 
 1. From the comparative anatomy of man and animals. — From 
 those types of animals in which the cerebral hemispheres begin to 
 appear, through all the grades — fish, birds, dogs, horses, apes, go- 
 rillas — up to the creation of man, we find that the intelligence bears 
 a decided relation to the quantity and quality of the brain. (See 
 the chapter on Man Compared with other 'Animals.) 
 
 The relative size of the brain, as compared with the body, is also 
 an important factor in estimating the intelligence. The whale and 
 the elephant are the only animals that have larger brains than man. 
 But the brains of these animals are far inferior in quality to those 
 of man, are moreover of less relative weight, and therefore have far 
 less capacity for manifesting intelligence. The brains of gorillas 
 and of the man-like apes — the most intelligent orders of animals 
 below man — are inferior to the human standard not only in quality, 
 but also in quantity. The most intelligent apes or gorillas have 
 less weight of brain than the average of human idiots. 
 
 2. From the comparative anatomy of the different races. — The 
 contents of the cranial cavity are determined in two ways — by 
 weight and by measurement in cubic inches. The lamented Dr. 
 Morton, who devoted a laborious lifetime to this investigation, found 
 the cranial capacity of the Germans, English, and Anglo-Americans 
 to be 92 cubic inches ; of the Celtic, 87 cubic inches ; of the Malays, 
 85 cubic inches ; of the Chinese, 82 cubic inches ; of the American 
 negro, S3 ; of the American Indian, 84; of the Toltecan Indian, 77; 
 of the Hottentots and Australians (the lowest) 75 cubic inches. It 
 will be observed that these measurements correspond to the relative 
 intelligence of these races as recognized by history. 
 
 Dr. J. B. Davis, Tiedman, Dr. Ira Russell, and other observers, 
 both in this country and in Europe, have arrived at substantially the 
 same conclusions as Dr. Morton, though by comparing the weight 
 rather than the cubic measurements of the brain. From the re- 
 searches of Dr. Bussell it would seem that when negroes and whites 
 amalgamate, the weight of the brain tends to diminish below the 
 standard of the black race. 
 
90 ANATOMY AND PIIYSIOLOGY. 
 
 3. From ths comparative anatomy of the sexes. — Women have 
 on the average five ounces less brain than men. This difference in 
 quantity is to a certain extent made np by the superior quality of 
 the feminine brain. Women are usually more finely organized than 
 men. High organization is generally accompanied by a corre- 
 spondingly fine quality of brain. A moderately sized brain of a 
 fine quality is oftentimes far superior, particularly in special apti- 
 tudes, to a larger brain of coarse quality. Therefore woman, though 
 more or less subject to man, is oftentimes his equal, and in some 
 particulars incomparably his superior. 
 
 4. From the comparative anatomy of individuals in the various 
 grades of intellectuality. — The brains of really great men are always 
 superior to those of average humanity, in quality or quantity, or in 
 both. The brain, of Daniel Webster measured 122 cubic inches, and 
 the gray matter, on which thought more particularly depends, was 
 of remarkable thickness. The brain of Cuvier was also remarkably 
 large. It is probable that in coming time chemistry and the micro- 
 scope will be able to detect even the very minute shades of differ- 
 ence between the various orders of intellect simply by microscopi- 
 cal and chemical examination of the brain after death. 
 
 5. From the fact that morbid changes in the brain ahcays acco?n- 
 pany mental disease, such as idiocy and insanity. — It is only quite re- 
 cently that physicians have been able to say with certainty that every 
 case of absolute insanity is caused by some disease of the brain. From 
 the researches of Prof. Schroeder Yan der Kolk, who has devoted 
 over a quarter, of a century to this subject, and also of other observers, 
 it is clear that there can be no mental disease, without some corre- 
 sponding morbid change in the brain. Careful and repeated obser- 
 vations have also shown that the percentage of phosphorus is less in 
 idiots than in the healthy, less in infancy and the decline of old age 
 than in adult life. It has also been ascertained that other constituents 
 of the brain are more or less modified by disease either in quantity 
 or quality. It is logically probable, though not directly established, 
 that the slightest forms of mental disease, the mildest stages of idiocy, 
 hypochondriasis, melancholy, dementia, or imbecility are but the symp- 
 toms and results of correspondingly slight morbid changes in the brain. 
 
 On the other hand it is well established that there can be no im- 
 portant injury of the brain without a corresponding impairment of 
 the intellect. Excess or deficiency of blood in the cranium, pressure 
 of pieces of bone, or other foreign substances on the brain, the con- 
 cussion of a blow or fall, will cause either temporary or permanent 
 injury to the mind, such as is not observed when other parts of the 
 body are similarly affected. 
 
THE BRAIN THE ORGAN OF THE MIND. 91 
 
 There are degrees and stages in the diseases of the brain, just as 
 there are degrees and stages of the diseases of any other organ, and - 
 the conclusion is logical and inevitable, that the slightest forms of 
 mental or nervous derangement are but the symptoms and expres- 
 sions of corresponding slight disturbances of the central nervous 
 system. The present prospects are that the microscope and 
 chemistry will establish this question beyond a doubt. On the 
 other hand it is established, by logical probability, that disease 
 of any other organ, however severe or long-continued, never 
 produces mental derangement without first inducing disease of the 
 brain. 
 
 6. From our knoivledge of the minute anatomy of the brain as 
 revealed by the microscope and chemistry. — According to Lockart 
 Clarke — a high authority on this subject — the convolutions of the 
 human brain consist of eight distinct concentric layers. These are 
 formed of very fine fibres, and of cells in an infinite variety, lying 
 very closely together. Under a very close examination it is seen 
 that there are an infinite number of communications between an 
 infinite multitude of cells, of an infinite variety of forms. These 
 cells vary in diameter between the ^ \ to -g-^-g- of an inch, and in 
 shape may be pyramidal, pyriform, triangular, round, oval, or fusi- 
 form. 
 
 Macaulay finely compares the mind of Bacon to the tent which 
 the fairy Peibanon gave to Prince Ahmed, " Fold it, and it seemed 
 the toy for the hand of a lady ; spread it, and the armies of power- 
 ful sultans might repose beneath its shade." 
 
 In view of what is now known of the wonderfully complex ana- 
 tomy of the human brain, we see that this happy comparison may 
 with full justice be applied to every intelligent being. 
 
 Chemistry has shown that the proportions of the solid constitu- 
 ents of the brain, and especially of phosphorus, vary with the 
 intelligence in different individuals, and in the same individual at 
 different epochs of life, being least in infancy and the decline of old 
 age, and greatest at maturity. 
 
 7. From the fact that after intellectual labor an increase of 
 alkaline phosphates is detected in the urine. — We have already 
 stated that phosphorus is an important constituent of the healthy 
 brain. We believe that all of our physiological psychologists would 
 substantially endorse the bold declaration of a recent German 
 writer, " ohne Phosphor kein Gedanke " — no thought without phos- 
 phorus. 
 
 The- phosphates that are found in the urine after intellectual 
 labor are the products of the metamorphosis of the tissues of the 
 
y^ ANATOMY AND PHYSIOLOGY. 
 
 brain. Dr. II. Byasson, in a recent pamphlet on this subject, 
 states, that " Provided a man should be subjected for three days to 
 a uniform diet, and placed under nearly similar external circum- 
 stances, it would be possible to determine, by analysis of urine 
 alone, which day had been passed in repose, and which had been 
 spent in physical or mental exertion." We hold that every intel- 
 lectual act, from the meanest to the most exalted, is attended by 
 a corresponding metamorphosis of nerve-tissue. It has been found 
 by chemical analysis of the extractives of nerves that their func- 
 tional activity is accompanied by definite change or waste of tissue, 
 closely resembling that which is observed in muscles after they 
 have been thrown into activity. 
 
 The logical conclusion is inevitable, that for all the phases of 
 intellectual activity — the cool calculation of the man of sense and 
 the wild frenzy of the poet — the hate of the ruffian and the affec- 
 tion of the maiden — for the lightest whisper of fancy, and the 
 weightiest toil of reason — for the oath that falls from the reprobate 
 and for the prayer that breathes from the heart of the devotee — for 
 all thought, all will, all emotion, there is a corresponding change 
 and waste of tissue in the brain, of which the mind is the func- 
 tion. 
 
 8. From the facts already established in regard to the Correla- 
 tion and Conservation of Forces (see chapter on " Life "). — The 
 known and familiar forces — light, heat, electricity, magnetism, and 
 motion — are correlated to each other, and, so far as experiments are 
 able to show, no force is ever annihilated. From these known facts, 
 that to a certain extent are visible to sense-perception, we may rise 
 toward the unknown, and by logical probability we may arrive at 
 the grand conception that the soul of every man is correlated to all 
 the other known forces of the body — heat, electricity, magnetism, 
 nervous force, and motion — and that the Creator himself is corre- 
 lated to his entire creation. 
 
 This theory harmonizes with our intuitive ideas in regard to the 
 immortality of the soul and the existence of a God. If none of the 
 forces are ever annihilated, but are correlated to and persist in each 
 other, the soul, if it be correlated to the other forces of the body, 
 can never oe annihilated, hut must oe immortal. For the same rea- 
 son God himself must be eternal. 
 
 We already know that the human body contains several forces 
 that are correlated to each other. Why may it not contain other 
 forces still ? Beside electricity, magnetism, heat and motion, why 
 may it not contain nervous force and a soul, and why may not all 
 be correlated to each other % According to Prof. Helmholtz, it ap- 
 
THE BRAIN THE ORGAN OF THE MIND. 93 
 
 pears that the rate of travel of the nervous force can be measured 
 with perfect accuracy. He has ascertained, by means of the chro- 
 noscope, that the rapidity of the nervous force varies in different 
 individuals, but that its average speed is 97.1 feet a second ; in the 
 active and nervous it moves more rapidly than in the cold and 
 phlegmatic. Those experiments may lead to important discove- 
 ries. 
 
 This doctrine, and the facts of the correlation and conservation 
 of forces, are of vast import and of profound significance. 
 
 9. From the observed facts of our common, every -day experi- 
 ence. — Every studious school-boy knows that after working hard 
 and long over any knotty problem, the head becomes more tired 
 than any other portion of the body. When we wish to recall an 
 idea or to start a train of thought, how often do we involuntarily 
 scratch the head or rap the brows. The common expression, " the 
 eyes are the mirrors of the soul," is as true scientifically as it is 
 metaphorically. The optic nerve which expands on the retina 
 comes directly from the central nervous system, and is in fact a 
 process of the brain itself. Therefore the eye becomes necessarily a 
 revealer of the inmost workings of the brain — of the secret thoughts 
 and emotions that we would not presume to speak of with our lips 
 — and even of those feelings and sentiments that we most earnestly 
 strive to conceal. All persons who are subject to headache know 
 that it interferes with the intellectual processes far more than most 
 severe pain in any other part of the body, and in some cases renders 
 mental exertion impossible. 
 
 That alcohol, opium, hashish, and other poisons which affect the 
 brain, also craze or stupefy the intellect ; that all fevers which, as 
 the expression is, " go to the brain," render the patient delirious or 
 positively unconscious; that starvation of the body enfeebles or 
 destroys the intellect — all these corroborative proofs of the depen- 
 dence of mind on matter are so familiar that they hardly need to be 
 mentioned. 
 
 The essential conditions for a good memory are these three : 
 
 1. Natural endowment of brain. — There are as many differ- 
 ent kinds of memory as there are different kinds of talent among 
 men, and all are as much dependent on the brain for their existence 
 as digestion is dependent on the apparatus of digestion, or respira- 
 tion on the lungs. 
 
 The intellect is the function of the brain. Memory is one of the 
 faculties of the intellect. Therefore memory is one of the functions 
 of the brain, and in its quantity and quality must correspond to the 
 quantity and quality of the cerebral substance. 
 
94: ANATOMY AND PHYSIOLOGY. 
 
 2. Careful and special training. 
 
 3. A healthy brain. — The soul acting on the brain produces 
 memory, and all the other faculties of the intellect, just as when 
 acting upon the digestive organs it produces digestion. 
 
 If the organs of digestion are sound, the digestion will be good, 
 though all the rest of the body is saturated with disease. Just so, 
 if the brain be sound, the memory will be good (so far as its natural 
 or acquired capacities will admit), even though every other organ 
 of the body is in a morbid condition. 
 
 It is true that disease of any part of the body may impair the 
 digestion, but only by sympathetic or reflex action, and probably 
 not until it has communicated a morbid condition to the organs of 
 digestion. Just so, disease Of any part of the body may impair the 
 memory, but not until by sympathetic or reflex action it has given 
 rise to some morbid condition of the brain. 
 
 There is no question that the word " functional," which at best 
 is a mere cover for our ignorance, must in time be gradually dis- 
 carded as that ignorance grows less. 
 
 The lungs may be hollowed by wasting tubercles, the liver may 
 be eaten by cancer, the function of digestion may be attended with 
 perpetual distress, and the conscience may be harrowed by remorse, 
 or seared as with a hot iron, and yet the memory and all the other 
 faculties of the intellect remain clear and unimpaired. 
 
 On the other hand, the slightest effusion of blood in the brain, 
 and even a congestion or molecular disturbance of the hemispheres, 
 may destroy the entire memory, or some special phase of it, for a 
 lifetime. 
 
 Coleridge says that a " sound logic, healthy digestion, and a 
 quiet conscience, are the proper conditions of memory." 
 
 This remark of Coleridge was recorded in the times of men's 
 ignorance, and is not worthy of our day, nor of modern science. 
 As a scientific explanation it is of about as much value as the semi- 
 witticism that Emerson quotes so approvingly : The man who has 
 a diseased liver is a Presbyterian, while he in whom this organ is 
 healthy is a "Unitarian. These generalizations are the relics of dark 
 eras, when even physicians did not know whether the intellect was 
 located in the head or in the abdomen, and when diseases of the 
 organs of digestion were supposed to be the direct causes of diseases 
 of the mental, moral, and emotional nature. 
 
 It is only indirectly, and probably by first inducing disease of 
 the brain, that indigestion can affect the memory, or any of the in- 
 tellectual faculties. 
 
PHRENOLOGY. 95 
 
 PHRENOLOGY. 
 
 In the light of these facts, we find it a not very difficult task to 
 distinguish the true from the false in what is commonly known as 
 Phrenology. Cranioscopy, or the examination of the head, informs 
 us with considerable accuracy of two particulars only. 
 
 In the first place, it informs us of the quantity of the brain. 
 Although in some exceptional cases the skull is developed out of 
 proportion to the cerebral substance — although in some few cases 
 of disease the size of the head gives no indication of the size of the 
 brain, and although the frontal sinuses interfere very seriously with 
 the examination of a certain limited portion of the forehead, yet it 
 is unquestionably true that, as a rule, the exterior surface of the 
 skull corresponds to the quantity of the cranial contents. 
 
 In the second place, Oranioscopy informs us in regard to the 
 relative development of the different regions of the brain. Al- 
 though the divisions and subdivisions of the head that have been 
 mapped out by phrenologists, and about which charlatans talk 
 and lecture, are far from being scientifically demonstrated, yet it 
 is now quite generally conceded among those who have given spe- 
 cial attention to this subject that the anterior lobes of the brain 
 are the organs of the pure intellect and reason, the posterior lobes 
 of the passions and propelling powers, and the upper portion of the 
 moral faculties. It is furthermore conceded that it is entirely prob- 
 able and consistent with analogy, and with what we know of the 
 brain, tJmt its various faculties may all be separately localized to 
 even a greater 'extent than has been claimed by phrenologists. 
 
 On the other hand, examination of the exterior of the head 
 gives us no information whatever in regard to two vitally important 
 factors, a knowledge of which is indispensable when we attempt to 
 estimate character by the study of the brain. 
 
 First : it does not inform us in regard to the quality of the brain. 
 The intellect depends on the number and depth of the convolutions, 
 the thickness of the gray matter, the number and shape of the cells 
 and the method of their arrangement, and also on the nature of the 
 cerebral substance — in a word, on all those elements that make up 
 what I call the quality of the brain. It is obvious that examina- 
 tion of the head can give us no information in regard to these ele- 
 ments of quality, upon which the intellect depends as much as on 
 the quantity, and in special aptitudes even more. 
 
 Secondly : examination of the head does not tell us how much a 
 brain has been educated and trained. A small brain that has been 
 long and elaborately disciplined, that has been stored with know- 
 
96 ANATOMY AND PHYSIOLOGY. 
 
 ledge and fortified b} r experience, that has acquired tone and vigor 
 and elasticity by systematic activity, through a responsible and in- 
 dustrious lifetime, may be, and often is, far superior in every intel- 
 lectual attribute to even a very large brain that has been suffered to 
 vegetate in ignorance and inactivity, that has never been trained to 
 bear responsibility, to originate thought or to experience emotion. 
 It is true that education and the discipline of activity do cause the 
 brain to grow in size, and therefore to make the skull larger, but 
 only within certain limits. The brain, in this respect, follows the 
 analogy of the muscles, but probably to a less degree. 
 
 If the human arm were covered with unyielding bone, like the 
 brain, we could judge no more of its muscles by exterior examina- 
 tion than we now can of the brain. We could ascertain the size of 
 the arm, and the relative size of its main divisions. But of the 
 quality of the arm — whether muscle or fatty matter, coarse or fine, 
 flabby or wiry — of the extent of training, gymnastic or pugilistic, 
 to which it had been subjected, exterior examination could teach us 
 little more than it can of the brain. 
 
 It is manifest, therefore, that Cranioscopy must be a veiw un- 
 certain method of ascertaining character. It must necessarily teach 
 more of error than of truth. It is in the very nature of things im- 
 possible that it should ever become an exact science. Even if future 
 investigations should entirely confirm what has been so long as- 
 sumed, in regard to the localization of special faculties — which is 
 by no means impossible — yet, for the reasons already given, Crani- 
 oscopy can never rise to the dignity even of an approximately exact 
 method of determining character. No advance in science can ever 
 make it possible to ascertain the quality of the brain, or the amount 
 of culture it has received, from external manipulation of the skull. 
 
 But though Phrenology must, in the very nature of things, ever 
 be unmathematical and uncertain in its teachings, it is yet worthy 
 of attention, chiefly because of what it suggests on this important 
 theme, of the relation of mind to matter. In connection with 
 Physiognomy — which, from the anatomical fact of the direct con- 
 nection of the face with the brain by numerous and complicated 
 nerves, is our best method of studying the character — and also with 
 the science of Physiology, it becomes a most valuable and sugges- 
 tive aid to the metaphysician, the man of the world, and the philo- 
 sopher of human nature. 
 
 The fact of the dependence of the mental, moral, and emotional 
 nature on a material organ, in no way destroys or modifies 
 human responsibility. Man is just as much a free moral agent 
 whether his mental and emotional nature depend on a single mate- 
 
TUBER ANNULARE. 97 
 
 rial organ like the brain, or the system at large, as Hamilton believes, 
 or on no visible or tangible* medium whatever. As a matter of ex- 
 perience, we all know that men differ in their mental and moral 
 endowments just as they differ in their physical capacities ; — that 
 there is even a wider range in the powers of thought and feeling 
 among different individuals and races of men than in their physical 
 endurance and muscular strength ; — that every man is as free to 
 think and to feel as he is to act and to move, and is morally respon- 
 sible according to the extent of the capacity of his mental and 
 emotional, as of his physical powers. 
 
 FUNCTIONS OF SPECIAL PORTIONS OF THE BRAIN. 
 
 The cerebrum is the organ of the intellect. It is an interesting 
 fact that it is not sensitive to pain from cutting or lacerating. The 
 cerebellum is now supposed to be merely " an additional generator 
 of nervous power , — a ganglion to be added to the cerebrum, and per- 
 forming analogous offices in the economy" 
 
 This is the view taken by Dr. Hammond, in a paper recently 
 published on this subject. It was formerly supposed that the cere- 
 bellum was the organ of amativeness. This was the view of Gall, 
 the founder of Phrenology. 
 
 Then, again, the cerebellum was regarded as the seat of co-ordi- 
 nating power. That view also has been abandoned. 
 
 Numerous experiments have been made on animals with a view 
 to settle this question, and yet it remains undecided. 
 
 It may here be remarked that many of the conclusions of 
 Physiology have been derived from experiments made on animals. 
 It is, however, erroneous to suppose that animals are always tortured 
 by these experiments. 
 
 Since the discovery of the anmsthetic properties of ether and chlo- 
 roform, it is possible to experiment freely on animals without inflict- 
 ing pain. If Mr. Bergh, the noble President of the Society for the 
 Prevention of Cruelty to Animals, had been as well informed in mat- 
 ters of science as in questions of philanthropy, he would never have 
 attempted to interfere with the studies of physiologists. 
 
 TUBER ANNULARE. 
 
 This is the seat of will. Impulsive, instinctive, voluntary move- 
 ments have their seat in this ganglion. If we see a bull running 
 after us, we instinctively and without any process of reasoning 
 hasten to get out of the way. This attempt to escape comes from. the 
 
 tuber annulare. 
 
 1 
 
98 ANATOMY AND PHYSIOLOGY. 
 
 MEDULLA OBLONGATA. 
 
 This organ presides over "breathing or respiration. This function 
 is not under the control of the will. The cerebrum, the cerebellum, 
 and the tuber annulare maybe destroyed, and yet the breathing may 
 go on as well as ever. Destroy or injure seriously the medulla 
 oblongata and respiration is at once suspended. 
 
 Nature provides for the security of this organ by placing it 
 within and under the brain, so that it may be less liable to injury. 
 
 REFLEX ACTION OF THE NERVOUS CENTRES. 
 
 When an excitation is received by the nerves, at any part of the 
 body, the stimulus may be conveyed to the central nervous system, 
 and thence transmitted to some other portion of the body. This 
 is what is known by reflex action. This is the great fact with 
 reference to the nervous system. By this power it presides over 
 and regulates the whole body. The spinal cord has this power 
 above and without the aid of the brain. By means of this reflex 
 power of the nervous centres, injury or disease of one part may 
 give rise to disease of another. Many of our paralyses are caused 
 by reflex action. Little children often become paralyzed in an arm 
 or leg by reflex action from the irritation of worms in the bowels, 
 or from other causes. 
 
 6. DIFFERENT PARTS POSSESS DIFFERENT DEGREES OF SENSIBILITY. 
 
 Thus we see that the brain, spinal marrow, and nerves alone 
 constitute the sensitive or feeling part of the human system ; and that 
 all its other parts, being composed of matter totally insensible in itself, 
 are possessed of the capability of feeling only in proportion as they 
 receive the branches of nerves. Hence, there is a gradation of feel- 
 ing throughout the whole body, each of its organs and parts being 
 endowed with that precise degree of sense which will be sufficient 
 for the performance of its function in the living machine. The cel- 
 lular membrane, for instance, whose office it is to unite into one 
 whole all the moving parts of the system, is without feeling, being 
 insensible to stimuli. This also is the case with the coverings of the 
 brain, the coats of the nerves, the sheaths of muscles, of tendons, 
 ligaments, and all the apparatus of joints, together with the sub- 
 stance of the tendons and ligaments themselves; for these parts, 
 performing only subservient offices to the living organs, would 
 derange the whole system by being possessed of a sensibility which 
 would leave them no longer capable of bearing the friction, straining, 
 shocks, and blows which they now endure without injury in the 
 
DIFFERENT DEGREES OF SENSIBILITY. 99 
 
 different movements of the frame. The feeling of bones is decided. 
 They certainly do not send the sensation to the brain ; but in their 
 diseases, as in wounds of joints, &c, the great pain which the 
 patient suffers, evidently shows them to be then not insensible. 
 The muscles are all endowed with the sense of feeling, by a dis- 
 tribution of the nervous fibre everywhere throughout their sub- 
 stance. This is necessary to their office. As agents of voluntary 
 motion, they must be capable of receiving and obeying the commands 
 of the will ; and they are so. Hence, the mind no sooner wills an act 
 than the command flies along the nerve to the part to be moved, and 
 the action is instantly performed. This dispatch is illustrated in the 
 rapid movements of an opera dancer, every one of which were resolved 
 upon in the mind before they could have been executed by the feet ; 
 and at least as strikingly in the organs of speech, by which two 
 thousand letters can be pronounced in a minute, each requiring a 
 distinct and successive contraction of many muscles. The skin 
 possesses a finer degree of sense than the flesh, being fuller of nervous 
 branches ; and, rising in the scale of sensibility, may be said to form 
 the lowest of the organs of the senses. Feeling is the property and use 
 of the skin of the human body, which enjoys it over its whole surface, 
 but more exquisitely in some parts than in others. Thus, while the 
 greater part of the skin possesses it in a degree sufficient only to 
 guard the body from danger, by warning it of the contact of sub- 
 stances which might be injurious, there are other parts, as the palm 
 of the hand and sole of the foot, which are endowed with a greater 
 sensibility, so much as, on a slight friction, to create a tickling kind 
 of pleasure, and in some persons involuntary laughter. But this 
 sense exists in a higher degree at the points of the fingers, which, 
 from their convexity, are particularly adapted to be the organs of 
 touch. The tongue, the organ of taste, possesses this sensibility in 
 a higher degree still ; for though it judges of the substances which 
 constitute our food, by the same process as that used by the fingers — 
 namely, contact — yet the latter with their finest feeling would be 
 inadequate to discover bodies by their flavor. A step higher may be 
 ranked the organ of smelling. The nose is so acute in its sense, as to 
 be impressed by the light and volatile effluvia rising from bodies and 
 floating in the air, and can consequently distinguish substances at a 
 considerable distance. Higher again stands the sensitive faculty of 
 the ear. This organ is qualified to be acted upon by the mere vibra- 
 tions of the air, which, striking against this delicate part of our 
 mechanism, produce sounds, and afford us information of things 
 occurring at a great distance. But the most acute sense, and rank- 
 ing, perhaps, next to the more simple operations of the mind, is that 
 
100 ANATOMY AND PHYSIOLOGY. 
 
 of sight. The eye, the beautiful organ of this power, is a type of its 
 functions. In transparency, delicacy, and brilliancy it surpasses all 
 other parts of the body, appearing to lose the grosser characteristics 
 of animal matter, and to approach the nature of the mind, to which 
 it serves as the most useful, rapid, and extensive messenger for 
 procuring knowledge of the various objects around us. 
 
 Such is the varied distribution of sense which we see the brain 
 and nerve bestowing upon the other parts of the frame. "We are 
 familiar with its uses. We know the kinds of bodies which are 
 calculated to impress the different organs, and even the manner in 
 which those bodies effect their impressions. And further, we can 
 define and trace the limits of the senses themselves. For instance, 
 we can determine the extent of vision, hearing, &c. ; but, when we 
 ascend one step higher in our researches, and inquire into the inti- 
 mate structure of the brain and its operations, the more we are 
 lost in wonder and admiration of this astonishing part of our 
 system. 
 
 THE GREAT SYMPATHETIC NERVE. 
 
 The name has been given to a chain of nervous knots, or gan- 
 glia, which extend along the front and sides of the spine. These 
 ganglia or knots are connected by small fibres ; each one of them 
 is also connected with the nerves that come from the cerebro- 
 spinal system. The nerves of the great sympathetic are distributed 
 to the stomach, the kidneys, the liver, the intestines, the heart, and 
 other organs which are not under the control of the will. 
 
 There are four of these ganglia or knots in the head. One of 
 these is called the ophthalmic ganglion, and is situated in the orbit 
 of the eye. This nerve probably has something to do with sick 
 head-ache, for the pain in that affection is often felt through the 
 eye. One of the other ganglia is called the otic ganglion, and is 
 found near the base of the skull. This nerve has something to do 
 with hearing. 
 
 In the neck, the great sympathetic has two or three ganglia. 
 These are closely connected with each other, and with the spi- 
 nal cord. It has also ganglia in the chest, that connect with 
 the nerves that go to the heart and lungs, and ganglia in the abdo- 
 men that form the solar plexus, which is perhaps the most im- 
 portant part of the great sympathetic. In the pelvis the sympa- 
 thetic has also several ganglia. Two of these supply the genital 
 organs. 
 
 
FUNCTIONS OF THE SYMPATHETIC NEEVE. 101 
 
 All these ganglia are connected with each other, with the cere- 
 brospinal system, and with the internal organs of the body. 
 
 FUNCTIONS OF THE SYMPATHETIC NERVE. 
 
 We know much less of this sympathetic system than of the 
 cerebro- spinal axis. There are great difficulties in the way of 
 studying it. 
 
 There are three kinds of reflex action that are produced by the 
 sympathetic system. 
 
 1. From the internal organs to the surface and to the muscles. 
 — It is through the sympathetic system that indigestion, constipa- 
 tion, diseases of the liver, worms, and so forth, cause convulsions 
 in children and that the same diseases produce headache in grown 
 people. 
 
 The truth probably is, that most of our headaches and back- 
 aches are caused by the reflex action of this sympathetic system. 
 
 2. From the surfaces and extremities to the internal organs. 
 — We all know by experience that wet feet cause us to take cold, 
 often bring on a headache, or an attack of diarrhoea. 
 
 Mental and moral emotions, fear, joy, and so forth, affect the 
 stomach, the liver, and the heart through the sympathetic. 
 
 It is the sympathetic system that causes us to blush. It may be 
 said in general, that those who blush easily and deeply have a 
 sympathetic system of peculiar sensitiveness. The sympathetic 
 system is more sensitive in women than in men, in the finely or- 
 ganized than in those of an opposite temperament, in children 
 than in adults. Under great mental excitement the cheek is often 
 flushed, and the ears are red and warm. These symptoms are 
 caused by the sympathetic system. 
 
 3. From one internal organ to another. — The stomach, the 
 liver, the intestines, the heart, the brain, and the genital organs — 
 all are apt to sympathize with each other in affliction. Diseases 
 of the genital organs in male or female usually affect the stomach, 
 or the brain, or the bowels through the sympathetic. It is for 
 this reason, chiefly, that patients afflicted with even very slight 
 disorders of the genital organs, are apt to suffer at the same time 
 from mental depression and hypochondriasis, which they cannot 
 throw off even with their utmost striving. 
 
 The sympathetic system is a kind of slow means of telegraphic 
 communication between all the important organs of the body. 
 The lungs are not very liberally supplied from the sympathetic 
 
102 ANATOMY AND PHYSIOLOGY. 
 
 system, while the stomach is very abundantly supplied from the 
 solar plexus, which is partly made up from the sympathetic. This 
 accounts for the fact which we are all familiar with, that consump- 
 tives are usually in good spirits, even when in the last stages of the 
 disease, while dyspeptics are frequently much depressed, and often- 
 times exceedingly and unreasonably melancholy, even when their 
 symptoms and pains are very slight and transient. 
 
 The sympathetic system works slower than the cerebro-spinal 
 system. It frequently takes a long time for disease of any organ to 
 affect another injuriously. A child may have worms for weeks and 
 months before convulsions appear. A person may be dyspeptic 
 for years before the intestines are affected and constipation or 
 diarrhoea ensues. A person exposes himself to cold and dampness, 
 and becomes chilled through and through. The next morning he 
 awakes with a cold in his head, or a diarrhoea. The sympathetic 
 system has brought on his bad symptoms, but several hours were 
 necessary. 
 
 The sympathetic system has also important offices in connection 
 with the eye, the ear, and the nose. These organs are provided 
 with two sets of muscles — one deep, the other superficial. These 
 muscles regulate the amount of sensation that these organs receive. 
 The superficial muscles are supplied by the cerebro-spinal system, 
 and the deep-seated by the sympathetic. 
 
 It is a very interesting fact connected with the sympathetic sys- 
 tem, that if it be divided on one side of the neck there is an in- 
 crease of temperature of the face on that side, and dilatation of 
 the pupil. The same effect has been observed from injury to the 
 sympathetic ganglion in the neck. The sympathetic nerve is pro- 
 bably much more at fault in many of our nervous diseases than is 
 commonly supposed. 
 
 There is yet much room for study of the functions of the sympa- 
 thetic, and it is to be hoped that in a few years our knowledge of 
 this very important system will be greatly perfected. 
 
DESCRIPTION OF THE EYE. 103 
 
 THE SENSES AND THEIR ORGANS. 
 
 Next in order to the Brain and Nerves, come the Organs of the Senses. 
 
 We commence with the description of the eye. 
 
 DESCRIPTION OF THE EYE. 
 
 The eye is lodged, for its safety, in a socket formed partly by the 
 bones of the skull, and partly by those of the face ; and for the greater 
 security of this delicate organ, it is defended on the outside by the 
 eye-lids, which serve as an occasional covering against external 
 bodies ; while a fine, limpid fluid, secreted from a small gland, situa- 
 ted near the outer angle of the eye-lids, is constantly spread over the 
 surface of the eye, to keep it moist and transparent ; and to wash 
 away those particles, which, floating in the air, might have attached 
 themselves to this surface, and produced injury. This fluid, called 
 the tears, afterwards passes off by two small openings at the opposite 
 or inner angle of the eye ; and thence descends by means of a canal, 
 info the nose. The eye-lashes serve not only to protect the eye from 
 insects and minute bodies ; but also to moderate the action of the 
 rays of light in their passage to the eye. 
 
 Each eye-ball is partly transparent and partly opaque. The 
 former portion transmits the rays of light to the nerve spread at the 
 back part of the eye ; while the latter serves as a covering to this 
 organ, and is intended also to confine the waters of the eye, and limit 
 the passage of light. The opaque part consists ; first, of the white 
 outside coat which covers all the back part of the globe of the eye ; 
 and, running forward, joins its anterior edge to that of the transparent 
 coat, called cornea, which is placed at the fore part of the eye. These 
 two coats form the outside covering or case for containing the other 
 parts of the eye, and from their difference of structure and use, are 
 not inaptly compared to the outside case of a watch ; the transparent 
 coat answering to the glass, and the opaque one to the case into which 
 it is fixed. It is the external part of this opaque coat which forms 
 the white of the eye. Immediately upon the inner surface of this 
 coat is spread the second coat, the choroid, which is also opaque ; but 
 being of a more delicate structure than the former it serves as a soft 
 easy bed for the optic nerve to expand upon. This coat also runs 
 forward towards the circular edge of the transparent part of the eye, 
 and here its edges appear to be thrown off, to form a kind of curtain 
 with an opening in the middle, the pupil, for the passage of the rays 
 of light. This curtain is called the iris, and together with the choroid 
 
104 
 
 ANATOMY AND PHYSIOLOGY. 
 
 coat, of which it seems to be a continuation, owes its dark color to 
 a black material called pigment, and which is spread more or less on 
 the surfaces of these parts of the eye, for the purposes of accurate 
 
 figure of the eye [after Wells). 
 
 S. Sclerotic. 
 
 C. Cornea. 
 
 Ch. Choroid. 
 
 Ch. p. Its pigment layer. 
 
 Pc. Ciliary processes. 
 
 m. ci. Ciliary muscle. 
 
 I. Iris. This is thinnest at its origin, be- 
 coming thicker toward the edge of the pupil, to- 
 wards which it is bevelled off. 
 
 P. Retina. 
 
 No. Optic nerve. 
 
 H. Hyaloid. 
 
 L. Lens. 
 
 Cv. Vitreous humor. 
 
 va. Anterior chamber. 
 
 ha. Posterior chamber. 
 
 and distinct vision, by absorbing the superfluous rays. The optic 
 nerve, descending directly from the brain, passes through an open- 
 ing into the orbit, to enter the posterior side of the eye in a trunk, 
 and is about the size of a goosequill. Having penetrated the coats 
 
VISION. 105 
 
 which we have described, it then expands into a very delicate mem- 
 brane, lining the ball of the eye, for receiving the rays of light, 
 which the transparent parts of the eye transmit to it. We will now 
 describe those parts. 
 
 The lucid or transparent portion of the eye constitutes the prin- 
 cipal share of this organ, and is composed of extremely fine mem- 
 branes, and humors of a greater or less density. The first and prin- 
 cipal membrane is that which we have compared to the glass of a 
 watch, serving at the fore part of the eye as a covering to the parts 
 within, and adapted also to transmit the rays of light. Immediately 
 before the retina or expansion of the optic nerve, and occupying the 
 posterior part of the eye, lies the vitreous humor, so called from its 
 resemblance to fused glass. This humor consists of a fine clear 
 liquid, contained within the very minute cells of a delicate mem- 
 brane ; and is a little hollowed at its fore part for lodging another 
 humor, the crystalline, which is of a firmer texture, and of a len- 
 ticular (or double convex) shape. All the remaining space of the 
 eye is filled with what is named the aqueous humor, because it is a 
 thin, clear water, not contained within any cells, but lying imme- 
 diately in contact with the coats and other parts of the eye. This 
 fluid supports the convexity of the eye before, and will escape on 
 puncturing the transparent cornea, which lies on its outside. 
 
 VISION. 
 
 Vision is effected by the eye through the medium of light, for 
 the rays, passing directly from the objects which we behold to this 
 organ, penetrate its transparent parts, till they fall upon and impress 
 the retina or expanded nerve at the bottom of the eye. Now, the 
 scope of vision being great, while the retina or seat of impression is 
 but limited in size, it follows that objects can be painted only in 
 miniature on this part, and that for this purpose its apparatus is 
 necessary to converge the rays of light, so that they should convey 
 a diminished figure of the object to the nerve of the eye. This is 
 really and principally the use of the transparent humors of this or- 
 gan. They refract and converge the rays of light in the manner 
 of a camera obscura, which represents an artificial eye ; so that a dis- 
 tinct image of the object we look at is formed at the bottom of the 
 eye; and this point of convergence of the rays is called its focus. 
 As in a camera obscura, so also on the retina, objects are painted 
 in an inverted position. This happens from the necessary crossing 
 of the rays in their passage to the nerve, and may be seen by cutting 
 away the 'back part of the opaque coat of the eye, and placing a 
 piece of paper to receive the object. Habit alone enables us to 
 
106 ANATOMY AND PHYSIOLOGY. 
 
 judge of the true situation, and likewise of the distance and magni- 
 tude of objects. To a young man who was born blind, and who 
 was couched by Mr. Cheselden, every object (as he expressed him- 
 self) seemed to touch his eyes, as what he felt did his skin ; and he 
 thought no objects so agreeable to him as those which were smooth 
 and regular, although for some time he could form no judgment of 
 their shape, or guess what it was in any of them that was pleasing. 
 
 Eyes that are of a proper length bring the rays of light that come 
 from distant objects (parallel rays) exactly to a focus on the retina, 
 or on the screen which receives the image, without any effort. 
 Rays that come from an object near at hand, a book which is being 
 read, for instance, are divergent. Consequently an effort must be 
 made to bring them to a focus. This effort is made by a little mus- 
 cle inside the eye, which passes all around the ball, and is attached 
 to the cornea, the iris, and the choroid coat. (The muscle may be 
 seen in the cut.) This muscle acts on the lens of the eye, and 
 causes it to become thicker in looking at near objects. Thus the 
 divergent rays are also brought to a focus on the retina. 
 
 This act of adapting the eye to vision at different distances is 
 called the act of accommodation. It is an act that takes place every 
 time we turn the gaze from a near object to one that is more remote, 
 and vice versa. We are conscious of this movement going on with- 
 in the eye-ball, and we may prove that it takes place by attempting 
 to see two objects situated at different distances from the eye at the 
 same instant of time. "We are never able to do it. This action of 
 accommodation is all done within the eye, by the ciliary muscle 
 acting on the lens. 
 
 As life advances this muscle becomes weakened, and the lens 
 becomes rigid. The muscle cannot then act as powerfully on the 
 lens, consequently the rays from near objects cannot be exactly focus- 
 ed on the retina. The book must be held farther off, whence the 
 rays are less divergent, — more nearly parallel. Finally, it must be 
 held so far off that the image on the retina becomes too small to be 
 perceived. This state of things is far-sightedness. It is relieved by 
 putting a double convex lens in front of the eye, to compensate for 
 the loss of power in the muscle to make the lens inside the eye as 
 thick as is necessary. Placing a convex lens in front of the eye in 
 effect lengthens the eye-ball. 
 
 Some eyes are born too short, and they require double convex 
 glasses, just as those of old people do, as soon as they are used 
 for reading, sewiug, or the like. Their condition is essentially the 
 same as that of the eyes of old people, although produced by a 
 different cause. In the man of advanced years the rays cannot be 
 
HEARING. 
 
 107 
 
 focused, because the lens cannot be sufficiently altered, that is, 
 made long enough, by the weakened muscle. In the child who 
 needs convex glasses it is the whole eye-ball which is too short. 
 
 Other eyes are born too long. They are the so-called short- 
 sighted eyes. They require dispersing or concave lenses in front of 
 the eye, in order that vision for the distance may be distinct. Per- 
 sons with eyes that are too long can usually read without glasses, 
 because divergent rays, which always proceed from near objects, are 
 focused on long eyes without difficulty. Placing concave lenses 
 before eyes in effect shortens them, hence their use in looking at a 
 distance. Some eye-balls are so unsymmetrical or irregular in 
 shape, that they are too long in one meridian and of the proper 
 length in others. This defect makes the vision indistinct at any 
 distance. Such eyes require glasses which are ground from a cylin- 
 der — cylindrical glasses. 
 
 When eyes are so formed, or when they become so changed by 
 age that glasses are required in order to distinct vision, they should 
 be worn ; a failure to employ them produces harm, and prevents 
 the proper use of the eyes. 
 
 HEARING. 
 
 FIGURE OF THE EAR, SHOWING THE AUDITORY CANAL, THE DRUM, AND THE LITTLE BOXES. 
 
 The internal ear, the immediate organ of hearing, is seated 
 within the temporal bone of the skull, and consists of certain cavi- 
 ties, labyrinths, and passages, hollowed out of its substance ; to- 
 gether with their tine lining 
 membranes, some very minute 
 bones, and the auditory nerve. 
 The first passage is a canal of 
 considerable length, which leads 
 from the external to the inter- 
 nal ear. It m lined with a fine 
 membrane, and is furnished with 
 several small hairs for guarding 
 the parts within from the entrance of insects. The inner extremi- 
 ty of this canal is closed by a thin transparent membrane, set in a 
 bony circle like a drum-head. Under this membrane runs a branch 
 of a nerve ; and immediately beyond it lies a small cavity, called 
 the drum of the ear. This cavity contains a chain formed by 3 small 
 bones, which are furnished with muscles, cartilages, and regular 
 articulations. It is of a hemispherical shape, and has four openings 
 
 EXTERNAL, INTERNAL, AND MIDDLE EAR, WITH 
 DRUM AND LITTLE BONES. 
 
108 ANATOMY AND PHYSIOLOGY. 
 
 from it ; the first is a small canal communicating with the back-part 
 of the mouth ; the other three are holes which open into different 
 recesses of the ear, and are covered with a very fine membrane. 
 One of these openings directly leads through a bony partition, into 
 what is called the labyrinth of the ear. This part of the organ of 
 hearing consists, first, of an irregular cavity much smaller than the 
 drum of the ear ; next, of three semicircular canals, each of about a 
 line, (the twelfth part of an inch) in diameter, which open by both 
 their extremities into this cavity ; and lastly, of a spiral canal, not 
 unlike the shell of a snail, making two turns and a half from its 
 base to its apex, and opening also into the former cavity. All these 
 parts of the labyrinth are lined with a very fine membrane, and are 
 filled with a watery fluid, which transmits to the nervous pulp in 
 contact with it, the vibrations it receives from the membrane separa- 
 ting the labyrinth from the drum of the ear. 
 
 Owing to the situation, the variety, and the minuteness of the 
 parts composing the ear, we do not know exactly the mode of action 
 of this intricate but admirable organ. It is certain however, that the 
 auditory nerve, which is distributed over the whole of the labyrinth, 
 is the seat of the sense of hearing ; and that a certain modulation of 
 the air, collected by the funnel-like shape of the external ear, and 
 conveyed through the first canal which we have described to the 
 membrane, and thence communicating its vibrations to the nerve, is 
 the cause of hearing. That sound is propagated to the ear by means 
 of the air, is proved by ringing a bell under the receiver of an air- 
 pump ; the sound it affords being found to diminish gradually as the 
 air becomes exhausted, till at length it ceases. We now describe 
 the manner in which it is supposed that hearing is effected. 
 
 The stroke of some body against another, causes an undulating 
 action in the surrounding air, not unlike to the circles which take 
 place on throwing a stone into smooth water ; and these waves of the 
 air, beat against the external ear. Here they are collected and con- 
 veyed through the canal to the membrane closing th£ drum of the 
 ear. This membrane they force into vibration, which is propagated 
 onwards by the email bones in the drum of the ear, till it reaches 
 the labyrinth, where communicating its impulse to the watery fluid 
 contained in its cavities, the auditory nerve at length becomes 
 affected by the tremor of the water, and the sense of sound is pro- 
 duced. 
 
 SMELLING. 
 
 The nose externally is constructed of bones, cartilages, small 
 muscles, and the skin. Its internal part, which is the seat of smel- 
 
THE TASTE. 109 
 
 ling, has an extensive surfaee formed by the convolutions of four small 
 bones; two in each nostril. A soft pulpy membrane covers them 
 through all their windings, and upon this the branches of the olfac- 
 tory or smelling nerve are copiously distributed. 
 
 Many cavities and recesses, formed in the bones of the skull, 
 communicate with the nose, perhaps to increase the power of the 
 organ, as well as to give distinctness and volume to the voice. 
 
 The sense of smelling is effected by the membrane before 
 described. The subtile and invisible effluvia of bodies, being carried 
 with the air in which they float, through the nose in inspiration, 
 strike against the almost naked and soft olfactory nerves which are 
 every where spread throughout this membrane, and are kept moist 
 by a constant secretion of mucus, and produce in them a feeling, 
 which we call smelling. This sense, besides adding to our pleasura- 
 ble feelings, seems intended to direct us to a proper choice of aliments, 
 warning us to avoid those which may be putrid or otherwise dan- 
 gerous ; and also admonishing us to avoid exhalations and vapors 
 which render the air unhealthy. When we wish to take in much of 
 the effluvia of anything, we naturally close the mouth, that all the 
 air we inspire may pass through the nostrils, and at the same time, 
 by means of the muscles of the nose, the nostrils are dilated, and a 
 greater quantity of air is drawn into them. 
 
 THE TASTE. 
 
 Another sense which the all- wise Creator has given to assist us 
 in the proper choice of food, and also for combining pleasure with the 
 reception of nourishment, is that of taste. This property resides 
 in the nervous extremities or papillae, (minute terminations of the 
 nerves) which lie upon the extremity and sides of the tongue. It is 
 excited by the contact of those bodies, whose properties are fitted to 
 act upon these nerves. Thus by making different kinds of impressions, 
 owing to their various qualities, (some substances being mild, others 
 acrid and pungent,) the different tastes of sour, sweet, austere, &c. 
 are produced ; but the particular state of these nervous papillae, of the 
 tongue, with respect to their moisture, their figure, and their covering, 
 will produce a considerable difference in the exercise of this sense. 
 Hence it varies in different people, and suffers great changes even in 
 the same person, by sickness, and various other causes. 
 
 The ability of the tongue to distinguish tastes, has been provi- 
 dently implanted, that we may discern what food is most salutary. 
 In general that which is so, is pleasant, and that which is ill-tasted is 
 rarely fit for our nourishment. In this manner nature has invited 
 us to take necessary food, as well by the pain called hunger, as by 
 
110 ANATOMY AND PHYSIOLOGY. 
 
 the pleasure arising from the sense of taste. Brute animals, governed 
 by instinct merely, have the faculty of distinguishing flavors more 
 accurately, by means of which they abstain cautiously from poison- 
 ous or unhealthy food. Thus herbiverous animals, to which many 
 noxious plants are offered, are furnished with long and large papillae 
 in the tongue ; which are not so necessary to man, whose reason and 
 means of information serve, m part, instead of mere animal instinct. 
 
 TOUCH. 
 
 The sense of touch is that faculty by which we distinguish cer- 
 tain properties of bodies by the feel ; and in a general acceptation, 
 may, perhaps, be said to exist in all the parts of the body possessed of 
 sensibility. But the term is commonly confined to the nervous 
 extremities or papillae of the skin, which being more numerous, or 
 covered with thicker or thinner cuticle in some places than in others, 
 give, as we before observed, a grosser or finer degree of feeling to the 
 different parts. These papillae are capable of being impressed by 
 the exterior properties of bodies, whence the mind is enabled to form 
 ideas of their solidity, moisture, inequality, smoothness, dryness, 
 measure, fluidity, and heat. But the part of the skin which most 
 possesses this sense for the examination of substances, is that cover- 
 ing the points of the fingers ; which from the peculiar disposition of 
 its nervous papillae, and also from the convex shape of the part on 
 which they lie, is admirably adapted for inquiring into the nature of 
 bodies by the feel. 
 
 We have now rapidly described the senses and their organs. In 
 each of the latter we have seen the nerve to be the seat of impression ; 
 and the organ itself to be an apparatus for conveying to the nerve a 
 particular influence from the impressing object. Thus the transpar- 
 ent parts of the eye transmit the rays of light to the nerve which is 
 spread behind them. The ear is adapted to collect, concentrate, and 
 propagate the vibrations of sound, till they strike against the nerves 
 distributed in the labyrinth. The nose, tongue, and fingers, are so 
 constructed that the nerves, spread upon those parts, receive different 
 kinds of impressions from contact, owing partly to the difference of 
 the medium through which the nerves are acted upon ; the mem- 
 brane which covers them, being in some organs of a different structure, 
 and in some of greater density than in others. Thus there is a 
 common seat for impression in all the organs. The difference of 
 sense is created by the organ itself, whose peculiar construction is 
 fitted to receive only a particular influence from the impressing body. 
 What admirable simplicity ! and yet how astonishing are the opera- 
 tions of these beautiful parts of our mechanism. 
 
THE FACE. Ill 
 
 THE FACE. 
 
 The features of the face viewed collectively present a striking and 
 beautiful characteristic of the superior nature of man. Perhaps 
 nothing in creation enjoys and expresses so many, various, and elevated 
 influences as does the human countenance. It is the image of the 
 soul, the place where its ideas, motions, &c. are chiefly set to view, 
 and the seat of the principal organs of sense. To the countenance 
 we naturally look in conversation for the full meaning of the words 
 expressed. By it we are enabled to anticipate the emotions and 
 feelings of others, before they yet reach the tongue. It speaks a 
 language peculiar to itself, anticipating and outstripping all others 
 in rapidity ; which is general to all nations, and intelligible to every 
 individual of the whole human race. Even brutes, whom man has 
 domesticated and made his occasional companions, are not ignorant 
 of this kind of expression. When the dog would know the commands 
 of his master, unable to understand them in the complicated sounds 
 of speech, he looks intently upon his face, and endeavors to collect 
 thence his wishes and the disposition with which he regards him. 
 Nor does this expression entirely forsake the face of man even in 
 death. All the affections of the mind are more or less portrayed in 
 turn in this limited but expressive field ; love, pity, courage, fear, 
 calmness, anger, and every other strong characteristic of the man. 
 
 To the size and proportion of the bones underneath, which con- 
 stitute the base of the face, the difference of features is to be princi- 
 pally attributed. Youth, age, sickness, health, and even the stronger 
 affections of the mind, have an effect in changing the countenance ; but 
 that diversity of feature consisting of the difference of length, breadth, 
 or projection, depends chiefly upon the bony frame that lies below it. 
 
 From this difference of features, is that great diversity produced, 
 which varies the countenances not only of nations, but of individuals ; 
 so that no two, perhaps, of the whole family of mankind, could be 
 found exactly alike. But, notwithstanding this surprising diversity, 
 we are not to suppose that the individual features composing each 
 face are different from those of all other faces. We are rather led to 
 believe, that each is capable of an indefinite number of combinations 
 with other features ; and that from a very few kinds of features, the 
 astonishing and beautiful variety of faces we see round us are, by 
 transposition, produced. 
 
 This supposition is supported by the simplicity of means which 
 nature selects for effecting her purposes ; and in a great degree by 
 the likeness which often exists between two faces, sometimes so exact 
 that one shall be mistaken for the other. 
 
112 ANATOMY AND PHYSIOLOGY. 
 
 THE COMPLEXION. 
 
 It was not till lately that the true seat of the color of the skin 
 became known. Previously anatomists supposed that color depended 
 on the outer or scarf-skin. Malpighi, an eminent Italian physician, 
 at length led to the knowledge of its true seat. He found that the skin 
 of the human body consists of three parts, separable one from the 
 other ; namely, the scarf-skin which is external, the thicker or true 
 skin beneath it, and a coagulated substance which lies between both. 
 On future investigation it was discovered that this coagulated 
 substance is exclusively the seat of color in the skin, and is what 
 causes the various shades of complexion in the different inhabitants 
 of the globe. This discovery has been since fully confirmed. If the 
 scarf-skin be separated from the coagulated substance beneath, it will 
 be found to be semi-transparent. This is invariably the case with 
 the scarf-skin of the blackest negro, and with that of the purest white. 
 Whence it follows that the outer skin of both being similar in trans- 
 parency and color, (and the inner or thicker skin being known not to 
 differ in persons of the most opposite complexions,) the intermediate 
 coagulated substance must be the seat of color ; and this substance 
 varying in its tint, and appearing through the transparent scarf-skin, 
 produces the different complexions of the human race 
 
 Whatever causes co-operate in creating these appearances, 
 produce them by acting upon the coagulated substance ; which, from 
 the almost incredible manner in which the scarf-skin is perforated, is 
 as accessible as this skin itself. These causes are probably those 
 various qualities of thmgs, which, combined with the influence of the 
 sun, contribute to form what we call climate. For the coagulated 
 substance is found to vary in its color from the equator to the poles 
 
 SPEECH. 
 
 We shall now proceed to examine briefly, the organs of speech 
 which give to man a superior and distinctive faculty. 
 
 The organs of speech are the mouth, the windpipe, and the lungs. 
 The first of these is known to every one, as also the parts which it 
 contains. The windpipe is a passage commencing at the back part 
 of the mouth, and thence descends along the neck to open into the 
 lungs. At its upper part it is constructed of five thin cartilages, 
 connected together by ligaments, and put into motion by small 
 muscles. These cartilages form a chamber at the head of the tube, 
 which is situated at the root of the tongue, and may be felt to project 
 in the upper and fore-part of the throat. The opening of this chamber 
 into the throat is a very narrow chink, which is dilated and contracted 
 
LARYNX. 113 
 
 to produce every change in the modulation of the voice, by tht muscles 
 attached to the cartilages. To defend this opening, a beautiful 
 contrivance is adopted of an elastic valve, which falls flat upon it 
 whenever we swallow, like the key of a wind instrument ; and which 
 at other times rises up and leaves the aperture uncovered for the 
 uninterrupted ingress and egress of the air. 
 
 The tube leading to the lungs is formed by numerous semicircular 
 cartilages, connected by muscular fibres and membranes. They are 
 elastic and firm, to keep the canal of the windpipe always open, and 
 to resist compression. At the same time it is nearly as flexible as 
 though it was wholly membranous, and gives way to all the bendings 
 of the neck. Had it not been so, we should have been in perpetual 
 hazard of strangulation. The passage to the stomach, on the contrary, 
 being intended only for occasional use, has its sides always collapsed, 
 unless when distended by the passing food. The lungs are two 
 cellular bags for containing air ; they are situated in the chest, and 
 both open into the bottom of the windpipe. 
 
 In inspiration the air dilates the lungs. These, like bellows, 
 force it back in expiration into the windpipe. Here the air is 
 straightened in its passage, and made to rush with force along the 
 tube towards its upper end, where striking against the elastic carti- 
 lages of this part, it is variously modulated, and the sound of the 
 voice produced. But these cartilages do not articulate the sounds ■ 
 to effect this the voice is required to pass through the mouth, where 
 it is differently modified by the action of the tongue, which is either 
 pushed against the teeth, or upwards towards the palate, detaining 
 it in its passage, or permitting it to flow freely, by contracting or 
 dilating the mouth. It has been humorously and truly remarked 
 of the tongue, that it is the only muscle under the control of the will 
 which is not wearied bv incessant use. 
 
 LAEYNX. 
 
 The following description of the larynx I take from my transla- 
 tion of Tobold's Chronic Diseases of the Larynx : — 
 
 " The larynx belongs to the musical instruments which are de- 
 signated as tongue-piped. There are wind instruments with hard 
 and with soft tongues. To the former belongs the well-known mouth- 
 drum, to the latter, the larynx, with its double-lipped membranous 
 tongues extended within its cavity, with its bellows (lungs), its- air-tube 
 8 
 
1U 
 
 ANATOMY AND PHYSIOLOGY. 
 
 (bronchial ramifications, trachea), and its mouth-piece (pharynx, 
 mouth, and cavity of the nose). If the vocal chords are put in 
 vibration by a continuous expiratory stream of air from beneath, 
 while the glottis is contracted, a sound is made, the height and 
 depth of which depends on the length, the elasticity, and the extent 
 of the tension. 
 
 " The formation of the voice depends on four main points. 
 
 " 1. The air must be moved against the chink of the glottis with 
 a certain expulsive power. 
 
 " 2. The chink of the glottis must not exceed a certain diameter. 
 If the opening of the glottis extends more than one-twelfth or one- 
 tenth of an inch, no more sound will arise. But the opening is 
 made chiefly by the glottis, ligamentosa, while the glottis cartila- 
 ginea must remain closed to give rise to a pure sound. 
 
 " 3. The vocal chords must every time have a defined tension, for 
 if they be very much extended, a shrieking, piping sound is made, 
 whereas, if they be much slackened, only a dull sound is produced, 
 if at the same time the glottis be much shortened. 
 
 "4. The excursive capability of the vocal chords must not be in- 
 terfered with, and their elastic power must be fully intact, as they 
 are extended by the pressing forward column of air, and are thus 
 dilated and elevated. The degree of tension depends on the power 
 of the stream of air and the elasticity of the vocal chords." 
 
 THE LARYNX. 
 
 Laryngoscopic drawing, showing the vocal cords Laryngoscopic drawing, showing the approxima- 
 
 drawn widely apart, and the position of the 
 various parts above and below the glottis, 
 during quiet inspiration. 
 u. Upper surface of epiglottis. 
 I. Lip of epiglottis. 
 vc. Vocal cord. 
 
 tion of the vocal cords, and the position of the 
 various parts in the act of vocalization. 
 a. Arytaenoid cartilages. 
 a. Arytaenoid cartilages. 
 pv. Process of the vocal cords. 
 
 (See articles on Larynx and Laryngoscope.) 
 
THE BLOOD. 115 
 
 THE BLOOD. 
 
 Having now described those parts of the human body on which 
 its figure, support, strength, motion, sensibility, &c, immediately 
 depend, we next come to those which are intended to replace the 
 waste of the machine, and to supply it with new energies. 
 
 Like all other animal matter, the human body suffers a constant 
 change. Life itself is an action inducing change, which ultimately 
 leads to death. This change is continually taking place, a removal of 
 the old, worn-out particles, and an incessant deposition of new 
 ones. To effect the latter purpose, nutritious matter must be 
 lodged in the animal machine, otherwise it will speedily wear down 
 and run into dissolution. We therefore find it supplied with a rich 
 store of a nutritious fluid, fine enough to penetrate its minutest 
 parts, and constantly circulating through the whole machine. 
 
 The following description of the blood, from the excellent 
 treatise of Professor Dal ton, I present in full in his own language : — 
 
 " The blood is a thick opaque fluid, of a rich deep red hue, so 
 peculiar that it may usually be distinguished by its color alone. It 
 contains many different ingredients, of which the most important 
 are, first, icater / second, mineral substances f and, third, albuminous 
 matters. 
 
 " The water of the blood is what gives it its fluidity. For if the 
 water be driven off by evaporation, the other ingredients remain 
 behind in the form of a dry mass, which would be entirely useless 
 for the purpose of nutrition. But in its natural condition the water 
 of the blood unites all its other ingredients into a uniform liquid, 
 which easily moves through the blood-vessels, and dissolves the 
 new substances which are absorbed from without. Taken alto- 
 gether, the water forms rather more than three-fourths of the whole 
 mass of the blood. 
 
 " The mineral ingredients are in much smaller proportion. The 
 most abundant is common salt, which we know is taken with the 
 food, and is a necessary ingredient of all the tissues. It forms, 
 however, only about four parts in a thousand of the whole blood. 
 The combinations of lime, which the bones and teeth require for 
 their nourishment, are found in still smaller quantity, dissolved in 
 the animal fluids of the blood. Other mineral substances of various 
 kinds are also present in their requisite quantity. 
 
 " But the most remarkable of all the ingredients of the blood 
 are its albuminous matters. It is these substances which give to 
 it its thick and animal consistency, and which also act the most 
 important part in the nutrition of the body. They are of two dif- 
 
HO ANATOMY AND PHYSIOLOGY. 
 
 ferent kinds, which are naturally mingled together in the blood in 
 a liquid form. 
 
 ki The first of these is the albumen. We can obtain a tolerably 
 correct idea of the characters of albumen from the fresh white of egg, 
 which has received a similar name. This is not exactly the same 
 thing with the albumen of the blood, but still the two resemble each 
 other very closely. They may both be coagulated by boiling, when 
 they become solid, white, and opaque. The principal dilference 
 between them is, that the fresh white of egg is partly gelatinous in 
 consistency, while the albumen of the blood is perfectly fluid, and 
 may readily be made to flow through the veins, or to run from one 
 glass vessel into another. 
 
 " The albumen is about forty parts in a thousand, or one twenty- 
 fifth of the whole blood. . It represents, in great part, the concen- 
 trated nourishment derived from the food, for it is probably into 
 this substance that most of the albuminose is converted, after being 
 absorbed from the intestine in the digestive process. It is the ma- 
 terial out of which the tissues of the body are afterward formed. 
 
 " The other animal matter in the blood is the fibrine. Although 
 this is in very small quantity — viz., only two parts in a thousand — 
 it is an exceedingly curious and important ingredient. For it pos- 
 sesses a property which does not belong to any other animal sub- 
 stance, viz., the property of 'spontaneous coagulation' — that is, it 
 will coagulate by itself, without being boiled or brought in contact 
 with an acid, or treated by any other chemical substance. We 
 shall see hereafter what an important character this property gives 
 to the blood. 
 
 
 
 " But these substances are only the liquid portions of the blood. 
 They are all dissolved in each other, and form a perfectly transpa- 
 rent and almost colorless fluid. Beside them there are a multitude 
 of little rounded bodies contained in the liquid mixture, w T hich 
 make the blood opaque, and give to it its red color. They are so 
 abundant that they are crowded together by thousands in each drop 
 of blood, and so minute that they are only visible by the aid of the 
 microscope. They are called the blood-globules. 
 
 " Globules of the Blood. — If we examine a drop of blood under 
 the microscope, we see the blood-globules floating in profusion in 
 the fluid parts. Each one is a delicate circular plate or disk, some- 
 what like a piece of money in form, only with the edges rounded, 
 and rather thicker than the central part. In human blood they 
 are about -g-g-^-jj- of an inch in diameter, when measured across their 
 flat surfaces, and about -g-J-g-jr of an inch in thickness. 
 
 a The blood-globules are exceedingly soft and flexible in con- 
 
 I 
 
THE BLOOD. 117 
 
 sistency. In fact, they are nearly fluid, like drops of very thick 
 oil or honey, only they do not dissolve in the other parts of the 
 blood, but retain their own form and substance. Consequently, 
 when moving about in the fluid, as they often do under the micro- 
 scope, following accidental currents in the blood, passing through 
 narrow channels, and turning corners among the other globules, 
 they may be seen to twist about, and bend over, and elongate in 
 various ways, and then resume their natural figure as before. This 
 peculiar semi-fluid and flexible consistency is one of their greatest 
 peculiarities. 
 
 "When seen by transmitted light and in thin layers, they are 
 of a very pale amber color, and nearly transparent. Nevertheless 
 they contain all the red color of the blood ; and when seen heaped 
 together in layers only five or six deep, they show distinctly the 
 ruddy color which belongs to them. Beside, if they are separated 
 by filtration or any other means, or if they are not formed in their 
 natural quantity, the blood becomes paler, exactly in proportion as 
 its globules are deficient. 
 
 " They also communicate to the blood its opacity. Although 
 each globule by itself is transparent, yet, when they are crowded 
 together and mingled with the fluid parts of the blood, the whole 
 becomes opaque, and apparently impenetrable to light. This is 
 because the globules of the blood and its fluid parts are of a differ- 
 ent nature and composition. The same thing will happen when 
 oil is emulsioned by a watery alkaline solution. The oil is trans- 
 parent by itself, and the alkaline liquid is transparent by itself; 
 but if you mix the two together, the whole becomes white and 
 opaque like milk. So the globules of the blood and its fluid parts, 
 mingled together, produce a thick red and opaque liquid. 
 
 " The red globules are the vivifying elements of the blood. They 
 communicate to it its animating and stimulating properties, by 
 which all the organs are maintained in a condition of vital activity. 
 
 " Beside the red globules, the blood contains other little bodies 
 of a different form and aspect. These are the vjhite globules. They 
 are very much less numerous than the red, as there are not more 
 than three or four of them for every thousand of the others. They 
 are of a little larger size, measuring about ^-gVo" of an i ncn nl di- 
 ameter, of a rounded form and a finely granulated texture. They 
 are usually concealed, for the most part, in the greater abundance 
 of the red globules. 
 
 " When the ingredients of the blood are examined by analysis, 
 they are found to be mingled together in the following propor- 
 tions : 
 
118 anatomy and physiology. 
 
 " Composition of the Blood in 1000 parts. 
 
 " Water 795 
 
 Globules. 150 
 
 Albumen 40 
 
 Fibrine 2 
 
 Other animal matters 5 
 
 Mineral substances. 8 
 
 1000 
 
 " Coagulation of the Blood. — Such are the properties and con- 
 stitution of the blood while circulating in the interior of the body. 
 Eut if it be withdrawn from the vessels a very remarkable change 
 takes place, w T hich alters its whole appearance. 
 
 " This change is its coagulation. 
 
 " When a patient is bled from the arm or is accidentally wounded, 
 the blood runs from the opened vein in a perfectly liquid stream ; 
 but soon afterward it begins to appear thicker than before, and will 
 not run in drops, nor moisten the fingers so easily when touched. 
 When this alteration has once commenced, it goes on rapidly in- 
 creasing, the blood growing thicker and thicker, until it finally sets 
 into a uniform, firm, elastic, jelly-like mass. It is then said to be 
 ' coagulated .' or ' clotted.' This change is usually complete in about 
 twenty minutes after the blood has been withdrawn from the veins. 
 
 " Now this coagulation of the blood is entirely dependent upon 
 its fibrine. This substance alone has the property of coagulating 
 spontaneously. None of the other ingredients can solidify in this 
 way, and if the fibrine be taken out, the blood loses altogether its 
 power of coagulation. 
 
 "But how is it that the whole blood becomes clotted in a single 
 mass, if this power belongs only to the fibrine ? 
 
 " It is because the fibrine, though in very small quantity, as 
 compared with the other substances in the blood, is diffused uni- 
 formly throughout the whole ; and when it coagulates, therefore, 
 on being withdrawn from the vessels, it entangles all the other in- 
 gredients witli it, and holds them imprisoned in its own substance. 
 The water of the blood, accordingly, the albumen, the globules, 
 etc., are all mechanically retained by the coagulating fibrine. 
 
 " But not long afterward a partial separation takes place between 
 them. The fibrine solidifies still more; and, by contracting upon 
 itself, squeezes out the liquid portions of the blood from between its 
 meshes. Drops of a clear, amber-colored fluid begin to exude from 
 its surface, and these drops, growing larger and larger, run together 
 
THE BLOOD. 119 
 
 into little pools, which still increase in size until the entire surface 
 is covered with the transparent liquid. The remainder grows at the 
 same time smaller and firmer, until at last the whole is permanently 
 separated into two parts, a solid and a liquid. The solid part is 
 called the clot ; the liquid part is the serum. 
 
 " If you examine, therefore, a cupful of blood, at the end of 
 twelve hours after it has been drawn from the veins, you will see 
 that it is no longer a uniform mass, but appears as a solid clot float- 
 ing in the transparent serum. 
 
 " The clot, at this time, is still firm, red, and opaque, since it 
 contains all the globules of the blood as well as the fibrine. For 
 these globules cannot escape from the clot, owing to their form and 
 size, and are therefore retained by the meshes of the coagulated 
 fibrine. The serum, on the other hand, is transparent, and nearly 
 colorless. It contains all the albumen, the water, and other sub- 
 stances dissolved in them. 
 
 "Importance of Coagulation. — Now this coagulation of the 
 blood is a property of the greatest importance ; for it is the only 
 thing which prevents our bleeding to death after the slightest inci- 
 sion or injury to the blood-vessels. Whenever these vessels are 
 opened by an accidental cut in the skin or in the muscles, the 
 blood at first flows with great freedom, according to the size of the 
 wound. But if we press firmly upon the injured part with a 
 bandage or with the fingers, and then, after a short time, remove 
 the pressure, we find that the bleeding has stopped altogether. 
 This is because the thin layer of blood between the edges of the 
 wounded vessels has coagulated and blocked up the opening. No 
 matter how thin this layer may be, it still coagulates ; for every 
 particle of the blood, however small, contains its due proportion of 
 fibrine, and, consequently, solidifies at the proper time. The clot 
 thus formed adheres to the edges of the wounded parts, and so acts 
 as a continuous bandage or plug, until the tissues have again grown 
 together and become permanently united. 
 
 "It is in this way that the bleeding from all ordinary wounds 
 is usually arrested by nature. No matter how freely the blood may 
 flow at first, if you keep the parts steadily compressed for twenty 
 minutes or half an hour, the fibrine will then be coagulated and 
 the bleeding will stop. 
 
 " But when the wound is very deep, or when any of the princi- 
 pal arteries have been severed, this means will not succeed ; for the 
 blood comes with so much force from those larger vessels that it 
 cannot 'be kept back by ordinary pressure, and no time is allowed 
 for its permanent coagulation. Then we must call for the assist- 
 
120 ANATOMY AND PHYSIOLOGY. 
 
 ance of the surgeon, who is often compelled to search for the blood- 
 vessels in the deeper parts of the wound, and to tie up their open 
 mouths with a fine cord or ligature. Why this operation is suc- 
 cessful requires a further explanation. 
 
 " Coagulation in the Interior of the Body. — It is a curious fact 
 that the blood will coagulate, not only when it is discharged ex- 
 ternally, but also even in the interior of the body, whenever it is 
 withdrawn from the ordinary course of the circulation. Thus, if 
 we receive a bruise, and the little vessels beneath the skin are torn, 
 the blood which flows from them coagulates in the neighborhood 
 of the injury. Any internal bleeding produces, after a time, a clot 
 in the corresponding situation where the blood is effused. After 
 death, also, coagulation takes place in the cavities of the heart, and 
 in the great veins near it ; and whenever any part of the body is so 
 injured as to stop its circulation, the blood necessarily coagulates in 
 its vessels. 
 
 "Accordingly, when the surgeon places a ligature upon a 
 wounded vessel, he stops the circulation through it. The blood is 
 imprisoned in the neighborhood of the ligature, and soon afterward 
 coagulates and blocks up the cavity of the vessel with its solidified 
 fibrine. After a time the ligature separates and is thrown off, and 
 the wounded parts unite by the healing of the tissues. 
 
 " We see, therefore, that the coagulation of the blood is a prop- 
 erty that belongs to the fibrine, and that it is spontaneous. As 
 soon as the fibrine is formed it possesses this property, by which it 
 is distinguished from all other substances. It is not manifested 
 immediately, for it requires a certain time for its completion ; but, 
 owing to the very nature of the fibrine, wherever it may be, within 
 a short period after it is shut off from the circulation it exhibits 
 this peculiar character, and coagulates inevitably. 
 
 " Why, then, does it not coagulate in the vessels, and thus stop 
 the circulation of the blood? 
 
 " To understand this, we must remember that the history of all 
 the animal substances in the living body is one of incessant change. 
 None of them remain the same, but all undergo successive trans- 
 formations. The albuminose formed in digestion is no sooner 
 taken up by the blood-vessels than it is converted into albumen. 
 The oily matters absorbed with the chyle, and the sugar produced 
 in the liver, are also rapidly decomposed, as w T e have seen, and dis- 
 appear in the circulation. What is destroyed in this way for the 
 purposes of nutrition is constantly replaced by a fresh quantity 
 formed in the same organs. 
 
 " This is also true of the fibrine. That which is circulating in 
 
THE BLOOD. 121 
 
 the blood-vessels to-day is not the same fibrine which was there 
 yesterday, but a new supply, freshly produced in the process of 
 daily nutrition. It is estimated by physiologists that all the fibrine 
 which exists in the blood is destroyed and reproduced at least three 
 times over in the course of a single day. What the new substances 
 are which are formed by its decomposition is still unknown, for 
 we cannot yet follow out all the details of these changes which 
 take place so rapidly in the living body. But there is every reason 
 to believe that the renovation of the fibrine in the blood takes 
 place as constantly and rapidly as that of its other ingredients. 
 
 " The blood, therefore, does not coagulate while the circulation 
 is going on, because its fibrine is being incessantly altered and con- 
 verted into new substances. It has been found that in certain of 
 the internal organs, especially in the liver and kidneys, the fibrine 
 disappears, and that little or none of it is contained in the blood 
 returning from them. When we come to learn with what rapidity 
 the circulation is carried on, we shall easily understand how co- 
 agulation may thus be prevented. But if the blood be withdrawn 
 from the circulation altogether, or confined in any part by a liga- 
 ture, then its fibrine can no longer go through with the natural 
 changes of its decomposition, and it accordingly coagulates, as we 
 have above described. 
 
 " Quantity of the Blood. — The entire quantity of blood in the 
 vessels is about one-eighth part, by weight, of the whole body ; so 
 that in a man weighing 140 pounds, the quantity of blood is very 
 nearly 18 pounds. The quantity of blood, however, as well as its 
 composition, varies somewhat at different times. Soon after di- 
 gestion it is considerably increased ; for it has absorbed all the 
 nutritious materials taken with the food, and these materials must 
 necessarily pass through the blood in order to reach the tissues. 
 After long abstinence it is diminished in quantity to a correspond- 
 ing degree. For the same reason, its composition varies to a certain 
 extent, since its different ingredients will diminish or increase, ac- 
 cording as they have been discharged or absorbed in greater or 
 less abundance. 
 
 " Effects produced by Loss of Blood. — Only a small proportion 
 of the blood in the body can be lost without causing a serious effect 
 upon the system. Generally speaking, the loss of one pound of 
 blood causes faintness, and that of a pound and a half or two 
 pounds is followed by complete unconsciousness. If the bleeding 
 be then stopped, the patient usually recovers ; but if a still larger 
 quantity -of blood be lost, recovery becomes impossible. 
 
 " When the strength, however, has been very much reduced by 
 
122 ANATOMY AND PHYSIOLOGY. 
 
 excessive bleeding, it may sometimes be restored by injecting into 
 the blood-vessels healthy blood from another person. This is called 
 the ' Transfusion of the Blood.' In several instances, where the 
 vital powers were nearly exhausted, life has been restored by this 
 operation. 
 
 " Two different hinds of Blood in the Body. — Finally, there is 
 a most remarkable difference in the appearance of the blood in dif- 
 ferent parts of the body. In one half of the circulation, that is, in 
 all those vessels which are called 'arteries,' it is of a brilliant scarlet 
 hue; while in the 'veins' it is of a deep bluish-purple, almost black 
 color. These two kinds of blood follow each other in the circula- 
 tion, changing alternately from one color to the other ; so that, 
 although there is always red blood in the arteries, and always blue 
 blood in the veins, yet the same blood is alternately scarlet and 
 purple, as it passes from one set of vessels to another." 
 
 THE OKGANS OF CIKCITLATIOK 
 
 THE HEART. 
 
 This organ is situated nearly in the centre of the human body, 
 occupying a place in the chest rather to the left of the centre of this 
 cavity, and lying immediately upon the diaphragm or muscle dividing 
 the chest from the cavity below, with its apex or point inclining 
 towards the bony extremity of the sixth rib of the left side, and 
 against which it may sometimes be felt to strike. In this situation 
 the heart is sustained by the large blood-vessels which originate from 
 its base ; but its point is entirely free, and it is surrounded by a 
 strong membranous bag or purse, which is firmly fastened to theoe 
 vessels, and to the diaphragm. It serves to preserve the moisture of 
 its surface, by constantly exuding a fine thin lubricating fluid, and 
 thus lessens its friction with the parts in contact with it ; at the same 
 time that it supports the heart itself when under violent action. 
 
 The heart consists of four cavities or chambers for receiving the 
 blood, and for giving it a fresh impulse. Two of these cavities are 
 on each side, and communicate with each other by an opening 
 through the partition which divides them ; but they are totally dis- 
 tinct from the cavities on the other side, although they correspond 
 with them in shape, structure, and use. The heart may be said, 
 therefore, to consist of two distinct organs ; the one on the right 
 for sustaining the circulation through the lungs, and the other on 
 the left for impelling it through the rest of the body. The first cavity 
 on the ri^ht side of the heart is called its auricle, and receives the 
 terminations of two large veins which reconvey the blood returning 
 
THE HEART. 123 
 
 from all parts of the body to the heart. This cavity may be viewe 1 
 as a reservoir for the returning blood, which it discharges into the 
 other cavity of the same side, called the right ventricle. The opening 
 into the ventricle is closed by a valve, which is so contrived as to 
 admit the blood, but to prevent its return. The ventricle has another 
 opening leading from it into an artery, and the right ventricle, when 
 filled with blood from the auricle, contracts and forces it into the 
 artery of the lungs ; and (that it may be able to propel the blood with 
 sufficient force into this tube) it is constructed of greater strength 
 than the auricle, having its walls firmly supported by fleshy columns, 
 which extend across the cavity of the ventricle, and connect its 
 opposite sides together. There are valves also situated at the com- 
 mencement of the artery of the lungs, and for the same use as in the 
 auricle, viz., to prevent the blood from returning into the cavity, 
 whence it had just been expelled. 
 
 This description of the right side of the heart will suffice for that 
 of the left ; both being constructed nearly in the same manner, 
 having corresponding cavities or chambers, and for similar purposes. 
 But it ought to be observed, that as the right auricle receives the 
 blood returned to the heart from all the parts of the body ; and the 
 ventricle of the same side propels it into the vessels of the lungs ; so 
 the auricle on the left side of the heart receives this blood from the 
 lungs, by four veins which open into it, while it is the office of the 
 left ventricle to force it into a new circulation along the extent of 
 the whole body. The left ventricle is stronger than the right, be- 
 cause it has a greater resistance to overcome. 
 
 The substance of the heart is muscular, being composed of red 
 and elastic fibres, similar to those which constitute the other muscles 
 of the body ; but so arranged as to admit of contraction in all direc- 
 tions,, and with such a peculiar modification of the excitable principle 
 as to be contracted and dilated alternately through the whole of life ; 
 so that the circulation never ceases. The heart, in fact, possesses the 
 contractile power in a higher degree than any other muscle. It is 
 called into action partly by the mechanical distension of the blood, 
 although principally, no doubt, by its peculiar qualities as a stimulus. 
 The auricles of each side are filled at the same instant, while the 
 ventricles are at the same time emptying themselves. The right 
 auricle, when filled, contracts, and urges the blood onward into the 
 now relaxed ventricle ; the last, when distended, contracts in its turn ; 
 the flaps of the valves are thrown back, and close the opening into 
 the auricle, and the blood has no other outlet but into the pulmonary 
 artery, which leads to the lungs ; where it is to be changed in its 
 color and other properties. Th-e artery is now dilated, its valves are 
 
124: ANATOMY AND PHYSIOLOGY. 
 
 instantly closed, and prevent the return of the blood into the ventri- 
 cle. Then the artery contracts, and impels its contents onward, to 
 make way for a new wave of blood. During this time corresponding 
 motions take place in the left side of the heart, with this difference 
 t>nly, that the left ventricle forces the blood into the aorta, or great 
 artery of the body, after it has undergone its due changes in the lungs, 
 through which it was circulated by the force of the right ventricle. 
 
 It is observable, that this motion of the heart not only survives 
 that of the organs of voluntary motion, but continues a considerable 
 time even after it is separated from the body. Nay, after it has 
 ceased to palpitate, yet its contraction and dilatation may, by the 
 application of stimuli, be alternately renewed and continued some 
 time longer. Hence in drowning and suffocation, though the pulse 
 be imperceptible, and life apparently extinguished, the heart still 
 preserves this latent power, or susceptibility of motion ; for though 
 unable to propel the blood through the vessels of the body, it needs 
 only to be excited by suitable stimuli to renew its action. In the 
 first rudiments of life, even before the brain is formed, a pulsating 
 point or spot shews the embryo heart in miniature, and marks its 
 primeval irritability, as a sure pledge of vitality. The heart of the 
 chick begins to move before we can presume that there is any organ 
 for distributing the nervous power. The palpitating point is the 
 heart of the chick, and it is seen beating while its body is but a rude, 
 unformed, and gelatinous mass. 
 
 As this singular organ exhibits irritability the first, so it never 
 relinquishes it till the last, and may therefore be considered as the 
 first part of the animal which lives, and the last which dies. 
 
 In animals with cold blood, this irritability is very great, and con- 
 tinues a long while. The heart of a viper will palpitate when 
 taken from the body, twenty-four hours ; and that of a turtle, thirty, 
 or longer. In the warm blooded animals, it moves till the fat is ren- 
 dered stiff by the cold, when the motions of the heart and all the 
 other muscles commonly cease. 
 
 THE ARTERIES. 
 
 From the ventricles of the heart arise two large elastic tubes, 
 called arteries, which afterwards divide like the trunk of a tree, into 
 innumerable branches. The one commencing at the right side of the 
 heart, conveys the blood to the lungs, while that which is continued 
 from the left ventricle, carries it to all the other parts of the body. 
 The arteries are composed of three membranes called coats, an exter- 
 nal coat, a middle coat, which is muscular, and an inner one, which 
 is smooth. They partake of the nature and action of the heart, for 
 
THE VEINS. 125 
 
 being dilated and irritated by the blood impelled into them from the 
 heart, they contract, by means of their muscular coat, upon this 
 blood, and thus propel it to all parts of the body, for their nutrition, 
 and the various secretions. This dilatation and contraction is called 
 the pulse, and is perceptible in the trunks and branches of the arteries, 
 but not in their minute ramifications, except when inflammation 
 
 THE VEINS. 
 
 The blood, having been conveyed by the arteries, even to the 
 extreme parts of the body, for its nourishment and repair, the sur- 
 plus is carefully returned to the heart and lungs, to be prepared for 
 a new circulation ; and for this purpose are the veins provided. 
 They commence from, or rather are continuous with the minute 
 arteries, and as they approach the heart, they run into larger but 
 fewer tubes, till at last they terminate in it by six great trunks. 
 Two of them empty their contents into the right auricle ; the one 
 collecting the blood from the vessels of the head and the upper extre- 
 mities, while the other ascends with it from the lower parts of the 
 frame. These are loaded with venous blood ; but the remaining 
 four veins pour the blood from the lungs into the left auricle ; it is 
 now changed into a bright red color, and is called arterial blood, 
 because it has the appearance with which it is always found in 
 arteries ; so that in the lungs the office of the arteries and veins is 
 transposed ; the former conveying venous blood, while the latter are 
 filled with arterial blood. 
 
 The continuation of the extreme branches of the arteries to those 
 of the veins, resembles two trees united to each other at their tops, 
 while their trunks are so disposed as to terminate in a common point, 
 the heart ; and if we suppose that both these trunks and their rami- 
 fications are hollow, and that a fluid is incessantly circulating through 
 them, by entering into one of these trunks, and returning through 
 the other, we can conceive how the blood is circulated through the 
 human body. 
 
 The veins do not pulsate, like the arteries. The blood which they 
 receive from those vessels flows through them very slowly, and is 
 conveyed back to the heart by the current of blood from the arteries, 
 and the contraction of the muscles, among which they ramify. It is 
 prevented from flowing backwards in the veins by valves, which con- 
 stitute one of the great distinctions between these vessels and the 
 arteries. The valves are formed by the innermost membrane of the 
 vein rising up in a fold into the cavity of the vessel, like a curtain, 
 and stretching itself along the vein so as to form a kind of crescent. 
 
126 ANATOMY AND PHYSIOLOGY. 
 
 which permits the blood to flow on towards the heart, but imme- 
 diately stops it if attempting to flow back. 
 
 The absorbents are thin and pellucid vessels arising from the 
 various surfaces of the body, and running to a common trunk or 
 tube, called the thoracic duct, because it lies principally in the thorax 
 or chest, which empties itself into a vein a little before it comes to 
 the heart. They are distinguished into two kinds, the lacteals and 
 the lymphatics ; the former absorb the nutriment from the intestines, 
 and convey it by the thoracic duct into the circulation, while the 
 latter vessels take up the colorless fluid, called lymph, (whence 
 they receive their name) and convey it from all the parts of the 
 body to the same point. Thus the parts of the blood which 
 either from their thin, oily,- or nutritive qualities, had been separated 
 from the red, circulating mass, and thrown out by the secreting 
 or exhaling arteries, are absorbed, after having performed their various 
 uses, and are again conducted by the lymphatic vessels back into 
 the circulation to mix with the blood ; and the lacteals, or absorb- 
 ing vessels of the intestines, drink up the milky fluid formed from 
 our food, and carry it to the heart and lungs to be changed into 
 blood. 
 
 Hence we see that absorption is a function necessary to the 
 circulation, and highly essential to life. It completes the circle in 
 which our fluids move, and supplies the constantly decreasing blood 
 with new parts. But there are other purposes, which this curious 
 and beautiful operation of our frame accomplishes. The skin is full 
 of small pores which are the mouths of lymphatic vessels. Through 
 these are absorbed properties from the surrounding bodies, as from 
 the air, water, or such substances as may be in contact with the 
 skin, and are thence conveyed into the system for its refreshment, or 
 cure ; for instance, medicines rubbed on the skin enter the body, and 
 affect the frame. 
 
 But a grand, constant, and universal agency of our lymphatic 
 system, is the removal of old, useless, and worn out parts, and the 
 making room for new ones. This astonishing power of our frame to 
 change its withered, for sound, healthy particles, is not confined to 
 any one part or organ of the body, but is possessed by all. Delicate 
 membranes, and strong tendons, the soft moving muscle, and the 
 hard, solid, inactive bone, are all acted upon by these modellers of 
 our frame, throw off the old exhausted particles of which they were 
 composed, and acquire fresh ones. By this constant and general 
 renovation of all its parts, which endures through life, are the health 
 and vigor of the whole body preserved. 
 
 Absorption also helps to remove those injuries which happen to 
 
THE GLANDS. 127 
 
 the frame by accidents. If a tumor arises from a blow, the absorb- 
 ents will soon begin to act, and eventually remove the swelling. A 
 fluid poured from its ruptured vessel will be absorbed by the lympha- 
 tics, and carried again into the circulation. Even parts of the body 
 which are diseased, or have their organization destroyed, and are 
 consequently unable to perform their functions, will have their dead 
 particles carried off by absorption, and room made for fresh, healthy 
 depositions. The black or greenish spot which is left by a bruise, is 
 owing to blood having exuded from a ruptured blood-vessel. Its 
 disappearance is the effect of the action of the absorbents, which is 
 at all times, and in a similar degree, operating in every part of our 
 body, but not equally obviously. According to the proportion which 
 the action of the absorbing vessels bears to that of the arteries, by 
 which fresh supplies of nourishment are brought to all parts, will the 
 size of the body depend. Hence in youth the absorbents depositing 
 more nutritious matter than the arteries convey away, the frame 
 grows and expands. In middle age there being a balance between 
 the actions of the two systems of vessels, no change can take 
 place ; but the absorption being greater in old age than the nu- 
 tritious action of the arteries, the body shrinks from its usual di- 
 mensions, the limbs become wasted and shriveled, and the whole 
 frame totters towards the grave. 
 
 The absorbents are full of valves like the veins, for preventing 
 the flowing back of the lymph ; and the power by which they drink 
 up this fluid, and with it the decayed and dissolved solids of the 
 body, is supposed to depend principally on their muscular structure ; 
 the mouths of these vessels being filled with the particles of the fluid, 
 their coats contract, and their contents being pressed upon at the 
 sides, and prevented from returning by the valves, are necessarily 
 propelled towards the termination of the absorbents in the veins, 
 there to be mixed with the blood. 
 
 THE GLANDS. 
 
 These organs are designed to separate various substances from 
 the blood, and are situated in different parts of the body. They differ 
 in size, shape, and construction, according to the peculiar kind and 
 quantity of fluid which is meant to be separated from the mass oi 
 blood. Thus while some are of a small and roundish figure, others 
 are much larger and variously formed. Each of the small glands 
 consists, first of an artery for supplying the gland with blood, and 
 also for 'separating, by the peculiar disposition of its extremity, a 
 particular kind of fluid from this blood ; next of an excretory duct 
 
128 ANATOMY AND PHYSIOLOGY. 
 
 or canal which goes out of the gland, and conveys thence the secreted 
 fluid, by the contractility of its coats ; and lastly, of a vein for 
 returning to the circulation, the blood remaining after the secretion 
 has been accomplished. 
 
 Of this simple kind are most of those little glands, which are 
 found in different parts of the body, as under the skin, in the mouth, 
 nose, eye, &c. and which, by secreting an oily or mucilaginous fluid 
 from the blood, keep the parts on which they lie constantly moist, 
 prevent friction, defend them from the air, and from the floating 
 particles which it may contain. That the vessels necessary to effect 
 secretion may not be extended into long and inconvenient lines, they 
 are skilfully coiled into a small space, and connected together by 
 cellular substance, and assume the roundish and even appearance, 
 which those little glands exhibit. 
 
 The large glands consist principally of an aggregation of the small 
 ones, but have the following peculiarities of general structure ; 1st, 
 all the arterial branches which bring the blood to the gland, and 
 afterwards become the organs of secretion, arise from one great trunk, 
 which does not divide till it has reached the body of the gland ; 2nd, 
 the excretory ducts of the various small glands, composing the great 
 one, all run to unite into one large, common tube or canal for con- 
 veying away the collected secretions of the little glands ; and 3rd, 
 the branches of the veins, corresponding with those of the artery, all 
 pour their blood into one great trunk, by which it is returned into the 
 circulation. 
 
 This process of separating various bodies from the mass of blood 
 is termed secretion, and it is a most important function ; for every 
 animal production is a secretion, whether there be a complicated 
 apparatus for forming it or not. Thus bone, flesh, fat, skin, &c. are 
 as strictly secretitious as the urine, the bile, or the tears ; only that 
 in the latter case, for the sake of compactness, or because the secretion 
 was wanted in one spot for a specific purpose, the apparatus for 
 producing it is limited ; while in the other instances, the substances 
 are formed in many parts of the body. 
 
 The term gland has been confined to the congeries of vessels, &c. 
 above described ; but as we have seen parts the least peculiar in their 
 structure perform the functions of a gland. 
 
 In general the substances they secrete are of immediate use in 
 the animal system, and are so either constantly or occasionally. In 
 the latter case, a reservoir is attached to the gland in which the 
 secretion is accumulated till it is wanted. 
 
 There are other secretions which separate useless or noxious 
 bodies from the blood ; these are termed excretions ; such are the 
 
REVIEW OF THE CIRCULATION. 129 
 
 urine, the perspirable matter, and some others. They are the vehicles 
 by which worn out particles are removed, as well as noxious ones. 
 
 The manner in which the glands effect secretion is wholly un- 
 known. They are composed of similar vessels, have a common fluid 
 to secrete from, and still they separate substances wholly differing 
 from each other and from the blood. 
 
 Their mechanism is too minute for our inspection ; and it never 
 will be in our power to examine the machine when at work ; all our 
 observations must, therefore, be confined to the dead body. Hence 
 we have little hope of penetrating this mysterious process, although 
 we may conceive in general, that vessels of different sizes, lengths, 
 convolutions, and angles of separation from their trunks, will be fitted 
 to deposite different compounds. In truth the body is a complicated 
 laboratory, where chemical and other changes are incessantly taking 
 place. 
 
 REVIEW OF THE CIRCULATION. 
 
 The celebrated Harvey was the discoverer of the circulation of 
 the blood. " Seeing," says he, " that the blood passed from the arteries 
 in abundance into the veins, unless these were to empty themselves, 
 and the others to be refilled, that ruptures of vessels every where 
 would take place, which does not happen, I began to conjecture there 
 must be a circular motion of the blood ; but this doctrine was so 
 new and unheard of, that I feared much detriment might arise from 
 the envy of some, and that a number would take part against me, so 
 much does custom and doctrine once received, and deeply rooted, 
 pervert the judgment. However, my resolution was bent to set this 
 doctrine forth, trusting in the candor of those who love and search 
 after truth." 
 
 No sooner had he published his discovery of the blood's circulation, 
 than prejudice assailed him. Few physicians, and none passed the 
 age of forty, believed his doctrine, which they stigmatised as an 
 heretical innovation in philosophy and physic. Even his practice 
 began to decline. But he had the happiness to outlive the clamors 
 of ignorance, envy, and prejudice. Professional men were at last 
 ashamed to own that they had ever disbelieved his doctrine, which 
 was essentially the same as that which we have previously described. 
 
 The circulation of the blood can be easily seen, by the help of a 
 microscope, in the bodies of different creatures, which are either 
 9 
 
130 ANATOMY AND PHYSIOLOGY. 
 
 wholly, or in part transparent ; and the observations made by this 
 means are preferable to any others we can make, since, in dissections, 
 the animal is in a state of pain, or dying ; whereas in animals 
 viewed in the other mode, all is left in its usual course, and we see 
 what nature does in her own undisturbed method. The tail of the 
 newt, or water-lizard, affords a very entertaining prospect of the cir- 
 culation of the blood, through almost numberless small vessels. But 
 no object shows it so well as one of those animals while so young 
 as not to be above an inch long ; for then the whole body is so very 
 transparent, that the circulation may be seen in every part of it, as 
 well as in the tail ; and in these subjects nothing is more beautiful 
 than the course of the blood to and from the toes, where it may be 
 traced all the way with great ease. Near the head there are also 
 found three small fins, which afford a very clear view of the circula- 
 ting blood. These are all divided like the leaves of the common 
 fern, and, in every one of their branches, the blood may be very 
 accurately traced, running to the end through the artery, and then 
 returning back again by a vein of the same size. As the vessels 
 are very numerous and large in this part, when the third or fourth 
 magnifier is used, there are sometimes seen thirty or forty channels 
 at once. The large size of the globules of blood in the newt, and 
 their fewness in proportion to the quantity of serum, renders them 
 particularly distinct ; and we remark that their "figure, as they 
 are protruded through the vessels, changes in a very surprising 
 manner. 
 
 The impetus, occasioning the circulation, is great enough in some 
 animals to raise the blood six, seven, or eight feet high from the 
 orifice of a divided artery ; and that the force of the heart must be very 
 great, appears also from its expelling about eight pounds and twelve 
 ounces every minute, with a velocity equal to one hundred and fifty- 
 nine feet in that time, besides overcoming a great resistance in dis- 
 tending the arteries. The space of time wherein the whole mass may 
 ordinarily circulate, is not ascertained. Some of the latest writers 
 however, state it thus. Supposing the heart to make two thousand 
 pulses in an hour, and that at every pulse there is expelled an ounce 
 of blood, as the whole mass is not ordinarily computed to exceed 
 twenty-four pounds, it must be circulated seven or eight times in the 
 space of an hour. 
 
 Such is the circulation of the blood, and the astonishing arrange- 
 ment and powers of its organs. "Whether we consider the force 
 which they exert, their never wearying action, or the admirable wis- 
 dom with which they are disposed, the subject forcibly impresses the 
 mind. Here we find one of the most noticeable and peculiar animal 
 
THE TRACHEA OR AIR-TUBE. 131 
 
 functions. Far less magnificent in their plans, and less skillful in 
 their execution, hydraulics offer us but faint analogies with it, in 
 those machines, by means of which water is distributed into every 
 quarter of a great city. Upon the whole contrivance of the circula- 
 tion we may truly say that the Creator has impressed distinctly 
 his own signet. 
 
 ORGANS OF RESPIRATION. 
 
 "We will now consider one of the most beautiful and important 
 functions of the animal body ; upon which life itself immediately 
 depends, and which is constantly replenishing all its springs. Breath- 
 ing, like the circulation of the blood, is essential to the preservation 
 of the animal. The one supplies it with fresh nutriment, and thus 
 prevents decay. The other animates the whole of the machine, and 
 invigorates all its movements. To comprehend this function, it will 
 be necessary to extend our views to the nature and properties of the 
 air engaged in respiration, and to those influences which it has upon 
 the animal body. We here describe the organs of respiration, and 
 the manner in which it is performed in man, and in other creatures. 
 
 THE TRACHEA OR AIR-TUBE. 
 
 The trachea, or windpipe, by which the air is conveyed from the 
 mouth and nostrils into the lungs, has nearly the same construction 
 in quadrupeds as in man. It is formed of cartilaginous rings, and 
 an elastic ligamentous membrane. The rings are intended to keep 
 the area of the tube constantly open, but do not describe a circle ; 
 the back part of the windpipe, or that side of it which lies next to 
 the canal leading from the mouth into the stomach, being composed 
 almost wholly of the elastic membrane, for the greater convenience 
 in the act of swallowing. This membrane also connects the cartil- 
 aginous rings together, and completes the sides of the tube. The 
 upper part of the trachea, as we have before observed, is peculiarly 
 formed for producing the voice, and has a small thin cartilage placed 
 over the mouth of the tube, which occasionally shuts down, and 
 closes the passage to the lungs, as in swallowing. From this part 
 the air-pipe descends along the fore-part of the throat, till it passes 
 into the cavity of the chest, to enter the lungs. Its internal surface 
 is constantly kept moist, and defended from the air when passing, by 
 a mucus which is poured out from small glands every where strewed 
 
132 
 
 ANATOMY AND PHYSIOLOGY. 
 
 on the membrane lining this tube. A similar mucus lines all the 
 passages which lead to the internal cavities from without. 
 
 When the air-pipe has nearly reached the lungs, it divides into 
 two great branches. One of these goes to each lung, and is dis- 
 tributed through the whole of its substance, in an infinite number of 
 ramifications, all constructed in a manner similar to the original 
 tube, till they become very minute ; when instead of having cartila- 
 ginous rings, they are found to be wholly membranous. These 
 small branches terminate in innumerable cells, which communicate 
 with each other, and give the lungs the appearance of a honey-comb 
 when its substance is cut into, particularly in some animals where 
 the cells are large ; as in the turtle. 
 
 EXPLANATION OF FIGURE III. 
 
 HEAKT AND LUNGS. 
 
 This Plate shows the Larynx, Wind- 
 pipe, Heart, and Lungs, and the large 
 
 vessels by which they are connected. 
 
 L. Larynx, or Vocal-box ; the organ 
 in which the voice is formed. 
 
 T. The Trachea, or Windpipe; con- 
 necting the Larynx to the Lungs. 
 
 A. The Aorta, or Large Artery of the 
 Heart; arising from the Left Ven- 
 tricle. 
 
 P. Pulmonary Artery, or Artery of the 
 Lungs; this Artery arises from the 
 Right Veutricleof the Heart, and 
 divides into two branches, one go- 
 ing to each Lung. 
 
 C. Left Auricle of the Heart. 
 
 R. Right Auricle. 
 
 E. Air Cells of the Lungs. 
 
 V. Right Ventricle of the Heart. 
 
 D The cut ends of Arteries going 
 from the Heart. 
 
 S. Small branches of the Right Pil- 
 monary Artery ; a portion of each 
 Lung having been cut away to show 
 the«p branches and the Air Cells. 
 
 THE LUNGS. 
 
 We have already observed that the trunk of the body is divided 
 into two great cavities by the diaphragm, which is a horizontal fleshy 
 partition, and that the superior cavity is called the thorax or chest, 
 and contains the heart and organs of respiration. This cavity 
 is again divided into two lesser ones, by a strong membranous 
 partition, which runs in a direction perpendicular to the diaphragm, 
 and extends from the back-bone to the fore-part of the chest. It is 
 composed of the membranes lining the two cavities, which being 
 applied to each other laterally, like two bags, form a partition for 
 
RESPIRATION. 133 
 
 separating and sustaining the lungs, and for preventing them from 
 pressing upon each other, in the different positions of the body. The 
 laminae composing this partition do not every where adhere together. 
 At the lower part of the chest they recede from each other, to make 
 room for lodging the heart, and at the upper part of the cavity they 
 receive between them a gland called the thymus, the use of which in 
 the animal economy is not yet ascertained. The internal surface of 
 the chest, like all other cavities, is kept constantly moist and smooth, 
 for the greater safety of the delicate organs of respiration, by means 
 of this lining membrane, which is called the pleura, and which 
 exudes a fine watery fluid, preventing friction and adhesion of the 
 lungs to the sides of the chest. 
 
 The lungs are the principal organs of respiration. They are two 
 in number, one occupying the right, and the other the left cavity of 
 the chest ; but they respire by one common tube, the windpipe. 
 Their texture, as may be seen in those of any quadruped, is soft and 
 spongy, being composed of blood-vessels branching out with exquisite 
 minuteness upon the sides of the air-cells. They are united into a 
 mass of cellular membrane, and so disposed, that the blood can ex- 
 tract from the air certain properties which shall be hereafter ex- 
 plained. 
 
 RESPIRATION. 
 
 Respiration consists of inspiration, or the ingress of the air into 
 the lungs, and expiration, or the egress of the air from the lungs ; it 
 commences at birth, and continues through life. In man and quad- 
 rupeds it is performed in the following manner. 
 
 The diaphragm, dividing the chest from the abdomen, is strong 
 and muscular, and can act with great power in enlarging the cavity 
 of the chest. It is convex towards the lungs, and concave below. 
 When it contracts, its surface becomes nearly flat, and of course the 
 chest is deepened. At the same instant the intercostal muscles con- 
 tract, and raise the lower ribs which are moveable towards the upper 
 one which is more fixed. When the ribs are raised, they are so 
 contrived as to be drawn outwards, and the cavity of the chest is 
 dilated laterally. 
 
 Thus we see that when we inspire the chest is enlarged in all 
 directions. The lungs are suspended in the cavity, and follow all the 
 motions of the parts which enclose them, for when the pressure of the 
 ribs is removed, the air they contain expands by its elasticity, and 
 the external air rushes in to restore the balance. The lungs are now 
 in a state of inspiration, and they are emptied by the following 
 process. 
 
134 ANATOMY AND PHYSIOLOGY. 
 
 When the diaphragm contracts, it would lessen the abdominal 
 cavity as much as it enlarges that of the chest if its loose enclosure 
 did not give way by protruding. 
 
 This protrusion of the belly excites the abdominal muscles to re- 
 act. Their contraction pushes up the now relaxed diaphragm into 
 the chest, and as they are attached to the lower edges of the ribs, 
 they pull them down with great power, and thus lessen the cavity 
 of the chest. The lungs are compressed, and the air which they 
 had just received is now expelled. This is expiration. 
 
 It is pleasing and instructive to observe this admirable alterna- 
 tion of motion by which the mechanism of respiration is effected. 
 The diaphragm and intercostal muscles co-operate in enlarging the 
 chest ; they contract and are relaxed in the same instant ; while the 
 abdominal muscles seize, as it were, the moment of their relaxation 
 to counteract their motion, and to diminish the size of the chest. 
 
 Respiration is performed in the mode above described ; in ani- 
 mals which have a muscle, the diaphragm is for this specific purpose. 
 Breathing is essential to all animals, though it is effected variously 
 in different creatures, in correspondence with that indefinite diver- 
 sity of forms and of habits with which animal existence is endued. 
 
 In Prof. Dalton's treatise before quoted, respiration is thus 
 clearly described : — 
 
 " Quantity of Air used in Respiration. — At every respiration 
 twenty cubic inches of air (^ of a pint) are taken into the lungs. 
 If we count the entire number of respirations in a day, including 
 those caused by muscular exertion, this will give about 600,000 
 cubic inches, or 350 cubic feet of air which passes and repasses 
 through the lungs in every twenty-four hours. This is nearly 
 eighty times the bulk of the whole body. 
 
 " Character of the Respiratory Movements. — The movements 
 of respiration are involuntary. The diaphragm descends and the 
 chest expands without any exertion of the will, and even without 
 our knowledge. From the instant of our birth to the last moment 
 of existence, during the activity of our waking hours and in the 
 unconsciousness of sleep, they continue in untiring and ceaseless 
 operation. For the necessity of respiration is not occasional, but 
 incessant ; and the performance of this function, therefore, is not 
 confided to the will, but is provided for by an involuntary action, 
 which requires no attention and produces no fatigue. 
 
 "It is true that we can exercise a partial control over the move- 
 ments of respiration ; that is, we can hasten or retard them at will. 
 But this is only for a very short time. If we try to breathe much 
 more rapidly than is natural, say one hundred times a minute, we 
 
RESPIRATION. 135 
 
 shall soon find how laborious and exhausting the movements be- 
 come. On the other hand, if we stop respiration altogether, we at 
 once feel an internal impulse which calls for its renewal, and which 
 grows rapidly stronger and more imperative, until it becomes at 
 last irresistible. There are few persons who can voluntarily sus- 
 pend the breath for more than thirty or forty seconds at a time. 
 
 " Such is the manner in which the movements of respiration are 
 performed. Now let us see what happens while the air is thus 
 taken into the cavity of the chest. 
 
 " Change in the Air during Respiration. — In the first place, 
 as the air penetrates into the lungs it is robbed of its oxygen. This 
 substance disappears, so that the air which has once been drawn 
 into the chest, and again expelled with the breath, no longer con- 
 tains it in due proportion. 
 
 "What has become of the oxygen which thus disappears from 
 the air in respiration % 
 
 "It is absorbed by the blood. For the blood-vessels coming to 
 the lungs are distributed everywhere in the minute spaces between 
 the air-vesicles, and envelop their walls with an abundant vascular 
 network. If we recollect the great extent of surface represented 
 by the tissue of the lungs, we shall see that the blood circulating in 
 their vessels is spread out over a corresponding surface ; and that, 
 in a thousand minute currents, it moves through, the lungs almost 
 in contact with the air contained in the vesicles. It is as if the 
 blood were sprinkled through the air in a fine shower ; so that every 
 particle of the blood and every particle of the air are brought into 
 the closest proximity. At this moment the oxygen leaves the air 
 and enters the blood over the whole internal surface of the pulmo- 
 nary tissue. 
 
 " Change in the Blood during Respiration. — At the same time 
 a most remarkable change takes place in the blood itself. 
 
 "The blood which is distributed to the lungs is venous blood. 
 It is that which has already circulated through the organs and tissues 
 of the body, and has served for their nutrition. From them it is 
 collected by the veins, brought back to the heart, and from the 
 heart distributed to the lungs. At this time it is of a dark blue or 
 purple color, approaching to black. 
 
 "Now, as this venous blood enters the lungs and takes possession 
 of the oxygen contained in the air-vesicles, it changes from a dark 
 blue to a brilliant scarlet color. This change is instantaneous and 
 complete ; so that the blood, as it leaves the lungs on one side, is 
 entirely different in appearance from that which is entering them on 
 the other. 
 
136 ANATOMY AND PHYSIOLOGY. 
 
 " After the blood has passed through the lungs, and has changed 
 its color from blue to red, it returns to the heart, and is again dis- 
 tributed throughout the body by another set of vessels, which are 
 called the " arteries." 
 
 " Accordingly, there are always two kinds of blood in the general 
 circulation, of different colors and occupying two different sets of 
 vessels. The blood in the veins is blue, and is called Venous blood ; 
 that in the arteries is red, and is called Arterial blood. The blood 
 is also constantly changed from, venous to arterial while passing 
 through the vessels of the lungs. 
 
 "It is for this reason that the lips turn purple and the face as- 
 sumes a dark ashen color whenever the breathing is seriously ob- 
 structed. For the blood, no longer becoming arterialized, retains 
 its venous hue, and communicates a dark color to all the transpa- 
 rent and vascular tissues. 
 
 " But the change in color is not the only difference between these 
 two kinds of blood. The venous blood, which has already circulated 
 through the body, has lost its vital properties. It has expended a 
 part of its substance in the nourishment of the tissues, and is no 
 longer fit for the maintenance of life. 
 
 " What is it that the blood has thus lost in passing through the 
 tissues which is necessary to its vitality ? 
 
 " It is its oxygen. 
 • " For the arterial blood, as it passes out from the heart to be dis- 
 tributed throughout the body, carries with it the oxygen which it 
 has absorbed in the lungs. It arrives at the tissues charged with 
 this vivifying principle, and the tissues immediately seize upon it 
 and appropriate it to themselves. Thus the blood, as it passes 
 through the circulation, gives up its oxygen and returns to the 
 venous condition. There is, therefore, a double change going on 
 incessantly in the blood in the different parts of the body. In the 
 tissues it loses oxygen, and changes from red to blue ; in the lungs 
 it absorbs oxygen, and changes from blue to red. 
 
 " Action of the Blood Globules in Respiration.— -Now the in- 
 gredients of the blood which are most active in producing this 
 change are the Blood globules. It is these little bodies which take 
 the oxygen from the air, and fix it in their own substance for the 
 renovation of the blood. They are the carriers, which load them- 
 selves with oxygen in the lungs, to transport it afterward to distant 
 parts in the current of the circulation. As all the color of the blood 
 resides in them, we easily see why this color should change with the 
 changing constitution of the globules themselves. 
 
 " It is by the process of respiration, accordingly, that the blood 
 
RESPIRATION. 137 
 
 is kept constantly renovated and restored to the arterial condi- 
 tion. 
 
 " Quantity of Oxygen Consumed. — The importance of oxygen to 
 the living body is shown by the quantity which is consumed. At 
 every inspiration one cubic inch of oxygen is withdrawn from the 
 air and absorbed by the blood. This amounts in the course of an en- 
 tire day to about 17-J cubic feet, or by weight a little over one pound. 
 
 "Evolution of Carbonic Acid. — But, at the same time that 
 oxygen is absorbed from the air in respiration, another substance 
 makes its appearance in the lungs, and is expelled with the breath. 
 This is carbonic acid. It is a gas, like oxygen, but differing from 
 it in its properties. It is the same gas which is formed in the fer- 
 mentation of bread, wine, beer, and all substances containing sugar. 
 It is produced from burning coal and candles, and many other 
 combustible bodies. It is sometimes exhaled from the surface of 
 marshy pools, and often collects at the bottom of old wells. It is 
 not fit for respiration ; and when a man is accidentally caught in an 
 atmosphere composed of carbonic acid, as sometimes happens in 
 cleaning beer-vats or in repairing old wells, he at once becomes in- 
 sensible, and soon dies by suffocation. 
 
 " This gas, as we have said, is found in the breath. No less than 
 one twenty-fifth part of the air passing out of the lungs consists of 
 carbonic acid. This is immediately diffused through the atmos- 
 phere, or carried away by its movements ; and the fresh air then 
 taken into the lungs is again loaded with carbonic acid and expelled 
 in its turn. This process goes on with every successive respiration ; 
 so that in the course of an entire day the amount of this gas dis- 
 charged with the breath is nearly 15 J cubic feet, or by weight about 
 one pound and a half. 
 
 " Now the carbonic acid so produced is formed in the tissues. It 
 is absorbed from them by the blood, carried by the blood to the 
 lungs, there exhaled into the pulmonary vesicles, and finally dis- 
 charged with the breath. It is a useless and exhausted material 
 which the tissues have rejected, and which is therefore expelled 
 from the body in the process of respiration. 
 
 "Exhalation of Water and Animal Vapors with the Breath. 
 — Besides carbonic acid, the breath also contains a peculiar animal 
 vapor, which is produced in the interior of the body. Though this 
 vapor is in very small quantity, it is sufficient to give to the breath 
 a faint but perceptible odor. There is also some water discharged 
 from the lungs in a gaseous form. The breath therefore is damp ; 
 and if we breath upon a mirror, its polished surface becomes dimmed 
 from the deposit of the watery parts of the expired air. 
 
13S ANATOMY AND PHYSIOLOGY. 
 
 ANIMAL HEAT. 
 
 The temperature of the body is about 100 degrees Fahrenheit. 
 This temperature remains the same in winter and in summer, in 
 the Tropics and at the Poles. 
 
 The animal heat is not peculiar to man. It is a quality of all 
 other animals. Those animals which, like reptiles and fish, have a 
 temperature much lower than that of man, are called cold-blooded. 
 
 Animal heat is the result of all the chemical changes of nutri- 
 tion going on in the body. 
 
 Some organs of the body are warmer than others. The liver is 
 now regarded as the warmest of the organs. 
 
 Animal heat is regulated by the perspiration. 
 
 There are in the body over 2,000,000 perspiratory glands. 
 The length of tubing connected with them has been estimated 
 at two and a half miles. Through these glands the perspiration 
 is always being secreted. Most of the time it is invisible and 
 insensible. When the system becomes over-heated, the amount of 
 perspiration is increased, and evaporation ensues. Evaporation 
 produces cold, and thus the body is kept at its normal temperature 
 amid the extremes of heat and cold. 
 
 If the body from any cause is cooled down even a few degrees 
 below 100 Fahrenheit, death is the sure result. 
 
 ORGANS OF DIGESTIOK 
 
 These occupy, for the most part, the great cavity of the abdomen, and are, principally, the 
 Stomach, the Intestines, Liver, Spleen, and Pancreas, or Sweet Bread. 
 
 THE STOMACH. 
 
 The stomach is a large bag or pouch for receiving the food. It is 
 situated a little below the diaphragm, and has two muscular tubes or 
 pipes opening into it. One of these, leading from the back part of the 
 mouth down through the chest into the stomach, opens into this or- 
 gan at the left side. This tube is called the oesophagus. It runs be- 
 tween the air-tube and the spine, and conveys the food from the mouth 
 into the stomach. The stomach is a highly irritable and sensitive 
 organ, having numerous muscular fibres entering into its composition, 
 and being plentifully supplied with nerves. On its outside it is 
 covered by a membrane called peritonaeum, because it lines the abdo- 
 men, and contains the different digestive organs within its fold. This 
 
THE INTESTINES 
 
 139 
 
 membrane not only sustains those organs in their proper situations, 
 but also affords a fine mucous fluid for keeping their surfaces con- 
 stantly moist, thus 
 to prevent injuries 
 ^fi(Bii • which would other- 
 
 wise arise from fric- 
 tion. From the in- 
 ternal surface of the 
 stomach there is a 
 fluid constantly se- 
 creting, called the 
 gastric juice, which 
 has the peculiar pro- 
 perties of dissolving 
 and attenuating the 
 food before it passes 
 into the intestines. 
 
 EXPLANATION OF FIGURE IV. 
 
 o End of gullet. fg Lower or pyloric end of stomach. 
 
 c Large end of stomach. k Muscular band round pyloric end. 
 
 d Cavity of the stomach. II Folds of mucous membrane of stomach. 
 
 THE INTESTINES. 
 
 The intestines are a long membranous and muscular canal, which 
 arises from the right orifice of the stomach, and is generally five or 
 six times the length of the body, forming many circumvolutions in 
 the cavity of the abdomen,, which it traverses from right to left, and 
 again from left to right. Their structure is not unlike that of the 
 stomach, being composed partly of muscular and nervous fibres, and 
 possessing a high degree of irritability, as may be seen by their worm- 
 like motions, even out of the body after death, when pricked with a 
 needle, or otherwise stimulated. Soon after the intestinal canal goes 
 out from the stomach, an oblique opening may be perceived by which 
 the fluids from the pancreas and liver are poured into the intestine 
 for the purpose of mixing with the food as it passes downwards. 
 That the descent of the aliment may not be too rapid, by which the 
 body would be deprived of a supply of nutrition sufficient for life 
 and health, the inner coat of the intestines is thrown into a number 
 of plaits, admirably fitted to retard the progress of food, till its 
 nourishing properties are absorbed by the proper vessels. The whole 
 internal surface of the intestines is kept constantly moist by the 
 discharge of a mucous fluid, which favors the proper descent of the 
 alimentary pulp, and helps to secure these organs from injury. The 
 intestines and stomach have a structure very similar to each other ; 
 
14:0 ANATOMY AND PHYSIOLOGY. 
 
 so that the description of one applies to the other with sufficient 
 accuracy for our purposes. 
 
 They have three coats. The internal one has been described as 
 secreting a defending mucus. Here open into the cavity of the intes- 
 tines those small absorbing vessels which take up the nutritive 
 particles ; they are called lac teals. They arise from the upper 
 intestines principally. Next to this is the muscular coat, the fibres 
 of which run in two directions. The one set embraces the intestines 
 as small circular bands, or nearly so ; and their purpose is obviously 
 to shorten, by their contractions, the diameter of the intestines. 
 Other fibres take a longitudinal course and lessen its length. The 
 combined action of these fibres produces the vermicular or worm-like 
 motions, and propels the contents of the intestines downwards ; as 
 the parts are stimulated by the distention of the food. The last coat 
 is the peritonial, or investing one ; it is a common covering to all the 
 contents of the abdomen ; which it at the same time lines. To cover 
 the intestines it rises double from the spine, to which it is attached. 
 It passes some distance before it reaches the intestines. These it 
 embraces and slings in its fold, as an injured arm is slung from the 
 shoulder. Between the spine and the intestines, it is seen like a thin 
 and transparent membrane, allowing a sufficient motion to their 
 different convolutions, without permitting them to become confused 
 and entangled. 
 
 This is the mesentery, which is thus found to be a double mem- 
 brane, including between its laminae arteries and veins, nerves and 
 lacteals, all ramifying with exquisite minuteness and delicacy. 
 
 THE LIVEK. 
 
 This is the largest gland in the body, of a dusky red color, sit- 
 uated immediately under the vaulted cavity of the diaphragm, chief- 
 ly at the right side, but having the thin edge of its left lobe over 
 the right side of the stomach. Anteriorly it is convex. Posteriorly 
 it is concave. It is very thick in its superior part, and thin in its 
 inferior. The upper side adheres to the diaphragm, and is fixed to 
 this and to the breast-bone, by a broad suspending ligament. It is 
 also tied to the navel by a ligament, formerly the vein by which the 
 foetus received nourishment from the mother. 
 
 The liver secretes a dark-colored fluid called bile. For this pur- 
 pose it is supplied with a large quantity of blood. Most of the veins 
 of the other viscera of the abdomen, instead of returning their blood 
 to the heart, agreeably to the general laws of circulation, by the 
 great returning veins, run forward towards the liver, where they 
 unite in one large trunk, called vena porta, and which soon after 
 
THE LITEK. 141 
 
 enters this gland, and is ramified throughout its substance. Here 
 this great vein performs the office both of an artery and a vein ; for 
 like the latter it returns the blood from the extremities of arteries, 
 while like the former (and by a singular exception) it accomplishes 
 secretion. Besides this vena porta, which furnishes the materials for 
 the secretion of bile, the liver has an artery of large size, for the pur- 
 poses of nutrition to the organ itself ; which, it would seem, could not 
 be effected by the venous blood of the vena porta. 
 
 The bile, after being separated from the mass of blood in the liver, 
 is conveyed by very minute excretory ducts into larger ones, which 
 also convey it into one great duct or channel, and which, as we before 
 observed, opens into the intestines not far from the stomach. There 
 is attached to the lower part of the liver a little membranous bag, 
 shaped like a pear, and which, as a small reservoir, contains a por- 
 tion of the bile secreted in the liver. Its neck is continued in the 
 form of a canal, running to unite with that of the liver, when both 
 enter the intestine, and pour in their contents by a common opening. 
 With respect to the precise use of the bile physiologists are not 
 determined. It seems to perform some important part in the econo- 
 my, and especially in the conversion of food into chyle, since that 
 fluid is not separated until the pulpy contents of the stomach have 
 been mixed with bile and the pancreatic juice. It certainly stimu- 
 lates the intestines to act ; for when the entrance of bile into the 
 intestines is prevented by gall-stones or any other obstructing cause, 
 the bowels are costive. We know, too, that many of our diseases, 
 particularly those which we experience in hot climates, arise from 
 derangements of this organ. 
 
 Between two and three pounds of bile are secreted every day. — It 
 is somewhat remarkable that we have not as yet found out what is 
 the precise function of the bile. We know that it is being secreted 
 all the time, and not periodically like the gastric juice, but in the 
 largest quantity during the process of digestion. It can always be 
 detected in the intestines, before meals as well as immediately after. 
 
 It does not seem to aid digestion. — Its own elements are changed, 
 transformed in the intestines, and are then absorbed and taken into 
 the circulation. The secretion and flow of the bile are necessary to 
 life. Experiments on animals have shown that if the flow of bile 
 into the intestines ceases, weakness and death are the result. 
 
 The production of sugar. — Sugar is produced in the liver, is ab- 
 sorbed by the blood-vessels of that organ and mingles with the blood 
 in the hepatic veins. This sugar is soon decomposed in the circu- 
 lation. * Carnivorous animals, that eat no starch, yet have sugar 
 formed in the liver. 
 
142 ANATOMY AND PHYSIOLOGY. 
 
 The liver is a very large and important organ, but it is hardly 
 worthy of the importance that is sometimes given to it. It is charged 
 with being the cause of most of the maladies of the human race. 
 All this comes from our ignorance. We as yet know but very little 
 about the liver. We know that it produces bile and produces sugar. 
 The precise functions of this bile and sugar we do not know. 
 
 THE PANCREAS. 
 
 This is a gland, in structure similar to the salivary glands. It is 
 placed behind the bottom of the stomach, towards the first vertebra 
 of the loins, w T ith one end pointing towards the spleen, and its other 
 extremity extending forwards. It is about eight inches in length, 
 two or three broad, and one in thickness ; has a yellowish color, 
 inclining to red, and secretes a fluid resembling the saliva, by a duct 
 which enters the intestine, together with the biliary canal. 
 
 THE SPLEEN. 
 
 The spleen is situated immediately under the diaphragm, above 
 the left kidney, and between the stomach and ribs. Its use is un- 
 known. So unimportant, however, is its function in the animal 
 economy, that Cheselden asserts it may be taken from dogs without 
 any marked inconvenience. A case has been recently reported 
 where the spleen was entirely removed, yet the patient lived and 
 recovered. 
 
 The spleen is an organ that has been very much slandered. By 
 the ancients it w T as supposed to be the seat of melancholy ; and even 
 now the words " spleeny," " splenetic," are used to signify a per- 
 son of a grouty or ugly disposition. But modern research has 
 made it more than probable that the brain and nervous system, or 
 sympathetic nerve, are at fault in hypochondria and melancholy. 
 
 We do not know that diseases of the spleen ever directly cause 
 the " blues," although it is by no means impossible that they may 
 do so. The truth in the matter probably is, that the same diseased 
 condition that causes the spleen to be diseased, also causes the ner- 
 vous system to be deranged. 
 
THE OMENTUM OK CAWL. DIGESTION. 
 
 143 
 
 THE OMENTUM OR CAUL. 
 
 There is a broad, thin, and transparent membrane arising from 
 the inferior border of the stomach, 
 and reaching down as far as the 
 navel ; it is every where double, 
 consisting of two thin mem- 
 branes, joined by cellular texture, 
 in the cells of which great quan- 
 tities of fat are sometimes depo- 
 sited. The secretion of this fat 
 is performed in the most simple 
 manner. The fat is distributed 
 very unequally in this membrane, 
 it being in some places quite thin 
 and transparent, and in other pla- 
 ces above an inch thick. The caul 
 of calves gives a beautiful repre- 
 sentation of this fact. 
 
 The use of the caul is princi- 
 pally to interpose itself between 
 the peritoneum, the intestines, 
 and the stomach, to keep all these 
 parts moist, warm, slippery, and 
 to prevent their adhesion. 
 
 EXPLANATION OF FIGURE V. 
 
 REPRESENTING THE VISCERA OP THE CHEST AND ABDOMEN. 
 
 1. The Trachea or Windpipe, before it divides 
 to plunge into the substance of the Lungs. 
 
 2. The internal Jugular Vein returning the Blood 
 from the inside of the head. It joins the 
 
 3. Subclavian Vein, conveying the Blood which 
 has circulated through the Arm ; both form a com- 
 mon trunk, the 
 
 4. Descending Cava, which pours its contents 
 into the 
 
 5. Right Auricle of the Heart, which receives 
 also the Blood from the rest of the body by a large 
 Venous Trunk, the Ascending Cava, not to be seen 
 in this view. 
 
 6. The Right Ventricle. The Left Ventricle 
 cannot be seen, as it is situated behind the parts 
 now in view. 
 
 7. The Aorta, or Great Artery of the Body. 
 
 8. The Right Lobe of the Lungs, part of which is 
 cnt off to show the great Blood-vessels ; as is the 
 Mediastinum, a Membranous Partition between the 
 two Lobes of the Lungs, and dividing the Chest into 
 two distinct cavities. 
 
 The Pericardium also is removed to show the 
 Heart more distinctly. 
 
 9. The Left Lobe of the Lungs. 
 
 10. The Diaphragm, or great Muscle of Respira 
 tion, separating the Chest from the Abdomen, and 
 upon which the Heart is seen to rest in its natural 
 position. The Diaphragm is observed to be convex 
 towards the Chest, and when we inspire this con- 
 vexity is lessened, so that the Cavity of the Chest is 
 lengthened ; the Intestines are pushed down, and 
 are protruded at the same time, because the Ab- 
 dominal Muscles are then relaxed. 
 
 11. The Liver, which is suspended to the Dia- 
 phragm by a Ligament. 
 
 12. The Round Ligament, or what was the Um- 
 bilical Cord before birth ; now rendered solid. 
 
 13. The Gall Bladder. 
 
 14. The Stomach pressed to the left side by the 
 Liver. 
 
 15. The Small Intestines. 
 . 16. The Spleen. 
 
 DIGESTION. 
 
 The processes of Digestion. — Digestion is a complicated process. 
 
144 ANATOMY AND PHYSIOLOGY. 
 
 The first division of the alimentary canal is the mouth. Here takes 
 place the process of mastication. By the action of the teeth the 
 food becomes thoroughly chewed, triturated, and divided. By the 
 saliva it becomes thoroughly moistened. This saliva is secreted in 
 glands situated in front of the ear, under the jaw and the tongue. 
 The saliva flows at all times, and keeps the mouth moist, but it 
 flows in much larger quantities when the operation of chewing is 
 going on. Were it not for this process of mastication solid food 
 would not reach the stomach in a condition to be easily digested. 
 
 It is the opinion of Dr. Austin Flint, Jr., that the saliva converts 
 some of the starch of the food into sugar. 
 
 About three pounds of saliva are secreted by every adult daily. 
 
 2. Swallowing. —The oesophagus is a tube extending from the 
 throat to the stomach. The food is carried down through this tube 
 involuntarily, by the action of the muscles. Sometimes, in " swallow- 
 ing the wrong way," the food gets behind the little valve that pro- 
 tects the opening of the wind-pipe, and then w T e cough and hack 
 until the particle is expelled. 
 
 3. Action of the Stomach. — The stomach is composed of muscles 
 and of a lining membrane. The membrane is filled with tubules, out 
 of which gastric juice is poured as soon as the food enters the 
 stomach. 
 
 Action of the muscles of the Stomach. — The muscles of the stomach 
 are partly circular, partly longitudinal. The presence of food in 
 the stomach not only excites the flow of the gastric juice, just as it 
 excites the flow of saliva in the mouth, but also stimulates the mus- 
 cular coat into action, just as it stimulates the muscles of the oesopha- 
 gus into action and produces involuntary swallowing. 
 
 .This action of the muscles of the stomach is to produce a kind of 
 churning motion, and is called the peristaltic action. The effect of 
 this action of the muscles is to aid the secretion of the gastric juice, 
 and to cause it to thoroughly mix with the food. 
 
 The gastric juice is composed of water, pepsine, lactic acid, and 
 some albuminous and mineral ingredients. The action of this juice 
 on the food is to reduce the albuminous substances of the food to w T hat 
 is called albuminose. The starchy and oily portion of the food is un- 
 changed in the stomach. As fast as the albuminous substances be- 
 come transformed into albuminose they pass out of the stomach, in 
 the form of chyme, into the small intestines. 
 
 This chyme consists : 
 
 1. Of the albuminose, mixed with gastric juice. 
 
 2. Of the starchy matters of the food. 
 
 3. Of the oily matters of the food. 
 
THE CHYLE TO BE MIXED WITH THE BLOOD. 145 
 
 The intestines secrete what is called intestinal juice. The 
 action of this is to change the starch of the chyme into sugar. 
 
 PANCREAS AND PANCREATIC JUICE. 
 
 The pancreas, an organ situated behind and below the stomach, 
 secretes pancreatic juice. This is poured into the intestine, acts 
 upon the oily portion of the food, and changes it into an emulsion 
 called chyle. 
 
 The food is carried down by the peristaltic action of the mus- 
 cular coat of the intestines. This muscular coat is composed of cir- 
 cular and longitudinal layers, and their action is analogous to the 
 peristaltic action of the oesophagus and of the stomach. 
 
 COMPLETION OF DIGESTION LN THE INTESTINES. 
 
 The process of digestion is completed in the intestines. As fast 
 as the food becomes thoroughly digested, it is taken up by the 
 absorbents and carried into the circulation. The substances which 
 are not digestible are carried into the large intestine, and rejected 
 from the system. When digestion is not well performed, constipa- 
 tion or diarrhoea may result. Therefore, in order to cure them, it 
 is necessary to cure the indigestion of which they are the results. 
 
 The digestion is very much influenced by the condition of the 
 mind. Many years ago, Dr. Beaumont had a patient with a per- 
 manent gunshot wound in his stomach, through which he could 
 easily watch the processes of digestion. 
 
 He observed that bad news, or anything that made a disagree- 
 able impression on the mind, arrested the secretion of the gastric 
 juice, and consequently interfered with digestion. ' We all know 
 by experience that mental distress or annoyance impairs the appetite 
 and brings on attacks of indigestion. Dyspepsia is therefore very 
 frequently the result of over-work and over-worry. 
 
 COURSE OF THE CHYLE TO BE MIXED WITH THE BLOOD. 
 
 The intestines, as we have observed, are generally five or six 
 times the length of the body, and their internal surface is increased 
 by the plaiting of its internal coat. From a large proportion of this 
 great surface the new-formed chyle is constantly absorbed by the 
 lacteals, which are minute transparent vessels, arising in infinite 
 number from the inner surface of the intestines. 
 
 These vessels imbibe their chyle by absorption ; for this nutritious 
 fluid, being pressed against their mouths in the various motions of 
 the intestine, acts as a stimulus, when these delicate and highly 
 10 
 
1-iG ANATOMY AND PHYSIOLOGY. 
 
 sensitive organs contract, and propel the fluid forwards beyond the 
 first set of valves, which prevent its return. It would seem, how- 
 ever, that those orifices of the lacteals act by some other power 
 besides capillary attraction, inasmuch as they select the chyle from 
 the rest of the chyme, and do not take up some fluids that have been 
 introduced into the intestines for the purpose of experiment. Thus 
 the lacteals perform absorption in the same manner as do the lym- 
 phatics ; nor is there any difference in the construction or functions 
 of these vessels. There is however a difference in the color of the 
 fluids which they convey. 
 
 From the intestines the lacteal vessels convey the chyle along the 
 membrane called mesentery, which extends from the intestine to the 
 spine, to sustain the former in its proper place. Here they may be 
 easily seen in an animal killed two or three hours after feeding, for 
 then they are distended with the new, white chyle, which is going 
 forwards into the circulation. Passing through this membrane, the 
 lacteals run onwards to the thoracic duct. Into this duct the lacteals 
 empty their contents. Soon after, mixing with the lymph, conveyed 
 to this tube from the various parts of the body, both fluids are carried 
 along the thoracic duct to its opening into the vein, and there are 
 poured together into the circulation. Before it reaches the thoracic 
 duct, the chyle enters one or more glands, where it undergoes some 
 unknown change. These glands are attached to every part of the 
 absorbent system ; more especially to the lacteals. They are very 
 numerous at the root of the mesentery. 
 
 The chyle now mixing with the blood becomes soon assimilated. 
 From the vein where it enters, it is carried directly to the right side 
 of the heart, whence it is propelled into the lungs, to imbibe the 
 oxygen or vital portion of the atmospheric air, and to part with some 
 of its carbon ; returning to the heart again, now formed into perfect 
 blood, it is forced by the left side of this organ along the arterial tubes, 
 to distribute life and health to every part. 
 
 NUTRITIVE CHANGES WITHLN THE BODY. 
 
 These are of three kinds, Assimilation, Secretion, and Excretion. 
 
 Assimilation is the making of the food into tissues. The tissues 
 of the body vary in their composition, and the chyle which is made 
 from the food is different from the tissues. Each tissue takes from 
 the blood just what of the inorganic substances it needs for its own 
 nutrition. 
 
 Each tissue also takes from the blood just what organic sub- 
 stances it needs, and converts it into its own substance. 
 
EXCRETION. 14:7 
 
 In tins way, by this perpetually recurring miracle, the body is 
 nourished. It is marvellous chemistry, and seems to be almost past 
 our finding out. 
 
 Secretion is also a wonderful process. Secretions come from the 
 blood, are prepared in certain organs, for certain purposes. The 
 bile, the gastric juice, the tears, the saliva, the mucus of mucous 
 membranes, the perspiration, the wax of the ear — all these are secre- 
 tions. 
 
 Secretions are formed in glands. These glands are composed 
 of follicles grouped together. 
 
 EXCRETION. 
 
 Every act, every thought, every feeling, is attended by a change 
 of tissue. This change of tissue causes necessarily waste. The 
 effete products of these changes are called excretions. Excretion is 
 as healthy a process as assimilation or secretion. It is the elimination 
 of the waste matters from the system. 
 
 The principal excretions are : 
 
 1. Urea. — This is found in the blood, and is excreted by the 
 kidneys to the extent of about one ounce per day. The amount 
 varies with the constitution of each individual and with the amount 
 of work that is done. 
 
 2. Carbonic Acid. — This is exhaled by the lungs, together with 
 some watery vapor. 
 
 The presence of carbonic acid and this watery vapor, together with 
 the perspiration, makes the air of crowded assemblies so disagreeable 
 and pernicious. 
 
 Besides urea and carbonic acid and w T atery vapor of the lungs 
 and skin, there are the faeces, and there are also found in the urine 
 urate of soda, creatine, creatinine, and various salts. 
 
 It is estimated that seven pounds of material are absorbed and 
 discharged every clay by a man of average size and in good health. 
 In about 20 or 25 days a quantity equal to the whole body passes 
 through the system. 
 
 THE KIDNEYS. 
 
 There are two glandular bodies, situated in the loins, contiguous 
 to the two last short ribs, and lying close to the spine ; the right 
 under the liver, and the left under the spleen. 
 
 In each kidney three kinds of substance may be distinguished. 
 
14:8 ANATOMY AND PHYSIOLOGY. 
 
 The outer part is glandular, beyond this is tubular, and the inner 
 part is papillary or membranous. 
 
 The kidneys drain the system of its redundant water. For this 
 purpose a considerable portion of the blood is constantly passing into 
 each kidney by an arterial branch, which runs directly from the 
 aorta or main artery of the body into this organ. Here, in the 
 glandular part of the kidney, the blood undergoes a change, having 
 its superfluous water, together with some saline bodies, separated, 
 and is itself again returned to the circulation by means of a vein 
 which goes to the great ascending vein of the body. The water 
 being now strained from the blood is conveyed by an infinite number 
 of small tubes, constituting the second substance of the kidney, out 
 of its glandular part. These tubes, as they approach the inner sub- 
 stance of the kidney, gradually unite together ; and thus forming 
 larger canals terminate at length in ten or twelve little protuberances, 
 called papillae, the orifices of which may be seen with the eye. 
 These papillae open into a small reservoir, called the pelvis of the 
 kidney, and formed by a distinct membranous bag which embraces 
 the papillae. The water being conveyed by the different tubes into 
 the reservoirs of the kidneys is farther conducted by two large mem- 
 branous canals, each about the size of a common writing-pen, and 
 which go out from the hollow sides of the kidneys. These canals 
 open into the back and under part of the bladder, whither they convey 
 the redundant water of the system, and where, as in a great reser- 
 voir, it remains till a quantity is collected sufficient to induce a contrac- 
 tion of this organ, by which the contained fluid is necessarily expelled. 
 
 The bladder is a hollow, membranous, and muscular organ, 
 situated at the bottom >ri the abdomen, immediately above the ossa 
 pubis. 
 
 It is lined by a membrane which is defended by a mucus secreted 
 from its inner surface. Next to this is its muscular coat, formed of 
 fibres running in various directions, to contract it when filled, and to 
 empty it completely. The outlet of the bladder is called its neck. 
 Here the muscular structure is more obvious, and by the action of 
 its fibres, which embrace the organ, the passage is closed until the 
 bladder is so distended, that the muscles of its upper part by their 
 contraction overcome those at the neck of the bladder, and expel the 
 urine. 
 
 The canals conveying the urine from the kidneys, are called 
 ureters. By a very sample but effectual mechanism, they convey 
 their contents without a possibility of their being returned, merely 
 by passing obliquely about half an inch between the muse alar and 
 inner coats ; which oblique entrance answers the purpose of a valve. 
 
THE UTERUS AND ITS APPENDAGES 14:9 
 
 Part of the bladder is covered by the lining membrane of the 
 abdomen ; which having descended to the lower and fore-part of that 
 cavity, is reflected upwards over the top of the bladder. The neck 
 of the bladder leads to the uretha or canal, which guides the urine 
 altogether out of the body. 
 
 The kidneys and bladder are the seats of a most distressing 
 disease, when calculi or stones are deposited from the urine, either 
 by a constitutional tendency, or from the presence of a nucleus, on 
 which the matter is incrusted. Any part of the urinary system may 
 contain them. They are much more commonly found in the bladder. 
 They may be removed by an operation, the most formidable, and the 
 most painful one in surgery. It consists in making an artificial 
 opening near the neck of the bladder, and extracting the irritating 
 substance. 
 
 Happily, much talent and skill have combined to render this one 
 of the most successful and beneficial operations practiced by the 
 
 THE UTEKUS AND ITS APPENDAGES. 
 
 The uterus, in form and bulk, resembles a middle-sized pear. 
 The broader part is called its fundus, the narrower extremity is its 
 neck, which is its lower part, and is closed by a chink leading 
 to the vagina, or canal communicating with the outside of the 
 body. 
 
 The uterus is placed immediately behind the bladder. 
 
 Besides its lower orifice there are two smaller ones leading from 
 its fundus, on each side, to corresponding tubes, which are called the 
 uterine tubes, and which terminate at a short distance in open 
 mouths. The extremities of these tubes have several small finger- 
 like projections, which are loose, and allow of their grasping any body 
 to which they may become attached. These tubes are bent towards, 
 (without,, however, being attached to,) two small bodies of an egg-like 
 form, placed on each side the uterus, called ovaries. These are firm, 
 
150 ANATOMY AND PHYSIOLOGY. 
 
 and without any cavity, but they have several small vesicles im- 
 bedded in their substance. 
 
 The uterus, its ducts, and the ovaries, are connected together, 
 and covered by an enveloping fold of the peritoneal membrane, which 
 after having covered the top of the bladder, descends in order to re- 
 ascend over the uterus, and to be continued over its whole surface 
 and its appendages. 
 
 PREGNANCY. 
 
 When an intercourse takes place between the sexes, the whole 
 uterine system experiences a peculiar excitement. The fibrous ex- 
 tremities of the uterine tubes grasp the ovaries, and squeeze out of 
 them one of the small bodies we have described. This is the origin 
 of the foetus, and is conveyed into the uterus along the channel, 
 probably by a muscular power. Then the female constitution expe- 
 riences striking changes. The monthly indisposition is stopped. 
 The uterus gradually enlarges to a prodigious size, and a far greater 
 quantity of blood circulates through its vessels. Its internal surface 
 pours out lymph, which is the bond of union between it and the 
 vesicle, previously detached from the ovaries ; for blood-vessels shoot 
 into it from the uterus, and enlarge its dimensions. It is now called 
 the ovum. "When it is large enough to enable us to distinguish its 
 parts, we find it consists of membranes containing a fluid, in the 
 midst of which floats the foetus ; at first gelatinous and shapeless. 
 Gradually its parts are developed, and we find that one extremity of 
 the ovum is attached to the uterus by a thick and spongy mass. 
 This is the placenta, the organ through which the future infant re- 
 ceives its nutrition in the womb. From the centre of the placenta a 
 cord is continued to the navel of the foetus, along which run the 
 trunks of the vessels of which the placenta is made up. 
 
 Usually, when nine months have elapsed, the muscular fibres of 
 the uterus contract upon their contents, and labor commences. The 
 lower orifice of the womb, (during pregnancy sealed by lymph,) now 
 gradually opens. The cone-like form which the membranes of the 
 ovum assume, acts as a wedge, when their fluid contents are pushed 
 against the orifice, by the contraction of the uterus. While the 
 opening dilates, the membranes burst, the fluid runs off and lubri- 
 cates the passage. 
 
 The dimensions of the head are nearly proportioned to those oi 
 the outlet, and it can escape with facility only in one direction. 
 
 The structure of the head, being made up of many pieces, en- 
 ables it to be moulded to the outlet. The bones overlap each other, 
 and the size of the head is much lessened. When the head is released, 
 
THE FCETTJS, AND ITS CHANGES 
 
 151 
 
 the great difficulty of labor is accomplished, and the infant is quickly- 
 born. The placenta and membranes usually follow the child in a 
 few minutes. The uterus contracts, and is soon reduced to its for- 
 mer size: 
 
 THE F03TUS, AND ITS CHANGES. 
 
 The entrance of the infant into the world is accompanied with 
 great changes in its mode of existence, and with curious alterations 
 in its internal structure to fit it for its new situation. 
 
 In one word, it is now a breathing animal instead of floating in a 
 fluid. 
 
 Part of its organization is rendered superfluous, and gradually 
 disappears ; while other parts, which, in its original state, were inac- 
 tive and useless, are now called into immediate use. 
 
 The more striking changes we have hinted at, are connected with 
 the circulation of the blood, and the state of the lungs. These it will 
 be interesting to point out. 
 
 The placenta, before mentioned, the organ by which the foetus re- 
 ceives from the maternal blood what is necessary for its growth, is 
 composed of blood-vessels, yet these, it is to be noted, do not com- 
 municate directly with those of the mother ; and the mode of com- 
 munication is still a mystery. The cord which connects the placenta 
 to the navel of the foetus, is called the umbilical cord. It has gener- 
 ally three blood-vessels twining around it, namely, two arteries, and 
 one vein. If this cord is by accident torn asunder after birth, and 
 the dividing end towards the foetus is not bound up, the infant bleeds 
 to death ; but the mother does not lose blood, although the placenta 
 should be still attached to the uterus, and that end of the cord un- 
 tied. The vein conveys the blood from the mother to the foetus, 
 after it has gone through a process in the placenta, analogous to that 
 which the lungs perform after birth ; and, probably, it is by the same 
 means supplied with new materials for the nutrition of the foetus. 
 The arteries bring the blood from the navel to the placenta, where 
 they branch out very minutely, and are exposed to the influence of 
 the maternal blood in cells contained in the substance of the placenta, 
 from which the small ramifications of the umbilical vein arise. 
 
 The vein enters the foetus at the navel, conveys its blood by a 
 peculiar passage, termed the " venous canal," to the great vein, the 
 vena cava, near to the heart. It enters the right auricle, and part of 
 it passes by an oval hole into the left auricle. This opening (like the 
 
152 ANATOMY AND PHYSIOLOGY. 
 
 before-mentioned canal,) is peculiar to the foetal state. It is in 
 tended to avoid the circuitous course through the lungs ; these being 
 now dense, compact, and impermeable to so much blood ; for they 
 are not yet inflated by respiration. Still, however, part of the blood 
 enters the right ventricle ; too much it would seem to find a passage 
 through the lungs. On this account there is another canal provided, 
 (termed in contradistinction to the former, the arterial,) connecting 
 the pulmonary artery with the aorta. Therefore when the right ven- 
 tricle forces its blood into the pulmonary artery, which leads to the 
 lungs, part of it passes directly into the aorta without entering these 
 organs, while a very small portion circulates through them. 
 
 In one of these two ways, all the blood gets to the left side of the 
 heart, to circulate through the foetal system. It enters the aorta, 
 and just below the branching of that- vessel in the pelvis two arteries 
 originate (the umbilical) which pass out at the navel to carry the 
 blood to the placenta. 
 
 Having traced the circuit which the blood takes, we find this 
 peculiarity ; (which the foetus has, in common with many animals, 
 particularly the amphibious ;) that it is not furnished with pure arte- 
 rial blood in its arteries ; for the umbilical vein mixes its pure blood 
 with that of the vena cava before it gets to the left side of the heart, 
 which dilutes it with venous blood. 
 
 Yet it is partly arterial blood which is conveyed by the umbili- 
 cal arteries to the placenta, for it has not all circulated through the 
 system, and thus become venous. This state of the blood always 
 exists in frogs. These animals have (strictly speaking) but one 
 heart ; viz : an auricle and a ventricle. An artery rises from the 
 ventricle, and branches into two ; one goes to the lungs, the other is 
 distributed through the body of the animal. The pulmonary artery 
 brings back its now altered blood from the lungs towards the auricle, 
 where it is mixed with the venous blood returning from all parts of 
 the system ; so that here also, as in the human foetus, the blood is 
 never purely arterial, nor purely venous. 
 
 In man and quadrupeds after birth the blood is carried to the 
 lungs, and is purely venous blood, and circulates through their bodies 
 when wholly arterialized. The reason for this remarkable difference 
 is not ascertained ; excepting, indeed, that there seems to be a pretty 
 uniform connection between imperfect arterialization of the blood 
 and languid exertion of the powers of life, as well as the converse of 
 the proposition. 
 
 The foetus also may be considered as having one heart, while the 
 infant, when born, may be said to have two ; one belonging to the 
 lungs, and one to the general system. The communication by the 
 
INTEGUMENTS OF THE BODY. 
 
 153 
 
 oval hole in the foetus, renders the heart in effect single, and its 
 closure perfects the two circulations. In fact the right auricle and 
 ventricle are of no use to the foetal system ; they are provided for 
 the future wants of the child, and 
 particularly for its breathing state ; 
 being wholly connected with the 
 lungs, which are quiescent. When 
 the connection with the placenta 
 is cut off, the lungs come into play ; 
 breathing takes place, and the 
 blood rushes through them. The 
 venous and arterial canals, to- 
 gether with the oval hole, are su- 
 perseded by new channels ; the 
 latter is closed up, and the former 
 are gradually changed to solid 
 ligaments, instead of being hollow 
 tubes. 
 
 New supplies of food are now 
 requisite, a bland, nutritious, and 
 annualized fluid, is secreted in the 
 mother's breasts ; and nature, uni- 
 formly benevolent, has rendered 
 the duties of a mother a source 
 of exquisite gratification. 
 
 EXPLANATION OF FIGURE V 
 
 JWORRi-BRn 
 
 EXHIBITING THE DEEPER VISCERA OF THE ABDOMEN, BY THE REMOVAL OF THOSE FIRST IN VIEW. 
 
 1. The under Surface of the Liver. 
 
 2. The round Ligament by which the Liver is 
 raised. 
 
 3. The Gall Bladder. 
 
 4. The Pancreas, lying upon and across the 
 Spiue. 
 
 5. The Spleen. 
 
 6. The Kidneys. 
 
 7. The Descending Aorta. 
 
 8. The Ascending Cava. 
 
 9. The Vein which return's the blood from the 
 Kidney. 
 
 10. A Probe. 
 
 11. The Ureters, which carry the Urine from the 
 Kidneys to the Bladder. 
 
 12. The Great Artery and Vein dividing into 
 smaller vessels to go to the Lower Limbs. 
 
 13. The Lower Intestine, the Rectum. 
 
 14. The Bladder. 
 
 INTEGUMENTS OF THE BODY, 
 
 AND THEIR APPENDAGES. 
 
 The human body is protected and ornamented by a strong, 
 pliable, and sensitive covering, which not only defends the parts un- 
 derneath from external injuries, but also gives symmetry and beauty 
 
154 ANATOMY AND PHYSIOLOGY. 
 
 to the figure. This covering consists of several parts, each having 
 its peculiar use and structure. 
 
 We begin with that which lies immediately above the muscles, 
 or flesh, and which presents itself to view on removing the skin. 
 
 THE CELLULAR MEMBRANE AND FAT. 
 
 Between the skin and the muscles, (or flesh,) and the fibres of 
 each muscle, is interposed a loose, oily substance. It is continued 
 without interruption over the whole exterior of the muscles, filling 
 up their depressions, and affording a smooth and regular surface for 
 the skin to lie upon. This substance is composed of a cellular tex- 
 ture and fat. The latter is fluid in the body, and is deposited in the 
 cells of the former, for facilitating muscular motion. Though found 
 in the greatest quantity in the cells of the membrane, filling up the 
 space between the most external muscles and the skin, it may be 
 met within several other parts of the body. 
 
 The cellular membrane, which contains this fat, is not confined 
 to any particular part, but is to be found at every point of the body. 
 Its use and importance are very great. It serves as a bond of union, 
 by tieing and fastening all the parts together ; (yet in such a manner 
 as not to prevent or obstruct their necessary motions ;) to contain fat, 
 as under the skin and other places, or, marrow, or serum, or a thin 
 vapor, to render parts smooth, moist, and flexible ; and to hinder 
 them from growing together. It yields a commodious way, or road, 
 for vessels and nerves to glide along. It furnishes a considerable 
 part of the linings of the great cavities of the body, and immediately 
 covers and envelops each particular viscus of the body. 
 
 Fat is deposited very unequally throughout the body. Among 
 the viscera it is sometimes in great abundance, particularly where a 
 constant and equable motion is required. Hence the heart is im- 
 bedded in a cushion of fat, and well defended from agitation or 
 interruption. The intestines slide over one another with great facility, 
 owing to the masses of this substance which are interspersed among 
 them. On the outward surface of the body, between the flesh and 
 the skin, it is more uniformly diffused ; although even here it is in 
 in some parts more abundant than in others ; as on the soles of our 
 feet, where it serves as a cushion on which the frame rests. It fills 
 up the chinks and crevices of the muscles, and gives that gently 
 undulating outline to our bodies, on which the beauty of the human 
 form depends. The artist finds extreme difficulty in endeavoring to 
 trace its flowing curves even when we are at rest, and still more to 
 seize its flitting forms in the rapid succession of our motions, or in 
 the greatest efforts of the muscular power. The fat undoubtedly 
 
THE SKIN. 155 
 
 answers other purposes. It defends the parts of more delicate or- 
 ganization from external impressions that would injure or destroy 
 them. It protects them from heat and from cold. 
 
 In health and middle age it is accumulated, perhaps, for the 
 supply of the system, when other sources fail. Hence it is absorbed 
 in disease, and taken into the circulation. In old age its quantity 
 lessens, when the appetite and the other functions give way. 
 
 THE SKIN. 
 
 The skin covering the human body is found to consist of three 
 separate parts or layers, which lie in close contact with each other, 
 and adhere by r leans of numerous small vessels, and fibres which 
 pass from one to the other. 
 
 The first layer is called the cutis, or true skin, to distinguish it 
 from the scarf-skin, which is external to it. The cutis is spread 
 immediately upon the adipose (fatty) membrane which we have 
 described, and is always white whatever may be the complexion. 
 This skin is exceedingly vascular, and is endowed with exquisite 
 sensitiveness, being supplied with numerous nerves, whose papillse 
 stand out, and are the seat of feeling, as we have observed. It is 
 extremely elastic, stretching, as in dropsy, many feet. After tapping, 
 it returns nearly to its natural dimensions. It is thickest in those 
 parts intended by nature to bear weight or pressure, as on the back, 
 the soles of the feet, and the palms of the hands. It is thinner on the 
 fore-part of the body, on the inside of the arms and legs, and where 
 its surfaces touch opposite surfaces. On the lips it is extremely thin, 
 so as to allow the color of the blood to shine through them. Under 
 the inferior surface of this skin, are situated numerous small glands. 
 They secrete an oily fluid, which they pour out upon the external 
 surface of the skin, by means of excretory tubes, to keep it soft and 
 flexible. 
 
 It is this skin in animals, which being prepared by tanning, con- 
 stitutes what is called leather. 
 
 Immediately on the surface of the true skin, between it and the 
 scarf-skin, is interposed a mucous substance, on which, as we have 
 said, depends the color of the body. It is black in the Negro, of a 
 copper-color in the Mulatto, brown in the Egyptian, white in the 
 Albino, and in the inhabitants of cold climates. With us it becomes 
 brown in those exposed to the beams of the sun, and particularly so 
 when reflected from the surface of the water, as in a sea voyage, or 
 Irom the white sands, as in Africa. The color of this mucus is 
 transmitted from parents to their children, but is capable of great 
 modifications. The offspring of a black man by repeated intermarriages 
 
156 ANATOMY AND PHYSIOLOGY. 
 
 with white women, will in the fourth generation become perfectly 
 white, and the converse of this is equally true. 
 
 Externally tc this mucous membrane lies the cuticle or scarf-skin. 
 It is a fine transparent, but insensible membrane, every where invest- 
 ing the body, and is the part of the skin which is raised in the form 
 of bladders, by the operation of a blister. The u"se of this last cover- 
 ing of the body is to protect the delicate nervous fibres, which stand 
 out from the true skin, from the external air ; and also to modify 
 their too great sensibility, by interposing itself between them and 
 the body in contact. The cuticle is perforated by innumerable pores 
 for the passage of the perspirable matter, as will be shown in the 
 next article. 
 
 PERSPIRATION. 
 
 An important office of the skin, on the due accomplishment of 
 which health very much depends, is to exhale from the body a part 
 of the watery fluid it contains. For this purpose it has innumerable 
 excretory vessels opening upon its surface. 
 
 That this exhalation, though frequently insensible, is perpetually 
 going on, appears evident from a variety of phenomena. Hold a 
 polished, dry, clean, rubbed, piece of metal, close (without touching) 
 to any bare part of the body, in warm weather, and it will be quickly 
 sullied. Wipe it clean and dry, and hold it again to the part, and 
 the same effect will be constantly renewed. Put your naked arm 
 into a wide-mouthed chemical glass vessel, very dry, and you will 
 soon see the internal surface of the glass dimmed with the exhalation 
 from the limb ; and if it be kept long enough within the glass, there 
 will be seen streaks of moisture trickling down its sides. 
 
 From this experiment it is evident that the matter of perspira- 
 tion has water for its basis, and that this water is constantly flying 
 off in subtle vapor ; or when the action of the perspirable vessels 
 becomes increased either by exercise or heat, the perspiration becomes 
 more sensible, and is seen to exude from the skin in large quantities. 
 
 The uses of perspiration are to free the blood from its redundant 
 water; to expel from the body those particles, which by repeated 
 circulation, have become acrimonious ; and to cool, and regulate the 
 heat of the system, by keeping up a constant evaporation. 
 
 Besides these exhaling vessels, the skin, (as we before observed,.) 
 is full of the mouths of lymphatic vessels. They constantly inhale 
 their vapors from the surrounding air, when it is not very cold ; but 
 more especially when the air is damp, the body unexercised, and the 
 mind oppressed with grief. This absorption of the skin is proved by 
 the operation of medicine pervading the air, or applied to the skin ; 
 
THE NAILS. — THE EAIE. 157 
 
 such as the vapors of mercury, turpentine, &c, by the fatal effects 
 of contagious or other poisons entering through the skin, and by 
 other facts. 
 
 The quantity of this inhaled matter in animals it is difficult to 
 ascertain, because it is not known how far the lungs are concerned 
 in this process of irfhalation and exhalation. 
 
 It is a matter of greater certainty that the skin acts upon the air, 
 as the lungs do, in depriving it of its oxygen, and in loading it with 
 fixed air ; so that it would seem to co-operate with them in changing 
 venous into arterial blood. 
 
 THE NAILS. 
 
 Their origin is a subject of dispute ; yet they seem to possess 
 many properties in common with the scarf-skin; like it they are 
 neither vascular nor sensible, and when the scarf-skin is separated 
 from the true skin by any means, the nails come away with it. 
 They appear to be composed of different layers, of unequal size, ap- 
 plied one over the other. Each layer seems to be composed of longi- 
 tudinal fibres. 
 
 In each nail we distinguish three parts, viz. : the root, the body 
 or middle, and the extremity. The root is a soft, thin, and white 
 substance, terminating in the form of a crescent ; the scarf-skin 
 adheres very strongly to this part ; the body of the nail is broader, 
 redder, and thicker, and the extremity is of still greater firmness. 
 The nails increase from their roots, and not from their upper extrem- 
 ity. Their principal use is to cover and defend the ends of the fingers 
 and toes from external injury ; they also strengthen those parts ; and 
 prevent their bending backwards when applied with force against 
 any hard resisting body. 
 
 THE HAIR. 
 
 It arises from distinct capsules or bulbs seated in the cellular 
 membrane under the skin. Some of these bulbs inclose several hairs, 
 but more generally each hair has its own particular bulb. The hairs, 
 like the nails, grow only from below by a regular propulsion from the 
 root, where they receive their nourishment. Their bulbs, when 
 viewed with a microscope, are found to be of various shapes. In the 
 head they are roundish, and in the eye-brows oval. Each bulb seems 
 to consist of two membranes, between which there is a certain quan- 
 tity of moisture* "Within the bulb the hair separates into three or 
 four fibrillse (small fibres.) The bodies of the hairs, which are the 
 parts without the skin, vary in softness and color according to the 
 
 * For illustrations and further explanations see Diseases of Hair. 
 
158 ANATOMY AND PHYSIOLOGY. 
 
 difference of climate, age, or temperament of body. They afford a 
 light and ornamental covering to the head ; serve as a defence to the 
 delicate organs of vision, as in the case of the eyelids and brows ; 
 and also greatly adorn the figure by the richness of their color, and 
 by the beautiful tresses which they form. 
 
 MAN AS COMPARED WITH OTHER ANIMALS. 
 
 It is important that we should compare man with the animal 
 creation, for several reasons. 
 
 1. Such a comparison reveals to us the fact that there is far less 
 physical difference between man and the higher order of the ani- 
 mals than is commonly supposed. 
 
 Man resembles the apes in the processes of his conception and 
 birth, in his mode of growth, in his manner of taking food before 
 birth and after birth. 
 
 Man is formed from an egg. This egg develops into an embryo. 
 The embryo becomes a child. The child grows into a man. The 
 adult man declines into old age, and finally dies. 
 
 The common house dog also begins life as an egg. It passes 
 through the same complicated and wonderful processes as the 
 human egg, and becomes instead of a child, a puppy. The puppy 
 is born, and grows to be a full-sized dog. The dog declines to old 
 age, and finally dies. 
 
 The chicken, as everybody knows, begins its existence as an 
 egg. It passes through the same processes as the egg of the dog ; 
 in turn a chicken grows into a hen ; in its turn produces other 
 chicks, and ultimately dies of old age. 
 
 The same is true with all the other animals that have back- 
 bones — frogs, snakes, lizards, fishes, dogs, cats, and monkeys. 
 
 2. There are less intellectual differences between man and 
 the higher orders of animals than is cornmonly supposed. 
 
 The intellect of man, as all know, is the function of the brain, 
 just as digestion is a function of the organs of digestion, or respiration 
 of the lungs. (See Brain.) 
 
 The intellectual power of any man depends on the quantity 
 and quality of his brain, just as his digestive power depends on the 
 size and health of his stomach, or just as his breathing power de- 
 pends on the volume and condition of his lungs. 
 
 The same law applies to animals. Animals have more or less 
 brain. The first rudiments of the hemispheres in the brain appear 
 in the fishes. There appears to be quite a regular gradation both 
 in the quantity and the quality of the brain as we ascend the scale 
 
MAN AS COMPARED WITH OTHER ANIMALS. 159 
 
 of the animal creation. The higher order of animals — dogs, horses, 
 monkeys, and gorillas — have considerable amount of brain, although 
 in quantity far inferior to those of man, and in quality probably 
 still more so. The whale and the elephant are the only animals 
 that have larger brains than man, but their superiority is far more 
 than counterbalanced by their inferiority in quality. 
 
 Animals of the higher orders at least have the five powers of 
 sensation, perception, memory, will, and judgment. Their great 
 deficiency is in reasoning ; their judgments seem to be mostly in- 
 stinctive, yet they do not seem to be wholly destitute of reason. 
 
 The highest order of animals — the apes, gorillas, and chimpan- 
 zees — have a far less quantity of brain than man, and more espe- 
 cially in those portions that are supposed to be devoted to reason- 
 ing and comparison, and to the higher intellectual and moral 
 faculties. The difference seems to be one chiefly of degree rather 
 than of kind. The weight of the brain of man is about. 50 ounces, 
 and of the gorilla about 15 or 20 ounces. Idiots sometimes have 
 very small brains — as low sometimes as 30 or 35 ounces — rarely 
 lower than 30 ounces. 
 
 There is therefore a wide gulf in quantity between the highest 
 type of monkey and the average order of intelligent man. There 
 is probably a still wider gulf in the element of quality, though of 
 that we are not as yet so well informed. 
 
 Man's superiority to the brute is seen, then, chiefly in the quali- 
 ty of brain. It is of a finer structure. It is richer in gray matter. 
 It has more numerous folds. Its intimate structure is more com- 
 plex. The microscope tells us that the human brain is composed of 
 eight distinct layers, like the layers of an onion. These layers are com- 
 posed of cells of every variety of shape, and connected by every varie- 
 ty of communication. The human brain is also rich in phosphorus. 
 Examinations have shown that the brains of animals vary in their 
 quality as well as in quantity with their intelligence. 
 
 Man is also superior to the animals in his method of speech. It is 
 unfair, however, to deny the faculty of speech to animals. They 
 have among themselves a language that expresses clear and defi- 
 nite ideas. The neighing of the horse, the lowing of the cow, the 
 barking of the dog, the mewing of the cat, the singing of the bird, 
 all are so many different kinds of speech. 
 
 So far as can be seen, then, the great structural difference between 
 man and other animals is in degree, and chiefly, though not solely, 
 in the quantity and quality of brain. 
 
 It is' very true that man differs from the other animals imme- 
 diately below him in the curves of his spine, the shape of his pelvis, 
 
160 
 
 ANATOMY AND PHYSIOLOGY, 
 
 
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MAN AS COMPARED WITH OTHER ANIMALS. 161 
 
 the arch of his foot, the relative length of his upper and lower 
 limbs, etc. ; but all these are. small matters. That which raises 
 man above the chimpanzee, the lemur, and the gorilla^ is the quan- 
 tity and the quality of his hrain. 
 
 Reduce the volume of the human brain one half, and the human 
 race would be brought to the level of monkeys. 
 
 The accompanying cut, taken from Professor Huxley's work on 
 " Man's Place in Nature" is exceedingly suggestive. It repre- 
 sents, side by side, man and the higher orders of apes. 
 
 There is probably as much difference between the quality of the 
 brains of men and of animals, as there is between fine silk and 
 linsey woolsey, or between a handkerchief of fine linen and one of 
 coarse cotton. Chemistry and the microscope may yet settle this 
 question beyond dispute. 
 
 Professor Schroeder van der Kolk has shown that there is a dif- 
 ference in the quality of the brains of different orders of the animal 
 creation. 
 
 In order to find out the intelligence of animals, it has been 
 thought to be necessary to take the weight of the brain as compared 
 with the weight of their bodies. It is probable, however, that if we 
 would, in all cases, accurately determine the exact quality of the 
 brain by chemistry and the microscope, there would always be found 
 a correspondence between that quality and the intelligence. On 
 this subject I quote from a very able article recently published on 
 this subject in the North American Review : — 
 
 " There is no action of the human mind which is not an act either 
 of knowledge, feeling, or will. There is but a single faculty of 
 willing, while our acts of knowledge and feeling are the product of 
 several special and distinct faculties. In many of our complex men- 
 tal operations, and even in some of those which appear to be the 
 simplest, all the faculties of knowledge, the power of the will, and 
 some one or more of the feelings, are brought into action. In the 
 following instance of brute intelligence we shall find, upon careful 
 consideration, that the case is precisely the same. The story will be 
 given substantially in the words of the journal from which it is taken. 
 
 " In the Garden of Plants, in London, the keepers were recently 
 engaged in destroying a great number of rats, when one of them 
 escaped and ran to the spot allotted to the elephant. Seeing no 
 other refuge, in the twinkling of an eye the rat snugly ensconced 
 himself in the trunk of the elephant, very much to the elephant's 
 dissatisfaction. lie stamped his foot and twisted his trunk around 
 like the sail of a windmill, and then stood suddenly still, apparently 
 reflecting on what it was best to do. Presently he ran to the 
 11 
 
162 ANATOMY AND PHYSIOLOGY. 
 
 water-trough where he was accustomed to drink, plunged in Ins 
 trunk and filled it, and then raising it dashed out the rat in a tor- 
 rent like that which issues from the hose of a fire-engine. When 
 the rat struck the ground, the elephant seized him and made him 
 undergo the immersion and projection four times. The fourth time 
 the rat fell dead. The elephant, with a quiet but majestic air, 
 crushed it under his foot, and then went round to the spectators to 
 make his usual collection of dainties. 
 
 " In considering the mental operations involved in, and indicated 
 by, the actions of the elephant in this contest, we will begin with 
 the knowing or cognitive faculties. In the first place, he could not 
 have become aware of the presence of the rat in his proboscis, ex- 
 cept through an act of perception, — that faculty which gives "to the 
 mind its knowledge of external things. But perception involves 
 self-consciousness : for the mind cannot become aware of the exist- 
 ence of something besides itself, without perceiving a difference be- 
 tween that something and itself; and the perception of differences 
 presupposes a knowledge of the things which differ. Thus the 
 elephant must have been conscious of his own existence at the same 
 time that he was conscious of the present relation of some external 
 object to his senses. He must have had, for aught we can see, as 
 clear an idea of the me and the not-ine as belong to most men. 
 This is not asserting that the elephant is a philosopher, but only 
 that he possesses the essential groundwork of intelligence. 
 
 "But the mental operation already described involves the exercise 
 of other faculties than those of perception and self-consciousness. 
 In distinguishing itself, the percipient subject, from the perceived 
 object, the mind compares the two, and affirms that they are not 
 the same. We have here comparison and judgment, the prime 
 elements of all reasoning. However complicated any train of 
 thought, it is capable of being resolved into a succession of 
 simple acts of comparison and judgment. It is this fact which 
 leads so many to deny to brutes the possession of these two allied 
 faculties. The course of reasoning adopted is something like the 
 following. One of the faculties of the human mind is the faculty 
 of relations, or the power of comparing and judging. To the ex- 
 ercise of this power are to be ascribed all the grandest achievements 
 of the human intellect, such as the discovery of the law of gravita- 
 tion, and the evolution of the fundamental principles of ethical and 
 metaphysical science. No animal has ever accomplished such re- 
 sults, and therefore the brute creation does not possess this faculty." 
 
 " Sorrow for the loss of friends many animals manifest in a 
 striking degree. Examples of this emotion in domestic animals 
 
MAN AS COMPARED WITH OTHER ANIMALS. 163 
 
 will readily occur to every one. Forbes, in Lis ' Oriental Me- 
 moirs,' tells us that a friend of his having shot a female monkey 
 and carried off the body, forty of the animals soon surrounded his 
 tent, and, making a great noise, gave evidence of an inclination to 
 attack him. On the presentation of his gun, all retired except one. 
 who appeared to be the leader : he stood his ground, chattering 
 furiously. As the man did not fire, the monkey at last came to the 
 door of the tent and began a lamentable moaning, and by the most 
 expressive gestures seemed to beg for the dead body. When it was 
 given him, he took it sorrowfully in his arms and bore it away to 
 his companions. 
 
 " Whether brutes sympathize with the happiness and sorrow of 
 others might at first sight seem doubtful ; but facts like the following 
 compel us to decide the question in the affirmative. The story is 
 taken by Brougham from an apparently trustworthy French autho- 
 rity. 'A swallow had slipped its foot into the noose of a cord 
 attached to a spout in the College des Quatre Nations at Paris, and 
 by endeavoring to escape had drawn the knot tight. Its strength 
 being exhausted in vain attempts to fly, it uttered piteous cries, 
 
 which assembled a vast flock of other swallows They seemed 
 
 to crowd and consult together for a little while, and then one of 
 them darted at the string and struck at it with his beak as he flew 
 past ; and others following in quick- succession did the same, 
 striking at the same part, till, after continuing this combined ope- 
 ration for half an hour, they succeeded in severing the cord and free- 
 ing their companion. They all continued flocking and hovering 
 till night ; only, instead of the tumult and agitation in which they 
 had been at their first assembling, they were chattering as if with- 
 out any anxiety at all, but conscious of having succeeded.' 
 
 " The emotion of satisfaction at success, and the opposite emotion 
 of dejection at failure, as well as that self-satisfied feeling which we 
 call pride or self-esteem, are often exhibited in the actions of do- 
 mestic animals : it is not necessary to specify instances. 
 
 "Although we should hesitate to affirm that there are many ani- 
 mals which have a sense of the ludicrous, yet it can hardly be denied 
 to the ape and monkey tribes, or to parrots. 
 
 " Surprise, curiosity, and the enjoyment of the new, all of which 
 may be considered modifications of one and the same feeling, are 
 noticeable in all the higher animals. Dogs meeting for the first 
 time especially exhibit this emotion. 
 
 " That birds apparently delight in the brilliant plumage of their 
 mates is an indication that they are capable of enjoying beauty. 
 The fact that brutes do not seem to manifest any appreciation of 
 
164: ANATOMY AND PHYSIOLOGY. 
 
 the sublime cannot be considered as due to any radical defect in 
 their natures, so long as the philosophers make no fundamental dis- 
 tinction between the sublime and the beautiful." 
 
 Prof. J. W. Draper, in his Treatise on Physiology, describes the 
 genius of animals in the following eloquent passage, which I tran- 
 scribe in full : 
 
 " Insects form societies for mutual assistance, defence, invasion, 
 emigration, mere pleasure — societies which undoubtedly arise in the 
 experience of passions, such as love and fear. Of these the dura- 
 tion is variable ; some last through the larva state only, some are 
 confined to the imago, some are maintained through life. The 
 organization by which their object is accomplished is various, mo- 
 narchical, republican. The caterpillars of the processionary moths 
 are guided in their march by a leader ; the termites obey at once 
 a king and a queen. The lust of power is not alone felt among 
 human monarchs ; the queen bee never rests till she has assassinated 
 her rival. All insects of the same kind are not born equal, nor do 
 all pursue the same occupation ; some follow a life of leisure, some 
 devote themselves to the profession of arms, some are laborers. 
 When the metropolis of the termites is attacked, the laborers, as 
 non-combatants, retire, but the soldiers come out. The ants, with 
 which w T e are more familiar, engage in military and filibustering 
 expeditions ; they make reconnoissances, set sentinels, march in a 
 definite order, the van alternately falling to the rear; their lines of 
 communication are maintained, and, if necessary, swift couriers are 
 dispatched for re-enforcements. If successful, they not only carry 
 oif their enemies' stores, but reduce the vanquished to actual servi- 
 tude, compelling them to w T ork as slaves. They have notions of 
 property, and though some of them practice cannibalism, they will 
 amuse themselves in more pleasant occupations, tumbling and play- 
 ing together like kittens or puppies. With a sentiment of strict 
 justice, the wasp who has returned from a successful foray divides 
 his booty among the males, females, and the laborers who have been 
 working in the vespiary ; nor is the sentinel, who is doing duty at 
 the door, forgotten. If, through the chances of war or by accident, 
 any one has sustained a grave injury, in some tribes the most de- 
 voted sympathy is shown ; the ant will carry his wounded friend 
 out of the heat of the fight ; in other tribes a more than Roman 
 firmness is displayed: the sufferer is put out of pain by his com- 
 panion. Expecting an attack, some insects will shut their doors at 
 night, and barricade them within, or, if the danger is continual, 
 will build masked gateways in succession, with interior walls that 
 command them. They are no contemptible engineers. They can 
 
MAN AS COMPARED WITH OTHER ANIMALS. 165 
 
 construct and maintain roads of great length, with paths branching 
 from them, which, if necessary, they keep mown ; they cross streams 
 by throwing themselves into floating bridges, and the damage done 
 to their premises by an invader they show the most singular skill 
 and alacrity in repairing. How many are the contrivances to 
 which insects resort to carry out their purposes ! The caterpillar 
 of the cabbage butterfly makes a ladder and goes up it; the geo- 
 metrical caterpillar lets down a rope, and, for fear of hurting him- 
 self, drops a foot at a time. The gossamer spider sends forth a 
 thread fine enough to rise like a balloon, and, floating in the air, 
 descends or rises by winding it up or letting it out. There are other 
 insects which make diving-bells, and go under the water. No bird 
 makes a net, no beast a pitfall ; men and insects do both. A gang 
 of sailors will carry a spar by supporting it on alternate sides on 
 their shoulders ; a gang of ants will, in like manner, carry a straw 
 or a long worm. There are spiders which show as much dexterity 
 as an Indian in sneaking forward to get in reach of their prey. 
 
 " In their domestic economy, how wonderful ! Some build their 
 houses of artificial stone, some of pasteboard, which they make. 
 Some cover their rooms with tapestry, some lay carpets of silk on 
 the floor, some hang their doors on silk hinges, so that they shut by 
 their own weight. They make arches, domes, colonnades, stair- 
 cases. They practice concealment of food." 
 
 Dr. Laycock (quoted by Prof. Draper) remarks thus boldly : 
 " On what structures depend, if not on these cephalic ganglia, 
 all those wonderful instincts which mimic in their operation the 
 arts of man. There is hardly a mechanical pursuit in which in- 
 sects do not excel. They are excellent weavers, house-builders, 
 architects ; they make diving-bells, bore galleries, raise vaults, con- 
 struct bridges ; they line their houses with tapestry, clean them, 
 ventilate them, and close them with admirably-fitted swing doors. 
 They build and store warehouses, construct traps in the greatest 
 variety, hunt skilfully, rob and plunder. They poison, sabre, and 
 stab their enemies. They have social laws, a common language, 
 divisions of labor, and gradations of rank. They maintain armies, 
 go to war, send out scouts, appoint sentinels, carry off prisoners, 
 keep slaves, and tend domestic animals. In short, they are men- 
 tally a miniature copy of man." 
 
 It is proper here to speak of the " Darwinian Theory" 
 
 Darwin has written a work on the " Origin of Species" in which 
 
 he brings a large number of facts which go to show that all men 
 
 and all animals, all organic life, have developed from one simple 
 
 form, into which life was first breathed. He holds that men were 
 
166 ANATOMY AND PHYSIOLOGY. 
 
 formerly monkeys, that monke} r s were formerly of a lower order 
 of animals, that cats, dogs, horses, mules, oxen, sheep, &c., all have 
 reached their present condition in the animal world by slow de- 
 velopment — from animals below them. He holds that this develop- 
 ment takes place through " selection," or "survival of the fittest ; " 
 that the best selects the best in each order of life, and thus the 
 children improve on their parents, while the inferior specimens of 
 each race or tribe die out. 
 
 In the great struggle for existence which men and plants and 
 animals have to encounter, the best always wins. In this way 
 animals have improved and developed into the measure and the 
 stature of men. 
 
 This theory of Darwin is rendered plausible by a large array of 
 startling and suggestive facts. We know by experience that we 
 can, by selection and care, improve or change breeds of animals and 
 birds, such as horses, dogs, and pigeons. We know that we can do 
 the same with plants and flowers. We know that we can do the 
 same with man. 
 
 The question now arises — are the facts sufficient to prove the 
 theory % Concerning this many of us must doubt. We know 
 so little of the antiquity of man, so little of the early history of 
 different races, so little, indeed, of human history, so little of the 
 history of the animal world, that it seems to be impossible either to 
 prove or disprove this brilliant generalization. 
 
 The investigations of Darwin have at least brought out some 
 very valuable and interesting facts. 
 
 Thus we are told that the organic life on the island bears a close 
 resemblance to the organic life on the mainland near it. The 
 luscious peach of our gardens has descended, by the process of 
 selection and development, from the bitter almond of Persia. Our 
 cabbages even grew wild — a dismal weed — on the shores of Europe. 
 The race-horse of England, under the culture and training of 
 modern times, has become a different animal from its ancestors, 
 both in shape and in quality. 
 
 Both his " Origin of Species " and his " Variations of Animals 
 and Plants under Domestication " are worthy of careful study by 
 every thinking mind. 
 
HYGIENE, 
 
 AET OF PRESERVING HEALTH AND PRO- 
 LONGING LIFE. 
 
 POPULAR FALLACIES CONCERNING DIET. 
 
 There are more fallacies abroad among the people in regard to 
 diet than on almost any other subject of hygiene. These are not 
 confined to the ignorant and uneducated. They are accepted among 
 the most learned and by those in the highest literary and social 
 positions. These errors are due partly to the fact that the subject 
 of food is a very difficult one, and cannot be entirely understood 
 without some study and care. 
 
 Most of these errors, however, are the result of the false teach- 
 ings of writers on health. Alcott, Graham, President Hitchcock — 
 all sincere, honest men, but thoroughly at fault on nearly all their 
 ideas of hygiene — exercised a powerful influence in their day, and 
 the evil effects of their teachings still remain, and work terrible 
 mischief. 
 
 I will briefly point out some of the errors that have been taught 
 by these and others, and which are still abroad among the people. 
 
 In the first place, it is a fallacy to suppose th&tpeople, as a rule, 
 eat too much, and that most of the diseases of the world come from 
 overfeeding. . 
 
 The truth is that, among all decent or civilized people, the ten- 
 dency is directly the reverse. In our country, and especially in our 
 large cities, far more are underfed than overfed. In civilized, hard- 
 working communities, excessive alimentation is the exception, and 
 not the rule. Throughout our land, thousands and thousands die 
 every year from actual starvation. Some of these unfortunates are 
 little children whose parents are too ignorant, or too poor, to give 
 
168 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 them what is necessary to sustain life. But many of them are 
 adults, whom hard poverty, or sad ignorance, has forced into a 
 habit of systematic though undesigned starvation. Day after day 
 their stomach receives less nutriment than the system demands. 
 Day after day the vital powers slowly fade, the strength grows less, 
 the spirits become morbid, and the face wan and dejected. Disease 
 now steps in, attacks and carries by force some important citadel 
 of the body, and death follows. The process is a slow one — some- 
 times very slow — extending, perhaps, over many years, but it is 
 oftentimes just as sure as it is slow. 
 
 As a rule, the savages eat less than the civilized. They may 
 gorge themselves at long intervals, like the Bushmen and Hotten- 
 tots of South Africa, and the Greenlanders, and Esquimaux ; but 
 between these seasons of hideous gluttony many days often inter- 
 vene. The average quantity of nutriment that most of the barba- 
 rous tribes consume is unquestionably less than that of the civilized, 
 who take three regular meals daily. Indeed, most of the wild 
 races lead a very precarious existence in regard to food. They sub- 
 sist on snails, bugs, clay, insipid or bitter fruit, unsightly worms, 
 and other substances equally abominable, which are neither nutri- 
 tious nor agreeable. 
 
 I say, then, that the civilized eat more than the savage, and that 
 they ought to do so. The reason is clear. They work harder. 
 .They use their brains more. Labor of the brain is always accom- 
 panied by waste of tissue. It has been estimated, by Professor 
 Houghton, that three hours of brain-work cause as important 
 changes of tissue aer a whole day devoted to mere muscular labor. 
 
 There are drones, all through society, who do nothing but live 
 on others. There are gluttons and gourmands, all through society, 
 who do nothing but eat and drink. But gluttons and gourmands 
 are exceptions in civilized lands. Many children undoubtedly eat 
 too much and too often ; but they almost always break off the 
 habit before reaching adult age. 
 
 Even among our rich and luxurious classes, the number of those 
 who injure themselves by over-eating is far less than the number of 
 those who injure themselves by under-eating. Rich and fashionable 
 people use their brains very actively— oftentimes, it must be allow- 
 ed, in acts of frivolity and dissipation — are usually hard-working 
 men of business, and need more and a greater variety of food than 
 those who do little or nothing, or who live by muscular toil alone. 
 
 In the second place, it is a fallacy to suppose that vegetable food 
 is healthier and easier of digestion than animal. 
 
 Comparative anatomy, physiology, experience, our natural ap- 
 
POPULAR FALLACIES CONCERNING DIET. 169 
 
 petites, and the history of the world, all show us that man should 
 have a mixed diet — flesh, fish, fruit, and vegetables. 
 
 The contrary doctrine is one of the most monstrous errors that 
 ever infested society. It has carried hundreds and thousands to 
 early graves. The popularity of this error, at one time, was partly 
 the result of the popularity of the men who advocated it. 
 
 In this country, we love extremes, and roll them as sweet mor- 
 sels under our tongues. Vegetarianism is an extreme, and there- 
 fore Americans cherished it. At the present time it is not practical- 
 ly advocated by any large or influential number; but there are 
 very many who theoretically believe in the heresy, and who think 
 tli at they do wrong when they eat flesh or fish. Thus they go on 
 all their lives violating their consciences. " Woe unto the man 
 who creates a sin ! " 
 
 The truth is, that vegetables, potatoes, turnips, carrots, etc., are 
 not only less digestible than fresh beef and mutton, but they are 
 also less nutritious. The}' linger longer on the stomach, and, being 
 composed mostly of water, give less nutriment to the system. 
 Therefore, many, who cannot digest vegetables at all, can eat and 
 relish and assimilate beefsteak, mutton, lamb, chicken, turkey, etc., 
 without difficulty. Chronic invalids and dyspeptics should, as a 
 rule, eat largely of fresh meat and fish, and very moderately of 
 vegetables. 
 
 It is true, however, that vegetables, bread, and fruit, are all 
 necessary, and all should be used under the guidance of experience, 
 and the taste of each individual. 
 
 But it must not be forgotten that more acute diseases — far more 
 — arise from fruit and vegetables than from flesh and fish. Each 
 individual must, therefore, find out for himself, by his own experi- 
 ence, what he can indulge in, and what he must forego. 
 
 Another fallacy, in regard to diet, is to suppose that the natural 
 appetite is not the hest guide as to the quantity and quality of our 
 food. 
 
 It is true that the appetite does sometimes become perverted. It 
 is true that it does become sometimes a symptom of disease. But 
 these cases are exceptional. 
 
 Hideous doctrines have been taught on this subject. We have 
 been solemnly told to rise from the table as hungry as when we sat 
 down. We have been told to be always ready for a meal — in other 
 words, to live in a state of perpetual hunger. We have been told to 
 eat those things that we most hate, and to avoid those things that we 
 most love — that to have a longing for any article is the very reason 
 why we should be denied it. 
 
170 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 These doctrines are monstrous. They are unworthy of the nine- 
 teenth century. They are a libel on the Creator who gave us taste 
 and appetite, in order that we might know what to eat and drink, and 
 gave us also judgment to direct appetite and taste when the system 
 becomes diseased. 
 
 Notwithstanding all its liability to perversion, the appetite is, 
 on the whole, a better guide in selecting food, and in measuring 
 its quantity, than all the books on hygiene that have ever been 
 written. 
 
 The practice of weighing the food, which was introduced to the 
 world by the example and teachings of Cornaro, the Italian, cannot 
 be too strongly reprobated. It is impossible for the scales to tell us 
 how much to eat. The .quantity of food that we need depends 
 on the amount of labor that we do, on the nature of the constitu- 
 tion, on our mental moods, and on the quality and variety of the 
 food which is served. 
 
 To weigh or measure the food habitually is not only silly, un- 
 necessary, and useless ; it is actually a crime. It wastes valuable 
 hours that should be better employed. It makes us miserable, and 
 that fact alone is argument enough against it. It brings on indi- 
 gestion and all other woes, and therefore prevents us from getting 
 the best advantage of what we eat. 
 
 Another common fallacy, in regard to diet, is the theory that one 
 or two hinds of food, at each meal, are more easily digested, and more 
 wholesome, than a large and palatable variety. 
 
 Our books on health tell us over and over again that tvjo arti- 
 cles at each meal are sufficient, and that we shall be liable to eat 
 more if the table is covered with a generous variety. 
 
 My advice is emphatic and clear. Let there be as generous, 
 agreeable, and attractive a variety at each meal as we can afford. 
 Let the limits of that variety be determined by our purses, our tastes, 
 our appetites, and our talent in cooking, and not by the books. 
 
 It is possible for nearly every family to have a good variety of 
 food at each meal, or, at least, at the principal meal of the day, 
 without great expense. Cookery is one of the fine arts. It should 
 be made a study. We have good books on cookery at the present 
 time, and every young wife who loves her household, and every 
 young maiden w T ho hopes to have a household to love, should study 
 the best works on this subject, just as they study grammar, arith- 
 metic, and geography in the schools ; and, above all, should practise 
 the art with their own hands at home. 
 
 Genius never made any lady a good cook. The art is acquired 
 by close study and patient practice, by many and repeated failures. 
 
DIET OF BRAIN-WORKEKS. 171 
 
 A good cook can make a pleasant and healthful meal out of a few 
 simple articles. A poor cook will make a wretched dinner, even 
 with the whole market at her disposal. I hope to see the day when 
 the art of preparing food will be taught in our schools, like other 
 important branches ; when young girls and young wives will go to 
 the cooking-school as they now go to the dancing-hall, and when 
 even ladies of fashion will boast of their bread and their puddings 
 as they now boast of their acquisitions in music and French. 
 
 A variety of food is more healthful than one or two kinds, be- 
 cause it is more easily digested. This is a law of Nature. Appetite 
 teaches us to combine sweet with sour, vegetables with meat, dry 
 food with watery, etc. 
 
 A meal composed simply of dry Graham bread, or of potatoes, 
 or of fruit even, is far, far less palatable and less digestible than a 
 meal composed of all three varieties at once. Science and experi- 
 ence are here in perfect accord. 
 
 If, therefore, we must eat candy, let it either be with or just 
 after our meals. If we must eat sweets in the evening, let us have 
 sour fruit — apples, or lemons, or oranges — at the same time, and we 
 shall be less injured. We should never eat a large quantity, either 
 of sweet or of sour substances, on a perfectly empty stomach. 
 
 Still another common fallacy is, that h rain-workers need less nu- 
 triment than those who live by their muscles. 
 
 This idea would never have been entertained if people had de- 
 pended on their own observation and experience. But we have been 
 influenced by false teachings and erroneous theories. 
 
 Any one who has attended associations of clergymen, or alumni 
 meetings, or has boarded with students, has had opportunity to see 
 that brain-workers are large eaters, as indeed they should be if they 
 are really hard workers. The changes of tissue in the brain, that take 
 place during study and thought, are very important and very rapid, 
 and must be replaced by abundant food. 
 
 The ruling classes in all powerful countries have been liberal feed- 
 ers. Babylon was a powerful city in its day, and all accounts 
 agree that its inhabitants were given to free and luxurious living. 
 The same was true of Persia, and indeed of all the Oriental powers 
 that successively held sway over that portion of the earth. The an- 
 cient Greeks were far from being Grahamites or vegetarians, but 
 availed themselves of the best that their little peninsula could afford. 
 
 They were not, however, as extravagant and luxurious as are 
 the civilized nations of the present day ; but, on the other hand, 
 they were not as aggressive and powerful in all that becomes a nation 
 as were many other kingdoms of ancient times. 
 
/ 172 
 
 The most powerful nation of antiquity was Eome. It governed 
 120,000,000 of people, and displayed great skill and gigantic energy 
 in works of internal improvements. Of the manner of life of the 
 Romans we have more direct and authentic testimony than of any 
 other nation of ancient times. No people of any era of the world 
 were so devoted to the pleasures of the table. The countrymen of 
 Caesar and Pompey, of Livy and Cicero, of Yirgil and Augustus, 
 were as vigorous performers at the table as on the field of battle, in 
 the discussions of the forum, or in the realm of poesy. 
 
 Not content with the products of their own soil, or the ordinary 
 articles of diet, they ransacked the most distant lands and seas for 
 the rarest specimens of flesh, and fowl, and fruit, and served them 
 'up in every combination then known to the culinary art. The de- 
 scriptions that historians give us of the banquets of the Roman pa- 
 tricians, in the time of the greatest glory of their empire, seem more 
 like mythical tales than realities; and if they were not thoroughly 
 substantiated, would hardly be worthy of credence. 
 
 It is true that the sj^stems of cookery of that time were much in- 
 ferior to our own, and the best methods of preparing ordinary dishes 
 were not as diffused among the masses as among our own population ; 
 but the patricians — the ruling order of Roman society — who made 
 Rome what it was among the nations, left no known means untried 
 to make their tables tempting and luxurious. 
 
 If now we come down 1,800 years, we find that the dominant 
 classes of the great powers of the earth are, without exception, good 
 feeders. The skilful cooking of the French, and the roast beef and 
 plum-pudding of the English, have long been proverbial. 
 
 France and England are confessedly the two great powers of 
 Europe. The better classes among the Germans and Russians are 
 free and easy livers, though they are not, as a rule, as fastidious con- 
 noisseurs nor as voracious as the English. The Americans are, un- 
 questionably, the greatest eaters of the civilized world. There may 
 be Greenlanders who consume, at irregular periods, incredible quan- 
 tities of train-oil and blubber ; there may be certain classes in 
 Europe who live perhaps more expensively ; but there is no country 
 anywhere, the mass of whose population live as generously as ours. 
 
 Our raw material is greater in variety and abundance than that 
 of any other, and we have all the commercial products of other lands. 
 Said Carlyle to Emerson : " The best thing he knew of that country 
 [America] was, that in it a man can have meat for his labor." 
 
 So much has been said of the abstemiousness of Socrates, of 
 Cincinnatus at his plough, and of the simplicity and frugality of 
 many other philosophers of ancient and modern times, and so many 
 
DIET OF BRAIN-WORKERS. 173 
 
 precepts inculcating temperance and moderation have been handed 
 down from age to age, that few will be readily inclined to accept 
 these statements concerning the liberal diet of those who live by 
 their brains without specific examination. Elaborate statistics can- 
 not be obtained in regard to the personal habits of any consider- 
 able number of the brain-workers of history, but biography is suffi- 
 ciently explicit to warrant the assertion that vegetarians or dieta- 
 rians (as the term is popularly understood) have been the exceptions 
 and not the rule among them. The common and almost universally 
 received impression, that severe mental activity is inconsistent with 
 free living, and that vegetarians can think harder and longer than 
 nesh-eaters, seems to have derived its plausibility from the following 
 observed facts, which, as we shall see, can be entirely explained on 
 other principles. 
 
 First. — Intuition and experience teach us all that two so impor- 
 tant organs as the stomach and the brain cannot both be overtasked 
 at once, without injury to the one or the other. It is said that 
 General Elliot, the defender of Gibraltar during that memorable 
 siege, lived. for several days on a very little boiled rice. 
 
 Sir Isaac New 7 ton fasted for long intervals while he was en- 
 gaged on his Principia. Most of the great generals of the world 
 have been rigidly abstemious under the pressure of great emergen- 
 cies. A number of authors could be mentioned, who, during the 
 execution of great life-tasks, have, for the time, starved' the body 
 that the mind might, as it were, act independently of its earthly 
 tabernacle. In this respect they but imitate the shrewd merchant, 
 who, on entering upon some unusually great speculation, retrenches 
 his expenses, and withdraws his funds from other directions, until 
 the emergency is over, when perhaps he spends and invests again 
 with still greater freedom than before. 
 
 Secondly. — The standard of living has been so much raised 
 under our modern civilization, that the diet of the heroes of the past 
 seems to be very meagre, though they may have been as liberal as 
 the best of their day. 
 
 The laborer of our age and country often spreads a more delicate 
 table than the Court of Queen Elizabeth. Not that the worthies 
 of Queen Bess's reign were poorly fed ; for their diet was nutritious, 
 but not as agreeably served and varied as ours. 
 
 Thirdly. — There have been, and there are still living those 
 among our prominent litterateurs who, for a season at least, have 
 been so attracted by the novelty of vegetarianism, and by the views 
 of Alcott and Graham, that they have practically adopted them, 
 and with the usual ardor of first converts, they have loudly pro- 
 
174 
 
 claimed their experience, and have exhorted others to march under 
 the same banner. 
 
 Among them I may mention the names of the poet Shelley, 
 Lewes, the biographer of Goethe, and Horace Greeley. 
 
 But it is observed most of these gradually lose their enthusiasm 
 over the new doctrine, and finally abandon the system altogether. 
 As has already been suggested, those who suddenly change to a 
 vegetarian or very simple mode of diet at first find that they can 
 study harder and perhaps longer than before, for the reason that 
 they eat much less quantity than when they partake of a variety of 
 food. 
 
 The stomach has so little to do that the brain is always in work- 
 ing order, and for a time the new convert, especially if he be of a 
 poetic turn, lives in a kind of intellectual heaven. 
 
 But in the majority of cases, this ecstatic existence gradually yields 
 to a feeling of depression and weakness, that can only be relieved 
 by an abundant supply of food. If they have sublime faith in the 
 truth of their theories, united to great strength of will, they may 
 persevere in this misguided course until sickness or death close the 
 scene. Such has been the fate of some very able and promising 
 young students in our colleges and professional schools. But the 
 majority, after testing the new doctrines for a few months or years, 
 gradually abandon them, and return to the natural manner of life. 
 The result is, that after all the discussions that have taken place on 
 this subject, the number of consistent vegetarians is exceedingly 
 small. The impression that those who depend on the labor of their 
 brains need less food than mechanics and laborers, is so deeply 
 fixed in the minds of the community, that it is probable that only the 
 most direct and telling statistics will suffice to introduce a new 
 belief. 
 
 OBJECTS OF DIGESTION. 
 
 The great object of digestion is the formation of chyle ; hence, 
 whatever substances yield this fluid in the largest quantity, and of 
 the best quality, will necessarily afford the most nourishment. But 
 the various substances used for food differ greatly in their nutritious 
 and digestive qualities. Some are highly nutritious, and are, never- 
 theless, difficult of digestion ; others, again, pass quickly out of the 
 stomach without supplying much nourishment to the body. Food is 
 introduced into the stomach with the object of being converted into 
 a fluid fitted to become a constituent part of the living body. It 
 might, therefore, naturally be presumed that substances, already of 
 an animal nature, and similar to the structure which they are in- 
 
OBJECTS OF DIGESTION. 175 
 
 tended to supply, would be better adapted for this purpose than 
 either herbaceous or farinaceous food ; and this is the case, for 
 animal food contains a greater quantity of nutriment in a given 
 bulk than any kind of vegetable aliment. But it is not alone suffi- 
 cient that substances used for food are capable of being assimilated ; 
 their consistence ought to be soft and loose enough to allow them 
 to be easily acted upon by the digestive organs ; because the more 
 tender the aliment, and the easier it is divided, the more readily 
 will it be dissolved by the gastric juice, and converted into chyle. 
 On the other hand, hard and close-grained substances are propor- 
 tionally slow and difficult of digestion. We also see that persons 
 who eat quickly, without properly chewing their food, are often 
 troubled with indigestion, and frequently void fragments of various 
 alimentary substances, which have passed through the intestinal 
 canal in a half digested state. Old people who have lost their 
 teeth, being unable to chew their food sufficiently, suffer in the same 
 manner. The digestibility of food, then, is owing, in a great meas- 
 ure, to the tenderness of its texture and minuteness of division by 
 the teeth. It has been shown, by direct experiments on the living 
 body, that the different kinds of animal food, whether of flesh, fish, 
 fowl, or game, are more or less easily digested, according as their 
 texture and tenderness of fibre render them easy of mastication 
 and solution ; these properties in butcher meat depend greatly on 
 the time that has elapsed since the animal was killed, on its age, 
 sex, food, mode of killing, and of cooking. 
 
 The kind of food which the animal consumes in its natural state, 
 or on .which it is fed artificially for the purpose of fitting it for the 
 table, will considerably modify the character of its flesh. Animals 
 which feed on corn are firmer in their flesh than those eating the 
 herbs ; and animals using mountain herbs are firmer and more 
 savory than those feeding on the succulent and watery herbage of 
 plains. Animals which feed on flesh are coarse and heating ; and 
 few of them can be used as food without proving injurious to the 
 system. Castration renders all animals fatter, and causes the fat 
 to be better mixed through the fibrous parts, while it improves the 
 quality of the flesh, and makes it more tender. The flesh of the 
 female is also much more delicate than that of the entire male ; 
 and it appears to be generally understood, that depriving females 
 of the ovaries {spaying) improves the flavor of the flesh. The tex- 
 ture of the muscular fibre is likewise improved by violent exercise ; 
 bull-baiting, hunting, and the old German custom of whipping a pig 
 to death, render the flesh more easy of digestion. A teaspoonful of 
 vinegar given to a fowl some time before killing it renders the flesh 
 
176 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 more tender when intended for immediate rise. Wild animals, 
 when young, are easier of digestion than the same species in the 
 domestic state ; and the parts principally exercised, as the wings of 
 birds, and the legs of swift animals, are harder and of stronger tex- 
 ture than the rest of the body. The effect of decomposition or in- 
 cipient putrefaction on fibrous animal food is to render the muscu- 
 lar fibre less hard, and consequently more easy of digestion. Game, 
 after hanging a sufficient length of time, acquires another quality, 
 which.no doubt tends to render it more digestible. A pheasant, 
 for example, if used too soon, is comparatively insipid, but if kept 
 a proper length of time acquires a much finer flavor, and this, by 
 gratifying the palate, increases the flow of saliva, while, by sympa- 
 thy, the stomach is excited, the secretion of gastric juice is augment- 
 ed, and digestion is consequently promoted. But tainted meat, 
 though easier of digestion, is more heating ; high flavored game 
 would be too exciting for an invalid, and too strong for his stomach. 
 Decayed cheese, like tainted game, is stimulating. A little of it, 
 taken after a full meal, excites the stomach, and would be highly 
 improper for an invalid. But of all the means by which the tex- 
 ture of our food is acted upon, and its digestibility modified, cook- 
 ery is certainly the most important. A few remarks, therefore, 
 upon the principles which render the ordinary culinary processes 
 serviceable in the preparation of our food, may be useful. 
 
 DIFFERENT MODES OF PREPARING FOOD. 
 
 Roasting. Flesh, when roasted, and neither too much nor too 
 little done, contains nearly all the juicy parts, and more of the nu- 
 tritious principles, than boiled meat. Roasting softens the tendinous 
 parts better than boiling, while the crust retains the juice, and gives 
 the gravy a brown color and an agreeable taste ; but during the 
 process it is computed that the meat loses about a third of its weight 
 by the melting out of the fat and the evaporation of the water. By 
 roasting, the fibre is not rendered so soft and pulpy as by boiling, 
 and the meat is consequently not so easy of digestion ; for the di- 
 gestibility of food depends in a great measure upon the softness of 
 its texture ; but roasted meat is much more nutritive. One pound 
 contains as much nourishment as two of boiled meat. The gela- 
 tinous and viscid meats, however, of the younger animals, veal and 
 chicken for example, are more wholesome and easier of digestion 
 when roasted ; for, by boiling, the gelatin acquires properties which 
 render it very oppressive to the digestive organs. Many people 
 suppose that underdressed meat is easier of digestion, but this is a 
 mistake, for when not sufficiently done, its texture is more dense. 
 
CLASSIFICATION OF FOOD. 177 
 
 Boiling. If boiled too long, or too fast, the albuminous part 
 of meat becomes coagulated, and the flesh is rendered hard. The 
 water should not be brought quite to the boiling point, but should 
 be kept long at a temperature a little under it. By this plan of 
 cooking the meat will be found more wholesome, and easier of di- 
 gestion. Mutton in boiling generally loses about one-fifth, and 
 beef about one-fourth of its original weight. The quality of the 
 water is also of importance ; beef or mutton boiled in hard water is 
 more tender and juicy than when soft water is used. Water of this 
 description, or with a considerable quantity of salt in solution, is 
 also best suited for the boiling of fish. Vegetables, on the contrary, 
 require soft or rain water, and care should be taken to have them 
 boiled sufficiently. By neglecting this precaution their digestibility 
 is greatly diminished, and they are rendered injurious. Vegetables, 
 if not well boiled, pass through the alimentary canal without under- 
 going much alteration; and in some stomachs they ferment and run 
 into acid, causing heart-burn and disorders of the bowels. 
 
 Broiling-. If the portion of meat is not too thick, and its fibre 
 cut across, the heat quickly penetrates and loosens the texture. 
 From the suddenness of the operation the juices are retained, and 
 it is thus rendered peculiarly tender. There is no kind of cooking 
 more wholesome than this. A well-broiled rump-steak or mutton- 
 chop is juicy and rich, and is by far the most nourishing and the 
 best suited for the stomach. From the nutritive and digestible 
 qualities of meat dressed in this way, broiling is considered the 
 best mode of cooking, where it is thought proper to give animal 
 food to restore the strength of invalids. 
 
 Frying. This is the most unwholesome kind of cooking; it 
 should be carefully shunned by invalids. 
 
 Baking. By this operation (inferior to roasting) the meat is 
 equally done and tender, but the retention of the oil or fat prevents 
 the easy digestion of baked meat. Baking, however, may be 
 safely employed in the preparation of light puddings for convales- 
 cents ; but butter should not be used for the purpose of browning 
 the surface of the pudding. 
 
 CLASSIFICATION OF FOOD. 
 
 The different articles of food have been variously classified. 
 
 In this work I shall not attempt to present any formal classifi- 
 cation, but shall give merely the ordinary division, which can easily 
 be remembered and understood. 
 
 1. Albuminous substances. — Under this class are included the 
 albumen of eggs / fibrin, found in the blood ; casein, found in milk ; 
 12 
 
178 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 gluten, found in wheat flour. Albuminous matters can coagulate, 
 ferment, and putrefy. 
 
 2. Oleaginous or fatty substances. — These are found both in ani- 
 mal and in vegetable food. 
 
 3. Starch and sugar. 
 
 4. Inorganic substa?ices. — Under this class are included water, 
 lime, common salt, soda, potash, iron, and magnesia. Our diet 
 should be composed of all these substances. 
 
 Thirteen different substances make up the human body. Our 
 food must contain these substances — all of them — in order to supply 
 the waste of tissue that is continually going on. 
 
 The average quantity of food required for adults is between two 
 and three pounds of solids, and three or four pints of liquids. In 
 regard to quantity every one must judge for himself by his own ex- 
 perience. The quantity depends on the age, the sex, the constitu- 
 tion, the state of the health, and above all on the amount of muscu- 
 lar or brain work that we do. Appetite is the best guide. 
 
 The quality of the food also depends on the hind of work that we 
 do. Brain-workers need food that contains a large amount of nutri- 
 ment, and does not tax too severely the digestive organs. There" 
 fore let them eat fresh meats, fish, eggs, oysters, and bread, and ab- 
 stain from pork and veal, and use vegetables sparingly. 
 
 FLESH FOOD. 
 
 Butcher's meat, and all the fleshy or muscular substances used as 
 food, are chiefly composed of fibrin, which sustains the same rela- 
 tion to the muscular parts of the animals, that fecula (or starch) 
 does to farinaceous substances. But fibrin is more quickly digested 
 than fecula, and more nutritious. In general the nutritive qualities 
 of the different kinds of animal food are proportioned to the quan- 
 tity of fibrin which they contain. 
 
 The red meats, more especially those which are dark colored, are 
 imbued with a principle called osmazome. This substance is con- 
 tained in the fibrin, to which it gives a stimulating action, and tends 
 greatly to aid in its assimilation; although of itself it does not 
 appear to possess any nutritive quality. It is to osmazome that the 
 stimulating effects of animal food are attributed ; and to this also 
 beef, mutton, and the colored flesh of all animals owe their grateful 
 odor when dressed. It enters sparingly into the composition of 
 young and white meats, which are consequently deficient in savor. 
 Osmazome does not exist to so great an extent in red colored flesh as 
 in that which is dark ; and the color of the latter is ascribed to the 
 increased quantity of this principle. These two classes, however, 
 
FLESH FOOD. 179 
 
 cannot be distinctly separated; they gradually merge into each 
 other. 
 
 In arranging the different kinds of animal food according to their 
 nutritive qualities, the flesh of quadrupeds, generally speaking, takes 
 the first rank ; next that of birds ; then fish ; and lastly oysters and 
 other shell-fish. 
 
 Beef. Beef affords much nourishment, but being of a firmer 
 texture is not considered so easy of digestion as mutton, though 
 equally nutritious. The flesh of a bullock about the middle age is 
 much superior to that of one which has been worn out with labor, 
 because in all old animals (besides the disadvantage of the greater 
 density of the muscular fibre) the fat is chiefly connected in layers 
 on the outside of the muscles ; whereas in young animals it is mixed 
 with the flesh, giving it that marbled appearance which is always 
 expected in good butcher meat. Cow beef is considered inferior in 
 every respect to ox beef. 
 
 Beef-tea is much employed for the sick, when the state of the 
 patient admits of animal diet ; and, taken with bread, is one of the 
 best restoratives during convalescence, but should be used sparingly, 
 on account of its stimulating properties. Dr. Kitchener, a good 
 authority in such matters, has given the following receipt for making 
 it : — " Cut a pound of lean gravy meat into thin slices, put it into a 
 quart and half a pint of cold water, set it over a gentle fire, where it 
 will become gradually warm ; when the scum rises, let it continue 
 simmering gently for about an hour, then strain through a fine sieve, 
 or a napkin, let it stand ten minutes, and then pour off the clear 
 tea." (See Food for the Sick.) 
 
 Mutton. Mutton in good condition has the proper tendency of 
 fibre to render it easy of digestion. It is not so savory nor so stimu- 
 lating as beef, but is well known to be very nourishing. The flesh 
 of the wether is by far the most digestible, and is considered best 
 about five years old. Ewe mutton is generally preferred about two 
 years old, but is not so savory or sweet. 
 
 Pork. Pork is highly nutritive, and is less stimulating than 
 beef ; but being the meat most mixed with fat, it remains long upon 
 the stomach. Hence laborers prefer pork and bacon, because, with 
 this food, they are able to remain longer at work without being 
 hungry. 
 
 Pork is an article of food that should he eaten only by those who 
 have strong constitutions, and work hard in the open air. 
 
 Pork, whether salt or fresh, is hard of digestion, remains for 
 a long time in the stomach, and may be filled with worms — the 
 trichina spiralis. (See Trichina spiralis.) 
 
180 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 Buckle tells us, in his " History of Civilization," that for a 
 number of centuries pork was the chief article of diet in Europe. 
 Even at the present day and in our own land, favored as we are 
 with every variety of flesh and fish, of cereals and fruit, yet pork 
 constitutes the principal meat of thousands of families. 
 
 The food ought always to be adapted to the constitution and the 
 age. Delicate ladies, the wives and daughters of our farmers, who 
 live indoors, ought not to have the same diet as the farmers them- 
 selves who live in the open air. Farmers, lumbermen, sailors, 
 and soldiers may preserve health on pork, but brain-workers of all 
 classes, invalids, and delicate ladies and children, should abstain from 
 pork as they would abstain from death. There is not a disease in 
 the whole catalogue which it may not bring on ; there is not a pain 
 of which it may not be the father. It is the parent of dyspepsia, 
 neuralgia, headaches, sleeplessness, "biliousness," constipation, hy- 
 pochondria, and every other physical ill. 
 
 I am a strong friend of meat, and of fat meat, but I am a bitter 
 enemy of pork for those who live by their brains. 
 
 Salted meats in general are less nutritious, less palatable, and 
 less digestible than fresh meats. Ham and bacon are better than 
 other portions of the hog. 
 
 If you must eat pork — cannot get hold of anything better — see 
 that it is thoroughly cooked, so that the worms in it are all killed. 
 (See Trichina spiralis.) 
 
 Farmers, mechanics, and laborers may eat pork and vegetables 
 w T ith greater freedom. In this country, however, it is eaten by farm- 
 ers in too great excess. Some are so far away from market that they 
 can get no fresh meat. Let all such keep and kill for their own use 
 plenty of chickens, turkeys, and geese. 
 
 The wives and daughters of our country farmers in this country 
 are not on the whole as healthy and strong as the wives and daugh- 
 ters of our city merchants. One reason among others for this fact 
 is, that they are compelled to feed on indigestible pork, and are denied 
 fresh meat. The sturdy master of the house, who is always in the 
 open air, can digest and keep strong on pork and potatoes ; but his 
 wife and daughters need a different kind of food. 
 
 Hare. The flesh of the hare, like dark-colored flesh in gen- 
 eral, is stimulating, and when young and fat, is delicate, and not 
 difficult of digestion. Hares, however, differ much in quality, ac- 
 cording to the places where they live. Those that are bred in moun- 
 tainous countries, from feeding on aromatic herbs, are richer in 
 flavor, and much superior to those inhabiting moist and marshy 
 places. Hare, in whatever manner cooked, especially if made into 
 
FLESH FOOD. 181 
 
 soup with the blood, is rich and stimulating ; and therefore improper 
 for invalids, unless in certain cases, where it may be deemed neces- 
 sary to administer food of this description. 
 
 Rabbit. The flesh of the rabbit is more tender and juicy than 
 that of the hare ; but remains longer on the stomach, and is not so 
 nourishing. Wild rabbits are in every respect better than such as 
 are domesticated. The rabbit, like the hare, is in better condition 
 for the table in winter than in summer. 
 
 Venison. The flesh of the stag, well known under the name of 
 venison, is not so close-grained as that of beef or mutton ; and when 
 not too fat is, to a stomach in full vigor, perhaps the most diges- 
 tible of all meat ; but, like other kinds of game, though very nutri- 
 tious, is more stimulating than mutton. The fat is esteemed a great 
 delicacy, and highly valued by gluttons. 
 
 Bibds. All kinds of wild birds have their flesh of a looser tex- 
 ture than those that are domesticated, and are therefore easier of di- 
 gestion, though they are for the most part more stimulating. 
 
 The common or domestic fowl, although rather slow of digestion, 
 is very mild, and well suited for invalids. Chicken \& generally the 
 first kind of animal food allowed to the convalescent from fever, 
 and other acute diseases, because it is less stimulating than the flesh 
 of other animals. All white meats, though not so nutritious, are 
 less stimulating than red or dark-colored flesh ; and this should 
 never be forgotten in regulating the diet of invalids. For example, 
 a patient recovering from inflammatory disease, though his appe- 
 tite and the state of his stomach might allow him to digest a beef- 
 steak in shorter time than the wing of a fowl, yet, from the 
 highly nutritive and exciting nature of the former, it could not be 
 indulged in without a great risk of bringing back the inflammation, 
 and endangering the life of the patient. 
 
 Turkey yields a similar but stronger nourishment than the barn- 
 yard fowl or capon, but partridge and most kinds of game are more 
 digestible. 
 
 Geese and ducks, from the fat and oily nature of their flesh, are 
 difficult of digestion, and are the most oppressive kinds of poultry. 
 Wild ducks, though very savory, are equally indigestible. 
 
 All kinds of animal food cured or prepared with salt, vinegar, or 
 spices, are much more indigestible and heating than in their fresh 
 state, and not so nutritious or wholesome. Both fish and flesh, when 
 dried or smoked, having lost their juices by evaporation, become hard 
 and compact. Their digestion requires much greater labor from the 
 stomach than any other kind of food. With many people, however, 
 a small portion of ham, tongue, or bacon at breakfast, by stimulating 
 
182 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 the stomach, promotes digestion ; with others, again, food of this 
 description remains long on the stomach, and invariably prodnces 
 irritation. Gelatin exists in the flesh of all the domestic quadrupeds 
 used as food, and constitutes the greater part of young animals ; the 
 younger they are the more of this substance they contain, and the 
 less digestible and nutritious is their flesh. Gelatinous substances 
 are not so nutritious nor so easy of digestion as those in which fibrin 
 and albumen predominate. The gelatin contained in the flesh of 
 the sucking pig, in that of birds before they begin to fly, and in all 
 very young animals, presents a glairy or jelly-like appearance. In 
 this state it is neither nutritious nor easy of digestion, and should 
 therefore be avoided by the invalid. The flesh of the calf, of the 
 lamb, and the pig, or that of other young animals, if fed for some 
 time, is firmer, less viscid, and contains more perfect gelatin ; hence, 
 it is better adapted for food, but is still far from being so nutritious 
 or easy of digestion as the flesh of the same animals in a state of 
 maturity. 
 
 The diminution of fibrin, and the increase of gelatin in the 
 younger animals, are. not the only circumstances that distinguish 
 them from those which have attained their full growth. The flesh 
 of the former does not appear to contain (or at least is only provided 
 with a very small proportion of) the stimulating principle, osma- 
 zome, which gives the rich flavor to red and dark-colored meats, 
 and which renders them so much more heating than veal, lamb, 
 poultry, and the various kinds of white meat. 
 
 Veal contains a greater proportion of gelatin, and is much more 
 difficult of digestion, than lamb. In order to have good veal, the 
 calf should be fed on the mother's milk until it is six weeks old. 
 The practice of feeding calves on milk adulterated with chalk, or re- 
 peatedly bleeding them with the intention of making the meat appear 
 white, cannot be too strongly reprobated. The flesh is deprived of 
 its due proportion of fibrin, and its alimentary properties are greatly 
 depraved. 
 
 Lamb. Although it is customary to eat this meat when very 
 young, yet it is not so wholesome as when the lamb has been allowed 
 to suck until it is six months old. The flesh is then of a firmer 
 consistence, fatter, more nutritive, and in every respect superior to 
 that of the lamb killed at two months old. 
 
 Chicken, the young rabbit, pheasant, and nearly all the young 
 animals used at table, in which the flesh is soft and tender, without 
 being viscid or glairy, are the most digestible and wholesome of 
 gelatinous food. Albumen is more or less easy of digestion, accord- 
 ing to the state in which it is used. When slightly coagulated, it 
 
FLE SH FOOD. 183 
 
 is easily digested ; not coagulated, it is less so ; and if taken in a solid 
 state, it is very indigestible. But although the digestibility of the 
 albuminous substances commonly employed as aliment is greatly 
 modified by the degree of heat and mode of cooking, yet they are 
 considered very nutritious. The articles of food in which albumen 
 predominates are eggs, oysters, mussels, cockles, the brain, liver, 
 and sweetbread of various animals which give suck to their 
 young. 
 
 Eggs. Eggs are composed almost entirely of albumen. The 
 yolk, besides this substance, contains gelatin, oil, and water, in com- 
 bination with yellow coloring matter. There is also a little sulphur 
 mixed with the albumen. Hence silver spoons used in eating eggs 
 are stained. Raw eggs pass quickly out of the stomach, and pro- 
 duce a gently laxative effect. When taken in this state they are said 
 to be serviceable in jaundice and obstructions of the liver. When 
 boiled in' the usual manner they afford a mild strengthening aliment, 
 not difficult of digestion. Hard boiled eggs remain long on the 
 stomach, and are apt to constipate the bowels. They are rendered 
 easier of digestion when used with vinegar as a condiment. The 
 eggs of the granivorous fowls are considered the best ; those of the 
 common hen and the guinea hen are most esteemed. The eggs of 
 ducks, geese, and of all the water fowls, contain a greater propor- 
 tion of oil, and are more strongly flavored ; they are only suited for 
 vigorous stomachs. 
 
 An egg, boiled until the greater part of the white is slightly 
 thickened, without depriving the yolk of its fluidity, and taken with 
 a due proportion of bread, is excellent for a child, or a person in a 
 state of convalescence; but when the stomach is deranged, eggs, in 
 whatever state, are apt to increase the disorder. 
 
 Oysters are very nutritive, easily digested, and agree with the 
 stomachs of most people. They are well adapted for convalescents, 
 and may be taken even by those affected with chronic disorders, 
 unless where it is necessary to reduce the patient. They are often 
 resorted to by persons affected with indigestion, being found less 
 distressing to the stomach than any other kind of food. Boiling 
 coagulates the albumen of which oysters are chiefly composed, thus 
 rendering them harder and less easy of digestion ; not nearly so 
 many should be eaten when boiled as in a raw state. Oysters cast 
 their spawn in the month of May, after which they are sickly and 
 unfit for food ; but in July they recover, and are brought to market 
 in August, when they are considered in perfection. 
 
 Mussels are of a more solid texture than oysters, and are not so 
 easily digested. The eruption on the skin called nettlerash is said 
 
184 HYGIENE, OR THE AET OF PRESERVING HEALTH. 
 
 to occur more frequently after eating mussels than any other kind 
 of shell fish. Cockles, prawns, and shrimps are more wholesome, 
 but should only be slightly boiled. Lobsters and crabs are cer- 
 tainly nutritive, but they remain long, even on the strongest 
 stomachs ; their digestion, however, is greatly aided by the use of 
 vinegar. 
 
 The brain of the sheep, and the sweetbread of the calf, although 
 they contain a large proportion of albumen, combined with fatty or 
 oily matter, yet preserve their softness when cooked, are easily di- 
 gested, and very nourishing. The liver is also a strengthening 
 food ; but is much harder, and more difficult of digestion. 
 
 FISH. 
 
 Fish are less nutritive than land animals, but afford more nour- 
 ishment than vegetables. From their great variety the^ present 
 every degree of digestibility. Fish may be divided into two classes, 
 the fat or oily, and those without fat ; but these classes cannot be 
 distinctly separated. 
 
 In the first class may be placed the herring, mackerel, salmon, 
 eel, the trout, and carp in certain seasons, and to these we may add 
 the turtle ; all of which, and indeed every kind of oily or fat fish, 
 are nutritive, but more or less difficult of digestion, and consequent- 
 ly improper for valetudinarians. To the second class belong the 
 whiting, haddock, cod, ling, turbot, sole, flounder, and the trout and 
 carp when not fat. All fish of this description, if plainly cooked, 
 and taken without much butter, are more congenial to the stomach, 
 and more easily converted into wholesome nourishment than the 
 former. 
 
 Whiting. The whiting is very tender and delicate. It is not 
 very nutritive, but produces no stimulating action on the system. 
 Not being oily or viscid it is easily digested, and therefore well 
 suited to delicate stomachs, and to patients laboring under various 
 complaints, in which the daily use of even the least exciting meat 
 might prove injurious. Physicians know the advantage of varying 
 the diet of invalids, and of those convalescent from acute diseases ; 
 and hence, when the use of the mildest animal food is admissible, 
 they frequently order whiting and chicken to be taken at dinner on 
 alternate days, followed by a little sago pudding, or some other mild 
 article of farinaceous aliment. 
 
 Haddock. In respect to its nutritive qualities, haddock com- 
 pares with the full-grown barn-yard fowl ; and is, perhaps, equally 
 digestible, though not so nutritious. 
 
FISH. 185 
 
 Cod. Cod contains more gelatinous matter, and is rather richer 
 and heavier than haddock ; but is an excellent and wholesome fish. 
 The glutinous parts about the head of the cod should be avoided by 
 invalids. 
 
 Salmox. Salmon is a more nutritive fish than any of those 
 mentioned before ; but being rich and oily, it is by no means easily 
 digested, and requires condiments, the best of which are salt and 
 vinegar. The thinnest part of the fish is the fattest. Salmon is 
 cleaned and boiled as soon as caught, and served up cold, and thus 
 is comparatively easy of digestion, when taken with vinegar and 
 pepper. Salmon is less oppressive to the stomach, and more whole- 
 some, when used in its freshest state ; and, as in the greater part of 
 fish when in perfection, there is a deposition of a curdy-looking 
 substance between its layers or flakes. 
 
 Salmon Trout. This fish is not so heating as salmon, and, being 
 less rich and oily, is not so nutritious, but is more under the com- 
 mand of the stomach. All the varieties of trout, though they con- 
 tain more or less oil, are easier of digestion than salmon ; but, like 
 the latter, they uniformly disagree with some persons whose sto- 
 machs are not particularly feeble. 
 
 The great proportion of fat or oil contained in the herring, the 
 mackerel, and more especially in the eel, imparts a degree of rich- 
 ness that renders them very palatable, but with which few stomachs, 
 unless in perfect vigor, are able to contend. The oily matter con- 
 tained in fish is much more difficult of digestion than the fat of 
 meat. The green fat of the turtle, however, when properly pre- 
 pared, and not scorched in cooking, is for the most part congenial 
 'even to the most delicate stomach ; is very nutritious, and easy of 
 digestion. In the West Indies, turtle soup, moderately seasoned, 
 agrees better with patients laboring under chronic dysentery, than 
 other kinds of food. 
 
 Perch and many of the fresh-water fish are more digestible than 
 the generality of sea fish ; and those caught in rivers and brooks, 
 than others found in stagnant waters." Eels which inhabit ponds 
 and stagnant pools are tough, and not nearly so digestible and whole- 
 some as the silver eel of rapid streams ; and the latter soon becomes 
 inferior in every respect, if placed in marshes or dark muddy 
 waters. 
 
 The above remarks are sufficient to enable the invalid to judge 
 of the qualities of fish appropriate to the delicate stomach, and to 
 show him the necessity of abstaining from the more oily varieties, 
 and such as are not quite fresh. Rigidity and firmness of texture 
 are the best indications that fish has not begun to spoil. 
 
186 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 Fish are not adapted to scrofulous cases, and would be improper 
 when we are desirous of giving tone and vigor to the system. 
 
 The best mode of cooking fish for invalids is simply boiling them, 
 or, if perfectly fresh, they may be broiled ; but frying is the worst 
 method for a stomach out of order. 
 
 PHOSPHORUS IN FISH AND PHOSPHORUS IN THE BRAIN. 
 
 A great deal has been said of late about Phosphorus in the 
 Prain, and it has been claimed, on the authority of Prof. Agassiz, 
 that those who eat fish are more intellectual than those who do not. 
 
 On this subject, the American people, true to their nature, have 
 gone to extremes. 
 
 It is true that fish contains phosphorus. It is true that the 
 brain in health contains more or less phosphorus. It is true also 
 that fish is very good food for the brain. 
 
 But on the other hand, it is true that meat contains about as much 
 phosphorus as fish. It is also true that meat contains more of the 
 solid constituents and less of water than fish. It is furthermore true 
 that experience has shown that the question of diet and its effect on 
 the brain is a very complicated one, and cannot be so summarily 
 disposed of by an opinion. 
 
 It is certainly not true that the greatest fish-eaters of the world 
 are the most intellectual* 
 
 Phosphorus is not the only food that the drain requires. The 
 percentage of phosphorus in the brain, though very important in- 
 deed, is yet small, and is far outweighed by other substances. 
 
 Phosphorus is also contained in the husks or bran of wheat, and 
 in fact in all nitrogenous alimentary substances. 
 
 There is danger at the present time of making our food too much 
 a matter of chemistry. The natural appetite is our test chemical 
 adviser in matters of diet, at least until the chemistry of the body 
 becom.es better understood. 
 
 FAT AND OILY FOOD. 
 
 This is the least digestible of all the classes of aliment. If used 
 in considerably quantity for any length of time, it is deposited in the 
 cellular structure which binds the muscles together, and consequently 
 augments the bulk of the body without enlarging or increasing the 
 
 * The greatest fish-eating nations of the world are the Japanese, the New Zealanders, 
 the inhabitants of the North of Europe, and the Esquimaux. None of these nations can 
 boast of much intellect. 
 
CASEOUS OR CHEESY FOOD. 187 
 
 strength of the muscular fibres. Oil or fat, if taken in moderate 
 quantity, and well mixed with other food, is not generally indiges- 
 tible. Oil, for example, is commonly understood to render salad 
 easier of digestion, and appears to prevent raw vegetable substances 
 from fermenting in the stomach, and causing flatulence. 
 
 Young people usually have a natural dislike to fat food, and it 
 almost invariably disagrees with them. The antipathy which the 
 stomachs, both of the young and the aged, have to fatty substances 
 demonstrates the impropriety of using them in their diet. (For ex- 
 ception to this rule, see Consumption^) A very distinguished Amer- 
 ican physician, Dr. Beaumont, ascertained that meat containing much 
 fat, and all oily substances, caused a flow of bile into the stomach; 
 and it is well known that persons of a bilious habit are for the most 
 part unable to digest pork, ducks, goose, and other fat meats ; when 
 in a liquid state, as in fat broths or gravy, it is still more objection- 
 able. Oily and fat substances, if taken while hot, are less digestible, 
 and more apt to disorder the stomach than if eaten when cold. 
 
 Olive Oil. The finest olive oil seldom offends the stomach. 
 Before reaching the United States it always becomes more or less 
 rancid, and never has the delicious flavor of the pure oil used at 
 table in the countries which yield the olive. This oil, when in 
 perfection, is tolerated by the delicate stomach, even when unac- 
 customed to it, where the mischievous effects of melted butter 
 would not fail to be experienced. 
 
 Butter, in the operation of melting, acquires properties which 
 almost invariably render it injurious to persons subject to disorders 
 of the digestive organs. 
 
 Almonds, walnuts, filberts, &c, chiefly composed of fecula 
 and oil, are proverbially indigestible. 
 
 CASEOUS OR CHEESY FOOD. 
 
 Mile. The nutritive properties of milk hold a middle rank 
 between vegetable and animal food. It is strengthening, nutritive, 
 and easily assimilated. It is mild, soothing, and, instead of ex- 
 citing the system and quickening the pulse (like beef-tea or other 
 preparations of animal food), has a tendency to produce languor 
 and disinclination for exercise. The milk of different animals 
 differs in its composition and nourishing qualities, and it varies 
 according to the food on which the animal has been fed. 
 
 Cow's Milk. Cow's milk, being the most plentifully furnished, 
 is one of the greatest importance as an article of diet. In its pure 
 state, it is only adapted for strong stomachs ; but in cases where 
 
188 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 we wish to supply the system quickly with much nutritive matter 
 in small bulk, it is one of the best aliments. It should not be 
 taken by persons laboring under indigestion, nor by those with 
 weak stomachs. Under such circumstances it is very apt to turn 
 acid on the stomach. To prevent this effect, a small quantity of 
 lime water often proves a useful addition. In all acute diseases 
 milk should be prohibited, and, if taken undiluted, it is not well 
 suited for the convalescent. 
 
 The albuminous part of milk is not coagulated into a mass by 
 boiling like the white of an egg; this is owing to the greater quan- 
 tity of water with which it is united. By the action of heat a thin 
 film rises to the surface. By skimming this from time to time, the 
 whole of the albumen may be removed. By this process milk is 
 rendered less nutritive, but more digestible, and is, therefore, better 
 adapted to weak stomachs than if taken in a pure state. 
 
 Asses' Milk is not so rich in cream and cheesy matter as that 
 of the cow or goat, but contains more sugar, and is much easier of 
 digestion, being eminently adapted to patients whose digestive 
 organs are in a debilitated condition. In many instances it proves 
 gently laxative, and in this respect diners from that of the cow, 
 which, in most cases, has rather an opposite tendency. To persons 
 threatened with consumption, and in the early stages of that dis- 
 ease, more especially when associated with a deranged state of the 
 stomach and bowels, the milk of asses, when it can be procured in 
 sufficient quantity, is of the greatest service. 
 
 Goat's Milk. The milk of the goat is richer and stronger than 
 that of the cow, but does not contain so much sugar. It is easier 
 of digestion to many stomachs than the milk of the cow. 
 
 Curd. The curd or albuminous part of milk is separated from 
 the whey by acid, alcohol, and other substances, but the best co- 
 agulating agent is the gastric juice. " The infusion of a piece of 
 calf's stomach (rennet) not larger than a half-dollar, will coagulate 
 a quantity of milk sufficient for making a cheese of sixty pounds' 
 weight, although the quantity of coagulating matter cannot in this 
 case exceed a few grains " 
 
 Milk coagulates upon all stomachs, and the curd thus formed is 
 soft and loose ; but when prepared out of the body, it often dis- 
 agrees with the digestive organs, and often oppresses the stomach. 
 
 Whet. When milk is coagulated by the addition of a small 
 piece of rennet, the whey, when separated from the curd, contains 
 some butter and curd in solution. It also holds in solution nearly 
 all the sugar of the milk, and is, therefore, more liable than milk to 
 ferment in weak stomachs, and produce flatulence. The whey from 
 
FARINACEOUS FOOD. 189 
 
 mare's milk contains a greater quantity of sugar than that from 
 any other animal. Whey is not so nutritious as milk, but affords 
 an excellent demulcent drink in consumption, coughs, jaundice, 
 dysentery, and other diseases. 
 
 Cream. Cream is more easily digested than butter, and when 
 mixed with tea or coffee not only render these beverages more 
 palatable, but corrects their stimulating principle. 
 
 Cream and Fat Meat in Consumption. — Of late years con- 
 sumption has been treated by cod-liver oil, cream, and fat meat, 
 and with good success. Some patients cannot take cod-liver oil ; 
 it is too nauseating. Such patients are often benefited by cream 
 and/"^ meat. 
 
 It is a very interesting and suggestive fact, that patients who are 
 consumptive, or are inclined' that way, have an aversion of a most 
 positive character to fat meat. This is a subject to which I have 
 given much attention. I have made inquiries of my patients to a 
 considerable extent, and have found that the majority of consump- 
 tives have a positive aversion to the fat of meat, and that they 
 usually cut it off on the plate. Such patients should try and learn to 
 use fat fresh beef, by eating a very little at a time, with other food. 
 
 Cod-liver oil seems, in a measure, to take the place of fat. 
 
 Butter. Butter, like other animal oils, unless very sparingly 
 employed, is not congenial to weak or delicate stomachs, or to per- 
 sons of bilious temperament ; but taken in moderation, when 
 fresh and good, it agrees with any age or constitution. When 
 slightly affected by heat it is very oppressive to the stomach, and 
 often produces heartburn. Persons of delicate constitution, or 
 those affected with indigestion, should, therefore, avoid eating any 
 food fried with butter. 
 
 Cheese. It- is a strong and nourishing food to those who can 
 digest it, but is only adapted to robust constitutions and to those 
 who take much exercise. It is almost invariably hurtful to per- 
 sons whose digestive organs are weak. 
 
 Toasted cheese is particularly injurious to the delicate stomach. 
 
 FARINACEOUS FOOD. 
 
 The base of all the substances of this class is a distinct princi- 
 ple, possessed of peculiar properties, named fecula, or starch. This 
 is the most widely diffused principle of the vegetable kingdom, and 
 is met with in various parts of plants, in the seeds, roots, pith, or 
 leaves ; and appears intended by nature to be the chief food of 
 mankind. Fecula, however, is never used in its pure state ; it is 
 
190 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 always associated with different substances, such as gluten, sugar, 
 albumen, mucilage, &c. 
 
 The elementary principles of fecula and gum are the same, yet 
 they differ widely in their chemical properties and nutritive quali- 
 ties. Fecula exists in the various farinaceous substances in the form 
 of numerous globules or grains, more or less round or elongated, 
 each formed of a succession of concentric layers, one within another, 
 like the coats of an onion, having the same elementary composition, 
 but varying in their physical qualities ; the external coats being en- 
 dowed with a much greater power of resisting the action of the 
 agents capable of modifying the fecula. Hence, the stomach has 
 very little influence in changing the formation of fecula in its orga- 
 nized condition, and it cannot be .considered as actually nutritive 
 until submitted to the action of heat. Whatever mode of cookery 
 is adopted, the heat produces the effect of bursting all the grains, 
 and thus renders fecula one of the most easily digested substances, 
 although completely useless as an article of diet until this physical 
 change be effected. 
 
 Sweet Potato. It is very nutritious, and when simply roasted 
 or boiled, forms a very palatable and wholesome food. As it does 
 not appear to be so easy of digestion as the common potato, it should 
 be eaten more sparingly by those who have weak stomachs. 
 
 Yam. This root very much resembles the sweet potato in its 
 properties. It forms a very extensive article of food in the West 
 Indies, and is very nutritious. It is sometimes ground into flour 
 and made into bread. 
 
 Wheat. The most important of all farinaceous substances is 
 wheat, which, besides fecula, contains a large quantity of gluten ; 
 and hence of all the grains wheat is the best adapted for making 
 bread. Animals do not live for any length of time when fed on 
 gelatin, fibrin, or albumen singly ; in general, they cause such dis- 
 gust that the animals prefer dying rather than taking them. Glu- 
 ten, or the adhesive part of wheat, will, on the contrary, nourish 
 an animal well, and for a long time. The flour or meal of other fari- 
 naceous seeds does not contain a sufficient quantity of gluten to allow 
 it to undergo what has been called the jpanary fermentation, and 
 cannot, therefore, be made into loaves like the flour of wheat. 
 
 Indian Corn. The meal made from Indian corn furnishes a 
 most wholesome and nourishing food, well adapted for the support 
 of the active and laborious class. Indian bread, when properly pre- 
 pared, were it not for habit and fashion, would be preferred to bread 
 made from wheat, both on account of its agreeable flavor and deli- 
 cious taste. In the Southern and New England States it is prepared 
 
FARINACEOUS FOOD. 191 
 
 in a great variety of ways, and is a most excellent article of 
 food. 
 
 Bread. Bread differs widely from the flour of which it is com- 
 posed, and may be considered as a new substance. It is easier of di- 
 gestion than any other preparation of flour, and mixes more readily 
 with water, but is considered less nutritive. Newly baked bread, 
 however, swells in the stomach, and is not easily digested. Indeed, 
 the process of fermentation does not appear to be completed until the 
 bread is cold ; for new bread differs from old not only in its effects, 
 but in smell and taste. " The best bread," says Dr. Coghan, " is 
 made of pure flour of good wheat, sufficiently leavened, somewhat 
 salted, well moulded, well baked, and at J east a day and a night old, 
 and not past four or five days old, except the loaves be very great." 
 Besides the nutritive qualities of bread, it prevents the bad effects 
 which would result from the use of too much animal diet, rich soup, 
 and other concentrated food. It also serves to divide and give our 
 aliment a proper bulk and consistence. It may be allowed to the 
 stomach of the weakest patient. It neither stimulates nor relaxes 
 the system, and is justly called the staff of life. 
 
 There are three sorts of bread, the white, the wheaten, and the 
 household. Fine white bread is made of flour only ; w T heaten bread, 
 of flour mixed w T ith the finer bran ; and household bread of the 
 whole substance of the grain, including the coarser bran. Fine 
 white bread is the best, and to most people is more agreeable to 
 the palate than any other kind of bread, being entirely deprived of 
 the bran ; but it is not so nourishing. The common coarse bread, 
 winch contains a considerable quantity of bran, is much more nutri- 
 tious than white bread; so much so that dogs fed on the former have 
 remained in health, whereas those fed on white bread have gradually 
 wasted away and died. This difference, it appears, arises entirely 
 from the absence of the bran. From the mechanical action of the 
 particles of bran upon the lining membrane of the bowels, the 
 household bread acts on many persons as a gentle laxative. The 
 white bread, on the contrary, has a tendency to constipate the 
 bowels, because the astringent action of the starch which it contains 
 is not counteracted by the bran. 
 
 BREAD-MAKING. 
 
 Aerated Bread. — This is made by mixing the dough with 
 water and carbonic acid. This kind of bread is made in large 
 manufactories erected on purpose. It cannot well be made in a 
 private family. The bread made in this way is quite palatable, 
 
192 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 and is easier of digestion than ordinary fermented bread. When 
 toasted it is excellent. 
 
 Prof. IlorsforcVs Process. — Prof. Horsford, of Harvard Col- 
 lege, has devised and popularized a method of bread-making by 
 the use of phosphate of lime and bi-carbonate of soda, so as to form 
 neutral phosphate of lime and phosphate of soda, carbonic acid be- 
 ing evolved. 
 
 The advantages of this process are: 
 
 1. It supplies phosphorus to the bread, of which it is deprived 
 by sifting. 
 
 2. It is easily made, is baked in half an hour, and is palatable. 
 Fermented bread is usually less digestible when hot than bread 
 
 which is raised by these other, processes. 
 
 Heavy, soggy bread, hot or cold, should never be eaten except 
 by those who are in imminent peril of starvation. 
 
 Various articles are used in the adulteration of bread ; the most 
 innocent of them is the potato. Alum is much employed to give 
 whiteness to bread, and to prevent the loaves from sticking to each 
 other in the oven. The daily introduction of small quantities of 
 alum into the stomach must interfere in some degree with the exer- 
 cise of its functions, and to those troubled with indigestion it must 
 prove highly injurious. Persons affected with stomach complaints 
 should, therefore, be careful to get their bread made without alum. 
 The carbonate of ammonia (sal volatile) is extensively used instead 
 of yeast in making the finer kinds of bread; but it does no harm, 
 and is rather advantageous than otherwise. 
 
 There is phosphorus in the bran of wheat. This fact is worthy 
 of consideration by those who live entirely on white bread. 
 
 There is, however, danger of going to an extreme in the matter 
 of bran bread. Those who do not like it should not as a ride eat it. 
 
 This subject I have discussed and explained more fully under 
 " Constipation." Those whose stomachs are very wealc and sensitive, 
 and liable to acidity, oftentimes cannot digest easily bran or Gra- 
 ham bread. 
 
 Indian meal or corn bread — including, of course, the luscious 
 johnny-cakes — is in some respects more nutritious than white wheat 
 bread, and should be used by those who love it and can digest it. 
 
 Pastry is not so injurious as is commonly supposed, provided 
 the crust is light and flaky. Soggy pie-crust is a crime. But yet 
 pastry and cakes should not be eaten largely, and never shoidd con- 
 stitute, as they too often do, especially in country places, the chief 
 part of a ?neal. 
 
 Buckwheat Cakes. In the United States, buckwheat cakes are 
 
FARINACEOUS FOOD. 193 
 
 a staple article, especially in cold weather. In Europe they are 
 little known. 
 
 When they are well made they are healthful. To be well made 
 they should be light, crisp, and sweet. In cold weather they are 
 eaten freely with sugar, butter, molasses, syrup, and gravy, because 
 at that season of the year we need heat-producing substances. 
 Buckwheat is not as nutritious as wheat or corn, but it helps our 
 variety of food, is very palatable and easy of digestion, and therefore 
 should be encouraged. Buckwheat cakes should not he used too ex- 
 clusively : other food — wheaten bread, meat, &c. — should be com- 
 bined with them. 
 
 Buckwheat sometimes produces eruptions on the skin, and there 
 are persons to whom it seems to be poisonous. 
 
 Oats. Oatmeal, prepared in various ways, constitutes one of 
 the principal articles of diet in Scotland, and in some parts of Eng- 
 land, where it is found both wholesome and nutritious. It is, how- 
 ever, inferior to wheaten flour in nutritive qualities. Oats contain 
 a considerable proportion of sugar, and on this account cakes and 
 other preparations of oatmeal are apt to run into fermentation in 
 the stomach ; they are also more heating to the system than either 
 wheat or barley. 
 
 Rice. Bice contains about eighty-five parts of starch in the 
 hundred, and having no stimulating matter in it to quicken diges- 
 tion, remains longer on the stomachs of some persons than other 
 farinaceous substances. In India, and other eastern countries, 
 where it constitutes the principal food of the inhabitants, it is usually 
 taken with curry powder, peppers, and other stimulating condiments, 
 in order to assist digestion. Mixed with other food it is wholesome 
 and well adapted for delicate stomachs. Bice-water is an excellent 
 demulcent drink when there is irritation of the bowels, dysentery, 
 or diarrhoea. Ground rice and milk, flavored with orange peel and 
 sweetened, is a valuable article of diet during convalescence. Some 
 of the French authors strongly recommend rice diet for those affect- 
 ed with red gravel. 
 
 Barley. Barley contains a large proportion of starch, and much 
 saccharine matter. The latter renders it well adapted for distillation. 
 Dr. Coghan quaintly remarks, that "Though barly, as Galen saith, 
 is of a cooling nature, yet it maketh such hot drinke that it setteth 
 men oftentimes in a furie." 
 
 Bye. Bye flour contains a greater quantity of gluten than any 
 other kind of flour except that of wheat, and also a considerable 
 proportion of mucilage ; when well kneaded it ferments, and par- 
 tially rises ; the bread is of a brown color and not disagreeable to 
 13 
 
194: HYGIENE, OR THE ART OF PRESERVING HEALTH 
 
 the taste, but is rather slow of digestion ; it is also apt to turn acid 
 on the stomach, and to relax the bowels of those unaccustomed to 
 its use. Hence bread made of wheaten and rye flour is found 
 very serviceable to persons who are subject to constipation of the 
 bowels. 
 
 This grain yields a black, morbid excrescence, curved like the 
 spur of a fowl, called ergot of rye, which is often of the greatest 
 service in the hands of the skilful accoucheur. 
 
 Potatoes. Potatoes contain a large proportion of starch, but no 
 gluten ; they improve in quality, becoming more farinaceous or 
 mealy from the time they are taken out of the earth until they be- 
 come waxy, when their nutritive qualities diminish, and they are 
 less easy of digestion. The soluble nutritive matter contained in 
 the potato is not nearly so great in the same bulk as in any of the 
 grains. It has been computed that 2 lbs. of wheat contain as much 
 nourishment as 7 lbs. of potatoes. 
 
 Potatoes are easy of digestion only when mealy. Many persons 
 use potatoes with animal food, in preference to bread, and, when 
 not new or waxy, they constitute a very wholesome substitute. 
 They are not considered a suitable article of diet for invalids, par- 
 ticularly for those affected w T ith indigestion. The form of cookery 
 best adapted for potatoes is, boiling in water containing a consider- 
 able quantity of salt in solution. When saturated with the fat of 
 roast meat they are suited only for the strongest stomachs. When 
 mashed they are swallowed without being sufficiently mixed with 
 the saliva, and are, consequently, less easy of digestion. When 
 roasted they sometimes agree best with persons whose digestive or- 
 gans are weak ; but this is not generally the case ; and when over- 
 done they are insipid, and deprived in a great measure of their 
 nutritious qualities. But, whatever mode of cookery is employed, 
 they should be used as soon as possible after being removed from the 
 Are. The starch of the potato closely resembles arrow-root powder, 
 for which it is very frequently sold. This fraud, however, does no 
 harm, for the one starch is little inferior to the other, and their pro- 
 perties, are the same. Potatoes are also extensively employed to 
 adulterate bread, and it would be well if nothing worse were used 
 for this purpose. 
 
 Potato is not the most valuable kind of food. Potatoes are 
 largely composed of water. According to Pereira it takes 10J 
 pounds of potatoes to give us as much nourishment as is con- 
 tained in one pound of beef. Potato diet, when exclusive, makes 
 potato Drains. Witness the Irish peasantry. Other causes besides 
 their diet operate to depress these people, but the potato must 
 
 
FARINACEOUS FOOD. 195 
 
 have a portion of the blame. Potatoes should always be used with 
 meat, fish, eggs, and bread, and should never constitute the principal 
 part of the meal. .We should study the effects of diet not alone on 
 the muscle, but on the brain, on the intellect. The Irish peasantry 
 have strong muscles, but their intellects are dull and hard. 
 
 Nothing very great or very good was ever achieved by a nation 
 of potato-eaters or of vegetarians. 
 
 Peas. Peas, when green and young, are watery, and contain 
 little nourishment, but when properly dressed are light and whole- 
 some. When ripe and dried they are used in the form of pudding 
 and in soup. In both ways they are very nutritious, but the former 
 is difficult of digestion, and only suited for the strong laboring classes. 
 The soup, though less objectionable, should be avoided by those 
 troubled with stomach complaints. Peas, when full grown and dry, 
 in whatever manner they may be cooked, are remarkable for their 
 production of flatulence. 
 
 Beans. Beans, when young, possess nearly the same properties 
 as peas. The pod of the kidney bean is a succulent, tender, and 
 much esteemed vegetable, though not very nutritive. The bean 
 itself, when ripe and still tender, is more nutritious, but not so easy 
 of digestion. The dried kidney beans contain eighty-four per cent, 
 of nutritive matter, of which fifty are pure farina, and the rest gluten 
 and mucilage. Hence they are more nutritive than wheat or any 
 other kind of pulse. They are much more wholesome than peas, 
 and are well suited to correct the effects of fat animal food. They 
 agree well with the laboring classes who are accustomed to their 
 use, and they are very fond of them. " In certain parts of Scotland," 
 says Dr. Cullen, " the farm servants would not engage unless their 
 masters stipulated , that they were to receive so much meal of this 
 bean by the day or the week." 
 
 Chestnuts. Chestnuts are composed almost entirely of fecula and 
 sugar, and form one of the principal articles of diet in many coun- 
 tries. If kept for some time after they are gathered, they become 
 sweeter, more mealy, and easier of digestion ; but, notwithstanding, 
 they are unsuited to weak stomachs. 
 
 Arrow-Root. This well-known powder, which consists of pure 
 starch, is obtained from the root of a plant which is a native of the 
 West Indies. Boiled in water it forms a mild nutritious jelly, much 
 used as food for children and invalids. It is prepared in the follow- 
 ing manner : A portion of the powder, mixed with a little cold 
 water, is to be made into a paste by rubbing it in a basin with a 
 spoon ; over this boiling water is to be poured. It should be stirred 
 briskly at the same time ; then boiled five minutes and sweetened 
 
196 HYGIENE, OR THE ART OF PRESERVING HEALTH, 
 
 with sugar. A little milk and nutmeg may be added, or a small 
 quantity of Sherry or Madeira wine, according to the state of the 
 patient. Port wine does not answer so well because it precipitates 
 the starch. Half an ounce is sufficient to make half a pint of the 
 
 jelly. 
 
 Sago. Sago is composed of starch, with a little salt and coloring 
 matter. It is derived from the pith of several species of palms. 
 The best is called pearl sago. It soon becomes sour if allowed to 
 remain in the form of powder, and is, therefore, made into grains 
 by pressing it through a strong coarse sieve when half baked. 
 Potato starch is easily formed into grains in the same manner, and 
 is often fraudulently sold as sago. The usual way of preparing sago 
 is to put a tablespoonful of the grains into a pint of hot water, and 
 allow it to remain at the side of the fire for two hours; then to boil 
 it for a quarter of an hour, stirring it diligently during the boiling. 
 Sugar and milk, or wine, may be added to it in the same manner 
 as with the arrow-root. 
 
 Tapioca. Tapioca is the produce of the roots of a plant which 
 grows in great abundance in Brazil and in the West Indies. The 
 roots in their raw state are called cassada, and are strong poison, 
 yet the starch extracted from them is similar in its nutritive qualities 
 to sago, which it resembles in appearance, but is not so high-colored, 
 and is formed into larger grains. It is prepared in the same manner, 
 only that it does not require to be macerated, or boiled more than 
 half the time. 
 
 Salep, which is obtained from different kinds of the orchis, the 
 species of arrow-root called Tous les Mois, and the vegetable ex- 
 tracts above noticed, are all merely varieties of starch, and do not 
 differ in their properties. They are very generally prescribed as 
 diet for the sick, and it is not of the slightest consequence which of 
 them is preferred, unless as a matter of taste. They may be either 
 taken simply boiled in water, or with the addition of milk or wine, 
 
 according to circumstances. 
 
 MUCILAGINOUS FOOD. 
 
 Mucilage is a distinct principle abounding in different parts of 
 vegetables, but is never found alone in the mucilaginous substances 
 used as food. It is always associated with sugar, or some bitter, 
 acrid, or acid principle, without which it would be indigestible, and 
 almost devoid of nutritive properties. Several of the vegetable sub- 
 stances, usually classed under this head, contain more sugar than 
 
MUCILAGINOUS FOOD. 197 
 
 mucilage, and in all there is a large quantity of fibrous and coloring 
 matters, which are entirely indigestible. Hence the evacuations 
 from the bowels are more copious after this than from any other 
 kind of aliment. The numerous herbs and roots which belong to 
 this class are more valuable in correcting the effects of stimulating 
 animal food than from their own nutritive properties. 
 
 Cabbage. Red and white cabbage are much relished by many 
 people, but they have a great tendency to ferment in weak stomachs, 
 and are only suited to persons of robust constitutions who take 
 plenty of exercise. 
 
 Broccoli and Cauliflower. These are much superior to cab- 
 bage, being more tender, easier of digestion, and less apt to produce 
 flatulency. 
 
 Spinage yields very little nutriment, and is, perhaps, the least 
 nutritious of all the vegetable substances used at table; it passes 
 quickly out of the stomach without being digested, and imparts its 
 green color to the faeces. 
 
 Lettuce. The lettuce is generally used as salad, and is the most 
 tender and delicate of all the vegetables eaten in a raw state. It is 
 cooling, and has a tendency to induce sleep ; but, when employed 
 with this intention, it should not be very young, and must be eaten 
 without vinegar. This, as well as all kinds of salad and raw vege- 
 tables, is rendered more wholesome by an ample accompaniment of 
 the usual condiments ; but, in whatever manner taken, they rarely 
 agree with weak stomachs. 
 
 Asparagus. Asparagus is a very wholesome vegetable and is 
 easily digested. It does not create flatulency or acidity, but with 
 some people acts as a diuretic. 
 
 Artichoke. Artichokes afford a light and tender food, and are 
 similar in their properties to asparagus. 
 
 Esculent Roots. The principal mucilaginous roots used as food 
 are the carrot, turnip, Jerusalem artichoke, and the large Spanish 
 or Portuguese onion. All the roots of this description are chiefly 
 composed of mucilage, sugar, indigestible fibrous substance, and 
 essential oil. 
 
 Carrot. In its wild state it is hot and acrid,* but by cultivation 
 it has been greatly changed, and is now a nutritious and wholesome 
 vegetable. It contains a considerable proportion of sugar, and a 
 much larger quantity of fibrous matter. It is not considered quite 
 so easy of digestion as turnip, and in general acts gently as a laxa- 
 tive." Carrots and turnips should be well boiled and eaten when 
 young. The carrot forms an excellent poultice for foul and ill-con- 
 ditioned sores. 
 
198 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 Turnip. Turnip is considered one of the best vegetables used 
 at table ; but is rather flatulent, and requires seasoning. 
 
 Beet Root. The red beet is more nutritive than any other root 
 except the potato; but it extricates so much gas in the stomach and 
 bowels as to prevent it from being much used as an article of diet. 
 Beet root contains a large proportion of sugar ; 14 lbs. yield 1 lb. of 
 sugar. 
 
 Jerusalem Artichoke. This is the root of a species of sun- 
 flower, which has obtained the name of artichoke from its similarity 
 in flavor to that vegetable. It is considered a very delicate vegeta- 
 ble ; but requires the addition of pepper, salt, or other condiments, 
 to prevent flatulency. 
 
 Onion. Onions afford a considerable proportion of nourishment. 
 When boiled they are mild, succulent, and seldom disagree with 
 the stomach. The French introduced the use of onion soup, as a 
 restorative after dancing, sitting up late, or any unusual fatigue; 
 and this practice is now very generally followed in other countries. 
 Sir John Sinclair was of opinion that onions possess more nourish- 
 ment than perhaps any other vegetable. " It is a well-known fact," 
 says he, "that a Highlander with a few raw onions in his pocket, 
 and a crust of bread or bit of cake, can work or travel to an almost in- 
 credible extent for two or three days together, without any other food." 
 
 The leek, garlic, and shallot are similar in their qualities to 
 the onion. 
 
 Cucumbers are difficult of digestion, and are the most unwhole- 
 some of all raw vegetables. " The digestibility of celery is greatly 
 increased by maceration in vinegar." 
 
 The stimulating vegetable substances are horseradish, mustard, 
 parsley, sauer-kraut, pickles, spices, &q. These, and all vegetable 
 productions of this description, employed as condiments to aid di- 
 gestion, should be taken sparingly by invalids. Horseradish is 
 considered the best condiment for the prevention of flatulency. 
 
 SACCHARINE OR SWEET FOOD. 
 
 " Sugar," says Dr. Prout, " is the only crystallizable product 
 employed in considerable quantity as an aliment ; and by the per- 
 fectly healthy stomach seems to be readily assimilated. There are, 
 however, certain states of disease in which this organ appears to 
 lose, in a great measure, the power of assimilating this principle ; 
 and in such states of disease, sugar, consequently, is ill-adapted as 
 an aliment." Sugar is most abundant in the sugar-cane, in the 
 
ACIDULOUS FOOD. 199 
 
 grape, and fruits in general. The roots which possess the most are 
 the beet, carrot, and parsnip. 
 
 Sugar. As I explained under Physiology, the starch of our 
 food is converted into sugar during the process of digestion. 
 
 According to Banting, sugar and saccharine food produce 
 obesity. Therefore, corpulent and pursy persons who want to reduce 
 their weight should abstain from sugar so far as possible. 
 
 He carried out his ideas practically in his person, and with very 
 good success. Others have tried the same system and have seri- 
 ously injured themselves. 
 
 It is said that the negroes of the South become fat during the 
 sugar season. 
 
 When sugar is eaten freely in the form of candies, confections, 
 cakes, <&c, it should be eaten with or just after our meals— not be- 
 fore meals — and better still, with some acid, like lemonade, sour 
 ■wine, cider, or fruits. 
 
 Figs, raisins, prunes, dates, and other dried fruits, contain a 
 large quantity of sugar and mucilage. To many people they are 
 salutary and easy of digestion. To some they prove gently laxa- 
 tive, and are very serviceable in this respect ; but, from the quan- 
 tity of sugar contained in them, they are very liable to undergo fer- 
 mentation in the stomach, and to most people are more or less 
 oppressive. 
 
 Honey is very little used as an article of food. It ought never 
 to be taken by the sick and delicate, because it is detained long on 
 the stomach, and frequently causes flatulence and acidity. 
 
 ACIDULOUS FOOD. 
 
 Under this head are placed the different species of fruit used at 
 table. These are, in general, composed of mucilage, vegetable 
 jelly, sugar, water, malic, acetic, and other acids, and some of them 
 contain a portion of farinaceous matter. They afford less nourish- 
 ment than any other class of aliment, and are considered more as a 
 luxury than as articles of food. When taken as a dessert, unless 
 used very sparingly, they are particularly injurious to invalids, 
 because they interfere with the full meal which has just preceded 
 them. When ripe, and taken at proper times, they are light, re- 
 freshing, and very wholesome. In intertropical countries there is 
 always an abundant supply of various delicious and fragrant fruits, 
 which are both cooling and refreshing, and many of them, contain- 
 ing farinaceous matter with a considerable proportion of sugar, 
 afford nourishment well adapted to the indolent inhabitants of warm 
 
200 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 climates. In fever and inflammatory disorders (with the exception 
 of dysentery, diarrhoea, and other affections of the alimentary canal) 
 the juicy and watery fruits, such as grapes, oranges, &c, tend to 
 alleviate thirst, are cooling, and very grateful to the patient. In 
 spitting of blood, and other similar complaints, they serve as a 
 valuable auxiliary to more powerful means in lessening the activity 
 of the circulation, and thus moderating or preventing the return of 
 these discharges. The acid fruits, such as lemons and limes, are 
 well known to be specific in scurvy ; and the infusion of tamarinds 
 is a useful remedy in vomiting of blood from the stomach. 
 
 Owing to certain peculiarities, which we are unable to explain, 
 the stomach is more capricious with respect to fruits than any other 
 article of diet. The stone fruits are considered the least digestible, 
 and the most disposed to fermentation in the stomach. They differ 
 considerably, however, in these respects. Of those in common 
 use, the various kinds of plums, probably, most disagree with the 
 stomach and bowels. 
 
 The peach, apricot, and nectarine are the best of the stone 
 fruits ; and, when perfectly ripe, seldom disorder the digestive 
 organs. The peach is the most esteemed, and is the easiest of di- 
 gestion. Cherries, even in large quantities, are not so unwhole- 
 some as is generally imagined. In various parts of Italy, this fruit, 
 with bread, constitutes the principal food of the lower orders, and 
 agrees w T ell with them, being much better suited to the system, 
 when heated and excited by the warmth of summer, than much 
 animal food. 
 
 The strawberry, raspberry, and gooseberry are wholesome 
 fruits. Apples and pears are the most nutritious, but as their 
 texture is firmer they require more labor from the stomach, and are, 
 generally speaking, improper for invalids. Pears, being the softest, 
 are more easily digested. The great English physician, Sydenham, 
 allowed no other aliment to his patients, in the febrile stages of 
 small-pox, erysipelas, and quinsy, than boiled apples. 
 
 The melon contains more farinaceous matter than any of the 
 fruits previously mentioned. It should never be eaten after din- 
 ner without a plenty of pepper and salt, and is altogether improper 
 for persons with weak stomachs. 
 
 Of the smaller berries, the cranberry, bilberry, &c, when baked, 
 are very wholesome, and seldom disagree with the stomach. Indeed, 
 many fruits, otherwise unwholesome, are rendered salutary by cook- 
 ing, and all fruit pies are excellent articles of diet, if the soggy pastry, 
 which is very indigestible, be rejected. Currants, mulberries, and 
 the more acescent fruits, cannot be tolerated by many stomachs. 
 
ADULTERATIONS OF FOOD. 201 
 
 CONDIMENTS. 
 
 Salt is not only indispensable to man, but appears to be neces- 
 sary to other animals, many of which, in a wild state, seek for it 
 with the greatest avidity. Abstinence from salt soon occasions dis- 
 order of the digestive organs, paleness of the countenance, and ema- 
 ciation ; and unsalted diet almost invariably has the effect of gener- 
 ating worms in the intestines. Bread is rendered more grateful to 
 the palate and easier of digestion by the addition of salt, about 
 twelve to sixteen ounces of which are generally mixed with each 
 bushel of flour. 
 
 Yinegae is very serviceable in aiding the digestion of celery, 
 lettuce, beet-root, and other raw vegetables, and in preventing them 
 from inducing flatulence. It is equally useful in promoting the 
 digestion of rich and oily substances, such as salmon. Lemon-juice 
 has a similar effect when used with goose and wild fowl ; upon the 
 same principle apple-sauce is, probably from the malic acid which 
 it contains, eaten with pork. 
 
 Spices and Aeomatics. The various spices and stimulating 
 vegetable condiments should be used sparingly by invalids. They 
 are only wholesome for persons in health, when the stomach has to 
 contend with food known to be difficult of digestion. The habit 
 of using them daily injures the tone of the stomach and impairs the 
 digestive functions. In warm climates, the stimulating action on 
 the stomach of the different species of pepper and aromatics is more 
 particularly requisite ; and these, when not used in excess, are in 
 general decidedly beneficial. 
 
 ADULTEKATIONS OF FOOD. 
 
 That food is more or less adulterated, everybody well knows ; 
 the extent to which adulteration is carried, very few suspect. In 
 France the laws are so rigid that very many of the articles of food 
 are kept pure ; in England and the United States, on the contrary, 
 nearly everything is adulterated. Wherever it will pay, men will 
 adulterate articles of commerce. Food is adulterated in order 
 
 1. To increase its size and weight. 
 
 2. - To enable one dealer to undersell another, by lessening the ex- 
 pense of manufacture. 
 
 3. To improve its color, or taste, or appearance. It is for this 
 
202 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 purpose that candies are largely adulterated with poisonous 
 colors. 
 
 Wheat flour is adulterated with alum in order to make it lighter 
 and whiter. Bakers' bread is whiter and lighter than home-made 
 bread, on account of the alum which it contains. Alum, however, 
 (j Ives it an insipid taste and also makes it less healthful. Baiters'' 
 oread is also adulterated with potatoes and com or rye meal. These 
 substances are, of course, harmless. 
 
 Cocoa is adulterated with starch, flour, sugar, oxide of iron, 
 arsenic, and Venetian red. These latter substances are used to 
 improve its color. Dr. Hoskins, in his excellent work on this sub- 
 ject, says that American cocoa and chocolate are the best in the 
 market. 
 
 Butter is adulterated with water, salt, lard, and even flour. 
 
 Honey is not only adulterated, but is actually manufactured. It 
 is made out of sugar, syrup, water and flavoring extracts, cream 
 of tartar, and alum. None of these substances are injurious, ex- 
 cept alum. Manufactured honey is less palatable than natural 
 honey. 
 
 Sugar is adulterated with, flour and sand. The latter article is 
 put into brown sugar to increase its weight. 
 
 Spices and condiments are adulterated, especially when they are 
 sold in powder. Dr. Hoskins says that the insects which prey upon 
 spices are often ground up with them. 
 
 Ginger and pepper are ground up with roots, flour, insects. 
 Cloves are adulterated with various barks. Cayenne pepper even is 
 mixed with salt and corn meal and red lead. Lead may cause 
 that dreadful disease — lead poison. Mustard is fearfully adul- 
 terated with flour and turmeric. The latter is used to restore the 
 color after it has been whitened by adding flour. While I was 
 acting as surgeon in the navy during the late war, I found that the 
 mustard that was brought to us was almost tasteless. It consisted 
 very largely of flour. When I wished to make a mustard plaster I 
 found that it was necessary to use a very large amount. 
 
 Candy is one mass of adulteration. According to Dr. Hoskins, 
 confectionery is colored by chr ornate of lead, gamboge, cochineal 
 dye, bisulphuret of mercury, Antwerp blue, Prussian blue, Bruns- 
 wick green, verdigris, emerald green, mineral green, ScheeWs green, 
 gypsum, whiting, flour, rice. 
 
 The character of most of these substances, especially of the leads, 
 is well known. They are fearfully poisonous, although, like all other 
 poisons, they can be used in moderation without injury, and some 
 of them, it may be, with benefit. Large quantities of colored can- 
 
ADULTERATIONS OF FOOD. 203 
 
 dies are unquestionably injurious, and should not be allowed to chil- 
 dren. Let them rather have abundance of ripe fruit. If candy 
 must be eaten, let it be taken with our meals or just after, or with 
 some neutralizing acid, like cider, sour wine, or lemonade. 
 
 Candies are flavored with fusel oil and Prussia acid. Colored 
 confectionery should be banished from our homes. 
 Vinegar is adulterated with sulphuric acid. 
 
 Pickles are made of a salable green color by letting them "stand 
 for twenty-four hours in copper or brass pans." 
 
 Milk, I need not say, is adulterated with water/ sometimes also, it 
 is said, by other substances, such as chalk, flour, &c. Hoskins is of 
 the opinion that these — chalk and flour — are not used, to any ex- 
 tent at least, in the adulteration of milk. 
 
 The " slop milk " from the distilleries is unfit for man or beast. 
 " Slop milk" is adulterated by first adulterating the com in the dis- 
 tilleries. This horrible nuisance, once so rife in our cities, has been 
 of late measurably abolished. 
 
 For the adulteration of tea, coffee, fermented and distilled liquors, 
 tobacco, opium, &c, see " Stimulants and Narcotics? 
 
 Drugs and medicines are abominally and criminally adulterated ; 
 but this subject is hardly appropriate for a book like the present 
 volume. Physicians 1 prescriptions often fail simply because t/ie 
 medicine ordered is adidterated. 
 
 Hoskins, who writes well on this subject, and to whom I am 
 indebted for many facts, speaks thus strongly : 
 
 " When we come to examine the list of adulterated articles of 
 food, we are surprised at its extent. Nothing seems to have es- 
 caped which is not in its nature insusceptible of vitiation. Bread 
 and butter, tea, coffee, cocoa, sugar, milk, spices, confectionery, pre- 
 served fruits and meats, vinegar, pickles, oils, wines and liquors, 
 almost every article which we find upon our tables, bear upon them 
 the trail of the serpent in the form of such delectable substances as 
 salts of copper and arsenic, the chromate, oxide, acetate, and car- 
 bonate of lead, bi-sulphuret of mercury, gamboge, chromate of 
 potash, Prussian blue, Brunswick green, catechu, alum, indigo, sul- 
 phuric acid, Yenetian red, yellow ochre, bronze powders, to say 
 nothing of less injurious, though not less dishonest, additions of plas- 
 ter of Paris, chalk, starch, burnt peas, beans, rye, and chiccory, 
 water, turmeric, lard, meal, potatoes, &c. All of these articles, and 
 not a few others of the same kind, shall be demonstrated to exist in 
 the food consumed daily by the people of this country. 
 
 " The more poisonous substances are usually found in minute, 
 though by no means homoeopathic quantities ; but this makes them 
 
20-i HYGIENE, OR THE ART OF PRESERVING IIEALTH. 
 
 only the more deadly, because it admits of their constant and unde- 
 tected use, until the constitutions of the victims are fatally under- 
 mined. Sometimes, however, immediately serious and even fatal re- 
 sults occur, and we not uncommonly see accounts of the death of chil- 
 dren, especially from the use of colored confectionery. How many 
 attacks of ' colic,' ' vomiting,' ' dysentery,' ' sick headaches,' how 
 much nervousness, blindness, deafness, dyspepsia, or even paralysis 
 and insanity, might be traced by rigorous investigation to such 
 sources, it is frightful to think of." 
 
 TABLE OF ADULTERATIONS. {After HoshiriS.) 
 
 
 ADULTERATIONS 
 
 ADULTERATIONS 
 
 
 FOR BULK AND WEIGHT. 
 
 FOR COLOR, TASTE, ETC. 
 
 Arrow-root. 
 
 Cheaper arrow-roots and 
 
 starches. 
 
 
 Brandy (often entirely facti- 
 
 Water, neutral spirits, 
 
 Burnt sugar, sugar, spirits 
 
 tious). 
 
 whiskey, rum. 
 
 of nitre, fusel oil, kino and 
 other astringents,acetic acid. 
 
 Butter. 
 
 Water, lard, salt. 
 
 
 Bread. 
 
 Corn-meal, potatoes, rye- 
 meal. 
 
 Alum. 
 
 Bottled fruits. 
 
 
 Salts of copper. 
 
 Confectionery. 
 
 Starch, flour, plaster of 
 
 Cochineal, indigo, Prussian 
 
 
 Paris. 
 
 blue, ultramarine, carbo- 
 nates of copper and lead, 
 red lead and the chromate 
 of lead, or chrome yellow, 
 gamboge, true and false, 
 Brunswick greens (either 
 oxychloride of copper or a 
 mixture of chrome yellow 
 with Prussian blue or in- 
 digo), emerald green or 
 arsenite of copper, various 
 ochres (umber, Sienna, etc.), 
 bronze powders. 
 
 Coffee. 
 
 Chicory, carrot, peas, beans, 
 corn. 
 
 Burnt sugar. 
 
 Cocoa and chocolate. 
 
 Arrow-root, starch, sugar. 
 
 Red and brown ferrugin- 
 ous earths. 
 
 Cider (often entirely factitious). 
 
 Water. 
 
 Honey, sugar, tartaric acid, 
 whiskey, alum, burnt sugar. 
 
 Cayenne. 
 
 Corn -meal, salt. 
 
 Red lead, Venetian red. 
 
 Ginger. 
 
 Corn-meal. 
 
 Turmeric. 
 
 Gin. 
 
 Water,sugar, neutral spirits. 
 
 Flavoring substances. 
 
 Honey (often entirely facti- 
 
 Sugar, water, glucose. 
 
 
 tious). 
 
 
 
 Lard. 
 
 Water. 
 
 Salt. 
 
 Mustard. 
 
 Wheat flour, com flour, 
 6alt, Cayenne. 
 
 Turmeric. 
 
ADULTERATIONS OF FOOD, 
 
 205 
 
 
 ADULTERATIONS 
 
 ADULTEBATIONS 
 
 
 FOB BULK AND "WEIGHT. 
 
 FOB COLOB, TASTE, ETC. 
 
 Milk. 
 
 Water. 
 
 Burnt sugar, salt, bi-carb. 
 soda. 
 
 Pickles. 
 
 
 Salts of copper. 
 
 Potted meats and fish. 
 
 
 Bole Armenian, Ven. red. 
 
 Kum. 
 
 Water. 
 
 Burnt sugar and flavoring 
 substances. 
 
 Sugar (refined). 
 
 Wheat flour. 
 
 
 Spices. 
 
 Flour, dirt, corn -meal, in- 
 ferior or cheaper spices. 
 
 
 Tea. 
 
 Lie tea, stalks and leaves 
 
 Black-lead, gum, Prussian 
 
 
 of other plants. 
 
 blue, gypsum, indigo. 
 
 Vinegar. 
 
 Water. 
 
 Burnt sugar, sulphuric 
 acid. 
 
 Whiskey. 
 
 Water, neutral spirits. 
 
 Spirits nitre, fusel oil, 
 burnt sugar, acetic acid. 
 
 Water. Water enters abundantly into the solids of the body, 
 and is the basis and largest portion of the fluids. It is an essential 
 constituent of all living bodies ; and, as it is incessantly expended 
 during life, the waste must necessarily be supplied, to preserve the 
 proper proportion of fluid and solid matter requisite for the due 
 performance of the various functions, and the preservation of health. 
 Water, of all simple drinks, is certainly the best adapted to quench 
 thirst, and impart a due degree of solubility to the food in the 
 stomach. It should he used freely at our meals, to the full extent of 
 our desires. 
 
 Saunders, in his book on " Mineral Waters," remarks that "Water 
 drinkers are, in general, long livers, are less subject to decay of the 
 faculties, have better teeth, more regular appetites, and less acrid 
 evacuations than those who indulge in a more stimulating diluent 
 for their common drink." But man lives and thrives when habitu- 
 ally using different 'kinds of drink, which the tastes and customs 
 of civilized life have rendered congenial to him ; and there is no 
 necessity for restricting ourselves exclusively to water, unless other 
 beverages are found injurious. 
 
 Water should contain as few foreign matters as possible; the dif- 
 ference of its varieties in this respect, according to the sources from 
 which it is obtained, are worthy of some attention. 
 
 Rainwater is very pure when collected in an open country; but 
 in large towns it is more or less contaminated by the smoky atmos- 
 phere through which it falls, and by the impurities lodged on the 
 roofs of the houses from which it drops. When collected from 
 houses, it k generally found impregnated with calcareous matter, 
 and should therefore be boiled and strained before it is used. 
 
 Spring water is the best adapted for drink when soft ; it is often 
 
206 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 oppressive to weak stomachs. It even proves injurious to some of 
 the domestic animals when confined to its use, and is particularly 
 disliked by horses. 
 
 River water. River water frequently contains earthy matter 
 in solution, which renders it unwholesome, and in the vicinity of 
 laro-e cities it is more or less contaminated with animal and ve»;e- 
 table substances, which tend still more to impair its salubrity ; rest 
 and filtration are therefore requisite before it can be used with 
 safety. 
 
 LEAD PIPES. 
 
 Water that has stood over night in lead pipes of our cities may 
 become poisonous. Persons have been poisoned by drinking ale 
 that has stood long in lead pipes. It is well to let the water run 
 a few moments in the morning before using it. 
 
 Recently pipes have oeen made lined with tin. 
 
 PURIFYING WATER. 
 
 Impure water may be cleansed — 
 
 1. By distillation. 
 
 Our ocean steamers now distil their water from the sea. The 
 water thus distilled is insipid until by agitation it is made to take 
 up a certain amount of air. 
 
 2. By boiling. 
 
 3. By filtration through sand. 
 
 GENERAL REGULATIONS FOR DIET. 
 
 Having briefly noticed the chief articles of food in common use, 
 we shall now proceed to point out a few precautions to be attended 
 to in regulating the diet of the invalid, with some observations on the 
 quantity and quality of his food, the regulation of the periods at 
 which the different meals should be taken, and the bodily and mental 
 exercise which ought to follow them. 
 
 Meals. According to the often repeated saying of Diogenes, the 
 best time for eating is, " for a rich man when he can get an appetite, 
 and for a poor man when he can get food." But we know that habit 
 exercises the greatest influence in regulating the appetite. Persons 
 who are accustomed to breakfasting and dining at certain hours of 
 the day, will always, if in health, feel inclined to eat at those hours ; 
 and in many people the desire for food, if not relieved at the usual 
 period, goes off for a time, and indigestion is frequently the conse- 
 quence. The practice of eating at certain fixed periods is strongly 
 advocated by physicians, as essential to the maintenance of health ; 
 and regularity in this respect, besides being in accordance with the 
 
LUNCHES AND DINNER AT NIGHT. 207 
 
 proper regulation of domestic economy, allows the food to be entirely 
 digested and the stomach prepared for a fresh supply, before it is 
 charged with another meal. But the number of meals and the times 
 at which they should be taken must depend upon the circumstances 
 connected with each particular case, and must vary according to the 
 age and digestive powers of the individual, the quality of the food, 
 and the amount of exercise taken. 
 
 The habit of eating little and often is very properly condemned by 
 all writers on dietetics. By eating frequently we disturb the healthy 
 action of the stomach, and interfere with the natural process of diges- 
 tion. The stomach follows the general law of the animal economy 
 in requiring rest after labor, and therefore the proper quantity of food 
 should be taken at once, in order that it may be digested, and a few 
 hours of rest allowed before another meal. But this applies only as 
 a general rule ; for in many cases of chronic disease, and during 
 convalescence from fever or inflammatory disorders, it would be im- 
 proper to introduce much food into the stomach at one time. Under 
 such circumstances nature requires that we should administer ali- 
 ment at short intervals, in order to supply the system with sufficient 
 nourishment without oppressing or irritating the digestive organs. 
 
 Some individuals complain of a distressing sensation of depression 
 and languor between meals, and consequently seek relief from fre- 
 quent refreshment ; but this habit is always more or less hurtful, 
 and, like many other artificial wants, requires only a little resolution 
 to be overcome. If perseveringly discontinued for some time, the 
 symptoms in which it originated cease, and the languid and capri- 
 cious stomach is restored to its healthy tone. 
 
 The intervals between meals should not exceed six hours ; 
 although such is the power that the system has in accommodating 
 itself to our habits, that many individuals are able to transgress this 
 rule with impunity during many years. 
 
 LUNCHES AND DINNER AT NIGHT. 
 
 Business men in our large cities are compelled to take their din- 
 ner at night, after the labor of the day is over. 
 
 I do not think that this is so bad a habit as many suppose. Un- 
 questionably the middle of the day is the best time for dinner for 
 those who, like farmers, have quiet leisure at that time. Bat busi- 
 ness men in our large cities are usually busiest from 11 to 2 o'clock. 
 A hearty meal should not usually be taken when the mind is bur- 
 dened, with pressing cares and duties. Therefore merchants in our 
 large cities do well to have dinner at night, when their brains are, 
 or ought to be, free from immediate cares. 
 
20S HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 For those who dine at night, substantial and agreeable lunches 
 are a duty and a necessity. 
 
 Merchants should give one half -hour, or better still, a full hour, 
 to a substantial lunch, and, if 'possible, in pleasant company. 
 
 Breakfast. From the length of time that intervenes between 
 breakfast and the previous meal, it might be presumed that a per- 
 son in the morning would have a greater appetite for food, and would 
 be able to eat more than at any other period of the day. " This, 
 however," says Dr. Paris, " is not always the fact ; the gastric juice 
 may not be secreted in any quantity during sleep, while the muscu- 
 lar energies of the stomach, although invigorated by repose, are not 
 immediately called into action ; it is, therefore, advisable to allow an 
 interval to pass before we commence the meal of breakfast." But 
 many persons, from a weakened condition of the system, experience 
 an uneasy sensation of languor, accompanied with a feeling of debil- 
 ity and depression, which unfit them for the ordinary duties of life 
 until they have taken some food. 
 
 Breakfast, being the meal which is to support the body during 
 the most active part of the day, should be sufficiently substantial, 
 but no fixed rule can be given with regard to its quantity or quality. 
 These must depend on the constitution and habits of the person, the 
 exercise to betaken, and the time that is to elapse before luncheon. 
 Liquids are instinctively desired at breakfast to supply the loaste 
 by perspiration / for it has been ascertained that a healthy person, in 
 a given space of time, perspires insensibly twice as much during the 
 night as when awake. 
 
 Tea and coffee are the morning beverages generally used, and the 
 choice of these must depend on the experience of each individual of 
 what agrees best with him. Persons affected with indigestion, and 
 those with weak stomachs, are frequently troubled with heartburn, 
 and other uneasy sensations, every time they take much warm fluid 
 with bread and butter, toast, muffins, or meat, especially if fat. In 
 such cases dry toast should be used, and an egg or two, if found to 
 agree with the stomach, should be substituted for meat. Sometimes 
 it is advisable to take a glass of cold water, or a cup of weak tea, on 
 rising in the morning, and only a small cup of tea at breakfast, in 
 order to avoid mixing much liquid with solid food, a combination 
 which rarely agrees well with the enfeebled or delicate stomach. 
 
 Where this weakened condition of the digestive powers exists, 
 new bread, spongy rolls, butter, and the fat of meat should be care- 
 fully avoided. The lean of cold mutton, or eggs with bread a day 
 old, or plain toast, will probably better agree with the stomach. The 
 adopting of these and similar dietetic measures, according to cir- 
 
EATING BEFORE GOING TO BED. 209 
 
 cumstances, for the purpose of aiding digestion, and restoring the 
 healthy tone of the stomach, is certainly more rational, and more 
 likely to prove successful, than constantly resorting to the use of 
 medicine when the digestive organs are in a deranged condition. 
 
 Dinner. Dinner should generally be taken by invalids from four 
 to six hours after breakfast. There can be no doubt that the 
 stomach more easily digests a mass composed of several ingredients 
 than an equal bulk of any one substance. This fact likewise applies 
 to the elementary principles of which the different articles of diet 
 are composed. If only one be taken, in whatever quantity, it affords 
 little nourishment, and is incapable of supporting life for any length 
 of time ; whereas, when two or three are combined, the compound 
 substance yields ample nourishment. This fact should not be lost 
 sight of when the stomach is weak. In such cases the meals should 
 consist of several articles ; but the principle is only applicable within 
 certain limits. 
 
 The working classes, especially in large towns, suffer neither 
 from a variety of dishes nor from dining at late hours ; but their 
 digestion is frequently rendered laborious by eating a full meal 
 hastily, and returning to their work when the process of digestion is 
 hardly commenced. Among the less robust inhabitants of towns 
 repose is necessary after meals ; and eating slowly, in order to allow 
 the food to be properly blended with the saliva, is another obser- 
 vance of no less importance. 
 
 Tea. To those who dine late, tea or coffee do not constitute a 
 meal, and should soon follow dinner, as they are intended merely to 
 quicken the action of the stomach, so that the food, already con- 
 verted into a soft pulpy fluid (chyle), may be diluted, and thereby 
 aided in passing into the blood, in order to be assimilated into the 
 substance of the body. 
 
 eating before going to bed. 
 
 Every day I am asked, Is it well to eat just before going to 
 bed? 
 
 Each person must answer this question by his own experience. 
 As a rule, it is not, I think, a necessary habit. In England, how- 
 ever, the custom of " suppers," as they are called, is very common. 
 
 It is better to eat some light food before retiring, than go to 
 bed hungry. 
 
 Some persons cannot sleep if they retire on a stomach perfectly 
 empty. If we eat during the evening (if we are out at late parties), 
 14 
 
210 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 it is well to select food that is most readily digestible. Oysters are 
 good evening food, except where they are fried. Very hard apples 
 in large quantities are not good evening food. 
 
 Eating in the evening has the effect to make some people con- 
 stipated and sleepless. I need not say to such, beware. 
 
