Olass^RCH Book : COPYRIGHT DEPOSIT DICTIONARY OF DOMESTIC MEDICINE HOUSEHOLD SURGERY. By SPENCEE THOMSON, M.D. L. R.C. S., EDINR. FIRST AMERICAN, FROM THE LAST LONDON EDITION. REVISED, WITH ADDITIONS, By HENRY H. SMITH, M.D. SURGEON TO ST. JOSEPH'S HOSPITAL, PHILADELPHIA. thty-f^ Si PHILADELPHIA: LIPPINCOTT, GRAMBO & CO. 1853. Entered according to the Act of Congress, in the year 1853, by LIPPINCOTT, GKAMBO & CO. in the Clerk's Office of the District Court of the Eastern District of Pennsylvania. STEREOTYPED BY L. JOHNSON AND CO. PHILADELPHIA. TO THE RIGHT HONOURABLE W$t € ix\ ,rf Carlisle, THIS WORK IS DEDICATED IT IS OFFERED, AS A TRIBUTE OF UNFEIGNED RESPECT, TO A NOBLEMAN, WHOSE EXALTED RANK HAS BEEN ADORNED BY PERSONAL EFFORTS 'TO ELEVATE THE MINDS, AND TO AMELIORATE THE PHYSICAL CIRCUMSTANCES OF HIS COUNTRYMEN. EDITOR'S PREFACE. The Dictionary of Domestic Medicine and Household Surgery, written by Dr. Spencer Thomson, of England, having been originally published in parts, and just completed, has received the highest encomiums from the various jour- nals of G-reat Britain. "Many a useful life might have been spared, and many an insidious disease checked in the bud, had works such as that of Dr. Thomson been earlier in existence. To the traveller by sea or by land, to the settler and emigrant far from medical aid, it must prove invaluable." Being written, however, with a view to the peculiar wants of his own coun- trymen, the author has presented many items of information which possess rather too local an interest to prove useful to the American reader, such as the " Act of Victoria regulating the sale of Arsenic," recommendations of London manufacturers, advantages of "English Watering-places," &c. &c. In revising the volume for the American press, the Editor has therefore omitted these articles, corrected typographical errors, furnished many new illustrations, and added such matter of a practical kind as could be briefly incorporated with the text without impairing its original character. All the additional matter will be found included in brackets [ ] in such a manner as to be readily apparent to the reader, and will, it is hoped, aid, rather than impair the efforts of its accomplished author in the extension of such knowledge as will furnish, in "thinly peopled colonies, ready information respecting what is best to be done in many of the emergencies and accidents of daily life," as well as serve, "as a counter-agent to the impudent quackery which preys upon the credulity and lamentable ignorance of the simplest principles of health that pervades the mass of the people." In the United States quackery has certainly free scope, and nothing will be more likely to check it, than the extension of such knowledge as shows the community how they are imposed on by unprincipled men. A desire to increase the circulation of such informa- tion, especially as presented by the Author, has therefore been a prominent object with the Editor in the prosecution of his duties. No. 120 South Ninth Street, Philadelphia. April, 1853. a2 AUTHOR'S PREFATORY ADDRESS. That works professing to afford popular information on medical subjects may thoroughly answer the purpose for which they are designed, one especial point requires ever to be kept in view — the information given must be safely usable by those who are put in possession of it. It is an objection frequently adduced against such works, that they place a little dangerous knowledge in the hands of the public, in a form so apparently simple, as to make it a source rather of evil than of benefit; and, undoubtedly, the allegation has in some respects been cor- rect. But is it necessary, in preparing a work on domestic health, to incur this, hazard ? I think not. For without entering upon that difficult ground which correct professional knowledge and educated judgment can alone permit to be safely trodden, there is a wide and extensive field for exertion, and for useful- ness, open to the unprofessional, in the kindly offices of a true Domestic Medi- cine ; the timely help and solace of a simple Household Surgery, or better still, in the watchful care, more generally known as "Sanitary Precaution," which tends rather to preserve health than to cure disease. "The touch of a gentle hand" will not be less gentle, because guided by knowledge, nor will the safe domestic remedies be less anxiously or carefully administered, Inseparably con- nected with the intelligent use of these remedies, there must be correct general ideas respecting the anatomical arrangements and physiological requirements of the human frame. This also has been objected to. I hesitate not to say, that it is such knowledge as ought to be in the possession of every responsible man. Making apparent the importance, and rational foundation of the means of pre- serving or of invigorating health, or of restoring it when impaired, it renders submission to the requirements of those means, a more sure and cheerful service, when rendered to the conviction of the understanding, rather than to the dictum of an adviser. Amid the humbler classes especially, the diffusion of such know- ledge is highly requisite as a counter-agent to the impudent quackery which preys upon the credulity and lamentable ignorance of the simplest principles of health, which pervade the mass of the people. But health will fail, either in old or young, and accidents will happen, in spite of the most careful precaution ; it then becomes a question, how far non-professional interference may go. In many of the emergencies and accidents of daily life, even in a settled country, but more especially in the thinly peopled colonies, ready information respecting what is best to be done, possessed by a neighbour or a bystander, is often of the most essential service ; indeed, every medical man must have witnessed how much mischief may result, either actively or passively, and in a very short time, from ignorance of even the most obvious and common- sense modes of treatment. The information upon these points, given in a popu- AUTHOR'S PREFATORY ADDRESS. 7 lar work, can scarcely be too full or too accurate. In the requirements of House- hold Surgery, or of sudden emergency, such as poisoning, burning, &c, the question is, " What must be done ?" Generally speaking, little or no skill is requisite to determine the nature of the case, or of the injury, which is often too apparent: the anxious question, "What must we do?" is that which calls for an- swer ; and if, sometimes, it happens that the exact nature of the accident be not sufficiently evident, that is no reason why knowledge on the subject generally, aided by common sense, may not do much to relieve. Life may be saved, suffer- ing may always be alleviated. Even to the resident in the midst of civilization, the "knowledge is power" to do good; to the settler and the emigrant it is invaluable. We come to a point more liable to cavil — the actual treatment of disease, pro- perly so called, by the unprofessional, and how far it is well to afford information, which may tempt the rash to use that which education only can safely employ. It may be trite, but it is true, that in order to treat a disease safely, and with benefit, we must learn its nature. Now, when it is remembered how the nicest judgment that observation and experience can form, the most patient attention, aided by practised ear and eye, by microscope and test-tube, are frequently ne- cessary to enable the conscientious physician to judge of his case before he can apply the remedy, it is evident how great must be the responsibility of those who, in rashness or ignorance, venture upon the treatment of serious disease, either in their own persons or in those of others ; incapable of judging of its nature, still less capable are they of selecting the appropriate treatment. There is, however, a vast difference between the management of real disease and of ordinary ailment— between endeavouring to strike at the root, or only to relieve the symptoms. Any unprofessional man, or woman either, in this kingdom, who, with all the facility that there is for procuring skilled advice, ventures to take the medical manage- ment of a case of real illness, acts most unwarrantably ; but there are numbers of lesser ailments, many of the more painful incidents and symptoms, simply and easily removable by mccans which all may employ, and with which it is most im- portant that all should be acquainted j which the parent may use to the child, or the pastor recommend to his parishioners, without fear. One step further. If clanger may result from rash treatment, none can arise from a general acquaintance with the most prominent symptoms which herald the approach of dangerous sickness ; these, I think, should be made known -, while JJLl remarks upon the management, whether limited as for use in this country, or more extended for the sake of the dweller in remote or unsettled districts, I trust so to guard as to make them safe and useful guides. I know well what is said by a few, about injuring the medical profession by making the public their own doctors. Nothing will be so likely to make "long cases" as for the public to attempt any such folly; but people of moderate means — who, as far as medical attendance is concerned, are worse off than the pauper — will not call in and fee their medical adviser for every slight matter, and, in the absence of a little knowledge, will have recourse to the prescribing druggist, or to the patent quackery which flourishes upon ignorance, and upon the mystery with which some would invest their calling. And not patent quackery alone, but professional quackery also, is less likely to find footing under the roof of the intelligent man, who, to common sense and judgment, adds a little knowlege of the whys and wherefores of the treatment of himself and family. Against that knowledge which might aid a sufferer from accident, or in the emergency of sud- den illness, no humane man could offer or receive an objection. 8 AUTHOR'S PREFATORY ADDRESS. To resume. The information which it is proposed to offer in this Dictionary may be classed as Anatomical and Physiological, Sanitary or Hygienic, the Treatment of Accident and Emergency, and the Management of Illness. In some respects, perhaps, the adoption of this classification might be advantageous, but as a means of ready reference, the alphabetical arrangement of subjects will, it is thought, be found more convenient. SPENCER THOMSON, Haunton, JBurton-upon- Trent. PREFATORY NOTICE. As it would involve much repetition, to give the forms, doses, and mode of administration of the various remedies each time they are individually mentioned, the reader is referred, for the requisite information, to the individual articles them- selves, and to the article " Materia Medica," which will appear in its proper place, and under which all that is necessary for the purposes of the Dictionary will be fully given. When doses are mentioned in the general articles — unless otherwise specified — they are the average for an adult. S. T. [For Concluding Address of the Author, see page 581. — Ed.] . MEDICAL DICTIONARY. ABDOMEN.— Figs. i. and ii. The abdo- >men, or belly, the largest cavity of the body, Fig. i. is bounded above by the chest, (Fig. ii. 7 ;) and below by the pelvic bones, which are joined in front, (Fig. ii. 8.) These bones, which every one may feel in their own per- son, likewise enclose a cavity — the cavity of ! the pelvis — which is sometimes described 1 separately from the cavity of the abdomen ; but the two are so completely united, that they are better treated of together. The cavity of the abdomen is divided from that of the chest, by the midriff or diaphragm, (Fig. ii. 6;) posteriorly, it is supported and protected by the spine ; and it is enclosed by the short ribs and abdominal muscles. To facilitate description, medically, the abdo- men is mapped out into regions by imagina- ry horizontal and vertical lines, drawn as represented in Fig. i. The horizontal lines ■ drawn across the abdomen divide it into 1 three zones, which, by the vertical lines, are ; divided into nine anterior regions, as fol- low:— 1, 1, Right and left Hypochondriac ; 2, Epigastric ; 3, 3, Right and left Lumbar ; 4, Umbilical ; 5, 5, Right and left Iliac ; 6, Hypogastric. In the upper zone lies the Fi~ELLA BARK — Is an aromatic tonic, and is used as a spice. It may be given in powder, in doses of fifteen or t went v grains. CANINE TEETH.— See Teeth. CAXTHARILES.— The word is the Latin plural of Cantharis — uesicatoria, the Spanish blistering-fly. — See Blister. In addition to its uses as a blistering agent, the Spanish fly is used internally ; but is too hazardous a remedy for general use. I: is s:raeiimes given as a poison for malicious or criminal purposes. When swaUowed in a poisonous dose, cantharides quickly produce severe pain in the stomach and bowels, and in- tense inflammation; distressing irritation of the urinary organs foUows, with constant desire to pass urine, which comes away in small quantities, with or without blood, or is entirely suppressed : stupor and delirium precede death. The remedies, in a case of poisoning by Spanish fly, must be of the most soothing character. Milk given cold may. as it coagulates in the stomach, enve- lop the irritant particles, or it may be used boiled with flour ; white of egg, linseed-tea, or indeed the emoRient most quickly and easily procurable, should be swallowed largely, and vomiting, if not present, pro- moted by a feather in the throat, or by ipecacuanha. Oil is sometimes forbidden in such cases, from its being a solvent of cantharides : but after vomiting, or even before if the dose is not large, one or two doses of castor-oil may safely and advan- tageously be given, each in combination with twenty or thirty drops of laudanum. Clysters of starch, linseed-tea, or the Eke, with or without laudanum, wRl allay the irritation in the lower bowels. Hot appli- cations to the abdomen generally should be used, and if there is much tenderness, leeches freely. Should the patient recover, the state of the aEmentary canal and uri- nary organs for some time require care, and the mildest and most unirritating mode of Eving must be pursued. A Ettle can- tharides ointment, smeared upon the silk of a seton, increases the discharge when de- ficient. Refer to Blister. CAOUTCHOUC, op. Elastic Sum, or Ix- DiA-RrBBES — Is obtained from different species of trees, both in South America and in the East Indies. It is interesting in me- dicine, from being the basis of the various CAP 88 CAR elastic mechanical contrivances now so ex- tensively used in the relief and cure of disease. One of the chief inconveniences in the use of caoutchouc was its becoming hard when cold ; the discovery of its com- bination with sulphur — vulcanized India- rubber — has obviated the difficulty, and we now have a material which remains perfectly elastic and soft at all temperatures. This valuable property has been quickly taken advantage of. The water-cushion, a bed, is one of the most useful applications of the material ; it can be filled either with boiling or with iced water, the latter a very valu- able resource in fever, for keeping — what there is always much difficulty in doing — the back of the head cool. Refer to Elastic. CAPILLARY.— Hair-like. The term is applied to the minute vessels connecting the arteries with the veins in the animal body ; also to tubes of minute calibre. CAPSICUM. — Cayenne pepper is better known as a condiment than as a medicine. A product of warm climates, it is admirably suited as a stimulant counter-agent to the relaxing effects of heat. It is extensively used in this country, and, when not im- moderately, is undoubtedly serviceable to persons of languid digestion. In too large quantity it will, of course, prove an irritant poison. Two parts of cayenne, three of compound rhubarb pill, and one of quinine, form an excellent dinner-pill, from three to six grains of which may be taken twenty minutes before the meal, for a week or ten days at a time, by persons of feeble habit of body, with tendency to constipation. Dr. Christison recommends a strong infusion of cayenne — a teaspoonful in six fluid ounces of boiling water — to be used as a gargle in incipient sore throat — fever being absent. The accidental introduction of a particle of cayenne into the larynx is dangerous ; it has occasioned death. CARAWAY-SEEDS— Are the fruit of an umbelliferous plant, and are too familiarly known to require description. They are a good carminative, may be given whole, in teaspoonful doses, or in the form of distilled water, a wineglassful at a time, or may be added to other medicines, such as senna. CARBON — Carbonic Acid — Carburetted Hydrogen. — Carbon, charcoal, occurs in its purest natural state in the form of the dia- mond and of plumbago, both of which are pure carbon. It is one of the bodies con- sidered elementary, and forms a large pro- portion of the matter of our globe and of its productions. The most familiar form of carbon is that of wood charcoal, which is interesting in a medical and hygienic point of view, from its powerful antiseptic proper- ties, and the rapidity with which it removes the signs of, and tendency to, putrescency. Water which has become putrid, as it fre- quently does, at sea, is quickly restored to wholesomeness by agitation with charcoal powder. The powder is frequently applied to fetid and sloughing sores, either sprinkled upon them or mixed with one of the common poultices : it is a good dentifrice. Carbon, either in a fixed or in a tran- sitory condition, is an important and abun- dant constituent of organized bodies. Of the vegetable kingdom it is the characteristic element ; every leaf and every blade of grass which is exposed to the influence of daylight is busy abstracting from the at- mosphere the carbonic acid, which is con- tinually diffused through it in small propor- tions, decomposing it, and rendering back to the air the vital oxygen, but fixing the carbon as a component of the vegetable solids, and putting it in that form in which, along with other elements, it is fitted to become the nutriment of the animal. Car- bon, although not so characteristic a com- ponent of the animal as of the vegetable kingdom, yet enters largely into the con- stitution of the former ; it assists to give permanent form to the various tissues, and furnishes one of the most active material agents, which, under the influence of life, make up the sum, and contribute to the varied changes and effects which are ever going on in the animated body. We have every reason to believe that carbon is the medium by which, as it combines with the oxygen inhaled by the lungs, and carried through the system by the blood — the ani- mal temperature is maintained. Such being the case, it is evident that, next to oxygen, carbon is the element which must be most regularly and sufficiently supplied to the living body ; the other constituent elements must undoubtedly be provided in food, but their omission for a time is not so apparently and quickly felt as that of carbon ; if this be not furnished from outward sources, it is used up from the bodily tissues as long as they will yield it, even though its use in- volves their destruction, and the dispersion of the other elementary bodies of which they are composed. This actually happens in long fevers, during which little or no nourish- ment is taken ; the carbon — and hydrogen — of the fat in the first place, and afterward of the other portions of the body, is used up in sustaining the animal heat — as fuel — until a point is reached when it can be yielded no longer, and when the patient will CAR 89 CAR actually die of colcl, unless there is freely I administered the gelatinous soups, the wine and spirit, with their abundant carbon and hydrogen, which yield their own combustible elements, to maintain the heat and to pro- J tect the tissues of the already exhausted patient. The discoveries of modern chemistry show us how beautifully the Almighty, in his I goodness, has arranged the products of the various latitudes of the globe, has disposed the varied articles of food he gives to , his creatures, to man, in accordance with the various climates, and modes of life in those climates, so that carbon may be con- | sumed in due proportion along with the j other elements ; less in the watery fruits of the tropics and of our own summers, more in the fats and oils of the cold north. Refer to' Aeration — Blood — Bile — Diges- \ lion — Food — Respiration, §c. CARBONIC ACID GAS, ok Choke-damp— \ Is a compound of one part of carbon with j two parts of oxygen : it is colourless, and much heavier than atmospheric air, a pro- perty which gives it a dangerous tendency to collect at the lower parts of any enclosed spaces in which it may be disengaged. Old j wells, brewers' vats, the holds of ships, &c. j are all liable to become the receptacles for carbonic acid gas, which, formed from some i decomposing vegetable matter, lies like a j stratum of water at the bottom of the re- ceptacle. Should any one incautiously ' descend, so as to become enveloped in the carbonic acid atmosphere, respiration is j either instantly stopped by spasmodic clo- ■ sure of the chink at the upper portion of : the windpipe, and complete suffocation is ■ the consequence ; or the gas, if sufficiently diluted with air to be drawn into the lungs, ■ speedily manifests its narcotic effects upon the system, and the person quickly falls in a complete state of stupor. The respira- tion becomes laboured, and after a time ceases ; the countenance is livid or pale, and there may be convulsion and frothing at the mouth. In such a case, the body of the individual must be removed, if possible, and as soon as possible, from the poisonous atmosphere, or the lat- ter must be destroyed or dispersed. The many fatal accidents which have occurred from persons venturing rashly into wells, and such like places, might be a warning for the future, and prompt the invariable employment of the simple test of lowering a lighted candle into the suspected place. If the flame be extinguished, the atmo- sphere is certainly destructive to life ; if it burn even with a feeble and diminished in- h 2 tensity, there is danger. Of the various modes for destroying a carbonic acid atmo- sphere, none is more speedily effective than the introduction into it of newly slaked lime, either spread upon a board, or mixed with water, and dashed into the place ; fresh lime, having a powerful affinity for carbonic acid, quickly absorbs it. In the absence of lime, a quantity of fresh water dashed freely down, so as at the same time to absorb the gas and promote circula- tion of air, will be serviceable ; or large bundles of combustible material, which will cause currents of air, may, when blaz- ing freely, be thrown in. Caution in the first instance is the best preservative ; but in the event of an individual dropping in an atmosphere of choke-damp, it is per- fectly useless for others to rush in to bring him out ; they can no more exist in it than he could, and in stooping to lift a fallen body, they become all the more thoroughly immersed in the poisonous gas. Instead of rashly sacrificing life in the ill-directed en- deavour to rescue another, let those who are present dash bucket after bucket of water or weak lime and water into the place, and on the fallen person, until the unextin- guished flame tokens that the fatal atmo- sphere is weakened at least ; and when they do venture in, tie over the mouth a cloth soaked in lime water, in a iceak solution of caustic potash, or of simple water, if these cannot be obtained. In cases of suffocation from immersion in choke-damp, cold water should be dashed freely over the individual as soon as re- moved into the open air, and this measure, succeeded by heat applied to the surface, stimulant embrocations to the chest, spine, &c. stinmlant clysters, and ammonia held at intervals to the nostrils, while artificial respiration [compressing the chest and allowing it to expand, or by breathing into the patient's lungs] is at the same time brought into action, and steadily persevered in for some hours. [Medical advice should also be obtained as soon as possible.] Carbonic acid is produced during fer- mentation, or by the slow decomposition of vegetable matter, such as damp straw, sawdust, wood-chips, &c. It is the gas dis- engaged in effervescing liquors generally ; it is also produced, along with other vapours of which carbon forms a constituent, in the burning of charcoal. Poisoning by charcoal fumes, either by design or accident, is not an unfrequent occurrence. In the latter case, it usually occurs from persons ignorantly retiring to sleep in a closed-up room, in which burn- CAR 90 CAR ing charcoal is used as a means of warmth. The carbonic acid and other fumes disen- gaged act slowly and insidiously, and exert so powerful a narcotizing effect, that those exposed to the influence are quickly ren- dered unable to remedy the circumstances, and perfect insensibility ensues. Too often it happens that the discovery of the acci- dent does not take place until morning, long after it is too late to remedy the fatal effects ; the sufferers being usually found dead. If living, they will probably be per- fectly insensible ; the countenance pale and livid. Immediate removal to the open air, and free exposure to its influence by re- moval of the greater part of the clothing, is the first proceeding, when the treatment recommended in cases of poisoning from choke-damp should be followed. Carbonic acid is largely evolved in the process of lime-burning, and persons who have in- cautiously slept in the immediate neigh- bourhood of a kiln have been destroyed by it. The poisonous contamination of the air in crowded assemblies has already been treated of in the articles, "Aeration," " Air," "Blood," &c. There is yet another source of poisoning by carbonic acid, which occurs when it is largely given off from fluids taken into the stomach in a state of fermentation. This accident is said by Liebig to happen in Ger- many in consequence of persons drinking wine while it is fermenting ; the genera- tion of the carbonic acid is stimulated by the heat of the stomach, and it is given off in such quantity as to permeate even the lungs, causing suffocation. The best reme- dy is ammonia, both inhaled and taken into the stomach. In medical practice, carbonic acid is given in the form of effervescing drinks. Some mineral waters contain it naturally ; soda-water and other similar fluids are mechanically impregnated with the gas; it is, also, very frequently given as disen- gaged from one of the carbonates of the alkalies by means of an acid. In most cases, the action of carbonic acid, given in this way on the stomach, is very beneficial ; it appears to be both stimulant and sedative, and no remedy is more generally useful in cases of vomiting ; it is an agreeable form of medicine to most persons. When effer- vescing drinks are given to persons confined to bed, they should always sit up for a few minutes after the daught is swallowed, to allow of the eructation of the air, which, not being got rid of in an horizontal pos- ture, may produce uncomfortable distension. Prefer to Effervescing. CARBURETTED HYDROGEN.— Coal- gas, or fire-damp, is a compound of carbon with hydrogen. The fearfully destructive explosions in the coal-mines are the result of the ignition or this gas when it has col- lected in quantity. Its constant use in dwelling-houses, as a means of light, some- times gives rise to similar accidents ; and occasionally life has been endangered by the inhalation of it when it has escaped into an apartment, as has sometimes oc- curred from persons, unused to gas-light, blowing out the flame on going to bed, in- stead of turning the stopcock. In such cases, a .treatment very similar to that pur- sued in poisoning by carbonic acid may be followed out. CARBUNCLE resembles a boil in many respects, but is larger. It is a hard, in- flamed, intensely painful swelling, of any size up to that of a saucer, or even larger. It is flat on the top, and contains a slough, or mortified portion of cellular tissue, which must be discharged before the disease can subside. After the inflamed swelling has ex- isted for some days, small points of ulcera- tion begin to show themselves through the skin on its surface — they enlarge, coalesce, and at last form one large opening, through which the slough or core is discharged, either entire or broken down and mixed with bloody matter. When all has been got rid of, the cavity begins to fill up from the bottom ; and generally in the course of a few weeks becomes entirely healed. Such is the progress of a carbuncle, which does not | require interference. The treatment con- I sists, in the first place, of assiduous foment- i ation, and poultices of bread, oatmeal, or I linseed meal, and, in the open stage, yeast. When the cavity is fairly emptied of sloughs, the poultice must be exchanged for water- dressing, which will in all probability re- quire no alteration during the cure. A small carbuncle may thus, as far as the sore is concerned, be simply and safely attended to, but much more may be re- quired. Carbuncle occurs in two very opposite states of system — in those of full habit, and in those of broken constitution. In the former, eight or ten leeches may with advantage be applied round the base of a large incipient carbuncle, and free purging, cooling saline medicines, and low diet be resorted to. Should a surgeon be in attendance, he will probably make a free crucial incision to facilitate the exit of the core. In those of broken constitution, the opposite treatment will be requisite — all unnecessary loss of blood must be avoided, and while gentle alterative mercurial ape- CAR 91 CAR rients are given, the system must be soothed by opiates, and supported ty quinine or bark, along with strong meat-broths, wine or porter. In such constitutions, a car- buncle of any size is a serious, and not unfrequntly a fatal affection. Carbuncle is certainly indicative of a deranged state of the system generally, and of the assimila- tive powers in particular ; it more frequent- ly happens, too, that a large carbuncle has been preceded by two or three smaller ones, or boils, in succession. The occur- rence of these ought always to be taken as a warning; the man of full habit should re- duce his diet, meat and stimuli in particu- lar; take exercise freely, and five or six grains of blue pill and compound colocynth pill every night, or every second night, for a week or ten days, with a gentle saline ape- rient in the morning. A tendency to car- buncle in the delicate or aged should always be seriously regarded, not only as indi- cative of functional disorder in assimi- lation, but from the direct danger arising from the disease itself. On this account, it is always desirable that the case should be early put under efficient medical care, so that constitutional treatment may, if possible, ai*rest the threatened evil. In case a carbuncle of any size is developed in persons advanced in life, or of weak constitutional power, it is too dangerous to be left to domestic management if medi- cal assistance can be procured. If not, the treatment should be carried out as above directed. The most frequent seat of carbuncle is the back part of the body and head, the arms and thighs. CARDAMOMS— Are the seed-capsules and seed of a shrub which is a native of the islands of the Indian sea. They resemble orange-seeds in shape, are about half an inch long, and the covering which envelops the seeds is brown and tough, and must be removed. Cardamoms are one of the best aromatics we possess, particularly the com- pound tincture, in one or two teaspoonful doses in water. The powder of the seeds may be given in from ten to fifteen grains at once. CARDIAC— Belonging to the heart. CARDITIS.— Inflammation of the heart is named pericarditis when it affects the membrane covering the outer surface ; endo- carditis when the lining of the cavities is affected ; and carditis when the muscular substance is involved. Acute inflammatory affections of the heart may arise from cold, violence, &c. but in the majority of cases they are concomitant with rheumatism, in the progress of which they are so apt to arise that the medical attend- ant must be constantly on his guard to coun- teract the slightest symptom indicative of a tendency toward the heart becoming in- volved. This tendency he may sometimes detect by means of the stethoscope, even before the patient complains or is conscious of any uneasiness about the organ ; this is of course a great advantage and strong ar- gument why every case of rheumatic fever, however slight in appearance, should be placed under the care of the regular medical practitioner. But the symptoms of inflamed heart, particularly in the above disease, may come on suddenly — while medical aid is hours distant. The patient being seized with palpitation, increased rapidity of pulse, op- pression of breathing, and sense of extreme anxiety in the region of the affected organ, (pain may or may not be present,) every minute is of consequence. Leeches, if pro- curable, should be applied over the region of the heart to the number of twelve or eighteen, according to the condition of the patient. Continued nausea should be main- tained by the fourth or sixth of a grain of tartar emetic, given every three or four hours, and a pill containing three grains of calomel and half a grain of opium given every four hours. Perfect quiet and the lowest diet must be observed. If the rheu- matic inflammation has suddenly deserted a previously inflamed joint, it will be well to apply a mustard-plaster to the place, with the view of re-exciting the action which appears to have been transferred to the heart ; at the same time, it must be remem- bered that the heart may be affected with- out any such apparent transference. The above measures judiciously carried out will do much to retard the progress of so serious a disease as carditis ; and there is the advantage, that from its so frequently accompanying rheumatic fever, an unpro- fessional person will have less difficulty than in many other affections, of making up his mind on the nature of the seizure. In- flammation of the heart, whether arising in the progress of rheumatic fever or not, will of course be characterized by the same symptoms. The treatment recom- mended above rs to be resorted to irre- spective of cause. CARMINATIVES— Relieve flatulence and spasm in the bowels. The principal car- minatives are dill, anise, caraway, lavender, peppermint, pennyroyal, and their various preparations ; but any stimulants and aro- matics, such as nutmeg, ginger, spirituous liquors, &c. &c. are carminatives. C AE 92 CAS CAROTIDS— Are the large arteries which pass up the neck on each side of the wind- pipe, to supply the head with blood. — See Artery. CARRARA WATER— Is an artificially pre- pared effervescing water, holding carbonate of lime in solution by means of an excess of carbonic acid. It is useful in some forms of dyspepsia. CARRAGEEN MOSS.— The article sold under this name is a sea-weed. When boiled in water it yields a vegetable jelly, or muci- lage, which requires flavouring to make it palatable. It is nutritive, but probably not more so than other jellies. One ounce of carrageen, previously soaked for a quarter of an hour in cold quarter, is to be boiled in a pint and a half of water till it is dis- solved. CARRON-OIL, [or "Lime-water Lini- ment"] — Is a mixture of equal parts of lime-water and linseed-oil ; it has been much celebrated as an application in burns, having first come into use at the Carron iron-works, in Scotland. It is certainly soothing, but need scarcely be employed while there are other and less disagreeable remedies at hand. When used it is smeared over the burnt part by means of a feather. Refer to Burns. CARROT— The well-known vegetable, is nourishing, and contains a considerable pro- portion of saccharine matter, but it is not easily digested by weak stomachs, and re- quires thorough boiling to make it whole- some for any. In the experiments of Dr. Beaumont, a carrot was found to take three hours and fifteen minutes of the healthy digestive process for its solution. CARTILAGE— Gristle— Is a white-look- ing, semi-transparent substance, closely re- sembling gelatine in composition. It covers the extremities of the bones at the joints, and also serves as a bond of union between different bones. Bone itself is in the first place deposited in cartilage, which is abun- dant in the young; but as age advances, much of the latter substance — such as that which connects the ribs with the breast-bone — becomes ossified. CASCARILLA BARK— Is obtained from a tree native to Jamaica and the Bahamas. It bears considerable resemblance to cin- chona bark, but is" more aromatic. In dys- pepsia and debility generally it is useful. The infusion is made by pouring on an ounce and a half of bruised cascarilla bark a pint of boiling water, and macerating for two hours. The dose is from a half to a whole wineglassful. The tincture is, of course, a warmer stimulant. One to two teaspoonfuls of the latter may be taken in water, or adgied to other bitter infusions. Cascarilla is used in the formation of pas- tiles. CASSIA PULP — Is obtained from the pod of a species of cassia by boiling. It is a mild laxative in doses of two or three ounces; but at present has fallen into disuse. CASSIA. — See Cinnamon. CASTILE SOAP— Is a hard soap, com- posed of soda and olive-oil, and is used in medicine for making pills, plasters, &c. It is sold both white and mottled ; the former is preferable. CASTOR-OIL— The well-known aperient, is obtained from the seeds of the Ricinus communis, or castor-oil plant, by expression either hot or cold, or by boiling in water. Cold-drawn castor-oil, or what is sold as such, is most generall}' used in this country. [But lard-oil is often added to it by un- principled dealers. The adulteration may be discovered by placing the suspected oil in a cool place, when the lard will harden.] Castor-oil is one of the most certain and safest of our aperients ; in most persons it acts quickly, without pain, clears the bowels effectually, leaves them with a greater tendency to relaxation than before, and does not require the dose to be increased in con- sequence of repetition. From earliest in- fancy to old age, castor-oil may, as a general rule, be given with perfect safety ; but yet there are some persons who cannot take it. Some stomachs will not retain the oil, how- ever disguised ; in a few individuals it acts almost drastically, and produces a painful sensation of piles, and occasionally it causes, during its action, deadly faintness. These, however, are but exceptional instances. In consequence of its gentle but effectual action it is most valuable as an aperient, in properly regulated doses, for persons of weak habit of body. Its certain action, the tendency to relaxation which remains after its employment, and the circumstance that the dose requires rather to be diminished than increased by continued use, render castor-oil peculiarly adapted for those who suffer from habitual constipation. In all conditions of body in which it is desirable to clear the bowels effectually, but without much disturbance, the oil is invaluable — in pregnancy more particularly. Irritation of the mucous lining of the bowels, whether inflammatory, or in the form of simple diar- rhoea, is in many cases more quickly relieved by castor-oil than by any other remedy. — See Bowel Complaint, Diarrhoea, fyc. The great objection to castor-oil, its sickly CAT 93 CAT nauseousness, has given rise to a variety of modes of taking it. Floated in brandy and •water, barley-water, or some aromatic water, are favourite modes with many ; others take it best in hot fluids, tea, coffee, or gruel, the heat getting rid of the feeling of oily con- sistency so disgusting to some. A piece of orange or lemon-peel, chewed just previous to taking a dose of castor-oil, blunts the acuteness of the nerves of taste. Castor-oil may be taken in emulsion made with mu- cilage or milk ; but rubbed up with yolk of egg is the best form of mixture. In this way, it is not so active an aperient as when uncombined ; but in irritable and inflamed conditions of the lining membrane of the bowels, it is especially valuable when com- bined with opium. Six drachms, by measure, of castor-oil, are to be well triturated in a mortar with the yolk of one egg, and to this soft water or some aromatic distilled water is to be added gradually to the extent of six ounces. If an aromatic water is not used, a few drops of some essential oil, such as cin- namon, may be added before the water. The mixture resembles custard in consist- ence. The dose an ounce — two tablespoon- fuls. The usual dose of castor-oil alone is about half an ounce, or one tablespoonful. [When beaten up with the froth of porter, the oil is perfectly disguised, and the porter, rising on the stomach, prevents the eructa- tion of the oil from causing nausea.] CATALEPSY— Is a peculiar affection of the nervous system, caused generally by sudden violent mental emotion. Sensibility to ex- ternal things and the power of voluntary movement is lost ; the limbs remain flexible, but retain whatever position they may be placed in. The signs of life are in this af- fection occasionally so obscured that the person has been accounted dead. Stimulants should be used — as ammonia to the nostrils and stimulant enemata, with continued friction over the body, particularly down the spine. — See Electricity. Refer to Death, Signs of CATAMENIA.— The female monthly dis- charge. See Menstruation. CATAPLASM.— A poultice. See Poultice. CATARACT— Is an affection of the eye which produces opacity of the crystalline lens, and more or less obstructs vision, ac- cording to the extent of the disease. The affection is most common in persons advanced in life, but may occur at any age. An indi- vidual who is becoming the subject of cata- ract complains of seeing objects, as it were, covered by a mist or veil : vision is some- times better in an obscure light, when the pupil becomes dilated. When the disease is a little advanced, any thing placed a little to one side is better distinguished than if it is directly in front. The first opaque spot of cataract occupies the centre of the lens, or the axis of vision, in which situation it can be detected by examination. When cataract is in its incipient stage, its progress may perhaps be arrested by judi- cious treatment : and for this reason the case should, as quickly as possible, be placed un- der medical care. In the interim, the bowels must be attended to, stimulants avoided, and a blister applied to the nape of the neck. When cataract occupies the whole circle of vision, and produces blind- ness, it may be removed by operation. An oculist or surgeon should always be con- sulted on the case. CATARRH — Is an inflammatory irritation of the mucous membrane lining the air-pas- sages — the nostrils and bronchi. It usually commences in the former, and extends to the latter. Catarrh, or "a cold," as its popular name implies, is generally the result of cold combined with damp, but quite as frequently of checked perspiration, in consequence of the individual passing from a heated room to a current of cold air ; it is, too, not im- probable that the recently discovered agent azone, when it exists in excess in the atmo- sphere, exerts an irritant effect upon the respiratory membrane. Catarrh commences with feverish symptoms more or less severe, shivering followed by heat. A peculiar dry- ness and heat of the lining membrane of the nostril is followed by discharge of thin acrid watery fluid, " a running at the nose," and with this there is intense headache between the eyes. Or the throat may be first affected, or the chest itself may be directly attacked, though if not, it will quickly become so ; the windpipe feels as if raw ; there is frequent cough, dry and harsh, or with thin expecto- ration, and the breathing is oppressed ; there is, in fact, subacute bronchitis. The evil of a " neglected cold" has become proverbial, and justly so as it is great. The attack ought to be checked at the first. It has been recommended, that as soon as the nos- trils become affected, a solution of sulphate of zinc — five or six grains to the ounce of water — should be injected into them by means of a syringe ; and it is said that by this means, if adopted in the very first stage, the catarrh may be stopped. This cannot be expected, however, to influence in the least the constitutional symptoms. The first measure in incipient cold is to restore and excite the action of the skin, to get free per- spiration. This is best accomplished by the vapour or warm-bath ; but if these cannot CAT 94 CAU be had, the best remedies are hot water to the feet, a warm bed, and hot diluent drinks, along with diaphoretic medicine. A draught consisting of half an ounce of spirit of min- dererus, one to two drachms of paregoric, and ten to fifteen drops of ipecacuanha wine, with water sufficient to fill a wineglass, should be given with five grains of Plum- mer's pill, on getting into bed, and about an hour after the warm drinks ; in the morning, some gentle aperient, senna, or castor-oil, or seidlitz powder, is to be taken. If there is much irritation of the chest at night, a bran-poultice, a mustard-plaster, or friction with a stimulant liniment may be employed. The treatment above recommended may be followed up for two or three nights in suc- cession; confinement to the house, low diet, and demulcent drinks, such as barley-water, &c. &c. being superadded. When catarrh is not checked, it runs on to cough, in fact to bronchitis, more or less severe. — See Bronchitis. Catarrh is unquestionably the effect in many cases of unavoidable atmospheric changes and influences, but it is much oftener the result of carelessness or impru- dence — of carelessness in not guarding the body against the effects of our changeable climate — for catarrh is a very common dis- ease, and particularly the neglect of wearing flannel or some woollen material next the skin, which is the very best preservative. Rooms, in the house, too warm, and exposure to the air insufficiently clothed, are fertile sources of catarrhal affection, especially in children. Insufficient protection to the feet, and dampness, is another. There is, too, in females, the exposure of the chest, after heated ball-rooms, public amusements, &c. &c. The use of fur round the neck is not unfrequently the cause of cold affecting the throat : while close to the skin, it produces warmth and perspiration, but when the boa or victorine is thrown back, a chill at once ensues. It is not meant to controvert the use of fur, so requisite in this climate, but to guard against the incautious and sudden relinquishment of the protection. Refer to Bronchitis — Influenza. CATECHU, [Terra Japonica.]— An ex- tract obtained principally from trees of the acacia genus. It is chiefly brought from the East Indies and Singapore, is powerfully astringent, and is met with in masses of va- rious sizes, either of a dark brown or of a pale reddish-brown colour. It is used both externally and internally. In some forms of diarrhoea, catechu, used either in the form of infusion, tincture, or confection, is ser- viceable, and also in the form of infusion as a gargle in relaxed sore throat or elongated uvula. In the latter cases, a convenient mode of emplojang catechu is to. permit a few grains to dissolve in the mouth ; for this purpose the pale catechu is the pleasantest. In sponginess of the gums, powdered catechu forms a good dentifrice. One of the most valuable external applications of catechu is in the sore and chapped nipples of nurses ; it must be used in the form of tincture, put on the nipple each time after the infant has been nursed, by means of a small paint- brush or feather, and wiped off with the wetted corner of a towel before the child is put to the breast. To make the infusion of catechu, a pint of boiling water is to be poured upon six drachms of the powdered extract, along with one drachm of bruised cinnamon, and the whole infused for an hour; the dose is from two to four table- spoonfuls. The dose of the tincture is from one to two teaspoonfuls, and of the electuary twenty to forty grains ; the latter is astrin- gent and aromatic, and contains about one grain of opium in every 193 grains. CATHARTICS— Are medicines which sti- mulate the bowels to increased action. Refer to Purgatives. CATHETER.— An instrument used by sur- geons, and with slight exception to be used by them alone, for drawing off urine from the bladder, which is retained in it in con- sequence of disease. Some peculiar cases are entirely dependent upon the use of the catheter for relief, and remain so for years. Under this state of circumstances, the pa- tient ought to learn to employ the instru- ment for himself, and many do so ; with this exception, it must be used by professional hands alone, for even in these it requires both skill and care, and may do serious mischief. In cases which require a catheter to be regu- larly passed, the operation generally becomes easier. The passage of the catheter being simply a mechanical operation, requiring tact, and a correct knowledge of the parts of the body implicated, may of course be ac- quired by any one who will take the trouble to educate himself upon these points. Refer to Bladder. CAUL. — The omentum. — See Omentum. — The term is also applied to a portion of the uterine membranes, which is sometimes carried along with the head of the child at birth, and covers it like a veil. The caul is frequently preserved. Much superstition used to be attached both to the circumstance and to the object itself. CAULIFLOWER— A vegetable of the cab- , C AU 95 CH A bage ti'ibe, agrees better than most other vegetables -with those of weak digestion. The addition of melted butter is injurious. CAUSTICS— Are substances which de- stroy organized tissues by combining with their constituent elements. The mineral acids, strong acetic acid, potassa, lime, ni- trate of silver, [burnt alum,] and refined sugar, belong to this class, and may be re- ferred to under their respective heads. CAUTERY — Is iron applied at a red or white heat to the animal body. It is a powerful means of counter-irritation. CAYENNE.— See Capsicum. CELLULAR MEMBRANE or Tissue, or Areolar Tissue — Is the reticular mem- braneous web which connects the various portions of the body and fills up the inter- stices. It is made up of numberless little fibres and bands crossing each other in every direction, and enclosing small spaces, which freely communicate throughout the body. The most familiar exemplification of cellular tissue, and of its free inter-com- munication, is seen in the blown-up veal of the butcher. In the living body, the areo- lar tissue contains a thin water or serous fluid, which, when it accumulates in undue quantity, constitutes one form of dropsy, finding its way by permeation through the cellular meshes to the most dependent part of the body. CERATE.— An ointment, of which wax forms a component. The hard wax and fluid oil or lard, when combined, forming a compound of convenient consistence. Simple cerate is formed by melting to- gether equal parts of white wax and olive- oil, and stirring during cooling. Calamine, or Turner's Cerate. — See Ca- lamine. [Cold Cream is made of one ounce of rose-water, two ounces of oil of sweet al- monds, half an ounce of spermaceti, and a drachm of white wax, melted together and stirred till cold.] Lead Cerate. — Acetate of lead five drachms, white wax eight ounces, olive-oil twenty ounces. Dissolve the wax by heat in eighteen ounces of the oil, rub up the acetate of lead finely with the remaining two ounces, add this gradually to the larger quantity, and stir during the cooling. Resin Cerate, [Basilicon.] — Take of resin five ounces, lard eight ounces, bee's- wax two ounces, melt them together with a gentle heat, and then stir the mixture briskly while it cools. Soap Cerate — Is sometimes useful : it is better procured ready prepared. CEREBRUM.— The brain.— See Brain. CEREBELLUM.— The lesser brain.— See Brain. CERUMEN— Is the watery matter of the ear, of which the chief purpose is, probably, the repulsion (by its bitterness and other qualities) of insects which might enter or harbour in the passage. It sometimes ac- cumulates to so great an extent, especially in the aged, and in the young, particularly after acute diseases, as to cause deafness, more or less complete, which is generally accompanied with noises and other uneasy sensations in the affected organ. The ac- cumulated wax may possibly be detected by examining the ear-passage with the aid of a candle, [or what is better, a ray of sunshine.] In order to remove the harden- ed mass, a small portion of warm olive or almond-oil must be dropped into the ear for two or three nights in succession, for the purpose of softening and loosening the wax ; after that has been done, the passage must be thoroughly syringed out with warm water, by means of a two-ounce syringe, till the wax is detached and washed out. Some persons become faint and giddy on having the ears syringed ; in such cases the operation is best undergone in the horizon- tal posture. Refer to Ear-syringe. CHALK. — Carbonate of lime occurs abun- dantly in various parts of the world ; it is used in medicine as an absorbent and ant- acid. For medicinal purposes it requires to be levigated, by which process the finer particles are separated: when dried, the pre- paration constitutes the " prepared chalk" of the shops. As a general antacid, chalk is scarcely to be recommended ; but in cases of diarrhoea, especially in children, where much acidity exists, it is highly useful. For the latter purpose, from twelve to eighteen grains of chalk rubbed up in an ounce and a half of dill-water form a mixture of which a teaspoonful may be given to an infant six weeks old, every few hours if requisite. In the case of adults, the ordinary chalk mixture is an excellent preparation ; it may be made with prepared chalk two drachms, powder of gum acacia two drachms, cinna- mon water, or water simply, eight ounces ; a drachm and a half of sugar maybe added, but is quite as well omitted ; better, if the climate is a warm one, as it causes fermenta- tion. To the above mixture, rhubarb, laudanum, &c. may be added if requisite. The dose, two or three tablespoonfuls, re- peated more or less frequently, according to the amount of diarrhoea. The compound chalk-powder, (dose thirty to sixty grains,) CHA 96 CHA and the same powder with opium, (dose five to twenty grains,) are both useful and easily carried preparations, which ought to form part of the domestic medicine-chest of the emigrant ; or, indeed, wherever the usual sources for procuring efficient medicines are far distant. The powders ought to be pro- cured ready prepared. Forty grains of that compounded with opium contain one grain of the drug. Chalk forms an ingredient in the aromatic confection. The practice of sprinkling chalk-powder upon sores, for the purpose of absorbing discharges, &c. is not to be recommended. CHALK-STONE— Is the concretion de- posited around and in the joints of those who sutler from chronic gout. It consists of the lithic acid and soda, which form a comparatively insoluble salt. The liability to the formation of chalk-stone is a reason why those who are subject to gout should, when an antacid is required, make use of potassa, which, in union with lithic acid, forms a much more soluble salt than soda does. Refer to Gout — Lithic Acid — Urine. CHALYBEATES— Are medicines contain- ing iron. The term is well known in con- nection with mineral waters. The most generally used chalybeate springs in England are those of Tunbridge-wells, Cheltenham, and Scarborough ; Leamington and Harrow- gate also possess chalybeate waters, and there are many others, including Hartfell and Peterhead, in Scotland, scattered throughout the island. [These springs are equally nu- merous in the United States, but those of Bedford, Pittsburgh, and Brandy wine are the most widely known. The springs of Saratoga also contain iron combined with other saline substances.] In chalybeate waters the iron is generally in combination with carbonic acid, the taste of the water is inky, and if it be one of those (and they are the most ge- neral) in which the metal is in combination with carbonic acid, when the water has stood exposed to the air for some time, it lets fall a yellowish sediment. Chalybeate waters are, by virtue of the iron they con- tain, powerful tonics, and well adopted as curative agents in diseases of debility gene- rally ;' but they are not to be lightly and unthinkingly used, or without professional sanction. Many persons do themselves se- rious injury by unadvisedly drinking mine- ral waters, under the idea that if they do no good, they cannot do much harm. To persons of full habit, and with any tenden- cy to head affection, even a short course of chalybeate water might be most seriously dangerous. — Refer to Iron. CHAMOMILE— The " Anthemis Nohilis" of botanists, is too well known to require description. The flowers, either fresh or dried, are deservedly classed amid the most useful, safe, and generally employed do- mestic remedies. They are often, it is true, wasted, in making fomentations and poul- tices, for which they are no better than the simple water or bran ; but their infusion taken internally is an aromatic bitter of un- doubted tonic properties, and without nau- seousness. In simple debility of the stomach and loss of appetite, chamomile tea, if not used too frequently, and for too long a time, is at once a safe and a good remedy. Half an ounce of chamomile flowers may be in- fused like common tea, in rather less than a pint of boiling water, or, if time be given, [twelve hours,] in cold water, which makes an equally efficacious and pleasanter dose. Chamomile tea taken warm is often employed as a gentle emetic by itself, or to aid the action of other medicines of the class ; alone it is very uncertain, unless made very strong. From five to ten drops of the essential oil of chamomile, dropped on sugar, is a useful, and not unpleasant carminative. CHAMPAGNE.— This well-known wine contains about 12 per cent, of alcohol, a much less proportional quantity than the strong dry wines, such as port, sherry, ma- deria, &c. When effervescing, however, it exerts a powerful but transient intoxicating effect. Champagne is often accused of causing gout, indigestion, &c. but perhaps these are more likely to be the results of the other luxuries which accompany a cham- pagne dinner, than of the wine itself. CHANCRES— Are small ulcers, the re- sult of inoculation with the venereal poison. They commence in the form of small pus- tules, which, after breaking, degenerate into yellowish-gray-looking sores, around which the skin feels firm or hard. Thorough de- struction of the chancre in the first instance, by means of nitrate of silver, (lunar caus- tic,) is the only safe measure. When the disease has advanced beyond the incipient stage, or indeed in any stage, it cannot be a subject for domestic treatment, and ought more especially, on account of the lament- able results which may ensue should the constitution become affected, be intrusted without delay to proper medical care. CHAPPED HANDS— So troublesome to many in frosty weather and during cold dry east winds, may partly be avoided by care in thoroughly drying the skin after washing. The following lotion will be found useful : — Take of borax two scruples, glyce- CHA 97 CHE rine half an ounce, water seven and a half ounces. This may be used twice a day. CHARCOAL.— See Carbon. CHARPIE. — The loose fibres from scraped linen, used to absorb the discharge from sores. It is more used in France than in this country. CHEESE — Is the curd or caseine of milk mixed with a proportion of butter, pressed, salted, and dried. A general and nutritious article of diet, it is not one suited to weak stomachs. A meal of bread and cheese alone, requires a thoroughly strong diges- tion to dispose of it comfortably. Many, however, who cannot eat cheese in this way, may take it in small quantity with impunity, and, when old, almost with advantage, at the close of a moderate meal. Much of the indigestibility of cheese arises undoubtedly from its toughness- and the cohesion of its particles : this diminishes as it verges toward decay; but is much increased by toasting, which renders the article decided- ly unwholesome. Cheese is said to assist the digestion of other articles of diet; and there is an old rhyme — " Cheese is a peevish elf, Digests every thing but itself." Probably, the power put forth by the stomach for the solution of the cheese acts more readily upon the less tenacious sub- stances submitted to it at the same time. The habitual use of old cheese in any quan- tity is injurious, and may occasion cutaneous eruptions. In Germany a peculiar kind of decay in cheese has occasioned symptoms of irritant poisoning. The caseine, or curd o'f milk, which forms the basis of cheese, very closely resembles albumen in composition ; its nutritive pow- er may be known from the fact, " that from caseine alone, the chief constituent of the young animal's blood, as well as its muscu- lar fibres, membranes, &c. are formed in the first stage of its life." The contrast shown between tough indi- gestible cheese and the milk-curd adapted for easy solution in the stomachs of the young, is a good example of the manner in which an article of diet, nutritive and wholesome, maybe modified as regards its digestibility, by preparation. Caseine is found in the vegetable kingdom, chiefly in seeds. Refer to Milk. CHELTENHAM.— The climate of Chel- tenham is. considered particularly adapted to health, there being neither great extremes of heat nor of cold. To those, however, with whom a dry and bracing atmosphere agrees, its climate is less favourable than some other localities. " The mineral springs of Cheltenham are exclusively employed for internal adminis- tration. They, for the most part, resemble each other as to the nature of their compo- nent parts, yet present considerable differ- ences in the relative proportions of their in- gredients. They are rich in muriate and sulphate of soda. Several of them contain a small portion of iron, and iodine has been lately detected in them. They are but slightly gaseous, and though two or three of them have, when first drawn, a slight odour of sulphuretted hydrogen, it soon passes off, and is probably dependent upon the springs passing through a layer of mud or matter in a state of decomposition. It must not, therefore, be supposed that the so-called sulphuretted wells are analogous in their action with the class of sulphurous springs. * * Besides its saline springs, Cheltenham possesses two chalybeate ones, which, like others of the same class, have a disagreeable inky taste, and are somewhat dark-coloured. From their not containing much carbonic acid, they do not sparkle, and are soon decomposed on exposure to the atrsosphere. " There are many diseases in which the Cheltenham springs may be used with ad- vantage. Persons who have lived in India and other tropical climates, who have been accustomed to take large doses of mercury, will generally derive benefit, less from the aperient than the tonic properties of the waters. For gouty patients, also of a ple- thoric or irritable habit, they are advisable. And in cases of amenorrhea and chlorosis they do good service, where with it a faulty condition of the digestive organs exists." For the substance of the above article, and of others similar to it, the author is in- debted to the work of Mr. Edward Lee, on the " Watering-Places and Mineral Springs of England," and those who desire further information cannot do better than have re- course to the publication itself. [The ex- cellent works on baths and mineral waters published in the United States, especially that of Dr. John Bell, will supply the Ame- rican reader with every item of information required on this subject.] CHERRY.— The fruit of the Primus c&ra- sus. Like other stone-fruits, it is apt to disagree. CHESTNUT— Is the fruit of the Castanea vulgaris; it is nutritious, contains much starch and no oil, like many others of the nut tribe. It is certainly, indigestible from its firm and coherent substance, but is ren- dered much more wholesome by being con- verted into flour, in which state it is largely CHE 98 CHE used on the continent. Roasted chestnuts are more wholesome than raw, but are not fit for weak stomachs. CHEST — Or, in medical language, the thorax, is the important cavity situated be- tween the neck and the abdomen (see fig. xxxiii.) which contains the heart and large Fig. xxxiii. blood-vessels and the lungs. It is separated from the abdomen by the diaphragm, (A,) and is bounded by the breast-bone anteriorly, laterally by the ribs, and supported poste- riorly by the spine, (fig. xxxiv.) It is singu- lar how much ignorance there is among the uneducated regarding the situation of what is called the chest : generally it is referred to the pit of the stomach ; and what is called " a pain in the chest" is in many instances a pain in the former situation. In ordering applications, leeches, blisters, and such like to the chest among the poor, it is absolutely requisite to indicate with the finger the exact spot on which they are to be placed ; otherwise the chances are, that if the chest simply is named, the pit of the stomach will be understood — a serious mis- take in many of the acute affections of the chest, particularly in children. The form of the chest itself is, or ought to be, that of a truncated cone, broad be- low, narrow above, (fig. xxxiv.) It is true it appears the reverse of this, even naturally, and is made to do so still more by the ab- surd ideas about small waists : but the greater apparent width at the upper part of the chest in the living person is due to the shoulders and arms; when these are removed, the contrary is seen to be the case, and the cavity itself, as exemplified in fig. xxxiv., is evidently much more capacious in its Fig. xxxiv. < ^t»- lower than in its upper part. The princi- pal contents of the chest are the lungs (fig. xxxiii. 2, 3,) and the heart (1) with the large vessels immediately connected with it. When by tightly laced stays, or other con- trivances, the lower part of the chest is compressed, the contained viscera must find room somewhere ; the diaphragm yields more readily than the long ribs, and is pressed down upon the liver, stomach, and bowels, disordering their functions, and laying the foundation of disease, while at the same time the free play of both lungs and heart are impeded. In other words, the possessor of that most-desirable physical conformation, a capacious chest, is doing all that is possible to render it otherwise ; or should the cavity be naturally small, to make it still more deficient in size, by arti- ficial restraint, instead of every means being used to augment its capacity. A small chest always gives a greater liability to disease ; all tendency therefore to contraction, stoop- ing of the shoulders, &c. ought most sedu- lously to be watched and attended to, par- ticularly in young people, while the bones are still soft and yielding ; disease may be either the cause or the consequence. The spine, too, should be well examined. Exer- cises which, from moderate exertion, call for full expansion of the chest by respira- CHE 99 CHI tion, and fall play of the arms, are gene- rally useful. The elastic "chest expander," made of vulcanized India-rubber, is a most excellent contrivance for the purpose. Some trades, particularly that of shoe-mak- ing, tend in the course of time to affect the conformation of the cavity of the chest. The physical examination of the chest as regards measurement, the sounds elicited by tapping upon it in various ways with the fingers, and heard by the application of the ear, either directly, or mediately by means of the stethoscope, are most important aids in the investigation of disease, and should never be omitted or objected to. For the purpose of facilitating description, the ca- vity is mapped out by vertical and horizontal lines, in a similar manner to that shown on the abdomen. Refer to Abdomen — Heart — Lungs — Respi- ration. CHEST— Water in.— See Dropsy. CHICKEN-POX— Is a mild eruptive dis- ease, which spreads by infection, and chiefly attacks children, occurring once during life. It is preceded in most, but not in all cases, by slight feverishness for one or two days. The eruption first appears in the form of conical pimples with a white head, on the breast, shoulders, and neck, more sparingly on the face, and on the body generally. On the second day, the vesicles appear like little globular blisters, but with very slight surrounding inflammation ; on the third and fourth days the fluid they contain becomes opaque or whey-like ; they now either break or shrivel up, forming ^hin puckered crusts, which fall off piecemeal in one or two days more, seven or eight days being the whole time occupied by the course of the disorder. Little or no treatment is required beyond a gentle aperient repeated once or twice, and care taken that the child does not irritate by scratching. Chicken-pox might be mistaken for modi- fied small-pox by the inexperienced ; it is distinguished by the absence or extreme mildness of premonitory fever, and by the rapid development, course, and different form of the vesicles, particularly in the absence of the central depression, which characterizes the true small-pox vesicle. CHICORY. — The Cicorium intybus, the root of which, when roasted and ground, forms the well-known adulteration of coffee. Some persons consider the admixture of chicory with coffee an improvement, and at all events harmless, but the recent investi- gations of the "Lancet Sanitary Commis- sion" tend to show that infusion of chicory, alone especially, and also when mixed with coffee in the proportion of twenty-five per cent., produced sense of weight at the sto- mach, languor, and headache ; it has, by an eminent continental authority, been assigned as one of the exciting causes of amaurosis. Infusion of chicory occasionally acts as an aperient, at other times as a diuretic. ■ In consequence of chicory not containing es- sential oil, it has not, when roasted, the fragrance of coffee. Its infusion has a "sweetish and mawkish taste, and is dark coloured, thick, and glutinous." But, al- though chicory is used as an adulteration, the recent Lancet investigations go to prove that it is itself extensively adulterated with various substances. These are " carrot, parsnip, mangel-wurzel, beans, lupin-seeds, wheat, rye, dog-biscuit, burnt sugar, red earth, horse-chestnut, acorns, oak-bark, tan, mahogany sawdust, baked horse's and bullock's liver, Hamburg powder," which consists of peas roasted and ground, and coloured with the next article, "Venetian red," also an adulteration. Perhaps after such disclosures, few persons will prefer chicory in their coffee ; and, at all events, the moral fraud of vending for the pure article that which is mixed, ought not to be suffered. When hot water has been allowed to stand for some time on coffee containing chicory powder, the grains of the latter lose their colour and resemble small brown sago, while those of the coffee become rather darker than before. CHILD-BED.— The term may be applied, either to the actual labour itself, or to the confinement generally, from the first com- mencement of the symptoms to the com- pletion of convalescence. It is in the latter sense it will be considered in this article. The process of child-birth exhibits a series of the most beautiful adaptations to the mechanism and structural and vital endow- ments of the human frame, with every pro- vidential provision for the safety both of the mother and infant during the trying but important event. When the full period of pregnancy is completed, the process, which is to free the womb of its contents, com- mences with the preparatory relaxation of the various parts connected with the pas- sage of the child into the world. Shortly, the long-closed orifice, or "mouth" of the organ begins to open or dilate, allowing, in the first place, the protrusion of the mem- braneous bag which contains the fluid, or waters, in which the infant floats, and which protrusion forms a soft wedge, dilating the maternal structures preparatory to the pas- sage of the hard head of the infant, which follows as propelled by the expulsive efforts CHI 100 CHI of the womb. Sooner or later, however, this membraneous bag gives way under the pressure, the waters are discharged with a gush, and the head itself becomes, in a great measure, the dilating agent. Although at the commencement of labour, the head of the infant is not in this position it should pass at its conclusion from the mother with the face looking directly backward, and in the great majority of cases it does so, attaining the position by a series of turns which can- not be profitably explained to the unprofes- sional. In some cases, however, the position of the head is reversed, so that it passes with the face directed forward, causing a more protracted and painful labour. More- over, the head may not come forward, or "present" first, at all, but some other por- tion of the child will appear, thus causing an irregular or cross birth. Most women form, or endeavour to form, a calculation as to the period at which they may expect to be confined, and, while some do it with considerable apparent exactness, others get far wrong, much to the inconve- nience of themselves and of those appointed to attend upon them. The most usual calcu- lation as regards the duration of pregnancy, is forty weeks from the last menstrual crisis, and this is generally made the basis of the calculation ; but as more cases fall within the period than extend beyond it, it is safer for expectant mothers to arrange their pre- parations for the thirty-eighth week than later. By some it is thought that the duration of pregnancy in the case of a male child is longer than in that of a female. As, however, cases of premature confine- ment of living children are not uncommon, it is always desirable that essentials be pro- vided as early as possible. The most generally received premonitory sign of approaching labour at the full period, is "sinking," that is, from twenty-four to forty-eight hours before the actual process commences, the female seems as if she were smaller and lighter altogether, the waist especially showing a diminution in size. At this time, also, there "is generally a degree of fidgetiness, or undefined mental anxiety, similar to that which is observable in the lower animals, and there frequently exists irritability of the bowels and bladder, call- ing for repeated efforts at relief. When the bowels are very troublesome, and there is much involuntary straining, or, as it is call- ed, "tenesmus," nothing relieves more than a clyster consisting of half a wineglassful of gruel [or thin starch] with twenty drops of laudanum. At length, slight twinges of pain are experienced, either in the womb itself, or in the back, hips, and thighs, or in all together, and there is more or less dis- charge of slimy mucus, generally streaked with blood. Shivering, with nausea or vo- miting, are also frequent concomitants of the first accession of labour. As time advances the pains become more defined and regular ; and when these, the " grinding" pains, have fairly commenced, the first stage of labour may be considered as established. This stage lasts, on an average, from six to twelve hours, but may, of course, much exceed or fall short of this stated period : during its continuance, the mouth of the womb undergoes "dilatation," or full opening. Toward the close of the first or dilating stage of labour, the pains are altered in character, and become ex- pulsive, or, as they are popularly termed, "bearing down;" at first slightly so, but as the process advances their forcing character is more strongly marked, and, in most in- stances, the nearer the birth of the child, the more powerful and nearly connected are they, until at last the infant is expelled. Generally toward the middle of the expul- sive stage, the "waters" are discharged; the sudden gush sometimes causes alarm to the inexperienced, who ought on this account to be forewarned of the circumstance. The whole process of labour, in the case of first children, averages from twelve to thirty hours ; it is, however, not only as regards time, but in every other respect, liable to great variation. Attacks of spurious pain, resembling true labour, are not uncommon during the last month of pregnancy, but these may be known by the absence of the previous sinking, and of most of the other symptoms above enumerated, as character- istic of the real process. The attack is often the result of confined bowels, or of indigestion, and is removable by a table- spoonful of castor-oil with ten drops of laudanum, or by a dose of rhubarb and magnesia. Occasionally, active labour com- mences with a species of spurious spasmodic pains, which want the regularity of the true ones, and only tease and exhaust the patient, who is herself conscious that they are " doing no good." In such a case, the best treatment is to administer five-and- twenty drops of laudanum, and to keep the patient perfectly quiet, so that she may sleep if possible ; if she does so, in all pro- bability she wakes in a few hours with real labour in full activity. But sometimes even sleep does not intervene : the anodyne seems at once to convert the spasmodic into the real useful labour pain, and, contrary to its usual effect, actually to stimulate the pro- CHI 101 CH. gress of the case, Occasionally, when labour has reached a certain stage, pain becomes suspended without obvious cause, and continues so for a longer or shorter period : in such cases patience is the best resource, unless the cessation of pain ap- pears to be connected with some of the complications of child-birth to be hereafter noticed. The discharge of the waters is sometimes the first sign of the commence- ment of labour, or perhaps, more correctly, their discharge from imprudent exertions, such as shakes, jumps, &c. hurry on the pro- cess, which, in such cases, is often lingering. This premature discharge not unfrequently occurs when some other portion of the child than the head is first in the birth. It being presupposed, that every female in expecta- tion of her confinement, if inexperienced herself, will, under the advice and guidance of female friends, provide for and make those arrangements most suited to her indi- vidual case and circumstances, as soon as the first symptoms of approaching labour exhibit themselves, the female attendants ought certainly to be summoned ; but should a medical man be engaged, it is proper, be- fore sending for him, to feel assured that the process has commenced in earnest. When sinking pains, recurring regularly every ten minutes or quarter of an hour, are accompanied with slight " show," as the discharge of slimy mucus is termed, the medical attendant may be safely summoned, and he will, or ought to, see to all subse- quent details. When female attendance is trusted to, these details require to be carefully and judiciously insisted upon: A lying-in chamber ought to be as roomy, and, while free from draughts, as well ven- tilated as circumstances will permit. — See Bed-room. It ought too to have a fire- place, which it is ascertained beforehand can be used without half suffocating the patient with smoke, not an uncommon an- noyance. The bed should be of such mode- rate height that an attendant can con- veniently give assistance to the patient. A mattress is always preferable to feathers, and curtains, as in beds generally, are bet- ter dispensed with. In addition to the ordi- nary furniture, a night-chair and bed-pan should be provided ; and a vessel of some kind which can be used as a bath for the infant. Some waterproof material is requisite for " guarding" the bed against injury from moisture. Formerly, a pre- pared skin used to be the general material, but there are now many waterproof arti- cles, quite as well or better adapted for this i2 purpose. Sheet gutta-percha or India rub- ber answers well, and is cheap. An easy chair, a bottle for pure water, a little bran- dy, a fan, and a bottle of smelling salts, cups and vessels, including a sick-feeder, (see Bed-room,) for administering either food or medicine, are all advantageous additions to the numerous little etceteras ; these are, sponge, washing-flannel, and starch-powder ; a little lard without salt, or cold cream, soft towels, and abundance of napkins or doubles ; four ties or ligatures, each six inches long, and com- posed severally of four plies of stout linen thread; a pair of blunt-pointed scissors that will cut, and a flannel receiver for the infant. A little laudanum and sal-volatile ought always to be at hand ; but when a medical man is in attendance, he more generally carries these with him. One female friend, and no more, in ad- dition to the nurse, should be present at the accouchement; but it is advisable to have another female in the house, though not actually present in the room, particu- larly if a midwife only has charge of the case. Mothers ought never to be present at the confinement of their daughters. As soon as labour commences, the cham- ber should be prepared, all extraneous articles removed, and whatever may be wanted put in order ; the guard placed upon the bed, and the latter so arranged, that when the patient lies upon her left side near the edge of it, there may be plenty of room for those about her to pass and act. The patient herself ought to be encouraged to walk about, and her mind kept occupied and cheerful by conversation ; light nourish- ment, such as a cup of tea or gruel, being given as desired, in small quantity at once ; at this time too, if the bowels are at all confined, they should be unloaded by a dose of castor-oil, or better still, by an enema, consisting of a pint of thin gruel, to which a tablespoonful of olive-oil is added. As time advances, and as soon as the pains ex- hibit signs of "bearing down," the patient, if not previously undressed, should now be so, and the folded binder (see Binder) placed on the abdomen, so as to give gentle and equa- ble support. The patient may still continue to walk about a little ; but as soon as the pains become decidedly expulsive, she must be placed in bed upon her left side, and remain so unless raised up for necessary purposes, until the infant is born. During all this time the room should be kept mode- rately cool — if regulated by a thermometer, about 55° Fahr. The patient, most likely, particularly toward the end of her labour, CHI 102 CHI will become extremely hot, and then the occasional and moderate use of the fan is very agreeable. She should be induced, from time to time, to take a few spoonfuls of gru- el ; but the stomach is not to be overloaded, and above all things, the pernicious and too prevalent custom of giving stimulants, bran- dy, rum, &c. is to be avoided. A case which really requires such aids requires also the presence of a medical man to sanction and regulate their use ; if given when not re- quired, feverish heat, headache, thirst, general uncomfortableness, and, it may be, after bad consequences, are the only results. Amid the poorer, and indeed among some of the better classes in the country, it is customary for patients to be "put to-bed" in their day-clothes. Independent of the uncleanliness of the proceeding, it is"not at all times free from danger, when, after the confinement is over, it becomes requisite to remove, these clothes and substitute the bed-dress. The usual excuse, that it is for the support given by the stays, is quite in- admissible when the binder is used, which amply supplies the place of the y^ove un- desirable articles ; besides, the presence of the stays and clothes may seriously inter- fere with measures which must be taken in some particular cases, such as those of flooding. Another practice which is often followed by midwives cannot be too strongly condemned : it is that of delivery being effected with the patient kneeling on the floor ; it is highly dangerous. Such atten- tion should always be given to the bladder, that it may be duly emptied ; although, in most instances, the sensations of the patient herself insure this point. When the last strong pains of labour are expelling the head of the child, the mid- wife who has, or who ought to have, suffi- cient experience to be aware of the pro- gress of the case, should elevate the upper knee during the occurrence of each pain, for the purpose of affording free space ; this mode of proceeding is preferable to the pil- low placed between the knees, which heats, and is always getting displaced. A towel or some such material is frequently attached to the bedpost or some fixed point, and many women appear to derive comfort from hold- ing it during the paroxysm of pain ; it may be permitted, if if does not encourage too great efforts at straining. The feet must be kept warm; cold feet may retard the frequency and force of the pains. It cannot be too strongly impressed upon the minds of all, that child-birth is a natu- ral process, and that nature is fully compe- tent in all ordinary cases — and in more ex- traordinary ones than might be imagined— to accomplish its end safely and unassisted. And it must and ought to be completed without assistance, or any attempt at assist- ance, as far as female attendance is con- cerned. As soon as the head of the infant is born, the attendant midwife ought to pass her fingers around its neck, to ascertain, as sometimes occurs, that the navel-cord is not twisted around it ; should it be so, she must endeavour gently to slip it over the head, otherwise the neck may be so strongly com- pressed as to occasion fatal strangulation. The cord may be coiled once, or two or three times around the neck. At this period also, the mouth and nostrils of the child — ■ if there is any delay in the passage of the body — should be kept as free as possible from the surrounding discharges, which may be drawn in by the efforts to breathe. Neither ought the body, or even the legs of the infant, to be drawn from the mother ; their expulsion should be left to the natural efforts of the womb; for if too suddenly emptied, its natural action becomes em- barrassed, and irregular contraction, accom- panied with unnecessary pain and discharge, may be the consequence. The infant being fully born, the navel-cord must be tied by the ligatures, which have been ready pro- vided ; the first being placed about three fingers' breadth from the body of the child, and the other about an inch and a half further ; the intervening portion of cord being divided by the scissors. The infant now separated from the mother is to be placed in the flannel, in the arms of the nurse, and put in a moderately warm situ- ation.