 Exercise before and after taking Food. We are naturally 
 inclined to rest after eating. Active bodily exercise immediately 
 after a meal disturbs the process of digestion. Not only do our own 
 feelings convince us of this, but the fact has been made still more 
 apparent by experiments performed on the lower animals. Sir 
 Busick Harwood, having fed two hungry pointers, allowed one of 
 them to rest in his kennel, the other he kept for two hours in con- 
 stant exercise. On his return both were killed after the same lapse 
 of time. On opening the dog which had remained quiet, the diges- 
 tion was found nearly completed, but in the other the digestive pro- 
 cess had scarcely commenced. This, however, applies only to 
 active exertion ; healthy persons may take gentle exercise after 
 meals without suffering inconvenience ; their digestion may be 
 slightly impeded, but will certainly not be prevented. But if 
 the stomach be weak and easily disordered, or a very full meal 
 has been taken, repose is essential to the due performance of the 
 digestive functions. Invalids should, therefore, amuse themselves 
 with light reading or conversation, for an hour or two after din- 
 ner. AVhen the digestion is completed, and the chyle has entered 
 into the circulation, we feel invigorated and inclined to bodily 
 exertion. This is the proper time for active exercise, which is 
 then of as much service as at an earlier period ; wdien the food is 
 still on the stomach, it would be injurious. But though the be- 
 nefit to be derived from exercise, either on foot or on horseback, 
 in promoting the appetite and assisting digestion, cannot be called 
 in question ; yet the invalid should never forget that if it be car- 
 ried to excess, or if he dine without having rested, the functions 
 of digestion are very liable to be deranged. 
 
 Eating a full meal in a state of bodily fatigue tends strongly to 
 check the digestive operations. The exhaustion of the nervous 
 energy from long-cortinued mental exertion will also produce the 
 same effects, nor will the stomach be capable of performing its duty 
 if the mind be severely exercised immediately after eating. Most 
 literary men, and persons intently devoted to business, are the 
 greatest sufferers from indigestion ; and we should always bear in 
 mind that, when this disorder is kept up by thus deviating from the 
 rules which nature clearly points out as essential to the mainte- 
 nance of .the general health, it frequently gives rise to consumption, 
 
STIMULANTS AND NARCOTICS. 211 
 
 or at least is the first symptom of that fatal malady, as well as of 
 many other formidable disorders. 
 
 STIMULANTS AND NAKCOTICS. 
 
 The subject of stimulants and narcotics is of so great and in- 
 creasing importance that it not only deserves a special chapter, but 
 is in fact worthy of an entire volume. 
 
 It is proper and necessary that people everywhere, at least in 
 civilized lands, should understand something of the nature of stimu- 
 lants and narcotics, in order that they may know how to use them 
 and how not to abuse them. 
 
 I may say at the outset, that by stimulants and narcotics I mean 
 not only rum and tobacco, but every substance to which the human race 
 have been accustomed to resort for stimulating and narcotizing effects. 
 
 There are as many different kinds of stimulants and narcotics as 
 there are different races and tribes and families of men on the face 
 of the earth. 
 
 The following list and explanations, though incomplete, will give 
 some idea of the varieties that are now used in different parts of the 
 world. It will be seen that many of these substances are not known 
 here, even by name. 
 
 Fermented and distilled liquors. — Rum, gin, brandy, whis- 
 key, champagne, sweet and sour wines, cider and beer — all con- 
 tain alcohol, in greater or less quantities. They are used in all 
 civilized and many of the semi-civilized lands, among about 500,- 
 000,000 people. In the United States and Great Britain the 
 stronger liquors are used ; in France, Germany, Spain, and Italy, 
 the lighter wines. 
 
 From Sheen's little treatise I extract the following interesting 
 facts with reference to alcoholic liquors : 
 
 " The vine is said to have been introduced into England by 
 the Romans, and vineyards are mentioned in the earliest Saxon 
 charters, as well as gardens and orchards. 
 
 " Bede, writing in 731, alluded to vineyards being in existence at 
 that time. Domesday Book also speaks of vineyards in several 
 counties. William of Malmesbury, in his work ' De Pontih'cibus,' 
 written in 1123, informs us that the vale of Gloucester used to pro- 
 duce as good wine as many of the provinces of France. From the 
 date of the Conquest vineyards appear to have been attached to all 
 the abbeys and monastic institutions in the southern and western 
 
212 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 parts of the island. But about the time of the Reformation, when 
 the ecclesiastical gardens were either neglected or destroyed, ale, 
 which had been known in England for many centuries, seems to 
 have superseded the use of wine as a general beverage. 
 
 " We have no historical record of the period when the distillation 
 of spirits was first known. The Greeks and the Romans were igno- 
 rant of ardent spirits, and, from the absence of any evidence to the 
 contrary, we must assume that the art of distilling was not known 
 until long afterwards. 
 
 " The use of the still appears to have been well known in the time 
 of Geber, who lived in the seventh century, and who describes very 
 accurately the process of distillation by the alembics— -per descensori- 
 uno et filtruno — in his work entitled ' Liber Investigationis Ma- 
 gisterii.' It has been stated that Albucasis, who is supposed to have 
 lived in the twelfth century, taught the method of procuring spirit 
 from wine ; but as the process of distillation was evidently known 
 long before his time, it is equally certain that his predecessors had 
 submitted fermented liquors to this operation. Arnauld de Ville- 
 neuve,.a physician of the thirteenth century, is the first author who 
 speaks explicitly of an intoxicating spirit obtained by the distillation 
 of wine, and he considers it to be the universal panacea, so long 
 sought after in vain. His disciple, Raymond Lully, was acquainted 
 with spirit of wine (which he called aqua ardens), as well as of the 
 mode of depriving it of water by means of some alkali. 
 
 " Morewood considers the Chinese to have been acquainted with 
 this process long before the rest of Asia, Africa, and Europe. In 
 his ' Essay on Intoxicating Liquors,' page 107, he says : ' In China, 
 a country which has preserved its civil polity for so many thousand 
 years, the art of distillation was known far beyond the date of any 
 of its authentic records. The period of its introduction into that 
 country, in common with the rise and progress of other chemical 
 arts, is, however, concealed amidst the darkness of ages. But, taking 
 dates as we find them sanctioned by respectable authority, and leav- 
 ing the assumed antiquity of the nation as a point for the discus- 
 sion of chronologists, we are certainly led to attribute to the 
 people of this empire the merit of an invention which seems to 
 have eluded the grasp of the human intellect in the rest of Asia, 
 Africa, and Europe, until a more advanced period in the history of 
 the world.' 
 
 " The preparation of alcohol may be divided into three stages — 
 the production of a fermented vinous liquor, the preparation from 
 this of an ardent spirit by distillation, and, lastly, rectification or 
 purification. When vegetable substances are placed in contact with 
 

 STIMULANTS AND NARCOTICS. 213 
 
 air and moisture they undergo that kind of decomposition which is 
 denominated fermentation. The products of this process vary at 
 different periods or stages, and on this depends the distinction into 
 kinds or varieties of fermentations. Thus starchy liquids, under 
 some circumstances, become saccharine, the process being termed 
 the saccharine fermentation. Sugar, dissolved in water and mixed 
 with nitrogenous matter, is converted into carbonic acid and alco- 
 hol, and to this process the name of vinous fermentation is applied. 
 Under some circumstances mannite, lactic acid, and a syrupy mu- 
 cilage are formed by the action of the nitrogenous or albuminous 
 principles of vegetable juices on the sugar. This change has been 
 denominated the viscous or mucilaginous fermentation. Vinous 
 liquids are capable of generating acetic acid, and the process is 
 called acetous fermentation. Lastly, most vegetable substances are 
 slowly converted into gases, and a substance called vegetable mould, 
 constituting the process termed the putrefactive fermentation. The 
 liquid obtained by the vinous fermentation has received different 
 names, according to the substance from which it is obtained. 
 
 "When procured from the fresh juices of fruits, as grapes, cur- 
 rants, gooseberries, &c, it is denominated wine j from a decoction 
 of malt and hops, ale or beer/ from the expressed juice of apples, 
 cider ; that of pears, perry; and from a mixture of honey and wa- 
 ter, mead. Fermented infusions of barley (raw grain and malt 
 prepared by distillers for the production of ardent spirits) are tech- 
 nically termed washes. 
 
 " Brewing consists in the process of extracting a saccharine solu- 
 tion from grain, and in converting that solution into a fermented 
 and sound spirituous beverage called beer or ale. This art, although 
 a perfectly chemical one in nearly all its stages, had not until com- 
 paratively lately been indebted to chemistry for any of the improve- 
 ments which have been made in its details. This w T e may attribute 
 to the rare occurrence in former days of a practical chemist being 
 engaged in the operation of brewing. However, we find that 
 within the last few years very great additions have been made to 
 our knowledge of this art — particularly in our being acquainted 
 with that principle by means of which the conversion of starch 
 into sugar whilst in the mash-tun is brought about. Various 
 other improvements affecting the mode and appliances as well as 
 the principles of the art of brewing have also been adopted by 
 many of our leading firms, which contribute largely to facilitate 
 their means of production and supply. 
 
 " The process usually followed by the brewer may be divided into 
 eight distinct parts independent of malting, namely : first, the 
 
214 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 grinding of the malt ; secondly, the operation of mashing ; thirdly, 
 the boiling ; fourthly, the cooling ; fifthly, the fermentation ; sixthly, 
 the cleansing; seventhly, the racking or vatting; and, eighthly, 
 the fining or clearing. In brewing the various beers, or ale, 
 porter, and stout, three distinct sorts of malt are employed — the 
 pale or amber malt, the brown malt, and the roasted or black malt. 
 
 " The first of these alone is used for ales ; indeed, for the article 
 so extensively known as pale bitter ale, very light-colored malt 
 only is applicable. The brown malt is the article in general use 
 forgiving the flavor to beer, and the roasted malt is chiefly used with 
 the latter sort in imparting the requisite color to porter and stout." 
 
 Tobacco. — This is used in the form of smoking, chewing, or 
 snuff-taking more "universally than any other stimulant or narcotic 
 — among the civilized, the semi-civilized, and the barbarians — prob- 
 ably among 900,000,000 of the human race. 
 
 It is estimated that four billion pounds of tobacco are raised 
 annually throughout the world, which is nearly four pounds a } r ear 
 for every man, woman, and child on the face of the earth. Six mil- 
 lions of acres of land are devoted to its cultivation. The history of 
 tobacco is now pretty well known. It is supposed to be indigenous 
 to tropical America. Certainly it was not used in Europe until it 
 was brought there after the discovery of America. 
 
 Tobacco received its name from the fact that the plant was first 
 recognized by a Spanish monk in Tabaca, a province of St. Do- 
 mingo. How long it had been used by the Indians prior to the 
 discovery of America it is impossible to ascertain. Doubtful legends 
 say that the plant was known in Asia many centuries ago, but that 
 it w T as never smoked or chewed, as at the present day. In 1560 it 
 was reported to the court of Portugal by JSIicot, the ambassador of 
 the French, and was introduced from Virginia into England. 
 
 It was popularized by the example and influence of Sir Wal- 
 ter Kaleigh, and by the close of the sixteenth century it had 
 become quite well known throughout England. Since that time it 
 has extended over a large part of the globe. It was introduced into 
 Turkey and Arabia in the early part of the seventeenth century. 
 
 Says Johnston : '* In Turkey the pipe is perpetually in the 
 mouth. In India, all classes and both sexes smoke. The Siamese 
 chew moderately, but smoke perpetually. The Burmese, of all 
 ranks, of both sexes, and of all ages, down even to infants of three 
 years old, smoke cigars." 
 
 In China the practice is so universal that every female, from 
 the age of eight or nine, wears, as an appendage to her dress, a 
 small silken pocket, to hold tobacco and a pipe. 
 
STIMULANTS AND NARCOTICS. 215 
 
 There is reason for believing that the Chinese knew of tobacco, 
 as the j knew of almost everything else, long before the discovery 
 of America. 
 
 Opium. — This is used habitually among 400,000,000 inhabitants 
 of the East, just as we use tobacco here. It is estimated that it is 
 indulged in by about 100,000 in the United States. It is certainly 
 used among us much more than formerly. It is, as all know, the 
 juice of the poppy. 
 
 Hemp and Haschisch. — These are used in Turkey, India, Persia, 
 Africa, and Brazil, by two or three hundred millions of people. 
 
 Hemp appears to have been used in the days of Homer, Hero- 
 dotus, and Diodorus Siculus. It is raised chiefly in India, Persia, 
 and Arabia. The hemp is a resinous exudation from the plant. It 
 is also raised in Africa and Brazil. 
 
 In the plains of India it is consumed in every form, and on the 
 slopes of the Himalayas it is cultivated for smoking as high up as 
 the valleys of Sikkim. In Persia, in the east of Europe, and in 
 Mahommedan countries it is in extensive use. In Northern Africa 
 it is largely employed by the Moors. In central and tropical 
 Africa it is almost everywhere known as a powerful medicine and 
 a desired indulgence. In Southern Africa the Hottentots use it, 
 under the name of dasha, for purposes of intoxication ; and when 
 the Bushmen were in London they smoked the dried plant in short 
 pipes, made of the tusks or teeth of animals. And what is astonish- 
 ing, when we consider the broad seas which intervene, even the 
 native Indians of Brazil know its value, and delight in its use ; so 
 that over the hotter parts of the globe generally, wherever the plant 
 develops in abundance its peculiar narcotic principle, its virtues 
 may be said to be known, and more or less extensively made 
 use of. 
 
 Effects of Hemp on the System. — " This wide use of the plant 
 implies that the effect of hemp upon the system is generally very 
 agreeable. In India it is spoken of as the increaser of pleasure, the 
 exciter of desire, the cementer of friendship, the laughter-mover, 
 and the causer of the reeling gait — all epithets indicative of its 
 peculiar effects." — Johnston. 
 
 The effect of hemp, or of haschisch, which is prepared from 
 hemp, by boiling the leaves and flowers with water and butter, add- 
 ing cloves, nutmegs, mace, &c, is said to be very delightful. It 
 obliterates ideas of time, and creates a kind of temporary heaven. 
 These- effects, however, vary in different individuals. The word 
 " assassin " is said to be derived from the fact, that some individuals 
 under the influence of haschisch are inclined to rave furiously, to 
 
216 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 threaten, and even to murder. These terrible effects are observed 
 among the Orientals more than among the inhabitants of our own 
 land. 
 
 On some persons it causes the most intense anguish for several 
 hours, a sort of double consciousness, and symptoms somewhat similar 
 to the hallucinations of delirium tremens. 
 
 Coffee. — This familiar drink is used to the extent of about 
 1,000,000,000 pounds annually.* Like most of our popular stimu- 
 lants and narcotics, it has come into use chiefly within the past two 
 or three centuries. Like many of the other stimulants and nar- 
 cotics, it was introduced amid great opposition. Like other stimu- 
 lants and narcotics also, it has triumphed over all its enemies, and is 
 now used in the best portion of the globe. 
 
 " Arabian Coffee. — The tree which produces this seed is said to 
 be indigenous to the countries of Enarea and Caffa, in Southern 
 Abyssinia. In these districts the coffee-tree grows like a wild weed 
 over the rocky surface of the country. The roasted seed or bean 
 has also been in use as a beverage in Abyssinia generally from time 
 immemorial, and is at the present day extensively cultivated in that 
 country. In Persia it is known to have been in use as early as the 
 year 875. From Abyssinia it was introduced into Arabia in the 
 beginning of the fifteenth century, when it partly superseded the 
 older cliaat, or Abyssinian tea. About the middle of the sixteenth 
 century it began to be used in Constantinople, and in spite of the 
 violent opposition of the priests, became an article of general con- 
 sumption. In the middle of the seventeenth century (1652), the first 
 coffee-house was opened in London by a Greek named Pasqua ; and 
 twenty years after the first was established in Marseilles." — Johnston. 
 
 The use of coffee was unknown to the Greeks and Romans, and 
 does not appear to have been known in the Asiatic countries as late 
 as the time of the Crusades in the thirteenth century, although its 
 first introduction into Europe was from Arabia. It seems to have 
 been earliest in use in Ethiopia, where it has been drunk by the 
 natives for a great length of time. Mr. Bruce, in his Travels in 
 Abyssinia, states that the Gallse, a wandering nation of Africa, in 
 their incursions on Abyssinia, being obliged to traverse immense 
 deserts, and wishing to be encumbered with as little baggage as 
 possible, take with them a mixture of coffee and butter rolled up 
 into balls, and carried in a leathern bag. One of these, about the 
 size of a billiard ball, keeps them, they say, in strength and spirits 
 during a day's fatigue. 
 
 * Two hundred millions of pounds are imported to the United States alone. 
 
COFFEE AXD ITS SUBSTITUTES. 217 
 
 K Coffee was introduced into Mecca, Medina, and Cairo about 
 the middle of the fifteenth century, and two coffee-houses were 
 opened at Constantinople in 1554. Both at Cairo and in Turkey it 
 had to encounter political and religious opposition. The dervises 
 affirmed that roasted coffee was nothing but a coal, and that the 
 eating of coals was forbidden by the laws of their prophet. So 
 that the coffee-houses were obliged to be shut up until ' a more 
 sensible mufti' succeeded in convincing the people that roasted 
 coffee was not a coal ; upon which they were again opened. In 
 later years the use of coffee became extremely prevalent throughout 
 the East. Houses for selling it were established in all parts of the 
 Turkish empire : it was introduced into private families, and the 
 refusal of a husband to supply his wife with coffee was reckoned 
 among the legal causes of a divorce. In Europe coffee was intro- 
 duced into France and England about a century and a half ago. 
 So rapid was the progress of a taste for it after it became known, 
 that in eight years from its introduction it had become in England 
 a subject of public revenue." — Bigelovj. 
 
 Other Coffees. — "Besides the real Coffea Arabica, other species 
 of the coffee-plant are grown in various countries, and yield a use- 
 ful marketable bean. Thus, in Silhet and Nepaul the C. Beu- 
 hahnsis is cultivated ; on the coast of Mozambique, the C. Mozam- 
 bicana ; on the coast of Zanguebar, the C. Zanguebaria ; and in the 
 Mauritius, the C. Mauritiana. The seed of the last of these tastes 
 disagreeably sharp and bitter, and sometimes causes vomiting, yet 
 it is in some places cultivated instead of the Coffea Arabica. It is 
 possible that these so-called different species may, like the varieties 
 of the tea-plant, be only differently modified forms of the same ori- 
 ginal species." — Johnston. 
 
 Very many substitutes are used for coffee. One of the best 
 known of these is chiccory. It is largely used to adulterate coffee ; 
 in moderate quantities is not harmless, but when used to any 
 great extent is decidedly injurious. 
 
 " It is a native weed, which, with its large pale-blue flowers, is seen 
 scattered about in numerous places. It has a large white parsnip- 
 like tap-root, which increases in size when the plant is subjected to 
 cultivation. This root abounds in a bitter juice, which has led to its 
 use as a substitute for coffee. The plant is now extensively culti- 
 vated for the sake of its root." — Johnston. 
 
 Chiccory itself is often adulterated. It is almost as hard to find 
 it pure in the shops, as it is to find pure coffee itself. According 
 to Johnston, Yenetian red is much used to color chiccory. Nor is 
 this all; Yenetian red is itself adulterated. The manufacturer 
 
218 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 grinds up his color with brick-dust, in order to be able to sell it 
 cheaper and to give it a variety of colors. 
 
 Tea. — Of the different varieties of tea there are raised annually 
 about 3,000,000,000 pounds. It is estimated that three millions of 
 acres of land are devoted to the culture of tea. It is more used 
 than any other form of beverage, except water. It is a product of 
 temperate climes, and seems to be adapted for all countries. It is 
 certainly used among more than half of the human race. Its culti- 
 vation, transportation, and sale give employment to millions of 
 men and billions of capital. In New York City alone there are a 
 number of large firms whose yearly transactions in the article of 
 tea are fabulous. Much as it is used in this country and in England, 
 it is used still more freely in China and Russia, where it is drunk 
 several times daily. * 
 
 Like coffee, tea was not introduced into Europe until the seven- 
 teenth century. It is stated that it did not come into general use 
 in China until the year 600, and was introduced into Japan in 810. 
 
 The tea-plant is a small evergreen tree or shrub, of the height 
 of six or eight feet. It grows in the valleys, and on the sloping 
 sides of mountains with a southern exposure. In Japan it is plant- 
 ed around the borders of fields, without regard to the kind of soil ; 
 while in China, where it is an important article of commerce, whole 
 fields are covered with it, and cultivated with the greatest care. 
 
 The origin of the employment of tea as a beverage amongst the 
 Chinese is wrapped in the obscurity which generally belongs to 
 ancient usages; and a fabulous tale is narrated as to its introduc- 
 tion among inhabitants of the empire, whilst, as is usual with fables, 
 it has been imagined to have some allegorical allusion, which, if ex- 
 plained, would satisfy the lover of antiquarian lore. The tale is 
 thus related by one of the compilers of a history of China : 
 
 " D anna, a very religious prince, and third son of an Indian king 
 named Kosjusvo, is said to have landed in China in the year 510 
 of the Christian era. He employed all his care and thought to dif- 
 fuse throughout the country a knowledge of God and religion ; and, 
 being desirous to excite men by his example, imposed on himself 
 privations and mortifications of every kind, living in the open air, 
 and devoting the days and nights to prayer and contemplation. 
 After several years, however, being worn out with fatigue, he fell 
 asleep against his will ; and, that he might faithfully observe his 
 oath, which he thought he had violated, he cut off his eyelids and 
 threw them on the ground. Next day, having returned to the same 
 spot, he found them changed into a shrub which had never before 
 been produced. Having eaten some of the leaves of it, he found 
 
STIMULANTS AND NAECOTICS. 219 
 
 his spirits exhilarated and his former vigor restored. He recom- 
 mended this aliment to his disciples and followers. The reputation 
 of tea increased, and after that time it continued to be generally 
 used. Kampfer, in his £ Amgenitates Exoticae,' gives the life with 
 a portrait of this saint, so celebrated in China and Japan. There 
 is seen at the feet of Darnia a reed, which indicates that he had 
 traversed the seas and rivers." — Sigmond on Tea, p. 12. 
 
 Nicolaus Fulpius was about the first medical man who wrote 
 professionally upon tea ; but his were not original observations : 
 they were the opinions of the most eminent men which he had col- 
 lected to give to the world. But in 1678 appeared the first edition of 
 a book, which speedily ran through three large impressions, and had 
 a considerable influence upon the introduction of tea. It was en- 
 titled " Cornelio Bontekoe, Tractaat van het exellenste Kruyd 
 Thee." Although this work was, from the extravagance of its com- 
 mendations on tea, severely handled by some of the critics, it was 
 translated into many languages, and quoted as the highest authority. 
 He pronounced tea to be the infallible cause of health, and that if 
 mankind could be induced to drink a sufficient quantity of it, the 
 innumerable ills to which man is subject would not only be dimin- 
 ished, but entirely unknown. He thinks that two hundred cups 
 daily would not be too much. He is said to have been rewarded 
 for his judgment by the liberality of the Dutch East India Compa- 
 ny. Heydentrick Overcamp, who wrote the life of Bontekoe, 
 states that his inducement to write was to recommend himself to 
 his fellow-citizens, and to defend himself against his colleagues, who 
 did not follow his theory or his practice. Etmuller recommended 
 tea as a fine stomachic, cephalic, and anti-nephritic. Pechline wrote 
 a dialogue on tea, which he entitled " Theophilus Bibaoulus," and 
 several poets indulged themselves in its praise. Petit wrote a 
 poem ; Peter Erancius, two anacreontics ; Heincich, a Doric Mely- 
 drion ; and our poet-laureate, Tate, joined the melodious bards. 
 Whilst it met with so much approbation there were, likewise, those 
 who were not equally satisfied with its merits. Boerhaave, Van 
 Swieten, and others attempted to stem the tide that was setting in its 
 favor ; but they have proved themselves incapable of resisting the 
 general impression, for no beverage that has ever yet been intro- 
 duced sits so agreeably on the stomach, so refreshes the system, 
 soothes nervous irritation after fatigue, or forms a more grateful re- 
 past. It contributes to the sobriety of a nation ; it imparts all the 
 charms to society which spring from the enjoyment of conversation, 
 without that excitement which follows upon a fermented drink. 
 
 The introduction of tea-drinking into England has been ascribed 
 
220 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 to Lord Arlington and Lord Orrery, and the year 1666 (the annus 
 mirabilis of Dry den) has been assigned as the exact date ; but in 
 the diary of Mr. Pepys, Secretary to the Admiralty, the following 
 is registered : " I sent for a cup of tea, a Chinese drink, of which I 
 had never drunk before." In the diary of Henry, Earl of Claren- 
 don, there is a memorandum : " Pere Couplet supped with me, 
 and after supper we had tea, which he said was really as good as 
 any he drank in China." The first historical record, however, is an 
 act of Parliament, passed in the year 1660, 12 Carl II. c. 23, which 
 enacts that a duty should be laid of eight pence per gallon on all 
 tea made and sold in coffee-houses ; which were visited twice daily 
 by officers, whose duty it was to ascertain what quantity had been 
 made. 
 
 Very much has been said and written of the difference between 
 green tea and black tea. The common impression is, that green 
 tea is always poisoned more or less in the preparation. This im- 
 pression is only partly true. Undoubtedly drugs are sometimes 
 used to color the teas ; but in China, in the tea-growing regions, 
 the two varieties are made by difference in the manner of prepara- 
 tion. 
 
 Johnston thus describes the processes : 
 
 " First, That in the process of drying the leaves are roasted and 
 scorched in such a way as necessarily to bring about man y chemical 
 changes within the substance of the leaves themselves. The result 
 of these changes is to produce the varied flavor, odors, and tastes by 
 which different varieties of tea are more or less distinguished. 
 
 " Second, That the treatment or mode of handling by which the 
 leaves are converted respectively into green and black teas, is the 
 cause of the different colors of these two main varieties. 
 
 " It is by lengthened exposure to the air, therefore, in the pro- 
 cess of drying, accompanied, perhaps, by a slight heating and fer- 
 mentation, that the dark color and distinguishing flavor are given 
 to the black teas of commerce. The oxygen of the atmosphere acts 
 rapidly upon the juices of the leaf during this exposure, and changes 
 chemically the peculiar substances they contain, so as to impart to 
 the entire leaf the dark hue it finally acquires. The precise nature, 
 however, of these changes has not, as yet, been chemically investi- 
 gated." 
 
 " Mate, or Paraguay tea, though not used over so large an 
 area as the Chinese tea, is as much the passion of the Brazilians 
 and their neighbors in Southern America, as the latter is of the 
 nations of north-eastern Asia. It is prepared from the dried 
 leaves of Brazilian holly, is said to have been in use among 
 
STIMULANTS AND NARCOTICS. 221 
 
 the Indians from time immemorial ; has been drunk by all 
 classes in Paraguay since the beginning of the seventeenth cen- 
 tury, and is now consumed by ' almost the whole population of 
 South America,' The leaf of this tree is four or five inches long, 
 and after being dried it is rubbed to powder before it is infused. The 
 dried leaf has much of the aroma of some varieties of Chinese tea, 
 and the infusion has a pleasant odor, and an agreeable bitter taste. 
 In the state in which it is commonly used in South America, it is 
 more exciting than China tea, producing a kind of intoxication, 
 and by excessive use leading even to delirium tremens." — Johnston. 
 " Some writers have asserted that the tea is roasted upon plates of 
 copper, and that its color is owing to verdigris, with which it thus 
 becomes impregnated. But those travellers who are most entitled 
 to credit affirm that the plates are, without exception, of iron, and 
 Dr. Lettson, after a great number of experiments made with chem- 
 ical tests, never detected any trace of copper ; so that this suspicion 
 appears to be void of foundation." — Bigelow. 
 
 This Mate is very largely used in the whole of South America. 
 In many respects it is very similar to the tea of China, though much 
 inferior. It acts, however, upon the kidneys and bowels. 
 
 A great many substitutes have been used for tea. Johnston 
 gives the names of twenty-four of these, and states that many more 
 might be mentioned. 
 
 ''"Abyssinian Tea, called in its native country Khat or Chaat, 
 is very extensively cultivated in Shoaand the adjoining regions, and 
 is in general use among the inhabitants, just as tea is in China. It 
 consists of the dried leaves of a species of small tree from 
 which the poorer classes of Chinese prepare an inferior kind of 
 tea. In a light gravelly soil the plant attains a height of twelve 
 feet. The leaves are plucked in the dry season, and well dried in 
 the sun. They are either chewed, boiled in milk, or infused in 
 boiling water, and, by the addition of honey, yield a pleasant bev- 
 erage. They have much resemblance to Chinese tea, both in their 
 qualities and their effects. They are bitter to the taste, possess ex- 
 hilarating properties, and dispel sleep if used to excess. 
 
 " The leaves of this plant are also used green. Forskall states 
 that the Arabs eat them green because of their property of prevent- 
 ing sleep. To such a degree do they exhibit this influence, that a 
 man who chews them may stand sentry all night without feeling 
 drowsiness. They are also regarded as an antidote to the plague ; 
 and the Arabs believe that the plague cannot appear in places 
 where the tree is cultivated. Botta adds to these qualities that, 
 when fresh, the leaves are very intoxicating." — Johnston. 
 
222 HYGIENE, OR THE AKT OF PRESERVING HEALTH. 
 
 Cocoa. — The different varieties of cocoa are used to the extent 
 of 100,000,000 of pounds annually. It is prepared from seeds. It 
 is sold in the shops in three different and familiar forms : — 
 
 1. Rock-cocoa of the stores. — This is made by roasting the whole 
 cocoa bean, beating it into a paste, and then mixing it with sugar, 
 starch, &c. 
 
 2. Cocoa nibs. — These are prepared by depriving the bean 
 of the husk and then crushing it. This is the purest form of 
 cocoa. 
 
 3. Chocolate paste. — This is prepared by shelling the bean, 
 grinding it into a paste, and then mixing it with sugar, cinnamon, 
 vanilla, &c. 
 
 There are several varieties of cocoa — the Mexican, Brazilian, 
 and one or two substitutes. 
 
 " The Mexican cocoa is the seed of the Theobroma cacao (fig. 
 35). This is a small but beautiful tree, with bright dark green 
 leaves, which is a native of the West Indies and of the central 
 regions of America. It grows spontaneously in Mexico and on the 
 coast of Caraccas, and forms whole forests in Demerara. 
 
 " When the Spaniards first established themselves in Mexico, 
 they found a beverage prepared from this seed in common use among 
 the native inhabitants. It was known by the Mexican name of 
 chocollatl, and was said to have been in use from time immemorial. 
 It w r as brought thence to Europe by the Spaniards in 1520, and has 
 since been introduced more or less extensively as a beverage into 
 every civilized country. Linnaeus was so fond of it that he gave 
 to the tree the generic name of Theobroma — 'Food of the Gods/" — 
 Johnston. 
 
 Lettuce. — This is a kind of substitute for opium. The juice of 
 the plant somewhat resembles opium. Every one who has eaten 
 lettuce for dinner knows that it will produce drowsiness. 
 
 " If the stem of the common lettuce, when it is coming into 
 flower, be wounded with a knife, a milky juice exudes. In the 
 open air this juice gradually assumes a brown colour, and dries into 
 a friable mass. The smell of this dried juice is strongly narcotic, 
 recalling that of opium. It has a slightly pungent taste, but, like 
 opium, leaves a permanent bitter in the mouth. It acts upon the 
 brain after the manner of opium, and induces sleep. 
 
 "To this crude extract the name of Lactucarium has been 
 given. Like opium, it dissolves in water to the extent of about one- 
 half, and in this soluble portion the narcotic virtue resides. The 
 principal active ingredient is supposed to be a peculiar substance 
 named lactucarium, of which the crude contains about one-fourth of 
 
STIMULANTS AND NARCOTICS. 223 
 
 its weight. It contains other active ingredients, however, the 
 chemical nature and physiological influence of which have not as 
 yet been rigorously investigated." — Johnston. 
 
 " Lactucarium is one of those narcotics in which many of us un- 
 consciously indulge. The eater of green lettuce as a salad takes a 
 portion of it in the juice of the leaves he swallows; and many of 
 my readers, after this is pointed out to them, will discover that their 
 heads are not unaffected after indulging copiously in a lettuce salad. 
 Eaten at night, the lettuce causes sleep ; eaten during the day, it 
 soothes and calms, and allays the tendency to nervous irritability. 
 And yet the lover of lettuce would take it very much amiss if he 
 were told that he ate his green leaves, partly at least, for the same 
 reason as the Turk or Chinaman takes his whiff from the tiny opium 
 pipe ; that, in short, he was little better than an opium eater, and 
 his purveyor than the opium-smugglers on the coast of China." — 
 Johnston. 
 
 Other substitutes for opium are : 
 
 Syrian Rye. — It is used by the Turks. 
 
 Bulls'* Hoof. — This is used in Jamaica, and has been called the 
 "Dutchman's laudanum." —Brown, quoted by Johnston. 
 
 " The Hop, which may now be called the English narcotic, was 
 introduced into this country at a comparatively recent period. It 
 may have been employed in Germany in the times of the Roman 
 writers, but was probably unknown to them. Its use, as an addition 
 to malt liquor, appears to be of German origin. Hop gardens, by the 
 name of Humolarice, are spoken of in documents of the early part 
 of the ninth century, frequently in those of the thirteenth century. 
 In the breweries of the Netherlands, the hop seems to have been 
 introduced about the beginning of the fourteenth century. From 
 the Low Countries, or, as some say, from Artois, which borders upon 
 them, it was brought to England in the reign of Henry YIIL, some 
 time after his expedition against Tournay, and about the year 1524. 
 In the twenty-second year of his reign (1530), that monarch, in an 
 order respecting the servants of his household, forbade sulphur and 
 hops to be used by the brewers. Three-quarters of a century later 
 (1603), the introduction of spoilt and adulterated hops was forbidden 
 by James I., under severe penalties. This appears to show that, 
 though considerable attention is known to have been already given 
 to the cultivation of the hop in England, a large part of the hops 
 supplied to the home market was still brought from abroad." — 
 Johnston. 
 
 Hop is chiefly used in the manufacture of beer. 
 
 It gives to beer an agreeable bitter taste. 
 
224: HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 # 
 
 It directly affects the brain and nervous system by virtue of its 
 narcotic properties. The well-known soporific effects of beer are 
 caused by the hop used in its manufacture. 
 
 Hop also keeps beer from souring, by arresting fermentation. 
 
 There are a number of varieties of the hop, which differ very 
 widely in quality. 
 
 Hop pillows were once prescribed to King George III. of England, 
 as a remedy for sleeplessness, and since that time they have con- 
 tinued to be used for that purpose. 
 
 Whatever effect comes from the hop pillow must be due to the 
 escape of the volatile narcotic principles in exceedingly small quan- 
 tities. 
 
 Coca is a narcotic that is used among 10,000,000 of the human 
 race, chiefly among the South American Indians. It must not be 
 confounded with the beverage cocoa. 
 
 "It is not less interesting than the narcotics of the East, either 
 in its social or in its physiological relations. It is little known in 
 Europe, its use as an indulgence being in a great measure confined 
 to the native Indians of Bolivia and Peru. 
 
 " The Erytliroxylon coca is a bush which attains the height of six 
 or eight feet, and resembles the black thorn in its small white flow- 
 ers and bright green leaves. It is a native of the tropical valleys 
 which occur on the eastern slope of the Andes in Bolivia and Peru, 
 and it still grows wild in many parts of these countries." — Johnston. 
 
 " Consumption of Coca Leaf. — We have no accurate data from 
 which to form an estimate of the actual weight of coca leaf collected 
 and consumed in Bolivia and Peru. Poppig estimates the money 
 value of the yearly produce to be about four and a half millions of 
 Prussian dollars, which, at Is. a pound, the price it yields to the 
 grower, would make the annual produce nearly 15,000,000 lbs. The 
 approximation is sufficient to show us its importance to the higher 
 regions of South America, in an agricultural and commercial, as 
 well as in a social point of view." 
 
 " When we consider that eastward from Bolivia and Peru the 
 culture and use of coca have extended into parts of Brazil and to 
 the banks of the Amazon, it will not appear exaggerated if we esti- 
 mate the actual growth and consumption of the dried coca leaf at 
 30,000,000 lbs. a year. At Is. a pound, this is worth a miLlion and 
 a half sterling ; and at the average produce of 800 lbs. an acre, it 
 implies the use of 37,000 acres of good and carefully cultivated 
 land for the growth of this plant. We may estimate also that the 
 chewing of coca is more or less indulged in among about ten mil* 
 lions of the human race." — Johnston. 
 
STIMULANTS AND NARCOTICS. 225 
 
 By the Peruvian Indians coca is both smoked and chewed. The 
 leaves, dried in the sun, are the portions of the plant which are used. 
 Of these the Indian will consume daily an ounce, or an ounce and 
 a half. 
 
 Its effects at first are pleasant and mild. When used to ex- 
 cess it begets a kind of insanity. In South America, an Indian 
 who becomes a great slave to the use of the coca is called a coquero 
 — a term meaning the same as our drunkard. 
 
 The Betel Nut. — This is a narcotic which, though hardly 
 known by name in this country, is yet used among 100,000,000 of 
 the human family. 
 
 It is the seed of one of the species of palm. It is cultivated 
 in India, Malabar, Ceylon. It is chewed like tobacco. It is to 
 the Eastern Islands what the coca is to South America. Those 
 who use it become most extravagantly fond of it. Like tobacco and 
 opium, it makes them unwilling slaves. "When used in moderation 
 its effects are agreeable and exhilarating. Among the wretched 
 poor of India it is an actual substitute for food. Millions of the 
 natives of India would rather be denied their regular meals than 
 their betel nut. 
 
 " The visible effects of the betel are, that it promotes the flow 
 of the saliva, and lessens the perspiration from the skin. It tinges 
 the saliva red, so that when spit out it falls on the earth like blood. 
 It gives a red color to the mouth, teeth, and lips, which, though at 
 first sight disgusting to Europeans, is by the natives considered 
 ornamental. It imparts also an agreeable odor to the breath, and 
 is supposed to fasten the teeth, cleanse the gums, and cool the 
 mouth. The juice is usually, but not always, swallowed." 
 
 " We have no means of estimating the absolute quantity of this 
 nut which is consumed yearly by the Asiatic nations, but it must 
 be very great. It is chewed by probably not less than fifty millions 
 of men ! If we allow to each chewer ten pounds weight a year, 
 which is less than half an ounce a day, this would give the enor- 
 mous consumption of five hundred millions of pounds weight every 
 year ! Only tobacco, among the narcotics in common use, is used 
 in larger quantity than this. The small quantity of the betel-nut 
 imported into this country is converted into charcoal for tooth- 
 powder, probably from some imaginary idea that it is superior for 
 this purpose to other kinds of charcoal." — Johnston. 
 
 2. Chica, or Maize Beer. — The use of m alt beer in Germany, and 
 probably also in England, is very ancient, and that of chica or maize 
 beer in South America appears to be equally remote. It was a com 
 mon drink of the Indians long before the Spanish conquest. 
 15 
 
226 HYGIENE 
 
 The usual way of preparing chica is to water or moisten Indian 
 corn, as the English maltster does his barley — to leave it till it 
 sprouts sufficiently, and then to dry it in the sun. It is now maize 
 malt. This malt is crushed, mashed in warm water, and then 
 allowed to stand till fermentation takes place. The liquor is of a 
 dark yellow color, and has an agreeable, slightly bitter, acid taste. 
 It is in universal demand throughout the west coast of South 
 America, and is consumed in vast quantities by the mountain In- 
 dians. Scarcely a single hut in the interior is without its jar of the 
 favorite liquor. 
 
 In the valley of the Sierra, however, the most highly prized chica 
 is made in a somewhat different manner. "All the members of 
 the family, including such strangers as choose to assist in the opera- 
 tion, seat themselves on the floor in a circle, in the centre of which 
 is a large calabash, surrounded by a heap of dried maize (malt). 
 Each person takes up a handful of the grain and thoroughly chews 
 it. This is deposited in the calabash, and another handful is imme- 
 diately subjected to the same process, the jaws of the company being 
 kept continually busy until the whole heap of corn is reduced to a 
 mass of pulp. This, with some minor ingredients, is mashed in hot 
 water, and the liquid poured into jars, where it is left to ferment. 
 In a short time it is ready for use. Occasionally, however, the jars 
 are buried in the ground, and allowed to remain there until the 
 liquor acquires, from age, a considerable strength, and powerful in- 
 toxicating qualities. 
 
 "Chica thus prepared is called chica mascada, or chewed chica, 
 and is considered far superior to that prepared from maize crushed 
 in the usual manner. The Serrano believes he cannot offer his guest 
 a greater luxury than a draught of old chica mascada, the ingredi- 
 ents of which have been ground between his own teeth." — Johnston. 
 
 This method of making beer seems hideous enough. But the ex- 
 planation of the process is quite interesting. The saliva changes 
 the starch into sugar. This sugar afterwards ferments and makes 
 beer. 
 
 According to Von Tc/mdi, chica cah be made from grapes, pine- 
 apples, rice, barley, peas, barley, and bread. 
 
 "JPalmWine, or Toddy. — The sap of many palm-trees is rich in 
 sugar. In some countries this is extracted by boiling down the 
 collected juice, as cane sugar is extracted from the expressed juice 
 of the sugar-cane. In other countries the juice is allowed to fer- 
 ment, which it does spontaneously, and in hot climates within a very 
 short period of time. This fermentation converts the alcohol and 
 juice which contains it into an intoxicating liquor. 
 
STIMULANTS AND NARCOTICS. 227 
 
 " In the islands of the Indian Archipelago and the Philippines 
 an intoxicating liquor is prepared in this way from the sap of the 
 gomuti palm. It is called neva in Sumatra, and the Batavian 
 arrack is distilled from it. The cocoa palm produces the palm 
 wine known in India and the Pacific by the name of toddy." — 
 Johnston. 
 
 One tree yields from two to six pints of sap or " toddy" After 
 standing a few hours it ferments. When this fermented juice is 
 distilled it makes a powerful brandy. It is said that the palm wine 
 is used by a larger number of the human race than the wine of the 
 grape. 
 
 It is used in Chili, South America, in India, and throughout 
 Africa. 
 
 The taste of the best qualities is said to be very agreeable, close- 
 ly resembling champagne. 
 
 Sugar-cane Wine, or Guarapo. — This is the fermented sap of the 
 sugar-cane. It receives its name from the fact that it is largely used 
 among the natives of Guarapo. 
 
 " Bouza, murma, or millet beer, is a favorite drink of the Crim 
 Tartars. They prepare it from fermented millet-seed, to which 
 they add certain admixtures which render it excessively astringent. 
 They call it bouza." — Olvphant. 
 
 " The Arabians, Abyssinians, and many African tribes give 
 the same name to a fermented drink which they usually prepare 
 from the seeds of the Poa Abyssinica. They occasionally em- 
 ploy millet-seed, however, and even barley, for the purpose. Their 
 bouza is described as a sour, thick drink." — Johnston. 
 
 This drink is much like our ordinary malt liquors. It is some- 
 times sucked through a tube, as boys suck cider through a straw. 
 
 According to Hooker it is very weak, but in a hot day's march 
 is a very grateful beverage. It is drunk while warm, like our tea 
 and coffee. 
 
 " Quass or rye beer, a favorite Russian drink, is a sharp, acid, 
 often muddy liquor, which, in taste and appearance, resembles some 
 of the varieties of bouza. It is made by mixing rye-flour, and 
 occasionally barley-flour, with water fermenting. It may possibly 
 contain lactic acid, but I am not aware that its composition has yet 
 been made the subject of special chemical inquiry. 
 
 " This is one of the cases in which unmalted grain is employed 
 in the manufacture of beer on the continent of Europe. 
 
 " Koumiss, or milJcbeer. — Milk, as I have explained in the preced- 
 ing chapter, contains a peculiar kind of sugar, less sweet than cane 
 sugar, to which the name of milk sugar is given. This sugar, when 
 
22S HYGIENE, OK THE ART OF PRESERVING HEALTH. 
 
 dissolved in water, does not ferment upon the addition of yeast ; 
 but when dissolved in the milk along with the curd and butter, it 
 readily ferments, is transformed into alcohol and carbonic acid, and 
 gives to the liquor an intoxicating quality. This fermentation will 
 take place spontaneously, but it is hastened by the addition of 
 yeast or of a little already fermented milk. The fermented liquid 
 is the koumiss of the Tartars. Mare's milk is richer in sugar than 
 that of the cow, and is usually employed for the manufacture of 
 milk beer." — Johnston. 
 
 Brandy can be obtained from the koumiss by distillation. The 
 natives call this milk-brandy arraca. In the north of Scotland 
 and in Ireland buttermilk is . kept until it undergoes a vinous fer- 
 mentation. 
 
 Ava. — This liquor is used in the South Sea Islands, in the Ton- 
 ga, Feejee, and Samoan Islands ; in short, throughout the Pacific 
 Ocean. It is prepared in very much the same way as the chica or 
 maize beer. 
 
 It is a very interesting and suggestive fact that this method of 
 preparing fermented drink — chewing the ava and the chica — should 
 exist in regions so far apart as South America and the islands of 
 the Pacific. 
 
 The process of making the ava and its effects are thus described 
 by Johnston : 
 
 " The name of ava is given to the root of the intoxicating long- 
 pepper (Macropiper methysticum\ which is chewed, either in the 
 fresh or in the dried state, as the Indian chews his maize. The pulp 
 is then mixed with cold water, which after a brief interval is strain- 
 ed from the chewed fibre, and is ready for use. The taste, to one 
 unaccustomed to it, is not pleasant. It reminded Captain Wilkes 
 of the taste of rhubarb and magnesia ! According to the white 
 persons who have tried it, this infusion does not intoxicate in the 
 same manner as ardent spirits. It more resembles opium in some 
 of its effects ; producing a kind of temporary paralysis, tremors, 
 indistinctness and distortion of vision, and a confused feeling about 
 the head." 
 
 Cocculus Indicus is chiefly known as a means of adulterating 
 beer and other drinks. It is very bitter, has a rich taste, and di- 
 rectly affects the brain, and thus produces intoxication. 
 
 It is very powerfully poisonous when used in quantity. The 
 poorer classes like to have their liquor drugged with it, because they 
 can "feel it." It takes a less quantity of liquor that has been 
 drugged with coccxdus indicus to affect one than of pure liquor. 
 
 " It is the fruit or berry of the Anamirta cocculus, a beautiful 
 
STIMULANTS AND NARCOTICS. 229 
 
 climbing-plant, which is a native of the Malabar coast and of the 
 Indian Archipelago. It is sometimes called the Levant nut, or the 
 Bacca orientalis. It has some resemblance to the bayberry, and 
 in 1850 was imported into this country (England) to the extent of 
 2,359 bags, of one hundredweight each." — Johnston. 
 
 There is no doubt that it is slowly injurious to the system even 
 in moderate doses, and it should be regarded as a crime to adulte- 
 rate liquors with it. Yery much of the intemperance among the 
 lower and degraded classes is caused by the cocculus indicus in 
 the liquor which they drink. 
 
 A person who has been made drunk by it feels worse after the 
 debauch than one who has been made drunk simply on pure alco- 
 holic liquors. 
 
 Sweet Gale. — This narcotic is not known in this country, but 
 is used in Sweden. It is said to be used largely for the purpose 
 of imparting bitterness to beer. 
 
 Emetic Holly. — This narcotic is used by the Indians of Florida. 
 The infusion of the leaves is called the " black drink," and, ac- 
 cording to Johnston, is drunk largely by the chiefs when about to 
 be engaged in important deliberations. 
 
 Siberian Fungus — a hind of toad-stool. — This is a native of 
 Kamtschatka. It closely resembles our common mushroom. It is 
 gathered in the hot weather and dried. It is chewed like tobacco. It 
 produces at first lightness of spirits, then giddiness, flushing of 
 face, and finally, in sufficient quantities, intoxication. Some of our 
 own mushrooms are also narcotic in their effects. It is well known 
 that certain varieties when eaten produce poisonous effects. 
 
 Thorn Apple (stramonium). — This is indulged in by the Indians 
 of the Andes. From the fruit of the plant they prepare a strong 
 narcotic drink. It produces stupor and sometimes furious excitement. 
 
 Among other stimulating and narcotizing preparations I may 
 merely mention — 
 
 Arrack, made from rice, used by the Hindoos and Malays. 
 
 Eaki, " " " Greeks and Turks." 
 
 Samshoo, " " " Chinese. 
 
 Sacio, " " " Japanese. 
 
 Kawa, " macropiper " Pacific Islanders. 
 
 Yodki, " potato " Eussians and Poles. 
 
 Tallah, " millet " Abyssinians. 
 
 In surveying the history of the use of these various stimulants 
 and narcotics we learn 
 
 1. That some forms of stimulant or narcotic have been used all 
 over the world, and from time immemorial. 
 
230 HYGIENE, OE THE ART OF PRESERVING HEALTH. 
 
 2. That their use has increased with the progress of civilization. 
 
 3. That at the present time they are used to the greatest extent 
 and in the largest variety by the most civilized and Christian na- 
 tions — England, France, Germany, and the United States. 
 
 According to the recent report of Mr. Wells, special commis- 
 sioner of revenue, it seems that the value of the liquors annually 
 sold over the counter in this country alone is equal to half of our 
 national debt. 
 
 This says nothing of tobacco, which is now used so freely; 
 nothing of tea and coffee, which are used in every family, and to 
 the extent of several pounds annually for every man, woman, and 
 child in the country; nothing of opium, which is used habitually 
 by nearly 100,000 of our countrymen ; nothing of chocolate 
 (cocoa, shells, &c), which as a substitute for coffee is found in every 
 saloon and hotel, and freely used in thousands of families. 
 
 It is safe to say that the money annually expended for stimulants 
 and narcotics in this country would pay the whole of our national 
 debt, principal and interest, and at the same time support all our 
 benevolent societies. 
 
 Important and practical questions now arise. Shall we continue 
 to use these stimulants and narcotics ? Do they fulfil any purpose in 
 the animal economy ? Are they, in any sense, food ? Would not the 
 world be better without them ? If we are to use them at all, what 
 shall we use ? How shall we use without abusing them \ 
 
 Before attempting to answer these queries 1 must say, at the 
 outset, that I cannot answer them for every individual. Every 
 person must decide for himself, in the light of science and of his 
 own individual experience, whether to use these substances or to 
 abstain from them, just as he decides what kind of food to eat and 
 what to avoid. All I shall attempt to do will be to give information 
 and to arrange facts which may help my readers in answering these 
 questions. All I can do is to present the general principles of sci- 
 ence, by which my readers may enlighten their consciences and 
 learn their individual duty. 
 
 There are some general facts that will apply to all these stimu- 
 lants and narcotics. 
 
 1. They all contain poison. The active principle of tea is theine j 
 of coffee, caffeine / of chocolate, theobromine j of tobacco, nicotine 
 and nicotianin / of opium, morphine ; of hops, lupuline ; of fer- 
 mented and distilled liquors of all kinds and varieties (wines, beers, 
 cider, porter, whiskey, rum, gin, brandy, arrack, koumiss, samshoo, 
 sacio, kawa, vodki, toddy, tallah, raki), is alcohol. 
 
 All these active principles are poisonous. Nearly all of them. 
 
STIMULANTS AND .NARCOTICS. 231 
 
 when given in sufficient quantities, will kill animals, and in a very 
 short time. 
 
 Even theme and caffeine, in large doses, will kill animals, as has 
 been recently proved by the experiments of Dr. Amory. That 
 nicotine and alcohol will kill animals and men is now known to 
 every one. When theine is taken pure by a human being it causes 
 terrible nervousness and distress, and probably a sufficient quantity 
 would prove fatal. The probability is that experiments would show 
 that the active principles of all the other stimulants and narcotics 
 are capable of producing fatal results, when given in sufficient 
 quantities. 
 
 The fact that all these stimulants and narcotics contain poison 
 does not assist us much in the solution of the question of their effects 
 on the system, because there is poison, in nearly all of our ordinary 
 articles of diet. 
 
 There is poison in our garden lettuce, and in the hops with which we 
 raise our bread. The oils contained in our table mustard and pepper, 
 and in that most common and healthy vegetable, the onion, are among 
 the most acrid and destructive poisons with which chemistry is familiar. 
 Phosphorus is one of the most virulent of poisons, and even in very 
 small doses it has been known to destroy life ; in moderate quanti- 
 ties it powerfully stimulates, like alcohol. And yet phosphorus 
 exists in all nitrogenous alimentary substances, and has been proved 
 to be indispensable to the vigor and health of the brain. Children 
 especially, who for any long period are confined to food in which 
 phosphorus does not exist to a sufficient degree, are very apt to 
 suffer from disease of the bones and scrofulous enlargement of the 
 glands. 
 
 The most skilful chemistry can hardly prepare a meal that would 
 not contain more or less poisonous elements. There is poison in 
 the dry loaf and plainly-served vegetables of the hardy laborer, in 
 the yolk of the egg that we give to the tender invalid, and in the 
 very milk that the infant draws from its mother's breast. 
 
 But the use of poison is not confined to our articles of food. 
 Poison is a normal constituent of the atmosphere. Even in the 
 healthiest localities it contains more or less carbonic acid, and not 
 unfrequently slight traces of iodine and nitric acid. Those who 
 are most ignorant of chemistry know that these agents, when un- 
 diluted, are terribly destructive and fatal. Therefore, then, not 
 only in every mouthful of food we eat, but in every breath of air 
 we inspire, there are elements of poison that, in a pure and uncom- 
 bined form, would prove instantly fatal to all animal creation. But 
 the consumption of poisons does not stop with our air and food. 
 
232 HYGIENE, OB THE ART OF PRESERVING HEALTH. 
 
 The water we drink or in which we bathe is rarely, if ever, found 
 in a state of absolute purity. 
 
 If there be any drink in the world that may properly be called 
 natural, surely it is the waters of our springs and rivers, but all of 
 these contain poisonous substances in greater or less proportions. 
 The purest springs hold in solution the chlorides of sodium, mag- 
 nesium, or potassium, as well as lime, in combination with sulphuric 
 acid. Even rain-water, the purest of all, contains traces of nitric 
 acid, that it derives from the atmosphere in its passage through 
 it. 
 
 2. They all seem to have the power of sustaining the system with- 
 in certain limits ', and to a certain extent supply the place of food. 
 
 Tea and coffee drinkers know by experience that they can both 
 live and work on their favorite beverages without any solid food what- 
 ever. There are thousands — aye, millions — in the world who would 
 give all the rest of the breakfast rather than their cup of coffee. 
 There are millions of ladies in the land to whom their cup of tea is 
 more important — or, at least, seems to be so — than all their other 
 food. 
 
 Opium has a wonderful power of sustaining the system, the 
 natives of the East working hard for days on nothing but a little of 
 this drug. 
 
 Tobacco has the same power, though to a less degree. Great 
 smokers are usually moderate eaters. 
 
 The South American coca has the same effect. The Indians 
 there travel for days subsisting on nothing else. 
 
 Alcohol— in all its myriad preparations — is a powerful substi- 
 tute for food ; I therefore term it negative food. In fevers, in ex- 
 haustion, and in health even, it supplies the place of food. When 
 used largely it impairs the appetite, and may almost destroy it. This 
 fact is a powerful argument against the free use of this agent. 
 
 Everybody knows that sots and debauchees are usually moderate 
 eaters. The confirmed drunkard always prefers his grog to his 
 dinner. Those who indulge in champagne and brandy to any ex- 
 tent partake less freely of the solid articles on the table, even when 
 the system is in excellent health, and all the conditions for a vigor- 
 ous appetite are fulfilled. The fact that drunkards eat so little, and 
 even neglect their meals, has long been so patent to superficial ob- 
 servation, that temperance men have seized upon it— and with good 
 reason — as an argument against intemperance. The body needs 
 positive, solid nutriment, and any great excess in the use of alco- 
 holic liquors must so benumb the appetite that it will not crave suffi- 
 cient food to keep the system in its best working condition. 
 

 STIMULANTS AND NARCOTICS. 233 
 
 The classes who are poorly fed, half starved, are apt to indulge 
 excessively in alcohol. 
 
 It is chiefly the poorer and laboring classes — mechanics, artisans, 
 draymen, stevedores, and the like, who breathe impure air, in close 
 tenant-houses, whom poverty compels to subsist on meagre and in- 
 sufficient food — that particularly appreciate the need of the " acces- 
 sory or negative food " supplied by alcoholic stimulants. They find 
 by experience that, under the depressing circumstances in which 
 they live, move, and have their being, they can work harder and 
 longer with their glass of beer, or perhaps of whiskey, than without 
 it. It is a matter of fact, which very few recognize, that most of 
 the liquors are used by the poorer and laboring classes. 
 
 This fact, that the lower orders of society are the chief consumers 
 of ardent spirits, is of such vital import in the study of social econo- 
 my, that it is hard to understand why it has been so strangely ig- 
 nored. New York City consumes an immense quantity of ferment- 
 ed and distilled liquors — more especially the beers and whiskey — 
 but the greater portion of it is used by the occupants of the tenant- 
 houses. 
 
 Indeed, most of our grog-shops are located in those quarters of 
 the city that are frequented by the ignorant and the lowly. . The in- 
 telligent and wealthy do indeed keep wines and brandies in their 
 houses — and there are a small minority who use them regularly and 
 freely at dinner, or on other occasions are habitual and it maybe ex- 
 cessive drinkers — but take the country through, the lower orders of 
 society, in proportion to their numbers, use far more of intoxicating 
 drinks than the intelligent and cultivated. 
 
 Yery many experiments have been made in order to determine in 
 what way stimulants and narcotics thus sustain the system and take 
 the place of positive food. 
 
 It is the opinion of many able physiologists that stimulants and 
 narcotics — or some of them, at least — retard the change of tissue. 
 In nautical language, they " slow the fires " of the system. 
 
 Alcohol and opium are now very largely and very successfully 
 used in the treatment of many of the severe fevers and inflammations. 
 They have, in a measure, taken the place of Heeding and calomel. 
 
 3. They all are liable to make slaves of those who indulge in 
 them to excess. 
 
 It is an interesting fact, however, that most of the intoxication 
 from alcoholic liquors of civilized lands is confined to the ignorant 
 and low-born. 
 
 In spite of all the warnings that have been given to the children 
 of aristocracy, the fact remains, that among the educated and influ- 
 
234: IIYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 ential the number of those who go down to drunkards' graves is so 
 exceedingly small, that any isolated case that occurs elicits the deep- 
 est interest and sympathy. Among these classes — even among 
 students and graduates of colleges — there are not a few who at some 
 period of their lives occasionally make excessive use of intoxicating 
 drinks, but yet not in such a way as to be grossly intemperate. Ac- 
 cording to the police reports of New York City, and the valuable 
 statistics of Mr. Halliday, of the Five Points Mission, nearly all 
 of the arrests for intemperance in the Metropolitan district are 
 from the lowest rank of foreigners. 
 
 In England, also, gross intemperance is comparatively rare 
 among the educated nobility, but is distressingly common among 
 the peasantry. The truth is, the intemperance of the poor and ig- 
 norant is more the result than the cause of their depressed condi- 
 tion. The logical explanation of this is not difficult. "Accessory 
 food " in the form of whiskey and beers compensates in a measure 
 for the insufficiency of their diet. Moreover, the tonic properties 
 of alcohol temporarily brace them against the evil effects of foul air 
 and damp, gloomy homes. Then again, the classes who are thus 
 unfortunately circumstanced in regard to material comforts are 
 usually still more deficient in moral and mental training, and when 
 once hunger or thirst or weariness has driven them to the bar- 
 room, they have not sufficient moral force to stop when they 
 have supplied the demands of nature; hence follow intemperance 
 and its long catalogue of woes. This is, after all, the natural history 
 of every form of vice. I say, then, that intoxication from alcoholic 
 liquors is pre-eminently the vice of ignorance and poverty. In pro- 
 portion as communities grow at once wiser and better, in that pro- 
 portion do they become more temperate. The ruling classes of 
 England during the last century were far less moderate in the use 
 of ardent spirits than the nobility of the present day. 
 
 The Roman patricians were almost as great debauchees at their 
 feasts, even on their meagre variety of drinks, as are the common 
 laborers of our day in the ale-houses and corner groceries. 
 
 Rome cultivated the minds of her youth, but not their morals 
 — thus the citizens yielded to gluttony and intoxication. The 
 Spartans cultivated both mind and morals, and were paragons of 
 sobriety. 
 
 In our day the educated ruling classes of society injure them- 
 selves more by tobacco than by alcohol. Among the very highest 
 classes even coffee injures more — though in a very gradual way — 
 than alcohol. 
 
 Our people are not able to bear tobacco and coffee, or even 
 
STIMULANTS AND NARCOTICS. 235 
 
 tea, as formerly, or as perhaps tlieir fathers and mothers were able 
 to do. 
 
 The types of constitution change with the progress of civiliza- 
 tion, and the food and drink must change accordingly. Very many 
 of my patients tell me that they cannot use coffee or tobacco at all, 
 and some are obliged to forego even tea. 
 
 Tea is used too strong in this country, and there are thousands of 
 ladies especially who subsist on it too exclusively, and are therefore 
 seriously injured by it. Tea in excess begets nervousness, sleepless- 
 ness, dyspepsia, headache, constipation, hysteria, and all forms of 
 nervous disorder. Its evil effects come slowly, but they often come 
 too surely. Coffee injures more than tea. Coffee and tea are both 
 excellent drinks, and fortunate are they who can use them without 
 injury. 
 
 Those who work hard with their muscles in the open air can 
 use tea, coffee, tobacco, more freely than those whose lives are se- 
 dentary and confined. During the late war the soldiers and sail- 
 ors thought more of their coffee and tobacco than of all their other 
 rations. 
 
 4. They vary in their effects in different climates. Tea is a pro- 
 duct of temperate climes, and can be used with about equal benefit 
 everywhere and in all countries, and with no greater injury in one 
 country than another. It is, however, more largely used in cold or 
 cool latitudes. . The Russians are the greatest tea-drinkers of the 
 world, next to the Chinese. Tea is very freely used in England. 
 In France, Italy, Spain, and Turkey, coffee, in a certain measure, 
 takes the place of tea. In our own country tea is more used in 
 the Northern States and coffee in the Southern. 
 
 Coffee is a product of warm climes, therefore it can be used 
 more freely in the torrid and sub-torrid zones than in the colder 
 regions. The nations of the world seem to find this out by instinct, 
 for the inhabitants of hot countries in both hemispheres use coffee 
 very freely, while those of the colder regions in a measure substitute 
 for it tea and alcoholic drinks. 
 
 During the late war our soldiers and sailors on the Union side 
 used far more coffee, and probably without serious injury, than they 
 had been wont to do in their Northern homes. 
 
 In 1864 and 1865 I was acting for a year and a half as surgeon 
 in the navy, on the blockade in Farragut's squadron in the Gulf of 
 Mexico. When I first arrived at the station, — which was off the 
 coast of Texas, — and, indeed, for a number of months, I continued 
 to abstain from coffee, as all my life I had been obliged to do in the 
 North. Gradually, however, I fell into the habit of the officers 
 
236 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 about me, and began to drink strong coffee three, four and five times 
 daily. To my surprise I found that instead of being made nervous, 
 sleepless, and dyspeptic by it, as would have been the case had I 
 indulged even in a single cup at home, I actually improved in my 
 health, and ever afterwards during my stay I persevered in taking 
 the beverage at all my meals, and frequently at habit lunches. 
 
 When I returned to the North I was obliged almost immediately 
 to stop my allowance of coffee, and have never since indulged in it. 
 Shortly after my return I met a very intelligent gentleman, who had 
 visited all the Southern States, and who related precisely the same 
 experience in regard to the use of coffee. It is the habit of the 
 Southerners to drink strong coffee on rising in the morning, at 
 breakfast, and during the day as they may wish it. The same cus- 
 toms are observed in the warm countries of Europe. 
 
 Opium can apparently be used more freely in the warm coun- 
 tries of the East than in other parts of the world. Of the 400,000,- 
 000 who habitually indulge in the drug, probably only a comparative- 
 ly few are ruined by it. Medical travellers in the East report that 
 opium eating does not usually have as marked injurious effects on 
 the inhabitants as it does with us. There are, of course, thousands 
 who there use it to enormous excess, become slaves to it, and are 
 made wretched indeed. 
 
 It is not possible that opium-eating will ever become a national 
 habit in America. Of the 100,000 in this country who are said to 
 use it, nearly all first resorted to the drug as a relief from pain. In 
 Europe and America our tobacco, our tea, and our various forms of 
 fermented and distilled liquors have saved us, and will continue to 
 save us, from the opium-eating habits of the East. 
 
 Alcohol is a product of both temperate and warm climates, and 
 can be used in all the latitudes. It seems, however, to be most 
 injurious when excessively used in extremely hot or extremely cold 
 climes. Nearly all travellers agree that in the polar regions or in 
 the tropics more injury than benefit results from a large amount of 
 alcohol in any form. 
 
 Tohacco, like tea, is a product of temperate latitudes, and like 
 tea it can be used without any special or markedly observed differ- 
 ences of effects in all countries. Like tea, it can be indulged in 
 with comparative impunity in the regions of the tropics and of the 
 poles. All the injurious, all the beneficial, and all the negative 
 effects of tobacco seem to be about equally observed in all latitudes. 
 If there is any difference whatever in its effects in the various cli- 
 mates, it is this, that it can be used most freely in those which are 
 warmest. 
 
STIMULANTS AND NARCOTICS. 237 
 
 5. They all vary in their effects on different constitutions. 
 
 Chocolate, cocoa, shells — all these are mild drinks, but there are 
 those to whom they are positively noxious. 
 
 Tea acts very differently with different temperaments. I know 
 a man who is so exceedingly sensitive to this beverage, that even a 
 cup of the very weakest tea will keep him awake all night. I know 
 many who cannot habitually use tea in any shape. On the other 
 hand I know many — and so do we all — who can take several cups 
 daily of the very strongest tea without showing any effects from it. 
 
 Coffee is terribly poisonous to very many, especially in our north- 
 ern latitudes, while others can indulge in the charming beverage to 
 an almost unlimited extent. I am convinced that the number of 
 those among us who cannot drink coffee is increasing. I account 
 for this by the changes being made in the type of constitutions. 
 We are growing more impressible, more nervous, and more sensi- 
 tive to those drugs and agents that directly affect the nervous cen- 
 tres. I doubt whether more than half of those in this country who 
 lead sedentary and confined lives can habitually use coffee with 
 impunity. Those who labor hard with their hands out-doors can 
 use it more freely. 
 
 Ojjium very rarely has the effects described in De Quincey's 
 " Confessions of an Opium-Eater. " Even those who use it to enor- 
 mous excess do not usually experience any of those dreamy visions 
 which his gifted imagination has pictured in such brilliant and 
 hideous colors. Opium varies in its effects even when given in 
 small doses. The majority are put to sleep by it, but some it keeps 
 wide awake. There are those whom it makes actually raving. 
 
 Alcohol varies in its effects with different constitutions. There 
 are many hundred different forms of fermented and distilled liquors 
 now in use in the world. The differences between these are very 
 wide. 
 
 The strongest whiskeys, brandies, rums, gins, &c, contain over 
 fifty per cent, of alcohol. The stronger wines — port, madeira — con- 
 tain from ten to twenty per cent, of alcohol. The weaker, lighter 
 wines, as hock, claret, Burgundy, champagne, contain from five to 
 ten per cent. Ales, porter, and cider contain but from three to six 
 per cent, of alcohol. 
 
 It is manifest at a glance that these different forms of alcohol 
 must not only vary widely in their effects, but also in their effects 
 on the same individual ; for besides the alcohol, all of them con- 
 tain other important substances, on the proportions of which their 
 influence on the constitution must very materially depend. Some 
 can drink claret, Rhine wines, hock, cider, beer and porter, and 
 
238 HYGIENE, OR THE ART OF PRESERVING HEALTH, 
 
 are unable to use rum, gin, or brandy. Some can drink beer, but 
 not cider. Hard cider with many makes the head ache. For others 
 it clears the digestion, corrects the liver, and sharpens the appetite. 
 Gouty patients are oftentimes unable to take a drop of champagne, 
 or acid wines of any kind or in any quantity, without paying ter- 
 rible penalties. Many who cannot use brandy, even when largely 
 diluted, find that claret, Burgundy, and even champagne, give 
 them no discomfort. 
 
 There are no special rules to guide one in the selection of wines. 
 If one feels that he must use wine, let him find out by experience 
 what kind serves him best. As a rule, claret and Rhine wine agree 
 with more persons than any other kinds of wine that reach this 
 country. There is no question, however, that wines are luxuries 
 and not necessities for us, and that life and health can be perfectly 
 maintained without them. One of the strongest arguments in their 
 favor is, that they keep us from abusing ourselves with stronger 
 liquors, and with other and more potent forms of accessory food, 
 such as tobacco, opium, and coffee. But tea and coffee, opium and 
 tobacco, are, strictly speaking, luxuries, although in our modern 
 civilization they have long been deemed as actual necessities. There 
 is no question that health and life, at least in individual cases, can 
 be maintained without any of these substances. 
 
 Tobacco varies wonderfully in its effects with different indivi- 
 duals. With many the first whiff of a cigar is disagreeable, and the 
 first " cud " absolutely nauseous ; but there are very few who can- 
 not become so accustomed to the drug as to enjoy it. I must, 
 however, plead an exception. 
 
 Tobacco dries up some, fattens others. In some it causes dys- 
 pepsia, in others it relieves it. Some use it to keep awake, others 
 to promote sleep. With all persons, or nearly all, it has a tendency 
 to diminish the appetite, and within certain limits to take the place 
 of ordinary food. 
 
 Persons who have been slaves to tobacco very often suddenly or 
 gradually break up the habit ; the results are of the most opposite 
 character. Some at once improve in health, grow fatter and 
 stronger; others at once go backward, and grow thinner and 
 weaker. It constipates some and relaxes others. 
 
 On many it produces all the horrors of extreme nervousness. 
 Some it makes brilliant, others it stupefies. 
 
 Some take a smoke before going to battle, to fortify them for 
 severe and unusual effort ; others take it after the battle, when 
 their effort is completed, to calm their nerves and soothe them to 
 slumber. 
 
STIMULANTS AND NARCOTICS. 239 
 
 6. They vary in their effects at different ages and times of life. 
 
 The reason of this is quite apparent. The constitution varies at 
 different times of life. The size and quality of the brain, of the 
 muscles, of the bones, vary wonderfully between infancy and old 
 age. A youth of twenty-one is a different being from what he was 
 at the age of one year. A man in middle life is a different being 
 from what he was at twenty-one. An old man at seventy is a very, 
 very different being from what he was at middle life. 
 
 It is very clear, therefore, why on r food acts differently with us at 
 different periods of our life. Our food is almost a constant quantity. 
 It does not vary much in its quality from year to .year, while our 
 bodies into which it enters are ever changing. As with ordinary 
 food, so with stimulants and narcotics. 
 
 Many who have been accustomed to indulge, as they desired, in 
 tea, or coffee, or tobacco, or chocolate, or in some form of fermented 
 or distilled liquor, find sometimes that they are obliged to disconti- 
 nue the use of some one or all of them. The rule works both ways. 
 I have had patients who have found by trial and experience that 
 they could use with impunity, and perhaps with benefit, stimu- 
 lants and narcotics which formerly were exceedingly injurious to 
 them. 
 
 There are many who are obliged to abstain from coffee all their 
 lives until they reach old age, when they find, to their great sur- 
 prise, that they can use it freely. Probably this experience would 
 be repeated more frequently if people only made trial of them- 
 selves in this respect every year or two during their lives. 
 
 Infants should not habitually use stimulants and narcotics. 
 Those who are growing need positive and not negative or accessory 
 food. Their tissues need to be changed rapidly in order that the 
 growth may be carried on. In infants the brain and nervous system 
 is but little used, and therefore but little needs the aid of stimu- 
 lants and narcotics. The intuition of the people everywhere is op 
 posed to the use of these substances by very young children. 
 
 For the same reason, children and youth should not use stimu- 
 lants and narcotics until they arrive at years of discretion. 
 
 There are two very decided arguments against the use of tea, 
 coffee, tobacco, fermented and distilled liquors, by those who are 
 under fifteen or twenty years of age. First, they do not at that 
 time need negative food, but on the contrary as much positive food 
 as they can digest. Growing children need fresh meat, with fish, 
 oysters; good vegetables, wholesome fruit, and all in a palatable 
 variety. They do not need anything that will interfere with the 
 rapid changes of tissue that always accompany the growth of the 
 
2±0 HYGIENE, 
 
 body. Secondly, children and youth have not sufficient self-control 
 and force of mind to use these substances without becoming in a 
 sense slaves to them. 
 
 It would be better for the young and growing generation if they 
 abstained entirely, or nearly so, from tea, coffee, until fifteen or 
 twenty years of age, to say nothing of tobacco, fermented and dis- 
 tilled liquors. Our children drink tea and coffee too young, and in 
 too large quantities. Like all of us, they take their tea too strong . 
 The best drinks for children are milk, cocoa, and water. 
 
 Still further, if young men would abstain entirely from tobacco 
 and alcoholic liquors until the age of twenty-five or thirty, intoxi- 
 cation and all forms of intemperance would be almost unknown 
 by the next generation. 
 
 Intemperance in the use of tobacco and alcohol is usually the 
 result of habits formed in youth, or before the age of twenty -five or 
 thirty. 
 
 On the other hand, persons of mature age, and especially those 
 in the decline of life, are usually benefited by a reasonable indul- 
 gence in tea or coffee. 
 
 In the very aged the digestion is often weak, and therefore the 
 sustaining power of stimulants and narcotics is especially grateful. Tea 
 is pre-eminently the drink for the aged. Undoubtedly there are many 
 even among old people who injure themselves by tea, coffee, as well 
 as by tobacco and alcohol ; but the proportion of persons over sixty 
 who thus injure themselves is very small indeed in comparison with 
 the thousands of youths who are undermining their manly vigor 
 and impairing their prospects for usefulness by indulging in these 
 forms of negative food. 
 
 7. They are nearly all liable to be adulterated. 
 
 Tea is adulterated with at least twenty-five different herbs or imi- 
 tations that more or less closely resemble the original article. Green 
 teas are adulterated in China, according to Mr. Fortune, by adding 
 to them various coloring substances. Prussian blue and gypsum are 
 much used for this purpose. The Chinese never drink the adulter- 
 ated teas, but sell them to foreigners, because they bring a higher 
 price. Indigo is also used for the purpose of adulteration. Tea is 
 also much adulterated with what is called " lie-tea," which is com- 
 posed of the sweepings and dust of the warehouses. 
 
 Coffee is largely adulterated with chiccory, as everybody knows. 
 Chiccory itself is adulterated with Yenetian red, and the Venetian 
 red is adulterated with brick-dust. (See chapter on Adulter- 
 ations?) 
 
 Fermented and distilled liquors are adulterated in thousands oi 
 
STIMULANTS AND NARCOTICS. 241 
 
 ways ; even pure hard cider is difficult to obtain in our cities. 
 Much of the cider that is sold in the saloons is made of sugar, 
 water, and tartaric acid. Sometimes I have searched for a long 
 time in New York, and in many different stores, for pure hard 
 cider, and without avail. The bottled cider is very apt to be impure. 
 Sulphite of soda and other chemicals are mixed with it in order 
 to preserve its sweetness. It is very unfortunate that it is thus 
 difficult to get pure hard cider, for it is a most valuable beverage. 
 It is usually an excellent drink for the nervous and dyspeptic. It 
 is the Rhine wine of America, and better, far better would it be for 
 our American ladies if they took more hard cider and less tea and 
 coffee. 
 
 Malt beer is adulterated with coccidus indicus, tobacco, sweet 
 flag, sweet gale, yarrow, and thorn-apple. The Javans adulterate 
 their rice beer with cakes, made of onions, black pepper, and capsi- 
 cum (Johnston). It is not adulterated with strychnine to any 
 extent. 
 
 Wine is adulterated with poppy-heads, and in myriads of ways 
 that it is not necessary to mention. 
 
 Pure wines can be obtained in this country from California, 
 and also from Europe, by those who will take special pains and 
 make the matter a study. In wine-making countries the pure 
 article is as common as water. It may yet be so with us. The 
 introduction of pure wine into our country would not cure intem- 
 perance, though it might diminish its horrors. Intemperance is 
 the vice of poverty and ignorance, and can only be driven from the 
 land by the introduction of knowledge. . 
 
 Ardent Spirits, — rum, gin, brandy, and whiskey, — as everybody 
 knows, are adulterated to a most fearful degree. Even those who 
 pay the highest price are by no means sure that they obtain the 
 pure article. All of these drinks are manufactured from chemi- 
 cals. 
 
 According to the recent analyses of Prof. J. C. Draper, fusel oil 
 and other bad ingredients are found in highest-priced liquors, and 
 in the most aristocratic hotels and saloons of New York City. 
 These adulterations are not all, however, of such a kind as to 
 seriously injure the health, but all of them are less beneficial and 
 more injurious than alcohol. The rums, gins, whiskeys of the 
 poorer classes are horrible mixtures, and thoroughly deserve their 
 well-known title — " chain lightning." Much of the intemperance 
 of the poorer classes is produced not so much by alcohol as by 
 cocculus indicus. It is a terrible substance, and is terribly per- 
 nicious. It is largely used in the adulteration of beer. 
 16 
 
242 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 But, after all, it is an exaggeration to say that pure or nearly 
 pure liquors cannot be obtained in this country. However it may 
 have been in the past, there is no question that at the present time 
 it is entirely possible to obtain pure wine, and nearly pure liquors 
 of some other kinds, provided we go to the proper authorities in 
 such, and make the matter a special study. They will, at least, be 
 about as near to absolute purity as our tea, our coffee, or our 
 tobacco. Brandy and champagne are very rarely found here in 
 absolute purity. 
 
 The Boston Journal of Chemistry — a good authority — says that 
 thousands of gallons of claret are made by allowing water to soak 
 through shavings, and adding thereto a certain portion of logwood 
 and tartaric acid, and a little alcohol. Good judges can hardly 
 tell the difference between this mixture and the genuine article. 
 
 This is unfortunate, for good, pure claret is one of the best of 
 our wines, and is the least liable to injure. 
 
 Hoskins gives the following prescriptions for manufacturing 
 liquors : 
 
 " Sweet Cider. — Imitation : Water, 100 gallons ; honey, 5 gallons ; 
 catechu, powdered, 3 ounces ; alum, 5 ounces ; 1 quart of yeast ; fer- 
 ment for 15 days in a warm position in the sun. Then, bitter almonds, 
 half a pound; burnt sugar, one quart; 3 gallons whiskey; if acid 
 predominates, correct by addition of honey; if too sweet, add sul- 
 phuric acid to suit taste." 
 
 Another recipe by the " Bordeaux Guide " is, in accordance with 
 his avowed principles, harmless: 
 
 "To 8 galls, soft water. 
 8 lbs. K O. sugar. 
 7 oz. tartaric acid. 
 1 qt. yeast. 
 
 "Put the ingredients into a cask and stir it up. After standing 
 24 hours with the bung out, bung it up close, add 1 gallon spirits, and 
 let it stand 48 hours, after which time it is ready for use. 
 
 "Port Wine. — Cheap cider or claret, twenty gallons ; honey, two 
 gallons ■; carbonate of soda, twelve ounces ; strong tincture grains of 
 paradise, one and a half gallons ; powdered catechu, 5 ounces ; color 
 with a strong tincture of logwood and a small portion of burnt sugar. 
 The reader observes that this wine is made without the addition of 
 any spirit, though a small portion would greatly improve it. The 
 object of the carbonate of soda is to neutralize a portion of acid in 
 the wine or cider, which, if allowed to remain, would present too large 
 a proportion of acid for good port. 
 
 " Sherry.— -Cider, two gallons ; bitter almonds, four ounces ; honey, 
 
STIMULANTS AND NARCOTICS. 243 
 
 one gallon ; mustard, four ounces. Boil for thirty minutes and 
 strain, then add spirit of orris root one half pint, essence of cassia 
 two ounces, and rum three quarts. 
 
 " Jamaica is preferable, as this wine, when made from this formula, 
 is often prepared for the auctions. The amount of neutral spirit 
 added becomes an important item owing to the cost. When this is 
 kept in view the tincture of grains of paradise should be substituted 
 for spirit. 
 
 "The volatile oil is produced in excess during the distillation of 
 brandy, only a portion of it being dissolved by the spirit. It is im- 
 ported into this country under the name of ' Oil of Cognac,' and 
 possesses a strong, pungent, and disagreeable taste and odor. On 
 it chiefly depends the flavor of brandy. 
 
 " Acetic acid is pure concentrated vinegar. Acetic ether is a corn- 
 bin ation of acetic acid with alcohol. It has a pleasant, diffusive, and 
 somewhat fruity smell, and a cooling, agreeable taste. Nitrous 
 ether, or ' sweet spirits of nitre,' is often used in flavoring spirits as 
 a substitute for acetic ether. 
 
 " (Enanthic ether is an oily, fragrant, and volatile liquid. From 
 it brandy derives most of its peculiar odor. This, like the cognac 
 oil, is imported from the wine-making countries specially for use in 
 preparing artificial brandies. 
 
 " Tannic acid, or tannin, is the vegetable astringent principle 
 existing chiefly in the bark, seeds, and wood, and sometimes in the 
 sap and fruit of vegetables. In genuine brandy it is principally 
 derived from the seeds and skins of the grape, and from the wood 
 of the casks in which it is kept. 
 
 " Cognac Brandy. — To forty gallons pure spirits add two to three 
 ounces oil cognac (dissolved in alcohol), one and a half pounds loaf 
 sugar, two ounces cenanthic ether, two ounces acetic acid, and two 
 ounces tincture of kino. To this add from five to ten gallons of the 
 brandy to be imitated. Let it stand about eight or ten days. Color 
 it with burnt sugar, using a sample of the kind to be in^Hed as a 
 guide. If you desire a higher flavored brandy, use more of the 
 cognac oil ; if a higher odor, more cenanthic ether; if ■ Vter and richer, 
 more sugar; if stronger, increase the proof of the spirit by adding 
 strong alcohol. 
 
 u JVew York Brandy. — Filtered whiskey, twenty gallons ; clear 
 water, seventeen gallons ; tincture of Guinea pepper, one and a half 
 gallons ; tincture of pellitory, one pint ; strong tea, one gallon Color 
 with burnt sugar and red saunders, and add four ounces of nitric 
 ether and half a gallon tincture of prunes." 
 
 Tobacco is very much adulterated. 
 
2U 
 
 According to Pereira, molasses, sugar, and honey are used to in- 
 crease the weight of tobacco, and also to make it more palatable. 
 The leaves of the rhubarb, the beech, the walnut, mosses, bran, 
 beet-root dregs, liquorice, rosin, yellow ochre, fuller's earth, sand, 
 saltpetre, common salt — all these substances have been detected in 
 tobacco. 
 
 Our ordinary articles of food are likewise adulterated. It is 
 difficult to obtain pure groceries of any kind. It is unfair to claim 
 that all the adulteration of the country is confined to the dealers in 
 stimulants and narcotics. The same difficulty is felt across the 
 water. 
 
 8. They all may be used so as to directly injure the nervous 
 system. 
 
 Tea is one of the mildest of the stimulants, and yet there are 
 thousands who are injured by it. Coffee injures more constitutions 
 among the leading classes of American society to-day than all the 
 forms of alcohol combined. It would be better for our American 
 ladies if they would use less tea and coffee — much less — and more 
 cider, sour wines, and good beer. 
 
 It is a very significant fact that the men of America — even 
 those who indulge freely in tobacco and in fermented and distilled 
 liquors — are much healthier and stronger than our women, who 
 rarely use these substances, but use more tea and coffee than 
 their lords. The complicated question arises, Why is this so ? Is 
 it not, at least, probable that our wives and mothers would be 
 stronger if they would use less tea and coffee, and more cider, beer, 
 and wine, like the Germans, French, and English % 
 
 Coffee injures thousands. Only a fractional portion of those 
 who lead sedentary lives in America can drink it habitually all their 
 lives. It can bring on every nervous symptom imaginable. 
 
 Tobacco is capable of producing nearly every possible nervous 
 symptom. Dyspepsia, hypochondriasis, neuralgia, sleeplessness, 
 are sometimes caused by it. 
 
 Tea and coffee give rise to the same disorders even more fre- 
 quently than tobacco. Insanity has been charged upon tobacco, 
 and it has been stated that the increase of insanity in our modern 
 civilization is largely due to the increase in the consumption of 
 tobacco. This statement cannot, however, be proved, and is not at all 
 probable. There is an immense amount of false reasoning on this sub- 
 ject. A person who has been in the habit of using tobacco is taken 
 insane. Some of his friends, who may not themselves use tobacco, and 
 who regard chewing and smoking in public as breaches of etiquette, 
 as thev trulv are, at once give out that his insanity was caused by 
 
STIMULANTS AND NARCOTICS. 245 
 
 tobacco. This inference they have no right to make. They might 
 with just as much propriety have charged his insanity upon the 
 tea or coffee, or cider or beer, which he may very likely have been 
 in the habit of using. 
 
 They might even have charged it upon his daily food, for there 
 is no question that bad diet often brings on nervous diseases. 
 
 The truth is, that no one has a right to charge the nervous diseases 
 — insanity, or any other form — of any individual upon any special 
 kind of diet, or of stimulant or narcotic that he may have been in the 
 habit of using, toithout overwhelming evidence and after the most 
 careful study. It is indeed extremely difficult for a physician — 
 whose life is devoted to the study of disease — to decide in any 
 given case of dyspepsia, neuralgia, paralysis, hypochondria, sleep- 
 lessness, debility or insanity, whether the symptoms were or were not 
 brought on by the tea, the coffee, the tobacco, or the alcohol that the 
 patient has been accustomed to use. The newspapers report at times 
 that tobacco has caused death. Some of our books on hygiene de- 
 clare that insanity has increased of late years in direct proportion 
 to the increase in the use of tobacco. Now it is impossible for one 
 not a physician to tell in any given case whether death has teen 
 caused by tobacco, or by tea, or by coffee, or even by alcohol, except in 
 very marked cases indeed. 
 
 Therefore, all such reports are unreliable. Precisely so with the 
 relation of insanity to the use of tobacco. The question is a very, 
 very complicated one, and cannot so easily be answered. It is true 
 that insanity has somewhat increased of late years — though not to 
 the extent that is commonly supposed. It is also true that the con- 
 sumption of tea, of coffee, of tobacco, of alcohol, and of opium has 
 greatly increased in, our civilized land. Shall we attribute the in- 
 crease of insanity to the tea, the coffee, the tobacco, the alcohol, or 
 the opium ? We see at once that the question is very difficult to 
 answer. 
 
 Still again, there has been a wonderful increase in the cares, 
 the labors, the anxieties, the passions, and the strifes of our 
 modern civilization. Over- work and over- worry of the brain are the 
 great causes of diseases of the brain. But, after all, it appears from 
 statistics recently published that insanity has not increased to the 
 extent that is commonly supposed. 
 
 That nervous diseases in general have increased, there can be no 
 question ; but this increase is probably due more to the passions and 
 strife of our modern civilization than to the use of any special article 
 of food or drink. 
 
 Alcohol, when used in large quantities and for many years, un- 
 
216 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 questionably injures the brain and nervous system. This view is 
 confirmed by actual examination of the brains of those who have 
 died drunkards. Alcohol also injures the liver, the stomach, and 
 indeed the whole system. There is, however,^ great liability to err, 
 just as in the case of tobacco. Because a man who has been addict 
 ed to alcohol dies, even in his prime, of some disease of the brain, 
 stomach, liver, or other vital organ, we are by no means always jus- 
 tified in convicting him of death from alcohol. So many causes are 
 continually acting upon us that the question is a very complex one, 
 and can only be answered after careful study and close investiga- 
 tion by some professional authority. 
 
 There are two well-known diseases that come from the abuse of 
 alcohol. They are delirium tremens and chronic alcoholism. The 
 symptoms of the former are well known, and need not be here 
 repeated. 
 
 The symptoms of chronic alcoholism are (according to Marcet) — 
 
 1. Inability to sleep. 
 
 2. Trembling. 
 
 3. Giddiness and headache. 
 
 4. Hallucinations. ' 
 
 5. "Weakness. 
 
 6. Difficulty of breathing. 
 
 All of these symptoms may come from a thousand other causes 
 besides the abuse of alcohol, and in any given case it is impossible 
 even for a physician to settle the question without very close scru- 
 tiny. Of late years much attention has been given to the reformation 
 of drunkards. It is now well understood that intemperance is very 
 often a symptom of insanity. It is a kind of mania, and has been 
 honored with various special names — " dypsomania," " methomania," 
 " vinomania" &c, &c. This mania may be the' result or the 
 cause of intemperance. Long-continued abuse of alcohol may so 
 injure the brain that the victim becomes insane on that subject, and 
 is unable to control his appetite. On the other hand, insanity, how- 
 ever produced, may give rise to intemperance. 
 
 In either case the patient should, if possible, go to an inebriate 
 asylum. This disease, if taken early, and well managed by skilful 
 hands, is nearly as curable as any form of insanity. The State reports 
 of the asylums are very encouraging. Much of the intemperance 
 of our time, especially among the educated classes, is the result of 
 insanity, and should be treated accordingly. The pledge never 
 saves such patients. For such total abstinence is a duty. If 
 they cannot control themselves, let them, if possible, go to an 
 asylum. 
 
STIMULANTS AND NARCOTICS. 247 
 
 Opium, when used habitually and for a long time, produces worse 
 effects than tea, or coffee, or alcohol, or tobacco. 
 
 These effects have been very forcibly described by De Quincey, 
 and in the work recently published, entitled " The Opium Habit." 
 All of the writers on the subject are, however, inclined to exag- 
 gerate the horrors from which they have suffered. Thousands take 
 opium and take it habitually, and take it in large doses and for a 
 long time, and yet never experience the dreams of De Quincey, or 
 the sufferings depicted in the " Opium Habit." 
 
 The results of opium-eating must depend, and very manifestly, 
 on the temperament. That opium is the most powerful for evil of 
 any of our common stimulants and narcotics, all will admit. If 
 the habit of opium-eating were to become universal in our climate, 
 I should tremble for the results. I have no fear that we shall ever 
 be thus afflicted. Our tea, our coffee, our tobacco, our large and 
 abundant variety of fermented and distilled liquors, every year im- 
 proving in quality, will undoubtedly continue to save us from the 
 horrors of opium in the future as they have done in the past. 
 
 I am inclined to forgive tea, coffee, tobacco, and alcohol what- 
 ever evil they have wrought in the world, for this one great redeem- 
 ing benefit — that they have, in a good measure, delivered us from 
 the opium-eating habits of the East. 
 
 Opium-eating, like the use of alcohol, is often a symptom of 
 disease of the brain. Like chronic alcoholism, it maybe either the 
 result or the cause of mental disease. This affection, which is,T am 
 happy to say, quite rare in our country, is called opio-mania. 
 
 9. They have never been successfully prohibited by law. A 
 complete history of the attempts that have been made in various 
 countries to prohibit or regulate the sale or use of stimulants and 
 narcotics would be exceedingly interesting. 
 
 Law has been directed not only against alcoholic liquors, but 
 also against opium, against tobacco, and against coffee. 
 
 The government of China used vigorous and desperate meas- 
 ures to prevent the introduction of opium in that country, but it 
 failed. 
 
 Opium, however, has been less opposed by law than tobacco, 
 and possibly that may be one reason why it is less used at the 
 present. Always arid everywhere the breeze of opposition fans the 
 flame of enthusiasm, and it is as true now as in Bible days, that 
 bread eaten in secret is pleasant. Nothing advertises a substance 
 so thoroughly as to oppose it by law. 
 
 It is with stimulants and narcotics as with books. The more 
 widely and severely are they criticised, the better the sale. 
 
248 HYGIENE, OK THE ART OF PRESERVING HEALTH. 
 
 Tobacco made trouble everywhere, and has fought and triumphed 
 in more battles than any other stimulant or narcotic. 
 
 King James I. of England wrote, as everybody knows, a terri 
 ble counterblast against it. In the beginning of the seventeenth 
 century, Abbas, the first Shah of Persia, " proclaimed that every 
 soldier in whose possession tobacco was found would have his nose 
 and lips cut off. and afterward be burnt alive." One of the Sultans 
 of Turkey — Amurath IV. — made the use of tobacco a capital 
 offence. Another Sultan ordered that every one who was caught 
 in the act of smoking " should have his nose pierced with his pipe." 
 One of the Czars of Kussia punished smokers with, the bastinado 
 and the cutting off of the nose. A bull was thundered against the 
 habit of smoking and snuff-taking in church by Pope Urban VIII. 
 
 Alcohol has been regulated and prohibited in every way con- 
 ceivable. The history of the laws that have been enacted against 
 this substance would make a volume. 
 
 The recent enactments that have been made in this country — 
 our prohibitory and license laws — are very familiar, and need not be 
 cited. 
 
 Coffee also has triumphed over great opposition. In Constanti- 
 nople the priests used all their influence against it, but in vain. In 
 France, Madame Sevigne — a high literary authority of the time — 
 tried her best to prevent the popularization of the beverage. In 
 London, also, coffee found virulent enemies, but there, as every- 
 where, it triumphed over all. 
 
 From a very interesting paper in a recent issue of " Appletons' 
 Journal" I extract the following. "We see that our good fore- 
 fathers also were unsuccessful in their legislative attempts against 
 stimulants and narcotics, even under the most favorable circum- 
 stances. 
 
 "In the good old times of which we write, it is evident that the 
 evils of intemperance were as great as they have ever been in any 
 portion of our history. Mr. Winthrop complains bitterly of the 
 amount of hot drinks consumed by the young people on board the 
 Arbella during the voyage from Southampton to America ; and 
 every art of legislation was devised to check the ravages of this 
 vice, short of absolute prohibition, or any restriction upon the pri- 
 vate use, by the more respectable members of society, of what is some- 
 times termed in the statute ' the good creature of God.' Mr. John 
 Josselyn, gent., who visited Boston eight years after its settlement, 
 says : ' I found two houses of entertainment, called ordinaries, into 
 which if a stranger went, he was presently followed by one ap- 
 pointed to that oflice, who would thrust himself into his company 
 
STIMULANTS AND NARCOTICS. 249 
 
 uninvited, and, if he called for more drink than the officer, in his 
 judgment, thought he conld soberly bear away, he would presently 
 countermand it, and appoint the proportion beyond which he could 
 not get one drop.' 
 
 " The custom of ' drinking one to another, which draweth the 
 abominable practice of drinking healths,' is positively forbidden by 
 law. Among the reasons assigned by the General Court for this 
 order, are the following : — 
 
 " ' 1. It was a thing of no good use. 
 
 " ' 2. It was an inducement to drunkenness, and occasion of 
 quarrelling and bloodshed. 
 
 " ' 3. It occasioned much waste of wine and leer. 
 
 " ' 4. It was very troublesome to many, especially the master 
 and mistress of the feast, who were forced thereby to drink more oft 
 than they would.' 
 
 " Drinking with disreputable associates, more especially if it was 
 not accompanied by judicious and timely remarks on the evils of 
 intemperance, also appears to have brought the offender under the 
 reproof of the magistrate. Thus l Benj. Hubbard is solemnly ad- 
 monished of his failing for being in company with James Brown 
 and the rest, and often drinking of the strong-water bottle with 
 them, and not reproving them? 
 
 " A man, convicted of drunkenness in the year 1633, was sen- 
 tenced to attend every day upon the session of the General Court, 
 and in their presence wear the ominous scarlet cloth, with the letter 
 D inscribed upon it. The thought will here suggest itself, whether 
 some such exhibition as this might not have a salutary effect upon 
 our modern representative assemblies, and also whether the general 
 aspect of these bodies would not be somewhat enlivened if the err- 
 ing members thereof were adorned in like manner with scarlet. 
 
 " Some time before the transfer of the patent to America, a 
 petition was forwarded to the Massachusetts Bay Company to this 
 effect : ' We especially desire you to take care that no tobacco be 
 planted under } T our government, unless it be some small quantity 
 for mere necessity and for physic, for preservation of their healths ; 
 and that the same be taken privately by ancient men, and none 
 other.' It would appear as though ' the ancient men ' were a 
 little inclined, to monopolize the poisonous weed. 
 
 " A few years later, we find that the court felt it to be necessary 
 to relax in some degree the rigidity of the law ; for it is ordered 
 'that no person shall take any tobacco publicly ; and every one 
 shall pay one penny for every time he is convicted for taking tobacco 
 in any place.' Still later, the law is again modified : ' It is fur- 
 
250 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 tlier ordered, that no person shall take tobacco privately, in his own 
 house, or in the house of another, before strangers ; and that two 
 or more shall not take it together, anywhere, under the penalty of 
 eleven shillings and sixpence for every offence.' 
 
 " From the tone of legislation adopted soon after this, we may 
 infer that the early settlers of Boston found it as hard to regulate 
 such matters as these by law as their posterity have proved it to be. 
 ' This court, finding that, since the passage of . the former laws 
 against tobacco, the same is more abused than before, it is therefore 
 ordered that no man shall take any tobacco in the fields, except in 
 his journey or at meal-times, upon pain of twelvepence for every 
 offence ; nor shall take any tobacco in any inn or common victual- 
 ling-house, except in a private room there, so as neither the master 
 of the same house, nor any other guests there, shall take offence 
 thereat.' Constables are further charged ' to take special notice 
 of common coasters, unprofitable fowlers, and tobacco-takers.'" 
 
 I cannot attempt to lay down rules for my readers in regard to 
 the use of stimulants and narcotics, as it would be in regard to the 
 use of ordinary food. In all these matters each one must work out 
 his own salvation with fear and trembling. The individual experi- 
 ence of every man is a better guide than all the books on hygiene that 
 have ever been written. 
 
 All that I can do in this book — all that any scientific man can 
 do — is to collect and arrange the general facts that bear on these sub- 
 jects ; to present the results of scientific study and the experience of 
 mankind. By the light of these facts let each one guide his own 
 life. 
 
 If you find by experience that you are positively benefited 
 by anyone of these stimulants or narcotics, then use it with the same 
 judgment and moderation that you would use any article of food on 
 your table. 
 
 If you find that you are becoming a slave to any one of these sub- 
 stances, disentangle yourself and make yourself master of the situa- 
 tion at all hazards and at whatever cost. You may know that you 
 are abusing your favorite stimulant — be it tea, coffee, tobacco or 
 alcohol — when you find that you are such a slave to it that you 
 cannot possibly do without it. 
 
 If, on the other hand, you find by experience that you are injured 
 by any stimulant or narcotic that you may be in the habit of using — 
 no mutter how moderately — drop it as you would drop a hot coal, and 
 never give it another thought, even though you see your friends 
 about you on every hand using the same substance even more freely 
 than yourself, not only without injury, but with real apparent ben- 
 
STIMULANTS AND NAKCOTICS. 251 
 
 efit. In these matters every man must be a law unto himself. Some 
 facts of my own personal experience may be of interest to my read- 
 ers, and may perhaps help to illustrate the doctrine I am here en- 
 deavoring to teach. 
 
 At no period of my life have I been able to smoke even the mild- 
 est cigar, without experiencing immediate and long-continued un- 
 easiness. 
 
 I have frequently experimented with smoking in order to test its 
 physiological effects, and I have always found that, although it gave 
 intensity and clearness to the mental operations, yet its influence on 
 the nervous and digestive systems especially were so pernicious that 
 I feel positive that even a moderate indulgence in the use of the weed 
 for any length of time would undermine my constitution. I there- 
 fore totally abstain from tobacco — although I see about me on every 
 hand those who use without injury a number of cigars daily — and 
 although I am well assured that there are thousands who can smoke 
 and chew and take snuff, even to a good old age, without any per- 
 ceptible injury to themselves or their posterity. The law for them 
 is not the law for me. "While the use of tobacco may be right and 
 proper for them, for me it would, with my present knowledge of its 
 effects on my constitution, be a positive crime. 
 
 Coffee also affects me injuriously, and in very much the same 
 way as tobacco, though with less rapidity. Therefore I very rarely 
 indulge in it. 
 
 Weak tea in very closely restricted quantities seems to have on me 
 only a pleasant effect. I strongly suspect, however, that I should 
 do better to abstain from it altogether, and I should do so, provided 
 I could always be sure of some warm drink of a different kind, or of 
 some quality of acid wine. 
 
 Ale and porter, as we find them generally, affect me very ca- 
 priciously. Therefore I do not habitually use them. 
 
 Hard cider and mild acid wines — claret, Rhine wine — almost 
 affect me beneficially, and accordingly I frequently, though by no 
 means regularly, use them. I go for weeks using them almost daily, 
 and again weeks pass in which I do not think of them. 
 
 If I could always obtain them I should use them oftener, and 
 take them at meal-time instead of tea or water. 
 
 The stronger liquors — whiskey, brandy, and the like, or even 
 the heavier wines, sherry, port — I rarely use, because they seem to 
 do me only harm. 
 
 I .have presented my personal experience in this detail, in order 
 to clearly illustrate the principles by which we are to be guided 
 in the selection of our stimulants and narcotics. 
 
252 HYGIENE, OR THE ART OF PRESERVING- HEALTH. 
 
 Every individual is a law unto himself. Just as no human face 
 is precisely like any other, just so no constitution is precisely like 
 any other in its adaptability for special articles of food or drink. 
 
 There are those who, on account of the terrible evils of intoxica- 
 tion, desire to abstain entirely from all alcoholic liquors. This is a 
 matter of conscience, with which science has nothing to do. In 
 this luxurious age, all proper encouragement should be given to the 
 spirit of self-sacrifice for the good of others ; but we must all admit 
 that those who do thus abstain, no matter how conscientiously, are 
 very apt to do unintentional harm ; and, in the words of Hudibras, 
 to 
 
 " Compound for sins they are inclined to, 
 By damning those they have no mind to." 
 
 I have known scores of active, earnest, and conscientious re- 
 formers in the temperance movement, who would pluck out a right 
 eye or give their right hand to be burned rather than touch a drop 
 of fermented or distilled liquors, who yet are grossly and criminally 
 intemperate in the use of tea, of coffee, and tobacco, all of which 
 contain poisonous active principles, while the latter contains ni- 
 cotine and nicotianin, in comparison with which the fiercest alcoholic 
 liquors are mild and innocuous. 
 
 Indeed it may be said in general that the nervous orain-workers 
 of our modern civilization — our educated classes — are, at the 
 present time, less injured by alcoholic liquors than by tobacco, 
 opium, tea and coffee. 
 
 Throughout the land there are thousands of nervous and feeble 
 and dyspeptic men, and especially women, and who, through the ha- 
 bitual use of tea and coffee, are growing more nervous, more feeble, 
 more dyspeptic, who by abstaining from these articles, or by using 
 them in greater moderation, or by wisely substituting for them 
 Borne pure and healthful wines, beers, or ciders, might vastly im- 
 prove their own constitutions, and those of their children and 
 children's children. 
 
 The only consistent teetotalism is that which abstains from all 
 forms of stimulants and narcotics. The only consistent prohibitory 
 law is that which should prevent the production, the importation, 
 or the sale of tea, or coffee, or tobacco or alcoholic liquors, or opium. 
 
 Such absolute teetotalism is very rarely seen among the adult 
 population. In the whole circle of my personal acquaintances, ex- 
 tending through all ranks and grades of society, 1 cannot now re- 
 call the names of a dozen consistent adult teetotallers. 
 
 Such a consistent prohibitory law has not to my knowledge 
 ever been proposed or suggested during all these fierce contests on 
 
STIMULANTS AND NARCOTICS. 253 
 
 the subject of temperance. If proposed, it could never be enacted ; 
 if enacted, no earthly power could enforce it for one day. The 
 great fault of the noble heroes, who in spite of their ignorance and 
 errors have so successfully engineered the temperance reform, is that 
 they have taken too narrow a view of the question — have combated 
 some one form of stimulant or narcotic, as alcohol, or tobacco, or 
 opium, ignoring the rest. In this way they drive the disease from 
 one part of the body to another, but do not thoroughly eradicate 
 it. 
 
 To prohibit stimulants and narcotics from our modern civiliza- 
 tion would be as morally impossible as it would be to prohibit the 
 use of beef or bread or fruit. They are woven into and have 
 become a part and parcel of modern society, and will probably con- 
 tinue to be so until that society shall perish from the face of the 
 earth. 
 
 But in the next generation they will be used very differently 
 from what they are now. With the progress of civilization and 
 the consequent change in the type of constitution, we must instinct- 
 ively change our habits in the use of stimulants and narcotics, just 
 as we have done and are doing in the use of our ordinary food. 
 The probabilities are that in the next century our brain-workers, at 
 least in this climate, will use less strong tea, less coffee, less tobacco, 
 and more beers, wines, and cider. Intoxication and intemperance 
 will not necessarily increase with the increased consumption of stimu- 
 lants and narcotics. Three centuries ago intoxication, on the average, 
 was far more gross and flagrant than it is now ; and yet during 
 these three centuries the use of stimulants and narcotics has increased 
 several fold more rapidly than the population. 
 
 It is the same with licentiousness. It is a great evil now; but 
 it was a far greater evil three centuries ago. Both of these giant 
 woes have diminished with the intellectual and moral elevation of 
 mankind. If savage nations could have access to the immense 
 variety of stimulants and narcotics that are found among the civil- 
 ized, they would be as beastly in their intemperance as they pro- 
 verbially are in their licentiousness. 
 
 In these latter days intoxication has decreased oecause Jcnoioledge 
 has increased. The same law will be observed in the future. In 
 proportion as mankind become intellectually and morally enlight- 
 ened, in that proportion will they become temperate, however freely 
 they may be provided with the different varieties of stimulants and 
 narcotics. As long as ignorance and extreme poverty exist among 
 men, just so long will there be intoxication and all forms of intem- 
 perance. 
 
254 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 The foundations of Temperance, as of every other virtue, must 
 be laid on these four great corner-stones — the Family, the School, 
 the Church, and the Press. 
 
 AIR. 
 
 Common air is a mixture of four different kinds of matter, all of 
 which sustain vital relations to organized existence. These substan- 
 ces are oxygen and nitrogen, watery vapor and carbonic acid. The 
 two latter exist only in very small quantities. Of these substances, 
 oxygen is of the most importance, and the one which is the most 
 essential to life. Although it constitutes but about one-fifth of the 
 ordinary dry atmosphere, yet it is the only part that is absolutely in- 
 dispensable to existence. It is the oxygen of the air that supplies the 
 lungs in respiration, and that excites combustion. Without it we 
 could not produce light nor heat from any combustible substance, nor 
 could animal life be supported for a moment. Nitrogen is purely nega- 
 tive in its character, and is merely designed to dilute the oxygen, so 
 that the life of man and of all animals may not be consumed too rap- 
 idly, and that combustion may not be too fierce and ungovernable. 
 
 The carbonic acid of the atmosphere is to the life of plants what 
 oxygen is to the life of animals. To animal life it is a deadly poi- 
 son ; to vegetative growths it is necessary food. Plants breathe just 
 as animals do, only they reverse the process, and inhale carbonic acid 
 and give off oxygen. Plants are therefore the great conserving 
 forces of nature ; they give off oxygen, that is essential to animal life, 
 and breathe the carbonic acid that animals exhale, and which, if it 
 were not thus consumed, would accumulate in such large quantities 
 as to be fatal. 
 
 Every leaf of every species of tree on the face of the earth is 
 covered with little pores that are continually sucking in carbonic 
 acid from the air. The estimate has been made that " a common 
 lilac-tree, with a million of leaves, has about four hundred thousand 
 millions of pores at work sucking in carbonic acid ; and on a single 
 oak-tree as many as seven millions of leaves have been counted." 
 
 During night-time plants reverse the process of the day, giving 
 off carbonic acid and inhaling oxygen, and thus compensate for their 
 great advantage over animals in point of numbers. 
 
 A moderate degree of moisture in the atmosphere is also essen- 
 tial to the healthy existence of both vegetable and animal life. The 
 animal breathes in watery vapor, and thus helps to retain the nor- 
 mal moisture of the body. The plants give off watery vapor from 
 
air. 255 
 
 their leaves, and, were the air absolutely dry, this process would go 
 on too rapidly, and the nice balance between the solids and fluids 
 would be disturbed. The watery vapor also descends at night in the 
 form of dew on the thirsty plants, and when accumulated in large 
 quantities falls in showers. The rain, in its passage through the air, 
 clears it of many substances floating in it that are unwholesome for 
 respiration. 
 
 Our atmosphere is liable to become poisoned in a thousand differ- 
 ent ways. From decaying vegetable matter, from the stagnant pools 
 in swamps and filthy cities, from the vile garbage of the streets, from 
 the breath and bodily exhalations of man and of all animals, from 
 the combustion of oil, gas, wood and coal in the ordinary modes of 
 illumination and heat — from all these, and from many other sources, 
 the air is continually becoming poisoned with substances that are 
 harmful, and, in sufficient quantities, fatal to existence. 
 
 This universal agent that surrounds our globe to a depth of fifty 
 or a hundred miles ; that is so essential to animal and vegetative life, 
 that if it were taken away for a moment, the world would be left de- 
 void of organic or inorganic existence ; that is continually becoming 
 laden with poisons, not only from animal and vegetable decompo- 
 sition, but, worse than all, from animal breath and exhalations, and 
 by the very means of light and warmth that add such a charm to civ- 
 ilization, ought surely to be thoroughly studied and understood in 
 all its manifold relations by those who wish to follow the best meth- 
 ods of hvgiene. 
 
 Brain-workers of all classes especially need to study the art of 
 breathing. Amid the rush and whirl of our nervous civilization we 
 are often in danger of starving, not for want of food, but for want of 
 oxygen. To breathe well and plentifully, under our artificial sys- 
 tem of life, requires special study and attention, just as much as it 
 does to eat well and abundantly. 
 
 In order to breathe well there is need of good lungs and a general 
 vigorous condition. This can only be maintained by activity of 
 mind as well as of body, by resting the faculties through variations 
 of employment, by abundance of sleep and food, superadded to a 
 faithful and joyous cultivation of the moral nature. 
 
 In order to breathe well it is necessary to take more or less active 
 physical exercise in the open air. In entire repose a man of aver- 
 age size inhales about 20 cubic inches of air with each inspiration, 
 and at the same time gives off from his lungs considerable watery 
 vapor and carbonic acid. In walking, running, sleeping, or in any 
 kind of labor or play, there is an increase both of the air inhaled 
 and of the substances given off from the lungs, proportioned to the 
 
256 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 severity of the exercise. Walking, especially with an object in view, 
 and in pleasant company, is one of the very best modes of exercise 
 for brain-workers, because it allows of the full and free expansion of 
 the lungs. 
 
 It has been computed by an accurate observer that an ordinary 
 gas jet , when in full operation, vitiates as much air as eight human 
 beings. This accounts for the much greater oppression that is felt 
 after an evening's entertainment, than after an attendance upon an 
 equally crowded gathering in the same place in the daytime. 
 
 But sermons on ventilation are becoming old stories now, and I 
 can add little to what every intelligent member of society knows per- 
 fectly well. And yet most of our private houses, sleeping apart- 
 ments and all, are badly aired. And as for public halls, there is 
 scarcely one in the country that in respect to ventilation is adapted 
 for the abode of more than an average-sized family, although hun- 
 dreds and even thousands nightly crowd them. 
 
 If many people are confined in one apartment, with fires, and a 
 great number of lighted candles or lamps, without due ventilation, 
 the air soon becomes unwholesome and unfit for respiration; hence 
 delicate persons are very apt to faint or become sick in crowded 
 assemblies of any kind, or in any place where the air is injured, not 
 only by the breath of many persons, but by fires, candles, &c. 
 
 The air of cities and large towns, where a great variety of manu- 
 factures are carried on, with a crowded population, is not only 
 breathed over and over again, but is also loaded with exhalations, 
 besides the effluvia constantly arising from slaughter-houses, privies, 
 dunghills, and common sewers. To prevent the air from being thus 
 injured, police-officers should take due care that the streets be daily 
 cleared of all filth and rubbish ; that the offals from slaughtering- 
 houses be not suffered to accumulate ; and that the common drains 
 and sewers be frequently opened and kept clear from obstruc- 
 tions. 
 
 Burial-grounds in populous cities are a nuisance. 
 
 Air is sure to become corrupted and unwholesome wherever it 
 stagnates long ; hence the low, dirty, and close habitations of the 
 poor, as well as jails, prisons, workhouses, and hospitals, where the 
 strictest attention is not paid to ventilation and cleanliness, and a 
 number of persons are crowded together, may be considered as lurk- 
 ing-places in which typhus and other malignant fevers are likely to 
 be generated, and are frequently communicated to those who visit 
 them, or are within the sphere of their influence. 
 
 No house can be wholesome where the air has not a free passage 
 through it. Houses ought to be daily ventilated by admitting a 
 
air. 257 
 
 current of fresh air into every apartment. Instead of making up the 
 beds as soon almost as people rise from them, the different coverings 
 ought to be turned down, or be wholly taken off, exposing them for 
 some time to the fresh air. 
 
 In jails, hospitals, ships, &c, where this process cannot be gone 
 through, the foul air may be expelled, and fresh air introduced by 
 means of ventilators. In all places where numbers of people are 
 crowded together, a strict attention ought to be paid to cleanliness 
 and a free ventilation. 
 
 If fresh air is necessary for those in health, it is still more so for 
 the sick. To them it is the most reviving of all cordials, if admitted 
 into their chamber gradually. Where the sick are laboring under 
 fevers of the typhus and malignant kind, dysenteries, or other dis- 
 eases of an infectious nature, we cannot pay too great attention to 
 a free ventilation, both for the benefit of the sick and their at- 
 tendants. 
 
 The air of large cities or great towns should be avoided as much 
 as possible by persons in a delicate state ; particularly by the con- 
 sumptive, asthmatic, hypochondriac, and nervous. When unavoid- 
 ably obliged to remain in the like situations, such persons should go 
 as often as they can into the open air, and keep their houses prop- 
 erly ventilated. 
 
 Many are afraid of night air. Florence Nightingale replies to 
 this objection by asking, What can we breathe at night except the 
 night air ? 
 
 Her rule in regard to ventilation of sick-rooms was to " keep the 
 air which the patient breathes as pare as the external air, without 
 chilling hirnP 
 
 If this rule were acted upon, many of our fevers and other dis- 
 eases would lose much of their terror. 
 
 Patients suffering from typhoid fever have been treated success- 
 fully without medicine, by removing them out-doors, under tents. 
 
 Houses surrounded with plantations or thick woods, and those 
 situated in low marshy soils, or near large ponds or lakes of stagnated 
 water, are always unhealthy. 
 
 When the weather becomes warm, the muscular fibres are re- 
 laxed. When it is cold, they are rigid and contracted, and the 
 power of cohesion is increased, so as to affect even the hardest 
 metals. 
 
 The weight of air which our bodies sustain at different seasons 
 
 is very 'great. That which presses on the body when the mercury 
 
 is highest in the barometer is said to be equal to 39,900 pounds troy 
 
 weight, and, even under the least degree of pressure from the air, is 
 
 17 
 
258 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 thought to be equal to 3,9S2 pounds troy. As the body must sus- 
 tain so immense and variable .a weight, we cannot be surprised that 
 our health should become affected by the changes of the weather, 
 and that frequently in a sudden manner. Air is so closely connected 
 with health and life, that it is impossible for the animal functions to 
 be properly carried on, even by the most vigorous and athletic con- 
 stitutions, where a due attention to it is treated with indifference or 
 neglect. 
 
 METHODS OF VENTILATION. 
 
 The first and simplest method of admitting pure air into a room 
 is by opening the window. 
 
 Letting down the window from the top and putting it up from 
 the bottom, and having a?i open fire-place, give the foul air a chance 
 to escape and allow the pure air to enter. The foul warm air al- 
 ways rises, and will pass out at the top, while the cool air enters 
 from without. If the window is guarded by shades or blinds, air 
 can be admitted in this way without causing any unpleasant or dan- 
 gerous current, both by night and by day. 
 
 A little management and study will enable any one to keep 
 their bed and sitting-room well ventilated in this manner, without 
 exposing even the invalid to the risk of taking cold. But manage- 
 ment and care cost time and patience, and the majority of people 
 are not willing to pay so high a price. 
 
 2. Houses may be ventilated by constructing them so that the foul 
 air can be expelled through the flues. 
 
 Dr. John H. Griscom, so long and so favorably known to the 
 country as a writer on Hygiene, and as a conspicuous leader in sani- 
 tary reform, has introduced a system of heated flues through which 
 the foul air is expelled. He claims, that 
 
 " To secure a high temperature within a ventilating flue, and to 
 be able to multiply heated flues, are the considerations demandedfor 
 the thorough and efficient ventilation of all ordinary buildings ■." 
 
 He also claims that by his method "sufficient, reliable, and per- 
 fectly controllable ventilation can be secured in dwellings, school- 
 houses, churches, court-houses, stores, and all edifices which are 
 warmed by hot-air furnaces of any description. It costs but little, 
 and it can be maintained without expense." 
 
 From a " Report on the Importance and Economy of Sanitary 
 Measures to Cities" by John Bell, M.D., I extract the following 
 description of Dr. Griscom's method of ventilation : 
 
 " It pertains to the * chemical method,' the motive power of the 
 
METHODS OF VENTILATION. 259 
 
 air being heat, but requiring no extra expenditure of fuel ; the beat 
 used for the purpose being only the waste heat of the furnace by 
 which the house is warmed. The arrangement consists in the con- 
 struction of independent ventilating flues in the walls of the house, 
 in proximity to the hot-air tubes, so that the two may be connected 
 together by means of a lateral or branch tube, by which a current 
 of hot air may, at any desired moment, be transmitted from the hot- 
 air tube to the ventilating flue. By this means the ventilating 
 flues, which terminate in the open air like an ordinary chimney, 
 will be warmed by the hot air from the furnace when the ordinary 
 hot-air register is closed, as at night in a dwelling, or in a school- 
 house after school hours. 
 
 " If properly constructed as to shape and material, the walls of 
 a flue will, after a current of hot air has passed through it a short 
 time, become sufficiently heated to rarefy the air within ; thus giv- 
 ing the flue a good ventilating power, even after the current of hot 
 air has been withdrawn. For example, if the hot-air register of a 
 parlor be closed at ten o'clock at night, and the heat, instead of be- 
 ing thrown back into the furnace, is allowed to pass through the 
 lateral tube into the ventilating flue, and so continue till six the 
 next morning, it is evident that, during those eight hours, the inte- 
 rior of the ventilating flue must become thoroughly heated, so that 
 the next day, when the current of hot air is restored to the parlor, 
 the heated sides of the ventilating flue will continue to rarefy the 
 air within them for many hours, and perhaps even days, after- 
 ward. 
 
 " There being no danger of a reaction of the air of the flue 
 through the ventilating register (as is the case when ventilating 
 openings are made in ordinary fire-fliies), connections with the apart- 
 ment to be ventilated may be made at any point, and even carried to 
 the opposite side of the house, between the beams of the ceiling, to 
 ventilate distant apartments. Dr. Griscom's method has the ad- 
 vantage of being applicable to all edifices warmed by hot-air fur- 
 naces of any description, which, in general, are those most needing 
 ventilation. This arrangement may be introduced into many 
 houses already erected, by connecting the hot-air tubes with such of 
 the ordinary chimney-flues as are not used with fire. 
 
 " One of the principal advantages appertaining to this plan, is 
 the capability of having a large number of ventilating flues put in 
 connection with the furnace. In fact, the number may correspond 
 with the number of hot-air registers, and thus any desirable amount 
 and extent of ventilation be obtained." 
 
 In addition to the advantages enumerated in the foregoing ex- 
 
260 HYGIENE, OK THE AET OF PEESEEVING HEALTH. 
 
 tract is that of avoiding the danger of fire, incurred by overheating 
 the hot-air tubes when the registers are closed, as the hot air then 
 passes up through the ventilating shaft, instead of being confined 
 below." 
 
 Dr. Griscom's method does not admit pure air from without ; 
 it simply allows the foul air free exit. 
 
 3. The admission of pure air from without is accomplished by 
 the Ventilator of John Zesperance. This invention is just now 
 being brought to the public attention as this book is going through 
 the press. The ventilator is so arranged that it can be placed in 
 the window as a substitute for a pane of glass. 
 
 Among the advantages claimed for it in the report of the Special 
 Committee of the New York Association for the Advancement of 
 Science and Art, are : 
 
 " The object of this ventilator is sevenfold. 
 
 " 1st. That air shall be admitted at all times ! 
 
 " 2d. That its course shall be inwards and upwards, trans- 
 versely, not horizontally. 
 
 "3d. That the air shall be divided into numerous streams, so as 
 to make it equally divisible into every part of the place to be ven- 
 tilated. 
 
 " 4th. That no suspended organized matter shall pass in with 
 the air. 
 
 " 5th. That the air in passing through the ventilator be deprived 
 of its carbonic acid and sulphuretted hydrogen gases, the two gases 
 most generally found to predominate in impure air, and most dan- 
 gerous to animal life. 
 
 " 6th. That when the air is overcharged with aqueous vapor, a 
 portion of it can be absorbed in the ventilator. 
 
 " 7th. That the admission of the air will produce no sensible 
 draught. 
 
 " Your Committee, after careful examination and mature deli- 
 beration, are convinced that the Lesperance Yentilator will perform 
 all that the inventor proposes it should do, and we hail with great 
 satisfaction this addition to science and art, considering that it will 
 be found one of the best means for the preservation of health, and 
 its restoration to diseased bodies, especially in hospitals." 
 
 " An adult man in ordinary work gives off in 24 hours from 12 
 to 16 cubic feet of carbonic acid gas, and also emits an indetermin- 
 able quantity of the same gas by the skin. In hospitals, in addition 
 to being vitiated by respiration, the air of the sick-rooms is also 
 contaminated by the abundant exhalations from the bodies and by 
 the effluvia from discharged excretions. 
 
METHODS OF VENTILATION. 261 
 
 " That the breathing of air rendered impure from any cause is 
 hurtful, and that the highest degree of health is only possible where, 
 to other favorable conditions, is added that of a proper supply of 
 pure air, might be inferred from physiological evidence of the para- 
 mount importance of proper aeration of the blood. Experience 
 strengthens this inference ; statistical inquiries on mortality prove 
 beyond a doubt, that of the causes of death which, usually are in 
 action, impurity of the air is the most important. Indeed, observa- 
 tions confirm this. The air must be removed so immediately that 
 there shall be no risk of a person breathing again his own expired 
 air, or that of another person. In hospitals, especially, it is desira- 
 ble, that there shall be no chance of the air of one sick person passing 
 over the bed of another ; therefore the movement of the air should 
 be rather vertical than horizontal ; and as the expired air and all the 
 exhalations from the body or bedclothes at first pass upwards from 
 their rarity, it is desirable that they should be discharged above, and 
 not drawn down again, past the patient.*" 
 
 Speaking of ventilation, Mr. Parkes says : 
 
 " In order to keep air in its necessary purity it must be continually 
 changing. Whatever way the air is supplied, certain conditions must 
 be laid down : the air which enters must itself be pure, its movements 
 must be imperceptible, otherwise it will cause the sensation of draught 
 and will chill. It must be well diffused all through the room, so that 
 in every part movement shall be going on ; in other words, the dis- 
 tribution must be perfect. A moving body of air sets in motion 
 all air in its vicinity ; it drives air before it, and at the same time 
 causes a partial vacuum on either side of its own path, towards 
 which all air in the vicinity flows, at angles more or less approach- 
 ing right angles." 
 
 Mr. Parkes gives a description of the many modes invented for 
 the transmission of pure air into buildings, but does not seem to 
 have much confidence in any of them. Some of them are clumsy 
 and useless, and many very expensive. Amongst the many are drill- 
 ing holes in the panes of glass ; having two panes, the outside open 
 in the bottom, the inside in the top, the air to pass between the 
 two panes ; tubes passing into the room and perforated ; air passing 
 round hot steam pipes ; pieces of board constructed in the upper 
 part of the window, to direct the air inwards and upwards ; fine 
 wire screens, &c, &c, &c. 
 
 ACTION OF THIS VENTILATOR. 
 
 The ventilator is thus described in the inventor's own words : — 
 " As the air in my ventilator has to pass through three plates 
 
2G2 HYGIENE, OK THE ART OF PRESERVING HEALTH. 
 
 of perforated tin, a covering of sponge, and a box filled with char- 
 coal, it is impossible that any suspended organic matter can pass 
 through it, and, when necessary, a portion of damp in the air is 
 absorbed and retained in the sponge in the first chamber, and all 
 impure gas is absorbed by the charcoal in the second chamber. The 
 air is rendered warm, first, by the amount of friction it has to under- 
 go ; secondly, by being deprived of its watery vapor ; and thirdly, by 
 the chambers through which it passes being warmed by the heat of 
 the room." 
 
 DESCRIPTION AND EFFECT. 
 
 " From the formation of the ventilator, the air passes upwards 
 and inwards, vertically and not horizontally ; therefore there can be 
 no sensible draught ; and as it passes through three plates of perfo- 
 rated tin, it is divided into numerous streams, and is discharged into 
 the room, like water from a fine rose on a watering-pot, in continu- 
 ous streams. It may be objected that my theory, although good 
 when there is an abundance of wind, would not prove equally so 
 when there is little or no wind stirring ; but where the wind is said 
 to be still, it travels at the rate of one mile and one-half per hour. 
 Even then there is a stream of pure air admitted, being drawn in 
 by the heat of the chamber or house to be ventilated, on the princi- 
 ple that heat draws the current of air towards it. This fact every 
 one knows by observing in winter, when he opens the small pane 
 of glass (called a ventilator) in his window. It is the cold air 
 that rushes in, not the hot air that rushes out. Of course, if a 
 double current is established, the hot air will rush out as it is dis- 
 placed by the cold. Yentilation, however, should be on every side 
 of a house, but even when it is not, there will always be a current 
 of air through the ventilator." 
 
 MANNER OF USING THE VENTILATOR. 
 
 " In every private house there should be one large or two small 
 ventilators in every large room, particularly in bedrooms. In hos- 
 pitals, barracks, schools, prisons, &c, there should be one large or 
 two small ones for every twelve persons in the daytime, and in 
 the sleeping-rooms, one for every eight persons sleeping therein. 
 In prisons, one large ventilator should be in each cell. The venti- 
 lator should take the place of one of the highest panes of glass 
 in the window, care being taken that no obstruction is allowed to 
 prevent the easy withdrawal of the box of the ventilator ; when 
 necessary to do so, to dust it once every day. The box of the ven- 
 
MANNER OF USING THE VENTILATOR. 263 
 
 tilator will of course face the inside of the room. Where double 
 windows are used, the tunnel takes the place of the corresponding 
 pane of glass to that in which the ventilator is placed, and the tun- 
 nel drawn out to cover the mouth of the ventilator. When neces- 
 sary to deprive the air of part of the aqueous vapor (damp), the 
 sponge must be placed in the vacant chamber under the box ; and 
 should the wind blow very strong and cold, direct on the mouth of 
 the ventilator the piece of red flannel must be placed over the top 
 of the box. At other times it hangs down useless. When the air 
 is not over wet. the sponge should not be used. As stated above, 
 the' box of the ventilator, as well as the whole of the ventilator, 
 should be dusted daily. 
 
 " When the ventilators are used for railroad cars, they must be 
 in the cars. Their size will depend upon that of the car. Four 
 ventilators, one facing each end and one on each side, as shown in the 
 model, will be sufficient. It will be at once seen that only two ven- 
 tilators admit air at the same time. The tubes for the escape of 
 foul air generated in the cars must he below the ventilator, otherwise 
 the fresh air, as well as the foul air, would pass through, and the 
 object intended to be obtained would be lost. By my plan the 
 fresh air displaces the foul air, and forces it out through a perpen- 
 dicular tube eight inches in diameter, placed in each corner of the 
 car ; these tubes are carried through the top of the car, and are 
 mounted with a cowl turning on a pivot, to prevent the wind blow- 
 ing down. Into each of these perpendicular tubes six horizontal 
 tubes, 4: inches in diameter, enter, as shown in the model. This 
 gives 24: inch tubes to carry off the foul air, which is certainly suffi- 
 cient for sixty persons. 
 
 " When the cars are in motion, only two of the ventilators are in 
 actual use, namely, the one in front, and the one in the side with 
 the funnel towards the locomotive ; the keys of the other two should 
 be turned. The sponge should be always in use on railroad cars, 
 but the piece of flannel will not be necessary. If the wind blows 
 very strong and cold, the keys may be used to regulate the admis- 
 sion of the fresh air. Every builder of a car may arrange these 
 ventilators to suit his own taste ; he may beautify them and make 
 them as expensive as he pleases, but in all cases the principle 
 must be adhered to, i. e., the ventilators must be inside the car, 
 as high up as it is possible to place them, and the escape tubes 
 must be below the ventilators, yet not as low as the heads of the 
 persons sitting in the cars." 
 
264: HYGIENE, OR THE ART OF PRESERVING HEALTH 
 
 LESPERANCE VENTILATOR. 
 
 External view. 
 
 This Ventilator may take the place of a 
 pane of glass. 
 
 LESPERANCE VENTILATOR. 
 
 Interior view. 
 
 The arrows indicate the direction of the air, through the 
 charcoal and wire gauze, into the room. 
 
 CIRCULATION OF AIR IN ROOM. 
 
 Advantage of fireplace illustrated. The icarm air, being lighter, rises to the top of the room, and the 
 
 cold air falls to th£ bottom. 
 
 (From Leeds' work on Ventilation.) 
 
EFFECTS OF ANTHRACITE COAL ON THE HEALTH. 265 
 ADVANTAGES. 
 
 " In conclusion, I have no hesitation in stating that I find from 
 experience that the ventilator, placed in any building according 
 to the directions given, will ventilate the building with fresh pure 
 air without producing any sensible draught ; and as the same prin- 
 ciple is applied in the adaption of it to railroad cars, if it is used 
 in the manner pointed out, and as shown in the model, the car will 
 be thoroughly ventilated without any sensible draught." 
 
 EFFECTS OF ANTHRACITE COAL ON THE HEALTH. 
 
 Nearly all nervous persons who have lived much in close rooms 
 heated by coal have observed a feeling of depression, headache, or 
 other unpleasant symptoms, which they have attributed to the stove 
 or furnace. 
 
 Recent experiments have shown that carbonic oxide escapes from 
 our stoves, as ordinarily manufactured. It is claimed that this car- 
 bonic oxide is exceedingly deleterious to the health. It is even as- 
 serted that there is among us a separate, special disease caused by 
 this poison. 
 
 It was once supposed, and is now the general belief, that these 
 unpleasant sensations are the result of the dryness of the air. But 
 according to the experiments of Dr. George Derby, of Boston, who 
 has written an excellent treatise on " Anthracite and Health" this 
 opinion is erroneous. He contends that " iron heated to any point 
 possible in our furnaces has no power to abstract moisture from the 
 air" 
 
 He contends, furthermore, and with a great array of evidence, 
 that dry air is healthier than mmst air. His conclusion is, that 
 " no artificial evaporation whatever is required on the score of 
 health" 
 
 General Morin, of France, has made elaborate experiments, which 
 go to show most clearly that carbonic oxide escapes from our cast- 
 iron stoves and diffuses itself through the atmosphere. His view is, 
 that the headaches and general uneasiness and distress that we so 
 often experience when confined in rooms heated by cast-iron or 
 sheet-iron stoves are caused by the presence in the air of this carbonic 
 oxide. 
 
 His experiments consisted in chemical examination of the air 
 around the heated stoves. 
 
 The remedy proposed is to make furnaces " of wrought-iron 
 plates riveted together tightly, as those of a steam-boiler, so that 
 the whole apparatus shall be practically of one piece." 
 
266 HYGIENE, OR THE ART OF PRESERVING HEALTH, 
 
 LOCATION OF HOUSES. 
 
 Whatever may be the temperature of the climate, the air, gen- 
 erally, may be considered healthy, if pure and clear, and occasion- 
 ally visited with the agitating and renovating power of the wind. 
 On the other hand, an air that is gross, or strongly saturated with 
 animal, vegetable, or mineral substances, is highly injurious to all. 
 
 In the selection of a residence with a view to health, preference 
 should always be given to an elevated situation, which is neither 
 exposed to extreme heat in summer, nor to piercing cold in winter. 
 The rooms should be lofty, and of suitable dimensions. Low, con- 
 fined ones are injurious. (See views of Dr. Bowditch under Con- 
 sumption?) 
 
 The air of any place is salubrious where the water is good, and 
 where this is pure and tasteless, the air, in general, is free from any 
 offensive smell. "Where sugar readily enters into a dissolved state 
 spontaneously, the walls of the house are stained and changed in 
 color, the papering loose and detached, and metals acquire rust or 
 verdigris on their surface; these are presumptive evidences that the 
 situation is damp, and therefore unwholesome. 
 
 The higher parts of a house are generally the most healthy. All 
 the rooms in a house should be daily ventilated by the seasonable 
 admission of air for a sufficient length of time. 
 
 By immoderate warmth, either in sitting-rooms or sleeping 
 apartments, with doors and windows made what is called air-tight, 
 the body will become enervated. To avoid indisposition from this 
 cause, it may be stated as a general maxim, that the temperature of 
 a sitting-room should not exceed 60 degrees of Fahrenheit's ther- 
 mometer, nor that of the bedroom 50. 
 
 As the warmer weather is progressively succeeded by a state of 
 greater cold, we should inure ourselves to the effects of these changes. 
 By these means, if we use moderate exercise, and are properly 
 clothed, we shall neither feel the cold unpleasant, nor will it cause 
 any obstruction of the necessary perspiration. 
 
 MUSCULAR EXERCISE AND RECREATION. 
 
 About thirty years ago the attention of physicians and of society 
 in general, was called to the fact that new forms and phases of 
 nervous diseases were arising, and that old and familiar nervous 
 symptoms that had been quite rare were increasing in frequency. 
 
MUSCULAR EXERCISE AND RECREATION. 267 
 
 It was found that neuralgia — a name hardly mentioned in the 
 earlier part of the present century — was becoming popularized in 
 nearly every household ; that dyspepsia, instead of being an occa- 
 sional and exceptional malady, was rapidly becoming fashionable, 
 especially in the circles of the wealthy and cultivated ; and that 
 hysteria and hypochondria — maladies of dark and ugly significance — 
 were spreading through all ranks and classes, like some mysterious 
 contagion. At the same time, it began to be observed that inflam- 
 matory diseases were rather less frequent and less violent. About 
 the same time also — partly on account of the manifest changes in 
 the type of disease, and partly as a result of a better knowledge on 
 the part of the profession — a revolution began to be wrought in the 
 treatment of disease. Bleeding and calomel gave way to tonics and 
 stimulants. About this same time also a number of well-known 
 writers began to publish works on the laws of health, in which literary 
 men especially were exhorted to exercise furiously in order to work 
 off and cure the nervous diseases to which they were liable. The 
 cure for the physical maladies of the human race was to be found 
 not in taking away the little blood that remained in the exhausted 
 invalid, or in confining him in a dark room on a starving diet, but 
 in long walks before breakfast, in climbing high mountains, in pro- 
 tracted rides on horseback, and in furious gymnastic exercises with 
 clubs and dumb-bells. It is always the tendency of ambitious pa- 
 tients to go ahead of what they are advised to do. Tell them to 
 walk one mile a day, and they will walk twain. Tell them to ex- 
 ercise gently a few moments before breakfast, and they will very 
 likely perform violently with dumb-bells, or at the w T ood pile for an 
 hour, and thus secure far more injury than benefit. 
 
 As a result of the teachings of which I have spoken, numerous 
 errors, bothin the theory and in the practice of physical exercise, 
 have arisen, not only among the students, but among teachers and 
 professors — errors that are of a serious character and of which they 
 will in time become convinced by experience, even though no one 
 should attempt to point them out. 
 
 1. It is an error to suppose that we need great muscular strength. 
 Long ago the philosopher Seneca wrote that a scholar should not 
 pride himself on length of arm or breadth of back. This remark 
 of the old philosopher was unconsciously based on sound physiologi- 
 cal principles. 
 
 I desire that my precise meaning on this subject should be clearly 
 understood. All classes need a certain amount of muscular exer- 
 tion, and should make it a duty and a pleasure to engage every day 
 in some exercise that will call the muscles into vigorous activity. 
 
26S HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 But the increase of the size of the muscles should not be the 
 leading aim in the exercise of students. It is well and necessary 
 that we should obtain a good muscular development, but it should 
 be an incidental and unconscious result of our exercise rather than 
 its special distinct object. We should not in our exercise be all the 
 time on the watch, as to whether our muscles are growing firmer 
 and larger. When we seek to develop the intellect, we do not stop 
 each moment in the midst of our studies to measure our heads to 
 see how the brain grows ; no more should we stop in the midst of 
 our exercises to see how our muscles are developing. The best way 
 to develop the brain is to regularly pursue a variety of studies 
 adapted to our tastes, and let the growth take care of itself. Just 
 so, the best way to develop the muscles is to regularly pursue a va- 
 riety of exercises, adapted to our tastes, and let the muscles grow or 
 not as they choose. 
 
 Again I say that muscle is not always health. A man may have 
 fearful flexors and extensors, may be the champion at the dumb- 
 bells and on the race crew, and yet have a weak nervous system and 
 be utterly incapable of protracted study or thought. The worst 
 cases of nervous exhaustion that I meet with in my practice are 
 oftentimes in men of large frames and powerful muscles. 
 
 2. It is an error to suppose that gymnastics ; or bowling, or "bil- 
 liards, or ten-pins, or any form of in-door exercise, can compensate 
 for the lack of out-door air and sunlight. These three — air, exer- 
 cise, and sunlight — are all great physicians, but the greatest of them 
 is not exercise, but air. Sunlight itself is a more potent healer than 
 mere muscular exercise. A passive life in the open air is more 
 healthful than an active life under cover. In the severest weather, 
 and when time is limited, it is convenient to resort to the exercises 
 of the gymnasium, the bowling-alley, or the billiard-room, and yet 
 we are all of us too much afraid of stormy weather. The worst 
 seasons for walking are not in the midst of a storm, but just before 
 a storm is coming on. For twenty-four hours or more before a 
 north-east storm reaches us the atmosphere is usually in a bad elec- 
 tric condition. (See Atmospheric Electricity^) This fact has been 
 long and painfully known to nervous invalids, and has recently been 
 confirmed by careful observations with the electrometer both in this 
 country and in Europe. On the other hand, while the storm is ac- 
 tually raging about us the atmosphere is frequently in a good elec- 
 tric condition. The depressing heat of summer is the only at- 
 mospheric condition which, in our climate, ought to prevent us from 
 exercising in the open air. Air and sunlight are the best remedies 
 we know of for consumption and general nervous debility. Sunlight 
 
MUSCULAR EXERCISE AND RECREATION. 269 
 
 possesses mysterious and subtle chemical virtues that give it a great 
 power over the nervous system. Our first choice of exercise should 
 therefore be those methods which, like walking, climbing hills and 
 mountains, and out-door games, can be taken in the open sky and 
 under direct exposure to the solar ray. 
 
 3. It is an error for sedentary or feeble persons to take very vio- 
 lent or exhausting exercise of any kind. For a brain-worker to at- 
 tempt to concentrate a large amount of severe exercise in the shortest 
 possible time, is unphysiological and absurd. Therefore straining at 
 heavy dumb-bells, protracted running, and especially the so-called 
 " spouting " of boat-racing, are to be unsparingly condemned. 
 
 A few years since Dr. Winship excited not a little attention by 
 his wonderful feats at lifting heavy weights. The influence that 
 his example has exercised, even among the intelligent classes, is 
 another historical illustration of the great injury that even a weak 
 and ignorant man may accomplish who sincerely believes his 
 own errors. Even if the chief object of college education were to 
 train up a race of pugilists, the system of Winship would not be a 
 good method of accomplishing it. 
 
 Boating is a method of exercise that has many advantages. It 
 is pleasant, congenial to the tastes of a large number, sufficiently 
 active, and must be pursued in the open air. 
 
 In our country, boat-racing is of such recent date that we have 
 not yet had opportunity of testing its special effects on the heart, on 
 the general health, or on longevity. 
 
 4. It is an error to make exercise a duty rather than a pleasure. 
 " Of all remedies for the nerves," says Jean Paul Kichter, " enjoy- 
 ment is the most powerful." As a rule, food which is best enjoyed is 
 best digested. Just so exercise which is most agreeable is usually 
 the most beneficial. In selecting methods of exercise, every indi- 
 vidual should be guided by his own individual tastes. It is better 
 to change frequently from one form of exercise to another. It is 
 well even to consult our whims and our varying moods. Above all 
 things we should strive to prevent our exercise from becoming a 
 dry, hard, mechanical routine. The heart should go with the mus- 
 cles. Those who are constitutionally nimble and athletic enjoy 
 gymnastic exercises, and within certain limits are benefited by them ; 
 while those who are feeble, nervous, and awkward positively dislike 
 them, and should by preference select amusements in the open air. 
 The delicate and nervous should remember that excessive exercise 
 must weaken rather than strengthen them, especially if it be uncon- 
 genial. Let such always leave off before they are exhausted. Let 
 them not confine themselves to any one method or system, but ring 
 
270 HYGIENE, OK THE ART OF PRESERVING HEALTH. 
 
 the changes on all, as their fancy may direct, and when they are 
 too wearied for active exertion, let them, by an easy stroll under 
 the open sky, seek the beneficent and grateful aid of the two great- 
 est of physicians— Air and Sunlight. 
 
 5. It is an error to neglect all exercise. — To some it may appear 
 strange that I have not placed this first in my catalogue of errors ; 
 but in these days there are, I hope, very few who need exhortation 
 to the general duty of physical exercise. I have rather assumed that 
 all my readers were conscious of that duty as they were conscious of 
 the duty of virtue, and needed only suggestions and guidance, so 
 that they might best use without abusing the rich variety of exer- 
 cise of which in these days they are now availing themselves. 
 
 Best Times for Exercise. — It is better, so far as possible, to take 
 our exercise in the daytime than at night. At night the electric 
 condition of the atmosphere is not usually so favorable as in the 
 greater portion of the day. Then again, those who exercise after 
 dark lose the healthful influence of sunlight. The evening — just 
 before the hour of retiring — is a good time for light gymnastics, for 
 those whose duties are so pressing that they cannot devote a portion 
 of the daylight to out-door exercise. The general rule should be 
 to take out-door exercise in the daytime, and in-door games and 
 gymnastics in the evening. 
 
 Except in the hottest weather, the middle of the afternoon is the 
 best portion of the day for exercise for students and literary men. 
 — This is, as has been said, a bad time for study, and for that reason 
 it is well to improve it for the purpose of physical recreation. 
 
 The forenoon — between nine and one — would be the best 
 time for exercise of the muscles, as it is for activity of the brain, if 
 the object of life were to make pugilists and athletes, but those who 
 desire to make the most of intellectual culture should devote the best 
 part of the day to study. Physical exercise for students is a means 
 and not an end, and should, with occasional exceptions, be taken at 
 the times when we are least fitted for study. 
 
 The worst time for exercise is early in the morning, and before 
 breakfast. — The errors that prevail on the subject of early morning 
 exercise are simply monstrous. Even the strong and athletic are 
 liable to injure themselves, by exercising long and vigorously in the 
 early morning on an empty stomach ; while the delicate, the dyspep- 
 tic, and the nervous should not allow themselves to indulge in any 
 sustained activity of brain or muscles until the system has been for- 
 tified by at least a preliminary breakfast. Farmers sometimes injure 
 themselves by working too hard and too long before breakfast. 
 
 Moderate exercise, such as walking, the lighter forms of gymnas- 
 
MUSCULAR EXERCISE AND RECREATION. 271 
 
 tics and easy games, can be taken indiscriminately jnst before or 
 just after meals, without injury ; but the severer tasks — rowing, ac- 
 tive games — should usually be reserved for the middle of the fore- 
 noon or afternoon, or for the evening. It is not well to go to our 
 meals in a condition of exhaustion, either of the brain or of the 
 muscles. It is not well to be over-fastidious about exercising just 
 after meals, for our own feelings will usually guide us aright. After 
 a hearty meal we do not care to plunge into the severest work. 
 
 Quantity of Exercise. — It is impossible to give mathematical 
 rules for the amount of muscular exercise to be taken, or for the 
 time that it should occupy, as it is to prescribe the weight of food 
 we should take, or the number of hours of sleep we should indulge 
 in. The question of time and quantity must be settled by the tastes, 
 the constitution, and the experience of each individual. There is 
 one general rule by which we may all be guided — and that is, to 
 stop short of exhaustion. 
 
 Riding Velocipedes. — It is proper that I should here speak of a 
 form of exercise that is now exceedingly popular — riding velocipedes. 
 This is about the only method of exercise of which I cannot speak 
 from extended personal experience. My impressions are decidedly 
 in its favor. It seems to me, judging from the few trials I have 
 made, from observation of the subject in the public rinks, and from 
 inquiries of those who are masters of the art, that it may appropri- 
 ately be compared with skating, which, as we all know, is a most 
 excellent form of active exercise. 
 
 Like skating, it requires practice in the art of balancing. Like 
 skating, it is attended with the exhilaration of rapid movement. 
 Like skating, it can be taken in the open air. Like skating, it 
 pleasantly exercises the whole system, and at the same time, uncon- 
 sciously to ourselves, it sufficiently develops the muscles. Like 
 skating, also, it is sometimes attended with unpleasant and even 
 serious accidents. The fact that occasional ruptures or bruises result 
 from skating or riding velocipedes, ought not, I think, to lead us to 
 indiscriminately condemn these amusements. Accidents and in- 
 juries — even of a serious character — are liable to occur from nearly 
 all forms of active exercise — gymnastics, bowling, and foot-ball. 
 
 Biding velocipedes has this advantage over skating, that it can 
 be taken at all seasons of the year. If it is to become a permanent 
 amusement in the country, the rinks should be so constructed that 
 they may be both open to the sunbeams and protected from storms. 
 
 In every stage and state of life, exercise is necessary for our 
 welfare and health ; and it is equally requisite for the female as for 
 the male. By food our bodies may be nourished ; but if not assist- 
 
272 
 
 ed, by due exercise, to carry on digestion with, advantage, and to 
 help in throwing off the superfluous humors by perspiration, we 
 must unavoidably feel all the inconvenience of repletion and fulness 
 in the blood-vessels, while, at the same time, the body will be afflict- 
 ed with many painful diseases. 
 
 Indolence, moreover, not only occasions diseases, and renders 
 men useless to society, but promotes all manner of vice. Indolence, 
 when indulged, gains ground, and at length becomes agreeable. 
 Hence, many who were fond of exercise in the early part of life 
 become somewhat averse to it when more advanced in years. Idle- 
 ness may well be said to be the root of many evils. On the contrary, 
 a life of activity and industry -of brain and of muscles is not only 
 the greatest promoter, as well as preservative of health, but likewise 
 the best guardian of virtue. 
 
 The tendency with many of our farmers, laborers, and mechanics 
 is to use their muscles too much and their brains too little. They 
 should devote their leisure everyday to literature, to history, and to 
 popular science. The world is now filled with books that are interest- 
 ing as well as instructive. 
 
 The eight-hour law will be a curse to society if it does not tend 
 to increase the amount of brain-work among our laboring popu- 
 lation. 
 
 Horseback riding, playing croquet, riding velocipedes, skating, 
 rowing, playing base-ball, pitching quoits, foot-ball, walking, run- 
 ning, jumping, gymnastics (Indian clubs, dumb-bells, &c.) — all 
 of these are good methods of exercise. It is well to try them all 
 when opportunity offers, provided we can enjoy them. It is not 
 well to place too exclusive dependence on any one form of exercise. 
 As soon as we get tired of one style of exercise it is well to try 
 another. 
 
 I am fully aware that this work will be read by many who 
 labor with their muscles all the day, and who need none of these 
 methods of muscular amusement. Such persons need to exercise 
 their brains in order to rest their muscles. 
 
 Let them read and study in the evening. 
 
 (For more detailed remarks on exercise and illustrations see 
 Gymnastics and Movement Cure.) 
 
 SUNLIGHT. 
 
 The effects of sunlight are observed in the animal even more 
 markedly than in the vegetable creation. It has been demonstrated 
 by experiment that animals whose natural color is white will present 
 an entirely different hue and appearance if reared in darkness. 
 
SUNLIGHT. 273 
 
 That the development of tadpoles can be retarded by confining 
 them in dark vessels has been sufficiently demonstrated by the ex- 
 periments of Edwards and Hammond. The fish found in the 
 Mammoth Cave have no sight, because the development of the eyes 
 is arrested by the absence of light. Sir Humphrey Davy in his 
 " Salmonie, or Consolations of Travel," describes the Proteus An- 
 guinus, found in the grotto of Madalene, in Illyria, several hundred 
 feet below the surface. He represents them as pale, slender crea- 
 tures, almost transparent in their natural condition, but gradually 
 becoming of a darker color when they are brought to the light. 
 They have no eyes, but in their place two small dots. 
 
 Sunlight also penetrates the sea to the distance of several hun- 
 dred feet, and the fish are as susceptible to its influence as are the 
 animals that move on the earth, or the birds that fly in the air. All 
 the varieties of fish live near the surface of the ocean. All observa- 
 tion shows that even the lower orders cannot live at very great depths. 
 The great majority of fishes move within a few hundred feet of the 
 surface, and only the lower orders are found below 100 fathoms. 
 These facts have been abundantly demonstrated by the investigations 
 of Professors Forbes and Bailey, and Lieut. Brooke. 
 
 On man the influence of sunlight is as direct and positive, and 
 far more perceptible than on the lower forms of existence, although 
 he is by nature endowed with greater power of resisting exter- 
 nal influences. The merest tyros in hygiene know that children 
 brought up in dark cellars, in gloomy attics, or in any of the dismal 
 corners of a great city, look paler and flabbier than the offspring of 
 the same class of parentage in the country, who, though equally 
 poor, and just as meagrely fed and clothed, are yet allowed the free 
 range of the fields and meadows. Even the children of the better 
 classes in our'large villages, who have abundance of nutrition and 
 all the comforts and luxuries of civilized life, are not un frequently 
 kept pale and thin by forced confinement, until maturer years and 
 emancipation from school discipline allow them opportunity to en- 
 joy the air and the sunlight. 
 
 Sunlight discolors the skin in proportion to its intensity, and the 
 length of time to which the body is exposed to its influence. Country 
 people are of a browner cast than the non-laboring classes of the 
 city, although they are not always or necessarily in a better physi- 
 cal or mental condition. Savages who have no abiding place and 
 no permanent shelter from the elements, are of a deeper shade than 
 civilized nations who inhabit the same zone. But among the civi- 
 lized and the savage it is observed that the parts that are most ex- 
 posed to the sun — the neck, face, skin, and hands — are darker than 
 18 
 
274 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 the rest of the body, that is mostly covered by some form of gar- 
 ment. In the polar regions, where there is almost perpetual day, 
 either from the direct rays of the sun, or from the reflection of the 
 aurora borealis on the fields of ice and snow, the inhabitants are 
 almost as brown as some races that reside near the tropics. 
 
 That the rays of the sun have a distinct chemical effect is 
 proved by a number of special experiments. Pharmaceutical pre- 
 parations undergo greater or less changes, if the bottles in which 
 they are contained are kept for a length of time exposed to the 
 rays of the sun. " If camphor is kept in a bottle, ciwstals will be 
 formed on the side of the glass upon which the light falls. If 
 that side is turned from the light the crystals will be gradually re- 
 moved, and again be deposited on those parts upon which the rays 
 of light first impinge." 
 
 It has been ascertained by the experiments of Mr. Hunt, that 
 when the sunlight is transmitted through media of different colors, 
 the growth of plants is variously modified. " Under glasses of an 
 orange, yellow, red, or ruby color, the roots of tulips exhibited some 
 vitality, and in some cases buds appeared. Underneath the green 
 glass the plant grew slowly but strongly. The flower-buds gene- 
 rated under these circumstances never could be made to blossom, 
 notwithstanding the greatest care and attention bestowed upon them." 
 
 But the investigations of science have not stopped here. By 
 means of the spectroscope, Professors Bunsen and KirchhofT have 
 even presumed to analyze the sunlight by the prism, and they have 
 found that it contains various metallic substances, such as iron, nickel, 
 barium, copper, and zinc. They account for the presence of these 
 metals in the rays of the sun by supposing that, in their passage to 
 the earth, they have passed through vapor containing them. 
 
 Most of the savage and wandering tribes make their home in 
 the sunlight, and need no instructor; but the child of civilization, 
 who lives beneath the shelter of thick walls, in rooms agreeably 
 warmed and lighted by the skilful appliances of art, should make 
 the enjoyment of the open sky a study and a duty. In these latter 
 days we have made such astonishing advances in the methods of 
 producing artificial warmth and light, that we forget the great na- 
 tural source of these comforts, and ignore the fact that the sunlight 
 possesses many subtle chemical virtues that are essential to animal 
 or vegetable life, and which exercise a mighty and perpetual influ- 
 ence on the health, the life, the beauty, and the character of hu- 
 manity, which thus far has not been clearly understood by the 
 ; genius of science, nor in any way supplied by the resources of 
 modern art. 
 
SUNLIGHT. 275 
 
 We act, indeed, as if we were afraid of the sunlight. ¥e not 
 only fly from its presence under cover of high, dark walls, but we 
 close our doors, darken our windows with gloomy blinds and thick 
 shades, as if it were our enemy and were perpetually besieging our 
 houses, in order to force an entrance and destroy us by some terri- 
 ble plague. No walled town, surrounded by armed foes, was ever 
 so vigilantly and perseveringly defended as our own modern homes 
 against the invasion of sunlight. Into the majority of our city 
 dwellings and churches the sunlight, with its direct rays, scarcely 
 ever enters. 
 
 The world over, country people are more hospitable than city 
 people, and this is no less true in regard to the sunlight. But even 
 our rural cottages are often encompassed by thick ranks of shrub- 
 bery, and high trees, armed with long, heavy branches, to protect 
 the family mansion from one of the best friends God ever sent to 
 his suffering creatures. 
 
 When the fair sex venture forth from their poorly ventilated 
 and sun-excluded dwellings, how cautiously and jealously they 
 shield themselves against the sun's rays, by the heavy shawl, the 
 thick veil, the parasol, and the tightly fitting glove ; and that too on 
 the mildest and loveliest days of the year — as far as possible making 
 themselves proof against those genial influences to which they are 
 indebted, not only for health and life, but also for the delicate hues 
 of beauty which they prize so highly. 
 
 We ride out to " take the air," in covered vehicles, from which 
 the sunlight is excluded almost as effectually as from our darkened 
 chamber at home. We draw' our infants in little carriages, but 
 shield them from the rays of the sun, which they never see at home, 
 and which is almost as essential to their perfect health as pure air 
 itself. And, worse than all, when this unnatural deprivation of 
 the influence of the great source of health, and life, and beauty has 
 induced disease that renders it impossible to go out beneath the 
 open sky, one of the very first steps taken is to make the dark cham- 
 ber of the invalid still darker by tightening the blinds and drawing 
 lower the shades, as if it were desired to test, to the utmost, the re- 
 cuperative forces of nature against all the appliances of art. 
 
 The beneficent influence of sunlight should be studiously con- 
 sidered in our treatment of the sick, especially those afflicted with 
 the so-called nervous disorders. Dyspeptics, rheumatics, paralytics, 
 and sufferers from neuralgia and other nervous diseases, do well to 
 take frequent and protracted sunlight baths. The rooms of the 
 invalid should be flooded with sunlight, and the entire surface of the 
 body should be systematically and thoroughly exposed to it. If 
 
276 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 these principles were understood and acted upon by the profession 
 and the laity, the ratio of nervous symptoms would largely de- 
 crease, and nature would experience far less difficulty in curing her 
 afflicted children. 
 
 From Dr. Winslow's excellent work I quote as follows: 
 
 " Fourcault affirms that where life is prolonged, perhaps to the 
 average term, the evil effects of the want of light are seen in the 
 stunted forms and general deterioration of the human race. It ap- 
 pears that the inhabitants of the arrondissement of Chimay, in Bel- 
 gium, three thousand in number, live partly as coal-miners and 
 partly as field-laborers ? The latter are robust, and readily supply 
 their proper number of recruits to the army ; while among the 
 miners it is in most years impossible to find a man who is not ineli- 
 gible from bodily deformity or arrest of physical development. 
 
 " In the spring a potato was left behind in a cellar where some 
 tools had been kept during the winter, and which had only a small 
 aperture at the upper part of one of its sides. The potato, which 
 lay in the opposite corner, shot out a runner which first ran twenty 
 feet along the ground, then crept up along the wall, and so through 
 the opening by winch light was admitted. 
 
 " This fact is observed in the etiolation or blanching, as it is termed, 
 of certain kinds of vegetables, such as celery, sea kale, endive, &c. 
 Their leaves, deprived of the sun's rays, do not attain their nor- 
 mal growth or form, neither is the natural odor of such plants fully 
 developed. 
 
 " Professor Robinson, descending into a coal-mine, accidentally met 
 with a plant growing luxuriantly. Its form and qualities were new 
 to him ; the sod on which it grew was removed, potted, and carefully 
 attended to in his garden. The etiolated plant languished and died ; 
 but the roots speedily threw out vigorous shoots, which, from the 
 form of the leaves and their peculiar odor, he readily recognized as 
 tansy. He repeated similar experiments upon other plants, viz.: 
 lovage, carvi, and mint, with analogous results." 
 
 Of the influence of moonlight, Dr. Winslow thus expresses 
 himself: 
 
 "It is curious to trace the effects of sol-lunar influence upon the 
 return and progress of maniacal paroxysms. They generally be- 
 gin immediately after the summer solstice^ are continued with more 
 or less violence during the heat of summer, and commonly termi- 
 nate towards the decline of autumn. This duration is limited 
 within the space of three, four, or five months, according to defi- 
 ciency of individual sensibility, and according as the season may 
 happen to be earlier, later, or unsettled as to its temperature. Ma- 
 
SUNLIGHT. 277 
 
 macs of all descriptions are subject to a kind of effervescence or 
 tumultuous agitation upon the approach of stormy or very warm 
 weather! They then walk with a firm bnt precipitate step ; they 
 declaim without order or connection ; their anger is roused by trivial 
 or imaginary causes ; and they express their feelings by clamorous 
 and intemperate vociferation. 
 
 " It is a well-established fact that insanity is a disease of the mind, 
 upon which the moon exercises an unquestionable influence. The 
 new moons and the last quarters of the moon are the lunar phases 
 which influence the insane most frequently and painfully. 
 
 " The first quarters and the full moons are the phases which I 
 have observed to have the least influence in inducing relapses of in- 
 sanity — the insane at these periods being less insane and quieter, 
 and they reasoned almost as if they were not ill at all. Those who 
 are still susceptible of being cured, as well as those who have been 
 cured, are precisely those upon whom the two most powerful lunar 
 phases have had the greatest influence during the whole of their 
 illness. 
 
 " Those who are acutely maniacal are much more susceptible to 
 the influence of the lunar phases than others." 
 
 Daguin says : " I have also observed a difference between the influ- 
 ence exerted by this planet on madness characterized by excessive 
 joy, and that by sorrow and melancholy. It is proved that this influ- 
 ence is much more marked in parts of the countries bordering on the 
 sea than in those at a distance from it." 
 
 We have not yet spoken of water as one of man's best physicians. 
 Water is composed of oxygen and hydrogen, in the proportion of 
 eight parts of the former to one of the latter. We have seen that 
 atmospheric air is the result of a mixture of oxygen and nitrogen ; 
 water, on the contrary, is the result of a chemical combination of 
 its two elements, oxygen and hydrogen, so that there is produced a 
 substance entirely different from either. 
 
 Those who have not studied the subject may be surprised to 
 learn how universal and abundant water is when compared with 
 other substances. It covers three-fourths of the surface of the earth, 
 and constitutes much more than half the weight of animal and ve- 
 getative life. There is water in the atmosphere, even in the driest 
 season ; water is carried by the gentlest zephyr as well as by every 
 stormy wind that blows. There is water in the hardest of the woody 
 fibres, in the most shrivelled barks on the trees, in the thinnest 
 leaves and in the most delicate flowers. Water forms three-fourths 
 of the human body. It is found in the hairs, in the tough cartilage, 
 in the hard bony tissue, and even in the dense, pearly teeth. Water 
 
278 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 impregnates and saturates nearly every substance on the face of the 
 earth, so that there is scarcely an article of furniture or adornment, 
 of food or apparel, that would not weigh less when thoroughly, 
 absolutely dried. 
 
 The uses of water are as varied as its presence is universal. It 
 is nature's great chemist, and is invested with power to dissolve a 
 large number of other substances, and yet it does not irritate the 
 animal tissues of which it forms a part. On the other hand, the 
 powerful solvents that man has sought out and contrived are more 
 or less painful if not destructive to animal life. 
 
 Water is also the great cooler of the world. It possesses a 
 greater capacity for taking up heat than any other substance. For 
 this reason it is always cooler in the neighborhood of the sea-shore, 
 or on the borders of lakes, pools, swamps, and rivers. When water 
 is evaporating its capacity for heat is much greater than when it is 
 in a liquid state. Hence the evaporation from the lungs and skin 
 is a cooling process ; for this reason those whose lungs are so feeble 
 that they cannot take full breaths, or who do not perspire freely, 
 always suffer intensely in hot weather, or after severe physical exer- 
 tion. 
 
 The delights of the sense of taste are largely dependent on the 
 solvent power of water, and, as a rule, all the most luscious and 
 highly prized meats, and fruits, and plants are chiefly composed of 
 liquids. Water is also a powerful absorbent of gases, both the good 
 and the bad. Within a few hundred feet of the surface of the sea, 
 where most of the fish are found, there is always present a sufficient 
 amount of oxygen, sufficient to meet their wants. 
 
 Water is rarely or never found in a state of absolute purity. The 
 water of the ocean is one-thirtieth part solid matter, including the 
 salts of potassium, sodium, calcium, and magnesia. The waters of 
 rivers, lakes, and springs all contain more or less solid material that 
 they take up from the soil through which they pass. Rain-water, 
 the purest of all, usually contains more or less traces of nitric acid 
 and ammonia that it has derived from the air in its passage through 
 it. Pure water, which can be only obtained by distillation, is quite 
 insipid, because it contains no solid matter that we are accustomed 
 to taste in our ordinary drinking water. 
 
 In view of the universality of water and the variety of uses to 
 which it is applied, its hygienic and therapeutic importance is at 
 once suggested* Water should be drunk freely during our meals, 
 or after them, or in the intervals, just as the natural thirst demands. 
 There are those who have advised to abstain from drinking entirely 
 until we have eaten the solid articles of our meals. The advocates 
 
 
SLEEP. 279 
 
 of this theory base their argument chiefly on the fact that our do- 
 mestic animals never drink while they are eating. There is no 
 absurdity to which we may not be led if we take the lower animals 
 as our guides in the study of hygiene. Any enlightened man will 
 find his own natural appetite, under the guidance of reason and ex- 
 perience, a far safer adviser than the entire animal creation. Iced 
 water at meals is a most unnatural drink, especially when not com- 
 bined with hot tea, coffee, or spirits. It lowers the temperature of 
 the stomach, and thus impedes digestion, while tepid or warm 
 drinks, by their solvent and gently stimulating power, have a di- 
 rectly reverse effect. Cool waters from deep wells are always to be 
 preferred to iced drinks, not only during meals but at all other 
 times, even when the stomach is absolutely empty. 
 
 SLEEP. 
 
 From fifteen to twenty hours is as long as the average of men can 
 keep in activity without an interval of absolute rest. After we have 
 become wearied of study and thought, wearied of muscular exercise, 
 wearied of social life, and of every form of recreation, there comes 
 in every twenty-four hours a time when we feel the need of more 
 perfect rest than can possibly be obtained by any variation or change 
 of activity. Nature meets this great need by allowing us to sleep. 
 
 Sleep is food for the brain. It is not positive nutriment like our 
 ordinary food, but in a necessary or negative sense it is really nu- 
 tritious, for it retards the changes of tissue in the brain, and thus in 
 a measure takes the place of food. It slows the fires of the system, 
 and therefore diminishes the consumption of fuel. In sleep, the 
 system, to borrow a nautical phrase, a goes under one bell." 
 
 Sleep is the most absolute form of rest that the system is capa- 
 ble of, and yet it is far from being perfect. The brain, the muscles, 
 and the vital organs are never perfectly at rest, even in the soundest 
 sleep. Even though the interval between retiring and rising is 
 passed in blissful unconsciousness, yet changes of tissue are inces- 
 santly going on in every organ and in every fibre. In the soundest 
 sleep of which we are capable, still beats the heart with its mighty 
 and rhythmical pulsations ; still courses the blood through all its 
 myriad channels to every organ and molecule ; still rise and fall the 
 lungs, harmonious with the throbbing of the heart ; still goes on the 
 complex processes of digestion and assimilation, of absorption and 
 secretion, of waste and repair ; still are maintained, with constant 
 though diminished activity, those unnumbered processes of vital 
 chemistrv, which eve hath not seen nor ear heard, neither hath it en- 
 
2S0 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 tered into the heart of man to conceive ; and what is more wonderful 
 and marvellous than all — still are elaborated in the brain, with con- 
 stant though irregular activity, the functions of memory and imagi- 
 nation, of emotion, fear, apprehension, sorrow, and joy — of every 
 faculty of the human intellect, except the gift of reason and the 
 might of will. 
 
 The intellect is never perfectly at rest. In the soundest sleep 
 the brain is ever busy with those unguided and erratic fancies and 
 activities which we dignify by the name of dreams. 
 
 In sleep the volume of blood in the brain is diminished. — This 
 fact has been pretty well established by recent experiments. It has 
 also been proved by experience, that remedies which have a ten- 
 dency to reduce the volume of blood in the brain assist us to sleep, 
 and are therefore useful for those w T ho are troubled with wake- 
 fulness. 
 
 Though sleep is not perfect rest, it is yet the best that is allowed 
 to mortals, and when taken in sufficient quantities is sufficient for the 
 wants of the system. Its laws are therefore worthy of careful study. 
 
 Our mechanics and laborers, as a rule, have less than students 
 and literary, professional, and business men. The majority of our 
 artisans and day-laborers are obliged to commence work by seven 
 o'clock in the morning, and therefore find it necessary to rise by five 
 or six. Many others are obliged to walk or. ride several miles to 
 their places of labor, and must therefore have breakfast long before 
 the brain-working classes are out of bed. Farmers are compelled to 
 rise early in the busy season of the year, and oftentimes they are 
 accustomed to work hard and long before breakfast. It is true that 
 the classes here mentioned oftentimes go to bed somewhat earlier 
 than students, or literary and professional men, but their habits in 
 this respect are by no means uniform. Thousands of our artisans 
 and mechanics spend their evenings in amusement or dissipation 
 until nearly midnight, or even later, and after five or six hours of 
 sleep start again to their daily tasks. 
 
 On the other hand, about all classes of brain- workers — merchants, 
 bankers, lawyers, clergymen, men of letters, teachers, and students — 
 are, with some exceptions, accustomed to lie in bed until six, seven, 
 and eight o'clock, although they retire, on the average, before eleven. 
 Thus they get from seven to nine hours of sleep, or at least pass that 
 time in bed ; while their subordinates — their draymen, the coachman, 
 the laborers, and artisans in their employ, and their family servants 
 — must content themselves with but five to eight hours. On that 
 average, then, our brain-workers have from one to two hours of 
 sleep more than the muscle-workers. This is just as it should be. 
 
SLEEP. 2S1 
 
 Those who live by thought consume more tissue than those who live 
 by muscular activity, and, in spite of all erroneous teachings, they 
 find by experience that they must have a correspondingly greater 
 amount of sleep. 
 
 Laborious workers need all the sleep that they can get, whether at 
 night or in the daytime. — The night is the most appropriate season 
 for sleep, and yet we should never hesitate to take a nap in the day- 
 time whenever we find it necessary. Amid the cares and responsi- 
 bilities of our modern civilization, there are unnumbered interrup- 
 tions and contingencies that make it practically impossible for us to 
 obtain our full amount of sleep in the hours that are usually devoted 
 to that purpose. 
 
 To sleep is the one great hj-gienic commandment. It is the 
 Alpha and the Omega, the beginning and the end, the first and last 
 of the great laws of mental hygiene. He who understands and obeys 
 this law really understands and obeys the whole hygienic decalogue, 
 for no one can long sleep well who persistently disregards the other 
 laws of health. Sleep is one of the best of our thermometers of 
 health. By the quantity and quality of sleep that our patients can 
 take we can best judge of their daily condition and of their progress 
 toward recovery. We always feel assured that whatever improves 
 the sleep of the exhausted invalid, to that degree helps him toward 
 recovery, and that whatever disturbs this sleep, to that degree brings 
 on relapse and disease. Prolonged sleeplessness is one of the earli- 
 est and most constant symptoms of insanity, of hypochondria, and 
 of all the nameless forms of nervous disarrangement. Whenever, 
 therefore, we find that we are not sleeping as well as we are wont ; 
 when our dreams are peculiarly dark, and ugly, and distressing, and 
 leave unsightly scars in the memory ; when we roll, and toss, and 
 worry through the watches of the night, anxiously waiting for the 
 day ; when we awake long before our accustomed hour of rising, 
 and find no pleasure in the morning nap, then may we suspect that 
 our bark is nearing the quicksands and shallows, and then without 
 delay should we examine our charts, revise our calculations, and 
 according to our best judgment, return to the channel from which 
 we have suffered ourselves to be driven. 
 
 Sleep of Plants. — A certain author thus compares the rest of 
 plants to the sleep of the animal creation : — 
 
 " In many plants we even find something which may with great 
 propriety be compared to the daily sleep of man. Their leaves 
 every " evening are contracted, or droop, their flowers shut them- 
 selves up, and their whole external appearance displays a state of 
 rest and repose. Some have ascribed this to the coolness and 
 
2S2 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 moisture of the evening ; but the same tiling takes place also in 
 the greenhouse. Others have considered it as a consequence of 
 darkness ; but many shut themselves up in summer at six o clock in 
 the afternoon. Nay, the Tragopogon luteum shuts itself up so early 
 as nine in the morning, and this plant therefore gives us reason to 
 compare it to certain night birds and beasts of the animal world, 
 which are active only during night, and sleep in the daytime. 
 
 " Every hour of the day even has some plant which then shuts 
 itself up, and on this is founded what is called & plant-dial" 
 
 CLOTHING. 
 
 A necessary rule to be attended to, for preserving the body in a 
 proper state of health, is to protect it from such effects as have a 
 tendency to obstruct the perspiratory matter. In the sultry days of 
 summer, every precaution should be taken that the body be not 
 suddenly exposed to cold when overheated by exercise, by throwing 
 off a portion of our clothing, as some persons are apt to do. Another 
 rule to be attended to is to adapt our clothing to the climate, the 
 different seasons of the year, and the period of life. 
 
 In warm climates, what is worn next to the skin should be made 
 of cotton in preference to linen, which, when moistened with perspira- 
 tion, is very apt to convey a sense of chilliness when the body be- 
 comes cool again. A proper attention ought to be paid, at the same 
 time, to the situation of the person's residence ; to the frequency and 
 violence of storms, and to the different periods of the day ; avoiding, 
 if possible, an exposure to the moist and damp air of the nights ; 
 but, where this is unavoidable, clothing the body accordingly. 
 
 Our summer clothes ought not to be worn too long, nor our 
 winter ones put on too soon. In making the change, it will be best 
 to do it gradually, which precaution is more particularly necessary 
 for those who have passed the meridian of life. 
 
 Another material rule to be attended to, with respect to cloth- 
 ing, is to adapt it not only to the seasons, hut to the vicissitudes of 
 the weather at different periods of the same day. An attention to 
 this point is particularly necessary where the weather is variable, 
 and the transitions from heat to cold very sudden at different times 
 of the same day. 
 
 In early life it is not so necessary to cover the body with a 
 quantity of clothes, because the blood circulates with due energy, 
 and the perspiration is free ; but in advanced life, when the circu- 
 

 CLOTHING. 283 
 
 lation is more languid and the skin more rigid, the clothing ought 
 to be increased. A defect of due perspiration is probably the cause 
 of many of the diseases to which the latter period of life is subject ; 
 but this may, in some measure, be prevented by wearing, next to the 
 body, those articles of clothing which are best calculated for pro- 
 moting a due discharge from the skin by perspiration, such as those 
 made of cotton, flannel, or fleecy hosiery. 
 
 The precise quantity of apparel which may be necessary for 
 any person cannot be prescribed. It must be entirely a matter of 
 experience, and every person is the best judge what quantity of 
 clothes is necessary to keep him sufficiently warm and comfortable. 
 
 Every person should be careful that his linen is properly dried 
 previous to its being put on. Many lives are annually sacrificed by 
 persons putting on damp linen, as well as by sleeping in sheets not 
 properly dried. 
 
 Due care should be taken to change the stockings, and other 
 clothing, as speedily as possible after their becoming wet by an ex- 
 posure to inclement weather. Many persons are so imprudent as to 
 neglect this very necessary change, and to suffer their clothes, after 
 such an exposure, to dry on them, assisted probably by going near 
 a fire for some time ; but such a practice is always attended with 
 risk, and not unfrequently gives rise either to rheumatism, fever, 
 pleurisy, cough, consumption, or some other disease of a dangerous, 
 or even fatal nature. 
 
 In warm climates, most persons are in the habit of changing 
 their dress twice a day, particularly their body linen. Indeed, 
 where such articles of dress are once soiled by copious perspiration 
 their sj^eedy renewal and change is not only necessary for the sake 
 of comfort, but also for the preservation of health. 
 
 No part of our dress should occasion pressure. Cravats, stocks, 
 necklaces, &c, should not be tight about the neck, as in this way 
 they obstruct the blood in its course from the brain, and thereby 
 give rise to headache, giddiness, fainting fits, or apoplexy. Neither 
 should our garters be worn too tight, as they thereby not only pre- 
 vent the free motion and use of the parts about which they are 
 bound, but likewise obstruct their equal growth and nourishment, 
 and give rise to varicose distention of the veins, aneurism of the 
 crural artery, &c. But the most destructive way of applying 
 tightness is that of squeezing the stomach and bowels into as nar- 
 row a compass as possible, by the close lacing of stays, for the pur- 
 pose of moulding the figure into what is called a fine shape. Many 
 women are sacrificed by this injurious practice. Tight lacing is 
 attended with very injurious consequences, as the action of the 
 
284: HYGIENE, OR THE ART OF PRESERVING- HEALTH. 
 
 stomach and intestines, the motion of the heart and lungs, and all 
 the vital functions are impeded ; hence arise fainting fits, indiges- 
 tion, costiveness, obstructed menstruation, coughs, consumptions, 
 and many other complaints. 
 
 Attention should be given to the different materials from which 
 our clothes are made. 
 
 Wool is an excellent material for clothing. Clothing keeps us 
 warm, bj retaining the heat that is in the body. They im- 
 part no heat. Clothing, in order to be warm, should be a had 
 conductor of heat. Wool is such a bad conductor. It is therefore 
 very warm. Flannel is the best substance to be worn next to 
 the body. 
 
 Linen is a good conductor of heat. It is therefore not warm, 
 but is adapted for hot weather. 
 
 Cotton is not so good a conductor of heat as linen, and is there- 
 fore warmer. 
 
 Clothing should be more or less porous, so that the perspiration 
 may have free passage. 
 
 The color of the clothing is a matter of importance. 
 
 White clothing does not absorb the rays of light well, and is 
 therefore cool. Dark clothing absorbs the rays, and is therefore 
 warm. 
 
 These facts have been established by direct experiment. 
 
 BATHING. 
 
 Personal cleanliness is chiefly effected by a frequent change of 
 dress, but is much increased by ablutions of different parts of the 
 body daily with water. The teeth ought to be cleansed after every 
 meal, as the refuse of the food settles about them, rapidly becomes 
 putrid, and proves injurious to them, as well as to the gums. 
 Every morning the tongue should be cleansed, and the throat be 
 well gargled and washed out with water. 
 
 The teeth are apt to become incrusted with tartar, which in 
 time very much injures the enamel with which they are coated ex- 
 ternally ; it should not, therefore, be suffered to collect, but be 
 removed from time to time. They should be washed every morn- 
 ing with a small piece of sponge, or very soft brush, dipped in cold 
 water, joining occasionally the powder of charcoal. If any of the 
 teeth have a tendency to caries or rottenness, or the gums are 
 spongy and bleed, the mouth may be washed with equal parts of 
 the tincture of myrrh and bark, somewhat diluted with water. 
 
BATHING. 285 
 
 Attention to the feet is also very necessary, particularly in warm 
 weather, and with those who, from a peculiarity of constitution, 
 have them very moist. The perspiration proceeding from them in 
 hot weather, and after much walking, emits a very disagreeable 
 smell. They ought, therefore, to be frequently washed ; but no 
 means for stopping the discharge should be resorted to, as serious 
 diseases might thus be induced. Great cleanliness, by daily ablu- 
 tions of the feet and a change of stockings, are not only the most 
 •convenient, but the most salutary means of preventing all dis- 
 comforts. 
 
 Ablutions with water should also be extended to other parts of 
 the body. When a habit of cleanliness is once established, no 
 rules will be requisite, as the feelings of the individual will suffi- 
 ciently indicate what is proper in this respect. 
 
 Frequent ablutions or immersions in water are very beneficial, 
 and are the most effectual preventives of many distressing mala- 
 dies. Cleansing the skin by rubbing, washing, and bathing is a 
 very salutary operation. Indeed, it is nearly impossible for any 
 person to be perfectly healthy who lives in the constant and habi- 
 tual neglect of these means. 
 
 Where the person labors under no disease which is contra- 
 dictory to the employment of a cold bath, this may be substituted 
 in the summer and autumnal periods of the year for minor ablu- 
 tions of the body ; and bathing in the sea is entitled to a preference 
 among the young and middle-aged. Gold bathing does not, how- 
 ever, produce any considerable tonic effect upon old persons ; and 
 besides, any sudden chilling of the skin repels the circulation from 
 the surface of the body, and determines the blood upon the inward 
 parts, which is always attended with some risk to persons advanced 
 in life. 
 
 To ascertain whether or not cold bathing is likely to be service- 
 able to the person who employs it, he has only to attend to the 
 following circumstance. If, after bathing, he feels a genial glow 
 of warmth pervade the body, with an increased degree of vigor, he 
 may be assured that it is likely to prove beneficial ; but, on the 
 contrary, if he feels a cold or chilly sensation remaining some time 
 after, it should not be persisted in. 
 
 The best time of the day for cold bathing is before breakfast, 
 but it may be used at any period of the forenoon, taking due care 
 not to resort to it when the body is heated by exercise, nor imme- 
 diately after a meal on a full stomach. 
 
 Inuring children to cold bathing is generally productive of much 
 advantage to them, particularly those who are perceived to be of a 
 
2S6 HYGIENE, OK THE AET OF PRESERVING HEALTH. 
 
 weak constitution, provided they labor under no organic disease. 
 In conjunction with proper exercise, it is of all means the best cal- 
 culated to make them strong and healthy, and may be considered 
 as a powerful antidote against the rickets, scrofula, and many other 
 disorders. 
 
 For elderly people tepid bathing will be more appropriate than 
 the use of a cold bath, and will be found no less salutary than pleas- 
 ant. A warm bath is a remedy of high utility where any check 
 has been suddenly given to the perspiration by an exposure to cold 
 or wet, and it proves very serviceable in many disorders, such as in- 
 flammatory affections of the stomach and bowels, rheumatism, and 
 various other diseases. 
 
 PAN FOR SPONGE OR HAND-BATH. 
 
 The topical as likewise the general use 
 of hot water in the form of vapor is like- 
 wise a remedy of great utility in various 
 complaints. Whenever the joints become 
 rigid, and the pain upon motion exquisite- 
 ly severe, or where the muscles are con- 
 tracted (and, indeed, in all protracted 
 cases of any disease of the hip-joint, lum- 
 bago, or sciatica), the vapor of hot water, 
 properly applied, will seldom fail, in con- 
 junction with other suitable applications, 
 to prove a safe and successful remedy. 
 arrangement for snowER-BATH. The mode of applying it topically must be 
 regulated according to circumstances. A large boiler, with a long 
 pipe or tube affixed to it, forms a simple apparatus. By means of 
 this the parts affected may be steamed for about half an hour at a 
 time, repeating the process twice or thrice a day. 
 
 TURKISH AND RUSSIAN BATHS. 
 
 These methods of bathing are now rapidly growing into popular- 
 ity. In New York City there are several establishments where the 
 
BATHING. 
 
 287 
 
 baths are provided for those who have the time, the means, and the 
 opportunity to enjoy them. 
 
 The only difference between the Turkish and the Eussian bath 
 is, that in the former the patient is first subjected to hot air, and 
 in the latter to hot vapor. The subsequent processes of shampooing, 
 kneading, and rubbing, and showering, and plunging are the same 
 in both. The common impression that it is injurious to take a 
 shower-bath of cold water, after a hot-air or vapor-bath, is erroneous. 
 The truth is, that the system is better fitted to take a cold shower 
 or a plunge into cold water after the system has been thoroughly 
 warmed provided we a,re not exhausted. Those who bathe in a cold 
 stream, after they are wearied by severe labor or a long walk, are 
 very apt to injure themselves. 
 
 In the Turkish and Eussian baths the bather reclines, as repre- 
 sented in the accompanying cut, for some little time, until, by the 
 
 THE TURKISH AKD HOT-AIR, ASD RUSSIAN OR VAPOR BATHS. 
 
 influence of the hot air or vapor, he is thrown into a profuse perspi- 
 ration. He is then rubbed by an attendant, and afterward receives 
 a shower or douche of cold water. 
 
 The duration of the bath is from ten minutes to two hours, ac- 
 cording to the constitution and habits of the bather. 
 
 Besides their general cleansing and invigorating effects, these 
 
2S8 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 baths are oftentimes of decided service in rheumatism, neuralgia, 
 and various nervous conditions. 
 
 They ought always to be in the hands of careful, and skilful, and 
 honorable men. In every bath-room there should be a superin- 
 tendent, to take especial charge of all invalids and newcomers. For 
 want of this guidance and direction, the weak oftentimes have the 
 same treatment as the strong, and are thereby injured. Every es- 
 tablishment should have two or three rooms, with the temperature 
 graduated to the strength of the bathers. 
 
 REGULATION OF BOWELS. 
 
 Too great a looseness of the bowels or habitual diarrhoea, is pro- 
 ductive of as much danger and inconvenience, as considerable con- 
 stipation. The occasional occurrence of a moderate looseness is 
 frequently only an effort of nature to expel and carry off something 
 morbid from the intestines, and therefore not to be considered in the 
 light of a disease ; still, when it occurs too frequently, or too copiously, 
 and is long continued, some obscure disorder in the bowels, or some 
 material defect, may be suspected. Under circumstances of this 
 nature, the looseness must be stopped, or rather mitigated by the 
 assistance of medicine ; otherwise the body will be deprived of its due 
 nourishment, the strength and spirits be exhausted, and ultimately it 
 will destroy life. 
 
 One copious stool a day is sufficient for an adult in health. More 
 or less may be injurious in a general way. To obtain this regular 
 action of the bowels, the best plan is to rise betimes in the morning, 
 take gentle exercise in the open air, then breakfast, and very soon 
 afterwards visit the privy, whether the person has an inclination or 
 not, soliciting nature patiently and perseveringly and by proper 
 efforts. Habits of this kind may be acquired, which will in time 
 become perfectly natural. In this way many cases of habitual cos- 
 tiveness have been completely subdued, and perfect regularity in the 
 action of the bowels established. 
 
 A serious evil attendant on frequent recourse to medicines for the 
 purpose of removing costiveness is, that after a time, the bowels will 
 not act without them, from a want of the accustomed stimulus. Those 
 who are subject to habitual constipation, had better attempt to re- 
 move it by diet and exercise, than by drugs, carefully avoiding, at 
 the same time, all articles of aliment which are of an astringent 
 nature. 
 
 Persons troubled with habitual looseness, should make use of 
 food that is likely to brace and strengthen the bowels, and which 
 
THE EVACUATIONS. 289 
 
 is rather of an astringent quality, such as rice boiled, milk, eggs, 
 cheese, sago, arrow-root powder, and wbeaten bread made of the 
 finest flour. Red Port wine, brandy sufficiently diluted, and toast 
 and water, will be the most appropriate liquors to drink. 
 
 As obstructed perspiration is not unfrequently a cause of loose- 
 ness in the bowels ; persons who are affected with it, should wear 
 flannel next to the body, and carefully avoid all exposures to cold. — 
 (See Constipation.) 
 
 THE URINE. 
 
 When it is too copiously discharged, it gives rise to thirst, emaci- 
 ation of the flesh, prostration of strength, depression of spirits, &c, 
 and constitutes that species of disease called diabetes. On the 
 contrary, when the urine is too long retained, it is not only re-ab- 
 sorbed or taken up again into the mass of fluids, but by stagnating 
 in the bladder, it becomes thicker, and the formation of gravel and 
 stone is promoted. Hence it happens, that indolent and sedentary 
 persons are much more liable to these diseases than those who lead 
 an active life. 
 
 It has been supposed that the quantity of urine secreted, and 
 voided in the course of the twenty-four hours by a person in health, 
 is generally about a third part of the fluids that are taken. This 
 being habitually exceeded is presumptive proof of debility, with too 
 great a laxity of the urinary organs and passages, the effect of which 
 is to expose the person to a general waste of the flesh and strength 
 The urine being smaller in quantity than what has been stated as 
 the general average, unless proceeding from a deprivation of liquids, 
 denotes an extraordinary degree of heat in the system, or it may 
 arise from a dropsical tendency, or from some obstruction in the 
 urinary passages. 
 
 By retaining the urine too long, many persons have greatly 
 endangered their lives. The calls of nature in this way, ought, 
 therefore, never to be postponed ; for if the bladder is over distended, 
 it is very apt to lose its power of action altogether, and to become 
 unable to expel the urine properly, and this over-distension destroys 
 the powers of the organ. 
 
 A retention or suppression of urine, under all circumstances, and 
 in all situations, may be considered as an alarming and dangerous 
 disease, which demands the most prompt and speedy means of relief 
 that can be afforded. In pregnant women, in or about the time of 
 labor, the urine being retained or suppressed, calls for prompt 
 assistance, otherwise they will be exposed to the risk of a ruptured 
 bladder, or a retroversion of the womb. 
 19 
 
290 HYGIENE 
 
 PERSPIRATION. 
 
 Perspiration is the fluid that is secreted by the extremities of the 
 cutaneous arteries from the external surface of the body. It is 
 usually distinguished into sensible and insensible. The last is 
 separated in the form of an invisible vapor ; the first is visible in the 
 form of very little drops adhering to the skin. 
 
 The insensible perspiration is supposed to exceed any of the 
 other discharges from the human body, and is of the utmost import- 
 ance to health; for when it is obstructed, the whole frame soon 
 becomes disordered. It varies in quantity according to the temper- 
 ature of the atmosphere, the season of the year, climate, age, sex, 
 and general mode of living. Thus men have a more copious, viscid, 
 and higher colored sweat, on summer days, and in warm countries, 
 than in colder regions. The sweat of a man usually exceeds that of 
 a woman, and is also supposed to be of a more acrid smell. The 
 young are more subject to sweat than the aged, who, during the 
 excessive heat of summer, perspire very little. A long abstinence 
 from drink causes a more acrid and colored sweat ; and the drinking 
 a great quantity of cold fluids in warm weather, a limpid and thin 
 perspiration. 
 
 The uses of the insensible perspiration are, to liberate the blood 
 from superfluous animal gas, azote, and water; to discharge the 
 noxious and heterogenous excrements ; hence the acid, rancid, or 
 putrid perspiration of some men. 
 
 The use of what is termed the sensible perspiration, or sweat, in 
 a healthy man, is scarcely observable, unless from an error of the six 
 non-naturals, which comprehend air, meat and drink, sleep and 
 watching, motion and rest, retention and excretion, and the affections 
 of the mind. The first effect of the sensible perspiration on the body, 
 is somewhat prejudicial, by its exhausting and drying it, although it 
 is sometimes of advantage by supplying a watery excretion ; (for 
 when the urine is deficient in quantity, the sweat is frequently more 
 abundant;) and also by discharging at the same time, any morbid 
 matter ; thus various subtile particles are critically expelled from 
 the human body, in acute and chronic diseases, with the sweat. 
 
 "Whatever gives a sudden check to perspiration may be productive 
 of very injurious consequences, and these should be carefully 
 guarded against, as many persons annually die by not paying 
 proper attention to the various causes from which perspiration may 
 become obstructed ; one of the most common of which is, taking 
 cold. 
 
 By sudden transitions from heat to cold, either from changea- 
 
VENTILATION. 291 
 
 bleness of the weather, the state of the atmosphere, going immedi- 
 ately from a hot room into the cold air, or throwing off some part of 
 the clothing when heated by exercise, the perspiration is very apt 
 to be obstructed, and colds, coughs, and inflammation of the lungs 
 are the usual effects of such conduct. Drinking freely of cold water, 
 or any other small liquor, when the oody is heated, is not only inju- 
 dicious, but fraught with many ill consequences. Damp houses, and 
 damp beds, or linen ; exposure to night air, especially in hot coun- 
 tries ; not changing clothes quickly after their getting wet ; and con- 
 tinuing to wear stockings, shoes, or boots which are saturated with 
 water, exposing the feet thereby to cold, are all likely to be at- 
 tended with injurious consequences, by occasioning obstructed per- 
 spiration. The same will happen by throwing open a window, when 
 the room is hot, and sitting in or near it, so as to be exposed to a 
 current of air. In the hot season of the year, some persons sleep 
 with a window open. Whenever this practice is adopted, great 
 care should be taken that the window is at a considerable distance 
 from the bed, and that the air admitted into the chamber does not 
 come in a current upon the person. Some, however, can sleep in a 
 current of air without injury. When the windows are open there 
 should he plenty of clothes on the led. It is always injurious to 
 sleep cold. 
 
 Some are so imprudent or foolhardy as to bathe themselves in 
 cold water when considerably heated by exercise, and by such con- 
 duct have been soon attacked with severe disease. In some instances 
 death has been the consequence. 
 
 Some persons, when they happen to get wet feet, wash them 
 with some kind of ardent spirit. This is always attended with very 
 great danger ; for instead of promoting and keeping up the due cir- 
 culation in the feet, it will greatly increase the check which has 
 been given to it by the exposure to wet. The speedy evaporation 
 of the spirit produces a considerable degree of coldness. The better 
 and safer way is, to well dry the feet, then to rub them for some 
 time with flannels made warm by the fire, covering them afterward 
 with woollen stockings ; and lastly, for the person to take a little 
 warm drink, keeping for some time in motion. 
 
 On all occasions, carefully avoid sudden transitions from heat to 
 cold, keep the body in as uniform a temperature as possible, and 
 when it is overheated let it cool gradually. 
 
292 HYGIENE, OR THE ART OF PRESERVING HEALTH, 
 
 INFLUENCE OF THE WEATHEK OIST THE CHAKACTEE. 
 
 The three great influences that determine the character of 
 individuals and nations are race, climate, and diet. 
 
 To a certain extent, individuals as well as communities are 
 elevated or depressed by the government under which they live, 
 by their religious belief, by their education, and by their material 
 and social surroundings; but, then, all these ultimately depend 
 on the character that has been inherited from generation to gen- 
 
 eration, and that has been developed and modified by climate 
 and diet. Comparing the influence of hereditary descent and 
 climate, we know by the testimony of history that the first has 
 always been dominant. The Indo-European race, for example, has 
 always triumphed wherever it has extended. It has embraced 
 a large number of widely-diverging nationalities under opposite 
 phases of climate, but it has always conquered. The Indo-Europeans 
 of warm climates have not been equal to those of temperate or 
 colder regions, but they have shown relative superiority as com- 
 pared with the nations about them who were subject to the same 
 climatic conditions. 
 
 The same general facts have been observed in the history of 
 races everywhere. All people can, in a measure, rise superior 
 to the depressing influences of excessive heat ; but all, whatever may 
 be their descent, however great their native energy and ability, 
 are inferior to the same people in the temperate zones. 
 
 It has been the custom to speak of the religious belief, the form 
 of government, the system of education, as the great causes of the 
 differences in nations. As I have said, these influences have, 
 undoubtedly, a share in the work of moulding humanity ; but inas- 
 much as they are themselves determined very largely by hereditary 
 descent and by climate, they cannot be regarded as final causes. 
 
 The effect of climate is seen in the history of the Jews more 
 markedly, perhaps, than in that of any other people. The Jews, 
 in all parts of the world, are descended from a common stock. 
 Almost invariably they intermarry, and in every way strive to 
 maintain and perpetuate themselves as a distinct and peculiar 
 people. Their success has been almost complete. Their blood has 
 but rarely mingled with that of any of the races with which they 
 have associated. Therefore, whatever differences are seen in Jews 
 in the various parts of the world may fairly be attributed to climate. 
 In Palestine — their native country — they are of a tawny color; 
 further east they are of a darker hue, in proportion as we ap- 
 
INFLUENCE OF THE WEATHER ON THE CHARACTER. 293 
 
 proach the regions of torrid heat. In Europe and in JSTorth America 
 their color is comparatively fair, and not unfrequently is as white 
 as that of the Anglo-Saxon. They retain, however, wherever they 
 have penetrated, or under whatever systems they have lived or 
 suffered, the leading distinctive characteristics of their race. The 
 shape of the nose, the color and expression of the eye, and the 
 general physiognomy of the Jew, are as unmistakably diagnostic 
 in Malabar as in Europe, in all the extremes of climate as in their 
 own native Judaea. 
 
 The effect is also seen in the branch to which we belong. Con- 
 cerning this important subject of races, there is much that is con- 
 jectural and misunderstood, but certain facts have been gleaned from 
 the experience and research of the world that seem to be pretty well 
 established. It is quite clear that Indo-Europeans — including the 
 inhabitants of Europe easterly to Hindostan — are descended, in the 
 main, from a common stock. But how very positive are the differ- 
 ences of color and appearance between the inhabitants of India and 
 Central or Northern Europe ! So far back as history sheds light on 
 this subject, we find that the Gauls and the Britons were described 
 as blue-eyed and of fair complexion. The color of the Hindoos is 
 brown, and so far as is known or can be ascertained, has always 
 been so. 
 
 All denizens of high latitudes are essentially inferior in intellec- 
 tual as much as in physical stature. Their temperaments are not 
 only coarse, but are exceedingly inactive, for their climate does not 
 seem to allow them to exercise and develop what little of character 
 may inhere in their race. Their nervous fluid seems to be literally 
 congealed, and they evince less force of will, less character, less ac- 
 tivity than the dweller by the Amazon, or even the negroes on the 
 Congo. 
 
 It is very pertinent to inquire whether climate may not modify 
 the quality and the quantity of the cranial contents. The question 
 is, however, so deeply complicated by the differences, varieties, and 
 intermixtures of races, that it is not entirely easy to answer. Sea- 
 soning from analogy, it seems very clear that when the brain is not 
 used it must become more or less modified in form and structure, 
 and undergo degeneration both of quality and quantity. We know 
 that the muscles increase in size and hardness by exercise, and be- 
 come flabby and small by long disuse, and it would seem that the 
 brain and nervous system must follow the same law. Accordingly 
 we find that the skull, which always adapts itself to its contents, 
 slowly changes in form under long-continued and unfavorable con- 
 ditions. Even in civilized lands we can trace a difference in the 
 
29i HYGIENE, OR THE ART OF PEESEEVING HEALTH. 
 
 form of the skull of the higher and the degraded classes. Thick- 
 ness of the lip, widely opened mouth, large and projecting jaws, 
 low and especially retreating foreheads — these are the symptoms of 
 ignorance, hard poverty and low life, just as the opposite appear- 
 ances — thin, delicately chiselled lips, firmly closed, narrow gums, and 
 broad, expansive brows — are the marks of intellectuality, character, 
 and social position. Dr. Prichard calls attention to the fact that 
 the Turks of Europe have lost the pyramidal shape of cranium that 
 characterized their ancestors in Asia, and have gradually taken on 
 the elliptical form. This change is the result of change in climate 
 and mode of life. 
 
 Dr. Draper presents the following suggestive theory concerning 
 the effect of climate on color : 
 
 " Eow there is no organ which is more quickly disturbed in its 
 duty by a high temperature than the liver. Whether such a high 
 temperature produces its effect through a disturbance of the action 
 of the lungs, or through an impression on the skin, is quite imma- 
 terial. If the organ be in any manner enfeebled in its duty, and 
 no other avenue is open through which the degenerating hsematin 
 may escape, it must accumulate in the circulation, and be deposited 
 here and there in suitable places. Under such circumstances, there 
 arises a tendency for its accumulation in a temporary manner in 
 the lower and more spherical cells of the cuticle, from which it is 
 removed by their gradual exuviation and destruction as they be- 
 come superficial. The temporary deposit of the coloring matter in 
 this situation imparts to the skin a shade more or less deep. It 
 may amount to a perfect blackness ; for the origin of the black pig- 
 ment of the negro is the same as that of the black pigment of the 
 eye in all races, and the predominating percentage of iron it pre- 
 sents plainly betrays that it arises from a degenerating hsematin, 
 in which the same metal abounds." 
 
 u I believe, therefore, that the coloration of the skin, whatever the 
 particular tint may be, tawny, yellow, olive red, or black, is con- 
 nected with the manner in which the liver is discharging its func- 
 tion. That deposits of black pigment can normally arise in the 
 way of a true secretion by cell action is satisfactorily proved by 
 their occurrence in angular and ramified patches in the skin of such 
 animals as the frog ; and that hasmatin, in its degeneration, may 
 give rise to many different tints, is substantiated by the colors ex- 
 hibited by ecchymoses." The great difficulty in our study of the 
 effect of climate consists in our want of positive and reliable know- 
 ledge of the early history of mankind. If we could trace the history 
 even of any one race or tribe for a sufficiently long period, the ques- 
 tion might be settled. 
 
CHANGE OF RESIDENCE. 295 
 
 CHANGE OF RESIDENCE. 
 
 RULES FOR PERSONS WHO GO FROM A COLD TO A TROPICAL CLIMATE. 
 
 Avoid arriving in a tropical climate during what is termed tl ;e 
 rainy season of the year ; this, with some little variation, according 
 to the place of destination, commences in August, and terminates at 
 the end of October, or beginning of November. 
 
 Your place of abode should be somewhat elevated, dry, open to 
 the air and sun. Marshy grounds, and stagnant waters, when acted 
 upon by a powerful sun, always send forth noxious exhalations and 
 vapors, which give rise to intermittent and remittent fevers, fluxes, 
 &c. "When obliged to inhabit a house which is situated low, it will 
 be prudent to occupy one of its highest apartments. 
 
 Expose yourself at first, as little as possible, to the intense heat 
 of the sun at mid-day, and cautiously avoid the dews and damp air 
 of the night. 
 
 Wear cotton* next to the skin, not linen. Gro early to bed, rise 
 betimes, making use very soon afterward of a cold bath, one of the 
 best means of counteracting the injurious influence of a warm 
 climate, and affording the most grateful sensations. 
 
 After cold bathing, take gentle exercise, the morning being pre- 
 ferable for this to any other part of the day. Avoid any exposure of 
 the body afterward to a current of air, and the drinking any cold 
 liquor when you are much heated. If at any time overtaken by 
 rain, so as to have yoar clothes wetted, change them as quickly as 
 possible. Pay strict attention to cleanliness, not only by changing 
 the linen once or twice every day, but also by minor ablutions of 
 different parts of the body with cold water. 
 
 Persons just arrived in a tropical climate should partake only 
 moderately of the delicacies of the table, and make a very temperate 
 use of vinous or spirituous liquors. Before dinner, a solution of pre- 
 served tamarinds in water, simple lemonade, or the liquor known by 
 the name of imperial, are appropriate drinks. 
 
 Such persons should also refrain from all amusement and exer- 
 cises of a heating nature. They should moderate all sensual grati- 
 fications, and cautiously guard against a costive state of the bowels, 
 by regularly repairing to the privy once or twice a day at a stated hour, 
 and then soliciting natural evacuations. If at any time these efforts 
 should- not be attended with due effect, one or two motions ought to 
 oe procured by the aid of an injection, or some cooling laxative. 
 
 * Flannel is, on some accounts, preferable to cotton. 
 
296 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 Soldiers and sailors are very apt to suffer, in a tropical climate, 
 from the effects of intemperance, conjoined with an exposure to 
 intense heat during the day, and moist air at night ; and it therefore 
 greatly behooves those who are placed in command over them, to be 
 as attentive as possible in preventing such occurrences. The health 
 of seamen, in particular, will much depend upon their avoiding undue 
 exposure to the sun, rain, night air, intemperance, unwholesome 
 duties on shore, and, in fine, to all such occupations as subject them 
 to excessive heat or noxious exhalations, as these never fail to be 
 highly dangerous to those not assimilated to the climate. 
 
 When pitching tents for soldiers or sailors on shore duties, the 
 driest and highest spots should be chosen, and under cover of these, 
 hammocks should be suspended. The men ought not to be suffered 
 to sleep on the ground. 
 
 Persons who come from a cold to a warm country are more liable 
 to many diseases, and particularly to fever, than the natives, and 
 those ^ho have been acclimated by time. The same exposure will 
 produce fever, or other disease, in a stranger, while the native and 
 old inhabitant will not be at all affected by it ; or even supposing 
 that both are attacked, the symptoms will be tenfold more urgent 
 and severe in the former than in the latter. 
 
 Observe a strict temperance in diet, living chiefly on veget- 
 ables and ripe fruits for the first two or three months, partaking very 
 moderately of pure wine, and avoiding, as much as possible, any 
 exposure to the intense rays of the sun during the day, and the cool 
 or damp air of the night, until the constitution has become assimi- 
 lated to the climate. In closing this article we give a word for those 
 who come from a warm climate. 
 
 The principal precaution to be observed by those who leave a 
 warm climate, and either visit or become settled inhabitants of a cold 
 one, is to arrive in the latter before the approach of winter, and to 
 make such a suitable change in every part of their dress as shall 
 effectually guard their bodies against the difference and vicissitudes 
 of the atmosphere which they must encounter. On this account 
 waistcoats and drawers of flannel should be worn by persons of both 
 sexes next to the body on the approach of cold weather, and the outer 
 garments should consist of articles of a close and warm texture. 
 
ATMOSPHERIC ELECTRICITY. 
 
 297 
 
 ATMOSPHEKIC ELECTEICITY. 
 
 Electricity is usually present in the atmosphere. The amount 
 varies with different seasons of the year and different hours of 
 the day. Atmospheric electricity has a positive effect on the health, 
 for good or evil. When the electricity is low — that is. when the 
 amount of positive electricity in the air is small, as in the middle 
 of the afternoon, or twenty-four hours before one of our north-east 
 storms — then we are apt to feel stupid, sleepy, and depressed ; then 
 our corns, bunions, and sores begin to ache, then neuralgia and 
 rheumatism and headache come on. These are not matters of ima- 
 gination ; they are realities. 
 
 The following table and remarks I quote from the report of Dr. 
 Wislizenius, of St. Louis : 
 
 " Yearly Mean of Positive Electricity, of Temperature, and of 
 Relative Humidity of the Atmosphere at the hours of 6, 9, 12, 
 3, 6, and 9, from morning till night, "based upon daily observa- 
 tion at those liours in 1861, 1862, 1863, 1864, and 1865, at St. 
 Louis, Mo. 
 
 ELECTRICITY. 
 
 Year. 
 
 6 A.M. 
 
 9 A.M. 
 
 12 m. 
 
 3 p.m. 
 
 6 P.M. 
 
 9 p.m. 
 
 1861 
 
 8.5 
 8.9 
 10.5 
 7.9 
 6.1 
 
 9.9 
 
 10.0 
 
 10.6 
 
 8.8 
 
 7.1 
 
 9.0 
 
 9.1 
 
 10.0 
 
 7.4 
 6.0 
 
 7.7 
 7.3 
 7.5 
 5.4 
 5.3 
 
 8.5 
 8.1 
 9.1 
 5.9 
 5.4 
 
 6.8 
 
 1862 ..'. 
 
 6.8 
 
 1863 
 
 7.4 
 
 1861 
 
 5.5 
 
 1865 
 
 3.8 
 
 
 
 Mean 
 
 8.4 
 
 9.3 
 
 8.3 
 
 6.6 
 
 7.4 
 
 6.1 
 
 
 
 REMARKS. 
 
 " The above table contains a summary of my observations of 
 atmospheric electricity, for five years. They are based upon five 
 daily observations, made with Dellman^s instruments. As a result 
 of these researches, I have found the following laws : 
 
 " 1. The positive electricity, floating generally in our atmosphere, 
 exhibits a daily periodicity, by two maxima and two minima in 
 twenty-four hours, a first maximum appearing about 9 a.m., a sec- 
 ond about 6 p.m. ; and a first minimum about 3 p.m., and a second 
 about 9 p.m., which is continued till after midnight. 
 
 " 2. Besides this daily periodicity, there exists a monthly one. 
 
298 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 The far greater quantity of positive electricity appears in the colder 
 half of the year, and the lesser in the warmer half. 
 
 " 3. There is possibly also a yearly periodicity of eleven years, fol- 
 lowing the same periodicity that exists between terrestrial and solar 
 magnetism — between the declination of the magnetic needle and 
 the solar spots. The present period extends from 1859 to 1870, 
 with maxima at these two end points, and with a minimum in the 
 middle, in 1865. The uncommonly low mean of electricity in 
 1865, which cannot be accounted for by other meteorological phe- 
 nomena, seems to favor this supposition ; but observations must be 
 continued for many more years to decide that point." 
 
 This subject of the dependence of mental states on atmospheric 
 electricity is one of exceeding interest. It is only recently that we 
 have had observations concerning atmospheric electricity sufficiently 
 detailed and reliable to be of service in studying this dependence of 
 the character on the electrical state of the atmosphere. The writ- 
 ings of Dr. Wislizenius, above quoted, are of special value, be- 
 cause he is one of the very few who have given this subject atten- 
 tion. 
 
 In the morning, between 9 and 12 o'clock, we can usually work 
 better than at any other portion of the day. This is the time of the 
 day when there is the greatest amount of positive electricity in the 
 air. 
 
 Between midnight and sunrise there is less positive electricity 
 in the atmosphere than at any other time of the day. This is the 
 time when, as we are told, more people die than at any other period 
 of the twenty-four hours. 
 
 In the winter — in December and January especially — there is 
 more positive electricity in the air than at any other season of the 
 year. These are the months when we feel most like work. These 
 are the months that students love. 
 
 In the summer, in July and August especially, there is less posi- 
 tive electricity in the air than at any other season of the year. 
 These are the months when we feel least like work. 
 
 Some attention has been given to the relation between atmos- 
 pheric electricity and disease. The subject is yet in an unsettled 
 condition, but some of the theories that have been advanced are at 
 least suggestive. It is believed by some that our epidemics are 
 caused by electrical changes. It is even claimed that the very fami- 
 liar disease, intermittent fever, is caused by disturbances in the 
 atmospheric electricity. 
 
 These theories have not commanded much attention, and are 
 not generally accepted. 
 
MANAGEMENT OF SICK-ROOMS. 299 
 
 MANAGEMENT OF SICK ROOMS. 
 
 FURNITURE. 
 
 This should always be both selected and arranged so that every 
 article whenever wanted, and however suddenly, may be instantly 
 found, and without needless disturbance of the patient in any way. 
 In cases of severe sickness (to which alone we here refer) the sick 
 room should be disencumbered of all needless furniture ; and all 
 which can avail to the comfort and convenience of the invalid, 
 should, if possible, be procured. 
 
 One small table should stand near the bed for all articles wanted 
 for frequent use, such as glasses, cups, spoons, drinks, medicines for 
 the day, &c. 
 
 A larger table placed more remotely from the bed, should also be 
 provided for medicines and utensils occasionally used, and for an 
 extra supply of pure water. This should be furnished, and from time 
 to time replenished, and amply, with articles necessary to the vari- 
 ous ministrations of the sick room, that the patient may not be dis- 
 turbed by the opening and closing of the door whenever any such 
 article may be suddenly needed. 
 
 There should always be in the room a convenient place of deposit 
 for broad and narrow tape ; old, clean linen ; sponges ; lint ; rolls 
 of muslin ; linen and flannel bandages about two inches wide ; pins, 
 needles, thread, scissors, plasters, &c, that they may always be at 
 hand upon any possible emergency. 
 
 Drawers should be furnished for a plentiful supply of clean, well- 
 aired linen. Soiled linen should never be allowed to remain in the 
 room a moment. 
 
 Again — provide a distinct place of deposit for an abundance of 
 towels. 
 
 Let the wash-stand be constantly provided with additional ves- 
 sels, and with an abundance of water. 
 
 A sofa, easily moveable, or something which will answer the 
 same purpose, is very desirable — sometimes essential — for the com- 
 fort of the patient when the bed-linen needs to be changed. 
 
 The entire room should be carpeted for the sake of stillness, clean- 
 liness and dryness. If but a part of the room can be thus covered, 
 let the remainder never be washed, but swept, and (to avoid annoy- 
 ing the patient) with a brush, rather than with a broom. 
 
 A matress, a bed-pan, a pillow stuffed with curled horse-hair, or 
 one made of India-rubber, to be filled with air, a thermometer, a 
 pair of apothecaries' scales, a basin — when it can be procured — 
 graduated to ascertain the quantity of blood taken by bleeding, a 
 
300 HYGIENE, OB THE ART OF PRESERVING HEALTH. 
 
 minim measure, to measure precisely the quantity of fluid medi- 
 cine to be given at a dose, a syringe for the bowels, and a common 
 nurse lamp, should always be at hand. "With these articles every 
 family should at all times be provided. Most of them can be obtain- 
 ed at small expense. 
 
 No kettle or any implement of cooking should be allowed in thf* 
 room. The nurse lamp will answer for heating fluids. 
 
 BEDS AND BEDDING. 
 
 Beds without curtains are always preferable. In cases of fever 
 especially, the matress should be placed uppermost. The bed-clo- 
 thing should not be burdensome, and should be immediately remov- 
 ed and well aired, when the patient is transferred from the bed. The 
 sheets used at night should be exchanged for others in the morning, 
 and again used, if not soiled, at night. If this latter cannot be done, 
 the sheets should be changed once in twenty-four hours, especially 
 when the fever is infectious. This will essentially prevent its com- 
 munication to the blankets or to the furniture of the room. 
 
 NOISE. 
 
 Even the slightest is excessively irritating and therefore injuri- 
 ous to the sick. To prevent it — open and shut the doors with the 
 utmost gentleness, list them and oil their hinges — check the whist- 
 ling of the wind through doors, windows, and key-holes — move all 
 articles in the room with care — let every person in the room be shod 
 with slippers or with something equivalent — forbid all needless con- 
 versation even in whispers, for concealed conversation will very 
 probably excite the jealousy and fears of the patient — and let no 
 neighbors enter the room merely to gratify curiosity, to express sym- 
 pathy or to give advice. If their services are needed, employ them 
 and thank them ; otherwise exclude them. Medicines and medical 
 skill have often been baffled, and the lives of the sick sacrificed by 
 the intrusion, always agitating, of friends whose assistance is not 
 needed. 
 
 VENTILATION. 
 
 Ventilation is always of primary importance, particularly in 
 those fevers in which miliary eruptions display themselves ; under 
 no circumstances is it so essential as in febrile diseases of an infec- 
 tious kind. Infection, however, rarely extends above a few feet 
 from the body of the patient ; and, even in the most malignant dis- 
 eases, with the exception of confluent small-pox and malignant 
 scarlet-fever of the worst kind, its influence does not exceed a few 
 
MANAGEMENT OF SICK-ROOMS. 301 
 
 yards if the room be well ventilated. On the contrary, if ventilation 
 be neglected, the power of infection becomes greatly augmented, it 
 even settles upon the clothes of the attendants and on the furniture 
 of the room ; and these imbibe it most readily when their texture is 
 wool, fur or cotton, or any loose or downy substance capable of re- 
 ceiving and readily retaining the air. Smooth and polished surfaces 
 do not easily receive or retain infectious matter ; consequently the 
 nurses and attendants, in cases of infectious diseases, should have 
 glazed gowns, and aprons of oiled silk. 
 
 In no infectious diseases are these rules more essentially necessary 
 than in small-pox and scarlet-fever. It is well known that if the 
 bed-clothes of a patient laboring under either scarlet-fever or small- 
 pox be closely folded up, they will retain the infectious matter, and 
 communicate the disease at a great distance of time ; but the influ- 
 ence of free ventilation is so great, that medical practitioners who are 
 attending small-pox patients, and who go from them into the open 
 air, do not spread the disease. Indeed all infection is weakened by 
 dilution with air. The danger of infection is augmented, if, along 
 with bad ventilation, the atmosphere of the room be moist from any 
 cause. 
 
 Infectious matter, even of the most virulent description, is not 
 poisonous to every one within its influence. A predisposition of the 
 body to receive the infection must exist before it can be communi- 
 cated : a condition which is augmented by fatigue and watching, de- 
 fective nourishment, mental depression, or anything which can lower 
 the vital powers. The necessity, therefore, of maintaining these 
 powers by attention to rest, a sufficient quantity of good and generous 
 diet, and cheerfulness of mind, need not be insisted upon. 
 
 In every case of infectious disease, the attendants, even in the 
 best ventilated rooms, should stand on the windward, or on that 
 side of the sick-bed from which the current of air comes ; as by 
 neglect of this rule, and by standing in the current which has passed 
 over the patient, the infectious exhalations are blown upon them in 
 a direct stream from the body of the patient. The attendants should 
 never lean over the sick, nor should they receive their breath. The 
 health also of the nurses should always be supported by a nutritious 
 and generous diet. 
 
 The term infection, in its most extensive signification, implies 
 some deleterious matter, originating from any source and transmitted 
 through the air, which is capable of causing diseases in the human 
 body. When this matter is emanated from the diseased bodies of 
 men, the term is frequently regarded as synonymous with conta- 
 gion ; but, in strictness of language, the latter refers only to the 
 
302 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 communication of disease by contact. To prevent the communication 
 of disease by infection, not only is it necessary to dilute the atmo- 
 sphere of the room with pure air, but also to destroy the virulence 
 of the infecting matter by chemical agents or fumigations. (See 
 Disinfectants^) But no such agent is equivalent to cleanliness, fre- 
 quent changes of the sheets and linen of the patient, and free venti- 
 lation, for checking the propagation of infection. 
 
 TEMPERATURE. 
 
 Next to ventilation, nothing is of more importance than the regu- 
 lation of the temperature of the sick-room, avoiding both extremes of 
 elevation or of depression ; but much depends on the nature of the 
 disease. 
 
 The best general temperature of a sick-room is 60° (Fahr.), 
 or that of summer in this climate ; and it is preferable to regulate 
 this rather by the thermometer than by the sensations of the patient 
 or the attendants. Under some circumstances, however, the feelings 
 of the patient, and his susceptibility of impressions upon the skin, 
 should not be overlooked. Thus, if the temperature be a little above 
 that of summer, and the patient, nevertheless, feel chilly, it should 
 be raised five or six degrees. This chilliness is very apt to be felt in 
 a dyspeptic state of the habit, and more especially when it is accom- 
 panied with hypochondriasis. It differs from that more severe but 
 transient coldness which accompanies intermittent fevers and some 
 other periodical affections ; and it requires only an elevated tempera- 
 ture of the air for its removal, whilst the cold stage of intermittent 
 diseases is best relieved by the warm bath, either general or local. 
 
 So important is the regulation of temperature, especially in fevers, 
 that it often does more good than any other remedial measure. I 
 have seen patients laboring under high delirium, in a close, ill vent- 
 ilated room, become rapidly quite collected by merely lowering the 
 heat of the apartment twelve or fifteen degrees. On the contrary, 
 even a moderate depression of the usual temperature of the sick- 
 room, in pulmonary diseases, will excite coughing and augment the 
 severity of all the symptoms. 
 
 In regulating both the admission of air into the apartments, and 
 temperature of the bed-rooms of the sick, in particular of those sus- 
 ceptible of pulmonary diseases, much caution is requisite not to over- 
 heat, nor to keep too dry, the air of the room. 
 
MANAGEMENT OF SICK-ROOMS. 303 
 
 CLEANLINESS. 
 
 Although cleanliness in the sick-room is essential, yet it may be 
 carried so far as to become an annoyance to the invalid, and conse- 
 quently to prove injurious. It is not requisite to sweep the room 
 daily, nor to dust and to arrange the furniture every morning, pro- 
 vided order be preserved in the room, and nothing but what is im- 
 mediately necessary for the comfort and the convenience of the in- 
 valid be permitted to remain in it. It is truly distressing to observe 
 the confusion which prevails in some sick-rooms : everything being 
 out of place, and to be searched for when it is wanted. 
 
 The period chosen for cleaning and arranging the sick room should 
 be the morning ; as, after a night's rest, the patient is more able tc 
 bear the little noise and bustle which it always more or less occa- 
 sions. The carpet should be sprinkled with moist tea-leaves and 
 lightly swept ; and, during this operation, the curtains of the bed, 
 if there be any, should be drawn. 
 
 It is scarcely requisite to insist on the necessity of the utmost 
 attention to the cleanliness of everything in the sick room. The mo- 
 ment after any vessel or implement is used by the invalid, it should 
 be removed from the apartment, and returned as soon as it is clean- 
 ed. Nothing in the form of a slop-basin or a slop-pail is admissible: 
 they only administer to the laziness of nurses. 
 
 The necessity of cleanliness in the vessels used for the food of 
 invalids is strikingly illustrated in the bad effects arising from the 
 neglect of it when an infant is brought up by hand. In such a case, 
 if either the feeding-bottle or the boat which is employed be not 
 instantly cleansed after the meal has been given, the small portion 
 o r - the pap or food which remains in the vessel becomes sour, and 
 taints the whole of the fresh food mixed with it, causing colic and 
 convulsions in the infant. The same risk of injury occurs in the 
 sick-room, if the vessels used for administering food to the invalid 
 be not instantly and well cleansed, after every time they are used. 
 
 It is too customary, also, to use one glass or cup for administer- 
 ing medicines, and to leave it unrinsed from time to time — a custom 
 which may prove as deleterious as a defect of cleanliness of vessels 
 employed for food. Some medicines, when they are exposed to the 
 air, rapidly undergo changes which alter their properties ; and this 
 alteration having been undergone by the small portion which is al- 
 ways left in the glass or cup, communicates the disposition to be 
 decomposed to that which may be next poured into the cup. An 
 active medicine may be thus rendered inert ; or one which is mild in 
 its operation may be so changed as to operate with hazardous energy. 
 
3(M HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 The same precaution, as to cleanliness, is also requisite with respect 
 to the minim measure, when the medicines are directed to be ad-, 
 ministered in a form which requires its employment. 
 
 FUMIGATIONS AND DISINFECTANTS. 
 
 It is necessary to preserve the sick-room free from all smells, and 
 in as pure a state as possible. But this is difficult to be done when 
 typhoid fever is present, or when any disease which is under treat- 
 ment is accompanied with ulcers on the legs or on other parts of the 
 body ; and the difficulty is increased when the complaint is cancer, 
 or when mortification occurs. In such cases, chloride of lime should 
 be sprinkled over the floor of the room ; and dishes containing it mix- 
 ed with water placed in different parts of the apartment, and fre- 
 quently replenished. 
 
 "Whenever infectious or contagious fevers occur, fumigations are 
 employed to prevent the spreading of the deleterious effluvia which 
 emanate from the bodies of the invalids, and the extension of the 
 diseases. 
 
 They are also necessary after these diseases ; for the tenacity 
 with which the infectious matter adheres to the substances in the 
 sick-room is scarcely credible. 
 
 It is often, therefore, of as much importance to purify an apart- 
 ment and its furniture after the termination of an infectious disease, 
 as during its existence. In this case, the fumigation with chlorine 
 about to be described should be used after the floor of the room and 
 every solid thing in it have been washed with soap and water ; and 
 all bright metallic substances, such as pokers, tongs, and fenders, 
 have been removed from it. The walls should afterwards be white- 
 washed, or fresh painted or papered, and the room thrown open to 
 the air for some time before it is again inhabited. 
 
 It may be said that fumigations are not to be solely relied upon; 
 and that they ought never to supersede ventilation or cleanliness. 
 Whilst this must be admitted, it would be absurd to deny their util- 
 ity ; consequently, their nature and the mode of employing them 
 should be understood. 
 
 Fumigations of the most varied kind have been suggested and 
 employed for this purpose ; namely, Pastiles, Tobacco, Camphor, 
 Vinegar, Ammonia, the Mineral Acids, and Chlorine. 
 
 Pastiles, Tobacco and Camphor, are unworthy of the slightest 
 confidence as agents for neutralizing infection. Merely to diffuse an 
 agreeable smell throughout the sick apartment, pastiles and camphor 
 may very properly be employed, but further than this, they ought 
 not to be relied on. 
 
MANAGEMENT OF SICK-ROOMS. 305 
 
 Vinegar is, not without reason, regarded as possessing some 
 chemical influence in decomposing infectious and contagious mat- 
 ters ; and, consequently, it is almost invariably sprinkled over the 
 floor of the rooms of those suffering under infectious diseases ; or the 
 vapor of hot vinegar is diffused through their apartments. It is 
 thought to be still more salubrious, and a more powerful disinfectant, 
 when it holds camphor or aromatic oils in solution ; hence the great 
 popularity of the preparations called Aromatic Vinegar and Thieves 1 
 Vinegar. 
 
 Vinegar, in this state of combination, is extremely agreeable and 
 refreshing, both to the invalid and the attendants of the sick-room. 
 The benefit which it produces depends upon a certain degree of stim- 
 ulus imparted to the sensitive nerves, which are generally in a low 
 condition in an infectious atmosphere : but, as a chemical agent, its 
 powers are too feeble to be followed by much benefit. 
 
 The most efficacious fumigation which has yet been proposed is 
 chlorine. This is extricated from the decomposition of muriatic 
 acid by peroxide of manganese ; but this is too expensive a process 
 for ordinary occasions. The best materials, and the proportions of 
 them, for extricating chlorine at a cheap rate was ascertained by Dr. 
 Faraday, in the disinfection of the Millbank Penitentiary : — namely, 
 two ounces of powdered peroxide of manganese, mixed with ten 
 ounces of chloride of sodium (sea-salt), and six ounces of strong sul- 
 phuric acid, diluted with four ounces of water. This quantity of 
 materials is sufficient for purifying a room forty feet by twenty. The 
 mixture should be put into a porcelain cup or basin, which should 
 be placed in a pipkin of hot sand. The doors and the windows of 
 the room being shut, the fumigation may be left in it for ten or 
 twelve hours ; after which, both the doors and the windows should 
 be thrown open, to admit a current of air to pass through the apart- 
 ment and carry off the chlorine. 
 
 One objection exists to the employment of the above mode of ex- 
 tricating chlorine in apartments which are inhabited ; namely, its 
 powerful irritant influence on the lining or mucous membrane of the 
 air tubes in the lungs, and the cough which it excites. In order to 
 obviate these inconveniences, the chloride of lime is employed ; 
 which, by attracting the carbonic acid of the air, and causing the 
 conversion of the lime into a carbonate of lime, separates the chlorine 
 in a free or gaseous state. The chloride of lime should be mixed 
 with water, in the proportion of one part to forty of the water, in a 
 flat dish or plate, so as to expose a large surface to the action of the 
 air ; and the dish holding this mixture should be placed on a table, 
 on the leeward side of the bed of the patient. The floor of the sick- 
 20 
 
306 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 room should be also sprinkled with it ; and rags, moistened with it, 
 suspended in different parts of the room. The solution of chloride of 
 soda may be employed instead of the chloride of lime. 
 
 If the putrid odor in a sick-apartment do not arise from the 
 general state of the system of the invalid, but from ill-conditioned 
 ulcers and sores, these should be washed and poulticed with the solu- 
 tion of chloride of soda, which operates not only by destroying the 
 foetor, but by improving the condition of the sores. 
 
 Chlorine, even when extricated from chloride of lime, or from 
 chloride of soda, is apt to excite coughing in those unaccustomed to 
 breathe it. But the nurse should be made aware of this fact ; and 
 should so apportion the quantity of the materials on the first intro- 
 duction of it into the room, that it may cause no such effect : and by 
 afterwards adding to the number of the dishes in which it is distri- 
 buted through the room, no inconvenience will result ; the lungs 
 being thus gradually accustomed to the irritant impression. 
 
 The decomposition and consequent development of the chlorine 
 is much quickened by placing a piece of coarse calico in the bottom 
 of the vessel containing the chloride of lime or the chloride of soda 
 and water. 
 
 Dr. Ellis thus speaks of some of the best known disinfectants : 
 
 " M. Bonjeau directs charcoal, well powdered, two pounds ; 
 sulphate of iron, one pound ; to be mixed, of which two or three 
 tablespoonfuls are to be placed in the chamber vessels used by the 
 sick. 
 
 "Dr. Procter has great confidence in iodine placed in open sau- 
 cers about the room, or gently volatilized by moderate heat. 
 
 "Burnett's fluid consists of a saturated solution of chloride of zinc. 
 
 " Collins's disinfecting powder contains dry chlorinate lime, two 
 parts ; burnt alum, one part ; used dry or moistened with water. 
 
 " Condy's fluid is a solution of the alkaline permanganates. 
 
 "Ellermann's deodorizing fluid consists of a solution of the per- 
 chloride of iron and the chloride of manganese. 
 
 " Ledoyen's disinfectant is a solution of two troy ounces of nitrate 
 of lead in a pint of water. 
 
 " Siret's compound No. 2 contains sulphate of iron, 20 parts ; 
 sulphate of zinc, 10 parts ; oak-bark, powdered, 4 parts ; tar and 
 oil, each one pint ; made into balls. Used for deodorizing cesspools. 
 
 " Professor K. E. Rogers advises a mixture of quick-lime and sul- 
 phide of iron. 
 
 " The U. S. Army disinfectant consists of a powder of common 
 salt and binoxide of manganese in packages, upon which is to be 
 poured in a shallow dish a solution of sulphuric acid and water 
 
MANAGEMENT OF SICK-ROOMS. 307 
 
 At the present time carbolic acid is largely used as a disinfec- 
 tant. It is certainly very efficacious. 
 
 Earth closets are now being introduced, and must in time become 
 very popular. 
 
 "In the commode, the apparatus and earth reservoir are self- 
 contained, and a movable pail takes the place of the vault. This 
 must be emptied as often as necessary, and the contents may be ap- 
 plied to the garden or field, or be allowed to accumulate in a heap 
 under cover until wanted for use. This accumulation is inodorous, 
 and rapidly becomes dry. For use in bedrooms, hospital wards, 
 infirmaries, &c, the commode is invaluable. It is entirely free 
 from those faint, depressing odors common to portable water-closets 
 and night-stools / and through its admission one of the greatest 
 miseries of human life, the foul smells of the sick-room, and one of 
 the most frequent means of communicating infection, may be en- 
 tirely prevented. It is invariably found that if any failure takes 
 place, it arises from the earth not being properly dry. Too much 
 importance cannot be attached to this requirement." 
 
 NURSES. 
 
 When all the arrangements are completed in the sick-room, little 
 benefit can be anticipated if a proper nurse be not obtained to render 
 them available to the invalid. Before describing the qualifications 
 requisite to constitute an efficient nurse, we cannot avoid embracing 
 this opportunity of mentioning the great difficulty of procuring prop- 
 erly instructed nurses in this country. It is, indeed, to be greatly 
 lamented, that, amidst the numerous improvements which charac- 
 terize the present era, the females who assume to themselves the 
 character of sick nurses, and are employed as such, are still left to 
 acquire information, respecting the important duties which their 
 office demands, from imperfect experience, or from accident. We 
 expect that the skill of our medical attendants shall be certified by 
 diplomas and licences before they are permitted to practice; but we 
 leave their orders to be executed by the ignorant and the prejudiced, 
 who not only too often fail in performing what they are ordered, but 
 who, with the usual temerity of ignorance, presume to oppose their 
 own opinions to those of the physician. 
 
 In hiring a sick-nurse, the qualifications which should regulate 
 our choice, refer to age, strength, health, temper ', disposition, habits, 
 and education. 
 
 1. Age. She should not be under twenty-five, nor above fifty 
 
308 HYGIENE, OE THE ART OF PRESERVING HEALTH. 
 
 years of age. This period is fixed upon, on account both of the phy- 
 sical powers and the moral conduct of the individual. Under twenty- 
 five, the strength of a woman has not reached its maturity, and is 
 scarcely adequate for lifting patients in and out of bed, and for many 
 other duties which require strength, connected with the office of a 
 nurse ; but the strength and the muscular power in females begin 
 to fail after fifty-five, when the natural transition from maturity to 
 decay takes place. There is also a greater proneness to disease at 
 this age than in the middle period of life. 
 
 2. Strength. Whilst strength is requisite, the frame should be 
 such as to indicate activity. The stature should not exceed the me- 
 dium degree ; a little below this being less exceptionable than a little 
 above it, provided the appearance displays a frame well knit together. 
 Obesity and a heavy movement are objections, as they are frequently 
 connected with self-indulgence, defective energy, and an inability to 
 keep awake, or to be easily aroused from sleep. 
 
 3. Health. None of the qualifications of a sick-nurse are of more 
 importance than health. An individual who herself requires atten- 
 tion is ill calculated to attend upon others. 
 
 4. Temper and Disposition. It is scarcely requisite to say that 
 an attendant upon the sick should possess a happy, cheerful, equal 
 flow of spirits ; a temper not easily ruffled ; and kind and sympathe- 
 tic feelings ; but, at the same time, not such as to interfere with 
 firmness of character. 
 
 When the mind is weakened, and the nervous system 
 morbidly susceptible, a harsh look or an unkind expression sinks 
 deep into the mind of the invalid ; and when the disease is of 
 a nervous kind, a melancholy, anxious, or forboding look, or one 
 which in any degree indicates an apprehension of danger, either in 
 the physician or the nurse, instantly excites alarm in the mind of 
 the invalid ; and may counteract, in a great measure, the influence 
 of the medical treatment. 
 
 On the other hand, a collected, cheerful expression of counte- 
 nance, in the attendant on the sick, is likely to inspire hope, and to 
 aid the efforts of the physician for the recovery of his patient. 
 
 The general disposition of a sick-nurse should be obliging. Every 
 little office which the invalid may require to be done, should be per- 
 formed at once, and without the smallest apparent reluctance, even 
 when the necessity for its immediate performance is not absolute. 
 There is also an earnestness of manner, which should, if possible, be 
 obtained, or acquiesced in, by the sick-nurse ; as it impresses the 
 idea that she feels deeply interested in the case ; a circumstance 
 which is always highly appreciated by the patient. 
 
MANAGEMENT OF SICK-ROOMS. 309 
 
 "With respect to gossiping, it is a detestable habit under any cir- 
 cumstances ; but, in a nurse, it may be productive of the greatest 
 danger, produce family feuds, and a thousand other evils. 
 
 5. In her habits , a sick-nurse should be sober, active, orderly, ana 
 clean and neat in her person. 
 
 The activity essential for a good nurse does not imply a bustling 
 or fidgety manner, but a quiet, steady method of proceeding in the 
 performance of her duties, equally devoid of fluster, turbulence, or 
 noise. This activity is generally associated with orderly habits ; a 
 most valuable qualification, and without which the sick-room becomes 
 a scene of confusion and disgust. Every medical man must have 
 witnessed this state of disorder with regret : when, on visiting his 
 patient, he finds no chair to sit upon, until some article of bedding, 
 or of clothing, be removed from it, and the seat dusted with the apron 
 of the nurse ; and when a former prescription, or any thing else, is 
 wanted, he must wait until the nurse rummages out half a dozen 
 of drawers in search of it. 
 
 Another quality, usually conjoined with activity and orderly 
 habits in a nurse, is cleanliness in her own person, and in that of her 
 charge, as well as that of the sick-room. The dress of a nurse 
 should be simple and neat, without trimmings. Nothing is more 
 out of place than a fine lady attempting to perform the duties of a 
 nurse. Whatever may be the stuff of which it is made, the apron 
 should have pockets in it, in the fashion of the Parisian servants. 
 Neither the gown, nor any of the outer garments, however, should be 
 woolen, especially if the disease be infectious ; as owing to its 
 spongy tissue, woolen is apt to absorb and retain the infection. 
 "When the disease is decidedly infectious, the apron of the nurse 
 should be made of glazed calico, or oiled silk. 
 
 Every nurse should be able to read and write. The bettei 
 informed, the less likely is she to be biased by low prejudices. A 
 nurse, also, who cannot read, may be the cause of much mischief in 
 the administration of medicines. 
 
 The term " an experienced nurse," is supposed to comprehend 
 every good quality. Experience deserves to be much and justly prized 
 in a nurse, were the term not too frequently misapplied, and confidence 
 placed in the nurse merely because she is advanced in years and has 
 seen much, without any inquiry as to her capacity for observing, 
 and making a proper use of what she has seen. Number of years 
 and much opportunity are not a guaranty of wisdom nor of true expe- 
 rience. Age may undoubtedly be supposed to afford the means of 
 enlarging the ideas ; but every one is not endowed with the power oi 
 benefiting by the best opportunities ; and it is here that the advan- 
 
310 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 tages of education are displayed in the nurse. Without it, seventy 
 years may have only added to her sum of stupidity. The poor wo- 
 man has had eyes ; but she has never fixed them with attention 
 upon what was before them ; and when she has accidentally observ- 
 ed, having no capacity for generalization, the observations, like most 
 isolated facts, have been lost. She is a mere creature of routine ; a 
 machine moved by custom or prejudice ; whereas the properly edu- 
 cated nurse acquires the power of observing and comparing, and 
 consequently of reflecting and drawing proper conclusions. 
 
 COOKERY FOR THE SICK AND THE CONVALESCENT. 
 
 The cookery for the sick and the convalescent is confined to the 
 simple processes of boiling, baking, and roasting. Before entering 
 into the details of Sick-room Cookery, therefore, it will be useful to 
 offer a few remarks upon the principles which render these processes 
 serviceable in the preparation of food. 
 
 1. Boiling softens the animal fibre, and enables it to be more 
 readily and effectually acted upon by the juices of the stomach ; but, 
 at the same time, it robs it of some of those nutritive matters which 
 are soluble in boiling water. Much depends, however, on the slow 
 or the rapid manner in which the process is conducted. If the 
 boiling be too quick, it coagulates the albuminous matter of the 
 meat, renders the flesh on the outside hard, whilst the interior is not 
 sufficiently done ; consequently, quick boiling diminishes its digesti- 
 bility. In boiling meat, the water should scarcely be brought to the 
 boiling temperature ; and it should be long kept at a lower than a 
 boiling point of heat, or at that state which approaches more to 
 simmering than to boiling. Every kind of meat for invalids, except 
 poultry, should be put on the fire with cold water, and very slowly 
 boiled. 
 
 The nature of the water is also of some importance. Beef or 
 mutton boiled in hard water is always more tender and juicy than 
 when soft water is employed ; a fact, probably, depending on the 
 solvent properties of the water increasing in the ratio of its density. 
 Fish, on the contrary, is rendered firm in the ratio of the hardness of 
 the water in which it is boiled. Hence, fish boiled in sea-water, or 
 in water containing much salt, is always firmer and more highly- 
 flavored than that which is boiled in soft water, or water without salt. 
 
 Vegetables require rain or soft water, with the addition of salt. 
 
 
SICK-ROOM COOKERY. 311 
 
 In general, they are rendered indigestible from being too little boiled. 
 This is especially the case with respect to the cabbage, the cauli- 
 flower, brocoli, turnips, and peas ; which, too frequently, are cooked 
 rather to please the eye than to afford nutriment. For the sick-room, 
 vegetables should be boiled in two waters ; when too little boiled, 
 they prove highly injurious. 
 
 2. Stewing requires the heat to be kept under the boiling point ; 
 and a small quantity of water only is required. It softens the meat? 
 and renders it more readily acted upon by the juices of the stomach 
 than when it is boiled ; stewed meat, therefore, is a good form of 
 cookery for the convalescent. 
 
 3. The process of Baking is inadmissible for the preparation 01 
 animal food for either the sick or the convalescent ; but it may be 
 employed in the preparation of light puddings for the latter. The 
 surface of the puddings, however, should not be browned by the aid 
 of butter. 
 
 4. Roasting softens the tendinous parts of animal food better than 
 boiling, and it retains more of the nutritive principles of the meat ; 
 hence, if the meat be neither too little nor too much done, roasted is 
 more nutritive than boiled meat ; but it is less easily digested. This 
 fact is demonstrated by the comparative loss which takes place in 
 these two modes of cooking. It has been ascertained that mutton 
 loses one-fifth and beef one-fourth of its weight by boiling ; but both 
 lose only a little more than one-sixth in the process of roasting. The 
 digestibility of the meat, however, being in the ratio of the softness 
 of the fibre, that property is increased by slow boiling. It has, of late 
 years, been much the fashion to regard under-done roasted meat well 
 adapted for weak stomachs ; but no opinion is more erroneous. 
 
 The processed of frying and broiling are wholly incompatible in 
 cookery for the sick-room.* 
 
 The cookery for those actually suffering under the pressure of 
 disease differs considerably from that which is required to repair the 
 ravages of previous illness, and to restore the vigor and the strength 
 of the body in convalescence. The following directions are, therefore, 
 arranged under two distinct heads, namely, 
 
 1. Cookery for the Sick-room. 
 
 2. Cookery for Convalescents. 
 
 1. The cookery for the sick-room comprehends farinaceous 
 preparations, animal teas, broths, milks, and drinks. 
 
 FARINACEOUS PREPARATIONS. 
 
 The whole of these may be regarded as modifications of starch, 
 * Yide Human Health, by R. Dunglison, M. D. 
 
312 HYGIENE, OK THE ART OF PRESERVING HEALTH. 
 
 more or less pure. They are not capable of conveying much nourish- 
 ment into the habit; and being mild, and completely devoid of 
 stimulant properties, they are well calculated for the sick. 
 
 ARROW-ROOT MUCILAGE. 
 
 Arrow-root is a white, inodorous, insipid, light powder, procured 
 from the tubers of the Maranta arundinacea, or arrow-root plant, and 
 manufactured in the East and West-Indies, of which it is a native* 
 The powder is a pure starch, which, although insoluble in cold water, 
 yet forms a mucilage with boiling water. This mucilage is made 
 by rubbing the arrow-root powder with a little cold water in a basin, 
 by means of the back of a spoon, until it is completely mixed with 
 the water; then pouring boiling water over it, at the same time 
 stirring it assiduously until a soft, gelatinous, tenacious mucilage is 
 formed ; and, lastly, boiling it for five minutes. A table-spoonful of 
 the arrow-root powder is sufficient to make a pint of the mucilage. 
 It may be moderately sweetened, and rendered more palatable by the 
 addition of a little lemon-juice ; but cinnamon powder, or any 
 astringent substance, precipitates the starch, and destroys the 
 smoothness of the mucilage ; hence, if wine be ordered with it, Port- 
 wine should not be used. 
 
 TOUS LES MOIS. 
 
 This is a species of starch prepared from the rhizomes or tubers 
 of some species of Canna, either C. edulis, or coccinea, both of which 
 are natives of Peru. It is converted into a mucilage, and used in the 
 same manner as arrow-root, over which it possesses no superiority. 
 The great advantage of both, indeed, as articles of diet for the sick, 
 depends on the small quantity of nutriment which they convey into 
 the habit. It is often useful to satisfy the prejudices of the friends 
 of invalids, by the appearance of supplying nourishment, when it 
 would prove injurious. 
 
 MUCILAGE OF SAGO. 
 
 Sago-f is the pith of several species of Palms and Cycadeae, 
 
 * In the island of Portland, the farina of the roots of the Arum maculatum, cuckow- 
 pint, which grows abundantly there, is manufactured into starch, and sold under the name 
 of British arrow-root. Much potato starch is also sold as arrow-root. The fraud, however, 
 is not a hurtful one, as the properties of these starches do not materially differ. Potato 
 starch mucilage sooner becomes sour than arrow-root mucilage. 
 
 f There are three varieties of Sago known in European commerce ; namely — Sago of 
 the Maldives, in brownish-grey grains, possessing few of the chemical properties of starch ; 
 2, Sago of New Guinea, in grains of a brick-red hue, passing to dull white ; it is a nearly 
 pure starch ; 3, Malacca Sago, of which there are three kinds — a, in fawn-colored grains, 
 
SICK-ROOM COOKERY. 313 
 
 natives of tropical climates : the best is that made by the Chinese at 
 Malacca, and known in commerce by the name of Pearl Sago 
 It resembles rotyidish seeds, of a brownish-grey color, passing to 
 pearl-white, or brick-red passing into dull- white. When soaked in 
 water, at a moderate temperature, it absorbs from five to ten times 
 its weight of water, swells, and becomes transparent. It consists of 
 starch, with a small proportion of salt. 
 
 To make Sago into a proper Mucilage for the sick, an ounce or 
 a table-spoonful of it should be macerated in a pint of water, in a 
 pan placed on the stove, or on a hot plate, for two hours, and then 
 boiled for fifteen minutes, stirring assiduously during the boiling. 
 The Mucilage may be sweetened with sugar, and flavored with 
 lemon-juice ; or milk may be added to it, according to circumstances. 
 Like other farinaceous mucilages, it affords very little nourishment ; 
 and is, therefore, well adapted for invalids laboring under acute 
 diseases. 
 
 MUCILAGE OF TAPIOCA. 
 
 Tapioca is the pith of the roots of Jatropha Manihot, sl native of 
 Brazil, which, although combined with a poisonous principle in the 
 fresh state, yet is easily freed from it by washing in cold water, after 
 the roots are barked and crushed. The fecula is then dried and gran- 
 ulated. It resembles Sago ; but it is less colored and in larger grains. 
 
 The mucilage of tapioca is prepared in the same manner as that 
 of sago, and with the same proportions of tapioca and water ; but 
 tapioca is more soluble than sago, and, consequently, it requires only 
 half the time for its maceration and boiling. It forms a semi-opaque 
 mucilage, which may be sweetened and flavored in the same raan- 
 
 MUCILAGE OF SALEP. 
 
 Salep is prepared from the cormi or bulbs of the Orchis mascula. 
 It is imported chiefly from the Levant ; but some is brought from 
 India. It consists of a peculiar kind of gum, termed Bassorin, and 
 Fecula. It is more nutritive than either Arrow-root or Sago, and 
 consequently is better adapted for the convalescent than for the sick. 
 The mucilage is prepared by dissolving the powdered Salep in hot 
 water, with assiduous stirring, and adding to the solution sugar and 
 milk.* 
 
 passing into grey ; a pure starch, containing more salt than the other varieties ; b, in rose- 
 colored grains, in chemical characters the same as the former ; c, in white grains, a very 
 pure starch. 
 
 * Dr. Percival states that a mixti^e of Salep and flour makes excellent bread.— 
 Med. and Experimental Essays. 
 
314 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 GRIT-GRUEL. 
 
 Take three ounces of Grits,* wash them well in cold water, and, 
 having poured off the fluid, put them into four pints of fresh water, 
 and boil slowly, until the water be reduced one-half; then strain 
 the whole through a sieve, to separate the mucilage from the undis- 
 solved part of the Grits. 
 
 OAT-MEAL GRUEL. 
 
 Take two ounces of Oat-meal, free from mustiness, and a pint 
 and a half of soft water. Rub the meal in a basin, with the back of 
 a spoon, in a moderate quantity of the water, pouring off the fluid 
 after the grosser particles have subsided, but whilst the milkiness 
 continues ; and let this operation be repeated until no more milkiness 
 is communicated to the water. Next put the washings into a pan, 
 after having stirred them well, in order to suspend any fecula which 
 may have subsided ; and boil until a soft, thick mucilage is formed. 
 
 Both the gruel of grits and of oat-meal consist not only of the 
 starch of the oat, but also of a small proportion of gluten ; on which 
 account, they are more nutritive than any of the feculaceous mucil- 
 ages. They may be sweetened and acidulated, or mixed with milk, 
 according to circumstances. Butter and honey, which are frequently 
 added to these gruels, are inadmissible in inflammatory diseases. 
 
 Besides being excellent demulcent articles of diet, these gruels 
 are usually employed as the vehicles for administering substances in 
 the form of clyster ; for which purpose they are better adapted than 
 the purer starches, as they are not so susceptible of precipitation by 
 astringent vegetable infusions and decoctions. 
 
 Gruel is apt to ferment when it is kept longer than twenty-four 
 hours. 
 
 MUCILAGE OR JELLY OF ICELAND MOSS. 
 
 The Iceland Moss is a Lichen, named Cetraria Islandica, which 
 grows on mountains, exposed situations in Iceland ; in the north of 
 Germany ; and in other northern countries. It contains a bitter 
 principle, which is useful, as a medicinal agent, in some diseases ; 
 but from which it should be freed, when it is to be employed as diet. 
 This is to be effected by pounding the dried Lichen, and soaking it 
 for twenty-four hours in tepid water containing a small quantity of 
 carbonate of soda, and then pressing it forcibly in a coarse cloth ; 
 after which, if any bitterness remain, the process must be repeated. 
 
 * These are Oats freed from their cuticle or testa, and coarsely broken. 
 
SICK-ROOM COOKERY. 315 
 
 The Lichen, thus treated, is next to be put into water, in the 
 proportion of an ounce to a quart of water ; then slowly boiled down 
 till one half the fluid is evaporated ; and, lastly, strained through a 
 sieve. The mucilage may be sweetened and acidulated ; or it may 
 be mixed with milk, in the same manner as the mucilages already 
 noticed. 
 
 Any portion of the bitter may be separated by regulating the 
 period of the maceration. "When the bitter is not objectionable, it 
 has one advantage ; namely, that of enabling the stomach to digest 
 more readily the mucilage, by the tone which it affords to that organ. 
 The idea that it possesses any specific medicinal virtue for the cure 
 of consumption is erroneous. 
 
 MUCILAGE OF CARRAGEEN IRISH MOSS. 
 
 Carrageen is a Fucus, the Chondrus crispus, which grows upon 
 rocks and stones in the sea, and is very common on the Irish coast. 
 It has a tough, horny, flexible, crisp appearance ; it almost wholly 
 dissolves in water during boiling. One ounce of it, boiled in a pint 
 and a half of water, is sufficient to form a semi-transparent, moder- 
 ately consistent, nearly tasteless jelly ; which, when sweetened and 
 acidulated, or when mixed with milk, forms an excellent diet for 
 invalids who require to have the strength supported. 
 
 MUCILAGE OF RICE. 
 
 Take one ounce of good Carolina rice, and, having washed it, 
 macerate it for three hours in a quart of tepid soft- water, in a pan 
 placed upon the stove, then boil the whole slowly for another hour, 
 and strain through a sieve. ■ 
 
 This mucilage may be sweetened and acidulated, or mixed with 
 milk, in the same manner as the other feculaceous mucilages. It 
 forms an excellent demulcent diet for the sick, especially in irritable 
 conditions of the intestinal canal, and in diarrhoea ; but it is a mis- 
 take to suppose that it possesses any astringent property. 
 
 The soluble part of rice is chiefly starch, which it contains in the 
 proportion of eighty-five parts in the hundred. The less soluble parts 
 are about five per cent, of parenchymatous matter ; an animalized 
 principle, amounting to rather more than three and a half per cent. ; 
 and some phosphate of lime. It is the animalized matter that affords 
 any nutritive property which the rice possesses ; but this is not 
 taken up by the water in the above preparation ; consequently, in a 
 nutritious point of view, it is on an equality with the foregoing 
 mucilages. 
 
316 HYGIENE, OR THE ART OF PRESERVING- HEALTH. 
 
 GROUND RICE. 
 
 Take a table-spoonful of ground rice, a pint and a half of milk, 
 and half an ounce of candied lemon-peel. Rub the rice smooth with 
 the milk, then add the lemon-peel cut into small pieces ; boil for half 
 an hour, and strain whilst the milk is hot. 
 
 This is an excellent nutritious beverage for the sick, when strict 
 abstinence is not required ; and for early convalescence. 
 
 SIMPLE BREAD PANADA. 
 
 Put any quantity of grated, stale bread into enough of water to 
 form a moderately thick pulp ; cover it up and let it soak for an 
 hour ; then beat it up with, two table-spoonsful of milk, and a small 
 portion of refined sugar, and boil the whole for ten minutes, stirring 
 all the time. 
 
 This may be eaten by the sick, laboring under any disease in 
 which abstinence is not strictly enjoined. 
 
 ANIMAL PREPARATIONS 
 
 HARTSHORN JELLY. 
 
 Take six ounces of hartshorn shavings, cut into small pieces ; 
 boil them in four pints of water down to two pints ; strain, and add 
 to the liquor, whilst hot, two table-spoonsful of lemon-juice, six 
 ounces of white sugar, and two glasses of Sherry wine. This forms 
 an excellent light nutriment for the sick and convalescent, when 
 wine is not improper. "Without the acid and the wine, but with an 
 equal quantity of milk, it is an excellent substitute for the breast- 
 milk, for infants wh© are unfortunately brought up by hand. 
 
 BEEF-TEA. 
 
 Take half a pound of good rump steak, cut it into thin slices 
 and spread these in a hollow dish ; sprinkle a little salt over them, 
 and pour upon the whole a pint of boiling water. Having done this, 
 cover the dish with a plate, and place it near the fire for an hour ; 
 then throw the sliced beef and the water into a pan, cover it, and 
 boil for fifteen minutes ; after which, throw the whole contents 
 of the pan upon a sieve, so as to separate the beef-tea from the 
 meat. 
 
 The quantity of water directed to be used is too little for the 
 strength of the beef-tea usually proper for invalids ; but it is suf- 
 
CHICKEN-TEA. 317 
 
 ficient to extract all the soluble matter of the beef; and tea can be 
 reduced to the strength required by the addition of boiling water. 
 1001. Liebig's Beef tea. — " Owe pound of lean beef, free of fat 
 and separated from the bones, in the finely chopped state in which 
 it is used for mince-meat, is uniformly mixed with its own weight 
 of cold water slowly heated to boiling; and the liquid, after boiling 
 briskly for a minute or two, is strained through a towel from the 
 coagulated albumen and fibrin, now become hard and horny. Thus 
 we obtain an' equal weight of the most aromatic soup, of such 
 strength as cannot be obtained even by boiling for hours from a 
 piece of flesh." This is to be seasoned to taste. 
 
 1003. MarceCs New Process of Beef tea. — " Take one pound of 
 lean beef, cut into small pieces ; put into a pint of cold water. To 
 this add : 
 
 Hydrochloric Acid (sp. gr. 1.15) 58 grains, 
 
 or about 50 minims, 
 
 Boudault J s Pepsine 50 grains. 
 
 "Bring it up to about 100° Fahrenheit, and maintain it at that 
 temperature in a water-bath until the meat becomes disintegrated ; 
 then strain it, and neutralize with 80 grains of bicarbonate of soda. 
 " This makes a palatable and exceedingly digestible nourishment. 
 In cases of fever, where the acid is rather desirable than not, the 
 editor has found it quite agreeable to the patient, without the addi- 
 tion of the soda." 
 
 1004. Eggs, Cream, and Extract of Beef — " Wash two ounces 
 of the best pearl sago, until the water poured from it is clear ; then 
 stew it in a half pint of water until it is quite tender and very 
 thick; mix with it half a pint of good boiling cream and the yolk of 
 four fresh eggs^ and mingle the whole carefully with one quart of 
 good beef-tea, which should be boiling. Let cool sufficiently when 
 it is ready for use." — Ellis. 
 
 CHICKEN-TEA. 
 
 Take a small chicken, free it from the skin and from all the fat 
 between the muscles ; and having divided it longitudinally into two 
 halves, remove the whole of the lungs, the liver, and everything ad- 
 hering to the back and the side bones. Then cut it, bones and 
 muscles, by means of a strong, sharp knife, into as thin slices as 
 possible ; and, having put these into a pan with a sufficient quanti- 
 ty of salt,, pour over them a quart of boiling water, cover the pan, 
 and simmer, with a slow fire, for two hours ; lastly, put the pan 
 upon the stove for half an hour, and strain off the tea through a 
 sieve. 
 
318 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 Both of these animal decoctions are of a strength proper for any 
 invalid whose condition, during the progress of actual disease, admits 
 of animal diet in its lightest form. When concentrated with some 
 farinaceous additions, and slightly spiced, they are equally useful in 
 convalescence. 
 
 VEAL-TEA. 
 
 This may be made in the same manner as beef-tea, using a 
 pound of fillet of veal, free from fat and sliced, and apint and a 
 half of boiling water, and boiling for half an hour instead of fifteen 
 minutes. It may, also, be made with the same quantity of the 
 fleshy part of a knuckle of veal. 
 
 By boiling down the knuckle-ofveal tea, whilst the meat is in 
 it, to one-half, and straining, the decoction gelatinizes ; and, when 
 it is poured into small cups, it will keep good for several days. By 
 adding an equal quantity, or more, of toiling water to a cupful of this 
 jelly, a moderate quantity of veal-tea for one individual is prepared 
 in two minutes. 
 
 MUTTON-TEA. 
 
 This is prepared with a pound of good mutton, ^freed from the 
 fat and cut into thin slices, and a pint and a half of boiling soft 
 water poured over it, in the same manner as for beef-tea ; but it re- 
 quires to be boiled, after the maceration, for half an hour, before it 
 is strained through a sieve. 
 
 If the invalid desires the addition of barley, an ounce of good 
 pearl barley, washed and macerated in boiling water for an hour, 
 may be boiled with the mutton-tea, and the undissolved barley sep- 
 arated on straining. 
 
 1011. CHICKEN BROTH. 
 
 " Clean half of a chicken, and pour on it one quart of cold water ; 
 acid a little salt and one tablespoonful of rice ; cover the vessel 
 closely, and boil for two hours ; throw in near the end of the boiling 
 a little parsley, chopped fine ; skim the broth before using. 
 
 " This is one of the most valuable articles of diet at the command 
 of the physician in the low stages of disease, when the patient's sys- 
 tem requires support, but his digestive powers will not admit of 
 solid food."— EMs. 
 
 1014. MULLED WINE. 
 
 "Take two drachms of bruised cinnamon, half a nutmeg grated, 
 ten bruised cloves, and half a pint of boiling water; infuse one 
 
DISTILLED WATER. 319 
 
 hour; strain, and add of hot port or hot sherry wine (or of good 
 domestic wine) one pint, and white sugar, one ounce. Mix. 
 
 " This is a mild stimulant drink, used in the convalescence from 
 low forms of disease." — Ellis. 
 
 TURTLE-SOUP. 
 
 Plain turtle-soup, made from the green turtle, Chelonia mydas, 
 without wine or spices, is sold in pots, and requires only the addi- 
 tion of water to reduce it to a proper consistence for the use of the 
 sick and convalescents. It is extremely nutritious, and of very easy 
 digestion ; but it should be given only in small quantities, at mod- 
 erate intervals. In cases of great debility, the consequence of long 
 continued chronic diseases, either wine or brandy may be added to 
 the soup; but the propriety of such an addition, and the quantity 
 requisite in each case, must be left to the judgment of the medical 
 attendant. 
 
 PREPARATION OF BEVERAGES. 
 
 DISTILLED WATER. 
 
 This, the purest state of water, may be readily obtained by fix- 
 ing a curved tin tube, three or four feet long, to the spout of a tea- 
 kettle, and conducting its free end into a jar placed in a basin of 
 cold water, and enveloped with a wet towel. The steam thus con- 
 densed is distilled water. The softer the water is, the better solvent 
 it is of all soluble animal and vegetable substances ; and distilled 
 water, being free from every foreign ingredient, is necessarily the 
 softest of all water, and consequently the best adapted, not only for 
 diluting in febrile affections, but for pervading the minutest vessels, 
 and improving their secreting powers. Its use is recommended in 
 diseases of the kidneys, in gout, scrofula, consumption, and cancer- 
 ous affections. 
 
 Distilled water is mawkish to the taste ; but this is easily cor- 
 rected by pouring it from one jug to another, successively, for ten or 
 fifteen minutes, so as to involve in it a quantity of atmospheric air. 
 
 The temperature of water, when low, is most agreeable to the 
 palate, yet it should approach to that of the body ; and, therefore, 
 when the diluent influence only of water is required its temperature 
 should jiot be under 60 dee:., nor above 70 deo-. When the heat of 
 the body, however, is considerable, and the skin dry, in febrile dis- 
 eases, water at as low a temperature as it can be obtained in the fluid 
 state may be used. 
 
320 HYGIENE, OE THE AET OF PEESEEVING HEALTH. 
 
 TOAST-WATEE. 
 
 Toast thoroughly, but not to a cinder, half a slice of a loaf, of 
 the usual size and of a day or two old, put it into a jug, and pour over 
 it a quart of water which has been boiled and cooled ; and, after two 
 hours, pour off the water gently from the bread. A small piece 
 of orange or of lemon-peel, put into the jug at the same time as the 
 bread, is a great improvement to toast- water. 
 
 The toast, in this case, communicates taste and color to the water, 
 without affecting its diluent properties. The reason for employing 
 water which has been boiled is to bring the fluid as near as possible 
 to the state of distilled water. . 
 
 Toast- water may be used at will in every febrile affection. It 
 diminishes the heat of the mouth, the throat, and the stomach ; and, 
 by sympathy, that of the whole body. 
 
 APPLE-TEA OE WATEE. 
 
 Slice two large, not over ripe, apples, and pour over the slices a 
 pint of boiling water. After an hour, pour off the fluid, and, if 
 necessary, sweeten with a moderate quantity of refined sugar. 
 
 LEMON-PEEL TEA OE WATEE. 
 
 Pare the rind of one lemon, which has been previously rubbed, 
 with half an ounce of refined loaf sugar, put the peelings and the 
 sugar into a jar, and pour over them a quart of boiling water. 
 When cold, pour off the fluid, and add one table-spoonful of lemon- 
 juice. If wine be not improper, a glass of Sherry may be added, 
 instead of the lemon-juice. 
 
 ORGEAT. 
 
 Blanch two ounces of sweet almonds, and four bitter almonds 
 Beat them in a mortar with a little orange-flower water into a paste, 
 and rub this with a pint of milk diluted with a pint of water, until 
 an emulsion is formed. Strain, and sweeten with sugar. The 
 Bitter Almond, when treated with water, develops a volatile oil, 
 which has the odor of the peach-blossom, and contains prussic acid. 
 In some individuals, the bitter almond causes an eruption on the 
 skin, closely resembling nettle-rash ; consequently this fact should 
 be ascertained in reference to the individual for whom the orgeat is 
 intended, before it be ordered. 
 
 RASPBERRY VINEGAR WATER. 
 
 This is merely diluted raspberry vinegar. It is generally made 
 too acid. 
 
SICK-BOOM COOKERY. 321 
 
 All of these drinks are good diluents in fever, and may be taken 
 at the pleasure of the invalid. 
 
 LEMONADE. 
 
 Take the juice of two lemons ; add it to a quart of boiling 
 water, having the rind of one of the lemons in it, in a covered jar, 
 and sweeten it moderately with refined sugar. 
 
 BAELEY-WATER. 
 
 Simple Barley-Water. — Take two ounces and a half of pearl 
 barley, and four pints and a half of soft water. Wash first the 
 barley with cold water, to remove from it every foreign matter ; and 
 then pour upon it half a pint of the water, and boil for fifteen 
 minutes. Throw this water away ; and, having heated the four 
 remaining pints of the fluid, pour them upon the barley, and boil 
 down to two pints, and strain. 
 
 Compound Barley-Water. — " Take two pints of simple barley- 
 water, two ounces and a half of figs, sliced ; five drachms of 
 liquorice root, sliced and bruised ; two ounces and a half of raisins, 
 and a pint of soft water. Boil down to two pints, and strain." 
 
 These decoctions are not only good demulcent diluents, but, in 
 cases where a very moderate degree of nutriment is not objectionable, 
 they answer the purpose of diet. 
 
 Simple barley-water, when mixed with an equal quantity of 
 milk and a small portion of refined sugar, is a good substitute 
 for the breast-milk, for infants who are brought up with the 
 spoon. 
 
 When announce of gum is dissolved in a pint of simple barley- 
 water, an excellent beverage is formed for cases of strangury from 
 blistering plaster ; and in gravel. 
 
 ALMOND EMULSION. 
 
 Take one ounce and a quarter of sweet almonds, blanched ; five 
 drachms of sugar ; and a quart of soft water. Beat the almonds 
 with the sugar, in a porcelain mortar, into a smooth pulp, adding 
 the water gradually, and stirring assiduously until the whole of the 
 fluid is added ; then strain through linen. 
 
 An excellent demulcent in febrile affections. 
 
 MARSH-MALLOW TEA. 
 
 Take four ounces of dried roots of the marsh-mallow (Althcea 
 officinalis) ; two ounces of raisins, freed from the seeds ; and five 
 21 
 
322 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 pints of boiling water. Boil slowly down to three pints, and when 
 the sediment has subsided, pour off the clear liquor. 
 
 This is an excellent demulcent drink in diseases of the kidney 
 with a tendency to gravel. 
 
 FLAXSEED TEA. 
 
 Take an ounce of flaxseed, not bruised; two drachms of liquorice 
 root, bruised ; and one pint of boiling soft water. Place the jug 
 containing these ingredients, covered, near the fire for four hours, 
 and then strain through linen or cotton. 
 
 The mucilage resides in the husk, and the fixed oil in the kernel 
 of the flaxseed ; and, therefore, the seeds ought not to be bruised. 
 When flaxseed is boiled, the fixed oil is extracted, and renders the 
 decoction both nauseous and stimulant. 
 
 Flaxseed tea is a useful demulcent drink in coughs, and affections 
 of the urinary organs ; but it should be made daily, as it soon gets 
 ropy, and spoils. 
 
 RENNET-WHEY. 
 
 Infuse a moderate-sized piece of rennet # in a sufficient quantity 
 of boiling water to abstract all the soluble matter ; separate the fluid, 
 and stir a table-spoonful of it into three pints of milk ; cover up the 
 mixture with a clean cloth, and place it before the fire until it forms 
 a uniform curd. Divide this, curd with a spoon, and, pressing it 
 gently, separate the whey. 
 
 Good whey should be nearly transparent, of a pale straw-yellow 
 color, and should have a sweetish taste. It constitues ninety-two 
 parts in one hundred of the milk ; and, besides water, contains sugar 
 of milk, and some salts. It is an excellent diluent in febrile affec- 
 tions. When boiled down to one half, it proves nutritive as well as 
 diluent. 
 
 VINEGAR AND TAMARIND WHEYS. 
 
 A small wine-glassful of vinegar, sweetened with a dessert- 
 spoonful of Muscovado sugar ; or two table-spoonsful of tamarinds, 
 stirred into a pint of boiling milk, and the whole boiled for fifteen 
 minutes, and strained, form these wheys. They are useful refri- 
 gerant drinks in febrile diseases. 
 
 * Rennet is a production of the inner or mucous membrane of the stomach of a calf. 
 Its action in coagulating milk is not understood. It does not depend on the acid which 
 the rennet contains ; but on a peculiar substance, which has been named Chymosi-ie. The 
 quantity of liquid rennet necessary to curdle 1000 grains of milk is only eight diops ; but 
 it requires a heat of 68 deg. of Fahrenheit; and its action is aided by the acidity of the 
 rennet. 
 
SICK-ROOM COOKERY. 323 
 
 WHITE WINE WHEY. 
 
 Take two-thirds of a pint of good milk, and dilute it with as 
 much water as will make up the pint. 
 
 Take two glasses of sherry wine, or any other good white wine, 
 and a dessert-spoonful of Muscovado sugar. 
 
 Place the milk and the water in a deep pan upon the fire ; and, 
 watching the moment when it boils, which is known by a scum 
 rising to the edge of the pan, pour into it the wine and the sugar, and 
 stir assiduously, whilst it continues to boil for twelve or fifteen 
 minutes. Lastly, strain the whey through a sieve. 
 
 This is an excellent mode of administering wine in small quan- 
 ties in low fevers, and in cases which demand a moderate degree 
 of excitement. It may be drank either cold or tepid, in a wine- 
 glassful at a time. 
 
 MUSTARD-WHEY. 
 
 Take half an ounce of bruised mustard seeds, and one pint of 
 milk ; boil them together until the milk is curdled, and strain to 
 separate the whey. 
 
 This whey has been found to be a useful drink in dropsy ; it 
 stimulates the kidneys, and, consequently, augments the urinary 
 secretion. It may be taken in a tea-cupful at a time. 
 
 MIXTURE OF SPIRIT OF FRENCH WINE. 
 
 Egg Brandy. Take four ounces of French brandy, four ounces 
 of cinnamon water, the yelks of two eggs, half an ounce of purified 
 lump sugar, and two drops of oil of cinnamon. Mix the yelks of the 
 eggs first with the water, the oil, and the sugar, agitating assidu- 
 ously ; and then add the brandy by a little at a time, until a smooth 
 fluid is formed. 
 
 This is an excellent mode of administering brandy in the sinking 
 stage of Typhus and other low fevers. 
 
 Take an ounce of fresh suet, cut into small pieces, and tie them 
 in a muslin bag, large enough to leave the morsels free from com- 
 pression; boil this in a quart of cow's milk, sweetened with a 
 quartei of an ounce of white sugar-candy. 
 
 This is an excellent article of diet in scrofulous emaciation, es- 
 pecially when ordinary articles of food pass through the bowels nearly 
 undigested. It is also useful in the later stages of pulmonary 
 consumption. It may be used for infants who are unfortunately 
 brought up by the spoon. 
 
324: HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 ARTIFICIAL ASSES' MILK. 
 
 Take half an ounce of gelatine ; dissolve it, by the aid of heat, 
 in a quart of barley-water ; add one ounce of refined sugar ; then 
 pour into the mixture a pint of new milk, and beat up the whole 
 with a whisk. N 
 
 It should be drunk warm, and exercise taken after it. It may 
 be also prepared by dissolving two ounces of sugar of milk in one 
 pint of tepid skimmed cow's milk. These, however, are but poor 
 substitutes for asses' milk ; which is one of the best restoratives in 
 convalescence from severe disease. "When taken in too great quantity 
 it is apt to cause diarrhoea. 
 
 MILK AND SODA WATER. 
 
 Heat, nearly to boiling, a tea-cupful of milk, and dissolve in it a 
 tea-spoonful of refined sugar ; put it into a large tumbler, and pour 
 over it two-thirds of a bottle of good soda-water. 
 
 This is an excellent mode of taking milk when the stomach is 
 charged with acid, and consequently is apt to feel oppressed by milk 
 alone. 
 
 BUTTERMILK. 
 
 When buttermilk is newly churned, it is a wholesome, delicious, 
 and cooling beverage in fever or any disease of excitement ; but, as 
 it cannot be procured in large towns, and not always in the country, 
 the method of making it in small quantities, daily, should be under- 
 stood. It is readily prepared by putting a quart of new Milk into a 
 bottle which will hold half a gallon, corking the bottle, and covering 
 it with a towel in such a manner, that, by drawing alternately each 
 end of the towel, the bottle can be rolled upon a table. This move- 
 ment should be continued until such time as all the butter is separated, 
 which is known by its appearing in clots or masses swimming in the 
 milk. During the rolling, it is necessary to open the bottle occa- 
 sionally to admit fresh air into it, as that is essential for the formation 
 of the butter. When the process is finished, all the butter should be 
 carefully separated from the buttermilk. 
 
 Buttermilk may be drunk at pleasure. 
 
 SAGO POSSET. 
 
 Put two ounces of sago into a quart of water, and boil until a 
 mucilage is formed ; then rub half an ounce of loaf-sugar on the 
 rind of a lemon, and put it, with a fluid drachm (a teaspoonful) 
 of tincture of ginger, into half a pint of sherry wine; add this 
 mixture to the sago mucilage, and boil the whole for five minutes. 
 
COOKERY FOR THE CONVALESCENT. 225 
 
 This is an excellent cordial where acute diseases, not of an in- 
 flammatory kind, have left the body in a state of great debility. A 
 large wine-glassful may be taken at once, at intervals of four or five 
 hours. 
 
 COOKERY FOR THE CONVALESCENT. 
 
 This comprehends farinaceous and animal preparations of a more 
 nutritious and stimulant nature than is admissible for the sick-room ; 
 but, at the same time, considerably within that which is usual and 
 not improper in a state of health. 
 
 FARINACEOUS PREPARATIONS. 
 
 These are not solely modifications of starch ; but they admit of 
 the presence of gluten and other components of the Cerealice. They 
 are rendered more nutritive by the addition of milk and other animal 
 substances of a moderately stimulant character. 
 
 BOILED FLOUR AND MILK. 
 
 Knead any quantity of wheaten flour with water into a ball, and 
 tie the whole firmly in a linen cloth; put it into a pan with water, 
 and boil it slowly for twelve hours. Place it before the fire to dry ; 
 and afterwards, on removing the cloth, separate a thick skin, or rind, 
 which has formed, and again dry the ball. 
 
 A table-spoonful or more of this, grated and boiled with a pint of 
 milk, forms an excellent article of diet in convalescence from 
 diarrhoea, or from dysentery, and in cases of emaciation. 
 
 ARROW-ROOT PUDDING. 
 
 Take a table-spoonful of arrow-root powder, rub it with a little 
 cold water in the same manner as in making the mucilage, and add 
 to it, stirring assiduously, a pint of boiling milk. With this muci- 
 lage, mix the contents of one egg, and three tea-spoonsful of powdered, 
 refined sugar, which have been previously beaten up together. 
 The pudding thus formed may be baked, or it may be boiled in a basin. 
 
 This is an excellent pudding for the early stage of convalescence 
 For a more advanced period, a table-spoonful of Scotch orange-mar- 
 malade is a good and agreeable addition to this pudding. 
 
326 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 ARROW-ROOT BLANC-MANGE. 
 
 Make the mucilage in the usual manner, using tnree times the 
 quantity of the arrow-root powder; then add milk in a moderate 
 proportion ; and having boiled down the mixture to a sufficient degree 
 of thickness, pour it into a shape to cool and set ; after which it may- 
 be turned out. 
 
 In convalescence, this blanc-mange may be eaten with currant- 
 jelly, or with wine or lemon-juice and sugar. It is sometimes 
 eaten with cream ; but such an addition is improper in convalescence. 
 
 MILK OR BEEF-TEA ARROW-ROOT MUCILAGE. 
 
 This mucilage is made exactly in the same manner as the simple 
 arrow-root mucilage, except that beef-tea, or milk, is used in the 
 boiling state instead of water ; and the mucilage is boiled for twenty 
 minutes instead of five minutes. 
 
 Either of these preparations forms an excellent diet in the early 
 stage of convalescence, and for delicate children. 
 
 FLUMMERY OR SOWANS. 
 
 Take a quart or any quantity of grits, or of oatmeal ; rub the 
 grits or the meal for a considerable time, with two quarts of hot 
 water and leave the mixture for several days at rest, until it becomes 
 sour ; then add another quart of hot water, and strain through a hair 
 sieve. Leave the strained fluid at rest until it deposits a white sedi- 
 ment, which is the starch of the oats ; lastly, pour off the float- 
 ing water, and wash the sediment with cold water. The washed 
 sediment may be either boiled with fresh water, stirring the whole 
 time it is boiling, until it forms a mucilage or jelly ; or it may be 
 dried, and afterwards, prepared in the same manner as arrow-root 
 mucilage Flummery should not be made in a metallic vessel. 
 
 Flummery is light, moderately nutritious, and very digestible ; 
 it is, consequently, well adapted for early convalescence. It may be 
 eaten with milk or with wine, or lemon-juice and sugar. 
 
 OAT-MEAL PORRIDGE. 
 
 Sprinkle into a pint of water, kept boiling, small quantities of 
 oatmeal, at short intervals, stirring assiduously, until a moderately 
 consistent mixture is formed ; and continue to boil, afterwards, for 
 half an hour. 
 
 Oatmeal porridge, eaten with milk, is a moderately nutritive 
 diet, well adapted for early convalescence, when there is no dyspeptic 
 tendency. "When the stomach is deranged, it is apt to prove 
 acescent, and is improper. 
 
COOKERY FOE THE CONVALESCENT. 327 
 
 RICE AND APPLES, OR SNOW-BALLS. 
 
 Instead of preparing this dish in the usual manner — namely, cut- 
 ting the apples, freed from the rind and internal seed-cells, into 
 quarters longitudinally, then surrounding them with rice, and boil- 
 ing the whole in cloths — it is preferable to boil the rice in hot water 
 rapidly, and after straining off the water through a cullender, to 
 expose it for ten or fifteen minutes before the fire, and having stewed 
 the apples separate from the rice, to mix them together with a very 
 moderate quantity of sugar. 
 
 The rice thus prepared is more digestible, and assuredly much 
 more palatable, than when it is run together into a paste. Too 
 much sugar is apt to disagree with the stomachs of convalescents, 
 and induce an attack of dyspepsia. The butter which is often 
 added to this dish is improper in convalescence. "With these precau- 
 tions, rice and stewed apples form a dish well adapted for invalids 
 recovering from acute disease. 
 
 BOILED BREAD PUDDING. 
 
 Grate half a pound of stale bread, pour over it a pint of hot milk, 
 and leave the mixture to soak for an hour in a covered basin ; then 
 beat it up with the yelks of two eggs. Put the whole into a 
 covered basin, just large enough to hold it, which must be tied in a 
 cloth, and placed in boiling water for half an hour. It may be 
 eaten with salt or with sugar ; and, if wine be allowed, it may be 
 flavored with a glass of Sherry. 
 
 SIMPLE RICE PUDDING. 
 
 "Wash two table-spoonsful of good Carolina rice, and simmer 
 them in a pint and a half of milk, until the rice is soft ; then add 
 the contents of two eggs, beaten up with half an ounce of sugar. 
 Bake it for three-quarters of an hour in a slow oven. 
 
 In an advanced state of convalescence, two glasses of Sherry to 
 the pudding, before it is baked, is an agreeable addition. 
 
 MACARONI OR VERMICELLI PUDDING. 
 
 Take two ounces of macaroni or of vermicelli, a pint of milk, and 
 two fluid ounces (four table-spoonsful) of cinnamon- water ; simmer 
 until the macaroni or vermicelli is tender. Next, beat up three yelks 
 of eggs and the white of one egg, an ounce of sugar, one drop of the 
 oil of bitter almonds, and a glass of Sherry wine, in half a pint of 
 milk ; and add the mixture to the macaroni or vermicelli. Bake in 
 a slow oven. 
 
328 HYGIENE, OR THE ART OF PRESERVING HEALTH 
 
 BATTER PUDDING. 
 
 Take a table-spoonful of wheaten-flour, a pint of milk, tl. e yelk 
 of two eggs, and half an ounce of sugar. Beat the yelks of the eggs 
 with the sugar, and mix them with the milk and flour. This pud- 
 ding should be boiled, in a basin tied in a cloth, in boiling water. 
 
 TAPIOCA PUDDING. 
 
 Beat the yelks of two eggs and half an ounce of sugar together, 
 and stir the mixture into a pint of tapioca mucilage made with milk. 
 Bake in a slow oven. 
 
 Sago, arrow-root, or millet-seed mucilage may be converted into 
 light puddings in the same manner. 
 
 In advanced convalescence, these puddings may be eaten with 
 wine. 
 
 MASHED CARROTS AND TURNIPS. 
 
 Boil the turnips and the carrots, peeled, separately, in three suc- 
 cessive waters ; then press strongly the water out of them, through 
 a clean coarse cloth. Mash them together with enough of new 
 milk to form them into a pulp, and season with salt. Place them 
 before the fire until the surface seems dry. 
 
 This is an admirable dish for convalescents who are restricted to 
 farinaceous and vegetable diet ; and it is one which invalids get fond 
 of. The author once ate of this dish for dinner daily, in conva- 
 lescence from a severe disease, for several months; and he now 
 prefers it to every other kind of vegetable food. 
 
 PLAIN BOILED VEGETABLES. 
 
 Almost every kind of vegetable may be eaten by the convales- 
 cent, if it is well boiled. All the cabbage tribe, turnips, carrots, and 
 onions should be thoroughly boiled in two waters. If salt be added, 
 and the boiling be brisk, in an uncovered vessel, green vegetables do 
 not lose their color ; and, whilst by this means they are well boiled, 
 they remain pleasant to the eye. 
 
 ANIMAL PREPARATIONS. 
 
 RICE OR VERMICELLI, OR MACARONI SOUP. 
 
 Make a quart of beef-tea, in the manner already described, and 
 boil it down one third ; then add to it an ounce of vermicelli, or two 
 ounces of macaroni, which have been previously well boiled in water, 
 
COOKERY FOR THE CONVALESCENT. 329 
 
 and boil down the whole to one pint. The soup may be salted to the 
 taste, and five grains ot Cayenne pepper added to one pint of it ; 
 provided the condition of the invalid does not forbid the addition of 
 so moderate a stimulant. 
 
 When rice is used instead of vermicelli or macaroni, it should be 
 put into boiling water, and boiled rapidly in a close vessel ; then 
 thrown upon a cullender, and slightly dried before the fire. It should 
 not be boiled with the soup, but added after the concentration of the 
 soup, in quantity agreeable to the taste of the invalid. 
 
 This is an excellent soup for convalescents. 
 
 CHICKEN-BROTH. 
 
 "When chicken-tea, is boiled down one half, with the addition of 
 a little parsley or celery, and the yelk of an egg previously beat up 
 in two ounces of soft water, it forms a soup much relished by the 
 convalescent. It may be rendered still more palatable by the addi- 
 tion of some properly boiled rice, or vermicelli, or macaroni ; and 
 by the addition of three or four grains of Cayenne pepper, to a pint 
 of the broth. 
 
 CHICKEN-PANADA. 
 
 Take the white meat of the breast and of the wings of a chicken 
 
 , free it from the skin, 
 
 which has been either boiled or roasted, free it from the skin, and 
 
 cut it into small morsels ; pound these in a mortar with an equal 
 quantity of stale bread, and a sufficiency of salt ; adding, by little 
 and little, either the water in which the chicken was boiled, or some 
 beef-tea, until the whole forms a thin, fluid paste : lastly, put it into 
 a pan, and boil for ten minutes, stirring all the time. 
 