— See Children. In tying the navel-cord, one or two cautions are requisite. The first ligature must not be placed nearer the body than the distance above-named; and before the second is put on, it is well — to prevent spurting — to squeeze the blood up toward the body of the mother, out of the inter- vening portion. For cutting the cord, a pair of blunt-pointed scissors should be used, and care taken at the moment that no other portion of the child is intruded between the blades ; it has occurred that a finger or toe has been lopped off by a careless attendant. After the cord is cut through, the cut extremity attached to the child must be carefully examined, to make certain that it does not bleed, particularly if the cord be thicker than usual, in which case the tying must be most carefully per- formed. From careless tying and neglect, infants have bled to death from the navel CHI 103 CHI vessels immediately after birth. Should the infant not appear to breathe as soon as born, it is well to delay the severance of the cord for a minute or two, while at the same time the mouth and nostrils are freed from all adhering mucus, and efforts are made to rouse, by blowing upon the face, or by two or three smart taps on the back. As soon as the infant is separated from the mother, it is proper to ascertain by the hand placed upon the abdomen that there is not a twin child ; if there be, the remaining bulk will indicate it in a way that can scarcely be mistaken ; and should it prove so, the recurrence of the pain which is to effect the expulsion of the second child, must be quietly waited for, unless hemorrhage, or some other occurrence, dictates a different course. In most cases of twin children, the second is quickly and easily born, after pain sets in. When labour is completed, the binder must be tightened up, so as to give gentle and com- fortable support to the now lax abdomen, and the patient left quiet until the accession of pain gives signal of the throwing off of the afterbirth. — See Afterbirth. When this is effected, the binder will again require slight tightening, and a warm napkin, sprinkled with brandy, should .be applied' to the mother. At this time, chilliness, succeeding the profuse perspiration, is often complained of, and should be counteracted by some ad- ditional covering. The female must now be allowed to remain quiet, but not left alone, and so far attended to that any symptoms of faintness or undue discharge of blood — ■ flooding — may be detected. If all goes well, a cupful of gruel or arrow-root maybe given, if desired, in the course of half an hour; in the course of another half-hour, a dry, warm, open, flannel skirt, and dry napkins should be substituted for those which have become wet ; but by this time every thing ought to be arranged and quiet for the pa- tient's repose. Such are the incidents of natural and regular labour ; and could we calculate upon the process following undeviatingly the same course in all cases, it might safely and at all times be left to the care of judicious and in- structed females. But, as too well known, accidents and difficulties of the most formi- dable nature will arise, which tax to the utmost the skill and nerve of the well-edu- cated practitioner; and with some, this is an argument why every case of confinement should be attended by a medical man — in many situations, at least, a physical impos- sibility. As, therefore, many cases must be left to female care, the foregoing directions will, it is trusted, lead to their safer and better management, while those which are to follow are intended to point out what cases ought never to be trusted to a female attendant, and what symptoms occurring in a case un- der female care, indicate the approach of such difficulty or danger as requires the at- tendance of the male accoucheur. As a general rule, in a first confinement, it is always desirable to have the attendance of a medical practitioner, and especially so should the female be the subject of any de- formity, such as curvature of the spine, should she in early life have suffered from any tendency to rickets, or been the subject of epileptic fits at any period of life. Also, if there exists any suspicion of heart or other organic disease. If a previous confinement has in any way been irregular, or has re- quired insti-umental or artificial delivery of any kind ; if convulsions have occurred ; or if there has been flooding, either from diffi- culty with the afterbirth, or any other cause, the woman ought never to trust her- self in the hands of a female. When a midwife, either professed or other- wise, is in attendance upon a case, fainting coming on at any period, any symptoms of wandering or delirium, or of convulsion, any unusual discharge of blood while the pro- cess is going on, should at once be the sig- nal for summoning medical assistance ; also, should the labour be more than usually pro- tracted, without obvious cause, provided the pains are regular, sufficiently numerous, or forcible ; should the navel-cord, or any thing unusual, such as the infant's hand, be felt protruding externally ; and lastly, if, after the child is born, there is any difficulty with the afterbirth, (see Afterbirth,) either with or without flooding. In the interval which must or may elapse in many cases before medical assistance can be obtained, should fainting come on, the female must be laid on the bed with the head on a level with the body, air should be freely admitted around her, and smelling- salts used to the nostrils, while brandy or sal-volatile is administered by the mouth. It ought to be ascertained whether there is any discharge of blood externally, and if so, cloths dipped in cold or iced-water are to be freely used to the lower part of the bowels. Wandering or delirium, or convul- sion, must be soothed by the most perfect quiet, and by the free use of cold applica- tions to the head, and mustard-plasters to the calves of the legs ; while if the person be of full habit, and if the face is full and flushed, from six to a dozen leeches are to be applied to the temples. In all cases of unusual dis- CHI 104 CHI charge of blood, the measures recommended tinder the article "Abortion" iire to be em- ployed; and it must be borne in mind, that if the accident occurs after the birth of the child, firm pads composed of folded napkins must be kept firmly bound over the situation of the womb — in other words, one or two inches below the navel — and kept there while cold is used to the external parts. In a case of sudden and profuse outward flood- ing after the birth of the child, occurring in a thin individual, much may be done to ar- rest it, by some one instantly pressing the hand firmly and steadily upon the belly — at the navel — until the pulsation of the great main artery, or aorta, is felt, and felt, as ar- rested by the pressure, to beat up to the hand, but not beyond it. It must, however, be kept in mind that alarming, and even fatal loss of blood — in- ternal hemorrhage, as it is called — may be going on within the womb, and yet be unma- nifested by any outward flow, the first signal of the mischief probably being faintness ; and if the abdomen is now examined, it will be found to have enlarged more or less since the birth of the child. This dangerous con- dition requires the most energetic and well- directed efforts of a medical man to save life, and not one moment should be lost in procuring his assistance. In the interval, the binder well spread over the bowels, and two or three folded napkins placed under- neath it to assist the pressure, is to be tightened well up, and in addition, firm pressure must be exercised with the ex- panded hands of an attendant on the outside of the binder. By this method, the ordinary attendants will do more to retard the further filling of the womb with blood ; at the same time cold is to be used to the lower part of the bowels, and stimulants given sparingly. The medical man, on his arrival, will take much more active measures which could not properly be employed by others. The above dangerous accident of the lying-in chamber will sometimes occur in spite of every care, but it frequently results from bad manage- ment, such as too sudden emptying of the womb by abstracting the child, instead of allowing the natural efforts to accomplish the entire process ; by impatience with the afterbirth, neglect in putting on the binder insufficiently, or not at all, or by moving too soon after delivery. The existence of cough has a tendency to promote its occurrence. The occurrence of internal flooding is some- times indicated by continued pain complained of in the bowels or back, different from the usual intermittent after-pain. Lastly, whatever accident may occur in the lying-in room, it should be the endeavour of those around to avoid the excited hurrying, which too often seeks to do every thing, and does every thing but what is right. This is one reason at least why it is proper to exclude all but the necessary attendants, and especially mothers, from the scene ; they communicate their own alarm to the patient, and aggra- vate the danger, if it exists, by so doing. When a female has enjoyed a few hours' repose after her delivery, if the bladder has not been relieved, it should now be so [but the patient should use a sheet or bed-pan, and not be allowed to rise or even sit up in bed] ; a little light nourishment, such as gruel, may then be taken, and the infant ap- plied to the breast, whether it appears to contain milk or not. — See Breast. If the confinement be a first one, the afterpains will scarcely give trouble. When they are severe, twenty drops of laudanum may be given in a little water. — See Afterpain. Perfect quietude is to be observed. It is not probable that the bowels will act of themselves, particularly if opium has been given ; it is therefore right on the morning of the third day after confinement to give an aperient. Castor-oil is almost universally prescribed ; but when the person is of full habit, and if there exists any tendency to fever, a common black draught is preferable. After the bowels have been moved, the pa- tient, if going on well, is to be allowed an improved diet; a little meat-soup, or light pudding ; and now, provided it can be done without putting the person in the erect pos- ture, the bed may be made, and the night- clothes changed. After the fourth day, ac- cording to the state of the patient, a little solid animal food is to be allowed ; but sti- mulants, whether immediately after the con- finement, or during the period of convales- cence, should never be taken unless for some special reason, such as great debility. At the end of the week, if all goes on well, the female may get on the sofa, toward the tenth day begin to get her feet to the ground, and gradually return to her usual mode of life. During the whole of the convalescence, there is no greater comfort, or more salutary prac- tice, than the free use of tepid water, so as to preserve the strictest cleanliness. By the use of gutta-percha sheeting, drawn under the patient, it may be fully employed with- out wetting the bed. When a confinement has been a moderately favourable one, if the foregoing directions are attended to, there are few cases that will not progress regularly to complete conva- lescence : it is true, that among the poor, some of the means and conveniences cannot CHI 105 CHI be carried out or procured as fully as could be wished ; but the most essential, fresh air and cleanliness, are mostly at command, and might be more freely taken advantage of than they are ; and in all cases something like moderate care ought to be observed — •which is too often not the case. As regards comforts and conveniences, in no way can the charity of the more fortunate be applied to the relief of their poorer sisters, than in the provision both of linen and diet suitable to a time of trial, when poverty is often so severely felt. But recovery after child-birth does not always preserve the smooth course. The accession of the milk may be accompanied with feverish excitement. This, if not ex- treme, is to be allayed by means of aperients, as castor-oil, black draught, or seidlitz pow- der, and effervescing saline draughts, to each of which may be added five grains of nitrate of potassa. Within the first few hours or days after delivery, the woman, if attacked with shivering, or rather shaking, so severe as to shake the bed, succeeded by heat of skin, thirst, delirium, with or without severe pain in the bowels, may be attacked with child-bed fever, and cannot be too quickly seen by a medical man ; in the mean time, the diet must be kept at the lowest ebb. If time must elapse before efficient aid can be got, there should at once be given a pill composed of one grain of opium and five grains of calomel, and this repeated regu- larly every six hours ; if pain is severe, a dozen of leeches at least, if they can be pro- cured, must be put on the' abdomen, and if not, light hot bran-poultices continually ap- plied. If the bowels have not been moved, they must be opened by an enema of gruel and castor or olive-oil, and the thirst be re- lieved by toast-water freely allowed. But the above active measures are not to be the substitutes for a medical attendant ; the attack threatens life, and may require all that skill can do for its removal ; if only a few hours are likely to elapse before aid is procured, the poultices, a single dose of calomel with opium, and the enema, should only be resorted to. If a woman, at any time during the first few weeks after her confinement, becomes excited and talkative, if she wanders slightly, if the eye becomes restless and wild-looking, and if sleep is absent, she requires imme- diate attention, for an attack of child-bed mania is probably impending. A medical man should be immediately summoned. In the mean while, the most perfect quiet is to be preserved around the patient, who should be placed in bed, in a room with the light slightly shaded ; cloths dipped in cold or iced- water be applied to the head, the feet kept perfectly warm, and the bowels, if con- fined, opened by a gentle aperient, but not purged. This, perhaps, is all that it is de- sirable should be done before the case is seen by a professional man ; but on an emergency it may be requisite, without this aid, to re- sort to the use of opium — Battley's sedative solution is the best — of that ten drops, or of laudanum fifteen drops, along with a grain of ipecacuanha powder, should be given in a little water, every half-hour, till quiet sleep is procured, or till at least four doses of either of the above have been administered. Occasionally, shortly after labour, the skin of the patient becomes covered with a "miliary" eruption, consisting of number- less points resembling minute blisters. This is generally the result of overheating or stimulating, and was much more frequently met with in former times than now, that a more cooling and rational system has been adopted. The principles to be kept in mind in the domestic management of child-birth, by those in attendance, are : — To have every thing in order and ready at hand ; to ex- clude all useless attendance ; to encourage the mind of the patient ; to preserve the moderate temperature of the room, and its free ventilation ; to abstain from giving stimulants, and from loading the stomach with food ; to have the bowels clear ; to avoid all meddling interference ; to summon medical assistance on the first appearance of any thing unusual ; lastly, let the patient be assured, that the process, though a painful, is a natural one, and He, who has ordered its marvellous arrangement and adaptations, will be present in the hour of travail. CHILD. — Infancy. — Childhood. — The period of childhood, including infancy, may be said to extend from birth to the thir- teenth or fourteenth year; and truly may it be said that the child is the father of the man; for upon the original constitution, and upon the physical and mental training of this most important epoch of human life, de- pends in great measure the usefulness, and consequently the happiness — it may be the eternal welfare — of the future man and wo- man. The subject of the management of childhood, all-important as it is, can, how- ever, be but briefly treated of in a work like the present ; and the reader who wishes fur- ther information than is to be found under the head of this article, is referred to the admirable work of the late Dr. Andrew Combe. CHI 106 CHI Infancy. — Continued from Child-birth. — When an infant is born, should it, in conse- quence of protracted labour or some other cause, not draw breath, and appear purple on the surface, it is advisable in the first place to pass the end of the finger, covered with a piece of thin calico or linen, into the mouth, for the purpose of clearing away the stringy mucus which not unfrequently ob- structs the passage of air into the lungs. If, under these circumstances, the navel- cord continues to pulsate, it should not be tied for at least two or three minutes, during which efforts are to be made to rouse the child, by blowing sharply on the face, or by one or two slight slaps on the back ; at the same time an attendant ought to be getting a warm bath — temperature 98° Fahr. — in readiness. If, after the lapse of time above mentioned, animation still seems suspended, the cord should be tied without further de- lay, and the infant at once removed and placed in the warm water up to the neck, the body being well supported, and the mouth and nostrils carefully kept from being accidentally submerged. The mouth and throat having been cleared from obstructing mucus as above directed, some one, while the nostrils of the infant are closed, should, by placing their mouth over that of the child, endeavour to inflate the lungs with their breath, and then withdrawing the mouth, to empty them by pressure exerted upon the abdomen and sides of the chest. The direct effort to inflate the lungs having been re- peated a few times, the artificial respiratory movements — alternately pressing upon the ribs and abdomen, and allowing them to recover by means of their own resiliency — should be persevered in for a considerable period. In these cases of suspended anima- tion in infants, electricity is unquestionably a powerful restorative ; but hitherto the difficulties attending its ready application just at the moment have rendered it almost unavailable ; now, however, the newly in- vented electric chains of Pulvermacher will probably place in the hands of the accou- cheur, and, from their simplicity, even of others, a readily applicable source of the above powerful stimulant. — See Electricity. When an infant exhibiting full signs of life is separated from the mother, and placed in the flannel receiver, it must not be covered up too closely — the caution is not superflu- ous, for infants have actually been smo- thered in this way by the extra carefulness of the nurse ; it must, too, be placed where it will be warm. As soon as the child can be attended to, it ought to be examined all over, to ascertain whether it be perfectly formed ; and the tying of the navel-cord should be seen to be secure. Washing with warm soft water — temperature 98° — soap, and soft flannel, is the next requisition. The skin of a newly-born infant is covered with a white unctuous matter, which is to be removed. This may be best accom- plished by greasing the skin thoroughly with lard or oil before washing it, and then rub- bing it as gently and effectually as possi- ble, without fraying the skin, the arm-pits and other folds of the body being particu- larly attended to. The child, after being washed, is often dried upon the receiver, placed on the nurse's knees ; a better plan is to have placed on the lap a moderately soft pillow, covered with two or three large warm napkins, on which to lay the child. The drying, which should be done in cold weather at a moderate distance from a fire, having been effected gently, without scrub- bing, a little starch-powder should be dusted into the folds of the groins and arm-pits, but not elsewhere, unless the skin appears frayed. The portion of the navel-cord re- maining attached to the child is now to be wrapped in a piece of soft linen, which is kept in place by a binder of fine flannel, five inches wide, and long enough to pass twice round the body of the child, so as to give support without pressure, and fastened by needle and thread — not by pins : if too firmly applied, the respiration of the infant is inter- fered with. The remainder of an infant's clothing is so much regulated by custom and other considerations, that it is unnecessary to mention it here, further than to impress the rule that it should be perfectly loose and easy, and fastened entirely by tying or sew- ing. A cap should never be placed upon a child's head, which is naturally hot enough to do without artificial covering. [This is the general practice of the present day, and is chiefly adopted by mothers as saving trouble ; but it is doubtful whether the cases of deafness and gatherings in the head, snuffles, and sore eyes, now so common among children, may not arise from this departure from the habits of our forefathers. A thin cap is a protection from sudden changes of temperature, and upon the bare head of an infant cannot do harm. Few adults even with a full head of hair sleep comfortably without covering the head.] When the in- fant has been dressed, it should be laid to rest in the cradle, or place prepared for it, perhaps beside its mother, but at all events where it will be sufficiently warm. It will probably sleep for some hours. It ought not to be fed for the first few hours after birth. As too frequently practised, the unfortunate CHI 107 C II I baby is dosed with "rue tea," " sugar and butter," or some such mess, or stuffed with soaked bread or gruel, and the first founda- tion laid of the disordered bowels, wind, screamings, &c. &c. which are so general in young infants. When the infant wakes from its first sleep, or, at all events, in the course of four or five hours after birth, it should be put to the breast ; even should there not be sufficient secretion of milk to satisfy the child, it is well both for it and the mother that it should be thus early in- duced to take the nipple. If, as may occur, the milk-flow is delayed, it will be necessary to give the infant the artificial support of cow's milk, unskimmed, but diluted with nearly half water, and very slightly sweet- ened : this may be given, either from a com- mon nursing-bottle, or by means of a spoon, but the former is preferable. On no account should any thing like bread, gruel, or the like, be allowed to pass the lips of a newly- born infant, unless under the pressure of extreme necessity, such as might happen on board ship, and then the powder of grated biscuit, or of twice-baked bread, softened in water, is the least hurtful substitute. The first milk of the mother is thin and serous, and is generally considered to exert an ape- rient action upon the infant's bowels, by which the slimy olive-green discharge named "meconium," which first occurs from them, is carried off. Should the bowels not act within twenty-four hours after birth, from six to eight drops of castor-oil should be given, mixed with a small quantity of moist sugar. Should this have no effe<5t, it may be re- peated ; but should the infant appear to make the straining effort to relieve the bowels, without its being effected, the vent ought to be carefully examined by a medical man, as it may happen that closure of the bowel, complete or partial, exists, but which may, nevertheless, be remediable. The case is not common, but its possibility is not to be forgotten. The majority of mothers are able, and ought, as a sacred duty, to nurse their own infants ; but cases occur in which, from illness suc- ceeding the confinement, or from general weakness of constitution, a female is unable to do so, either with benefit to herself or the child. When she cannot, it becomes a se- rious question, whether the duty of nursing is to be devolved upon another, or whether the infant is to be brought up by hand. The general voice says the former — the au- thor confidently asserts that the latter is preferable. In the first place, it is requi- site to provide a nurse whose own infant is of the age, or nearly so, of the infant to be wet-nursed ; it will not do to put a young infant to the breast which has been nursing for many weeks or months. This is the first but the lightest difficulty. [Children have often done perfectly well upon breast-milk eighteen months old, though that nearer the age of the child is certainly the best.] But there is a much more serious consideration. We have yet to learn the full measure of influence, both physical and mental, which may be exerted upon the child by the pecu- liar physical and mental constitution of the foster-mother from which it draws its first nourishment. It is true the physical de- velopment is generally rigorously scruti- nized, but how are passions and mental tendencies to be measured ? And we do know that the class from which wet-nurses are often selected are certainly not in the habit of controlling their appetites and passions ; and further we know, that the physical qualities at least of the milk are very liable to be affected by the mental emotions of the nurse : here at least is one source of danger, were we sure, which we are not, that there is no deeper, more lasting, life-felt influence exerted. And withal, it is quite possible that some physical taint, venereal perhaps, (it has happened and may happen,) has escaped the searching examination of the selecting physician. These are all serious consider- ations for a mother before she submits her child to draw its first nourishment from the body of a stranger ; one too, who must either be suffering from the intense grief which every mother feels who loses her infant from her breast, and whose milk must be affected by that grief, or who must have been com- pelled by poverty, and all its physical evils, to undertake the task ; or one whose mental constitution is so unscrupulous, that, with- out necessity, she will consent, for gain, to east aside her own infant, and, at the risk of its welfare, give its birthright to a stranger. Are any of these the qualifications which a mother will choose for the nurse of her child, even if she has the selfishness to tempt another to desert her own legitimate offspring ? Medical men often witness the painful sight of one infant declining away, while the mother is nourishing another into strength. The system and importance of wet-nursing has been much overrated ; for it is perfectly possible, if the care and trouble requisite will be incurred, to bring up a child by hand, as well and healthily as at the breast of a foster-mother. Care and trouble it does involve ; but if these are grudged, the child had better go to its grave at once. In bringing up a child by hand* milk CHI 108 CHI must be its only nourishment for the first three or four months. Ass's milk or goat's milk may be employed, but more generally cow's milk will be used, either with or without the cream removed, according to its richness, and according (as the first few days' experience will show) to its effect upon the infant. The milk is to be diluted with one-third water, and just perceptibly sweetened. It is not to be given by spoon, but by means of a common nursing-bottle, which should always be of glass. (See fig. Fig. xxxv. xxxv.) Of these bottles there should be two, both on account of accidents, and also, that unvarying and essential cleanliness may be observed. Without the most scrupulous care, (and on this depends the success of bringing a child up by hand,) the purity and wholesomeness of the food cannot be pre- served. The milk and water should be mixed fresh, at least twice a day, and, in summer, kept in vessels immersed in cold water ; it is to be given to the child at nearly the temperature of the body, about 96°. The food is to be sucked from the bottle, and much care is requisite in the management of the artificial " sucks" which are used for the purpose, and which are of great variety : they are made of silver, caoutchouc, prepared teats, wash-leather, parchment, linen, muslin, &c. Whichever material is preferred, it should, without being too impervious, occasion the infant some exertion to draw the milk through it, if it does not, the child is apt to overfill the stomach, and loses the exercise which it has when it draws its nourishment from the breast of the mother. Silver is gene- rally too hard for the gums. India-rubber sucks of excellent quality are now made ; or wash-leather, or parchment, or double linen, or muslin will be found convenient, accord- ing to the strength of the infant. Which- ever is used, it must be made up into the form of a cone, or like a small jelly-bag, with a piece of sponge about the size of a large pea, to give a little substance, fastened inside by one or two stitches passed through. The suck must then be firmly tied to the end of the feeding-bottle, and will require changing every day, otherwise it becomes sour-smell- ing and unwholesome ; independent of which, wash-leather thickens and becomes impervious, and the other materials arc apt to wear through. Again it is repeated, that the most thorough cleanliness, in milk-can, bottle, and suck, is to be observed, and must, except in rare instances, be a mother's care. Another caution is requisite. In feeding children from the bottle, careless nurses may frequently be observed to incline it the wrong way, so that the infant goes on for a time sucking wind. For the first three or four months this milk-and-water food is all that is requisite, with the addi- tion, if at any time the bowels should be too much relaxed, of a portion of isinglass, from one to two small teaspoonfuls dis- solved in the half-pint of fluid. About the fourth or fifth month, a small portion of arrow-root or wheat-flour may be boiled in the water before it is added to the milk; and about the seventh or eighth month, the spoon may be used to give some of the more solid milk and farinaceous preparations. In bringing up by hand, the child will, as at the breast, require feeding about six or seven times in the four-and-twenty hours, for the first three months at least — about six tablespoonfuls, or one ounce and a half, on the average, being given at once, at first, and the amount gradually increased. Small, delicate children, however, will scarcely take half the amount above stated, and great care must be taken, both with them and others, not to allow the stomach to be overloaded. If an infant is habitually sick, [or has diarrhoea,] the quantity allowed at once must be reduced ; for, though happily the infant stomach relieves itself easily of superfluous food, it is better to avoid the superfluity than trust to the sickness, not- withstanding the popular fallacy that sick- ness is a sign of infant health. The system of rearing by hand is much more prevalent in some parts of Germany than in this country. The following pas- sage from the work of Dr. Andrew Combe, the substance of which he says he derived from the German work of Dr. Von Ammon, is so full of practical instruction, that the author makes no apology for quoting it at length : — " In some constitutions, however, cow's milk does not agree when merely diluted and sweetened ; but answers perfectly well when a large proportion of water and a small quantity of any well-prepared fari- naceous substance is added. In this case, it is a common custom in some parts of Germany to dilute the milk with a weak infusion of any light aromatic, such as - linden-tree flowers, instead of pure water. But after the first month or two, where CHI 109 CHI diluted milk does not agree, a small pro- portion of well-boiled arrow-root, grated Dutch rusk, or well-baked or toasted bread, sometimes forms a very useful addition wherewith to thicken the milk to the con- sistence of thin gruel. Briand, indeed, re- marks that milk diluted and boiled for a length of time with any light farinaceous substance, is more easily digested by some infants than pure milk ; and that when the use of milk alone is followed by white and curdy evacuations, a change to a bouilli, made of milk and farina, often restores them to a healthy colour and consistence. For this reason he recommends panada, made by boiling for a length of time in water, or milk and water, thin slices of bread, previously well dried in the oven. Another, of which he speaks highly, is the creme de pain, made by infusing in water for several hours well-baked bread, previ- ously dried in the oven in slices, and boil- ing it gently for some hours more, adding water from time to time to prevent it be- coming too thick. It is then strained and sweetened, and a few drops of orange- flower water are added. For infants a few months old, arrow-root, sago, or semo- lina may be used in the same way. The bouilli in common use in France, as the first food of infants, is made by gently roasting the best wheat-flour in an oven, then boiling it for a considerable time, either in water or in milk and water, and adding sugar to it. When carefully made, not too thick, and free from knots, it is considered an excellent food, especially where the use of milk excites a tendency to diarrhoea, or colicky pains. On changing to the bouilli, the digestion immediately im- proves, and the evacuations become healthy and unattended by pain. "In some instances, especially when the bowels are sluggish, barley-water or thin gruel, with or without the addition of weak chicken-tea or beef-tea, answers best ; and the grand rule ought to be to follow what seems best suited to the individual consti- tution. In soft, flabby children, the chicken or beef-tea is often most useful ; while in thin, active, and irritable infants, the milder milk and farinaceous diet answers best. But in trying the effect of any alteration we must not be too rash, and, because no advantage is apparent within a day or two, conclude that therefore it will not agree. In many instances, the effects of a partial change of diet show themselves so gradu- ally, that it is sometimes only after an in- terval of a week or two, or even longer, that K we can tell positively whether benefit will result from it or not." When the infant is to be nursed at the breast of its mother, it ought, as above di- rected, to be. put to it, unless some cogent reason forbids, within six hours after birth, and from that time it will require it every three or four hours for the first few months. It may be requisite, either from weakness of the child, or some other cause, (see Breast,) to have the nipple drawn out either by a stronger or older infant, or by some other means. Should the mother not be able to nurse her infant entirely, the extra feeding must be conducted upon the rules laid down for bringing up by hand. The first few weeks of an infant's life are spent principally in sleeping and taking nourishment ; movement is but little in- dulged in, and consequently the power of sustaining the animal temperature is but slight; for this reason care is always re- quisite that sufficient heat be preserved, both of clothing and of situation, during the day, and by the infant sleeping with its mother or nurse during the night, for the first few weeks of its life at least. Equally important with temperature, nay, even more so, is the purity of the atmosphere which a young child breathes ; errors in this respect have led to the most deplorable loss of infant life. One instance is sufficient to illustrate the point : it is the well-known one of the Lying-in Hospital of Dublin, in which, at one period, one child out of every six died within the first fortnight of exist- ence ; but by the adoption of proper means of ventilation, this very great mortality was at once reduced to one death for every nine- teen or twenty children born. It is unne- cessary here to repeat what has been said in the article, "Bed-room," upon the means of ventilation, &c, and to that article the reader is referred. The cradle or bassinet in which an infant sleeps should not be smothered up with curtains ; and it is bet- ter, for some time at least, without sheets, light blankets only being used. The mattress should be hair if possible ; but where economy is requisite, cotton-wool will answer the purpose ; it should be pro- tected from wet by means of waterproof material of some kind. A pillow too large and soft is not advisable, for, by allowing the head to sink into it, an injurious amount of heat and perspiration is promoted, and the child rendered susceptible of cold when taken up. The skin of an infant requires the most scrupulous care ; by its powerful agency it frees the body from matter which CHI 110 CIII must be noxious if retained, and which is especially apt to act injuriously upon the susceptible infant nervous system. The skin ought to be washed with tepid water and soap, night and morning, and, after each washing, reaction promoted by gentle friction with the hand for a few minutes. Care must always be taken that the situa- tion for washing is sufficiently warm, but not, as too often the case, before a scorch- ing fire ; draughts of air are especially to be guarded against. Before leaving this subject, it is requisite to notice the filthy custom, prevalent among the poor, of allow- ing the scurf, the oily secretion, and the dirt, to cake upon the skin of the head, under the idea that it preserves from cold. The habit is not only disgusting, but is pro- ductive of disease — perfect cleanliness is as requisite here as elsewhere. In fat children the creases or folds in the skin require extra attention, from the liability of the opposed surfaces to become inflamed, and to pour out an irritating moisture ; dusting with starch-powder, or the intervention of a piece of soft linen spread with simple cerate, may either of them be used as a remedy. The portion of navel-cord which is left attached to the child, will require attention. This separates by a kind of moist decay ; it may come off en- tirely by the fourth day, or take a fortnight to do so ; it must never be hurried. Gene- rally, when the navel separates, it leaves the puckered closing of the skin perfectly com- plete. It sometimes, however, occurs, that bleeding or inflammation and ulceration take place at the time of separation ; such cases ought at once to be placed under medical care. When actual bleeding occurs, the condition is all but hopeless. When the opening at the navel does not thoroughly close at birth, protrusion of a portion of the bowel takes place when the child cries. This state of things, apt to occur when the cord has been of more than average thick- ness, requires much attention, as the com- fort and safety of the individual, especially of a female, in after life, may be considerably interfered with if the malformation is not, as it may be, cured in childhood. The belly-band, or binder, has of course con- siderable power in preventing the protru- sion through the navel opening ; but in these cases it is not sufficient; and for the first few weeks, one or two graduated compresses, made of folded linen, should be placed over the navel underneath the binder ; and when the child is a month or six weeks old, the following apparatus must be used: — From a cork, the diameter of which is about half as large again as that of the protrusion, a slice the eighth of an inch thick is to be cut, flatly padded, covered with linen, and affixed to two cross-pieces of plaster by stitching. (See fig. xxxvi.) The plasters, Fig. xxxvi. being warmed before application, are used to retain the padded cork directly over the opening of the navel ; above all the binder is applied. The plasters will probably re- quire renewal every few days. It is better to trust to the linen pads alone, as long as any tendency to inflammation of the skin exists, using at the same time a plaster of simple cerate or goldbeater's leaf next the skin. Instead of either linen or cork pad, one of vulcanized India-rubber, filled with air, might be substituted. The treatment of navel protrusion, or hernia, in infants, and the management of the apparatus, in- volves some amount of care and trouble, but not more than the necessity and im- portance of the evil demands for its rectifi- cation. In such cases the infant should be kept from crying by all reasonable means, the best preventive being the careful atten- tion to the rules of health laid down in this article. Rupture at the groin may occur in chil- dren at birth, and may be suspected to exist when unusual fulness or swelling is observed in this situation ; and if the fulness and tension is increased when the child cries, the case should at once be seen by a medi- cal man. Any malformation with which an infant is born, ought as soon as possible to be sub- mitted to the judgment of the surgeon, so that he may have full opportunity of fixing the appropriate time for its rectification or removal. The operations for hare-lip, dis- torted joints, such as club-feet, are how performed at a much earlier period than they used to be formerly. In the case of vascular nsevus, or mother-mark, which often increases rapidly from a mere percep- tible point to a large size, surgical interfe- rence as early as possible is most important, These ngevi are composed of so thick a net- CHI 111 CHI work of capillary vessels as to be almost spongy, and, should they be accidentally ■wounded, bleed freely, and if of any size, dangerously ; they vary in colour from bright re'd to purple ; if the finger be pressed upon a nsevus, it becomes emptied of blood, and pale; but the instant the pressure is removed the blood, and consequently the colour, instantly return. There are various methods employed for their removal ; but the one used in each case must depend upon the surgeon. A simple, painless, and fre- quently successful mode of cure, is vacci- nating upon the naevus, "which is cured by the inflammation which takes place in the progress of the cow-pox. The possibility of this being done is an additional reason why the disease should be seen as early as possible by a medical man. The continued use of the compound tincture of iodine to a nsevus, the surface being painted over with it night and morning, will, sometimes, if per- severingly adhered to, be successful in remov- ing it ; the application being intermitted for a few days should the skin become sore. Tongue-tying in infants is not uncom- mon ; it depends on too great prolongation of the "fraenum," or bridle which retains the tongue in place. It is easily rectified by a snip of the surgeon's blunt-pointed scissors. The time at which an infant may first be taken out of doors after birth must depend, of course, greatly upon the time of year ; in fine "warm summer weather, in the course of ten days or a fortnight, it will be safe to make the change ; in winter it can scarcely be prudent to do so for a month or six weeks, and then only on a fine day. In either case, free exposure in the house should first be practised, the first airing should not extend longer than twenty minutes, and the eyes, especially at first, must be shaded from the glare of the sunlight : of course, either the chill of morning or the damp of evening must be avoided. A young infant should not be taken. out during the prevalence of an east wind. The principal ailments, likely to come under domestic management, to which in- fants are liable, are thrush, red gum, colicky pains in the bowels, and diarrhoea. For the first — thrush — the reader is referred to the article " Aphtha." Red gum is a mild species of "papular" eruption, to -which many children are subject soon after birth. It is quite devoid of danger, and requires no treatment if the bowels are in good order ; if uot, a dose or two of castor-oil may be given. The usual friction after washing must be moderate during its con- tinuance. Inflammatory swelling of the breasts in infants is not unfrequent. — See Breast. Most infants are troubled, more or less, with wind, or colicky pains in the bowels, and not unfrequently with diarrhoea, but these are much aggravated by errors in feeding so universally prevalent, particu- larly among the poorer classes : sometimes, when the child is nursed entirely at the breast, particularly of a wet-nurse, they are caused by the nurse's transgressions in diet. Attention to the rules already laid down under the head of feeding will greatly pre- vent the above ailments ; but when they do occur they must be rectified as simply as possible, but never by the dangerous and baneful quack carminatives so extensively sold and used. Pain and wind in the bow- els in children are generally connected with superabundant acidity; for the cor- rection of the cause and its consequences, either of the two following mixtures may be used moderately, both with safety and good effect. No. 1. — Take of calcined mag- nesia twelve grains, dill [or anise-seed] water one ounce and a half. No. 2. — Take of prepared chalk ten grains, dill-water one ounce and a half. Of either of the above mixtures, a small teaspoonful may be given, and repeated if requisite. The first, No. 1, is to be selected, should the bowels be at all confined ; the second, No. 2, should they be too relaxed. It is not recommended that either of these medicines, simple as they are, or any others, are to be given too freely to infants, and on every slight occa- sion; but it is better to give them than to allow a child to suffer; they, or something similar, ought to be the substitutes in every nursery for the secret quack nostrums. It is true they will not either as quickly stop pain or put a child to sleep as mixtures which contain opium or poppy syrup ; but they cannot, like them, either put it into its last long sleep by an overdose, or injure not less fatally, when frequently used, even in small doses, by gradually disordering the brain and nervous system. When either of the mixtures above recommended are given to children, or indeed whenever magnesia or chalk is given habitually, it is always prudent to give an occasional dose of castor- oil, as cases have occurred in which concre- tions of the above antacids have accumulat- ed in the intestines. The dose of castor-oil for a young infant may be from ten drops to half a teaspoonful. In cases of diarrhoea, should the affection be slight, and the infant be a hand-nursed one, the addition of isin- glass to the milk food will, in most cases, stop the tendency at once, particularly if CHI 112 CHI assisted by a few doses of mixture No. 2, and by a warm bath for five or six minutes, at a temperature of 98°, regulated by a ther- mometer. Should the affection be more severe, the emulsion of castor-oil with yolk of egg (see Castor-oil) must be given. To one ounce and a half of the emulsion, made with a teaspoonful or drachm of castor-oil, two drops of laudanum are to be added, and one teaspoonful, or twelfth part, given once in six hours. And here the opportunity is taken to warn the reader respecting the administration of opiates to children. They are most susceptible of the influence of the drug, and accidents are continually occur- ring — more frequently perhaps than comes to light — from its effects : a single drop of laudanum has been known to prove fatal to a young infant. The above treatment is given, not as an inducement for parents, who can readily procure medical aid, to take the treatment of their children, when ill, into their own hands, but it is because it may be of service in situations when skilled assistance is not readily procurable. Many of the diseases of children commence in- sidiously, but after attaining a certain stage, run their course rapidly. No parent, therefore, who either values his child's life or his own peace of mind, should delay pro- curing medical assistance when real illness shows itself; but at the same time, the very same reason ought to induce every parent to inform himself upon the nature of the symptoms which most generally usher in real illness in children, and also how and by what means the illness which these symptoms indicate is to be most effectually retarded and obviated. More upon this head will be given when the diseases of childhood generally are touched upon. Within the first five months of an infant 's life, vaccination ought to be performed, that is, before the constitution is liable to suffer from the irritation of teething. — See Vacci- nation. The period of teething varies extremely, and not less so in the manner in which it affects children. For information upon the mode in which the teeth are developed, the reader is referred to the article " Teeth." Some children cut the two front teeth of the lower jaw — which always appear first — as early as the .fourth or fifth month, while others, apparently equally strong, do not have them developed within the year. The usual and popularly received sign of approaching tooth-cutting is water- ing of the mouth; but this may continue for many weeks before the teeth appear. Before the teeth come through, the gums flatten on the top, look semi-transparent and full, and are sometimes extremely swelled and inflamed. The constitution of the child always sympathizes more or less with the cutting of the teeth — most simply and beneficially so by the occurrence of mild diarrhoea, which is always — unless it goes to an undue extent — a safeguard, and is better not interfered with. When the gums are much swollen and inflamed, and must be very painful, the susceptible brain and nervous system of the child is strongly and injuriously affected by the irritation. The little sufferer is fevered, flushed in the cheeks, and peevish ; sleep is disturbed with moaning and starting, and the fingers are constantly in the mouth, or the lower jaw is moved from side to side. In such cases, lancing the gums thoroughly, warm baths, and aperients if the bowels are not relaxed, are the remedies, the first especially, without which the others are useless or nearly so. The popular idea, that lancing the gums is beneficial, by assisting the passage of the teeth through them, is quite erroneous, and may lead to an erroneous method of performing this simple little operation, which every parent who lives at a distance from medical assistance, and par- ticularly in emigrant life, ought to know how to do. The real benefit is derived from the relief which the incisions afford to the tense and distended gum, and from the slight flow of blood which follows ; and on this account it is advisable, not only to cut the upper surface, but also the side of the gum, so as to divide the vessels freely. The operation is most conveniently and safely done by a "gum lancet" made for the pur- pose, (see fig. xxxvii.,) but a common pen- Pig, xxxyii. knife may be employed on emergency, the blade being wrapped with a piece of linen, to within a short distance of the point, to prevent any chance cut to the lips. It is superfluous to describe this simple proceed- ing : it should be seen done once, or at least the method shown. It is not recommended, of course, that the gums are to be lanced for every slight irritation of teething ; but when the child exhibits the graver symp- toms above described, it ought to be done at once, and, if requisite, repeated again and again. In addition to lancing the gums, a warm bath for ten minutes will be found CHI 113 CHI eminently serviceable in soothing the Irri- tated system, and aperients should be given — a couple of grains of gray powder at night, followed by a small teaspoonful of castor- oil in the morning ; or if stronger action be thought requisite, a powder composed of one grain of calomel to two of powdered scammony is to be given at bedtime to a child of six or eight months old. If the irritation attendant on teething produces convulsion, medical aid must be had as soon as possible, and, in the mean time, those remedies employed which are suitable. — See Convulsion. In judging of the diseases of children, it ought to be borne in mind that the pulse of an infant is always quick, averaging from 120 to 130 in the minute, and that at the end of the first year its average is still con- siderably above 100. — See Pulse. The regulation of the exercise of young children is of much importance. At first the mere respiratory movements, occasional crying, and the effort of sucking, are exer- cise sufficient, if gentle nursing movements be employed : but gentle they must be ; the system so often adopted of jerking infants about is much to be condemned, and may be extremely hurtful. In the course of a few weeks after birth, the infant begins to show signs of increased power of movement, and evidently experiences phy- sical pleasure in the exercise of its limbs. As time goes on, its next effort is to sit up in the nurse's arms, till, if a vigorous healthy child, at about fourteen months, it generally tries to walk. All these move- ments will come spontaneously to the child, when its frame and muscular powers are adequate to the exertion, but- they should never be forced. It is astonishing what an amount of practical ignorance prevails on the above point ; children are put to sit in chairs, held upon their feet, or put in go- carts of various construction, long before the bones are fit to bear the weight — and curved spines and distorted legs are the consequences. Again it is repeated, every advance of the child toward walking and the upright posture can only be safe when spontaneous. When a child first commences to walk it must get falls, but it is sur- prising how little material injury the head, which most generally suffers, seems to receive. At the same time, in families in which a tendency to head affection exists, extra care must be taken ; a padded band round the head is a useful protection, and one frequently employed. When a child begins to walk, and to at- tempt to talk, the period of infancy may be k2 considered as ended, and childhood begun. Many of the directions applicable to the former are equally so, in a modified degree, to the latter, and vice versa; but "child- hood" requires further remark. When dis- tinct nursing is no longer requisite, the child becomes more truly the inhabitant of the nursery, and much of its health and hap- piness for the next few years of its life will depend upon the proper regulation of this important department of the household. Whatever is said respecting the necessity for pure air and proper ventilation, either in this article or in any other, such as "Bed-room," applies of course to the nur- sery, or rather nui'series ; for every parent, whose means will admit, should provide a night and a day nursery for his children, in neither of which should such operations as washing clothes, cooking, &c. &c. ever be carried on. The double room will allow all necessary airings, washings of floors, &c. to be perfectly carried out without the health or comfort of the children being interfered with. Should one nursery only be available, the children should be taken out of it in the morning as soon as possible after rising, the windows thrown wide open, and all necessary cleaning performed before they again enter it ; and, both now, and at every period of the day, all kinds of slops should be removed. Should any action of the bowels take place during the night, the receptacle should be put out of the room at once. The observations respecting the sanitary regulation of the nursery are more particularly applicable in the case of the middle classes, who want the abun- dant accommodation of the wealthy, and whose children, in towns at least, do not have the same free access to the open air as those of their poorer neighbours. The situation of a nursery in the house is import- ant ; it must, if possible, be in the upper stories, it should have a south aspect, and be abundantly supplied with light : the latter is a most necessary consideration. A guarded open fire-place is the best means of warmth, and the heat, regulated by a thermometer, should be kept as near 60° as possible. But however salubrious the nursery ar- rangements, children must have as much open air as possible ; and when the exercise can be taken as play, in summer, upon the grass, or otherwise, it is certainly the most beneficial. When weather and other con- siderations forbid, and walking is had re- course to, it must not go to the extent of real fatigue. At all times it adds much to the beneficial effect of exercise, if the mind CHI 114 CHI be engaged pleasurably in it, and there- fore all active plays, either in doors or out, are preferable to the mere walk, which few children enjoy. The clothing during the whole period of childhood, in a changeable climate, requires much attention ; woollen textures next the skin, both winter and sum- mer, is indispensable for health. During the former season, it should cover the chest and abdomen, and come at least halfway down the thighs ; but in the latter, it may be a lighter material, and not extend so far over the chest. Woollen stockings extend- ing over the knees ought always to be worn in winter ; and at all times should the entire clothing be such as will keep the surface of the skin comfortably warm. There is no greater or more fatal error than that which exposes children lightly clad to the influences of a variable climate, with the view of hard- ening them. Thorough purification of the skin must be maintained. A child should be washed all over with soap and water at least once a day. In the case of strong children the water may be cold, in the weaker, tepid, and in both friction with a tolerably rough towel should be used after the bath, both to cleanse and to promote reaction. If a child continues chilled and cold-looking, and ap- pears languid after a cold bath, it is a sign it does not agree, and the temperature of the water should be raised, or the washing should first be performed in tepid water: and then just at the last, a little cold water dashed over the body. The food in childhood claims care, equally with air, clothing, exercise, and cleanliness ; its regulation in infancy has already been sufficiently noticed. For strong healthy children, particularly those inclined to full or gross habits, the milk and farinaceous diet, such as rice, sago, bread, &c. cannot be exchanged for a better, for the first four- teen months at least ; but if children are delicate, and incline to the lymphatic con- stitution, the use of animal broths ought to be commenced even as early as the sixth month. The broth made from fowl, mut- ton, beef, or veal, should not be too strong, should be .free from fat, and is better thickened with arrow-root or sago for a young child, or with rice or bread crumb for an older one. Toward the twelfth month, a lightly boiled egg may be given ; but the best method of giving the powerful nutriment of egg to children is. to break the saw egg into some one of the milk preparations, while the latter is quite hot, and to beat up together. In this way, the albumen is sufficiently cooked but not hardened. When the teeth of a child are sufficiently advanced to masticate it, ani- mal food in the solid form may be given, but the quantity and frequency must en- tirely depend upon the constitution of the child. Strong ruddy children are better with it only twice or three times a week, weaker children should have it once a day at least, and in the more advanced stages of childhood, perhaps twice ; but this is a point which should be settled by a medical adviser. ' Potatoes, and the more whole- some vegetables, ripe fruits in their season, may all be allowed to children, in modera- tion, after the first eighteen months, and particularly should there be a tendency to costiveness, or to eruptions on the skin, and other affections depending upon gross habit of body ; weaker children may also partake of them, but more moderately, and provided they do not become substituted for more indispensably nourishing food. Children at any age are better without baked pastry of any kind, but boiled paste puddings are not unwholesome ; cheese, and all sorts of spiced and seasoned dishes, are quite objec- tionable. A healthy child should never have an alcoholic stimulant within its lips ; and tea or coffee, if allowed, should be very weak, and made with much milk : but there are some delicate children, nay infants, who may derive much benefit from a portion of alcoholic stimulant, carefully given as medicine, and as medicine requiring so much care and consideration, that it should only be employed when and as advised by a medical man. Children should not be made to wait long without some nourish- ment in the morning: the rapid changes which go on in their systems render them peculiarly sensitive to any, even temporary, want of nourishment. Eegularity in meals i is important even from the earliest period of existence ; it is always advisable that the principal meal be taken early in the day. Physical training, however, and the closest attention to physical regulations, require the addition of mental training to carry out thoroughly even the physical education of a child. For the infant a cheerful nurse- is most valuable. As childhood advances, whatever may depress or frighten ought especially to be guarded against, and all threats or practices which excite undefined terror especially avoided. Affection of the brain may be the result. Undue precocity in a child should always be regarded, if not with alarm, at least with suspicion. Many scrofulous children are unusually precocious; and as a general rule in such instances, the brain is more prone to disease, which may CHI 115 CHI end life, or predispose to mental affection. In such cases it is of the highest importance not only to avoid every thing which can stimulate to mental effort, but to excite them to such moderate and regular physical exertion as will in some degree draw off from the brain itself both the activity of the circulation and the nervous energy. There are some diseases which are more particularly considered as those of child- hood ; such are measles, hooping-cough, scarlet fever, small-pox at times, and chick- en-pox ; not that they do not occur in adults. but being most generally passed through only once, it is in the earlier years of life. In addition to the above, such affections of the brain as acute inflammation ending in effusion of water, convulsive disease, croup, inflammation of the lungs, and diarrhoea, are the most common acute affections of children. They and other diseases may be referred, to under their proper heads. Children quickly exhibit the general symp- toms of illness, but it often requires much more tact and discrimination to make out its exact seat and nature than it does in the case of adults ; it is, therefore, always de- sirable to place them under proper medical care as quickly as possible. At the same time, the following ought to be some guide as to the site of the affection, and to its provisional treatment. When in a child complaining of illness, or appearing ill, the eyes look heavy, and are wholly or partially closed against the light, if the brow is contracted, and if with these symptoms there is' general fever, some acute affection of the head is to be dreaded, and the indications should not be neglected for an hour ; if sickness is present with the above, so much the worse. Oppression of the breathing, along with general appearance of depression, is often the forerunner of severe inflammatory affection of the chest, which may be considered as established, if heat of skin, general fever, rapid breathing, and cough succeed. In the chest affections of children, the movements of the nostrils are much affected. Constipation, which can scarcely be classed as a disease, is almost natural to some children, but requires cor- rection, and this should be effected if possi- ble by food. Coarse bread should always be employed, and fruits, either cooked or ripe, such as roasted apples, given in moderation ; honey or treacle are useful, but nothing is more so than the daily use of porridge made from Scotch or other oatmeal. When the ten- dency to constipation in children cannot be overcome by diet, the next best remedy is the use of a small enema of gruel simply, or medicated with castor-oil, senna, or any simple aperient, or made with soap-water ; but the simple gruel ought always to be tried first. Dr. Marshall Hall considers, that in children especially, the use of warm enemas exerts a peculiarly beneficial effect in stimulating the liver. An enema for a child of six years old should not exceed twelve ounces, and ought to be administered slowly. When medicine must be given, as general aperients, castor-oil or infusion of senna are most useful: caution must, how- ever, be exerted in forcing the former me- dicine (as sometimes must be the case) upon very young children ; death has been occasioned from its getting into the wind- pipe. Rhubarb is a most excellent and safe aperient for children, but its bulk and nauseousness frequently make it difficult to get it taken satisfactorily ; magnesia is easily given in milk, and may be useful either in the solid or fluid form where active effects are not required, but the former especially ought not to be long con- tinued. Calomel and gray powder, alone, are too much employed for their aperient action ; they should not be administered except under medical sanction. As a general rule, in giving medicine to children, deception should not be practised; but while the child knows that it is medi- cine which it takes, it ought to have it in as palatable a form as may be, without inter- fering with the efficacy of the drug. Refer to Bed-room — Breast — Clothing — Diet — Electricily — Exercise — Milk — Rupture — Skin — Teeth — Vaccination — Ventilation — and to the articles on diseases and medicines gene- rally. CHILBLAIN.— A chilblain is an inflam- matory affection of the skin, more particu- larly of the fingers or toes, caused by alter- nations of cold and heat, and is characterized rather by irritating and troublesome itching than by pain. Persons of fine skin, scrofu- lous constitution, or languid circulation are most liable to suffer from chilblains, and old people and children more than those of mid- dle life. The sudden exposure of the skin when very cold to a high temperature is generally and justly considered to be an exciting cause of the affection ; but one quite as frequent is keeping the surface in a state of artificial warmth by the use of sleeping-socks and hot applications in bed, or of fur-lined shoes and foot-warmers in the day time. All these applications keep the skin in a continual state of unnatural per- spiration, weaken its tone, and so render it more susceptible of the effects of cold when exposed to it. To prevent chilblains, in the CHI 116 CHL predisposed, the feet ought to be regularly bathed with cold, or, (in the case of the aged, ) tepid water, or salt water, every morning, and afterward well rubbed with a rough towel, exercise being employed to preserve the warmth of the extremities rather than ar- tificial heat. When chilblains have formed and the skin is unbroken, stimulating appli- cations are requisite ; many different ones are used; spirit, such as brandy, camphorated spirit, paregoric, or turpentine, will any of them be of service, applied by means of a piece of linen, or gently rubbed on. When the skin of a chilblain breaks, an ulcer is the consequence, which discharges a thin slimy fluid, and is often difficult to heal. In this case, the inflammation should be subdued in the first place by means of a poultice, and afterward an ointment used, made either with forty drops of Goulard, or ten grains of red precipitate, to the ounce of lard. Of course all friction or pressure from boots or shoes must be guarded against. CHIMNEY. — A chimney, by intention the channel through which the smoke and fumes of fire are conveyed away, also performs the no less important but slightly (until of late) estimated office of a ventilator.— In former times, when the chimney formed almost a separate chamber, in which per- sons sat round the fire, or indeed as long as it retained its ample dimensions, the people enjoyed an efficient means of ventilation, although in ignorance of the benefit. By change of fashion, the chimney has been gradually contracted and lowered to the mo- del of the present modern fire-place. While this has been done, from ignorance of the necessity for pure air, no provision has been made to supply the loss of the efficient ven- tilating power of the old-fashioned construc- tion, and health must consequently have suffered and does suffer materially from the omission ; although it is to be hoped that the diffusion of popular knowledge upon this and other points of sanitary regulation will not allow such to be the case much longer. The chimney, however, is a notable instance of society enjoying ignorantly an arrange- ment conducive to health; and that igno- rance, while making alterations more con- sistent with comfort and convenience, doing away with one great advantage, of which it remains for science to point out both the loss and the means of reparation. As whatever goes up, or ought to go up, the chimney, are vapours and gases which cannot remain down without injury to health, it is a matter of importance that the chimneys of a house draw well — more especially those of bed- rooms in which fire is used. As a means of ventilation simply, independent of the fire, the importance of a chimney is so great, that rooms in this climate which are destitute of one cannot be considered healthy, although it must be confessed that this secondary office appended to the original intention is rather a clumsy method of effecting so im- portant an end. It is one, however, of which it is requisite to make the most, and there- fore chimneys ought to have a thorough draught for smoke, ought never to be stopped up when not in use, unless other means of efficient ventilation are possessed, and, when possible, should be fitted with some efficient mechanical contrivance for increasing their ventilating power. — See Bed-room, Ventila- tion, fyc. CHIN-COUGH.— See Hooping-Cough. CHLORINE — Is a gas of a green colour. It is an important agent in manufactures, on account of its bleaching properties ; and its powers as a disinfectant, or destroyer of the noxious emanations from decomposing bodies, whether vegetable or animal, render it a most valuable assistant in sanitary ar- rangements. When undiluted, it exerts an extremely irritating effect upon the lining membrane of the respiratory organs ; and as serious and even fatal accidents have occur- red from this cause, caution is requisite in its use. A small proportion of chlorine gas diffused through the atmosphere, very quick- ly and thoroughly destroys not only the smell, but the injurious properties of float- ing emanations, which are capable of engen- dering disease. Chlorine gas is obtained in various ways, but the great magazine for its supply is common salt, which is composed of chlorine and sodium. For sanitary pur- poses, various preparations calculated to yield chlorine simply and easily have been used ; of these the chloride of lime is the best known. This and most of the prepara- tions, however, have the disadvantage of, when alone, yielding the gas too slowly and sparingly to be of much service, and, when mixed with an acid, of pouring it out in quantity so great as to affect disagreeably or injuriously any persons exposed to its influ- ence, particularly the sick. Other prepara- tions require sprinkling about the place to be purified ; and as this is often done in ignorance of its colour-destroying powers, much damage is done to furniture, &c. A late preparation — Collins's disinfecting pow- der — seems to be free from the above objec- tions ; when a portion of it is exposed to the atmosphere, it keeps up a certain but suffi- cient exhalation of chlorine for some days, as it continues to absorb moisture. It is the best, most effective, and agreeable method DHL ir CHL for employing chlorine in the chambers of the sick which the author has met with. In no case of continued sickness, whether of an in- fectious character or not, ought chlorine fumigation to be neglected. The principal preparations used in medi- cine into the composition of which chlorine enters are chloride of sodium or common salt, (see Soda,) chlorate of potass, (see Potassa,) chloride of zinc, (see Zinc,) and hydro-chloric acid. Hydro-chloric acid is a gaseous com- pound of chlorine with hydrogen gas, but is usually met with in solution of a yellow co- lour, when it is generally called muriatic acid or spirit of salt. It is of course a pow- erful corrosive poison when swallowed alone ; its antidotes are the carbonates of potassa, chalk, or magnesia in any form, or milk, or white of egg, whichever is first at hand, un- til the antacids are procured. In the ab- sence of any of these, soap-water may be given ; but, in poisoning with any acid, it should be remembered that mortar or white- wash, rubbed up finely with water or milk, may be used on emergency as an antidote ; the lime neutralizing the acid. Of course the other antacids, particularly magnesia, are to be employed if procurable at once. Of the latter, a dessertspoonful may be given every ten minutes, and repeated ac- cording to the effect and probable amount of acid swallowed. Muriatic acid is used in medicine as an unstimulating tonic, particularly in diseases such as malignant scarlatina, which are ac- companied with tendency to putrescency ; it is also used as a mouth-wash or gargle in the same disease. Muriatic acid is given in doses of ten drops, in a wineglassful of wa- ter sweetened with sugar ; or it may, if pre- ferred, be taken much more largely diluted, and then forms a pleasant drink. It may be used as a gargle, in the proportion of two drachms to the pint of water. As in the case of acids generally, unless largely di- luted, the doses should be sucked through a quill or glass tube, to preserve the teeth from corrosion ; and it is likewise a useful precaution, for the same purpose, to rinse the mouth with a diluted solution of carbon- ate of soda. In the absence of means for procuring chlorine, if fumigation is required, muriatic acid gas may be used as a substi- tute, as it is disengaged by mixing equal weights of common salt and oil of vitriol, (sulphuric acid,) care being taken against inhaling its irritating fumes in too concen- trated a state. CHLOROFORM— Is a fluid ; it is transpa- rent, heavy, colourless, and possesses an agreeable etherial smell. Its power of pro- ducing " antesthesia," or insensibility U pain, when inhaled, is now too universally known to require comment. It is, however, too potent an agent to be trusted in unpro- fessional hands, except, indeed, under di- rect medical sanction and direction in each particular case. In the more painful and larger operations of surgery it is one of the greatest boons conferred upon suffering humanity, and its use tends to diminish the average mortality after them. In the case of minor operations, however, such as tooth- drawing, it becomes a question whether its employment is advisable. Fatal cases have followed its inhalation ; and although these have been in very small proportion com- pared with the numbers in which it is daily and hourly administered, still the fact of their having occurred is sufficient to make us pause before incurring even the remote chance of so serious a result, for the sake of avoiding a momentary though sharp pain, [especially when ether is as good an anaes- thetic, and is perfectly safe in the hands of a medical man.] In some cases very disa- greeable effects, such as headache, sickness, hysteria, &c. &c. have succeeded the use of chloroform. No one should, therefore, ever be tempted to inhale this agent, without being certain beforehand that no tendency to organic disease exists, especially of the heart or lungs. Although not suited for domestic use as inhaled, chloroform may be employed with perfect safety and much advantage as an external application in painful affections, of the nerves especially, such as neuralgia and toothache. For this purpose a piece of linen or lint, of a size proportioned to the part affected, is to be soaked in the fluid, ap- plied to the skin, and then covered with some material, such as oiled silk, to prevent quick evaporation. It destroys the silk ; and in the course of a few seconds produces an in- tense but scarcely disagreeable burning sen- sation, which continues until the fluid is all dispersed. In many cases the neuralgic pain disappears at once. When the cover- ing is removed, the portion of skin to which the chloroform has been applied is found much reddened, sometimes slightly blistered. A small portion of cotton wool soaked in chloroform will, if placed in the cavity, some- times allay the pain of toothache. Chlo- roform, taken into the stomach, has been found useful in spasmodic diseases, as asth- ma, hysteria, &c. and might be adminis- tered, in the absence of other remedies, in doses of from six to ten drops, along with a teaspoonful of brandy in three tablespoon- fuls of water. CHL 118 CHO CHLOROSIS.— See Anjemia. CHOCOLATE.— See Cocoa. CHOKE-DAMP.— See Carbonic Acid. CHOLERA — Asiatic ok Malignant. — The modern pestilence which first visited England in the year 1832, and again in 1849, in which latter visitation it carried off, in London alone, 15,000 people, and in the en- tire kingdom, not less perhaps than 80,000. At present, we know the disease but in its symptoms ; its true nature and seat, not- withstanding numerous investigations and hypotheses, are still undetermined, and as regards the best mode of treatment there is nearly equal uncertainty. Happily, such is not the case with respect to those conditions of body, and still more with respect to the external circumstances, which favour the attacks of the scourge and foster it into activity. Dirt, bad air, bad water, bad food, insufficient clothing, and irregular and vicious habits, are all the favourers of cho- lera; and were it not for these, singly or combined, it would, in all probability, pass comparatively lightly over our land. We know not how, in future times, the Almighty may order the mysterious agency of Asiatic cholera to fulfil his own good purposes ; but we have every reason to calculate, that by a more diligent observance of those organic laws with which he has linked our material existence, we may be enabled to break the force of another, it may be more fearful visitation than the last. If the compara- tively healthy homes, the habits of cleanli- ness, the sufficient food and clothing of the higher classes have hitherto protected them from the sweeping virulence of the disease, as it has been shown in the less advantage- ously placed families of the poor, it gives confidence to suppose that the elevation of the sanitary status of the whole mass of the people will have an equally good effect. It is not supposition — it is certainty — that such would be the case ; certainty, that, whatever the virulence or the mildness of the next visitation of Asiatic cholera, the suffering- will be proportionally commensurate with the sanitary condition of the people when it comes. And yet this was eqrially well known after the warning of 1832 as it is now; and, after a respite of seventeen years, the pestilence came again and found us un- prepared as regards our own safety, but prepared to nourish and foster its myste- rious germs in the foetid, stagnant air of city, town, and village, unventilated and undrained, half supplied in water or not supplied at all, or tainted with decomposi- tion of every kind, from human excrement upward; and such will be the case again, unless the people themselves stir — and to them this is addressed. Governments cer- tainly may do much, vastly more than they now do, but they cannot do all ; the people themselves must be fully awakened to the necessity of observing the laws of health, now so well ascertained — awakened to the sin before God of neglecting them. The teachers of the people, and especially the clergy and the higher orders, must be more conversant with the laws which regulate the existence, and on which depend the health of their own bodies and of those of their less favoured brethren — must be able to de- tect and point out those sanitary deficiencies which must so often come before them, and which they have it in their power to rectify. While resignation to the will of God is re- quired from all, surely it is not true resig- nation, but sinful ignorance and apathy, to submit the mind, while the cause remains, to the loss of husband or child carried off by cholera or by fever, generated by the unhealthy habitation or the stagnant pool. For, whether it be cholera or fever — and they both inhabit the same localities — or the slow undermining of the health, or scro- fula, or consumption, they are too often looked upon as the direct visitations of God, when they are due to the sinful neglect of those laws with which he has connected the health and soundness of our material body, the healthy and happy working of our minds, both for our own good and that of our fel- low-men. This may perhaps be deemed a digression from the main subject of this article, but the subject itself is one which arrests men's attention, and will do so still more should the pestilence again threaten our shores; it has, therefore, been seized as another opportunity for reiterating the advantage, the necessity, the religious duty of attention to sanitary regulation, to sup- plies of light, pure air, and pure water in abundance ; to regular and temperate habits, and to their usual attendants in this land, good food and sufficient clothing. It is a privilege to be able to afford relief to sick- ness and suffering in the hour of need — and to further that end the present work is in part devoted ; but more important still is the enforcement of those measures which will, under Providence, ward off or modify disease, The first commencement of Asiatic cholera is traced to the year 1817, when it took its rise in a swampy district at the mouth of the Ganges, from whence it spread over India to various parts of Asia and Europe, and finally reached England in the year 1831, where it continued till the end of 1832, dis- CHO 119 CHO appeared for seventeen years, and re-ap- peared, in a more virulent form than before, in the year 1849. [In Canada and the United States cholera first appeared in 1832, and again in 1850. It has also prevailed along the Mississippi and other rivers since that period.] The mode of propagation of cho- lera is undetermined ; it exhibits the most apparent capriciousness in the course it follows ; but one thing is certain, that those unhealthy external conditions already al- luded to, almost, as it were, seem to attract the disease. The violence of its symptoms, and the fearful rapidity with which it often termi- nates life, render cholera one of our most alarming diseases. Occasionally, but more frequently in hot climates than in temperate ones, persons are, as it were, prostrated at once by the cholera-poison, and die, perhaps within an hour of the first attach, without any other symptom than total collapse of the powers of life. More generally the seizure is not so sudden : probably there has been slight diarrhoea, or rumbling move- ments of the bowels, with sinking sensation at the stomach, for some days previously ; or, at all events, the person has felt unwell. When the disease sets in earnestly, which in the larger proportion of cases it does during the night, the patient vomits, and is purged with more or less frequency and violence, the evacuations quickly coming to resemble thin gruel or rice-water; cramps of the limbs succeed, the surface becomes cold, blue, bathed in sweat, and has, par- ticularly the fingers, a peculiar shrunken, sodden appearance; the' tongue is cold, the pulse imperceptible; the urine is suppressed, and the voice acquires a peculiar pitch of tone. Many die in this, the collapse stage of the disease ; but if it is passed through, reaction comes on, the surface gets warm, the thirst continues, the quick pulse becomes perceptible, the tongue is dry and brown, and delirium is present; in short, fever is established, and may end either in recovery or death. During the prevalence of cholera, many err in making material changes in their or- dinary modes of living, and, by so disorder- ing the regularity of the functions, lay themselves open to attacks of the disease. Of course, if a man is aware that he is habitually indulging in practices injurious to health, such as intemperance, debauchery, &c. &c. he only acts wisely as regards his physical safety in changing those habits ; but it is hazardous to alter regular modes of living, which have hitherto been found compatible with good health — it being un- derstood that whatever tends to lower the standard of health favours the attack of the disease. There is, however, one important precaution which ought to be observed, at all times indeed, but more particularly during the epidemic of cholera : the perfect purity of the drinking-water should be ascer- tained, and its freedom from all decomposing organic matters made certain. Care is also to be observed not to take active purgatives, particularly salines, which produce watery evacuation; if aperient medicine is required, it ought to be of a warm character, such as magnesia and rhubarb, with some aromatic ; for whatever produces free action of the bowels apparently increases the suscepti- bility to attack. For this reason, too, the slightest tendency to diarrhoea should at once be arrested by the aromatic confection or chalk- mixture, repeated as often as requisite, with the addition of from five to ten drops of lau- danum [and tincture of camphor] to each dose, and the use of milk, and farinaceous preparations containing gelatine, for food. The speedy adoption of these measures, in places distant from medical assistance, and their enforcement, by the clergyman or some intelligent individual, might do much to check the disease. Should the astringents above recommended fail, three or four doses of acetate of lead and opium might be given by a careful person. With regard to the actual treatment of the disease itself, when fully established, many different methods have been proposed and practised, and few of them, perhaps, without apparent advantage in some cases ; but as yet no treatment which can be called decidedly successful (a cure) has been dis- covered. Of course, in so formidable a dis- ease, proper medical assistance ought to be obtained as quickly as possible ; but as far as our present knowledge extends, those around the patient would be fully justified in using every possible method of hot ap- plication to maintain the temperature of the body, and in permitting the gratification of the intense thirst to the full, by cold water, alone, or containing one drachm of common salt, one drachm of carbonate of soda, and twenty grains of chlorate of po- tassa, in every quart. In doing this there will be at least the consolation that the comfort of the patient is promoted ; every thing further must be left to medical judg- ment. We must live in hope, that before the scourge again visits us, which it pro- bably will do, particularly if the present sanitary evils are permitted to remain, me- OHO 120 CIE dical science will have some more efficient method of cure to offer than we at present possess. The consecutive fever of cholera requires the treatment of fever generally. CHOLERA, BRITISH.— See Bilious Cho- lera. CHOLERA.— See St. Vitus's Dance. CHRONIC. — A term applied to diseases of slow progress, in contradistinction to ''Acute." — See Acute. CHYLE— Is the milk-like fluid which is separated from the chyme, or digested food mass, after it has passed from the stomach and become mixed in the small intestines with the bile and pancreatic fluid. The vessels by which the chyle is absorbed from the intestine have been named lac- teal, from the milk-like or white appear- ance of this fluid, which they contain abundantly after a full meal ; the charac- teristic whiteness being more particularly apparent if the food has contained much fat. Refer to Absorbents — Chyme — Digestion — Pancreas. CHYLOPOIETIC— Is a term applied to the viscera which assist in the formation of the chyle. CHYME — Is the pultaceous, gray-looking acid substance, to which food is reduced by digestion in the stomach, before it passes — in the healthy state at least — into the small intestines. CICATRIX— Is the scar or mark left upon the skin or upon an internal organ, at the place where separation of substance, either from violence or ulceration, has been healed. CIDER. — The well-known fermented drink made from apples. Its characteristic prin- ciple is malic acid. It contains but little alcohol, not above 9 per cent., and is gene- rally considered wholesome ; but to its use has sometimes been attributed a form of dry belly-ache, resembling painter's colic, which occurs in cider districts. There ap- pears, however, to be some doubt whether this is not owing to accidental impregnation with lead, which readily combines with the malic acid of the cider. CINNAMON — The well-known spice, is the bark of a tree. It is brought from Ceylon and the islands of the Indian Archi- pelago. It is largely used in medicine for the same purposes as other stimulant aro- matics ; chiefly as an addition to correct the nauseant, or add to the stimulant pro- perties of other more active medicines. The distilled water is well known. In conse- quence of the high price of true cinnamon, a coarser description, the cassia bark, is very generally sold in place of it in this country, and, though not so fine in flavour as the true bark, is equally well adapted for medicinal use. True cinnamon is thinner, lighter in colour, and consists of more quills one within another, than cassia bark. CIRCOCELE. — An enlargement or vari- cose condition of the veins of the testicle. CIRCULATION OF THE BLOOD.— By this is understood the entire course of that fluid from its leaving the heart to its return to that organ. In man, and in warm-blood- ed animals generally, including birds, there are two complete systems of circulation, (see fig. xxxviii.,) the one through the body Fig. xxxviii. at large, the other through the lungs ; and this double circulation involves the presence of a double propelling organ, that is, a heart consisting of four cavities. The structure and requirements of our animated bodies, as they have been consti- tuted by the Creator, depend for their main- tenance in healthy existence and action upon the continual passage of arterial blood throughout every portion of their structure — for this the circulation provides. The heart, which is muscular, consists of four cavities, two auricles and two ventricles ; of these, the left ventricle, (Gr,) which gives the first propulsion to the arterial wave of blood, is considerably the most powerful. When it contracts, the blood contained with- in it at the moment is forcibly propelled CIT 121 CLE into the aorta (A) or main blood-vessel of the body, from which it diverges into the secondary branches, until at last, by the division and subdivision of the vessel, it is conducted into the capillaries, (C,) in which it comes into more intimate connection with the elementary components of the body, and undergoes such chemical change that when it emerges it is an altered fluid ; instead of the bright red arterial, it is the dark black- looking venous blood, unfit for the mainte- nance of the vital functions. It is now col- lected by the veins (V) and conducted back to the heart, the right auricle of which it enters ; from this cavity it passes into the right ventricle, (D,) and is propelled by its muscular power into the pulmonary artery (B) and through the lungs ; in its passage through which it is brought into contact with atmospheric air, casts off the carbonic acid with which it has been laden, absorbs oxygen, and, being chemically changed, is once more the bright arterial fluid, which, returning through the pulmonary vein (E) up to the left auricle of the heart, (H) is transmitted by it to the left ventricle, to be sent once more upon its mission of life. Although the forces which circulate the blood, namely, the muscular propelling power of the heart, the muscular and elastic contractility of the arterial coats, and the suction power exerted within the chest, are sufficient of themselves, during health, to maintain the vital current, which flows, and must flow, from the first moment of life until death, — their power and efficiency is much assisted by the muscular movements of the body by exercise, which, quickening the respiration and the action of the heart, sends the blood with increased force and frequency throughout the frame, and stimu- lates every function to increased action. Thus provision has been made by the Crea- tor, that while the powers which circulate the blood can, of themselves, carry on that necessary process sufficiently to preserve life, high health and vigour can only be at- tained by the active exercise of our limbs. In the aged, and in those exhausted by disease, who are long confined to a horizon- tal posture, the circulating powers become too feeble to overcome the force of gravity, and the blood tends to accumulate, more particularly in the lungs, in the most de- pendent part ; for this reason, change of posture is advisable. — See Bed. Refer to Artery — Blood — Heart — Respira- tion, §c. CITRATE OF IRON— Is a compound of iron and citric acid, introduced into medical practice within the last few years. It is an elegant and pleasant form, and maybe given in solution in water in one or two grain doses. It becomes moist if exposed to the action of the air. CITRATE OF QUININE AND IRON— Is a compound of iron, citric acid, and quinine, and is an elegant and highly useful form of tonic ; it may be given in a similar way, and in doses similar to the above. CITRINE OINTMENT— Is a mercurial preparation much used by some in skin dis- eases. [It is also often employed in the form of sore eyes attended by redness of the edges of the lids, and by a disposition in them to stick together in the morning. It should be applied at the roots of the eyelashes at night, so that it cannot get into the eye, and the part should be washed in the morning with warm water. An application every other night is sufficient to create a change in the action of the part, and thus cure the com- plaint.] In its ordinary form the ointment is too strong, and should be mixed with once or twice its weight of lard. Iron utensils or spatulas must not be used in its manipula- tion. It is an ointment which very quickly spoils, [as may be told by its decided green colour or hardened condition.] CLARET — Is one of the most wholesome of the light wines. It contains 15-10 per cent, of alcohol. In convalescence from acute febrile disease in which wine is ad- missible, but where there exists a tendency to febrile action from slight causes, claret is most useful, and preferable to the stronger and heavier wines. In diabetes, claret has been recommended as superior to every other form of stimulant. CLAVICLE. — The Collar-bone — extends from the upper part of the breast-bone to the point of the shoulder. It is particularly liable to fracture from falls upon the shoulder : the accident is easily detected. — See Fracture. CLERGYMAN'S SORE-THROAT— Is a peculiar affection of the throat and organs of voice to which public speakers are liable. According to Mr. Macready, actors, who have to assume feigned tones, are more liable to it from that cause. The seat of the dis- ease is the mucous follicles scattered over the membrane of the throat, larynx, &c. being extended to the latter from the former. The commencement of the disease is insidi- ous ; it begins with an uneasy sensation, as if there was something in the throat which required to be hawked up or swallowed down; at the same time the mucus secre- tion is viscid. As the larynx becomes af- fected the voice is changed, becomes hoarse, unequal in tone, or quite extinguished ; there may be slight pain about the parts, but not CLI 122 CLI much cough in the earlier stage of the dis- ease. All the symptoms become aggravated by cold, by vicissitudes of temperature, or by exertion of the voice in reading, speak- ing, &c. The above sources of aggravation are of course to be guarded against, and the general health attended to ; but the cure of the disease, which consists chiefly in the repeated application of a strong solution of lunar caustic to the parts affected, must only be intrusted to the medical man. Dr. Green, of New York, has the credit of first accurately describing the disease, and of prescribing the treatment above mentioned, which is very successful. CLIFTON— Lies within a mile of Bristol. Sir James Clark speaks highly of its climate. "In its local advantages and geographical position it yields, perhaps, to no place in the kingdom as a residence for a large class of invalids. Within its own limits it affords a sheltered winter, and an open airy summer residence ; while it is surrounded by nume- rous places of agreeable resort in the fine season, suited to the various classes of per- sons who may seek its shelter during the winter. Compared with the south and south- west coasts, the spring is the period of the year in which this climate appears to the greatest advantage. For consumptive pa- tients, and those labouring under irritable affections of the bronchial membrane, the softer and more humid air of Devon will be found more soothing, while for invalids whose constitutions have suffered from long-con- tinued derangement of the digestive organs, or a congested state of the mucous mem- brane, with copious secretion, and also for young scrofulous persons, and those of re- laxed habits of body, generally, Clifton will prove a preferable climate." " The spring termed Hotwell rises at the base of the lofty St. Vincent's Rock, and is said to yield as much as forty gallons of water in a minute. * ; * * The temper- ature of the water is 76° Fahr. Like the springs of Bath and Buxton, the salts of lime predominate. The following table will ex- hibit the proportion of the saline constituents in a gallon of water : — Grains. Muriate of magnesia 7-25 Muriate of lime 3-80 Sulphate of lime 7-5 Sulphate of soda 16-15 Carbonate of lime 13-5 47-30 "A gallon also contains, according to Dr. Carrick, thirty cubic inches of carbonic acid gas. " The water emits a few gas bubbles when drawn into a glass. Taken internally, it generally acts upon the kidneys, and occa- sionally produces vertigo and headache. It is recommended in various states of deranged health. The baths are not much used. The internal use of the water is considered to be very efficacious in cases of dyspepsia with acidity, in affections of the kidneys, as dia- betes, gravel, and tendency to stone." CLIMACTERIC DISEASE— Is a sudden giving way of the vital powers in persons of advanced life, without any definite disease to account for the change. The affection seldom occurs before fifty years of age, and is more common in men than women ; for one reason, probably, that its most frequent ex- citing cause is over-work and anxiety of the mind in business. The person who is be- coming the subject of climacteric disease, complains of weakness coming on gradually, the appetite gives way, sleep is deficient, the bowels sluggish, the pulse quick, and the tongue furred ; the flesh falls away, and the altered countenance assumes an aged look in a short period: in other words, the "con- stitution is breaking up," and the individual's friends remark that "he ages very fast." Swelling of the limbs, eruptions of the skin, and mental apathy are further concomitants of the disease, which, if unchecked, may run on to a speedy, fatal termination ; while it also renders the patient liable to sink easily under any attack of acute illness, even of a common cold, which too, it may be observed, is often the first traceable commencement of the attack of climacteric. Another very frequent cause is grief caused by the loss of friends or relatives, who have been much mingled in the affections and habits of daily life. When an aged person exhibits the symp- toms described above, they should imme- diately be attended to : the case must be put under medical management, and will require tonic treatment, generous living, complete relaxation from the cares and anxiety of business, and, if possible, change of climate. CLIMATE — Is the condition of the atmo- sphere which generally prevails over any particular tract of country, a condition which is of course regulated and modified by a great variety of circumstances. The lati- tude, the elevation, the proximity to or distance from the sea; the soil, the absence or presence of water, including the drain- age, the amount of wood, and the shelter or otherwise from prevailing winds, all exert important influences upon the characteristic climate of any locality, and have to be con- sidered in the recommendation given, or CLI 123 CLO plan of action resorted to by invalids. The subject is quite too extensive to admit of profitable consideration in this work ; and the decision respecting the climate, resort to which is likely to benefit each individual case, is so much matter of judgment, and is really so important, that medical opinion ought always to be taken when change of air or climate is seriously sought as a re- medy in illness. Very much precious time is often lost, and real injury inflicted, from want of due care upon this head, and from persons acting upon their own ideas, or upon insufficient advice. Those who desire to get for themselves the most complete in- formation upon the subject of climate, will find it in the valuable work of Sir James Clark. There are few diseases, perhaps, which do not derive either temporary or permanent relief from change of air and climate, but some are more strikingly benefited than others ; they are particularly diseases of a neuralgic, intermittent, or spasmodic cha- racter, of which hooping-cough and asthma are good examples. Chronic rheumatism, scrofula, weakness of the constitution gene- rally, including pulmonary consumption and dyspepsia, may also be mentioned. As a general rule, benefit appears to result from change to a climate presenting characters which contrast with those of the one in which the individual is or has been gene- rally resident ; the dyspeptic or consumptive patient will derive advantage by removing from the colder to the mere genial region; the fever-stricken resident of the sultry or vaporous plain will regain health and strength in the bracing air of the hills ; and even the country child, in whose constitu- tion hooping-cough lingers, will probably lose it if transferred to city air for a short period. Perhaps no air exerts such uni- versally tonic effects as that of the sea, but to some it is too stimulating in some particu- lar localities, though not so in others ; but, in fact, the differences in climate, and its effects, are so numerous and varied that it is impossible here to pass beyond the general consideration of the subject. Unquestion- ably some amount of the beneficial influence of the change of climate is due to the stimu- lant effect upon the mind which excitement and change of scene produce, this being more particularly the case if the condition of the individual permits or calls for the continued change of travelling from place to place. The error is frequently committed of re- sorting to the change of climate as a last resource, which, if earlier had recourse to, might have proved of essential or real ser- vice. Another error is trusting too much to the curative power of climate ; and inva- lids, by throwing aside the restraints of the regimen to which they have been previously subjected, and neglecting the other acces- sory adjuncts to recovery, fail to derive the full measure of benefit which they ought ; and this more especially if they do not con- sider and endeavour to accommodate them- selves to the modes of living and other requirements adapted to the climate in which they are resident for the time. Sir James Clark divides the "mild region of England" into four districts or groups of climate ; that of the south coast, compre- hending the tract of coast between Hastings and Portland Island ; the south-west coast, from the latter point to Cornwall ; the dis- trict of the Land's End; and the western group. In Scotland, the island of Bute, situated in the Frith of Clyde on the west coast, is a remarkable instance of climate modified by situation : surrounded by sea- water and sheltered by lofty hills, its cli- mate is remarkably mild and equable — so much so, that snow rarely lies above a few hours. It is much to be regretted that the beneficial effects of change of air are so little attainable by the poor, particularly in re- covery from acute illness, when it is fre- quently all that is requisite to re-establish firm health, and to hasten an otherwise lin- gering convalescence. The establishment and support of convalescent stations for the poor would constitute a truly useful end for charitable support. Refer to Atmosphere — Convalescence, §c. CLOTHING.— The protection of the body from the influences of climate, by means of clothing, is most intimately connected with health, more especially in any climate sub- ject to the numerous and sudden vicissitudes of temperature, moisture, &c. The form of clothing must ever vary with fashion ; the principle ought always to continue the same, that is, it should involve complete and tho- rough protection of the surface of the body, and especially of the cavities of the chest and abdomen, from cold or sudden chill. This is best insured by a covering of woollen mate- rial next the skin ; the habit should be com- menced from the earliest childhood, and con- tinue through life in every season of the year, varying only the thickness of the flan- nel, or other woollen texture, according to the average temperature. No outward clothing can be so uniformly efficacious as the inner one of wool, as a protection against a variable climate ; and yet very many there are who, both in their own persons and in CLO 124 CL Y those of their children, neglect this real preservative of health, and therefore this real economy, although the cost at first may seem much to the poor. In addition to the inner clothing, the outer ought of course to be suf- ficient, and, in winter, an addition made on going from the warmth of the house into the open air. In this respect, men are generally better provided, under all circumstances, than women and children. Women, from the nature of their dress, and from the per- nicious custom of occasionally exposing the chest and arms — which would be less hurt- ful if constantly done — suffer much from errors in clothing; they subject themselves to the extremes of fur and thick shawls in the morning, and of thin dresses at night ; added to which there is often exposure to currents of air when heated, and without any protection against their effects. Any article of clothing, such as fur, which keeps up a more than average degree of heat, and even induces perspiration, and which is liable to be thrown off or put on easily and as fancy dictates, is hazardous and inju- rious. Children are in many cases most insufficiently protected from the weather; numbers are without a single article of woollen under-clothing, either in consequence of carelessness, or from the erroneous idea of rendering them hardy ; a system which may answer in the offspring of hardy pa- rents, whose- children are hardy in every other respect, but which can only be pro- ductive of injury to health in those who spend most of their time in warm, perhaps too warm, rooms and nurseries. The surface of a child, from the neck downward, ought to be kept warm by clothing; exposed chests, bare legs, and thin insufficient coverings, are synonymous •with croup, inflammation of the lungs, and scro- fula. For the same reason that boas, &c. are unsafe articles of dress for women, com- forters and woollen neck-wrappers are not advisable, except under particular circum- stances, for boys : they heat the neck, and, if thrown off carelessly, predispose to cold or bronchitic affection. The clothing of the feet is a matter of the highest importance to all; dryness and warmth must be attended to by those who value health. On the other hand, the head is often, especially in infants and children, kept too hot [by wadded caps, &c] CLOVES — Are the undeveloped flower- buds of a tree originally a native of the Mo- lucca Islands, but which is now cultivated in various parts of the tropics. They are well known as a spice, and used as a stimu- lant aromatic in medicine, their properties depending upon the volatile oil, which is in- tensely acrid. Cloves are rarely used in medicine alone. CLUB-FOOT.