 A similar panada may be made with a slice from the under side 
 of a cold sirloin of roasted beef ; or from a leg of cold roasted mutton. 
 Either should be freed from fat and skin ; and the gravy, kept until 
 the fat is thrown in a cake and separated, may be added to it. 
 
 This panada is a nutritive article of diet for convalescents and 
 delicate children. 
 
 RICE AND GRAVY. 
 
 Take the gravy from a leg of roasted mutton, or from a sirloin 
 of roasted beef; leave it at rest until the fat forms a cake on the 
 surface ; remove this ; and stir into a tea-cupful of it as much well- 
 boiled rice as will suffice for a meal. This is also a wholesome diet 
 in early convalescence for delicate children. 
 
 GLOUCESTER JELLY. 
 
 Take of rice, pearl barley, sago, and gelatine, each an ounce ; 
 
330 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 simmer the whole in three pints of water until they are reduced to 
 two pints, and strain. When cold, the decoction forms a strong jelly, 
 which may be dissolved in warm milk or in beef-tea, or melted in 
 hot water, and flavored with wine and sugar. 
 
 SAGO MILK. 
 
 Soak an ounce of sago in a pint of cold water for an hour, pour 
 off this water, and add a pint and a half of good milk, and boil 
 slowly until the sago is well incorporated with the milk. 
 
 MUTTON BROTH, WITH VEGETABLES. 
 
 Take a pound of mutton-chops, freed from the fat, put them into 
 a pan with three pints of water and boil them slowly, and simmer 
 them for two hours. Take three moderate-sized carrots and the 
 same number of turnips, peel and cut them into slices ; boil them for 
 half an hour in a quart of water ; then throw them upon a cullender 
 to drain off the water ; and, having boiled two onions, sliced, in a 
 pint of water, and also poured off the water, add the turnips, the 
 carrots, and the onionte to the mutton liquor, after removing the 
 mutton-chops. Season with salt and a little celery-seed. Simmer 
 slowly for four hours, then put in the chops again, and continue the 
 simmering for another hour. The chops may be dished up with the 
 broth. 
 
 This is a palatable, and nutritive dish for convalescents ; and, 
 owing to the long and slow simmering, the mutton is rendered solu- 
 ble and of easy digestion. 
 
 TRIPE. 
 
 Few things are more easily digested than tripe, when it is pro- 
 perly cooked. After partially boiling it in the usual manner, and 
 also after boiling some onions in two waters, both should be slowly 
 boiled together, until the tripe is very soft and tender. A sufficient 
 quantity of salt, and a pinch or a few grains of Cayenne pepper, may 
 be added. 
 
 SWEETBREADS. 
 
 These, when plainly cooked, are well adapted for the convales- 
 cent. They should be slowly boiled, and very moderately seasoned 
 with salt and Cayenne pepper. 
 
 FOWL, WITH RICE. 
 
 Free a young fowl from the skin and the fat between the muscles 
 
COOKERY FOR THE CONVALESCENT. 331 
 
 on the surface of the body, and simmer it in good beef-tea, till it is 
 very tender ; season with salt only ; and having boiled some rice 
 as if for currie, add it to the liquor before the fowl is dished. 
 
 PREPARATIONS OF FISH. 
 
 WATER-SOUCHY. 
 
 Take two small fresh flounders, boil them in a quart of water to 
 one-third, or long enough to reduce the fish to a pulp. Strain 
 the liquor through a sieve, and, having cut the fins off four other 
 small flounders, put them into the above-mentioned liquor, with 
 a sufficient quantity of salt, a few grains of Cayenne pepper, and a 
 small quantity of chopped parsley ; and boil just long enough to 
 render the fish proper to be eaten. The fish and the sauce should be 
 eaten together. 
 
 If flounders are not in season, soles, or whitings, or small had- 
 docks, may be prepared in the same manner. 
 
 Few dishes are so much relished as this by convalescents from 
 fever. Invalids sometimes ask for it daily for ten or more days. It 
 is sufficiently nutritive, and very easily digested. 
 
 In advanced convalescence, the yelk of one or two eggs may be 
 beaten up with a little soft water, and added to the strained liquor 
 before the fish is put into it. 
 
 BROILED WHITINGS. 
 
 Broil the whitings without freeing them from the skin; and 
 when they are sufficiently done, take out the back bone, .and intro- 
 duce a little cold butter in its place. 
 
 By cooking whitings in this manner, the juices of the fish are 
 retained, and its nutritive property augmented. The fish thus 
 cooked is of easy digestion, and well adapted for convalescents. 
 
 PREPARATION OF BEVERAGES. 
 
 AROMATIC BARLEY WINE. 
 
 Take a quart of barley-water, and boil it down one-third ; then 
 add to it, while it is hot, a pint of Sherry wine, a drachm of tincture 
 of cinnamon, and an ounce of refined sugar. 
 
332 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 A wine-glassful, two or three times a day, is a good cordial in con- 
 valescence attended with much debility. 
 
 MULLED WINE. 
 
 Take a quarter of an ounce of bruised cinnamon, half a nut- 
 meg grated, and ten bruised cloves ; infuse them in half a pint of 
 boiling water for an hour, strain and add half an ounce of lump 
 sugar ; and pour the whole into a pint of hot port or sherry wine. 
 
 This is a useful cordial in the low stage of typhus fever, and in 
 the debility of convalescence from fevers. 
 
 INFLUENCE OF THE OCCUPATIONS ON HEALTH AND 
 
 LONGEYITY. 
 
 The subject is one that presents inherent difficulties in the 
 investigation, although it is of vast importance and of peculiar 
 interest. It involves questions that cannot be solved by theory 
 alone, but which demand the largest possible amount of statistical 
 information. Unfortunately, however, until of late years, very 
 little effort has been made by statisticians to prepare tables of the 
 relative mortality in different occupations. 
 
 But these, such as they are, gathered at different periods by 
 candid and painstaking men, are of very great value. 
 
 It is obvious that health and longevity must depend very mate- 
 rially on the occupation. In civilized lands we all lead lives 
 more or less artificial, shaping or narrowing our activities accord- 
 ing to the varying demands of advancing society. "Lead a natural 
 life " is a convenient form of rhetorical advice, but practically it 
 can mean nothing more than to make the wisest selection of the 
 benefits of civilization. 
 
 An ideal occupation, consisting in every way with the healthiest 
 and most enduring development of all the faculties, would require 
 four conditions : 
 
 1. It would admit of the harmonious development of the whole 
 nation. 
 
 2. It would be congenial to the taste. 
 
 3. It would admit of system. 
 
 4. Its pursuits would be calm and unworried. 
 
 Now, it is evident that, taking the world as we find it, such an 
 ideal occupation cannot exist; in no pursuit that men follow for 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 
 
 333 
 
 maintenance, or even for dignity merely, is it possible to conform, 
 any more than approximately, to the ideal laws of hygiene. 
 
 Such being the case, we are compelled to form our estimate of 
 the comparative healthfulness of different occupations by the results 
 of observation and statistics. Assuming that all the pursuits in 
 which we are engaged are more or less removed from the ideal 
 supposed, we ascertain by theory and calculation which are, on the 
 whole, the most favorable to health and longevity. 
 
 Dr. Jarvis has prepared the following tabular statement of the 
 average longevity in some leading occupations in Massachusetts, 
 New York, and Rhode Island : 
 
 Averase 
 Occupations. Deaths. Longevity. 
 
 Clergymen 389 55.36 
 
 Lawyers 276 54.26 
 
 Physicians 540 54.32 
 
 Coopers 338 5T.04 
 
 Blacksmiths 822 51.51 
 
 Carpenters 2,052 49.72 
 
 Masons 492 48.29 
 
 Tanners 230 47.90 
 
 Merchants and clerks 2,386 47.46 
 
 Cabinet-makers 253 46.34 
 
 Shoemakers 3,233 43.03 
 
 Painters 500 43.37 
 
 Tailors 486 41.08 
 
 The Register of the city of Boston has the following table of 
 ages of seven hundred and six men, in the principal professions and 
 trades, who died in 1855 : 
 
 Av. age. 
 
 305 Laborers 40.30 
 
 69 Mariners 38.59 
 
 35 Tailors ' 39.08 
 
 32 Merchants 58.81 
 
 32 Traders 49.68 
 
 33 Carpenters 45.76 
 
 22 Painters 40.36 
 
 8 Farmers 57.12 
 
 6 Ship-carpenters 51.16 
 
 5 Physicians 48.80 
 
 5 Clergymen 53.80 
 
 4 Coopers 40.50 
 
 Av. age. 
 
 45 Clerks 32.98 
 
 20 Shoemakers.... 24.35 
 
 15 Teamsters 34.40 
 
 12 Gentlemen 59.83 
 
 11 Printers 39.45 
 
 10 Masons 40.20 
 
 9 Machinists 33.77 
 
 8 Bakers 38.62 
 
 7 Blacksmiths 35.00 
 
 4 Curriers 28.50 
 
 4 Engineers 45.75 
 
 5 Lawyers 60.20 
 
334: HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 In the twenty-second registration report of Massachusetts for 
 1866, 1 find a very carefully prepared table, showing the number and 
 average ages of all persons over twenty years of age, whose occu- 
 pations were specified, and whose deaths were registered during a 
 period of twenty years and eight months, from May 1st, 1843, to 
 December 31st, 1866. As the number of persons whose occupations 
 and average ages are there given is upward of 95,000, this record 
 is the most important contribution to vital statistics that has ever 
 been made. I append the statistics of the most important represen- 
 tative employments. (See Statistical Tables.) 
 
 In the eleventh registration report of Rhode Island for 1863, 
 the average ages of those who died during that year in that State 
 are given, with their respective occupations, the ages under twenty 
 being excluded. 
 
 As the whole number specified is less than eight hundred, the 
 results are not very conclusive ; in some of the trades only one or 
 two cases of death are recorded. I select those that are of the 
 greatest importance in a statistical point of view, omitting all such 
 as do not present a sufficient number of deaths to be of value: — 
 
 No. of Per- Av. 
 
 Occupations. sons. Age. 
 
 1. Agriculturists 147 65.22 
 
 2. Mechanics and artisans : 
 
 Blacksmiths 13 60.84 
 
 Carpenters 24 57.37 
 
 Jewellers 12 39.41 
 
 Machinists 14 57.85 
 
 Shoemakers 12 53.91 
 
 Weavers 10 49.60 
 
 3. Laborers : 
 
 Laborers 141 48.56 
 
 4. Business men : 
 
 Manufacturers 10 47.80 
 
 Merchants 39 54.33 
 
 5. Seafaring men : 
 
 Mariners 16 38.81 
 
 These are all the statistics in regard to the occupations of, this 
 country that I have been able to obtain, and are, I believe, all of 
 any importance that exist, or have been prepared in the United 
 States, with the exception of a few observations of the longevity 
 of special classes, which will appear under their appropriate heads. 
 
 Let ns now compare the reports of the English Registrar-Gen- 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 335 
 
 eral with that of Massachusetts and Rhode Island. The first regis- 
 tration report of England was published in 1838, since w T hich time 
 there has been continued progress in the system of arrangement and 
 collation. 
 
 Dr. Caspar, of Berlin, and Dr. Guy, of London, both wrote on 
 the subject of the relation of occupation to health and longevity ; 
 but, inasmuch as very few statistics had at that time been gathered, 
 their speculations are of no great value. Ramazzini and Thackeray 
 gave some advice to artisans by which they might in a measure 
 counteract the evil effects of their callings. 
 
 But by far the best work on this subject that has yet appeared 
 on either side of the Atlantic is a small book written by Dr. 
 Thackrah, an eminent surgeon of Leeds, and published in 1832. 
 Although he had few figures to aid him, his book is of great value, 
 both for the compass and accuracy of its general observations, and 
 for the originality and clearness of its ideas. 
 
 In 185T, Dr. Neison published a large work on vital statistics, 
 the main object of which was to present the mortuary facts of the 
 friendly societies of England, and also of the medical profession. 
 
 Dr. Earr, Registrar-General of England, in his fourteenth annual 
 report, made some important statements in regard to the ages of 
 men dying in different employments. From a careful examination 
 of his tables, I am convinced that they are in the main corroborative 
 of the experience of the registrars of Massachusetts and Rhode 
 Island. 
 
 Of those that died in England in 1851, the different classes stand 
 thus in order of mortality : — 
 
 1. Farmers. 5. Blacksmiths. 9. Miners. 
 
 2. Shoemakers. 6. Carpenters. 10. Bakers. 
 
 3. Weavers. 7. Saiiors. 11. Butchers. 
 
 4. Grocers. 8. Laborers. 12. Innkeepers. 
 
 It thus appears that miners, bakers, butchers, and innkeepers 
 experienced the heaviest mortality. In regard to the professions he 
 states that the percentage of death is less or at least not greater 
 than that of the average in all th.e employments, as we have seen to 
 be the case in this country. 
 
 In Dr. Neison's report I find the following table, showing the 
 expectation of life of the clerks, plumbers, bakers, and miners of the 
 friendly societies of England : — 
 
 Ages. Clerks. Plumbers. Bakers. Miners. 
 
 - 20 31.83 36.50 40.02 40.67 
 
 30 27.57 30.50 32.35 33.15 
 
 40 21.83 24.30 24.07 24.42 
 
336 HYGIENE, OR THE AET OF PRESERVING HEALTH, 
 
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INFLUENCE OF THE OCCUPATIONS ON HEALTH. 343 
 
 Such, then, are the leading statistical tables that we have been 
 able to obtain from the English and American reports. Although 
 a system of registration was inaugurated in Geneva in 1549, and in 
 Sweden in 1751, yet no elaborate, statistical comparison of the rela- 
 tive longevity in the different occupations has been made in any 
 European country except Great Britain. 
 
 But from the fact, already noted, that the results of the obser- 
 vations on this subject in England and America agree in the main 
 particulars, and from the fact that the expectation of life is about 
 the same in Sweden, France, England and America, we are war- 
 ranted, I think, in concluding that, were the same attention given 
 to the comparison of the longevity in the different employments in 
 these countries, we should find that the same general principles hold 
 good in all. 
 
 Let us now inquire what general principles in regard to the rel- 
 ative heal thf ulness of different employments may be deduced from 
 vital statistics. 
 
 First of all, we observe the pre-eminent healthfulness of ichat 
 may be called the intellectual occupations. 
 
 According to the table, the average age of all classes of occupa- 
 tions was a little over fifty years. The relative longevity of those 
 engaged in the different classes of occupations are in the following 
 order, beginning with the highest : 
 
 1. Cultivators of the earth (managers of estates, farmers). 64.40 
 
 2. Clergymen, lawyers, physicians, and pxrof essoins . . . . 56.48 
 
 3. Active mechanics abroad 51.04 
 
 4. Professional men of all classes (including musicians, 
 
 editors, architects, etc.) 50.35 
 
 5. Merchants, financiers, capitalists 48.26 
 
 6. Active mechanics in shops 47.93 
 
 7. Laborers — no special trades 46.49 
 
 8. Employed on the ocean 45.38 
 
 9. Inactive mechanics in shops 42.89 
 
 10. Factors laboring abroad (butchers, pedlers, drovers, 
 
 teamsters, etc.) 34.71 
 
 These statistics are exceedingly suggestive and thoroughly con- 
 vincing. Observe that of these ten classes — which are here arranged 
 in the order of their longevity — the first five may properly be re- 
 garded as brain-workers, while the last five — the lowest on the scale 
 of longevity — includes those who depend chiefly on their muscles. 
 Observe that laborers with no special trades, and consequently with 
 
344 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 no special responsibility, come four years short of the average longe- 
 vity ; while cultivators of the earth, who own and control farms, 
 exceed it by fourteen years. This distinction between responsible 
 and irresponsible labor is one of vital importance. 
 
 Observe also the fact, of such great interest to collegiate students, 
 that clergymen, lawyers, and physicians exceed the average lon- 
 gevity by six years, having a greater expectation of life than any 
 of the ten classes, except cultivators of the earth. Comparing the 
 four professions with each other, I find from all the statistics I can 
 gather from this country and Europe, that the average expectation 
 of life for 
 
 Clergymen is 60 years. 
 
 Lawyers is 57 u 
 
 Physicians and Professors is 56 " 
 
 In. view of what has been previously advanced on the relation 
 of the intellect — including, of course, the entire emotional and re- 
 ligious nature — to the brain, we can easily understand why clergy- 
 men live longer than any other class, except farmers. 
 
 The ministerial calling, when rightly pursued, approximates 
 more nearly than perhaps any other to an ideal occupation. The 
 pastor is called upon to use his whole nature, the emotional and physi- 
 cal as well as the distinctively intellectual. The exercise of the 
 moral faculties is specially conducive to a healthful manhood. No 
 exercise in the world is so healthful as public speaking. 
 
 On comparing the different tables it will be seen that they all 
 agree in allowing the greatest expectation of life to those professions 
 and occupations that call for the severest exercise of the mind. This 
 is a vitally important fact, for it strikes at the root of popular and 
 professional impression. It has always been supposed that those 
 who depend on the labor of the mind must expect to sacrifice health 
 to a greater or less degree, as well as the prospects for a green old 
 age ; that the immortal part of our nature could be exercised only at 
 the expense of the mortal. But if the facts I have collected are of 
 any value, if general observation is of any value, then the reverse is 
 the truth, and we can but wonder that for so many scientific, progres- 
 sive years the belief has prevailed, both in the profession and out of 
 it, that activity of the mind is unfavorable to health and longevity. 
 
 Even Dr. Thackrah, original and untrammelled as he was, in- 
 clined towards the prevailing belief on the deleterious effects of mental 
 toil ; but not he, nor Caspar, nor Guy, were furnished with statis- 
 tics of value, and only gave the inferences of false theories and pre- 
 
JxYFLUENCE OF THE OCCUPATIONS ON HEALTH. 34:5 
 
 judiced observation. The doctrine that lias for years been taught 
 by the profession and believed by the people is, that in the economy 
 of man mind and body are necessarily at war ; that they can pros- 
 per and grow only as the nations of Europe can extend their domin- 
 ions — by infringing on the rights of each other. This doctrine is 
 worse than unscientific ; it is a libel on the Creator, who has ordain- 
 ed that body and soul should work together, and be developed in 
 grand and beautiful harmony. God makes nothing in vain, and if 
 a mind of wondrous power is given to man, it is designed that it 
 should be used, and it is also provided that it should be strengthened 
 and not weakened by its own activity ; and furthermore, that the 
 body should be benefited and not injured by the growth of the soul 
 it incases. The law is this : mental activity is healthful • mental 
 anxiety is injurious. 
 
 Let us now look at the special occcupations that call for the 
 largest exercise of the intellectual nature. 
 
 Clergymen very properly demand our first attention. They are 
 in many respects the most prominent of our professional men. In 
 this country they have always taken the initiative in the cause of 
 education and social progress. Moreover, they have always been 
 cited as illustrations of the destructive effects of mental toil, and in 
 the popular mind the ministry has ever been associated with bron- 
 chitis, consumption, insanity, and an early grave. Now while it is 
 true that clergymen, in common with all classes of brain-workers, are 
 peculiarly subject to the class of diseases that result from undue activ- 
 ity of the nervous system and vocal organs, it is also true that they are 
 remarkably free from most of the inflammatory affections that carry 
 away our mechanics and laborers before the average term of life is 
 reached. Let it be remembered that the nervous diseases peculiar 
 to literary men, of which so much is said and written, although they 
 annoy existence and cripple usefulness, are by no means as serious 
 in their character as many acute disorders that over-exertion of 
 the physical powers with attendant exposure seem to invite and 
 foster. 
 
 The ministerial calling approximates more nearly than almost 
 any other to the ideal occupation we have supposed. The pastor 
 is called upon to use his whole nature. The exercise of the moral 
 faculties of reverence, hope, spirituality, and benevolence is spe- 
 cially conducive to health and longevity — a fact which appears to 
 have been almost wholly ignored by writers on hygiene. 
 
 Again the pastor can, if he will, perform his work in calmness 
 and repose. His life is usually free from the unequal pressures, the 
 agitating storms and crises that at times embitter the existence of 
 
346 HYGIENE, OR THE AKT OF PRESERVING HEALTH. 
 
 speculators and politicians ; if he labor in any other than an equa- 
 ble frame, the fault is usually due to himself more than to externals. 
 
 Lastly, no one better than the pastor can systematize his time, 
 giving to each day, and each portion of the day, its appropriate 
 work or recreation. 
 
 The facts of clerical biography sustain the theories here ad- 
 vanced. Concerning no other occupation are the figures so accor- 
 dant. 
 
 The average longevity of clergymen of all denominations, ac- 
 cording to' the Registration report of Massachusetts, is 57.79; .and 
 53.80 according to that of Boston alone. In Rhode Island it is 59.25. 
 
 Of 417 clergymen whose names are recorded in Allen's Biogra- 
 phical Dictionary, the average age was 65.7 ; and of these there 
 died :* 
 
 13 between 90 and 100 years. 
 
 6Q " 80 " 90 " 
 
 123 " 70 " 80 " 
 
 84 " 60 " 70 " 
 
 53 " 50 " 60 " 
 
 43 " 40 " 50 " 
 
 25 " 30 " 40 ; < 
 
 5 " 20 " 30 " 
 
 Dr. Lombard, of Geneva, found the average age of 53 Protestant 
 clergymen to be 63.8, excluding those who died under thirty. 
 
 Of 888 clergymen who died in Massachusetts, and whose ages 
 were known. 
 
 90 averaged 61.77 
 
 124 " 65.00 
 
 302 " 62.00 
 
 372 " 64.00 f 
 
 Of 840 clerical graduates of Harvard College, the average age 
 was 63.62 ; 41 in each 100 reached 70. Of those dying between 
 1835 and 1841, the average age was 56.J 
 
 Dr. Madden, in a work on the infirmities of genius, while argu- 
 ing that the professions in which the imagination was largely exer- 
 cised were relatively unfavorable to longevity, allows clergymen 
 70 years. 
 
 * Prize Essay of Benj. W. McCready, M.D., Transactions New York State Medical 
 Society. 
 
 f Report of Sanitary Commission of Mass., 1850. 
 % Quarterly Register, vol. x., p. 39. 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 347 
 
 If, then, there be any truth in statistics, as well as any logic in 
 our reasoning, the prospects of a long life for the minister are ex- 
 ceedingly flattering, in spite of the temptations to excessive work 
 of the brain, and of their manifold bronchial and laryngeal disorders. 
 Among no public bodies do we find more aged and venerable men 
 than in the synods of clergymen. 
 
 Lawyers. — Of lawyers it has been said, that they need a " bad 
 heart and a good digestion." If this be true, then our pleaders and 
 counsellors are certainly supplied with these conditions, for they 
 stand very high on the tables - of longevity. The law is indeed 
 very far from being a natural or ideal profession. The advocate 
 must spend hours and days in the horrible air of court-rooms ; 
 the counsellor leads the most sedentary of all lives in his office 
 chair. 
 
 On the other hand, law presents a field for the exercise of the 
 largest powers of reason and judgment ; as a science, it is pre- 
 eminently intellectual in its character, and is intimately interwoven 
 with statesmanship and diplomacy. 
 
 Public pleaders speak long and earnestly, sometimes for days 
 together, but they rarely complain of the clergymen's sore throat 
 or of anything analogous, for the simple reasons that their tones are 
 more conversational ; their briefs are merely used for reference ; and, 
 far more than clergymen, they harden the neck to the variations 
 of the atmosphere by a wise and judicious neglect. 
 
 The average age of lawyers in Massachusetts is 56.21 ; in the 
 city of Boston 60.20. It is clear that they do not stand as high as 
 ministers in statistics any more than in theory. Judges live to be 
 66.38. 
 
 Physicians. — Medicine is, in some particulars, the most incon- 
 sistent -and unequal of the professions. In one aspect it is peculi- 
 arly conducive to health, in another is theoretically most hazardous. 
 It calls into action the best faculties of both mind and heart ; its 
 study embraces, in its totality, the whole range of human thought 
 and feeling. 
 
 Moreover, the physician is not alone an operator in bodily inju- 
 ries, and a prescriber for merely physical diseases ; it is his solemn, 
 responsible privilege to 
 
 " Minister to a mind diseased; 
 Pluck out from the memory a rooted sorrow ; 
 Raze out the written troubles of the brain." 
 
 —a task that demands his own moral as well as intellectual sympathy 
 and inspiration. In so far, then, as medicine gives scope for the ex- 
 ertion of man's best faculties of mind, in so far as it quickens and 
 
348 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 intensifies the moral nature, in just so far does it approximate to the 
 ideal type of a profession. But there is another side to the picture. 
 
 The physician, especially the country practitioner, cannot adjust 
 his hours of labor according to hygienic principles. The life of a 
 faithful, successful practitioner must, then, be one of exposure, anx- 
 iety, and irregular toil. The city physician is often able to com- 
 bine in a most happy manner the physical exercise of daily practice 
 with various study and acquisition; thus marrying, as it were, bodily 
 exercise with a purpose, to the calm pursuit of science — a most for- 
 tunate union, that cannot fail to be conducive to vigorous health 
 and length of years. 
 
 It is stated on very good authority, that physicians are more than 
 ordinarily subject to cardiac disease, owing to the fact that they are 
 so continually obliged to disguise their feelings and thoughts while 
 in the presence of patients. Whatever of truth there may or may 
 not be in the statement, it does not prevent their attaining a high 
 average longevity. 
 
 Of 490 physicians of Massachusetts who died before 1840, the 
 average age was 57, and 35 in each 100 attained to 70 years.* 
 
 In Thacher's Medical Biography (quoted by Dr. McCready) 145 
 physicians are mentioned, whose average age is 62.8. Of these : 
 
 and 
 
 3 
 
 died 
 
 between 
 
 90 
 
 25 
 
 a 
 
 u 
 
 80 
 
 37 
 
 a 
 
 a 
 
 70 
 
 30 
 
 a 
 
 it 
 
 60 
 
 21 
 
 u 
 
 u 
 
 50 
 
 18 
 
 u 
 
 u 
 
 40 
 
 15 
 
 u 
 
 a 
 
 30 
 
 12 
 
 u 
 
 a 
 
 20 
 
 100 
 
 years. 
 
 90 
 
 u 
 
 80 
 
 a 
 
 70 
 
 u 
 
 60 
 
 a 
 
 50 
 
 u 
 
 40 
 
 a 
 
 30 
 
 a 
 
 It thus appears that 59 of these lived to be over 70, and 100, or 
 more than two-thirds, over fifty. 
 
 Of 32 physicians and surgeons whose lives are sketched in Gross' 
 Medical Biography (including several who died before their prime), 
 the average age was 59. 
 
 The farmers of intelligent districts are properly included in the 
 class of brain- workers. A gulf as wide as the Atlantic separates the 
 husbandman, ruling " sua arva pater ?ia" and the common laborer on 
 the farm, hired at so much a week. A stupid or shallow-brained man, 
 devoid of energy or foresight, can no more make a successful farmer 
 than he can make a successful lawyer, merchant, pastor, or physician. 
 
 It is a fact generally known that the average longevity among 
 
 * Report of Sanitary Commission of Massachusetts, 1850. 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 349 
 
 farmers in this country is greater than that in any other occu- 
 pation. But their green old age is not due to their muscular exer- 
 cise alone, for mechanics and laborers, who work even harder than 
 the majority of farmers, do not live as long by many years ; it is not 
 due to the pure air they breathe, for many outdoor workers are 
 much lower in the scale of longevity than they ; nor, lastly, is it due 
 to the calmness of rural life, for the farmer is burdened with grave re- 
 sponsibilities and oppressed often by weightier cares than the work- 
 man he hires by the day or month, the butcher in the market, or the 
 teamster on the highway, all of whom die much younger than he. 
 
 Farmers are long-lived not only because of pure air, moderate 
 exercise, and country quiet, but more especially because they can 
 counteract the animalizing effects of merely physical labor by varied 
 activity of the mind. 
 
 In Massachusetts the average age of 22,764 cultivators of the 
 earth was 64.40. 
 
 Merchants, manufacturers, and men of business next demand 
 our attention. That the head of any business firm must be 
 a man of intellectual activity and resource, there can be no 
 room for question. Mercantile life, with its myriad complica- 
 tions and crises, makes heavy drafts on the wits and genius of the 
 ablest. And yet the pursuits of commerce, manufactures, and trade 
 do not usually develop the best faculties of man in their entirety ; 
 they may be successfully prosecuted without the aid of the moral 
 nature, or the highest capabilities of the mind. The frequent but 
 by no means necessary tendency of commercial life is to sordidness, 
 externalities, and morbid worship of property as the end rather 
 than the means of existence. So far, then, as business life of any 
 kind begets narrowness and greed of gain, just so far is it unfavor- 
 able to .health. The merchant who is master of his affairs can be 
 measurably systematic in his labor. Moreover, the pursuits of trade 
 will always be congenial to human nature, until the worship of 
 Mammon is less universal than now ; and the man of business can- 
 not fail to be inspired by the hope of the bright rewards of his oc- 
 cupation, though at times he may be sickened with its cares and 
 uncertainties. But he is the victim first prostrated by the financial 
 storms which at irregular periods sweep over the land, paralyzing, 
 for the time, the mighty arm of trade. We find business disasters are 
 very frequently the exciting causes of insanity. 
 
 But in spite of all drawbacks attendant on business life, mer- 
 chants are usually healthy, and their average longevity, though 
 below the standard of clergymen, lawyers, or physicians, is greater 
 than that of artisans and laborers. 
 
350 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 Iii the table of Dr. Jarvis, their average age is 48.39 ; in the 
 report of Massachusetts, covering twenty-three and more years, it 
 is 47.95 ; in Rhode Island it is 54.33, while manufacturers are put 
 down at 47.80; in Boston, 58.81. The average of all (merchants, 
 financiers, and capitalists) is 48.26. 
 
 AN ARTIST. 
 
 Artists and Musicians, as a class, only cultivate the peculiar 
 gifts they enjoy, ignoring oftentimes the higher intellectual and 
 moral endowments. Whatever in art or music is ennobling, en- 
 larging to mind and soul, serving to make man more intellectual, 
 more spiritual, and more catholic in feeling, must be conducive to 
 health and longevity ; but the great body of musicians in this coun- 
 try, at least, are simply men of special aptitudes, and are oftentimes 
 very irregular and dissipated in their lives. Tbe average age of 101 
 artists in Massachusetts was 45.19. As a class they are unbalanced 
 men, for the reasons just stated, and, if the statistics of insane asy- 
 lums are worthy of credence, artists furnish a greater percentage of 
 inmates in proportion to the numbers in the profession than almost 
 any other class. 
 
 Students in academies and colleges are as healthy and vigorous 
 as any other body of young men of similar ages in the country. 
 
 In spite of the late hours, and oftentimes irregular habits of 
 students; in spite of their excessive use of tobacco, and spasmodic 
 industry, they are, as a rule, both in this country and in Europe, 
 eminently vigorous and healthful. Neither among clerks, mechan- 
 ics, nor laborers have I seen so pleasant an average of sturdy, wiry, 
 bounding health as among the undergraduates of Harvard and Yale. 
 
 Teachers of primary schools are not usually over-healthful nor very 
 long-lived, but the occupation of teaching itself is not necessarily in- 
 jurious. On the contrary, the beneficial effect of the intellectual 
 exercise required in instructing is seen in the gray hairs of our col- 
 lege and academy professors, and managers of private schools. Of 74 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 
 
 351 
 
 professors mentioned in Allen's Biographical Dictionary, the ave- 
 rage age was 61 ; of 22 in Massachusetts, 55.81 ; while of 359 teach- 
 ers in the same State, the average age is but 30.95. 
 
 Why is this discrepancy % The answer is obvious. Teachers 
 stand low on the list, partly because very few follow teaching as 
 a life calling, but abandon it usually before arriving at maturity ; 
 and therefore of those who die and are registered as teachers, the 
 average age can, of course, be no guide in determining the healthful- 
 ness of the occupation ; partly because the duties of instruction in the 
 elementary branches do not call forth the highest powers of intel- 
 lect, like pleading and sermon-writing ; and partly because they are 
 confined for many hours each day in poisonous and over-heated 
 rooms, subject all the while to multitudinous petty vexations and 
 " insect cares," which, though they are mighty enough to torture 
 the body and fret the spirit, are too insignificant to develop the high- 
 est type of character. 
 
 Authors, as a distinct registered class, are not numerous either in 
 this country or in Europe, but they are scattered through all the pro- 
 fessions. Whatever hygienic laws apply to professional men must 
 also apply to authors, as such. It follows, therefore, from what has 
 been said that authorship is favorable, and eminently so, to health 
 and long life. 
 
 On the score of congeniality, we may safely assert that no class 
 so love their calling as do authors. Says one : u Of all artists, the 
 poet is most fond of his work ; " and the statement may be extended 
 to embrace all classes of writers. 
 
 Unless driven by pecuniary straits, authors can regulate their 
 hours of labor according to hygienic laws. They can systematize 
 their time ; they can think in repose. But authors are usually men 
 
352 HYGIENE, OR THE ART OF PRESERVING HEALTH, 
 
 of genius endowed with exalted imaginations, and subject to vary- 
 ing moods and fitful humors. The muse is often coquettish, and will 
 not come and go by clock-work ; fancy will not soar by the laws of 
 arithmetic. It is one of the compensations of genius, that he who pos- 
 sesses it largely must be its slave. The imagination of great 
 souls breaks from the fetters of hygiene, and they cannot restrain it 
 if they will. 
 
 It is useless for such geniuses to attempt to regulate their sea- 
 sons of creating by the chronometer, like the compiler or statistician. 
 
 So much has been said of Kirke White, Chatterton, Keats, 
 and others who were similarly unfortunate, and so many homilies 
 have been written on the lessons of their lives, that those who have 
 not investigated the subject will be surprised at the statement that 
 the average age of the poets, essayists, historians, and novelists of 
 England, whose names have been handed down with various de- 
 grees of fame, is nearly sixty years. If we go back to classic times, 
 we find that Cicero died at sixty-four ; Demosthenes at sixty ; So- 
 crates at ninety ; Yirgil at fifty-one ; Tacitus at sixty ; Plato at 
 eighty ; Aristotle at sixty- three ; JEschylus at sixty-nine ; Ovid at 
 sixty ; Livy at seventy-six ; Anaxagoras at eighty-eight ; Zeno at 
 ninety-nine, and Xenophon at ninety; and if the list be extended 
 to include all the immortal authors of antiquity, the average longev- 
 ity is still found to be very high. Comparing the different spheres 
 of intellectual activity, w T e find that philosophers and men of science 
 live longer than poets, or those who are endowed with rich gifts 
 of fancy. Observe the following comparative list : 
 
 Philosophers and Men of Science. 
 
 Galileo 78 
 
 Franklin 84 
 
 Herschel 84 
 
 Newton 85 
 
 Halley 86 
 
 Locke 73 
 
 Eoger Bacon 78 
 
 Buffon 81 
 
 Harvey 81 
 
 Galen 79 
 
 Jenner 75 
 
 Haller. . . . 70 
 
 Galvani . . 61 
 
 Francis Bacon 78 
 
 Poets and Romancers. 
 
 Yirgil 52 
 
 Dante 56 
 
 Petrarch 70 
 
 Fenelon . , 63 
 
 Pope 56 
 
 Moliere 53 
 
 Horace 57 
 
 Racine 59 
 
 Milton (j6 
 
 Young 80 
 
 Corneille 78 
 
 Yoltaire 85 
 
 Wieland 80 
 
 The causes of this difference are sufficiently obvious. The life 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 353 
 
 of the philosopher is one of calmness, regularity, and unworried ac- 
 tivity of mind ; the life of the poet is often one of excitement and 
 irregular and spasmodic industry, or of absolute dissipation ; the ave- 
 rage longevity of the one class is probably between 70 and 80 years. 
 
 That even these irregularities and excesses are not of themselves 
 so destructive as is supposed, is proven by the records of literature. 
 With the sad examples of Kirke White, Schiller, Chatterton, Byron, 
 and Poe before our minds, we find that the average age of authors is 
 very high. The average age of the writers of France, Germany, 
 and America, of the past century, will not, fall much below that of 
 clergymen. Journalists in this country are not as healthy or as 
 long-lived, on the average, as authors, and for very obvious reasons. 
 Those, however, who work regularly and calmly, and obtain a 
 proper amount of sleep, may and do live as long as other classes of 
 literary men. 
 
 We seem, then, to be shut up to the conclusion that intellec- 
 tual activity is not only healthful, but pre-eminently so, and that the 
 effects of the mental excesses of professional men are far more than 
 counteracted by the conserving tendencies of the exercise of the 
 higher faculties. 
 
 A corroborative argument in favor of this position is to be found 
 in the fact that the expectation of human life increases with the 
 progress of civilization. Although this has been denied by some, 
 there can be little room for doubt to the candid inquirer. 
 
 Registrations of births and deaths were kept by the Greeks and 
 Romans, but as they were not preserved, we are unable to compare 
 the different periods of classic history ; but from the tables which 
 have been continued at Geneva with great care for several centu- 
 ries, we learn that the expectation of life at the present day in that 
 city isfve times as great as it was in the sixteenth century. The 
 following table represents the rate of increase : 
 
 Period. 
 
 Years. 
 
 Months. 
 
 Days. 
 
 Pate of Increase. 
 
 1551-1600 
 
 8 
 
 7 
 
 26 
 
 100 
 
 1600-1700 
 
 13 
 
 3 
 
 16 
 
 153 
 
 1701-1750 
 
 27 
 
 9 
 
 13 
 
 321 
 
 1751-1800 
 
 31 
 
 3 
 
 5 
 
 361 
 
 1801-1813 
 
 40 
 
 8 
 
 10 
 
 470 
 
 1814-1833 
 
 45 
 
 
 
 29 
 
 521 
 
 In round numbers, the average expectation of life at Geneva in 
 
 1551 was 9 years; in 1833, 45 years — a most marvellous increase, 
 
 and one that is to be accounted for partly by the progress of social 
 
 science, government, and sanitary knowledge, but chiefly by the^ 
 
 23 
 
354: HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 mental and moral activity to which this progress is due. The rate 
 of annual mortality in France in 1781, was one in 29 ; in 1802, one 
 in 30 ; and in 1823, one in 40. In London in 1700 the annual mor- 
 tality was one in 25 ; in 1781, one in 40. 
 
 If, then, there has been a gradual and continual increase in the 
 expectation of life on both sides of the Atlantic, the inference is 
 warranted that such increase is owing very materially to the expand- 
 ing intellectuality of our modern civilization, as well as to a better 
 knowledge and observance of the laws of health. 
 
 The second fact that we learn from the study of vital statistics 
 is this : that the greater the mental and moral endowments of a man, 
 the greater the amount of intellectual labor he can undergo, and the 
 better his prospects for longevity. It would seem that those upon 
 whom nature has been most prodigal of her intellectual gifts can 
 work harder and longer, with better expectation of life (other 
 things being equal), than the rank and file of humanity in any of 
 the professions. Although this idea has not been advanced before, 
 so far as I am aware, its truth is, I think, satisfactorily established 
 by analogy and by literary and scientific biography. 
 
 Isolated illustrations of longevity among great men are familiar 
 to us all. But we have no right to generalize from a few instances. 
 In order to establish the general principle that the greatest geniuses 
 and hardest brain-workers of the world attain an exceedingly high 
 longevity, we need as many cases as can well be obtained. 
 
 I have therefore taken the pains to go through the Cyclopaedia, 
 and to note down the ages of one hundred of the greatest men of his- 
 tory — those who have created epochs, and have been the leaders of the 
 world's thought in literature, art, science, and statesmanship — and I 
 have found that the average age of these was much higher than that of 
 literary and professional men generally; nay, even much higher 
 than that of clergymen, the longest livers of all. This list, which 
 covers a period of many centuries, contains such names as G-oethe, 
 Coleridge, Lessing, Beranger, Wordsworth, Yoltaire, Hume, Milton, 
 Shakspeare, Dante, and Irving, among men of letters ; Raphael, 
 Michael Angelo, and Reynolds, among painters; Malebranche, 
 Locke, Leibnitz, Hobbes, and Hamilton, among modern philoso- 
 phers ; Socrates, Aristotle, Plato, and Cicero, among the ancients ; 
 Harvey, Cuvier, Buffon, Galileo, Humboldt, ISTewton, Jenner, and 
 Faraday, among men of science; Napoleon, Marlborough, Wash- 
 ington, Metternich, Richelieu, Burke, Webster, Calhoun, and Clay, 
 among warriors and statesmen ; and Calvin, Luther, Knox, Butler, 
 Paley, and Edwards, among theologians. ISTo one will deny that 
 these, and similar names, fairly represent the giants of history. 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 355 
 
 "Now, the aggregate ages of the one hundred men on this list was 
 not far from 7,500, giving the astonishing average of nearly 
 seventy-five years, which is twelve to fifteen years higher than that 
 of the most favored of ordinary professional men. 
 
 Whoever will make the effort to fill out any list of names that 
 thoroughly represent the leaders of the world's thought and activity 
 will, I am sure, arrive at results not essentially different from 
 mine. 
 
 In opposition to the facts here presented, it will be said that 
 nervous diseases are on the increase among us, and that they are 
 most frequent and most severe among brain-workers. That this 
 impression is well founded there can be no question. Paralysis, 
 neuralgia, hysteria, dyspepsia, hypochondriasis, and insanity are 
 certainly more frequent, both in this country and in Europe, than 
 they were thirty or fifty years ago. In my own practice, I am con- 
 tinually amazed by the variety and subtlety of phase that these 
 diseases assume even in the young and growing generation. But 
 it is one of the compensations of these nervous disorders that they 
 are not rapidly fatal, and that they protect the system against 
 febrile and inflammatory affections that hurry the Indian, the 
 negro, and the poor laborers of our own race into early graves. 
 
 The third fact which we learn from these statistics is, that of those 
 occupations which are not distinctively intellectual, those are most fa- 
 vorable to health and longevity which, on the whole, demand the great- 
 est relative activity of the mind. 
 
 Those mechanics who, like carpenters, carriage-makers, black- 
 smiths, use their brains as well as their muscles, although they work 
 much indoors, are healthier and longer-lived than shoemakers, 
 tailors, jewellers, and operatives in factories, whose labor is so rigidly 
 systematized that they are obliged to do very little more thinking 
 than the machines on which they are employed. 
 
 It should be remembered, also, that a variety of muscular acti- 
 vity is more conducive to health than mere routine, that calls into 
 play but a single set of muscles. 
 
 Active mechanics abroad 'live to be 51.04. 
 
 Brickma'kers live to be 48.63. This is a very good average. 
 Their occupation admits of a variety of toil, and much of the time 
 they have the benefit of the sunlight. 
 
 Carpenters attain the age of 51.20. Their trade admits of a 
 variety of toil. Some of the time they are outdoors, and then again 
 they labor in shops. Most of the time they are exposed to the 
 sunlight. All of the principal muscles are called into exercise 
 at various times and in various combinations. 
 
356 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 The carpenter, breathing no noxious gases and no poisonous dust, 
 cramped in no narrow position and imprisoned in no heated rooms, 
 is, on the whole, the healthiest of artisans. 
 
 A CARPENTER. 
 
 Calkers and ship-carpenters are also comparatively vigorous, and 
 live a comfortable length of years. Calkers are obliged to labor 
 in a confined position, and the mere exercise of their trade is not 
 stimulating to the mind, nor calculated to develop the whole physi- 
 cal man. That their average longevity is good is due to the pare 
 air they breathe, more than to any other cause. 
 
 Coopers, carriage and clockmalcers, and wheelwrights are all 
 quite healthful and have a good expectation of life, and for the same 
 reasons that apply to the carpenters and joiners. The journeyman may 
 become an architect, provided he be able and willing to climb the 
 rounds of the ladder, one by one. These considerations act as a 
 stimulus to those mechanics who are not dead to all ambition, and 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 357 
 
 impel to active thought and strong exertion. In those callings 
 where the chances of promotion are distant and cloudy, we shall 
 see that men become desperate and annualized, while in the same 
 proportion their life-expectation diminishes. 
 
 Grocers are said to be troubled with a kind of itch, caused by the 
 irritation of sugar and other substances they handle. But although 
 this affection is disagreeable, it is neither dangerous nor fatal. Their 
 life is active, and allows of a wide range of intelligence and energy ; 
 while sluggish dotards may exist by the occupation, it yet affords 
 scope for the highest business abilities. They die at 48.03 years. 
 
 A BLACKSMITH. 
 
 Blacksmiths live long, and are not subject to any peculiar dis- 
 ease. Of more than 1,000 in Massachusetts, the average age was 
 52.69. While their work is hard, it admits of not a little variety. 
 They breathe good air and observe regular hours of labor. The 
 cinders, smoke, and heat are injurious to the eyes, and give rise to 
 chronic inflammations, bu t have no marked effect on the general health. 
 
 Millers do not seem to be injured by the dust of flour and meal 
 they continually breathe, although Thackrah distinctly asserts that 
 starch and farina manufacturers are more than ordinarily subject to 
 bronchial and pulmonary disorders. Their occupation is in all other 
 respects healthful and elevating, and they may not improperly 
 be classed as manufacturers. The average age of 186 in Massachu- 
 setts was 58.58. 
 
 We now come to speak of those employments that are not re- 
 garded as favorable to health and longevity, which we find to be by 
 far the largest class, including most of the trades and mechanic arts 
 that attend upon and are a part of our modern civilization. 
 
 Butchers are proverbially fleshy, bloated, and red-faced. So 
 
358 HYGIENE, OK THE ART OF PRESERVING HEALTH. 
 
 universally is this the case, that to " look like a butcher " is the 
 everyday phrase applied to any one whose countenance indicates 
 more of the animal than of the spiritual nature. To this rule, as to 
 all rules, there are marked exceptions. I have seen butchers in 
 carts and in markets, with their shrunken faces, who seem to gain 
 no flesh or color, even after dealing in meat for years; yet those 
 few are almost always healthful and strong. 
 
 The inquiries at once arise, What is the cause of this profession- 
 al redness? Does it indicate unusual vitality % 
 
 Although our knowledge of vital chemistry is too imperfect to 
 enable us to make a scientific demonstration of the theory, it is yet 
 very clear, I think, that the butcher's face is due to the emanations 
 of the stalls and slaughter-houses. We seem, indeed, to be driven to 
 this explanation by exclusion. If exposure, if vigorous exercise, if 
 intemperance, or all conjointly, can account for this color, then the 
 sailors, laborers, and teamsters, who are even more exposed and 
 active, and, as a rule, even more intemperate, ought to exhibit this 
 peculiarity to a far greater degree. 
 
 A BUTCHEB. 
 
 To the next inquiry, whether the color and fat of the slaughter- 
 house are healthful, very opposite responses are given from Massa- 
 chusetts and from beyond the sea. Of 335 butchers in Massachu- 
 setts, the average age was 49.85 ; while in England they are next 
 to the last of the twelve classes in order of heal thfuln ess. Dr. Parr, 
 in the report already quoted, states that the mortality among 
 butchers was fearful ; that the proportional percentage of deaths 
 among them was greater than that among the miners, and only ex- 
 ceeded by that of inn-keepers and beer-shop tenders. 
 
 It seems hard to explain this discrepancy. Dr. Thackrah thought 
 that the emanations of stalls and stables were peculiarly healthful, 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 359 
 
 if not medicinal in their character, and on that theory accounted for 
 the vigor of butchers, groomsmen, and stable-keepers. 
 
 That these odors and emanations of dead and living animal matter 
 are not very deleterious to health is proven by the strong frames and 
 fair longevity of those who all their lives are subject to them. 
 
 Tanners and curriers are the most singular paradoxes among 
 artisans. They breathe an atmosphere intensely offensive, even to 
 nerves that are not sensitive ; they labor in dampness and amid 
 decaying animal substance, and yet their lives are not short, nor are 
 they subject to any special form of disease. A stranger visiting a 
 tan-yard for the first time is sickened and well-nigh suffocated by the 
 horrible stench, while he sees burly gray-haired men handling and 
 cleaning the hides, to all appearance drinking in health at every 
 breath. Years ago it was observed in Europe that the vile odors of 
 tan-yards were not injurious to the health of those employed in 
 them, and very naturally the theory arose that they were, in fact, 
 medicinal in their character, and particularly adapted for consump- 
 tives. 
 
 In the " Annales d'Hygiene" for 1862 is an essay by Dr. M. C. 
 Beaugrand, from which I glean a brief history of the variations in 
 medical sentiment on this important subject. 
 
 A TAXXER OR CURRIER. 
 
 Rainazzini, in his "Advice to Artisans," published in 1797, distinct- 
 ly asserts that tanners are very unhealthy ; Civillo, of Naples, gave 
 a contraiy opinion in 1799. Ackermann, of Germany, in a work 
 published in 17S0, also was of the opinion that tanners and curriers 
 were as strong and vigorous as any class of laborers. Patissier, of 
 France, favored the views of Civillo and Ackermann, declaring with 
 great positiveness, " la profession de tanneur plus desagreable que 
 dano;ereuse." 
 
360 HYGIENE, OK THE ART OF PRESERVING HEALTH. 
 
 Halfort, of Germany, and Dr. Thackrah, of England, agree in 
 attributing to the atmosphere of tan-yards conservative if not me- 
 dicinal virtues. It was at one time asserted that patients far gone in 
 phthisis had been restored by laboring over skins and hides, breath- 
 ing the disagreeable air of the yards, but from observations that 
 have since been made it seems to be fully established that phthisis is 
 as common among tanners as among laborers in any healthy occupa- 
 tion. 
 
 Of 160 cases of sickness in the hospital of Wiirtzbourg, cited by 
 Schlegel, there were very many cases of tuberculosis. Statistics 
 clearly show that pneumonia is both common and fatal among them, 
 while they are far from being exempt from bronchitis and kindred 
 affections. 
 
 Their average age in this country is about 46, which is certainly 
 not very high, even for laborers whose occupation demands little ex- 
 ercise of the nobler faculties. The conclusion we must accept, then, 
 is this, that the occupation of tanning and currying, as compared 
 with other employments of a similar grade, has neither a positively 
 deleterious nor salutary effect on health and longevity, but that it is, 
 indeed, rather negative in its influence on those who become habit- 
 uated to its disagreeable and stifling odors. 
 
 Teamsters, stablers, and drivers do not live to be much over 
 40. It is the common belief that the odors of barn-yards and stables 
 are healthful, and there are those who, with failing health, seek re- 
 lief by hiring themselves out as groomsmen. It cannot be denied 
 that some are thereby benefited, just as some have been cured of 
 consumption by the air of tanneries ; but in both cases it is more than 
 probable that the same kindly results would have followed the change 
 to any active occupation. 
 
 Tallow-chandlers seem to belie the aspersion cast on their trade, 
 by living longer than almost any other class of artisans, for of 48 
 in Massachusetts, the average longevity was 54.19. But inasmuch 
 as many of these were not unlikely heads of, or partners in firms, 
 with the responsibilities and cares of manufacturers, it is evident 
 that more abundant statistics are necessary before we rush to the 
 conclusion that soap and tallow establishments of modern times 
 seem to prolong the lives of those employed in them. 
 
 Glass-blowers have a most unfortunate calling, which, although 
 it demands a kind of skill and practice, is always seriously detri- 
 mental to the system. They are exposed to an unnatural tempera- 
 ture, and are continually obliged to overwork the lungs. Pulmonary 
 troubles are common among them, and, according to the statistics 
 in Massachusetts, they die at 38.77. 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 361 
 
 GLASS-BLOWERS. 
 
 Founders and furnace-men are subject to rheumatic disorders, 
 arid die before they are 45. Thackrah maintains that the sudden 
 transitions from heat to cold to which these classes are liable have no 
 noticeable influence on the health. His statement needs to be consid- 
 erably modified. While it is true that habit to a degree reconciles 
 the system to such changes and irregularities, as, indeed, to almost 
 all others, it is also true that those who are much exposed to exces- 
 sive heat, with sudden transitions to cold and wet, are more than or- 
 dinarily afflicted with the pains and inflammations of rheumatism. 
 More than that, the experience of many surgeons establishes beyond 
 a doubt the fact that the coal-heavers and firemen on ship-board 
 send a much larger relative percentage to the sick-bay than do the 
 seamen and landsmen. 
 
 FOOTDRYMEX. 
 
 Those who work in an atmosphere the temperature of which is 
 
362 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 considerably higher than that of the system, are, in fact, much of 
 the time in a kind of fever that must consume the vital force. 
 
 Their labor being neither elevating nor energizing to the mind, 
 affords no stimulus to the higher nature, by which the injurious fea- 
 tures of their occupation may be counteracted. 
 
 Stone-cutters and knife-grinders suffer from a kind of bronchitis 
 peculiar to themselves, caused by the irritation of the fine particles 
 continually inhaled. It has been estimated that in one of the Sheffield 
 manufactories 75 pounds of dust are given off every day ; that a sin- 
 gle packet of needles loses 5 pounds on the grindstone. 
 
 Dr. Hall, of the Sheffield Hospital, says that the expectation of 
 life for a grinder at 21 is but 14 years. 
 
 Stone-cutters are more out of doors, and have a little greater va- 
 riety of exercise, but in the nature of things they cannot be healthy 
 or long-lived. In Massachusetts they live to be about 46 years old. 
 
 Shoemakers, tailors, jewellers, engravers, labor many hours in 
 cramped positions, breathing most unwholesome air, with but little 
 active exercise of any kind. 
 
 The shoemakers in Eastern Massachusetts usually take no pains 
 to ventilate their shops, but work blindly on, 12 or 15 hours a day, 
 around hot stoves, and in crowded rooms. The result is seen in 
 their wan, sallow features, hollow chests, and sunken eyes. Inflam- 
 matory diseases do not attack them as readily as they do butchers, 
 teamsters, and outdoor laborers, for the reason that their blood is 
 usually thin and watery, and they have little superfluous adipose 
 tissue which a fever can feed on and consume. The same is true of 
 all who are employed in unhealthy, sedentary occupations indoors. 
 
 In the large shoe manufactories, where the rooms are more spa- 
 cious, and arrangements are made for working in a standing pos- 
 ture, and where machines are used in some of the merely mechani- 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 363 
 
 cal operations, the general appearance and standard of health of 
 the employes is much more favorable than in the old-fashioned, yet 
 still existing cobbling shops. 
 
 1 * 
 
 Of over 6,000 shoemakers in Massachusetts the average age was 
 43.12 ; of 20 in Boston alone, 34.35 ; of 12 in Ehode Island, 53.91. 
 The Registrar-General of England places them second on the list in 
 order of longevity — most surely a wide discrepancy, and one that 
 we cannot explain, if the shoe business in England is carried on in 
 the same way as in Massachusetts. 
 
 Certainly the average of more than 5,000 cases is sufficient to es- 
 tablish the general law in that State, at least, which is the head- 
 quarters of the boot and shoe manufacturing interest of the coun- 
 try. 
 
 Tailors, jewellers, engravers, and machinists die before they are 
 forty. 
 
 Machinists are injured by the filings of iron and steel, by the 
 confined air of their shops. They have opportunity for the exer- 
 cise of the inventive faculties. Their trade is directly associated with 
 engineering and with all forms of machinery, yet the vast majority are 
 mere routinists, perfectly content with the wages of manual labor. 
 They seem to be as low on the tables of longevity as the tailors or 
 jewellers. 
 
 They are also injured by the iron filings which they breathe. 
 They die at forty. 
 
 Printers are short-lived. They work hard and long, at un- 
 seasonable hours, in low, over-heated, wretchedly ventilated apart- 
 ments, with little opportunity for exercise either of mind or body. 
 Although brought into constant communion with the best thoughts 
 of the world, they are but little more elevated and stimulated by 
 
364 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 them than are the type and presses. They are usually reckless and 
 intemperate. That the occupations of type-setting and printing are 
 not necessarily injurious is proved by the fact that in every large 
 establishment there are a few individuals who attain a good old age. 
 
 The average age of 441 in Massachusetts was 38.15. "Working 
 over bad manuscript, oftentimes by artificial light, makes diseases 
 of the eye very frequent among them. 
 
 Bakers, cooks, and confectioners are said to be peculiarly liable 
 to apoplexy, which is due to the fact that their heads are often ex- 
 posed to sudden gushes of hot air, while in a stooping posture. By 
 the Registrar-General of England, bakers are placed tenth in the 
 order of longevity — only two classes, butchers and shop-tenders, being 
 below them. It has been supposed that the dust of flour may ope- 
 rate injuriously, but if so why are millers so healthy and long-lived ? 
 
 Miners and colliers, although living under ground and forced to 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 365 
 
 breathe air not unfrequently poisonous, though liable to fatal acci- 
 dents and explosions, seem to have a better expectation of life in 
 England than either bakers, butchers, or beer-shop keepers. 
 
 Painters and plumbers are liable to lead-colic, with its terrible 
 train of woes. Beginners in the painter's trade almost invariably 
 complain of headache and general malaise, and some are obliged to 
 abandon the occupation. Even the smell of turpentine has on some 
 a powerful stimulating effect on the kidneys, that cannot fail to be 
 of injury. The average age of over 1,000 was about 46 years. 
 
 MASON OR BRICKLAYER. 
 
 Masons and hrichlayers live to a fair age. Theirs is not, on the 
 whole, as healthy or as ennobling as that of carpenters and joiners, 
 and does not call for as varied activity of the mind. 
 
 Operatives are very unhealthy and short-lived. "Working an ex- 
 cessive number of hours, amid the fearful, confusing clatter of ma- 
 chinery, in greasy, over-heated factories, and compelled to bolt down 
 their meals in half the requisite time, we cannot wonder that indi- 
 gestion and phthisis parch and shrivel their frames, and hurry them 
 away at the early age of thirty-eight. Observations in England and 
 America give about the same results. 
 
 Nearly all operatives, male and female, are mere routinists, going 
 through their appointed toil with the blind regularity of the shafts 
 and looms. 
 
 Draw-filing cast iron is a very injurious occupation. The dust 
 is much more abundant, and the metallic particles much more mi- 
 nute, than in the filing of wrought iron. The particles rise so copi- 
 ously as to blacken the mouth and nose. The men first feel the 
 annoyance in the nostrils. The lining membrane discharges copi- 
 ously for some time, and then becomes preter naturally dry. The 
 
HYGIENE, OR THE ART OF PRESERVING HEALTH 
 
 air-tube is next affected. Kespiration is difficult on any increase of 
 exertion ; and an habitual cough is at length produced. At the 
 same time the digestive organs become impaired; and morning 
 vomiting, or an ejection of mucus on first rising, is not infrequent. 
 The disorder varies, of course, with the constitution of the individual ; 
 but a common termination, when men pursue the employment for 
 years, is bronchial or tubercular consumption. 
 
 The founders of brass suffer from the inhalation of the volatilized 
 metal. In the founding of yellow brass in particular, the evolution 
 of oxide of zinc is very great. It immediately affects respiration ; it 
 less directly affects the digestive organs. The men suffer from diffi- 
 culty of breathing, cough, pain at the stomach, and sometimes 
 from vomiting in the morning. 
 
 DRUGGIST OR CHEMIST. 
 
 Chemists and Druggists are exposed to various odors, and the 
 evolution of gases, many of which are injurious. Hence the per- 
 sons employed in laboratories are frequently sickly in appearance, 
 and subject to serious affections of the lungs. There is no question, 
 however, that druggists and chemists may and do attain advanced 
 age. Chemistry, in its highest departments, calls for the best 
 powers of the intellect. My remarks here chiefly refer to those 
 who are engaged in preparing and dispensing chemicals and 
 drugs. 
 
 Schools demand our particular attention. Children are crowded 
 in rooms of disproportionate size. The air, consequently, is greatly 
 contaminated, and the vital power is more or less reduced. Even 
 where attention is paid to ventilation, the evil must, in a greater or 
 less degree, exist in large schools. Children, and very young chil- 
 dren, are kept, too, for many hours daily, in a state as nearly 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 367 
 
 motionless as it is possible for the masters to produce. The time 
 devoted to amusement is much too little. Instead of two or three 
 hours a day being allowed for play, only two or three hours a day 
 should be devoted to confinement and labor. To fix a child in a 
 particular posture for hours, is vile tyranny, and a cruel restraint on 
 nature. 
 
 Young ladies especially suffer from habits of schools. Their 
 exercise is much too limited. Full romping exercise, exercise which 
 brings all the muscles into play, is discouraged. It is vulgar to use 
 the limbs as nature designed ; it is vulgar to take the food which 
 nature requires; and young ladies must not do anything that is 
 vulgar. Sitting, moreover, for hours at needlework, or in learning 
 what are called accomplishments, they leave a numerous class of 
 muscles wasting for want of exercise. The muscles of the back are 
 especially enfeebled, — and the spinal column, in youth comparatively 
 soft and flexible, bends under the weight of the head and arms. The 
 spine yields, because the muscles, which closely connect the bones, 
 and by their action keep them in a proper line, are too weak. I 
 am often asked, Why are spinal complaints so common ? I answer, 
 that a principal cause is the want of full exercise ; we say that young 
 persons are obliged to acquire what is of little or no use in after life, 
 while they neglect what is necessary to the establishment of the 
 body in health and vigor; in short, we have daily to lament that 
 muscular exercise is so often sacrificed to accomplishments and 
 to learning. If it be asked, why are girls more subject to distortion 
 than boys, we reply, because they do not romp like boys. The 
 amusements of boys are far more active than sedentary ; those of 
 girls are more sedentary than active. Several hours a day they 
 must devote to music, and frequently a considerable time to the 
 more injurious occupation of drawing ; most of the remaining day 
 they spend in finger occupations. Little time is devoted to exercise 
 in the open air, and the exercise they do take is such as to chill, 
 rather than invigorate the circulation. 
 
 Laborers on farms, and jobbers at various kinds of outdoor 
 work, do not seem to live as long as many classes of artisans who 
 are shut up in bad air, and with little exercise. Of upwards of 
 17,266 in Massachusetts, the average age was 46.74 ; of 305 in 
 Boston, 40.30. Undoubtedly most of those thus registered as labor- 
 ers were employed, more or less, in farm labor ; and if country air, 
 and country quiet, and country industry are sufficient to insure 
 longevity, then ought they, at least, to have attained the age of fifty- 
 five. But, as has been remarked, there is a wide gulf between the 
 status of the manager of a farm and the workman hired by the 
 
368 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 month. The common laborer, owning no land, paying light taxes, 
 feels no interest in his work, beyond the money value represented 
 by it. While, then, his muscles grow hard and strong, his intel- 
 lectual nature becomes dwarfed and stunted. His very fulness of 
 habit invites and feeds every form of inflammation, and, unsustained 
 by loftiness of moral or intellectual purpose, he easily succumbs and 
 dies before his prime. 
 
 It should be considered, also, that laborers, printers, operatives 
 in factories, and artisans generally, are very apt to form dissipated 
 habits, consume large quantities of bad whiskey, breathe bad air, eat 
 bad food, and are surrounded by bad home associations. All these 
 influences — as well as their lack of brain- work — tend to make them 
 short-lived. 
 
 Pilots, fisher men, and naval officers are usually very robust, and, 
 in spite of irregularities and intemperance, are quite long-lived. 
 Common sailors who remain before the mast die at forty-five ; but 
 those who rise to be commanders of vessels attain to a good old age. 
 From these facts the inference is clear that the sea air, as such, is 
 healthful, both for those who breathe it all their lives, as well as for 
 the invalids who resort to it at intervals. The system does not 
 necessarily become so accustomed to it as to fail to be benefited by 
 its tonic powers, for many who spend their lives upon the ocean re- 
 present that appetite and health are much better at sea, even on long 
 voyages, than on shore. Were it not for the healthful medicinal 
 virtues of the sea air, their lives would probably be shorter than 
 that of any class of laborers or artisans on shore. 
 
 On the other hand, rheumatism and consumption are very often 
 brought on or aggravated by salt air, although there are cases 
 where both of these diseases are cured by & long voyage. Rheuma- 
 tism of the chronic variety is exceedingly common among seamen, 
 and on shipboard is often obstinate against every form of treat- 
 ment. 
 
 So far as the air of the sea is appetizing and invigorating to the 
 general system, just so far is it beneficial to consumptives; but that 
 it is irritating to the inflamed surfaces of the lungs, is proved by the 
 experience of the majority of those who resort to it in advanced 
 stages of the disease. 
 
 During the late war it was found that many landsmen in 
 the navy were attacked with consumption in its rapid form 
 within a few months after first going to sea; and many were 
 discharged in the second and third stages of phthisis, who at the 
 time of enlistment had never dreamed that they were particu- 
 larly susceptible to the disease. Not a few who were taken on sup- 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH. 
 
 ply vessels from northern latitudes to southern, were sent back to 
 die before serving out half their time. 
 
 On the whole, then, as pilots and fishermen and lighthouse 
 keepers attain to such good longevity, it is fair to conclude that sea 
 air is, in the main, conservative to health and life. 
 
 A few other classes remain to be noticed. Manufacturers 
 of white lead and friction matches die early, for reasons too 
 obvious to be stated. 
 
 Railroad conductors average but thirty-eight, according to sta- 
 tistics in Massachusetts ; but it is not just to infer that the occupa- 
 tion is so very unheal thful, inasmuch as few remain in it after they 
 become old. Yet, as brakemen, express and baggage men are also 
 low down on the tables of longevity, the question arises whether con- 
 tinuous car-riding is not, of itself, injurious — aside from the liability to 
 accident — Conductors, both on steam and horse railroads, frequently 
 complain of general malaise, which they attribute to the continual 
 jarring of the body caused by the motion and sudden stopping of 
 the cars. The average age of 169 railway agents and conductors in 
 Massachusetts is 39.14. Railway accidents, frequent and bloody as 
 they are, will not account for the mortality among employes on 
 the trains. Moreover, they breathe good air, and in nearly all other 
 respects their life is not unhealthy. 
 
 Potters ought to attain a fair longevity. Their occupation 
 labors under the same difficulty as that of many other artizans ; 
 it is toe narrow in its sphere, and demands very little intellectual 
 activity. 
 
 24 
 
370 HYGIENE, OK THE ART OF PRESERVING HEALTH. 
 
 Tobacconists do not seem to be as much injured by their calling 
 as was at one time supposed. It has been thought that working in 
 tobacco had a bad effect on the health, but this theory is not sus- 
 tained by sufficient evidence. 
 
 It is now proved, both by general observation and by statistics, 
 that tobacconists are, if anything, healthier and longer-lived than 
 the average ot indoor operatives. In some of the rooms of tobacco 
 manufactories the workmen live in an atmosphere of tobacco dust, 
 large quantities of which they must take into their lungs with each 
 respiration ; and yet they become so entirely accustomed to it that 
 they not only are as free from disease as the average of operatives, but 
 are really longer-lived. It is thought by some that working in to- 
 bacco protects the system from consumption and fevers, and some 
 other diseases. The average age of 29 tobacconists in Massachusetts 
 was 52.17 years. This is four years above that of active mechanics 
 in shops, and only four below that of clergymen, lawyers, and phy- 
 sicians, who are noted for their longevity. 
 
 Operators on Sewing- Machines. — It is said that there are over 
 one million of sewing-machines in the United States. All these 
 have come into use within 25 years. This is a short time in which 
 to test the effects of operating these machines on the longevity, and 
 the statistical table on this special occupation sheds no light. Many 
 physicians and other close observers now agree that operating on the 
 sewing-machine for an exclusive occupation is injurious to the health, 
 especially of women. In operating on our ordinary machines the 
 body is in a sitting position, and only a limited number of muscles 
 of the arms and limbs are used. The position is cramped and un- 
 natural. The movements required become exceedingly tiresome. 
 A very intelligent lady, of more than average health, once told me 
 that half an hour at the sewing-machine completely exhausted her, 
 and that it made her for the time exceedingly nervous. 
 
 Besides the general results, operating on sewing-machines 
 sometimes injuriously influences the genital apparatus, and there- 
 by, by its mechanical effects, may give rise to serious local dis- 
 order. 
 
 Finally ', we observe that those occupations of women which are 
 allied to and are a part of her duties as wife and mother, and 
 mistress of the household, are more favorable to her longevity than 
 the special trades. 
 The average age of 4,070 females {of all classes) was 45.31 years. 
 
 u 
 
 it 
 
 " " 57 nurses 
 
 " 61.53 " 
 
 « 
 
 ii 
 
 " " 2,309 housekeepers 
 
 " 50.33 " 
 
INFLUENCE OF THE OCCUPATIONS ON HEALTH, 
 
 371 
 
 The average age of 
 
 a 
 
 a 
 
 a 
 
 a 
 
 a 
 
 a 
 
 M 
 
 a 
 
 a 
 
 tt 
 
 u 
 
 it 
 
 u 
 
 u 
 
 it 
 
 a 
 
 a 
 
 a 
 
 of 
 
 361 domestics 
 
 it 
 
 195 seamstresses 
 
 a 
 
 154 tailor esses 
 
 a 
 
 37 shoebinders 
 
 a 
 
 147 dressmakers 
 
 u 
 
 29 straw-braiders 
 
 a 
 
 84 milliners 
 
 u 
 
 26 straw-sewers 
 
 a 
 
 205 teachers 
 
 a 
 
 466 operatives 
 
 was 46.15 years. 
 45.81 
 45.16 
 43.84 
 41.90 
 38.69 
 38.45 
 31.92 
 29.99 
 28.07 
 
 It will be observed that there is here a regular gradation — that 
 nurses, housekeepers, domestics, are quite long-lived, while those 
 engaged in the special trades of straw-braiding, millinery, attain 
 only an average age of less than forty. 
 
 Making all allowances for the fact that young women are more 
 apt to engage in these special trades, these facts are yet very signi- 
 ficant. 
 
 When woman is allowed to participate actively in politics, and 
 in professional and business life, it is probable that her longevity 
 will be increased. Her present duties do not sufficiently exercise 
 her brain. Home duties give more and a better variety of activity 
 to the brain than working in the mills or standing behind the 
 counter, and are therefore more healthful. In proportion as woman 
 uses her fingers less and her brain more, in that proportion, other 
 conditions being favorable, will she become longer-lived. 
 
 There is, then, a difference of at least ten years in favor of those 
 
372 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 who labor in the household. Stern necessity compels the widows 
 and unmarried of civilized lands to engage in irksome mechanical 
 employments, but it would be far better for woman's health and hap- 
 piness if the laws of society made it more honorable to wait on the 
 door and preside over chambers than to sew on coats or make 
 straw hats. 
 
 Of the relative age of the married and the unmarried, these sta- 
 tistics give us no information. 
 
 It has been shown, however, by other statistics, that the mar- 
 ried live much longer than the unmarried ; that widows and wid- 
 owers have less expectation of life than if they remained all their 
 lives in the married state. 
 
 It is a very suggestive argument in favor of the healthfulness of 
 the married state that, in spite of all its necessary cares, and anxi- 
 eties, and distresses, in spite of its frequent and life-long uncon- 
 geniality and misery, in spite of the sorrows of parturition, and all 
 the nameless trials that children cause their parents, yet the mar- 
 ried live much longer than the spinsters and bachelors. 
 
 This fact is also an argument in favor of the healthfulness of labor 
 of the brain. The brains of the married are usually much more active 
 than those of bachelors and old maids. They have weightier and 
 more numerous cares. They have severer anxieties. The care of the 
 children, the unnumbered duties of the household, the perpetual bat- 
 tle for bread and shelter, the continuous planning and forecasting, 
 the constant activity of the emotional and moral nature — all these 
 things, on the average, tend to health and longevity. 
 
 On this important subject of longevity, Dr. J. Y. C. Smith re- 
 marks as follows : 
 
 " 1st. Short persons, of sound constitutions, unimpaired by viola- 
 tions of natural laws of health, have a prospect of a longer life than 
 tall persons, all other circumstances being equal. 
 
 " 2d. Females having particularly long necks have shorter chests 
 and narrower at the base than those whose necks are of the ordinary 
 appearance. 
 
 " 3d. Diseases of the lungs do more frequently exist in tall men 
 than in those of medium height, or those between five feet seven 
 inches and five feet nine; and a hereditary tendency to pulmonary 
 consumption is thought to be found in tall families more frequently 
 than in others. 
 
 " 4th. When pulmonary disease is hereditary in a family, chil- 
 dren are not unfrequently born with tubercles in the tissues of the 
 lungs. Years may be required to develop them, unless they are sub- 
 iected to some exciting causes. Slight inflammatory action in the 
 
PORTRAITURE OF A MAN DESTINED TO LONGEVITY. 373 
 
 mucous membrane of the bronchial tubes sometimes suddenly ex- 
 tends to them and quickens them into activity, and ulceration soon 
 appears, destroying the delicate texture of the neighboring air-cells, 
 interrupting the aeration of the blood, and death follows." 
 
 DR. SMITH'S PORTRAITURE OF A MAN DESTINED TO LONGEVITY. 
 
 " A fully developed osseous frame and muscular organization. 
 
 Stature not too tall, rather middle size, somewhat thick-set. 
 
 A capacious chest. 
 
 Shoulders rather round than flat. 
 
 Pulse strong and regular. 
 
 Yeins full at extremities. 
 
 Head not too large. 
 
 Neck neither very long nor short. 
 
 Abdomen not projecting. 
 
 Sands large, but not too deeply cleft. 
 
 Foot rather thick, and broad than long. 
 
 Skin strong, smooth and clear. 
 
 Complexion not too florid, nor too ruddy in youth. 
 
 Hair approaching rather the fair than black. 
 
 Yoice strong, with faculty of retaining the breath long without 
 difficulty. 
 
 Senses acute and clear, but not too delicate. 
 
 Appetite good and digestion easy. 
 
 Teeth sound, eats slowly, without extra thirst. 
 
 Excretions all regular and free. 
 
 No violent passion. 
 
 Temperament sanguine, with a little of the phlegmatic. 
 
 " Both men and women born of parentage remarkable for lon- 
 gevity inherit vitality, and are generally tenacious of life. They 
 occasionally reach a very advanced period, being rarely the victims 
 of acute or epidemic diseases. 
 
 " 2d. Children born of parents one but -r\ot both of whom inherit- 
 ed long life, do not equally inherit vitality. ^Tn any considerable 
 number of brothers and sisters born, some of tnem will live to be 
 aged, but not all. 
 
 " 3d. Men or women with particularly long bodies, otherwise 
 well developed, and governed by all the circumstances and condi- 
 tions heretofore noted, give satisfactory physical signs of a long 
 life. 
 
 " 4th. Married women who have borne children, if in comforta- 
 
374 
 
 ble circumstances, especially in the country, have the prospect of a 
 longer life than those who were never mothers. 
 
 " 5th. Widows have not the prospect of so long a life as mar- 
 ried women. 
 
 " 6th. Widowers have not a prospect of so long a life as married 
 men. Married persons, if happily connected, have a prospect of a 
 longer life than the unmarried. 
 
 " 7th. Unmarried women in health, easy in their circumstances, 
 and pleasantly conditioned in society, have the prospect of a longer 
 life than unmarried men of the same social condition. 
 
 " 8th. Unmarried women, dependent upon their personal efforts 
 and harassed by anxieties, have not a prospect of a long life. 
 
 " 9th. Excitable, fractious men or women, when married, who 
 are subject to paroxysms of sudden anger, peril their prospects for a 
 long life. 
 
 " 10th. Both men and women, although in easy circumstances, 
 if of a jealous, irritable disposition, or subject to morose exhibitions 
 of temper — married or unmarried — have not a prospect of long life- 
 Still a few out of many may sometimes live to be aged. 
 
 " 11th. Men or women who have changed their residence from a 
 cold or moderately temperate climate of one continent to a similar 
 climate in another, if comfortable in their circumstances and indus- 
 trious and correct in their habits, do not have their vitality im- 
 paired. 
 
 " 12th. Men or women who thus remove from one continent, as 
 from Europe to America, or from America to Europe, if inclined to 
 excesses which impair the vital force, may die prematurely." 
 
 LONGEVITY OF AMIMALS. 
 
 This is a subject of exceeding interest, and is very suggestive. 
 
 Hufeland, in his excellent work, " The Art of Prolonging Life," 
 has some reliable facto lP and theories in regard to longevity that I 
 present below. 
 
 The facts he records are reliable, even though we may not agree 
 with all of his theories. 
 
 Among other general principles he enumerates the following: — 
 
 < ' 1st. Bulk shows a greater provision of the vital or plastic power. 
 
 " 2d. Bulk gives more vital capacity, more surface, more external 
 access. 
 
LONGEVITY OF ANIMALS. 375 
 
 " 3d. The greater mass a body has, the more time is required be- 
 fore it can be wasted by its external and internal consumptive 
 and destructive powers" 
 
 " Of the tenacity of life we have instances truly astonishing. Tor- 
 toises have been seen to live a considerable time without the head ; 
 and frogs when their hearts were torn out have still continued to 
 leap about. A tortoise has existed six whole weeks without any 
 food ; and this sufficiently shows how small its intensive life is, 
 and how little need it has of restoration. Nay, it is proved that 
 toads have been found alive inclosed in stones and blocks of marble. 
 "Whether they were shut up there in the egg or as perfect beings, 
 both cases are equally astonishing ; for what a number of years 
 must have been necessary for the marble to generate, and before it 
 could acquire its solidity ! 
 
 " This shows how much influence the power of regeneration has in 
 prolonging life. A great many dangers and causes of death are 
 thereby rendered harmless ; and whole parts which have been lost 
 are again renewed. 
 
 " To this belongs that phenomenon of the skin which we find 
 among most animals of this class. 
 
 u Snakes, frogs, lizards, c&c, cast their skin every year; and it 
 appears that this method of becoming again young contributes very 
 much to their support and duration. Something of the like kind 
 seems to prevail throughout the whole animal world ; birds change 
 their feathers, as wells as their bills, which is called moulting ; in- 
 sects transform themselves, and most quadrupeds change their hair 
 and their claws. 
 
 " The tortoise and crocodile attain to the highest age, as far as we 
 have yet been able to learn from observation. 
 
 " The tortoise, an indolent, slow in all its motions, and phlegmatic 
 animal, and which is so long in growing that in twenty years one 
 can scarcely observe an increase of a few inches, lives to the age of 
 a hundred years and more. 
 
 " The crocodile, a large, strong, vigorous animal, enclosed in a 
 hard coat of mail, incredibly voracious, and endowed with extraor- 
 dinary powers of digestion, lives also very long, and, according to 
 the affirmation of several travellers, is the only animal which grows 
 as long as it exists. 
 
 "It is astonishing what instances of great age may be found among 
 fishes, the cold-blooded inhabitants of the waters. We know from 
 the ancient Roman history that in the imperial fish-ponds there 
 were several lampreys (mursenge) which had attained to their six- 
 tieth year, and which had at length become so well acquainted and 
 
376 HYGIENE, OR THE ART OF PRESERVING- HEALTH. 
 
 familiar with man, that Crassus, orator, unam ex illis de fleverit. 
 The pike, a dry, exceedingly voracious animal, and carp also, ac- 
 cording to undeniable testimony, prolong their life to a hundred 
 and fifty years. The salmon grows rapidly, and dies soon. On 
 the other hand, the perch, the growth of which is slower, preserves 
 its existence longer. It appears here worthy of being remarked, 
 that natural death occurs more rarely among fishes than in any 
 other part of the animal kingdom. 
 
 " The law of the transition of one into another according to the 
 right of the strongest prevails here far more generally. One 
 devours another — the stronger the weaker ; and one may assert 
 that death exists less in the water, as the dying pass immediately 
 into the substance of another living being, and consequently the 
 intermediate state of death is less common than on land. Putre- 
 faction takes place in the stomach of the stronger. This regulation 
 is a proof of exalte and divine wisdom. If the innumerable mil- 
 lions of the inhabitants of the waters which die daily remained only 
 one day unentombed, or, what is the same thing, not devoured, they 
 would speedily diffuse abroad the most dreadful pestilential evapor- 
 ation. In water, where vegetation, that great means of correcting 
 animal putrefaction, exists in less extent, every cause of corruption 
 must be guarded against, and on this account continual life must 
 prevail" 
 
 According to Grin don, "the longest-living mammal, after the 
 whale, appears to be that affectionate, docile, and sagacious creature, 
 the elephant. Nothing is known positively as to its lease, but the esti- 
 mate of one hundred and fifty years is certainly not beyond the mark. 
 The rhinoceros and the hippopotamus are reputed to come next, a 
 maximum of seventy or eighty being assigned to each of these huge 
 brutes ; then, it is said, follows the camel, a meagre, dry, active, ex- 
 ceedingly hardy animal, whose useful life extends not infrequently to 
 fifty. The period, reckoning by decrements, between fifty and thirty 
 is reached by few. The stag, longseval only in romance, dies at thirty- 
 five or thereabouts ; the leopard, bear, and tiger fail fully ten years 
 earlier ; twenty-five or thirty is the ordinary maximum of the horse 
 and ass, though the severe treatment of man rarely allows them to 
 reach even this. 
 
 k 'The mule, it is worthy of notice, is stronger lived and becomes 
 older — a circumstance anticipated in plants, where hybrids frequent- 
 ly live longer than their parents. The cause is probably the same 
 in both, and to be found in their infertility, whereby their whole 
 vigor is left at liberty for self-maintenance, instead of being expend- 
 ed in two directions. Many leases expire between twenty and ten. 
 
LONGEVITY OF ANIMALS. 377 
 
 The former seems to be the ordinary maximum of the lion as reached 
 in menageries, though when unconh'ned it evidently lives longer, for 
 it has sometimes been found without teeth. Twenty is the limit 
 also with the bull, despite his great strength, size, and solidity ; the 
 dog and the wolf seldom pass eighteen ; the sheep, the goat, and the 
 fox rarely live more than twelve. 
 
 " The maximum of the domestic cat is said to be ten, that of the 
 rabbit, hare, and guinea-pig seven or eight, that of the mouse five or 
 six, and of other such little animals about the same. As to the leases 
 of the remainder of the four-footed creatures of our planet, except- 
 ing a dozen or so, zoology is entirely uninformed, and until they 
 shall have been ascertained of course nothing like a proper list can 
 be constructed. The animals which have been mentioned are cer- 
 tainly among the chief, and indicate the scope and limits which a 
 table of ages when completed will exhibit; but so far the list is 
 only like a boy's first map— unfurnished, except with the names of the 
 seas, the metropolis, and his native town. One thing is plain, that 
 man, regarded as a member of the animal kingdom, has no occa- 
 sion to murmur at the shortness of his lease of life; bat shoidd rather 
 congratulate himself, seeing that he enjoys a considerably longer term, 
 even in his ordinary duration, than the great mass of his physiolo- 
 gical fraternity / while it is pretty certain that there is not an animal 
 of his own size that does not return to dust before half as old. The 
 scale of ages attained by birds is much about the same as that of 
 mammals, but taking one with another they probably live longer 
 in proportion to their bulk. No creatures are better adapted for 
 longevity — they are peculiarly well clothed, for no covering can be 
 more complete, or better calculated to preserve warmth than their 
 soft, close-lying feathers ; and as these are renewed periodically 
 they are maintained in the best possible condition. Many birds 
 also cast their beaks and acquire new ones — a most advantageous 
 exchange for them, since they are thereby rendered so much the 
 better able to feed themselves. Besides these peculiarities, birds live 
 almost entirely in the fresh air, and their habits are cheerful and 
 sportive — conditions eminently conducive to long life. 
 
 " As to the particular terms of life which obtain among them, 
 Flourens says he knows 'nothing certain.' There is plenty of evi- 
 dence, nevertheless, that such birds as the eagle, the vulture, the falcon, 
 and the swan, far surpass all others in longevity, and attain ages so 
 remarkable as often to exceed very considerably that of man. Even 
 the crow is reputed to live a hundred yea?*s, and the raven no less 
 than ninety. 
 
 " There have been instances of the parrot living for sixty years a 
 
378 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 prisoner, and its age when captured would have to be added. Peli- 
 cans and herons are said to reach forty to fifty years ; hawks thirty 
 to forty ; peacocks, goldfinches, and blackbirds about twenty ; 
 pheasants and pigeons about the same ; nightingales fifteen, the 
 robin a little less ; domestic fowls about ten ; thrushes eight or nine; 
 wrens two or three. Concerning the ages of fishes even less is 
 known than about birds. It is vaguely believed of them that they 
 are longaeval. The reasons for this opinion are, that the element in 
 which they live is more uniform in its condition than the atmos- 
 phere, and that they are less subject in consequence to those injuri- 
 ous influences which tend to shorten the lives of terrestrial creatures; 
 and, secondly, that their bones, being of a more cartilaginous nature 
 than those of land animals, admit of almost indefinite extension, so 
 that the frame is longer in growing to maturity. 
 
 In regard to the longevity of tortoises, Grindon substantially 
 indorses the views of Hufeland above quoted. 
 
 "Reptiles .'.ttain surprising ages. The tortoise, which is so 
 slow in growing that in twenty years an increase of a few inches 
 is all that can be detected, has lived even in captivity above a cen- 
 tury. One placed in the garden of Lambeth Palace, in the time 
 of Archbishop Laud, lived there till the year 1753 ; and its death 
 was then induced seemingly through misfortune rather than old age. 
 
 " The enormous creatures of this kind, natives of the Galapagos, 
 undoubtedly live twice or thrice as long as the common species. 
 An individual possessed some years back by the London Zoologi- 
 cal Society had every appearance of being at least a hundred and 
 seventy-five. Even these immense ages were probably far exceeded 
 by the great fossil testudinata of the Himalayas. It is easy to see 
 the cause of such longevity. The same law which obtains in the 
 mechanics of inanimate matter operates in the organisms of vital- 
 ized matter — namely, that which is gained in time must be lost in 
 power. The active habits which in short-lived animals accelerate 
 the vital processes and bring the lease to an early close, here are no 
 longer found. 
 
 " The tortoises have no excitable nervous system to wear out 
 the durable materials incased in their impenetrable armor. 
 They spend the greater part of their lives in inactivity, and exist 
 rather than live. By analogy it may be inferred that the loricate 
 and ophidian reptiles reach an age fully as advanced as the tortoises. 
 The crocodile, large, strong, vigorous, enclosed in a coat of mail, 
 and incredibly voracious, is without doubt exceedingly long-lived. 
 The larger serpents, also slow in growth, and passing a considerable 
 portion of their lives in semi-torpor, are also unquestionably long- 
 
LONGEVITY OF ANIMALS. 379 
 
 seval. Feeding voraciously at long intervals, so familiar in the 
 case of serpents, seems invariably associated with prolonged life. 
 As regards the amphibia, Smellie refers to a toad known to have 
 been at least thirty-six. The frog, which by reason of its slow 
 growth in this climate, at least, is incapable of producing young till 
 its fourth year, reaches, however, what in proportion to this late 
 puberty is the very inconsiderable age of no more than from twelve 
 to about sixteen. Insects for the most part are short-lived, espe- 
 cially after their last transformation. Some after acquiring their 
 wings live for only the remainder of the day. 
 
 " In calculating the ages of insects, of course, they must he reckoned 
 from the hatching of the egg. Different species exist two, three, 
 and even four years in the grub state, then a considerable time in 
 the chrysalis, the winged state being merely that of completed 
 maturity. That which especially marks the latter is the fitness of 
 the creature for propagation, and this as the period of its bloom is 
 also the briefest. The ephemerae in their winged state a?>e not even 
 creatures of a day. Scarcely a single gnat as such survives a 
 week / not half the beetles, nor any of the grasshoppers nor lipulw, 
 those long-legged dancers of the autumn, enter on a second month. 
 A fortnight sees the death of almost every kind of butterfly and 
 moth. One of the longest-living insects is that brilliant beetle, the 
 scarabmus auratus, or rose-chaffer — the only one that feeds upon 
 the flower from which it takes its English name. 
 
 "After four years spent as a grub and a fortnight as a chrysalis, it 
 has lived in captivity from two to three years more. That curious 
 but treacherous and cruel creature, the mantis religiosa, or praying 
 cricket, which holds up the foremost pair of its long, desiccated, 
 skeleton legs, as if in the act of prayer, is said to attain a full 
 octave." 
 
 LONGEVITY OF TREES AND PLANTS. 
 
 It is quite difficult to obtain reliable facts from observation in 
 regard to the age of trees, because some species live hundreds and 
 thousands of years, and must therefore be watched by many genera- 
 tions of men in order to ascertain their exact age. It is therefore 
 customary to count the rings that are formed in the growth of 
 trees that attain to great age. 
 
 On this subject Hufeland writes as follows : 
 
 " Plants may all, however, be reduced, according to their dura- 
 tion of life, into three principal classes : annual, or properly only 
 semi-annual, which grow up m spring and die in autumn; 
 
380 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 biennial, which die at the end of the second year ; and, lastly, per- 
 ennial, the duration of which extends from four to a thousand 
 years. 
 
 " All plants of a soft, watery constitution, and which have fine, 
 tender organs, have a short life, and last only one or at most two 
 years. Those alone which have stronger organs and tougher juices 
 exist longer, but wood is absolutely necessary in order to attain 
 to the highest degree of vegetable existence. 
 
 "Even among those which live only one or two years, a 
 remarkable difference may be observed. Those which are of a 
 cold, insipid nature, and destitute of smell, live, under like circum- 
 stances, not so long as the strong-scented balsamic plants, which con- 
 tain more essential oil and spirits. 
 
 " Lettuce, wheat, oats, barley, and all hinds of corn live no more 
 than a year / but, on the other hand, thyme, mint, hyssop, balm, 
 wormwood, marjoram, sage, &c, can live two years, and even longer. 
 Shrubs and small trees can live sixty years, and some even twice 
 that number. 
 
 " The vine attains to sixty or a hundred years, and continues fruit- 
 ful at the greatest age. This is the case also with rosemary. The 
 acanthus and ivy, however, can exceed the age of a hundred. 
 Among many such, for example, as the different kinds of rubus 
 (common bramble, blackberry, raspberry), it is difficult to deter- 
 mine the age, as the branches creep along the ground and always 
 form new plants, so that it is almost impossible to distinguish the 
 new from the old ; and by these means they make their existence, as 
 it were, perennial. Those which attain to the highest age are the 
 greatest, strongest, and hardest trees ; such as the oak, the lime-tree, 
 the beech, the chestnut, the elm, the palm-tree, the cedar, the olive, 
 the palm, the mulberry-tree, and the baobab. We may with cer- 
 tainty affirm that some of the cedars of Lebanon, the celebrated 
 chestnut tree, di centi cavalli, in Sicily, and several of the sacred 
 oaks under which the ancient Germans performed their religious 
 ceremonies, may have attained to the age of a thousand years and 
 more. These are the most venerable, the only now existing testi- 
 monies of the ancient world, and inspire us with reverence and 
 awe when the rustling wind plays through their silvery locks, 
 which once served to overshade the Druids and our wild ancestors 
 clothed in their bear-skins." 
 
 Grindon remarks on the longevity of trees : 
 
 " How vast are the periods of life allotted to the long£eval trees 
 may be judged from the following list of ages known to have been 
 reached by patriarchs of the respective kinds : 
 
LONGEVITY OF TREES. 381 
 
 " Cercis 300 years. Walnut 900 years. 
 
 Elm 335 " Oriental Plane. . 1,000 
 
 Ivy 450 " Lime 1,100 
 
 le 516 " Spruce 1,200 
 
 Larch 576 " Oak 1,500 
 
 Orange 630 " Cedar 2,000 
 
 Cypress 800 " Schubertia 3,000 
 
 * Olive 800 " Yew 3,200 
 
 " Four and five thousand years are assigned to the Taxodium 
 and the Adansonia, and Von Martins describes locust-trees in the 
 South American forests which he believes to have begun their quasi 
 immortality in the days of Homer. Whether or no, it may safely 
 be asserted that the world possesses at this moment living memo- 
 rials of antiquity at least as old as the most ancient monuments of 
 human art. How grand and solemn is even the thought of a tree 
 coeval with the pyramids of Egypt and the sculptures of Nineveh, 
 yet still putting forth leaves, and inviting the birds to come and 
 ' sing among the branches ! ' 
 
 " Well might the old preacher of Alexandria discern in a tree 
 the terrestrial image of heavenly truth. 
 
 " The age may he estimated by ascertaining as nearly as possible 
 the annual rate of increase, then talcing the diameter of the trunk 
 at about a yard from the ground, and calculating by rule of three. 
 Thus, if in the space of an inch there be an average of five annual 
 layers, a hundred inches will indicate five hundred years of life. 
 The latter method requires to be used, however, with extreme 
 caution, because of the varying rate of earlier periods of life, trees 
 increase much faster than when adult. The oak, for instance, grows 
 most rapidly between its twentieth and thirtieth years, and when 
 old the annual deposits considerably diminish, so that the strata 
 are thinner and the rings proportion ably closer. Some of the oak 
 become thinner after forty, those of the elm after fifty, those 
 of the yew after sixty. Unless allowance be made for this, 
 and also for the irregular thickness of the layers, which vary 
 with the positions of the tree in regard to the sun, errors are in- 
 evitable. 
 
 There are trees which are altogether destitute of rings. These 
 
 * There are olive-trees in the supposed garden of G-ethsemane which hare been 
 estimated at 2,000 years; but these are probably mere descendants of those connected 
 with the narratives of the Gospel, put forth originally as suckers from their roots, and 
 to be regarded rather as restorations than as identically the same. 
 
382 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 belong to the class called endogens, of which the noblest and typi- 
 cal form is the palm. Here the sign of age is usually furnished 
 by the scars or stumps of the fallen leaves, which are of prodigious 
 size, few in number, and produced only upon the summit of the 
 lofty, slender, and branchless trunk. A certain number of new 
 leaves expand every year, and about an equal number of the oldest 
 decay; so that, by taking the total of the scars, and dividing it by 
 the average annual development of new leaves, a tolerable approxi- 
 mation may be come to. But it can rarely be relied upon ; it is a 
 method, indeed, by no means universally practicable, the scars of the 
 fallen leaves being very variable in their degree of permanence in 
 different species. 
 
 Of the potential longevity of a tree or plant, a fair estimate may 
 be arrived at from a variety of circumstances. 
 
 For example, there are relations between the duration of life and 
 the quality of the fruit which plants produce. Those which give 
 tender and juicy fruit, or at all events such trees as do this, are in 
 general shorter-lived than those which yield hard and dry fruit, and 
 these are shorter-lived than such as produce only little seeds. The 
 apple and the pear live shorter lives than nut-trees, which are out- 
 lived in turn by the birch and the elm, as these are by the major 
 part of the eoniferse, in which family there is probably not a species 
 that does not flourish for at least a hundred years. 
 
 The Alpine firs and larches frequently attain five centuries, and 
 even the common red pine and the Scotch fir reach three to four. 
 With a few exceptions, the seeds of the whole family are noticeably 
 small, though the containing cones may be of considerable size. 
 One of the greatest trees in the world, the Wellingtonia gigantea 
 of California, a member of this tribe, with an estimated maximum 
 age of 2,000 years, has a beautifully formed but remarkably small 
 cone, and seeds in proportion. Such trees as the birch, the elm, 
 and the conifers are useful to man for their timber, a service rarely 
 rendered by the fruit-bearers. Trees, again, that yield pleasant 
 fruit fit for human, food ordinarily live for shorter periods than 
 those of which the produce is bitter and austere and unserviceable 
 to man as an edible. Most, if not all of the plants on which man 
 in his civilized state depends for food, are exceedingly short-lived. 
 The cerealia or corn -producing plants, as wheat, rice, barley, and 
 oats, are annuals, without exception ; so are nearly all kinds of pulse. 
 The large classes of esculent vegetables, represented by the turnip, 
 carrot, and cabbage, are also either annual or biennial. 
 
 " How much man has benefited by this wise arrangement, it is im- 
 possible to estimate. Did his daily bread grow on longseval trees, 
 
THE LAWS OF HEREDITARY DESCENT. 383 
 
 like acorns, asking no care and toil, the most efficient means to his 
 development would have been wanting, as is still evidenced in the 
 lands of the cocoa-nut and the banana; but depending, as he has 
 been so largely obliged to do, on annual plants demanding inces- 
 sant care, they may be gratefully regarded as the prime instrument 
 of his rise in intelligence and morals. 
 
 "It may be taken as an axiom in vegetable physiology, that, co3te- 
 ris paribus, no plant dies a natural death until it has ripened seeds. 
 If its life be endangered by penury of food or mutilation, the 
 entire vital energy of the plant concentrates itself in the production 
 of a flower, it ceases to put forth leaves, and expends its whole force 
 in efforts to secure progeny. 
 
 " This is strikingly exemplified in hot, dry gardens, and by sum- 
 mer waysides, where, as if conscious of the impending danger, 
 plants ordinarily of considerable stature begin to propagate while 
 scarcely an inch high." 
 
 THE LAWS OF HEEEDITAKY DESCENT. 
 
 The laws of hereditary descent are the most potent of all the 
 influences that determine the character and destinies of individuals 
 and of nations. Climate and diet, powerful as they are, must always 
 yield to the unconquerable might of race, and can of them- 
 selves work only incidental and transient changes in the original 
 types. 
 
 The fundamental law of hereditary descent that has been ascer- 
 tained by science and experience is, that every quality of organic 
 existence tends to be hereditary. This law, so far from being a tru- 
 ism, as it might at first appear, has not been even approximately 
 understood until recent times, and even now is not generally recog- 
 nized or appreciated. Not only the general characteristics of mind 
 and body, but also the distinct peculiarities of look, voice, man- 
 ner, all the parts of the system, must be equally or nearly 
 so. The transmissibility of exceptional formations, such as su- 
 pernumerary fingers or toes, can only be explained by the general 
 law that every quality of organic existence tends to be heredi- 
 tary. 
 
 The transmissibility of physical peculiarities were very well 
 illustrated by the celebrated Lambert family, or "porcupine men." 
 Edward Lambert, when a boy of fourteen, was exhibited to the 
 
384 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 Royal Society, and was then described as having a skin that resem- 
 bled the bark of a tree. " The bristly parts, which were chiefly 
 about the belly and flanks, looked and rustled like the bristles or 
 quills of a hedgehog, shorn off within an inch of the skin." The 
 boy grew to be a good-looking and healthy man. He married, and 
 had six children, all of whom had the same covering as their 
 father. 
 
 All constitutional, and very many local diseases, or tendencies 
 to diseases, may be hereditary. It has been, and is now, the custom 
 to speak of the hereditariness of certain maladies, as consumption 
 and the like, as though they were exceptions to the general law. 
 The truth is that all vices of the system may be transmitted. Con- 
 sumption, being a frequent as well as very fatal disease, has long 
 been recognized as transmissible ; but it may be questioned whether 
 it is any more so than many other diseases, which are less serious in 
 their issue, and, therefore, less dreaded and less observed. Gout 
 and rheumatism are very transmissible, especially the former. 
 Probably there are very few cases of the constitutional varieties of 
 these diseases that cannot be traced to some of the ancestors of the 
 sufferer. Insanity, apoplexy, and other symptoms of cerebral dis- 
 eases, are certainly as transmissible as tuberculosis of the lungs. 
 We may say, in general, that all diseases of the nervous system are 
 very hereditary. Some families exhibit through many generations 
 a tendency to disorder of the digestive system, and complain of 
 dyspepsia and derangement of the liver and bowels. Others inherit 
 weakness of the circulating apparatus, and are annoyed by affections 
 of the heart, such as enlargement, dilatation. A hereditary ten- 
 dency to nervous disease may break out in one member of a family 
 as St. Titus' dance, in another as epilepsy, and in another as apo- 
 plexy with paralysis ; or it may manifest itself in the form of 
 hypochondriasis, or actual insanity. The records of insanity 
 alone — which is merely one of the symptoms of the tendency to 
 nervous disease — show that a very marked proportion are hereditary. 
 Mr. Sedgwick records the case of a man whose brother, father, and 
 four uncles were all insane; and of a Jew whose father, mother, 
 and six brothers and sisters were all victims of the same disease. 
 Suicide, which is one of the results of insanity, also seems to run in 
 families, and instances have been recorded where a large number of 
 near relatives have died by their own hands. 
 
 Many of the diseases of special organs are also subjected to inhe- 
 ritance. Cataract, strabismus or squinting, long and short-sighted- 
 ness, the incapacity of distinguishing colors, and some forms of 
 amaurosis, are also hereditary. Certain morbid conditions of the 
 
THE LAWS OF HEREDITARY DESCENT. 385 
 
 middle ear, that give rise to deaf -mutism, are also transmitted from 
 parents to offspring. Thus our illustrations might be extended 
 almost indefinitely. It must, however, be allowed that we very 
 often fail in determining the hereditability of many of these 
 diseases, especially when we are misled, as we are so often apt 
 to be, by the name of the symptom. Certain skin diseases, with 
 their large variety of modifications, are transmitted from parent to 
 offspring ; and especially is this true of those maladies that are 
 the direct punishment of vice. Baldness and premature grayness 
 of hair run in families to a very marked degree, and without any 
 seeming dependence on the general health. 
 
 In the animal creation, so far as has been observed, diseases 
 and morbid conditions are as hereditary as in man. One of 
 our highest authorities on this subject — Youatt — states very 
 emphatically that " there is scarcely a malady to which the horse 
 is subject which is not hereditary." Darwin, who has traversed 
 the whole literature of the subject, states that all authors agree that 
 " contracted feet, ring-bones, curbs, splints, spavin, founder, and 
 weakness of the front legs, roaring or broken and thick wind, 
 melanosis, specific ophthalmia and blindness, crib-biting, jibbing, and 
 ill-temper, are all plainly hereditary." The diseases of cattle are 
 probably just as transmissible as those of horses ; but they have 
 not been studied as minutely, and therefore the facts on the subject 
 are not as abundant or reliable. 
 
 But, very fortunately, this subject has a brighter aspect. Good 
 qualities are just as liable to inheritance as bad ones, and the charac- 
 teristics of physical strength, health, and endurance may be as per- 
 manent in different generations as incidental diseases or deformities. 
 The single quality of physical size may characterize even widely 
 divergent branches of a family through many generations. There is 
 no one who cannot recall, more or less, families, most of whose 
 members are noted for striking tallness or largeness of form. King- 
 Frederick of Prussia collected an army of very tall men, and it was 
 remarked that their descendants in the vicinity where they 
 were quartered were of remarkable stature. Hardness and firmness 
 of muscle, united with a very small amount of adipose tissue and 
 a great capacity of endurance — the signs of what is known as the 
 bilious organization — are family characteristics. I know a family, 
 some of whose members, even in quite divergent branches, are 
 noticeable for their thinness, the hardness of their muscles, and 
 general" wirin ess of constitution, that renders them capable of under- 
 going much and living long, though seemingly very frail. Plethora 
 and pursiness are transmissible, and may characterize the weakly 
 25 
 
386 HYGIENE, OK THE ART OF PRESERVING HEALTH. 
 
 as well as the strong. Fat, when excessive, is a sign of disease, or, 
 at least, of a morbid tendency ; and when it is the result of a strong 
 hereditary disposition, all attempts to retard or limit its formation 
 are very discouraging. For remarks on this subject, see Corpu- 
 lence. 
 
 Another law of hereditary descent is, that inherited qualities 
 manifest themselves at corresponding ages, and harmoniously with 
 each other. But I have not space to develop this subject in detail, 
 interesting and suggestive though it be. 
 
 It is not unfrequently the case that the children of talented an- 
 cestors, after a youth of idleness or stupidity, are suddenly, at the 
 outset of maturity, transformed into energetic and efficient rftem- 
 bers of society, and ever afterward prove themselves worthy of 
 those from whom they are descended. We are often surprised that 
 the children of sober and industrious parents are wild and lawless, 
 and we are inclined therefore to doubt the potency of hereditary 
 influence ; but if we look back far enough we shall find oftentimes 
 that their fathers or some of their ancestors were similarly wild and 
 lawless in their youth, and were only converted on reaching mature 
 years. It is a fact which I have long observed, that the children 
 of pious and intelligent parents, however reckless or dissipated they 
 may be in their younger days, usually grow up to be worthy and 
 useful citizens. Those who are inclined to lose their faith in the 
 power of hereditary descent, or in the truth of the inspired promise, 
 " Train up a child in the way he should go, and when he is old he 
 will not depart from it," because they see so much of degeneracy 
 and vice in the offspring of noble and illustrious ancestry, would 
 often find consolation in the subsequent career of those who began 
 life by disgracing their parentage. It is often said that the chil- 
 dren of clergymen are worse than those of any other class ; but 
 statistical facts and general observation prove directly the con- 
 trary. If the sons of clergymen, especially in our large cities, often- 
 times rebel against moral and social laws, just like thousands of 
 others whose fathers do not happen to be so conspicuously before 
 the community, it is nevertheless true that in after years they often 
 develop entirely new phases of character from early manhood to old 
 age, prove themselves honorable and useful, and not unfrequently 
 acquire distinguished fame in various departments of human activity. 
 
 In regard to hereditary genius, these points can, I think, be es- 
 tablished by statistics : 
 
 1. That the great majority of the talented and distinguished of 
 both sexes are closely related to others who are similarly distin- 
 guished, or who, at least, have more than average ability. 
 
THE LAWS OF HEREDITARY DESCENT. 387 
 
 2. That not only general intellectuality, but special aptitude for 
 literature, music, art, war, politics, and finance run in families so 
 markedly, that men of genius, who number no one of superiority 
 or eminence among their kinsmen, are to be regarded as exceptions. 
 
 3. The tendency is for talent to concentrate itself in families. 
 The number of intellectually aristocratic houses is continually in- 
 creasing, even under our democratic institutions, and must continue 
 to do so in the future more than in the past, because society is be- 
 coming more and more stable. 
 
 If our marriages were arranged from motives of advantage and not 
 of affection, the brains of the country might in time become almost 
 exclusively concentrated in a limited number of powerful families. 
 
 Another law of hereditary descent is, that the qualities of or- 
 ganic existence may he derived from very remote as well as from 
 immediate ancestors. This law is a logical inference from the first, 
 and like that applies more or less to all organic life. It has long 
 been observed by breeders that animals exhibit a tendency to as- 
 sume the peculiarities of distant ancestors, and this tendency has 
 been variously designated as reversion or atavism. 
 
 A want of a proper knowledge on this subject has led to a great 
 deal of confusion and obscurity, both in the minds of the profession 
 and of the laity. Hereditary diseases of all kinds are liable to skip 
 a number of generations, and when they reappear in a family are 
 oftentimes regarded as spontaneous by those who do not look back 
 into the history of the progenitors. Parents who are themselves in 
 perfect health, and whose ancestors, so far back as they may remem- 
 ber, died at an advanced age. are sometimes astonished by the 
 appearance among their children of consumption, or some other 
 hereditary disease, that may have skipped, perhaps, a number of 
 generations. Insanity, epilepsy, St. Titus' dance, and all the mani- 
 fold diseases of the nervous system, are thus hereditary. 
 
 It must be conceded that these constitutional diseases cannot in 
 all cases be traced to a hereditary origin. There are throughout 
 the land many cases of consumption, of insanity, of epilepsy, that 
 cannot be said to be the heritage of any ancestry, distant or remote. 
 There are in our modern society thousands of exciting causes that 
 may bring on constitutional disease, even when no hereditary taint 
 exists ; and yet, if we study closely into family history, we shall 
 find that the number of such cases is much less than is commonly 
 believed. In the majority of instances of constitutional disease, 
 exciting causes act upon a hereditary tendency. 
 
388 HYGIENE, OK THE ART OF PRESERVING HEALTH. 
 INTERMARRIAGE OF RELATIONS. 
 
 This is a question that has attracted deserved attention. The 
 most varying opinions have been expressed, and are now held by the 
 profession on this subject. There are those who hold that it is wrong 
 for blood relations to intermarry, who are utterly opposed to the 
 union of cousins of the first degree, because the offspring of such mar- 
 riages are apt to be degenerate. There are those, on the other hand, 
 who believe that the offspring of blood relations who intermarry is 
 not in the average less healthy than are the children of those who are 
 not related to each other. Statistics have been collected on both 
 sides, but the weight of evidence seems to show that the popular im- 
 pression is correct, and that the children of cousins who marry are 
 not as healthy as the average. 
 
 That very near relatives — brothers, sisters — should not marry, 
 is abundantly clear. The instincts of mankind, the laws, customs, 
 and usages of all nations, barbarous as well as civilized, are opposed 
 to the crime of incest. 
 
 The only doubt is in regard to the marriage of cousins. My 
 own view is, that the difference between marrying cousins and mar- 
 rying nearer relatives is only one of degree. 
 
 As a general rule, cousins should not marry, and yet it is not ne- 
 cessary that the rule should be rigidly observed. It is much better 
 to marry a cousin than to marry one who inherits a positive tendency 
 to insanity, or even to consumption. When cousins marry there is dan- 
 ger that any evil tendency that may exist in the family may he heighten- 
 ed ; out cousins are not necessarily related. Persons may be cousins by 
 name and by law, and yet have no traits or elements in common. They 
 may be so widely separated from each other by the influence of the 
 families into whom their parents married, that they are really of 
 different blood. It is obvious that such persons may marry, and 
 should have as healthy offspring as though they were not legally 
 cousins. 
 
 Each case must be studied by itself. There is no unvarying 
 law. 
 
 On the other hand, cousins, even of the third degree, who close- 
 ly resemble each other in important features of mind or body, who 
 give unmistakable evidences of having descended from a common 
 stock, ought not to marry. Here, also, each case must be studied by 
 itself. 
 
 These are the conclusions to which I have gradually arrived, 
 and which, if I mistake not, the profession are slowly beginning to 
 accept. 
 
INTERMARRIAGE OF RELATIONS. 389 
 
 The scope of this book will not allow me to discuss the subject 
 in any greater detail. 
 
 Dr. Nathan Allen, of Lowell, who has written excellently for the 
 people on kindred subjects, has recently sent me a pamphlet on 
 the Intermarriage of Relations, from which I make the following 
 extracts : 
 
 " Dr. S. M. Bemiss, of Louisville, Ky., published a large collec- 
 tion of facts bearing on this subject in the North American 
 Medico- Chirurgical Review for 1857. Says he: ' By much labor 
 I have obtained statistical accounts of 34 marriages of consanguinity ; 
 of this number 28 were between first cousins, and 6 between second 
 cousins. Of the total number of marriages, 27 were fruitful and 7 
 sterile. The 27 fruitful unions produced 192 children. Of the 2S 
 marriages of cousins, 23 were fruitful and 5 sterile ; of the 6 mar- 
 riages of second cousins, 4 were fruitful and 2 sterile. In both these 
 latter instances of sterility the female was the product of a marriage 
 of consanguinity. 
 
 " ' Of the 192 children resulting from these marriages, 58 perished 
 in early life. In 24 of the 58 deaths the causes were stated as fol- 
 lows : Of consumption, 15 ; of spasmodic affections, 8; of hydroce- 
 phalus, 1. Of the 134 who arrived at maturity, 46 are reported as 
 healthy ; 32 are set down as deteriorated, but without absolute in- 
 dications of disease ; and 9 are returned without any statement as to 
 health or condition. The remaining 47 all possess such abnormities 
 as to render them the subjects of particular observation. These 
 are classed as follows : 23 are scrofulous ; 4 are epileptics ; 2 are in- 
 sane ; 2 are mutes ; 4 are idiots ; 2 are blind ; 2 are deformed ; 5 are 
 albinos; one has chorea, and 6 have defective vision. While these 
 statistics present a goodly number of children, there was an unusual 
 number tuberculous (15 dying of consumption) or scrofulous (23), 
 making 38 in this class. Nearly one-half inherited, probably, an 
 imperfect organization.' 
 
 " In the Transactions of the American Medical Association for 
 1858 is an extended paper by Dr. Bemiss on this subject, made up 
 mostly of tables, reporting 833 such marriages, giving the time of 
 marriage, the occupation, the temperament, the health, habits, etc., 
 of the parents, with the number of children, their defects, peculiar- 
 ities, etc., etc. The whole number of children was 3,942, of which 
 1,134 were defective ; 145 deaf and dumb, 85 blind, 308 idiotic, 38 
 insane, 60 epileptic, 300 scrofulous, 98 deformed, and 883 died 
 early. - The proportion reported deaf and dumb, blind, idiotic, scro- 
 fulous, and deformed, is altogether larger than what would be 
 found among the children of families in the community, taking 
 
390 HYGIENE, OE THE ART OF PRESERVING HEALTH. 
 
 them indiscriminately. The degree of relationship in these cases 
 is thus given : 10 marriages between brother and sister, or parent 
 and child ; 12 between uncle and niece, or aunt and nephew ; 61 
 between blood-relations, w r ho were themselves the descendants of 
 blood-relations ; 27 between double-first cousins ; 600 between first 
 cousins ; 120 between second cousins, and 13 between third cousins. 
 In a careful examination of the several degrees of consanguinity 
 here given, the hereditary effects are found to be the worst in the 
 first and second degrees, in the third not so bad ; but when we come 
 to the fourth, fifth, and sixth, the difference is not so perceptible." 
 
 " These statistics of Dr. Bemiss, already referred to, were care- 
 fully collected, mostly by medical men, from almost every State in the 
 Union, and from no extreme point of view; they may be considered, 
 therefore, as a fair and correct representation of the case as it is found 
 in all grades or classes of society. This report gives 580 instances of 
 intermarriage of cousins, resulting in 2,778 children, of which 793 
 were defective ; 117 deaf and dumb ; 63 blind ; 231 idiotic ; 24 in- 
 sane; 44 epileptic; 189 scrofulous; 53 deformed; and 637 died 
 early. 
 
 "The proportion of offspring here reported as defective, dis- 
 eased, constitutionally impaired in body or mind, is certainly much 
 larger than what would be found in the same number of children 
 taken from the same number of families indiscriminately in the com- 
 munity. This same report embraces a large number of such marriages 
 where there were few children with defective, diseased, or impaired 
 organization ; and also some families among them having numerous 
 offspring, very healthy and promising in character. These were 
 instances where the parents had not only good sound constitutions, 
 but temperaments and a physical organization different, so that the 
 parties were well adapted or matched to each other, rendering the 
 union prolific and the progeny comparatively sound." 
 
 Dr. Yoisin has recently published statistics which go to show 
 that epileptic and idiotic children are no more likely to be descended 
 from parents who w T ere related to each other than from those not 
 related to each other. He investigated the family histories of over 
 1,000 idiots and epileptics. 
 
WHAT IS LIFE? 391 
 
 WHAT IS LIFE? 
 
 This question has been asked for ages, and has been variously 
 answered. 
 
 Of the many theories of the ancients in regard to this subject I 
 do not intend to speak. 
 
 Within the past few years some attempts have been made to 
 solve the mystery of life by actual scientific investigation. 
 
 The facts and theories in regard to the Correlation and Con- 
 servation of Forces, that have been recently advanced by Met- 
 calfe, Count Eumford, Grove, Helmholtz, Mayer, Faraday, Liebig, 
 Carpenter, and others, have started a new method of investigating 
 life. 
 
 According to the theory of the Correlation and Conservation 
 of Force, " light, heat, electricity, magnetism, motion, and chemical 
 affinity are all convertible material affections ; assuming either as 
 the cause, one of the others will be the effect. Thus heat maybe 
 said to produce electricity, electricity to produce heat / magnetism 
 to produce electricity, electricity magnetism; and so of the rest. 
 We must humbly refer their causation to one omnipresent influ- 
 ence" 
 
 According to this view, heat is but a mode of motion. All these 
 forces with which we are so familiar — light, heat, electricity, 
 magnetism, motion, the vital force of plants, and the nervous 
 force of man — are simply modes of motion. They are forms of 
 energy or power. They are all mutually convertible. Mechanical 
 motion -may become changed into heat, or into electricity. Elec- 
 tricity is now held to be a subtle motion of the molecules of matter. 
 All of these changes may be reversed. Electricity, magnetism, and 
 heat, as every one knows, can produce motion. 
 
 Count Eumford observed that when brass cannon were bored a 
 great quantity of heat was produced. He afterwards found by ex- 
 periment that in boring under water, the heat produced made the 
 water boil in two hours and thirty minutes. Of this experiment 
 Count Eumford says : — 
 
 " It would be difficult to describe the surprise and astonishment 
 expressed in the countenance of the bystanders on seeing so large 
 a quantity of water heated, and actually made to boil, without any 
 fire." 
 
 " Just fifty years subsequently to the experiment of Eumford, 
 
392 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 (according to Prof. E. L. Youmans), Dr. J. P. Joule, of Manchester, 
 England, after a most delicate and elaborate series of experiments, 
 determined that 772 units of force produce one unit of heat ; that is, 
 772 pounds falling through one foot produce sufficient heat to 
 raise one pound of water 1° F. This law is known as the mechani- 
 cal equivalent of heat." 
 
 The law is that a definite quantity of any one form produces a 
 definite quantity of another. So much heat produces just so much 
 electricity, or so much magnetism, or so much motion, and vice 
 versa. If a boy kicks a football, the quantity of force that he uses is 
 exactly represented in the motion given to the ball. If the ball rolls 
 on the ground, the quantity of friction that it meets with is exactly 
 represented in the amount of stoppage that it gives to the ball. A 
 thousand familiar illustrations of this law will occur to every one 
 who can comprehend this theory. 
 
 This leads us to the second part of this theory, namely, that no 
 force is ever annihilated. Light passes into heat, heat passes into 
 motion ; electricity produces magnetism, and magnetism produces 
 electricity ; but amid all these changes no force is ever lost. The 
 form or manifestation is changed, but the quantity remains the 
 same through all time. Our house is burned tip, but it is not anni- 
 hilated. It passes away in the form of smoke, gases, and watery 
 vapor and ashes. The larger the house, and the more combusti- 
 ble the material, the greater the quantity of smoke, or gases, or 
 vapor, or ashes. 
 
 A plant or animal dies, but it is not annihilated. It passes 
 into dust, and gases, and vapor ; is resolved into its original 
 chemical elements, or into something that represents them. Strict- 
 ly speaking there is no such thing as death. Death of plants or 
 of animals is simply a change of condition. Thus the teach- 
 ings of religion and the conclusions of science beautifully har- 
 monize. 
 
 The nervous force — the mind of man — is correlated to the other 
 forces. Give to any man a definite quantity and quality of brain, 
 and there will be a definite and corresponding quantity and quality 
 of thought. On this subject I have spoken in more detail in the 
 Physiology of the Brain. 
 
 This law of the Correlation and Conservation of Forces governs 
 everything. It embraces the universe. It directs the movements 
 of the stars, and holds in ordered activity the mighty procession of 
 the firmament. 
 
 Prof. Huxley, in a recently published pamphlet entitled " The 
 Physical Basis of Life" has advanced the startling idea that 
 
WHAT IS LIFE? 393 
 
 what is termed " Protoplasm " is the basis of all life in plants, in 
 animals, and in men. 
 
 This protoplasm contains four elements — carbon, hydrogen, 
 oxygen, and nitrogen — in very complex union. I quote as 
 follows : — 
 
 "All work implies waste, and the work of life results, directly 
 or indirectly, in the waste of protoplasm. Every word uttered by a 
 speaker costs him some physical loss ; and in the strictest sense, he 
 burns that others may have light — so much eloquence, so much of 
 his body resolved iuto carbonic acid, water, and urea. It is clear 
 that this process of expenditure cannot go on forever. But, hap- 
 pily, the protoplasmic peau de chagrin differs from Balzac's in its 
 capacity of being; repaired, and brought back to its full size, after 
 every exertion. For example, this present lecture, whatever its in- 
 tellectual worth to you, has a certain physical value to me, which 
 is, conceivably, expressible by the number of grains of protoplasm 
 and other bodily substance wasted in maintaining my vital processes 
 during its delivery. ~}Iy peau de chagrin will be distinctly smaller 
 at the end of the discourse than it was at the beginning. Bv and bv 
 I shall probably have recourse to the substance commonly called 
 mutton, for the purpose of stretching it back to its original size. 
 Xow this mutton was once the living protoplasm, more or less modi- 
 fied, of another animal — a sheep. As I shall eat it, it is the same 
 matter altered not only by death, but by exposure to sundry artificial 
 operations in the process of cooking. But these changes, whatever 
 be their extent, have not rendered it incompetent to resume its 
 old functions as matter of life. A singular inward laboratory, 
 which I possess, will dissolve a certain portion of the modified pro- 
 toplasm, the solution so formed will pass into my veins ; and the 
 subtle influences to which it will then be subjected will convert the 
 dead protoplasm into living protoplasm, and transubstantiate sheep 
 into man. Xor is this all. If digestion were a thing to be trifled 
 with, I might sup upon lobster, and the matter of life of the crus- 
 tacean would undergo the same wonderful metamorphosis into 
 humanity. And were I to return to my own place by sea, and 
 undergo shipwreck, the Crustacea might, and probably would, 
 return the compliment, and demonstrate our common nature by 
 turning my protoplasm into living lobster. Or, if nothing better 
 were to be had, I might supply my wants with mere bread, and I 
 should find the protoplasm of the wheat plant to be convertible into 
 man, with no more trouble than that of the sheep, and with far 
 less, I fancy, than that of the lobster. Hence, it appears to be a 
 matter of no great moment what animal or what plant I lay under 
 
394 HYGIENE, OR THE ART OF PRESERVING HEALTH, 
 
 contribution for protoplasm, and the fact speaks volumes for the 
 general identity of that substance in all living beings. I share this 
 catholicity of assimilation with other animals, all of which, so far 
 as we know, could thrive equally well on the protoplasm of any of 
 their fellows, or of any plant ; but here the assimilative powers of 
 the animal world cease." 
 
 SCHOOLS AND SYSTEMS OF MEDICINE. 
 
 Medicine, like theology, has been divided into numerous sects 
 or schools. The schools of medicine, like the sects of theology, 
 have multiplied with the advance of civilization. The reason of 
 this is quite apparent. In barbarous and semi-civilized countries 
 there is comparatively little thought or liberty of thought. Even 
 those who have a talent for thinking, inventing, discovering, pioneer- 
 ing, are kept down by the tyranny of law or custom, and dare not 
 advance new views. The consequence is that in all such countries 
 there is apt to be a uniform faith in medical science as in religion, 
 to which all without question give allegiance. Even in enlightened 
 Europe and America, liberty of thought is a plant of very recent 
 growth. 
 
 Even the last quarter of a century has witnessed angry persecu- 
 tions for scientific or religious opinion in the most enlightened por- 
 tions of the globe, and on both sides of the Atlantic. 
 
 Political liberty, religious liberty, literary liberty, scientific lib- 
 erty, all are children of our modern civilization, but of these politi- 
 cal liberty w r as the first-born. Scientific liberty is the youngest 
 child of all, and it is now in its infancy. Within my own memory 
 some of the noblest benefactors of science have been derided and 
 persecuted for holding and advancing different scientific views from 
 those which were generally received by their neighbors. Some of 
 the most honored leaders of scientific thought of our time — names 
 that are known and loved in both hemispheres — have fought their 
 way to success inch by inch, against opposition that would have 
 crushed men of merely ordinary power. 
 
 I believe that very much and very valuable scientific truth has 
 been lost to the world because its discoverers dared not risk their 
 lives or their reputations by revealing their treasures. 
 
 On the other hand, as humanity progresses, as men become more 
 
SCHOOLS AND SYSTEMS OF MEDICINE. 395 
 
 thoughtful and more liberal, sects and schools multiply. It is as im- 
 possible for all men to think alike on matters of opinion, as it is for 
 all men to be born alike. So long as men are born with different 
 capacities and tastes, just so long will they think differently on 
 all matters of opinion, provided they have the liberty of so 
 doing. 
 
 There are certain facts in science which are demonstrated, con- 
 cerning which there can be no difference of opinion among intel- 
 ligent men ; but there is much in science, and very much in practi- 
 cal science, especially in therapeutics, or the cure of disease, that 
 can never be absolutely settled, that must remain a matter of 
 opinion. 
 
 Accordingly we find that ever since men have enjoyed the 
 luxury of thinking and talking as they pleased on matters of 
 science, schools in medicine have multiplied with great ra- 
 pidity. 
 
 They have particularly nourished in America, because this is a 
 land of liberty. 
 
 These " schools " or " pathies " have received various names, some 
 of them given to them by their friends and others by their 
 enemies. 
 
 Among these names I may mention " Old School" " JVew 
 School" "Eclectics" " Allqpathists" " Ho?no3opathists" "Hydro- 
 pathists" " Thompsonians" " Electricians" " Mesmerizers" 
 "Rubbers" " Kneaders" " Pounders." 
 
 In regard to all these systems of treatment, I may remark : 
 
 1. Many of them — I will not say all — have some basis of truth. 
 It is true that water is a most excellent remedy, and all wise physi- 
 cians of our day use and recommend it. It is true that small doses of 
 medicine are oftentimes less injurious and more beneficial than large 
 doses, and all wise physicians of our day act accordingly. It is true 
 that " herbs " are sometimes more efficacious than minerals, and all 
 wise physicians of our day recommend and use herbs whenever they 
 may be indicated. It is true that there is healing virtue of the most 
 wonderful character in electricity ; in animal magnetism, so-called ; 
 in the muscular exercise that comes from systematic rubbing, knead- 
 ing, and pounding; and the wise physicians of our day are begin- 
 ning to avail themselves of the advantages of these methods of treat- 
 ment. Again, it is just as true that the minerals, the large doses, the 
 purging, and the bleeding, and the blistering of what is commonly 
 called the " Old School," are sometimes of service in the treatment 
 of certain diseases ; and the wise physician of our time does not hesi- 
 tate to use even these unpopular methods of treatment in those cases 
 
396 HYGIENE, OR THE ART OF PRESERVING HEALTH. 
 
 where they offer a better chance of helping the patient than any 
 other known methods. 
 
 2. All of these systems have suffered from the extreme views 
 and practices of their disciples. 
 
 It is not true that water is a specific for all diseases ; and no 
 wise physician believes that it is, or confines himself to that method 
 of treatment for all diseases. It is not true that minute or small 
 doses of medicine are always or usually more efficacious than large 
 doses, and no wise physician of any school restricts himself to such 
 a system of medication. It is not true that "herbs" are generally 
 more potent than minerals, or that they are necessarily less in- 
 jurious than minerals; for the most terrible poisons in the world 
 are vegetable poisons, and no wise physician confines himself to 
 treatment by herbs alone. 
 
 It is not true that electricity — mighty an agent as it is — will 
 cure every disease from which the world suffers, and no wise 
 physician uses it to the exclusion of other remedies. 
 
 It is not true that rubbing, kneading, and founding will re- 
 new the youth or cure incurable maladies; and no wise physician 
 recommends them indiscriminately for everything. 
 
 Again, it is not true that minerals, active purging, blistering, 
 and bleeding are called for in all or even in the majority of the dis- 
 eases of our time; and no wise physician, who appreciates and un- 
 derstands the change that has taken place in the types of diseases, 
 and the wonderful advance that has been made in their treatment, 
 now uses these so-called heroic methods as much as was formerly 
 the custom even of our leading practitioners. 
 
 3. Most of these schools, in spite of the errors and extremes, and 
 even crimes, of their followers, have been of more or less service 
 to the cause of medical science. 
 
 Opposition, discussion, and quarrels arouse the mind to un- 
 wonted activity, and make us at once more energetic and more 
 cautious. With all their errors, blunderings, enmities, despisings, 
 backbi tings, narrowness, prejudices, and ignorance, the different 
 schools have aided the general cause of medical science, oftentimes 
 unconsciously to themselves. 
 
 The world is even now crowded with empirics, charlatans, and 
 w T ith narrow, prejudiced, ignorant pretenders to science; and yet, in 
 spite of all, medical science has progressed and progresses very 
 rapidly. In spite of all, or by means of all, diseases are now treated 
 much more successfully than formerly. Patients suffer less, and 
 live longer. Many chronic diseases especially, that were formerly 
 neglected, are now relieved and cured. For some of this progress 
 
SCHOOLS AND SYSTEMS OF MEDICINE. 397 
 
 our educated physicians, our leaders in science, are indebted to their 
 enemies as well as to their own efforts. 
 
 4. Patients make a serious mistake who desert a wise and 
 judicious and advanced physician for any special "sect" or 
 " school" or "pathy," or " ism" as such. 
 
 I have known families who have deserted well-tried and up- 
 right physicians, men of science, ability, and experience, for vastly 
 inferior and utterly unprincipled men of some special school or 
 ism. Patients who act thus do great wrong to themselves, but still 
 greater wrong to others. They do wrong to other patients who, 
 by them, are influenced to commit a similar mistake. 
 
 I have known intelligent, conscientious, liberally educated men 
 and women who have deserted their family physician in this way, 
 under the mistaken notion that some special sect can have a pana- 
 cea for all diseases. The ignorance of society on this subject is 
 most fearful. 
 
 The simple truth is, that the science of healing disease is not, 
 and in the nature of things never can be a mathematical science, 
 and is chiefly made up of experience. Happy hits are sometimes 
 made by special pathies or isms, and will be until the end of time ; 
 but in the long run the best results, the surest cures, are made by 
 the intelligent, upright, educated, liberal-minded physician, who 
 judiciously avails himself of all means for the treatment of dis- 
 ease that experience has demonstrated to be useful. 
 
 Patients should know the fact — which among physicians is well 
 understood — that in all these special schools, which are so rife to- 
 day, their really intelligent folloivers do not confine themselves to 
 the theories on which their systems profess to be founded, and only 
 adopt the name as a matter of policy. 
 
 I admit that in all these modern schools there are even yet to 
 be found men so narrow, so ignorant, or so criminally prejudiced 
 as to believe implicitly that the science of medicine must live 
 and die with the special theories on which they found their 
 practice. 
 
 Of late years great use has been made of the word "eclectic" 
 and many have been charmed and misled by it. I say nothing for 
 and nothing against the eclectic school, when I assert that every 
 physician of our day who is worthy of his profession is in the true 
 sense of the word eclectic. 
 
 The terms " old school," " allopathic, " &c, are of modern 
 growth entirely. They have never been adopted by any respectable 
 body of physicians anywhere, but have been used by the people 
 mostly to designate those who are not homoeopathists, or hydropa- 
 
398 HYGIENE, OK THE ART OF PRESERVING HEALTH. 
 
 thists, or " Thompsonians," or of some other special sect. It is suffi- 
 cient to say that these terms — allopathists, " old school," &c. — en- 
 tirely misrepresent the character of the great majority of the really 
 liberal, progressive physicians to whom they are applied. 
 
 
SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 THE IMPORTANCE OF SOME SURGICAL KNOWLEDGE TO EVERT PERSON. 
 
 The following directions are not designed to induce the public 
 to usurp the province of the regular surgeon, but merely to put our 
 readers in possession of a few broad principles, and a certain por- 
 tion of the modes of operation, by which they can calmly face the 
 danger of an accident that involves the question of life or death in 
 a fellow-being, grapple with it until the arrival of a surgeon, and, 
 when life can he preserved, to preserve it ! No family is proof 
 against accidents. Yon may, perhaps, be called on, almost at any 
 instant, to listen to the painful intelligence that a calamity of a 
 threatening nature has happened to a member of your own house- 
 hold. Suppose such an one to have severed the main artery of the 
 thigh — an accident entailing certain death, unless aid be imme- 
 diately rendered — and no surgeon within some miles. The blood 
 is gushing out in torrents from the wound, or he is already at the 
 point of exhaustion ! You would go calmly and scientifically to 
 his relief, quiet the tumultuous grief of his surrounding friends, 
 while dexterously applying a bandage which you would instantly 
 construct of your pocket-handkerchief, and coolly put aside the 
 arm of death ! 
 
 There are accidents of a very common character which require 
 surgical assistance, but which do not threaten life ; such, for ex- 
 ample, are fractures and dislocations. But even here assistance 
 cannot be obtained too soon ; for after the utmost and permanent 
 contraction of the surrounding muscles, which generally takes place 
 in about three-quarters or even half an hour, the reduction is 
 effected with the extremest difficulty, and with inconceivable suffer- 
 ing to the patient ; while, accomplished in the first moments after 
 the accident, the adjustment of the displaced parts is comparatively 
 easy, and is accompanied with very little pain. In short, the surgi- 
 cal cases of which we treat are those in which relief may be admin- 
 istered in the first moments, which are the most precious ; and that, 
 too, with as much facility, and with as much efficacy, in almost 
 every instance, as if a surgeon were actually present. 
 
 Sea-captains are obliged to know something of surgerg. What 
 I shall hereafter sag concerning fractures and dislocations will be 
 designed chiefig for them, and for those who like them, are liable 
 
400 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 to meet with serious accidents in places where no physician can 
 he procured. 
 
 OF THE MEANS OF ARRESTING A FLOW OF BLOOD. 
 
 Whenever an accident occurs, wherein the loss of blood is liable 
 to expose the wounded person more or less immediately to danger, 
 the hemorrhage, or flow of blood, may be always suspended by 
 applying one or more fingers, according to the extent of the injury, 
 upon the place whence the blood issues, while the other more impor- 
 tant means are being prepared. 
 
 These consist of any soft substances which are capable of being 
 rolled up or moulded into the form of a plug, and are to be applied 
 directly upon the open vessel, so as completely to fill up and cover 
 the wound ; for this purpose recourse may be had to sponge, Ger- 
 man tinder, puff-ball, spiders' web, moistened paper, tow, lint, old 
 and soft linen, wool, or, if in the country, and at a distance from 
 any habitation, even fine moss. But whenever it can be obtained, 
 the preference should be given to sponge, as it can be more easily 
 insinuated into the wound, the interstices of which it fills completely 
 up, by reason of its peculiar structure and its elasticity. 
 
 But in order to impart the greatest efficacy to the means just 
 recommended, the clots of blood, if there are any, should be re- 
 moved, and the wound washed with cold water, in order that the 
 place from which the blood issues may be exposed as completely as 
 possible; the point of the plug ought then to be placed directly 
 upon the vessel, and not upon the clot. The cleansing of the 
 wound alone will often cause the flowing of the blood to cease. 
 The substances thus wedged in should be maintained in their situa- 
 tion by a neckerchief or a pocket-handkerchief, folded in the 
 form of a cravat, a common band, or even a garter. If the means 
 already pointed out should be insufficient to suspend the flow of 
 blood, the whole application should be removed, and the pressure 
 of the finger alone relied upon, until the surgeon, or a person ac- 
 quainted with the nature and treatment of such accidents, can be 
 called in. The wounded person could manage this himself in case 
 of need. 
 
 The pressure of the fingers upon the same place during several 
 hours would suffice to arrest the most considerable hemorrhage ; 
 but as this continued pressing, if confided to one person, would be- 
 come too painful to be long endured, two or three persons should 
 be employed to aid alternately. 
 
 If, however, it should be found necessary, from the great depth 
 or extent of the wound, to have the powers of restraining the hemor- 
 
 
STOPPING BLEEDING. 
 
 401 
 
 STOPPING BLEEDING BY APPLICATION OF A TOURNIQUET. 
 
 26 
 
402 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 rhage under still more complete control, a tourniquet should be 
 applied to the limb. When this instrument cannot be obtained, 
 (which is most likely to be the case,) it may be readily and effica- 
 ciously replaced by the following means, namely, a handkerchief 
 folded in the form of a cravat, to each end of which is to be fastened 
 a band or garter, should be bound tightly round the upper part of the 
 thigh or arm, care being taken to apply previously along the inner 
 side of the limb, immediately beneath the bandage, a handkerchief 
 folded several times over, or a piece of linen doubled backwards and 
 forwards of sufficient thickness to press upon the principal vessel 
 which runs along this part, and which may be easily felt by its 
 pulsation or beats. 
 
 In the majority of cases, and particularly when the wounded 
 person is not very fleshy, the above method of exerting compression 
 upon the main artery would alone suffice; but otherwise, a substitute 
 for the tourniquet, not less simple, more expeditive, and, on the 
 whole, much better, may be formed from a cravat, in the middle of 
 which is to be made a double knot. This knot is then to be applied 
 upon the course of the main vessel which it is necessary to compress, 
 while the ends of the cravat are carried, one before and the other 
 behind the limb, to its outer side, from whence, after crossing, they 
 are to be returned over the knot and effectually secured, either upon 
 the front or back part of the limb, by means of pins, or on the oppo- 
 site side by a knot or bow. A powerful compression may be also 
 effected by applying the ends of the fingers upon the part where the 
 pulsation of the main artery is felt.* 
 
 The best means is to tie or twist the bleeding vessel itself just 
 above the part which is open, — the course which is generally pur- 
 sued by surgeons, and which is not a very difficult thing to perform ; 
 but if, from timidity or otherwise, this be not practicable, nothing 
 more can be done than to employ the means just pointed out, which 
 will effectually suspend the flow of- blood, until a surgeon can be 
 procured. It may not be altogether useless to observe, before pro- 
 ceeding further, that when, after the common operation of bleeding in 
 
 * The tourniquet is used to produce so powerful a compression upon a severed artery, 
 or upon any wound accompanied by alarming hemorrhage, that the blood shall oe 
 restrained by mere mechanical force. A very simple means of effecting this object is as 
 follows. Suppose, for example, that the large artery of the thigh has been cut, by which 
 death will be produced in a few minutes, unless the flow of blood be stopped. Take a 
 common pocket-handkerchief, and pass it around the thigh above the wound, previously 
 inserting a strong stick between the outside of the limb and the handkerchief. Let the 
 latter be drawn tight, and firmly knotted. Then turn the stick, which will operate as a 
 lever, and will make the bandage press upon the artery with almost any force desirable. 
 Many lives have been lost which might have been saved by this application, and whict 
 almost any one can command at any time. 
 
ASSISTANCE IN CASES OF DANGEROUS ACCIDENTS. 403 
 
 the arm, and the surgeon has left the patient, the blood should gush 
 out afresh, — which not unusually happens — the bandage should be 
 removed from the arm, the wound washed, a fresh pledget placed upon 
 the orifice, and the ligature re-applied in a similar manner ; that is to 
 say, in the form of the figure eight, the inter-crossing of it brnng of 
 course made to correspond to the pledget ; the patient should then 
 be told to keep the arm quite still, and in a half bent position. Some- 
 times a completely bent position will, of itself, suffice to arrest the 
 flow of blood. 
 
 Leech bites, especially in children and very delicate individuals, 
 will often give rise to a loss of blood difficult to suppress. If the 
 means ordinarily employed, fail to effect the desired end, recourse 
 may be had to the following methods. The skin is to be gently 
 pinched up, about the spot where the blood is flowing freely, and the 
 part itself covered with finely powdered charcoal or powdered alum, 
 or, better still, a morsel of sponge or lint soaked with a spirituous 
 liquor. Surgeons sometimes employ a small needle, which is run 
 through the cuticle, or outer skin, immediately above the orifice ; 
 this is instantly and effectually closed, and the flow of blood quickly 
 suspended. 
 
 A most essential thing to be observed is, to keep the wounded 
 person perfectly quiet, in order that whatever may have been applied, 
 may not become displaced. He should never be lost sight of, in 
 order that if the hemorrhage return, instant assistance may be 
 offered him; but unless such a circumstance take place, nothing 
 should be touched, for fear of the slighest alteration occasioning the 
 closed vessel to re-open. Attention, however, should be paid to the 
 bandage, so that if it should be found at all loose it may be gently 
 tightened ; or that if on the contrary, it should prove too tight, so as 
 to occasion pain or swelling of the parts, it may be relaxed. In no 
 case should any exciting food or drink be given to the patient ; he 
 should be alloioed but little aliment, and the use for drink of nothing 
 but pure water. 
 
 ON THE FIRST ASSISTANCE TO BE RENDERED IN CASES OF DANGEROUS 
 
 ACCIDENTS. 
 
 In the event of a fall, or of a severe blow, or of any considerable 
 violence which may have given rise to accidents of a serious charac- 
 ter, or at least to those which are supposed to be so, every thing 
 depends, in most instances, upon the first attentions afforded to the 
 injured person; their aim should be to relieve his sufferings, and 
 facilitate his re-establishment. On some occasions they will even 
 recall life and preserve his existence. 
 
404 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 But before proceeding upon what ought to be done, a few remarks 
 i ftay be offered upon what is essential to be avoided. 
 
 1st. On no account let beer, wine, ardent spirits, or spirits and 
 water be given him in the mistaken view of reviving him, of doing 
 him good, or affording him strength. It is exceedingly rare that 
 such means are useful ; and in the vast majority of cases they are 
 positively injurious, not to say highly dangerous. Pure water alone, 
 if he asks for drink, should be offered him. 
 
 2d. The patient should not be surrounded by a number of per- 
 sons, for fear that, in the disorder and confusion inseparable from a 
 crowd, his case may be aggravated, some fatal movement be occa- 
 sioned, or some misunderstanding arise about what should be done 
 or what given, while the employment of things which are really 
 useful may be neglected or prevented. Two or three persons are 
 quite sufficient to be about him ; and more particularly if the chamber 
 be small and close, and the weather warm. 
 
 3d. The greatest caution should be used, that he be not shaken 
 or inconsiderately removed before it has been ascertained whether 
 such removal would not be injurious, or, at least, whether it would 
 not be preferable to tender him the attentions his situation requires 
 on the spot, in allowing him to remain quiet. The first thing to be 
 done is to place him in a good position ; one that will enable him to 
 breathe freely ; his nose and mouth should be cleared of any dirt or 
 blood that might impede respiration ; his limbs also should be placed 
 in a favorable direction, in order that if there should exist a fracture, 
 this might be less menacing by being less complicated ; his dress 
 should be attended to in order that nothing tight should press about 
 his neck, body or limbs. An examination must be made to ascer- 
 tain if there is any loss of blood, and from whence this hemorrhage 
 arises, to the end that if it be considerable it may be restrained by 
 the means which we have previously indicated. If not considerable, 
 the flow of blood should not be suppressed, but encouraged by the 
 use of a sponge and warm water, for it is well known that blood- 
 letting is generally necessary in cases of this character, as it tends 
 to ward off the most serious consequences of an injury, and that 
 therefore a moderate loss of blood advantageously replaces that which 
 on other occasions must be drawn by leeches or the lancet. When 
 these first cares have been devoted to the sufferer, the good sense of 
 his attendants will teach them not to expose him to the cold, to an 
 undue degree of heat, or to the wet, as also to call in immediately a 
 surgeon, But in very grave cases it would be advisable to send for 
 the two nearest ; for the presence of both would not be too much under 
 
ASSISTANCE IN CASES OF DANGEROUS ACCIDENTS. 405 
 
 such circumstances, while, on the other hand, there would be an 
 extra chance in favor of enlightened aid. 
 
 If the protracted absence of the medical men, or the great dis- 
 tance from their dwellings, should give rise to serious apprehen- 
 sions for the safety of the sufferer, no hesitation should be made 
 in sending for a good nurse, or some one who may have had 
 an opportunity of frequently witnessing cases of accident, and 
 the usual methods of treatment of such cases ; and then, perhaps, 
 it would be advisable, after taking off, as well as can be done, 
 the patient's dress, to apply leeches, fomentations, or emollient 
 poultices upon the seat of the injury, which is generally swollen and 
 painful. But as these means, especially the two first, are not always 
 easy, nor always requisite, it will be enough, in the first instance, to 
 have recourse to cold water constantly applied to the seat of the 
 injuries by means of soft rags upon the cut, lacerated, or contused 
 parts. 
 
 Water, simple as it may appear as an application, is, in the 
 opinion of the greatest surgeons of all nations, the very best of reme- 
 dies, and renders totally superfluous the application of the balsams, 
 ointments, and other external remedies which are ordinarily em- 
 ployed. Some persons are led to expect a miraculous good from the 
 addition of certain articles to the water, but let them rest assured, 
 that so far from increasing its efficacy, they are far more likely to 
 render it irritating and injurious. 
 
 Let attention be paid to the temperature of the chamber, that it 
 be neither too warm nor too cold, and that there be no more persons 
 present than are absolutely necessary to the duties required by the 
 situation of the sufferer. The occasional visit of a friend, which is 
 always better avoided, should be of short duration, and more partic- 
 ularly if it should appear to cause much excitement to the patient, 
 or to trouble him. 
 
 On no account should heating liquids be administered ; a little 
 lemon whey, or better still, lemonade or barley water, should be 
 preferred ; nothing should be given to the patient to eat ; (the 
 strictest abstinence is rigorously to be observed and persisted in for 
 the first few days;) the bowels are to be gently opened by means of 
 injections; (an ounce or an ounce and a half of salts in a little thin 
 gruel ;) and the wet rags frequently changed, attention being paid to 
 those which are saturated with blood, for the reasons already men- 
 tioned. A good nurse will always preserve her presence of mind, 
 and that calm which is so necessary to assure the patient. She will 
 endeavor by all means to restrain the sobbings and lamentations of 
 
406 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 assistants, and, in short, babbling and noise of all kinds, which not 
 only tend to fatigue the patient, but to trouble that repose of body 
 and mind of which he stands so eminently in need. 
 
 In circumstanoss such as these, and when there exists general 
 and very serious contusions, a warm bath is particularly recommen- 
 dable ; and where it is possible to procure one, it is advisable to keep 
 the patient in it an hour or more. But when this is difficult to obtain, 
 or when it would be necessary to wait a considerable time, a sheet, 
 or what is still better, a blanket, soaked in warm water, and fre- 
 quently renewed, may be advantageously substituted for it. 
 
 It is the same with the freezing body as with fruits when 
 nipped by the frost, and which become almost immediately rotten, 
 if care be not taken to thaw them first in cold water ; and experience, 
 moreover, teaches us the suffering we expose ourselves to, when being 
 extremely cold we approach our hands too near the stove. If the 
 individual's feet who has received an injury are extremely cold, hot 
 flannels may be applied to them, or otherwise a bottle of hot water. 
 A cup of tea may be administered, or a little gruel, to which may be 
 added two or three table-spoonsful of wine, or a tea-spoonful or two of 
 spirits. If he should have been in liquor, or should have the stomach 
 overcharged with food, vomiting should be excited by tickling the 
 fauces or back part of the mouth with a feather. This operation, or 
 rather the evacuation which results from it, is of the highest utility, 
 and prevents, or at all events calms, many very bad symptoms. 
 
 If the individual is insensible, and if the means just pointed out 
 fail to recover him, or if from the exhaustion and debility occasioned 
 by the loss of blood he is in a fainting state, means should be em- 
 ployed to re- animate him, such as are usual in similar states arising 
 from ordinary causes ; namely, the application of hot flannels on the 
 pit of the stomach ; rubbing the limbs with a brush or a hard towel ; 
 strong vinegar or spirits applied to the mouth, to the temples, or 
 introduced into the nostrils by means of a feather ; a clyster (or 
 injection to the bowels) composed of one half water and the other 
 half vinegar ; sudden aspersions of cold water upon the face or the 
 region of the heart, taking care afterwards to rub the parts dry with 
 hot towels ; in short, by currents of fresh air. But the best and most 
 energetic of all these means is, without contradiction, boiling water. 
 To use this conveniently and effectually, it must be brought alongside 
 the patient, and a metallic body plunged into it, which is then to be 
 carried alternately and in the following manner over the different 
 parts about to be pointed out. 
 
 The bowl of a spoon or a hammer are as good as any thing for 
 this purpose, and are extremely convenient. The instrument must 
 
ASSISTANCE IN CASES OF DANGEROUS ACCIDENTS. 407 
 
 be plunged into boiling water, and placed with rapidity upon the sole 
 of one of the feet. After some instants it must be applied to the sole 
 of the other foot ; then successively upon the neck, the pit of the 
 stomach, the calves, along the spine of the back, and upon various 
 parts of the head ; the application being pursued in this manner until 
 the patient returns to himself, or until the surgeon arrives, who will 
 prescribe other remedies. 
 
 The application of the hot iron need rarely be continued beyond 
 one second upon each particular part ; that is to say, it should be 
 made to touch the skin but lightly ; although in some serious cases 
 it will be found necessary to allow the instrument to remain some- 
 what longer in contact with the part which it is considered necessary to 
 irritate, in order that a stronger and more lasting impression may be 
 produced. 
 
 Should there exist reasons for managing with still more control 
 the delicate susceptibility of the patient, a sheet of paper or a morsel 
 of linen rag may be interposed between the skin and the instrument ; 
 but then the latter must be more frequently applied, and allowed to 
 remain longer upon the part. 
 
 The very slight and circumscribed burns thus occasioned, of an 
 inch or an inch and a half in extent, are in no respect dangerous, 
 and are unattended with any inconvenience ; but, renewed with 
 sufficient frequency, they offer the most powerful agent medicine 
 possesses for awakening sensibility, and reviving the spark of life 
 about to become extinguished. 
 
 "With this view it is that the method just described is recom- 
 mended, it being a means so simple and so much within the reach 
 of ordinary persons ; it is one which imitates, in short, the happy and 
 salutary effect of mustard poultices, blisters, and the moxa ; while 
 it is unattended by the unpleasantness of all those applications. 
 
 The moxa is the application of a burning substance to the surface 
 of the body, to act as a counter-irritant in a variety of diseases. The 
 operation for the moxa is usually performed thus : — A piece of Ger- 
 man tinder, of the size of a shilling, is dipped in camphorated spirits 
 of wine, and, after being inflamed at a candle, is held, by means of 
 an instrument, in contact with the skin, which becomes burnt, and 
 afterwards forms an eschar. 
 
 OF THE FIRST ATTENTIONS GENERALLY REQUIRED BY WOUNDS. 
 
 The first thing to be done is to wash or gently cleanse the 
 wounds" which may happen to be covered with earth, clots of blood, 
 or other foreign bodies. If the blood flows abundantly or disa- 
 greeably, the hemorrhage may be stopped by the means already 
 
408 SUKGICAL ACCIDENTS AND EMERGENCIES. 
 
 mentioned ; and in general it suffices to apply upon the injured part 
 a bit of soft linen, moistened with cold water, and maintained in 
 place by a handkerchief. Should the wound be produced by a slug 
 or ball, or should it be lacerated and considerably contused, nothing 
 remains to be done but to sprinkle the dressing from time to time 
 with cold water. 
 
 This is all that it would be necessary to do, if it should be a case 
 of burn. 
 
 But if it should be a cut or incised wound, whether from a sabre, 
 hatchet, knife, scythe, or other cutting instrument, there is this pre- 
 caution always to be taken ; namely, to bring into exact contact the 
 edges of the wound, in order that they may unite, and the cure be 
 accelerated. As to the after treatment, it is strictly the affair of a 
 regular surgeon, but every one may be taught to imitate it, by 
 placing the injured limb in such a position that the wound gape as 
 little as possible. The good sense of the attendants, and some little 
 instruction, will suffice to put each in a condition to effect this im- 
 portant object. Thus, the fingers and hand must be closed as when 
 the fist is clenched, if the wound be within, and kept maintained in 
 that position ; if, on the contrary, the wound be on the opposite side, 
 the hand must be kept upon the stretch. If the wound be on the 
 bend of the knee or of the elbow, the leg or arm must be bent ; or, 
 on the contrary, extended, if it occur upon the knee or elbow them- 
 selves. 
 
 When the wound is on the neck, the head must be brought to 
 incline toward the side upon which the wound exists. 
 
 As a general rule, that position is to be sought for, which will 
 diminish to the greatest degree the extent of the wound, and must 
 be maintained in the best manner possible, after the edges have been 
 brought with great exactitude together. 
 
 Such will be the object of the surgeon upon his arrival ; but before 
 his presence can be procured, and there is no possibility of construct- 
 ing the appropriate bandage, the hands of an attendant should be 
 made to supply its deficiency. It is more especially when wounds 
 occur in the neighborhood of the joints, or when they are accompa- 
 nied by a division of the bones or sinews, (tendons,) that the edges 
 of the wound should be immediately brought into contact, and 
 maintained so by" the means just recommended. 
 
 What has been already said of the regimen to be imposed on the 
 patient, and of those attentions which wounds in general demand, is 
 not less applicable to the injuries lastly spoken of, and must be rig- 
 orously observed. 
 
 Every family ought to be in possession of a large piece of 
 
APPLYING ADHESIVE STRAPS TO WOUNDS. 
 
 409 
 
 adhesive plaster ; as to linen rag, it will in general be readily found. 
 The general directions given above for the first attentions to be 
 bestowed npon a wound, suffice for every case; as to the application 
 of the dressings, the following rules will be found equally to hold 
 good. 
 
 There are circumstances in which surgical aid cannot be procured. 
 In such cases ersons should be able to conduct the after-treatment 
 
 CUTTING ADHESIVE STRAPS. 
 
 throughout. "We will suppose a common incised wound, from a 
 sharp instrument, in which no large vessel is implicated. The first 
 thing to be done is to cleanse it. The next is to cut a number of 
 
 APPLYING ADHESIVE STRAPS TO WOUNDS. 
 
 strips of adhesive plaster, and prepare some soft linen rag for com- 
 presses or pledgets. When these have been prepared, the muscles 
 of the injured parts must be brought into relaxation, the edges of the 
 
410 
 
 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 wound brought into contact, and strips of adhesive plaster, previously 
 warmed, applied so as effectually to maintain them thus. These strips 
 
 ROLLING A BANDAGE. 
 
 should be placed at distances apart,varying from half an inch to an 
 inch, according to the extent of the wound, so as to allow of the exuda- 
 
 BANDAGING THE LEG. 
 
 tion of fluids in the progress of the cure. A light compress or 
 pledget should then be laid over the injury, and a bandage applied 
 
BANDAGE APPLIED TO FINGER AND HAND 
 
 411 
 
 to keep the whole in place, and support the action of the stick- 
 ing plaster. The bandage may always he constructed by means of 
 
 BANDAGING THE LEG. 
 
 a handkerchief, or a piece of linen of the same form, folded to suit 
 the nature of the accident, or the part upon which it is to be ap- 
 plied. 
 
 BANDAGE APPLIED TO FINGER AND HAND. 
 
 After the wound has been dressed and the bandage applied, which 
 should always be done rather lightly, to guard against subsequent 
 inflammation, the sufferer, should be compelled to observe perfect 
 repose. The process of healing will then instantly commence ; but 
 should there be too much action in the parts — that is to say, should 
 inflammation arise and the parts swell — the bandage should be 
 loosened and cold water constantly applied, which will soon restore 
 the parts to a healthy state. Under common circumstances, the first 
 dressing should remain until about the fourth day, when it is to be 
 changed in the following manner. 1st. The bandage is carefully to 
 be lifted oil'. 2dly. The compresses, which generally adhere, and 
 
412 
 
 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 require the application for some time of warm water to detach them 
 easily. 3dly. The plasters, the ends of which should be first lifted 
 up ; and then the person officiating, seizing them with his right hand 
 (while with the left he presses gently the thumb on one and the 
 fingers on the other side of the wound, to prevent the uniting edges 
 
 BANDAGES EOR HEAD. 
 
 from being at all disturbed), raises them perpendicularly, but slowly 
 and gradually, never acting upon more than one plaster at a time. 
 The wound ought then to be gently sponged with warm water, and 
 a fresh dressing applied in the way already stated. 
 
 IRRIGATING A WOUND. 
 
 Although strapping be not rigorously required in wounds of this 
 character (the bandage sufficing in a great majority of instances, 
 
OF FKACTTJBES. 413 
 
 with a compress on each side of the wound), yet it is unquestionably 
 the most secure method, and particularly in hands not often accus- 
 tomed to treat such accidents. 
 
 Torn or lacerated wounds demand nearly the same treatment, but 
 the dressings require to be put on with the utmost gentleness, and the 
 bandage applied still more lightly. When inflammation comes on the 
 wounded limb may be cooled by water, in the manner represented 
 in the cut. 
 
 OF FKACTUKES. 
 
 Although the bones are almost insensible to pain when in a sound 
 state, yet when they are fractured the slightest motion of the frac- 
 tured extremities is attended with acute suffering. This has the 
 effect of securing repose and quietude, without which the process of 
 recovery would be prevented, and an exact reunion of the broken 
 part could not be accomplished. The irritation produced has also the 
 effect of exciting the healthy action of the nutritive vessels of the 
 part, causing them to pour out the soft substance technically called 
 callus, which, when fractured parts are in an exact state of adapta- 
 tion, glues them, as it were, together.' This union in the course of a 
 few weeks is consolidated, and the limb is again fitted for the per- 
 formance of its functions. In ordinary cases of fracture, nature sets 
 up no greater action than is necessary for the reparation of the injury; 
 if the bones be properly set, and kept in their natural position by the 
 judicious use of splints and bandages, the limb being retained in a 
 suitable posture, little or no pain or inflammation will occur. We 
 shall now proceed to notice the methods of treating the fractures 
 which are of the most frequent occurrence. 
 
 Simple fractures may be easily cured by any one possessed of 
 common sense and a gentle hand. Yet from ignorance of a few sim- 
 ple rules, the patient's friends are often unable to afford him any 
 relief, the future usefulness of the limb is impaired, and permanent 
 deformity is frequently the result. In more complicated cases, where 
 the bones are crushed, and the soft parts bruised and lacerated, or 
 the fractured extremities of the bones protrude through the skin, all 
 the skill of the experienced surgeon is required to restore the injured 
 parts. Yet the following hints, for the management of simple 
 fractures, may be of service when the aid of the surgeon cannot be 
 obtained. 
 
414 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 EKACTURES OF THE THIGH-BONE. 
 
 The bone is generally broken about the middle, or towards the 
 lower extremity; the fracture is often transverse, but more frequently 
 oblique. 
 
 The patient experiences severe pain at the moment of the acci- 
 dent, and is unable to move the limb; the foot is turned outwards 
 from the weight of the limb ; and the thigh is more or less shortened, 
 according to the degree of obliquity of the fracture, the lower end of 
 the bone being almost invariably drawn behind the upper one, which 
 remains stationary; thus the ends of the fracture ride over each 
 other. If the bone be broken directly across, there can be no shorten- 
 ing of the limb, unless the upper end of the fracture ride over the 
 lower, which rarely happens. 
 
 Dr. H. G. Davis states, in his work " Conservative Surgery," 
 that in case of fracture, in moving the patient, or, if he has fallen, 
 in taking him up,' " continued extension " should be applied, that is, 
 a continuous pulling ; this can be done with the hands. This pull- 
 ing prevents the rough ends of the bone fractured from piercing into 
 and wounding the soft parts ; it also prevents pain. 
 
 The first thing to be done is to prepare a long splint, which may 
 be made of a piece of firm deal-board, of a degree of thickness suffi- 
 cient to prevent it from being bent, or easily broken. It must be 
 long enough to extend from a little above the false ribs to three or 
 four inches beyond the sole of the foot, and should decline gradually 
 in breadth, so that the breadth shall correspond to the dimensions of 
 the limb. At the lower end two deep notches are to be made for the 
 attachment of the bandages, and the upper end is to be perforated by 
 two holes, for the same purpose. The patient having been placed on 
 a smooth and firm bed (a hair mattress is generally preferred), his 
 limb is to be covered with a common bandage or roller, from the toes 
 to near the knee. This is done merely to prevent the leg from swel- 
 ling, which would otherwise happen from the pressure that must 
 necessarily be made higher up. The operator should now gradually 
 draw out the fractured member, while an assistant keeps the upper 
 part of the thigh firmly fixed until the limb is of the same length and 
 direction with the sound one. The long splint, well padded with 
 proper cushions, in order to prevent the skin from being injured, is 
 then to be applied, and attached to the limb by means of a roller, 
 which is to be passed round both, from above the knee down to the 
 foot, and having been turned round the ankle is to be passed through 
 the notches, so as to be firmly fastened to the end of the splint ; the 
 
FRACTURES OF THE BONES OF THE LEG. 415 
 
 toot is thus effectually prevented from changing its position. A 
 broad bandage is now to be applied round the lower part of the body, 
 so as to fix the upper extremity of the splint, thence down over the 
 groin, and continued downwards, still involving borh the limb and 
 splint, until it reach the bandage first applied. The splint being now 
 firmly attached along the whole length of the limb, we are next to 
 fasten a broad bandage round the lower part of the waist, in order to 
 bind it to the trunk of the body. Next pass a handkerchief or shawl 
 over the groin and buttock, and securing its ends through the holes 
 at the top of the splint. By tightening the handkerchief, or whatever 
 bandage may be employed, we of course extend the limb, and this 
 must be done frequently, in order to preserve it of the proper length. 
 It will be advisable to reapply the bandages twice or thrice in the 
 course of the cure, which generally takes place in about six weeks ; 
 but the patient must be careful not to rest his whole weight upon 
 the limb till three months have elapsed, because the osseous sub- 
 stance, by which the ends of the bones are united, is for a long time 
 tender, and might be readily broken again. To prevent the skin 
 from being injured, it will be necessary to pay particular attention 
 in adjusting the cushions about the ancle and at the groin, where the 
 bandage, which passes up between the thighs, must necessarily cause 
 considerable pressure. 
 
 FRACTURES OF THE BONES OF THE LEG. 
 
 Sometimes the shin bone, or tibia, is fractured, while the fibula, 
 which is situated behind and towards the outside of the leg, remains 
 entire. When it occurs near the protuberance below the kneepan, 
 the injury is readily recognized, particularly if the knee be bent, for 
 then the upper part of the broken bone is thrust forwards. Roll a 
 bandage round the limb from the toes upwards. Extend the leg. 
 A splint of wood, hollowed to fit the limb, and long enough to reach 
 from the middle of the thigh to near the heel, is to be placed behind, 
 whilst a pasteboard splint is to be applied on each side. The whole 
 are then to be secured in the usual way by means of a bandage. If 
 the two side splints are of wood, they should be applied by means of 
 a linen splint- wrapper a yard wide, and of sufficient length to cover 
 the splints. The wrapper is to be placed underneath, and the splints 
 rolled up in its longitudinal border, until they reach the limb; if 
 they do not fit properly, we must roll them over again, until they 
 come accurately in contact with the sides of the limb. Wherever 
 two wooden splints are required they may be applied in this manner, 
 which, though a little more troublesome, is decidedly the best. Five 
 bands of tape, or strong linen, two fingers' breadth wide, placed 
 
4:16 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 under the lower splint, are now to be brought round and tied at the 
 outer side of the limb ; or a roller may be applied as above directed. 
 Care must be taken to keep the heel sufficiently raised, by placing 
 pads under it. 
 
 If the shin-bone be broken lower down, the patient loses all 
 power of the limb, and the slightest movement causes great pain, 
 but there is not much deformity. By moving the fingers along the 
 front and sharp edge of the bone, which are only covered by skin, the 
 seat of the fracture may be easily ascertained ; or if we grasp both 
 ends of the bone, and move them in opposite directions, the displace- 
 ment of the pieces may be perceived, and we may also distinguish a 
 grating noise. The treatment here consists in placing a pasteboard 
 splint on the outside of the leg from a little above the knee to the 
 ancle ; and another on the inside of the same length, cushions having 
 been interposed between the splints and the leg, to prevent the skin 
 from being injured. The apparatus is then to be secured by five or 
 six flat pieces of tape, which may be easily relaxed or tightened, 
 according to the degree of swelling. The limb is to be placed upon 
 its outer side, with the knee bent upon a pillow. If wooden splints 
 are employed, they should be applied with the wrapper in the man- 
 ner above described, and oaten chaff cushions or proper pads placed 
 along the limb, to protect the skin. 
 
 "When both the bones of the leg are broken together, they seldom 
 give way opposite to each other. There may be a distance of several 
 inches between the fractures. This injury causes the foot to be 
 turned out, and the leg to be bent and deformed. The eighteen- 
 tailed bandage, is generally employed in the treatment of this frac- 
 ture ; many surgeons use it in every case of fracture of the extremi- 
 ties. It is made as follows. To a piece of linen three or four inches 
 wide, according to the size of the limb, and as long as the leg, are to 
 be stitched crosswise eighteen strips of the same width, and in length 
 sufficient to make a turn and a half round the limb, from the knee 
 down to the ancle. They are to be stitched so as to cover each other 
 for about two-thirds of their breadth. The lower ones do not require 
 to. be so long as the upper, and they should be attached rather 
 obliquely to the middle piece, so as to allow them to fit properly 
 round the limb. In setting the bones, the knee is to be slightly bent, 
 and the leg drawn out so as to bring the ends of the bone in contact. 
 The limb having been carefully raised, a splint extending from above 
 the knee to beyond the ancle, covered with a soft pad, and having 
 over this the eighteen-tailed bandage, is to be placed underneath; 
 the leg is then to be gently lowered until it rests upon the apparatus. 
 But in raising the limb from the bed, the operator must be careful tc 
 
FRACTURE OF THE COLLAR-BONE, 
 
 417 
 
 keep the upper and lower parts of the bone on the same level, by 
 firmly grasping the limb above and below the fracture, and elevat- 
 ing them together, so that the fractured surfaces maybe maintained 
 in apposition. The eighteen -tailed bandage is now to be applied in 
 the following manner. The operator lays hold of the extremity of 
 the lowest band or tail, the opposite one being fixed by an assistant, 
 and passes it obliquely across the leg to the opposite side ; he then 
 brings over the end held by the assistant with one hand, while with 
 the other he retains the first firmly in its place, and applies it in 
 the same manner round the limb so as to intersect the first. The 
 tails are to be thus applied in succession from the ankle up to the 
 knee. The ends should always be carried underneath the limb. 
 Another pad of some soft substance is next to be applied over the 
 upper part of the limb, and over that another splint of the same 
 length as the first. Five or six pieces of flat tape or strong linen, 
 which ought in the first instance to be placed under the lower 
 splint, are now to be brought round and tied. The limb should be 
 fixed upon a frame in the form of a double inclined plane, made by 
 nailing the boards together at an obtuse angle, with the addition of 
 a foot board. The splints are to be retained for five or six weeks, 
 the time required for the union of the bones varying according to 
 circumstances. After their removal, the limb should be accustomed 
 to its former functions by degrees ; and the patient should be care- 
 ful not to put much weight upon it for at least two months. 
 
 FRACTURE OF THE COLLAR-BONE. 
 
 The fracture generally takes place about the middle of the bone 
 and is easily detected, because we can feel the bone along its whole 
 
 APPARATUS FOR BROKEN COLLAR-BONE. 
 
 length. The weight of the shoulder and arm makes the outward 
 
 27 
 
418 
 
 SURGICAL ACCIDENTS AND EMERGENCIES 
 
 portion of the broken bone fall downwards and forwards along witb 
 the arm; and thus causes the shoulders to seem narrower, while the 
 piece which is attached to the breast-bone appears raised, without 
 really being so. To place the broken ends of the collar-bone in 
 contact, both shoulders must be pulled strongly backwards, and 
 kept in that position by turning an appropriate bandage round the 
 shoulders. The arm being -now placed across the chest, with the 
 fingers pointing to the top of the opposite shoulder, is to be support- 
 ed and fixed in that position by fastening a broad bandage round 
 the arm and chest, or by rolling a firm pad made of soft material in 
 a shawl and placing it in the arm-pit, which it should be large 
 enough to fill. The shawl . is then to be tied over the opposite 
 shoulder, and the ends brought down and secured at the arm-pit of 
 the sound side ; cushions or pads being interposed to prevent the 
 knots from injuring the skin. The arm is to be supported and fixed 
 as above directed. ~No splints or lotions are required, but the part 
 should be examined occasionally, and the bandages adjusted so as 
 to keep the ends of the bone accurately in contact. 
 
 It may be necessary to draw blood, and to keep the patient on 
 spare diet for a few days. 
 
 FRACTURE OF THE RD3S. 
 
 The fracture unites readily, and the only danger to be dreaded 
 is inflammation of the lining membrane of the chest, called the 
 pleura; hence it is absolutely necessary to bleed the patient freely, 
 if his countenance becomes anxious, his pulse quick and strong, the 
 
 BANDAGE FOR BROKEN RIBS. 
 
 breathing short and hurried, with other symptoms indicating the 
 
FRACTURE OF THE ARM-BONE. 419 
 
 approach ,or commencement of pleurisy. When one or more ribs are 
 fractured^ the patient feels the broken surfaces grating on each other 
 every time he attempts to take in a full inspiration ; the ribs may also, 
 in most cases, be felt working backwards and forwards under the fin- 
 gers. This crepitating or grating movement cannot, however, be dis- 
 covered in every case. The pain is sharp, and augmented by moving 
 the trunk of the body, by coughing, sneezing, or attempting to take 
 in a full breath. All that is necessary to be done for the cure of frac- 
 tured ribs is to apply a broad belt or bandage round the chest, to 
 prevent the ribs from being alternately raised and lowered during 
 respiration, and the firmer it is applied the more relief the patient 
 experiences. It is usual to pass a split cloth over the shoulders, 
 which is to be fastened to the circular bandage, to prevent its being 
 displaced. In general it is proper to draw blood from the patient 
 soon after the accident, and to confine him to low diet for a few days. 
 
 FRACTURE OF THE ARM-BONE. 
 
 Fractures of the arms are quite frequent. They happen to little 
 children, to adults, and to the aged. It is very important that 
 they should be well managed, because the arms and hands are 
 really more necessary for our comfort and existence than the lower 
 limbs. A man with a broken arm is really more helpless in many 
 respects than one whose leg is broken. Many who are paralyzed 
 in their legs, and yet have the use of their arms, can follow some 
 sedentary occupation, and thus support themselves and their 
 families.. 
 
 The fracture is sometimes oblique, but more commonly trans- 
 verse ; there is generally considerable displacement of the broken 
 ends of the bone, and more or less shortening of the limb; 
 the latter is sure to occur if the fracture be oblique ; the arm 
 hangs useless by the side, and the slightest movement of the limb 
 causes the broken ends of the bone to grate against each other 
 (crepitation) ; \n fact, there can be no mistake about the nature of 
 the accident. There is no difficulty in setting this fracture. The 
 operator grasps the elbow with one. hand, and gently extends 
 the arm, while with the other he straightens the limb and 
 replaces the bones. To secure the fractured parts in their situa- 
 tion, a splint of strong pasteboard is to be placed along the out- 
 side of the arm, from the top of the shoulder to a little way 
 beyond the point of the elbow ; and another splint of the 
 
420 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 same description is to be applied from the arm-pit to the elbow on 
 the inside. The splints should be steeped in hot water, and padded 
 with some soft substance, to prevent them from galling the skin. 
 " The conjoined breadth of the splints," says Mr. Liston, " should be 
 sufficient to embrace the limb almost entirely ; some space being 
 left, so that when the swelling subsides they may neither meet, and 
 consequently lie loose, nor overlap each other. A long bandage or 
 roller, is now to be applied over the whole, commencing from the 
 fingers, and extending it as high as the shoulder. This must not, 
 however, be applied so tight as to interrupt the circulation of the 
 blood in the limb. A wooden splint should be placed on the outside", 
 and another bandage applied ; this, however, is only to be retained 
 until the pasteboard splints dry, so as to form a sort of case for the 
 arm. The elbow should be bent at a right angle, and the whole of 
 the fore-arm properly supported in a sling. If pasteboard cannot be 
 obtained, wooden splints may be substituted. On the seventh or 
 eighth day, if the bandages have slackened from the subsidence of 
 the swelling, the bandages must be removed, and one of the splints 
 raised, to ascertain that there is no shortening of the limb, nor any 
 displacement of the bones, and again carefully applied as before. If 
 any deformity be observed it may easily be remedied, for the bones 
 do not begin to unite before the seventh day from the date of the 
 accident. In ordinary cases the bone will be firmly united in about 
 a month ; but the arm should not be used with much freedom before 
 the expiration of six or seven weeks. 
 
 FRACTURES OF THE BONES OF THE FORE-ARM. 
 
 Of the bones of the fore- arm, the one called the radius, is more 
 exposed to fractures than the other, called the ulna. Fracture of 
 the radius is an accident of frequent occurrence. There is very little 
 distortion unless the fracture takes place close to the wrist, and then 
 there is considerable deformity. Whether the bone be broken high 
 up towards the bend of the arm, or down near the wrist, the fracture 
 may be easily ascertained by tracing the bone with the ringers. In 
 all cases the patient experiences difficulty and pain in attempting 
 to turn the arm round ; and if we grasp the limb above and below 
 the part where the pain is chiefly felt, and endeavor to move the 
 hand in different directions, a grating noise will be heard, while a 
 sensation is experienced by the patient in consequence of the motion, 
 which convinces him of the nature of the accident. 
 
 When the radius is fractured, the ulna, or inner bone, serves as 
 a splint on one side, while it effectually prevents shortening of the 
 arm, and therefore renders extension unnecessary in setting the frac« 
 
DISLOCATIONS. 421 
 
 ture. There is no difficulty in placing the ends of the bone in 
 apposition, and retaining them in their situation. A pasteboard 
 splint, which has been softened in hot water, is to be placed upon 
 the outside of the arm, from a little above the elbow, to the tips of 
 the fingers, soft pads being interposed between it and the arm. A 
 similar splint is to be applied on the inside, from the bend of the arm 
 to the end of the palm of the hand. A long bandage is then to be 
 applied, to retain the splints in their places. The arm is to be 
 placed in a sling, the palm of the hand being turned towards the 
 breast. The patient must take care to keep the hand in this posi- 
 tion, and the wrist steady ; no attempt should be made to turn the 
 palm up or down, because nothing tends more to displace the bones. 
 
 The ulna, or inner bone of the fore-arm, is not so often fractured 
 as the radius ; but is as easily set, and is kept in its place by means 
 of two splints, with a bandage, as above directed. 
 
 Both the bones of the arm are sometimes broken ; in this case the 
 patient is unable to move the hand ; there is much deformity and 
 shortening of the limb, and considerable swelling soon follows the 
 accident. In setting the bones, it is necessary to extend the arm 
 until it is of the proper length, the ends of the bones are then- to be 
 placed in contact, and two splints, with a bandage, applied as already 
 directed. It is advisable to apply a wooden splint on the outside of 
 the fore-arm, until the pasteboard splints are sufficiently dry and 
 firm ; it is then to be taken away. When the patient is thin, it is 
 customary to place a compress of soft linen or lint between the 
 bones, both before and behind, to prevent them from approaching 
 each other, and growing together. When pasteboard is not at hand, 
 wooden splints may be employed, but the former is always preferable, 
 because it readily takes the shape of the limb, and, when dry, forms 
 for it a sort of firm mould or case. 
 
 FRACTURE OF THE FINGERS. 
 
 When a finger is fractured, the injury is easily recognized. The 
 treatment consists in applying on the front of the finger a narrow 
 wooden splint, padded with tow or lint, which is to be supported by 
 a suitable bandage. 
 
 DISLOCATIONS. 
 
 In consequence of an accident, or some violence, a bone is occasionally 
 dislodged from its natural situation, or, perhaps, removed out of its 
 socket, whereby its proper functions are greatly impeded or obstructed, 
 
422 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 and, as such occurrences frequently take place at a considerable 
 distance from any surgical assistance, it appears proper to point out 
 a few of the most common cases of this kind, with the method of 
 restoring them, through the medium of other persons possessed of a 
 mechanical turn. 
 
 The dislocation of a bone is usually ascertained with ease, from 
 its being attended with a swelling or degree of protuberance on one 
 side, and a corresponding hollow on the other, which are particularly 
 apparent on making a comparison between the member that has been 
 injured and its fellow ; by tension and pain, and by inflammation and 
 febrile symptoms being present. 
 
 The usual causes of dislocations are, any sort of external violence 
 suddenly and forcibly applied, as in falling, leaping, twists, blows, &c. 
 
 A recent dislocation may frequently be reduced with great ease 
 by extending the limb, and using such a degree of force, in a gradual 
 manner, either by the hands, or a towel tied round it, as will be 
 requisite to overcome the power and resistance of the muscles. If, 
 with the dislocation, there be a fracture of a part of the bone, the 
 difficulty of reduction will be much increased, as well as the cure 
 protracted. Moreover, when the reduction of a dislocated part has 
 been long delayed, such as to the distance of some weeks, there will 
 be but little prospect of being able to replace it, so that the patient 
 will have a stiif joint, and, if the injury is in the lower extremity, 
 will be rendered lame through life. 
 
 Treatment. — When the bone has been displaced for some time, 
 and swelling and inflammation occupy the joint, it will be necessary 
 to bleed the patient, and, after well fomenting the part with flannel 
 cloths, wrung out in warm water, to apply soft poultices composed 
 of oat-meal, oil, and vinegar, for a time, before we make any attempt 
 to reduce it, which should never be done till the tension and inflam- 
 mation have subsided. 
 
 After the reduction has been effected in the manner before men- 
 tioned, all that will then be necessary is to apply one or two folds of 
 linen cloth, wetted in vinegar or camphorated spirits, to the part, and 
 keep it perfectly still and quiet, with the muscles in a state of 
 relaxation. If it be the shoulder, arm, or elbow, the arm should be 
 kept in a sling, fastened round the neck. If the lower extremity, it 
 should be raised on a chair, or sofa, as high as that on which the 
 patient sits. "When a dislocation and fracture exist together, the 
 healing of the fracture might first take place, previous to any attempt 
 being made to reduce the disjointing. 
 
DISLOCATION OF THE SHOULDER. 
 
 423 
 
 DISLOCATION OF THE SHOULDER. 
 
 The head of the upper bone of the arm may and does slip out 
 in different directions, in consequence of a fall, and other violences. 
 It seldom takes place upwards, however, but most commonly 
 downwards, in which case a hollow place is found in the upper 
 part of it, easily perceived by pressing the finger on it. The head 
 of the bone may also be felt in the arm-pit, and the patient cannot 
 move the limb without experiencing severe pain. 
 
 In such a case there is a considerable difference in the length of 
 the arm which has not been injured, when compared with the one 
 which is dislocated, and, when it remains long in this state unas- 
 sisted, a swelling and impaired sensibility of the limb ensue. 
 Moreover, there is an inability to move the arm, and every attempt 
 to do so is attended with considerable pain. 
 
 When the bone has been recently dislocated, and no tension 
 and inflammation have come on, it may, in general, be readily re- 
 duced by employing a moderate force ; but when it has remained 
 out of its socket for a considerable time, the operation of reduction 
 will prove both painful and difficult. 
 
 BETTING THE SHOULDER. 
 
 Treatment. — When a dislocation of the shoulder is accompanied 
 with swelling and inflammation, the reducing it should be sus- 
 pended until these have in a great degree subsided. The limb is 
 to be kept perfectly at rest, and the part moistened with vinegar 
 and water, by linen cloths wrung out therein. 
 
 As soon as the swelling and inflammation have subsided, the 
 
424 
 
 SURGICAL ACCIDENTS AND EMEKGENCIES 
 
 following course should be adopted. The patient is to be placed 
 upon a low stool, an assistant is then to hold the body very firmly, 
 so that it cannot give way on exerting the necessary force, whilst 
 another person lays hold of the arm a little above the elbow, and 
 gradually extends it, increasing the force as may be requisite. The 
 operator then is to put a napkin under the patient's arm, causing 
 it to be tied behind his own neck, and by this he is gradually to 
 
 SETTING A DISLOCATED SHOULDER. 
 
 raise the head of the bone, whilst at the same time a considerable 
 extension and resistance are effected by the assistants, and with 
 his hands directs it into its right place, on which a slight crack or 
 noise is usually heard. After the reduction the parts may be rub- 
 bed with camphorated liniment made gently warm, and the arm 
 be kept very still by putting it into a sling. 
 
 Dislocations of the shoulder, though they may be readily set by 
 a surgeon, are yet very serious injuries, and those who meet with 
 such an accident, or who have reason to suspect that it has happened 
 to them, should avail themselves of skilled surgical assistance if it 
 can he obtained. It is proper to remark just here, that many of 
 those who profess to be natural bone- setters, are really great hum- 
 bugs. They often .pretend to set bones that were never out of 
 joint. 
 
 Should pain, swelling, or inflammation succeed the reduction of 
 the bone, they are to be relieved by topical bleeding with leeches, 
 
DISLOCATION OF THE THIGH-BONE. 425 
 
 laxative medicines, and a cooling regimen. If the limo remains in 
 a weak state for any length of time in consequence of the injury, 
 pouring cold water from a tea-kettle, or pumping on it, may bf 
 likely to strengthen it. 
 
 DISLOCATION OF THE ELBOW. 
 
 The bones of the fore-arm may be dislocated in various directions, 
 and the injury may readily be discovered by the patient's inability 
 to bend the limb, together with its stiffness, and a protuberance 
 being observed on that side of the arm towards which the bone is 
 pushed, although this is occasionally obscured by a degree of swell- 
 ing and inflammation. 
 
 To reduce a dislocation at the elbow, it will be necessary to have 
 the assistance of two persons, one of whom must hold the arm above, 
 and the other below the joint ; an extension is then to be made by 
 one of them in a gradual manner, till the operator is enabled to 
 return the bones into their proper place, after which the arm is to be 
 bent, and kept suspended in a sling for a considerable time, the 
 injured part being for a few days frequently wetted with equal parts 
 of vinegar and camphorated spirits. 
 
 Dislocations of the wrists, fingers, &c, are to be reduced much 
 in the/same manner as those of the elbow, viz. by making a proper 
 extension, and guiding the bones into their natural situation with 
 the operator's ringers. 
 
 DISLOCATION OF THE THIGH-BONE. 
 
 The head of the thigh-bone may be dislocated in almost any 
 direction, but in general it takes place inward and downward. In 
 this case the knee and foot are turned outwards, and the leg is 
 longer than the other. But when it is displaced backward, it is 
 usually pushed upwards at the same time, by which the limb is 
 shortened, the foot turned inward, and the head of the thigh-bone 
 may be felt on examination. 
 
 To replace this bone when it is dislocated forward and down- 
 ward, the patient must be laid on his back, and either be held by 
 proper assistants or fastened by bandages. A strong extension is 
 then to be made by other persons through the means of a sling 
 fixed on the thigh a little above the knee, and during this period 
 the head of the bone is to be pushed outward by the operator, till it 
 slips into its socket. If the dislocation be outward, the patient must 
 be laid on his face, and while the assistants are making due exten- 
 sion, the operator is tc push the head of the bone inward until it is 
 
426 
 
 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 replaced, to succeed in which effectually, a proper co-operation of 
 the assistants in raising the bone must be attended to. 
 
 Dislocations of the knees, ankles, and toes are to be reduced by 
 making a due extension in opposite directions, through the medium 
 of assistants, while the operator replaces the bones in their right 
 situation. When tension and inflammation prevail, active means, 
 by both general and topical bleeding, freely evacuating the bowels 
 by purgatives, and confining the patient to a spare regimen, must be 
 resorted to, not only in dislocations of the thigh-bone, but likewise 
 in those of the minor ones. 
 
 In very robust persons, the force of the muscles sometimes resists 
 every effort to reduce a disjointed limb, in which case it may be 
 well to excite some degree of languor and debility, either by putting 
 the patient into a warm bath, or giving him a grain or two of tar- 
 tarized antimony, the operator taking the advantage of the effect 
 produced thereby previous to the act of vomiting, for reducing the 
 dislocated bone ; or by the inhalation of chloroform, or sulphuric 
 ether. 
 
 DISLOCATION OF THE JAW-BONE. 
 
 To reduce a . dislocation of the jaw-bone, the person is to be 
 placed on a low stool, and his head being firmly held by an assist- 
 ant, the operator is then to thrust his two thumbs, covered with 
 
 DISLOCATED JAW. 
 
 SETTING THE JAW. 
 
 linen cloths that they may not slip, as far into the mouth as he can, 
 while his fingers are applied externally to the jaw. After he has 
 
EUPTTJEES. 427 
 
 got a firm hold of this, he is to press it strongly downward and 
 backward, by which means the protruded ends of the jaw-bone may 
 be easily restored to their proper cavities or sockets. The jaw is 
 afterward to be kept still for some time, the patient avoiding 
 mastication, particularly of any hard substance, till the parts have 
 acquired their former tone. 
 
 DISLOCATION OF THE KECK. 
 
 When the neck is completely dislocated, speedy death ensues if 
 it is not instantly replaced, owing to the pressure made by the parts 
 on the spinal marrow. If it be only partially displaced, the life of 
 the patient may be preserved if the reduction be promptly made. 
 
 When only partial dislocation of the neck has taken place, the 
 chin appears fixed to the patient's breast, which prevents his speak- 
 ing, swallowing, or at all moving the parts ; his face is generally 
 turned towards one side, his countenance appears bloated, and his 
 neck swells. Moreover, he is deprived of sensibility. 
 
 The patient must be turned immediately on his back, and the 
 operator place himself immediately behind him, so as to be able to 
 lay hold of his head with both his hands, whilst a proper resistance 
 is made by fixing his knees against the shoulders of the patient. 
 The head is then to be pulled with some force, which is to be gra- 
 dually increased, the head being moved at the time from side to 
 side until the joint is replaced, and this may be known by the snap- 
 ping of the bone when passing into its socket, as well as from the 
 sensibility of the patient being in some measure restored, and his 
 beginning to breathe. 
 
 After the dislocation has been reduced, the head should be 
 secured in its place by a proper bandage, the parts be well bathed 
 with camphorated spirits, the patient bled and put to bed, and the 
 bowels freely purged. Until the tone of the injured part is properly 
 restored, quietness will be necessary, and for a due length of time a 
 spare diet will be advisable. 
 
 • EUPTTJEES. 
 
 Euptures are common to both sexes, although, from the peculiar 
 structure of the parts where they most usually occur, they are far 
 more frequent in males ; and are occasioned by a variety of causes 
 which tend to overcome that nice balance of forces, which exists in 
 
428 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 every individual, between the intestines themselves and the sur- 
 rounding muscles which contain them ; the first by their elasticity 
 tending to escape outwards ; the second by their contractile struc- 
 ture exerting a uniform compression, and opposing their displace- 
 ment. There are, at the lower part of the belly, corresponding to 
 the bend of the thigh, certain openings, by which vessels, &c, pass 
 out ; and it is through these openings that a bowel is protruded, 
 when, by any sudden exertion, the whole mass are forcibly pressed 
 downwards. Among the most common causes are violent horse 
 exercise, or violent exertion of any other kind, more particularly 
 when the body is tightly girt by stays, belts, high trowsers, &c. 
 The causes which predispose to this accident, or, in other words, the 
 peculiar state of the individual most favorable to its occurrence, is a 
 laxity of fibre, from constitutional weakness, or from a previous di- 
 latation or extension of the walls of the body from dropsy or child- 
 bearing. 
 
 Be careful not to keep a truss on while a hernia is still down ; it 
 may excite an inflammation which will make it impossible to return 
 it again, or it may indeed cause strangulation of the hernia and 
 sudden death. 
 
 A hernia is comparatively a slight trouble so long as it is easily 
 put back, but a slight injury may render it at any moment a most 
 dangerous condition. 
 
 As this condition may be caused by a badly fitting truss alone, 
 be careful either to wear no truss at all, or else to be sure that the 
 one you use fits you accurately. 
 
 Ruptures in adults are rarely completely cured ; but ruptures in 
 children, if properly treated, may be considered as a rule pretty surely 
 curable, with a permanent and satisfactory result. 
 
 The treatment must consist in the use of a good-fitting, easy truss, 
 applied just as soon as the rupture is first discovered. 
 
 Do not delay treatment for a day ; if you do, it will and must 
 get worse and worse daily. 
 
 "Not only must the truss be applied early, but its use must be 
 maintained constantly ; it must not be removed even for the time of 
 using a bath or being washed, because a single momentary protrusion 
 undoes all the good that it may have taken weeks to accomplish. 
 
 In the absence of a truss, while one is being procured in these 
 cases, pass a narrow bandage around the body, and then from that 
 pass another down the groin, and around behind the buttocks, fast- 
 ening it by successive turns to the bandage behind. This will 
 suffice to bind down over the seat of the rupture a little pad, which 
 may be made of muslin or soft flannel, and prevent it from protru- 
 
RUPTURES. 429 
 
 sion more or less during crying or violent motion of the little 
 patient, until a truss be procured. 
 
 This complaint may exist for a considerable length of time, and 
 cause no inconvenience to the patient, nor in any way affect his 
 health ; but notwithstanding this, should he neglect the use of the 
 truss, or abandon it too early, under the impression that he is cured, 
 and that he has no relapse of the accident to apprehend, he is bat 
 too frequently lulling himself into a fatal error ; for the parts, from 
 a slight cause, will again suddenly protrude, and often become diffi- 
 cult of reduction, or sometimes even incapable of being replaced. 
 This latter state is what is generally termed strangulated rupture, 
 and oftentimes requires a surgical operation ; for it is, in certain cases, 
 so dangerous, that without this, the patient's life must infallibly be 
 lost. 
 
 Now, the use of the truss, be it clearly understood by every one, 
 is to press upon the opening, and supply an artificial strength to the 
 surrounding fibres, whose power of resistance has been overcome by 
 the violence already spoken of. It is quite evident, therefore, that 
 the first thing to be done, when a rupture has been distinctly recog- 
 nized, is to return the protruded parts into their natural place, and 
 maintain them by an accurate and well regulated pressure for a 
 considerable period of time. No delay should ever be indulged in, 
 whether the rupture be altogether new, or one which has been already 
 long existing ; for strangulation occurs so suddenly, that frequently, 
 before a surgeon can be procured, or employ the means of his art, 
 the danger has become insurmountable. 
 
 How, then, is a rupture to be recognized ? — There is to be per- 
 ceived, in the parts in which rupture usually takes place, a swelling, 
 sometimes tense or elastic, at others soft and compressible, without 
 any discoloration of the skin. The causes of the accident should be 
 considered, and will probably reveal at once the fact. However, the 
 more certain signs are, a variation in the size of the swelling from 
 the position of the individual ; being smaller while he is lying down, 
 and larger when he is standing upright and holds in his breath ; a 
 disappearance, or at least considerable diminution, when pressure is 
 exercised upon it, and a return to its former dimensions when that 
 pressure is removed. The swelling is usually larger and more tense 
 when the patient coughs, or after he has taken a full meal ; but is, 
 on the contrary, smaller and softer in the morning before he has 
 broken his fast. He is often troubled with colic, vomiting, and con- 
 stipation. 
 
 "When the rupture is easily reducible, it is sufficient to place the 
 individual in a convenient position, and exert a gentle compression 
 upon the swelling from below upwards, and a peculiar gurgling 
 
430 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 noise will at once announce that the protruded bowel is restored to 
 its proper place. But when, on the contrary, the rupture is stran- 
 gulated, (which is known by the great hardness and pain under 
 pressure, or from coughing, sneezing, or any other agitation of the 
 body ; by the absolute constipation ; the continuance of vomiting ; 
 and the general symptoms of fever,) something more is required than 
 a mere attempt at pushing up the intestine. The warm bath should 
 be first employed. If this fail, bloodletting must be resorted to, 
 which had better be practised while the patient is in the bath. It is 
 hardly necessary to observe, that, in all such cases of danger, no 
 time should be lost in procuring the aid of a surgeon ; but such is 
 the danger of a strangulated rupture or hernia attended with the 
 symptoms last described, that it is highly advisable, when a consider- 
 able delay would take place before his arrival, to employ the means 
 first pointed out, which are not only the best, but by far the rriost 
 secure in the hands of others than regularly educated practitioners. 
 
 The position of the patient at the time of effecting the restoration 
 of the intestine is of the highest consequence. He should repose on 
 his back, his head and shoulders raised with pillows, his body bent, 
 to put the muscles of the belly into perfect relaxation, by the knees 
 being brought upwards. The person who officiates should then take 
 hold of the neck of the swelling (for it is of the form of a pear the 
 thick end downwards) with the left hand, while with the right he 
 grasps the larger portion, and gently pushes the protruded parts 
 upwards, which the left hand is intended to direct through the 
 opening. This should be done very gradually, and patiently, and 
 always in the direction in which the parts have protruded. It will 
 sometimes require to be persisted in for a considerable time, (per- 
 haps for an hour,) before all hope of reduction can be fairly given up. 
 If violence be employed the greatest danger is liable to ensue ; mor- 
 tification being almost sure to follow. 
 
 While the patient is in the warm bath, and before the reduction 
 is attempted by the hand, he should be placed as directed for the 
 latter attempt, and not unfrequently the parts return of themselves. 
 
 "When bleeding and the warm bath have been employed without 
 avail, the end has been attained by dashing cold water over the 
 parts. But this should only be done as a last resource. 
 
 BRUISES. 
 
 A slight bruise is of little consequence, and requires no particular 
 attention ; but when severe, it demands proper treatment. A severe 
 
BRUISES. 431 
 
 bruise is followed by swelling and discoloration of the injured parts, 
 as is exemplified when a blow is received on the eye, which causes 
 what is commonly called a black eye. The extensive discoloration 
 which, in many cases, arises from a bruise, alarms some patients ; 
 this is, however, a favorable sign. Danger arises in consequence of 
 blood escaping from the vessels in particular situations, and not from 
 the quantity discharged. Hence, a small quantity effused into the 
 brain, in consequence of a blow on the head, or into the chest or belly, 
 from a similar cause, will endanger life, and probably cause death ; 
 while a large quantity thrown loose under the skin, causing extensive 
 discoloration, may be rapidly absorbed without much inconvenience 
 to the patient. A severe blow received on a large joint always 
 produces serious consequences ; and a blow on the lower part of the 
 belly may burst the bladder, if it happen to be distended with urine 
 at the time, and cause death. 
 
 The effusion of blood under the skin is not the only effect of a 
 bruise. The muscles, and other soft parts, are generally injured, and 
 remain in a weak and painful state during a longer or shorter time, 
 according to the severity of the injury ; or they may be so destroyed 
 as to deprive them of life. In this case sloughing, as it is called, or 
 the separation of the dead parts from the living, must take place. 
 
 Treatment. — The first thing to be attended to in treating a bruise 
 is to prevent inflammation. Cold lotions should be constantly applied 
 to the parts. The sooner they are employed the better. When 
 resorted to early, they are not only useful in keeping off and sub- 
 duing inflammation, but tend also to prevent the further effusion of 
 blood from the lacerated vessels. The best lotions are those in 
 common use, namely, Groulard water and vinegar, or spirits and 
 water. When the bruise is slight, and the injured parts kept at 
 rest, no other treatment than this will be required. But if inflam- 
 mation comes on in consequence of a severe bruise, leeches ought to 
 be repeatedly applied, low diet strictly adhered to, and the bowels 
 freely opened by occasional doses of cooling purgatives. Quiet is 
 necessary. The inflammation which arises from a bruise seldom 
 terminates in suppuration ; but, if the formation of matter appears 
 inevitable, the cold lotions should be discontinued, and warm poul- 
 tices applied. 
 
 If the above means have had the effect of preventing or subduing 
 inflammation, apply friction with opodeldoc, the compound camphor 
 liniment, or sal-ammoniac, half an ounce, vinegar and spirits, of 
 each twelve ounces, mixed. 
 
 The pouring of cold water from a height on the bruised parts, 
 two or three times a day, is one of the best remedies that can be 
 
432 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 used. Pressure by the application of a bandage rolled round the 
 parts is also an excellent treatment. The application of electricity 
 in bruises oftentimes is of very great service (see Electricity). It 
 seems to aid absorption. The best method of application in such 
 cases is with the hand of the operator. 
 
 BTJKNS AND SCALDS. 
 
 Burns are usually divided into four varieties or degrees. 
 
 In the first degree there is redness, slight swelling, heat, and 
 acute pain of the part. These. symptoms continue a few hours, or 
 perhaps two or three days ; in the latter case the injury terminates 
 in a peeling oif of the scarf-skin. 
 
 In the second degree there are, in addition to the symptoms of 
 the first, vesicles (or bladders) filled with a transparent fluid of a 
 pale, yellowish color ; this fluid (or serum) lies between the true skin 
 and the thin scarf-skin (or cuticle). 
 
 In the third degree the life of the (true) skin is destroyed, and 
 the burned part presents a moist and soft surface of a yellowish or 
 brown color, with or without vesicles, containing fluid of a dirty 
 brown or of a bloody and turbid appearance ; or it may be dry, 
 black, and charred. 
 
 In the fourth degree the injury extends deeper than the skin, 
 the fat and muscles are more or less destroyed, and the tendons, liga- 
 ments, and other parts, even as far as the bone, may subsequently 
 inflame and mortify. 
 
 When parts are burned deeply, so as to destroy their vitality, the 
 pain is less severe than when the surface of the skin only is injured. 
 
 When a great extent of surface is burned, the intensity of the 
 pain may cause death in the course of a few hours. 
 
 After a burn of the worst description, the patient complains of 
 being cold, his pulse is weak and almost imperceptible, and shivering 
 usually comes on. If there be also great pain, he soon falls into 
 a state of stupor or insensibility, which, if reaction do not take 
 place, continues until death. This state of insensibility to pain 
 seems wisely ordained to prevent the extreme suffering which would 
 otherwise be the fate of the unfortunate patient. 
 
 Treatment. — It becomes every one to know how to act in case of 
 such accidents, because burns are inflicted suddenly, medical men 
 are not always at hand, and yet it is necessary to do something im- 
 mediately, to relieve the acute pain which follows these injuries. 
 
BURNS AND SCALDS. 4:33 
 
 The want of presence of mind at the time of the accident often 
 renders bnrns more severe than they otherwise would be. How fre- 
 quently does it happen that females, when their dresses catch fire, 
 instead of taking the most prompt means of extinguishing the flames, 
 generally increase them by running about screaming for assistance, 
 when they ought to lie down on the floor and roll over and over on 
 the carpet. The erect position of course allows the flames to spread 
 and rise rapidly to the head and neck — parts where the fire is most 
 to be dreaded ; whereas the horizontal position, on the contrary, has 
 a considerable effect in preventing their extending. In such cases 
 the hearth-rug, table-cover, a shawl, or any woollen article, are the 
 things to be used by any one who may happen to be near, for the 
 purpose of extinguishing the flames. It also frequently occurs when 
 the legs and feet are scalded, that instead of cutting the stockings 
 and removing them gently, they are drawn off, carrying the scarf- 
 skin along with them ; and the true skin being then exposed, the 
 most excruciating pain is produced. 
 
 The principle on which burns are now treated is that of exclud- 
 ing them from the air ; which may be done by covering the burned 
 or scalded parts with flour, or enveloping them with cotton wool. 
 It is in general advisable, before employing the cotton, either to im- 
 merse the parts in cold water, if their situation will admit of this be- 
 ing done, or apply to them pieces of fine linen dipped in cold water, 
 or vinegar and water, and wetted frequently during several hours, 
 or until the pain and heat are removed. But when the burned sur- 
 face is extensive there is always a sensation of chilliness, which is 
 generally accompanied with shiverings. In this case cold applica- 
 tions would do harm, and they ought not to be employed, even when 
 the burn is slight, if there be a tendency to shivering ; nor should 
 they be continued if the patient be not relieved by them, or if they 
 bring on shivering; and they are always improper when the injury 
 is on the breast, belly, or on any part of the trunk of the body. 
 
 When the legs and feet are scalded, they should be plunged as 
 soon as possible into cold water, and kept immersed in it a consid- 
 erable length of time before the stockings are removed. By this 
 means blisters are often prevented. 
 
 The blisters, or vesicles, which frequently make their appear- 
 ance suddenly in consequence of a burn or scald, should be punc- 
 tured with a needle, and the fluid allowed to escape. The burned 
 parts are afterwards to be carefully washed with tepid water before 
 applying flour or cotton. 
 
 The cotton employed should be finely carded, and then applied 
 over the burned surface in thin layers, one over another, until there 
 28 
 
434: SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 is a covering sufficiently thick to exclude the air, and protect the 
 parts from undue pressure. Bandages are then to be applied over 
 the whole of this envelop, so as to keep up a moderate and equal 
 degree of pressure. In mild cases this dressing will be sufficient, and 
 when removed in the course of ten or fourteen days, the part will 
 be found covered with new skin. But if the discharge of matter 
 be very profuse, it will find its way through the dressing, the soiled 
 part of which must then be removed, allowing that which adheres 
 to the skin to remain, and fresh layers of cotton applied with as little 
 delay as possible, in order to prevent the action of the air on the 
 burned parts. The dressing is to be renewed in this manner as 
 often as it may be found necessary, until the cure is completed. 
 
 The application of flour to burned and scalded parts has long been 
 popular. This method is preferable to the use of cotton, inasmuch 
 as the flour relieves the pain almost as soon as it is applied, thus 
 rendering the application of cold lotions unnecessary. 
 
 In cases of deep burns, treated either by cotton or flour, it be- 
 comes necessary to remove the dressing and examine the parts about 
 once a week, until the sloughs have separated, and the subsequent 
 discharge of matter is diminished. After the dead parts have been 
 detached, it is often found difficult to keep down proud flesh ; in 
 such cases pressure over the dressing by means of sheet lead has an 
 excellent effect when properly graduated. The principal advantage 
 derived from cotton or flour is during the acute stage ; and therefore, 
 when the crust or paste formed in the manner above mentioned is 
 detached from the ulcerated surface, the ulcers may either be treated 
 by astringent lotions, pressure, keeping the proud, flesh under by 
 touching it with lunar caustic or blue vitriol, and the other means in 
 general use in such cases (see Ulcers) ; or the flour or cotton may be 
 re-applied and removed every six or eight days until a cure is ef- 
 fected. 
 
 The dressings should be changed quickly, so that the parts may 
 be exposed as little as possible to the air ; and when the burned 
 surface is extensive, it must not be all exposed at once. Another 
 and more recent remedy for burns is carbolic acid. It may be used 
 in solution — ten to twenty grains to the ounce of water. 
 
 In whatever manner burns may be treated, the greatest care 
 must be taken to prevent contractions of joints, and improper adhe- 
 sions between the raw surfaces. The position ought always to be 
 such as to keep the skin extended. Hence, when the front of the 
 arm and fore-arm, or the back of the leg and thigh, are burnt, 
 splints are required to keep the limbs extended ; but attention must 
 be paid not to allow the joints to become stiff by retaining them 
 
BURNS AND SCALDS. 435 
 
 too long in one position ; they ought to be moved by an attendant 
 from time to time in order to prevent rigidity, otherwise it might 
 afterwards be both a tedious and difficult matter to restore them to 
 freedom of motion. To prevent raw surfaces from adhering to each 
 other they must be kept separated by placing something between 
 them ; for example, to keep the lingers from growing to each other, 
 it is usual either to place strips of adhesive plaster between them, 
 or to keep them extended on a hand-board. 
 
 In slight burns no internal treatment is necessary, repose and 
 low diet are sufficient ; but in severe cases, when there is shivering, 
 or a tendency to it, and the patient complains of being cold, and has 
 sickness at stomach, a pale countenance and weak pulse, stimulants 
 are indicated ; a little brandy or wine and warm water, with six or 
 eight drops of laudanum, are to be given occasionally ; and bottles 
 of hot water, or hot bricks, are to be applied to the feet, until the 
 system recovers from the sudden shock which it has received, and 
 reaction takes place. The warm bath is the best thing for restoring 
 reaction in children. 
 
 During the inflammatory stage the diet must be very sparing, 
 and confined to vegetables, fruit, and farinaceous substances ; and 
 barley-water, with thirty or forty grains of nitre, may be given in 
 the course of the day, or the patient may drink freely of soda-water, 
 lemonade, or any other cooling beverage. Attention should also be 
 paid to the state of the bowels, which are to be kept moderately open, 
 without producing purging ; for this purpose castor-oil is preferable 
 to saline medicines, which might bring on shivering. The feverish 
 symptoms, after being absent for many days, may return at the time 
 when the eschars or sloughs are being detached, and the same treat- 
 ment is then again requisite. 
 
 When there is much ulceration, with a free discharge of matter, 
 the patient's strength must be supported by light and nourishing 
 diet, such as soup, jelly, and light puddings ; and at dinner a little 
 chicken or fish, with a moderate quantity of wine or porter, maybe 
 allowed. In this stage it is also advisable to give a grain of quinine 
 in port-wine twice or thrice a day, in order to increase the appetite 
 and promote digestion. 
 
 We wish to turn the attention of our readers to a preparation de- 
 signed for injuries upon the surface of the skin, whether by violence, 
 burns, or otherwise. It consists simply of a solution of gun cotton 
 (a recent discovery) in ether, or collodion (see Collodion). Upon the 
 application of this liquid the ether almost instantly evaporates, 
 leaving upon the surface of the wound an almost imperceptible 
 shield, answering the purpose of a new and instantaneous epidermis, 
 
4-36 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 or outside skin ; thus protecting the wound securely from the ag- 
 gravating influence of the air, dust, &c. 
 
 Yet the common gun-cotton, although partially soluble in ether, 
 and forming a shield analogous to what we have described, is not a 
 perfect preparation. The gun-cotton should be prepared with par- 
 ticular reference to this specific purpose. Otherwise it will leave a 
 deposit upon the wound resembling whitewash ; whereas the prepa- 
 ration which we recommend leaves, as we have said, a shield almost 
 imperceptible to the eye. 
 
 TO RESTORE PERSONS APPARENTLY DEAD FROM 
 
 DROWNING. 
 
 the DIRECT METHOD of prof, benjamin Howard, of new tore, 
 
 As taught under the auspices of the Metropolitan Board of Health of the 
 City of New York. 
 
 Rule 1. — Unless in danger of freezing, never move the patient 
 from the spot where first rescued, nor allow bystanders to screen off 
 the fresh air, but INSTANTLY wipe clean the mouth and nos- 
 trils, rip and remove all clothing to a little below the waist, rap- 
 idly rub dry the exposed part, and give two quick, smarting slaps 
 on the stomach with your open hand. 
 
 If this does not succeed immediately, proceed according to the 
 following rules to perform artificial breathing : 
 
 Rule 2. — Turn the patient on his face, a large bundle of lightly 
 rolled clothing being* placed beneath his stomach, and press heavily 
 over it upon the spine for half a minute. 
 
 Rule 3. — Turn the patient quickly again on his back, the roll 
 of clothing being so placed beneath it as to make the short ribs bulge 
 prominently forward, and raise them a little higher than the level 
 of the mouth. Let some bystander hold the tip of the tongue out of 
 one corner of the mouth with a dry handkerchief, and hold both 
 hands of the patient together, the arms being stretched forcibly back 
 above the head. 
 
 Rule 4. — Kneel astride the patient? s hips, and with your hands 
 resting on his stomach, spread out your fingers so that you can grasp 
 the waist about the short ribs. Now, throw all your weight steadily 
 forward upon your hands, while you at the same time squeeze the 
 ribs deeply, as if you wished to force everything in the chest upwards 
 out of the mouth. Continue this while you can slowly count — one, — 
 two, — three ; — then SUDDENLY let go, with a final push, which 
 
KESTOEATION OF PEE60NS APPARENTLY DROWNED, 
 
 437 
 
 Fig. 1. 
 
 MODE OP FORCING AND DRAINING OFF WATER AND OTHER ACCUMULATIONS FROM THE STOMACH, 
 THROAT, AND MOUTH, ACCORDING TO RULE 2, PREPARATORY TO PERFORMING ARTIFICIAL 
 BREATHING. 
 
 a, Patient's clothing rolled tightly. 
 
 Fig. 2. 
 
 MODE OF PERFORMING ARTIFICIAL BREATHING ACCORDING TO RULES 3 AND 4. 
 
 A, Posture of patient according to Rule 3 — arms extended backward, and ribs thrown prominently 
 forward by roll of clothing (a) beneath back. 
 
 £, Assistant holding tongue, so as to prevent it falling back into the throat and blocking up air-pas- 
 sages to chest. By using handkerchief or similar article, the tongue cannot slip from the grasp, b, Right 
 hand of assistant grasping both wrists of patient, keeping arms forcibly extended backwards. If not 
 available, the assistant may be dispensed with. 
 
 C,- Operator forcing out of chest all foul air, preparatory to the sudden letting-go, which compels an 
 inrush of fresh air, on the principle of the ordinary bellows. The operator may, if he choose, kneel beside 
 the patient, or in case of a child, where little force is required, may conduct the process in any attitude 
 most convenient. 
 
438 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 springs you bach to your first kneeling position. Remain erect upon 
 your knees while you can count — one, — two ; — then throve your weight 
 forward again as before, repeating the entire motions — at first about 
 four or five times a minute, increasing the rate gradually to about 
 fifteen times a minute, and continuing with the same regularity of 
 time and motion as is observed in the natural breathing which you 
 are imitating. 
 
 Rule 5. — Continue this treatment, though apparently unsuccess- 
 ful, for two hours, until the patient begins to breathe ; and for a 
 while after this help him by well-timed pressure to deepen his first 
 gasps into full, deep breaths ; while the friction of the limbs, which 
 should if possible have been kept up during the entire process, is now 
 further increased. 
 
 Eule 6.— AFTER-TREATMENT— externally. As soon as 
 the breathing has become perfectly natural, strip the patient rapidly 
 and completely. Enwrap him in blankets only. Put him in bed 
 in a room comfortably warm, but with a free circulation of fresh 
 air, and except for the administration of internal treatment, let him 
 have perfect rest. 
 
 Internally. Give a little hot brandy and water, or other stimu- 
 lant at hand, every ten or fifteen minutes for the first hour, and as 
 often thereafter as may seem expedient. 
 
 THE PHILOSOPHY OF THE TREATMENT. 
 
 Death from drowning is caused not because of the presence of 
 water as such, but because of the absence of fresh air from the 
 chest. 
 
 "Whether excluded by water, as in drowning ; by a cord closing 
 the windpipe, as in hanging ; by dense smoke, as in a burning build- 
 ing ; by foul gas, as in an old well, or from escape of ordinary burn- 
 ing gas into a close room ; whether by burying the face in a soft 
 pillow, or by a piece of tough meat lodged in the throat, corking 
 up the entrance to the windpipe — in all these cases the immediate 
 cause of death is one and the same. 
 
 The breath is the life. Le' it be shut out from the chest, or 
 anything else be entirely substituted for it, and suffocation at once 
 begins, and this continued always ends in death. 
 
 To avert death, then, and reawaken life in all these cases, you 
 must not begin by giving a little stimulus, or " something reviving," 
 
THE PHILOSOPHY OF THE TREATMENT. 439 
 
 as it is called ; not by applying hot blankets, nor putting the patient 
 into a nice warm bed. The first and instant necessity is, if possible, 
 to give breath until the patient is sufficiently recovered to be able 
 to take breath for himself. This alone can start life again, and 
 maintain it in action. If the draft and door of a stove is long 
 kept tightly closed the fire dies away to an interior spark. If in 
 this condition you begin to put in more coal, your disturbance is 
 very likely to completely extinguish the remaining spark. 
 
 To apply heat in any form to the outside around the stove 
 would be simply absurd and ridiculous. If, on the contrary, you 
 should open the draft, rake away the ashes and dead coals from the 
 mouth of the draft up to the interior spark, open the damper and 
 set a current of air in motion through the stove, or in a great emer- 
 gency add a few gentle steady puffs from the bellows, you would 
 be adopting what all experience proves to be the most sensible 
 and only successful way to rekindle your fire to brightness and 
 warmth. 
 
 The relation of fresh air to the burning of a fire is precisely what 
 it is to the reviving and continuance of life. Therefore, if the friction, 
 the breeze, and the slap upon the nerves over the stomach, as 
 directed in Rule 1, fail to startle and revive the patient, then it is 
 necessary to at once see that the track from the mouth to the chest 
 is clear, so that the passage of air to the chest be not obstructed. 
 
 By following the directions of Rule 2, fluids accumulated in 
 the stomach, chest, or throat are removed. The stomach, at a greater 
 elevation than any other part of the track, is pressed between the 
 roll of clothing and the spine, whence water or other accumulations 
 have a complete drainage down to and out of the mouth, which is 
 the lowest point. 
 
 The next step is to induce air to enter the chest by what is called 
 artificial breathing or respiration. Rule 3 prevents the tongue 
 tumbling back into the throat, to choke it up as by a piece of dead 
 meat, and provides for its tip being kept out and to one side of 
 the mouth. Also by keeping the arms well stretched back, helps to 
 keep the chest somewhat expanded. 
 
 The actual breathing is effected by the directions in Rule 4. 
 In order to understand this, it must be remembered that the chest 
 containing the elastic lungs is an open-work, ribbed, bony box, which 
 above the bottom of the breast-bone is scarcely movable, except by 
 one's own will, the ribs being fastened both in front to the breast- 
 bone and behind to the spine. The ribs below the breast-bone, known 
 as the short ribs, are fastened only behind to the spine ; they are 
 very elastic and loose, and thus are called the floating ribs. 
 
4A0 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 It is this enables any foolish woman to diminish the size of her 
 waist to any standard fashion may demand. 
 
 All the breathing necessary to life can be performed by this part 
 of the chest alone, as is generally the case during sleep. 
 
 When the pressure is made upon this part of the chest, then, as 
 directed in Rule 4, the cavity of the chest is greatly diminished ; 
 what air is in it is partially forced out, and on suddenly letting go, 
 the natural elasticity of these semi-cartilaginous ribs compels them 
 to spring back to their natural position. This would create a 
 vacuum, but that the fresh air is thus compelled to rush in through 
 the mouth to occupy the otherwise vacant space. 
 
 This action, repeated as directed, compels successive volumes 
 of fresh air to enter the chest just as occurs in natural breathing, 
 and so it is called and constitutes " artificial breathing " or " arti- 
 ficial respiration." 
 
 The first returning natural gasps are apt to be irregular, and if 
 the artificial breathing be continued regardless of them, the motions 
 of the operator may actually interfere with, and interrupt them ; 
 therefore, as directed in Rule 5, let your motions be so timed 
 to the natural effort of the patient as simply to aid and deepen his 
 breathing, which is as yet imperfect and insufficient. 
 
 With life comes heat, but the latter may be greatly favored by 
 following the direction in Rule 6. Warmth, rest, and fresh air 
 are now to be regarded as important means of completing the resus- 
 citation already begun. 
 
 To make this chapter more complete, the following method of 
 artificial respiration, known as Marshall Hall's, or the " Keady 
 Method," is appended ; it is described by its author as follows : 
 
 " Place the patient on his face, his arms under his head, that the 
 tongue may fall forward, and leave entrance into the windpipe free, 
 and that any fluids may flow out of the mouth ; then 
 
 " Turn the body gradually but completely on the side and a 
 little more, and then again upon the face alternately, to induce in- 
 spiration and expiration. 
 
 " When replaced, apply pressure along the back and ribs, and 
 then remove it to induce further expiration and inspiration, and 
 proceed as before. 
 
 " Let these measures be repeated gently, deliberately, but effi- 
 ciently and perseveringly, sixteen times in the minute only." 
 
 HANGING AND SUFFOCATION. 
 
 Hanging induces death chiefly because the rope closes the 
 
STILL-BIETH. Ml 
 
 windpipe, and keeps fresh air from the kings. Suffocation, whether 
 caused by something covering the mouth, or by smoke, foul gas of 
 wells, or other noxious vapors, causes death from the same cause 
 equally, viz., by preventing fresh air from reaching the lungs. 
 
 In hanging, the first thing is instantly to cut and remove the cord. 
 
 Then proceed at once to perform artificial breathing, as directed 
 in drowning, dispensing, of course, with the attempt to remove 
 accumulations from the mouth or chest, and being careful to keep 
 the head raised a little more than in the position after drowning, 
 because in hanging the head becomes filled with blood, and this 
 congestion is partly relieved by a more elevated position of the head. 
 
 In suffocation, proceed simply with the process for artificial 
 breathing, just as for hanging. 
 
 STILL-BIRTH. 
 
 If the infant does not breathe immediately on coming into the 
 world, be careful not to divide the navel-string for the present, 
 because so long as that is complete the blood of the mother con- 
 tinues to nourish the child, just as it did in the womb. Wipe 
 cleanly from its mouth and nostrils all mucus, and give it a smart 
 slap with your open hand upon the belly. Dash upon its face 
 sharply a little very cold water, then a little warm water, then 
 a little cold water. If this does not succeed cut the cord, wrap the 
 child in flannel, and proceed at once with artificial breathing, as 
 for suffocation, but with this difference : — remember the infant has 
 never once had any air enter its lungs, so there is none which by 
 pressure can be displaced, therefore it is better to try and blow 
 up its lungs first, and apply pressure afterwards ; or let one per- 
 son blow while another person makes the pressure for artificial 
 breathing. In order to do this properly, wipe the nose and lips of 
 the child very clean ; open the mouth wide, by pressing your fore- 
 finger down upon the tongue and lower jaw. Let some one else 
 press upon the larynx, or Adam's apple, as it is called, so as to keep 
 it at the back part of the throat, and prevent any air from passing 
 behind it into the stomach. Now apply your lips to the lips of the 
 child, and steadily and forcibly blow, not quite emptying your own 
 chest. ISTow let your assistant make the pressure, as described ; 
 then blow again, and so on, alternating the blowing and the pres- 
 sure, in imitation of natural breathing ; continuing the process, 
 if necessary, for an entire hour, without intermission. 
 
 HEMOBEHAGE FEOM WOUNDS. 
 
 Firm, steady pressure on the Heeding part is the first treatment 
 
442 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 for bleeding wounds in every case, and will usually be at once suc- 
 cessful. 
 
 Cold — ice or ice-water — is very efficient when only small blood- 
 vessels have been divided. 
 
 Pressure above the wound, applied in the course of the artery, 
 is more reliable than either the other methods. In the arm or 
 thigh this may be made and continued by tying a stone in a hand- 
 kerchief, allowing the stone to rest right over the course of the 
 artery, and then tighten it thereupon, by twisting the ends of the 
 handkerchief around a stick, constituting a tourniquet sufficient to 
 control the most violent hemorrhage, until the patient can be bet- 
 ter cared for. 
 
 TREATMENT OF PERSONS STRUCK WITH LIGHTNING. 
 
 " When persons happen to be overtaken by a thunder storm, 
 although they may not be terrified by lightning, yet they naturally 
 wish for shelter from the rain which usually attends it, and therefore, 
 • if no house be at hand, generally take refuge under the nearest tree 
 they can find. But in doing this they unknowingly expose them- 
 selves to a double danger ; first, because, their clothes being thus 
 kept dry, their bodies are rendered more liable to injury, the light- 
 ning often passing harmlessly over a body whose surface is wet ; and, 
 secondly, because a tree or any elevated object, instead of warding 
 off, serves to attract and conduct the lightning, which, in its pas- 
 sage, frequently rends the trunks or branches, and kills any person 
 or animal who happens to be close to it at the time. Instead of 
 seeking protection, then, by retiring under the shelter of a tree, 
 hay-rick, pillar, wall, or hedge, the person should either pursue his 
 way to the nearest house, or get to a part of the road or field which 
 has no object that can draw lightning towards it, and remain there 
 until the storm has subsided. 
 
 " It is particularly dangerous to stand near leaden spouts or iron 
 gates at such times ; metals of all kinds have so strong a conducting 
 power for lightning, as frequently to lead it out of the course which 
 it would otherwise have taken. 
 
 " When in the house, avoid standing near the window, or door, 
 or walls, during a thunder-gust. The nearer you are placed to the 
 middle of a room the better. 
 
 " When a person is struck by lightning, strip the body and throw 
 bucketsful of cold water over it for ten or fifteen minutes ; let con- 
 tinued frictions and inflations of the lungs be also practised ; let 
 gentle shocks of electricity be made to pass through the chest, when 
 
CONVULSIONS IN CHILDREN. 443 
 
 a skilful person can be procured to administer them ; and apply 
 blisters to the chest." 
 
 TREATMENT OF APPARENT DEATH FROM THE EFFECTS OF COLD. 
 
 The body should be brought into a room in which there is no 
 fire, and rubbed with snow or cloths dipped in cold water. The 
 frictions should be directed from the stomach towards the extremi- 
 ties. In a few minutes after, the temperature of the water should 
 be very gradually increased, so as not to heat the body suddenly. 
 Stimulants may be applied to the lips and nostrils. 
 
 The lungs must be inflated as in the treatment of the drowned. 
 "When the natural warmth of the body is returning, the patient 
 should be put into a bed, wrapped in dry blankets, and be well 
 rubbed with a flesh-brush. A little weak wine and water may be 
 given, or a clyster administered containing a little wine or some- 
 thing slightly stimulative. 
 
 Strict diet should be adhered to for some time after recovery. 
 
 When the limbs only are frozen, the application of snow or wet 
 cloths is to be confined to the affected parts ; half a teaspoonful of 
 hartshorn in a glass of water may be advantageously administered, 
 or a little weak spirit and water. 
 
 CONVULSIONS IN CHILDREN. 
 
 In children there are two remarkable kinds of convulsions, 
 namely, what are called inward fits, and the common violent con- 
 vulsions. The inward fits occur generally during sleep, and are 
 known by the corners of the mouth being drawn up into a sort of 
 smile ; the eyelids are open, and the eyes are usually turned up, so 
 as to show the whites. There is a fluttering in the breathing, and 
 the child frequently starts. Fits of this kind are generally relieved 
 by a warm cordial medicine, such as a little aniseed or syrup of rue ; 
 appearing as they do to depend on wind and flatulence of the 
 intestines. 
 
 As to the more violent convulsions, they depend on disorders of 
 the nervous system, most usually brought about by the irritation 
 dependent on teething. The symptoms by which such convulsions 
 maybe known are these: — There is spasm throughout the muscular 
 system, the arms and legs are drawn up and agitated, the body 
 drawn back, the eyes are either fixed in their sockets, or are rolled 
 to and fro, the child grinds its teeth, and the countenance is dis- 
 torted. Sometimes there is a sort of breathing, which resembles 
 greatly the breathing in croup. The first thing to be done is to 
 place the child in a warm bath, to which a handful of mustard or 
 
444 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 salt may be advantageously added, and while in the bath to sprinkle 
 cold water upon the head. A clyster should also be administered. 
 After remaining some time in the bath, if the violence of the 
 symptoms is but little mitigated, the child should be removed, and 
 after being wiped dry, the spine should be rubbed with spirits, 
 or hartshorn and oil, and mustard poultices applied to the feet. 
 But whenever there is reason to believe that the convulsions are 
 from teething, the gums should be immediately and freely lanced. 
 A sharp pen-knife will serve perfectly well in this operation, which 
 any one would be able to perform. At times, however, the child 
 is weak and pale, and then, instead of applying leeches or bleeding, 
 a little stimulant medicine should be given, containing two or three 
 drops of laudanum. 
 
 When the child has recovered from the fit, it is usual to give a 
 dose of calomel with a little rhubarb, in quantity proportioned to 
 the age. 
 
 POISONING. 
 
 There are many different kinds of poisons. There is poison in 
 the water we drink, and in which we bathe.. But within certain 
 limits, poisonous substances, when properly diluted, may be benefi- 
 cial, and not injurious. There are poisonous ingredients in the 
 ordinary articles of diet, and some of the best qualities of food 
 contain the most powerful poisons. Flesh, fish, and wheat are the 
 three most digestible and most nutritious of cur common alimen- 
 tary substances, and yet they contain phosphorus — one of the most 
 virulent of poisons. 
 
 But beyond certain limits poisonous substances cannot be taken 
 without injury. 
 
 Carbonic acid may be breathed for years in moderate doses ; but 
 in large quantities, as it is sometimes found in deep wells, it will 
 prove instantly fatal. 
 
 Nearly all of our best medicines are poisons, some of them of the 
 most virulent character. In small doses they benefit; in large 
 doses they may work terrible mischief. 
 
 The same remarks will apply to stimulants and narcotics, all of 
 which contain more or less poisonous substances. (See Stimulants 
 and Narcotics.) 
 
 It is not necessary, in a treatise like the present, to enter into 
 particulars relatively to the modes of action of the numerous descrip- 
 tions of poisons to which the unfortunate who resolve on suicide 
 have recourse, or* to which such as are the victims of their own 
 
CONCENTRATED MINERAL ACIDS. 445 
 
 carelessness or that of others, or even of circumstances purely acci- 
 dental, are but too often exposed. They are for the most part 
 extremely doubtful, and can serve only, when understood, the mem- 
 bers of the profession. Happily, however, the antidotes to the 
 greatest number of poisons are perfectly well known, and it is to 
 their skilful administration that it is most necessary to attend. 
 
 Our purpose is to state as clearly and as fully as the nature of 
 the work will admit of, the means of distinguishing the kind of 
 poison swallowed, (where there is doubt upon the subject,) deduced 
 from the symptoms which invariably ensue, in order that the proper 
 antidote may be at once administered. 
 
 Poisons are so numerous, that it would be more than absurd to 
 attempt to describe them all; it would be attended with danger, 
 resulting from the confusion in which a person would be thrown 
 from the examination of so much detail. Those only will be men- 
 tioned which are the most commonly made use of ; and they will be 
 arranged in such a manner, that each respective group will embrace 
 those which have a common train of symptoms, and require similar 
 modes of treatment to counteract their effects. 
 
 It must not be supposed, that the descriptions here given of the 
 symptoms of each respective class of poisons, are to be all met with 
 at the same time ; for it is with poisoning as with other disordered 
 states of the system, the symptoms are by no means constant ; yet, 
 herein, the symptoms, as they will be found grouped, are sufficiently 
 characteristic to lead to the detection of the nature of the poison, 
 when the judgment is not aided by the light of more favorable cir- 
 cumstances. 
 
 For the sake, then, of simplicity and of real utility, they will be 
 arranged in the following classes. 
 
 1. CONCENTRATED MINERAL ACIDS. 
 
 The most common concentrated mineral acids are, Sulphuric 
 Acid, or Vitriol ; Nitric Acid, or Aqua fortis ; and Muriatic Acid, or 
 Spirits of Salts. 
 
 Common Characters of Symptoms. — Astringent taste, with burn- 
 ing heat ; acute pain at the entrance and along the course of the 
 gullet, and also at the stomach ; an insupportable stench from the 
 breath, nausea, and the abundant vomiting of a liquid, sometimes 
 black, at others reddened with blood, and which effervesces when it 
 falls upon the pavement or upon chalk or whiting ; hiccup ; some- 
 times constipation, sometimes stools tinged with blood ; acute pain 
 in the "belly, extending to the chest ; difficulty of breathing ; coldness 
 of the feet and hands, and cold sweats ; the desire but impossibility 
 
446 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 of urinating ; the voice altered, and sometimes resembling the 
 sound observable in children who suffer from the croup ; the lips and 
 inside of the mouth covered with black or white gangrenous spots. 
 
 The following are the more distinctive characters of each of the 
 above poisons; 
 
 Vitriol is remarkable for reducing to a black pulp the parts it 
 touches. 
 
 Aqua Fortis produces, on the parts it touches, lemon or orange 
 colored spots. 
 
 Spirits of Salts disengages thick white fumes of a very penetra- 
 ting smell. 
 
 Oxalic Acid (a vegetable poison) has occasionally been taken 
 through mistake for Epsom Salts, which it strongly resembles in 
 appearance. The treatment for it is the same as for mineral acids. 
 
 Treatment. — The patient should be made to drink freely of 
 liquids containing in suspension a quantity of calcined magnesia ; or, 
 when the latter cannot be procured, water in which soap is abun- 
 dantly dissolved ; after which may be given linseed or marsh mallow 
 tea, or barley-water. These same remedies should also be adminis- 
 tered in the form of clysters. 
 
 "When it is presumed that the acid has been neutralized, and that 
 it has been ejected from the inside, and it is perceived that inflam- 
 mation has set in, let leeches be applied to the pit of the stomach 
 and to the throat ; let warm fomentations be constantly applied to 
 the belly, or very large warm poultices. Should there be cramps or 
 convulsions they ought to be treated by antispasmodics. 
 
 2. ALKALIES. 
 
 These are usually Potash, Soda, Ammonia (generally in a liquid 
 state, as in the form of hartshorn) and lime. 
 
 Common Characters of Symptoms. — The symptoms much resem- 
 ble those present in cases of poisoning by the mineral acids, but they 
 more particularly affect the throat. The vomited matters, however, 
 do not effervesce upon the pavement, or upon chalk or whiting. 
 The action of ammonia (hartshorn,) is by far the most powerful, 
 giving rise to horrible convulsions. 
 
 Treatment. — The patient should be made to swallow, from time 
 to time, a glass of water containing the juice of a lemon or a table- 
 spoonful of vinegar ; if neither of these are at hand, warm water 
 should be given abundantly, and vomiting excited by tickling the throat. 
 
 If olive oil can be readily obtained, it might be advantageously 
 administered, as it would form a soap, which would be easily got rid 
 of by the last means above described 
 
METALLIC POISONS. 447 
 
 3. METALLIC POISONS. 
 
 Arsenic. White arsenic — yellow arsenic — the Ague-drop. 
 
 Copper. Blue vitriol — Verdigris — The peculiar poison found 
 where copper coins are put into the pot in which greens are boiling, to 
 give them a bright green color, or when the latter are boiled in coppei 
 vessels. 
 
 Lead. "White lead — Ceruss powder — Groulard's extract or Grou- 
 lard water — Litharge — Red lead — Sugar of lead. 
 
 Antimony. Tartar emetic, — Antimony wine, — James's powders. 
 
 Silver. Lunar caustic. 
 
 Mercury. Corrosive sublimate — Vermilion. 
 
 Iron. Green vitriol. 
 
 Zinc. "White vitriol. 
 
 Tin. Salts of tin, used by dyers. 
 
 Common Characters of Symptoms. The patient experiences an 
 acrid and metallic taste in the mouth, with a sense of constriction at 
 the throat ; pains, at first slight, afterwards most severe, along every 
 part of the digestive canal ; nausea, and vomiting of matters which 
 do not effervesce ; a continual and ardent thirst ; difficulty of urina- 
 ting ; hiccup, difficulty of breathing, and a sensation approaching to 
 that of suffocation ; cramps and convulsions ; and lastly, the limbs 
 become cold, indicative of approaching dissolution. 
 
 Treatment. In all these cases, vomiting is the first thing to be 
 attended to, and should invariably be produced, but before giving 
 fluids to the patient ; for these, by dissolving more completely the 
 particles, and spreading them over a wider surface, increase the 
 liability of absorption. There are, however, some of these poisons 
 which require in addition other means ; as, for instance, Antimonial 
 preparations, which require the administration of an infusion of 
 Peruvian bark, or other astringent barks, or even of common tea, 
 which is a good antidote. If the pains still continue very violent, a 
 grain of opium, or twenty drops of laudanum, may be administered 
 every three hours till they abate ; or a table-spoonful of syrup of pop- 
 pies at the same intervals, mixed with a glass of water. 
 
 Lunar caustic requires the frequent administration of a tea-spoon- 
 ful of table salt in solution. 
 
 Arsenical preparations should be treated with linseed or marsh- 
 mallow tea, or barley water. 
 
 For salts of tin, the best antidote is milk. 
 
 For corrosive sublimate, the whites of a dozen eggs should be 
 mixed with two pints of cold water, and a glassful given every two 
 minutes. 
 
 For the preparations of lead, Epsom or Glauber salts, dissolved 
 
448 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 in water in the proportion of a dessert-spoonful to a quart, adminis- 
 tered frequently by glassesful. If plaster of Paris is at hand, it should 
 be given, in the absence of salts, mixed with water. 
 
 "When, however, inflammation has set in, as it most often does, 
 the then after-treatment requires the same measures to be employed 
 as those which have been pointed out for the after-treatment of poi- 
 soning by mineral acids. 
 
 4. VEGETABLE POISONS. 
 
 1. Opium or Laudanum, Prussic Acid, Laurel-water, Henbane. 
 
 General Character of Symptons. — Numbness all over the body, 
 with weight and swimming in the head ; nausea, vomiting, state of 
 intoxication ; swelling of the eyes ; slight convulsive movements. 
 The pupil of the eye afterwards becomes greatly dilated, and the 
 patient falls into a torpid state resembling apoplexy. 
 
 Treatment. — For prussic acid and laurel-water, tickling the 
 throat or an emetic, to excite vomiting ; afterwards, strong coffee, or 
 coffee with a little brandy or turpentine, or hartshorn and water. 
 
 For opium or laudanum, and henbane, emetics to excite vomit- 
 ing, but administered in very small quantities of water ; an active 
 purgative clyster, when it is supposed that the poison has reached 
 the bowels. 
 
 After the poison has been evacuated, drinks should be given 
 freely acidulated with lemon-juice or vinegar, and then strong coffee. 
 To overcome the numbness of the limbs they should be vigorously 
 rubbed with a flesh-brush or a piece of flannel; and the patient 
 should be constantly moved about, and spoken to, to prevent his 
 sleeping. For opium the best single antidote is atropine, in doses 
 of one- thirtieth of a grain and upwards. (See Atropine.) 
 
 2. Monkshood, Hellebore, Tobacco, Foxglove, Meadow-saffron, 
 
 Hemlock, Deadly Nightshade. 
 
 General Character of Symptoms. — Excited state of the nerves ; 
 the patient is greatly agitated and convulsed ; there is delirium ; 
 the pupil of the eye becomes dilated, and sometimes violently con- 
 tracts ; vomiting, looseness of the bowels, with extreme pain all over 
 the belly. Occasionally there is a great prostration of strength, in- 
 sensibility, trembling, desire and incapability of vomiting. 
 
 Treatment.— -The same as in poisoning by opium, &c. 
 
 3. Nux Vomica. 
 
 General Character of Symptoms. — After the poison has been 
 swallowed, the patient undergoes, alternately, a state of calm and 
 
POISONOUS MUSHROOMS. 
 
 449 
 
 one of horrible spasmodic contraction of all the muscles of the body. 
 These attacks rarely extend beyond the fifth or sixth, and terminate 
 by death the patient's sufferings. 
 
 Treatment. — A vomit ; afterwards the following mixture : — A 
 teaspoonful of ether, one of spirits of turpentine, and half a tumbler- 
 ful of water sweetened with sugar. Give a tablespoonful every 
 
 seven or eight minutes. 
 
 4. Poisonous Mushrooms. 
 General Character of Symptoms. 
 
 •Weight and pain at the pit 
 
 POISONOUS MUSHROOMS. 
 
 of the stomach ; then nausea, violent pains in the stomach and 
 bowels, with vomiting and looseness; cramps and convulsions; un- 
 quenchable thirst ; sometimes delirium, at others, stupor ; lastly,, 
 faintings and cold sweats. 
 
 The symptoms only come on from seven to fourteen hours after 
 the swallowing of the poison. 
 
 Treatment. — Active emetics and purgative clysters ; afterwards^, 
 antispasmodics (the mixture prescribed for poisoning by ratsbane) 
 and water acidulated by vinegar. 
 
 5. Ergot of Eye (Blighted rye, Spurred rye). 
 This is a peculiar excrescence which appears upon the ear r in- 
 29 
 
450 
 
 SURGICAL ACCIDENTS AND EMERGENCIES, 
 
 the form of a long grain, very slightly curved, three-sided, and 
 pointed at each extremity, of a dark violet color; it is a disease of 
 the corn which appears in wet seasons. 
 
 General Character of Symptoms. — An unpleasant tickling or 
 creeping sensation at the palms of the hands and the soles of the 
 feet ; heaviness in the head ; occasional blindness, delirium, and in- 
 
 POISONOUS MUSHROOM. 
 
 toxication ; spasmodic contraction of the muscles, violent convul- 
 sions, and foaming at the mouth ; afterwards, violet-colored spots 
 appearing all over the body. 
 
 Treatment. — No emetics ! Alternate doses of an antispasmodic 
 mixture and water acidulated with vinegar. If gangrene or morti- 
 fication ensues, the medical practitioner alone can treat it properly. 
 
 5. ANIMAL POISONS. 
 
 1. Poisonous Mussels. 
 
 General Character of Symptoms. — About three or four hours 
 after eating poisonous mussels, an uneasiness is felt all over the 
 body, succeeded by numbness, and afterwards by intense pain at 
 the pit of the stomach, excessive thirst, and continual nausea. 
 
cupping. 451 
 
 If vomiting do not take place, the belly becomes considerably 
 swollen, the symptoms increase altogether in intensity, and very 
 often a rash appears on the face, which sometimes extends itself 
 over the rest of the body. Lastly, delirium sets in, convulsions, and 
 cold sweats. 
 
 Treatment. — Emetics, or the tickling of the throat to induce 
 vomiting; afterwards, cordials, ether, and drinks acidulated with 
 vegetable acids. 
 
 2. Spanish flies. 
 
 General Character of Symptoms. — These are very remarkable, 
 the poison affecting to a horrible degree the urinary organs and the 
 organs of generation. 
 
 Treatinent. — Linseed tea, or other emollient drinks ; from 12 to 
 20 drops of laudanum every four hours ; frictions of spirits of cam- 
 phor all over the body. 
 
 CUPPING. 
 
 The principal use of cupping will be found in its being a substi- 
 tute for leeches, when the topical abstraction of blood becomes 
 requisite, and these animals are not at hand. Military, naval, and 
 country physicians are frequently unprovided with the usual instru- 
 ments, and they resort in such cases to the following means : 
 
 They provide themselves with three or four wine-glasses (those 
 which have the stems broken off are the most commodious), or the 
 same number of small beer-glasses, a lancet, a little strong spirits, 
 a sponge or some pieces of soft rag, two towels, or a sheet and 
 towel, and a basin of warm water. Whatever glasses be employed, 
 they should be quite level at the edges, in order that they may lie 
 perfectly flat. 
 
 To commence the operation, the patient must lay bare the part 
 to be acted on, below which one of the towels or a sheet is to be 
 placed, to protect his clothes or the bed-linen. 
 
 Being thus prepared, the operator takes one of the glasses and 
 introduces therein a few drops of ardent spirits, which he allows to 
 spread over the sides ; and then, holding it for an instant to the 
 flame of a candle or bit of lighted paper, applies it, whilst the spirit 
 is still inflamed, with the utmost rapidity, and with the mouth of 
 the vessel downwards, flat upon the skin. In a few seconds, in 
 consequence of the vacuum formed in the glass, the parts become 
 
452 SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 engorged with blood and greatly swollen, the glass remaining firmly 
 fixed by the atmosphere, which presses on it at the rate of 15 lbs. 
 to the square inch of surface which it covers. 
 
 The effect of this application may be favored by dashing cold 
 water over the surface of the glass while it is still hot, which causes 
 the little air remaining therein to become more speedily condensed. 
 
 As soon as one glass has been applied, the rest should be ap- 
 plied in succession, and in the same manner; and after they have 
 remained on from four to six minutes, or more, to give time for the 
 afflux of blood into the parts, the first glass is to be lifted off, which 
 is readily done by putting the nail under the edge and allowing the 
 entry of the air. The operator then takes the lancet, and makes a 
 number of rapid incisions into the skin, but not quite through it, if 
 this can be avoided, drawing the lancet from the shoulders to the 
 point. During this part of the operation, an assistant should wipe 
 the glass quite dry ; and the operator, introducing into it a few 
 more drops of spirits, applies it as before, first to the flame, and 
 then with rapidity upon the skin. He then proceeds to take off* the 
 second glass, scarifies the parts, and re-applies it as before directed; 
 doing the same with the remainder, one only at a time. When 
 the last has been re-applied, the first will be found sufficiently full 
 of blood ; this should be emptied of its contents, plunged into warm 
 water to cleanse it, and then wiped and again applied; but the 
 scarifications should be well sponged or cleansed by means of the 
 soft rag, with warm water, to remove the clots. The others are to 
 be treated in succession in the same way ; but if, after the removal 
 once or twice of the glasses, enough blood has not been obtained, 
 the parts should be again scarified. 
 
 The great secret of good cupping is rapidity in the application 
 of the glasses, and dexterity in placing them quite flat upon the 
 parts ; and as regards the scarification, the cutting into and not 
 quite through the skin, otherwise the fatty tissue beneath enters 
 into the incisions and blocks them up. 
 
 When sufficient blood has been obtained, the patient is to be 
 wiped clean, and the scarified parts covered with square pieces of 
 sticking plaster, snipped along the edges to make them lie flat, in 
 number corresponding to the glasses. 
 
 Dry cupping — that is, the application of the cups without 
 scarification or drawing of blood — is oftentimes of .service. It 
 removes congestion and relieves pain. The "Exhausting Treat- 
 ment " is simply dry cupping on a large scale. 
 
VACCINATION. — APPLICATION OF LEECHES. 453 
 
 VACCINATION. 
 
 This is an operation which is well known as a preventive of 
 small-pox. 
 
 It will be better that the vaccine matter be taken from the hu- 
 man subject. It is generally obtained from the pustule from six 
 to nine daj^s after the operation ; it should be transparent, colorless, 
 or of a very light yellowish tinge. It suffices merely to introduce 
 into the pustule the point of the lancet, upon which it will remain 
 for some time without its qualities being at all impaired. It is 
 sometimes kept between little square bits of glass, or in a fine glass 
 tube hermetically closed at both ends ; and when destined to be 
 used at a distant period, it is better preserved by these means. 
 However, when about to be employed, it should be rubbed down 
 with the point of a lancet upon a bit of glass, the point being pre- 
 viously dipped in cold water. 
 
 The operation is usually performed upon the upper and outer 
 part of the arm. The operator should lay hold of the back and in- 
 ner part with the left hand, in order to stretch the skin at the place 
 where he intends to operate ; then, the lancet being properly fur- 
 nished at its point with the matter, and straight open, he inserts 
 it flatwise under the cuticle to the extent of about the eighth of an 
 inch, allowing it to remain there for some instants. Three or four 
 other punctures are to be made in the same manner, with this pre- 
 caution — that they are to be far enough apart to prevent the red 
 circular patches, which ought to surround them when the matter 
 has taken effect, from touching each other. This precaution is so 
 much the more necessary to be observed in infants, as erysipelas 
 not unfrequently arises from this cause. 
 
 It is not necessary, and is sometimes dangerous, to vaccinate in- 
 fants before the age of six weeks or two months. (For remarks on 
 He-vaccination, see Vaccination in latter part of book.) 
 
 APPLICATION OF LEECHES. 
 
 The best leeches are those of a moderate size, which have never 
 been before applied, which have been but recently taken out ot 
 water, and which are vigorous and brisk in their movements. 
 
 The first thing to be done is to shave off any hairs that may be 
 present on the parts, washing and sponging these parts well with 
 
4:54: SURGICAL ACCIDENTS AND EMERGENCIES. 
 
 warm water, and moistening them with a little milk or sugar and 
 water. 
 
 In disorders of the eyes they should not be applied immediately 
 upon the lids, but just below the ridge or border which forms the 
 lower part of the orbit ; and never, as a general rule, upon the red 
 ness of inflamed parts, but as near, however, toward the verge of 
 this as prudently may be. 
 
 When they are to be applied over some extent of surface, they 
 should be thrown into a basin of warm water, and then put into a 
 dry square piece of linen, the angles of which are to be drawn up 
 together, so as to form a sort of bag ; the warmth thus communi- 
 cated to them tends to excite them, and render them more apt to 
 bite. Having acquired sufficient energy, which will be seen by the 
 briskness of their movements, the corners of the rag, which rests 
 upon the palm of the hand, are to be thrown back, and the whole 
 reversed upon the part where it is intended they should take. They 
 should be kept in place either by means of a glass applied over rag 
 and all, or merely the hand, which should be stretched out so as 
 only to rest upon the borders. Or they may be placed in the cover 
 of a small pill-box, and applied. 
 
 But when they are to be applied upon those parts where they 
 can only be directed one by one, the best plan is to procure a small 
 card, and roll it up so as to leave two openings ; the one large 
 enough to admit the whole body, the other very small — just large 
 enough, in short, to give passage to the head ; the animal being 
 then introduced, the head downwards, the small end is to be 
 applied to the proper spot, and the other closed by means of the 
 pulp of one of the fingers ; when it has adhered, this funnel-shaped 
 card may be loosened and withdrawn, and reconstructed for the rest. 
 
 There are three ways of encouraging the bleeding : the first is 
 by the application of a cupping-glass, a method only employed by 
 practitioners ; the second by bathing the bleeding orifices, left by 
 the leeches, with warm water ; the third by the application of 
 poultices, which are best made of linseed meal. 
 
 When leeches are to be applied to the chest, stomach, or bow- 
 els, it is advisable to fold a sheet three or four times long-wise, and 
 lay it across the bed, under the patient, before commencing the 
 application of the leeches ; during which time a second person 
 should be engaged in preparing a large linseed-meal poultice, to be 
 applied as soon as the leeches have fallen or been taken off. The 
 ends of the folded sheet should then be lifted up, lapped over the 
 whole, and secured with pins ; and in this way the soiling of the 
 patient's dress and bed-linen will be totally prevented. 
 
 
QUACKERY AND QUACK MEDICINE. 455 
 
 QUACKERY. 
 
 I shall not attempt to define quackery. The meaning of the 
 word is sufficiently clear, and is well understood. 
 
 In our country, quackery of all kinds has been exceedingly popu- 
 lar, and is so at the present time. Its popularity is not confined to 
 the ignorant and uneducated. Many of our best cultured minds 
 — our leading clergymen, lawyers, men of letters, and men of busi- 
 ness — prefer quacks for their medical advisers to regularly educated, 
 scientific, and honorable men. 
 
 Our clairvoyants, our astrologers, our chiromancers, and all of our 
 ignorant, unscrupulous charlatans and empirics, by whatever name 
 they may be called, are patronized by men who, in other matters, 
 are both intelligent and conscientious. 
 
 This inconsistent and wicked conduct on the part of men and 
 women who profess better things may be thus partly explained : 
 
 1. An innate love of being humbugged. — There are very many 
 in society who delight in humbuggery of all kinds. They dislike 
 whatever is stable, judicious, open, and true, and readily fall in love 
 with whatever is ridiculous, mysterious, secret and false. With some 
 this love of quackery becomes a disease, and may properly be 
 termed quackomania. Such persons, when they leave their homes 
 and go to any large capital for medical advice, usually avoid the 
 scientific and responsible and conscientious physicians, and seek out 
 the most ignorant, the most vulgar, the most degraded, the most un- 
 scrupulous charlatans that they can find, and allow themselves to be 
 fleeced of their money, cheated of their health, and perhaps of their 
 lives. Clergymen, and conscientious Christian people of the very 
 best orders of society, who would rather bury a child than allow it 
 to go to a theatre or attend a heretical church, yet intrust the lives 
 of themselves and their children to the vilest criminals that an im- 
 perfect legislation ever suffered to roam at large. Men who would 
 never sleep in a hotel where liquor is sold, cheerfully patronize 
 the jail-birds and pickpockets who advertise themselves as physicians 
 and surgeons. 
 
 2. The erroneous impressio?i that quacks are more progressive, more 
 informed, and more successful than regularly educated physicians. — I 
 admit that the profession has not always been as liberal as could be de- 
 sired, but the advanced men among us now eagerly seize hold of 
 every remedy that promises relief for their patients. They take pains 
 to inquire into all new plans, methods, and systems of cure, even 
 when they are in the hands of comparatively ignorant men. It is a 
 
456 QUACKERY AND QUACK MEDICINE. 
 
 fact which the people should understand, that nearly all of the pro- 
 gress made in science is made by scientific men, and not by quacks. 
 Quacks simply borrow from the writings and teachings of physicians. 
 They appropriate the ideas of others, call them original, and thus 
 delude the people. Quacks undoubtedly stumble on some excellent 
 methods of treating disease, but the profession know all that they 
 know, and vastly more. 
 
 The great objection to quacks is, that they are not usually con- 
 scientious. People who know nothing of medical science should 
 intrust health and life only to those who are faithful, reliable, and 
 conscientious, as well as skilful. 
 
 Quackery is not a new delusion. The world has always loved 
 it. 
 
 From Pettigrew's work I make the following suggestive ex- 
 tracts : — 
 
 " Grose, from a MS. in the Cotton Library (Julius F. 6), tells us 
 that • between the towns of Alton and Newton, near the foot of 
 Rosberrye Toppinge, there is a well dedicated to St. Oswald. 
 
 " ' The neighbors have an opinion that a shirt taken off a sick 
 person and thrown into that well will show whether the person will 
 recover or die — for if it floated it denoted the recovery of the party, 
 if it sunk, there remained no hope of their life ; and to reward the 
 saint for his intelligence they tear off a rag of the shirt and leave 
 it hanging on the briers thereabouts, where,' says the writer, ' I have 
 seen such numbers as might have made a fayre rheme in a paper- 
 myll.' 
 
 " Fabian Withers, speaking of physicians, declares : — 
 
 " ' So far are they distant from the true knowledge of physic 
 which are ignorant of astrology, that they ought not rightly to be 
 called physicians, but deceivers ; for it hath,' says he, ' been many 
 times experimented and proved, that that which many physicians 
 could not cure or remedy with their greatest and strongest medi- 
 cines, the astronomer hath brought to pass with one simple herb, by 
 observing the moving of the signs.' The virtues of herbs were con- 
 sidered to be according to the influence of the planet under which 
 they were sown or gathered. Black hellebore was to be plucked, 
 not cut, and this with the right hand, which was then to be covered 
 with a portion of the robe, and secretly conveyed to the left hand. 
 The person gathering it was also to be clad in white, to be bare- 
 footed, and to offer a sacrifice of bread and wine. Yerbena or ver- 
 vain was to be gathered at the rising of the dog-star, when neither 
 sun nor moon shone, an expiatory sacifice of fruit and honey having 
 been previously offered to the earth. Hence arose its power to 
 
QUACKERY AND QUACK MEDICINE. 457 
 
 render the possessor invulnerable, to cure fevers, to eradicate poison, 
 and to conciliate friendship. The mistletoe was to be cut with a 
 golden knife, and when the moon should be only six days old." 
 
 " A belief in the philosopher's stone lasted for a very long period, 
 and the memory of several eminent men is chargeable with the folly. 
 Lord Bacon speculated upon it, and Sir Isaac Newton is said once 
 to have entertained the possibility of finding it, and also to have 
 acknowledged that the idle and vain pursuit of astrology had led 
 him to cultivate astronomy. 
 
 " - The sons of chymistry,' says Lord Bacon, c while they are 
 busy seeking the hidden gold, whether real or not, have, by turning 
 over and trying, brought much profit and convenience to mankind.' 
 
 " It has been remarked as singular, that among the vulgar errors 
 exposed by Sir Thomas Browne in his ' Pseudodoxia Epidemica,' 
 there should be no mention made of the royal gift of healing ; but 
 from a case related in the c Adenochoiradelogiae,' it would seem that 
 this eccentric but able man (who, it will be recollected, received the 
 honor of knighthood from Charles II.) had himself faith in the touch, 
 inasmuch as he recommended the child of a nonconformist in Nor- 
 folk, who had been long under his care without receiving benefit, to 
 be taken to the king, then at Breda or Bruges. Little faith, how- 
 ever, being held by the father of the child as to the efficacy of such 
 intervention, he scorned the advice, and the child was therefore, 
 under the pretence of a change of air, taken without the privity of 
 the father abroad to the king, where it was submitted to the royal 
 touch, and returned perfectly healed. Astonished at the change 
 effected in his child's appearance, the father inquired as to the means 
 that had been employed, and upon being made acquainted with 
 them he not only acquired faith as to the power of the royal touch, 
 but also cast off his nonconformity, exclaiming, ' Farewell to all 
 dissenters and to all nonconformists. If God can put so much vir- 
 tue into the king's hand so to heal my child, I'll serve that God 
 and that king so long as I live, and with all thankfulness.' 
 
 " Professor TVoodhouse, in a letter to Dr. Whitehill, of New 
 York, has given a recital, which also tends to show what singular 
 effects can be caused if the imagination be previously and duly pre- 
 pared for the production of wonders. At the time that nitrous oxide 
 excited almost universal attention, several persons were exceedingly 
 anxious to breathe the gas, and the professor administered to them 
 ten gallons of atmospherical air, in doses of from four to six quarts. 
 Impressed with the idea that they were inhaling the nitrous oxide, 
 quickness of the pulse, dizziness, vertigo, tinnitus aurium, difficulty 
 of breathing, a sensation similar to that of swinging, faintness, 
 
458 QUACKERY AND QUACK MEDICINE. 
 
 weakness of the knees, and nausea, which lasted from six to 
 eight hours, were produced — symptoms entirely caused by the 
 breathing of common air, under the influence of an excited ima- 
 gination." 
 
 In regard to quackery this one fact must be conceded, that there 
 is no method of treatment so absurd that it may not in some cases 
 perform remarkable cures. 
 
 The story of Perkins's tractors is familiar to many now living. 
 Perkins made his tractors of metal of different colors, and by touch- 
 ing the patient with them cured many diseases. A physician of 
 England made some tractors of wood, resembling those of Perkins 
 in appearance and color. "With these he performed the same cure 
 as Perkins had done with his metallic tractors. The delusion was 
 dispelled, and the tractors soon fell into disrepute. 
 
 PATENT MEDICINES. 
 
 In this country enormous fortunes have been and are now being 
 made by the manufacture and sale of patent medicines. I would 
 not say that for every dollar that has been made by these prepara- 
 tions some valuable life has been sacrificed, but I do say that many 
 of these work most serious harm. 
 
 I would not say that all of these preparations are always and 
 necessarily injurious ; for it is perfectly well known among physi- 
 cians that some very simple, and, when used with discrimination, 
 very useful prescriptions are patented under popular titles, and sold 
 in enormous quantities. 
 
 Thousands of people are every day buying, at a high price, some 
 combination of drugs, labelled with some euphonious name, which 
 their family physician could give them by a stroke of the pen, or 
 which they themselves might oftentimes obtain of the druggist, or 
 even at the corner grocery. 
 
 The great objections to the use of these really useful or harmless 
 patent medicines are these two : — 
 
 1. They are given indiscriminately, without regard to the nature 
 of the disease. A wise physician does not usually give medicine 
 until he has some conception of the purpose for which he gives it. 
 A medicine that is in itself harmless in ordinary conditions of 
 the system, may be injurious in some conditions of the system. 
 
 2. To use these medicines is to encourage quackery. If all people 
 
QUACKERY AND QUACK MEDICINES. 459 
 
 everywhere refused to buy or to use patent medicines, the health 
 and the morals of society would be much improved. 
 
 I need not give any reasons why I object to the use of patent 
 medicines that contain substances that are injurious. The very 
 fact that they contain injurious substances in injurious quantities is 
 all the argument that need be urged against them. 
 
 Just here it is proper for me to remark, that the common idea 
 that vegetable poisons are less pernicious and fatal than mineral poi- 
 sons is erroneous, and leads to great mischief. This idea arose from 
 the fact that in former times many have been injured by the abuse of 
 mercury in some of its forms. Mercury is indeed a poison, and when 
 abused may work sad havoc with the constitution ; but there are very 
 many vegetable poisons which are far more speedily, and terribly, 
 and surely fatal than mercury. Prussic acid is a vegetable poison, 
 but it can kill almost instantaneously; nicotin of tobacco is a veget- 
 table product, but a drop of it will kill a dog or cat. Strychnine is a 
 vegetable poison, and is so powerful, that when long used as a medi- 
 cine its effects must be always watched. 
 
 Venders of quack medicine have seized hold of this popular 
 prejudice against minerals, and advertise their preparations as con- 
 taining " no minerals" — as being purely vegetable. 
 
 It is proper that their victims should know that many of these 
 statements are utterly false ; and even when they are true, when the 
 medicine advertised is of a purely vegetable character, it does not 
 follow that it is harmless. 
 
 (For further remarks and illustrations of this subject, see Hair, 
 Diseases of j Hair Dyes, and Cosmetics.) 
 
DOSES OF REMEDIES 
 MENTIONED AND PRESCRIBED IN THIS BOOK. 
 
 The doses of the medicines spoken of in this work are for adults. 
 In order to determine the doses for children of various ages, the 
 following rules of Gaubius are very reliable : 
 
 For children one year old -^ of the dose for an adult. 
 " two years " \ " " " 
 
 " three " " •§- " " " 
 
 " four " " \ u " " 
 
 " seven " " i « " " 
 
 " fourteen " \ " " " 
 
 In giving any of the preparations of opium to children — mor- 
 phine, or laudanum, or paregoric, or Dover's powder, or cold pow- 
 der or simple powdered opium, or any prescription that contains 
 opium, the proportionate dose should be even less, because chil- 
 dren are much more susceptible to opium than adults. 
 
 In all cases it is better to be on the safe side — to give too little 
 rather than too much. It is therefore well to begin with the small- 
 est dose mentioned and increase it gradually until the full dose is 
 reached. 
 
 One teaspoonful is used for one fluid drachm, or -|- of an ounce. 
 One tablespoonful " " four " " " £ " « " 
 
 Two tablespoonfuls " " eight " " " 1 ounce. 
 
 One wine-glassful " " two " ounces. 
 One pint " " sixteen" " 
 
 These measures, though not accurate, are sufficiently so for all 
 practical purposes. 
 
 For all except the more powerful medicines, 60 drops or minimi 
 are regarded as equal to one fluid drachm, or one teaspoonful. 
 
 APOTHECARY MEASURE. 
 
 One scruple (3) = twenty grains (gr.). 
 Three " = sixty " or one drachm. 
 
 Eight drachms ( 3 )= one ounce. 
 Twelve ounces ( 3 )= " pound (flb.). 
 
GENERAL 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 AND OF THE MOST RECENT 
 
 METHODS OF TKEATMENT, 
 
 m POPULAR LANGUAGE, ALPHABETICALLY ARRANGED, WITH BRIEF 
 ACCOUNTS OF THE MODERN DISCOVERIES IN MEDICAL SCIENCE. 
 
 ABBASION OF THE SKIK 
 
 When the skin has been accidentally ruffled or grazed, the in- 
 jured part should be carefully washed with tepid water, in order 
 to remove any sand or other impurity from the abraded surface. It 
 should then be bathed with spirit and water until the pain has in 
 some measure subsided. 
 
 To protect the part from the air, and prevent inflammation, a 
 piece of folded lint, or soft linen rag, moistened with water, should 
 then be applied, and covered with a piece of oiled silk, to retain the 
 moisture. Glycerine is an excellent application. 
 
 Sometimes warm poultices will be found to give more relief than 
 cold applications. The application of strips of adhesive plaster is 
 often perfectly curative. 
 
 ABSCESS. 
 
 An abscess is a collection of matter, or j?us, in some part of the 
 body, invariably caused by previous inflammation. Abscesses are 
 generally situated in the cellular structure or tissue, and they form 
 more frequently in that structure near the surface than where it is 
 deep-seated ; the same structure or tissue also enters into the forma- 
 tion of all the internal organs liable to abscess. 
 
 An abscess is either acute or chronic. 
 
 ACUTE ABSCESS. 
 
 " "When acute inflammation is about to terminate in abscess, the 
 pain, which was previously sharp, becomes dull, the swelling is 
 
462 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 increased, and throbbing of the part commences. When the mat- 
 ter is completely formed, the part becomes softer, with an uneasy 
 feeling of weight, the throbbing ceases, and, if the matter be not 
 too deeply seated, we may feel it fluctuating by pressing with the 
 fingers. At the same time the feverish symptoms, which existed 
 during the inflammatory stage, lessen, and rigors or shiverings take 
 place at intervals ; they are felt principally in the back and loins. 
 The tumor at length begins to point at or near the middle of its 
 surface. The skin at this part gradually becomes thinner, ulti- 
 mately gives way, and the matter is freely discharged. 
 
 CHRONIC ABSCESS. 
 
 Chronic abscess is frequently situated in the lymphatic glands, 
 as well as in the cellular tissue. It forms slowly. The tumor is 
 round, without redness or heat of skin, and does not offer much re- 
 sistance when pressed upon. The pain, if any exist, is compara- 
 tively slight, but there is an uneasy sensation of tension and weight. 
 After remaining a longer or shorter period in this state, the pain 
 becomes a little increased, a slight degree of redness may be ob- 
 served on the tumor, and softening commences at its centre, gra- 
 dually extending throughout. The inflammation then goes on 
 until the skin bursts, and allows the matter to be expelled. 
 
 The matter of acute abscess is a bland fluid, thick, white, and 
 without smell. This is called healthy pus ; but sometimes, when 
 long confined, it becomes thin, fetid, and acquires a grayish color. 
 In chronic abscesses the matter varies in consistence. It is gen- 
 erally serous, containing little flaky or curdy masses, which have in 
 some cases the consistence of cheese, and the smell is disagreeable ; 
 this, in contradistinction to the former, is called unhealthy pus. 
 
 Treatment — Acute Abscess. — When inflammation of a part is 
 going on, threatening abscess, our object must be to prevent this 
 termination, if possible. But, if suppuration cannot be prevented 
 by the usual means — viz. low diet, keeping the bowels freely open, 
 the liberal use of leeches, and the constant application of cold lo- 
 tions to the part, such as Goulard water , vinegar and water, &c. — 
 recourse should then be had to the soothing treatment, which con- 
 sists of warm applications, as fomentations' of marsh-mallow, and 
 large poultices of bread and milk, or linseed ; these are to be 
 changed frequently, so as to keep up a due degree of heat and 
 moisture, all stimulating applications being carefully avoided. In- 
 ternally, the following mixture, recommended by Sir Astley Cooper, 
 should be administered : 
 
AND MOST RECENT METHODS OF TREATMENT. 463 
 
 Liquor of the acetate of ammonia, six ounces, 
 Epsom salts, one ounce, 
 Laudanum, sixty drops. Mix. 
 
 The dose of this mixture is three or four table-spoonfuls three 
 times a day. Half a grain of acetate of morphia may be substituted 
 for the laudanum. 
 
 When the abscess has gone through its stages regularly and be- 
 gins to point, it should be left to burst of itself; but, if the matter 
 be confined under the membrane which envelopes the muscles, or if 
 the skin be very thick and unyielding, it will be necessary to make 
 a free opening with the lancet. 
 
 Chronic Abscess. — The treatment of chronic abscess is very dif- 
 ferent from that of acute. In this case the diet must be generous, 
 and tonic medicine should be administered to give strength to the 
 constitution. 
 
 Sulphate of quiniDe, forty grains. 
 
 Extract of gentian, a sufficient quantity to form a mass, to be divided into twenty 
 pills. One to be taken twice or three times a day. 
 
 Cold stimulating poultices should be applied over the part. 
 The one generally used is made by dissolving a table-spoonful of 
 common salt in a pint of water, and mixing it with oatmeal or 
 flour. If the case be very tedious, a compound galbanum plaster 
 may be applied. This form of abscess will also require the lancet 
 if the matter be deeply seated, or under the muscular covering, so 
 as to prevent its spreading among the muscles ; and as a general 
 rule all abscesses, whether acute or chronic, situated in the arm-pit, 
 near the anus, in the groin or neck, should be opened early, in or- 
 der to prevent the matter from accumulating and extending in the 
 cellular tissue. When it is found necessary to use the lancet, a free 
 opening should be made in the most depending part of the abscess, 
 and a piece of lint smeared with olive oil or spermaceti ointment 
 placed in the wound, to prevent its closing before the cavity has 
 healed up from the bottom. 
 
 If the abscess has been extensive, a roller or bandage should be 
 applied, so as to bring the sides of the cavity together without cov- 
 ering the mouth of the wound. Whether the matter has been dis- 
 charged through an opening made by the lancet, or from the spon- 
 taneous bursting of the abscess, it will be necessary to continue the 
 poultices for some time after. 
 
 In people of scrofulous constitution, the absorbent glands of the 
 neck not unfrequently become enlarged and hard without being dis- 
 colored or painful, though there is generally tenderness on pressure. 
 These glandular swellings, for the most part, come on slowly, re- 
 main for a considerable length of time, perhaps weeks or months, and 
 
464: DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 occasionally disappear of themselves without any treatment. But 
 in general, after they have continued for some time in this indolent 
 state, matter begins to form, the skin over the enlarged gland ac- 
 quires a reddish tint, and there is pain either more or less severe. 
 Warm poultices, and sometimes stimulating applications, are then 
 made use of by those who are ignorant of the means which ought 
 to be adopted in such cases ; after a time the skin assumes a livid 
 or purplish color, and at last bursts, and the matter is discharged. 
 A considerable portion of the dark-colored skin is lost by sloughing, 
 and an ugly ulcer forms, which is healed with difficulty, leaving an 
 indelible scar which remains for life. In a boy a scar in the neck 
 is kept out of sight, being covered by the dress, and is, therefore, of 
 no great consequence ; but to a girl it is of the utmost importance, 
 for when arrived at womanhood it must be a source of deep regret 
 to bear scars not only offensive to the sight, but which point her 
 out as tainted with scrofula, or king's evil, a disease that has always, 
 been considered as more decidedly hereditary than perhaps any other 
 
 Food difficult of digestion, or of a stimulating quality, should 
 not be given, but the diet should be sufficiently nutritions, and not 
 confined to vegetable or farinaceous substances. When a slight 
 blush or degree of redness is observed on the skin covering the part, 
 and when matter can be distinctly felt on pressing with the fingers, 
 vent should be immediately given to it. The opening should be 
 made transversely with a lancet, or a fine double-edged knife, and 
 the greatest care must be taken to squeeze out all the peculiar curdy 
 matter which these abscesses almost invariably contain. By making 
 the wound transversely, it follows the course of the folds or creases 
 of the neck, or runs parallel with them, and consequently when 
 healed the cicatrix will scarcely, if at all, be observed. 
 
 After the matter has been discharged, bread poultices mixed with 
 either of the following cold lotions should be applied. 
 
 Sulphate of zinc, twenty grains, 
 
 Water, ten ounces, 
 
 Spirit of wine, half an ounce. Mix. Or, 
 
 Nitric acid, twenty drops, 
 
 Distilled water or common water, a pint. Mix. 
 
 The strength of these lotions must be gradually increased, but 
 not made so strong as to produce pain. 
 
 If the wound do not heal readily, which is sometimes the case, 
 the best plan is to inject a little of the following lotion with a syringe 
 every time it is dressed. 
 
 Water, a pint, 
 
 Sulphate of zinc, twenty to twenty-five grains. Mix. 
 
AND MOST RECENT METHODS OF TREATMENT. 465 
 
 The time to make the opening, as has been already stated, is 
 when the matter can be felt on pressure with the fingers ; the skin 
 covering the tumor will then in all probability have a slight appear- 
 ance of redness ; but if this stage of the abscess has not been taken 
 advantage of, and suppuration has been allowed to go on until the 
 skin has acquired a livid or purple color, the use of the knife will 
 then do no good ; it will be better to apply fomentations and warm 
 poultices until the abscess burst of itself. 
 
 The time required for the formation of an abscess varies accord- 
 ing to its situation and the constitution of the patient. Matter 
 generally begins to form from seven to fourteen days after the com- 
 mencement of inflammation, and an acute abscess usually runs its 
 course in about three weeks. A lumbar or psoas abscess, or any 
 other extensive chronic abscess, requires a much longer period, 
 sometimes several months. In chronic abscesses the patient will 
 need to be supported by stimulants and tonics and good food. 
 
 ABSINTHE, OR WORMWOOD. 
 
 This is a plant that grows both in Europe and America. It is, 
 as everybody knows, exceedingly bitter. It is given in dyspepsia 
 to increase the appetite and improve the digestion, in green sickness, 
 m jaundice, and for the expulsion of worms. 
 
 The dose of the powder is twenty or thirty grains / of the infu- 
 sion, one or tioo fluid ounces. 
 
 Absinthe in large quantities is very injurious. Of late years it 
 has been much used in France, in a wine of that name. It works 
 disastrously. 
 
 ACONITE (Wolfsbane or Monkshood). 
 
 The extract is a powerful remedy in all the stages of rheuma- 
 tism and in gout. It soothes the excruciating pain arising from 
 cancer and diseases of the womb, when the extract of hemlock ceases 
 to produce that effect. It is of the greatest service in tic-douloureux, 
 scrofulous swellings, old syphilitic diseases, long continued cough, 
 and affections of the stomach. 
 
 The symptoms which point out the extent beyond which aconite 
 should not be carried are a slight degree of uneasiness at the sto- 
 mach, with inclination to vomit, and occasional dimness of sight, 
 which may be removed almost immediately by taking a little warm 
 brandy and water. 
 
 Of- this medicine both the leaves and the root are used. The 
 plant grows in rocky places. The ancient Gauls dipped their arrows 
 30 
 
466 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 in its juice in order to make them poisonous. It is used in the form 
 of tincture of root, or of leaves. 
 
 It is used to reduce the pulse in child-bed fever, in pneumonia, 
 and other fevers. It is useful in neuralgia, in gout, in rheumatism, 
 in diseases of the heart. For neuralgia it is used locally, in the form 
 of ointment of aconitia, or equal parts tincture and chloroform. 
 
 The dose of the tincture of the root (the best form of it) is three 
 drops. It is a remedy which should usually oe given by a skilled 
 physician. 
 
 JETHEE. 
 
 Sulphuric aether is used in nearly all spasmodic diseases, such 
 as asthma, hysterics, hiccough, cramps, and other nervous affections. 
 It is given sometimes as a cordial in low fevers, and also in ma- 
 lignant fevers for the purpose of allaying spasmodic twitchings. 
 
 Applied externally, aether stimulates and reddens the skin ; it is 
 used for this purpose in nervous headache, and in toothache, being 
 applied to the cheek. To produce the effect of irritating the skin, 
 the part to which it is applied must be kept covered, otherwise it 
 evaporates so quickly as to cause extreme cold. 
 
 The dose is from half a teaspoonful to a teaspoonful in a little 
 water, or in three or four ounces of camphorated mixture. 
 
 ^Etherization. — The power of aether to produce insensibility had 
 been known for many years before its use became popularized. This 
 fact, however, was known only to a few, and attracted no attention. 
 
 The first experiments which demonstrated the anaesthetic pow- 
 ers of aether, and forced the public to give them heed, were made by 
 Dr. Morton, a Boston dentist, September 30th, 1846. Before that 
 time, Dr. Wells, of Hartford, had experimented with nitrous oxide, 
 or " laughing gas." The progress of aetherization in this country was 
 at first very slow. Europe went ahead with it much more rapidly 
 than we. It became popular in England, in France, and in Ger- 
 many, before America — the land of its birth — was willing to receive 
 it. This is another illustration that a prophet is not without honor, 
 except in his own country. 
 
 It is now used throughout the civilized world to produce uncon- 
 sciousness in surgical operations. It is also used in midwifery, and 
 for the relief of neuralgic and other pains. 
 
 Except in great emergencies, it should only be administered by 
 a skilful physician. The dose varies with the temperament of the 
 patient, and with the method of administration. Yarious forms of 
 inhalers have been devised. Usually a sponge is employed. Inha- 
 
AND MOST EECENT METHODS OF TREATMENT. 467 
 
 lers that admit atmospheric air at the same time with the vapor of 
 aether are the safest. 
 
 ^Etherization is also used in convulsions, in locked jaw, in 
 hysteric fits, in asthma, in attacks of madness, and in painful men- 
 struation. As Dr. John Brown says, " it is one of God's best gifts 
 to his sufferino; creatures." 
 
 As compared with chloroform, aether is much the safer. A few 
 deaths have occurred from its use, but only a few, while we know 
 that several hundred have fallen victims to chloroform. 
 
 It is much slower than chloroform, and its odor is more disagree- 
 able. The present feeling among the profession is to use chloroform 
 less and aether more. 
 
 Recently aether has been used to produce local anaesthesia. 
 ^Ether spray is blown on the part which we desire to benumb. The 
 rapid evaporation produces great cold. The part becomes be- 
 numbed, and slight operations, such as removing a toe-nail, can be 
 performed without pain. 
 
 AGUE, OR INTERMITTENT FEYER. 
 
 Ague generally declares itself under three regular forms, namely, 
 the quotidian, tertian, and quartan. 
 
 The quotidian form has an interval of twenty-four hours, and the 
 fit usually commences in the morning. This type of ague is not so 
 common as the other two, and occurs generally in spring. 
 
 The tertian has an interval of forty-eight hours, the fit occurring 
 about noon. This is the most common form, and prevails also in spring. 
 
 The quartan has an interval of seventy-two hours, commencing 
 in the afternoon. This form prevails in autumn, and is the most 
 difficult to overcome. 
 
 It must not be supposed that these forms of ague commence 
 invariably at certain periods of the day ; they may commence at any 
 hour ; the periods we have mentioned, however, are the most usual. 
 
 Each paroxysm or fit of intermittent fever has three well-marked 
 stages — a cold, a hot, and a sweating stage. 
 
 The cold stage is ushered in by the following train of symptoms : 
 Languor, listlessness, general uneasiness, with depression of spirits, 
 aversion to food, a feeling of soreness on the back and extremities. 
 The face and extremities then become pale, and a cold sensation is 
 felt in the back and loins, gradually extending over the whole body, 
 until decided shivering takes place ; the lips and nails assume a livid 
 hue, the teeth chatter, the skin presents the appearance of what is 
 vulgarly called goose* s skin, respiration becomes oppressed, the pulse 
 
468 
 
 is weak, the mouth and throat dry, all the secretions are diminished, 
 and the patient sometimes vomits. 
 
 The hot stage. — After a longer or shorter duration, the shaking 
 gradually goes off, the heat of the body returning, until it goes far 
 beyond the natural standard. The skin then becomes dry, the face 
 flushed, the pulse full and hard, the tongue furred, and the breathing, 
 which was considerably affected during the cold stage, becomes easier. 
 There is great thirst, severe headache and restlessness. The urine, 
 which in the first stage was pale, is now high-colored ; the sensibility, 
 previously more obtuse than natural, is now increased ; the eyes have a 
 bright and glistening appearance, and sometimes delirium comes on. 
 
 The sweating stage. — The hot stage having continued an indefi- 
 nite time, a slight degree of moisture is at length observed on the 
 forehead and neck ; this gradually extends to the trunk and ex- 
 tremities, and terminates in profuse perspiration, which relieves the 
 patient from his suffering. He is left, it is true, with a feeling of 
 fatigue ; but the appetite returns, all the secretions again become 
 natural, and he is able to follow his usual occupation until the 
 commencement of another fit. 
 
 The quotidian has the shortest cold stage, but the longest 
 paroxysm or period required for the completion of the three stages ; 
 the tertian has a long cold stage, but a short paroxysm ; and the 
 quartan has the longest cold stage and the shortest paroxysm. 
 
 The usual duration of the quotidian paroxysm is from twelve to 
 fifteen hours, of the tertian ten hours, and the quartan form com- 
 monly completes its stages in six or seven hours. These rules, 
 however, admit of many exceptions. 
 
 When the disease is giving way, the fits become milder, and 
 gradually later, until at length the ague is no longer felt ; but when 
 it is increasing, the fits become more severe, and gradually return 
 earlier, so that it is not unusual for the tertian form to become quo- 
 tidian, and the quotidian to assume the remittent type of fever. 
 
 Causes. — The exciting or specific cause of ague is undoubtedly 
 malaria, or the exhalation from decaying vegetable matter. In 
 some parts of Italy, during the excessive heat of summer, the 
 malaria becomes so noxious that it causes ague of a pernicious or 
 malignant character, the patient sometimes being carried off in the 
 second or third fit. The most deleterious effects of malaria, whether 
 derived from decaying vegetable matter or not, can only be man- 
 ifested under a high temperature ; it then acquires a virulence truly 
 extraordinary. Ague is now supposed to be due to spores. 
 
 Ague is certainly very apt to relapse, and slight causes, such as 
 exposure to cold and moisture, errors in diet, certain winds, such as 
 
AND MOST RECENT METHODS OF TREATMENT. 469 
 
 the north-east, &c, will bring it back after an absence of months, 
 or even years. Individuals whose general health is not good are 
 more liable to be acted on bj malaria than those in robust health. 
 Poor diet, fatigue, debauchery, or any other debilitating cause, by 
 enfeebling the powers of life, predispose the body strongly to ague, 
 when exposed to the influence of malaria. 
 
 Treatment. — In the treatment of ague, we have two objects in 
 view — the one to alleviate and shorten the fits, the other to prevent 
 their return. 
 
 Treatment during the fit. — In the cold stage it will readily occur 
 to every one to cover the patient with blankets or other warm 
 clothing, and to administer warm drinks. The quantity of bed 
 clothes is to be diminished, and the patient should be allowed to 
 drink freely of cold water or cold acidulated liquids, such as cream 
 of tartar, or tamarind beverage, with the addition of twenty or 
 thirty grains of purified nitre. The cream of tartar beverage is 
 made in the following manner: 
 
 To three pints of boiling water, add 
 
 Four ounces of refined sugar, 
 
 Half an ounce of cream of tartar, and 
 
 Three drachms of orange-peel, or an orange cut in slices. 
 
 Sweating stage. — In this stage medicine is not requisite. We 
 have merely to take care that the body is not chilled when the pa- 
 tient's clothes are being changed. 
 
 Treatment during the intermission. — It is only during the inter- 
 vals or periods between the fits that we can expect to effect a cure. 
 We then have recourse to Peruvian dark, or the sulphate of quinine, 
 which are possessed of almost a specific property in preventing the 
 return of the fits, and may be considered as our sheet-anchor in all 
 the forms of ague. The dose of bark in powder is from a drachm 
 to two drachms every three or four hours, so as to allow nearly two 
 ounces to be taken durino; each intermission. The concentrated 
 form of sulphate of quinine is much preferable, and should be given 
 in the following manner : 
 
 Sulphate of quinine, twenty-four grains, 
 
 Extract of gentian, a sufficient quantity to make a mass to be formed into twelve 
 pills. 
 
 One pill may be given three or four times a day, commencing 
 immediately after the sweating stage, or two grains of quinine may 
 be given in place of each pill, in a little port-wine and water, care 
 being taken to continue this medicine for some time after the dis- 
 ease appears cured. The power possessed by quinine in overcom- 
 ing ague is truly extraordinary, and must ever be considered as one 
 
470 
 
 of the most curious facts in medicine. It does not, however, pro- 
 duce the desired effect in all cases, and, when it fails, we have rea- 
 son to suspect that the ague is kept up by some organic derange- 
 ment of the bowels, lungs, liver, spleen, &c. If there be disease of 
 any organ, it is aggravated during the fit, in consequence of the 
 increased determination of blood to the part, causing congestion ; 
 and during the intermission the affected organ keeps up constantly 
 a greater or less degree of irritation in the system, and thereby pre- 
 sents the quinine acting as it otherwise would do. 
 
 In such cases, when quinine is obstinately resisted, the arsenical 
 solution, or Fowler's solution, which is the most powerful antiperi- 
 odic remedy we possess, next to quinine, may be found of the great- 
 est advantage. The dose to commence with should be as follows : 
 
 Fowler's solution of arsenic, three drops, 
 Laudanum, eight or ten drops, 
 
 "Water, an ounce. Mix. To be given every four or six hours, gradually increasing 
 the dose of the solution to eight or ten drops, according as the stomach will bear it. 
 
 It should not be given before breakfast, or on an empty stomach. 
 If carefully watched, there is no danger whatever in using the ar- 
 senical solution, and it frequently cures ague when quinine fails. 
 If it produce griping of the bowels or sickness at stomach the dose 
 should be diminished. 
 
 The bowels must never be allowed to remain constipated at any 
 period of the disease. 
 
 Purging to any extent is never necessary in ague. Keeping the 
 bowels gently open is sufficient. 
 
 It is only during the intermission that food should be taken, 
 and, as ague is almost invariably attended with debility, the diet 
 ought to be light, nourishing, and of sufficient quantity. 
 
 General electrization has been found very efficacious in the chro- 
 nic exhaustion resulting from ague. (See General Electrization.) 
 
 ALOES. 
 
 This medicine is an excellent purgative, and one of the most 
 certain in its action we possess. It does not produce watery stools 
 nor create wind in the bowels, rarely disagrees with the stomach, 
 and w r hen taken in small doses assists digestion. It is particularly 
 useful in cases of habitual costiveness in connection with indigestion, 
 and answers well with hypochondriacal people, and those of seden- 
 tary habits ; it is also serviceable when the constitution is sluggish 
 or scrofulous. Aloes, when combined with myrrh and a prepara- 
 tion of iron, is beneficial in obstruction of the menses, and when 
 
AND MOST RECENT METHODS OF TREATMENT. 471 
 
 given in conjunction with small doses of blue-pill has been found 
 one of the best medicines in jaundice. 
 
 It acts principally on the lower intestines, and has a tendency 
 to irritate them when given too frequently or in too large doses. 
 Hence it ought not to be given to those who have piles, nor when 
 there is inflammation of the bowels, and should be particularly 
 avoided by females who are subject to immoderate flowing of the 
 menses. It is improper when there is any disease of the womb, 
 during pregnancy, and also during the period of the menstrual dis- 
 charge. Aloes is usually given in the form of pills ; the dose is 
 from five to fifteen grains ; it is, however, seldom taken alone. 
 When intended to give tone to the digestive organs and also to 
 open the bowels, the following form of combination, recommended 
 by Professor A. T. Thompson, will be found one of the best : 
 
 Take of myrrh, six drachms, 
 
 Subcarbonate of soda, three ounces, 
 
 Ammonia, four drachms and a half, 
 
 Extract of aloes, six drachms, 
 
 Sherry wine, twenty -four ounces. Macerate during seven days, and strain. 
 
 Two or three tablespoonfuls of this mixture to be taken twice a 
 day in the same quantity of a solution of extract of liquorice (the 
 common Spanish liquorice dissolved in warm water), which answers 
 the purpose of concealing the taste of bitter medicines better than 
 anything else. 
 
 ALUM 
 
 was formerly employed in internal bleeding and gleet, but is now 
 very little used internal^. It has been found useful in stopping 
 the bleeding from leech bites in children, by keeping a portion for 
 some time applied to the parts, and may be used in the same way 
 to stop the bleeding arising from the extraction of a tooth. It is 
 serviceable as a wash in arresting bleeding from the nose. Alum, 
 also, forms a very useful gargle in common sore-throats. 
 
 In the following form it is found beneficial as an injection in 
 the discharge called the whites : 
 
 Take of alum, a drachm, 
 Water, seven ounces. Mix. 
 
 It is often used as a lotion for the eyes, after the inflammatory 
 
 stage of ophthalmia has been subdued. 
 
 Take of alum, ten grains to a scruple, 
 Eose water, six ounces. Mix. 
 
 AMAUKOSIS. 
 
 "When there was no means of examinino; the bottom of the eve, 
 where the nerve enters from the brain, all defects in vision, which 
 
472 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 could not be traced to some external cause, were placed under the 
 head of amaurosis. Since the invention of the ophthalmoscope — 
 which is simply a reflector, by means of which light can be thrown 
 from a lamp or other source of illumination upon the retina and 
 nerve of the eye, thus allowing these parts to be plainly seen (see Oph- 
 thalmoscope) — when we speak of amaurosis we mean certain diseases 
 of the optic nerve and retina which can only be certainly recog- 
 nized by means of this instrument. These affections are usually in- 
 curable, and result from inflammations of the brain, of the nerve 
 itself, from the bursting of an artery within the eye, the plugging 
 up of a blood-vessel, or similar causes. They are not as common 
 as they were formerly supposed to be. They were at one time con-' 
 founded with affections of the eyeball that only required the proper 
 use of spectacles. No one but a person medically educated is 
 competent to decide that an affection of the eye is amaurosis. 
 
 ■ AISLEMIA. 
 
 Anosmia means poverty of blood. 
 
 It is caused by hemorrhage, by exhausting diseases, by blood- 
 poisons, and by confinement indoor. 
 
 The symptoms are paleness, debility, nervousness, nervous palpi- 
 tation of the heart. 
 
 This disease is very apt to be confounded with what I call neu- 
 rasthenia or chlorosis, which are nervous diseases. Anaemia is a 
 disease of the blood, neurasthenia of the nervous system. One may 
 cause the other. They are often associated. Both are liable to 
 occur in young girls, or boys about the age of puberty. 
 
 The treatment of anosmia is important, for the disease may give 
 rise to neuralgia, and other and nameless shapes of nervous disease. 
 
 1. Iron, quinine, and stry chine, in the form of elixir of the pyro- 
 phosphate of iron, quinine, strychnine. 
 
 2. General electrization. — I continually use this method of treat- 
 ment of anaemia, and with good results. It is especially useful for 
 those cases that are associated with chlorosis (green sickness) or 
 nervous exhaustion. 
 
 It often succeeds in these cases after internal tonics have failed. 
 It may be used in connection with other tonics. My own habit is 
 to treat anaemic and exhausted patients by general electrization alone 
 for some time, and when they have abandoned treatment to give 
 them a prescription of the elixir spoken of above. 
 
 3. Air, sunlight, and exercise. — I mean to improve every oppor- 
 tunity to speak a good word for these three great physicians, even 
 at the risk of frequent repetition. 
 
AND MOST RECENT METHODS OF TREATMENT. 473 
 
 4o. Abundant and nourishing food. — Anaemic patients need 
 plenty of meat, beef-tea, fresh eggs, and bread. 
 
 5. Plenty of sleep. — Sleep can only be expected by those who 
 obey the laws of health. Sleep is food for the blood, as well as for 
 the nerves. 
 
 ANGINA PECTORIS, OR BREAST-PANG. 
 
 This is an intermittent affection, coming on in fits at irregular 
 intervals, and is one of the most painful and most fatal of all dis- 
 eases. The fit commences suddenly, and usually when the patient 
 is walking, with a severe lancinating or stabbing pain, generally 
 behind the lower part of the breast-bone, extending in the direction 
 of the left nipple. The constrictive suffocating sensation which ac- 
 companies the pain compels the patient to stop, and in the course 
 of a few minutes, if quiet be observed, the attack goes off. The 
 first attacks are comparatively slight and of short duration, no par- 
 ticular inconvenience being felt when they are over ; but after a 
 time they become more severe, and continue much longer ; the pain 
 extending to the arm, and even to the ends of the fingers, generally 
 on the left side only, though sometimes it extends to both, accom- 
 panied with a feeling of numbness, which prevents the use of the 
 arm. Occasionally the neck, the left jaw, and even the ear, are af- 
 fected, the speech being slightly impeded ; and the anxiety and suf- 
 focating sensation are frequently so severe, that the patient dreads 
 immediate death. When the disease has advanced to this extent, 
 the fits last from half an hour to an hour, or even longer. The res- 
 piration is usually very little affected, though it may be sometimes a 
 little more frequent than natural. The pulse is in some cases natural ; 
 in others quick, strong, irregular, or intermitting. The face may 
 be either pale or red ; sometimes pale, or with a sallow tinge. The 
 skin may be hot, or covered with a cold, clammy sweat. 
 
 After the termination of a severe attack the patient experiences 
 a feeling of fatigue and soreness of the parts affected, and the sen- 
 sation of numbness frequently continues for a considerable length 
 of time. 
 
 TREATMENT OF ANGINA PECTORIS. 
 
 The treatment of this affection is not very satisfactory. It is 
 difficult at the outset to determine whether we have or have not 
 the disease. It is still more difficult to tell what the cause is. The 
 disease may depend on a variety of causes. 
 
474 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 For treatment we can, as a rule, only relieve. We can palliate, 
 and make more comfortable. 
 
 Electrization lias been found of service in this day by Duchenne, 
 of France, and by my associate, Dr. Rockwell. The results, how- 
 ever, are by no means been satisfactory. 
 
 Those who suspect that they have this or any other affection of 
 the heart should consult some medical authority and have their 
 doubts confirmed or dispelled. (See Heart, Diseases of.) 
 
 APOPLEXY. 
 
 Apoplexy is characterized by a sudden suspension, more or less 
 complete, of the power of sense and motion, the organic functions 
 of circulation and respiration continuing to be performed, though 
 impaired to a certain extent. 
 
 This disease is caused by pressure on the brain from an effusion 
 of blood, its symptoms varying according to the extent of the 
 effusion. 
 
 There are certain symptoms which sometimes give notice of the 
 approach of apoplexy, namely, giddiness, indistinct vision, with the 
 appearance of motes or sparks before the eyes, buzzing or ringing 
 in the ears, drowsiness, a sensation of fulness in the head, general 
 headache, or a pain in some particular part of the head, inability to 
 articulate distinctly or to walk firmly. But in the majority of cases 
 people are struck with apoplexy when to all appearance in excel- 
 lent health, and without any indications of the approach of this 
 dreadful disease. 
 
 This disease may be mistaken for a fainting fit, though the dis- 
 tinction is sufficiently well marked. When a person faints, the face 
 and lips lose their color, and the skin becomes cold. In apoplexy, 
 on the contrary, the face is generally red and the skin hot. In 
 fainting, the pulse and respiration are almost suspended. This is 
 not the case in apoplexy. A fainting fit is but of short duration, 
 and the individual on recovering does not experience pain. 
 
 Epilepsy, or the falling sickness, resembles apoplexy in so far as 
 the individual in both cases falls down in a fit ; but in the former 
 disease there are convulsions, the limbs are not paralyzed, but rigid, 
 and the eyes are convulsed and look upwards ; these symptoms dis- 
 tinguish it sufficiently from apoplexy. (See Epilepsy.) 
 
 Complete intoxication is distinguished from apoplexy by the 
 smell of the liquor which the individual has drunk, and by the 
 weakness of the pulse. 
 
AND MOST RECENT METHODS OF TREATMENT. 475 
 
 This disease is undoubtedly on the increase among us. It is 
 certainly very common. 
 
 The great cause is over-work and over-worry of the brain. 
 High living is not so much the cause as is commonly supposed. It 
 comes on most frequently at night and after dinner. Intemperance 
 causes it. It is most frequent after the age of fifty, but is now quite 
 common between 30 and 50. 
 
 The country has been recently startled by the sudden death, by 
 apoplexy, of Mr. Henry J. Raymond. As usual in such cases, vari- 
 ous and opposite causes are assigned for the sudden and fatal at- 
 tack. 
 
 Nothing is more difficult than to determine in any given case of 
 apoplexy, or indeed of any affection of the nervous system, the pre- 
 cise cause of the calamity. In the majority of cases these mala- 
 dies are the results of many injurious causes acting upon the system 
 perhaps for years. 
 
 In Mr. Raymond's case excessive labor was probably one of the 
 principal causes, and yet many die of apoplexy who have never 
 overwwJced, and who have been very regidar in all their habits. 
 
 TREATMENT OF APOPLEXY. 
 
 1. Rest. Let them alone. Bleeding usually does more harm 
 than good. 
 
 In the majority of cases a patient taken with apoplexy needs at 
 first only careful and judicious nursing. The head should be kept 
 raised, and cool cloths should be put on the head. 
 
 2. Mustard plasters to the calves of the legs and back of the 
 neck. These have the effect to draw the blood from the head. 
 
 3. Strong purgatives. A drop or two of croton oil on the 
 tongue, a good dose of jalap or podophyllin, or any other powerful 
 purgative, will answer the purpose. 
 
 Apoplexy often leaves a patient paralyzed in one half the body. 
 This paralysis is best treated by general or localized electrization 
 and rubbing with the hand. 
 
 Concerning this affection, Prof. Austin Flint thus advises : 
 " The liability to a recurrence of apoplexy after recovery from an 
 attack renders it important to observe all possible precautions by 
 way of prophylaxis. Placing the system in the best possible condi- 
 tion by means of a well-regulated diet and regimen, and avoiding 
 exciting causes, will afford all the security which can be obtained. 
 It is not probable that any protection is afforded by reducing the 
 powers of the system, and other evils may thereby be induced. It 
 is injudicious to adopt a diet which is insufficient for the wants of 
 
476 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 the system, or the resort to repeated blood-lettings, cathartics, or 
 other lowering measures. In striving to avoid excesses and impru- 
 dences of all kinds, care must be taken not to err in the opposite 
 extreme. Mental occupation within certain limits is advisable. 
 
 " The liability to apoplexy, if an attack have never occurred, 
 cannot be estimated with any degree of certainty. This is one of 
 the affections which persons are apt to apprehend ; and if certain 
 cerebral symptoms are experienced, especially vertigo, the fear of 
 apoplexy is often a source of much unhappiness. The suggestion 
 by the physician that there is danger of this affection is an indis- 
 cretion which I have known to prove most calamitous. When ap- 
 prehension is felt, the physician is warranted in giving assurances 
 that vertigo and other cerebral symptoms are sufficiently common 
 without being followed by apoplexy, and that an apoplectic attack 
 is rarely preceded by obvious premonitions. Needless uneasiness 
 may oftentimes be removed by these assurances." 
 
 APHASIA. 
 
 This is a disease that has recently attracted considerable atten- 
 tion. It signifies a lack of the power of speech. The difficulty is 
 sometimes so severe that the patient can only say " yes " and " no." 
 He cannot say the word that he desires to say. Memory fails, as 
 well as power of speech. This affection sometimes occurs after an 
 attack of apoplexy. It is an affection of a very grave character. 
 It is always a result of some injury of the brain. It is now be- 
 lieved by many that in aphasia the posterior lobe of the third con- 
 volution is injured. 
 
 Aphonia. (See Larynx, Diseases of.) 
 
 APHTHAE, OR THRUSH. 
 
 This is a very common complaint amongst children, and almost 
 invariably arises from a disordered condition of the stomach and 
 digestive organs. It is sometimes caused by improper diet in chil- 
 dren brought up by the hand, or by milk of a bad quality from an 
 unhealthy nurse, or one who is immoral or intemperate in her 
 habits. 
 
 Symptoms. — When this complaint is of a mild character, the 
 general system is not much disturbed ; there is commonly an in- 
 creased degree of redness on the inside of the mouth and about the 
 tongue, and these parts are covered with specks or patches resem- 
 oling curdled milk. But in more severe cases these whitish-looking 
 flakes extend to the back parts of the throat, and even down into 
 
 
AND MOST RECENT METHODS OF TREATMENT. 477 
 
 the gullet. The child is fretful, an increased degree of slavering 
 and hesitation in sucking may be observed, and the mouth is hot 
 and tender. The little patient now becomes slightly feverish, al- 
 though this symptom is not always present, is sick at stomach, 
 drowsy, and starts in its sleep, as if frightened or suffering pain. 
 In all cases there is acidity of the stomach, while the breath, and 
 the coagulated milk which is vomited up, have a sour smell; the 
 bowels are also affected, the stools being watery, and of a green 
 color, with considerable griping. Sometimes the anus becomes ex- 
 coriated by these acrid evacuations, which are discharged so fre- 
 quently as greatly to distress the child, who now becomes pale and 
 loses flesh. Thrush generally lasts eight or ten days, but is not 
 dangerous unless in some cases where the white flakes or crusts fall 
 off, leaving the surface of a brown or bluish color, followed by a 
 bad kind of ulceration of the parts. When this occurs the purging 
 is very severe, and the stools have a slimy appearance. 
 
 Thrush is not contagious, and is generally observed in weak 
 children, or when the mother's milk is of a bad quality. 
 
 Treatment. — If there be no purging at the commencement of 
 this affection, the stools will generally be found of a green color; 
 and as there is always acid in the stomach and bowels, one of the 
 best remedies is magnesia in small doses, repeated from time to 
 time until the bowels are freely opened. One of the best local appli- 
 cations is finely-powdered dorax, mixed with an equal quantity of 
 sugar, and placed upon the tongue, which, by its natural movements, 
 will soon carry the powder to every part of the mouth. This should 
 be repeated every two or three hours, or the honey of borax may 
 be applied to the affected parts of the mouth with a camel's hair 
 pencil. In mild cases no other treatment will be required. 
 
 If the evacuations from the bowels still retain a green color, and 
 if there be little or no purging, equal parts of lime-water and milk 
 will be found useful. A tablespoonful of this mixture may be 
 given four or five times a day. If there be thin watery stools, with 
 griping and straining, a teaspoonful of the following mixture may 
 be given every two hours until the child is quieted : — 
 
 Magnesia, twelve grains, 
 
 Laudanum, three drops, 
 
 Water, one ounce, 
 
 With a sufficient quantity of sugar to make it palatable. 
 
 Weak solutions of chlorate of potash will be useful. The child 
 may swallow a little of solution. 
 
 To aid in relieving the irritation of the bowels, the little patient 
 should be placed from five to ten minutes in a bath of about eighty 
 
478 DESCRIPTION OF THE PRINCIPAL DISEASE! 
 
 degrees of Fahrenheit's thermometer, and then well dried and 
 wrapped up warmly. 
 
 During the continuance of this complaint the mother's diet 
 should be carefully regulated, so as to prevent acidity at stomach, 
 and should be of such a nature as to ensure the purity of her milk. 
 Plain animal food, with bread or rice, is the most suitable kind of 
 diet ; no vegetables which will induce acidity upon the stomach 
 should be taken, and water should be the only beverage at dinner. 
 
 Thrush generally occurs before the child is weaned, and then 
 the mother's milk is the only nourishment that should be allowed. 
 But if the child has been weaned before the complaint makes its 
 appearance, the diet should consist of chicken broth, or weak beef- 
 tea ; lime-water with milk, or gum-water made by mixing gum 
 arabic with warm water. But, although there is generally con- 
 siderable thirst, children seldom have much appetite for food during 
 the progress of thrush. 
 
 Bubbing the inside of the child's mouth with a rough cloth or a 
 piece of flannel is a barbarous custom. 
 
 As long as the complaint continues the greatest attention should 
 be paid to cleanliness; the lower extremity of the bowels and the 
 hips should be washed with tepid water, or milk and water, after 
 every evacuation, and then, if there be any excoriation or abrasion 
 of the skin, the parts should be anointed with fine soft pomatum or 
 glycerine. 
 
 ABEICA. 
 
 This, in the form of tincture, is very much used as a liniment. 
 It may be combined with other substances. For applications to 
 sprains it is one of our most valued remedies. It is supposed to 
 produce absorption. On this theory it is sometimes given inter- 
 nally in apoplexy, in order to cause the absorption of the clot of 
 blood in the brain. 
 
 ABSENIC. 
 
 The Arsenical Solution, commonly called Fowler's Solution, 
 is the only preparation of arsenic used internally. It is seldom 
 given until other medicines fail, and then, when conducted with 
 due caution, is as safe as many other remedies in every-day use, 
 such as prussic acid, morphine, strychnine, &c. When the sulphate 
 of quinine does not produce the desired effect, this is the most pow- 
 erful remedy we possess in curing the ague. (See Ague.) 
 
 This remedy i3 of the greatest service in some cases of the 
 
AND MOST RECENT METHODS OF TREATMENT. 479 
 
 remittent fever of warm climates, when no local inflammation could 
 be discovered; and, indeed, in this, as well as in many other diseases 
 of a periodic nature, such as periodic headache, rheumatic pains 
 coming on at certain hours, and rheumatic affections of the eyes, 
 it is a valuable medicine, and should never be lost sight of 
 when quinine and preparations of iron have been tried without 
 success. 
 
 This solution has been used advantageously in many nervous 
 affections, such as epilepsy, St. Titus's dance, catalepsy (or trance), 
 and tic-clouloureux. Good effects have resulted from its use in some 
 diseases of the skin, also in cancer ; and it is the most efficacious 
 remedy in the treatment of elephantiasis (or Barbadoes leg). 
 
 The dose of the arsenical solution is four to six drops, with six 
 or eight drops of laudanum to each dose, twice a day. The proper 
 time for taking it is about half an hour after eating. When given 
 in this manner no bad effect will result ; in larger doses (twelve or 
 fifteen drops) it sometimes causes a little griping and sickness at 
 the stomach, which may be removed by giving a small quantity of 
 laudanum (fifteen or twenty drops). When these symptoms come 
 on the dose should be diminished. 
 
 Arsenic has been used externally in cases of cancer and inveter- 
 ate ulcers, but in this manner is attended with considerable risk ; 
 indeed, it has been known to find its way into the system by ab- 
 sorption, and cause death. It has been the means of curing many 
 obstinate ulcers of the lips and face, but in some cases, when ap- 
 plied externally, has caused the most intolerable pain. We can 
 only use this remedy with safety internally. Arsenic enters into 
 the composition of several dangerous quack medicines. It is a tonic 
 of decided power. 
 
 ASSAFCETIDA. 
 
 This medicine is principally used as an antispasmodic in doses 
 of five grains to twenty. It is useful in allaying inordinate muscu- 
 lar action in asthma, hooping-cough, colic, and hysterical affections; 
 and is given to promote expectoration in long-continued coughs, 
 particularly in those of old people w T ith debilitated constitutions. 
 When there is any inflammatory action going on it ought not to be 
 administered, on account of its stimulating and heating properties. 
 In flatulent colic it is often of the greatest service when given as a 
 clyster ; when used in this manner, a drachm to two drachms should 
 be dissolved in a pint of warm milk or linseed tea. 
 
 The action of the tincture of assafmtida is quicker than that of 
 
480 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 the gum, and should be given in the quantity of one or two 
 drachms. 
 
 ASTHMA. 
 
 It is generally unaccompanied with fever, and is characterized 
 by great difficulty in breathing, recurring in fits at irregular inter- 
 vals, attended with a feeling of constriction in the che3t, wheezing, 
 and a difficult cough, terminating in expectoration. 
 
 There are certain symptoms which give notice of the approach 
 of a fit of asthma, particularly if the individual has been subject to 
 it for some time ; viz., a sensation of oppression and fulness at the 
 pit of the stomach, eructation of air, headache, sickness, disturbed 
 rest, and not unfrequently an increased flow of pale urine ; they 
 are, however, by no means regular, and in some cases are entirely 
 wanting. 
 
 The fits usually come on between eleven o'clock at night and two 
 o'clock in the morning. The patient awakes suddenly with great 
 difficulty of breathing, and a most distressing sensation of tightness 
 and constriction about the chest, which compels him to sit up in bed ; 
 he raises his shoulders, throws back his head and elbows, and uses 
 every means in his power to expand his chest ; he breathes with a 
 wheezing noise, which may be heard at some distance, and coughs 
 occasionally, but with considerable difficulty ; and though he can 
 scarcely speak, he requests the windows to be opened, that he may 
 breathe fresh air. The face sometimes remains pale, but in general 
 becomes red, or acquires a bloated appearance ; the eyes also appear 
 red and prominent, and the face and breast are covered with sweat. 
 The pulse is quick, weak, and not unfrequently irregular or inter- 
 mittent ; the hands and feet are cold, and in some cases, when the 
 fit is very severe, the patient vomits frothy, bilious-looking matter. 
 
 The fit having continued two or three hours, or even longer, 
 terminates with cough and expectoration, either more or less pro- 
 fuse, and the exhausted patient falls asleep. When any one has 
 once suffered from a paroxysm of asthma, he maybe almost certain 
 that it will recur at intervals of longer or shorter duration. 
 
 When asthma is purely spasmodic, uncomplicated with any other 
 disease, the individual, after the fit is over, recovers his breathing 
 entirely, and suffers no inconvenience until the recurrence of an- 
 other attack. True, spasmodic asthma, not associated with other 
 diseases, is not common, yet it does occur ; and we have the best of 
 evidence that individuals have died during the fit, and on opening 
 the body not a trace of disease has been found. In the great ma- 
 
AND MOST RECENT METHODS OF TREATMENT. 481 
 
 joritj of cases, however, the breathing during the intervals is either 
 more or less affected, and symptoms of the morbid changes, which 
 have either caused the disease or resulted from it, may be easily 
 traced. 
 
 Exciting causes. — The exciting causes which have an immediate 
 tendency to bring on fits of asthma are very numerous, the principal 
 of which are, errors in diet, particularly if attended by acidity at 
 stomach or heartburn • excess in drinking wine and spirits ; disten- 
 tion of the stomach from an accumulation of wind ; exposure to cold, 
 moist air, or too dry an atmosphere ; suppressed perspiration of the 
 lower extremities, caused by sitting with cold or wet feet, sudden 
 changes of weather, certain winds, and indeed all the causes which 
 bring on cold or catarrh of the bronchi or air-passages ; sudden 
 mental emotions, as anger, terror, surprise, &c. ; loud, or too long 
 speaking ; certain occupations of artisans, which expose them to an 
 atmosphere charged with dust ; irritating gases, metallic fumes, or 
 minute particles of cotton, wool, fur, and metal. In some people 
 exhalations from the vegetable kingdom, as the effluvia from ipeca- 
 cuanha, from hay, or from grass in flower, will induce an attack of 
 asthma. (See Hay Fever}) Some suffer least in flat countries and in 
 large towns, pure mountain air being almost insupportable to them ; 
 others, again, are rendered miserable by the smoky atmosphere of a 
 large town. 
 
 TREATMENT OF ASTHMA. 
 
 First. To relieve the attacks. — This is done in various ways. 
 
 1. The following prescription may be tried : 
 
 Wine of ipecac, 
 
 Tincture of lobelia, equal parts, 
 Half a teaspoonful every half hour. 
 
 2. Tincture of henbane sometimes does good. 
 
 3. Hoffman's anodyne in the ordinary doses may be tried. 
 
 4. Smoking tobacco, or smoking cigarettes of stramonium. 
 
 5. Burning paper soaked in saltpetre and breathing the air. 
 
 6. Mustard plasters and dry cupping between the shoulders. 
 
 7. Hot foot-baths. 
 
 8. Inhaling oxygen. It is well for each patient to try all these 
 remedies in order, nntil he hits on the one that best answers his pur- 
 pose. What will help one may injure another. 
 
 One remedy may lose its efficacy in time ; then it is necessary 
 to try something else. 
 
 Secondly. Treatment in the intervals. — Asthmatic patients gen- 
 erally need tonic remedies. 
 31 
 
4S2 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 Anions; the tonics that are found most useful are : 
 
 o 
 
 Iodide of potassium, 
 Arsenic (Fowler's solution), very small doses — 5 to 10 drops in water, after meals, 
 The elixirs of quinine, pyrophosphate of iron, and strychnine, 
 Nitre-muriatic acid, 
 Phosphoric acid, 
 Bromide of potassium, 
 General electrization. 
 
 All of these remedies may be tried until benefit is received \for 
 all of them have in some cases done good, and again all of them 
 have failed. There is no specific for asthma. Although the bro- 
 mide of potassium and electrization are placed last, it is not because 
 they are of least service. It may be well to try them first, and the 
 other remedies subsequently; Asthmatic patients are very capri- 
 cious. Some are benefited by going to the sea-shore, others by going 
 to the interior. Some can sleep better on the first floor, others in 
 the upper stories. 
 
 I knew an asthmatic patient in whom the odor of buckwheat 
 cakes would bring on an attack immediately. If he entered the 
 front door of a house when they were cooking buckwheat cakes in 
 the kitchen, he would sometimes be thrown into a violent paroxysm. 
 
 Asthmatic patients have these consolations. They rarely die 
 during an attack. They will usually live to a good old age. 
 
 Prof. Flint has the following very judicious remarks on this 
 subject : 
 
 " During the paroxysm the objects of treatment are to lessen the 
 suffering and bring the paroxysm to an end as speedily as possible. 
 The measures for these objects have reference to spasm as the essen- 
 tial pathological condition. The measures to relieve spasm are va- 
 rious, each of which proves efficacious in some cases and not in 
 others. Frequently the past experience of the patient is the best 
 guide as to the particular measure which will be most likely to 
 afford relief. In cases of asthma unaccompanied by bronchitis, I have 
 known a full opiate quickly and completely successful ; but, in the 
 larger proportion of cases, it will not succeed in cutting short the 
 paroxysm, nor afford marked relief. Of other narcotics, stramonium 
 is best suited to this affection. The usual mode of administration 
 is to smoke the dried leaves or fibres of the root either in a pipe or 
 prepared as a cigarette. It is undoubtedly true that this measure in 
 some persons acts like a charm, and may be confidently relied upon 
 as a prompt and effectual mode of obtaining relief; but in the 
 majority of cases it either produces no effect, or merely mitigates 
 the severity of the paroxysm. Assafcetida, dracontium or skunk- 
 
AND MOST RECEXT METHODS OF TREATMENT. 483 
 
 cabbage, and the Indian hemp have been found to be sometimes ef- 
 ficacious. The ethers, given internally, are to some extent useful as 
 palliatives, and occasionally produce complete relief. 
 
 "Marked relief is frequently obtained, and the paroxysm is some- 
 times cut short, by nauseaut remedies, viz. : antimony, ipecacuanha, 
 lobelia inflata, and common tobacco. The two remedies last named 
 are especially efficacious in a certain proportion of cases. The com- 
 mon tobacco will be more likely to be successful if the patient be not 
 accustomed to its use. "With a view to the relief of spasm, these 
 remedies need not be carried to the extent of producing vomiting ; 
 if not effectual when nausea is induced, it will be useless, if not in- 
 jurious, to push them further. I have known a paroxysm to be ar- 
 rested at once by blood-letting, but this is a measure too potent to 
 be employed except occasionally in plethoric persons. 
 
 "The inhalation of the vapor of chloroform or ether is a measure 
 of great value in the treatment of asthma. Not unfrequently the 
 paroxysms are completely controlled by it, the patient passing, in 
 the space of a few moments, from a condition of great suffering in- 
 to one of ease and comfort. These cases are among those which 
 afford the most striking examples of the resources of practical med- 
 icine. The dry bronchial rales which, before the inhalation, were 
 loud and universally diffused over the chest, sometimes disappear 
 as soon as complete relief is procured by the inhalation, a fact 
 proving conclusively the existence and cessation* of spasms. Un- 
 happily this measure, like the others, is only efficacious in a certain 
 proportion of cases. It should be tried always, provided there are 
 no circumstances to contra-indicate it. Its employment should never 
 be intrusted to the hands of the patient. 
 
 " It is hardly necessary to say that if there be ground to suppose 
 the attack to have been brought on by overloading the stomach or 
 by constipation, an emetic or cathartic is indicated. And, of course, 
 the patient is to be removed from the action of any known exciting 
 cause, such as the emanations from hay, feathers, etc. The apart- 
 ment should be large, high, and airy. Warm and stimulating pe- 
 diluvia are useful as palliatives. Strong coffee, taken hot, is gene- 
 rally highly useful as a palliative. Another palliative measure, which 
 sometimes proves to be curative, is to be added. This consists in 
 diffusing throughout the apartment the fumes of burning nitre-paper ; 
 that is, bibulous paper dipped in a saturated solution of the nitrate 
 of potassa, and dried. Some patients find great relief, and occa- 
 sionally the paroxysms are arrested by this measure." 
 
 The manner of living and habits of people affected with asthma 
 are generall v such that thev can have verv little chance of getting rid of 
 
484 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 the disease. Indeed they too frequently adopt the most direct means 
 to prolong their suffering. Knowing their liability to catch cold, 
 and being well aware that a cold or catarrh is generally the prelude 
 to a fit of asthma, they (at least those who have it in their power) 
 shut themselves up in close rooms on the approach of winter, dread- 
 ing the slightest exposure to cold air. They deprive themselves of 
 exercise, and in consequence indigestion is brought on, the general 
 health is impaired, and life becomes almost a burden. If they do 
 occasionally venture into the open air they return to the same over- 
 heated atmosphere or sit near a large fire, not taking into considera- 
 tion that by far the most common cause of cold is the sudden change 
 from cold air to an overheated rooin. The patient blames the cold 
 air, but the fact is the lungs bear cold well, or an equal tempera- 
 ture, whether cold or hot. 
 
 More dependence should be placed in proper regimen than 
 medicine in this disease. Regular exercise in the open air, either 
 on foot or horseback, is absolutely necessary in all seasons, and the 
 means of next importance is cold bathing. In winter the patient 
 should sponge his body every morning, on getting out of bed, with 
 salt w T ater (two tablespoonfuls of salt to each pint of water), rub- 
 bing the body well after the ablution with rough towels. The water 
 used should at first be tepid, and then gradually colder until the pa- 
 tient can bear it perfectly cold. In summer, bathing in the sea or 
 the cold shower-bath will be preferable. Cold ablution in winter 
 tends more than anything else to do away with the susceptibility to 
 cold which exists in the catarrhal forms of asthma. After using it 
 regularly for some time, exercise in the open air can not only be 
 taken in winter w T ith impunity, but with the greatest advantage. 
 
 ATROPINE. 
 
 This is the alkaloid principle of oelladonna. It is a remedy 
 of great power, and must be used with caution. It is now em- 
 ployed in subcutaneous injections. (See Hypodermic Injections.) It 
 is used in the treatment of diseases of the eye. Its administration 
 should only be intrusted to those who are exceedingly Vigilant and 
 careful. Atropine is our best antidote to opium poisoning. 
 
 Dose of sulphate of atropine is from one-fiftieth to one-twentieth 
 of a grain. When injected beneath the skin a less dose is required 
 — from ywq *° one-fiftieth of a grain. For the purposes of subcu- 
 taneous injection it may be combined with morphine. They are 
 antidote to each other. Atropine causes dilatation of the pupil, 
 dryness of the mouth, and sometimes giddiness. 
 
AND MOST EECENT METHODS OF TREATMENT. 485 
 
 AUSCULTATION, OR SOUNDING THE CHEST. 
 
 This method of studying diseases of the chest was discovered 
 by Laennec in 1816. Laennec himself died of consumption, in the 
 forty-fifth year of his age. 
 
 In auscultation the ear of the physician is applied directly to 
 the chest, or to an instrument called a stethoscope, placed against 
 the chest of the patient, through which the sounds are transmitted. 
 (See Stethoscope.) 
 
 This method of examining the chest has wrought a great change 
 in the study of diseases of the heart and lungs. Physicians now 
 rarely attempt to give a positive opinion in any case of suspected 
 disease of the heart or the lungs, without using this method of ex- 
 amination. 
 
 The skill and facility that can be obtained in this art by long 
 practice is wonderful. 
 
 For those physicians who thoroughly understand it, and who 
 have enjoyed good opportunities for practice in the art, this 
 method of diagnosis is very reliable, and far more satisfactory 
 than the mere study of the general symptoms of the patient. 
 
 Auscultation and percussion (see Percussion) together are often 
 sufficient to settle the important question whether a patient is or is 
 not suffering from disease of the heart or lungs, and also to deter- 
 mine the stage of the disease. The subject itself is wide enough to 
 occupy a lifetime. 
 
 Auscultation has been sometimes resorted to in order to deter- 
 mine the condition of the intestines, and is also used to detect the 
 beatings of the foetal heart. 
 
 BACK-ACHE. 
 
 Back-ache is a symptom of numberless diseases. It is only 
 very rarely the symptom of disease of the spine, or of the spinal 
 cord, or of the kidneys. In order to ascertain what disease it be- 
 tokens, it must be studied in connection with other symptoms. In 
 the majority of cases it is a symptom of nervous exhaustion. 
 Pain in the " small of the back" is a frequent complaint of 
 dyspeptics. Women often suffer from pain in the lower portion 
 of the back, at the foot of the spine. Difficulties of the womb 
 oftentimes make themselves felt in the back. Whenever a per- 
 son gets run down from any cause or causes, back-ache is liable 
 to appear. In such cases the aching is done by the nerves that 
 
4S6 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 issue from the spine. Such nervous pains I have called head- 
 ache in the lack. They come on in the afternoon, or when we 
 are specially wearied. They come when we sit too long, or when 
 we stand too long, or when we lie down too long. They may trou- 
 ble us even at night. 
 
 Back-ache, then, may be a symptom of all these and many 
 other different conditions : 
 
 Nervous exhaustion. 
 
 Dyspepsia, or derangement of the digestive organs. 
 
 Diseases of the genital organs. 
 
 Diseases of the spine and sjpinal cord. 
 
 Diseases of the kidneys. 
 The two first-named are, in the great majority of cases, the causes 
 of hack-ache. 
 
 Besides these chronic conditions, it is well known that most of 
 the principal fevers — yellow fever, remittent fever, intermittent, 
 small-pox, <&c. — are ushered in by pain in the back. 
 
 Treatment. — The treatment is to treat the cause. Cure that, 
 and the symptom will disappear. Great relief may be obtained by 
 anodyne plasters. My preference is for those made of belladonna. 
 
 Barber's Itch. (See Skin, Diseases of.) 
 
 BENZOIK 
 
 This is the juice of a tree that grows in Sumatra. It is used 
 chiefly in the form of benzoic acid and compound tincture. The 
 acid is given for the purpose of diminishing the formation of uric 
 acid' calculus. 
 
 The compound tincture is applied to sore nipples of nursing 
 women with great success. A mixture of compound tincture of 
 benzoin and glycerine is one of the very best remedies for chapped 
 hands. It is used also for the removal of freckles, and in various 
 diseases of the skin. 
 
 Dose. — Benzoin or benzoic acid may be given in doses of from 
 5 to 30 grains. 
 
 BISMUTH. 
 
 The subnitrate of bismuth is an excellent antispasmodic and 
 sedative. It is a valuable remedy in chronic affections of the 
 stomach, and very efficacious in checking vomiting. In cases of 
 indigestion, attended with heartburn and pain at the stomach 
 
AND MOST RECENT METHODS OF TREATMENT. 487 
 
 after eating, I have known it produce the best effects when com- 
 bined with the extract of henbane, in the following form : 
 
 Take of subnitrate of bismuth, thirty grains, 
 
 Extract of henbane, the same quantity. Mix, and divide into twelve pills. One to 
 be taken in the morning, one in the middle of the day, and two at bed-time. 
 
 This treatment, with low diet and abstinence from everything 
 stimulating, is to be continued during a week or ten days. 
 
 Some practitioners prefer combining it with rhubarb and mag- 
 nesia. 
 
 Take of subnitrate of bismuth, two or three grains, 
 Ehubarb, two grains, 
 Magnesia, five grains. Mix. 
 To be given as a dose, and repeated twice or thrice in the course of the day. 
 
 Bismuth does not dissolve in water, and, if not given in the form 
 of pills, should be mixed with a little jelly, honey, or any other 
 convenient vehicle. 
 
 Subnitrate of bismuth was popularized in France by the late 
 Trousseau. It is now very much used in dyspepsia, in chronic 
 diarrhoea, in heartburn, and pains in the stomach. In spasms of 
 the stomach and in water-brash it has been of service. Powdered 
 bismuth is used externally for burns, tetter, bed-sores, and ulcers. 
 It is combined with pepsin, and given with good results in the 
 diarrhoea of infancy. 
 
 Dose. — This is a safe remedy, and may be given in large or 
 small doses. The dose ranges between two or three grains for in- 
 fants to one drachm for adults. 
 
 Subcarbonate of bismuth is sometimes substituted for the sub- 
 nitrate. It does not constipate the bowels as much as the subni- 
 trate, and neutralizes the acids of the stomach better. 
 
 BLADDER, INFLAMMATION OF. 
 
 The symptoms which characterize acute inflammation of the 
 bladder are heat, tension, and pain more or less severe at the lower 
 part of the belly, which is increased on pressing with the hand over 
 the bladder, or by sneezing, coughing, going to stool, or by any 
 movement of the body. There is great and frequent desire to void 
 the urine, which is high-colored, and passed in a few drops at a 
 time with much pain and difficulty, and sometimes it cannot be dis- 
 charged at all. As the disease advances, the lower part of the belly 
 appears swollen, in consequence of the space which is taken up by 
 
4S8 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 the bladder distended with urine. The slightest pressure there is 
 then insupportable, and the whole abdomen is painful to the 
 touch, the pain extending to the loins and anus, and even shoot- 
 ing down the thighs. When the inflammation has gone to this ex- 
 tent, the skin is hot and dry, the pulse quick and hard, and the 
 tongue dry, with great thirst. If the disease go on increasing, the 
 pulse becomes small and very frequent, hiccough, vomiting, deli- 
 rium, fainting, and death ensue. 
 
 The inflammation, however, may be of any grade. Sometimes 
 it is mild, yielding readily to proper treatment, and continuing but 
 a short time, 
 
 Causes. — It may be brought on by a variety of causes, such as 
 stone in the bladder, wounds, blows, irritating injections, the in- 
 flammation of gonorrhoea, extended along the urethra or urinary 
 canal to the bladder, boils, swelling of the prostate gland, the inter- 
 nal use of Spanish flies (cantharides), allowing the urine to remain 
 too long in the bladder, excess in drinking wine or ardent spirits, 
 long-continued exercise on horseback, particularly if the individual 
 has been unaccustomed to it; inflammation of neighboring parts, 
 as the womb or rectum, the introduction of instruments into the 
 bladder, exposure to cold or sudden changes of temperature, and 
 long-continued compression of the bladder by the head of the child 
 during tedious labor. The sex, also, must be considered as a pre- 
 disposing cause, men being more liable to this disease than women. 
 
 Acute inflammation of the bladder continues from ten to twenty 
 or thirty days, and is in general subdued by the necessary treat- 
 ment without leaving any bad symptoms. But sometimes it termi- 
 nates in ulceration or mortification, or matter is formed which 
 passes off along with the urine, or is discharged into the cavity of 
 the abdomen. These terminations, however, are rare, compared 
 with its not unfrequent sequence, chronic inflammation. When 
 the urine is examined with the microscope we often find evidences 
 of the inflammation. 
 
 Warm fomentations should be constantly applied over the lower 
 part of the belly, and the bowels are to be acted on by a full dose 
 of castor oil, or a clyster of decoction of marsh-mallow or linseed- 
 tea, with an ounce of castor oil. The diet must be carefully regu- 
 lated in this, as in all other inflammatory diseases. At the commence- 
 ment, only very small quantities of linseed-tea, or other mucilaginous 
 drink, should be allowed ; but when the inflammation is giving way, 
 and the urine begins to be voided more easily, the linseed-tea, or 
 any other demulcent beverage (such as gum-water, prepared by 
 pouring a pint of boiling water on an ounce of gum-arabic), may be 
 
AND MOST RECENT METHODS OF TREATMENT. 489 
 
 given freely, with the addition of from five to ten grains of nitre to 
 each pint. 
 
 BLEEDING FEOM THE NOSE. 
 
 This is by far the most common, and entirely the least dangerous 
 hemorrhage. In general it is slight and frequently advantageous 
 to the individual, and is injurious only when it continues too long 
 or recurs too frequently. 
 
 Causes. — Bleeding from the nose occurs most frequently in young 
 people with an excess of blood, and in females with suppressed men- 
 struation. The causes which commonly produce it are those which 
 determine the blood too strongly to the head, such as exposure to 
 heat, too full living, excess in drinking intoxicating liquors or strong 
 coffee ; long-continued study, anger, or any violent mental excite- 
 ment, long watching, constipation of the bowels, and suppression 
 of the discharge from piles. It is also caused by wearing the neck- 
 cloth or stays too tight, blows on the nose, &c. It comes on from 
 scurvy, in consequence of the blood losing its natural consistence, 
 and also during typhus fever, and sometimes from disease of the 
 heart and liver. 
 
 Treatment. — In the majority of cases, bleeding from the nose is 
 salutary. If it go on to such an extent (which it seldom does) as to 
 cause paleness of the face, sickness at stomach, and a sensation as if 
 the patient were about to faint, it then becomes necessary to use 
 means to arrest its progress. 
 
 The individual should be exposed to cool air, and his head should 
 not hang over the basin which receives the blood, but must be kept 
 raised. Pieces of linen dipped in vinegar and water or ice are to be 
 applied over the forehead and temples and round the nose; nor 
 should the popular remedy be forgotten of placing a large key or 
 piece of cold metal between the clothes and the back. If the bleed- 
 ing still continue, vinegar and water or iced water should be applied 
 frequently over the head, and the feet and hands placed in warm 
 water containing powdered mustard. Bleeding from the nose sel- 
 dom resists this treatment, but in the event of its doing so we have 
 still other means in reserve. 
 
 Powdered gum-arabic blown into the nostrils by means of a quill 
 will sometimes stop the hemorrhage when everything else fails. 
 When clotted blood begins to form in the nostrils it should be dis- 
 turbed as little as possible. 
 
 Cold vinegar and water, or ice applied to the thighs and genitals, 
 has sometimes an excellent effect. A method of arresting bleeding 
 
490 DESCRIPTION OF THE PRINCIPAL 
 
 from the nose, which is said to be very effectual, is the following. 
 The patient is to stand up, with the head elevated. The nostril 
 from which the blood flows is to be compressed by the finger, and 
 the corresponding arm to be raised perpendicularly, and to be 
 kept in that position about two minutes ; this in almost all cases 
 has proved sufficient. 
 
 Pressure on the small artery by the side and angle of the nose 
 for ten minutes will generally stop bleeding at the nose. 
 
 BOILS. 
 
 A boil begins with a pimple in the skin, which continues to en- 
 large until it reaches the size of a walnut, though sometimes it does 
 not extend beyond the size of a large pea ; it is of a conical shape, 
 red, or of a purple hue, and hard, with burning heat and great pain. 
 Between the fourth and eighth day it becomes very prominent, and 
 begins to point / a speck of matter may then be seen on the summit, 
 which gradually softens ; the skin at last bursts, and matter mixed 
 with blood is discharged through a small opening. A day or two 
 after this, the core, which is supposed to be a portion of dead cellu- 
 lar substance, finds its way out of itself, or may be squeezed out, 
 leaving an open cavity, which soon fills up, and heals entirely about 
 the twelfth or fourteenth day. 
 
 A boil seldom comes alone ; there are generally several, either 
 at the same time or following one another. Boils may appear on 
 any part of the body, but they commonly form on the face, nape of 
 the neck, inside of the thighs, hips, arm-pits, groin, or near the 
 anus. 
 
 Causes. — Children and people in robust health are most subject 
 to boils ; they often come on without any known cause, and appear 
 more frequently in spring than at any other season. They may be 
 brought on by friction, inattention to keeping the skin clean, or 
 from irritation of the digestive organs, and they sometimes follow 
 fever or inflammatory eruptive diseases. They are very common 
 among sailors, and are by them called " salt-water boils." 
 
 Treatment. — It is needless to attempt preventing a boil going on 
 to suppuration ; it almost invariably follows the course above de- 
 scribed, in spite of every means used to arrest its progress. We 
 should, therefore, endeavor to hasten the suppurative process, by the 
 application of warm bread and milk poultices, or poultices of linseed. 
 In many cases a piece of diachylon plaster applied over the part and 
 changed twice a day, will answer better than anything else. If the 
 boil be of a very indolent character, the application of roasted on- 
 
AND MOST KECENT METHODS OF TREATMENT. 491 
 
 ions will be of service, or poultices of honey mixed with oatmeal. 
 As soon as it is known that the tumor contains matter, the best 
 plan is to give it vent, by making a free opening with the lancet, 
 and then squeezing out the matter and the core. When the patient 
 is averse to this and allows the boil to burst of itself, the opening is 
 always small, and the core consequently does not readily find its 
 way out. In some cases it requires to be drawn away. In general 
 the cavity heals quickly after the core is discharged, and nothing is 
 required except a little cerate or other simple dressing ; the sore in 
 some cases, however, becomes indolent, and requires dressing of a 
 more stimulating nature, such as 
 
 Basilicon, a drachm, 
 Red precipitate, five grains. Mix. 
 A little of this ointment to be applied on a piece of lint or linen rag. 
 
 Where there is hardness of the part after the sore is healed, it 
 should be rubbed with camphorated mercurial ointment night and 
 morning. 
 
 "With regard to the internal treatment, all that is necessary in 
 general is to abridge the diet a little, avoid stimulating food, and 
 keep the bowels open with Epsom salts or other cooling purgatives. 
 
 BAD BEEATH. 
 
 Bad breath may be caused by decayed teeth, by a disordered 
 stomach, by exhalations f? 7 om the lungs, by ulceration or other dis- 
 ease of the lungs, bronchial tubes, wind-jpijje, throat and nose, or gums, 
 or by all of these causes combined. The only way to treat bad 
 breath is to remove the cause or causes. Instead of keeping the 
 mouth filled with antidotes for bad breath, consult some good physi- 
 cian or dentist, or both, and ascertain the cause of your bad breath, 
 and then, if it be possible, let them cure it. Cure the dyspepsia. 
 Extract the decayed teeth. Relieve the catarrh (rhinitis). Give 
 tone and health to the spongy girms. 
 
 Bad breath may temporarily arise from eating onions or from 
 drinking spirits, or from tobacco. The cure in such cases is of 
 course very simple — abstain. 
 
 INFLAMMATION OF THE BOWELS. 
 
 This disease, when severe, is preceded by general uneasiness, 
 shivering and heat alternately, listlessness, and a feeling of weakness. 
 A sharp pain in the bowels soon follows, with griping, and a sensation 
 
492 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 of internal heat at the seat of the pain, which is generally about the 
 navel. The pain is constant, and is increased by the slightest pres- 
 sure over the belly, which after some time becomes hot, swollen 
 and tense. There is great prostration of strength, urgent thirst, 
 sickness at stomach, perhaps vomiting, and constipation of the 
 bowels, though sometimes there is purging of a thin, bilious, stink- 
 ing matter. The pulse is quick, hard, and small ; the urine hio-h- 
 colored, and passed in small quantities ; and the tongue is at first 
 white, and becomes afterwards furred and brown in the middle, 
 with its point and edges red. The patient moves his head and arms 
 frequently, and appears very restless, though afraid to move his 
 body, from a dread of increasing the pain ; his limbs are drawn up 
 towards his belly, and he can only lie on the back. All these symp- 
 toms, however, are not present in every case, and they are of course 
 more or less severe according to the extent and severity of the in- 
 flammation. 
 
 When inflammation of the bowels is about to prove fatal, the 
 pulse becomes exceedingly weak, the features shrink, hiccup and 
 cold sweats come on, and the hands and feet become cold ; but when 
 it is about to terminate favorably, the pulse recovers its firmness, 
 the stools become natural, the urine is voided freely, and the pain 
 lessens by degrees. 
 
 Causes. — The most common causes of this disease are, exposure 
 to cold when the body is much heated, or drinking cold fluids when 
 in the same state ; accumulation of hardened excrements in the 
 bowels ; eating too freely of high-seasoned food, unripe fruit, or 
 crude vegetable substances ; excess in drinking ; too strong purga- 
 tives ; blows on the belly ; swallowing acrid or poisonous sub- 
 stances; but it may come on without any obvious cause. 
 
 TREATMENT OF INFLAMMATION OF BOWELS. 
 
 1. Opium in large doses , and frequently. — This is at present 
 the one remedy for this disease. It is proper to give doses of 
 one or two grains every two or three hours. In this disease the 
 system bears a large amount of opium. It constipates the bowels, 
 but that is of little account. In severe cases enormous doses of opium 
 have been given without injury. No other disease bears so much 
 opium as inflammation of the bowels — in men or in women. We 
 may use morphine or laudanum, if we prefer, instead of the crude 
 opium. 
 
 2. Tonics and stimulants. — These are to be given when the stage 
 
AND MOST RECENT METHODS OF TREATMENT. 493 
 
 of exhaustion comes on. Quinine may be combined with the opium. 
 Besides, we may give beef-tea, wine, brandy, or whiskey. 
 
 When the disease has been subdued, the greatest care must be 
 taken to prevent a relapse. Flannel should be worn next the skin, 
 and the diet should be easy of digestion, and as little stimulating as 
 possible. Wine and spirits should be abstained from for a consid- 
 erable length of time. 
 
 The diseases most likely to be mistaken for inflammation of the 
 bowels, are rupture, colic, and affections of the kidney. .Rupture 
 may always be suspected ; it is, therefore, necessary to examine 
 carefully both the abdomen and groin. Colic is a spasmodic affec- 
 tion, and commonly requires to be treated with opium, brandy, and 
 other stimulants: The greatest care must, therefore, be taken not 
 to confound it with inflammation of the bowels, in which stimulants 
 would be highly injurious. Colic commences suddenly, and is not 
 attended with fever ; the pain is not constant, as in inflammation 
 of the bowels, and it is rather relieved than otherwise by pressing 
 on the belly. In affections of the kidney, though the patient com- 
 plain of severe pain in the belly, yet it is not increased by pressure, 
 which is invariably the case in inflammation of the intestines. It 
 is needless to say that this disease needs prompt and good medical 
 advice, if it can be obtained. 
 
 CONCUSSION OF THE BRAIK 
 
 Concussion of the brain generally arises from injury done to the 
 head by blows, or from a violent shock received by the whole body, 
 in consequence of falling from a height. When the concussion is 
 very severe, the following are the most marked symptoms : insensi- 
 bility, without the power of moving ; pulse weak, slow, and per- 
 haps intermitting ; cold extremities ; oppressed breathing, but with- 
 out snoring; pupils of the eyes generally contracted. When to 
 these symptoms are added coldness of the whole body, with short 
 and interrupted breathing, a fatal termination is about to take place. 
 But if the system recover, and reaction come on, then the pulse 
 becomes regular and stronger, the breathing more natural, and the 
 legs and arms get gradually warmer. If the patient be now spoken 
 to in a sufficiently loud tone of voice, he will answer questions, 
 though not very coherently, and if pinched he will show by mov- 
 ing that he is not insensible to pain. These symptoms may give 
 way by degrees, until at length the patient is left without anything 
 to complain of, except perhaps a headache. This favorable termi- 
 nation, however, does not always follow reaction, which in some 
 
494 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 cases is very strong, and accompanied by inflammation of the brain, 
 which, in spite of every treatment, may in a short time end in 
 death. Concussion is more or less severe, according to the injury 
 which the brain has sustained. When the shock is slight, and the 
 person only stunned, he remains but a very short time insensible, 
 and then gets up as if nothing had happened ; when more severe, 
 sickness and vomiting follow, and the patient may have his ideas 
 confused, attended with unwillingness to move about for several 
 hours, or perhaps days. 
 
 TREATMENT OF CONCUSSION OF BRAIN. 
 
 1. Rest. — The patient should be taken to a quiet room, and his 
 clothing should be loosened. 
 
 2. Friction. — The hand or a cloth may be used to restore the 
 circulation. 
 
 3. Mild Stimulants. — Hartshorn may be held to the nose. A 
 very little wine may be given if the patient can or will swallow. 
 Warm water may be applied to the feet and cold to the head. 
 
 4c. Best and Time. — The patient cannot get well at once usually, 
 and cannot be forced into health by violent measures. 
 
 Sometimes the patient appears to be getting better when really 
 he is worse. The patient should be very slow about returning to 
 the active duties of life. 
 
 INFLAMMATION OF THE BRAIN. 
 
 This disease may come on suddenly, but when not caused by 
 external injuries, there are in general certain symptoms which give 
 notice of its approach, namely, headache, attended by a sensation 
 of weight and fulness of the head, slight giddiness, ringing in the 
 ears, occasional drowsiness, confusion of ideas, irritability of temper, 
 and disturbed sleep. The face is more or less flushed, the head 
 feels hotter than natural, and any unusual noise or strong light an- 
 noys the patient. 
 
 After chills or shivering, which in general precede all inflam- 
 matory diseases, strong symptoms of fever come on. The skin be- 
 comes hot, the face much flushed, the eyes red, and the pulse full 
 and hard. The patient is then very restless ; and light and the 
 slightest noise are insupportable to him. As the disease advances, 
 the thirst becomes urgent, the tongue white, the urine high-colored, 
 and the bowels constipated. In the majority of cases there is irri- 
 tability of stomach, accompanied by vomiting. At length spasm? 
 
AND MOST RECENT METHODS OF TREATMENT. 495 
 
 of the face and limbs, and the most furious delirium come on, and 
 the pupils of the eyes remain contracted. In many cases it is ne- 
 cessary to confine the patient's arms, to keep him from injuring him- 
 self or those near him. One or both arms first, and then the legs 
 become stiff and contracted, and occasionally convulsed. When 
 the limbs are in this rigid state, any attempt to straighten them, or 
 even any effort on the part of the patient to move in bed, is 
 attended with severe pain. 
 
 In the majority of cases inflammation of the brain reaches its 
 height about the third or fourth day, and generally terminates 
 fatally within a week or ten days. It is one of the most dangerous 
 diseases to which man is liable, and even when it has been over- 
 come, its effects are of the most serious nature. 
 
 Causes. — The usual causes of inflammation of the brain are, 
 injuries done to the head by blows or falls ; great mental excite- 
 ment ; exposure to excessive heat or cold ; excess in drinking spir- 
 ituous liquors ; suppression of the menstrual discharge, or of that 
 from piles. It often comes on in the course of fevers, rheumatism, 
 small-pox, scarlatina, and other diseases of the skin, and may be 
 brought on by certain diseases of the ear. •• 
 
 TREATMENT OF INFLAMMATION OF BRAIN. 
 
 1. Active Purging. — The bowels may at first be opened with 
 one drop or half a drop of croton oil on the tongue, or by a dose 
 of elaterium, or better still for the majority of cases, Epsom salts. 
 
 The bowels should be kept free by medicine during the whole 
 progress of the disease. 
 
 2. Cold to the Head. — Pounded ice may be placed in a bag and 
 kept on the head. The head may be shaved, so that the ice and 
 water may be more directly applied. Wet cloths are not as good 
 as pounded ice, and when they are used they must be kept con- 
 stantly wet, else they may do no good, but rather injury. 
 
 3. Warmth to the Feet. — Mustard plasters can be applied to the 
 calves of the legs. The feet may be soaked in warm water, and 
 thoroughly rubbed. Sometimes children are benefited by a warm 
 bath. 
 
 4. Blisters to the Scalp. — These should not be used until the 
 inflammatory stage is over. They should be applied over the entire 
 scalp. 
 
 5. -Stimulants and Nutritious Food. — In the later stages the 
 debility is so marked oftentimes, that whiskey, or brandy, or wine, 
 
496 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 or opium may be needed in addition to nutritious food. In the 
 inflammatory stages the diet should be light. 
 
 The recovery needs great care. It is a matter usually of consi- 
 derable time. Patients should be exhorted to take it easy, and not 
 be in too great haste to return to activity. In all real or suspected 
 inflammations of the brain, medical advice should, if possible, be 
 obtained without delay. 
 
 Bright's Disease. (See Kidneys, Diseases of) 
 
 BROMIDE OF AMMONIUM. 
 
 This remedy has been given of late in whooping-cough. It is 
 very often combined with bromide of potassium. It is the opinion 
 of Dr. Brown-Sequard that when it is given in combination with 
 bromide of potassium, less heroic doses of the latter remedy are 
 necessary. 
 
 BROMIDE OF POTASSIUM. 
 
 Bromide of potassium is one of our most recent and most suc- 
 cessful remedies. Fifteen years ago it was hardly known of. It is 
 now used to a most enormous extent, and fully deserves most of its 
 reputation. It is a remedy of wonderful efficacy. It tends to 
 reduce the volume of blood in the brain, and also exercises a pecu- 
 liar anaesthetic or calming effect on the nervous system. 
 
 It is very successful in sleeplessness. In the majority of cases 
 of sleeplessness, though not in all, it proves very beneficial, and 
 rarely leaves* any unpleasant effects. It is therefore superior to 
 opium, henbane, &c. 
 
 It is the best remedy that we know of for epilepsy. It is very 
 useful in neuralgia, in insanity, in delirium tremens, in hysteria, 
 in asthma, in sick headache, and in over-excitement of the genital 
 organs. 
 
 Indeed, it is used with advantage in nearly every form of 
 nervous trouble. It is sometimes applied locally to the throat. 
 
 It may be given in doses of five or fifty grains. It may be 
 used very freely. When small doses do not answer our purpose, it 
 is well to increase them until we see some effect. In ordinary 
 cases it can be given in doses of twenty or thirty grains three times 
 a day, without injury. Sometimes it produces eruptions on the body. 
 In rare cases it has, when given in very large doses, produced the 
 symptoms of insanity. Such cases are, however, exceptional. 
 
 Epileptics sometimes take this remedy in large doses for months 
 and years, without experiencing any evil effects. When it is taken 
 
AND MOST RECENT METHODS OF TREATMENT. 497 
 
 for a long time it is well to combine it with bromide of ammonium, 
 or with some bitter tonic, such as gentian. 
 
 Bromide of potassium has a saltish taste. If it is given largely 
 diluted with water — say one-half a tumblerful — the taste is much 
 disguised, and it is less irritating to the stomach. 
 
 Bromide of potassium, like carbolic acid, glycerine, pyrophos- 
 phate of iron, and cod-liver oil, has grown into popularity with 
 very great rapidity. 
 
 BKONCHITIS. 
 
 By this term is meant inflammation of the bronchi, or tubes 
 which convey the air into the lungs. 
 
 When the wind-pipe arrives as low down as the third or fourth 
 vertebra of the back, it divides into two great branches, called bron- 
 chi, one of which goes to the right and the other to the left lung. 
 These branches having entered the lungs, divide, subdivide, and 
 ramify into innumerable small branches, all of which terminate in 
 very minute bags, called air-cells. These air-tubes and cells are 
 lined with a membrane, termed, from the nature of its secretion, 
 mucous membrane, which is the seat of bronchitis. 
 
 Bronchitis shows itself in two forms, the acute and chronic. 
 
 ACUTE BRONCHITIS. 
 
 After exposure to cold, which is the usual cause of this affec- 
 tion, the mucous membrane, which lines the nostrils, wind-pipe, and 
 bronchi, becomes slightly inflamed. The consequences of this are 
 dryness and stuffing of the nose, hoarseness, dry cough, and a slight 
 degree of fever, soon followed by expectoration of a thin fluid, a 
 feeling of tightness about the chest, and increase of cough. After 
 some time the expectoration becomes very copious, and of a much 
 thicker consistence; all the feverish symptoms give way, and in the 
 course of a few days the cough gradually moderates, and the patient 
 recovers. This is a mild form of bronchitis. It is frequently ac- 
 companied by cold in the head, is not of a serious nature, and 
 requires very little medical treatment. 
 
 Bronchitis, however, does not alwaysappear in this mild form. 
 It presents a variety of grades, from the slightest common cold to 
 the most acute inflammation, causing symptoms of a character so 
 urgent as to require the most active treatment to prevent a fatal 
 termination. 
 
 When severe it commonly commences with hoarseness, slight 
 sore throat, perhaps cold in the head, and the feverish symptoms 
 32 
 
which usually precede all acute inflammatory diseases, viz., chilli- 
 ness or shivering, alternating with flushes of heat, lassitude, unwil- 
 lingness to move about, and pain (or at least a sensation of soreness) 
 in the back and loins. The pulse is quick and weak, and the urine 
 diminished in quantity. These symptoms are soon followed by 
 headache, hot and dry skin, thirst, foul tongue, quick and full 
 pulse, and scanty urine of a high color. To these general symp- 
 toms of fever are added those more peculiar to bronchitis, namely, 
 oppression on the chest, attended with dull pain and heat, a dis- 
 tressing dry cough, and considerable difficulty in breathing. At 
 first there is no expectoration, because the mucous membrane is 
 dry ; but as the disease advances, each fit of coughing brings up a 
 thin acrid fluid of a salt taste. As the expectoration increases 
 in quantity, it becomes less acrid and loses its salt taste. It then 
 acquires a thicker consistence, and assumes the appearance of 
 white of egg ; is very viscid, and sticks to the sides of the vessel. 
 The more viscid and tenacious it is, the more severe is the inflam- 
 mation. The feverish and other symptoms become more severe 
 towards evening, and during the night the patient is very restless, 
 and the fits of coughing continue longer and recur more frequently 
 than during the day. About the sixth or seventh day the expecto- 
 ration begins to grow thicker and more opaque, and the difficulty 
 of breathing and tightness at the chest sraduallv diminish. At 
 length the expectoration acquires a yellow or greenish color, and is 
 brought up easily, the sensation of heat within the chest is no 
 longer felt, and the cough is not so frequent or troublesome, except 
 on awakening in the morning, when it continues until the mucus 
 which accumulates in the air-passages during the night is freely 
 discharged. 
 
 Bronchitis seldom terminates fatally, unless complicated w T ith 
 other diseases; but when it attacks a great part of the mucous 
 membrane of the air-passages of one or both lungs, and extends to 
 the smallest air-tubes, it is not unattended with danger, and in old 
 people and children frequently proves fatal. In such cases the 
 breathing becomes much oppressed, a wdieezing or rattling noise is 
 heard in the chest, and there is great prostration of strength. (See 
 Auscultation.) Only the experienced physician can determine the 
 meaning of these sounds. The mucus accumulates in the air-pas- 
 sages, and the patient has no longer strength to cough it up. The 
 face and lips then change from deadly pale to a livid color, the 
 pulse is small and quick, cold clammy sweats break out on the 
 body, the extremities become cold, and the patient sinks. At the 
 present time the physician, in studying this and all other diseases of 
 
AND MOST EECENT METHODS OF TREATMENT. 499 
 
 the chest — acute and chronic — relies upon his ear more than upon 
 the appearance of the patient. 
 
 CHRONIC BRONCHITIS 
 
 Is almost invariably the result of the acute form, and is generally 
 met with among old people and those of weak habit of body. It 
 differs from the acute form merely in the mildness of its symptoms 
 and in its longer duration. There is cough, and profuse expectora- 
 tion of an opaque, white, yellow, or greenish matter, of a loose con- 
 sistence, not resembling the viscid discharge of the first stage of the 
 acute form. In many cases there is a slight degree of feverish excite- 
 ment during the day, which increases a little towards night ; but 
 fever is not a characteristic symptom of the chronic form, unless in 
 the worst cases, when it comes on in the evening, followed by night- 
 sweats and other hectic symptoms. The cough is most troublesome 
 during the day, and on awaking in the morning it continues for an 
 hour or two, followed by very copious expectoration. One may 
 labor under chronic bronchitis for years without the general health 
 being much impaired, but in most cases, when it continues long, 
 habitual shortness of breathing, wheezing and oppression in the 
 chest ensue ; and these symptoms are aggravated on going up stairs, 
 or in using any particular personal exertion. With many persons 
 chronic bronchitis is of so mild a character that they scarcely con- 
 sider it a disease. In other cases, the patients are completely worn 
 out by the cough and excessive expectoration. 
 
 Causes. — A most fruitful cause of bronchitis is exposure to cold 
 after the body has been heated by exercise or sitting in a warm room. 
 The theory is advocated by some, that cold is caught just as readily 
 by changing suddenly from cold to warm air. When the body has 
 been chilled by long exposure to cold, warmth should be restored 
 by degrees. When a person has been in the cold air, he should 
 remain for some time in a room moderately heated, and avoid at 
 first sitting near the fire. By avoiding sudden changes of tempera- 
 ture any one, however susceptible of catching cold, may take exer- 
 cise with impunity in the coldest air, provided the surface of the 
 body and feet are kept warm by suitable clothing. 
 
 TREATMENT OF ACUTE BRONCHITIS. 
 
 1. To open the pores of the sTcin and cut short the disease. — 
 This is best done by my cold powder (see Cold Powder). A dose (3 
 to 5 grains) should be given as early as possible after " taking cold." 
 
 Every hour of delay makes it harder to break up the attack. 
 
500 
 
 The powder is best given at night, in a little water. It may be taken 
 for several nights in succession. 
 
 The ordinary Dover's powder should be given when the more 
 agreeable Cold powder cannot be obtained. It should be given in 
 doses of 5 to 10 grains in water, but it is at best an unpleasant 
 compound. 
 
 Besides these powders it is well to take a brisk purgative of 
 some kind, and it is of little consequence just what substances are 
 used. It is an advantage also to take a hot foot-bath. 
 
 2. To cure the bronchitis after the above attempt to shorten it has 
 failed. 
 
 The principal remedies used during the fever are these : 
 
 1. Tartar emetic. — 8 or \ of a grain every three or four hours. 
 
 2. Blister over the breast-bone, or friction with croton oil. 
 Milder cases may be treated differently : 
 
 1. Warm and soothing drinks. 
 
 2. The following prescription for an expectorant: 
 
 Syrup of ipecac, 
 
 Syrup of squills, equal parts. 
 
 Half a teaspoouful every two or three hours. 
 
 "When the cough is very agonizing, a little laudanum, or pare- 
 goric, or morphine may be added to this mixture. 
 Expectorants are uncertain medicines. 
 
 3. Inhalations of tar-water, or simply steam of water. 
 
 4. Stimulants, tonics, and nourishing food.— When the stage 
 of debility comes it is necessary to sustain the system by abundance 
 of good food — eggs, fresh meat, beef-tea, &c, by whiskey, and the 
 bitter tonics and wine. 
 
 Chronic bronchitis may be mistaken for consumption, and con- 
 sumption may be mistaken for chronic bronchitis. — In a doubtful case 
 there is only one way to settle the question. Consult some educated 
 physician who is accustomed to sound the chest. It is only by 
 actual examination of the chest that we can tell accurately whether 
 a patient has consumption or chronic bronchitis. The general 
 symptoms of cough, poor appetite, paleness, weakness, and night- 
 sweats, &c, do not settle the question ; but in the present state of 
 science it is possible for a physician practised in auscultation to deter- 
 mine certainly whether a patient has consumption or simply chronic 
 bronchitis. The question is a very serious one. Charlatans grow 
 rich by prescribing for patients with chronic bronchitis who imagine 
 they have consumption. Thousands of patients are cured of chronic 
 bronchitis by quack medicines — or rather get well while they are 
 taking them, or in spite of them — who suppose that they are cured 
 
AND MOST RECENT METHODS OF TREATMENT. 501 
 
 of consumption. Thousands of certificates of cures of consump- 
 tion are continually published by patients who never had consump- 
 tion at all. 
 
 On the other hand, thousands of patients are annually dying of 
 consumption, who, until perhaps the very latest stages, never sus- 
 pected or admitted that they were suffering from anything more 
 than chronic bronchitis. 
 
 The true course for the patient who is harassed by a lingering 
 cough, night-sweats, is to consult some skilful physician and abide 
 by his decision. 
 
 TREATMENT OF CHRONIC BRONCHITIS. 
 
 1. Tonics and stimulants. — The elixir of quinine, strychnine, 
 and iron (Wyeth's or Caswell & Hazard's), or any of the ordinary tonic 
 mixtures, will serve the purpose. Arsenic (Fowler's solution) is good. 
 General electrization is useful where it can be employed. Cod-liver 
 oil is valuable here, as it is also in consumption. Pure air, sunlight, 
 and sleep are indispensable. 
 
 2. Counter-irritation over the chest — This is done by croton oil, 
 or pitch plaster, or mustard plaster. 
 
 3. Inhalations of carbolic acid, creosote, tar- water, muriate of 
 ammonia, chlorate of potash. (For doses, &c, see Inhalations.) 
 
 4. Expectorant medicines. — These are uncertain. Any one of 
 the hundreds of prescriptions may be tried. No one is a specific. 
 There is a vast amount of humbuggery in the use of expectorauts. 
 
 5. Change of air. — Going to a warm climate for a few months 
 is often useful, but frequently disappoints us. 
 
 The patient must wear warm clothing, remain at home as much 
 as possible, avoid changes of temperature, live sparingly, and ab- 
 stain from all stimulating liquors. To relieve the cough and assist 
 expectoration, the following mixtures may be found useful — 
 
 Squill vinegar, an ounce and a half, 
 
 Tincture of henbane, two drachms, 
 
 Mucilage of gum arabic, two ounces and a half, 
 
 Syrup of orange peel, honey, or common syrup, an ounce and a half, 
 
 Peppermint-water, six ounces. Mix. A tablespoonful to be taken four or five times 
 in the course of the day, or at any time when the cough is troublesome. Or, 
 
 Almond emulsion, eight ounces, 
 
 Acetate of morphia, half a grain. Mix. A tablespoonful of this mixture is to be 
 taken four or five times a day, and two tablespoonful3 at bed-time. Or, 
 
 Almond oil, half an ounce, 
 
 Solution of the carbonate of potash, half a drachm, 
 
 Syrup of tolu, an ounce, 
 
 Syrup of poppies, an ounce, 
 
 Water, five or six ounces. Mix. A dose of two tablespoonfuls to be taken several 
 times in the course of the day, or when the cough is troublesome. 
 
502 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 The debility which attends this affection renders both general 
 and local blood-letting improper. Without the greatest caution it 
 cannot be resorted to even when acute bronchitis supervenes upon 
 the chronic form, a complication which always constitutes a very 
 serious case. The acute form, in such case, is announced by con- 
 siderable diminution or a total cessation of expectoration, great 
 difficulty in breathing, and the usual train of febrile and inflam- 
 matory symptoms ; it is very difficult to manage, and frequently in 
 old people and debilitated subjects goes on rapidly to a fatal ter- 
 mination, in spite of every effort to arrest its progress. 
 
 The constant use of cough mixtures, composed principally of 
 expectorant remedies, such as squill, ammoniac, &c, can only tend 
 to debilitate and weaken the patients. Small and frequently re- 
 peated doses of anodyne remedies should be administered to miti- 
 gate the cough, and thereby diminish the irritation ; and though 
 this treatment can only be considered as palliative, it gives consid- 
 erable relief. "We ought to remember that every anodyne medicine 
 loses its effect after a time ; consequently it becomes necessary either 
 to increase the dose, or have recourse to another remedy of the same 
 class. 
 
 Concerning the use of remedies in bronchitis, Professor Flint 
 thus remarks : "Medicines may be employed with a view to pal- 
 liation and cure. If cough be troublesome, exceeding the amount 
 requisite for expectoration, soothing remedies are called for. 
 Opium, however, is to be prescribed with circumspection, in the 
 first place, lest the habit of using it be formed. This is a con- 
 sideration to be taken into account in all chronic affections. And, 
 in the second place, in feeble subjects, and under circumstances in 
 which there may be danger from an accumulation in the tubes, 
 serious consequences may sometimes follow the blunting of that 
 sense of the presence of morbid products' which leads to their re- 
 moval by efforts of expectoration. Moreover, the use of opium 
 tends to impair the digestive powers. For this reason, other ano- 
 dynes, such as hyoscyamus, conium, belladonna, and hydrocyanic 
 acid are generally to be preferred. 
 
 " As a rule, the remedies which are given as expectorants are 
 not indicated. The nauseant expectorants do harm by their de- 
 pressing effect, and by disturbing the appetite and digestion. The 
 stimulant expectorants, such as squill, senega, etc., are of doubtful 
 efficacy, and, if not useful, are more or less hurtful. Certain re- 
 medies, however, sometimes exert a curative effect. This is true 
 of the balsam of copaiba. I have known this remedy to act almost 
 as a specific ; yet, in many cases, it has little or no effect." 
 
AND MOST RECENT METHODS OF TREATMENT. 503 
 
 ANODYNE COUGH MIXTURES. 
 
 Acetate of moi phia, a grain, dissolved in a .little almond oil, 
 Almond emulsion, three ounces, 
 Camphor mixture, the same quantity, 
 
 Mucilage of gum arabic, half an ounce. Mix. A table-spoonful to be given as a dose 
 three or four times in the course of the day. 
 
 Extract of hemlock and extract of henbane, of each five grains, 
 
 Mucilage of gum arabic, two drachms, 
 
 Spirit of mindererus (solution of the acetate of ammonia,) half an ounce, 
 
 Peppermint- water, or common water, six ounces, 
 
 Syrup of red poppy, a drachm. The two first ingredients to be well mixed with the 
 mucilage before the others are added. A table-spoonful a dose, three or four times a day, 
 or at any time when the cough is troublesome. 
 
 To prevent the recurrence of bronchitis, the patient should guard 
 against changes of temperature as much as possible, take regular 
 exercise in the open air, attend to the state of his bowels, and wear 
 flannel next the skin. Sponging the chest every morning with 
 sea-water, or cold water containing a portion of salt, and in summer 
 bathing in the sea, and the shower bath, are also excellent preven- 
 tives of bronchitis. 
 
 BRONCHOCELE. 
 
 Bronchocele is a swelling on the fore-part of the neck, caused by 
 a preternatural enlargement of the thyroid gland, one of the cartil- 
 ages of the. larynx. In England it is generally called Derbyshire 
 neck, and in France and Switzerland is known by the name of goitre. 
 The swelling, in its simple state, presents a smooth surface; the 
 skin which covers the tumor is not discolored, and is neither painful 
 nor tender when touched. In the more complicated cases the neigh- 
 boring parts become affected, and the swelling sometimes increases 
 to a great extent, causing a shocking deformity. In some individuals 
 it hangs down over the upper part of the breast, and in others it rises 
 as high as the ears. "When the tumor is large it presses on the wind- 
 pipe, and causes hoarseness of voice, and impedes the breathing; 
 the jugular veins being also compressed, the free circulation of the 
 blood in the head cannot be carried on, and the consequences are 
 head-ache, drowsiness, giddiness, and sometimes apoplexy. 
 
 Bronchocele is very seldom attended with danger ; it may con 
 tinue for years, and even throughout life, without causing pain or 
 much inconvenience. There are no doubt cases occasionally in 
 which inflammation comes on ; the tumor then becomes hot and 
 pair ful, the skin covering it assumes a red and shining appearance, 
 and the veins running under the skin are much enlarged. In scro- 
 fulous persons matter has even been known to form and find vent 
 
504 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 externally. Scrofula, however, does not appear to be particulaily 
 connected with this disease. 
 
 Causes. The various opinions started respecting the cause of 
 Bronchocele, when closely examined, appear so doubtful and contra- 
 dictory, that we are left, after all the inquiries and observations 
 made with regard to it, as ignorant of its origin as we are of the use 
 of the thyroid gland, where the complaint is seated. 
 
 Treatment. Iodine, if judiciously used, particularly when the 
 individual is removed from the locality where this disease prevails, 
 may be said to cure it in the majority of cases. This should be 
 given in small doses frequently repeated. It is then perfectly safe ; 
 but if given in too large doses, or carried too far, it brings on low- 
 ness of spirits, loss of appetite, dimness of sight, nervous irritability, 
 and palpitation of the heart, or it may irritate the stomach am 
 produce purging. If the patient complain of heat of the stomach 
 and griping, the iodine should be discontinued for a day or two, or 
 the dose may be diminished ; these effects, however, are very seldom 
 produced when the following preparation is given as here directed — 
 
 Hydriodate of potash, thirty-six grains, 
 Iodine, ten grains, 
 
 Distilled water, ten ounces. Mix. Dose of five drops three times ; gradually increase 
 to twenty or thirty drops. 
 
 As an external application, use the following ointment— 
 
 Hydriodate (or iodide) of potash, half a drachm, 
 
 Lard, an ounce to an ounce and a half. Mix. A drachm of this is to be well rubbed 
 in over the surface of the tumor night and morning. 
 
 Or a liniment composed of 
 
 Tincture of iodine, a drachm, 
 
 Compound soap liniment, an ounce. Mix. 
 
 In some cases the skin covering the tumor is irritated by the 
 iodine ointment, and a considerable degree of inflammation takes 
 place. When this occurs, the ointment should be discontinued, and 
 the inflammation reduced by the application of six or seven leeches 
 to the part, to be followed by poultices of warm bread or linseed. 
 
 In some cases Bronchocele yields to iodine in the course of a 
 month or two, in others it is necessary to keep the system under its 
 influence during ten or twelve months before a cure can be effected. 
 
 A seton placed in the skin over the Bronchocele has sometimes 
 the effect of curing it when iodine fails ; but if the tumor be very 
 hard or partly ossified, neither of these remedies produces any good 
 
AND MOST EECENT METHODS OF TREATMENT. 505 
 
 effect. The diet ought to be of a sufficiently substantia] and nutri- 
 tive quality, since this disease generally occurs in delicate females 
 of relaxed constitutions. Bronchocele has disappeared entirely in 
 many cases, particularly in young people, from change of residence 
 alone. In others it has been cured by simply rubbing the tumor two 
 or three times a day (a quarter of an hour or twenty minutes each 
 time) with a dry towel ; or with a little camphor liniment. The 
 swelling must be always carefully covered, so as to prevent its being 
 acted on by sudden changes of temperature. 
 
 BUCHU LEAVES. 
 
 These are useful in gleet, and certainly have an excellent effect 
 in strengthening the digestive organs. 
 
 The leaves of the buchu are given in the forms of infusion and 
 tincture. 
 
 Infusion. — Take of buchu leaves an ounce, boiling water a pint ; 
 macerate for four hours in a lightly-covered vessel, and then strain 
 through a piece of linen. Two or three tablespoonfuls to be taken 
 as a dose three or four times a day. 
 
 Tincture. — Take of buchu leaves two ounces, proof spirit a pint ; 
 macerate for seven days. Three or four teaspoonfuls a dose, in a 
 little water, three or four times daily. 
 
 BUXYONS. 
 
 A bunyon is a swelling on the inside of the first joint (or ball, as 
 it is commonly called) of the great toe, caused by the pressure of 
 tight boots or shoes. The same term, however, is sometimes applied 
 to a similar swelling on the first joint of the little toe, or on the 
 instep. Those who are troubled with bunyons have generally the 
 great toes turned outwards, and the little toes inwards, to an unna- 
 tural extent. This almost invariably arises from wearing boots or 
 shoes too narrow at the extremities, thereby causing the toes to be 
 squeezed in an improper position against each other. 
 
 Treatment. — Since a bunyon is caused by undue pressure, the 
 pressure, of course, should be removed. The necessity, therefore, of 
 wearing loose boots or shoes is obvious. They should be without 
 high heels, which would cause improper pressure on the fore part of 
 the foot, and made of cloth or of buck-skin, or some other soft leather, 
 and so constructed as to allow ample room at the parts corresponding 
 to the .bunyons. 
 
 When a bunyon is not inflamed, the pressure may be, in a great 
 
506 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 measure, removed by applying over it and the surrounding parts a 
 piece of thin linen or silk, spread with diachylon plaster, and over the 
 latter a piece of thick buck-skin leather of the same dimensions, like- 
 wise covered with diachylon, perforated with a hole of the size of the 
 bunyon. The pressure is thus removed, and thrown on the adjacent 
 parts. This method of treatment may be assisted by having the 
 sole of the shoe considerably thicker towards the inside of the foot. 
 
 Wearing a new shoe, or one tighter than usual, much walking, 
 particularly in warm weather, or other causes, may bring on inflam- 
 mation in the bunyon, which then becomes so painful that the 
 slightest pressure cannot be tolerated. In this case, use warm lin- 
 seed poultices and warm fomentations, and apply leeches to the 
 surrounding parts. But it sometimes happens that, notwithstanding 
 these remedies, matter forms, and the lancet is required to give vent 
 to it. The application of iodine ointment, prepared as follows, has 
 often an excellent effect in relieving an inflamed bunyon. 
 
 Iodine, twelve grains, 
 
 Lard, or spermaceti ointment, half an ounce. Mix. 
 
 A small portion of this ointment (about the bulk of a horse-bean) 
 is to be rubbed gently on the bunyon twice or thrice a day. 
 
 CALAMINE, OR CARBONATE OF ZINC. 
 
 Prepared calamine is sometimes sprinkled over ulcers, with the 
 intention of diminishing the discharge of matter when in excess ; or 
 for the purpose of absorbing acrid matter, and thus preventing it 
 from spreading, and irritating the surrounding parts. It is used in 
 the same manner when the skin is chafed, particularly in children, 
 who are very liable to excoriations at the arm-pits, groin, and behind 
 the ears. It generally checks the discharge of matter in these cases, 
 and prevents the necessity of employing astringent lotions. To pre- 
 vent excoriations in children, the powder is also frequently dusted 
 over the parts where they are most likely to take place. 
 
 Calamine enters into the composition of the cerate commonly 
 known by the name of Turner's Cerate, which is prepared by mix- 
 ing calamine and yellow wax, of each half a pound, with a pint of 
 olive oil. The oil is first mixed with the melted wax, and, when 
 removed from the fire, the calamine is gradually added, and the mix- 
 ture constantly stirred until it becomes cold. This cerate is used to 
 promote the healing of ulcers and excoriations, and was formerly 
 much in repute as an application to the ulcerated surface arising 
 from burns. 
 
AND MOST RECENT METHODS OF TREATMENT. 507 
 
 CALUMBA. 
 
 Calumba, or columbo, has been long in high esteem as a mild 
 tonic and stomachic, having no astringent quality, and being but- 
 very slightly stimulant. When there is loss of appetite, flatulency, 
 acidity, nausea, and the train of symptoms arising from a debilitated 
 state of the stomach, calumba is of great use, and sits lightly on the 
 most delicate stomach, without producing any excitement of the 
 system ; on this account, it is the tonic commonly used to strengthen 
 the stomachs of consumptive patients. We may give it with 
 advantage to relieve the acidity and sickness of stomach so common 
 at the commencement of pregnancy ; and also to children, for the 
 purpose of allaying the vomiting and purging to which they are so 
 subject when teething. Those who have lived long in tropical 
 climates have generally weak stomachs, easily deranged by errors in 
 diet, and are subject to occasional derangement of the biliary organs ; 
 in such cases, calumba will often be found more beneficial than any 
 thing else, by giving tone to the weakened stomach, and correcting 
 the depraved or redundant secretion of bile. It is of the greatest 
 service in the bilious disorders of warm climates. 
 
 The dose of calumba root in powders is from fifteen to sixty 
 grains. The tincture is given in doses of two or three tea-spoonsful. 
 The dose of the infusion, which is made in the following manner, is 
 two or three table-spoonsful, repeated three or four times a day. 
 
 Take of calumba root, sliced, five drachms, 
 
 Boiling -water, a pint. Macerate for two hours, and then strain through a linen rag. 
 
 This infusion spoils if kept long. 
 
 CAMPHOR. 
 Camphor is a powerful stimulant. It should be given in doses 
 of from four to fifteen grains in malignant typhus, in the worst forms 
 of measles, small-pox, scarlet-fever, and other eruptive diseases, when 
 accompanied with typhoid symptoms ; and also to bring back the 
 eruptions when they have disappeared too suddenly. It has often an 
 excellent effect in painful menstruation, when given in doses of three 
 grains three or four times a day. As an antispasmodic, it is given in 
 asthma, hysterics, St. Yitus's dance, epilepsy, hiccup, and other 
 spasmodic diseases. To promote perspiration at the commencement 
 of a cold, an ounce of the camphor mixture, with ten grains of nitre 
 in barley-water, or any other warm drink, every three or four hours, 
 is a common and very serviceable remedy. Camphor is useful as a 
 sudorific in many cases ; but should never be given when any inflam- 
 matory action is present. Camphor mixture is given to prevent, ad 
 
508 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 well as to soothe the irritation of the urinary organs, which some- 
 times arises from the application of a blister ; and with the same 
 intention when squills, balsam of copavia, turpentine, and other 
 medicines which act on these organs, are administered. 
 Camphor mixture is prepared in the following manner. 
 
 Take of camphor, half a drachm, 
 Rectified spirits, ten minims (drops,) 
 
 Water, a pint. First rub the camphor with the spirit, then with the water, gradually 
 poured in, and strain through linen. 
 
 Of this mixture four table-spoonsful may be given every three or four hours. 
 
 The following camphor julep, in common use, is made by rubbing 
 together 
 
 A scruple of camphor, 
 
 Two drachms of sweet almonds, blanched, 
 
 A drachm of sugar, 
 
 And six ounces of peppermint -water, 
 
 Two table-spoonsful to be taken as a dose every two or three hours. 
 
 Camphor is much in use as a counter-irritant ; for this purpose 
 it is usually mixed with oil. An ounce of camphor dissolved in four 
 ounces of olive oil forms the camphor liniment of the London Phar- 
 macopoeia ; either this or the compound camphor liniment, which 
 contains ammonia, is rubbed over the joints, or other parts affected 
 with chronic rheumatism. It is used in the same manner for nervous 
 pains, bruises, sprains, indolent swellings, &c. A piece of flannel 
 soaked in a strong solution of camphor, (two ounces of camphor 
 mixed with four ounces of rectified spirits of wine,) applied over the 
 chest, and covered with oiled skin, has sometimes the effect of reliev- 
 ing attacks of spasmodic asthma, angina pectoris, cramp, and other 
 cases, where there is local derangement of the nervous power. 
 
 CANCER. 
 
 Although the most enlightened and skilful men regret their utter 
 ignorance of any means of eradicating this formidable malady, em- 
 pirics are everywhere to be found, who boast of being able to cure 
 this disease by secret remedies, which they pretend to have discov- 
 ered ; and thus live by deceiving the ignorant and unfortunate 
 individuals who, with that clinging to life so natural to every one, 
 resort to them in the vain hope of being cured. 
 
 Cancer is a disease common to both sexes, but women are more- 
 subject to it than men. It is not often seen in people under twenty- 
 five years of age, and very rarely before the age of puberty. Women 
 are most frequently attacked after the menstrual discharge has 
 
AND MOST RECENT METHODS OF TREATMENT. 509 
 
 entirely ceased ; but it often occurs in men at an earlier period of 
 life. It may attack any organ of the body ; but in women the 
 breast and womb, and in men the lower lip, stomach, liver, and tes- 
 ticles, are the parts most frequently affected. 
 
 The exciting causes of cancer are general and local. The most 
 frequent general causes are low diet, long-continued trouble of 
 mind, the depressing passions generally, and the suppression of any 
 habitual discharge, such as the menstrual secretion, or the discharge 
 from piles. The most common local causes are blows, or other 
 local injuries, undue pressure, and repeated and long-continued irri- 
 tation ; but in many cases no cause whatever can be traced. The 
 general opinion, however, is, that none of these causes could have 
 any effect in bringing on cancer unless the system were previously 
 disposed to the complaint ; but of the nature of this predisposition 
 we know little : it is probably often hereditary. 
 
 The pain of non-malignant tumors is generally aggravated by 
 pressure, while that of cancer is most severe when the patient is 
 perfectly quiet and undisturbed. 
 
 CANCER OF THE FEMALE BREAST 
 
 Is by far the most common of all cancerous affections ; and the 
 period at which it is usually observed is between forty and fifty 
 years of age. 
 
 It is often a very difficult matter to distinguish between other 
 tumors of the breast and those resulting from the first stage of can- 
 cer. The symptoms, however, the most characteristic of a cancer- 
 ous tumor are, its constant progress, great hardness, irregular shape, 
 and unequal, lobulated, or knobbed surface ; the darting or lancin- 
 ating pains (though similar pains are sometimes felt in other tu- 
 mors) ; and, at a more advanced period, the dusky, leaden color and 
 puckered appearance of the skin, and its attachment to the tumor. 
 When a tumor of the breast is felt fluctuating, and the skin is 
 changed in color and feels hotter than natural, it is certainly not 
 of a cancerous nature. Cancer of the breast is influenced by the 
 menstrual discharge during three or four days prior to its occur- 
 rence, the pain in the tumor increases, and it is much relieved for 
 several days after that discharge has ceased. An indurated tumor 
 of the breast may exist for years without giving any pain or un- 
 easiness, until the entire cessation of the menses, at which period it 
 becomes increased in size, very painful, acquires all the characters 
 of cancer, and goes on rapidly to a fatal termination. But when 
 the tumor does not appear until some years after that period, and 
 
510 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 more particularly if not till after sixty years of age, it sometimes 
 progresses slowly, and is accompanied by little pain. 
 
 Treatment. — Many tumors of the breast are not of a cancerous 
 nature, are harmless, and may be cured by very simple means. 
 Yet they ought all to be looked upon with the greatest suspicion, 
 particularly if they have originated without any known cause, or 
 have existed for any length of time. No female, on detecting any 
 unnatural hardness in her breast, should rest satisfied until the ne- 
 cessary means have been adopted to get rid of it. There can be no 
 greater folly than to trifle with a tumor of the breast, whether it 
 may have arisen from a blow, or from a milk abscess, or any other 
 cause. 
 
 In this, as in all other ca.ses of incurable disease, it is lest to 
 consult some good physician, and have our doubts settled for better 
 or for worse. Anything is preferable to suspense. 
 
 Treatment of Cancer of the Breast — When the tumor is removed 
 by an operation it usually returns. The propriety of an operation 
 in each case must be determined by some reliable surgeon. 
 
 All that w T e can do usually is : — 
 
 1. To sustain the general system by nourishing food, tonics and 
 stimulants, and sunlight. 
 
 2. To relieve the pain by opium and other anodynes. 
 
 The treatment then consists in mitigating the pain, and tran- 
 quillizing the nervous system, by means of hemlock and other 
 narcotics ; in dressing the sore with emollient and soothing applica- 
 tions; in supporting the patient's strength by light nutritious diet, 
 easy of digestion, and by the administration of tonics, the most 
 suitable of which are quinine, and elixir calisaya, and strychnine. 
 
 CANCER OF THE STOMACH. 
 
 Women are most liable to cancer of the breast ; men to cancer 
 of the stomach, which is equally to be dreaded, since the latter form 
 is also invariably fatal in its termination. It is usually brought on 
 from blows over the stomach and other external injuries ; long-con- 
 tinued excess in eating and drinking ; distress of mind, and hereditary 
 disposition. It is seldom met with before the age of thirty, and is 
 in general a disease of advanced life. 
 
 This form of cancer commences with uneasiness at stomach 
 without pain, heartburn, eructations, and other symptoms of indiges- 
 tion ; and it cannot at first, and even for several months, in many 
 cases, be distinguished from that complaint. After a longer or 
 
AND MOST RECENT METHODS OF TREATMENT. 511 
 
 shorter period, however, the symptoms of cancer become so decided, 
 that there can be no longer any doubt with regard to the nature of 
 the case. Shooting pains are felt at times extending to the back and 
 loins ; the mind becomes much dejected and the body emaciated ; 
 sickness and vomiting are experienced from the slightest error in diet. 
 The parts of the stomach most frequently affected with cancer are 
 the pyloric, or lower opening leading to the gut; and the cardiac, 
 or upper opening, where the gullet terminates. When the lower 
 orifice, which is more frequently the seat of this disease than the body 
 of the stomach, or its upper orifice, is affected, the pain is much 
 increased about three or four hours after taking food ; sickness then 
 comes on, followed by vomiting, which relieves the patient for a time ; 
 but, if the disease be at the upper orifice, the pain is severely felt as 
 soon as the food has passed down the gullet ; from the irritation 
 produced, the food is frequently returned almost immediately ; when, 
 however, it has entered the stomach the pain ceases. Some patients, 
 rather than be subjected to this kind of torture, almost starve them- 
 selves. When these apertures are in a state of health, and the 
 cancer is situated in the body of the stomach, the food enters without 
 inconvenience, but gives great pain shortly afterwards, and vomiting 
 frequently follows. At this stage of the disease the pain is increased 
 on pressure over the stomach, and in many cases a hard swelling 
 may be felt. To these symptoms are added, obstinate costiveness, 
 thirst, feverish restlessness during the night ; and, in some cases, the 
 stomach retains the food which has been just swallowed, and rejects 
 that which had been taken the day before ; in others it accumulates 
 during several days, until at last the stomach becomes so distended, 
 that free vomiting of the half-digested aliment, mixed with watery 
 or ropy mucus, takes place. 
 
 At first there is considerable difficulty in detecting this disease, 
 inasmuch as the pain may not be of a lancinating or stinging kind, 
 and the vomiting not regular ; and though there may be acid eruc- 
 tations, fetid breath, flatulence, distention and a feeling of weight at 
 the stomach, and occasional vomiting, yet all these symptoms might 
 arise from other causes. But when the more marked signs already 
 enumerated are present, particularly when there is vomiting of a 
 fetid dark-colored matter, resembling coffee-grounds or chocolate ; 
 and when a hard tumor can be felt between the false ribs of the right 
 side and the navel, which changes its position to a certain extent, 
 according as the stomach is full or empty, there can then be no doubt 
 with regard to the nature of the disease. 
 
 Cancer of the stomach is very irregular in its progress : some- 
 times the symptoms are much relieved for a time, and the patient 
 
512 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 thinks lie is getting better ; in some cases it advances rapidly, and 
 terminates fatally within a few months ; in others, it continues 
 during many years. 
 
 This disease does not usually occur before forty years of age. 
 
 The patient is usually starved to death in the course of one or 
 two years. 
 
 Treatment of Cancer of the Stomach. — There is no treatment 
 for this disease. All that can be done is to smooth the patient's 
 passage to the tomb. He should be nourished by beef-tea, milk, 
 wine whey, and stimulants. It may be necessary in some cases to 
 inject the fluid food into the rectum. 
 
 The pain should be relieved by the use of opium, henbane, and 
 chloroform. 
 
 In these incurable diseases we are justified in using anodynes in 
 just as large doses as may be found necessary to relieve pain and 
 procure sleep. All that we can do in cancer of the stomach is, 
 then : — 
 
 1. To sustain the strength by appropriate nourishment. 
 
 2. To relieve pain by anodynes. 
 
 Since cancer of the stomach cannot be distinguished at first 
 from disorders of that organ, of a slow, inflammatory nature, it fol- 
 lows that the treatment, as long as there is any doubt existing, 
 should be directed towards a radical cure, and not to merely pallia- 
 ting the symptoms. A rigorous and properly regulated diet is at 
 this early period the chief means to be relied on. The patient must 
 confine himself to food of a mild nature, and everything which 
 would excite the stomach or increase the irritation should be strictly 
 avoided. Milk in most cases answers better than anything else ; 
 some stomachs, however, cannot support it. When milk turns acid 
 on the stomach, it is of course unsuitable. In some cases a little 
 animal food, properly masticated, is most easily digested ; in others, 
 liquid diet, such as mutton broth, veal broth, and beef-tea, is more 
 suitable. But, in general, arrow T -root, tapioca, sago, blanc-mange 
 of rice, the preparation of oats, w T ell known in Scotland under the 
 name of sowens, and other mild farinaceous substances, taken in 
 small quantities at a time, will be found to produce the least irrita- 
 tion. Animal jellies in small quantities may be tried ; and there 
 can be no better article of diet than asses' milk, w T hen it agrees with 
 the stomach. The object is to give the stomach as little work to 
 perform as possible, and to avoid irritation by improper food ; nor 
 should it ever be overcharged with any kind of food, since we know 
 that when in a disordered state it cannot carry on the process of 
 digestion as in health ; and half-digested aliment must of course act 
 
AND MOST RECENT METHODS OF TREATMENT. 513 
 
 as a source of irritation. The drinks to which the patient should 
 give, the preference are, lemonade, orgeat, barley-water, a decoction 
 of liquorice, and linseed tea. 
 
 CANCER OF THE WOMB. 
 
 When cancer attacks the hollow organs or cavities, it begins 
 almost invariably at their openings, as the lips, the upper and lower 
 openings of the stomach, the fundament, and the mouth of the 
 womb. The body of the latter organ is very seldom primarily 
 affected ; its mouth and neck first become gradually indurated and 
 enlarged, and the symptoms at this stage are so obscure that the in- 
 dividual may be a considerable length of time without knowing 
 that any diseased action is going on. But when the second or ul- 
 cerated stage has begun, the symptoms are sufficiently apparent. 
 ~No cause can be assigned for this disease ; it attacks the married 
 and unmarried, and may commence at any age after puberty ; but 
 the period at which it usually begins is a little before or after the 
 turn of life. 
 
 In general the first symptom that alarms the patient is a more 
 or less profuse flooding, recurring at irregular intervals, which is pre- 
 ceded or followed by the discharge called the whites. This discharge 
 after some time acquires a fetid smell and becomes thin, and brown 
 or greenish in its appearance. A disagreeable sensation of weight 
 soon begins to be experienced at the lower part of the belly, accom- 
 panied with occasional pains of a bearing down or aching kind. The 
 patient at this time may retain her usual strength and appearance, 
 but by degrees her limbs waste and lose their natural plumpness, 
 though the face may appear very little changed, and she complains 
 of an aching sensation and weakness about her loins. As the dis- 
 ease goes on the emaciation and debility increase, the face appears 
 shrunk and deadly pale, or of a pale straw color; dull, dragging, 
 burning, and lancinating pains are felt at the lower parts of the 
 belly and back, extending to the groins and thighs, the urine re- 
 quires to be frequently discharged, and there is considerable pain 
 attending the evacuation of the bowels. At a still later period of 
 the disease all the symptoms are aggravated ; the pain, without the 
 aid of strong anodyne remedies, would be intolerable ; the peculiar 
 smell from the matter discharged is almost insupportable, the stom- 
 ach becomes very irritable, frequent vomiting harasses the patient; 
 and the debility is often greatly increased by frequent discharges of 
 blood" from the genitals. The patient being no longer able to with- 
 stand the pain, hectic fever, and want of sleep, sinks from exhaus- 
 33 
 
514 
 
 tion, or slie may perish from a profuse discharge of blood. Some- 
 times the cancer eats its way both into the bladder and bowels ; the 
 urine and excrements are then mixed with the cancerous matter, 
 and are discharged involuntarily. This deplorable state, however, 
 cannot exist long; inflammation soon follows, and puts an end to 
 the patient's suffering. The length of time required by this disease 
 to run its course is very variable ; in general, the younger the 
 patient is, the quicker it carries on its ravages ; but it may remain 
 in the occult or scirrhous state during several years. 
 
 We have already mentioned that cancer of the womb commonly 
 commences with flooding, but this symptom is not peculiar to it ; 
 the disease may arise from polypus or other tumors of the womb, or 
 from chronic inflammation of, the same part, attended with soften- 
 ing. But when any unnatural discharge of blood take place be- 
 tween the periods of the menstrual discharge, or after its final ces- 
 sation, no time should be lost in seeking the best medical advice. 
 
 Great relief may be obtained by the judicious administration of 
 narcotics, and the patient may be rendered comparatively comfort- 
 able by thorough cleanliness and the free use of disinfectants. 
 
 The removal of the diseased growth by a surgical operation is 
 sometimes advisable in the early stages of the malady, but this is a 
 matter that must be left to the decision of competent authority in 
 each individual case. 
 
 Prof. Thomas, one of our best authorities on diseases of women, 
 gives the following suggestions for those who are afflicted with this 
 malady : 
 
 " The relief of pain should be accomplished by the free, unre- 
 stricted use of opium by the mouth, the rectum, the vagina, or un- 
 der the skin. I often encourage my patients to become opium- 
 eaters, and urge them to obtain as complete relief as the use of this 
 drug can afford. In place of opium other narcotics may be tried, 
 but there is none which compares with it for efficiency. 
 
 " When opium produces the painful results noticed where an 
 idiosyncrasy exists against it, the persistent use of it will often 
 effect a tolerance. 
 
 " The fetor of the discharges maybe, to a great extent, corrected 
 by the use of vaginal injections containing disinfectant substances 
 in solution. Solution of carbolic acid from one to two drachms to 
 a pint of water, Labarraque's solution of soda in the same propor- 
 tion, one drachm of powdered persulphate of iron to the pint, or 
 a weak solution of the iodide of lead, will prove very useful. Of 
 all these, carbolic acid is the most certain and effectual. 
 
 '• The general strength should meantime be maintained by fresh 
 
AND MOST RECENT METHODS OF TREATMENT. 515 
 
 air, residence in the country, generous food, alcoholic stimulants, 
 iron and bitter tonics, while the mind should be kept cheerful by 
 lively company and avoidance of the society of those who encourage 
 conversation concerning the existing disease. As the digestion is 
 weak, the most digestible substances should constitute the staple 
 diet ; and very often a patient who will become emaciated upon 
 solid food and a mixed diet will improve upon the exclusive use of 
 milk, beef-tea, and similar substances. So marked is this fact, that 
 the milk diet strictly adhered to has been regarded, and is now by 
 many non-professional persons, as a cure for cancer." 
 
 Canker, Cancrttm Oris. (See Mouth, Diseases of.) 
 
 CANELLA BAKK. 
 
 Canella bark is tonic and aromatic ; it is seldom given alone, 
 but is found useful in preventing griping from aloes, senna, and 
 other strong remedies, and also tends considerably to cover their 
 disagreeable taste. In people of sedentary habits, who are troubled 
 with indigestion, attended with constipation of the bowels, canella 
 is a very efficacious medicine in conjunction with aloes. It enters 
 into the composition of hiera jncra, an old and well-known popular 
 remedy. The rainier, or wood-pigeon, so well known in Dominica 
 and other islands of the West Indies, derives the agreeable aromatic 
 and bitter flavor, for which it is so much admired, from feeding on 
 the berries of the canella tree, which is common in those islands, 
 where it is known under the name of the wild cinnamon tree. The 
 dose of canella bark is from ten grains to half a drachm. 
 
 CAEBOLIC ACID. 
 
 This remedy, which a few years since was not heard of, is now 
 growing into popularity with remarkable rapidity. There are those 
 who predict that it will have its day and be forgotten. This is not 
 probable. It possesses real merits, and of a high order, and will be 
 permanently used. It may be regarded as the twin of oromide of 
 potassium, for it came into popular use about the same time, and 
 both are now consumed by the ton. 
 
 Carbolic acid was first employed in the form of coal-tar, in 
 1859, by MM. Corme and Demeaux. . 
 
 The great fact about carbolic acid is that it is a disinfectant. 
 In appearance and in smell it much resembles creosote, but it is 
 less disagreeable, and is more useful. 
 
 Carbolic acid is used internally and externally. It is used ex- 
 
516 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 tern ally and locally for gangrene, for ulcers, for slcin diseases, for 
 chronic inflammations of mucous membranes (rhinitis — catarrh of 
 the nose), sore throat, whites, clap, piles, &c. It is used internally 
 for chronic diarrhoea, intermittent fever , <&c. It is used in the form 
 of inhalation for coughs, colds, and consumption. 
 
 As a disinfectant, it is used in surgery and by sanitary authorities. 
 
 CARBUNCLE. 
 
 Carbuncle may appear without constitutional disturbance, but 
 in general it is preceded by loss of appetite, foul tongue, headache, 
 lassitude, general uneasiness, and shivering. At first it can scarcely 
 be distinguished from a common boil, commencing in the form of a 
 pimple, which gradually enlarges and becomes hard, broad, and ele- 
 vated. The tumor is circumscribed and flat, the skin of a dark red 
 or violet color ; the hardness or firmness which accompanies it is 
 compared to that of brawn ; it is hot to the touch and very painful, 
 with a sensation of burning heat, and a disagreeable feeling of stiff- 
 ness. A carbuncle may not go beyond the size of a hen's egg, but 
 sometimes it becomes as large as a saucer, or may even attain a 
 diameter of eight or nine inches. The accompanying symptoms are, 
 hot skin, thirst, severe headache, restlessness, high-colored urine, 
 and other feverish symptoms. When left to itself it softens at the 
 most prominent part, and little vesicles or bladders form, which 
 burst and discharge a small quantity of a bloody, badly formed and 
 fetid matter. The softening goes on, the openings increase in num- 
 ber, enlarge, and run into each other. The matter now discharged 
 has an appearance which Sir Astley Cooper says is peculiar to car- 
 buncle, and which he compares to flour and water mixed together. 
 The skin between the openings is gradually destroyed and sloughs 
 off, allowing the cellular substance or fat which the tumor con- 
 tains to be easily seen. This substance is in a state of mortification, 
 though it does not appear black, in consequence of being saturated 
 with matter which gives it a grayish or ash color. The smell ex- 
 haled is strong and very disagreeable. Carbuncle commonly goes 
 on to mortification in the course of ten days from its commencement, 
 and the dead parts are thrown off* towards the end of the fourth 
 week, leaving a deep cavity which requires a considerable length of 
 time to fill up and heal. An ugly cicatrix is invariably left. 
 
 Children and robust people are most subject to boils, several of 
 which may exist at the same time ; but carbuncle appears alone, 
 and elderly people, whose constitutions have been impaired by im- 
 proper living, are most subject to it. Carbuncles are seldom seen 
 
AND MOST RECENT METHODS OE TREATMENT. 517 
 
 on the limbs : the parts which they generally attack are the back, 
 particularly between the shoulder-blades, the loins, the nape of the 
 neck, and hips, though they are occasionally met with on the belly, 
 and over the chest. Carbuncle generally terminates favorably, but 
 is a disease by no means unaccompanied with danger; the risk 
 attending it depends upon the age, constitution, and previous habits 
 of the individual, as well as on its size, and the part which it attacks. 
 
 TREATMENT OF CARBUNCLE. 
 
 1. A few incisions crossways, made early. 
 
 2. The cauterization of the diseased part by nitrate of silver or 
 caustic potash. 
 
 3. Poultices of yeast, charcoal, and port wine. 
 
 4. Tonics and stimulants, and nourishing food. 
 
 There is frequently great debility and exhaustion. Therefore 
 every means must be used to sustain and strengthen the system. 
 
 CALISAYA BAEK. 
 
 This is a species of cinchona bark with which every one is fami- 
 liar. It is now exceedingly popular. It is frequently given in com- 
 bination with pyrophosphate of iron. It is an ingredient of Caswell's 
 celebrated tonic preparation. 
 
 CASCAEILLA BAEK. 
 
 This country is supplied with cascarilla bark principally from the 
 Bahama Islands. It is an excellent tonic and stomachic, without 
 being astringent, and was much used before the discovery of quinine 
 as a remedy in ague, particularly in cases in which the Peruvian 
 bark could not be given without producing sickness at stomach and 
 purging. In simple indigestion, arising from weakness of stomach, 
 cascarilla is one of the best and most grateful tonics that can be ad- 
 ministered ; it is also very useful in checking purging when not 
 caused by inflammation. 
 
 An agreeable sensation of warmth in the stomach is produced 
 by this medicine, which never causes vomiting, and is easily digested. 
 Quinine has now, however, in a great measure, superseded the use 
 of cascarilla, canella, and other tonic barks. Cascarilla, when 
 burned, gives out an agreeable aromatic odor, and is on this account 
 used. as an ingredient in pastiles, and some people smoke a little of 
 it along with tobacco. The dose of cascarilla, in powder, is from 
 
518 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 ten to thirty grains ; and the dose of the infusion, which is the best 
 method of using it, is from two to four table- spoonsful. " Take of 
 cascarilla bark, bruised, an ounce and a half; boiling water a pint; 
 macerate for two hours in a vessel lightly covered, and strain." 
 
 CASSIA. {Cassia fistula.) 
 
 The cassia tree is cultivated in Jamaica, and its pods, which are 
 about a foot and a half to two feet in length, are imported into this 
 country from the West and East Indies. The pulp of the pods 
 mixed with manna, pulp of tamarinds, and syrup of roses, form the 
 confection of cassia of the pharmacopoeia, which acts gently as a 
 laxative, without producing irritation of the bowels or griping, and 
 is therefore well suited for old people and children. It is given in 
 doses of from two drachms to an ounce. 
 
 CASTOR OIL. 
 
 Castor oil is obtained from the seeds of the Palma Christi, a 
 plant which grows in great abundance in nearly all warm climates. 
 Cold-drawn castor oil is brought to this country from the East 
 Indies, where it is prepared by pressing the seeds without the aid of 
 heat. It is of a pale straw-color, possesses very little smell, and its 
 taste, though not strong, is mawkish and disagreeable. The West- 
 India castor oil is prepared by boiling the seeds in hot water, and 
 skimming off the oil as it rises to the surface ; it is of a darker color 
 than the East-India oil, has a disagreeable odor, and is apt to pro- 
 duce griping. The best East-India castor oil acts quickly as a mild 
 purgative, seldom producing griping or constitutional disturbance ; 
 hence it is considered the best purgative in all inflammatory affec- 
 tions of the bowels, in colic, piles, the dry belly-ache of the West 
 Indies, and habitual costiveness. There is no better laxative than 
 this oil for children, and for females during pregnancy. When a 
 person is in the habit of taking purgative medicine, it is in general 
 found necessary to increase the dose ; the reverse of this, however, 
 is the case with castor oil, the doses of which may be gradually di- 
 minished, hence the advantage of it in the treatment of habitual 
 costiveness. In the East Indies it is used externally in the treat- 
 ment of gout and rheumatism, by rubbing it into the parts affected, 
 and then covering them well with flannel. Various plans are adop- 
 ted to cover its nauseous taste ; some take it with warm milk, others 
 prefer it floating in a little spirit. One of the best methods is to 
 beat it up with the yelk of an egg y and then add gradually a little 
 
AND MOST RECENT METHODS OF TREATMENT. 519 
 
 cinnamon or peppermint water, or a little plain water, with two 
 teaspoonfuls of the tincture of cardamoms, to prevent sickness at 
 stomach. It may be given to very young children in the dose of 
 half a teaspoonfuls to two or more teaspoonfuls, according to the age. 
 For a grown-up person the dose is one, two, or three tablespoonfuls. 
 
 CATALEPSY, OE TKAJSTCE. 
 
 Catalepsy is a disease of the nervous system, of an intermittent 
 nature, and recurring in fits at irregular intervals. It is character- 
 ized by the sudden and complete suspension of consciousness and 
 voluntary motion ; the body and limbs retaining, throughout the fit, 
 the position in which they were at the moment of the attack ; or 
 any other position which may be given to them during its course. 
 Females are most subject to this rare and singular disease. Many 
 theories have been proposed to account for its extraordinary symp- 
 toms, but none of them are satisfactory, and its nature remains still 
 unknown. 
 
 Hypochondriacal and hysterical women, and those with irritable 
 nervous systems, appear to be most predisposed to this disease. 
 Habitual melancholy, religious enthusiasm, love, great anxiety, ex- 
 treme sorrow, and other passions which act strongly on the nervous 
 system, are supposed to be predisposing causes. The immediate 
 exciting causes are anger, terror, sudden fright, or any strong men- 
 tal emotion. In some instances it would appear that catalepsy de- 
 pended, at least to a certain extent, upon irritation of the brain or 
 spinal marrow, a deranged state of the stomach and bowels, ob- 
 struction of the menstrual discharge, and other irritating causes ; 
 but individuals have been affected with it in whom no other dis- 
 ease could be detected, though in the majority of cases it seems to 
 have been intimately connected with hysteria. It is not a danger- 
 ous disease, but there is reason to believe that in some instances in- 
 dividuals have been buried while in a cataleptic state. 
 
 TREATMENT OF CATALEPSY. 
 
 This disease is so very rare that the treatment may be dismissed 
 in a few words. 
 
 There is no specific for the disease. During the attack little or 
 nothing needs to be done. The patient who is subject to attacks of 
 catalepsy should receive tonic treatment — outdoor air, sunlight, 
 nourishing food, plenty of sleep ; and internal tonics, such as iron, 
 strychnine, quinine. 
 
520 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 General electrization would probably be useful in such cases. 
 (See Nervous Diseases and General Electrization}) 
 
 CATAEEH OF THE NOSE, OE EHINITIS.* 
 
 For the past ten or fifteen years there has been scarcely any 
 disease (excepting, perhaps, the venereal) that has brought in so rich 
 and abundant a harvest to charlatans as the inflammations of 
 the nose and pharynx. Gentlemen who in all other matters are 
 prudent, judicious, and reliable, suffer themselves to be robbed in 
 purse and health, if not in life, in order to win a doubtful chance 
 of being; relieved of lon^-standino; " catarrhs " at the hands of those 
 who do not even desire to comprehend the simplest principles of 
 pathology. 
 
 But that good and true citizens are thus deceived, is rather the 
 fault of the profession than of themselves. In the desperation of 
 self-defence, they are compelled to consult those for whose attain- 
 ments or principles they have no respect. 
 
 Although rhinitis is not usually absolutely painful, it is yet in 
 many cases intensely harassing, and embitters existence far more 
 than very many diseases that have called forth the best energies of 
 the profession. It has been stated that rhinitis is a very frequent 
 form of disease. It might be said with propriety that it is univer- 
 sal. Neither sex and no age is free from liability to attacks of acute 
 rhinitis, and at least a majority of those who dwell in our northern 
 climate are affected more or less, at some time of their lives, with 
 the sub-acute or chronic form, though it may not necessarily be so 
 severe or long continued as to call for treatment. 
 
 Causes. — The one great cause is, of course, exposure to cold. 
 Sitting in a draught of air, premature removal of the under-cloth- 
 ing, wetting the feet, and all the various circumstances that con- 
 spire to close the pores of the skin, may bring on an acute attack 
 of rhinitis within a few hours. 
 
 In the vast majority of cases these attacks pass off either with 
 or without treatment, leaving behind no unpleasant consequences. 
 
 But oftentimes one cold follows so closely after another, that the 
 mucous membrane of the nasal passages does not have time to re- 
 cover its normal condition. Consequently it becomes weakened by 
 repeated attacks, and the inflammation may take on the sub-acute 
 form. 
 
 This in turn may pass away, leaving the mucous membrane, 
 
 * These remarks on Catarrh of the Nose are mostly taken from my Introduction to 
 TobolcTs Chronic Diseases of the Larynx. 
 
AND MOST RECENT METHODS OF TREATMENT. 521 
 
 however, in a more susceptible state than is natural. But if, on 
 the other hand, the individual be of a scrofulous or delicate habit, 
 with a mucous membrane throughout relaxed and flabby, the in- 
 flammation may very slowly go on to the chronic stage, hastened 
 in its advance by each repeated chill. In those of firm, wiry con- 
 stitutions, however, this chronic stage is not usually reached until 
 after severe and frequently repeated exposure to wet and cold. 
 
 The chief predisposing causes are confinement in over-heated 
 rooms, and the eating and drinking of hot substances. 
 
 Those who labor or idle over registers or near hot stoves, are of 
 necessity more susceptible to rhinitis, as well as to pharyngitis and 
 laryngitis, than those who are more active and more uniformly ex- 
 posed to outdoor temperature. Hot air, continually breathed in 
 against the delicate mucous membrane of the nasal passages, ren- 
 ders it susceptible to acute inflammation whenever the system re- 
 mains chilled for any length of time. 
 
 Exposure to night air is perhaps the most frequent, as well as 
 the most powerful exciting cause o£ rhinitis, and one also that in- 
 terferes with treatment more than almost anything else. Those 
 whose occupation compels them to travel much by night, and par- 
 ticularly the hahitues of late evening amusements, are very liable 
 to suffer from rhinitis, and are very rebellious to any method of 
 treatment so long as they remain unchanged in manner of life. 
 
 Smoking; has Ions; been a stone of stumbling and rock of offence 
 to those afflicted with inflammation of the lining membrane of the 
 air-passages. Hot smoke has a far more locally relaxing tendency 
 than hot air, and when the two are combined, as always in the act 
 of smoking, the pernicious effects are very marked. A perfectly 
 healthy nose and pharynx, in an adult, is quite hard to find, and in 
 habitual and excessive smokers there is always evidence of more or 
 less chronic inflammation of these parts. Tobold is of the opinion 
 that sitting in a room where much smoking is going on is more 
 injurious to chronic laryngitis than the act of smoking. If this be 
 true (and it is hard to prove or disprove the assertion), then it 
 would seem that fumes of the tobacco smoke were chemically weak- 
 ening to the tissues. 
 
 Hot drinks, including tea, coffee, liquors, unquestionably pre- 
 dispose to rhinitis, by first affecting the mucous membrane of the 
 pharynx. 
 
 The great majority of cases of acute rhinitis, whether accompa- 
 nied with pharyngitis and laryngitis or not, usually recover in a 
 few days, and the patient goes on and forgets that he was ever 
 afflicted. But now and then one attack supervenes on another so 
 
522 
 
 rapidly as to destroy the tone and recuperative power of the mucous 
 membrane, and then the disease falls into the sub-acute, and ulti- 
 mately into the chronic stage. 
 
 As a rule, the light-haired, fair-skinned, and delicate are espe- 
 cially liable to this, as to every other form of inflammation of mu- 
 cous membranes ; and yet some of the most obstinate cases of chro- 
 nic rhinitis I have ever treated have been in vigorous, hard-working 
 men, every way healthy in other respects. Farmers, day-laborers, 
 and outdoor mechanics, with powerful lungs and muscles, and who 
 have every function of every other portion of the body performed in 
 absolute harmony, are often the victims of chronic rhinitis. But, as 
 with nearly all other diseases, this also is more frequently the appa- 
 nage of the poor and oppressed than of the cultivated and wealthy. 
 When it attacks the weakly and scrofulous, it is apt to improve 
 with the bettering of the general condition. Therefore children 
 who suffer from rhinitis in early years often " out-grow it," as the 
 grandmothers say, as they advance to maturity, and the enemy 
 may never again disturb them. Cases, however, that ensue after 
 measles and scarlatina are more likely to run a protracted course, 
 and being always associated with pharyngitis, are sometimes diffi- 
 cult to treat, and the results are not as certain or as speedy. 
 
 But though the heirs of scrofulous parentage are particularly 
 liable to this form of inflammation in all its stages, it has yet to be 
 proved that there is any direct connection between rhinitis, or 
 pharyngitis even, and tuberculosis of the lungs. The plausible 
 idea that the disease will " work down " is a favorite theme with 
 quacks, and is quite universally dreaded by the masses. But it is, 
 I think, untenable. Pulmonary tuberculosis is very often associ- 
 ated with rhinitis, just as it is with conjunctivitis, but it is no 
 more a consequent in one case than in the other. 
 
 What the issue will be in any given case, if entirely let alone, 
 it is impossible to predict, for the disease seems to be a law unto it- 
 self. I have known quite severe cases to recover, absolutely and 
 permanently, without any treatment whatever, even in persons of 
 delicate and susceptible constitutions. 
 
 Sometimes there appears to be a metastasis of the affection. I 
 have very recently treated a case of acute rhinitis, from which the 
 patient had often suffered, and always apparently as a metastasis 
 of rheumatism in the ankles. 
 
 It may remain stationary for years, or slowly grow worse and 
 worse, until in old age it becomes at once incurable and intolerable. 
 
 But, after all, the chief thing to be dreaded in rhinitis is the ex- 
 tension of the inflammation into the upper part of the pharynx, 
 
AND MOST RECENT METHODS OF TREATMENT. 523 
 
 and from thence through the Eustachian tube into the middle ear, 
 with the long train of pathological results — obstruction of the tubes, 
 chronic inflammation of the middle ear, sinking in of the mem- 
 brana tympani — and the invariable consequence, permanent hard- 
 ness of hearing. For this reason, if for no other, the attention of 
 physicians should be directed to rhinitis and pharyngitis at their 
 incipiency ; and these very serious results should be forestalled by 
 appropriate treatment. 
 
 After the mucous membrane of the nose has been once affected 
 by chronic inflammation, and has been well cured, it will ever 
 afterward be more or less susceptible to acute or sub-acute attacks, 
 however careful or judicious the treatment may have been. 
 
 The treatment of catarrh of the nose consists in the application 
 of very weak solutions of chlorate of potash, carbolic acid, LugoVs 
 solution, iodine and glycerine, tanni and glycerine, permanganate 
 of potash, and nitric acid, or other similar substances, by means of 
 the nasal syringe and nasal douche. (See Syringe and Nasal Douche}) 
 
 No two cases can be treated exactly alike. The special remedy 
 to be used and the strength of the solution must be determined by 
 the progress of the case. Every family should know that for recent 
 acute attacks chlorate of potash is almost a specific. Those who 
 have no douche at hand can snuif of weak solutions of chlorate of 
 potash through the nostrils several times daily, whenever they have 
 a bad cold in the head. 
 
 Common salt is also a good remedy. The patent u snuff s " are 
 rarely of service. Long-standing cases of catarrh cannot be cured 
 in this way, but will need persevering treatment with the other 
 substances mentioned above. In ordinary cases nothing is gained 
 by using painful applications. 
 
 Some cases of chronic catarrh may be complicated with some 
 morbid growth or other serious disease of the nostrils. Those who 
 are so affected should obtain surgical advice. 
 
 Those cases that are accompanied by very offensive discharge and 
 bad breath are susceptible of treatment, and may obtain much relief. 
 
 CATECHU. 
 
 Catechu is produced from a species of acacia, which grows in 
 various parts of India. It is an excellent and very powerful astrin- 
 gent, and is frequently used for the purpose of stopping purging, 
 when there are no inflammatory symptoms present, in combination 
 with chalk mixture and laudanum. It is given to check gleet, 
 whites, discharges of blood from the bowels and womb, and all im- 
 
524 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 moderate discharges when not attended with inflammation. The 
 dose of the powder is from ten grains to a drachm. 
 
 CAYENNE PEPPER, OE CAPSICUM. 
 
 Cayenne pepper is more used as a condiment to food than medi- 
 cinally ; it promotes digestion and prevents flatulence. The natives 
 of warm climates, who live principally on vegetable food, mix with 
 it a large quantity of the various kinds of capsicum, to promote di- 
 gestion and give tone to the stomach ; and this diet appears much 
 better suited for those climates than the rich and stimulating dishes 
 
 JO 
 
 of animal food, with wine and spirituous liquors, on which Europe- 
 ans generally live. The former kind of aliment appears intended 
 by nature for the inhabitants, of hot climates, since, without being 
 either too exciting or irritating, it allows them to resist the action 
 of malaria, or the effluvia from decaying vegetable and animal 
 matter ; and to avoid the fevers, dysentery, and other inflammatory 
 diseases which cause the death of so many, in consequence of their 
 indulging in the latter mode of living, which disposes to those dis- 
 eases, and also renders them more frequently fatal than they other- 
 wise would be. 
 
 Capsicum is at present extensively cultivated in Europe, and as 
 it is now understood to possess all the virtues of the oriental spices, 
 without producing any of their bad effects, has in a great measure 
 superseded their use. In fact there is at present no other stimulat- 
 ing vegetable substance so much in use in the seasoning of food as 
 this; it is extensively used in the preparation of pickles ; and vine- 
 gar which has acquired a sufficient degree of pungency from the 
 pods of the bird-pepper (Chili vinegar), is considered the most 
 wholesome and one of the most agreeable things that can be used 
 with all kinds of fish. 
 
 From a drachm to two drachms of the tincture of capsicum, with 
 half a pint of water, form an excellent gargle for malignant sore 
 throat ; and Chili vinegar diluted with water is also used in the same 
 manner in relaxed sore throat, with elongation of the uvula. Poul- 
 tices of the bruised pods of capsicum are much employed in the 
 West Indies, instead of mustard poultices ; they are equally power- 
 ful, and not so apt to blister the parts. Cayenne pepper with 
 brandy, in strong doses, frequently repeated, is the best remedy that 
 can be used for the purpose of counteracting the effects of the pow- 
 erful narcotic poison from the land crabs of the West Indies. Cay- 
 enne pepper is sometimes used along with the preparations of iron, 
 when there is obstruction of the menstrual discharge ; and it is also 
 
AND MOST RECENT METHODS OF TREATMENT. 525 
 
 used as a tonic in scrofulous and other chronic cases. It is more 
 used as a medicine in tropical than in temperate climates. The 
 dose of the powder is from six to ten grains, made up in pills ; and 
 that of the tincture is from ten drops to a drachm, in barley-water. 
 The tincture is prepared thus : " Take of capsicum, bruised, five 
 drachms ; proof spirit, a pint ; macerate for fourteen days, and 
 strain." It is good in sea-sickness. (See Sea-sick?iess.) 
 
 CHALK. 
 
 Chalk is principally employed in medicine for the purpose of 
 checking purging, from acidity in the stomach and bowels. It is 
 mild in its action, and well suited for children. The dose of pre- 
 pared chalk in powder is from fifteen to thirty grains, but it is 
 usually given in the form of the chalk mixture. " Take of prepared 
 chalk, half an ounce ; sugar, three drachms ; mucilage of gum 
 arabic, an ounce and a half; cinnamon water, eighteen fluid ounces; 
 mix. The dose is from two to four tablespoonfuls every three or 
 four hours." The compound powder of chalk is used for the same 
 purpose, and is prepared as follows : " Take of prepared chalk, a 
 quarter of a pound; cinnamon, two ounces; tormentil and gum 
 arabic, of each an ounce and a half; long pepper, a quarter of an 
 ounce ; rub them separately to a very fine powder, then mix them. 
 Dose from five to thirty grains." The utility of these preparations 
 of chalk is increased by giving along with them a little laudanum, 
 catechu, or kino. 
 
 CHAMOMILE FLOWERS. 
 
 Chamomile is an excellent stomachic, and is one of the best pop- 
 ular remedies in common use. Those who sutler from heartburn, 
 flatulency, loss of appetite, and other symptoms of indigestion, may 
 find much benefit from cold chamomile tea, with a little powdered 
 ginger, taken early in the morning. The cold infusion, which i3 
 the best and most agreeable way of using it as a tonic, is made 
 with half an ounce of the flowers to a pint of cold water. If the 
 warm infusion be preferred, care should be taken in prepar- 
 ing it not to allow the flowers to remain with the water longer 
 than ten minutes. When there is nausea in consequence of the 
 stomach being overcharged with food, a strong infusion of cham- 
 omile taken warm acts as an emetic ; and it is often given to assist 
 the action of other emetics. The flowers steeped in hot water and 
 wrapped in flannel retain the heat a long time, and are therefore 
 very useful as a fomentation. The extract of chamomile is service- 
 
526 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 able as a tonic, in doses of from eight to sixteen grains : it is usually 
 combined with a little myrrh and a preparation of iron. 
 
 CHEMICAL FOOD. 
 
 Of late years use has been made of lime and phosphorus in 
 the form of " chemical food," as it is termed. It is given on the 
 theory that the system sometimes needs these substances in greater 
 quantity than they can be obtained in ordinary food. The question 
 is not yet settled in the profession whether the system can be 
 well nourished by giving these pure chemicals. It is supposed by 
 some that phosphorus, iron, lime, &c, can only be assimilated 
 when they are given in organized substances. 
 
 Prof. Horsford has popularized a method of bread-making which 
 gives more phosphorus to the flour during the preparation. (See 
 Bread, under Food.) 
 
 CHICKEN-POX. 
 
 This disease has been so seldom met with in grown-up people, 
 that it may be considered as peculiar to children. It is a disorder 
 of very little importance, though at the commencement it is often a 
 source of considerable uneasiness to parents, who think that their 
 children have caught small-pox; and indeed it is sometimes no easy 
 matter to distinguish chicken-pox from the mild or modified small- 
 pox, so frequently observed since the introduction of vaccination. 
 
 The eruption of chicken-pox generally makes its appearance 
 without symptoms of fever, though it is not unfrequently preceded 
 by headache, drowsiness, foul tongue, sickness at stomach, and 
 slight increase in the heat of the skin and quickness of the pulse ; 
 but these symptoms seldom continue longer than twenty-four hours. 
 The. eruption is generally first observed either on the breast, or all 
 over the body, at the same time. The pocks are distinct, irregular 
 in shape and size, though for the most part they are oblong, or of 
 an irregularly circular form, and vary from the size of the head of a 
 pin to that of a split pea. They are filled, on the first day of their 
 appearance, with a clear inodorous fluid, are accompanied with a 
 sensation of itching, and there is a red margin round the base of 
 each. On the second or third day, the pocks or vesicles, which are 
 formed merely by the elevation of the scarf-skin, begin to burst of 
 their own accord, or are broken ; and on the third or fourth day 
 the fluid in those that remain entire acquires a straw-colored appear- 
 ance, and soon dries up, leaving crusts which crumble away gra- 
 
AND MOST RECENT METHODS OF TREATMENT. 527 
 
 dually, or fall off in scales about the fifth or sixth day, without 
 leaving pits or any other appearance, except a little redness, which 
 soon disappears. It ought to be remarked, however, that all the 
 eruption does not come out at the same time ; there are successive 
 crops of vesicles, and while some are just appearing, others are in 
 a state of maturity, and at the same time crusts may be here and 
 there observed. During the progress of the eruption the general 
 health is little or not at all affected, the sleep is not disturbed, nor 
 the appetite impaired. 
 
 Chicken-pox cannot be propagated by inoculation. It is quite 
 independent of small-pox and vaccination, and may come on before 
 or after them, nor does it in the slightest degree interfere with the 
 regular progress of cow-pox. 
 
 Chicken-pox is a disease of so mild a character that it cannot 
 easily be mistaken for small-pox, which is a very serious, and fre- 
 quently a fatal disease. It may be well, however, to point out the 
 difference between it and the mild or modified small-pox, with 
 which it is more likely to be confounded. There is little or no 
 fever before the appearance of chicken-pox ; the skin round the 
 pocks is red ; they are filled with a clear fluid on the first day of 
 their appearance ; and they have neither a hardened base nor cen- 
 tral depression, and, when punctured, they fall to the level of the 
 surrounding skin. In modified small-pox there is always fever, 
 accompanied with severe headache, and sometimes delirium, during 
 at least forty-eight hours before the eruption, which appears first on 
 the face in the form of hard pimples, surmounted with small circu- 
 lar vesicles, containing matter, and depressed in the centre. The 
 scabs or crusts are always considerably raised above the level of 
 the skin, and when they fall off leave small hard swellings, which 
 disappear slowly. There is still another distinction between small- 
 pox and chicken-pox : the former, whether modified or not, is 
 highly contagious ; whereas the latter is not considered to be so. 
 
 Treatment. — This disease is of so harmless a character that it 
 may be safely left to nature. A little castor oil, or rhubarb and 
 magnesia, may be given if the bowels be constipated, and the patient 
 should not be allowed to eat animal food for a few days. 
 
 CHAPPED HAXDS. 
 
 Chapped hands are very common and very disagreeable. At cer- 
 tain seasons of the year when high winds blow, some persons are much 
 annoyed by chapping and cracking of the hands, lips, and fingers. 
 
 The treatment of this affection is very simple. Use compound 
 
528 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 tincture of benzoin, glycerine, equal parts, one, two, or three 
 times a day, as may be convenient. Glycerine alone will answer. 
 If we make the application but once a day, let it be before retiring. 
 
 CHILBLAINS. 
 
 Chilblain is a name given to a species of inflammation which 
 arises from exposure to a severe degree of cold. The parts most fre- 
 quently attacked by it are the fingers and toes, particularly the 
 little finger and little toe, and the heels ; the extremity of the nose, 
 the tips of the ears, and the cheeks are also sometimes affected with 
 it. A chilblain, in the first or mildest degree, is neither accompa- 
 nied with pain nor heat, unless the part affected be kept near the 
 fire, or be influenced by the atmosphere of a warm room, and then 
 it becomes only a little warmer than natural, with a peculiar sen- 
 sation of itching and tingling, which is troublesome and disagreea- 
 ble, though it cannot be called painful ; but there is always more 
 or less swelling of the part, and the skin has a livid or purple color. 
 In the second degree of this affection there is considerable heat, 
 pain, and swelling, and these symptoms are occasionally so severe 
 as to deprive the person of the use of the parts ; the hands of young 
 ladies, for example, are sometimes so swollen and painful that they 
 cannot write or play on the piano-forte; and, in fact, are for a time 
 rendered incapable of doing anything requiring the free use of the 
 joints. In the third degree, little vesicles or blisters rise on the 
 surface of the chilblain, which break and discharge a thin brown- 
 ish-colored fluid. A raw surface is thus exposed, and sores are 
 produced which give out an acrid matter that irritates the sur- 
 rounding parts ; and the ulceration, if not checked, penetrates 
 deeply, and destroys the soft parts, even as far as the bones. 
 
 Children, females, delicate individuals with fair complexion and 
 tender and irritable skin, and those of a scrofulous habit of body, 
 are most liable to chilblains. They are frequently brought on by 
 the bad habit of sitting near the fire immediately after coming out 
 of a frosty atmosphere, with the feet and hands benumbed from 
 cold ; and they are just as likely to be produced by quitting a warm 
 apartment suddenly and going out into the cold air, particularly if 
 the feet and hands happen at the time to be slightly moist from 
 perspiration. 
 
 Treatment. — Stimulating applications are found to be the most 
 efficacious in curing chilblains. One of the best liniments in gene- 
 ral use is composed of an ounce of camphorated spirit of wine, 
 mixed with half an ounce of Goulard's extract. Mercurial oint- 
 
 
AND MOST EECENT METHODS OF TREATMENT. 529 
 
 ment spread on lint, or on a piece of soft linen rag, is an excellent 
 application when the skin is not broken. Lunar caustic is much 
 employed in the following manner. The chilblain, having been 
 first moistened with a wet towel or handkerchief, is to be gently 
 rubbed two or three times with a piece of caustic, which gives the 
 skin, in the course of a few minutes, first a white, and shortly after- 
 wards a dark brown color. Care, however, must be taken not to 
 make the part too moist before applying the caustic, which should 
 not be used more freely than is really necessary. This plan of 
 treatment is not attended with pain, and when properly managed 
 generally effects a cure in the course of a few days. Tincture of 
 iodine, prepared by dissolving a drachm of iodine in three ounces 
 of rectified spirit of wine, is, perhaps, the best remedy for this trou- 
 blesome complaint which has yet been tried. It. should be used 
 only once a day, and applied gently over the part with a soft 
 brush. Carbolic acid may be tried in weak solution. 
 
 The proper treatment for broken or ulcerated chilblains is, in the 
 first instance, to apply warm poultices of bread and milk, or linseed- 
 meal, which are to be discontinued after two or three days, and the 
 tincture of iodine applied. The ulcers, and all the discolored skin 
 surrounding them, are to be moistened with it once a day, and then 
 dressed with basilicon ointment spread on lint or on a piece of soft 
 linen rag. Lunar caustic, in the proportion of from five to ten grains 
 to the ounce of water ; and a drachm of red precipitate, mixed with 
 an ounce of basilicon, are useful dressings for broken chilblains. 
 When the sores assume a healthy appearance and begin to heal, these 
 stimulating applications must either be made very much weaker or 
 discontinued altogether, and basilicon or any simple dressing substi- 
 tuted for them. 
 
 Persons whose feet and hands become chilled and benumbed from 
 exposure to a moderate degree of cold, should avoid sudden vicissi- 
 tudes of heat and cold as much as possible ; they should take- regular 
 exercise in the open air, having the extremities of the body well 
 protected by warm clothing ; and if those parts should become 
 chilled from exposure to cold, care ought to be taken to restore the 
 heat gradually by friction, by means of warm water or otherwise, 
 and not to expose them to the fire or to sudden heat. Those who are 
 subject to chilblains should take care, after washing the hands and 
 feet, to dry them properly, and not leave them in the slightest degree 
 moist ; and during the winter months they should avoid washing 
 the hands in cold water. Bathing the feet and hands every night in 
 warm -water, with some common salt dissolved in it, is one of the 
 best means of preventing chilblains. 
 34 
 
530 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 CHLOKATE OF POTASH. 
 
 This remedy is of recent introduction, and is of very great value. 
 
 For acute inflammations of the mouth and throat it is almost a 
 specific. In salivation from the abuse of mercury it is also excellent. 
 In ulcers of the tongue and mouth, for sore gums, it is, perhaps, the 
 best remedy we have. In acute colds in the head, accompanied by 
 profuse discharge, or a sense of stoppage — what is known as coryza, 
 rhinitis, cold, catarrh — it is a specific. It should, in such cases, be 
 injected into the nares with a posterior nasal syringe. 
 
 When given internally, it is believed to impart oxygen to the 
 blood. 
 
 Doses. — It may be given in doses of from five to thirty grains 
 dissolved in hot water, before meals. The solutions for gargling 
 the throat or injecting the nasal passages may be of almost any 
 strength — say, one teaspoon ful to one tumbler of tepid water. 
 
 CHLOROFORM. 
 
 This fluid was discovered at about the same time by Mr. 
 Guthrie, of Sackett's Harbor, N. Y., and Soubeiran, of Paris, in 
 1832. 
 
 In 1847 Dr. Simpson, of Edinburgh, first used it as a substitute 
 for aether. In a short time it became known all over the world. 
 It has some advantages over ether. 
 
 1. It is more rapid. It will sometimes produce insensibility in 
 a few seconds. 
 
 2. It is more effectual. It succeeds after aether and laughing- 
 gas have failed. 
 
 3. Its odor is less disagreeable. 
 
 On the other hand it is more dangerous than aether. Neither 
 of them should be given to patients except by a competent physi- 
 cian, or by one who is practically familiar with their effects and 
 the rules for their administration. When a sea-captain or miner is 
 compelled to use some agent to benumb sensibility, he should by 
 all means prefer aether. 
 
 Many deaths — certainly several hundred — have happened from 
 the use of chloroform, even in the hands of skilful physicians. 
 
 It is believed by some that the mortality after surgical opera- 
 tions is greater since the introduction of chloroform than before. 
 The question is a difficult one to decide. 
 
 Chloroform is given in childbirth with very good results. 
 
AND MOST RECENT METHODS OF TREATMENT. 531 
 
 When it began to be used for this purpose it met with silly and 
 absurd opposition, on the ground that the Bible enjoined that 
 woman should bring forth children in sorrow. It was wickedly 
 claimed that woman ought to suffer all the pains that were sent 
 upon her. This monstrous and criminal doctrine was proclaimed 
 not only by fools and idiots, but by men who on other subjects 
 were entirely rational, and even by physicians. Chloroform or 
 aether, when skilfully given, affords great relief in the agonies of 
 childbirth, and by many practitioners is used almost habitually. 
 
 No case of death from the use of chloroform at childbirth is 
 on record. Two ladies, however, died while inhaling chloroform 
 on their own responsibility, during the absence of the physician. 
 It is claimed by some that chloroform at childbirth produces " ex- 
 haustion, hemorrhage, fever, and inflammation and cerebral dis- 
 turbance." On this question professional opinions vary. 
 
 Chloroform is also given in locked-jaw, in asthma, in convulsions, 
 in St. Vitutfs dance, in delirium tremens, in neuralgia, in toothache, 
 in sleeplessness, and in all the forms of pain. 
 
 It is at best a dangerous agent. It should only be used when 
 necessary, and when aether fails. Neither of them should be taken 
 habitually. Neither of them should be inhaled by any one alone, 
 without a responsible attendant. Even a physician cannot with 
 safety use the agent on himself. The risk is too great. Deaths 
 are continually occurring from carelessness in the use of these 
 agents. 
 
 If we must use aether to relieve our headache, neuralgia, or other 
 pain, let it be administered by some responsible attendant, if a physi- 
 cian cannot be obtained. 
 
 If bad symptoms occur — pallor, suspension of breathing— use 
 artificial respiration as directed in the chapter on surgery, electri- 
 city through the chest and neck, and dash cold water on the head. 
 
 Doses. — Chloroform is best given by a handkerchief formed 
 like a funnel, so that* the patient may breathe common air at the 
 same time. The dose varies with the temperament. In midwifery, 
 neuralgia, simple insensibility is all that should be attempted. This 
 may be accomplished oftentimes by a few drops of chloroform. In 
 surgical operations the patient must be made unconscious. From 
 one to four or five drachms is sometimes necessary. 
 
 Chloroform is given internally for a large variety of diseases, 
 but not with uniform success. It is also applied locally for neur- 
 algia, sprains, &c. 
 
532 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 CHEOMIC ACID. 
 
 Tins acid has been recently substituted for nitric acid and nitrate 
 of silver. It is frequently applied to the womb, for the cure of in- 
 flammation and ulceration. 
 
 It must be applied with care, by means of a glass rod. 
 
 CHOLEEA. 
 
 Cholera is generally divided into two species — cholera morbus, 
 and the Asiatic cholera. 
 
 Cholera morbus occurs in every country and at all seasons of 
 the year, though it is most common in warm climates, and when 
 the heat is greater than usual. It generally commences with griping 
 pains in the belly, and sickness at stomach ; and these symptoms 
 are soon followed by frequent vomiting and purging. The food in 
 the stomach is first discharged; then a fluid, varying in color, but 
 always containing bile, is thrown up in great abundance ; the evac- 
 uations from the bowels also contain bile, and are voided with 
 considerable straining, heat, and pain at the lower bowel. There is 
 at the same time a violent pain at the stomach ; and the belly, and 
 in some cases the calves of the legs, are contracted by strong spasms, 
 which recur at short intervals, accompanied with great pain. These 
 distressing symptoms are attended with much anxiety, restlessness, 
 and a sensation of burning heat at the stomach, with urgent thirst 
 and severe headache ; and the pulse, which is at first full and rather 
 quicker than natural, becomes feeble and rapid as the disease pro- 
 ceeds ; and the patient's strength diminishes. In ordinary cases 
 these symptoms abate of their own accord, or are checked by the 
 assistance of remedies in the course of a few hours, or they may 
 continue during two or three days, and then cease gradually. But 
 in the more severe cases the symptoms acquire a more alarming 
 character. The vomiting and purging become almost constant, and 
 the matter vomited is sometimes watery, frothy, or slimy, and only 
 occasionally mixed with bile ; but that fluid in a highly acrid state 
 forms always a part of the discharge from the bowels, and this 
 appears to be one of the most marked distinctions between the com- 
 mon and the Asiatic cholera, in which the stools do not contain bile. 
 The body and limbs are covered with cold sweat ; the muscles of 
 the belly are frequently contracted, and drawn into knots by violent 
 spasms, which also attack the legs, the thighs, and even the hands 
 and arms. If the progress of the disease cannot be arrested, the face 
 
AND MOST BECENT METHODS OF TREATMENT. 533 
 
 soon becomes deadly pale, shrunk, and expressive of the greatest 
 pain. The eyes appear sunk in their orbits. The extremities of the 
 body become cold, and the pulse weak and intermitting. Sometimes 
 the patient recovers even after the disease has advanced to this 
 extent ; but in general the strength diminishes rapidly, frequent 
 faintings, laborious breathing, arid hiccup supervene ; and death is 
 then inevitable. If from the unaided efforts of nature, or from the 
 judicious use of medicine, the stage of collapse or sinking, which has 
 just been described, be prevented, the symptoms, after a longer or 
 shorter period, varying from six to forty-eight hours, usually abate 
 suddenly, and not in the gradually decreasing manner in which 
 recovery takes place from inflammatory diseases ; the skin assumes 
 its natural warmth ; the pulse becomes more full and less frequent ; 
 the vomiting, purging, and cramps cease ; and the patient, though 
 very weak, remains quiet, and free from pain. No disease reduces 
 the strength so quickly as cholera, nor is there any other of so 
 violent a character from which recovery is so rapid. Convalescence, 
 however, when proceeding in the most favorable manner, is often 
 abruptly terminated by the imprudence of the patient, who, finding 
 himself completely rid of the disease, and his appetite again in full 
 vigor, indulges in eating animal food, and in consequence all the 
 symptoms are reproduced, and soon become less manageable than 
 before ; or inflammation of the stomach and bowels comes on, which 
 supervening on cholera, generally runs on to a fatal termination in 
 spite of the best conducted treatment. 
 
 Cholera morbus has always been observed to be most prevalent 
 when the weather is hot during the day, and cold and moist at night ; 
 and the frequency of its occurrence as well as its severity appear to 
 depend on the degree of heat and humidity of the atmosphere. 
 
 Cholera morbus is easily distinguished from other diseases by the 
 sudden manner in which it commences, the quickness of its progress, 
 and abrupt termination. The symptoms arising from swallowing 
 acrid poisons, such as arsenic, vitriol, corrosive sublimate, &c, have 
 in most cases a strong resemblance to those of cholera morbus ; but 
 the burning sensation extending from the throat down the gullet to 
 the stomach, before the commencement of vomiting ; the frequent 
 occurrence of violent vomiting, some hours before the bowels are 
 acted on ; the dark, bloody appearance of the matter vomited ; and 
 in general the absence of cramps ; are signs which sufficiently indi- 
 cate poisoning from irritating substances. 
 
534: DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 TREATMENT OF CHOLERA MORBUS. 
 
 1. Mustard plaster over pit of stomach. 
 
 2. The following prescription : 
 
 Tincture of capsicum, 
 Tincture of opium, 
 Spirits of camphor, 
 Tincture of ginger, equal parts. 
 Give from 20 to 60 drops in water every half hour, until the pain is relieved. 
 
 Or this prescription : 
 
 Tincture of rhubarb, 
 Tincture of ginger, 
 Tincture of opium, 
 Peppermint water, equal parts. 
 Give in same doses as the preceding. 
 
 This treatment alone will usually afford relief in two or three 
 hours. 
 
 3. In the last stages inject into the rectum one ounce of starch 
 and 50 drops of laudanum, and give brandy internally. 
 
 CHOLERA MIXTURES. 
 
 Cholera morbus and Asiatic cholera are continually liable to 
 disturb us. It is well, therefore, to be provided against all the 
 emergencies. 
 
 Of late years various modifications of so-called cholera mix- 
 tures have been used with success. 
 
 One form is this : 
 
 Syrup of ginger, 
 Laudanum, 
 Tincture of capsicum, 
 Tincture of rhubarb, 
 Spirits of camphor, equal parts. 
 Dose from 20 to 60 drops in water every half hour, until relief is afforded. 
 
 Another form : 
 
 Chloroform, 
 Tincture of rhubarb, 
 Spirits of camphor, 
 Laudanum, equal parts. 
 Lose same as for the first. 
 
 The power of these mixtures to relieve the griping and vomiting 
 of cholera morbus is very decided. 
 
 ASIATIC CHOLEEA. 
 
 This disease is said to have commenced in 1817 at Jessore, a 
 town situated near the mouth of the Ganges, about sixty miles from 
 Calcutta. It soon extended throughout the entire province of Bengal 
 
AND MOST EECENT METHODS OF TREATMENT. 535 
 
 and the neighboring territories, and in the course of the following 
 year reached the utmost limits of the Indian peninsula. It devastated 
 China, the Birman empire, and adjacent countries in 1820 ; and in 
 the two following years extended to the numerous islands of the 
 Indian ocean, and also to Arabia, Persia, and the borders of the 
 Mediterranean in Syria. In 1823 it ravaged many towns in the 
 Russian dominions. In 1829 it crossed the Don and the Ural 
 mountains, and appeared in Europe ; at Moscow in 1830, and at St. 
 Petersburg in 1831, and then accompanied the Russian army into 
 Poland. In the same year it pursued its frightful career in Egypt, 
 Austria, Hungary, Bohemia, and Prussia, and in the month of 
 October appeared at Sunderland. In 1832 it continued its de- 
 structive course to London and Paris. In 1833 it crossed the 
 Atlantic, and raged in the United States of America, Canada, and 
 in the island of Cuba, but did not extend to the other West Indian 
 islands. It subsequently visited the south of France, Portugal, and 
 Spain ; and broke out at Naples and Rome in 1837, in wdrieh year 
 it disappeared entirely. More than half of all those who were 
 attacked perished ; and it is supposed to have carried off at least 
 fifty millions of people. It visited the United States in 1832, 1849, 
 1850, 1854, 1865, and 1866. 
 
 The nature of the Asiatic cholera still remains a mystery. 
 Nothing satisfactory has yet been found out with regard to the 
 specific cause, nor has the part of the body in which the disease 
 originated been ascertained ; and whether or not it is contagious is 
 still a question at issue. There is no doubt, however, that people 
 in easy circumstances of life, who have been well fed and clothed, 
 and live regularly, are less liable to it than those who subsist on 
 poor diet and are addicted to drinking spirits. 
 
 This disease in the majority of cases commenced with slight 
 giddiness, a feeling of languor and general debility, an uneasy sen- 
 sation of fulness, heat, and sickness at stomach, flatulent noises in 
 the bowels, and frequent purging, which was the most prominent 
 symptom of the premonitory stage. These symptoms lasted only a 
 few hours in some cases, in others they continued during three or 
 four days; and when they ceased spontaneously or were checked by 
 timely treatment, the disorder was termed by the French cholerine. 
 But it frequently happened that these w r arning symptoms were 
 neglected or could not be arrested, and the disease ran its course; and 
 in many cases the patients without any previous notice were struck 
 down suddenly and died in the course of a few hours. When it 
 came on suddenly the patient was seized with uneasiness or pain at 
 the stomach, quickly followed by retching and vomiting. The con- 
 
536 
 
 tents of the stomach were first thrown up, and then a thin fluid, 
 characteristic of the disease, resembling rice-water, was discharged 
 in great abundance both upwards and downwards. These symptoms 
 were either accompanied or soon followed by a sense of constriction, 
 anxiety, and weight upon the chest; great restlessness; quick and 
 laborious breathing ; and painful spasms beginning first at the fingers 
 and toes, and then extending to the arms, legs, and muscles of the 
 belly, and in many cases to the loins and lower part of the chest. 
 There was a burning sensation at the stomach, and dryness of the 
 throat with great thirst, though the tongue remained cool and moist; 
 and the discharge of urine was entirely suppressed. The strength 
 gave way rapidly ; the pulse became quick, weak, and at times 
 scarcely perceptible ; and the voice was husky, peculiarly plaintive, 
 or almost extinct. As the disease approached a fatal termination, 
 the extremities became cold and shrunk ; the fingers and toes 
 appeared corrugated, as if they had been long immersed in warm 
 water ; the surface of the body was covered with cold sweat ; the 
 eyes were sunk and surrounded with a livid circle ; the face, the 
 hands and feet, and in many cases the whole body, acquired a blue 
 or purple color, and the pulse could no longer be felt at the wrist. 
 When the patient recovered, reaction took place, the heat gradually 
 returned to the surface of the body, all the bad symptoms ceased, 
 urine was again discharged, and bile made its appearance in evacua- 
 tions from the bowels ; but instead of this favorable termination it 
 often happened that reaction was followed by fever, which frequently 
 proved fatal. After death, which generally took place in from six 
 to twenty-four hours, the fingers, toes, and lower jaw were in some 
 instances seen to move ; and even the head was observed to shake, 
 and the legs to approach each other. This extraordinary phenomenon 
 has never been known to follow death from any other disease. 
 
 CAUSES OF CHOLERA. 
 
 The cause of cholera has been a subject of much discussion. 
 The view which is now considerably received is that of Pettenkofer. 
 He holds that cholera spreads through the " rice-w r ater " discharges. 
 It either exists in them or is formed in them. The contagion, 
 therefore, comes from one patient to another through water-courses, 
 above or under ground, and " possibly in the form of dry dust in the 
 air." 
 
 Therefore the stools of patients should be promptly disinfect- 
 ed by chloride of lime, Labarraque's solution, dry earth, peat, 
 sulphate of iron, &c. {See Disinfectants.) The house should be 
 thoroughly fumigated and disinfected. The cellars should be 
 
AND MOST RECENT METHODS OF TREATMENT. 537 
 
 white-washed. Chloride of lime should be placed in pans or 
 saucers in various parts of the house. Chloride of lime, dry 
 earth and peat, &c, should be kept in the privies. All foul cloth- 
 ing should be washed, disinfected, or burned. 
 
 Besides all these general measures, which should be adopted by 
 the city and town authorities and by the master of every household, 
 every individual should see to it that his own health is preserved, 
 by obedience to the acknowledged laws of health. (See Hygiene.) 
 
 Above all things never be frightened, for fear brings on a mul- 
 titude of diseases. 
 
 Every possible precaution for preventing, as well as every proba- 
 ble means of curing the disease, should be familiar to the public as 
 well as to the medical profession. In many parts of the country 
 professional aid cannot be obtained at all ; in other parts a disas- 
 trous delay must necessarily occur. The disease is sudden in its 
 attack, rapid in its progress, and, according to statistics, in one case 
 out of two, fatal in its effects. It is therefore only common wisdom 
 to guard against it by unusual care, and to arrest the first symptoms 
 by a prompt resort to remedies. The following rules, if strictly ob- 
 served, will greatly contribute to personal security, and to check 
 the epidemic : 
 
 1. Let immediate relief be sought in any disorder of the bowels, 
 however slight : the invasion of cholera may thus readily and at once 
 be prevented. 
 
 2. Let every impurity, animal or vegetable, be removed as soon 
 as possible from human habitations. 
 
 3. Let all uncovered drains be frequently and carefully cleaned, 
 and let the grounds around dwelling-houses be so drained as effec- 
 tually to cany off the moisture that otherwise might be in excess. 
 
 4. Let all the rooms of the house be thoroughly ventilated every 
 day when the weather is dry, and let dry scrubbing be substituted 
 for wet. 
 
 5. Avoid exposure to damp and cold, and excessive fatigue. 
 
 6. Let the use of cold drinks and acid liquors, especially under 
 fatigue, or when the body is heated, be avoided. 
 
 7. Avoid the use of cold acid fruits and indigestible vegetables. 
 
 8. Let excess in ardent or fermented liquors, and the use of im- 
 pure water in cooking or drinking, be avoided. 
 
 9. Use a healthy and nourishing diet that will preserve the 
 strength of the body, and enable it to resist as far as possible the 
 attacks of deleterious agents. 
 
 10. Avoid wearing wet or insufficient clothing. 
 
 11. Wear a flannel shirt, or at least a woollen belt around the 
 
538 
 
 belly. This has been found serviceable in checking the tendency to 
 bowel complaints so common during the prevalence of the cholera. 
 
 12. Let personal cleanliness be scrupulously observed. 
 
 13. Avoid every cause tending to depress the moral energies. 
 
 14. Let the crowding of persons within houses or apartments, 
 and sleeping in low, damp rooms, be avoided. 
 
 15. If the weather be moist or chilly, let small fires be kept up 
 clay and night, although out of season for them. 
 
 16. Finally, as every form and variety of indisposition during 
 the prevalence of the epidemic has a tendency to merge itself in the 
 prevailing disease, take immediate steps for relief, whatever may 
 be the nature of the malady with which you are affected. 
 
 RECAPITULATION OF SYMPTOMS OF CHOLERA. 
 
 1. Premonitory diarrhoea. — This is painless and watery. It 
 does not occur in all the cases, but in the majority. It may last 
 an hour, or three or four days. Sometimes the patient dies in a 
 few minutes, but such instances are rare. 
 
 2. Rice-water Stage.— The diarrhoea increases and vomiting 
 comes on. The discharges become of the color of rice-water, and 
 are thrown out with great force. The skin gradually becomes cold. 
 The patient grows feeble. There are cramps in the limbs. 
 
 3. Collapse. — The patient loses his voice, or has what is called 
 the " choleraic voice." His breathing becomes difficult ; his thirst is 
 great. The urine is suppressed ; the pulse disappears ; the skin 
 becomes cold, sunken, and of a blue color. — Death. 
 
 After all this the patient may suddenly recover. 
 The disease may run its course in a few minutes, a few hours, 
 a few days, or in two or three weeks. 
 
 After death the head and fingers and toes sometimes move. 
 
 TREATMENT OF CHOLERA. 
 
 All that we can do for cholera is very simple : 
 
 1. Treat the premonitory diarrhoea by the cholera mixture. 
 (See Cholera Mixture^ 
 
 Let the patient rest. Apply mustard plasters over the abdomen. 
 Give hot foot-baths. 
 
 2. In the rice-water stage this prescription of Prof. Horner is 
 recommended by Hartshorne : 
 
 Chloroform, 
 Laudanum, 
 Spirits of camphor, 
 
AND MOST RECENT METHODS OF TREATMENT. 539 
 
 Aromatic spirits of ammonia. Of each, one teaspoonful and a half. 
 Creosote, three drops, 
 Oil of cinnamon, eight drops, 
 Spirits of Gallic wine, two teaspoonfuls. 
 Dissolve a teaspoonful of this in a wine-glassful of ice-water, and give of that two 
 teaspoonfuls every five minutes, followed each time by a lump of ice. 
 
 Give a little brandy at times, or other stimulants. 
 
 Kub the limbs with brandy or whiskey. Apply mustard-plaster 
 to the pit of the stomach. 
 
 Persevere with all these remedies until the patient either dies or 
 begins to recover. 
 
 The true way to cure cholera is to prevent it. The next lest 
 thing is to cure the premonitory diarrhoza. 
 
 Under our present sanitary regulations, and with our present 
 knowledge of the causes of the disease, we can prevent it much 
 better than formerly. 
 
 It is not probable that in future the epidemics of cholera will be 
 as terrible as they have been in the past. Although we cannot 
 cure it much letter than formerly, we have learned to prevent and 
 control it oy sanitary measures. 
 
 CHOLEKA INFANTUM, OR SUMMER COMPLAINT. 
 
 This disease of the summer and early fall months is almost pe- 
 culiar to the United States, consequently English and French wri- 
 ters give but a very partial and deficient description of this disease. 
 It attacks almost exclusively children between the ages of four and 
 twenty months. 
 
 Causes. — The causes are excessive heat. An unusually warm 
 and moist season will especially favor the production of this disease ; 
 impure air ; insufficient or improper food ; insufficient clothing ; 
 and lastly, the irritation of teething. 
 
 Description.^-The manner of seizure is not always the same. 
 It may commence as a simple diarrhoea, with but few symptoms of 
 derangement of the stomach ; or violent vomiting and purging may 
 suddenly occur. The discharges from the bowels are very variable. 
 They may be thin and watery, but are often mucous and mush-like. 
 The features are anxious and expressive of suffering, sometimes 
 pinched and contracted from the first. The skin is drier than nat- 
 ural, and the extremities cooler. In severe cases they may be cold 
 and blue. The abdomen is usually warmer than natural. The 
 general feverish symptoms increase towards evening. 
 
 .Preventive Treatment. — In a work like this, this division of 
 the subject is of the first and highest importance. It is in the power 
 
540 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 of almost every mother to prevent this ferocious disease. If the 
 child's constitution is originally faulty and feeble, no solicitude how- 
 ever anxious — no care however prudent and skilful — may suffice to 
 ward oif an attack, but it is \k\e preventive plan alone which affords 
 a shadow of hope. 
 
 The gums should be frequently examined, and freely lanced, 
 they giving the first symptoms of irritation. But the most impor- 
 tant measure, without which all others may prove ineffectual, is 
 early removal to a healthy locality. A child predisposed to bowel 
 diseases, if resident of a city, should be sent into the country as 
 early as June. The selection of a proper place is of no slight im- 
 portance. The land should be elevated, the air pure and dry. 
 The vicinities of large fresh rivers, the head of tide-waters where 
 salt and fresh water mingle, and marshy districts, should be avoided. 
 The sleeping-room should be large and airy ; the bed a hair mattress 
 or folded blanket ; cold bath or cold spongings should be used every 
 morning. The child should be taken into the open air every pleas- 
 ant day ; not for a few minutes only, but for hours. The dress 
 should be loose and suitable to the temperature ; a flannel roller 
 should be kept constantly applied to the abdomen. The mother's 
 milk is the child's best food, if the parent is healthy. It is her duty 
 to attend carefully to her own diet, avoiding indigestible substances, 
 crude and raw vegetables, &c- 
 
 TREATMENT OF CHOLERA INFANTUM. 
 
 This is a very severe and fatal disease, and requires great care 
 in its management. If possible, skilled medical advice should 
 always be obtained. 
 
 The general course of treatment is as follows : 
 
 1. Internally should be given a prescription containing aromatic 
 syrup of rhubarb, bicarbonate of soda and prepared chalk, and a 
 very little paregoric. (See Astringents.) The dose must, of course, 
 be regulated by the age and constitution of the child. 
 
 2. Injections of starch and laudanum into the bowels. 
 
 3. If the stomach rejects food, place a little chalk on the tongue. 
 A little of the oxalate of cerium will also check vomiting oftentimes. 
 
 Pepsin in doses of 3 or 5 grains is also excellent for this purpose. 
 
 Subnitrate of bismuth may be used also, either alone or with 
 the pepsin. Recently, Dr. Caro has warmly recommended the bro- 
 mide of potassium for cholera infantum. 
 
 Sometimes, when the bowels are exceedingly loose and intract- 
 able, it may be necessary to inject acetate of lead (two grains to 
 one ounce of starch) into the bowels. 
 
AND MOST RECENT METHODS OF TREATMENT. 541 
 
 To quench the thirst, place hits of ice on the tongue. 
 
 4. To sustain the strength. — The food should be lime-water and 
 milk, farina, arrow-root, beef-tea. A very little brandy may be 
 given with the food. 
 
 Raw oeef scrajped fine has been nsed as food in snch cases with 
 success. 
 
 But after all that we can do the disease is a hard one. It may 
 be necessary to try all the well-known astringents. 
 
 The great thing is a change of air. Keep the child away from 
 the city during the hot months of summer. Cure the disease oy 
 preventing it. 
 
 CLUB FOOT. 
 
 This is a deformity which is very familiar, and need not be 
 described. 
 
 The treatment consists in cutting the tendons of the affected 
 muscles with a " tenotome" and in wearing some form of club-foot 
 apparatus. 
 
 In the hands of a skilful surgeon great benefit results from per- 
 severing treatment. Parents make a great mistake when they 
 suppose that their children will outgrow these or any other 
 deformities. 
 
 CIKNAMOK 
 
 Cinnamon is a medicine seldom given alone, but is much used 
 on account of its vegetable, aromatic, and stimulant properties as 
 an auxiliary to other remedies. Medicines for disorders not of an 
 inflammatory nature are frequently given in cinnamon- water, which, 
 to a certain extent, covers their disagreeable taste and flavor, and 
 tends to prevent sickness at stomach. The best vehicle for the ad- 
 ministration of prepared chalk, in cases of simple purging {diarrhoea), 
 is cinnamon-water. 
 
 The oil of cinnamon, in doses of three or four drops, on sugar, 
 is sometimes given to relieve spasms of the stomach and flatulent 
 colic. 
 
 CITKIC ACID. 
 
 Citric acid is obtained from the juice of lemons and oranges. It 
 is principally used in forming effervescing draughts, and is the best 
 remedy for sea-scurvy when fresh vegetables and lime-juice cannot 
 
54:2 DESCRIPTION OF THE PRINCIPAL 
 
 be procured. A pleasant lemonade is made by dissolving thirty 
 grains or more of citric acid in a pint of water, which is to be 
 sweetened with sugar, and flavored with a drop or two of the es- 
 sential oil of lemons. (See Effervescing Draughts.) 
 
 CITKINE OINTMENT. 
 
 Citrine ointment, which is made with lard and the nitrate of 
 mercury, is used in chronic ophthalmia, specks, and ulceration of 
 the front of the eye. When reduced in strength by an equal quan- 
 tity of olive oil or lard, it is a very efficacious remedy for old 
 sores, scald-head, and various diseases of the skin. Citrine oint- 
 ment, when properly prepared, is of a golden yellow color. 
 
 COLCHICTIM AUTUMNALE, OE MEADOW SAFFKOK 
 
 There is 'no better remedy in gout, rheumatism, and some other 
 inflammatory diseases, than the root and seeds of this plant. When 
 given in moderate doses it soothes the pain, and lowers the pulse 
 without acting as an evacuant; but is an active purgative in large 
 doses. It is a mistake to suppose that this remedy does no good 
 unless it purges. The best manner of administering it is in doses 
 suited to the urgency of the case, so as to produce its sedative or 
 soothing effects without bringing on much purging or nausea. In 
 very severe cases, it is proper to draw blood before using colchicum ; 
 but in general this is not necessary. It should always, however, be 
 preceded by a purgative of calomel and jalap or colocynth. 
 
 The dose of the powered root, in acute cases, is five or six grains 
 every four hours, or oftener, until slight purging is produced ; the 
 doses are then to be gradually diminished. The dose of the tincture 
 of the seeds is twenty drops in a little water, to be repeated every 
 four hours, or at longer or shorter intervals, according to its effects. 
 
 COD-LIYER OIL. 
 
 This is one of the most popular remedies of modern times. It 
 is used as largely as calomel was thirty years ago. Cod-liver oil is 
 obtained from the livers of the common cod. There are three va- 
 rieties of the oil — pale, light brown, and dark brown. 
 
 Cod-liver oil has been used for scrofula, rickets, &c, in Scotland 
 for a long time. In the latter part of the last century it was used 
 at Cologne for chronic rheumatism. It was introduced into Eng- 
 
AND MOST RECENT METHODS OF TREATMENT. 513 
 
 I \ from Germany by Dr. Bennett, and at first, like all good 
 s, encountered opposition. 
 
 is remedy is used chiefly for consumption. It has the power 
 o ducing fat. Its effects vary with different individuals. To 
 
 son it is so very nauseous that they take it with great difficulty. 
 Other, become readily accustomed to it. In what is called rachitis, 
 or soi'tf ning of the bones in children, it is very efficacious. It is used 
 in sere idous enlargements, in some diseases of the slcin, general 
 nervous lelility, but especially in consumption. It increases the 
 weight, Tiiinishes the congh and expectoration, and night-sweat- 
 ing, and 1 , every way improves the nutrition. It is not believed to 
 have any specific effect on consumption, but benefits those afflicted 
 with that disease by improving their nutrition. Although it does 
 not usually cure the patient, yet it retards the progress of the disease. 
 Doses. — Cod-liver oil is best given in the froth of leer, in wine, 
 or in ivhisJcey, in doses of from -J to 2 tablespoonfuls, tw T o or three 
 times a day. It may be injected into the bowels, when necessary. 
 The best time to take it is about two or three hours after meals. 
 
 COLD IN" THE HEAD. 
 
 Although a di^oMe f no great consequence in itself, yet when 
 neglected the inftamn on attending it frequently extends to the 
 mucous membrane of tin • indpipe and air-passages of the lungs, 
 and brings on severe' cough (see Bronchitis); or it may even ter- 
 minate in pleurisy or inflainmatioa of the substance of the lungs. 
 
 To infants, severe cold in the head is very distressing ; the nos- 
 trils being completely obstructed, fchc '';ild : , after sucking a few 
 mouthfuls, is obliged to quit the breast, and returning to it again 
 and again, becomes at length quite exha and perhaps falls 
 
 into convulsions. Catarrh is a common att^F^ant of measles, and 
 frequently accompanies scarlet fever aLd small-p.x. 
 
 TREATMENT OF A COMMON COLD. 
 
 Nothing is easier than to cure a common cold, pre r ' tak# 
 
 it in time. Few things are harder than to cure a common cl> ] 
 has oeen long neglected. 
 
 The first hour after a cold is taken it may readily be cured by 
 anything that restores the warmth and equalises the circulation. 
 
 When you even suspect that you may have taken cold, stand for 
 fifteen minutes with your bade against a hot stove-pipe, or sit with 
 your lack against the fire, in the stove, fire-place, or furnace. 
 
 Our colds enter through the back of the neck and spine more 
 than through the breast, as is commonly supposed. "We must drive 
 
Oitt DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 out our colds by the same door through which they enter. 1 1 
 are a very common cause of cold, therefore it is well to b? i< bl 
 in hot water with mustard, at the same time drinking am King 
 is hot. It is not of so much consequence what we drink as thf/t we 
 should drink it promptly, and in sufficient quantities to open th( pores 
 of the skin that have been closed by the chill. Alcoholic liquors, tea, 
 coffee, herb teas of the various kinds, "composition" powders, and 
 cold water, &c, all are good. 
 
 My own remedy for a common cold is my cold poi> der see >ld 
 Powder). I find it amply sufficient. If used in time, it alnost 
 always breaks the force of a cold, and sets it on the v ay toward re- 
 covery. It opens the pores of the skin in a gentle but most effec- 
 tive manner, promotes sleep, and, when not given in tool Iarg< loses, 
 leaves no unpleasant effects behind. It is a very simj le r. It is 
 
 not unpleasant to the taste. It requires no complica as, no 
 
 profuse sweating, no forcing down of disagreeable packing 
 
 in flannel, and no scalding with hot water ; and, more than all, does 
 not make us liable to take a new cold the next day The following 
 morning after we have taken it we are safe to rise at our usual time 
 and go about our business. (For dose, &c., see Cold Powder.) 
 
 Next to the cold powder I rank the well-known Dover's powder. 
 It is, however, more disagreeable — is, indeed, to many exceedingly 
 nauseous — and is no more effective, and, w T htn given in large doses, 
 is more apt to leave disagreeable effects. 
 
 Formerly Dover's powder was my gi reliance. 
 
 COLD I )ER. 
 
 This is a name that lb iven to a powder that I have for 
 
 some time been accustom to use in colds and catarrhs. 
 
 I obtained the sn*" ion originally from a friend and patient. 
 I regard it as • for a common cold, provided it is given in 
 
 time. The i for making it is as follows : 
 
 Camphor, two parts, 
 Powdered opium, one part, 
 , Carbonate of ammonia, two parts. 
 
 Dissolve the camphor in ether to the thickness of cream, then add 
 •pium and ammonia. I regard this cold powder as much supe- 
 rior to the ordinary Dover's powder, for these reasons : 
 
 1 . It is more efficacious. — It more surely breaks up a cold. 
 
 2. It is more agreeable to the taste. — The ipecac of the Dover's 
 powder is exceedingly nauseous. In this preparation there is no 
 ipecac, and the bitter taste of the opium is disguised by the cether 
 and ammonia. 
 
AND MOST RECENT METHODS OF TREATMENT. 545 
 
 The preparation should be kept in a bottle tightly corked. It 
 should usually be given at night, before retiring. The effect of it 
 is to open the pores of the skin and to produce sleep. Unless an 
 over-dose is given, no bad effects are experienced. 
 
 Dose, from three to six grains in a little water. It should be kept 
 on hand at all times, and should be taken as soon as possible after 
 we become chilled through, or even suspect that we have taken cold. 
 The dose may be repeated the following night. 
 
 COLIC. 
 
 Common colic commences suddenly with griping pain, and a 
 sense of twisting about the navel and lower part of the belly ; and 
 sometimes the whole belly is affected. The pain is not constant, 
 but comes on in paroxysms. The bowels are constipated. There 
 may be slight nausea, and even vomiting. A frequent, though not 
 a constant symptom, is a rumbling noise in the bowels, arising from 
 wind, which sometimes accumulates and distends the belly until it 
 feels quite tense. The disorder is then called Flatulent Colic. In 
 other cases, the belly is drawn inwards towards the spine, and the ab- 
 dominal muscles are sometimes seized with strong spasms, and are 
 drawn into hard knots which feel like balls in the belly. There is 
 no fever ; but, on the contrary, the skin is cool, the pulse generally 
 weaker than natural, and the face bedewed with perspiration. When 
 this affection continues longer than usual, the pulse becomes very 
 feeble, the skin is covered with cold sweat, and the patient some- 
 times becomes so weak that he occasionally faints. Common colic 
 is, however, almost invariably relieved in the course of a few hours. 
 
 This form of colic may proceed from sudden or long exposure to 
 cold, wet feet, hardened or accumulated fseces lodged in the bowels, 
 eating food difficult of digestion, cold drink swallowed too quickly, 
 violent mental emotions, metallic poisons, rupture, and various 
 other causes. It is distinguished from inflammation of the bowels 
 by the absence of fever, and by the pain being relieved on pressure, 
 which always increases it when inflammation is present. It must, 
 however, be remembered that colic occasionally terminates in in- 
 flammation ; there is then pain when the belly is pressed upon, 
 heat of skin, thirst, and quick pulse. 
 
 TREATMENT OF COLIC. 
 
 The course of treatment in colic is — 
 
 1. To empty the stomach, if it should contain any irritating sub- 
 stances. This may be done by giving 15 or 20 grains of ipecac, or 
 35 
 
546 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 a tablespoonful of mustard or common salt, in a cupful of tepid 
 water. Simply tickling the throat with the finger will cause many 
 to vomit, and will much assist those in vomiting who have already 
 taken an emetic. 
 
 2. To relieve pain and spasm. — In order to quiet the horrible 
 griping pains and correct the spasms, place a mustard plaster over 
 the abdomen, or use hot fomentations on the abdomen with flan- 
 nels wrung out in hot water. Give internally chloroform, one-fourth 
 or one-half a teaspoonful, or opium (one-grain pills), or laudanum 
 in the usual doses, until relief is obtained. Sometimes the patient 
 can bear a large quantity of opiates in this affection. 
 
 Colocynth in very small doses has been given with pleasant 
 results. 
 
 The cholera mixture I have often used with success in colic. 
 
 The prescription varies, but the ingredients are these : 
 
 Tincture of rhubarb, 
 Tincture of capsicum, 
 Tincture of ginger, 
 Tincture of opium, equal parts. 
 Dose, from 20 to 60 drops in water every half hour until the pain is relieved. 
 
 Exceedingly small doses of colocynth sometimes afford immediate 
 relief in colic. 
 
 TREATMENT OF BILIOUS COLIC. 
 
 Bilious colic, during the attack, is to be treated in the same way 
 as the ordinary colic. In the intervals measures should be used to 
 prevent the recurrence of the attacks. The patient often needs 
 tonics — air, exercise, sunlight, bathing, quinine, strychnine, phos- 
 phorus, arsenic, &c. 
 
 Bilious colic seems to run in families. When it is thus here- 
 ditary it is sometimes almost if not quite impossible to drive it from 
 the system. Patients often outgrow it, or the disease takes some 
 other form. 
 
 COLIC FROM LEAD, 
 
 This form of colic arises from the action of lead on the body, 
 and occurs principally among house-painters, miners, plumbers, 
 color-grinders, glaziers, gilders, those who are employed in melting 
 lead, and among manufacturers of white lead and other prepara- 
 tions of that metal. It is also caused by drinking wine, cider, 
 spirits, or water containing litharge, or the carbonate or acetate of 
 lead in solution. Lead colic was first traced to its source about a 
 hundred and thirty years ago, in Germany, where it was ascer- 
 
AND MOST RECENT METHODS OF TREATMENT. 54:7 
 
 tained that a custom had long existed of sweetening wines with 
 litharge ; and indeed this pernicious method of adulterating wine 
 is far from being extinct. It is well known, for example, that the 
 sweet wines of Italy are frequently adulterated with sugar of lead. 
 
 This disease seldom commences suddenly. During three or 
 four days, or even longer, before the patient is prevented from at- 
 tending to his work, he experiences a slight degree of numbness in 
 his hands and feet, a dull, uneasy sensation in his bowels, loss of 
 appetite, and sometimes slight purging during a day or two. At 
 length sickness at stomach, headache, acute pain in the limbs, cos- 
 tiveness, and griping pain, with retraction of the belly, come on. 
 These symptoms increase in violence as the disease advances ; the 
 bowels remain obstinately constipated ; the pain in the belly and 
 limbs becomes very severe, and extends to the back, loins, and hips; 
 and, as in common colic, is not constant, but recurs in frequent 
 paroxysms, which are accompanied in many cases with painful 
 retraction of the testicles. The patient lies on his belly, or presses 
 his hands against it ; he tosses about in bed, and is exceedingly rest- 
 less ; and his suffering is so much increased in the night, that he is 
 almost if not entirely deprived of sleep. Vomiting of acrid mucus 
 or bile is not an unusual symptom, particularly when the fits of 
 pain reach their height ; but there are no symptoms of fever. The 
 pulse continues natural, unless in bad cases, when it ultimately 
 becomes quick and weak. The countenance throughout the dis- 
 ease appears sallow, and expressive of acute suffering. It does not 
 often happen that the first attack of painters' colic is either accom- 
 panied or followed by palsy of the limbs ; but in subsequent attacks 
 the hands and arms, and sometimes the feet and legs, are para- 
 lyzed ; and the right arm is more frequently affected in this man- 
 ner than the left. The palsy affects the motion of the limbs only, 
 and not the sense of feeling; and in many cases the paralyzed 
 parts become greatly emaciated. But although this is both a 
 tedious and a painful disease, yet it rarely proves fatal. It lasts 
 generally from eight to ten days, but sometimes much longer, and 
 is very apt to return, from re-exposure to its specific cause. The 
 distinctions already noticed between common colic and inflamma- 
 tion of the bowels are also applicable to colic from lead. 
 
 TREATMENT OF LEAD COLIC. 
 
 Iodide of potassium is the remedy now given for colic which 
 results from poisoning by lead. It combines with the lead, and 
 forms iodide of lead, which is eliminated from the system. It may 
 be given in doses of 5 or 10 grains in gum-arabic water. 
 
548 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 Alum is used for the same purpose, but it is not so good as 
 iodide of potassium. 
 
 Opium may be given to relieve the pain. In lead colic, opium 
 seems to loosen the bowels. 
 
 Electrization is a most excellent remedy for poisoning by lead, 
 and for the paralysis that is caused by it It is of course best 
 adapted for the chronic condition. (See Electricity and General 
 Electrization.) 
 
 COLIC LN INFANTS. 
 
 Infantile colic sometimes comes on in consequence of the reten- 
 tion of the dark matter called meconium, which collects in the 
 bowels during a month or two previous to the birth of the infant. 
 It also arises from too early feeding, improper food, and from the 
 state of the mother's or nurse's milk, which may be deranged in 
 consequence of bad health, an improper manner of living, or from 
 certain moral causes. 
 
 An infant affected with colic is very restless, screams frequently, 
 and appears in great distress. The lower extremities are drawn up 
 upon the belly, the bowels are constipated, there is generally puk- 
 ing, and the belly is either more or less distended. 
 
 Treatment. — Although colic is sometimes caused by meconium 
 being retained and becoming acrid and irritating to the bowel, yet 
 this seldom happens when the mother is able to suckle the infant ; 
 but when a nurse is employed for that purpose, it is by no means an 
 uncommon occurrence. This is owing to the quality of the milk, 
 which, when first secreted, is sufficiently laxative to carry off the 
 meconium.: It is, however, very improper to interfere with the 
 bowels, unless we are certain that it is really necessary to do so ; 
 and yet there is nothing more common than to find nurses forcing 
 castor oil down the throats of infants within half an hour or an hour 
 after they are born ; indeed, this is frequently the first thing they 
 are allowed to taste. The consequence is, that griping and purging 
 are very often brought on ; then a little paregoric elixir is given to 
 soothe the bowels. This of course produces costiveness, to relieve 
 which the nurse deems another dose of castor oil, or perhaps a little 
 calomel necessary ; and thus the poor infants are tormented in con- 
 sequence of the absurd meddling of nurses, many of whom think 
 that they are not doing their duty unless they are frequently em- 
 ployed in closing infants with medicine and feeding them with 
 thick gruel, arrow-root, and other substances which at that early 
 age their stomachs cannot possibly digest ; flatulency necessarily fol- 
 lows ; then come the symptoms already mentioned, indicative of 
 
AND MOST RECENT METHODS OF TREATMENT. 549 
 
 colic. The treatment to be adopted in such cases is very simple. 
 The following injection is to be given as soon as possible : 
 
 Warm water, a wine-glassful, 
 
 Peppermint -water, two teaspoonfuls, 
 
 Castor oil, a teaspoonful, 
 
 Tincture of assafcetida, from ten to twenty drops. Mix. 
 
 This injection usually gives immediate relief; but if it fail in 
 doing so, a small teaspoonful of Hollands gin with a little sugar 
 and warm water, or from eight to twelve drops of the tincture of 
 assafcetida, or the same quantity of sweet spirits of nitre in a small 
 quantity of water, should be given. The warm bath, and rubbing 
 the belly with the following liniment, are to be resorted to if neces- 
 sary : 
 
 Camphor, a drachm, to be dissolved in 
 
 Olive oil, an ounce and a half, 
 
 Laudanum, a drachm. Mix. 
 
 This treatment rarely fails in relieving the little patient, who 
 soon falls fast asleep. The following powder may be given some 
 hours afterwards in sugar and water, or the bowels may be opened 
 by means of a little manna dissolved in warm milk : 
 
 Calcined magnesia, six or eight grains, 
 
 Rhubarb, two grains, 
 
 Anise-seed, in powder, two grains. Mix. 
 
 COLLODION. 
 
 Collodion is a solution of gun-cotton in aether and alcohol. 
 
 It was introduced by Dr. J. O. Maynard, when a medical stu- 
 dent. It is used to protect wounds, and for burns and raw surfaces. 
 It forms a coating over the surface, and protects it from the air and 
 other injurious influences. It is therefore of service for ulcers, 
 carbuncles, in erysipelas, and in various diseases of the skin. 
 
 It is an excellent remedy for domestic use. It should be applied 
 to the raw surface by means of a camel's-hair brush. When it dries 
 a coating is left over the surface. 
 
 COLOCYNTH, OK BITTEE APPLE. 
 
 This plant is a native of various parts of Europe and Africa. 
 The dried fruit, which is the only part of it used in medicine, is im- 
 ported from the Levant. Colocynth is seldom used alone, on ac- 
 count of its violent purgative action ; the preparation of it in com- 
 mon use is the Compound Extract of Colocynth, which is composed 
 
550 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 of the spirituous extract of colocynth, aloes, scammony, cardamom 
 seeds, and castile soap. This compound acts chiefly on the large 
 intestines, and is one of the best purgatives we possess. It is very 
 generally employed to keep the bowels regular, and enters into the 
 composition of nearly all the purgative pills used for that purpose. 
 The dose is one, two, or three pills, containing each five grains. 
 
 CONSTIPATION. 
 
 Constipation is a disease that everyone in this country is familiar 
 with. Very many errors are abroad in regard to it. It is supposed 
 to be the result of mechanical obstruction of the bowels, and that 
 therefore it should be treated by purgatives entirely, and by eating 
 coarse food. 
 
 The truth is this : constipation is a symptom of very many and 
 diverse morbid conditions of the body. In our times it is usually 
 one of the symptoms of nervous derangement. It is a symptom of 
 nervous dyspepsia. When the food is properly digested in the 
 stomach and intestines, and when the nervous system is in a proper 
 condition, the towels will usually he regular, whatever our diet may 
 he. 
 
 Constipation is exceedingly frequent. There is scarcely a fam- 
 ily in the land that is not annoyed by it. This bad condition is 
 brought on by these, among other causes : 
 
 1. Over-work and over-worry of the brain and nervous system. 
 
 2. Hereditary descent. 
 
 3. Bad diet — too much pork and sausages ; too little fruit and 
 fresh beef. 
 
 4. Neglect of the bowels. Every one should go to the water- 
 closet at a regular time, once a day at least, whether they feel dis- 
 posed to do so or not. This is an imperative duty. 
 
 The best time of the day for most persons is shortly after break- 
 fast. 
 
 5. Neglect of physical exercise. 
 
 Farmers' wives and daughters are often sufferers from constipa- 
 tion, because they eat the same food — pork, ham, sausages, cab- 
 bages, etc. — as those laboring actively on the farm, and yet re- 
 main all the time indoors. 
 
 Any cause that injures the system at large may produce consti- 
 pation of the bowels. 
 
 TREATMENT OF CONSTIPATION. 
 
 1. Treat the cause of the constipation. — Cure the nervous dys- 
 
AND MOST RECENT METHODS OF TREATMENT. 551 
 
 pepsia. Strengthen the constitution by the rules already given. 
 Treat the dyspepsia as directed under that disease. (See Dys- 
 pepsia.) If nervous exhaustion is the cause, treat that by all forms 
 of external and. internal tonics — air, sunlight, exercise, water, 
 strychnine, phosphorus, quinine, iron. 
 
 If disease of the liver is the cause, treat that by the principles 
 laid down under that head. 
 
 2. Stop the evil habits that bring on constipation. — Rest the 
 brain. If possible, cease to worry. Take plenty of sleep. Take a 
 change of air. Take occasional and short vacations, for one or two 
 days at a time. Avoid, tight lacing. Use less tobacco, less brandy, 
 less tea, and less coffee, provided you have been accustomed to use 
 any of these substances in large quantities. 
 
 3. Regulate the diet. — Study the rules given under Dyspepsia. 
 Have a variety of food— -fresh meat, vegetables, bread, and fruit. 
 Remember these golden rules — 
 
 1. Food which is best enjoyed is best digested. 
 
 2. Food which is best digested is best for the bowels. 
 
 Do not attempt to live on bran-bread and fruit exclusively. 
 
 If you like Graham bread and fruit, eat them in conjunction with 
 fresh meats, fish, and other palatable varieties of food. 
 
 It is a great error to suppose that constipation is to be cured by 
 mechanically forcing down the fceces by bran-bread, johnny cakes, 
 and fruit. — For weak stomachs — and constipated patients often have 
 weak stomachs — Graham bread, fruit, and Indian bread are usually 
 more difficult of digestion than common white bread and biscuit, 
 and therefore should be avoided. 
 
 Salt pork, sausages, ham, heavy bread of any kind, soggy pies, 
 and cakes produce constipation by first inducing dyspepsia. As 
 a rule, avoid eating very late at night, unless you are exceedingly 
 hungry just before retiring. 
 
 It is hard for an invalid to sleep on a very empty stomach. 
 The best kinds of food to eat just before retiring are oysters — raw or 
 stewed — crackers, white bread and butter, and ripe mellow fruit ; the 
 worst kinds are soggy pies and cakes, nuts, candies, raisins, hard 
 apples, and vegetables. 
 
 4. Cultivate the habit of visiting the water-closet regularly each 
 day at a certain hour. — It is sometimes difficult to do this, especially 
 when visiting among strangers and travelling, but yet it is a duty 
 that we should never neglect. The habit will soon become a second 
 nature. The best time in the day for visiting the water-closet is 
 just after breakfast, or at least before entering on the active duties 
 of the day. 
 
552 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 Persons vary in their habits in this respect. Some maintain 
 their health with two passages daily, others appear to be equally 
 well with one passage every other day. 
 
 5. Exercise the bowels in variety of ways. — Riding on horseback, 
 climbing hills and mountains, the Swedish movements, walking, 
 playing active games, gymnastics, all forms of muscular exercise, 
 and especially those which employ the muscles of the trunk, are to 
 be recommended. We should select those methods of exercise which 
 we love best, and as soon as we get tired of one method try another. 
 
 Kneading the bowels with the hands — the so-called Halstead 
 method — is sometimes of decided service. This method, like " rub- 
 bing" " lifting" etc., is simply a modification of the movement cure. 
 
 6. Use of medicines. — Cathartics are terribly abused. Many 
 patients purge all their strength away. It is quite rarely that 
 patients should take large doses of cathartics for constipation. 
 
 If the preceding measures that 1 have recommended are not suc- 
 cessful, it is best to obtain good medical advice. As I have said, it 
 is well to take powerful cathartics only vei\y rarely, if at all. If 
 medicine is to be taken to act directly on the bowels, some gentle 
 laxative is preferable. 
 
 The common dinner pill is a very good combination. 
 
 The following prescription contains four excellent articles for 
 both indigestion and constipation : 
 
 Podophyllin, 
 Khubarb, 
 Nux vomica, 
 
 Carbonate of soda — equal parts. 
 Make pills of one grain each, and take one at night before retiring. 
 
 It may be necessary to reduce the quantity of podophyllin for 
 those who are very sensitive to this drug. 
 
 The podophyllin acts on the liver ; the rhubarb acts on the bow- 
 els ; thenux vomica gives tone to the stomach ; and the carbonate of 
 soda corrects the acidity. 
 
 But after all it is better that the bowels should be somewhat con- 
 stipated than that they should be continually irritated by drugs. 
 
 Injections of cold water into the bowels in the morning have a 
 tonic effect on the mucous membrane of the rectum, and help to bring 
 away the faecal matter. I think that they may be used without 
 injury for months. But they do not cure the indigestion. They do 
 not remove the cause of the constipation. 
 
 Hard cider is a good remedy for constipation. It does not 
 agree with all patients. It is apt to cause headache. It may be 
 taken at bed-time, or on rising. 
 
AND MOST EECENT METHODS OF TREATMENT. 553 
 
 Seidlitz powders and the mineral waters are sometimes perma- 
 nently useful for constipated patients. It is unfortunate, however, 
 to be compelled to use any such substance habitually. 
 
 General Electrization is the remedy that I have found more use- 
 ful in constipation than any other form of treatment. It should 
 be used skilfully, cautiously, and perseveringly (see General Elec- 
 trization). Its results in constipation are often immediate, and fre- 
 quently permanent. It calms the nervous system, improves sleep, 
 sharpens the appetite, and strengthens the digestion, thus relieving 
 the morbid condition of which constipation is a symptom. 
 
 Besides all this, general electrization acts mechanically on the 
 bowels, in the same manner as horseback riding and the Swedish 
 movements. 
 
 It may be said that it is too much work to go through all these 
 processes and labors ; that it is much easier to gain temporary relief 
 by taking blue pills, calomel, rhubarb and senna, indefinitely, if 
 necessary. I would remind those who feel thus that indigestion 
 and constipation produce piles, headache, diseases of the genital 
 organs in male and female, nervous exhaustion, and oftentimes seem 
 to lead to diseases of the brain and spinal cord. Is it not worth 
 while to prevent these serious conditions ? Will it not be sufficient 
 reward to save ourselves the pain, the distress, the depression, the 
 exhaustion that are sure to result from chronic indigestion and con- 
 stipation unless they are relieved ? 
 
 There are cases of constipation which are of a markedly heredi- 
 tary character, and which will not permanently yield to any method 
 of treatment. Patients who are thus afflicted can, however, save 
 themselves many sorrows by obeying the great laws of health, and 
 by giving special attention to the management of their digestive 
 organs, according to the principles I have indicated. 
 
 (For more extended remarks on constipation, see Dyspepsia and 
 Nervous Diseases.) , 
 
 CONVULSIONS, OE FITS. 
 
 The symptoms of convulsions or fits, especially in children, are 
 very familiar. 
 
 Before the fit comes on the child is often fretful, restless, and 
 perhaps grinds its teeth in its sleep. 
 
 The special symptoms of the attack are : 
 
 1. Twitching of the muscles of the face. 
 
 2. The body becomes rigid, and then is thrown into jerks. 
 
 3. The limbs are rapidly flexed and extended. 
 
554 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 4. The head and neck are thrown backward. 
 
 5. The eyes roll, and have an unnatural appearance. 
 Sometimes a number of attacks rapidly succeed each other. 
 
 CAUSES OF CONVULSIONS. 
 
 Convulsions in children may be caused by worms, by constipa- 
 tion, by teething, by fear, by indigestion, by disease of the brain, 
 by sudden drying up of eruptions on the head, and by very many 
 of the acute and chronic diseases of childhood. 
 
 TREATMENT OF CONVULSIONS. 
 
 1. Ascertain the cause of the convulsions, and treat that. If 
 the gums are swollen, lance them. If the bowels are constipated, 
 open them by an injection of warm water, soap, and molasses. 
 
 2. Apply cloths wet in cold water to the head, and especially 
 to the back of the neck. 
 
 Nearly all forms of convulsions in children and in adults may 
 be cut short sooner by applying cloths wet in cold water, or, better 
 still, ice to the back of the neck, than by making the same applica- 
 tions to the top and front of the head, because the back part of the 
 brain and upper portion of the spine are frequently congested dur- 
 ing the attacks. 
 
 Chapman's ice-bags are very useful in such cases. (See Ice-bags.) 
 As a substitute for the rubber ice-bags we may wrap the ice in a 
 piece of oiled silk, or even a common towel. The ice or wet cloths 
 should not be kept too long on the child, else they may work injury. 
 
 3. Put the child in a warm bath if the cold applications fail. 
 
 4. Apply mustard plasters to the stomach and legs ; cup the back 
 of the neck in desperate cases. 
 
 During the intervals of attacks, use all means to improve the 
 general condition of the child. 
 
 Besides infantile convulsions, there are convulsions of epilepsy, 
 of hysteria, of childbirth, and of St. Yitus's dance. 
 
 It should be remembered that convulsions may be evidences of 
 serious disease of the brain, for which, of course, medical advice 
 should be obtained if possible. 
 
 COPAIYA. 
 
 The balsam of copaiva is obtained by making incisions in the 
 trunk of a lofty tree (Copaifera officinalis) which grows in South 
 America and the West Indies. This balsam is not easily obtained 
 in a pure state, being frequently adulterated with castor oil, and 
 
AND MOST EECENT METHODS OF TREATMENT. 555 
 
 sometimes with rape oil ; and there is no doubt that it is manufac- 
 tured both in London and Paris to a very considerable extent. 
 Copaiva was formerly employed as a remedy in disorders of the 
 mucous membranes of the bowels and lungs ; but gonorrhoea, and 
 its sequence gleet, are now the only diseases in which it is used. 
 The dose is from twenty to thirty drops or more, either taken on a 
 little sugar or beat up with the yolk of an egg, or a little mucilage 
 of gum arabic. The French use it enclosed in thin gelatinous cap- 
 sules, by which means the disagreeable taste, and also the odor, to 
 a certain extent, are concealed. (See Gonorrhoea.) 
 
 COPPER. 
 
 The only preparation of this metal in general use is the sulphate 
 of copper, or hlue vitriol, which is principally used externally to 
 destroy " proud flesh," and is sometimes applied to the inner sur- 
 faces of the eyelids in chronic ophthalmia. Sulphate of copper is 
 considerably used in the treatment of inflammations of the eye. It 
 is also employed in weak solutions in the treatment of nasal catarrh. 
 The solutions are injected with the posterior nasal syringe. It may 
 be given in a dose of from ten to fifteen grains in three ounces of 
 water, as an emetic in cases of poisoning, when tartar emetic and 
 sulphate of zinc (white vitriol) have not had the effect of producing 
 vomiting. 
 
 CORXS. . 
 
 This term is given to the circumscribed, horny-looking excres- 
 cences of the toes and feet, which are caused by wearing improperly 
 made boots or shoes. Corns are for the most part situated on the 
 outside of the little toes, on the soles of the feet, and between the 
 toes; and in some individuals all the prominent parts of the toes 
 to which undue pressure has been long applied are invaded by 
 them. 
 
 Treatment. — The first thing to be done is to remove the cause 
 of corns, by wearing boots and shoes neither too large nor too small, 
 and constructed as nearly as possible to the shape of the foot, so as 
 to obviate unequal pressure. If shoes be worn, they should come 
 sufficiently high on the instep to prevent undue pressure on the 
 toes, and the material of which they are made ought to be soft and 
 pliable ; without these precautions other means will be of no avail, 
 at least as far as regards effecting a radical cure, whereas by atten- 
 
556 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 tion to them alone, corns frequently disappear entirely, or at all 
 events their progress is arrested. 
 
 There are several ways by which corns may be eradicated, pro- 
 vided, as we have just mentioned, that properly constructed boots 
 and shoes are worn. The following are the best methods with 
 which we are acquainted : 
 
 The first method consists in removing the pressure from the 
 corn, by applying over the toe on which it is situated a piece of 
 doe-skin spread with adhesive plaster, with a hole cut in the centre 
 large enough for the corn to rest in ; the pressure of the shoe is 
 thus removed from it and thrown on the surrounding parts. If this 
 be kept constantly applied, and the prominent part of the corn cut 
 occasionally with a sharp knife or razor, it will gradually disappear. 
 
 The second method is that of removing the corn entirely with- 
 out breaking it ; this, however, can only be practised by an expert 
 person accustomed to the operation, who, with an instrument for 
 the purpose, scrapes round the circumference of the corn, carefully 
 and gradually detaching it, until at length he reaches the extreme 
 point of the root, and in this manner it is completely extracted, 
 without giving the least pain. The cavity is then filled with a little 
 simple ointment, and the part covered with adhesive plaster. 
 
 The third method, which is very frequently practised, consists 
 in destroying the corn by means of lunar caustic. The hard part 
 of the corn is first to be cut away as much as possible without 
 causing pain or making it bleed ; the foot is then to be kept in 
 warm water during a quarter of an hour or twenty minutes, and 
 after drying it properly the lunar caustic is to be applied over the 
 surface of the corn without using it too freely. The part is then to 
 be covered with adhesive plaster, and at the expiration of ten days 
 or a fortnight the dead scarf-skin generally comes away with the 
 corn attached to it ; if not, the caustic is to be re-applied. A few 
 hours' rest are necessary after the caustic has been employed ; hence 
 the most convenient time to apply it is immediately before going 
 to bed. 
 
 Sir Benjamin Brodie is of opinion that concentrated nitric acid 
 or strong aquafortis is the best thing for destroying the soft corns 
 which are usually seated between the toes. It is to be applied by 
 means of a probe with a bit of lint attached to the end, and em- 
 ployed so as to penetrate into the substance of the corn without 
 injuring the parts beneath. 
 
 The corns which form on the soles of the feet are exceedingly 
 troublesome and not easily got rid of. Relief to a certain extent 
 may be given by taking off the pressure from the corn and throw- 
 
AND MOST RECENT METHODS OF TREATMENT. 557 
 
 ing it on the surrounding parts, by means of the diachylon plaster, 
 employed in the manner recommended for bunyons, or by wearing 
 a felt sole in the shoe, with a hole in it corresponding to the corn. 
 
 COKPULENCE (OBESITY). 
 
 Corpulence is rightly called a disease. In some cases it becomes 
 exceedingly annoying, and may even shorten life. 
 
 Even as I am writing, the tidings comes from Philadelphia that 
 a lady has just died near that city from corpulence. For two months 
 before her death she had been unable to move about. Her weight 
 was enormous. 
 
 A Mr. Banting, of England, has written a little pamphlet, in 
 which he gives his own experience in the reduction of fat. His 
 principle was to abstain from sugar and starchy substances. The 
 results were quite successful. It should be remarked, that some 
 persons cannot prevent the formation of fat by merely abstaining 
 from food, or by drinking vinegar or other acids. 
 
 Banting had previously tried all the ordinary methods. Some 
 others who have tried his method have thereby seriously injured 
 themselves. What does well for one, may not for another. 
 
 COSMETICS. 
 
 Cosmetics are preparations that are used to improve the color 
 and appearance of the skin. Some of them are quite harmless ; 
 others are injurious. The well-known cucumber cream is, I sup- 
 pose, a harmless preparation. It is made, according to Piesse — a 
 good authority on this subject — of benzoinated lard, spermaceti and 
 spirit of cucumber. It is rubbed over the face at bed-time. Gly- 
 cerine is one of the best cosmetics, and it enters into many of the 
 recent preparations. 
 
 Rouges, or paints for the face, and poioders are now quite popu- 
 lar. Actresses and singers make a very free use of rouge and red 
 paints to improve the color of the face. The use of paint among 
 these classes is almost Universal. 
 
 According to Piesse, bloom of roses is made of strong liquid 
 ammonia, carmine, rose-water, esprit de rose triple. Piesse states 
 that this preparation is much used in France and Germany. 
 
 Theatre rouge is made of Brazil-wood, lake, and the safflower. 
 White paint for actresses is made of oxide of bismuth. 
 
 I-must warn my readers against the patented preparations that 
 are now so freely used. Some of them contain lead in poisonous 
 
55S DESCKIPTION OF THE PKINCIPAL DISEASES, 
 
 quantities, and cases of lead poisoning have come under the obser- 
 vation of the profession, that are caused by the free use of these 
 preparations. A few years ago a young lady came into the clinique 
 of one of our medical colleges complaining of symptoms which had 
 evidently resulted from working in lead. She said that she had 
 been making bloom of youth. She was quite pale, and the pro- 
 fessor aptly remarked that " in making the bloom of youth she had 
 lost her own" 
 
 Piesse states also that the blue of the vein is imitated by chalk 
 tinted with Prussian blue. 
 
 Yery much of the apparent softness and delicacy and color of 
 the faces of our city ladies especially is manufactured every day to 
 order by paints and rouges. 
 
 It would be very appropriate for me to say just here that the 
 best cosmetic is the sunlight, and the prettiest color a healthy brown ; 
 but I know very well that few would believe me, and still fewer 
 would act upon the suggestion. 
 
 Poivders for the face are made of starch and orris root, and are 
 perfumed by cloves, bergamot, lavender, lemon, and otto of roses. 
 The " puff" with which they are applied is made of swan's down. — 
 Piesse. 
 
 COW-ITCH, OK COWHAGE. 
 
 This is a creeping plant, which grows in great abundance in the 
 East and West Indies. It bears pods covered with brownish-colored 
 hairs, which, when allowed to touch the skin, occasion the most 
 violent itching. An electuary, made at the time it is to be used, 
 by mixing these hairs with molasses, jelly, or honey, is an excellent 
 remedy for expelling worms. The dose for a child is one or two 
 teaspoonfuls (according to the age), which should be taken before 
 breakfast, and followed by an active purge of castor oil after the sec- 
 ond or third dose. This remedy, no doubt, acts mechanically on the 
 worms, and yet when given in large doses does not produce griping 
 or purging. "We have used cow-itch in the West Indies in some 
 hundreds of cases, and have never known any bad effect result from 
 it, nor have we ever found it to fail in expelling the long round 
 worms. It produces no effect on the tape-worm, and very little on 
 the small worm of the lower bowel. (See article Worms.) 
 
 CEEAM OF TAETAE. 
 
 Cream of tartar acts as an excellent diuretic in dropsy of the 
 belly, not depending on diseased liver or other visceral obstructions, 
 
AND MOST RECENT METHODS OF TREATMENT. 559 
 
 when taken to the extent of an ounce, dissolved in a pint and a half 
 or two pints of water, in the course of the day. An excellent pur- 
 gative in common use is cream of tartar and jalap, in the following 
 proportions : 
 
 Cream of tartar, thirty grains, 
 Jalap, fifteen grains. Mix. 
 
 The solution of cream of tartar known by the name of imperial 
 drink is a useful beverage in feverish affections. 
 
 The best laxative for those who are troubled with piles is com- 
 posed of cream of tartar and sulphur, of each a drachm. 
 
 It is a cooling drink in fevers. 
 
 CREAM. 
 
 Sweet cream is a good medicine for consumptives. Some con- 
 sumptive patients cannot or will not take cod-liver oil, on account 
 of the taste, but are willing to take cream in large doses. It is by 
 no means as useful for consumptives as cod-liver oil, but it is cer- 
 tainly a remedy of value. It may be combined with whiskey. 
 Some patients can take, with benefit, half a tumbler of cream and 
 whiskey with their meals. It is an interesting and suggestive fact 
 that consumptive patients oftentimes dislike fat meat, and fat of all 
 kinds. 
 
 Such patients frequently enjoy the taste of cream, and are bene- 
 fited by using it freely. 
 
 COLD CREAM— CAMPHOR ICE. 
 
 Cold cream, so much used in the toilet, may be made of almond 
 oil, rose-water, otto of roses, white wax, and spermaceti. With the 
 addition of camphor, this becomes the so-called camphor ice. 
 
 CREOSOTE. 
 
 This was discovered in 1832. It is obtained by distillation of 
 vegetable and animal substances. It is useful in vomiting, in diar- 
 rhoea, in sea-sickness, in hemorrhages, in toothache (applied in the 
 cavity), in inflammation of mucous membranes, in burns, in chil- 
 blains, gangrenes, in skin diseases, and for ulcers. 
 
 In its action it much resembles carbolic acid, but is inferior to 
 it. On account of its disagreeable odor, it is much less used than 
 it would be if its odor were more agreeable. Of late years carbolic 
 acid seems to be taking its place. 
 
560 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 In diarrhoea I have found remarkable results from creosote. 
 Perhaps carbolic acid might have served my purpose just as well. 
 
 Doses — One or two drops in water, well shaken. Some per- 
 sons will bear very large doses. 
 
 CKOTON OIL. 
 
 The plant from which it is produced grows in Ceylon, the 
 Malabar coast, China, and the neighboring countries. This oil is 
 a powerful purgative in the dose of one or two drops, either made 
 into a pill, with crumbs of bread, or taken in a little castor oil ; 
 and two or three drops rubbed on the tongue act with equal cer- 
 tainty ; hence its value in apoplexy attended with difficulty in 
 swallowing, mania, tetanus accompanied with locked jaw, and in 
 other diseases where remedies in more bulky doses could not be 
 easily administered. When apoplexy is threatened, the prompt 
 and powerfully revulsive action of this remedy may be the means 
 of warding off the impending danger; and it has been often known 
 to give relief in cases of obstinate costiveness and colic when other 
 means had failed. It has been used with advantage to assist the 
 action of other remedies in expelling tape- worm. 
 
 Croton oil rubbed in upon the skin produces an eruption of 
 small pustules, and when used in this manner has been found in 
 some cases preferable to the tartar emetic ointment as a counter- 
 irritant. 
 
 Croton oil, two drachms, 
 
 Almond oil, an ounce. Mix. 
 
 CKOUP. 
 
 The disease termed croup, although it occurs occasionally in the 
 full-grown person, may be considered to belong to children. It 
 consists in a peculiar inflammation of the windpipe, which gives 
 rise to the production of a whitish membrane, somewhat similar to 
 the lining of an egg-shell. Upon this inflammation, upon the 
 presence of the white membrane in the air-passages, and upon the 
 spasmodic action which both are apt to produce, the symptoms of 
 croup and its dangerous consequences mainly depend. 
 
 Croup occurs commonly in young children between the ages of 
 two and six years. It is rarely met with in infants at the breast. 
 
 Symptoms. — Croup usually commences with all the appearance 
 of common cough, and is not easily detected, even by the medical 
 man, in its earliest stage. The child coughs, and has more or less 
 
AND MOST RECENT METHODS OF TREATMENT. 561 
 
 fever, with, hot and cold fits, flushed face, watery red eyes, and 
 restlessness at night. The cough at this time is occasionally 
 hard and hollow, and the child shows signs of uneasiness about 
 the throat by frequently carrying the hand to this part, and 
 complaining of pain. The voice may also be hoarse ; and when 
 these symptoms exist, no time should be lost in the application 
 of appropriate remedies, for although they may be nothing more 
 than common congh with irritation of the throat, yet they may 
 be the first signs of an attack of croup, and it is infinitely better 
 to have expended a little care, anxiety and medicine for noth- 
 ing, than to allow a disease of the most fatal kind to gain ground 
 and establish itself, from the want of proper attention. The 
 symptoms just enumerated may continue for a few days or 
 weeks without much change ; but sooner or later the character of 
 the cough suddenly alters, and assumes what is called the croupy 
 sound. This changes usually takes place in the night, and is so 
 peculiar that when a person has once heard the croupy cough he 
 can never mistake it again. It is a sharp dry, ringing congh, which 
 is followed by a hissing inspiration, and is compared to the crowing 
 of a cock or the barking of a young puppy. The fits of coughing- 
 are most frequent during the night, and soon produce a most un- 
 favorable effect on the state of the little patient ; the face is flushed, 
 and often bathed in perspiration ; the eyes watery ; the skin burn- 
 ing hot ; the pulse frequent and hard ; the voice is hoarse ; and the 
 upper part of the windpipe is often tender to the touch. This is 
 the first dangerous change in the character of the complaint, and 
 when it has once taken place, the symptoms commonly proceed 
 from bad to worse. During the early stage the fits of coughing 
 are not very frequent, and during their intervals the child may ob- 
 tain a little rest ; but they soon return with renewed severity. The 
 croupy sound, hissing breathing, and suffocation, are now more 
 evidently marked {confirmed stage) ; the face is bloated ; the pulse 
 extremely quick, and the skin hot ; each fit of coughing seems to 
 threaten death by suffocating the child ; and when the fit has passed 
 over he lies in a state of extreme anxiety and restlessness, with the 
 head thrown back and all the muscles of respiration in full action, 
 showing that nature is making violent but vain efforts to convey 
 air in sufficient quantities to the interior of the chest. The fits of 
 coughing are now sometimes followed by vomiting, and very often 
 by the discharge from the windpipe of viscid phlegm or shreds of 
 the white membrane which is formed inside ; in some cases regular 
 moulds- of the air passages, resembling pieces of macaroni, are spit 
 up. This gives a temporary relief, but the fits of suffocative cough- 
 36 
 
562 DESCRIPTION OF THE PRINCIPAL DISEASES. 
 
 ing soon return, and reduce the patient to an extreme degree of 
 weakness {collapsed stage). The difficulty of breathing is now 
 permanent, and the little sufferer does not seem to obtain a mo- 
 ment's relief, but lies gasping for breath, with a sunken counte- 
 nance and cold skin. The pulse is now very quick, small and, weak ; 
 the face bathed in a cold sweat, and pale, with lividity of the lips; 
 the cough is less frequent, and is evidently failing with the strength 
 of the child; the voice is almost inaudible; the patient becomes 
 restless, often makes convulsive efforts as if to free his throat from 
 some obstruction, and either perishes in convulsions, or falls into a 
 state of lethargy, which gradually settles down into death. 
 
 There are two kinds of croup— true and false. True croup 
 comes on gradually ', and is less likely to excite alarm than false 
 croup, which comes on suddenly. True croup is attended with fever 
 and false membrane in the throat ; false croup is not attended with 
 fever or false membrane in the throat. True croup is almost always 
 fatal in the course of four or five days ; false croup always recov- 
 ers, but is liable to come on again. (See False Group.) 
 
 TREATMENT OF TRUE CROUP. 
 
 If no physician can be obtained, begin the treatment early, for 
 although almost all cases of true croup die, yet there is every pos- 
 sibility of a mistake, and what we suppose to be true croup may be 
 only an attack of false croup. Even if the case prove to be one of 
 true croup, and ultimately it will be a consolation to have tried to 
 save the life of the patient, and to have somewhat relieved his suf- 
 ferings. 
 
 1. Give ipecac in doses just large enough to cause mild vomit- 
 ing. 
 
 2. Place a warm poultice around the neck. During all the 
 treatment sustain the patient by beef-tea and stimulants cautiously 
 used. 
 
 3. Fill the room with the vapor of boiling water. A large kettle 
 filled with boiling water may be kept on the stove until the room is 
 filled with hot steam. The room should be kept at a very warm 
 temperature. 
 
 In desperate cases physicians sometimes open the larynx. 
 
 It is proper to remark here that true croup is not so common an 
 affection as is commonly supposed. The great majority of cases of 
 the so-ccdled croup are simply cases of spasm of the glottis, or false 
 croup>. " Croupy children " are those who are liable to these attacks 
 of false croup. I repeat again that these attacks cause unnecessary 
 alarm. 
 
 \ 
 
AND MOST RECENT METHODS OF TREATMENT. 56^ 
 
 FALSE CKOITP, OR SPASM OF THE GLOTTIS. 
 
 This is a spasmodic closing of the glottis, with shrill breathing. 
 
 It comes on quickly, and lasts but a little time. It is most 
 frequent during the period of teething. 
 
 It sometimes greatly alarms the parents of the child, who fear 
 that the symptoms betoken real croup. 
 
 TREATMENT OF FALSE CROUP. 
 
 1. Slap or strike the back and limbs. 
 
 2. Apply cold to the head. 
 
 3. Put the feet in hot mustard water. This treatment is almost 
 always successful. 
 
 Some children are subject to these attacks very frequently. 
 During the intervals they should be treated by tonics, such as iron, 
 phosphorus, strychnine, sunlight, &c. 
 
 This subject of false croup is so important that I quote in full 
 from Tobold : 
 
 "During an attack we place the child in an upright position, 
 sprinkle water in the face, admit pure fresh air, strike with the hand 
 on the back, rub the extremities with flannel, or put sinapisms on 
 the breast and calves of the legs, and apply quieting lavements, 
 especially with infused chamomile or valerian. 
 
 " Sometimes the excitation of choking, through irritation of the 
 soft palate and pharynx by means of the finger, relieves the spasm. 
 Inhalations of ether or chloroform are also highly spoken of by many 
 authors. But they must be used on children with great caution. 
 
 " In regard to the prophylaxis (prevention), which is not less im- 
 portant than the therapeutics, we have first of all to prevent the 
 recurrence of the attacks by improving the diet and avoiding all in- 
 jurious causes. All physical excitation, terror, anger, sudden wak- 
 ing out of sleep, irritation of the air-passages through faulty swal- 
 lowing in drinking hastily, also punishment that tends to frighten 
 children, should be zealously avoided. The sucking child may be 
 allowed to remain at the mother's breast, unless other diseased states 
 demand a change. 
 
 " If the child has been weaned shortly before the attack, restore 
 it again to the mother's breast, or provide a good wet nurse. When 
 this is not convenient, at least provide unadulterated milk from one 
 and the same good cow, or ass's milk, either pure or adulterated 
 with one-third water, according; to the age of the child. 
 
 " In the next place, provide for good and healthy air, and for a 
 
564 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 residence in a sunny mountain region that is protected from the 
 north-east winds, or on the sea-coast. 
 
 " Taking cold must be sedulously avoided by appropriate warm 
 clothing. The diet of older children should be stimulating; and 
 nourishing, but as easily digestible as possible. 
 
 " Weakly, cachectic children we treat by means of tonics, ad- 
 ministering bark, or the syrup of the iodide of iron, from 2 to 5 
 grains, three times a day. 
 
 " In our special therapeutics, we have chiefly to direct our at- 
 tention to the existing basis of disease. Disordered digestion, in- 
 testinal catarrh, the irritation of worms, diarrhoea, demand corre- 
 sponding remedies." 
 
 CUBEBS. 
 
 The plant from which this species of pepper is obtained is a 
 native of Java, the Mauritius, the island of Ceylon, and other east- 
 ern countries. Cubebs were first used medicinally in Europe in 
 1816, and are now in very general use in the treatment of gonor- 
 rhoea, which yields readily to this pepper when taken in the dose of 
 a drachm (about a dessert-spoonful) thrice a day, in a small quantity 
 of water, or in wine and water. (See Gonorrhoea^) Cubebs have 
 also been known to give considerable relief in chronic catarrh of the 
 bladder, in doses of ten or twelve grains three times daily. 
 
 DANDELION. 
 
 This is a very common and well-known plant ; the only prepara- 
 tion directed in the pharmacopoeia is the extract of dandelion, which 
 is not supposed to possess any active medicinal property. It is 
 sometimes given, on account of the bitter principle which it con- 
 tains, as a tonic in indigestion, and from its diuretic virtue is oc- 
 casionally administered in dropsical affections, along with more 
 active remedies. This plant is said to have been of great service 
 in jaundice, and in chronic inflammation of the liver, and of the 
 lining membrane of the stomach ; but its virtues appear to be much 
 overrated by some medical men. The dose of the extract of dande- 
 lion is half a drachm, four times a day, in peppermint or cinnamon 
 water. 
 
 DEADLY NIGHTSHADE, OR BELLADONNA. 
 
 This plant grows in hedges, thickets, and shady places, and is 
 frequently met with amongst old ruins. In the month of Septem- 
 
AND MOST RECENT METHODS OF TREATMENT. 565 
 
 ber it bears sweetish-tasted berries, of a purple color, which are 
 powerfully narcotic, and from their resemblance to cherries, chil- 
 dren are sometimes tempted to eat them, and death is not unfre- 
 quently the consequence. The symptoms arising from eating the 
 berries are delirium, accompanied with violent laughter and various 
 gestures, as if the individual were grasping at imaginary objects ; 
 the eyes are red, and appear as if they protruded from their orbits, 
 and the pupils are dilated and immovable. These symptoms are 
 soon followed, when the case terminates fatally, by loss of voice, 
 difficulty in swallowing, and convulsions. This poison has the 
 effect of paralyzing tlie stomach, so that emetics are rarely found 
 to act ; it is advisable, however, in the first instance, to give three 
 grains of tartar emetic, or twenty-five to thirty grains of sulphate 
 of zinc {white vitriol), or six grains of sulphate of copper (blue 
 vitriol), in a little water ; but the only way which can be trusted to 
 of emptying the stomach is by means of the stomach-pump. The 
 best antidotes are strong coffee, and the effusion of cold water on the 
 head and body, and morphine. 
 
 We are indebted to the German physicians for our knowledge of 
 the medicinal virtues of this plant, which, though of great value in 
 the hands of experienced medical men, is nevertheless of too danger- 
 ous a nature to admit of being used with safety as a popular 
 remedy. 
 
 Belladonna was first used in the form of infusion as a fomenta- 
 tion, to soothe the pain of cancerous and other foul sores, and has 
 since been employed internally in a similar manner to hemlock, 
 henbane, and other narcotic remedies, as a palliative in cancer. 
 The extract of belladonna rubbed over the eyebrows and eyelids 
 has the peculiar property of dilating the pupils of the eyes; hence 
 it is generally used for that purpose before the operation for 
 cataract is performed. In cases of blindness arising from opacity 
 of the centre of the lens, a little of the infusion of the leaves 
 of belladonna dropped into the eyes three or four times a day, by 
 dilating the pupils, allows the sight to be restored for a time ; and 
 it has been stated that this practice may be continued for years. 
 Professor Beer, the celebrated oculist of Vienna, recommends half 
 a drachm of the extract, with an equal proportion of mercurial 
 ointment, to be rubbed in upon the temple every night at bed-time 
 in cases where there is deep-seated pain of the eye-ball; and the 
 extract alone, applied in the form of plaster, often gives relief in 
 cases of tic-douloureux and rheumatic pains. The belladonna 
 plaster of the pharmacopoeia, applied under the loins, is often of 
 great service in allaying the pain attending difficult menstruation. 
 
566 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 An ointment composed of a drachm of the extract of belladonna 
 mixed with seven drachms of lard is an excellent remedy in piles, and 
 when rubbed on the perinseum gives relief in chordee. Belladonna 
 has been used of late years as a remedy in hooping-cough. Professor 
 A. T. Thompson says : " I have ordered the extract in doses of one- 
 eighth of a grain to a child eight years of age, and gradually 
 increased the dose to a quarter of a grain. Its power over the 
 cough is extraordinary. It produces a state of the skin closely 
 resembling scarlatina, accompanied with fever, suffused eye, dim- 
 ness of sight, and frequently, though not always, headache. Whilst 
 these symptoms continue, the cough remains absent, but it returns 
 as soon as they disappear. By keeping the habit for a sufficient 
 time under the influence of the remedy, the period of the disease 
 has always been greatly shortened." Hahnemann, Hufeland, and 
 other German physicians, recommend belladonna to be given in the 
 following manner as a preventive of scarlet fever : 
 
 Extract of belladonna, three grains, 
 
 Cinnamon water, an ounce. Mix. Three drops of this solution are to be given 
 twice a day to a child a year old, adding one drop for every year, until twelve be taken 
 for a dose. 
 
 This defensive preparation has, however, been known to fail in 
 several cases in which it has been tried where scarlatina was raging 
 as an epidemic. The smallness of the dose, however, renders it 
 perfectly harmless. 
 
 In administering belladonna, the precaution must be attended 
 to of commencing with small doses ; half a grain of the extract, or 
 a grain of the powder of the dried leaves, gradually increased to 
 three or four grains, or until slight giddiness, dimness of sight, and 
 a sensation of dryness and- heat of the mouth and throat are felt. 
 (See Atropine.) 
 
 Deafness. (See Ear, Diseases of.) 
 
 DELIKIUM TREMENS. 
 
 This disorder' arises from excess in drinking spirituous liquors, 
 or from the abuse of opium ; rarely from other causes. It comes 
 on generally after a debauch, or in drunkards, in consequence 
 of giving up their accustomed stimulus too suddenly. In some 
 cases delirium is the first symptom observed ; but in general there 
 are certain premonitory signs, indicative of its approach. The 
 patient is restless, peevish, and cannot sleep well; his manner 
 becomes hurried and abrupt, and he appears low-spirited. After 
 remaining some time, perhaps two or three days or a week, in this 
 
AND MOST RECENT METHODS OF TREATMENT. 567 
 
 state, his ideas become confused, he Djustles about as if he had 
 more business to do than he could manage, he is exceed- 
 ingly restless, and there is an appearance of wildness in his 
 countenance. The characteristic symptoms of the disease then 
 begin to declare themselves; the haikls, and sometimes the 
 whole body, are in a constant state of i tremor ; the tongue is 
 also tremulous, and there is a twitching motion of the tendons 
 at the wrist. If the patient sleep, it is only for a short time ; 
 he awakes suddenly, alarmed by some [ frightful dream. At 
 length the mind becomes affected ; he fancies that there is some 
 mischief plotting against him, or that fcis affairs are going 
 wrong, and is constantly talking about them. When the deli- 
 rium is fully established he cannot sleep, and attempts frequently 
 to get out of bed. If he escape from his apartment there is 
 no difficulty in leading him back to bed, if he be spoken to 
 quietly; but if thwarted he becomes exceedingly suspicious, 
 accuses those near him of having some mischievous design 
 against him, and struggles to get away. The hallucinations 
 attending this disease are always of a desponding character; the 
 patient fancies that he is attacked by robbers, and struggles as 
 if he were defending himself; or he supposes that a swarm of bees 
 are hovering around him, and he mdves his arms as if he were 
 driving them away. 
 
 It is of the utmost importance that delirium tremens should 
 not be mistaken for inflammation of the brain, inasmuch as the 
 treatment required for the latter wcjld produce the worst effects 
 in the former disease, which is to rbe distinguished from other 
 affections of the brain by the absence of pain, the trembling 
 of the hands and tongue, the starting of the tendons at the wrists, 
 the peculiar character of the delirj'um, and the knowledge of the 
 previous habits of the patient. Oil the other hand, a patient with 
 inflammation of the brain has a strong, full pulse, hot skin, flushed 
 face, red eyes, dry and red tongue ; he suffers from a distressing in- 
 tolerance of light and sound ; and the delirium is generally furious. 
 
 The length of time required by delirium tremens to. run its 
 course is very uncertain, but it generally terminates within a 
 week, and is not a dangerous disease when judiciously treated. 
 (See Stimulants and Narcotics for remarks on Chronic Alcohol- 
 ism.) 
 
 TREATMENT OF DELIRIUM TREMENS. 
 
 1.- Give the patient one grain of opium every three hours. If 
 this fails, double the dose. 
 
568 DESCRIPTION OF T JI E PEINCITAL DISEASES, 
 
 2. Give nourishing and 'easily digested food. 
 
 3. Try chloroform, in doses of one or two teaspoonfuls, or bro- 
 mide of potassium, in dos'^s of 40 grains. It is the opinion of many 
 that delirium tremens is b£st treated by giving no medicine what- 
 ever — by simply " letting/ the patient rip." 
 
 Delirium tremens sec/ms to be caused both by sudden withdrawal 
 of stimulants and by continuing to use them to excess. 
 
 During the attack tip patient should be kept where he can do no 
 harm. The bromide of J potassium may be given during the inter- 
 vals of the attacks, in o/oses of 10 or 15 grains. 
 
 On the treatment o£ this disease Aitken thus remarks : 
 
 " Opium may be administered with, safety and advantage only 
 in protracted cases, provided the quantity given in twenty-four 
 hours is never allowed to exceed the fall dose which would be con- 
 sidered safe for a healthy ^person of the age and sex of the patient. 
 "Where it appears to be indicated in protracted cases, it ought to be 
 pushed as rapidly as possible for two or three doses, while its effects 
 are carefully watched. Its\ use must be discontinued for at least a 
 good many hours, as soon as a full maximum amount of from half a 
 drachm to two drachms of the tincture in all has been reached, or 
 even sooner if the pupils have become at all considerably contracted 
 during its use. This remedy should always be given in the fluid 
 forms, otherwise it is apt to 'accumulate in the bowels, owing to the 
 weakened state of the digestion ; and a laxative, or even a purga- 
 tive, should be alternated with opium, followed by a bitter tonic, 
 which always operates favorably in lingering cases of nervous and 
 dyspeptic exhaustion. NarcUics are thus only safe in delirium 
 tremens when they are given with the object of aiding and second- 
 ing the natural cure of the disease, employed in moderate closes, and 
 given only at the later stages. The heroic use of them, as heretofore 
 too often advocated, even by the most eminent physicians, is now 
 recognized as a treatment which merely substituted narcotic poison- 
 ing for alcoholism or delirium tremens." 
 
 DIABETES. 
 
 This disease usually commences slowly, and the general health 
 often suffers materially before the nature of the disorder is discov- 
 ered. The first symptoms experienced are indigestion, general de- 
 bility, constipation of the bowels, thirst, and irregular, capricious, 
 and sometimes voracious appetite. At length the patient accident- 
 ally notices that his urine is considerably augmented in quantity, 
 and, from the time that this observation has been made, he finds 
 
AND MOST RECENT METHODS OF TREATMENT. 569 
 
 that the quantity discharged gradually increases. As the disease 
 proceeds, the symptoms already mentioned become more severe ; 
 the skin feels harsh and dry ; there is a sensation of heat and weight 
 at the stomach; alternate chills and flushes of heat are experienced, 
 and the patient is very low-spirited. All, the symptoms go on 
 steadily increasing in severity ; the urgent thirst and frequent desire 
 to empty the bladder become very distressing, particularly during 
 the night ; there is a dull aching sensation across the loins, slight 
 giddiness, and occasional headache ; cough, and shortness of brea- 
 thing, and entire loss of sexual desire. As the disease advances 
 towards a fatal termination, the gums become red, swollen, and 
 bleed from the slightest pressure, the taste is depraved, the tongue 
 is foul, with red edges ; the strength is much diminished, and the 
 body emaciated ; the appetite, which was previously voracious, 
 gives way ; the legs become dropsical, and the pulse is quick and 
 weak. 
 
 The urine is of a pale straw color, sometimes insipid, but in the 
 great majority of cases it has a sweetish taste and faint smell, some- 
 what resembling that of violets, and contains a considerable quantity 
 of sugar. The presence of sugar is ascertained by chemical tests. 
 There is a form of diabetes where there is no sugar in the urine. 
 This form is less serious in its character. The quantity of urine 
 voided varies from eight to twenty pints daily, and there are well- 
 authenticated cases on record in which the average discharge was 
 from forty to fifty pints a day. The weight of the urine when the 
 disease is confirmed invariably exceeds that of the liquids drunk, 
 and is in some cases greater than both the food and drink consumed, 
 even when the hunger and thirst are extreme. The quantity of 
 sugar contained in the urine is much greater in some cases than in 
 others, and it varies in the urine of the same individual at different 
 times ; an ounce of sugar has been extracted, in several cases, from 
 each pound of urine. 
 
 The nature of diabetes is so little understood, that medical men 
 have not yet been able to decide with regard to the part of the body 
 in which it is seated. Some suppose that the kidneys are the pri- 
 mary seat of the disease, others that it depends on the state of the 
 stomach or of the skin ; and it has been imputed to a diseased state 
 of the blood. Various causes have been assigned for this disease, 
 such as exposure to cold when the body is in a state of perspiration, 
 abuse of spirituous liquors, long-continued bodily and mental exer- 
 tions, excess in venery, grief, and, in a word, whatever depresses the 
 vital .powers ; but if these or other exhausting causes could of them- 
 selves bring on this disorder, it would certainly be of more frequent 
 
570 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 occurrence ; there can be no doubt, however, that they act as exciting 
 causes, when there is a {disposition to the disease in the system. 
 
 Diabetes runs its course in some cases in a month or two, and 
 continues in others during several years. It is sometimes compli- 
 cated with pulmonary consumption or chronic bronchitis, and is so 
 frequently fatal that many medical men, though they admit that 
 it may be much relieved, or even suspended for a time, are never- 
 theless of opinion that a radical cure cannot be effected. 
 
 There are two kinds of diabetes. In one there is sugar in the 
 urine ; in the other there is not. Diabetes with sugar in the urine 
 is the more serious form. Physicians detect the presence of sugar 
 in the urine by chemical processes. 
 
 The prospects of a patient afflicted with diabetes are not good. 
 Recovery is rare. They may, however, be much benefited by 
 dieting and by medicine, and may live many years. 
 
 TREATMENT OF DIABETES. 
 
 There is no specific for this disease. Everything has been tried, 
 with failure. The patient may take any of the ordinary tonics with 
 advantage. It is found by experience to be best to abstain from 
 sugar and from starch, which is converted into sugar in the process 
 of digestion. Bicarbonate of soda, in doses of a drachm three or 
 four times a day, appears to do good. 
 
 Dr. Champlin recommends bran bread for diabetic patients. 
 He speaks from personal experience of its efficacy. The formula 
 for making these bran cakes is as follows: 
 
 " Take a quantity of wheat bran. Boil it in two successive 
 waters for a quarter of an hour, each time straining it through a 
 sieve ; wash it well with cold water on the sieve, until the water 
 runs off perfectly clear. Squeeze the washed bran in a cloth as 
 dry as possible, then spread it thinly on a dish, and place it in a 
 slow oven. When it is perfectly dry and crisp it is fit for grinding 
 into fine powder. 
 
 " The bran thus prepared is ground in the mill for the purpose, 
 and must be sifted through a wire sieve of such fineness as to require 
 the use of a brush to pass it through, and what remains on the 
 sieve must be re-ground till it is sufficiently soft and fine. 
 
 " To prepare a cake, take of this bran powder three or four 
 ounces, three new-laid eggs, one and a half or two ounces of but- 
 ter, and about half a pint of milk. Mix the eggs with a little of 
 the milk and warm the butter with the remainder of the milk ; stir 
 the whole well together, adding a little nutmeg and ginger, or any 
 other spice that may be agreeable. Bake in small tins (pattipans, 
 
AXD MOST EECENT METHODS OF TREATMENT. 571 
 
 which must be well buttered), in a rather quick oven, for about half 
 an hour. The cakes when baked should be a little thicker than 
 a captain's biscuit. 
 
 " These cakes may be eaten with meat or cheese for breakfast, 
 dinner, and supper, and require a free allowance of butter ; and the 
 cakes are more pleasant if placed in the oven a few minutes before 
 being placed on the table. 
 
 " When economy is an object, when a change is required, or if 
 the stomach cannot bear butter, the cakes may be prepared as fol- 
 lows : Take of the prepared bran four ounces, three eggs, about 
 twelve ounces of milk, with a little spice and salt ; to be mixed and 
 put into a basin (previously well buttered). Bake it for about an 
 hour ; the loaf may then be cut into convenient slices and toasted 
 when wanted ; or, after slicing, it may be re-baked and kept in the 
 form of rusks. 
 
 " Nothing has yet been discovered of equal utility to these 
 bran cakes, combining, as they do, moderate cost with freedom 
 from starch, and sufficient pleasantness as an article of food." 
 
 However surely an exclusive animal diet may lessen or entirely 
 remove the sugar in the urine of a diabetic patient, it is certain 
 that it cannot long be tolerated. Under its use the appetite fails, 
 and a loathing of all food soon happens. The necessity of a mixed 
 diet for man has been shown ; and it is as necessary for him when 
 surferino; from diabetes as in a state of health. In this disease the 
 nervous system is undoubtedly implicated, and a rigid adherence to 
 animal food alone, were it practicable, would soon be followed by 
 an aggravation of the nervous trouble. There is, from the very be- 
 ginning, and throughout the course of the disorder, a strong tenden- 
 cy to devitalization, and this, too, must be guarded against. For- 
 tunately, the sugar in the urine may be kept down, and at the same 
 time the general strength of the system maintained, by a properly 
 adjusted diet of mixed food. Along, then, with the carnivorous die- 
 tary, whose importance is not to be undervalued, certain vegetables 
 may be permitted, not only with impunity, but with advantage, and 
 these are cabbage, cauliflowers, onions, spinach, water-cress, sorrel, 
 endive, lettuce, &c. Trousseau has found no ill consequences from 
 eating acid fruits, as strawberries, gooseberries, cherries; and he has 
 allowed apples, pears, and grapes. He even suffers his diabetic 
 patients to eat a small quantity of bread, if they greatly crave it, 
 for, as he remarks, there, are many persons who are unable to 
 make a meal without it. Such a regimen is more likely to keep 
 the disease stationary, and secure the general comfort of the patient, 
 by upholding his strength, than by confining him to one kind of 
 
572 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 diet, which his stomach soon revolts against, and which must result 
 in innutrition, general debility, the development of intercurrent af- 
 fections, and, sooner or later, death. Enforced daily exercise in the 
 open air, when possible, just short of fatigue, is of as much impor- 
 tance in the treatment of diabetes as diet. Gymnastics should be 
 practised. Trousseau says that he has repeatedly seen, during the 
 hunting season, diabetic patients, abroad with their gun and dog, 
 cease both to drink and urinate to excess, and regain their strength, 
 and even their virile powers. A suit of flannel or buckskin should 
 be worn next the skin. Warm alkaline baths should be frequently 
 taken. Diabetics insipidus, where there is no sugar in the urine, is 
 far less serious in its character, and may sometimes be successfully 
 treated by ordinary tonics, or by small doses of permanganate of 
 potash. 
 
 DIARRHCEA. 
 
 FLUX, LOOSENESS OF THE BOWELS, PURGING. 
 
 This is a common and well-known disorder, characterized by 
 more frequent and thinner evacuations from the bowels than natural, 
 accompanied or not with griping pains in the belly, and occurring 
 generally without fever. Diarrhoea is frequently a prelude to dysen- 
 tery, and both these disorders are caused by a morbid state of the 
 mucous or lining membrane of the bowels : in the former there is 
 simply irritation or relaxation of the mucous membrane ; in the lat- 
 ter there is inflammation, attended with constant pain and fever. 
 
 Diarrhoea arises, in the majority of cases, from errors in diet, 
 and may take place from eating too much, from unwholesome food, 
 or from a peculiarity of the patient's constitution, which allows him 
 to be acted on by certain articles of diet which would produce no 
 unpleasant effect on other people. Other not unfrequent causes are 
 checked perspiration from exposure to cold, sitting with wet feet, 
 drinking cold water, cider, beer, or other cold beverages, and taking 
 ices when the body is overheated at the time ; suppression of the 
 menstrual or other evacuations, and increased or depraved secretion 
 of bile. In some constitutions this affection comes on from sudden 
 fright, surprise, anger, or any other strong mental emotion ; and is 
 also common in fever and measles, and generally accompanies the last 
 stage of pulmonary consumption. Diarrhoea is frequently induced 
 in warm climates by malaria, and is in all countries occasionally 
 epidemic, from causes the nature of which we know little or nothing. 
 
 Diarrhoea, from whatever cause it may proceed, is commonly 
 announced by flatulency, slight distention and griping of the bowels, 
 
AND MOST KECENT METHODS OF TEEATMENT. 573 
 
 and sickness at stomach. In some cases the belly is considerably 
 swollen, hot, and painful. The patient feels relieved after each 
 evacuation, which is voided without the slightest straining. The 
 stools vary from six or eight to twenty or more in number in the 
 course of twenty-four hours, and are at first copious, and appear as 
 if a dose of salts had been taken, but afterwards scanty and watery, 
 in some cases mixed with bile, and in others with mucus. 
 
 Treatment. — The first thing to be taken into consideration in 
 directing the treatment of diarrhoea is the cause which has produced 
 or may still keep it up. 
 
 When diarrhoea arises from over-eating, from irritating or un- 
 wholesome food, or from constipation of the bowels, it is then an 
 effort of nature to expel the offending matter, and ought not there- 
 fore to be checked abruptly by astringent remedies, which, though 
 of great service when judiciously used, are often given indiscrimi- 
 nately in all cases of this disorder, which they frequently aggravate, 
 or bring on other diseases of a more serious character. In many 
 cases the efforts of nature are sufficient to restore the bowels to a 
 healthy state, and in general there is very little occasion for the in- 
 terference of art. In most cases a mild dose of castor oil, or the 
 following mixture, is all that is necessary : 
 
 Khubarb in powder, fifteen grains, 
 
 Henry's magnesia, a scruple, 
 
 Cinnamon water, an ounce and a half, 
 
 Compound tincture of lavender, half a drachm. Mix. 
 
 In the treatment of diarrhoea observe these simple rules. They 
 will answer for the great majority of cases. 
 
 1. Do not check it too early.— -If treatment is commenced at the 
 outset, some mild laxative may be useful, to remove the irritating 
 substances in the bowels. 
 
 2. Use mild astringents. — The common chalk mixture is de- 
 servedly popular. For all ordinary diarrhoea I use creasote, in doses 
 of from two to six drops, largely diluted in water. I have had 
 excellent success with it. It may be given every two hours, and 
 may be combined with paregoric, or laudanum, or morphine. The 
 cholera mixture (see Cholera Mixture) is to be recommended. 
 
 Children are successfully treated by lime-water, by pepsin, and 
 by suhnitrate of hismuth. Laudanum and starch injections are 
 useful in bad cases. Except in severe cases, an astringent mixture 
 should not contain much opium. 
 
 The diet in diarrhoea should be very bland. Arrow-root and 
 brandy may be taken for a day. Common flour paste is excel- 
 lent. Cold drinks should not be used. The cure will he hastened 
 
574 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 by staying in the house, keeping a horizontal position, and bind- 
 ing tightly over the abdomen a flannel bandage. 
 
 TREATMENT OF CHRONIC DIARRHC3A. 
 
 This is a very obstinate and intractable disorder. Subnitrate 
 of bismuth in doses of five grains has been used with success. It 
 was found to be very successful during the late war, in the diarrhoea 
 of the army and navy. All the astringents may be tried, one after 
 the other. The common lead and opium pill is much used in 
 chronic as in acute diarrhoea. Ipecac, in vomiting doses, once 
 wrought a remarkable cure in my hands. 
 
 The diet must be carefully managed in both chronic and acute 
 diarrhoea. 
 
 It is necessary to abstain from vegetables and raw fruits, and 
 subsist for a time on bread, meat, rice, &c. 
 
 Diarrhoea, or Looseness of the Bowels in Infants. (See 
 Management of Children?) 
 
 DIPSOMANIA, OR METHOMAMA. 
 
 This is the insanity of hard drinkers. It is not so uncommon 
 a disease as is supposed. Most of the gross intemperance of our 
 day is the result of disease of the brain. Spirituous liquors in 
 great excess and largely adulterated often injure the brain, and de- 
 prive the individual of his self-control. This is one of the worst 
 effects of hard drinking. Opium has the same effect. Such per- 
 sons can never be saved by the pledge. They violate all 
 pledges. They plunge headlong to destruction. In spite of 
 the tears of their families, in spite of warnings, in spite of the 
 horrors of impending poverty, in spite of disease and threatening 
 death, in spite of the most solemn promises to themselves and to 
 their friends, they cannot resist the temptation to drink to excess. 
 For all such persons we should be as charitable as we are for those 
 who are raving mad. They are not responsible beings. The time 
 has come when we must revise our treatment of drunkenness. 
 When we administer pledges we do not give protection. (See 
 Insanity}) 
 
 TREATMENT. 
 
 Dipsomaniacs and opiomaniacs should be treated like other 
 maniacs. They should be restrained. They have no will, and we 
 must supply will for them. It is frequently well to confine such 
 patients in a good inebriate asylum. 
 
AND MOST RECENT METHODS OF TREATMENT. 575 
 
 DIPHTHERIA (PUTEID SORE THROAT). 
 
 The name diphtheria was first given in 1827. The disease has 
 been known for centuries. In some sections of the country it is 
 more frequent than in others. It may be either a very mild or a 
 very severe disease. 
 
 The symptoms are, sore throat, general exhaustion, swelling of 
 the glands behind the jaw, difficulty of swallowing, fever, headache, 
 and disturbance of digestion • bad breath, thick, yellowish deposit 
 or exudation in the tonsils and in the throat / rapid pulse. 
 
 Some very mild cases do not have all of these symptoms. In the 
 milder cases there may be very little fever, and the exudation may 
 be very slight indeed. In the worst cases there is a high fever, 
 very great swelling of the glands, great difficulty of swallowing ; 
 sometimes exceedingly offensive breath; hemorrhage from the 
 mouth, rectum, or stomach, and in the last stages stupor. Death 
 may take place in two, three, or six days. 
 
 Sometimes albumen is found in the urine ; sometimes a blistered 
 or abraded surface on the body will be covered with a whitish 
 membrane ; sometimes lung fever occurs. 
 
 Diphtheria often leaves bad effects behind it, even when the 
 patient recovers. It leaves paralysis ; it leaves disorders of the eye 
 or of the ear. 
 
 Diphtheria is a constitutional disease — a blood disease, and not 
 merely a local inflammation of the throat. I knew a patient who 
 died from mere exhaustion after the throat had entirely recovered. 
 It is a poison in the system, and the affection of the throat is only 
 one of the accompanying symptoms. It should be remembered 
 that sore throat, and even whitish exudation in the throat, does not 
 always mean diphtheria. Many persons who have suffered from 
 some attack of sore throat, that perhaps may have been accompa- 
 nied by some slight deposit in the tonsils, oftentimes erroneously 
 suppose that they have recovered from an attack of diphtheria. 
 Physicians used to make the same mistakes. 
 
 The mild form of this disease is not usually fatal ; the malig- 
 nant form is one of the most dangerous diseases that we have to 
 contend with. 
 
 TREATMENT OF DIPHTHERIA. 
 
 There is no specific for diphtheria. Moreover, it is one of those 
 diseases that demand the best-trained medical skill that can be 
 obtained ; and those are particularly unfortunate who are attacked 
 with the grave form of this disease when far away from home. 
 
576 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 1. The great tiling in diphtheria is to sustain the system, as in 
 typhus and typhoid fever. The disease is one of debility. Therefore 
 we give quinine, muriated tincture of iron in the ordinary doses, 
 with stimulants if necessary. Sulphite of soda is given by some, 
 in doses often grains, on account of the power which it is supposed 
 to have to destroy the poison in the blood. 
 
 Chlorate of jpotash iu tern ally, in large doses, and locally in the 
 throat. 
 
 2. Local treatment in the throat. — This, after all, is a secondary 
 matter, although it is of importance. Ice in small pieces, creasote, 
 or carbolic acid, or glycerine, gargles of chlorate of potash, of alum, 
 or of chlorinated soda — all may be tried. With all of these sub- 
 stances the solutions should be made just strong enough to smart 
 slightly — but not stronger. Better have the solutions too weak 
 than too strong. Outside the neck, flannels wrung in hot water 
 afford relief. 
 
 Inhalations of the spray of lime-water and other substances, or 
 even of pure water, are good. (See Inhalations.) 
 Disinfectants. (See Hygiene.) 
 
 DOVEK'S POWDEK. 
 
 Dover's powder is composed of one grain of opium, one grain of 
 ipecacuan, and eight grains of the sulphate of potash. This cele- 
 brated powder was discovered by Dr. Dover, a physician of con- 
 siderable reputation in the reign of George II., and was long in 
 general use before it received a place in the pharmacopoeia. Opium 
 alone, in inflammatory diseases, would do mischief; whereas, when 
 given in this combination, in cases where sweating is indicated, it 
 often produces the very best effects. The patient should remain 
 in bed while under the influence of this remedy, and as soon as 
 perspiration begins to break out he ought to drink freely of barley- 
 water, toast and water flavored with lemon-peel, or any other mild 
 beverage, not acidulated, in order to keep up the discharge from 
 the skin. 
 
 Dover's powder is now mack used to calm the nerves, to pro- 
 duce sleep, and especially to open the skin after catching cold. 
 For the latter purpose it should be taken as early as possible, and 
 just before retiring. 
 
 For reasons that I have elsewhere given, I much prefer my 
 cold powder to the ordinary Dover powder. It is less nauseous to 
 the taste, and, I think, more efficacious. The dose is ten grains, 
 and five grains more may be given at the expiration of an hour if 
 necessary. 
 
AND MOST RECENT METHODS OF TREATMENT. 577 
 
 DKOPSY. 
 
 Various names are given to this disorder, according to the parts 
 in which the fluid is deposited : if in the general cellular substance, 
 it is called anasarca; in the belly, ascites ; in the chest, hydrothorax / 
 in the head, hydrocephalus ; and in the testicle, hydrocele. 
 
 Dropsy is either active or passive. Active or acute dropsy 
 may be general, in consequence of increased action of the heart, in- 
 duced by various causes, such as exposure to a cold, moist atmos- 
 phere, particularly when the body is in a state of perspiration from 
 active exercise or long exposure to heat, suppression of the menses 
 or other customary evacuations, sudden disappearance or repression 
 of eruptive diseases, abuse of spirituous liquors, etc. ; or it may be 
 local, arising from irritation or inflammation of the parts where the 
 fluid is deposited ; for example, dropsy of the belly or chest may 
 take place in consequence of increased action in the vessels of the 
 serous membrane which lines these cavities. 
 
 Passive Dropsy arises in general from causes which impede the 
 circulation of blood in the veins, such as various tumors pressing on 
 the great blood-vessels, ossification of the valves of the heart, etc. 
 The blood being, from these or similar causes, retarded in its course, 
 the vessels become distended, and at length relieve themselves by 
 pouring out the watery part of the blood. This form of dropsy 
 sometimes comes on from directly debilitating causes, such as re- 
 peated blood-letting, or excessive loss of blood from other causes ; 
 inordinate discharges of every description ; poor or relaxing diet ; 
 drinking immoderate quantities of watery fluids ; living in low, 
 damp situations; long- continued chronic diseases, as pulmonary 
 consumption, dysentery, etc., and various other debilitating causes. 
 Dropsy, in fact, is generally a symptom or sequence of other dis- 
 orders, and rarely a disease of itself, arising, in the great majority 
 of cases, from organic disease of the heart, lungs, liver, kidneys, and 
 other internal organs. 
 
 general dropsy (anasarca) 
 
 Is either acute or passive, and consists in the effusion of serum r 
 or the watery part of the blood, into the cellular substance situated' 
 beneath the skin. 
 
 Passive general dropsy may arise from any of the debilitating* 
 causes above mentioned, but occurs most frequently from disease 
 of the heart or some internal organ. Under these circumstances,, 
 37 
 
578 
 
 desc: 
 
 PRINCIP. 
 
 DISEASES 
 
 the fluid is thrown out slowly ; the face, or the feet and the ankles, are 
 swollen at night ; and the parts pit on pressure, which is a character- 
 istic symptom of the affection. At the commencement of the dis- 
 ease the swelling disappears in the morning ; but after some time 
 becomes more permanent, and gradually ascends higher, until the 
 whole body is aifected. While the dropsy is gradually increasing, 
 the face and eyelids become sallow, swollen, and bloated, the 
 breathing oppressed, and the pulse frequent, weak, and sometimes 
 intermitting. There is considerable thirst, the urine is scanty and 
 high-colored, the appetite greatly diminished, the bowels are con- 
 stipated, and towards the termination of the disease there is great 
 debility, and the mental faculties are much impaired. 
 
 Acute general dropsy commonly arises from some cause capable 
 of suddenly checking perspiration, or it comes on during convales- 
 cence from scarlet fever or measles. This form of dropsy is decidedly 
 inflammatory, and may result from exposure to cold, wet, or any of 
 the ordinary causes of inflammation. It is ushered in by shivering, 
 full or hard pulse, headache, thirst, and heat of surface. These 
 symptoms, in the course of twenty-four hours, are followed by drop- 
 sical swelling, which generally appears first in the face, and shortly 
 afterwards extends to the trunk and extremities of the body. In 
 most cases there are well-marked inflammatory symptoms accom- 
 panied with headache, a sensation of tightness about the chest, and 
 difficulty of breathing ; but sometimes there is very little general 
 excitement, and the pulse may not rise above the natural standard. 
 Dropsy attended with inflammatory symptoms, more or less acute, 
 frequently follows scarlet fever, both in children and adults ; and the 
 one disease may supervene upon the other in the course of a few 
 days or weeks. Acute general dropsy is usually associated with 
 inflammation of some internal organ; but cases are occasionally 
 met with in which no local disorder can be traced. 
 
 DROPSY OF THE BELLY. 
 
 {Ascites.) 
 
 This is the most common of all kinds of dropsy, and may come 
 on at any period of life. The causes which have been already 
 enumerated as capable of developing general dropsy may also 
 bring on this form of the disease, which, as in the former affection, 
 may be either active or passive ; but in the great majority of cases 
 it comes on slowly, without inflammatory action, and is symptomatic 
 of organic disorder of the abdominal viscera, more especially of the 
 liver. Another not unfrequent cause is inflammation, either acute 
 or chronic, of the peritonaeum, or lining membrane of the belly. 
 
AND MOST RECENT METHODS OF TREATMENT. 579 
 
 The water accumulates first at the lower part of the belly, which 
 gradually enlarges, and the swelling goes on increasing until the 
 entire abdomen becomes very prominent, tense, and shining. The 
 swelling may be observed to gravitate towards the side on which the 
 patient leans; and if the left hand be placed on one side of the belly, 
 and a smart tap be given to the opposite side with the right hand, 
 the water may be felt fluctuating. There are in most cases con- 
 siderable thirst, loss of appetite, and dry cough, and the urine is 
 scanty and of a dark brown color. When the water has accumulated 
 to a considerable extent, the breathing is oppressed, and the face 
 and parts of the body not consecutively infiltrated become much 
 emaciated. In some cases the feet and ankles are swollen before 
 any change is observed in the size of the belly ; but in general the 
 lower extremities are not affected until the abdominal dropsy has 
 existed some time. 
 
 Dropsy, as we have already mentioned, is almost invariably a 
 symptom of organic disorder, and therefore, in order to direct the 
 treatment on scientific principles, it is of the utmost importance that 
 the organ affected should be known. In general there are well- 
 marked symptoms of visceral obstruction before dropsy makes its 
 appearance, and, after it is considerably developed, the general ap- 
 pearance of the patient allows a sufficiently accurate opinion to be 
 formed with regard to the organ which has given rise to the affusion. 
 "When the belly is much enlarged and the lower extremities swollen, 
 while the arms and upper parts of the body are emaciated, the face 
 being at the same time thin, sharp, and of a sallow, dingy color, it 
 may be inferred that the liver is diseased, or, at all events, that the 
 cause of the dropsy is situated in the belly ; on the other hand, when 
 the face is bloated, the lips swollen, so that the mouth remains 
 partially open, and the eyes appear as if protruding from their orbits, 
 there is every reason to suppose that the obstruction is in the chest, 
 and that, most probably, the heart is diseased; and this opinion will 
 be strengthened if it be ascertained that the dropsical swelling 
 commenced at the feet and ankles, and subsequently extended to 
 the belly. The reverse of this takes place when dropsy arises from 
 inflammation of the per itonamm, or from obstruction of the liver, or 
 of any other abdominal organ ; here the swelling of the lower extre- 
 mities of the body is always a consecutive symptom. 
 
 There is another kind of dropsy of the belly, called Encysted 
 Dropsy, in which the water is confined in a cyst, or membranous 
 bag. In this case the swelling is at first unequal and confined to a 
 particular part, and when the affection is farther advanced the belly 
 is never so uniformly distended as in the former variety, where the 
 
580 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 water is loose in the abdominal cavity. Encysted dropsy progresses 
 slowly, is entirely local, and not attended with disorder of the 
 general health. 
 
 DROPSY OF THE CHEST. 
 
 This affection frequently results from inflammation, either acute 
 or chronic, of the pleura, or serous membrane which lines the 
 cavity of the chest, and envelopes the organs contained in it ; or it 
 may take place from any of the causes which give rise to general 
 dropsy, but chiefly from diseases of the heart and lungs. When 
 the effusion is the consequence of inflammation of the pleura, the 
 water is generally confined to one side of the chest, and is merely a 
 symptom of pleurisy ; but when it arises from organic disease of 
 an internal organ, the water collects slowly in both sides of the 
 chest, and constitutes, in connection with the original affection, a 
 very formidable and dangerous disease. 
 
 When dropsy of the chest proceeds from disease of the heart, the 
 first symptoms generally observed are, a swollen state of the eye- 
 lids in the morning, and of the feet and ankles at bed-time, accom- 
 panied with slight oppression of the chest and difficulty in breath- 
 ing. The patient may be affected in this manner during a con- 
 siderable length of time without suffering much inconvenience, 
 until the water, which has been gradually accumulating, at last 
 increases to such an extent that a train of very alarming symptoms 
 is brought on. The face becomes much swollen and bloated; the 
 lips assume a livid tint, approaching at times to a deep purple 
 color ; the breathing is greatly oppressed ; the patient starts in his 
 sleep, and cannot lie in bed without having his head and shoulders 
 raised with additional pillows ; and towards the termination of the 
 disease, the sensation of suffocation is so distressing on lying down 
 that he is compelled to sleep sitting in a chair. The difficulty of 
 breathing is much increased by going up-stairs, or by any ordinary 
 exercise ; the pulse is generally irregular and intermitting ; and 
 the feeling of anxiety is at times very distressing, and strongly de- 
 picted on the countenance. To these symptoms are generally 
 added palpitations of the heart and a troublesome dry cough. 
 
 When water collects in the chest in consequence of bronchitis 
 or of inflammation of the lungs, the difficulty of breathing, and of 
 lying in a horizontal position, is the same as in the former case ; 
 but the effusion is seldom to the same extent, and is not attended 
 with palpitations of the heart and intermitting pulse. Although 
 the above symptoms generally accompany water in the chest, yet 
 they may arise from organic disorders of the heart and lungs, inde- 
 
AND MOST RECENT METHODS OF TREATMENT. 581 
 
 pendent of dropsy; and there is no doubt that prior to the discovery 
 of the stethoscope, diseases of these organs were frequently mis- 
 taken for this affection. 
 
 TREATMENT OF DROPSY. 
 
 The different varieties of dropsy are all to be treated on the same 
 general principles. 
 
 1. Give jalap and cream of tartar by some such prescription as 
 this: 
 
 Jalap, twenty grains, 
 Cream of tartar, six ounces. 
 Give one-third or one-half of this every day or two. 
 
 The object of this medicine is to act freely on the bowels and 
 kidneys. Sweet spirit of nitre is much given, to act on the kidneys. 
 In bad cases, where the bowels are very obstinate, elaterium may be 
 given, in doses of one-eighth of a grain or one-quarter of a grain, 
 every four or five hours. 
 
 When the patient is weak and feeble, tonics should be given — 
 iron, quinine, strychnine, and nourishing food. 
 
 When in spite of all treatment the water remains, it may be- 
 come necessary, in dropsy of the belly, to tap the patient. This 
 operation is performed by the surgeon. 
 
 But, after all, the directions that I can give for the treatment 
 of dropsy are at best very general and unsatisfactory. Dropsy is 
 not a disease / it is a symptom of a disease. The true way to treat 
 it is to treat the disease that causes it. "What this disease may be 
 can only be ascertained by the experienced physician. It is most 
 apt to depend on some disease of one of these three organs — the 
 liver, the heart, and the kidneys. It is a very common symptom in 
 Bright's disease of the kidney. (See Kidney, Diseases of.) 
 
 ACUTE DROPSY OF THE BRAIN 
 
 Is a very frequent and fatal disease among children. It consists 
 in an inflammation of the membranes which surround the brain or 
 line its central cavities ; the dropsy (or effusion of fluid into the 
 cavities) being nothing more than an accidental occurrence towards 
 the close of the disease, nearly in the same way as dropsy of the 
 belly may follow disease of the liver, or dropsy of the chest may 
 attend a disease of the heart. 
 
 Causes. — It is often difficult to assign any cause for this com- 
 plaint, because it frequently attacks robust children in the midst of 
 apparent health ; but we know from experience that it has been 
 produced by the following causes : blows upon the head, exposure 
 
582 
 
 of the head to a hot sun, the sudden removal of some eruption on 
 the head, irritation of the brain, occasioned by teething or by de- 
 rangement of the bowels, and, finally, the disturbance of the blood- 
 circulation in the brain, which often takes place in the course of 
 hooping-cough, measles, scarlet fever, or small-pox. But of all the 
 exciting causes of this fatal complaint, none is more frequent than 
 scrofula. In a great number of cases it depends on a true scrofu- 
 lous inflammation of the brain or its membranes. This explains 
 the insidious nature of the complaint, its prevalence in certain 
 families, the hereditary tendency to it, and its fatal termination ; 
 for we have every reason to fear that one species of this malady is 
 just as fatal amongst children, as pulmonary consumption is 
 amongst grown-up people. 
 
 To understand the nature and cause of the premonitory 
 symptoms we should state, that it has been shown that acute 
 dropsy of the brain is often preceded, for months or years, by 
 a slow scrofulous inflammation of the membranes of the brain. 
 The existence, then, of this scrofulous inflammation of the brain, 
 or in other words, the premonitory stage of acute dropsy in the 
 head, is indicated by the following signs. The child loses its 
 natural liveliness of temper, and becomes dull and morose; the 
 sleep is disturbed, and the little patient often drowsy during the 
 day; he complains every now and then of headache; the bowels 
 are usually costive, and occasional vomiting, with accesses of fever 
 and tenderness of the belly, are noticed ; the gait of the child is 
 sometimes very peculiar during this stage : he staggers when walk- 
 ing, stumbles without any cause, or may drag one foot after him ; 
 squinting and convulsive movements are sometimes observed, with 
 a bending in of the thumbs, and curving of the toes towards the 
 soles of the feet. These symptoms may last, as we have said, for 
 several months or years ; they are frequently mistaken for infantile 
 remittent fever ; but at length severe headache, with vomiting, con- 
 stipation, and stupor, supervenes, and the slow disease becomes all 
 at once converted into the acute malady. 
 
 Acute dropsy of the brain almost invariably proves fatal when it 
 has passed th.Q first stage without having been relieved; our great 
 anxiety should therefore be to detect the disease in its most early 
 stages, and not to confound it with other complaints of children, to 
 which it may bear some resemblance. The symptoms of the first 
 stage of acute dropsy of the brain should be distinguished from those 
 of the typhus fever, from the commencement of eruptive disorders, 
 and from the peculiar head symptoms which sometimes accompany 
 exhaustion of the vital powers in young children. 
 
AND MOST RECENT METHODS OF TREATMENT. 583 
 
 TREATMENT OF ACUTE DROPSY OF THE BRAIN. 
 
 1. Give purgatives. Adapt the quality and quantity to the 
 strength and age of the patient. Keep the bowels free, but do not 
 exhaust the patient. 
 
 2. Apply blisters and cups to the back of the neck. 
 
 3. Apply cold to the head, but with great caution. 
 
 4. Give iodide of potassium internally, in doses suited to the 
 age of the patient. This causes absorption of the fluid in the brain. 
 
 5. Give nourishing but easily digested food. Beef-tea, mutton- 
 broth, and milk are to be recommended. 
 
 These measures are about all that we can do. 
 
 CHRONIC DROPSY OF THE BRAIN. 
 
 Chronic dropsy of the brain consists in the slow collection of a 
 clear fluid in the cavities of the brain, generally accompanied by 
 gradual enlargement of the head. This disease may either occur in 
 the child before it is born, or may come on very soon after birth. 
 In the first case, it is usually attended by such changes in the brain 
 itself as render it impossible for the child to live ; in the second 
 case, the head enlarges slowly, or even retains its natural size, and 
 some small hope remains of obtaining a cure ; hence we shall con- 
 fine ourselves to giving an account of this latter form. 
 
 The causes which excite chronic dropsy of the brain in children 
 are very obscure. It is said to occur most frequently in the chil- 
 dren of scrofulous parents, as a consequence of fright experienced 
 during pregnancy; as the effect of depressing passions, drunkenness, 
 &c, on the part of the mother ; it may also be produced in the in- 
 fant after birth by improper food, teething, spirituous liquors, affec- 
 tions of the bowels, or other complaints which reduce the strength. 
 
 Symptoms. — Chronic dropsy of the brain sometimes comes on in 
 a very insidious manner, and often escapes our notice at an early 
 stage. When the natural articulations of the head are open, and 
 the skull much enlarged in size, with a sensation of fluctuation at 
 the anterior part of the crown of the head, there can be no mistake 
 about the nature of the disease ; but when the skull retains its natural 
 shape and size, or enlarges very slowly, and when the child's health 
 is not much deranged, it is not an easy matter to discover the nature 
 of the complaint, although it is of the utmost importance that we 
 should be acquainted with its existence as soon as possible. The 
 early symptoms, then, of chronic dropsy of the brain are : an unu- 
 sual peevishness and perversity of temper, dulness, and an inclina- 
 tion to sleep ; irregular appetite, with constipation of the bowels and 
 scanty urine ; if the child be able to walk about, it will often be ob- 
 
584: DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 served that the legs are weak and small in proportion to the rest of the 
 body, while the belly is large and tense. The senses of hearing and 
 seeing are at first acute, but soon become dull, and are more or less 
 injured ; the child cannot articulate words distinctly ; the tongue 
 seems to be getting too large for the mouth, and the mental faculties 
 are also weakened. These latter symptoms should always excite 
 our attention to the state of the head in young children ; the head 
 should be carefully measured with a tape, and if it be found to have 
 increased very sensibly in a short time, we may be almost certain 
 that the child labors under chronic dropsy of the brain. 
 
 As the disease advances the symptoms become more clear. The 
 mental and bodily powers are more or less injured ; the memory is 
 lost, and the power of speech much diminished ; a copious saliva 
 flows from the mouth ; the child is unable to support himself on his 
 legs, and the head begins to hang on one side ; the pupils are dila- 
 ted, the sight lost, and the eyes frequently affected with squinting ; 
 the bowels are still irregular, and the contents of the stomach are 
 often vomited up. 
 
 In the third stage of the disease the head becomes so enlarged 
 that the child is no longer able to support it ; he lies in a state of 
 stupidity, and does not notice what passes around him ; the senses 
 are almost completely destroyed ; the power of moving is lost, the 
 evacuations are passed without the patient's being conscious of 
 them ; in this state he lies for a considerable time, when he is cut 
 off by convulsions, or sinks into profound insensibility, which soon 
 terminates in death. 
 
 TREATMENT OF CHRONIC DROPSY OF THE BRAIN. 
 
 It is impossible to cure these cases. They may, however, linger 
 many years. Usually they die in a few months or years. 
 
 The best we can do is to sustain the strength of the patient by 
 tonics, good food, and leave the results with Providence. 
 
 I may say just here that the friends of patients usually make a 
 serious mistake when they follow after unprincipled quacks in order 
 to obtain relief from diseases that have been proved to be incurable 
 by the experience of honorable and scientific men. 
 
 There are many excellent people who run after every charlatan 
 they can hear of, and seem to prefer their advice to that of sensible 
 and reliable physicians. 
 
 While it is true that happy guesses are sometimes made by these 
 swindlers, it is also true that in the great majority of cases they 
 are less successful than are educated physicians, and oftentimes 
 they do incalculable harm. 
 
AND MOST RECENT METHODS OF TREATMENT. 585 
 
 DYJSTAMOMETEE AND DYSTAMOGKAPH. 
 
 This apparatus is used to test the strength of paralyzed arms. 
 
 By means of this the physician can determine the condition of 
 the limb, and the progress of the case under treatment. 
 
 The clock-work attachment is similar to that connected with the 
 Sphygmograph. (See Sjphygmograjph.) 
 
 Figure 4.— The Dynamogeafh. 
 
 THE DYNAMOGRAPH. 
 
 Figure 3. — The Dynamometer. 
 
 THE DYNAMOMETER. 
 
 The instrument is not yet very much used. 
 
586 
 
 DYSENTERY, 
 
 In treating of dysentery, the division into acute and chronic 
 may be adopted, though the disease presents many different forms 
 and complications. 
 
 ACUTE DYSENTERY. 
 
 Acute dysentery is usually preceded by a disordered state of the 
 stomach and bowels, as indicated by nausea, vomiting, loss of appe- 
 tite, flatulence, and constipation, or the bowels may have been re- 
 laxed for some time previous. It commences with frequent evacu- 
 ations, accompanied by severe griping pains, great desire to strain 
 while at stool, and a burning sensation at the rectum and anus ; 
 there are frequent chills, followed by flushes of heat ; the pulse is 
 quick, or perhaps not much affected ; the stools at first may be 
 copious and feculent, and contain pieces of hardened fseces, but 
 they soon become scanty, and consist chiefly of mucous matter 
 tinged with blood ; a dull, uneasy sensation is felt in the belly, 
 which is relieved after each evacuation ; the tongue is furred, and 
 there is considerable thirst. These are the most prominent symp- 
 toms of the disease as it occurs in its mildest forms, but in its 
 more severe states all the symptoms are aggravated ; the calls to 
 stool are very frequent and distressing, and sometimes accompanied 
 with cramps in the thighs and legs ; the abdominal pain is more con- 
 stant, and increased on pressure with the hand, though often merely 
 a feeling of heat is complained of, except when a motion is about 
 to be passed; the tongue is thickly coated, and- the appetite gone, 
 w T hile the thirst becomes urgent, the patient preferring cold water, 
 each draught of which is invariably followed by severe griping ; the 
 urine is high-colored, passed in small quantities, and often with 
 great pain and difficulty ; the skin is hot and dry, or perhaps only 
 feels hot over the abdomen, the extremities being cold, though 
 sometimes there may be free perspiration. With the advance of 
 the disease the strength gives way, there is despondency, rapid 
 emaciation ensues, and the straining is occasionally so violent that 
 a portion of the gut descends beyond the anus, greatly augmenting 
 the suffering. As a fatal termination approaches, the abdomen be- 
 comes swelled and tender to the touch ; the tongue dry and glazed, 
 or covered with a dry brown fur ; the motions are passed in bed, 
 the patient being unable to get out to reach the close-stool ; the ex- 
 tremities of the body become cold, and delirium, hiccup, and cold 
 clammy perspirations, are the forerunners of death. 
 
 The character of the evacuations varies much, both as regards 
 
AND MOST RECENT METHODS OF TREATMENT. 587 
 
 appearance and quantity ; sometimes they are copious and watery, 
 containing shreds of matter like the washings of beef, or they are 
 scanty, and of a dark-brown or greenish color, with streaks of blood; 
 at other times, after violent straining, only a small quantity of slimy 
 mucus is passed. The odor in all cases is peculiar, but sometimes 
 it is extremely offensive, particularly in the last stage ; the motions 
 may then be composed of pure blood, or a dark fluid, mixed with 
 feculent matter, and occasionally small whitish masses resembling 
 fat are discharged. 
 
 The disease in its worst form may terminate in a few days, 
 though generally its duration is from two to five weeks. The 
 symptoms may be considered favorable when the griping pain and 
 straining at stool diminish, and the motions are less frequent and 
 more healthy in their appearance, while a gentle perspiration breaks 
 out over the whole body, with abatement of the febrile excitement. 
 It may be remarked that changes for the better will sometimes take 
 place, resembling remissions ; these may last for twelve or twenty 
 hours, or longer, and be followed by a return of all the bad 
 symptoms. 
 
 In warm climates, dysentery is witnessed in its most intense 
 forms, and is very frequently complicated with great derangement 
 of the biliary organs, or disease of the liver. With most of the 
 symptoms of the first or most common variety, the tongue has a 
 yellow coating or a white covering over its surface, and appears 
 swollen or larger than natural ; there is nausea and bilious vomit- 
 ing, occasional chills, hot, dry skin, and quick, irritable pulse; the 
 burning sensation in the rectum, and straining at stool, are very 
 severe ; the evacuations may be copious, yellow-colored, or of a dark 
 brown color and uniform consistence ; and sometimes they are frothy, 
 and have a greenish, mixed appearance, with streaks of blood. The 
 stools at the commencement, and even through the course of the 
 disorder, may be little if at all tinged with blood, though usually 
 in the last stage they are mixed with dark bloody matter. A dull, 
 heavy, uneasy feeling is experienced in the right side, increased by 
 pressing with the fingers under the ribs, the pain often stretching 
 to the right shoulder, where there may be a constant aching sensa- 
 tion ; there is sometimes a feeling of oppression at the chest ; the 
 patient is troubled with a harassing, irritating cough ; and in the 
 last stage the tongue is red, smooth, or dark-colored and dry. The 
 first symptoms of dysentery, where the liver has been long diseased, 
 are frequently a sensation of fulness and uneasiness at the stomach 
 and right side, copious discharges of bilious matter, with pain of 
 belly and griping. 
 
588 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 CHRONIC DYSENTERY. 
 
 Ill chronic dysentery the pulse is but little disturbed, except 
 towards evening, when it may be quickened and accompanied with 
 slight feverish symptoms ; the evacuations are much less frequent 
 than in the acute states, and are seldom attended with much strain- 
 ing, though in general there is a griping or twisting sensation about 
 the navel before each motion, which is entirely relieved after leav- 
 ing the close-stool. There is not often pain or pressure over the 
 belly (which may be swelled and hard, or natter than usual), though 
 sometimes there is a heavy feeling, or sensation of heat and sore- 
 ness, as the patient may express it. The stools vary greatly, even 
 in the same patient, at different times ; they may be copious and 
 of a dark-brown color, or white, like clay diffused in water ; hence 
 the disease has been called white flux; or there is feculent matter 
 intimately mingled with blood ; sometimes there is a bloody mucus 
 mixed with a substance resembling matter (pus), or the evacua- 
 tions have a marbled and greenish appearance. 
 
 Causes. — Dysentery prevails chiefly in autumn and the begin- 
 ning of winter, during cold moist weather, following great heat or 
 long-continued drought ; or it may be induced by high ranges of 
 temperature succeeding to moist and very wet weather. An at- 
 tack may be brought on by exposure to cold and wet, or to the 
 dews of night, particularly after fatigue ; by wearing damp clothing, 
 by scanty and unwholesome food or drink, eating acid or unripe 
 fruits, the use of water contaminated with impurities, breathing air 
 rendered impure by many persons being crowded together, as in 
 camps, vessels, prisons, &c, and then the disease is likely to assume 
 the typhoid and malignant forms, and may become highly con- 
 tagious ; by constipation and the accumulation of morbid biliary 
 secretions, the use of intoxicating liquors in excess, very rich stimu- 
 lating diet, exhalations from the soil and from marshes, as well as 
 putrid animal exhalations and epidemic states of the atmosphere. 
 In hot countries the disease is frequently associated with worms, 
 particularly in the dark races, who are peculiarly subject to bowel 
 complaints. 
 
 Chronic dysentery differs only in degree from the acute form, 
 and arises from the same causes. 
 
 TREATMENT OF ACUTE DYSENTERY. 
 
 1. Rest. The patient must keep perfectly quiet, in a horizontal 
 position. This is the first and great requisite to success. 
 
 2. A dose of castor oil and laudanum (10 to 30 drops). If the 
 
AND MOST RECENT METHODS OF TREATMENT. 589 
 
 patient is seen early, this old -fashioned treatment is excellent. It 
 clears the bowels of irritating substances. 
 
 3. Dover's powder, or the cold powder, in doses of from three 
 to five grains. The Dover's powder may be given in doses of ten 
 or fifteen grains, if necessary. (See Cold Powder and Dover's 
 Powder) 
 
 The following prescription will frequently be found of service: — 
 
 Opium, six grains, 
 Ipecac, twenty-four grains, 
 Calomel, twelve grains, 
 Mucilage or syrup, as much as is necessary. 
 Mix, and divide into twelve pills. Take one every five hours. 
 
 4. Inject starch and laudanum into the bowels (twenty drops of 
 laudanum to one ounce of starch), in order to relieve the straining 
 and irritation, and the burning sensation. 
 
 5. Sugar of lead is sometimes given internally in the form of the 
 lead and opium pill (half a grain of each in the pill), and is also 
 injected into the bowels in the form of a solution (three or four 
 grains to the ounce). 
 
 HopJs Mixture is often given for dysentery. The prescrip- 
 tion is — 
 
 Nitric acid, one drachm, 
 Laudanum, forty drops, 
 Camphor water, eight ounces. 
 The dose is a tablespoonful. 
 
 6. Give stimidants and tonics. — Quinine, brandy, and opium all 
 are good, and if necessary, when the patient is much exhausted, 
 should be given freely. 
 
 Dysentery often becomes a disease of debility. The patient 
 falls into a typhoid condition. This is always a bad symptom. 
 This condition must be treated by tonics and stimulants. 
 
 Dysentery is a disease which sea captains and others who are 
 beyond the ready call of a physician are obliged to treat. It comes 
 on suddenly, and sometimes prostrates a large number of seamen 
 at once. In such cases pains should be taken to thoroughly fumi- 
 gate the ship, for the disease is always fostered by filth. 
 
 The diet of dysenteric patients should be of a mild and soothing 
 character — chicken-water, rice-water, arrow-root, and beef-tea. The 
 intense thirst may be checked by chewing bits of ice. 
 
 Dysentery within the tropics is often extremely insidious in its 
 commencement; looseness of the bowels and slight griping pains 
 may exist for weeks, unheeded by the patient, until exhaustion of 
 strength and some aggravation of the symptoms compel him to take 
 to bed ; and though the attack has been apparently very mild, yet 
 
590 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 the delay which has taken place in commencing the treatment may- 
 lead to a fatal termination, whatever means be employed. I can- 
 not, therefore, point out in too strong terms the necessity of attend- 
 ing at once to the slightest derangement of the bowels in tropical 
 climates, since a gentle purgative, followed at night by fifteen 
 grains of Dover's powder, or a pill, composed of two grains of 
 opium and two grains of ipecacuan, repeated for a few nights, and 
 the occasional use of the warm bath, will frequently put a stop to 
 those symptoms which, otherwise, might have ended in danger or 
 destruction to life. 
 
 TREATMENT OF CHRONIC DYSENTERY. 
 
 Chronic dysentery is treated on the same general principles 
 as the acute form. What has already been said on the treatment of 
 acute dysentery need not be here repeated. 
 
 In tropical climes chronic dysentery is very frequent, and some- 
 times quite fatal. 
 
 In addition to the treatment already laid down for acute dys- 
 entery, it is well to try the various astringents. The disease at 
 best is obstinate. 
 
 Simaruba is found very serviceable in this affection. It cured 
 a patient of mine in the Gulf of Mexico, after other measures had 
 entirely failed. Sugar of lead, sulphate of zinc, nitrate of silver, 
 sulphate of copper, and tannic acid may also be tried in succession. 
 The doses of these medicines are given under their appropriate 
 names, and prescriptions are found under Astringents. 
 
 It is absolutely necessary in this disease, but more especially in 
 the chronic form, that the warm or rather tepid bath should be fre- 
 quently used, in order to keep the skin clean. 
 
 With regard to regimen the patient must be particularly guard- 
 ed, for medicine can be but of little avail if he be induced to 
 satisfy those morbid cravings which are so frequently a symptom of 
 this form of the disease. The diet should be mild, easy of diges- 
 tion, and unstimulating, being chiefly composed of farinaceous sub- 
 stances, as rice, bread, sago, arrow-root, &c, with milk. The drink 
 also must be mild and demulcent, unless in cases attended with 
 much debility ; and where there are no inflammatory symptoms, 
 port wine in moderation may then be allowed, with water, or thin 
 arrow-root, which is perhaps the best method of taking it ; and 
 those who have been in the habit of using spirits may take weak 
 brandy and water. 
 
AND MOST RECENT METHODS OF TREATMENT. 591 
 
 DYSPEPSIA. 
 
 Dyspepsia is one of the most common, most fashionable, and 
 most annoying of the nervous symptoms of our modern society. 
 Within the past quarter of a century it has increased in frequency 
 and with great rapidity, so that there are very few who pass through 
 life without making its acquaintance. 
 
 It is a most capricious, fickle, and uncertain visitor. It appears 
 when it is little looked for, and when we suppose that it has de- 
 parted from our doors forever it may suddenly re-appear in a more 
 hideous shape than before. It comes and goes without law or order 
 or regularity, and oftentimes without any seeming dependence on 
 our behavior. At some times we may violate all the rules of diet 
 and of hygiene in general without suffering the punishment of dys- 
 pepsia ; at other times the fiend seizes fast hold of us, and will not 
 let go his hold though we pay the uttermost farthing of our debt to 
 the laws of health. 
 
 As will be explained more distinctly in the section on " Ner- 
 vous Diseases of Modem Times" dyspepsia is usually a nervous 
 disease. It is usually a result of over- work, over- worry, over-con- 
 finement, bad air, bad and insufficient food, sexual excesses and 
 genital disorders, the abuse of stimulants and narcotics, want of sleep, 
 and in short of all influences that tend to depress the vital powers. 
 
 It is not brought on by errors in diet so frequently as is sup- 
 posed. Those who are most careful, and even literal and ra- 
 tional in their diet, are frequently the greatest sufferers from dys- 
 pepsia. 
 
 It is brought on by the same diseases that bring on hypochon- 
 dria, hysteria, nervous exhaustion, spermatorrhoea, paralysis, in- 
 sanity, and other well-known nervous diseases. It often exists in 
 connection with these and other nervous diseases ; nearly all hypo- 
 chondriacal, hysterical, and nervously exhausted patients are more 
 or less dyspeptic. 
 
 Like all other nervous diseases, and like all other conditions of 
 the body, both good and bad, dyspepsia is exceedingly hereditary. 
 
 Those who have ever suffered from dyspepsia — and who has not 
 —will not need to be told what its symptoms are. For the benefit 
 of those who have never experienced this malady— if there be any 
 such — I present below a detailed explanation of the symptoms. 
 