— See Deformity. CLYSTER, Enema, or Injection — Are all names for the same useful adjunct to medi- cal treatment — the mechanical injection of fluid into the bowels by the fundament and rectum. Clysters are most commonly em- ployed as aperients, but they are also used as anodynes, or antispasmodics, for the pur- pose of dispelling wind, or as internal fo- mentations, or as styptics. In illness they are generally administered to the patient by others, but instruments are constructed to facilitate their self-administration, which is of course preferable when, as frequently occurs, they are often required in ordinary health. The mechanical means used for the ad- ministration of clysters are very numerous ; the most useful are the self-injecting syringe, (fig. xxxix.,) and the vulcanized India-rubber Fig. xxxix. bag, (fig. xl.) The pipe and bladder, which was formerly the only method used, is still employed in country districts, and though clumsy, may be had recourse to on an emer- gency. The injection-syringe, or pump, is most useful when the clyster to be administered much exceeds half a pint in quantity, when it is used as an aperient, and requires to be forcibly injected. When the clyster does not exceed half a pint, as in the case of chil- dren, or when used as an anodyne or styp- tic, the vulcanized India-rubber bag (fig. xl.) is quite the most convenient mechanical agent, from its simplicity, and the ease with which any one may use it. Either instru- ment may be procured good from any re- CL Y 125 CLY spectable maker of surgical instruments, and directions are, or ought to be, given with them. When a clyster is administered to the sick, the patient may either be laid on the face or on the left side, near the edge of the bed, "with the knees drawn up. The metal or bone pipe which is introduced into the bowel should be well oiled or greased, and its introduction should be effected with perfect gentleness, not straight up, but in a direction slightly inclined toward the back bone, care being taken that no abrasion or scratching of the parts be occasioned : this is a most necessary caution in all cases, but more especially in those in which repeated use of the remedy will probably be required. Even with the greatest care, the parts are liable to become sore, causing the patient both to dread and suffer each time the in- strument is used, and even to be unable to bear a continuance of the practice. In all cases a clyster should be given slowly and gently, and care taken that air is not thrown up into the bowel as well as fluid ; with the syringe, this is to be avoided by pumping it full of fluid before it is applied to the pa- tient, and by not continuing the operation when the fluid used gets so low in the basin as to allow air to be drawn in ; with the bag care should be taken that the pipe-end is always held the lowest. When the bag is used, air is less likely to be introduced if the patient is laid on the face. When the syringe is used, if the flexible tubes have been kept bent in one position, they should be slightly warmed before any attempt is made to straighten them for use ; otherwise, especially in cold weather, they are apt to crack. If an instrument has been used for any thing but simple water, it ought always to be well washed out with warm water be- fore putting by. When taken to pieces it must always be unscrewed by the hand hold- ing the metal mountings. Clysters can only be conveniently self- administered by means of the syringe, (fig. xxxix.) Aperient clysters may be simply mecha- nical, of water, gruel, and the like, either cold, tepid, or warm, or they may be medi- cinal. There is an objection to clysters of simple water, that in some cases they are apt to wash off the natural protecting mucus of the bowel, and therefore it is perhaps better as a general rule, and where the remedy is often or habitually used, to employ a demul- cent, such as gruel or barley-water. Cold clysters, though sometimes useful, ought never to be resorted to except by medical direction ; the fluid about the temperature of 90° will generally be found most appro- l2 priate, and when used simply, about a quart thrown up slowly, but with sufficient force, be found a suitable amount for the generali- ty of adults. Some use a much larger quan- tity, as much as two or three quarts ; this, in certain cases of illness, may be a useful measure, but as an habitual thing it is bad ; the frequent over-distension with so large a quantity of warm fluid produces want of tone, which aggravates the torpid tendency of the bowels, and favours faecal accumula- tion. For a child six years of age, half a pint of simple gruel clyster is ample. These simple clysters act by stimulating the bowel by their mechanical bulk ; when a medicinal clyster is used, the object is in some degree to avoid this, so that the medical agent may not be expelled before it has time to exert its peculiar agency. The medical clyster ought, therefore, as a general rule, not to ex- ceed one-half the quantity of the simple one. The simplest and readiest medicinal clys- ter is made, either with a tablespoonful of common salt in a pint of gruel, or with a piece of brown soap, the size of a hazel-nut, rubbed down into a pint of warm water ; or instead of these, from half an ounce to an ounce of Epsom salts, or tAvo ounces of olive- oil, or half that quantity of castor-oil ; or infusion of senna, half an ounce of leaves to the pint, may be employed. Stronger clys- ters, with turpentine, croton-oil, &c. are also used by medical men. Anodyne clysters ought always to be so small in bulk — not exceeding three fluid ounces — ^as not to stimulate the bowel to expel them, which from the nature of the cases in which they are usually given, it is apt to do. In all cases, anodyne clysters are most conveniently administered by means of the vulcanized bag, and the best form is from fifteen to twenty-five drops of laudanum in three [or two] ounces of mode- rately thin starch. This clyster is of course to be retained in the bowel if possible. One of the most useful clysters for dispersing flatu- lence is made with two drachms of tincture of assafoetida to half a pint of gruel, to which, if there is much pain, ten or fifteen drops of laudanum may be added ; or the same quantity of assafoetida tincture may, if required, be added to an aperient clyster. A useful domestic clyster, in the country, for the same purpose, is half a pint to a pint of strong " rue tea," or infusion of rue. Clysters used for the purposes of internal fomentation, may be given to the amount of a quart, and of a temperature of 98° or 100° Fahr. In hemorrhage from the lower bowel, when it is proper to interfere with it, a two CO A 126 COC or three-ounce cold styptic clyster may be used, made with sulphate of zinc four grains, or sulphate of iron one grain, to the ounce of fluid. COAGULATION— Is the conversion of the whole of a fluid, or of some of its constitu- ents, into a solid. The solidification of the white of an egg by heat is an instance of the former ; that of the clot in blood, or of the curd in milk, of the latter. The coagu- lating power of the blood is the great safe- guard in bleeding, which could not be per- manently stopped by any appliances, without this property of the vital fluid ; and it is the loss of this property that gives rise to the occasional cases of danger or death from bleeding, in consequence of com- paratively slight wounds, such as those from leech bites, or from the extraction of a tooth. COAL-GAS. — See Carburetted Hydrogen. COB-WEB— Employed as a styptic, to arrest bleeding from simple flesh-wounds or from leech-bites, is often used in the country. The web of the black spider, which builds in out-houses, &c. has been used with much success as a medicine in ague, given in doses of ten grains, in the form of pills, every two hours, commencing six hours before the return of the paroxysm. The fact is worthy of remembrance. — Refer to Ague. COCCULUS INDICUS— Is the fruit of an East Indian tree. It resembles a large brown shrivelled pea in outward appear- ance. The kernel is intensely bitter, and on this account is sometimes used fraudu- lently in the manufacture of beer, instead of the hop ; also with the view of increasing the intoxicating power of the beverage. In some districts, a deleterious, but rapidly in- toxicating ale, named "tear-brain," sup- posed to contain cocculusindicus, is, or used to be, consumed by regular drinkers, on account of the smaller quantity of it, com- pared with ordinary ale, which produces intoxication, or rather stupefaction. This power of stupefying has occasioned coccu- lus indicus to be popularly used as a fish poison. COCHINEAL— An insect which yields the well-known colouring matter carmine, is brought from Mexico, being gathered from various species of cacti, on which it feeds. It is used chiefly as a colouring agent ; but has been employed especially as a domestic remedy in hooping-cough. Its powers are very doubtful. Refer to Hooping-cough. COCOA— CHOCOLATE.— Cocoa is pre- pared from the seeds or beans of a tree— the Theobroma cacao — cultivated chiefly in the West Indies and South America. The beans are roasted to develop the aroma and free them from the husks, which are comparatively innutritious, though frequent- ly mixed up with the prepared cocoas of commerce. Cocoa, when genuine and pro- perly prepared, is a wholesome and nutri- tious article of diet; it contains a consi- derable quantity of oily or fatty matter, starch, &c. &c. and a peculiar principle, "the obromine," which, according to Liebig, nearly approaches theine and caffeine — the characteristic principles of tea and coffee — in composition ; cocoa does not, however, affect the nervous system in the same manner as these beverages, and may therefore be taken in cases when they are inadmissible. Cocoa, as a beverage, ought to be prepared only from the crushed bean3 themselves, or "nibs," as they are called, for there is no certainty as regards the purity of the various artificial preparations sold under the names of "flake," "rock," "granulated," "homoeopathic" cocoa, &c. &c. &c. In the recent investigations of the "Lancet Sanitary Commission," more espe- cially, these often puffed-off compounds have been found to be made up of cocoa, sugar, starch or flour, husks of the cocoa bean, &c. &c. and sometimes with fats and oils of various kinds, and earthy and colour- ing matters. Chocolate is professedly a manufactured article, and should be made with the kernels of the cocoa bean, perfectly free from husks and reduced to a smooth uniform paste with sugar, and starch of some kind, such as arrow-root ; vanilla or cinnamon being used to impart flavour. Such a preparation as chocolate is of course liable to many adul- terations, of which the most deleterious are those with ochre, red lead, vermilion, sulphate of lime, chalk, &c. &c. ; tallow is sometimes used in the preparation of the cheap forms. It need scarcely be said that those who make use of chocolate ought always to procure it from dealers on whom they can depend. That of French make is generally to be preferred. As an article of diet, chocolate is extremely nutritious, but, on account of the oil it contains, is apt to disagree with weak stomachs, particularly if too great heat be used in preparing; moreover, the addition of vanilla is apt still more to increase its indigestibility, and, according to Dr. Paris, to occasion nervous disorder. COCOA-NUT— The well-known fruit of the palm, is, in its ordinary state, extremely indigestible, from the same cause that most COG 127 COF other nut-kernels are so — the solidity of the structure and the oily constitution, a com- bination which strongly resists the digestive powers. The reduction into paste or flour probably remedies the objection. CODLIVER-OIL— Is obtained from the liver of the common codfish and other allied species ; it was formerly employed in medi- cine in this country, fell into disuse, was revived as a remedy in Germany, and again brought into public notice in Britain, by Dr. Hughes Bennett, of Edinburgh, in 1841, since which time it has advanced rapidly and deservedly in the estimation both of the profession and of the public. It had never, however, been entirely abandoned as a domestic remedy in rheumatism ; and among the sailors, particularly those con- nected with the northern fisheries, had been regularly used both internally and exter- nally in the above disease. Now, however, it is principally employed and celebrated for its curative powers, especially in pul- monary consumption, in scrofula, and in all diseases connected with the scrofulous constitution, or depending on general de- bility. In the atrophy or wasting of the flesh in young children, connected with enlarged glands in the belly, which is tumid and hard, feels knotty, and with the veins of the surface enlarged, codliver-oil, given internally, a teaspoonful twice a day, and well rubbed into the skin of the belly two or three times a day, will in many cases cure, in a way which no other remedy we are acquainted with could do. For some time, the jlark, heavy, strong oil was considered to be the most efficacious ; but now, especially since more care has been bestowed on the manufacture, the purer and lighter oil, of the colour of light mahogany, is as good as any that can be used. The dose for an adult is generally one tablespoonful twice or three times a day ; it is however by some given much more largely. It is always advisable at first to begin with smaller, such as tea- spoonful doses, till the patient and the stomach become accustomed to the remedy, which even children quickly do, although sickness is sometimes produced at first. Tastes differ much as to the best method of taking codliver-oil ; floated in a little bitter beer [or beat up with the froth of porter] answers well, or the dose may be shaken up with half the quantity of syrup of marsh- mallow, and swallowed at once, or it may be taken in water, simple or aromatic. With many, codliver-oil acts slightly upon the bowels. In some cases of chest affec- tion, the breathing is certainly apt to become more difficult for the first few days of its use, and it has been said to induce spitting of blood. There cannot be stronger evidence of the nutritious power of cod- liver-oil, than the way in which its omission is felt by patients who have taken it regu- larly for some time : neither wine nor any- thing else appears to be a sufficient substi- tute. Refer to Scrofula, §c. COFFEE. — Active principle, Caffeine. — Coffee is the berry of a shrub, the Coffea arabica, indigenous to Arabia, and now cultivated in the East and West Indies, in America, &c. &c. It contains a consider- able amount of essential oil, and a peculiar principle, caffeine, which is identical with " theine," the characteristic principle of tea. The berry requires roasting to develop the well-known fragrant aroma. As an article of diet, coffee is for most persons wholesome and stimulating, but when there exists any tendency to head affection, or when the biliary secretion is apt to be over-abundant, it ought not to be used. Dr. Paris remarks that coffee, "if taken after a meal, is not found to cause that disturbance in its digestion which has been noticed as the occasional consequence of tea ; that, on the contrary, it accelerates the operations of the stomach." When strong, it most undoubtedly exerts much influence over the brain and nervous sys- tem, producing watchfulness and feverish symptoms ; it is thought, too, to affect the skin, and the sallow hue of the Parisians has been ascribed to the excessive use of coffee. The nutrient power of coffee is con- sidered greater than that of tea, although this cannot be great in either, irrespective of the characteristic principles — theine and caffeine — above mentioned, which, probably, are peculiarly beneficial to those who, either from necessity or inclination, consume much non-azotized, or vegetable food. In such individuals, who are often of sedentary ha- bits, a deficient consumption of animal diet, and inactivity together, render the biliary secretion deficient, and these principles of tea and coffee are, according to Liebig, "in virtue of their composition, better adapted" to supply the otherwise deficient "biliary azotized principles than all other nitro- genized vegetable principles." It is sin- gular that the above is supported by what we might almost call an instinctive habit among many of the poor in our own country who are unable to procure animal, that is azotized food, but who will make every effort to procure tea and coffee ; the custom is, and is no doubt felt to be, salutary. Coffee COL 128 COL is more suitable, for most persons, for the morning meal than tea, Avhich is more likely to affect the nervous functions. A cup of strong coffee, taken immediately after rising, is considered a good protective from the effects of malaria. In poisoning by opium, coffee is one of the most useful antidotes, but in this case ought to be fresh, pure, and strong, and taken without milk or sugar. The infusion of one ounce, taken every twen- ty minutes, is considered a suitable dose. Coffee should always be infused, never boiled ; when made with half milk, it is more nutritious for the weak, if it agrees with the stomach in this form. The adul- terations of coffee are numerous ; for that with chicory, which is the most prevalent, the reader is referred to the article "chi- cory." According to the "Lancet," roasted wheat-flour, and beans, mangel-wurzel, acorns, potato-flour, and a "coffee colourer," made with coarse burnt sugar, are likewise used. From what has been said respecting the properties of pure coffee, it is evident that none of the above additions or adulte- rations, although they may give the ap- pearance of it, can add real strength to the infusion, or be in any way substitutes for coffee itself; indeed, it would be much cheaper, and more nutritious and whole- some, for the poor to make and drink good toast-water, than to spend their money on coffee so called, which in reality is half, or more than half chicory, or something worse ; for the chicory itself is very greatly adul- terated. Coffee sold in "air-tight" canis- ters is always to be suspected. The only real security at present is for persons to grind their own coffee, not too much at once, and to preserve both the whole berry and the powder in canisters, or wide- mouthed, well-closed bottles. In the West Indies an infusion of raw coffee is used by the negroes, and found serviceable in pro- moting the flow of urine. Refer to Diet — Tea, $c. COLCHICUM. — Colchicum autumnale is the botanical name for the " autumnal cro- cus," found wild in many parts of England south of the Trent. The root and bulb and the seeds are both used in medicine, par- ticularly in gout and rheumatism ; but the drug requires too much care, and its im- proper use is too liable to produce evil consequences, to make it a safe domestic remedy, unless previously sanctioned by medical authority. In some persons par- ticularly, it acts most powerfully upon the bowels, even in small doses. The prepa- rations chiefly used are the tincture, the wine, and the vinegar. According to Dr. Christison, two drachms, or teaspoonfuls, of the wine of colchicum has proved a fatal dose. The symptoms produced by an over- dose of colchicum are vomiting, purging, colic, heat in the throat and abdomen, ge- neral depression, headache, and stupor or delirium. The remedies to be used until medical assistance is procured are diluents, such as barley-water, linseed-tea, or thin gruel, and laudanum or opium in some form. Refer to Opium. COLD — Is generally considered to be a negative result of the absence of heat rather than an active principle ; in consequence, however, of its energetic influence upon the living body, either in health or disease, it is usually spoken of as an active agent. The animated human frame is endowed with the power of maintaining a certain average tem- perature, which — except in rare instances — is higher than that of the surrounding medium, and this power is adequate to re- sist all ordinary impressions of cold ; but when, from great intensity, or long continu- ance, and especially when combined with moisture, the depressing action of cold is irmch augmented, the powers of life sink, and disease or death is the consequence. This power of the living body to resist cold, is in great measure dependent upon the supply and proper assimilation of a suffi- ciency of nourishment; the ill-fed and the dyspeptic always suffer most from the effects of cold. But in order that full benefit may - be derived from the power of food to protect against low temperature, particularly when at all severe or long continued, it is requisite •that more or less muscular exercise — accord- ing to circumstances — be engaged in, for the purpose of quickening the functions of re- spiration, circulation, and metamorphosis of tissue ; in other words, for the purpose of increasing the supply of oxygen taken into the system, and thereby facilitating the con- sumption of the internal fuel, (see Animal Heat,) either obtained directly from the food, or from the compounds carbon and hydro- gen already existing in the body. This is no more than common experience testifies ; for all know that, of two men exposed to a continued degree of intense cold, even if equal in other respects, should one perse- vere in muscular exertion, and the other give way to indolence or torpor, the former will be much more likely to survive the effects than the latter. And even under exposure to cold not so immediately dan- gerous to life, and especially if combined with moisture, the most ignorant are aware that "as long as they keep moving" there COL 129 COL is comparatively little danger of those bad consequences ■which almost invariably re- sult if rest is indulged in. In fact, as long as the muscular movement is kept up, the circulation, respiration, and change of tissue goes on with sufficient activity to maintain temperature adequate to resist the cold, which, however, prevails as soon as inac- tivity permits the cessation of the resisting forces. Thus we have a point of every-day experience confirmed and its rationale ex- plained by the researches of modern science. In northern latitudes, however, the inter- nal means of resisting cold are of them- selves insufficient for the purpose, and, therefore, clothing, shelter, or habitations, and the production of artificial heat, are re- sorted to, and these, indeed in some degree, stand in the place of nourishment; for the man who is sufficiently well protected from the effects of cold certainly requires a less supply of food to maintain health than he who is not. As regards food, habitations, and fuel, most who have it in their power are inclined to use their protecting influ- ences sufficiently. It is in clothing that the chief errors and negligences are met with, and the reader is referred to the subject itself for their exposition. There may, cer- tainly, be such over-precaution in guarding against cold, that it is impossible to keep up the protection on all occasions, so that an accidental omission in dress, or expo- sure, after being habituated to air of too high a temperature, at once gives rise to disease. But the abuse is no argument for the non-employment of ► sufficient rational protection against the influences of weather, especially in latitudes like our own, in which a low temperature frequently prevails, and that, too, combined with moisture, while, at the same time, the vicissitudes from heat to cold are often extreme and violent. It may safely be asserted that a large proportion of the diseases to which the inhabitants of this country are liable are, either directly or indirectly, the result of cold. It is suf- ficient to mention inflammatory attacks, general and local, apoplexy and paralysis, rheumatism and neuralgia, scrofula with its long train of disease, and consumption, as diseases, among many others, traceable to the influences of low temperature, to convince the most careless of the necessity of due protection against an agent so potent for evil. In many warm climates the prin- cipal danger from cold is incurred by ex- posure to the chill dews of evening, after hot days. The effect of extremely low temperature acting upon a limited portion of the body is rigidity of the muscles, blistering of the skin, particularly from grasping metallic bodies with the bare hand, and frost-bite or death of the part affected. The general effect of extreme continued cold is depression of the nervous system, of the functions of the respiratory organs and skin, deterioration of the blood, torpor, insuperable drowsiness, and death. In case of frost-bite, as of the fingers or toes, although the part may ap- pear quite lifeless, pale, and shrivelled, it may often be saved by proper treatment ; and the principal thing to be attended to is, that the temperature be not suddenly raised ; circulation, nervous power, and heat, must be very gradually restored ; and probably the method followed in countries in which this accident is common, will be found safest and best, that is, continued friction of the part affected with snow, till reaction is established : at all events,friction should be used ; after inflammation may be soothed by tepid poultices. When, in consequence of long exposure to external cold, drowsiness comes on, both mind and body must be exerted te keep off the influence ; to indulge it is death ; mus- cular motion must be kept up : if the in- dividual is alone, and has a supply of alco- holic stimulant, brandy or wine, it ought to be resorted to when it is felt that other- wise the powers must give way ; then, it may give strength to reach safety and shelter ; but the greatest caution is requisite before those who are exposed to severe con- tinued cold have recourse to these stimu- lants ; as a last resource they are invalu- able, but their aid must be unsought as long as possible, for if resorted to too soon, the after depression adds fatal facility to the further depressing power of a low tempera- ture. Experience proves that those who are likely to be exposed to great continued cold should provide abundant nourishment, particularly of a fat or oily character ; they should never be without a flask of spirits, but never have recourse to it except as a last resource. The sudden application of cold, even if it be not intense, may be very serious, in case the nervous powers are at all exhausted. Of this, the cramp to which bathers are subject is an example, and like- wise the fatal accidents so frequent during harvest, from persons drinking largely of cold water. The fatal effect is usually ascribed to the heated state of the body, but much is also due to the shock commu- nicated to the stomach and its numerous nervous connections, while the system gene- rally is exhausted. The effect of cold, not extreme, but long continued, especially if COL 130 COL combined with moisture, is one of the most fertile sources of diseases, some of which have been already enumerated. The young and the aged are more peculiarly liable to suffer, and for this reason require especial protection. The partial application of cold, particularly by a moving current of air, most generally produces disease of a neu- ralgic or rheumatic character, partial para- lysis, especially of the face, or erysipelas. All these injurious influences are more readily exerted if the body is at the time in a state of heated excitement, combined with nervous exhaustion, the result of previous exertion, and at rest. The partial application of cold and wet may produce inflammatory action in the immediate vicinity of the part exposed, or, as in the case of wet feet, in some distant organ. The most effectual remedy for the effects of " a chill," is warmth with moisture, in the form of bath, vapour or warm, or of hot bran bags, and the free use of warm diluent drinks, such as tea, gruel, &c. and, in case of much depression, warm wine and water. The use of cold as an hygienic agent, or in the treatment of disease, is invaluable. When, either as cold air or cold water, it is adapted in intensity and continuance to the resisting power of the constitution, it is a most admirable tonic. When used to subdue certain forms of excited and inflam- matory action, the temperature must of course be suited to the case, but ice-cold is most generally useful — care being taken, in the application of ice itself, that the part is not, as has happened, actually frozen or killed. Various forms of evapo- rating lotions, made with spirit, &c. are employed, but as the additions are made simply to increase the cold by increasing the evaporation, if a sufficient supply of sufficiently cold water can be procured, it is all that is requisite. The best mode of ap- plication is by cloths dipped in the cold fluid, and renewed again and again by a careful nurse. When, from circumstances, this cannot be done, the next best method is to keep up a continued system of irrigation, by means of a vessel of cold water placed a little higher than the part to be cooled, the fluid being conducted from the vessel to the part by bundles of woollen thread, or thin strips of flannel — care being taken, by means of waterproof material of some kind placed underneath, to carry off the superfluous water ; in this way the head or a broken limb may be kept constantly under the in- fluence of a stream of cold water, without the necessity for constant attendance. There has always been considerable difficulty in the application of cold to the back of the head in a person confined to bed ; this is now completely removed by the use of the vulcanized [India-rubber] cushions, which can be filled and refilled with ice-cold water as often as required, without disturbing the patient. Refer to Animal Heat. COLD IN THE HEAD, or Coryza— Is an inflammatory affection of the membrane lining the nostrils ; it is accompanied with more or less fever. It commences with a sense of dry fulness or obstruction of one or both nostrils, which is quickly succeeded by watery discharge of an acrid character, and there is frequent sneezing. The mem- brane of the eyes and their lids, being con- tinuous with that of the nose, is also affected ; and/from a similar cause, extension of the irritation to the membrane lining the frontal sinus, there is more or less headache. If simple cold in the head be not renewed, which it is extremely apt to be, it gradually subsides within the week ; more generally, however, as it leaves the nostrils, it travels downward into the lungs, and ends in ca- tarrh, cough, &c. &c. Coryza is a concomi- tant of some other diseases, such as measles and influenza. From its tendency to recur, and also to produce and keep up irritation of the lungs, coryza is not only not to be neglected, but should be checked at first, if possible, and for this purpose various methods of treat- ment are recommended. The injection of a solution of sulphate of zinc, five grains to the ounce, into the nostrils, at the very com- mencement of the disorder, has been said to stop it without fail. A dose of opium, either in the form of a large teaspoonful of pare- goric, of six or eight grains of Dover's powder, or quarter of a grain of muriate of morphia, when taken at bedtime, will often check a cold in the head at once ; and the usual system of hot foot-baths, confinement to bed, low diet, and diluent drinks, along with diaphoretic medicines, such as spirit of mindererus, antimonial wine, &c. &c, is certainly calculated to mitigate the disorder, and may be followed with advantage. The following mode of treatment comes recom- mended by the high authority of Dr. C. J. B. Williams. He says, "It is the common practice to drink copiously of tea, gruel, or some other diluent during a cold ;' as long as this promotes perspiration it is of some utility, and although it augments the flow from the pituitary or nasal membrane, it has the effect of diminishing its acrimony COL 131 COT by dilution. It is the acrimony of this dis- charge which reacting on the membrane, keeps up the inflammation, and its accompa- nying disagreeable symptoms. On this cir- cumstance depends the efficacy of a measure directly opposed to that just noticed, but to the success of which we can bear decided testimony — we mean a total abstinence from liquids. To those who have the resolution to bear the feelings of thirst for thirty-six or forty-eight hours, we can promise a pretty certain and complete riddance of their colds, and what is, perhaps, more im- portant, a prevention of those coughs which commonly succeed to them. Nor is the suf- fering from thirst nearly so great as might be expected. This method of cure operates by diminishing the mass of fluid in the body to such a degree that it will no longer supply the diseased secretion. Any thing that will contribute to reduce the quantity of fluid in the body will assist in the plan of cure and shorten the time necessary for it to take effect. It is, therefore, expedient to begin the treatment with an aperient, followed by a diaphoretic, as is usual, and this is the more necessary when any fever attends ; but beyond this no further care need be taken, and the individual can devote him- self to his usual employments with much greater impunity than under the ordinary treatment. The coryza begins to be dried up about twelve hours after leaving off liquids ; from that time the flowing to the eyes and fulness in the head become less and less troublesome; the secretion becomes gelatinous, and between 'the thirtieth and the thirty-sixth hour ceases altogether : the whole period of abstinence need scarcely ever to exceed forty-eight hours. It is then as well to return to the moderate use of liquids, as the first indulgence is apt to be excessive. It is not necessary to limit the solid food any more than to that which is plain and simple, except where there is an acceleration of the pulse, or gastric irri- tation, in which cases animal food should be proscribed. For the sake of comfort in mastication, the food should not be of the driest kind. Thick puddings and vegetables, with or without meat, will be the best din- ner; and toasted bread or biscuit merely moistened with tea or other liquid for other meals. A single cup of tea is sufficient to bring back the coryza immediately, after twelve hours' abstinence has removed it. "We doubt not that it will be said that this plan of cure is worse than the disease, and so it may be in "some instances. It may be called always a choice of evils ; but we do not believe that any one who is liable to severe colds, after once experiencing the amount of good and evil resulting from this method, would hesitate between them, and it is for them that we make it known. "We have never witnessed any evil from this abstinence from liquids for the time prescribed: but it is not unlikely that it may do harm in persons with irritable sto- machs, or in those liable to urinary disor- ders. Moderation in liquid food, which may be assumed as a corollary from what has been already said, is one of the best pre- ventives against the bad effects of exposure to cold. When there is a large quantity of liquid in the system there must be increased perspiration, and therefore greater risk from the effects of cold." If coryza be not in itself a disease of im- portance, its tendency to frequent renewal, and, as often as it is renewed, to the repro- duction of irritation in the lungs, renders it really a disease of consequence, and one not to be neglected. Moreover, those individuals who are most susceptible to repeated attacks of coryza are those who are most likely to suffer from frequent or continued irritation within the chest. Refer to Catarrh — Cold, $c. COLD CREAM — Is a pleasant cooling ointment, made by melting four ounces of white wax in a pound of almond-oil, by means of gentle heat, and mixing gradu- ally with a pint of rose-water in a warm mortar. COLIC — Is the painful spasmodic con- traction of the muscular fibres of the bowels, particularly of the colon, occasioned by the presence of an undue amount of wind, or of some irritating matter, such as accumulated faeces, undigested food, acrid bile, over-doses of strong purgatives, or poison ; it may also be brought on by exposure to cold. The pain of colic comes on and goes off suddenly, is of a rolling or twisting character, is re- ferred chiefly to the umbilical or navel region, and is relieved by pressure ; there may or may not be vomiting. In some cases of colic, the spasmodic contraction of the bowel is so complete and permanent, that inverted action takes place, and the faecal contents are vomited ; to this form the name of ileus, or iliac passion, has been given. The above symptoms distinguish colic from inflamma- tion, the pain of which is of a more persist- ent, burning character, and is aggravated rather than relieved by pressure ; in the latter case, too, febrile symptoms are present from the commencement. The distinction is, of course, requisite for active medical treatment, but many remedies which may be used safely and effectually to relieve the COL 132 COM one will also be beneficial in the other, and, indeed, in other spasmodic or inflammatory attacks within the abdomen, which might be mistaken for colic. The sudden accession of an attack of colic, its peculiarly painful character, and the danger that, if continued, it may pass on to one of inflammation, renders immediate relief imperative. The first remedy is heat, either locally to the abdomen by bran-bags or similar applications, as hot as they can be borne, or by the hot bath of the temperature of 100°, if not undesirable on other accounts. The use of heat, if promptly and effectually carried out, will often of itself relieve the attack at once, particularly if it is the result of cold ; but even should it do so, it will be well to give a dose of castor-oil, or rhubarb and magnesia, to insure the freedom of the bowels from irritating matter ; a few drops of laudanum being added to either medicine should the spasm show a tendency to return. Should the pain not be relieved by the employment of external heat, as recom- mended, a warm clyster, temperature 102°, should be administered, and a cup of tea or of some unstimulating fluid taken as hot as it can be swallowed. If the pain still re- mains, ten drops of laudanum must now be given, and repeated every quarter of an hour until relief is obtained, or until forty drops, or even more, have been administered. If the case is violent, a clyster containing twenty drops of laudanum may be given. These means, if thoroughly carried out, will scarcely fail to afford relief until the arrival of medical assistance, which should always be procured, if the case is at all severe or continued ; it may depend on causes which a medical man alone can discover or remove. Alcoholic stimulants are scarcely to be recommended for use in non-medical hands, not because they are not serviceable in colic, but because, should the case be mistaken, and prove one of inflammation, they would prove most injurious, which the remedies above prescribed could not. Still, in a case in which no doubt could exist, a tablespoonful of undiluted tincture of rhu- barb, or a glass of hot brandy and water, with or without laudanum, are either of them good remedies. Painter's colic, or dry belly-ache, is a dis- ease to which persons are subject who work much among lead ; it is said also to be oc- casioned by new cider, &c. &c. It is severe colic, accompanied with obstinate constipa- tion. The disease, either in itself or from concomitant constitutional affection, may prove fatal, and should always be treated by a medical man if possible. The treatment is much the same as that for common colic as far as allaying pain goes, but the obstinate constipation which accompanies it, requires the laudanum and other means to be com- bined with active purgatives, castor-oil, senna, compound colocynth pill, &c. Alum has been strongly recommended as a remedy in painter's colic. Much might be done by those engaged in employments connected with lead, to avoid not only this, but other bad effects, by due attention to cleanliness, particularly of the hands at meal-times. The use of lemonade, acidulated slightly with sulphuric acid, or of aromatic sulphuric acid, in water, would probably be additional protection. Lead colic has been induced in whole families, by the use of water which acted strongly upon leaden pipes or cisterns. Those who have once suffered from an attack of colic should pay particular atten- tion to the bowels. A pill composed of one grain of extract of henbane, with two of compound colocynth and rhubarb pill, will be found a most suitable aperient. Refer to Alum — Lead — Water — Sulphuric Acid, §c. COLLAPSE. — The term applied to a state of sinking or prostration of the powers of life. COLLAR-BONE.— See Clavicle. COLLIQUATIVE.— A term applied to any profuse exhausting evacuation, more par- ticularly the diarrhoea and perspirations of pulmonary consumption. COLLYRIUM.— A lotion for the eyes.— See Eye. COLOCYNTH, or Bitter Apple— Is the fruit of a creeping plant, and is brought to this country chiefly from the shores of the Mediterranean. An extract made from the dried pulp is used in medicine. It is a powerful irritating purgative, never used alone, and only likely to be employed domes- tically in its well-known combination, the compound colocynth pill, one of the most universally useful purgatives we possess, of which the dose is from five to ten grains. Refer to Pill. COLON. — The large bowel.— See Ali- mentary Canal. COMA. — A state of insensibility, resem- bling sound sleep, from which the person either cannot be roused at all, or only to partial consciousness. The condition is generally the result of pressure on the brain, either from injury to the skull, or from effu- sion of blood or watery fluid, or of matter, within the head. In apoplexy, poisoning by narcotic drugs, and complete alcoholic intoxication, the comatose condition exists ; it may also be owing to exhaustion of the COM 133 CON brain. In coma the action of the heart con- tinues sufficiently perceptible ; in fainting it does not. — Refer to Apoplexy, §c. COMPLEXION.— The hue of the face. Much information may frequently be ob- tained of the existing constitutional condi- tion, by observation of the complexion; but in judging, it is requisite to consider the original temperament and the family descent of the individual. In fair races, such as the Anglo-Saxon, a certain amount of colour is usually associated with our ideas of health, and in some respects truly so ; the reverse, a perfectly pallid face, can scarcely be con- sistent with a sound bodily condition. But colour may be too high at all times ; and the capillary vessels of the face, partaking of the fulness of those of the body generally, may indicate that from some cause, such as over- feeding, or indolence, combined with good digestive powers, the system of the individual is too full of blood; for the colour is not confined to the parts naturally tinged, but is diffused over the face generally, and even the white of the eye is covered with distended vessels. Such a state is one of danger ; it is often accompanied with headache, giddi- ness, confusion of thought, sleepiness ; and when these occur, apoplexy may be dreaded. A high or brilliant colour may also accom- pany the consumptive constitution ; but in this it is very generally associated with a fine skin, and often with light or red hair, with freckles, and also with a pearly or bluish appearance of the white of the eye. This appearance of high health is apt to de- ceive the inexperienced,; but the colour is generally not equal or persistent. It varies much, being easily heightened by excite- ment, or depressed by the reverse, and it continues to add beauty even to the last stages of the hectic of consumption. In the dark-haired, and dark-complexioned, colour is less commonly developed. The complet- ion of disorder or disease is very varied ; it may be muddy, pallid, pasty, white, sallow, cachectic, yellowish-green, and purple. The muddy complexion may be the natural one of the skin, but it frequently accompanies dyspeptic ailments, and is directly depend- ent on depressed nervous power and languid circulation of blood : it is most strongly marked in the dark depressions underneath the eyes. Whatever lowers or exhausts the nervous power will produce this complexion, which may be seen in perfection when the light of morning shines in, either upon the votaries of a too protracted dance, or upon the weary watcher beside the bed of sick- ness. Sleep is the best restorer of the ex- haustion of nervous power indicated by this M condition of complexion ; but if rest is im- possible, it is one of those cases in which stimulants, hot tea or coffee first, and then alcoholic stimulants, is perfectly requisite. The pallid complexion is often the result of too close confinement to the house, and especially of deficient exposure to diffused daylight — it is well marked in miners. The pasty complexion accompanies the lymphatic constitution, and general laxity of the solids. The subjects of it require a good allowance of animal food, in preference to milk and grain preparations, puddings, &c, of which they are often too fond. They almost in- variably derive benefit from preparations of iron. A marked white complexion not natural to the individual is often indica- tive of serious disease, probably of the kidneys or heart, and when it appears in persons advanced in life, the case ought most certainly to be investigated by a medi- cal man. The sallow complexion is very generally a natural one. The cachectic accompanies a diseased state of the system, and often of the abdominal organs ; it is muddy, and accompanies emaciation of the features. The yellow complexion may be the bright hue of jaundice, or the muddy yellow associated with malignant disease, especially cancer. In the greenish-yellow skin of chlorosis or green sickness, there is also extreme pallor of parts usually coloured — such as the lips. A purple complexion is indicative of deficient oxygenation of the blood, either from disease of the heart or lungs ; generally of the former. Refer to Skin, Countenance, §c. CONCRETION— Is a term applied to the unusual aggregation of any substance or substances within the body — most generally to intestinal concretions. Persons who have been in the habit of taking large and re- peated doses of magnesia have not unfre- quently suffered from its concretion into hard lumps or balls in the stomach or in- testines. Any substance which possesses the power of felting or matting together is liable to form a concretion in the bowels. One has been found of ends of thread matted together, which a female had been in the habit of biting off and swallowing when at work; but perhaps the most common cause of the intestinal concretion is the felting of the bran of the oatmeal, as used in Scotland, when too exclusively employed as food, and in too dry a state. Good boiling and di- luting, or the mingling of other articles of food, particularly those of an oily nature, is the best preventive. ^ CONCUSSION.— A term applied in medi- cine to the effects of a severe blow over some CON 134 CON of the more important organs of the body, or on the body generally. For Concussion of the Brain, see Brain. Severe concussion of the chest affecting the heart, or over the region of the sto- mach, may prove fatal immediately, or at least produce much alarming faintncss and collapse. In the latter case the use of stimu- lants, such as ammonia or spirit internally, or stimulant clysters, and the dashing of a jug of cold water over the chest and face, immediately following it by hot applications, mustard, &c, would be the most appropriate treatment. CONDIMENTS— Are substances which are not of themselves nourishing, but which are taken along with food as seasoning, and to promote its digestion. Salt is the most ex- tensively used, and also the most whole- some condiment. To civilized man its use is second nature, and very many of the lower animals are not only fond of it, but seek it instinctively as a necessity, and improve in health and appearance when they have ac- cess to it. The vegetable acids, vinegar, &c. are useful and wholesome in moderation, particularly with oily food. The aromatics and spices, such as cayenne, white or black pepper, ginger, &c, can scarcely be called injurious to healthy individuals, if used in moderation ; in debility of the stomach they are often of service, and they seem espe- cially adapted to counteract the effects of a warm climate upon the digestive organs, and also to the constitution, acquired or otherwise, of the inhabitants. They are, however, generally used along with vege- table productions. Refer to Salt — Vinegar — Aromatics, §c. CONDYLE.— The extended extremity of a bone which forms the joint. CONFECTION.— A term applied to me- dicinal preparations generally made with sugar. The most useful are almond confec- tion, aromatic confection, cassia, rose, and senna confections. Of these, the aromatic confection is the most useful and generally used preparation. It is thus made : — Take of cinnamon, nutmeg, saffron, of each two ounces ; cloves one ounce, cardamons half an ounce ; prepared chalk sixteen ounces. Reduce these materials, when dry, to a fine powder, and keep them in a close vessel. Sugar, to the extent of six ounces, may or may not be added to the preparation. Refer to Almond — Rose — Senna, fyc. CONFECTIONARY— Literally, " things made up," — is not necessarily unwholesome, if used in moderation ; it is, however, too often deleterious if made with much butter, or when made of bad materials, or mingled with poisonous ingredients. Baked confec- tionary, in which the butter or grease is rendered empyreumatic and acrid by the heat employed in its preparation, is always liable to disagree, and especially so when, as often happens, bad materials are em- ployed and disguised with flavours of va- rious kinds, which are often in themselves unwholesome, particularly those so largely used, such as the oil of bitter almond, peach- kernel, and laurel flavouring, which are actual poisons, when taken even in not very large quantity. Another flavouring in- gredient, recently introduced, but already largely used, called "jargonelle pear," is not devoid of danger, and has been known to produce dangerous head symptoms in a child. It is made from the fussel-oil ob- tained in distillation from grain, potatoes, &c. But perhaps the most numerous cases of injury have arisen from coloured confec- tionary and sweetmeats, a large proportion of which are tinged with deleterious sub- stances ; the greens with arsenite of copper or Scheele's green, verdigris, or a mixture of chrome and prussian blue ; the yellows by chromate of lead ; the reds by vermi- lion, a compound of mercury, or by oxide of iron ; and the whites by carbonate of lead, oxide or carbonate of zinc, chalk, or sulphate of baryta. The frosting of cakes and the white-sugar comfits often con- tain a large percentage of plaster of Paris. These facts ought to be sufficient to make people very cautious in the use of such articles, particularly with children ; and, in case of sudden unaccountable illnesses, they should not forget the possibility of such causes. The colour of a sweetmeat would afford some clue to the nature of the poison, and reference to the proper article in this work will show the measures proper to be adopted in the interval of procuring medi- cal assistance. CONGESTION.— A morbid accumulation of fluid, such as blood, in its own proper vessels. CONJUNCTIVA— Is the membrane which lines thg eyelids, and is folded from them upon the forepart of the eyeball, which it covers, extending over both the white and the clear portion, or cornea. In its ordinary healthy condition the conjunctiva is a trans- parent membrane, with, perhaps, one or two tortuous vessels seen upon it. Refer to Cornea — Eye, §c. CONSERVE — Is a compound of some fresh vegetable substance with sugar. The conserves are now classed with the con- fections. CONSTIPATION.— See Costiveness. CON 135 CON CONSUMPTION, or Pulmonary Con- sumption — As its name implies, is a disease of the lungs, or at least one in which the lungs are more prominently affected than any other organ. In Britain [and in the United States] its fatality and frequency render it but too familiar, as year by year it numbers for its victims the young, the good, and the fairest in the land. Consumption is a portion only of a con- stitutional malady, which very frequently develops its intensity in the organs of respi- ration, but may do so in other modes and in other organs of the body. Its constitu- tional nature requires to be impressed upon the mind of people in general ; for, regarded only as a disease of the lungs, alarm is not taken, nor are remedies generally resorted to, until its effects upon these organs be- come manifest; the antecedent period, in which the constitution is giving way, is overlooked, and that time is lost in which the first indications of disease might have been successfully attended to. The causes of pulmonary consumption are all those which occasion debility gene- rally, not excepting the most frequent of all, hereditai'y predisposition, or that tendency to the disease which exists so strongly in some families, that no care or precaution can ward it off, nor prevent it seizing in succes- sion member after member of a household. Fortunately, this intensity of hereditary transmission is not so very frequent, but there are few families in this country in which the tendency does not more or less exist ; there are few which cannot number amid their deceased relatives some victim of consumption. With a susceptibility so widely diffused, it becomes a serious con- sideration with all by what this tendency is encouraged, and how it may be diminished. The first consideration that presents is mar- riage. There can be no question, that from errors in the contraction of this great en- gagement of life, much of the hereditary tendency to consumption is developed, and especially when the union is betwen parties nearly related by blood ; doubly so if the predisposition already exists in the family. Delicacy of either parent, particularly of the father, is very apt to entail consumptive tendencies upon the children ; and the same follows if the parents are either too young, or if the father be advanced in life. The mistake is a very common one, that mar- riage and child-bearing act as a check upon the progress of consumption, and the step is often advised even to the comparatively young with this view. The error is a serious one ; nothing can be more trying even to a healthy female, in this country, than having a family before the constitution is formed ; and most certainly it is so to the weak. It is true, apparent temporary amendment of consumptive symptoms sometimes occurs, but the powers of life are sapped by the too early call on their exertions. In the management of the children of even the most healthy parents — doubly so of those who are the reverse — much may be done either to weaken or to fortify the constitu- tion, to pull down the one to the level of the scrofulous diathesis which ripens into consumption, or to infuse into the other such strength and vigour that it may resist during a long life any development of the disease. For information respecting the management of children, the reader is re- ferred to the article itself. As the period of puberty approaches, care is required with all, but doubly so in the case of those who have displayed any scrofulous or consumptive tendency. The development of the body which is going on requires a full supply of the most nutritious food, animal food particularly. The secre- tions should, if possible, be kept in healthy activity, and, more especially, all sources of exhaustion most strictly avoided. Youths especially must be warned against the evil of prolonged physical exertion ; and not less so against the mental efforts, which those especially, who partake of the nervous and excitable constitution of the hereditary con- sumptive, are apt to give way to, in compe- titions at school or college. At any period of life, mental anxiety or over-exertion, intemperance or dissipation, the habitual breathing of vitiated air, low damp situation, insufficient clothing, and exposure to the weather, or peculiarity of employment, particularly that which neces- sitates the inhalation of irritating matters, or any continued drain upon the powers of the constitution, such as suckling, may any of them develop or induce consumption. Two very opposite conditions of physical development are found to exist along with the consumptive tendency. In the one, there is the fair fine skin and bright red com- plexion, the fair hair, the light eye, with its pearly looking white, and the tapering fingers ; in the other, the dark hair and skin, the latter almost dirty-looking, and the swollen-looking upper lip. Consumption varies much in its initiatory stage ; some- times it steals upon the patient most slowly and imperceptibly; at others, developed probably by some acute attack, it appears to start at once into activity. Generally, for a considerable period before marked CON 138 CON symptoms — or at least symptoms which attract general attention — show themselves, the person has felt weak, languid, and com- plained much of cold, probably has sunk in flesh, and a short dry cough has come on, apparently without cause, or there has been continued dyspepsia. If the patient is a female, the monthly discharge has become irregular, or stopped. It may be that these symptoms have been aggravated during winter, and disappeared partially or entire- ly with the advent of warm weather. Such symptoms may go on for a longer or shorter period, ebbing and flowing, but still gaining ground, or they may progress more unre- mittingly, though still slowly, or become suddenly aggravated by some adventitious circumstance, such as taking cold, some unusual fatigue, or the like. The emacia- tion becomes too evident to escape notice, the cough is unabated and becomes trouble- some, the voice assumes a peculiar hollow sound, the breathing is quickened, and it may be that spitting of blood, profuse night perspirations, or even diarrhoea, have set in before the patient's condition excites either alarm in their own mind or in that of their friends. Indeed it very frequently happens that the patient is the last to take the alarm, the last to entertain the idea of the fatality of the disease, of which this hope- fulness of recovery is a well-marked symp- tom. Threatened consumption is no disease for domestic treatment. On the first suspicion of its presence, the person should at once be examined medically. The above symp- toms may excite alarm, may afford most grave ground for suspicion, not only to the friends, but also in the mind of any medical man, but their certainty cannot possibly be pronounced upon without the physical exa- mination of the chest, which well-educated medical practitioners only can conduct. By that, the case may very generally be de- cided, groundless fears dispelled, or just apprehensions confirmed and acted upon, while yet there is time to save or prolong life. As regards the prospect of recovery from consumption — for recovery does undoubt- edly take place— much depends upon the original and existing constitution and the habits, past or present, of the indi- vidual, and the worldly means within his power. If the disease has become established in an individual of strong hereditary tendency to it, or in one who has broken down his constitution by dissipation or intemperance, or who is the subject of some other debi- litating disease, hope of amendment can be but small. If, on the contrary, the affection is more probably induced, and rather acci- dental than the result of original constitu- tional tendency, the probability is that under proper management, and with the aid of the great curative powers of cod-liver- oil, not only amendment, but permanent recovery, may be obtained. When consump- tion has advanced beyond its first stage, all the symptoms already mentioned are in- creased, the cough and perspiration parti- cularly become more distressing, and the ten- dency to diarrhoea, (frequently with severe spasmodic pain in the bowels,) notably in- creased ; expectoration is often difficult, either from weakness, or from viscidity of the expectorated matter ; the hair falls off, progressive emaciation continues, and be- fore death the skin of the most prominent portions of the back is apt to become ulcer- ated. The disease, however, may be termi- nated earlier by sudden bleeding from the lungs, by an acute inflammatory attack, or by giving way of a weak constitution. Its ordinary duration is about nine months. Amid the other symptoms of advanced con- sumption, a peculiar broadening — " club- bing" — of the extremities of the fingers, with incurvature of the nails, is often observable ; and recent observations have been directed to the occurrence of a peculiar pink-looking marginal line at the junction of the gums with the teeth, which occurs in some cases. The prevention of so fatal a disease as consumption is a more important subject, in a work like the present, than its treatment ; and in those predisposed, the preventive or "prophylactic" system must be continued life through, even into old age. It is a popular error, that by the time middle life is reached the liability to consumption is over. Such is not the case, for even the "three score and ten" is sometimes terminated by the disease. According to the tables of Sir James Clark, it appears "that the greatest number of deaths from phthisis (consumption) happens between the ages of 20 and 30 ; the next greatest number from 30 to .40 ; the next from 40 to 50, and many even up to 70 years of age ; more women than men, Gn the average, dying from the disease. It has already been remarked what a potent influence hereditary predispo- sition toward consumption exerts, and how strongly this predisposition may be deve- loped or increased in a family by marriage union. People will marry, whatever their constitutional predisposition ; but if either their own constitution or that of their family generally is at all consumptive, it ought CON 137 CON to be a very weighty consideration with them that the union should be with one as little inclined toward the disease as possible. When the children in a family evidently inherit or display consumptive tendencies, in addition to the precautionary measures already enumerated in the article " Children," it should become a question, how far permanent removal to a more genial and dryer climate might be desirable. To the rich, who have it in their power to change their residence as and when they may, the consideration is perhaps of less immediate consequence ; but to the labourer, the mechanic, or the man of small income, it must be a question of paramount import- ance, whether, by emigration to such a climate as that of Australia, he may not only save himself the constant sorrow, actual and anticipated, of seeing his family drop one by one into their early graves, but also save the constant pull-back upon his exertions and drain upon his resources which a sickly family necessarily entails. But, indeed, in any condition of life, the question of tendency or not to consumptive disease should always influence the choice of field for exertion, and not only of field, but also of the nature of the business of life. Any occupation which renders the inhala- tion of irritating substances unavoidable, is to be eschewed by the consumptively in- clined man ; and not less so, that which involves confinement in a constrained posi- tion or in a close room. Of the former class, grinding or polishing of metal or stone, especially if dry," flour-grinding, &c. are examples ; of the latter, the occupation of the tailor, the shoemaker, the seamstress, or the compositor. The most eligible em- ployments are those which require muscular exertion of not too exhausting a kind, and without too great exposure to the weather ; the gardener, the carpenter, the butcher, the farm-servant, are all less likely to be the victims of the disease. In whatever situa- tion or grade of life, however, a person may be placed who is predisposed to consump- tion, much may be done to keep up the powers of resistance, by keeping up the ge- neral health to the highest possible standard, by diet, early hours, attention to the skin, [by thorough and daily washing of the whole body,] and avoidance of all kinds of dissi- pation and intemperance. Smoking tobacco should be shunned as particularly injurious. Regular exercise is to be taken — [especially in the open air, when the weather is not too damp. A distinguished physician of Phila- delphia prolonged his life thirty years by con- stant exercise, though at one period ad- m 2 vanced in consumption. He never remained in-doors except when it rained.] The chest and shoulders should be bathed every morning with cold salt-water, and rubbed afterward to promote reaction. Cheerful- ness of mind and moderate mental exertion are important, while perfect temperance in the use of alcoholic stimuli is indispensable ; but any change to their total disuse cannot be made in many cases without danger. All the usual sources from which "cold is taken" are to be shunned, particularly wet feet, sitting in damp clothes, crowded ball- rooms, and public assemblies ; and, lastly, when exposure to cold air, especially to east winds, or to the foggy atmosphere of night, is unavoidable, the protection of a respirator of some description should be resorted to. The question is often mooted with respect to the communicability of consumption from one person to another. That it is not ge- nerally communicable is certain; that it has been thought to be so under circum- stances of predisposition, and when there has been close communication between two per- sons, should be sufficient to caution other members of a consumptive family from hanging too much over one affected with the disease ; and certainly, in any case, for- bid the occupation of the same bed. With respect to the treatment of consump- tion, little remains to be said. It can never be an emergency, and the first suspicious symp- toms should be the signal for obtaining pro- per medical advice ; if the disease is really threatened, the well-conducted treatment of a competent medical man can alone be trusted to. In the progress of consump- tion, however, there are many painful symp- toms which may be alleviated by measures independent of the treatment of the dis- ease properly so called. As regards diet, there is the greatest variation, some patients being most com- fortable with a milk or farinaceous diet alone, while others require the constant use of stimuli, wine or porter, and consume ani- mal food in good quantity. For allaying the troublesome cough, demulcents of various kinds may be tried, with or without the ad- dition of small doses of morphia, laudanum, paregoric, or Battley's sedative solution. When a tendency to perspiration exists, and there is no diarrhoea, the following is a very useful and palatable mixture, which allays both nervous irritability and cough : — Take of muriatic acid thirty drops, muriate of morphia one grain, refined sugar two drachms, water six ounces ; of this mixture, a tablespoonful may be given every few hours. In the later stages, when the cough CON 138 CON is partly spasmodic, and expectoration diffi- cult, much relief is often experienced by the inhalation of steam, along with the vapour from a few drops of sulphuric ether put in the boiling water. The perspirations may be kept in check by fifteen-drop doses of dilute sulphuric acid in a wineglassful of water ; but when diarrhoea is present, this cannot be persevered in. To relieve diar- rhoea, the abundant use of isinglass or gela- tine will be found serviceable, also chalk mixture with opium ; five-grain doses of the oxide of bismuth, with a quarter of a grain of powdered opium, is often a useful remedy. Acetate of lead, gallic acid, &c. are also used, but scarcely likely to be so domestic- ally. In case of sudden bleeding from the lungs, refer to Hemorrhage. Refer to Chest — Children — Lungs — Respira- tion — Respirator — Scrofula — Temperament, $c. CONTAGION — Is sometimes used to ex- press the actual agent by which disease is propagated ; but more generally the propa- gation itself. Properly speaking, the term ought to be confined to the propagation of disease by actual contact, in contra-distinc- tion to infection ; but it is now used in the more extended sense of "infection" like- wise. Contagious diseases may be commu- nicated only by actual contact of individuals, as in the case of itch, &c. ; by inoculation, as in the case of cow-pox ; or in addition to both or either of these modes of transmis- sion, through the atmosphere by infection, as in the case of small-pox, &c. This power of propagation through the atmosphere, however, does not, independent of epidemic and endemic influences, extend far from the patient. Certain circumstances influence the extent of contagious diffusion. Of these, the most distinctly ascertained are atmospheric impurities ; for it is ever ob- served, and we believe it may be predicated of every disease possessing the property of remote contagion, that its contagious matter is propagated to greater distances in a dirty, crowded, and ill-ventilated apartment, than in one of which the air is pure. The same prin- ciple applies to articles of dress and furni- ture ; those which are contaminated by animal secretions and effluvia being much more readily impregnated with contagious matter than those which are clean. Peculiar atmospheric conditions certainly, also fa- vour the propagation of disease by conta- gion ; sometimes these conditions are inap- preciable, at others they are evidently con- nected with a superabundance of warmth and moisture ; and also, we have good rea- son to conclude, with certain states of electrical disturbance. The discovery of the new agent, or modification of the known existing agent oxygen — named ozone — may probably shed some new light upon the sub- ject of contagion. Actual contact, however, or even immediate vicinage, to a person labouring under a contagious disease, is not requisite for its propagation to others. This may be effected by means of substances to which the contagious matter clings. These substances, which go by the name of fomites, are more generally clothing and stuff furni- ture which have been about or near the bodies of those labouring under the disorder. These fomites are apt to be impregnated with the poison in a very concentrated con- dition, and are capable, not only of retain- ing it for a long period, but of transporting it from place to place. A sofa on which a patient labouring under scarlet fever had lain has been known to propagate the disease six months afterward ; and clothes which have been about the sick are con- stantly ascertained to have been the media of conveying fever, &c. to distant localities. Wool and cotton seem particularly apt to attract and retain contagious emanations ; but, indeed, all loose textures appear to have the property ; while on the other hand, polished and hard surfaces and substances are much less likely to act as fomites, if they do so at all. Every thing of unneces- sary drapery or clothing should be removed from the chambers of those sick of contagious maladies, or indeed of any malady; for a sick chamber must always, in a lesser or greater degree, have an atmosphere con- taining unhealthy emanations, which it is expedient, both for the good of the patient and of others, should find no unnecessary attractions or lodgments. Further, it is advisable to have the furniture as much as possible of hard and polished substances ; and the dresses of those in attendance upon the sick, especially if habitually so, might with advantage be made with a glazed sur- face. Those substances which have neces- sarily become the fomites of contagious matter ought to be scrupulously freed from it by complete and lengthened exposure to the open air, by washing, or by exposure to the fumes of chlorine in a close apartment ; or by all three, the chlorine fumigation be- ing first resorted to. Indeed those persons under whose management a case of conta- gious disease has occurred, ought, as a Christian duty, to make sure that every ar- ticle of stuff, furniture, clothing, &c. has been fully and carefully purified before others, either in the way of social intercourse or in occupation, particularly that of the wash- erwoman, come in contact with them. The CON 139 CON following systematic course of action should be pursued when the generation of contagious matter has ceased in an apartment, either by the death or recovery of the patient, premising, of course, that throughout the illness measures have been (or ought to have been) resorted to to preserve purity. During the day, the door being shut, the windows should be open to their full extent, and the infected articles freely exposed to the air ; during the night, the windows and door be- ing closed, chlorine should be well diffused through the apartment. This having been re- peated, if possible, for two days and nights, all textile fabrics and the like should be re- moved; those that are capable of being wash- ed put into cold water, and the others placed in the open air. All articles of furniture left in the room, also the floor and oil-painted wood-work, should be well scoured. If the chamber be a white-washed or coloured one, it should be "re-done;" if papered, it is only a safe precaution to repaper it. The bed requires the greatest amount of care ; if of wool, it is better destroyed altogether; if of hair or feathers, these should be exposed to the heat of rebaking, that is, at least to a temperature of 210° Fahr. ; and the tick- ing either thoroughly fumigated and washed, or entirely renewed. These directions may appear minute and troublesome, but they are far from being too much so when put in comparison with the fearful scourge of a contagious disease which has established itself in a household or community, and which perhaps might have been checked at the outset by the adoption of prompt and vigorous measures. The poor and the ignorant cannot or will not adopt, in most instances, effective precautions ; it remains for the rich, for the well-infoi'med, to point out their necessity, and lend a helping hand to their fulfilment, not only as an act of Christian charity, but as a means of safety for themselves. The disease which takes its origin in the cellar of Lazarus, not unfre- quently ends by establishing itself in the mansion of Dives. It is not a necessary character of contagious disease that it has itself sprung from contagion; some of the most virulent and spreading fevers, such as those of the ship, or of the old jails, had no such commencement, but had their origin in the decomposing emanations from the bodies of numbers of individuals confined in unventilated and insufficient spaces. In addition to the disinfectants already men- tioned, air, water, and chlorine, many others are and have been used, such as the vapour of vinegar, of pitch, or of tobacco or camphor, [or roasted coffee] ; large fires also used to be a favourite method ; but none of these last- mentioned are to be solely depended upon. The vapour of muriatic acid and the absorb- ing properties of newly slaked lime may be resorted to, in the absence of chlorine, with advantage. In many instances, particularly | in the case of clothes and other textures > which will not wash, heat might be used more extensively than it is at present as a disinfect- ant. The experiments of the late Dr. Henry, of Manchester, proved that while the various textile fabrics might be exposed to a heat of at least 215°Fahr. without injury,their power as fomites, or of propagating contagious disease, after having absorbed the emana- | tions, is destroyed by the high temperature. Refer to Air — Bed-room — Chlorine, §c. CONTUSION.— See Bruise and Concus- sion. CONVALESCENCE— Is the transition pe- riod between the cure or cessation of severe , disease, whether acute or chronic, and the ! re-establishment of health. The commence- ! ment of convalescence, or the point at which ' the characteristic symptoms of disease cease, j is sometimes distinctly marked, more espe- cially after acute disorders; frequently, how- ever, the tendency toward health, particularly I after chronic disease, is much more insen- i sibly established. In the latter case, too, l the progress of the convalescence is slower I than it is in the former. Its rapidity or pro- \ traction, moreover, is much influenced by : age, and the nature and treatment of the 1 previous malady. Children convalesce ra- pidly, old people the reverse ; but in all cases I the natural power of resiliency of the consti- I tution exerts much effect. In no case, per- [ haps, is convalescence more tardy and un- ' satisfactory than after illness in which much j loss of blood, or of its constituents, has taken j place, either as a consequence of the disease or of blood-letting in the treatment of it. j Since, however, the practice of abstracting i blood in a large quantity by the lancet has j been modified, there are fewer cases of pro- tracted convalescence from this cause. When convalescence from acute disease commences, the previously quick pulse falls to the natural standard, the tongue begins to clear, the skin becomes cool, sleep is re- freshing, the mind acquires a more healthy and hopeful tone, and the person looks better. There is nothing which more assures a me- dical man of the condition of his patient than the look, the expression of the counte- nance, to which the first glance, as he enters the room of sickness, is almost instinctively directed. The look of convalescence is tran- quil and placid, not the heightened colour and bright eye of hectic, which so often deceives CON 140 CON the inexperienced with delusive hopes. When the brain has been much affected, however, the condition of the mind, and consequently the countenance, assumes its natural look more slowly. The management of convalescence is ex- tremely important. Errors in this respect frequently expose the already weakened patient to attacks of other disorders, or in- duce relapses to the diseased actions which had just been cast off. The convalescence after some particular diseases is more liable to such accidents than it is in others. That after fever is peculiarly so ; and after scarlet fever, the tendency to cold and its conse- quences, dropsical swelling, and affection of the kidneys, is so very common, and so frequently fatal, that the greatest possible care is requisite. During convalescence from acute disease, and especially of an eruptive character, many of the disorders characteristic of the scrofulous constitution show themselves : the eyes become the seat of chronic inflammation, purulent discharge from the ears occurs, and chronic eruptions show themselves upon the skin, of the head especially. Moreover, these disorders, now, perhaps, for the first time apparent, are apt to continue even after convalescence, pro- perly so called, is over. Further, relapse in convalescence often occurs from too soon employing actively the previously affected organ ; the liability to this mishap must be evident to the common sense of every one. In the case of the eye, it is evident to the senses, after inflammation of that organ, its undue exercise, or even its exposure to full daylight, will often be followed by a return of the disease. Such is the case elsewhere ; and whether it be the eye, or the brain, or the stomach which has been affected, re- turn to the ordinary exertions of health must be made with the greatest caution. The clothing of a convalescent patient re- quires particular attention ; there is much susceptibility to cold and to atmospheric vicissitudes. For the requisite informa- tion the reader is referred to the article "Clothing." General exercise is to be resumed cautiously, and should never be carried to the extent of fatigue. Diet, how- ever, is the great source both of error and mischief — the greatest difficulty which the medical man has to contend with ; that is, in getting it properly attended to, and his orders properly carried out, particularly among the poor. While a disease is in pro- gress and alarm is felt, directions are tole- rably well, or indeed strictly, obeyed; but no sooner does the patient begin to get better, than irregularities commence. The popular idea seems to be that convalescence must advance in proportion to the amount, and often to the stimulant qualities, of the food given ; and many a hopeful case sinks back into fatal relapse from the wilful and injudicious kindness of friends. The point is one which requires to be strongly en- forced, not only on the minds of the poorer and more ignorant, but on those of people generally, that in diet, as in every thing else, convalescence must be gradual, and that nothing is more dangerous, more likely to induce relapse, than the injudicious use of solid animal food or of stimulants. Milk, and the various farinaceous preparations with which it is usually combined, such as arrow-root, sago, rice, bread, &c. is perhaps the most generally useful article of diet in convalescence ; next come the broths made from fowl, mutton, veal, or beef, alone, or mixed with some of the farinacea ; next in succession, are eggs lightly boiled ; and, lastly, solid meats, of which tender mutton is probably the best, are to be permitted. Ripe fruits in their season, if not contra- indicated by the nature of the previous disease, and if they do not occasion flatu- lence or diarrhoea, are both grateful and serviceable. If alcoholic stimulants can be dispensed with, it is the safer plan, and when requisite, the time of their employ- ment, and the kind used, is best left to a medical attendant. A good deal must de- pend upon the previous habits of the person. Gin, in cases in which the urinary secre- tion is deficient, is most suitable ; or light sherry, if the circulation is excitable ; and port wine or porter in extreme debility. One of the most useful of the alcoholic stimuli, in convalescence, is the bitter India beer or pale ale ; the amount of alcohol it contains is not large, its bitter exerts a beneficial tonic effect upon the stomach, while the narcotic principle of the hop tranquillizes the nervous system, often so painfully irritable. In whatever form nour- ishment is given to the convalescent, it should be in small quantity at a time, but as frequently repeated as the natural appetite requires. The atmospheric purity of the chambers occupied by persons recovering from sickness requires great attention, and the temperature ought to be kept as nearly as possible about 58° Fahr. Lastly, when convalescence has reached a certain point, there is no remedy which so surely promotes perfect recovery and confirms health as change of air. Almost any change is beneficial, but in many cases much more advantage would be derived if persons thus seeking health acted upon CON 141 CON competent medical. advice. It is to be re- gretted, that so many of the accessories which promote speedy and certain conva- lescence have hitherto been unattainable by the poorer classes in this country. Care and good nursing and the highest medical skill in the country are bestowed upon the poor inmate of the hospital up to a certain point, and convalescence is barely esta- blished, when too often the patient has, in order to make room for others, to leave the comfortable home of his sickness, with all its nourishing food and its comforts, and return to scanty nourishment, exposure to weather, and to an unhealthy home. In a climate like that of Britain, [as well as in the United States,] the point is one which requires more attention than it has hitherto received. Proposals for the establishment of convalescent villages have certainly been made, and some steps have been taken to- ward providing convalescent stations; but an immense deal requires to be done before the want is supplied, and charitable bequests and donations might be worse directed than into such a channel. Refer to Air — Bed-room — Clothing — Cook- ery — Diet, $c. CONVULSION— Is a state of alternate violent contraction and relaxation of the muscles, independent of the influence of the will ; those under its direct control are most frequently affected, but not invariably so. The muscular fibres of the stomach and other involuntary muscles are often the seat of convulsion, but in this case the term spasm is generally applied to the disorder. Convulsions are classed by medical men as "tonic," or those in which the state of con- traction is maintained for a considerable period without alternation with relaxation, and as " clonic," or those in which the two states succeed one another with more or less rapidity. When the relaxations and con- tractions are very slight and very rapid, the condition is tremour. The first of these, or the tonic convulsion, occurs in lock-jaw in its most perfect form ; the second, or clonic, in hysteria ; the third is seen in the persons of hard drinkers when not under the in- fluence of their stimulant. % Convulsions may be either general or partial, affecting only the muscles of the eyes or eyelids, of the face, or of one of the extremities, or of one side of the body ; or they may shake the whole frame in convul- sive agitation, such as occur in epilepsy. Some of the most characteristic local con- vulsive actions occur in the muscles of the face, causing squinting, &c. &c. or the pecu- liar "sardonic sniile,"or grin, which is caused by forcible retraction of the corners of the mouth, exposing the teeth. Sometimes an attack of general convulsion is prewarned by a local affection, the eye is unnaturally turned, or the thumbs, as often occurs in children, drawn across the palm of the hand; or hiccup, which is a convulsive affection of the diaphragm, pre- cedes the more widely diffused affection. In partial convulsion, the mind is probably unaffected ; but when the affection is widely distributed, or general, there is frequently no outward sign of consciousness, and when the convulsion ceases, and consciousness does return, there is no recollection of the past paroxysm. An attack of convulsion may come on suddenly, without any previous warning, but more generally it is preceded by symp- toms. If in a child, there has probably been disturbed and moaning sleep, starting, screaming, grating of the teeth, peevishness, heaviness about the eyes, or squinting, or rolling of the ball in sleep, and a disordered condition of the bowels. If in an adult, dreaming and unsettled sleep have occurred, headache, noises in the ears, disturbed and clouded vision, giddiness, nervous fears, loss of memory, and confusion of mind, have accompanied disorder of the digestive organs ; a tendency to vomit without obvious cause, or colicky pains in the bowels, hic- cup, and cramps in the hands or feet, have been the premonitors, and, just before the accession of the paroxysm, a creeping sen- sation or " aura" is often felt to extend gradually from an extremity up to the head. In one of the most terrible and protracted successions of convulsive attacks the author ever witnessed, each paroxysm could be dis- tinctly traced, commencing in one toe, gra- dually extending up the limb and trunk, until the whole frame was fearfully agitated. In such cases the convulsive movements of the limbs and the distortion of the features are truly terrible to witness ; but there is every reason to suppose that in many in- stances, and it is a great consolation to do so, the trial is to the spectators, and that the cerebral disorder which causes such violent commotion of the body extinguishes for the time any consciousness of suffering. Of course, when the mind is unaffected, as it is in lock-jaw or tetanus, or in hydrophobia and other cases, the pain of the convulsion is severely felt. The length of time a con- vulsion continues may vary from a few minutes to many hours, but generally the period is short, the paroxysms returning after intervals of cessation. The fit of con- vulsions may terminate in apoplectic stupor^ CON 142 CON in a state of extreme nervous exhaustion, in lethargy, or in prolonged sleep. For some time after, there is usually much languor, both physical and mental, and the faculties of the mind are confused and incapable of being exerted. There may remain perma- nent lesion of the nervous functions, such as paralysis, or disordered nervous action, such as St. Vitus' s dance : a squint often dates from an attack of convulsions in child- hood. In some cases bleeding from the nose or ears, or vomiting or diarrhoea appear to terminate the attack. Convulsions are the result of a great va- riety of causes. The brain itself may be the organ primarily affected ; there may be dis- ease of its structure, or pressure or irrita- tion exerted upon it, by disease or accident; there may be too great determination of blood to the head, or the reverse condition may exist, and the supply of stimulant blood to the brain may be inadequate. But con- vulsions quite as frequently arise from irri- tation of distant organs affecting the brain and spinal cord. In childhood, the irritation of teething is a most prolific source of con- vulsions — and perhaps not less so, irritation of the stomach and bowels ; causes which might, in the adult, produce transient head- ache, in the susceptible nervous system of the child may cause convulsion. In females, irritation connected with the generative system is a frequent source of convulsive action ; and, indeed, one of the most formida- ble phases of the disorder occurs in the pro- cess of childbirth. Strong mental emotion of any kind, such as joy, fear, &c. &c, are apt to cause convulsion. Suppression of accustomed discharges likewise is often followed by an attack of the malady. Worms in the intestinal canal cause it ; and the onset of acute disease, small-pox in par- ticular, but also febrile disease of any kind, is, in many instances, heralded by an attack. In fact, with those who are susceptible, there is scarcely an agent, from a carious tooth or the scent of a flower upward, which has not the power of exciting convulsive ac- tion — or something nearly approaching it — of the human frame. Some persons are much more liable to be affected than others, and children, as a general rule, especially so ; it is therefore very important that the premonitory symp- toms, either in them or in individuals of excitable temperament, should be carefully noted and attended to, and the exciting cause, if possible, discovered and removed. In children, the state of the gums and of the secretions from the bowels are espe- cially to be watched ; the first may require lancing, or the second clearing out by an active purgative, such as calomel and scam- mony. But when, from the occurrence of warning symptoms, and especially if the child, or any other member of the family, have previously suffered from convulsions, an attack is supposed to be impending, medical advice should be procured. A point of great importance to be determined is whether the disordered condition is con- nected with excess or deficiency of circula- tion in the vessels of the head and spine ; for if the former, it is evident that the low- ering treatment which it requires must be injurious should the latter condition prevail, for this must be corrected by tonic medi- cines, or even by the exhibition of stimulants, such as sal-volatile, or brandy in minute quantity. It must be clear to all how im- portant it is, either in the prophylactic or in the actual treatment of convulsions, whether in children or adults, that this point should be clearly ascertained. And as it is one which sometimes requires considerable me- dical acumen and experience satisfactorily to determine, it must be equally clear that it must render non-professional interference in such cases a matter of hazard, and not lightly to be undertaken. At the same time, the sudden and alarming nature of convul- sive attacks renders it necessary that some means of discrimination and some safe rules of treatment should be known to all who are likely to be appealed to in such cases, par- ticularly if resident in places far removed from immediate medical assistance ; and it is reiterated that the two opposite states must be kept in mind, the one arising from excess, the other from deficiency of circulation, and the treatment modified accordingly. If convulsion be threatened in a child of full habit, with firm flesh and good colour ; if teething is going on, the gums must be looked to, and lanced if requisite, the bowels may be freely purged with calomel and scammony, or with gray powder at night, followed by senna in the morning, the diet being at the same time reduced ; and should there be much heat about the head, and the symptoms remain unabated, leeches — one, two, or more, according to age — may be applied to the temples, and cold to the head generally. If, on the contrary, the child, even though fat, be pale, and the flesh loose, and if it is of feeble habit, any thing like lowering must be avoided; the gums ought, of course, to be attended to, and if the bowels are disordered, the secretions must be gradually corrected by a couple of grains of gray powder, given every night at bedtime, and, if requisite, a small dose of CON 143 COO castor-oil in the morning ; likewise, in either of the above cases, an antacid will probably be of service, such as three or four drops of solution of potash, or a teaspoonful of fluid magnesia, in the milk food, given twice a day. In judging of the energy or weakness of the cerebral circulation in infancy, as long as the opening of the head is unclosed, it affords a guide to judgment. When at this point, the scalp and sub-jacent parts ap- pear depressed, the condition is one in which any thing like lowering measures are inad- missible. Keeping the already given cautions in view, and remembering how often, both in child and adult, convulsion is threatened in consequence of irritation, not in the brain or spine, but at a distance from them, when it is suspected that an attack is impending, and when medical assistance cannot be at once procured, at- tention should be directed to any possible source of irritation, and should any such be found, its removal should, if possible, be effected. If no appreciable source of irrita- tion is discovered, to which symptoms of threatened convulsion can be referred, and if the brain itself be suspected to be in fault, the same cautions respecting excess or defi- ciency of vascular action must still be remembered. If plethora is undoubted, if the individual is of full habit, florid, and with a strong pulse, leeches and cold to the head, and free purging, with low diet, may be resorted to with every prospect of advan- tage. On the contrary, if the habit is feeble, the more negative system will be most safely pursued ; the bowels niu&t be regulated but not purged, the diet attended to as regards di- gestibility but not lowered, and every source of nervous exhaustion, either fatigue of body or mind, or of a sexual character, most scru- pulously avoided. If the extremities are cold, as they often are, their warmth must be preserved ; if the head is hot, the mode- rate use of cold will allay nervous excite- ment, as well as vascular action. Provision- al measures like the above will, if used with judgment, be most valuable even in unpro- fessional hands, but they are not to super- sede medical examination, which must be submitted to. In the treatment of an attach of convulsion the above directions must equally be borne in mind and acted upon. When a child is seized with convulsions, the most generally available remedy is the warm bath, and if used with judgment it is a good ontkThe temperature should be 98° ; if the child is strong and plethoric, it should not be im- mersed above the waist, and, while in the bath, cold should be applied to the head ; if the child is weak, it may be put in the water above the shoulders ; in either case the immersion is to be continued for twenty minutes. The gums are to be lanced if requisite, and leeches applied to the head under the cautions already given as to the abstraction of blood ; and under the same cautions purgatives are to be resorted to, either the more powerful ones of calomel and scammony, or calomel and jalap, or senna, or indeed the first efficient medicines of the class at hand, or the milder agency of castor- oil ; in addition, an aperient clyster may be administered with advantage. When the child is taken out of the bath, it should at once be wrapped up in warm blankets, and laid in its cradle, or in bed, and cold used to the head, or not, as thought well ; and if the fits still continue, mustard-plasters made with half oatmeal may be applied to the legs, but must be removed as soon as the skin is well reddened. When an adult is seized with convulsions, the treatment, conducted upon the same principles, must be very similar to that recommended for a child, with exception of the bath, which cannot be conveniently used ; in its stead, a warm bed, with hot applications to the feet, limbs, &c. must be substituted, and mustard-plasters may be used more freely. . If there is much heat or excited action about the head, it should be shaved, or the hair cut close off, and cold or iced applications freely employed. In following out these directions, the non-pro- fessional will be doing much, and indeed all they can legitimately do during the longer or shorter interval that must neces- sarily elapse before the case is seen by a medical man. Lastly, it must be borne in mind that convulsions are not unfrequent in extreme intoxication, and also in poison- ing from narcotics, such as opium : their occurrence from such causes would of course materially modify the treatment. In chil- dren particularly, they are unquestionably the frequent result of the administration of laudanum, and more frequently still of quack soothing and carminative medicines and elixirs. Refer to Apoplexy — Bath — Children — Clys- ter — Croup — Spasmodic — Head — Lockjaw — Spasm — Teeth — Worms, $e. COOKERY — For the sick and convales- cent. — The best methods of preparing suit- able nourishment for the sick is a matter of so much consequence, that its consideration here cannot be out of place. Its import- ance is, perhaps, scarce sufficiently appre- ciated by any class ; and among the poor, almost total ignorance prevails respecting it. Even when the needful materials are coo 144 COO abundantly provided, still things are pre- pared in such a barbarous and uninviting fashion, that the fastidious appetite of an invalid turns loathing from them ; and this simply from lack of knowledge or of attention in preparing. Constantly is the medical man told, "I could eat, but I can- not fancy such food as we have here" — and this, when material is amply provided, but nicety wanting. The reader is referred to the separate articles which treat of the various forms of food for further information ; but the follow- ing recipes are a few of those most directly useful. Sick-room Articles of Diet. — And here it may just be hinted that neatness in serving up, as well as care and perfect cleanliness in preparing, makes sick-room cookery more likely to be attractive to an easily offended appetite. ARRO-w-RooT.