 Accidental attacks of indigestion are of very frequent occurrence, 
 and arise for the most part from overloading the stomach with food 
 
592 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 and indulging too freely in wine, spirits, or other intoxicating 
 liquors. The principal symptoms are, a sense of fulness, weight, 
 and uneasiness at stomach; foul tongue, a bitter taste in the mouth, 
 nausea, loss of appetite, with a particular aversion to fat or oily 
 substances, and sweet or insipid articles of diet; flatulency, sick 
 headache, and sometimes heartburn. In such cases a gentle emetic 
 of ipecacuanha, a draught of warm chamomile tea, or irritating the 
 throat with a feather, in order to rid the stomach of the aliment 
 with which it is overcharged ; followed by a mild dose of tincture 
 of rhubarb, Gregory's stomachic powder, or some other gentle lax- 
 ative ; and spare diet for a few days, so as to allow the weakened 
 stomach to recover its tone — are the simple means to be resorted to 
 for the purpose of restoring the healthy functions of the digestive 
 organs. Other causes, however, besides repletion may give rise to 
 an accidental fit of indigestion. Of these we may enumerate 
 articles of food difficult of digestion; certain circumstances 
 occurring shortly after a mealj as exposure to extreme heat or 
 cold, the use of ices, and strong mental excitement ; eating quickly 
 after long fasting; constipation of the bowels ; accumulation of bile 
 or mucus in the stomach, &c. In all cases of this description, 
 when the disorder can be easily traced to some accidental cause, 
 the above treatment, if no inflammatory or feverish symptoms 
 be present, will soon restore the stomach and bowels to a healthy 
 state. 
 
 The chronic form of indigestion, depending on debility or 
 functional derangement of the stomach, commences slowly, and 
 often advances to a considerable extent without particularly attract- 
 ing the patient's attention. The symptoms that indicate the 
 approach of this insidious disorder are numerous, but we shall 
 only notice those which most frequently present themselves : the 
 sleep is disturbed, and the patient is restless during the night, but 
 in the morning he sleeps heavily, beyond his usual hour of rising, 
 and awakes unrefreshed, with a bitter taste in his mouth. He has 
 very little appetite for breakfast, and can only relish savory articles 
 of food ; during the day he feels languid, and sometimes drowsy, 
 particularly after meals; and has little inclination for exercise or 
 mental exertion. After some time a sensation of dryness in the 
 throat begins to be felt in the morning, attended with expecto- 
 ration of gray-colored phlegm, and sometimes with slight sore 
 throat. As the disease advances the appetite becomes more im- 
 paired, nausea and inclination to vomit are occasionally expe- 
 rienced ; an unpleasant sensation of heat is sometimes felt at the 
 stomach during the day; disinclination to exercise and mental 
 
AND MOST RECENT METHODS OF TREATMENT. 593 
 
 occupation increases, and there is drowsiness after dinner. These 
 symptoms are followed by a dull, heavy pain in the head, and 
 a feeling of weight at the stomach, with flatulency and heartburn 
 after eating. When this form of indigestion becomes confirmed, 
 the face is pale, the eyes appear dull and heavy, the mouth feels 
 clammy ; the tongue is flabby, pale, or whitish, and more or less 
 furred ; there is a constant sense of fulness and distention in the 
 belly ; and the bowels are irregular, the evacuations being scanty 
 and particularly fetid, or copious, and frequently containing bile 
 and portions of half-digested food ; the urine is clear, copious, and, 
 after standing some time, deposits a reddish sediment indicating aci- 
 dity in the stomach and bowels; or it may become turbid and deposit 
 a whitish substance, showing an alkaline state of the contents of the 
 stomach ; the temperature of the body is lower than natural, the feet 
 are often cold, and the pulse is soft and weak. When the disorder 
 is of long continuance, other organs of the body become sym- 
 pathetically affected; in some cases there is a troublesome dry 
 cough, or there may be palpitation of the heart and intermitting 
 pulse, which lead the patient, now low-spirited and timid, to 
 suppose that his heart is diseased, and this idea preys upon his 
 mind and tends to aggravate all the symptoms. The mental 
 powers, particularly of application and memory, become impaired 
 along with the general health and strength. The patient may 
 remain in this state a considerable length of time, and then gra- 
 dually recover, or the inflammatory form of indigestion about to 
 be described supervenes. 
 
 TREATMENT OF DYSPEPSIA. 
 
 Dyspepsia, unless it is a result or symptom of ulcer or cancer of 
 the stomach, is not & fatal disease. 
 
 Indirectly, by reacting injuriously on the cerebro-spinal system, 
 it may bring on softening of the brain, or some incurable disease 
 of the spinal cord. Possibly, also, it may help to bring on insanity. 
 Yet I think that there is a tendency to charge dyspepsia with 
 crimes of which it is not guilty. It must be remembered that dys- 
 pepsia is itself often a result, an effect of exhaustion of the nervous 
 system, and that the brain-disease of which dyspeptic patients often 
 die may itself be the cause of the dyspepsia. 
 
 The greatest mistakes in medicine, as on all other subjects, are 
 made ly confounding effects with causes. 
 
 I have very often observed that patients who in their early man- 
 hood, and perhaps in adult life, suffer from dyspepsia, in the decline 
 38 
 
594: DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 of old age are affected with some disease of the brain or spinal cord. 
 And yet I am not sure that, in such cases, even the dyspepsia is the 
 cause of the disease of the brain. The morbid tendency in the ner- 
 vous system may simply change its locality. It may leave the 
 stomach, or the nerves that supply the stomach — the solar plexus — 
 and go to the brain. 
 
 In the treatment of dyspepsia we must therefore consider : 
 
 First. That it is usually not so much a symptom of disease of 
 the stomach as of general nervous exhaustion. 
 
 Dyspepsia that results from inflammation of the lining membrane 
 of the stomach is merely a local disease. 
 
 Secondly. That the treatment must therefore be directed to the 
 general system, and not to the stomach merely. 
 
 Thirdly. That the treatment must in the main be tonic in its 
 character. 
 
 Those who understand these three principles are qualified to 
 treat dyspepsia. Those who do not appreciate these principles 
 will probably fail in their efforts to remove this disease. 
 
 Let it also be understood distinctly that dyspepsia is a relievable 
 and a curable disease. The common impression that nothing can 
 be done for the dyspeptic is very erroneous. It is true that little 
 can be done for the dyspeptic by ordinary medication, directed 
 merely to the complaining stomach ; but with our modern systems 
 of treatment it is one of the most relievable and even curable of any 
 of the nervous diseases of our time. 
 
 The course of treatment for the dyspeptic is as follows : 
 
 1. General electrization (see article on General Electrization), 
 used faithfully, skilfully, and perseveringly. For dyspepsia I know 
 of no remedy so efficacious. To this subject I have given long and 
 special attention, and I think that, without over-estimating this 
 method of treatment, it may be regarded as the best of our reme- 
 dies. In order to be successful it must be used with the judgment 
 and the studious adaptation to each case that only experience can 
 teach. General electrization is now being studied and employed 
 by many physicians in various parts of the country, and will soon 
 become much more widely known than it is at present. It takes 
 time, both for the patient and for the physician who administers 
 it ; but the dyspeptic who is not willing to take time to get well 
 does not deserve to get better. 
 
 2. The Movement Cure. (See article on Movement Cure!) — 
 This is a most valuable remedy for dyspepsia, as for many other 
 conditions of nervous debility. It should be directed by a practised 
 physician. It takes more time than general electrization. A 
 
AND MOST RECENT METHODS OF TREATMENT. 595 
 
 patient may use the two methods of treatment at the same time. 
 There is no necessary interference. 
 
 3. A generous and palatable variety of food. 
 
 The old-fashioned habit of " dieting for dyspepsia " was based on 
 the radical error that dyspepsia was caused by over-eating. The 
 reverse is very often the case. Under-feeding, going without 
 meals, eating hard, dry, indigestible and ill-nourishing food, such 
 as pork and boiled cabbage, and soggy bread and vile pastry — these 
 errors of diet may cause dyspepsia, but rarely does simple and 
 regular over-eating of good food bring on permanent dyspepsia. 
 
 The dyspeptic, above all others, needs to be nourished. Star- 
 vation is sure to work injury, and rarely fails to aggravate the 
 disease. The dyspeptic should take his meals with good regular- 
 ity — should eat plenty of fresh beef, mutton, lamb, chicken, 
 turkey, and eggs, oysters, fish, light bread, white or brown, as may 
 suit him best. He should have a variety of food at each meal, 
 especially at dinner. He may, if he chooses, use with advantage 
 light sour wine or cider with his meals instead of tea and coffee. 
 Rhine wine is usually agreeable and beneficial to the dyspeptic. 
 
 In regard to the choice of food, each person must judge for 
 himself, by his own experience. As a rule, dyspeptics find it to 
 their advantage to abstain from pork, salt or fresh, hard-boiled 
 eggs, soggy bread, heavy pastry, rich confectionery, and some of the 
 vegetables ; also from strong tea and coffee. 
 
 4. jPlenty of Sleep. — Sleep is food for the nerves. Let the dys- 
 peptic seek sleep at any time or at all times, whenever he may feel 
 disposed. A short nap before dinner rests the stomach, and pre- 
 pares it for the digestion of food. 
 
 5. Spongiopiline and wet compresses worn against the pit of 
 the stomach. (See articles on Spongio-piline and Water Cure.) — 
 Great relief for the pain in the stomach, and for the indefinable un- 
 easiness and sense of " goneness " that dyspeptics feel, is afforded by 
 the spongio-piline compress. It may be worn for days, and weeks, 
 and months. Sometimes it affords relief of pain and distress in the 
 stomach in half an hour from the time of application. The wet 
 compress is also of use, applied in the same way, but is less neat 
 and convenient than the modern spongio-piline. 
 
 6. A liberal variety of moderate exercise in the sunlight. — The 
 great mistake of dyspeptics is to exercise too violently and too 
 long. When a person finds out that he is suffering from dyspep- 
 sia, he often feels that it is his duty to take long walks, or to toil 
 hard at the wood-pile before breakfast ; to tramp fifteen or twenty 
 miles a day ; to exercise furiously in the gymnasium with dumb- 
 
596 
 
 bells and on parallel bars. All this is an extreme. When the sto- 
 mach is weak the body usually shares more or less in that weakness. 
 This is especially the case in the so-called nervous dyspepsia. An 
 engine that is poorly supplied with fuel, and in which the fire is 
 half out, cannot be expected to draw as heavy a load of cars as an 
 engine that is well supplied with fuel, in which the fires are briskly 
 burning. 
 
 Just so, a man whose appetite is capricious, who cannot digest 
 his food, and who is more or less starved, cannot be expected to 
 perform as much labor as a man with a vigorous appetite, who 
 thoroughly digests his food, and who is consequently well nou- 
 rished. 
 
 The dyspeptic should always bear in mind these rules in regard 
 to exercise : — 
 
 First. Never exercise hard or long before breakfast, for that is 
 a blunder that is almost a crime. 
 
 Secondly. Never exercise very hard just before or just after 
 meals, except in emergencies. It is not necessary to be squeamish 
 on that point. 
 
 Thirdly. Take the Jcind of exercise which you most enjoy, if 
 you are so situated that you can do so, and change from one form 
 to another as often as you get tired. 
 
 Fourthly. Never exercise to absolute exhaustion, if you can 
 avoid it. 
 
 For more detailed hygienic suggestions the reader is referred to 
 my chapters on Air, Sunlight, Exercise, Food, Stimulants, and 
 Narcotics. The views and facts therein presented are of special in- 
 terest to the dyspeptic. 
 
 7. Best, travel, and change of occupation. — For the dyspeptic, rest 
 is oftentimes more useful than exercise. It is well to take short and 
 frequent vacations, to throw off the cares and the trials of business, 
 and simply vegetate in some quiet nook, when our humor may lead us. 
 The nervous dyspeptic would do well to study and acquire the art 
 of lounging or loafing. Some dyspeptics think that they are bene- 
 fited by smoking, especially when the effect of the tobacco is to 
 calm, to soothe, to make the hours glide easily and unconsciously. 
 When tobacco has the opposite effect — to excite, to irritate, to in- 
 crease nervousness — it probably injures the dyspeptic. 
 
 Travelling often cures dyspepsia, but it is by no means a certain 
 remedy, nor is it necessary to a cure. 
 
 A sea-voyage to Europe often does good to the dyspeptic, not 
 on account of the sea-sickness which it produces, but in spite of it. 
 Sea-voyages, if not too long, are beneficial to dyspeptics in two 
 
AND MOST RECENT METHODS OF TREATMENT. 597 
 
 ways. First, by giving him opportunity and means of rest, and 
 quiet and freedom from the strifes and din and worry of business 
 life on shore. (See Sea-sickness.) 
 
 Secondly, by the tonic and calming effects of the sea- air itself. 
 
 Mountain air and climbing mountains are better for many dys- 
 peptics. 
 
 Internal remedies. — As a rule, tonics and stimulants best serve 
 our purpose. Caswell's or Wyeth's elixir of iron and quinine are 
 both good. (See Prescriptions for Tonics.) Subnitrate of bismuth 
 is much used, and sulphite of soda is recommended in doses of five 
 or ten grains. 
 
 Pepsin is much used, and in some cases it is certainly benefi- 
 cial. But, after all, it is not well to place much reliance on internal 
 medication. (For further remarks see Nervous Diseases.) 
 
 INFLAMMATION OF THE EAE. 
 
 Acute inflammation of the ear usually begins in the throat, and 
 travels along the Eustachian tube to the middle part of the ear, or 
 that portion of the organ of hearing situated between the membrane 
 of the drum and the nerve. If unchecked, it may pass outward 
 through this membrane, or to the brain. The latter result is very 
 dangerous to life. Such an inflammation is usually the result of 
 exposure to a draught, of getting the feet wet, or of similar causes 
 of catching cold. There is great pain in the ear, noises in the 
 head, and fever. 
 
 The treatment should be prompt and energetic. Leeches should be 
 applied just in front of the external opening of the ear, and warm 
 or hot water be kept in the ear constantly until the pain is subdued. 
 A hot foot-bath should be given, and the patient kept in a warm room. 
 
 If matter has formed in the ear and is discharging, it should be 
 removed from once to three times a day by syringing ; and then an 
 astringent of some kind, which has been previously warmed, say 
 of alum, of the strength of one to three grains to the ounce, may 
 be dropped into the ear. Deafness from imperfect action of the 
 Eustachian tube, or the canal leading from the throat to the ear, is 
 apt to remain after these attacks of acute inflammation, or it may 
 occur of itself. The tube does not open as it should during the 
 action of swallowing, consequently the interchange of air between 
 the middle ear and pharynx is not effected ; the drum-head of the 
 ear sinks inwards, there being a greater pressure upon its outer than 
 uponits inner surface ; and deafness, or improper or imperfect con- 
 duction of the waves of sound results. In such cases the muscles that 
 open the tube should be kept in action by a gargle of alum, or chlorate 
 
598 DESCRIPTION OF THE PKINCIPAL DISEASES, 
 
 of potash, or cold water, while at intervals of twenty-four hours air 
 is forced through the Eustachian tube by the following method : 
 
 The affected person takes a little water in the mouth, which 
 he is instructed to hold there until he is told to swallow it. The 
 operator then takes a tube of india-rubber, or the like, of about 
 twelve inches in length, and inserts one extremity in one nostril of 
 the patient, at the same time closing the other with the finger. He 
 then places the other extremity in his mouth, and causes the pa- 
 tient to swallow at the instant he forces a column of air from his 
 own lungs into the tube. He may indicate the proper instant by 
 a gesture. The air will be forced against the mouth of the tube, 
 and, in most instances, through the tube itself into the ear. This 
 procedure may be repeated three or four times, and it is usually 
 followed by considerable improvement in the hearing. 
 
 A chronic discharge from the ear should be treated by careful 
 and daily syringing with warm water, afterwards dropping in an 
 astringent such as has been mentioned, always warming it before 
 use. It is a very obstinate affection, but it is also a dangerous one 
 to life, and should always be carefully and thoroughly treated until 
 the discharge ceases. Many children and some adults die every 
 year in consequence of a neglect of a discharge from the ear. 
 
 Hard wax does not collect in the ear as often as has been sup- 
 posed ; when it does, however, it should be removed by syringing 
 with warm water. 
 
 If a substance such as a button, bead, or the like, or any insect, 
 has got into the ear in any way, it should be removed by syringing 
 with warm water. No instrument should be introduced into the 
 ear to remove any such substance, unless a thorough attempt has 
 been made to remove it by syringing. If instruments are intro- 
 duced, none, but a competent surgeon should use them, and he 
 will seldom or never need such an aid. Substances remaining in 
 the ear will do no harm for a long time, while improper attempts 
 to remove them have caused the greatest injury in many cases; and 
 sometimes death has resulted from careless manipulation. Chronic 
 affections of the ear that are unaccompanied by discharge can only 
 be treated by a physician, and should never be meddled with by 
 non-medical persons. They usually result from a chronic inflam- 
 mation of the throat, which has extended along the Eustachian 
 tubes to the ear. 
 
 EFFERVESCING DRAUGHTS. 
 
 Effervescing draughts are much used in fevers and inflammatory 
 diseases, in order to quench thirst, check vomiting, moderate the 
 
AND MOST RECENT METHODS OF TREATMENT. 599 
 
 heat of the surface of the body, and cause gentle perspiration. The 
 one generally used is made as follows : 
 
 Take of subcarbonate of potash, or of soda, a scruple, 
 
 Syrup of orange-peel, a drachm. Mix, in a wine-glassful of water, and then add a 
 tablespoonful of lemon-juice, or fifteen grains of citric or tartaric acid, in powder, dis- 
 solved in a little water. 
 
 The above may be swallowed while in a state of effervescence, or 
 the alkaline solution may be hrst taken, and the acid immediately 
 afterwards, so that the effervescence may take place in the stomach. 
 In fever it is a common practice to add five grains of nitre to this 
 draught, with the intention of increasing the determination to the skin. 
 
 A mild and agreeable effervescing purgative draught is made 
 from the patent Seidlitz powders. These consist of two different 
 powders ; the one contained in the white paper consists of two 
 drachms of tartarized soda (Rochelle salt), and two scruples of 
 carbonate of soda; that in the blue paper, of thirty-five grains of 
 tartaric or citric acid. The contents of the white paper are to be 
 dissolved in half a pint of spring water, to which those of the blue 
 paper are to be added. The draught is to be taken in a state of 
 effervescence. 
 
 ELATEKIUM. 
 
 Elaterium, or the dried juice of the wild cucumber, is the most 
 powerful of all purgative remedies. It is principally used in dropsy, 
 from the action it possesses of discharging through the bowels the 
 water which has accumulated in the cavities of the body, or in the 
 cellular substance under the skin. (See Dropsy.) When properly 
 prepared, its action is as regular and certain as that of any other 
 remedy. The dose is the eighth or the quarter of a grain, twice or 
 thrice in twenty -four hours, which should be continued until copious 
 evacuations are procured. In dropsy it is frequently used in the 
 following form : 
 
 Take of the extract of elaterium, one grain, 
 Sweet spirits of nitre, two ounces, 
 Tincture of squills, and 
 
 Oxymel of colchicum (or meadow saffron), of each half an ounce, 
 Syrup of buckthorn, an ounce. Mix. The dose is a teaspoonful three or four times 
 a day. 
 
 It has been used with advantage in gout and acute rheumatism, 
 in combination with other purgatives, as follows : 
 
 Take of the extract of elaterium, ten grains, 
 
 Compound extract of colocynth, two drachms, 
 
 Jalap, and 
 
 Castile soap, of each a drachm, 
 
 Oil of juniper, a sufficient quantity to make a mass, to be divided into fifty pills: two 
 or three a dose. 
 
600 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 ELECTRICITY— ELECTRIZATION. 
 
 Electricity has been used for the treatment of disease for more 
 than a century. 
 
 At first, sparks from the Ley den jar were employed. Then the 
 electricity generated by frictional machines was used. These fric- 
 tional machines are now exhibited among the philosophical instru- 
 ments of our schools and colleges. All sorts of diseases were treated 
 by this frictional electricity — paralysis, St. Yitus's dance, rheuma- 
 tism, and many other conditions of disease were treated by this 
 agent, and oftentimes with apparent or real success. 
 
 The Voltaic pile was also used to treat disease, and at one 
 time it was thought that it would cure all maladies. 
 
 The profession, however, became disappointed with the results, 
 and for these reasons: 
 
 1. The apparatus of those days were not reliable. 
 
 2. They did not know in what diseases electricity was most 
 useful. 
 
 3. They did not know how to apply the electricity. 
 
 But in spite of all the efforts of these able men, electrization, 
 for the reasons above given, fell into disrepute. 
 
 After the discovery of the induction current by Faraday, in 1834, 
 a new impetus was given to this department. Masson and Du- 
 chenne and Remak in Europe experimented and wrote on this sub- 
 ject, and really created a new era for electro-therapeutics. 
 
 Since 1850, thirty or forty different books and pamphlets have 
 been written on the application of electricity to disease. 
 
 In Europe, electricity is largely used in the form of localized 
 electrization for the cure of paralysis, neuralgia, and many other 
 affections. It is exciting more and more attention. It is certain 
 that in a few years it will be used much more than it is now. 
 
 In this country electricity has been until recently almost en- 
 tirely in the hands of quacks, or at least ignorant men. It cannot be 
 denied, however, that many of these have often been successful in 
 their cases. The fact that such ignorant, reckless, unprincipled 
 charlatans have been so successful oftentimes, is itself powerful 
 evidence that electricity is an agent of very great efficacy in the 
 treatment of disease. 
 
 METHODS OF ELECTRIZATION. 
 
 There are several methods of using electricity for the treatment 
 of disease: General electrization , localized electrization , partial 
 
AND MOST EECENT METHODS OF TREATMENT. 
 
 601 
 
 electrization, galvano-puncture, galvano-cautery, and electro-punc- 
 ture are really modifications of localized electrization. (See Gen- 
 eral Electrization and Localized Electrization^) 
 
 Localized electrization was first employed by Hasson, and was 
 developed and popularized by the efforts and writings of Duchenne, 
 of France. In this method the poles are applied near each other 
 through separate parts or organs, with a view to local effects merely. 
 It is chiefly used for paralysis, neuralgia, and rheumatism. 
 
 ONE OF THE FORMS OF APPARATUS FOR ELECTRIZATION. 
 
602 DESCRIPTION" OF THE PRINCIPAL DISEASES 
 
 ^ESTHESIOMETER. 
 
 iM li.mni.il. «i i "| 
 
 ESTHESIOMETER. 
 
 >= b»a> •* a ax tf. 
 
 ESTHESIOMETER. 
 
 This is used to determine the sensibility of paralyzed parts. 
 
 The value of the sesthesiometer depends on this fact, that the 
 consciousness of the distance hetween any two points applied to the 
 skin, varies in different parts of the body, and is modified by dis- 
 ease. The ordinary compass with a graduated scale is much used. 
 By the sesthesiometer we can also ascertain whether the paralytic is 
 recovering, because usually the affected part as it gets better be- 
 comes more sensitive. 
 
AND MOST RECENT METHODS OF TREATMENT. 603 
 
 The ends of the fingers and tip of the tongue are the most sen- 
 sitive portions of the body ; the least sensitive parts are the back 
 and outer portion of the thigh. This sensitiveness is greatly modi- 
 fied by paralysis. (See cuts of Esthesiometer.) 
 
 Elixdrs of Quinine, Strychnine, and Pyrophosphate of Iron are 
 now deservedly popular. (See Prescriptions for Tonics.) 
 
 EPILEPSY, OR FALLING SICKNESS. 
 
 In the great majority of cases the fits of epilepsy come on with- 
 out any previous indication of their approach ; but sometimes the 
 following premonitory symptoms are experienced. Headache, gid- 
 diness, ringing in the ears, flushed face, low spirits, irritability of 
 temper, the fancied appearance of certain objects before the eyes, 
 and in some cases dilatation of the pupils, announce the approach 
 of an attack. These sensations continue some time, perhaps a day 
 or two, before the fit comes on ; but in other patients the warning 
 symptoms are of short duration, and of a different description. A 
 feeling of pain, heat, cold, or tingling comes on suddenly in one of 
 the toes or fingers, or in a particular part of the back or belly, then 
 rises gradually through the stomach and heart until it reach the 
 head, when the patient immediately falls to the ground as if struck 
 with lightning. But in ordinary cases, at the moment when the 
 patient least expects it, perhaps when conversing with his friends 
 at table, he utters a loud unnatural scream, and falls down bereft 
 of sense and voluntary motion, and violent convulsions instantly 
 follow. In some cases, however, the convulsive movements precede 
 the fall; particular motions or gesticulations of the limbs take place, 
 or the head is drawn backwards or turned gradually round towards 
 one of the shoulders, by a spasmodic action of the muscles of the 
 neck, which appears, very distressing; but in general the piercing 
 shriek, the fall, and the convulsive movements follow each other 
 with the rapidity of lightning. The muscles of the trunk and ex- 
 tremities of the body are violently agitated, and the patient is 
 severely shaken ; the limbs are alternately extended and flexed, the 
 toes are curved inwards, the thumbs are firmly grasped in the palms 
 of the hands, and it has been remarked that in many cases the 
 muscles of one side of the body are more severely convulsed than 
 those of the other. The convulsive action of the muscles of respiration 
 causes the breathing to be at first slow and difficult, but after some 
 time it becomes quick, irregular, and occasionally stertorous. The 
 muscles of the belly and the bladder are acted on in a similar man- 
 ner, so that in some patients the faeces and urine are expelled 
 
604: DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 involuntarily. The face is swollen and red, or of a purple color; 
 the veins of the temples and neck are enlarged ; the face is drawn 
 to the right or to the left, or the head may be drawn backwards or 
 downwards on the chest. Sometimes the eyelids are closed, at 
 other times wide open ; the eyes are fixed and staring, or they roll 
 in their orbits, the pupils remaining dilated or contracted, but 
 always immovable. The face is violently distorted, the patient 
 gnashes his teeth, and thrusts out his tongue, which is often severely 
 injured ; foam flows from the mouth, and is not unfrequently bloody, 
 from the wounds inflicted on the tongue. The action of the heart 
 is strong, tumultuous, and irregular ; and the pulse is quick, small, 
 and at times scarcely perceptible. 
 
 It seldom happens that, the attack continues longer than a few 
 minutes, but in some cases the patient becomes immovable for a 
 short time, and is again suddenly convulsed. Sometimes a series of 
 attacks and remissions follow each other in this manner during half 
 an hour, an hour, or even considerably longer. In general, however, 
 the convulsions gradually cease ; perspiration breaks out on the fore- 
 head, neck, and breast ; the breathing becomes natural, and is 
 occasionally attended with sighing ; the face loses its livid color, and 
 appears pale. The patient now remains for some time in a sort of 
 stupor, and is then restored to a slight degree of consciousness ; he 
 appears very drowsy and overcome with fatigue, and soon falls into 
 a deep sleep. While in this state the perspiration breaks out freely 
 over the whole body, the breathing becomes natural, the pulse full, 
 soft, and slow ; and after sleeping profoundly during several hours 
 he awakes slowly, without retaining the slightest recollection of 
 what has taken place. He may recover his senses immediately on 
 awaking, but in most cases the power of voluntary motion, sensation, 
 and consciousness return slowly, and a feeling of languor, weakness, 
 and weight, or oppression in the head, with pain, or a sensation of 
 soreness about the chest and limbs, is experienced for some time after. 
 
 When the fits recur frequently, and the complaint has been of 
 long continuance, the memory fails, the intellect becomes impaired, 
 the countenance assumes a vacant appearance peculiar to epileptic 
 patients, and at last a state of idiocy is induced ; but when the at- 
 tacks appear at long intervals, without being immoderately severe, 
 their influence on the general health and intellect is scarcely if at 
 all perceptible. In fact, when confined within due bounds, epi- 
 lepsy is not incompatible with the development of the most power- 
 ful intellect. Many celebrated men of all ages, military, political, 
 and literary, have been affected with this disease ; Julius Csesar, 
 Mahomet, Petrarch, Eousseau, and Bonaparte were epileptic. 
 
AND MOST RECENT METHODS OF TREATMENT. 605 
 
 Causes. — Idiots and people of weak minds are very subject to 
 epilepsy. The hereditary influence of this disease is generally ad- 
 mitted ; and it appears to be well understood that people of scrofu- 
 lous habit of body labor under it more frequently than others. It 
 is said to be more common in the lower than in the middle and 
 upper classes of society. 
 
 The most frequent exciting cause is terror or sudden fright. For 
 example, how often it happens that a nurse makes a sudden noise 
 behind a child in order to stop hiccup, and that the infant, in con- 
 sequence, falls instantly into a fit of epilepsy, which recurs from time 
 to time throughout life. Sudden fits of passion, disappointment, dis- 
 tress of mind, and excess in venery, are the causes which rank next 
 to terror in producing this disease. 
 
 TREATMENT OF EPILEPSY. 
 
 Comparatively few cases of epilepsy permanently recover under 
 any treatment. The disease is, however, very frequently the im- 
 mediate cause of death. Patients may live for years in spite of 
 violent and frequently repeated attacks. It is a bad sign to have 
 many attacks at night. 
 
 During the attack very little is to be done. 
 
 Loosen the clothing of the patient. Place him in a comfort- 
 able position. Give him fresh air. 
 
 For treatment during the intervals, the profession have now 
 settled down upon a very few remedies. The chief of these is 
 bromide of potassium. 
 
 This may be given to epileptics in very large doses, and for a 
 long time. Occasionally, though quite rarely, the bromide of potas- 
 sium produces unpleasant effects when given in large doses. For 
 this and for many other reasons, epileptic patients should always, 
 if possible, put themselves under the care of a good physician, and 
 take the remedies under his direction. The bromide of potassium is 
 frequently combined with the bromide of ammonium. (See Bromide 
 of Ammonium and Bromide of Potassium.) Twenty and thirty 
 grains at a dose may be taken of bromide of potassium for epilepsy. 
 
 A prescription somewhat like the following may be used by 
 those who are beyond the reach of medical aid. It should not be 
 taken for a long time without advice : 
 
 Bromide of potassium, one ounce, 
 Bromide of ammonium, half an ounce, 
 Iodide of potassium, quarter of an ounce, 
 Tincture of gentian, seven ounces. 
 The dose is a teaspoonful. Before bedtime a double or treble dose may be given. 
 
 Oxide of zinc, and belladonna, and strychnine are also given. 
 
606 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 In those cases where the bromide of potassium does not succeed, it 
 is well to try these others. It is unwise, however, to experiment 
 much on one's self with these powerful remedies. They should 
 usually be given under the care of a medical adviser. 
 
 General electrization is sometimes of service in epilepsy, and 
 should be used, if possible, in connection with internal medication. 
 (See General Electrization^) 
 
 Epileptic patients should carefully observe the laws of health in 
 respect to diet, air, sunlight, bathing, sleep, and exercise, and should 
 be very moderate in the indulgence of their passions. 
 
 Epilepsy is treated more successfully than formerly. By acting 
 upon the principles above indicated, physicians are now able to 
 diminish the frequency of the attacks, to lengthen the intervals, 
 and sometimes to cure entirely. 
 
 The treatment, to be successful, must ~be very persevering / and, 
 as a rule, patients must be content if they only get permanent re- 
 lief, and not absolute cure. 
 
 Physicians are yet in the dark about the nature of epilepsy ; but 
 in the treatment of the disease we have certainly made progress. 
 
 When the attacks are of frequent occurrence, the patient must 
 be carefully watched, and a piece of india-rubber, or a wedge- 
 shaped piece of soft wood, should be always ready to place between 
 the teeth, in order to prevent him from biting his tongue. It is 
 scarcely necessary to mention, that he ought to avoid all dangerous 
 situations, such as going near the edge of a precipice, sitting on the 
 top of a coach, &c, and not walk near water, nor sit near the fire, 
 unless it be completely protected by a strong wire fire-screen. An 
 indulgence in venereal pleasures might prove fatal to an epileptic 
 person. 
 
 EPSOM SALT, OE SULPHATE OF MAGNESIA. 
 
 Epsom salt is a well-known and very excellent purgative. In 
 the dose of from two teaspoonfuls to an ounce, dissolved in half a 
 pint of warm water, and taken when tepid, it acts freely, without 
 griping. To prevent this salt from causing sickness at stomach, it 
 may be taken in an infusion of orange-peel, or in any other aro- 
 matic or bitter infusion, to which two teaspoonsfuls of tincture of 
 rhubarb may be added. It quickens considerably the action of the 
 infusion of senna-leaves ; hence it is frequently given in the form 
 of the black draught. 
 
 Oxalic acid has a strong resemblance to Epsom salt, and has 
 frequently been mistaken for it ; the former, however, may easily 
 
AND MOST RECENT METHODS OF TREATMENT. 607 
 
 be known by its acid taste when mixed with water, and by chang- 
 ing the color of blue paper to red. The antidotes against oxalic 
 acid are powdered chalk or magnesia, followed by hot brandy and 
 water, with small doses of laudanum. 
 
 EKGOT OF EYE. 
 
 This substance is principally used during labor, in order to assist 
 in expelling the child ; and there can be no doubt that it exerts a 
 strong influence over the womb when given in suitable doses, and 
 in the cases in which its use is indicated ; under other circum- 
 stances it would produce the very worst effects, and is only, there- 
 fore, of value in the hands of a physician of experience. 
 
 The ergot of rye is now well ascertained to be one of the most 
 efficacious remedies in arresting the alarming discharges of blood 
 from the womb commonly called flooding s ; also in checking exces- 
 sive menstruation, in gonorrhoea, the whites, and in all mucous 
 discharges. But its most certain property is the power which it 
 possesses of causing the womb to contract, and thereby expelling 
 the child, and also the after-birth, in cases where it has been too 
 long retained. 
 
 The average dose of the ergot, in powder, during labor, is 
 twenty-four grains in* a little water, or with the addition of a glass 
 of sherry wine, which enables it to sit easier on the stomach ; and 
 it may be necessary to repeat the dose three or four times, at inter- 
 vals of two or three hours. In cases of flooding, a drachm may be 
 divided into six or eight doses, and given at longer or shorter in- 
 tervals, according to the circumstances of the case. In whites, and 
 other mucous discharges, the dose is from five to ten grains, three 
 or four times a day ; or twenty grains may be boiled in eight 
 ounces of water, and taken in the course of two clays. The tincture 
 is made by macerating two ounces of the ergot in a pint of proof 
 spirit for ten days. The dose, in cases of tedious labor or flooding, 
 is two or three teaspoonfuls every twenty minutes. The infusion 
 in common use is made with half a drachm of the ergot to half a 
 pint of boiling water, and one-half administered at a time. 
 
 The ergot of rye must be kept in a dry place ; if exposed to 
 moisture it becomes useless ; the greater part of that found in the 
 shops is completely inert. 
 
 EKIGERON CANADENSIS (FLEABANE). 
 This medicine is an astringent. It is used in diarrhoea and 
 
608 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 dysentery. It has also been used in uterine hemorrhage. Recently 
 it has been used for gleet and irritation of the bladder with good 
 results. It is sometimes combined with oil of sandal- wood. 
 The dose of the oil of erigeron is from three to five drops. 
 
 ERYSIPELAS, ROSE, OR ST. ANTHONY'S FIRE. 
 
 Erysipelas is a peculiar inflammation of the skin, attended with 
 fever, and frequently accompanied by elevations of the scarf-skin 
 resembling blisters. Sometimes it is a mild disorder, confined to a 
 small portion of the skin {simple erysipelas) ; sometimes the inflam- 
 mation extends deeper than the skin {phlegmonous erysipelas)', 
 while in other cases it attacks the face, extends to the head, and is 
 attended with very great danger to life. 
 
 Simple erysipelas is generally ushered in by febrile symptoms, 
 such as shivering, headache, hot skin, quick pulse, sickness at 
 stomach, or vomiting; pains about the loins, and lassitude; but 
 many of these symptoms are absent when the disease is to be very 
 mild in its nature. In the part which is about to be attacked, the 
 patient often experiences a feeling of heat, itching, or weight. On 
 the second or third day the inflammation makes its appearance, and 
 is attended with the ordinary signs, viz., redness, heat, pain, and a 
 certain degree of swelling. The color of the inflamed part is com- 
 monly deep rose, of a shining aspect, and soon spreads uniformly 
 over the surface ; it disappears under pressure made by the finger, 
 and immediately returns again when the pressure is removed. The 
 pain is of a pungent, burning kind, and is often attended with itch- 
 ing, or a pricking sensation ; it extends all over the inflamed surface ; 
 the swelling is not considerable, unless the disease be very severe ; 
 it is uniformly spread over the inflamed part, and is more easily de- 
 tected by the finger than by the eye. About the third or fourth 
 day blisters of various sizes sometimes appear on the inflamed skin, 
 but in other cases the inflammatory symptoms begin to subside on 
 the fourth and fifth, days, and soon terminate, without any accident, 
 in a separation of the scarf-skin or cuticle from the true skin 
 underneath. 
 
 Phlegmonous erysipelas is a more severe form of the complaint, 
 which attacks the structures underneath the skin as well as the skin 
 itself. It generally occurs in young, strong persons, and affects the 
 limbs more frequently than any other part of the body. In phleg- 
 monous erysipelas the fever is much more violent, and the pain more 
 severe than in the former species; the swelling of the inflamed parts 
 is more manifest, harder, and does not gradually disappear in the 
 
AND MOST RECENT METHODS OF TREATMENT. 609 
 
 surrounding skin, but lias more the feel of a tumor. When the 
 disease has continued for four or five days, it may subside and dis- 
 appear, as in cases of simple erysipelas; but it more frequently 
 happens that, while the fever diminishes with the local pain and 
 redness, the swelling of the part does not diminish in proportion ; 
 it becomes soft, continues to retain the impression of the finger, and 
 in a few days matter is formed between the muscles and underneath 
 the skin. In still more severe cases the matter extends along the 
 cellular tissue, in the direction of the muscles, and destroys the ad- 
 jacent parts, which are discharged in dirty-looking shreds of mortified 
 substance mixed with pus; and this discharge may continue for 
 weeks, until it completely exhausts the patient. 
 
 Simple erysipelas usually terminates on the third or fourth day ; 
 when blisters form it may continue for eight, ten, or even fifteen 
 days; and in cases of a severe kind, where matter forms or the parts 
 become mortified, the disease may last for several months. Erysipelas 
 is commonly a mild disease, and terminates without any accident ; 
 but when attended by copious discharge of matter, or mortification 
 of the cellular substance, it often ends in death. There is also much 
 danger to be apprehended when it suddenly leaves any part (as the 
 face, scalp, &c.) to attack the brain ; or when it occurs in old per- 
 sons of broken-down constitution, in drunkards, &c, or after severe- 
 injuries. 
 
 Causes. — Erysipelas is sometimes an epidemic malady, and pre- 
 vails extensively in hospitals or crowded establishments. It fre- 
 quently depends on some derangement of the digestive organs, a 
 circumstance which is explained by the well-known sympathy be- 
 tween the skin and mucous lining membrane of the stomach and 
 bowels ; in other cases it is manifestly excited by some wound or 
 injury of the skin. Finally, erysipelas prevails during the spring 
 and autumn, and under certain conditions of the atmosphere which 
 favor its production. 
 
 TREATMENT OF ERYSIPELAS. 
 
 1. Belief of pain. — This is accomplished by tepid fomentations 
 — cloths wrung in tepid water and applied to the affected part. 
 The common lead and opium wash is one of the best remedies to 
 a Pply- It i s yer y sa ^ e f° r those who are beyond the call of a phy- 
 sician. Besides this, ointment of oxide of zinc, or flour, may be 
 spread over the affected part. 
 
 2. To sustain the general system. — Muriated tincture of iron, 
 quinine, strychnine, may be used internally, with nourishing but 
 easily digested food, such as beef-tea. 
 
 39 
 
610 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 In the severer or " phlegmonous '" forms it is sometimes neces- 
 sary to make incisions and let out the pus. 
 
 INFLAMMATION OF THE EYE. 
 
 The eye is subject to a great variety of affections, and several 
 forms of inflammatory disease ; it will, however, be necessary for 
 us to mention only the most common disorders. 
 
 EYE, INFLAMMATIONS AND DISEASES OF. 
 
 These are acute and chronic inflammation of the outside of the 
 eye, inflammation of the tear passages, inflammation of the pupil, 
 and inflammation of the retina and nerve. 
 
 The affection known as cataract should also be named, and 
 glaucoma. (For method of examining the eye employed by physi- 
 cians, see Ophthalmoscope.) 
 
 Acute inflammation of the membrane covering the lids and 
 front of the eye — the conjunctiva — may be usually known by the 
 following symptoms : The lids are more or less swollen, accord- 
 ing to the severity of the attack. The eyelashes adhere together, 
 and mucus or pus, or both, exudes from between the lids. The lids 
 are also hot and red. 
 
 The eye is painful, and there is a sensation as if sand or par- 
 ticles of dust were in the eye. There is not apt to be any fever 
 or disturbance of the general system. There is a very great differ- 
 ence in different cases in the severity of these inflammations. In 
 some the heat, redness, and swelling of the lids are very great. 
 The lids cannot be raised at all, and the matter is constantly flow- 
 ing over the cheeks. In others the lids are very little swelled, and 
 only a half-watery fluid exudes very slowly and in small quantities. 
 The lids are glued together in all the cases, and there is the sensa- 
 tion of sand in the eye. The mild form of the disease is called 
 catarrhal conjunctivitis ; the severer, purulent conjunctivitis. The 
 causes of the former are exposure to cold and dust, long-continued 
 straining of the eyes, and so on. 
 
 The causes of the latter are the inoculation of the pus with 
 matter from some source, sometimes with matter from the urethra 
 which is affected with gonorrhoea. Sometimes the use of improper 
 means of treatment in the catarrhal or simple variety of the disease 
 will cause it to run into the purulent variety. 
 
 The treatment of the simple variety consists essentially in the 
 use of cold water until the heat is subdued ; then of an astringent, 
 
AND MOST RECENT METHODS OF TREATMENT. 611 
 
 such as alum or sulphate of zinc, with an ointment to be rubbed in 
 between the edges of the lids at bedtime. 
 
 The alum may be used in the proportion of one drachm to the pint 
 of water ; sulphate of zinc, two grains to the ounce ; simple cerate 
 or sweet oil may be rubbed between the lids at night. Poultices 
 should never be used, no matter how made, of tea-leaves, oysters, 
 bread and milk, and the like. They have destroyed thousands of eyes. 
 
 Purulent inflammation of the outside of the eye, or purulent con- 
 junctivitis, is a very dangerous disease to the eye. It occurs very 
 often in infants, and is then called ophthalmia of the newly born. 
 It is the same affection as that which we have described above, and 
 is to be treated in the same general way. The dangers to the eye are 
 from ulceration of the transparent part of the eye, or of spots or opa- 
 cities forming on it. Irreparable loss of vision sometimes occurs in 
 forty -eight hours. 
 
 Treatment. — Perfect cleanliness of the eyes, whether they be 
 those of an adult or of an infant, is the first and chief matter. This 
 may be secured by means of soft bits of rags dipped in lukewarm 
 water, or by a small sponge. Alum wash, a drachm to the pint, may 
 be allowed to run through the eye four or six times a day. Ice- 
 water should be applied over the lids during the early stages of the 
 disease, taking care never to allow the applications to become hot. 
 The coldness of the water should be moderated as soon as the les- 
 sening of the swelling of the lids and the subsidence of the discharge 
 show that the force of the inflammation has abated. Simple cerate 
 should be smeared between the lids at night. Morphine or opium 
 may be given to adults only, to quiet severe pain. The patient 
 should remain in bed, in a half-darkened room. Great care should 
 be taken that none of the matter from the diseased eye enters into 
 the eyes of any of the attendants. 
 
 The chronic inflammations of the outside of the eyes, or. chronic 
 conjunctivitis, are characterized by the following symptoms : Red- 
 ness of the edges of the lids, thickening of the lids, and glueing of 
 the edges in the morning. Mild astringents, eye-washes made of 
 alum or sulphate of zinc, tannic acid, with an ointment, are the best 
 means of treatment. All these astringents may be used in solutions 
 of about two grains to the ounce of water. Tannin should be 
 mixed with glycerine. The general health should always be attended 
 to by fresh air, exercise, bathing, and so on. 
 
 Blue glasses to protect the eye from excessive light maybe worn 
 in all the chronic inflammations of the eyes, or a blue cloth or paper 
 shade shaped like a cap front. 
 
 Children and even adults are very liable to an affection of the 
 
612 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 eyes which was formerly known as scrofulous ophthalmia, but since 
 it arises where there is no scrofula in the system is better known as 
 pustular ophthalmia, or pustular conjunctivitis. The chief symp- 
 toms are dread of the light ; the child will bury its head in the pil- 
 low or in its mother's lap, and the adult who sometimes has the 
 same disease can scarcely be induced to hold his head up and 
 his eyes open even for a moment. There is also a great deal of 
 watering of the eyes. On close observation pustules or red points 
 may be seen on the white coat, or on the transparent part of the 
 eye, or on both. 
 
 The patients with this affection are usually improperly or half 
 fed. They need good food, such as beef and mutton, milk, eggs, 
 and the like, with fresh air, frequent bathing, and exercise. Abstin- 
 ence from tea and coffee, pastry and confectionery, is to be espe- 
 cially enjoined. The eyes themselves need very little attention 
 beyond bathing with lukewarm water. A belladonna wash 
 (aqueous extract of belladonna, two drachms; water, four to eight 
 ounces) may be applied to them twice a day. 
 
 Inflammation of the pupil of the eye, or iritis , is usually charac- 
 terized by great pain in the eyeball and in one side of the head, and 
 by fear of light, so that the patient attempts to keep his eye closed. 
 It is a very dangerous affection to the sight. It depends chiefly on 
 the poisoning of the blood by syphilis or rheumatism. The chief 
 local remedy is sulphate of atropia, of the strength of one to three 
 grains to the ounce of water, one drop of which should be placed in 
 the eye by means of a camel's-hair brush or the like, once to four 
 times a day. The syphilis or rheumatism, if manifesting itself in 
 the other parts of the body, is also to be treated. 
 
 Inflammation of the tear passages may be recognized by the 
 running of the tears over the cheeks, and usually by a little tumor 
 or swelling in the inner corner of the eye. Sometimes an abscess 
 forms here. A surgeon will treat such a case by slitting up the 
 canal leading along the edge of the lid to the corner of the eye, and 
 then by probing the passage into the nose. 
 
 Cataract is an opacity of the lens of the eye, and is only to be 
 cured by the removal of the lens from the eye. The operation of 
 removing the lens of the eye is one of the most delicate and diffi- 
 cult in surgery. None but a person who has paid especial attention 
 to diseases of the eye and their treatment should ever operate for ' 
 cataract. An opacity of the outside of the eye is not a cataract. 
 
 Cataract may be caused by an injury to the inside of the eye. 
 A needle or any sharp substance passed into the lens will cause it 
 to become cataractous. 
 
AND MOST RECENT METHODS OF TREATMENT. 613 
 
 Children are sometimes born with cataract. The disease is more 
 common in old persons, however. The causes of opacity of the lens 
 in old people are not very well known. About 80 per cent, of 
 those operated upon by extraction of the lens for cataract, by good 
 surgeons, recover their sight. Patients who have been operated 
 upon by removal of the lens are obliged to wear cataract glasses, 
 or double convex lenses, to replace the lens that has been taken 
 from the eye. 
 
 Glaucoma. — This is a painful affection of the eye, that is very 
 dangerous to sight, and which is often mistaken for neuralgia of the 
 head, because it is often accompanied by very severe pain in the 
 temples and face. It is sometimes mistaken for cataract, because 
 the lens becomes opaque as a result of the disease. In true catar- 
 act there is no pain. 
 
 Glaucoma can only be certainly recognized and treated by a 
 surgeon. The prominent symptoms are pain in the ball of the eye 
 and in the head, and rapidly increasing loss of sight. The eyeball 
 becomes as hard as wood when the disease is far advanced, and the 
 lens becomes of a greenish color ; hence the name given the disease 
 by the ancients : Glaucoma — literally, green tumor. 
 
 The only proper treatment for glaucoma is an operation, first 
 performed for this disease by Prof. Grsefe, of Berlin. This opera- 
 tion consists in cutting out a piece of the iris or pupil. 
 
 MUSCULAR AFFECTIONS OF THE EYES. 
 
 The muscles of the eyeball often become weakened from ex- 
 cessive use on near objects, and the pain and discomfort are so great 
 as to cause the patients to believe that they have some dangerous 
 disease of the inner part of the eye. The eyes water, become red, 
 and the sight blurs on every attempt to use the eyes in reading, 
 writing, or sewing. 
 
 Such a weakness of the muscles may depend on over-use of the 
 eye, or on faulty conformation at birth. Rest will cure the one, 
 while appropriate spectacles are required for the other. 
 
 A FEW SIMPLE RULES FOR THE CARE OF THE EYES. 
 
 1. Cold water is about the safest application for an inflamed eye. 
 
 2. Poultices are never to be used. 
 
 3. No one should read or sew, or use the eyes for any work on 
 objects close at hand, "before breakfast or immediately after a full 
 meal. 
 
614 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 4. Bad air and lad food make many diseased eyes; therefore 
 avoid unventilated rooms, and sloppy, unnutritious food. 
 
 5. Nearly all persons, except short-sighted ones, should use 
 glasses to read with as soon as they begin to hold a book more than 
 eight inches from the eye. 
 
 6. Short-sighted persons should use glasses for seeing objects at 
 a distance. 
 
 7. Glasses properly chosen save sight, and do not injure it. 
 
 8. Always hold a book so that the light will strike it over the 
 shoulders of the reader — that is, from behind. 
 
 9. Do not use home prescriptions, or quack ointments and eye- 
 washes for diseased eyes, but consult a surgeon as soon as possible. 
 
 INJURIES TO THE EYE. 
 
 If a bit of steel or any other substance has entered the eye, it 
 should be removed by competent hands as soon as possible. If it 
 be left in the eye, not only the sight of the affected eye, but of its 
 fellow, will be lost, by what is known as sympathetic inflammation 
 of the eye. Other injuries, where no substance has entered the eye, 
 are treated in a manner similar to that advised for inflammation of 
 the outside of the eye — that is, by the use of cold water, and if neces- 
 sary by the use of some eye-wash. The simpler the eye-drops the 
 better. Those of alum or the sulphate of zinc, used in the propor- 
 tion of one to three grains to the ounce of rose or distilled water, 
 are the best. 
 
 Concerning the use of the substances that compose eye-washes, 
 Stellwag makes the following suggestive remarks : 
 
 " The acetate of lead and corrosive chloride of mercury are least 
 to be recommended, on account of their great liability to decompo- 
 sition. Sugar of lead is, besides, dangerous when there are ulcers 
 on the cornea or conjunctiva, since it readily forms a deposit on 
 their floor. This becomes encapsulated, and causes various evil re- 
 sults. Nitrate of silver and sesquichloride of iron cause stains in 
 clothing which are not easily removed. Tincture of opium readily 
 forms a sediment, and therefore acts unequally. The sulphates, 
 especially the sulphate of zinc, should therefore have the preference 
 in catarrhal inflammation, especially if the results of some recent 
 experiments should be confirmed, according to which sulphate of 
 zinc contracts the vessels more powerfully than any other agent, 
 except cold." 
 
 There is little question that many injure themselves by reck- 
 lessly abusing popular eye-washes, of the composition of which 
 
AND MOST RECENT METHODS OF TREATMENT. 615 
 
 they know nothing. It is better to let the eyes alone than to tam- 
 per with them, when we do not know the real nature of the 
 difficulty. 
 
 FAINTING OH SWOONING. 
 
 Fainting is for the most part a symptom of some other affec- 
 tion, rather than a disease in itself. It often accompanies disease 
 of the heart, and may be brought on by any very painful disorder ; 
 by loss of blood, excessive discharges or evacuations ; debility, how- 
 ever induced ; and by sudden and violent mental emotions. Females 
 and delicate people are most subject to fainting ; in the former it is 
 often brought on by wearing stays too tightly laced, and by sitting 
 with the back to the fire during meals. Some people, from pecu- 
 liarity of habit, swoon on seeing blood or any disagreeable object ; in 
 others the same effect is produced by pungent or disgusting smells. 
 
 Fainting, in connection with hysterical affections, is never attend- 
 ed with danger ; but when it arises from obstruction in the heart or 
 great blood-vessels, at the commencement or during the course of 
 fevers, or from extreme debility, it is to be viewed in a more serious 
 light, and its source should be ascertained. This affection, in fact, 
 is only to be dreaded when the cause which gives rise to it is of a 
 dangerous nature. A common fainting fit is usually of very little 
 consequence, and often occurs in people otherwise in good health. 
 
 Treatment. — Nature alone, in ordinary cases, is able to effect 
 restoration in a few minutes, if the patient be placed in the hori- 
 zontal position, which is the first thing to be done to arrest the fit. 
 Removing the patient to a cooler apartment, or exposing him to a 
 current of cold air, sprinkling cold water on the face and hands, 
 rubbing the left side of the chest with eau de cologne or any other 
 stimulating fluid, and applying hartshorn or aromatic vinegar to 
 the nostrils, are the simple means usually resorted to for the pur- 
 pose of rousing the individual. Internally, a little brandy and 
 water, or a teaspoonful of cether, may be given as soon as he is able 
 to swallow. 
 
 In severe and protracted fainting-fits, consequent on flooding 
 after delivery, it becomes absolutely necessary to administer brandy 
 or wine, and laudanum, in small and frequently repeated doses, in 
 order to restore animation and prevent the recurrence of the fits. 
 Fainting, in such cases, is not unattended with danger, and the 
 frequent renewal of the fits might soon prove fatal ; the dread, there- 
 fore, of increasing the flooding by the stimulating action of these 
 remedies on the system ought not to prevent their use, since it is 
 
616 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 obvious that to prevent the patient sinking from exhaustion, her 
 strength should be supported at all hazards. 
 
 FAKADAIZATION (Trench, FARADISATION). 
 
 This term was applied by Dnchenne to the medical use of the 
 Farad aic current. General electrization is usually applied with the 
 Faradaic current. 
 
 In cases of paralysis, and sometimes of neuralgia, it sometimes 
 fails to produce muscular contractions, and may, perhaps, be of no 
 service. In such cases it is necessary to use the galvanic current 
 from twenty, thirty, forty, or fifty or more cups, or elements, united 
 together. This current will sometimes produce muscular contrac- 
 tions, and so help paralysis when the Faradaic current fails. 
 
 Both Faradaization and galvanization aid the physician in 
 diagnosticating disease — in finding out the complaint from which 
 the patient is suffering. (See Electricity ', Galvanization, and General 
 Electrization.) 
 
 FLOODING. 
 
 By flooding we here understand those sudden and copious dis- 
 charges of blood from the womb which take place soon after the 
 birth of the child. Flooding may occur under two different circum- 
 stances, which it is of importance to distinguish ; either the after- 
 birth {placenta) remains in the womb and is the cause of the bleed- 
 ing, or the after-birth has been expelled, and the flooding depends 
 on want of proper contraction in the womb, to close up the open 
 mouths of its vessels. 
 
 In the first case — that is, when the after-birth remains in the 
 womb — we can only stop the bleeding by removing the after-birth. 
 This operation, however, must not be attempted without due con- 
 sideration. When the woman has been reduced by the loss of blood 
 to a very dangerous state, shown by the constant fainting, absence of 
 the pulse, and coldness of the skin, it would be improper to remove 
 the clots of blood in the genital parts, or disturb the patient in any 
 way, lest the bleeding return, and quench the feeble spark of life 
 which remains. But when the patient has rallied under the use of 
 small quantities of brandy and other cordials, or when the flooding 
 has not been extremely copious, then an effort may be made to re- 
 move the after-birth. This is to be done by very gently pulling the 
 navel-string, or by rubbing the lower part of the belly with the 
 hand ; by pouring cold water on the belly, and by giving the ergot 
 of rye / three or four teaspoonfuls of the tincture, or half a drachm 
 
AND MOST RECENT METHODS OP TREATMENT. 617 
 
 of the powdered ergot, may be administered every twenty minutes, 
 during one hour, until the desired effect is produced. Should these 
 remedies fail, a silk pocket-handkerchief should be passed into the 
 vagina, and gradually pushed up against the womb, until the gen- 
 ital parts are completely filled ; this done, medical assistance must 
 be immediately sought, for the only way of stopping the bleeding 
 effectually is to pass the hand into the womb and bring away the 
 after-birth. 
 
 Flooding may occur, however, even when the after-birth has 
 been entirely expelled. Here we must endeavor to make the womb 
 contract, by rubbing the lower part of the belly smartly with the 
 hand ; by applying very cold cloths over the same part ; or by placing 
 a firm pad over the womb, and then binding it around the body 
 with a linen or flannel bandage, as tightly as the woman can bear 
 it with comfort. The ergot of rye must be given at the same time, 
 in the doses which we have just mentioned. 
 
 In some cases the flooding is internal ; that is, the blood contin- 
 ues to be discharged into the hollow of the womb, where it collects 
 in large quantities, and does not find its way out through the genital 
 parts. This is a very dangerous form of flooding, because, as there 
 is no external appearance of blood, it might easily be supposed that 
 the woman was not suffering from the disease. The existence of 
 internal flooding may be suspected when the womb can be distinctly 
 felt rising for some height at the bottom of the belly ; and when at 
 the same time the patient complains of ringing in the ears, giddi- 
 ness, and an inclination to vomit. If the face now become sudden- 
 ly pale, the pulse sink, the skin become cold, and the woman fre- 
 quently faint, no time is to be lost ; the means before described are 
 to be employed, and should they fail, the hand must be passed up 
 into the womb, in order to remove the clots of blood and excite the 
 womb to contract upon it. 
 
 As a general precaution during the treatment of flooding, we 
 should mention that the patient must be kept perfectly quiet, in a 
 cool room, and that she should never be suddenly raised from the 
 lying posture, or be permitted to make any bodily exertion what- 
 ever. 
 
 The management of the patient, after flooding has ceased, re- 
 quires very great care and caution. "When the loss of blood has 
 been excessive, the woman is reduced to the lowest state ; complains 
 of a constant feeling of sinking, and is extremely restless and de- 
 pressed in spirits. Notwithstanding her desire to change posture, 
 she must be kept at rest ; forty drops of laudanum or two grains of 
 opium are to be given, and, if necessary, repeated in the course of 
 
618 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 an hour. When a little sleep has been thus procured, some light 
 nourishment may be allowed, such as beef- tea or jelly, given in 
 small quantities and frequently repeated ; and when the stomach 
 begins to recover itself the diet may be cautiously improved. 
 
 Diarrhoea, or looseness of bowels, may be checked by the chalk 
 mixture, with opium, or any other mild astringent. 
 
 One of the most frequent and distressing effects of severe flooding 
 is headache, which often lasts for several weeks, in spite of our efforts 
 to relieve it. The headache in this instance depends upon loss 
 of blood, and the patient should be nourished as rapidly as possible. 
 
 FOXGLOVE. (Digitalis.) 
 
 Foxglove is one of the most beautiful and useful of our indige- 
 nous plants. It grows on sandy and gravelly banks, in woods and 
 uncultivated places, and flowers in June and July. 
 
 Foxglove is directly sedative, and possesses the peculiar power 
 of depressing the circulation of the blood ; when given in full doses 
 it reduces the pulse from seventy-five to forty-five or forty beats in 
 a minute, rendering it at the same time feeble and frequently inter- 
 mitting. If given in too large doses it produces giddiness, dimness 
 of sight, nausea, faintness; and then vomiting, swooning, convul- 
 sions, stupor, and death. 
 
 From the influence which this remedy exerts in lowering the 
 action of the heart, it is of great service in enlargement, and other 
 affections of that organ attended with increased action ; and is used 
 on the same principle at the commencement of pulmonary consump- 
 tion, in spitting of blood, bleeding from the nose, and in excessive 
 discharges of the menstrual fluid. 
 
 In dropsy there is no diuretic medicine so powerful and certain 
 in its action as foxglove, more especially in dropsy of the chest ; and 
 it is much used in all inflammatory affections after the circulation 
 has been to a certain extent diminished by blood-letting. 
 
 Though there are few remedies of more value, when judiciously 
 used, than this, yet it is by no means well adapted for popular use, 
 since, from the irregularity of its action, and the difficulty in finding 
 the preparations of the shops alwa} r s of an uniform strength, it re- 
 quires to be used with much caution, and with strict attention to 
 the rules laid down for its administration. In a practical point of 
 view, the principal thing to be attended to in administering digitalis 
 is to watch its action carefully, and as soon as the pulse begins to 
 fall, or any of the lowering symptoms already noticed manifest 
 themselves, the remedy must either be discontinued entirely for a 
 
AND MOST RECENT METHODS OF TREATMENT. .619 
 
 short time, or given in diminished doses. Prom neglect in not at- 
 tending to the state of the patient while under the influence of fox- 
 glove, its lowering action may be induced to such an extent as to 
 require the use of warm brandy and water, aether, laudanum, am- 
 monia, or other strong stimulants, in small and frequently repeated 
 doses. 
 
 The powder of foxglove should be kept in opaque bottles, and 
 ought not to be used if deprived of the green color and peculiar odor 
 of the fresh plant. The dose is one grain every five or six hours, or 
 oftener, until it begin to act on the system, and then the quantity 
 must be gradually diminished, or given at longer intervals. The 
 dose of the tincture is ten drops, gradually increased to thirty, three 
 times a day ; and of the infusion one or two tablespoonfuls may be 
 taken twice a day in a little cold water. 
 
 It is a remedy that should not be used indiscriminately by 
 patients. Even those who cannot obtain a physician may dispense 
 with it, or substitute some other remedy. 
 
 Freckles. (See Skin, Diseases of.) 
 
 GALYAXIZATIOX 
 
 There are two kinds of current used in electrization — the gal- 
 vanic and the Faradaic, respectively named from Galvani and Fara- 
 day. 
 
 These names of electro-therapeutics are indefinite and much 
 confused. I will not here attempt to give half of the different 
 names that are applied to these two currents, nor to explain in 
 detail the difference between these currents. In the majority of 
 cases I employ the Faradaic current, and find that, in the hands of 
 those who understand it, it is for most diseases more useful than the 
 galvanic, and withal is less liable to injure. (See General Electri- 
 zation.) In Germany the galvanic current is used more than the 
 Faradaic. "Within the past few years a large number of treatises 
 have been written in Germany on the use of the galvanic current 
 alone. 
 
 GAMBOGE. 
 
 Gamboge is a gum resin, brought principally from China. The 
 species of the tree from which it is produced is not yet accurately 
 ascertained. 
 
 This substance is powerfully purgative, and was formerly much 
 used to expel the tape-worm. It causes watery evacuations, and is 
 therefore sometimes given in dropsy along with cream of tartar, or 
 in combination with the sulphate of potash. 
 
620 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 The dose, when taken alone, is from two to six grains, mixed 
 with a little syrup or honey, and a few grains of powdered cinna- 
 mon. Gamboge is usually taken in the following form : " Gam- 
 boge, powdered, a scruple ; aloes, powdered, a scruple and a half; 
 ginger, powdered, half a scruple ; Castile soap, two scruples. Mix 
 well together, and divide into five grain pills." These are the com- 
 pound gamboge pills of the London Pharmacopoeia, which, in doses 
 of from two to four, act very effectually in opening the bowels. 
 
 GELSEMIN. 
 
 This is one of our new remedies, and has not yet come into very 
 general use. It is given in fevers, in seminal emissions, in epilepsy, 
 in convulsions, and to expel worms. It is a remedy of some power, 
 and should be used with caution. Bad results have come from an 
 overdose. As yet it is hardly to be classed among the domestic 
 remedies. The dose is from one-fourth of a grain to two grains. 
 The value of this remedy has not yet been established. It is claimed 
 by some that it will cut short fevers and arrest attacks of acute 
 rheumatism. 
 
 GENEKAL ELECTRIZATION - . 
 
 This is a term which I have given to the application of elec- 
 tricity all over the body. (See Electrization.) 
 
 General electrization is a tonic, and is used for those cases and 
 conditions of disease where tonics are needed. It is not a specific 
 any more than quinine, or strychnine, or iron is a specific. Like 
 quinine, strychnine, cold bathing, exercise, sunlight, and so forth, 
 it is a tonic, and is to be used when tonics are needed, without re- 
 gard to the name of the disease. It meets with its best success in 
 dyspepsia, neuralgia, St. Vitus' ] s dance, hypochondriasis, hysteria, 
 sleeplessness, nervous exhaustion, some forms of paralysis, some 
 diseases of women, and general debility. It is also useful in sub- 
 acute rheumatism. In chronic rheumatism, in gout and rheumatic 
 gout it does not usually accomplish what we wish, though it may 
 afford some relief. For nervous dyspepsia and for neuralgia I know 
 of no remedy that can be compared with general electrization. 
 
 It is needless to say that it meets with failures. 
 
 On the other hand it must be allowed that it very often succeeds 
 in cases of dyspepsia, chorea, nervous exhaustion, neuralgia, hypo- 
 chondria and hysteria, &c, when other internal remedies have 
 utterly failed. 
 
 In paralysis, neuralgia, and rheumatism general electrization 
 
AND MOST RECENT METHODS OF TREATMENT. 621 
 
 succeeds as well or better than the method of localized electrization 
 that is used in Europe. 
 
 It possesses these advantages over localized electrization (see 
 Localized Electrization) : 
 
 1. In a large variety of diseases it is more efficacious. 
 
 2. It is more agreeable to the patient. 
 
 3. It is more convenient for the operator. 
 
 GENTIAN". 
 
 This plant grows in great abundance in Switzerland and Ger- 
 many ; its root is highly esteemed throughout Europe as one of the 
 most powerful and most useful of the bitter tonics. This remedy 
 is very serviceable in indigestion, in general debility, and also in 
 tedious convalescence, particularly in those cases in which the 
 patients have a pale and waxy appearance of countenance, with loss 
 of appetite, slow digestion, weak pulse, and a tendency to swelling 
 of the ankles at bed-time. In scrofulous cases, where strengthening 
 medicines are indicated, there is no better tonic than gentian. 
 
 The dose of the infusion of gentian is two tablespoonfuls or a 
 wine-glassful twice a day. Of the extract, ten grains to half a 
 drachm twice or thrice a day. Of the tincture, a teaspoon ful in a 
 little cold water. These preparations form the basis of nearly all 
 stomachic or tonic remedies. 
 
 GLAUBEK'S SALT. (Sulphate of Soda) 
 
 It is a mild and sure purgative, in doses of from two drachms to 
 an ounce and a half, and was formerly much in use, but at present 
 Epsom salts are almost invariably preferred. 
 
 GONOKRHCEA (or Clap). 
 
 Gonorrhoea consists in a discharge of yellow matter from the 
 genital parts of the male or female, excited, in all cases, by the 
 application of a contagious material from one individual to another. 
 In males the discharge comes from the inside of the urethra or pas- 
 sage to the bladder ; in females, from any part of the membrane 
 which lines the genital parts. The infectious matter which excites 
 gonorrhoea is generally communicated during unclean coition ; but it 
 has been proved beyond all doubt that a discharge exactly similar 
 to that of gonorrhoea may, under certain circumstances, be produced 
 by connexion with a woman whose genital parts are perfectly sound. 
 Gonorrhoea may commence at any time after impure connexion, 
 but usually begins from the third to the seventh day, by an itching 
 
G22 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 at the orifice of the urethra, which, if examined, appears to he un- 
 usually red and a little swollen. Soon afterwards a slight running 
 takes place from the urethra, of a whitish fluid, and this gradually 
 increases in quantity, while at the same time it becomes more thick, 
 until at last thick yellow matter issues from the canal. The disease 
 is now fully established, and gives rise to pain during the passage 
 of the urine (scalding); sometimes this pain is extremely severe, 
 but in other cases the patient scarcely feels any uneasiness of the 
 kind during the whole course of the disease. In ordinary cases of 
 gonorrhoea the peculiar inflammation of the urethra, which consti- 
 tutes the disease, does not extend up the passage beyond two inches 
 from its orifice; when the inflammation is acute or passes further 
 up the scalding is very severe, the under surface of the urinary 
 passage becomes hard, feels like a cord, and is very painful to the 
 touch ; the stream of urine is diminished from the swelling of the 
 parts which surround the urinary passage, and blood is often dis- 
 charged with the urine, from the bursting of small inflamed blood- 
 vessels. The patient should not be alarmed at this mixture of blood 
 in his urine, even when the quantity of blood is pretty considerable. 
 When the inflammation or irritation extends from the urinary pas- 
 sage to the spongy substance which surrounds it, a very painful 
 affection of the genital organ, called chordee, is excited ; and when 
 the irritation reaches the bladder the patient cannot retain his 
 urine for a moment, but is compelled to empty the bladder as soon 
 as ever the desire to make water is felt ; if he attempt to keep in 
 the urine, an intolerable pain is produced in the bladder and in the 
 extremity of the genital organ, exactly similar to what happens 
 during a fit of the stone. 
 
 Gonorrhoea is often attended with two unpleasant consequences, 
 which arise from the irritation extending to the glands in the groin, 
 or to the testicles. In the first case a hard painful swelling (sym- 
 pathetic bubo) appears in one of the groins ; in the second case the 
 inflammation extends along the seminal ducts clown to the testicle, 
 which becomes swollen and extremely painful to the touch (swelled 
 testicle). 
 
 When a proper attention is not paid to cleanliness during the 
 course of gonorrhoea, or the extremity of the genital organ is un- 
 usually irritable, the discharge of matter is apt to produce small 
 sores on the end of the penis, and to cause inflammation of the 
 foreskin. If this state be neglected, the foreskin sometimes swells to 
 such a degree that it can not be drawn back over the end of the 
 penis, or what is still more dangerous, when the foreskin has been 
 drawn back it contracts like a tight cord round the end of the geni- 
 
AND MOST RECENT METHODS OF TREATMENT. 623 
 
 tal organ, cannot be pulled forward, and sometimes gives rise to 
 mortification of the part. 
 
 We have as yet described gonorrhoea only as it exists in men ; 
 when women are affected the disease is generally more mild, and 
 not so apt to irritate the bladder or to produce swelling in the glands 
 of the groin. The pain is commonly slight and soon disappears ; 
 the scalding also is more frequently absent altogether, and the run- 
 ning soon terminates in a discharge of matter which bears a close 
 resemblance to the whites, or fluor albus. 
 
 The time during which a gonorrhoea lasts is extremely variable; 
 if left to itself the inflammation usually subsides in four or five 
 weeks, and turns into a chronic discharge {gleet) of slimy mucus 
 from the urinary passage, without any pain, scalding, or unpleasant 
 symptom ; but it will always be prudent to endeavor to cut short 
 the disease, not so much on account of any danger attending it, as 
 of the disagreeable consequences to which it often gives rise. 
 
 TREATMENT OF GONORRHOEA. 
 
 1. Rest. — Gonorrhoea is a disease of inflammation, and needs 
 quiet. In severe cases the patient should keep in a recumbent posi- 
 tion. Simple and unstimulating diet. 
 
 2. Demulcent drinks, such as flax-seed tea or tea of marsh-mallow. 
 By these methods alone, well persevered in, severe cases of gon- 
 orrhoea may be cured. 
 
 3. Injections into the urethra. 
 
 For this purpose various substances are nsed — sulphate of zinc, 
 or sulphate of copper, or of nitrate of silver {two or three grains to 
 the ounce of water). I present below more specific suggestions on 
 this too important subject. I may say, however, that any one who is 
 so unfortunate as to contract this disease makes a serious mistake 
 — indeed, commits a crime against himself — if he does not consult 
 some good medical authority. The worst consequences may come 
 from self- treatment. Patients are very apt to overdo the matter of 
 injections, and thereby may bring on serious, and perhaps incura- 
 ble diseases. 
 
 These same remarks will apply to syphilis and all other important 
 maladies of the genital organs. Self-treatment for such affections 
 especially is oftentimes worse than no treatment at all. It is better, 
 however, to have no treatment at all, or to doctor one's self, than to con- 
 sult any one of the vast army of charlatans who advertise to cure these 
 diseases. Thousands have lost their health and their lives by intrust- 
 ing to these abominable harpies the cure of their private diseases. 
 
 I am well aware that many, very many — especially seamen — are 
 
624: DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 so situated that they cannot obtain medical advice of any kind when 
 they contract these diseases, and for the benefit of such I give the 
 treatment in detail. 
 
 But, after all, the best way to cure these diseases is to ^prevent 
 them ; the surest way to prevent them is to abstain from impure 
 intercourse. 
 
 When eopaiva is employed, from twenty to thirty drops may be 
 given three times a day, on a bit of sugar (see Copaiva) ; or in the 
 following manner, as recommended by Sir A. Cooper : 
 
 Balsam of copaiva, one ounce, 
 
 Mucilage of gum arabic, one ounce, 
 
 Camphor mixture, four ounces. A tablespoonful to be taken night and morning. 
 
 To conceal the unpleasant, taste of the balsam, it may be rubbed 
 up with magnesia into a kind of soap, and then made into pills ; 
 the dose then being from twelve to twenty grains. 
 
 The eopaiva or cubebs may be continued for eight or ten days, 
 beyond which it would be useless to employ them if they do not 
 produce any good effects. "We must then have recourse to injec- 
 tions, which are to be thrown into the urinary passage by means of 
 a small syringe. People have often a dislike to use injections lest 
 the fluid pass up into the bladder. There is no fear that this will 
 happen. The sides of the urinary passage lie in close contact with 
 one another, and "fluid cannot be driven into the bladder with the 
 ordinary syringe; besides, we should remember that in no case is it 
 necessary to push the injection with force ; if it pass for a couple of 
 inches into the urinary canal this will be sufficient. The following 
 substances may be used for injections : 
 
 Sulphate of zinc, six grains, 
 "Water, four ounces. 
 
 Sulphate of copper (blue vitriol), one grain, 
 Rose-water, two ounces. 
 
 Nitrate of silver, five grains, 
 Water, one ounce. 
 
 The fluid is to be injected two or three times a day into the ori- 
 fice of the urinary passage : one injection may be substituted for 
 another, and the strength may be gradually increased by adding half 
 a grain, or even a grain, of each substance to the water. As a general 
 rule, it will be prudent not to commence injections before the disease 
 has lasted for ten or twelve days ; but under urgent circumstances it 
 may sometimes be cut short by injecting the nitrate of silver (ten 
 grains to the ounce) as soon as the pain and scalding are discovered. 
 
 We have now to describe the treatment applicable to the different 
 accidents which may arise during the course of gonorrhoea. Severe 
 inflammation must be subdued by leeches, purgatives, and cold lo- 
 
AND MOST RECENT METHODS OF TREATMENT. 625 
 
 tions. When the matter accumulates underneath the foreskin the 
 parts should be washed two or three times a day in tepid water, and 
 if there be any small sores about the root of the foreskin these 
 should be dressed with a small quantity of zinc ointment on a piece 
 of lint. If the bleeding from the urinary passage be copious, it 
 may be arrested by ice-cold lotions to the genital organ, and cooling 
 drinks. The chordee and painful erections which almost always at- 
 tend severe gonorrhoea may be relieved by the following draught, 
 taken before going to bed : 
 
 Extract of hemlock, five grains, 
 Liquor of potash, twenty drops, 
 Camphor mixture, four ounces. 
 
 Or a pill, containing one grain and a half of opium with five 
 of camphor, may be taken at bed-time, and repeated, if necessary, 
 in the morning. It has also been found beneficial to rub the under 
 surface of the genital organ with an ointment composed of equal 
 parts of fresh belladonna leaves (powdered) and lard. When the 
 effects of the chordee are long in going off we must rub in a small 
 quantity of the camphorated mercurial ointment every night along 
 the surface or sides of the genital organ. When the irritation ex- 
 tends to the bladder and gives rise to a frequent desire of making 
 water, with pain, a draught containing six grains of the extracts of 
 hyosciamus or of hemlock, in four ounces of camphor mixture, must 
 be taken at night ; or two grains of opium may be taken in pill, and 
 an ounce of castor-oil administered in the morning, to prevent cos- 
 tiveness. When the glands in the groin begin to swell and are 
 painful, six to ten leeches should be applied to the painful part ; the 
 patient should endeavor to keep as quiet as possible, and should con- 
 stantly apply cold Goidard vmter to the swelling, with lint covered 
 by oiled silk. The extension of the inflammation to the testicle 
 produces a very painful affection ; the testicle swells, the skin which 
 covers it becomes red, and a constant pain shoots up from the tes- 
 ticle to the groin. This complaint may often be prevented by wear- 
 ing a suspensory bandage to support the testicle from the commence- 
 ment of the gonorrhoea; but when it has seized on the part, we 
 should at once apply ten to twenty leeches to the surface of the in- 
 flamed testicle, and repeat the leeches a second time if the pain con- 
 tinue unabated. The bowels must be freely acted on by cathartics. 
 The testicles must be supported by a suspensory bandage or a silk 
 handkerchief, and a lotion composed of Goulard water, or one ounce 
 of spirits of wine in five ounces of water, should be constantly ap- 
 plied to the inflamed parts. Swelled testicle is now treated by strap- 
 ping with adhesive plaster. 
 40 
 
626 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 GLEET. 
 
 "When gonorrhoea has continued for some time, and the pain has 
 completely disappeared, the discharge gradually loses its yellow color, 
 becomes greenish, and finally clear ; the constant running of this 
 clear discharge from the urinary passage is called a gleet; but any 
 excess of diet, &c, is apt to bring back again the greenish or even 
 yellowish running. Gleet is not attended w T ith much personal in- 
 convenience, and is often neglected on this account, and allow r ed to 
 continue for many months or years. When it has lasted for a long 
 time it is frequently difficult to cure it by any treatment which we 
 may adopt. 
 
 TREATMENT OF GLEET. 
 
 Gleet is treated on two principles. 
 
 1. Local applications of fluids by injection, as described under 
 treatment of gonorrhoea ; and bougies of various sizes passed up to 
 the bladder, one, two, or three times a week. Sometimes these 
 bougies are smeared with calomel ointment or glycerine, and are 
 placed in very cold water or on ice before they are applied. The 
 use of bougies may be alternated with the injections. 
 
 2. General tonic treatment. — Gleety patients are often debilitated. 
 Quinine, muriated tincture of iron, and strychnine may be used with 
 advantage in connection with general electrization (if any physician 
 near understands this method of treatment), and nourishing food. 
 
 Recently the oil of erigeron (see Erigeron) has been used inter- 
 nally in gleet with success. It has some special influence on the 
 inflamed urethra. , 
 
 Many patients who have a slight gleety discharge from the ure- 
 thra are much more annoyed by it than is necessary. They become 
 blue and hypochondriacal.' They imagine that great evil is to befall. 
 They frequently suppose that the discharge is seminal fluid, and 
 that they will soon become impotent. Even when the physician 
 ascertains by microscopic examination that the discharge comes en- 
 tirely from the urethra, still they refuse to be comforted. All this 
 is extreme folly. One great advantage to patients in consulting 
 some honest physician when they are afflicted with maladies of the 
 genital organs is that they are immediately reassured and informed 
 as to the real truth in these matters. (See Seminal Emissions.) 
 
 The teachings of quack doctors are chargeable with a vast 
 amount of needless distress. 
 
627 
 
 GLYCERINE. 
 
 Glycerine is a neutral substance that is left when fatty acids 
 unite with alkalies to form soaps. 
 
 "Within the past few years it has been much used in medicine. 
 It is very bland and unirritating, and also possesses some peculiarly 
 curative effect on diseased mucous membranes. It is used for dis- 
 eases of the skin, for rhinitis (catarrh), and for inflammations of 
 mucous membranes in the various parts of the body. 
 
 It is used as a vehicle to contain other remedies. Thus we use 
 iodine, tannin, in glycerine for inflammations of the nose and throat. 
 
 Goulard Water. (See Lead and Opium Wash.) 
 
 GOUT. 
 
 We shall make only two divisions of gout, the regular or acute, 
 and the irregular or chronic gout. 
 
 REGULAR OR ACUTE GOUT. 
 
 An attack of gout is invariably preceded by certain symptoms, 
 which, though not observed in every case, always take place in a 
 more or less marked manner. These premonitory symptoms vary 
 greatly in different individuals, but are in all cases connected with 
 a deranged state of the digestive organs ; the tongue is foul, or 
 much redder than natural ; there is heartburn, sometimes belching 
 of sour fluid, and perhaps vomiting ; the patient feels sleepy and 
 uncomfortable after eating, is frequently low-spirited, and sleeps 
 badly. The feet are sometimes very cold, at other times distress- 
 ingly hot ; a pricking, darting, or numb sensation is felt occasion- 
 ally in the legs and feet, particularly in the foot which is about 
 to be attacked; and some hours previous to the paroxysm there 
 are generally flushes of heat alternating with shivering. Indeed, a 
 long train of warning symptoms might be easily enumerated, but 
 they are all so irregular, and vary so much in different individuals, 
 that we see no necessity for noticing them further. It is worthy 
 of remark, however, that every person subject to gout experiences 
 some particular sensation or symptom which serves to announce 
 the approach of an attack. 
 
 At length the first paroxysm declares itself, as in asthma, about 
 two or three o'clock in the morning. The patient awakes suddenly, 
 with a violent throbbing pain, generally at the ball of one of the 
 great toes, though sometimes at the heel, instep, or ankle. The pain 
 goes on increasing, accompanied with a sensation of burning heat, 
 weight, and stiffness of the part, and severe shooting pains in the 
 
628 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 limb. This local suffering is at first attended with rigors or shiver- 
 ing, which is soon replaced by fever and great restlessness. In 
 mild cases the pain after a few hours abates a little, and gentle 
 perspiration breaks out ; but in general it continues without any 
 amelioration until about midnight, and then begins to diminish 
 until towards two or three o'clock in the morning, when the patient 
 falls asleep, after twenty-four hours' severe suffering. On awaking he 
 finds the part very tender, red, shining, and swollen, with consider- 
 able distention of the veins of the foot. The following night the 
 pain and fever are renewed, and again relieved in the morning ; 
 this goes on regularly during a longer or shorter period, each par- 
 oxysm being less severe than the preceding one, until at last the 
 attack terminates entirely. The part remains swelled for some days 
 afterwards, there is severe itching, and the skin falls off in scales ; 
 the patient then feels better in every respect than before the attack. 
 
 The first attacks of gout seldom continue beyond three or four 
 days, and are confined to one foot ; but when the disease has gone 
 on for some time the inflammation, when declining in one foot, 
 suddenly attacks the other, and frequently the fingers, wrists, or 
 knees. Then the acute, gnawing pain, the shivering and subse- 
 quent fever, the swelling and redness of the part, and all the symp- 
 toms as above described, recommence. At the expiration of three 
 or four days the pain is again relieved ; but the attack does not end 
 here. A similar fit supervenes, affecting the same or another joint, 
 or perhaps several parts simultaneously, accompanied with the 
 same series of symptoms and continuing during the same length 
 of time. Hence, to complete an attack of gout three or four con- 
 secutive fits are required, each taking three, four, or five days to 
 run its course. Fifteen days may be considered as the average du- 
 ration of an attack of gout, but it frequently continues much longer. 
 
 The time which may elapse between the attacks is very uncer- 
 tain ; twelve months or even several years may intervene between 
 the first and second attack, but the interval is often much shorter ; 
 this depends in a great measure on the constitutional tendency and 
 manner of living of the patient. 
 
 "When the disease has been confirmed, the attacks occur more 
 frequently, are more severe, continue longer, extend to several 
 joints, and affect to a certain extent, in some individuals, almost 
 every joint of the body, until at last the constitution gives way 
 and the patient is rendered miserable. 
 
 One of the most constant phenomena connected with gout is 
 the passing of high-colored urine during the attack, frequently con- 
 taining particles of sand or gravel ; but when the feverish symp- 
 
AND MOST RECENT METHODS OF TREATMENT. 629 
 
 toms have abated the sediment acquires a white color, and re- 
 sembles chalk or magnesia. 
 
 IRREGULAR OR CHRONIC GOUT. 
 
 Chronic gout is generally the consequence of several attacks of 
 the acute form, or it may appear as a primary affection. In both 
 cases the difference which exists between it and acute gout con- 
 sists in the pain being less severe, the feverish symptoms milder 
 or entirely absent, and the attacks of much longer duration, con- 
 tinuing in some cases several months, in others all the year round, 
 with the exception of two or three of the summer months. But in 
 general, before gout becomes chronic, several of the joints have been 
 affected ; from the feet it has passed to the ankles, fingers, wrists, 
 knees, &c. In this state of the disease several joints are seized in 
 succession during the same attack; but when it wanders in this 
 manner from one part to another it rarely happens that the pain 
 keeps up its original intensity. 
 
 The pain in chronic gout is constant, but not nearly so severe 
 as in the acute form. At times, however, it becomes considerably 
 increased, particularly after meals, during the early part of the night, 
 and when the patient changes the position of the affected parts ; it 
 is also aggravated by changes of temperature and fits of anger. 
 Under these or other circumstances the suffering occasionally be- 
 comes acute in the very extreme. Even persons otherwise robust, 
 and possessed of the greatest fortitude, are driven almost to a state 
 of madness by the violence of the pain. In such cases a fainting 
 fit is not an extraordinary occurrence. 
 
 After acute gout the joints soon resume their usual strength and 
 freedom of motion, but in the chronic form they remain stiff, swollen, 
 and not unfrequently deformed. In some cases, especially in those 
 who have been long subject to gout, a substance resembling soft 
 mortar, or plaster of Paris in a half-liquid state, is deposited about 
 the small joints; and when this matter becomes hard it is commonly 
 called chalk-stone. These chalky concretions may be formed im- 
 mediately under the skin or within the joints. They are often the 
 source of great pain, sometimes cause inflammation, and the forma- 
 tion of matter, along with which they are occasionally discharged. 
 Chalk-stones were discovered by Dr. Wollaston to be composed of 
 urate of soda. 
 
 One of the most remarkable and peculiar phenomena of gout is 
 the facility with which it moves from one part to another. After 
 attacking several of the joints in succession it may be suddenly 
 transferred to the stomach, bowels, brain, heart, kidneys, or in fact 
 
630 
 
 to any internal organ or part. This is distinguished by the term 
 retrocedent gout. If gout change its seat from a joint to the stomach 
 or any other organ during an acute paroxysm, the internal affection 
 will also be acute; but if the gout be chronic the internal disorder 
 will be less severe and longer continued. When gout is thus trans- 
 ferred, the stomach and bowels are the parts most frequently at- 
 tacked ; the former with pain, spasm, sickness, and vomiting ; the 
 latter, either alone or in conjunction with the stomach, with violent 
 colic or acute inflammation. Gouty people, however, are too apt 
 to attribute every internal disorder, whether functional or inflam- 
 matory, to the influence of gout ; though it by no means follows 
 that the numerous derangements to which they are subject are 
 characteristic of this disease, merely because they co-exist or follow 
 it. In fact, the translation of gout from the joints to internal parts 
 is not nearly of such frequent occurrence as is generally supposed ; 
 and this ought always to be kept in recollection in order to avoid 
 errors in treatment. 
 
 Causes. — That a predisposition to gout is transmitted from 
 parents to their children is a fact not to be doubted ; and when 
 hereditary disposition exists there is every reason to believe that 
 the disease is more ready to declare itself than under other circum- 
 stances ; but the cases in which it occurs without the more power- 
 ful influence of intemperance and idleness are very rare indeed. 
 Gouty people attribute the disease to this predisposition, as if it were 
 the only cause ; but we know that there is nothing more natural 
 than that the son should acquire the same indolent and luxurious 
 habits as his gouty father, and that there is nothing more likely to 
 happen than that the influence of those habits on the system, parti- 
 cularly when associated with hereditary disposition, should bring 
 on the same disease. But if the son be placed in a different position 
 in life, if from reverse of fortune he be compelled to toil daily in 
 order to gain a scanty maintenance, he may at least rest assured 
 that, whatever misfortunes and sufferings he may have to labor 
 under, gout is not likely to be one of the number. 
 
 The influence of age is more clearly shown than that of predis- 
 position entailed on offspring. It was stated by Hippocrates, and 
 has been remarked from his time downwards, that gout rarely if 
 ever occurs before the age of puberty. The first attack may take 
 place at any period of life from twenty-five to fifty ; but when the 
 predisposition is strong, and the habits of the individual intemperate, 
 it may declare itself much earlier. 
 
 "Women are most frequently attacked by gout after the entire 
 cessation of the menstrual discharge ; but at no period of life are 
 
AND MOST RECENT METHODS OF TREATMENT. 631 
 
 they so subject to it as men. The late Professor Gregory stated 
 the proportion as one to fifty in England, and one to a hundred in 
 Scotland. This relative exemption is, no doubt, owing to their 
 temperate habits, and the periodical discharges by which the sys- 
 tem relieves itself. 
 
 One of the causes to which gout has been attributed by many 
 authors, both ancient and modern, is over-indulgence in drinking 
 wine ; and there can be no doubt that this habit has a strong ten- 
 dency to bring it on. Observation has also shown that the habitual 
 use of claret, champagne, and port is more likely to produce this 
 effect than indulgence in other w T ines, and malt liquor and cider 
 more than spirits. 
 
 A patient of mine, who had suffered for many years from the so- 
 called rheumatic gout, once told me that whenever she took "one 
 sip of champagne at a dinner, she felt it instantaneously in the 
 affected joints" 
 
 TREATMENT OF GOUT. 
 
 Acute gout is treated by colchicurn or meadow-saffron. The wine 
 of the root may be given in doses of from ten to twenty -five drops, 
 three, four, or five times a day. Colchicum should not be given 
 in very large doses. It may produce unpleasant and serious effects. 
 
 Local applications of alkaline washes (solutions of carbonate of 
 potash) may be made to the affected joints, or of laudanum. The 
 joint may be wrapped in oiled silk or spongio-piline. Cold appli- 
 cations should not be used, as they may drive the disease to some 
 important organ. 
 
 When gout attacks the stomach the horrible pain may be re- 
 lieved by hypodermic injections (see Hypodermic Injections), or by 
 chloroform or laudanum, or Hoffman's anodyne, or brandy, inter- 
 nally. Mustard plasters may be placed on the pit of the stomach, 
 and the feet may be bathed in mustard water. 
 
 A change of air, a trip over the ocean, will sometimes cure an 
 attack of gout when other remedies have failed. Patients in the 
 North might try a trip to the Southern States. 
 
 Prevention of Gout. — The most important part of the preven- 
 tive treatment is a proper regulation of the diet, which ought to 
 consist of tender, well-boiled vegetables, stale bread, fruit, eggs, fish, 
 and a moderate allowance of plainly dressed beef or mutton once a 
 day. Pich and highly seasoned dishes, heavy puddings, pastry, 
 salads, pickles, salmon, &c, are to be avoided. No general rule, 
 however, can be laid down ; the particular articles of diet must vary 
 in different individuals, and the quantity of food to be allowed must 
 
632 
 
 depend in a great measure on the extent of daily exercise made 
 use of. A spare diet should be rigidly adhered to by full-blooded 
 persons, who have a strong hereditary disposition to the disease ; 
 but in general this is not necessary. The maxim should be, not 
 to eat more meat or drink more wine than is really necessary; 
 to regulate the quantity and quality of food so as not to injure 
 the health, always keeping in recollection that people in general, 
 and gouty people particularly, eat more than is good for them ; 
 more, in fact, than is consistent with the due performance of all the 
 functions of the body ; that is to say, with perfect health. 
 
 The preventive agent ranking next in importance to a well-regu- 
 lated diet is exercise. But exercise, in order to produce the desired 
 effect, must be regular and sufficiently active. Walking is to be 
 preferred, if the state of the feet will admit of it, otherwise active 
 exercise on horseback should be employed. Much benefit may also 
 be derived from friction of the limbs with rough towels or a flesh- 
 brush night and morning. Flannel should be worn next the skin ; 
 cold, wet, and sudden changes of temperature are to be avoided ; 
 the feet must be carefully kept warm, particularly during the night ; 
 and the patient should retire to rest at an early hour in order to 
 insure early rising in the morning, than which there is nothing 
 more conducive to health. 
 
 The principles already laid down show the necessity of guarding 
 against a change from a very active to a sedentary life, and from 
 low to high living ; indeed, the reverse of these changes, if adopted 
 suddenly, are not without risk. In fine, all the usual rules for the 
 preservation of health ought to be particularly attended to by gouty 
 people. Nearly all that can be said on the subject is comprehended 
 in the old Scotch saying, that " any man might cure himself of gout 
 by living on a sixpence a day, and working for it." 
 
 (For Rheumatic Gout see Rheumatism.) 
 
 GTTAIAC. 
 
 The substance called guaiac exudes from a tree, native of the 
 West Indies, the wood of which is well known under the name of 
 lignum vitm. It is possessed of moderately stimulating and sudori- 
 fic properties, and is given to promote perspiration in some forms 
 of gout, chronic rheumatism, and in certain affections of the skin, 
 but is rarely trusted to alone. In the West Indies it is much used 
 in the treatment of syphilis and yaws. 
 
 The dose of gum guaiac is ten or twenty grains, mixed with a 
 little mucilage of gum arabic, or made into pills ; the ammoniated 
 
AND MOST RECENT METHODS OF TREATMENT. 633 
 
 tincture may be taken in doses of from thirty drops to a drachm 
 and a half twice or thrice a day. with yolk of egg or a little muci- 
 lage ; if given by mistake in w T ater it becomes white and thick. 
 
 GUM AMMONIAC. 
 
 Gum ammoniac is the produce of an umbelliferous plant which 
 grows in Persia. This gum-resin is seldom used alone, but is found 
 useful as an expectorant in the chronic cough in old persons, and in 
 some forms of asthma. In the cough which attends hysterical, 
 dyspeptic, and hypochondriacal affections it is said to be a service- 
 able remedy. Ammoniac ought not to be given in consumption, 
 nor when inflammatory symptoms are present. Externally it is 
 used to reduce indolent tumors. 
 
 The dose of gum ammoniac is from ten to thirty grains. 
 
 GUM AEABIC. 
 
 Gum arabic is obtained from a genus of plants called Mimosa 
 or Acacia. 
 
 "When dissolved in water it is in common use as a demulcent 
 drink, and enters into the composition of many of the mixtures, 
 jujube and other lozenges, used to allay coughing. It is also some- 
 times employed in strangury, and at the commencement of gonor- 
 rhoea. Gum-water is much used by the French in irritation and 
 inflammation of the stomach and bowels; but there is no evidence 
 to show that it possesses any advantage over linseed-tea, barley- 
 water, and similar demulcent drinks. Gum arabic may be taken 
 in any quantity ; indeed, the negroes of some parts of Africa sub- 
 sist on it in seasons of scarcity. Dissolved in twice its quantity of 
 water it is called mucilage, which is much used to render oils, 
 balsams, and resinous substances diffusible in water, and serves to 
 give consistence to medicines made into pills. 
 
 GUM-BOIL. 
 
 A gum-boil sometimes arises from exposure to cold, but is caused 
 in the majority of cases by the irritation of a spoiled tooth. Inflam- 
 mation of the gum generally goes on to suppuration, to promote 
 which warm fomentations and poultices are frequently applied 
 externally, but they appear to be of very little service. The treat- 
 ment consists in cutting into the abscess as soon as there is reason 
 to suppose that the smallest quantity of matter has formed. After- 
 
DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 wards the mouth may be washed occasionally with an astringent 
 lotion composed of tincture of galls and water, or of twenty or 
 twenty-five grains of sulphate of zinc {white vitriol) dissolved in 
 half a pint of rose-water. When the pain and inflammation have 
 entirely subsided the decayed tooth should be extracted or filled 
 by the dentist. 
 
 HAIE, STKUCTUEE OF. 
 
 The following cut shows the appearance of a section of the skin 
 under the microscope : 
 
 SECTION OF THE SKIN UNDER THE MICROSCOPE, AFTER BEIGEL. 
 
 The cut represents the outlines of a vertical section through the human skin, A A being the epidermis 
 adapting itself to the elevations (c C) and depressions (B B) of the sensitive layer ; C C, papilla? of the 
 corium, D D ; E E, fat deposited in the lower meshes of the corium ; F F, globular balls of perspiratory- 
 apparatus ; G G, tubes of the same apparatus ; H H, openings of these tubes on the skin, called pores ; 
 1 1, oil glands of the skin ; K K, their openings into the sheath of the hair ; L L, papillae of the root of 
 the hair ; M M, sheath of the hair ; N N, bulb and shaft of the hair. 
 
 The shin in which the hair grows is composed of three layers : 
 the epidermis, the sensitive layer, and the corium. 
 
AND MOST RECENT METHODS OF TREATMENT. 635 
 
 The skin is everywhere filled with pores. According to one of 
 our highest authorities on this subject, there are seventy- three feet 
 of pores in every square inch of skin. Through these pores the per- 
 spiration exudes. 
 
 From the same authority, as quoted by Beigel, we learn that : 
 " On the pulps of the fingers, where the ridges of the sensitive 
 layer of the true skin are somewhat finer than in the palm of the 
 hand, the number of pores on a square inch a little exceeded that 
 of the palm ; and on the heel, where the ridges are coarser, the num- 
 ber of pores on a square inch was 2268, and the length of tube 567 
 inches, or forty-seven feet. To obtain an estimate of the length of 
 tube of the perspiratory system of the whole surface of the body, I 
 think that 2800 might be taken as a fair average of the number of 
 pores in the square inch, and 700, consequently, of the number of 
 inches in length. Now the number of square inches of surface in 
 a man of ordinary height and bulk is 2500 ; the number of pores, 
 therefore, seven millions, and the number of inches of perspiratory 
 tube one million seven hundred and fifty thousand — that is, one 
 hundred and forty-five thousand eight hundred and thirty-three 
 feet, or forty-eight thousand six hundred yards, or nearly twenty- 
 eight milesP 
 
 COLOR OF THE HAIR. 
 
 According to Beigel (previously quoted) the color of the hair 
 depends on these three conditions : 
 
 1. The color of the cortical cells, which plays the most impor- 
 tant part, and varies from very light yellow, through intense red 
 and all shades of brown, to a deep, dark hue, as seen in the hair of 
 the negro. 
 
 2. The molecules, consisting of pigment, diffused through the 
 cells of the cortical substance. It is diminished in fair, and entirely 
 absent in gray and white hair, in w r hich the coloring matter of the 
 cells may likewise have — though not necessarily — disappeared. 
 
 3. The amount of air contained both in the air cavities and the 
 medullary canal. — It is only recently that the part of the air con- 
 tained in hairs has been more carefully investigated and recog- 
 nized. 
 
 HAIR AND SCALP, DISEASES OF. 
 
 I cannot attempt to give any full description of diseases of the 
 hair. I shall endeavor only to give a few suggestions for the guidance 
 of those who are troubled with some of the more frequent affections 
 of the hair, such as dandruff, baldness, and premature grayness. 
 
 Dandruff is one of the most common and most annoying of the 
 
636 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 affections of the scalp. There are very few who are not at times 
 more or less troubled by it. 
 
 The best way to treat this disease is : 
 
 1. To keep the scalp clean by frequently washing it. We are too 
 much afraid of having dry hair, because fashion requires us to keep 
 our locks in certain positions. 
 
 The heads of infants and children should be kept carefully clean. 
 There are many people who zealously wash every other part of the 
 body, who perhaps take daily baths, and yet never wash their heads. 
 Is it a wonder that the skin becomes diseased and the hair falls out ? 
 Dandruff is to the scalp what scurf skin is to the body generally. 
 
 2. Use mildly stimulating washes. 
 
 The following preparation I have found to be very serviceable : 
 
 Bay rum, 
 
 Glycerine, 
 
 Carbonate of ammouia, 
 
 Rose-water, of each four parts ; 
 
 Tincture of Spanish flies, one part. 
 Mix, and shake. Dilute with water as may be convenient, enough to cause only a 
 very slight smarting sensation on the scalp, and thoroughly shampoo the head once or 
 twice a week. 
 
 By the use of some such preparation as this the scalp may be 
 kept quite clean and comfortable. 
 
 We should avoid using too much of alkalies on the scalp. A 
 moderate amount of borax or ammonia is, however, beneficial, 
 especially when combined with glycerine. Sometimes the above 
 preparation ultimately makes the hair moist, by stimulating the 
 secretion of lubricating oil. The temporary effect is always to re- 
 move the oil on the hair. The permanent effect is to restore the 
 healthy action of the scalp. 
 
 BALDNESS. 
 
 This is sometimes congenital. It is certainly very often here- 
 ditary. It certainly is not a sign of debility in all, or even in the 
 majority of cases. Some families who are quite weakly do not 
 become bald until very advanced ages ; in other families who are 
 very strong the head becomes bald between thirty and forty. (See 
 Laws of Hereditary Descent?) 
 
 There is very little to be done for baldness. My directions are 
 very simple. 
 
 1. Do not keep the head too hot. Closely fitting and heavy hats 
 are probably injurious to the scalp. Over-work of the brain induces 
 congestion of that organ, and is probably injurious to the scalp and 
 hair. 
 
AND MOST RECENT METHODS OF TREATMENT. 637 
 
 "In respect to the treatment of alopecia (baldness), it must be 
 remembered that the falling off of the hair is not the disease, but the 
 consequence of the same. Medical advice is therefore necessary, in 
 order to investigate the nature of the individual case, and to find out 
 the cause of the affliction. Hence it is evident that no general remedy 
 is possible, and that no cure of baldness can be successful until the 
 cause has been discovered and removed. If the patient be of weak 
 constitution or ill-nourished, he must be strengthened; if some im- 
 portant functions, as digestion, &c, have been deranged, they must 
 be restored to their normal action ; if undue nervous activity be the 
 cause, special attention must be directed to the nervous system, and 
 it requires sometimes the most attentive consideration of the case, 
 and a very rational treatment, in order to arrive at the desired end. 
 Some time ago I had a lad, twelve years of age, under my care in 
 the Farringdon Dispensary, who, in the course of a few weeks, had 
 lost his hair in such a manner as to leave the scalp entirely bald. 
 The boy was very ill-fed, his complexion pale, and his constitution 
 weakened. After I had procured better food and administered 
 appropriate internal remedies, the hair soon began to grow, and the 
 head regained its normal appearance, without my having applied 
 any local remedy in the shape of lotion, ointment, plaster, &c." 
 
 If people used less grease on their heads, and more water, and if 
 they were more obedient to the laws of health in other respects, I 
 believe there would be less complaints from baldness. 
 
 I am inclined to the opinion, however, that a moderate amount 
 of pomade is not injurious, provided the head is frequently and 
 thoroughly cleansed in the manner above described. 
 
 On this subject Beigel thus remarks : 
 
 " Concerning the management of healthy hair, the most simple 
 means will prove the most beneficial. Cleanliness of the scalp, 
 cutting the hair now and then, and keeping it moderately greased 
 by some simple pure oil or pomatum, will suffice under all circum- 
 stances. Falling out of the hair or other abnormal phenomena are 
 diseases, and must be treated as such. 
 
 " It may, perhaps, be convenient to add some prescriptions for 
 the preparation of oils or pomatums generally in use, and (like 
 pomatum of quinia, or of tannin and quinia) considered to act bene- 
 ficially on the skin and roots of the hair. 
 
 " The best means of cleansing the scalp is a weak solution of 
 alcohol in water, or a solution of subcarbonate of soda, distilled 
 water, and essence of vanilla. 
 
 " The preparations called ' bandoline,' ' fixature,' &c.,much used 
 for the purpose of rendering the hair glossy and fixing the bandeaux 
 
638 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 in the required position, according to the same author, are pre- 
 pared of 
 
 Gum tragacanth, 
 
 Distilled water. 
 To be allowed to digest for live or six hours, then strain through muslin, press, and add 
 
 Alcohol, 
 
 Rose-water. 
 Mucilage of cydonia and eau de Cologne are also frequently employed for a similar 
 purpose. 
 
 PRESCRIPTIONS FOR OIL. 
 
 Take — Provence oil, 3 oz. ; 
 
 Essential oil of sweet almonds, 
 
 Oil of roses, 2 drops of each ; 
 
 Orange oil, 5 drops ; 
 
 Lemon oil, 10 drops. 
 If preferred colored, this may easily be done by digesting a little alkanet-root in it for a 
 few days. 
 
 MARROW OIL. 
 
 Take of— Clarified beef-marrow, 1£ oz. ; 
 Oil of almonds, \ pt. 
 Melt them together and scent the mixture at will by a few drops of any essential oil, viz., 
 bergamot, cloves, lavender, lemon, neroli, nutmeg, &c." 
 
 It should be remarked here that those who are afflicted with 
 chronic inflammation of the middle ear, with catarrh, should be 
 cautious about bathing their heads or letting the shower-bath fall 
 directly on it. They should, as a rule, use tepid water. 
 
 HAIR DYES. 
 
 These are more or less injurious. They are usually composed of 
 very poisonous substances. The substances may be absorbed and 
 injure the system. Sugar of lead and nitrate of silver are common 
 ingredients in our popular hair-dyes. Lead, sulphur, and lime 
 also enter into the composition of these preparations. A case of 
 direct injury to the nervous system from the use of these substances 
 has come under my observation. 
 
 The following I copy from a foreign medical journal ; it tells its 
 own story : 
 
 " Hair Restorer. — The sample examined consisted 
 
 of a colorless fluid and a grayish-yellow deposit. The deposit con- 
 sisted almost entirely of sulphur, with a minute quantity of car- 
 bonate of lead. The solution contained acetate of lead and gly- 
 cerine. 
 
 " In a bottle containing 10 fluid ounces, 44.8 grains of sulphur, 
 
AND MOST EECEiXT METHODS OF TREATMENT. 639 
 
 and lead corresponding to 21.87 grains of acetate of lead, were 
 found." 
 
 " Sample No. 2. Hair Restorer. — The bottle exam- 
 ined contained 8-J fluid ounces of mixture, composed, like the last, 
 of a colorless fluid and a yellowish gray powder ; this latter consist- 
 ing of sulphur, with a trace of carbonate of lead, the solution con- 
 taining acetate of lead and glycerine. 
 
 " The results of an analysis of the contents of the 8-§- ounce bottle 
 indicated 75.6 grains of sulphur, and an amount of lead correspond- 
 ing to 87 grains of acetate of lead." 
 
 " Sample No. 3. Hair Restorer. — Like the prepara- 
 tions previously noticed, this consisted of a colorless fluid and a 
 yellowish gray deposit, and also contained the same ingredients, 
 viz., sulphur, acetate of lead, and glycerine, the deposit in this case 
 being pure sulphur. 
 
 " A bottle containing 8 fluid ounces furnished 31.8 grains of 
 sulphur, and lead corresponding to 45.1 grains of acetate of lead." 
 
 "Another preparation was found to be similar to the others, the 
 deposit containing sulphur, sulphate of calcium, and a trace of 
 sulphate of lead; the solution containing acetate of lead, glycerine, 
 and a trace of acetate of calcium. In distinguishing this prepara- 
 tion by the epithet vegetable, the maker has allowed his inventive 
 faculty to overstep the bounds of truth, and has given moralists 
 another instance of the common commercial practice of calling 
 things by their wrong names. 
 
 " A bottle containing 6 fluid ounces furnished 70.2 grains of 
 sulphur, mixed with sulphate of calcium (milk of sulphur having 
 evidently been used in this case) ; also lead corresponding to 50.8 
 grains of lead." 
 
 The simple truth in the matter is, as Beigel remarks, " that of the 
 two principal chemicals used for staining the hair, viz., nitrate of 
 silver and lead, the former colors the skin as well as the hair, while 
 the latter is poisonous, and liable to cause most painful colics, and 
 even contractions of the limbs." 
 
 A perfectly harmless dye for the hair has not yet been discovered. 
 
 ABNORMAL GROWTH OF HATR. 
 
 This is not a very common disease. The accompanying cuts 
 illustrate one or two phases that this disease may assume. They 
 are chiefly interesting as curiosities. 
 
 It is perhaps hardly fair to call this a disease, but rather a defor- 
 mity. There is, as we all know, a great difference in the quantity 
 of hair with different individuals. 
 
640 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 (For remarks on scald head and other diseases of the hair, see 
 Skin, Diseases of.) 
 
 ABNORMAL GROWTH OP HAIR ON THE BODY. 
 
 ABNORMAL GROWTH OF HAIR ON 
 THE FACE AND SCALP. 
 
 HAY FEVER OR ROSE-COLD. 
 
 This is a severe form of catarrh (rhinitis), of a periodic character. 
 Some persons are subject to it every season during haying-time. 
 Some are attacked in June, others in July or August. It usually 
 runs its course in a few weeks and then passes off. Some are at- 
 tacked early in the season, others later. 
 
 The general sjmiptoms of the disease are much like those of 
 catarrh of the nose (rhinitis), but are of a more violent and obstinate 
 character. (See Catarrh.) 
 
 For the treatment, quinine is strongly recommended. In con- 
 nection with quinine I would suggest injections through the nasal 
 passages of weak solutions of chlorate of potash in tepid water. 
 
 The following description, translated from a French author, and 
 recently published in the Boston Medical and Surgical Journal, is 
 of interest : 
 
 " It is certain that in some cases the odor of the hay appears to 
 be the exciting cause of the paroxysms. The observations of Gor- 
 don and Elliotson leave no doubt as to the fact, although the latter 
 
AND MOST RECENT METHODS OF TREATMENT. 641 
 
 is wisely reserved as to the determining cause of the symptoms. 
 He gives, among others, the remarkable case of a lady patient ob- 
 served by Dr. Payser. 
 
 " The father of this lady had a sudden but temporary coryza 
 every time he crossed a grass-field in flower. 
 
 " She herself, every year, towards June, experienced a sensation 
 of heat and fulness in the eyes, accompanied by redness and water- 
 ing. To these symptoms there soon succeeded an irritation of the 
 nasal mucous membrane and sneezing ; then the inflammation 
 spread to the throat and the trachea, with a sensation of heat and 
 itching in the situation of these organs. At this time the dyspnoea 
 was most painful. All these symptoms disappeared towards the mid- 
 dle of July. This lady had no doubt of their connection with the 
 grass in flower. On the middle of August she could walk through 
 the fields with impunity, whilst in June and July the neighborhood 
 of grass would cause her the most acute suffering. If at this time 
 she picked a handful of grass, the integuments of her hands be- 
 came red and itchy ; the same symptoms would appear if she em- 
 ployed dry hay in packing boxes. For the purpose of escaping 
 the vicinity of hay-fields during the fatal season, she took refuge 
 at the sea-shore in the roughest countries. Here she found relief 
 when the wind came from the sea, but was less well when the land 
 breezes blew. One day when walking at the foot of Harwich cliffs 
 she was taken with a sudden and violent paroxysm, explained in 
 the morning, when she learned that at the very hour of her walk 
 they were mowing a small patch of grass upon the crest of the 
 cliff. 
 
 "At another time, in the centre of a small town, at a distance 
 from any grass, she was seized with a sudden paroxysm, and on 
 looking out of her window saw men making a stack of hay brought 
 from a distance. Another time a paroxysm was brought on by her 
 children, who entered the room after having been at play in a barn 
 filled with hay. 
 
 " I might doubt the accuracy of these facts had I not seen others 
 which present a great analogy to them. 
 
 " Three of this lady's children, acids Elliotson, inherited this in- 
 firmity ; a fourth had common asthma, with this peculiarity, that 
 paroxysms were brought on by the odor of guinea-pigs. Many 
 similar facts are found in the books, enough, in my mind, to prove 
 the influence of emanations from hay in causing the development 
 of asthmatic coryza in certain individuals. 
 
 " But although this influence is incontestable, we can see, even in 
 the observations cited for its support, that the affection may appear 
 
64:2 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 without these conditions, even in the individuals most susceptible 
 to its effects ; thus proving that it is only an exciting cause. We 
 also find, as I was just saying, analogous conditions in the etiology 
 of common asthma. Certain odors, certain localities always, or at 
 least during a certain period of life, provoke the paroxysms. I 
 have come across two asthmatics in whom the odor of flax-seed 
 meal had this effect. One of them seems to have a special suscep- 
 tibility for this ordinarily inoffensive grain. It is impossible to 
 make a poultice in his apartments without his discovering it and 
 being seized with an attack of asthma. There are other cases in 
 which the odor of bean-flowers, or the odor of the cat, produces the 
 same effect. The emanations of hay are indeed much more active 
 than many of the substances feared by certain asthmatics. 
 
 " A farmer of Normandy has said to me quite lately that during 
 haying-time both he and his laborers suffered from violent head- 
 aches. 
 
 " This circumstance is mentioned in a great number of observa- 
 tions, with all the more authority, as the authors have drawn no 
 conclusions from the fact, and hence had no preconceived notions 
 upon its etiological bearing. 
 
 " Periodicity is a characteristic of many arthritic affections. A 
 spring-time periodicity is especially peculiar to them. I have often 
 remarked that many diseases of an arthritic origin, which are recur- 
 rent or subject to periodical exacerbations, return especially at the 
 times in which the gout of the joints most naturally shows itself. 
 Neuralgias, headaches, affections of the joints, have exhibited this 
 tendency ; sometimes even the neuralgias have, like the gout, been 
 marked by a nocturnal increase in intensity. Thus the characters 
 of the original type are found in its derivatives." 
 
 GENEEAL EEMAEKS ON HEADACHE. 
 
 Headache is a symptom of a great many and very different dis- 
 eased conditions of the hody. 
 
 Strictly speaking there are as many different kinds of headache 
 as there are different diseases that may give rise to headache. As 
 a matter of convenience, however, we only distinguish a few varie- 
 ties of headache, and between these the line is not very closely 
 drawn. Headache may come from actual diseases of the brain of 
 various kinds; in the great majority of cases, however, it is merely 
 symptomatic or reflex — the result of disease in the stomach, in the 
 liver, in the womb or genital organs, or in the general nervous sys- 
 tem, or of a poison in the blood. 
 
AND MOST RECENT METHODS OF TREATMENT. 6i3 
 
 It is one of the most common and most annoying of the nervous 
 maladies of our time. It visits every family, and at one time or 
 another attacks nearly every individual. 
 
 GENERAL TREATMENT OF. HEADACHE. 
 
 1. Treat the cause that produces the congestion, if it can be as- 
 certained. Treat the rheumatism, the dyspepsia, the disease of 
 the liver, or of the womb. Remove the cause, and the result must 
 then disappear. 
 
 2. Give internally bromide of potassium in large doses {ten to 
 forty grains), one, two, or three times a day, as may be necessary. 
 Hemember always in giving this remedy that it may, in very rare 
 cases, produce unpleasant results ; may aggravate the disease, and 
 produce temporary insanity j and that, like iodide of potassium, it 
 often produces eruptions on the shin. 
 
 Bromide of potassium reduces the volume of blood in the head. 
 
 It is difficult, and oftentimes impossible, for patients to distin- 
 guish the congestive horn, the nervous headache. -The distinction is 
 not ordinarily observed by physicians, and only introduced here for 
 convenience of description. 
 
 Sick headache is a form of constitutional neuralgia, at once 
 very frequent, very distressing, and very rebellious to treatment. 
 
 The constitutional character of this affection is proved by its 
 manifestations, its course, its causation, and its hereditary character. 
 Like all the neuroses, it runs in families, and oftentimes skips a 
 generation. 
 
 The nervous diathesis which in the parent appears as epilepsy, 
 may be developed in the child as sick headache, and reappear in 
 the grandchildren as epilepsy again. 
 
 Chorea and hysteria, neuralgia and paralysis, hypochondriasis 
 and insanity, seem thus to be interchangeable and varying manifesta- 
 tions of the nervous constitution. Sick headache is a storm in the 
 system, not unlike the storms that we observe in nature. Like a 
 storm, it comes on with haziness, dulness, heaviness, at once un de- 
 finable and oppressive. Its progress is marked by derangement of 
 all the vital forces — probably by magnetic disturbances analogous 
 to those which occur in nature — by general agony and distress, that 
 render exertion of brain or muscle almost impossible, and existence 
 itself a sorrow. 
 
 Like a storm, also, sick headache seems to relieve the system by 
 driving out the impurities, equalizing the circulation, restoring the 
 
6-±4 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 magnetic equilibrium. Therefore it often leaves the patient brighter 
 and happier than before. When accompanied, as it often is, by 
 vomiting, by abstinence from food, and by rest from all exertion, 
 sick headache appears to be as much a remedial process, and as 
 necessary and beneficial to the system, as a thunder-storm to the 
 atmosphere. Sick headaches also are analogous to storms in their 
 intensity and vehemence, and in the fact that, when in full blast, 
 measures that aim to stay their progress are often futile. 
 
 The aifection is usually accompanied by a sharp or dull pain in 
 the forehead, and especially through the left eye. The general 
 depression that accompanies the attack seems to bear no relation to 
 the severity of the pain, for ordinary neuralgias, even when far 
 more severe, are not half so depressing, and do not interfere to the 
 same extent with the processes of thought. 
 
 It is more than probable that the sympathetic or ganglionic sys- 
 tem is chiefly at fault in sick headache, and by this theory we may 
 explain the fact that it is brought on or aggravated by such diverse 
 causes. The vomiting that is an accompanying symptom some- 
 times relieves the distress, but frequently aggravates it. The com- 
 mon idea that sick headache is the result of the accumulation of 
 bile, or indeed of any local disorder of the digestive apparatus, is 
 mostly erroneous. In the majority of cases, the vomiting is itself 
 the result of the attack of headache, which in its turn is the 
 result of some cause that has acted injuriously on the nervous sys- 
 tem, such as great excitement, anxiety, prolonged abstinence from 
 food, or some undue mental exertion. It is probable that indiges- 
 tion brings on sick headache chiefly through its effects on the ner- 
 vous system. 
 
 TREATMENT OF SICK HEADACHE DURTNG- THE ATTACK. 
 
 I have myself been a frequent sufferer from this disease, and 
 have experimented thoroughly on myself and on others with nearly 
 all of the well-known remedies and systems of treatment. My con- 
 clusion is, that sick headache is much more relievable and curable 
 than is commonly supposed. 
 
 The disease is a very common one. It visits nearly every house- 
 hold. It is, moreover, a disease that patients are usually obliged to 
 treat themselves. 
 
 The plan of treatment which I propose, and which I usually find 
 more or less successful, is as follows : 
 
 1. Begin treatment early, before the disease is at its height. 
 This rule is as important in the treatment of sick headache as in 
 the treatment of a common cold. (See Common Cold.) Commence 
 
AXD MOST EECEXT METHODS OF TREATMENT. 645 
 
 treatment as soon as you suspect that an attack is coming on. Some 
 persons can foretell when they are to have an attack for several hours 
 in advance ; others have very little warning. 
 
 2. Take twenty, thirty, or forty grains of bromide of potassium 
 in half a tumbler of water. If this fails, repeat the dose. This 
 remedy is very efficacious, although it is not a specific. (See Bro- 
 mide of Potassium.) 
 
 3. Take one, two, or three grains of oxalate of cerium dry on the 
 tongue. It is not necessary to be particular about the dose. The 
 finger may be moistened and dipped in the powder once or twice. 
 This remedy, which is very little known, sometimes acts like magic. 
 
 The dose may be repeated a number of times, if necessary. (See 
 Oxalate of Cerium?) 
 
 4:. Hypodermic injections of atropine and morphine. These 
 should only be used as a last resort, at least by those not medically 
 educated. They afford immediate relief. (See Hypodermic Injec- 
 tions.) 
 
 5. Applications of ice to the back of the neck and spine. — Pieces 
 of ice may be folded in a towel and held firmly against the back of 
 the neck and down the spine for ten, fifteen, or twenty minutes. 
 Sometimes this remedy alone will relieve the pain and induce an 
 agreeable slumber. 
 
 By one or by all of these methods sick headache can in almost 
 all cases be relieved or cured. Emetics, purges, alkalies, opium 
 internally, and the other remedies that are so much used for this 
 disease, are so uncertain as well as disagreeable that I cannot recom- 
 mend them. 
 
 Patients are frequently so disappointed by their failures in the 
 use of these remedies, that they become discouraged and try noth- 
 ing whatever. 
 
 During the intervals, we should strengthen the system by avoid- 
 ing -purgative medicines and using tonics and stimulants. 
 
 (For particulars see Nervous Diseases, Treatment of.) 
 
 NERVOUS HEADACHE. 
 
 This variety of headache occurs most frequently in females, more 
 especially in those who are hysterical, and in hypochondriacal per- 
 sons. It may arise from various causes, such as anxiety and trou- 
 ble of mind acting on those who lead a sedentary life ; intemper- 
 ance in eating and drinking; not eating a sufficient quantity of 
 food, or living on diet of bad quality ; excess in venery, long watch- 
 ing, suppression of habitual discharges ; malaria, or the effluvia from 
 
6±Q 
 
 decaying vegetable matter. It may also be caused by a decayed 
 tooth, and sometimes appears to be hereditary. 
 
 Nervous headache generally commences suddenly. It may at- 
 tack one of the eyebrows, the temple, or the orbit ; or one half of 
 the head may be affected. The pain is dull, lancinating, or throb- 
 bing, sometimes exceedingly acute, and aggravated by noise or a 
 strong light. There are no feverish symptoms, nor is the tempera- 
 ture of the head greater than natural. Some patients are restless 
 and irritable ; others are languid, and almost constantly yawning. 
 
 This affection, like ague, is often intermittent, and may come on 
 daily, every other day, once a week, or monthly ; but in the major- 
 ity of cases the attacks recur at irregular intervals. The pain con- 
 tinues three or four hours a day, or even considerably longer ; but 
 in general it goes off during the night. 
 
 TREATMENT OF NERVOUS HEADACHE. 
 
 1. Treat the cause, treat the general nervous debility of which the 
 headache is merely a symptom. Nervous headache, like sick head- 
 ache, with which it is sometimes confounded, and with which it may 
 be associated, is a nervous disease, and should be treated accordingly. 
 The patients who suffer from it are usually more or less debilitated. 
 They need tonics. They should be treated by quinine, pyrophosphate 
 of iron, strychnine, phosphoric acid, arsenic, cod-liver oil, general 
 electrization, plenty of beef and mutton, outdoor air and sunlight, 
 and abundance of sleep. 
 
 2. Eelieve the pain by hypodermic injections, by oxalate of 
 cerium (one, two, or three grains at a dose), or by bromide of potas- 
 sium in doses of twenty or thirty grains. The oxalate of cerium is a 
 remedy that is used far too little for headache. 
 
 GENEEAL EEMAEKS ON DISEASES OF THE HEAET. 
 
 1. There are two classes of diseases of the heart : organic and 
 functional. Organic diseases are those which are connected with 
 actual morbid changes in the heart. Among these we may mention 
 enlargement, dilatation, aneurism, inflammation of the lining mem- 
 brane, inflammation of the covering, disease of the valves, fatty de- 
 generation, angina pectoris or breast-pang. 
 
 Functional disease of the heart is disturbance in its action, 
 caused by sympathy of reflex action. Between these two conditions — 
 functional and organic — there is a very wide gulf. The distinction 
 between these is a distinction between a grave disease and one of a 
 trifling character ; oftentimes a distinction between death and life. 
 
AND MOST RECENT METHODS OF TREATMENT. 647 
 
 And yet the general symptoms of organic and functional dis- 
 ease are oftentimes quite similar. 
 
 Palpitation, uneasiness in the region of the heart, and even 
 difficulty of running and climbing, as well as actual pain in or near 
 the heart — all these unpleasant symptoms are common to both or- 
 ganic and functional diseases of the heart. 
 
 Those who are afflicted with these general symptoms, and who 
 are annoyed and worried by them, ought as soon as possible to have 
 the question definitely settled. Now there is only one way in which 
 this question can be settled ; and that is, by getting the opinion of 
 some sJcilfid and honorable physician, who is practised in the arts 
 of auscultation and percussion, or what is commonly known as 
 " sounding the chest." (See Auscultation and Percussion?) 
 
 The most skilful physicians in the world cannot tell whether 
 a patient is suffering from organic or function al disease by the 
 patient's story alone. The last appeal must always be to ausculta- 
 tion and percussion. The sphygmograph also helps to study dis- 
 eases of the heart. (See Sphygmograph?) 
 
 Some persons fear to consult a physician lest he may tell them 
 unwelcome truths. This feeling is unmanly. The true way is to 
 look our difficulties squarely in the face. Anything is preferable 
 to suspense. Better to know our danger, and to face it. The man 
 who knows that he has some incurable organic disease of the heart 
 is usually much happier than he who fears and suspects he may 
 have, yet dares not consult a physician and have his doubts solved. 
 
 But as a matter of fact, the great majority of those who fear or 
 suspect that they have organic disease are really suffering only 
 from sympathetic or functional disturbances, coming from dyspep- 
 sia, anaemia, or general nervous debility. There are thousands in our 
 country who go all their lives fearing lest they may die at any 
 moment from some imagined disease of the heart, who, if they con- 
 sulted some good physician, would find out that really their symp- 
 toms meant nothing more than dyspepsia or general debility. 
 
 On this subject the following remarks of Prof. Austin Flint are . 
 worthy of attentive consideration : 
 
 " It is extremely desirable, in view of the comfort and welfare 
 of the patient, to determine with positiveness, in cases of functional 
 disorder, that structural lesions do not exist. Several points con- 
 nected with the history and symptoms have a bearing on the diag- 
 nosis. The occurrence of the disturbance in paroxysms, the action 
 at other times being regular; the paroxysms occurring at night 
 rather than in the daytime, and frequently not being occasioned by 
 an} r obvious cause, such as muscular exertion or mental excitement ; 
 
648 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 the ability of the patient to take active exercise without palpitation, 
 or difficulty of breathing when not suffering from the disorder, and 
 the intensity of mental anxiety and apprehension, are points which 
 render it probable that the difficulty is purely functional. These 
 points, however, are not conclusive. A positive diagnosis is to be 
 based on the exclusion of lesions of structure, by the absence of 
 the physical signs of the latter. If, on a careful examination of the 
 chest, the heart be not found to be enlarged ; if there be no mur- 
 mur present, or if an existing murmur be inorganic, and the heart- 
 sounds be normal, the affection may be confidently pronounced 
 functional. Without the negative proof afforded by physical explo- 
 ration, the mind of the practitioner must be in doubt as to the 
 diagnosis. If he give a deckled opinion, it is a guess which may 
 prove to be either right or wrong. If he avoid giving a decided 
 opinion, the inference which the patient usually draws is that or- 
 ganic disease exists, and the physician is reluctant to tell him the 
 truth. I could cite from the cases which have come under my ob- 
 servation not a few in which patients were for many years rendered 
 unhappy, and deterred from engaging in the active duties of life, 
 by either an erroneous medical opinion that they had organic disease 
 of heart, or by a fixed belief that such was the fact, based on the 
 indecision of their physicians." 
 
 Organic diseases, even, are not always such terrible maladies as 
 many suppose. They are not always speedily fatal. They are not 
 always fatal at all. A patient with organic disease of the heart 
 may live for years, and yet finally die of some other disease. 
 
 TREATMENT OF ORGANIC DISEASES OF HEART. 
 
 Tonics, quiet, easy activity, nourishing food, abstinence from 
 excitement, and from all sudden, violent, spasmodic exertion of 
 mind or body — this is about all that we can do. 
 
 Other medicine, except that which is given for the relief of pain, 
 is valueless. 
 
 Acute inflammation around the heart (pericarditis) and within 
 the heart (endocarditis), occurring in rheumatic fever, are to be 
 treated by the remedies that are given for rheumatism. (See Ilheio- 
 matism.) 
 
 INFLAMMATION OF THE HEART. 
 
 In very many cases inflammation of the heart is not attended 
 w r ith positive symptoms, but we may suspect its existence if the 
 patient, after having suffered under rheumatic fever, complains 
 of a load or fulness about the heart, with dull pain, restlessness, 
 anxiety, and occasional palpitation. 
 
AND MOST RECENT METHODS OF TREATMENT. 649 
 
 NERVOUS DISEASE OF THE HEART. 
 
 The heart is very subject to disturbance of its action, not de- 
 pending on organic disease, but on certain impressions conveyed to 
 it from distant parts through the nervous system. The only symp- 
 tom of this nervous disturbance to which we need allude is palpi- 
 tation. It is of great importance to distinguish nervous palpita- 
 tions of the heart from palpitations which depend on derangements 
 of the heart's structure {organic) ; because the former, although they 
 excite considerable anxiety and alarm in the patient's mind, are 
 completely under the control of medical treatment. Nervous pal- 
 pitation may be distinguished from organic palpitation by the fol- 
 lowing circumstances. Nervous palpitation is apt to come on more 
 particularly when the patient is lying awake in bed, at the begin- 
 ning of the night. It is not rendered worse by moderate exercise, 
 but is rather relieved by it ; whereas organic palpitation is neces- 
 sarily increased by any corporeal exertion, however slight. Nervous 
 palpitation is often accompanied by other nervous symptoms, and 
 whenever the latter are increased the palpitation becomes increased 
 with them. Finally, in nervous palpitation there is generally some 
 intermission — that is to say, the patient is free from it at certain 
 times, during which the pulse and heart beat quite naturally ; while 
 in organic palpitation there is hardly ever any cessation of this 
 distressing symptom, because the diseased structure upon which it 
 depends is constantly irritating the heart, and compelling it to act 
 with violence. 
 
 Nervous palpitation commonly occurs in men of nervous tem- 
 perament, who have been rendered more irritable by the too free 
 use of ardent spirits, by excessive venery, long study, or the depress- 
 ing passions. It often attacks persons who are much addicted to 
 smoking tobacco, or have frequently suffered from indigestion. In 
 women this affection generally depends on green-sickness {chlorosis), 
 or hysteria : it may also be connected with excessive loss of blood. 
 
 Treatment. — As nervous palpitation is merely a symptom of 
 some other disorder, its treatment must be subordinate to that of 
 the disease upon which it depends ; to prevent repetition, therefore, 
 I would refer my readers to the articles on dyspepsia, green-sick- 
 ness, hysterics, and nervous disorders, &c. The first point in the 
 treatment will naturally be to remove, if possible, the cause of the 
 symptom. Excesses of all kinds must be avoided; the patient 
 should take gentle exercise in the open air, and regulate his diet 
 with attention. When the palpitation seems to depend on a very 
 irritable and nervous temperament, change of air, sea-bathing, and 
 
650 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 the enjoyment of rational amusements will have much effect in 
 quieting the heart's action ; after which a course of mineral waters 
 may be tried with advantage. When the palpitation is very dis- 
 tressing at night, it may be necessary to give some medicine which 
 will quiet the patient, and afford him relief until the other remedies 
 that we are employing have time to produce some effect. (See 
 Nervous Diseases.) 
 
 HEARTBURN, OR WATER-BRASH. 
 
 Heartburn, though not attended with danger, is often very diffi- 
 cult of cure. It occurs most frequently among poor people, is sel- 
 dom met w T ith before the age of puberty, and not often in old peo- 
 ple. Females are more subject to it than males, and some women 
 suffer from it only during pregnancy. It is often caused by eating 
 fat or oily substances, cheese, or some particular article of food 
 which disagrees with the stomach, and in general is merely a symp- 
 tom of indigestion. It may arise from exposure to cold, sitting 
 with wet feet, or from any sudden mental emotion ; and in some 
 individuals it cannot be traced to any cause. 
 
 The symptoms are a burning sensation, attended with a feeling 
 of constriction at the stomach, which, after continuing some time, 
 is followed by frequent belching of a thin fluid, sometimes exceed- 
 ingly sour, at other times insipid. The attack may come on at any 
 period of the day, and may continue during several hours. In some 
 people it comes on daily for weeks or months ; in others it occurs 
 only occasionally, in consequence of indulging in some article of 
 diet difficult of digestion. Heartburn sometimes accompanies or- 
 ganic disease of the stomach or liver. 
 
 Treatment. — When heartburn comes on only occasionally, it 
 may be relieved by means of a teaspoonful of carbonate of soda, or 
 the same quantity of magnesia, taken in a little water ; but w T hen 
 it recurs frequently and becomes very troublesome, more active 
 treatment should be resorted to. In some cases, however, it is pro- 
 tracted through a period of many months, uninfluenced by any 
 medical treatment w r hich may be adopted. 
 
 Water-brash is one of the symptoms of dyspepsia. In order to 
 treat it successfully we must treat the dyspepsia that causes it. 
 (See Dyspepsia.) 
 
 As a means of temporary relief when the attack comes on, we 
 may use creasote (one or two drops in water, well shaken), or oxalate 
 of cerium (one, two, or three grains dry on the tongue), or by sid- 
 
AND MOST KECENT METHODS OE TREATMENT. 651 
 
 jphite of soda or subnitrate of bismuth. Some one of these four 
 remedies will usually afford relief. 
 
 HECTIC FEYEE. 
 
 In this species of fever the patient is attacked daily, between 
 five and six o'clock in the afternoon, with rigors or shivering, which 
 continues from a quarter of an hour to an hour, and is followed by 
 quick pulse, hot skin, thirst, and restlessness. Delirium is not a 
 symptom of this affection, and headache only occasionally occurs. 
 Profuse sweating breaks out about ten or eleven o'clock, which re- 
 lieves the patient, who then falls asleep, and on awaking, about five 
 or six in the morning, finds himself bathed in perspiration. There 
 is also another attack about noon, which is slight, and sometimes 
 not attended with shivering. Indeed, hectic fever, when it has 
 continued for some time and is completely formed, never ceases 
 entirely, inasmuch as the pulse beats at least ten strokes in a minute 
 more than it would do in a state of health ; and in this respect dif- 
 fers from ague, in which there is a complete intermission. 
 
 The pulse is always quick, varying from a hundred to a hun- 
 dred and twenty, and sometimes it reaches a hundred and forty. 
 " Almost from the first appearance of the hectic, the urine is high- 
 colored, and deposits a copious branny red sediment, which hardly 
 ever falls close to the bottom of the vessel." The appetite is at 
 first very little or not at all impaired, but gradually gives way as 
 the patient's strength diminishes ; the tongue is red and clean ; the 
 face is pale in the morning, but towards evening, when the fever- 
 ish symptoms commence, a circumscribed redness appears on the 
 cheeks, called hectic flush ; and the white of the eyes has a delicate 
 pearly tint. 
 
 The patient becomes weak and emaciated, the cheeks are hol- 
 low and sunken ; the face is long and thin, and the eyes appear 
 sunk in their orbits. Purging comes on at last ; and this, with the 
 excessive perspiration during the night, rapidly reduces the patient's 
 strength, and he dies completely exhausted. (See Pulmonary Con- 
 sumption.) 
 
 Hectic fever may arise from irritation or slow inflammation of 
 any part or structure of the body, associated with debility, or, as it 
 is sometimes termed, a broken-down constitution ; or it may be 
 caused by the fluids of the body becoming corrupted in consequence 
 of the- absorption of morbid matter (pus). 
 
 Treatment. — Hectic fever being generally, if not invariably, 
 symptomatic of some other disorder, the means of cure must, of 
 
652 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 course, have direct reference to the morbid state of the organ or 
 part with which the fever is associated. I must therefore refer the 
 reader to treatment directed for the diseases on which it depends. 
 
 HEMLOCK. 
 
 This is a well-known indigenous plant, found growing in 
 ditches, on the banks of rivers, and in waste places. It flowers in 
 July and early in August, and is distinguished from plants which 
 resemble it in appearance by the spotted stem. 
 
 The extract of hemlock, taken in moderate doses, acts on the 
 system in a similar manner to henbane and aconite ; and, like those 
 remedies, is also narcotic and sedative, without producing any sti- 
 mulant effect. 
 
 The diseases in which it is principally employed are cancer, 
 syphilis, scrofula, rheumatism, and inflammatory or spasmodic 
 affections of the urinary organs. It has also an excellent effect in 
 allaying the cough at the commencement of pulmonary consump- 
 tion. 
 
 HENBANE. (Hyosciamus.) 
 
 All parts of this plant are poisonous, and accidents have fre- 
 quently occurred from mistaking its root for that of parsnip, to 
 which it has a strong resemblance. 
 
 Great advantage is to be derived from it, as a narcotic, in can- 
 cer and other painful disorders. Its value as a narcotic is now 
 well established, and next to opium it is considered the most useful 
 remedy of this class. Indeed, in many cases it has a great advan- 
 tage over opium, inasmuch as it possesses no stimulating principle ; 
 or, in other words, is directly sedative and narcotic. Hence in all 
 inflammatory affections, where it is found necessary to administer 
 an anodyne or soporific, this remedy will have the effect of tranquil- 
 lizing the patient, without producing the least excitement ; whereas 
 opium, on the contrary, from its stimulating action, would tend to 
 increase the restlessness and aggravate the inflammation. Hen- 
 bane has also the advantage of being divested of the constipating 
 property which opium possesses, and has a tendency rather to open 
 the bowels than otherwise. It seldom produces headache, which 
 opium very frequently does. 
 
 We have already had occasion to mention the benefit to be 
 derived from this remedy in relieving indigestion arising from irri- 
 tability or functional derangement of the stomach. 
 
AND MOST RECENT METHODS OF TREATMENT. 653 
 
 A poultice made with the fresh leaves of henbane, or a watery 
 solution of the extract, is often very serviceable in allaying the pain 
 of irritable ulcers, or of scrofulous and cancerous sores. 
 
 The dose of the extract, in chronic disorders, should not be less 
 at first than two grains three times a day, which may be gradually 
 increased to five or six grains. When intended as a soporific in 
 acute affections, the dose may be from five to ten graius at bed- 
 time. The dose of the tincture is from twenty drops to a drachm. 
 The effects of an over-dose of henbane are similar to those produced 
 by aconite. It ought to be remarked that the extracts of. henbane, 
 aconite, and hemlock, commonly found in the shops, are often 
 iuert, and may be taken in almost any quantity; hence many prac- 
 titioners prefer the tinctures of these plants, as preparations more 
 to be depended upon. 
 
 HICCUP. 
 
 This affection usually arises from eating a too full meal or 
 highly-seasoned food, drinking cold fluids, wind, acidity, and similar 
 causes, particularly when the stomach is predisposed to it from de- 
 bility. When arising from simple causes of this description, it is 
 of little consequence, and seldom continues long; but when it 
 comes on in a far advanced stage of fevers and internal inflamma- 
 tory diseases, a fatal termination may soon be expected. 
 
 Treatment. —In ordinary cases hiccup ceases of its own accord, 
 or may easily be checked by drinking a little cold water ; by a sud- 
 den excitement of some degree of surprise, fear, or any other strong 
 mental emotion ; by swallowing a small quantity of vinegar, lemon- 
 juice, or any other strong acid ; and when it occurs after a full meal, 
 everybody knows that a little brandy generally puts a stop to it. 
 
 When hiccup is symptomatic, the treatment must depend en- 
 tirely on the nature of the disease under which the patient is 
 laboring. 
 
 Opium, henbane, and similar narcotic medicines are generally 
 administered to palliate the distressing hiccup which so frequently 
 comes on when fevers and inflammatory diseases are about to ter- 
 minate fatally. 
 
 HIP-DISEASE. 
 
 This terrible and familiar malady, which I need not here de- 
 scribe, is now treated much more successfully than formerly. The 
 principle of treatment, as originally proposed by Dr. H. G. Davis, 
 
654 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 is by extension of the limb, thus relieving the pressure in the joint. 
 Apparatus has been devised to carry out this principle most suc- 
 cessfully. The treatment requires time, patience, and skill on the 
 part both of the physician and of the friends of the patient. 
 
 In connection with this mechanical treatment, physicians also 
 use internal tonics and nourishing food. 
 
 HOFFMAN'S ANODYNE. 
 
 This remedy is now much used. It consists of ether, alcohol, 
 and ethereal oil. It is used in hysteria, and in nervousness gene- 
 rally. It has a calming influence in sleeplessness. It is therefore 
 often used in fevers. The dose is one or two teaspoonfuls. 
 
 HOOPING-COUGH OE CHIN-COUGH. 
 
 This disease sometimes attacks children suddenly, and without 
 giving any warning ; but it generally happens that the child suffers 
 under common cough for a week or two before the convulsive fits 
 of coughing begin to show themselves. The first circumstance 
 noticed about the child is, that the fit of coughing is more protracted 
 than it was wont to be; there is a kind of hitch in the cough, which 
 is peculiar, and this soon passes into the regular fit of hooping- 
 cough. The fits of coughing succeed each other more or less rapidly, 
 and are continued for a longer or shorter time, according to the 
 severity of the disease, until they terminate in vomiting, or the 
 spitting up of a thick frothy mucus from the lungs. When the 
 convulsive efforts during a fit of hooping-cough are mild, the child 
 suffers but little from the attack, and soon returns to his ordinary 
 amusements ; but if the fit be severe, the blood is often driven to 
 the head with such violence that it rushes from the nose or ears, or 
 renders the eyes completely blood-shot, from rupture of small ves- 
 sels in the white of the eye ; these circumstances should not cause 
 alarm, for they are not attended with any immediate danger. The 
 number of fits is extremely variable in different cases : sometimes 
 the child will have only three or four during the day ; at other 
 times they come on as often as every quarter of an hour, and are 
 particularly annoying during the night. The convulsive coughing 
 may last for three or four weeks, or even longer, when it begins to 
 decline ; the fit gets less violent ; the mucus is spit up from the 
 lungs in greater quantity, and the disease gradually wears itself 
 out in five or six weeks. 
 
 Such is whooping-cough in its simple and mild form ; but in many 
 cases the disease, either from its violence or from certain tenden- 
 
AND MOST RECENT METHODS OF TREATMENT. 655 
 
 cies of the patient to disease of the head or chest, becomes attended 
 with very great danger to life. The danger is, in general, propor- 
 tioned to the tender age of the infant, its constitutional powers, and 
 the organ which may be attacked during the course of hooping- 
 cough. Thus infants are more liable to be cut off by this disease 
 than children ; weakly children run greater risks than those who 
 are strong ; and much greater danger is to be apprehended when 
 the head is attacked than when the lungs only become involved in 
 the consequences of the disease. 
 
 TREATMENT OF HOOPING-COUGH. 
 
 1. Tonics to sustain and strengthen the system. — "We may give 
 the child pyrophosphate of iron, in combination with quinine and 
 strychnine (Wyeth's, or some similar preparation), or cod-liver oil, 
 with nourishing food. (See article on Food.) 
 
 2. Expectorants and other remedies to relieve the distress and 
 coughing. The profession at the present time have very little faith 
 in the so-called expectorant remedies, yet they are sometimes useful. 
 We may give any of the simple "cough mixtures." There is much 
 less difference between them than is commonly supposed. Thus, 
 
 Syrup of ipecac, 
 
 Syrup of squills, equal parts, in teaspoonful doses, 
 
 have been given. Recently hromide of ammonium has been used 
 for hooping-cough, in doses of from 3 to 10 grains. 
 
 The patient should only be kept in the house during the first 
 few days. 
 
 It should ever be remembered that the disease is contagious. 
 
 HOPE'S MIXTURE. 
 
 The prescription for this familiar remedy is as follows : 
 
 Nitric acid, one drachm, 
 Laudanum, forty drops, 
 Camphor water, eight ounces. 
 The dose is a tablespoonful. 
 
 This remedy is much used in dysentery and diarrhoea. 
 
 HORSE-RADISH. 
 
 This root is familiar to every household. It is used in scurvy 
 with some success. It has been used in dropsy as a diuretic. It is 
 sometimes applied to the soles of the feet, mixed with mustard, as 
 a revulsive. The juice mixed with vinegar has been recommended 
 to remove freckles and tan. 
 
656 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 The close when given internally is from half a teaspoonful to 
 two, three, or four teaspoonfuls. When used as a diuretic it is given 
 in the form of an infusion, with mustard seed. Of this infusion the 
 dose is two fluid ounces. 
 
 Hydropathy. (See Water Cure.) 
 
 HYDKOPHOBIA. 
 
 Hydrophobia arises from a morbid poison introduced into the 
 system by the bite of a rabid animal. The animals that most fre- 
 quently communicate this disease are the dog, cat, fox, and wolf; 
 but whether it originates spontaneously in those animals, or is 
 always transmitted from one to another, is unknown. Hydrophobia 
 is always communicated through the medium of the saliva ; but it 
 does not appear that this is capable of producing the disease with- 
 out a wound having been inflicted, or the skin abraded. Some 
 cases, however, are on record which would lead us to believe that 
 the poison may find its way into the system through the mucous 
 membrane of the lips, without abrasion of surface. The great 
 majority of people bitten by mad dogs are not attacked by hydro- 
 phobia ; indeed, Dr. Hamilton is of opinion that at an average not 
 more than one person out of ten of those titten becomes affected 
 with the disease, and this may be in a great measure accounted for 
 by the saliva being wiped from the teeth in passing through the 
 clothes ; hence the disease occurs most frequently from wounds in- 
 flicted on the face and hands. 
 
 The length of time which may elapse from the date of the bite 
 of a rabid animal to the commencement of hydrophobia is very un- 
 certain, but in general it declares itself after thirty or forty days; 
 though the poison has been known to remain in the system in a 
 latent state during eighteen months, and even longer. The bitten 
 part heals in the course of a few days, like any other simple wound ; 
 but when the disease commences the cicatrix or scar becomes pain- 
 ful, red or livid, and swollen ; in some cases it re-opens and dis- 
 charges a thin, reddish-colored fluid. This, however, is not always 
 the case; symptoms of hydrophobia may commence without the 
 part presenting the slightest change in appearance, or being in the 
 least degree painful. The disease is ushered in by slight shivering, 
 headache, general uneasiness, and loss of appetite ; by the sleep 
 being disturbed by frightful dreams, and by extreme restlessness, 
 agitation, and other symptoms of an excited or altered state of the 
 nervous system ; at length the patient accidentally discovers that 
 the sight of water or any shining substance distresses him, and on 
 
AXD MOST EECEXT METHODS OF TEEATMEXT. 657 
 
 attempting to drink he is suddenly seized with a general and in- 
 voluntary shivering. The circumstance of the bite is now brought 
 to his recollection, associated with the idea of hydrophobia, which 
 strikes him with horror ; a distressing sensation of heat and constric- 
 tion at the throat is soon experienced, attended with urgent thirst ; 
 he appears exceedingly anxious and alarmed; the throat is fre- 
 quently seized with violent spasms threatening immediate suffoca- 
 tion, and the whole body is agitated. The spasms, after some time, 
 extend to other parts of the body, and the fits become more violent 
 and occur more frequently. The saliva increases in quantity, 
 becomes viscid, and is sometimes suddenly thrown out from the 
 mouth. Thick mucus also collects in the throat and air-passages, 
 and in attempting to bring it up harsh sounds are uttered, which 
 have been supposed to resemble the peculiar growling of a dog in a 
 similar state. The breathing is oppressed from slight causes, such 
 as the motion of the air caused by opening a door ; the slightest 
 noise, and the sight or even the sound of water greatly increase the 
 suffering. The miserable patient, however, cannot refrain from 
 attempting to quench the urgent thirst which continually torments 
 him ; he musters resolution, and with a determined effort raises the 
 water suddenly to his mouth ; but before he can drink, is seized with 
 a violent spasmodic fit, and the vessel is dashed from his lips ; thus, 
 like another Tantalus, with the water within his reach, he is doomed 
 to suffer from the most intolerable thirst. 
 
 Feverish symptoms are always present from the time that the 
 disease is fairly constituted ; and frequent bilious vomiting, with 
 much difficulty of breathing, adds greatly to the patient's distress ; 
 the feeling of debility, also, which has been complained of from the 
 commencement, is much increased towards the termination of the 
 disease. Delirium seldom occurs, but there is great irritability both 
 of body and mind ; while anxiety, distress, and occasionally fury 
 are strongly depicted in the countenance. Sometimes, when in a 
 fit of passion, the patient will even attempt to bite or spit at those 
 near him, but he appears to be perfectly conscious of what he has 
 done, and as soon as the paroxysm is over is ready to apologize for 
 his conduct. In some cases though the pulse is very quick, yet the 
 skin remains cool; and though blood has frequently been drawn 
 from the arm, it has not in any case presented the buff-colored crust 
 indicative of inflammation. 
 
 The unfortunate sufferer is at last either carried off by a convul- 
 sive fit, or is worn out by repeated paroxysms, and sinks completely 
 exhausted. The duration of the disease varies from thirty hours to 
 five or six days. The average period is two daya 
 42 
 
65S DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 Treatment.— The real nature of hydrophobia is totally unknown, 
 and we are equally ignorant of any method of treatment from which 
 the least chance of success might be expected. Blood-letting, mer- 
 cury, tartar- emetic, opium, arsenic, ammonia, tobacco, and a variety 
 of other means, have been tried in vain ; in fact, there is not a well- 
 authenticated case on record of any one having recovered from this 
 disease. 
 
 Opium, in large doses, is the only remedy that has been found 
 to produce any very decided effect in alleviating the terrible suffer- 
 ing which the miserable patient is destined to undergo. 
 
 Various plans have been adopted to prevent the saliva of a rabid 
 animal from acting on the system, but the one on which the great- 
 est reliance ought to be placed is to cut out the bitten part as soon 
 as possible after the injury has been inflicted ; this, though a harsh 
 means, is the most effectual hitherto tried ; but in order to insure 
 success the operation must be effectually performed by the removal 
 of every part which the dog's teeth may have touched. If any delay 
 be likely to occur before the part can be removed, the individual 
 should suck the saliva from the wound (if it has been inflicted on 
 a part which renders this step practicable), and then immediately 
 spit oul the fluid he has withdrawn and carefully wash his mouth. 
 This simple method of preventing the absorption of the morbid saliva 
 naturally occurs to every one ; a mother never hesitates to put it in 
 practice when her child is the sufferer, and many lives have been 
 saved in consequence. We do not believe that any risk is incurred 
 from adopting this measure, provided the mouth be repeatedly and 
 carefully washed ; and the best thing for this purpose is a saturated 
 solution of alum / or salt and water may be used if alum be not 
 at hand. The wound should also be well washed with the solution 
 of alum, which may have the effect of preventing the poisonous saliva 
 from contaminating the system, since we know that it possesses the 
 property of destroying all morbid animal secretions. 
 
 Another simple mode of removing the poisonous saliva, is by 
 cupping, by means of a common wine-glass. This is a very easy pro- 
 cess ; in order to exhaust the air, a piece of paper, moistened with 
 spirit, and then lighted, is to be put into the glass, which is to be 
 immediately applied over the part. These means, however, are not 
 intended to exclude the use of the knife or burning the part with 
 caustic, and therefore surgical assistance should be procured as soon 
 as possible. 
 
 As we cannot cure the unfortunate hydrophobic patient, we 
 should do the next best thing, and relieve his horrible agonies. 
 
 This we can do — 
 
AND MOST RECENT METHODS OF TREATMENT. 659 
 
 1. By inhalations of aether or chloroform. 
 
 2. By hypodermic injections of morphine or atropine (see Hypo- 
 dermic Injections), or by large doses of opium internally. 
 
 In concluding this subject it may not be considered unnecessary 
 to give a short description of the appearance which a dog presents 
 when in a rabid state. He at first appears dull and sullen, avoids 
 the light, prefers solitude, and has an aversion to food ; he snarls at 
 the sight of a stranger, and may endeavor to bite him. He recog- 
 nizes his master, and fawns as usual on those whom he knows, but 
 is peevish, irritable, and apt to snap or bite suddenly without any 
 provocation. After two or three days, if not confined, he quits his 
 master's house, and runs along panting, with the tongue hanging 
 from his "mouth. His ears and tail droop, he appears much dejec- 
 ted, and his eyes are red and watery. He stops occasionally and 
 gnaws at stones, bits of wood, etc., and attempts to bite every person 
 he meets, but does not go out of his way to attack any one. He 
 does not bark, but makes a peculiar growling noise, almost amount- 
 ing to howling. Foam appears at his mouth, he is seized from time 
 to time with sudden fits of fury, and bites every animal within his 
 reach, particularly his own species. Two or three days after leaving 
 home he is observed to be palsied behind, and to carry his head 
 near to the ground ; he becomes at last completely exhausted, and 
 dies. 
 
 (For cut representing a mad dog, see Poisonous Bites.) 
 Hydrophobia is not peculiar to any country. It is found in 
 Europe, America, aud Asia. It is found in all climates — amid the 
 cold of the north and the heat of the tropics. It prevails at all 
 seasons of the year. The popular idea that it is more frequent in 
 the heat of summer and in dog-days, is erroneous. It has been 
 shown that it occurs with nearly equal frequency in winter, spring, 
 summer, and autumn. 
 
 HYPOCHONDKIA, YAPORS, OE LOW SPIEITS. 
 
 A person affected with this singular disorder is said to be hipped. 
 It presents itself under such a variety of forms, and the symptoms 
 vary so much in different individuals, that many pages might be 
 filled in attempting to describe it. The opinions of physicians also 
 differ widely with regard to the source and true nature of hypo- 
 chondria. 
 
 A hypochondriacal patient often says that he is tired of 
 life, and wishes that death would come to relieve him from his 
 
660 DESCRIPTION OF THE PRINCIPAL DISEASES," 
 
 suffering ; and yet his conduct shows how very desirous he is of 
 living, and how much he dreads death. He consults every medi- 
 cal man of his neighborhood, and is perhaps in communication with 
 several of them at the same time ; but not believing that they pay 
 sufficient attention to the Protean forms which his disorder assumes, 
 he never follows out the treatment prescribed by any of them. He 
 reads every medical book which comes in his way, and leaves no 
 description of fashionable quackery untried. He has recourse to 
 animal magnetism, and as long as he is impressed with the idea 
 that it will be the means of cure, he fancies that it does him good ; 
 but getting tired of this, he consults a variety of schools, and suc- 
 cessively abandons them. A variety of empiric remedies are 
 resorted to ; but, instead of finding a specific for his numerous 
 ailments, his digestive organs become materially affected from 
 the quantity of medicine he has taken. The healthy appearance 
 which he has probably hitherto retained now begins to leave him, 
 and the consequences might soon be of a serious nature, unless he 
 sees the necessity of following the advice of the celebrated Ital- 
 ian physician Baglivi. " Although at first sight," he says, " hy- 
 pochondriasis may appear a destructive and incurable disease, yet 
 the patients may generally be very easily cured, not by taking great 
 quantities of medicine, but by the cheerful discourse of friends, the 
 innocent pleasures of a country life, frequent exercise on horseback, 
 and by following the mode of living pointed out by a wise physi- 
 cian." 
 
 TREATMENT OF HYPOCHONDRIA. 
 
 Concerning hypochondria, these facts are worthy of considera- 
 tion : 
 
 1. It is probably a symptom of some disorder of the central 
 nervous system or of the sympathetic nerve. It is frequently the 
 premonition of actual insanity. 
 
 2. It may be brought on by any cause that injures the nervous 
 system. 
 
 The persons most subject to this disease are those who, after 
 vjorJcing and worrying with their drains too hard and too long in 
 the pursuit of wealth, suddenly retire and do nothing. 
 
 3. It is really a disease — is to be treated as a disease, and is as 
 curable and as relievable as the majority of nervous diseases. 
 
 (For treatment see Treatment of Nervous Diseases.) 
 The disease is undoubtedly increasing in frequency. 
 
AND MOST RECENT METHODS OF TREATMENT. 661 
 
 HYPODERMIC OK SUBCUTANEOUS INJECTIONS. 
 
 The accompanying cut represents a syringe that is now much 
 used for the purpose of injecting remedies beneath the skin. This 
 method of treating neuralgia and a number of other diseases is be- 
 coming very popular with the profession. 
 
 When morphine and atropine are thus injected beneath the skin, 
 pain is usually relieved almost instantly. 
 
 There is no remedy to be compared with this for the temporary 
 relief of pain. When frequently repeated, its effects are sometimes 
 permanent. 
 
 Fatal accidents have sometimes happened from the use of hypo- 
 dermic injections, but when cautiously and skilfully used they are 
 harmless. As a general rule they should be employed only by 
 physicians, but nurses and those who are not physicians can be in- 
 structed in the use of them in cases when the physician cannot 
 remain in constant attendance. Sea captains should understand 
 the use of the hypodermic syringe. The syringes that are mostly 
 used are of glass and hold about half a fluid drachm, and are gradu- 
 ated for drops. -"In operating, draw the skin tense with the fore- 
 finger and thumb of the left hand, and pass the point of the tube 
 quickly and steadily through it. Then push in, not rapidly, the 
 desired amount of the fluid." Avoid the veins. One of the best 
 places for injection is the upper and outer surface of the arm. 
 
 Great caution should be used not to inject too large a quantity. 
 
 On the advantages of this method of using medicines, Dr. C. E. 
 Brown-Sequard thus remarks : 
 
 " This method of administering remedies, which is now very ex- 
 tensively used, has very great advantages over most of the other 
 methods. I will only point out a few of these advantages. 1. 
 Rapidity of effect. 2. Certainty that the remedy will not run the 
 risk of being decomposed by food, secretions, or faeces, as may be 
 the case in the digestive tube. 3. Possibility of introducing safely 
 into the circulatory system a much larger dose than by other methods. 
 This last advantage is the principal one in the use of the hypoder- 
 mic method against neuralgia. This explains how neuralgic patients 
 who had taken apparently large doses of narcotics by the mouth, 
 with no permanent and even no temporary marked benefit, are 
 sometimes completely cured by one or by a few hypodermic injec- 
 tions of narcotics." Although narcotics have been chiefly used 
 hypodermically, yet other remedies, such as strychnine, quinine, 
 have been used in the same way. 
 
662 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 DOSES OF MEDICINES FOR HYPODERMIC INJECTIONS. 
 
 Sulphate of morphia, one eighth to one quarter of a grain. 
 Sulphate of atropia, one hundredth to one fiftieth of a grain. 
 
 HYPODERMIC SYRINGE. 
 
 HYPODERMIC INJECTION. 
 
 As a rule, about one third the ordinary dose of any medicine 
 is used for hypodermic purposes. Morphine and atropine may be 
 combined. 
 
 HYSTEEICS. 
 
 Hysteria ha3 in many respects a close resemblance to epilepsy, 
 and is supposed by some physicians to be a species of that disease. 
 Several well-marked symptoms, however, distinguish these disorders 
 from each other. In hysteria the face is not nearly so much dis- 
 torted, nor does it ever acquire a livid color, as in epilepsy ; and in 
 the former affection the patient generally hears what is said to her 
 
AND MOST RECENT METHODS OF TREATMENT. ' 663 
 
 and seldom becomes entirely insensible ; froth does not appear at the 
 month, there is no grinding of the teeth, nor is the tongue ever in- 
 jured ; the breathing is not stertorous or snoring, and the hands 
 remain open. 
 
 A paroxysm or fit of hysteria is generally announced by head- 
 ache, restlessness, cramps, coldness of the feet, yawning, and some- 
 times by immoderate fits of laughing, or crying and laughter alter- 
 nately. The patient experiences a peculiar sensation, as if a ball 
 were moving about with a rumbling noise in the belly. This, after 
 some time rises, to the stomach, and thence to the throat, where it 
 fixes itself, causing a most intolerable feeling of choking or strangu- 
 lation. The breathing now becomes hurried, the heart palpitates ; 
 giddiness, sickness at stomach, and dimness of sight follow. The 
 patient then falls down, seized with convulsions ; she screams, per- 
 haps tears her hair, and beats her breast ; her body is writhed to and 
 fro, and the limbs assume a variety of postures. The convulsive 
 movements are not constant ; a succession of fits take place, with 
 longer or shorter intervals between them. Sometimes the urine is 
 discharged involuntarily ; and during the absence of the convulsions 
 the patient laughs wildly, cries or screams ; and sometimes a dis- 
 tressing hiccup comes on. The abdominal muscles may be irregu- 
 larly contracted, or the belly may be drawn inwards towards the 
 spine, or is tense, and distended with air ; the veins of the neck are 
 greatly distended, and the carotid arteries beat with unusual vio- 
 lence. In delicate females the face is pale and flushed alternately ; 
 in the more robust it is flushed, and appears fuller than usual. The 
 patient having remained in this state during a longer or shorter- 
 period, often for twenty-four hours, and sometimes considerably 
 longer, at length begins to recover gradually. The spasms abate ; 
 wind is freely discharged from the stomach ; there is frequent sigh- 
 ing or sobbing ; she complains of severe headache, with a feeling of 
 soreness over the whole body and limbs, and lies in a languid and 
 listless state for some time before she is able to rise. The recovery 
 in some cases is sudden, and accompanied with a loud fit of laugh- 
 ing or immoderate crying ; and there is often a copious discharge 
 of pale urine. 
 
 This disease imitates so many others, and assumes such a variety 
 of symptoms, that a concise description fails in conveying an ade- 
 quate idea of it ; but we do not see any necessity for giving a min- 
 ute account of all its various forms and relations, because, however 
 formidable in appearance, it is never attended with danger. 
 
 A point, however, of considerable importance with regard to 
 hysteria is the difficulty of distinguishing it from other diseases; 
 
664: DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 indeed, it lias such a near resemblance in many respects to hypo- 
 chondria in males, that medical men are often embarrassed by the 
 variety of symptoms which occur in hysterical females ; and in 
 many cases considerable experience and judgment are required in 
 order to be able to discriminate between functional or even organic 
 disorders, and the endless variety of forms which this affection pre- 
 sents. An hysterical female sometimes complains of great pain and 
 tenderness of the belly, and even screams if it be touched ; she may 
 have headache at the same time, and remain in bed during several 
 days ; but the pulse continues tranquil, and the skin is not hotter 
 than natural. Many girls, however, have been bled repeatedly 
 while in this state, under the idea that some inflammatory action 
 was going on. 
 
 Pain about the region of the heart, accompanied with palpita- 
 tions and occasional fainting fits, constitute another form which 
 hysteria assumes, and may at first lead any one ignorant of the use 
 of the stethoscope to suppose that organic disease of the heart 
 existed. 
 
 Causes. — Females from fifteen to thirty years of age are most 
 liable to hysteria, and it is generally observed in those of a highly 
 nervous temperament, with spare habit of body; or in plethoric 
 and fat persons with soft and relaxed muscles, who are subject to 
 irregularities of the menstrual discharge. 
 
 The most common exciting causes are disappointed love, jeal- 
 ousy, undue excitement, ungratified desires, and all powerful men- 
 tal emotions w T hich act strongly on the nervous system, and tend to 
 induce disorders of menstruation. Hysteria, in fact, depends almost 
 entirely on the education, social position in life, mode of living, 
 and moral training of females; many, from having been over- 
 indulged when children, become irritable, wayward, capricious, and, 
 in a word, are so self-willed that the slightest disappointment or 
 opposition brings on a paroxysm. Sydenham remarked long ago 
 that, " Upon the least occasion they indulge terror, anger, jealousy, 
 distrust, and other hateful passions; and abhor joy, and hope, and 
 cheerfulness, which, if they accidentally arise, as they seldom do, 
 quickly fly away, and yet disturb the mind as much as the depress- 
 ing passions do ; so that they observe no mean in any thing, and 
 are constant only to inconstancy. They love the same persons ex- 
 travagantly at one time, and soon after hate them without a cause ; 
 this instant they propose doing one thing, and the next change their 
 mind, and enter upon something contrary to it, but without finding 
 it. So unsettled are their minds that they are never at rest." Peo- 
 ple in general are not much inclined to sympathize with hysterical 
 
AND MOST KECENT METHODS OF TREATMENT. 665 
 
 females, however formidable or alarming the fits may appear, be- 
 cause it is well known that this affection is in a great measure un- 
 der their own control, and, in fact, in nine cases out of ten the 
 paroxysm is the result of a fit of bad temper, or of some excitement 
 which could not have arisen in a well-regulated mind. 
 
 Strong religious feeling, acting on delicate or weak-minded 
 females, is another fruitful source of hysteria ; and in such cases it 
 is readily communicated from imitation and sympathy. 
 
 Treatment. — Two indications are to be attended to in the treat- 
 ment of hysteria ; the first is to shorten or moderate the violence 
 of the paroxysm, the other to prevent the return of the fits. 
 
 When the fit is slight, the application of cold water to the head 
 and neck, putting salt in the mouth, and sal volatile, or aromatic 
 vinegar to the nostrils, are the means commonly put in practice, 
 and sometimes with advantage ; but, at all events, in mild cases the 
 fit may be allowed with perfect safety to run its course. When the 
 paroxysm is severe the first thing to be done is to prevent the 
 patient from receiving injury by the violence of her struggles. She 
 should be placed in bed in a well-aired apartment, her shoulders 
 ought to be raised, and her dress loosened. If she be capable of 
 swallowing, a teacupful of cold water or the following draught may 
 be given : 
 
 Camphor mixture, two ounces, 
 
 Sal volatile (aromatic spirit of ammonia), a teaspoonful. Mix. 
 
 Or a teaspoonful of mther may be given in a little cold water. 
 Should the face be flushed and the head hot, cloths moistened with 
 aether are to be placed on the forehead, or wet towels or pieces of 
 linen may be applied to the same part. 
 
 Treatment during the intervals. — In order to effect a radical cure 
 of this affection, attention must be paid to the general health of the 
 patient, and to the state of the digestive organs and womb. If the 
 habit of body be full and plethoric, low diet and exercise are proper ; 
 but if the patient be delicate and her stomach debilitated, tonic 
 remedies, such as small and repeated doses of quinine, and prepara- 
 tions of iron, are the most suitable remedies. 
 
 Should the disease be connected, which it very frequently is, 
 with disorders of menstruation, I must refer the reader to a subse- 
 quent part of the work. (See Women and Menstruation, Diseases 
 
 of.) 
 
 Valerian, castor, assafoetida, galbanum, and other remedies 
 termed antispasmodic, are in very general use in the treatment of 
 hysteria, but I cannot say that we have ever known any permanent 
 benefit derived from them ; and we believe that medicine, to have 
 
DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 any decided effect in this disorder, must be directed towards im- 
 proving the state of the digestive and uterine functions. 
 
 Hysteria may attack any part or organ of the body, and resemble 
 organic disease. Like hypochondria, it is really a disease, and is 
 to be treated accordingly. Moral influence can do much, but it can- 
 not do everything. It is a nervous disease, and is to be managed 
 on the same general principles as other nervous diseases. 
 
 It should always be remembered that hysteria is to woman 
 what hypochondria is to man. Both are really diseases. Both are 
 probably symptoms of some disturbance of the central nervous 
 system. Both are increasing in frequency. Both are often pre- 
 monitions of actual insanity. Both may occur at any time of life 
 after puberty. Both diseases may often be relieved and cured by 
 appropriate treatment. 
 
 (For principles and details of treatment see Treatment of Ner- 
 vous Diseases.) 
 
 ICE-BAGS AND BAGS OF HOT WATEK. 
 
 Dr. Chapman, of London, has introduced to the profession a 
 method of treatment that consists in the application of rubber bags, 
 filled with ice or hot water, to the spine. This method of treat- 
 ment has been found to be quite successful in a variety of nervous 
 
 diseases. They are recommended for convulsions, neuralgia y sick head- 
 ache, sea-sickness, epilepsy, St. Vitus' 8 dance, and a variety of other 
 affections. The bags for holding the ice are simply a matter of 
 
AND MOST RECENT METHODS OF TREATMENT. 667 
 
 neatness and convenience. Ice wrapped in a cloth or towel serves 
 our purpose very well. I have used this treatment successfully for 
 sick headache. 
 
 ILIAC PASSION. 
 
 Iliac passion, or Ileus, consists of excessive vomiting, with ob- 
 stinate constipation of the bowels. This dangerous disease may 
 commence suddenly and terminate fatally in the course of four or 
 five days; but cases of this description are fortunately very rare. 
 It usually commences with acute griping pain, obstinate constipa- 
 tion of the bowels, retraction of the navel, and the usual symptoms 
 of severe colic, which not being relieved by any mode of treatment, 
 a still more distressing state supervenes. The patient is racked 
 with violent pain ; the belly becomes swollen, and tender to the 
 touch ; the pulse is weak, small, and quick ; the thirst is urgent ; 
 the face appears anxious and shrunk ; faecal matter is vomited ; 
 cold sweats, hiccup, and frequent fainting fits follow, and death 
 generally puts an end to the patient's misery. In some cases, acute 
 pain is felt at a particular part of the abdomen, accompanied with 
 heat of skin, quick pulse, thirst, and the ordinary symptoms of in- 
 flammation ; in others there are no symptoms of fever ; in the latter 
 case life may be prolonged a considerable length of time. 
 
 Causes. — Ileus may arise from various causes, the principal of 
 which are ruptures ; one portion of the bowels passing within an- 
 other, and becoming entangled ; contraction, or stricture of the 
 bowel ; obstruction from cancerous or other morbid growths ; bands 
 formed by false membranes, strangulating or compressing a portion 
 of gut ; paralysis, or torpor of the bowels, arising from hardened 
 faeces, impacted in some part of the intestinal canal ; or it may be 
 a symptom of inflammation of the bowels. 
 
 Treatment. — In. every case the first thing to be done is to ascer- 
 tain whether or not the disease is the result of hernia or rupture. A 
 hernial tumor is sometimes so small that the patient is ignorant of 
 its existence, or may not consider it worthy of notice ; and females 
 are often ashamed or unwilling to admit that they have any com- 
 plaint of this nature. We ought not, therefore, to rest satisfied 
 with the statement of the patient, but should examine the parts 
 subject to rupture with the greatest care. The necessity of procur- 
 ing the best professional assistance at an early stage of the disease, 
 in order to avoid intense suffering and death, is absolute. 
 
 Another essential point to be attended to, before having recourse 
 to any remedial means, is to ascertain whether or not the disease is 
 accompanied by inflammation, the signs of which are, a constant, 
 
668 
 
 acute, and burning pain in the belly, which is distended, tense, hot, 
 and acutely sensible to the slightest pressure ; urgent thirst, and 
 high-colored urine. In this case, instead of giving opiates and 
 strong purgatives, which would soon destroy the patient, recourse 
 must be had to general and local blood-letting, and the means usual- 
 ly adopted to subdue inflammation of the bowels, of which the ileus 
 may be only a symptom ; and will then, of course, be removed along 
 with the inflammation. 
 
 If the disease do not depend on hernia, and if no inflammatory 
 symptoms be present, it then becomes advisable to administer pur- 
 gatives and opiates. 
 
 TREATMENT. OF ILIAC PASSION. 
 
 1. Cathartics. — Castor oil may be given in large doses, and may 
 be injected into the bowels. Croton oil, a drop or two on the tongue, 
 may be resorted to. We may inject into the bowels Epsom salts 
 with warm water and molasses, and in large quantities. Localized 
 electrization may be used with a powerful current. 
 
 If all these measures fail, we have reason to suspect that the 
 bowels are obstructed, and should next try — 
 
 2. Opium in doses of one grain or less every half hour to relieve 
 the pain, and if possible relax the bowels. Together with the 
 opium try warm hip-baths, and injections of warm water in large 
 quantities. Physicians sometimes use long tubes in such cases, 
 and push them as far as possible up the bowels. 
 
 3. Inject air by air bladders or by large bellows. It is claimed 
 that lives have been saved by this method of treatment. 
 
 INDIAN HEMP. 
 
 This is used chiefly in painful and spasmodic affections, and in 
 cases where we are accustomed to employ opium and belladonna. 
 
 It is used to produce sleep, to relieve the pains of neuralgia, and 
 in delirium tremens. 
 
 One form of Indian hemp is haschish. This is much used in 
 the East. Its effects on the nervous system are peculiar, and some- 
 times alarming. It may produce a kind of double consciousness. I 
 tried a dose once, and the effects on my nervous system were such 
 that I never desire to repeat the experiment. 
 
 The dose is from half a grain to two or three grains. The tinc- 
 ture may be given in doses of from three to six drops on sugar. 
 
 It is not a good remedy for domestic use. 
 
 Indigestion. (See Dyspepsia^ 
 
AND MOST RECENT METHODS OF TREATMENT. 669 
 
 INFLUENZA. 
 
 Influenza, or epidemic catarrh, has generally been observed to 
 commence suddenly, with chills or shivering, alternating with 
 flushes of heat, loss of appetite, great lassitude, and debility. These 
 symptoms are soon followed by pain and a sensation of weight in 
 the forehead, sneezing, a copious discharge of thin acrid fluid from 
 the nostrils, a sensation of rawness along the course of the wind- 
 pipe, hoarseness, and dry cough. To these are conjoined anxiety 
 and a feeling of oppression about the chest ; pain in the back and 
 knees, and shooting pains in different parts of the body and limbs; 
 quick and weak pulse, and moist tongue, covered with white mucus. 
 
 The abruptness of the attack, the extraordinary debility, the 
 severe headache, accompanied with giddiness, and the flying pains 
 in the back, knees, and various parts of the body, distinguish this 
 affection from common catarrh. (See Cold in the Head and 
 Bronchitis.) 
 
 The duration of influenza varies from three or four days to a 
 fortnight ; but in aged and delicate people it frequently leaves con- 
 siderable debility and susceptibility, to cold for many months. It 
 seldom continues longer in any place than six weeks, and generally, 
 towards the termination of the epidemic, the symptoms are mild, 
 and differ little from those of a common cold. 
 
 TREATMENT OE INFLUENZA. 
 
 Influenza at the outset is to be treated like a common cold. 
 (See Common Cold and Cold Powder.) 
 
 In addition to these measures, the patients often need tonics. 
 Quinine is given with benefit ; sometimes the preparations of iron 
 are of service. These tonics are not usually given at the commence- 
 ment of the attack, but subsequently, after the system has become 
 more or less exhausted. In this disease it is more necessary to 
 have medical advice than in a common cold. 
 
 Sometimes when the epidemic prevails in any place, no amount 
 of caution can prevent our taking it. Those who keep carefully at 
 home and who never expose themselves are as much, if not more, 
 liable to be attacked than those who move freely about in the open 
 air. Sometimes hundreds are attacked almost simultaneously. 
 
 Daily ablution with cold water is strongly recommended by 
 nearly all the best authors on these affections, and several distin- 
 guished medical men speak of the advantage which they have per- 
 sonally derived from it. Sir Astley Cooper makes the following 
 observation with regard to this practice : 
 
670 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 "The methods by which I preserve my own health are tem- 
 perance, early rising, and sponging my body every morning with 
 cold water immediately after getting out of bed, a practice which 
 I have adopted for thirty years ; and though I go from the hot 
 theatre into the squares of the hospital, in the severest winter 
 nights, with merely silk stockings on my legs, yet I scarcely ever 
 have a cold." 
 
 INHALATIONS. 
 
 Of late years the practice of taking medicine by inhalation has 
 been revived, and has now resumed some of its former popularity. 
 Different styles of apparatus have recently been devised that enable 
 us to administer a large variety of medicines in the form of cold or 
 hot spray. 
 
 One of these is represented in the accompanying cut. 
 
 STEAM ATOMIZER (INHALER). 
 
 There is no question that much good may be accomplished by 
 inhalations ; but their importance has, I think, by some been over- 
 estimated. They are of decided assistance in the treatment of 
 diseases of the larynx and bronchial tubes. They afford relief in 
 croup. They have been used as a means of relief in consumption. 
 
 Inhalation is to many a very agreeable mode of taking medicine, 
 and on that account patients are sometimes inclined to over-estimate 
 their value — to form too extravagant hopes of their efficacy. 
 
 Charlatans have availed themselves of this popularity of inhala- 
 tions, and have terribly deceived the people. They have professed 
 to cure incurable diseases, have held out false hopes, and fleeced 
 the unsuspecting. 
 
AND MOST EECENT METHODS OF TREATMENT. 671 
 
 The people should understand that inhalations are not panaceas ; 
 that they are pleasant and effective aids to our other methods of 
 treatment, in a certain class of diseases, and under judicious advice. 
 
 DOSES OF REMEDIES FOR INHALATION. 
 
 Tar-water, one to three drachms, 
 
 Lngol's solution of iodine, three to ten drops, 
 
 Chlorate of potassa, five to thirty grains, 
 
 Carbolic acid, five to fifteen drops, 
 
 Tannin, ten to twenty-five grains, 
 
 Alum, ten to fifteen grains, 
 
 Muriate of ammonia, ten to thirty grains, 
 
 Laudanum, five to twenty drops, 
 
 Nitrate of silver, one to five grains. 
 
 These medicines may be placed in a large or small quantity of 
 water, according to the nature of the apparatus used. Patients 
 should not use the more powerful substances, such as nitrate of 
 silver and carbolic acid, without caution. The different forms of 
 apparatus are usually accompanied by general instructions for their 
 use. It is always safe to make the first inhalations short — say five 
 or ten minutes, according to substance used. After inhaling hot 
 spray, it is well to rest a few moments before going into the open 
 air, in order to avoid taking cold. This caution is not necessary 
 after cold inhalations. 
 
 IODIDE OF POTASSIUM. 
 
 This remedy is now much used, and in a variety of diseases. 
 It is given in syphilis, both to cure the disease itself and to coun- 
 teract the evil effects of mercury. It is given in rheumatism, and 
 is sometimes very successful in that malady. It is given in inflam- 
 mation of the brain to promote absorption of the fluid. For the 
 same purpose it is used in pleurisy. It is given in lead-poisoning. 
 For lead-poisoning it is the best remedy we have. The iodide of 
 potassium sets the lead free, and allows it to escape through the 
 urine. 
 
 Iodide of potassium is successfully given to promote absorption 
 of enlarged glands. It is also useful in consumption. The dose is 
 from three to ten or fifteen grains in water. 
 
 IODIDE. 
 
 Iodine is obtained from the ash or cinder called kelp, which is 
 procured from burning sea- weeds (algee). 
 
672 DESCRIPTION OF 
 
 Iodine is principally valued for the extraordinary power it pos- 
 sesses in promoting absorption ; hence it is employed in Derbyshire- 
 neck (bronchocele), chronic enlargements of the liver, spleen, tes- 
 ticles, uterus, &c. In various scrofulous affections it is the most 
 efficacious remedy we possess. It is now extensively used in com- 
 bination with various other substances. 
 
 INSANITY. 
 
 Insanity receives various names, according to the special man- 
 ner in which it is manifested. Mania is general insanity. 
 
 Monomania. — Any one who is insane on some one subject is 
 called a monomaniac. 
 
 Under this head there are many subdivisions. 
 
 Dipsomania (or methomania, or oinomania). (See Dipsomania.) 
 Those who so lose their self-control that they cannot touch wine or 
 other liquors without making beasts of themselves are frequently 
 called dipsomaniacs. Yery many of our drunkards, especially 
 among the better classes of society, have diseased brains, and are 
 really dipsomaniacs. 
 
 Pyromania. — Those who have an insane desire to set buildings 
 on fire are called pyromaniacs. Some boys have been thus af- 
 flicted. 
 
 Kleptomania. — Those who cannot avoid stealing are called 
 kleptomaniacs. Some of the best educated people in the land have 
 been thus diseased. There have been ladies of abundant wealth 
 and high social position who have had the habit of purloining all 
 sorts of articles from the stores where they trade, and the houses of 
 friends where they visited. There have been clergymen who have 
 been unable to repress their tendencies to steal, notwithstanding all 
 the unpleasant consequences that would result from exposure. 
 
 Homicidal Mania is an insane propensity to kill. There is a 
 great prejudice against the use of this phrase, because it has some- 
 times been unfairly laid hold of to screen real criminals. There is 
 no question that there is such a form of mania, and that those who 
 suffer from it are not free moral agents. There is no definite line 
 where sanity ends and insanity begins. The question of insanity 
 is simply a question of degree. Each case must be studied by itself. 
 There should be in every State a board of sworn commissioners, 
 capable and honest experts in this department, to whom all doubt- 
 ful cases should be referred. It should be for them to give evi- 
 dence in criminal trials and to decide whether patients are or are 
 not fit candidates for an asylum. 
 
AND MOST RECENT METHODS OF TREATMENT. 673 
 
 The present laws on this subject are a disgrace to our civiliza- 
 tion. There are throughout the land a great number of insane 
 people who are not fit for liberty. They are a nuisance to them- 
 selves and to all their friends. They turn their households into 
 hells. Many of them are liable at any time to commit some ter- 
 rible offence against peace and order. They are not free moral 
 agents ; their brains are diseased. They should be placed under 
 some form of restraint. It is not always necessary to place such 
 patients in an asylum. Insanity is a malady of degrees, and the 
 restraint of the insane should be a matter of degree. 
 
 Under the present laws those who are so unfortunate as to have 
 insane relatives are oftentimes obliged to endure their miseries until 
 death brings relief. If they attempt to place their insane fathers or 
 mothers, or brothers or sisters, or other relatives, under restraint, they 
 are very apt to excite odium against themselves, especially if the 
 relatives happen to be very aged and wealthy. 
 
 The remedy for this evil is to have in every State a sworn and 
 able commission, who shall at least be as much above reproach as 
 our judges, whose office it shall be to decide such cases. 
 
 TREATMENT OF INSANITY. 
 
 Every case of actual or of suspected insanity must be treated 
 by itself. In all cases the best of medical advice should be obtained. 
 Only those who are skilled in the study of disease can judge whether 
 or not separation and confinement are necessary. 
 
 In these days lunatics are treated kindly. They are allowed 
 all the liberty and all the favors consistent with their own welfare 
 and the welfare of society. 
 
 I need not say that the great majority of those who are in the 
 milder and incipient stages of insanity — as I have described them 
 — need no confinement at all. They are about us on every hand, 
 and mingle with success in the various activities of life. It is only 
 when insanity becomes violent, when it positively disturbs society, 
 when it unfits one for the duties of life, that it must be treated by 
 separation. 
 
 These mild and incipient stages must be treated just like ner- 
 vous diseases in general. (See Treatment of Nervous Diseases.) 
 
 But in those cases where medical advice adjudges that separa- 
 tion is necessary, the friends of patients should not hesitate. Much 
 of the prejudice against our modern asylums is unfounded. In the 
 main the patients are treated with all possible kindness and consid- 
 eration, and the results of the treatment are as satisfactory as can i 
 be expected. 
 
 43 
 
674 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 It is a mistake to suppose that insane patients never perfectly 
 recover. There is always hope of those who are young. After 
 forty or fifty the chances of recovery diminish with the age. 
 Some of the best and greatest men that the world has ever seen 
 have been at some period of their lives insane. 
 
 IPECACUAK 
 
 Ipecacuan is well known as a mild and efficacious emetic ; for 
 this purpose it is given in powder, in the dose of from fifteen to 
 thirty grains, mixed with a little warm water ; or ten grains of it 
 may be administered, combined w T ith one grain of tartar-emetic. 
 The wine of ipecacuan, commonly called hippo wine, is well adapted 
 for the diseases of children where emetics are desirable. The dose 
 is one or two teaspoonfuls, repeated at intervals of a quarter of an 
 hour, until vomiting is produced. 
 
 Ipecacuanha lozenges generally contain each from a quarter to 
 half a grain of the powdered root, and are much used to promote 
 expectoration in chronic affections of the lungs. 
 
 Ipecacuan combined with opium forms the celebrated sudorific 
 remedy called Dover's powder. 
 
 IKOK 
 
 Iron, so indispensable to the welfare and happiness of mankind, 
 is, as the great chemist Fourcroy states, perhaps the only metal 
 possessed of medicinal properties which has no poisonous quality. 
 Indeed, there are few remedial agents of more importance than the 
 preparations of iron. The salts of iron are deservedly considered 
 to be invaluable in the various chronic affections occurring in con- 
 nexion with that state of the body called, in medical language, 
 anaemia, in which the blood is deficient in quantity, and probably 
 altered in quality. The symptoms which indicate this condition of 
 the system are a soft, flabby state of the flesh, pale countenance, a 
 peculiarly pallid appearance of the lips, general debility, loss of 
 appetite, occasional palpitation of the heart and shortness of breath- 
 ing on any sudden bodily exertion. This state is most frequently 
 met with in females, and generally in those who are affected with 
 obstruction of the menses {chlorosis). The diseases in which the 
 preparations of iron have been found most serviceable are scrofula, 
 rickets, dropsy, menstrual disorders, and various nervous affections, 
 as epilepsy, St. Yitus's dance, hysterics, asthma, and neuralgia. 
 
 In persons of a full habit of body, with florid countenance, ip 
 
AND MOST RECENT METHODS OF TREATMENT. 675 
 
 those who have a tendency to inflammatory diseases or apoplexy, 
 and in all cases of chronic inflammation, iron is not admissible in 
 any form. 
 
 The subcarbonate, or prepared rust of iron, has been frequently 
 given in tic douloureux and other nervous diseases to the extent of 
 an ounce in the course of twenty-four hours ; but though such doses 
 may be given with impunity, it does not appear to be really neces- 
 sary, under any circumstances, to exceed three drachms a day; and 
 indeed, in most cases where this remedy is indicated, scruple doses, 
 if continued for a sufficient length of time, will be followed by all 
 the good effects which iron is capable of producing. The method 
 generally adopted is to commence with ten grains three times a day, 
 increasing the dose gradually to the extent of a drachm. In obsti- 
 nate cases of chlorosis, and in the discharge from the vagina, called 
 the whites, it is often advisable to administer drachm doses for a 
 considerable length of time. 
 
 The tincture of the muriate of iron, or tincture of steel, as it is 
 termed, is a very agreeable and convenient form of administering 
 iron. The ordinary dose is from ten to thirty drops, three times a 
 day, in cold water, or conjoined with an infusion of quassia, gen- 
 tian, or orange peel ; or it may be given once a day, in a glass of 
 soda-water. This is considered the most suitable preparation in 
 indigestion arising from functional derangement or weakness of 
 stomach; but iron and all other tonic remedies are improper when 
 the alimentary canal is in an irritable condition. In retention of 
 urine, from spasm at the neck of the bladder, the tincture of steel, 
 in small doses frequently repeated, is an excellent remedy; ten drops 
 to be taken every ten minutes, until some relief is afforded. 
 
 The sulphate of iron (green vitriol) produces sickness at stomach 
 when used in full doses, and should therefore be taken at first in 
 the dose of half a grain three times a day. It may be used in the 
 following form with great advantage as a substitute for waters im- 
 pregnated with iron : 
 
 Sulphate of iron, half a drachm, 
 
 White sugar, a drachm and a half. Mix, and divide into twelve powders. 
 
 Bicarbonate of soda, half a drachm, 
 
 White sugar, a drachm and a hahl To be also mixed, and divided into twelve pow- 
 ders. One of each to be dissolved separately in water, and taken in a state of efferves- 
 cence. 
 
 Other preparations of iron are iron by hydrogen, pyrophosphate 
 of iron, acetate of iron, &c. 
 
 Pyrophosphate of iron is now very much used. It is given in 
 combination with quinine and strychnine. It is a prominent in- 
 gredient in Caswell's and in Wyeth's tonic preparations. 
 
676 
 
 ITCH. 
 
 The face is the only part which it does not attack. Its imme- 
 diate cause is the presence of an insect, acarus scabiei, which is not 
 situated in the vesicle itself, but at the termination of a small red- 
 dish furrow with which it communicates. This insect may be de- 
 tected by the microscope. 
 
 Tailors, old-ciothes men, seamstresses, and the medical attend- 
 ants and servants of hospitals, are most frequently affected with 
 this filthy disease. In grown-up people from ten to twenty days 
 elapse between the infection and the breaking out of the eruption; 
 in children it appears at an earlier period, generally from four to 
 six days. 
 
 Treatment. — The itch never gets well without treatment. The 
 remedy generally resorted to is sulphur, which seldom if ever fails 
 in curing the disorder. The sulphur ointment of the shops, or the 
 flour of sulphur mixed with butter or lard, rubbed in five or six 
 times on the parts affected, effectually destroys the acarus. It -is well 
 to take a warm bath so as to thoroughly cleanse and soften the skin 
 before rubbing on the sulphur ointment. (See Skin, Diseases of.) 
 
 JALAP 
 
 Is a familiar remedy, that needs no description. Like calomel it 
 has been much abused. 
 
 JAMES'S POWDER 
 
 The antimonial powder of the pharmacopoeia is an imitation of 
 this empiric remedy, and both these preparations of antimony are 
 used to promote perspiration in inflammatory diseases and fever ; 
 but the tartrate of antimony (tartar-emetic) in small doses is now 
 generally preferred, because it acts with a greater degree of certainty 
 than any other antimonial. The ordinary dose of James's powder 
 or of the antimonial powder is from five to ten grains, mixed with 
 a little jelly; but it has been frequently given in much larger doses 
 without producing any perceptible effect. It is not much used in 
 these days. 
 
 JAUNDICE. 
 
 Jaundice is characterized by a yellow color of the eyes, skin, and 
 urine, and by the white or clay-colored appearance of the evacua- 
 tions from the bowels. 
 
 The circumstances which impede the passage of the bile into the 
 bowels, and consequently produce jaundice, are various. The ob- 
 struction may arise from gall-stones in the biliary ducts, from the 
 
AND MOST RECENT METHODS OF TREATMENT. 677 
 
 bile being preternatirrally thickened, from enlargements of neigh- 
 boring parts, from accumulation of mucus in the duodenum plug- 
 ging up the orifice of the duct, or from inflammation of the liver 
 or duodenum, or of the gall ducts themselves. But jaundice often 
 arises under circumstances which do not admit of any explanation 
 of the immediate cause of the obstruction ; for example, it occa- 
 sionally arises suddenly from violent mental emotions, as intense 
 grief, terror, or a violent fit of rage ; sometimes again it makes its 
 appearance slowly, in consequence of long-continued domestic grief, 
 jealousy, or disappointed ambition ; it may also be brought on in 
 consequence of the pain and shock given to the nervous system 
 from falls, blows on the head, or any other part ; from the reduc- 
 tion of a dislocation, the amputation of a limb, or the enduring of 
 any other severe surgical operation ; from the bite or sting of ven- 
 omous animals, &c. The nature of several of the varieties of jaun- 
 dice is still little known ; cases often occur in which the treatment is 
 on this account rendered very uncertain. Indeed it is often neces- 
 sary to trust almost entirely to the efforts of nature for the removal 
 of the disorder. 
 
 The yellow color is first observed in the eyes ; it then extends to 
 the face, neck, and upper part of the chest; and at last the whole 
 skin becomes imbued with it ; troublesome itching, or a tingling 
 sensation of the surface of the body, usually accompanies the dis- 
 coloration of the skin. The urine at first is clear and of a yellow- 
 ish tin ; but as the disease advances it acquires a saffron color, and 
 ultimately becomes dark green, or of a mahogany color, and deposits 
 a thick slimy sediment. The urine, even when it has acquired a 
 very dark color, tinges the linen of a bright yellow. In general 
 there is a great tendency to constipation of the bowels ; the evacua- 
 tions are scanty, clay-colored, or white, and voided with difficulty. 
 To these symptoms. are added great depression of spirits, watchful- 
 ness, a bitter taste in the mouth, furred and yellow tongue, nausea 
 or vomiting, loss of appetite, thirst, and sometimes shivering, 
 copious perspiration or dry skin, and perhaps pain at the stomach. 
 To some jaundiced patients all objects appear of a yellow color, 
 but this is by no means a common symptom of the disease. 
 
 Treatment. — Our knowledge is very imperfect with regard to 
 many phenomena connected with jaundice, and until the advances 
 of science throw light on these obscure points, the treatment must 
 be confined chiefly to controlling or removing the symptoms. 
 
 Gall-stones are always formed in the gall-bladder, and as long as 
 they remain there are not attended with pain or any inconvenience; 
 but when they find their way into the gall ducts, particularly if 
 
678 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 their size happen to be large, they cause jaundice, and the most 
 excruciating pain ; the latter is not constant, but recurs in violent 
 paroxysms, and is said to be more severe than that which results 
 from the most acute inflammation. The pain may come on several 
 days in succession, and continue several hours each time ; it is at- 
 tended with occasional shivering and profuse perspiration, but not 
 with feverish symptoms. When the paroxysm continues long, it 
 induces extreme lassitude and exhaustion. As soon as the stone 
 escapes from the duct into the bowels the urgent symptoms cease, 
 and recovery soon follows ; sometimes, however, it falls back into 
 the duct, and in this case, though the patient is likewise relieved 
 from his suffering, he has reason to anticipate a recurrence of the 
 disorder at some future period. ' 
 
 The treatment in this species of jaundice consists in alleviating 
 the pain by means of opiates. Fifty drops of laudanum, the third 
 of a grain of the acetate of morphia, or hypodermic injections of 
 morphine, should be given and repeated at the expiration of an hour, 
 or after a longer interval, according to the urgency of the case. A 
 warm bath may be of considerable service, and the patient should 
 remain in it until a slight degree of faintness is produced. After 
 two or more doses of the anodyne medicine have been taken, a dose 
 of castor-oil is to be administered, and the bowels are to be kept 
 gently open throughout the disorder by mild doses of the same or 
 of some other purgative. If the bowels be obstinately constipated, 
 which is not unfrequently the case, the compound rhubarb pill or a 
 dose of podophyllin (see Podophyllin) should be administered, and 
 the dose repeated as often as may be found necessary. Emetics 
 are seldom required in any form of jaundice, and when it arises 
 from gall-stones they cannot be administered with safety. Warm 
 fomentations, applied constantly over the pit of the stomach, may 
 afford some relief, and effervescing draughts may be given to allay 
 
 vomiting. 
 
 Treatment of jaundice during the intervals is oftentimes a 
 matter of difficulty. Each case must be studied by itself, and ad- 
 vice should be obtained in all obstinate cases, at least. 
 
 It should be remembered that jaundice is merely a symptom, 
 or an effect, and that it must be treated by treating the cause. If 
 w r e must work in the dark, we can by those remedies that act upon 
 the liver, or are supposed to do so. It is proper to state just here, 
 that many physicians now doubt whether calomel has any specific 
 effect upon the liver, as has been generally supposed. There are 
 many who use podophyllin instead of calomel. It may be given in 
 doses of from one-half of a grain to one or two grains. 
 
AND MOST KECENT METHODS OF TREATMENT. 679 
 
 Nitro-muriatic acid is believed to have an effect on the liver. 
 It may be given in sweetened water. The drink may be made 
 agreeably sour, and taken before meals. Hard cider is a good re 
 medy for jaundice, and should be faithfully tried. Dandelion is 
 also supposed to have some influence on the liver. It is well also to 
 try some of the tonic preparations, such as Wyeth's or Caswell's 
 elixirs. (See Tonics.) 
 
 If internal medicines fail, it is proper to resort to the movement 
 cure or electrization. Travelling, a change of air and scene, some- 
 times succeed when medicine fails. 
 
 KIDNEYS, DISEASES OF. 
 
 A fit of the gravel is caused by the descent 'of gritty particles 
 like sand, or of small stones [renal calculi), from the kidney, along 
 ' the ureter to the bladder. Small stones sometimes reach the blad- 
 der without occasioning much pain or uneasiness, but in general 
 they give rise to very distressing symptoms. The patient is sud- 
 denly seized with severe pain in the region of the kidney, extending 
 along the ureter to the bladder, and even to the point of the penis; 
 and generally accompanied with great tenderness at the part of the 
 belly corresponding with the portion of the ureter in which the 
 stone is arrested in its progress. There is also a dull pain, or sen- 
 sation of numbness, at the inside of the thigh, and sometimes of the 
 leg, of the side affected, with painful retraction of the testicle. 
 The urine is passed in small quantity, tinged with blood, or mixed 
 with clots ; and there is frequent vomiting, with violent sickness at 
 stomach, and extreme anxiety. The duration of this affection is 
 variable, and depends on the resistance offered to the passage of the 
 stone towards the bladder ; as soon, however, as it gets into that 
 organ, the symptoms cease in the same abrupt manner in which 
 they commence. In general, after a long or shorter time, the stone, 
 with perhaps a considerable quantity of gravelly particles, passes 
 out of the body along with the urine ; but sometimes the painful 
 sj mptoms above described are only a prelude to a disorder of a 
 much more serious nature. The stone, instead of being discharged 
 along with the urine, remains in the bladder, gradually increases in 
 size, and occasions frequent attacks of the most excruciating pain, 
 from which the patient has no means of escaping, except that of 
 submitting to a formidable surgical operation. 
 
 Treatment. — The treatment of this affection should be chiefly 
 directe'd to two points : 
 
 1. To mitigate the pain. 
 
680 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 2. To facilitate the progress of the stone from the kidney to the 
 bladder. 
 
 Opium, which may be regarded as our sheet-anchor in this 
 affection, is then to be given in the dose of a grain to two grains, 
 and repeated every two or three hours, or at longer or shorter inter- 
 vals, according to the urgency of the symptoms. When the stom- 
 ach is very irritable, the best way of administering this remedy is 
 in the form of clyster ; a drachm of laudanu , with half a teacup- 
 ful of thin starch, may be injected every two or three hours, or at 
 longer intervals, according to the effect which it produces ; or a 
 suppository, containing two grains of solid opium, may be used. 
 In whatever manner or form opium is exhibited in this distressing 
 disorder, it has the effect of soothing the pain, tends greatly to re- 
 lieve spasm, and consequently favors the descent of the stone into 
 the bladder. The warm bath should be employed, and afterwards 
 warm fomentations are to be applied over the abdomen and loin 
 of the side affected. The pain is sometimes so severe that the per- 
 spiration is seen to drop from the patient, and even fainting fits or 
 convulsions may be brought on. Great languor and debility 
 necessarily follow this extreme suffering ; care must therefore be 
 taken to give wine, brandy and water, and other stimulants, in 
 quantities suited to the degree of exhaustion. Stimulating diuretic 
 remedies are not to be given, but the patient may drink freely of 
 linseed tea, decoction of marsh- mallow, or other demulcent drinks. 
 
 The symptoms of the acute form of Bright 's disease are pains 
 in the limbs and back, difficulty of breathing, nausea and vomit- 
 ing, pain in the head, dropsy of the face and limbs, and albumen in 
 the urine, as revealed by chemical tests. All these symptoms come 
 on shortly after an unusual exposure to cold. They may also fol- 
 low scarlet fever. 
 
 The majority of cases recover ; some go on to the chronic form. 
 Some die from the poisoning of the blood by urea (urcemia). 
 
 1. Keep the skin warm and open by hot-water baths and hot- 
 air baths. 
 
 2. Keep the bowels free by purgative medicines. 
 
 3. Relieve the kidneys by dry cups over the loins. (See Dry 
 Cupping.) 
 
 Most of the inflammations of the kidneys will come under either 
 acute or chronic Bright's disease. 
 
AND MOST RECENT METHODS OF TREATMENT. 681 
 
 There may, however, be a congested state of the kidneys, that 
 does not go on to actual inflammation. Congestion may be treated 
 by warm baths, purgatives, and dry cupping of the loins. 
 
 One great cause of the fatal character of Bright's disease is the 
 presence of urea in the blood (ur'ce?nia). The urea is exceedingly 
 poisonous. The convulsions of pregnant women are frequently 
 due to the presence of urea in the blood. 
 
 This disease of the kidneys, which has recently attracted so 
 much attention, received its name from Dr. Bright, of England, 
 who was the first to closely study and define it. 
 
 The leading symptoms of Bright's disease are : 
 
 1. Albumen in the urine. 
 
 2. Casts of the tubes of the kidneys found in the urine by the 
 microscope. 
 
 3. Dropsy, general or local. 
 
 4. Headache and dimness of vision. 
 
 5. Disorder of digestion. 
 
 6. Stupor, vomiting, or diarrhoea. 
 
 There are several varieties of this disease. In all of them the 
 kidneys are more or less diseased. In all of them it is necessary 
 to call in the aid of the microscope (see Microscope) and chemistry 
 before we can pronounce an opinion upon any case. In all of them 
 the probabilities are that the patient will never entirely recover, 
 although he may live a number of years. 
 
 Many of the symptoms of Bright's disease— indigestion, head- 
 ache, dimness of vision, etc. — are also the symptoms of many other 
 conditions. It is therefore necessary to take all the symptoms. It 
 is necessary to have the urine examined by chemical tests, and if 
 possible by the microscope. 
 
 The chemical test that is usually employed is the addition of a 
 few drops of nitric acid to a little of the urine in a test-tube, and 
 then heating it. If albumen is present there will be a whitish 
 deposit, somewhat resembling the white of an egg. 
 
 Those who suspect that they may have Bright's disease of the 
 kidneys should consult some good medical authority, and abide by 
 his opinion. 
 
 Many who fear that they have some disease of the kidneys 
 really have no such disease. Many who have pains in the back are 
 apt to imagine that they have disease of the kidneys. Nothing is 
 so unreasonable as this fear. (See Backache) When Bright's 
 disease actually exists there is usually no pain in the hack at all. 
 
682 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 Chronic Bright's disease advances slowly and insidiously. The 
 kidneys may be diseased a long time before the patient begins to 
 suspect that he is laboring under ^serious disease. 
 
 Patients with chronic Bright's disease often suffer at the same 
 time from bronchitis. 
 
 1. To keep the skin open, and thus to relieve the kidneys. Use 
 warm baths. Give the following prescription : 
 
 Mindererus spiritus, 
 Syrup of ipecac, 
 
 Tincture of chloride of iron, equal parts. 
 One teaspoonful three times a day. 
 
 Flannel should be worn next to the skin. 
 
 2. To sustain the system. 
 
 Give tonics of various kinds. Cod-liver oil, the preparations of 
 iron, quinine, strychnine — all may be tried. The diet should be 
 nourishing and digestible. 
 
 3. To relieve the dropsy. (See Dropsy, Treatment of.) 
 
 The patient should avoid all careless exposure to cold, and 
 should be as temperate as possible in his habits. 
 
 In spite of all that can be done, the tendency is toward a fatal 
 result. 
 
 KEEASOTE. 
 
 Kreasote has been found useful in checking spitting of blood 
 from the lungs, and in cases of sickness and vomiting dependent on 
 pregnancy, or connected with nervous and hysterical symptoms ; it 
 has also been recommended as a preventive of sea-sickness. The 
 dose is one drop three or four times a day, formed into a pill with 
 liquorice powder and mucilage, or given in camphor mixture, and 
 may be gradually increased to eight drops. 
 
 A small portion of lint, or soft linen rag, moistened with krea- 
 sote, placed in the hollow of a decayed tooth, has an astonishingly 
 rapid effect in allaying the pain, and is deservedly considered one 
 of the best local applications yet discovered for toothache. It is 
 one of the best of remedies in common diarrhoea. 
 
 LARYNGITIS, OR INFLAMMATION OF THE LARYNX. 
 
 This may be acute or chronic. The acute form is not very com- 
 mon, but when it occurs is liable to be a very severe disorder. The 
 symptoms are sometimes alarming, and the danger is great. The 
 symptoms are great hoarseness, jpain over larynx, violent coughing, and 
 difficulty of breathing. Surgeons sometimes resort to opening the 
 
AND MOST RECENT METHODS OF TREATMENT. 683 
 
 wind-pipe in this formidable disease. Patients can do little but ap- 
 ply leeches over the throat, and take soothing inhalations. (See 
 Inhalations.) 
 
 CHRONIC LARYNGITIS. 
 
 This disease is exceedingly common. It is also very susceptible 
 of relief. The symptoms are spitting, hoarseness, sometimes loss 
 of voice (aphonia), coughing, difficulty of swallowing, &c. 
 
 The laryngoscope (see Laryngoscope) will at once settle the ques- 
 tion in any doubtful case. It will reveal a chronically inflamed 
 condition of the vocal cords and of the other portions of the larnyx, 
 and sometimes there will be seen ulceration and loss of substance. 
 
 From my translation of Tobold's " Chronic Diseases of the 
 Larynx " I select the following description of this disease : — 
 
 " In certain cases the change of the voice manifests itself only 
 in the morning to a very slight degree, but in the course of the day 
 it becomes much more marked. The respiration is never disturbed 
 in these cases, unless neoplasms which narrow the cavity, or a 
 severe bronchitis exist at the same time. The feeling of roughness 
 or tickling occasions repeated hemming and expectoration. There 
 may be with it an habitual, gentle cough, and sputa may even be 
 expectorated, rolled up in little balls, and tinged with blood. After- 
 wards, in the more advanced stages of this form of inflammation, 
 there is more violent coughing, with spasmodic paroxysms, and this 
 affection may be much increased by an intervening acute catarrh. 
 
 " The general condition is usually undisturbed. 
 
 " The course of the disease is often very irregular, unless local 
 treatment is employed, and the evil tends rather to increase than 
 decrease. So long as the patient is kept quiet the complaint 
 recedes, while on some trifling cause all the symptoms become 
 worse. In general the evil condition becomes entirely corrected 
 under proper treatment, after a shorter or longer time, without leav- 
 ing behind any organic disturbance in the vocal apparatus. 
 
 " It should not be forgotten that mucous membranes that have 
 for a long time been affected with inflammation are very prone to 
 relapse after complete. or partial recovery, provided considerable 
 vigilance be not exercised. This is especially true of disease of the 
 respiratory passages, and of this fact patients should always be 
 forewarned. 
 
 u One of the greatest and most annoying difficulties experienced 
 by laryngologists is the recklessness with which patients expose 
 themselves to night air, and to other injurious influences, while 
 taking a course of treatment for pharyngitis or laryngitis. 
 
684 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 " Amid the cold, dampness, and variations of our northern 
 climate it is often impossible to avoid these relapses, even though 
 every hygienic law be sacredly observed. 
 
 " In the milder and not very old forms of chronic laryngitis, rest 
 of the organs, with other appropriate hygienic management, will 
 be followed by good results. 
 
 " The protection of the organ of speech must be regarded as a 
 condition sine qitd non, especially in the female sex. It forcus an 
 important adjuvant with every general as well as local treatment. 
 The larynx, with its inner structures, is so delicate and movable an 
 organ, that all mechanical influences are at once more sensitively felt 
 by it when it is once affected with disease, than by any other part 
 of the human body. 
 
 " Therefore the patient should avoid all loud speaking and sing- 
 ing, and all talking in the open air in cold weather, especially while 
 walking. Yery irritable, sensitive individuals may use a respirator 
 with advantage, and may wear a flannel jacket, or any tight-fitting 
 close jacket, next to the skin, especially if they are inclined to per- 
 spire easily. Laborers who are exposed for a length of time to a 
 pernicious atmosphere, filled with dust or irritating chemicals, must 
 select an occupation that allows them to live in healthy rooms, 
 where the air is not too dry, but rather is somewhat moist. 
 
 " The diet of weak persons should be very nourishing and blood- 
 enriching, and they should wholly abstain from all spicy and acid 
 foods that irritate the mucous membrane, but especially from all 
 spirituous drinks, strong beer, and other heating liquids that cause 
 
 congestions. 
 
 " Therefore staying for an unreasonable length of time in restaur- 
 ants where beer-drinking is going on, and where the thick tobacco 
 fumes darken the air, is to be forbidden most decidedly. 
 
 " Continual inhalation of the smoke of tobacco is without doubt 
 far more injurious and irritating to many than the act of smoking 
 itself. I therefore allow a moderate amount of smoking, provided 
 other symptoms do not imperatively forbid, to those who are un- 
 questionably affected with a mild form of laryngitis, inasmuch as 
 I have not observed therefrom any marked disturbances either of a 
 subjective or objective character. As appropriate drinks, I usually 
 recommend milk, cocoa, soda-water alone or with milk, red wine 
 and sugar water. 
 
 " Among the so-called hygienic domestic remedies, the drinking 
 of warm water in the morning, and the eating of the roe of herring, 
 sometimes afford a little relief; but we can no more expect a com- 
 plete cure from these than we can from the hydropathic packings of 
 
AND MOST RECENT METHODS OF TREATMENT. 685 
 
 the throat so much praised by the laity and even by the physicians. 
 They may temporarily diminish the subjective symptoms, but can 
 never accomplish a complete cure, as may be shown by a daily in- 
 spection of the parts." 
 
 In this country and in England the so-called " dysphonia cleri- 
 corum," " clergymen's sore- throat," has attracted considerable 
 attention, and was at one time quite fashionable. 
 
 There is in this disease nothing that is peculiar, nothing that 
 is distinct from the inflammations of the same parts in laymen. 
 
 It is probable, however, that clergymen are more frequently the 
 victims of the various grades of inflammation of the larynx than any 
 other class of professional men. 
 
 The causes of this discrepancy are quite obvious. 
 
 1. Clergymen do most of their speaking on the Sabbath, often- 
 times under great pressure, and little or none during the week. The 
 vocal organs are therefore periodically overworked. 
 
 Our successful and busy advocates speak more than clergymen, 
 but their labor is more evenly distributed from day to day. 
 
 2. Most of our clergymen affect the "pulpit tone," which is to 
 the last degree unnatural, and is as harmful to the vocal organs as 
 it is to the cause they advocate. Lawyers usually speak in a more 
 natural conversational tone, and are not as closely confined to their 
 notes. 
 
 3. Until recently, clergymen have felt it to be their duty to 
 remove the covering that God designed for the throat — the beard, 
 and to substitute the white cravat of many folds. 
 
 This sinful custom is, however, passing away, and with it, in 
 a certain measure, the disease that it invited. 
 
 To these three special causes, then, we must look for an ex- 
 planation of the prevalency of " dysphonia clericorum," and not to 
 other general harassments of their calling ; for it is abundantly 
 established by statistics that clergymen are the longest-lived of any 
 class except farmers. 
 
 The local treatment of this disease consists in the application of 
 solutions of nitrate of silver, or alum, or iodine, or tannin, or gly- 
 cerine, or carbolic acid to the diseased membrane by means of 
 sponges or brushes. Sometimes physicians make these applications 
 with the aid of the laryngoscope. 
 
 At home patients may take inhalations. (See Inhalations.) 
 
 The treatment should be followed up perseveringly. Much re- 
 Lief, and sometimes permanent cure, may result. 
 
686 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 LARYKX, DISEASES OF. 
 
 The larynx is liable to very many diseases, only a few of which 
 can be spoken of here. 
 
 LARYNGOSCOPE. 
 
 Since the invention and popularization of the laryngoscope we 
 are much better able to study the diseases of the larynx than for- 
 merly, and can also treat them much more successfully. 
 
 The laryngoscope consists of a reflector to send the light into 
 the throat, and a small mirror to receive the image of the vocal 
 cords. (See cuts of Laryngoscope^) The discovery and populari- 
 zation of this instrument are due to two Germans, Czermak and 
 Tiirck. It is now quite extensively used by physicians. By means 
 of this apparatus it is possible to see the vocal cords with perfect 
 distinctness. When sounds are made they open and close with 
 great rapidity. (See cuts of Larynx under Anatomy and Physi- 
 ology.) 
 
 It is also possible to get a view of the rings of the windpipe 
 below the vocal cords. 
 
 Among the diseases which are found in the larynx by means of 
 the laryngoscope are the following : 
 
 Acute and chronic inflammation. (Laryngitis.) 
 
 Tubercular disease. (Laryngeal phthisis.) 
 
 Tumors and cancers. 
 
AND MOST RECENT METHODS OF TREATMENT. 
 
 687 
 
 Paralysis of one or both of the vocal cords, or of the cartilages 
 or muscles that move them. 
 
 Loss of substance of some portion of the larynx. 
 
 LAMP FOE THE LARYNGOSCOPE. 
 
 In examining the larynx with a laryngoscope a good light is 
 needed. The one which I prefer is represented in the accompany- 
 ing cut. It is called the Saint Germain, or German Study or Office 
 Lamp. When used for the purpose of examining the larynx, the 
 porcelain shade is removed. Tobold's lenses are placed around the 
 chimney, and the light is reflected by the reflector against the small 
 mirror in the back part of the throat. (See Laryngoscope^) 
 
 LAiTP FOR THE LARN'YGOSCOPE. 
 
 A X is the holder that contains the kerosene oil. 
 
 C is the cylinder on which the circular wick is placed. 
 
 F is the chimney-holder. 
 
 This lamp gives a mild, steady light, and for those who have 
 weak eyes is far preferable to the wretched lamps that are too fre- 
 quently used. It is much pleasanter for the eyes than gas-light. 
 
DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 Loss of voice, hoarseness, expectoration, pain, difficulty of 
 breathing, cough and general debility — these are some of the gen- 
 eral symptoms that accompany many of these diseases of the larynx. 
 The laryngoscope helps us to determine just what the disease is that 
 causes these symptoms. It has therefore completely changed the 
 treatment of laryngeal diseases. 
 
 Quite a number of errors prevail in regard to the diseases of 
 the throat. 
 
 1. That the inflammations of these parts " work down" and 
 cause consumption 
 
 Unprincipled charlatans have pushed and advertised the idea 
 that consumption begins in the throat. The truth is that the de- 
 posit of tubercles first appears in the lungs. The throat is not 
 affected until later. When consumptive patients suffer also from 
 serious diseases of the throat we may generally rest assured that 
 the lungs were first attacked, although the patient was not aware 
 of it. Tuberculous disease of the larynx is rarely cured. Ordi- 
 nary inflammation of the larynx, even of the chronic form, may 
 often be relieved and cured. 
 
 It is for the physician to decide by the aid of the laryngoscope, 
 if possible, what the disease is, and what treatment must be used. ■ 
 
 Loss or Yoice (Aphonia) is a very common symptom. It may 
 be caused by. inflammation of the vocal cords, by foreign growths, 
 and by paralysis. Sometimes the patient loses his voice entirely, 
 but most frequently is able to whisper. In many cases it is simply 
 an aggravated degree of hoarseness. Loss of voice may last a short 
 time, or for many months and years. 
 
 The Treatment of loss of voice consists in treating the disease 
 that causes it. (See Laryngitis^) * 
 
 When it depends on paralysis there is one remedy that is more 
 efficacious than any other — electricity. This may be employed in 
 the form of localized or general electrization. (See Localized Elec- 
 trization and General Electrization^) 
 
 The latter method is the more convenient, and in cases associa- 
 ted with general debility more efficacious. 
 
 Sometimes patients who have lost their voice recover it very 
 suddenly after any fright or excitement. 
 
 LAUGHING-GAS (NITKOUS OXIDE). 
 This was first described by Sir Humphry Davy. Dr. Wells, of 
 
AND MOST KECENT METHODS OF TREATMENT. 689 
 
 Hartford, first used it to destroy sensibility in extracting teeth. The 
 gas is made from nitrate of ammonia by heating and infiltration. 
 
 The gas is administered through tubes. At the present time it 
 is used chiefly to produce insensibility during the extraction of 
 teeth. It may, however, be used instead of chloroform and aether 
 during some of the operations of minor surgery, such as opening 
 abscesses, tearing out toe-nails, &c. 
 
 It is a safer anaesthetic than aether or chloroform. I have fre- 
 quently administered it, and sometimes to quite feeble patients. I 
 have never known any bad effects from its use. I would give it 
 even to the young children, if necessary. In these days it seems to 
 me to be entirely unnecessary to bear the pain of surgical opera- 
 tions. 
 
 "Were it not for its bulk, laughing-gas would be used much more 
 than it now is for surgical operations. It takes several gallons of 
 the gas usually to make a patient unconscious. This gas must be 
 carried in bags, and these bags occupy much space, while aether or 
 chloroform can be carried in the pocket. Nitrous oxide is called 
 " laughing-gas " because some people laugh and make fools of them- 
 selves while under its influence ; but it does not produce this effect 
 on all. iEther and chloroform will sometimes cause foolish lau^h- 
 ter. 
 
 The use of laughing-gas has been popularized mainly through 
 the lectures and efforts of Colton. 
 
 It is believed that the original experiments of Horace Wells, of 
 Hartford, with laughing-gas suggested to Morton the idea of trying 
 to produce insensibility by aether. 
 
 LEAD. 
 
 The acetate or sugar of lead is the only preparation of this metal 
 used internally ; from its astringent and sedative properties it is con- 
 sidered a powerful remedy in checking profuse bleeding from the 
 lungs, womb, and other internal organs ; we have given it repeatedly 
 in urgent cases of hemorrhage, to the extent of ten grains in the 
 course of twenty-four hours, mixed with a little distilled vinegar ; 
 two or three drops of Battley's opiate are usually given with each 
 dose. It has been also used with great advantage, combined with 
 opium, in cases of chronic dysentery and diarrhoea. Twelve grains 
 to a scruple of it dissolved in a pint of water, with the addition of 
 a little vinegar, are used externally as a lotion to inflamed surfaces ; 
 and three grains to an ounce of water form a good injection in 
 gonorrhoea. Goulard water , which is made by mixing a drachm 
 44 
 
690 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 and a half of extract of lead with a pint of water and a table- 
 spoonful of spirit, is much employed as an application in superficial 
 inflammation. 
 
 LEAD AND OPIUM WASH. 
 
 This is made by mixing one drachm of sugar of lead, one drachm 
 of opium, and one pint of water. It should be steeped and strained. 
 It is a substitute for the Goulard water. 
 
 LEPTANDKIN 
 
 Leptandrin is used as a laxative and to act on the liver, and it 
 is also claimed that it has tonic properties. It is frequently com- 
 bined with podophyllin. It is nsed in dyspepsia, jaundice, and in 
 chills and fever. The dose is from one to four grains. 
 
 LICE— LOUSINESS. 
 
 The skin of man is infested by five kinds of lice. The most 
 familiar forms are the head-louse, the body-louse, and the crab- 
 louse. The latter is generally found in the hair around the genital 
 organs. 
 
 Lice may cause a disease of the skin, such as prurigo, or 
 itching. 
 
 Head-lice may be destroyed by applying ointments of sulphur, 
 first cutting the hair short. 
 
 Body-lice may be destroyed in the same way. The clothing 
 must be destroyed, or boiled or steamed, or in some way exposed 
 to a very high temperature, so as to kill the insects with which it 
 may be infested. 
 
 Crab-lice may be treated in the same way as head-lice, or by 
 mercurial ointment, or infusion of tobacco. 
 
 LIME. 
 
 Lime-water is prepared in the following manner : " Take of lime 
 half a pound ; water twelve pints. Upon the lime, first slaked 
 with a little of the water, pour the remainder of the water, and 
 shake them together. Then immediately cover the vessel, and set 
 it by for three hours ; afterwards keep the solution with the re- 
 maining lime, in stoppered glass bottles, and when it is to be used 
 take from the clear solution." Lime-water is useful in indigestion 
 attended with acidity at stomach, is sometimes taken in protracted 
 
 
AND MOST RECENT METHODS OF TREATMENT. 691 
 
 cases of purging (diarrhoea), and in the last stages of dysentery. 
 The dose is one or two pints daily, in milk ; ten ounces of it con- 
 tains only four grains and a half of lime. 
 
 Lime-water is employed as an injection in leucorrhcea (whites), 
 and is applied as a lotion to indolent ulcers. 
 
 The chloride of lime, well known under the name of Ldbar- 
 raque's disinfecting fluid, has a powerful efTect in decomposing 
 and rendering harmless the putrid effluvia arising either from dis- 
 eased or decomposing animal matter, and as a disinfecting agent 
 6tands unequalled. Hence it is extensively employed for the pur- 
 pose of purifying sick-rooms, the wards of hospitals, crowded ships, 
 the cells of jails, and in a word, wherever it is necessary to destroy 
 infectious effluvia or to correct offensive odors. 
 
 A weak solution of the chloride of lime is much used as a lotion 
 for cancerous or other foul sores. 
 
 LITHIA. 
 
 This remedy is now considerably used for rheumatic gout. It 
 seems to have the effect to reduce the swellings of the joints in this 
 obstinate disease. It is given in doses of two, three, or four grains 
 in water. 
 
 Iodide of lithia ointment is now used with some success as an 
 external application to the inflamed joints in gout and rheumatic 
 gout. 
 
 These two remedies — lithia internally, and the ointment of the 
 iodide of lithia externally — seem to be our best remedies for rheu- 
 matic gout. It is unnecessary to state that their effects are by no 
 means certain. 
 
 LIYEK COMPLAINTS. 
 
 ACUTE INFLAMMATION OF THE LrVEE. 
 
 Inflammation may attack the substance of the liver, or may be 
 confined to the peritoneal membrane with which it is covered ; but 
 in the great majority of cases both these structures are affected at 
 the same time. The disease commences with a sense of chilliness, 
 or shivering, followed by hot and dry skin, full and hard pulse, 
 thirst, nausea, and generally bilious vomiting. The tongue is 
 white, or coated with yellow fur, and the patient complains of a 
 bitter taste in the mouth ; the bowels are generally constipated, 
 though sometimes there is bilious purging; the urine is scanty, 
 high-colored, and deposits a copious brick-colored sediment. In- 
 
692 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 deed the general symptoms can scarcely be distinguished from those 
 of bilious fever. When the inflammation is deep-seated, and con- 
 fined to the substance of the liver, the pain is dull ; but when it ex- 
 tends to the surface of the organ, or is seated in the peritoneal 
 covering, the pain is then acute, and augmented by coughing, 
 drawing in a full breath, lying on the sound side, or by pressing 
 with the hand under the ribs at the right side, either in front or 
 behind, towards the spine. When to the above symptoms are add- 
 ed jaundice, pain at the top of the right shoulder, and swelling at 
 the region of the liver, this cannot be mistaken for any other, dis- 
 ease ; but these signs, even in the most severe cases, are sometimes 
 entirely absent. 
 
 Acute inflammation of the liver, when not neglected at the 
 beginning, generally ends favorably between the seventh and twelfth 
 day from the commencement of the disease, and is usually followed 
 by bilious purging, a copious sediment in the urine, severe itching 
 of the skin, or bleeding from the nose. 
 
 When the inflammation terminates in the formation of an abscess, 
 which is not an uncommon occurrence in warm climates, the pain 
 becomes more acute, and is accompanied with a sensation of throb- 
 bing ; there is a troublesome dry cough, and in many cases hurried 
 breathing; the pulse, though still full, becomes softer; the palms of 
 the hands are distressingly hot ; the sleep is disturbed ; fits of shiver- 
 ing, alternating with profuse perspiration, are experienced; and all 
 these symptoms are aggravated towards night. In some cases, as 
 soon as the matter begins to form, all the feverish symptoms abate, 
 and the pain gradually diminishes ; but the swelling continues, and 
 the chills or shivering, alternating with perspiration, never fail to be 
 experienced. This termination is generally fatal, either in conse- 
 quence of the matter remaining confined in the liver, or by the 
 abscess bursting into the cavity of the belly. But it sometimes 
 happens that the abscess points externally, and the aid of the surgeon 
 is required to give vent to the matter ; or it bursts spontaneously, 
 and the patient recovers. Sometimes, again, the matter escapes 
 from the body through other channels, and the patient is thus 
 rescued from death 
 
 CHRONIC INFLAMMATION OF THE LIVER 
 
 Is frequently met with in temperate climates, and is much more 
 common in intertropical countries than the acute form of the dis- 
 ease. It is sometimes a sequence of the latter ; but in most cases 
 it comes on gradually, and is at first scarcely noticed by the patient. 
 Pain in the region of the liver is the principal symptom in the 
 
AND MOST RECENT METHODS OF TREATMENT. 693 
 
 chronic as well as in the acute form of the disease ; in the former it is 
 dull, heavy, and increased bj pressing with the hand over the part, 
 by going quickly up stairs, riding on horseback, and, in fine, by 
 any kind of active exercise ; it is also aggravated by lying on the 
 left side, or by any excess in eating or drinking ; and in some 
 cases may not be felt during many months, unless under the above 
 or similar circumstances. Cough is only an occasional symptom 
 when the inflammation is acute, whereas the chronic form of the 
 disease is almost invariably accompanied with a short dry cough ; 
 and quick walking or any unusual exercise brings on hurried and 
 difficult breathing, and perhaps a fluttering sensation at the heart. 
 The skin and eyes acquire a slightly yellow tinge, the evacuations 
 from the bowels have occasionally a white or clay-colored appear- 
 ance, indicating a deficiency of the biliary secretion ; while at the 
 same time the urine is scanty, high-colored, and deposits a copious 
 sediment ; and when the disease is of long standing, the liver 
 is generally observed to be unnaturally large. The symptoms, 
 however, are sometimes so obscure that the only indication of the 
 disease observed by the patient is a dull pain or an uneasy sensation 
 under the ribs at the right side. In many cases the first symptoms 
 noticed are a yellowish color of the skin and of the whites of the 
 eyes ; the unnatural appearance of the evacuations from the bowels 
 above mentioned, and the saffron-colored urine, depositing a brick- 
 dust-like sediment. If the right side be examined, the liver will 
 probably be found slightly enlarged, and tender when pressed upon; 
 but when not touched, the patient only experiences an uneasy sen- 
 sation of weight at the part, and is unabled to sleep when lying on 
 the left side. 
 
 The liver is a much-abused organ in various ways. It is worked 
 too much and dosed too much. Nor is this all. It is charged with 
 crimes of which it is not guilty. Nervous dyspepsia is too fre- 
 quently called biliousness. The word bilious is very indefinite, and 
 frequently misleads. Probably the nervous system is more at fault 
 than the liver in most of the cases of nervous dyspepsia. Those 
 who have a bad taste in their mouth, who are wearied, worn, dys- 
 peptic, and sleepless oftentimes, say that they are bilious when they 
 are really only nervously exhausted. Perhaps the bile may be de- 
 ficient in quantity or bad in quality ; perhaps it may flow into the 
 stomach and cause aversion to food, nausea, and vomiting; but in a 
 great many cases of the so-called biliousness the trouble lies in the 
 nervous system. The patient, therefore, does not need to be purged 
 and pulled down, but to be fed and built up. When they get 
 stronger their fancied biliousness will disappear. This is a subject 
 
694 
 
 of great importance, and should be thoroughly understood. Pa- 
 tients who are in this condition of exhaustion should take iron, 
 bark, phosphorus, arsenic, and the like. Every case is a law unto 
 itself, and must be studied by itself. 
 
 There are a variety of diseases of the liver which need not here 
 be described in any detail. I may simply give their names : "hob- 
 nailed " liver, which is said to be common among drunkards ; fatty 
 degeneration, enlargement, cancer, abscess, &c. 
 
 These diseases can only be made out and studied by a competent 
 physician. Percussion (see Percussion) is one of the means by 
 which physicians ascertain the condition of the liver. 
 
 All that patients can do when they suspect congestion or 
 chronic inflammation of the liver is to take good care of the general 
 health in every way, to use podojphyllin, nitro-muriatic acid, and 
 dandelion. Active out-door exercise sometimes works wonders in 
 these cases, especially for those whose occupations are sedentary. 
 
 TREATMENT OF INFLAMMATION OF LIVER. 
 
 It is next to impossible for one not medically educated to make 
 out correctly an inflammation of the liver as such. It will very 
 likely be confounded with abscess, or some other affection. 
 
 When we have good reason to believe that the liver is either 
 congested or inflamed, we can cautiously use those remedies that are 
 supposed to act upon that organ. These are : 
 
 1. Calomel. 
 
 2. Nitro-muriatic acid, from two to five drops in water, several times a day. 
 
 3. Dandelion. 
 
 4. Leptandrin. 
 
 See remarks on these remedies {Dandelion, Leptandrin). 
 
 In abscess of the liver little can be done but sustain and sup- 
 port the system, and let nature do the rest. 
 
 A foot-bath composed of three gallons of water, at the tempera- 
 ture of 96°, mixed with two ounces of nitric acid and one ounce 
 of muriatic acid, used every night for half an hour at bedtime, is 
 strongly recommended by several distinguished East Indian medical 
 men ; and sponging the body with a wash of the same nature has 
 also been found serviceable. 
 
 CHRONIC PAIN AT THE RIGHT SIDE. 
 
 Many persons are affected with pain at the region of the liver, 
 which becomes, at times, exceedingly severe, without being accom- 
 
AND MOST BECENT METHODS OF TREATMENT. 695 
 
 panied by symptoms of general excitement or swelling. It gener- 
 ally occurs in females ; but whether it be of a purely nervous char- 
 acter, or the effect of partial congestion, is not known. This affec- 
 tion, though sometimes very distressing, is not attended with dan- 
 ger. In some instances, after continuing several years, and obsti- 
 nately resisting every method of treatment, it has gone off entirely, 
 without any perceptible cause. It is more frequently removed by a 
 course of the rust of iron, with aloetic purgatives and regular ex- 
 ercise in the open air, than by local bleeding and mercury. 
 
 Torpor of the liver, or deficiency of the biliary secretion, is 
 indicated by the evacuations from the bowels being more or less 
 whitish or clay-colored, by languor and depression of spirits, capri- 
 cious appetite, impaired digestion, languid pulse, a sluggish state of 
 the bowels, and sometimes giddiness or headache ; there may be 
 also a yellowish tinge of the eyes and skin. 
 
 LOBELIA PDIAK TOBACCO). 
 
 Lobelia is used as an emetic, and in spasmodic affections and in- 
 digestion. It is not used as much now as formerly. The dose of 
 the wine tincture is from one drachm to two or three ounces. 
 
 LOCALIZED ELECTKIZATIOK 
 
 This term was first employed by Duchenne to distinguish a 
 method of using electricity in the treatment of disease. It is very 
 successful in paralysis, in some forms of neuralgia, and in some 
 other affections. 
 
 In the treatment of constitutional diseases, like dyspepsia, hys- 
 teria, hypochondria, nervous exhaustion, &c, general electrization 
 is for every reason to be preferred to localized. (See General 
 Electrization.) 
 
 Localized electrization is now very much used both in this coun- 
 try and especially in Europe. It has become known since 1850. 
 (See Electricity^) 
 
 LOCOMOTOR ATAXY. 
 
 This is a name that Duchenne has given to a disease that was 
 formerly confounded with paralysis of the lower limbs. The 
 patient afflicted with it cannot properly control the movements of 
 his legs. He staggers oftentimes like a drunken man. The diffi- 
 culty may extend to the hands. Sometimes he fails of grasping an 
 
696 
 
 object that lie aims for. The sight may also be affected. Sharp, 
 piercing pains are often felt in the limbs. 
 
 These are only a few of the general symptoms of this disease. 
 It is not to be expected that any but experienced physicians will be 
 able to make out this disease, or to discriminate between it and 
 common paralysis. 
 
 The results of the treatment of this disease are not very encour- 
 aging. Yery few cases recover. This disease is usually caused by 
 degeneration of a portion of the spinal cord. 
 
 General electrization is oftentimes of very decided service. (See 
 General Electrization^) 
 
 Phosphorus, phosphoric acid, and sometimes strychnine have 
 been beneficial. But with all our treatment the disease is a 
 grave one. 
 
 LUGOL'S SOLUTION. 
 
 This is a preparation of iodine and iodide of potassium. It is 
 used for the same purposes as iodine. The dose is from five to fif- 
 teen drops in sweetened water. 
 
 LUNAK CAUSTIC. 
 
 Lunar caustic, or nitrate of silver, has been used internally, in 
 the dose of a quarter of a grain made into a pill with bread-crumb, 
 given three times a day, gradually increased to five grains, in cases 
 of epilepsy, St. Yitus's dance, angina pectoris, and indigestion ; but 
 it does not appear to have been attended with much success, and in 
 many cases has produced the effect of imparting a permanent purple 
 or slate color to the skin. Externally a solution of from five to ten 
 grains in an ounce of water has been used with much benefit in 
 cases of irritable ulcers. The mode of applying it is by means of a 
 bit of lint fixed to the end of a probe, or with a hair pencil. A 
 weaker solution is an excellent application in purulent ophthalmia, 
 and is sometimes used as an injection in chronic gonorrhoea. It is 
 employed as a caustic to destroy chancres on their first appearance, 
 and in strictures of the urethra it is frequently applied at the end of a 
 bougie with great advantage. Applied round the inflamed surface 
 in erysipelas, it often has the effect of arresting the progress of the 
 disease. 
 
 LUNGS, INFLAMMATION OF. 
 
 Inflammation of the lungs {pneumonia), like all other in flam- 
 
AND MOST KECENT METHODS OF TREATMENT. 697 
 
 matory diseases, is generally ushered in by the usual symptoms of 
 fever. The patient is first attacked with a fit of shivering, which is 
 soon followed by hot skin, flushed face, quick pulse, and the charac- 
 teristic symptoms of the disease, namely, pain ? more or less severe, 
 in some part of the chest, quickened and oppressed breathing, with 
 cough and reddish-colored expectoration. When the substance of 
 the lungs only is inflamed, the pain is dull and heavy, or there is a 
 sensation of heat and weight in the chest without pain ; bat in the 
 great majority of cases the pleura, or membrane which envelops the 
 lungs, is also affected, and then a fixed pain, more or less severe, is 
 experienced at a particular part of the chest, which is increased by 
 coughing, or attempting to take in a full breath. Difficulty of 
 breathing is a constant symptom, and is more or less urgent accord- 
 ing to the extent or intensity of the inflammation. The respira- 
 tions in a healthy person vary in number from sixteen to twenty in 
 a minute ; but in this disease they are increased to thirty, or even to 
 forty, within the same time. When both sides of the chest are af- 
 fected, and the inflammation is severe, the anxiety, oppression of 
 the chest, and difficulty of breathing are exceedingly distress- 
 ing, and the patient feels as if he were about to be stifled ; but in 
 ordinary cases only one lung is affected, and the symptoms are then 
 less urgent. The patient finds the difficulty of breathing increased 
 by lying on the sound side, and therefore remains on the side af- 
 fected, or on the back, with the shoulders well elevated ; the latter 
 is the attitude generally preferred under all circumstances. The 
 expectoration is at first scanty, and composed, of a little thin frothy 
 mucus, but in the course of a day or two becomes more copious, 
 exceedingly viscid, and assumes a yellow, reddish, or rusty color, 
 according to the quantity of blood with which it is mixed. The more 
 severe the inflammation is, the more coherent and high-colored is 
 the expectoration, which becomes, when the disease is at its height, 
 so remarkably tenacious, that it adheres to the sides of the vessel 
 even when inverted and shaken in that position. The pulse in 
 most cases is quick and sharp, sometimes hard ; there is a pecu- 
 liarly hot, dry, or parched feeling of the whole surface of the body ; 
 the urine is scanty, and very high-colored ; and with these are con- 
 joined the other symptoms of fever, namely, thirst, loss of appetite, 
 furred tongue, headache, pain in the loins and extremities, and 
 weakness. Sometimes the brain becomes affected in the course of 
 the disease, causing delirium ; or the stomach, giving rise to nausea, 
 and perhaps vomiting ; and not unfrequently the fever, instead of 
 being inflammatory, is of the typhoid form. 
 
 The symptoms in favorable cases begin to decline about the 
 
698 
 
 fourth day; this change is indicated by the skin becoming more 
 cool and moist ; by the cough, which was previously short and dry, 
 becoming loose and less painful ; by the expectoration being more 
 abundant, less viscid, and gradually changing from the reddish or 
 rusty tint to a yellowish color ; these signs of amelioration being 
 accompanied with a corresponding diminution of the feverish symp- 
 toms. Some critical evacuation also usually takes place, such as 
 perspiration, a copious deposit of red or white sediment in the urine, 
 or purging ; the first is generally understood to be the most common. 
 The average duration of the disease is from eight to twelve days, 
 but sometimes it is prolonged for a fortnight or three weeks, and 
 followed by tedious convalescence, which is liable to be interrupted 
 by a relapse from any slight cause. 
 
 The symptoms which mark an unfavorable termination, are a 
 small, jerking, and rapid pulse, the expectoration being much dimin- 
 ished or altogether suppressed, great frequency of respiration, and 
 a livid appearance of the countenance. Lethargy and delirium also 
 indicate extreme danger. 
 
 The symptoms which particularly characterize inflammation of 
 the lungs are the peculiarly pungent heat of the skin at the com- 
 mencement of the disease, and when further advanced, the orange- 
 red or rusty color of the expectoration, arising from the intimate 
 admixture of blood with the secretion from the bronchial membrane; 
 and its great tenacity, which, as we have already mentioned, does 
 not allow it to be detached from the receiving vessel even when we 
 turn it upside down. 
 
 Cold is undoubtedly the most common exciting cause of inflam- 
 mation of the lungs. This is clearly shown by its prevailing to a 
 much greater extent in winter and spring than in summer, by its 
 frequent occurrence in cold climates, and rare appearance in inter- 
 tropical countries. Congestion of the lungs may be relieved by the 
 application of bran poultices to the chest and back between the 
 shoulder-blades. The poultices may be made of wheat or rye bran. 
 A small bag, containing a pint of bran, may be dipped in hot 
 water and immediately applied. This simple treatment may afford 
 great relief until the physician arrive. 
 
 Lung fever may be inflammation of the substance of the 
 lung or of the pleura. In the former case it is called pneu- 
 monia, in the latter pleurisy. The two may exist at the same 
 time. 
 
 Physicians now determine these diseases by auscultation (see 
 Auscultation) and percussion (see Percussion and Stethoscope). 
 
 It is therefore very important to have good medical advice in 
 
AND MOST RECENT METHODS OF TREATMENT. 699 
 
 all severe and acute inflammations of the lungs, especially as these 
 diseases are frequently fatal. 
 
 When no physician is at hand, and the symptoms are such as 
 have been described, the following treatment should be used : 
 
 1. Keep the bowels freely open by Epsom salts, or some simple 
 laxative. 
 
 2. Give small doses of ipecac, one to three grains, every three or 
 four hours. Tartar-emetic and veratrum viride (see Yeratrum 
 
 Viride) are used in this disease to reduce the inflammation and 
 lower the pulse. 
 
 3. Keep the chest covered by oiled silk. Allow the patient cool- 
 ing and agreeable drinks, such as lemonade and the effervescing 
 draughts. 
 
 In typhoid lung fever, when the patient is much exhausted, the 
 system should be sustained by beef tea, whiskey, brandy, punches, 
 opium, and quinine. (See Typhoid Fever, Treatment of.) 
 
 In pleurisy it is necessary to give some diuretic, like iodide of 
 potassium, to carry off the fluid that accumulates in the pleural 
 cavity. Blisters are also applied over the affected side with bene- 
 fit. Sometimes it is necessary to " tap " the chest and drain off* 
 the fluid. 
 
 LUPULIN (HOPS). 
 
 This remedy is given to calm and soothe the nerves, to promote 
 sleep. It is a mild substitute for opium and henbane. It is vastly 
 inferior to bromide of potassium. It may be tried, however, when 
 bromide of potassium fails. The dose is from one to six grains. 
 
 MAGNESIA. 
 
 This substance, from the property it possesses of neutralizing the 
 acid which forms in the stomach, is much used to relieve heartburn. 
 Calcined magnesia is in common use as a purgative, in the dose of 
 a teaspoonful. From the mildness of its action it is more especially 
 useful in cases of piles, stricture of the rectum, &c. ; and being also 
 insipid, is well adapted for children. It diminishes the secretion of ( 
 lithic* acid by the kidneys, and is therefore a useful remedy in red 
 gravel, in doses of from twenty to thirty grains twice a day. 
 
 Magnesia is the best antidote in cases of poisoning by the 
 mineral acids. 
 
 Magnetism (Animal). See remarks on this subject under flub- 
 bing. 
 
 * " Pertaining to the stone in the bladder. Lithic acid, generally called uric acid, 
 forms the most common variety of urinary calculus." 
 
700 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 MANNA. 
 
 The dose is from one to two ounces, but it is not to be depended 
 upon as a purgative for adults ; hence it is generally used in com- 
 bination with the infusion of senna leaves, the bitter taste of which 
 it tends in a great measure to conceal. From the mildness of its 
 operation it is well suited for children, in the dose of from ten to 
 sixty grains given in whey. 
 
 MEASLES. 
 
 Measles generally occurs as an epidemic malady amongst chil- 
 dren, but it may attack only a few individuals in a locality, or may 
 affect adults as well as those of tender years. 
 
 The symptoms which show that a child is about to be attacked 
 by measles are commonly significant enough. The little patient 
 complains of general heaviness, the eyes are red and watery, and a 
 thin fluid often runs from the nose as from persons affected with a 
 cold in the head ; the patient also sneezes frequently. More or less 
 fever now sets in, accompanied in many cases by a very hoarse 
 barking cough, which has often been mistaken for a symptom of 
 croup ; the stomach rejects food ; the child complains of pains in 
 the limbs or back, and if very young is often attacked by slight 
 convulsions, while older children are in many cases delirious at 
 night. Nothing can be more various than the intensity of these pre- 
 monitory signs ; sometimes the eruption makes its appearance wdtli 
 so little disturbance of the general health, that the patient is not even 
 confined to bed ; but in other cases the fever runs extremely high, 
 and great alarm would be excited did we not know that it was the 
 forerunner of an eruptive disease. Towards the end of the third or 
 beginning of the fourth day (but in some cases as late as a week), 
 small red spots, resembling flea-bites, makes their appearance about 
 the face, and then extend over the neck, chest, belly and limbs. The 
 spots are at first separated from one another, but they soon join and 
 form clusters of a horse-shoe shape and dusky red color. 
 
 The appearance of the eruption, however, does not, as in the 
 case of small-pox, bring with it much alleviation of the symptoms. 
 The fever, cough, and hoarseness continue or are more severe, and 
 in many instances the whole face is swollen, and the patient com- 
 plains of violent headache, with difficulty of breathing. 
 
 About the third or fourth day after the appearance of the erup- 
 tion the redness on the face begins to diminish, and it subsides on 
 
AND MOST RECENT METHODS OF TREATMENT. 701 
 
 other parts of the body in the same order as that in which it com- 
 menced. When the eruption has completely passed away the scarf- 
 skin comes off in small mealy scales, and some patients at this 
 time experience a most intolerable degree of itching. Finally, 
 about the ninth day the skin is completely free from any sign of 
 the eruptive affection. 
 
 Such is the course of measles in its mild or benignant degree; 
 but in many cases the disease does not hold this favorable course. 
 Two things are chiefly to be apprehended during its progress : first, 
 the appearance of nervous, or what were anciently called putrid 
 symptoms ; and, second, the occurrence of inflammation of the lungs, 
 by which a very great number of children affected with measles 
 are cut off. 
 
 Although, generally speaking, measles is a mild complaint, yet 
 during certain epidemics it assumes a most dangerous character 
 and destroys an immense number of children. The symptoms of 
 the malignant form are, at the commencement, great prostration of 
 strength, anxiety, and tendency to sleep; vomiting and looseness 
 of the bowels ; hemorrhages from the nose, stomach, or bowels ; 
 violent delirium, and convulsive tremor of the limbs, or general con- 
 vulsions. The eruption breaks out on the second day, and the fever, 
 with all its attendant symptoms, is aggravated ; the eruption rapidly 
 declines, or assumes a livid hue, and is mixed with the blue fever- 
 spots ; the delirium now becomes more violent, the convulsions are 
 frequent, and the patient commonly sinks in a state of complete 
 insensibility. This highly dangerous and fatal form is, however, rare, 
 and seldom occurs except during certain epidemics. But children 
 are peculiarly liable to inflammation of the lungs during the de- 
 cline of the eruption, or within a few days after its disappearance. 
 This occurrence is indicated by a change of color in the face and lips, 
 which assume a purplish hue ; the skin becomes very hot and dry ; 
 the respiration is oppressed and quick, often rising to sixty or seventy 
 in the minute; the nostrils dilate at each inspiration, and the pulse 
 is excessively quick. The child may or may not cough ; but we 
 should never forget that young children may labor under a very se- 
 vere degree of inflammation of the lungs without either coughing 
 or spitting up any mucus from the chest. Inflammation of the 
 lungs thus attending measles, often lays the foundation of consump- 
 tion, by which the patients are carried off many months, or even 
 years, after the cure of the original disease. 
 
 In some cases the eruption suddenly disappears from the face 
 and body. The sudden subsidence of the eruption is in itself a 
 matter of little consequence; it becomes, however, one of much im- 
 
702 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 portance, because it generally depends on, or at least is connected 
 with, an inflammatory condition of the lung, intestines, brain, or 
 some other internal organ. 
 
 Treatment. — In an ordinary attack of measles we have little more 
 to do than keep the child in bed, administer any mild laxative 
 medicine, so as to keep the bowels open, and give cooling drinks. 
 The disease must run its course ; and unless untoward accidents 
 arise, the patient will, generally speaking, get well through the aid 
 of nature in twelve or fifteen days. 
 
 Measles, as all know, is a very contagious affection. There 
 are those who have had two attacks. A case is reported of a fam- 
 ily, when, after all the children were successively attacked, the dis- 
 ease again attacked the one who first had it. 
 
 The course of treatment is usually very simple indeed, even 
 for the quite severe cases: 
 
 1. Keep the skin open with the following mixture : 
 
 Syrup of ipecac, 
 Syrup of squills, equal parts. 
 Dose a teaspoonful every three or four hours. 
 
 2. Give cooling and agreeable drinks ; lemonade and hard cider 
 are both excellent. Let the taste of the patient decide which to 
 have. 
 
 3. Tonics and nourishing food. 
 
 This treatment is only necessary for the cases that are followed 
 by debility. 
 
 It is not necessary to use many expectorant remedies. They are 
 all uncertain in their action, and are very apt to disturb the stomach. 
 
 Care should be taken to prevent the patient jfrtfm taking cold. 
 
 It is therefore not well to expose one's self very soon after re- 
 covery. 
 
 Measles leaves the eyes in a weak condition, therefore it is neces- 
 sary to take especial care that the patient does not begin to read 
 or to sew during convalescence. There are many who seriously 
 and permanently injure their eyes by beginning to use them too 
 early and too often when convalescing from measles. 
 
 Another bad result that measles sometimes leaves behind it is 
 deafness, with discharge from the ear. The inflammation of the 
 throat extends into the middle ear and causes ulceration. To avoid 
 this danger the throat should be frequently gargled, if the patient 
 is old enough to gargle, with solutions of chlorate of potash and 
 water — one drachm of chlorate of potash to one ounce of water. 
 The same solution may be snuffed up the nostrils three or four 
 times a day during convalescence. 
 
AND MOST RECENT METHODS OF TREATMENT. 703 
 
 "When the eruption suddenly disappears, we must not conclude 
 that this is necessarily a sign of weakness, and commence at once 
 with wine or other stimulating fluids. On the contrary, it will be 
 more prudent to endeavor to ascertain whether this may not depend, 
 as has already been mentioned, upon some internal inflammation ; 
 but if the disappearance seem to be connected with a general state 
 of weakness, or to have occurred without any apparent cause, then 
 we may give small quantities of wine and water, but with very great 
 caution, or administer the carbonate of ammonia in the following 
 manner : 
 
 Sub-carbonate of ammonia, six grains, 
 Camphor, three grains, 
 
 White sugar, three scruples. Divide into three powders ; one to be taken every 
 second hour. 
 
 MENSTKUATIOK 
 
 The periodical discharge of females termed menstruation indi- 
 cates the power of procreation, and when regular and in due quan- 
 tity serves not only as a sign of health, but as a powerful means of 
 preserving it. This discharge appears intended to relieve the sys- 
 tem of the blood which is destined for the support of the foetus dur- 
 ing pregnancy, as well as for the secretion of milk, the natural ali- 
 ment of the child during the first months of its existence ; and has 
 also the effect of stimulating the womb, and fitting it for conception. 
 If, therefore, the superabundant blood which is intended by nature 
 to be discharged through the medium of the womb, be retained in 
 the system, it must accumulate in other important organs, or tend 
 to deprave the whole mass of blood in circulation, and thus induce 
 local disease or general derangement of the health ; and if, on the 
 other hand, the discharge be much greater, or occur more frequently 
 than natural, the body will be weakened, and the health otherwise in- 
 jured. Hence, from the great influence which menstruation must 
 necessarily exercise over the whole system, it is obvious that perfect 
 health cannot be maintained while there is any irregularity or dis- 
 order of this important function. 
 
 A delicate and luxurious manner of living, early excitement of 
 the imagination, want of suitable exercise in the open air, sleeping 
 upon down beds, late rising, and, in a word, mismanagement or 
 neglect of the moral or physical education of girls, tend strongly to 
 induce precocious menstruation. The non-appearance of the dis- 
 charge before the age of seventeen, or even later, is more desirable 
 than its premature occurrence ; the latter, however, is not to be 
 
704 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 considered as a disease in itself, although it generally indicates a 
 feeble constitution. 
 
 Young women are often late in menstruation, and this some- 
 times becomes a source of much anxiety to parents; but although 
 it be delayed considerably beyond the fourteenth year, there is no 
 occasion for alarm as long as the usual signs of puberty are absent. 
 In this case we are not anthorized to adopt means for the purpose 
 of hastening menstruation, nor should we be justified in attempting 
 to remove the various ailments to which girls are subject at this 
 period of life, by administering remedies to bring on the menstrual 
 flux. But on the other hand, when, at the usual age of puberty, 
 pain is experienced from time to time at the loins and in the abdo- 
 men, with an unusual development or painful sensation of tension of 
 the breasts, a periodical swelling at the lower part of the belly, and 
 other symptoms indicating that the system is making fruitless at- 
 tempts to establish menstruation, it then becomes necessary to adopt 
 means to aid the efforts of nature, in order to prevent the serious 
 consequences which might result from retention of this salutary 
 evacuation. But we are not to interfere more than is really neces- 
 sary. When medical aid is realty required, the remedies to be em- 
 ployed must depend greatly upon circumstances. If the girl be full- 
 blooded and of a robust constitution, and if, at the period when the 
 symptoms above enumerated are experienced, she complain of head- 
 ache, while at the same time the pulse is full, the face flushed, and 
 other symptoms are present, indicating an excess of action, the 
 bowels should be mildly acted on by cooling purgatives every sec- 
 ond or third day ; and the diet must be mild and carefully regulated, 
 and stimulants of every description entirely abstained from. 
 
 An opposite state of the system, approaching to chlorosis (green 
 sickness), occurs much more frequently than the ' plethoric state 
 above described. In this case the patient becomes pale, languid, 
 emaciated, loses strength, and is easily fatigued ; the pulse is feeble, 
 the bowels are constipated, and she complains of being unable to 
 keep her feet warm. The treatment indicated in the last case was 
 to lower the plethoric patient to a state favorable to menstruation ; 
 here, on the contrary, we must endeavor to raise the patient to the 
 same state by tonic and strengthening remedies. Of this class of 
 medicines, preparations of iron hold the first rank in all menstrual 
 disorders. From ten to fifteen drops of the tincture of chloride of 
 iron in a little water should be taken regularly three times a day, 
 and the bowels are to be kept open by some aloetic aperient. 
 
 The hip-bath and foot-bath should also be frequently used ; the 
 water at first ought to be about the temperature of a hundred de- 
 
AXD MOST EECEXT METHODS OF TEEATMENT. . 705 
 
 grees of Fahrenheit's thermometer, and afterwards gradually in- 
 creased until it be as hot as the patient can bear. 
 
 The strength must be supported by generous diet. Frequent 
 friction of the lower extremities with the flesh-brush or horse-hair 
 glove is serviceable ; and instead of depressing the gifrs spirits by 
 confining her to the house, and treating her as if she were laboring 
 under a serious illness, she ought to be allowed to enjoy the benefit 
 of change of air to the sea-coast, plenty of exercise in the open air, 
 •particularly on horseback, dancing, and the society of agreeable 
 companions. Every care should be bestowed to render her cheer- 
 ful and happy. 
 
 In general, the duration and quantity of the first discharges are 
 not to the same extent as when menstruation is fully established; 
 and it often happens that two or three months elapse between the 
 first and second discharge, and sometimes the menses do not appear 
 at regular periods until the expiration of a year or two. 
 
 It is of the greatest importance that young women should be 
 instructed early by their female friends in the management of them- 
 selves during menstruation. Exposure to cold, dancing, and all 
 kinds of active exercise, food difficult of digestion, bathing, medi- 
 cines, particularly emetics and purgatives, mental excitement, and 
 other causes which might check the discharge, ought to be carefully 
 avoided at this period. 
 
 Even in the most healthy women menstruation occasions a 
 general disturbance of the system that cannot be entirely disre- 
 garded with impunity. There is peril in exposure or exertion at 
 that time which might be perfectly harmless during the interval ; 
 and thousands of suffering and feeble women date their troubles 
 from slight indiscretions at this critical period. The daily routine 
 of ordinary duties may often be performed with little or no discom- 
 fort, but it is always of the greatest importance to guard against 
 any exertion that fatigues either mind or body. Those who suffer 
 from irregular or painful menstruation should be especially careful 
 of themselves, not onlv during their sickness, but for two or three 
 days before and after. Much may be lost and nothing can be gained 
 by taxing the energies to their utmost, when nature imperatively 
 demands repose. 
 
 CHLOEOSIS. 
 
 A characteristic symptom of chlorosis is a pale yellowish- green 
 complexion ; hence it is commonly called green-sickness. 
 
 Chlorosis is always a chronic disorder, and commences slowly. 
 The patient is at first languid and listless, disinclined to amuse- her- 
 45 
 
706 
 
 self as usual, and is easily fatigued by ordinary mental or bodily 
 occupation ; her face gradually becomes pale, and the skin assumes 
 a sallow appearance ; the bowels are constipated ; she loses her appe- 
 tite, and has sometimes an unnatural craving for certain articles of 
 food ; the tongue is white, the breath fetid ; and if menstruation has 
 been already established, the discharge loses its red color, and di- 
 minishes in quantity until it no longer appears. 
 
 In the confirmed state of the disease there is often considerable 
 emaciation ; the flesh loses its firmness ; the lips, tongue, gums, and 
 inside of the mouth are unnaturally pale or whitish ; slight swelling 
 in the eyelids and face is observed in the morning, this w T ears off 
 during the day, and at night the feet or ankles are swollen ; the 
 urine is pale and limpid ; the belly is frequently enlarged from 
 flatulency, particularly after eating ; there is sometimes nausea or 
 vomiting in the morning, heartburn, and other symptoms of indi- 
 gestion. The appetite is in many cases morbidly capricious. 
 Sometimes there is a craving desire to eat pickles, chalk, lime, pipe- 
 clay, cinders, &c. The shortness of breathing, which in the first 
 stage w r as only slight, is now exceedingly oppressive, and accom- 
 panied with palpitation of the heart on ascending the stairs, at- 
 tempting to walk quickly, &c. The pulse is feeble and small, 
 there is great difficulty in keeping the feet warm; sometimes there 
 is cough, periodical headache, and a variety of nervous or hysterical 
 symptoms. 
 
 Causes.— Females, of the lymphatic temperament and of weak 
 constitution are most frequently attacked with chlorosis. It is de- 
 veloped under various debilitating causes, as frequent exposure to a 
 cold moist atmosphere, watery or poor diet, more especially when 
 conjoined with fatigue and long watching, the various depressing 
 passions, as grief, unrequited love, &c. 
 
 This disease seldom proves fatal ; but, when left to itself, or badly 
 treated, it may be prolonged during many months, or even years, 
 and may leave traces of its injurious effects on the constitution in 
 after life. 
 
 Treatment. — There is no disease in which the administration of 
 iron, in some of its many forms, is attended with such uniformly 
 favorable results. The tincture of chloride of iron should be taken 
 in doses of fifteen drops three times a day, about half an hour be- 
 fore each meal ; the diet must be nourishing, as fresh meat and 
 bread, and easy of digestion. The patient should walk out in the 
 air and sunlight, take plenty of sleep, and frequently sponge the 
 body off and rub thoroughly dry with a coarse towel. Care is 
 necessary, however, to avoid attempting too much at first. The 
 
AND MOST EECENT METHODS OF TREATMENT. 707 
 
 bowels are to be regulated before beginning a tonic course, and the 
 stomach must be gradually accustomed to the medicine. Exercise^ 
 too, must be carefully regulated according to the patient's strength, 
 and increased by slow degrees as health returns. (See Women, 
 Diseases of.) 
 
 SUPPRESSION OF THE MENSES. 
 
 Women in the full enjoyment of health may have the discharge 
 arrested suddenly, from exposure to cold, sudden fright, or any 
 strong mental emotion. In this case there are headache, pain in 
 the limbs, back and loins, full frequent pulse, and other symptoms 
 of fever. The foot-bath is to be used as early as possible, or the 
 patient may sit with the lower part of the body immersed in a tub 
 of water, at the temperature of one hundred degrees, for twenty 
 minutes or half an hour, and after being carefully wiped dry, she 
 is to be well wrapped up and placed in a warm bed. Two or three 
 of the pills of rhubarb and aloes are to be taken every three or 
 four hours, until the bowels are freely opened ; and, to promote 
 perspiration, eight or ten grains of Dover s powder may be given 
 every six hours, until three or more doses are taken. This treat- 
 ment, conjoined with light nourishing diet, or abstinence, if the 
 feverish symptoms run high, seldom fails to bring back the dis- 
 charge. But if the patient be neglected, or if the treatment 
 adopted fail to produce the desired effect, the menses may not ap- 
 pear at the next expected period, and the suppression becomes 
 chronic. In many cases, again, the obstruction is the result of 
 general bad health, and comes on slowly ; the discharge either 
 gradually diminishing in quantity or appearing at unusually pro- 
 tracted intervals, until at length it ceases entirely. The health for 
 the first month or two may not suffer materially, but the important 
 function of menstruation cannot be long suspended without pro- 
 ducing a series of morbid symptoms. The balance of the circulation 
 may be deranged, and determination of blood to different organs 
 may take place, and. give rise to hemorrhage (discharge of blood) 
 from the lungs, stomach, bowels, or nose. The latter occurs most 
 frequently, and is a salutary effort of nature to relieve the patient. 
 The digestive organs frequently suffer, the tongue becomes foul, the 
 appetite impaired, and the bowels constipated, or otherwise disor- 
 dered. The lower part of the abdomen is at times swollen and 
 painful, and the breasts are sometimes tense and tender, or painful 
 when pressed upon. Many women are troubled with various ner- 
 vous diseases, as hysterics, spasms, &c, while the menses are ob- 
 
708 DESCRIPTION OF THE PKINCIPAL DISEASES, 
 
 structed, and recover entirely when tlie healthy function of the 
 womb is restored. 
 
 In the treatment of chronic suppression of the menses, we must 
 in the first instance endeavor to restore the general health. If 
 there be a greater inclination to sleep than is compatible with health, 
 lassitude, occasional giddiness, and a sensation of fulness or weight 
 in the head, full pulse, an overcharged state of the veins, a more or 
 less turgid appearance of the countenance, suffusion of the eyes, 
 slight palpitation of the heart, and other symptoms indicating ple- 
 thora, or repletion of the blood-vessels, the bowels are to be kept 
 freely open, and spare diet, abstinence from wine or malt liquor, 
 early rising, and regular exercise in the open air, must be strictly 
 enjoined. When by these or other means suited to the circum- 
 stances of the case, the system is sufficiently lowered and the gen- 
 eral health improved, the menstrual flux will probably return with- 
 out the assistance of remedies which are understood to exercise a 
 specific influence on the womb ; but if the discharge fail to appear, 
 we must then have recourse to preparations of iron ; and at the 
 period when the patient feels as if she were about to be unwell, the 
 hip-bath, and the application of hot fomentations to the lower part 
 of the belly, are to be repeatedly employed. The repeated appli- 
 cation of mustard poultices to the breasts has been known to bring 
 back the menses after they had been a long time suppressed. But 
 it must be kept in mind that these remedies are only to be used at 
 the periods when the menses ought to appear, or when they seem dis- 
 posed to flow / and if there be no symptoms to indicate these periods, 
 they should be employed during three or four days every month, 
 for four or five months in succession, or longer if necessary ; the 
 regimen and diet, as above directed, being strictly followed during 
 the intervals. 
 
 No one is justified in administering remedies with the intention 
 of bringing back the menses, without being satisfied that the sup- 
 pression is not the result of pregnancy. To neglect this precaution, 
 or to mistake the natural for a morbid suspension of the discharge, 
 might lead to the most serious consequences. It should also be 
 borne in mind that suppression of the menses is more frequently 
 the effect of other diseases than a disease of itself; when merely 
 symptomatic, the principal indication is to remove the disorder on 
 which it depends ; but at the same time we should not neglect to 
 use the necessary means to restore the healthy functions of the 
 womb, because the absence of the menstrual discharge always in- 
 creases any disorder with which it may be complicated. In all 
 cases of this description, however, it would be improper to use 
 
AND MOST RECENT METHODS OF TREATMENT. 709 
 
 medicines internally, with the intention of stimulating the womb, 
 inasmuch as this effect cannot be produced without at the same 
 time exciting the diseased organ on which the suppression depends ; 
 and we must therefore trust to diet, leeching, the warm hip-bath, 
 and other local means above prescribed, conjoined with treatment 
 suited to the principal disease. 
 
 PAINFUL MENSTRUATION. 
 
 This is a very common disorder, and is a source of great suffering 
 to many women. Two or three days before the discharge appears, 
 the patient complains of pain in the back, loins, and lower part of 
 the belly, irritation of the stomach, constipation of the bowels, 
 general uneasiness and irritability of temper. The latter symp- 
 tom, however, is not constant. The discharge comes away at first 
 in drops, accompanied with increased suffering. The pain extends 
 from the loins and lower part of the abdomen to the hips and thighs. 
 The belly may be swollen from flatulency. Sometimes there is con- 
 siderable pain and difficulty in voiding urine, or it is altogether 
 suppressed during the first day or at the time the symptoms are 
 most urgent. The pain is not constant, is much more severe at one 
 time than another, and generally ceases with the discharge, which 
 is generally scanty, although it may continue to flow three or four 
 days, or even longer. At the commencement of the disorder the pa- 
 tient may experience pain only during the first day of the discharge, 
 but the suffering gradually becomes more severe and of longer dura- 
 tion, until at last from eight to fifteen days of every month are 
 passed in this manner; the general health, spirits, and vigor de- 
 cline, and after many years of unceasing bodily or mental distress, 
 at one period suffering acute pain, at another dreading its approach, 
 the constant irritation of the system, which has been unavoidably 
 kept up, frequently induces consumption, organic disease of the 
 womb, or some other fatal disorder, and the patient is carried off. 
 
 Treatment. — The warm hip-bath should be employed three or 
 four times daily ; this has considerable effect in increasing the dis- 
 charge, and mitigating the pain ; and the bowels are to be kept 
 open by mild laxatives. In general it is found necessary to admin- 
 ister ojrium, in the dose of one or two grains, every four or five 
 hours, or at longer intervals, according to the circumstances of each 
 particular case; or three grains may be passed up the rectum. 
 When symptoms of hysteria are present, assafmtida should be com- 
 bined with the opium; and if the belly be much distended, an 
 enema (injection to the bowels) of a solution of the former remedy 
 seldom fails in removing the flatulence. 
 
710 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 Some preparation of iron should be given during the intervals. 
 If the patient be of scrofulous habit of body, the iodide of iron is 
 to be preferred ; if it produce slight nausea, giddiness, and head- 
 ache, the dose should be diminished, or the medicine altogether dis- 
 continued for a time. 
 
 Immoderate flowing of the menses cannot last long without the 
 patient experiencing a variety of symptoms arising from deficiency 
 of blood in the system. She gradually loses strength, and becomes 
 exceedingly languid ; the breathing is hurried on any ordinary exer- 
 tion ; the face is pale and contracted, or may appear bloated and 
 fuller than natural, and there is a livid circle round the eyes ; the 
 appetite is greatly impaired ; the bowels are constipated ; and at 
 night the feet and ankles are swollen. Symptoms indicating a defi- 
 ciency of blood in the brain are often superadded to these ; headache, 
 giddiness, and ringing in the ears are complained of; there is con- 
 siderable nervous irritability, the patient being disturbed by the 
 slightest noise ; the pulse is quick, weak, and easily excited ; and pal- 
 pitation or fluttering at the heart is brought on by slight exertion. 
 
 EXCESSIVE MENSTRUATION. 
 
 Some women menstruate much more freely than others, and yet 
 enjoy perfect health. But when, in any individual case, the men- 
 strual discharge lasts longer than usual, or, lasting the usual time, 
 is remarkably profuse in quantity, the condition is one significant 
 of some disease. It may be that there is an impaired condition of 
 the blood, or some disorder of the circulation ; or there may be 
 disease of the uterus itself, or the surrounding organs. Profuse 
 menstruation occurs when the system is plethoric, and also when 
 it is debilitated and relaxed. One of the worst causes of this 
 menstrual irregularity is excessive matrimonial indulgence, which 
 induces an irritable and congested state of the uterus and its 
 appendages. Entire abstinence in this respect is essential in the 
 management of the disorder under consideration. 
 
 The treatment must of course be varied according to the condi- 
 tion of the patient and the cause of the disease. If that cause be 
 debility, the chief attention must be directed to the restoration of 
 health by tonics, nourishment, exercise and fresh air. Iron will be 
 found of service in this condition. Cold hip-baths, and vigorous 
 rubbing of the skin with coarse towels, will aid in restoring the 
 circulation, care being taken at all times to keep the feet and limbs 
 comfortably warm. 
 
 If the patient is of full and robust habit, a different course of 
 treatment will be required. The bowels must then be kept freely 
 
AND MOST RECENT METHODS OF TREATMENT. 711 
 
 open by saline aperients, the diet must be sparing, and all stimu- 
 lants, even coffee, avoided. 
 
 Excessive menstruation is often a symptom of uterine disease ; 
 it may be of tumors within or without the cavity of the womb, &c, 
 in which case it will be impossible for an inexperienced person to 
 form any satisfactory opinion of the case, or to distinguish between 
 an excessive discharge at the menstrual period, and bleeding from 
 some cause independent of menstruation. Skilled advice should 
 be sought in all cases of doubt, since prolonged uterine hemorrhage, 
 from any cause, is always accompanied by danger. 
 
 The immediate treatment during a profuse flow consists in keep- 
 ing the patient perfectly quiet upon her back, and the application 
 of cold water by means of towels to the lower part of the bowels 
 and to the bleeding parts. Cold and acid drinks should be given, 
 and all hot drinks, even tea, strictly prohibited. The room should 
 be cool and quiet, conversation with the patient avoided, and an 
 opiate administered to calm the nervous system. If these simple 
 measures do not speedily check the flow, no time should be lost in 
 obtaining competent medical advice, as it may be necessary to make 
 applications directly to the womb, or even to plug the vagina firmly 
 with cotton. 
 
 CESSATION OF THE MONTHLY DISCHARGE. 
 
 The cessation of the menses being a natural process, and not a 
 disease in itself, we may safely leave nature to accomplish this salu- 
 tary change in the system, and should carefully avoid interfering, 
 unless symptoms occur to authorize the employment of remedial 
 •measures. The treatment in ordinary cases consists in attention to 
 diet, which should be light, nourishing, and easy of digestion; in 
 regular exercise in the open air, care being taken to avoid exposure 
 to cold or damp ; in wearing warm clothing, and paying great at- 
 tention to keep the feet warm ; in the occasional administration of 
 castor-oil, or any other mild medicine, if the state of the bowels re- 
 quire the aid of laxatives ; and in keeping the mind tranquil. 
 
 Various symptoms occasionally occur which lead women to be- 
 lieve themselves pregnant : besides the absence of the discharge at 
 the usual monthly periods, the breasts become enlarged, tender, and 
 sometimes painful ; the belly is gradually distended from flatulence 
 collected in the bowels, and there is sickness, and sometimes vomit- 
 ing in the morning ; but these symptoms may easily be relieved by 
 means of the usual remedies for expelling flatulence, viz. purgatives 
 and active exercise. 
 
712 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 MERCUEY. 
 
 * 
 
 In small and frequently repeated doses, are the preparations princi- 
 pally employed in various chronic disorders, in order to check or 
 alter diseased action ; hence they are called alteratives ; and from 
 the influence which they exercise on all the secreting organs of the 
 body, certainly constitute the most effective remedies of this class. 
 
 CORROSIVE SUBLIMATE 
 
 Is seldom used internally. A useful gargle for syphilitic sores in 
 the throat is composed of three or four grains of this mercurial dis- 
 solved in a pound of barley-water, with the addition of two ounces 
 of honey of roses ; and one grain to three or four ounces of water 
 forms a serviceable lotion for ulcerations, or specks on the cornea or 
 anterior part of the globe of the eye. 
 
 Which is composed of one grain of calomel, one grain of the golden 
 sulphuret of antimony, and two grains of gum-guaiac, has been 
 long celebrated as an alterative remedy in a variety of diseases, 
 especially chronic affections of the skin, chronic rheumatism, and 
 syphilitic eruptions ; it is also of great service in the cure of obsti- 
 nate ulcers, connected with general derangement of the health. 
 
 MERCURY WITH CHALK 
 
 Is the mildest preparation of mercury ; hence it is often used in 
 many of the complaints of children. It acts less on the stomach 
 and bowels than other mercurials, and is therefore frequently pre- 
 scribed when calomel and blue pill cannot be borne. The dose for 
 an adult is from five grains to a scruple. 
 
 MERCURIAL OINTMENT 
 
 Rubbed into the skin produces the same effect on the system as 
 other preparations of mercury taken internally ; hence this is the 
 most eligible method of inducing salivation when the digestive or- 
 gans are too irritable to bear calomel or blue pill. Half a drachm 
 to a drachm, rubbed in night and morning on the inside of the 
 thighs, is the quantity used ; but when it is necessary to produce a 
 speedy effect, the same quantity may be employed every hour. The 
 warm bath occasionally favors the absorption of the mercury. This 
 
AND MOST RECENT METHODS OF TREATMENT 
 
 713 
 
 ointment is also used as a dressing to syphilitic sores, to destroy in- 
 sects on the skin, and, combined with camphor (byway of friction), 
 to reduce various kinds of chronic tumors. 
 
 MICKOSCOPE. 
 
 The microscope is an instrument that is now quite familiar to 
 many who know little or nothing of the science of medicine. 
 
 The accompanying cut (see cut) represents one of the more 
 common forms of microscope. The tube a, b contains the lenses. 
 Those at a form the <?y<?-piece, and those at b the 6>&/<?<?£-glasses. 
 The specimens to be examined are put on c, on which the mirror 
 d throws the light. The apparatus is adjusted at f and e. 
 
 Some microscopes have three eye-pieces, several object-glasses. 
 Microscopes magnify in all directions, and many thousand times 
 the measurement of the object examined. 
 
 The microscope has wrought a great revolution in the science 
 of medicine. It has given a new impetus to the study of disease, 
 and has really created an era in science. 
 
 It informs us of the constitution of the blood, 
 of the bones, and of the various tissues, se- 
 cretions, and excretions of the body in health 
 and in disease. By its aid we can distinguish the 
 mucous secretions of the urethra, the bladder, 
 the mouth, and the vagina. By its aid we 
 can detect in the spermatic fluid the presence 
 or absence of spermatozoa. By its aid we 
 can determine the existence of that most 
 serious affection of the kidneys — Bright's 
 disease. (See BrigMs Disease.) By its aid 
 we can study a large number of diseases 
 of the brain and spinal cord, of which with- 
 out it we could know little or nothing. By 
 its aid we can determine the internal struc- 
 ture of tumors, and decide in regard to the 
 
 probabilities of life or death with those who suffer from them. By 
 its aid we can detect the stains of blood, and thns help to convict 
 the guilty criminal, or acquit the innocent. By its aid we now 
 know, or think we know, the mysterious sources of many of our 
 most terrible diseases ; that ague is caused by a spore in the atmos- 
 phere, and that a large number of our fevers are transmitted by 
 the same agency ; that the water we drink and the air we breathe 
 are always filled with animalcules and fungi, in number and variety 
 
714 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 past comprehension. By its aid we have recently solved the 
 mystery of that loathsome disease trichiniasis (see TricJiiniasis) , 
 and discovered that the worm found in the flesh of the hog 
 is propagated by millions in the muscles of those who carelessly 
 eat it uncooked or underdone. And yet microscopic science is yet 
 in its infancy. Its proudest triumphs are yet in the future. 
 
 MILK ABSCESS. 
 
 Inflammation may attach both the breasts at the same time, but 
 is generally confined to one only; and it often happens that after 
 one is healed the other becomes inflamed. The acute form of this 
 affection usually commences three or four days after delivery ; the 
 breast becomes hot, painful, .swollen, hard, and red at particular 
 parts, or over its whole surface. The local symptoms are accompa- 
 nied with fever, which is more or less severe according to the 
 extent and intensity of the inflammation. Sometimes the pain 
 becomes excruciating, and is increased by the slightest movement ; 
 the patient is deprived of sleep ; the whole breast is enlarged, and 
 the swelling and pain even extend to the arm-pit. In some cases 
 the breast acquires a lobulated or knotted appearance, as if there 
 were several distinct tumors. This disease requires prompt treat- 
 ment, lest an abscess form, producing a " broken breast." 
 
 Treatment.— -The first indication is to prevent the inflammation 
 terminating in the formation of matter. But the means usually 
 employed for this purpose are not likely to be successful unless 
 resorted to at a very early stage ; and in numerous instances, in 
 spite of the most active remedies, suppuration cannot be prevented. 
 The bowels ought to be freely acted upon by repeated doses of Ep- 
 som salts, Seidlitz powders, or any other cooling saline purgative. 
 Low diet is to be strictly enjoined; and the breasts are to be drawn 
 at proper intervals by means of the breast glass or pump, this opera- 
 tion being performed as gently as possible. 
 
 If cold applications increase the patient's suffering, warm linseed 
 or bread poultices are to be substituted ; or the well-known popular 
 mode of applying warmth, called by nurses " bowling the breast," 
 may be employed. A wooden bowl, well heated by immersion in 
 boiling water, is to be wiped dry, and the breast, being properly 
 protected by flannel, is then to be placed in it, and supported by a 
 suitable bandage. The dish retains the heat a considerable time, 
 and thus an equal degree of warmth is constantly applied, under 
 the soothing influence of which the milk often flows copiously, to 
 the great relief of the patient. 
 
AND MOST RECENT METHODS OF TREATMENT. 715 
 
 To moderate the feverish symptoms and alleviate the pain, the 
 subjoined draught may be given every four hours : 
 
 Mmdererus' spirit, three drachms, 
 
 Solution of the acetate of morphine, from five to eight drops, 
 
 "Water, sweetened "with a little sugar, two ounces. Mix. 
 
 MILK FEYEK. 
 
 It frequently happens that women are affected, on the third day 
 after delivery, with headache and feverish symptoms, generally pre- 
 ceded by slight- shivering or a sensation of chilliness ; the skin be- 
 comes hot, the pulse full and quick, the tongue dry, with considera- 
 ble thirst, and the breasts are turgid, and tender or painful. 
 
 To counteract this state of febrile excitement, the child ought 
 to be applied to the breasts at an early period after delivery, and 
 this should be done repeatedly until the milk begins to flow. On 
 the third morning a mild dose of castor-oil (half an ounce), lenitive 
 electuary, or rhubarb and magnesia, should be taken ; but cooling 
 saline purgatives are to be preferred if there be a tendency to fever. 
 
 If the breasts become much distended with milk, and if relief 
 be not afforded by frequently putting the child to them, it will then 
 be advisable to draw off two or three spoonfuls of the milk by 
 means of a breast-glass or pump. 
 
 To subdue the feverish symptoms, two scruples or more of nitre 
 dissolved in barley-water may be given in the course of the day ; 
 the bowels are to be pretty freely acted upon by laxative draughts, 
 as above directed ; and low diet must be strictly enjoined. 
 
 MIXDEEEEUS' SPIEIT. 
 
 Mindererus' spirit, or solution of the acetate of ammonia, is 
 much employed as a sudorific, i.e. a medicine producing sweat. 
 It promotes perspiration, without quickening the circulation, or 
 increasing the heat of the body ; hence it is given in fever, acute 
 rheumatism, and other inflammatory disorders, where stimulating 
 sudorifics are inadmissible. The dose is one or two tablespoonfuls 
 every two or three hours, warm barley-water or some other mild 
 beverage being taken freely to promote its operation. It is usually 
 taken in combination with nitre and the preparations of antimony. 
 
 MISCAERIAGE AND ABOETION. 
 
 The expulsion of the child from the womb at any time between 
 the seventh month and the full term of utero-gestation is called 
 
716 DESCRIPTION OF THE PRINCIPAL 
 
 premature labor; and when the foetus is expelled before the seventh 
 month the process is called miscarriage or abortion. In the latter 
 case the foetus is either already dead, or its different organs are not 
 sufficiently developed to admit of life being sustained. 
 
 So many circumstances in life act as occasional causes of mis- 
 carriage, that the limits of this work will only allow us to notice 
 some of the principal of them, among which may be mentioned 
 various mental emotions, as sudden fright, anger, joy, disappoint- 
 ment, and distress of mind from whatever cause : violent coiiffhinsr, 
 excessive purging or constipation of the bowels, profuse blood-let- 
 ting, falls, blows, sea-sickness, the extraction of a tooth, and the 
 various causes which excite undue determination of blood to the 
 womb, as over-exertion in walking, riding, or dancing, errors in 
 diet, and immoderate sexual indulgence. 
 
 Some women are so constituted that any of the above-mentioned 
 causes may readily induce miscarriage, whereas in others it cannot 
 be brought on by the strongest moral or physical causes. "Numer- 
 ous cases are recorded of violent means having been unsuccessfully 
 employed to procure abortion ; and it cannot be too generally known 
 that even where these criminal measures do succeed, it is often at 
 the expense of the woman's life. The symptoms preceding or ac- 
 companying miscarriage vary according to the period of pregnancy 
 at which it occurs ; during the first two months the embryo or 
 foetus is discharged without pain or much loss of blood, and it often 
 happens at this early stage that the woman is not aware she has 
 miscarried, and attributes the discharge to the return of the menses. 
 At a later period the death of the foetus is announced by great 
 depression of strength and spirits, palpitation of the heart, paleness 
 of the countenance, fetid breath, a sensation of coldness and weight 
 at the lower part of the belly, mucous discharge from the genital 
 organs ; sometimes there is frequent desire to void urine, and after 
 the middle of the fifth month the movements of the child cease to 
 be felt. These signs are followed by more or less profuse flooding, 
 and clots of coagulated blood may be observed, which serve to dis- 
 tinguish this discharge from that of the healthy menstrual fluid, 
 which never coagulates. The flooding is accompanied with acute 
 pain, extending from the navel to the genitals ; and bearing-down 
 pains, resembling those of regular labor, are occasionally felt. At 
 last the foetus comes away, and is generally enveloped in its mem- 
 branes when the accident occurs before the third month of preg- 
 nancy ; in the following months the membranous bag containing 
 the foetus bursts, and the waters are immediately discharged ; then 
 the foetus comes away, and finally the after-birth. 
 

 AND MOST RECENT METHODS OF TREATMENT. 717 
 
 Sometimes symptoms threatening abortion continue during two 
 or three days; the woman is first attacked with rigors or shiver- 
 ings ; shortly afterwards the pulse becomes quick and full, the skin 
 hot with thirst, and other signs of general excitement, accompanied 
 by a sensation of weight and fulness at the lower part of the belly 
 and loins, followed by discharge of blood from the womb in larger 
 or smaller quantity, with pains at intervals resembling those which 
 take place at the commencement of natural labor. When snch 
 symptoms are manifested miscarriage is very likely to occur, yet 
 by timely and judicious treatment this accident may be averted, the 
 bearing-down pains may be suspended, and the flooding checked, 
 and the womb may retain the child until the full period. But 
 when the mouth and neck of the womb soften, and the bag of 
 waters begins to protrude, while the discharge and contractile pains 
 continue, all our efforts to prevent miscarriage will be fruitless. 
 
 Miscarriage takes place most frequently during the first three 
 months of pregnancy; when it happens in consequence of the 
 gradual decay and death of the foetus, which is by far the most 
 common cause, it is less dangerous than when it occurs suddenly 
 from accidental or violent causes; under all circumstances, the 
 danger increases with the advance of pregnancy. Sometimes the 
 after-birth is retained for several weeks after the foetus has been 
 expelled, becomes putrid, and is discharged in detached pieces; 
 or it may remain during several months, and then be thrown off 
 in a shrivelled or partially dried state, or in the form of a fleshy 
 mass. 
 
 Treatment. — When, from the symptoms above mentioned, we 
 have reason to believe that the foetus is dead, it would be useless to 
 attempt preventing miscarriage ; but if signs of plethora (fulness 
 of blood) and general excitement be manifested, together with the 
 local premonitory symptoms already noticed, we then have it 
 greatly in our power to ward off the threatened accident, and this 
 may even be effected after flooding and irregular pains have been 
 experienced ; but if the waters be discharged, miscarriage is in- 
 evitable. In all cases, but more especially where the woman is 
 nervous and of an irritable temperament, it is advisable to ad- 
 minister an opiate (half a grain of morphine, or fifteen drops 
 of laudanum) immediately after the bleeding, in order to allay the 
 bearing-down pains or contractions of the womb. The diet should 
 consist of light farinaceous food, as arrow-root, sago, toasted bread, 
 &c. ; and lemonade, soda-water, or any other cool beverage may be 
 drank freely. But the most essential part of the treatment, with- 
 out which neither the above nor any other means are likely to 
 
718 
 
 be of much service, is mental and bodily quietude. This must be 
 strictly attended to from the time that premonitory symptoms 
 make their appearance until all danger is past. The apartment 
 should be large and well-aired, and the patient should lie on a 
 mattress or couch, with the body lightly covered. In the event 
 of flooding coming on, cold applications are to be assiduously 
 employed, as before directed, until the discharge is arrested. 
 When the pains and flooding have ceased, a little castor-oil, with 
 from ten to fifteen drops of laudanum, or a mild dose of rhubarb 
 and magnesia, may be given to act gently on the bowels. 
 
 When all our efforts to prevent miscarriage prove ineffectual, 
 and the foetus is expelled, while the after-birth is retained in the 
 womb and the flooding continues, the ergot of rye, or plugging 
 the vagina, in the manner recommended under the head of 
 Flooding, should be employed ; or the acetate of lead, which has 
 a powerful effect in subduing hemorrhage, may be administered. 
 
 The cold hip-bath, or sponging the lower extremities and lower 
 part of the belly with cold vinegar and water, strict attention 
 to diet, moderate but regular exercise, cooling saline laxatives, 
 and abstaining from conjugal intercourse during the first five 
 months of pregnancy, will be found the best preventives of mis- 
 carriage. 
 
 Women who have once miscarried should be especially careful 
 of themselves at the time corresponding to the menstrual period, 
 and for two. or three days before and after. The recumbent po- 
 sition should be maintained at such times, and the diet should be 
 moderate. Hot drinks of all kinds must be avoided. 
 
 MONSEL'S SOLUTION (OR SOLUTION OF PERSUL- 
 PHATE OF IRON). 
 
 This is our best agent for arresting the flow of blood from 
 a wound. It may be applied directly to the bleeding orifice. It 
 is hardly necessary to state that, when a large artery has been 
 opened, pressure must be used in addition to our other appli- 
 cations. 
 
 MORTIFICATION. 
 
 The appearances of a mortified part are very striking, and when 
 once seen can seldom be mistaken afterwards. They are best 
 observed in cases of mortification from cold, or in that peculiar 
 form of the disease which often attacks the extremities of old people. 
 
AND MOST KECENT METHODS OF TREATMENT. 719 
 
 The parts so affected lose gradually all feeling, the natural heat is 
 also lost, and the mortified portion of the body or limb becomes 
 quite cold ; it is of a brown, livid or black color : decomposition 
 now takes place sooner or later ; the scarf-skin is raised up in little 
 tumors from the gas which is disengaged by the decomposing flesh ; 
 a very offensive odor is emitted, and any discharge which may 
 accompany the mortification is of a highly fetid kind. The dead 
 part is now either removed from the body by a natural process, 
 or excites a species of low fever, which eventually terminates 
 in death. 
 
 It should, however, be remarked that in many cases mortifica- 
 tion is not so complete as we have just described it to be; but is 
 preceded by what medical men call gangrene. Here the parts are 
 not completely dead, but are more or less rapidly approaching to 
 a state of mortification ; the powers of life in the part are much 
 diminished, but not quite extinct ; some feeling still remains, and 
 the blood circulates in some of the vessels. 
 
 Causes and Symptoms. — One of the most frequent causes of 
 mortification is unquestionably inflammation. When certain parts 
 of the body are violently inflamed (more especially if the inflam- 
 mation be of an erysipelatous kind) they are subject to partial or 
 complete mortification, and this is the more to be dreaded in per- 
 sons of dissipated habits, or those whose health is reduced by poor 
 food, bad air, and irregular modes of life. When mortification is 
 about to take place we generally find that the pain and fever which 
 accompanied the inflammation suddenly diminish or altogether sub- 
 side ; the affected part gets soft, and loses its natural heat and feeling, 
 while at the same time it assumes a dark or livid color ; the scarf- 
 skin soon becomes separated from the true skin underneath, and 
 sometimes vesicles filled with fluid, and resembling small blisters, 
 appear on different points of the mortified surface. Our descrip- 
 tion is confined to mortification of external parts, for when any of 
 the internal organs are attacked by mortification, the case is alto- 
 gether beyond the reach of medicine. 
 
 The life of any portion of the body cannot be sustained without 
 a due supply of blood and nervous power ; hence any cause which 
 suspends or interrupts this supply may excite mortification. Thus 
 long-continued pressure will often occasion mortification, as we 
 frequently see in cases of typhus fever, &c. Cold, also, is often 
 another cause; and people should always remember that when 
 parts which have been frost-bitten or frozen are suddenly warmed, 
 they are very apt to be attacked by gangrene and mortification. 
 
 Treatment. — When the inflammatory symptoms have been, re- 
 
720 
 
 DESCEIPTIOtf OF THE PRINCIPAL DISEASES 
 
 moved, or when from the beginning the mortification is attended 
 with low nervous fever, and the patient seems to be sinking under 
 the disease, it will be absolutely necessary to support his strength 
 by a mild, nourishing diet, by stimulants and tonics, and by cor- 
 dials. The best cordial, perhaps, which we can give is a wine-glass- 
 ful of Sherry or Madeira wine, every four hours or oftener, accord- 
 ing to the necessities of the case. 
 
 As in many cases of mortification, the pain, restlessness, and 
 anxiety of the patient are distressing, we must endeavor to mitigate 
 the pain and relieve the suffering by opiate medicines. These may 
 be combined with the quinine, if the latter be given, or with a few 
 grains of nitrate of potass or camphor. As it has been proved that 
 in many cases opium produces a stimulating effect, it will be more 
 prudent to administer half a grain of the acetate of morphia every 
 five or six hours. 
 
 However, in the peculiar species of mortification which attacks 
 the toes and feet of old people, w T e may give one grain of solid 
 opium every three or four hours with advantage. 
 
 The local treatment of mortification is very simple. The best 
 thing that we can do is to envelop the mortified part in a large 
 poultice, and renew the latter as often during the day as cleanliness 
 may require. The following poultices are those most frequently 
 recommended by surgeons : 
 
 Charcoal Poultice. 
 
 Add about two ounces of finely powdered charcoal to half a pound of common lin- 
 seed poultice. 
 
 Beer Poultice. 
 
 Take of the grounds of strong beer half a pint; add as much oatmeal as will make 
 it pretty thick, and then stir it up. 
 
 Yeast Poultice. 
 Add to an infusion of malt as much oatmeal as will render the substance of a proper 
 thickness, and then add a spoonful of yeast. When the mortified portions are being de- 
 tached, and the patient complains of much pain, we may add two or three teaspoonfuls 
 of laudanum to the poultice. 
 
 To counteract the fetid discharge and smell which always attend 
 cases of mortification, we may use with advantage the chlorine 
 lotion, composed of one part of chloride of lime to eight parts of 
 water. 
 
 MOUTH, INFLAMMATIONS OF. 
 
 Children are most liable to diseases of the mouth. 
 
 Simple inflammation of the mouth is recognized by the redness, 
 swelling, and soreness of the gums and tongue. 
 
 It is treated by solutions of marsh-mallow ', or borax, or chlorate 
 of potash. 
 
AND MOST RECENT METHODS OF TREATMENT. 721 
 
 Thm.sh. — The symptoms of this disease are small whitish points 
 and patches in the mouth. It is sometimes accompanied by fever. 
 It is connected with a vegetative growth, — the o'ideum albicans. 
 
 One of the best remedies for this disease is chlorate of potash, in 
 doses of from 5 to 30 grains, according to age of patient. It may 
 be given in solution. (See Chlorate of Potash.) 
 
 When the child is feeble it should be supported by tonics. 
 
 Parents should avoid tampering with their children too much in 
 this or in similar affections. It is best to be on the safe side, and use 
 only simple measures until the physician arrives. 
 
 It is generally safe to use chlorate of potash in almost any form 
 of inflammation of the mouth. 
 
 Canker of the mouth is a very disagreeable and sometimes pro- 
 tracted disease. 
 
 It consists of an ulcer, that forms on the gums, or lips, or cheek. 
 It is of a whitish, grayish, or yellowish color. It is usually of a 
 very offensive odor. 
 
 The ulcer may be washed with glycerine and water, weak solu- 
 tions of carbolic acid and water (see Lotions), and may be touched 
 with " blue-stone " or sulphate of copper. Everything should be 
 done to sustain and strengthen the patient. 
 
 Gangrene of the ?nouth is a very serious disease. It begins with 
 an ulcer on the cheek or gums. In time this spreads and assumes 
 the character of mortification. The discharge is of a most offen- 
 sive character. The disease may extend even to the bone. 
 
 This disease is caused by poor and insufficient food, and by bad 
 air. It is an alarming affection, and needs the best possible skill. 
 
 The great thing is to strengthen and sustain the system of the 
 child by stimulants, tonics, and nourishing food. Beef-tea should 
 be used freely, and if necessary brandy or whiskey may be given. 
 
 To the ulcer we may apply lotions of carbolic acid, or of per- 
 manganate of potash, or sulphite of soda. (See Lotions.) 
 
 Nursing sore mouth. — This is the familiar complaint of those 
 who nurse children. 
 
 Like all other inflammations of the mouth, it is best treated by 
 chlorate of potash. For adults it may be given in large doses, say 
 20 grains. 
 
 MOVEMENT CURE. 
 
 The Swedish Movements, that were originally proposed by Ling, 
 have recently obtained a deserved popularity. Establishments for 
 conducting this method of treatment are already in operation. 
 46 
 
722 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 OPERATIONS OF THE MOVEMENT CURE. 
 
AND MOST RECENT METHODS OF TREATMENT. 723 
 
 Strictly speaking, all muscular exercise — walking, running, 
 riding, jumping, skating, riding velocipedes— is a part of the move- 
 ment cure. In our establishments, which are, or should be, con- 
 ducted by experienced hands, the movements are carefully elaborated 
 and systematized by the aid of machinery and various contrivances. 
 In short, the " movements " are simply exercise refined and sys- 
 tematized. They exercise portions of the body, especially of the 
 internal organs, that are little affected by ordinary activity. Hence 
 their great benefit in many cases of chronic disease of these internal 
 organs, especially of the abdomen. 
 
 General electrization and the " movements " both cause many 
 muscular contractions, and in this way increase the processes of 
 waste and repair in the system. Both are useful in dyspepsia, 
 hypochondria, constipation, paralysis, and nervous exhaustion and 
 other conditions of debility. 
 
 EXERCISES OF THE MOVEMENT CURE. 
 
 We present herewith some cuts representing a few of the exer- 
 cises and manipulations of the movement cure. They are taken 
 from Roth's treatise on the subject. These are but a few of many 
 that might be described. Mechanical appliances of various kinds 
 are employed. Some of these are put in motion by steam-power. 
 
 Gymnastics are very properly included under Movement Cure. 
 The gymnasium is really an establishment for the preservation of 
 health and the cure of disease by muscular movements. The chief 
 difference between the two lies in this, that in the one case the 
 movements are mostly passive, in the other mostly active. The 
 movement cure is chiefly designed for those who are partial or com- 
 plete invalids, the gymnasium for those who are comparatively 
 well. The one is used to regain health, the other to retain it. 
 
 DUMB-BELLS. 
 
 This distinction is a very general one, and is by no means always 
 or necessarily observed. Invalids who are quite weak may be much 
 benefited by a judicious use of light gymnastics, and those who are 
 
724 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 in comparative health may also be profited by the passive exercises 
 of the movement cure. 
 
 Gymnastics have been recommended by physicians from very 
 early periods. The Greeks were famous for their athletic games. 
 Concerning the dress of the gymnast Mr. Watson remarks : 
 " The dress opens in front, and is both more convenient and 
 more beautiful than one which opens behind. It is so constructed 
 that the wearer's limbs are as free as air ; that she can even clap 
 her hands, with arms vertical, above her head without discomfort. 
 " It will be observed that the gentleman's dress is loose and com- 
 fortable. The primary object of the costume is not to 
 exhibit rounded and shapely limbs and well-devel- 
 oped muscles, but to give ease and comfort to the 
 student in all of his positions and movements. The 
 military jacket, without unnecessary padding, is 
 selected. It has no useless skirt, and the collar is 
 neither high nor stiff. The trousers, which are very 
 loose, are gathered in and buttoned at the ankle, 
 or fastened with an elastic band or a small strap. 
 
 " Students may exercise in their street dresses. 
 The gentlemen will remove their coats. The ladies 
 will use elastic bands to sustain their skirts, so that 
 the wearers' legs and feet may have free play. 
 Bathing dresses will very generally be found pretty 
 and appropriate for these exercises." 
 
 Concerning dumb-bells Mr. Watson gives these 
 suggestions : 
 
 " Cast-iron dumb-bells of proper form and 
 weight are deservedly popular among the best gym- 
 nasts. Heavy bells, however, are almost useless for 
 exercise, affording only a few movements that serve 
 as a test of strength. When using a single bell for 
 this purpose, both arms should be employed to the 
 same extent, so as to avoid a one-sided development. 
 "Dumb-bells weighing from three to fi.ve 
 pounds, properly used, are sufficiently heavy for 
 the strongest man. Be one's time never so much 
 limited, they should not weigh more than twenty- 
 five pounds to the pair. 
 
 " The best and most approved dumb-bell at the 
 present time is turned from wood. The timber 
 should be sawed into scantlings, and well seasoned 
 before turning it into bells. Maple, beech, birch, 
 
 INDIAN CLUBS. 
 
AND 
 
 MOST RECENT METHODS OF TREATMENT. 725 
 
 EXERCISES WITH INDIAN CLtTBS. 
 
 WITH WAND. 
 
726 DESCRITTION OF THE PRINCIPAL DISEASES, 
 
 K X 
 
 S-J 
 
 "WITH WAND. 
 
 EXERCISES WITH DUMB-BELLS. 
 
 HAND-SWING, WITH RINGS. 
 
AND MOST RECENT METHODS OE TREATMENT. 727 
 
 
 \ 
 
 EXERCISES WITH DUMB BELLS. 
 
r 28 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 :<&>-. 
 
 ,-*•*? 
 
 D 
 
 EXEBCISE WITH DUMB-BELLS. 
 
 HAND-OVER-HAJS T D ASCENT. 
 
 EXEBCISE WITH DUMB-BELLS. 
 
 HORIZONTAL LADDEB EXEBCISE. 
 
AND MOST RECENT METHODS OF TREATMENT. 729 
 
 EXERCISES WITH RINGS. 
 
 ROWING IN A SINGLE WHERRY. 
 
 This, when not carried to excess, is one of the best of our methods of exercise. Boat-racing, for 
 tnose who are to lead sedentary lives, is not to be commended. It is too violent and exhausting. 
 
730 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 oak, and hickory make very good bells for family and school use. 
 Locust is the best domestic wood for this purpose ; rosewood is still 
 better ; lignum-vitae is best of all." 
 
 From J. Madison Watson's excellent treatise on this subject I 
 have, by the courtesy of the author, selected a few cuts illustrating 
 some of the exercises with the wand, rings, dumb-bells, and Indian 
 clubs. The dotted lines denote the positions assumed by the operator 
 during the exercises. 
 
 The " Lifting Cure " is a modification of the movement cure, 
 and is to be so considered by those who inquire concerning it. The 
 objection to the lifting cure is that it is too exclusive. The move- 
 ment cure should exercise the whole body, and in a variety of ways. 
 And yet there is no question but that some patients do receive 
 benefit from the use of these special methods of movement. 
 
 There are those to whom any form of active or passive exercise 
 — by whatever name it may be called — is always more or less bene- 
 ficial. 
 
 It is a mistake to suppose that there is any mysterious virtue in 
 any special method of exercises as such. Many who are benefited 
 by a course of treatment by the lifting cure, or by the rubbing cure, 
 or by pounding, or by any or all of the operations of the movement 
 cure, would have been still more benefited by a trip into the coun- 
 try, a week of hunting or fishing, or by a few weeks' experience 
 in boating. The great advantage of the movement cure is that it 
 systematizes exercise, and by the novelty of its arrangements in- 
 duces many to avail themselves of its benefits who otherwise would 
 not use their muscles at all. As I have before remarked, one secret 
 of the remarkable success of general electrization in nervous diseases 
 is in the fact that it causes vigorous and repeated contractions of a 
 large number of the principal muscles of the body. 
 
 RUBBING 
 
 Is a species of muscular exercise. It constitutes an important ele- 
 ment of the movement cure. 
 
 ANLMAL MAGNETISM. 
 
 Of this science we as yet know little or nothing. The evidence 
 that there is a certain mysterious force in the system, by means of 
 which one person can influence another, is, to say the least, sug- 
 gestive. 
 
 The rubbing exercises of the movement cure unquestionably 
 benefit in some other way than by merely exciting muscular activity 
 and stimulating the circulation. 
 
AND MOST RECENT METHODS OF TREATMENT. 731 
 
 It is not impossible that in the future the mystery of this force 
 will be explained. 
 
 MUMPS. 
 
 This disease is seated in the parotid gland and surrounding 
 cellular substance. It is sometimes epidemic, and is generally be- 
 lieved to be contagious. It usually commences with slight shivering, 
 followed by hot skin, thirst, and other feverish symptoms, which sel- 
 dom run high. The constitutional derangement is soon followed by 
 swelling under the angles of the jaws, gradually extending over a 
 considerable part of the throat affected. The swollen parts feel 
 firm and elastic, are slightly red, and tender or painful. When 
 the tumefaction is extensive, there is some difficulty in swallowing, 
 and pain on moving the jaws. The disease generally begins to 
 subside on the fourth or fifth day, and in the course of a few days 
 the neck resumes its natural appearance ; but in some cases, when 
 the swelling is diminishing at the neck, the testicles in males and 
 the breasts in females become swollen ; this continues for some 
 days, and then disappears gradually. Sometimes, however, the 
 testicles remain enlarged for a considerable length of time. When 
 the disease is confined to one side of the neck, the testicle or 
 breast of the same side only is affected. This disease occurs 
 most frequently in children, and generally in those of scrofulous 
 constitution. 
 
 Treatment. — The mumps seldom require medical treatment. 
 Stimulating food and drink should be avoided ; mild laxatives are 
 necessary, and a little purified nitre dissolved in barley-water may 
 be taken. The neck should be protected from cold by covering it 
 with fine flannel. If the testicles or breasts become swollen and 
 painful it will be advisable to apply leeches, and afterwards warm 
 fomentations of marsh mallow or poppy-heads, and warm poultices 
 of linseed or bread and milk. 
 
 MUEIATIC ACID. 
 
 It is sometimes employed both internally and as a gargle 
 in typhus fever and scarlatina. From eight to fifteen drops, mixed 
 with four ounces of water, are used by some practitioners as an 
 injection for the cure of gonorrhoea. Muriatic acid is a good 
 adjuvant to mercury in syphilitic cases, where there is constitu- 
 tional irritability complicated with debility. 
 
 Nitro-muriatic Acid, which is so much used in diseases of 
 
732 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 the liver, is composed of three parts nitric acid to five parts of 
 muriatic acid. 
 
 The dose is from three to eight drops in sweetened water. 
 
 MUSK. 
 
 Musk is a peculiar secretion which is deposited in a small sac 
 situated near the umbilicus of the Moschus Moschiferus, or musk 
 animal, a native of the Himalaya Mountains and other elevated 
 regions of Asia. 
 
 The dose is from six to twenty grains, repeated, if necessary, 
 every five or six hours. It is difficult to obtain that which is 
 genuine. 
 
 NASAL DOUCHE. 
 
 This is a very simple arrangement for cleansing the nasal pas- 
 sages in catarrh (rhinitis). (See Catarrh.) It consists of a bottle, 
 with a piece of rubber tubing attached to an outlet at the bottom. 
 To use the douche, fill the bottle partly or entirely with the weak 
 solution of common salt or chlorate of potash, or whatever is desired ; 
 
 NASAI, DOUCHE. 
 
 place one end of the rubber tube in one of the nostrils ; now slowly 
 raise the bottle high enough so that the liquid will flow into one 
 nostril and out of the other, thus cleansing both passages. (See cut.) 
 This is an excellent domestic remedy for catarrh of the nasal 
 passages. (See Catarrh^ 
 
 NERVOUS DISEASES OF MODERN TIMES. 
 
 The types of disease, like the types of character, change with the 
 progress of civilization. If we look closely enough into this subject, 
 
AND MOST RECENT METHODS OF TREATMENT. 733 
 
 we see that it could not be otherwise. All disease is an abnormal 
 condition of the body, and is, of course, variously modified by the 
 nature and condition of the body. As the body changes, so must 
 its diseases change. Take, for illustration, the very familiar disease 
 which we call measles : we find that it behaves very differently with 
 different constitutions and in different states of the system. Although 
 there are certain characteristics by which it is to be recognized in all, 
 yet it behaves very differently in the strong and the weak, in the 
 phlegmatic and the nervous. 
 
 What is true of measles is more or less true of all other dis- 
 eases. 
 
 Small-pox, rheumatism, the different forms of fever, diseases of 
 the skin, affections of special organs — all are variously modified by 
 the age, the sex, and the nature of the constitution. This fact is 
 so well recognized in science that it may be regarded as a truism. 
 
 But the modification of disease by the constitution does not 
 stop here. JVew diseases, or new phases of disease, are developed 
 corresponding to changes in the constitution. The diseases of youth 
 are different from those of infancy, of adult life from those of youth, 
 while those of old age are different from those of adult life. 
 
 The same law applies to nations as well as to individuals. In 
 the infancy of mankind the diseases of mankind were both fewer 
 and simpler than at present. With the advance of civilization, with 
 the increase in the forms of activity, with the modifications that the 
 constitution has undergone, by the pressures, the excitement, and the 
 manifold anxieties of modern society, there has been a correspond- 
 ing change in the types of disease. Instead of a few diseases, we now 
 have many. The few diseases of old times were, however, more 
 fatal than the many of recent dates. Instead of a few plain symp- 
 toms, we now have legions of symptoms — subtle, undefined, over- 
 lapping and running into each other. 
 
 In the infancy of mankind, indeed in all ages and countries 
 prior to the last two centuries, the muscles were used more than the 
 brain. Consequently, the predominant diseases were those which 
 chiefly affected the muscular and vascular systems, such as fevers, 
 inflammations, etc. In this ripening maturity of mankind, and 
 among all enlightened people, especially since the invention of print- 
 ing, the brain has been used more than the muscles. Consequently, 
 the predominant diseases of our day are those which chiefly affect 
 the brain and nervous system. 
 
 Within the past twenty-five or thirty years there has been ob- 
 served a marked increase in the number and in the severity of what 
 are known as nervous diseases. This fact has been observed, not 
 
734 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 only by the profession but by the people, and is now generally ac- 
 cepted. 
 
 I am aware that on these subjects there is great liability to error. 
 We are apt to judge from indefinite general impression, without 
 regard to statistical facts. Now general impressions, in regard to 
 changes in the types of disease, are very apt to be erroneous. And 
 yet on this subject the general belief is, I think, correct. Statistics, 
 so far as they go, seem to confirm this general impression. 
 
 There is no question in my mind that nervous diseases have been 
 on the increase for the past quarter of a century, and that they are 
 still increasing with the advance of our civilization. 
 
 The question now arises, what are nervous diseases f I reply, 
 diseases that primarily or chiefly affect the brain, the spinal cord or 
 the nerves that issue from them, or the sympathetic system. 
 
 Paralysis is a nervous disease. It is always a result of some 
 diseased condition of the brain, of the spinal cord, or of some of the 
 nerves that issue from them. It may take place by reflex action from 
 diseases of the bowels, the womb, etc. ; but in such cases it takes 
 place through the nerves. (See Paralysis.) 
 
 Neuralgia is a nervous disease. It may result from the same 
 causes that produce paralysis. The derivation of the word itself 
 means "pain of the nerve." It is a very distressing and very 
 common affection, but very fortunately it is much more susceptible 
 of relief than formerly. (See Neuralgia, Tic Douloureux.) 
 
 Dyspepsia and Constipation are usually nervous diseases. They 
 are usually results of general nervous debility. They are symp- 
 toms of exhaustion. Dyspepsia may result from inflammation of 
 the stomach, from cancer, from ulcer, or other local difficulty ; but in 
 the majority of cases in our times it is a symptom of constitutional 
 nervous disturbance, and should be treated accordingly. (See Dys- 
 pepsia and Constipation.) 
 
 Nervous exhaustion is a nervous disease. The blood may be 
 healthy in quantity and quality, the muscles may be large and firm 
 and wiry, and withal the system may be thoroughly debilitated: 
 no organic disease can be detected ; and yet the patient is depressed, 
 sleepless, feeble, incapable of severe exertion of mind or body. There 
 are thousands of women in our land who spend nearly their whole 
 lives in a condition of nervous exhaustion. They are never actually 
 confined to the bed for any length of time. Perhaps they rarely 
 consult a physician, and yet they never know what it is to be really 
 well. To vigorous, lively health they are strangers. There are 
 students who, during their educational career, pass through this stage 
 between the ages of fifteen and twenty. There are young ladies 
 
AND MOST RECENT METHODS OF TREATMENT. 735 
 
 who pass through this same stage perhaps for many years before 
 they arrive at strength and womanhood. There are in our time 
 both men and women who never know any other condition or feel- 
 ing than that of nervous exhaustion. (See Nervous Exhaustion.) 
 
 Hypochondria is a nervous disease. It is probably in all cases 
 a symptom of some disturbance of the brain or of the sympathetic 
 system. It is oftentimes, though not always, a premonitor of in- 
 sanity. This statement need not frighten those who are troubled 
 with hypochondria, except so far as to make them vigilant to use all 
 proper means to accomplish a cure. It was formerly supposed that 
 hypochondria was not a disease, but merely a whim. Physicians 
 are now beginning to see that it is really a disease, and that it must 
 be treated as such ; and that it is curable, frequently as relievable, 
 as other diseases. It may afflict those who have exceedingly strong 
 muscles, who have excellent good sense, and who naturally are 
 jovial and light-hearted. In hypochondria the whole character fre- 
 quently becomes changed. This change probably corresponds to 
 some changes in the nervous system. The hypochondriac is not 
 entirely a free moral agent. (See Hypochondria.) 
 
 St. Vitus' 's dance is a nervous disease. It occurs chiefly in chil- 
 dren, though it maybe met with in adults, and even in the aged. It 
 occurs in those whose nervous systems are in some way debilitated. 
 It is caused probably by some subtle derangement of the spinal 
 cord or brain, or of both. Sometimes it is confined to a single nerve, 
 or branch of a nerve. (See St. Vitus' *s Dance.) 
 
 Epilepsy is a nervous disease. This also is a symptom of vari- 
 ous diseased conditions, and oftentimes of the most opposite char- 
 acter. It may occur in those who are apparently strong. (See 
 Epilepsy.) 
 
 Spermatorrhea is usually a nervous disease. It was formerly 
 supposed to be a local difficulty merely, a result of local inflamma- 
 tion. The truth is that it is like dyspepsia, — usually a symptom of 
 constitutional debility. It is more frequently a result than a cause. 
 The masses of the people have very erroneous ideas on this subject. 
 The tendency is to exaggerate its importance, and to attribute to it 
 many diseases that it does not bring on, but of which it is itself the 
 result. Nearly all the popular ideas on the subject of seminal 
 emissions are wrong. (See Spermatorrhoea.) 
 
 Hysteria is a nervous disease. It is a symptom of some subtle, 
 indefinable difficulty of the brain, the spine, or of the sympathetic 
 system. Like many other nervous diseases, it may occur in those 
 who are apparently muscular and strong. Hysteria sometimes runs 
 into actual insanity. It is a positive disease, like hypochondria ; and 
 
736 
 
 like hypochondria it should be treated with patience and with judg- 
 ment. Like hypochondria it is very susceptible of treatment, is 
 oftentimes relievable and curable. (See Hysteria^) 
 
 Sick headache is a nervous disease. Like epilepsy it is a kind 
 of disturbance of the nervous force, somewhat analogous to the mag- 
 netic disturbances of the heavens. Like the other nervous diseases, 
 it may occur in those who have large, firm muscles. It is popularly 
 supposed to be the result of " biliousness." Biliousness is a term 
 that really means nothing, and is very apt to mislead. When one 
 feels sick at the stomach we say that he is bilious. Now sickness at 
 the stomach may result from lack of bile as well as from overflow 
 of it. It may result from a merely diseased condition or morbid 
 irritability of the nerves that supply the stomach. The nausea and 
 vomiting of sick headache are frequently, like the pain in the head, 
 the results of the nervous disturbances, and not the causes. (See 
 Sick Headache.) 
 
 Sea-sickness is a nervous disease. (See Sea-sickness.) 
 
 Insanity is a nervous disease, and like all other nervous diseases, 
 it has probably increased with the advance of civilization. It is 
 always a symptom of some morbid condition of the most important 
 part of the central nervous system. (See Insanity.) 
 
 Besides these, loss of voice, asthma, may be nervous in their 
 character. (See larynx, Diseases of, and Asthma.) 
 
 Tetanus, or locked-jaw, is a nervous disease. It was formerly 
 supposed to be of an inflammatory character. It is now regarded 
 as essentially a nervous affection. 
 
 Hydrophobia is a nervous disease, and is treated accordingly, 
 though unfortunately without success. (See Hydrophobia.) 
 
 Delirium tremens and chronic alcoholism and dipsomania, and 
 other similar or allied affections that arise from the abuse of 
 stimulants and narcotics, are pre-eminently nervous diseases. (See 
 Delirium Tremens, Dipsomania, and Stimulants and Narcotics.) 
 
 Convulsions of all kinds, and from whatever cause proceeding, 
 are to be classed among nervous diseases. (See Convulsions.) 
 
 Sleeplessness {insomnia) is usually a nervous disease. It is a 
 symptom of some disordered condition of the brain or of some por- 
 tion of the nervous system. It is a symptom which in these days 
 is exceedingly common. Prolonged and obstinate sleeplessness is 
 one of the symptoms of impending insanity. (See Sleeplessness.) 
 
 Catalepsy is a nervous disease. This is not, however, a very 
 common affection, and is only mentioned here for the sake of com- 
 pleteness. (See Catalepsy.) 
 
 Green- sickness is now regarded as a nervous disease ; formerly 
 
AND MOST RECENT METHODS OF TREATMENT. lOi 
 
 it was confounded with anasmia (poverty of blood). Recent inves- 
 tigations have shown that in green-sickness the blood may be in a 
 healthy condition. 
 
 GENERAL TREATMENT OF NERVOUS DISEASES. 
 
 Nervous diseases are usually to be treated by concentrating on 
 the system all possible tonic influences. While every case must be 
 studied by itself and treated by itself, yet this general principle will 
 apply to nearly all the nervous diseases of our time. In connec- 
 tion with tonic influences it may be necessary to use remedies that 
 have a calming influence on the system, such as bromide of potas- 
 sium, oxalate of cerium, and the like. 
 
 It is not well to depend exclusively on any one tonic remedy, 
 but to concentrate the influence of a number simultaneously on the 
 system. 
 
 The chief tonic influences that may be employed in the treat- 
 ment of nervous diseases are : 
 
 1. Air, and sunlight, and exercise. 
 
 There are many, however, who cannot take active exercise. 
 Such persons may often be benefited by the passive exercises of 
 the Movement Cure. (See Movement Cure; see also Air, Sunlight, 
 and Exercise under Hygiene}) 
 
 2. Nourishing food. 
 
 Nervous patients were formerly half-starved. We now know 
 that they need the best of nourishment. (See Food under 
 Hygiene.) 
 
 3. General electrization. 
 
 This remedy, though not a specific for any one disease, yet is 
 remarkably efficacious in the treatment of nervous disorders. (See 
 General Electrization}) 
 
 4. Movement Cure. — That active and passive exercise of the 
 muscles operate beneficially on the nervous system, no one will now 
 question. (See Movement Cure, Gymnastics}) 
 
 5. Internal tonics. — The best internal tonics for nervous diseases 
 are phosphorus, phosphoric acid, pyrophosphate of iron, strychnine, 
 arsenic, quinine. (See remarks on these remedies.) 
 
 6. Water. — Bathing is oftentimes very useful for nervous 
 patients. Some are greatly benefited by the Russian or Turkish 
 baths. The shower-bath is a very powerful tonic for those few who 
 can bear it and know how to use it. Salt-water bathing is for many 
 an agreeable and very efficient tonic. (See Water Cure.) 
 
 Several of these remedies and systems of treatment may be tried 
 simultaneous! v or consecutively. 
 47 
 
738 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 When all these measures fail, the patient, if able, and unless 
 the judgment of his medical adviser forbid, may visit the various 
 springs and baths. 
 
 The results of the treatment of nervous diseases depend very 
 much on the perseverance and force of will of the patient. 
 
 Nervous patients should not expect too much. In very many 
 cases they should be content if they are relieved or approximately 
 cured. 
 
 Besides all these general principles of tonic treatment, nervous 
 patients will frequently need special treatment of a very different 
 kind. 
 
 Most of these special methods of treatment are described under 
 the different nervous diseases. 
 
 NETTLE-RASH. 
 
 No part of the body is exempt from nettle-rash. It appears in 
 large, flat, elevated patches or wheels, of irregular shape, hard, 
 of a pale red color, but in some instances whiter than the 
 surrounding skin, and is attended with severe itching and 
 tingling.. The eruption is sometimes accompanied by a slight 
 degree of fever ; in other cases it appears suddenly, without any 
 constitutional disturbance. It generally appears in the morning, 
 vanishes in the course of a few hours, and perhaps reappears twice 
 or thrice in the course of the day. After breaking out repeatedly 
 in this manner, it usually disappears entirely at the expiration 
 of six or eight days, sometimes much sooner. Nettle-rash occurs 
 most frequently in young people and females ; it is generally 
 if not always connected with disorder of the digestive organs, and 
 in particular constitutions is readily produced by certain articles 
 of food, as lobsters, crabs, mussels, and other kinds of shell-fish; 
 cucumbers, mushrooms, &c. 
 
 Treatment. — In mild cases little will be required beyond light 
 farinaceous diet and gentle laxatives. When the eruption appears 
 after taking into the stomach certain substances which disagree 
 with it, or to which it is unaccustomed, an emetic of ipecac 
 generally effects a cure. Nettle-rash generally yields in the course 
 of two or three days under the use of low diet, mild laxative medi- 
 cine, and .drinking freely of lemonade, or barley-water containing 
 a little nitee. 
 
 NEURALGIA. 
 
 Under the general term neuralgia, which, fifty years ago, was 
 
AND MOST RECENT METHODS OF TREATMENT. 739 
 
 but little known either to the profession or the laity, is now in- 
 cluded one of the most frequent and distressing symptoms of the 
 chronic diseases of our time. 
 
 Strictly speaking, all pain, in any disease, is nerve pain ; and 
 therefore the term neuralgia might be applied to every phase of 
 disease, acute and chronic, that is attended with unpleasant sensa- 
 tions. This term, however, as ordinarily employed, designates an 
 affection of the nervous system, which is attended with pain in the 
 course of some of the principal sensory nerves. 
 
 When, in any disease, the pain follows the course of any parti- 
 cular or prominent nerve-branch, it receives the name neuralgia. 
 The pains of the affection are usually quite sudden in their onset, 
 and are of a lacerating, stabbing, darting, or burning character. 
 They are more or less intermittent, and are not ordinarily accom- 
 panied by any constitutional febrile disturbance. 
 
 The following division of the neuralgias is taken from Rey- 
 nolds' " System of Medicine : " 
 
 " (a) Neuralgia of the fifth {trifacial or trigeminal). 
 
 " (b) Cervico-occipital neuralgia. 
 
 " (c) Cervico-brachial neuralgia. 
 
 " id) Intercostal neuralgia. 
 
 " (e) Lumlo-abdominal neuralgia. 
 
 " Lf) Orural neuralgia. 
 
 " (g) Sciatic neuralgia." 
 Complicated cases occur that arise from a variety of causes. 
 A patient afflicted with anaemia or neurasthenia may suffer from 
 neuralgia that may be aggravated by neuritis, or by a wound or 
 bruise. A curable case of neuralgia of malarial origin may be 
 rendered incurable by the supervention of organic disease of the 
 brain or spinal cord. Illustrations of these varied forms are suffi- 
 ciently familiar to the practitioner. The prognosis of the affection 
 manifestly depends on its causation. It is impossible to give an 
 intelligent opinion in any given case, without first ascertaining the 
 predominant condition on which the symptoms depend. The 
 principles on which neuralgia is to be treated are simply these 
 two : first, to relieve the pain ; and, secondly, to remove the cause. 
 
 Constitutional neuralgias are those which depend on morbid 
 constitutional conditions. Under this head are, therefore, included 
 those which are caused by anaemia, by neurasthenia, and by the 
 poisons of malaria, minerals, and the various toxic diseases. 
 
 The constitutional conditions that are most frequently the causes 
 of this form of neuralgia are unquestionably anaemia and neuras- 
 thenia, or what is commonly known as nervous exhaustion, inas- 
 
740 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 much as these conditions are themselves very frequently the results 
 of poisoning of the system by mercury, lead, opium, alcohol, mala- 
 ria, rheumatism, gout, etc. 
 
 Neuralgia unquestionably causes a vast amount of suffering. 
 In this country it afflicts nearly every family. Some are martyrs 
 to the disease all their lives, and find from medicine only temporary 
 relief. It is therefore important for every one to know what meth- 
 ods of treatment are used by physicians, as well as those measures 
 that are of a domestic character. 
 
 TREATMENT OF NEURALGIA. 
 
 1. To relieve the pain temporarily. 
 
 The best method of relieving neuralgic pains is by hypodermic 
 injections of morphine and atrophine. (See Hypodermic Injec- 
 tions.) This method of treatment is not, however, well understood 
 by the people, and is not used by all in the profession. Accidents 
 occasionally occur from its use. 
 
 Electrization frequently acts like magic in neuralgia. General 
 electrization is usually to be preferred. Sometimes galvanization 
 is most successful, and in other cases faradaization. (See Galvani- 
 zation, Earadaization, and Electrization^) 
 
 Veratria ointment (fifteen grains of veratria to one ounce of 
 lard) rubbed over the painful nerve is sometimes efficacious. 
 
 In some cases it is well to make a small blister, and then to 
 place on the raw surface a grain of morphine diluted with a little 
 gum arabic. Of all these measures my preference is for electriza- 
 tion, in those cases where it will succeed. It not only affords tem- 
 porary relief, but when repeated perseveringly is one of the best 
 curative remedies that we have. There are many, however, who 
 are so situated that they cannot avail themselves of the assistance 
 of a physician who employs electrization. For such it is, of course, 
 necessary to depend on other remedies. In desperate cases physi- 
 cians sometimes give inhalations of aether or chloroform. 
 
 2. To break up the attacks. Usually the patients need tonic 
 treatment. (See Nervous Diseases, Treatment of.) 
 
 There are some cases of neuralgia that are in their nature incu- 
 rable. They may depend on some incurable disease. 
 
 NEURASTHENIA, OR NERVOUS EXHAUSTION. 
 
 The character of this malady, if I be allowed to call it such, 
 may best be understood by comparing and contrasting it with ance- 
 
AND MOST RECENT METHODS OF TREATMENT. 74:1 
 
 mia, a condition which has been more thoroughly discussed, and is 
 therefore more vividly appreciated, by the profession at large. 
 
 Anaemia is to the vascular system what neurasthenia is to the 
 nervous. The one means want of blood ; the other, want of ner- 
 vous force. 
 
 Both anaemia and neurasthenia may be the effects of acute or 
 chronic diseases, and both may be either acute or chronic in their 
 course. Thus neurasthenia may be the effect of wasting fevers, 
 exhausting wounds, parturition, protracted confinement, dyspepsia, 
 phthisis, and so forth. Anaemia, as is well known, may result from 
 the same diseases. 
 
 Both angemia and neurasthenia may also be the cause of chronic 
 and acute diseases. Thus neurasthenia, or nervous exhaustion, 
 may give rise to dyspepsia, headaches, paralysis, insomnia, neural- 
 gia, rheumatic gout, spermatorrhoea in the male and menstrual 
 irregularities in the female. Anaemia also is the source of many 
 of these diseases, though perhaps it is more frequently the effect. 
 
 Anaemia and neurasthenia may cause each other; anaemia is 
 often the result of neurasthenia, and vice versa. 
 
 Both anaemia and neurasthenia are most frequently met with in 
 civilized, intellectual communities. They are a part of the com- 
 pensation for our progress and refinement. ■ 
 
 Anaemia and neurasthenia may run into each other, and become 
 so closely in terblended that it is oftentimes impossible to determine 
 which w r as the cause and which was the effect, or which is the rul- 
 ing condition. 
 
 Both of these conditions, whether existing separately or in com- 
 bination, are best treated by some form of constitutional tonics. 
 In anaemia we give those tonics that directly and specially affect 
 the blood J in neurasthenia we give those remedies that directly 
 and specially affect the nervous system. 
 
 Neurasthenia may result from any causes that exhaust the ner- 
 vous system. Hereditary descent terribly predisposes to neurasthe- 
 nia, just as it predisposes to all forms of nervous derangement. 
 The law of 'reversion is frequently illustrated here ; and sick head- 
 ache, epilepsy or insanity or dyspepsia in the grandfather may skip 
 over a generation, and show itself as neurasthenia in the grand- 
 children. Among the special exciting causes of neurasthenia may 
 be mentioned the pressure of bereavement, business and family 
 cares, parturition and abortion, sexual excesses, the abuse of stimu- 
 lants and narcotics, and civilized starvation, such as is sometimes 
 observed even among the wealthy order of society, and sudden 
 retirement from business. 
 
Ttt2 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 The diagnosis of the neurasthenic condition is sometimes en- 
 tirely clear, and again is quite difficult. The diagnosis is obtained 
 partly by the positive symptoms, and partly by exclusion. If a 
 patient complains of general malaise, debility of all the functions, 
 poor appetite, abiding weakness in the back and spine, fugitive 
 neuralgic pains, hysteria, insomnia, hypochondriasis, disinclina- 
 tion for consecutive mental labor, severe and weakening attacks of 
 sick headache, and other analogous symptoms, and at the same time 
 gives no evidence of anaemia or of any organic disease, we have 
 reason to suspect that the central nervous system is mainly at fault, 
 and that we are dealing with a typical case of neurasthenia. Bat 
 neurasthenia may be associated with ansemia and with almost every 
 conceivable form of organic disease. In such cases it is sometimes 
 very difficult to ascertain whether it is the cause or the effect. The 
 history of the symptoms will help us to decide this question ; which 
 is, however, of little import, for in either case the general treat- 
 ment will be substantially the same. 
 
 Chronic neurasthenia — of which form I am chiefly speaking — 
 may result in paraplegia, in general paralysis, in neuralgia, in 
 uterine disturbances, in dyspepsia, in chorea, in hypochondriasis, 
 in hysteria, and in actual insanity ; or under proper treatment it 
 may go on to perfect recovery. 
 
 Chronic neurasthenia sometimes proves directly fatal, without 
 causing any organic disease ; but such a termination is not usual. 
 It is a chronic condition, and patients afflicted with it may last for 
 half a century. We are all of us more or less familiar with such 
 cases. I have a friend who has been afflicted with neurasthenia 
 for more than fifty years, and yet during all this time he has been 
 severely engaged in the complicated duties of a lawyer, a judge, 
 and a man of business. There is not an organ of his body that 
 has not suffered from this prolonged neurasthenia ; from the time 
 he was fifteen years old until now there has been no day in which 
 he has been free from pain. Even ansemia has supervened, but 
 though the lamp of life has often flickered, yet at the advanced age 
 of seventy it still "holds out to burn." 
 
 The one principle on which neurasthenia is to be treated is by the 
 concentration of all possible tonic influence on the nervous system — 
 air, sunlight, water, food, rest, diversion, muscular exercise, and the 
 internal administration of those remedies — such as strychnine, phos- 
 phorus, arsenic, &c. — which directly affect the central nervous system. 
 (See Nervous Diseases, Treatment of) 
 
AXD MOST EECEXT METHODS OF TREATMENT. 713 
 
 XIPPLES, SOEE. 
 
 TTomen when nursing are liable to have sore nipples, — a com- 
 plaint which is very troublesome, and in many cases not easily 
 subdued. This may sometimes be prevented by washing the 
 nipples frequently during a month or two before delivery, with 
 equal parts of the tincture of myrrh, and a strong decoction of oak 
 bark. When, however, the nipples have become excoriated and 
 chapped, an artificial teat attached to a shield should be em- 
 ployed, and some mild astringent lotion used several times daily. 
 
 When the nipple and parts surrounding it become inflamed and 
 sore, it will be necessary to apply warm poultices of bread and 
 milk, or flax-seed meal, to reduce the inflammation, after which a 
 little sweet cream should be used to heal the excoriation. 
 
 XITEATE OF SILYEE CEYSTALS. 
 
 Of late years solutions of nitrate of silver have been much used 
 for chronic inflammations of mucous membranes. 
 
 It is used for chronic inflammations of the larnyx, and with 
 good results. It is also used for chronic inflammation of the uterus 
 and urethra. It is sometimes given internally in small doses, as a 
 tonic in epilepsy and other nervous diseases. 
 
 It is applied to the larynx by means of sponges or brushes. (See 
 Laryngitis and Laryngoscope.) 
 
 The solutions used vary in strength from 2 grains to 60 or 120 
 grains to the ounce. 
 
 The common prejudice that nitrate of silver is necessarily in- 
 jurious is not well founded. It is one of the best of our remedies 
 for chronic inflammations of mucous membranes. 
 
 NITRE. 
 
 Nitre (nitrate of potash, saltpetre) is an excellent medicine to 
 abate heat, and is used for this purpose in all inflammatory diseases 
 and hemorrhages. Given in small and frequently repeated doses, 
 to the extent of a drachm or eighty grains in the course of twenty- 
 four hours, in cold water, toast water, or barley-water (each dose 
 being dissolved at the time it is to be administered), it diminishes 
 the strength and frequency of the pulse, while it lowers the animal 
 heat, and abates thirst ; and is consequently regarded of great value. 
 
 Nitre is sometimes given as a diuretic in dropsical cases ; and in 
 
7U 
 
 the proportion of a drachm and a half to half a pound of water, is 
 frequently prescribed as a gargle in different kinds of sore throat. 
 
 Five ounces of nitre, with five ounces of sal ammoniac (muriate 
 of ammonia) dissolved in sixteen ounces of water, will reduce the 
 temperature of the liquid forty degrees. Hence this mixture placed 
 in a bladder is used as an external application in various cases : to the 
 head in inflammation of the brain and apoplexy, to the lower part 
 of the belly in some cases of retention of urine, to the belly in vio- 
 lent floodings, and to hernial tumors (when ice cannot be obtained) 
 to diminish their size and facilitate their reduction. 
 
 NITRIC ACID. 
 
 Nitric acid is often of great service in syphilis when the use of 
 mercury would be improper. . It is more particularly useful when 
 the disease is complicated with scrofula or scurvy, when it is accom- 
 panied with much debility, and in patients whose constitutions 
 have suffered from the excessive use of mercury. In such cases it is 
 generally given along with the compound decoction of sarsaparilla ; 
 sometimes it produces salivation. The diluted nitric acid of the 
 pharmacopoeia is the form in which it is generally used. This is 
 prepared by mixing one fluid ounce of nitric acid with nine fluid 
 ounces of distilled water, and the dose is from twenty to thirty 
 drops, in water sweetened with syrup or sugar, three times a day. 
 This acid injures the teeth ; it is therefore advisable to drink the 
 mixture through a glass tube, and afterwards wash the mouth. 
 
 Nitric acid is given in the same manner as the sulphuric and 
 muriatic acids, in cases of gravel, where the urine deposits a white 
 sediment. 
 
 As an application to certain ill-conditioned or sloughing ulcers, 
 Sir Astley Cooper recommends a lotion composed of fifty drops of 
 nitric acid to a pint of water. Some practitioners use two drachms 
 of the diluted acid mixed with an ounce of water, as a stimulating 
 application to fetid sores attended with a thin acrid discharge. 
 
 Nitro-Muriatic Acid. (See Muriatic Acid.) 
 
 NUX YOMICA (STRYCHNINE). 
 
 This is the product of a tree that grows in Ceylon. 
 
 It is much used as a tonic. It directly affects the spinal cord, 
 and is therefore frequently successful in paralysis that is depen- 
 dent on diseases of the cord. Nux vomica is one of the best of our 
 many uncertain drugs for dyspepsia and nervous exhaustion. It is 
 
AND MOST EECEXT METHODS OF TREATMENT. 745 
 
 very useful in constipation, and is an ingredient in some of onr laxa- 
 tive pills. The dose is from three to five grains. The tincture is 
 usually given in doses of from ten to twenty drops. 
 
 At the present time strychnine — which is prepared from nux 
 vomica — is more used than the nux vomica itself. (See Strych- 
 nine.) 
 
 OPHTHALMOSCOPE AND OTOSCOPE. 
 
 Physicians examine the- eye with the ophthalmoscope. With 
 the otoscope they examine the ear. The ophthalmoscope is repre- 
 sented in the accompanying cut. 
 
 liebreich's ophthalmoscope. 
 
 The use of the ophthalmoscope has wrought a great change in 
 the study of diseases of the eye, just as has the laryngoscope in 
 diseases of the larynx, and the stethoscope in diseases of the chest, 
 and the microscope in diseases of the urinary organs. 
 
 By the aid of the ophthalmoscope the physician can see the 
 retina and the nerve of the eye, and can determine whether they 
 are in a condition of health or disease. Since the discovery of 
 the ophthalmoscope the science of diseases of the eye has made 
 wonderful progress. 
 
 The otoscope consists simply of a mirror to reflect the light, and 
 a speculum for the auditory canal. (See Speculum.) 
 
 OPIUM. 
 
 Opium is the concreted juice of the capsule or head of the white 
 poppy. 
 
 Opium renders the pulse fuller, stronger, and quicker. The 
 latter action, however, is not always produced. Per example, 
 when the pulse is quick and frequent in consequence of debility, 
 opium makes it slower and more regular, and strong doses render 
 it even slow and similar to that which is met with in apoplexy. A 
 moderate dose taken when in a state of health always slightly 
 accelerates the pulse. 
 
746 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 Opium, besides the property which it possesses of increasing the 
 action of the heart and the fulness and frequency of the pulse, 
 exerts a powerful influence as ^narcotic — that is, in diminishing the 
 sensibility of the nervous system, allaying pain, and procuring 
 sleep. But when the pulse is hard, the skin hot and dry, and other 
 feverish symptoms are present, or when we have reason to believe 
 that inflammation is commencing, it would be improper to adminis- 
 ter opium as a narcotic, because its primary or stimulating action 
 would certainly aggravate the symptoms. 
 
 Opium is much used externally to mitigate pain and allay 
 spasmodic action. When employed in this manner, it is applied in 
 the form of laudanum, or mixed with camphorated oil; and is found 
 very serviceable in colic, hysteria, and other similar diseases. 
 
 Two or three grains of opium, introduced into the rectum, are 
 very efficacious in relieving tenesmus,* spasmodic stricture, and in 
 alleviating the pain arising from cancer of the womb. 
 
 The wine of opium dropped into the eye is an excellent applica- 
 tion in chronic ophthalmia, and is in very general use. 
 
 In 1804, a German chemist, named Serturner, discovered an 
 alkaline substance which has been called morphia / this combines 
 with several acids, and forms salts. The acetate, muriate, and sul- 
 phate of morphia are at present in general use, and have the ad- 
 vantage of being less injurious to the digestive organs than solid 
 opium. These salts are given instead of opium in the dose of from 
 a quarter to three quarters of a grain ; the subjoined formula is of 
 the same strength as laudanum : 
 
 Acetate of morphia, sixty- four grains, 
 Distilled water, fifteen ounces, 
 Proof spirit of wine, one ounce. Mix. 
 
 The usual dose of opium is one grain, of laudanum twenty drops, 
 and of the salts of morphia a quarter of a grain. 
 
 OXALATE OF CEEIUM. 
 
 This medicine, which comes in the form of a whitish powder, 
 was recommended by Dr. Simpson, of Edinburgh, for nausea of 
 pregnancy. I have found it very efficacious in sickness of the 
 stomach, sick headache, and in irritable conditions of the stomach 
 generally. It was first recommended to me by my friend Dr. 
 Heath. I feel quite confident that if the remedy were better known 
 
 * " An urgent, distressing, and almost painful sensation, as if a discharge from the 
 intestines must take place immediately; always referred to the lower part of the 
 rectum." 
 
AND MOST RECENT METHODS OF TREATMENT. 747 
 
 it would be more used. Sometimes it acts like mao-ic, relieving 
 headache and nausea almost as quickly as a hypodermic injection. 
 The dose is from one to three grains, repeated as frequently as 
 may be needed. The powder may be taken dry on the tongue. 
 
 OXYGEN. 
 
 Inhalation of oxygen is now beginning to be used as a stimulat- 
 ing tonic in a variety of diseases. It is used with more or less suc- 
 cess in asthma, bronchitis, debility, and various affections of the 
 heart and lungs. I believe that it will certainly prove an excellent 
 aid to general electrization and movements, in the treatment of dys- 
 pepsia and other nervous disorders of our times. I believe that it 
 is destined to be used much more than it has been in the past. 
 Scientific men are now investigating its properties with most com- 
 mendable zeal. 
 
 Oxygen is prepared by those who have the requisite appliances, 
 and is administered in doses of one, two, three, four or more gal- 
 lons, according to the patient. 
 
 It is usually, and I believe most successfully, given in combina- 
 tion with common air. 
 
 PAKALYSIS. 
 
 Paralysis may be loss of motion or of sensation, or of both. It 
 is a symptom of many different diseases. It results from apoplexy, 
 and is then called hemiplegia, — from softening of the brain, and in- 
 deed from a large variety of injuries of the brain. It results from 
 disease of the spine, congestion, inflammation, and degeneration; 
 and then it attacks the lower limbs. Paralysis of the lower limbs 
 is called paraplegia. 
 
 Of late years much attention has been given to a disease called 
 locomotor ataxy, in which the patient, though not actually paralyzed, 
 yet cannot control the movements of his limbs. It is a very grave 
 disease. 
 
 Paralysis may extend to almost any nerve or branch of a nerve. 
 It attacks the face and draws it one side. It attacks the tongue 
 and throat, and renders speaking difficult or impossible. It attacks 
 the bowels, the bladder, and the heart. It attacks the whole trunk 
 and limbs at once, and then it is called general paralysis. This is 
 observed in insane persons. It attacks all ages, but especially the 
 two extremities of life — the very old and the very young. Paralysis 
 of infants — which is quite frequent — is called infantile paralysis. 
 
748 
 
 Paralysis sometimes results from exhausting fevers. It may 
 follow diphtheria. 
 
 Paralysis results from lead poisoning, from rheumatism; indeed 
 it may come from almost any cause that injures the system. 
 
 Over-worry, anxiety, excitement, undue ambition, the indulgence 
 of passions — these are the great causes of paralysis. Labor of the 
 brain is healthful ; within reasonable limits it is conducive to health 
 and longevity. (See Influence of Occupations on Health and 
 Longevity?) But labor of the brain that is accompanied by exces- 
 sive anxiety, and that is pursued irregularly, spasmodically, and 
 under unequal pressures, exhausts the nervous system, and may bring 
 on paralysis, or almost any other manifestation of nervous disease. 
 
 Apoplexy, which gives rise to paralysis of half the body (hemi- 
 plegia), appears to be on the increase among us. It was formerly 
 the impression that those who had large heads, heavy and full 
 cheeks, were most liable to apoplexy ; but in these times we find 
 that not unfrequently the thin, nervous, delicate, and even the 
 young, are taken down by this disease. 
 
 Even children are sometimes paralyzed in one-half of the body. 
 
 PARALYSIS OF THE LOWER LIMBS. 
 
 This form of paralysis, which is called paraplegia, is also very 
 frequent. It occurs at all periods of life. It may result from some 
 disease of the spinal cord. (See Spinal Cord, Diseases of) It 
 may result from diseases of the urinary organs. 
 
 There is a difficulty of controlling movements, which, closely 
 resembles paralysis, and yet is a really different affection. (See 
 Locomotor Ataxy.) 
 
 Paralysis may attack the eye, the ear, the larynx, the tongue, 
 the nerves that supply the lungs, stomach, heart, and bladder, and 
 indeed any part or organ of the body. 
 
 To specify and describe in detail all the varieties of paralysis 
 that may occur would occupy much space. To mention even the 
 names that are given to them by physicians would be useless. 
 
 INFANTILE PARALYSIS. 
 
 When paralysis of the arms or legs occurs in children it is called 
 infantile paralysis. This disease is of quite frequent occurrence. 
 It should be treated early. Under the combined influence of the 
 various methods of treatment that are used for paralysis, it is often- 
 times very much relieved. Sometimes perfect cures result. 
 
 Shaking palsy is a familiar form of paralysis, that not unfre- 
 quently attacks old people. It is usually very obstinate to treat- 
 
AND MOST EECEXT METHODS OF TREATMENT. 719 
 
 ment. In some cases it maybe relieved, and in some cases may be 
 cured by electrization. 
 
 The insane are sometimes attacked by general paralysis. 
 
 Paralysis of various kinds may result, by what is called " reflex 
 action," from diseases of the internal organs, as the bowels, or 
 bladder, or womb. 
 
 TREATMENT OF PARALYSIS. 
 
 The treatment of paralysis is based on the same general prin- 
 ciples as the treatment of nervous diseases in general. (See Ner- 
 vous Diseases.) 
 
 Every case must, of course, be studied by itself. There are many 
 cases that can be perfectly cured. Others can be greatly benefited. 
 There are others still that can receive no benefit whatever. 
 
 It is for the physician to decide in which of these three classes — 
 the curable, the relievable, or the incurable — any patient probably 
 belongs. 
 
 The remedy which is now used for paralysis more perhaps than 
 any other single remedy is electricity. Electricity has been used in 
 the treatment of paralytic affections for more than a century. 
 
 All those physicians who give attention to the application of elec- 
 tricity to disease agree that it is useful in paralysis, however widely 
 their opinions may differ on other particulars. (See General Electri- 
 zation and Localized Electrization.) 
 
 Strychnine, phosphorus, are used for paralysis, both internally 
 and by hypodermic (or subcutaneous) injections. (See Hypodermic 
 Injections.) 
 
 Passive movements, with rubbing, are beneficial in paralysis. 
 They may be used in conjunction with other remedies. Patients, 
 or the friends of patients, may assist the physician in this way, pro- 
 vided they are so disposed ; although it is much better, when it is 
 practicable, to have these movements directed by some one who 
 thoroughly understands his business. 
 
 Perseverance is extremely essential in the treatment of paralysis, 
 whatever treatment may be adopted. Almost all cases take time 
 and patient care. Oftentimes it takes many months to benefit or 
 cure the patient. 
 
 The friends of patients are apt to expect too much from treat- 
 ment in this affection. They expect that what they call a " shock " 
 of electricity or a few doses of medicine will restore complete mo- 
 tion to limbs that have been paralyzed for months and years. All 
 such expectations are absurd. Paralysis is frequently the result of 
 diseases of the brain or spinal cord, that have been years coming 
 
750 
 
 on ; it is not rational to expect that these diseases will be cured in 
 a day or in a week. Nature does not work in this way. The rule 
 is, that diseases which have been a long time corning on must be a 
 long time in recovering. 
 
 Another great mistake of patients is to delay too long before- 
 consulting advice. Parents allow their children to be paralyzed for 
 years, and then expect their physician to perform a cure in a week. 
 
 Patients give as a reason for their delay that they have no hope 
 of relief. This also is a mistake. Paralysis, if taken in time, is 
 frequently as relievable and as curable as other nervous diseases. 
 
 In most of the paralyses of the limbs the muscles in time, shrink, 
 and the limbs become smaller. The paralyzed limbs may be from 
 one to a number of inches smaller in circumference than those 
 which are healthy. 
 
 One great advantage of treatment by electricity and movements 
 is, that it exercises the muscles, keeps them in activity, and thus re- 
 tards the process of shrinking and waste. 
 
 PAEEGOEIC ELIXIR. 
 
 Paregoric elixir is prepared in the following manner : " Take of 
 camphor two scruples and a half; hard opium, powdered, and benzoic 
 acid, of each seventy-two grains; oil of anise, a drachm; proof spirits, 
 two pints ; macerate for fourteen days, and strain." This remedy 
 is much used in chronic asthma, and cough, when no inflammatory 
 symptoms are present. A teaspoonful of it may be taken three or 
 four times a day, and two teaspoonfuls at bedtime. Half an ounce 
 of this elixir contains a grain of opium. 
 
 PEPSIN. 
 
 This is a preparation made from the stomach of the calf. It is 
 supposed to contain the active principle of the gastric juice, and 
 therefore it is much gi ven in dyspepsia. The wine of pepsin is a 
 preparation that is highly recommended. The taste of pepsin 
 nearly resembles that of old cheese. Pepsin has been recommended 
 in the diarrhoea of infancy. The dose is from two to ten grams. It 
 may be taken just before or just after meals. 
 
 PERCUSSION. 
 
 This is a method of examining the condition of internal organs 
 by striking on the outside. This is done on the same principle 
 that the farmer taps on the end of a cider barrel to know by the 
 
AND MOST RECENT METHODS OF TREATMENT. 751 
 
 sound whether it is full or empty, or on a water-melon or pumpkin 
 to learn whether they are rotten or sound. 
 
 Physicians percuss with their fingers, or with what is called the 
 pleximeter. (See cuts.) By means of percussion it is possible to 
 ascertain the condition of the lungs, the stomach, the liver, the 
 spleen, and the bowels. Percussion detects consumption of the 
 lungs, cancers of the liver, and tumors of the ovaries. To use it 
 successfully requires experience. It is sometimes combined with 
 auscultation. (See Auscultation.) These two methods of studying 
 disease have wrought a great change in medical practice, especially 
 of diseases of the chest. 
 
 PERMANGANATE OF POTASH. 
 
 This remedy has of late been much used as a cleanser. It may 
 be used in this way : 
 
 Permanganate of potash, six grains, 
 "Water, one ounce. 
 
 A few drops of this in half a tumbler of tepid water make an excel- 
 lent injection for the nasal passages. (See Catarrh.) It is also 
 used for chronic ulceration of the ear, and for inflammation of other 
 mucous membranes. It is said to be good internally for diabetes, 
 when there is no sugar in the urine. 
 
 PERUVIAN BARK. 
 
 Peruvian bark, or Cinchona, is commonly termed bark by way 
 of pre-eminence. 
 
 Bark, or the sulphate of quinine, is deservedly considered the 
 most valuable tonic medicine we possess, and has a wonderful power 
 in checking all periodic or intermitting diseases ; the latter effect is 
 more especially shown in ague, in which it acts almost as a specific, 
 and also exercises, when properly managed, a powerful influence in 
 subduing the remittent fevers of warm climates. 
 
 All the preparations of bark are to be withheld in inflammatory 
 diseases, and in all disorders complicated with an inflammatory con- 
 dition of the alimentary canal. 
 
 The facility with which small doses of sulphate of quinine can 
 be taken has led to the substitution of this preparation for that of the 
 bark in powder, which is objectionable on account of its nauseous 
 taste, bulk, and from the woody fibre and inert matter contained in 
 it rendering it indigestible and oppressive to the stomach. The 
 ordinary dose of the powder is half a drachm, three times a day, 
 
752 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 mixed with wine and water ; but in urgent cases it may be taken 
 to the extent of one or two ounces in the course of twenty -four 
 hours. The dose of the sulphate of quinine is from one to six grains, 
 three times a day. In many cases we have known larger doses to 
 cause buzzing, ringing, and other noises in the ears, giddiness, deaf- 
 ness, confusion of ideas, and other symptoms of cerebral excitement ; 
 and even grain doses administered during convalescence from fever, 
 dysentery, and other acute diseases, sometimes produce this affection 
 of the head. The brain is more especially excited by this remedy, 
 even in small doses, when administered as a tonic in chronic dysen- 
 tery. Quinine, from its excessively bitter taste, is usually given in 
 the form of pill, made up with a little crumb of bread or mucilage. 
 It is also frequently given in a liquid form; but as it is not very 
 soluble in water, a little spirit, or a few drops of the elixir of vitriol 
 (aromatic sulphuric acid) are generally added to increase its solu- 
 bility. 
 
 The cold infusion of hark is a useful tonic in indigestion, and is 
 in many cases more grateful to the stomach than quinine ; it is pre- 
 pared in the following manner. Take of Peruvian bark, bruised, 
 an ounce ; boiling water, a pint ; macerate for six hours in a vessel 
 lightly covered, and strain. A wine-glassful to be taken as a dose 
 three or four times a day. 
 
 The tincture of hark is sometimes taken as a stomachic in the 
 dose of two or three teaspoonfuls. Many people residing in districts 
 where they are constantly exposed to the influence of malaria from 
 decaying vegetable matter, take this tincture habitually with the 
 intention of keeping off fever. 
 
 PESSAKIES. 
 
 conant's pessary. 
 
 HOFFMAN'S PESSARY. 
 
AND MOST RECENT METHODS OF TREATMENT. 753 
 
 Pessaries are contrivances of various shapes employed to keep 
 the womb in position, when through any cause it has become mis- 
 placed. Specimens of these are represented in the accompanying 
 cuts. They should only be used under the direction of a medical 
 adviser. 
 
 PETKOLEUM. 
 
 Petroleum, and kerosene that is made from petroleum, are 
 sometimes applied to inflamed joints in rheumatism. Good re- 
 sults have been claimed. 
 
 PHOSPHATE AND PYROPHOSPHATE OF IRON. 
 
 These preparations of iron are now taking the place of the much 
 used tartrate of iron and potash, iron by hydrogen. They are given 
 on the theory that phosphorus is a good tonic for the nerves, and 
 iron for the blood. 
 
 (For doses of the different preparations of iron, see list of medi- 
 cines at the end of the book.) 
 
 PHOSPHORIC ACID. 
 
 This is a most agreeable and efficacious method of adminis- 
 tering phosphorus. Given in doses of from -five to twenty drops in 
 sweetened water, it is to some almost as palatable as lemonade. 
 
 It will be taken readily by those who would utterly refuse pure 
 phosphorus, or even pyrophosphate of iron. It is an excellent tonic 
 in dyspepsia and the nervous diseases. 
 
 PHOSPHORUS. 
 
 Phosphorus is a remedy of great power and great utility. It 
 is at the present time very much used as a tonic in diseases of the 
 nervous system. (See Nervous Diseases.) 
 
 The pure phosphorus is an unpleasant remedy to give. Both 
 the odor and the taste are disagreeable. It is, however, prescribed 
 by physicians in doses of from one-thirtieth to one-quarter of a grain 
 in sweet oil. The remedy has a special influence on the sexual 
 organs. 
 
 Phosphorus is usually given in the form of the hypophosphates of 
 48 
 
754 
 
 soda, lime and potash (see Syrup of Hypophosphites), pyrophos- 
 phate of won and phosphoric acid. (See Phosphoric Acid.) 
 
 PILES. 
 
 Piles are small painful tumors situated at the extremity of the 
 great gut called the rectum, either within the anus or fundament, or 
 around its margin. In popular language, these swellings, when 
 situated within the gut, are termed internal piles ; when beyond 
 the verge of the anus, external piles / and when there is no discharge 
 of blood they are usually called blind piles. 
 
 There are two kinds of piles, differing from each other in struc- 
 ture. The first kind is formed by dilatation of the veins of the anus ; 
 in those which are external, the veins are covered by thick indurated 
 cellular substance, and the skin surrounding the verge of the anus ; 
 the internal are also covered with dense cellular tissue, and by the mu- 
 cous or lining membrane of the gut. In the second hind the piles 
 are soft, spongy, and not composed of enlarged veins, but of numer- 
 ous minute vessels interwoven with each other. When irritated, 
 they increase in size, become hard, and blood is exuded from innu- 
 merable points on their surface ; whereas in the first kind the 
 hemorrhage takes place from the bursting of the vein, and the blood 
 Hows in a stream. Some authors describe other varieties of piles, 
 but they appear to be only modifications of the kinds above described. 
 
 Causes. — The causes which induce piles are numerous. The 
 principal of the predisposing causes are, a plethoric habit of body, a 
 melancholic, bilious temperament, hereditary disposition, hot and 
 variable climates. Piles are seldom met with before puberty, and 
 women are most frequently affected with them after the turn of life. 
 Sedentary occupations and indolent habits, conjoined with full gener- 
 ous diet and the habitual use of wine, malt liquor, spirits, &c, in- 
 duce a state of general plethora, and more especially fulness of the 
 blood-vessels of the abdomen. In such cases the discharge of blood 
 from piles is merely a salutary effort of nature to relieve the system, 
 and is to be considered as one of the means which nature makes use 
 of to maintain the balance of the various functions of the animal 
 economy, which numerous circumstances, even during the most- 
 satisfactory state of health, tend constantly to disturb. 
 
 The chief occasional causes are : constipation of the bowels, which 
 is by far the most frequent; pregnancy; large or too often repeated 
 doses of purgatives. This disease is also brought on by long sitting ; 
 hence it is common among tailors, shoemakers, &c. ; by sitting on 
 the damp ground, wearing tight stays, and various causes which 
 
AND MOST RECENT METHODS OF TREATMENT. 755 
 
 tend to obstruct the circulation of blood in the abdomen, and irri- 
 tate the lower part of the rectum. 
 
 Piles at first give very little trouble, and seldom protrude, unless 
 the bowels have been neglected, or the person has been indulging 
 more than usual at table. Under such circumstances they become 
 slightly painful, with a sensation of heat and itching at the anus. 
 These symptoms may be soon relieved by attention to diet and 
 regimen, and regulating the bowels by suitable doses of the above 
 electuary. A laxative in common use in such cases is composed of 
 equal parts of cream of tartar and sulphur, made into an electuary 
 with syrup or molasses ; the ordinary dose of this is a large tea- 
 spoonful at bedtime. The patient should pass his motions at night, 
 just before going to bed. This is an important part of the treatment, 
 and ought never to be neglected. 
 
 Other means besides the above may be employed with advan- 
 tage to remove piles which have arisen from occasional or accidental 
 causes. Sir B. Brodie and several of the best French authors re- 
 commend an injection of half a pint of cold water every morning after 
 breakfast. The following astringent ointment is very generally 
 used, but perhaps the best local application is a saturated solution 
 of alum : 
 
 Powder of oak galls, an ounce, 
 
 Elder ointment, or bog's lard, the same quantity. Mix. 
 The piles and anus are to be anointed with this night and morning. 
 
 Washing of the parts should be resorted to after each evacuation 
 from the bowels, and Mr. Mayo suggests that they should be washed 
 with yellow soap and water. 
 
 When piles come on spontaneously, and have become constitu- 
 tional, giving out blood periodically, they are in a manner necessary, 
 and act as a safety-valve for the relief of the overloaded circulation, 
 and thus serve, in a great measure, to protect the system from gout, 
 internal hemorrhage, apoplexy, and other dangerous diseases. 
 Hence it is obvious that in many cases it would be dangerous to 
 interfere with bleeding piles, more especially when the habits of 
 the individual are such as to render an outlet of this description 
 necessary. 
 
 Piles frequently become so troublesome that the patient is de- 
 sirous of getting rid of them at all hazards. There are two methods 
 of removing piles ; the one is by excision, and the other by ligature. 
 The former is always preferable when the piles are external, the 
 latter when they are internal. 
 
756 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 PLASTEES. 
 
 Plasters are made of gums, fats, wax, resins, oils, and other sub- 
 stances. 
 
 They are spread on muslin, linen, or leather. They are usually 
 more or less hard, but are warmed by the heat of the body, so that 
 they firmly adhere. They support weak and neuralgic parts, re- 
 lieve the pains of rheumatism and neuralgia, and act as mild counter- 
 irritants. {For rules for making, etc., see Prescriptions?) 
 
 PLEUKISY. 
 
 This is an inflammation of the pleura, a painful disease of very 
 frequent occurrence, though rarely fatal when not complicated with 
 other diseases. At its commencement the blood-vessels immediately 
 under the inflamed portion of the pleura become distended with 
 blood, and form a kind of network of a bright red color. The 
 natural secretion from the affected part is at first supposed to 
 be considerably diminished; but amoverflow of thin serous liquid 
 soon takes place, and, if the inflammation increase, the fibrinous 
 part of the blood which, in a state of health, nourishes and sustains 
 the pleura, is also thrown out, and forms in solid films or layers 
 upon its surface, or is mingled with the effused liquid which has 
 accumulated in the side of the chest affected. This excessive secre- 
 tion sometimes continues until the side in which the inflammation 
 is seated becomes completely filled with liquid, and the lung is in 
 consequence so compressed that it ceases to perform its function. 
 The inflammation, however, may attack both sides of the pleura 
 (double pleurisy) ; but this is comparatively a rare occurrence. 
 
 Pleurisy commences with a slight degree of chilliness, sometimes 
 with severe rigors or shivering. The patient, either at the same 
 time or shortly after, complains of an acute cutting pain {stitch) 
 below the nipple, or towards the anterior edge of the arm-pit, which 
 occasion ally catches or in terr upts the breathing. The ordinary series 
 of feverish symptoms soon follow, viz. hot, dry, and harsh skin, 
 thirst, high-colored urine, and a firm hard pulse. Yet cases fre- 
 quently occur where it is small, soft, sometimes unequal or inter- 
 mittent, and closely resembling that which results from great debil- 
 ity ; while the patient is at the same time laboring under much 
 oppression and tightness at chest, accompanied by distressing anx- 
 iety. Now, if this oppressed state of the system were mistaken for 
 real debility, and stimulants administered, all the symptoms would 
 be aggravated, and serious consequences might accrue. But these 
 
AND MOST RECENT METHODS OF TREATMENT. 757 
 
 symptoms, instead of being the result of direct debility, indicate 
 the violence of the inflammation ; the acute pain prevents the 
 patient from breathing freely, and the constantly impeded respira- 
 tion causes obstruction in the lungs; part of the blood, therefore, 
 only readies the heart, and consequently the quantity in general 
 circulation is greatly diminished. Every time the patient coughs, 
 or attempts to draw in a full breath, the pulse becomes suddenly 
 full and hard. 
 
 Cough is a symptom which is always present in every inflamma- 
 tory affection of the lungs ; in ordinary cases it is brought on each 
 time the patient endeavors to take a deep inspiration, and when the 
 inflammation is severe, is induced by speaking, or even by moving 
 the chest. In pleurisy the cough is short, dry, and very painful ; 
 and the expectoration is scanty, a little whitish, or transparent. 
 
 The patient generally lies on the back ; but, at the early stage 
 of the disease, sometimes on the sound side. In the chronic form 
 the patient lies on the back, or more frequently on the side affected, 
 because the weight of the liquid would impede the motion of the 
 healthy lung if the patient lay upon that side. 
 
 In mild cases, or when active treatment has been adopted at the 
 commencement, and only a small quantity of liquid is effused 
 into the chest, recovery takes place in a few days ; but when the 
 accumulation of liquid is considerable, the disease may continue 
 from one to three months. 
 
 There is a form of pleurisy frequently met with which is at first 
 attended with pain and slight feverish symptoms ; but afterwards 
 slight cough, difficulty of breathing, and an uneasy sensation at the 
 chest are the only symptoms experienced by the patient. In some 
 cases no pain is felt at any period of the disease, and the cough, 
 difficulty of breathing, &c, are so slight as scarcely or not at all to 
 be observed. This latent species of the disease comes on sometimes 
 during convalescence from fever, and there is often a considerable 
 accumulation of liquid before any affection of the chest is suspected. 
 Many people who are supposed to die from old age perish from this 
 latent form of pleurisy. 
 
 When pleurisy declares itself in the usual way, and active treat- 
 ment is adopted at the commencement, recovery generally takes 
 place ; but when the subjects of the disease are children, or people 
 far advanced in life, it often proves fatal. 
 
 Pleurisy usually arises from cold and wet ; but it may be brought 
 on by any of the causes which give rise to inflammation of the 
 lungs. 
 
 For treatment of pleurisy see Treatment of Lung Fever. 
 
758 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 PLEURODYNIA, OK FALSE PLEUKISY. 
 
 This is a rheumatic affection of the muscles of the side or 
 chest. By those who do not understand the art of auscultation and 
 percussion (see Auscultation, Percussion, and Stethoscope) false 
 pleurisy may be. and often is, confounded with real inflammatory 
 pleurisy. False pleurisy closely resembles neuralgia of the side of 
 the chest. The difference between them is almost as important as 
 the difference between real croup and false croup. The great dif- 
 ference between them is this, that in true pleurisy there is inflam- 
 mation of the pleura, with effusion of fluid. This fact the physician 
 ascertains by examination of the chest. In false pleurisy there is no 
 inflammation of the pleura, and consequently no effusion of fluid. 
 This fact of the absence of fluid the physician also ascertains by the 
 examination of the chest. 
 
 The treatment of false pleurisy is very simple. Relieve the pain 
 by plasters of belladonna, or opium, or by spongio-piline. (See 
 Spongio-piline) The disease will soon recover. Neuralgia of the 
 side of the chest closely resembles false pleurisy : it is to be treated 
 like neuralgia in general. (See Neuralgia.) 
 
 PLEXIMETER AND HAMMER. 
 
 The pleximeter and hammer are used by physicians in percus- 
 sion. (See Percussion) Many physicians prefer their fingers 
 
 PLEXIMETER AND HAMMER. 
 
 to any form of artificial pleximeter, just as many prefer the direct 
 application of the ear in auscultation to any form of stethoscope. 
 (See Stethoscope) 
 
 PODOPHYLLIN, OR MAY APPLE, OR MANDRAKE. 
 
 This has recently come into use as a substitute for calomel. It 
 is believed to act upon the liver more potently than calomel, and 
 with far less injurious effects on the system. It does not produce 
 
AND MOST RECENT METHODS OF TREATMENT. 759 
 
 salivation. It does, however, produce nausea and vomiting when 
 given in large doses. Some patients are so susceptible to it that 
 even a small dose will produce great prostration. Podophyllin has 
 a bitter taste, and in that respect is certainly inferior to calomel, 
 which is almost tasteless. Podophyllin enters into the composition 
 of many of our cathartic pills. It is said that common salt increases 
 its cathartic effects. 
 
 The dose is from one-half a grain to two grains. Larger doses 
 may produce vomiting and prostration. 
 
 POISONOUS WOUNDS. 
 
 The treatment of poisons taken internally is described under 
 Surgical Accidents and Emergencies, to which section the reader is 
 referred. 
 
 Under the head of poisonous wounds I include the wounds made 
 by poisonous serpents, insects, spiders, fish, mad dogs. 
 
 The course to be pursued when bitten by a poisonous snake is 
 as follows : 
 
 1. To remove the poison from the wound. — Pass a ligature, a 
 cord or handkerchief tightly around the limb, as near to the wound 
 as possible, and between it and the heart. Then, if possible, cut the 
 poisoned part entirely out. Then suck the wound with the mouth 
 or apply a cup over it. (See Dry Cupping.) Then cauterize it 
 with a stick of lunar caustic {solid nitrate of silver), or with a red- 
 hot iron, if the patient will bear it. 
 
 2. To combat the effects of the poison. — For this there are several 
 methods of treatment. One is to make the patient completely 
 drunk with brandy or whiskey. Favorable results are reported 
 from this treatment. Other stimulants, such as hartshorn (ammonia), 
 may be given at the same time. The wound should be bathed in 
 ammonia. 
 
 Another method of treatment is by giving large emetics, in suf- 
 ficient doses to thoroughly vomit the patient. 
 Another remedy is the following : 
 
 Iodide of potassium, four grains, 
 Corrosive sublimate, two grains, 
 Bromine, four drachms. 
 Ten drops of this mixture are given in a tablespoonful of wine or brandy. The dose 
 may be repeated if necessary. 
 
 In addition to all these other remedies it may be well to try the 
 effect of the electric currents through the chest, and artificial 
 respiration, (See Surgical Accidents an.d Emergencies.) 
 
760 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 Poisonous wounds made by insects are to be treated as fol- 
 lows : 
 
 Apply hartshorn, or cologne water, or vinegar directly to the 
 wound. A poultice of ipecac has been recommended for the same 
 purpose. 
 
 This is all the treatment that is needed for the bites of wasps, 
 bees. Sometimes a person may be stung by a great many bees or 
 wasps at once. In such cases fainting may be produced, and the 
 patient will need internal stimulants — hartshorn, wine, brandy, or 
 some liquor. Some persons appear to be more susceptible to poisons 
 than others. 
 
 Poisonous wounds made by spiders, centipedes, and scorpions are 
 treated in the same way as those made by insects — that is, by the 
 direct application of hartshorn to the wound, and, when necessary, 
 internal stimulants. 
 
 Poisonous wounds made by the horns of the so-called " horn- 
 pout" of the Southern waters are best treated by thrusting a 
 sharpened stick of lunar caustic directly into the puncture made 
 by the horn of the fish, and as speedily as possible and as early as 
 possible. This treatment always cuts short the inflammation and 
 irritation that the wounds from these fish are apt to produce. While 
 acting as surgeon on the blockade I had many opportunities of test- 
 ing this treatment on myself and others. The sailors were accus- 
 tomed to while away the dull hours of the blockade by catching 
 these " horn-pout," and more or less were bitten almost daily. The 
 poison of these fish is, of course, not very powerful, but is sufficient 
 to excite painful and sometimes alarming swelling. 
 
 (For treatment of the poison of the common ivy, see Shin, Dis- 
 eases of.) 
 
 POLITZER'S EAR INFLATOR. 
 
 This consists of a rubber bag and a rubber tube, with a nozzle. 
 It is used by surgeons to inflate the middle ear through the nose. 
 (See cut of ear, and Ear, Diseases of.) By means of the inhaler, 
 which has been connected with this inflator, it is possible to send 
 vapors of iodine and other substances through the nostrils into the 
 middle ear. 
 
 This little contrivance, though very simple, is of very great ser- 
 vice in the treatment of diseases of the ear, especially those which 
 result from catarrh (see Catarrh) by extension of the inflammation 
 from the throat to the ear. 
 
Centiped. Page 760. 
 
 Scorpion. Page 760. 
 
 Mad Dog. Page 656. 
 
 Black Spider (Tarantula). Page 759. 
 
 Rattle-Snake. Paee 759, 
 
AND MOST BECENT METHODS OF TREATMENT. 763 
 
 POTASH, CARBONATE OF. 
 
 The bicarbonate, or, as it is commonly called, carbonate of 
 potash, is sometimes used in indigestion, to correct acidity, to pre- 
 vent the formation of lithic acid or red gravel; and for the latter 
 purpose it is frequently employed in gout, which, as we have al- 
 ready had occasion to mention, is frequently complicated with the 
 formation of red gravel. When it is found necessary to administer 
 effervescing draughts to relieve irritability of the stomach, many 
 practitioners prefer this salt to soda. The effervescing draught in 
 common use is made by dissolving a scruple of the bicarbonate of 
 potash in water, and then adding fifteen grains of citric acid, or the 
 same quantity of tartaric acid, or three drachms and a half of lemon 
 juice. The dose of the bicarbonate of potash is from ten to thirty 
 grains three times a day. There are a number of salts of potash. 
 
 Pott's Disease. (See Spine, Diseases of.) 
 
 POULTICES (CATAPLASMS.) 
 
 Poultices are used for the purposes of warmth and moisture. 
 They are made of a variety of substances — bread and milk, yeast, 
 flax-seed, oatmeal, carrot, Indian meal, mustard, charcoal, onion, 
 arrow-root, and so forth. 
 
 The general rule for making them is to mingle the substance — 
 whatever it may be — with sufficient hot water to make amass suffi- 
 ciently thick and soft. It is not necessary to weigh or measure the 
 ingredients. Poultices are sometimes medicated by mingling with 
 them a little laudanum or belladonna, or other anodyne, in order 
 to relieve the pain. Poultices are used for boils, abscesses, ulcers, 
 gangrene, and as counter-irritants. Spongio-piline is a very neat 
 and convenient form of poultice. (See Sjpongio-joiline.) 
 
 PKUSSIC ACID. 
 
 This acid, in its concentrated state, is the most powerful and 
 rapid poison known. "When prepared for internal use, it is given 
 in the dose of from three to ten drops, three times a day, in sugar 
 and water; and has been found very useful as a sedative in asthma, 
 hooping-cough, chronic bronchitis, at the commencement of con- 
 sumption, in some forms of indigestion, in allaying nervous palpita- 
 tions, more especially when caused by a disordered state of the di- 
 gestive organs. In running tetter and some other diseases of the 
 
764 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 skin, accompanied with severe itching, the following lotion is said 
 to be useful : 
 
 Prussic acid, two drachms, 
 
 Acetate or sugar of lead, sixteen grains, 
 
 Alcohol, half an ounce, 
 
 Distilled water, eight ounces. Mix. 
 
 PUERPERAL OR CHILDBED FEYER. 
 
 This is the name given to a very dangerous inflammatory dis- 
 ease, to which women are liable shortly after delivery. It assumes 
 two forms; the first is purely inflammatory, the second is accom- 
 panied with typhoid symptoms. In both varieties the inflammation 
 is seated in the peritoneum, or serous membrane, which lines the 
 cavity of the abdomen, and envelops the various organs contained 
 in it. The whole or only a part of this membrane may be affected, 
 and sometimes the substance of the womb and its appendages are 
 inflamed. 
 
 The first variety commences with general shivering, or merely a 
 sensation of chilliness in the back and loins. In either case the feel- 
 ing of cold is soon followed by heat of surface ; full hard pulse, 
 sometimes not quicker than natural, but generally varying from a 
 hundred to a hundred and ten beats in the minute ; headache, great 
 restlessness, and other symptoms of general excitement, attended by 
 pain and swelling in the whole or part of the abdomen, according to 
 the extent or progress of the disease. The discharge called the 
 lochia, or in popular language, the cleansings, which always follow 
 delivery, is commonly checked, but sometimes it continues to flow 
 as usual. The breasts become flaccid, and if the milk have begun 
 to flow, it is dried up, but the disease generally commences before 
 this secretion is established. The patient lies on her back, with the 
 knees raised upwards towards the belly; this position being found 
 the least painful, inasmuch as it slightly relaxes the inflamed 
 peritoneum. 
 
 This alarming disease generally makes its attack about the third 
 day after delivery, sometimes on the first, and often not until the 
 sixth day, or even later. It is always the more dangerous the 
 earlier it commences. By energetic treatment it may be subdued 
 in the course of a few days, the pain and swelling subside, the 
 appearance of anxiety and distress so strongly depicted in the 
 countenance gradually wears off, and the woman quickly recovers ; 
 or it may be prolonged from eight to fifteen days, and then terminate 
 favorably, or pass into a chronic state, from which the patient very 
 
AND MOST RECENT METHODS OF TREATMENT. 765 
 
 seldom recovers. In many cases the symptoms progress with fright- 
 ful rapidity, the belly becomes enormously distended, the inflamma- 
 tion extends to the peritoneal covering of the stomach, vomiting 
 supervenes, and the patient dies delirious and in great agony. It 
 occasionally happens, after a longer or shorter period of severe 
 suffering, that the pain subsides, and the patient becomes perfectly 
 quiet and composed. This deceitful calm indicates the near approach 
 of death. 
 
 In the second, or typhoid variety, the shivering is severe and 
 long continued; the headache is intense, and accompanied, even 
 from an early period, with constant low delirium, which is in most 
 cases preceded for a short time by drowsiness and listlessness ; the 
 latter symptom is shown more particularly by the patient becoming 
 careless about her child. The pulse is small, hard, and exceedingly 
 quick, being from 130 to 160 in a minute ; the higher it is the 
 greater is the danger. The skin is hot and dry, whereas in the 
 former variety it is generally moist ; the face is pale and contracted, 
 there is great prostration of strength, and frequently vomiting and 
 purging. 
 
 Causes. — Childbed fever may be caused by violence during 
 delivery, exposure to cold, premature exertion, agitation of mind, 
 errors in diet, or the imprudent use of stimulants ; and it sometimes 
 prevails as an epidemic. 
 
 Treatment. — It is supposed that half the women who die in child- 
 bed fall victims to puerperal fever ; hut the mortality would not be 
 nearly so great if medical aid were procured at an early period of 
 the disease, for it is only within the first twenty-four hours that 
 much confidence can be placed in remedies. It cannot, therefore, be 
 too strongly impressed upon the minds of the friends and attendants 
 of childbed women, that medical counsel should be sought at the 
 very onset of this formidable malady, for, from the moment the first 
 symptoms are manifested, the woman's life is in peril, and this will 
 be increased by every hour's delay. 
 
 The violent character of childbed fever, the rapidity of its pro- 
 gress, and the little control which the physician has over it, show 
 the great importance of adopting measures to prevent its occur- 
 rence. Regular exercise ought to be taken during the last months 
 of pregnancy, and the bowels should be carefully kept open by the 
 occasional use of a dessert-spoonful of lenitive electuary, or mild 
 doses of fine East India castor-oil. If the woman be robust and 
 full-blooded, the abstraction of a moderate quantity of blood from 
 the arm is a necessary precaution, if not forbidden by peculiar cir- 
 cumstances. Two or three hours after delivery the infant should 
 
766 DESCRIPTION OF THE PRINCIPAL 
 
 be allowed to take the breast, and this practice should be continued 
 during the first fortnight, even if the mother have no intention of 
 suckling the child herself. She ought to remain in bed during the 
 first nine days, and not quit her apartment for a fortnight. 
 
 % 
 
 PUEKPERAL MANIA. 
 
 "The period at which this mental disease appears is various; 
 but it is seldom, if ever, sooner than the third day, often not for a 
 fortnight, and in some cases not for several weeks after delivery. 
 It usually appears rather suddenly, the patient awakening, perhaps, 
 terrified from a slumber ; or it seems to be excited by some casual 
 alarm. She is sometimes extremely voluble, talking incessantly, 
 and generally about one object ; supposing, for example, that her 
 child is killed or stolen ; or, although naturally of a religious dis- 
 position, she may utter a succession of oaths with great rapidity. 
 In other cases she is less talkative, but is anxious to rise and go 
 abroad. In some instances the patient recovers in a few hours, in 
 others the mania remains for several weeks, or even some months ; 
 but I believe it never becomes permanent, nor does it prove fatal 
 unless dependent on inflammation of the brain." 
 
 Treatment. — Puerperal mania is a disorder of the nervous sys- 
 tem. The treatment consists in keeping the patient as quiet as 
 possible, in opening the bowels occasionally by mild laxatives, in 
 keeping the head cool by the application of eau de cologne and 
 water, vinegar and water, or any other simple cooling lotion. Mild 
 anodyne remedies are useful in soothing the patient and preventing 
 restlessness during the night. The bromide of potassium maybe 
 of service. The diet should be light and nutritious. The secretion 
 of milk should be stopped by removing the infant from the mother. 
 But in this disorder, which is seldom dangerous, time and careful 
 nursing are more to be relied upon than medicine. 
 
 PULMONAKY CONSUMPTION. 
 
 Consumption is caused by the deposition of scrofulous matter in 
 the substance of the lungs. The deposition takes place in small 
 granules, called tubercles, which are of a dull white or yellowish 
 color, of firm consistence, slightly transparent, varying from the 
 size of a small pin's head to that of a garden pea or a small hazel- 
 nut, and disseminated more or less extensively through the lungs ; 
 but they are almost invariably more numerous, larger, and more 
 fully developed towards the upper and back part than at the base. 
 
AND MOST RECENT METHODS OF TREATMENT. 767 
 
 The progress of the disease, therefore, is usually from above down- 
 wards. In their earliest stage these little bodies are distinct from 
 each other, but as they increase in size and number they coalesce, 
 so as to form thick opaque masses of a yellow color and of consid- 
 erable size. These small tumors at length soften, and acquire the 
 consistence and appearance of matter (pus) ; they communicate 
 with each other, and the matter finds its way into the bronchial 
 tubes or air-passages, and passes off by expectoration. Each mass 
 or cluster of tubercles, after reaching a certain size, undergoes the 
 same change, and the cavities necessarily produced by the evacua- 
 tion of the matter tend to run into each other, in consequence of 
 the gradual development and softening of surrounding portions. 
 The openings formed are at first small, but the softening of tuber- 
 cles forming the walls of the cavities goes on gradually until a free 
 communication takes place. The excavations thus produced vary 
 in size ; sometimes they are not larger than a pea, at other times 
 they might contain half a teacupful, or even a cupful of fluid; they 
 may be seated deeply in the substance of the lungs, or may approach 
 the surface so as to be bounded only by the pleura, or enveloping 
 serous membrane. The walls of the cavities constantly secrete 
 matter, and portions of them gradually become detached. Some- 
 times the surrounding substance of the lungs remains sound, but 
 in general it becomes more or less impervious to air; and before 
 the patient dies it is supposed that on an average three-fourths of 
 the whole texture of the lungs are rendered incapable of carrying 
 on the function of respiration. 
 
 In the first stage of consumption the principal symptom is cough, 
 which at first occurs only on rising in the morning, and is little 
 noticed ; but after some time it becomes more or less troublesome 
 during the day, particularly after going up stairs or on taking ordi- 
 nary exercise, but for a considerable length of time is not accom- 
 panied by expectoration. 
 
 Cough is a symptom of some trouble of the air-passages or of the 
 lungs. It is by no means necessarily a bad or dangerous symptom. 
 It may be caused by trouble in the larynx, or even in the pharynx, 
 as well as by bronchitis or consumption, or any other affection of the 
 lungs. 
 
 Cough is simply an effort of nature to get rid of some irritation. 
 The cough is not the disease, as many suppose ; it is nature's method 
 of relieving us somewhat of the irritation of disease. It is bad to 
 cough ; it might be worse oftentimes not to cough. 
 
 At length the patient begins to expectorate a thin, whitish, 
 semi-transparent mucus resembling saliva, and this is observed to be 
 
768 
 
 more copious on getting out of bed than during the day. A sensa- 
 tio*n of constriction now begins to be felt at the chest, and is at 
 times attended with slight difficulty of breathing. After a longer 
 or shorter period the general health commences to give way, a slight 
 degree of shivering is experienced occasionally, and is followed by 
 restlessness and heat of the skin, more especially of the palms of the 
 hands and soles of the feet, terminating in slight perspiration. As 
 the disease gains ground the patient becomes gradually emaciated, 
 and is unfitted for much bodily or mental exertion. His face is 
 sometimes flushed, at other times pale. The pulse is considerably 
 quickened, and the face appears flushed after eating, or any bodily 
 exertion. Lassitude soon follows, and the countenance assumes a 
 peculiar expression of languor and fatigue. The patient feels at 
 times chilly, and cannot bear cold as formerly ; he is restless during 
 the night, and sometimes awakes with his chest or the calves of his 
 legs bathed in perspiration ; and in many cases the hair loses its 
 strength and falls off. At this period the tubercles are interspersed 
 to a greater or less extent through the substance of the lungs, but 
 are still grayish and semi-transparent. 
 
 The second stage commences with softening of the tubercles, and 
 is manifested by a decided change in the appearance of the expec- 
 toration, which is now whitish, opaque, and does not run together 
 in masses, but is seen in detached portions, of a round form, with 
 irregular indented edges, and floating in the thin transparent liquid 
 secreted by the lining membrane of the air-passages. During this 
 stage, sometimes at an earlier period, spitting of blood, which is one 
 of the most marked symptoms of the disease, generally takes place. 
 This may be slight, from a few streaks of blood to a spoonful, or it 
 may be to the extent of a pint or more. In some instances the 
 patient is seized with spitting of blood while enjoying apparent 
 health, and this may be the first symptom which he observes. Blood 
 sometimes comes from the mouth or throat, or spitting of blood may 
 be caused by deranged menstruation, or by local injuries. But it 
 rarely happens that blood comes from the lungs, unless the patient 
 be consumptive. The cough is now greatly aggravated, and is 
 troublesome during the night; the pulse is permanently quicker 
 than natural, and ranges from ninety to one hundred and twenty 
 beats in the minute ; hectic fever becomes confirmed ; the debility 
 and emaciation increase; the face is pale during the day and flushed 
 in the evening ; and pains resembling rheumatism are felt at the 
 shoulders and chest. 
 
 In the third stage all the symptoms already enumerated increase, 
 the rigors or chills in the evening are severe, the consequent heat of 
 
AND MOST KECENT METHODS OF TREATMENT. 769 
 
 the surface of the body, thirst and restlessness, are very distressing, 
 and the morning perspirations more profuse. The cough occurs more 
 frequently, and is followed by breathlessness ; the voice becomes 
 more or less hoarse or indistinct ; the slightest exertion increases the 
 difficulty of breathing, and many patients suffer severely from pains 
 in the chest. The expectoration is now very copious, and assumes a 
 yellow color, with a dirty grayish tinge and nauseous smell ; it no 
 longer appears in round masses with indented edges, but runs 
 together, still appearing unmixed with the thinner liquid. Frequent 
 purging also harasses the patient, and tends greatly to increase the 
 debility and emaciation; the ankles begin to swell in the evening, 
 and after some time remain permanently swollen. Some patients 
 suffer comparatively little towards the termination of the disease ; 
 they waste away gradually until the powers of life are completely 
 exhausted, and death takes place without a struggle. In other cases, 
 again, the hectic fever, difficulty of breathing, and frequent cough, 
 followed by a sense of suffocation and sinking, are severe to the last. 
 
 The duration of consumption varies greatly in different indi- 
 viduals ; sometimes it commences almost insensibly, progresses very 
 slowly, and passes through its different stages almost without either 
 fever or cough ; this latent form of the disease is common in children, 
 and in persons far advanced in life. In other cases, again, the 
 tubercles are extensively disseminated through the substance of the 
 lungs, and the disease declares itself abruptly ; the fever and pros- 
 tration are sometimes so intense and the emaciation so rapid that 
 the patient sinks in the course of a few months. This form of the 
 disease is known to the public at large under the denomination of 
 galloping consumption, and occurs more frequently in women than 
 in men. It often happens that consumption advances slowly 
 during a year or two, or even considerably longer; then becomes 
 suddenly developed, and terminates fatally in a very short 
 time. In such instances a slight cough is perhaps the only 
 symptom particularly noticed by the patient or his friends, until 
 he is suddenly seized with shivering, followed by a considerable 
 degree of fever, with oppression and difficulty of breathing ; and 
 on examining the chest the physician now discovers that the 
 disorder has advanced beyond the reach of our art. In cases of 
 this description, it is more than probable that tubercles had 
 long existed in the lungs in a latent state, and that the softening 
 process had commenced suddenly in a great many of them at the 
 same time, giving rise to fever and the usual symptoms of the dis- 
 ease in their most intense form. 
 
 Sometimes the symptoms of consumption appear to intermit ; 
 49 
 
770 
 
 they cease during summer, and the friends of the patient are led to 
 believe that there is no longer any cause for alarm ; the following 
 winter, however, brings back the symptoms, which again disappear 
 almost entirely when the weather becomes mild; these changes, 
 perhaps, take place during several years before the disease becomes 
 fully developed. 
 
 The duration of consumption depends greatly on the circum- 
 stances of the patient. Those who have it in their power to avoid 
 all the causes which tend to aggravate the disease are, of course, 
 more likely to linger during a longer period than those who have 
 not. The average duration of consumption is from twelve to eigh- 
 teen months. 
 
 The first duty of the consumptive is to find out whether he 
 really has the disease or not. This question can only he answered 
 by a competent physician. 
 
 Many who are troubled by a cough arising from bronchitis 
 ignorantly suppose that they have consumption, and when the 
 cough leaves they represent to their friends ever afterward that 
 they recovered from consumption. 
 
 The true way is to face our danger bravely ; to have our lungs 
 examined by a competent and honorable physician in the early 
 stages of the disease, before it is too late to try remedial measures. 
 
 If our lungs are not affected, it is a gratification to know the 
 fact / if they are affected, it is important that we should be in- 
 formed in time. There is, therefore, every reason why we should, 
 as soon as possible, have a reliable opinion concerning the condition 
 of our lungs. 
 
 Causes. — Pulmonary consumption is generally admitted to 
 be referable in all cases to one common origin, viz., that de- 
 bilitated state of the constitution termed the scrofulous habit. 
 This is more particularly remarkable in the hereditary transmis- 
 sion of consumption in scrofulous families, and in the frequent 
 connection which exists between consumption and various symp- 
 toms and appearances of scrofula. The development of an ex- 
 ternal scrofulous abscess bears a strong analogy to the forma- 
 tion and progress of tubercles in the lungs. Both commence 
 in the same slow, insidious manner, become solidified, then soften, 
 and present the same kind of thick curdy matter. We also ob- 
 serve the same general symptoms — the hectic fever, the exces- 
 sive sweating, the flushing of the face, emaciation, purging, &c., 
 in scrofulous inflammation of the hip or knee-joint, as in confirmed 
 consumption. 
 
 Although the tuberculous or scrofulous constitution, or that 
 
AND MOST RECENT METHODS OF TREATMENT. 771 
 
 state of the system which precedes consumption, can generally be 
 traced to hereditary origin, it may nevertheless arise from various 
 causes, the principal of which are the following : 
 
 1. A cold, damp, and variable climate ; hence consumption is 
 of rather more frequent occurrence in countries which have wet 
 and cold alternating with heat, than in those which have a dry 
 atmosphere, whether cold or hot. This is illustrated by the fre- 
 quency of the disease in England and in Holland ; whereas within 
 the tropics and in the northern part of Russia, where the atmosphere 
 is dry, it is perhaps not quite so frequent. 
 
 2. Improper food. Diet composed of substances not sufficiently 
 nutritious or stimulating, or an inadequate supply of food, tends 
 strongly to produce consumption. Hence the disease occurs 
 most frequently amongst the poor, and many consumptive in- 
 dividuals of this class of society attribute their illness to the priva- 
 tions they have undergone from want of food ; and among the in- 
 digent, particularly in large towns, it is observed that women fre- 
 quently become consumptive while nursing. On the other hand, 
 among the more affluent classes of society, there is reason to believe 
 that the disease is often induced by abstaining from nutritious food, 
 through false theories on the subject of diet. (See Food.) 
 
 3. Impure air. Some modern authors place this at the head of 
 the causes of consumption, and there can be no doubt that it ex- 
 ercises a very pernicious influence on the animal economy. Breath- 
 ing an atmosphere loaded with smoke, and polluted with numerous 
 exhalations necessarily connected with the various processes of 
 animal and social life, must tend greatly to increase the mortality 
 of large towns, more especially among the working classes, who 
 reside in narrow, dirty streets, lanes, confined courts, and similar 
 localities, where the ventilation is imperfect, and the vivifying rays 
 of the sun are excluded. (See Air and Sunlight.) 
 
 4. Excessive labor. This cause depresses the energies both of 
 the physical and moral system ; and whatever tends to debilitate 
 the body tends also to induce consumption. 
 
 5. Deficient exercise must also rank among the causes of con- 
 sumption. 
 
 6. Certain occupations. The sedentary occupation of literary 
 men, tailors, shoemakers, weavers, dressmakers, &c, conjoined 
 with want of pure air, induce that state of the constitution 
 of which consumption is to be considered as the local manifes- 
 tation. This disease also appears to be frequently brought on 
 by certain trades, which expose the workmen to an atmosphere 
 loaded with irritating gases, and minute particles of various 
 
772 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 substances. (See Influence of Occupations on Health and 
 Longevity?) 
 
 TREATMENT OF PULMONARY CONSUMPTION. 
 
 Those who are afflicted with pulmonary consumption should re- 
 member these facts : 
 
 1. The disease is constitutional, and not simply local. Therefore 
 all the measures which merely affect the lungs and air-passages can 
 at best afford only temporary relief. 
 
 2. No specific has yet been found for this disease. "Whatever 
 charlatans may advertise, whatever those who profess and who really 
 believe that they have been cured of consumption by some particu- 
 lar nostrum may assert, the people should understand that no specific 
 has yet been found for this .terrible disease. 
 
 3. Most of those who declaim and who honestly believe that they 
 have been cured of consumption really never had the disease 
 at all, but have simply recovered from bronchitis, or some other 
 less serious affection of the air-passages. Very few patients can 
 judge whether they have or have not consumption, and physicians 
 themselves are liable to error, especially in recent and doubtful cases. 
 
 4. Consumptives sometimes recover. When they do not get per- 
 manently better their lives are oftentimes much prolonged. It has 
 been estimated that the lives of consumptives have been quadrupled 
 under the modern methods of treatment. 
 
 The first great thing in the treatment of consumption is Air. 
 The patient must be as much as possible out of doors. So far as 
 possible, he should live in the open air, and exposed to the sunlight. 
 (See A ir, Sunlight, and Exercise.) 
 
 Next to air comes nourishing food. The consumptive needs 
 plenty of carbonaceous food. He should therefore be encouraged 
 to eat freely of beef, mutton, eggs, fish, and milk. If he properly 
 observes the laws of health in regard to air and exercise, his appe- 
 tite will usually be good, except, of course, in the last stages. 
 
 Next to air and food comes medicine. The medicines which 
 are now found most useful for consumptives are cod-liver oil, cream, 
 and alcoholic stimulants. 
 
 It is a mistake for patients to place too much dependence on 
 medicine of any kind, for it is at best merely an aid to nature. 
 Cod-liver oil may be taken in doses of one or two tablespoonfuls, 
 two or three times a day. Some patients are unable to take it on 
 account of its nauseous taste. 
 
 There are certain accompanying symptoms that may be relieved 
 or mitigated, even though we cannot cure the disease. 
 
AND MOST RECENT METHODS OF TREATMENT. 773 
 
 The night sweats may be checked by the use of vitriol or aroma- 
 tic sulphuric acid, with quinine. 
 
 The cough may be checked by opiates, although it cannot be 
 prevented. 
 
 But the patient should be discouraged from taking the thousand 
 and one expectorant medicines that are offered by sympathizing 
 friends. They irritate the stomach, and rarely do any good. 
 
 PREVENTION OF CONSUMPTION. 
 
 Consumption is to be prevented on the same principles by which 
 it is treated. Those who inherit a tendency to this disease, or who 
 suspect that it may attack them, should give attention to the follow- 
 ing points : 
 
 1. Air, Exercise, and Sunlight. — These three are the best anti- 
 dotes of consumption that we know of. (See Air, Exercise, and 
 Sunlight under Hygiene?) Sometimes it may be necessary to change 
 occupation ; but I dislike very much to compel patients to leave 
 any occupation that they dearly love, and for which they have a 
 positive taste, for one that they hate, and which is uncongenial to 
 their tastes. I rarely advise one to leave a mental occupation for 
 one which is purely muscular, unless the indications are very strong 
 indeed. 
 
 2. Abundant food, especially of meat. — Those who have a ten- 
 dency to consumption should live as generously as their purses will 
 allow. They should have abundance of flesh. They should take 
 fat meat, if they can make themselves enjoy it. 
 
 Consumptives make great mistakes when they refuse meat as a 
 matter of principle, as some do, and confine themselves to vege- 
 tables and fruit. (See Diet, under Hygiene}) 
 
 3. Special exercises to expand and develop the lungs. — It is well 
 to take full long breaths habitually, several times daily, from youth 
 up to manhood. It is well to devote a little time, when we are 
 dressing and undressing especially, to this very pleasant amusement 
 of slowly inflating the lungs to their utmost capacity, and then as 
 slowly exhaling the air, at the same time standing erect and throw- 
 ing the arms back. This practice may be aided by holding small, 
 light dumb-bells in the hands. Dr. H. G. Davis's method of expand- 
 ing the chest by swinging from a bar may be used with benefit by 
 those whose lungs are in a weak condition. Practice with the spiro- 
 meter is also of advantage, provided it is guided by common sense. 
 
 It is undoubtedly possible to injure one's self by pursuing these 
 methods of developing the chest too exclusively and too severely. 
 
774 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 That they can be of great benefit to those who use them -under the 
 guidance of good common sense, there can be no question. 
 
 4. Residence in a favorable locality. — It appears from the sta- 
 tistics of Dr. Bowditch, that those who live in houses situated in low 
 marshy places, where the soil is damp, are more liable to consump- 
 tion than those who live in a dry soil. Dr. Bowditch states most 
 emphatically, that in those towns of Massachusetts where the soil is 
 dry, consumption is less frequent and less fatal than in those towns 
 where the soil is moist. The difference in mortality from con- 
 sumption between the different towns of Massachusetts is most 
 surprising. 
 
 The same fact of the dependence of consumption on moisture 
 of soil has also been observed in England. The question of a per- 
 manent change of climate must be determined by each individual 
 for himself, and by the advice of his physician. 
 
 In preventing consumption, as in preventing nervous diseases, we 
 should not depend on any one method of treatment, or any one sys- 
 tem, but on all measures .that have been proved to be beneficial. 
 
 Every necessary precaution should be taken to avoid danger from 
 wet feet, sitting in currents of air, the long-continued influence of 
 cold and wet, and sudden alternations of atmospheric temperature, 
 as going out of hot rooms into the cold night air, or passing from 
 the latter into heated rooms ; but exposure to the open air at all 
 seasons, when the body is protected by suitable clothing, and proper 
 precaution is observed, improves the general health and strength, 
 and tends strongly to fortify the system against the impression of 
 cold ; whereas confining phthisical persons in warm rooms during 
 winter, and the adopting of other measures for the purpose of escap- 
 ing the effects of a cold and variable atmosphere, have a tendency 
 to debilitate the constitution, and, instead of counteracting the un- 
 favorable influence of the climate, only render the invalid more sub- 
 ject to it, and thus produce the very opposite effects to those inten- 
 ded. Another powerful means of hardening the body so as to allow 
 the invalid to withstand atmospheric vicissitudes, and render him 
 capable of following his usual avocations, and enjoying the rational 
 pleasures of life, is cold bathing. At first the tepid shower-bath may 
 be used, or simple ablution of the trunk of the body by means of a 
 sponge or a towel dipped in water, containing a portion of salt or 
 vinegar (two ounces of either to a pint of water), and after the skin 
 has been carefully dried, friction with the hair glove or a rough 
 towel should be used. The time for using this process is immedi- 
 ately on getting out of bed. It is advisable in all cases, whether 
 the shower-bath or sponging be employed, to begin with warm 
 
AND MOST RECENT METHODS OF TREATMENT. 775 
 
 water, reducing the temperature gradually until it can be used quite 
 cold. Either of these methods may be continued daily through the 
 coldest winter, but the latter, being the least troublesome, is gener- 
 ally preferred. Both sexes should wear flannel next the skin, from 
 the collar-bones to the ankles. It ought to be worn of a thinner 
 texture in summer than in winter, out never altogether discontinued. 
 Many young ladies bring consumption on themselves by deficiency 
 in clothing, and wearing silk stockings and thin shoes during winter. 
 
 Dr. Mattocks thus remarks on the effects of climate upon the 
 lungs : 
 
 " Dr. Bowditch, in his writings upon consumption, both for the 
 profession and for the people, lays much stress upon dampness as 
 the great exciting cause of consumption. 
 
 " While we do not claim that tubercle is deposited by a peculiar 
 fungus, generated by dampness with cold, yet we do claim that 
 where there is a damp cold climate, subject to sudden changes by 
 reason of lake or marine winds, tubercle follows as surely as mould 
 attacks clothing or damp wood. 
 
 u While pathology has not yet taught us conclusively the source 
 or origin of this tuberculous matter, yet experience has taught us the 
 condition of the system most favorable for its attack. Often a 
 slightly congested lung by reason of cold, followed by imperfect re- 
 covery, may be the exciting cause, preceded in the great majority 
 of instances by a lessened vitality, in consequence, perhaps, of a re- 
 cent attack of illness, grief, or the depressing effect of poverty — all 
 these reasons may predispose to the disease, accompany or hasten it, 
 but a ' cold ' lights the flame. 
 
 " As an illustration of our premises, I give below the census re- 
 turns of 1S60 of the deaths by consumption. The census in many 
 of its details is incorrect, but for the purposes of comparison I find 
 it mainly correct. As the death-rate is very different in many States, 
 for more correctness of comparison I have estimated the number of 
 deaths from the population of each State. For instance, in Massa- 
 chusetts, for 1860, one person died with consumption in every 250 
 inhabitants : 
 
 "Maine 1 in 280 
 
 New Hampshire " 280 
 
 Khode Island " 300 
 
 Connecticut " 360 
 
 Vermont " 400 
 
 New York " 470 
 
 New Jersey " 490 
 
776 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 Delaware 1 in 550 
 
 Maryland " 570 
 
 Pennsylvania " 580 
 
 Michigan " 630 
 
 Kentucky " 660 
 
 Ohio " 670 
 
 California " 720 
 
 Virginia " 750 
 
 Indiana " 760 
 
 Tennessee " 770 
 
 Louisiana " 840 
 
 Wisconsin " 850 
 
 Illinois " 880 
 
 Missouri " 900 
 
 Iowa " 902 
 
 Kansas " 910 
 
 Minnesota " 1,139 
 
 North Carolina " 1,300 
 
 Arkansas " 1,322 
 
 Mississippi " 1,420 
 
 Texas " 1,430 
 
 Florida " 1,440 
 
 Alabama " 1,618 
 
 South Carolina " 1,720 
 
 Georgia " 2,150 
 
 " The ' sine qua non ' should be first a dry climate, and leave 
 it to the judgment of the patient which he will choose, or rather 
 which agrees with him the best — hot or cold. 
 
 " Some patients cannot stand the cold at all ; it seems to wither 
 them all up. These are, as a general thing, of a phlegmatic tempera- 
 ment, anaemic, and bloodless. They have no life, no vitality, and 
 they seem to desire none ; they want perpetual sunshine, with little 
 stirring about them. Such, of course, should be sent South, if moved 
 at all ; generally there is but little to hope from such patients. 
 
 "As we prescribe for each case remedies suitable for individual 
 cases, so should we prescribe a climate ; ever bearing in mind that 
 the same remedy given for the same disease oftentimes affects two 
 persons entirely differently by reason of peculiar idiosyncrasies. 
 This holds true as regards climate, perhaps in a more marked de- 
 gree than in medicine, hence the necessity of a patient and careful 
 examination into all the circumstances connected with each case; 
 and by all means let it not be confined to the chest, but let age, 
 
AND MOST RECENT METHODS OF TREATMENT. 777 
 
 sex, temperament, tastes, individual preferences, means, and gen- 
 eral condition of health exert their influence on the mind of the 
 physician before venturing an opinion as regards a change of 
 climate." 
 
 Concerning the influence of climate on consumption Aitken 
 thus speaks : 
 
 " The science of medicine is not unfrequently indebted to non- 
 professional people for correcting prevailing errors of belief and 
 establishing correct opinions. No one, perhaps, contributed more 
 in this direction, in the discharge of his own professional duties, 
 than the late Sir Alexander Tulloch. It was long a prevalent be- 
 lief that consumption was limited by latitude, arid that it never 
 appeared in warm countries — for instance, south of the Mediterra- 
 nean. But this is proved not to be the case ; for the returns of the 
 army, prepared by the above writer, have shown that phthisis is 
 more frequent in the West Indies than even in this country — a 
 statement first made by Sir James Clark in his work on climate, 
 in illustration of the injurious effects of that climate on consump- 
 tive patients sent there from this country. 
 
 "According also to the recorded opinion of this author, great 
 heat appears to have a powerful effect in predisposing to tuberculous 
 diseases (probably by diminishing the exercise in the open air). 
 That it is not the climate of the place which alone produces this 
 result in the West Indies, is shown by the fact that officers were 
 attacked in infinitely smaller proportions than private soldiers ; and 
 in consonance with the views entertained regarding the nature of 
 tuberculosis, it is more than probable that crowded barrack-rooms, 
 a restriction to salt diet, and drinking spirits may have produced 
 the result. 
 
 "It would appear that England and Wales, the Cape of Good 
 Hope, and the Ionian Islands are more exempt from phthisis than 
 many countries which, from their higher temperature, have hitherto 
 been supposed to enjoy a remarkable exemption from this com- 
 plaint. The result of extended observation now entirely refutes 
 the hypothesis, that paludal districts are in an eminent degree 
 exempt from phthisis — an opinion first promulgated by the late 
 Dr. Wells, and advocated by M. Boudin. England and Wales, the 
 Cape of Good Hope, Canada, and Malta — countries either the 
 driest or the best drained, and consequently suffering the least from 
 paludal diseases — are actually those countries the most free from 
 phthisis." 
 
 Concerning the relation of dampness of the soil to consumption. 
 Dr. Bdwditch speaks as follows : 
 
778 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 "1st. Phthisis (consumption) is very unequally distributed in 
 New England. 
 
 " 2d. There are some places which enjoy a very great exemp- 
 tion from its ravages, if not quite as much exemption as any por- 
 tion of the globe can claim. 
 
 " 3d. There are some spots, nay, even particular houses, which 
 are frightfully subject to it. 
 
 " 4th. There is a cause governing this unequal distribution of 
 the disease, — a law not recognized before these investigations, and 
 still practically ignored by the majority of human beings, which, 
 however, is one of the main causes, if not the sole cause, of the 
 unequal distribution in New England, and possibly elsewhere. 
 
 " 5th. This cause is intimately connected with, and apparently 
 dependent on, moisture of the soil, on or near which stand the 
 villages or houses in which consumption prevails." 
 
 On the subject of the contagiousness of consumption, the same 
 authority remarks : 
 
 " During the last quarter of the last century there was great 
 indecision on the part of the faculty, and many protested against 
 this strong position. From the writings of that period it is evident 
 that the idea of contagion had met a strong opposition, and finally, 
 early in this century, an opinion the exact reverse of contagion was 
 arrived at. Forty years ago scarcely any one believed in it, and 
 Italy relaxed its strict rules. But within a few past years the be- 
 lief in the contagiousness of tubercle, which is usually synonymous 
 with consumption, has suddenly again sprung up in Germany, 
 under the influence of experiments made by modern physiologists. 
 Inoculations of tuberculous matter from men to animals have been 
 made, and the disease has been reproduced in the animal. It is 
 true that doubt has been thrown upon the real value of the experi- 
 ments; and we think that doubt is a just one, because it has been 
 found that any long-continued local irritation of an animal — as, for 
 instance, the keeping up of a violently irritating sore on the body 
 — may eventually excite tubercular disease. Moreover, the fact 
 that tubercle inoculated — that is, put under the skin by means of 
 an operation — produces consumption in an animal, is no valid rea- 
 son for thinking that the emanations from the breath or skin of a 
 tuberculous patient would certainly convey the disease from man 
 to man. Still further, if the disease were really so contagious as 
 some believe, why have not physicians and nurses and attendants 
 at special hospitajs for the lungs — as at Brompton, for example 
 — been taken clown by the disease ? 
 
 "Briefly, we may say that medical opinion is at present much 
 
AND MOST RECENT METHODS OF TREATMENT. 779 
 
 divided upon the topic of the contagiousness or otherwise of con- 
 sumption. Few, if any, believe it to be equally contagious with 
 small-pox and other kindred contagious diseases. Still medical 
 opinion rather verges now towards the belief that the disease is at 
 times capable of producing a like disease in others, unless precau- 
 tions are taken by those who have the care of ministering to the 
 consumptive. With these precautions we believe there is no 
 danger ; without them there is peril." 
 
 PUSTULE, MALIGNANT. 
 
 This is " the result of a specific poison, which produces, in the 
 first instance, a redness like the bite of a gnat, and afterwards a 
 minute vesicle. A peculiar form of gangrenous inflammation is 
 excited, which rapidly spreads from the point first affected to the 
 neighboring tissues. Hardening and blackening of this part is 
 extreme, and death of tissue is so entire that the part creaks when 
 cut with a knife. No pain attends the incisions, crops of secondary 
 vesicles form round an erysipelatous-like areola, chains of lymphatics 
 become inflamed, the breath fetid, and death follows amid all the 
 indications of septic poisoning." — Budd, quoted by Aitken. 
 
 This disease, though not common in this country, has long pre- 
 vailed in various parts of Europe. It frequently attacks animals. 
 
 The disease may be communicated to man by eating the flesh 
 of animals that were affected with it. On this subject, however, 
 there is a difference of opinion. 
 
 It certainly may be communicated by immediate inoculation. 
 Skinners, butchers, and drovers are likely to take it. 
 
 It may also be communicated to man by insects that have been 
 in contact with the dead bodies of diseased animals. 
 
 There are those who believe that it may be generated spon- 
 taneously. 
 
 Treatment is useless unless it is commenced early. The remedies 
 are cauterization with potassa f%isa or nitric acid, and stimulants 
 internally, with beef-tea and other nourishing food. 
 
 The disease is so rare in this country that probably few of my 
 readers will ever see a case. 
 
 PYAEMIA. 
 
 This word literally means pus in the blood. It is a disease that 
 is well recognized. It is sometimes called septicemia. The disease 
 is not fully understood. It usually proves fatal. 
 
780 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 It probably results oftentimes from inflammation of the veins 
 {phlebitis). Phlebitis may occur in different parts of the body. 
 Very few people would be able to ascertain the existence of pycemia 
 during life. 
 
 There are no remedies for pyasmia. All that w T e can do is to 
 sustain the system. We may give tonics and stimulants and 
 nourishing food. Beyond that we cannot go. 
 
 QUASSIA. 
 
 The wood, bark, and root of the quassia tree are all exceedingly 
 bitter, but possess no aromatic principle. The wood, which is the 
 part chiefly used for medicinal purposes, is a cheap, simple, and 
 valuable tonic, especially in some forms of indigestion, in looseness 
 of the bowels (diarrhoea), in ague, and remittent fevers of warm 
 climates. 
 
 The infusion of quassia is prepared in the following manner : 
 " Take of quassia, sliced, two scruples ; boiling water, a pint ; macer- 
 ate for two hours in a vessel lightly covered, and strain. The dose 
 is a wine-glassful three times a day." 
 
 Quinine. (See Peruvian Bark.) 
 
 QUINSY. 
 
 Quinsy, or inflammation of the throat, is seldom ushered in by 
 shivering, as in other inflammatory diseases ; it usually commences 
 with a slight degree of headache, and stiffness of the neck, and a 
 feeling of general uneasiness. At the same time or shortly after a 
 slight difficulty in swallowing is experienced, together with a sensa- 
 tion of heat and dryness or rawness of the throat, which is soon 
 followed by pain more or less severe, according to the intensity of 
 the inflammation. The patient has a constant inclination to swal- 
 low, and every attempt at deglutition greatly increases the pain ; 
 the voice becomes nasal, and the articulation imperfect, so as ma- 
 terially to affect the speech ; the mucus of the mouth is very tena- 
 cious or slimy, and every attempt to spit it out is attended with an 
 aggravation of the pain. Sometimes the patient cannot open his 
 mouth sufficiently to allow the throat to be examined, but if this 
 can be effected, one or both tonsils — generally both, although one is 
 usually more affected than the other — are red and swollen, the uvula 
 or pap of the throat is also enlarged, and hangs down on the base 
 of the tongue. It often happens that the tonsils enlarge until they 
 touch each other ; the uvula is then thrown backwards, and almost 
 
AND MOST RECENT METHODS OF TREATMENT. 781 
 
 entirely concealed by them. In many cases the inflammation ex- 
 tends over all the back part of the throat, and is attended by slight 
 deafness, buzzing, and pain. The tonsils are not nnfrequently 
 swollen to such an extent that swallowing is entirely prevented, 
 and if the patient attempt to receive any kind of drink it is imme- 
 diately returned by the nostrils. 
 
 If the throat be examined at the commencement of the disease, 
 the tonsils appear like two red balls, dry and shining ; but at a later 
 period we may observe in the majority of cases several oval or 
 irregular-shaped spots of a yellowish, sometimes of a greenish color, 
 not only upon the surface of the tonsils, but on all the parts to which 
 the inflammation has extended. We must be careful not to mistake 
 this appearance, which arises simply from thick tenacious mucus 
 deposited upon the inflamed surface, for that which results from a 
 much more dangerous form of the disease — the malignant or putrid 
 sore-throat, in which false membranes are thrown out similar to 
 those which we have described as being formed upon the lining 
 membrane of the windpipe in croup. 
 
 The feverish symptoms which accompany quinsy are generally 
 more severe than the local disorder would lead us to expect ; the 
 pulse is full and frequent, sometimes as high as 120 in the minute ; 
 the face is flushed ; there is headache, with a sensation of fulness 
 and weight in the head ; there is considerable heat of skin, which 
 sometimes alternates with slight shivering ; the toDgue appears 
 swollen, and is covered with white or yellowish-colored mucus, and 
 there is a disagreeable taste in the mouth ; sometimes there is 
 nausea or vomiting ; the bowels are generally constipated ; the 
 urine is scanty and high-colored ; the patient is restless during the 
 night, and complains of a feeling of fatigue and general op- 
 pression. 
 
 Causes. — Exposure to vicissitudes of temperature, sitting in a 
 current of air, wet feet, wearing damp linen, going out of a heated 
 room into the cold air, or cold and wet, in whatever manner ap- 
 plied, are the most frequent causes of quinsy. This disorder occurs 
 generally in young people, and is common in all cold and variable 
 climates, more especially in spring and autumn. "V7omen are more 
 particularly subject to it during the period of menstruation. The 
 tendency seems to run in some families. Some who are subject to 
 it in early life in time outgrow it. 
 
 TREATMENT OF QnNSY. 
 
 1. Take a dose of the cold powder (see Cold Powder) before re- 
 tiring, at the same time soaking the feet in hot water and mustard. 
 
782 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 2. Use gargles of chlorate of potash — twenty or thirty grains 
 to an ounce of water — and take chlorate of potash internally, in 
 closes of ten grains. 
 
 3. If this treatment does not break up the attack, apply flaxseed 
 poultices to the sides of the neck. 
 
 4. Inhalations of the steam of water or of medicated solutions 
 may afford relief in severe cases. (See Inhalations) 
 
 Chronic enlargement of the tonsils. This is a very common af- 
 fection. The treatment is — 
 
 1. To give iodide of iron or Lugol's solution internally. 
 
 2. To apply Lugol's solution and glycerine, equal parts, to the 
 tonsils. 
 
 3. To sustain and strengthen the health of the patient by good 
 food, outdoor air, etc. Very rarely is it necessary to cut out the 
 tonsils. 
 
 In the relaxed sore throat, or that state of chronic enlargement 
 of the tonsils and uvula to which many people are subject in the 
 spring and winter seasons, in all countries where the weather is 
 cold and variable, the remedies usually employed are astringent 
 gargles, such as a strong decoction of oak bark, or the follow- 
 ing: 
 
 Purified alum, one drachm, 
 Tincture of myrrh, half an ounce, 
 Water, seven ounces. Mix. 
 
 Ten grains of nitrate of silver {lunar caustic), dissolved in one 
 ounce of water, constitute an excellent application for this descrip- 
 tion of sore throat : it should be applied by means of a camel's-hair 
 pencil. Many people derive benefit from the use of Cayenne lozenges ; 
 but it often happens that the throat continues in this relaxed state 
 for months, obstinately resisting every kind of local treatment. 
 Under such circumstances, change of air, active exercise, and tem- 
 perate habits will be found the best remedies. 
 
 REMITTENT FEVER. 
 
 Some indisposition usually precedes an attack of remittent fever 
 for several days. The patient is listless, languid, complains of head- 
 ache, pains in the back and loins, and oppression at the chest. The 
 appetite is impaired, and the bowels are irregular. 
 
 The attack in general commences with shivering, or a sensation 
 of cold and chilliness, alternating sometimes with flushes of heat. 
 This state is soon succeeded by burning heat and dryness of the skin, 
 flushing of the countenance, and injected eyes, with great increase 
 
AND MOST RECENT METHODS OF TREATMENT. 783 
 
 of the headache, and pains of the back and limbs. The tongue is 
 foul, and the mouth sometimes dry and clammy ; there is nausea, 
 and perhaps vomiting, with much thirst. The pulse, which during 
 the cold stage was weak and quick, is now full and strong ; the 
 breathing may be hurried, and the patient is extremely restless. 
 The throbbing and pain of the head are occasionally very violent, and 
 may end in delirium ; the urine is scanty and high-colored ; the 
 bowels are generally, though not always, constipated ; and some 
 degree of tenderness is felt on pressing with the hand over the 
 stomach. 
 
 After these sj-mptoms have continued from twelve to eighteen 
 hours, partial perspirations appear, followed by an abatement of the 
 febrile symptoms ; or they subside without any moisture on the skin. 
 The remission is marked by the pulse being less full and frequent, 
 the skin cooler, and the pains in the head, back, and loins relieved ; 
 and by the patient being free from delirium, and the stomach in a 
 less irritable condition. Nine or ten hours elapse before the patient 
 is seized with another paroxysm, which may come on at once without 
 any feeling of cold, or be preceded as at first by chilliness or shivering. 
 The disease goes on in this manner with alternate remissions and 
 returns of fever. If the case end favorably, each succeeding parox- 
 ysm becomes milder, until the fever entirely disappears, or it may 
 be carried off by copious perspirations. The periods of remission 
 and increased severity are very irregular, though the abatement of 
 fever very generally takes place in the morning. In cold climates 
 the disease may run on to the fourteenth day, or later ; but in hot 
 countries it is much more rapid in its course, terminating sometimes 
 as early as the third day ; but the usual period is from five to seven 
 or nine days. 
 
 In the more violent and dangerous cases the skin is burning hot 
 and the thirst intense; the vomiting is incessant, scarcely anything 
 being retained on the stomach ; there is violent throbbing or shooting 
 pain of the head, attended sometimes with furious delirium ; and 
 the pulse is full, quick, and strong. The remissions are short and 
 indistinct, and if the fever proceed to a fatal termination it may 
 become continued. The tongue is furred, red, contracted, and dry, 
 or crusted with black matter ; the skin and eyes may have a yel- 
 lowish tinge ; and dark-colored matter may be discharged from the 
 stomach. In some cases before death there are copious perspira- 
 tions, and the patient sinks rapidly; or the hot, pungent, dry skin 
 continues to the last. 
 
 Feyer of the remittent type has been divided into different 
 varieties from some peculiarity of the symptoms, or from particular 
 
784 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 organs being affected. Thus, for example, when the liver is diseased, 
 or there is much disorder of the biliary organs, it has received the 
 name of bilious remittent / when the eyes become yellow, and the 
 skin acquires a dusky yellowish hue ; there is vomiting or purging 
 of bilious matter ; the tongue is loaded with a yellow fur ; and there 
 is often tenderness on pressing with the hand under the ribs, at 
 the right side, in the situation of the liver. The irritability of the 
 stomach in this form is generally very obstinate, and the determina- 
 tion of blood to the head great. 
 
 TREATMENT OF REMITTENT FEVER. 
 
 1. Open the bowels by a dose of Epsom salts. 
 
 2. Quench thirst with lemonade and effervescing draughts. If 
 the head is hot, apply ice, and bathe the feet in hot water. 
 
 As soon as a remission takes place, which may be known by an 
 abatement of all the symptoms, as already pointed out, the sidphate 
 of quinine should be administered ; and in hot climates, although 
 the remission be short, and not very well marked, still the oppor- 
 tunity should not be lost of giving this excellent medicine. Two 
 grains may be taken at first in a little water, or wine and water, 
 every hour and a half or two hours ; or, 
 
 Sulphate of quinine, a drachm, 
 
 Elixir of vitriol (aromatic sulphuric acid), two drachms, 
 
 Water, a quart Mix. A wine-glassful to be taken every two hours. 
 
 If the bowels have not been well evacuated an ounce of Epsom 
 salts should be added to this mixture, but purgative medicine ought 
 always to precede the exhibition of quinine. It ought always to be 
 borne in mind that in administering this medicine the same dose 
 will not answer for each individual ; some persons can scarcely bear 
 the smallest quantity, while others require it to be given in large 
 doses to produce any decided effect; hence the safest method of 
 employing it is to commence with a small dose, increasing the 
 quantity gradually until some of its usual effects on the system ■ are 
 felt — as giddiness, ringing in the ears, slight deafness, nervo r lost- 
 lessness, &c. ; the medicine ought then to be left off for a time. The 
 quantity which the system will tolerate can be thus ascertained, 
 and the doses regulated accordingly. The exhibition of quinine 
 must, of course, be suspended on the recurrence of febrile symptoms, 
 and again resumed during the period of remission. For several days 
 after the fever has entirely disappeared it ought to be continued in 
 gradually diminished doses. If left off too soon a return of fever is 
 a very probable consequence. 
 
 In the malignant form, where there is great depression from the 
 
AND MOST RECENT METHODS OF TREATMENT. 785 
 
 beginning, with weak, quick pulse, stimulants must be given early. 
 In hot climates sudden sinking of the vital powers sometimes occurs; 
 the pulse becomes weak and irregular, or is scarcely to be felt ; the 
 extremities are cold and clammy, and the body may be covered with 
 cold perspiration ; the face is pallid; the eyes sunk in their sockets; 
 and the voice fails. When these symptoms are present no time is 
 to be lost in giving stimulants. Port or Madeira wine, or brandy, 
 in sago, arrow-root, &c, or champagne, which is the best stimulant 
 in such cases, should be given every hour until the pulse begins to 
 rise and the extremities are warm ; stimulants are then to be dis- 
 continued. The cold perspirations must be constantly wiped off, 
 and the extremities rubbed with warm flannels or rough towels. To 
 rouse the system, mustard poultices or blisters are to be applied over 
 the stomach or to the calves of the legs. If the tongue be charged 
 with a yellowish or brownish-colored fur, and the bowels have not 
 been well cleared out, the following pills should be given every 
 third hour till discharges follow : 
 
 Calomel, four grains, 
 Quinine, two grains, 
 Camphor, two grains. Mix, and form into two pills for one dose. 
 
 But if the bowels have been well evacuated, a quarter of a grain 
 of opium may be added to the above prescription, and the dose of 
 calomel reduced to two grains, discontinuing it altogether if the 
 gums become sore. The opium ought also to be omitted if much 
 drowsiness arise ; but in these states it usually acts as a stimulant 
 when given in small doses. 
 
 In the course of the attack the patient may be put in a warm 
 bath when there is much restlessness and hot, dry skin ; or at the 
 commencement, if the extremities be cold, the pulse weak, and" 
 reaction have taken place but imperfectly, a hot bath will be of* 
 great utility. The patient's drink should consist of barley-water, 
 lemonade, soda-water, tamarind beverage, &c. ; and if requested by 
 the patient, cold water may be allowed, a copious draught of which 
 we have known to bring on perspiration when other means had 
 failed. Liquids should never be taken in large quantities if irrita- 
 bility of stomach be present, as they will be rejected almost imme- 
 diately. In the low malignant varieties, effervescing liquors, such 
 as Seltzer or socla water, light beer, &c, will be useful, and are 
 likely to remain on the stomach. The diet ought to be light and 
 nourishing — as arrow-root, sago, pan ado, &c, and if the strength 
 be much reduced, beef-tea, soups, custards, &c, should be allowed. 
 Sometimes the vomiting is so intractable that no nourishment will 
 remain on the stomach ; in that case the patient's strength may be 
 50 
 
786 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 supported by injections of arrow-root, broths, or other nourishing 
 fluids in small quantities. The apartment ought to be kept per- 
 fectly quiet ; the evacuations are to be immediately removed, and 
 the room sprinkled with vinegar or chloride of lime, if the effluvia 
 be disagreeable. 
 
 In some cases it may be necessary to give arsenic instead of 
 quinine. 
 
 The period of convalescence is sometimes very tedious, tonic and 
 strengthening medicines being necessary ; but change of air will be 
 found one of the best of remedies ; this is particularly beneficial when 
 the fever has ended in the intermittent form (ague), which in many 
 cases will not yield to the usual remedies until the patient resort to 
 change of situation. 
 
 KHEUMATISM. 
 
 The more immediate or exciting cause of rheumatism is cold, 
 especially when it succeeds an opposite state of the atmosphere, or 
 is combined with moisture ; and the system is more particularly 
 susceptible of the injurious influence of cold when the person is 
 fatigued, or in a heated and perspiring state. But although undue 
 exposure to cold in some way or other will be found to have pre- 
 ceded an attack of rheumatism in by far the greater number of cases, 
 it does not appear that this alone is sufficient to give rise to the 
 disease, inasmuch as the instances where individuals are attacked in 
 consequence of exposure to cold are small indeed compared to the 
 numbers who are constantly exposed to atmospheric vicissitudes, and 
 to the influence of cold under all the circumstances in which it would 
 be most likely to prove injurious, without any disease being induced. 
 Hence it may be inferred that cold cannot produce rheumatism, 
 unless the system be predisposed to it ; but of the real nature of this 
 predisposition we have no positive knowledge. 
 
 Rheumatism appears under two forms — the acute and the chronic. 
 
 ACUTE RHEUMATISM, OR RHEUMATIC FEVER, 
 
 Is often preceded during several days by general uneasiness, gid- 
 diness, ringing in the ears, a feeling of weight and fulness in the head, 
 sometimes headache; there may be also occasional palpitations, 
 hurried breathing on any slight exertion, and symptoms of conges- 
 tion or fulness of blood in different organs. But these premonitory 
 symptoms are not always observed; it frequently happens that the 
 disease comes on suddenly, in consequence of the body having been 
 
AND MOST RECENT METHODS OF TREATMENT. 787 
 
 exposed to cold and wet. In either case certain general symptoms 
 nsually precede the local inflammation. These consist in more or 
 less severe shivering, alternating with flushes of heat, followed by 
 quickness and fulness of the pulse, hot skin, thirst, and a sensation 
 of fatigue in the back and extremities. After several hours, some- 
 times not before the expiration of a day or two, an aching or gnawing 
 pain is felt in one or more of the larger joints, which goes on increasing 
 until it becomes exceedingly severe, often lancinating as in gout, and 
 greatly aggravated by the slightest movement or pressure. The 
 affected joints become swollen, and the skin covering them acquires 
 a rosy tint, which generally appears in patches. The fever gains 
 ground with the increased severity of the local symptoms ; the pulse 
 becomes full and bounding, varying from a hundred to a hundred 
 and twenty beats in a minute ; the face is flushed or pale, and 
 bedewed with perspiration ; the eyes are red ; the skin is hot, and 
 occasionally covered with perspiration which emits an acid, pungent 
 smell ; the urine is scanty, and deposits a brick-colored sediment ; 
 the tongue is white and furred, but continues moist ; there is con- 
 siderable thirst, and the appetite is lost. When many of the joints 
 are affected at the same time, the patient lies on his back, and is 
 incapable of moving, his limbs being completely disabled ; the 
 slightest movement of the body is attended with excruciating pain ; 
 the suffering is greatly increased during the night, and if sleep over- 
 take him towards morning, he is soon roused by some frightful 
 dream. Sometimes the fever almost entirely subsides in the 
 morning ; this, however, is attended with little or no mitigation of 
 the pain ; and it is equally remarkable that no relief is afforded by 
 the profuse sweating which frequently occurs during the progress 
 of the disorder. The migratory character of rheumatic inflamma- 
 tion is another singular feature of the disease ; it often shifts its 
 seat from one joint to another, and after some time perhaps returns 
 to the joint originally attacked. 
 
 Rheumatism, though a painful and severe disease, is seldom 
 dangerous unless it extend to the heart, and then the risk is 
 greatly increased. Even in this case the immediate danger gener- 
 erally ceases along with the fever ; but in many instances disease of 
 the valves of the heart is subsequently induced, and gives rise to 
 enlargement of its substance (hypertrophy), and dilatation of its 
 cavities, — lesions which sooner or later terminate in dropsy and 
 death. 
 
 The febrile symptoms usually abate about the end of the second 
 week; the local symptoms then gradually diminish until they entirely 
 disappear, or the disease passes into the chronic form. 
 
788 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 CHRONIC RHEUMATISM. 
 
 The symptoms being less severe and of longer duration, are the 
 principal circumstances which distinguish chronic from acute 
 rheumatism. The general character of both these forms of the dis- 
 ease is the same, and the former is in many cases merely the sequel 
 of the latter. In the chronic form the joints are more or less 
 swollen and painful, while symptoms of general excitement are 
 always present in a sufficiently marked degree to indicate the ex- 
 istence of inflammation. The tongue is white and furred, the skin 
 is hotter, and the pulse quicker than natural ; the latter, it is true, 
 sometimes appears feeble and easily compressed, but is always in 
 some degree increased in quickness ; and if blood be drawn from the 
 arm, it will invariably present the buff-colored appearance on its 
 surface which is observed in all inflammatory diseases. Both the 
 constitutional and local symptoms may continue, varying at times 
 in severity according to circumstances, during a longer or shorter 
 period, perhaps several years ; and the disease, if not checked by 
 proper treatment, gradually undermines the 'patient's health, while 
 it disorganizes the joints, wastes the muscles, and renders him a 
 cripple. 
 
 Chronic rheumatism, after continuing a considerable length of 
 time, may ultimately wear itself out ; that is to say, the febrile symp- 
 toms may cease, and the local disease may no longer carry on its 
 ravages in the joints. The parts which have been inflamed may 
 remain cold, stiff, and contracted ; and exposure to cold or atmos- 
 pheric vicissitudes may render them painful, but rheumatism, 
 properly speaking, no longer exists ; the patient now only labors 
 under the morbid changes which the disease has already induced. 
 This state requires little or no medical treatment, and ought there- 
 fore to be carefully distinguished from that above described, in 
 which the judicious use of suitable remedies may be of the greatest 
 service. 
 
 In the above brief description of rheumatism, we have men- 
 tioned that the disease sometimes extends to the heart. This acci- 
 dent occurs most frequently when the disorder has been neglected 
 at the commencement, or when inappropriate remedies have been 
 employed. The symptoms by which we judge that inflammation 
 has invaded this vital organ are, unusually hurried breathing, pain 
 in the region of the heart, perhaps palpitation, and a feeling of op- 
 pression at the chest. 
 
 Physicians ascertain that rheumatism has gone to the heart by 
 auscultation. (See Auscultation.) 
 
AND MOST RECENT METHODS OF TREATMENT. 789 
 
 TREATMENT OF ACUTE RHEUMATISM. 
 
 Acute rheumatism is now chiefly treated by alkalies. This 
 method of treatment was introduced by Dr. Fuller, of England. 
 Alkalies are given on the theory that rheumatism is caused by acids 
 in the blood. 
 
 The alkalies that are usually given for rheumatism are the car- 
 bonate or bicarbonate of potash, Pochette salts, and saltpetre. 
 
 These remedies may be given in doses of from twenty to forty 
 grains, or about half a teaspoonful in water three or four times a 
 day. 
 
 These alkaline remedies, though by no means certain or infalli- 
 ble, are yet more surely efficacious than any other mode of treat- 
 ment for acute rheumatism with which the profession is familiar. 
 
 A certain distinguished physician once made the statement that 
 when " he began practice he had twenty remedies for rheumatism, 
 but in his old age he had not one." 
 
 The truth is, that what will cure acute rheumatism in one may 
 only aggravate the disease in another. 
 
 If the alkalies do not cure the patient, directly opposite treat- 
 ment may be used, and lemon juice may be given in doses of a 
 tablespoonful every two or three hours, and large quantities of 
 lemonade may be drank. 
 
 Quinine acts well in many cases. 
 
 The Cold Powder maybe given at night to relieve pain and in- 
 duce sleep. (See Cold Powder.) 
 
 Colchicum sometimes assists us when all these other remedies 
 fail. 
 
 The swollen limbs may be bathed in laudanum and alkaline 
 solutions, and also wrapped in flannel or oiled silk. ISTo powerful 
 applications should be made to the inflamed parts, lest the disease 
 may be driven to the heart. 
 
 It is always well to try the alkaline treatment first. Especially 
 on account of the tendency of acute rheumatism to go to the heart, 
 patients should in all possible cases place themselves under the care 
 of a physician. 
 
 TREATMENT OF CHRONIC RHEUMATISM. 
 
 One of the best remedies for the nameless phases of chronic 
 rheumatism that are so common everywhere, is general electrization. 
 (See Electrization and General Electrization.) There are, how- 
 ever, many severe loug-standing cases of chronic rheumatism that 
 nothing will ever cure or even relieve. There are cases which all 
 
790 
 
 known methods of treatment, including general electrization, seem 
 only to aggravate. 
 
 Such patients are justified, I think, in trying the various " waters " 
 and " baths " and " climates " that their means allow them to avail 
 themselves of. Anything is preferable to hopeless despair. It 
 must be confessed that our treatment for the severe obstinate forms 
 of chronic rheumatism is very unsatisfactory. 
 
 The best internal remedies are iodide of potassium, guaiac, qui- 
 nine, and cold castor-oil. All of them may be tried in succession. 
 
 Russian and Turkish baths often afford relief. (See Russian 
 and Turkish Baths.) 
 
 Sunlight is a good remedy, and sunlight baths are to be recom- 
 mended. 
 
 But all of these remedies too often fail us. 
 
 Lumbago is simply another name for rheumatism in the back. 
 It may be much relieved by dry cupping (see Dry Cupping), and 
 by the application of spongio-piline (see Spongio-piline), or by the 
 use of oiled silk or rubber cloth. 
 
 The thousand and one liniments that are used for rheumatism 
 do little harm, and sometimes may afford relief. In obstinate cases 
 they may be tried to an indefinite extent. 
 
 Plasters of belladonna or opium, and the common plasters of the 
 shops, sometimes relieve pain, even though they do nothing toward 
 removing the disease. 
 
 Sciatica is either rheumatism or neuralgia in the sciatic nerve 
 of the leg. It is caused oftentimes by inflammation within the 
 sheath of the nerve. It is most usually classed among the neural- 
 gias. It is sometimes a terribly painful affection, and in exceptional 
 cases appears to be incurable. The majority of attacks are dissi- 
 pated after a short time, but are apt to recur. Sciatica is best 
 treated by hypodermic injections of morphine, and by applications 
 of spongio-piline. (See Spongio-piline.) (For details of treatment 
 see Neuralgia?) 
 
 KHEUMATIC GOUT. 
 
 This is apparently a combination of gout and rheumatism. 
 
 It appears, however, to be a distinct disease from either gout or 
 rheumatism. The joints become swollen, and oftentimes painful. 
 The disease is very apt to attack the fingers and toes. Sometimes 
 the patient becomes terribly crippled, and may indeed be bedrid- 
 den. The affected joints are usually but little used. The disease 
 is frequently confounded with chronic rheumatism, which it so 
 
 
AXD MOST RECENT METHODS OF TREATMENT. 791 
 
 closely resembles. In the chronic form there is very little if any 
 fever. The patient is usually more or less debilitated. The dis- 
 ease seems to be caused by anything that exhausts or weakens the 
 constitution. Females are attacked by it oftener than males. 
 The treatment of rheumatic gout consists — 
 
 1. In tonics of various kinds, such as cod-liver oil, strychnine, 
 quinine, general electrization, and so forth. 
 
 2. Lithia internally, in doses of from three to five grains (it is 
 sometimes given in "carbonated water")', and iodide of lithia oint- 
 ment, applied to the affected joints. 
 
 The rest of the treatment is the same as for chronic rheumatism. 
 
 EHITBABB. 
 
 Ehubarb is much employed to give tone to the stomach and 
 bowels, in doses of two or three grains twice or thrice a day ; and 
 in doses of from twenty-five to thirty grains it acts as a mild and 
 excellent purgative. Ehubarb, besides its cathartic property, pos- 
 sesses a slightly astringent principle ; hence after its full purgative 
 action the bowels are liable to become constipated. To obviate 
 this it may be taken with cream of tartar, or a small quantity of 
 jalap or magnesia; and it should be combined with calomel when 
 the liver is in a torpid state. The constipating effect which usually 
 follows the purgative action of rhubarb renders it very serviceable 
 in diarrhoea, in cases where we have reason to suppose that the dis- 
 order is caused by offending matter lodged in the bowels. Perhaps 
 the best medicine that can be employed to relieve common colic is 
 an ounce of the compound tincture of rhubarb, with twenty or 
 twenty -five drops of laudanum. The compound rhubarb pill of 
 the London Pharmacopoeia is a mild and very useful laxative medi- 
 cine : " Take of rhubarb, powdered, an ounce ; aloes, powdered, 
 six drachms ; myrrh, powdered, half an ounce ; Castile soap, a 
 drachm ; oil of caraway, half a drachm ; syrup, as much as may 
 be sufficient. Mix the powders together, then beat the whole to- 
 gether until incorporated." The usual dose is two pills of five 
 grains each. 
 
 PICKETS. 
 
 Pickets occurs generally in children between the ninth month 
 and the fourth year of their age, and is essentially characterized by 
 softening of the bones. At the commencement of the disease the 
 child -is observed to be less cheerful than usual, languid, and disin- 
 
792 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 clined to be amused ; the appetite is impaired, or capricious ; and 
 the bowels are irregular. These symptoms are either accompanied 
 from the commencement, or soon followed, by a slight degree of 
 febrile excitement and disturbed sleep. The process of teething 
 goes on slowly and with difficulty, and the teeth soon decay and 
 fall out. The bones of the skull, instead of gradually closing and 
 becoming united, separate from each other, and the head increases 
 in size; the belly is also enlarged; while the limbs, more especially 
 the thighs and legs, appear thin and wasted. After a longer or 
 shorter period the symptoms which more particularly characterize 
 the disease are manifested. The ends of the long bones at the 
 wrists and ankles, and the extremities of the ribs where they join 
 the breast-bone, become swollen and knotted ; the spine is curved 
 in the form of the italic letter S ; the right shoulder rises, the 
 breast-bone is thrust forwards, and appears somewhat like that of a 
 bird. If the child have begun to walk, he is now unwilling to be 
 left on his feet, and cannot cross the room without difficulty ; the 
 knees approach each other, the feet are turned outwards, the limbs 
 are unsteady, and seem to yield under the weight of the body. As 
 the disease advances the digestive organs suffer, and the urine de- 
 posits a white sediment ; the bones now begin to lose the phosphate 
 of lime which gives them firmness, and are softened in such a man- 
 ner that they bend in all directions, and the little patient is soon 
 reduced to a shocking state of deformity, which renders him a sin- 
 gular, though distressing, object of observation. 
 
 Rickets does not generally prove fatal unless the disease declare 
 itself shortly after birth, and then it almost invariably destroys life. 
 When it appears at a later period, and proper attention is paid to 
 the patient the general health improves, and recovery frequently 
 takes place, but not without leaving a raised shoulder, a hump-back, 
 or some other deformity. In females, the bones of the pelvis often 
 remain distorted, and this, in the event of pregnancy, necessarily 
 leads to consequences of a more or less dangerous nature. If the 
 disease do not give way before the patient reach his fifth or sixth 
 year, he is doomed to be a miserable object during life, which is 
 seldom prolonged to middle age. 
 
 Causes. — In the higher classes of life this disease is compara- 
 tively rare, and when it does appear, can generally be traced to 
 hereditary transmission ; but among the children of the working 
 classes it is far from being uncommon, and appears to originate from 
 the same debilitating causes which give rise to scrofula. Mothers 
 of weak constitution and relaxed habit of body, who live on poor 
 diet, and neglect or have it not in their power to take sufficient ex- 
 
AND MOST RECENT METHODS OF TREATMENT. 793 
 
 ercise in the open air, or are exposed to the long-continued influence 
 of any of the various debilitating causes which impair the vital ener- 
 gies, cannot be expected to bring forth robust and healthy infants ; 
 neither is it possible that they can nurse them properly after they 
 have given them birth. 
 
 Treatment. — Children who have every attention paid to them 
 are sometimes attacked by rickets, but in the great majority of 
 cases much may be done to prevent the disease coming on. If the 
 child be delicate from its birth ; if any individuals of the same 
 family be rickety; if the parents be scrofulous ; or if there be any 
 other circumstances which might lead us to dread the occurrence of 
 the disease, it will be advisable to procure a strong healthy nurse for 
 the infant, in whom confidence can be placed, and her diet should 
 be carefully attended to as long as the child continues at the breast, 
 in order that her milk may be plentiful and nutritious. Chicken 
 or mutton broth, beef-tea, &c, may be allowed at an earlier period 
 than would be proper for robust healthy children. The child should 
 be washed daily, and the limbs frequently rubbed with a warm 
 hand ; and, when the weather permits, he should be carried out into 
 the open air as much as possible, and kept clean and dry. 
 
 SUMMING UP OF THE TREATMENT. 
 
 1. Air and sunlight. (See Hygiene}) 
 
 2. Nourishing food. — Beef-tea, beef, mutton, eggs, fish. These 
 should be taken freely, according to the age of the patient and the 
 appetite. Nothing brings on rickets like starvation. 
 
 3. Tonic medicines. — One of the best remedies for rickets is 
 " chemical food," or the syrup of the hypophosphites of lime and 
 soda. (See Syrup of Hypophosphites.) 
 
 The elixirs of iron, strychnine, and quinine may also be given. 
 
 RINGWORM, OR SCALD-HEAD. 
 
 Ringworm, or scald-head, is a common and well-known disorder 
 of the hairy scalp, occurring chiefly in children. It is manifested 
 under various forms, which have been minutely described by writers 
 on cutaneous diseases ; but such distinctions, although they may be 
 interesting to medical men, are, in a practical point of view, of no 
 value, inasmuch as the essential characters of the disease are always 
 the same, and the different appearances which it assumes are, no 
 doubt, owing. to some local or constitutional peculiarity. 
 
 Ringworm usually appears in patches of an oval or circular 
 
794: DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 form, each of which consists of numerous pustules of a pale yellow 
 color, and often so minute as not to be seen with the naked eye. 
 These soon burst, and the thin acrid matter which they discharge 
 forms crusts or scabs. In the course of a few days a fresh crop of 
 pustules break out round the patch; these burst in their turn, and 
 the exudation increases the size of the scabs, which, if not removed 
 by proper attention to cleanliness, become thicker, firmer in con- 
 sistence, and run into each other ; in this manner the disease, if not 
 arrested in its progress, extends over the whole head, and sometimes 
 attacks the forehead and neck. The hair appears to be affected 
 from the commencement of the disease, and gradually falls off; the 
 baldness thus produced constitutes one of the leading features of 
 the disorder. 
 
 Ringworm is decidedly contagious ; it is often caught at schools 
 by boys putting on each other's caps, using the same towels or combs, 
 or sleeping in the same bed. "To show you," says Dr. Elliotson, 
 " how very contagious this disease is, I may mention that a barber 
 had a child with a scald-head, and he kept a razor specially for 
 shaving it. One day by mistake he shaved himself with it, and 
 although he had washed and stropped the razor well, and had put it 
 into hot water first, yet the disease came out upon his chin about a 
 week afterwards. I saw it distinctly. Small circular pustules 
 came out. You must strongly impress upon the minds of people 
 the necessity of a child's dress being kept by itself in this affection, 
 lest the disease should spread." When it breaks out in large schools 
 or manufactories, it is often exceedingly difficult to eradicate. 
 
 Treatment. — The first thing to be done is to shave the head ; but 
 if the disease has advanced so far as to render this impracticable, 
 the hair is to be cut as short as possible. In the latter case it is 
 always advisable to wash the head repeatedly with soap and warm 
 water, and apply warm poultices of bread or linseed meal, to remove 
 the scabs. When we have succeeded in this the parts of the scalp 
 affected should be well anointed night and morning with the follow- 
 ing ointment, and after each rubbing the head is to be covered with 
 brown paper. 
 
 Common soda (barilla, or natron), three drachms, 
 Sulphuret of potash (liver of sulphur), the same quantity, 
 Lard, three ounces. Mix. 
 
 The head must be well washed with soap and water, and carefully 
 dried with soft rags, before the application of the ointment. This 
 is the best application for scald-head with which we are acquainted, 
 and when assiduously used generally effects a cure in the course of 
 
 
AND MOST RECENT METHODS OF TREATMENT. 795 
 
 three weeks. The ointment may be made stronger if not found 
 sufficiently active. 
 
 Creosote ointment is at present much employed in mild cases, 
 and frequently with success ; it should be applied at bedtime, and 
 the precaution above-mentioned, to wash the head previously, should 
 not be neglected. 
 
 Sometimes the patches are considerably inflamed at the com- 
 mencement of the disease ; in this case it will be necessary, before 
 using the ointment, to wash the head frequently with tepid water or 
 a decoction of poppy heads, and apply emollient poultices until the 
 irritation is removed. 
 
 In every case the local treatment will be greatly aided by atten- 
 tion to diet and regimen ; the food should be light, yet sufficiently 
 nutritious; the feet must be kept warm ; the tepid or cold bath, or 
 sponging the body, should not be neglected ; and in a word, every 
 means ought to be adopted to support the general health. 
 
 There is a species of this disorder occasionally met with, called 
 bald-scall, which is characterized by oval or circular patches of 
 baldness on different parts of the scalp. The denuded spots present 
 a smooth, shining, silvery appearance, without any kind of eruption. 
 
 The treatment of this form of the disorder consists in shaving 
 round the bald places to the extent of an inch, and rubbing them 
 twice a day with an ointment composed of equal parts of sulphur, 
 tar, and lard. Equal parts of oil of turpentine and spirits of wine 
 also constitute a very successful application. 
 
 The following course of treatment has been recommended for 
 scald-head : 
 
 1. Arsenic internally. (See Fowler's Solution.) 
 
 2. After washing the parts with a solution of carbonate of 
 potassa (one drachm to a pint of water), apply an ointment of this 
 prescription : 
 
 Carbonate of potassa, one drachm, 
 Glycerine, two drachms, 
 Lard, one ounce. 
 
 This ointment may be applied every day, or even more fre- 
 quently. (See Skin, Diseases of.) 
 
 Many of these diseases of the skin are quite difficult to manage ; 
 and in all important cases, or severe affections, like scald-head, 
 medical advice should be obtained. 
 
 KOCHELLE SALT. 
 
 E-ochelle salt acts as a cooling, mild laxative, and is less dis- 
 
796 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 agreeable to the taste than Epsom or Glauber salts. It is the prin- 
 cipal ingredient in the well-known Seidlitz powders. The dose is 
 from three drachms to an ounce and a half. 
 
 Rubbing. (See Movement Cure.) 
 
 INFUSION OF ROSES. 
 
 The infusion of roses is prepared in the following manner : " Take 
 of red rose petals or leaves, dried, three drachms ; diluted sulphuric 
 acid, a drachm and a half; sugar, six drachms ; boiling water, a pint. 
 Pour the water upon the rose leaves in a glass vessel ; then mix in 
 the acid. Macerate for four hours, and strain the liqnor ; lastly, add 
 the sugar to it." This infusion is useful in spitting of blood, in 
 the dose of two or three tablespoonfuls three times a day ; and is 
 much employed as a gargle for sore throat. It is principally used 
 as a vehicle for the administration of quinine and Epsom salts. 
 
 Salt Rheum. (See Tetter) 
 
 ST. YITUS'S DANCE, OR CHOREA. 
 
 There is no better description of St. Titus's dance than that 
 given by Sydenham a hundred and fifty years ago. This disease, 
 he says, is " a species of convulsion, which for the most part attacks 
 boys or girls, from the tenth year to puberty. First it shows itself 
 by a lameness, or rather instability of one of the legs, which the 
 patient drags after him like a fool. Afterwards it appears in the 
 hand of the same side, which he that is affected with the disease 
 can by no means keep in the same posture for one moment ; if it be 
 brought to the breast or any other part, it will be distorted to another 
 position or place by a convulsion, let the patient do what he can. 
 If a cup of drink be put into his hand he represents a thousand 
 gestures, like jugglers, before he brings it to his mouth ; for whereas 
 he cannot carry it to his mouth in a right line, his hand being drawn 
 hither and thither by the convulsion, he turns it often about for 
 some time, till at length, happily reaching his lips, he flings it sud- 
 denly into his mouth, and drinks it greedily, as if designing only to 
 make sport." 
 
 It must not, however, be supposed that the above will apply to all 
 the forms under which this morbid affection is manifested. In 
 many cases the involuntary motions are confined to one side of the 
 body ; sometimes the face, or only one of the limbs, is affected ; the 
 muscles of the windpipe and tongue are occasionally attacked, and 
 
AND MOST RECENT METHODS OF TREATMENT. 797 
 
 then the patient cannot articulate properly. In some instances de- 
 glutition is performed with difficulty. The disease assumes a variety 
 of appearances, according to the severity of the muscular disorder, 
 and the number of parts affected. It is very liable to relapse, and 
 has been known to recur several times in the same person. It is 
 not dangerous, and in young persons generally terminates favorably. 
 It may continue only a few weeks, or as many months ; in some 
 cases it has been known to continue through life, without having 
 materially injured the general health. 
 
 St. Vitus's dance is essentially a nervous disease. 
 
 There is no specific for chorea. All tonic remedies are of value, 
 and may be used. 
 
 The tonic remedy on which I chiefly rely for the treatment of 
 this disease is general electrization. 
 
 Gymnastic exercises are also of service. Internal remedies are 
 those to which the people most naturally resort in this as in all 
 similar affections. Valerianate of zinc has been used successfully 
 for chorea. So also has sulphate of zinc, in doses of one grain three 
 times a day. Bromide of potassium, cod-liver oil, pyrophosphate 
 of iron, strychnine, etc., all succeed and all fail. There is no uni- 
 formity in the results. 
 
 It should be remembered that many cases recover by time with- 
 out any medical treatment. On the other hand, there are obstinate 
 cases that will yield to no treatment or combination of treatment. 
 
 Partial chorea, limited to one arm, or to the muscles around the 
 eye, nose, or corners of the mouth, I have found more obstinate 
 Usually than general chorea of the whole body. 
 
 Parents should remember that it may attack a child through 
 sympathy. Sometimes it may attack quite a number in succession 
 in the same school. 
 
 St. Vitus's dance is sometimes complicated with some disease 
 of the heart. This fact, when suspected, can be ascertained only 
 by the ear of the physician. 
 
 There is no necessity for purging in this disease, but care should 
 be taken to keep the bowels gently open, with mild laxative medi- 
 cines. The cold bath ought never to be neglected. The above 
 treatment will be greatly aided by attention to diet and regimen ; 
 the food should be light and nourishing, and exercise should be ta- 
 ken in fresh and open air. Sea-bathing is of great service. 
 
798 
 
 SAL-AMMONIAC. 
 
 Sal-ammoniac is only used externally. Equal parts of this salt 
 and powdered nitre, dissolved in six or eight parts of water, form a 
 cold lotion, which may be substituted for ice, in the reduction of 
 strangulated hernia. An ounce of sal ammoniac, dissolved in nine 
 ounces of water, with the addition of two tablespoonfuls of spirit of 
 wine, is an excellent discutient lotion for scrofulous or indolent tu- 
 mors • but when the parts are red and painful it should not be used. 
 
 SAL-AMMONIAC (MUEIATE OF AMMONIA). 
 
 This remedy is much used for inflammation of the air-passages. 
 In inflammation of the mucous membranes generally, it is quite 
 beneficial. Internally it is employed for gout, rheumatism, and 
 neuralgia. 
 
 For the throat it can be employed in the form of a gargle, or 
 as an inhalation. (See Inhalations.) The fames of sal-ammoniac 
 are used by aurists in the treatment of inflammation of the middle 
 ear. 
 
 The dose of the powder is from five to twenty-five grains. 
 
 SANTONINE. 
 
 This remedy is used to destroy w T orms. In some cases it is very 
 successful. 
 
 The dose of santonine is from two to five grains. 
 
 SAESAPAKILLA. 
 
 In the broken-down state of the constitution which has arisen 
 from long-protracted syphilis, or from mercurial irritation, the 
 compound decoction of sarsaparilla, prepared in the following 
 manner, is generally considered an excellent restorative, — at least, 
 it is very extensively employed : Take of sarsaparilla, sliced, 
 five ounces; boiling water, four pints; macerate for four hours in 
 a vessel lightly covered, near the fire, then take out and bruise 
 the sarsaparilla. When bruised, return it to the liquor, and again 
 macerate in the same manner for two hours; afterwards boil 
 down to nearly two pints; then add sassafras, sliced, guaiacum 
 wood shavings, and liquorice bruised, of each five drachms; 
 mezereon, a drachm and a half; boil the whole for a quarter 
 
AND MOST RECENT METHODS OF TREATMENT. 799 
 
 of an hour, and strain. A pint of this decoction must be taken 
 in the course of the day. The powdered root may be taken to 
 the extent of an ounce, in divided doses during the day. In what- 
 ever manner sarsaparilla is taken, it must be continued regularly 
 during several weeks. 
 
 SCAMMONY. 
 
 Scammony, in the dose of from five to fifteen grains, acts as 
 a strong purgative ; it is frequently given with cream of tartar, 
 in dropsy; and in combination with calomel and jalap to destroy 
 worms, and to carry off slime from the bowels of children. It 
 enters into the composition of many of the purgative pills in gen- 
 eral use. 
 
 SCARLATINA, OE SCARLET FEVER. 
 
 The first, or mildest form of scarlatina, commences with loss 
 of appetite, sometimes slight nausea, but rarely vomiting ; a dull 
 heavy pain in the loins and lower extremities, and occasional chills 
 or shiverings, which are soon followed by fever. The surface 
 of the body becomes hot, although the feet are sometimes cold. 
 The pulse varies from 106 to 120 ; in some cases it reaches 140, 
 and the thirst is urgent. On the following day, sometimes later, 
 the rash appears upon the skin, but its commencement is not 
 so regular as that of other eruptive diseases ; sometimes it breaks 
 out first on the face, or on the neck, and upper part of the chest ; 
 at other times, on the trunk or on the limbs, and spreads, in the 
 course of twenty-four or thirty hours, over the whole surface of the 
 body and extremities. It consists of innumerable small red points 
 so closely set together that the skin acquires a uniform red color, 
 which has been compared to that of the shell of a boiled lobster, 
 and feels rough to the touch, more particularly at the parts where 
 it is brightest. The rash extends to the inside of the nostrils and 
 mouth, to the tonsils or almonds of the ears, and over all the 
 back part of the throat. The tongue is also covered with the 
 rash, but it generally happens that its edges and point only 
 present a bright red appearance, the surface being coated with 
 white mucus. The eruption, in many instances, is not diffused 
 over all the trunk of the body, but is distributed in large irregu- 
 larly shaped patches. The parts on which the body rests are 
 of a bright raspberry-red tint ; the color is also deeper at the folds 
 of the joints, and is more vivid in the evening than in the morn- 
 
800 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 ing. The skin is always intensely hot, and affected with trouble- 
 some itching. Sometimes there is considerable swelling of the 
 face, of the throat, and of the extremities of the body, and occasion- 
 ally a slight degree of delirium. The burning heat of the skin, 
 the thirst, sickness at stomach, constipation of the bowels, and diffi- 
 culty in swallowing become less severe in some instances when the 
 rash breaks out, but more frequently they continue until it begins 
 to disappear. 
 
 The eruption loses its brightness and gradually diminishes 
 towards the fifth day, and generally disappears on the seventh ; 
 the patient can now swallow with ease, and the fever has 
 ceased. It frequently happens that perspiration or purging takes 
 place at this time, or the urine deposits a quantity of sediment. 
 On the seventh day, the cuticle or scarf-skin begins to scale off, 
 and this process is completed on the tenth day. In some instances, 
 the falling-off of the skin is scarcely perceptible ; in other cases, 
 again, it continues to separate and peel off during two or three 
 weeks ; and as long as the scaling of the skin goes on, the patient 
 is annoyed with a troublesome itching. 
 
 The second form of scarlatina, with severe sore throat, com- 
 mences with stiffness of the neck and lower jaw, and the throat is 
 affected before the feverish symptoms are manifested ; these are 
 much more urgent than in the simple form of the disease above 
 described, and precede the rash during two or three days. The 
 edges of the tongue are red, and numerous red points are seen 
 rising through the crust with which it is covered ; the uvula or 
 pap, tonsils, and all the back part of the throat are intensely red, 
 painful, and so much swollen that swallowing is rendered distress- 
 ing and difficult, sometimes impossible; and then, when the patient 
 attempts to quench the burning thirst which constantly distresses 
 him, the drink passes off through the nostrils. The breathing 
 is more or less embarrassed, the voice is hoarse, and there is a 
 very distressing sensation of constriction in the throat. The 
 pulse is very quick, the skin hot, there is sickness at stomach 
 and sometimes vomiting, great restlessness, headache, often deli- 
 rium towards evening, and not unfrequently bleeding from the 
 nose. The rash does not cover the whole body, but appears in 
 broad, irregular patches; these often vanish, and again make their 
 appearance on different parts of the body at uncertain times. 
 The red color of the skin is more particularly observed on the 
 buttocks, about the loins, in the arm-pits and hams, and at the 
 bend of the arms. 
 
 But the predominant symptom of this form of the disease is 
 
AND MOST RECENT METHODS OF TREATMENT. 801 
 
 sore throat. In most cases the tonsils and back part of the throat 
 and mouth are covered with specks or patches of adhesive matter 
 (coagnlable lymph) of a grayish- white or ash color, which at first 
 sight might be mistaken for ulceration. These little masses or 
 patches of lymph sometimes acquire a dark-brown or black color, 
 from being mixed with blood. When the throat presents this black 
 appearance, the tongue and lips are often at the same time covered 
 with dark-colored crusts. A very tenacious, tough phlegm also col- 
 lects in the throat, and by inducing the patient to make frequent 
 efforts to get rid of it, greatly aggravates his sufferings. The throat 
 may become slightly ulcerated, but this does not generally occur. 
 
 On the fifth or sixth day of the disease, sometimes later, the 
 inflammation of the throat and the febrile symptoms begin to sub- 
 side, while the rash grows less vivid, and gradually disappears. If 
 the rash has been slight, the scarf-skin does not scale off, but in or- 
 dinary cases it is detached, as in simple scarlatina, and the scaly 
 peeling of the skin often continues during two or three weeks, or 
 even longer ; in the more severe cases, the skin peels off the hands 
 in large masses resembling portions of a glove. 
 
 TJie third, or malignant form of scarlatina, commences like the 
 one last described, but the eruption appears at an earlier period, 
 usually within twenty-four hours, advances slowly, and is seldom 
 of a bright red color. It often recedes suddenly, and reappears ; 
 and after some time the rose color which it first assumed changes 
 to a livid-red hue. The pulse is very quick, varying in fatal cases 
 from 120 to 140 even to the last moment ; the eyes are bloodshot 
 and watery, there is great heat of skin, with vomiting and oppres- 
 sion of the system. On the third day, or at an earlier or later 
 period, low delirium comes on, and the pulse loses strength, al- 
 though it still continues exceedingly quick ; the tongue is covered 
 with a dark-colored crust, and, in a word, the worst symptoms of 
 typhus fever are present. The throat presents the same dark-brown 
 or ash-colored appearance already described, and the breath is very 
 offensive ; but mortification or sloughing of the throat is not a fre- 
 quent occurrence, even in fatal cases. The soft, pulpy gangrenous 
 appearance of the tonsils and fauces arises from the exudations 
 with which the mucous or lining membrane of these parts is cov- 
 ered becoming putrid from exposure to heat and moisture. 
 
 As the disease advances, the prostration of the vital powers 
 increases, numerous purple-colored fever spots make their appear- 
 ance, and a disagreeable odor exhales from the skin. AYhen young 
 children are affected with this form of the disease they lie in a state 
 of stupor, and the pulse is so quick that it can scarcely be counted. 
 51 
 
802 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 In malignant scarlatina the system appears to be saturated with 
 a peculiar poison, which constitutes, as it were, the essence of the 
 disease, and while nature is struggling to expel this morbific mat- 
 ter the patient dies. This termination often occurs on the fourth 
 or fifth day, sometimes on the third, and in many instances death 
 does not take place till the second or third week. Some patients 
 recover even when the urgency of the symptoms appeared to pre- 
 clude all hopes of recovery, but in such cases the convalescence is 
 always exceedingly tedious. 
 
 Various affections occasionally follow scarlatina, as swelling of 
 the glands under the angles of the lower jaw, abscesses of the ton- 
 sils, inflammation of the ear, leaving a discharge of fetid matter, 
 sometimes deafness ; but the disorder most to be dreaded is dropsy, 
 which not unfrequently attacks the patient during the second or 
 third week after the disappearance of the rash. Dropsy occurs 
 oftener, and is for the most part more dangerous in children than in 
 adults, and is more frequently observed in winter than in summer. 
 Before this affection makes its appearance the patient generally 
 complains of depression of spirits, loss of appetite and disturbed 
 sleep ; these symptoms are soon followed by quick, hard pulse, hot 
 skin, constipation of the bowels, scanty urine, and much restless- 
 ness. The dropsical swelling is first observed in the eyelids; it 
 then attacks the face, the limbs ; and soon extends, in many cases, 
 to the whole body. When dropsy is confined to the external parts 
 of the body, there is comparatively little danger ; but when in the 
 belly, or in any of the internal cavities, the disease is then to be 
 viewed in a more serious light. 
 
 Scarlet fever may sometimes be confounded with measles. The 
 differences between them are these : In scarlet fever the eruption 
 comes out on the second day, with sore throat, but no catarrh of 
 the nose. Measles comes out on the third day, with catarrh of the 
 nose. The eruption of scarlet fever is of a brighter-red color than 
 that of measles, and is more evenly diffused. 
 
 Scarlet fever is contagious, but it acts very capriciously. A great 
 many who are exposed do not take the disease. Sometimes it runs 
 through a family of children. It usually goes harder with adults 
 than with children. Yery rarely it attacks the same person twice. 
 
 TREATMENT OF SCARLET FEVER. 
 
 The majority of mild cases recover without any special medical 
 treatment. 
 
 The bowels are to be kept freely open by Epsom salts. Sweet 
 spirits of nitre may be given in the ordinary doses. 
 
AND MOST RECENT METHODS OF TREATMENT. 803 
 
 The patient may drink cold water or suck ice to almost any ex- 
 tent. 
 
 The inflamed throat may be treated by a gargle of vinegar and 
 water, to which a little capsicum or cayenne pepper has been added. 
 
 The surface of the body may be freely sponged with cool or 
 tepid water. 
 
 Under this plan of treatment mild cases of scarlet fever will re- 
 cover. 
 
 Malignant forms and cases attended with debility will need in 
 addition nourishing food ', such as beef -tea, chicken broth, &c. ; tonics, 
 such as quinine, phosphoric acid (see Phosphoric Acid), &c. ; and 
 in some cases stimulants, in the form of brandy, whiskey, or wine. 
 
 Sulphite of soda is now considerably used in malignant scarlet 
 fever. It is supposed to be an antidote for the poison. 
 
 Solutions of chlorate of potash (one drachm to a pint of water) 
 may be applied to the throat, and may also be taken internally. It 
 is very important the throat should be well treated, so that the in- 
 flammation may not enter into the middle ear and cause life-long 
 deafness, and perhaps ulceration of the ear, with discharge. 
 
 Patients recovering from scarlet fever should not be allowed to 
 leave their room for three or four days after the attack. 
 
 For the treatment of the dropsy that sometimes follows scarlet 
 fever, see Dropsy. 
 
 Severe cases of scarlet fever demand the best skill, experience, 
 and patience of the physician. 
 
 SCIATICA. 
 
 Sciatica is a very painful affection of the great sciatic nerve. 
 This is the largest nerve of the body ; it runs from the posterior part 
 of the hip-joint down the back of the thigh to the ham. In severe 
 cases of sciatica, the pain extends along the whole course of the 
 nerve, and is so distressing during the night that the patient is com- 
 pletely prevented from sleeping ; sometimes it is accompanied by 
 quick hard pulse, thirst, foul tongue, and the usual symptoms of fever. 
 In chronic cases the patient occasionally suffers from cramp, and a 
 sensation of tingliug and numbness is felt in the limb. In long- 
 protracted cases the limb shrinks, and the patient has great difficulty 
 in keeping it warm. This affection generally arises from exposure 
 to cold and moisture, and occurs chiefly in adults, and people ad- 
 vanced in life. In females it not unfrequently comes on during 
 pregnancy, and after labor. Sciatica is a form of neuralgia. (For 
 treatment, see Neuralgia.) 
 
804 
 
 SCKOFULA. 
 
 Scrofula, in the general sense of the term, consists of a morbid 
 deposit, called tuberculous matter, which commonly appears in small 
 tumors or knots called tubercles. 
 
 The lungs are more frequently affected with scrofula than any 
 other internal part ; in that organ it is manifested at first in the 
 form of numerous small tubercles, which, after remaining in a latent 
 state during a longer or shorter period, gradually increase in size, 
 then soften, and cause incurable consumption. (See Consumption.) 
 
 No age confers complete immunity from scrofula, but different 
 periods of life render some organs more liable to be affected, than 
 others. The parts of the body in which the vital functions are most 
 active are more particularly subject to the disease. Hence tuber- 
 cles of the brain frequently occur in infancy and seldom in grown- 
 up people, because in the former the brain is the seat of constant 
 and strong functional action. The glands of the neck are most fre- 
 quently affected during the process of teething, probably in conse- 
 quence of the continued irritation about the jaws which this occa- 
 sions. External scrofula seldom originates after puberty ; on the 
 other hand, consumption, or as it may be termed, scrofula of the 
 lungs, chiefly occurs in adults, in consequence, it is presumed, of 
 the greater activity of the lungs at this period of life. At a more 
 advanced age, when the digestive organs are stimulated to a greater 
 extent and the abdomen increases in size, the liver and other organs 
 contained within that cavity are almost exclusively the seat of the 
 disease. Irritation of the stomach and bowels may develop scrofu- 
 lous disorders of the mesenteric glands at any time of life; this 
 variety of the disease, however, is more commonly met with in chil- 
 dren. 
 
 Scrofula appears to be so mixed up with the very elements of 
 existence, that it has the effect of modifying the symptoms of a great 
 part of the diseases to which the body is liable. The effects of this 
 influence are more particularly observed when syphilis and diseases 
 of the eye occur in individuals of scrofulous constitutions ; and the 
 unmanageable and obstinate character which many inflammatory 
 diseases acquire when modified by a scrofulous taint in the system 
 is well known to medical men. It is also well known that wounds 
 and other injuries of the soft parts in scrofulous people are often very 
 slow in healing. In many chronic diseases connected with scrofula 
 it is frequently found necessary to administer tonic and stimulant 
 remedies, which in the same diseases under other circumstances 
 would be inadmissible. 
 
AND MOST RECENT METHODS OF TREATMENT. 805 
 
 Causes. — Many causes are said to give rise to scrofula ; in fact, 
 every agent, moral or physical, which depresses the energies of the 
 system tends to develop the disease. One of the most powerful of 
 these is, without doubt, the long-continued action of a cold moist 
 atmosphere. The injurious influence of this cause will be greatly 
 aided bv defective or unwholesome diet, want of cleanliness, seden- 
 tary habits, living in confined situations, where the atmosphere is 
 not renewed and the direct light of the sun is excluded. 
 
 There cannot be the slightest doubt that impure air and the 
 absence of the direct solar rays exercise a powerful influence on 
 inducing scrofulous affections ; this is shown by their greater preva- 
 lence among the inhabitants of large towns than among those who 
 breathe the pure air of the country. 
 
 We see the influence exercised by climate over this disease in 
 the aggravation of the symptoms during the spring and winter 
 seasons, whereas in the summer months scrofulous sores generally 
 improve or disappear altogether. All external agents, all circum- 
 stances which reduce the energies of the system below the natural 
 standard (more especially when conjoined with atmospheric humidity 
 and cold), are exciting causes of scrofula. The children of scrofu- 
 lous parents, under whatever circumstances they may be placed, are 
 more liable to the disease than the children of healthy parents in 
 parallel circumstances. 
 
 Our limits will not allow us to notice in detail the various means 
 recommended to prevent the development of the disease in children 
 predisposed to it ; but we may say with the celebrated philosopher, 
 Hunter, "let an infant have plenty of sleep, plenty of milk, and 
 plenty of flannel;" these, when conjoined with plenty of pure air, 
 are the principal objects in domestic treatment to be observed 
 during infancy, and should be strictly attended to from the very 
 first hours of birth. 
 
 The cold bath is improper for newly-born or very young children ; 
 in the delicate, and those in whom there is reason to suspect a dis- 
 position of scrofula, it increases the debility, and may lead to very 
 injurious consequences. The cold bath, however, agrees well with 
 many children ; this is evinced by their soon becoming warm and 
 appearing lively after being taken out of the water, whereas in others 
 it has an opposite effect ; they continue chilly and pale for some 
 hours afterwards, and the faculties of the body appear, as it were, 
 overpowered. But although cold bathing is generally inadmissible, 
 washing the body with warm or tepid water is necessary, not only 
 with respect to cleanliness, but also to promote the healthy functions 
 of the skin. 
 
806 DESCRIPTION OF THE PKINCIPAL DISEASES 
 
 As the child grows up constant care is required in regulating 
 the diet. This should consist principally of animal food, taken at 
 regular intervals, but never in such quantity as to overload the 
 stomach. 
 
 All healthy children have a natural desire for exercise, than 
 which nothing is more conducive to the digestion of the food, the 
 circulation of the fluids, and the health and growth of the body. 
 To scrofulous children, or those who have a predisposition to the 
 disease, plenty of exercise is indispensable, and should always be 
 taken in the open air when the weather is fine ; otherwise they should 
 be allowed to play in a large well- aired room. A judicious writer of 
 the last century, Dr. Cheyne, speaking of the advantage of exercise 
 to children, says : " 'Tis beautiful to observe the earnest desire 
 planted by nature in the young persons to romp, jump, wrestle, and 
 run, and constantly be pursuing exercise and bodily diversions that 
 require labor even till they are ready to drop down, especially the 
 healthier sort of them, so that sitting or being confined seems to be 
 the greatest punishment they can suffer; and imprisoning them for 
 some time will much more readily correct them than whipping. 
 This is a wise contrivance of nature, for thereby their joints are 
 rendered pliable and strong, their blood continues sweet and proper 
 for a full circulation, their perspiration is free, and their organs 
 stretched out by due degrees to their proper extension." 
 
 Without the assistance of pure country air, children are not likely 
 to derive much benefit from any other means. We ought therefore 
 to make choice, as far as lies in our power, of a dry and temperate 
 atmosphere, untainted with exhalations, and known by experience 
 to be salubrious ; and sudden extremes of heat and cold should be 
 avoided as much as possible. 
 
 Sea-bathing, when judiciously managed, is one of the most valu- 
 able remedies that can be employed in scrofulous disorders. In 
 delicate children the sea water should be used warm at first, then 
 tepid, reducing the temperature by degrees until the system is pre- 
 pared to withstand the shock of immersion in the open sea. 
 
 All scrofulous people of delicate constitution, and those affected 
 with chronic diseases, should wear flannel constantly next the skin ; 
 this is the best safeguard in protecting the body from the injurious 
 influence of damp and variable climate, and, although it may be 
 worn of a thinner texture during the warm weather, should never he 
 entirely thrown off. Flannel gently stimulates the skin, promotes 
 the insensible perspiration, while it absorbs the moisture as it is 
 thrown out, and tends greatly ,under all circumstances, to keep up an 
 equable temperature ; this last is an object of much importance 
 
AND MOST EECENT METHODS OF TREATMENT. 807 
 
 where there are great and often sudden vicissitudes of the tempera- 
 ture of the climate. 
 
 The giddy practice of throwing aside our winter garments too 
 early in the spring, and of exposing our bodies, when overheated, 
 to sudden colds, has destroyed more than famine, pestilence, and 
 sword. 
 
 Much depends, in counteracting the disposition to scrofulous 
 maladies, upon the management of childhood. If the physical 
 education of early life is of the utmost importance, the moral train- 
 ing, even from the earliest dawn of reason, also demands the strictest 
 attention. Parents should commence early to discipline the minds 
 of children and train them to habits of obedience, for on this their 
 future health in a great measure depends. How often do we see 
 that those who have been over-indulged and pampered when children 
 are unable in after life to control their appetites and passions, and 
 thus cause the disease to be lighted up in the lungs, when it other- 
 wise might have remained quiescent or inactive during a long life- 
 time. 
 
 A great variety of drugs have been employed in the treatment 
 of scrofula, but they are all of secondary importance in comparison 
 with the means above recommended. A remedy much used at 
 present, and which is generally understood to possess a greater in- 
 fluence in overcoming scrofulous affections than any other medical 
 agent hitherto discovered, is iodine. 
 
 Iodine, one grain, 
 Iodide, two grains, 
 Distilled water, eight ounces. Mix. 
 To a child under seven years of age, a dessert-spoonful of this mixture is to be given 
 three times a day, in half a teacupful of water, sweetened with a little sugar. 
 
 The dose should be gradually increased to two tablespoonfuls, 
 and the remedy is to be continued, if no untoward symptoms occur, 
 for a period of four or five weeks ; its use is then to be suspended, 
 and gentle laxatives are to be administered. After an interval of 
 a fortnight the mixture is to be again administered, commencing 
 with a dessert-spoonful, and gradually augmenting the dose as before. 
 At the expiration of a month the remedy is to be again discontinued, 
 and again renewed. In this manner iodine may be employed with 
 perfect safety, and continued until the cure is accomplished. 
 
 For adults the following formula will be found convenient : 
 
 Iodine, ten grains, 
 
 Iodide or hydriodate of potash, twenty grains. Mix. 
 From four to twelve drops, to be taken in a glass of water, three or four times a 
 
808 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 Daring the internal administration of iodine, the following oint- 
 ment may be employed externally : 
 
 Ioduret of lead, a drachm, 
 Lard, an ounce. Mix. 
 About the size of a nutmeg, or a larger or smaller quantity according to the bulk 
 of the swollen glands, is to be rubbed in every night during six minutes. 
 
 In adults it should be applied in this manner twice a day. This 
 ointment, spread on soft linen or lint, is also an excellent application 
 to scrofulous sores. 
 
 In addition to iodine, scrofulous patients do well to take cod- 
 liver oil, cream, and abundance of nourishing food — beef, mutton, 
 fish, and beef-tea — outdoor air, sunlight, sea-bathing, and all tonic 
 measures. 
 
 Scrofulous diseases oftentimes fall into the domain of surgery, and 
 demand operative procedures and mechanical appliances. (See Sip 
 Diseases ; Spine, Diseases of.) 
 
 Scrofula can never be cured rapidly, inasmuch as it is the result 
 of a morbid change affecting the entire organization of the body ; 
 and we repeat, that the best means, not only of preventing, but 
 of controlling and removing this obstinate disorder, are proper 
 diet and clothing; pure, dry, and warm air; and regular exereise. 
 It must also be borne in mind, that though the medicines above 
 mentioned are of the greatest service, it is only when they are 
 employed with steady and patient perseverance, aided by the 
 strictest attention to the rules requisite for the improvement of the 
 general health. 
 
 SCUKVY. 
 
 Scurvy evidently arises from a depraved state of the blood, 
 caused chiefly, if not altogether, from want of fresh animal and 
 vegetable food. The blood, when in a natural state, stimulates 
 and nourishes every organ and structure of the body; but when 
 this vital fluid is altered in quality, it is no longer capable of 
 fulfilling the purpose for which it is destined, and the whole 
 animal economy suffers in consequence. The first symptoms 
 w T hich announce this morbid change in the circulation are gen- 
 eral weakness, disinclination to move about, great lassitude after 
 any ordinary bodily exercise, dull, heavy pains in the back and 
 limbs, great depression of spirits, disturbed sleep, wea!$ and fre- 
 quent pulse, loss of appetite, slow digestion, cold dry skin, hurried 
 breathing and palpitation of the heart on walking a little quicker 
 than usual, or from any other bodily exertion. A sailor, for ex- 
 
AND MOST RECENT METHODS OF TREATMENT. 809 
 
 ample, on going aloft experiences the two last-mentioned symp- 
 toms, along with a sensation of giddiness, and a feeling as if he 
 were about to faint. 
 
 This stage of the disease often continues a considerable length 
 of time, and is at first little noticed ; but at last the signs which 
 more particularly characterize the disease make their appearance. 
 The skin, which is at first unusually pale, gradually assumes a 
 dingy yellowish hue ; the face looks puffed or bloated ; the gums 
 become swollen, dark, red-colored or livid, spongy, and bleed from 
 the slightest friction. As the disease advances the teeth loosen, 
 the gums ulcerate ; fungous excrescences shoot .up from the ulcers, 
 and the breath acquires an exceedingly offensive smell. The urine 
 also emits a peculiarly disagreeable rank odor, and appears muddy 
 and high colored. While the gums become gradually affected in 
 the manner above described, dark-colored spots at the same time 
 make their appearance on the calves of the legs, on the thighs, 
 sometimes on the arms and back, rarely on the face; these run 
 into each other, and form large blotches of a yellowish, greenish, 
 or livid color, similar to the marks which follow bruises or blows. 
 The small, round, purple-colored spots, and the large, discolored, 
 bruise-like patches are most frequently seen on the lower ex- 
 tremities, and both are the consequence of effusion from the blood- 
 vessels. Ulcers in many cases form on the legs, and soon present 
 an appearance peculiar to scurvy ; the edges of the sore are of a pur- 
 plish color, and appear as if inflated ; a thin acrid fetid matter is at 
 first discharged ; but as the disease advances, a dark-colored cover- 
 ing of coagulated blood is deposited upon the surface of the ulcer, 
 which is not easily removed, and is soon replaced by a similar 
 coagulum. The surface of the sore under this dark-colored mass 
 is soft, putrid, and spongy, like the gums, and bleeds from the 
 slightest cause. As the disease gains ground, the knee-joints con- 
 tract, the hams become swollen, hard, and painful; and in two 
 cases we have seen, the calves of the legs were hard like a piece of 
 wood, so that the skin covering them could not be pinched up 
 between the finger and thumb. In most cases the nostrils bleed 
 occasionally, and blood is discharged from the bowels. Such are 
 the symptoms of scurvy as we have observed them on board of ship 
 in northern latitudes, all of which vanish in a surprisingly short 
 time when the natural remedies — vegetables and fresh animal 
 food — can be procured. 
 
 Towards the termination of the disease, one of the most re- 
 markable symptoms is the tendency to swooning on any bodily 
 exertion. It has also been observed, that the appetite for food 
 
810 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 generally continues to the last. "Many of our people," says 
 Mr. Walter, in the Narrative of Lord Anson's Yoyage, " though 
 confined to their hammocks, ate and drank heartily, were cheerful, 
 and talked with much seeming vigor, and in a loud, strong tone 
 of voice ; and yet, on their being the least moved, though it 
 was only from one part of the ship to another, and that in 
 their hammocks, they have immediately expired ; and others, who 
 have confided in their seeming strength, and have resolved to get 
 out of their hammocks, have died before they could well reach 
 the deck. And it was no uncommon thing for those who could 
 do some kind of duty and walk the deck, to drop down dead 
 in an instant on any endeavors to act with their utmost vigor ; 
 many of our people have perished in this manner during the course 
 of the voyage." 
 
 Causes. — The grand cause of scurvy is the want of fresh 
 animal and succulent vegetable food, more especially of the lat- 
 ter ; and the disposition to the disease from this cause is, no doubt, 
 greatly promoted by long exposure to a cold damp atmosphere, 
 fatigue, long-continued watching, deficient exercise, mental dis- 
 tress, and, in a word, all the debilitating causes which depress the 
 powers of life. 
 
 Treatment. — Such is the power which we now possess in pre- 
 venting scurvy, that many surgeons of the British navy of long 
 standing have never seen a case of it. But the crews of merchant- 
 men, during long voyages, often suffer severely from this disease, 
 in consequence of being obliged to live on unwholesome food; 
 from this cause alone many valuable lives are annually lost. Hard 
 bad beef, and worse biscuit, constitute the only food which the 
 sailors in some vessels are allowed for weeks together. The biscuit 
 is often so hard that it cannot possibly be masticated without pre- 
 viously soaking it in water. 
 
 The means to be adopted in order to preserve the general 
 health of seamen, and consequently to prevent scurvy, consist in 
 wholesome food ; that is to say, the articles of victualling generally 
 used on board of ship should be sound, and of good quality; in an 
 abundant supply, when in port, of fresh animal and vegetable diet, 
 more especially of succulent vegetables and fruit ; in a plentiful 
 supply of lemon-juice, without which no vessel should ever proceed 
 on a distant voyage; in personal cleanliness, exercise, and cheerful- 
 ness ; and in strict attention to ventilation, cleanliness, and dryness 
 of the ship. 
 
 Lemon or lime juice, in the absence of fresh vegetables or fruit, 
 is now admitted on all hands to be the best preventive of scurvy, 
 
AND MOST RECENT METHODS OF TREATMENT. 811 
 
 and also the best remedy after the disease makes it appearance. 
 This juice is preserved by mixing a tenth part of brandy with it. 
 The first account we have of the use of lemon-juice in scurvy is in 
 a curious old work by John Woodall, surgeon of St. Bartholomew's 
 Hospital, published in 1636. entitled the " Surgeon's Mate, or Mili- 
 tary and Domestic Medicine." "And further experience," says the 
 author, many of whose observations are very judicious, " teacheth, 
 which I have oft found true, that where a disease most raigneth, 
 even there God hath appointed the best remedies for the same 
 grief, if it be his will they should be discovered and used; and note, 
 for substance, the lemmons, limes, tamarinds, oranges, and other 
 choice of good helps in the Indies, which you shall finde there do 
 farre exceed any that can be carried thither from England ; and 
 yet there is a good quantity of juyce of lemmons sent in each ship 
 out of England by the great care of the march ants, and intended 
 onely for the reliefe of every poore man in his neede, which is an 
 admirable comfort to poor men in that disease ; also, I finde we 
 have many good things that heal the scurvy well at land, but the 
 sea chirurgeon shall do little good at sea with them, neither will 
 they indure. The use of the juyce of lemmons is a precious medi- 
 cine, and well tried, being sound and good ; let it have the chiefe 
 place, for it will deserve it ; the use whereof is : It is to be taken 
 each morning, two or three spoonsful, and fast after it two hours ; 
 and if you adde one spoonful of aqimvitce thereto to a cold stomack, 
 it is the better. Also, if you take a little thereof at night, it is 
 good to mixe therewith some sugar or to take of the syrup thereof 
 is not amisse. Further note, it is good to be put into each purge 
 you give in that disease. Some chirurgeon s also give of this juice 
 daily to the men in health as a preservative, which course is good 
 if they have store, otherwise it were best to keep it for need. I 
 dare not write how good a sauce it is at meat, least the chiefe in the 
 ships waste it in the great cabins to save vinegar. In want where- 
 of, use the juice of limes, oranges, or citrons, or the pulpe of tama- 
 rinds." In another part of the work he remarks, " And generally 
 note, that bitter and sower medicines prevail most to the cure of 
 this griefe, amongst which you have that are approved good there- 
 to ; those that follow as chiefe, juyce of lemmons, of limes, of cit- 
 rons, and oranges. In like manner, the juyce or pulpe of tama- 
 rinds hath a great acetositie, and is found a precious remedy 
 against the disease." 
 
 Another excellent and cheap remedy, though inferior to lemon- 
 juice, is sour Jcrout, which " is prepared by slicing the soundest 
 and most solid cabbages in the way cucumbers are used in this 
 
812 DESCRIPTION OF THE PRINCIPAL DISEASE! 
 
 country. In this state they are put into a barrel in layers, hand 
 high, and over each is strewed a handful of salt and caraway seeds; 
 in this manner it is rammed down, layer above layer, till the barrel 
 is full, when a cover is put over it, and it is pressed down with a 
 heavy weight. After standing for some time in this state it begins to 
 ferment, and it is not till the fermentation has entirely subsided that 
 the head is fitted to it, and the barrel is shut up and prepared for use." 
 
 The preparation of oatmeal, well known in Scotland under the 
 name of sowens, has been proved to be very efficacious both in pre- 
 venting and curing scurvy. It is prepared by putting some oat- 
 meal into a wooden vessel, pouring hot water upon it, and allowing 
 it to stand for two or three days in a place moderately warm until 
 the liquid ferments and becomes sour. The liquid is then removed 
 from the grounds, and boiled to the consistence of a jelly ; it may 
 be sweetened with raw sugar, and flavored with a little cinnamon. 
 
 When no lemon-juice can be procured, good effects result from 
 the use of an ample daily allowance of molasses and vinegar. 
 
 A great variety of medicines have been employed in scurvy ; 
 but they are all insignificant in comparison with fresh succulent 
 vegetable juices, as lemon-juice, &c, and it appears questionable 
 whether they ever produce any good effect. 
 
 They are sometimes much troubled with constipation of the 
 bowels. When this occurs, castor oil, tincture of rhubarb, and 
 sulph. of potash will be found the best laxatives. From three 
 drachms to an ounce or more of the latter dissolved in a basin of 
 thin gruel operates mildly, and is perhaps the best opening medi- 
 cine that can be employed. Opiates at bedtime produce sleep and 
 relieve the patient greatly during the night, but upon the whole they 
 do more harm than good. Mercury is decidedly injurious, and ought 
 never to be given under any circumstances, not even when the dis- 
 ease is complicated w r ith syphilis. 
 
 The best wash for the mouth is a weak solution of chloride of 
 lime, or chloride of soda, or chlorate of potash. These may also be 
 used as a local application to ulcers which are induced by the dis- 
 ease. For these, lint soaked in lemon or lime juice, diluted with 
 twice or thrice its quantity of water, is recommended. It is always 
 advisable in such cases to cover the dressing with oiled silk to pre- 
 vent evaporation. A solution of alum in water, in the proportion 
 of two drachms to the quart, is an excellent application for spreading 
 or sloughing sores of this kind. 
 
 On the subject of scurvy I quote the following very interesting 
 remarks from Aitken : 
 
 " The early history of navigation, as it records the greatest rava- 
 
AND MOST KECENT METHODS OF TREATMENT. 813 
 
 ges of scurvy, so does it also record the best antidote to the disease. 
 Of four ships which sailed from England in the beginning of April, 
 1609, for the establishment of the East India Company, they were 
 all so severely visited by scurvy as to have lost nearly one-fourth of 
 their crews when they arrived at the Cape of Good Hope. The 
 crew of the Commodore's ship was not attacked. This immunity 
 arose from three tablespoonfuls of lemon-juice having been served 
 daily to each of his men. But notwithstanding this evidence of the 
 success of lemon-juice in preventing scurvy — evidence the most con- 
 clusive — this valuable remedy and preventive was altogether slighted 
 for a hundred and fifty years afterwards. — Copland. Lord Anson's 
 people, in 1740, on reaching the Island of Tinian, were recovered 
 principally by eating oranges ; and that noble, brave, and experi- 
 enced commander was so convinced of their usefulness, that, before 
 he left the island, he ordered one man from each mess to lay in a 
 stock for future security. Sir Charles Wager's people, also, were 
 terribly afflicted with scurvy in the Baltic. Sailing, however, in 
 the Mediterranean, and having heard how effectual oranges and le- 
 mons were in the cure of this disease, he took on board at Leghorn 
 a large quantity of them, ordered a chest each day to be brought 
 on deck, and allowed the men, besides eating what they chose, to 
 mix the juice with their beer, and to pelt each other with the rind, 
 so that the deck was strewed with the fragrant liquor. By these 
 means he brought his men home in good health. 
 
 " In the year 1747, Dr. Lind made some comparative trials be- 
 tween this and some other modes of treatment (as vinegar, sulphuric 
 acid, and tamarinds) on board the ' Salisbury,' at sea. As a general 
 conclusion from his experiments, he affirms that orange and lemon 
 juice, or, more properly, the citric acid obtained from all the species 
 of the botanical genus Citrus, or the natural order of fruits called 
 Hesperidse, are greatly more efficient than any other remedy in the 
 cure of scurvy. 
 
 "Notwithstanding this strong opinion of Dr. Lind, the navy con- 
 tinued to suffer severely from scurvy for half a century, till the 
 Admiralty gave a general order for the supply of lemon-juice. This 
 salutary measure was accomplished by a representation from the 
 Medical Board of the Navy, in the year 1795, when Lord Spencer 
 was First Lord of the Admiralty, after a trial made on board the 
 1 Suffolk,' of seventy-four guns. 
 
 " This ship sailed from England on the 2d of April, 1794, supplied 
 with a quantity of lemon -juice sufficient to serve out two-thirds of 
 a liquid ounce daily to every man on board, and this was mixed with 
 their grog, with two ounces of sugar. She arrived at the Madras 
 
814 
 
 roads on the 11th of September, after a passage of twenty-three 
 weeks and one day, without having had any communication with 
 the land, without losing a man, and having only fifteen on the sick- 
 list. Scurvy appeared in a few of the men during the voyage, but 
 disappeared on an increased dose of lemon-juice being administered. 
 1 Let this fact,' says Sir Gilbert Blane, ' be contrasted with the state 
 of the Channel fleet in 1780, when Admiral Geary's fleet returned 
 into port after a ten weeks' cruise in the Bay of Biscay, with 2400 
 men ill of scurvy ; and let the state of this fleet be contrasted with 
 that of the Channel fleet in 1800, which, by being duly supplied with 
 lemon-juice, kept the sea four months without fresh provision, and 
 without being affected with scurvy.' " 
 
 The same authority advises the following course of treatment : 
 
 " 1. The supply of fresh vegetables by all means in our power. 
 Even unripe fruits are better than none, and we must risk a little 
 diarrhoea for the sake of their anti-scorbutic properties. In time 
 of war every vegetable should be used which it is safe to use, and 
 when made into soups all are tolerably pleasant to eat. 
 
 " 2. The supply of dried vegetables, especially potatoes, cabbage, 
 and cauliflowers, turnips, parsnips, &c, are perhaps less useful ; 
 dried peas and beans are useless. As a matter of precaution, these 
 dried vegetables should be issued early in the campaign, but should 
 never supersede the fresh vegetables. 
 
 " 3. Good lemon-juice should be issued daily (one ounce), and 
 it should be seen that the men take it. 
 
 " 4. Vinegar (half ounce to one ounce daily) should be issued 
 with the rations, and used in the cooking. 
 
 " 5. Citrates, tartrates, lactates, and malates of potash should 
 be issued in bulk, and used as drinks or added to the food. 
 
 " The easiest mode of issuing these salts would be to have packets 
 containing enough for one mess of twelve men, and to instruct the 
 men how important it is to place them in the soups or stews. Pos- 
 sibly they might be mixed with the salt, and issued merely as salt." 
 —Praci Hygiene, 2d ed., 1866, p. 466. 
 
 It should be remembered that scurvy is not confined to the sea. 
 It may also break out, though usually in a milder form, on land, 
 among those who are fed on a too exclusive diet, and are long de- 
 prived of acids and fresh good food. Scurvy is a powerful argu- 
 ment against exclusiveness of diet. Man needs a variety of food. 
 
 SCUTELLARIA (BLUE SKULLCAP). 
 Scutellaria is a most excellent nervine. It calms, soothes, quiets 
 
AND MOST RECENT METHODS OF TREATMENT. 815 
 
 the agitated patient in convulsions, in Si. Vitus' s dance, in hysteria. 
 It seems to act very muck like valerian, only with greater power. 
 In general nervousness and sleeplessness it is found to be of great 
 service, though far inferior to bromide of potassium. The remedy 
 is not yet very extensively used. I am inclined to believe that it 
 will gain in popularity. It may be combined with other nervines 
 and antispasmodics. 
 
 The dose is from one to Jive grains. 
 
 SEA-SICKNESS. 
 
 This affection is very common and very disagreeable, and by no 
 means as beneficial as is commonly believed. 
 
 I regard sea-sickness as essentially a nervous disorder — a dis- 
 turbance of the nervous system caused by the motion of the ship. 
 Just what this disturbance is, just how the nervous system is affected, 
 science has not yet demonstrated. It is not necessary to go to sea 
 in order to be sea-sick. Many experience sensations similar to 
 those of sea-sickness when they travel by the cars or by the stage, 
 or when they swing or rock in a chair. 
 
 The nervous and delicate are more liable to sea-sickness than 
 the hardy and strong. Therefore women suffer more at sea than 
 men. 
 
 A friend of mine who has been in the employ of the Children's 
 Aid Society, and who in that capacity has had charge of transport- 
 ing many hundreds of children to the West, once told me that he 
 always expected that many of the company would be sick after 
 travelling a day or two in the cars. 
 
 The difference between the sickness of those who travel by land 
 and those who travel by sea seems to be only one of degree, and 
 not of kind. 
 
 The term sea-sickness is really an unfortunate one. Travellers^ 
 sickness would better express the character of the disease. 
 
 Sea-sickness is not always or necessarily accompanied by vomit- 
 ing. Headache — quite similar in its sensations to the ordinary sick 
 headache — is a very common symptom. 
 
 Great exhaustion, constipation, are among the unpleasant symp- 
 toms that accompany or follow the disease. 
 
 I have said that sea-sickuess was not as beneficial a process as 
 is commonly supposed. There are many who, after a voyage at sea 
 or a long trip by land, find it necessary to rest for several days before 
 they recover their usual strength. 
 
 The benefit that comes from a voyage by sea or a trip by land 
 
816 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 is due to the change of scene, the passive exercise, the prolonged 
 rest, the freedom from labor and anxiety, and the tonic effects of 
 the air. These influences are beneficial in spite of the sea-sickness. 
 
 On this subject I speak from a considerable observation and per- 
 sonal experience while acting as surgeon in the navy. 
 
 I then improved my opportunities to study the treatment of this 
 disease, and I came to the conclusion that it is by no means wholly 
 unrelievable. 
 
 The plan of prevention and treatment that I propose is as 
 follows : 
 
 1. Go on board of the ship in as good a condition as possible. 
 It is not necessary to use violent purges. The great thing is to have 
 the nervous system in as healthy a state as is possible, consistently 
 with the labor of preparation* Those who embark in a condition of 
 exhaustion will be likely to be the greatest sufferers from sea-sick- 
 ness. Eat a substantial meal just before embarking. 
 
 2. Before the vessel is fairly at sea — better still (as Dr. Fordyce 
 Barker advises), before she leaves her moorings — retire to your 
 berth in some loose clothing, and lie flat on your back for at least 
 twenty-four hours. Do not get out of your berth at all, if it is 
 possible to avoid it. Give no heed to those who urge you to go on 
 deck. 
 
 3. Eat some light and digestible food three or four times a clay. 
 Do not allow the stomach to be long empty. 
 
 4. If nausea or headache comes on, try the following remedies : 
 Tincture of capsicum (cayenne pepper). — A few drops of this 
 
 in a tumbler of water should always be kept at hand. Whenever 
 unpleasant sensations arise in the stomach or head, take a swallow. 
 I have found this to be a most excellent remedy. 
 
 Oxalate of cerium. — This may be taken dry on the tongue. The 
 dose is about as much as can be placed on the point of a pen-knife. 
 
 Ice to the spine. (See Ice-bags.) 
 
 This method of treatment is strongly recommended by Dr. Chap- 
 man, the inventor of the ice-bags. Although his theoretical argu- 
 ments are not yet susceptible of demonstration, yet practically the 
 application of ice to the spine exercises great power over the ner- 
 vous system. The remedy is worthy of a trial. It is not necessary 
 to have ice-bags. Pieces of ice may be wrapped in a towel and ap- 
 plied to the spine. . 
 
 The advantage of the ice-bags is, that they are neater and moro 
 convenient than any other method of applying ice to the spine. 
 
 5. Electrization and hypodermic injections have been recom- 
 mended for sea-sickness. These remedies, however, can only be 
 
AND MOST REGENT METHODS OF TREATMENT. 817 
 
 used by a physician, or at least by some unusually reliable and skil- 
 ful attendant. 
 
 After spending twenty or thirty hours in the berth, it will usu- 
 ally be safe to go on deck, unless the sea should be exceedingly 
 boisterous. 
 
 It is well to prepare the few simple medicines before embarking, 
 and to have them near at hand. 
 
 Mental diversion and force of will assist very materially in the 
 prevention of sea-sickness. One of the best methods of diverting 
 the mind is reading novels or other entertaining works. 
 
 Whenever I take a sea-voyage I always take with me some 
 light and entertaining reading, as an indispensable part of my outfit. 
 One can read, with some little difficulty, while reclining in the 
 berth. 
 
 SEMINAL EMISSIONS, OE SPEKMATOKKHCEA. 
 
 The views that I shall present on this subject will be directly 
 opposed to those which are commonly entertained. I may say at 
 once that nearly all the writings on this subject to which the people 
 have access are erroneous. The views that have been advanced on 
 this and many other affections of the genital organs have come from 
 ignorant, unscrupulous, and designing men, whose opinions on this 
 or any other subject are valueless. 
 
 1. Seminal emissions are not necessarily a disease. For one 
 who is unmarried and in good health, the voluntary emission of 
 seminal fluid is, within reasonable limits, both natural and health- 
 ful. But for the teachings of bad books, this fact would be recog- 
 nized. Involuntary emissions only become a disease when they are 
 inordinately frequent. The question now arises, "What is meant by 
 the term inordinately frequent % This it is impossible to answer 
 mathematically. I have said that it was impossible to lay down 
 any rules concerning the quantity of food that we should take, or 
 of stimulants and narcotics that we should use, that should cover 
 every case. Just so it is impossible to say how many emissions of 
 seminal fluid can be borne without injury. Some are apparently 
 injured by one emission a week, while others have several weekly, 
 and maintain perfect health and strength. 
 
 Seminal emissions should never excite any alarm so long as our 
 health in other respects remains good. 
 
 Let the genital organs take care of themselves so long as our 
 digestion is good, our sleep sound, and our strength firm ; and when 
 52* 
 
818 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 we do begin to take treatment, take the first and chief care of the 
 general system. 
 
 2. Seminal emissions are not so frequently the cause of nervous 
 and other diseases as is commonly supposed. 
 
 In science, as in other departments, serious mistakes are made 
 by confounding effects with causes. 
 
 Seminal emissions are the effects as well as the causes of disease, 
 and should be so considered. 
 
 Anything that weakens the nervous system may bring on semi- 
 nal emissions. Exhausting fevers, dyspepsia, diseases of the brain 
 and spinal cord, constipation, &c, &c, may give rise to over-fre- 
 quent seminal emissions. Persons recovering from exhausting dis- 
 eases oftentimes experience this trouble for several weeks. It usu- 
 ally lasts for a short time only, and disappears as the patient 
 resumes his usual strength. The great fact to be remembered is, 
 that seminal emissions, when in excess, are symptoms of general 
 debility. 
 
 There is no question that in turn they do have a debilitating in- 
 •fluence on the system, but only when they are in considerable excess, 
 and by no means to the extent that is commonly supposed. 
 
 There are probably cases of insanity, of imbecility, and of death 
 brought on by self-abuse and spermatorrhoea, but I am inclined to 
 the opinion that such cases are exceptional. 
 
 This leads us to the consideration of the important subject of 
 
 SELF-ABUSE, OR MASTURBATION. 
 
 This habit, when commenced early and carried to a great 
 extreme, injures the nervous system, but it acts very differently 
 with different constitutions. It makes a very material difference 
 whether the habit is begun in very early life or after the age of 
 twenty. 
 
 The earlier the habit is formed, other conditions being the same, 
 the more injurious it is. 
 
 The habit is almost universal. It is indulged in by both sexes. 
 It is not confined to civilized lands. The semi-barbarous and the 
 savage are addicted to it. It is not confined to the human species, 
 for animals also acquire it. 
 
 The wonder is, not that it does so much injury, but that it does 
 so little ; that so few comparatively are permanently injured by it. 
 
 I know very well the popular feeling on the subject ; but I also 
 know that almost all the ideas now prevalent among the people con- 
 cerning this habit, and the diseases to which it gives rise, are bor- 
 rowed from unprincipled and ignorant quacks, who have availed 
 
 
AND MOST KECENT METHODS OF TREATMENT. 819 
 
 themselves of the ignorance of society on these matters to fill their 
 own pockets. 
 
 In order not to be misunderstood on this important subject, I 
 sum up my views in the following propositions : 
 
 1. The involuntary emission of seminal fluid is not usually a 
 disease, and therefore does not, in the majority of cases, need any 
 treatment. For an adult male in good health, and who is unmar- 
 ried, it is a process that is a natural result of his continence, and is 
 not usually injurious. 
 
 2. In some cases the emissions are so frequent that they may be 
 regarded as a symptom of a relaxed and debilitated condition of the 
 body, and should be treated, if they are treated at all, not locally, but 
 by strengthening the general system. The cases where these involun- 
 tary emissions are directly injurious to the constitution are much 
 less frequent than is commonly supposed. In the majority of cases 
 excessive frequency of seminal emissions is an effect rather than a 
 cause of disease. 
 
 3. The number and frequency of emissions that may be con- 
 sistent with perfect health cannot he determined by any mathemati- 
 cal rules. What may be a sign of perfect health in one may in 
 another be a symptom of general debility. It is just as impossible 
 to lay down mathematical rules that will apply to all constitutions 
 on this subject, as it would be to lay down definite rules concerning 
 the quantity of food that we should eat, of water that we should 
 drink, or of exercise that we should take. So long as the general 
 health remains good, seminal emissions should never cause us a 
 moment's thought, even though they may be frequent. 
 
 4. The true way to treat seminal emissions when they are, or are 
 supposed to be, more frequent than is consistent with health, is usu- 
 ally not to treat them at all. Take good care of the general health. 
 Strengthen the constitution by every agreeable method. Live 
 generously. Work hard, keep brain and muscle active, and let the 
 genital organs take care of themselves. 
 
 This advice, if acted upon, would save a multitude of unneces- 
 sary sorrows. 
 
 As soon as convenient get married, but at all events keep dili- 
 gently at work. 
 
 5. In those exceptional cases where there is some real difficulty 
 of the genital apparatus — some irritability of the urethra, or other 
 slight morbid condition — do not attempt self-treatment, but consult 
 some honorable and judicious physician, in whom you have reason 
 to feel confidence, and submit to his direction just as you would for 
 any other disease. 
 
820 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 6. Self-abuse is by no means as injurious a habit as is commonly 
 supposed. The habit is universal in both sexes, and among all na- 
 tions — the barbarous and semi-civilized, as well as the enlightened. 
 If it were as prejudicial to the constitution as is currently believed, 
 the whole earth would be converted into insane asylums, and hos- 
 pitals for epileptics. "When practised to great excess, especially by 
 those who are very young, it undoubtedly does work injury, but 
 even in early years it is not as injurious as excessive sexual inter- 
 course. Young boys who go to great excess with the women 
 injure themselves more than those who practise self-abuse. The 
 truth is, that the genital organs, like the stomach, can bear and 
 were designed to bear a vast amount of abuse. Had it been other- 
 wise, the human race would long since have perished from the earth. 
 
 This remark is not made to justify the revolting habit in any 
 one, but to present the actual truth on this subject, which all per- 
 sons everywhere should understand and appreciate. 
 
 Although the habit of masturbation, when begun in tender 
 years, and carried to great excess for a long time, may give rise 
 to or aggravate epilepsy, St. Vitus's dance, insanity, and other 
 nervous affections ; yet such instances are far less frequent than 
 is generally believed. The insane are oftentimes addicted to this 
 habit ; then it is the result of their insanity more frequently than 
 its cause. 
 
 Any injury that comes from this habit or from excessive sexual 
 intercourse is due not so much to the loss of the semen — which is 
 comparatively a trifling matter — as to the nervous excitement But 
 often the evil effects of this habit are chiefly felt on the moral na- 
 ture. It destroys self-respect 
 
 7. Impotence is usually, though not always, a disease of the ima- 
 gination. To one person who is really incapable of performing the 
 sexual act there are one hundred who suppose themselves to be so. 
 The treatment for imagined impotence is usually the same as that for 
 seminal emissions. Do not treat it at all. Go to work. Develop your 
 muscles and brain. Devote yourself to money-making. Resolve 
 to become useful or famous. The activity which will be necessary 
 in carrying out these ambitions will divert your mind from your 
 imaginary evils, if they are imaginary, and will be the best means 
 of cure if they are real. 
 
 If you wish to get married, do so without a moment's hesitation, 
 and without even asking whether you are or are not capable of 
 performing the sexual act. In the great majority of cases patients 
 after their marriage forget all about their imagined impotence. 
 
 It is very natural to inquire why it is that young men are so 
 
AND MOST KECENT METHODS OF TREATMENT. 821 
 
 inclined to worry and become hypochondriacal on imagined disor- 
 ders of the genital organs. Why is it that the slightest disease or 
 suspicion of disease of the genital apparatus causes such absurd 
 and unnecessary mental depression? The explanation is to my 
 mind quite clear. The great sympathetic nerve is at fault. This 
 nerve sends prominent branches to the stomach and to the genital 
 organs. Therefore these three — the brain, the stomach, and the 
 genital apparatus — are in very distinct and close sympathy with 
 each other. They form a kind of family. They are in constant 
 telegraphic communication with each other, and any injury of one 
 is soon felt by the other two. 
 
 In the light of this explanation we see also why it is that dys- 
 pepsia so frequently causes depression of spirits. 
 
 Another reason why patients worry over and exaggerate their 
 genital difficulties is the peculiar, and, to a certain extent, unne- 
 cessary privacy that is associated with the genital function. The 
 desire for sexual intercourse is the most powerful passion of human 
 nature, for the reason that it is indispensable to the perpetuation 
 of the species, and yet children are brought up in blank ignorance 
 of the structure and functions of these organs ; are compelled to 
 learn through vile associates and evil communications what they 
 should have been taught at home and under parental guidance. 
 
 Finally, patients get false and exaggerated ideas on these sub- 
 jects through the published writings of quacks, for the profession 
 have written little or nothing for the people concerning the genital 
 apparatus. Let me say in conclusion, that almost all that is written 
 on this subject, to which patients will be apt to gain access, is not 
 only wrong, but is terribly, criminally wrong, and should not be 
 heeded for an instant. 
 
 These views on this subject I have long held, and on several 
 occasions have presented them to the profession and to the students 
 to whom I have lectured. I am well aware that they are radically 
 different from the views that have been generally held and adopted 
 by the profession as well as by the people. I have therefore been 
 interested to find some of these substantially confirmed by one of 
 our highest authorities in this department, Prof. W. H. Yan Buren. 
 In a lecture recently published in the New YorJc Medical Gazette 
 he remarked as follows : 
 
 " Masturbation is a subject that cannot escape attention in con- 
 nection with the etiology of this so-called spermatorrhoea ; but I 
 have very little to say upon it. There is no doubt of the generality 
 of the practice ; as little doubt, I think, that it is less harmful to 
 the physique of the individual than to his morale. It does its harm 
 
822 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 to the man's self-respect, by giving him daily proof that his cannot 
 hold the pre-eminence that belongs to it. It destroys his manliness, 
 his higher qualities, in this way ; and that is the reason the young 
 man cannot look you in the face. That the practice is physically 
 hurtful I am not prepared to admit. I have never seen any very 
 striking evidence of it except the so-called spermatorrhoea, which I 
 have told you is a disease of function and of the mind rather than 
 of the body. There is no question that this habit has a vast deal to 
 do with spermatorrhoea. But, on the other hand, in our Southern 
 States, in old times, I have seen many an instance where a boy has 
 gratified himself in the natural way from the earliest dawning of 
 the sexual appetite, even before puberty ; and I have seen, much 
 more come from excesses of this kind than from masturbation. 
 And, moreover, I have seen bad effects from masturbation, even 
 where there was free access to the natural gratification among the 
 slaves. The difference between the morale of the Southern young 
 man and that of the Northern was very marked in the days when 
 our medical classes were divided about equally between them ; and 
 from the many examples I have seen of the peculiar effect of the 
 * peculiar institution' upon the white race, I think we have nothing 
 to regret in its loss. Similar conclusions might be drawn from the 
 social status in Oriental countries, where the young male inclined 
 to yield to temptation has the means of indulgence freely open to 
 him. 
 
 " The causes, then, of this functional disease may be summed 
 up in a word — ungratified desire. Whatever begets this desire 
 produces a flow of blood to the prostatic portion of the urethra ; 
 and every time this congestion occurs in an unnatural way it leaves 
 behind it a weakened condition of the parts." 
 
 SENNA. 
 
 Few domestic remedies are more extensively employed than senna, 
 and it may be taken with perfect safety in almost every disease 
 where laxatives are required. The simple infusion is prepared by 
 pouring six ounces of boiling water over three drachms of the leaves, 
 and letting it stand near the fire for at least half an hour. Half a 
 cupful to a cupful or more of this may be given to children. Dr. 
 Paris states that the nauseous taste of this infusion is covered by 
 mixing it with Bohea tea, sugar and milk being added in the same 
 proportions as in common tea. The infusion is more frequently 
 given in combination with salts, &c, in the form of the black 
 draught. 
 
AND MOST RECENT METHODS OF TREATMENT. 823 
 
 The electuary of senna, or lenitive electuary, is a mild and very 
 useful laxative ; it is generally recommended in cases of piles, to 
 pregnant women, and for habitual costiveness. 
 
 SHINGLES. 
 
 This singular disease is characterized by an eruption of vesicles, 
 extending in a semicircular form round one-half of the body. In 
 general the eruption is preceded for two or three days by a feeling 
 of languor, slight headache, occasional rigors or shivering, loss of 
 appetite, and increased quickness of the pulse, with heat, aching, a 
 disagreeable feeling of tingling, and sometimes a stinging or burn- 
 ing pain in the part where the vesicles are about to make their ap- 
 pearance. The eruption usually commences at or near the navel, 
 sometimes at the lower part of the chest, and extends gradually 
 round to the spine ; or it breaks out first close to the spine, and fol- 
 lows an opposite course, so as to appear in either case like half a 
 sash about three or four inches in breadth. It very rarely surrounds 
 the body entirely, but sometimes passes upwards across the shoulder, 
 like a sword-belt. The vesicles are filled with a limpid fluid, have 
 a silvery transparent appearance, and are generally distinct, although 
 they are often closely agglomerated, and seem to run into each 
 other. They appear in clusters surrounded by a red inflamed bor- 
 der. Although very minute at first, they enlarge in the course of 
 twenty-four or thirty hours to the size of small pearls, and in the 
 course of three or four days attain their full size, which is about that 
 of a pea. The clusters or patches of vesicles do not all appear at 
 once, but in succession, so that at one part they have arrived at 
 maturity while at another they are only commencing. On the third 
 or fourth day the vesicles begin to lose their transparent appear- 
 ance, while the red margin surrounding them changes to a pur- 
 plish or livid hue ; they assume a yellowish color, flatten and dry 
 up by degrees, or break; and the matter discharged forms dark- 
 colored scabs, which fall off about the tenth or twelfth day. 
 
 This disorder is sometimes very slight, unattended with feverish 
 symptoms, and terminates completely at the expiration of a fort- 
 night ; but in most cases it lasts from twenty-five to thirty days, or 
 even longer, and sometimes leaves a severe pain in some part of the 
 skin which has been covered by the vesicles. 
 
 Shingles is not a dangerous disease, although always very trouble- 
 some, and often painful ; the causes which give rise to it are un- 
 known.; it occurs most frequently in autumn and summer ; and at- 
 
824: DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 tacks adults in preference to children. It is not contagious, but 
 may attack the same individual repeatedly. 
 
 Treatment. — Active treatment is not required in this disease; 
 mild laxatives should be taken occasionally ; and as long as feverish 
 symptoms are present the diet should be mild, consisting principally 
 of farinaceous articles, such as sago, arrow-root, rice or bread pud- 
 ding, &c. All kinds of strong drink ought to be abstained from, but 
 lemonade or any other cooling beverage may be taken freely. To 
 relieve the smarting and tingling sensation, which is often very dis- 
 tressing, the patient may wash the parts affected from time to time 
 with equal quantities of laudanum and tepid water. The oxide 
 of zinc (commonly called tutty-jpowder) should be sprinkled over 
 the vesicles when they begin to break, with the intention of ab- 
 sorbing the fluid; this has an excellent effect in relieving the 
 irritation, and is preferable to the application of lotions, poulticing, 
 or any other method of treatment with which we are acquainted. 
 Glycerine and rose-water is a good application. (See Skin, Dis- 
 eases of.) 
 
 SKIN, DISEASES OF. 
 
 The skin is liable to a large variety of diseases that have been 
 variously classified. If I should attempt to give these classifica- 
 tions I should only bewilder my readers and confer no benefit what- 
 ever. My remarks will therefore be exceedingly general. 
 
 Most of the common diseases, and those which those not med- 
 ically educated will be most likely to understand, are mentioned 
 in the course of the book. (See Itch, Nettle Rash, Tetter, Shingles, 
 Ringworm or Scald-Head.) What is said concerning those dis- 
 eases need not be here repeated. 
 
 There are some other diseases of the skin that are liable to 
 those who are beyond the call of a physician, and which are sus- 
 ceptible of relief by simple means of treatment. 
 
 Scarlet rash is a very mild disease. In appearance it resembles 
 scarlet fever, but it is less severe, is not accompanied by sore throat, 
 and very scon passes away without treatment. 
 
 Eczema is a very common form of disease of the skin. When 
 it attacks infants at nursing- time it is called milk-crust. Eczema 
 receives a variety of names, according to the part of the body that 
 it attacks. 
 
 Eczema is oftentimes a very obstinate disease, and demands good 
 care, firm patience, and experienced medical advice, if it can be ob- 
 tained. 
 
AND MOST RECENT METHODS OF TREATMENT. 825 
 
 If the mother is left to herself, she will be safe in bathing the 
 parts in tepid water and using the ointment of the oxide of zinc, or 
 a mixture of glycerine and water, equal parts. 
 
 Scaly diseases. — Dandruff of the scalp is one form of scaly dis- 
 ease of the skin. (See Hair, Diseases of.) 
 
 Nervous diseases of the skin are not uncommon. Pruritus or 
 itching, neuralgia, and numbness are the principal of these nervous 
 diseases. 
 
 This itching is sometimes terrible. It is aggravated by the 
 heat of the bed, and oftentimes sleep is impossible. It is some- 
 times confounded with itch, but it is a very different disease. 
 
 This is a hard malady to treat. The patient needs tonics to 
 strengthen the system. 
 
 Fowler's solution of arsenic may be given. (See Fowler's 
 Solution.) Opium may be given to relieve the pain, or hypoder- 
 mic injections in extreme cases. Baths are sometimes useful. 
 
 Numbness is best treated by electrization. The results of treat- 
 ment of this condition of the skin by general electrization, and 
 sometimes by localized electrization, are delightful. 
 
 Neuralgia of the skin is also to be treated by electrization, and 
 in the same w T ay as neuralgia in general. (See Neuralgia.) 
 
 Parasitical diseases of the skin are those in which parasites are 
 discovered by the microscope. 
 
 Itch is one of these diseases. It is caused by a parasite — the 
 acarus scdbei. This is killed by sulphur. (See Itch.) 
 
 Favus of the scalp is a parasitical disease of the scalp. It is 
 a contagious disease. It is best treated by Fowler's solution of 
 arsenic internally, and by glycerine or carbolic acid or tar ointment 
 applied locally to the diseased parts. (See Ointments.) In this 
 disease the hair often falls out. 
 
 Barber's itch is a parasitical disease. It is contagious. It 
 occurs principally on the chin. It is sometimes given to the cus- 
 tomers in barber shops. It may be transferred from one customer 
 to another by dirty razors. Sometimes the beard is destroyed. 
 Here also the microscope shows us a parasite. 
 
 Barber's itch is to be treated by cutting the beard short, keeping 
 the parts clean, and applying ointments of nitrate of mercury or 
 carbolic acid. (See Ointments.) 
 
 Chloasma or yellow spots on the body is a parasitical disease. It 
 is treated by Fowler's solution internally, and by the local applica- 
 tion of carbolic-acid ointment. 
 
 Freckles and sunburn are diseases of the skin that are both 
 frequent and disagreeable, although they are no't serious in their 
 
826 
 
 character. People very often complain of them, yet rarely think 
 of consulting their physicians for assistance in treating them. The 
 best treatment for sunburn is the application of cream. 
 
 Moles and birthmarks are affections of the skin that only the 
 surgeon can treat. 
 
 Acne, or pimples. — With the appearance of this disease every 
 one is familiar. It consists of small, reddish pimples on the face. 
 Sometimes they become hard and large, break, and form scabs. 
 
 The disease is caused by anything that injures the system. It 
 is very common in young people. 
 
 This disease is usually obstinate. Those who desire to treat 
 themselves locally may try cold cream or glycerine, which can at 
 least do no harm. 
 
 Lupus is a very serious disease. It attacks the cheek, nose. 
 It may last for a long time. The disease should be treated only by 
 the surgeon. 
 
 SLEEPLESSNESS, OR INSOMNIA. 
 
 This is a very frequent and a very annoying symptom of a large 
 variety of diseases. It is a symptom which, like other nervous 
 symptoms, is increasing in frequency in modern times. It is caused 
 by the same influences that give rise to other nervous disorders. 
 (See Nervous Diseases) Over-work of the brain, over-worry, or 
 inordinate indulgence of the passions, are among the leading causes 
 that give rise to the state of constitution that finds it difficult or 
 impossible to sleep. Sleeplessness is a part of the compensation for 
 our progress in civilization. It is, however, entirely possible for 
 one to be through life a hard brain-worker and yet enjoy abundance 
 of sleep. (See Sleep, and Influence of Occupations on Health and 
 Longevity) 
 
 Among the exciting causes of sleeplessness are anxiety, and us- 
 ing the brain too late in the evening. Therefore study, writing, and 
 even reading, attending exciting assemblies, exciting conversation, 
 improper food, and exhaustion of any kind, late in the day, may 
 cause a sleepless night. 
 
 TREATMENT OF SLEEPLESSNESS. 
 
 1. Correct the general condition. This should be done by obe- 
 dience to the laws of hygiene, and by adopting every possible mea- 
 sure that will tend to fortify and strengthen the constitution. (For 
 special directions, see Nervous Diseases, Treatment of.) 
 
 As a rule, whatever helps the general health will promote sleep, 
 for sleep is a thermometer of health. 
 
AND MOST RECENT METHODS OF TREATMENT. 827 
 
 If we do not sleep, we may be sure that the system is in some 
 way out of order. 
 
 2. To gain temporary relief. — Take a tepid or warm bath just 
 before retiring. Do not remain in the bath too long. Ten or fif- 
 teen minutes will usually be sufficient time. See to it that the water 
 is not hot, but simply tepid. Strong constitutions, who are accus- 
 tomed to the use of water, can bear a cold shower for a moment or two 
 after the warm bath, on the head and neck. This measure is rather 
 heroic, and cannot be indiscriminately recommended. It must be 
 used with great caution by invalids. Sometimes a hoi foot-oath 
 will induce sleep. 
 
 Sleep with the head high. Use two or three pillows. Sleepless 
 persons are usually troubled with a rush of blood to the head. This 
 tendency may be somewhat remedied by sleeping with the head 
 considerably raised. 
 
 Take large doses of oromide of potassium — say dose of from 10 
 to 40 grains — just before retiring, and repeat the dose during the 
 night, if necessary. Bromide of potassium is, on the whole, our best 
 internal remedy for sleeplessness. It reduces the volume of blood 
 in the brain and calms the nervous system. (See Bromide of Potas- 
 sium^ There are cases, however, where it does no good whatever. 
 
 Such exceptional cases must experiment with other remedies. 
 The best remedy known is opium and its preparations, cold powder 
 (see Cold Powder}, Dover's powder (see Dover' 1 s Powder}, hops of 
 the " hop pillow ," lupulin (see Lupulin). 
 
 Some of these remedies — in the regular doses — may be of ser- 
 vice after bromide of potassium. Both cold powder and Dover's 
 powder contain a little opium. A grain of opium or a grain of 
 morphine may be taken, but opiates are apt to leave unpleasant ef- 
 fects. They often cause headache and nausea the following day. 
 When opium is used for sleeplessness it should be given in as small 
 doses as possible. Sometimes opium aggravates sleeplessness, and 
 all the preparations which contain it must be dispensed with. What- 
 ever happens, avoid the patent anodynes. 
 
 Alcoholic stimulants sometimes will induce healthful sleep. 
 Whiskey or some form of wine may be tried. Lager leer, ale, and 
 porter act like magic with some constitutions. Smoking is a sopo- 
 rific to many. In all these matters the only guide is the experience 
 of each individual. Hoffman's anodyne and valerian may be tried. 
 
 But no one should experiment with himself. Protracted sleep- 
 lessness is too often a symptom of serious trouble of the brain or 
 nervous system, that may demand the counsel and aid of the physi- 
 cian. Many patients injure themselves by a reckless use of opiates. 
 
828 DESCRIPTION OF THE 
 
 General electrization is a remedy that I have found, on the whole, 
 more efficacious in sleeplessness, both for temporary and permanent 
 effects, than internal medication. When I have opportunity to em- 
 ploy it I prefer it even to the bromide of potassium. (See General 
 Electrization^) 
 
 SMALL-POX. 
 
 The two principal divisions of small-pox are the distinct and 
 confluent. In the former the pocks are distinct and separate from 
 each other; in the latter they unite, and the eruption is continuous. 
 
 MILD OR DISTINCT SMALL-POX. 
 
 The specific contagious principle, or poison, of small-pox remains 
 in a latent state in the system during a longer or shorter period — 
 generally ten or twelve days — and then gives rise to fever. The 
 patient is seized with shivering, which is soon followed by thirst, 
 restlessness, and anxiety ; he complains of pain in his head, back, 
 and joints ; nausea is always experienced, vomiting generally oc- 
 curs, and pain is felt at the pit of the stomach. Children usually 
 appear sleepy and oppressed, and are sometimes attacked with con- 
 vulsive fits. 
 
 At the expiration of forty-eight hours, or on the third day from 
 the commencement of the shivering, the eruption makes its appear- 
 ance in small red spots like flea-bites. These are first observed on 
 the forehead, face, and neck, next on the wrists, and gradually in- 
 creasing in number and size, extend, in the course of a day or two, 
 over the whole surface of the body ; the legs and feet being always 
 the parts last affected. The feverish symptoms abate on the appear- 
 ance of the eruption ; the pulse diminishes in strength and quick- 
 ness ; the pain of the back, headache, and sickness at stomach are 
 greatly relieved ; and the patient is not so restless, and the sleep is 
 more refreshing. The numerous red points constituting the erup- 
 tion are from the first slightly elevated above the skin ; on the second 
 day their base becomes enlarged and feels hard to the touch ; on 
 the third day, beyond which the eruption seldom continues to be 
 thrown out, a small vesicle or pock, having a central depression, and 
 containing a thin limpid fluid, shows itself on the summit of each 
 pimple. The pocks are now about the size of a small pea, and 
 with an inflamed border of a damask-red color, more or less vivid, 
 according to circumstances. On the sixth day, reckoning from the 
 beginning of the eruption, the central depression disappears, and 
 the fluid, which was at first thin and limpid, is changed to a yellow 
 
AND MOST RECENT METHODS OP TREATMENT. 829 
 
 color, and presents all the appearance as well as consistence of the 
 matter of an abscess. On the following day the pustules on the 
 forehead, face, and parts where the eruption first appeared, burst ; 
 and on the eighth day, still counting from the date of the eruption, 
 scabbing commences over the whole body; but on the legs and feet 
 the pustules are slow in reaching maturity, and do not, in many 
 cases, begin to decay or discharge their contents until three or four 
 days after scabs have appeared on the face. 
 
 The fever, which had in a great measure or altogether subsided 
 on the appearance of the eruption, recommences when the pocks are 
 ripened ; the pulse becomes quick, the sleep is much disturbed, the 
 urine is again scanty and high colored, and sometimes there is de- 
 lirium at night. This is called the secondary fever, in contradis- 
 tinction to the primary fever which preceded the eruption. During 
 three or four days previous to the bursting of the pustules the face 
 and hands are in most cases considerably swollen, and the eyes are 
 closed up. At this period the skin emits a sickly, disagreeable 
 smell, peculiar to the disease ; it is tender and more or less painful, 
 accompanied with a distressing sensation of itching throughout the 
 whole period of maturation. 
 
 In this form of the disease the secondary fever seldom continues 
 long, the swelling of the face and hands soon subsides, and about the 
 fourteenth or fifteenth day of the eruption the crusts have fallen from 
 the face, neck, and upper parts of the body, leaving the skin of a 
 brown or clarety hue, which sometimes does not disappear for two or 
 three months. In many cases ulceration succeeds the bursting of 
 the pocks, and pits or depressions are the consequences, which con- 
 tinue through life. 
 
 CONFLUENT SMALL-POX. 
 
 The fever which precedes the eruption in this form of the dis- 
 ease is usually very severe ; the symptoms enumerated in describing 
 the distinct variety appear in a much more intense degree ; the 
 languor and general oppression, the pain in the back and sickness 
 at stomach are more severely felt ; the pulse is quick, contracted 
 or oppressed ; delirium often sets in early, and is sometimes of the 
 lower character described under the head of typhus, or the patient 
 is outrageous, and requires to be controlled. 
 
 The eruption is thrown out to a much greater extent than in the 
 distinct kind, and this constitutes the principal feature of confluent 
 small-pox. The vesicles appear early on the third day, and are 
 tilled with a thin brownish fluid ; they never rise to an eminence, 
 but run" into each other, forming large patches or blisters, and some- 
 
830 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 times the face is completely covered, as if with a mask. The face 
 and head begin to swell on the third or fourth day, the glands of 
 the mouth become affected about the same time, and copious sali- 
 vation continues until the ninth or tenth day ; this symptom is also 
 not uncommon in distinct small-pox. On the fifth day the eyes are 
 closed up, and the limbs are much swollen. As the disease ad- 
 vances the glands of the neck become enlarged, while the head and 
 face are hideously swelled and disfigured, and contrast in a striking 
 manner with the healthy and blooming appearance which the 
 countenance presented only a few days before. When the pustules 
 break, large dark-colored scabs are formed, accompanied with an 
 exceedingly loathsome smell. 
 
 There is little or no diminution of the fever on the breaking out 
 of the eruption; the patient continues very restless, the sleep is 
 much disturbed, the skin is hot, and the thirst urgent. With the 
 approach of the disease towards its crisis, the symptoms in many 
 cases become still more alarming ; the brain and nervous system are 
 affected as in typhus fever, and a long train of typhoid symptoms 
 are manifested ; there is a great prostration of strength ; the tongue 
 is dry, tremulous, and protrudes with difficulty; low muttering 
 delirium or a state of stupor comes on ; the urine and stools are 
 voided involuntarily ; convulsive starting of the tendons, picking 
 at the bed-clothes, and hiccup take place; and the patient dies 
 between the eighth and ninth days of the eruption. 
 
 Some patients, however, are fortunate enough to escape all these 
 impending dangers, and the disease reaches the period of decline; 
 but another ordeal, fraught with extreme danger, has still to be 
 gone through. The restorative process has no sooner commenced 
 than a state of general excitement, called secondary fever, is lighted 
 up ; this occurs in all cases where the inflammation has penetrated 
 to the cellular texture beneath the skin, and is also frequently ex- 
 perienced in children and delicate persons even in the distinct 
 variety of the disease, where the cellular substance is little or not at 
 all implicated. On the ninth or tenth day of the disease, some- 
 times later, the skin becomes hot and dry, the pustules are hard 
 and scaly, the pulse is increased in frequency, the tongue is white, 
 there is great thirst, and the patient is deprived of sleep. This 
 secondary constitutional disturbance may be complicated with 
 various local disorders ; these are sometimes confined to the exter- 
 nal parts of the body ; in other cases, again, the internal organs are 
 affected. 
 
 MALIGNANT SMALL-POX. 
 
 In this form of the disease the fluids of the body are in a de- 
 
AND MOST RECENT METHODS OF TREATMENT. 831 
 
 praved state, and hemorrhage or discharge of blood takes place from 
 the nose, the gums, the stomach, or bowels ; and in females, from 
 the womb. Purple-colored fever-spots make their appearance on 
 all parts of the skin not covered by the eruption. The pocks, as 
 they advance to maturity, instead of being filled with yellow-colored 
 matter (pus), contain a thin bloody-colored serum, and run into 
 each other as in the confluent form above described. There is great 
 prostration of the vital powers, the countenance is haggard, the 
 breathing is hurried and irregular, the urine is dark-colored or 
 bloody, and the patient is affected with low muttering delirium 
 almost from the onset of the disease, although in some instances the 
 intellectual faculties continue unimpaired to the last. This is by 
 far the worst form of small-pox, and almost invariably destroys life 
 between the fifth and eighth days from the commencement of the 
 eruption. 
 
 Mild or distinct small-pox seldom proves fatal ; but when the 
 disease appears under the confluent form it is much more to be 
 dreaded, and the malignant variety almost invariably proves fatal. 
 The signs which lead us to anticipate a favorable termination are a 
 small and soft pulse, undisturbed sleep, quiet of mind, and a crim- 
 son-colored border surrounding the pocks. The unfavorable symp- 
 toms are restlessness, sleepless nights, delirium, hoarseness, cough, 
 &c, occurring at an early period of the disease ; the appearance of 
 vesicles on the tongue, or the inside of the mouth and throat ■; a pur- 
 ple or claret-colored margin surrounding the pocks, a white and 
 pasty appearance of the face, and flatness of the pocks on the body 
 and extremities. Purple-colored fever-spots, and loss of blood from 
 the mucous membrane of any part of the body, announce a fatal 
 termination. Infants and people advanced in life seldom recover 
 from confluent small-pox. The most favorable age for receiving 
 the disease is from the seventh to the fourteenth or fifteenth year. 
 
 Causes. — In every instance it arises from a specific poison, or 
 contagious principle, derived from some one already affected with 
 the disease. It is well known that the infectious effluvia are con- 
 tained in the air which surrounds the patient ; and also that the 
 seeds of the disease adhere to linen, clothes, bedding, and other 
 things, and may lurk in them a long time in full force, until they 
 are extricated by some cause and occasion the complaint. 
 
 Although in Georgia, Circassia, Egypt, and India inoculation 
 has been practised from time immemorial, in order to mitigate the 
 violence of small-pox, yet in Europe the practice was unknown for 
 centuries ; and the disease swept off tens of thousands during every 
 generation, and left thousands more disfigured, crippled, or blind, 
 
832 DESCRIPTION OP THE PRINCIPAL DISEASES, 
 
 burdensome to themselves and distressing to the feelings of others. 
 At last Lady Mary Wortley Montague, whilst with her husband 
 during his embassy to Constantinople, witnessed inoculation, and, 
 being convinced of its efficacy, submitted her children to the opera- 
 tion, which fully answered her expectation. In one of her letters, 
 dated April 1, 1717, she says : " The small-pox, so general and so 
 fatal amongst us, is here entirely harmless, by the invention of 
 engrafting, which is the term they give it. There is a set of old 
 women who make it their business to perform the operation. Every 
 year thousands undergo it, and the French ambassador observes 
 pleasantly that they take the small-pox here by way of diversion, as 
 they take the waters in other countries, There is no example of any 
 one that has died in it ; and you may believe I am well satisfied of 
 the safety of the experiment, since I intend to try it on my dear 
 little son. I am patriot enough to take pains to bring this careful 
 invention into fashion in England." This highly accomplished and 
 spirited lady fulfilled her promise, and introduced the practice into 
 England in 1721 ; thence it spread rapidly over all Europe, and 
 deprived this loathsome disease in a great measure of its virulence 
 and fatality. Inoculation, however, was attended with many seri- 
 ous disadvantages, and is now therefore entirely superseded by vac- 
 cination, which is in every respect decidedly preferable. 
 
 Treatment. — Small-pox, like scarlatina and other diseases which 
 result from a specific contagion, must run a certain course, and pass 
 through its natural stages before the patient can be restored to 
 health ; hence we must not attempt to stifle the development of 
 the symptoms or unnecessarily interfere with the natural progress 
 of the disease, but should confine our treatment to palliative meas- 
 ures, and to preventing or counteracting any untoward accident 
 w r hich may occur during its course. The inflammatory disorders 
 which sometimes arise during the progress of the disease should, on 
 the contrary, be treated by remedies of a more active nature. 
 
 In the mild or distinct species of small-pox the inflammation of 
 the skin is always comparatively slight, and that of the mucous 
 membrane of the air-passages is seldom very severe ; it should never- 
 theless be borne in mind that the eruption is not always developed 
 in these structures in an equally mild form. In some instances, 
 although mild and perfectly distinct externally, it may be accom- 
 panied with internal affections of a sufficiently serious nature to 
 require the greatest attention and the most careful management 
 When, however, the eruptive fever is mild and the inflammatior 
 of the skin moderate, we have merely to keep the patient in bed 
 in a cool, well-aired chamber, and watch the progress of the disease 
 
 
AND MOST RECENT METHODS OF TREATMENT. 833 
 
 TREATMENT OF SMALL-POX. 
 
 There is no specific for small-pox. Recently, sidesaddle {sarra- 
 cenia purpurea) has attracted some attention in the treatment of 
 this disease, but the profession are not satisfied that it is of any 
 special service. 
 
 The great thing in the general treatment of small-pox is good 
 nursing. In spite of all that we can do the disease will run its 
 course. The same remark will apply to nearly all fevers. 
 
 During the progress of small-pox the patient may drink freely of 
 lemonade, ice-water, and carbonated water — that is, water impreg- 
 nated with carbonic acid gas — or of the effervescing draughts. (See 
 Effervescing Draughts.) 
 
 The body should be frequently sponged with cool or tepid water. 
 
 The sickness at the stomach may be relieved by oxalate of 
 cerium in doses of one or two grains, dry on the tongue ; or by 
 subnitrate of bismuth in doses of five grains. 
 
 When the patient becomes debilitated it is frequently neces- 
 sary to use stimulauts. Brandy, whiskey, and wine may be em- 
 ployed in such doses as the patient will bear. 
 
 If the patient is not much debilitated it may not be necessary 
 to use any stimulants. 
 
 Pure air is important. The sick-room should be freely ven- 
 tilated without chilling the patient. This same rule should be 
 observed in the treatment of all fevers. 
 
 If the throat is very troublesome it may be gargled with salt 
 and water, or with chlorate of potash and water — one drachm to an. 
 ounce of water. 
 
 If the eyes are exceedingly troublesome they may be treated as- 
 directed under diseases of the eye. (See Eye, Diseases of.) 
 
 During the progress of small-pox complications occasionally arise 
 that require special treatment. 
 
 One of the most interesting points in the history of the treat- 
 ment of small-pox is the various efforts which have been made from 
 time to time to prevent the pustules from coming to maturity, and 
 thus diminish the irritation and other unpleasant consequences that 
 invariably accompany an extensive crop of confluent pustules over 
 a large surface of the skin ; for obvious reasons the greatest atten- 
 tion has been paid to the state of the face and neck. The Arabian 
 physicians were in the habit of opening the pustules when com- 
 pletely formed, and pressing out the matter in order to prevent its 
 absorption ; the parts are then washed gently with a rag moistened 
 in tepid milk ; this practice may always be followed with advantage.. 
 53 
 
834 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 Some physicians endeavor to prevent the formation of pustules 
 altogether by cauterizing them on the first or second day with 
 the nitrate of silver. This may be done most safely by touching the 
 pustule with a sharp-pointed stick of lunar caustic ; the caustic 
 should be applied lightly twice a day, so as not to burn the surface 
 of the skin deeply ; in this way the pustules are frequently prevented 
 from coming to maturity. 
 
 Another method of treating the pustules is the application of 
 collodion. (See Collodion.) This should be applied once or twice 
 a day with a brush. This method is rather agreeable to the patient 
 than otherwise. 
 
 Another method consists in covering the face, or such parts of 
 the body as we wish to preserve from scars, with a mask of mild 
 mercurial plaster. The plaster must be applied as soon as the pus- 
 tules make their appearance, and be kept on for four or five days 
 without intermission. This method is not attended with any danger, 
 and may be safely entrusted in the hands of persons who have not 
 received a medical education. 
 
 Persons laboring under confluent small-pox, especially towards 
 the end of the disorder, require constant care and attention. When 
 the whole body is covered with pustules which emit fetid pus in 
 greater or less quantity, the surface shonld frequently be sprinkled 
 with starch powder; the linen must be frequently changed, and 
 every attention paid to cleanliness. Sores of an evil nature are about 
 this time apt to form on the buttocks, or other parts of the body 
 exposed to pressure ; these sores must be carefully looked for, and 
 undue pressure prevented by placing pillows under the back, legs, 
 &c. ; the sores may be dressed with a decoction of bark, and the 
 patient's strength supported by wine, nourishing broths, and cordial 
 draughts. The following is a good form : 
 
 Compound infusion of orange-peel, twelve ounces, 
 Aromatic confection, six scruples, 
 Sulphate of quinine, one scruple. 
 Two ounces to be taken every four hours. 
 
 SODA. 
 
 The carbonate of soda is sometimes used in preference to the 
 carbonate of potash, in the preparation of effervescing draughts. 
 
 The dose is from fifteen grains to a drachm in water twice a 
 day. 
 
 The borate of soda, or borax, is seldom used internally. A 
 drachm of this salt, powdered and mixed with an ounce of clarified 
 honey, forms a useful local application to the sore mouths of chil- 
 
 
AND MOST RECENT METHODS OF TREATMENT. 
 
 835 
 
 dren. The following mixture is very serviceable as a cooling gargle 
 in common sore throat, and as a wash for the mouth where profuse 
 salivation has been produced by the inordinate use of mercury. 
 
 Borax, in powder, two drachms, 
 Rose-water, eight ounces, 
 Tincture of myrrh, two drachms, 
 Honey, a teaspoonful. Mix. 
 
 (See Sulphite of Soda.) 
 
 SODA-WATEK. 
 
 Soda-water, which is so popular in this country, is almost as 
 harmless as it is agreeable. I think, however, that it would be 
 better for our citizens to take more acid and less sweet drinks. 
 Lemonade is on many accounts to be preferred as a summer drink 
 to soda-water with rich syrups. There are comparatively few with 
 whom lemonade will not agree. 
 
 SPECULA. 
 
 Specula are contrivances for examining the cavities of the body 
 
 O 
 
 o 
 
 o 
 
 SPECULUM FOR VAGINA. 
 
 that are not directly open to the inspection of the eye. They are 
 
836 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 of various shapes and composed of different substances, according to 
 the part that they are designed to aid us in examining. 
 
 Specula for the ear separate the walls of the external auditory- 
 canal, and admit reflected light from a mirror against the drum 
 of the ear, and enable us to study it with accuracy. (See Otoscope.) 
 
 Specula for the vagina separate the vaginal walls and bring into 
 distinct view the neck of the womb, and reveal any disease that 
 may exist there. Of these specula for the vagina there are a large 
 variety. (See Women, Diseases of.) 
 
 These specula are not designed for domestic use, but their in- 
 troduction into medical practice has revolutionized the treatment 
 of the diseases of the parts and organs which they aid us to examine. 
 
 SPINE, DISEASES OF. 
 
 The word spine is a very indefinite word. It is applied to the 
 spinal cord, to the spinal column, to the nerves that issue from the 
 cord, and to the muscles of the back. 
 
 Pain in the back may come from one or all of these causes. It 
 is an interesting fact that where there is serious organic disease, 
 there is usually very little pain in the hack. 
 
 Pain in the back is usually, though not always, the symptom 
 and result of nervous exhaustion. Therefore dyspeptics, hypochon- 
 driacs, &c, frequently complain of uneasiness and distress in the 
 small of* the back. (See Backache}) 
 
 Pain in the back, from whatever cause it may arise, may be 
 relieved by the following measures: 
 
 1. Plasters of belladonna, or of some other anodyne. 
 
 2. Spongio-piline, well moistened, applied directly over the 
 aching part, and kept there by firm pressure of a band or bandage, 
 or of the clothing. (See Spongio-piline}) 
 
 These backaches arise from nervous exhaustion and from dis- 
 eases of the genital organs, and are only to be cured by curing the 
 causes. Where we are unable to cure the causes we can at least 
 relieve the distress and annoyance of backache by the measures 
 that I have recommended. 
 
 When the pain in the back, from any cause, is exceedingly 
 severe, it may be necessary to resort to hypodermic injections of 
 morphine or atropine. (See Hypodermic Injections}) 
 
 When we have reason to suspect the existence or approach of 
 real organic disease of the bones of the spine, we should consult 
 some reliable surgeon, accept his opinion, and obey his advice. 
 
AND MOST RECENT METHODS OF TREATMENT. 837 
 
 Parents should watcli their children when they think that they 
 see evidence of spinal disease, and have them taken in time. 
 
 There are many cripples in the land who might have been well 
 to-day if their parents had early acted upon the suggestion here 
 offered. 
 
 CURVATURES OF THE SPINE. 
 
 The spine curves from a variety of causes. Disease of the hones 
 may produce curvature. Weakness of the muscles of the back may 
 also bring on the same result. There are three kinds of curva- 
 ture — backward, forward, and lateral. 
 
 Of late years great improvements have been made in the treat- 
 ment of spinal curvatures by means of mechanical appliances. 
 
 There is no reason why parents should necessarily be discour- 
 aged when they find out the unwelcome fact that a child has a 
 curved spine. Even if the curvature results from disease of the 
 bones (the so-called Potfs disease), it may be entirely or approxi- 
 mately cured. 
 
 The mechanical appliances that are used must be adapted to 
 each case. To give any rules or special suggestions for the use of 
 these appliances would be impossible. 
 
 PREVENTION OF DISEASES OF THE SPINE. 
 
 Every one can do something towards preventing diseases of the 
 spine, even if they can do but little to cure them after they are fully 
 upon us. 
 
 We can prevent these diseases by obedience to the laws of 
 health ; by allowing our children plenty of air, sunlight, good food ; 
 by giving them comfortable chairs in our schools and homes; and by 
 taking in time all the beginnings of evil. 
 
 DISEASES OF THE SPINAL CORD. 
 
 Congestions, inflammations, and other affections of the spinal 
 cord, like all other diseases of the nervous system, are increasing 
 in frequency. 
 
 Both the brain and the spinal cord are very much at fault in a 
 large number of the chronic diseases of our time. 
 
 From Dr. Chas. F. Taylor's suggestive treatise on the diagnosis 
 of diseases of the spine I quote the following passage : 
 
 " The peculiarity in the patient's attitude is unmistakable. He 
 does not always lean to one side or the other, though frequently 
 doing so ; but there is an expression intimated and easily detected ; 
 
838 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 an effort to get as many springs under him as possible ; a letting 
 down of each joint of the body, so as to avoid shock. This is in- 
 stinctive, and the patient is unconscious of it. He takes a peculiar 
 crouched position, and sometimes is disinclined to sit at all ; for in 
 sitting he would be folded together, and the pressure upon the 
 bodies of the vertebrae would be increased. When the child comes 
 to his mother's lap he will fall heavily upon it, and wish to bear 
 his whole weight upon his elbows. These symptoms are more 
 noticeable in the severer cases, which will serve as types by which 
 to judge of slighter indications of the same character. 
 
 " I have often alluded to the fact that in Pott's disease there 
 never is sensitiveness along the spinal column. Out of three hun- 
 dred and eighty-two record cases, attended during the last three 
 years, I have never found one case with spinal hyperaesthesia. 
 
 " Feeling along the back for tenderness must therefore be aban- 
 doned, as a means of diagnosis in these cases. Percussion over the 
 supposed seat of the disease is equally worthless as a means of diag- 
 nosis. Too many cases are allowed to run on until past cure, by 
 trusting to a symptom which does not exist. 
 
 " Another symptom which may occur in the first stages- of Pott's 
 disease, is paralysis. It may appear very early, even before any de- 
 formity can be noticed. It is not difficult to distinguish this form 
 of paralysis from that due to other causes. In such a case we fall 
 back at once upon the rational symptoms. Inquire into the state 
 of the child's health for the last six or eight months, and we gener- 
 ally find that he suffered some injury a few weeks before the date 
 of the earliest symptoms, which will always resemble more or less 
 closely those previously described. Paralysis arising from spinal 
 disease in the early stages is apt to be brief. The child is put to 
 bed, gets rest, and his paralysis passes off* in a few days. The paral- 
 ysis is apt to be more protracted, lasting one or two years, when 
 occurring in the later stages of the disease. 
 
 " If you find a child with some dragging of the foot in walking, 
 it should at once call your attention to the spine ; and generally when 
 the attention is once directed there, if the paralysis is caused by dis- 
 ease of the vertebrae, it will be possible to discover some slight devia- 
 tion in the contour of the back. There will probably be no decided 
 projection, but only a slight deviation from the normal curve— the 
 lumbar vertebrae being perhaps less curved forward, or the dorsal 
 more curved backward than normal." 
 
 Dr. H. G. Davis says of the relation of the general health to 
 spinal curvature : 
 
 " The general health begins to fail gradually, and the effort to 
 
AND MOST RECENT METHODS OF TREATMENT. 839 
 
 maintain the erect position during walking and sitting becomes 
 more tiresome ; derangement of the stomach is apt to supervene, 
 with constipation of the bowels. Pains occur in the side and back. 
 In the female, dysmenorrhea is often present, and the countenance is 
 pale, careworn, and exhibits a chlorotic appearance. 
 
 " In many slight cases of lateral curvature, the health suffers little 
 or nothing ; the local symptoms may be principally those of which 
 the patient complains — as pain in the right shoulder, fatigue on 
 making slight exertion, interference with the respiration ; after a 
 while, as the distortion increases, with altered size of the thorax ; 
 palpitation of the heart from the same cause, as well as from its 
 mechanical displacement and compression; disorders of the digestive 
 and other organs, both primarily produced by the deformity, and 
 secondarily through failure of the general health and strength. 
 
 " One symptom may be particularly mentioned, namely, a con- 
 stant pain in the left side in cases which have progressed, the pain, 
 which is difficult to relieve, being referred to the left side, just 
 below the ribs." 
 
 SPRAINS. 
 
 When a joint is twisted or strained in a direction contrary to its 
 natural range of motion, or is moved to too great an extent in a 
 natural direction, the injury done to the part is called a sprain. In 
 all cases, the ligaments and tendons are stretched, and the soft parts 
 about the joint are more or less injured. The pain which immedi- 
 ately follows the accident is always very acute, and greatly increased 
 by the slightest motion of the joint ; sometimes it is accompanied by 
 sickness at stomach, and faintness. The parts soon become swollen, 
 and in many cases there is considerable discoloration occasioned by 
 the bursting of numerous small vessels, and the consequent effusion 
 of blood into the cellular or fatty substance beneath the skin. In 
 severe cases, the ligaments are partially torn, and the muscles of the 
 limb are injured. Sprains are always very troublesome injuries ; and 
 often, especially in elderly persons, require a longer time before the 
 cure is completed than a broken bone or a dislocation. In persons 
 of scrofulous constitutions, a sprain frequently becomes a very serious 
 and tedious disorder, and, when neglected or improperly treated, 
 sometimes give rise to the disease of the joints called white swelling. 
 The parts most liable to this accident are the ankles, wrists, and 
 joints of the thumbs and fingers ; the ankle is most frequently 
 affected, particularly at the outside of the joint. A fall, making a 
 false step as it is usually called, and leaping, are the ordinary causes. 
 
840 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 A sprain at the wrist, or at the thumb or fingers, commonly arises 
 from falling upon the hand. 
 
 Treatment. — The first object in the treatment of sprains is to 
 prevent or subdue inflammation ; and for this purpose the most 
 essential of the measures to be adopted consists in keeping the joint 
 perfectly at rest, the limb being elevated higher than the rest of the 
 body, in order to diminish the flow of blood to the part. "When 
 the ankle is sprained, the limb should be placed upon a pillow cov- 
 ered with a piece of glazed cloth ; and the parts are then to be kept 
 constantly wet with any simple cold lotion, as Goulard water, or 
 vinegar and water. But cold applications are not to be employed 
 if the patient be troubled with cough, or disposed to inflammatory 
 disorders of the lungs ; and females are, no doubt, aware that they 
 would be improper during menstruation. Many surgeons, instead 
 of applying cold lotions to sprained or bruised parts, prefer the 
 practice of fomenting them with warm water, or decoction of poppy- 
 heads. On this point the patient must judge for himself. If cold 
 applications do not produce the effect of soothing the pain and 
 abating the inflammation, it will then be proper to have recourse 
 to warm emollient fomentations. 
 
 In severe cases it may be necessary to apply twelve or fifteen 
 leeches round the joint, and afterwards warm emollient fomenta- 
 tions and poultices; cooling saline purgatives are to be taken, and 
 the patient ought to confine himself to low diet until the inflamma- 
 tory action is entirely subdued. 
 
 The second object is to restore the proper tone of the vessels, and 
 to brace the weakened parts, in order to allow the joint to perform 
 its natural functions. But no measures are to be had recourse to 
 with this purpose, until we have succeeded, by keeping the joint 
 perfectly quiet, and by the means above directed, in subduing the 
 inflammation. It will then be necessary to -pump cold water on the 
 joint, and employ friction with opodeldoc, or some other stimulat- 
 ing application. The treatment is to be conducted on the same 
 principle as that of bruises. There is no better method of keeping 
 down the swelling, of supporting the parts, and restoring their 
 tone, than pressure by means of a laced stocking, or the application 
 of a flannel roller. Some practitioners apply strips of adhesive 
 plaster in opposite directions round the joint, and this, when pro- 
 perly managed, is perhaps the best plan of employing pressure. 
 
 We repeat, that the most essential part of the treatment consists 
 in keeping the joint at rest. Without attention to this, no remedies 
 are likely to be of much service. Kecovery is often retarded by 
 premature attempts at using the limb; by this imprudence the 
 
AND MOST RECENT METHODS OF TREATMENT. 84:1 
 
 inflammation in many instances is renewed, and becomes chronic, 
 the bones at the joint become diseased, and amputation is the con- 
 sequence. One of the best methods of treating sprains is by elec- 
 trization. (See General Electrization and Localized Electrization}) 
 This treatment may be used at almost any stage of the injury. In 
 my hands it has frequently been very efficacious indeed. 
 
 SPANISH, OK BLISTEKESTG FLIES. 
 
 Spanish flies, or cantharides, are a species of beetles common in 
 Spain, Sicily, Italy, and some other parts of Europe. They are 
 found adhering to the leaves of the ash, the lilac, willow, and other 
 plants, and are collected before sunrise in the months of June and 
 July; they are killed by being exposed to the vapors of vinegar, 
 and are afterwards dried in a stove. 
 
 These insects are employed for medical purposes both internally 
 and externally, but are chiefly used to make the common blistering 
 plaster. When the immediate effect of a blister is required the 
 vinegar of cantharides is the most effectual application. A piece 
 of blotting-paper moistened with this fluid raises a blister almost 
 immediately; hence it may prove of essential service when applied 
 behind the ears in toothache, or over the stomach in cases of sud- 
 den cramp ; and the raw surface produced in this manner affords a 
 ready means of introducing certain medicinal substances into the 
 system by absorption. Morphine, for example, when sprinkled upon 
 a portion of the skin which has been deprived of its cuticle, is 
 quickly absorbed, and the patient may be thus relieved where reme- 
 dies could not be otherwise employed, as in cholera, colic, &c. 
 
 Cantharides are sometimes employed internally in cases of palsy 
 of the bladder, whites, gleets, -&c, and are administered either in 
 tincture or in powder, the dose of the former being from ten to 
 thirty drops, that of the latter from one to three grains. In full 
 doses they act powerfully on the urinary and generative organs, 
 and if taken incautiously may produce strangury, bloody urine, 
 vomiting, and inflammation of the bladder, kidneys, or intestines. 
 
 Cantharides are sometimes absorbed into the system from a blis- 
 ter, and cause great heat, pain, and difficulty in making water. 
 When this accident occurs the patient should drink freely of barley- 
 water, linseed tea, or any other demulcent drink; and take four 
 ounces of camphorated emulsion, with twenty drops of laudanum or 
 half a drachm of the tincture of henbane, to each dose. 
 
 SPHYGMOGKAPH. 
 
 This is a contrivance for recording the character of the pulse. 
 
842 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 It is of material assistance in the study of the pulse in various mor- 
 bid conditions. It is a somewhat complicated apparatus, and has 
 not yet come into general use in the profession. 
 
 A general idea of this apparatus may be derived from the cut. 
 
 Figure 1. — The Sphygraograph applied to the Fore-arm. 
 
 Figure 2. — Enlarged view of the frame of the Sphygmograph in profile, showing the arrangement 
 of the levers. 
 
 A A' a, the writing lever, the axis of which is at c ; K, the spring ; B, the lever by which the move- 
 ments of K are transmitted to A ; D, its knife edge ; T, an adjusting screw for vaiying the distance 
 between K and D according to the pressure required ; P, an adjusting screw for permanently adjusting 
 the spring at the proper obliquity ; F, G, the box in which the clockwork is contained ; L, M, the trav- 
 eller. 
 N. B. — The same letters are used in both figures. 
 
AND MOST EECENT METHODS OF TREATMENT. 
 
 843 
 
 It represents the sphygmograph applied to the fore-arm. It 
 is kept in its position by a bandage passed round the wrist. The 
 plate rests on the artery. Each pulsation of the artery slightly 
 moves the plate, and a clockwork attachment moves a frame from 
 m towards l, at the rate of three inches to a tenth of a minute. At 
 the end of the lever a is a pen of a peculiar shape, which writes on 
 a piece of glazed paper as the frame moves. 
 
 A similar clockwork attachment is connected with the dynamo- 
 meter. (See Dynamometer.) 
 
 That the pulse varies in disease and in health with the nature 
 of the constitution and the condition of the system, everybody knows. 
 The advantage of this apparatus is, that it definitely records the 
 character of the pulse. 
 
 The accompanying cuts represent the firm and long pulse of 
 vigorous health, and the hard pulse of chronic Bright's disease. 
 
 Inflammations of the heart, enlargement of the heart, typhus 
 fever and irritative fever, all have their characteristic pulse, that 
 may be distinctly recorded by this ingenious contrivance. 
 
 PLATE I. SOFT PULSES. 
 
 TJndulatory pulse of typhus. 
 (Frequency, 160.) 
 
 Hard pulse of chronic Bright's disease (contracted kidney). 
 (Frequency, 70.) 
 
 The firm and long pulse of vigorous health. 
 (Frequency, 50.) 
 
 SPITTING OF BLOOD, OR HEMORRHAGE FROM THE 
 
 LUNGS. 
 
 This disorder may come on suddenly, when the patient least ex- 
 pects it ; but in general it is preceded by symptoms of congestion of 
 
844: DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 the lungs. A sensation of tightness, heat, and itching is felt through- 
 out the chest, or at some particular part of it, accompanied with 
 difficulty of breathing and a feeling of anxiety. The pulse may be 
 felt jerking or vibrating under the finger ; the patient experiences 
 frequent chills, alternating with flushes of heat; his extremities are 
 cold, and he feels languid. When the blood has escaped from the 
 vessels, and is thrown loose into the air-passages, a sense of ebullition 
 or bubbling is felt in the chest, arising from the air coming in con- 
 tact with the blood during the alternate movements of inspiration 
 and expiration ; at the same time there is often a saltish taste in the 
 mouth, and the difficulty of breathing is increased. At length the 
 irritation in the air-passages produces cough, which is followed by 
 expectoration of a greater or less quantity of blood. Sometimes the 
 titillation excited in the windpipe and throat causes the contents of 
 the stomach to be thrown up, and, as these are mingled with blood, 
 we might at first suppose that the hemorrhage has proceeded from 
 the stomach. But in most cases the red vermilion color and frothy 
 appearance of the blood, and the previous symptoms of internal dis- 
 ease, are sufficient indications that the lungs are the source of the 
 hemorrhage. The extent of the discharge varies greatly. Many 
 cases are on record where persons have ejected considerable quanti- 
 ties of blood from the lungs, periodically, for years, and yet have 
 ultimately recovered ; but in persons of a scrofulous or tuberculous 
 constitution the slightest expectoration of blood is a symptom of 
 fearful omen. 
 
 Women are more subject to spitting of blood than men, owing 
 in a great measure to the facility with which the menstrual flux is 
 obstructed from various causes. When that important function is 
 suppressed, or ceases to be performed, the superabundant blood 
 sometimes seeks its way out of the body through other channels; 
 occasionally it escapes from the blood-vessels of the lungs into the 
 air-passages, and is coughed up without causing pain or much incon- 
 venience. This may continue periodically for a considerable length 
 of time, perhaps for years ; and at last ceases when the natural func- 
 tion of the womb is restored. Many women, otherwise in good 
 health, are affected with periodical spitting of blood every time they 
 become pregnant ; but in all cases of this description the discharge, 
 even when profuse, is not to be viewed in so serious a light as when 
 it occurs under other circumstances. Another fruitful source of this 
 disorder in girls is the bad habit of wearing tight stays. When the 
 chest is strongly girt with stays the natural movements of respira- 
 tion are impeded, and the blood is retarded in its passage through 
 the lungs ; the obstruction thus produced acts in the same manner 
 
AND MOST RECENT METHODS OF TREATMENT. 845 
 
 as malformation of the chest, organic diseases of the heart, or any 
 other circumstances, which, by mechanically interrupting the balance 
 of the circulation, may cause the blood to stagnate in the lungs un- 
 til, as not unfrequently happens, it is forced out of the vessels into 
 the bronchial tubes or air-passages, and discharged by the mouth. 
 Spitting of blood is not the only evil which this artificial system of 
 restraint induces : the free expansion of the lungs being impeded, 
 the breathing is rendered shorter and quicker than natural, and the 
 air not being admitted in due quantity, the blood is not sufficiently 
 oxygenized, and the whole organization of the body suffers in con- 
 sequence. The healthy temperature cannot be kept up, the coun- 
 tenance is pale, the feet are often cold, and there is a degree of list- 
 lessness and depression which unfits the body for the requisite exercise 
 of its physical powers. This imperfectly vitalized state of the blood 
 prevents the process of nutrition from being adequately accomplish- 
 ed; hence every part of the animal economy is reduced below the 
 standard of healthful vigor, and if any dormant predisposition to 
 consumption be present, nothing will more certainly rouse it into 
 action than this depressed condition of the vital powers, — a condition 
 which but too frequently brings on this fatal malady where no here- 
 ditary disposition exists, and in all cases increases the susceptibility 
 to the impression of other diseases. 
 
 The exciting causes of this disorder are numerous. It may arise 
 from any violent bodily exertion, as running, rowing, or wrestling ; 
 from sudden changes of temper, or from sudden exposure to cold 
 when the body is overheated; and it may be brought on by any 
 circumstances which debilitate the body or render the circulation 
 irregular. Fatal hemorrhage from the lungs has occurred in some 
 instances from distress of mind. 
 
 All blood that comes from the month does not necessarily come 
 from, the lungs. It may come from the throat, the windpipe, the 
 bronchial tubes, the mouth, or the stomach. 
 
 Eleeding from the mouth occurs in scurvy, from ulceration or 
 weakness of the gums, or from extraction of teeth. When it pro- 
 ceeds from scurvy it should be treated by mild astringent washes 
 of tannin, or alum {five grains to one ounce of water.) When it 
 follows the removal of a tooth the cavity may be plugged by lint 
 or cotton dipped in Monsel's salt. (See MonseVs Salt, or Creasote, 
 or Carbolic Acid.) 
 
 The great point is to distinguish between the blood that comes 
 from the lungs and that which comes from the stomach. 
 
 The differences are these : — 
 
846 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 FBOM THE LUNGS. 
 
 Blood coughed up, red and frothy, and mix- 
 ed with spittle. 
 Difficulty of breathing. 
 
 FROM THE STOMACH. 
 
 Blood vomited, dark color and not frothy, 
 
 and mixed with food. 
 Sickness at the stomach. 
 
 Bleeding from the throat and windpipe is not usually of a seri- 
 ous character. 
 
 TREATMENT OF SPITTING OF BLOOD FROM THE LUNGS. 
 
 1. Absolute rest in a horizontal position. 
 
 Rest is the principal thing, and should be chiefly insisted on. 
 The friends of patients are frequently more alarmed than is neces- 
 sary, and desire to pour down a large quantity of medicine. In 
 many cases no medicine at all is needed. 
 
 2. Common salt, in doses of one or two teaspoonfuls dissolved 
 in water. This is a popular remedy, and is very serviceable. 
 
 lee and alum may be held in the mouth and slowly swallowed. 
 
 The tincture of the chloride of iron may, in bad cases, be given 
 in doses of ten or fifteen drops in water. Usually, however, rest, 
 common salt, ice, and alum are all that are necessary. 
 
 The diet should be mild and unirritating. 
 
 These are the means to be adopted during the attack ; the sub- 
 sequent treatment must depend on the nature of the disease which 
 has given rise to the hemorrhage, for, as has been already men- 
 tioned, this affection is much more frequently symptomatic of dis- 
 ease of the lungs, heart, &c, than a disease in itself. 
 
 "We mentioned at the commencement of this short essay that 
 spitting of blood may arise from obstruction of the menses, and 
 that when we succeed in restoring this important function the 
 hemorrhage from the lungs does not recur. It must, however, be 
 kept in recollection that spitting of blood rarely occurs from this 
 cause, although for the most part it attacks young women whose 
 menses have been for some time obstructed ; and it has been well 
 ascertained that under such circumstances both these affections, 
 in the great majority of cases, result from tubercles in the lungs, as 
 we have had already occasion to notice in another part of this vol- 
 ume. (See Pulmonary Consumption^) It is therefore preferable 
 to wait until the advice of a physician can be obtained, rather than 
 to administer stimulating remedies with the intention of bringing 
 back the menstrual discharge. In certain cases severe hemorrhage 
 from the lungs occurs in females at the turn of life, when the men- 
 strual discharge is about to cease altogether. The symptoms of 
 this form are often very alarming, but the loss of blood is usually 
 restrained by an assiduous use of the means just pointed out. 
 
AND MOST RECENT METHODS OF TREATMENT. 847 
 
 SPONGIO-PILIKE. 
 
 This is a combination of sponge, rubber, and wool, that has re- 
 cently come into use, and has been found very serviceable as a kind 
 of extemporaneous poultice, and also a substitute for the " compress" 
 of the water cure. It is made of rubber, lined with sponge and 
 wool to the thickness of about a quarter of an inch. It comes in 
 large rolls, and is sold by the square inch or square foot. If it were 
 not so expensive it would be much more used than it is now. 
 
 In order to use this spongio-piline for a poultice, simply wet it 
 with warm or cold water, as may be desired, or with some medicated 
 solution, and apply it directly to the parts, the sponge lining being 
 inside. The robber covering acts like oiled silk, and retains the 
 moisture. When much used, the spongio-piline will need to be 
 frequently washed. The spongio-piline may be applied in the same 
 way to the pit of the stomach in dyspepsia, over the bowels, over 
 the ovaries, to sprained joints, in rheumatism, and so forth. It 
 keeps up a mild and pleasant counter-irritation. 
 
 SPOTTED FEVEK, OR CEKEBKO-SPIXAL FEVER. 
 
 This disease has only recently become known. It was heard of 
 in Europe in the 13th and 14th centuries. It appeared in the 
 United States in 1806. Since 1848, several epidemics of it have 
 occurred in various parts of the country. 
 
 It is a dreadful disease. The majority of the cases die, and 
 usually within three days. 
 
 The attacks usually come on suddenly. The symptoms are 
 severe pain in the head, chills, nausea, vomiting. Then comes 
 delirium, perhaps convulsions, sometimes deafness or blindness. 
 Stupor may occur, or exceeding sensitiveness over the body. 
 
 The pulse at first is slow, but is afterwards more rapid. 
 
 Spots occur in the majority of cases on the neck, breast, and 
 limbs, rarely on the face. These spots vary in size. Some of them 
 are three-fourths of an inch in diameter. They do not disappear on 
 pressure. 
 
 In glancing over these symptoms it will be seen that many of 
 them are similar to those which announce many other fevers. It is 
 therefore impossible to tell at first what kind of a fever the patient 
 is to have. Any one who is taken down with these general symp- 
 toms of fever should secure at once the lest possible medical advice. 
 If they are so situated that they cannot obtain medical assistance, 
 
848 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 all that they can do is to treat themselves, or allow their friends to 
 treat them, on general principles, and without making any attempt 
 to find out at once what kind of fever is coming on, or what its 
 name may be. 
 
 These remarks have a general application, and do not alone 
 concern spotted fever. If there is an epidemic about us of small- 
 pox, or spotted fever, or typhus fever, then, of course, we have rea- 
 son to suspect that the fever that attacks us is the one which 
 prevails. 
 
 TREATMENT OF SPOTTED FEVEB. 
 
 No treatment seems to be of much service. The profession are 
 yet in the dark on the subject. We may give quinine, and brandy, 
 and opium, and whiskey ; we may rub the body with hot cloths ; 
 we may apply blisters and dry cups ; and after all the patient will 
 probably die. 
 
 After death there is usually found more or less change in the 
 brain and spinal cord. Therefore the disease is sometimes called 
 cerebrospinal fever. 
 
 SQUILL. 
 
 Squill is principally employed as a diuretic and expectorant. 
 
 The dried root of squill is often of great service as a diuretic 
 in dropsy, in the dose of a grain evening and morning, gradually 
 increased to three grains ; its power is augmented by combining it 
 with small doses of calomel or blue pill. This combination is more 
 particularly useful when dropsy is connected with obstruction of 
 the liver or spleen. 
 
 The tincture and oxymel of squills are frequently prescribed to 
 promote expectoration in chronic cough, asthma, hooping-cough, 
 and difficulty of breathing occasioned by the lungs being oppressed 
 with tenacious phlegm. The stimulating property of squill renders 
 its use improper in all cases connected with inflammation. The 
 dose of the tincture of squills is from ten to twenty drops three 
 times a day, and of the oxymel half a drachm may be given three 
 or four times a day. 
 