-'-Not quite a tablespoonful of arrow-root powder is to be mixed slowly and smoothly in a basin with a little cold water — and when done, a pint of boiling water added ; it should then be sweetened to taste, and put on the fire to boil for five minutes, stirring well the whole time. If wine is permitted, it should be put in after the arrow-root is poured into the bowl. The same quantity of arrow-root is a proper one, when it is prepared with milk instead of water. Oatmeal Gruel. — A dessertspoonful of meal must be mixed smoothly with two of cold water — a pint of boiling water poured on, and the whole boiled on the fire for ten minutes, well stirring for the time — sugar, or pepper and salt, being added, as may be agreeable to or proper for the sick person. Sago requires thorough washing in cold water to take away its earthy taste ; after doing so — (a tablespoonful will be a suita- ble quantity) — put it in a pint of milk, and boil it slowly till it is quite soft and has thickened the milk — ten minutes or a quarter of an hour is sufficient time — sweeten to the taste, and add wine, or flavour with lemon- peel, according to circumstances. Some in- valids prefer tapioca to sago. It is pre- pared in the same quantity as the other, but does not require the previous washing, and takes only half the time for softening on the fire. In all preparations for the sick, let the constant stirring while on the fire be at- tended to, whether directed or not. The least tendency to burning renders sick- cookery perfectly abominable. Ground-Rice Milk. — A tablespoonful of ground rice, a pint and a half of milk, and half an ounce of candied lemon-peel. Mix the rice very smoothly with the milk, then add the lemon-peel cut into very small pieces ; boil for half an hour; and strain as soon as off the fire. [Farina is to be pre- pared in the same manner, and flavoured to suit the taste.] This is an excellent nutritious beverage for the sick, or for early convalescence, when strict abstinence is not required. Simple Bread Panada. — Put a moderate quantity of grated or soft stale bread into enough boiling water to form a moderately thick pulp ; cover it up, and leave it to soak for an hour — then beat it up with two or three tablespoonfuls of milk, and fine sugar to sweeten — boil the whole for ten minutes. This preparation is occasionally acceptable to the invalid, when milk diet alone is re- jected. Carrageen Moss. — One ounce of it boil- ed in a pint and a half of water is suffi- cient to form a semi-transparent, moderate- ly 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. The Gelatine,' now so commonly used, is a very palatable preparation combined with either water or milk, and may be taken dis- solved in tea, coffee, or broth, without im- pairing the flavour of one or the other. Jelly from Gelatine. — To rather more than an ounce of gelatine add half a pint of cold water to soften it, then pour over it a pint of boiling water, and stir till the gela- tine is dissolved ; pare very thinly the rind of one lemon, and add, with the juice of three or four — if acids are permitted — one pound of loaf-sugar, the whites and shells of three or four eggs, thoroughly well whisked together, and stirred into the whole ; let it come to the boil upon the fire without more stirring, — if wine is ordered with it, it should be added after coming off the fire; pour it through a thick flannel jelly- bag, — what runs through at first will not be clear, and should be returned to the bag again ; let it stand still cold, and you will have a clear, sparkling jelly, which few in- valids will refuse. Gelatine with Milk. — An ounce of gela- tine is to be soaked in half a pint of cold milk ; when softened, a pint of boiling milk stirred well with it, till it is quite dissolved; it may be sweetened to taste, and put upon the fire to boil up altogether. It may be flavoured with lemon-peel, or cin- namon, or brandy, as is most liked, or most suitable. It will be quite solid when cold. coo 145 COP White Wine Whey. — Boil a pint of milk; add to it one or two glasses of sherry "wine, and sugar enough to sweeten ; let it boil till the curd has separated, then strain through muslin. If the wine does not possess sufficient acid to turn the milk, a little ren- net, or a teaspoonful of lemon-juice, or three or four grains of tartaric acid may be added. Barley-Water. — See Barley. Lemonade. — The juice of two lemons, the rind of one added to a quart of boiling water, sweetened moderately, and kept in a covered jar, or jug, is a useful drink for those suffering from cold or slight fever. Toast-Water. — This simple beverage is seldom well prepared. Let the water with which it is made have been boiled and be- come cold. Toast thoroughly of a fine deep brown, but not black color, half a slice of a stale loaf; put it into a jug, and pour a quart of the water over it ; let it stand two hours, and decant the water from the bread. A small piece of either orange or lemon-peel added with the bread is an improvement to toast-water. Linseed [Flaxseed] Tea. — One ounce of flaxseed, not bruised, two drachms of liquo- rice-root, bruised ; pour over one pint of boiling water ; place the jug (covered jugs with perforated spouts should always be used for drinks for sick people) near the fire for three or four hours, then strain off. When flaxseed-tea is ordered to be continu- ed, it should be made fresh every day. "Milk and Soda- Water. — Heat, nearly to boiling, a teacupful of milk ; dissolve in it a teaspoonful of fine sugar, put it into a large tumbler, and pour over it two-thirds of a bottle of soda-water. This is an excel- lent mode of taking milk when the stomach is charged with acid, and consequently feels oppressed by milk alone. "Rice and Gravy. — Let the rich gravy from a leg of roasted mutton or sirloin of beef stand till the fat forms a cake on the surface, remove it, and heat the gravy with as much well-boiled rice as will make it thick. A teacupful of this is very strengthening in the early convalescence of delicate children." — Dr. A. T. Thomson. ["Biscuit Jelly. — White biscuit, four ounces ; water, four pints. Boil down one half, strain and evaporate to one pint. Add one pound of white sugar, four ounces of red wine, and a teaspoonful of cinnamon or peach-water. "Almond Jelly — Blanc Mange. — Sweet almonds bleached, one ounce ; white sugar, six drachms ; water, four ounces. Bub into an emulsion in a mortar ; strain, and N add isinglass or hartshorn jelly, eight ounces ; orange-flower water, one drachm ; essence of lemon, three drops. "Rice Jelly. — Rice, picked and washed, four ounces ; loaf-sugar, half a pound ; water sufficient to cover it. Boil till it be- comes a glutinous mass, then strain and and season to the taste. "Indian or Corn-meal Gruel. — Three tablespoonfuls of corn-meal sifted; water, one quart. Wash several times with fresh water, turning off the water as the meal settles ; then boil for twenty minutes, stir- ring all the time ; add a little salt ; then strain and sweeten, adding a little butter, wine, and nutmeg, if proper. "Oatmeal Gruel — Is made in the same manner. " Vegetable Soup. — One potato, one tur- nip, one onion, one carrot, (if liked,) and a little celery. Slice, and boil in one quart of water for an hour ; add salt to the taste, and cut up toast to soak in it. " Mutton Broth. — Lean of mutton, one pound ; water, one quart ; a little salt, pars- ley, and crust of bread. Boil slowly for two or three hours, skimming carefully. Vegetables, rice, or barley may be added. "Chicken Water. — Half a chicken, free from fat ; break the bones, add half a gal- lon of water, season with salt, and boil half an hour. " Suet Drink. — Sheep suet, two ounces ; milk, one pint ; starch, half an ounce. Boil slowly for half an hour. An excellent drink in dysentery." — American Medical Formula- ry, by Dr. J. J. Reese.'] COPAIBA, or Copaiva, or Balsam op Copaiva — Is a fluid resin obtained from trees native of Brazil. It is principally used in treatment of chest and venereal dis- eases. — See Balsam. COPPER.— This well-known metal is used in medicine, principally in the form of its sulphate, better known by the name of "blue vitriol," which occurs in crystals of a beautiful blue colour. It can never be employed as a domestic medicine internally, and scarcely, if at all, as an external appli- cation, with much benefit. In the latter form, indeed, mischief is often done, by the popular practice of sprinkling "powdered blue stone" upon sores and ulcers ; its injudicious and copious application giving much unnecessary pain, producing slough- ing or mortification of the surface to which it is used, and thus retarding, instead of hastening the cure. All the salts of copper are poisonous, but those which are most generally known and used as poisons are blue vitriol and verdi- COP 146 COP gris. Another combination, the arsenite of copper — a compound of arsenic and copper — also known as Scheele's green,- a deadly- poison, has already been noticed under the head of arsenic. In addition to the above, poisoning by copper frequently occurs in consequence of the use of copper vessels in cooking, &c. Blue vitriol is sometimes taken to procure abortion ; its strong metallic taste, however, would prevent its being administered with- out the knowledge of the person taking it. It has been taken for the purpose of suicide, and the author has witnessed one case of the kind Which proved fatal in ten hours, to a woman above seventy years of age, who swallowed a large dose in order to commit self-destruction. The poison produces, in the first instance, violent vomiting, and in this way life may be saved by the emetic action of the salt itself ; purging succeeds, followed by extreme depression of the vital powers, cramps in the limbs and severe pain in the bowels ; occasionally jaundice has occurred. The matters ejected are tinged with the blue colour of the poison. In a case of poisoning by a salt of copper, the object must of course be to get the stomach freed from it as quickly as possible. Its own emetic action should be assisted by warm drinks, warm water, or milk, or mucilaginous drinks of some kind, such as linseed-tea, or barley-water ; sugar has been found useful in these cases as an anti- dote, and should be added in good quantity to the fluids which are administered. After the stomach has been well cleared by the vomit- ing, raw eggs should be given largely ; and if sickness does not recur, which it proba- bly will, it should be reinduced by putting a feather down the throat, or by the admi- nistration of a scruple of white vitriol in a little water. Of course, medical assistance should be obtained, but the above measures may be advantageously had recourse to in the interval. When poisoning by copper occurs in consequence of its presence in food which has been prepared improperly, or in badly cleaned copper vessels, the amount of the poison may not be sufficient to occa- sion death, but it produces severe symp- toms, similar to those above detailed. Cop- per vessels, unless protected by tinning, and even then, unless the protection is in a per- fect state, cannot be considered desirable cooking utensils; and when they are used, the strictest cleanliness is requisite for safety. Even if water is allowed to stand in a copper pan for any length of time, a poisonous salt is formed. But if the water contains an acid of any kind, such as vine- gar, if it holds common salt in solution, or if there be oily or fatty matter present, poisonous compounds are quickly formed. Consequently, food which contains any of these ingredients should never be prepared in copper vessels. The same objection, of course, holds good as regards preserving fruits, which all contain more or less acid, and are therefore liable to act upon copper. There is, however, less danger as long as the active operations of cooking are going on, than there is from allowing the articles above enumerated to stand for any length of time in a copper utensil freely exposed to the air. German silver, which contains a more or less considerable proportion of copper, is in some degree open to similar objections; and those who have used this material for any purposes, must have no- ticed the green stains which form upon its surface, and which are owing to decomposi- tion of the copper it contains. Many of the cheaper green pickles contain copper, which is added to them to make the colour appear finer. The adulteration may be detected by introducing a perfectly clean plate of iron — a table-knife — into the suspected arti- cle ; if copper is present, it will be depo- sited upon the surface of the former metal, in the form of a fine metallic film or coating. It has been the practice, on the continent, to add a small proportion of sulphate of copper to dough in the making of bread; the practice is not known to be followed in England. Copper has been detected in mussels which have caused symptoms of poisoning, but it is not considered to be the invariable cause of the injurious results which occasionally follow the use of this shell-fish as food. It should be remembered that the majority of the green colouring matters and pigments at present in general use are compounds of copper ; and, therefore, care should be ob- served in permitting children to have access to them. A child has been poisoned by a cake of green paint from a toy colour-box. Copper coins are sometimes swallowed by children, and may pass away by stool with- out any apparent bad consequences ; but this is not always the case, and severe epi- leptic fits have ensued in consequence of the accident. In the event of a child being known to have swallowed a piece of copper, salt, acids, and fatty matters should be ex- cluded from its food, which ought to consist of thick milky preparations, such as hasty pudding and the like, well sweetened with sugar; gentle doses of aperients being ad- ministered. The thickened food should be given as soon as possible after the accident. Refer to Arsenite of Copper. COR 147 COS CORDIALS — Are stimulants generally of an alcoholic nature ; the name is derived from the old idea that they "strengthened the heart." They certainly stimulate the circulation, and are useful in cases of de- pression from any cause, where such an effect is required. Brandy is, perhaps, as good and as generally attainable a cordial as any; the compound tincture of carda- mon and the aromatic spirit of ammonia constitute two of the best medicinal cordials. Refer to Excitants. CORIANDER SEEDS— Are produced by a plant, a native of Southern Europe ; it now grows wild in Britain. They are a pleasant and powerful carminative, the pro- perty depending upon the volatile oil Avhich they contain. In medicine, coriander is principally used to correct the griping pro- perties of senna. CORN. — A corn is a thickened state of the epidermis, or outer or scarf skin, caused by irritation, such as pressure or friction, act- ing upon the true or sensitive skin, which causes an increased growth of the flattened cells of which the epidermis is composed. The corn, produced in the first place by external pressure or friction, soon becomes in itself an additional source of irritation, and, by its hardness, increases proportion- ally the inflamed and sensitive condition of the true skin underneath. If the causes are removed, the disease gets well, as any one who has suffered from corns can testify, after having been confined hj illness for any time. Tight shoes are undoubtedly the most general originators of corns ; but badly made, ill-fitting ones also give rise to the affection, not by pressure, but by friction. Soft corns generally form between the toes, and are very troublesome and painful : they are kept soft by the continued perspiration of the part. The most efficient cure for corns is, of course, to get quit of the cause — the offend- ing boot or shoe — but as some persons are so liable to the affection, or have their feet so formed, that if they wear boots or shoes at all they must suffer from corns, the best palliative is keeping the hardened mass well pared down in the centre. Vinegar, or strong acetic acid, applied to a corn every evening will sometimes effect a cure, a little olive-oil being smeared over every morning. Various corn-plasters are used ; the most effective and rational are those which are made thick, and have a hole cut in the centre for the corn, which is thus preserved from pressure. [A piece of buckskin spread with adhesive plaster, cut to the size of a sixpence, and with a hole in its centre large enough to permit the corn to come through, serves the same purpose.] Soft corns should be cut with scissors, a piece of linen should be worn between the toes, and the strictest cleanliness observed. [Soaking the feet in strong oak-bark tea will do much toward hardening the skin and checking excessive perspiration.] A peculiar kind of corn oc- casionally forms under the corner of the nail of the great toe, and causes much pain and irritation ; if discovered by slightly ele- vating the nail, the thickened mass may be turned out. Refer to Skin. CORN.— See Grain. CORNEA. — The transparent, glass-like portion of the eye. — See Eye. CORROSION.— The term, when applied to the living body, means the gradual de- struction of any of its tissues by chemical action. CORROSIVE SUBLIMATE.— See Mer- cury. COSMETICS — Are external applications used to improve the appearance of the skin, as regards whiteness, &c. Their employ- ment is always to be condemned ; moreover, they frequently contain deleterious matters, such as corrosive sublimate of mercury, salts of lead, &c. &c. Lndirectly they are injurious, by leading the mind from the only true cosmetics, obedience to the laws for the maintenance of physical health, which the Almighty has linked with our existence — Cleanliness, temperance, abundant fresh air and exercise, and early hours, and the cheer- fulness which results from the healthful oc- cupation of the mind in legitimate pursuits, are cosmetics which no art can imitate or supply. COSTIVENESS, or Constipation — Is undue retention of the fcecal contents of the bowels, and their evacuation in a harder and drier condition than natural. The state is one in a great degree dependent upon habit and constitution ; for that which would be con- sidered constipation in one person, would not be so in another, and vice versa. As a general rule, however, the bowels ought to relieve themselves thoroughly once in the twenty-four hours; when such is not the case, the condition may be said to be one of costiveness. With some individuals, a single evacuation of the bowels once every three or four days, and even less often, seems to be sufficient, and perfectly compatible with their enjoy- ment of perfect health ; and when such is the case, it is of course superfluous to endeavour to correct it, and it is better to let well alone. If, however, in conjunction with COS 148 COS this condition of the bowels, the person suf- fers from headache, from languor, from dis- tension of the abdomen, if the breath is disagreeable, and the tongue furred, the state is not compatible with health, and should be corrected. The causes of costiveness are very nume- rous. The nature of the food, as might be ex- pected, exerts considerable influence ; bread badly made, and especially if alum be mixed with it, cheese, milk with some persons, fari- naceous articles, such as arrow-root or ground rice, and food of too concentrated a character, all tend to constipate. Deficient exercise, particularly if combined with much exertion of mind ; any drain upon the sys- tem, as in suckling, abundant perspirations, loss of nervous power, and old age, have the same effects. Pregnancy, and tumours in the abdomen, constipate by mechanical ob- struction, and in the same way contraction of any portion of the alimentary canal. The colon or large bowel is very frequently the seat of the constipation; it loses tone, allows itself to be distended, sometimes to an enormous extent, or contracts to a very nar- row calibre in some portion of its course. Lastly, a very common inducing cause of costiveness, particularly in females, is inat- tention to the intimation of nature to relieve the bowels. As, except in the case of a few persons of constitutional peculiarity, confined bowels cannot be compatible with health, comfort, or activity of either mind or body, the state must be rectified, and that in a proper man- ner, not as it is usually attempted. Perhaps there is no ailment to which the human body is subject which is more frequently mis- managed than constipation. Every effort should be made to correct the disorder with- out the aid of medicine. In the food, all those articles which have been enumerated, or which are known to constipate, must be avoided. The bread used should be made of coarse flour [or bran] ; if vegetables and fruits agree in other respects, they may be freely consumed, and cocoa substituted for tea or coffee : food is not to be taken in a state of too great concentration, but so that by the bulk of its refuse it may afford sub- stance to stimulate the action of the bowels. In addition, there are various articles of diet which exert an aperient effect, and which may be used -or not, according to the taste of the person : such as Scotch oatmeal in the form of porridge, honey, prunes, &c. Exercise, whether on foot or horseback, is another valuable aid in the removal of the costive state ; it not only quickens all the functions, but it assists defecation by the mechanical motion it communicates to the intestines. A similar effect may in some cases be produced by friction or kneading the abdomen with the hand ; the practice is scarcely so much resorted to as it might be. Another very important point is regularity in the time of evacuating the bowels ; not waiting for the urgent sensa- tion, but retiring for the purpose at one set period of the day, when time can be given. [Soon after breakfast is the most natural time, as digestion is perfected during the night.] Persons who are liable to costive- ness should give themselves at least a quar- ter of an hour, or even longer, for the daily evacuation of the bowels. Lastly, as con- stipation is so frequent an attendant upon the sedentary life of the student, and upon the anxious-minded man of business, a holi- day both from books or desk, and change of air and scene, is both a good and pleasant remedy. When neither diet nor regimen will effect the cure, other means must be had recourse to. If there is simple costiveness, without disorder of the digestive functions, the best remedy will be the regular use of some simple clyster : if, on the other hand, furred tongue, with acidity of stomach, flatulence, pain between the shoulders, headache, &c. betoken deranged digestion, medicine will be required, at all events in the first in- stance : the liver is probably at fault, and five or six grains of blue pill, or of com- pound colocynth and calomel pill, followed in the morning by the black draught, or by castor-oil, will be requisite to commence the treatment. When the stomach, liver, and upper bow- els have been well cleared by the above medicines, it is requisite to keep the bowels open ; otherwise a few days will see all the symptoms returned — and, in fact, such is too often the case. Persons are content with taking a dose of strong opening medi- cine every few days, or once a week, as the case may be, and rest content with thus, as it is called, having a good clearing out — albeit they are under the necessity of increasing the strength of the doses. The practice is one incompatible with sound health, and is most injurious to the stomach and bowels themselves : many cases of ob- struction, and even inflammation of the bowels are produced by it. The principle to be proceeded upon in the treatment of costiveness is, that it is more easy to keep the bowels in action than to excite them to it when they have become thoroughly torpid, and therefore the individual should not rest content without the daily evacua- COS 149 COT tion. As has been said above, if simple constipation, depending upon inaction of the lower bowel, exists, the use of the clyster will in all probability be sufficient ; but medicine may be required, perhaps daily, for some time, or it may be used alternately with the clyster. Some medi- cines are better adapted than others to the treatment of habitual costiveness, and of these castor-oil, aloes alone or in its com- binations, senna, and ipecacuanha are the principal ; their great advantage is not los- ing their effect by continued use. When castor-oil can be taken regularly, in most cases it answers extremely well ; and if taken regularly, the dose requires rather diminution than increase. It is a medicine, moreover, which never seems to injure the tone or the mucous coat of the bowels. In the constipation of pregnancy, castor-oil is so well known as the best and safest aperi- ent that it scarcely requires mention. Aloes is peculiarly well adapted to relieve certain forms of costiveness, particularly that of the sedentary, and may be taken in the form of pill, in combination with soap, in the compound rhubarb pill, or compound colo- cynth pill : any of these are most excellent combinations. If there is debility of sto- mach, the addition of a quarter or half a grain of quinine to each pill increases the efficiency of the medicine and gives tone to the stomach. The quinine must not be con- tinued for more than a fortnight at a time. The dose of aloes when regularly taken does not require to be augmented. When quicker action is required, the compound decoction of aloes may be taken with ad- vantage instead of pills. The principal contra-indication to the use of aloes is the occuirence of piles, which, if inflamed, or if the dose be too strong, are apt to be ag- gravated by the medicine ; in this case cas- tor-oil, or infusion of senna, or. the clyster, should be substituted for a time at least. In some cases, on the other hand, when the piles are not inflamed, aloes taken regularly in small doses, seems to exert a beneficial and curative action upon them ; probably in consequence of keeping the intestinal veins from becoming overloaded with blood. Senna, either in infusion or electuary, is a medicine well adapted for the relief of cos- tiveness ; it is perfectly safe, and does not seem soon to lose its effect. Ipecacuanha, not alone, but in quarter or half grain doses, especially when added to the aloetic pills, exerts a most beneficial effect in cases of habitually confined bowels. A weak solu- tion of Epsom salts, a drachm to the half pint of water, with or without the addition of five n2 or ten drops of dilute sulphuric acid, when taken on first rising in the morning, will prove effectual with some, and forms a change from the use of the other aperients. [A quarter of a pound of salts in a pint of water, and a wineglassful taken at bed- time, is also a useful and easy method of taking it.] Again it is repeated, keep the bowels free, by food, by exercise, by habit, if possible, by clysters or medicine if ne- cessary, but do not let them become costive. In some individuals in whom the walls of the abdomen are very flaccid, and do not afford sufficient tonic support to the con- tained bowels, costiveness frequently exists, and is much remedied by the use of an elastic or other belt, worn to support the entire belly. Refer to Alimentary Canal — Aloes — Clys- ter — Digestion — Laxatives, §c. COTTON— Is a soft downy fibre obtained from the seed capsules of the cotton-plant, a species of gossypium. In its manufac- tured state, as calico, it is useful for many purposes, such as bandages, &c. in medical practice. The use of cotton cloth [muslin] in the treatment of sores is generally consi- dered to be more likely to irritate than linen, but the difference, if there is much, is great- ly exaggerated. The cause has been said to be in the different form of the constituent fibre ; that of the cotton, as seen under the microscope, being flat — that of the lint round. Much of the manufactured lint consists of cotton alone or mixed with flax. It has been thought that the flat sharp (?) edges of the cotton fibre were the irritating agents. The use of the sheet cotton, in the form as used for wadding dresses, is a most invaluable application in burns. It is also sometimes used to dress blisters. Refer to Lint — Burns, $c. COTYLEDON UMBILICUS, or Wall Pennywort — Is a native of Britain, and is found growing on old walls, chiefly in the south of England. The whole plant is suc- culent, and its leaves, which are round, spring directly from the soil, or nearly so ; from their centre there is sent up a round stem about nine inches high, which bears a number of yellowish-green, drooping flow- ers. The plant is remarkable from its juice having lately come prominently into notice as a remedy for epilepsy. It was introduced by Br. Salter, of Poole ; and the author can from his own professional experience testify to its marked good effects in this most in- tractable and distressing malady. Of course, in those neighbourhoods in which the plant grows, the fresh expressed juice may be used ; but most efficient extracts are madq cou 150 COU from it by various of the London chemists. The dose of the fresh juice is one ounce twice a day. COUCHING — Is an operation performed upon the eye, by -which the lens, when it has become opaque from disease, is shifted or depressed to another part of the interior of the eye-ball, and thus removed from the axis of vision, which it obstructs. Eefer to Eye. COUGH — Consists in the violent expul- sion of air from the lungs through the air- passages. In most cases it must be re- garded rather as a symptom of disease than as a disease itself. Cough may arise from a great variety of causes. From direct ir- ritation of the air-tubes themselves, by the inhalation of cold and damp air, or of irri- tating vapours, by the mechanical irritation of foreign substance accidentally introduced into them, by the pressure of tumours, or by irritation of the throat and fauces, par- ticularly when there is relaxation of the uvula, and also in consequence of disease, inflammatory or otherwise, of the lungs themselves. Further, cough may be sympa- thetic with disorder in the stomach, or liver, or with irritation in the bowels, occasioned by worms or other irritant agents, or it may be the result of nervous derangement, such as hysteria, or be spasmodic, like hoop- ing-cough. So numerous are the ailments and diseases of which cough is a symptom, that it frequently requires considerable dis- crimination to determine the real cause of the irritation. Many of the acting causes are undoubtedly trivial, but many are deep- ly seated and fatal diseases ; and therefore, whenever an individual becomes the subject of cough which cannot be readily account- ed for by cold or some other direct cause, a medical examination ought to be submitted to. And even if the cough has been in the first instance the result of cold, should it continue "hanging about" a person, without obvious reason, medical advice ought to be taken ; mischief may be brewing, and be the cause of the irritation, or the cough ex- cited by some trivial and easily remedied cause, may itself be causing disease in the lungs of a predisposed person. Cough is spoken of both medically and popularly as dry and moist. A dry cough may be the result of direct temporary irri- tation of the air-passages, but more gene- rally it is symptomatic, either of incipient disease connected with the chest, or of sym- pathetic nervous irritation, probably con- nected with the abdominal viscera. Moist cough is generally connected with direct affections of the chest, such as common catarrh, and with inflammatory affections, or with asthma or consumption. It has already been said that a cough should never be allowed to continue for any length of time without the cause being ascer- tained by medical examination; till this is done, it can scarcely be expected that the proper remedy can be applied. In the first instance, however, simple remedies may be tried. If the cough be clearly traceable to cold or catarrh, it may be treated according to the directions given under these heads ; if it be very dry, demulcent medicines, such as the mucilage and tolu-mixture, or barley- water, or linseed-tea, may be taken freely, with from five to ten drops of ipecacuanha wine two or three times a day, to which may be added fifteen or twenty drops of tincture of henbane to allay irritation. Opium and its preparations are not gene- rally desirable in dry cough — unless, indeed, it be spasmodic — as. the drug itself exerts a drying effect upon the mucous membrane of the lungs. The inhalation of the steam from boiling water is sometimes highly be- neficial. In dry, and also in moist cough, counter-irritation, by blisters, on the ante- rior part of the chest, or between the shoulders, is often of much service. The surface of the chest should be well pro- tected by flannel next the skin, by a dressed hare-skin, or by a warm plaster, either in front or behind. In moist coughs, the amount of fluids and of demulcents must be somewhat more restricted than in the above. The preparations of opium may be given in small quantity, either alone or in cough-mixtures, but none answers better than paregoric, taken in one or two tea- spoonful doses, in water ; this allays the irritation and teasing frequency of the cough ; and to each dose, if expectoration is difficult, five or ten drops of ipecacuanha wine, and the same of tincture of squill may be added. The author has found the following pill most extensively useful in coughs depending upon irritation in the bronchi or air-passages: — Take of powdered opium five grains, of powdered squill sixteen grains, of powdered ipecacuanha twelve grains, of powdered camphor eighteen grains, of powdered gum-ammoniac twenty-four grains, of powdered rhubarb twelve grains : make into a mass with syrup, and divide into thirty pills : of these, one or two may be taken for a dose, The foregoing remarks apply only to chronic or continued cough ; of course the treatment of the affection as it arises in connection with other disease, either acute, such as inflammation of the lungs, or chro- cou 151 COU nic, falls under the general management of these disorders. When feverish symptoms occur along -with cough, all stimulation, either in diet or by stimulant expectorants, is to be avoided ; indeed, as a general rule, when cough exists, the diet should be as little stimulating as circumstances "will per- mit, and the usual allowance of animal food curtailed ; but in old people, and those who have lived freely, the lowering system must not be carried too far ; it may be requisite even, at times, to stimulate, and to support strength by strong meat-soups. Again, it is repeated, a cough ought not to be allowed to continue. If not relieved by some of the simple remedies mentioned above, medical advice should be sought — particularly in the case of the aged — and if there is much secretion of phlegm or mu- cus, the least continued impediment to the expectoration of which, in an old person, may rapidly induce dangerous or fatal em- barrassment of the lungs, often most unex- pectedly. The possibility of a relaxed or elongated uvula being the cause of cough must not be forgotten. An examination of the throat will detect it, and the state may be relived by the use of some astringent gargle, by a small fragment of catechu allowed to dissolve in the mouth, or by touching the uvula once or twice a day with a camel' s-hair brush dipped in "tincture of steel." Refer to Catarrh — Cold — Counter-irritation — Expectorants — Lungs, §c. COUNTER-IRRITATION— Is irritation or excited action in one portion of the body, ■which counteracts or withdraws analogous action going on in another portion. It may be naturally or artificially established, and it may be called into action within the body, as well as without ; but the term is now generally applied solely to counter- irritant action artificially excited upon the skin. There are many various modes of ex- citing counter-irritation : some may be and are used popularly with perfect safety ; others are only admissible in medical hands. Counter-irritants may simply produce red- dening of the skin, or they may blister, or they may cause discharge of purulent mat- ter, or even mortification of the surface. Heat, according to the temperature at which it is used, may give rise to any or all of these effects : mustard will redden smartly, and may blister ; ammonia will do the same, according to strength ; camphor in solution, either in spirit or oil, will redden. Of the blistering counter-irritants the Spanish fly is the best, and almost univer- sally employed. Boiling water, or its steam, or metal heated in boiling wate* have all been used for the purpose, and might be, on emergency. Counter-irritation by tartar emetic, or tartarized antimony, takes the form of pustules or pimples. The salt is applied either in the form of ointment, or as a saturated solution, used as hot as can be borne, and rubbed upon the skin by means of a piece of flannel. The pustules formed by the latter mode are said to heal speedily, and to leave no scar, which some- times happens after the ointment. When a common blister is irritated, " kept open," secretion of purulent matter takes place ; but the system is a bad one, and is pro- ductive of much unnecessary pain and irri- tation. Issues and setons cause discharge of mat- ter. Counter-irritation by means of galvanic agency has recently attracted notice. Iron heated to a red or white-heat, moxas, and other applications which destroy the texture to which they are applied, fall under the head of cauterants, and can never be used as domestic remedies. There is, how- ever, one application of the hot iron, intro- duced by Dr. Corrigan, of Dublin, which might safely be used by the non-professional, and, as the instrument can be made by any blacksmith, might prove a valuable resource in remote districts, for the relief of nervous and rheumatic pains, such as lumbago, sciatica, &c. &c, in which it is often of essential service. The instrument (fig. xli.) consists of an iron portion (1) about four inches and a half long, which ends in a disc (2) half an Fig. xli. cou 152 COW inch in diameter, and a quarter of an inch thick, and a "wooden handle, (3.) When it is used, it is grasped so that the point of the forefinger may rest upon the bend at 4. The disc is then to be introduced into the flame of a spirit-lamp, or a piece of burning paper, and held till the metal (at 4) be- comes uncomfortably hot ; the handle is then to be grasped, and the disc applied lightly, and momentarily, and at short in- tervals to the skin over the affected part. Each touch of the disc produces a shining mark on the skin, and very shortly the whole surface becomes reddened and slightly in- flamed. As regards the use of counter-irritants generally, it is often serviceable to excite the skin by friction or heat before using them. When fever is present and inflamma- tion goiny on, non-professional persons will do quite as much, if not more good, and be much less likely to do harm, by using the mild counter-irritation of moist heat than by applying blisters, mustard, &c, particu- larly close upon the seat of the disease. If a blister is put on in these cases, it should be a large one. For further information respecting the counter-irritants individu- ally, the reader is referred to the various articles — Antimony — Blister — Mustard, §c. COUNTENANCE.— The expression and aspect of the human face is much and peculiarly affected by the various diseases •which affect the body ; and the first view of a countenance often conveys to a physician, who has studied the subject, immediate, valuable, and certain prescience as to the nature of the disease for which his patient is about to ask advice. The indications are partly due to the changes of complexion ■which are associated with different forms of disease ; but expression is equally signifi- cant. The physiognomical evidences have been classed by a writer, Mr. Corfe, who, enjoying abundant scope for such observa- tions, has made them an object of special attention. The following is a summary of Mr. Corfe's arrangement: — Countenance in — A. — Brain Affections. 1. Lethargic, in disease causing insen- sibility. Examp. : Apoplexy. 2. Livid, in disease causing deficient change in the blood. Examp. : Suffocation and Coma. 3. Distressed, in disease causing men- tal disturbance. Examp. : Paralysis and Fever. B. — Chest Affections. 1. Dusky, in disease interfering with blood changes. Examp. : Bronchitis. 2. Anxious, in disease impeding respi- ration. Examp. : Croup. C. — Abdominal Affections. 1. Pinched, in painful seizures. Examp. : Colic and Cholera. D. — Nutrition Affected. — Emaciation General. 1. Wan, in diseases of debility. Examp. : Consumption and Cancer. 2. Hue peculiar, in diseases affecting the blood. Examp. : Heart disease and Jaun- dice. E. — Enlargement of Organs, Glands, &c. 1. Disturbed, in diseases causing con- tinued uneasiness. Examp. : Sore-throat, Rheuma- tism, &c. F.— Vascular Disturbance. 1. Flushed, in febrile disease. Examp. : Inflammatory fever. 2. Pale and languid. Examp. : Hemorrage, &c. Refer to Complexion, fyc. COUP DE SOLEIL, or Sun-stroke.— See Heat, effects of. COW-POX— Is the disease affecting the cow, which, transferred to the human sub- ject, confers in the majority of cases immu- nity from attacks of small-pox ; and in those in which it does not give complete protec- tion, renders the attack of that usually virulent disease comparatively mild. Cow-pox shows itself upon the teats of the cow in the form of bluish or livid- looking vesicles, surrounded by a ring of inflammation, while at the same time the animals are feverish and the milk dimi- nished. At first the vesicles contain clear fluid, but ultimately become pustular, or filled with matter. The cow is liable to other forms of pustular disease affecting the teats, but they do not present the same characters nor follow the same course as the genuine cow-pox: which is, moreover, a constitutional disease, sometimes extremely severe, and even fatal to the animals. The name of Dr. Jenner, who discovered this inestimable boon and introduced the practice of vaccination — as the inocula- tion of cow-pox matter is termed — must be known to all. His attention was first directed to the subject from the known circumstance, that when the cow-pox had prevailed among the cows of a particular C w 153 COW district or farm, many of those connected with the management of the animals, like- wise became affected with the disease, and therefrom a certain number were protected against small-pox. The value of this cir- cumstance seemed at first to be materially impaired by the fact that the protection was neither universal nor certain, until the investigations of Dr. Jenner made it clear that the protection or non-protection de- pended upon the stage which the disease had attained in the animal at the time it was contracted by the human attendant ; that is to say, if the vaccine disease advanced into the stage of maturation, or that in which the contents of the vesicle, which forms its outward manifestation, had become con- verted from a limpid-looking fluid into matter, although sores were produced upon the hands of the milkers, that certain pro- tection was not afforded which ensued when the sores were produced by the fluid from the vesicle in an earlier stage. Following up his investigations, Dr. Jen- ner clearly demonstrated, that tvhen the human subject w as properly inoculated ivith virus taken from the cow-pox vesicle, at the proper stage of its progress, and when in consequence of that inoculation the disease was regularly produced and went through its proper stages, both locally and constitutionally, the individual thus affected was thenceforth all but certainly protected from the contagion of small-pox. These circum- stances call for particular attention at the present time, when the value of vaccination and its protective power is becoming much disputed. It is unquestionable, that within the last few years, small-pox has prevailed much more extensively, and been more fatal, than was the case some time previously ; also, that many persons who had been vac- cinated have taken the disease, and that a certain proportion of that number have died from it. As regards the complete protec- tion of every individual who is vaccinated, against the contagion of small-pox, it could never be expected — for the simple reason, that one attack of small-pox is not in every case a security that the disease may not be contracted a second time ; for, although, in the eruptive fevers generally, as well as in small-pox, the general rule is one attack in a lifetime, it by no means invariably holds good ; and it is unreasonable to look for more from cow-pox than we find in the analogous cases already alluded to. Admit- ting, then, that certain exceptional instances may fairly be expected in which the most perfectly developed cow-pox will not pro- tect against small-pox even in its most fatal form, it becomes a question how far its pro- ; tection really extends, and whether, from i some cause or other, its influence has not | become diminished since the early days of its introduction. Many are inclined to this opinion, on account of the recent epidemics of small-pox which have prevailed in various districts ; but it will require much stronger evidence of the fact than has ever yet been produced to justify, as some would have it, the abandonment of vaccination and the recurrence to inoculation for small-pox. One thing is certain, that Dr. Jenner, strongly alive to the circumstance that milkers inoculated with the genuine cow- pox were not protected by it if the disease had passed a certain stage, both practised and insisted upon the practice as a condi- tion necessary for success, that the same law should be had regard to in the trans- ference of the matter from one human sub- ject to another. It must be asked, has this precaution been observed in the cases of those who have proved to be insufficiently protected. It may or may not have been the case ; but there is some reason to expect, that among the thousands and millions who have undergone vaccination, a certain pro- portion have thus been lulled by the sem- blance of protection which was no protection at all. Again, it is an ascertained fact, that the presence of other disorders materially interferes with the regular progress and perfect development of cow-pox ; and thus there is introduced another element of fallacy and of failure. And, lastly, are there not those who have been vaccinated, but in whom the disease, owing to constitutional peculiarity, or insufficient performance of the vaccinating process, has either been irregularly developed or not at all, but who nevertheless rank among the vaccinated? With all these sources of failure, it cannot be matter of surprise, that a proceeding to which is confided the protection of millions against so active an enemy as small-pox, should in a certain proportion of instances fail. Still less so when it is reflected, that amid the various hands to which its per- formance is intrusted, some will prove careless ; nay, that it is not unfrequently performed by those who are ignorant of the distinctive characters of the true cow-pox disease. This is not said in condemnation of the performance of vaccination by non- professional persons, under peculiar circum- stances ; for in many cases it has proved and must prove of the most essential benefit ; but still they cannot be expected to distinguish accurately an irregular development from one which is the reverse. The most interesting recent fact connected cow 154 COW with the history of vaccination, and one which throws light upon its constitutional influence, has been elicited by the experi- ments of Mr. Ceely, of Aylesbury, which prove the identity of the two diseases, cow- pox and small-pox, and that their apparent difference depends upon their mocliiication by the animal constitution. In other words, that by taking the matter from a patient labouring under small-pox, and therewith inoculating a cow, the genuine cow-pox was produced ; and thus, that by its passage through the constitution of the cow, the former virulent disease is deprived of its virulent and fatal character, and converted into a mild and'perfectly safe disorder, and, equally important, deprived of its contagious property, otherwise than as it can be communi- cated from one person to another by direct introduction of its tangible virus into the blood. Connected with this fact is the occurrence of the grease on the heels of horses, which was at one time considered identical with cow-pox, but must now be considered as the same virus, but modified by the equine constitution. The next point is one intimately connected with the prejudices of the public, and espe- cially of the poor — the possibility of other diseases, or a tendency to them, being in- troduced along with the cow-pox virus, taken from persons who either had the dreaded disease, or a tendency thereto. The idea is not without apparent foundation, but the state of the case is one which most parents are unwilling to admit. Any medi- cal man who has had much to do with vac- cination, and who has watched its effects, must have known cases in which children, previously apparently healthy, have, after passing through cow-pox, become liable to cutaneous eruptions, discharges from the ears or eyes, and even abscess ; some of these are of course adventitious circumstances, but they occur too often and too closely fol- lowing vaccination, to be entirely so ; more- over, they are precisely analogous to what is witnessed every day of the effect of eruptive febrile diseases, such as measles and scarlatina, upon children of weakly and scrofulous constitution. That the virus itself introduces other than its own specific disease is not to be believed, but that the peculiar disturbance it occasions in the constitution, stirs up, as it were, the latent tendencies to disease above named, cannot be doubted. It is proper that the public should be rightly informed upon this point, for it is one on which much misconception prevails, and it is the chief ground of pre- judice and even of resistance to vaccination, especially among the poor. The medical man is constantly met with objections, on the score of the liability to the intro- duction of other diseases along with the cow-pox, and when a reluctant consent is yielded, it is always guarded with strict injunctions as to the selection of the matter from a " healthy child, "each person consider- ing their own offspring as unexceptionable. It certainly is not a pleasant admission for parents, either to themselves or to others, that their children have bad or scrofulous constitutions ; but the fact still stands, that vaccination, as well as the other eruptive fevers, may in them give the first impetus to latent disease. A parent may decide not to subject a child to the chance, but in doing so, it is exposed to the much greater hazard of an attack of small-pox, in the first place as a disease, and in the second as an excitement of other diseases, still more powerful than vaccination. Further, however, as a proper concession to the opinions of the public, a medical man ought to take the vaccine virus from perfectly healthy children only ; and it may be said, if we find such a powerful modification of the constitutional effects of the disease by its passage through the body of the cow, there may be some influence, to us unappre- ciable, exerted in the passage through the varied constitutions of mankind. At all events, the simple supposition is sufficient to dictate care in the selection of those from whom the vaccination lymph is taken. The best period of life for the performance of vaccination, is infancy, between the third and fifth months, before the constitution be- comes disturbed by the process of teething ; it may, however, be performed at any time, from immediately after birth, should cir- cumstances, such as exposure to the conta- gion of small-pox, render it advisable, and of course at any period of after life. A child ought to be free from illness or disor- der at the time of vaccination ; any tend- ency to fever, to diarrhoea, &c. &c or any eruption, should be removed before the pro- cess is undergone. It is always preferable to vaccinate from the fresh arm if possible. When this cannot be done, vaccine virus or lymph is used, which has been preserved for the purpose, either dried on ivory points, or between two small squares of glass, or li- quid, in small glass tubes. In these cases it ought to be as fresh as possible, otherwise it is liable to fail ; but if well preserved from the air by means of oiled silk or me- tallic leaf wrapping, and kept in as cool a place as possible, it Will keep its efficiency far longer, and is thus sent or taken to cow 155 COW warm climates. The hermetically sealed tubes are said to be peculiarly well adapted for the above purposes, and sugar has also been used as a medium for preserving the lymph for a lengthened period. The scabs, also, dried and kept from the air, are capable of pdlducing the disease after keeping ; they require to be [powdered and] rubbed down with a little water when used. The part of the body on which vaccina- tion \s usually performed is the arm, about halfway between the shoulder and elbow ; a point not of very great importance in males, but to be attended to in females, who may wear low dresses or short sleeves, and who will not thank the doctor for a scar upon a visible part. Some vaccinate upon both arms ; others consider three, or even two well-developed vesicles upon one arm sufficient. In choosing the arm in a child, it should be done with reference to the arm on which the nurse or mother habitually nurses it ; attention to this simple point may save the child some uneasiness, or even from failure of the entire process, by the vesicles being rubbed or broken. All that is requisite for the process of vaccination is the contact of the virus with the surface of the true skin, which of course is done by piercing through the upper or scarf skin ; this may be effected without pain sufficient to make an infant cry, by a series of scratches crossing one another, continued till the slightest exudation of coloured serum takes place. A small quan- tity of the vaccine is 'now to be placed upon the abraded spot, and the thing is done. If the lymph has been dried, it is advisable to rub it into the exuded serum with the point of the instrument used. The points of insertion should be placed about three quarters of an inch asunder. Of course any thing which will abrade the skin in the manner described above, and apply the virus, may be used as a vaccinating instru- ment ; a large needle will do, if nothing better is at hand, but a lancet, not over sharp, is perfectly convenient for the purpose ; or the vaccinator of Dr. Graham Weir (fig. xlii.) which is furnished with a series of metallic points (1) at one end of the instrument, for the abrasion of the cuticle, and a small knife (2) at the other, for the collection and appli- cation of the virus. When ivory [or glass] "points" (fig. xliii.) are used to vaccinate from, the charged extremity (1) may either be well rubbed on the scratched surface of the skin, or the virus may be scraped off and applied with the lancet, or, a deeper in- cision being made with the lancet, in place of the scratches, the extremity of the point Fig. xlii. Fig. xliii. is to be pressed into it for twelve or fifteen seconds. The course of the vaccine disease is gene- rally a regular one. About the third day after the insertion of the lymph, the spots appear slightly elevated and inflamed, like small pimples ; on the fifth, each has a per- ceptible vesicle upon it, which continues enlarging, until, about the eighth day, it assumes its perfectly developed character- istic form, (fig. xliv.,) that of a circular Fig. xliv. vesicle with depression in the centre. At this period it contains a transparent "lymph" and it is surrounded by a perceptible blush, or " areola," the vesicle itself looking pearly or yellowish. By the tenth day, the lymph has become changed into matter, and the vesicle looks more opaque and darker ; the areola of inflammation has much extended, cow 156 OR A the affected skin feels hot and hard, and is sometimes covered with minute blisters. After the eleventh day, the areola begins to fade, the vesicle darkens still more in colour, becomes dryer and shrivelled, and finally assumes the form of a dark choco- late-brown scab, which separates somewhere about the twenty-first day, leaving the skin healed, but permanently marked with the impression of the vesicle, and with a num- ber of little pits. Occasionally the process does not go on quite so regularly ; four, five, or six days may elapse before the points of insertion inflame ; and it may be the tenth or eleventh before the vesicle is fully formed. On the other hand, it may advance so quickly as to be well formed by the seventh day. These differences are chiefly due to constitution. In a weakly child the process is apt to be delayed, and vice versa. The constitutional symptoms also vary, but generally are palpable about the eighth day ; the child is fretful and feverish, and continues so, more or less, for three or four days. Without the evidence of constitutional disturbance, the protection cannot be calculated on as complete. The management during the progress of the vaccine disease is very simple, the prin- cipal being the protection of the vesicles from injury, either by rubbing or by the dress. A piece of soft linen should be placed upon them on the fifth day. If the inflammation of the arm is severe, as some- times happens, a cold poultice of bread and water should be applied. A little Goulard water will allay the after-irritation, if troublesome. A dose of some simple aperi- ent, castor-oil or senna, should be given on the tenth or eleventh day, and repeated once or twice afterward. Care should be taken that the scabs are not forcibly de- tached, otherwise a sore, sometimes difficult to heal, may be the consequence. Some- times this will happen in spite of all pre- caution, in children of a scrofulous habit, and a troublesome ulcer form. It may be dressed with cold cream, or simple water- dressing, or may require a weak astringent lotion, such as two grains of the sulphate of zinc to the ounce of water. Occasionally, an eruption of vaccine vesi- cles comes out all over the body; it is not a circumstance of importance, and makes no difference in the treatment. When matter is taken from the cow-pox vesicle for the purpose of propagating the affection, it is requisite to puncture the vesicle all round ; for, in consequence of its being divided into separate cells by par- titions radiating from the centre — such as we see in the section of an orange — if one cell only is opened, the amount of lymph which exudes is comparatively small. The ivory points may simply be dipped in the exuded lymph and dried ; or the square of glass, if glass is used, gently applied to the vesicle. The "points," when dry, fkould be enveloped in some material which will exclude the air, such as goldbeater's leaf, or they may be kept in a bottle. When glass is used, the two squares should be put together before the lymph is quite dry, and if likely to be kept long before using, they also should be wrapped up from the air ; if to be used at once, paper is suffi- cient. The question of revaccination is much mooted. If the process has been properly passed through in early life, there can be no possible necessity for its repetition before puberty; but after that period, during which the constitution undergoes considerable change, it is an expedient precautionary measure which ought to be resorted to. The process of a second vaccination is very different from that of a first, being irregular in everyway, sometimes causing the slightest degree of irritation, at other times giving rise to rapid, almost erysipelatous inflam- mation of the arm. When it takes effect, it usually occasions slight feverish symptoms, loss of appetite, and headache, for a day or two. A dose or two of aperient medicine should be taken when these symptoms are passing away. The virus of a second vacci- nation is quite inefficient, and should never be taken. [In many of the large towns of the United States, physicians are appointed to vacci- nate the people without charge. Their re- sidences may usually be learned at the city halls.] Refer to Skin — Small-pox. CRAB — The well-known shell-fish, is an article of diet unsuited to those of weak digestion. In some constitutions it causes griping when eaten, and in others a cuta- neous eruption. CRAB'S-EYES— Formerly used in medi- cine as antacid remedies, particularly in cases of gravel, are concretions which form in the stomach of the craw-fish. CRAMP — Is a spasmodic, involuntary, and painful contraction of the muscular fibres. The term is generally applied to the affection of the voluntary muscles, in contradistinction to spasm, applied to that of the involuntary. Any muscles may be- come affected with cramp, but those of the legs and arms, of the former especially, are most liable to do so, doubtless from the CRA 157 CRE greater liability of the nerves supplying the lower extremities, to irritation and pres- sure, two great exciting causes of the dis- order. The cramp may be confined to one or two muscles, such as those of the calves of the legs, or may be more general, as happens in cholera. The affected fibres are drawn in hard knotty contractions, and maintain this condition for a longer or shorter time. The most frequent causes of cramp are the presence of indigestible food in the stomach, or of acid in the bowels, or the pressure exerted on the nerves by over- loaded bowels. The weight and pressure of the child, acts in a similar manner in preg- nancy and labour, and occasions painful and troublesome cramp. The disorder is also often associated with the presence of worms. When cramp affects the arms and fingers, it may be connected with disease of the heart and great blood-vessels of the chest. The power of the application of sudden and prolonged cold in producing cramp is often sadly exemplified in the case of bathers. The best immediate remedy for cramp is friction with the hand, or better still, with the soap and opium liniment. When the legs are affected, it is always expedient to take medicine, rhubarb and magnesia, with a teaspoonful of sal-volatile, or fifteen grains of carbonate of soda, with sal-volatile or a little ginger ; and afterward to clear out the bowels with some active aperient, such as castor-oil, especially if there is any exist- ing constipation, or a possibility of their being loaded. Any other disorder of the digestive organs ought, of course, to be at- tended to. Some persons find relief from the immediate attack of cramp, by tying a band of some kind tightly round the limb, be- tween the affected part and the body, while others are in the habit of standing upon some cold substance. The first process is perfectly safe, and may be tried ; the second certainly is often effectual, but it is not devoid of danger. Active friction is quite the best temporary remedy. Cramp affecting the arms is always to be regarded with suspi- cion ; if it recurs, a medical opinion should be taken. Refer to Convulsion — Spasm, §c. CRANIUM.— The skull containing the brain. CRADLE— The old form of child's bed, is now nearly superseded by the more con- venient bassinet. Either, if well arranged, should have a tolerably firm mattrass, a, firm pillow, a piece of protective waterproof cloth over the mattrass, and soft blankets, but no curtains, which are quite incompatible with the health of the child. Rockers beneath, if they allow only very gentle motion, are admissible, but not otherwise. Refer to Children. CREAM— Is that bland, oily portion of the milk which separates and floats on the top ; its composition is very nearly that of fat. It is a constituent of the milk of all animals. As the amount of cream, contained in cows' milk especially, varies consider- ably, the proportion may be ascertained by allowing the milk to repose in tall cylindri- cal glasses. Zinc pans have been recom- mended for use in dairies, as exerting some chemical action upon the milk, and causing the more abundant separation of cream. If there is chemical action, there must be danger of impregnation from the metal, and though it may be slight, it is better avoided. Cream is nourishing, but not suited for weak stomachs, except in small quantity, mixed with other articles of diet, such as arrow-root mucilage, when it may some- times be advantageously substituted for a larger proportion of milk. Refer to Milk. CREAM OF TARTAR, or Bitartrate of Potash. — See Potash. CREATINE, or Kreatine— Is a crystal- lizable substance, existing in the flesh of animals. CREASOTE— Obtains its name from its powerful antiseptic properties. When pure, it is a colourless fluid, of a strong pene- trating odour, which is known to most persons from its being extensively used as a palliative in toothache. It is obtained from tar, and, for that reason, is sometimes called "spirit of tar." For allaying the pain of toothache its power is superior to that of any other remedy. A single drop of creasote, rubbed up with a little sugar or gum, in an ounce of water, will often allay obstinate vomiting. It can be made into pill very nicely with crumb of bread ; but the pills should not be kept for more than three or four days. It may also be given with spirit of juniper, or with acetic acid, (vinegar,) which dissolves it. It disgusts some patients, but others like the smoky flavour, and in such cases it is a specific against sea-sickness, and rarely fails in the vomiting of pregnancy. It is an admirable ingredient for pomades for chilblains, threatening, incipient, or ulcer- ated, five or six drops being rubbed up with the ounce of lard. Dr. Cormack, in his treatise on creasote — Edinburgh, 1836 — brought forward many arguments and facts to prove that the Egyptian mummies owed their preservation, as well as their medical virtues to creasote ; and upon the occasion CRE 158 CRO of the unrolling of an Egyptian mummy in 1850, the same author addressed a very in- teresting communication to the Athenseum, of June 15th, 1850, in which he seems to establish beyond doubt that the essential part of the mummifying process was the application of heat to bodies filled with bitumen. He shows, upon the authority of Royer, &c. &c. that large quantities of bitu- minous substances were always introduced into the body, and that the strong heat was then always applied. CRESSES — In the various forms of land and water-cresses, are wholesome salads, but, like other vegetables which are eaten uncooked, are not likely to agree with those of weak digestion. Water-cresses, so famed popularly, for their effect "in purifying the blood," probably owe their beneficial influ- ence to the presence of a small portion of iodine. CRETINS — Are individuals in whom de- ficient development of the brain, and of the body generally, is associated with mental imbecility. " Cretins are met with in various quarters of the world, and even in this country, but their peculiar location is in the dark, deep valleys of Switzerland. The condition is often associated with the exist- ence of bronchocele, and the two diseases have been considered as connected, but it is probably not more than coincidence of ex- citing cause. The most characteristic features of cre- tinism are, the stunted stature, which seldom exceeds four and a half feet, the deformed head, large belly, and distorted limbs, the countenance being an index of the imbecile or idiotic condition of the mind. There are, of course, various grades of cretinism. The malady is instructive in showing how strong an influence is exerted upon the develop- ment of the human frame, by circumstances such as surround these unfortunate beings in their childhood ; deficiency of light, and deficient change of the damp malarious at- mosphere of the deep valley. It is also to be feared that it exemplifies the power exerted by the habits of the parents upon their offspring ; and that drunkenness and debauchery of the former often entail cre- tinism upon the latter. There is no chance of amelioration, either physical or mental, unless the cretin is removed from his native home to the free air of the mountains above. The endeavour to improve the condition of these unfortunates is now being made in an establishment situated on one of the Swiss mountains, under the care of a philanthropic physician — Dr. Guggenbuhl — who is de- voting his life to the object. The results obtained, both mental and physical, are said to be encouraging. CRISIS— -In disease, means a sudden change, tending either to recovery or death. Much more importance used formerly to be attached to the critical periods of diseases than there is at present, although, in some, undoubted periodical changes do take place, but not with sufficient certainty or regu- larity to admit of much calculation. A crisis has generally been considered to be denoted by some well-marked circumstance, such as profuse perspiration, discharge of blood, cutaneous eruptions, boils, abscesses, or the like, or by the appearance of copious deposites or sediment in the urine ; and there can be no question that decided and per- sistent improvement in the character of a disease does often follow immediately upon the occurrence of these " critical" ejections. Refer to Fever, #c. CRO TON-OIL— Is obtained by pressure from the seeds of a shrub, the Crolon tig' Hum, a native of Hindostan, Ceylon, &c. The oil, when good, should be of a pale amber colour, about as thick as castor-oil. It is very acrid, and so powerfully cathartic as to be a very unsafe remedy for domestic use internally ; and, indeed, should never be resorted to, except in the one case of apoplectic seizure, when medical assistance is at a distance. In such a case, a single drop of croton-oil — if it is procurable — mingled with a little sugar, might be placed on the tongue. As a counter-irritant, croton-oil is ex- tremely useful. It may be made into a liniment, with equal parts of the strong solution of ammonia and water, or it may be used alone. It brings out a thick crop of pustules, when rubbed on the skin in small quantity. It sometimes, however, affects not only the part to which it is ap- plied, but causes a general cutaneous erup- tion, with swelling of the eyelids. It occasionally exerts the latter effect upon persons who happen to be near while the oil is used. It is not improbable that what are said to be concentrated preparations of castor-oil contain croton-oil. CROUP — Is an inflammatory affection of the larynx and upper portions of the air passages. It is peculiar to children — males are more liable to it than females — and when one in a family suffers from the disease, the rest almost certainly have a tendency to it. The malady seldom occurs during the first year of life, but is most frequent in the second ; at puberty the tendency to it ceases, although cases of genuine croup have oc- curred after that period. The rapidity with CRO 159 CRO which croup at times progresses to a fatal termination, and the distressing character of the malady, always render it a dreaded dis- ease. Fortunately, it is one which, if taken in time, is greatly under the control of well- directed treatment. Its dangerous nature must ever make proper medical advice a necessity, but the importance of early active remedial measures renders it at the same time highly desirable that treatment should be resorted to without the slightest delay. Moreover, the well-marked characters of the disease render it easily distinguishable by the unprofessional — doubly so by those who have once witnessed it, or heard its peculiar cough. The great danger in croiip arises not only from the possibility of the narrow chink in the larynx through which the air passes becoming closed by swelling; but also from the remarkable product of a pe- culiar inflammation which is formed upon, or thrown out by, the lining membrane of the trachea and larynx. This formation, " false membrane" as it is named, resembles thin leather of an ash colour. It tak_es the form of the tube which it lines, and indeed is sometimes coughed up in perfectly tubular portions. More generally, however, when this false membrane forms, death is the result, from its clogging up the narrow chink of the larynx, and preventing the ingress of air to the lungs. Croup may begin very suddenly. A child goes to bed to all appearance perfectly well, and in the course of two or three hours comes a cough, which strikes even the most unob- servant as peculiar, which falling upon the ear of the anxious parent, who has ever heard it before, tells at once of danger. The child seems as if it coughed through a brazen tube. Perhaps at first the little invalid is not awakened, and if now visited, is found flushed and fevered, moaning slightly, perhaps, and restless, the breath- ing slightly quickened ; the cough comes again, the child awakes or is awakened ; if it speaks, the voice is hoarse ; if it cries, hoarser still. Should the disease be neglect- ed at ihis time, or go on uncontrolled, the cough, still retaining its peculiar character, becomes more frequent; the breathing quick- ened, is also accompanied by the character- istic dry wheezing occasioned by narrowing of the passage through which the air is drawn ; the head is thrown back in the efforts to breathe, respiration is insuffi- ciently performed, and the blood being insufficiently changed, begins to evince its deteriorated character in the blue colour of the lips, the dusky coldness of the skin, and the affection of the brain which gives rise to partial insensibility or delirium. The pulse, previously quick, becomes still quicker, but at the same time feebler, and at last the child dies in a state of almost unconscious suffocation. There may, how- ever, in the progress of the disease, be intervals of comparative ease, alternating with paroxysms of spasmodic obstruction to the breathing, threatening, and some- times causing immediate suffocation. The average duration of a fatal attack of croup is from three to four days, but it may, and does, terminate much more speedily. When under proper treatment the disease is checked, the first best sign is the cough beginning to "loosen," the breathing at the same time becoming tranquil, and the skin moist ; the pulse changes from its hard quick beat to one of a softer and a slower character. Croup does not, however, in- variably begin suddenly ; frequently the child has been suffering, apparently, from common cold in the head, and the attack of croup seems to be a consequence of the in- flammatory affection of the membrane of the nose and throat extending into the trachea, and taking on the peculiar charac- ter of the more fatal disease. At other times there has been slight drowsiness for some days previously, but not sufficiently well marked to attract attention, although at the same time, from hoarseness not being common among children, its occurrence should always rouse suspicion, especially if the child itself, or any of the family, have suffered from croup. Sometimes a child will have a croupy cough for some nights in succession before the attack of the real formed disease ; and parents are apt to be lulled into security by the fact, that in children susceptible of croup, any cough partakes more or less of the shrill croupy intonation. Another, and highly dangerous form of croup, is that in which the inflam- mation commences on the throat, the ton- sils and soft palate, and uvula, which quickly become covered with an ash-co- loured membrane. At first the child is supposed to be merely suffering from sore throat, for there may be little or no cough, or embarrassment of breathing, but the in- flammation extends downward into the air passages, and the croupy symptoms become developed ; by the time this stage is reached the case is all but hopeless. Fortunately this dreaded disease, the most distressing, perhaps, by which a parent can lose a child, is, in every form but the last, amen- able to proper remedies if adopted at once. So strikingly, indeed, is this the case, that it is very common to find parents taking the CEO 160 CKO matter in their own hands after they have seen a child treated for the disease once or twice, keeping, as they ought to do, a supply of the proper medicines constantly at hand, and by their prompt application, nipping the incipient attack in the bud ; the medical attendant is either not sent for, or if he is, it is only to find that the proper treatment has been followed and the disease checked. The remedy, in incipient croup, is tartar emetic given in tolerably full doses, either in the form of solution in water, or rubbed up with sugar, but never as antimonial wine. The form of a powder, one or two grains of sugar with the appropriate dose of the remedy, is the best form for keeping, as the solution decomposes and becomes inert, but the latter is perhaps the most quickly efficient form of administration. In a house which contains a child liable to croup, six or eight of the powders ought to be ready at all times, and also bran-bags. To a child of two years of age, the eighth of a grain is to be given at once, to one of four years the sixth ; and this dose to be repeated every ten minutes or quarter of an hour, till full free vomiting is produced. [A much safer and often more certain emetic is a drachm of powdered alum.] At the same time a warm bath may be got ready, into which the child is to be immersed for a quarter of an hour as soon as possible, or what will in the author's opinion answer equally well, large poultices of hot moist bran should be placed over the upper part of the chest and fore- part of the throat, while the child is kept in a sufficiently warm situation. In the habita- tions of the poor, especially, the latter mode of treatment is certainly preferable to the bath, which cannot always be procured with- out delay, nor managed without danger of after-chill. An hour after the vomiting, the dose of tartar emetic [or alum] is to be re- peated, and vomiting again excited, and its subsequent repetition at the end of one, two, three, or more hours, must depend upon the continuance and urgency of the symptoms ; the bran poultices being continued. The child may be allowed to drink freely of toast or barley water, or thin gruel, but not tea — which decomposes the tartar emetic — unless the infusion is extremely weak. If a case of incipient croup be thus treated, it will, in all probability, and may be subdued without medical assistance — though it is certainly safer to have it ; but if the fever is extremely high, and if the breathing has any approach to a crowing sound, medical attendance must be procured if possible, and with the shortest possible delay. If it can- not be procured, and if the attack does not seem to yield after the second or third dose of tartar emetic, leeches must be used — one, as a general rule, for each year of the child's life — not on the throat itself, but over the upper part of the breast-bone, in which situ- ation a blister must also be placed, if it be tried, as it may be, later in the disease. If, after tartar emetic has been used for four or five hours, the disease progresses, the fre- quency with which the remedy is given must now be diminished, and sickening doses given at longer intervals, otherwise there may be danger of depressing too much ; but calomel must be commenced with, and to a child of two years of age, a grain is to be administered every four hours. The strength, if it seems to fail, should be supported with weak animal broth — that made from veal or fowl is the most suitable — given in small quantity and at short intervals. Later in the disease, when weakness increases, the strength of the broth must be increased, the tartar emetic entirely stopped, and solution of acetate of ammonia given instead, a tea- spoonful every two or three hours to a child of three years old. Or if symptoms of sink- ing, cold or blue surface, and weak pulse, seem to demand it, five to ten drops of sal- volatile, or the same quantity of brandy, must be given in a little water, or the car- bonate of ammonia resorted to ; eight grains should be dissolved in an ounce and a half of water, and of this, two teaspoonfuls given during one hour. A little white-wine whey may also be given. Such must be the general outline of treatment to be pursued in a case of confirmed croup, should it fall to be treated without the presence of a medi- cal man. But again it is reiterated, the first twelve, nay the first eight hours, are the all- important period, which, if lost, can scarcely be recovered ; for, though children do recover when the disease has advanced into its second stage, and even sometimes from such despe- rate circumstances as to make it a duty never to despair of saving life, the chances are but small compared with those which the first few hours hold out, that period, which in some situations must elapse before medical assistance can be procured, and which thus places the life of the child in the hands of a parent or guardian. If it is croup, even if it is suspected to be, let there be no temporizing, but let the treatment now laid down be promptly, actively, un- sparingly carried out. If the antimonials act strongly on the bowels, they should be checked with one or two drops of laudanum. Bleeding from the arm is practised . by medical men in croup, but cannot be a safe proceeding for the unprofessional. In the CRO 161 CRO last stage, opening the windpipe holds out the last, and that but a faint hope of saving life. Of course a surgeon is required for its performance, if the parent consents to it. In that fatal form of croup which com- mences in the fauces, an unprofessional person can do but little with hope of suc- sess ; if discovered in time, medical aid should be procured. The local application of the solution of caustic to the whole sur- face within sight, and to the interior of the larynx, may be successful. If croupy symptoms have come on, one or two emetics of ipecacuanha may give relief; but the case is so desperate that it is a question whether, in the absence of a medical man, it is not better left entirely alone. If, however, the life of one child cannot be saved, the possi- bility of this form of the disease extending to the others of a family by contagion, should be known, and guarded against by timely and effectual separation. But should another child become affected, the disease being thus discovered at once, a solution of lunar caustic (nitrate of silver) should be made, in the proportion of twenty grains to the tablespoonful of rain-water, and the in- flamed throat thoroughly brushed over with it, with a hair pencil, and the process re- peated in eight or ten hours. If fever is present, small doses of tartar emetic, the twelfth of a grain, should be given every three or four hours to a child of six years of age, and two grains of calomel every eight hours, and an aperient given if required. These measures are to be fol- lowed out until medical assistance is pro- cured. The causes of croup are almost invariably connected with cold and moisture, and par- ticularly during east winds ; hence, on the east side of Britain the disease is con- sidered to be more prevalent than on the other ; but it may also be occasioned by the removal of wrappings from the throat, and exposure to a cool air when a child is heated. Children liable to croup are still more so after attacks of acute or debilitating disease. The prevention of croup is, of course, of the highest importance, and, therefore, the causes of it, just enumerated, must be avoided in every way. Slight colds should never be neglected in children or families predisposed, but should be treated by con- finement to the house, or to bed if requisite, by milk diet, diluent drinks, and by the tolu and mucilage cough mixture, with the addition of ipecacuanha wine ; paregoric should also be given to allay troublesome cough, and, in fact, those measures recom- o2 n mended in Cold carried out. The sus- ceptibility may also be lessened by not clothing the throat too warmly, and by the regular practice of bathing the throat and chest well with cold water every morning, rubbing afterward with a rough towel till thorough reaction ensues. This practice is, of course, better commenced in warm weather, and not too soon after an attack of the disease. Flannel should always be worn next the skin, and care taken particu- larly that bed-chambers, and rooms chil- dren habitually live in, are not too warm, and never occupied while the floors are wet after washing. A residence at a distance from water is to be preferred. Refer to Antimony — Children — Larynx — Trachea, §c. CROUP — Spasmodic, or Child-crowing — Is a species of convulsive or spasmodic affection of the muscles of the larynx, which, by narrowing and closing the chink in that organ, through which the air passes, occasions the sound of the breathing to re- semble that of the true inflammatory dis- ease. This spurious croup is often an alarming, and sometimes a fatal disease ; it generally occurs before the end of the third year of life, and in consequence of irrita- tions acting more or less at a distance from the affected larynx, which receives the im- pressions through its nerves. Enlargement of the glands of the neck, affections such as eruptions of the scalp, the irritation of teething more especially, or the presence of irritating matter in the bowels, may any of them give rise to the affection. It comes on suddenly, the child is seized in a moment with " catching at the breath," struggles, the face changes colour, and the veins are full. If the spasm be not relaxed, after a few ineffectual efforts at breathing, the child must die ; but if the spasm gives way, the air is drawn into the chest with a crowing, croupy sound. It is of much importance that this spasmodic disease should be dis- tinguished from xeal inflammatory croup, on account of the very different treatment required ; it may be known by the absence of fever, the stopping of the breath being much more instantaneous than that which occurs in the real disease. In an affection presenting symptoms so sudden and so alarming, immediate remedies must be used ; a little cold water should be dashed on the face at once, and, as recommended by Dr. Watson, a sponge dipped in hot water ap- plied to the forepart of the throat — medi- cal assistance being, of course, procured quickly. In this disease, a child, even when apparently dead, might be saved by open- CRU 162 ing the windpipe. After one of these at- tacks have occurred, the strictest examina- tion as to the probable cause should be in- stituted by a medical man. The gums lanced if requisite, the bowels cleared with a purgative, and the glands of the neck specially observed, and, if enlarged, the cause ascertained and removed. Refer to Convulsion — Glands, §c. CRUSTA-LACTEA.— An eruptive disease affecting the head and face. — See Skin, dis- eases of. CRY OF CHILDREN.— The principal distinctive difference in the cry of children is, whether it be that of expiration from, or inspiration into the lungs. The cry of a strong child, suffering pain, is more of the expiratory ; that of a weak, exhausted child, of the inspiratory or sobbing character. CRYSTAL LENS.— See Eye. CUBEBS, or Cubeb Pepper — Is the fruit of a climbing plant, a native of the islands of the Indian Ocean. It is used in affec- tions of the urinary organs. The dose from a half to a whole teaspoonful. CUCUMBER.— A pleasant article of diet for the strong, but a very unwholesome one for invalids. CUMIN — is the fruit of an umbelliferous plant, a native of Greece and Egypt. The seeds contain an aromatic volatile oil. Cu- min plaster is stimulant to the skin, and useful in cases in which very active excitant action is uncalled for. CUPPING — Is a process of blood-letting, by which blood is drawn from wounds made for the purpose, by the agency of suction, exerted by a cup or other vessel exhausted of air, or nearly so. It is a very old surgi- cal expedient, and in former times it was, and, indeed, among uncivilized nations at the present time, it is still effected by the primitive agency of a sharp flint or knife, and a cow's horn with the tip removed, suc- tion being made by the mouth of the opera- tor. In modern surgery, cupping, when well performed, is at once one of the most ele- gant and most useful of our methods of treatment. For the purpose of wounding the skin, a metallic box, containing a set of lancets, varying in number, is provided. In this box, (fig. xlv.,) which is called the scarificator, the lancets are so fixed as to be discharged, when set or cocked, by a trigger (1) and spring, which causes them to pass rapidly through the skin in a semi- circular sweep — so rapidly indeed, that the usual sensation of cutting is not felt. The most convenient number of lancets is twelve, and the depth of the wound made by them can be increased or diminished by turning CUP llx. sir. the screw, (2 ;) this must be done while they are fixed at half-cock, and protruding from the instrument. The only other es- sentials for cupping are a vessel from which the air can be exhausted, and kept so when it is applied to the skin, and flame of some kind, or some others means, for exhausting the air. There are, however, sundry other little requisites convenient for the operation, to be mentionod hereafter. Cupping is applicable in most instances where local abstraction of blood is called for, and may often be substituted for leeches, and even for general bleeding; it is a safe operation when used in proper situa- tions, and most may be taught its perform- ance by a few practical lessons. It is, more- over, a most useful accomplishment for per- sons who are far removed from medical as- sistance. It is hoped that the following de- tails may be sufficiently clear to enable even those who have never seen cupping perform- ed, to effect it in case of need ; but by all means let every one who contemplates -the possibility of such a requirement get prac- tical instruction, which there can be no difficulty in doing. Cupping-glasses of various kinds are and have been used, but the most general is the bell-shaped form, (fig.xlvi.,) of various sizes; Fig. xlvi. some of these are made with brass fittings at the top, for the attachment of an ex- hausting syringe. But the most useful form of all, and that most easily applicable by an unpractised or an unprofessional hand, is the leech cupping-glass, (fig. xlvii.,) which is the invention of Dr. Fox, of Derby. When this is used, the next instrument, the lamp or torch, (fig. xlviii.,) is not required as it is for the application of the bell-shaped glass ; 163 CUP this torch is simply a lamp made for burn- ing spirits of wine, by means of a wick which will afford a large flame. xlviii. Cupping maybe performed in most situa- tions on which it is possible to fix a glass, by a proficient; but the range of the un- professional operator must be much more limited, partly on the score of safety, but also for the reason, that in some situations they are not likely to draw blood sufficient to effect any good object. As a general definition, an unprofessional person may cup anywhere upon the back of the trunk of the body, from and including the nape of the neck, to the bottom of the spine, and also on the forepart of the chest. In selecting a place within the above limit it should always be ascertained that there is room for the rim of the glass to be in contact with the skin throughout its entire circle. It being pre-supposed that the abstraction of blood is called for, and it being also pre- supposed that the intending operator is pro- vided with the necessary instruments, he should also have some warm water, a good- sized piece of sponge, or, in lieu of it, a piece of flannel, a light, and some plaster. The person to be operated upon being conveniently placed, and the skin bared, it should be moistened with warm water, or the circulation of the part excited by means of hot water fomentation applied for some time ; an exhausted glass is then to be ap- plied for a few minutes ; removed, the scari- ficator placed upon the portion of skin which had been drawn up by the glass, and the lancets, which have been put on full cock, discharged. The scarificator being removed, the exhausted glass is again to be applied over the wounds made by the lan- cets, (fig.xlix.) The blood ought immediately Tig. xlix. to commence flowing. If the bell-shaped glass is used, when applied, one edge should be made to rest upon the skin, (fig. 1.,) the Fie. 1. flame of the spirit torch passed rapidly under it and withdrawn, and the glass at the same instant pressed entirely down upon the skin. This is the point of the opera- tion most difficult to perform well and effi- ciently by the unpractised, for if the ex- haustion is incomplete, suction, and conse- quently the abstraction of blood, are so likewise ; and in endeavouring to make the movements quickly, there is a liability of burning the skin. Fortunately, an indivi- dual can practise the manoeuvre upon the skin of his own thigh at any time. Much of this is avoided by the use of the leech cupping- glass, from which the air is exhausted by simply putting into it a small fragment of paper, half an inch square, dipped in spirits of wine, or spirit of some sort. A short piece of wire (fig. xlvii. 1) with a small "por- tion of tow tied to the end of it and dipped in the spirit, is used to ignite the paper in the glass, the latter being applied -to the skin the moment this is done, and the wire withdrawn ; the confined air extinguishes the lighted paper in the cupping-glass at once. In addition to simplicity in application, the leech-glass has also the advantage of taking at once a considerably larger quan- tity of blood than the other form, and thus CUP 164 CUE, of requiring to be less frequently reapplied; moreover, the blood, as it flows, gravitates to the bottom of the glass, and does not clot over the wounds, as it does with the bell- shaped instrument. These remarks do not refer to the quick, elegant, and efficient manipulation of a professed cupper, but as the operation must be in the hands of the unskilled. When an applied cupping-glass is to be removed, it must be done by press- ing down a portion of the skin at its edge with the point of the finger, so as to admit the air, which enters with a hiss. If, after a cupping-glass has been on some time, the blood does not flow freely, but clots upon the wounds, and it is desirable that more blood be drawn, the glass should be taken off, and — when the wounds have been cleansed with warm water — reapplied. When the operation is concluded, it is only neces- sary to cleanse the wounds, which will not continue to bleed in the situations indicated for cupping in this article, and to put a little adhesive plaster upon them, [or a greased rag will suffice.] Such is the operation, under the pre- supposition that the operator is provided with the requisite instruments; but in the absence of these, very good substitutes may often be made. To make the incisions, which should be about the eighth of an inch in depth, any sharp instrument will suffice ; for the cup, a tumbler, or wineglass, or any similar vessel with a uniform rim will do ; and to exhaust the air, whatever will blaze freely. In cases of poisoned wounds, the application of a cupping-glass, where it can be done, either with or without enlargement of the original wound, is a good precaution, and will retard the absorption of the poison, during the interval of procuring medical assistance. Dry cupping is a most useful remedy, perhaps too little used ; it is the application of the cupping-glass for from ten to twenty minutes, without any previous scarification. The blood is thus withdrawn from parts in the vicinity of that operated on, and relief afforded without weakening by actual ab- straction of blood. In local congestions of blood, in local pain, &c. it is often of much service. The principle of dry cupping has been brought forward as a remedial measure on a large scale by M. Junot, who, by means of vessels capable of being exhausted after the manner of a cupping-glass, and which are made sufficiently large to include a whole limb, thus draws temporarily a great mass of blood — from three to four pounds — out of the current of the general circulation, and produces the effect of a large bleeding, without its weakening results. The method is said to be successful, but it has not been much employed in this country. Cupping is certainly a most useful accom- plishment for the emigrant. It is a safe method, and, when once practised, an easy one of blood-letting ; but, by all means, let it be practically learned if possible, and then the above, though meant for all, will be more certainly useful in bringing back to the memory the minutiae which so aptly escape it. The chief inconveniences of the leech cupping-glass are its greater bulk and liability to fracture than, the bell-shaped form. CURD.— See Cheese. CURRANTS— The well-known fruit, either black, red, or white, are extremely whole- some, disagree with few, and are particu- larly well adapted, either fresh or cooked, to form part of the cooling diet requisite for health in very hot weather. Moreover, the mechanical action of their seeds has a most beneficial effect in exciting the bowels. Some bilious persons say they find benefit from eating a few ripe red currants a short time before breakfast, and that the practice tends to keep off the increased liability to bilious attacks during the hot weather, when currants are in season. The black currant possesses more astrin- gency than the other varieties, and when preserved, is much domestically used in sore throats, &c. ; it also acts upon the bowels. Boiling water poured upon a por- tion of currant preserve, and the infusion allowed to cool, forms one of the pleasantest and most useful of our fever beverages. Black currant leaves are used in infusion as a domestic diuretic. What usually goes by the name of the dried black currant is no currant at all, but a species of small grape. It is brought almost solely from the islands of the Levant. It is a favourite do- mestic aperient — particularly in the lying-in chamber — mixed with gruel. It probably acts mechanically. CURRY — Is food of any kind prepared with the well-known condiment curry-pow- der, which is composed of turmeric, cayenne, and black peppers, mustard, ginger, and other spices. The preparation is not adapted for inva- lids, and should only be used sparingly by those in health, especially if they have any tendency to irritation of the stomach and bowels, or to head affections. It is pro- bably better adapted, as regards wholesome- ness, to give requisite stimulating power to the rice and other foods of hot climates, than as an addition to an animal diet. 165 BAR CUT.— See Wounds. CUT-THROAT.— In this horrible casual- ty two dangers chiefly threaten life imme- diately : the one, death from immediate bleeding, if any of the large vessels of the neck have been divided ; or, if this has not been the case, death from blood finding its way into the windpipe. In the first, few unprofessional persons could possess on the instant either sufficient knowledge or presence of mind to render much efficient assistance — certainly not in the case of the large arteries ; but bleeding from a small branch might be arrested by the means suggested in article Artery. Should a su- perficial vein be wounded, and pouring out dark blood, gentle pressure in its course, between the wound and the head, might be of service. To prevent the danger of suffo- cation, when the windpipe is opened, and when the bleeding does not immediately threaten life, the position of the person is the principal thing to be attended to ; this should be either on the side or on the face, in whichever situation fluids may most easily run off without entering the tube. This being done, and some light gauze material thrown loosely over the wound, nothing more should be attempted before the arrival of that medical assistance which must as speedily as possible be procured. Above all things, no attempt should be made to close the wound. Refer to Artery — Hemorrhage — Wounds. CUTANEOUS.— Belonging to the skin. CUTICLE. — The epidermis or scarf skin. • — See Skin. CYNANCHE.— A term applied to affec- tions about the throat, which tend to pro- duce suffocation. CYST. — A membraneous-like bag, within the body, containing morbid matter. The matter varies much in consistence and appearance. Cysts frequently form just beneath the skin, and some persons are peculiarly liable to them. In aged people cysts often form, and are conspicuous upon the head. Cysts in superficial situations are generally quickly and easily removable by the surgeon. The upper eyelid is often the site of a small cyst. BALBY'S CARMINATIVE— Is a quack compound of carbonate of magnesia with va- rious essential oils. It also contains opium, and this fact alone ought to be sufficient to exclude it from use. Magnesia, carmina- tive distilled waters, and opium likewise, are all unquestionably, when properly em- ployed, useful even for infants ; but in the majority of cases, the latter drug is quite uncalled for, and when it is necessary, its administration requires the utmost care and circumspection of the medical man. It can- not, therefore, be a matter of indifference whether a medicine sold and kept for gene- ral use contains so powerful an ingredient as opium, or whether, when a simple mix- ture of magnesia, or chalk and dill water will answer every purpose, a medicine — that is, opium — is given, which cannot fail to act injuriously, unless positively indi- cated by the peculiar circumstances of the case. A dose of "Balby" will undoubtedly "still" a child, perhaps more quickly than a simpler or more cautiously combined pre- paration ; but its very power of action in this respect indicates its power likewise of inflicting evil consequences. If a carmina- tive simply is required, a simple carminative should be given in some such mode as that recommended in the article Children. If opium is called for, let it be given — under medical sanction — as opium, in known and graduated doses ; but it is criminal folly to use it in the indefinite hap-hazard way in which such productions as the one in ques- tion are used. " According to Br. Paris, there are five drops of the tincture of opium to two ounces of this mixture ; but in another formula it is stated that this tincture forms one eighteenth part of the liquid. Like most of these quack prepara- tions, it probably varies in strength. An infant is reported to have been destroyed by forty drops of this preparation — a quan- tity equivalent to little more than two drops of the tincture of opium." — Taylor's Juris- prudence. The possibility of any preparation intended for children containing a variable propor- tion of opium, ought to be sufficient to deter those who have the care of the young from hazarding either the lives of the latter, or their own peace of mind, by its administra- tion. Moreover, it is impossible, habitually, to give opium, even in small doses, to chil- dren without injury, even if fatal conse- quences do not result. Refer to Opium — Quack Medicines, §~c. BARNEL GRASS— Is a species of rye- grass, the seed of which has a beard or awn, like barley, and which, unlike the grasses generally, is poisonous. It is more common on the continent than in England, and the seeds are occasionally so abundantly mingled with those of barley, or other grain, as to cause symptoms of poisoning in those con- suming articles of food made from the meal — a point of some consequence, now that so much continental grain and meal is con- sumed in this country. When chewed, meal containing darnel grass causes a burning BAM 166 DAN sensation in the throat, and giddiness, head- ache, and lethargy follow. An emetic would probably be the best remedy. DAMP. — 'Moisture is one of the most prolific and most generally acknowledged sources of disease ; in whatever way applied to the body, whether in the atmosphere, or clothing, or bed, it is alike apt to be pro- ductive of bad consequences, often of the most serious character. "When combined with decaying vegetable matter, and more especially when favoured by heat, fever and ague are the results of undue moisture ; when cold and damp unite their depressing influences, colds of every kind, inflamma- tory attacks, scrofula and consumption, rheumatism and neuralgia ensue. Dampness, or injurious excess of mois- ture, may depend upon the natural forma- tion of the country, or character of the soil, or upon a superabundant growth of timber, which obstructs the drying effect of the sun's rays and of a free circulation of air. The effects of these conditions are evidenced by the agues of the marsh districts, the cre- tinism of the low, dark, damp valleys of the Alps, the fevers of the tropical forests and African rivers, or in a lesser degree by the relaxing effect of a damp and some- what mild climate, like that of Devonshire. The advance of the improvements of civil- ization does much, if it cannot do all, to rectify these sources of disease. The cut- ting of watercourses, the clearing of timber, are for the most part attended with increas- ed salubrity of the district. The latter, of course, requires circumspection ; for much harm may be and has been done by the in- judicious removal of protecting belts of trees ; neither must it be forgot, as mention- ed in article Ague, that the intervention of a wood may prevent the extension of the malaria of a marsh. But the shelter of trees is a different thing from closely encircling a house with them ; they will retain moisture around, more or less according to the nature of the soil and the denseness of their growth, and in a way which is not compatible with health. Dampness and moisture in excess cannot of course be prevented, when owing to the vicinity of large bodies of water ; but in such a case the chief evils to be dreaded are the cold winds which " come off the water" laden with vapour, and which, as happens in many situations, are liable to produce croup in children and catarrhal affections in the predisposed. If these influences cannot be guarded against, of course re- moval is the only remedy. Damp houses must be unwholesome; if occupied too soon after building; disease, especially of a rheumatic character, is the frequent consequence. Most generally, in- sufficient drainage, particularly in the coun- try, is the cause of dampness, and it is, moreover, after a house has been built, one difficult to rectify, but it should be done as far as possible ; even houses which appa- rently stand high are damp* from this cause, especially if the ground slopes to, as well as from them. If no other remedy is avail- able, nothing is so effectual as covering the damp floor with sheet lead, which effec- tually excludes the moisture, if it does not do away with the cause. Damp clothes and beds are so generally recognised as causes of disease, that the fact scarcely requires to be insisted on or indeed the additional one, that when the former are unavoidable, the danger is much if not wholly done away with by continued active motion, which keeps up the animal temperature ; and it is probable that this preventive not being available in the case of the latter, renders a damp bed almost synonymous with disease and death. Damp in most instances acts, undoubt- edly, by abstracting, either by evaporation or otherwise, the natural temperature of the body ; but as dry cold does this likewise without producing the same certain injuri- ous consequences, it is probable that mois- ture also calls into action changes connect- ed with the electrical conditions of the body, of the precise nature of which we are not at present cognizant. One thing is certain, that moisture is always more apt to act injuriously upon the system when the nervous power is either depressed or not in its full state of activity, as it is during sleep, or for the first hour or more in the morning, after rising, and before food of some kind has been taken ; hence it is always found that fogs and moisture are much more likely to injure during the first morning period, and that the best protec- tion is some warm food or drink, [not alco- holic,] which may support or gently stimu- late the system. Refer to Ague — Neuralgia — Rheumatism — Scrofula. DAMSON — The well-known fruit, is wholesome when ripe ; but for invalids should be cooked. It is slightly aperient. DANDELION, on Leontodon Taraxa- cum. — The plant, native to this country, is too universally known to require descrip- tion. Its leaves, when blanched, are used as a salad in some parts of the continent, and the root is sometimes roasted and mixed with coffee. As a medical agent, taraxacum DAN 167 DEA is too much neglected. It is found by every hedge side, and is one of the most cer- tain and active diuretics we possess, whether native or foreign. Perhaps no better proof of its utility can be cited than that the author always finds patients who have once taken the medicine, recurring to it again and again of their own accord. No doubt something is due — and it is a consideration of some weight to the fact — that it is procura- ble without expense. It rarely fails to in- crease very considerably the flow of urine. Various preparations, extracts, &c. of dan- delion are recommended and are employed, and are undoubtedly efficient, but the fresh infusion of the recent root is the best mode of administration. For this, roots of not less than the thickness of the little finger should, if possible, be used, and after being washed from the soil, sliced transversely in pieces a quarter of an inch thick. Of these, a good double handful, or from two ounces and a half to three ounces, are to be put into a jug, a pint of boiling water poured upon them, and the whole allowed to "draw" for an hour or two beside the fire, but not boiled. The infusion will have a greenish-brown colour, and two or three cupfuls should be taken during the day, until the desired effect is produced. The taste is not very unpleasant, is slightly bitter, and to some mawkish, but may be improved by the ad- dition of a little orange-peel. In addition to its action in increasing the flow of urine, dandelion improves the tone of the diges- tive organs, and most certainly exerts a stimulant action upon the liver. Indeed, it is in disorder of the digestive organs accom- panied with deficient action of the kidneys, the urine being scanty, high coloured, and depositing a pink sediment, that dandelion exhibits its most beneficial influence. It may be advantageously combined with broom, as a diuretic, and of course with other medi- cines, such as the tincture of columbo, with potassa, &c. Refer to Broom — Liver — Kidneys. DANCING— Properly so-called, is the ac- tive exertion of the body in sprightly, graceful movement, accompanied with ex- hilaration of mind, and, when thus indulged in by the young, is a most beneficial and healthful recreation. It is no argument against dancing in itself, that it is too often connected with many things that are injuri- ous, such as heated rooms, late hours, and the like — these belong to other considera- tions ; but as an exercise, congenial both to the minds and the physical requirements of the young, it is, as every exercise of the body in which the mind enters with pleasure and interest, a most efficient promoter of health, and it is much to be regretted that its abuse and associations, in some instances, both with physical and moral evil, should cause its abandonment in any place where there are young people. DANDRIFF — Is the formation and sepa- ration of numerous thin white scales, or scurf, from the skin, and is most usual upon the scalp ; but in persons of delicate skin, occurs also upon the face. In infancy it is very common upon the head, and among the poor there is a prejudice against its re- moval, "for fear of cold," so that it is allowed to accumulate along with the dirt, and presents a most filthy appearance. Generally, the skin underneath, the seat of dandriff, is not much changed, but some- times it becomes reddened and slightly irritable. In adults, the disease, if it can be called so, is troublesome, from the quantity of scales, or scurf, which mingle with the hair and shake from it upon the clothes. In any case, care should be taken to avoid irritating the skin; the hair-brushes should be soft, and the small-tooth comb — at all times a doubtful substitute for thorough washing — must never be used. In the case of infants, washing regularly with soap and water, and the use of some simple pomatum, or of an ointment com- posed of ten grains of red oxyde of mer- cury to the ounce of lard, will remove the inconvenience ; and either in their case, or in that of adults, an alkaline wash will be found useful. Mr. Erasmus Wilson re- commends two drachms of solution of caus- tic potash to eight ounces of soft or rose- water. [A drachm of borax in four ounces of water, with a few drops of oil of berga- mot, is also a cleansing wash for the head afflicted with dandriff.] DANGER.— See Death. DATE.— The fruit of the date-palm con- stitutes a considerable portion of the food of the people of Egypt and Northern Afri- ca, Arabia, and Persia. The nutritive ma- terial is chiefly sugar. As imported into this country, dates are not a digestible arti- cle of diet. DATURA STRAMONIUM.— See Thorn Apple. DEADLY NIGHTSHADE.— See Bella- donna. DEAFNESS— Or deficiency in the sense of hearing, may be either partial or com- plete, and it may be accompanied with dumbness. The causes of deafness may be temporary or permanent, and the affec- tion may be due to disorder of the brain BE A 168 BE A and nervous system, to disease and dis- organization of the essential portions of the organ of the hearing itself, or to causes which interfere with the transmission of sound. The temporary causes of deafness may be such as have their origin in temporary dis- order of the brain, resulting from external violence, or from disorder either local or general, more particularly some forms of fever, of which deafness is a frequent con- comitant. Some drugs, quinine particu- larly, given in too large doses, also give rise to the affection. Temporary deafness is frequently occa- sioned by common cold, which seems to cause tumefaction of the membranes lining the passage of the external ear; or when the throat is affected, obstruction of the Eustachian tube, which extends between the internal ear and the throat, either by swell- ing or accumulated mucus. These causes often continue in action, and keep up the deafness, long after the cold has disappeared. [Infants whose heads are left without caps in cold weather are very liable to suffer in this manner; and many cases of "run- ning from the ears" are also due to the same cause.] Permanent deafness may result from dis- ease of the brain, such as paralysis, or from violence, such as severe blows or falls upon the head. The author has one patient, a gentleman afflicted with permanent partial deafness, the result of a dangerous fall when hunting, the effect upon the brain being evidenced by the fact that his pulse, which formerly ranged at 72, has never since exceeded, in health, which is perfect, 40 in the minute. Disease of the ear itself, or its effects, can scarcely fail to cause deaf- ness. The internal portions of the ear are liable to a variety of. disorders or diseases which it would be useless and out of place to notice in this work. Many of these take their origin during attacks of acute disease — particularly measles or scarlet fever — in scrofulous individuals. Discharges occur from the ears, and the minute bones con- tained in the cavity are sometimes discharged. To allow of this, of course, the membrane of the tympanum or drum of the ear must be wholly or partially destroyed. This im- portant membrane -of the ear being dis- eased, is often the occasion of deafness. As mentioned above, the obstructions, either in the outer ear passage, or in the Eus- tachian tube, first arising from common cold, may become permanent ; in the case of the latter, when the swelling subsides, thick mucus may block it up ; in that of the former, hardened wax, or cerumen. Thi3 last mentioned cause of deafness is very fre- quent, is easily discoverable, and no less easily removed, affording most striking relief to an almost total defect of hearing. It is perhaps the only affection of the organ causing deafness which is likely to be well or safely treated domestically. — See article Cerumen. The subject of deafness, and of diseases of the ear generally, has been greatly neglected by medical men, and consequently has fallen into the hands of quack aurists. Within the last few years, however, it has been taken up by more than one distinguished member of the profession, and promises fair to take the place its importance demands, and to have its causes and treatment investigated and established on a true, scientific, and rational basis. A person affected with temporary deaf- ness, if it is traceable to an assignable cause, such as cold, should wait the effect of time for its alleviation. A blister ap- plied behind the affected ear, or, better still, an eruption brought out just below the ear, by tartar emetic or croton-oil, may pro- bably give some relief. If wax be suspected or ascertained to have accumulated, it should be removed, as directed under article Ceru- men, but never by ear-picks or such like dangerous weapons. When no assignable cause for the deafness, whether permanent or temporary, can be discovered, a medical man should be consulted — if he has given special educated attention to aural surgery, so much the better — but unqualified quacks with nostrums and never-failing cures must be shunned. No one, surely, can be so cre- dulous as to believe that any application, or variety of applications, put into the outer ear — and strong stimulants are often used in this way — can be remedial for a symptom owing to causes so varied. Some varieties of deafness are alleviated by appliances to the external ear-passage, and some remark- able cases have been published of great im- provement in hearing resulting from small pellets of cotton wool, or other substances, moistened and introduced so far into the ear as to be in contact with the tympanum mem- brane, which had been perforated by disease. For moistening these, and indeed for moist- ening the passage of the external ear, when too dry, — an occasional cause of deafness, — or for moistening hardened wax previous to syringing, the fluid named glycerine is better adapted than the oil generally in use. Va- rious other modes of treating deafness, with reference to its various causes, have been and are employed. Its dependence upon DEA 169 DEA obstruction of the Eustachian tubes has ori- ginated the practice of passing an instru- ment, or Eustachian catheter, np these pas- sages, for the purpose of clearing them. The operation is one which requires both practice and tact for its safe and efficient performance. Some years ago the same thing -was attempted by forcing air into these tubes by an instrument made for the pur- pose ; but a fatal accident seems to have interfered with the continuance of the prac- tice. Lately, the pressure exerted upon the membranes of ears by the diving-bell has been brought forward as a cure for deafness. These and other practices and propositions may be good, or the reverse ; but one thing is certain, either these or any other reme- dies, except the one or two simple ones mentioned above, should never be resorted to without proper medical sanction and management. When deafness is confirmed, and cure cannot be obtained, relief must be sought in the various artificial methods — ear-cornets, and the like — for collecting and conveying to the ear as large a body of sound as possible. The remarkable power of gutta-percha in the conveyance of sound has afforded many facilities for adding com- fort to the deaf, and improving their means of hearing ; and many instruments for the purpose are manufactured by the Gutta- percha Company. It seems probable, how- ever, from the investigations of Dr. Allen Thomson, that while attention is given to concentrate and convey sound in cases of deafness through the usual ear-passages, its communication through the bones or hard parts of the head is too much overlooked. Dr. Thomson's investigations were founded upon the fact, "that sounds transmitted by contact of the sounding body directly to the head or other hard parts, appear louder when the external meatus — or ear-passage — is closed." The same authority further remarks, " I am inclined to think that much more might be done than has yet been attempted, in a certain proportion of such cases, by assist- ing the hearing through the hard parts of the head, or by other means. Indeed, it seems surprising, considering how long it has been known that in some deaf persons the hearing of sounds is improved by pro- moting their transmission through the bones of the head, that an apparatus calculated to facilitate this mode of communication of the sonorous vibrations has not been em- ployed instead of the ear-trumpet, which can be of comparatively little service to them." Further, "In those hearing best through the hard parts of the head, it has long been known that the air passages, or P accessary parts of the organ, principally are affected. In those partially deaf per- sons, on the other hand, who hear best by the meatus, it appears very probable that in general an affection of the internal ear, or loss of sensibility of the auditory nerve, is the cause of deafness. In these last the ear-trumpet is of essential service, by concentrating all the weaker vibrations in the passage which is to carry them to the nerve, whose sensations are deadened. In the former the meatus should be closed, and every means ought to be used, as by sound- ing-boards, to collect, and solid elastic rods to conduct the vibrations to the hard parts of the head." With respect to the deaf and dumb, or " deaf-mutes," as they are now' called, whatever the cause, whether congenital deficiency, or complete deafness brought on by disease or accident before the power of speech had been thoroughly acquired, the education should be conducted in an es- tablishment for the purpose. It cannot be done at home, but much may be done by the philanthropic and earnest endea- vours which have devised, and are now daily devising, new methods for imparting to these unfortunate individuals the bless- ings of knowledge. It has probably been an error in the education of the deaf-mutes hitherto, that they have been brought up in establishments by themselves — a plan, it would seem, less likely to fit them for mingling usefully with the world in general in after-life, than commingling them with children who have the power of speech. In Donaldson's hospital for the education of poor children, recently opened in the neighbourhood of Edinburgh, an endeavour is now being made to correct this error, and a considerable number of deaf and dumb children are being brought up with the others, being of course taught in a different manner. It seems unquestionable that this commingling must have a beneficial influ- ence, not only on the unfortunates them- selves, but also upon the others, teaching them to regard their deaf-mute playmates with familiar kindness, instead of the dis- tant dislike or ridicule, which are too apt to be attached to, or openly displayed toward, the persons and manners of those who pre- sent any unusual defects, either of mind or body, by children more happily constituted. Dr. Allen Thomson further remarks — "Dumbness is known usually to proceed from deafness, either existing from birth, or arising early in life. The exceptions to this are very rare, and occur only from de- fective formations of the organs of voice and DEA 170 DEA speech, or from disease of the brain. In the case of dumbness arising from total congenital deafness, sounds can never be associated with ideas, and consequently feelings, emotions, actions, and the names of objects or description of their qualities and states, must find a language in natural gesture, or in conventional written and manual signs. In the second case, that, viz., of total deafness coming on later in life, even if speech shall already have been acquired, it may be gradually lost, in con- sequence of the want of habit to associate sounds with speech. This occurs, however, only in early life, when the habit of speech has not been fully impressed on the memory. I am informed by Mr. Kinniburgh* that it rarely happens that dumbness is entailed by deafness so late as the tenth or eleventh year, and that the extent to which this may occur will depend very much on the cir- cumstances in which the individual is placed. In those who become only partially deaf, but to such an extent as to incur the risk of becoming also mutes, it seems probable that much of the power of retaining voice and speech, or of regaining it, may depend on a very small difference in the amount of hear- ing ; and I am inclined to think that much more might be done than has yet been at- tempted, in a certain proportion of such cases, by assisting the hearing through the hard parts of the head, or by other means." Refer to Ear — Glycerine, §c. DEATH.— The departure of the animat- ing spirit from the material body, the separation of the living soul from the frame so "fearfully and wonderfully made," which is no longer fitted to be its habita- tion or medium of communication with earth and earthly things, is a subject which few can approach without awe and fear — none without interest, though it may be of a solemn kind, as the one event from which no child of Adam is exempt. The possibi- lity or the probability of illness having a fatal termination, devolves a great respon- sibility, and much anxiety upon the mind of a medical man, as regards the patient more particularly. There is the preparation of the mind for the great change to be con- sidered ; the settlement of worldly affairs on which may depend the future welfare of others to be thought of; but there is also the effect of the announcement, nay, of the slightest hint of danger, upon some indi- viduals, to be duly pondered, lest the mental shock may put the finishing stroke to what * The late superintendent of the Deaf and Dumb Asylum in Edinburgh. disease has begun, and extinguish the last faint chance of recovery. None but those who have had to bear it know the weight of anxious thought that such considerations press upon a conscientious mind. It is a position for which no stated rule can be framed, and in which the judgment must be guided by the many contingencies and considerations which surround every case of the kind. It may be requisite on the first symptoms of danger occurring in some dis- eases, particularly in those likely to affect the powers of the mind, to make the an- nouncement early ; in others it may be de- layed for some time after the physician has decided in his own mind that the case can have none but a fatal issue, till, indeed, the idea, without being actually imparted, has gradually dawned upon, or been gently awakened in the mind of the patient, and has by degrees ripened into conviction. The question of encouraging hope of re- covery depends upon considerations similar to those which influence the announcement of necessary death. Many of these rest upon religious grounds, which it would be out of place to touch upon here ; but in a medical point of view, the tonic influence of this powerful emotion of the human heart must never be forgotten. With some, the hopes of a blissful future may be so strong that they overpower all wishes connected with this world : but these are, it must be said, exceptional cases ; the love of life is strong, the majority hope to get well. This hope is as it were an anchor and cable, linking them with the life and activity of earth : destroy it, and they sink at once ; the emotion is a sustaining tonic which no remedy can sup- ply. It is for this reason that the office of announcing the possibility or probability of death should not be devolved upon the medi- cal attendant, except in certain cases. Coming from him, it takes too much the form of a final sentence. There are, it is true, various ways of breaking the subject; but softened down as it may be, it comes with a depressing force which it has not when friends or ministers breathe the pos- sibility of such an occurrence. To the poor, and even to those who might know better, an important caution is required. Too frequently it happens that while a medical man is examining his patient, or still within hearing, questions relative to the patient's state are put, whether " there is any danger ?" whether the person will "get better?" and other interrogatories, which he can scarcely either answer or re- fuse to reply to, without conveying to the patient information he may not wish to DE A 171 DE A communicate. Every medical man must have felt himself at times thus unfairly embarrassed. The symptoms of approaching death must of course be liable to great variation, de- pending upon the cause of the fatal event, and the peculiar constitution and tempera- ment of the patient. Sudden death is usually considered to be that which occurs without immediate pre- vious warning ; for there are few cases in which some indications have not been de- veloped of the disorder of the organ, or structure, which at last gives way and snaps the thread, unless, of course, life has been quickly destroyed by some external acci- dental agency. Dr. Alison says, " All causes of sudden or violent death operate either by directly depressing or suspending the vital actions of the organs of circulation, or by obstruct- ing the arterialization of the blood, and thence arresting the circulation at the lungs." The action of the organs of circu- lation, that is, of the heart and blood-ves- sels, may be fatally depressed by a sudden shock communicated to the brain and nervous system, and death quickly pro- duced, as in the case of severe blows, ex- tensive burns, and the like : or the depres- sion may be caused by abstraction of the blood itself by hemorrhage. In such cases, death is the result of faintness. The arte- rialization of the blood may be fatally in- terfered with, and speedy death ensue, from injuries to the nervous'system, which inter- fere with the process of respiration, or by causes which impede directly the access of air to the lungs, causing asphyxia or suffo- cation, death being the result of the influ- ence of the unchanged, or it might be called poisonous, blood upon the brain. Nearly all cases of death are, indeed, refer- able to the above direct causes ; but many cases of sudden death are most obviously so. Neither is death always owing to one or other of these causes distinctly acting by itself, for they may be variously commingled. The premonitions of approaching dissolu- tion are often strongly marked. Independ- ent of these authenticated cases, in which the mind has been powerfully impressed with the conviction of impending death, in- dependent of, or not directly connected with physical causes, there are others which come under the notice of the physician ; such are strange and sudden impulses of the mind, longing after familiar friends or scenes suddenly acquiring unusual force, to be in- dulged in before the eyes are sealed to the things of this world. As the closing scene draws near, most appear conscious of the coming change ; but some hope on to the last, and cherish the idea of a return to earthly joys and sorrows and business, till the latest breath is drawn. "When death is slow in its approaches, the physical signs, though varying, preserve a measure of uniformity, which in most cases too plainly points out the coming event. They are thus well described in a recently published work.* "When the evidences of dissolution, however, begin to manifest them- selves, a general failure of the temperature, with a cold dew on the skin, may generally be considered as indicative that the scene is about to close. In many cases it is easy to recognise the fatal turn which diseases take by the alteration which the symptoms un- dergo. Where internal inflammations are about to issue in death, there is mostly a striking change in the expression of the face, and sometimes a curious shrinking of the body." " The nose and lips are very character- istic in the dying. The lips become pale, the nostrils dilated and dark-looking, and the hairs about the lips seem more than usually apparent ; the teeth look like pieces of ordinary bone, and the eyes seem to shadow through the eyelids, or are partially turned under the lids ; the nails look dark, and the ends of the fingers sodden. Finally, convulsive twitchings often show themselves in the face, with singular elevations of the eyebrows, and staring of the eyes. A gap- ing attempt to breathe terminates the strug- gle. W f hen coma is present, a mucous rattle is of fatal import ; and I contrario, when the lungs are affected, the supervention of coma is equally to be dreaded. "When fluids taken by the patient flow- back from his mouth, or fall heavily down his throat, as if poured into an ordinary tube, death is soon to be expected. " In young children a curious playing with the bed-clothes often attends fatal affections of the brain. I remember a little child, who had her handkerchief in her hand, which she spread out repeatedly with appa- rent care, and in a fantastic manner that would have been amusing, but for its fatal import. The picking of bed-clothes, and catching of the hands as if at imaginary objects, are well known as terrible indica- tions. " Chomel remarks, as of serious presage, the automatic manner in which a patient will unceasingly draw his hand to his side, * "Medical Aspects of Death," by J. Bower Har- DE A 172 DE A in spite of the efforts of the physician to ascertain his pulse. "The signs of death are not, however, always very marked ; for when death arises in advanced and feeble age, the vital powers are so easily depressed, and the heart's action brought to a stand in so impercep- tible a manner, that it is common to speak of it as a quiet sleep." These signs of approaching dissolution are terrible and distressing to witness in those we have loved ; and though, undoubtedly, existence is sometimes terminated in a pa- roxysmal agony of pain, there is reason to believe that in slowly approaching death, such as has been described, the sensations are much blunted in consequence of the insufficient change of the blood. The symptoms which indicate that death has actually taken place are, in the majority of instances, perhaps too unequivocal to be mistaken; but sometimes it is not so, and there is a difficulty in determining whether life actually has departed, even hours after any appreciable sign of conscious existence has been given. The signs of death may be divided into those which precede putrefac- tion, and the occurrence of that unequivocal evidence itself. Some, indeed, have con- tended that it alone should be received as evidence of death ; but there are obviously many circumstances under which it is im- possible to await its occurrence, nor is it necessary to do so. The absence of apparent respiration is a generally received symptom of death, and a looking-glass, or light feather or down, placed before the lips, are used as tests. Mr. Harrison, whose work has been already quoted, says both are fallacious, and in- stances the circumstance represented by Shakspeare, of Prince Henry having been deceived when he carried off the crown from his father's pillow. " By his gates of breath There lies a downy feather which stirs not; Did he suspire, that light and weightless down Perchance must move." The light down may be stirred by any passing current, or the mirror may be dim- med by some exhalation from the body, and either prove deceptive. Mr. Harrison further observes, "If the observance of the- respiration be taken as the indication of life, and its absence as a proof of death, the exposure of the naked chest and abdomen would enable the spec- tator to form a much more accurate appre- ciation of it, especially if it be made care- fully and for a sufficient length of time." Stiffening or rigidity is another generally received sign of death, but it may not occur at all, or very transiently. A false rigidity may be present immediately after dissolu- tion, in consequence of death from some nervous affection. It was formerly thought that persons killed by lightning did not become rigid, but the examination of re- cent cases has proved this to be erroneous. "The rigidity of death appears to come on with various degrees of rapidity, an,d its duration is also various. It usually com- mences in about seven hours, but it may be deferred considerably longer, even from twenty to thirty hours. When the body is greatly weakened by disease, the rigidity comes on much sooner, but is much more evanescent. It has been known to arise in fifteen or twenty minutes. Its duration varies from twenty-four to thirty-six hours, but may continue many days. In some nervous diseases affecting the living body, rigidity occurs, but scarcely in a way to deceive. When the limbs have become rigid, and the rigidity has been succeeded by flexibility, the fact of death having oc- curred can never be doubted." Professor Louis, from observations made upon more than five hundred subjects after death, found that the articulations began to be- come stiff even before the loss of animal heat. Fodere, another authority, has veri- fied the justness of this observation several times in hospitals, and concludes that the flexibility of the limbs is one of the prin- cipal signs by which we may judge that a person is not dead, although there is no other sign of lffe. The cooling of the body after death depends much upon contingencies ; the co- vering, the surrounding temperature, the presence of much fat, &c. all exert a modi- fying effect. In cases where much blood has been lost the body is observed to become cold rapidly. The occurrence of discolorations on va- rious parts of the body, particularly the most dependent portions, are frequent se- quents to death, and the darkening of that portion of the white of the eye which is exposed to light, has also been pointed out as a symptom to be depended upon, and along with it, dilatation of the pupil. The above symptoms, singly, might not per- haps convince of the occurrence of death ; but more or less combined, they cannot be doubted. Putrefaction commencing of course does away with all doubt. It may seem to some that it is unneces- sary to dwell so minutely upon the evi- dences of the last great change ; but it is a subject on which many entertain great DE A 173 DE A anxiety, and from the fact that a considerable number of ascertained cases have occurred, in which mistakes have been made with respect to death, it is desirable that accu- rate information upon the subject should be generally diffused. It ought to be re- membered that the corpse of a person who has died of a contagious disorder, particu- larly the eruptive fevers, may propagate the disease. The influence of season in causing death is well marked. "According to Quetelet's tables of mortality in Belgium, the greatest number of deaths among indi- viduals above twenty-five takes place in February, and the smallest number in July. Other researches, as regards Berlin, show that the greatest number of children die in summer and the fewest in winter, while with adults the case is exactly reversed. It has also been observed that more deaths on the average occur between six a. m. and noon, than at any corresponding period in the twenty-four hours. Lastly, one word as to the treatment of the dying. Let quiet, attention to every sign, the moistening of the lips, the gently shifted position, be the attentions ; but who can tell how painful the disturbance of the forced stimulant or medicine, the noisy lamenta- tion, or the pulling about or pulling away of pillows which nurses are apt to practise, may be to the last moments ? In persons found dead, or apparently so, the first thing is of course to ascertain the real state of the case. If death is doubtful, judging by the signs 'stated in the early part of this article, the first object must be to ascertain, if possible, the cause of the condition which so nearly approaches to it: this must be the first step, but it must be taken with all possible speed, in order that proper measures for resuscitation may be adopted. The causes may either be natural or violent. Of the former, apoplexy, sudden fainting, or suffocation from internal affec- tions, may be in operation ; of the latter, suffocation from unnatural causes, poison, wounds, burns, cold, starvation, lightning, include the most probable influences. Some of these, such as burns, wounds, the action of lightning, cold, and many of the usual modes of suffocation, such as hanging, drowning, &c. are too evident, either in themselves or from concomitant circum- stances, to be overlooked ; but others, par- ticularly those cases of apparent death resulting from natural causes, from some forms of suffocation, and from poisons, are almost beyond the power of the un- professional to investigate. For the mode of distinguishing, and for the subsequent p2 treatment, the reader is referred to the articles devoted to these subjects. It is repeated, when a person is found apparently dead, do not let the fact be assumed without investigation, [do not wait for the coroner ;] the spark of life may yet linger in its earthly tenement, may yet be not past recall, beyond which the loss of even a short time, or the total abandonment of care, may quickly place it. If there is the faintest hope that life is i not quite gone, while the causes of the mis- j hap are investigated, means, such as are | recommended under the peculiar circuni- I stances, should be at once adopted, and | vigorously — no half measures will turn the I scale between life and death. These things I are peculiarly important, for often it can only be a fortunate chance that places a medical man on the spot where cases such as the above have occurred. Of course, where it is possible, medical assistance ought to be as quickly procured as may be, but time may or must necessarily elapse, and while it slips by, life slips away, which might be preserved by the knowledge pos- sessed by some intelligent bystander, which might lead him to think that there was still hope — often too readily given up by the crowd — and lead him to direct the adop- tion of rational and really efficient measures, instead of the useless, or worse than useless, treatment followed, where there is no infor- mation to guide or head to direct. When persons are found who are undoubt- edly dead, there yet remains something to be done, for the cause may be natural or unnatural, and in the latter case the ends of justice may either be forwarded or re- tarded by those who first discover the body. The exact position should be noted. The stiffening or not of the limbs. The presence or absence of warmth about the chest or abdomen particularly. The state of the clothes. Whether there are signs of vomited or other matters discharged from the body. Wounds noticed, and the state of the blood upon them, whether fresh, coagulated but yet soft, or hardened. And, indeed, what- ever the circumstances connected with the finding of the body can suggest to the intel- ligent mind, should be ivritten down. On the arrival of the judicial and medical authori- ties, there are other matters of course to be investigated, which only they can undertake ; but as most of those above mentioned are evanescent, the persons first on the spot can best, or only, testify to them, and facts, which may appear trivial to note at the moment, may, in criminal cases, be the turning point on which conviction hinges. — Refer to Apo- plexy — To causes of unexpected death generally. DEB 174 DEB DEBILITY, or Weakness— Is a falling off from the usual power of the individual to perform those exertions, -whether of duty or pleasure, in -which he has habitually en- gaged, and which, judging from the consti- tution, mode of life, &c. he might naturally be expected to perform. Illness and debility may also be said to be synonymous, for it is difficult to imagine the former unaccompanied or not followed by weakness, except in the few exception- al instances in which apparent debility, caused by the presence of morbid matter in the blood, is relieved by the disorder which carries off the cause of the depression. Such is seen to be the case in mild attacks of bilious diarrhoea, which do not go far enough to affect the general strength, and which are immediately followed by relief to the feelings of languor and weakness which preceded them; indeed, unwonted discharges of any kind, whether in the urine, or from the skin, or even of blood in small quantity, if they do not go too far, are often followed by feelings of strength rather than of de- bility. In these cases, however, the debility was apparent, not real ; that of oppression, rather than of depression. To these and similar sources, then, may be referred all those causes of apparent debility, or in other words, of languor or torpor, which arise from impurity of the blood, conse- quent upon the retention of noxious matters in that fluid, which are from some cause un- removed, as they ought to be, by the agency either of lungs, liver, kidneys, bowels, or skin, or which have been absorbed into the vital fluid from without. It may be said that these are not cases of debility at all, and perhaps by medical men, understanding and strictly investigating their causes, they would not be considered so; nevertheless they give rise to an appear- ance of weakness, of which the unprofes- sional only can judge ; and under these cir- cumstances, it is requisite plainly to point out the distinction, which is of no light im- portance, in the modes of treatment and management usually resorted to. A per- son from some cause or other gets his blood loaded with morbid matter ; either he has indulged in too full living, animal diet, and alcoholic drinks especially, or he has ne- glected to take exercise, or to keep the skin in active operation ; or the lungs, liver, kidneys, or bowels are oppressed or inac- tive ; he has, in fact more or less poisonous matter circulating throughout his frame, — he feels low, both in body and mind, languid and listless, thinks himself weak, and takes, perhaps, a little extra animal food, a little more wine or malt liquor, to correct the (supposed) debility. The consequence must be a fit of illness of some kind, " a bilious attack;" a fit of gout or gravel, of piles or of some cutaneous eruption, which the sys- tem makes a safety valve ; or it may be that apoplexy or some other congestive disease is induced. It is surely superfluous to say more respecting the serious tendency of such an error as that which mistakes false debility for real, and induces the individual, instead of seeking strength by the reduc- tion and alteration of his diet, and by the regulation of the excreting functions of the body, either by general or medicinal means, to rush to the other extreme, and, in the endeavour to get rid of the disorder, to add to the cause of it. Of course real debility may co-exist with apparent, the result of impure blood ; such happens in acute or exhausting affections of the liver, lungs, &c. &c. and the case assumes a complicated and highly dangerous character. As apparent debility is referred to im- purity of blood, so the cause of real debility must be looked for, in many cases, in its deterioration or deficiency. The vital fluid, which is the medium for supporting our animal temperature, and for supplying plas- tic elements to the ever-wearing textures of the body, may be deficient in all or any of the elements required for these purposes, or it may itself have been drained away by hemorrhage. The first office of the blood, the maintenance of animal heat, is so essen- tial, that it seems arranged by the Author and supporter of our life, that to carry on this, the soft constituents of the body may be sacrificed almost to the extreme limit ; but this very circumstance must be a cause of debility during illness, when, to obtain fuel as it were, muscular substance is con- sumed away, while muscular motion is un- exercised. Again, whatever plastic elements the blood may be deficient in, the organs to which those elements should be supplied become debilitated. This is most striking- ly exemplified in the case of the bones in childhood, where food is deficient, which become soft — rickety — for want of the due supply of earthy matter; still more gene- rally is it exemplified, in those cases so often quoted, of animals fed, or rather starved, upon certain kinds of food, such as arrow-root, white sugar, bread made of fine flour, &c. &c, which, however whole- some as articles of diet in themselves, do not contain plastic elements for the build- ing up or sustaining the bodily tissues in strength and healthy active operation ; to deficiency, therefore, of the blood, as regards DEB 175 DEB those elements required in the unceasing operations of the living frame, must we look for the most generally operating and palpa- ble cause of debility. But this cause is itself only an effect of other causes. If the blood is to nourish well, it must be well nourished itself. The supplies it is ever yielding to the system must be rendered to it from without ; the food must not only be in quantity and quality sufficient to pre- serve the balance of nutrient materials in the blood, but it must be properly digested, properly fitted for its commixture with the vital fluid ; if either food or digestion be defi- cient, more or less debility must result. Many causes, of course, may operate to diminish or totally prevent the supplies of food taken. Febrile disease of any kind, accident, disorders of the digestive organs, and numberless others do this; and so certain as they do — except, to be sure, where a little wholesome starvation is required — so certain does debility follow ; for although food may neither be taken nor digested, the bodily requirements, heat, movement, and even the power of thought, must be kept going, and if the materials are not furnish- ed from without, they will be taken from within — the body preys upon itself, or lives, as it were, upon its capital — and it is need- less to say that debility must result. The body, in such a case, might well be com- pared to a steamship at sea, run short of coal, the inner wood-work of which, even at the risk of weakening the hull, is neces- sarily broken up to supply the engine and enable the vessel to reach the harbour of safety. So the body, suffering under acute disease, and unsupplied with food, must make use of that which constitutes its in- ternal structure, although it may be fear- fully weakened, or perhaps destroyed, by the process. The supply of proper nutri- ment, and its presence in the blood, are so intimately connected, that they may be re- garded as one and the great source of real strength. Without good blood, neither muscle, nerve, nor any other constituent of the body can be in its best state of healthy efficiency. Of course, deficiency of the circulating fluid caused either by loss from hemorrhage, or any other drain which ab- stracts all or part of its constituents, must act as a cause of debility equally with those previously mentioned. Again, the blood may be adequate to ful- fil all that is required of it, but some organ fails ; it seems to lose its power of appro- priating to itself elements fitted for its nutrition, although brought to it in the circulation, even in sufficient proportion to maintain moderate healthy action ; cr the individual organ may be overtasked and debilitated, its tissues used up more rapidly than they can be repaired, or its nervous power exhausted. Here we have another source of strength or weakness, real or apparent, the nervous power, the agent through which movement is communicated. The action of the nervous system, as regards strength or debility, must be looked at in connection with its healthy or its morbid operation ; in other words, its strength con- sists in the amount of exertion it is capable of stimulating and maintaining, either gene- rally or partially, without subsequent ex- haustion. This limitation is requisite, for were it not drawn, it would make the ex- citement of the nervous system the measure of strength — it would make the transitory exertions of enormous power exhibited at times by patients in the last stages of real debility, from fever, or the almost resistless struggles of the delicate hysterical girl, tests of real strength, instead of paroxysms of morbid excitement, which terminate in the most exhausting, or it may be, fatal de- bility and collapse. In the healthy constitution, and sufficient nutriment of the organic constitution of the body, and of the nervous system, lies the true element of strength, or the real seat of weakness. To use a simile, the machine must be strong in all its parts, and its moving power adequate to its require- ments, to constitute real, well-balanced strength. When the central organ of the nervous system, the brain itself, becomes debili- tated, the condition may be manifested by partial or general affections of the body, or by disorders of the mind. The brain may be debilitated or exhausted by the excessive stimulation of alcohol, opium, and other agents which act upon it peculiarly, also by sensual excesses, over-nursing, and the like ; but perhaps the most frequent source of a weakened brain in this country is undue exertion of it as the agent of the mind ; it is tasked till it gives way — is used up. This is not a figurative expression — it is the actual truth that the substance of the brain is actually consumed by the process of intense thought, the amount of consump- tion, probably, being in proportion to the exertion the mind is put to. In persons of irritable and nervous temperament it is not uncommon to find deposites of phosphatio salts in the urine after the mind has been strained ; and we can only look to the nerv- ous system and brain as the most probable source of the additional excretion of phos- DEB 176 DEB phorus. The subject is undoubtedly an obscure one at present, but it is deserving of notice, from bringing directly and sen- sibly to the mind, and in a physical point of view, the possible and probable manner in •which this wonderful agent of man's intel- lect may be and is exhausted. Having then seen that debility may either be apparent or real, and that in the latter case it may depend upon deficient nutriment or deficient healthy supply of nervous power, it remains to consider the causes which most generally tend to bring about these conditions. Debility has been divided into original and acquired. The former is witnessed in the children of parents whose constitutions have been weakened by any cause, such as dissipation, advanced life, &c. &c. and also in the children of scrofulous families. The latter, or acquired debility, may of course be caused by whatever lowers the standard of health. As already mentioned, insuf- ficient nourishment is one great source of debility ; likewise the absence of the usual stimuli of solar heat and light, deficiency of fresh air and exercise, and of stimulation to the mind by a proper amount of healthy active exertion. Again, there is the de- bility produced by the direct action of injurious agents, a continued damp climate, either warm or cold, poisons gradually absorbed in necessary employment, or acci- dentally but continually taken into the sys- tem, and such like ; and also by depressing passions of the mind, such as anxiety, fear, &c. &c. Lastly, there is debility, the result of direct abstracting and exhausting influ- ences. Any habitual loss of blood, or drain or discharge of any kind, over-nursing, or sexual excesses. One especial cause of debi- lity requires notice : it is that occasioned in young children or people who sleep with the aged ; for the fact is an undoubted one, that the practice has an extremely debili- tating effect upon the former. It is one which should never be followed or permitted. The withdrawal of accustomed excitements often occasions debility of an alarming and even fatal character. The debilitated drunkard or the opium-eater cannot without danger be deprived of his usual stimulant ; and even the man who has lived in the most perfect moderation cannot always, without danger of inducing great debility, leave off an accustomed stimulus. It is not said that in many instances this may not be done with impunity, or even benefit, but there are cases in which it is hazard- ous. The effect is not manifested, perhaps, for a considerable time — it may be weeks or months — but it is manifested some time ; and the author has met with some cases of extreme depression and general weakness, traceable to no other cause than an unad- vised and rigid adherence to the strict rule of teetotalism. It matters not what the long-accustomed stimulant may have been, whether of alcohol, of fresh air, or of mental exertion, it cannot be withdrawn without danger of inducing weakness. In the treatment of debility, whether simple, or complicated with disease, it mast be obvious to all that it must be adopted with due reference to the cause. This must, if in continuance, be removed or rectified as quickly as it may be. If the mischief, as occurs in original debility, or in that produced by causes which have ceased to operate, cannot be prevented, of course nothing remains but to build up or restore strength by nourishment, tonic medi- cines, change of air and scene, especially to the seaside when that is practicable. In every case, however, of marked debilit} r , the medical man should be consulted ; he only is likely to detect with certainty the cause or causes, and to direct the adoption of appropriate remedies. It may seem that too much space has been devoted to this subject, but it is one which is so erroneously regarded by the public in general, particularly by the lower classes, that it is a matter of importance that more correct views should be imparted, and that there should be a more enlightened under- standing of the subject, of the principles by which debility is to be judged and treated. The case of apparent debility was disposed of in the first portion of this article. In the weakness which accompanies fever and acute inflammatory attacks, nothing is at times more difficult than to convince people not only of the utter uselessness, but of the injuriousness, of administering any food but that of the mildest and most unstimulating character, such as the appetite alone desires, if it desires it at all ; and notwithstanding nature herself points instinctively to the proper course, they will persist in the idea that if the person "would eat, he would be better." Undoubtedly if he would and could eat and digest the food taken, he would be better, for he must be better be- forehand to do so. But the popular idea is, that if food can be got into the stomach, it must give strength ; and foolish friends foster the same impression in the mind of the invalid, till he forces himself to take food ; and many a promising case is thrown back in this way, although the medical DEO 177 DEF attendant is never informed of it, and can only guess at the cause. Fortunately, nature often resents the error, and vomiting relieves the stomach of its injurious load; if not, fever, headache, &c. and relapse are the too frequent consequences. It is repeated, in the treatment of debility, •whatever may be the cause> if still in ope- ration, that must be rectified ; but the -weak- ness itself is only to be repaired by a suffi- ciently ample supply and circulation of healthy blood. The latter must be pro- cured by every means which tend to enrich and purify the vital fluid. Good food well digested, air, exercise, and the use of all accessories to health, assisted when suitable by such regular and regulated ex- ercise of the debilitated parts themselves as will increase the circulation of blood through them, without exhausting either their constituent tissues or nervous power ; but it is useless, and worse than useless, to load a stomach which cannot digest it, with food and drink, in the vain hope of giving strength, as people too often do, or wish to do, in cases of febrile or other disease. To resume the simile of the steamer, although the seasoned wood-work within may be broken up to feed the engine and to carry the vessel safely into port, it would be no slight hinderance, and no small aggravation of her danger, were she to be loaded with water-logged or green wood, which would not burn when it was wanted. So it is with the body in fever : the, already prepared and digested components stored up in its tis- sues, though not perhaps accumulated for the special purpose, will yet answer well to keep its works in movement; but crude food is like the green, wet wood, useless for good, and fitted only to overload and retard. "When increase of nourishment is called for in cases of debility, care must always be taken to adapt it to the condition of the digestive organs ; these are generally weak- ened, and while the food given contains much nutriment, it should be as easily soluble in the stomach as possible. For information on this head, however, the reader is referred to the articles on Digestion, Food, &c. Refer to Animal Heat — Bilious Cholera — Blood — Fever — Nerves, $c. DECAY — Or the gradual giving way of the physical powers in old age, may almost be considered as a part of the preceding article. After the sixtieth year in men, and somewhat earlier in women, as a general rule, the period of old age or of decay com- mences. The descent has begun impercep- tibly perhaps at first, but it is progressive. There may be no positive disease, but the circulatory powers fail, the arteries lose their elasticity and tone ; and in this, per- haps, lies one great cause of the decay of the body generally — the deficient circulation of blood; the brain, the muscles, the whole body becomes smaller, and shrinks, and if there is no disease, the powers of material life are gradually extinguished, a few degrees' fall in the thermometer may be all that is required to put out the flickering flame. For the management of this stage of life the reader ir referred to the article on Old Age. DECIDUA, or Deciduous Membranes — Are those which line the uterus during pregnancy, and which are cast off shortly after the birth of the child. DECLINE.— See Consumption. DECOCTION— Literally, means a prepa- ration .which has been boiled ; but in medi- cine, by the term is understood that which has been boiled for a certain length of time for the purpose of extracting matters from crude materials, which cannot otherwise be obtained. Moreover, when improperly em- ployed as a process, it drives off volatile matters which ought to be retained. The most useful decoctions used in medicine are — Compound decoction of aloes. Decoction of cinchona-bark. Decoction of oak-bark. Decoction of sarsaparilla. Decoction of senega-root. Decoction of elm-bark. Decoction of poppy. The preparations of gruel, barley, flaxseed, &c. &c. are also clas-sed with the decoctions. There are many other medicinal decoc- tions, but they either do not require men- tion in this work, or the preparation, as in the case of dandelion, broom, &c. is better made as an infusion. For information re- specting those mentioned, the reader is re- ferred to the respective articles. DECOMPOSITION— Is the separation of the component principles or elements of compound bodies from each other, the pro- cess being either naturally or artificially excited. — See Antiseptics — Fermentation — Pu- trefaction. DEFORMITY— Means "any and every deviation from the recognised symmetrical proportions of the human frame; but the word is more definitively applied to those irregularities of form which consist in a partial deviation from the natural position of the body, unaccompanied by malforma- tion of the general original structure. It is probable that to a conviction on the part of the profession that club-feet are actual malformations, we are to ascribe the unac- 12 DEF 178 DEE countable fact of this species of distortion having almost to the present day been left without rational or truly scientific attempts made to remedy it." Deformities are either congenital — that is, dating from birth — or acquired. With respect to the causes of congenital deformities, "some are at present inclined to attribute them to a mental im- pression, generally a sudden one, received by the mother during pregnancy — but it oftentimes happens that the mother can as- sign no cause ; in other cases the deformity appears hereditary." "In non-congenital cases, teething, worms, and irritation of the spinal chord are frequent causes. Certain occupations, such as much standing, or car- rying heavy loads ; position also may be regarded as a cause, especially in lateral curvature of the spine ; but occasionally we are at a loss to discover any cause, the deformity coming on insensibly, while the patient is apparently in perfect health." These cases, if attended to at their com- mencement, might certainly be relieved and prevented ; but it often unfortunately hap- pens that there is little interference with the general health. The deformity, as in the foot for instance, coming on insidiously, no attention is paid to the circumstance; a weakness, as it is termed, of the ankle is felt, and the foot deviates occasionally from its natural position ; and thus, if the case be neglected, the foundation is laid for a per- manent deformity, or at all events a perma- nent weakness of one or both limbs, which may involve their being disabled for life. The most simple form of distortion is the horse-foot, which consists of complete ele- vation of the heel, so that the patient in walking rests entirely on the toes, (fig. li.) Fig. li. Mr. Tamplin, the experienced surgeon to the Royal Orthopaedic Hospital, from whose work the substance of this article is taken, says that he has never met with this kind of deformity as a congenital one, but it is a con- sequence of disorder of the system, and more especially of nervous irritation, such as that caused by teething, worms, &c. It may also be occasioned by wounds or local irri- tations, such as ulcers, affecting the calf of the leg, or " it may arise spontaneously, the patient experiencing no pain or inconve- nience beyond the inability to bend the foot or ankle-joint in the act of walking, and retaining at the same time power over all the muscles." When weakness of the liga- ments of the ankle-joint is conjoined with the above deformity, in the course of time the foot is liable to become so much dis- torted that the person at length comes to rest on its outer edge in walking. Another deformity of the foot, that in which it is simply bent inward, may date from birth, and frequently does ; but it may also be induced by various causes of irrita- tion affecting the nervous system. The flat or splay foot, although it may be a con- genital formation, is also liable to be caused, where previous debility exists, by the carry- ing of heavy loads, and other things which necessitate much pressure upon the arch of the foot. " The first thing which attracts the attention of the patient to this deformity in its incipient state, is a sense of weakness, more especially on the outer side of the ankle-joint;" they then observe the flat appearance of the sole of the foot, and the tendency of the inner ankle to approach the ground in walking. As the deformity in- creases, the pain in the joint and the sense of weakness increase to such an extent that the patient becomes totally unable to follow his ordinary occupation. It would be a superfluous waste of time and space here to enter further into a con- sideration of the various deviations from the natural formation to which the limbs are liable : suffice it that whether the infant is born with these deformities, or whether it becomes the subject of them as life ad- vances, they cannot too soon be submitted to medical management. Modern surgery has demonstrated that they are remediable so far that all striking deformity can be removed, and that an otherwise almost useless member can be adapted to perform its natural offices, if not with grace, at least with comfort. The great improvement in the treatment of these defects consists in division of the tendons which occasion the distortion. This practice Mr. Tamplin strongly recommends as the preferable one, whether " for in- fants at the earliest age, or late in life," for the following reasons: — "First, from the facility with which it is accomplished ; DEL 179 DEL secondly, because it incurs comparatively no risk, and scarcely any inconvenience; thirdly, because you at once overcome the principal resistance, and render the after- treatment painless to the patient, and com- paratively easy to the attendant. Independ- ently of this the child is not subjected to such constant confinement of the limb as is absolutely necessary when you do not have recourse to an operation ; you can allow exercise to be taken for a certain time during the day — and that, even in infants, must have a most beneficial effect." The above remarks of perhaps the most experienced surgeon in this kingdom in the treatment of distortions, have been brought forward in the hope that parents and others having the care of children may not, knowing the general causes of non-congeni- tal deformity, neglect the first warning symptoms of its insidious approach ; and in the case of children born with distortions, may place them at the earliest possible pe- riod under efficient surgical management, and not be deterred by the fear of an ope- ration, which, in proper hands, is perfectly safe, comparatively painless, and unattended with loss of blood. Deformity occurs from the softened con- dition of the bones, in the disease of child- hood named rickets, and also from soften- ing of the bones in adults, but these cases are the effect of distinct and well-marked diseases. — See Rickets — Softening of Bones, ^c. Deformities and contractions of the shoul- der and elbow-joint are very generally the result of injury or disease. The wrist-joint and the joints of the fingers are also liable to distortion from the same cause. In some cases the contraction is seated in the skin ; in others the joints are deformed and per- haps displaced by rheumatic disease. De- formity of the fingers may also be congeni- tal. Such cases should be put at once under the management of the surgeon. Refer to Neck — Rickets — Spine, $c. DELIRIUM — Is a temporary disordered condition of the mental faculties, occurring during illness, either of a febrile or of an exhausting character. It is generally a symptom of serious import, but not always. Many children, and some adults, become partially delirious, or "wandering," from very slight causes — even a simple feverish cold being sufficient to produce the effect. In such cases, of course, judgment must be formed with some reservation. In fever, and febrile diseases generally, delirium may be no more than slight confusion of ideas on waking from sleep, or it may amount to furious and dangerous excitement, or merge in low muttering, or terminate in confirmed coma or stupor. Delirium may be the effect of disordered or inflammatory action affecting the brain itself, or it may be sympathetic with active disease in other parts of the body, such as the heart ; it may be caused by long-con- tinued and exhausting pain, and by a state of inanition of the nervous system. In the treatment and alleviation of the symptom, it is of the highest importance that it should be ascertained to which of the above con- ditions it is owing ; and from this circum- stance, any attempt to remedy it by the un- professional (who must be liable to error on this head) cannot but be attended with some risk. It may, however, at times, be requisite even to run this risk for the chance of doing good, and then the follow- ing directions may serve as some guide. When delirium occurs in a person of full habit of body, accompanied with inflamma- tory fever, with quick strong pulse, blood- shot eye, and flushed countenance, abstrac- tion of blood in the first instance, either from the arm, by leeches, or by cupping, cannot fail to be of service. Along with bleeding, free purging with calomel, com- bined with compound colocynth pill, with jalap or scammony, or followed by senna and Epsom salts, should be resorted to ; the head should be shaved and kept cool with the coldest applications to be procured, the feet should be kept warm, the room dark- ened, and every source of excitement re- moved. If there is violent effort and unruly conduct, the limbs must be restrained firmly, but gently, whenever attempts to exercise them in an improper manner are made. In this case a broad belt passed loosely over the bed, and fastened at each side, so as to confine only when any attempt at rising is made, is of considerable assistance. In this form of delirium, it is of the most es- sential import that watch should be kept without one moment's interval, night and day. There must be no risk run of sleepy attendants, and there must be sufficient physical power to restrain the almost super- human, though transient, efforts made by delirious patients. Some of the most pain- fully distressing accidents of illness have occurred in consequence of neglect of these precautions. One unguarded moment, one five minutes' sleep, have neutralized days and nights of anxious care and watching. In the brief interval of remitted surveillance, the patient has escaped from bed, from room, even from house, by the usual modes of egress, or has dashed madly through the first window in his way, or laid hold of the DEL 180 DEL first means of self-destruction. The force of the excitement, it is true, is generally soon over, but it lasts long enough for se- rious or fatal mischief. No apparent quiet for some time is to be trusted ; unceasing care must be exercised till intelligence returns. The low form of delirium is differently- characterized. The mental disturbance is equally complete, but wants the violence of the inflammatory form. Generally the per- son lies in a dreamy state of incoherent thought ; but even in this form, occasional fits of excitement, and attempts to get out of bed, and the like, occur, and must be guarded against. It is this form of delirium which generally becomes developed in the progress of typhus and typhoid fever. The head is hot, but it is not the fierce heat of the inflammatory attack, the vessels do not throb in the same manner, and the eyes are not bloodshot, the pulse is feebler and more easily extinguished, the tongue and the hands are tremulous, the former when pro- truded, and the latter are perhaps affected with convulsive startings. When these symptoms are at all marked, there can be but little doubt as to the nature of the case. To take away blood now, is to kill. The head should be shaved and kept cool, the bowels moderately but sufficiently open- ed, and the warmth of the feet attended to, perfect quiet being observed around the patient. In such a condition, particularly if there is tendency to nervous or convulsive twitching of the fingers or of the tendons at the wrist, opium may certainly be given with benefit — the best form is Battley's sedative solution ; the dose for an adult, fifteen drops in the evening, five drops additional being given every two hours till sleep is procured, or till thirty drops have been administered in all; or the mwiate of morphia may be given, in half or quarter grain doses, in the same manner ; or in the absence of these, any other preparation of opium in corre- sponding quantity. Sleep is the only remedy for the irritation and irritable exhaustion of the nervous system which is attended with this form of delirium, and opium alone is to be trusted to for procuring the soft restorer. Strong meat-soups and wine may also be requisite, but the consideration of these matters rather belongs to the sub- ject of fever. A form of delirium, accompanied with much nervous irritation, is apt to be de- veloped in the course of scarlet fever, to- ward the third day of the eruption, or when it is beginning to fade. In the pro- gress of rheumatic fever, this same delirium of exhaustion may occur, and, like the others already mentioned, requires the treat- ment by opium. Sympathetic delirium takes either of the above forms, according to circumstances, but it is more generally the low type, espe- cially when consecutive to severe accident or operation, or during protracted child- birth. Generally, therefore, opiates and supporting measures, meat-broth, wine, and bark, &c. are required rather than the re- verse. It is of consequence that delirium should not be mistaken for insanity, as it might be, and has been, but scarcely ought to be by a medical man. The concomitant circum- stances of disease, &c. &c. will generally guide. In true delirium, the presence of fever more or less, the acute disorder of the functions generally, such as digestion, &c. and the disorder of the whole mind, generally sufficiently indicate its distinct- ness from insanity, in which the faculties of the mind are only perhaps partly affected or perverted, and disconnected. The in- sane, moreover, do not exhibit the appear- ance of illness which accompanies true de- lirium, and the functions are not usually impaired in the same way. Still the two affections may nearly approach one another ; and in the form of delirium which follows childbirth, or the delirium tremens of the drunkard, it may often be difficult to make the definition as to which the case belongs. Still more difficult of discrimination are some cases of hysterical delirium, which, when long continued, might well be mis- taken for insanity, unless submitted to medi- cal judgment. Indeed, in every case of delirium, medical assistance should be pro- cured as early as possible. No unpro- fessional person in his senses would think of treating a case of delirium, when pro- fessional assistance is at hand. In its absence, the foregoing article should be useful. DELIRIUM TREMENS— [" The Hor- rors," or Mania a Potu] — Consists of a pe- culiar exhausted condition of the nervous system, which is accompanied with more or less mental disorder of a peculiar kind. This disease is generally the result of excessive continued intoxication with alcoholic liquors, or of their withdrawal when they have been habitually consumed in considerable quan- tity. It may also, however, be produced by the continued use of opium, and has been known to arise from other causes of cerebral exhaustion. The first symptom of delirium tremens is a state of restless nerv- ous irritation ; if the exciting cause be DEL 181 DEL continued sleeplessness follows, there is no rest, and if there is any approach to sleep, it is haunted by dreams and figures, which seem to excite the greatest terror. The mind is more collected than in most other forms of delirium, but seems always to be more or less haunted with suspicions of those around. The entire frame is in a state of tremor, the closed eyelids and the pro- truded tongue are tremulous ; the hand which attempts to perform any action re- quiring exactness, cannot execute it for shaking ; the patient is exhausted, and still sleep does not come. Succeeding the above condition, the nervous excitement becomes so great that the person cannot be kept in bed, the mind becomes more disordered, a state of temporary insanity ensues, and convulsions, epilepsy, or apoplectic stupor closes the scene — a scene of the most painful nature, perhaps, which the physician is called to witness — the death-bed of the drunkard — of the man slain by his own sui- cidal act, by the poison of alcohol. It can rarely happen that an unprofes- sional person could have to undertake, un- assisted, the management of a case of de- lirium tremens, and never should do so, except under extreme necessity. The na- ture of the disease is, unhappily, in almost all cases too palpable, from its exciting cause. It is an exhausted condition of the brain and nervous system ; and the great effort must be to alleviate this exhaustion, which is too great even for sleep. Opium is the remedy among others, and must be given in full doses. A medical man will, of course, give it more freely at once than another person ; but in a confirmed case of delirium tremens, twenty-five drops of Battley's so- lution, or thirty of laudanum, should be given at once, and ten drops every hour afterward, until sleep has been procured, or until fifty drops of the former, or sixty or se. 3nty of the latter have been admi- nistered. A medical man would venture con- siderably further than this, if necessary ; but cases might occur in which it would be unsafe for the unprofessional to do so. It often happens that the stomach is in so irri- table a condition that it will retain neither food nor medicine ; in such a case the opium is better given solid, in the form of pill, one grain and a half at first, and half a grain repeated at hour intervals, if requisite. If the stomach is still irritable, a drop of crea- sote, in a little spirit and water, may be given, and a mustard-plaster applied to the pit of the stomach. In cases of delirium tremens, the liver is more or less affected ; it is loaded with dark, unhealthy bile ; and so much is this the case, that some have been inclined to attribute many of the symp- toms of delirium tremens to the liver dis- order, and to recommend a purgative treat- ment in preference to that by opium. The author has generally found the medium course the best, that is, the combination of opium with calomel, and the compound col- ocynth pill. Five grains of powdered opium, ten grains of calomel and twenty of com- pound colocynth pill, are to be compounded together and divided into twelve pills ; of these, two or three should be given for the first dose, and one at intervals of an hour between each, till six have been given. Under this treatment, after sleep has con- tinued for some time, the bowels are gene- rally acted upon, with immense discharge of dark, black-looking bile, much to the relief of the patient. After this, the re- maining pills may be given, two every night, and castor-oil in the morning, if required ; five, ten, or fifteen-drop doses of laudanum, or two teaspoonful doses of paregoric being given,if the nervous irritation is unsubdued, or threatens to return. After the nervous irritation has tolerably well subsided, the next object must be to restore the tone of the stomach. Eight-gx-ain doses of the carbon- ates of soda or potassa, combined with a bit- ter tonic, as columbo, gentian, or chamomile, may be given for this purpose, every eight hours ; or quinine or bark, in some form, will be found useful. The India bitter beer, with ten drops of potassa solution, may be very serviceable. During the whole treat- ment, it will be necessary to allow the un- fortunate subject of the disease a certain regulated portion of alcoholic stimulant, such as brandy and water, in some degree pro- portioned to the previous habits ; and as soon as the stomach will bear it, the nourish- ment of strong meat-broths, yelk of raw egg beat up with a little brandy, or gruel, or arrow root, with brandy, should be given. If the tongue is very red at the tip, and if the pit of the stomach is very tender, milk, with or without the addition of a little brandy, should be substituted for the above ; fifteen drops of the solution of potash, or one or two tablespoonfuls of fluid mag- nesia or of lime-water, may be added to the milk with advantage. In cases of persistent sickness, effervescing draughts, and ice given in small fragments, frequently repeated, are often useful. The reception of nourishment by the system is of the highest importance in this disease : so much, indeed, is this the case, that as long as a man continues to take food freely, he is not likely to become the subject of delirium tremens. The necessity DEL 182 DEL for the continuance, in reduced quantity, during the treatment, of the stimulant which has produced the disease, is evidenced by the fact, that many cases of delirium tre- mens are precipitated at least by the sudden withdrawal of the accustomed excitement, and relieved by its renewal ; and for the same reason the radical removal of this fearful disease, or indeed of intemperance generally, though it can only be effected by the abandonment of the pernicious habit, must, in many cases, be conducted with ex- treme caution ; otherwise dangerous or fatal consequence may result. Undoubtedly, men of naturally good nervous power, whose stomachs still retain some of their pristine tone, and can receive and digest food in tolerable quantity, and where the constitu- tion has not been thoroughly sapped by in- temperance, may, and do with impunity and benefit abandon at once their habits of drinking, and when this can be done, it is the safest and most certain plan ; but many cannot do this without risk, and must go more cautiously to work. Where spirits have been consumed, let them be exchanged for wine or malt liquor, in reduced and re- ducing quantities. At the same time, with all who are endeavouring to break through the evil habits of intemperance, some inno- cent and rational excitement ought to be substituted for the pernicious one. Excite- ment of mind or body of some kind must take the place of that which has been abandoned, if the full benefit of the change is to be derived. Many methods have been devised for gra- dually weaning the intemperate from the craved excitement. Perhaps one of the most feasible is that of commencing with a cer- tain quantity of the accustomed stimulant, taking from it a measured proportion only, every day, and for every measure with- drawn substituting an equal quantity of water. The plan is a good one; but no plan will succeed without the firmest deter- mination of the drinker to conquer the vice which is dragging him to ruin in this world and the next. If he will make this resolve, and pray to Him who alone can strengthen and uphold man's feeble will, then may he hope to overcome. Again it is repeated, the intemperate man, whose constitutional powers will enable him at once and without compromise to cast aside the vice, has the easiest task: but no man should do so ex- cept by medical sanction, and the further advanced in life, and the more confirmed the habits of the abstainer, the more neces- sary does the precaution become. But in any case in which a person who has been in the habit of taking alcoholic stimuli, abandons the custom, he should be under medical surveillance for a considerable time after ; otherwise formidable depression of some or all of the vital functions may be the result. The question of restraint in cases of deli- rium tremens is one of much importance ; at times it becomes absolutely necessary to exercise it, for the preservation both of the patient and of those around. When the necessity does arise, it must be put in force with as much gentleness as may be compatible with firm command. The indi- vidual suffering should be kept in a bed where there is room for persons to be on each side, and all efforts at violence should be restrained by perfectly adequate physical power in the attendants. It is not necessary to keep the hands constantly upon the pa- tient; if he knows — and he is generally conscious enough for this — and feels that he is mastered, he will remain quiet ; but if by the temporary absence of an attendant, he thinks he can overpower the others, he again becomes unruly. This conscious- ness of hopeless effort on the part of the patient is in many cases the most powerful means of restraint. A strong webbing band, made to cross over the bed about the middle, and to buckle at one side, is often extremely useful in checking sudden violence, while it ought to be sufficiently loose to prevent any feeling of restraint, such as the straight waistcoat gives rise to, thereby irritating the patient to a great degree, and inciting him to ceaseless and exhausting efforts to get free ; the latter should never be used except under great necessity. The question of per- manent restraint, where repeated attacks of delirium tremens occur, and where the patient is continually in a condition verging upon insanity, is a very puzzling one, in consequence of there being no asylum adapted for such cases. The person when at liberty will drink, and when he drinks he is mad ; but when sober, or nearly so, his mind is not sufficiently affected to class him with the insane. The difficulty of dealing with such cases is often extreme, both to the family of the patient and to the medical attendant. There may, it is true, be procured a keeper or guardian, but comparatively few can incur this expense, and it is but an insufficient safeguard after all. The consequence is, that numbers of such patients are kept at home, they cannot be prevented indulging their irresistible propensity to intoxication, and so, for a longer or shorter time, they are a source of danger and of terror to their DEL 183 DER, family, and to every one around, and run hourly risk of terminating their own mise- rable existence by a more speedy description of suicide than the one they are following. It is much to be regretted that no proper provision is made in this country for the reception of such cases, which cannot pro- perly be handed over to a lunatic asylum ; for no sooner is the stimulant withheld, or regulated, than they become restored to sufficient intelligence, at least, to make them unfit inmates of the place. Refer to Alcohol — Intemperance, §c. DELIVERY.— See Childbed. DEMULCENTS.— This name, as used in medicine, is applied to remedies which ex- ercise a soothing influence, more especially upon the mucous membranes and upon the skin, when these are from any cause in a state of irritation. The demulcent may be applied either . directly to the irritated and irritable surface, as in the case of the stomach and bowels, or indirectly, as in the case of irritation of the urinary passages, and of the bronchi or air-tubes. The principal demulcents are — Almonds (sweet.) Arrow-root. Carrageen moss. Eggs, in the form of emulsion. Gelatine and isinglass. Gum Arabic. Grains, and their preparations : barley- water, gruel, &c. Lard. Linseed. Liquorice. Marsh-mallow. Oils. , Sago. Salep. Spermaceti. Tragacanth gum. Wax. It cannot be said that any of the above substances act as medicines in the proper sense of the word ; nevertheless, they con- stitute a class of remedies peculiarly valu- able for domestic use. They are perfectly safe, and certainly most beneficial ; at the same time, it is a necessary caution that the prolonged use of demulcent remedies is liable in some persons to occasion a relaxed and debilitated condition of the system. For further information respecting the indi- viduals of the class, the reader is referred to the separate articles. DENTIFRICE.— See Teeth. DENTITION.— See Teeth. DEOBSTRUENTS— Are medicines which have, or are supposed to have, the power of removing unnatural thickenings or forma- tions from any portions of the body. Such medicines were formerly much more used and depended upon, particularly as external applications, than they are now. That is, there were many substances employed for a sort of mysterious deobstruent action, which probably possessed no such action at all. Mercury, iodine, codliver-oil, and friction are, however, deobstruents to be trusted, and are much employed as such in the pre- sent day. DEPILATORY— Is an application which removes the hair from the skin. Pitch ap- plied to the surface to be denuded, and then forcibly pulled off, so as to bring the hairs with it, was formerly used for this purpose, but has, deservedly, with other barbarous customs of another age, fallen into disuse. Preparations of quicklime and of arsenic have also been used for the same purpose. In the few cases, such as some kinds of skin disease, in whi«h it may be thought neces- sary to detach the hairs by the roots, they often come out easily, and the process is better effected by means of tweezers than by the wholesale, painful, and it may be dangerous, though perhaps- quicker methods above mentioned. DERBYSHIRE NECK.— See Broncho- CELE. DERIVATIVE.