 STAMMERING A1STD STUTTERING. 
 
 According to Hunt, " Stammering is characterized by an in- 
 ability or difficulty of properly enunciating some or many of the 
 elementary speech sounds, either when they occur at the beginning 
 or the middle of a word, accompanied or not, as the case may be, 
 
AND MOST RECENT METHODS OF TREATMENT. 849 
 
 by a slow, hesitating, more or less indistinct delivery, but unat- 
 tended with frequent repetitions of the initial sounds, and conse- 
 quent convulsive efforts to surmount the difficulty. 
 
 " Stuttering, on the other hand, is a vicious utterance, manifested 
 hj frequent repetitions of initial or other elementary sounds, and 
 always more or less attended with muscular contortions." 
 
 The causes of stammering and stuttering are various. It maj T 
 be caused by cleft-palate, hare-lip, elongated uvula, enlarged tonsils, 
 diseases of the tongue and had position of the teeth, disease of the 
 brain and spinal cord. 
 
 It may be what is called a purely nervous affection, not con- 
 nected with any organic condition whatever. It may result from 
 nervous exhaustion. Poisons in the blood, loss of blood, stimulants 
 and narcotics, old age, imperfect development, deficiency of brain, 
 and consequent lack of will, all may be the causes of this disease. 
 
 TREATMENT OF STAMMERING. 
 
 Each case should be treated by itself by some one who thoroughly 
 understands the art. The treatment consists mainly in training 
 the patient to control his speech by appropriate discipline. 
 
 Mr. Hunt says that on the average it takes at least twenty 
 weeks to perform a cure. He believes that under practice and per- 
 severing treatment the disease is much more relievable than is com- 
 monly believed. Relapses sometimes occur. 
 
 Some cases may be cured in a very short time. 
 
 Stammering seems to be analogous to St. Vitus's dance, writer's 
 cramp. Its nature is mysterious, and its cure, though a matter of 
 difficulty, is frequently possible. 
 
 On the statistics of stammering, Hunt has the following inter- 
 esting remarks : 
 
 " Colombat assumed that there were in France about 6,000 per- 
 sons laboring under defective articulation, or nearly 1 in 5,000. 
 There can be no doubt that the actual proportion is much greater. 
 Colombat himself admits that he included in his estimation such 
 only whose impediments were strongly marked. In Prussia, which 
 in 1830 contained a population of about 13,000,000, the number 
 ascertained from official returns of many places, was calculated to 
 amount to more than 26,000 cases for the whole kingdom. Accord- 
 ing to this calculation, taking the population of the globe to amount 
 to about 1,000,000,000, the number of stutterers and stammerers 
 would form an army of 2,000,000, of which London alone would poss- 
 ess nearly- 6,000. It would be very desirable if the Registrar-Gen- 
 eral would emplov the means at his disposal to ascertain the actual 
 54 
 
850 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 number of persons laboring under various impediments of speech in 
 Great Britain, which, I have little doubt, would be found to ap- 
 proach the proportion of 3 in 1,000. It is unquestionable that im- 
 pediments of speech are far less frequent in females than in men. 
 Itard declares he never met with a female stutterer, although he 
 does not deny that such exist. According to Colombat, one woman 
 only in 20,000 stutter; while the proportion according to the same 
 authority in men is one in 5,000. 
 
 STARVATION. 
 
 Starvation is very properly included among the diseases. Among 
 the poorer classes the disease is much more frequent than may be 
 readily believed. Starvation is not necessarily a speedy process. It 
 may be exceedingly gradual. The quantity of nutriment received 
 oy the system may he constantly less than it should he, and yet suffi- 
 cient to sustain life " at a poor dying rate " for years. There is no 
 question that among the poorer classes especially, thousands of chil- 
 dren and even adults are slowly starved to death every year. The 
 same is true even of many who have abundant means. Erroneous 
 ideas on hygiene have induced many to slowly starve themselves by 
 a rigid diet. The horrible teachings of Alcott, Graham, and Presi- 
 dent Hitchcock have injured many of the best minds of the land. 
 
 Starvation may also result from cancer of the stomach, that 
 renders it impossible to digest food. 
 
 Among the symptoms of starvation are an irresistible tendency 
 to fall asleep, feeble circulation, a constant feeling of languor, diffi- 
 culty of breathing, palpitation of the heart, emaciation, and a down- 
 cast, wearied cast of countenance. 
 
 Starvation may bring on other diseases. It may bring on 
 typhoid fever, rickets, scrofula, consumption, scurvy. 
 
 Starvation is to be treated by nourishing food* tonics, and stimu- 
 lants. After prolonged abstinence the food should be of a mild and 
 easily digested character, and should be given very gradually and 
 in very small quantities. It may be necessary in some cases to 
 inject beef-tea into the rectum, instead of giving it by the mouth. 
 Stimulants and tonics should also be given at first with great 
 caution. 
 
 " The effects of continued insufficient alimentation have been 
 graphically described by De Meersman, as observed in Belgium 
 during the famine years of 1846-47 (quoted by Longet in his ' Traite 
 de Physiologie,' t. i.). The extreme emaciation of the body, pallid 
 face, and sunken cheeks ; the bright eye and dilated pupil ; haggard, 
 
AND MOST KECENT METHODS OF TKEATMENT. 851 
 
 bewildered look ; the weak, tremulous voice, the feeble memory, 
 infirm mind ; the slow, uncertain, tottering gait ; dry, yellow, parch- 
 ment-like, and fetid skin ; stinking breath ; shrunken belly ; slow, 
 sighing respiration ; small, frequent, and gaseous pulse, are all de- 
 scribed with sickening fidelity. But the largest field for the obser- 
 vation of the consequences of gradual continuous starvation was 
 afforded by the Andersonville military prison towards the end of 
 the late war, where thirty thousand men were exposed, within an 
 area of twenty-seven acres, without shelter, and with food insufficient 
 in quantity and quality, to the weather, with all the ills of over- 
 crowding, and were literally, slowly, and surely starved to death. 
 The report of Professor Joseph Jones, of Nashville, Tenn., made to 
 the Surgeon-General of the Confederate army, on the condition of 
 the prisoners of war, has been well called 'the most complete 
 scientific history of inanition ever written, deduced from data which 
 are, and probably always will be, unparalleled in magnitude.' This, 
 in a medical point of view, invaluable and instructive report is pub- 
 lished at length in the ' Medical Memoirs of the U. S. Sanitary 
 Commission.' " 
 
 STETHOSCOPE. 
 
 ALLISONS DIFFERESnTAIi STETHOSCOPE. 
 
 CAMMAxara stethoscope. 
 
S52 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 Stethoscopes are tubes of various shapes, employed in sounding 
 the chest. (See Auscultation.) The physician presses one end of 
 the stethoscope firmly over that part of the chest which he wishes 
 to examine, and applies his ear to the other end. Many physicians 
 use no stethoscope at all, but apply the ear directly against the 
 walls of the chest. 
 
 STOMACH, INFLAMMATION OF. 
 
 Acute inflammation of the stomach is a rare disease. "When 
 severe it is characterized by symptoms which distinguish it from 
 other disorders. After the usual premonitory symptoms of all 
 acute inflammatory affections, such as pain of the limbs and loins, 
 slight giddiness, lassitude, general uneasiness, and a fit of shivering 
 or chills alternating with flushes of heat, the patient is attacked 
 with burning pain at the pit of the stomach, nausea, retching, 
 great anxiety, and extreme restlessness. There is an urgent and 
 constant desire for cold drinks, which for the most part are no 
 sooner swallowed than they are thrown up again, mixed with por- 
 tions of mucus or bile. The region of the stomach generally feels 
 uuusually hot, and the slightest pressure upon it greatly augments 
 the pain. The pulse is quick and small, sometimes soft, but more 
 frequently hard ; the tongue, at the commencement of the disease, 
 may be white and furred, or it may present no particular ap- 
 pearance, but in general it soon becomes rough in the centre and 
 towards the root, while its edges and point are red. In bad cases 
 the pain extends upwards along the gullet and across the abdomen, 
 attended with a great sense of tightness, and shooting pains are 
 felt extending to the back between the shoulders; the breath- 
 ing is quick, hiccup is a more or less troublesome symptom, 
 and the countenance is expressive of anxiety and extreme suffer- 
 ing. If the disease continues to gain ground, the thirst becomes 
 unquenchable; and although the patient is well aware that 
 whatever he takes into the stomach will be almost immediately 
 vomited up with great pain, yet so urgent is the thirst, that he is 
 unable to resist the craving for cold drink with which he is unceas- 
 ingly tormented ; the breathing becomes quick and laborious ; the 
 patient lies on his back, and perhaps faints when any attempt is 
 made to raise him up in bed ; the pulse is now small, feeble, and 
 intermitting; cold sweats break out all over the body, the ex- 
 tremities are cold, the features are shrunk, and for some time be- 
 fore death there is great prostration of strength. 
 
 "When inflammation of the stomach gives rise to the alarming 
 
AND MOST RECENT METHODS OF TREATMENT. 853 
 
 train of symptoms above enumerated, we have always reason to 
 suspect that some acrid or corrosive substance has been swallowed, 
 such as arsenic, cantharides, or corrosive sublimate; because we 
 know that this violent form of the disorder seldom occurs indepen- 
 dently of the operation of irritating poisons. If, therefore, the 
 vomiting and other symptoms already noticed, which announce the 
 disease, can be traced to this cause, no time should be lost in re- 
 moving the poison from the stomach. This is most effectually 
 done with the stomach-pump ; by means of this instrument the 
 surgeon fills the stomach with warm water, then pumps it out, 
 introduces more water, removes it in the same way, and continues 
 in this manner to fill and empty the stomach until the fluid comes 
 away quite clear. But if medical aid cannot be obtained, an 
 emetic of from twenty-five to thirty grains of the sulphate of zinc 
 {white vitriol), or ten grains of the sulphate of copper (blue vit- 
 riol), dissolved in a wine-glassful of water, should be administered 
 as soon as possible. These emetics are to be preferred, because 
 they act more promptly than ipecacuan or tartar-emetic. After 
 the poison has been removed, whether by means of the stomach- 
 pump or an emetic, the ordinary remedies for inflammation of the 
 stomach are to be employed according to the urgency of the symp- 
 toms. 
 
 The occasional causes of inflammation of the stomach are ex- 
 cess in eating and drinking, bad liquors, indulging in the use of 
 highly seasoned food, blows inflicted over the stomach, drinking 
 cold water or using ices when the body is overheated from exercise, 
 exposure to cold and damp, or any of the ordinary occurrences 
 which produce inflammation in other organs or parts. In children 
 it occurs most frequently during the process of dentition, and it 
 often arises during the course of fevers and other inflammatory dis- 
 orders of warm climates. 
 
 All the treatment that is necessary is rest, abstinence from 
 food, ice melted in the mouth, and a very small dose of magnesia. 
 The patient generally recovers in three or four days. 
 
 CHRONIC INFLAMMATION OF STOMACH. 
 
 The symptoms of this affection closely resemble those of dys- 
 pepsia. (See Dyspepsia) 
 
 It is impossible in many cases to distinguish between the two 
 diseases : they are, indeed, essentially one. Dyspepsia is a symp- 
 tom of chronic inflammation of the stomach. All the symptoms of 
 dyspepsia may exist, however, without any inflammation of the 
 
854: DESCRIPTION 
 
 stomach. Dyspepsia is usually and chiefly a nervous affection, par 
 ticularly among the brain-working and luxurious classes. Among 
 barbarous people, and ignorant degraded classes, it is more fre- 
 quently a symptom of chronic inflammation of the stomach, caused by 
 gluttony or some error of diet. 
 
 ULCER OF THE STOMACH. 
 
 This is found most frequently in persons of delicate constitution. 
 The symptoms are the general symptoms of dyspepsia, together 
 with vomiting of Mood, localized pain in the stomach. 
 
 CANCEK OF THE STOMACH. 
 
 This is indicated by some of the same symptoms as ulcer of the 
 stomach. (See Cancer of the Stomach.) 
 
 The treatment of ulcer of the stomach and cancer of the stom- 
 ach is substantially the same. Both are severe and fatal diseases. 
 (See Cancer of the Stomach) 
 
 STOKE AND GEAYEL. 
 
 Stone and gravel are the terms applied to concretions formed in 
 the kidneys and bladder, by a morbid deposition from the urine. 
 This fluid, when in a healthy state, contains in solution at least 
 twelve different ingredients ; of these, some belong to the class of 
 acids, others are alkaline or earthy substances. JSTow, in certain 
 morbid conditions of the system, the urine undergoes changes with- 
 in the body ; and some of these ingredients accumulate until they 
 are no longer held in solution, but are deposited in a solid form in 
 the kidneys or bladder. The salts which form the deposition are 
 chiefly of two classes, depending on two distinct states of the con- 
 stitution, with which they are respectively associated. In the frst 
 class, which is by far the most common, the lithic or uric acid, and 
 lithates, more especially the lithate of ammonia, form the deposit 
 which is called, in popular language, red gravel, whether it appear 
 in the form of sand or distinct concretions. In the second class, the 
 deposition consists of the phosphatic salts ; namely, the ammonio- 
 magnesian and the phosphate of lime, generally the latter. This 
 species of the disorder is known under the denomination of white 
 gravel. 
 
 The passing of red sand or gravel is preceded, during a consider- 
 able length of time, by a copious deposition from the urine of a 
 tawny, reddish-brown, or brick-dust color, or of a more or less vivid 
 pink hue. The urine from which this sediment is precipitated, when 
 
AND MOST RECENT METHODS OF TREATMENT. 855 
 
 first voided, is generally clear, rather scanty, and high colored. It 
 is most frequently met with in children, and in persons beyond forty 
 years of age. 
 
 All authors who have written on this subject have noticed the 
 intimate connection which exists between gravel and gout; both 
 diseases, in numerous instances, appear to derive their origin from 
 the same source. The peculiar condition of constitution, whether 
 derived from hereditary origin, or acquired by luxurious living, whicli 
 is considered essential to the production of gout, is acknowledged on 
 all hands to be of the same nature as that which is associated with 
 gravel. Sudden and frequent alternations of temperature, long ex- 
 posure to cold and wet, and similar circumstances, are classed as 
 predisposing causes of considerable influence ; and this appears pro- 
 bable, from the fact that gravel complaints are more common in 
 temperate than in very cold or warm climates ; indeed, in the latter 
 these disorders are scarcely known, probably owing to the free per- 
 spiration which is kept up by the constant heat. It has been well 
 ascertained that the red gravel occurs most frequently in persons 
 whose skin is habitually harsh and dry ; in fact, a free and regular 
 action of the skin seems almost incompatible with the occurrence of 
 this form of the disorder. {For method of relieving an attack or fit 
 of gravel, see Kidney, Diseases of.) 
 
 The medical treatment consists in the use of alkaline remedies, 
 for the purpose of correcting the morbidly acid state of the stomach 
 and of the urine. The medicines of this class usually employed are 
 soda, potash, and magnesia ; these are administered either to prevent 
 the formation of red gravel, where the state of the urine above de- 
 scribed exists, or to palliate the symptoms where the disorder has 
 already commenced. From half a drachm to a drachm of bicar- 
 bonate (commonly called carbonate) of soda or of potash, dissolved in 
 from half a pint to a pint or more of barley-water, toast-water, rice- 
 water, linseed tea, decoction of quince-seed, or any other mild dilu- 
 ent, should be taken twice or thrice a day, according to circumstan- 
 ces, about two or three hours before or after eating, and continued 
 daily for a considerable length of time. These alkaline salts may, 
 in most cases, be taken for many months without deranging the di- 
 gestive organs, and with much benefit to the patient's general health. 
 If, however, the stomach become weakened from their long-contin- 
 ued use, it will then be advisable to take them along with an infu- 
 sion of camomile flowers, or dissolved in a decoction of gentian 
 or of calumbo. The manner of preparing and using these tonic 
 remedies has been already pointed out in other parts of this volume. 
 Magnesia, in doses of ten grains once or twice a day, has sometimes 
 
856 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 been found more serviceable than the carbonate of potash or of soda. 
 Equal parts of lime-water and rennet whey constitute one of the best 
 remedies that can be employed in this species of gravel. Every 
 alkaline medicine, when taken for a long time, is apt in many cases 
 to disagree with the stomach ; it is therefore, in general, advisable 
 to vary these remedies, rather than to persist long in the use of any 
 one of them in particular. In making out the two kinds of gravel 
 the microscope is of great service. (See Microscope.) 
 
 The second kind of gravelly disorders, in which the urine de- 
 posits the phosphatic salts in the form of white sediment or sand, 
 generally depends on some constitutional derangement of a serious 
 character, or on great irritation or organic disease of the urinary 
 organs. In the first, or lithic-acid gravel, the urine is generally 
 more or less scanty, high-colored, and deposits a red sediment ; 
 here, on the contrary, it is of a pale color, secreted abundantly, and 
 deposits, when cool, a copious white sediment, sometimes white 
 sand. This species of gravel is also frequently met with among the 
 ill-fed* and half-clothed children of sickly or dissipated parents in 
 the lower classes of society. The countenances of persons affected 
 with red gravel often appear florid, and the appetite is good ; but 
 in this form of the disorder the face is pale, and appears careworn ; 
 the patient is unfitted for any ordinary mental or bodily exertion ; 
 he becomes irritable, discontented, and gradually loses flesh ; he has 
 little or no appetite, and is troubled with flatulency, constipation, 
 and other symptoms of indigestion. In this state of things the 
 patient, if residing in a large town, should remove to a healthy part 
 of the country, and remain as much as he can in the open air ; he 
 may take daily a few glasses of wine, or some sound malt liquor ; 
 his diet should be nutritious, and composed of such articles as the 
 stomach will most easily digest. "Where the object is to invigorate 
 the system and improve the general health, it would be impossible 
 to lay down a general rule with regard to the kind of food which 
 ought to be taken ; this must depend on the peculiarities of consti- 
 tution and previous habits of each individual. As the celebrated 
 Yan Swieten justly remarks, " to assert a thing to be wholesome 
 without a knowledge of the condition of the person for whom it is 
 intended, is like a sailor pronouncing the wind to be fair without 
 knowing to what port the vessel is bound." 
 
 To quiet the irritability of the system which always accompa- 
 nies this form of the disorder, opium will be found an invaluable 
 remedy ; it may be given to the extent of two or three grains daily 
 until the irritation is in a great measure quieted. To correct the 
 predominance of alkali or alkaline earths in the urine, it is usual to 
 
AND MOST RECENT METHODS OF TREATMENT. 857 
 
 prescribe acids. Ten drops of diluted muriatic acid, or the same 
 quantity of elixir of vitriol or diluted nitric acid, may be given 
 three times a day in an infusion of gentian or calumbo. 
 
 STONE IN THE BLADDER 
 
 Arises, in the great majority of cases, from a portion of gravel having 
 passed from the kidney along the ureter to the bladder, and there 
 gradually increased in size by successive depositions upon its sur- 
 face ; sometimes it originates in the bladder, and occasionally the 
 nucleus of the stone consists of a clot of blood, or a foreign body 
 which has accidentally got into the bladder, such as the broken end 
 of a catheter, or a portion of a bougie. 
 
 The immediate relief which follows the escape of a small stone 
 from the kidney into the bladder often deceives the patient, and 
 leads him to believe that all danger is past. The means most likely 
 to secure the passage of the stone out of the body are not resorted 
 to, and this neglect is generally fraught with consequences of the 
 most distressing and ultimately dangerous nature. 
 
 Should timely measures not be adopted to remove the stone, a 
 train of painful symptoms are sooner or later manifested, and the 
 patient's life is rendered miserable. At first a dull uneasy sensa- 
 tion is occasionally felt about the neck of the bladder, at the lower 
 part of the belly, or in the groin, and the patient experiences an 
 unusually frequent desire to make water. The symptoms soon 
 undergo a change for the worse, the desire to make water becomes 
 more frequent and urgent, with an inclination to empty the bowels 
 at the same time. While the urine is flowing the stream is sud- 
 denly stopped, so that it is expelled, as it were, by fits, the expul- 
 sion of the last drops being attended with excruciating pain. The 
 urine is mixed with mucus, and is often tinged with blood, parti- 
 cularly after exercise ; pain is frequently felt at the point of the 
 penis, more especially after making water, walking, or taking any 
 ordinary bodily exercise. " This pain is one of the most marked 
 symptoms of the disease. A child who labors under stone tells 
 you of it, not in words, but in his actions. He is always pulling at 
 the end of the penis, and pinching it with his fingers, even so as to 
 cause the prepuce (foreskin) to become elongated. You often find 
 his fingers with the skin soft and sodden, as if they had been soaked 
 in water, from the urine which had been imbibed." 
 
 The suffering is greatly aggravated by the motion of a carriage 
 or riding on horseback. 
 
 A patient affected with stone in the bladder may do much to 
 palliate the painful symptoms to which it gives rise, by strict atten- 
 
858 
 
 tion to diet, and the judicious use of medicine. Whatever remedies 
 are employed, they should be directed to correct the particular 
 states of the constitution on which the formation of different kinds 
 of stone depend. If the lithic-acid condition of the urine predomi- 
 nate, which is generally the case, the alkaline remedies already 
 directed should be had recourse to, not with the expectation of dis- 
 solving the stone, bnt of restoring the urine to its healthy state, and 
 improving the general health. Great care should be taken in pro- 
 portioning the doses of these remedies to the particular circum- 
 stances of each case. 
 
 Surgery possesses two methods of extracting a stone lodged in 
 the bladder. The first is Lithotomy, an operation which consists 
 in making an incision into the bladder sufficiently large to allow 
 the surgeon to lay hold of the stone with forceps and extract it en- 
 tire. The second is Lithotrity, which consists in breaking the stone 
 within the bladder, by means of certain instruments constructed for 
 the purpose, so that the fragments may be discharged from the 
 bladder by the natural passage. 
 
 Patients should not be afraid to undergo either of these opera- 
 tions when recommended by a competent and honorable surgeon. 
 
 STKICTUKE OF THE UKETHKA. 
 
 When a part of the canal or urethra which conveys the urine 
 from the bladder out of the body is rendered narrower than it is in 
 a natural state, in consequence of morbid action or a change of 
 structure, the. disorder is called stricture. Writers on this subject 
 generally agree in describing strictures under three forms : the spas- 
 modic, the inflammatory, and the permanent. 
 
 Spasmodic stricture, not associated with inflammation, is a rare 
 disease. It comes on suddenly, and is not attended with pain until 
 the patient attempts to make water. Various causes are said to 
 give rise to this kind of stricture : it may proceed from exposure to 
 cold and damp, excesses in drinking wine, spirits, &c, retaining 
 the urine too long in the bladder, irritation of distant parts; or 
 "even an irritated state of mind, or a mind deeply engaged in 
 study, will occasionally influence the nervous system to such a de- 
 gree as to produce spasmodic stricture of the urethra." 
 
 Treatment. — Put the patient in a warm bath. In obstinate 
 cases administer sether to relax the parts, and introduce a bougie 
 or catheter. " You should introduce a bougie," says Sir A. Cooper, 
 " letting it steal gently along the urinary passage, and when it ar- 
 rives at the strict ured part there let it rest for a short time ; after 
 
AND MOST EECENT METHODS OF TREATMENT. 859 
 
 this you should gradually push it forward, using only a very slight 
 force, but continuing that force until you have succeeded in passing 
 the stricture. Let the bougie rest for a minute or two in the stric- 
 tured part, and then withdraw it ; the patient will be immediately 
 enabled freely to pass his urine. If you have not a bougie at hand 
 you may employ a catheter, and it will answer equally well ; you 
 must take care, however, to use it gently, as I have just described." 
 The chief point to be attended to in such cases is not to irritate the 
 parts by attempting to pass the stricture with a bougie, or to reach 
 the bladder with a catheter. If much resistance be offered to the 
 introduction of instruments, it will be better to have recourse to 
 other means rather than persist in overcoming the obstacle by using 
 force. The bowels should be well cleared out by means of copious 
 injections of warm water, and afterwards an injection consisting of 
 fifty or sixty drops of laudanum with a wine-glassful of warm water 
 should be administered, or from forty to fifty drops of this medicine 
 may be given by the mouth ; and the dose may be repeated after a 
 few hours, if the patient be not relieved. (See Urine, Retention 
 of.) 
 
 PERMANENT STRICTURE. 
 
 This is by far the most common form of stricture, and in the 
 great majority of cases proceeds from gleet or frequent attacks of 
 gonorrhoea, riding horseback, and so forth. Astringent injections 
 employed in the cure of gonorrhoea and gleet are sometimes the 
 causes of stricture. 
 
 The number of strictures varies in different cases. The usual 
 number is one, or at most two ; but cases have occurred where six, 
 or even more, existed at the same time. The form of stricture also 
 differs. In the callous or indurated stricture the whole circumfer- 
 ence of the passage, or only a part, may be affected. Some stric- 
 tures are confined to a small part of the circumference of the ure- 
 thra, or they may occupy from half an inch to an inch of the canal ; 
 in other instances, again, the stricture is formed by a small band 
 stretching across the urethra. 
 
 It frequently happens that persons, either from ignorance or in- 
 attention, are affected with stricture for a considerable length of 
 time without their knowledge; but as the disorder gains ground 
 the symptoms become sufficiently urgent to attract the patient's at- 
 tention, and convince him of the nature of his ailment. " At the 
 commencement of every permanent stricture you are made acquain- 
 ted with, the real nature of the complaint by the following symptoms. 
 The first is the retention of a few drops of urine in the urethra after 
 
860 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 the whole appears to have been discharged, so that when the penis 
 has been returned into the small-clothes the linen becomes slightly 
 wetted ; and if you press on the under side of the urethra a few 
 drops more will be voided, which had collected between the bladder 
 and that part of the urethra where the stricture is situated. The 
 next circumstance you notice is an irritable state of the bladder. 
 This is evinced by the person not being enabled to sleep so long as 
 usual without discharging his urine. A man in health will sleep for 
 seven, eight, or nine hours without being obliged to empty his blad- 
 der ; but when he has a stricture, he cannot continue for a longer 
 period than four or five hours, and frequently much less even than 
 this. The next circumstance observable is the division of the 
 stream ; the reason of which is, that the urethra is in an uneven 
 state from the irregular swelling that surrounds it, and consequently 
 the urine is thrown with an inequality of force against its different 
 sides ; sometimes the stream splits into two, becoming forked ; 
 sometimes it is spiral ; at other times it forms, as it were, a thin 
 sheath. Occasionally the stream rises perpendicularly, its long axis 
 being at right angles to the long axis of the penis; thus, then, the 
 retention of a few drops of urine after the whole appears to have 
 been discharged, a more frequent propensity to make water than 
 when in health, and the peculiar character of the stream, as just 
 described to you, will be conclusive evidence of the existence of 
 stricture." 
 
 Treatment. — Patients afflicted with permanent stricture should 
 place themselves under competent surgical care whenever possible. 
 
 Yarious plans have been proposed for the cure of permanent 
 stricture, but almost the only method of treatment now employed is 
 the gradual dilatation of the part by means of bougies. 
 
 The first thing to be done is to ascertain the situation of the 
 stricture, by passing a common-sized bougie into the urethra. The 
 introduction of this instrument requires considerable caution and 
 address ; it should be first warmed before the fire, or dipped in w r arm 
 water, then smeared with olive oil or lard ; if made of wax, it should 
 be slightly curved in the form of a catheter, and is then to be gently 
 passed along the canal until the stricture prevents it from proceeding 
 farther ; it is then to be withdrawn. On the following day, a small 
 conical or taper-shaped gum-elastic bougie is to be introduced ; it 
 should be of the same size as the stream of urine, and, being pre- 
 viously greased as above directed, is to be carefully passed along the 
 urethra. "When it reaches the stricture it should be allowed to rest 
 a little, and is then to be pushed gently forward ; if resistance be 
 still offered it must be again allowed to rest for a minute or two, so 
 
AND MOST KECENT METHODS OF TREATMENT. 861 
 
 as to avoid producing irritation or pain. If we succeed in introduc- 
 ing the instrument through the stricture, the cure is then in our 
 power ; but sometimes this cannot be effected without repeated trials 
 and a great deal of trouble. When the bougie is introduced, it be- 
 comes tightly grasped by the stricture, and the patient is to retain it 
 in that position until it passes through the stricture easily ; this 
 generally soon takes place — in many cases only a few minutes are re- 
 quired ; it is then to be gently withdrawn. On the next day, or not 
 until the expiration of two or three days, if irritation occur, the same 
 bougie is to be again introduced, and if it pass easily, one a little 
 larger is to be employed, and the same directions followed. In this 
 manner the treatment is to be conducted, substituting successively 
 larger bougies, always taking care to allow sufficient time to elapse 
 between each introduction, in order to avoid irritation of the ure- 
 thra ; should this arise, the employment of a larger instrument is to 
 be deferred until the symptoms of reaction pass off. By thus steadily 
 but cautiously persevering in the introduction of bougies, the stric- 
 ture will be at length overcome, and the largest bougie may be pass- 
 ed with facility. Five or six weeks, or perhaps a considerably 
 longer period, may be required to complete the cure ; but this mode 
 of treatment, though slow, is safe, and very successful. !No attempt 
 should ever be made to get rid of a stricture suddenly, because it 
 has been well ascertained that the dilatation is the more durable the 
 more slowly it has been effected. 
 
 After the stricture is relieved the patient should pass a bougie 
 or a catheter, once or twice a week, for a fortnight or three weeks, 
 and afterwards at longer intervals. Should the stream of urine at 
 any time diminish, he must again have recourse to the gradual pro- 
 cess of dilatation above described, until the cure be permanent. 
 
 In long-neglected strictures, it sometimes happens that even the 
 smallest instrument cannot be introduced into the bladder. In cases 
 of this description much benefit will be derived from very carefully 
 introducing a bougie every day, and gently pressing on the face of 
 the stricture. By patiently persevering in this mode of treatment, 
 a depression is made on the anterior part of the stricture, and ulti- 
 mately the bougie will penetrate the constricted part. The cure 
 may then be completed by gradually dilating the stricture, as 
 already directed. Sometimes five or six weeks are required in ob- 
 stinate cases before the instrument can be passed, but in general 
 the obstruction is soon overcome. 
 
862 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 STKYCKNTNE. 
 
 This is the alkaloid of nux vomica. It is a remedy that at the 
 present time is very much used. It is a medicine of great power, and 
 must be given in small doses. Its main action is that of a tonic to 
 the nervous system. It has a special influence on the spinal cord. 
 For nervous diseases it is probably more efficient than any other in- 
 ternal tonic that we have. It is given in paralysis, nervous ex- 
 haustion, constipation, epilepsy, chorea. In paralysis it is sometimes 
 administered by the hypodermic syringe. (See Hypodermic Injec- 
 tions.) The dose of strychnine is from one-thirtieth of a grain to one- 
 tenth of a grain. The effects should be watched. It can hardly be 
 called a domestic remedy. Those who have no medical adviser 
 would do better to take the tincture of nux vomica. (See JVux 
 Vomica.) 
 
 STY. 
 
 A sty is simply a small boil, projecting from the edge of the 
 eyelid. Matter forms slowly, but at last the tumor is observed to 
 point ; that is to say, a small white speck appears on its most promi- 
 nent part. After a longer or shorter period, sometimes two or three 
 days, it bursts, and a small quantity of matter is discharged along 
 with a little mass of disorganized cellular membrane commonly 
 called the core / the swelling then subsides, and the eyelid soon 
 resumes its natural appearance. But it often happens that only a 
 small quantity of curdy -looking matter is discharged, and the core 
 is retained within the tumor ; the opening heals, and the swelling 
 continues for a considerable length of time. In other cases, again, 
 the suppurative process advances slowly, and the sty remains hard 
 and painful, without showing the slightest disposition to point, or 
 to undergo any further change. 
 
 Treatment. — The treatment of styes is very simple. They usu- 
 ally get well of themselves, but their course may be hastened. 
 
 Apply warm poultices of bread and water, or of linseed meal, 
 enclosed in a small linen bag. A fresh poultice should be applied 
 at least three or four times in the course of twenty-four hours, and 
 each time the eye must be well fomented with warm milk and wa- 
 ter. These local applications are to be assiduously employed until 
 the suppurative process is completed, and the matter discharged. 
 
AND MOST RECENT METHODS OF TREATMENT. 863 
 
 SUBCAKBONATE OF AMMONIA. 
 
 The subcarbonate of ammonia, or hartshorn, is a powerful 
 stimulant and antispasmodic. It is sometimes employed as a sudor- 
 ilic, but is more frequently used as a stimulating application to the 
 nostrils in fainting (sal volatile). The dose of this salt is from five 
 to fifteen or even twenty grains. 
 
 The aromatic spirit of ammonia is a more agreeable stimulant 
 than spirit of hartshorn, and is employed in weakness of the stomach, 
 languor, fainting, flatulent colic, hysterics, and other nervous disor- 
 ders. The dose is from half a drachm to a drachm in a wine-glass- 
 ful of water, and repeated from time to time until relief is obtained. 
 
 Liquid hartshorn mixed with olive oil forms the volatile lini- 
 ment, a useful external application for sore throat. All the pre- 
 parations of ammonia should be kept in stoppered phials. 
 
 SULPHITE OF SODA. 
 
 This remedy is now used to prevent fermentation, and as an 
 antidote to the poisons in the blood in certain fevers. Good results 
 have been claimed for it in dyspepsia, in diseases of the shin, in 
 erysipelas, in scarlet fever, in typhoid fever, and in yellow fever, 
 in diarrhosa, in dysentery and cholera. It is a good disinfectant. 
 The dose is from ten to fifty grains three or four times a day, or 
 even more frequently. In the proportion of half an ounce to a pint 
 of water it may be applied externally. 
 
 SULPHUR 
 
 Sublimed sulphur, commonly called the flowers of sulphur, acts 
 as a mild laxative and promotes the insensible perspiration. It per- 
 vades the whole system, and transpires through the pores of the 
 skin, as appears from the smell which exhales from the bodies of 
 persons who are under its influence, and by staining silver in the 
 pocket of a blackish color. Equal parts of sulphur and magnesia 
 (fifteen grains or a scruple of each) taken every night at bedtime 
 affords great relief in piles. 
 
 This remedy, employed both internally and externally, has long 
 been celebrated for its power of curing the itch and other diseases 
 of the skin. (See Itch.) When taken alone for some time it produces 
 a slight degree of feverish excitement ; hence its use should be dis- 
 
864 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 continued occasionally, and a Seidlitz powder or some other saline 
 medicine administered. The dose, as a laxative, is one or two 
 drachms in milk, or mixed with molasses, jelly, or some kind of 
 conserve. 
 
 SULPHUKIC ACID. 
 
 This acid is generally administered in the form of elixir of vit- 
 riol, which is an excellent tonic in the dose of from ten to twenty 
 drops, twice or thrice a day, in a cupful of cold water. It is some- 
 times of very great service in indigestion, where bitter and aromatic 
 remedies have failed to produce any good effect ; and is employed 
 in spitting of blood, and to check excessive perspiration in consump- 
 tion. It may be advantageously combined with the decoction of 
 Peruvian bark, or of quassia. 
 
 SUJSTSTKOKE. 
 
 This is a sudden attack in hot weather, and after or during 
 exposure to the heat, of loss of consciousness, with convulsions or 
 stupor. The aifection oftentimes so closely resembles apoplexy that 
 it is difficult to distinguish it. It is sometimes called " heat apo- 
 plexy." It does not, however, have the paralysis of one side of the 
 body that accompanies apoplexy. 
 
 Patients are suddenly taken with pain in the head, sickness at 
 the stomach, vomiting, dizziness, blurred vision, general feeling of 
 weakness that goes on to unconsciousness. Before assistance ar- 
 rives the patient is generally in a condition of stupor. The pupils 
 are sometimes dilated and sometimes contracted. The pulse at 
 first is full, as in apoplexy; but afterwards becomes feeble. The 
 disease is fatal in half the cases. 
 
 TREATMENT OF SUNSTROKE. 
 
 For cases that are very much debilitated. — Remove or loosen 
 the dress of the patient, and do not attempt to take him home or to 
 any hospital, unless near by. Let the air about him be as cool as 
 possible. Give small doses of whiskey or brandy by the mouth, 
 and inject some into the bowels. Sponge the surface of the body 
 with spirit and water. Avoid purges and emetics. 
 
 For cases that closely resemble apoplexy. — Apply cold to the 
 head, ice, and wet cloths; raise the head; apply mustard plasters to 
 the calves of the legs ; give a drop of Croton oil on the tongue. 
 (For other treatment, see Apoplexy.) 
 
AND MOST RECENT METHODS OF TREATMENT. 865 
 
 The history of the early investigations of sunstroke are thus pre- 
 sented byAitken: 
 
 " One of the earliest accounts of sunstroke, in which its nature 
 was distinctly recognized, is that given by Mr. Russell, of the 73d 
 Regiment, while in medical charge of the 68th, in May, 1834. The 
 regiment had then recently arrived in Madras — a fine corps of men 
 in robust health. The funeral of a general officer being about to 
 take place, the men were marched out at an early hour in the after- 
 noon, buttoned up in red coats and military stocks, at a season, too, 
 when the hot land winds had just set in, rendering the atmosphere 
 dry and suffocating even under the shelter of a roof, and when the 
 sun's rays were excessively powerful. The funeral procession forth- 
 with advanced ; and after having proceeded two or three miles, 
 several men fell down senseless. As many as eight or nine were 
 brought into hospital that evening, and many more on the follow- 
 ing day. Three men died — one on the spot, and two within a few 
 hours. The symptoms observed (and they were alike in the three 
 cases) were, first, excessive thirst and a sense of faintness ; then dif- 
 ficulty of breathing, stertor, coma, lividity of the face ; and, in one 
 whom Dr. Russell examined, contraction of the pupil. The re- 
 mainder of the cases (in which the attack was slighter, and the 
 powers of reaction perhaps greater, or at all events sufficiently great) 
 rallied; and the attack in them ran on into either an ephemeral or 
 more continued form of fever. The symptoms of these cases did 
 not more nearly resemble each other than did the post-mortem 
 appearances. The brain was healthy in all ; no congestion or 
 accumulation of blood was observable. A very small quantity of 
 serum was effused under the base of one; but in all three the lungs 
 were congested, even to blackness, through their entire extent; and 
 so densely loaded were they, that complete obstruction must have 
 taken place. There was also an accumulation of blood in the right 
 side of the heart, and in the great vessels." — {Medical Gazette, 
 " Graves's Clinical Lectures.") Aitken. 
 
 SUPPOSITORIES. 
 
 Suppositories are medicinal substances introduced in a solid form 
 into the rectum, there to remain and dissolve gradually. In this 
 manner opium, the extracts of henbane, hemlock, &c, are employed 
 to relieve the pain and irritation arising from diseases of the lower 
 bowel, the womb, the bladder, the prostate gland, and adjacent 
 parts. Aloes and soap are sometimes introduced as a suppository. 
 to destroy the small thread-worms called ascrrides. 
 55 
 
866 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 SWEET SPIKIT OF NITRE. 
 
 Sweet spirit of nitre is obtained by distilling alcohol and 
 nitrous acid ; it is an excellent sudorific in the dose of a drachm 
 and a half or two drachms, given with a basin of warm gruel, or 
 some other warm drink, at bedtime. When taken in this manner 
 at the commencement of a common cold, it generally succeeds in 
 arresting the progress of the disorder. This medicine also acts as a 
 diuretic when given in smaller doses frequently repeated, mixed with 
 cold water ; but is more frequently used to correct or promote the 
 action of more powerful diuretics in dropsy. 
 
 SYPHILIS, OR YENEREAL DISEASE. 
 
 There are few complaints either more prevalent or more interest- 
 ing to the public than the venereal disease. The business of the 
 medical man is to relieve the bodily sufferings of his fellow-men, 
 without inquiring how those sufferings may have been produced. 
 His duty is simply to prevent or cure disease^ by medical counsel 
 or the administration of remedies ; and he may, with a safe con- 
 science, reject all other considerations, provided he can attain the 
 great object of his labors — the restoration of health. 
 
 The venereal disease, or syphilis, arises from the introduction of 
 a peculiar animal poison into the system. The manner in which the 
 poison or virus is generally introduced is well known. 
 
 CHANCRE. 
 
 As we have already observed, syphilis arises from the effects of 
 an animal poison on the body. The poisonous matter is placed in 
 contact with some part of the genital apparatus and there excites a 
 sore, which secretes poisonous matter similar to that which first gave 
 rise to the sore ; after a certain lapse of time the poisoned matter is 
 taken up, mixes with the blood, and produces a regular succession 
 of disorders or secondary affections in the skin, throat, or other 
 parts of the body. The sore produced by the application of the 
 syphilitic virus to the skin is called a chancre, but it does not follow 
 that every sore which may appear on the genital parts after impure 
 connection is a syphilitic sore or chancre. Hence, a very important 
 question presents itself — viz., by what means can we distinguish 
 simple sores from the true venereal ulcer or chancre. This is a 
 question more easily asked than answered. The medical man can 
 always ascertain the virulent nature of a sore by inoculation ; but 
 
AND MOST RECENT METHODS OF TREATMENT. 867 
 
 this is an experiment which others should never venture to make. 
 It will therefore be more prudent for such persons, as a general rule, 
 to regard all sores on the genital organs as syphilitic, provided they 
 treat them in the manner presently to be described. 
 
 The progress of the sore will assist better in deciding upon its 
 nature than any external characters. The true venereal ulcer com- 
 monly pursues a certain course for some time, and is not much in- 
 fluenced by ordinary applications ; hence, says Mr. Colles, " if an 
 ulcer be not interfered with by any stimulant or caustic application, 
 and after eight or ten days it shows no disposition to heal, and if at 
 the same time there be an absence of any cause (such as defect in 
 the general health) to account for this obstinate condition of the 
 local disease, we may then pronounce the ulcer to be syphilitic." 
 
 It is unnecessary to confuse the reader with minute descriptions 
 of its varieties ; for all practical purposes it will be sufficient to, dis- 
 tinguish the five following forms — viz., 1, the common chancre ; 2, 
 the indurated chancre ; 3, the irritable ; 4, the inflammatory ; and, 
 5, the sloughing chancre. 
 
 Indurated Chancre. — This is the sore which has often been called 
 the Hunterian chancre, because it was so perfectly described by the 
 great John Hunter. It is supposed to constitute the most regular 
 and perfect type of the venereal ulcer, but it is now met with much 
 less frequently than in former years. In men, chancres generally 
 make their appearance on the glans penis, frsenum, or at the angle 
 between the skin and glans, because these are the parts on which the 
 virus is most easily retained ; in some rare cases the virus gets into 
 the urinary canal or urethra, and gives rise to a hidden chancre in 
 that part ; and this explains the fact why many persons are affected 
 with constitutional symptoms who have never had any appearance 
 of sore or ulcer on the external parts. In females, the sores may 
 occur on any part of the genital organs, in the vagina, or even as 
 high up as the neck of the womb. 
 
 The interval between the application of the virus and its effects 
 on the parts is very uncertain ; in some few instances, chancres ap- 
 pear within twenty-four hours after the application of the matter. 
 Generally the interval varies from three days to a week ; but cases 
 are on record where the disease did not appear until after several 
 weeks. The first appearance of a chancre is generally indicated by 
 an itching in the part where the sore is about to form ; a small pim- 
 ple then arises ; this soon contains matter, and turns into a regular 
 ulcer ; the base of this ulcer feels hard when it is pressed between the 
 fore-finger and thumb ; the edges are regular, and the thickening 
 of the tissues which surround it does not spread far into the neigh- 
 
DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 boring parts, but is very circumscribed ; the edges of the ulcer are 
 surrounded by a narrow line of inflammation (areola), somewhat 
 similar to that which encircles the small-pox pustule. The bottom 
 of the sore is usually covered with a grayish yellow-colored matter, 
 which adheres tenaciously to the abraded surface, and differs evi- 
 dently from common pus ; after some time the secretion becomes 
 altered, and the edges of the sore lose their sharp aspect and become 
 rounded off, the inflammatory areola disappears, small granulations 
 form on the surface of the sore, and it gradually heals, leaving a 
 hardened red mark or cicatrix, which is very apt to break again. 
 
 Simple Chancre. — This is the most common form in which the 
 disease appears at the present day. In general features it resembles 
 the Hunterian chancre just described ; but the base of the sore is 
 free from hardness, and it is not attended with signs of irritation or 
 inflammation. 
 
 In irritable chancre the surface of the sore is red, and bleeds on the 
 least touch ; it is painful, often of irregular appearance, and has a 
 tendency to spread whenever it is excited by irritating applications. 
 
 The inflamed chancre is nothing more than a simple venereal 
 sore when it is attacked by inflammation ; here the sore, generally 
 in consequence of excesses on the part of the patient, becomes pain- 
 ful, red, and swollen ; the regular appearance of the sore is lost, the 
 edges are removed by grayish or black sloughs, and the secretions 
 from the part are of a very acrid and irritating character. 
 
 Sloughing chancre generally occurs in persons of broken-down 
 constitution, or who have injured their health by debauchery and 
 excesses of various kinds; it is also apt to occur in those who give 
 themselves up to drinking, &c, while under the use of mercury. 
 In cases of this kind the original sore and the surrounding parts are 
 rapidly destroyed by foul sloughs or gangrene; and unless the utmost 
 attention be paid, the unfortunate sufferer may lose the greater part 
 of the sexual organ. 
 
 Syphilis is a disease that no one should attempt to treat for him- 
 self, unless he is beyond the call of a physician. Unfortunately, 
 many of those who are attacked by this dreadful malady are so situ- 
 ated that they are obliged to doctor themselves. For the benefit of 
 such, I give an outline of the course of treatment. It is impossible 
 for me to give the treatment in complete detail that will apply to 
 every individual case. The truth is, that every case must be studied 
 by itself. By carelessly treating one's self with this disease, most se- 
 rious results frequently happen. (For further remarks on this sub- 
 ject see Gonorrhoea.) 
 
 Treatment. — The treatment of chancre is local and constitution- 
 
AND MOST EECENT METHODS OF TREATMENT. 869 
 
 al. We shall first speak of the local means, and shall point out a 
 few remedies on which the greatest reliance may be placed. The 
 virus first excites a local sore, but four or five days may pass over 
 before the virus is taken up by the absorbing vessels, and passes 
 into the blood, to produce what are called constitutional symptoms. 
 
 This fact leads us to a first rule in the treatment of chancre. As 
 soon as any sore or pimple appears on the sexual organs after im- 
 pure coitus, it should be immediately cauterized, by passing over it 
 lightly a stick of lunar caustic / this may be done twice in succes- 
 sion, but care should be taken not to press the caustic firmly on the 
 sore, or carry it beyond the edges ; our object is merely to destroy 
 the surface which secretes the virus ; a piece of fine dry lint should 
 then be placed over the sore, and supported by any convenient band- 
 age. When the eschar (scab, caused by the caustic) falls off, the 
 caustic may be applied a second time in the same way, as a precau- 
 tion. Even when the sore has existed for five or six days before it 
 has been noticed, this mode of treatment may be employed. I 
 should here observe that it is only applicable to simple and indu- 
 rated chancre. 
 
 When the eschar has fallen off the sore should be dressed with 
 some mild astringent or gently-stimulating application. The zinc 
 ointment, weakened by the addition of one-third part of spermaceti 
 ointment, is a very useful one ; some practitioners recommend the 
 Hack wash ; if there be much pain and soreness in the ulcer the 
 following will be beneficial : 
 
 Prepared lard, eight ounces, 
 Wine of opium, half an ounce. 
 
 A weak solution of alum, applied with lint, also forms an excel- 
 lent dressing. During the use of these means the patient should 
 live as quietly as circumstances will permit him, and avoid all ex- 
 cesses in food, drink, exercise, &c. The dressings should be changed 
 at least three times every day. 
 
 Under this treatment common chancre will usually heal in a short 
 time. The other forms of chancre require a somewhat different treat- 
 ment, according to their nature. If the sore be of an inflammatory 
 character, we must not think of applying caustic or any exciting 
 remedies ; the organ or ulcered part should be wrapped up in lint, 
 moistened with tepid water or Goulard water, and covered with a 
 piece of oiled silk ; the patient should keep as much at rest as pos- 
 sible, live low, and take an opening draught occasionally. For 
 irritable chancre the best local dressing is the opiate cerate men- 
 tioned above, or a strong aqueous solution of opium. 
 
870 DESCRIPTION OF THE PRINCIPAL 
 
 We have now to speak of the constitutional treatment of chancre. 
 When the means already mentioned have been applied early and 
 assiduously, the patient has a great chance of escaping what is 
 called secondary syphilis; and, as a general rule, I would not advise 
 the use of mercury for any primary venereal sore except the indu- 
 rated one. Experience shows that this form of sore is very often 
 followed by secondary or constitutional symptoms, and that the cure 
 of the sore itself is hastened by the use of mercury. It is impos- 
 sible to lay down rules for the employment of this powerful remedy 
 which shall suit every individual case. Generally speaking, the 
 safest preparations that can be employed are iodide of potassium 
 in doses of five grains three times a day, and bichloride of mercury 
 in doses of one-twelfth of a grain. Should the mercury, as it some- 
 times does, occasion much griping or purging, three grains of the 
 extract of henbane or one-fourth of a grain of opium may be added 
 to the evening dose ; it will not be advisable to push the mercury 
 beyond touching the gums. The precautions to be observed during 
 a course of mercury will be noticed when I treat of constitutional 
 syphilis. 
 
 SECONDARY SYMPTOMS, OR CONSTITUTIONAL SYPHILIS. 
 
 Bubo. — The virus which is secreted by a syphilitic sore may be 
 taken up by the absorbent vessels of the part, and conveyed by them 
 to one or more of the lymphatic glands situated in the groin, where 
 it excites inflammation ; the gland thus inflamed and swollen is 
 called a bubo. This swelling generally commences on the second or 
 third week after the appearance of the chancre ; it may be ushered 
 in by shivering and symptoms of fever ; but generally speaking, the 
 patient's attention is first directed to it by some pain, stiffness, or 
 uneasiness about the groin, and on examination he finds a small 
 knot or tumor ; this gradually increases in size and then as gradu- 
 ally disappears, or it may suppurate and break, continuing to dis- 
 charge matter for weeks or months ; in some cases, however, the 
 bubo will remain obstinately stationary for a great length of time. 
 
 When a bubo first appears we should endeavor to keep it from 
 suppurating by applying the tincture of iodine, and by compressing 
 it with a tight bandage. 
 
 If the inflammation is very active it may be necessary to apply 
 leeches. 
 
 If suppuration approaches in spite of all that we can do, we 
 should apply poultices to favor the rapid formation of the pus. 
 
 Secondary symptoms are those which make their appearance 
 after the venereal virus has been carried into the blood from a chan- 
 
AND MOST RECENT METHODS OF TREATMENT. 871 
 
 ere, or syphilitic bubo ; they very seldom come on before the second 
 week, generally towards the fifth, sixth, or eighth week, but occa- 
 sionally later. It is not easy to say what length of time may elapse 
 between the occurrence of chancre and the subsequent breaking-out 
 of secondary symptoms ; still, there is much reason to believe that 
 the stories of confirmed syphilis having appeared several years after 
 infection are fabulous. 
 
 SOKE THROAT. 
 
 This form of secondary syphilis occurs very frequently, and is 
 often mistaken for common sore throat; on looking into the back of 
 the throat we see a dusky redness, and here and there circular or 
 semicircular patches, covered with a whitish and very tenacious 
 secretion ; these patches often occupy the surface of each tonsil ; 
 they may remain indolent for a length of time, but sooner or later 
 they ulcerate, and form deep irregular sores ; in ordinary cases the 
 pain, inflammation, and swelling are much less than what we find 
 in common sore throat. • 
 
 The local treatment consists in using gargles, or in touching the 
 sores with some stimulating application. As a gargle, the following 
 will be found useful : 
 
 Diluted muriatic acid, one drachm, 
 Decoction of cinchona bark, four ounces. 
 
 To stimulate the ulcers, they may be touched occasionally with 
 a strong solution of lunar caustic (fifteen or twenty grains to the 
 ounce of water). 
 
 CONSTITUTIONAL TREATMENT OF SECONDARY SYMPTOMS. 
 
 When secondary symptoms, such as coppery spots on the skin, 
 sore throat, &c, make their appearance after chancre, mercury 
 must be at once employed, with the exception of the cases present- 
 ly to be mentioned. 
 
 Mercury may be administered for the cure of syphilis in either 
 of two ways — viz., as an ointment by friction, or internally. The 
 choice of the form in which this remedy should be used must depend 
 on several circumstances ; its internal administration is usually the 
 more convenient, but some patients cannot bear mercury when 
 taken into the stomach ; in such cases, therefore, we must have 
 recourse to frictions. 
 
 The method of employing mercurial unction is very simple; from 
 half a drachm to a drachm of blue ointment (mild mercurial oint- 
 ment) should be rubbed in along the inner side of the thigh or leg 
 before a -fire every alternate night. The frictions should be alter- 
 nately on the lower extremities and in the direction of the hair, in 
 
872 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 order to avoid, as much as possible, irritation of the skin. In some 
 cases where concealment is necessary, instead of friction on the 
 legs, a drachm of the ointment may be placed in the armpit on 
 going to bed. 
 
 The best preparation of mercury for internal use is the hive pill/ 
 of this, five grains in the form of pill may be taken night and 
 morning. Should it cause pain in the bowels or purging, a small 
 quantity of opium (one-sixth of a grain) may be added to each pill ; 
 but if the purging be severe, and continue for more than two or 
 three days, the use of mercury must be suspended. 
 
 I have already said that mercury is a remedy unsuited for cer- 
 tain states of the constitution ; when, therefore, the general health 
 of the patient will not admit of his undergoing a mercurial course, 
 we must employ a remedy which' is scarcely less efficacious in the 
 treatment of secondary syphilis. This remedy is the iodide of 
 potash; four grains may be added to a quart of the compound 
 decoction of sarsaparilla, and the whole taken at intervals during 
 the day. The iodide must be gradually increased until the patient 
 takes fifteen or twenty grains in the above quantity of vehicle during 
 the day. When it is not convenient to obtain the compound decoc- 
 tion of sarsaparilla, the simple decoction, or a decoction of guaiacum, 
 with a few grains of nitre, will answer. In cases of foul, sloughing 
 ulcers which occur in debilitated subjects, nutritious diet, with opiates 
 at night and the iodide of iron, will afford the best chance of cure. 
 The iodide of iron may be administered in the form of syrup or of 
 pill ; the quantity to commence with is two grains, which may be 
 gradually increased to ten daily. 
 
 
 SYKDTOES. 
 
 6 h 
 
 5 l m 
 
 7 / «- 
 
AND MOST RECENT METHODS OF TREATMENT 
 
 873 
 
 A large variety of syringes are now used by physicians. Besides 
 the ordinary rubber and other syringes for injecting into the bowels, 
 we have the posterior nasal syringe for injecting behind the soft 
 palate in the nares. This is much used in the treatment of catarrh 
 of the nose. (See Catarrh.) We also have syringes for the ear, the 
 larynx, the urethra, the vagina, and the womb. Some of these are 
 represented in the accompanying cuts. 
 
 Every family should be provided with some convenient syringe 
 for the bowels. (See Constipation , Treatment of.) , 
 
 
 LARYNGEAL SYRINGE. 
 
 POSTERIOR NASAL SYRINGE. 
 
 SYEUP OF HYPOPHOSPHITES OF LIME AND SODA. 
 
 This remedy has been proposed for consumption. The state- 
 ment has been made that the tonic effects of this preparation are 
 very decided ; but it is yet on trial. 
 
 TAPTAK-EMETIC. 
 
 Tartar-emetic, or the tartrate of antimony. Of all the prepara- 
 tions of antimony, this is the most to be depended on, and when 
 
874 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 given in appropriate doses is capable of fulfilling every purpose for 
 which antimonial remedies are employed. The action of this salt 
 varies according to the dose, and the state of the system at the time 
 of its administration. In doses of three or four grains it acts power- 
 fully as an emetic, and the safest plan of exhibiting it with this 
 intention is by dissolving three or four grains in half a teacupful 
 of water, and giving a tablespoonful of the solution every ten min- 
 utes till free vomiting takes place. Tartar-emetic is not so much 
 used as formerly. 
 
 Tartar emetic, when applied externally in the form of ointment, 
 produces an eruption on the skin resembling that of cow-pox, and 
 is on this account frequently employed as a means of counter-irri- 
 tation. A hot solution of tartar-emetic, rubbed in by means of a 
 piece of flannel, produces pustules of a smaller size, which heal .up 
 without leaving any marks on the skin. This last method of 
 counter-irritation is, therefore, preferable for females. 
 
 TAK-WATER. 
 
 This is prepared by " stirring a pint of tar with half a gallon of 
 water for fifteen minutes, then allowing the tar to subside, and 
 straining the liquid." 
 
 Tar-water is an excellent domestic remedy for the purposes of 
 inhalation. (See Inhalations.) It is entirely safe, and may be 
 used freely. Its effects on the mucous membrane of the air-passages 
 are certainly agreeable. A mixture of equal parts of tar-water and 
 paregoric has a soothing effect when inhaled. 
 
 TEETH, DISEASES OF, AND MANAGEMENT OF. 
 
 The art of dentistry of modern times has revolutionized the 
 management of the teeth and the treatment of their diseases. 
 
 In spite of all our care the teeth will decay, although this decay 
 may be retarded, and within certain limits prevented, by diligently 
 brushing and cleansing the teeth. But we must not be satisfied 
 with merely cleansing our teeth. If we have any pride whatever, 
 or any desire for our future comfort, we should from time to time 
 have our teeth examined by a good dentist, follow his advice, and 
 submit to his treatment. It may be necessary to have all the teeth 
 cleaned. There may be cavities that need filling with gold or 
 amalgam. There may be some which have been neglected too 
 long and must be extracted. Decayed teeth are frequently the 
 cause of bad breath. (See Bad Breath.) 
 

 AND MOST RECENT METHODS OF TREATMENT. 875 
 
 No one should now be afraid to visit the dentist on account of fear 
 of pain. By the aid of nitrous oxide ("laughing-gas"), aether, and 
 chloroform it is now possible to extract teeth without any pain what- 
 ever. The laughing-gas can certainly be taken with very little risk 
 indeed. I have never yet seen any bad effects from it, though I 
 have seen it given to quite young children, and adults in compar- 
 atively delicate health. 
 
 Parents owe it to their children to watch their teeth, to see that 
 they regularly brush them every day, or better still, after each meal ; 
 and that they are early submitted to the examination of a dentist. 
 
 Nearly all cases of toothache are preventable by carrying out 
 the principles I have indicated. (See Toothache.) 
 
 The following hints on the care of the teeth I extract from 
 Shaw's treatise on this subject : 
 
 "tartar on teeth. 
 
 " This is a deposit almost wholly composed of lime and animal 
 matter, in various proportions, frequently found upon the teeth. 
 Its source and mode of deposit are uncertain. Dr. Harris gives an 
 excellent summary of what is known on this subject, and declares 
 that ' the conclusion appears to us irresistible, that this earthy mat- 
 ter is chiefly a salivary deposit, and takes place in the following 
 manner : It is precipitated from the saliva as this fluid enters the 
 mouth upon the surface of the teeth, opposite the openings in the 
 ducts, from which it is poured. To this its particles become agglu- 
 tinated by the mucus always found in greater or less quantity upon 
 them. Particle after particle is» deposited, until it sometimes accu- 
 mulates in such quantities that nearly all the teeth are almost en- 
 tirely encrusted with it.' When first deposited, tartar is soft and 
 creamy in its appearance ; but if allowed to remain, it loses a por- 
 tion of its animal matter and water, and, as the lime predominates 
 in its composition, becomes harder, and clings with great tenacity 
 to the teeth. 
 
 " The adhesion of the tartar to the teeth does not directly induce 
 decay ; but indirectly, through the irritation of the gums which it 
 occasions, it greatly promotes this malady. The deposit of tartar 
 usually commences on the teeth at the edges of the gums. While 
 soft it does not much interfere with these structures, but as it gets 
 harder the gums are irritated and become inflamed. 
 
 "brushing teeth. 
 
 " It is a great mistake to use a hard brush, for if the gums be 
 tender, either the brush will not be allowed to touch them, as is 
 
876 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 usually the case, and hence the teeth will not be cleansed at the 
 edges of the gums (the very places where cleansing is most impor- 
 tant) ; or else the gums will be unnecessarily lacerated and inflamed. 
 Besides, quite contrary to the popular belief, a soft brush in any 
 case cleans better than a hard one. In using the brush, it should 
 be applied to the lingual as well as to the labial surface of the teeth, 
 and it should also be carried over them lengthwise as well as cross- 
 wise. 
 
 {For receipts for tooth-powders see Prescriptions.) 
 " Dead teeth and roots are frequently kept in the mouth under 
 the impression that they prevent the eheek falling. When the 
 front teeth are lost the lip falls, but it would be impossible to detect 
 from the appearance of the face that a posterior tooth had been 
 removed. This objection to the removal of a tooth or roots is 
 therefore less puerile than mistaken; it may serve for an excuse, 
 but it never can constitute an intelligent reason. And for a patient 
 to endure the pain and baneful contingencies of diseased teeth on 
 this account, is folly in the extreme. 
 
 " Even if the loss of a diseased tooth were slightly apparent, the 
 author thinks that its deleterious effects on the health would, in 
 many cases, give the face a more sunken appearance than would 
 result from its loss. When several of the posterior teeth have been 
 lost there may possibly be some appearance of it in the face ; but 
 this is nothing in comparison to the evils resulting from the pres- 
 ence of so many decaying and dead teeth in the mouth." 
 
 TEETHOTG. 
 
 When the first teeth are about to pierce the gums a certain train 
 of symptoms usually occurs; these may be briefly noticed in order 
 that they may not be mistaken for disordered actions ; the edges of 
 the gum where the tooth is about to come through presents a slight 
 ridge or eminence ; the infant becomes a little uneasy at night, cries 
 frequently, and carries its fingers to the mouth ; the point of the gum 
 just above the tooth now becomes red and sore ; it softens, then is 
 covered with a white point, and at length the crown of the tooth 
 makes its appearance. 
 
 While the symptoms which accompany dentition are of the local 
 and mild character just described, the process may be regarded as 
 natural. In many cases, however, the symptoms accompanying the 
 eruption of the milk teeth are much more severe ; the child is more 
 or less feverish ; the digestive organs are deranged, and vomiting or 
 diarrhoea supervene ; finally the local irritation in the mouth may 
 
 
AND MOST BECENT METHODS OF TREATMENT. 877 
 
 extend to the nervous system, and excite either general convulsions 
 or an almost endless variety of nervous disorders. 
 
 I shall examine each of these affections successively. 
 
 One of the most common effects of difficult teething is sympathe- 
 tic fever ; the febrile symptoms occur with various degrees of inten- 
 sity, in some cases being very slight, in others extremely severe. 
 Slight feverish action need excite little apprehension ; but when the 
 skin is very hot, when the child becomes exceedingly restless and 
 refuses to take the breast, we must not neglect the sympathetic dis- 
 turbance of the vascular system, lest dangerous consequences follow. 
 As a general rule, it may be stated that, whenever any serious ac- 
 cidents accompany the eruption of the teeth, we should have recourse 
 to the simple but efficacious operation of lancing the gums ; this 
 may be done with a gum-lancet or even a common pen-knife, the 
 edge of the instrument being placed over the point where the tooth 
 is about to come through ; a cut ma} T be made until the blade is felt 
 to grate against the edge of the tooth. The operation may be re- 
 peated three, four, or even six times, on every alternate day, should 
 circumstances require. To calm the general disturbance, tepid baths 
 will be found useful, and the bowels may be opened with manna, 
 the syrup of senna, or a few grains of calomel. No one who is not 
 a physician should on any account administer opium by itself to 
 infants of tender age. 
 
 The febrile disturbance now alluded to is often accompanied by 
 diarrhoea, or looseness of the bowels ; this may be considered as the 
 most frequent accident of teething. "When the diarrhoea does not 
 last beyond four or five days, it is attended with no danger ; but in 
 man}' cases the looseness continues beyond this period, and is in- 
 creased at the appearance of each new tooth; the child occasionally 
 vomits up its food ; the face assumes an unhealthy, dull, and leaden 
 look ; the flesh wastes away ; and the little patient may be suddenly 
 cut off by convulsions, or perish in a state of great exhaustion and 
 debility. 
 
 Far from considering, then, the diarrhoea which accompanies 
 teething as an useful flax that should not be interfered with, we are of 
 opinion that it should be restrained whenever the looseness continues 
 beyond a few days, or seems to affect, even in a slight degree, the gen- 
 eral health of the infant. Lancing the gums must be had recourse to 
 here, as in the former case ; the state of the skin, which in old cases of 
 this kind is generally dry and hard, must be improved by the use of 
 the tepid bath twice a week. Should the looseness be attended with 
 any signs of inflammation about the abdomen, then we must endeavor 
 to remove this state, without reducing too much the strength of our 
 
878 
 
 little patient ; warm fomentations may be applied to the belly ; small 
 doses of ipecacuan (two grains every three or four hours) may be given, 
 unless vomiting accompany the diarrhoea. The bromide of potas- 
 sium, or 'pepsin, or the subnitrate of bismuth may be given in the 
 proper doses, according to the age of the child. 
 
 Vomiting generally arises from sympathetic irritation of the 
 stomach ; it can only be relieved by removing the irritation of the 
 gums on which it depends ; this may be done by the means already 
 pointed out ; and the same laxative medicines should be adminis- 
 tered (unless diarrhoea exists), and the quantity of food given in the 
 twenty-four hours must be diminished. Oxalate of cerium may 
 be given for the vomiting — a very little dry on the tongue. 
 
 But the most dangerous affection to which children are subject 
 during the period of teething is convulsions. The severity of the 
 symptoms connected with the nervous system is extremely various ; 
 in some cases we have nothing but an undue degree of sleepiness ; 
 in others the effects on the general condition of the nervous system 
 are shown by restlessness, want of sleep, starting in the sleep, flush- 
 ing of the face, partial paralysis, squinting, irregular movements of 
 the muscles ; in a word, by an almost endless variety of nervous 
 disorders. Thus, irregular motions similar to St. Titus's dance are 
 often connected with difficult teething. (See Convulsions.) 
 
 LOCKED JAW, OE TETANUS. 
 
 Tetanus is characterized by violent and painful contractions of 
 the voluntary muscles of the whole or some part of the body, 
 accompanied with tension and permanent rigidity of the muscles 
 affected ; the mental faculties and power of sensation remaining 
 unimpaired. 
 
 The approach of this painful and dangerous disease is seldom 
 announced by any premonitory signs. In general the earliest 
 symptom is a feeling of stiffness about the neck and at the back of 
 the head, which in most cases is first observed on awaking in the 
 morning, or after sleeping daring the day; this increases and ex- 
 tends to the jaws, while the throat becomes dry and slightly sore. 
 These symptoms, however, so frequently occur from exposure to cur- 
 rents of air or other circumstances, and wear off without putting 
 the patient to much inconvenience, that at the commencement of 
 this disorder they are generally overlooked. But a train of symp- 
 toms soon follows which distinguish this from all other diseases. 
 The muscles of the neck and jaws become rigid, painful, and are 
 occasionally seized with spasms ; the patient then finds considera- 
 
 
AND MOST RECENT METHODS OF TREATMENT. 879 
 
 ble difficulty in opening his mouth ; the power of swallowing is 
 impaired ; and before long a sudden spasm brings the teeth firmly 
 in contact, so that the mouth cannot be opened by the most pow- 
 erful efforts. If the spasms and rigidity do not extend to other 
 muscles the disease is called trismus or locked jaw. which, though 
 a less painful form than that in which the muscles of the body and 
 limbs are affected, can scarcely be considered as less dangerous. 
 The next circumstance which generally takes place is great diffi- 
 culty of breathing, occurring in paroxysms, and accompanied with 
 violent pain about the midriff or diaphragm ; this is occasioned by 
 the spasmodic action and rigidity having extended to the muscles 
 of the chest; but although the violent and painful contractions 
 about the chest, and consequent difficulty of breathing, are much 
 more severe at one time than at another, they never entirely cease, 
 and constitute the chief source of the patient's suffering throughout 
 the progress of the disease. The muscles of the belly are drawn in 
 towards the spine, and in some cases become as hard as a board. 
 When the disease is at its height the muscles of the limbs are also 
 rendered stiff, and partake of the general spasm, which is some- 
 times so violent that the body is bent in the form of an arch, its 
 whole weight bearing upon the crown of the head and the hips, or 
 sometimes on the heels; in other instances, again, the body is bent 
 so as to rest upon the forehead and toes ; but this is a rare occur- 
 rence, and the lateral incurvation is still more rare. We have had 
 several patients with chronic tetanus under our charge, in whom 
 the trunk and limbs were perfectly rigid. In such cases the indi- 
 vidual is completely helpless, and lies on his back. 
 
 The extraordinary postures into which the body is thrown dur- 
 ing the paroxysms of spasms, the strangely and frightfully distorted 
 appearance of the features, caused by the spasmodic contraction of 
 the muscles of the face, and sometimes the expression of laughter 
 or grinning which the countenance retains during the most intense 
 pain, unite in rendering the patient a remarkable but truly painful 
 object of observation. The eyes appear watery, and remain fixed, 
 staring, and motionless in their orbits ; sometimes the tears are seen 
 to trickle down the cheeks ; and in the more severe cases, the teeth 
 are occasionally broken by the violent spasmodic action of the mus- 
 cles of the jaws. 
 
 It rarely happens that any kind of treatment is resorted to at 
 the onset of tetanus, because, as we have already mentioned, its 
 earliest indications are common to other disorders of comparatively 
 little importance, and are therefore almost invariably overlooked. 
 The first symptoms which alarm the patient are slight stiffness 
 
880 
 
 about the jaws, and some degree of difficulty in swallowing, espe- 
 cially of fluids. These uneasy sensations are usually accompanied 
 or soon followed by a painful feeling of constriction under the 
 breast-bone. More importance is to be attached to these symptoms, 
 if the patient has previously pricked, bruised, or in any way injured 
 one of his thumbs or fingers, or if he has wounded one of his toes 
 in cutting a corn ; in a word, if he bear a wound, whether slight or 
 severe, upon any part of his body or limbs, he may then be certain 
 that the indications above mentioned announce the approach of a 
 series of more urgent symptoms, which may soon place his life in 
 imminent peril. He ought, therefore, to lose no time in endeavor- 
 ing by active measures to ward off the sufferings with which he is 
 threatened. 
 
 TREATMENT OF TETANUS. 
 
 Many methods of treatment have been proposed and attempted 
 for tetanus, but all are uncertain. 
 
 1. Give a grain of opium every two or three hours. 
 
 Brandy or other stimulants may be given at the same time in 
 large doses. 
 
 2. Ice to the spine. This may be applied wrapped in a towel 
 or cloth, or in the ice-bags. (See Ice-bags.) 
 
 Important cures have been claimed by this method of treatment 
 alone. It is certainly worthy of a trial. 
 
 3. The inhalation of mther or chloroform is all the treatment 
 that I can recommend. 
 
 Tartar-emetic has been recommended. 
 
 LOCKED JAW OF INFANTS. 
 
 This affection is very common in warm climates, more especially 
 in the West Indies, where it was formerly computed to have de- 
 stroyed upwards of a third of the negro infants shortly after birth. 
 
 It usually occurs within the first ten days after birth, and has 
 been ascribed to various causes, such as irritation produced by ty- 
 ing the navel cord, or by subsequent neglect of cleanliness, expo- 
 sure to currents of air, and irritation of the bowels. 
 
 The infant, at the commencement of the disease, appears less 
 lively than usual, and is observed to suck with some degree of diffi- 
 culty ; the jaw soon becomes stiff and immovable, and the child, 
 being then rendered incapable of sucking the breast c or of swallow- 
 ing, gradually sinks, or dies in convulsions. 
 
 Dissection has thrown no light on the nature of this disease; no 
 morbid appearances whatever were discovered in any of the bodies 
 which we have examined. 
 
AND MOST RECENT METHODS OF TREATMENT. 881 
 
 TETTER, OE SALT EHEUM. 
 
 The names of diseases of the skin are very complicated. I de- 
 scribe the diseases under the names by which they are popularly 
 known. 
 
 There are two diseases of the skin commonly called tetter : the 
 one is dry and scaly (psoriasis) ; the other is moist, and known 
 under the name of running tetter (impetigo). 
 
 THE SCALY TETTER, OR DRY SCALL, 
 
 Is characterized by irregularly shaped scaly patches, chiefly confined 
 to the hands and arms, although they often appear on all parts of 
 the body. Fissures or cracks are very apt to form in these patches, 
 and give out a thin fluid, which is concreted into crusts or scabs. 
 The surface under these is red, tender, and irritable. This disor- 
 der is always attended with heat and itching, which are more dis- 
 tressing at one time than at another. Sometimes it is periodical,, 
 vanishing and reappearing at certain seasons of the year. The 
 patient generally suffers most in spring and autumn, in consequence 
 of the sudden alternations of temperature which take place during 
 those seasons. 
 
 Persons with dark complexion and full habit of body, whose 
 skin is usually harsh and dry, are most subject to this kind of tet- 
 ter ; it is said to occur more frequently in women than in men, is 
 often connected with gout and gravel, and is generally understood 
 to be of a hereditary nature, and not contagious. 
 
 Many physicians are of opinion that scaly tetter is a species of 
 leprosy. Whether this be the case or not, it must be admitted that 
 these affections are closely allied, and often exhibit themselves in. 
 the same person. 
 
 Makes its appearance in circumscribed, irregular, round, or oval" 
 shaped patches of small pustules closely set together, which, after 
 discharging their contents, continue to throw out a thin acrid 
 matter. This dries, and forms into yellow or greenish-colored 
 scabs, from under the edges of which the matter still continues 
 to ooze, giving rise to itching, or a stinging or smarting sen- 
 sation accompanied with heat. This disease may appear on any 
 part of the body, and may continue for months or for several 
 years, being kept up by repeated eruptions of pustules. It is not: 
 contagious. 
 
 56 
 
882 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 This eruption often breaks out in children while cutting their 
 teeth, in young people, and in females with fine delicate skin 
 and rosy complexion. It generally appears in spring, and some- 
 times breaks out at that season for several years in succession. 
 It may be developed on the neck, on the trunk of the body, or 
 on the limbs ; but in children the scabs are generally first ob- 
 served on the middle of the cheeks, or at the sides of the nose, 
 and gradually extend to the corners of the mouth and round 
 the chin. The crusts or scabs resemble dried honey in appear- 
 ance. When they fall off, the skin, appears red and shining, and 
 is sometimes deprived of the cuticle or scarf-skin. "When the 
 disease is not prolonged by successive eruptions, the crusts gen- 
 erally dry up, and after remaining two or three weeks fall off, and 
 the skin gradually resumes its natural appearance. 
 
 This affection is often very difficult to cure in old people, more 
 especially when it appears on the lower extremities ; but it is never 
 attended with danger. 
 
 Treatment. — In the commencement of this disorder frequent 
 gentle doses of Epsom salts, or sulphur and cream of tartar, are to 
 be taken ; and during all its stages the diet should be sparing, and 
 confined to farinaceous substances and milk, with a small quantity 
 of animal food once a day. It may be necessary after some time 
 to resort to the carbonate of soda or of potash, with sulphur as pre- 
 scribed for dry tetter. 
 
 The best local treatment consists in dusting the parts with tutty 
 or calamine powder {oxide of zinc), in order to absorb the acrid 
 matter and thereby diminish the distressing sensation of itching. 
 The constant application of tepid water, or decoction of poppy heads 
 with marsh mallow, will also afford great relief. 
 
 Half a drachm of nitric acid, dissolved in a pint of barley-water, 
 taken daily, is salutary. If this oppress the stomach, it must be 
 discontinued for a few days, and the warm bath employed occa- 
 sionally. In long-continued cases, which have resisted the reme- 
 dies usually employed, this treatment seldom fails in effecting a 
 cure in the course of a month or a month and a half. {For other 
 remarks on treatment, see Eczema, under Skin, Diseases of) 
 
 THEKMOMETEE IN MEDICINE. 
 
 The thermometer is now much used in the study of disease. 
 There are different varieties constructed expressly for medical use. 
 The best form is the self-registering axilla thermometer. In order 
 

 AND MOST RECENT METHODS OE TREATMENT. 883 
 
 to test the temperature of the patient the bulb of the thermometer 
 should be kept in the armpit (axilla) from three to five minutes. 
 In health the temperature in the armpit should be 98.4° or 98.5° 
 Fahrenheit. It ranges between 92° and 100°. It is higher in the 
 tropics than in cold regions by a degree. It is higher in children 
 than in adults by one or two degrees. This temperature is variously 
 modified by disease. Hence the value of the thermometer. 
 
 In scarlet fever the temperature rises to 108°, 110°, or 112° ; in 
 lung fever and typhoid it rises to 104°, 105°. 
 
 The temperature varies from day to day in many diseases, and 
 with the hour of the day. Hence physicians who are accustomed to 
 use the thermometer can, by its aid, determine the character of the 
 disease and its progress for better or for worse from day to day. 
 
 TOE-XAIL, IXGEOWIXG OE LSYEKTED. 
 
 This affection is sometimes exceedingly painful, and may cause 
 great distress. Sometimes the edges of the nail sink into the flesh 
 and cause inflammation and ulceration. The disease is caused by 
 wearing tight boots. 
 
 The best treatment is to scrape the nail very thin indeed with a 
 bit of glass. The earlier this treatment is resorted to the better. 
 
 Xext press some bits of cotton wool beneath the nail, so as to 
 separate it from the inflamed and chafed flesh. This treatment 
 will usually give relief. It may be necessary to remove the nail in 
 certain cases, but this operation is not advised by physicians so 
 much as formerly. If actual ulceration has taken place, the best 
 treatment will be the strips of adhesive plaster firmly applied over 
 the toe. (See Ulcers.) 
 
 TIC-DOULOUEEUX, OE XEUEALGIA OF THE FACE. 
 
 Tic-douloureux is the term usually applied to a painful affec- 
 tion of certain nerves of the face. It may be seated in one of the 
 temples, at the side of the nose, under the eye, or in the gums ; 
 sometimes the pain attacks one side of the head and face, and may 
 extend to the eye or ear. But although this affection is for the 
 most part confined to the face, it may nevertheless attack the ex- 
 tremities of the body, the female breast, the liver, the womb, or any 
 other internal organ, and has in many instances been known to fol- 
 low diseases of the skin ; for example, it frequently succeeds the 
 disorder- called shingles, before described. The pain comes on in 
 paroxysms, is of a peculiar kind, and differs from that which accom- 
 
884 DESCRIPTION OF THE PRINCIPAL DISEASES. 
 
 panies inflammation. The patient describes it as being lancinating, 
 stabbing, sudden, and excruciating. In severe cases the pain is 
 increased by the slightest touch, shaking of the room, or even by- 
 blowing upon the part, or by the least bodily exertion ; and, when 
 constant, delirium is sometimes the consequence. In some instances 
 convulsive twitchings of the face are observed, and the tears are 
 seen to run down the cheeks. There is perhaps no disease to which 
 the human frame is liable, accompanied with more intense suffering 
 than that which results from the more severe forms of tic-douloureux. 
 The attacks at first are comparatively mild, do not occur frequently, 
 nor continue long ; but when the disease is confirmed they last for 
 days, weeks, or even months, and may recur after very irregular 
 intervals, without the slightest warning or any apparent cause ; and 
 it is worthy of remark, that although the long duration or constant 
 return of severe pain may render the patient's existence a wretched 
 burden, yet it appears to have very little effect in abridging the 
 period of life. 
 
 Tic-douloureux, whether seated in the face or in any external 
 or internal part or organ of the body, is distinguished from inflam- 
 matory disorders by the sudden manner in which it appears and 
 disappears, — the absence of swelling, redness, heat of the part, and, 
 in a word, of all the symptoms which characterize inflammation, 
 with the exception of pain. It ought, however, to be observed, that 
 in persons of an irritable habit of body the violence of the pain 
 sometimes occasions a greater or less degree of febrile excitement. 
 Of the causes of this disease we know nothing. But often a de- 
 cayed tooth, or a disordered state of stomach and bowels, or general 
 debility, may act as exciting causes. 
 
 Treatment. — {For Treatment see Neuralgia, Treatment of.) Tic- 
 douloureux is to be treated like neuralgia of any other part of the 
 body. 
 
 TONGUE-TIE. 
 
 Infants who cannot or do not suck readily are frequently called 
 tongue-tied, and the physician is asked to divide the frcenum below 
 the tongue in order to cure. It is proper to say that this malady 
 usually exists in the imagination of the nurse. The cases where 
 the tongue needs to be liberated in this way are very rare indeed. 
 If the tongue can be put out of the mouth beyond the lips, or can 
 touch the palate, no operation is necessary. 
 
 The operation, although apparently slight, should never be un- 
 dertaken by any one who is not familiar with the anatomy of the 
 parts. 
 
AND MOST RECENT METHODS OF TREATMENT. 885 
 
 TOOTHACHE. 
 
 Sometimes the pain may be relieved immediately by the appli- 
 cation of a little creasote or carbolic acid, or by a little strong nitrous 
 acid mixed with three or four times its weight of spirit of wine, 
 introduced into the hollow part of the tooth by means of a hair- 
 pencil or a little lint. But when the irritation extends to the peri- 
 osteum or fibrous membrane which envelops the tooth and lines 
 its socket, the pain becomes permanent and exceedingly distressing. 
 The treatment in this case consists in the employment of warm 
 fomentations of poppy-heads, blistering behind the ear, and draw- 
 ing blood from the gums. When by these means the inflamma- 
 tion is subdued and the pain in a great measure relieved, the tooth 
 should be extracted ; or when the pain and inflammation have en- 
 tirely subsided, the cavity should be filled with gold, zinc, tinfoil, 
 or whatever substance an experienced dentist may deem the most 
 appropriate. 
 
 A tooth much decayed and often attended with pain should cer- 
 tainly be extracted. This measure should also be adopted when a 
 fungous growth begins to spring up in the hollow part of the de- 
 cayed tooth. But when a tooth decays to a certain extent, and then 
 remains stationary, without occasioning pain, it may be serviceable 
 for many years, and ought not, therefore, to be rashly interfered 
 with. 
 
 Toothache is sometimes intermittent. For example, it may 
 come on every night, and wear oh? towards morning ; and this some- 
 times occurs in teeth apparently sound, or only slightly decayed. 
 In all such cases the tooth should not be removed until a fair trial 
 has been given to quinine, or the arsenical solution as recommend- 
 ed under the head of ague. It is oftentimes very difficult to decide 
 whether an apparent toothache proceeds from a bad tooth, or is 
 a neuralgia simply. The best way to solve the difficulty is to con- 
 sult a dentist. It is impossible to relieve the pain by the ordinary 
 remedies for neuralgia. 
 
 The pain which arises from cutting the wisdom teeth (so called) 
 may be relieved by scarifying the gums, and taking cooling saline 
 purgatives. 
 
 TKUMPETS FOE THE EAR 
 
 The cuts represent some specimens of ear-trumpets, in which, 
 unfortunately, quite a large number of people are more or less in- 
 terested. 
 
886 
 
 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 The best course to pursue when deafness comes on is to consult 
 without delay some surgeon, to ascertain the cause of the deafness, 
 and if possible to have it removed. Oftentimes it will be found 
 that the trouble is only due to a collection of wax, that will be re- 
 vealed to the surgeon by the otoscope, and may easily be removed 
 by careful and persistent syringing with warm water ; more fre- 
 quently it will be found to depend on some form of inflammation that 
 has extended from the throat to the middle ear, but which, if taken 
 in time, may be relieved or cured. The great and criminal mistake 
 of patients is to defer consulting medical advice for their deafness 
 until relief or cure is no longer possible. For those who from neg- 
 lect or from misfortune are afflicted with very severe and incurable 
 deafness, the only remedy is to be found in some form of ear-trum- 
 pet. Many object to using these from motives of delicacy. This 
 
 EAR TRUMPET. 
 
 CONVERSATIONAL TUBE (EAR-TKUMPET). 
 
 sensitiveness is both foolish and unnecessary. The incurably deaf, 
 like the incurably blind, ought to meet their unpleasant fate hon- 
 estly and squarely, and should not be ashamed to use any legiti- 
 mate measures that may render their existence more comfortable. 
 Unfortunately the best of our trumpets are more conspicuous and 
 unsightly than eye-glasses or spectacles. " Spectacles for the ears " 
 have not yet been discovered. 
 
 We need not be without hope, however, that in future time ad- 
 
AND MOST RECENT METHODS OF TREATMENT. 887 
 
 vancing science may devise some form of ear-trumpet that shall 
 be more useful and less annoying than those that we now have. 
 
 TUKPENTIKE. 
 
 Oil of turpentine is much employed for destroying worms. To 
 expel the tape- worm it is given in the dose of an ounce and a half 
 to two ounces ; and is also used against other intestinal worms in 
 children, in the dose of a teaspoonful, or twice or thrice that quan- 
 tity, according to the age. 
 
 An ounce of the oil of turpentine mixed with the yolks of two 
 eggs and a pint of thin starch, constitutes an excellent clyster 
 (injection) in cases of flatulent colic. 
 
 Turpentine is a very useful and safe counter-irritant in all inter- 
 nal inflammatory diseases, where counter-irritation is desired. A 
 large piece of folded flannel, dipped in hot water and wrung as dry 
 as possible, and then freely sprinkled with turpentine, should be 
 applied with the least possible delay over the part where the pain 
 is most severely felt, and carefully covered with a dry cloth to pre- 
 vent evaporation ; this is to be kept on as long as the patient can 
 bear it, and should be renewed as often as may be found necessary. 
 This method of counter-irritation has an excellent effect in deter- 
 mining the blood to the skin, is easily managed, and affords almost 
 immediate relief. The external use of turpentine in this manner, 
 when employed at the very onset, or in mild cases of inflammation, 
 is sometimes of decided service. 
 
 TYPHUS FEVER AND TYPHOID. 
 
 Various species of continued fever have been described by med- 
 ical writers, such as nervous, spotted, putrid, malignant, ship, and 
 jail fevers ; but of late years the observations of many scientific 
 men, in this country and in Europe, have shown that nearly all 
 these continued fevers that have been classed as distinct febrile dis- 
 eases, are merely varieties of the* fever of which I now propose 
 to give a brief description, and which, in its mitigated form of ty- 
 phus fever, is by far the most common kind of continued fever in 
 this country. It is also generally admitted, that the numerous 
 forms under which typhus fever appears, are owing chiefly to in- 
 flammatory affections of the brain, lungs, bowels, or other organs 
 with which it frequently becomes complicated ; thus giving rise to 
 many symptoms not manifested in the simple or regular course of 
 

 888 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 the disease. Patient investigation has also convinced nearly all the 
 medical men who have taken the trouble to inquire into the subject, 
 that typhus fever, in the great majority of cases, is distinguished 
 from all other febrile diseases by a specific eruption of the skin, and 
 moreover that, as a general rule, it only attacks the same individual 
 once in the course of his life — thus obeying the law which governs 
 small-pox, scarlatina, and other eruptive diseases. 
 
 Typhus fever sometimes commences abruptly ; at other times it 
 is preceded, during several days, by certain symptoms which are 
 called precursory or premonitory. The patient feels low-spirited, 
 debilitated, and fatigued ; he becomes dull, morose, and complains 
 of a sensation of constriction and oppression at the chest, and of 
 soreness or lassitude of the back and limbs. The countenance is 
 unusually pale and sallow, the eyes lose their natural brilliancy and 
 appear languid, the breath is cold or fetid, and the appetite is lost. 
 These symptoms vary in severity. They may be so slight that the 
 patient does not confine himself to his room, and in some instances 
 they escape particular attention. Observation has shown that 
 usually the quicker and shorter this premonitory stage is, the more 
 severe and rapid will be the subsequent fever. 
 
 First stage. — The fever begins with a sensation of cold at the 
 loins, followed by shiverings alternating with flushes of heat, consid- 
 erable depression of strength and spirits, restlessness, and general 
 uneasiness. At the expiration of a few hours, fever in its more 
 literal sense is manifested. The pulse is full and quick or oppressed, 
 the head feels heavy, giddiness and headache are experienced, the 
 face is flushed, or sometimes continues pale ; there is considerable 
 disturbance of the intellectual faculties, and an expression of distress 
 is seen in the countenance, which is highly characteristic of the dis- 
 ease. The patient complains of constant thirst ; the tongue is cover- 
 ed with a thin, whitish-colored fur ; there is nausea ; the bowels are 
 often in a natural state ; and the urine is scanty, high-colored, and 
 hot. As the disease advances, the drowsiness increases; there is 
 singing or buzzing in the ears, and the patient lies in a half-stupid 
 state, and is unable to sit up in bed. When roused he still answers 
 questions coherently, although in a slow and unusua 1 manner ; and 
 when he awakes or is spoken to abruptly his countenance expresses 
 an air of astonishment. There is now oppression at the chest ; the 
 general prostration is much increased, and in many cases there is 
 cough with expectoration. On the fourth or fifth day, often at a 
 later period, an eruption of pink or reddish -colored measles-like 
 spots, about the size of the head of a pin, breaks out on various parts 
 of the body, but chiefly on the chest and abdomen ; they are slightly 
 
AND MOST KECENT METHODS OF TREATMENT. 889 
 
 rough to the touch, and disappear when pressed upon with the fin- 
 gers, but soon reappear when the pressure is removed. This rash 
 usually continues from three to five days, but is occasionally so 
 slight and indistinct, particularly in children, that it often escapes 
 observation ; and in some instances the fever runs through its dif- 
 ferent stages without the skin exhibiting the slightest appearance 
 of any kind of eruption. Bleeding from the nose sometimes occurs 
 about this period, and much relieves the head for a time. All the 
 symptoms are aggravated during the night ; the slumbers are short, 
 disturbed, and unrefreshing, and there may be slight wandering 
 or delirium. The duration of this stage is generally about a 
 week. 
 
 Second stage. — The surface of the body, which may have been 
 previously moist, is now dry, and greatly increased in temperature. 
 If the hand be pressed upon it for a minute or two, a peculiarly hot, 
 pungent sensation is communicated, which continues for some time 
 after the hand is removed. The pulse is variable ; it may be mode- 
 rately quick, fall, or soft, and easily compressed. In fatal cases it 
 continues very frequent, generally above 125. Often a deep-colored 
 red suffuses the cheek, approaching either purple or mahogany 
 color. The tongue, which was at first moist, now begins to get 
 brown, dry, and shrunken ; and the parched state of the throat causes 
 some difficulty in swallowing. The desire for cold and acid drinks 
 is still urgent. Small purple-colored spots, or numerous minute 
 white vesicles, like millet-seeds, are frequently seen upon the skin 
 about the eight or tenth day from the occurrence of the shivering. 
 Sometimes the fever spots exist at the same time with the specific 
 eruption already noticed. When this occurs, they both present 
 nearly the same color, but may nevertheless be easily distinguished 
 from one another. The brain is now more under the influence of 
 the disease ; the patient lies on his back in a sort of stupor, and ap- 
 pears careless about everything, although he is still aware, at times, 
 of what is going on around him. When roused, he says that he is 
 very well ; his ideas are so confused that his answers to questions 
 are generally incoherent, and he soon relapses into the same state 
 of insensibility to external objects. He talks deliriously, and dreams 
 without sleeping. This kind of delirium is almost characteristic of 
 the disease. In some instances the delirium is noisy, and the patient 
 requires restraint. The abdomen is painful when pressed upon, and 
 sometimes becomes distended and tense. There is also purging to 
 a greater or less extent, and in many instances dysentery comes on ; 
 the urine is passed with difficulty, or may even accumulate in and 
 distend the bladder ; the hands tremble, twitchings or spasmodic 
 

 890 
 
 movements of different parts are observed, and black adhesive mu- 
 cous matter covers the lips, gums, and teeth. 
 
 Third stage. — Towards the fourteenth day, sometimes two or 
 three days earlier, if the disease is about to terminate favorably, a 
 gradual amendment of all the symptoms is observed. A slight de- 
 gree of moisture breaks out in the skin ; sometimes bleeding from 
 the nose takes place; the tongue, gums, and nostrils become 
 moist, while the dark-colored matter with which they are covered 
 is detached and falls off, and the patient now expectorates easily 
 and freely. In many cases, free perspiration' breaks out all over 
 the body and limbs, and emits a peculiar odor; the urine flows 
 abundantly ; the delirium ceases ; the senses recover their activity ; 
 the patient is again able to sleep ; the appetite returns ; the strength 
 gradually increases ; and convalescence commences about the twen- 
 ty-first day. The memory often remains impaired ; while the buz- 
 zing in the ears, which has been more or less troublesome through- 
 out the disease, and the deafness, continue long after the fever has 
 ceased. 
 
 When, on the contrary, the disease proceeds to a fatal termina- 
 tion, the symptoms become more alarming, and new morbid pheno- 
 mena are developed. The skin is covered with a viscid fetid sweat ; 
 the urine and fseces are passed involuntarily ; the expectoration is 
 dark- colored and fetid ; gangrenous sores form on the parts which 
 have been subjected to pressure ; the delirium is low and mutter- 
 ing, and the patient picks at the bedclothes ; the dead rattle (as 
 it is commonly called) is heard in the throat, and death takes place 
 about the termination of the third week, frequently at an earlier 
 period, rarely later. 
 
 The congestion, or accumulation of blood in the principal in- 
 ternal organs, which always occurs to a greater or less extent in 
 the course of this disease, frequently causes inflammation. The 
 brain is more or less affected in every case ; but inflammation only 
 occasionally occurs, and then we are often unable to determine its 
 existence. This complication is most frequently met with in 
 young robust individuals, and is manifested for the most part dur- 
 ing the first stage of the disease, sometimes within twenty-four 
 hours from its commencement, by buzzing and other noises in the 
 ears, severe pain in the head, throbbing at the temples, delirium, 
 convulsive movements, &c. ; sometimes nausea, vomiting, purging, 
 and pain in the bowels are the predominant symptoms. The dan- 
 ger is then not so great as in the preceding case. In other in- 
 stances, pain in the chest, bloody expectoration, cough, and diffi- 
 culty in breathing indicate inflammation of the lungs; or inflam- 
 
AND MOST RECENT METHODS OP TREATMENT. 891 
 
 mation of the liver may be announced by an acute pain of the right 
 side, a jaundiced appearance of the skin, &c. These affections 
 greatly increase the danger, and they are the more to be dreaded 
 because the extreme drowsiness and oppression of the brain often 
 prevent the patient from directing the attention of the practitioner 
 to the affected organ, and often conceal their existence from or- 
 dinary observers. 
 
 Typhus fever frequently appears under a very mild form 
 (typhoid), which is in no way dangerous when not improperly 
 treated. Griping in the bowels, aching pains in the limbs, and 
 headache, with disturbed sleep, constitute the chief sources of 
 complaint. The headache is generally aggravated towards night, 
 but is seldom accompanied with much intellectual disturbance. 
 Sometimes an air of astonishment is observed in the patient's coun- 
 tenance on awaking, and his ideas are slightly confused for a short 
 time. This benign form of the disease does not occasion fear of 
 contagion, is its most prevalent form with us, and generally lasts 
 from twenty to forty days. 
 
 On the other hand, in severe epidemics, the contagious principle 
 is so virulent that the vital powers soon become overwhelmed. The 
 patient lies as if he were in a state of apoplectic stupor. Black 
 spots soon appear in different parts of the body ; dark-colored, un- 
 healthy-looking blood issues from the nostrils ; the prostration in- 
 creases, and the patient dies before the seventh day from the com- 
 mencement of the disease. 
 
 Much diversity of opinion still exists- in the medical world re- 
 specting the cause of typhus fever. Many physicians believe that it 
 cannot in every instance arise from intercourse with an infected 
 person, and that it may be generated and developed by various ex- 
 ternal agents, such as filth, foul air, improper food, intoxicating 
 liquors, &c, and afterwards become susceptible of communication 
 from one individual to another. 
 
 The circumstances which operate in the diffusion of typhus 
 fever are filth and impure air, deficient nourishment and food of 
 bad quality, intemperance, a cold and moist state of the atmosphere, 
 and everything of a depressing and debilitating nature. 
 
 All the excretions from a patient with the graver form of 
 typhus are charged with contagious effluvia, which become highly 
 concentrated when cleanliness is neglected, and the ventilation is 
 defective. 
 
 The long-continued use of ardent spirits lowers the vital en- 
 ergies, weakens and emaciates the body, and prepares it for the 
 reception of typhus contagion, or of any epidemic disorder which 
 
892 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 may happen to prevail; and thus keeps the system, as it were, 
 constantly upon the brink of disease. Besides the injurious 
 influence which the use of alcoholic liquors exercises directly 
 upon the animal economy, a train of evils are indirectly in- 
 duced. The family of the drunkard are deprived of sufficient 
 food, fuel, clothing, and other necessaries and conveniences of 
 life; while filth arid all the concomitants of poverty, which so 
 strongly tend to the diffusion of typhus fever, are brought into 
 play ; and hence the disease chiefly prevails in the districts of large 
 towns where the greatest quantity of spirits is consumed. 
 
 DISTINCTION BETWEEN TYPHUS AND TYPHOID FEVER. 
 
 In typhus fever there is no 
 bleeding at the nose or bronchitis ; 
 the bowels are constipated ; there 
 is an eruption, that does not dis- 
 appear on pressure, about the 
 5th, 6th, or 7th day; progress 
 more rapid than in typhoid fever. 
 
 Death may occur within 10 
 days. 
 
 In typhoid fever there are 
 bronchitis and bleeding at the 
 nose; gurgling in the bowels; 
 diarrhoea; eruption of rose spots, 
 that disappear on pressure ; very 
 slow progress. 
 
 Death not usually takes place 
 under 14 or 15 days. 
 
 It is oftentimes quite difficult for the physician to distinguish 
 between the two diseases. Typhus is rather more fatal than typhoid. 
 Of the former, about one in ten or fifteen die ; of the latter, about 
 one in twenty. 
 
 The general principles of treatment are nearly the same for both 
 diseases. 
 
 Treatment. — In mild cases of typhoid fever, convalescence is 
 established between the fourteenth and eighteenth days from the 
 commencement of the disease ; that is to say, the patient, although 
 still in a feeble condition, begins to relish his food and sleeps more 
 soundly, while his tongue is tolerably clean and his pulse natural. 
 In ordinary cases, as we have already mentioned in describing the 
 disease, the patient cannot be considered convalescent until about 
 the twenty-first day ; and in the more severe cases the disease may 
 be protracted to the thirtieth or fortieth day, or even later. In the 
 treatment of typhus and typhoid fever, our remedies are to be di- 
 rected, not to cutting short, but to controlling the fever, and 
 relieving the local disorders which may occur during its course, 
 until nature effects the cure. But when, after frequent contact with 
 the sick, a person finds he has headache, pain in the back, and 
 general lassitude, by taking an emetic at night, or a cathartic, or 
 

 AND MOST RECENT METHODS OF TREATMENT. 893 
 
 both, he may be relieved of these symptoms, which otherwise might 
 prove the precursors of the fever. 
 
 In mild cases of typhus, or in the simple forms of continued 
 fever, above alluded to, the only remedies required are mild laxa- 
 tives, such as a little castor-oil. The daily use of purgatives 
 interferes with the regular course of the disease, aud might pro- 
 duce considerable irritation, or even inflammation of the bowels. 
 
 The two great remedies now used for typhus and typhoid fever 
 are pure air and stimulants. Pure air is to be obtained by free 
 and abundant ventilation of the sick-room, or, as has been success- 
 fully tried in some cases in hospitals, in moderate weather, remov- 
 ing them into tents. In treating these fevers we should carry 
 out the suggestions of Florence Nightingale, to " keep the air 
 which the patient breathes as pure as the outside air, without 
 chilling him? 
 
 If I were taken down with this disease I should desire, first of 
 all, pure air, good nursing, and stimulants if I became debilitated. 
 The old-fashioned method of bleeding, purging and dosing with all 
 sorts of drugs in fevers is now abandoned, and very fortunately for 
 our patients. 
 
 Stimulants are administered in the form of whiskey, brandy- 
 punch, wine, and champagne. The doses of these stimulants, and 
 the frequency of their administration, must be determined by the 
 wants of each individual case. For this reason, among others, a 
 medical adviser of experience is imperatively needed in these seri- 
 ous and exhausting diseases. A tablespoonful of brandy may be 
 given every two, three, or four hours. Sometimes very much 
 larger doses are given. All cases of typhus or typhoid fever do not 
 need stimulants. 
 
 Beef-tea is to be highly recommended, either alone or connected 
 with the stimulants. 
 
 Sponging the body with cold or tepid water and sprinkling the 
 pillow and sheets is very beneficial in all cases ; it diminishes the 
 distressing heat and dryness of the skin, is soothing and grateful 
 to the patient, and is sometimes followed by gentle perspiration 
 and more tranquil sleep. When the skin is hot and dry, cold water 
 may be employed with perfect safety, and without any risk of inter- 
 rupting the regular course of the rash which usually appears on 
 the skin ; but tepid water is to be preferred if there be any de- 
 gree of moisture on the skin, and at very advanced periods of the 
 disease. 
 
 If rawness or excoriation of the hips, haunches, or back occurs, 
 the part may be washed with a solution of ten to fifteen grains of 
 
894: DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 nitrate of silver (lunar caustic) in an ounce of water, or with a 
 weak solution of the acetate of lead {sugar of lead) in spirits of 
 turpentine; and if sloughing or gangrenous ulcers form, carrot 
 poultices, and the means recommended under the head of Mortifica- 
 tion, are to be employed. But we should endeavor to avoid these 
 untoward occurrences by supporting the patient with pillows, so as 
 to take off the pressure from the parts most likely to suffer; and in 
 all tedious cases, when a tendency to excoriation is observed, the 
 parts should be defended by soap-plaster. The India-rubber water- 
 bed and the India-rubber air-pillows are the best means of guard- 
 ing against the effects of pressure. 
 
 It sometimes happens, in the course of typhus fever, that the 
 bladder becomes distended and incapable of discharging its con- 
 tents. The state of this organ should therefore be carefully attended 
 to ; and if fulness or swelling be observed at the lower part of the 
 belly, the urine must be drawn off with the catheter. 
 
 Ventilation of the sick chamber, as has already been stated, is 
 always of primary importance, and is more particularly demanded 
 in all contagious febrile diseases. But great care must neverthe- 
 less be taken to screen the patient from currents of air, and to regu- 
 late the temperature according to the stage of the disease and the 
 state of the patient. As long as the surface of the body continues 
 hot and dry the room should be kept cool and the bedclothes light ; 
 but towards the termination of the fever, or when the temperature 
 of the body is considerably reduced, additional covering must be 
 employed. The bed-pan for evacuations should be used on the 
 necessary occasions, and the patient disturbed as little as possible; 
 and should the evacuations be passed involuntarily, the bed should 
 be protected by placing a piece of oiled silk or glazed cloth under 
 the patient. The gums should be carefully washed, the linen and 
 bedclothes frequently changed ; and the necessity for the utmost 
 attention to cleanliness in the patient's person, and to everything 
 around him, must be obvious to every one. 
 
 During convalescence the patient should wear flannel next the 
 skin, and avoid sudden alternations of atmospheric temperature. 
 He must carefully abstain from premature mental or bodily exer- 
 tion, and the return to his ordinary occupations ought to be gradual 
 and, cautious. 
 
 Diet and regimen. — During the first, or inflammatory stage of 
 the disease, no kind of nourishment should be allowed beyond 
 newly prepared whey or barley-water; but when the excitement 
 subsides, small quantities of very light food should be given, such 
 as thin arrow-root, gruel, tapioca ; and vegetable jellies. When 
 
AND MOST RECENT METHODS OF TREATMENT. 895 
 
 wine and stimulants are considered necessary, it will also be ad- 
 visable to keep up the patient's strength with beef-tea, chicken or 
 mutton broth, as before stated. 
 
 It may be inferred, from what has been stated in a previous 
 part of this article, that the best means of diminishing the power 
 of contagion, in this and other eruptive fevers, are cleanliness and 
 proper ventilation. The attendants should avoid standing in a 
 current of air which has passed over the patient, or, in other words, 
 should stand between the patient and the channel through which 
 the air enters the apartment; they should also avoid inhaling his 
 breath, or leaning over him ; and should avoid entering the sick 
 apartment in the morning with an empty stomach. It will like- 
 wise be advisable to purify the room from time to time, by placing 
 flat dishes, containing the chloride of lime mixed with water, on 
 different parts of the floor. 
 
 The late Dr. Henry, of Manchester, discovered that clothes im- 
 pregnated with the contagious effluvia from the bodies of patients 
 with typhus, scarlatina, &c, are disinfected by exposing them to a 
 temperature of 204° F. for an hour and three-quarters, and may 
 afterwards be worn with perfect safety by healthy persons. 
 
 ULCEES. 
 
 Ulcers, whether proceeding from local or constitutional causes, 
 are classed by surgeons under different heads, according to their 
 appearances and the symptoms with which they are accompanied. 
 The species of ulcers usually described are the healthy, the indo- 
 lent, the irritable, and the sloughing, or phagedenic. 
 
 The simple or healthy ulcer is covered with small fleshy pro- 
 jections, which are of a red color, firm, and pointed. These granu- 
 lar eminences are closely connected, forming an equal surface, and 
 are bedewed with cream-colored matter {pus). This form of ulcer 
 is not painful, but is attended with a peculiar sensation of itching ; 
 its edges are smooth, soft, and though slightly florid, do not present 
 the fiery-looking appearance of an inflamed part. !Now, when an 
 ulcer, whether proceeding from a wound, a burn, an abscess, or, in 
 a word, from any other cause, either local or constitutional, exhibits 
 these appearances, we know that the process which nature sets up 
 for the restoration of the part is going on favorably, and needs no 
 assistance from art. In fact, no means possessed of the direct 
 power of promoting a cure are known ; hence, all that remains for 
 us to do is to preserve the natural process from interruption by 
 defending the part from injury. 
 
896 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 In ordinary cases, it will be sufficient to dress the sore with dry- 
 lint or old linen once in twenty-four hours, when it should be 
 carefully washed with milk-warm water. If part of the dressing 
 adhere to the edges of the ulcer, it should be carefully removed, 
 so as not to produce irritation, or injure the numerous red points 
 already noticed, called granulations. The necessity of protecting 
 these little bodies from mechanical injury is obvious, because they 
 secrete the matter which flows from the ulcerated surface, and 
 without which the healing process could not be carried on ; while 
 at the same time they gradually fill up the cavity of the sore, until 
 its surface reach the level of the surrounding skin — thus constituting 
 the means adopted by nature for the completion of the cure. Many 
 surgeons smear the lint, or whatever covering is employed, with a 
 little Turner's cerate, sugar of lead ointment, or some other mild 
 unctuous substance ; this, however, is not done with the intention 
 of expediting the cure, but merely to prevent the lint from adhering, 
 and the edges of the ulcer from being injured on its removal. The 
 dressing must be kept on by a roller wound round the limb, from 
 its extremity to some distance above the sore. This is not to be 
 applied so tightly as to produce pain, but with sufficient firmness 
 to retain its own place and that of the lint, or whatever dressing 
 may be employed. 
 
 "When a wound cannot be healed by the adhesive process, or by 
 what surgeons call the first intention, and when it is found neces- 
 sary to open an abscess, we should apply warm poultices to the 
 part, in order to promote the growth of granulations, until these 
 have sprung up to a level with the surrounding skin. The poul- 
 tices are then to be discontinued, and lint applied as above directed. 
 
 Sometimes the granulations become too luxuriant, and spring 
 up higher than the edges of the sore, forming what is called proud- 
 flesh, which may cover the whole or only part of the ulcer. When 
 this occurs, we must touch the fungous part daily with olue vitriol 
 {sulphate of copper), or lunar caustic, until it be brought down to 
 the proper level ; or we may apply pressure, by means of strips of 
 adhesive plaster and suitable bandages. In some instances, the or- 
 dinary means of keeping down proud-flesh do not succeed; we then 
 have recourse to the application of a piece of sheet-lead over the 
 sore. When this measure is deemed necessary, a pledget of lint, 
 covered with simple ointment, should be interposed between the 
 lead and the ulcer, and a long roller or laced stocking applied so 
 as to embrace the whole limb, and retain the lead in place. 
 
 The indolent ulcer is characterized by a smooth surface, with- 
 out granulations, of various colors. Sometimes it is glossy or 
 
AND MOST RECENT METHODS OF TREATMENT. 897 
 
 semi-transparent, or covered with a layer of viscid mucus ; its 
 edges are hard, white, and sometimes turned outwards, while the 
 surrounding skin presents a varnished appearance, looks polished 
 like a pebble, or exhibits a rough and scaly aspect. The limb on 
 which this description of ulcer is seated is always more or less 
 swollen, and the matter discharged is a thin, serous-looking fluid, 
 or is tenacious and fetid. 
 
 Some people submit to all the inconvenience and discomfort of 
 an indolent ulcer for years, being afraid to dry it up through a dread 
 of injuring the system, and inducing some inveterate or acute dis- 
 ease by suppressing a long-continued discharge. These ulcers, 
 however, maybe healed with perfect propriety, provided proper 
 treatment be adopted, and the patient adheres to a sufficiently rig- 
 orous diet, until the system accommodates itself to the change, and 
 the state of the general habit is corrected. 
 
 The mode of treatment now generally preferred is that by pres- 
 sure with adhesive straps, which is not only very efficacious, but 
 possesses the advantage of being simple and easily managed. It is 
 performed in the following manner. The limb having been shaved,, 
 a slip of adhesive plaster, about an inch and a half in breadth, is 
 to be applied completely round the limb, about two inches below 
 the ulcer ; and, in order to fix the strap firmly, one end of it should* 
 be made to overlap the other ; then a second strap is to be applied. 
 a little higher, so as to cover two-thirds of the first ; then a third im 
 the same manner, proceeding upwards until the ulcer is entirely 
 covered, and an inch or two of the skin above it. Having com- 
 pleted this part of the process, a long cotton roller, three inches 
 broad, is then to be wound round the limb, from the toes to the 
 joint immediately above the sore, or a laced stocking may be em- 
 ployed in place of the roller. The ulcer should be dressed once in 
 thirty-five or forty-eight hours ; and if the patient complain of se- 
 vere itching and heat at the part, the bandage must be freely 
 moistened with cold water. The straps and roller should not at 
 first be applied very tight, or in such a manner as to produce pain ; 
 but after they have been used several times the patient will, with- 
 out inconvenience, bear to have the pressure considerably increased. 
 This method of treatment soon produces the effect of subduing the 
 swelling of the limb and reducing the callous edges of the ulcer ; 
 granulations begin to spring up and discharge cream-colored matter;: 
 the part assumes a healthy action, and presents the appearance of 
 the simple ulcer, above described ; and the cure is soon completed. 
 
 Although the most obstinate cases of indolent ulcer are often 
 remedied by the above plan of treatment, yet it is not to be ex- 
 57 
 
898 
 
 pected that this or -any other method shall be invariably successful ; 
 we are therefore occasionally under the necessity of having re- 
 course to other remedies. Various stimulants are employed to ex- 
 cite the growth of granulations, and induce a healthy action of the 
 part. Mild citrine ointment spread on lint or on soft linen rag, or 
 salve composed of an ounce of basilicon mixed with a drachm of 
 the red precipitate of mercury, are useful dressings; but they 
 must be used stronger or weaker, according to the effect produced. 
 If the patient complain of smarting or pain, the strength of the 
 ointment should be diminished by the addition of a little lard. 
 The best plan, however, is not to persist in the use of any particu- 
 lar ointment or lotion, but to vary the dressing as soon as we ob- 
 serve that the ulcer begins to fall back into the same indolent state, 
 or remains stationary. Whatever application is employed, the use 
 of the roller should never be neglected, because there is no fact in 
 surgery better ascertained than the efficacy of pressure in cases of 
 indolent ulcer. 
 
 Irritable ulcers vary considerably in appearance in different 
 cases. In general, the surface of the sore at the commencement 
 presents a very unequal aspect ; the granulations at some parts are 
 seen shooting up too high, in others they are scarcely perceptible. 
 There is much pain and tenderness of the part, and redness of the 
 adjacent skin; the discharge consists of bloody matter, which Sir 
 Astley Cooper compares to strawberry-cream in appearance. If 
 the irritation be allowed to continue, the granulating action is 
 gradually destroyed ; the surface of the sore acquires a smooth, 
 buff-colored appearance, the matter discharged is thin, and the part 
 becomes exceedingly tender, and is very painful when touched. 
 Sometimes this species of sore is level with the surface of the limb; 
 at other times it is deep like a cup, with thin sharp edges, and con- 
 tinues to spread as long as the excess of action exists. Weak, irri- 
 table individuals, more especially those whose constitutions have 
 been injured by intemperance, are most liable to this kind of ulcer; 
 it also occurs in full-fed, plethoric persons. 
 
 In the treatment of irritable ulcers we must avoid everything 
 which can keep up the excitement, and employ remedies of a sooth- 
 ing tendency. Of these, the best, if the excitement be merely 
 local, are fomentations of the decoction of poppy-heads, and warm 
 bread and milk poultices. The following ointment is strongly re- 
 commended : 
 
 Spermaceti ointment and 
 
 Citrine ointment, of each half an ounce, 
 
 Opium in powder, a drachm. Mix. 
 
AND MOST RECENT METHODS OF TREATMENT. 
 
 To be spread on lint, and applied to the part twice a day. 
 
 When an nicer is of an indolent character, moderate exercise on 
 foot may be allowed, and is even serviceable in many cases ; here, 
 on the contrary, motion wonld certainly have the effect of increas- 
 ing the irritation, and absolute rest must therefore be strictly en- 
 forced. 
 
 The sloughing , or phagedenic ulcer. — The irritable ulcer with- 
 out granulations is very liable to become affected with inflammation 
 of a low character, which soon terminates in sloughing or mortifi- 
 cation. 
 
 The sloughing ulcer generally arises from constitutional causes, 
 such as great irritability of the system brought on by drinking 
 spirits, by the abuse of mercury, or by the deleterious influence of 
 an unwholesome atmosphere. The inflammation produced by the 
 local application of certain morbid poisons may likewise end rapidly 
 in sloughing ulceration. 
 
 When the sloughing has commenced, carrot poultices should be 
 had recourse to ; or a lotion composed of fifty drops of nitric acid 
 to a quart of water may be constantly used, the strength being in- 
 creased or diminished according to the patient's sensations. Car- 
 bolic acid — five grains to an ounce of water — is a good application. 
 This application has an excellent effect in promoting the growth 
 of healthy granulations. Oiled silk should be applied over the 
 ulcer until the slough be detached, in order to prevent the dis- 
 agreeable smell which would otherwise arise from the mortifying 
 parts. The state of the constitution must be carefully attended to. 
 In most cases the administration of opium, as already recom- 
 mended, is found necessary. (See article Varicose Veins.) 
 
 UKINE, INCONTINENCE OF. 
 
 When a person is unable to retain his urine, and it constantly 
 passes off involuntarily, he is said to be affected with incontinence 
 of urine. 
 
 Inability to retain the urine is a symptom of various disordered 
 conditions of the urinary organs. In people advanced in life it is 
 frequently associated with retention of urine. The bladder is con- 
 stantly full, and every movement of the body causes the urine to 
 escape ; in this manner it passes involuntarily, as quickly as it is 
 secreted by the kidneys. (See Urine, Retention of.) 
 
 Incontinence of urine is often connected with a weakened or 
 paralyzed state of the lower limbs, which in many cases is caused 
 by injuries done to the spine, or by some disorder of the spinal 
 
900 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 
 marrow. Sometimes, again, the paralytic condition of the inferior 
 extremities, to which the incontinence of urine is obviously subor- 
 dinate, comes on gradually, without any known cause. In such 
 cases the bladder does not appear to be distended ; but its sphinc- 
 ter muscle offers no resistance to the escape of the urine, which 
 dribbles constantly from the parts, to the great discomfort of the 
 patient. The treatment generally relied on in this form of the dis- 
 order consists in cold bathing, more especially the daily application 
 of the cold douche to the lower parts of the body ; the application 
 of blisters to the lower part of the back (sacrum) ; the internal use 
 of the tincture of cantharides, in doses of ten drops, three times a 
 day, in half a teacupful of gum-water or linseed-tea ; belladonna in 
 the form of the tincture ; and tonic remedies, such as quinine or 
 the prepared rust of iron. In some cases the introduction of the 
 catheter has been found serviceable. I have found general electri- 
 zation efficacious in incontinence of urine. (See General Electri- 
 zation^) 
 
 Children are particularly liable to incontinence of urine. In 
 general, they are troubled with it only when asleep ; but in many 
 cases the calls to void the urine during the day are more frequent 
 than in health ; and the child, if spoken to sharply, or alarmed from 
 any cause, makes water involuntarily. This nocturnal incontinence 
 of urine sometimes resists every kind of treatment ; but it usually 
 gets well of itself as the child grows up and acquires strength. 
 Much benefit may be derived from tonic remedies ; of these, per- 
 haps the most eligible is the tincture of chloride of iron, which 
 should be given in doses of five drops three times a day, in a wine- 
 glassful of the infusion of gentian or decoction of whortleberry, 
 and continued daily for several weeks or months, according to the 
 circumstances. A succession of blisters to the sacrum, or lower 
 part of the back, have been often successfully employed. Bathing 
 the lower part of the abdomen and genital organs night and morn- 
 ing with cold water has often an excellent effect. The state of the 
 stomach and bowels should be carefully attended to. Watery diet 
 should be avoided, and tea prohibited in the afternoon. Eating 
 shortly before going to bed is improper. Contrivances which me- 
 chanically prevent the discharge of urine often do serious mischief, 
 and are never followed by any permanent benefit. In all cases of 
 this disease in the male sex, a small bag of oiled silk or India-rubber 
 cloth (Macintosh), appended to the parts, will be found very service- 
 able as far as regards cleanliness ; and a piece of the same descrip- 
 tion of cloth, about a yard square, placed under the hips at night, 
 it also conducive to cleanliness and comfort. 
 
AND MOST RECENT METHODS OF TREATMENT. 901 
 
 URINE, RETENTION OF. 
 
 Retention of the urine, or strangury, as it is commonly called, 
 is either complete or incomplete. In the former case, no urine can 
 be passed, or only a few drops are voided with great straining and 
 at intervals, without affording any relief to the patient, whose state 
 soon becomes one of the most distressing to which man is liable. 
 In the latter case the symptoms are not so urgent, and the patient 
 passes, occasionally, a considerable quantity of urine, without the 
 pain or distention at the lower part of the belly being much, or in 
 any degree relieved, or the restlessness and symptoms of general 
 excitement abated. 
 
 Retention of urine sometimes occurs in persons who have been 
 prevented from making water by delicacy, indolence, or other causes, 
 until the bladder, from over-distention, has become so weakened 
 that it loses its contractile power, and is unable to empty itself. In 
 this case the feet ought to be placed in water as hot as it can be 
 borne, and warm fomentations should be applied over the lower 
 part of the belly, or the penis may be immersed in a basin of warm 
 water; by these means, continued for some time, and the applica- 
 tion of gentle pressure over the bladder, the patient will occasion- 
 ally succeed in voiding his urine. The disorder, when depending 
 on this cause, may be relieved by other methods of treatment; 
 but in general it is found necessary to draw off the urine by means 
 of a catheter. In many instances this instrument must be employ- 
 ed twice or thrice daily, or even more frequently, for several days 
 or even weeks, until the muscular structure of the bladder recovers 
 its tone. A simple and excellent method of restoring the tone of 
 the bladder is to pour cold water on the lower part of the belly from 
 a height, by means of a jug or tea-kettle. This should be done night 
 and morning until the catheter is no longer required. Retention 
 of the urine, from a weakened or paralyzed state of the bladder, may 
 also arise from certain affections of the brain, or from injuries done 
 to the spine by blows or otherwise. In the latter case, some degree 
 of insensibility and weakness of the lower limbs is generally pres- 
 ent. This form of the disorder is often symptomatic of particular 
 diseases. It occurs sometimes in the course of fevers, painters' colic, 
 dysentery, &c. In all such cases the state of the bladder should 
 be carefully attended to, and the catheter employed at least three 
 or four times in the course of twenty-four hours, until the patient 
 recovers from the disease on which the retention depends. 
 
 Strangury sometimes arises from the internal administration of 
 
902 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 Spanish flies (cantharides) or their external application in the form of 
 blisters. In this case there is a sensation of fulness and weight at 
 the region of the bladder, attended with frequent inclination to make 
 water, smarting, heat, and difficulty in voiding it. These symp- 
 toms are soon relieved by drinking freely of linseed tea, barley wa- 
 ter, decoction of marsh-mallow. In severe cases it will also be ad- 
 visable to take forty or fifty drops of the tincture of henbane, in two 
 ounces of camphor mixture, every four or six hours. These reme- 
 dies are also very serviceable in relieving the strangury which at- 
 tends gonorrhoea. In this last case much relief may also be derived 
 from the immersion of the penis in warm water. 
 
 In extreme cases of retention of urine, when all other means 
 have failed, it is the duty of the surgeon to withdraw the urine by 
 puncturing the bladder, in order to prevent a fatal termination. 
 
 Persons subject to this disease should live abstemiously, and 
 carefully guard against exposure to cold, sudden vicissitudes of tem- 
 perature, wet feet, and every kind of severe bodily exercise ; and, 
 of all things, they should never neglect to attend instantly to a call 
 to make water. 
 
 VACCINATION. 
 
 The improved method of treating small-pox by the free admis- 
 sion of fresh air into the patient's room, the avoiding of everything 
 heating or stimulating, the use of cooling drinks, conjoined with 
 other appropriate remedies, and the introduction of inoculation 
 into England by Lady Mary Wortley Montague, in the year 1721, 
 had greatly diminished the mortality from that loathsome and 
 dangerous disease ; but it was not until 1798 that the illustrious 
 Jenner announced the fact, that the human system could be effec- 
 tually and permanently secured from its influence by vaccination. 
 In the course of two or three years from the time that this benefac- 
 tor of his race began to promulgate his invaluable discovery — the 
 most important recorded in the annals of medicine — the practice 
 of vaccination had almost superseded inoculation throughout the 
 kingdom, and is now known in the most remote countries in every 
 quarter of the globe. 
 
 A tradition, which had long existed among the peasantry in dif- 
 ferent parts of England, led Dr. Jenner to observe that in the 
 dairies of Gloucestershire the cows were subject to an eruption on 
 their teats and udders, which was sometimes communicated to the 
 hands of the persons engaged in milking them, and was attended in 
 most instances by a slight degree of fever. He also observed that 
 
AND MOST RECENT METHODS OF TREATMENT. 903 
 
 those who had undergone this disease, known under the name of 
 cow-pox, were never afterwards liable to small-pox, either by inocu- 
 lation or by exposure to the most active contagion. After carefully 
 investigating the causes and effects of cow-pox, during a period of 
 upwards of twenty years, he satisfied himself of the correctness of 
 the fact, that vaccination produced such a change in the constitu- 
 tion as effectually to preserve it from the influence of the contagion 
 of small-pox. He also maintained that both these diseases are 
 essentially the same ; and this has since been confirmed, both in 
 England and in Germany, by experiments, which have clearly 
 proved that the cow receives the small-pox by inoculation, and 
 changes it into vaccine. This, if again introduced into the human 
 body, produces the true cow-pox. He also established the identity 
 of the cow-pox with the disorder called the grease in horses. It 
 has since been ascertained that cow-pox may be communicated to 
 man from the horse, without the agency of the cow ; and it is now 
 generally understood, contrary to the opinion entertained by Jenner, 
 that the disease may originate in the cow without access to horses. 
 
 Children, if healthy, and their skin perfectly free from every 
 kind of eruption, should be vaccinated before the process of teething 
 commences. The most suitable age for the operation is about the 
 fourth or fifth month after birth. The vaccine matter, or lymph, as 
 it is commonly called, should be taken from the pock, or vesicle, 
 between the fifth and eighth days ; and, if circumstances admit, 
 should be inserted in a recent state. It ought to be perfectly limpid 
 and transparent. The operation is very simple. The operator 
 having grasped the child's arm with a sufficient degree of firmness 
 to keep the skin tight, should make two small oblique punctures, 
 by means of a clean sharp lancet, charged with lymph. The punc- 
 tures should be made merely below the scarf-skin, so as to place the 
 matter on the surface of the true skin, from which absorption 
 rapidly takes place. No blood should be drawn. A single full 
 drop of blood is apt to dilute and wash away the matter inserted. 
 A particle of blood usually follows the puncture, showing that it 
 has reached the true skin, and does not interfere with the success 
 of the operation. It will also be proper to charge the point of the 
 lancet a second time with lymph, and wipe it upon the wounds. 
 This precaution is particularly necessary, if the skin be unusually 
 tough or the lancet blunt ; circumstances which in the first instance 
 may have prevented the matter from entering the wounds. 
 
 The effects of vaccination are thus accurately described by Mr. 
 Bryce : — " About the third day after the insertion of the virus of 
 cow-pox, either by puncture or by slight incision in the arm, a small 
 

 904 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 inflamed spot may be observed in the part where the inoculation 
 was performed. Next day this spot appears still more florid, es- 
 pecially if the person be warm; and by passing the point of the 
 finger over it, a degree of hardness and swelling in the part is readily 
 perceived. On the fifth day a small pale vesicle occupies the spot 
 where the inflammation was, and the affection begins to assume the 
 characteristic appearance of cow-pox. In place of inflammation 
 extending round the base of the vesicle at this period, as is common 
 in small-pox and most other pustular diseases, the whole has a milky- 
 white appearance. The vesicle is now turgid, but evidently de- 
 pressed in the centre, while the edges are considerably elevated. 
 For the next two days, the vesicle increases in size, and retains the 
 same character ; so that by the seventh it has acquired very consid- 
 erable magnitude, and is of a circular form if the inoculation was 
 performed by a puncture, or of an oblong form if done by an inci- 
 sion ; but in both cases the margin is regular and well defined ; 
 while the centre, becoming still more depressed, and a small crust 
 forming there, and the edges becoming more turgid, give the whole 
 a very particular appearance and character, which, in my opinion, 
 may readily serve to distinguish this affection from every other. 
 
 "About the eighth day from the time of inoculation the glands 
 in the armpit become a little swelled, occasioning pain and stiffness 
 on moving the arm. Headache, shiverings, a frequent pulse, and 
 other febrile symptoms take place ; and these have been observed to 
 continue from a few hours to two or more days. These symptoms, 
 however, are in general so slight and transient as to require no aid 
 from medicine." 
 
 The dark-colored scab becomes gradually detached, and drops off 
 about the twenty-first day after the insertion of the lymph, leaving 
 an indelible scar, which is of a circular shape, depressed, and in- 
 dented with several small pits, corresponding to the number of cells 
 of which the vesicle had been formed. 
 
 Sometimes, in consequence of a bad habit of body, certain con- 
 ditions of the atmosphere, the use of impure lymph, or other causes 
 with which we are unacquainted, vaccination is rendered imperfect, 
 and does not run through the regular course above described. In 
 such cases the part appears to fester, and is affected with a very 
 troublesome itching. The pock, on the fifth day, is filled with 
 opaque, straw-colored matter, which has no resemblance to the clear 
 limpid fluid contained in the true cow-pox vesicle. The scab which 
 afterwards covers the part is of a yellow color, and falls off on the 
 tenth or twelfth day, sometimes earlier. The above are the usual 
 appearances which result from imperfect vaccination ; but severe 
 
AND MOST KECENT METHODS OF TREATMENT. 905 
 
 inflammation, ulceration, the formation of scales, and other phe- 
 nomena may be manifested ; all of which may be easily distinguished 
 from the uniform signs of cow-pox. When any of these irregular 
 appearances occur, it is advisable to allow the parts to be perfectly 
 healed before 're vaccinating the child. 
 
 REVACCINATION. 
 
 It is known by experience that a few persons — a small propor- 
 tion — need to be revaccinated. Therefore it is advisable to renew 
 the vaccination occasionally, especially when exposed to an epidemic. 
 The operation may be repeated a number of times during the life- 
 time of an individual. It is certainly the safest course. ~No danger 
 or pain attends the operation ; and as it can do no harm and may 
 save life, we should not hesitate to resort to it. Small-pox very 
 very rarely attacks those who have been revaccinated. We should 
 always consider, also, that the first vaccination may have been un- 
 successful, through carelessness or bad luck in the operation. 
 
 VAGINISMUS. 
 
 The attention of the profession has been called to this disease 
 but recently. It is a spasm of the vagina, resulting from an irritable 
 condition of the part that makes sexual intercourse, and conse- 
 quently conception, difficult or impossible. 
 
 This disease causes much domestic unhappiness, and sometimes 
 undoubtedly leads to divorces. Those who suspect that they are 
 afflicted with this nervous condition should at once consult their 
 physician. By so doing they will save themselves much unhappi- 
 ness. The disease is now regarded as perfectly curable. Various 
 methods of treatment are employed for the dilatation of the vagina, 
 and all of them are successful. 
 
 Patients who are afflicted with this peculiar malady are usually 
 of a highly nervous organization, and in addition to the local treat- 
 ment by the physician should also use every means to improve their 
 general condition. 
 
 Barrenness or sterility is caused by this irritable condition of 
 the vagina more frequently than is commonly supposed. I do 
 not mean by this that it is the only or the principal cause of 
 barrenness. Barrenness is a result of a great many diverse causes. 
 It is oftentimes the result of causes which it is impossible to ascer- 
 tain. Very frequently, however, it arises from some difficulty such 
 as vaginismus, as I have above described it, which, under proper 
 treatment, can be entirely removed. Sometimes it is the fault of 
 
 « 
 
906 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 
 the husband, and sometimes of the wife. It should not necessarily be 
 made a ground of reproach against either party. It is frequently a 
 misfortune that is to be borne, like all other earthly afflictions, with 
 calm resignation. 
 
 The false delicacy which prevents many from consulting their 
 medical adviser for diseases of the sexual organs is not only absurd, 
 but in many cases is in the highest degree sinful. (See Women, 
 Diseases of.) 
 
 YAKICOSE YEINS AKD ULCEKS. 
 
 A varicose vein is generally of a blue color, sometimes of a 
 brownish hue, is considerably increased in size, appears knotted, 
 irregular, and winds in a serpentine manner beneath the skin. 
 Sometimes several veins enlarge in this manner within a small 
 space, and appear coiled up, or, as it were, interlaced with each 
 other, so as to form an irregular dark blue-colored tumor under the 
 skin. In other cases the enlargement or dilatation is partial ; and 
 round, circumscribed, elastic swellings or knots appear at irregular 
 distances along the course of a vein. Yaricose veins increase in 
 size when the individual is engaged in any active exercise, or con- 
 tinues long on his feet; whereas, on the other hand, repose, the 
 horizontal position, and pressure cause them to diminish, or dis- 
 appear altogether. 
 
 All veins are not equally liable to this disease ; those which are 
 deeply seated in the limbs or in«the internal parts of the body very 
 seldom become varicose ; this morbid alteration of structure is, on 
 the contrary, very common in the veins situated immediately under 
 the skin. The superficial veins of the legs and thighs are most sub- 
 ject to this disorder. Those on the fore-part of the abdomen and 
 about the scrotum are not unfrequently affected ; but it seldom 
 attacks the veins of the arms. When the veins about the lower 
 part of the rectum and anus become varicose, the disease is then 
 called piles. 
 
 At the commencement of the disorder, one or more veins, com- 
 monly one of the lower extremities, sometimes of both, are observed 
 to be larger than natural, but not attended with pain or any incon- 
 venience. The dilatation and change of structure of the vessels 
 advance very slowly. A year or two, or even a much longer period, 
 may elapse before the patient is induced to pay particular attention 
 to the disease. At length he observes, after walking or remaining 
 long on his feet, that the veins become considerably distended, while 
 the skin over them feels hotter than natural. Kesting in the re- 
 
 * 
 
AXD MOST RECENT METHODS OF TREATMENT. 
 
 907 
 
 curnbent position soon removes these symptoms, but they are readily 
 brought on again by the same causes. The veins being frequentlv 
 distended in this manner, at last become permanently dilated, ac- 
 quire a tortuous appearance, and roll under the skin. As the dis- 
 ease advances, the patient, after any active exercise, experiences a 
 painful sensation of tension in the dilated veins, accompanied with 
 numbness, swelling, and perhaps shooting pains in the limb, which 
 may render him for a time incapable of walking. These symptoms 
 are always aggravated towards night, and again diminished in the 
 morning. 
 
 Xature alone sometimes subdues and expels this disease. In 
 other cases again it continues to get worse, and occasions disorders of 
 the limb of the most serious nature. But in the majority of cases it 
 remains almost stationary ; and, although it may give rise to con- 
 siderable pain at times, is rather to be considered as an inconvenient 
 and troublesome affection than important or dangerous. 
 
 The accidents to which this disorder may give rise are loss of 
 blood from perforation or rupture of the veins, the formation of 
 painful ulcers over the affected parts, and sometimes inflammation 
 of the veins. 
 
 ELASTIC STOCKING. 
 
 Treatment.— We know very little of the nature and causes of 
 
 % 
 
908 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 varicose veins, and are equally ignorant of any effectual method of 
 curing them ; but it has, nevertheless, been proved by experience 
 that we have it greatly in our power to retard the progress of this 
 affection, to alleviate the pain, and to reduce the swelling by a 
 properly-regulated and permanent compression. For this purpose 
 a laced stocking is generally employed ; and this, with rest in the 
 horizontal position, are the grand means of palliating the disorder. 
 
 "When the veins or the adjacent parts become inflamed and 
 painful, leeches should be employed, and vinegar and water, Goulard 
 water, or any other cold lotion, ought to be constantly applied to the 
 parts. Sometimes cold applications do no good ; in such cases, 
 bathing the part with a warm decoction of poppy-heads, or warm 
 water with laudanum, will be found serviceable, and more agree- 
 able to the feelings of the patient. The bowels should be freely 
 opened by means of calomel and jalap, followed by Seidlitz powders, 
 Epsom salts, or any other cooling saline purgatives. Low diet and 
 quietude in the recumbent position are to be strictly enjoined until 
 the inflammation be entirely subdued. 
 
 The treatment is the same as for other ulcers. (See Ulcers.) 
 
 VERATRUM VIRIDE (AMERICAN HELLEBORE). 
 
 This grows in all parts of the United States. The remedy is 
 used in lung fever, acute rheumatism,, and in some other affections. 
 Its effect is to reduce the pulse. The dose of the tincture which 
 is chiefly used is from one to eight drops. The remedy is a power- 
 ful one, and is not adapted for domestic use. 
 
 VERTIGO, OR DIZZINESS. 
 
 This is a symptom of a large variety of nervous conditions. It 
 sometimes indicates some serious disease, and sometimes is a mere 
 occasional and temporary annoyance. 
 
 There are persons who are subject to attacks of vertigo. They 
 become giddy, and reel like one intoxicated. Their vision becomes 
 blurred, there is sickness at the stomach. These attacks may last 
 a moment or two, or several hours. 
 
 Vertigo may be caused by anything that injures the nervous sys- 
 tem — excessive mental labor, abuse of the appetites, loss of sleep, 
 anxiety — all causes and combination of causes that bring on dys- 
 pepsia, constipation, nervous exhaustion, and other nervous diseases. 
 (See Nervous Diseases.) 
 
 Verjjgo often causes unnecessary alarm. Patients who are sub- 
 
 . 
 
AND MOST RECENT METHODS OF TREATMENT. 909 
 
 ject to the attack fear that it may lead to something worse. They 
 fear lest it may lead to apoplexy, epilepsy, or insanity. This fear, 
 though very natural, is, as a general rule, unfounded. In the major- 
 ity of cases, patients who suffer from apoplexy, epilepsy, and paraly- 
 sis do not have these attacks of vertigo before the attack. 
 
 Frequently those who for years have been subject to attacks of 
 vertigo, die of some disease that has no connection with the brain. 
 
 There is no specific treatment for vertigo. The treatment, 
 hygienic and medical, is precisely the treatment for nervous diseases 
 in general. (See Nervous Diseases, Treatment of.) 
 
 VOMITING OF BLOOD. 
 
 Yomiting of blood sometimes takes place in consequence of a 
 blow on the stomach, from riding a rough-trotting horse, from 
 strong mental excitement, or other accidental causes ; but in gen- 
 eral it arises from disorders of internal organs. 
 
 In malignant diseases of a putrid character, where the blood it- 
 self is diseased, as in small-pox and malignant or putrid fevers, in 
 which dark-colored spots appear in the skin, vomiting of blood is a 
 symptom which indicates extreme danger, and is generally to be 
 considered as the forerunner of death. 
 
 In warm climates, vomiting of blood not unfrequently occurs 
 from an obstruction in the liver or enlargement of the spleen. It 
 sometimes proceeds from constipation of the bowels, or may be 
 caused by a simple or a cancerous ulcer in the stomach ; it occasion- 
 ally arises in young unmarried women, in consequence of suppres- 
 sion or diminution of the menstrual discharge, and in the latter case 
 is more alarming in appearance than really dangerous. The danger 
 principally proceeds from the source in which the hemorrhage 
 originates. 
 
 It is of importance, in every case, to ascertain whether the blood 
 is discharged from the stomach or from the lungs. In the former 
 case, the vomiting is usually preceded by a sensation of weight, 
 anxiety, and sometimes pain at the pit of the stomach ; is not ac- 
 companied by cough, or any uneasiness about the chest ; the blood 
 is usually in considerable quantity, of a dark color, not frothy, and 
 mixed in most cases with portions of food. When the discharge 
 proceeds from the lungs, the blood is generally in smaller quantity, 
 of a brighter red color, frothy, and not mixed with the contents of 
 the stomach ; a feeling of heat or other symptoms of uneasiness are 
 felt at the chest; and the patient in most cases has been previously 
 affected with cough, or has shown other symptoms of a disordered 
 
 I 
 
910 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 state of the lungs. Hemorrhage from the lungs is always a more 
 formidable symptom than when it proceeds from the stomach, inas- 
 much as in the former case it is generally a symptom of pulmonary 
 consumption. (See Spitting of Blood.) 
 
 Treatment. — In the great majority of cases, vomiting of blood 
 from the stomach is merely symptomatic, and not a disease in itself; 
 our remedies are therefore to be directed to remove the disorder on 
 which it depends. If it arise from derangement of the menstrual 
 function, the reader will find the necessary instructions in their 
 proper place. If it proceed from constipation of the bowels, the 
 treatment will be found under that head. In warm climates en- 
 largement of the spleen sometimes takes place suddenly from con- 
 gestion of blood, and gives rise to hemorrhage from the stomach. 
 
 In every case it is advisable to give the patient cold drink — 
 spring water — iced water, if it can be procured — or an infusion of 
 tamarinds. Bodily and mental quietude are absolutely necessary ; 
 and the diet for some time should be of the very lightest quality, 
 and in small quantities. The oil of turpentine, in doses of twenty 
 to thirty drops in cold water, every four or six hours, has been em- 
 ployed successfully to arrest the vomiting. It will be necessary to 
 give brandy, in small quantities, at short intervals, if the patient be 
 much exhausted. 
 
 VOMITING, OK KEGUBGITATIOK 
 
 Sometimes the habit of vomiting becomes so persistent as to de- 
 serve to be called a special disease. It is frequently a symptom of 
 a large variety of diseases, and especially of dyspepsia and of in- 
 flammation of the stomach. (See Dyspepsia; and Stomach, Inflam- 
 mation of.) 
 
 The form of which I speak here is rather a nervous disease, not 
 depending on any inflammation. It seems oftentimes to be an affec- 
 tion of the pneumogastric nerve that supplies the stomach. 
 
 When a patient is troubled with obstinate and persistent vomit- 
 ing, all that we can do is to try in succession the following remedies, 
 until we hit on the one that meets the case : 
 
 1. Oxalate of cerium, in doses of from one to three grains. 
 
 2. Bromide of potassium, in doses of from five to fifty grains in 
 water. 
 
 3. Subnitrate of bismuth, in doses of from five grains to half a 
 drachm. 
 
 4. Electrization, general or localized. (See General Electriza- 
 tion and Localized Electrization}) The disadvantage of this very 
 
 j 
 
AND MOST RECENT METHODS OF TREATMENT. 911 
 
 excellent method of treatment is that very few are situated so that 
 they can avail themselves of it. 
 
 5. Creosote, in doses of one, two, or three drops in water. 
 
 The diet should be carefully studied. Each case is a law unto 
 itself. I have at the present time under treatment a patient whom, 
 at one stage of his illness, a piece of cracker would apparently in- 
 jure, but who could at the same time eat a hard boiled egg with 
 impunity. 
 
 WARTS. 
 
 The excrescences from the skin called warts may appear on any 
 part of the body, but they occur most frequently on the hands. 
 
 Warts have sometimes narrow necks, more frequently broad 
 bases ; they may be quite superficial, or attached to the parts be- 
 neath by roots ; their surface is smooth, or rough and fissured ; and 
 they are not in general painful, unless when bruised or otherwise 
 injured. The popular opinion that warts may be propagated by the 
 blood, which they sometimes discharge when rubbed or roughly 
 touched, is incorrect ; but it appears probable that the matter se- 
 creted by soft warts is capable of producing a similar affection in 
 other persons. 
 
 Treatment. — Warts frequently disappear without treatment, but 
 in many cases they increase in size, become troublesome, and re- 
 quire to be removed. Pass a pin through the wart. Apply one 
 end of the pin to the flame of a lamp ; hold it there until the wart 
 fries under the action of the heat. A wart so treated will take 
 final leave. This method of treatment is warmly recommended. 
 The best method of removing hard warts is to cut them off with 
 a knife or scissors, and then apply caustic to destroy their roots. 
 These excrescences may be destroyed by touching them repeatedly 
 with lunar caustic, blue vitriol, or nitric acid/ or they may be effect- 
 ually removed by the application of the chloride of zinc. A wart 
 with a narrow neck may be easily destroyed by fastening round it a 
 silk thread or a horse-hair. After it drops off the roots should be 
 touched with caustic, to prevent it from growing again. A good 
 application for destroying warts about the anus or genital organs is 
 a powder composed of equal parts of the powder of savme-leaves 
 and verdigris. 
 
 WATER CURE, OR HYDROPATHY. 
 
 Water has been used in the treatment of disease from the 
 earliest times. By the example and influence of Priessnitz, the sys- 
 
912 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 tern called hydropathy was established in Germany. This system 
 consisted in using water as an exclusive method of treatment for 
 nearly all diseases. 
 
 Hydropathy has been, is now, and always will be more or less 
 successful in a variety of diseases. All good physicians make a 
 greater or less use of water in the prevention and treatment of dis- 
 ease; hut no good physician depends on water for the treatment 
 of all or the majority of diseases. 
 
 Some of the processes of the water cure are decidedly beneficial 
 in many diseased conditions ; others are severe, violent, are adapt- 
 ed but for a few, and in many instances have done great harm. 
 
 Among the processes of hydropathy I may mention the follow- 
 ing: 
 
 RUBBING WET SHEET. 
 
 A coarse sheet of linen or cotton, wet, and wrung out more or 
 less, is thrown over the patient's body. The assistant then rubs the 
 patient over the sheet from two to Hyq minutes, until the surface 
 of the body becomes warm. 
 
 The shock of the wet sheet is at first disagreeable ; but in many 
 cases the effects are most agreeable. 
 
 SHOWER BATH. 
 
 This is a powerful tonic, but it must be used with caution. 
 There are many — very many — who cannot use the shower bath. 
 Some persons who are quite strong cannot endure the shock. For 
 others, it is a most agreeable and beneficial luxury. Each case must 
 be studied by itself. 
 
 WET-SHEET PACK. 
 
 A linen or cotton cloth is wet and wrung out, is spread on a bed 
 which has previously been prepared by removing the usual clothing, 
 and placing on it some flannels and comforters. The patient, un- 
 dressed, lies down on the sheet. The sheet is wrapped closely 
 about his body, and over all are folded the flannels and comforta- 
 bles. The patient remains in the pack from ten to twenty minutes. 
 To some patients the sensations of these packs are delightful. Like ' 
 all the processes of the water cure it should be used with caution. 
 
 SITZ BATH. 
 
 In this process the patient sits in a tub, in which there is suffi- 
 cient water to cover the hips, from five to twenty-five or thirty 
 minutes. 
 
AND MOST RECENT METHODS OF TREATMENT. 913 
 
 WET BANDAGES AND COMPRESSES. 
 
 These can be used by every family. A piece of linen or cotton 
 maybe wet and wrung out, and placed over the stomach or bowels, 
 and over this may be placed a piece of flannel or oiled silk. The 
 cloth may be kept in place by tapes or pins. I have found this 
 treatment to afford great relief in dyspepsia. 
 
 A wet compress may be placed about the neck in the same way 
 in sore throat. Spongio-piline is a good form of compress. (See 
 Spongio-piline.) 
 
 DOUCHES. 
 
 A douche is a stream of water that falls from a certain height 
 upon any part of the body. For domestic use the common pump 
 or spout will afford a fall of a few inches, that may be sufficient 
 in the treatment of sprains. Another way of using the douche 
 is for the attendant to stand on a chair and pour water from a 
 pitcher or pail on the part desired to be affected. 
 
 DIFFERENT FORMS OF BATHS. 
 
 The cold hath is a tonic. Like other tonics it must be used with 
 caution, and with the limitations that have already been described. 
 Many cannot use it at all. The tepid and warm hath is slightly 
 tonic and sedative ; it induces sleep. It is well to take tepid or 
 warm baths before retiring. Tepid and warm baths relax the skin 
 and predispose to taking cold. They should not, therefore, be 
 taken in the morning (except when they are followed by a cold, 
 bath), but rather after the exposure of the day is over. 
 
 Hot haths are debilitating when they are used for any length of 
 time. It is rarely beneficial to take hot baths unless they are 
 followed at once by the toning influence of cold affusions or showers. 
 (See Turkish and Russian Baths under Hygiene.) Local applica- 
 tions of hot water are frequently of great benefit. 
 
 SEA-BATHING. 
 
 This is a method of employing water that, in a vast number of 
 cases, is as beneficial as it is agreeable. It will not, however, 
 answer for all. 
 
 It is well for invalids to take medical advice before taking a 
 course of sea-bathing. The feeble should always begin cautiously. 
 A course of sea-bathing acts beneficially in these ways : 
 
 1. By the direct tonic effects of the water, when directed with 
 force against the body. Fresh water in the form of the shower 
 bath or the douche is also a powerful tonic. 
 58 
 
914 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 2. By the absorption of the salts of the sea. These salts are 
 really medicinal in their characters. 
 
 3. By the air of the sea. Sea air is impregnated with minute 
 quantities of saline ingredients. These are continually breathed 
 into the lungs, and influence the general system. Sea air is not 
 always beneficial to consumptives. (See Pulmonary Consumption.) 
 
 4. By the rest and sleep which are enjoyed by the sea-side. 
 
 The air of the sea acts upon many like an agreeable anodyne. 
 It induces sleep. Sleep is food. It is the food which over-tired 
 brain- workers especially need. 
 
 Some persons are made sick by sea air. As soon as they visit 
 the shore they are troubled with nausea, indigestion, and headache. 
 
 Mountain air should be sought by those who are not benefited 
 by a residence on the shore. Mountain air is a powerful stimulat- 
 ing tonic. It is rarely injurious, except to those whose lungs are 
 exceedingly weak. 
 
 WATERS, MINERAL AND MEDICINAL. 
 
 The opinion of the physician is very frequently asked concern- 
 ing the various springs, baths, and waters that are so much lauded 
 in advertisements. 
 
 Without specifying any particular name I may make a general 
 reply to the query in this way : 
 
 1. All of these waters really or apparently benefit some of those 
 who try them. 
 
 If a thousand patients afflicted with a variety of diseases were 
 to visit some advertised and highly lauded spring that should con- 
 tain nothing but pure distilled water, unquestionably more or less 
 would be apparently benefited, and some would probably become 
 enthusiastic. 
 
 2. All of these are overrated. Patients expect too much of 
 them. Advertisements claim more than is true. Those who have 
 been benefited are apt to look only at the successes, forgetting en- 
 tirely the failures. 
 
 3. Some of these waters are beneficial for some diseases ', but 
 none of them will cure everything. 
 
 My opinion is often asked concerning electric baths. 
 
 I usually reply that bathing in general is beneficial, and that 
 electricity is a remedial agent of remarkable efficacy, but the effects 
 of the electricity when administered through water in the form of 
 baths must be very slight indeed. The currents become diffused 
 through the water, and are not sufficiently concentrated in any one 
 
AND MOST EECEXT METHODS OF TREATMENT. 915 
 
 part to be of much service. I have no doubt that some are really 
 benefited by electric baths, but I should attribute such benefit as 
 much to the effects of the water as to the effects of the electricity. 
 By these remarks I do not wish to be understood as condemning 
 all our mineral springs, iron springs, sulphur baths, hot springs, 
 our Vichy, Kissingen, Saratoga, and other waters ; on the contrary 
 I believe that benefit is often derived from them. I wish both to 
 moderate the enthusiasm of those who happen to receive assistance 
 from any of these waters, and to encourage those who have no 
 faith in them. Those who labor under incurable disease are often- 
 times justified in trying anything and everything that offers even 
 a shadow of hope, except to encourage villany and charlatanism. 
 Those who have gone the round of all these springs, after trying 
 other means of cure unsuccessfully, have at least the consolation 
 that they have left no means untried. 
 
 WHITES, OE LEUCOEEHCEA. 
 
 The mucous membrane of the vagina and womb, in the healthy 
 condition of the parts, is always kept moist by its own secretion ; 
 but from various general or local causes, this mucous fluid, which 
 is only intended to lubricate the parts, is often secreted in too great 
 abundance, and runs from the vagina. But the discharge, far from 
 being always white, as the vulgar term applied to the disease would 
 lead us to suppose, presents various shades of color. At first it is 
 transparent, glutinous, resembles the white of eggs, and is not very 
 copious ; but in the more protracted cases becomes thin, watery, or 
 appears slightly milky, opaque, and is freely discharged. This 
 disorder is not accompanied with pain, except occasionally in the 
 loins, when the patient is fatigued ; but never continues long with- 
 out producing more or less derangement of the general health. In 
 many cases the menstrual discharge is too profuse, irregular, or 
 altogether obstructed ; and although the patient may be robust, and 
 present the general appearance of good health for a considerable 
 length of time, yet at last she becomes pale, and at times haggard. 
 The eyes lose their natural brilliancy, and the lips their color. The 
 feet and hands are often cold ; the bowels are frequently constipated ; 
 she complains of general languor, and labors under the usual symp- 
 toms of indigestion ; and not unfrequently the disorder is compli- 
 cated with hysteria or chlorosis. (See Green-sickness.) In some 
 patients the discharge is slight, and not constant, being only observed 
 for some time after each menstrual period ; in others, again, it is so 
 profuse, that pieces of linen require to be constantly applied in 
 
916 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 order to prevent the fluid from running down the thighs ; and, with- 
 out the greatest attention to cleanliness, irritation or excoriation of 
 the adjacent parts is induced. "When it exists to this extent, the 
 parts are often much relaxed ; and sometimes there is considerable 
 prolapsus, or falling down of the womb ; but there is neither pain, 
 heat, nor swelling, and the discharge is without smell. The term 
 Whites is generally understood to apply only to the disease as above 
 described, which is wholly unconnected with inflammatory action, 
 and arises from debilitating causes — such as poor, watery, and de- 
 ficient diet, living in the confined and impure air of large towns, or 
 in damp, obscure, and ill- ventilated situations, and light or imperfect 
 clothing ; hence the lower classes of females in the country, who 
 wear worsted stockings and woollen under-garments, are very rarely 
 affected with this disorder. It may also arise from trouble of mind, 
 indigestion, obstructed or excessive menstruation, chlorosis, <fec. 
 
 But females are also very subject to discharges from the genital 
 organs of an inflammatory nature, resulting from various irritating 
 or exciting causes — such as the use of rich stimulating food and 
 drink; violent exercises, as dancing and riding on horseback; ex- 
 cessive sexual indulgence, improper habits, and irritation of the 
 parts, in whatever manner produced ; exposure to cold, difficult 
 labor, an acrid state of the lochia or cleansings, worms, piles, &q. 
 This form of the disease, when acute, cannot be distinguished from 
 gonorrhoea ; the symptoms are the same. The patient complains of 
 a feeling of tension of the parts, heat, pain, &c. (See Gonorrhoea.) 
 The discharge at first is milky, then of a dark yellowish appearance, 
 and afterwards changes to a greenish color ; or there may be from 
 the first a discharge of a glairy secretion resembling the white of 
 eggs ; this last indicates that the neck of the womb is affected. 
 If the disorder terminate favorably, the discharge begins to di- 
 minish from the tenth to the twentieth day, and gradually assumes 
 the appearance described in the first form of the disease, and 
 at length ceases entirely ; or it may become chronic, and then a 
 more or less thick discharge, of various colors, is voided, which may 
 continue during an indefinite period. In some cases the secretion is 
 devoid of smell ; in others again it is more or less fetid. This variety 
 of the disease may be characterized by symptoms of a much milder 
 description ; the degree of severity must, of course, depend upon 
 the intensity of the cause, the constitution of the patient, and other 
 circumstances. 
 
 Treatment. — The treatment of leucorrhoea must depend greatly 
 on the cause of the disorder. The indiscriminate use of cold water 
 \>r of strong astringent injections will do more harm than good. 
 
AND MOST RECENT METHODS OF TREATMENT. 917 
 
 Much benefit will often result from the use, by means of a David- 
 son's rubber syringe, of water, as hot as it can be borne. The in- 
 ' jection should be kept up for at least fifteen minutes, and used twice 
 a day. The addition of a drachm of common salt to each pint of 
 water used will often prove serviceable, and in more obstinate cases 
 half the quantity of alum may be substituted for the salt. At least 
 a gallon of hot water should be used at each injection, and the 
 water alone ought to be thoroughly tried for several days before 
 resorting to the salt or alum. This treatment is particularly appli- 
 cable to cases in which the discharge is white and creamy. Where 
 there is a greenish or a clear, glairy discharge, there is reason to 
 suspect some disease of the womb demanding special treatment. In 
 all cases of leucorrhoea the general condition of the patient must be 
 attended to. Tonics, as the various preparations of iron and qui- 
 nine, are very often of as much importance as local treatment. 
 Constipation of the bowels must be obviated, but the habitual use 
 of purgatives cannot be too strongly condemned. Much benefit 
 will be derived from sponging the abdomen and loins every morn- 
 ing with cold salt-and-water, and afterwards rubbing them with a 
 coarse towel until the skin is flushed and warm. 
 
 The use of the hot water, as already directed, should be con- 
 tinued for several weeks after the discharge* has been checked, else 
 the trouble may return ; but it may be sufficient to take one 
 thorough injection daily, instead of two, as at first. 
 
 When a careful use of the simple means recommended, includ- 
 ing tonics and good, nourishing diet, fails to cure or relieve the 
 leucorrhoea, it will be the duty of the sufferer to consult some phy- 
 sician, and follow his advice. 
 
 WHITLOW. 
 
 Whitlow is well known to be an inflammatory and exceedingly 
 painful affection of one of the fingers or thumbs, sometimes of one 
 of the toes, generally terminating in the formation of matter. There 
 are three kinds of whitlow, varying in severity, according to the part 
 of the finger in which the inflammation is seated. 
 
 In the first form of whitlow the inflammation is confined to the 
 surface of the skin at the point of the finger ; sometimes it extends 
 round the base of the nail. In the second form the inflammation 
 is seated in the cellular substance under the skin. In the third 
 form the disease attacks the membrane which covers the bone at 
 the extremity of the finger; and in severe cases extends upwards to 
 the fibrous sheath which binds down and retains the tendons in 
 
918 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 their position. But it must be kept in mind that these three varie- 
 ties of the disease are only to be recognized at their commencement, 
 or in mild cases ; for it often happens that the inflammation is 
 at first superficial, and afterwards extends to the more deep-seated 
 parts ; or it commences in the membranous structures near the bone, 
 and extends outwards. In severe cases, the whole organization of 
 the finger is involved ; and if the disorder be improperly treated, 
 the bone is destroyed, and one or two of the joints may be lost, or 
 rendered rigid and useless. 
 
 The first, which is much the mildest form of the complaint, 
 usually arises from a prick or slight bruise of the finger, particularly 
 when the injury is inflicted at the root of the nail. 
 
 The pain at the commencement is slight, and accompanied with 
 a sensation of itching; the part soon becomes slightly swollen, red, 
 and shining, while a feeling of throbbing is experienced at the point 
 of the finger. After twenty-four or forty-eight hours — sometimes 
 not until the expiration of three or four days — the scarf-skin or 
 cuticle rises from the true skin, so as to form a vesicle filled with a 
 turbid, reddish, or yellowish-colored fluid, which may be situated at 
 the end of the finger or at the root of the nail ; and then the pain, 
 which had gradually become very distressing, and even so severe 
 as to prevent the patient from sleeping, is much abated. 
 
 When the vesicle bursts and the serous fluid is discharged, the 
 true skin appears, covered with a thin layer of yellowish-colored 
 matter ; or it is slightly ulcerated, or even perforated, so as to com- 
 municate with the cellular substance beneath. (See Erysipelas.) 
 If at the commencement the whole of the inflamed part and some 
 distance round it be gently touched with lunar caustic, the disorder 
 may be very quickly and completely arrested in its progress. But 
 if this method of treatment be not resorted to at an early stage of 
 the inflammation, or if it be employed without producing the desired 
 effect, it will then be proper to apply warm poultices of linseed or 
 bread, moistened with laudanum, until a vesicle, as above described, 
 makes it appearance. This should be punctured early with a lancet, 
 or sharp pen-knife, or cut open with scissors, in order to allow the 
 matter to escape. The poultices are to be continued for two or three 
 days, and afterwards common cerate, or any simple dressing, may 
 be applied. Under this treatment the ulcerated part readily heals, 
 new scarf-skin forms over it, and the finger soon assumes its natural 
 appearance. In some instances matter forms under the nail, which 
 is detached in consequence, and falls off ; but this loss is supplied, 
 after a time, by the formation of a new nail. 
 
 In the second form of the disease, or that in which the inflamma- 
 
AND MOST RECENT METHODS OF TREATMENT. 919 
 
 tion is seated m the cellular or fatty substance under the skin, the 
 pain is more severe than in the preceding case; and is even, in many 
 instances, very distressing, before the finger presents any appearance 
 of swelling or redness. But these last-mentioned symptoms are not 
 long in exhibiting themselves, although for some time they are not 
 so well marked as the severe pain which the patient feels would 
 lead us to anticipate. In the course of three or four days the swel- 
 ling gradually increases, until the finger attains twice its natural 
 size ; the redness, pain, and tenderness are greatly augmented, and 
 the patient cannot bear the slightest pressure upon the finger. The 
 swelling extends to the palm of the hand ; in severe cases the whole 
 hand becomes affected, and the pain shoots upward to the elbow- 
 joint. Matter now forms ; and if an opening be not made for its 
 escape, it may accumulate under the skin, from the point of the 
 finger up to the hand, or even extend into the palm of the hand. 
 When at last the matter finds vent and the parts heal, the finger 
 appears greatly reduced in size, in consequence of the cellular sub- 
 stance having been destroyed by the suppuration ; while the joints, 
 from the adhesions which have taken place, are rendered stiff and 
 immovable, the point of the finger being no longer capable of exer- 
 cising the sense of touch. In this case — which is easily distinguished 
 from the first by the severe pain and the symptoms of general ex- 
 citement, which are always experienced for some time before redness 
 and swelling of the finder are manifested — the treatment must be of 
 a more active description. A free and deep incision should he 
 made lengthwise at the point of the finger, in order to prevent sup- 
 puration, or to give vent to matter if it be already formed. In 
 either case, by adopting this step early, the patient is soon relieved 
 from pain, and the disastrous consequences which would otherwise 
 follow are effectually prevented. Immediately after the opening- 
 has been made the finger should be immersed in warm water ; and 
 as the blood flows from the wound, the patient's suffering ceases. 
 This simple though painful operation is attended with no risk, and 
 may be performed by any one. The principal point to be attended 
 to is to make the incision sufficiently deep to reach the seat of the 
 inflammation, or the matter, if it be already formed. Emollient 
 poultices are afterwards to be applied ; and in the course of a day 
 or two matter begins to be discharged from the w T ouncl, which soon 
 fills up and heals. 
 
 In the third form of whitlow, whether arising from a punctured 
 wound or from any other cause, the inflammation is seated in the 
 periosteum, or membrane which covers the bone of the last joint, 
 or in the tendons, and their sheaths higher up. There is perhaps 
 
920 DESCRIPTION OF THE PRINCIPAL DISEASES 
 
 
 
 no kind of bodily suffering which equals this in intensity ; and the 
 acute pain gives an intimation of the nature of the disorder, which 
 is not to be mistaken. Making an incision, as already directed, is 
 indeed the only measure on which much reliance can he placed. To 
 be of service, this should be done early, because, if the smallest quan- 
 tity of matter be thrown out from the membrane of the last bone of 
 the finger, or be pent up within the sheaths of the tendons, which 
 rest upon the second and third bones, the pain becomes so excru- 
 ciating that high fever is produced, to sleep is impossible, and the 
 patient may even become delirious or be seized with convulsions. 
 Not only the finger, but the hand and wrist also become swollen ; 
 the pain extends to the elbow, and even to the shoulder, and, if vent 
 be not given to the matter, it spreads among the tendons, and may 
 even accumulate in the palm of the hand, while the finger-bones 
 become diseased, and are destroyed. If under such circumstances 
 the patient escape with the loss of one joint, he may consider him- 
 self fortunate. If the last joint of the finger be chiefly affected, the 
 incision should be made as already directed ; but if the pain and 
 inflammation be seated higher up, the cut should be made at one 
 side of the finger ; and care should be taken to carry it down to the 
 bone, whether it be required at the point of the finger, or higher 
 up near the hand. The subsequent treatment is the same as in the 
 preceding case. 
 
 DISEASES OF WOMEN. 
 
 In no single department of medical science has greater progress 
 been made within the last twenty years than in that pertaining to 
 diseases of women — by which we mean those maladies peculiar to 
 woman by virtue of her sex. These manifold diseases and derange- 
 ments are now better understood and more intelligently treated than 
 at any former period in the history of medicine. This advance is 
 due in a great measure to the invention and application of improved 
 means of investigation, enabling the practitioner easily to distin- 
 guish between various diseases having complicated or somewhat si- 
 milar symptoms. 
 
 The study of these diseases has doubtless been stimulated by 
 their extraordinary prevalence among all classes of society and in 
 all civilized countries. It is undoubtedly true that among American 
 women robust health is the rare exception, and disease, of some form 
 implicating the uterine system, the general rule. It would be a 
 long and laborious task to investigate in detail the numerous causes 
 that conspire to render our women the subjects of so many distress- 
 
AND MOST RECENT METHODS OF TREATMENT. 921 
 
 ing maladies. Yast numbers of children are born with the germ 
 of disease, that may remain latent during childhood to be developed 
 in early womanhood. But supposing a child to be ushered into life 
 with a fair constitution, and to pass safely through the dangers in- 
 cident to childhood, there begins for the girl a new series of dangers 
 from the very first occurrence of menstruation. Carelessness, ex- 
 posure, or improper management at that critical age may lay the 
 foundations of life-long trouble. Hence the necessity at that period 
 of maternal care and watchfulness, aided by an intelligent appreci- 
 ation of the perils to be avoided. 
 
 Young women should be early instructed in the care of their own 
 health, with particular reference to disorders of menstruation, since 
 nothing is more common than serious and painful disease solely 
 attributable to exposure, as to cold or wet, through carelessness, or 
 ignorance of the dangerous consequences. 
 
 Keeping the feet always warm and dry would of itself prevent an 
 incalculable amount of disease among young women, both married 
 and single. But the simj)lest preventive measures are constantly 
 neglected, at the expense of health and comfort. It seems almost 
 superfluous to explain to women the many evils that result from 
 tight-lacing, but the reality and frequency of disease due to that 
 cause are well known to every practitioner of any experience in the 
 diseases of females. By this unnatural compression of the body not 
 only are the lungs injuriously compressed, but all the organs below 
 the waist are crowded down, and the womb must ultimately suffer 
 from the violence to which it is subjected. The circulation, too, is 
 necessarily deranged, and it would be altogether unreasonable to 
 expect a healthy performance of the uterine functions under such 
 circumstances. 
 
 Errors in diet, by deranging the general health, indirectly pro- 
 duce or aggravate many uterine diseases. 
 
 The abuse of purgatives, especially of the popular quack medi- 
 cines, is one of the abominations against which women cannot be 
 too emphatically cautioned. Nearly all the pills lauded as remedies 
 for constipation are composed of the cheapest aloes and other purga- 
 tives, and their habitual use leads to a morbid condition of the 
 bowels, and consequent uterine disturbance. 
 
 Married women are liable to a multitude of diseases, hinging, 
 as does the whole active life of woman, on the organs designed for 
 the perpetuation of the species. 
 
 In very early marriages the chances of inflammatory uterine af- 
 fections are greatly increased, and the danger of miscarriages is also 
 greater than when the organs are mature. Miscarriages at any age 
 
922 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 are often followed by a long train of evils, many of which might be 
 avoided if it were thoroughly understood that more care is neces- 
 sary after a miscarriage than after a natural labor. Excessive ma- 
 trimonial indulgence is often a cause of inflammation of the womb, 
 especially if there be any previous displacement. 
 
 Displacement of the womb, either backward or forward, is a 
 common affection, and occurs both in married and single women. 
 Recent cases of displacement can generally be treated with success; 
 but old cases, complicated with inflammation or its results, are often 
 very troublesome and tedious. Falling of the womb is a disorder 
 often capable of cure, and almost always of relief. Tumors of 
 various kinds form upon and around the womb, and demand skilled 
 treatment for their relief. Polypus is a growth generally within 
 the uterus, and commonly first suspected on account of a frequent 
 and profuse discharge of blood. Fistulous openings between the 
 vagina and the bladder or rectum may now be cured with tolerable 
 certainty by a surgical operation. Indeed, so numerous are the ills 
 to which woman is heir, that we have not space even to name them 
 all. It is gratifying, however, to know that they are not now less 
 amenable to treatment than diseases in general. It must be 
 acknowledged that to woman herself is due a large share of the 
 success that attends the management of her diseases at the present 
 day, and every conscientious physician must honor the courage that 
 leads suffering women, for the sake of health, to submit with pa- 
 tience and confidence to means of treatment from which they were 
 formerly debarred by mistaken delicacy and an inconsiderate public 
 opinion. There can be no doubt in the mind of any afflicted 
 woman, that it is her duty, at almost any sacrifice, to recover and 
 preserve her health, since upon that blessing commonly depend the 
 happiness and welfare of an entire family. 
 
 The speculum of Dr. J. Marion Sims, and its modifications (see 
 Specula), is to uterine practice what the ophthalmoscope is in dis- 
 eases of the eye ; it has brought about a revolution in this field of 
 medicine, and is to-day one of the simplest and most valuable sur- 
 gical instruments in use. The patient is placed on the left side, and, 
 without causing pain or exposure, the experienced practitioner in 
 uterine diseases is enabled to see the uterus, gauge its size, judge 
 accurately of its position, observe the condition of the surrounding 
 organs, and make any necessary applications with as much ease and 
 nicety as if any external part were the subject of treatment. Many 
 other instruments are used in connection with the speculum, but 
 most of them depend almost entirely upon it for their utility. Like 
 all other useful instruments, the speculum is of course liable to 
 
AND MOST RECENT METHODS OF TREATMENT. 923 
 
 abuse, but in the hands of the judicious and experienced practitioner 
 its benefits can hardly be over-estimated. 
 
 WOKMS. 
 
 The production and development of worms in the body is one of 
 the most remarkable facts in connection with disease. They are 
 
 Xt 3 2&i 
 
 Fig. 1. — The Round- worm, natural size. 
 " 2. — The Long Thread-worm, magnified. Fig. 2 a. — The Long Thread-worm, natural i 
 
 ** 3.— The Short Thread-worm, magnified. " 3 a.— The Short Thread-worm, natural 
 
 found most frequently in the intestinal canal, but have been observed 
 in the bladder, kidneys, liver, brain, and eyes ; indeed, there is 
 
924 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 scarcely an organ or structure of the bod}' in which they are not 
 occasionally seen. The body is infested with about thirty different 
 kinds of worms. I shall speak here only of the round-worm, thread- 
 worm, tape-worm, and the trichina spiralis found in the muscles'. 
 
 The general symptoms which indicate the presence of worms in 
 the bowels are the following : The face is pale, there is a bluish or 
 livid-colored circle round the eyes, the countenance frequently 
 changes color, the appetite is variable and capricious, sometimes 
 voracious. There is itching of the nostrils and of the anus, dis- 
 turbed sleep, and grinding of the teeth ; the belly is swollen, though 
 not hard ; the stools are slimy and irregular, and griping pains are 
 sometimes felt in the belly. It must be confessed that all of these 
 symptoms are uncertain. The only reliable symptom is to see 
 worms after the child has passed them. 
 
 The round-worm varies from six to ten inches in length, is 
 usually found in the small intestines, and resembles the common 
 earth-worm in its general appearance ; it chiefly infests the bowels 
 of children, sickly persons, and those who are badly fed. The par- 
 ticular symptoms which lead us to suspect the presence of this 
 species of worms are swelling of the abdomen, and sharp or colicky 
 pains felt occasionally in different parts of it, more especially about 
 the navel ; slimy evacuations from the bowels, and a disagreeable 
 breath. 
 
 The thread-worm or ?naw-wor?n is from a quarter to half an inch 
 in length, and is usually seated in the rectum or lower bowel. It 
 is remarkable for the quickness of its movements. People of all 
 ages are liable to be troubled with worms of this description; but 
 they are more common in the bowels of children than in those of 
 adults, or persons advanced in life. The particular symptoms 
 occasioned by thread- worms are itching about the fundament, which 
 is often very distressing when the patient is warm in bed ; occa- 
 sional scalding or difficulty in voiding the urine, a bearing-down 
 sensation at the lower bowel, an oozing of slimy matter from the 
 fundament, irritability of temper, and sometimes great depression 
 of spirits. This and also the round-worm occasionally crawl out 
 of the anus during the night. 
 
 The tape-worm is composed of numerous pieces united by joints, 
 and is generally an inmate of the small intestines, where it lives on. 
 the chyle or milky juice which is intended to nourish the body. It 
 is seldom less than several feet in length, and is frequently dis- 
 charged in pieces four or five yards long. In some instances it has 
 been known to measure upwards of fifty feet. The tape-worm is 
 more common in adults, particularly females, than in children. It 
 
AND MOST RECENT METHODS OF TREATMENT. 925 
 
 is often found alone. Hence the term taenia solium. Itching 
 about the nostrils and anus, pain in the belly, and colic more or less 
 severe, occurring occasionally, are signs which may lead us to sus- 
 pect the existence of tape-worm ; but there is no unequivocal 
 symptom by which the presence of this worm in the bowels can be 
 ascertained. 
 
 For the round-worms and thread-worms the following course of 
 treatment will usually be effectual : 
 
 1. Give of the infusion of senna and pink-root (half an ounce of 
 each to a pint of water), a tablespoonful before breakfast. The dose 
 may be increased or diminished according to the age of the patient. 
 This remedy is much used by the profession and by the people. 
 
 2. Give santonine. (For doses see Santonins.) This medicine re- 
 quires care in using it. It may produce unpleasant symptoms. One- 
 half or one-quarter of a grain is a sufficiently large dose for a child to 
 begin. This dose may, of course, be modified by the age. Three or 
 four grains of santonine may be mixed with cacao butter, and put 
 into the rectum every night. 
 
 3. Give oil of turpentine in doses from one to four teaspoonfuls. 
 This is a very effectual remedy. This is also a good remedy for tape- 
 worm. 
 
 4. Give pumpkin seeds, made into a paste, in large quantities, 
 and on an empty stomach. Among other familiar remedies I may 
 mention cowhage, calomel, powder of tin, &c. 
 
 Turpentine may be given to children with perfect safety in the 
 dose of a dessert-spoonful along with half a cupful or more of milk, 
 linseed tea, gruel, or any other demulcent drink. The best time to 
 take it is in the morning, about half an hour before breakfast ; but 
 if it produces much sickness of stomach or vomiting, the next dose 
 should be given the following forenoon about two hours after break- 
 fast. The dose must be repeated daily for three or four days or a 
 week, a dose of castor oil (a dessert- spoonful or more, according to 
 the age) being given every second day with the turpentine, until 
 all the worms are expelled. The internal use of oil of turpentine is 
 attended with no risk whatever ; even in large doses it either passes 
 off by the bowels or is vomited up without doing any harm. 
 
 In the West Indies the remedy generally employed is cow-itch, 
 which seldom fails in effectually clearing the bowels of this species 
 of worms. 
 
 When tape-worm occurs in adults, which is generally the case, 
 the turpentine must be given in sufficiently large doses to act as a 
 purgative ; or it should be given with castor-oil, in order to ensure 
 its speedy expulsion from the bowels. The usual dose is a table- 
 
spoonful or half an ounce, in conjunction with the same quantity of 
 castor-oil, or twice the quantity of olive oil, which may be taken 
 floating on milk, or on cinnamon or peppermint water. It may be 
 necessary to increase the dose to two or three tablespoonfuls, and in 
 all cases the remedy should be given every second day until the 
 worm be expelled. 
 
 Pumpkin seeds, petroleum in doses of twenty to thirty drops, 
 oil of male fern in doses of a drachm or two, and kousso, in half- 
 ounce doses — all are good remedies against tape-worm. 
 
 Worms, by the irritation which they produce, and the disorder 
 which they occasion by drawing their sustenance from the juices 
 intended to nourish the body, exercise over all the vital functions, 
 and even over the intellectual faculties in some instances, a more or 
 less injurious influence, which is felt throughout the whole animal 
 economy, and may give rise to diseases of a formidable and even 
 dangerous character, such as epilepsy, St. Yitus's dance, catalepsy, 
 hysteria, somnambulism, and other obscure nervous affections. 
 Hence, in all these disorders, when no other cause can be traced, we 
 have reason to suspect the existence of worms in the bowels, even 
 though none of the ordinary symptoms by which they are manifest- 
 ed be present. In many cases the remedies usually administered 
 with the intention of destroying worms have been the means of 
 curing diseases which have obstinately resisted all other methods 
 of treatment. 
 
 Preventive Treatment. — Plainly dressed animal food, well sea- 
 soned with common salt ; good bread, with a sufficiently liberal 
 allowance of wine or porter ; plenty of exercise, and the occasional 
 use of purgative medicine, constitute the best means of correcting 
 that state of the system which appears to be favorable to the devel- 
 opment of worms. Tape-worm comes from infested pork, beef 
 and mutton ■• therefore let the meat he thoroughly cooked. 
 
 Salt is absolutely necessary as a condiment to our food, and 
 appears to be essential to the prevention of worms. According to a 
 law which once existed in Holland, criminals were condemned to 
 live on bread made without salt ; the effect of which was, that worms 
 were generated to such an extent that a lingering and terrible 
 death is said to have been the consequence. Salt is not only an excel- 
 lent preventive, but is one of the safest and best remedies that can be 
 employed against worms. In the dose of from half an ounce to an 
 ounce, taken every morning before breakfast, in warm barley-water 
 or thin gruel, it has had the effect of expelling tape- worm after tur- 
 pentine and other powerful remedies have been tried in vain. The 
 same quantity dissolved in water, and used as an enema, is a pop- 
 
AND MOST RECENT METHODS OF TREATMENT. 927 
 
 ular and frequently a successful method of destroying the ascarides, 
 or thread-worms. 
 
 WORMS IN MUSCLES (TRICHINA SPIRALIS), OR TRICHINOSIS. 
 
 In 1860 a disease was discovered in Germany which is now known 
 as trichinosis, or the existence of worms in the human muscles. This 
 is one of the diseases for the discovery of which we are indebted to 
 the microscope. {See Microscope.) The existence of this parasite has 
 been known since 1832. Small ovoid sacs were found in the human 
 
 TRICHINA SPIRALIS. 
 
 muscles that contained a small round worm coiled upon itself. It 
 was at first supposed that these worms did no injury, and the dis- 
 covery commanded but little attention. 
 
 In 1860 a peculiar epidemic broke out in Dresden, Germany. 
 The symptoms somewhat resembled those of typhoid fever and rheu- 
 matism. On examination of the muscles of one who died, it was found 
 that they were filled with trichinae. . Portions of these muscles were 
 given to a rabbit, and the rabbit died, and his muscles were found to 
 be infested with trichinae. Portions of the muscles of this rabbit were 
 given to another rabbit. This second rabbit also became infested 
 with trichinae, and died. 
 
 Such was the discovery of the disease known as trichinosis. It 
 is manifest that these trichinae grow very rapidly. A single 
 female can produce an enormous number of young. It should be 
 remembered that lower orders of life breed rapidly. " One species 
 of infusoria, visible only under a high magnif} T ing power, is calcula- 
 ted to generate one hundred and seventy billions in four days." 
 
 Concerning the symptoms caused by the presence of tri chinas, 
 Prof. Dal ton remarks as follows : 
 
 " Now to what symptoms does this accident give rise ? As I have 
 already said, within the first ten days there is irritation of the in- 
 testines. In some instances this irritation is very great ; and the 
 greater it is, the more favorable the prognosis, as a general rule. 
 After eating trichinous flesh the patient generally begins to suffer 
 within the first week, sometimes within two days. Now, if the 
 irritation of the intestine be extreme, so that frequent and abun- 
 dant evacuations are produced, the chances are very great that all, 
 or nearly all, of the parasites will be discharged from the intestine. 
 If so, the patient is safe. But if the irritation be not very marked, 
 
time is allowed for the young trichinae to penetrate the intestinal 
 walls, and enter the muscular tissue — from the end of the first to the 
 end of the second week. This is the most dangerous period, the 
 second stage of the disease. There is general pain and soreness, and 
 oedematous swelling throughout the muscular system. At the same 
 time typhoid symptoms manifest themselves ; the patient is debili- 
 tated, his pulse rapid, skin hot, tongue and lips dry, and his general 
 appearance closely resembles that of a patient with typhoid fever. 
 
 " The passage of the worms into the muscular tissue, and the 
 changes taking place there, are very apt to produce symptoms 
 which result in the patient's death at or before the end of the 
 fourth week. By that time the worms have become completely en- 
 cysted, and after this the symptoms of irritation begin to disappear. 
 The muscular system becomes habituated, as it were, to the pres- 
 ence of the parasite, and after a while the symptoms all subside ; 
 the patient can move his limbs as before, and then considers him- 
 self as entirely recovered. 
 
 " The disease may be said to have two stages : 
 
 " First, the presence and procreation of the worms in the intes- 
 tines. The symptoms of this stage are diarrhoea, vomiting, and 
 general debility. 
 
 " Secondly, removal of the worms from the intestines to the mus- 
 cles. The symptoms of this stage are severe pains and stiffness 
 in the muscles, great debility, complete prostration, and a typhoid 
 condition. The disease may terminate fatally in five or six days, 
 or may last six weeks." 
 
 The great cause of trichinosis in man is eating jpork that is 
 either raw or not thoroughly cooked. The Committee of the Acad- 
 emy of Sciences in Chicago examined large number of hogs, and 
 found trichinoe in one out of fifty. " Some of their muscles con- 
 tained from 10,000 to 18,000 in a cubic inch." 
 
 The disease cannot be cured. It can be prevented. The way 
 to prevent the disease is, never to eat pork that is not thoroughly, 
 completely cooked. Thorough cooking (not merely warming) de- 
 stroys the life of the trichinae. If we act upon this rule we need 
 not fear the disease. 
 
 Among other parasites found in the human body I may men- 
 tion the Guinea worm, which is found beneath the skin. It is not 
 uncommon in tropical regions. It is about one-twelfth of an inch 
 in breadth, and in length varies between a few inches to five or 
 six feet. They usually attack the lower limbs. They seem to get 
 into the limbs of those who bathe or wash in ponds or streams. 
 They are apt to produce ulceration at some point in the leg. Lit- 
 
AND MOST RECENT METHODS OF TREATMENT. 929 
 
 tie weights are then attached to the worm, and it is slowly worked 
 out. The process sometimes takes days and weeks. 
 
 A few years since I saw a terrible case of this in the State Hos- 
 pital in JS"ew Haven. 
 
 WRITER'S CRAMP. 
 
 This name is given to a spasmodic action of the muscles when 
 one attempts to make a particular movement, such as writing, 
 sewing, playing on a musical instrument, &c. Though called 
 " writer's cramp," it is not confined to writers. It may attack the 
 milkmaid, the seamstress, and the artist, and may render it difficult 
 or impossible for them to pursue their respective occupations. 
 When it attacks the writer he finds that his pen slips from his fin- 
 gers, that he cannot control it as usual, and that his handwriting 
 becomes illegible. 
 
 The disease is a nervous one, and should be treated accordingly. 
 It seemed to be caused by excessive use of certain muscles. The 
 idea advanced by Professor Felton, of Harvard College, that the 
 disease was caused by using steel pens is a delusion. 
 
 The disease is very obstinate. It seems to be a form of partial 
 chorea, or St. Titus's dance ; and partial chorea, as stated under 
 that disease (see St. Vitus' s Dance), is usually an obstinate affection. 
 
 The best treatment that I can recommend for this disease is the 
 assiduous and persevering use of electricity, in the form of general 
 and localized electrization. (See General and Localized Electriza- 
 tion.) I have seen good results from the use of this remedy in one 
 or two instances. Both galvanization and Faradaization may be 
 needed. (See Galvanization and Faradaization.) The results 
 from the use of electricity in this disease are by no means uniform. 
 There are some cases that nothing will help. It is better to take 
 treatment early / it is better still to prevent the disease, by taking 
 good care of the general health, by exercising all the muscles of the 
 body more or less every day, and by avoiding the too excltisive use 
 of any one set of muscles in any employment for too long a period. 
 
 WRYNECK. 
 
 The appearance of this disease every one is familiar with. The 
 
 head is drawn to one or the other shoulder by the contraction of 
 
 the muscles of the neck. The disease is often accompanied by 
 
 considerable pain of a dull, heavy character. This pain is some- 
 
 59 
 
930 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 times relieved by lying down. The head at first seems to be 
 drawn to one side by a succession of jerks. When the disease be- 
 comes fixed the head remains constantly on one side. 
 
 Wryneck must be distinguished from a common " stiff neck," 
 resulting from a cold or rheumatic attack in the muscles of the neck, 
 of a temporary duration. Wryneck is a chronic affection, and is 
 apt to be very persistent. It sometimes resists all remedies. When 
 it once yields to treatment it is very apt to return. 
 
 In the early stages wryneck will sometimes yield to the electric 
 current (see General Electrization and Localized Electrization), or 
 to friction {rubbing). 
 
 In the advanced and obstinate stages there are only two methods 
 of treatment that promise any relief. These are localized electri- 
 zation with the galvanic current (see Galvanization), and the 
 hypodermic injections of morphine (see Hypodermic Injections). It 
 is w T orse than useless to torture the poor patient with blisters, and 
 annoy him with mechanical appliances. 
 
 The morphine may be injected into the arm in doses of from 
 one- tenth of a grain up to as large a quantity as will be borne. 
 
 Neither the use of galvanization nor of hypodermic injections of 
 morphine are well adapted or to be recommended for domestic use, 
 except in special cases. 
 
 Those who are afflicted with obstinate wryneck, and yet cannot 
 obtain skilled medical advice, had better attempt little or no treat- 
 ment whatever. 
 
 YELLOW FEYEB. 
 
 This species of fever very closely resembles the malignant or 
 virulent typhus. The only difference is, that in the former the skin 
 is not unfrequently tinged of a yellow hue, and there is a vomiting 
 of dark-brown matter. 
 
 This vomiting of dark or black matter is characteristic of the 
 disease, but the yellow tinge of countenance is not so ; for although 
 a symptom generally met with, it is not universal. 
 
 Symptoms. — An attack of the disease, known under the name 
 of the yellow fever, is not unusually preceded by a defect of appetite, 
 perverted taste in the mouth, heat in the stomach, flatulency, giddi- 
 ness or pain in the head, dejection of spirits, languor, debility, and 
 costiveness. 
 
 After a lapse of twenty-four or thirty-six hours, the patient is 
 seized with lassitude and weariness ; frequent rigors or chilliness, 
 succeeded by flushings of the face ; redness of the eyes,with pains in 
 
AND MOST RECENT METHODS OF TREATMENT. 931 
 
 the eyeballs and forehead, extending in some cases backwards to 
 the neck ; great faintness, prostration of strength, and frequent sigh- 
 ing, with a tendency to stupor. There is excessive thirst ; the tongue 
 is coated with a tenacious fur of a dark-brown color ; the spittle is 
 viscid ; the skin hot and dry ; the pulse quick, small, and hard ; the 
 urine is high-colored, and scanty in quantity ; but there is an un- 
 usual secretion of bile, which, getting into the stomach by a flowing 
 back from the gall-bladder, is discharged by frequent vomiting. 
 
 In the further progress of the disease, the eyes and face in many 
 instances become of a deep yellow color, which soon extends also 
 to the chest ; the stomach is highly irritable, and almost incessantly 
 throws up a dark-brown or black matter; while at the same time 
 the bowels are very costive, the urine is still high-colored, some- 
 what turbid, and small in quantity, and delirium of a peculiar na- 
 ture arises. 
 
 It seldom happens that any perceptible remission occurs during 
 this first stage of the fever, which usually lasts from thirty-six to 
 forty-eight hours. At the end of this period there is generally some 
 abatement of the symptoms ; but a fresh paroxysm under a highly- 
 aggravated form soon again takes place, and excites alarm both to 
 the patient 'and his friends. 
 
 The fever proceeding in its course, with imperfect remissions 
 and fresh paroxysms every twenty-four hours for several days, great 
 debility becomes manifest, and symptoms indicating approaching 
 putridity make their appearance. The tongue now becomes dry 
 and black ; the teeth and whole of the mouth are coated with a very 
 dark-brown fur ; the breath is highly offensive ; the whole body is in 
 many cases of a livid yellow color ; dark and fetid stools are voided ; 
 discharges of blood take place from the nostrils, mouth, and ears ; 
 hiccups ensue ; the pulse intermits and sinks, and at last respiration 
 wholly ceases. 
 
 Causes. — Those which predispose a person to an attack of the 
 yellow fever are intemperance, a full plethoric habit of body, in- 
 tense hot and sultry weather, and exposure to night air or cold. 
 
 The exhalations arising from vegetable matter under a state of 
 decomposition, or marsh effluvia, as they are termed by professional 
 men, may, under a deranged state of the atmosphere from great 
 preceding heat and drought, have given rise to this species of fever 
 in the West Indies, particularly in persons habituated to a cold or 
 temperate climate. It is also an unsettled point whether or not it is 
 of a contagious nature. The opinion I hold, and ever did entertain 
 is, that -it is communicable from one person to another, or is con- 
 tagious in an impure or deteriorated atmosphere, where many sick 
 
932 DESCRIPTION OF THE PRINCIPAL DISEASES, 
 
 are lodged together in one room, and where there is at the same time 
 a neglect of cleanliness and proper ventilation ; but where there is 
 a free admission of pure fresh air, and a proper attention is paid to 
 strict cleanliness in every respect, its contagious properties may be 
 so diluted as to become harmless, and incapable of being communi- 
 cated to another person from the one laboring under it. 
 
 The yellow fever diners from typhus in the following circum- 
 stances, viz., it usually prevails only during or immediately after 
 very hot seasons, in which the typhus is soon extinguished ; and it is 
 in its turn completely annihilated by cold weather, in which typhus 
 is most prevalent, if accompanied by humidity in the atmosphere. 
 
 Our opinion as to the event of the yellow fever must be drawn 
 from a careful consideration, of the age and habit of the patient, the 
 mode of attack, and the nature of the symptoms. The danger will 
 be in proportion to the full and robust habit of the patient. Extreme 
 debility, severe and incessant vomiting of dark or black matter, the 
 sudden oppression of all the functions, tremors of the body when 
 moved, dilatation of the pupils of the eyes, with great stupor, pen- 
 sive sadness in the countenance, a weak irregular pulse, highly 
 offensive breath, black and fetid discharges of urine and stool, and 
 the appearance of purple or livid spots dispersed over the body — all 
 denote that the life of the patient is likely to fall a sacrifice to the 
 disease ere long. On the contrary, a considerable diminution of the 
 affection of the head, a lively appearance of the eyes, free perspira- 
 tion, a return of natural rest, the pulse becoming fuller and more 
 regular, a gentle purging arising, or the urine becoming very turbid 
 and depositing a copious sediment, and the stomach at the same 
 time perfectly tranquillized, are to be considered in a very favorable 
 light. The disease is apt, however, to exhibit deceitful appearances, 
 and appears at times to be going off, when a sudden change takes 
 place for the worse and carries off the patient ; nay, some sink under 
 it who apparently are in a state of convalescence. 
 
 TREATMENT OF YELLOW FEVER. 
 
 There is no specific for yellow fever. 
 
 In spite of all that we can do, the disease is very frequently 
 fatal. Some epidemics are much more fatal than others. 
 
 The treatment of the mild cases is very simple. Give the 
 patient perfect rest. Keep the sick-room freely ventilated. Sponge 
 the body with cool water. Use mild laxatives — small doses of 
 Epsom salts — to keep the bowels open. 
 
 Put the feet of the patient in a hot foot-bath, without raising 
 him from the bed. This can be done by letting the patient slip 
 
AND MOST RECENT METHODS OF TREATMENT. 933 
 
 down to the foot or edge of the bed, and allowing his feet to fall 
 into a tub of hot water. Eemember that perfect rest is necessary, 
 and the patient must not be disturbed, even to take a foot-bath. 
 
 Keep the skin open by the spirit of mindererus (see Mindererus, 
 Spirit of), or by a mixture of spirit of mindererus and sweet spirits 
 of nitre, in equal parts, and in doses of a teaspoonful every two or 
 three hours. 
 
 This treatment, cautiously carried out, is the best that we can do 
 for the mild cases of yellow fever. It is very well known in the 
 South, where yellow fever prevails, that the great thing in the 
 treatment is good nursing. 
 
 I saw something of the disease in New Orleans and the Gulf 
 of Mexico a few years since, and I am quite well convinced that 
 the common impression on this subject is correct. In the present 
 state of science the treatment for yellow fever is good nursing. 
 
 Besides the measures above indicated, severe cases of yellow 
 fever will need special attention^ according to the symptoms. 
 
 The irritability of the stomach may be relieved by swallowing 
 bits of ice, or by one-grain doses of the oxalate of cerium. (See 
 Oxalate of Cerium?) 
 
 To prevent the black vomit, it is well to try the lead and opium 
 pill (half a grain of acetate of lead and half a grain of opium). 
 
 If the patient becomes very much debilitated, alcoholic stimulants 
 are often needed, just as in typhoid fever. Whiskey or brandy, or 
 brandy-punch may be given, as the patient seems to need them. 
 
 The sick-room and the clothing of the patient should be tho- 
 roughly disinfected. (See Disinfectants?) 
 
 The good effects resulting from cold affusion in this fever are 
 such that it ought to be employed at a very early period. Cold 
 water, when applied externally, when the patient is distressed with 
 the sensation of burning heat, generally affords very great relief to 
 his feelings. It is only, however, when the temperature of the skin 
 is raised considerably above the natural standard that cold water 
 should be applied externally to the body by affusion, or even by 
 wetting it with a sponge dipped in w r ater and vinegar ; and the 
 period of its application and the frequency of its repetition must be 
 regulated by the feelings of the patient ; for should he become chilled 
 by the application, much injury might ensue. 
 
 For the purpose of avoiding fatigue to the patient, w T hich the 
 preparation for cold affusion is likely to induce, it has been recom- 
 mended that he should be covered in his bed with a single sheet 
 wetted- or wrung out in cold water, as this will reduce the heat of 
 his body very considerably by the evaporation which takes place. 
 
93± 
 
 Where neither of these modes of applying cold water can be 
 employed with convenience or safety to the patient, we ought to be 
 content to substitute the wetting of the hands, face, and other parts 
 of the body with a sponge dipped in vinegar and tepid water. 
 
 Some benefit may possibly be derived also from cold water, taken 
 inwardly for drink, as the heat of the body, thirst, and severity of 
 the fever have in many cases been moderated by frequent and 
 small draughts of it. 
 
 If we are fortunate enough to obtain perfect remissions, we 
 should immediately administer the Peruvian bark in substance, if 
 the stomach will bear it ; but if not, we must be content to substitute 
 some lighter preparation of it, such as the infusion or decoction, 
 persevering in the use of the medicine throughout the whole stage 
 of convalescence, which is usually long and tedious. A few drops 
 of the muriatic or diluted sulphuric acid will much increase the 
 efficacy of the bark ; and should any uneasiness of the stomach or 
 bowels arise, or purging be excited, we may add six or eight drops 
 of the tincture of opium to each dose of the bark and acid. 
 
 But should the fever resist our best endeavors to subdue it, and 
 no perfect remissions be observed, but, on the contrary, run its course 
 with violence and great exhaustion of strength, thereby threatening 
 approaching, if not already apparent, symptoms of putrescency, the 
 aid of the most powerful antiseptics must be called in. On some 
 occasions a use of spirituous baths has been added. 
 
 Throughout the whole course of the disease the strictest atten- 
 tion must be paid to cleanliness in every respect. The linen of the 
 bed, as also that of the body, should be changed frequently ; what- 
 ever is voided by urine or stool should be immediately removed, and 
 the chamber of the sick be kept perfectly cool, and properly venti- 
 lated by a free admission of fresh air into it. It may also be sprin- 
 kled now and then with a little warm vinegar. To assist in correct- 
 ing any fetid smell, we may make use of the gaseous fumes arising 
 from the muriatic or nitric acids. 
 
 At an early period of the yellow fever, the patient should be 
 confined to diet of a mild nature, consisting of preparations of arrow- 
 root, sago, barley, &c. ; but as the disease advances, his strength 
 must be properly supported by animal broths made of lean meat, 
 such as beef-tea, veal or chicken broths, somewhat thickened by an 
 addition of crumbled bread, oatmeal, or barley. Where great 
 debility and exhaustion become evident, a moderate use of wine 
 may be allowed ; but it will be best to give it in a diluted state, as 
 in the form of negus, which, as containing a vegetable acid, will 
 add to its good effects. 
 
AND MOST RECENT METHODS OF TREATMENT. 935 
 
 " The food during the course of yellow fever should be of 
 the blandest description, chicken tea, arrow-root, sago, and barley- 
 water constituting the chief articles ; and these should be taken in 
 minute quantities at a time when the stomach is at all irritable. 
 This rule applies to drinks of all kinds. The patient is greedy for a 
 large draught of fluids ; but by sucking them through a glass tube 
 or a straw, or a hollow reed of small bore, or by the tea or table 
 spoonful, they are much more likely to be retained. A cold infu- 
 sion of oatmeal was found an agreeable drink for Scotch seamen, 
 of which they did not seem to tire. A dislike of sweets was ob- 
 served among the patients, and when lemonade was asked for, the 
 usual quantity of sugar was objected to, probably from its rendering 
 the liquid too dense for ready absorption by the stomach, and there- 
 fore less quenching. Tea w T as found so uniformly to disagree with the 
 patients, and cause vomiting, particularly in the advanced stages, 
 that at length it had to be expunged from the yellow-fever dietary. 
 Dilute alcoholic drinks were given freely, and with good effect. 
 Where brandy could be obtained pure (tolerably free from acidity 
 and fusel oil), and was well diluted with water, that spirit answered 
 every indication. Sometimes the effervescing wines were relished 
 and retained, but they are very liable to the objections of contain- 
 ing foreign matters and the products of mismanaged fermentation. — 
 Blair y Aitken. 
 
 ZINC. 
 
 The sulphate of zinc, or white vitriol, in the dose of twenty-five 
 or thirty grains, acts quickly as an emetic, and is therefore the best 
 medicine that can be used for this purpose in cases of poisoning 
 from laudanum and other narcotic substances. It is employed as a 
 tonic and astringent in the dose of two grains twice or thrice a day 
 in chronic dysentery, whites, and other discharges from the mucous 
 membranes, and in the humid asthma of old people. 
 
 ZINC, YALEKIAISTATE OF. 
 
 This remedy is somewhat used in nervous diseases. It is some- 
 times successful in neuralgia. The dose is one grain in pill. 
 
PREGNANCY, LYING-IN ROOM, 
 
 MANAGEMENT OF INFANTS. 
 
 SIGNS AND SYMPTOMS OF PREGNANCY. 
 
 General Symptoms. — When pregnancy has taken place, the 
 face usually becomes pale, the under part of the lower eyelid is 
 of a leaden hue, the features become sharper, and not unfrequently 
 the person becomes thinner, the temper is often more than usually 
 irritable, sickness in the morning and after meals, feverishness, in- 
 digestion, heartburn, languor during the day, disturbed sleep and 
 disagreeable dreams at night, are often the accompaniments of 
 pregnancy. A sense of bearing down, an irritation about the 
 bladder and the seat, an unaccustomed fiow of urine, are also not 
 uncommon symptoms in the early stage of pregnancy. 
 
 State of the Navel. — This, many have considered, presents 
 one of the most decisive evidences of pregnancy. When it has 
 taken place, the navel is drawn inwards and downwards during 
 the two first months ; in the third it is natural ; in the fourth 
 it is not so hollow as before conception ; in the fifth and sixth it is 
 almost level with the surrounding surface ; in the latter part of the 
 sixth and the seventh month it is quite so ; while towards the latter 
 month of gestation it projects considerably. If these symptoms 
 follow in regular succession, it may be considered a decisive sign of 
 pregnancy. 
 
 Ceasing to be Unwell is one of the most common, and 
 generally an early symptom of pregnancy ; but it is by no 
 means a certain sign, as it may arise from many other causes ; 
 if you have been regular up to the time of marriage, it is good 
 presumptive evidence. Such, however, are the caprices of nature, 
 that in some persons this evidence is never decidedly manifested : 
 in such cases it will usually be found that the discharge is smaller 
 
SIGNS AND SYMPTOMS OF PREGNANCY. 937 
 
 in quantity, returns at irregular intervals, and does not last the 
 usual time. 
 
 Enlargement of the Breasts. — This is an appearance which, 
 if unaccompanied by other signs, is of little value ; but if it has 
 been preceded by somewhat of a diminution of their size, and this 
 enlargement then takes place about the third month after the pre- 
 ceding sign, and is accompanied by a slightly painful and prickling 
 sensation, with a sort of knotty external feeling when the hand is 
 applied to the surface, and particularly if there is occasionally a 
 milky discharge from the nipple, it may be considered presumptive 
 evidence of pregnancy. It frequently occurs that the breasts 
 become enlarged shortly after marriage, from the person becoming 
 stouter ; but in tbis case the whole person experiences the same 
 change, and the breasts are soft and have not that knotty feeling to 
 the touch. 
 
 Swelling of the Nipple, and the appearance of the areola 
 or circle surrounding the nipple, are by many writers considered 
 as among the most decisive of those signs of pregnancy which 
 are exhibited previous to quickening. In fair women, and par- 
 ticularly with their first child, the change in the areola is very 
 manifest : from its beautiful roseate hue it turns to a dusky- 
 brown shade ; it increases in size, and continues to darken until 
 the term of gestation is completed. As pregnancy advances, a 
 number of slight excrescences, resembling small pimples, will also 
 frequently appear thereon ; and when the individual has had chil- 
 dren, or is of a dark complexion, this appearance is one of the best 
 criterions for determining the true areola of pregnancy. 
 
 Morning Sickness. — This distressing affection of pregnancy oc- 
 curs during the earlier months. It may commence almost immedi- 
 ately after conception; but the most usual time of its appearance 
 is two or three weeks after. It arises wholly from sympathy with the 
 newly established action of the womb. This is neither a necessary nor 
 an infallible sign of pregnancy, as sickness may arise from other 
 causes, and by some individuals it is never experienced. It may be 
 observed, however, that it has this peculiarity, viz., that it does not 
 affect the general health, nor does it usually impair the appetite. 
 
 Enlargement of the Abdomen. — At an early period of ges- 
 tation the abdomen usually becomes flatter, and it is not until 
 about the third month that the enlargement is perceptible. 
 
 Quickening simply means the first sensation which proves to 
 the mother the vitality of her child. The feeling is so peculiar and 
 so sudden, that it often occasions fainting and hysteria. The sen- 
 sation, which has been compared to the fluttering of a bird, is occa- 
 
93S PREGNANCY, LYING-IN ROOM, 
 
 sioned by the womb suddenly rising from the pelvis, where the 
 motion of the child could not be felt, to a part that is more sen- 
 sible. It is not uncommon for a few drops of blood to escape 
 from the worn!) at the moment of the first sensation. Quick- 
 ening usually takes place about the fourth month or eighteenth 
 week ; but in some cases it occurs as early as the third month, 
 and as late as the fifth. At first the movements of the child 
 are feeble ; but in a short time they become strong, and its 
 motions are felt not only internally, but very distinctly, on ap- 
 plying the hand to the abdomen. Instances are of frequent occur- 
 rence when the motions of the child are so lively as to occasion 
 much distress to the parent ; but a sensation resembling this cannot 
 be depended on as a proof of pregnancy, if it be unsupported by 
 other evidence. 
 
 CONDITIONS SIMULATING PKEGNANCY. 
 
 Cessation of the Menses. — So many diseases may produce this 
 effect, that there is not space here to go into particulars ; suffice it 
 to warn those especially who are married late in life, that this dis- 
 appearance, though continued for months, is no proof of pregnancy, 
 although, as before said, if the individual be young, and has been 
 regular up to the time of marriage, it may be considered presump- 
 tive evidence. 
 
 Enlargement of the Breasts may arise from increased obesity, 
 or from the stoppage of the menses. 
 
 Sickness, Heartburn, Languor, Distension of the Abdomen, 
 may each arise from indigestion. 
 
 Quickening. — Persons who marry late in life are most liable to 
 be deceived by an appearance of quickening when pregnancy has 
 not taken place ; and even medical men have been deceived by this 
 appearance, when they have relied on it unsupported by other evi- 
 dence. This deception is occasioned by the collection of wind in 
 the bowels, which, even to the touch, resembles the movements of 
 a child. 
 
 Enlargement of the Abdomen may arise from dropsy, disease 
 of the ovary, excessive obesity, and many other causes, which bring 
 us to the conclusion with which we set out, viz., that although each 
 of the signs of pregnancy enumerated may be valuable as accessories, 
 yet, isolated, neither is an infallible one of pregnancy. 
 
 DUKATION OF PKEGNANCY, MODE OF BECKONING. 
 
 The duration of pregnancy is usually two hundred and eighty 
 
AND MANAGEMENT OF INFANTS. 939 
 
 days, but it may continue as long as three hundred days, and in 
 very rare cases even longer. In other cases the duration of preg- 
 nancy may be only two hundred and sixty days, or even less. It is 
 impossible to calculate the period of labor exactly, but the nearest 
 approach will be obtained by noting the last day on which signs of 
 menstruation were visible, and counting two hundred and eighty 
 days, beginning with the day after that on which the flow ceased. 
 
 DIET, EXERCISE, &o. 
 
 Diet. — It is of the highest importance that women about to be- 
 come mothers should be generously nourished. An abundance of 
 animal food should be taken, and such articles of diet as have been 
 found to disagree should be carefully avoided. The capricious ap- 
 petite common in the latter part of pregnancy may be indulged 
 within reasonable limits. All stimulants had better be avoided, or 
 taken only by the advice of a physician. 
 
 Dress. — The dress of a pregnant woman should be always loose ; 
 tight lacing must on no account be allowed ; it prevents the deve- 
 lopment of the breasts and abdomen ; impedes the growth of the 
 infant ; causes inflamed breasts, sore nipples, and all the disastrous 
 consequences which result therefrom ; occasioning acute suffering 
 to the mother, and frequently depriving her of the comfort of suck- 
 ling her child. In the advanced stage of pregnancy it will fre- 
 quently produce palpitation of the heart, swelling of the legs and 
 veins, costiveness, and scalding urinary evacuations. 
 
 Exercise. — Popular errors upon this subject of a directly oppo- 
 site character exist, both of which must be avoided. Let mothers 
 pay particular attention to the following remarks : After concep- 
 tion has taken place, the individual should for days take but little 
 exercise ; her mind should be kept perfectly quiet, and all exciting 
 causes avoided. Moderate exercise is, however, proper at every pe- 
 riod of gestation, unless symptoms of miscarriage present themselves. 
 "Walking is the best exercise, but it should not be continued until 
 fatigue is produced. Sailing is a very beneficial mode of exercise, if 
 the season be favorable. Long journeys — long walks — running or 
 dancing shouli be particularly avoided. Violent exercise is the 
 ordinary cause of floodings from the womb ; abortion, rupture, or 
 premature labor may follow; and be it recollected that miscarriage 
 is far more injurious than parturition at the proper period. La- 
 mentable instances of its effects are continually brought under the 
 observation of every medical practitioner. Eew, indeed, whose prac- 
 tice has been extensive but have seen the young and lovely thus 
 
940 
 
 hurrying onwards to a premature grave, from the momentary indul- 
 gence of a whim — a vanity — in spite of advice and in defiance of 
 warnings. 
 
 As the period of parturition approaches, more rest is required 
 than in the earlier months ; still, however, recollect that air and 
 exercise, if they can be taken without fatigue, will be highly bene- 
 ficial. But when there is a tendency to miscarriage exercise must 
 wholly be avoided. 
 
 Late Hours are highly injurious to the pregnant woman ; she 
 should retire to bed early, and take from seven to nine hours' repose; 
 common sense and ordinary experience must force this on her atten- 
 tion ; the lethargy and fatigue which affect her towards night ; the 
 desire to be disburthened of her clothes — the refreshment which 
 she experiences by their being loosened from their ordinary fasten- 
 ings, all point out to her the requirements of nature. 
 
 The state of the bowels should be constantly attended to, and 
 the usual constipation avoided as far as possible by diet, injections, 
 and the mildest measures, all violent cathartics being scrupulously 
 avoided. 
 
 DISEASES OF PKEGNANCY. 
 
 Vomiting generally commences shortly after conception, and 
 ceases on quickening. It is usually most troublesome on rising, 
 and hence has obtained the name of Morning Sickness, though its 
 attacks are not unfrequent after meals. Sometimes it is very vio- 
 lent and continues all day, and everything taken into the stomach 
 is rejected. This form of the disease requires great attention, and 
 the presence of a medical man. The former will generally be re- 
 lieved by a mixture composed of a scruple of bicarbonate of potash 
 or soda, dissolved in a wine-glassful of water and taken during 
 effervescence with a tablespoonful of lemon-juice. These draughts 
 may be repeated thrice a day if the sickness be troublesome ; or 
 half a teaspoonful of citrate of potash in water every hour until 
 the sickness is removed. Yery distressing cases of nausea may 
 sometimes be obviated by taking a small cup of tea or coffee and a 
 piece of toast or bread before rising in the morning. 
 
 Heartburn and Acrid Eructations denote acid in the stomach, 
 and are relieved by opening the bowels with magnesia, and taking 
 half a teaspoonful of carbonate of soda, or a wine-glassful of lime- 
 water in milk, three times a day, or when required. 
 
 Spasms or Cramp of Stomach and Bowels. — If slight, hot 
 fomentations should be applied as warm as they can be borne, and 
 
AND MANAGEMENT OF INFANTS. 94:1 
 
 ten drops of laudanum taken every fourth hour. If very severe, 
 advice must be obtained. 
 
 Incontinence of Urine is sometimes troublesome during preg- 
 nancy, but rest is the only remedy. 
 
 Fainting is most usual during the first three or four months. 
 It generally comes on after exertion, agitation, purging, or exposure 
 to heat. The patient should be laid down with the head low, air 
 should be freely admitted, the dress loosened, the face sprinkled 
 with water, and the forehead and temples rubbed with cologne or 
 any refreshing lotion. The same treatment will apply to hysterical 
 convulsions. 
 
 Cough. — It is generally dry and difficult of cure, and may de- 
 pend on so many causes, that advice from the medical attendant 
 had better .be sought. 
 
 Spitting or Vomiting of Blood calls for immediate professional 
 assistance. 
 
 Headache.— If severe and constant, and there is fulness of 
 blood indicated by a flushed face, dull or bloodshot eyes, sense of 
 giddiness, heaviness over the eyes or in the skull, and the person is 
 far advanced in pregnancy, advice should be taken without loss of 
 time. All headaches are, however, not dangerous. They may 
 arise from costiveness, indigestion, or nervousness. 
 
 Toothache often attacks sound teeth. In such cases extraction 
 is improper. 
 
 Irritation of the Bladder, Retention of the Urine, or Dif- 
 ficulty of Passing it, require the bowels to be kept open. Drinks 
 of linseed tea, barley-water, slippery-elm tea, &c, should be taken 
 freely ; and the patient should recline on a sofa. Great care should 
 likewise be taken not to retain the urine long. 
 
 Salivation is sometimes very troublesome. Washing the mouth 
 with alum-water, and keeping the bowels gently open, frequently 
 afford relief ; if they do not, have advice. 
 
 Pain and Enlargement of the Breasts may be treated by 
 warm fomentations frequently changed. 
 
 Swelling of the Feet and Legs. — The bowels should be kept 
 open, and a bandage applied every morning. The swelling usually 
 goes down in the night, and during the day the recumbent position 
 should be maintained as much as possible. 
 
 Enlargement of the Veins of the Leg requires the careful 
 application of a bandage, and rest in a recumbent posture. This 
 should be attended to by a medical man, as severe consequences 
 often follow neglect. 
 
 Cramps of the Legs and Thighs are often relieved by mere 
 
942 PREGNANCY, LYING-IN ROOM, 
 
 change of position. Gentle friction, with soap liniment six drachms, 
 and laudanum two drachms, is frequently very useful. 
 
 Despondency, Melancholy, Antipathies, &c. — These are not 
 uncommon. The two first are best remedied by change of scene, 
 air, gentle exercise, cheerful company, and due attention to the 
 diet, which should not only be nourishing, but varied and palatable. 
 
 Care of the Nipples. — For a month or six weeks before con- 
 finement, especially in a first pregnancy, attention should be paid 
 to the state of the nipple. If it appear healthy, not tender to the 
 touch, and the skin of moderate thickness, nothing more is re- 
 quired than that it should be rubbed two or three times a day with 
 a little sweet oil, and all pressure from corsets and the clothes most 
 carefully avoided ; for this pressure is frequently the cause of sore- 
 ness and flatness of the nipple. If the nipples are painful, and the 
 skin is thin, they should be washed three or four times a day with 
 any astringent infusion, as of green-tea, oak-bark, willow-bark, or 
 brandy or spirits, and exposed to the air each time for ten or fifteen 
 minutes, or longer. 
 
 SYMPTOMS OF LABOR 
 
 Generally for some days (it may be two, four, six, eight, ten, or 
 twenty days, or only a few hours) previous to the accession of those 
 phenomena which characterize the existence of labor, there are often 
 present certain premonitory signs of its approach, and which, by 
 women who have borne children, are viewed as precursors of that 
 eventful hour. 
 
 Restlessness, particularly at night, is frequent for days and 
 weeks, and is not to be considered unfavorable. 
 
 Subsidence of the Womb and Abdomen is a usual monitor, and 
 may be viewed in a favorable light, as it indicates room in the pel- 
 vis or basin of the body. The female feels as if she carried the 
 child lower than formerly, and thinks herself slacker and less than 
 she was before ; and in many cases, though before inactive and in- 
 dolent, she now feels lighter and more alert. 
 
 Glairy Mucous Secretion, sometimes streaked with Blood, 
 occasionally occurs days before the active symptoms of labor, and 
 renders the parts moister than usual ; which are also enlarged, re- 
 laxed and soft, and sometimes painful. The discharge spoken of 
 is commonly known by the term, a show. 
 
 Irritability of the Bladder, and Irritation and Griping of 
 the Bowels are often present as symptoms of approaching labor, 
 and demand their frequent relief. Pains in the back and loins, 
 
AND MANAGEMENT OF INFANTS. 94:3 
 
 commonly known as bearing-down pains, may occur at this time. 
 They are false pains, but so greatly do they resemble the pains of 
 labor that the medical man only, upon an examination, can distin- 
 guish between the two kinds. 
 
 The Movements of the Child become stronger and more active, 
 and are felt lower down; and there are also pain and weight in the 
 loins. When the above symptoms occur it will be well to send for 
 the nurse, and apprise the female friend who is to be present at the 
 approaching event. 
 
 THE LYING-IN CHAMBER. 
 
 The Bed should be so placed that the room ma}' be well venti- 
 lated, without its being in a draught. The bed-curtains, if any, 
 should be thin, and never completely drawn round the bed, so that 
 pure air may be freely admitted and the impure air easily escape. 
 The bed should not be against the wall, but placed so that assist- 
 ance could be afforded on either side if required. The patient is 
 liable, if placed on a feather heel, to sink into a hole, and thus pre- 
 vent her medical attendant from being of so much service to her 
 as he might be. It will, therefore, be advisable to place the mat- 
 tress on the feather bed, and over it should be put one or more 
 dressed sheep-skins, or a piece of oil-cloth or oiled silk, and above 
 this the ordinary binding blanket and a clean sheet in the common 
 manner ; another in the form of a roller should be applied across 
 the bed, having the ends folded in at the sides ; a coarse blanket, 
 folded within a sheet in the form of a table napkin, should be laid im- 
 mediately underneath the patient, so as to be easily removed after 
 delivery ; the upper sheet, blanket, &c, are put on as usual. 
 
 The Dress should be as slight as possible. A loose dressing- 
 gown does very well in the earlier stage of labor, but in the more 
 advanced a bed-gown and chemise should be worn ; the latter is to 
 be folded round the waist, so that it may be kept dry and be drawn 
 down after labor is over. The lower part of the body should be cov- 
 ered with a petticoat, so made that it can be taken off without rais- 
 ing the person when delivery has taken place. 
 
 The stays should never be worn, but in their place a broad double 
 calico bandage, or binder, made with three rows of tapes on each 
 side, so that it can be made tighter as labor progresses, and be used 
 for the ordinary binder afterwards. If it is made with straps to 
 come under the thigh from the back, to fasten in the front with a but- 
 ton, it will be kept down better. 
 
 Heat of the Room. — This should be regulated by the patient's 
 
944 
 
 feelings. If too hot, it will produce fever, add to the fatigue, often 
 i*ender the pains irregular and ineffective, and thus protract the labor. 
 
 Attendants. — The only attendants required are the nurse and 
 medical man, but a female friend may be allowed, for it inspires 
 confidence. Avoid whispering, or any appearance of concealment, 
 as it may make her distrustful of her own powers, and perhaps 
 doubtful of those of her necessary attendants. 
 
 Sleep. — If she be disposed to sleep between her pains, she should 
 not be disturbed. 
 
 Food.— There is seldom much inclination for food, and, if the 
 labor is not protracted, no occasion for it ; but if there is an inclina- 
 tion to eat, she may have a little tea with dry toast, soup, sago, or 
 light pudding ; but everything heavy must be avoided. 
 
 The Urine should be regularly and frequently evacuated. The 
 bowels, if not open, should be acted upon by taking, as labor ap- 
 proaches, a tablespoonful of castor oil, or an injection composed of 
 a pint of thin gruel and an ounce of castor oil. Much comfort is 
 derived from this, and the unpleasant consequences which some- 
 times take place near the end of labor (if this has not been attend- 
 ed to), avoided. On the other hand, if the bowels are too much 
 relaxed, take ten drops of laudanum in a w T ine-glass of water. 
 
 Shivering is very common, from a gentle tremor to a complete 
 and violent agitation of the body. "When this is the case, some warm 
 tea or gruel, without wine or spirits, should be taken. 
 
 Vomiting is not uncommon, and is useful by emptying, per- 
 haps, an overloaded stomach ; it also tends to facilitate the labor. 
 
 Cramp during labor is frequent, and may arise from having 
 been in one position too long, for change of posture relieves it ; but 
 if in the hip and thigh, it generally proceeds from the head of the 
 child pressing on a particular nerve in the pelvis, and is not re- 
 moved until it has passed that part. 
 
 Duration of Labor. — A first labor is generally the most pro- 
 tracted ; but under proper management, and due submission on the 
 part of the patient, is not more dangerous than subsequent ones. 
 
 Napkins, &c. — The nurse will of course attend to there being a 
 sufficient supply of well-aired napkins, a pair of scissors, a skein of 
 thread, and a proper receiver of flannel for the infant. 
 
 Hot Water. — It will also be well to have an abundant supply 
 of hot water in the house, which would be required if the infant 
 should happen to be born in a state of asphyxia, or suspended 
 animation. 
 
 Ice. — It is well to provide some ice also, in case it should be 
 necessary to arrest hemorrhage, or for other purposes. 
 
ANB MANAGEMENT OF INFANTS. 945 
 
 LABOR 
 
 Symptoms of Labor. — There is pain in the back and loins, oc- 
 curring at irregular intervals, and producing most disagreeable sen- 
 sations; there is also generally a show; these sensations continue; 
 the patient becomes uneasy; has frequent warm and cold fits, with 
 urgent desire to pass urine, &c, and is exceedingly restless; every 
 situation and position appears insupportable and uncomfortable to 
 her. By degrees the pains increase in frequency and force; they 
 occur now at regular intervals of ten or twelve minutes, and do not 
 occasion that continued uneasiness as at first, for when the pain is 
 passed she is pretty easy. 
 
 Close of Labor.— When the labor is proceeding rapidly and 
 the pains become bearing down, the bed must be kept altogether. 
 This is what medical men call the second stage, and having arrived, 
 the patient may assist by exerting her abdominal muscles and 
 diaphragm. To enable her to do this she must not scream, but 
 during pain hold her breath. A towel will also be fixed to the bed- 
 post for her to pull by, or the hand of another person. But this 
 auxiliary ought not to be employed to pull up by so much as to fix 
 the trunk. And if the patient only follow the dictates of nature in 
 this matter, she will do right ; for she will find that all that is 
 required is almost an involuntary exertion of voluntary muscles. 
 Let her, however, be careful to make no straining effort in the 
 absence of pain, during the intervals of which she ought to lie at 
 perfect rest, renewing her strength. As its termination immedi- 
 ately approaches, the patient must be careful not to give way to 
 feelings of impatience and become restless, but implicitly follow the 
 directions of her medical attendant, otherwise serious consequences 
 to herself might afterwards ensue. And now, if she have previously 
 obeyed his instructions, she will be in possession of that strength and 
 fortitude which are called for at this time, and prove invaluable. 
 
 HOW TO PROCEED IF THE CHILD BE BORN BEFORE THE ARRIVAL OF 
 
 the Medical Attendant. — It not unfrequently happens, subsequent 
 to a first confinement, that with some females their labors are so 
 rapid and short (two or three strong and powerful pains being suf- 
 ficient to bring the child into the world) that it is quite impossible 
 for any medical man to get to them in time for their delivery. 
 
 Under these circumstances the friends are generally excited and 
 alarmed. There is no occasion for this. x\ll that is necessary to do 
 is to see that the child is so placed that it shall obtain plenty of air. 
 
 Some nurses will tie the cord and separate the child. There is 
 60 
 
946 PREGNANCY, LYING-IN ROOM, 
 
 no objection to this, provided the child is alive, and respiration fully 
 established. But no nurse ought to he permitted to remove the after- 
 birth. This hint cannot be too strongly borne in mind ; for an inju- 
 dicious interference with the after-birth might be attended with the 
 most serious consequences. 
 
 After-pains. — About half an hour or so after delivery, a patient 
 must expect pain again to occur. These pains, however, will differ 
 from those which have just subsided; as they are not attended with 
 bearing-down efforts, and are accompanied by a slight discharge, 
 these are called u after-pains." They will continue off and on with 
 more or less frequency, severity, and duration, for about eight-and- 
 forty hours. In this respect, however, they vary much in different 
 individuals ; but, whether mild or severe, they must be borne with 
 patience, and must not give rise to anxiety, since they are useful 
 and salutary. If, indeed, they should be violent, they are under 
 the control of medicine, which will accordingly be ordered for that 
 purpose. 
 
 AFTER DELIVERY. 
 
 Faintness and Languor frequently occur immediately after the 
 child is born, even in short and easy labors. The medical attendant 
 will in this case order his patient wine, ale, or spirits, in the pro- 
 portion that may be required. 
 
 The Bandage. — If this is not already passed round the body the 
 medical man will do this, and make it as tight as he may think 
 needful. 
 
 The Dress, Bed-Clothes, &c. — The petticoat worn during the 
 labor may be removed soon after delivery, and the chemise, pre- 
 viously rolled around the waist, brought down. The wet clothes 
 may also be cautiously removed (without it has been ordered other- 
 wise); but in doing this great care must be taken not to move the 
 patient roughly, or permit her to make any effort. She must be 
 perfectly passive, and her attendants will on no account raise her 
 from the recumbent position in the least / but one person taking the 
 feet and another the head, gently remove her as much as may be 
 required to enable them to get away those things that are soiled. 
 Fatal flooding has been produced by raising the body to a sitting 
 position. 
 
 The Diet. — The old custom of starving after confinement has 
 cost many a woman her life. The other extreme must of course be 
 avoided, but the patient may generally be allowed a sufficient 
 quantity to satisfy the appetite of light nourishing food, including 
 
AND MANAGEMENT OF INFANTS, 917 
 
 some meat. Soups and slops are more likely to disagree, and 
 furnish less nutriment. But specific directions as to the most ap- 
 propriate diet in individual cases can be given only by the medical 
 attendant. Ale and spirits should never be given without advice, 
 "but in the absence of explicit instructions it is a good rule never to 
 let the woman complain of hunger. As soon as appetite shows 
 itself, let it be gratified with good nourishing food. 
 
 Acid drinks may be given freely, if there is much thirst. 
 
 The Mind after delivery is often in a state of excitement, and 
 highly susceptible of impressions. It is therefore obvious that any- 
 thing which could excite emotion m health should be guarded 
 against during confinement. For this reason the bedroom should be 
 at the back of the house, or means should be taken to lessen the 
 noise of the street. Above all things keep friends and acquaint- 
 ances out of the room, and guard the woman carefully against the 
 fatigues of conversation. Let the room be dark and quiet, and by 
 all means encourage sleep, and never allow it to be broken need- 
 lessly. After a difficult and exhaustive labor, absolute repose, 
 mental and physical, is indispensable to a good recovery, and the 
 want of it may endanger the woman's life. All the resources of the 
 pharmacopoeia cannot furnish the equivalent of an hour's sound sleep. 
 
 Ventilation. — It is necessary that the room be kept well ven- 
 tilated, and pure air often admitted. For this purpose the windows 
 should be opened from time to time, and the curtains round the 
 bed should not be closed. Everything that can give rise to an un- 
 pleasant smell should be directly removed. 
 
 The Lochia, ok Discharge. — This varies much as to quality, 
 appearance, and duration in different women, and in the same wo- 
 man in different confinements. It is sometimes scanty, and some- 
 times so profuse, especially in those who do not nurse, as to require 
 medical treatment ; but, without it runs into one extreme or the 
 other, it need create no alarm. For two or three days it has the ap- 
 pearance of pure blood; it gradually changes to nearly white ; then 
 to a greenish or brownish cast ; and at last entirely ceases. It does 
 not always follow this course, but the red color may disappear and 
 reappear two or three times. 
 
 Sudden obstructions of the discharge may be occasioned by ex- 
 posure to cold, or indicate some disease, and are always alarming; if 
 attended by pain in the abdomen, fever, sickness, &c, the medical 
 attendant must be sent for ; but in the meantime let the lower part 
 of the belly be well fomented, and let drink of some warm diluent, 
 as whey, barley-water, or thin gruel, be given. Extreme cleanliness 
 during the continuance of the discharge is imperative. 
 
948 PREGNANCY, LYING-IN ROOM. 
 
 Getting up. — Under no circumstances should the woman be 
 allowed to sit up before the seventh day, and then only if it is 
 evident that she can do so without dangerous fatigue. For several 
 days after first getting up the movements should be very slow and 
 gentle, and the reclining posture must be resumed whenever fatigue 
 is experienced. For every day that women are up too soon they 
 often suffer years of misery in after life. Some of the most obstinate 
 uterine diseases to which women are subject owe their origin to 
 exertion too soon after confinement, while the uterus is yet large 
 and heavy, and its surroundings weak and relaxed. If the bed- 
 room is cheerful and well ventilated, it is better for the mother to 
 remain in it from two to three weeks, and not to venture out-of-doors 
 before the fourth week. 
 
 Or Suckxing. — The child should be put to the breast at once — 
 the sooner the better. 
 
 If there is no milk, the action of sucking promotes its secretion. 
 The nipple should be washed with warm water, before applying the 
 babe, to remove a bitter substance which the glands round the nip- 
 ple furnish. 
 
 If, as often happens after the first confinement, the nipples are 
 so flat that the infant cannot take hold of them, they should be well 
 fomented and drawn out by a child a few weeks old, or by a proper 
 breast-pump ; but this must be used with great gentleness and care. 
 When this has been practised two or three times, the child will 
 generally be able to suck. The patient should not be fatigued by 
 the long-continued or frequent application of the child, and she 
 should place it in a position most easy to herself. 
 
 Sore Nipples. — If they are tender and fretted, the strong infu- 
 sion of green tea, brandy, or the lotion of zinc — using each daily in 
 its turn — will quickly harden the skin, and remove its irritability. 
 If not, try a lotion containing one grain of the nitrate of silver dis- 
 solved in one ounce of distilled rose-water; or, what is perhaps 
 better than all, wash the nipple often with the tincture of catechu. 
 These applications should be used freely and frequently during the 
 clay, and the part exposed to the air afterward. 
 
 If they are not only tender and fretted, but also hot, dry, and 
 very painful to the touch, and yet not chapped, the stimulating 
 applications before advised would only aggravate the mischief. A 
 bread and water poultice should be first applied, changed every 
 three hours, and fomentations of warm water, or decoction of poppy- 
 heads, after each poultice is removed. 
 
 When the unnatural heat and great pain of the part are relieved, 
 it must be dressed with a little spermaceti ointment spread upon 
 thin linen or lint. 
 
AXD MANAGEMENT OF IXFAXT8. 919 
 
 From the friction, however, of the child's tongue and gums, the 
 shin may have become excoriated, and cracks formed upon the 
 nipple, or around its base. Every time the infant sucks they bleed, 
 and the mother suffers exquisite pain. 
 
 The first object in the treatment is this : that the infant shall 
 obtain its nourishment from the breast without its mouth coming in 
 contact with the nipple. This is accomplished by means of shields 
 made of glass, wood, ivory, or silver. The shield is neatly covered 
 with an artificial, or prepared cow's teat, through which the child 
 sucks without biting or irritating the nipple. 
 
 The Diet, through the whole period of suckling, should be 
 simple, nutritive, and such as is easy of digestion. If the food taken 
 agrees well with the mother, it seldom if ever disagrees with the 
 infant. 
 
 !No food agrees with an infant so well as the natural; and for 
 six months nothing else, except it be absolutely necessary, should be 
 given. About that time it should be prepared for weaning, by hav- 
 ing a little thin gruel or sago given to it two or three times a day. 
 Weaning should take place when it is about ten months old. After 
 that time the milk becomes vitiated in quality. 
 
 It is an error to suppose that the constitution suffers from suck- 
 ling. Yery many women have improved in their health by per- 
 forming this most feminine of all offices. Many very delicate females 
 have experienced the best effects from nursing their children ; and 
 many of the complaints incident to women are removed or alleviated 
 by it. Excepting the period of gestation, fewer women die when 
 nursing than at any other period. The spirits during this time are 
 generally more- lively and uniform, the temper milder and more even, 
 and the general feelings more healthy and pleasant than before. 
 
 If a mother's own feelings for her infant alone will not lead her 
 to nurse it, there is yet another reason to urge that she should do so. 
 It is, that if not suckling, it is most probable that pregnancy will 
 again speedily ensue, and instead of there being an interval of two 
 or three years, she will be confined every year. Few constitutions 
 can bear up long against this ; the health soon becomes shattered, 
 and a premature old age supervenes. 
 
 Fretfulness, agitation, and all violent emotions should be es- 
 chewed ; they vitiate the milk. A fit of violent passion in the 
 mother has produced convulsions in the infant, and even death. 
 
 Nursing Sore Mouth. — Many mothers, while nursing their chil- 
 dren, are afflicted with extreme soreness of the mouth. In some 
 cases the suffering is acute and without intermission ; the patient can 
 take no food but liquids without torture ; she shrinks from the pain 
 
950 PREGNANCY, LYING-IN ROOM, 
 
 even of articulation, becomes disheartened, loses all elasticity of 
 spirits and all fortitude, her strength fails and her flesh wastes away. 
 Said one who had experienced it, " It is the most wearing suffering 
 which I ever endured." 
 
 This affliction is peculiar to nursing mothers. They must en- 
 dure it, wean their babes, or resort to skilful medical treatment. 
 
 It sometimes unfortunately happens that, from ill health or 
 other causes, a lady cannot suckle her own infant, which is always 
 to be regretted, for no milk will agree with its constitution so well 
 as that of the mother. It is then necessary to select a proper per- 
 son to take upon herself the maternal office. "When it can be done, 
 before engaging her she should be sent to the medical man for ap- 
 proval. But sometimes this is not convenient, and it is therefore 
 necessary to describe who is and who is not a proper person ; for, 
 from one not fit for the office, the infant will receive more hurt 
 than benefit, and had better be brought up on artificial food. 
 
 The wet-nurse should have an adequate supply of milk ; which 
 should be thin, and of a bluish-white color, of a sweetish and faint 
 taste ; and should, on standing, be covered with a considerable 
 quantity of cream. Her confinement should have taken place 
 about the same time as the lady's who requires her services, so 
 that her milk corresponds with the age of the child it is designed 
 she should nourish. 
 
 A woman above thirty-five years of age should not be chosen ; 
 nor one of a petulant disposition ; nor one with small breasts, or 
 excoriated nipples, or who is unwell while suckling; who has any 
 hereditary disease ; who has nursed several months, as the milk may 
 soon leave her, or become of bad quality ; nor one of bad moral 
 conduct, for one who drinks or who is otherwise dissipated will 
 do the child harm. 
 
 If the nurse's child is alive, it should be examined to see how 
 it has thriven, and both it and the nipple of the woman should be 
 inspected for fear of a taint. 
 
 MANAGEMENT OF THE NEW-BOKN INFANT. 
 
 The infant, warmly wrapped up in a flannel receiver by the 
 medical man, and given to the nurse, if it be cold weather, is to be 
 dressed by a good fire. This is necessary, both because the tem- 
 perature of the child's body at birth is several degrees below that of 
 the adult, and because its power of retaining its warmth is also less. 
 
 The first thing to be done is to wash the child ; and as its body 
 will be found covered with a white, greasy, curd-like substance, 
 
AND MANAGEMENT OF INFANTS. 951 
 
 this must be removed, and with great care, particularly from the 
 eyelids, groins, armpits, and from the folds in the skin. This is 
 most easily accomplished with warm water, fine soap, and a soft 
 sponge, the child having been previously well oiled. If any of 
 this secretion is not removed, it dries, hardens, irritates the deli- 
 cate skin of the infant, and sometimes even produces severe exco- 
 riations. 
 
 The surface of the child's body having been thoroughly dried 
 with a soft towel, the next thing is to put up the remains of the 
 navel string. Having been examined by the medical man previous 
 to his leaving the chamber, it is presumed that its vessels are prop- 
 erly secured, and it is now to be protected from injury until it sepa- 
 rates from the body of the child — an occurrence which usually takes 
 place somewhere between the fifth and fifteenth day from delivery. 
 The mode is as follows : A piece of soft old linen rag doubled, and 
 about four or five inches in diameter, is to be prepared, and a cir- 
 cular hole cut in its centre, through which the cord is to be drawn. 
 The cord being carefully folded up in this envelope, is to be laid on 
 the abdomen of the child, and secured by what is called the belly- 
 band, viz. a band of thin flannel five or six inches broad, and long 
 enough to go twice round the body. This ought to be fastened with 
 strings, pins in any part of an infant's dress being objectionable. 
 
 The child is now to he dressed; and about this it is unnecessary 
 to say more than that it should be sufficiently warm, and not cal- 
 culated to place the slightest restrictions upon the movements of 
 the limbs ; and in reference to the head-dress, that a thin muslin 
 cap in summer, and a thick one in winter, is all that is required ; 
 and more than this, or anything that shall compress or restrain the 
 free motion of the child's head, is highly injurious. 
 
 At birth, or two or three days subsequently, the breast of the 
 infant will frequently be found swollen, hard, and painful, contain- 
 ing a fluid much resembling milk. Nurses generally endeavor to 
 squeeze this out, and thus do great mischief; for by this means 
 inflammation is excited in the part, and sometimes abscess is the 
 result. 
 
 If the breasts are simply slightly enlarged, it is unnecessary to 
 do anything more than rub them occasionally and very gently with 
 warm almond oil, and a little time will restore them to their proper 
 size. 
 
 The face and eyelids, and many other parts, may be much dis- 
 colored when the labor has been very difficult ; but these appear- 
 ances generally go off in a few days, when no violence has been used 
 in the delivery. 
 
952 PREGNANCY, LYING-IN ROOM, 
 
 Retention op Urine. — Occasionally an infant will not pass any 
 urine for many hours after its birth. This most frequently arises 
 from the fact of none being secreted. In the last case of this kind 
 that I was called to, three days had elapsed since birth, and no 
 urine had been passed ; it proved that none had been secreted. 
 Sometimes, however, it is the effect of another cause, which the use 
 of the warm bath will be found to remove, which should always 
 therefore be employed four-and-twenty hours after the birth of the 
 infant, if it has not by that time passed any water. 
 
 Food. — The new-born infant will not require any food, if put to 
 the breast soon after its birth. 
 
 If it is necessary to give the infant anything, a little sweetened 
 barley-water, milk and water, or very thin and well-strained gruel, 
 are the best substitutes for the breast; these must, however, be 
 given slowly, and but a few teaspoonfuls at a time ; for an infant 
 a few hours old would be a long time in sucking a teaspoonful ; and 
 the person who may have it in charge must bear in mind that its 
 stomach will not contain more than two or three tablespoonfuls. 
 
 The stomach and bowels of a new-born infant are filled with a 
 blackish-colored matter, commonly called the meconium. This is 
 generally passed soon after birth by the mere effort of nature. The 
 custom of giving a purge is unnecessary ; the first part of the 
 mother's milk is laxative, and answers the purpose better than any 
 medicine. 
 
 ON THE GENERAL MANAGEMENT OF INFANTS. 
 
 By the word " Infancy " is to be understood that period of the 
 time included in the space from birth to the completion of the pro- 
 cess of teething ; when all the teeth have appeared, childhood com- 
 mences. 
 
 The temperature of the nursery should be much the same as is 
 agreeable to a healthy adult, during the whole of the first month ; 
 afterwards it should not be above 60 degrees. Sudden changes of 
 temperature should be avoided. The room should be well ventilated, 
 for the infant and mother both require pure air ; but a current of 
 air should not be allowed to pass over either of them. 
 
 Food. — The experience of ages is in favor of an infant's being 
 nourished entirely on the breast milk for at least six months. After 
 that time it is well to feed it once or twice a day with thin sago 
 or arrow-root, to prepare for weaning. 
 
 Clothing. — The clothing of infants should be, as already stated, 
 warm and light. The long clothes may be worn for about six 
 months; after that time shortened one quarter, and progressively 
 
AND MANAGEMENT OF INFANTS. 953 
 
 to the length which will enable the infant to walk. "Warmth is 
 most essential to an infant's well-doing and comfort ; and this is 
 best effected by using fine flannel next the skin. 
 
 "Washing and Dressing, as before recommended, should be per- 
 formed with great tenderness and care ; for if done violently and 
 hastily the child will scream and cry, and when this happens it is 
 generally owing to the awkwardness of the nurse. The whole body 
 of the infant should be washed night and morning ; and those parts 
 of the body liable to be soiled, after each evacuation. The parts 
 most likely to become excoriated are the folds of the skin about the 
 armpits, neck, and groins ; and these, after each washing, should 
 be well dusted with hair-powder or starch finely powdered, or some 
 other absorbent powder. 
 
 Cleanliness. — The most scrupulous regard must be paid to 
 this, not only for the comfort of the babe, but also from fear of cold, 
 &c. The moment a napkin is soiled or wet, it should be, even in 
 the night, instantly removed, and replaced by a dry and warm one; 
 the parts, if soiled, being first carefully washed with a sponge and 
 warm water, and the groins freely dusted. 
 
 Exercise. — For the first month the infant requires but little ; 
 the fatigue it undergoes from being washed and dressed twice a day, 
 and the requisite changing, is enough, together with being gently 
 carried a few times across the room five or six times a day ; but 
 after the month, on every fair day, it may be carried out for an 
 hour about noon with advantage. The person carrying it should 
 hold it in the horizontal position, and walk slowly and gently, 
 avoiding all running, jumping, or twisting round ; but she should 
 never stand still, and especially avoid doing so at the corner of a 
 street, because of the increased draught of air in that situation ; for 
 the same reason, standing in the lobby of a house with the door 
 open is particularly injurious. As the infant advances in age and 
 strength, the time of its being out should be prolonged gradually, 
 until it almost lives the whole day in the open air ; it should be 
 carried horizontally, until it shows a disposition to sit tep, and even 
 then its head and back should be carefully supported. Until the 
 infant is some months old, it should not be tossed up ; for these 
 tossings, from the fragile state of the bones, might occasion fracture. 
 Gentle exercise in the arms, often changing the position, and nurs- 
 ing on loth arms, is the best until it commences walking, though 
 there is no objection to permitting the infant to roll on the carpet, 
 
 Sleep. — For the first month an infant naturally, when in health, 
 sleeps nearly two-thirds of its time — afterwards rather less ; but 
 
95i PEEGNANCY, LYING-IN E00M, 
 
 during the whole period of infancy it should be allowed to sleep 
 twelve hours, or nearly, out of the twenty-four. While speaking 
 of this subject, it is well to observe that an infant in health should 
 not be taken out of bed in the night, save to be changed when re- 
 quired. It should not be carried across the floor to lull it to sleep, 
 nor spoken to or be allowed to look upon the light of a candle to 
 please it ; by so doing it will acquire a bad habit of waking in the 
 night, injurious to itself, and troublesome to its attendant. It is 
 not necessary to feed a child during the night, even when still 
 being nourished at the breast. A mother who manages well will 
 soon bring her little one into the habit of taking the breast immedi- 
 ately before going to sleep, and not again until morning. 
 
 The night clothes of the infant should be loose. Nothing can 
 be worse than the custom of confining the limbs during the night. 
 
 When the child sleeps in the day, it may be laid in the bed or 
 crib ; but at night, at least for some months, it should sleep with 
 its mother, whose bosom is its best and natural resting-place. 
 Nothing can be more cruel than to banish a sickly or delicate in- 
 fant to a cot or crib during the night, there to wail and cry for 
 lack of that heat which it cannot itself engender, and which its 
 mother's bosom would impart : the reason often gi ven for the use 
 of the crib is, that the parent fears to overlay the infant. But the 
 young mother soon becomes so accustomed to the presence of the 
 child, that its slightest movement is perceived, even while she 
 sleeps, and she will even alter its position without herself waking. 
 
 After the infant is five or six months old, especially in warm 
 weather, it will generate enough heat, and may then sleep in a cot 
 by the bedside. 
 
 It is too much the custom to give some nostrum or other to 
 infants to procure sleep. They all contain opium in some form or 
 other, and are very injurious to the infant, and ofttimes fatal. No 
 soothing medicine whatever should be given to an infant, without 
 it has been prescribed for the particular case by a medical man. 
 Avoid all " soothing syrups." They save the nurse much trouble, 
 but they cost the infant's health, and perhaps its life. 
 
 OF AETIFICIAL NUKSING. 
 
 If it unfortunately happens that a mother cannot suckle, and is 
 unable to procure a proper person to whom to dedicate the mater- 
 nal office, it becomes requisite to consider what is the best food for 
 an infant thus situated. It should of course be, especially in the 
 earlier months, as nearly like the milk of the mother as possible. 
 
AND MANAGEMENT OF INFANTS. 955 
 
 The milk of different animals varies much in the quantities of their 
 component parts, though they all consist of cream, curd, sugar, and 
 whey ; thus there is more cream in the milk of the human, female 
 than that of the cow, and also more sugar and whey. 
 
 Whatever food is given to an infant for the first six months 
 should be very thin, and not much sweetened. After the teeth are 
 all cut, solid food may be given, as rice pudding, &c. ; very little 
 animal food should be given during childhood. Those children 
 thrive best who have but little. 
 
 After the first teeth are cut, the child may have a light-boiled 
 egg or a little calf s-foot jelly, and may also drink new milk and 
 water. 
 
 WEANING. 
 
 This, with all infants, is a most important epoch in their exist- 
 ence, and frequently gives rise to disease if not conducted with 
 great caution. It is difficult to fix a period when weaning should 
 be attempted ; but it never should be done suddenly. The child 
 should be prepared for the change by having, about the sixth 
 month, some artificial food given it — at first once or twice a day, 
 and afterwards oftener; so that it becomes weaned from the Ireast 
 in a day, and has recourse to it only in the night. Let the process 
 be accompanied with gentle carriage in the open air, if the weather 
 is mild. 
 
 Though, as before remarked, it is difficult to fix a precise time 
 for weaning, most authors agree that after the tenth month of lacta- 
 tion the milk becomes deteriorated, and unfit for the infant ; be- 
 sides, after that time the mother's health, as well as that of the 
 babe, will suffer by continuing the practice. It may therefore be 
 cited as a general rule, that the infant should be weaned by or 
 soon after its second birthday, provided it be in good health ; if 
 not, the breast must be continued until the child is better. When 
 an infant is cutting one or more teeth, it is not a favorable time to 
 wean. 
 
 ON THE DISEASES OF INFANCY AND CHILDHOOD. 
 
 By infancy is to be understood the period of time extending 
 from birth to the cutting of the last tooth of the first set of teeth, 
 or about two years and a half. 
 
 Imperforations of various natural passages may take place, as 
 imperforated anus (the lower bowel), nostril, eyelid, urethra, sexual 
 organs of the female, &c. ; or they may be malformed, or the exit 
 
956 
 
 of the natural evacuations may take place from unnatural open- 
 ings. These all call for the immediate aid of the surgeon. 
 
 Nevi Materni (Mother's Marks) may be on any part of the 
 body. When merely discolorations of the skin, and not elevated, 
 they are not dangerous, but seldom admit of cure. But when they 
 are elevated, and of a purple color, and grow rapidly, an operation 
 becomes needful for their removal ; as they might burst, and cause 
 so great a loss of blood as to prove fatal. 
 
 Distortions oe various Parts oe the Body, as Club-foot, &c, 
 are not uncommon. They are to be treated by careful bandaging, 
 &c, under the direction of a surgeon. 
 
 Tongue-tie may be known by the child not being able to suck. 
 It is occasioned by the frcmum or bridle of the tongue being at- 
 tached too near the lips, and requires a simple operation for its 
 removal. 
 
 Hare-lip is well known. If the child cannot suck in conse- 
 quence of the cleft, an operation must soon be performed, though 
 always attended with danger to very young infants. If it can take 
 the breast freely, the operation had better be deferred for a year or 
 more. 
 
 Malformation of the Heart, if considerable, often shows it- 
 self as soon as the child begins to walk. The skin of the child is 
 dark, and looks dirty and leaden ; the nails and lips are blue and 
 livid ; the breathing is difficult ; there is a kind of asthmatic, suffo- 
 cating; cough, and sometimes convulsions. When cough and con- 
 vulsions arise there is danger ; but persons so affected have lived to 
 adult age, and then died suddenly. There is no remedy in medi- 
 cine for this disease ; but all excitement of body and mind should be 
 avoided, the child should have rest, its bowels are to be kept open, 
 and care taken that the stomach is never overloaded with food. 
 
 Dtsury (difficulty of passing water) is to be relieved by warm 
 fomentations, and a drop or two of sweet spirits of nitre. 
 
 Incontinence of Urine (inability to retain the water), especially 
 in bed, is generally incurable until towards puberty. The best 
 remedies are those that strengthen the habit of body, as country 
 air, exercise, and sea-bathing. 
 
 Earache is a frequent and painful disease, both of infants and 
 children. If too young to tell what ails it, it may be suspected by 
 its being seized with a sudden and severe fit of crying as if it had 
 colic, and like it the pain seems to be easier at times, but it does 
 not, as in colic, spur with its feet, nor is its belly hard ; but the 
 head is restless, and it complains if the ear is touched. In time the 
 child sobs itself to sleep, and in the morning perhaps its cap is 
 
AND MANAGEMENT OF INFANTS. 957 
 
 found stained by matter. Heat is the best remedy ; a warm poul- 
 tice or warm oil should be applied to the ear, and the back of the 
 ear should be rubbed with warm laudanum. If there is a foetid 
 discharge, the ear should be syringed carefully and gently every 
 day with warm milk and water, and the bowels well opened. 
 Some children, whenever they take cold, have a discharge from the 
 ear, and are deaf. In this case the ear should be kept warm and 
 frequently syringed, and the back of it rubbed with a little harts- 
 horn and oil. 
 
 Ophthalmia, or Inflammation of the Eyes. — This disease 
 may arise from exposure to a fire soon after birth; it then gen- 
 erally disappears in two or three days by washing with milk 
 and water. But it may be what is called purulent ophthalmia, 
 which is a very severe disease, and may cause loss of sight. It 
 begins with a redness of the eyelids, which soon swell so that 
 they cannot be opened, and discharge a large quantity of yellow, 
 greenish matter, which excoriates the cheek. If allowed to con- 
 tinue, the globe of the eye becomes involved and dissolved, and the 
 humors of the eye come away. It requires a very complicated 
 treatment, which should be conducted by a skilful surgeon. 
 
 Eruptions, almost endless, attend teething, but are of little con- 
 sequence if unattended by fever. 
 
 Infants who have artificial nourishment or bad milk are sub- 
 ject to troublesome successive crops of inflamed pimples, which 
 slowly gather and burst, and form brown scabs which fall off. 
 They may be on any part of the body, and sometimes are large 
 enough to be called boils. 
 
 Excoriations Behind the Ears take place during dentition. 
 If slight, they only require to be kept well washed with milk and 
 water, and covered with lint spread with simple ointment. If the 
 discharge of matter is great, they should be washed with two grains 
 of sulphate of zinc dissolved in an ounce of water. They should 
 not be healed quickly, without the child is well purged. Some- 
 times the ulcerations are so severe and extensive that the irritation 
 causes convulsions; even mortification may ensue. If, therefore, 
 they assume a very formidable appearance, a medical man should 
 be called in. 
 
 Teething. — Generally, the first teeth cut the gum from about 
 the sixth to the eighth month ; but some very delicate or rickety 
 children have no teeth until a year and a half old. The two middle 
 front teeth appear first, and in about a month the two opposite ones; 
 then two side teeth in front, both above and below ; about the 
 twelfth or fourteenth month the first double tooth appears ; about 
 
953 
 
 the sixteenth or twentieth month the eye-teeth appear, and from 
 that period to the thirtieth month the back double teeth come 
 through. The child is about two years and a half old when it has 
 all its first set of teeth, twenty in number. These continue to the 
 sixth or seventh year, when they begin to fade and fall out, to make 
 room for the permanent set. 
 
 Diarrhoea, or Purging, is often very severe, and at some sea- 
 sons of the year fatal. In this disease the stools are of various 
 appearances ; as green, curdled, &c. Sometimes it is attended 
 with inflammation and fever. It is common during the time of 
 dentition. 
 
 "When it does not proceed from dentition it generally arises 
 from improper food, and the diet should be attended to. If the 
 infant is at the breast, it should, if possible, have a change of breast, 
 especially if the nurse has been out of order ; and the diet of the 
 mother or nurse should be attended to. The infant's strength is to 
 be supported by beef-tea, animal jelly, &c. 
 
 Worms. — These are of various kinds, and give rise to number- 
 less morbid feelings and symptoms. There is pain in the belly, 
 purging, variable and voracious appetite ; the child is always hun- 
 gry, has a bad breath; its complexion becomes pale, its lips swelled, 
 a livid circle surrounds its eyes, the belly swells, and its sleep is dis- 
 turbed ; the child wakes terrified, has a dry cough, picks its nose, 
 has a slow fever, occasionally headache, sometimes convulsions, and 
 frequently grinds its teeth. Worm medicines are numerous, but 
 more benefit is derived from a proper attention to the general health 
 than any other plan. 
 
 Whooping-Cough. — This troublesome disease is familiar to 
 nearly all mothers and nurses. It is characterized by paroxysms 
 of a peculiar cough, most severe at night. Being a contagious dis- 
 ease, few children escape it, and it generally occurs but once. 
 When uncomplicated with other complaints it is seldom a danger- 
 ous disease, and exhausts itself in six or eight weeks. A great va- 
 riety of remedies are recommended for whooping-cough, and in the 
 hands of an experienced physician there are some remedies that 
 doubtless exercise a very beneficial influence. Advice should be 
 sought in all cases of this malady, as it is very important to guard 
 against dangerous complications. In the meantime the child should 
 be kept w^arm and the skin moist. 
 
 Catarrh (Common Cold). — Infants are subject to catarrh, either 
 common or epidemic. There is fever and inquietude, redness of the 
 cheeks, watery discharge from the eyes and nostrils, disposition to 
 sleep, panting and shortness of breathing, with frequent cough, but 
 
AND MANAGEMENT OF INFANTS. 959 
 
 not severe. It generally goes off in a week by gentle purging, 
 saline medicines, and the use of the warm bath. 
 
 Bronchitis — Inflammation of the Bronchia, or Am Tubes of 
 the Lungs — is far from being uncommon ; it begins with cough, and 
 a good deal of phlegm is secreted, which the child swallows. The 
 cough is frequent and comes on in fits ; it is a stifled cough, and 
 somewhat hoarse or shrill. The breathing is difficult, and on put- 
 ting the ear to the chest a rattling is at times heard. Vomiting 
 often takes place, the pit of the stomach is full, the stools are bad, 
 the face pale, and the child sick and dull. It will take the breast, 
 but no other food ; the breathing becomes more and more difficult, 
 the child appears choked with phlegm, the feet and hands swell, the 
 body is emaciated, the cheeks in the evening are flushed, the cough 
 is severe, and death ends the painful scene. Advice should be 
 sought and followed as early as possible. 
 
 Croup. — The form of croup most common, and often the most 
 alarming to mothers, is marked by severe paroxysms of noisy and 
 difficult breathing, and a peculiar cough. It generally begins by a 
 cold or sore throat, and the attacks take place towards night. The 
 child will appear well again the next day, and be up and running 
 about as usual. There is rarely much danger in this variety of 
 croup ; and all that can be done is to relieve the paroxysm by warm 
 baths, hot-water applications to the throat externally, the inhala- 
 tion of vapor from hot water, and sometimes the administration of 
 emetics. 
 
 The other variety of croup is a very different and a very fatal 
 disease. It begins by cough or catarrh and grows gradually worse, 
 the patient becoming rapidly prostrated. The inspiration is diffi- 
 cult and noisy, and the voice is often entirely extinguished. A 
 peculiar membrane is formed in the throat, and that alone may 
 cause death by suffocation. There is no remission in the symptoms, 
 and the voice once lost does not return during the disease, which 
 lasts from four to ten days. The child may die early from shock, 
 or from the false membrane, which sometimes extends downwards 
 and gives rise to bronchitis. 
 
 No time should be lost in obtaining the best possible advice, for 
 under the ablest treatment nearly three-fourths of these cases 
 prove fatal. It is not advisable to give emetics, because of their 
 depressing influence ; but great benefit is often derived from the in- 
 halation of vapor from hot water, by means of which the air 
 breathed by the patient should be kept constantly moist. When 
 there is imminent danger of suffocation, the operation of opening the 
 windpipe will sometimes save the patient's life. 
 
960 MANAGEMENT OF INFANTS. 
 
 The dress of children should be in some measure regulated by 
 the season of the year ; but it should always be easy and warm.* 
 
 Children should be allowed to run about much, and be in the 
 air the greater part of the day. They can hardly take too much 
 exercise. 
 
 Parents should not be over-anxious to commence the work of 
 education. Many children are ruined in health, bodily and men- 
 tally, by the hot-bed system of education now in vogue. It is better 
 that little creatures of four, five, or six years of age should be 
 dunces, than that they should have their bodily vigor lost, and their 
 mental energy in after life endangered by being employed in the 
 school-room, undergoing the process of manufacturing into preco- 
 cious prodigies, when they should be roaming free as the air in 
 the green fields and pleasant woods. 
 
 The diet of childhood should be simple, and consist for the most 
 part of good bread, potatoes, meat, and milk. Much fruit or many 
 cakes and sweetmeats are injurious, as also are all wines, ale, por- 
 ter, &c, in however small a quantity. Attention should be paid 
 to the bowels of children ; they should generally have two evacu- 
 ations a day. 
 
 The true w T ay, then, to have healthy children is to keep them 
 clean and warm; give them plenty of air and exercise ; few sweet- 
 meats ; sufficient, but not overmuch plain food ; and attention to 
 the bow T els. If these hints are acted upon, the visits of the medi- 
 cal attendant. w T ill be much curtailed in number, and the health of 
 children greatly improved. 
 
 * Infant Mortality. — From Report of the Metropolitan Board of Health of New York 
 " The records of infant mortality demand something more than a merely statistical analy- 
 sis ; but we have to confront the fact as it is daily registered on the death roll, that in 
 these cities more than 32 in every 100 deaths are those of nurslings that have not reached 
 their first birthday, and that 52 out of every 100 deaths are of children that have not 
 reached their fifth birthday. Certain it is that nearly ten per cent, of all children born in 
 our cities are constitutionally and organically too frail and imperfect to survive the ordi- 
 nary physical adversities through which they must pass during the first five years of ex- 
 istence. But there is another class of inevitable causes of child mortality which the vital 
 statist and hygienist must carefully study. It is that class which kills by cholera infan- 
 tum and bowel congestions in the summer, and by lung diseases and convulsions in the 
 cold season. Individually considered, most of these deaths seem to the medical attend- 
 ant to be inevitable ; but if we consider them with regard to their chief causes, they 
 plainly appear to be due to preventable circumstances." 
 
PRESCRIPTIONS 
 
 The Doses prescribed under these Prescriptions are designed for 
 adults. 
 
 The Rides for graduating Doses according to the age of children, 
 and also for measuring medicines, are given on page 460. 
 
 CATHARTICS AND APERIENTS. 
 
 Medicines belonging to this class have the property of exciting 
 the bowels to increased action, and in this manner promoting an 
 evacuation of their contents. The medicines arranged in this class 
 are very numerous, but they are not by any means all alike in the 
 mode in which they effect the common result. "While some strong- 
 ly excite the intestines, and especially the muscular coat, others 
 seem to direct their energy almost entirely to the mucous membrane 
 with which they are lined. There are also other peculiarities in 
 their action that it is useful to bear in mind. While some expend 
 their chief force upon one division of the bowels, others select a dif- 
 ferent division over which to exercise their influence ; while still 
 others act with very nearly equal power upon the whole extent. It 
 is apparent from these facts, that it is not always enough to know 
 that the general action of a cathartic is to purge the intestines ; it 
 is useful also to know its specific virtues, and to be able to determine 
 in advance whether it is the one that is most likely to execute the 
 end proposed in the most salutary manner. 
 
 By taking a sufficiently large dose, purgative effects may be 
 obtained from all, but the effects will not in all cases be equally ef- 
 ficient. If, for example, we select aloes, the action of which is 
 almost wholly on the lower section of the alimentary passage, its 
 operation will manifestly be very slow, because it can scarcely 
 be felt until it reaches that portion of the intestines where it is 
 most active. If it passes through the upper portions without pro- 
 
 * The prescriptions which appear in the course of the description of the principal dis- 
 eases are not repeated here. 
 
 61 
 
962 PRESCRIPTIONS. 
 
 ducing commotion, it is evident that evacuations obtained by its use 
 will be chiefly from the lower, and therefore the general purgation 
 of the bowels must be incomplete. It is not only ineffective, but it 
 at the same time produces disagreeable, uneasy sensations, that may 
 be avoided by using the remedy combined with other ingredients 
 which may either assist or modify its properties. Thus, for instance, 
 such being the effect of aloes, if we take rhubarb, which acts most 
 energetically on the smaller and upper intestines, and add these two 
 together, we have produced a compound medicine that acts pleasant- 
 ly on every part of the digestive tube, and accomplishes all that may 
 be expected of a thorough purgative. 
 
 Some cathartics stimulate the mucous membrane with so much 
 moderation, that they appear to do no more than cause an evacuation 
 of the bowels — resembling greatly the simple motion of nature alone. 
 Among such may be reckoned castor-oil, sulphur, and rhubarb. 
 Others act with more intensity, and promote copious watery secre- 
 tions. Salts and many others belong to this rank. There are still 
 others, such as podophyllin, that have a more complex action, and 
 expend part of their force upon distinct organs, and excite secre- 
 tions in distant parts ; if in this way the liver be much aroused, a 
 large quantity of bile will be poured into the upper intestine, 
 which, possessing aperient properties itself, assists the operation of 
 the medicine. 
 
 Cathartics are divided, for the sake of convenience, into three 
 heads. 1st. Aperients ; 2d. Purgatives ; 3d. Hydragogues. The 
 first, sometimes also called Laxatives, act very gently. The second 
 act briskly, and cause a number of copious motions. The third act 
 violently, and cause a large number of motions that are but little 
 else than water. Each kind is appropriate to certain conditions of 
 the system and particular diseases. 
 
 There is no question that cathartics have been terribly abused, 
 especially in the treatment of diseases of debility. Nervously exhaus- 
 ted patients need to be built up, and not pulled down. They need 
 tonics more than cathartics. The tendency with dyspeptics is to use 
 cathartic medicine too freely. 
 
 Some medicines of this class, when given in large doses, operate 
 with great intensity, but their effects rapidly subside, and leave the 
 bowels in much the same condition that previously existed. Some 
 others are more decidedly irritating, and in large doses produce 
 inflammation of the stomach and intestines. It is proper, therefore, 
 to bear in mind that excessive doses are to be guarded against ; and 
 when such seem to be demanded, it is advisable that they be used 
 under the direction of a professional man. 
 
CATHARTICS AND APERIENTS. 963 
 
 DECOCTIONS, INFUSIONS, MTXTUEES, &c. 
 
 Infusion of Senna, Salts, <&c. 
 
 Take of senna, half an ounce, 
 
 Epsom salts and manna, of each an ounce, 
 
 Fennel seed, a drachm, 
 
 Boiling water, half a pint. 
 Let it stand until cold ; strain. One-third may be taken for a 
 dose, and repeated in three or four hours after, unless it has operated 
 well. This is a mild and very certain medicine, and is especially 
 useful in diseases of excitement. It is an excellent cathartic to fol- 
 low the use of calomel. 
 
 Infusion of Pink Root and Senna. 
 
 Take of pink root, half an ounce, 
 
 Senna leaves, half an ounce, 
 
 Boiling water, one pint. 
 Let it stand for two hours in a covered vessel, and strain. The 
 dose for a child two or three years old is from four teaspoonfuls 
 to two tablespoonfuls, morning and evening. This is an excellent 
 remedy for worms. 
 
 If a teaspoonful or two of the tincture of rhubarb be added to 
 the dose, it improves the effects when the bowels are flatulent. 
 
 Mixture of Tartrate of Potash and Manna. 
 Take tartrate of potash, half an ounce, 
 Manna, one ounce, 
 Warm water, three ounces, 
 Cinnamon water, half an ounce. 
 Mix them, and take half for a dose, which may be repeated at 
 the end of three hours, if the bowels have not been sufficiently 
 moved. 
 
 This is a mild aperient, cooling in its effects, and may be advan- 
 tageously used m fevers. 
 
 Castor-Oil Mixture. 
 
 Take castor-oil, one ounce, 
 
 Gum arabic, two drachms, 
 
 Peppermint water, one ounce. 
 The oil and gum should be well rubbed together, and the mint 
 water added to them gradually. The whole may be taken for a 
 dose. When there is irritation of the bowels, and it is necessary to 
 employ a purgative, nothing can be milder and more suitable than 
 this. To have still gentler action, part of the above may be taken 
 at a time. 
 
964: PRESCRIPTIONS. 
 
 Olive Oil. 
 Take a gill of this oil, or more, in the colic of painters. It 
 is said by painters who use it to act like a charm. 
 
 Epsom Salts with Colchicum. 
 Take of Epsom salts, four drachms, 
 Calcined magnesia, thirty grains, 
 Wine of colchicum, eighty drops, 
 Mint water, five ounces. 
 This is to be divided into four equal doses, one of which, after the 
 bottle is shaken, may be given every six hours, in rheumatism ac- 
 companied with fever. 
 
 Mixture of Turpentine and Castor- Oil. 
 Take oil of turpentine, two drachms, 
 Castor-oil, one ounce. 
 Mix. Take all for a dose. This makes an excellent purgative 
 when quick and decided action is required, as in affections of the 
 drain. 
 
 Cream of Tartar. 
 Take of Glauber salts, six drachms, 
 Cream of tartar, two scruples, 
 Boiling water, sufficient to dissolve the salts. 
 The cream of tartar disguises the bitter taste of the salts very 
 much, and makes a pleasant medicine that sits well on the stomach. 
 If a laxative effect only is desired, the half of the above quantity is 
 sufficient for a dose. If free action is needed, take the whole of it. 
 It may be used in any inflammatory disease, when the system re- 
 quires reducing. If preferred, Epsom salts may be substituted for 
 the Glauber. 
 
 Mixture of Syrup of Rhuoarh and Soda. 
 Take aromatic syrup of rhubarb, four ounces, 
 Bicarbonate of soda, thirty grains, 
 Water, one ounce. 
 Mix. Dose : thirty to sixty drops, according to age, in the dowel 
 complaints of children, so common in summer. 
 
 Mixture of Magnesia, Rhubarb, &c. 
 Take of calcined magnesia, half a drachm, 
 Powdered rhubarb, two grains, 
 Powdered white sugar, one drachm, 
 Essence of peppermint, six drops, 
 Water, one and a half ounce. 
 Mix. A teaspoonful to be given every two hours to young chil- 
 
CATHARTICS AND APERIENTS. 965 
 
 dren when they need an aperient, especially during the period of 
 suckling and teething. It corrects the acidity of the stomach. 
 
 Decoction of Prunes. 
 
 Take of prunes three ounces, 
 
 Water, three pints, boil to two pints. Drunk as a cooling laxative. 
 
 Confection of Senna. 
 
 Take of senna, eight ounces, 
 
 Coriander seed, four ounces, 
 
 Liquorice root, bruised, three ounces, 
 
 Figs, one pound, 
 
 Pulp of prunes, half a pound, 
 
 Pulp of tamarinds, half a pound, 
 
 Sugar, two pounds and a half, 
 
 Water, four pints. 
 Pub the senna and coriander together, and separate ten ounces 
 of the powder with a sieve. Boil what remains with the figs and 
 liquorice root, in the water, down to one half; then press out the 
 liquor, and strain it. Evaporate the strained liquor, by putting the 
 vessel containing it into another vessel of boiling water, to a pint 
 and a half ; then add the sugar and form a syrup. Finally, rub the 
 pulps gradually with the syrup, and having thrown in the sifted 
 powder, beat the whole together until they are thoroughly mixed. 
 If the prunes and tamarinds are too dry for such use, they may be 
 boiled in a small quantity of water to soften them, pressed through 
 a hair sieve, and evaporated to a proper consistence. 
 
 This is an excellent and most agreeable laxative, and is well 
 adapted to cases of habitual constipation in pregnant women and 
 persons suffering from piles. When the object is merely to give gentle 
 action to the bowels, it may be used in almost any condition of the sys- 
 tem. I repeat ichat. I have previously stated, that these laxative 
 medicines are all much abused, especially oy dyspeptics. (See Dys- 
 pepsia.) 
 
 PILLS. 
 
 Pills of Rhubarh and Aloes. 
 Take powdered rhubarb, half a drachm, 
 Aloes, twenty-five grains, 
 Castile soap, half a drachm, 
 - Simple syrup to make the whole into a suitable mass. 
 Divide into twenty pills ; two for a close. This makes a very good 
 
966 PRESCRIPTIONS. 
 
 aperient, and is suitable for sluggish bowels that habitually demand 
 medicine. The best time for taking them is on going to bed. 
 
 Phubarb Pill. 
 Take powdered rhubarb, one drachm, 
 Powdered ipecacuanha, one scruple, 
 Syrup, sufficient quantity to make into pilular mass. 
 Divide into twenty pills. One may be taken at bedtime, in cos- 
 tiveness ; this is peculiarly mild. 
 
 Pills of Phubarb, Iron, c&c. 
 Take powdered rhubarb, ninety grains, 
 Sulphate of iron (green vitriol), thirty grains, 
 White soap, two scruples, 
 Water, enough to make a mass. 
 Dose : three or four at bedtime. This pill is intended to remove 
 costiveness. They are most properly applicable to pale and debili- 
 tated patients. 
 
 Pills of Croton Oil. 
 Take of croton oil, one drop, 
 Crumb of bread, enough for four pills. 
 Mix them together and divide. Dose : one every hour until they 
 operate. This is a very powerful medicine, but if taken in a proper 
 dose acts kindly. 
 
 Elaterium Pills. 
 Take calomel, five grains, 
 Elaterium, one fourth of a grain, 
 Compound extract of colocynth, four grains, 
 Cayenne pepper, one grain. 
 Mix, and divide into two pills. To be taken night and morning 
 in dropsy. 
 
 Another Elaterium Pill. 
 Take extract of gentian, five grains, 
 Extract of elaterium, half a grain. 
 Make a pill : one is to be taken every hour until liquid stools are 
 obtained. In dropsy. 
 
 Dandelion Pills. 
 Take extract of dandelion, thirty grains, 
 Calomel, six grains. 
 Mix. Divide into ten pills. Dose : two are to be taken three 
 times a day. Useful in dropsy of the belly from obstructions in the 
 liver. 
 
CATHARTICS AXD APEEIENTS. 967 
 
 POWDERS. 
 
 Powder of Rhubarb and Magnesia. 
 Take powdered rhubarb, four drachms, 
 Calcined magnesia, six drachms, 
 Powdered ginger, two drachms. 
 Mix. Dose : two teaspoonfuls. This is a good remedy in dys- 
 peptic headache, when the stomach is suffering from acidity. 
 
 Powder of Sulphur and Cream of Tartar. 
 Take of sublimed sulphur, four drachms, 
 Cream of tartar, one ounce. 
 Mix. Dose, for children, a teaspoonful, and for adults, a table- 
 spoonful, mixed in molasses or syrup, three times a day. This will 
 be found very serviceable m piles / some diseases of the skin, as itch ; 
 and by reducing the quantity of cream of tartar to two drachms, it 
 affords a very valuable remedy in chronic rheumatism. 
 
 Seidlitz Powders. 
 Take tartrate of soda and potash, two drachms, 
 Bicarbonate of soda, two scruples. 
 Make one powder. 
 
 Take powdered tartaric acid, twenty-five grains. 
 The two powders are to be dissolved in separate tumblers, each 
 about one-third full of cold water. Pour one into the other, and 
 drink while they are effervescing. 
 
 This is an aperient very grateful to the stomach, and will often 
 quiet nausea when other medicines would be rejected. 
 
 Powder of Sulphate of Potash, &c. 
 Take sulphate of potash, sixty grains, 
 Powdered rhubarb, forty grains. 
 Divide in six equal parts, and take one twice a day in syrup. 
 Useful in dyspepsia, and when the bowels are sluggish. 
 
 EXEMATA, OR PURGATIVE Ds T JECTIOXS. 
 
 The quantity of fluid proper for different ages is about four to six 
 ounces, for a child between one and six years of age ; a half a pint 
 for the age between ten and fifteen years ; and a pint or more for an 
 adult. 
 
 Injection of Senna and Epsom Salt. 
 Infusion of senna, one pint, 
 Epsom salts, two drachms. , 
 
 Use one-half of the quantity at a time. 
 
968 PRESCRIPTIONS. 
 
 Injection of Castor Oil, Molasses, and Salt. 
 Castor oil, two ounces, 
 Molasses, two ounces, 
 Common salt, one ounce, 
 Flax-seed infusion, one pint. 
 
 Injection of Table Salt. 
 Take of table salt, a tablespoonful, 
 Tepid water or gruel, one pint, 
 Sweet oil, a tablespoonful. 
 All to be used at once for an adult. 
 
 Injection of Epsom Salts. 
 Take of Epsom salts, an ounce and a half, 
 Tepid gruel, one pint, 
 Turpentine, one tablespoonful. 
 This is more powerful than the preceding. It may be used in 
 preference to the other when the head is much affected, as in apo- 
 plexy or convulsions. 
 
 Injection for a Child. 
 
 Take of warm gruel, five ounces, 
 
 Table salt, two teaspoonfuls, 
 
 Sweet oil, six teaspoonfuls. 
 If the bowels contain much wind, or if there be convulsions, 
 add a teaspoonful or two of turpentine. 
 
 Almost any of the purgatives may be used for injections, in the 
 proportion of three times more than is necessary wmen taken by 
 the mouth. Common sea-water makes as good a purgative injec- 
 tion as can be compounded when the object is merely to open the 
 bowels. In many cases, a large injection of water alone is suffi- 
 cient when the intention is merely to obtain a motion for the relief 
 of ordinary constipation. In such cases, water at the temperature 
 of 60 degrees is better than if it is warmer, as it imparts tone to 
 the lower intestines, and thus diminishes the necessity of resorting 
 to artificial means for relief. 
 
 Injections of the Nasal Passages. — Douches. 
 (See Catarrh and Nasal Douches?) 
 
 Douche of Common Salt, 
 Used in all stages of catarrh. 
 
 Common salt, one ounce, 
 Tepid water, one pint. 
 
EMETICS. 969 
 
 Douche of Chlorate of Potash. 
 Used for all stages of catarrh, but especially for the acute forms. 
 Chlorate of potash, one drachm, 
 Tepid water, half a pint. 
 
 Douche of Carbolic Acid. 
 Used for chronic catarrh. 
 
 Carbolic acid, five drops (or grains when solid), 
 Tepid water, one pint. 
 These douches are designed for domestic use. Too much depen- 
 dence is placed on them. Patients afflicted with chronic catarrh 
 should obtain medical advice at the same time. "When no advice 
 can be obtained, these simple douches are excellent means of relief. 
 
 Injections for the Nasal Passages. 
 (See Catarrh and Posterior Nasal Syringe.) 
 These injections are made behind the soft palate, and the fluid 
 comes out through the nose. 
 
 Injections of Chlorate of Potash. 
 Used as a specific for acute colds in the head. 
 Chlorate of Potash, one drachm, 
 Tepid water, one ounce. 
 
 Injections of Carbolic Acid. 
 Used for chronic catarrh. 
 
 Carbolic acid, two drops (or grains when solid), 
 Tepid water, one ounce. 
 
 Injections of Nitric Acid. 
 Used for chronic catarrh. 
 
 Nitric acid, two drops, 
 Tepid water, one ounce. 
 
 Injections of Permanganate of Potash. 
 Permanganate of potash, one grain, 
 Tepid water, four ounces. 
 Patients ought not usually to make these injections for them- 
 selves, until at least they have received instructions from a physician. 
 Each case must be studied by itself. 
 
 EMETICS. 
 
 This is a class of medicines that act especially on the stomach, 
 and cause it to discharge its contents by vomiting. There are a 
 
970 PRESCRIPTIONS. 
 
 large number of medicines which are capable of producing such 
 effects, if given in sufficient doses, but many of them are uncertain 
 in their operation, or violent in their action. Those of this char- 
 acter are not usually employed as emetics, and those only we re- 
 cognize as belonging to the class, the action of which is prompt, 
 moderate, and which generally follows a uniform dose. Most of 
 the cathartics, under peculiar conditions, may cause nausea and 
 vomiting ; and we often experience difficulty in administering them, 
 on account of the disturbance they excite in the stomach. "What- 
 ever is capable of irritating the stomach is also capable of acting as 
 an emetic. But some medicines appear to be more disposed to 
 affect the stomach than others, and they seem inclined to operate 
 on this rather than on other organs. 
 
 Before administering emetics, the condition of the patient ought 
 carefully to be considered. Emetics are improper in rupture, preg- 
 nancy, or in any case in which a strong physical effort might cause 
 injury. They should not be resorted to when there is inflammation 
 of the stomach ; nor can they be given with propriety when there 
 is great exhaustion of the powers of life. 
 
 If the vomiting is excessive, the means which are efficacious in 
 allaying it when induced by disease may be had recourse to, and 
 will prove equally useful at this time. 
 
 Stimulants applied over the region of the stomach, of which 
 perhaps the best is a mustard poultice, will usually afford relief. 
 A little brandy and water, spiced ; a little cold tea; a teaspoonful 
 of camphor-water occasionally given ; a tablespoonful of lime-water, 
 and the same quantity of milk, mixed together and drank cold, 
 every fifteen minutes ; an effervescing draught, made by adding two 
 teaspoonfuls of lemon-juice, or ten grains of tartaric acid to twelve 
 grains of the bicarbonate of potash or soda ; a little oxalate of cerium 
 or bismuth ; or, finally, small quantities of cold iced water, or small 
 bits of ice to dissolve in the mouth, will generally accomplish the 
 object for which they are given, and check the violent throes of the 
 stomach. 
 
 To promote vomiting, large draughts of warm water or camo- 
 mile tea ; or tickling the inside of the mouth with a feather, as far 
 back as can be reached with the finger, will be found of service in 
 assisting the action of the medicine. 
 
EMETICS. 971 
 
 MIXTURES, &o. 
 
 Hive Syrup. 
 Take compound syrup of squills, one ounce. 
 Ten drops may be given to a young child, and the dose should 
 be increased with age, and repeated every twenty or thirty minutes. 
 This is a remedy of great celebrity for children having the croup, 
 or an affection of the throat resembling it. 
 
 Mustard. 
 Take of powdered mustard, one drachm, 
 Warm water, half a pint. 
 Mix, and swallow it all at one draught. This produces prompt 
 vomiting, and is a good emetic. 
 
 Solution of Table Salt. 
 Take of table salt, one tablespoonful, 
 "Warm water, half a pint. 
 Dissolve and drink it at once. 
 
 Like the preceding one, this is an emetic that is generally at 
 hand, ready for any emergency. It is prompt in its action, and 
 causes free vomiting without much retching. They both may be 
 used in preference to others, when the stomach is languid, and the 
 system is suffering from food that it is unable to digest, causing, 
 often, sick headache. 
 
 POWDEKS. 
 
 Powder of Ipecacuanha. 
 Take the powder of ipecacuanha, two scruples. 
 
 This is to be divided into two doses, one of which may be given 
 mixed with syrup or molasses, and succeeded by a tumblerful of 
 warm water. If one powder does not answer, in twenty minutes 
 the second may be taken in the same manner. 
 
 This is one of the most useful emetics that we possess. It is 
 always safe to give it, when, from the tendency to irritation in the 
 stomach, many other substances of this class might do injury. There 
 is, besides, but little danger of administering too much ; for whether 
 twenty grains, or fifty, or one hundred be taken, the first effect of 
 vomiting will bring most of it up again, so that the subsequent ef- 
 fects will not be much varied by the quantity. 
 
 Powder of Sulphate of Copper. 
 Take of sulphate of copper, two grains. 
 Give it in a little syrup and water. 
 
972 PRESCRIPTIONS. 
 
 This medicine is very rarely employed for this purpose, except in 
 cases of poisoning, when the sensibility of the stomach has been 
 greatly impaired, and after other articles have failed. It should be 
 followed immediately with a large draught of warm water. 
 
 Powder of Sulphate of Zino. 
 
 Take sulphate of zinc, fifteen grains. 
 
 Mixed with syrup or molasses : all of it should be taken at once, 
 
 if strong effects are desired, as in poisoning. Copious draughts of 
 
 warm water should immediately be drank upon it. It is supposed 
 
 to act as a tonic to the stomach. 
 
 DIAPHOKETICS. 
 
 This class of medicines act by promoting the exhalation of the 
 surface of the body. It is a very important class of remedies, 
 and is useful in a great variety of cases. The free action of the 
 skin is always necessary to sound health ; and if this be interfered 
 with, as it generally is when the body is suffering from disease, it 
 is a matter of much importance to have it re-established. Sud- 
 denly checking perspiration when the body is in health, as every 
 one knows, is a very common cause of disease; and this com- 
 monly falls most heavily upon such organs as, either from ac- 
 cidental or hereditary conditions, are least able to contend with 
 the changes that take place in consequence of the suppression of 
 an excretion so essential to health. This is not a suitable place 
 for an exposition of the physiological uses of the perspiratory 
 functions ; but when I state that the skin of a person of ordinary 
 size daily exhales from two to five pounds — the quantity varying 
 with circumstances— it will readily be inferred that it cannot be 
 suspended with impunity, and that it has some great end to sub- 
 serve. 
 
 To promote perspiration the patient should get into bed, and be 
 moderately covered with clothing. Warm drinks freely used will 
 also conduce to this purpose ; and there are certain other methods 
 by the application of artificial heat — as with hot bricks, bottles of 
 hot water, hot sand-bags, hot vapor introduced under the bed- 
 clothes through a suitable tube, or hot air conducted to the body in 
 a similar manner — that are often employed in particular exigencies. 
 
 In fevers it would be a great mistake to increase the external 
 heat, whether by an increase of bed covering, or by warmth directly 
 conveyed to the surface. In such cases the skin is already too hot, 
 
DIAPHORETICS. \)76 
 
 and it often happens that a reduction of the temperature is the best 
 means for obtaining moisture. When the heat is great and the skin 
 dry, the body should be cooled by withdrawing as much covering 
 as may be necessary to lower the morbid temperature to that point 
 at which the patient feels comfortable. Even sponging with cold 
 water in many instances, when the warmth is very distressing, has 
 been found good practice. 
 