— The term, as used in medicine, signifies whatever tends to with- draw diseased action from any part of the body, by means of action — not necessarily diseased — set up in some other part. Thus, bleeding from the lungs may be stopped by the derivative action exerted by the flow of blood from a vein opened in the arm, or inflammation affecting the eyes may be re- lieved by a blister, or seton, at the back of the neck. Derivatives may be either natural or arti- ficial. The principal natural derivatives are either the discharge of blood or the increase of natural secretions ; thus, bleed- ing from the nose may act derivatively, as regards the brain, or the bleeding from piles as regards the liver, or parts within the abdomen; or an attack of diarrhoea may also act in the same way. Boils, cutaneous eruptions, ulcers, &c. also act as derivatives, but in many cases approach the class of coun- ter-irritants. The great principle involved in the existence of natural derivatives is, that they must be the effect of some cause, and, in many cases, of some internal disorder, which has thus formed for itself a safety- valve, through less important channels, for the protection of more important organs. Much caution is requisite in stopping, or DES 184 DI A permitting to be stopped, incautiously and blindly, what is to be regarded as a natural derivative. The symptom itself should be regarded only as the outward sign of some- thing which requires rectification within, and the efforts should be directed to the discovery of this inward acting cause, and to its removal when discovered ; this being done, the external symptom will possibly dis- appear. But even should it not do so quickly, in consequence of having established an habitual local tendency, it may be much more safely attended to as a local disease, after the constitution has been relieved. Not only, however, must the constitution be relieved at the time, but if the natural derivative is done away with, it must be kept, if possible, free from the primary dis- order ; otherwise, should this recur, and should the constitution fail to re-establish the natural derivation in time, serious or fatal consequences may be the result. It not unfrequently happens that, some months after an old ulcer has been healed, or cutaneous eruption removed, that the indi- vidual is seized with some dangerous inter- nal malady, perhaps apoplexy, which might have been prevented, if, after the natural drain had been closed, strict attention had been paid to the regulation of the general health. This is a cogent reason why persons in whom some natural derivative action, such as any of those named above, has stopped, or been stopped, should pay the greatest attention to diet generally, to the regulation of the bowels, to the functions of the skin by cleanliness, of the lungs by fresh pure air, and of the system generally by exercise, and why, on the slightest symp- toms of indisposition, they should subject themselves to medical treatment. A still more cogent reason is it why such persons should beware of tampering with themselves with quack ointments, lotions, andoutward ap- pliances, which, if they do cure sores, as they profess, without constitutional treatment, must do mischief, for they would merely obliterate the outward symptom of disease, and send the latter to attack perhaps some vital organ. Artificial derivatives, such as blood-let- ting, blisters, &c. may be referred to under their proper heads. DESQUAMATION— Is the separation, in scales or flakes, of the outward or scarf- skin. Strictly speaking, desquamation is constantly going on on the surface of the body, and scales or scurf are constantly being separated in small and almost insen- sible quantity ; but after some inflammatory diseases, particularly those of an eruptive character, such as scarlet fever, measles, &c. a much more copious desquamation takes place, and the scarf-skin separates in large pieces. The same thing occurs after irri- tants, such as mustard-plasters, blisters, &c. have been applied to the skin. Desquama- tion, whether natural or the consequence of disease, is always facilitated by the use of the tepid or warm bath. Refer to Skin. DIABETES— Is a disease in which the urine is discharged in unusually large, often in enormous quantity, and for the most part contains a large amount of saccharine mat- ter. The serious nature of the affection renders it one of those which should be trusted for treatment only to medical hands. The same reason renders it important that its first symptoms should be known, that they may not be neglected. It may creep on a person insidiously, or be suddenly developed. The first and most prominent symptom which usually awakens attention, is the frequent call to pass urine abundantly, at the same time the thirst is extreme and the appetite voracious. As Dr. Watson re- marks, some persons, especially among the lower orders, are apt to think that as they eat and drink so well, there cannot be much the matter, and are thus lulled into security while a fatal disease is undermining their constitution. In addition to the symptoms already mentioned, the mouth is dry, and the tongue clammy and sticky, often very red ; there is flatulence and indigestion, and the bowels are generally constipated. Emaciation and general debility also occur ; pain and weakness in the loins, and feeble- ness of the limbs. The leading symptom, however, is the discharge of urine, which has been authentically known to exceed forty pints in the twenty-four hours. At the commencement of the disease the urine may still retain the urinous properties of the diluted secretion ; but this passes into the saccharine condition, and sugar, which may be obtained in a crystalline state, is largely discharged. If yeast be added to the urine, it ferments, and alcohol is formed, the sugar partaking more of the character of grape, or fermentable sugar, than of the cane. Diabetes is often accompanied by other diseases, especially by pulmonary con- sumption. A disease of the nature of diabetes can never with propriety be treated domestic- ally, and an individual who may detect in himself the occurrence of the symptoms de- tailed above, should at once seek competent medical assistance. The dietetic treatment of diabetes is probably of more importance DIA 185 DIA than the medicinal ; the chief precaution being the avoidance of whatever — either sugar of any kind, or vegetable starchy matter — is capable of being converted into grape or fermentable sugar. This of course involves the prohibition of bread made from ordinary flour, which contains all the starchy matter of the grain. This priva- tion is always much felt and complained of, and various substitutes have been proposed. The following, by Dr. Percy, is probably the best : — " Take the woody matter of six- teen pounds of potatoes, washed free from starch ; three-quarters of a pound of mutton suet, half a pound of fresh butter, twelve eggs, half an ounce of carbonate of soda, and two ounces of dilute hydrochloric acid. This quantity to be divided into eight cakes, and baked in a quick oven until nicely browned. " It is, as must be obvious, an expensive article, but with many diabetic patients this will not be an object of consideration. It is somewhat improved in taste by being slightly toasted." Bullock's semola, which consists nearly entirely of wheat gluten, would form a nu- tritious substitute for the arrow-root and sago mucilages. Animal diet is principally to be depended upon for nourishment, and some of the green garden vegetables, such as spinach, are permitted. Distilled water, or boiled water, but not toast-water, may be used for drink. Dr* Prout, in some cases, found porter beneficial ; and, in France, claret has been given with advantage. The tepid bath, to induce perspiration, is often of service. As regards medicine, its prescription must be left to the medical man. Persons who suffer from any sus- pected tendency to diabetes cannot attend too strictly to the state of the digestive organs. Wet feet must be particularly avoided, and flannel should be worn next the skin ; while all sources of debility, sexual excesses in particular, must be most strictly eschewed. Refer to Fermentation — Sugar — Urine, §~c. DIACHYLON PLASTER— Is the com- monly used adhesive plaster spread on calico. It was formerly prepared by hand, but, as now executed by machinery, is a beautifully uniform preparation; and, not- withstanding many substitutes, is still the most firmly adhering and most to be de- pended upon of the plasters for retaining the edges of wounds in apposition. People in general have a very false idea of the nature and uses of this and of other plas- ters. They attribute to them some healing power over the wound, whereas their only Q2 use is, by keeping the edges of the wound in perfect apposition, to permit them to heal by the natural power with which the living tissues are endowed. This idea of the heal- ing properties of diachylon, however, often leads to mischief, from inducing persons to apply the plaster to abrasions and sores, which it seriously irritates, causing, with some, much increase of inflammation and troublesome ulceration. The practice is most hurtful, and should never be followed. This idea of the healing powers of diachy- lon has, also, been probably increased by its known use by surgeons in the treat- ment of the healing of ulcers. In this case, when used as a strapping round the leg, and over the sore, the latter quickly gets well, and it would seem under the influence of the diachylon plaster, which, however, in this case, is used only as a convenient mechanical agent, which will closely envelop the limb, and give support to the weakened vessels and infiltrated tis- sues which have encouraged and which surround the sore. The diachylon, it is true, passes over the ulcer, but it is pre- vented exerting any effect upon its surface by the intervening discharge. Sometimes, even when applied to the sound skin, dia- chylon is found too irritating, in which case soap or lead plaster must be substituted. If diachylon plaster is kept folded up in too warm a situation, it adheres together and becomes useless. Refer to Plasters. DIAGNOSIS — Is a term frequently used in medicine, which may be applied either to the "art of discovering the nature of diseases, and of distinguishing them from each other," or to the conclusion arrived at by the exercise of the art. In other words, when a medical man, after investigating a disease, expresses his opinion respecting its nature, it is called his "diagnosis" of the disease. It must be evident to all how much, indeed how every thing depends upon a correct diagnosis of the existing disorder ; for, unless correct- ness on this point be attained, treatment can scarcely be of much service, and if active, may be worse than no treatment at all. It is true that there are certain gene- ral symptoms of disease which may be treated, perhaps with benefit, in a general sort of way, without the medical attendant having any definite idea of the existing de- rangement. Such is the case with most febrile diseases, and many others ; and as the natural powers do much toward the removal of the malady, and promote resto- ration to health, a practitioner may practise in this loose sort of way with apparent sue- DIA 186 DIA cess : he treats prominent symptoms, attends to diet, &c. and his patients get well. But this is not the true practice of medicine : it is very different from the active, well- directed, and energetic measures of the man who, having both the knowledge and the will to truly investigate his case, and having done so, strikes home at once. The man who does not or cannot make a cor- rect diagnosis is working in the dark; and if he uses edged tools, so much the worse for his patients, whose safety must in some measure depend upon the treatment of their cases being conducted upon the same inert plan as their investigation. At the same time, if there be any efficiency in medical treatment at all — and no man who knows his profession and practises it conscien- tiously can doubt it — how much passive evil must result from insufficient and slovenly investigation of disease ; how much must be and is every day overlooked, which ought not to be so ; how often are germs of fatal disease undetected, which ought to be de- tected, until they have ripened into active growth that is not to be repressed ! One or two cases will more forcibly illustrate the difference between a loose and ill-defined treatment of disease, and that which is the result of accurate diagnosis. A child is taken ill, becomes feverish, the breathing quickened, and there is frequent cough, along with other symptoms, indicating in a general way inflammatory affection of the lungs ; and so far, perhaps, the diagnosis is too plain to be overlooked, even by a very cursory examination ; and tartar emetic, mercurials, &c. are remedies so generally useful in such cases, that they will be pre- scribed with probable success, and it may be that the little patient will get well under their use ; — but it may not so happen — the disease evidently does not yield, the fever- ish condition, the quick breathing, and the cough, all show that it is still active. It is evident that abstraction of blood is called for, but the child will not bear it from the arm, and it must be effected by leeches — where ? — of course on the chest. But on what part of the chest ? Here comes the point of diagnosis. The careless or slovenly practitioner will be content with the general indication of the forepart of the chest, un- less, indeed, there is complaint of pain — which may mislead as well as lead — to di- rect his aim elsewhere ; and the chances are that blood is taken away, comparatively little good is effected, and the child, not the disease, is weakened. The error may be a fatal one, which a correct diagnosis would have prevented. It may be that the ante- rior portions of the lungs are free from disease, which is confined to the posterior and lower portion of one or both. If a cor- rect diagnosis has been made, this should be known, the practitioner, by the percus- sion of his fingers and the application of his ear to the chest, will probably be able to lay his hand upon the skin over the seat of disease, and to mark out with confidence the limits within which blood may be abstrac'ted with the greatest certainty of benefit. Again, a patient suffers from indigestion, from weakness, pain in the back, and gene- ral symptoms of bad health ; the spirits are depressed ; a general diagnosis is perhaps made, and the round gone of various tonic remedies, alterative remedies, &c. ; but the urine, if thought of at all, is passed over with a cursory glance : to the unassisted eye it looks all right, and perhaps is pro- claimed so ; but place a drop of it under the invaluable microscope, and it is found laden with crystals of oxalic, or phos- phatic, or some other deposite. The cor- rect method of diagnosis affords at once the key to the main points of the disorder, and probably to its successful treatment, which might have been groped after in vain, or if stumbled upon by accident, and found successful, the success would give but little clue in the next case of the kind which might occur ; or it may be that false ideas of the nature of the disease, a false diagnosis having been formed, the success itself will constitute an abundant source of evil and error, not only to the individual practitioner, but to others. The fact being a false one, leads to false conclusions. The above cases — which might be multiplied to any extent — have been brought forward to show how much success in treatment must depend upon the correctness of the diagnosis which the attendant practitioner forms of the dis- ease of his patient. They have also been brought forward to show that this correct diagnosis can only be attained by time and patient attention and investigation, even by the greatest in science. In many cases, no extent of knowledge will enable a phy- sician to say what portion of a lung is affected, unless his sense of hearing conveys the exact information to his mind in a phy- sical examination. A physician may suspect from symptoms that his patient is suffering from disease which tends to the formation of oxalic gravel, but he cannot positively assure either himself or others that such is the case, unless he actually see with his eye — through the microscope — the peculiar crystal which marks the disease. From what has now been said, it must be evident DI A 187 DI A that the highest attainments in medical knowledge will not compensate for a hurried examination of cases : there must be time. People forget this ; attracted by some great name, and in all probability a really and truly great one, they crowd the reception- rooms, and are passed in quick succession through the consulting-room of the fashion- able practitioner, who cannot give time to the full investigation of the cases which come before him. Few, perhaps, attain the meed of popularity without having well deserved it, or retain it without deserving to retain it by their progressive attainments; but, withal, they are not gifted with intui- tion, and if the public will compel them to see ten cases in the time they ought to take to two or three, the public must suffer ; and they do suffer, for many a case overlooked is unravelled by the patient investigation of some less occupied practitioner. It must not, however, be supposed that it is here insinuated that time and patience alone are sufficient for the proper investigation of disease in the living body : the man of experience, and who to his experience has added accurate oservation, will undoubted- ly seize more quickly than one less inform- ed the most distinctive features of the case before him ; even at a single glance, in some cases, he may form a conclusion — and it may, probably, be a correct one — in his own mind respecting the nature of a case, and this conclusion will lead him at once to use the means of diagnosis best adapted quick- ly and surely to satisfy his mind. But even with all this, with abundant knowledge and ready tact, some time is required in all cases — often much more than is given by some in the full tide of practice. Nothing will compensate for a hasty and imperfect diagnosis, and evils innumerable spring from it. On this head, Dr. Watson, one of the ablest physicians of the day, remarks, "It is mainly to the uncertainty in the diagnos- tic part of medicine that we must attri- bute the uncertainty and variation both of doctrine and practice which have brought so much suspicion and reproach and ridi- cule upon the science we profess." The case of the fashionable London physician has been alluded to, overwhelmed with fees, and with work, which he cannot, in many cases, perfectly fulfil ; but there are others in our profession overwhelmed with work, with the same effect, but unfortunately with- out the fees, and without their patients hav- ing a choice of avoiding the evil. These others are the union surgeons, who are hired at a miserable pittance in many instances to attend an unlimited number of poor. Un- able to maintain an assistant out of their wretched salaries, they cannot, within the bounds of physical possibility, if they are to get through their day's work at all, give time to investigate their cases properly : it needs not to point out how this must con- vert a miserable economy into extravagant and unnecessary expenditure. There is yet, however, another essential — in many cases at least — either to facilitate or enable the formation of an accurate opinion of a case of disease, — and this is, perfect candour on the part of the patient toward the medical man consulted; and not only candour, but thoughtful consideration and communica- tion of every circumstance which is, or may appear to be, connected with the illness. Whether it be hereditary predisposition or personal transgression, nothing should be concealed. Females often permit prudery or mistaken feeling to interfere with their communications with a medical adviser. But one thing can be said upon this matter : if they cannot confide in him on these points, he is unworthy of their confidence at all; but the same resolution which in- duces the consultation, ought at the same time to give this resolve, to leave nothing untold connected with the state of health. So much has been said Avith regard to the necessity for a well-defined diagnosis, that it may lead some to suppose that this can be made out in all cases, which is not possi- ble. Many diseases are, it is true, so dis- tinctively marked, that there is no difficulty in assigning them their true name and cha- racter ; but there are many diseased condi- tions of the human frame, which will not fall under any classification, and which baf- fle the best-directed efforts of our present knowledge for their elucidation. In this case, the diagnosis must be what has been called "empirical;" it is imperfect, because the science of medicine is yet an imperfect one, and if it do not inform us of the real nature of the disease, it must, taken in con- nection with experience, be used as a guide to treatment. These observations are made, that too much may not be expected from medical men by the public, and to show, that because a medical man will not or can- not give a defined diagnosis of a disease, he is not necessarily ignorant of its proper, or, at all events, best-ascertained mode of treatment. Further, when it is reflected how strict an investigation is required at the hands of those whose lives are and have been devoted to the subject, it ought to make unprofessional persons doubly cautious in dealing with disease. To quote from the "prefatory address" to this work, — "When DI A 188 DIA it is remembered how the nicest judgment that observation and experience can form, the most patient attention, aided by prac- tised ear and eye, by microscope and test- tube, are frequently necessary, to enable the conscientious physician to judge of his case before he can apply the remedy, it is evident how great must be the responsi- bility of those who, in rashness or ignorance, venture upon the treatment of serious dis- ease, either in their own persons or in those of others." This is not meant as a discour- agement, but as a caution; for the real ob- ject of a work like the present can only be fulfilled, when the good it oflers is safely and judiciously employed. Lastly, either our physicians, most of them men of Christian character and of high honour, make a parade of their diagnosis of disease, and devote their lives of labour to deceive the public, or are themselves deceived, or quackery and quack medicine must be impudent lies and wicked deceits. The individual who purchases a quack nos- trum can either have no idea of the dis- ease — if he has one — under which he is suf- fering, or only the crude idea — diagnosis — of his own judgment; and upon the faith of this, he prescribes for himself the unknoAvn compound of — to him at least — an un- known individual, on the faith of some lying advertisement. Is the diagnosis of the physician a delusion and a snare, or does the patronizer of the quack remedy exercise the same judgment in the treat- ment of his body that he would in his worldly business ? To our readers we leave the answer. Refer to Advice, Medical — Disease, §c. DIAPHORETICS— Are agents used in the practice of medicine which " determine to the skin" or produce perspiration or sweat- ing. When it is considered how extensive the surface of the skin is, how largely it is supplied with blood, and how abundantly with means for exhaling moisture, (see Skin,) it must be evident how powerful an influence its excitation or depression must exert upon the condition and functions of the body. This influence is so undoubted, and so marked, that in all ages, and in almost all nations, even the most uncivil- ized, the cure by promoting the flow of the sweat has been a common and favourite mode of treatment. Among the tribes of North American Indians it is employed, as described by Mr. Catlin, both as a curative and as a sanitary agent. The most general mode of exciting perspiration, particularly among the more uncivilized portions of mankind, is by means of hot vapour or the vapour-bath ; but they also employ abun- dantly decoctions of various herbs as as- sistants to the process. The effect which the constant insensible perspiration from the body exerts in dimi- nishing its temperature must, of course, be augmented as the excretion and evapora- tion of fluid from the surface is increased, furnishing an active agent for lowering the temperature of the body in states of fever. Every one knows how much and distress- ingly the dry heat of the skin is felt, and how grateful the sensation of moisture upon the surface. In addition to the reduction of temperature, however, the action of dia- phoretics must tend powerfully to relieve congestion or collection of blood, or in- flammatory action in internal organs; and, indeed, the fact is every day manifest in the treatment of disease, not as regards general perspiration only, but also as a consequence of the effect of local agents — such as the bran-poultice so often mentioned in this work — which produce sweating of the part to which they are applied. The most useful diaphoretics for domestic pur- poses are — Ammonia — In the form of carbonate, when stimulation is required at the same time, and in the form of acetate or "spirit of mindererus," which is one of our most cer- tain diaphoretics. Antimony — In the form of the tartrate of antimony, in small doses, when fever is excessive, and the true James's powder, which is the safest form for children. Baths — Tepid, warm, or vapour, or used as in hydropathic establishments, by means of the wet sheet and blankets. Ipecacuanha — In any of its combinations. Opium — Particularly in its combination with ipecacuanha, named Dover's powder. To the above may be added sweet spirit of nitre, gin, and diluent drinks of all kinds, sometimes cold, but generally warm, and exercise. There are many other agents employed in medicine as diaphoretics, but they are not likely to be used domestically, unless, indeed, we except the dulcamara, or bitter-sweet, also called woody night-shade, which, being a common native plant, might be used in the absence of other remedies of the class. — See Dulcamara. For infor- mation respecting the other diaphoretics mentioned, the reader is referred to their respective articles. When perspiration is thought to be desir- able, it is immaterial What agent is selected to produce it ; thus, if there is very hot, dry skin, and quick, hard pulse, antimony will generally be most useful ; if there is DI A 189 DI A depression, spirit of mindererus, sweet spirit of nitre, or carbonate of ammonia will be most suitable ; and with any of these ipeca- cuanha or opium may be combined. To form one of the most useful and certain siveat- ing draughts, take of spirit of mindererus half an ounce, of antimonial or ipecacuanha- wine fifteen to thirty drops, and water four tablespoonfuls, adding or not, as circum- stances dictate, ten drops of laudanum or a teaspoonful of paregoric. As there is always a degree of uncer- tainty, especially in some constitutions, as to the action of diaphoretic medicines, when they are taken every means should be used to assist and promote the desired effect. Confinement to bed is absolutely necessary, and before retiring there it is always well to put the feet in hot water for twenty minutes. The diaphoretic medicine should be used on getting into bed, and nothing- more for three-quarters of an hour, when the warm diluent drinks are to be com- menced with, and may after that be taken very freely, and continued as long as the sweating process is kept up. If the warm diluent drinks are taken too soon after the medicine, sickness will probably ensue, and so the object in view be defeated. Purga- tive medicine, which is likely to act during the operation of a diaphoretic, should be avoided, for the disturbance occasioned thereby will not only effectually counteract the desired process, but may, by checking it, aggravate the disease it was intended to benefit. Some persons promote the action of sweating by cold instead of warm drinks. In cases of much febrile heat and excite- ment they may be useful ; but, as a general rule, it is the safer plan to keep to the warm fluid. When sweating is produced, the person should always have flannel next the skin, never linen; and of course there must be sufficient covering to maintain the requi- site temperature. If the person is labouring under infectious disease, .additional care is, of course, requisite in the after disposal and purification of the woollen clothing. When it is thought desirable to check the sweat- ing process, every source of chill must be avoided, the skin is to be dried with warm towels, and fresh clothing, previously slight- ly warmed, put on, the coverings lightened, and the hands and arms gradually exposed. There is sometimes great difficulty in pro- ducing perspiration in certain constitutions. When such is the case, the medicines should be given, and other means resorted to, to- ward four o'clock in the morning, that is, just previous to the time in the four-and- twenty hours, when the body, either in health or disease, appears most liable to perspiration. Refer to Skin. DIAPHRAGM, or Midriff— Is the partly muscular and partly tendinous and mem- braneous partition, which extends between the chest and the abdomen, (fig. lii.,) sepa- Fig. lii. rating the heart and lungs on one side from the liver and stomach on the other. The diaphragm assists materially in theprocessof respiration, descending and pressing down- ward upon the contents of the abdominal cavity each time a breath is drawn. This is more particularly seen in some cases of chest-disease, when the respiration becomes almost entirely dependent upon this action of the diaphragm. From this it must be evident to all how important it is that this muscle should have free play, and how much its essential movements must be impeded by any thing, such as tight lacing, which presses the contents of the abdomen up- ward. Refer to Lungs — Respiration, §c. DIARRHCEA— Consists in frequent and urgent calls to relieve the bowels, the evacuations being for the most part more liquid than usual. The causes of diarrhoea are very numerous, but may, perhaps, be classed under three heads — nervous causes, causes which act upon the surface of the body, and irritating causes which act di- rectly upon the bowels themselves. Per- haps the simplest form of diarrhoea is that arising from nervous causes, such as some experience on the approach of thunder, or from electrical disturbance generally, or DI A 190 DIA sucli as arises from emotions of the mind, [ as, for example, fear. In these cases the j bowels would appear to be simply "relax- ; ed," the evacuations being healthy, with ex- ' ception of being thinner, from their more rapid passage through the bowels. The simple salutary diarrhoea in teething chil- dren is an example of the same kind. Influences affecting the surface of the body, particularly cold, and especially cold feet, often produce diarrhoea. Cold nights succeeding hot days are often said to occa- sion the disease ; but it is also remarkable, that diarrhoea is apt to occur at the breaking up of a long frost — indeed to be epidemic, that is, of general prevalence. By far the most frequent cause of diar- rhoea, however, is irritation in the bowels themselves, caused either by undigested or indigestible food, by acid, by acrid, morbid bile, or by the deficiency of that fluid per- mitting the digested food to become unduly changed. It may also be caused by an ac- cumulation of hardened feculent masses, or, as they are called in medical language, "scybalse;" or by the lodgment of such matters as the skins of old peas or beans, or of raisins, in the folds of the large bowel : the above are frequent causes of teasing diarrhoea in children. Lastly, diarrhoea may be dependent upon disease of the bowels themselves, such as affection of their minute glands, when it constitutes dysentery, or ulceration of the glands and of the lining membrane, such as occurs in fever and consumption. It must be remembered, however, that to some persons an habitually relaxed condition of the bowels is natural, and at the same time essential for health, and that to check it is dangerous. It is evident, that in a disease depending upon so many and various causes, a due discrimination of these is requisite for proper treatment. It must not, either, be lost sight of, that diarrhoea is in many cases salutary, an effort of nature to free the con- stitution from some morbid matter which, if retained, would produce disorder or dis- ease. On this account, the simpler forms of diarrhoea are better left to right them- selves, so long as they keep within moderate bounds. This caution is particularly to be observed with regard to that which occurs in the teething of children, which, when moderate, is a safeguard ; but when it becomes so fre- quent that the child is evidently weakened by it, and especially if the evacuatious ap- pear to be losing their feculent character and become like shreds of skin, or streaked with blood — in such cases, a warm bath for six or eight minutes, of the temperature 92°, should be used for two or three evenings in succession ; isinglass or gelatine given in the milk-food, and the castor-oil emulsion with yelk of egg (see Castor-Oil) given three or four times a day, each dose con- taining from a quarter to half a drop of laudanum. Of course medical assistance being procured if the complaint is not quickly moderated, for checked entirely it should not be. In diarrhoea resulting from exposure to cold, the best plan of treatment is to mode- rately re-excite the skin according to the system recommended in the article "Dia- phoretics," and also, if requisite, to adminis- ter the remedies prescribed for continued diarrhoea generally. When diarrhoea is caused by irritating matters in the bowels, one thing is evident — ■ it cannot be properly relieved unless the bowels are freed from the irritant matters. It may, it is true, be stopped under these cir- cumstances, but it will recur, unless indeed the irritating substance has been removed by the purging, previous to the use of the astrin- gent medicine, and the continuance of the diarrhoea is merely the consequence of the previous irritation. In many cases in which the diarrhoea is owing to irritant matters in the bowels, particularly to acrid bile, all that is requisite is to diminish the acridity by means of demulcent drinks largely used, to which, if there is acid in the stomach, a little carbonate of soda is to be added. In other cases, when the action of the bowels is constant, painful, and exhausting, it is absolutely necessary to check these symptoms in the first place, and to soothe the bowels, before means are resorted to for freeing them from the irritant cause. For the former purpose, the common chalk-mix- ture, in three tablespoonful doses, with the addition of five drops of laudanum to each, may be given at short intervals till the dis- ease is checked ; or the compound chalk- powder — dose thirty to sixty grains — and the same powder, with opium — dose five to twenty grains — are both useful. Or aromatic confection may be given in half- drachm doses in water, with or without laudanum. If the active diarrhoea does not, from its comparative mildness, require these remedies at first, or when it is sufficiently moderated, the bowels should be thoroughly cleared out with a tablespoonful dose of castor-oil, to which ten drops of laudanum have been added ; this will probably clear away the irritating matters, if they consist of indigestible substances, hard feculent matter, or the like. When castor-oil cannot be, or is not taken, the best substitute is DI A 191 DIG twenty grains of rhubarb and fifteen of cal- cined magnesia, with some aromatic, such as half a teaspoonful of sal-volatile, or a teaspoonful of tincture of rhubarb, and, if there is much pain, five to ten drops of lau- danum, the dose being repeated, if requisite. After the action of the opening medicine, one or two doses of astringent may again be required, as the bowels are apt to keep up acting simply from irritability. Medical men sometimes give more active purgatives to clear away irritant matter ; but the prac- tice is not safe in the hands of the non-pro- fessional. When diarrhoea has been permitted to pass into the stage of irritation, when there is tendency to fever, the belly tender, the tongue red, and the motions resemble shreds of skin, or pieces of jelly, and are mixed with blood, the case is of that serious nature that medical assistance should at once be obtained, if it has not been so before. In the mean time, the emulsion of castor-oil with yelk of egg will be found the safest and most effectual medicine ; two tablespoonfuls, with five drops of laudanum, being given every four hours, and starch and laudanum clysters, the diet being as unirritating as possible, and containing abundance of gela- tine. A most excellent drink in these cases is rice-water, in each pint of which from a quar- ter to a whole ounce of gelatine or isinglass is dissolved, with a piece of toasted bread in- troduced to flavour it, or a little cinnamon. In the more severe forms of diarrhoea, such as that connected with consumption or fever, or when fever is present, medical attendance should alone be trusted to, but when unattainable, the disorder must be treated according to such of the methods above detailed as may appear most suitable. In all probability the soothing and astringent plan, such as chalk with opium, will answer best. The author has found Bismuth of much service in some of these cases. Creasote has been recommended in cases of intract- able diarrhoea. In case of much tenderness of the bowels, a few leeches might be used, but pain generally should be treated with the hot bran-poultice. The use of diluted sulphuric acid in frequently repeated doses has lately been highly recommended in the treatment of diarrhoea. Diarrhoea may occur as a chronic, or long- continued affection, lasting for months or years ; but these cases depend on such a variety of causes and influences, and require so much care in treatment, that they can only be advantageously managed by a medical adviser, and ought as soon as possible to be put under the care of one. In these and j in all cases of bowel complaint, diet exerts | great influence ; generally speaking, the ! preparations of milk and of the grains are most suitable, such as arrow-root, sago, tapioca, rice, &c. When broth is given, it should be in small quantity and of to- lerable strength ; it is improved by the addi- tion of gelatine and of well-boiled rice. Alum whey is sometimes found useful in these cases. Refer to Alimentary Canal — Bile, and Bilia- ry Disorder — Digestion, Qc. §c. DIASTASE— According to Liebig, is a portion of vegetable gluten in a state of de- composition, which possesses the power of converting starch into grape-sugar, in fact, of acting as a sort of yeast or ferment. DIATHESIS — Is a term used in medicine to indicate states of constitution peculiarly predisposed to certain diseases, such as scrofula, cancer, gout, &c. Peculiar dia- thesis is for the most part hereditary. DIASTOLE— Is the dilating action of the heart, or that by which its cavities are opened to attract and receive a portion of the current of blood, after a previous por- tion has been expelled by the systole or con- tracting action of the organ. Refer to Circulation — Heart. DIET.— See Food. DIGESTER, or Papin's Digester— Is a strong iron pot, the lid of which is fastened or screwed down, so as to be steam-tight, and is provided with a valve. By these ar- rangements, when the digester is placed near to or over the fire in cooking, the steam is confined, and by its pressure prevents the contents from boiling at the ordinary boil- ing temperature of 212° ; consequently it is possible to raise the temperature above this point, or that at which the amount of heat carried off by the evaporated steam balances that received by the fluid. This power of elevating temperature confers of course upon the water which must be used in the vessel increased power of acting upon bones, or any other substances immersed in it. The use of the digester, either in an economical or dietetic point of view, is to be strongly recommended. The valve, of course, pre- vents all danger from bursting. The price is moderate. Bones which have been well acted upon in a digester have their animal matter so thoroughly exhausted that when taken out they fall in pieces, little being left except the earthy constituents. The amount of animal nourishment in the form of gelatine thus extracted from bones is very consider- able, quite sufficiently so to make it an object to the poor in their own homes, and, in the houses of the rich, as the foundation of soup for distribution. Refer to Heat — Gelatine, §c. DIG 192 DIG DIGESTION*— Is the process by which food is fitted for the nourishment of the animal body. The whole process may be divided into— The mastication or chewing of the food, and its mingling with the saliva or spittle. The swallowing of the food. The digestion of the food in the stomach, by means of the gastric juice. The mixture of the food with the bile and juice from the pancreas, and its conveyance through the small intestines. The passage of the remains of the food into and through the large intestine or colon, during which it becomes acid and mixed with the feculent excretions from glands of that bowel. The discharge of the remnants of the food from the body along with other exGrementi- tious matters. To the above may be added the passage of the digested and nutritious part of the food into the blood. The first process of digestion, the masti- cation or breaking down of the food by the teeth, and its mixture with the saliva, is one of extreme importance [but often entirely overlooked by many in the United States]. The teeth of man are evidently adapted for the two processes of cutting and bruising; the front, or " incisor teeth," being construc- ted for the former purpose, the back, or molar, for the latter. These adaptations are well seconded by the action of the powerful mus- cles of the lower jaw, which give it a direct cutting, and a side to side or grinding motion. The morsel of food submitted to this mecha- nical action being at the same time kept ad- mirably under it by means of the extraordi- nary mobility and sensibility of the tongue, it is thoroughly moistened by the saliva or spittle, which is poured out abundantly from the " salivary glands," which lie imbedded around the mouth and jaws ; the same me- chanical action which grinds the food serv- ing also to press out the secreted saliva. This fluid, however, does not act simply as a moistener of the food ; it exerts a distinct chemical or digestive power upon its starchy components, acting in the same manner as the "diastase" mentioned a few articles back, and converting them into sugar, in which state they become fitted for absorption into the blood — a -capability which starch does not possess. It has also been imagined that air becomes mixed with the food during mastication, and that its presence in the stomach was in some degree connected with the process of digestion ; this, however, is * In connection with this article, the reader is re- quested to refer to that under " Alimentary Canal." doubtful. "When the food-morsel has been masticated, and moistened sufficiently — at least such ought to be the case — it is col- lected by the action of the tongue into a ball, and conveyed to the back of the throat or fauces, where it is consigned to the care of involuntary muscles, and passes for the most part from under man's direct control. Passing from the throat into the gullet, it is carried by the wave-like action of that tube into the stomach. This action is not, as some might imagine, a simply mechanical one, that is, the food does not drop into the stomach as it would into a bag, by means of its own weight, but it is carried thither by the muscular movements of the oesophagus, or gullet, by the same power that water is conveyed upward through the gullet of the horse or cow when drinking, or indeed in our- selves, as any one can testify who has drunk from a spring by stooping down to the water, f The entire process of swallowing, particularly that part of it by which the top of the windpipe is protected during the pas- sage of the food over it, is a series of beau- tifully connected actions. When the food has been passed down the gullet, and has reached the stomach, it lodges in its left or larger extremity. As soon as the lining membrane of the organ feels the contact of nutriment, it becomes reddened, there is evidently increased flow of blood to it, and quickly its peculiar se- cretion, the "gastric juice," or solvent fluid of the stomach, begins to be poured out. This fluid is "clear, transparent, and viscid, without smell, slightly saltish, and very perceptibly acid," its characteristic power being that of dissolving the chief components of the food, and reducing the varied ingredients of a common meal to one homogeneous, gray-looking, pulpy, acid mass, which is called the "chyme." This uniform mass, when formed, varies but slightly in perceptible character; when the food has been farinaceous, it is like gruel, but when much oily or fat nutriment is mixed with it, it has more of a creamy appearance. The solution of the food, and its forma- tion into chyme by the powers of the gas- tric juice, is much assisted by the muscular movements (alternate contractions and re- laxations) of the stomach, which turn the mass over and over, and thoroughly incor- porate it with the solvent fluid. When the chyme is fully formed, it is probable that the gelatine components of the food have f One of the African barbarian despots has been said to administer drink to his subjects — as an honour con ferred— while they were placed head downward. DIG 193 DIG been dissolved, and what are called its albu- minous components, such as the curd of milk, or cheese, or the muscular flesh of meat, or the gluten of grain, have for the most part been reduced to the condition of a soluble albumen, fitted for absorption into the system. The action of the acid gastric juice, however, puts a stop to the conver- sion of the starchy ingredients of the food into sugar by the saliva. But this is re- sumed in the small intestines, when the acid- ity of the chyme has been neutralized by the alkalinity of the bile and juice of the pancreas or sweetbread, with which it be- comes mingled, immediately after it passes or is passed through the opening at the right^ or smaller extremity of the stomach into the duodenum, or first portion of the small intestines. This passage of the chyme from the stomach into the intestines is ef- fected as each successive portion is perfectly formed, that is, has become of semi-fluid, perfectly smooth consistence ; for in a healthy condition of the digestive organs, should a portion of solid food attempt to pass the muscular valve at the "pylorus," or place of exit, it is immediately closed against it, and the morsel passed back into the stomach. As already mentioned, the chyme has no sooner passed from the sto- mach into the small intestines than it be- comes mingled with the bile, which is con- tinually distilling into them from the liver, and with the juice from the pancreas or sweetbread. The effect of this admixture is to neutralize the acidity of the chyme. The action of the saliva in converting the starchy matters into sugar is now re- sumed, and is probably assisted by the fluid from the pancreas, and the oily prin- ciples of the food are converted into a milky-looking emulsion, in which state they are fit for absorption into the system. The digested and altered food mass is now passed slowly through the small intestines by their muscular, " vermicular," or wave-like move- ments. During this passage, the nutrient portions are absorbed, partly by the blood- vessels, and partly (more particularly the oily emulsion portion) by the lacteal absorb- ent vessels, until the now almost exhausted food, reaching the valve-like opening into the large bowel, or colon, is discharged into it. Here the food mass again becomes acid, and this change is supposed by some, and not improbably so, to be of the nature of a second digestion, to insure the perfect solution of any, matters which may have escaped the first acid digestion in the sto- mach. A more striking change, however, is effected, for here the contents of the R bowels assume their natural faecal or excre- mentitious character, and acquire their cha- racteristic odour from being mingled with used-up matters thrown out or excreted from the system at large, from the small glands with which the lining membrane of the large bowel is studded. , The absorption of the nutrient matters from the chyme requires a little explanation. The process is now considered to be largely shared in by the blood-vessels, but much of it is doubtless effected by the lacteal vessels, which, in- deed, were at one time considered to be the sole agents for the purpose. These little vessels (fig. liii. 1) are abundantly distri- buted over the small intestines, (fig. liii. 3.) Fig. liii. The lining membrane of this portion of the alimentary canal is thrown into folds for the purpose of increasing the surface for ab- sorption, and this lining membrane has a velvety appearance, from innumerable small elevated points, or " villi," which cover it — each of these villi contains a small lacteal vessel. These vessels were formerly thought to absorb the nutrient portion of the food or "chyle" by means of open mouths, but it is now ascertained that the absorption is effected in the first place by minute cells, which burst when full, and deliver up their contents to the lacteal twigs in contact with them. By the lacteals, the "chyle," or milky-looking fluid absorbed from the intes- tines, is conveyed through a set of small glands, (the mesenteric, fig. liii. 2,) after passing through which, the chyle, this ex- tract from dead food, seems (if we may so speak) to become in some degree vitalized ; it acquires power of coagulating, and as- sumes a red tinge when exposed to the air. The chyle from the various smaller lacteal vessels is now collected in the larger trunks, which coalesce at one point, and form one main vessel, the "Thoracic duct," (fig. liv. 1,) which runs up and lies close upon the spine, Dia 194 DIG Fig. liv. till, arriving at the neck (2), it turns down and opens to discharge its contents into the general current of the circulation at the junction of the large veins of the head and neck (3, 3) with that from the arm. Such is the marvellous process by which man's material body is daily nourished, and its strength preserved and renewed ; such, at least, is the healthy process, as it ought to be. The most generally prevalent causes of its disorder, and they are very general and very prevalent, it remains now to point out. Of course the nature of the food must exert great influence, for good or evil, over digestion ; but as that will be fully discuss- ed under the article Food, it need not be entered into here. One of the most frequent causes of dis- order of the digestive function is insufficient mastication, either from want of teeth, from a habit of hurried eating, or from careless- ness : many persons but half, or indeed scarcely at all, chew their food, which is swallowed in lumps, and, of course, not being broken down, is unmixed with the due proportion of saliva. Fortunately, the solvent powers of the gastric juice are suffi- ciently active to compensate, in the course of time, for the imperfect performance of the first of the digestive operations. But it must be evident to all how much longer and more laborious the process must be of dissolving a solid lump of meat or potato, than of one well broken up and opened up to the operations of the gastric juice. It must also be evident, that in the case of farinaceous and vegetable food, insufficient admixture of saliva must occasion insuffi- cient digestion, or conversion of the starchy matter into sugar, and that, therefore, a portion of the food consumed may become useless. Another evil resulting from imperfect mastication is the rapidity with which food is introduced into the stomach, so that, pro- bably, the organ is overloaded before the natural sensation of appeased hunger can make itself felt. Many persons, again, hurry over their meals with minds intently engaged on some- thing else ; the food is swallowed as quickly as possible, and the scarcely interrupted mental effort or business anxiety is re- sumed, or, it may be, active exertion at once engaged in. Now, it is a law of the animal economy, that all the functions of the living body, and those which are only periodically called into exercise more than others, require, for their perfect perform- ance, some additional access of nervous power, and some increase in their usual supply of blood, while the peculiar function is in active operation. With the stomach this is peculiarly the case ; the disinclina- tion for exertion and the slight sensation of cold which generally follow a full meal, are the results of the call made upon the nervous energies, and upon the circulating blood, by the stomach during the first stages of digestion. These sensations are more felt if the individual remains quiet after a meal; less so, or not at all, if active exertion, either of mind or body, is at once engaged in ; and the reason for this is evident. In the first instance, the person who remains quiet permits the nervous power and the blood to be, as they ought, directed to the performance of the digestive function, and, consequently, their supply to the other por- tions of the body being diminished, inca- pacity for exertion, both of mind and body, is experienced. If, however, before the nervous and circulating energies have be- come fully directed toward the stomach, (or, indeed, if, after they have, exertion is made by a strong effort of the will,) they are attracted by a still stronger power, either of muscular movement or mental exercise, the inclination for rest is not experienced ; but this disinclination is attained at the expense of the stomach and of its digesti«ve powers, the food being more slowly, and perhaps imperfectly, digested. It is true that many DIG 195 DIG persons go on for a great length of time, without apparent bad results, violating the laws of their own constitution, snatching hurried meals, and running off to business, or study, or exertion, immediately after ; but the practice tells, in the course of time, and the extreme prevalence of disorder of the digestive organs, amid the commercial and professional classes in this country, is evidence sufficient of the hurtful tendency of such practices. There is, of course, much variation in the injury which the diges- tive powers sustain, for some have these naturally much more active than others, and can with much more impunity impose upon them ; but, as a general rule, moderate rest, both of body and mind, is requisite for a short period after a full meal has been taken, to insure the perfection and the con- tinued healthy operation of the digestive powers. If exertion is requisite, the meal should be made a light one, and the full supply of food delayed till rest can be taken. Somewhat similar consequences and enfeeblement of the function of digestion are apt to occur if an individual makes a hearty meal when in a state of fatigue or exhaustion from exertion previous to the taking food, even though quiet is observed after it ; the nerv- ous power being exhausted, cannot be suf- ficiently supplied to the stomach to support its efficient action. Another frequent cause of disordered di- gestion is excess of food, either at once or by its too frequent repetition. It would seem that the healthy digestive power and secretion of the gastric juice is dependent in some degree upon the requirements of the system; and, as the gastric juice can only dissolve a certain proportionate quan- tity of aliment, if more is taken than there is gastric juice to act upon it, it must be imperfectly or not all digested, and if it is not, it becomes subject to the same chemical laws as if exposed to heat and moisture out of the living body. Fermentation, and, it may be, putrefaction, take place ; gas — "wind" — is generated, acids are formed, both in the aliment itself, and thrown out, probably by the efforts of the irritated sto- mach, and heartburn, pain, and the many other uneasy sensations connected with indi- gestion are developed. Many of the causes of indigestion are undoubtedly traceable to other sources, but the consideration of those will be taken up in the articles devoted to the subject. ' The digestive power of the stomach is remarkably interfered with, or even negatived, in many diseases, especially those of an acute or febrile character; it seems to lose almost entirely its power of secreting the gastric juice, and with it, of course, all power of digesting. If food is put into it, it is unacted upon, and is pro- bably vomited after many hours almost unchanged. There can be no question that this instinctive sympathy, as we may call it, of the stomach with the constitution at large, is wisely intended to prevent nutri- ment being introduced into the system, and into the blood, when it would either only tend to embarrass the curative powers of nature or to aggravate' the disease. From the review now taken of the nature of the process of digestion, and of the more general causes of its disorder, the reader must have been made rationally aware of the necessity and reasons for attending to those requirements which have been pointed out as imperative for the immediate proper performance or for the continued health of the function. The food must be prepared for the stomach in the mouth, and the stomach must not have the nervous energy and blood supply, requisite for the im- portant office it performs for the system at large, abstracted from it by unseasonable exertion. The food must, too, be propor- tioned to the wants of the system. If a man will be sedentary, if he will not use up his blood, his muscle, and nerve in active exertion, he must not expect to enjoy food like one who does ; he may eat the food, and, if he possess naturally strong digestive powers, his stomach may dispose of it with- out giving him much inconvenience ; but when the excess of nutriment reaches the blood, it must either be deposited as fat — itself, when in excess, a disease — or it must be developed in the poison of gout, gravel, or biliary or other disorders. Hitherto, the processes of the first or pri- mary digestion have been considered, being the changes of the food from its introduc- tion into the mouth, to the discharge of its refuse on the one hand, and the passage of its nutrient materials into the blood on the other. Physiologists, however, recognise a secondary digestion, embracing the changes undergone by the blood and tissues in the performance of the various functions of the living body, and the final discharge of their components after they have fulfilled their offices. As the consideration of these changes is entered into in various articles, such as "Animal Heat," "Nutrition," "Re- spiration," " Motor Change," &c. it is un- necessary to pursue it further in this place. It may, perhaps, have puzzled the unpro- fessional reader that at times the digestive operations have been alluded to as if they had been actually witnessed by the eye, DIG 196 DIL and such is the fact ; for it happened that, between twenty and thirty years ago, an American physician — Dr. Beaumont — enjoy- ed the rare opportunity of experimenting and witnessing with his eyes the results of his experiments, upon the healthy stomach of a living, healthy man. The subject of Dr. Beaumont's experi- ments was Alexis St. Martin, a young Cana- dian of good constitution and robust health, who was accidentally wounded by the dis- charge of a musket, which carried away a portion of the skin and muscles covering the stomach, and perforated the organ : by good treatment, St. Martin recovered from the injury, but the opening into the stomach never closed. The case coming under the notice of Dr. Beaumont, he, fortunately for science, availed himself most fully and in- telligently of the unique opportunity it af- forded ; and, by numerous well-conducted and accurately recorded experiments, he cast light upon many unascertained points connected with the process of digestion, to some of which allusion will be made in future articles, particularly in that upon food. Those who wish further information respecting the case will find all its details in Dr. Beaumont's work. Refer to Absorbents — Alimentary Canal — Chyle — Food — Indigestion, fyc. DIGITALIS, or Fox-Glove— Is well known, and one of the handsomest of our native plants. It is biennial, that is, the first year a tuft of leaves only is formed, and the flowers do not appear till the second summer. About the middle of June, the wand-like stem, rising from two to four feet high from the centre of the root-leaves, begins to expand its purple blossoms, re- sembling in some degree, in shape, the finger of a glove, from which resemblance the plant is named. Digitalis is a very powerful medicine, and, except in skilled and careful hands, a dangerous one, and can never be employed with propriety as a domestic remedy, al- though in Ireland it is used by the peasantry for the cure of epilepsy. Fox-glove acts powerfully upon the kid- neys in many cases, but its most marked, and at the same time, most dangerous property, is that which it possesses of de- pressing the action of the heart, the hazard being increased from the tendency of the medicine to accumulate in the system, and suddenly to develop its depressing or poi- sonous effects. There are but few cases of direct poisoning by fox-glove recorded, but accidents sometimes happen from the in- cautious administration of it as a medicine : in these cases, great languor and depression of the action of the heart, yawning, giddi- ness, nausea, and a sense of anxiety are the usual symptoms. The best antidotes would be wine or brandy, small doses of opium, ammonia, and strong infusion of green tea. DILL, or Dill-Seed — Is the fruit of an umbelliferous plant, the Anethum Graveolens. It is a native of South Europe, but is culti- vated in England. The distilled water, or " dill-water," is one of our best carmina- tives for infants, in one or two teaspoonful doses, either alone or combined with mag- nesia or chalk. DILUENTS — Are agents used medicinal- ly for diluting the fluids of the body, and in many diseases their employment is a subject of much practical importance. In most cases, either in health or disease,, the necessity for the use of diluents is made known by the occurrence of thirst. This sensation, which is perceived in the mouth and throat principally, is evidently only felt from sympathy with the body generally, for it is not relieved by the mere moistening of these parts, but only by a supply of fluid afforded to the system at large, either, as in most cases, by the stomach, or through the medium of the skin. Diluents may, however, be very serviceable in the treat- ment of some diseases when thirst is not felt, as in gravel ; they are much more largely used, and perhaps abused, as medi- cinal agents, in Europe, than they are in this country. Many reputed mineral waters act most beneficially by their diluting ef- fects : under the hydropathic system, the treatment is carried to a most unlimited and often injurious extent. There is no question, however, that the employment of diluents is too generally neglected in the treatment of disease in this country, although it is more resorted to now than formerly. Dr. Holland classes the beneficial action of diluents under three heads : — First, the dilution and washing away of excrementitious and morbid matter from the alimentary canal ; secondly, as acting upon the blood by dilution ; and thirdly, by influencing the various secre- tions and excretions of the body. Diluents, therefore, are useful in many affections of the stomach and bowels, in which their contents — as in bilious cholera — are acrid ; in fever generally, and in those cases in which natural secretions and excretions, such as the urine, are diminished in quan- tity and irritating in quality. In health, a certain amount of fluid, or of diluent, is required periodically by the body to supply the waste continually going on by the dis- DIL 197 DIN charge of vapour from the lungs and skin, and by the excretions from the kidneys and bowels. The amount must, of course, vary somewhat according to the conditions of the surrounding atmosphere as to tempera- ture and dryness, and also according to the amount of exercise taken ; a man making much active exertion, and perspiring pro- fusely, requiring a much larger supply of diluent than one who is not. Stokers, iron- founders, and others who work hard under great heat, consume an almost incredible amount of fluid. The unnecessary use of diluents by persons in health is undoubted- ly hurtful, particularly when the amount is taken along with food; the gastric juice is thereby diluted too greatly, and its digestive powers impaired. Moreover, persons who drink largely with their food are apt to wash it down in a half-masticated condition, and to take more than is necessary. A certain amount of dilution is, nevertheless, requisite for digestion, and error on this side also is undoubtedly committed ; but these are points connected with individual consti- tution, which every man's sense and experi- ence ought, as far as he himself is concern- ed, to determine better than another can do for him. All dilution must, of course, be due to water, and the various forms of diluents used in illness are but varied modes of ad- ministering the pure element disguised. In many cases this is too largely practised, and patients very commonly, after having gone the round of -the various artificial drinks, are found to prefer and to adhere to the simple water as their most grateful and only drink. How often does the child with fever ask for " water from the pump, 1 ' in preference to every thing else. Water may be used as a diluent in its purest condition, that of distilled water, or rain-water, or as procured from the various sources of spring, well, river, or lake, in which cases it is more or less impregnated with foreign matters. Its temperature may be modified, for it may be used either ice- cold, or tepid, or warm ; or it may be ad- ministered in the form of some of the arti- ficial drinks, such as toast-water, barley- water, thin gruel, or, as on the Continent, as ptisan of various kinds. Weak tea is a common and favourite diluent with many. But diluents are not necessarily unstimu- lating, though most generally so : as a diete- tic diluent, beer, or wine, or spirit and water, may be more serviceable than the simpler forms, and the same may be the case on occasions, where there is intense thirst along with nervous exhaustion. Per- r2 sons who have become exhausted by severe labour, having at the same time been ex- posed to heat, may often with greater bene- fit and safety take a small quantity of slightly stimulating diluent, than a larger, or even the same amount, of plain water. This must not be understood as a recom- mendation of stimulants under circum- stances of ordinary labour, but as applying to cases of exhaustion; and even in these the stimulant must be in very moderate proportion. The instinctive desire for fluid in cholera, and in diseases generally which are attended with fever, ought not to be neglected. There appears to be almost a superstitious fear with many, particularly of the poorer classes, of allowing the sick to "drink cold water," and muny a sufferer regards most grate- fully the unlimited permission of the medi- cal attendant to take it freely, after it had perhaps been begged for, but withheld by mistaken friends. There are few safer pre- scriptions, none perhaps which may be more freely carried out by unprofessional per- sons, than the unrestricted allowance of simple, unstimulating drink, in all acute diseases in which thirst exists, and especial- ly if fever be present. As mentioned in the first part of this ar- ticle, diluents may be administered through the medium of the skin, and thirst and dis- tress allayed in this way, when the power of swallowing is impaired, or lost either tem- porarily or permanently, or when the only diluent at command, such as sea-water, is unfit for drinking. Diluents may also be administered by injection into the bowels. Refer to Cold — Cookery — Heat — Thirst — Water, §c. DINNER — Is the meal of the twenty-four hours, the principal occasion on which the daily waste of the body is restored by food. At dinner, for the most part, the articles either of food or drink taken, are stronger and more stimulating than at any other meal; consequently its disposal makes the greatest demand upon the digestive powers. It matters not that what some persons call dinner others would call supper, for by the designation is here meant the principal meal of the day. The regulation of the meal as to time and circumstances, often requires more attention and care, in rela- tion to health, than is bestowed upon it, either by medical men or the public. In more primitive times, and where primitive habits prevail at the present day, the tim- ing of this principal meal must obviously be very different from what it should be when taken in connection with the habits DIN 198 DIN and modes of life of many in this country, particularly in our large cities. When per- sons, such as those engaged in country and agricultural work, rise very early, break- fast early, and are engaged in active mus- cular exertion in the open air, there can be no question that, by the time of noon, the system is ready for, and requires a full sup- ply of good nourishment ; and the powers of digestion are fully equal to the task, even though the interval of rest be not very great; and that, further, half a dozen hours' work afterward, pave the way for another substantial meal. Such being the case with our agriculturists, the healthiest and strongest, probably, of our population, and people seeing this, have jumped some- what hastily to the conclusion that the early dinner is the secret of health, forgetting the other accessories of fresh air and exercise, and, in case of the labourer, not over-active minds. The case of mechanics and arti- sans generally, who begin the day early, is nearly, but not quite similar to that of the labourer. They require a good meal tolera- bly early in the day, but not having the ad- vantage in many cases of the fresh air of the agriculturist, many of them might with advantage divide the meals a little more equally, diminish the dinner, and add to the meal made after work is concluded, more particularly when the dinner-hour is short, or shortened by the necessity of walk- ing home from the place of employment to the meal. When the cases of the higher classes is considered, it must be evident how com- pletely the time for their principal meal must be altered by circumstances. Begin- ning the day, for the most part, some hours later than the operatives, making, general- ly, much less physical exertion, and work- ing the head more, there is not the necessity for the principal meal being early in the day ; moreover, the employments generally of the class in question being more of the mind than of the body, and often of an anxious and thought-engrossing nature, they cannot in the midst of them cast loose the mind, or place it in the same careless ease as the physical labourer can do — conse- quently the digestive powers are interfered with. If these observations are taken in connection with those upon "Digestion," in the article devoted to that subject, their force will be seen. From them the follow- ing deductions may be drawn ; that although those engaged in physical exertion, either of business or pleasure, particularly if early hours are observed generally, require and ought to have the principal meal of the day early, those engaged in occupations of mental rather than of bodily exertion, ought to delay it till the necessity for the mental stretch is passed over. This sub- ject has been more dwelt upon, from its so frequently being the case, that early dining is prescribed in cases of stomach disorder as a sort of a panacea, which it does not prove. It is not counselled that the dinner- hour should be thrown too late in the even- ing — probably six o'clock should be the limit; but it is far better that it should be late, than interpolated in the midst of the tur- moil and anxieties of business or mental strain of study. It is objected that a late dinner involves either too long an interval between breakfast and dinner, or a luncheon. This is matter of constitution simply. Some persons of good constitutional powers, who can make a substantial breakfast between eight and nine in the morning, do not re- quire, and indeed are better without food between that meal and a five or six o'clock dinner ; those who cannot take so much at a time, are much more likely to do well with a light luncheon, not a meat one, in the midst of their work, than with a heavy meal, as even the lightest dinner must be. It is no real objection against a late dinner, that its being made after work, induces people to indulge in the pleasures of the table more than if they dined early : abuse will neutralize the good of any thing, how- ever beneficial, but it is not an argument against its use. Further, there are un- doubtedly invalids, and certain impaired states of health, in which an early hour for dinner is found beneficial ; but these must be cases in which either the state of health or circumstances require or permit all ar- rangements to be made conformable to the one object — health. An early dinner al- most certainly involves supper of some kind, and this may or may not be an objection, according to circumstances. Undoubtedly, modern habits and luxury tend frequently to make even this principal meal a much too abundant one, chiefly by tempting the appetite with a variety of food ; and it is impossible to lay down any set rules on this head beyond that which every rational man must be well aware of, that none can perseveringly transgress the bounds of temperance, either in eating or drinking, without sooner or later disease being the result. Sleeping after dinner may suit a few per- sons, but it is not advisable for those of full habit of body. For the reasons already mentioned, the time immediately succeed- ing dinner should be one of easy relaxation, DIP 199 DIS to the man of mental toil in particular. The use of wine, beer, or any stimulant falls of course to be considered under the other articles more directly bearing on these sub- jects. A cup of coffee is sometimes taken shortly after dinner; opinions differ as to the propriety or not of the practice. It will probably be found to be best regulated by individual experience. The practice, how- ever, of taking tea or coffee two or three hours after the meal is unquestionably a serviceable one amid the usages of civilized life, and assists the perfection of the latter stages of digestion. These diluents, how- ever, ought not to be taken too strong, or too late in the evening; otherwise their effect upon the nervous system will interfere with sleep. Some individuals of weak digestive powers are in the habit of taking a "dinner-pill," for the purpose either of exciting the appe- tite, of stimulating the digestion, or of both. As a habit, the practice is bad, because it must be a substitute for more efficient and permanent means of improving appetite and digestion; occasionally, however, in some cases the dinner-pill is useful as a temporary remedy. Eighteen grains of compound rhu- barb pill, six grains of cayenne pepper, and twelve grains of extract of gentian, made up into twelve pills, of which one or two may be taken a quarter of an hour before dinner, will be found useful. The practice of taking spirits, or stimulant cordials or bitters, before dinner, is highly injurious to the stomach, exhausting and irritating in a way that must interfere with digestion. A draught of cold water is a much better preparative ; with persons of very weak powers, however, cold water, either before or during the meal, de- presses too much. Eefer to Digestion — Food — Stimulants, §c. DIPLOE — Is the name given by anato- mists to the more cellular or porous portion of bone (fig. lv. 2, 2) which intervenes between Fig. It. the more condensed and solid, but thinner, outer and inner "tables," or plates (fig. lv. 1, 1) of the skull. Refer to Skull. DIPSOMANIA— Is a state when habits of intemperance have reached such a height that the unfortunate victim becomes partly insane, or at least so much so as to lose ail self-control on the one point, and to become affected with the species of monomania to which the term " dipso-mania" has been ap- plied. Sir Alexander Morrison describes it as a "morbid craving for drink which gene- rally occurs at intervals, in which persons are seized with an irresistible propensity to drink to excess, although conscious at the time of their misconduct, but are unable to control themselves." Eefer to Delirium Tremens — Intoxication — Stimulants, Sfc. DISCHARGE— Used as a medical term generally, means any thing cast out from the body ; it is often applied, however, in a more restricted sense, to the excretion of purulent matter solely. DISEASE — Is any departure from the naturally healthy actions of the system at large, or of any structure or organ in par- ticular. The divisions and subdivisions of diseases, generally according to their nature, causes, &c. are very numerous. A distinc- tion is made into organic and functional diseases — the former being such as are ac- companied with perceptible and appreciable change from the natural structure or com- position of any component of the body — the latter those in which the actions are not healthy, but in which, as far as present means of investigation go, no appreciable departure from the ordinary structure can be detected. As, however, it may be doubted whether disordered action can take place without change of structure, temporary or permanent, its non-detection is probably owing to the deficiency of our present means of investigation ; and, indeed, chemi- cal analysis and the use of the microscope have demonstrated, and are daily demon- strating, the nature and tendencies of many alterations in the composition and structure of the bodily constituents which had pre- viously escaped notice. Perfect health consists in the uninter- rupted action and perfect balance of all the functions of the body — this involving of course perfection of structure ; the slightest pain or ache must be indicative of a hitch somewhere in the machinery. In this view, perhaps, none are free from disease for a day, for few can boast of such perfect un- deviating health as to pass four-and-twenty hours without some slight twinge of pain, without some ache or weariness to remind them that their bodies are mortal ; and from this slightest passing uneasiness to DIS 200 DIS the confirmed and fatal malady, disease passes through every gradation. Many of the most painful and deadly disorders are not more felt at their commencement than as a slight sense of discomfort ; and perhaps numberless of the lesser pains felt during what is considered health, might pass on to real disease, were it not for the natural tendency to cure with which our bodies are endowed — that which is called the " vis medicalrix naturae,'''' — the same tendency which restores the fractured bone to sound- ness and heals the ' wound. There can be no question, that, but for this tendency toward health, this power of resisting and casting off disease, our bodies would quickly succumb to the innumerable causes of dis- order to which they are hourly exposed. This power of resisting disease is without doubt much greater in some persons than others, and even in the same person at dif- ferent times, often without any perceptible reason why it should be so. The power of the system in casting off disease, when forming or formed, is for the most part more plainly exercised, but of this more will be said hereafter. Again, it it must be remembered that con- stitution and other causes occasion so much variation in the actions of the body, that what would be disease in one man is health in another. For instance, one man's pulse may average sixty in a minute, another's eighty ; and it is certain that the former could not rise to the level of the latter, or the latter sink to that of the former, with- out disease or disorder being present. Such considerations are important in judging of the real state of a person labouring under disease. To judge accurately of disorder, we must know the whereabouts of the level of health ; and in this consists the great advantage of the regular medical attendant over one who is casually consulted, and who first sees the patient when suffering under illness. In popular language, the regular attendant "knows the constitution" of his patient ; the other has it in many respects to learn. But if there is a tendency toward health, there is also a tendency, more or less, toward certain forms of disease, existing with every one — this tendency being either hereditary or acquired. The power of here- ditary tendency toward certain forms of dis- ease, such as scrofula and consumption, gout, gravel, and rheumatism, paralysis, &c. is so generally recognised as to be a matter of popular information ; that is to say, when these diseases have affected parents, or rela- tives of parents, they are regarded as here- ditary in descendants. There is, however, an hereditary predisposition not so apparent, which requires more notice than it receives : it is that which devolves upon children in consequence of the habits, &c. of the parents. The latter may be of healthy families, but if there has existed much inequality of age — especially if the father has been advanced in years, or if marriage has been contracted too early in life, or if either parents have lowered the standard of health by dissipa- tion or by any other means, their sins, in obedience to those laws which the Almighty has connected with our being, are visited upon the children, in tendencies to certain diseases. The offspring of drunkards are very frequently the subjects of affection of the brain and nervous system ; the child of the woman who gives way to indolence, or indulges in undue excitements, will in all probability fall below the standard of health. Tendency to disease may also be given in persons previously healthy, by whatever lowers their own standard of health. Dis- sipation of any kind, deficient food or sup- ply of pure air, exhaustion from whatever cause, depressing passions of the mind, &c. all give that tendency to disease which renders the constitution more susceptible of its attacks. Even the time of day exerts some influence ; for it is well known that a person is much more liable to become affected with any malady, either of a con- tagious or malarious character, such as ague, if exposed to its influences in the early morning, before the powers of the constitution have been invigorated with food, especially with that, such as warm tea or coffee, which affords the gentle stimula- tion of heat. Further, individuals are never so liable to succumb to disease as they are during the stage of depression succeeding a debauch. Every day adds to our experience of the way in which the ill-ventilated and J badly- drained dwelling gives the tendency to fever and to cholera, while at the same time it fosters their deadly germs into activity. Lastly, nothing predisposes more to disease, or increases the tendency to it, than the de- pressing passions, such as fear, despondency, &c. Those tvho give way to the fear of taking any malady, open the readiest door for its incursion; and even without the fear of the disease itself being the cause of the depression, the fact of the mind being depressed increases greatly the susceptibility to any causes of disorder in active operation at the time. This is often strikingly exemplified in the case of troops ; it is always observed that sickness is more prevalent among the men of a retreating and desponding army than under the reverse circumstances. Perhaps, DIS 201 DIS under no circumstances is the worldly ad- vantage of a firm reliance upon Providence more palpable than when that reliance sus- tains the mind in cheerfulness, hope, and resignation — resistants to diseases which come to the aid of those who hold them, when other help seems to have vanished. There is a kind of mixed tendency to disease, partly hereditary, and partly ex- cited by external circumstances. It is this form which the children born in India and other hot climates, of English parents, suf- fer, particularly if the parents have been long resident. They cannot be retained in the clime of their birth, without the greatest risk to life, before the age of puberty is attained. Most of those causes which give a ten- dency to disease, also, in themselves, when acting with increased intensity, tend to pro- duce it, or to aggravate it when existing. The influences of climate, of air, whether pure or impure ; of food, whether deficient in quantity or quality ; of occupation, of habits, or mental influences, are all power- ful excitants of disease. The remittent fevers of the tropics and the typhus of England, the scrofula, the rickets, and cuta- neous eruptions, the consumption of the metal-grinders, the delirium of the drunk- ard, are all instances which might be multi- plied, of diseases produced by external in- fluences. The diarrhoea of fear, the nostal- gia or home-sickness (which is actually ac- companied with disease in the lungs) of the Highlander or of the Swiss, the diseases of the heart which result from the agitation of political or commercial excitement, are all examples of the production of disease by the internal agency of the mind. When disease has established itself in the constitution, were it not for the "ten- dency to health," it must run on to a fatal termination. The wound would remain un- healed, the inflammation would extend, or its effect remain unrepaired, were it not for these curative powers existing in the consti- tution itself. If, then, whatever tends to lower the standard of health favours the inroads of disease, so the preservation of that standard, as far as may be consistent with the safety of the patient and the re- duction of his malady, insures a more certain and speedy throwing off of the effects of the disorder, or in one word — con- valescence. Patients who have been pro- fusely bled are often very long in recover- ing, and during the period of recovery are liable to relapse, and to be attacked by other forms of disease. Moreover, during the progress of disease, nothing assists more the powers of the con- stitution which tend toward health, and to throw off the enemy, than a cheerful and hopeful mind ; as the people call it, a "good spirit." It may make all the difference be- tween recovery or the reverse. Indeed, every medical man must have met with cases of illness, in which the patient seemed, as it were, resolved not to give in — seemed, even under unfavourable circumstances, determined not to die, if they could help it — and did not die. Even when physical powers tended to death, the mind tended to life, and the mind succeeded. Were it not for the tendency to health, or to cure, ex- isting in the body, our medicines would be in vain ; and he is the best physician who can detect those tendencies to recovery, permit them to act when they seem strong enough, and assist them when they do not. The patient in the lowest stage of fever still has the tendency to health existing, and acting within, and battling with the disease ; the powers of a good constitution may of themselves be sufficient to conduct him over the crisis ; but they may not, and unassisted, the patient must sink ere the tendency to throw off the disease gets the mastery. But the physician steps in ; he gives his help to the constitution ; his wine, and bark, and nourishment, and regulation of- the functions, support the frame till the struggle is over, and the disease is van- quished. This power of throwing off dis- ease, this tendency to health with which the living body is endowed, requires to be impressed upon the mind of people gene- rally ; for they are too apt to attribute that to the action of medicine, which medicine only gives its assistance to, and to despise the simpler modes of treatment, which place the natural powers in the most favourable position for curing. The vulgar attribute the healing of the wound to the plaster which merely holds it together, and cold water is too simple to do good. The aggravation of existing disease, both by physical influences and mental emotions, is one of the most serious enemies the phy- sician has to contend with. The subject is sufficiently entered into in the various articles of this work. Lastly, disease is often established as a secondary affection: it occurs in consequence of some previously existing morbid con- dition of, or in, some part of the body. Dropsy is a disease peculiarly of this class. Affection of the heart, liver, kidneys, or other disorders, all tending to produce it. Apoplexy may result from disease of the heart. In these cases the secondary disease DIS 202 DIS appears simply a result, without beneficial influence — but in many cases it exerts a tendency to remove the primary one ; and this fact is one of great importance in the treatment of all disorders of the body, for rash interference with the natural effort may throw the diseased action back upon the previously affected, or upon some more vital part. The healed-up ulcer, or cured (?) eruption, may occasion head disease, or the stopped diarrhoea may throw back upon the constitution, with serious or fatal effect, the blood poison of which the vital fluid was endeavouring to relieve itself. Even that alarming incident, spitting of blood, though in itself a grave symptom, may tend to re- lieve from worse evil. These efforts of the constitution, therefore, to cast off or cure disease, are to be cautiously interfered with. In the treatment of disease, two very different methods have to be pursued : the one is that which exerts itself directly to cure by the direct action of certain medi- cines. Of this, the cure of ague, of neu- ralgia, and other periodical diseases, by quinine or iron, is an example. Experience has unfolded to us that in these and similar cases, the medicine has the power of curing by some relation established between it and the disease by the Author of all things — and in nothing is his mercy more strikingly ex- emplified. But why quinine should cure neuralgia, why opium should allay pain, we cannot tell, at least in the present state of our knowledge ; the only approach to any explanation being one given by Liebig. The other method in the treatment of dis- ease is not so much of the active as of the expectant or passive character. There are many (perhaps the majority belong to this class) forms of disease for which we know of no cure, such as quinine is to ague. The throwing off the malady must be by the na- tural powers, and our only resource consists in putting and keeping those natural powers in as favourable a state for this purpose as possible. Of this, many forms of fever are ex- amples. We cannot hope to cure, we can only hope to pilot the body through the rocks and untoward currents which arise in the course of the disorder, to allay secondary diseases which show themselves, to alleviate painful symptoms, and to support the constitution. These facts should be made plain to the minds of unprofessional persons generally, for the most erroneous notions prevail upon the points just alluded to, and often lead to dissatisfaction with medical men. One who is content with guiding the course of -a fever, either with the gentlest treatment, or j with what people may consider no treat- ment at all, is looked upon as inefficient, while the busy meddler, who interferes without aim or object, and probably thwarts with uncalled-for medicine the natural tend- ency to cure, is regarded as the "active"(?) practitioner. The reference from this article must be to the work at large, for it bears upon the whole. DISINFECTANTS— Are any agents which detroy the power or means of propagation of such diseases as spread by infection or contagion. Purification of every kind, there- fore, either by fresh air or by water, is a disinfectant, these agents acting by dispers- ing or diluting the morbific germs, whatever these may be. A high temperature doubt- less acts as a disinfectant, by destroying their chemical composition, and chlorine and muriatic acids probably exert a similar influence. Quicklime and charcoal, on the other hand, most likely owe their disinfect- ing properties to their power of absorbing various gases. These chemical agents are all useful, but cleanliness and ventilation are disinfectants in the power of all, and their operation is both continued and conducive to comfort. Refer to Air — Contagion — Chlorine. • DISLOCATION— In medical, or rather surgical language, means the displacement from their natural positions of bones or portions of bones, at the points where they are connected together by means of joints or "articulations." There is not, perhaps, a bone in the body which may not be dis- placed by violence, but some are much more liable to the accident than others. It would answer no good purpose, in a work of this kind, to enter into details respecting the varied dislocations which may and do occur : a few, therefore, only of the com- monest, most easily recognisable, and most readily remediable will be noticed. There is some difficulty in treating the subject of dislocation in a popular work ; for, although, from the nature of the accident, and of the circumstances in which it is apt to occur, it is highly desirable that some knowledge should be possessed by the unprofessional, both as regards the signs and symptoms of dislocation, and its more immediate treat- ment, the difficulty that occasionally pre- sents itself, even to the skilful surgeon, in determining whether dislocation actually exists or not, or whether it is complicate^' with some other injury, such as a fracture renders the matter a delicate one for . la^ interference. With this caution, therefore, that unless tolerably clear upon the point, DIS 203 DIS it will be "better to wait even days for the arrival of skilled advice, than to make attempts to remedy an uncertainty ascer- tained injury, the following hints may be useful, particularly in those cases in which the accident does not happen for the first time, and this will often be the case ; for, having once occurred, it is very apt to do so again, even from slight causes. In such cases, the doubt as to the nature of the mis- hap' will be most materially diminished; indeed, the patient himself is generally perfectly well aware of what has occurred, and can often give directions accordingly. The symptoms of a dislocation having oc- curred after violence or accident are pain with loss of power over the limb or member, and its becoming fixed in one position, so that it cannot be moved, either by the patient or by others, at least not without occasioning severe suffering; numbness is felt in the limb, the person becomes faint and sick, and if the shape of the joint be examined, it will be found deformed. Whenever doubt exists as to whether dis- location has or has not happened, the case should be examined by a competent surgeon as early as possible, and no time wasted in fomentations and rubbings, which are per- fectly useless. If a bone is "out of place," it cannot be too soon restored to its proper position, and nothing will give relief, at least for a long period, if this is not effected. A bone certainly may remain permanently dislocated, and the member attain, in the course of time, a very considerable amount of motion, by the formation of a new joint ; but it is long before it does so, the power of movement is never equal to what it was was before, or would have been had the in- jury to the joint been properly rectified, and much unnecessary pain is suffered. The necessity for the speedy reduction of a dislocation is great, from the fact that every day increases the difficulty of its perform- ance ; and when a certain time has elapsed, no force which can be exerted — consistent with safety to life and limb — will be ade- quate to return the displaced bone, partly owing to the resistance of the muscles, but also to obliteration or doing away with the cavity which formed the one portion of the joint. When dislocation occurs, two differ- ent actions take place ; one, that by which the bone is driven from its usual position ; the other, the action of the muscles, which tend still further to draw it from its proper site as soon as the balance of resistance of bone against bone is removed. It is, too, in most cases, the action of the muscles which tends to keep the bone displaced, and to resist the efforts made to replace it. This is evident from the fact, that if a per- son be seen immediately after a dislocation, and while suffering from the faintness which almost invariably accompanies the accident, and while the muscles are necessarily in a state of weakness and relaxation ; the dis- location may often be reduced with the greatest possible ease, even by the unskill- ed ; and further, when the surgeon has to deal with a case of dislocation in a strong and muscular subject, he endeavours to produce this faintness — if that following the accident has passed away — by bleeding, nauseating medicines, warm baths, &c, [or by causing the patient to inhale aether or chloroform. These articles are, however, too dangerous for an unprofessional person to use ; and the necessary relaxation had better therefore be accomplished, when it is essential, by making the patient "dead drunk."] When, therefore, a dislocation occurs, the bone is not simply pushed out of its place, but is drawn for the most part upward, or toward the body ; the dislocated bone of the finger is drawn upward over its fellow ; the arm-bone, in dislocation of the shoulder, may be drawn upward, or into the armpit — in this case downward, it is true, as regards the joint, but still toward the body ; and the same will be found to be the case in most forms of dislocation. The first object, therefore, in treating a disloca- tion, must be to draw it down from or out of the situation to and in which it has been drawn and is retained by the muscles of the limb, and to get it as near the corre- sponding part of the joint, or, in other words, as near the part from which it has been dis- located, as possible. If the dislocated bone is thus drawn down to, or near to the level of the other portion of the joint from which it has been removed, the muscles will of themselves tend to draw it into its old posi- tion. A good deal is often said about the adjustment, &c, &c. of the bone in reducing dislocations ; and though, perhaps, useful in some cases, in many nothing of the kind is required, at least unprofessional persons should not attempt it ; all that is to be done is, give the muscles the chance of drawing the bone into its old place, by bringing it to a position in which this can be effected. This is often exemplified in cases in which much force is used in the reduction of a dislocation ; if the force be kept up strongly, the bone cannot be drawn into its socket, because the force is stronger than the mus- cles of the patient ; but relax the external force for a moment, and without any fitting or adjustment, the bone is instantly drawn BIS 204 DIS into its proper position by the power of its own muscles. The above principles will be better understood by a reference to the an- nexed cut — for which the author is indebted to Professor Fergusson's Manual of Surgery. In this, (fig. lvi.,) 1 is the shallow cup Fig. lvi. 2 / [glenoid cavity] attached to the shoulder- blade, (3,) in which the round extremity or head (2) of the arm-bone (4) ought to rest, but from which it is represented as dis- placed or dislocated. The muscles are not here represented. It is evident, that before the round head (2) is replaced in the cavity (1) it must be forcibly drawn down to its level ; this drawing down the muscles strongly resist, but also tend by the same power to draw the head of the bone into its place, as soon as it is drawn down sufficiently for them to do so. These principles respecting the nature and management of dislocations have been dwelt upon, from the author thinking that a knowledge of them would be more likely to lead an intelligent non-professional person to judge correctly and act efficiently on such emergencies, than the bare enumeration of certain sets of symptoms, often sufficiently obscure, which characterize the different forms of dislocations, and which he could not carry in his mind. There is, however, yet another important principle involved in the reduction of dislocations. It has been pointed out how the bone farthest from the body — which is usually drawn up — is to be drawn down; but, that this may be done properly, the bone above it must be fixed, otherwise it will be drawn down too. This is easily effected in such cases as the ankle or the wrist, by any one grasping and hold- ing firmly either the leg or the forearm ; but in the case of the hip or the shoulder, more management is requisite. In the lat- ter, which is the most likely to fall under non-professional treatment, the shoulder- blade must be fixed or prevented from giving way with the "extending" force ap- plied to the arm-bone ; how this is to be done will be pointed out when the particu- lar dislocation is treated of. Again, in "making the extension," that is, using the forcible effort to return the dislocated bone to its place, the extending force will best be made in the direction in which the limb is fixed, and in the manner most likely to bring the joint portion, or "articulation" of the displaced bone, as near to the old position as possible, and it must be applied directly to the bone which is displaced. Thus, in dislocation of the shoulder, the reducing force is applied to the arm-bone ; in dislocation of the hip to that of the thigh. This extending power may simply be by the hand, but a cloth, or band of some kind, put round the member to be replaced, is often more advantageous. In order to put this band on most efficiently, it is applied in the form of what is called the clove-hitch, [or knot often tied by sailors,] (fig. lvii.,) Fie;, lvii. which will be better understood from an examination of the cut than from any description. This double noose, which may be formed of any suitable material, such as a large soft handkerchief, being fitted to the part to which force is to be used, with a piece of cloth interposed between it and the skin, is not liable to tighten when its loose ends are used to pull by. The particu- lar dislocations most likely to be recognised and to be remedied by unprofessional per- sons, are those of the small joints, such as fingers and toes ; of the wrist and ankle ; of the elbow, shoulder, and lower jaw. Dislocations of the fingers or toes may generally be made out by any person, and should, if possible, be reduced at once ; the dislocated bone being grasped as represented, (fig. lviii., also taken from Ferguson's Sur- Fig. lviii. BIS 205 DIS gery,) and forcibly pulled into place ; or the clove-hitch noose, made with a piece of tape, may be used. Dislocation of the thumb, it should be known, is extremely difficult of reduction, and should this not be effected at once, the attempt ought to be given up until the surgeon's arrival ; it is, more- over, one of the dislocations which may be left unreduced with less subsequent incon- venience than many others. Dislocation of the ankle is very generally accompanied with fracture, but the distortion is often so great and evident, and the suffering so se- vere, that when the accident does occur far from proper aid, some attempt ought to be made to put the displaced parts in better position. For this purpose, while one indi- vidual grasps the leg firmly, another, put- ting one hand on the heel and the other on the instep, should endeavour, while steadily pulling downward, to bring the joint into its natural position. Dislocation of the wrist is reduced by the forearm being tightly grasped by one indi- vidual, the surgeon laying hold of the pa- tient's hand in his, and endeavouring by steady traction downward, and slight up and down movement, to bring the joint into its proper condition. Dislocation of the elbow, if attended to quickly after the accident, may often be easily reduced by seating the person in a chair, carrying the arm well behind the back, and pulling, not very forcibly, upon the forearm. Both these dislocations — of the wrist and elbow — may be suspected, when, after vio- lence — particularly such as is calculated to push either the hand or lower arm upward — inability to use the limb below the seat of the injury, and distortion and impaired mo- tion of the joint, are unaccompanied with any grating sensation, such as occurs when a bone is fractured. Dislocation of the shoulder is most generally occasioned by violence applied to the elbow, or by falls, while the arm is not close down to the side of the body. Sometimes the exact discrimination of an injury to the shoulder joint is a matter of much difficulty, for fracture alone or fractures with disloca- tion may occur. At other times, particu- larly in thin persons, it is tolerably easily made out — more so if the examination is made before swelling comes on. In addition to the general symptoms of dislocation al- ready enumerated, the injured shoulder will be perceptibly altered in shape ; it will ap- pear more depressed and flatter than the sound one, and if the hand is placed upon the spot which ought to be occupied by the S round head of the arm-bone — and this may be discovered by examination of the unin- jured shoulder — it will be found hollow; and further, if the arm be now gently moved about, and its bone traced up toward the shoulder, it will be found moving in some unusual position, most probably in the arm- pit. Supposing, therefore, that the case is sufficiently clear, and that the sufferer from the accident, in the absence of proper surgical assistance, is content to risk the matter upon non-professional judgment, or that, from having been the subject of the accident on some previous occasion, he is tolerably certain of its present nature, the means for the reduction ought to be set about as speedily as possible — if it can be, while faint- ness from the injuries continues. These means vary considerably. Hanging over doors or gates, the arm-pit being placed on the edge, have been employed and recom- mended; and, in persons who have been the subjects of frequent dislocations in the same shoulder, may be efficient ; but in a first dis- location should never be resorted to. One method of reducing dislocation of the arm- bone into the arm-pit frequently employed is for both patient and surgeon to lie down upon the ground side by side, but with their heads different ways, and so that the sur- geon having previously taken off his boot, can place his heel in the arm-pit of the pa- tient, while he grasps the hand, or a towel fixed to the arm of the affected side ; in this way, while the heel is used to push against the displaced bone in the arm-pit, it, combined with the traction exerted by the surgeon upon the limb of the patient, tends to give a leverage by which the bone is so placed that it can be drawn into the socket by the muscles. This method may be a con- venient one, when only one person is in com- pany with the individual to whom the acci- dent has happened. The following is the most useful and most generally resorted to method of reducing a dislocation of the shoulder. The patient being seated on a chair, a large towel or a table cloth, folded broad, is to be passed round the chest, close under the arm-pit of the affected side, crossed over the opposite shoulder, and held either by a strong assistant or fastened to some fixed point. By this application, the shoulder blade is fixed; the arm itself is then to be pulled, chiefly in the direction in which it has been fixed, firmly, steadily, and slowly; this being done, either directly by the hands of assistants, or by a towel fastened round the arm by the hitchnoose, (fig. lvii.) If when this steady pull has been persevered in for some time, the displaced bone does DIS 206 DOT not get into place, the effect of suddenly- taking off the attention of the patient may- be tried, either by some sudden exclamation, or by dashing a little cold water in the face. By such a proceeding, the muscles which resist the reducing or pulling force applied to the arm, are for a moment, so to speak, thrown off their guard, and that moment may suffice to permit the bone to pass into its socket. Dislocation of the lower jaw is not a very unfrequent occurrence, and happens from persons opening the mouth very wide, either in laughing or gaping ; the jaw slips, and its articulations or joint portions on both sides are drawn forward ; the person cannot close the jaws, but remains with the mouth wide open, a most inconvenient position should skilled assistance be far distant. The accident, however, can scarcely be mistaken, and may be rectified without much difficulty by a bystander. For this purpose, the thumb or thumbs, according to whether the joint is entirely dislocated or only on one side, are to be placed by the acting party upon the upper portions of the back teeth, and strong pressure exerted downward, while the chin is drawn upward by the fingers at the same time. As the jaw returns to its place, its powerful muscles draw it upward with a sudden snap, and if the fingers of the operator are not covered with a handkerchief or some other material, [or quickly slipped to the sides of the teeth,] they may get smartly bitten. After the dislocation of any part has oc- curred and been reduced, a bandage, or some application which will confine the in- jured members, should be worn for some days, not simply from fear of the accident recurring at the time, but to keep the parts, which must have been more or less lace- rated, quiet, and to permit the internal traces of the injury to be as much as possible ob- literated. In conclusion, although the sub- ject of dislocations has been dwelt upon at some length, it is chiefly for the reason that these accidents, painful at the time, and, if unremedied, productive of deformity and impaired usefulness for the future, are often overlooked, or are apt to occur at great dis- tances from skilled assistance. In such cases, the information given in the fore- going article may prove a useful guide, either by directing attention to the import- ance of the injury and of its speedy rectifi- cation, or, if acted upon with care and pru- dence, by pointing out the most effective treatment. — Refer to Joints — Muscles. DISORDERED FUNCTION— A term very frequently used in medical language, means departure from the usual healthy action of any portion of the body, either unaccom- panied with perceptible change of structure, or as a consequent of altered structure of the part. Refer to Disease. DISTILLED WATER.— See Water. DIURETICS— Are medicines which in- crease the flow of urine. The class em- braces very many substances, but it will be sufficient to notice only those which may be most safely and generally used ; they are — ■ Broom, Dandelion, Fir Top, } Gin, I which contain turpentine, Juniper, j Parsley, Potash — Solution or Liquor Potassee, " Acetate, < ' Bitartrate, or Cream of Tartar, " Carbonate, " Nitrate of Saltpetre, Soda — Carbonate, Spirituous Liquors, Spirit of Sweet Nitre, Squill, Turpentine. There is always some degree of uncer- tainty in the action of diuretic medicines, but with some more than others. The au- thor has found the two first on the list (broom and dandelion) as certain, or more so, than any others, and, as domestic reme- dies, they have the advantage of being easily procurable in this country, and of being perfectly safe. Fluids should be given freely during the action of diuretic remedies. It sometimes happens, that diu- retics which would not act before, act after the administration of an active purgative. Similar effects are found in the hands of medical men, before and after bleeding. As mentioned under the article Coffee, the infusion of the raw berry is diuretic. Men- tal emotion such as fear, and nervous dis- orders such as hysteria, it is well known, give rise to great increase in the flow of urine. Refer to the various separate articles, for the uses, &c. of the diuretics mentioned. DOVER'S POWDER— Is a compound of one grain of opium, one of ipecacuanha, and eight grains of sulphate of potass, well powdered together ; ten grains conse- quently contain one of opium. It is much used as a remedy to produce perspiration, (in which, however, it often fails,) and in cases generally where opium is requisite. The ipicacuanha may occasion sickness. Refer to Opium. DOU 207 DRA DOUCHE — Is a stream of water directed upon any part of the body, and "is most fre- quently performed while the patient is in the bath. Douches are of various kinds, as the descending, the lateral, and the ascend- ing. The water in the first kind falling from a reservoir, at a greater or lesser height, upon the patient in a single or di- vided stream, the size of which may be va- ried according to circumstances. The lateral douche is produced by a man's pressing the water through a tube, as with a fire-engine, the stream being directed against any part of the body that is indicated. The strength of this can be regulated by the attendants pumping with a greater or less degree of force, and also by a finger placed over the aperture, by which the stream is divided. In the ascending douche, the column of water is directed upward, and is usually taken in a sitting posture ; this douche being almost exclusively employed in com- plaints of the organs contained within the pelvis. " Douches are directly exciting remedies, and are mostly used to produce a greater de- gree of vitality and activity in the parts, as in cases of local debility, scrofulous swell- ing, muscular rigidity, paralysis, contracted joints, neuralgic pains, &c. They are mostly administered while the patient is in the bath, and are often advantageously com- bined with friction. The employment of the douche requires to be carefully super- intended." — Extracted from Lee's "Baths of England." Refer to Bath. DRASTIC— A medical term applied to purgative medicines, which act strongly and produce watery evacuations. Refer to Purgatives. DRAINAGE — Is the important process by which superfluous moisture is removed from the soil, through the soil itself, or by means of channels made in or through the earth. It may be either natural or artificial, to carry off the simple excess of fluid resulting from atmospheric moisture, such as rain, or to remove the impure and deteriorated fluids, which more or less result where man and the domestic animals are congregated. The salubrity of a district is always closely connected with its natural drainage. Whenever moisture accumulates, either from position, that is, want of inclination or slope to run it off, or from the nature of the soil, disease is apt to prevail. Professor Ansted* remarks, "there can be no doubt Professor of Geology, King's College, London. that the district where sand and gravel allow the water to drain off at once beneath the surface, and that where hard and im- permeable rock permits the rain to escape readily into the nearest running stream, will be on the whole the most healthy ; while, on the other hand, that in which the tough clays retain the water in ponds on the surface will be exposed to marsh fevers and various disorders affecting the throat and lungs. These remarks apply chiefly to temperate climates, but when the conditions of vegetation are taken into account, they are no less true than important for warm countries, where the rankness of the vege- tation must, no doubt, be connected with the nature of the sub-soil over which it grows." These considerations are important for all, and especially for the emigrant and settler in new districts, who ought always to fix, if possible, upon a site for his dwell- ing, where the water has or may be made to have an efficient drainage in every di- rection and way ; and to exercise caution, also, that the dwelling of himself and family is not so placed that any generally prevail- ing wind can blow upon it from a marshy or badly drained tract of country. The effect of draining the soil, in rendering a country more salubrious, and in removing disease, is well exemplified in the disap- pearance of ague from many parts of England in which it formerly prevailed, a circumstance which can only be accounted for by the increased attention to the drain- age of those districts. As might be ex- pected, low situations are not likely to be so well drained as those situated on elevated ground. The latter does not alone, how- ever, suffice in all cases, if the drainage is improperly managed, and some of the worst local forms of typhus have been known to prevail in such places. The drainage of houses or collections of houses, where day by day there must be removed the excretions, both solid and fluid, of man and animals, is one of the most important points connected with the preservation of health ; it might almost be added, and one of the most neglected ones. Both in town and country, the necessity for sufficient drainage, whether of the natural moisture of the soil, of the results of animal life, or of domestic habits, has been, if not entirely overlooked, most insufficiently pro- vided for. It might shame the boasted civilization of our era, to learn that in Mr. Layard's researches in Nineveh, he found the buildings (of an age estimated at 1200 DRA 208 DRA years before Christ) provided with a com- plete system of sewerage. Each room had a drain connected with a main sewer. It is generally thought that in the coun- try less necessity exists for perfect drainage than there does in large towns, and to some extent the idea may be correct, in so far as the smaller number of individuals collected in a given spot and the freer circulation of air must tend to preserve greater purity of atmosphere. But this idea, by lulling suspicion, has proved a dangerous one, and the single homestead or small isolated hamlet has been desolated by the scourge of fever, which a little precaution might have prevented. One most striking instance has been recorded by Dr. Christison, which occurred in and close round a farm-house occupied by an extensive farmer, in "a thinly-peopled rural district, in Peeble- shire." With respect to situation, Dr. Christison, after describing it, concludes with, "a healthier locality could not well be chosen ;" and yet, in, and close to this healthily-situated house, and in no other in the district, fifteen cases of a severe and peculiar form of fever occurred within the space of a few weeks, and three proved fatal. Such a well-marked visitation could not well escape searching investigation, which brought to light the fact that the house was completely surrounded by drains, which had, in the course of time, become filled up with the drainage of the farm- yard, of the necessaries, &c. &c. Such cases are by no means uncommon, even in country situations which would be at a first glance esteemed most salubrious, and indeed would be, but for the shame- ful neglect of the inhabitants. The author cannot recollect during ten years' prac- tice in a rural district, any invasion of fever going through a house, or collection of houses, which has not been traceable to deficient drainage and neglect of sani- tary measures generally. It is not fever, however, as generally so called, which alone occurs in consequence of deficient drainage, but bad health generally. And whatever case of disease or accident may remain within the tainted locality, ac- quires a certain unfavourable tendency and type; even recovery from childbed is affected by it, and perhaps more cases of childbed fever and death than would be imagined, might be traced to the unhealthy influences originated by habitations situated in a badly-drained locality. Surely this last consideration, if no other, might rouse men to act. The point touches the wealthy citizen as well as the poor one. Inflammation of the eye, or rather of its covering membrane, the "conjunctiva," has been found occurring commonly in parti- cular localities, no cause being assignable beyond that of stagnant and putrefying ditches or unwholesome drains. The con- tamination of wells which supply water used for drinking and cooking, by badly arranged or imperfect drainage, is a very fertile source of disease ; many of the worst invasions of fever, and cholera also, have been traced to this disgusting source. Whatever has been said respecting drain- age in country places, applies with increased force to the provision in towns, with their dense populations. On this head, Mr. Grainger, in his pamphlet published by the "Health of Towns Association," remarks, " The most prolific source of disease in towns is, certainly, defective drainage and sewerage. Where large numbers of human beings are collected together, it is apparent that there must result a vast amount of refuse matter of every description, to which must be added the solid and fluid excre- tions of the body, the former of which alone amount in a town like Liverpool to nearly six thousand tons annually." The first essentials for proper drainage are well-constructed sewers, that is, such as will not promote the deposition of solid matter in their interior. That the majority of the old sewers and drains do this has been proved before the Health of Towns Commission. It was shown that " by their unnecessary size and defective form, most of the old sewers being flat at the bottom, they cause a retardation in the flow of their muddy contents, and thus, of necessity, produce a lodgment of putrefying animal and vegetable matter. Another source of deposit is the improper direction of these conducts, the sharp angles and curves of which, especially where the smaller sewers enter the main trunks, lead to obstruction, and to these must be added the various irregularities of surface connected with the masonry." Again, drains are frequently placed too near the surface, and leave the under-ground premises either undrained, or, what is worse, receptacles for their leakages, should they get out of order ; then the gut- ters, the most superficial drains of all, are full of holes and crevices ; the entire sys- tem, including the gratings over the under- ground drains, being calculated rather to foster disease than to remove the causes of it. In addition, however, to construction, a full supply of water is requisite, one that can thoroughly and periodically, at not too distant intervals, be sent in full volume— DRA 209 DRA "flushed" — through the passages so as to sweep every thing before it. One gentleman, Mr. Guthrie, examined before the Health of Towns Commission, gives the following important points of evi- dence. He says, "My attention has been more especially directed to private drainage, or the sewerage of individual tenements ; for I am satisfied the public health is more deleteriously influenced by the exhalations which arise from pent-up matter in them, than by those which issue from the great main or common sewer. I hold every system of flushing to be imperfect which merely hurries along the contents of the principal or main sewers, while the putrefy- ing debris of inhabited tenements is left undisturbed in house-drains. The reason why house-drains act so imperfectly, that they frequently get entirely choked up, is simply because their too limited supply of water is spread over so great a surface that its power to carry along matter in suspen- sion is lost. Choking from accumulation seldom takes place in the small iron or lead soil pipe, neither would such a circumstance ever take place if the calibre of the tube or drains intended to carry off the soil were not made so great that the usual allowance of water is unequal to the task of washing out its interior. " The tubes made for house- drains should be circular, and not more, for any ordinary tenement, than from three to six inches in diameter. The form of main sewer most recommended by those who have paid much attention to the subject, is the oval, (fig. lix. 1,) or with a lesser curve at Fig. lix. bottom than at top, (fig. lix. 2.) It is calcu- lated that this latter form " gives full action to the water at the time it is most needed, namely, when the quantity is smallest. Drain-tiles or bricks may be used to form these oval sewers ; but tubes in moderate lengths are most strongly recommended. In addition, it is advised that whatever mate- rials are used for drains should be glazed in the inside, as tending less to promote depo- s 2 sition of solid matter, and also being mora easily cleansed. Sufficient fall for the fluid is of course requisite for a complete drain. EfiTuvia are very apt to escape from drains " by the improper position of the gully gratings, and from these not being trapped. By improper position is meant the top of an eminence, where no surface-water can properly accumulate." Gratings and gullies are therefore injurious in such situations ; and, indeed, should only be placed where absolutely necessary to carry off surface- water, which will clear them out ; and they should be trapped. The inmates of houses close to gully-holes have been known to be attacked with fever which could in no way be accounted for, except by the emanations, proceeding from the sewers, through the gratings. Lastly, all those parts of a house which are connected with sewers and drains, such as water-closets, sinks, &c, ought to be so constructed that they do not allow effluvia to escape. This may be simply and cheaply done by means of earthenware soil-pans, with siphon-pipes, as represented, (fig. lx.,) Fi£. lx. in which the stratum of water, (fig. lx. 1,) which always must remain in the lowest part of the pan, acts as a valve against all efflu- vium from the pipe, (2.) AVhere a sink is not attainable, a simple funnel-like pipe, with a cover, (fig. lxi.,) may be fitted into Fig. lxi. the floor, and made to lead into the drain. The subject of drainage generally is so im- DRE 210 DUE portant, and its connection with health is so intimate, that it might be extended to a much greater length than the limits of this work will admit of. Enough, it is trusted, has been said to direct attention to it; and those in whom a spirit of inquiry has been excited, and who desire more ex- tended information, cannot do better than seek it in the valuable and cheap publica- tions of the Health of Towns Association. DREAMING— Is the wakeful and sentient condition of some of the faculties of the mind, while the others are asleep. The whole subject of dreaming is highly interest- ing in a psychological point of view ; but it is only in its connection with the body that we have here to do with it. Some persons naturally dream more than others ; but there is no question that the occurrence and, more particularly, the nature of dreams are both much influenced by the con- dition of the body. Few are so fortunate as to have escaped an attack of incubus, or nightmare, arising from disordered diges- tion : and all who have been much with children, know well how liable they are to suffer from disturbing dreams, whenever the stomach and bowels are disordered. It may be safely asserted that a large proportion of uncomfortable dreams are connected with disorder of the digestive functions — gene- rally overloading, but sometimes the re- verse. Some people always dream if they do not take some slight refreshment just before retiring to rest. Mental excitement during the previous day is of course a fre- quent cause of dreaming. Organic diseases, which give rise to oppression within the chest, such as diseases of the heart, are peculiarly liable to occasion uncomfortable dreams and nightmare. Uneasy and pow- erful sensations excited upon any portion of the body occasion what are called sug- gestive dreams ; that is, the sensation seems to start some thought in relation to itself from which a train of incongruities, such as occurs in dreams, appears to arise ; a blister is the foundation for some dream of torture ; or a loud sound for one of tumult. Although made the subject of much cre- dulity, dreaming, not only in its general character, but as regards the nature of the dreams, is not to be altogether disregarded with respect to the indications it affords of the bodily condition. When natural sleep is thus disturbed, particularly by dreams which cause alarm and uncomfortable sen- sations, or which occasion children to start and scream, the cause should be investi- gated ; some error, simply as regards diet, either as to time, quantity, or quality, may be the reason ; or disease may be forming. One or two smart purges will frequently remove the symptom. Whether in child or adult, should much mental exertion be going on, and sleep become unusually disturbed by dreaming, mental relaxation and a greater amount of physical exercise should be com- bined with attention to all the functions. The shower-bath, either generally or as a local application to the head alone, will be useful in such cases. Refer to Sleep. DRESS.— See Clothing. DRESSING.— This word is employed by the surgeon to express the application of various substances or agents to diseased or wounded parts, to protect them from the action of the air and from external injury, and, either by mechanical action or other- wise, to promote their healing or cure. It is, of course, also requisite both for clean- liness and for the comfort of the patient and of those around. In former times, the process of a surgical dressing was a much more formidable and complicated affair than it is now under the modern, simpler, and more efficient practice of surgery, which is sometimes too simple to please patients. As the treatment and mode of dressing burns and wounds is re- ferred to in the articles on these and similar subjects, it is unnecessary to reiterate them here, and for what is requisite respecting the application of bandages, the reader is referred to the article itself. At present it is proposed to give rather the principles on which dressings generally should be con- ducted, than their details. The first essential in dressing is gentle- ness and lightness of hand. Parts which require the process are generally in a state of greater or less inflammation, and conse- quently of increased sensitiveness ; and the patient, owing to the weakness which ac- companies or follows disease or accident, is most probably in an irritable and nervous condition ; for these considerations, if for no other, the dressing, which is so often dreaded, should be conducted with the utmost gentle care. The next essential is to have at hand whatever is likely to be wanted; warm, soft water, with a sponge — or in its place some soft material — scissors, and lint, or linen. A piece of waterproof material to place under the part is often useful. If plasters, bandages, &c. are re- quired, they should not have to be sought for or cut when the wound is exposed and the patient waiting. If the old dressings have become in the least hard or adherent, DUE 211 DUE or, if plasters form part of the applications, they should all be well softened by the warm water before the attempt is made to remove them, and they should not be pulled away. When strips of plaster are to be taken off a wound, the lips of which they hold to- gether, they should be lifted at both ends, so that the detaching process meets just at the wound; the object of this proceeding is to prevent the newly-healed and adhering surfaces from being torn asunder, which they are likely to be if the plaster is pulled off from end to end. For taking dressings off wounds, a pair of "forceps," as repre- sented, (fig. lxii,) will be found useful. Fig. lxii. When the old dressings have been removed, the parts around the wound should be gently but thoroughly cleansed. If there are any loose, mortified, or "sloughing" substances upon the wound, they may be lifted off; but its surface must not — as is too frequently done, even by medical men — be washed and deluged with water. The matter which covers the surface of a wound is the protective covering provided for it by nature, and if this be removed, it is much more likely to become irritable and painful, and to be longer in healing. When the proper cleansing has been effected, the re- quisite dressings should be put on without delay, leaving room, if there is likely to be much formation of matter, for its due dis- charge — the part being so placed, when the dressing is finished, that the discharge can easily escape. The various dressings requisite for inju- ries will be mentioned in their proper places and articles, but one often recommended in this work requires notice here : it is the simple water-dressing. This is at once the most convenient, agreeable, and universally applicable dressing to wounds of every kind. The popular fallacy, that the applications have in all cases something to do with the healing of wounds, is very apt to make people, especially the poor, look suspiciously on so simple an agent as pure water. It is true, the interference of art is frequently requisite, either to stimulate or to repress action while wounds or diseases are in pro- cess of cure; but in the majority of in- stances the cure is the work of the natural powers alone. All that has to be done is to place these in as favourable a position for exerting their agency as possible, and nothing answers this purpose so well as pure, soft water. The application is made either by linen or lint soaked in the water — warm, tepid, or cold, as most agreeable to the sensations of the patient — and is in most cases covered over with some material which will prevent evaporation. Oiled-silk has generally been used for the purpose, and oiled-calico where economy is an object, but latterly thin sheet gutta-percha has been employed, and answers extremely well. If linen or common lint is used, it will require folding at least double to enable it to retain moisture sufficient. As a dressing, Taylor's new patent lint is a much thicker and more spongy, and, for this purpose, better adapted material than the others. Water-dressing is not necessarily covered with waterproof material ; if the part requires keeping very cool it is better not so, but then it will re- quire much more frequent wetting, either by a nurse or by the system of irrigation recommended under article Cold. When waterproof material is put over the wet linen or lint, it of course prevents evapora- tion, and keeps in heat ; it should always be larger than the lint. A mistake is very commonly made in this matter. A great piece of linen or lint is put on with its edges sticking out beyond the oiled-silk, or what- ever is used; and these edges, or even a very slight protrusion, are sufficient to drain off the entire moisture, leaving what ought to be a most soothing dressing, a dry and irritating one. Among the poor the most complete ignorance respecting the use of water-dressing prevails — it is too simple to get much of their confidence, and very often, unless the most particular and re- peated directions are given, the waterproof material — mistaken for a plaster — is put next the sore, and the wet lint on the top of it ! Of course, when requisite, any de- scription of lotion can be used as a dressing in this way in place of the simple water. So universally applicable is the water-dressing, and lotion applied in the same way, that DKI 212 DEO they may almost entirely supersede oint- ment, to which there are many objections. A greasy application is seldom as pleasant, and never so cleanly, as the fluid one ; moreover, ointments are very often indeed used rancid, and thus become sources of irritation rather than of benefit. When a simple greasy dressing is required, a little perfectly fresh lard, or olive-oil, is as good as any. Refer to Adhesion — Bandages — Blisters — Burns — Wounds, tyc. DRINKS.— Fluids taken by the mouth may be simple, medicated, nutrient, or sti- mulant. The only simple drink is -water. When agents which act medicinally upon the body are dissolved in that fluid, as in the case of mineral waters, either natural or artificial, when it is rendered alkaline or is acidulated, or is impregnated with car- bonic acid gas, as in the case of soda-water, it becomes a medicated drink. Barley- water, toast-water, milk, &c. are examples of nutrient, and alcoholic liquors, tea, cof- fee, &c. of stimulant drinks. It is difficult, however, to draw the line between these classes. Many drinks which might be called medicated are in daily use ; those which are stimulant are in many cases nutrient, and vice versa. As drinks come under the head of " Diluents," the reader is referred to the article under that head. DRIPPING. — As this article is often used for household purposes, or given away, it should be known that symptoms of lead- poisoning, or colic, have been induced by the drippings from meat which had been baked in a newly-glazed earthen vessel ; the lead-glaze being soluble in the fatty- matter. Neither should what was said of the power of fatty matters to act upon cop- per, when kept in vessels composed of that material, and especially if mixed with salt, be forgotten in connection with this subject. DROPSY — Is the effusion or accumulation of the serous or watery portion of the blood (such as we see thrown out in a blister) in any of the tissues or cavities of the body. Thus the watery effusion may take place in the cellular tissue, (see Cellular Tissue,) which connects the various portions of the body, and fills up their interstices, in which case it will show itself in the eyelids and other portions of the face, or swell the feet and legs, hands and arms, or the body gene- rally. This form of dropsy is called by medical men "Anasarca." The effusion, on the other hand, may be into some of the larger cavities, as into the abdomen, when it is named "Ascites ;" or into the cavity of the chest, between the lungs and ribs, when it is known as " Hydrothorax," or water in the chest. Again, effusion may take place into some of the smaller cavities, or rather "sacs," as into the bag which surrounds the heart. Whenever it occurs, dropsy is always to be regarded seriously. It is not, as the unprofessional generally think, a disease in itself, but it is almost invariably a symptom of disease, either constitutional or local, ex- isting in the system. It is not here meant that dropsy is not a disease, but that it is generally a secondary one, not the original affection, which may, however, be so ob- scure, that nothing is left for the practi- tioner to treat but the dropsy, and that he must get rid of, if possible ; for though in itself an effect only, it tends to produce other diseased actions, by impeding or stopping the functions of important or vital organs. Anasarca, or effusion into the cellular tissue, may be simply the result of general constitutional debility, of which the blood- vessels, both large and small, and the heart partake ; this form of dropsical swelling usually shows itself in the feet or ankles toward night, especially after long standing ; many delicate persons are subject to it as a temporary ailment, when from any cause the general health has become impaired. When it shows itself and continues in the weakly, as in delicate girls, along with weak- ness generally, pallor, &c. it is only to be got rid of by measures which restore the tone and vigour of the system, such as good diet, with port wine and porter, tonic medicines, exercise, and change of air. Should the error be made of confounding it with an in- flammatory condition of body — and the quick irritable pulse might mislead — and lower- ing measures be resorted to, the disease will be greatly aggravated. Local anasarca, or dropsical swelling, may arise from any cause which impedes the return of the blood through the veins, and is a very common accompaniment of disease of the liver or heart, or of tumours which press upon the great veins : of this, pregnancy, which often occasions swelling of the legs during its continuance, is an example, the effect passing off as soon as the cause is removed. The lower limbs are the most frequent seat of anasarcous, or, as it is often called, " ©edematous" swelling ; but the hands, face, &c. are also occupied by it; indeed, swelling of the eyelids in the morn- ing, with stiffness on first trying to open them, is often one of the first symptoms of the tendency to dropsical effusion, whatever the cause. Again, anasarcous dropsical swelling may be occasioned by an affection of the kidneys, which cannot carry off the DRO 213 DRO fluid from the body with sufficient rapidity. The above are all instances of what are called "passive" dropsies; the cause generally acting slowly, and unaccompanied with a marked feverish state of the system ; there are, however, forms of dropsy which are attended with this feverish state, and in which the watery effusion takes place rapid- ly — sometimes surprisingly so. The best instance of this is the acute form of dropsy, which is apt to happen to convalescents from scarlet fever, and which is traceable to cold. Whatever occasions "anasarca," or effusion of watery fluid into the cellular substance of the body generally, may also cause its occurrence in the cavities, as of the abdomen or chest; but it may also take place both in the large and small cavities, as a consequence of local inflammation. Their lining "serous" membrane becomes inflamed, and pours out a watery secretion in greater or less abundance. It is matter of popular information, that dropsy in the belly is apt to follow inflammation, and that water in the chest results from pleurisy. From what has now been said in expla- nation of the nature and causes of dropsy, it must be evident that its serious treat- ment is not for the unprofessional; the I causes are often too obscure, and the proper and efficient remedies too active, to be in- trusted to non-medical hands, particularly as it can rarely be an emergency. A case of inflammatory dropsy, such as occurs after scarlet fever, might of course happen at a distance from medical aid ; and for the measures to be adopted the reader is referred to the article Scarlet Fever. No matter what form dropsy assumes, the case should at once be put under medical superintendence. As temporary palliative measures, the bowels should be kept either simply open or actively purged, according as the patient is of weak or strong habit of body ; and the effusion of water may be kept in check by the use of diuretic remedies. (See Diuretics.) Of these, infusion of broom or dandelion, cream of tartar, sweet spirit of nitre, or saltpetre, will be found the most suitable. Refer to Blood — Diuretics — Urine, §c. DRO WNING— Is death by suffocation from immersion in fluid. Few subjects treated of in this work are more important. Accidental drowning is so frequent an occurrence, and it so often happens that no medical assist- ance is at hand during those first few precious moments after the body of a drowned person is recovered from the water, that some by- stander, who is possessed of the knowledge, not only of what ought to be done, but of what ought to be avoided, may have the satisfaction of saving a life which must otherwise have been lost. When an indi- vidual falls into the water, especially from a height, there may or may not be consi- derable shock, from the body striking the surface ; or the head or other parts may have struck against a stone or some hard body ; or there may have been fainting caused by the fright : all these circumstances must, of course, modify the effects. The last has been said to account for those cases which have been reported as recovered, after very long immersion, that is, half an hour or longer. The longest well-authenticated time of complete immersion, after which recovery has been effected, is fourteen minutes, and this case stands by itself. Other cases of ten, six, and five minutes are recorded, but there is always doubt whether immersion has been complete during the whole time; this doubt, however, which must occur in most cases, is the very reason why hope should not be abandoned, even after persons may be thought to have been in the water a considerably longer period ; and though it might be established that none could be entirely under water for five minutes, and recover, this is not to be acted upon ; half an hour's supposed immersion, or even longer, should be no barrier to efforts at restoration. When an individual falls into water, the body generally rises again to the surface, when an effort to breathe is made ; air may be drawn in to some extent, and with it water, more or less, which passes into the stomach ; this may be repeated two or three times, or efforts to breathe may be made beneath the surface. However this may be, the contact of the water in the breathing effort causes closure of the " glot- tis" or chink at the upper part of the wind- pipe ; a small portion of fluid may pass in ; but the principal effect is the exclusion of the air, and thus the drowned person is effectually suffocated, and the lungs in a considerable degree emptied of their air, which is pressed out in the vain respiratory efforts, and rises in bubbles to the surface. The amount of water which may have been swal- lowed is comparatively of little moment, andean have but little, if any thing, to do tvith the fatal consequence. A person, therefore, who is rescued from the water after immersion, if not dead beyond recall, — and here is the doubt of which they should be given the ad- vantage, — is partially suffocated; the vital powers are also depressed by the action of cold, and probably also by the struggles and shock, both mental and bodily ; but still the DRO 214 DEO machinery is perfect, — the pendulum may be stopped, but the spring may yet be capable of action. In other words, vitality, though apparently suspended, may yet linger in a frame of which the structures are as capable as ever they were of acting as its agents ; the mysterious link which binds them in ac- tion may be almost severed, but our efforts may restore it. The first thing to be done when a person apparently drowned is rescued from the water, is to wipe and cleanse thoroughly the mouth and nostrils — the next to apply warmth to the body. This last cannot pos- sibly be done as long as it is covered with wet clothing ; and if this is the case, it should be removed — cut off, if necessary for haste — as quickly as possible. If there is a house or shelter of any kind very near the spot where the body is got out, it may be taken to it at once and before the clothes are removed ; but if such is not the case, provided dry coverings are at hand, the wet clothes should be stripped off on the spot. In removing the body, it is best done by laying it on the back or side, on some flat board, such as a door or shutter, the head and shoulders being well raised ; but if there is no- thing at hand on which the body can be laid, care should be taken in carrying it that the head is well supported, neither allowed to fall back, nor forward upon the chest. As soon as may be, warmth is to be ap- plied to the entire external surface ; if a warm bath — temperature 98° — is available, it should be used ; if not, the body is to be covered up with warm things ; bags of hot bran, hot salt, or sand, or any other con- venient vehicles for heat are to be placed wherever they can be, without interfering with the necessary manipulations ; to the pit of the stomach, and to the feet espe- cially, their application is to be used. Frictions with stimulants of some kind, such as camphorated oil, brandy, or any other spirit mixed with oil, or turpentine, should any of them be used warm, and rubbed in with a flannel ; a warm stimulant clyster, consisting of gruel — temperature 100° — containing a tablespoonful of tur- pentine, or double the quantity of brandy, may be given, and strong-smelling salts held to the nostrils at intervals. Artificial respiration, recommended by some, is con- demned by others! Certainly the old me- thod of using bellows and other means to inflate the lungs was much more likely to do harm than good, particularly in the hands of the unprofessional, who would be much more likely to inflate the stomach, and thus impede respiration. Attempts to imitate the natural process of respiration may, however, be made by pressing inward the ribs and pit of the stomach, and allow- ing them to rise again by their own elas- ticity, repeating this process twenty or five- and-twenty times in the minute. Galvanic and electric shocks passed through the chest and upper portions of the spine would pro- bably be useful, if the apparatus chanced to be at hand — but this will seldom be the case. The new electric belts will probably, however, afford greater facility in this re- spect. These are, however, but accessary means, which may be employed or not, as available and convenient, and as far as they do not interfere with those essential remedies which are most to be relied upon: these are, external warmth and continued friction, with care taken that the shoulders and head are raised, the mouth and nostrils free. For the more easy application of remedies, the body should be laid on a table of convenient height. Having now mentioned what ought to be done in cases of drowning, it is necessary to notice what ought not to be done ; for many old and most injurious modes of treat- ment are still apt to be resorted to by the ignorant and prejudiced. Most of these have originated in the idea that water swallowed was, or had something to do with the cause of death ; hence patients have been hung up by the heels, rolled on barrels, choked with emetics, under the idea of making them disgorge the water. Undoubtedly, if there is much water swal- lowed — as sometimes happens — it would be better to remove it ; but any means which unprofessional persons can use for its re- moval would only be a worse evil. If a medical man is present, and thinks well to use the stomach-pump quickly, remove the water and replace it with a small quantity of hot brandy and water, it may be of service; but no attempts should be made to administer any thing by the mouth as long as uncon- sciousness continues. In cases of drowning, the motto should be, — never despair : when all hope seems to have vanished, and no sign of life been given for one, two, four, six, or even eight hours, the perseverance of those around has been at last rewarded, and existence preserved. After a person has been restored to con- sciousness, there may be considerable con- gestion of blood about the head, which may require leeches. In all cases of recovery, the greatest care must be taken to preserve the re -excited actions ; if stimulants are thought requisite, they must be given most DRU 215 DYS cautiously, and all sources of excitement, such as visits from friends or relatives, guarded against ; hot fluids, tea, coffee, and the like, should be given moderately, and the strength supported by nourishing meat soups. — Refer to Lungs — Suffocation, §c. DRUG — Is the general term applied to medicinal agents used in the treatment of disease ; it is, however, more generally em- ployed with reference to the crude or com- mercial substances ; after these have under- gone preparation, they are usually called medicines. Although, undoubtedly, many medicines are largely adulterated in this country, many are impure in consequence of the adulteration of the drug in its collec- tion or preparation by the natives of the country of which it is a product. Thus, senna is largely mixed with the leaves of other plants, opium with seeds and leaves, and sometimes with small stones, &c. &c, to increase its weight; scammony is mixed with chalk. As, however, the adulterations to be guarded against are mentioned under the respective articles, the reader is referred to them. [The recent appointment by Con- gress of an inspector of drugs will do much, it is hoped, to prevent or detect adulteration in drugs imported into the United States.] Refer to Medicines. DRUM of the EAR, or Tympanum — Is an anterior portion of the organ of hearing, which contains the small bones and air. See Ear. DRUNKENNESS.— See Intoxication. DRY CUPPING.— See Cupping. DUCT — Is a medical term applied to a tube or " canal," adapted to convey fluid from one part of the body to another. Thus, the "hepatic duct" conveys the bile from the liver into the intestines, the "salivary ducts" carry the saliva into the mouth from the glands, by which it is secreted from the blood; the "thoracic duct" (see Digestion) conveys the chyle into the blood, &c. &c. DULCAMARA, or Solanum Dulcamara, OR BITTER-SWEET, OR WOODY NlGHT-SHADE — Are all names for the same native plant, which is, however, widely distributed over the temperate portions of the globe. It is a shrubby climbing plant, bearing clusters of flowers, closely resembling, but smaller than those of the potato, which belongs to the same family. Under its name of "bitter- sweet" it is well known in the country. It flowers in June, and in the autumn bears clusters of red, somewhat transparent, ber- ries. The twigs are used in medicine, and arc directed to be gathered when of the thickness of a goose-quill. The medicinal use of dulcamara is as a soothing diapho- retic, producing perspiration, and it might be used in the absence of other remedies for this purpose. To make the decoction, one ounce of the twigs, chopped, is to be boiled in twenty-four ounces, or a pint and a half, of water, till it is reduced one-third. Of this, the dose is two to six tablespoonfuls twice or thrice a-day. [Dulcamara tea re- duces the venereal desires, or is an " aphro- disiac." In this way it is highly useful. It is also employed in the treatment of "Tet- ter."] Refer to Diaphoretics. DUMBNESS— Or inability to utter arti- culate sounds, may arise from absence of the tongue, or from defect in the formation of the organs of voice ; probably, also, from causes affecting the nerves which supply the organs of speech ; but most generally from complete deafness, either congenital, that is, dating from birth, or as the result of disease before the power of speech had been acquired and fixed in the memory. Refer to Deafness. DUODENUM.— The fifet portion of the small intestines, and that immediately con- nected with the stomach. It derives its name from the idea that it did not exceed twelve finger-breadths in length. Refer to Alimentary Canal. DURA MATER— Is the term applied to a firm white fibrous membrane which lines the skull on the one hand, and invests the brain. Between it, however, and that organ, two other membranes lie: the "arachnoid membrane," so named from its extremely fine texture, which lines the dura mater, and also covers the brain, forming a double layer, or "shut sac," in the interior of which a watery fluid is exhaled ; and the "pia mater," or vascular membrane of the brain, which lies directly upon and covers the organ itself. The " dura mater" is prolonged into va- rious "processes," or projections, which pass between and give support to the differ- ent portions of the cerebrum, or brain, and cerebellum, or little brain, which are in fact partially separated from each other by a fold of the dura mater. This membrane, and the others above mentioned, are con- tinued from the interior of the skull down the spinal column. Refer to Brain — Spine, Src. DWELLINGS.— See Houses. DYSENTERY— Or, as it has been popu- larly called, "bloody flux," is a disease characterized by severe diarrhoea, fever, &c. the accompaniment of a peculiar in- flammation of the mucous membrane lining the large intestines. It is much more fre- DYS 216 DYS quent in tropical climates and marshy dis- tricts than it is in this country at the pre- sent day, although formerly it was very prevalent, forming a large item in the bills of mortality of a hundred or a hundred and fifty years back ; and at times showing itself in a fatal epidemic form. It is pro- bable that the diminished occurrence of dysentery in England at the present day is owing to the increased comfort of the popu- lation, the drainage of the land, and some attention to sanitary influences ; for, defi- cient as the regulations attached to these still are, they are certainly better than they were a century ago. A kind of dysenteric affection — that is, severe diarrhoea, with fever, tenderness of the bowels, indicative of inflammation, and bloody stools — is fre- quently met with in autumn during the prevalence of the common cholera morbus. Dysentery appears to be engendered by exposure to cold, wet, and to privations connected with food ; hence it has been one of the greatest scourges of armies. " In two years and a half tne British army in Spain lost no less than 4,717 men by this com- plaint." The same causes and its connection with variations in climate, particularly with a hot one, must render dysentery a disease respecting which the emigrant ought to possess information ; for it may happen, and it often does, that the disorder attacks those far removed from medical aid, and it is not one which brooks much delay in treatment. Medical men in this country have comparatively so little experience of the disease, that the author gladly avails himself of the recent valuable work of Dr. Parkes in the compilation of this article. By this author the symptoms of dysentery are thus succinctly described: — "Dysentery commences either gradually or suddenly ; the general commencement is, however, by diarrhoea. " First, as to the kind of stools. "These are, first, simply numerous, per- haps feculent, in a few very rare instances scybalous — (that is, containing hard black- looking lumps, about the size of beans or nuts, called by medical men scybalse.) "After this the stools become numerous, slimy, gelatinous, bloody ; blood in streaks, or mixed with a dark watery fluid ; in an- other form pure, perhaps clotted. After- wards, stools watery, muddy, like the wash- ings of meat, or gelatinous-looking, shreddy, offensive in odour. Sometimes after this the stools present an appearance some- thing like pus, (matter,) or this is mixed with mucous slime and blood, in such a way as to form a variously coloured stool, which causes great griping and tenesmus when With respect to the causes of dysentery Dr. Parke says — " We may admit as both predisposing and exciting causes, according to circumstances, the following agents : — "1st. All acrid agents, whether pro- duced by irritating ingesta, or secretions ; as bad or too rich food, bad water, fruits, or retained excretions, or derangement of the biliary secretions, &c. " 2d. Suppression of secretions rapidly accomplished, as that of the skin by cold, wet, sudden changes of temperature from hot to cold, &c. "3d. Epidemic states of the atmosphere, and probable alteration of the blood, either from food or its digestion." The power of these causes to produce dysentery should be well fixed in the minds of all those whose lot it may be to be ex- posed to their influences ; for by their avoid- ance the disease may probably be escaped ; and there can be few misfortunes greater than for a new settler, whose welfare, and that, perhaps, of a family, depends upon his health and strength, to be attacked with dysentery. The treatment of dysentery which may most safely be practised by an unprofes- sional person, in the absence of a medical man, would be, in the first instance, if they were procurable, the application of leeches to the belly, [near the groins or around the fundament,] a dozen or more at once, and repeated according to the strength of the patient, if the symptoms remain unrelieved. Should leeches not be obtainable, and even if they are, a warm bath once or twice (if it did not exhaust too much) in the twenty- four hours, would be found useful, \or hot bran poultices to the bowels.'] To allay pain and re- lieve the disease generally, opium is the most valuable remedy ; but as there may be irritating matters in the bowels, they must not be confined, which the opium alone might do, and thus, though relieving apparently for a time, aggravate the disease ultimately. To avoid this, the opium should be combined with castor-oil, or olive-oil, either simply or in emulsion with yelk of egg. If castor-oil is procurable, it should be trusted to ; if not, Epsom salts, in tea- spoonful doses, each dissolved in from half a pint to a pint of gruel or barley-water, or some other demulcent, with four or five drops of laudanum added, may be given every four or five hours. Ten grains of Dover's powder, given once or twice in the twenty-four hours, may probably be of ser- vice, or a pill composed of half a grain of D YS 217 EAR opium, a grain and a half of blue pill, and half a grain of ipecacuanha, may be given every six or eight hours. The safest course, however, will be the treatment by the oily aperients and laudanum. In ad- dition [an enema of half a wineglassful of thin starch, with the addition of fifty drops of laudanum for an adult] will give much relief. Sometimes the lower bowel is too ir- ritable to bear the clyster, or even the clyster- pipe, in which case, a suppository, a pill, made with a grain of opium, mixed with a little flour and water, may be passed into the bowel. The food requires much attention, and should be of the mildest character : milk, and preparations of the grains, and sago, arrow-root, &c, combined with gelatine or isinglass, will be most suitable. [Fresh buttermilk, when agreeable to the patient, is an excellent article of diet, and has by some been regarded as a specific in the treat- ment of the complaint.] If the strength is much reduced, strong concentrated animal soup will perhaps be required. Of course so serious, and it may be fatal, a disease as dysentery should be put under medical care as shortly as possible. In the meantime the above directions may be of much service. " The first appearance of recovery is evi- denced by the stools becoming less slimy, perhaps copious and feculent, or bran-like, or dark and slightly beaten up ; or while one part of the stool is slimy, the remainder consists of natural feculence." A person convalescent from dysentery will, of course, require the greatest possible care in diet ; and also with respect to all exposure to the causes which originated it. Refer to Castor-oil — Clyster — Diarrhoea — Suppository — Tenesmus, §c. DYSMENORRHEA.— Difficult or painful menstruation. — See Menstruation. DYSPEPSIA — Indigestion.— See Indi- gestion. DYSPHAGIA.— Difficulty in swallowing. — See Sivallowing. DYSPNCEA.— Difficulty in breathing.— See Respiration. DYSURIA. — Difficulty in passing water. — See Urine, Bladder, Sfc, THE EAR — Is the organ of hearing, by means of which man and animals are made sensible of what we call sound, that is, of certain vibrations communicated to the at- mosphere, or surrounding medium, which give rise to the sensation of sound, by acting upon the organ fitted by structure to receive them, which organ is connected with the brain, or agent of the sentient mind, by nerves special to the purpose. The entire T organ of hearing is called the ear. Its ana- tomy and functions constitute a wide and interesting branch of study ; but here it will be sufficient to explain just so much as is requisite to give the unprofessional read- ers some idea of the nature of the organ — some rational view of the disorders to which it is subject; sufficient, it is trusted, to guard them against submitting so valuable an agent, of which the varied structures must give rise to varied forms of disease, to be tampered with by ignorant quackery. Any one who will for a moment consider in how many ways deafness may be produced, must see there can be no specific to effect its cure, but that the means of cure must vary with the cause of the disease. The human ear consists of an external, middle, and internal. The external being composed of the flat folded organ attached to the head, usually called the ear, (fig. lxiii. 1,) and of the ear-passage, or "me- atus," (2.) The external flap of the ear is divided by anatomists into various parts, which it would answer no good purpose to go over here ; its evident function is to col- lect as much as possible the body of sound. Its adaptation for this purpose is more plainly evidenced in the movable ears of the lower animals than it is in man. The air-passage, or meatus, is oval in form, curved upon itself, and rather narrowest in the middle ; it contains a few small hairs, and glands which secrete the peculiar bitter wax, or "cerumen," which is probably a provision to prevent insects entering the air-passage. The inner extremity of the ear-passage is closed by a membrane, (fig. lxiii. 3,) that of the tympanum, or drum of the ear : it is placed obliquely. The cavity of which it forms the external boundary, is the portion of the middle ear named the drum, or tym- panum, (4;) it contains air, and communi- cates with the atmosphere by means of the Eustachian tube (5) which opens into the throat. The tympanum contains three very minute bones, articulated or jointed together so as to admit of slight motion ; these, which are represented magnified, (fig. lxiv.,) extend across the cavity ; the small bone (fig. lxiv. 4) — which resembles a stirrup in shape, and, indeed, derives its name, " sta- pes," from that resemblance,) being at- tached at a small opening to a portion of the membrane which lines the inner ear or "labyrinth," as it is called from its com- plex construction. The "labyrinth," or inner ear, is composed of three parts, the vestibule, (fig. lxiii. 7,) the "cochlea," or shell-like portion, (10,) and the semicircular EAR 218 Tig. lxiii. EAR Fig. lxir. canals, (8.) Both the middle and inner ears, and indeed part of the external ear-passage, are accommodated in a portion of the tem- poral or temple bone, excavated for the purpose. To the small bones of the tym- panum are attached four minute muscles, which by their agency act upon the mem- brane of the drum. The office of these bones being evidently at the same time to conduct the vibrations of sound from the membrane of the tympanum, which is ex- posed to the external air, to the membrane of the vestibule, which, with the other parts of the labyrinth, constitute the essential organ of hearing. Within the labyrinth, a watery-like fluid is the medium for conduct- ing the vibrations of sound to the nervous expansions which are also contained within the cavity. The disorders to which the organ of hear- ing is most liable are loss of function, or deafness, noises in the ear, neuralgia or affection of its nerves, abscess within the meatus or in the cavity of the tympanum, chronic discharges, polypus ; and further, the meatus in children is very apt to be chosen as the receptacle for peas, small buttons, or indeed any thing they can poke in easily, but which are often extremely difficult to get out again. The subject of deafness has been already treated of, but the attention of the reader is again called to the many causes which may produce the one effect. The malforma- tion at birth of the inner ear, as a cause of complete deafness, is also connected with dumbness ; or accident may at any time of life injure the delicate structures contained within their cover of bone. The passage of the air through the external ear-passage may be obstructed or prevented by an ac- cumulation of wax or other matters ; the membrane of the drum may be perforated ; the bones may have been discharged by disease ; or the Eustachian-tube be blocked up by swelling temporarily, or permanently, by thickened mucus. There are no diseases, perhaps, which require — as must be evi- dent to all — more tact in their discovery and in their treatment than those of the ear; and yet, till lately, they have been almost entirely left in the hands of ignorant assumers, and the name of "aurist" has almost been synonymous with quack. The anomaly is now passing away, and the labours of talented and scientific men are placing the knowledge and treatment of these disorders upon a more rational and scientific basis. Noises in the ears, such as singings, ring- ing of bells, roaring as of the sea, &c. &c. are often extremely troublesome, and may arise from many and different causes. Mere temporary derangement of the digestive organs will in some persons produce them. They are often indicative of determination of blood to the head, and, when accompa- nied with symptoms of this tendency, ought not to be neglected. Partial obstruction of the Eustachian-tube by cold, or accumu- lation of wax in the external ear-passage, are apt to occasion these noises, and they are accompanied with some degree of deaf- ness. Of course the remedy must vary with the cause. If the digestive organs are de- ranged, they must be regulated ; if cold be the cause, the symptoms may be left to pass away with the temporary ailment. In some cases of chronic or continued noise in the ears, regularly bathing the head E AE, 219 MR with cold water every morning will, after a time, remove it. Ear-ache, or neuralgia of the ear, is treated of under the head of Neuralgia ge- nerally. Abscess in the meatus is often also called ear-ache. It is one of the most painful dis- orders, and is generally the result of cold. It is characterized by intense throbbing pain in the ear, with, frequently, perceptible swelling externally, and more or less fever. There is no relief to pain till the abscess bursts, and this result is to be encouraged by the assiduous use of fomentations, poul- tices, &c. After the matter has discharged, the ear ought to be gently syringed out three or four times a day with warm water, till the discharge ceases. It will be advisable to give a few doses of aperient medicine during the progress of the case. The abscess may form within the tympa- num, and the membrane be perforated in giving exit to the matter. Inflammation of the ear ending in abscess differs from true ear-ache, or neuralgia, in the pain being comparatively slight at first, and gradually increasing in intensity as the disease pro- gresses : whereas in neuralgia it commences with full severity. When the discharge after an abscess does not disappear, or when running from the ears shows itself after acute diseases, such as measles, scarlet fever, &c. the symptom must not be neglected, and should be ex- amined into by a medical man. It is most general in children of weak or scrofulous constitution, and may be with or without disease of the bone ; in the latter case the discharge is extremely fetid, and often stains the linen black. These discharges must not be too quickly stopped, neither can they be allowed to go on without risk ; in the former case, the sudden stoppage may throw back the disease upon the brain ; in the latter, this organ or its membranes may become affected by its gradual extension to them through the bones. Counter-irritation, by blisters or tartar emetic, behind the ears; strict attention to the bowels ; the general tonic treatment recommended under the article Scrofula ; and syringing with slightly astringent washes, such as one grain of lunar caustic, or two of white-vitriol, to the ounce of water, will constitute the most appropriate treatment. The safest plan, however, is to submit the case to medical inspection. Bodies of various kinds are apt to be thrust into the external ear-passage by children, or to find their way there by accident ; and farm-labourers sometimes get grain, peas, &c. projected into the ear dur- ing threshing. If the introduced body is much smaller than the passage, its removal may be attempted by syringing freely, and with a strong syringe ; but if the body fills up the meatus, or nearly so, this will not succeed; and, in the event of its being a pea, or any thing which will absorb fluid and swell, will do mischief. Neither, in case of a large body, which the syringe will not disengage, is it well for friends to attempt the removal in any other way ; they never do any good, and only push the obstruction farther in, rendering its extrac- tion by the surgeon more difficult, particu- larly if it is passed beyond the middle and narrowest portion of the canal. [When an insect gets into the ear, it may be quickly killed or made to come out, by turning the head to one side and pouring sweet-oil into the ear until the canal is full — a change of position will soon empty it, and then the canal should be syringed out with weak soap and water.] Refer to Cerumen — Head^Indigestion, §c. [EAR-ACHE.— See Neuralgia.] EARLY RISING. — There can be no ques- tion, as a general rule, that the habit of early rising is conducive to health ; but, like many other similar matters, the general application would, by many, be converted into a universal law, and much fallacy and no little mischief has been done by the pro- pagation of the dogma. The poets have given their strains, the philosophers their aphorisms, and the hearty centenarian his experience, to eulogize early rising as a sort of elixir of life, and preventive of illness and disease. It is a great good, but not a universal one. It is generally said that all those who have attained great and green old age hare been early risers ; therefore, say others, early rising is a promoter of health ; there- fore, it might be whispered, those whose constitutions have carried them through a long life have been able to be early risers. As in many other things, the truth probably lies between the two ; there have been good vital powers on the one hand, and good habits, of which early rising is often an indication, on the other. The wrong de- duction, however, that early rising is an unmixed good, has occasioned much erro- neous practice, and many a delicate person, either in consequence of the false idea, or badly advised by others, has injured their health materially by perseverance in the practice ; this, however, is more common among the young, than among the aged, who require less sleep. There is no question but that the bodily EAR 220 EDU powers and constitution undergo marked and regular changes during the twenty- four hours — changes which are probably influenced by electrical and other causes not at present understood. At all events, in disease, evening brings fever if it is pre- sent at all, and toward morning excitement abates if it does so at all : further, in health, the body, it is well known, is more obnoxious to the causes of disease in early morning than it is at other times ; and lastly, per- sons of weak nervous power generally feel better toward evening than they do in the morning, even when the refreshment of a night's rest might be expected to have given strength. The reason of these differences it is, perhaps, not possible fully to explain, but we may reasonably conclude that the same influence which causes or aggravates the evening fever, and abstracts excitement toward morning, may also act as the eleva- tor or depressor of the constitution gene- rally, although only felt when it is not in full vigour ; it may, or it may not, be owing to the presence or absence of solar influ- ence, but still it is so, and the fact is one of general experience. The fact, too, explains why early rising is not only not good for all persons, but why to some it is positively hurtful, and why those who are able to practice it are generally of strong and good constitution. Moreover, the fact tells that the person who cannot rise early with im- punity is not in full vigour, but requires means for attaining a better state of health. When the powers of life are raised to the proper level, then, by all means, let them be kept to it, and early rising used as one of the preservative means. What is meant by early rising is getting up from rest before the sun has exerted some power upon the earth ; the exact period to suit the invalid it is impossible to specify — it ought to be matter of experience : that is to say, retiring to rest at a reasonable, early hour, such as ten o'clock, the person should rise as early as can be done without creating feelings of sleepiness, languor, &c. during the day. There are certainly evils consequent upon continuance in bed in the morning, such as perspiration, &c. but they may be greatly obviated by the non- use of feather beds or too much clothing ; they are less, however, than those which result from a nervous system exhausted at a period of the day before it had come into full activity. The same arguments which apply to early rising, also do so to exer- tions or continuance without food by weak individuals in the first part of the morning; they can practice neither with impunity. There is no time of the day so pleasant, and the hale and strong can enjoy it to perfec- tion and gather health in its fresh breezes ; and their description will often tempt the unwary invalid to leave his couch and fol- low the example ; and he really does enjoy, for a short time, the novelty ; but shortly languor creeps over him ; the breakfast which disappears before the appetite of the strong morning-walker has no charms for his exhausted weaker companion, who pays with a day of listless languor for this ill- advised attempt. These hints will, it is trusted, not be taken as an encouragement to laziness, but as pointing out a very com- mon error in popular belief and popular practice. The person of weak vital power, who cannot be an early riser, must guard well that he does not mistake sloth for ina- bility, nor encourage the inability by in- dulging in late hours, which are often to him the most vigorous. Persons who suffer much from debility in the morning, and who are constrained to be up early, ought, as soon as possible, to have some warm re- freshment — a cup of warm milk if it agrees, or tea, coffee, or cocoa. In some cases, the popular addition of a teaspoonful of rum or brandy to milk is undoubtedly useful, parti- cularly where there is tendency to faintness ; but the cordial must be taken as a medicine, and abandoned as soon as possible. Refer to Bed. EATING. — See Food, Digestion, Indi- gestion. ECCHYMOSIS— Is a medical term ap- plied to discoloured swelling, caused by effusion of blood beneath the skin or in the tissues of the body. A common bruise is the most familiar example. ECTHYMA.— A disease of the skin in which pimple-like pustules containing mat- ter are developed. — See Skin. ECZEMA. — A disease of the skin in which minute vesicles are developed. [This disease is sometimes called " chronic ery- sipelas" by the public] — See Skin. EDUCATION — As applied to man, means literally the bringing forward or encourag- ing and regulating the qualities or proper- ties of which his whole being is capable. The natural division of the process is into mental and physical — the education of the mind and of the body. Strictly, in a work like the present, it is with the latter only we have to do, but the two are so intimately con- nected that it is impossible to separate them. So much that is applicable to the subject of physical education is said in the article EDU 221 EDU "Children;" and also in the various arti- cles on "Air," "Clothing," "Food," &c, &c. that it leaves but little to be added here ; and to the above-mentioned articles, and to those bearing upon sanitary mea- sures generally, the reader is referred for information. The great difference between the physical education of the male and female sex com- mences when children leave the nursery. The boy, much less hampered by the mode of clothing, and permitted much more free- dom in physical exertion than the girl, has, as far as these are concerned, a better chance of attaining his full measure of health, provided the mind be not over- worked, and constitution and surrounding circumstances are not absolutely deficient or adverse. The girl, on the other hand, is submitted to many artificial restraints and modes of education which militate strongly against the chance of her making a perfectly healthy woman. The diffusion of a knowledge of those principles on which health depends has, of late years, tended to ameliorate many of the most injurious practices connected with the bringing up of girls, but many yet require to be cor- rected. The bad results which are often brought about by the use of stays have been so often exposed and condemned, that the subject has become almost hackneyed, and yet by a majority of the female sex the practice is still followed to an injurious extent. It seems as if people imagined that the Creator had made the body of the adult female so weak that it cannot support its own weight ; for either on this account, or without reason, they case it up in artificial supports. This abuse extends even among the poorest; and girls of ten or twelve are kept from bending naturally by a stiff piece of wood stuck down the front of what, at least, stands instead of stays. True, these articles of dress do at last become in- dispensable, but it is only after the muscles of the frame have been weakened, in con- sequence of not being permitted to exert their appointed and regular action. Any muscle or set of muscles of the body, if not re- gularly exercised, becomes diminished both in substance and power. The human frame- work or skeleton is so constructed that the muscles with which it is furnished, and particularly those connected with the spine, preserve its equilibrium ; supersede these muscles by artificial support, and they be- come weakened. But as their artificial sub- stitutes cannot act with the perfection of the natural supporters, the defect sooner 12 or later shows itself; the unsupported spine gives way somewhere, and curvature, more or less, ensues. It would astonish most persons, if they were made aware of how many curved spines there are — in how many the deviation exists — who even do not them- selves suspect it; and how often it is the occasion of impaired health, palpitation of the heart, hysterical and other affections. To the above assertion it is only necessary to add the high testimony of Dr. John Forbes, who says, in a note to the article on " Physical Education," in the Cyclopaedia of Practical Medicine — "We lately visited, in a large town, a boarding-school containing forty girls ; and we learnt, on close and accurate inquiry, that there was not one of the girls who had been at the school two years — and the majority had been as long — that was not more or less crooked!" True, the Avhole of this enormous evil is not en- tirely due to the use of stays, but much of it is so coupled with long standing lessons, seats without backs, and too many hours devoted to the education of the mind, by which the constitutional powers generally are enfeebled. Moreover, the above spinal weakness is not the only evil consequence, for it is too often mixed up with disorders of the digestive and circulatory organs, originated by their compression by the clothing. The too prolonged hours of study inflicted upon girls have been alluded to, and are unquestionably a great evil, but they would be less so were the hours of relaxation and exercise more rationally conducted. No exercise can be beneficial j unless the mind be actively interested, or j at least pleasantly occupied during the | time of exertion ; but little good can result I from demure walks, taken without interest, and almost without enjoyment. Nothing perhaps is more certain than that, for the full development and healthy exercise of all the powers of the mind, a healthy body is required. The Almighty I has connected our mental manifestations in this world with a material organ, the brain, : and this organ, like every other in the* body, I is dependent for its healthy action upon that of the other organs: how evident, then, ! that to preserve this wonderful instrument in harmonious and vigorous exercise of its ] powers, the whole body must be in health ! But modern fashion and fallacy, and many modern educationists, say, No ; let the body- and instrument take care of themselves, our part is to elicit as many tones from the latter as possible. And elicit them they do, but they often sadly jar ; moral perceptions and acts, influenced by bodily disorder, EEL 222 EFF often war with moral and religious pre- cepts. The precept "slow to anger" cannot always control the irritabilities of a mor- bid nervous system ; and the not "slothful in business" cannot at all times rouse the body, oppressed by morbid and narcotizing blood, to the active and vigorous discharge of its duties. As long as our abode is in this world, our bodies and minds must be in intimate relation, in action and reaction with one another ; God has joined them, and man cannot dissolve the union without paying the penalty of his transgression. A perfectly healthy mind is only compatible with a perfectly healthy body ; and, in civilized life, with its many causes of dis- order, the latter can only be insured by attention to the laws of physical health and education. The mind, on the other hand, has its influences upon the physical health ; but these will be considered in the article devoted to the subject. EEL — Is one of the oily fishes, and is peculiarly indigestible. EFFERVESCENCE— Is the rapid extrica- tion of gas or vapour from a liquid; hence, foiling is effervescence : medically, however, the term is generally applied to the extrica- tion of carbonic acid gas solely. Many mineral waters, such as Seltzer water, are effervescing, from containing the gas na- turally; soda water and other effervescing drinks are impregnated with it by mecha- nical means, while in fermented liquors it is generated in the process of fermentation. In the practice of medicine, effervescing draughts are most frequently, perhaps, formed by the direct separation of the gas from one of the alkaline carbonates, such as the carbonate or bicarbonate — which latter contains the gas in greatest abun- dance — of potass, soda, or ammonia ; the solution of bicarbonate of magnesia, or "fluid magnesia," is also used for the pur- pose. In many forms of illness, particu- larly those attended with thirst, no kind of medicine is so grateful to the patient, or so readily taken, as that which is given in a state of effervescence. If the stomach is irritable, and a tendency to sickness present, medicines given in this way are more likely to be retained, the carbonic acid apparent- ly exerting a quieting and soothing effect upon the organ ; at the same time, the taste of medicine is considerably obscured by its administration by this method. When the tongue is much furred, and particularly in cases of sore throat, when medicine in any effervescing form can be swallowed, none appears to exert a more cleansing effect, in removing thick mucus and incrustations; and if it does this for the mucous membrane of the mouth, it must probably have the same effect on that of the stomach. Some persons who are liable to suffer from difficulty of breathing, whether from asthmatic or other causes, and those who do not easily get rid of flatulence, cannot take effervescing drinks without incon- venience; this, too, occurs if patients to whom they are administered are confined to bed, and lie down too soon after taking the close. A minute or two ought always to be allowed for the eructation of the gas, before a patient who has taken an effer- vescing draught resumes a recumbent posi- tion. One of the alkaline carbonates above men- tioned being made the effervescing agent, many medicines may of course be given in combination. The acids most generally and beneficially used to combine With the alkali and set free the gas are lemon-juice, citric acid, and tartaric acid ; they ought to be used in the following proportions : — To thirty grains of bicarbonate of potassa, a small tablespoonful of lemon-juice, or twenty grains of either tartaric or citric acid. To thirty grains of bicarbonate of soda, about one-fifth more of the above acids. To six grains of carbonate of ammonia, two tea- spoonfuls of lemon-juice, or about eight grains of either citric or tartaric acid. So common has the use of effervescing draughts become, that the materials, soda and tartaric acid, and a measure for the purpose, are kept in many houses. The practice is not free from danger or injury ; the continued use of soda being apt to im- poverish the blood. To the weakly it is of course more likely to prove hurtful than to the strong. The mode of mixing effervescing draughts which is commonly recommended is a bad one. The two powders are generally ordered to be quite dissolved in separate portions of water before mixing; the consequenee is, the gas is extricated all at once ; the vio- lence of the effervescence — unless the glass is a very large one — is very liable to carry up and spill over a portion of the liquid, and the action subsides before the person can drink. All this may be avoided if the acid and alkali, in fine powder, are put dry into the glass, and the water poured slowly upon them from some little height. In this way the gas is more sloAvly extricated ; there is no spilling, and, if properly done, full solu- tion of the powders ought to be effected. If lemon-juice is used, it should be mixed with the water, and poured upon the alkali in the same way. Of course, when the draught is EFF 223 E M A a very small medicinal one, the same pre- cautions are not required. Refer to Ammonia — Carbonic Acid — Potas- sa — Soda. EFFLUVIUM — Is a gaseous emanation or exhalation from any body, generally of an offensive or noxious character. Effluvia is the plural. Refer to Contagion — Disinfectant, §c. EFFUSION — Is a medical term applied to the throwing out of an unnatural amount of fluid into cavities, or tissues, which ordinarily contain a small quantity only. Thus, the watery fluid which is thrown out into the chest in consequence of inflamma- tion of the pleura or covering membrane of the lungs, is named an effusion. There are also effusions into the abdomen and in the head, also into joints and cellular tissue. EGG — Of the domestic fowl, or of birds generally, as articles of diet, is one of the most nutritious. This is evident, indeed, from the fact, that from the contents of the egg the entire young bird is formed. As a means of nourishment for the sick, espe- cially when it is beaten up, and given mixed either with hot or cold fluid, the yelk of egg is often most valuable. The white of the egg is composed of albumen and earthy salts ; its yelk, similarly constituted, con- tains in addition oily matter and sulphur. In the preparation of medicines of an oily character, the yelk of egg is often ad- vantageously employed, forming with them an emulsion which is'miscible with distilled or rain-water. Castor-oil and turpentine are both advantageously given by this method. ELASTICITY— Is the power possessed by various bodies of returning quickly to the form from which they have been forcibly altered. India-rubber, both in its natural and in its vulcanized condition, presents one of the most familiar and best examples. The elastic properties of this most useful pro- duct of nature have been abundantly taken advantage of in the formation of appliances of various kinds for the treatment of disease, and for the relief of suffering. — See Caout- chouc. The gum-elastic cushions have al- ready been adverted to under the above ar- ticle. The elastic bandages, stockings, and supporters of various kinds are among the most valuable additions to the modern prac- tice of medicine ; and with them may be classed the elastic pads of M. Bourjeaurd, which, while they exert a sufficient amount of pressure, yield, when, from counter- pressure such as that caused by swelling of the part to which they are applied, inelastic hardness would prove injurious. The author makes no excuse for bringing forward these improvements : many persons go on suffer- ing in consequence of not being aware that there are means of relief existing. ELATERIUM — Is a medicine possessing most powerful drastic cathartic properties. It is obtained from the juice of the Momor- dica elaterium, or "squirting cucumber." The plant. is native to the South of Europe. It is a most valuable remedy in proper hands, but one much too powerful to be used with safety by unprofessional persons. ELBOW-JOINT. — See Dislocations — Joints, &c. ELECTRICITY, or the Electric or Gal- vanic Fluid — Is a material agent diffused throughout nature, either latent or unmani- fested, or active and manifested, according to circumstances. Much yet remains to be learned respecting the electricity of our own bodies, and that of the objects and agents with which they are surrounded, and its relation with the phenomena of disease. As an agent in the treatment of disease, electric or galvanic action is now much employed. It is a powerful excitant. The shocks from an electric machine, or other electrical ap- paratus, are not often useful, except in such cases as suspended animation from drown- ing, &c. when their passage in not too great intensity, through the spine, to the pit of the stomach, may be of service. A continued current of the galvanic fluid is a much bet- ter application of the excitant powers of the agent ; and various contrivances for its con- venient medical employment are sold. The latest noticeable application of the curative powers of electricity is the electric chain or belt of M. Pulvermacher, which is made of various sizes and powers. The author has not yet tried the large and more powerful forms of the apparatus, but he has found the application of the smaller chains of much service in the cure and alleviation of neuralgic disease. ELECTUARY. — A medicinal preparation made of sugar. — See Confection. ELEPHANTIASIS— Is a name applied to two very distinct forms of disease. One is a cutaneous eruption, the other a thicken- ing of the tissues beneath the skin and around the muscles. Both are peculiar to hot climates. Their discussion could scarcely be of service in the present work. ELM-BARK, [Slippery El>i]— From the well-known tree, has been used as a remedy in skin diseases. EMACIATION— Is wasting of the tissues so that the body becomes thin. The process of emaciation, however, is very different from simple diminution of bulk : the latter may take place while the appearance of EMB 224 E ME health is still retained ; but with true ema- ciation, the skin, and aspect generally, pre- sent an unhealthy appearance. There are few diseases which are not accompanied with loss of flesh or emaciation, and it is not unfrequently the first observable symp- tom. Dr. Watson remarks — " It occurs in complaints that are not commonly danger- ous — as in dyspepsia, and in hypochondri- asis, which is often connected with dyspepsia — and when it does occur, it marks the reality of the disease. This wasting hap- pens in many fatal maladies — in pulmonary consumption, for example — and in dropsy, although the dropsical enlargement some- times masks it. It accompanies many acute diseases, and is reckoned an unfa- vourable symptom ; for it shows that the body is not properly nourished. Sometimes the emaciation is so extreme that the inte- guments give way — the bones of the patient are said to come through his skin. Refer to Atrophy. EMBROCATION.