 It often occurs, after diaphoretic medicines have been adminis- 
 tered in vain, that cooling the surface by any such means as have 
 been mentioned acts with magical power ; and a remedy which 
 previously was worse than useless will now cover the skin with a 
 life-giving dew. 
 
 MIXTURES, INFUSIONS, &c. 
 
 Infusion of Herbs. 
 Take of marsh-mallow, one ounce, 
 Balm and spearmint, of each one ounce, 
 Elder flowers and arnica flowers, of each one ounce, 
 Anise seed, half an ounce. 
 Pour boiling water on it, and use as a common drink. May be 
 advantageously drank in colds and slight fevers. It is useful to pro- 
 mote the action of other more powerful remedies of this class. 
 
 Mixture of Nitre, Ammonia, c&c. 
 Take sweet spirits of nitre, three drachms, 
 Solution of acetate of ammonia, three ounces, 
 Nitrate of potash, two scruples, 
 Camphor water, four and a half ounces, 
 Lemon syrup, two drachms. 
 Mix. Dose : two tablespoonfuls every four hours, in fevers. 
 Proportional doses to children in the collapsed stage, when the head 
 is much affected, and they are inclined to sleep. 
 
 Mixture of Carbonate of Ammonia, <&c. 
 Take carbonate of ammonia, half a drachm, 
 Camphor water, six ounces. 
 Mix. Dose : two tablespoonfuls every hour. Useful in fevers 
 when the powers of life are low, and in dropsy when stimulants are 
 needed. 
 
 Draught of Carbonate of Ammonia and Lemon-juice. 
 Take carbonate of ammonia, fifteen grains, 
 Fresh lemon-juice, half a drachm, 
 "Water, pure, seven drachms, 
 Syrup, two teaspoonfuls. 
 
974: PRESCRIPTIONS. 
 
 Mix. Take all at a dose, and repeat it every six hours. This is 
 a cooling diaphoretic, and may be given in fevers when the skin is 
 hot. 
 
 Draught of Carbonate of Potash and Lemon-juice. 
 Take of carbonate of potash, one scruple, 
 Fresh lemon-juice, half an ounce, 
 Water, pure, one ounce, 
 Antimonial wine, twenty drops, 
 "White sugar, one scruple. 
 Mix. Use as in the preceding prescription. It possesses more 
 decidedly diaphoretic properties. 
 
 Infusion of Pleurisy Root. 
 Take of pleurisy root, one ounce, 
 Boiling water, one and a half pint. 
 Infuse. Dose : a teaspoonfal to be taken warm as frequently as 
 it can be borne by the stomach. This is considered a very good dia- 
 phoretic, and may be given in any case when fever is present. 
 
 Infusion of Boneset. 
 Take of boneset, one ounce, 
 Boiling water, one pint. 
 Infuse for half an hour. Dose : a wine-glassful every half hour, 
 as hot as possible. 
 
 Infusion of Pipsissewa. 
 Take of pipsissewa (or winter green), two ounces, 
 Boiling water, one quart. 
 Infuse. Dose: a pint may be taken in the course of twenty-four 
 hours. It is highly esteemed by some persons in scrofula before and 
 after ulceration, in ill-conditioned ulcers, and in cutaneous affections 
 connected with a scrofulous taint. 
 
 Infusion of Blessed Thistle. 
 Take of the leaves of blessed thistle, one ounce, 
 Boiling water, one pint. 
 Infuse. Dose : a wine-glassful, as frequently as the stomach will 
 allow without vomiting, will produce copious perspiration, and may 
 be used in slight fevers and colds. 
 
 Decoction of Sarsaparilla. 
 Take of sarsaparilla, sliced and bruised, six ounces, 
 "Water, six pints. 
 Boil to four pints, and strain. Dose : a teacupful, four times a 
 day. May be used in skin diseases, and scrofula complicated with 
 syphilis. 
 
DIURETICS. 975 
 
 Infusion of Virginia Snake-root. 
 Take of Virginia snake-root, one ounce, 
 Boiling water, two pints. 
 Infuse for two hours in a covered vessel, and strain. Dose: two 
 to four tablespoonfuls every two hours in low forms of fever, when 
 the system requires support. It is useful in fever and ague, and is 
 frequently employed in measles when the eruption has receded, or 
 is tardy in making its appearance. In this latter case it is best to 
 give it warm. 
 
 Effervescing Draught. 
 Take of carbonate of potash, two drachms, 
 Water, four ounces. Dissolve. 
 
 Fresh lemon-juice, two ounces, 
 
 Water, two ounces. Mix, and keep in separate vessels. 
 Dose : two tablespoonfuls of the acidulated water is to be mixed 
 with one of the potash solution, and the whole drunk while it is 
 foaming. When lemon-juice cannot be obtained, eighty grains of 
 tartaric acid dissolved in four ounces of water, a tablespoonful of 
 which is to be used at a time, will answer as a substitute for it. 
 This is a pleasant diaphoretic m fevers, and is admirable in allaying 
 nausea and cholera morbus. 
 
 POWDERS. 
 
 Powder of Ipecacuanha and Opium, 
 Take of ipecacuanha, powdered, half a drachm, 
 Powdered opium, half a drachm, 
 Sulphate of potash, half an ounce. 
 Dose : ten or fifteen grains of this powder, known commonly as 
 Dover's powder, may be given for a dose. It is an admirable 
 diaphoretic and anodyne, and is applicable to all cases when the head 
 is not affected, and the stomach will bear its use. It is especially 
 useful in rheumatism, inflammation of the lungs, and other inflam- 
 matory affections. It is useful in diarrhoea, dysentery, and bleeding 
 from internal organs. Ten grains of the powder contains one grain 
 of opium. 
 
 DIUEETICS. 
 
 Medicines of this class stimulate the kidneys and increase the 
 secretion of urine. They act best when the skin is cool and the 
 bowels are quiet. If there be active purging or copious sweating, 
 
976 PRESCRIPTIONS. 
 
 the secretion of the kidneys will be very sensibly diminished. A 
 medicine, therefore, possessing diuretic properties, if administered 
 in quantities, or combined with purgatives, so as to produce a cathar- 
 tic effect, will no longer excite the kidneys ; and its influence will 
 either be wholly lost, or directed to the bowels. When combined 
 with diaphoretics, they in the same manner lose their specific proper- 
 ties, and either aid the medicines with which they are conjoined, in 
 promoting the cutaneous exhalation, or answer no good purpose 
 whatever. In compounding medicines, these facts should be kept in 
 view ; for an attempt to accomplish everything by uniting medi- 
 cines having what may be called antagonistic actions, will only be 
 successful in rendering the dose unnecessarily large, and often much 
 more disgusting. The effect of diuretics is increased by drinking 
 largely of water or any other bland fluid ; but in some cases, as in 
 dropsy, the object for which the remedy is taken would be defeated 
 if the blood-vessels were kept full of water by large potations. 
 
 MIXTURES, DECOCTIONS, &c. 
 
 Mixture of Digitalis, Acetate of Potash, c&c. 
 Take infusion of digitalis, three and a half ounces, 
 Cinnamon water, three and a half ounces, 
 Acetate of potash, two and a half drachms, 
 Vinegar of squills, three drachms, 
 Tincture of opium, ten drops. 
 Mix. Dose : two tablespoonfuls three times a day. May be 
 used in any form of dropsy. 
 
 Mixture of Horse-Radish, Juniper, dec. 
 Take compound infusion of gentian, five ounces, 
 Acetate of potash, half a drachm, 
 Compound spirit of juniper, half an ounce, 
 Compound spirit of horse-radish, half an ounce, 
 Sweet spirits of nitre, two drachms. 
 Mix. Dose : two tablespoonfuls, three times a day. Useful in 
 dropsy, when the system is much debilitated and requires strength- 
 ening. 
 
 Mixture of Squills, <&c. 
 
 Take oxymel of squills, four drachms, 
 Hyssop water, three ounces, 
 Peppermint water, one ounce, 
 Sweet spirits of nitre, half an ounce. 
 Mix. Dose : two tablespoonfuls, three or four times a day. This 
 
DIURETICS. 977 
 
 may be employed in coughs, asthma, &c, of the lungs. Like the 
 preceding, it relieves the lungs by acting on the kidneys. 
 
 Decoction of Bearhei^ry. 
 Take of leaves of bearberry, one ounce. 
 Water, one pint. 
 Boil it until about one-iifth of the fluid is evaporated, and strain. 
 Dose : two to four tablespoonfuls three or four times a day. Useful 
 in gravel, chronic inflammation of the kidneys, catarrh, of the Mad- 
 der, and most other affections of these organs. It has also been 
 very highly extolled by an English physician in consumption of the 
 lungs. 
 
 Mixture of Nitrate of Potash, &c. 
 Take nitrate of potash (saltpetre), three drachms, 
 Peppermint water, ten and a half ounces, 
 Sweet spirits of nitre, three drachms, 
 Lemon syrup, one ounce. 
 Dose : one to two tablespoonfuls in dropsy. 
 
 Mixture of the Acetate of Ammonia, <&c. 
 Take of the solution of the acetate of ammonia, two ounces, ' 
 Acetate of potash, two drachms. 
 Mix. Dose : a tablespoonful every three hours. 
 This may be given in dropsical affections, and in gravel when 
 the deposit has a brick-dust color, evincing uric acid in the urine. 
 
 Infusion of Juniper Berries. 
 Take of bruised juniper berries, one and a half ounce, 
 Cream of tartar, one ounce, 
 Boiling water, one pint. 
 Infuse. Dose : a teacupful six times a day. Used in dropsy. 
 
 Infusion of Juniper Berries in Cider. 
 Take of juniper berries, half an ounce, 
 Mustard seed, half an ounce, 
 Ginger root, half an ounce, 
 Bruised horse-radish, one ounce, 
 Parsley root, one ounce, 
 Fermented cider, two pints. 
 Infuse. Dose : a wine-glassful may be taken three or four times 
 a day. Useful in general dropsy, when stimulation is needed. 
 62 
 
978 PRESCRIPTIONS. 
 
 Mixture of Oil of Juniper, dec. 
 Take oil of juniper, eight drops, 
 White sugar, one and a half drachm, 
 Gum arabic, one and a half drachm, 
 Water, four ounces. 
 Mix. Dose : a tablespoonful every hour or two. 
 
 Solution of Cream of Tartar. 
 Take of cream of tartar, one ounce, 
 Boiling water, one quart. 
 Let it stand until it becomes cold, and then drink freely of it 
 during the day. Yery grateful when the system is inflammatory, 
 and requires a little reducing. 
 
 Mixture of Balsam of Copaiba, <&c. 
 Take copaiba, half an ounce, 
 Sweet spirits of nitre, half an ounce, 
 Gum arabic, powdered, one drachm, 
 Sugar, powdered, one drachm, 
 Spirits of lavender, two drachms, 
 Tincture of opium, one drachm. 
 Water, four ounces. 
 Mix. Dose: a tablespoonful three or four times a day. A 
 remedy in gonorrhoea, a specific disease of the urinary organs. 
 
 Mixture of Oil of Turpentine, <&c. 
 Take oil of turpentine, one hundred drops, 
 Gum arabic, powdered, two drachms, 
 Sugar, powdered, two drachms, 
 Peppermint water, four ounces. 
 Mix. Dose: a tablespoonful several times a day. Useful in 
 disease of the kidneys, and when a stone is passing from the kidneys 
 to the bladder; in rheumatism,, and in bleeding from the stomach 
 or lungs when there is no arterial excitement. 
 
 Infusion of Dandelion, dhc. 
 
 Take infusion of dandelion, four ounces, 
 
 Extract of dandelion, two drachms, 
 
 Carbonate of soda, half a drachm, 
 
 Tartrate of potash, three drachms, 
 
 Tincture of rhubarb, three drachms, 
 
 Tincture of henbane, twenty drops. 
 Mix. Dose: one-third part to be taken three times a day. 
 Good in dropsy, especially if it depends upon obstruction in the 
 liver, and in dyspepsia. 
 
EXPECT0KANT8. 979 
 
 Infusion of Dandelion. 
 
 Take of dandelion root, broken small, two ounces. 
 Boiling water, one pint. 
 Let it stand twenty-four hours, and strain. Dose : two table- 
 spoonfuls, four times a day. Used in such cases as the preceding 
 formula. 
 
 Decoction of Pipsissewa. 
 Take of pipsissewa (winter green), one ounce, 
 "\Tater, one quart. 
 Let it soak for twelve hours, and slowly boil it down to one-half. 
 Dose : a wine-glassful three or four times a day. In dropsy, in 
 which there is debility of the stomach and bowels. It is also ser- 
 viceable in gravel and disease of the kidneys* and has been thought 
 particularly valuable in scrofula, and in some kinds of eruptions on 
 the skin. 
 
 L fusion of Henbane. 
 Take henbane, one ounce. 
 Boiling water, one pint. 
 Let it infuse for twelve hours. Dose: the whole of this in one 
 day. Useful in inflammatory dropsy, and in affections of the uri- 
 nary organs. 
 
 Mixture of Calumlo, ^Ether, dec. 
 Take tincture of digitalis, one and a half drachm, 
 Tincture of calumbo, one and a half ounce, 
 Spirits of sulphuric aether, four drachms, 
 Laudanum, forty drops, 
 Camphor water, seven ounces. 
 Mix. Dose : two tablespoonfuls twice a day may be employed 
 when the patient is low and the action of a diuretic is required. 
 
 EXPECTORANTS. 
 
 This class of medicines are designed to relieve the mucous mem- 
 brane of the lungs, by increasing the secretion of mucus. In this 
 way inflammation and congestion of the membrane is removed. 
 Many remedies are expectorants under peculiar circumstances ; thus 
 even blood-letting, when the lungs are suffering from an inflamma- 
 tion of an acute kind, and the ordinary secretion is consequentlv 
 suspended, may act as a remedy of this description. But there are 
 certain medicines that more directly belong to the class of expecto- 
 rants, and appear to have a kind of specific tendency to the lungs. 
 
980 PRESCRIPTIONS. 
 
 When expectorants are used, the body should be kept well protected 
 from atmospheric changes, and from severe cold. The patient 
 should also avoid, so far as possible, the breathing of cold air. If 
 such precautions be neglected, the purpose for which the remedy is 
 administered will be partially if not wholly defeated. Expec- 
 torants are very much abused. They are expected to do far more 
 than they are able to accomplish. Excessive use of them, especially 
 in consumption, does but little good in the way of relieving the 
 cough, and weakens the stomach. 
 
 Mixture of Ipecacuanha Wine, dec. 
 Take of wine of ipecacuanha, three drachms, 
 Syrup of tolu, five drachms, 
 Powdered gum arabic, one drachm, 
 Water, one ounce. 
 Eub the gum and water first together, and then add the other 
 ingredients. Dose : a teaspoonful every hour. For common cold, 
 with tightness of the chest. In smaller doses this is a very good 
 mixture for children. 
 
 Mixture of Syrup of Squills, <&c. 
 Take of paregoric elixir, half an ounce, 
 Syrup of squills, one ounce, 
 Antimonial wine, two drachms, 
 Water, six ounces. 
 Mix. Dose : a teaspoonful every fifteen minutes, until the 
 cough is relieved. For influenza. 
 
 Mixture of Paregoric and Ipecac Wine. 
 Take of paregoric elixir, two ounces, 
 Ipecacuanha wine, one ounce. 
 Mix. Dose : a teaspoonful occasionally, in a dry cough threaten- 
 ing consumption. 
 
 Mixture of Seneka Snake-Root, dbc. 
 Take of seneka snake-root, three drachms, 
 Anise seed, three drachms, 
 Liquorice, two drachms. 
 Boil in eight ounces of water, strain, and add 
 
 Paregoric elixir, one and a half ounce, 
 Syrup of squills, one ounce. 
 Dose : a tablespoonful three or four times a day. This should 
 be used in cough when there is no fever and the system is languid. 
 
EXPECTORANTS. 981 
 
 Mixture of Liquorice, &c. 
 Take of powdered extract of liquorice, two drachms, 
 Powdered gum arabic, two drachms, 
 Hot water, four ounces. Dissolve, and add 
 Antimonial wine, two drachms, 
 Laudanum, half a drachm. 
 Mix all together. Dose : a tablespoon ful, to be taken occasion- 
 ally in influenza. 
 
 CoxJs Hive Syrup. 
 Take of squills, one ounce, 
 Seneka snake-root, one ounce, 
 Water, one pint. 
 Boil down one-half, and strain. Add 
 
 Clarified honey, half a pound, 
 Tartrate of antimony, twelve grains. 
 Mix. Dose : ten drops to a teaspoonful, for a child, according 
 to age. This is a celebrated remedy in croup, and may be advanta- 
 geously used in other affections of the lungs. 
 
 Mixture of Gum Ammoniac, dec. 
 Take of gum ammoniac, one drachm, 
 Water, four ounces, 
 Dissolve by rubbing in a mortar, 
 
 Syrup of squills, two ounces, 
 Paregoric elixir, half an ounce. 
 Mix. Dose : a tablespoonful, four times a day. Useful in chronic 
 cough, asthma, and other pectoral affections attended with a defi- 
 cient expectoration, without acute inflammation, or when there is 
 too copious an expectoration of mucus, caused by debility of the 
 mucous membrane. 
 
 Tincture of Bloodroot. 
 Take of the saturated tincture of bloodroot, one ounce. Dose : 
 twenty-five to forty drops, two or three times a day. Highly recom- 
 mended in consumption. 
 
 Syrup of Bloodroot, <&c. 
 Take of bloodroot, one ounce, 
 Anise seed, half an ounce, 
 Liquorice, half an ounce, 
 Boiling water, two pints. 
 Boil down to one pint, then add four ounces of honey. Dose : 
 a tablespoonful, three or four times a day. In consumption, attended 
 with dyspeptic symptoms, it may be used in preference to the pre- 
 ceding. 
 
982 PRESCRIPTIONS. 
 
 Infusion of Cherry Bark. 
 Take of wild-cherry bark, bruised, half an ounce, 
 "Water, one pint. 
 Let it stand for twelve hours, and strain. Dose : a wine-glassful, 
 three times a day. It calms the pulse in the hectic of consumption, 
 and acts as a tonic at the same time. 
 
 Mixture of Infusion of Wild Cherry. 
 Take of the infusion of wild cherry, one pint, 
 Ipecacuanha wine, one ounce, 
 Laudanum, two drachms, 
 Syrup, two ounces. 
 Mix. Dose : a wine-glassful, three times a day. Preferable, in 
 most cases, to the preceding, in consumptive diseases. 
 
 Tar Water. 
 Take of tar, one pint, 
 "Water, four pints, 
 Stir them together in the most thorough manner, then let the tar 
 settle, and strain the water off. Dose : a wine-glassful may be 
 taken four times a day. In consumption. 
 
 Infusion of Flaxseed. 
 Take of flaxseed, one ounce, 
 Liquorice root, half an ounce, 
 Boiling water, two pints. 
 Let it stand two or three hours near the fire, and strain. Add 
 what is agreeable to flavor. A common drink in influenza. 
 
 Decoction of Bran. 
 Take wheat-bran, one pint, 
 Raisins, mashed, half a pint, 
 "Water, four pints, 
 Honey, six tablespoonfuls. 
 Simmer for three or four hours, and strain. Dose : a wine-glass- 
 ful four or five times a day, or it may be used as a common drink 
 in coughs. 
 
 Mixture of Bitter Almonds, <&c. 
 Take of mixture of gum ammoniac, three ounces, 
 Mixture of bitter almonds, three ounces, 
 Tincture of squills, forty drops. 
 Mix. Dose : three tablespoonfuls twice a day. In dry, hoarse 
 cough. 
 
ANTHELMINTICS. 983 
 
 PILLS. 
 
 Pills of Gum Ammoniac, Myrrh, &c. 
 Take of powdered gum myrrh, one drachm, 
 Gum ammoniac, half a drachm, 
 Powdered squills, ten grains, 
 Syrup, a sufficient quantity to make pills. 
 Divide in twenty pills. Dose : two, morning and evening. 
 Useful in the chronic cough of the feeble and the old, when the 
 lungs become loaded w T ith mucus that the patient is unable to get 
 rid of. 
 
 ANTHELMINTICS. 
 
 Anthelmintics, or vermifuges are medicines possessing the pro- 
 perty of destroying or expelling worms from the intestinal canal. 
 Many medicines are capable of accomplishing this result, but there 
 is a class that specifically manifest such a power. It is customary 
 to combine remedies of this class with some one or more of those 
 having purgative action, by w T hich means their effects are much 
 improved. As the action of these medicines, however, is merely 
 temporary, it is proper, as soon as the worms are dislodged, to employ 
 means calculated to restore the digestive organs to a healthy condi- 
 tion, and to correct that peculiar state which favors their production. 
 The means best adapted to this purpose are such as improve the 
 general health. The body should be kept warm with suitable cloth- 
 ing ; the diet should be nutritious ; and, if necessary to invigorate by 
 medical agency, bitter tonics, with gentle aperients, may be adminis- 
 tered. In some cases, when the system is nearly bloodless, as is 
 known by the pallid countenance, the preparations of iron prove to 
 be the most suitable tonics that can be given. 
 
 It is perhaps more difficult to ascertain when worms exist in the 
 stomach and bowels than it is to destroy them. It is very much the 
 fashion to assume, whenever a child is mopish, that it is tormented 
 with these vermin. Sometimes the conjecture proves to be correct, 
 but more frequently it is wrong. Worm medicines in either case 
 are had recourse to, and should there be no worms to rout, the 
 chances are that the child will really be made worse by the quanti- 
 ties of remedies it is unhappily compelled to take. 
 
 We throw out these hints to save children from being unneces- 
 sarily tortured. If there be good reason for believing that a child 
 has worms, and especially if any have been passed at stool, then the 
 remedies of this class should be judiciously tried. But if the opinion 
 
984 PRESCRIPTIONS. 
 
 is merely a doubtful guess, it is better, after making a moderate 
 experiment, without any confirming result, to abandon their use, 
 and, if necessary, take the advice of a physician. (See Worms.) 
 
 Decoction of Pomegranate. 
 Take of bark of root of pomegranate, two ounces, 
 Water, two pints. 
 Boil to one and a half pints. Dose : two ounces every hour. 
 Three or four doses are generally sufficient to expel the worms. This 
 is intended for the tape-worm,, an animal of immense length, that is 
 most common to adults. 
 
 Anthelmintics. 
 Used for worms. 
 
 Santonin e, six grains, 
 Sugar, fifteen grains. 
 Mix, and divide into eight powders. To a child five years old 
 give one powder night and morning. 
 
 Infusion of Kousso. 
 Used for tape-worm. 
 
 Kousso, half an ounce, 
 
 Boiling water, ten ounces. 
 Dose : four ounces every hour. 
 
 Emulsion of Pumpkin Seeds. 
 Used for tape- worm. 
 
 Pumpkin seed, two ounces. 
 Remove the shells and mix in a mass. Then add gradually 
 eight ounces of water. Take the whole quantity in three doses. 
 
 Mixture of Turpentine. 
 
 Take of oil of turpentine, half an ounce, 
 
 Yolk of egg, one, 
 
 Peppermint water, two ounces. 
 Mix. Take all for a dose, for tape-worm j or it may be given in 
 smaller doses, and repeated three or four times in twenty-four hours. 
 This medicine is perhaps the best that can be used for any kind of 
 worms. For a child between two and five years of age, a teaspoon- 
 ful of oil of turpentine, mixed as directed, will be sufficient. Tur- 
 pentine is less likely to act on the urinary organs when taken in a 
 large dose than when taken in a small one, as it passes off through 
 the bowels as a purgative. It may also be mixed with castor-oil. 
 Thus, for a child, 
 
ANTHELMINTICS. 985 
 
 Take oil of turpentine, half an ounce, 
 Castor-oil, one ounce. 
 Mix, and give three teaspoonfuls once a day. 
 
 Infusion of Pink-Root, &c. 
 
 Take of Carolina pink-root, half an ounce, 
 
 Senna, two drachms, 
 
 Manna, one ounce, 
 
 Fennel seed, two drachms, 
 
 Boiling water, one pint. 
 Let it infuse in a covered vessel for an hour, and then strain. 
 A wine-glassful may be given to a child from two to four years old, 
 three times a day. This is an excellent remedy against the common 
 round-worm resembling the earth-worm. 
 
 Mixture of Worm-seed Oil. 
 Take of worm-seed oil, one drachm, 
 Sugar, one and a half drachm, 
 Gum arabic, powdered, two drachms. 
 Mix, and then add 
 
 Peppermint-water, two and a half ounces. 
 Dose : a teaspoonful three times a day for two or three days, 
 then to be followed by some brisk cathartic. For children this is a 
 good anthelmintic, and is much used in some parts of the Southern 
 States. 
 
 Cowhage (or cowitch) and Honey. 
 
 Take of cowhage, one drachm, 
 Honey, sufficient quantity. 
 Mix well together. Dose : a teaspoonful to a child two or three 
 years of age, given before eating in the morning, for three days in 
 succession, and then followed by an active cathartic. This is a very 
 good vermifuge for the common worm. 
 
 Aloes Injection. 
 Take of aloes, twenty grains, 
 Milk, four to six ounces. 
 Dissolve the aloes, and use it for an injection. This is suitable 
 for the destruction of the ascarides, a little worm that generally in- 
 habits the lower bowel in great numbers. For a child five to ten 
 years of age. 
 
9S6 PRESCRIPTIONS. 
 
 STIMULANTS. 
 
 Stimulants are a class of remedies that excite, in a transient 
 way, the vital powers. They increase the vigor of the body, and 
 some of them exalt the intellectual faculties. They have different 
 modes of action, some producing strong effects on both the nervous 
 and arterial systems, and arousing every organ of the body ; while 
 others appear to affect more especially the brain, spinal marrow, and 
 the nerves proceeding from them. 
 
 MIXTUEES, &c. 
 
 Ammonia, c&c. 
 
 Take of camphor water, six ounces, 
 
 Carbonate of ammonia, one drachm, 
 
 Sweet spirits of nitre, three drachms. 
 
 Mix. Dose: one tablespoonful may be taken frequently when 
 
 there is fainting. 
 
 Infusion of Mint, Camphor, <&c. 
 Take infusion of spearmint, six ounces, 
 Burnt brandy, one ounce, 
 Paregoric elixir, one drachm, 
 Sugar, half an ounce. 
 Mix. Dose : a tablespoonful frequently taken until the vomit- 
 ing ceases. To stop long-continued vomiting and retching. 
 
 Mixture of Sulphuric JEther, <&e. 
 Take of sulphuric aether, one drachm, 
 Water, six ounces, 
 Oil of caraway, six drops, 
 Peppermint water, one ounce, 
 Sugar, three drachms. 
 Mix. Dose : a tablespoonful occasionally, in flatulence of the 
 stomach. 
 
 Draught of Arnica, dec. 
 Take of arnica flowers, three drachms, 
 Boiling water, ten ounces, 
 Let it stand for an hour in a close vessel, and strain it ; then 
 add 
 
 Liquorice powder, one ounce, 
 Compound tincture of cardamoms, two drachms, 
 Syrup of ginger, one drachm. 
 Mix. Take this at a dose, and repeat it three times a day. In 
 paralysis. 
 
STIMULANTS. 987 
 
 Milk Punch. 
 Used in typhus and typhoid fevers. 
 
 Brandy, two ounces, 
 
 Milk, four ounces, 
 
 Sugar to suit the taste. 
 Dose : a tablespoonful or more every hour or two. 
 
 Egg-nog. 
 
 One egg, 
 
 "White sugar, two drachms. 
 Mix, and beat into a froth ; then add 
 
 Sherry wine, half an ounce, 
 
 Water, one ounce. 
 This preparation is nutritious, tonic, and stimulating. 
 Nutmeg may be added to suit the taste. 
 
 Mixture of French Brandy, dec. 
 
 Take of French brandy, four ounces, 
 
 Cinnamon water, four ounces, 
 
 Yelk of eggs, two, 
 
 Sugar, half an ounce, 
 
 Oil of cinnamon, two drops. 
 Mix. Dose : one to three tablespoonfuls, repeated every two 
 hours when necessary. An excellent remedy in the debility conse- 
 quent upon protracted disease, when the patient appears to be 
 sinking from exhaustion. 
 
 Draught of Valerian and Ammonia. 
 Take of valerian, one scruple, 
 Carbonate of ammonia, ten grains, 
 Cinnamon water, two ounces. 
 Take the whole at once, and it may be repeated every fourth 
 horn*. In nervous headache and low spirits. 
 
 Infusion of Virginia Snake-Boot. 
 
 Take of snake-root, half an ounce, 
 
 Boiling water, one pint. 
 Let it stand for four hours, and strain. Dose: two to four 
 tablespoonfuls three times a day. Useful in low fevers, fever and 
 ague, gangrene, &c. 
 
 Confection of Black Pejpper, &c. 
 Take of black pepper, four ounces, 
 Elecampane root, four ounces, 
 Fennel seeds, twelve ounces, 
 Honey and white sugar, of each eight ounces. 
 
988 
 
 PRESCRIPTIONS 
 
 Bub the dry ingredients together to a very fine powder, add 
 four ounces of water, and beat into an uniform mass. This is a 
 remedy that is known as Ward's Paste, and is very efficacious in 
 piles when they occur in the weak and debilitated. Dose : mass 
 as large as a hazel-nut, three times a day. 
 
 Balm Tea. 
 Take of fresh balm, two ounces, 
 Boiling water, half a pint. 
 Let it stand for a quarter of an hour. Dose : a wine-glassful to 
 a teacupful, frequently. It may be drunk warm to promote the 
 operation of sweating medicines. If the balm is dry, one-half the 
 above quantity is sufficient. Spearmint Tea may be prepared in 
 the same manner and proportions, and taken in half the dose of the 
 balm tea. 
 
 Wine Whey, 
 Take of fresh milk, half a pint, 
 Madeira wine, one to two ounces. 
 Boil the milk and then add the wine. Used in fevers when 
 the system requires support. It is a mild stimulant. 
 
 SOPOKIFICS, NABCOTICS, ANODYNES, AND 
 NEKVINES. 
 
 The medicines of this class are very numerous, and for practical 
 purposes in this place may embrace sedatives, anodynes, and sopo- 
 rifics. Most of them primarily produce a stimulating effect on the 
 nervous and vascular systems ; but this is soon succeeded by a de- 
 pression of the vital powers and sleep. If the stimulating effect 
 only be desired they should be administered in only small doses, 
 and frequently repeated. "When given with the intention of caus- 
 ing sleep, the dose ought to be larger, and repeated at more distant 
 intervals. Some individuals are nearly insensible to their action, 
 while others can scarcely endure the smallest quantities, becoming 
 either stupefied or excessively excited. 
 
 Habit influences the action of narcotics on the system more 
 than any other circumstance, their power being diminished in a 
 remarkable degree by repetition ; it is therefore necessary, where 
 their continued use is required, gradually to augment the dose, in 
 order to obtain their proper effects. These are remedies that are 
 very greatly abused. (See Sleeplessness) 
 
SOPORIFICS, NARCOTICS, ANODYNES, AND NERVINES. 989 
 
 NARCOTICS AND ANODYNES. 
 
 Anodyne Plasters. 
 
 Used for painful joints, backache, lumbago, &c. 
 Lead plaster, two drachms. 
 
 Melt, and add gradually 
 
 Powdered opium, half a drachm, 
 Powdered camphor, half a drachm. 
 
 Plaster of Opium and Camphor {used for neuralgia). 
 Powdered opium, half a drachm, 
 Powdered camphor, half a drachm, 
 Burgundy pitch, one ounce. 
 Mix with lead, as much as may be necessary. 
 
 Belladonna Plaster {excellent for neuralgia, backache, dec). 
 
 Extract of belladonna, one drachm, 
 
 Glycerine, half a teaspoonful. 
 Mix, and spread on adhesive plaster. 
 
 NERVINES. 
 
 These have a calming, quieting influence on the nervous sys- 
 tem. They produce sleep and allay irritability, and to a certain 
 extent relieve pain. 
 
 Bromide of potassium, one drachm, 
 Syrup of orange peel and 
 Water, each three ounces. 
 Dose : from one to three or four tablespoon fuls. 
 Ohlorodyne is made according to the following formula : 
 Chloroform, four drachms, 
 Sulphuric aether, two drachms, 
 Theraica, one drachm, 
 Mucilage of gum arabic, one drachm, 
 Muriate of morphine, eight grains, 
 Dilute hydrocyanic acid, two drachms, 
 Oil of peppermint, four drops. 
 Chlorodyne can only be made by a chemist. Other anodynes 
 are sometimes added besides those mentioned. The dose is from five 
 to ten drops. It is given in those cases where an anodyne is needed. 
 
 MIXTURES, DRAUGHTS, &C 
 
 Draught of Henbane, &c. 
 Take of tincture of henbane, one drachm, 
 Camphor water, two ounces. 
 
990 PRESCRIPTIONS^ 
 
 Mix. To be all taken at once at bedtime, and repeat it in two 
 hours if the patient does not sleep. An excellent narcotic draught 
 where from any cause opium is inadmissible. 
 
 Mixture of Tincture of Lettuce, <&c. 
 Take of tincture of lettuce, six drachms, 
 Distilled water, six drachms, 
 Water of cherry laurel, two drachms, 
 Simple syrup, one and a half ounces. 
 Mix. Dose : a tablespoonful morning and evening. An ano- 
 dyne draught, preferable to an opiate, in consumption. 
 Draught of Sulphate of Morphia, <&c. 
 Take of sulphate of morphia, half a grain, 
 Diluted sulphuric acid, two drops, 
 Water, two ounces, 
 Syrup, half an ounce. 
 Mix. Take half of it at a dose for an adult. 
 
 Mixture of Foxglove, c&c. 
 Take of tincture of purple foxglove, three drachms, 
 Camphor water, six ounces, 
 Orange syrup, one and a half ounces, 
 Prussic acid, six drops. 
 Mix. Dose : two tablespoonfuls two or three times a day. An 
 excellent remedy in nervous palpitations. It is a powerful medi- 
 cine, and must only be used with great care. 
 
 PILLS. 
 
 Pills of Morphia. 
 Take of sulphate of morphia, three grains, 
 Conserve of roses, sufficient to make pills, and divide into twelve. 
 Dose : one pill (which is equivalent to a grain of opium) when 
 necessary. 
 
 Pills of Lettuce. 
 Take of extract of lettuce, ten grains, 
 Divide in five pills. 
 Dose: one, which may be repeated at the end of two hours if 
 sleep be not procured. 
 
 Pills of Camphor. 
 Take of camphor, half a drachm, 
 Gum and alcohol, sufficient quantity to make pills. 
 Divide into fifteen. Dose : a pill every two hours. To quiet 
 nervousness, and to act gently on the skin. 
 
ANTISPASMODICS. 991 
 
 Opium Pill. 
 Take of powdered opium, twenty grains, 
 Castile soap, four scruples. 
 Beat together, and divide into five-grain pills. Useful when an 
 opiate is required. Each pill contains one grain of opium. 
 
 ANTISPASMODICS. 
 
 These are medicines that counteract irregular or involuntary 
 muscular action, which is known as spasm. This deranged state 
 of the system depends on so many different causes, and is produced 
 by so many different sources of irritation, that its successful treat- 
 ment will very frequently depend on the employment of remedies 
 calculated to remove the more remote cause or source of irritation 
 by which the spasmodic affection is produced. It hence follows 
 that, under peculiar circumstances, the remedies which will be found 
 most successful in counteracting spasm must be derived from very 
 distinct divisions of the Materia Medica ; and thus the term anti- 
 spasmodic may become applicable to a narcotic, a sedative, a stimu- 
 lant, a cathartic, a tonic, and several other kinds of medicines. 
 There are, however, certain substances which exercise a direct con- 
 trol over spasmodic action, independent of any influence upon its 
 exciting causes, and these are meant when antispasmodics are spo- 
 ken of. 
 
 MIXTURES, DRAUGHTS, &o. 
 
 Mixture of Valerian, JEther, <&c. 
 Take of aniseed water, two ounces, 
 Ammoniated tincture of valerian, thirty drops, 
 Spirit of sulphuric aether, one drachm. 
 Mix. Take one half of this for a dose, and repeat it two or 
 three times a day. In hysterics, epilepsy, &c. 
 
 Draught of Valerian, Castor, <&c. 
 Take of infusion of valerian, eleven drachms, 
 Foetid spirit of ammonia, half a drachm, 
 Tincture of castor, half a drachm. 
 Mix, and take all at a draught, two or three times a day, a short 
 time before an anticipated attack of epilepsy. 
 
 Tincture of Wood-Soot. 
 Take of pure wood-soot, two ounces, 
 Assafoetida, one ounce, 
 Proof spirit, thirty-two ounces. 
 
992 PRESCRIPTIONS. 
 
 Let it stand for three days, and strain. Dose : one teaspoonful, 
 three or four times a day. For children it must be proportionally 
 reduced. 
 
 Mixture of Hoffman's Anodyne, &c. 
 Take of Hoffman's anodyne, three drachms, 
 Tincture of opium, one and a half drachms, 
 Cinnamon water, six ounces. 
 Mix. Dose : tablespoonful every one or two hours. In hyste- 
 rics, or cramp in the stomach. 
 
 Mixture of Assafcetida, dice. 
 Take of assafcetida, one drachm, 
 Peppermint water, three ounces. 
 Dissolve, and add 
 
 Ammoniated tincture of valerian, two drachms, 
 Tincture of castor, three drachms, 
 Sulphuric gether, one drachm. 
 Mix. Dose : a tablespoonful (with plenty of water) every second 
 hour. In hysterics. 
 
 PILLS. 
 
 Pills of Assafcetida, <&c. 
 Take of assafcetida, one drachm, 
 Soap, ten grains, 
 
 "Water, sufficient, and make twenty pills. 
 Dose : one or two, three times a day. To relieve hysterical 
 symptoms. 
 
 TONICS. 
 
 Tonics constitute a class of medicines, the continued administra- 
 tion of which, in debilitated and relaxed conditions of the body, 
 imparts strength and a more vigorous feeling, without producing, 
 as stimulants do, any sudden excitement. To a certain extent to- 
 nics are stimulants, inasmuch as they arouse the vital energies ; but 
 the excitement has more the character of health, and is permanent. 
 If, however, they are given when the system is unimpaired by dis- 
 ease, their primary action, like that of stimulants, is followed by 
 prostration. 
 
 There is no class of remedial agents that requires more discri- 
 mination in its administration than tonics ; nor any, the injudicious 
 use of which more frequently produces evil consequences. The 
 diseases in which this class of substances should be principally em- 
 
tonics. 993 
 
 ployed are evidently those of diminished power. But diminished 
 power is often the consequence or concomitant of irritation or in- 
 flammation of the organs of digestion, and under such circum- 
 stances tonics will rather aggravate than mitigate the affection. 
 To be used with effect, this condition must first be removed by such 
 means as are pointed out in other parts of this work. Independent 
 of their tonic properties, some of the medicines of this class possess 
 the power of arresting those diseases that are distinguished by regu- 
 lar paroxysms. Peruvian bark is an example of this kind of reme- 
 dies, and from its universal application to fever and ague, is called 
 a febrifuge, or a medicine that checks fever. It cannot, however, 
 be imagined that either this, or the other remedies having the same 
 specific power over periodical fever, are directly antagonistic to its 
 phenomena, for they are equally efficacious in other periodical dis- 
 eases, in which febrile excitement may be altogether absent. This 
 subject of antiperiodic remedies is one of great interest, and is in- 
 volved in much obscurity ; but as this is not the place for its inves- 
 tigation, we can do no more than merely refer to it, as has been 
 done, and pass it by. Some of our best tonics are not drugs, but 
 rather methods of treatment ; such as travelling, sea and shower 
 bathing, general electrization, movement cure, dec. 
 
 TONICS. 
 
 Mixture' of Pyrophosphate of Iron. 
 Used as a tonic in nervous diseases. 
 
 Pyrophosphate of iron, one drachm. 
 
 Syrup, two ounces, 
 
 Cinnamon water, two ounces. 
 Dose : a tablespoonful after each meal. 
 
 Preparations of Iron, Quinine, and Strychnine. 
 
 Used as tonics in nervous diseases. 
 
 TVyeth's elixir and Caswell's preparation are now much used. 
 The advantage of these preparations is, that they are carefully made, 
 and are less offensive to the taste than many others. 
 
 Caswell, Hazard <& Co.'s Ferro-phosphated Elixir of Calisaya 
 
 Baric. 
 This preparation, which is now much used, contains three of our 
 best tonics — iron, phosphorus, and calisaya. 
 
 In one pint of the elixir there are represented the following 
 substances : — 
 
 63 
 
994 PRESCRIPTIONS. 
 
 Fluid extract of cinchona-calisaya, one ounce, 
 " " true cinnamon, two drachms, 
 
 " caraway seed, one drachm, 
 
 " " sweet orange, one drachm, 
 
 Pyrophosphate of iron, sixty grains, 
 Simple syrup, three ounces, 
 Best brandy, four ounces, 
 Whiskey, three ounces, 
 Pure spirits and water, four ounces. 
 It will be seen that this formula contains a large number of our 
 principal tonics. The preparation is more palatable than any com- 
 bination of the same substances that would be made from an ordinary 
 prescription. I do not think, however, that it is any more effica- 
 cious than other similar .preparations. I recommend it because 
 it is reliable, convenient, and comparatively agreeable to the taste. 
 
 For the same reason I frequently recommend Wyettis elixir of 
 quinine, pyrophosphate of iron, and strychnine. 
 
 Patients who are under medical treatment should, in all cases, 
 take the prescriptions that are given them ; but inasmuch as the 
 ingredients of these tonic preparations are not kept secret, as with 
 patent and quack medicines, and as their doses are fully established, 
 physicians who reside in districts where they can be obtained fre- 
 quently recommend them. 
 
 Each tablespoonful of the tonic preparation of Caswell, Hazard 
 & Co. contains — • 
 
 Sulphate of quinine, f of a grain, 
 Cinchonine, f " " 
 
 Alkaloids of bark, \ " 
 
 Pyrophosphate of iron, 4 grains. 
 One grain of strychnine is sometimes added to a pint bottle of 
 the ferro-phosphated elixir of calisaya bark. 
 
 Among the tonic prescriptions which in cases of necessity may 
 be prepared and used at home are these : 
 Used in ansemia and nervous exhaustion. 
 
 Mixture of sulphuric acid, four drachms, 
 Syrup of orange peel, two ounces, 
 Cinnamon water, one ounce. 
 Mix, and take ,a teaspoonful three times a day, in a wine-glass- 
 ful of water. 
 
 Mixture of Cinchona-Valerian. 
 Used in nervousness and debility. 
 
 Tincture cinchonse, one ounce and a half, 
 Tincture valerian, one ounce, 
 Peppermint water, four ounces. 
 
tonics. 995 
 
 Mix, and take a tablespoonful three or four times a day. 
 
 Sulphate of Quinine in Syrup. 
 
 Used in ague. 
 
 Sulphate of quinine, sixteen grains, 
 
 Syrup of ginger, two ounces. 
 Mix, and take from one to four teaspoonfuls before the attack 
 comes on. 
 
 Mixture of Arsenic and Iron. 
 
 Fowler's solution, one drachm, 
 Elixir of bark, three ounces, 
 Citrate of iron, two drachms. 
 Mix, and take two teaspoonfuls after each meal. 
 
 Elixir of Pepsin. 
 
 Used for dyspepsia. 
 
 Pepsin, one drachm and a half, 
 
 Water, six drachms and a half, 
 
 Sherry wine, twelve drachms and a half, 
 
 Alcohol, three drachms, 
 
 Sugar, one ounce. 
 Dissolve and strain. Take a tablespoonful, containing fifteen 
 grains of pepsin, after each meal. 
 
 Syrup of the Hypophosphites of Lime, Soda, and Potash. 
 
 This preparation is now frequently recommended as a tonic in 
 consumption and general debility. Though it does not do all that 
 is expected of it, it is yet oftentimes of great service. 
 The formula for it as is follows : 
 
 Hypophosphite of lime, six drachms, 
 " soda, two drachms, 
 
 " potash, two drachms, 
 
 Hot water, ten ounces. 
 Dissolve, strain, and add 
 
 Sugar, fourteen ounces. 
 Dissolve, strain, and add 
 
 Water of orange flowers, half an ounce. 
 Mix, and take a teaspoonful three or four times a day. 
 The formula for this preparation is given so that those who take 
 it may know what they are taking. It is not necessary to prepare 
 this at home. 
 
996 PKESCRIPTIONS. 
 
 Emulsion of Phosphorus. 
 Phosphorus, two grains, 
 Mucilage, one ounce. 
 Mix thoroughly, and add gradually 
 "Water, one ounce. 
 Make an emulsion, and add 
 
 Hoffman's Anodyne, thirty drops, 
 Syrup, one ounce. 
 Make a mixture. Dose : from one to four teaspoonfuls three 
 times a day. I do not recommend phosphorus in this form as a 
 domestic remedy. The best way to get the tonic effects of phos- 
 phorus is to take pyrophosphate of iron in the preparations above 
 described, or in the form of diluted phosphoric acid, in doses of from 
 ten to thirty drops in sweetened water. 
 
 MIXTURES, DECOCTIONS, &c. 
 Mixture of Sulphate of Quinine, dec. 
 Take of sulphate of quinine, twenty grains, 
 Diluted sulphuric acid, twenty-five drops, 
 Orange syrup, one ounce, 
 Water, five ounces. 
 Mix. Take a tablespoonful four times a day. To be taken 
 during the intermission in fever and ague. In some cases the dose 
 may be doubled with advantage. It may also be used as a tonic in 
 convalescence after a fever. 
 
 Decoction of Dog-wood Bark. 
 Take of dog-wood bark, bruised, one ounce, 
 Water, one pint. 
 Boil for ten minutes and strain while hot. Dose : two ounces, 
 frequently repeated. Substitute for Peruvian bark in fever and 
 ague, and as a general tonic. It answers a very good purpose, and 
 in parts of the country where no other remedy can be obtained, may 
 be resorted to with every hope of success. 
 
 Decoction of Willow Bark. 
 Take of willow bark, one ounce, 
 Water, one pint. 
 Boil for ten minutes, and strain. Dose: four tablespoonfuls 
 four or five times a day. This is another substitute for Peruvian 
 bark in fever and ague, and is thought by many to be very little 
 inferior to it. 
 
 
tonics. 997 
 
 Infusion of Virginia Snake-Root. 
 Take of Virginia snake-root, one ounce, 
 Boiling water, one pint. 
 Infuse for a few hours, and strain. Dose : one or two table- 
 spoonfuls four times a day in low forms of fever ; in chronic dis- 
 eases the quantity may be less. If given for fever and ague, for 
 which it is strongly recommended, the dose may be increased. It 
 is also successfully employed in promoting the monthly discharge 
 of females ; in this case it must be used all the time during the 
 intervals. 
 
 Infusion of Boneset or Thoroughwort. 
 
 Take of the boneset leaves, dried, one ounce, 
 
 Boiling water, one pint. 
 Let it stand for two hours, and then strain. This is another 
 medicine that has been employed as a substitute for Peruvian bark 
 in the treatment of fever and ague. It is not equal to it, but will 
 often cure. In all cases of debility, when a tonic is required, it 
 may be used ; and if there be also some fever, perhaps no better can 
 be employed. Dose : for ague, as much as the stomach will bear, 
 and should be drunk warm. 
 
 Compound Infusion of Gentian. 
 
 Take of bruised gentian, half an ounce, 
 
 Dried orange peel, one drachm, 
 
 Coriander, bruised, one drachm, 
 
 Alcohol, diluted, four fluid ounces, 
 
 Water, cold, twelve ounces. 
 Let it stand for twelve hours, and strain. Dose : two table- 
 spoonfuls, three times a day. This is an excellent tonic, and may 
 be used in all cases of debility of the digestive organs, if there be 
 no irritation or inflammation of the stomach. It is very good to 
 correct the acid secretions. 
 
 Infusion of Colomba, Ginger, dec. 
 Take of colomba, bruised, half an ounce, 
 Ginger, bruised, half an ounce, 
 Senna, two drachms, 
 Boiling water, one pint. 
 Let it stand for an hour, and strain. Dose : a wine-glassful 
 three" times a day. An excellent remedy in dyspepsia with consti- 
 pation and flatulence. * 
 
998 PRESCRIPTIONS. 
 
 Infusion of Wild-Cherry Bark. 
 Take of wild-cherry bark, one ounce, 
 Orange peel, two drachms, 
 Water, one pint. 
 Infuse the bark for an hour and then add the orange peel. Dose ; 
 a wine-glassful every hour or two. It is highly useful in the hectic 
 fever of scrofula and consumption. In the general debility often 
 succeeding inflammatory diseases it has been found advantageous, 
 and is adapted to many cases of dyspepsia. 
 
 Mixture of Peruvian Bark, in Wine. 
 Take of powdered bark, half an ounce, 
 Lemon-juice, two drachms, 
 Port wine, four ounces. 
 Mix. Dose : a w T ine-glassful every two hours, during the inter- 
 mission of fever. 
 
 Huxham's Tincture of Bark. 
 Take of Peruvian bark, in powder, two ounces, 
 Orange peel, one and a half ounce, 
 Virginia snake-root, bruised, three drachms, 
 Saffron and red saunders, rasped, each one drachm, 
 Alcohol, diluted, twenty ounces. 
 Let it stand for fourteen days, and filter through paper. Dose : 
 from one to four teaspoonfuls. This is an excellent stomachic cor- 
 dial. If a grain or two of quinine be added to each dose, it is a 
 very excellent remedy for fever and ague, and will often succeed 
 when the other preparations of bark have failed. 
 
 Mixture of Green Vitriol, dec. 
 Take of green vitriol, four grains, 
 Aromatic sulphuric acid, twenty drops, 
 Syrup, half an ounce, 
 Water, one ounce. 
 Mix. Dose : a teaspoonful to be taken three times a day in a 
 wine-glass of water. A very good tonic when there are no inflam- 
 matory symptoms present. None of the preparations of iron should 
 be administered wdien the patient is plethoric or inclined to fever. 
 Good in chlorosis or green-sickness, and for restoring monthly 
 sickness. 
 
 Tincture of Iron. 
 Take of tincture of muriate of iron, one ounce. 
 Dose : ten to twenty drops three times a day, in a wine-glass of 
 water. Used as the preceding prescription. It is aiso astringent, 
 and is employed to check passive hemorrhages. 
 
tonics. 999 
 
 PILLS. 
 
 Pills of Oxide of Zinc. 
 Take of oxide of zinc, two scruples, 
 Confection of roses, sufficient quantity. 
 Make ten pills. Dose : one, three times a day. This is often 
 employed with success in St. Titus's dance, epilepsy, and other simi- 
 lar nervous affections. 
 
 Pills of Iron and Aloes. 
 Take of sulphate of iron, three parts, 
 Aloes, two parts, 
 Aromatic powder, six parts, 
 Conserve of roses, eight parts. 
 Mix. Divide into five-grain pills. Dose : one to three. This 
 is a good pill in greensickness and interrupted menstruation. 
 Pills of Rhubarb and Iron. 
 Take of sulphate of iron, four parts, 
 Extract of rhubarb, ten parts, 
 Conserve of roses, five parts. 
 Mix. Divide into five-grain pills. Dose : two to four. A 
 stomachic. 
 
 Pills of Oxide of Bismuth. 
 Take of oxide of bismuth, two scruples, 
 Gum arabic and water, sufficient quantity. 
 Make a mass and divide into thirty pills. Two for a dose, four 
 times a day. A very good remedy in dyspepsia, when there is much 
 pain in the stomach. 
 
 ALTERATIVES. 
 
 These are " medicines that re-establish the healthy functions of 
 the animal economy without producing any active evacuation." 
 
 Their effects are slow, but positive, and oftentimes exceedingly 
 beneficial. In order to get the alterative effect of any medicine it 
 is generally necessary to give it in small doses, frequently repeated 
 for a long time. Calomel, arsenic, cod-liver oil, are classed among 
 the alteratives, although calomel in large doses is a cathartic, and 
 arsenic and cod-liver oil are tonics. Iodine is the most prominent 
 of the alteratives. 
 
 Ifixhcre of Iodide of Potassium. 
 Used in syphilis. 
 
 Iodide of potassium, one drachm, 
 Syrup of ginger, one ounce, 
 "Water, five ounces. 
 Take a tablespoonful three times a day. 
 
1000 PRESCRIPTIONS. 
 
 Mixture of Iodide of Potassium and Sarsaparilla. 
 Used in syphilis. 
 
 Iodide of potassium, two scruples, 
 
 Water, three ounces, 
 
 Sugar, one ounce, 
 
 Fluid extract of sarsaparilla, half an ounce. 
 Dose : one tablespoonful three times a day. 
 
 ASTRINGENTS. 
 
 This is a class of medicines which, when applied to a sensible or 
 visible part of the body, is found to produce a contraction or con- 
 densation. It is impossible to explain why such results take place, 
 but it is probable that they are generally chemical phenomena. 
 The consequence of their action is a diminished secretion ; and 
 most if not all of them act, finally, as tonics. 
 
 It is for their property of eonstringing the tissues that they are 
 arranged under this head, regardless of any other qualities they may 
 possess. Astringents have the power not only of checking secre- 
 tions of the part with which they are directly in contact, but also 
 that of parts more or less remote. 
 
 Remedies of this class cannot safely be resorted to in every case 
 in which a discharge is too great. It is only when diseases are of 
 long standing and have become chronic, or when there is no ac- 
 companying constitutional excitement, that they can properly be 
 employed. They otherwise may be expected to cause general re- 
 action, and induce a train of symptoms more aggravated than those 
 which existed in the first instance. 
 
 There are certain other medicines, though not belonging to the 
 class of astringents, that are equally powerful in arresting internal 
 secretions. They do this by establishing a new train of actions in- 
 compatible with the secreting functions. Some of the narcotics 
 have this property. Opium furnishes a striking example of such 
 substances. Ipecacuanha, acting by a different process, will also 
 cause a similar general result. 
 
 MIXTURES, DECOCTIONS, &c. 
 Chalk Mixture, dec. 
 Take cinnamon water, one ounce, 
 Chalk mixture, half an ounce, 
 Tincture of kino, two drachms, 
 Laudanum, eight drops, 
 Orange syrup, two drachms. 
 
ASTRINGENTS. 1001 
 
 Mix. Dose : one to two teaspoonfuls, in the purging of chil- 
 dren, when there is no fever. This is a very well-known and a very 
 excellent mixture. 
 
 Draught of Cascarilla, <&c. 
 Take of infusion of cascarilla, six drachms, 
 Cinnamon water, two drachms, 
 Compound powder of kino, ten grains, 
 Laudanum, eight drops. 
 Mix. Dose : all at once, — to be taken twice a day. In relax- 
 ation of the bowels after dysentery. For a young child, one-fourth 
 of this quantity. 
 
 Infusion of Angustura Bark. 
 
 Take of angustura bark, bruised, half an ounce, 
 Boiling water, one pint. 
 Let it stand for two hours, and strain. Doses : two ounces, re- 
 peated every three hours. This has high recommendations as a 
 remedy for bilious diarrhoea and dysenteries, especially of southern 
 latitudes. 
 
 Decoction of Logwood. 
 Take of rasped logwood, one ounce, 
 Cinnamon, one drachm, 
 Water, two pints. 
 Boil down to a pint, and strain. Dose : two ounces repeated 
 several times a day ; for a child two years of age, two teaspoonfuls. 
 This is an excellent astringent in chronic diarrhoea and dysentery, 
 for which it is peculiarly suitable, as while it checks the discharge it 
 does not produce the opposite condition — constipation. It has also 
 been used in the sweating of consumption. 
 
 Decoction of Avens. 
 Take of avens root, bruised, one ounce, 
 Water, one pint. 
 Boil down one-third. Dose : one to two tablespoonfuls, several 
 times a day. Useful in such cases and circumstances as the fore- 
 going. It is perhaps one of the best domestic astringents we pos- 
 sess, and is much used in some parts of the country. 
 
 Infusion of Rhatany. 
 Take of rhatany, one ounce, 
 Boiling water, one pint. 
 Let it stand for four hours, and then strain. Dose : two to four 
 tablespoonfuls. This is a powerful astringent and tonic, and is much 
 employed in the treatment of chronic diarrhoea and dysentery, in 
 

 1002 PRESCRIPTIONS. 
 
 passive hemorrhages, in Heeding from the womb and kidneys, and 
 in mucous discharges, that seem kept up by debility of the part. 
 
 Decoction of Oak Bark. 
 Take of oak bark, one ounce, 
 "Water, two pints. 
 Boil to one pint, and strain. Dose : one to four ounces. Used 
 like the preceding. Yery good, and always at hand. It is also a 
 useful injection for whites, and is sometimes serviceable, employed 
 in this way, in falling of the womb. 
 
 Devoction of Bearberry. 
 Take of bearberry, one ounce, 
 Water, one and a half pints. 
 Boil to one pint, and strain. Dose : one to three ounces every 
 four hours. Chiefly used in mucous discharges of the urinary or- 
 gans, as catarrh of the bladder, gleet, and in whites. 
 
 Hojpds Mixture. 
 Take of camphor water, four ounces, 
 Nitric acid, four drops, 
 Laudanum, fifty drops. 
 Mix. Dose : a tablespoonful every two hours. In diarrhoea 
 and dysentery. This mixture is somewhat celebrated, and is much 
 employed by medical men. 
 
 PILLS. 
 
 Pills of Sugar of Lead and Opium. 
 
 Take of sugar of lead, powdered, one scruple, 
 
 Opium, ten grains, 
 
 Gum arabic and water, sufficient quantity. 
 Divide in ten pills. Dose : one pill every two hours. In bleed- 
 ing from the lungs and other internal organs. These may be used 
 even when there is considerable excitement of the pulse, as they 
 have the effect of a sedative. It is well to remember that the car- 
 bonate of lead may produce the painter's colic. In taking this me- 
 dicine, therefore, it is advisable to drink a little vinegar and water 
 between the doses, to prevent any such serious consequences. The 
 sugar of lead and opium is also an admirable remedy, reducing the 
 quantity of opium one half, in chronic diarrhoea and dysentery ; and 
 it is recommended by some practitioners very highly in Asiatic 
 cholera. 
 
ASTEINGENTS. 1003 
 
 Pills of Tannin and Opium. 
 Take of tannin, thirty grains, 
 Powdered opium, six grains, 
 Gum arabic and water, sufficient quantity. 
 Divide into fifteen pills. Dose : one, every two or three hours. 
 In chronic diarrhoea and dysentery. 
 
 GARGLES. 
 
 Gargle of Borax. 
 Take of borax, one drachm, 
 Tincture of myrrh, half an ounce, 
 Pure honey, one ounce, 
 Water, four ounces. 
 Mix. Useful in scorbutic affections of the gums, and for cleans- 
 ing the mouth. 
 
 Gargle of Sage Tea, Alum, and Honey. 
 Used for all kinds of sore throat. 
 
 Sage tea, one pint, 
 Alum, half an ounce, 
 Honey, one ounce. 
 
 Gargle of Chlorate of Potash. 
 Used for quinsy and other forms of sore throat. 
 Chlorate of potash, two drachms, 
 Tepid water, one pint. 
 
 Gargle of Brandy. 
 Brandy, two ounces, 
 Water, four ounces. 
 Gargle of Sage and Flax-seed. 
 Sage, two ounces, 
 Flax-seed, one ounce, 
 Boiling water, one pint. 
 
 Gargle of Alum. 
 Take of alum, powdered, two scruples, 
 Water, four ounces. 
 Mix. In relaxation of the palate and bleeding gums. 
 
 Gargle of Chloride of Soda. 
 Take chlorine water, half an ounce, 
 Syrup, one ounce, 
 Water, five ounces. 
 
1004 PRESCRIPTIONS. 
 
 Mix. In putrid sore throat and scarlet fever. It is also highly 
 useful in severe salivation. If it should be too stimulating, add a 
 little more water to it. 
 
 Gargle, of Muriatic Acid. 
 Take of muriatic acid, thirty drops, 
 Honey, two ounces, 
 Barley-water, six ounces. 
 Mix. In inflammatory sore throat. 
 
 Gargle of Oak Bark. 
 Take of oak bark, two drachms, 
 Water, boiling, six ounces. 
 Let it stand for an hour, and strain. Ten grains of alum added 
 to it increases its astringency. In relaxation of the palate. 
 
 Gargle of Vinegar. 
 Take of barley water, five ounces, 
 Vinegar, pure, eight ounces, 
 Honey, six drachms. 
 Mix. For common sore throat, and as a wash to cleanse the 
 mouth. 
 
 EYE-WASHES. 
 
 Wash of Sugar of Lead. 
 Take of sugar of lead, twenty grains, 
 Laudanum, forty drops, 
 Pure water, four ounces, 
 Vinegar, two drachms. 
 Dissolve. (See Eye, Diseases of.) 
 
 Wash of Alum. 
 Take of alum, powdered, fifteen grains, 
 Rose-water, four ounces. 
 Dissolve. For the eye in chronic inflammation. 
 
 INJECTIONS FOR THE URETHRA. 
 
 Injection of Carbolic Acid and Glycerine. 
 Used for gonorrhoea. 
 
 Carbolic acid, eight grains, 
 Glycerine, two ounces, 
 Water, two ounces. 
 
ASTRINGENTS. 1005 
 
 Injection of Chlorate of Potash. 
 "Used for gonorrhoea. 
 
 Chlorate of potash, half a drachm, 
 Water, five ounces. 
 
 Injection of Sulphate of Zinc. 
 Take of white vitriol, ten grains, 
 Powdered gum arabic, two drachms, 
 Laudanum, one drachm, 
 Water, eight ounces. 
 Used for an injection in acute gonorrhoea. 
 
 Injection of Sulphate of Copper. 
 Take of blue vitriol, six grains, 
 Pure water, six ounces. 
 Dissolve. Used for the same purpose as the preceding. Lauda- 
 num may be added to any of them if thought proper, and it is often 
 of service. 
 
 The foregoing may all be employed as injections for whites, by 
 increasing the quantities. 
 
 PLASTERS. 
 
 The following description of the method of preparing plasters I 
 take from the United States Dispensatory : 
 
 " Plasters are solid compounds intended for external application, 
 adhesive at the temperature of the human body, and of such a con- 
 sistence as to render the aid of heat necessary in spreading them. 
 Most of them have as their basis a compound of olive oil and 
 litharge, constituting the Emplastrum plumbi of the United States 
 Pharmacopoeia. 
 
 " Plasters are prepared for use by spreading them upon leather, 
 linen, or muslin, according to the particular purposes they are in- 
 tended to answer. Leather is most convenient when the applica- 
 tion is made to the sound skin ; linen or muslin when the plaster is 
 used as a dressing to ulcerated or abraded surfaces, or with the view 
 of bringing and retaining together the sides of wounds. The leather 
 usually preferred is white sheepskin. 
 
 " A margin about a quarter or half an inch broad should usually 
 be left uncovered, in order to facilitate the removal of the plaster, 
 and to prevent the clothing in contact with the edges from being 
 soiled." 
 
 'Plaster of Belladonna {Emplastrum Belladonna}). 
 
 " Take of resin plaster, three ounces ; extract of belladonna, an 
 
1006 PRESCRIPTIONS. 
 
 ounce and a half. Add the extract to the plaster, previously melted 
 by the heat of a water-bath, and mix them." 
 
 Iron Plaster ; Strengthening Plaster (Emplastrum Ferri). 
 
 u Take of subcarbonate of iron, three ounces; lead plaster, two 
 pounds; Burgundy pitch, half a pound. Add the subcarbonate of 
 iron to the lead plaster and Burgundy pitch, previously melted 
 together, and stir constantly until they thicken upon cooling." 
 
 G-dlhanum Plaster (Emplastrum Gallani). 
 " Take of litharge plaster (Emplastrum plumbi), two pounds ; 
 galbanum, half a pound ; yellow wax, sliced, four ounces. Add the 
 litharge plaster and wax to the galbanum, previously melted ; then 
 melt the whole together with a moderate heat, and strain." 
 
 Ojpium Plaster (Emplastrum Opii). 
 " Take of opium, in powder, two ounces ; Burgundy pitch, three 
 ounces; lead plaster, a pound; boiling water, four fluid ounces. 
 Melt together the lead plaster and Burgundy pitch, then add the 
 opium, previously mixed with the water, and boil them over a gentle 
 fire to the proper consistence." 
 
 Lead Plaster / Litharge Plaster (Emplastrum Plumbi / Emplas- 
 trum Lithargyri). 
 " Take of semi- vitrified oxide of lead, in very fine powder, ^.ve 
 pounds ; olive oil, a gallon ; water, two pints. Boil them together 
 over a gentle fire, stirring constantly, until the oil and oxide of lead 
 unite into a plaster. It will be proper to add a little boiling 
 water, if that employed at the commencement be nearly all con- 
 sumed before the end of the process." 
 
 Adhesive Plaster (Emjplastrum Pesince). 
 " Take of resin, in powder, half a pound; lead plaster, three 
 pounds. To the lead plaster, melted over a gentle fire, add the 
 resin, and mix them." 
 
 Soap Plaster (Emplastrum Saponis). 
 " Take of soap, sliced, half a pound ; lead plaster, three pounds. 
 Mix the soap with the melted plaster, and boil for a short time." 
 
 OINTMENTS. 
 These are made by mixing lard with some medicated substance. 
 
ASTRINGENTS. 1007 
 
 Glycerine Ointment. 
 Used for chapped hands, abrasions of the skin, and sore lips. 
 
 White wax, half a drachm, 
 
 Oil of almonds, two ounces. 
 Mix by heating, and then add, 
 
 Of glycerine, one ounce. 
 
 Ointment of Iodine and Collodion, 
 Used for tumors, swellings, &c. 
 
 Iodine, one drachm, 
 
 Turpentine, one drachm, 
 
 Collodion, four ounces. 
 Apply with a brush. 
 
 Ointment of Iodide of Sulphur. 
 Used for itch, eczema, and other diseases of the skin. 
 Iodide of sulphur, twenty-five grains, 
 Lard, one ounce. 
 
 Ointment of Iodide of Arsenic. 
 Used for itch, and other diseases of the skin. 
 Iodide of arsenic, three grains, 
 Lard, one ounce. 
 
 Ointment of Carbolic Acid. 
 Used in diseases of the skin. 
 
 Carbolic acid, five grains, 
 Lard, one ounce. 
 
 Ointment of Bromide of Potassium. 
 Used for tumors. 
 
 Bromide of potassium, thirty grains, 
 Lard, one ounce. 
 
 Ointment of Ver atria. 
 Used for neuralgia. 
 
 Veratria, ten grains, 
 Acetic acid, ten drops. 
 Lard, one ounce. 
 
 Ointment of Galls, dec. 
 Take of powdered galls, one ounce, 
 Camphor, half a drachm, 
 Laudanum, two drachms, 
 Spermaceti, or lard, one ounce. 
 Make an ointment. An astringent ointment for piles, after the 
 inflammatory stage has passed away. 
 
1008 PRESCRIPTIONS. 
 
 Ointment of Tar, dec. 
 Take of tar, one ounce, 
 Powdered opium, two drachms. 
 Make an ointment. For piles. It may also be used for scald- 
 head. 
 
 Ointment of Sugar of Lead. 
 Take of sugar of lead, in very fine powder, one part, 
 Simple ointment, twenty parts. 
 Mix them thoroughly. This is an excellent ointment in burns, 
 blisters in an inflamed state, and other excoriated or ulcerated sur- 
 faces. 
 
 Simple Ointment. 
 Take of lard, one pound, 
 White wax, four ounces. 
 Melt together and stir till cold. Useful as a common dressing 
 to sores and inflamed surfaces. 
 
 Ointment of Oxide of Zinc. 
 Take of oxide of zinc, one ounce, 
 Lard, six ounces. 
 Mix. A drying ointment ; used in burns, blisters, excoriations, 
 various shin diseases, and in chronic inflammation of the eyelids. 
 
 Ointment of Pitch and Stdphur. 
 Take of tar, half a pound, 
 Wax, half an ounce, 
 Flowers of sulphur, two ounces. 
 Mix. Used in itch, tetter, and scaly diseases of the skin, ring- 
 worm, c&c. 
 
 Ointment for Piles. 
 Take of carbonate of lead, four drachms, 
 Sulphate of morphia, fifteen grains, 
 Stramonium ointment, one ounce, 
 Olive oil, sufficient quantity. 
 Mix. To allay pain and inflammation. 
 
 Ointment of Stavesacre. 
 Take of powdered stavesacre, one ounce, 
 Lard, three ounces. 
 Melt together, let it stand for three hours, and strain. In itch, 
 and to destroy vermin on the body. 
 
 Ointment of Thorn Apple. 
 Take of thorn-apple leaves, fresh, two ounces, 
 Lard, five ounces. 
 
LINIMENTS AND LOTIONS. 1009 
 
 Boil until the leaves become crisp, and then strain through linen. 
 Melt an ounce of wax, and mix all together while they are in a fluid 
 state. If the fresh leaves cannot be obtained, an ounce of dry pow- 
 dered leaves may be substituted for them. Useful to dress irritable 
 ulcers, and as an application to painful piles. 
 
 Ointment of Iodine. 
 Take of iodine, half a drachm, 
 Iodide of potassium, one drachm, 
 Rectified spirit (alcohol), one drachm. 
 Rub together, and add two ounces of lard. Used in enlarged 
 glands, scrofulous solves, <&c. 
 
 Itch Ointment. 
 Take flowers of sulphur, two ounces, 
 t Sulphate of zinc, two drachms, 
 
 Powdered hellebore, four drachms, 
 Soft soap, four ounces, 
 Lard, eight ounces. Mix. 
 
 Cerate of Savin. 
 Take of savin, in powder, half an ounce, 
 Resin cerate, four ounces. 
 Soften the cerate with heat, and mix the powder with it. This 
 is much employed for dressing blistered surfaces to prevent them 
 from healing. 
 
 Resin Cerate. 
 Take of resin, four ounces, 
 Yellow wax, two ounces, 
 Lard, eight ounces. 
 Melt. Useful to bring deep inflammations to a head, as boils, &c. 
 
 LINIMENTS AND LOTIONS. 
 
 Liniment for Burns. 
 • Take of olive or linseed oil, and lime-water, equal parts. 
 Mix, and agitate well. For severe burns. 
 
 Lotion of Carron Oil and Carbolic Acid. 
 Used for burns. 
 
 Liquid carbolic acid, one drachm, 
 Linseed oil, three ounces, 
 Lime-water, three ounces. 
 
 64: 
 
1010 PKESCRIPTIONS. 
 
 Lotion of Permanganate of Potash. 
 Used for burns, ulcers, and as a disinfectant. 
 
 Permanganate of potash, half a drachm, 
 Water, one pint. 
 
 Lotion of Creosote. 
 Used for diseases of the skin and ulcers. 
 Creosote, ten drops, 
 Olive oil, one ounce. 
 
 Compound Chloroform Liniment. 
 Used for neuralgia and rheumatic pains. 
 Chloroform, one ounce, 
 iEther, one ounce, 
 Spirit of camphor, one ounce, 
 Laudanum, one ounce, 
 Tincture of cayenne pepper, half an ounce. 
 
 Lotion of Glycerine and Borax. 
 Used for sore nipples, chapped lips and hands. 
 Borax, half a drachm, 
 Rose-water, eight ounces, 
 Glycerine, half an ounce. 
 
 Glycerine Cream. 
 Used for chapped hands, chilblains, &c. 
 Glycerine, one ounce, 
 Soft soap, one ounce, 
 Laurel water, one ounce. 
 
 Lotion of Sulphite of Soda. 
 Used for pimples and other diseases of the skin. 
 Sulphite of soda, one drachm, 
 Sulphate of alum, one drachm, 
 Hose- water, eight ounces. 
 
 Lotion of Tannin and Glycerine. 
 Tannic acid, fifteen grains, 
 Glycerine, one ounce. 
 
 Lotion of Carbolic Acid. 
 Used for burns and ulcers. 
 
 Carbolic acid, five grains, 
 Water, one ounce. 
 
LINIMENTS AND LOTIONS. 1011 
 
 Liniment of Petroleum, Camphor, c&c. 
 Petroleum, one ounce, 
 Camphor, half an ounce, 
 Alcohol, half a drachm. 
 
 Soap Liniment 
 Take of castile soap, four ounces, 
 Oil of rosemary, five drachms, 
 Camphor, two ounces, 
 Alcohol, one and a half pint. 
 Mix and dissolve. This is used in rheumatism, swellings, "bruises, 
 strains, local pains, &c. 
 
 Opium Liniment. 
 Take of soap liniment, six ounces, 
 Laudanum, two ounces. 
 Mix. An excellent anodyne in rheumatism, neuralgia, sprains, 
 &c. 
 
 FOMENTATIONS. 
 
 When fluids are applied to any special portion of the body by 
 means of a cloth or flannel, the process is called a fomentation. 
 
 Anodyne Fomentation. 
 Extract of opium, one ounce, 
 Water, one pint. 
 This is used for neuralgia and rheumatism. 
 
 Fomentation of Soap. 
 Used for sprains. 
 
 Soap, one ounce, 
 Alcohol, two pints. 
 
 MEDICATED BATH& 
 
 Emollient Bath. 
 For eczema, prurigo, and some other diseases of the skin. 
 Glycerine, one ounce, 
 Powder of tragacanth, one ounce, 
 Tepid water, fifteen gallons. 
 
1012 PRESCRIPTIONS. 
 
 Nitro-Muriatic Bath. 
 For diseases of the liver. 
 
 Nitric acid, two ounces, 
 Muriatic acid, three ounces, 
 Water, ten gallons and a half. 
 
 Alkaline Bath. 
 For itching, and diseases of the skin. 
 
 Impure carbonate of potash, eight ounces, 
 Tepid water, thirty gallons. 
 
 POULTICES. 
 
 Mustard Poultice. 
 Take of powdered mustard, two ounces, 
 Vinegar, as much as necessary to make a poultice. 
 This may be too strong for young children or persons having 
 very thin skins. In such case, from one-third to one-half of flour 
 or Indian meal may be added, and instead of vinegar, water may 
 be employed. It is seldom that it can be borne longer than half 
 an hour. 
 
 Poultice of Flax-seed. 
 Take of ground flax-seed, one part, 
 Barley meal, one part, 
 Water, enough to make a poultice. 
 Used for painful inflammations of all kinds. 
 
 Yeast Poultice. 
 Take of flour, one pound, 
 Yeast, half a pint. 
 Mix. To be applied warm to foul-smelling and gangrenous 
 sores. 
 
 Charcoal Poultice. 
 Take bread and milk poultice, and stir into it as much fine pow- 
 dered charcoal as it w T ill allow. Used to old and foul ulcers that 
 have & foetid smell, and to gangrenous sores. 
 
 Slijpjpery-ehn Poultice. 
 
 Take any quantity of slippery elm, and moisten it with hot 
 water. This is a poultice that is excellent for irritable sores, when 
 a soothing effect is desired. 
 
 If a more sedative effect be washed, half an ounce of laudanum 
 may be added to either the bread, flax-seed, or slippery-elm poul- 
 tice. 
 
 It may be added, that poultices should never be made unneces- 
 
MISCELLANEOUS RECIPES. 1013 
 
 sarily heavy nor thick, and they should be frequently repeated. 
 They always ought to be put on warm, and as moist as they can 
 be made without being so soft as to flow when placed upon the 
 skin. When they become dry, and the temperature falls, they can 
 do but little if any good, and may possibly cause more injury than 
 service. The common poultices are useful in all cases of inflamma- 
 tion that cannot be cut short, to assist the process of suppuration, 
 and the tendency of matter to the surface. 
 
 MISCELLANEOUS RECIPES. 
 
 PRINKS, BEVERAGES, &C. 
 
 Aniseed Cordial. 
 Take of bruised aniseeds, one pound, 
 Proof spirit, six gallons, 
 Water, half a gallon. 
 Put it into a still, and draw off by distillation five gallons with 
 a moderate fire. 
 
 Caraway Cordial. 
 Take oil of caraway, six drachms, 
 Sugar, four pounds, 
 Oil of cinnamon, ten drops, 
 Oils of orange and lemon, of each two drops, 
 Alcohol, six gallons, 
 Water, two gallons. 
 Fine with alum. 
 
 Cinnamon Cordial. 
 Take of oil of cinnamon, thirty drops, 
 Sugar, refined, three pounds, 
 Alcohol, fifteen qunces, 
 Orange and lemon, of eadi half an ounce, 
 Cardamom seeds, half an ounce, 
 Water, one gallon. 
 Fine with alum, and if it is wished colored, add burnt sugar. 
 
 Citron Cordial. 
 Take of essence of lemons, half an ounce, 
 Essence of oranges, half an ounce, 
 Refined sugar, four pounds. 
 
1014 MISCELLANEOUS RECIPES. 
 
 Beat all up together, add 
 
 Dried lemon and orange peel, of each four ounces. 
 
 Infuse all in six gallons of alcohol that has stood upon seven 
 pounds of figs for a week. If required, water may be added. 
 
 The cordials may be made either by distillation, as in the first 
 recipe ; or they may be made by dissolving the oils, as in the last. 
 Distillation is preferable, but it is not always convenient. 
 
 Ginger Beer. 
 White sugar, twenty pounds, 
 Lemon -juice, eighteen ounces, 
 Honey, one pound, 
 Bruised ginger, seventeen ounces, 
 Water, eighteen gallons. 
 Boil the ginger in three gallons of the water for half an hour ; 
 then add the sugar, the juice, and the honey, with the remainder of 
 the water, and strain through a cloth. When cold, add the white of 
 an egg, and half an ounce of the essence of lemon ; after standing 
 four days, bottle. This affords a very superior beverage, and one 
 that will keep for many months. A very refreshing drink in warm 
 weather. 
 
 Lemon Syrup. 
 Take oil of lemon, six drachms, 
 Eefined sugar, twelve pounds, 
 Water, one gallon. 
 Boil the sugar and water over a moderate fire, and remove the 
 scum. While hot, stir in the oil and a quarter of an ounce of tartaric 
 acid. When cold, bottle and cork. This is the lemon syrup that 
 is in common use at the shops and among the confectioners. 
 
 PERFUMERY, &C. 
 
 Cologne Water. 
 Take of alcohol, one gallon, 
 Oil of bergamot, one ounce, 
 Oil of rosemary, one ounce, 
 Oil of lemon, two drachms, 
 Oil of lavender, four drachms, 
 Oil of cassia and cloves, of each five drops, 
 Ottar of roses, twenty drops. Mix and filter. 
 There are many formulae for making this water, and the ingre- 
 dients may be varied to suit individual tastes. It should be known 
 
MISCELLANEOUS RECIPES. 1015 
 
 that it is essential that the spirit be of the purest kind, scentless and 
 tasteless, and that the oils be genuine and fresh. 
 
 Lavender Water. 
 Take oil of lavender, eight ounces, 
 Essence of bergamot, one and a half ounce, 
 Essence of musk, four ounces, 
 Alcohol, two gallons. 
 Mix well. This is very fine. 
 
 Rose- Water. 
 Take ottar of roses, twenty-five drops. 
 Hub it in with an ounce of white sugar and four drachms of car- 
 bonate of magnesia ; then add, gradually, half a gallon of water and 
 four ounces of proof spirit. 
 
 Stimulant for ike Hair, 
 Take of spirits of hartshorn, two ounces, 
 Lard oil, twelve ounces. 
 Shake well together, and take care that it is kept tightly bot- 
 tled. 
 
 Powder to Remove Hair. 
 Take of fresh lime, one ounce, 
 Pure potash, one drachm, 
 Sulphuret of potash, one drachm. 
 Reduce them to a fine powder in a mortar. If the hair be first 
 soaked or washed in warm water for ten minutes, this article, formed 
 into a thin paste with warm water, and applied while warm, will so 
 thoroughly destroy the hair in five or six minutes, that it may be re- 
 moved by washing the skin with a rough cloth. It is a powerful 
 caustic, and should therefore be removed as soon as it begins to 
 inflame the skin, by washing it off with vinegar. It softens the skin 
 and greatly improves its appearance. 
 
 Pearl Powder. 
 Take of fine starch, well sifted, four ounces, 
 White oxide of bismuth, one ounce. 
 Mix well together. For the skin. 
 
 Lip Salve. 
 Take of white wax, one ounce, 
 Sweet oil, one ounce, 
 Spermaceti, one drachm. 
 
1016 MISCELLANEOUS RECIPES. 
 
 Melt all together, adding a little alkanet root to color, and while 
 cooling add oil of roses to perfume. 
 
 White Liniment for Chapped Hands, &c. 
 Take of oil of turpentine, two ounces, 
 Soap liniment, three ounces, 
 Distilled vinegar, eight ounces, 
 Ammonia water, two ounces, 
 Spirit of rosemary, one ounce. 
 The ingredients to be mixed in the above order. 
 
 Cold Cream. 
 Take of oil of almonds, two ounces, 
 Spermaceti, half an ounce, 
 White wax. one drachm. 
 Melt together, and while cooling add two ounces of rose-water, 
 stirring it until cold. 
 
 Milk of Roses. 
 Take of sweet almonds, half a pound, 
 Rose-water, four pints. 
 
 White wax and white soap, of each six drachms, 
 Oil of almonds, six drachms, 
 Alcohol, twelve ounces. 
 Mix. Add oil of lavender, oil of roses, &c, to please the fancy. 
 
 Hair Oil. 
 Take of olive oil, sixteen ounces, 
 Cognac brandy, sixteen ounces, 
 Oil of bergamot, half an ounce, 
 Ottar of roses, ten drops. 
 
 Mix. 
 
 Mix. 
 
 Mix. 
 
 Macassar Oil. 
 Take of olive oil, one pound, 
 Oil of origanum, one ounce, 
 Oil of rosemary, one scruple. 
 
 Tooth Powder. 
 Take of prepared chalk, two ounces, 
 Myrrh, one drachm, 
 
 Powdered Peruvian bark, half an ounce, 
 White sugar, one ounce, 
 Rose pink, one ounce. 
 
MISCELLANEOUS EECIPES. 1017 
 
 Or, 
 
 Take of prepared chalk, four ounces, 
 Powdered alum, two drachms, 
 Cream of tartar, two ounces, 
 "White sugar, one ouuce, 
 Powdered orris-root, one and a half ounce. 
 Mix. This is a very good dentifrice. 
 
 Fumigating Pastils. 
 Take powdered gum benzoin, sixteen parts, 
 Balsam of Peru, four parts, 
 Powdered sandal-wood, four parts, 
 Light charcoal, forty-eight parts, 
 Powdered tragacanth, one part, 
 Powdered nitre, two parts, 
 Gam arabic, two parts, 
 Cinnamon water, twelve parts. 
 Heat to a smooth ductile mass, form into small cones with a 
 flat base, and dry in the air. 
 
 LOZENGES. 
 
 Bismuth Lozenges. 
 Take of white oxide of bismuth, two drachms, 
 "White sugar, two and a half ounces, 
 Mucilage of tragacanth. 
 Mix, and proceed as in the first recipe. Divide into one hun- 
 dred and twenty lozenges. Tonic and antispasmodic. One to three 
 may be sucked two or three times a day, in dyspepsia accompanied 
 with pain in the stomach. 
 
 Ginger Lozenges. 
 Take of finely powdered Jamaica ginger, one ounce, 
 "White sugar, one pound, 
 Mucilage of tragacanth, to mix. 
 Prepare as in the first one, and divide into fifteen-grain lozenges. 
 Useful in flatulency and dyspepsia. A good stomachic. 
 
 Lozenges of Nitre. 
 Take of nitre, three ounces, 
 "White sugar, nine ounces, 
 Mucilage of tragacanth, to mix. 
 
1018 MISCELLANEOUS RECIPES. 
 
 Proceed as in the others to prepare the mass. Divide into 
 lozenges of twelve grains each, and take one every two hours. A 
 diuretic. It is a good remedy for inflammation of the mouth and 
 throat. 
 
 Rhubarb Lozenges. 
 Take of powdered rhubarb, one ounce, 
 Sugar, eleven ounces. 
 
 Mucilage, to mix, and prepare in the same way as the preced- 
 ing ones. Divide into lozenges of twelve grains each. Stomachic 
 and laxative. For those who are habitually constipated, this is a 
 very neat and agreeable way of taking medicine for relief. 
 
 All other medicines in powder may be administered in the 
 shape of lozenges, and unless their taste is so strong and nauseous 
 that it cannot be disguised, it is often a very agreeable way of 
 taking them. 
 
 For Corns. 
 Take sal ammoniac, one ounce, 
 Spirit, four ounces. 
 Dissolve. Moisten the corn with this lotion morning and eve- 
 ning. 
 
 Or, 
 Take of white diachylon, two ounces, 
 Yellow rosin, two ounces. 
 Melt, and add finely powdered verdigris, one ounce. Spread it 
 on paper, linen, or leather, and apply a small piece to the corn. 
 
 Chilblain Lotion. 
 Take alum, two drachms, 
 Distilled vinegar, half a pint, 
 Alcohol, half a pint. 
 Dissolve, and use as a lotion. 
 
 Chilblain Ointment. 
 Take of lard, nine ounces, 
 Oil of almonds, three and a half ounces, 
 White wax, one and a half ounce, 
 Camphor, powdered, one and a half ounce. 
 Mix, and apply to the chilblain. 
 
LIST OF MEDICESTES, 
 
 PREPARATIONS AND DOSES. 
 
 The doses here prescribed are for adults. The rules for graduating the doses accor- 
 ding to the age of children are found on page 460. 
 
 This list includes not only the recent and common preparations, such as have already 
 been described, but also a large number of simple and popular remedies, which 
 have not yet been mentioned in the book. 
 
 TINCTURES. 
 
 These are made by bruising or grinding the substance used to a powder, 
 letting it stand from seven to fourteen days, and then filtering through paper. 
 The average proportion is about an ounce of the substance to a pint of alcohol. 
 This proportion is more or less modified by the strength of the substance used. 
 
 INFUSIONS. 
 
 These are made by pouring boiling water on vegetable remedies, and allow- 
 ing it to stand until it cools. The average proportion is about an ounce of the 
 substance to a pint of boiling water. 
 
 PILLS. 
 
 Pills are made by accurately weighing the substances to be used and then mix- 
 ing them with water, alcohol, syrup, or bread, or mucilage, or soap, or molasses. 
 or any other mild substance that will bring them to a proper consistence. 
 Powders are usually mixed with syrup or mucilage, resins with alcohol, liquid 
 remedies with staixh or bread. 
 
 The mass, after it has been thoroughly mixed with a knife or spatula, should 
 be rolled into a cylinder, and then cut off into equal portions, each portion con- 
 taining the dose of the medicine required. Each pill is to be rolled into around 
 shape between the thumb and fingers. 
 
 Only sea-captains, and others who are similarly situated in regard to medical 
 advice and druggists' shops, will ordinarily find it necessary to make pills. 
 
 Acid Acetic, diluted (Vinegar). — It is a refrigerant and diuretic. It is some- 
 - times administered in those affections of the urinary organs in which 
 there is a white deposit in the urine, caused by phosphatic salts. Em- 
 ployed as a lotion, externally, in bruises and sprains. Dose : one to 
 four teaspoonfuls in a little water. 
 
1020 list of medicines: 
 
 Acid Benzoic. — Prepared from benzoin. Used in gravel. Dose : from five to 
 
 thirty-five grains. 
 Acid Carbolic. — Disinfectant in various strengths. Used in skin diseases and 
 inflammations of mucous membranes. (See Inhalations, Catarrh, and 
 Ointments.) 
 Acid Chromic. — Used as a caustic. 
 
 Acid Citric. — Refrigerant or cooling, like lemon-juice. To prepare a solution 
 of the strength of lemon-juice, eight and a half drachms are to be dis- 
 solved in sixteen ounces of water. It is employed to form effervescing 
 draughts. Dose: a tablespoonful of lemon-juice, or an equivalent so- 
 lution of citric acid. 
 Acid Muriatic, diluted, or Hydrochloric Acid. — A refrigerant, and preventive of 
 putrescency. Employed in low fevers, malignant scarlet fever, when 
 there is gangrenous ulceration of the throat, in debility of the diges- 
 tive organs, when there is a tendency to produce worms, &c. Dose: 
 twenty to forty drops, largely diluted with water, or an infusion of 
 quassia. 
 Acid Nitric, diluted. — A tonic. Used internally, principally in chronic inflam- 
 mation of the liver, and secondary syphilis. Dose : ten to thirty drops, 
 administered in the same form as muriatic acid. 
 Acid Nitro-Muriatic, diluted. — Employed in chronic diseases of the liver, 
 chronic cutaneous diseases, and in debilitated and syphilitic constitu- 
 tions. It may cause salivation. Dose : ten to thirty drops, largely di- 
 luted. 
 Acid Phosphoric. — A tonic. Used in nervous diseases. Dose : from five to 
 
 twenty drops in sweetened water. 
 Acid Sulphuric, diluted. — It is a tonic, refrigerant, and astringent. Used in low 
 fevers, in internal bleedings, and in the excessive sweating of consump- 
 tion. Dose: ten drops to thirty, in a wine-glass of water, repeated 
 three times a day. 
 Acid Sulphuric, aromatic (Elixir of Vitriol). — Medical properties and dose the 
 same as the preceding, and used in the same kind of cases. Most 
 agreeable form for administering the acid. 
 Acid Tannic. — Astringent. Used in various forms of hemorrhage when there 
 is no fever, and in the night-sweats and diarrhoea of consumption. 
 Also as a gargle, injection, and lotion. Dose : half a grain to two 
 grains, in pill, or dissolved in water, several times a day. 
 Acid Tartaric. — Properties and uses the same as those of citric acid. Dose : 
 
 ten grains to thirty, dissolved in a large quantity of water. 
 Aconite (Monkshood). — A narcotic and sedative. Used in a large number of 
 nervous and painful diseases, as rheumatism, neuralgia and tic-doulou- 
 reux, paralysis, and epilepsy. It is very powerful, and must be 
 employed with great caution. Dose: the powder of the roots or 
 leaves may be given in doses of three grains to twelve, thrice a day ; 
 of the extract, one to two grains, gradually increased. 
 jEther Nitric (Sweet Spirits of Nitre). — A diaphoretic, diuretic, antispasmodic, 
 and stimulant. Employed in fevers, and in affections of the kidneys. 
 Dose : twenty drops to a teaspoonful every two hours, in a small por- 
 tion of water. 
 iEraER Sulphuric. — A powerful diffusible stimulant and antispasmodic. Used 
 in low fevers, hysterics, nervous headache, cramp in the stomach, 
 flatulent colic, fainting, &c. Dose: half a teaspoonful to two tea- 
 spoonfuls, in water. 
 ./Ether Sulphuric, compound (Hoffman's Anodyne). — The effects the same as 
 
 the preceding. Dose : the same. This is a preparation much used. 
 Alcohol. — Obtained by submitting a solution of grape sugar to the vinous fer- 
 mentation, by which the sugar is changed into it and carbonic acid, and 
 separated from the water by repeated distillation. 
 Allspice. — The oil is a powerful aromatic. Dose : two to six drops. 
 Aloes. — Cathartic. Used in habitual constipation, except when there are piles, 
 
THEIR PREPARATIONS AND DOSES. 1021 
 
 and in deficient menstruation. It is generally combined with other 
 medicines. Dose : two grains to five, made into pill. 
 
 Alum (Alumen). — Astringent. Used in chronic diarrhoea and dysentery, chro- 
 nic mucous discharges, passive hemorrhages, sweating of hectic fever, 
 and in some affections of the stomach. Also used as a gargle. Dose : 
 ten grains to thirty, several times a day. It is best given in solution 
 in some aromatic water. 
 
 Ammonia Acetate, Solution of (Spirit of Minder erus). — A diaphoretic. Employed 
 very generally in febrile and inflammatory affections. Dose : half an 
 ounce to two ounces, repeated every six hours. Commonly added to 
 mixtures. 
 
 Ammonia Bicarbonate. — An antacid. Used to neutralize acid in the stomach. 
 Free from the stimulating properties of carbonate of ammonia. Dose : 
 five grains to twenty-five, dissolved in cold water or bitter infusions. 
 The carbonate of ammonia may be used for the same purpose, and in 
 the same dose. 
 
 Ammonia, Muriate of (Sal Ammoniac). — Stimulant and alterative. Employed 
 in Europe in hooping-cough, mucous diarrhoea, chronic rheumatism and 
 gout, dropsy, visceral obstructions, and in serous inflammations. It is 
 there highly esteemed, and probably deserves to be more used in this 
 country than it has hitherto been. Dose : from five to thirty grains, 
 combined with gum or sugar, or in syrup. It is applied externally, as 
 a lotion, for the cold it produces during its solution with water. 
 
 Ammoniac Gum. — Stimulant and expectorant. Used in chronic catarrh, asthma, 
 and other affections of the lungs. Dose : two to thirty grains, three 
 or four times a day. It is commonly administered as an emulsion. 
 
 Angelica. — A very pleasant aromatic tonic. Dose : of the root or seed, is from 
 thirty grains to one drachm. 
 
 Angustura Bark. — A stimulant tonic. It has been found particularly serviceable 
 in the bilious diarrhoeas and dysenteries of hot climates ; it has also been 
 very successfully employed in the malignant fevers of the tropics. Dose : 
 from ten to thirty grains. It is also given in infusion, tincture, and extract. 
 
 Aniseed (Anisum). — A pleasant aromatic carminative, that relieves pain in the 
 bowels from flatulence, and may be used whenever the stomach requires 
 stimulating. Used much for flavoring liquors and for making a cordial. 
 Dose : in powder, twenty to thirty grains. 
 
 Antimonial Powder (James 1 Powder). — A diaphoretic. Employed in the early 
 stages of febrile diseases and inflammatory affections, and combined 
 with calomel and opium, in acute rheumatism. It is not a very certain 
 medicine in its effects. Dose : in powder, from three grains to ten, 
 every four or five hours. Not much used in these days. 
 
 Antimony, Sulphuret of. — A good diaphoretic and alterative. The golden 
 sulphuret is the kind now altogether used. It is employed in diseases 
 of the skin. Its combination with calomel and guaiacum, formed into 
 a pill known as the compound calomel pill, is the most popular form of 
 administering it. Dose : five grains to ten, three times a day ; of the 
 pill the same. 
 
 Antimony, Tartarized (Tartar Emetic). — An alterative, diaphoretic, diuretic, 
 expectorant, and emetic. Its different effects are produced by differ- 
 ence of dose, and accidental circumstances. Dose : as an alterative, 
 frequently repeated, is from the sixteenth to the eighth of a grain; as 
 a diaphoretic or expectorant, from an eighth to a sixth of a grain; as 
 a nauseating sudorific, from one-fourth to one-half a grain ; repeated 
 every two hours. As an emetic, the dose is from two to three grains, 
 given in divided portions every fifteen minutes, until free vomiting is 
 induced. It is not much used in these days. Ipecac is preferred. 
 
 Antimonial Wine. — Properties the same as the preceding. Dose : as an expec- 
 - torant or diaphoretic, is from ten to thirty drops, frequently repeated; 
 as an emetic for infants, from thirty drops to a teaspoonful. Very 
 little used of late years. 
 
1022 list of medicines: 
 
 Arnica (Arnica Montana. Leopard's Bane). — A nervous stimulant, much used 
 on the Continent of Europe in many nervous and painful affections. 
 It is said to produce diuretic, diaphoretic, and emmenagogue effects. 
 The tincture of it is much employed to allay inflammations of the skin, 
 and in bruises and other injuries. Dose : in powder, from thirty grains 
 to a drachm. The dose of the infusion (one ounce to a pint of water), 
 one to two tablespoonfuls, every two or three hours. 
 
 Arrow-Root. — Much used in dietetic preparations. 
 
 Arsenic (Ratsbane). — A poison and tonic. Has been used in scirrhus and can- 
 cer, diseases of the skin, fever and ague, chronic rheumatism, diseases 
 of the bones, frontal neuralgia, in epilepsy, in secondary syphilis, and 
 many other diseases of the constitution. It is unquestionably a remedy 
 of great value, but it should only be administered when other medicines 
 have failed, and then with the greatest care. Dose : one-sixteenth to 
 one-eighth of a grain, made into a pill with crumbs of bread. 
 
 Arsenical Solution (Foivler's Solution). — In this the arsenic is combined with 
 potash, forming the arsenite of potassa. The properties of this prepa- 
 ration appear to be the same as those of arsenic, and it is commonly 
 used as a substitute for that, on account of the greater ease and safety 
 in apportioning the dose. Dose : five drops to ten, two or three times 
 a day. Sometimes, if too much be given, a dropsical swelling is pro- 
 duced. This will subside in a few days on withholding the medicine, 
 and using gentle purgatives and diuretics. 
 
 Assafcetida. — A powerful stimulating antispasmodic. Employed in the nervous 
 diseases of females, in epilepsy, St. Vitus's dance, in the convulsions of 
 infants, when dependent, especially, on flatulence, and indeed in almost 
 every variety of spasmodic disease. It is given in several forms. Dose : 
 ten grains or more, made into pills. It is often used as an injection in 
 spasms. One or two drachms, rubbed up with warm water into an 
 emulsion, may be administered at once in this way. Assafcetida is fre- 
 quently combined with other medicines. 
 
 Atropine (Atropia). — Comes from the root of belladonna; yellowish-white 
 crystals. 
 
 Atropia, Sulphate of. — A white powder. "Atropia and its sulphate have the 
 same action on the system as belladonna ; should not be used in larger 
 quantities than ■£§ of a grain ; they are rarely used internally. A drop 
 of a solution of the sulphate (two grains to one fluid ounce) is often put 
 into the eye by the surgeon, to dilate the pupil." 
 
 Avens. — A tonic and powerful astringent. A native plant, used in chronic or 
 passive hemorrhages, in whites, and in diarrhoea, in dyspepsia, and in 
 the debility of consumption. Dose : of the powdered root, one scruple 
 to one drachm, three times a day. The decoction is made by boiling 
 one ounce in a pint of water ; and it is given in doses of one to two 
 fluid ounces. 
 
 Balm (Melissa). — Mild stimulant. Used in the form of infusion. 
 
 Barberry. — Laxative and astringent. Dose : of the powdered leaves, one tea- 
 spoonful. 
 
 Balm of G-ilead (Populus Candicans). — Tincture of the buds is used for rheu- 
 matism. Dose : from one to four drachms. 
 
 Balmony (Chelone). — Cathartic tonic, and used against worms. Dose: of the 
 powdered leaves, one drachm; of tincture, two drachms; of decoction, 
 from one to three ounces. 
 
 Balsam of Peru. — Used externally as a local stimulant for ulcers, &c. 
 
 Balsam of Tolu. — A stimulant expectorant. Used in cough mixtures because 
 of its agreeable flavor. Dose of tincture, half a drachm to one drachm ; 
 dose of syrup, one drachm to half ounce. 
 
 Barley (Hordeum). — Used as food, and as a demulcent. 
 
 Barley Water. — "Made by taking barley two ounces, washing well, then boil- 
 ing for a short time with half a pint of water, then throwing the li- 
 quid away, and finally boiling with four pints of water to two pints. 
 
THEIR PREPARATIONS AND DOSES. 1023 
 
 Used as a drink in inflammatory and febrile conditions of the system. 
 May be flavored with lemon-juice and sugar. 
 
 Bayberry.— Astringent. Dose of tincture, half an ounce. 
 
 Bearberrt ( Uva Ursi). — Astringent and tonic. Given in diseases of the urinary 
 organs of nearly every kind, in the chronic stage. Dose : of the powder, 
 one scruple to one drachm, three or four times a day. 
 
 Belladonna (Deadly Nightshade). — Narcotic. Used in neuralgia, convulsions, epi- 
 lepsy, rheumatism, dropsy, jaundice, and in a large number of nervous 
 and painful diseases. 
 
 Belladonna Plaster. — An anodyne plaster, used for headache and other pains. 
 
 Benzoin. — The juice of the Sty rax benzoin, which may be rarely used. Com- 
 pound tincture. Dose: half fluid drachm to one. 
 
 Bethroot (Trillium Pendulum). — Astringent and tonic. Dose: of infusion, one to 
 five ounces ; of decoction, two to three ounces. 
 
 Bismuth (Subnitrate. Subcarbonate. White Oxide of Bismuth). — Atonic and anti- 
 spasmodic. It is particularly useful in painful affections of the stomach 
 and diarrhoea. When there is an aching pain of the stomach it is a very 
 valuable remedy. Dose : three to six grains, combined with an equal 
 quantity of powdered ginger, three times a day. 
 
 Bitter Orange Peel. — An aromatic tonic. 
 
 Bitter Root. — Laxative and diaphoretic. Dose of solid extract, one to six 
 grains. 
 
 Black Alder (Prinos). — Tonic and astringent. Dose of tincture, two to three 
 drachms. 
 
 Bitter Sweet (Dulcamara Solanum). — Narcotic and alterative. Commonly used 
 in cutaneous eruptions of the scaly kind. Decoction, in which form it 
 is generally used, is made by boiling one ounce in a pint and a half of 
 water until there is left but a pint of fluid. Dose of this is two to four 
 tablespoonfuls, three or four times a day. 
 
 Blackberry Root (Rubus Villosus). — Tonic and astringent. Employed in chronic 
 diarrhoea. Used generally in the form of a decoction, which is made by 
 boiling one ounce of the root in a pint and a half of water down to a 
 pint. Dose : two ounces, several times a day. 
 
 Black Cohosh (Cimicifuga Racemosa). — Used in rheumatism, acute and chronic. 
 Dose of solid extract, three to six grains ; of fluid extract, half a drachm 
 to a drachm. 
 
 Black Oak Bark. — Same as "White Oak Bark. 
 
 Blood Root (Sanguinaria Canadensis). — Narcotic, stimulant, and emetic. This 
 article is getting into very general use in affections of the lungs, rheu- 
 matism, jaundice, &c. G-enerally given in the form of tincture. Dose 
 of tincture, from thirty to sixty drops, three times a day. 
 
 Black Willow (Salicc Nigra). — A tonic. Used in ague. Dose of decotion of the 
 buds, one to two ounces. 
 
 Blue Flag (iris Versicolor). — Cathartic and diuretic. Dose : of fluid extract, ten 
 to fifty drops ; of the tincture, one to two drachms. 
 
 Boneset (Thoroughu'ort). — Diaphoretic and tonic. Used in ague, dyspepsia, and 
 general debility. Dose : twenty grains in powder, three times a day, 
 or it may be given in infusion. Infuse one ounce in a pint of hot water. 
 Dose : three or four tablespoonfuls. A safe and popular domestic remedy. 
 
 Buchu (Barosma). — Diuretic, stimulant, and tonic, much used in disorders of kid- 
 ney. Dose : of fluid extract, half a drachm to a drachm. 
 
 Bugle Weed (Lycopus Virginicus). — A narcotic, tonic, and astringent. Used in 
 consumption, bleeding at the lungs, quieting irritation and allaying 
 cough. Given in infusion, which is made by infusing one ounce of 
 the' herb in a pint of boiling water. Dose : the whole of this quantity 
 daily. 
 
 Burdock (Lappa Minor). — Diaphoretic and aperient. Used in scrofulous, 
 venereal, cutaneous, gouty, and urinary affections. The decoction is 
 made by boiling two ounces of the root, seeds, or leaves in three pints 
 of water down to two. Dose : one pint daily. 
 
1024 list of medicines: 
 
 Burgundy Pitch. — This is much used in plasters. 
 
 Butterfly Weed. — (See Pleurisy Root.) 
 
 Butternut (Juglans. White Walnut). — Cathartic. A purgative. Dose : from five 
 grains to twenty-five. 
 
 Calamus {Sweet Flag). — An aromatic. Dose : one scruple to one drachm. 
 
 Calomel. — (See Mercury.) 
 
 Camphor. — A diffusible stimulant in moderate doses ; in larger, a narcotic. 
 This remedy is given advantageously in the advanced stages of typhoid 
 fever, when nervous symptoms predominate. In all other nervous 
 diseases it is often useful. As a liniment, it is very beneficial in local 
 pains, and it enters into the combination of a large number of officinal 
 preparations. Dose : two to ten grains, according to circumstances. 
 
 Canada Balsam. — Diuretic. Dose : from five to fifteen drops in emulsion. 
 
 Canada Fleabane (Erigeron Canadensis). — Diuretic and astringent, used in 
 chronic urethral discharges. Dose : of infusion, one to three ounces ; of 
 powder, from twenty to fifty grains. 
 
 Canella. — A mild tonic, used in dyspepsia. 
 
 Cantharides. — (See Spanish Flies.) 
 
 Caraway Seeks (Carum). — A pleasant stomachic and carminative. Used to 
 relieve flatulence, &c. Dose : in substance, from one scruple to one 
 drachm. It is generally used combined with other medicines. 
 
 Cardamom Seeds (Cardamomum). — A stomachic and aromatic like the preced- 
 ing, and used under similar circumstances and in like manner. 
 
 Carolina Pink. — (See Pink Root.) 
 
 Carrot. — Stimulant and diuretic. Used in affections of the kidneys and 
 dropsy. Generally given in infusion, which is made by taking an 
 ounce of the seeds or root, and infusing in a pint of boiling water. 
 Dose : a pint during the day. Carrots are also much used as poultices 
 in foul ulcers, the fcetor of which they are thought to correct. 
 
 Cascarilla (Eleuteria). — Aromatic and tonic. Used in dyspepsia, chronic 
 dysentery, and diarrhoea, &c. It has a very pleasant odor. Dose : one 
 scruple to half a drachm, several times a day. It is also administered 
 in infusion, tincture, and extract. 
 
 Castor ( Castoreum). — A nervine. Dose : from five to fifteen grains. 
 
 Castor Oil (Oleum Ricini). — Mild, but effectual cathartic. Used in inflam- 
 matory and spasmodic diseases of the bowels or of the urinary organs, 
 in diseases of infancy and childhood, and during pregnancy and after 
 delivery. If castor oil be at all rancid, it is very acrimonious, and 
 causes much irritation. Dose : half an ounce to two ounces. It is 
 best administered floating on the surface of water to which some aro- 
 matic tincture has been added. 
 
 Catechu. — Powerfully astringent and gently tonic. Used in chronic diarrhoea 
 and dysentery, and in hemorrhages unaccompanied with excitement. 
 Dose : ten grains to thirty, frequently repeated. It is best adminis- 
 tered with sugar, gum arabic, and water. 
 
 Catnip (Cataria). — Used in colic and nervousness. Dose: of infusion, one to 
 three ounces ; of fluid extract, one to four drachms. 
 
 Caustic Potash. — " Made by evaporating the officinal liquors and running the 
 melted potash into moulds ; very deliquescent; soluble in less than its 
 weight of water." Used as caustic. 
 
 Cayenne Pepper (Capsicum). — A powerful stimulant. Used in dyspepsia de- 
 pendent on debility of the stomach. It is sometimes added to tonic 
 medicines. Its most important application is in malignant sore throat 
 and scarlet fever. The following is the formula as it is commonly ad- 
 ministered in these cases. Two tablespoonfuls of the powdered pepper 
 and a teaspoonful of table salt are infused for an hour in one pint of 
 equal parts of boiling water and vinegar. It is then to be strained. 
 Dose : a tablespoonful every half hour. This infusion is also used as 
 a gargle at the same time. Dose : of the powder, is five to ten grains, 
 given in pill. 
 
THEIR PREPARATIONS AXD DOSES. 1025 
 
 Centaury, American. — Stomachic, tonic, and febrifuge. Used in dyspepsia, 
 fever and ague, remittent fevers, and as a tonic during convalescence 
 from acute diseases. It is generally given in infusions, made by pour- 
 ing a pint of boiling water on an ounce of the herb. Dose : of infusion, 
 two fluid ounces, frequently repeated. 
 
 Chalk, Prepared. — An antacid. Used to correct acidity of the stomach. It 
 is commonly used in diarrhoea, in the form of mixture, when it is sup- 
 posed an acid is causing the irritation. Dose of the powder, from ten to 
 forty grains. Dose of chalk mixture, a tablespoonful, often repeated. 
 
 Chamomile Flowers (Anthemis Xobilis). — Aromatic and bitter tonic. Used 
 chiefly in dyspepsia depending on debility of the stomach, in which it 
 is very efficacious. It is generally given in infusion, which is made by 
 taking two drachms of chamomile, and boiling water half a pint, in- 
 fusing for twenty hours, and straining. Dose : of infusion, one to two 
 ounces, several times a day. 
 
 Charcoal (Carlo Ligni). — Antiseptic. Used in indigestion, heartburn, bad 
 breath, and also in poultices that are applied to ulcers. Dose : from one 
 to three drachms. 
 
 Cherry Bark, wild. — Tonic and sedative. This is a remedy that has become 
 very popular in the hectic fever of scrofula and consumption. It is also 
 used in ague, dyspepsia, &c. Dose: of powder, thirty grains to one 
 drachm. It is better given in infusion. Take of the bark, bruised, 
 half an ounce; cold water, one pint. Let it infuse for twelve hours, 
 and strain. Dose : of infusion, three or four fluid ounces, several times 
 a day. 
 
 Chlorine Water. — Antiseptic. Locally to gangrenous ulcers, and in putrid sore 
 throat. A valuable disinfectant. 
 
 Chloroform (Chloroformum). — Used to produce unconsciousness in surgical ope- 
 rations. About a teaspoonful is required ; sometimes much less. 
 Should only be used by surgeons. Used internally for headaches, 
 neuralgia, &c. Doses of from ten to fifty drops. 
 
 Cinnamon. — A very grateful aromatic. It is generally used in combination with 
 other medicines. Dose, in powder, is from ten grains to one scruple. 
 
 Citrate of Potash. — A sedative and diaphoretic. Dose: five to twenty-five 
 grains. 
 
 Cleavers (Galium). — Diuretic. Used in disorders of the urethra and kidneys. 
 Dose : of infusion, one to four fluid ounces. 
 
 Cloves (CaryophyUus Aromaticus). — Stimulant and stomachic. Used in flatu- 
 lence and defective digestion. Dose : five grains to ten. in powder. 
 
 Cod-Liver Oil (Oleum Mo rrhuce). — A tonic and alterative. Used in consump- 
 tion and scrofula. Dose : a tablespoonful. 
 
 Colchicum (Cucumis Colcocynthis. Meadow Saffron). — Cathartic and sedative. 
 Used with great success in gout and rheumatism. It is seldom given 
 in substance. The wine is most employed. Dose of the wine is from 
 thirty drops to two drachms. Small doses should be administered to 
 commence with. 
 
 Collodion. — This is gun-cotton dissolved in aether. Used to form a thin skin 
 over raw surfaces. 
 
 Colocynth. — A powerful cathartic. A form known as the compound extract of 
 colocynth is an excellent purgative, and much used. The dose of this 
 extract is five to fifteen grains, according to the effects desired. 
 
 Coltsfoot (Far/ara Tussilago). — Expectorant. Used in coughs and consumption. 
 Generally given in infusion, made by infusing one ounce in one pint 
 of water. Dose : teacupful, often repeated. 
 
 Columbo (Cocculus Palmatus). — Tonic. One of the best tonics we possess after 
 
 acute diseases. It is used in hectic fever, and combined with aromatics 
 
 in flatulent bowels. Dose, in powder, from ten to thirty grains, three 
 
 • or four times a day. Infusion is the best form in which to administer 
 
 it. 
 
 Copaiba. — Stimulant, diuretic, and laxative. Used in whites, gleet, chronic dy- 
 65 
 
1026 list of medicines: 
 
 sentery, chronic coughs, chronic inflammation of the bladder, and 
 especially in gonorrhoea. Dose: twenty to thirty drops, three times a 
 day. It is very nauseous, and therefore is best mixed with gum muci- 
 lage and aromatic water, to conceal as much as possible its taste. 
 
 Compound Spirit or Ether (Hoffman's Anodyne). — A mild anodyne and nervous 
 stimulant. Used to promote sleep and relieve pain. 
 
 Copperas.— (See Iron.) 
 
 Copper. Sulphate (Cupri Sulphas). — In small doses, tonic and astringent; in 
 large, emetic. It is employed very successfully in obstinate cases of 
 chronic diarrhoea. Dose : as a tonic, one quarter to one grain ; as an 
 emetic, from two to five grains. In large doses it is a poison. 
 
 Corrosive Sublimate. — (See Mercury.) 
 
 Cotton (Gossypium). — Used in burns. It is applied in layers over the burn. 
 
 Cowhage, or Cowitch (Mucuna Pruriens). — Vermifuge. Used to destroy worms 
 in the bowels. For mode of administering and its dose, see Anthel- 
 mintics, under the head of "Prescriptions." 
 
 Crawley. — Diaphoretic. Dose is from fifteen to twenty-five grains. 
 
 Cream or Tartar. — A cathartic and diuretic. It is used in dropsy, and in some 
 febrile complaints, and combined with sulphur in piles. Dose : as a 
 cathartic, from half an ounce to an ounce ; one or two drachms will 
 act as an aperient. It is generally mixed with molasses when it is 
 administered. 
 
 Cranesbill (Geranium Maculatum). — A powerful astringent. Used in diar- 
 rhoeas, and all chronic discharges. A very popular medicine and a 
 very good one, and may be employed in all cases when an astringent 
 is required. It is best given in decoction. Boil an ounce of the root 
 in a pint and a half of water to one pint. Dose: from two to four table- 
 spoonfuls, four times a day. 
 
 Creasote (Creasotum). — Antiseptic, etc. Used in diarrhoea, in chronic inflam- 
 mations of mucous membranes, to check vomiting. Dose: from one to 
 three drops in pill, or largely diluted in water. Carbolic acid is now 
 taking the place of creasote. 
 
 Croton Oil (Oleum Tiglii.) — A powerful purgative. It acts with great rapidity. 
 It is generally used in obstinate constipation, when other medicines 
 have failed. Dose : one or two drops, mixed with crumbs of bread 
 and made into a pill. 
 
 Cubebs (Cubebce). — Stimulant and diuretic. Used in disease of the urinary 
 organs. Dose: in powder, one to three drachms, repeated four times a 
 day. 
 
 Culver's Root. — Tonic and laxative. It is also supposed to act on the liver. 
 Leptandrin is made from it. (See Leptandrin.) Dose : of leptandrin, 
 one-quarter of a grain to one grain ; of the fluid extract, from one 
 scruple to one drachm. 
 
 Cucumber Tree (Magnolia). — Gently stimulant, aromatic, tonic, and diaphoretic. 
 Used in chronic rheumatism and in ague. Dose, in powder, half a 
 drachm to one drachm. 
 
 Dandelion (Taraxacum). — Diuretic and laxative. Used with much benefit in 
 disorder of the liver and stomach. It promotes the secretion of bile. 
 It is usually given in decoction. Two ounces of fresh, or one ounce of 
 dried root, sliced, is to be boiled with a pint of water down to half a 
 pint. Dose : four tablespoonfuls, three times a day. 
 
 Deadly Nightshade. — (See Belladonna.) 
 
 Decoctions. — These are made by boiling vegetable substances in water. This 
 should be done in a covered vessel. The average proportion is about 
 one ounce of the vegetable substance to one pint of water. The dif- 
 ference between infusions and decoctions is, that the former are made 
 by pouring boiling water on the substance and allowing it to stand 
 until it cools, and the latter by actually boiling the substance. 
 
 Dewberry Root. — Used like Blackberry Root, which see. 
 
 Digitalis (Purple Foxglove). — Diuretic, sedative, and narcotic. Used in dropsy, 
 
THEIR PREPARATIONS AND DOSES. 102"7 
 
 consumption, disease of the heart, epilepsy, spasmodic asthma, &c. 
 Dose of the powder is one grain, two or three times a day. It is a 
 powerful medicine, and its effects must be closely watched. 
 
 Dock, Yellow, and Water. — Tonic and astringent. Used very much in affec- 
 tions of the skin. The two kinds possess similar properties, and are 
 used alike. The decoction is made by boiling one ounce of dried root, 
 or two ounces of fresh, in a pint of water, four tablespoonfuls of which 
 may be given, at a dose, four times a day. 
 
 Dog- wood Bark {Cornus Florida). — Tonic and astringent. Used sometimes 
 as a substitute for Peruvian bark in ague. Administered commonly in 
 decoction. Take of the bark, bruised, one ounce; water, one pint. Boil 
 ten or fifteen minutes, and strain. Dose: four tablespoonfuls, four 
 times or oftener. during the day. 
 
 Dover's Powder. {Ipecacuanhas et opii compositv.s.) — Composed of ipecac, opium, 
 and sulphate of potash. Diaphoretic and soporific. Dose: five to ten 
 grains. 
 
 Elaterium. — (See Wild Cucumber.) 
 
 Elder Berries (Sambucus). — Diaphoretic and aperient. Used in gouty, rheu- 
 matic, and eruptive diseases. Dose : of the dried juice, from one drachm 
 to half an ounce. 
 
 Elecampane Root (Inula). — Tonic, stimulant, and diaphoretic. Much used 
 formerly in suppressed menstruation, and is uow often employed in 
 diseases of the skin. Dose of the powder is one scruple to one drachm. 
 The decoction is made by boiling half an ounce in a pint of water, the 
 dose of which is two to four tablespoonfuls, three times a day. 
 
 Ergot (Spurred Bye). — This medicine is specific in its action. It is almost 
 wholly employed as a stimulant to the womb for promoting contraction 
 during and directly after labor. It has also been employed successfully 
 to check internal bleedings. Dose in powder, to a woman in labor, is 
 fifteen or twenty grains, to be repeated every twenty minutes, until its 
 effects are manifested, or until a drachm has been given. 
 
 Electricity. — A stimulating tonic. (See Electrization, General Electrization, 
 Localized Electrization. Ghdvan ization. Faradaization.) Used in dyspepsia, 
 constipation, neuralgia, nervous exhaustion, diseases of women, St. 
 Titus's dance, sleeplessness, paralysis, rheumatism, etc. Used in surgery 
 in the form of galvano-cautery. 
 
 Ether. — Used chiefly to produce insensibility in surgical operations. " Internally 
 used as a powerful diffusible stimulant in sudden prostration ; as an 
 anodyne stimulant in colic. Dose : half to one fluid ounce, given with 
 cold water. Externally, when allowed to evaporate, produces cold; when 
 confined to the skin., a rubefacient and anodyne effect/' 
 
 Fennel Seed. — A pleasant aromatic. Much used to correct the harshness and 
 griping operations of other medicines. Dose : twenty to thirty grains, 
 of the bruised or powdered seed. 
 
 Fever Few (Pyrethrum). — A tonic and nervine. Dose of infusion, one to four 
 ounces. 
 
 Figwort. — Diuretic and alterative. Dose of infusion, from one to three ounces. 
 
 Flaxseed. — Infusion used as a demulcent and diluent in affections of the kid- 
 ney. " The mucilage should be made by putting the seed in a little bag, 
 one ounce to one quart, in boiling water, and allowed to simmer, but not 
 boil. Lemon-juice and sugar may be added. 
 
 Fleabaxe. — A diuretic. Used in dropsy. Highly esteemed by some practition- 
 ers for this purpose. Administered in decoction, made by boiling one 
 ounce in a pint of water. Dose : a wine-glassful, every three hours. 
 
 Foxglove. — (See Digitalis.) 
 
 Gamboge. — A powerful cathartic, sometimes employed in dropsy, generally com- 
 bined with other strong purgatives; alone, it is seldom used. Dose: 
 ■ from two to six grains. 
 
 Gallic Acid. — " Preferable to tannic acid in hemorrhages from some remote 
 organ, to which access is to be had only through the blood (as in haema- 
 
1028 list of medicines: 
 
 turia, haemoptysis, &c.),as it is believed to enter that fluid more readily. 
 Dose : five to twenty grains, in powder or pill." 
 
 Garlic (Allium Sativum). — Expectorant. Dose : from one scruple to two drachms. 
 Sometimes it is applied as a poultice to the feet or chest. 
 
 Gentian Root (Gentiana Luted). — Tonic. It is much used when a mild and 
 agreeable tonic is desired. Dose of the powder is from ten to forty 
 grains. The tincture or infusion is the form in which it is usually 
 administered. 
 
 Ginger (Zingiber). — An excellent stimulant and carminative, and is frequently 
 given in dyspepsia, flatulence, and to correct other medicines. Dose 
 of the powder is from five grains to twenty. An infusion may be 
 made by pouring a pint of boiling water upon half an ounce of the 
 powder or bruised root, the dose of which is two to four tablespoonfuls. 
 
 Ginseng (Panax).- — Stimulant. Dose of root, from five to fifty grains. 
 
 Glauber's Salt. — (See Soda.) 
 
 Glycerine. — The sweet portion of oils. Much used as a vehicle for other remedies, 
 especially for applications to mucous membranes. 
 
 Gold, Chloride of. — This is used by some in affections of the liver, syphilis, and 
 rheumatism. Dose is from one-twentieth to one-tenth of a grain, in 
 pill. The ointment of chloride of gold is sometimes applied to rheu- 
 matic joints. 
 
 Golden-rod. — Aromatic and carminative. Used in flatulence, &c. It is gener- 
 ally given in infusion — one pint of water to the ounce of leaves. Dose : 
 two ounces. 
 
 Golden Seal (Hydrastis Canadensis). — A tonic. Used in fevers, dysentery, 
 chronic diarrhoea, &c. Dose of hydrastin, which is made from it, is from 
 one-quarter of a grain to four grains ; dose of tincture, from half an 
 ounce to two ounces. 
 
 Gold Thread Root. — Tonic. Useful whenever a tonic is needed, especially 
 after fevers. Dose of the powder, ten to thirty grains. A tincture 
 may be made by adding a pint of diluted alcohol to an ounce of the 
 root, the dose of which is a teaspoonful. 
 
 Guaiac — Stimulant and diaphoretic. Used much in rheumatism, gout, second- 
 ary syphilis, scrofula, cutaneous eruptions, and in suppressed menstrua- 
 tion. Dose, in powder, is from ten to thirty grains; of the tincture, one 
 to three teaspoonfuls. 
 
 Gum Ammoniac. — (See Ammoniac.) 
 
 Gum Arabic. — This is used to make mucilage. It is an excellent vehicle for 
 other medicines, especially those of an irritating character. 
 
 Gum Hemlock. — Used for plasters. 
 
 Hardhack Root. — Tonic and astringent. Used in diarrhoea, cholera infantum, 
 dyspepsia, &c. It is thought to be superior to many other astringents 
 in ordinary cases. A decoction is made by boiling an ounce of the root 
 in a pint of water, the dose of which is one to two ounces, three or 
 four times a day. 
 
 Hellebore, Black. — Powerful cathartic. Used in dropsy, and in promoting' the 
 monthly discharge of females, for which it is highly esteemed. It has 
 been used in diseases of the brain and of the skin. Dose : of tincture, 
 one to two drachms ; of powder, five to fifteen grains, as a cathartic. 
 
 Helonias. — Diuretic and tonic. Dose : of the fluid extract, one to two drachms; 
 of helonin, which is made from it, the dose is from a quarter of a grain to 
 a grain. 
 
 Hemlock (Conium). — A narcotic. Used in diseases of the skin, scrofula, chronic 
 rheumatism, neuralgia, chronic coughs, &c. Dose of the powdered 
 leaves, three or four grains twice a day. As the system soon becomes 
 accustomed to its use, it is necessary gradually to increase the dose, 
 that its effects may be maintained. 
 
 Henbane (Hyosciamus Niger). — A narcotic, acting occasionally on the skin, or 
 kidneys and bowels. Used in all kinds of painful nervous diseases, — in 
 chronic rheumatism, chronic coughs, in hysterics, and, in short, in every 
 
THEIR PREPARATIONS AND DOSES. 1029 
 
 kind of case in which opium is employed. It is not so potent as opium, 
 and it is sometimes borne when opium cannot be tolerated. Dose of 
 powdered leaves, five to ten grains. Dose of the tincture is a teaspoon- 
 ful for ordinary effects. 
 
 Hops (Humulus Lupulus). — Tonic and narcotic. Used in dyspepsia, the ner- 
 vousness of drunkards, and to allay pain. They may be used in an 
 infusion, made by pouring a pint of boiling water on half an ounce, in 
 the dose of four tablespoonfuls four times a day. Dose of the tincture 
 is half a teaspoonful to two teaspoonfuls. 
 
 Horehound (Marrubium Vulgare). — Tonic. Used much in common practice in 
 coughs, colds, &c, and in cases of debility. Generally given in infu- 
 sion, made with an ounce of the herb to a pint of boiling water. Dose : 
 a wine-glassful several times a day. 
 
 Horsemint (Monarda Punctata). — Diuretic, carminative. Used for flatulence. 
 Dose : of the oil, from one to four drops on a lump of sugar. 
 
 Horseradish (Armoracia). — Anti-scurvy medicine. Stimulant. Used in the 
 form of infusion. Dose : from one to three ounces. 
 
 Hydrangea. — Diuretic. Dose : of fluid extract, one drachm. 
 
 Hydriodate of Potassa. — (See Potassium.) 
 
 Hyssop. — Carminative and tonic. Used in coughs. Dose of infusion, one to 
 four ounces. 
 
 Iceland Moss (Cetraria Islandica). — Tonic and demulcent. Used for coughs. 
 Dose: of decoction, from one to four ounces. 
 
 Indian Turnip (Arum Tryphyllum). — Expectorant. Used for coughs and rheu- 
 matism. Dose: of the root, from three to twelve grains, in sj^rup. 
 
 Iodide of Potassium. — The action of this salt on the system is very similar to 
 that of iodine. Used in chronic rheumatism, tertiary syphilis, &c. Dose : 
 five to fifteen grains, in water. It should, as a rule, be taken after 
 meals. 
 
 Iodine (Iodium). — Special stimulant of the glandular system. Used in glandu- 
 lar enlargements; scrofula of every variety; chronic enlargement of the 
 liver, spleen, and ovaries ; in cutaneous diseases, and in consumption. 
 As an ointment, it is applied to many diseases of the skin, enlarged 
 glands, chronic swellings of the joints, &c. It is not administered in 
 substance. The dose of the tincture is five to twenty drops, two or 
 three times a day, in half an ounce of water syrup. The iodide of 
 potassium is generally employed in preference to this preparation. 
 
 Ipecacuanha. — In large doses, emetic ; in smaller, diaphoretic and expectorant ; 
 and in minute doses it acts as a stimulant to the stomach. As an 
 emetic it is preferable to all others when there is irritation of the 
 stomach, or for children and persons who are feeble. It may be given 
 in very large doses without causing any dangerous consequences. In 
 small doses, especially when combined with opium, it acts with great 
 certainty on the skin. It appears to possess some specific tendency to 
 the mucous membranes, by which their secretions are improved. It 
 has been used with much success in dysenteries and diarrhoeas, and it 
 is an admirable expectorant, not always by increasing expectoration, 
 but by bringing the lining membrane of the lungs to the condition of 
 health. Dose : as an emetic, twenty to thirty grains, which may be 
 repeated in twenty minutes; as a diaphoretic and expectorant, half to 
 one grain, every three hours. 
 
 Irish Moss. — " A sea-weed growing on the rocks on the coasts of Ireland and 
 Northern Europe. Odor and taste feeble; yields to boiling water. 
 Used as demulcent article of diet in various inflammatory affections. 
 Decoction, half ounce to one quart. Dose : one fluid ounce to three, 
 every three or four hours." 
 
 Iron (Ferrum). — The general effects of all the different preparations of iron 
 
 - employed for medical purposes are powerfully tonic, exciting the pulse, 
 
 increasing the secretions, and adding to the coloring material of the 
 
 blood. They are used in most female affections that are characterized by 
 
1030 list of medicines: 
 
 paleness and debility, in all exhausting discharges, in restoring the men- 
 strual evacuation, in scrofula, rickets, neuralgia, &c. Iron should not be 
 employed when active inflammation exists, nor in diseases of excitement. 
 
 Iron, Black Oxide of. — Possesses the general properties described above as 
 belonging to iron. Dose: from five to twenty grains, three times a 
 day. 
 
 Iron, Precipitated Carbonate of. — This is a very mild and excellent prepara- 
 tion. Dose : as a tonic and for ordinary cases, five to twenty grains ; 
 in neuralgia, half a drachm to a drachm or more, three times a day. It 
 is a good plan to add a few grains of ginger and a grain or two of 
 rhubarb to each dose. It may be administered in syrup or molasses. 
 
 Iron, Ammonio -Citrate of. — Another agreeable preparation that is getting into 
 very general use, as it answers all the ordinary purposes of iron, while 
 it is less offensive to the palate than most of the others. Dose: five 
 to eight grains, always in solution. 
 
 Iron, Ammonio-Tartrate of. — This preparation is nearly void of all astringency, 
 and is more agreeable to the taste than many others. Dose : five to 
 eight grains, in powder, pill, or solution. 
 
 Iron, Iodide of. — This preparation is better suited to scrofula, and other cases in 
 which iodine is indicated, combined with a tonic. Dose : two to five 
 grains, gradually increased, three times a day. 
 
 Iron, the Muriate Tincture of. — Strongly astringent. Used, in addition to the 
 common purposes, in affections of the urinary organs, and in the chronic 
 mucous discharges of females, and in passive hemorrhages from the 
 kidneys and bladder. Dose : ten to thirty drops, gradually increased 
 to one drachm, in a little water. 
 
 Other and recent preparations of iron are the pyrophosphate ; citrate of 
 iron and quinine ; iodide, lactate, and powder of iron ; tartrate of iron arid 
 potash. 
 
 Jalap. — An active cathartic, causing watery stools. It is usually combined with 
 other cathartics, as calomel, for bilious fevers ; and cream of tartar, for 
 dropsy. Dose : in powder, ten to twenty grains. 
 
 James' Powder. — (See Antimonial Powder.} 
 
 Jamestown Weed. — (See Thorn Apple.) 
 
 Jerusalem Oak. — (See Wormseed.) 
 
 Juniper Berries. — Stimulant and diuretic. Used in dropsy, disease of the blad- 
 der, and diseases of the skin. Best given in infusion, which is made by 
 pouring a pint of boiling water on an ounce of the bruised berries. 
 Dose : the pint in twenty-four hours. 
 
 Kameela. — The powder and hairs obtained from the capsules of Rottlera tinc- 
 toria of Southern Asia. A light, finely-granular, brownish-red powder, 
 with little smell or taste, producing some acrimony in the mouth ; con- 
 tains a crystallizable principle — rottlerin ; active principle, a resin. 
 Used against the tape-worm in dose of one drachm to three, in emulsion 
 or tincture. 
 
 Kino. — An intense astringent. Used in chronic dysentery, whites, and in hem- 
 orrhages, when there is no excitement. It is generally combined with 
 opium, chalk mixture, &c. Dose : of the powder, from ten to thirty 
 grains. It may be given in infusion. 
 
 Kousso. — The flowers and unripe fruit of Brayera Anthelmintica of Abyssinia. 
 Greenish yellow ; odor fragrant; taste slight at first, afterwards acrid, 
 disagreeable. Given in cases of tape-worm, in half-an-ounce dose, 
 mixed with water. 
 
 Lactucarium. — The inspissated juice of the Lactuca sativa, or garden lettuce, a 
 brownish solid, with somewhat resinoid fracture. It has been thought 
 to resemble opium in its action on the economy, except in its not pro- 
 ducing constipation. Its action is, however, very uncertain. Dose : 
 ten to fifteen grains. Syrup (one ounce to one pint) sometimes used as 
 an anodyne vehicle in cough mixtures. Dose : two fluid drachms to 
 half a fluid ounce. 
 
THEIR PREPARATIONS AXD DOSES. 1031 
 
 Ladies' Slipper (Cypripedium Pubescens). — Xervine and tonic. Dose : of tincture, 
 
 half an ounce to an ounce. 
 Laudanum. — (See Opium.) 
 Lavender. — An aromatic and stimulant It is generally used to render other 
 
 medicines more grateful, and in perfumery. 
 Lead, Sugar of (Plumbi Acetati). — Powerfully astringent and sedative. Used 
 in bleedings from the lungs, stomach, and womb (in which it is an ex- 
 cellent remedy) ; in chronic dysentery, diarrhoea, and cholera infantum, 
 and Asiatic cholera. It sometimes has been known to cause painters 1 
 colic and lead palsy when long continued. It is nearly always com- 
 bined with opium. Dose : one to two grains in pill, which may be re- 
 peated every two or three hours. 
 Lettuce (Lactuca Sativa). — A narcotic. It lulls pain and produces sleep. Its 
 action is much like that of opium, without affecting the head, or caus- 
 ing constipation, like that drug. It is mostly used to allay cough and 
 quiet nervous excitement It is used as a kind of extract, the dose of 
 which is two grains. 
 Liquorice. — Demulcent Used for coughs, combined with other medicines. 
 Lime (Cahf). — There are several preparations of this alkali employed in medi- 
 cine. It is generally used to correct acidity of the stomach. 
 Lime, Carbonate of (Chalk). — An antacid. Xearly always given combined 
 with other medicines. It is much used in chalk mixture. Dose : from 
 ten grains to a drachm. 
 Lime Water (Aqua Calcis). — Antacid, tonic, and astringent Used in dys- 
 pepsia, with acidity of the stomach, diarrhoea, sick stomach ; and exter- 
 nally as a wash to eruptions, foul ulcers, &c. "When employed inter- 
 nally, it is best given combined with an equal quantity of milk, which 
 quite conceals its disagreeable taste. Dose : two to four ounces, seve- 
 ral times a day. For nausea, a tablespoonful, mixed with milk, may 
 be given every fifteen minutes. 
 Lime. Chlorinated. — One of the best of disinfectants. 
 
 Liverwort (Repatica Americana). — Mild tonic, astringent, and diuretic. Much 
 used in bleeding from the lungs,consumption, cough, and liver complaints 
 It may be drank in infusion, in any quantity, as a common beverage. 
 Lobelia (Lobelia Injiata. Indian Tobacco). — Emetic, diaphoretic, expectorant, 
 and sometimes cathartic. It has been much used in coughs, asthma, 
 whooping cough, and in the latter stages of croup. Dose of the powder, 
 five to twenty grains. It is seldom given in this form, the tincture 
 being much more agreeable. This is made by taking four ounces of lo- 
 belia and two pints of diluted alcohol leaving them to stand together 
 fourteen days, and then straining. Dose : thirty drops to two tea- 
 spoonfuls, every three or four hours. 
 Logwood (Rmnaioxylon. Campechianuni). — A pleasant astringent Used in 
 chronic diarrhoea, chronic dysentery, and in the chronic bowel com- 
 plaints of young children. It is a very good remedy, and much em- 
 ployed. The decoction, in which, form it is best given, is made of one 
 ounce of rasped logwood, and two pints of water boiled to one pint. 
 The dose is four tablespoonfuls ; for a child two years of age. two tea- 
 spoonfuls, several times a day. 
 Magnesia, Calcined. — This is used for the same purposes and in the same man- 
 ner as the carbonate of magnesia. 
 Magnesia. Carbonate of. — An antacid. Used in sour stomach. By combin- 
 ing with the acid in the stomach it is slightly purgative. Dose : half 
 a drachm to two drachms, mixed with milk or water, and a little 
 syrup. 
 Magnesia, Sulphate of (Epsom Salts). — An excellent cathartic, producing 
 watery stools, without pain ; used generally in inflammatory diseases 
 and fevers. Dose : one ounce, or more. 
 Male Fern (Aspidium Filix Mas). — Tonic and astringent It has had a high 
 reputation for destroying worms, especially the tape-worm. Dose of 
 
1032 list or medicines: 
 
 the powder is from one to three drachms, to be given with molasses, 
 every morning and evening, for one or two successive days. It is cus- 
 tomary to administer a brisk cathartic directly afterwards. 
 Mallows (Althea). — Used in colds, dysenteries, and complaints of the kidneys 
 and bladder, for its demulcent properties. The decoction may be drank 
 in any quantity. 
 Mandrake (Podophyllum). — Cathartic, used to operate on the liver as a substitute 
 for calomel. Dose of the podophyllin — which is the active principle — 
 from one-quarter of a grain to two grains. Dose : of fluid extract, half 
 a drachm to one drachm ; of tincture, one to three drachms. 
 Manna. — A mild laxative, but producing sometimes flatulence. It is usually- 
 given to children and pregnant women. It is commonly combined with 
 senna, rhubarb, salts, &c, the taste of which it conceals. Dose : from 
 one to two ounces ; for children, one to two drachms. It may be dis- 
 solved in water. 
 Matico. — Styptic. Leaves are used to stop bleeding. Dose : of tincture, one 
 
 drachm to one ounce. 
 May- Apple Root. — An active cathartic. It acts much like jalap, and is gener- 
 ally used in the same manner and for the same purposes. Dose: of 
 powder, ten to twenty grains. There is also an extract. 
 May Weed ( Wild Camomile). — Given in nervous diseases, and in coughs and 
 colds, to produce perspiration. It may be drank in infusion freely. 
 Dose : four tablespoonfuls several times a day. 
 Meadow Saffron. — (See Colchicum..) 
 
 Mercury (Hydrargyrum), Chloride of (Calomel). — Cathartic, although seldom 
 employed alone. It stimulates the liver and every secreting organ in 
 the body, and increases their action. It is useful in bilious fevers, 
 jaundice, bilious colic, dysentery of hot climates, and indeed in nearly 
 every disease in which there is a derangement of the secretions, Dose : 
 as a purgative, from five to fifteen grains ; to produce a constitutional 
 effect, half a grain to a grain every night, followed in the morning by 
 a gentle cathartic. 
 Mercury, Bichloride of (Corrosive Sublimate). — In large doses it acts on 
 the bowels ; in smaller, it produces the specific action of all the mer- 
 curial medicines. It is less liable to salivate than calomel. It is gener- 
 ally used internally as an anti- venereal combined with other medicines, 
 and in many diseases of the skin, and in obstinate chronic rheumatism. 
 Dose : from one-eighth to one-fourth of a grain, repeated three or four 
 times a day. It is a corrosive poison in large doses. 
 Mercury, Pill of (Blue mass). — This is one of the mildest preparations of mer- 
 cury, and is commonly used to obtain the alterative effects. Dose : one 
 pill of five grains may be given night and morning, with an occasional 
 laxative. 
 Mercury with Chalk. — This is also a very mild combination. It is generally- 
 given to children, and to persons of irritable bowels. Dose : for a 
 child, five grains, twice a day, mixed with thick syrup. None of the 
 preparations of mercury are now as much used as formerly. 
 Mezereum. — A bark. — Stimulant and diaphoretic. 
 Milkweed. — Diuretic and cathartic. Dose: of tincture, one to three drachms; of 
 
 infusion, two to five drachms. 
 Monsel's Salt. Used to stop bleeding. — The powder is applied directly to the 
 
 wound. 
 Monk's-Hood. — (See Aconite.) 
 Motherwort (Leonurus Cardiaca). — Nervine. Used for sleeplessness. Dose: 
 
 of infusion, from one to four ounces. 
 Mountain Laurel (Kalmia). — Narcotic and sedative. Used for neuralgia. 
 
 Dose : of tincture, from five to fifteen drops. 
 Mullein ( Verbascum Thapsus). — Demulcent. Used for coughs and sore throat. 
 
 Dose of infusion, from one to three ounces. 
 Musk. — Stimulant and antispasmodic. Used in all spasmodic diseases, and in 
 
THEIR PEEPAEATIONS AND DOSES. 1033 
 
 typhus, when there is twitching and tremors. It is not much employed 
 on account of its high price. Dose : ten grains every two or three 
 hours. 
 
 Mustard. — A stimulant. Has been used in dyspepsia, particularly the white 
 mustard seed, taken whole in the quantity of a tablespoonful, two or 
 three times a day. Two teaspoonfuls or more make an excellent 
 emetic in cases of narcotic poisoning, by being mixed with a tumbler of 
 warm water. It is also an excellent emetic in the beginning of 
 Asiatic cholera, when the stomach is oppressed with undigested food. 
 
 Myrrh. — Stimulant tonic. Used in chronic coughs, consumption, asthma, and 
 in various affections connected with disordered function of the womb. 
 It is generally combined with iron, or aloes, or other medicines. Dose : 
 from ten to thirty grains. There is a large number of formulas into 
 which it enters in the Pharmacopoeia. 
 
 Naphtha. — Used chiefly for inhalations. 
 
 Nitrate of Potash (Potassce Nitras. Nitre). — A diuretic and diaphoretic. It 
 is used in active hemorrhages, fevers, and all diseases of excitement. 
 Dose : five to fifteen grains, dissolved in water. 
 
 Nitrate of Silver (Argenti Nitras. Lunar Caustic). — A tonic and antispas- 
 modic. It has been chiefly employed, beneficially, in epilepsy and 
 dyspepsia, when there is irritation of the stomach. It is much used by 
 surgeons externally. Dose : one-eighth of a grain, gradually increased 
 to four or five grains, three times a day, in a pill. It should not be 
 continued longer than two months. 
 
 Nutgalls. — Pure astringent. Only used for the manufacture of tannic acid. 
 Dose : of powder, ten to twenty-five grains. 
 
 Nux Vomica (Strychnos Nux Vomica). — Tonic. Used in paralysis and de- 
 bility. At present very much used, especially in the form of its active 
 principle — strychnine. Dose of strychnine, from one-thirtieth to one- 
 eighth of a grain. Dose of tincture, from five to ten drops ; of fluid ex- 
 tract, from three to fifteen drops. 
 
 Oak Bark. — Astringent and tonic. This bark is obtained from the white oak. 
 It has been given internally in chronic diarrhoea, and hemorrhages 
 when there is no excitement. It is best administered in a decoction, 
 made by boiling one ounce of bark in a pint of water. Dose : two to 
 four tablespoonfuls, four times a day. It is, however, generally used 
 externally, and as injections for whites, &c. 
 
 Oil of Amber. — A nervous stimulant. Used in hiccough, hysteria, whooping- 
 cough, and convulsions of children. Dose : five to ten drops, in emul- 
 sion. 
 
 Oil of Anise. — Stimulant. This, and nearly all the other volatile oils, are 
 chiefly used to flavor or to improve and correct the griping action of 
 other remedies. They are generally useful in flatulence and pain in the 
 stomach, when a stimulant is required. Dose : five to ten drops. 
 
 Oil of Cajeput. — Antispasmodic and stimulant. Used for hysteria, cramp, 
 colic, &c. Dose : from one to four drops on sugar. 
 
 Oil of Caraway. — Stimulant. Dose : one to ten drops. 
 
 Oil of Cinnamon. — Stimulant and cordial. Dose : one to two drops. 
 
 Oil of Cloves. — Stimulant. Dose : two to six drops. 
 
 Oil of Juniper. — Stimulant and diuretic. This oil is used sometimes, in connec- 
 tion with other medicines, in dropsies of debilitated subjects. Dose : 
 five to fifteen drops, three times a day. 
 
 Oil of Partridge Berry. — Stimulant. Used to flavor, having that of winter- 
 green. 
 
 Oil of Pennyroyal. — Stimulant, &c. Dose : two to ten drops. 
 
 Oil of Peppermint. — Dose : one to three drops. Essence of peppermint is 
 made from it. Dose: ten to twenty drops. 
 
 Oil of* Rue. — Stimulant and antispasmodic. Has been used in hysterics and 
 convulsions. Dose : two to five drops. 
 
 Oil of Sassafras. — Stimulant, &c. Much used. Dose : two to ten drops. 
 
1034: list of medicines: 
 
 Oil of Savine. — Stimulant. It has been much employed by empirics to restore 
 the monthly discharges of females, and to produce abortion, and some- 
 times with fatal consequences. Dose: two to five drops. 
 
 Oil of Turpentine. — Stimulant, antispasmodic, diuretic, and vermifuge. It ia 
 used in chronic diseases of the urinary passages, and in whites, gleet, 
 ulcerations; particularly in typhoid fever, rheumatism, and bleeding 
 from the stomach and lungs. It is an excellent remedy also for worms 
 in the bowels; and given conjoined with castor-oil, when free purging 
 is desired, will be of much advantage. In convulsions it is often the 
 best remedy we possess, in which case it may be used as an injection ; 
 hysterics it will frequently relieve almost instantly, administered in the 
 same manner. It sometimes occasions much irritation of the kidneys 
 and bladder, if given in an overdose. Dose: five drops to twenty 
 drops as a diuretic ; as a vermifuge, it may be given in an ounce dose, 
 As an injection, an ounce may be used with starch-water, &c. 
 
 Om of Vitriol. — (See Acid, Sulphuric.) 
 
 Olive Oil ( Oleum Olivce). Sometimes given internally, as nourishing food, in 
 doses of from one to three ounces. 
 
 Onion (Allium Cepa). — Roasted onions are much used in poultices, and are ap- 
 plied to the feet, to boils, &c. 
 
 Opium. — A stimulant and narcotic. It is impossible here to allude to all the 
 diseases in which this drug has been found serviceable. There is 
 scarcely any malady in which, under certain conditions, it has not 
 been useful. Its most common applications are to allay pain, to tran- 
 quillize the nervous system, and to produce sleep. If given in small 
 doses, it acts as a decided stimulant ; in larger doses it acts as a sedative 
 and causes sleep. It generally causes constipation, and in chronic 
 diarrhoeas it is much employed to relieve the pain and check the dis- 
 charge. It is a valuable remedy in rheumatism, in gout, in inflamma- 
 tory diseases, after the system has been prepared for it by reducing; in 
 cholera, in spasmodic affections, &c. Dose : half to one grain is the 
 usual quantity ; of laudanum, twenty drops. It is an ingredient in a 
 very large number of preparations directed in the Pharmacopoeia. 
 
 Orange Flowers. — Contain volatile oil. Used as a vehicle. 
 
 Orange Peel (Auraniii Cortex). — Carminative, but chiefly used to flavor other 
 medicines. Dose : syrup in almost any quantity. 
 
 Origanum. — A popular remedy for suppressed menstruation. The oil is used for 
 liniments. 
 
 Paregoric Elixir ( Camphorated Tincture of Opium). — This is an agreeable 
 anodyne and antispasmodic, and much used to quiet cough, to relieve 
 pain in the bowels, and is given to infants to induce sleep. The dose 
 for an infant is from five to twenty drops ; for an adult, one to two 
 teaspoonfuls. 
 
 Pareira — The root of the Pareira brava of South America. Similar to 
 buchu. Dose : one fluid ounce to two. 
 
 Parsley Root (Petroselinum Sativum). — Aperient and diuretic. Used in affec- 
 tions of the kidneys, and in dropsy. It is well spoken of by high 
 authorities. It is administered in infusion. Two ounces may be added 
 to one pint of boiling water, and allowed to stand for two or three 
 hours. Dose : two to four tablespoonfuls, frequently repeated. 
 
 Pennyroyal (Hedeoma). — Stimulant and aromatic. When taken as a warm 
 tea it promotes perspiration. It is given in flatulent colic and sick 
 stomach, and it is sometimes used in domestic practice to promote the 
 monthly discharge. A large cupful may be taken at bedtime for this 
 purpose. 
 
 Pepper, Black. — A warm stimulant. It is given in debility of the stomach, 
 and has been accounted a good remedy in ague. Dose : five to twenty 
 grains. 
 
 Peppermint {Mentha Piperita). — A stimulant and aromatic. It is useful to re- 
 lieve pains in the stomach and flatulence, and for giving an agreeable 
 
THEIR PEEPAEATI0N8 AND DOSES. 1035 
 
 flavor to other medicines. It may be given in infusion, but the essence 
 or oil is more in common use. 
 
 Pepsin. — Made from the stomach of calf, used for dyspepsia and diarrhoea. 
 Dose : from one to five grains. 
 
 Persimmon {Diospyros Virginiand). — Astringent. Used in dysentery and diar- 
 rhoea. Dose : of infusion, a tablespoonful. 
 
 Peruvian Bark {Cinchona). — An admirable tonic and febrifuge. There is no 
 medicine belonging to the class of tonics so extensively used as this. 
 It may be given in any of the diseases of debility in which tonics are 
 indicated; but its chief value is derived from its power in checking 
 fever, especially ague, and relieving all affections of a periodical 
 character. Dose: in ague, one drachm, to be repeated every four 
 hours during the intermission; in other affections, as a tonic, ten to 
 thirty grains. Sulphate of Quinine, which is prepared from it, being 
 so much more convenient to administer, has nearly superseded its em- 
 ployment. It is also given in decoction, infusion, and tincture. 
 
 Petroleum. — Stimulant and antispasmodic. Used externally for rheumatism in the 
 form of liniment. Used for tape-worm. Dose : from ten to forty drops. 
 
 Phosphate of Soda. — "A mild saline. Used for children on account of its taste. 
 Dose: one ounce. May be given in broth or soup." 
 
 Phosphorus. — Stimulating tonic. Chiefly used in the form of the phosphate 
 of iron, pyrophosphate of iron, and phosphoric acid. 
 
 Phosphate of Iron. — Dose : from one to three grains. 
 
 Pink Eoot (Spigelia Marylandica. Carolina Pink). — A vermifuge. For destroy- 
 ing worms we have in this country perhaps no remedy equal to it. 
 Dose of the powdered root for a child three or four years of age, from 
 ten to twenty grains ; for an adult, from one to two drachms, to be re- 
 peated morning and evening for several successive days, after which 
 an active cathartic should be administered. It is more generally, 
 however, given in infusion, for a form of which see Prescriptions, 
 under the head of " Anthelmintics." 
 
 Pipsissewa (Chimaphila Umbellata. Winter Green). — Diuretic, astringent, and 
 tonic. Used in dropsy, and affections of the kidneys and gravel, 
 scrofula, ulcers, and diseases of the skin. It is a very popular remedy, 
 and is much employed in all the empirical preparations recommended 
 for diseases of the blood. Its flavor is particularly pleasant. The 
 decoction is made by boiling two ounces of fresh leaves with three 
 pints of water down to a quart. Dose : a teacupful three times a day. 
 
 Plantain (Plantago). — The bruised leaves are applied to the bites of insects. 
 
 Pleurisy Root (Asclepias Tuberosa). — Expectorant and diaphoretic. It is much 
 used in some parts of the country in common colds, pleurisy, con- 
 sumption, and other affections of the lungs ; also in rheumatism, in 
 dysentery, flatulence, and indigestion. Decoction, made by boiling one 
 ounce in a quart of water ; a teacupful may be taken every three 
 hours, until it produces its effects. 
 
 Prepared Oyster Shell. — Pulverized. About same as prepared chalk. 
 
 Poison Oak {Rhus Toxicodendron). — Used for chronic rheumatism. Dose of 
 tincture, from three to six drops. 
 
 Poke Berry {Phytolacca Decandra). — It is purgative and emetic, in large doses. 
 Used chiefly in chronic rheumatism, for which it has a high character. 
 Generally administered in tincture, made by saturating brandy with the 
 berries. Dose : a teaspoonful thrice daily. Poke berries have also 
 been used externally as an ointment in piles and diseases of the skin. 
 
 Potash, Acetate of. — Diuretic and cathartic. Used in dropsies. Dose : one 
 scruple to two drachms. 
 
 Potash, Bicarbonate of. — An antacid and diuretic. Used in acid stomach, and 
 in gravel when the deposit is red sand. It is commonly used, also, 
 for making an effervescing draught. Dose : ten to forty grains. 
 
 Potash, Sulphate of. — Cathartic. Used when there are glandular obstructions 
 in the abdomen, especially in children, indicated by swelling. It is 
 
1036 list of medicines: 
 
 advantageous to combine it with aloes, rhubarb, or some other similar 
 purgative. Dose : a scruple to half a drachm for an adult ; five grains 
 to ten for a child three or four years old. 
 
 Potash, Supertartrate of. — (See Cream of Tartar.) 
 
 Potassium, Iodide of (Hydriodate of Potash). — Used in cases similar to those in 
 which iodine is employed. It is, however, more convenient to admin- 
 ister, and therefore more generally prescribed for internal use. Dose : 
 one to two grains, dissolved in water, twice a day, in all scrofulous 
 complaints and glandular enlargements. It is applied externally as an 
 ointment. 
 
 Potassa with Lime {Vienna Paste). — Made by mixing an ounce of potassa and 
 lime. Used as a caustic. 
 
 Potassium, Bromide. — Used in sleeplessness, nervousness, epilepsy, insanity, and 
 nearly all nervous disorders. Dose : from five grains to two drachms, 
 largely diluted in water. 
 
 Potash, Liquor. — Used as an antacid in dyspepsia, and for inflammations of 
 the urethra. Dose : from ten to thirty drops in water. 
 
 Potash, Bitartrate, or Cream of Tartar. — Used as a cooling diuretic. Dose : 
 as a purgative, one to two ounces. 
 
 Potash, Chlorate of. — Used for inflammation of the mucous membranes of the 
 mouth, nose, and throat. Dose : from, five to twenty grains. Used as a 
 gargle in doses of one drachm to one ounce of water. It dissolves best 
 in tepid water. 
 
 Prickly Ash {Xanthoxylum Fraxineum). — A stimulant and diaphoretic. Used 
 in chronic rheumatism and diseases of the skin. Dose : ten grains to 
 half a drachm, in powder, three times a day. 
 
 Puccoon. — (See Blood Root.) 
 
 Pumpkin Seeds. — Used for worms, and especially for the tape-worm. Dose of 
 the infusion, as much as the patient will drink ; dose of the oil, from five 
 to ten drops. 
 
 Quassia. — A tonic. Used when a mere tonic is required, in dyspepsia and in 
 the debility succeeding fevers. Given in infusion, which is made by in- 
 fusing two drachms of quassia chips in a pint of cold water for twelve 
 hours. Strain, and give four tablespoonfuls three or four times a day. 
 
 Queen of the Meadow (Ewpatorium Purpureum). — Used for gravel, rheumatism 
 and gout, strangury, &c. Dose: of the decoction, from one to five 
 ounces. 
 
 Queen's Koot {Stillingia). — Used for syphilis, rheumatism and scrofula, and 
 diseases of the skin. Dose: of the tincture, one to two drachms; of 
 the syrup, one to three drachms; of the fluid extract, three to ten 
 drops. 
 
 Pyrophosphate of Iron. — This preparation is now much used. 
 
 Quinine, Sulphate of. — Prepared from Peruvian bark, which see for ascertaining 
 its medicinal properties and uses. Twelve grains of quinine are con- 
 sidered equal to an ounce of bark. Dose as a tonic, one grain three or 
 four times a day; in ague it may be given in two to five grain doses 
 every three hours, during the intermission of the disease. 
 
 Rhatany (Krameria). — A powerful astringent, and moderate tonic. Used in 
 chronic diarrhoea and dysentery; hemorrhage without excitement, es- 
 pecially from the kidneys ; whites, and in every case in which the vege- 
 table astringents may be employed. It is usually administered in de- 
 coction, which may be prepared by boiling an ounce of the root, bruised, 
 in a pint of water. Dose : two to four tablespoonfuls, repeated ac- 
 cording to the necessity of the case. 
 
 Rhubarb (Rheum). — Tonic, cathartic, and astringent. This is one of the best 
 of cathartics when the bowels are in a debilitated condition, but from 
 its astringency it is calculated to induce constipation ; for this reason it 
 is often useful in diarrhoeas that are caused by irritating matter in the 
 intestines, and is highly serviceable in the bowel affections of infancy 
 and early childhood. It is generally given in combination with other 
 
THEIR PREPARATIONS AND DOSES. 1037 
 
 as calomel, aloes, magnesia, &c. In fevers it is inferior to 
 other cathartics, unless in the advanced stages, when the system is much 
 reduced. Dose : twenty to thirty grains as a purgative ; as a laxative, 
 five to ten. For infants the syrup may be used, the dose of which is 
 a teaspoonful or two. 
 
 Rochelle Salt. — A cooling purgative, more agreeable than the common cathar- 
 tic salts. Dose : one ounce or more. 
 
 Rue (Rata). — Stimulant, antispasmodic, and diaphoretic. Used in hysterics, 
 flatulent colic, and suppressed menstruation. On account of its irrita- 
 ting properties, it requires to be administered with caution. Dose of 
 powder, fifteen to thirty grains three times a day. It may be given in 
 infusion, made by adding a pint of hot water to one ounce of the 
 leaves. Dose : two tablespoonfuls three times a day. 
 
 Rose (Rose-water). — Used for eye-washes. The leaves are sometimes applied 
 to the eye. 
 
 Rosin. — Used in ointments and plasters. 
 
 Saffron (Crocus Sativus). — Stimulant, antispasmodic; and it is thought to pos- 
 sess the property of stimulating the womb and causing the menstrual 
 flux. It is now chiefly used in domestic practice to promote the erup- 
 tion in measles, &c. Dose : ten to thirty grains. 
 
 Sage (Salvia). — Diaphoretic and tonic. Used for indigestion, and for colds, 
 Dose of the infusion, from one to four ounces. It is a very popular in- 
 gredient of gargles. 
 
 Sago. — Its uses and manner of preparation like those of tapioca. 
 
 Saleratus. — (See Bicarbonate of Potash.) 
 
 Salicin. — (See Willow Baric.) 
 
 Salt, Epsom. — (See Magnesia, Sulphate of.) 
 
 Saltpetre. — (See Nitrate of Potash.) 
 
 Santonine. — " The unexpanded flowers of Artemisia contra and other species. 
 Two varieties: Barbary; covered with whitish down. Levant; green, 
 without down, odor aromatic, taste bitter, peculiar. Active principle 
 Santonin (Sanioninum, U. S.), crystallizable, nearly insoluble in water : 
 soluble in alcohol and aether, colorless, forming salts with alkalies. An 
 active vermicide. Dose of santonica, ten to thirty grains; of santonine, 
 two to three grains, followed by cathartic. Volatile oil; yellowish, 
 darkening with age. Dose : five to twenty drops." 
 
 Sarsaparilla. — Diaphoretic. Used in cutaneous eruptions and secondary syphi- 
 lis. It has become, through the agency of advertised nostrums, a 
 medicine of great repute in a large variety of affections. It is given 
 in infusion or decoction, combined with other ingredients. Dose : of 
 powder, from one to three drachms. See Prescriptions, under the 
 head of "Diaphoretics" for a recipe for decoction. 
 
 Sassafras Root (Smilax). — Diaphoretic. Never prescribed alone, but it is gen- 
 erally added to the sarsaparilla preparations. 
 
 Savin (Sabina). — Emmenagogue. Used to bring on the courses. Dose of 
 tincture, half an ounce to one ounce and a half; of the oil, from one 
 to four drops on sugar. A very dangerous medicine. 
 
 Scammony. — Powerful cathartic. In consequence of the difficulty of obtaining 
 it pure, it is now but little used. Dose : eight to ten grains. 
 
 Scull-cap (Scutellaria). — Antispasmodic, nervine, and tonic. Used for sleep- 
 lessness, nervous debility, &c. Dose : of tincture, from one to three 
 drachms ; of the fluid extract, from quarter of a drachm to a drachm. 
 Dose of Scutellarin, from one to five grains. 
 
 Scurvy Grass. — Gently stimulant, aperient, and diuretic. Used in sea-scurvy, 
 chronic rheumatism, &c. It may be eaten as a salad, or it may be ad- 
 ministered in tincture, in the dose of thirty or forty drops, several 
 times a day. 
 
 Seidlitz Powders. — These are made of Rochelle salts two drachms, and bicar- 
 bonate of soda forty grains, in a blue paper; and in the white paper, 
 thirty-five grains of tartaric acid. Dissolve the contents of each paper 
 
1038 list of medicines: 
 
 in half a tumbler of water. Pour one into the other, and drink as it 
 effervesces. 
 
 Senna (Cassia). — An active cathartic. It may be used in all cases requiring a 
 thorough purging, especially in the early stage of fevers and in inflam- 
 matory affections. It is commonly combined with Epsom salts, manna, 
 &c. As it has a tendency to gripe, some aromatic should always be 
 added to it. The infusion is prepared by pouring two ounces of boiling 
 water on two to four drachms of the leaves, and allowing it to stand for 
 thirty minutes. The whole for a dose. It may be sweetened with 
 sugar to render it more palatable. 
 
 Silk Weed (Milk Weed). — Its effects, uses, and doses are the same as those of the 
 Butterfly Weed, which see. 
 
 Simaruba. — Bark of a Jamaica tree. Similar in properties to quassia. Contains 
 •quassin. 
 
 Skunk Cabbage Root. — Stimulant and antispasmodic. Used in asthma, hys- 
 terics, rheumatism, and chronic cough. Dose of the powder, from ten 
 to twenty grains four times a day. 
 
 Slippery Elm. — Demulcent and expectorant. Used for coughs and colds. It 
 is frequently made into a poultice. Used as emollient in form of poul- 
 tice, made with ground bark, or in thick mucilage, in various external 
 inflammations ; as demulcent in dysentery. 
 
 Snake-root, Black. — Tonic, diaphoretic, diuretic, and antispasmodic. Used in 
 dropsy and rheumatism. It is probably one of the most valuable of our 
 native plants. The decoction is made by boiling for ten minutes an 
 ounce of the bruised root in a pint of water. Dose : two to four table- 
 spoonfuls several times a day. 
 
 Snake- root, Seneka. — Stimulating expectorant and diaphoretic. It is much used 
 in affections of the lungs, and in large doses it has been successful in 
 rheumatism. Dose of the powder is ten to twenty grains, but it is 
 usually given in decoction or prepared as a syrup with squills and anti- 
 mony. To make the decoction, take bruised seneca, one ounce; water, 
 two pints; boil down to a pint and strain. Liquorice root may be 
 added before boiling to improve the taste. Dose : four tablespoonfuls 
 three times a day. 
 
 Solomon's Seal (Convolaria). — Astringent and tonic. Used in dysentery. Dose 
 of the decoction, from one to five ounces. 
 
 Snake-root, Virginia. — Stimulant tonic, diaphoretic, and diuretic. It is used in 
 typhoid fevers, in ague, in obstructed menstruation, and for promoting 
 the eruption in measles, scarlet fever, &c. Administered generally in 
 infusion and tincture. To make the infusion, take half an ounce of 
 snake-root and a pint of boiling water ; infuse for two hours and strain. 
 Dose : two to four tablespoonfuls, repeated every hour or two in low 
 fever ; three times a day or oftener in other affections. 
 
 Soda, Bicarbonate. — An antacid. Used in gravel when the deposit is red, and 
 in acidity of the stomach. Dose: ten grains to one drachm dissolved 
 in a little water. 
 
 Soda, Carbonate. — Like the preceding in its general properties. It has been 
 administered in scrofulous affections, whooping-cough, gravel, dyspepsia, 
 &c. Dose : from five to fifteen grains three times a day. 
 
 Soda, Sulphite of. — Antiseptic. Used against poisonous fevers, such as scar- 
 latina, diphtheria, and so forth. Dose : from five to twenty grains in 
 water. 
 
 Soda, Muriate of (Table Salt). — Mild stimulant to the stomach in moderate doses ; 
 in larger it causes cathartic effects, and in still larger it acts as an emetic. 
 It is only for this latter purpose that it is used as a medicine. Dose : 
 one to two tablespoonfuls in a tumbler of water. It may be properly 
 employed to excite vomiting in cases of narcotic poisoning, and in 
 cholera, &c. 
 
 Soda, Phosphate of. — Cathartic, and resembles Epsom or Glauber salt in its 
 general effects. Its taste is like that of common table salt, and it may 
 
THEIE PREPARATIONS AND DOSES. 1039 
 
 be given in broth or soup, as it imparts to it the proper agreeable saline 
 taste. Dose : half an ounce to an ounce and a half. 
 
 Soda, Sulphate of ( Glauber's Salt). — An active cathartic, increasing very much 
 the intestinal secretion. Dose : half an ounce to an ounce and a half, 
 dissolved in water. A little cream of tartar added very much conceals 
 its taste. 
 
 Spanish Flies (Cantharides). — Powerfully stimulant and diuretic. In large 
 doses they produce violent irritation of the kidneys and bladder, stran- 
 gury, and bloody urine. In still larger they will cause death from in- 
 flammation of the bowels. Irritation of the urinary organs may be 
 relieved readily by an injection of laudanum, or the internal adminis- 
 tration of laudanum or camphor, together with a free use of mucilaginous 
 drinks. They are used internally in dropsy, suppressed menstruation, 
 gleet, whites, and in the incontinence of urine consequent upon debility 
 of the neck of the bladder. Dose : one or two grains, powdered, and 
 made into pills, twice a day. Dose of the tincture, twenty drops to a 
 teaspoonful three times a day, administered in two tablespoonfuls of 
 mucilaginous fluid. 
 
 Spearmint {Mentha Viridis). — Carminative and antispasmodic. Dose of the 
 oil, from five to fifteen drops on sugar. 
 
 Spermaceti (Cetaceum). — Chiefly used in ointments and cerates. 
 
 Spider's Web (Tela). — Sometimes given for nervous troubles. Dose: from 
 three to five grains. It is a good remedy to stop bleeding from small 
 cuts made by shaving. 
 
 Spikenard. — Diaphoretic and stimulant. Used for rheumatism and syphilis. 
 
 Spirit of Mindererus. — (See Ammonia, Acetate of.) 
 
 Sponge. — Burned sponge is used by some for scrofula, and diseases of the skin. 
 Dose : one to four drachms. 
 
 Star Grass {Aletris Farinosa). — Tonic. Used in disorders of the womb. 
 Dose of powder, from five to fifteen grains. 
 
 Spurred Rye. — (See Ergot.) 
 
 Squills (Scilla Maritima). — Expectorant, diuretic, and in larger doses emetic. 
 Used in affections of the lungs after the stage of excitement has passed 
 away; in dropsy, combined with calomel or digitalis; and in the croup 
 of children, combined with seneca snake-root and tartar emetic. See 
 Prescriptions, under the head of "Expectorants" for Coxe's Hive 
 Syrup. Dose as a diuretic or expectorant is one grain, repeated three 
 times a day. 
 
 Storax (Styrax). — Expectorant. Dose: from five to twenty grains. 
 
 Stramonium (Datura Stramonium). — Stramonium leaves contains an alkaloid 
 (Daturia), which very closely resembles atropia. Its effects on the 
 system very closely resemble those of hyoscyamus, but it appears to 
 have a greater power of relaxing spasm. It is especially used in spas- 
 modic asthma, very frequently by smoking. Extract (inspissated juice 
 of leaves), dose : one to two grains. Tincture : ten to twenty drops. 
 
 Sulphate of Iron. — Astringent and tonic. 
 
 Sunflower (Helianthus Annus). — Diuretic and expectorant. Dose of oil, from 
 five to twenty drops. 
 
 Sulphur. — Laxative and diaphoretic. Used in piles, diseases of the skin, espe- 
 cially itch, chronic rheumatism, catarrh, asthma, &c. It is often com- 
 bined with cream of tartar. Dose : one to three drachms a day, mixed 
 with syrup, molasses, or milk. 
 
 Sumach Berries. — Astringent and cooling. Used for making a cooling drink 
 in fevers, and as a gargle in inflammation of the throat Strongly re- 
 commended in mercurial salivation. 
 
 Sweet Flag ( Calamus). ^-A stimulant, tonic, and aromatic. Used in dyspepsia 
 and debility of the stomach and intestines. Dose : one scruple to one 
 - drachm. It may be taken in infusion, to be drank freely. 
 
 Sweet Fern (Comptonia Asplenifolia). — Tonic and astringent. Dose of de- 
 coction, from one to five ounces. 
 
1040 LIST of medicines: 
 
 Sweet Spirits of Nitre. — Diaphoretic, diuretic, and stimulant. Used in fevers 
 and diseases of the urinary organs. Dose : from twenty -five drops to 
 three drachms. 
 
 Syrup of Iodide of Iron.— Much used for children. Dose for children, from 
 five to fifteen drops in water. 
 
 Tag Alder (Alnus Rubra). — Popularly used in syphilis and diseases of the 
 skin. Dose of the infusion, from one to three ounces. 
 
 Tamarinds. — A. cooling laxative. They are often used for making a drink in 
 diseases of excitement. 
 
 Tansy. — Aromatic and tonic. Used for worms, hysterics, &c. An ounce of 
 tansy and a pint of hot water will make an infusion, a half a teacupful 
 of which may be taken several times a day. 
 
 Tapioca. — The fecula of the large, fleshy root of the Jatropha ma?iihot, or cas- 
 sava plant of the West Indies. There are two varieties of the root — 
 the bitter and the sweet. The former is poisonous, containing prussic 
 acid ; but this being driven off by heat, cooking renders it innocuous. 
 The tapioca is obtained by expressing the juice and allowing it to deposit 
 its fecula, which is afterwards dried by heat. Occurs in irregular, 
 hard, white grains. Odorless, tasteless. Used as a farinaceous article 
 of food. Prepared by prolonged boiling in milk or water, which con- 
 verts it into a sort of jelly. 
 
 Tar. — Stimulant and diuretic. Used in chronic coughs. Tar-water has been 
 thought a remedy for consumption. Tar is also used for piles. Por 
 the mode of preparing tar-water, see Prescriptions, under the head 
 of "Expectorants" The dose of tar is half a teaspoonful, three or four 
 times a day. It may be made into pills with flour, or mixed with 
 sugar. 
 
 Tartrate of Soda and Potash [RoclxeUe Salts). — Saline purgative. Used very 
 much in rheumatism. Dose: from one drachm to half an ounce, largely 
 diluted with water. 
 
 Tartrate of Iron and Potash. — Dose : from five to twenty-five grains, in solu- 
 tion. 
 
 Thorn Apple (Jamestown Weed. See Stramonium.) 
 
 Tragacanthus. — Used only as a vehicle. The foundation of the officinal troches. 
 
 Tulip Tree ( Wild Poplar). — Diaphoretic and tonic. Used as a substitute for 
 Peruvian bark in ague, in chronic rheumatism, and dyspepsia. Dose 
 of bark in powder, half a drachm, three times or oftener in a day. 
 A saturated tincture may be made, the dose of which will be a tea- 
 spoonful. 
 
 Turkey Corn {Corydalis Formosa). — Tonic and alterative. Dose of tincture, 
 one to ten drachms. 
 
 Turpentine. (See Oil of Turpentine.) 
 
 Valerian. — Stimulant and antispasmodic. Used in hysterics, epilepsy, and 
 low fevers in which there is great nervous disturbance. Dose of pow- 
 der, from thirty to sixty grains. It is often administered in tincture, 
 the dose of which is one to four teaspoonfuls. In some cases the 
 quantity of spirit may be an objection to the use of the tincture, when 
 an infusion may be employed in preference. 
 
 Valerianate of Iron. — Dose, from half a grain to two grains. 
 
 Vervain {Verbena). — A tonic and diaphoretic. Dose of the infusion, from 
 one to five ounces. 
 
 Violets. — They are diuretic and slightly laxative, and have been used in dis- 
 eases of the lungs, kidneys, and skin; and some of the varieties are 
 thought to possess virtue in gravel complaints. They may be admin- 
 istered in the shape of an infusion, made by adding a pint of hot 
 water to an ounce of the herb. Dose, two to four tablespoonfuls, 
 three times a day. 
 
 Wafer Ash ( Wine/seed). — Used as a tonic for ague and debility. Dose of the 
 infusion, from one to four tablespoonfuls. 
 
 White-Lead. — Used as a local desiccant and sedative. 
 
THEIR PREPARATIONS AND DOSES. 1011 
 
 White Oak Bark (Quercus Alba). — Astringent. Rarely used internally, but 
 as local application. 
 
 "Wild Carrot. — A mild, stimulating diuretic. Used as adjuvant. 
 
 Wild Cucumber {Elaterium). — An active cathartic. Used in dropsy, in which 
 disease it possesses great power. It causes copious watery motions, 
 and unless given with care, may do much mischief by the violence of 
 its action. Dose : half a grain, repeated once in an hour until it ope- 
 rates. 
 
 Wild Cherry Bark {Prunus Virginiana). — Tonic and sedative. Used in con- 
 sumption and dyspepsia, to increase the strength of the general system. 
 It quiets the cough and calms the nerves. 
 
 Willow (Silex). — Tonic and astringent. Is used as a substitute for Peruvian 
 bark in ague. Salicin, an active principle of willow bark, is getting 
 into very general use, and by some is considered but little inferior to 
 quinine. One ounce of the bark, infused in a pint of hot water for 
 three hours, will make an infusion which may be drank during the 
 intermission of the paroxysms. Dose of the salicin is from two to ten 
 grains. 
 
 Winter Green. (See Pipsissewa.) 
 
 Witch Hazel {Hamamelis). — Tonic, astringent. Used in diarrhoea and dysen- 
 tery. Dose of the infusion, one to five drachms. 
 
 Worm Seed {Jerusalem Oak). — An excellent vermifuge. Dose for a child two 
 or three years of age is one to two scruples of the seeds in powder, 
 mixed in molasses, and given morning and evening for three days. A 
 brisk cathartic should then be administered. 
 
 Wormwood {Artemisia Absinthium). — A strong tonic. Used in general debility, 
 dyspepsia, in worms, ague, etc. The infusion is made by drawing an 
 ounce of the tops in a pint of boiling water. Dose : two to four table- 
 spoonfuls, three times a day or oftener. 
 
 Yellow Dock {Rumex). — Tonic, alterative. Dose : of fluid extract one to two 
 drachms ; of syrup, quarter of an ounce to one ounce. 
 
 Yellow Root. — A native shrub of the South and West. The bark of the root 
 is intensely bitter. It is a tonic, and may be used in such cases as are 
 suited to quassia or columbo. Dose : two scruples. 
 
 Zinc, Oxide of. — Tonic and antispasmodic. Used in epilepsy, St Vitus's dance, 
 and other spasmodic affections. Dose: two to eight grains, four times 
 a day, made into pills. 
 
 Zinc. Sulphate of {White Vitriol). — Tonic, astringent, and, in large doses. 
 emetic. It is chiefly employed in epilepsy, whooping-cough, and other 
 spasmodic diseases. It is seldom used as an emetic, except in poisoning. 
 It causes vomiting very quickly. Dose : as a tonic, one to two grains : 
 as an emetic, twenty to thirty. 
 
 Zinc. Valerianate of. — Tonic and antispasmodic. Dose : one to two grains. 
 66 
 
GLOSSARY. 
 
 EXPLANATION OF MEDICAL TERMS. 
 
 This list includes many terms that have not been explained in the 
 course of the booh. 
 
 
 Abdomen. The belly, or the lower part of the body below the diaphragm. 
 
 Ablution. Washing the body. 
 
 Abortion. Birth of a child before the proper time. 
 
 Absorbent. A vessel which absorbs or sucks or takes up fluid. 
 
 Accoucheur. A man who attends women in childbirth. 
 
 Acid. Sour, biting. 
 
 Acrid. Pungent, sharp to the taste. 
 
 Actual Cautery. Burning or searing with a hot iron. Used in surgery. 
 
 Acupuncture. Pricking with needles. One of the operations of surgery. 
 
 Acute. Acute diseases are of short duration and have severe symptoms. The 
 
 reverse of chronic. 
 Adhesive. Tenacious. 
 Adhesive Plaster. Sticking-plaster. 
 Adipose Tissue. Fat. 
 Adult Age. A grown person. 
 Affection. Disease. 
 Albumen. An animal substance that coagulates when heated. The white of 
 
 an egg is albumen. 
 Albuminose. A substance produced in the stomach during digestion. 
 Alimentary Canal. The tube by which aliments are conveyed through the 
 
 body. It is composed of the mouth, pharynx, oesophagus, stomach, and 
 
 intestines. 
 Alkali. A substance which, when united to acids, neutralizes them. Potash, 
 
 soda, etc., are alkalies. 
 Alterative. A remedy which slowly changes the condition of the system. 
 Alvine. Relating to the intestines. 
 
 Amaurosis. A loss or decay of sight, produced by various causes. 
 Amputation. Cutting off a limb or other part of the body. 
 Anaemia. Poverty of blood. 
 
 Anaesthesia. Numbness, or paralysis of sensation. 
 Anasarca. A general dropsy of the body, all over. 
 Anastomose. To communicate the arteries and veins. 
 Anatomy, Study of the structure of the body. 
 
 Anodyne. A remedy that relieves pain, calms the nerves, and induces sleep. 
 Antacid. A substance that neutralizes acids. Alkalies are antacids. 
 Anthelmintic A medicine that destroys worms. 
 Antibilious. That cures "biliousness." 
 
 Antidote. A specific protective against poison or any disease. 
 Antiscorbutic. A remedy used for the scurvy. 
 
 Antispasmodic. Medicines which relieve cramps, spasms, and convulsions. 
 Aperient. A mild purgative or laxative. 
 
GLOSSARY. 1043 
 
 Apex. , The summit or top. 
 
 Apparatus. Collective organs which are associated in performing the same 
 
 function. 
 Aroma. Agreeable odor of plants and other substances. 
 Aromatic A fragrant, spicy medicine. 
 
 Artery. A vessel that conveys the blood from the heart to the organs. 
 Ascarides. Pin-worms or thread-worms found in the lower portion of the 
 
 bowels. 
 Assimilation. The process by which the food is changed into tissue. 
 Asthenic. Debilitated. 
 Atrophy. A wasting away. 
 
 B right's Disease. A serious disease of the kidneys. 
 
 Bronchial. Pertaining to the branches of the windpipe in the lungs. 
 
 Bougie. An instrument used to dilate the urethra. 
 
 Cachexy. A bad state of the body. It may be caused by blood poisons. 
 
 Calculi. Gravel and stone formed in the kidneys and bladder. 
 
 Callous. Indurated, hardened. 
 
 Caloric Heat. 
 
 Capillary. Like a hair. A small tube connecting the arteries and the veins. 
 
 Carbonic Acid G-as. A gas of two parts of oxygen and one part of carbon. It 
 is found in respiration. 
 
 Carminative. A medicine which relieves colicky pains by preventing the for- 
 mation of wind in the stomach and bowels. 
 
 Cartilage. A hard elastic substance of the body ; gristle. 
 
 Catamenia. Monthly discharges of females. 
 
 Cataplasm. A poultice. 
 
 Catheter. A curved instrument introduced into the bladder through the 
 urethra for drawing off the urine. 
 
 Cell. A small elementary form found in vegetable and animal tissue. 
 
 Cerebellum. The lower and back part of the brain. 
 
 Cerebrum. The upper and front part of the brain. 
 
 Cerebro-spinal. Pertaining to the brain and spinal cord. 
 
 Chancre. A venereal sore. 
 
 Chordee. A painful drawing up of the penis. It occurs in gonorrhoea. 
 
 Chronic The opposite of acute. A disease that lasts for a long time and 
 becomes a fixed condition of the body is called chronic. 
 
 Cicatrix. A scar that remains after a wound. 
 
 Clavicle. Collar-bone. 
 
 Clyster. An injection. 
 
 Coagulation. Becoming hard in a peculiar manner. Albumen coagulates. 
 
 Colliquative. Excessive discharges from the body which weaken the system. 
 
 Colostrum. The earliest secretion of milk. 
 
 Coma. Stupor. 
 
 Confluent. Bunning together. 
 
 Congenital. From birth, or born with. 
 
 Congestion. Settling of blood in any part. 
 
 Conjunctiva. The membrane which lines the eyelid and covers the eye. 
 
 Contagious. That may be communicated by contact ; catching. 
 
 Convalescent. Recovering after sickness. 
 
 Convulsion. Involuntary and violent movement of the body. 
 
 Cordial. A medicine that mildly stimulates and raises the spirit. 
 
 Corpse. The dead body of a human being. 
 
 Corrosive. Eating or consuming. 
 
 Counter-irritation. Drawing disease from one part by irritating another part. 
 
 Cranium (krfi-ni-um). The skull. 
 
 Cutaneous. Pertaining to the skin, as cutaneous diseases. 
 
 Cuticle. Outer skin. 
 

 104:4: GLOSSARY. 
 
 Decoctions. Medicines prepared by boiling. 
 
 Deglutition. Act of swallowing. 
 
 Delirium. Wandering of the mind. 
 
 Demulcent. That which soothes diseased mucous membranes. 
 
 Detergent. A cleansing medicine. 
 
 Diagnosis. Finding out a disease by its symptoms. 
 
 Diaphoretic. Any medicine which produces sensible or insensible perspiration 
 
 or sweating. 
 Diaphragm. The muscular division between the chest and abdomen. 
 Diathesis. Tendency of the body to any form of disease, as scrofulous diathesis. 
 Diluent. That which reduces the strength of liquids. 
 Diuretic A medicine which promotes the flow of urine. 
 Dyspnoea. Difficulty of breathing. 
 Drastic. Powerful, as drastic cathartics. 
 
 Electrization. Medical use of the electric currents. 
 
 Electuary. Medicines mixed with syrup or honey. 
 
 Emaciation. Wasting away of the flesh. 
 
 Emesis. Vomiting. 
 
 Emmenagogue. A medicine which aids the menstrual discharges of women. 
 
 Emulsion. A mixture; as oil and water mixed with mucilage or sugar. 
 
 Enamel. Hard covering of the teeth. 
 
 Enema. An injection. 
 
 Entozoa. Worms in any part of an animal body. 
 
 Epidemic. A disease that prevails. 
 
 Epithelium. Layer of cells covering membranes. 
 
 Epigastric. Region of the stomach. 
 
 Eructation. Belching ; gulping of wind from the stomach. 
 
 Eruption. Breaking out on the skin. 
 
 Eustachian Tube. A narrow canal that connects the middle ear and the 
 throat. 
 
 Exacerbation. Increase of severity in a disease. 
 
 Excoriate. To abrade the skin. 
 
 Excretion. Effete or worn matter thrown off from the system, as the perspi- 
 ration, faeces, &c. 
 
 Expectorant. A medicine which aids the discharge of phlegm from the bron- 
 chial tubes or lungs. 
 
 F^ces. The discharges from the bowels. 
 
 Faradaization. Use of the Faradaic current. 
 
 Fauces. Back part of the mouth. 
 
 Febrile. Feverish. 
 
 Fetid. Having a disagreeable smell. 
 
 Fc3tus. The child in the womb. 
 
 Fibrine. Animal matter found in the blood. 
 
 Filter. A strainer. 
 
 Fistula. A narrow ulcerous opening. 
 
 Flaccid. Weak, soft. 
 
 Flux. An unusual discharge from the bowels. 
 
 Function. The work or office performed by any part or organ of the body. 
 
 Fundament. The seat. 
 
 Galvanization. Use of the galvanic current. 
 Gargle. A wash for the mouth and throat. 
 Glottis. Opening of the larynx. 
 
 Hectic Fever with chills, heat, and sweat. Consumption is attended by hectic 
 
 fever. 
 Hemoptysis. Spitting of blood. 
 Hemiplegia. Paralysis of one side of the body. 
 
GLOSSARY. 1045 
 
 Hepatic (he-pat'-ic). Relating to the liver. 
 
 Hereditary. Coming down from ancestors. 
 
 Hernia (hernia). A rupture. 
 
 Hydragogue. A purgative that produces a watery discharge from the bowels. 
 
 Hyperesthesia. Excessive and abnormal sensibility. 
 
 Hygiene. The art of preserving and regaining health by obedience to the laws 
 
 of health. 
 Hypodermic Under the skin. 
 Hysterical. Nervous, subject to hysteria. 
 
 Infection. Communication of disease. 
 
 Infusion. Medicine made by steeping in cold or hot water. 
 
 Injection. Liquid sent into some part of the body by means of a syringe. 
 
 Inspiration. Drawing air into the lungs. 
 
 Integument. The skin. 
 
 Intermittent. Subject to intervals. 
 
 Laxative. A mild purge ; a medicine that loosens the bowels, but does not 
 
 cause profuse discharges. 
 Ligature. A thread, a tie. 
 Liniment. A medicated lotion or wash. 
 Lumbago. Rheumatic pains in the loins and small of the back. 
 
 Maceration. Softening with water. 
 
 Malaria. Air which causes disease. Ague is caused by malaria. 
 
 Marrow. A soft substance in the bones. 
 
 Medulla Oblongata. A nervous mass in the lower part of the brain. 
 
 Metastasis. A change of disease from one part of the body to another. 
 
 Miasma. Malaria ; exhalations from a decaying matter. 
 
 Morbid. Diseased. 
 
 Mucilage. Viscid fluid substance. 
 
 Mucus. The ropy, lubricating, tenacious fluid secreted by the mucous membrane. 
 
 Narcotic. A medicine that causes sleep, relieves pain, or stupefies. 
 Nausea. Sickness at the stomach, with a desire to vomit. 
 Nitrogen. A gas that forms four-fifths of the atmosphere. 
 Nervine. A medicine that acts on the nerves. 
 Neuralgia. Pain of a nerve, without apparent inflammation. 
 Neurasthenia. Nervous exhaustion. 
 Normal (nor'mal). Natural. 
 Nutritious. Nourishing. 
 
 Oblong. Longer than broad. 
 
 Olfactory Nerves. The nerves of smell. 
 
 Oxygen. A gas that forms one-fifth of the atmosphere. 
 
 Palpitation. A sensible beating of the heart, sometimes violent and painful. . 
 
 Panacea. A medicine that cures everything. 
 
 Paralysis. Palsy ; loss of the power of motion or sensation of any part of the 
 
 body. 
 Paraplegia. Paralysis of the lower limbs. 
 Paroxysm. A fit ; a sudden increase in violence of a disease. 
 Pectoral. Medicines given for diseases of the chest. 
 Pepsine. An important element of the gastric juice. 
 Perspiration. Sweat. 
 Periosteum. Membrane covering the bone. 
 Petechia. Spots on the skin in fever. 
 Pleura (plew'ra). A membrane that lines the inside of the chest and covers the 
 
 lungs. 
 Pleurisy. Inflammation of the pleura. 
 

 10±6 GLOSSARY. 
 
 Pneumonia. Inflammation of the substance of the lungs. 
 
 Polypus. A pear-shaped tumor. 
 
 Prognosis. Foretelling the issue of a disease. 
 
 Purgative. A medicine that opens the bowels. 
 
 Purulent. Consisting of pus. 
 
 Pus. The yellowish whitish matter in sores, wounds, ulcers. 
 
 Rectum. The end of the large intestines. 
 
 Respiration. The process of breathing. 
 
 Rubefacient. Application that causes redness of the skin. 
 
 Saccharine. Consisting of sugar, sugary. 
 Salivation. Increase of the secretion of saliva. 
 Scirrhous. Hard. 
 
 Scorbutic. Partaking of the character of scurvy. 
 Scrotum. The bag containing the testicles. 
 
 Secretion. Separation of any substance from the blood for a special purpose. 
 Sedentary. Sitting, inactive. 
 Seminal Emissions. Emission of semen. 
 Serous. Watery. 
 Sinapism, A mustard plaster. 
 Sialagogue. Medicine that makes the saliva flow. 
 Spinal Column. The backbone. 
 
 Spinal Cord. The nervous marrow in the spinal column. 
 Stimulant. A medicine that excites. 
 Stertorous. Snoring. 
 Stool. Discharge from the bowels. 
 Subcutaneous. Under the skin. 
 Sudorific. A medicine that causes sweating. 
 Suture. Jagged edges that unite the bones of the skull. 
 Syncope. A fainting-fit. 
 
 Syringe. An instrument for injecting liquids into the bowels, throat, ear, vagina, 
 or other cavities of the body. 
 
 Tendon. A cord that connects a muscle with bone. 
 
 Tenesmus. Painful bearing-down sensation in the lower bowel. 
 
 Tepid. Warm, but not hot. 
 
 Tertian. Occurring every other day. 
 
 Tibia. The large bone of the leg below the knee. 
 
 Tincture. Medicine dissolved in alcohol. 
 
 Tonics. Remedies which give strength and tone to the system. 
 
 Trachea. Windpipe. 
 
 Typhoid. Like typhus ; low, weak, debilitated. 
 
 Urinary. Relating to urine. 
 
 Urea. A substance found in the urine. 
 
 Urethra.. The canal of the penis through which the urine passes from the body. 
 
 Uterus. The womb. 
 
 Vagina. The canal that connects the vulva with the womb. 
 
 Vaginismus. Spasm of the vagina, caused by morbid irritability. 
 
 Varioloid. A mild form of small-pox. 
 
 Venery. Sexual intercourse. 
 
 Vertigo. Dizziness. 
 
 Vesicant. That which raises a blister on skin. 
 
 Virus. Poisonous and contagious matter. 
 
 Viscera. Internal organs of the body. 
 
INDEX. 
 
 Abdomen, Enlargement of in Preg- 
 nancy 937 
 
 Abnormal Growth, of Hair 639 
 
 Abortion and Miscarriage 715 
 
 Abrasions of the Skin 461 
 
 Abscess 461, 714 
 
 Abscess, Acute 461 
 
 Absinthe 465 
 
 Acacia 633 
 
 Accidents, Assistance in 403 
 
 , SurgicaL 399 
 
 Acetate of Ammonia, Mixture of . . . 977 
 
 of Lead 718 
 
 Acetic Acid 243 
 
 Ether 243 
 
 Acid. Acetic 243 
 
 , Carbolic 515 
 
 , Carbonic 444 
 
 , Chromic 532 
 
 . Citric 541 
 
 , Muriatic 731 
 
 , Nitric 744 
 
 , Nitro -Muriatic 731 
 
 , Phosphoric 753 
 
 , Prussic 448, 763 
 
 , Sulphuric 864 
 
 , Tannic 243 
 
 Acidulous Food. 199 
 
 Acids 445 
 
 Aconite 465 
 
 Action of Stomach. 144 
 
 Acute Abscess 461 
 
 Bronchitis ' 497 
 
 Gout 627 
 
 Inflammation of the Liver. . . 691 
 
 Rheumatism 786 
 
 Adhesive Plaster 1006 
 
 Strips 409 
 
 Adulteration of Stimulants and Nar- 
 cotics 240 
 
 ^Ether 466 
 
 ^Etherization 466 
 
 After Delivery 946 
 
 Ague 467 
 
 Air 254 
 
 — , Changes of, during Respira- 
 tion 135 
 
 Air : tube, or Trachea 131 
 
 Alcoholism 246 
 
 , Chronic 246, 736 
 
 PAGE 
 
 Alkalies 446 
 
 Alkaline Bath 1012 
 
 Allen's Hair Restorative 639 
 
 Allopathist 395 
 
 Almond Emulsion. 321 
 
 Almonds 187 
 
 Aloes 470 
 
 , Injection of .*. . . 985 
 
 Alteratives 999 
 
 Alum 471 
 
 , Gargle of 1003 
 
 , Wash of 1004 
 
 Amaurosis 471 
 
 American Hellebore 908 
 
 Ammonia 986, 446 
 
 , Muriate of 798 
 
 , Subcarbonate of 863 
 
 Ammoniated Tincture 633 
 
 Ammonium, Bromide of 496 
 
 Anasmia 472 
 
 Anasarca 577 
 
 Angina-pectoris, or Breast-pang 473 
 
 Angustura Bark, Infusion of 1001 
 
 Animal Heat 138 
 
 Animal Magnetism 730 
 
 Animals 158 
 
 , Longevity of 374 
 
 Aniseed Cordial 1013 
 
 Annulare Tuber 97 
 
 Anodyne Plaster 989 
 
 Anodynes 654, 988, 989 
 
 Anthelmintics 984 
 
 Anthracite Coal, Effects of on Health. 265 
 
 Antispasmodics 991 
 
 Aperients and Cathartics 961 
 
 Aphasia. 476 
 
 Aphonia 688 
 
 Aphthge, or Thrush 476 
 
 Apoplexy 474 
 
 , Treatment of 475 
 
 Apparatus, Form of, for Electriza- 
 tion 601 
 
 Apples 200 
 
 and Rice 327 
 
 Apple-tea 320 
 
 Apricot 200 
 
 Aquafortis 446 
 
 Arm 59 
 
 Arm-bone, Fracture of 419 
 
 Arm, Muscles of 74 
 
 Arnica. 478 
 
1048 
 
 INDEX. 
 
 
 PAGE 
 
 Arnica, etc. , Draught of 986 
 
 Aromatics 301 
 
 Arrow-Root 312 
 
 Pudding 325 
 
 Arsenic 478 
 
 and Iron, Mixture of 995 
 
 Arteries 124 
 
 Artichoke 197, 198 
 
 Artificial Asses' Milk 324 
 
 Artists. 350 
 
 Ascites 578 
 
 Asiatic Cholera 534 
 
 Asparagus 197 
 
 Assaf oetida 479 
 
 , etc. , Mixture of 992 
 
 , etc. , Pills of 992 
 
 Asses' Milk 188 
 
 1 Artificial 324 
 
 Assimilation within the Body 146 
 
 Assistance in Accidents 403 
 
 Asthma 480 
 
 Astringents 1000 
 
 Atmospheric Electricity 297 
 
 Atropine 484 
 
 Attachment and Mechanism of 
 
 Muscles 77 
 
 Auscultation, or Sounding the Chest. 485 
 
 Authors 351 
 
 Ava 228 
 
 Avens, Decoction of 1001 
 
 B. 
 
 Back-ache 485 
 
 Bad Breath 491 
 
 Bakers 365 
 
 Baking 177, 311 
 
 Baldness 636 
 
 Balm-tea 988 
 
 Balsam of Copaiva, Mixture of 978 
 
 Bandages 412 
 
 Bandage for Head 412 
 
 for Broken Ribs 418 
 
 Bandaging Finger and Hand 411 
 
 Leg 410, 411 
 
 Barbadoes Leg 479 
 
 Barber's Itch 825 
 
 Bark, Calisaya 517 
 
 , Canella 515 
 
 , Cascarilla 517 
 
 Barley 193 
 
 Barley-water 321 
 
 Bath, Alkaline 1012 
 
 , Hand 286 
 
 , Russian 287 
 
 , Shower 286, 912 
 
 , Turkish 287 
 
 Bathing 284 
 
 in Sea 913 
 
 Batter Pudding 328 
 
 Beans 195 
 
 Bearberry, Decoction of. 977, 1002 
 
 Beds, Sick-room 300 
 
 Beef 179 
 
 PAGB 
 
 Beef, Extract of. 317 
 
 Beef Tea 179, 316 
 
 Beer, Maize or Chica 225 
 
 , Millet 227 
 
 Poultice 720 
 
 Beet-Root 198 
 
 Belladonna Plaster 989 
 
 Benzoin. 486 
 
 Best Time for Exercise 270 
 
 Betel Nut 225 
 
 Beverages 331, 1013 
 
 , Preparation of 319 
 
 Bile 141 
 
 Bilious Colic 546 
 
 Birds 181 
 
 Birth-marks 826 
 
 Bismuth 486 
 
 Lozenges 1017 
 
 Bitter Almonds, etc., Mixture of . . . 982 
 
 Apple, or Colocynth 549 
 
 Black Pepper, Confection of 987 
 
 Blacksmiths 357 
 
 Bladder. 148 
 
 , Inflammation of 487 
 
 , Stone in 679, 854 
 
 Blanc-mange, Arrowroot 326 
 
 Bleeding from the Nose 489 
 
 Bleeding, to stop by Compression of 
 
 Arteries 401 
 
 Blessed Thistle, Infusion of 974 
 
 Blood 115 
 
 , Change in, during Respira- 
 tion 135 
 
 , Coagulation of 118 
 
 Globules during Respiration.. 136 
 
 , Means of arresting Flow of. 400 
 
 , Quantity of 121 
 
 Root, etc. , Syrup of 981 
 
 , Spitting of 981 
 
 , Tincture of 843 
 
 , To stop the Flow of 401 
 
 , Vomiting of 909 
 
 Blue Pill 712 
 
 Blue Skull-cap 814 
 
 Boating 269 
 
 Body, Assimilation within 146 
 
 , Brief View of 33 
 
 , Integuments of 153 
 
 , Muscles within 72 
 
 , Nutritive Changes within 146 
 
 , Secretion within 146 
 
 , Skeleton of 44 
 
 , Trunk of 52 
 
 Boiled Flour and Milk 325 
 
 Vegetables 328 
 
 Boiling 177, 311 
 
 Boils 490 
 
 Boneset, or Thoroughwort, Infusion 
 
 of 974, 997 
 
 Bone of Tongue 51 
 
 Bones 38 
 
 of Chest, Fracture of 418 
 
 of Face 46 
 
 of Fore-arm, Fracture of 420 
 
INDEX, 
 
 1049 
 
 PAGE 
 
 Bones, of Leg, Fracture of 415 
 
 , Sesamoid 65 
 
 Borax, Gargle of 1003 
 
 Bowels, Inflammation of. 491 
 
 , Regulation of 288 
 
 , Treatment of 492 
 
 Brain 82 
 
 , Concussion of 493 
 
 , Condition of, in Insanity. ... 90 
 
 , Chronic Dropsy of 583 
 
 , Description of 32 
 
 , Dropsy of 581 
 
 , Functions of 97 
 
 , Health of 89 
 
 , Inflammation of 494 
 
 in the Sexes 89 
 
 , Phosphorus in 186 
 
 , Quality of 89 
 
 , Size of 89 
 
 , Sleep necessary for 279 
 
 , Treatment of 495 
 
 under Microscope 89 
 
 Brain-workers 171, 252 
 
 Bran, Decoction of 982 
 
 Brandy 222, 228 
 
 , Cognac 243 
 
 , Gargle of 1003 
 
 Bread 191 
 
 , Panada 316 
 
 Bread-making, Process of 191, 192 
 
 Bread-pudding 327 
 
 Breakfast 208 
 
 Breast, Cancer of 509 
 
 Pang, or Angina-pectoris 473 
 
 Breasts, Enlargement of, in Preg- 
 nancy 937 
 
 Breath, Exhalation of Water and 
 
 Animal Vapors with 137 
 
 Brewing 213 
 
 Bricklayers 365 
 
 Brickmakers 355 
 
 Bright's Disease 680 
 
 , Use of Microscope 
 
 in 613 
 
 Broccoli and Cauliflower 197 
 
 Broiling 177 
 
 Broken Ribs, Bandage for 418 
 
 Bromide of Ammonium 496 
 
 of Potassium. 496, 645 
 
 of , Ointment of. 1007 
 
 Bronchitis 497 
 
 Bronchitis, Acute 497 
 
 Bronchocele. 503 
 
 Bruises 430 
 
 Brushing Teeth 875 
 
 Bubo 622 
 
 Burns 432 
 
 Butchers 357 
 
 Butter. 187 
 
 C. 
 
 Cabbage 197 
 
 PAGE 
 
 Calamine, or Carbonate of Zinc... 506 
 
 Calisaya Bark 517 
 
 Calkers 356 
 
 Calomel 712 
 
 , Substitute for 758 
 
 Calumba 507 
 
 , Ether, &c, Mixture of. . . 979 
 
 Camphor 507 
 
 Ice 559 
 
 , PiUs of 990 
 
 Cancer 508 
 
 of Breast 509 
 
 of Larynx 686 
 
 of Stomach 560 
 
 of Womb 513 
 
 Candies 202 
 
 Canker of Mouth 721 
 
 Canelia Bark 515 
 
 Capsicum, or Cayenne Pepper 524 
 
 Caraway Cordial 1013 
 
 Carbolic Acid 515 
 
 and Glycerine, Injec- 
 tion of 1004 
 
 , Injection of 969 
 
 , Lotion of 1010 
 
 , Ointment of 1007 
 
 Carbonate of Ammonia, Mixture of. 973 
 
 of Potash 763 
 
 of Zinc, or Calamine 506 
 
 Carbonic Acid 444 
 
 Carbuncle 516 
 
 Carpenters 355 
 
 Carron Oil and Carbolic Acid, Lo- 
 tion of 1009 
 
 Carrot 197 
 
 , Mashed 328 
 
 Cascarilla Bark 517 
 
 , &c, Draught of. ..1001 
 
 Caseous Food 187 
 
 Cassia 518 
 
 Castor Oil 518 
 
 Mixture 963 
 
 — , Mclasses, and Salt, In- 
 jection of 968 
 
 Catalepsy, or Trance 519, 736 
 
 Cataplasms 763 
 
 Cataract 612 
 
 Catarrh 520, 640, 732 
 
 in Infants 958 
 
 Catechu 523 
 
 Cathartics, Abuse of 962 
 
 and Aperients 961 
 
 Caul 143 
 
 Cauliflower and Broccoli 197 
 
 Causes of Cholera 536 
 
 of Iliac Passion 667 
 
 of Scrofula 805 
 
 of Scurvy. 810 
 
 Cayenne Pepper 524 
 
 Cerebellum 97 
 
 Cerebro- Spinal, or Spotted Fever. . 847 
 
 Cerebrum 97 
 
 Cerium, Oxalate of 645, 650, 746 
 
 Cessation of the Menses 938 
 
1050 
 
 INDEX, 
 
 PAGE 
 
 Chalk 525 
 
 , Mercury with 712 
 
 Mixture, etc 1000 
 
 Stone 629 
 
 Chamomile Flowers 525 
 
 Chancre 866 
 
 , Indurated 867 
 
 , Inflamed 868 
 
 , Irritable 868 
 
 , Simple 868 
 
 , Sloughing 868 
 
 Change of Residence 295 
 
 Chapped Hands 527 
 
 Character, Influence of Weather on. 292 
 
 Charcoal Poultice 1012 
 
 Cheese.. 189 
 
 Cheesy Food 187 
 
 Chemical Food 526 
 
 Chemists 366 
 
 Cherry-bark, Infusion of 982 
 
 Chest, Auscultation or Sounding of. 485 
 
 , Dropsy of 580 
 
 Chestnuts 195 
 
 Chiccory 217 
 
 Chicken 182 
 
 Broth 318, 329 
 
 Panada 329 
 
 Pox 526 
 
 Tea 317, 329 
 
 Child-bed Fever 764 
 
 Child, Injection for 968 
 
 Childhood, Diseases of 955 
 
 Children. Convulsions of 443 
 
 Chilblains 528 
 
 Chilblain Lotion 1018 
 
 Chin-cough 654 
 
 Chloasma, or Yellow Spots 825 
 
 Chlorate of Potash 530 
 
 ? Douche of 969 
 
 1 Gargle of 1003 
 
 ,Injectionof.969, 1005 
 
 Chloride of Lime 691 
 
 of Soda, Gargle of. 1003 
 
 Chloroform 530 
 
 Chlorosis 705 
 
 Cholera 532 
 
 , Asiatic 534 
 
 , Causes of 536 
 
 Infantum 539 
 
 Morbus, Treatment of 534 
 
 Chorea, or St. Vitus' Dance 796 
 
 Chromic Acid 532 
 
 Chronic Abscess 462 
 
 Alcoholism 246, 736 
 
 Bronchitis 499 
 
 Dropsy of the Brain 583 
 
 — '■ Inflammation of Stomach. . 853 
 
 Laryngitis 683 
 
 Pain at Right Side 694 
 
 Rheumatism 788 
 
 Chyle, Course of 145 
 
 Cinchona 751 
 
 Cinchona-Valerian, Mixture of 994 
 
 Cinnamon 541 
 
 PAGE 
 
 Cinnamon Cordial 1013 
 
 Circulation of Air in Room 264 
 
 Citric Acid 541 
 
 Citrine Ointment 542 
 
 Citron Cordial 1013 
 
 Clap 621 
 
 , Remedies used in 625 
 
 Classification of Food 177 
 
 Cleanliness 284 
 
 in Gonorrhoea 622 
 
 Clergymen 345 
 
 Clergymen's Sore Throat. 685 
 
 Climate 294 
 
 , Change from Cold to Tropi- 
 cal 295 
 
 Club-foot 541 
 
 Coagulation of Blood 118 
 
 Coca 224 
 
 Cocculus Indicus 222, 228 
 
 Cod...; 185 
 
 Cod-Liver Oil 189, 542 
 
 Coffee 216 
 
 and Tea, Effects of 244 
 
 Coffeine 231 
 
 Cognac, Oil of 243 
 
 Colchicum 542, 631 
 
 and Epsom Salts 964 
 
 Cold Cream 559, 1016 
 
 , Apparent Death from 
 
 Effects of 443 
 
 Cold in Head 543 
 
 Powder 544 
 
 , Use of 669 
 
 Colic 545 
 
 , Bilious 546 
 
 from Lead 546 
 
 in Infants 548 
 
 Collar-bone, Fracture of. 417 
 
 Colliers 364 
 
 Collodion 549 
 
 Colocynth, or Bitter- Apple 549 
 
 Cologne Water 1014 
 
 Color of the Hair 635 
 
 Columbo, Ginger, &c, Infusion of.. 997 
 
 Common Salt, Douche of 968 
 
 Comparative Table of Doses 460 
 
 Comparison of Mortality 335 
 
 Complexion 112 
 
 Compound Chloroform Liniment.. .1010 
 
 Concussion of the Brain 493 
 
 Condiments 201 
 
 Condition of the Brain in Insanity. . 90 
 Conditions Simulating Pregnancy. . 938 
 
 Conductors on Railroads 369 
 
 Confectioners 364 
 
 Constipation 734 
 
 Constitutional Syphilis 870 
 
 Consumption, Fat Meat in 189 
 
 , Pulmonary 766 
 
 , Treatment of Pulmo- 
 nary 772 
 
 Convalescents, Cookery for. ...310, 325 
 
 Convulsions 736 
 
 of Children 443 
 
INDEX, 
 
 1051 
 
 PAGE 
 
 Convulsions or Fits. 553 
 
 Cooks 364 
 
 Coopers 356 
 
 Copper 555 
 
 Copaiva 554, 624 
 
 Corium 634 
 
 Corns 555, 1018 
 
 Corpulence 557 
 
 Corrosive Sublimate 712 
 
 Cosmetics 557 
 
 Cough 654 
 
 Mixtures 503 
 
 Course of Chyle 145 
 
 Cowitch and Honey 985 
 
 or Cow-hage 558, 985 
 
 Coxe's Hive Syrup 981 
 
 Cranioscopy, or Examination of 
 
 Head 95 
 
 Cream 559 
 
 of Tartar 558, 964 
 
 , Solution of 978 
 
 Creosote 559 
 
 . Lotion of 1010 
 
 Croton OH, Pills of 966 
 
 Croup, False 563 
 
 , Infantile 959 
 
 Cupping 451 
 
 Curd 188 
 
 Currants 200 
 
 Dandelion 564 
 
 , &c. , Infusion of. 
 Pills 
 
 Dandruff 
 
 Dates 
 
 Deadly Xight-Shade. or Belladonna 
 Death from effects of Cold Apparent 
 Decoctions. Infusions, and Mixtures 
 
 Delirium Tremens 566, 
 
 Description of the Eye 
 
 Muscles 
 
 Diabetes 
 
 Diaphoretics 
 
 Diarrhoea 
 
 Diet 
 
 , Exercise, 
 
 and Dress in Preg- 
 nancy 
 
 in Infancy 
 
 , Regulations for 
 
 Different Parts, Sensibility of 
 
 Digestion 143, 
 
 , Organs of 
 
 Digitalis. Acetate of Potash, <fcc., 
 
 Mixture of 
 
 Dinner 
 
 Diphtheria, or Putrid Sore-throat. . 
 Dipsomania or Methomania .574. 672. 
 
 Disease, Tubercular . ." 
 
 Diseases 
 
 and Management of Teeth. 
 
 — -, Nervous, of Modern Times 
 • of Infancy and Childhood. . 
 
 966 
 635 
 199 
 564 
 443 
 963 
 736 
 103 
 68 
 568 
 972 
 572 
 167 
 
 939 
 960 
 
 206 
 
 98 
 
 174 
 
 138 
 
 976 
 209 
 575 
 736 
 686 
 461 
 874 
 732 
 955 
 
 PAGE 
 
 Diseases of Pregnancy 940 
 
 of the Genital Organs 866 
 
 of the Hair and Scalp 635 
 
 of the Heart, Remarks on 646 
 
 of the Hip. 653 
 
 of the Kidneys 679 
 
 of the Skin. ; 824 
 
 of the Spinal-cord 837 
 
 of the Spine 836 
 
 of Women 920 
 
 Disinfectants of Sick-room 304 
 
 Disinfecting Fluid 691 
 
 Dislocation of the Elbow 425 
 
 Jaw-Bone 426 
 
 Neck. 427 
 
 Shoulder 423 
 
 Thigh-Bone 425 
 
 Dislocations 421 
 
 Distinction between Typhus and 
 
 Typhoid Fevers 892 
 
 Diuretics 975 
 
 Dizziness, or Vertigo 908 
 
 Dog-wood Bark. Decoction of 996 
 
 Doses, Comparative Table of 460 
 
 Douches 968 
 
 Dover's Powder 576, 674 
 
 Drinks .1018 
 
 Drivers 360 
 
 Dropsy 577 
 
 Drowning 436 
 
 Drowning, Philosophy of Treat- 
 ment of 438 
 
 Druggists 366 
 
 Dry Cupping 452 
 
 Dry-scall, or Scaly Tetter 881 
 
 Ducks 181 
 
 Dumb-beUs 723 
 
 Duration of Pregnancy 938 
 
 Dynamometer and Dynamograph . . 985 
 
 Dysentery 566 
 
 , Chronic 588 
 
 Dyspepsia 591 
 
 E. 
 
 Earache in Infancy 956 
 
 Ear. Conversation Trumpet for 886 
 
 , Inflammation of 597 
 
 Trumpets 885 
 
 Earth-closets 307 
 
 Eclectics 395 
 
 Eczema, 824 
 
 Effects of Coffee and Tea, 244 
 
 of Loss of Blood 121 
 
 of Nervous Influence 80 
 
 Effervescing Draughts 598, 975 
 
 Egg-nog 987 
 
 Eggs 183 
 
 Elaterium 599 
 
 Pills 966 
 
 Elbow. Dislocation of 425 
 
 Electricians 395 
 
 Electricity 600 
 
1052 
 
 INDEX. 
 
 PAGE 
 
 Electricity, Atmospheric. 297 
 
 Electrization 600 
 
 , Form of Apparatus for 601 
 
 , General 620 
 
 in various Diseases 620 
 
 , Methods of. 600 
 
 Emergencies, Surgical 399 
 
 Emetic Holly 229 
 
 Emetics 969 
 
 Emollient Bath 1011 
 
 Enemata 967 
 
 Epidermis 634 
 
 Epilepsy, or Falling Sickness 603 
 
 Epsom Salts and Colchicum 964 
 
 , Injection of 968 
 
 or Sulphate of Mag- 
 nesia 606 
 
 Ergot of Rye 449, 607, 617, 718 
 
 Eruptions during Infancy 957 
 
 Erysipelas, Rose, or St. Anthony's 
 
 Fire 608 
 
 Esculent Roots 197 
 
 Esthesiometer 602 
 
 Estimate of Number of Pores 635 
 
 Ether, Acetic 243 
 
 , (Enanthic 243 
 
 Examination of Head, or Cranio- 
 
 scopy 95 
 
 Exercise 266 
 
 before and after taking Food 210 
 
 , best time for 270 
 
 , Dress, and Diet, in Preg- 
 nancy 939 
 
 of the Movement Cure 723 
 
 , Quantity of 271 
 
 Excessive Menstruation 710 
 
 Excretion 147 
 
 within the Body 146 
 
 Exhausting Treatment 452 
 
 Expectorants 979 
 
 Explanations and Suggestions for 
 
 the Reader 23 
 
 Extract of Beef 317 
 
 Extremities, Inferior 62 
 
 , Superior 58 
 
 , Muscles of Inferior. . . 75 
 
 , Muscles of Superior. . 74 
 
 Eye, Description of 103 
 
 , Inflammation of, in Infancy.. . 957 
 
 , Injuries to 614 
 
 Washes 1004 
 
 Eyes, Muscular Affections of 613 
 
 , Simple Rules for Care of 613 
 
 F. 
 
 Face Ill 
 
 , Bones of 46 
 
 , Neuralgia of 883 
 
 Fainting 615 
 
 Falling Sickness, or Epilepsy.. .603, 735 
 
 False Croup, or Spasm of Glottis . . 563 
 
 False Pleurisy 758 
 
 Faradization 616 
 
 PAGE 
 
 Farinaceous Food 189 
 
 Preparations 311 
 
 Fat and Membrane of, Cellular 154 
 
 Fat Food 186 
 
 Fat Meat in Consumption 189 
 
 Farmers 348 
 
 Favus of the Scalp 825 
 
 Fever, Hectic 651 
 
 , Intermittent 467 
 
 , Puerperal, or Child-bed 764 
 
 , Remittent 782 
 
 , Rheumatic 786 
 
 , Spotted, or Cerebro-Spinal. 847 
 
 , Treatment of Yellow 932 
 
 , Typhus, or Typhoid 887 
 
 , Yellow 930 
 
 Figs 199 
 
 Fingers 61 
 
 , Fracture of 421 
 
 Fire of St. Anthony 608 
 
 Fish 184,331 
 
 , Phosphorus in 186 
 
 Fishermen 368 
 
 Fits, or Convulsions 553 
 
 Flax-seed, Infusion of 982 
 
 , Poultice of 1012 
 
 Tea 322 
 
 Flea-bane 607 
 
 Flesh 178 
 
 Flies, Spanish or Blistering 841 
 
 Flooding 616 
 
 Florence Nightingale 257 
 
 Flummery 326 
 
 Foetus, and Changes of. „ . . . . 151 
 
 Fomentations 1011 
 
 Food, Acidulous 199 
 
 , Adulterations of 201 
 
 after and before Exercise 210 
 
 , Classification of 177 
 
 , Cheesy 187 
 
 , Chemical 526 
 
 containing Oil 186 
 
 , Modes of Preparation 176, 311 
 
 of Flesh 178 
 
 of Sweets 198 
 
 Foot 63 
 
 Fore-arm 60 
 
 Founders 361 
 
 Fowl 181. 330 
 
 Foxglove 448 
 
 , Powder of 619 
 
 Fractures 413 
 
 Fracture of Arm-Bone 419 
 
 of Bones of Fore-arm 420 
 
 of Bones of Leg. 415 
 
 of Collar-bone 417 
 
 of Fingers 421 
 
 of Ribs 418 
 
 of Thigh-Bone 414 
 
 Freckles and Sunburns 825 
 
 French Brandy, etc., Mixture of . . . 987 
 
 French Wine 323 
 
 Frying 177,311 
 
 Functions of Brain 97 
 
 
INDEX, 
 
 1053 
 
 PAGE 
 
 Functions of Sympathetic Nerve. . . 101 
 
 Fumigating Pastils 1017 
 
 Fumigation of Sick-rooms 304 
 
 G. 
 
 Galbanum Plaster 1006 
 
 Galls, &c, Ointment of 1007 
 
 Galvanization 619 
 
 Gamboge 619 
 
 Gangrene of the Mouth 721 
 
 Gargles 1003 
 
 Garlic 198 
 
 Geese 181 
 
 Gelsemin 620 
 
 General Electrization 620 
 
 Management of Infants 952 
 
 Remarks on Headache. . . . 642 
 
 Gentian 621 
 
 , Compound Infusion of . . . . 997 
 
 Ginger Beer 1014 
 
 Lozenges 1017 
 
 Snake-Root, Infusion of . . . . 997 
 
 Glands 127 
 
 Glass-blowers 360 
 
 Glauber's Salts 621 
 
 Gleet 623, 626 
 
 Glossary .1042 
 
 Glottis. Spasm of 563 
 
 Gloucester Jelly 329 
 
 Glycerine 627 
 
 Cream 1010 
 
 Ointment. 1007 
 
 and Borax, Lotion of. . .1010 
 
 Goat's Milk 188 
 
 , Artificial 323 
 
 Gonorrhoea 621 
 
 , Cleanliness in 622 
 
 , Testicles in 622 
 
 Gooseberry 200 
 
 Gorillas 159 
 
 Goulard Water 689 
 
 Gout 620,627 
 
 , Acute 627 
 
 . Irregular, or Chronic 629 
 
 , Prevention of 631 
 
 , Retrocedent 630 
 
 , Rheumatic 790 
 
 , Use of Champagne in 631 
 
 Gravel 679 
 
 and Stone 854 
 
 Green Sickness 705, 736 
 
 Vitriol. &c. , Mixture of 998 
 
 Grit Gruel... 314 
 
 Grocers 357 
 
 Ground Rice 316 
 
 Gruel, Oatmeal 314 
 
 Guaiac 632 
 
 Gum Ammoniac 633 
 
 Arabic 633 
 
 Ammoniac, &c, Mixture of. . 981 
 
 | Myrrh, &c. , Pills of 983 
 
 Gum Boil 633 
 
 Gymnastics 723 
 
 H. 
 
 PAGE 
 
 Haddock 184 
 
 Hair 157 
 
 , Abnormal Growth of. 639 
 
 and Scalp, Diseases of 635 
 
 , Color of 635 
 
 Dyes 638 
 
 Oil 1016 
 
 Restorers 639 
 
 , Structure of 634 
 
 Hammer and Pleximeter 758 
 
 Hand 61 
 
 Bath 286 
 
 Hanging 440 
 
 Hare 180 
 
 Hashish 215 
 
 Hay Fever 640 
 
 Headache, General Remarks on 642 
 
 , Sick 736 
 
 Head, Bandages for 412 
 
 , Examination of 95 
 
 , Muscles of 69 
 
 Health 167 
 
 of the Brain 89 
 
 , Effects of Anthracite Coal on 255 
 
 , Influence of Occupations on 332 
 
 Hearing 107 
 
 Heart 122 
 
 Heartburn 940 
 
 or Water-Brash 650 
 
 Heart, Diseases of 646 
 
 , General Remarks on Dis- 
 eases of 646 
 
 , Inflammation of 648 
 
 , Malformation of, in Infancy. 956 
 
 , Nervous Disease of 649 
 
 , Palpitation of 647 
 
 Hectic Fever 651 
 
 Hellebore 448 
 
 Hemlock 448, 652 
 
 Hemorrhage from Wounds 441 
 
 Hemp 215 
 
 Henbane 448. 652 
 
 , &c. , Draught of Wr 989 
 
 , Infusion of 979 
 
 Herbs, Infusion of 973 
 
 Hereditary Genius 386 
 
 Descent, Laws of 383 
 
 Hiccup 653 
 
 Hip Disease 653 
 
 Hive Syrup 971 
 
 Hoffman's Anodyne 654 
 
 , &c, Mixture of 992 
 
 Homicidal Mania 672 
 
 Homoeopathists 395 
 
 Honey 199 
 
 Hooping-cough 654 
 
 Hope's Mixture 655, 1002 
 
 Hops 699 
 
 Hop Pillows 224 
 
 Horse-radish 655 
 
 , Juniper, &c, Mixture 
 
 of 976 
 
1054 
 
 INDEX. 
 
 PAGE 
 
 Horsf ord's Process of Bread-making 192 
 
 Hot- water Bags and Ice-bags 666 
 
 Houses, Location of 266 
 
 J low to purify Water 206 
 
 Humid or Running Tetter 881 
 
 Huxham's Tincture of Bark 998 
 
 Hydropathy 911 
 
 Hydropathists 395 
 
 Hydrophobia 656, 736 
 
 Hygiene 167 
 
 Hypochondria 659, 735 
 
 Hypodermic Injections 661 
 
 Hypophosphites of Lime and Soda, 
 
 Syrup of 873 
 
 Hysteria 662, 735 
 
 Hysterics 662, 735 
 
 , Causes of 664 
 
 Ice-bags and Hot-water Bags. 666 
 
 Iceland Moss Jelly 314 
 
 Iliac Passion 667 
 
 , Cause of 667 
 
 Impotence 820 
 
 Incontinence of Urine 899 
 
 in Infancy.. 956 
 
 Indolent Ulcer 896 
 
 Indurated Chancre 867 
 
 Indian Clubs 724 
 
 Corn 190 
 
 Tobacco 695 
 
 Hemp 668 
 
 Infancy and Childhood, Diseases of. 955 
 
 , Bronchitis in 959 
 
 , Catarrh in 958 
 
 , Cholera in 539 
 
 , Colic in 548 
 
 , Croup in 959 
 
 , Diarrhoea in 958 
 
 , Diet in 960 
 
 , Earache in 956 
 
 Eruptions during 957 
 
 -, General Management in . . . 952 
 
 — , Incontinence of Urine in. . 956 
 
 , Inflammation of Eyes in. . . 957 
 
 , Lockjaw in 880 
 
 , Management in Early 950 
 
 , Paralysis in 748 
 
 , Purging in 958 
 
 , Tongue-tie and Hare -lip in. 956 
 
 , Whooping-cough in 958 
 
 , Worms in 958 
 
 Infantile Bronchitis 959 
 
 Catarrh 958 
 
 Cholera-. 539 
 
 Croup 959 
 
 Diarrhoea 958 
 
 Diet 960 
 
 Paralysis 748 
 
 Purging 958 
 
 Whooping-cough 958 
 
 Infants' Colic 548 
 
 PAGE 
 
 Infants, Lockjaw of 880 
 
 , General Management of 952 
 
 , Management of New-born.. 950 
 
 , Tongue-tie and Hare -lip of. 956 
 
 Inferior Extremities, Muscles of 75 
 
 Inflamed Chancre 868 
 
 Inflammation of the Bladder 487 
 
 of Bowels 491 
 
 of Brain 494 
 
 of Eyes in Infancy. . . 957 
 
 of Mouth 720 
 
 of Stomach 852 
 
 Influenza 669 
 
 Infusions, Decoctions, and Mixtures 968 
 
 Infusion of Roses 796 
 
 of Wild-cherry, Mixture of. 982 
 
 Ingrowing of Inverted Toe-nail 883 
 
 Inhalations 670 
 
 Injections 661 
 
 for Urethra 1004 
 
 , Subcutaneous 661 
 
 Insanity 672, 736 
 
 , Condition of Brain in 89 
 
 Integuments of the Body 153 
 
 Intermarriage of Relations 388 
 
 Intestines 139 
 
 . Completion of Digestion 
 
 in 145 
 
 Iodide of Lithia 691 
 
 of Arsenic, Ointment of 1007 
 
 of Potassium, Mixture of . . . . 999 
 
 and Sarsaparil- 
 
 la, Mixture of 1000 
 
 of Sulphur, Ointment of 1007 
 
 of Potash 671 
 
 Iodine 671 
 
 and Collodion .1007 
 
 , Ointment of 1009 
 
 Ipecacuanha 674 
 
 and Opium, Powder of 975 
 
 , Powder of 971 
 
 Wine, &c. Mixture of. 980 
 
 Irish Moss Mucilage 315 
 
 Iritis 612 
 
 Iron • 674 
 
 and Aloes, Pills of. 999 
 
 , Phosphate of 753 
 
 Plaster. 1006 
 
 , Preparations of. 993 
 
 , Pyrophosphate of 753 
 
 , Tincture of 998 
 
 Irrigating of Wounds 412 
 
 Irritable Chancre 868 
 
 Ulcer 898 
 
 Itch 676, 825 
 
 Ointment 1009 
 
 Jalap 676 
 
 James' Powder 676 
 
 Jaundice 676 
 
 Jaw-bone, Dislocation of 426 
 
INDEX, 
 
 1055 
 
 PAGE 
 
 Jaw, Lower 48 
 
 , Setting of 426 
 
 Jelly of Hartshorn 316 
 
 of Iceland Moss 314 
 
 Jerusalem Artichoke 198 
 
 Jewellers 362 
 
 Juniper Berries and Cider, Infusion 
 
 of 977 
 
 Juniper Berries, Infusion of 977 
 
 Kidneys 147 
 
 , Bright's Disease of 680 
 
 , Diseases of 679 
 
 Kleptomania 672 
 
 Kneaders 395 
 
 Knife-grinders 362 
 
 Koumiss 227 
 
 Kousso, Infusion of 984 
 
 Kreasote 682 
 
 L. 
 
 Labor 945 
 
 , Symptoms of 942 
 
 Laborers 367 
 
 Lamb 182 
 
 Lamp for Laryngoscope 687 
 
 Laryngitis, or Inflammation of the 
 
 Larynx 682 
 
 Laryngoscope 686 
 
 Laryngoscope, Lamp for 687 
 
 Larynx 113 
 
 , Cancer of 686 
 
 , Diseases of 686 
 
 , Tumor of 686 
 
 Late Hours, Effects of 940 
 
 Laudanum 448 
 
 Laughing-G-as 688 
 
 Laurel-water 448 
 
 Lavender-water 1015 
 
 Laws of Hereditary Descent 383 
 
 Lawyers 347 
 
 Lead 689 
 
 , Acetate of 718 
 
 and Opium Wash 690 
 
 Pills of 1002 
 
 Pipes 206 
 
 Plaster 1006 
 
 , Sugar of 638 
 
 Leaping, Movements of 79 
 
 Leech-bites 403 
 
 Leeches 453 
 
 Leek 198 
 
 Leg 62 
 
 , Bandaging 410, 411 
 
 Lemon-peel Tea 320 
 
 Leptandrin 690 
 
 Litharge Plaster 1006 
 
 Lettuce 197, 990 
 
 PAGE 
 
 Lettuce, Tincture of, Mixture of. . . 990 
 
 , Pills of 990 
 
 Leucorrhcea, or Whites 915 
 
 Lice 690 
 
 Liebig's Beef -tea 317 
 
 Life 167 
 
 , Physical Basis of 392 
 
 , What is it? 391 
 
 Lifting Cure 730 
 
 Ligaments 44 
 
 Lightning 442 
 
 Lignum-Vitas 632 
 
 Lime 690, 995 
 
 , Chloride of 691 
 
 Lime-water. 690 
 
 Liniments 1009 
 
 Lip-salve 1015 
 
 Liquorice, &c, Mixture of 981 
 
 List of Hlustrations 29 
 
 Lithia 691 
 
 Liver 140 
 
 , Acute Inflammation of. 691 
 
 Complaints 691 
 
 , Chronic Inflammation of ... . 692 
 
 , Torpor of 695 
 
 Lobelia, or Indian Tobacco 695 
 
 Location of Houses 266 
 
 Localized Electrization 695 
 
 Locked-jaw, or Tetanus 736, 878 
 
 Lockjaw of Infants 880 
 
 Locomotor Ataxy 695 
 
 Logwood, Decoction of 1001 
 
 Longevity of Animals 374, 379 
 
 , Influence of Occupation 
 
 on 332 
 
 of Plants 379 
 
 of Trees 379 
 
 of Woman 371 
 
 -. , Portrait of Man destined 
 
 to 373 
 
 , Tabular Statement of . . . . 333 
 
 Loss of Blood, Effects of 121 
 
 of Voice 688 
 
 Lotions 1009 
 
 Lousiness 690 
 
 Lower Jaw 48 
 
 Lower Limbs, Paralysis of 748 
 
 Low Spirits 659 
 
 Lozenges 1017 
 
 Lunar Caustic 696,869, 896 
 
 Lunches 207 
 
 Lungs 132 
 
 , Hemorrhage of 843 
 
 , Inflammation of 696 
 
 Lupus 826 
 
 Lying-in Chamber 943 
 
 M. 
 
 Macaroni Pudding 327 
 
 Soup 328 
 
 Macassar Oil , 1016 
 
 Machinists 363 
 
1056 
 
 INDEX. 
 
 PAQE 
 
 Magnesia 699 
 
 Magnesia, Rhubarb, &c, Mixture 
 
 of 964 
 
 Magnesia, Sulphate of, or Epsom 
 
 Salts 606 
 
 Malformation of the Heart in In- 
 fants 956 
 
 Malignant Pustule 779 
 
 Small-pox 830 
 
 Man 158 
 
 Mandrake 758 
 
 Management of New-born Infants. . 950 
 
 of Sick-rooms 299 
 
 Manna 700 
 
 Marrow 43 
 
 Marsh-mallow Tea 321 
 
 Mashed Carrots 328 
 
 Turnips 328 
 
 Masturbation 818 
 
 Matter and Mind 88 
 
 May-apple 758 
 
 Meadow-saffron 448, 542, 631 
 
 Meals 206 
 
 Means of arresting Flow of Blood. . . 400 
 
 Measles 700 
 
 Mechanism and Attachment of Mus- 
 cles . 77 
 Medicated Baths. ...... '. '. '. . '. '. '. '. '.. 1011 
 
 Medicine, Schools of 394 
 
 , Thermometer in 882 
 
 Medicines, valuable List of 1019 
 
 Medicinal Waters 914 
 
 Medulla Oblongata 98 
 
 Melon 200 
 
 Membrane and Fat of, Cellular 154 
 
 Men of Science 352 
 
 Menses, Cessation of 711, 938 
 
 , in Pregnancy 936 
 
 Menstruation 703 
 
 , Excessive 710 
 
 , Painful 709 
 
 , Suppression of 707 
 
 Merchants 349 
 
 Mercurial Ointment 712 
 
 Mercury 447, 712 
 
 with Chalk 712 
 
 Mesmerizers 395 
 
 Metallic Poisons 447 
 
 Methods of Electrization 600 
 
 , Ventilation 258 
 
 Methomania or Dipsomania. . ., 574 
 
 Microscope 713 
 
 , Use of in Bright's Dis- 
 ease 681,713 
 
 Microscopic View of the Brain 89 
 
 Mild Small-Pox 828 
 
 Milk 187 
 
 Abscess 714 
 
 Milk Beer 227 
 
 Fever 715 
 
 of Asses 188 
 
 of Cows 187 
 
 of Goats 188 
 
 Milk-punch 987 
 
 PAGE 
 
 Millers 357 
 
 Millet Beer 227 
 
 Mind and Matter 88 
 
 Mindererus' Spirit 715 
 
 Mineral Waters 914- 
 
 Miners 364 
 
 Mint, Camphor, &c., Infusion of . .. 986 
 
 Miscarriage and Abortion 715 
 
 Miscellaneous Receipts 1013 
 
 Mixtures... 961, 986, 989, 991, 996, 1000 
 
 , Infusions, Decoctions, &c. 963 
 
 Moles 826 
 
 Monkshood 448, 465 
 
 Monomania 672 
 
 Monsel's Solution 718 
 
 Monthly Discharge, Cessation of. 711, 938 
 
 Moonlight 276 
 
 Morning Sickness in Pregnancy. . . . 937 
 
 Morphia, Pills of 990 
 
 Mortality, Comparison of 335 
 
 Mortification 718 
 
 Motion 86 
 
 , Muscular 77 
 
 Mouth, Canker of 721 
 
 , Gangrene of 721 
 
 , Inflammation of 720 
 
 Movement Cure 721 
 
 , Exercises of 723 
 
 Movements of Walking, Running, 
 
 and Leaping 79 
 
 Mucilage, Arrow-root 326 
 
 of Irish Moss 315 
 
 of Rice 315 
 
 of Sago 312 
 
 of Salep 313 
 
 of Tapioca 313 
 
 Mulberries 200 
 
 Mulled Wine 318, 332 
 
 Mumps 731 
 
 Muriate of Ammonia 798 
 
 Muriatic Acid 731 
 
 Gargle of. 1004 
 
 Muscles within Body 72 
 
 , Description of 68 
 
 , Mechanism and Attach- 
 ment of 77 
 
 of Head 69 
 
 of Inferior Extremities 75 
 
 of the Neck 71 
 
 of Superior Extremities. . . 74 
 
 of Trunk. 71 
 
 , Worms in 927 
 
 Muscular Affections of the Eyes 613 
 
 Motion 77 
 
 Mushrooms 449 
 
 Musicians 350 
 
 Musk 732 
 
 Mussels 183, 450 
 
 Mustard 971 
 
 Poultice 1012 
 
 Whey 323 
 
 Mutton 179 
 
 Broth 330 
 
 Tea 318 
 
INDEX. 
 
 1057 
 
 N. 
 
 PAGE 
 
 Nail 157 
 
 Narcotics 988, 989 
 
 Narcotics and Stimulants. .211, 988, 989 
 
 , False Reasoning concern- 
 
 ' ing 244 
 
 Nasal Douche 732 
 
 Nasal Passage, Injection for 969 
 
 Navel, State of, in Pregnancy 936 
 
 Neck, Dislocation of 427 
 
 , Muscles of. 71 
 
 Nectarine 200 
 
 Nerves 82 
 
 of Spine 85 
 
 Nerve, Sympathetic 100 
 
 "Nervines 988, 989 
 
 Nervous Centres, Reflex Action of.. 98 
 
 Diseases 732 
 
 Diseases, General Treat- 
 ment of 737 
 
 Diseases of the Heart 649 
 
 Exhaustion 740 
 
 Headache 645 
 
 Influence, Effects of 80 
 
 Nettle Rash 738 
 
 Neuralgia 734, 738 
 
 of Face 883 
 
 , Treatment of 740 
 
 , Various Forms of 739 
 
 Neurasthenia, or Nervous Exhaus- 
 tion 740 
 
 New School of Medicine 395 
 
 New York Brandy 243 
 
 Night Air 257 
 
 Nipples 743 
 
 , Sore 743, 948 
 
 , Swelling of in Pregnancy. . 937 
 
 Nitrate of Potash, &c. , Mixture of. 977 
 
 of Silver 624, 638 
 
 of Silver, Crystals of 743 
 
 Nitre 743 
 
 , Ammonia, &c. , Mixture of . . 973 
 
 , Lozenges of 1017 
 
 , Sweet Spirit of 243, 866 
 
 Nitric Acid 744 
 
 , Injections of. . ... .968, 969 
 
 Nitro-Muriatic Acid 731 
 
 Bath 1012 
 
 Nitrous Oxide Gas 688 
 
 Nose-Bleed 489 
 
 Nose, Catarrh of 520, 640 
 
 Nurses 307 
 
 Nux Vomica (Strychnine) 448, 744 
 
 O. 
 
 Oak Bark, Gargle of 1004 
 
 Oatmeal Gruel 314 
 
 Porridge 326 
 
 Oats 193 
 
 Obesity - , 557 
 
 Occupations 336 
 
 , Lifluence of on Health 332 
 
 67 
 
 Occupations, Influence of on Lon- 
 gevity 332 
 
 ffinanthic Ether 243 
 
 OH, Cod-Liver 189, 542, 682 
 
 , Food containing 186 
 
 of Cognac 243 
 
 of Juniper, &c, Mixture of 978 
 
 of Turpentine 978 
 
 , Olive 187, 964 
 
 , Volatile 243 
 
 Ointments 1006 
 
 Ointment, Citrine 542 
 
 , Mercurial 712 
 
 Old School. 395 
 
 Laws concerning Stimu- 
 lants 249 
 
 Olive Oil 187, 964 
 
 Onion 198 
 
 Operatives. 365 
 
 Operators on Sewing Machines 370 
 
 Ophthalmoscope and Otoscope 745 
 
 Opium 215, 448, 680, 745 
 
 and Camphor, Plaster of 989 
 
 and Lead, Wash of 690 
 
 Liniment 1011 
 
 , Pills of 1002 
 
 Plaster 1006 
 
 Organs of Digestion. 138 
 
 of Respiration 131 
 
 Orgeat 320 
 
 Origin of Species 165 
 
 Otoscope and Ophthalmoscope 745 
 
 Oxalate of Cerium 645, 650, 746 
 
 Oxalic Acid 446 
 
 Oxide of Bismuth, Pills of 999 
 
 of Zinc, Ointment of 1008 
 
 Oxygen 747 
 
 Oysters 183 
 
 P. 
 
 Painful Menstruation 709 
 
 Painters 365 
 
 ' Colic 546 
 
 Palm Wine 226 
 
 Palpitation of the Heart 647 
 
 Palsy 748 
 
 Pancreas 142 
 
 Pancreatic Juice 145 
 
 Paralysis 734, 747 
 
 , Infantile 748 
 
 of the Lower Limbs 746 
 
 , Treatment of 749 
 
 Paregoric and Ipecac Wine, Mixture 
 
 of 980 
 
 , Elixir 750 
 
 Partial List of Authorities consult- 
 ed, quoted, and referred to 25 
 
 Pastry 192 
 
 Peaches 200 
 
 Pearl Powder 1015 
 
 Pears 200 
 
 Peas 105 
 
 Pelvis 55 
 
1058 
 
 INDEX 
 
 PAGE 
 
 Pepsin 750 
 
 , Elixir of 995 
 
 Percussion 750 
 
 Periosteum 43 
 
 Permanent Stricture of the Urethra 859 
 
 Permanganate of Potash 751 
 
 , Injections 
 
 of 969 
 
 , Lotion of 1010 
 
 Perspiration 156, 290 
 
 Peruvian Bark 751 
 
 in Wine, Mixture of. 998 
 
 Pessaries 752 
 
 Petroleum 753, 926 
 
 , Camphor, &c, Liniment 
 
 of 1011 
 
 Philosophers 352 
 
 Philosophy of the Treatment of 
 
 Drowning 438' 
 
 Phlegmonous Erysipelas 608 
 
 Phosphate of Iron 753 
 
 Phosphoric Acid 753 
 
 Phosphorus 753 
 
 , Emulsion of 996 
 
 in Fish 186 
 
 Phrenology 95 
 
 Physical Basis of Life: 392 
 
 Physicians 347 
 
 Piles 754 
 
 , Ointment for 1008 
 
 Pillows of Hops 224 
 
 Pill, Plummer's 712 
 
 Pills 965, 990, 992, 999,1002 
 
 Pilots 368 
 
 Pimples or Acne 826 
 
 Pink-root and Senna, Infusion of. . . 963 
 
 , Infusion of 985 
 
 Pipsissewa, Decoction of 979 
 
 , Infusion of 974 
 
 Pitch and Sulphur, Ointment of. . .1008 
 
 Plants, Longevity of 379 
 
 , Sleep of 281 
 
 Plasters '. 756, 1005 
 
 Pleurisy 756 
 
 , False 758 
 
 , Root, Infusion of 974 
 
 Pleurodynia, or False Pleurisy 758 
 
 Pleximeter and Hammer 758 
 
 Plumbers 365 
 
 Plummer's Pill 712 
 
 Podophyllin 758 
 
 Poets 352 
 
 Poisoning 444 
 
 Poisonous Wounds 759 
 
 Poisons, the Metallic 447 
 
 Politzer's Ear Inflator 760 
 
 Pomegranate, Decoction of 984 
 
 Pores, Estimate of Number of 635 
 
 Pork 179 
 
 Portraiture of a Man destined to 
 
 Longevity 373 
 
 Port Wine 242 
 
 Potatoes 194 
 
 Potato, Sweet 190 
 
 PAGE 
 
 Potash 446, 995 
 
 , Carbonate of 763 
 
 , Chlorate of 530, 969 
 
 , Permanganate of 751 
 
 Potassium, Bromide of 496, 645 
 
 Potters 369 
 
 Poultices 763,1012 
 
 Powders 967 
 
 Powder for Cold 544 
 
 to remove Hair 1015 
 
 Preface 3 
 
 Pregnancy 150, 936 
 
 , Ceasing to be Unwell in 936 
 
 , Diet, Exercise, and 
 
 Dress in 939 
 
 , Diseases of 940 
 
 , Duration of 938 
 
 , Enlargement of Abdo- 
 men in 937 
 
 . , of Breasts 
 
 in 937 
 
 , Morning Sickness in. . . 937 
 
 , Quickening in 937 
 
 , Signs and Symptoms of 936 
 
 , State of Navel in 936 
 
 , Swelling of Nipple in. . 937 
 
 Preparation of Food 176 
 
 COMPLETE LIST OF PRESCRIPTIONS. 
 A. 
 
 Acetate of Ammonia, Mixture of. . . 977 
 
 Adhesive Plaster 1006 
 
 Alkaline Bath 1012 
 
 Aloes, Injection of 985 
 
 Alum, Gargle of 1003 
 
 , Wash of 1004 
 
 Ammonia, etc 986 
 
 Angustura Bark, Infusion of 1001 
 
 Aniseed Cordial 1013 
 
 Anodynes 988 
 
 Anodyne Fomentation 1011 
 
 Plasters 989 
 
 Anthelmintics 984 
 
 Antispasmodics 991 
 
 Aperients and Cathartics 961 
 
 Arnica, etc. , Draught of 986 
 
 Arsenic and Iron, Mixture of 995 
 
 Assaf oetida, etc. , Mixture of 992 
 
 , etc., Pills of. . . , 992 
 
 Astringents 1000 
 
 Avens, Decoctions of. 1001 
 
 B. 
 
 Balm-Tea 988 
 
 Balsam of Copaiva, Mixture of 978 
 
 Bearberry, Decoction of 977, 1002 
 
 Belladonna Plaster 989 
 
 Be 1013 
 
 Bi. es 1017 
 
 Bi etc., Mixture of . . . 982 
 BL onf ection of 987 
 
INDEX 
 
 1059 
 
 PAGE 
 
 Blessed Thistle, Infusion of 974 
 
 Blood- Root, Tincture of 981 
 
 Boneset or Thoroughwort, Infusion 
 
 of 997 
 
 Borax, Gargle of 1003 
 
 Bran, Decoction of 982 
 
 Brandy, Gargle of 1003 
 
 Bromide of Potassium, Ointment of, 1007 
 
 C. 
 
 Calumbo, Ether, etc., Mixture of. . . 979 
 
 Camphor, Pills of 990 
 
 Caraway Cordial 1013 
 
 Carbolic Acid and Glycerine, Injec- 
 tion of 1004 
 
 , Douche of 969 
 
 , Injection of 969 
 
 , Lotion of 1010 
 
 , Ointment of 1007 
 
 Carbonate of Ammonia, Mixture of. 973 
 
 and Lemon 
 
 Juice, Draught of. 973 
 
 Carbonate of Potash and Lemon 
 
 Juice, Draught of 974 
 
 Carron Oil and Carbolic Acid, Lo- 
 tion of 1009 
 
 Cascarilla, etc. , Draught of 1001 
 
 Castor Oil, Molasses, and Salt, In- 
 jection of 968 
 
 Castor Oil, Mixture of 963 
 
 Caswell, Hazard & Co.'s Ferrophos- 
 
 phated Mixture 993 
 
 Cathartics and Aperients 961 
 
 Chalk Mixture, etc 1000 
 
 Chapped Hands, etc., White Lini- 
 ment for 1016 
 
 Charcoal Poultice 1012 
 
 Cherry Bark, Infusion of 982 
 
 Chilblain Lotion 1018 
 
 Child, Injection for 968 
 
 Chlorate of Potash, Douche of 969 
 
 , Gargle of 1003 
 
 , Injection of. . . .1005 
 
 Chloride of Soda, Gargle of 1003 
 
 Cinchona- Valerian, Mixture of 994 
 
 Cinnamon Cordial. . . . .1013 
 
 Citron Cordial 1013 
 
 Colchicum and Epsom Salts 964 
 
 Cold Cream 1016 
 
 Cologne Water 1014 
 
 Columba, Ginger, etc., Infusion of. 997 
 
 Common Salt, Douche of 968 
 
 Compound Chloroform Liniment. . .1010 
 
 Corns 1018 
 
 Cow-itch and Honey 985 
 
 Coxe's Hive Syrup 981 
 
 Cream of Tartar 964 
 
 , Solution of. 978 
 
 Creosote, Lotion of 1010 
 
 Croton Oil, Pills of 966 
 
 D. 
 
 Dandelion Pills. 
 
 PAGE 
 
 Dandelion, etc. , Infusion of 998 
 
 Decoctions, Infusions, Mixtures, etc. 963 
 
 Diaphoretics 972 
 
 Digitalis, Acetate of Potash, etc., 
 
 Mixture of 976 
 
 Diuretics 975 
 
 Dog- wood Bark, Decoction of 996 
 
 Douches 968 
 
 Drinks 1013 
 
 Effervescing Draughts 975 
 
 Egg-Nog 987 
 
 Elaterium Pills 966 
 
 Emetics 969 
 
 Emollient Bath 1011 
 
 Enemata 967 
 
 Expectorants 979 
 
 Eye-washes 1004 
 
 Flax-seed, Infusion of 982 
 
 , Poultice of 1012 
 
 Fomentations 1011 
 
 French Brandy, etc., Mixture of . . . 987 
 Fumigating Pastils 1017 
 
 G. 
 
 Galbanum Plaster 1006 
 
 Galls, etc. , Ointment of 1007 
 
 Gargles 1003 
 
 Gentian, Compound Infusion of . . . . 997 
 
 Ginger Snake-Root, Infusion of 997 
 
 Beer .' 1014 
 
 Lozenges 1017 
 
 Glycerine and Borax, Lotion of 1010 
 
 — Cream 1010 
 
 Ointment 1007 
 
 Green Vitriol, etc., Mixture of 998 
 
 Gum Ammoniac, etc., Mixture of . . 981 
 , Myrrh, etc. , Pills of 983 
 
 H. 
 
 Hair Oil 1016 
 
 , Stimulant for 1015 
 
 Henbane, Draught of 989 
 
 , Infusion of 979 
 
 Herbs, Infusion of 973 
 
 Hive Syrup 971 
 
 Hoffman's Anodyne, etc. , Mixture of. 992 
 
 Hope's Mixture 1002 
 
 Horseradish, Juniper, etc., Mixture 
 
 of 976 
 
 Huxham's Tincture of Bark 998 
 
1060 
 
 INDEX. 
 
 I. 
 
 PAGE 
 
 Infusions, Decoctions, Mixtures, etc . 963 
 Infusion of Wild-cherry, Mixture of. 982 
 
 Injections for Urethra 1004 
 
 Iodide of Arsenic, Ointment of 1007 
 
 Potassium, Mixture of 999 
 
 , and Sarsaparil- 
 
 la, Mixture of 1000 
 
 Sulphur, Ointment of ... .1007 
 
 Iodine and Collodion, Ointment of. . 1009 
 Ipecacuanha and Opium, Powder of. 975 
 
 , Powder of 971 
 
 Wine, etc., Mixture of. 980 
 
 Iron and Aloes, Pills of 999 
 
 Iron Plaster 1006 
 
 , Preparation of 993 
 
 , Tincture of : 998 
 
 Itch Ointment 1009 
 
 J. 
 
 Juniper Berries and Cider, Infusion 
 
 of 977 
 
 Juniper Berries, Infusion of 977 
 
 Kuosso, Infusion of 984 
 
 Lavender Water 1015 
 
 Lead, Pills of 1002 
 
 Plaster 1006 
 
 Lettuce, Pills of 990 
 
 , Tincture of, Mixture of. . . 990 
 
 Lime, Syrup of Hypophosphite of. . 995 
 
 Liniments 1009 
 
 Lip Salve 1015 
 
 Liquorice, etc. , Mixture of 981 
 
 Litharge Plaster 1006 
 
 Logwood, Decoction of 1001 
 
 Lotions 1009 
 
 Lozenges 1017 
 
 Macassar Oil 1016 
 
 Magnesia. Rhubarb, etc. , Mixture of. 964 
 
 Medicated Baths 1011 
 
 Milk Punch 987 
 
 Mint, Camphor, etc., Infusion of , . . 986 
 
 Miscellaneous Receipts 1013 
 
 Mixtures. . .961, 986, 989, 991, 996, 1000 
 
 Morphine, Pills of 990 
 
 Muriatic Acid, G-argle of , 1004 
 
 Mustard 971 
 
 Poultice 1012 
 
 N. 
 
 PAGE 
 
 Narcotics 988, 989 
 
 Nasal Passages, Injection for 969 
 
 Nervines 988, 989 
 
 Nitrate of Potash, etc., Mixture of. 977 
 Nitre, Ammonia, etc., Mixture of. . 973 
 
 , Lozenges of 1017 
 
 Nitric Acid, Injections of 968, 969 
 
 Nitro-Muriatic Bath 1012 
 
 O. 
 
 Oak-bark, Gargle of .1004 
 
 , Decoction of 1002 
 
 Oil of Juniper, etc., Mixture of 978 
 
 Turpentine, etc. , Mixture of. . 978 
 
 Ointments 1006 
 
 Olive OH 964 
 
 Opium and Camphor, Plaster of . . . . 989 
 
 Liniment 1011 
 
 , Pills of 1002 
 
 Plaster 1006 
 
 Oxide of Bismuth, Pills of 999 
 
 Zinc, Ointment of 1008 
 
 P. 
 
 Paregoric and Ipecac Wine, Mixture 
 
 of. 980 
 
 Pearl Powder 1015 
 
 Pepsin, Elixir of 995 
 
 Perfumery, etc 1014 
 
 Permanganate of Potash, Injections 
 
 of 969 
 
 Permanganate of Potash, Lotion of .1010 
 Peruvian Bark in Wine, Mixture of. 998 
 Petroleum, Camphor, etc., Lini- 
 ment of 1011 
 
 Phosphorus, Emulsion of 996 
 
 PiUs 965, 990, 992 
 
 Pink Root, etc. , Infusion of 985 
 
 and Senna, Infusion of. 963 
 
 Pipsissewa, Decoction of 979 
 
 , Infusion of 974 
 
 Pitch and Sulphur, Ointment of. . . .1008 
 
 Plasters 1005 
 
 Pleurisy Root, Infusion of 974 
 
 Pomegranate, Decoction of 984 
 
 Potash, Chlorate of 969 
 
 Poultices 1012 
 
 Powders 967,971, 975 
 
 Powder to remove Hair 1015 
 
 Prunes, Decoction of 965 
 
 Pumpkin Seed, Emulsion of ...... . 984 
 
 Pyrophosphate of Iron, Mixture of. 993 
 
 Q. 
 
 Quinine. 
 
 Sulphate of, in Syrup. ... 995 
 
INDEX. 
 
 1061 
 
 R. 
 
 PAGE 
 
 Resin, Cerate of 1009 
 
 Rhatany, Infusion of 1001 
 
 Rhubarb and Aloes, Fills of 965 
 
 and Iron, Pills of. 966, 969 
 
 and Magnesia, Powder of. . 967 
 
 Lozenges 1018 
 
 Pill 966 
 
 Rose Water 1015 
 
 Roses, Milk of 1016 
 
 S. 
 
 Sage and Flax-seed, Gargle of 1003 
 
 Sage-Tea, Alum, and Honey, G-argle 
 
 of 1003 
 
 Savin, Cerate of 1009 
 
 Seidlitz Powders 967 
 
 Seneca Snake-Root, etc. , Mixture of. 980 
 Senna and Epsoni Salts, Injection of. 967 
 
 , Confection of 965 
 
 . Salts, etc. , Infusion of 963 
 
 Syrup .1014 
 
 Slippery Elm Poultice 1012 
 
 Soap, Fomentation of 1011 
 
 Liniment 1011 
 
 Plaster .1006 
 
 Soda 995 
 
 Soporifics 988 
 
 Squills, etc. , Mixture of 976 
 
 Stavesacre, Ointment of 1008 
 
 Stimulants 986 
 
 Strengthening Plaster 1006 
 
 Strychnine 993 
 
 Sugar, Pills of 1002 
 
 of Lead, Ointment of 1008 
 
 , Wash of 1004 
 
 Sulphur and Cream of Tartar, Pow- 
 der of 967 
 
 Sulphate of Copper, Injection of . . . 1005 
 
 of , Powder of. 971 
 
 of Ether, etc. , Mixture of. 986 
 
 of Morphia, etc., Draught 
 
 of 990 
 
 of Potash, etc. , Powder of 967 
 
 of Quinine, etc., Mixture 
 
 of 996 
 
 of Soda, Lotion of 1010 
 
 of Zinc, Injection of 995 
 
 of , Powder of 972 
 
 Syrup of Rhubarb and Soda 964 
 
 of Squills, etc.. Mixture of... 980 
 
 T. 
 
 Table Salt, Injection of 968 
 
 , Solution of 971 
 
 Tannin and Glycerine. Lotion of . . . 1010 
 
 Opium, Pills of 1003 
 
 Tar, etc. , Ointment of 1008 
 
 PAGE 
 
 Tartrate of Potash and Manna, Mix- 
 ture of 963 
 
 Tar- Water 982 
 
 Thorn- Apple, Ointment of 1008 
 
 Tonics 992, 993 
 
 Tooth Powder 1016 
 
 Turpentine and Castor Oil, Mixture 
 
 of 964 
 
 Turpentine, Mixture of 984 
 
 U. 
 
 Urethra, Injection for 1004 
 
 V. 
 
 Valerian and Ammonia, Draught of. 987 
 
 , etc. , Draught of 991 
 
 , Ether, etc. , Mixture of . . . 991 
 
 Veratria, Ointment of 1007 
 
 Vinegar, G-argle of 1004 
 
 Virginia Snake-root, Infusion of . 975, 987 
 
 W. 
 
 Wild-cherry Bark, Infusion of 998 
 
 Willow Bark, Decoction of 996 
 
 Wine-Whey 988 
 
 Wood-Soap, Tincture of 991 
 
 Worm-Seed OH, Mixture of 985 
 
 Yeast Poultice 1012 
 
 Z. 
 
 Zinc. 999 
 
 Prevention of Diseases of the Spine. 837 
 
 Prevention of Gout 631 
 
 of Sea-sickness 816 
 
 Printers 363 
 
 Prunes 199 
 
 Prunes, Decoction of 965 
 
 Prussic Acid 448, 763 
 
 Pruritus or Itching 825 
 
 Pudding, Macaroni 327 
 
 Puerperal Mania 766 
 
 or Child-bed Fever. 764 
 
 Pulmonary Consumption 766 
 
 , Treatment 
 
 of 727 
 
 Pumpkin-seed, Emulsion of 984 
 
 Purging in Infancy 958 
 
 Pustule, Malignant 779 
 
 Putrid Sore Throat, or Diphtheria. 575 
 Pyaemia 779 
 
1062 
 
 INDEX. 
 
 Pyromania 672 
 
 Pyrophosphate of Iron 753 
 
 , Mixture of.. 993 
 
 Q. 
 
 Quality of Brain 89 
 
 Quantity of Blood 121 
 
 of Exercise 271 
 
 Quass or Rye-beer 227 
 
 Quickening- in Pregnancy 937 
 
 Quinine 993 
 
 in Syrup, Sulphate of 995 
 
 E. 
 
 Rabbit 181 
 
 Railroad Conductors 369 
 
 Raisins 199 
 
 Raspberry- vinegar Water 320 
 
 Raspberries 200 
 
 Reflex Action of Nervous Centres . . 98 
 
 Regulations for Diet 206 
 
 Relations, Intermarriage of 388 
 
 Remedies used in Clap 625 
 
 Remittent Fever 782 
 
 Rennet Whey 322 
 
 Residence, Change of 295 
 
 Resin, Cerate of 1009 
 
 Respiration 133 
 
 , Action of Blood-glo- 
 bules during 136 
 
 , Change in Blood during. 135 
 
 , Change in Air during. . 135 
 
 , Organs of 131 
 
 Restorer for the Hair 638 
 
 Retention of Urine 901 
 
 Retrocedent Gout 630 
 
 Retrospect of Skeleton 65 
 
 Revaccination 905 
 
 Rhatany, Infusion of 1001 
 
 Rheumatic Fever 786 
 
 Gout 790 
 
 Rheumatism 786 
 
 , Acute 786 
 
 Rhinitis or Catarrh of Nose 520 
 
 Rhubarb 791 
 
 and Aloes, Pills of 965 
 
 Lozenges 1018 
 
 and Iron, Pills of 966, 999 
 
 and Magnesia, Powder of. 967 
 
 Pill 966 
 
 Ribs 57 
 
 , Fracture of 418 
 
 Rice 193 
 
 and Apples 327 
 
 and Gravy 329 
 
 , Mucilage of 315 
 
 Pudding 327 
 
 Soup 328 
 
 Rickets 791 
 
 Right Side, Chronic Pain at 694 
 
 PAGE 
 
 Ringworm or Scald-head 793 
 
 River Water 206 
 
 Roasting 176, 311 
 
 Rochelle Salt 795 
 
 Romancers * 352 
 
 Room, Circulation of Air in 264 
 
 Rose 608 
 
 Rose-Cold 640 
 
 Rose-Water 1015 
 
 Roses, Infusion of 796 
 
 , Milk of. 1016 
 
 Rowing 729 
 
 Rubbers 395 
 
 Rubbing 730 
 
 Running 79 
 
 , Movements of 79 
 
 Rupture, or Hernia 427 
 
 Russian Bath 287 
 
 Rye 193 
 
 , Ergot of 449, 607, 617, 718 
 
 Rye-beer 227 
 
 S. 
 
 Sage 196 
 
 Sage and Flax-Seed, Gargle of 1003 
 
 Sage-tea, Alum, and Honey, Gargle 
 
 of 1003 
 
 Sago-Milk 330 
 
 Sago, Mucilage of 312 
 
 Saint Anthony's Fire 608 
 
 Saint Vitus's Dance 479, 735, 796 
 
 Sal-Ammoniac 798 
 
 Salep 196 
 
 , Mucilage of 313 
 
 Salmon 185 
 
 Salt 201 
 
 Rheum, or Tetter 796, 881 
 
 Salts, Spirits of 446 
 
 Santonine 798 
 
 Sarsaparilla 798 
 
 , Decoction of 974 
 
 Savin, Cerate of 1009 
 
 Scald-head, or Ringworm 793 
 
 Scalds 432 
 
 Scaly Tetter, or Dry Scall 881 
 
 Scalp, Favus of 825 
 
 Scammony 799 
 
 Scarlet Fever, or Scarlatina 799 
 
 Rash 824 
 
 Schools 366 
 
 Schools of Medicine 394 
 
 Sciatica 803 
 
 Science, Men of 352 
 
 Scrofula 804 
 
 , Causes of 805 
 
 Scurvy 808 
 
 , Causes of 810 
 
 Scutellaria 814 
 
 Sea-Bathing 913 
 
 Sea-Sickness 736, 815 
 
INDEX, 
 
 1063 
 
 PAGE 
 
 Sea-sickness, Prevention and Treat- 
 ment of 816 
 
 Secretions 147 
 
 Secretion within Body 146 
 
 Seidlitz Powders 967 
 
 Self-abuse 818 
 
 Seminal Emissions 817 
 
 Seneca Snake-root, etc., Mixture of 980 
 
 Senna 822 
 
 and Epsom Salts, Injection of 967 
 
 , Confection of 965 
 
 , Salts, etc. , Infusion of 963 
 
 Syrup 1014 
 
 Sensations 86 
 
 Sensibility of different Parts 98 
 
 of Skin 85 
 
 Sensitive Layer 634 
 
 Sesamoid Bones 65 
 
 Setting Dislocated Shoulder. . .423, 424 
 
 Setting Jaw 426 
 
 Shaking Palsy 748 
 
 Shallot 198 
 
 Siberian Fungus 229 
 
 Sherrv 242 
 
 Shingles 823 
 
 Shoemakers 362 
 
 Shoulder 58 
 
 , Dislocation of 423 
 
 , Setting of 424 
 
 Shower-bath 912 
 
 Sick, Cookery for 310 
 
 Sick-headache 643, 736 
 
 Sick-room Cookery 310 
 
 Sick-rooms, Management of 299 
 
 , Fumigation of 304 
 
 , Temperature of 302 
 
 Signs and Symptoms of Pregnancy. 936 
 
 Silver of Crystals, Nitrate of 743 
 
 , Nitrate of 624 
 
 Simple Cerate 1018 
 
 Chancre 868 
 
 Ointment 1018 
 
 Rules for Care of Eyes 613 
 
 Ulcer 895 
 
 Sitz Bath 912 
 
 Size of Brain 69 
 
 Skeleton of Body 44 
 
 , Retrospect of 65 
 
 Skin 155 
 
 , Abrasion of 461 
 
 , Diseases of 824 
 
 Skull 45 
 
 Sleep 279 
 
 Sleeplessness i Insomnia) 736, 826 
 
 Sleep of Plants 281 
 
 Slippery-elm Poultice 1012 
 
 Sloughing Chancre 868 
 
 Ulcer 899 
 
 Small-Pox 828 
 
 , Confluent 829 
 
 , Malignant 830 
 
 , Mild or Distinct 828 
 
 Smelling 108 
 
 Snow-balls 327 
 
 PAGE 
 
 Soap Fomentation 1011 
 
 Liniment 1011 
 
 Plaster 1006 
 
 Soda 446. 834, 995 
 
 , Sulphate of 621 
 
 , Sulphite of 863 
 
 Soda-water 324, 835 
 
 Soporifics 988 
 
 Sore Nipples 743, 941 
 
 Sore-throat 871 
 
 , Clergymen's 685 
 
 Souchy. 331 
 
 Sounding Chest, or Auscultation 485 
 
 Sowans 326 
 
 Spanish or Blistering Flies 451, 841 
 
 Spasm of Glottis, or False Croup . . . 563 
 
 Species, Origin of 165 
 
 Specula 835 
 
 Speech 112 
 
 Spermatorrhoea 735, 817 
 
 Sphygmograph 841 
 
 Spices 201 
 
 Spinage 197 
 
 Spinal Cord 85 
 
 Spinal Cord, Diseases of 837 
 
 Spinal Nerves 85 
 
 Spine 52 
 
 , Curvature of 837 
 
 , Diseases of 836 
 
 , Prevention of Diseases of . . . 837 
 
 . Sensibility of 85 
 
 Spirits of Salts 446 
 
 Spitting of Blood 843 
 
 Spleen 142 
 
 Spongio-piline 847 
 
 Spotted or Cerebro -spinal Fever. . . 847 
 
 Sprains 839 
 
 Squill 848 
 
 Squills, etc., Mixture of 976 
 
 Stammering and Stuttering 848 
 
 St. Anthony's Fire 608 
 
 Starvation 850 
 
 Stavesacre, Ointment of 1008 
 
 Sternum 57 
 
 Stethoscope 851 
 
 Stewing 311 
 
 Still-birth 441 
 
 Stimulants and Narcotics 211, 986 
 
 , Old Laws concerning. . . 249 
 
 , Opposition to 248 
 
 , Personal Experience in 
 
 Use of 251 
 
 Stomach 138 
 
 , Action of 144 
 
 and Bowels, Spasms and 
 
 Cramps of 940 
 
 , Cancer of 510, 854 
 
 , Chronic Inflammation of. . 853 
 
 , Ulcer of 854 
 
 Stone and Gravel 854 
 
 Stone-cutters 362 
 
 Stone in Bladder 679 
 
 Strawberries 200 
 
 Strengthening Plaster 1006 
 
1064 
 
 INDEX. 
 
 PAGE 
 
 Stricture of Urethra 858 
 
 Structure of the Hair 634 
 
 Strychnine 744, 862, 993 
 
 Students 350 
 
 Stuttering 848 
 
 St. Vitus's Dance or Chorea. 479, 735, 796 
 
 Sty 862 
 
 Sub-carbonate of Ammonia 863 
 
 Subcutaneous Injections 661 
 
 Suffocation 440 
 
 Sugar 141, 199 
 
 Sugar-Cane 227 
 
 Sugar of Lead 638 
 
 of Lead and Opium, Pills of 1002 
 
 of Lead, Ointment of 1008 
 
 of Lead, Wash of 1004 
 
 Sulphate of Copper, Injection of. . . 1005 
 
 of Copper, Powder of 971 
 
 of Magnesia, or Epsom 
 
 Salts 606 
 
 of Morphia, Draught of. . . 990 
 
 of Potash, etc. , Powder of 967 
 
 of Soda 621 
 
 of Soda, Lotion of 1010 
 
 of Quinine, etc. , Mixture 
 
 of 996 
 
 of Zinc, Injection of 1005 
 
 of Zinc, Powder of 972 
 
 Sulphite of Soda 863 
 
 Sulphur 863 
 
 and Cream of Tartar, Pow- 
 der of 967 
 
 Sulphuric Acid 864 
 
 Ether, etc., Mixture of. . 986 
 
 Summer Complaint '. 539 
 
 Sunburn and Freckles 825 
 
 Sunlight 272 
 
 Sunstroke 864 
 
 Superior Extremities 58 
 
 , Muscles of . . 74 
 
 Suppositories 865 
 
 Suppression of Menses 707 
 
 Surgical Accidents and Emergen- 
 cies 399 
 
 Sutures 45 
 
 Swallowing 144 
 
 Swedish Movements 721 
 
 Sweet Bread 330 
 
 Cider 242 
 
 Gale 229 
 
 Potato 190 
 
 Spirits of Nitre 866 
 
 Swooning 615 
 
 Sympathetic Nerve 100 
 
 , Functions of 101 
 
 Synovia 44 
 
 Syphilis, Constitutional 870 
 
 , or Venereal Disease 866 
 
 Syrup of Rhubarb and Soda 964 
 
 of Squills, etc., Mixture of... 980 
 
 T. 
 
 Table of Contents 28 
 
 PAGE 
 
 Table Salt, Injection of 968 
 
 Salt, Solution of 971 
 
 Tabular Statement of Longevity. . . 333 
 
 Tailors 362 
 
 Tallow Chandlers 360 
 
 Tanners 359 
 
 Tannic Acid 243 
 
 Tannin 243 
 
 and Glycerine, Lotion of 1010 
 
 and Opium, Pills of .... 1003 
 
 Tapioca 196 
 
 Pudding. 328 
 
 Tar Water 874, 982 
 
 , etc. , Ointment of 1008 
 
 Tartar Emetic 873 
 
 on Teeth 874 
 
 Tartrate of Potash and Manna, Mix- 
 ture of 963 
 
 Taste 109 
 
 Tea 209 
 
 and Coffee, Effects of 244 
 
 , Flaxseed. 322 
 
 , Marsh-mallow 321 
 
 , Mutton 318 
 
 Teachers 350 
 
 Teamsters 360 
 
 Teeth 49 
 
 , Diseases and Management of. 874 
 
 , Tartar on 874 
 
 Teething 876, 957 
 
 Temperature in Sick-rooms 302 
 
 Testicles in Gonorrhoea 622 
 
 Tetanus, or Lockjaw 736, 878 
 
 Tetter, or Salt-rheum .'. 881 
 
 , Humid or Swelling 881 
 
 Theine 231 
 
 Thermometer in Medicine 882 
 
 Thigh 62 
 
 Thigh-bone, Fractures of 414 
 
 Thompsonians 395 
 
 Thorax 57 
 
 Thorn-apple 229 
 
 , Ointment of 1008 
 
 Thrush, or Aphtha; 476, 721 
 
 Thumbs 61 
 
 Tic-douloureux, or Neuralgia of Face 883 
 
 Toast-water 320 
 
 Tobacco 214, 448 
 
 ---, Effects of 244 
 
 , Indian 695 
 
 Tobacconists 370 
 
 Toddy 226 
 
 Toe-nail, Ingrowing or Inverted 883 
 
 Toes.... 64 
 
 Tongue, Bone of 51 
 
 Tongue-tie 884 
 
 in Infancy 956 
 
 Tonics 992, 993 
 
 Toothache 885 
 
 Tooth-powder 1016 
 
 Torpor of the Liver 695 
 
 Touch 110 
 
 Tourniquet 402 
 
 to stop Bleeding by . . . 401 
 
INDEX 
 
 1065 
 
 PAGE 
 
 Tons les mois 312 
 
 Trachea, or Air-tube 131 
 
 Trance, or Catalepsy 519 
 
 Treatment of Apoplexy 475 
 
 of Bowels 492 
 
 of Brain 495 
 
 of Cholera-morbus 534 
 
 of Paralysis 749 
 
 of Sea-sickness 816 
 
 of Yellow Fever 932 
 
 Trees, Longevity of 379 
 
 Trichina Spiralis 927 
 
 Tripe 330 
 
 Trout 185 
 
 Trumpets for the Ear 885 
 
 Trunk, Muscles of 71 
 
 of Body 52 
 
 Truss, Use of 429 
 
 Tubercular Disease 686 
 
 Tumor of Larynx 686 
 
 Turkey 181 
 
 Turkish Baths 287 
 
 Turnip 190 
 
 , Mashed 328 
 
 Turpentine 887 
 
 , Mixture of 984 
 
 and Castor Oil Mixture. 964 
 
 Turtle Soup 319 
 
 Typhus and Typhoid Fever 887 
 
 U. 
 
 Ulcers 895 
 
 Ulcer, Indolent 896 
 
 , Irritable 898 
 
 , Simple 895 
 
 , Sloughing 899 
 
 Urethra, Injection for 1004 
 
 , Permanent Stricture of . . 859 
 
 , Stricture of 858 
 
 Urine, Incontinence of 899 
 
 - , Retention of 901 
 
 V. 
 
 Vaccination 453, 902 
 
 Vaginismus 905 
 
 Valerian and Ammonia, Draught of 987 
 
 , Castor Oil, &c, Draught of 991 
 
 , Ether, &c, Mixture of . . . 991 
 
 Valerianate of Zinc 935 
 
 Vapors 659 
 
 Varicose Veins and Ulcers 906 
 
 Various Diseases, Electrization in.. 620 
 
 Forms of Neuralgia 739 
 
 Veal 182 
 
 Tea 318 
 
 Vegetables Boiled 328 
 
 Vegetable Poisons 448 
 
 Veins 125 
 
 Velocipedes 271 
 
 Venereal Diseases, Cubebs in 624 
 
 PAGE 
 
 Venison 181 
 
 Ventilator of John Lesperance 260 
 
 Ventilation of Sick-room 300 
 
 , Methods of 258 
 
 Veratria, Ointment of 1007 
 
 Veratrum Viride 908 
 
 Vermicelli Pudding 329 
 
 Soup 328 
 
 Vertigo, or Dizziness 908 
 
 Vinegar 201 
 
 and Tamarind Whey 322 
 
 , Gargle of 1004 
 
 Virginia Snake-root, Inf us. of.. 975, 987 
 
 Vision 105 
 
 Vitriol 446 
 
 Voice, Loss of 688 
 
 Volatile Oil 243 
 
 Vomiting of Blood 909 
 
 , or Regurgitation 910 
 
 W. 
 
 Walking 79 
 
 , Movements of 79 
 
 Walnuts 187 
 
 Warts 911 
 
 Wash of Opium and Lead 690 
 
 Water 277, 319 
 
 Brash or Heartburn 650 
 
 Cure or Hydropathy 911 
 
 , how to Purify 206 
 
 Waters, Mineral and Medicinal 914 
 
 Weaning 955 
 
 W T hat is Life ? 391 
 
 Wheat 190 
 
 Whey '. 188 
 
 Whites 915 
 
 White-wine Whey 323 
 
 Whiting 184 
 
 Whitings, broiled 331 
 
 Whitlow 917 
 
 Whooping-cough 654 
 
 Wild-cherry Bark, Infusion of 998 
 
 Willow-bark, Decoction of 996 
 
 Wine, Mulled 332 
 
 , Palm 226 
 
 , Port 242 
 
 Whey 988 
 
 Wolfsbane 465 
 
 Womb, Cancer of 513 
 
 Women, Diseases of 920 
 
 , Longevity of 371 
 
 Wood-soot, Tincture of 991 
 
 Worm-seed Oil, Mixture of 985 
 
 Worms 923 
 
 in Infancy 958 
 
 in Muscles 927 
 
 Wormwood 465 
 
 Wound, Irrigating of 412 
 
 Wounds 407 
 
 , Hemorrhage from 441 
 
 Writer's Cramp 929 
 
 Wry Neck 929 
 
1066 
 
 INDEX. 
 
 Y. 
 
 PAGE 
 
 Yam 190 
 
 Yeast Poultice 720, 1012 
 
 Yellow Fever 930 
 
 , Treatment of 932 
 
 Z. 
 
 PAGE 
 
 Zinc 935, 999 
 
 , Carbonate of 506 
 
 , Ointment of 625 
 
 , Valerianate of 935 
 
TESTIMONIALS FOR " OUR HOME PHYSICIAN." 
 
 From L. J. Sanford, A.M., M.D., Professor of Anatomy and Physiology in Yale College. 
 
 The work entitled " Our Home Physician" embraces a well-selected series of topics, 
 which are discussed in a clear and concise manner. It abounds in valuable hints and sug- 
 gestions of a practical kind, which make it a useful companion in the family. It has af- 
 forded me much pleasure to peruse the work, both from the fact of its intrinsic merit and 
 also because I have known Dr. Beard for several years, and have been mindful of his prog- 
 ress and attainments in medicine. He has the genius and ability which fit a man to be 
 an educator, and is well qualified to bring within the popular reach those principles and 
 facts of health and disease which should be understood by all. 
 
 From A. E. M. Purdy, M.D., Medical Examiner to the Asbury Life Insurance Co., Surgeon 
 to the Metropolitan Police Force, N. Y., and Attending Physician for Diseases of Women 
 at the North-Eastern Dispensary, New York. 
 
 " Our Home Physician" is a work long needed by the masses, and I am glad it em- 
 anates from the hands of so competent a person as my friend Dr. Beard. 
 
 From D. B. St. John Eoosa, A.M., M.D., Clinical Professor of Diseases of the Eye and Ear 
 in the University of the City of N.Y., and Staff Surgeon of the 2d Brigade, N.Y.S.N.G. 
 
 I have carefully read the advance sheets of " Our Home Physician." Should the whole 
 of the work be equal to the pages you have sent me, it will do a much needed service to 
 our people in giving them correct information on one of the most important of subjects. 
 It will deserve and I have no doubt will attain success. 
 
 From W. Schoonover, M.D., Attending Surgeon to the North-Eastern Dispensary, New 
 York City, and Assistant Curator of the Charity Hospital, New York. 
 I have no scruples in recommending the work to the public. Such a work is invaluable, 
 and should be had in every family. 
 
 From the Buffalo Medical and Surgical Journal. 
 
 We most heartily sympathize with the effort to popularize medical science. # # # 
 The author of this work is a learned gentleman, and is assisted by some of the most em- 
 inent men of the profession. As to the sound excellence of the work, we wish to call at- 
 tention to one of its articles re-printed in our present number. 
 
 From the Cincinnati Medical Repertory. 
 
 An examination of "Our Home Physician" shows that the work will contain a very large 
 amount of useful information needed by the masses. Our experience has convinced us 
 that it would be much better for intelligent practitioners if there was more general 
 knowledge of physiology, hygiene, and the principles of medicine. The present great 
 ignorance makes it impossible to discriminate the scientific practitioner from the pretender, 
 and therefore favors quackery. 
 
 From the California (San Francisco) Medical G-azette. 
 
 From a hasty perusal of this work we are disposed to think that it is much superior to 
 the majority of works purporting to be "Medical Guides" for the people. The subjects of 
 which it treats are not only handled philosophically and comprehensively, but can scarcely 
 be better chosen to convey the information that the people require. 
 
 From the Scientific American. 
 
 We recommend the work to all who desire to obtain new and valuable information in 
 regard to the preservation of health and the proper treatment of disease. There are 
 numerous illustrations, a specimen of which we this week copy, in an article on the 
 restoration of persons apparently dead from drowning. 
 
 From the Rural New Yorker. 
 
 We judge this new medical work for the family will prove of rare value. The aim of 
 its author*, Dr. Beard, a physician of high repute, has been to prepare a guide to the art 
 of preserving health and treating disease — a guide which is needed in every household. 
 The work is based on the principle that the wise physician belongs to no "school," "ism y 
 or " pathy," but uses for his patients all things which have proved beneficial. 
 
TESTIMONIALS FOR "OUR HOME PHYSICIAN." 
 
 From Wm. L. Peck, M.D., Professor of Insanity and its Jurisprudence in the Starling 
 
 Medical College, Columbus, Ohio, and Superintendent of the Central Ohio Lunatic Asylum. 
 
 It gives me pleasure to say that the author of " Our Home Physician" deserves the 
 united praise of our profession for bringing forward at this time such a valuable work, 
 to take the place in the household of the vile trash that has heretofore been forced upon 
 an unsuspecting people. 
 
 From LOUIS Elsberg, M.D., Clinical Professor of Diseases of the Throat in the Univer- 
 sity of the City of New York. 
 
 I gladly bear testimony to the admirable planning and the timeliness of " Our Home 
 Physician," and the great good a popular treatise can do the cause of medical science 
 and humanity. 
 
 From Samuel Henry Dickson, M.D., Professor of the Practice of Medicine in the 
 Jefferson Medical College, Philadelphia, Pa. 
 
 Having perused thoughtfully the specimen pages of Dr. Beard's coming work, I take 
 pleasure in offering you this expression of warm approval of it. I regard his plan an 
 excellent one, agreeing cordially with him as to the propriety of popular lessons in 
 hygiene, &c, and I really admire the degree of intelligence, and fairness, and sound good 
 sense exhibited throughout. 
 
 From Joseph C. Hutchinson, M.D., Surgeon on the Medical Board of the Brooklyn 
 
 City Hospital. 
 
 I have examined with great interest " Our Home Physician," by Dr. Beard, and am 
 glad to express the opinion that it abounds in useful information, and will be especially 
 valuable to those to whom skillful medical aid is not accessible. 
 
 From Samuel Nickles, M.D., Professor of Physics and Medical Chemistry in the Ohio 
 Medical College, Cincinnati, Ohio. 
 
 I like the book. It is complete, reliable and intensely interesting. It will certainly 
 meet and deserve an extended circulation, and be the means not only of diffusing useful 
 knowledge, but also of prolonging many valuable lives. 
 
 From S. J. Holly, M.D., Sanitary Inspector of the City of Brooklyn, and Examining 
 Physician to the Great Western Life Insurance Company. 
 
 Having carefully reviewed the advance sheets of "Our Home Physician," I would 
 say no one can read this book without becoming convinced that it contains much valuable 
 information. 
 
 From John A. Murphy, M.D., Professor of the Principles and Practice of Medicine in 
 Miami College, Cincinnati, Ohio. 
 
 In my opinion the book will supply a want long felt. Dr. Beard is so well known as a 
 cultivated and scientific gentleman, that the book will be well calculated to enlighten 
 many now unwillingly ignorant. 
 From H. M. Brush, M.D., Physician in charge of the North-Eastern Dispensary, Neio York. 
 
 I have examined, with pleasure, the advance sheets of "Our Home Physician," by 
 Dr. Beard. I consider it a popular treatise on medical science much needed at the present 
 time, and prepared by one fully competent to the task. It is a work containing practical 
 information necessary to all persons, and useful in every household. 
 
 From J. Aitken Meigs, M.D., Professor of Institutes of Medicine in the Jefferson Medi- 
 cal College, Philadelphia, Pa. 
 
 I have examined "Our Home Physician," by Dr. George M. Beard, and can recom- 
 mend it as embodying sound medical instruction in clear and popular language. In both 
 style and matter it is well adapted to general and family reading. 
 
 From S. S. BOGERT, M.D., Physician for the Treatment of Diseases of the Throat and 
 Chest in the New York City Dispensary. 
 
 I can cheerfully recommend it to all persons, both professional and unprofessional, feel- 
 ing sure they will derive great instruction from its perusal and benefit from its advice. 
 From Edmund Fowler, M.D., Examining Physician to the Excelsior Life Insurance 
 
 Company, New York City. 
 
 The advance sheets of " OUR Home Physician" give excellent promise, written in 
 the full light of science, with all the aids of thorough research. The volume needs no 
 commendation beyond its intrinsic value. 
 
 From Edmund Andrews, A.M., M.D., Professor of Surgery in the Chicago Medical 
 
 College, Chicago, III. 
 
 I have long maintained the importance of bringing up the grade of public intelligence 
 on medical subjects, and of providing a substitute for the miserable works on domestic 
 medicine heretofore published. The excellence of this work is such that I commend it, 
 without hesitation, to the public.