— A fluid applied, with friction to any portion of the body. — See Liniment. EMETICS — Are substances which excite vomiting ; that is, which cause the stomach to be forcibly emptied of its contents by the mouth, and which do this by a peculiar action, exerted either directly upon the organ itself, or in consequence of their having been taken into the circulation; thus, vomiting maybe excited by the injection of some emetic substances into the veins. Many agents are capable of exciting vomiting, which are not classed as emetics, such as nauseous tastes or smells, swinging motions, such as that which causes sea- sickness, mechanical irritation of the throat, &c. ; but these causes are very different from the specific action of a true emetic, which acts independently of taste or smell. Emetics constitute a class of our most valu- able remedies, although not so indiscrimi- nately and extensively used as they were formerly. In ancient times, particularly among the luxurious Romans, emetics were commonly employed for the disgusting pur-, pose of enabling them to disgorge one luxu- rious meal as soon as swallowed, that they might immediately begin with another. " Cicero, in describing a visit paid to Csesar at a villa near Rome, states that Csesar paid him the high compliment of taking an emetic before dinner, when he understood that Cicero intended to spend the day with him." The emetics most generally used, and most useful, are — Antimony. Ipecacuanha. Sulphate of zinc, or white vitriol. Chamomile. [Alum.] Mustard. Salt is sometimes used as an emetic, and the mechanical irritation of the throat is often resorted to with benefit for the pur- pose of exciting vomiting. The reader will find further information respecting the above emetics under their individual articles. When an emetic is given, it should be mixed in the first place with a small quantity of water. Except in the cases of sulphate of zinc (and some other mineral emetics not adapted for domestic use) some little time will elapse before the effects of the emetic are experienced — longer if the sto- mach be full of food, and vice versa. The first sensation is one of nausea, accompanied with a flow of the saliva, slight faintness, and cold perspiration. At last the effort of vomiting supervenes, and the contents of the stomach are ejected. As soon as actual vomiting commences, as a general rule, but not before, some tepid fluid (water, gruel, chamomile-tea, or such like) should be given in moderate quantity, not exceeding a pint at a time. A slight caution is requi- site upon this head, for occasionally indi- viduals under the action of an emetic are encouraged to drink very freely of fluid and to distend the stomach. This is not well, for it not only embarrasses the action of the organ, but might cause its being lacerated or burst. It is also requisite to caution against giving the diluent fluid too soon, that is, before the specific power of the emetic substance has come into action. If this is done, the dilution will either delay, or altogether prevent the desired effect. When there is much debility of stomach, it is better to choose for the diluting fluid, a bitter, such as chamomile-tea, which has the additional advantage of being itself emetic. As a general rule, the mineral act more quickly and violently than the vege- table emetics. For this reason the former are generally selected in cases of poisoning, such as that by opium, in which there is some difficulty in rousing the stomach to action at all, and in which it is important that it should be relieved of its contents as speedily as possible. In such cases medical men may give the sulphate of copper ; but for the unprofessional, the sulphate of zinc, or white vitriol, is the safest, and is a nearly equally efficacious remedy. When there is much fever, and in some forms of inflammation, the salts of anti- mony, particularly tartar emetic, are most EME 225 EMI generally used if emetic action is desirable. As a simple emetic to relieve the stomach, and also in cases of chest affections, ipeca- cuanha will be found the best. In diseases of depression, mustard is most useful, and carbonate of ammonia may also be employed alone or combined with ipecacuanha. In cases -where the power of swallowing is lost, medical men can excite vomiting by the injection of emetic substances into the veins. This practice, of course, cannot be followed by the unprofessional, yet they may safely, and with much certainty of suc- cess, have recourse to mechanical irritation of the back of the throat, either by the fin- ger or by a feather. A few individuals possess the power of spontaneous vomiting, or at least of exciting regurgitation of the food from the stomach into the mouth, a process somewhat analogous to the rumina- tion of animals. Such persons usually suf- fer from dyspepsia, and have recourse to the operation to free the stomach from food it cannot digest. The evening is generally the most suitable time for administering an ordinary emetic, as the stomach has time to recover itself duiing the night, and the uncomfortable nausea which often follows is less felt. Emetics are used to fulfil various indi- cations, the most direct and obvious being the emptying of the stomach of any nox- ious substances, either formed within the body, such as bile, or taken in by the mouth, as indigestible food or poison. For- tunately, these matters often of themselves excite vomiting, but in many instances, they do not sufficiently empty the stomach, in which case the action must be kept up, or re-excited, either by a diluent or by some emetic medicine. It must be remembered, however, that in the case of some poisons it is not desirable to dilute largely. In addition to their power of emptying the stomach, emetics are valuable from the mechanical effects, both general and local, which they exert upon the body. Formerly, the general mechanical effect, or " shock," of an emetic, was believed to have the power of checking fever and other diseases at their outset. It is not now, however, much trusted to by medical men, and, if it does not do good, is apt to prove injurious, by causing an irritable condition of the organ, which may continue throughout the disease. In many cases of incipient disease, however, characterized by depression, coldness of the skin, &c. the mechanical action of a smart emetic of ipecacuanha, either alone, or with five to eight grains of carbonate of am- monia, is most beneficial, by rousing the system, and removing the tendency to in- ternal congestion, or accumulation of blood. Another and most beneficial mechanical emetic effect is in the case of children suffering from affections of the chest, with accumulation of mucus, or phlegm. Chil- dren cannot expectorate, and are liable to be suffocated, if the phlegm is in large quan- tity and cannot be removed. Nothing in- sures its removal so effectually as an emetic, or rather emetics repeated from time to time (every few hours) according to circum- stances. In cases of jaundice and over- loaded liver, the mechanical action of eme- tics is often beneficially had recourse to. In consumption, the periodical exhibition of emetics has been recommended. In spasmodic diseases, either general, as hys- teria, or local, as in spasm of the stomach, emetics are beneficial — in the latter case, often, of course, by freeing the stomach from the offending cause of the disorder. In asthma they often relieve when nothing else will. Emetics are not always safe remedies. In pregnancy, in persons of very full habit, particularly if there is determination to the head, in rupture, in falling down either of the bowel or of the womb, vomiting should, if possible, be avoided. The ancients held the opinion that emetics strengthened the stomach, and they were even used in the training of the athlet£e. Modern experi- ence certainly does not uphold the fact, for the habitual use of these agents assuredly injures the tone of the organ and weakens its power. An error is frequently committed in using antimonial, or, as it is called, " antimony wine," as an emetic ; it is far too depress- ing for general purposes. For these, ipe- cacuanha is quite the safest agent of the class ; it should be given in powder mixed with water, and not in the form of wine, if the former is procurable. EMIGRATION. — For those who leave their native country and go to seek a home and fortune in other lands, one thing is es- sential to success. Invaluable to all, health is necessary to the emigrant. It is to him a capital of more value than money ; and yet this foundation of future fortune, nay, even of existence, is often carelessly and ignorantly undermined at the very outset of the enterprise. Many are undoubtedly too poor and too ignorant to profit by coun- sel even when it is given, but thousands annually leave the shores of Britain as emi- grants, who are capable of acquiring and acting upon useful information concerning matters of health ; and how few, compara- 15 EMI 226 EMI tively, have even a slight acquaintance with the laws which regulate their being, on the observance of which their health and usefulness depend ! How few are capable of acting intelligently and promptly under the occurrence of those accidents and con- tingencies which it must often fall to the lot of the emigrant to encounter ! Into the hands of some who meditate emigration these pages may. fall ; to them the author more particularly addresses himself. The first thing to be considered must be, not whether gold is to be extracted from the river-sands in one place, or corn is to be grown without exertion in another, but the question should be, What is my consti- tution ? What are its tendencies, hereditary or acquired ? To what climate is it most adapted ? Will it endure the hot summers and severe winters of America, or will these probably develop the consumptive tendency I inherit ? Is it not more suited for Austra- lia or New Zealand ; are not my children more likely to be reared in the one climate than the other? These and numerous other considerations connected with the adaptation of constitution to climate and proba- ble occupation ought to hold the chief place in the decision as to emigration. That being decided, the next is the preservation of health during the voyage. As far as circumstances will permit, a vessel should be selected which guaranties sufficient room, ventilation, supply of water, and fresh food. Of course circumstances must, to a certain extent, modify these requirements ; but let circumstances be what they may, a man had better remain at home, and lay his bones with those of his fathers, than take ship in some of the floating pest-houses that have been permitted to carry across the Atlantic their freight of wretched humanity, marking their track on the deep with the bodies of those poisoned in their iniqui- tous holds, and landing the survivors with disease or death upon them, or with the strong arms that were to win the bread of themselves and children weakened and unnerved. Space will not permit, in a work like the present, the detail of all those means and measures which the intending emigrant should adopt as regards health. Much information on these points he may gather from the various Emigrant's Guides, particularly those of the Messrs. Chambers; and further, he is referred to the various articles in this Dictionary which treat of matters connected with the preservation and regulation of health, more particularly Ague, Bed, Climate, Clothing, Consumption, Food, Medicines, Ventilation, Water, $c. §c. These and others contain many hints which will be found valuable, both in the selection of the future home and of the mode and means of transit. One thing is generally agreed upon, that however good an emigrant ship's dietary may be, it is always advisable for the passengers to add a private one, of such preserves and pickles as means will allow — common cabbage will do, preserved in vinegar — which may afford a supply of the vegetable acids, the best counter-agents to the effects of the salted provisions which necessarily form a large proportion of the food on board ship ; a few bottles of lemon- juice are always a valuable addition to the sea-store. As regards clothing, it is unnecessary to repeat here what is said in the article on that subject ; but it may be mentioned that emigrants who probably have to encounter exposure on first landing in their adopted country, would do well to provide some cheap waterproof material to place beneath them at night. An attack of rheumatism is an unfortunate, and often, when once acquired, too constant companion of the emigrant, and may cripple him permanently. Those who have to undergo the confine- ment which a long voyage must entail, most especially require to attend to all the laws of health, and particularly exercise, which, from the small walking-space on board ship, is often neglected ; it should be a carefully observed rule to walk for a certain time daily. The amusement of the mind is a matter of much importance, even in a health point of view, for those exposed to the monotony of a long sea-voyage. Happy are those to whom books afford their never-ending re- source ! and the time might be worse em- ployed than in the perusal, or rather study, of works like the present. When the new scene of labour is reached, the opportunity will be past, but the man who has acquired for himself information which may enable him either personally to avoid, or, in the case of others, to counsel the avoidance of sources of disease, or to act intelligently and promptly in cases of sudden illness or accident, may have reason to bless the per- haps otherwise wasted time spent in the acquisition of the principles of Domestic Medicine, or of Household Surgery. After landing in his new country, the emigrant ought to inform himself as far as possible respecting the occurrence and causes of illness, either in the one district of his residence, or in those he may have to pass through. As said at the commencement of this EMI 227 EMP article, health is, next to trust in God, the essential; and it cannot be too jealously guarded by the emigrant, to whom its loss is ruin and misery. For information re- specting medicines, the emigrant reader is referred to the article. The following extract from an American publication will, perhaps, add force to what has been said respecting care in selecting a vessel, and attention to the means of health during the voyage : — " The condition of the German and Irish emigrants, prior to their embarkation and during their transit of the ocean,was, in most instances, conspicuously different. While the former were generally robust, and well provided on the passage with the means of subsistence, and observant of cleanliness and ventilation, the latter . were, in most cases, enfeebled for the want of sustenance, and on shipboard destitute of supplies of wholesome food, depressed in mind, clothed in filthy garments, and crowded and con- fined in air rendered pestiferous by the ex- crementitious matters eliminated from their own bodies. In contrasting the hygienic circumstances in which the two classes of emigrants were placed, it is easy to account for the greater amount of sickness and mortality which occurred in one class than in the other. It is said that of the admis- sions of emigrants into the hospitals and almshouses of New York, the Irish exceeded the German in proportion of ten to one. " The Montreal Immigrant Committee, in their report for 1847^-state that that year has been unparalleled for the amount of im- migration into Canada; near 100,000 souls have left the British Isles for these pro- vinces during that period ; over 5000 of these died on their passage out, 3389 at Grosse Isle, 3862 at Montreal, and other places in the same fearful proportions. Never had Canada presented such fearful scenes of destitution and suffering. ' From Grosse Isle, the great charnel-house for vic- timized humanity, up to Port Sarnia, along the borders of our magnificent river, upon the shores of Lakes Ontario and Erie, and wherever the tide of immigration has ex- tended, are to be found the final resting- places of the sons and daughters of Erin — one unbroken chain of graves, where repose fathers and mothers, sisters and brothers, in one commingled heap.' " The disease of which the emigrant pas- sengers, and in many instances the officers and crews of ships, perished at sea, and of which a great number were ill on their arrival in the United States and Canada, was typhus [or ship] fever in its genuine form. In some ships, dysentery, small-pox, h.nd measles swelled the amount of mortality, and added to the number of sick that reached the ports of destination." EMMENAGOGUES— Are medicines which exert, or are supposed to exert, their action upon the womb, and to promote the men- strual discharge. The only well-known medicinal agent which exerts an undoubted specific action of the kind, is the Secale cornulum, or ergot of rye. — See Ergot. Re- cently, a Chinese emmenagogue, the Key- tse-sing, has been highly spoken of; but at present the experience of its powers is limited. Some medicines seem to exert their influence upon the womb by stimulating neighbouring organs : to this class aloes belongs ; others, such as valerian and asa- foetida, by their action on the nervous sys- tem, and another set, such as iron, by their tonic influence upon the system at large. Refer to Menstruation. EMOLLIENTS — Are remedies which pos- sess the power of relaxing and softening parts to which they are applied. Heat and moist- ure, and oil or fatty matters, are the chief and best emollient remedies. EMPHYSEMA— Is a medical term ap- plied to two very different disorders. In one case it denotes a state of coalescence, and unnatural distension of the air-cells of the lungs. — See Lungs. In the other, it is applied to the distension or blowing up of the cellular or areolar tissue of the body by air. This latter form of emphysema sometimes follows upon the accident of frac- tured rib, when a point of the bone pene- trates the lung. In this case, with every breath drawn in, air passes from the lung into the cavity of the chest, from whence it finds its way through the wound made in the walls of the cavity, and by this means be- comes diffused through the cellular tissue ; the features and the whole body become greatly swollen, and when the surface is indented by the finger, a crackling sensation is experienced. The mere distension of the cellular tissue is not a circumstance of so much importance as the accident which gives rise to it, but in those perfectly una- ware of the possibility of such an occur- rence, the appearance presented by the af- fection would cause much alarm : of course the broken rib itself should be attended to ; the emphysema may be relieved by punc- tures made in the skin by a lancet, and by the application of bandages. Refer to Fractures — Rib, Sfc. EMPYEMA— Is a collection of matter in the cavity of the chest, between the lung and the ribs. _ Refer to Inflammation of Lungs. EMP 228 EPI EMPYREUMA — Is the peculiar, and often offensive smell which many substances acquire after exposure to considerable heat in close ovens or vessels. The fact of an article of diet becoming empyreumatized renders it unwholesome and irritating to the stomach ; on this account baked meats, pastry, &c. are more apt to disagree than the same articles roasted or boiled. Refer to Baking. EMULSION— Is a mixture of oil with water by the intervention of a third sub- stance. This may be effected by means of gum mucilage, syrup, &c. ; but perhaps the best agent for forming emulsions is the yelk of egg. The oil must first be rubbed up with the yelk, and then distilled, rain, or perfectly soft water added gradually. Milk, which is itself a natural emulsion, is also a very good agent for uniting some oily or such like matters resembling the oils in composi- tion, with water, particularly camphor. — See Camphor — Castor-oil — Turpentine. ENAMEL.— The outer hard casing of the teeth.— See Teeth. ENCEPHALON.— A medical term em- ployed to designate the parts. generally con- tained within the skull. Refer to Brain. ENDEMIC — Is a term applied to diseases which are peculiar to, and persistent in, certain districts or countries. Thus, ague is endemic in marshy districts; bronchocele or goitre where the water is impregnated with magnesian limestone ; and cretinism in the low dark valleys of Switzerland. These, and other endemic affections, are undoubtedly due to natural peculiarities of soil and climate ; but their power is un- questionably much augmented .by the pri- vations attendant on poverty, and by the depressing influence of dirt and vice ; or, as in the case of bronchocele, by laborious lives. Besides naturally caused endemic dis- eases, there are others which may equally be called endemic, though arising from the artificial circumstances which have hitherto been attendant on man when living in com- munity ; such are the fevers of our large towns, which are so constant in their ope- ration in particular localities, as truly to merit the name of endemic. In many situations, the constitutions of the natives of districts in which endemic influences prevail, appear to become habi- tuated to, or proof against, the morbific causes, which are quickly productive of disease in strangers. Such is strikingly the case in the rivers of the African coast; and the Niger expedition afforded melan- choly proof of how fatal to Europeans a climate may be, in which the natives live with comparative impunity. In many cases something is due to the adaptation of habits and modes of life by the inhabitants, which are either unknown to or neglected by strangers. Refer to Climate — Epidemic, §c. ENDERMIC — Is the transmission of medi- cinal actions to the constitution through the skin. — See Skin. ENEMA.— A clyster.— See Clyster. ENTERITIS.— Inflammationofthebowels. — See Alimentary Canal. Refer to Inflammation. ENTOZOA — Are parasitic animals which are found in a living state within the body. The most common entozoa in man are the various forms of worms. — See Worms. ENURESIS. —Incontinence of urine — See Urine. EPHEMERA.— A fever which does not last more than twenty-four hours. EPIGASTRIUM.— The pit of the stomach. EPIDEMIC — Is a term applied to a disease which attacks a large number of individuals simultaneously, or at least in quick succes- sion. Perhaps the best instance of an epidemic is the well-known influenza, which seems more independent of endemic, or local, influences, than most others of the class. Cholera is an epidemic disease, but the liability to its visitation is evidently connected with local circumstances, which either assist in developing the activity of its mysterious germs, or at all events exert an attracting influence over them. Scarlet fever, measles, small-pox, and other dis- eases of the class, most certainly prevail epidemically at times ; for though they un- doubtedly disseminate themselves by con- tagion, observation would show that the contagious influences are much more potent in different places at different times. The reason why this should be so is not always traceable ; but as regards the greater and more pestilential epidemics, it has been observed that they have been preceded or accompanied by striking vicissitudes in the weather. It is well known that the first extensive diffusion of the Asiatic cholera dated from a swampy district at the mouth of the Ganges, after a very wet season ; and it is matter of history that the epidemics of plague were associated with unusual modi- fications of weather ; the extremes of heat or cold, of drought or moisture. Neither are the epidemic influences always confined to man : the lower animals are also fre- quently and fatally subject to them. It is remarkable, as indicative of this influence, EP1 229 EPI that birds have been observed to forsake districts in which an epidemic pestilence prevailed. Epidemics were much more common and fatal in former times than they have been within the last hundred years. Such were the plague at Athens, 430 years before Christ, the black death or plague of the fourteenth century, the sweating sickness toward the end of the fifteenth, and the great plague of London of the seventeenth. At the present day, the plague of Eastern coun- tries, of Egypt in particular, and the cholera, are the modern pestilences. All these, and many others, are undoubted epidemics ; but equally certain is it that they owed and still owe much of their potency for evil, to local and endemic causes, and to the entire want of attention to sanitary arrangements. However deficient these may be in this country, even at the present day, were it not for such • regulations as there are, we know of no reason why the plague which still lingers around and some- times decimates the neglected oriental city, should not again visit our shores. Refer to Contagion — Fomites, $c. EPIDERMIS.— The outer or scarf skin, or cuticle. — See Skin. > EPIGLOTTIS— Is a cartilage of an oval or heart-shaped figure, situated at the root of the tongue, which falls upoa. and covers the glottis or opening into the larynx, so as to protect it, particularly during the passage of food, in the act of swallowing. Refer to Larynx — Swallowing, §c. EPILEPSY, or Falling Sickness — Is one of the very afflicting maladies to which man is subject, belonging to the class of convulsive diseases. It is also one of the most eminently characteristic, and at the same time terrible to witness, when it occurs in its severer forms. The fits, or convulsive seizures of epi- lepsy, are most varied as to occurrence. Occasionally an individual has suffered from one paroxysm, and one only, the disease never again returning ; in other cases, years have intervened ; frequently the interval is one of months, but again, daily fits, or even two or three times a day, are the rule in the worst cases. The attack of epilepsy is for the most part sudden : the individual, in the midst of some accustomed occupation, or while holding active communion with persons around, suddenly utters a loud — a fearful — cry, and, if unsupported, falls to the ground ; the eyes are staring or rolling ; the head, or rather chin, is drawn toward one shoulder, the countenance becomes dark or livid, the veins of the face and temples U turgid with blood, and the features are thrown into convulsive movement ; there is frothing at the mouth, while a kind of choking noise is often made in the throat ; the limbs are also more or less convulsed, and the excretions are often expelled involuntarily. The tongue very often suffers from being bitten, and the teeth have even been frac- tured during the fit. Gradually, these convulsive movements diminish, and the person awakes to consciousness, with a heavy stupid look, or falls into a deep lethargic sleep, which continues for some hours ; but even when roused from this, there often remains slight temporary sus- pension of the activity of the mental func- tions. Such are the phenomena of a severe epileptic paroxysm ; the disease, however, occurs in much milder forms, even in those who at other times suffer from it in greater intensity. A slight temporary unconscious- ness may be the only symptom, with or without the slightest approach to convulsive movement, as evidenced by the twitching of a finger, the roll of an eye, or slight spas- modic action of the muscles of the face ; the patient may fall gently as in a faint, or remain standing as it were asleep for a few moments. As there is every variety in the nature of the attacks, so is there likewise in their duration : from a few moments to the average period of from five to eight minutes, but sometimes much longer. The attack in many cases appears to by- standers to come on suddenly and without warning ; but most epileptic patients are sensible for some time previously of the approach of the paroxysm, and even for twenty-four hours are always aware that a fit is at least probable, although its direct accession may not be certainly known until just previous to its occurrence. It may, however, happen that these symptoms will pass off without a fit, either independently of any effort of the patient to ward off the attack, or in consequence of some of those measures found to be efficacious, and adopted by epileptic patients for the purpose. The premonitory symptoms vary greatly: low spirits, or unusual irritability, some- times an increased energy, dizziness, noises in the ears, floating specks before the eyes, and many other signs connected with dis- order of the nervous system, are the pre- cursors of the epileptic paroxysm. But the most generally marked and remarked precedent is the epileptic "aura," a sort of creeping sensation, which is described by the patient as arising at some par- ticular part of the body, such as the ex- EPI 230 EPI tremity of a limb, and gradually ascending upward to the trunk or head, till the indi- vidual loses his consciousness in the con- vulsion. Epileptic seizures are very frequent in the night- time, just as the person is falling asleep ; but they may occur at any period of the twenty-four hours, and may be in- duced by causes affecting the nervous sys- tem; the excitement of joy or passion, or the depression of grief, intoxication, and sexual excesses, are most frequently not only actual exciters, but also predisposers, to the attack of epilepsy. Epilepsy may be a congenital disease, that is, the child is born with the tendency, and becomes subject to the fits, either with or without apparent cause, early in life. Indeed, many of the convulsions of children occasioned by teething, &c. are in fact epi- lepsy, but as they arise from causes irri- tating the brain, and not from affections of the organ itself, they are possibly not re- peated when the cause of the irritation has subsided. If, however, the tendency exists strongly in the constitution, and has not developed itself before puberty, it is very apt to do so at that period, and more espe- cially if favoured by circumstances which lower the tone of the body generally or of the nervous system in particular ; but no period of life is exempt from becoming the period of epileptic development, even to old age. The following observations of Dr. Bright upon this point are generally instructive, he says — " There are leading periods in the evolution of the frame, and peculiar circumstances connected with cer- tain periods, which may well be considered as influential in the production of the dis- ease. In infancy, the nervous system is delicate, and easily acted upon by various causes of irritation. Then follows the try- ing period of teething. In a few years the second dentition occurs. In a few years later, all the great changes connected with the age of puberty. To this follow the excesses and exposures of manhood; and after the lapse of years the vigour of the system fails, and many causes act to derange the nice balance of the constitu- tion : the bowels often become sluggish, &c. &c." A person may die in an epileptic fit, even in the first, but this is seldom the case. More generally the disorder does not imme- diately threaten life, but the individual goes on from year to year, suffering more or less, and still lives ; even when the fits occur daily, or two or three times a day, this is the case. "When death does occur early in the disease it is more probably due to suf- focation arising from the spasm of the muscles of the throat and neck, than to the brain affection. But if life is continued to the confirmed epileptic, the intellect too often becomes affected. This may not be palpable after a first seizure, not even after many seizures for many years, not throughout a tolerably long life, but these are exceptions. The generality of epileptics become feebler in intellect, the memory fails, the power of continuous exertion of the mind is lost, and, perhaps, at last the condition ends in mental fatuity. That epilepsy is due to disease or dis- order of the brain and nervous system is unquestionable ; the affection either directly originating from them, or through them, in consequence of irritation in some portion of the body. It is well ascertained that hereditary predisposition gives greater effect to causes which have plainly exerted influ- ence in the production of this distressing malady. Dating, either directly or indi- rectly, from the nervous system, whatever weakens that system tends to cause epi- lepsy. From this it is evident how well founded the observation is, that there is no more fertile source of epilepsy than the abuse of the sexual organs, particularly in the young. The subject is a painful one, but the direful consequences of vice, with which the merest children become imbued at school, is frequently coming before medical men. Unaware of the sin and evil conse- quences of their acts, they ruin constitu- tions at the most critical period of life, and lay the foundations of epilepsy and other nervous diseases, which are either quickly developed, or do not show themselves till late in life. The subject is one to which parents and tutors cannot be too strongly alive. Intoxication is a cause of epilepsy, and delirium tremens may be complicated with it. Strong and prolonged mental exertion may induce epilepsy. Fright is another and very frequent exciting cause. Worms and irritations in the bowels, in- deed whatever can irritate the nervous system, may induce the disease in question. Imitation, or at least the witnessing an indi- vidual in the epileptic paroxysm, has been known to give rise to the fits in others ; but they were most likely predisposed, or at all events of nervous and susceptible tempera- ment ; for this reason, such persons, young females and children especially, should never, if possible, be permitted to witness an. epileptic fit. The premonitory cry is so terrifying that it has been known to affect even the lower animals. EPI 231 EPI Of the predisposing causes there is no question that hereditary tendency is a pow- erful one, and, especially, if the constitu- tion of the family be scrofulous. Epilepsy in the offspring has been traceable to no other cause than dissipated and, especially, drunken habits in the father. It is fre- quently observed to be concomitant with malformation, or at least mis- shape, of the head of the sufferer. From what has now been said, it must be evident that epilepsy is no disease for domestic management, in a curative point of view, but that it affords much room for preventive and other means. In families in which a tendency to epi- lepsy is known to exist, the greatest care should be taken to guard the nervous sys- tem from all causes either of irritation or exhaustion. In infancy, the period of teeth- ing and the condition of the bowels will require special attention, and the tone of the system to be maintained as directed in article "Children." The physical strength and health are to be cultivated in early life, even at some sacrifice of educational advancement. At puberty the strictest eye must be kept upon the habits and tenden- cies, and, while the constitution is develop- ing, and growth going on, all exhausting exercises prevented. Indeed, during life, the suspicion of a tendency to so terrible an affliction as epilepsy should be a never- forgotten check upon excess in every way — a check upon the man who consumes his energies in the exertions of business or of study, as well" as upon those who waste them in the pursuits of vice or sen- sualism. In addition to passive preventive means, all those measures which are fully laid down throughout this work for the preservation of health, should be well at- tended to, particularly the use of cold water to the head, spine, and surface generally, if there is sufficient reaction to bear the application. Care must be taken in the curing or sup- pression of accustomed or long-continued discharges, such as habitual diarrhoea, bleeding from piles, &c. At the same time it must be borne in mind that the dis- charge, by weakening the system, may be itself the cause of the disease ; but this is a point which the medical attendant must determine. Certain precautions are always requisite with those who suffer from epilepsy, and, as a general rule, it may be laid down that they should never, if possible, place them- selves or be placed in situations in which a sudden seizure will expose them to danger. Thus, employments which necessitate riding on horseback, ascending heights, &c. ought never to be engaged in, neither such as those in which even momentary uncon- sciousness may involve the lives of others in danger. Even the suspicion of epilepsy in a railway official ought to be a disquali- fying circumstance. Many, it is true, have sufficient warning to enable them to pre- pare for the attack and to withdraw from danger, but this is not always possible ; the worst case of burning, or rather roast- ing, the author ever witnessed, was in consequence of a fall into the fire in an epileptic paroxysm. When means will allow of it, the epileptic ought to have an attend- ant constantly with them. When an indi- vidual is seized with a fit of epilepsy, but little can be done for its immediate relief; the chief thing is to prevent the patient inflicting injury upon himself, by striking against surrounding objects, and also to protect the tongue. Those who are much in attendance upon the epileptic ought always to have at hand a piece of India- rubber, or a thick India-rubber ring — such as is used for children teething — to insert between the teeth. All fastening about the body, such as the neckcloth, &c. ought to be loosened, and air freely admitted ; the head should be raised, and cold wet cloths may be applied to it if there is much heat. It has been advised to cram the mouth full of salt as soon as the fit comes on. Dr. Watson, who had the plan tried in hospital, thought it seemed to curtail the duration of the convulsion. The treatment of an epileptic patient in the intervals of the fits must be left to a medical man ; it involves too many con- siderations to be advantageously managed by others. When well treated, there is a hope of cure, and this chance should be afforded to the patient, which can only be certainly done under efficient and educated management, for even with all that skill and attention can do, the disease often proves intractable. The various remedies which have been used in epilepsy — and they have been very numerous — it would serve no good purpose to enumerate here, further than to state that much benefit has fre- quently resulted from counter-irritation, such as the introduction of a seton in the neck, or, better still, a full and free erup- tion produced over the shaved scalp, by tartar emetic and croton-oil ointment, or down the spine, should any tenderness be detected there. It sometimes happens that accidental counter-irritating effects relieve epilepsy, at all events for as long as they are in action. In one case attended by the EP1 232 EPS author, a man who was suffering from daily- attacks of epileptic convulsion fractured his leg, and from that time had no attack for five or six weeks, during the period the ac- cident was being recovered from. Further, it is well to draw the attention of the reader to the article "Cotyledon." Where the plant is within reach, either of the patient or of friends, there could be no possible objection to its powers being tested, and of them the author can speak favourably. Epilepsy is often a feigned disease, par- ticularly among soldiers and sailors, and also by mendicant impostors. The latter usually choose public places for the exhibi- tion, throw their legs and arms about, foam at the mouth with a little soap mixed with the saliva, and continue their exertions for a much longer time, and with more expen- diture of heat, but with less active power than the real epileptic. A real epileptic is not susceptible to pain or sensation ; where suspicion exists, therefore, some test of this kind which will not injure may well be tried. Snuff may be put up the nostrils, and if it produces sneezing there is no epilepsy ; sometimes the proposal, within hearing of the person, to try some mode of treatment which involves considerable suffering is suf- ficient to dispel the fit. Refer to Ablution — Convulsion — Cotyledon — Children, fyc. EPIPHYSIS— Is the extremity of a long bone, such as of the arm or thigh, which is, in the young, connected with the shaft or main portion of the bone by means of gristle. When such bones are boiled for some time the epiphysis separates, as may be seen in the case of veal or chickens. In children the epiphysis is sometimes separated by ac- cident attended with violence. Refer to Bone. EPISPASTICS— Are substances used me- dicinally for producing inflammation of the skin, which may be followed either by blis- tering or by the formation of matter. Their action is in fact that treated of under the article "Counter-irritation," which may be referred to. — See also Blister, fye. <$fc. EPIST AXIS.— Bleeding from the nose.— See Hemorrhage, Nose, 8;c. EPITHELIUM— Is the external layer of a mucous membrane. — See Mucous Mem- brane. EPSOM SALTS — Are a compound of magnesia and sulphuric acid, (sulphate of magnesia,) and derive their name from hav- ing been first obtained by the evaporation of the water of a- spring, situated near Epsom, in Surrey, which contains the salt in large quantity. They are now prepared largely I by manufacturing chemists from magne- sian limestone, and also from sea-water. They are solid in the form of small pure white, needle-like crystals, and from theii cheapness are extensively, indeed too much so, used among the poor as a general aperi ent, and not unfrequently by all classes. Epsom salts are tolerably certain in their action, do not gripe much, and produce free watery evacuations of the bowels ; on these accounts the medicine is a most valuable one in many diseases, particularly in per- sons of a full habit, but, as generally em- ployed, it is not suitable for a common or frequently repeated aperient. From its being in many instances taken in a state of too concentrated solution, it induces a dis- charge of the watery part of the blood into the bowels, and thus seriously debilitates. Moreover, after the action of a dose of Ep- som salts, the bowels, in those liable to ha- bitual constipation, are very apt to be left with a greater tendency to inaction than be- fore ; nevertheless, in persons of full, strong habit, an occasional dose of the medicine is, without question, beneficial, but it should be taken in smaller quantity and much more largely diluted than is usually done. The question of dilution is a very important one in the administration of this salt, and, if attended to, renders it safe and efficient even for the comparatively delicate. From half a drachm, or even less, to a drachm, should be dissolved in at least six ounces or half a pint of cold or tepid water, and taken on first rising in the morning, when the dose should be followed by the fluid break- fast. Many persons liable to constipation find this method a simple and effectual remedy, which may be used for weeks to- gether. From five to ten drops of dilute [or aromatic] sulphuric acid are often a good addition to the dose, and one which at the same time corrects in some degree the bitterness of the salt. If there is debility, either of the stomach or generally, from a quarter to half a grain either of quinine or of some salt of iron may be added. The quinine appears to increase the aperient power. The most convenient method of taking Epsom salts in this form is to dis- solve one ounce in a pint (sixteen ounces) of water, adding the acid or other ingredients in proper proportion. Of the solution, from half to a whole wineglassful may be taken the first thing in the morning, diluted with the proper quantity of water before taking, or, if preferred, by the latter being drank immediately after the medicine. The following method for the administra- tion of Epsom salts has been recommended ERG 233 ERY in France : — -Take of water about sixteen ounces, powdered or roasted coffee two and a half drachms, Epsom salts one ounce, boil well for two minutes, (not in a tinned vessel ;) remove from the fire, and let the mixture infuse for some minutes, so as to allow time for the development of the aroma, then filter, or merely strain off. It must be sweetened to taste. This fluid does not impart the slightest taste of the bitterness of the salt. It should be observed that the simple infusion of coffee is not capable of removing the bitter taste. The combination of Epsom salts with in- fusion of senna, constituting the common black draught, is one of the best forms of active occasional purgative in common use. It is well to bear in mind that there is con- siderable resemblance between oxalic acid, in its crystalline commercial form, and Ep- som salts, and that, in consequence, fatal mis- takes have occurred. The intensely acid taste of a single crystal of the former would at once clear up any doubt. Perhaps it might be well always to use so simple a test. Refer to Oxalic Acid — Purgatives — Senna. ERGOT OF RYE— Is a peculiar diseased or fungoid growth which is developed upon the seed of the common rye. The affected grain is sometimes called " spurred rye," from the peculiar curvature of the growth, which varies from half an inch to an inch and a half in length, is about a quarter of an inch thick, slightly angular in shape, and black in colour. As a remedial ad- junct in the hands of the accoucheur, ergot of rye is most valuable, but is scarce likely to form part of the domestic medicine-chest. It is more commonly met with on the conti- nent, where much rye is grown, than in this country ; and when the grain is largely in- fected with it, pestilential diseases have been ascribed to the use of the flour in which it has been mixed. It is certain that a peculiar kind of dry mortification of the extremities has followed the prolonged use of grain containing ergot. Ergot of rye has been used in medicine in hemorrhagic and other diseases, but chiefly on account of its undoubted action upon the womb. It can only be safely used by medical men. ERRHIXES — Are medicinal substances used as snuff to excite discharge from the lining mucous membrane of the nostrils. They are, in fact, means of counter-irrita- tion, but are not much employed by medical men. In some cases of headache they are useful, and common snuff may be used with as much effect as any of the class. ERUCTATION— Is the rising, either of v2 gas or fluid, into the mouth from the sto- mach. It is a constant symptom in dyspepsia. Refer to Flatulence. ERUPTION. — A diseased appearance on the skin. — See Skin. ERYSIPELAS, or St. Anthony's Fire, or The Rose — Is an inflammatory affection of the skin, with or without vesication or blistering, sometimes extending to the cel- lular tissue beneath. It appears on various parts of the body, but most generally on the head and neck. Unless the attack is very slight indeed, the occurrence of erysipelas is generally ushered in by symptoms of fe- ver, shivering, and headache, furred tongue, perhaps sickness, followed by thirst, hot skin, quick pulse, &c. ; at the same time the part first affected, such as the nose, cheek, or ear, becomes stiff, painful, red and swollen, the pain being of a burning cha- racter. If unchecked, this inflammation of the skin extends with more or less rapidity, and so rapid indeed is its progress at times, that in a very few hours the whole head and face become enormously swollen. As the disease progresses, blisters resembling those raised by a scald form over the sur- face, which is intensely hot and red, or purplish ; the pain is severe, fever runs high ; sore throat is a very frequent accom- paniment, and delirium is common. So serious a disease as erysipelas ought only to be treated by a medical man ; but as it is important, if possible, to check it at its first onset, the following measures should be adopted if proper assistance cannot quickly be procured. A disease present- ing the symptoms above detailed must generally be recognisable even by unpro- fessional persons. There is great diversity of opinion respecting bleeding from the arm in the first onset of erysipelas, but here, as in many other cases, the treatment must hinge upon the constitution of the patient, and not on the name of the disease. Under any circumstances, however, it would not be well for an unprofessional person to use so active a remedy ; but if the affected in- dividual be of very full habit, there is no objection to the application of leeches around the inflamed patch ; that is, if there is no peculiar tendency to irritation of the skin after the use of leeches. If the tongue is very foul, an emetic may be given, and the bowels freely purged with the calo- mel and colocynth pill, while eighth of a grain doses of tartar emetic may be admi- nistered every three or four hours, the diet being kept as low as possible. In weakly persons, a more negative plan should be pursued ; the bowels must be more gently EKY 234 ERY acted upon, as by five grains of gray pow- der, followed in a few hours by some gentle aperient such as castor-oil ; effervescing saline draughts should be given (and, in- deed, are useful in the former case also) every few hours, while all stimulants and animal food are cut off. With respect to local applications, the most certain and effi- cacious is certainly the nitrate of silver, or lunar caustic, which, if carefully used, maybe employed beneficially even by the unprofes- sional. Indeed it is quite possible to imagine a clergyman, for instance, in the country, checking effectually a fast-spreading at- tack of erysipelas, which would, unattended to, gain a dangerous ascendency before the services of a medical man could be obtained. The lunar caustic is used for two objects, one to check the spread of the inflamma- tion over the skin, and the other to quell the disease; for the first it is best used in the solid stick, for the latter purpose in strong solution. Erysipelatous inflammation tending to spread may be stopped by surrounding the affected part entirely with a cauterized ring. The parts to be touched must in the first place be shaved, if covered with hair, and the skin must always be thoroughly cleansed from its natural oily secretion, by washing with soap and water. It must then be moist- ened all round, and the stick of caustic drawn slowly and gently over it, so as to make a line of demarcation at least a quar- ter of an inch broad ; but this line must be entire throughout — deficiency in one spot may permit the inflammation to extend by the outlet. It is not asserted that in every case this caustic line will inevitably stop the disease, but it will do so in the majority, if care be taken that it is efficiently done, and that it includes, without doubt, every por- tion of the affected skin. When the solu- tion of caustic is to be used to quell the disease, it should be used of the strength of forty grains to two drachms of distilled or rain water. The inflamed surface must be gently cleansed by soap and warm water, and the solution applied all over it by means of a camel-hair brush or a feather. The practice now recommended is perfectly safe, is very efficacious, both as a preventive against the extension, and as a cure of this formidable disease, and might be quite jus- tifiably employed by an intelligent person in the absence of medical assistance. It has, however, the inconvenience of turning the skin to which it is applied perfectly black for some time afterwards, that is, until the outer skin has peeled off, and been replaced by a fresh layer. For this reason it is better in mild cases to have recourse to some of the local remedies yet to be mentioned. It is desirable that per- sons should be duly impressed with the necessity of cutting or shaving off the hair whenever erysipelas in a severe form ex- tends to parts naturally provided with the covering. In addition to the local treatment by lunar caustic, which the author has always found the most to be depended upon, other applications are used, and may be used, when the other is not procurable, or when the cases are so very mild that it is unne- cessary to incur the temporary discolora- tion of the skin produced by the caustic ap- plication. ' . Flour [especially that of rye] is a very common and often a good and comfortable local remedy in erysipelas ; hot fomenta- tions, either of simple water or a decoction of poppy-heads, applied continuously for many hours, by means of flannel, give much relief in some cases ; or a lotion composed of twenty grains of sugar of lead, a drachm of laudanum, and sixteen ounces of distilled or rain water, may be used slightly warm, and applied by means of linen cloths, with much advantage. The remedial measures, both local and general, which have now been recommended, ought and may, under intelligent unprofes- sional management, do much to keep this formidable disease in check until the medi- cal man, whose presence must be necessary, can be got. Moreover, there ought not to be much doubt as to the nature of the dis- ease, if the distinctions pointed out in the first part of this article are attended to ; and further, many attacks of erysipelas are secondary ones, as persons who have once suffered are liable to do so again. Much confusion of ideas exists on the part of the public with regard to erysipelas, and many affections of the skin are imagined to be this disease, which do not in the least resemble it. It should be remembered that it is an affection which appears suddenly, tends to spread, and is accompanied with fever ; that the affected skin is red, hot, ten- der, and often blistered. The causes of erysipelas are numerous: cold and atmospheric vicissitudes, and pecu- liar conditions of the atmosphere, are all apt to excite an attack, and every thing which tends to produce debility predisposes to it. Wounds and sores often appear to be the first originators of the malady, and, in such cases, contagion has much to do with its diffusion through a hospital or a town ; even the most trifling scratch being sufficient to E EY 235 EXC become the attraction. For this reason, erysipelas is the most formidable enemy which can gain a footing in a surgical hos- pital; and for the same reason, when the disease occurs in private houses, caution should be observed that persons suffering from wounds do not come into close contact with the affected ; and, indeed, in any case, the same precautions should be adopted in erysipelas as in contagious diseases gene- rally. This is doubly requisite in a house in which a confinement is expected, or has recently taken place, for there is an un- doubted close connection between erysipelas and fatal childbed inflammation. The head and neck are the most frequent sites attacked by this disease, but any other portion of the body may be liable to it ; the throat not un- commonly suffers, and is a dangerous com- plication, best treated by the free applica- tion of the caustic solution to the tonsils, &c. It ought to be quickly attended to by a medical man, for death sometimes occurs most unexpectedly from suffocation, in con- sequence of swelling. Hot bran-poultices and mustard-plasters externally would per- haps relieve the throat in some degree. When erysipelatous inflammation extends to the tissue beneath the skin, it constitutes what medical men call "phlegmon;" puru- lent matter forms, and the parts slough or mortify. In such cases it is usual for the surgeon to cut through the skin to give free exit to the matter, &c. ; and by the proceed- ing much relief is afforded. This, of course, unprofessional persons cannot do, and poul- tices and fomentations must be their re- source, should it happen (which is not per- haps likely) that a case which has reached this stage has been unvisited by a medical attendant. Refer to Silver, Nitrate of — Skin, §c. ERYTHEMA — Is a more superficial and evanescent inflammation of the skin than erysipelas. The most familiar instance of it is the inflammation produced by the chafing which occurs in stout children, or adults, between the folds of the skin, and which has a tendency to spread from its point of origin. The application of cloths dipped in tepid water, or in the sugar of lead and laudanum lotion recommended in erysipelas, will allay the burning sensation. A few grains of gray powder should be given at bedtime, followed by castor-oil or senna in the morning, and then quinine administered in doses suited to the age of the patient. Rapidly spreading erythema, even in an in- fant, quickly yields to small doses of quinine. ESCHAR — Is the portion of "killed" ani- mal tissue which separates from the living body after the application of a caustic or cauterant. ESCHAROTICS— Are substances which possess the power of destroying chemically the living animal tissues to which they are applied. — Refer to Caustic, §c. ETHER.— See ^Ethers. EUSTACHIAN TUBE.— The canal which connects the throat with the ear. — See Ear. EXANTHEMATA.— The eruptive febrile diseases, such as scarlet fever, measles, &c. EXCITEMENT— Excitants, or Stimu- lants. — To excite, to stimulate, is either to originate action where no action previously existed, or to give increased energy to powers already in active operation. Ex- citants or stimulants, therefore, are agents which are capable of producing such effects, and excitement is the effect produced. Ex- citants may be artificially divided into — I. Ordinary excitants, the regular un- ceasing action of which is necessary for the preservation of sound health both of mind and body. II. Extraordinary or occasional excitants, which produce a certain amount of temporary exalted action of mind or of body, or of both. III. Superfluous excitants, which are gene- rally those comprised in the second division abused. Under the head of ordinary excitants we have the following : — A. — Physical Excitants. I. Heat. II. Light. III. Electricity, Mag- netism. IV. Atmospheric air. V. Aliment. VI. Muscular action — Exercise. B. — Mental Excitants. I. Occupation of the mind with some defi- nite object. Under the head of extraordinary excitants we have — A. — Physical Excitants. I. Alcoholic excitants. II. Excitant ingesta generally : tea, coffee, spices, drugs, &c. III. Atmospheric changes. B.— Mixed Excitants. I. Sexual stimuli. II. Extra exercises : dancing and athletic sports. III. Travelling, and exciting or novel scenes. Mental Excitants. _ I. Hope, Joy, &c. II. Love, Anger, &c. III. Social intercourse. IV. Argument, Politics, &c. V. Music. VI. Eloquence, written or spoken, Exciting literature. VII. Religion. EXC 236 EXE For the more particular consideration of the above-cited agencies, both as excitants and otherwise, the reader is referred to the various articles in which they are treated of in this work. From these it will be seen that certain ordinary physical stimuli, or excitants, are necessary for the sustenance of human health and life, and that equally important for the preservation of vigour, not only of mind, but of body, is the stimu- lus resulting from the ordinary but regular action and reaction of the mind of man, originating either in daily intercourse with his fellows, or in pursuits which con- tinuously engage the mental powers. And further, that the mental and bodily func- tions are at intervals acted upon by occa- sional or extraordinary stimuli, which tem- porarily occasion their exalted and increased action, not only without actual injury, but with positive benefit. And, lastly, that these extraordinary stimuli are not liable to lose their power of beneficial stimulation, unless exerted in a disorderly and unre- strained manner. EXCORIATION.— See Abrasion. EXCRETION.— Any thing, either super- fluous or noxious, separated and thrown out from the living body. Excretions may consist of noxious and superfluous matters which have been introduced into the cir- culation by the stomach — in the food — or through the lungs, or skin ; but the bulk of the excretions consist of " effete" matters, that is, of substances which, having fulfilled their part in the animal economy, could not be retained in it without danger to health or life, and are therefore cast out by some of the outlets specially provided for the purpose. The urine is perhaps the best specimen of an excretion, and consists of water holding in solution mineral salts, and the used-up elementary substances in various combinations. One of these com- pounds — the urea — is a narcotic poison, and if, from disease of the kidneys, or other cause, it is retained in the blood, it acts as such, and kills. The chief constituents of excrement from the bowels are matters ex- creted by the large bowel, which cannot be retained in the body without danger. The kidneys, the bowels, including the liver, the skin, the lungs, are the excretory outlets of the body ; and what has been said of the nature of excretions generally must render evident the paramount importance of keep- ing these outlets in free operation. Refer to Alimentary Canal — Bile — Blood — Lungs — Skin — Urine, S$c. EXERCISE — Spontaneous Muscular Movement. — The stimulus imparted to the system generally, and to every one of the vital processes particularly, by the exci- tant power of muscular movement which every healthy man is compelled or ought to undergo, is a fact generally recognised ; it is one of those ordinary excitements the agency of which is linked with our happi- ness and health, and, it may almost be said, with our existence. A man engaged in active bodily exercise is undergoing a re- gular course of excitement ; his will is stimulating the nervous system to rouse the muscles to action, and in this process both the rouser and the roused are using up their own substance ; the acting muscles are sending the blood more quickly through the capillaries and large vessels, and the heart must move more actively to keep pace with them, and transmit the quickly returned blood, loaded with effete matter, to be purified in the lungs. To preserve the balance the respirations are increased, and the stomach is stimulated to crave for nourishing food and unstimulating drink, fitted to keep in repair the ever-wearing structures of man's body, and to supply the fluid waste. Baron Liebig has done much to give us clear views respecting the changes which take place within the body under the influence of muscular movements ; and from him we learn that, in the ex- penditure of this force, the substance of the muscles is used — burnt up by the oxy- gen of the arterial blood, and that this burning up is requisite that the force may be produced. Exercise, therefore, is in the first place requisite as an ordinary excitant, to be brought into daily operation, that the vigour of all the functions of the body, whether of digestion or of secretion or ex- cretion, may be preserved. It is the mer- ciful provision by which the decree, that man should earn his bread by the "sweat of his brow," has been converted into a blessing. It is the great compensating ba- lance which gives the labourer sound sleep and healthy appetite and vigour, instead of the wealth which too often seduces to indo- lence and palls every enjoyment of life. Exercise, again, is requisite as an agent with reference to the food consumed. Food is taken to supply the waste of the body, which must go on more or less as long as man lives — more if actual exercise is taken, and vice versa,. Man ought not, therefore, to expect, if neglecting muscular exercise, that is to use up the substance of his body in exertion, to have the same appetite for and enjoyment of food as if he did; but man does expect this in many instances : EXH 237 EXP he indulges in indolence, and then excites the appetite and stomach, by artificial means and tempting food, to take nourishment which is not required, and which must, con- sequently, produce disorder somewhere. If an individual's employments are of a kind which do not require muscular exertion, his food should be diminished, either as regards quality or quantity, in due proportion. But even under this regulation none can be well or vigorous who do not take some amount of exercise in the open air daily. With regard to extra exercises, such as dancing, and athletic sports generally, which are only engaged in at intervals, it is cer- tain that their beneficial effect upon the functions and health depends quite as much upon the excitement of the mind as upon that of the body ; and every one's experi- ence must tell him how much his favourite exercise owes its renovating influence to the mental stimulation which accompanies it. Refer to Blood — Excitement — Food, §c. EXHALATION— Applied to the body, means an excretion in a state of vapour, such as that from the lungs. EXHAUSTION— Is the diminished or al- most extinguished power, either of the body generally or of one or more of its organs, to continue its natural active operations until it has been recruited by a pei'iod of repose. Exhaustion may arise from two principal causes — failure of the nervous power, and deficiency of organized mate- rials fitted to support the requirements of the living body. If every thought, every exertion of the will upon the body, occasions the con- sumption of nervous matter, exhaustion of nervous power must in all probability be due to using up of nervous substance. Sooner or later, according to circumstances, every exertion must come to an end, and repose must be taken, that the exhausted brain and nerves may be recruited ; and, if man acts wisely, he will if possible stop exertion either of mind or body at the first point of exhaustion. It is true that powerful exercise of the will can and does compel exertion beyond the point at which nature says "stop;" but the effort is not made with impunity, and the after exhaus- tion is proportionally increased. No per- manent injury probably arises from those occasional exhaustions, either mental or physical, which all have at times to un- dergo ; but no man can habitually go on exhausting his nervous power, whether in the direct service of the mind, in the la- bours of the body, or in the less excusable requirements of vicious excess, without suf- fering eventually. The early paralysis and softened brain of the mental, the prema- ture old age of the physical labourer, the wretched decrepitude of the debauchee, are all the results of continued nervous exhaustion. It is not, however, simply the brain and nervous system which suffer, but the other organs of the body, particularly those of nutrition, suffer also, if the supply of nervous power which ought to sustain their healthy action is withdrawn to sup- port the exhausting efforts either of mind or muscle. Those, therefore, who can, will do wisely to avoid the cause of these evils ; but all cannot do this : in many situations of life, continued exertions, which carry the individual to the extreme of exhaustion, be- come absolutely necessary. It becomes a question, therefore, how the evil effects of the necessity may be most efficiently coun- teracted. This must be done by the proper management of the nourishment. The sto- mach in such cases is not receiving its full supply of nervous stimulation, and, there- fore, its work must be made as light as possible, consistent with conveying good nourishment into the system. Small quan- tities of food should be taken at once, and more frequently repeated, rather than any thing like a meal made. In the majority of instances, the most efficient nourishment will be strong, concentrated animal soup, either alone or mixed with some farinaceous material ; and next in utility will be coffee or cocoa, along with bread or biscuit, or with the yelk of egg beaten with them. Of course, if these are unattainable, the next best substitute must be used ; but the principle must be to keep the system supported by means of repeated small quantities of food, of as nourishing a quality and in as digestible a form as may be ; the use of alcoholic stimulants being avoided as long as pos- sible. At length, if the exhausting agencies are still in operation, a time comes when the stimulation of alcohol is eminently ser- viceable, by virtue of its peculiar action upon the nervous system, when it does that to support the bodily powers which nothing else can ; and then the draught of porter, or the dose of wine, or of diluted spirit, does come like an elixir of life to "him who is ready to perish." Refer to Alcohol— Blood — Brain — Food, §c. EXFOLIATION— Is the separation of a scale of dead bone from the living. The term is applied either to the process itself or to the separated portion of the bone. EXPECTORANTS— Are a class of me- dicines which assist the separation and expulsion of mucus from the air-tubes or EXP 238 EYE bronchi of the lungs. Very many sub- stances are employed with this view ; the most useful are — Acids, which astringe and stimulate. Ammonia, which stimulates. Ammoniac [Gum], which stimulates. Antimonials, which relax. Ipecacuanha, which relaxes. Squill, which stimulates. Stramonium, or Thorn Apple. Tolu, which stimulates. Tobacco. Vapour, either simple or medicated. In whatever way these medicinal sub- stances exert their action upon the body, the most important practical point is the division into relaxing and stimulant. In the first stages of affection of the bronchi with cough, when there is fever (and pro- bably inflammation) present, the relaxing expectorants only should be used, either antimony or ipecacuanha ; the former may be given with solution of acetate of am- monia, the latter with carbonate of potassa. "When there is much debility, ammonia com- bined with camphor is generally employed, and probably squill added. In chronic cough, with difficult expectoration, the same combination may be used ; and when there is a relaxed state of the system, with co- pious expectoration and tendency to per- spiration, the acids, either vegetable or mineral, alone or combined with squill, are most serviceable. The combination of opium or some other anodyne with expectorants is both a com- mon and a useful practice ; it allays the irritability of the bronchial membrane and the frequency of the cough, and probably also relaxes spasm. Opium, hoAvever, tends to stop expectoration, and on this account ought in almost every case — in which it is given to allay cough — to be combined with some counteracting expectorant. More mis- chief is, perhaps, done with squill than with any other of this class of remedies ; its syrup is much given domestically, and generally too early, whereby both irritation and cough are increased. Tolu syrup is a good and pleasant addition to cough mix- tures. Many expectorants act also as eme- tics, and in so doing, especially in children, frequently assist most efficaciously their expectorant action. Tobacco or thorn-apple smoked, or watery vapour inhaled, act di- rectly upon the air-tubes. Refer to articles on various expectorant medicines, to Catarrh — Cough, $c. EXPECTORATION— Is the term applied either to the act of coughing up matters from the lungs, or to the matters so coughed up, [but the latter are more correctly desig- nated as the " sputa."] These vary greatly in consistence and appearance, and, conse- quently, are valuable guides in the investi- gation of disease affecting the chest ; indeed, until the physical examination of the chest by the ear was introduced into practice, the expectorated matters were the most distinc- tive evidences attainable. Expectoration may be thin and frothy, as it is when the lining membrane of the air-tubes is suffer- ing from irritation or inflammation, or thick and almost solid, as it becomes in the last stages of a cold. It may be ropy, as it often is in old people, or viscid, in inflammation of the substances of the lungs, when it generally becomes of a dull reddish-brown or rust colour ; it may consist more or less of purulent matter, or be tuberculous and semi-solid, as in pulmonary consumption ; it may be mixed more or less with blood, or pure blood may be expectorated, or it may be what is called the prune-juice ex- pectoration from its colour, as happens in mortification of the lungs. Generally, ex- pectoration is inodorous, but sometimes it is abominably fetid, the odour being mostly, but not invariably, indicative of mortifica- tion of the lung itself: other matters, such as bile, &c. are occasionally coughed up [or follow coughing]. EXPIRATION— Is the act of expelling air from the chest after it has been inspired. EXTRACTS — Are medicinal preparations made by separating the active portions of various drugs from the inert ones, this being effected by dissolving out the former, either by water, alcohol, or aether, and evaporating the superfluous fluid, until a tolerably firm consistent mass of extract is left. Formerly, heat was used in the evaporation ; but as this destroys in some measure the activity of the preparation, the best extracts are now all prepared without any heat what- ever, and these should always be purchased in preference. The extracts of aloes, of colocynth, of hemlock, of henbane, of gen- tian may be used by unprofessional persons. There are many others, but they are either dangerous, or the medicine is better used in other forms. EYE. — The organ of vision, not only in man, but in the lower animals, is an instru- ment so wonderful, so replete with beautiful structures and admirable contrivances, that it is always alluded to' as one of the most, if not the most splendid instance of the power and beneficence of God, as displayed in his physical creation. Its importance to man as an organ of sense ought to render the study of its construction and adapta- EYE 239 EYE tions one of intense interest, and must ever render its perfection and preservation an object of the greatest solicitude. The space which can be spared in a work like the pre- sent is too limited to do justice to the subject. The whole apparatus of vision naturally divides itself into two sections — the globe of the eye and the appendages of the globe. The conical-shaped sockets, or orbits, in which the eye-globes are suspended, have projecting edges, especially superiorly, which protect the organ from injury. The pent- house of the eye-brow slightly shades from the light and intercepts perspiration, which might trickle down and irritate. The fringed curtains of the lids are ever ready to close over and instinctively protect their charge, and on their internal surface secrete a lu- bricating mucus. On their edges a series of minute glands (fig. lxv. 2) open, which secrete an unctuous matter. In the upper and outer angle of the socket lies the lachry- mal gland, which furnishes the tears, and is always pouring out a watery fluid, which is continually passing over and cleansing the exposed surface of the eye, being taken up at its inner angle at the points (3) and conveyed through the lachrymal duct (1) into the nose, which it also supplies with moisture. Through this duct, also, the mem- brane (the conjunctiva) which lines the nose is continuous with that which covers the fore- part of the eye-globe and lines the lids. In the socket, the eye-globe lies embedded in fat, but is also, as it were, slung in a kind of membrane. It is, further, both fixed and moved by means of its six muscles, (fig. lxvi. 1, 1,) four of which pass forward from the Tig. lxvi. back or apex of the conical cavity to be at- tached to the globe. The optic nerve, fig. lxvi. (2,) and other nerves and blood-vessels, are also contained within the socket, the whole being arranged so as to afford the most facile but at the same time steady movement. The globe of the eye itself is barely an inch in diameter, and measures longest from before backward. Its outer coat, called the sclerotic, (fig. lxvii. 1,) is very firm, and is composed of interlaced fibres. Anteriorly, Fig. lxvii. a portion of it is, as it were, cut out to per- mit the insertion of the cornea, (figs. lxvi. 3, and lxvii. 3,) or glass of the eye ; poste- riorly it gives passage to the optic nerve, (figs. lxvi. 2, and lxvii. 6.) Within the outer coat is the choroid coat, (4,) of a dark cho- colate colour, and within that the retina, or nervous coat, (5,) which forms the sensitive field of vision. The mass of the globe is filled with a remarkably transparent semi- fluid substance, the vitreous humour, in the forepart of which the crystal lens (7) is imbedded. In front of this, and partly sur- rounding it, is the iris, (figs, lxvii. 8, and lxv. 8,) the circular aperture in which (fig. lxv. 9) constitutes the pupil. In front of the lens, between it and the cornea, is the chamber of the aqueous humour, (10,) so called from the watery fluid with which it is filled. It will be remembered that the entire fore- part of the globe, or white of the eye, and the clear cornea are covered with the con- junctiva, as already mentioned. To give the sense of vision, the rays of light from surrounding objects penetrate the eye, first by the cornea, (3,) pass through the aqueous humour, the lens, and the vi- treous humour, (10, 7, 11,) and, in doing so, EYE 240 EYE undergo a series of refractions, which bring them at last into focus in the retina, (5,) where the picture of external objects is formed, and where the impression is con- veyed to the brain by the optic nerve, (6.) The object of the black or chloroid coat (4) being to absorb the superfluous rays of light, which would otherwise be reflected within the eye and confuse vision. This rapid and necessarily imperfect sketch of the construction and functions of the organ of vision will, it is trusted, assist the unprofessional reader in gaining some rational idea of the dangers and diseases to which so important a portion of his frame is liable. The membrane, or conjunctiva, which covers the inside of the lids and white of the eye is, from its exposed situa- tion, liable to become inflamed from various causes. Minute particles of dust or other substances getting into the eye, and becom- ing fixed in the lining of the upper eyelid, between it and the globe, cause an amount of pain and irritation which could scarcely be credited from their size, but which is well accounted for by the accurate apposition of the two surfaces between which they lie. A particle so situated may be discovered without much difficulty by a second party examin- ing the sufferer with the head thrown back, while he slightly everts the upper lid with the thumb and finger. The slightest speck of foreign matter must be removed, and no better instrument can be employed for the purpose than [a camel's hair pencil] or a piece of not over-stiff writing-paper twisted like a match. Those who work in metals are apt to get minute scales imbedded in the forepart of the ball ; they cause much irritation, and are often so extremely difficult to remove that a surgeon's assistance is required. The effect of these mechanical irritations is to cause in- flammation of the conjunctiva. (See descrip- tion.) This, however, may often arise, and frequently does from cold, from disorder of the digestive organs, &c. The first symp- tom of inflammation is a sensation as if a particle of some kind had lodged in the eye, and if an examination be made there will be seen, not only an enlargement of any small blood-vessels that may be generally visible on the white of the eye, but a new develop- ment of others, the appearance varying from the slightest apparent increase of vascularity, to the most intensely red in- flammation. At the the same time there is considerable increase in the mucous secre- tion — not in the tears, as is often supposed — and in bad cases this becomes purulent or mixed with matter. There is, sometimes, considerable swelling of the surface, usually distinguished as the white of the eye. The above is the most superficial form of in- flammation to which the eye is subject; if neglected, it may extend itself over the cornea and produce permanent blindness. It is distinguishable from the next form, or inflammation of the sclerotic coat, by the size and winding character of the small blood-vessels, and by their being slightly movable along with the conjunctiva itself when the lids are drawn down. It is im- portant that these distinctive characters should be attended to in the first place, that no error may be committed between this form and a more serious and deep- seated inflammation of the eye, but also that proper treatment may be used. A great error is committed in treating this form of inflammation by means of warm fo- mentations, &c. applications tending rather to keep up than to cure the disease, which is generally quickly removed by astringents. A drop of laudanum or of Battley's solution in the eye, repeated two or three times, will often cure the disorder ; or a lotion of sul- phate of zinc, from one to three grains to the ounce of water, will be found efficient ; but the best of all is the solution of nitrate of silver, or lunar caustic, of the strength of four grains to the ounce of distilled water, as recommended by Dr. Mackenzie. Of this, a single drop may be introduced into the inflamed eye twice or three times in the twenty-four hours. The eye, of course, should be exercised as little as possible, and if the bowels are confined or the stomach disordered, a few doses of the blue pill and colocynth will be found useful. If the dis- ease is obstinate, a blister to the back of the neck may be applied with advantage. The disease which has just been treated of, is a comparatively mild disorder, but under certain circumstances it becomes much more virulent. The secretion of matter is very great, and acquires the power of propagating the disease by contagion from one person to another. The well- known Egyptian ophthalmia is of this nature, and is carried from individual to individual by the flies, which, according to travellers, seem to have acquired an instinctive ten- dency to fly toward the eyes in that country. Newly-born and young infants frequently suffer from a severe form of this ophthal- mia, which often shows itself within three days after birth. The inflammation is in- tense, and the matter often accumulates largely between the lids, gushing out when they are separated. In scrofulous children especially the affection is often obstinate. The nitrate of silver in solution is the best EYE 241 FAI application, and small doses of quinine the best internal remedy. Syringing between the lids with a solution of alum, four grains to the ounce of water, six or eight times a day, is also recommended. A little lard should be used on the edges to prevent them sticking together. In inflammation of the sclerotic or outer coat of the ball itself, there is more actual pain, it is more deeply seated, the redness seen on the white of the eye is more of a pink hue than in the conjunctival affec- tion, the vessels appear much smaller and straighter, radiate as it were from the cor- nea, and are not movable ; the affection is, moreover, generally a more serious one than the other. The more interior struc- tures of the eye may also become inflamed, and especially the iris. In all these cases of deep inflammation of the eye the consti- tution is much affected, there is shivering, followed by thirst, fever, &c. ; the pain in the organ itself is often most severe, and extends to the forehead ; light cannot be borne. If the iris is the part affected, its colour is changed and often becomes of a dirty brick red ; the pupil at the same time is irregular. In these, and indeed in all affections of so precious an organ as the eye, whenever proper medical treatment is attainable, it should be taken advantage of; if not, sup- posing symptoms such as those enumerated show themselves, some active treatment is requisite ; leeches should be freely applied to the temples, or behind the ears, or cup- ping on the back of the neck resorted to ; the bowels must be freely purged with ca- lomel and colocynth, &c. in the first in- stance, and then calomel in two-grain doses, or some other mercurial, given at intervals of six or eight hours. The diet must be reduced as low as possible, all stimulants avoided, every attempt at exertion even of the unaffected eye forbidden, and the person confined to a darkened room, the only local application being continued hot fomentation to the eye and a blister between the shoul- ders. By a continuation of the above treat- ment, even till the gums get sore with the mercury, much may be done, supposing circumstances are such that a medical man cannot be procured. If the iris is thought to be affected, some preparation of bella- donna (or, in its absence, of henbane) should be employed to keep up dilatation of the pupil. For this purpose ten grains of the extract should be rubbed up with half an ounce of water, and a few drops introduced into the eye. For information respecting the more chronic affections of the eye, the V 16 reader is referred to the articles Amaurosis, Cataract, &c. In some eye affections the lids are apt to become glued together during sleep by the secretion. This is best prevented by smearing the edges with some simple oil or ointment. The edges of the lids, likewise, are apt to become affected with a succession of small pustules, or abscesses, which often continue to form in spite of treatment, de- pending probably on some disorder of the digestive organs, which should be attended to. Local treatment seems to do but little for their amendment. The lachrymal sac, or some of its ducts (fig. lxv. 2) are apt to become the seat of in- flammation and to be blocked up in conse- quence ; the tears, not escaping by their natural outlet, run over the cheek, causing painful excoriation, and the corresponding nostril is dry. The disorder is not only troublesome to bear, but often to manage, and should be seen by a surgeon. A stye in the eye, or rather eyelid, is a small abscess, and often gives great pain. It is best treated by fomentations. Blows on the eye frequently give rise to effusion of blood beneath the conjunctiva, which occasions the white of the eye to become of a deep, almost black, red colour, and to present a very alarming appearance. The state of matters may be distinguished from inflammation by the uniformity of the redness, and by the absence of those charac- teristic symptoms enumerated above. The eyes frequently assume an "injected" or bloodshot appearance in affections of the brain. Disordered vision may be the result of causes, such as cataract, &c. which inter- fere with the transmission of the rays of light ; it may also arise from disorder of the digestive organs, and not unfrequently from incipient disease of the brain. Persons who become suddenly and unaccountably affected with disordered vision, should ma- nage themselves as directed in article Amau- rosis, and get medical advice as speedily as possible. Refer to Amaurosis — Cataract, $c. FACE. — See Countenance, Complexion, &c. FACE-ACHE.— See Neuralgia. FJECES. — The excrement from the bowels. Refer to Alimentary Canal — Digestion, fyc. FAHRENHEIT.— The German inventor of the thermometer which bears his name. — See Thermometer. FAINTING, on Syncope— Is a state of partial, or of total unconsciousness, in con- sequence of diminished circulation of blood through the brain, the result of depression FAI 242 FAR of the heart's action. Some persons are much more liable to become faint than others, and there is often a good deal of pe- culiarity with respect to the acting cause. Certain objects of sight will cause some persons to become faint immediately. The most general, probably, being accidents, or their consequences, which injure the human body, and cause effusion of blood ; certain smells affect others, and cause immediate faintness ; even the smell of a rose has been known to have this effect. Affections of the mind, and sudden emotions, debility, habitual or temporary, weakness of the heart itself, loss of blood, or, in fact, what- ever depresses the acting power of the central organ of circulation is apt to pro- duce faintness. A person about to faint becomes affected with ringing in the ears, the sight fails, the ideas are confused, and the mind incapa- ble of exertion, the countenance becomes deadly pale, cold sweat breaks out over the forehead, the power over the limbs either becomes very unsteady or fails altogether, and if actual fainting happens, the indi- vidual sinks down, and is really in a condi- tion which much resembles death, and might pass into death. As said above, the direct cause of fainting is diminished circulation of blood through the brain. It must be obvious, that in the endeavours to restore a person who has fainted, this condition must be altered as quickly as possible ; and for this purpose, the individual should be laid quite flat down, the head on a level with the body, so that the feebly-acting heart may not have to propel the blood upward, but hori- zontally. The neck and chest should be exposed, fresh air admitted freely, a little water sprinkled on the face, and stimulant vapours, such as ammonia, held to the nostrils at intervals. Sal-volatile, or a little spirit, or wine and water, may be given at the same time. It must be remembered that the first pe- riod of some apoplectic or paralytic seiz- ures is one of faintness ; and also, that where the affection is the consequence of loss of blood, its continuance to some ex- tent may be the safety of the patient. In either case the use of stimulants must be a very cautious one. Refer to Apoplexy — Hemorrhage, fyc. FAITH — In medicine is one of those strong emotions of the mind, which, like hope and despondency, exerts much influ- ence upon the progress of a case of illness, whether it attaches itself to the medical attendant, or to the system of treatment pursued by him. The history of popular delusions connected with the treatment of diseases is rich in illustration of how far simple faith in some method of treatment which has acquired reputation will add to the apparent curative powers of that method, in consequence of results which are due to that tendency to cure — vis medi- catrix naturce — which has no more powerful assistant than the hopeful and trusting, even if mistaken, mind. It sometimes becomes a nice question in medical ethics how far medical men are justified in using this agent in the treatment of their patients. With the intelligent and unprejudiced, a true faith in curative means, grounded in clear understanding of the nature of their case, and the requisite treatment, is always to be preferred to a blind and unreasoning trust, however implicitly given ; but amid the ignorant, if they will employ a foment- ation more assiduously because it has a few chamomile flowers in it, or such-like ; and if it will insure their greater faith in the treatment generally, it is a concession to prejudice at least, which ought to be made. Many persons err in placing too great reliance — faith — in mere medicines and drugging alone, to the neglect of the equally important general aids in the treat- ment of disease, so often alluded to in this work. Such persons are not content, and do not think themselves properly ("actively") treated, if they are not constantly swallow- ing physic. Refer to Advice, Medical, §c. FALLING SICKNESS, or EriLErsY.— See Epilepsy. FAMINE. — See Starvation. FARCY. — See Glanders. FARINA— Derived from " Far," corn- means literally the meal or flour formed from grain, when ground, and consists, therefore, of starch, gluten, &c. [Farina forms an excellent article for the diet of invalids. — See Diet.'] The word, however, is sometimes applied to the farinaceous matter contained in other vegetable pro- ducts, such as the potato, when it consists almost entirely of starch or fecula ; also in beans, peas, &c. The farinaceous matters, or particles, are contained in a network of cells. — See Fecula. FARINACEA.— Articles of food generally which contain farina. FARINACEOUS FOOD — Is an article of diet prepared from one or other of the grains, professedly, in such a manner as to make it easy of digestion. The varieties of the preparation are very numerous ; most of them consist of wheat flour baked, with FAS 243 FAS or without the addition of sugar ; others I contain rice-flour, potato-flour, &c. Semo- lina and semola belong to the class of fari- naceous foods, and contain more of the gluten of the grain. In consequence of the greater or less removal of the starchy com- ; ponents, they are more powerfully nutritious than those articles which have the full pro- portion of starch. Unquestionably, baking the flour must make it a more wholesome | article of diet for the infant; but there is no reason why persons should not do this for themselves, and thus avoid the chance of getting an article mixed with other things. Moreover, the sugar is not in all cases a desirable addition. Refer to Food — Gluten — Grains, $c. FASTING.— The remaining without food for a longer period than usual, may some- times be a useful proceeding, as a kind of negative remedy, for those who have been living too freely ; but even then abstemi- ousness, that is, the partaking of a reduced quantity of very plain food, is better than complete denial of aliment. Fasting, as a term, is more properly applicable to a con- dition in which the desire for food exists. When the appetite fails, as it does in dis- ease — and its failure is a natural indication that the system is not in a fit condition to receive nourishment — it can scarce be said that a person fasts. The power of fasting depends greatly upon habit, constitution, climate, and other contingent circumstances. It has been, and still is, the custom of many nations to take but one meal in the twenty- four hours, but if into that meal must be crowded the entire nutriment required for the body during that space of time, it is need- less to remark that for some time after, the individual can be fit for little beyond digest- ing his food, and that such a division of duties would but ill suit the arrangements of civilized life, even if it could be followed without serious detriment to health. As a general rule, it may be said that it requires more than an average of constitutional vigour to enable an individual in this country and climate to do with but two meals a day, that is, to fast twelve hours at a time. The consequence of too long fasting is physical exhaustion of the body generally, in which the stomach is involved; conse- quently, when a person has gone longer than usual without food, especially if under- going fatigue at the same time, although at the conclusion the system at large re- quires nourishment, the stomach is so weak- ened that it cannot digest a full meal. The inability to fast with impunity is increased the more rapid the changes going on in the system ; thus, children and young people tolerate fasting worse than others ; and for the same reason physical exercise or fa- tigue, which quickens all the usual func- tions within the body, also renders undue fasting less easily borne, and more inju- rious. External circumstances, again, such as shelter, clothing, climate, all exert much influence as regards the toleration of fast- ing. It has been shown in more than one article in this work, that a certain propor- tion of the nutriment taken is required as fuel, that is, as a physical agent, to assist in sustaining the bodily temperature ; and it is evident that the less abstraction there is in animal heat — in other words, the better either man or animals are protected from the cold — the less occasion have they for food within a certain limit ; and as a neces- sary inference, fasting may be practised with less inj ury in a warm than in a cold climate, and such is found to be the case among civilized people. Barbarians, or uncivilized tribes, such as the Esquimaux, who feed to a repletion which would kill other persons — and thus lay in a store of nutriment — are of course exceptional. Per- haps the best instances of the power — not exactly of fasting, but of extreme abstinence, is in the runners of Northern Africa, who are said to travel immense distances and at a very rapid rate, with only the sustenance of a limited portion of gum during the journey. The Arab horses, too, have often excited the wonder of travellers from their powers of endurance on extremely small supplies of nourishment, when compared, at least, with what is required by the same animal in this country. Hereditary con- stitution and habit, however, undoubtedly assist the influence of climate. As a general rule, it may be taken that entire abstinence from food by persons in health in this country for more than six or eight hours, must, if habitual, be injurious, and the more so the younger and more delicate the constitution. Very many cases of stomach disease date from the practice. The marvellous cases of long fasting which have from time to time been brought before the public have turned out on strict investigation, to be impositions, although they have served to exemplify the power of sustaining life on extremely small quan- tities of nutriment. The power of fasting, without injury, seems to be considerably increased in cases of insanity ; and if it is so in one form of nervous excitement, it may be so in other excited conditions of mind. The subject of fasting has been treated FAT 244 FAT in this article in an every-day life point of view, as it applies to society generally, more especially at the present day in this country, and without any reference to scriptural history, or to those miraculous powers which are recorded, either in the case of our Lord himself, or of holy men of old, when for his good purposes they were imparted. The remarks are made to impress the fact that absolute fasting is injurious to the majority — the more so if habitual — and may lay the foundation of disease. [Delicate persons should therefore never fast, even as a religious observance, without consulting a medical man.] Refer to Animal Heat — Blood — Digestion — Food, $c. FAT — Is a compound of three principles, stearine, margarine, and oleine, which at the temperature of the living animal body are fluid; but when, as after death, the temperature falls, the two former become solid. The fluid fat is contained in simple cells of a spherical form, which prevent its being diffused, or falling to the most de- pendent portions of the body. The uses of fat are, evidently, partly to form a soft pad or cushion for various parts ; but there can be no question that it also constitutes a store of fuel, or combustible material, for aiding the purposes of animal heat. This is palpable in the case of hybernating ani- mals, which are usually very fat before taking to their winter sleep, but the reverse on waking from it. A certain amount of fat, as a constituent element of the body, is requisite for health, and desirable for appearance ; but its accumulation may be- come so great as to amount to disease, and may become an impediment to the per- formance of the duties of life, as well as a cause of its shortened duration. The following remarks from the high authority of Dr. Chambers ought to be universally diffused. After adverting to a species of "monstrous" obesity, or fatness, which dates from birth, and is generally asso- ciated with intellectual deficiency, and fortunately proves fatal before the age of puberty, he remarks — " When the dis- ease" — that is obesity — "begins in child- hood, or about the time of puberty, we must not be deterred by the circumstance of its being hereditary from attempting to remedy the inconvenience arising from it. We cannot truly reduce our patients en- tirely to the average size and weight ; but we may enable them to pass life with com- fort and usefulness. The later the disease commences, the more controllable it is by management, until the middle period of life is passed, and then old age impedes in some degree the benefit which we may confer ; not by rendering our measures inert, but by preventing our employing them quite so actively as we should have done earlier. " The first thing indicated, in all cases, is to cut off as far as possible the supply of material. Fat, oil, butter should be rigor- ously interdicted in the diet-table. But all eatables contain some portion of oleaginous matter, and especially those most conve- nient to advise the use of for a lengthened period ; and almost all are capable of a transformation into fat, when a small quan- tity of this substance is previously present. It is desirable, therefore, that the mass of food should lie in the stomach as short a time as possible, in order that at least a fatty fermentation may not be set up in it. Very light meals should be taken at times most favourable to rapid digestion, and should consist of substances easy of solution and assimilation. To this end, the time of the * meals should be fixed for an early hour in the day, before exertion has rendered the power of the organs of nutrition languid and weak. Breakfast should consist of dry toast, or what is still better, sea-biscuit, and, if much active exercise is intended, a small piece of lean meat. Dinner at one o'clock, on meat with the fat cut off, stale bread or biscuit, and some plain-boiled maccaroni, or biscuit pudding, by way of second course. Liquids should be taken, not at the meal, but half an hour after, so as not to impede the action of the gastric juice upon the mass, and here should end the solid feeding for the day. No second dinner or supper should follow, nor, indeed, any more meals be taken sitting down. A piece of biscuit and a glass of water can be taken standing up, if faintness is experienced ; or a cup of gruel, or a roast apple, before going to bed. "The smallest amount of nutriment con- sistent with the health of the individual can be found by experiment only ; but we need not fear that ten ounces of solid food a day is too little. It may be remarked, by the way, that it is often advisable to add a small allowance of malt liquor at dinner, as otherwise the craving of the appetite is less easily appeased. The beers to be avoided are of course the thick, sweet kinds ; but that which is thoroughly fermented, at a low temperature, in the Bavarian way, seems to contain very little injurious matter. I do not know that any advice concerning sleep is peculiarly applicable to obese per- sons, beyond what we should recommend to all classes of men. They are usually FAT 245 FEC uneasy sleepers, and, though lethargic, by no means averse to early rising. "In cases where the fat is largely accu- mulated in the abdomen, it is very conve- nient for the patient to wear a band round the cavity, which may be tightened gradu- ally. The support thus given to the abdo- minal muscles relieves the dragging sen- sations in the loins, which many persons, whose viscera are heavy in proportion to their strength, expei'ience. It enables ex- ercise to be taken with more facility ; and appears also, by pressure, to afford some assistance to the absorption of fat. The above remarks will apply equally to all forms of obesity ; the abstinence recom- mended can be borne even by the aged, and only comfort be experienced. "As respects exercise, however, a dis- tinction requires to be made. The young and vigorous, whose obesity does not pre- vent the use of their legs, cannot employ them more usefully than in walking as long as they are able. The greater number of hours per day that can be devoted to this exercise, the quicker will 'be the diminu- tion of bulk. But as riding, by the gentle shaking of the abdomen, excites the secre- tions of the digestive organs more, it should, where practicable, be employed in addition. Where freedom of motion has once been gained, rowing, shooting — any, or all, of the forms of British gymnastics, should be adopted as regular habits. * * .' * "Purgatives I have generally found not needed in the pletheric form ; the bowels usually act once or twice in the day. But in the asthenic obesity of old people, where the abdominal walls are weakened by long pressure of an unnatural weight, it is neces- sary to employ them. "But there is one class of medicines so universally applicable to all cases of obesity that I think a trial should never be omitted. The chemical affinity of alkalies for fat point them out as appropriate alteratives in this complaint, and experience proves that they are suitable to the state of the digestive organs. The most eligible one is liquor po- tassse, and it may be administered in much larger quantities than any other. If given in milk and watei', we may safely commence with half a drachm, and raise the dose to a drachm and a drachm and a half, three times a day. The milk covers the taste of the potash better than any other vehicle. It has, truly, the advantage of saponifying a portion of the remedy, but there is no evi- dence to prove that its efficacy is thereby endangered ; indeed, soap itself has been strongly recommended." v2 Vinegar, which is sometimes foolishly taken largely, with a view to reduce fat, can only do so by disordering the digestive organs. Food of a fatty nature is generally diffi- cult of digestion. As a remedy in the cure of disease, the fats of various animals, deer, vipers, &c. were formerly used in medicine. In some cases of irritability or low inflamma- tion of the lining membrane of the stomach, fatty food seems to be serviceable. Refer to Axunge — Bacon — Digestion — Food, §c. FATUITY.— Mental imbecility. FAVUS. — A peculiar skin disease, gene- rally developed on the head, but occasion- ally elsewhere, and remarkable from the yellow cupped scabs being the site of de- velopment of a minute fungus. FAUCES.— The Gorge [or orifice of the oesophagus]. — The space and its sides be- tween the back part of the tongue and upper part of the gullet. FEAR — The exact opposite to faith, is one of those depressing agents which always acts unfavourably in cases of confirmed dis- ease, and lays the person open to the attacks especially of contagious or epidemic mala- dies. Sudden fear has sometimes acted bene- ficially, and paralytics have been known to recover the use of their limbs in their efforts under a paroxysm of terror ; more gene- rally, however, its operation is the reverse, and many cases of epilepsy, mania, heart- disease, &c. date from fright. In children, particularly of a nervous temperament, the influence of fear, either in jest or earnest, is most sedulously to be avoided. Above all things, care should be taken that cir- cumstances in which children may be placed accidentally, or individuals with whom they may necessarily have to come in contact, are not made sources of terror. This is too often practised, and threats of what the " doctor will do" so terrify a child that, when visited in illness, fright quickens the pulse, the tongue will not be shown, and the sounds of the chest are so obscured by sobs, that it is next to impossible to arrive at an accurate judgment of the case. Fur- ther, if a child has been systematically frightened about the dark, &c. it may, if accidentally placed \n it, suffer serious in- jury from fright. FEBRICULA.— A slight fever. FEBRIFUGE. — Any medicinal agent which has the power of subduing fever. The term was much more used in former times than it is now. FECULA, or Starch — Is a principle uni- versally diffused throughout the vegetable kingdom, nearly approaching gum in compo- FEC 246 FEE sition ; it is found in various parts of plants, where it is evidently destined to be a store of nutriment for their young or newly-de- veloped parts ; thus, in seeds it nourishes the young plant ; in tubers, such as the potato, the bud shoots ; in the sago palm, the young leaves. Before, however, it can afford suitable nourishment, it must be con- verted into sugar, and this is done by the influence of " diastase," a substance already treated of. It need scarcely be said that while starch fulfils its peculiar office as re- gards the vegetable, it is a no less important provision for animal wants ; it is, in short, one of the chief elements of nourishment derived from the vegetable kingdom for the support of animal life. Amid other exam- ples, arrow-root is nearly pure starch. Starch occurs in the form of granules, which vary considerably in size and shape, according to the tribe of plants from which they are obtained. These granules are com- posed of concentric layers, the outer of which, when exposed to a temperature of 160° in water, burst, and allow the inner layers to be dissolved ; consequently starch of any kind, after exposure to the above heat, can never be restored to its original condition. It is scarcely requisite to re- mark, that starch is insoluble in cold water, differing in this respect from gum. The composition of starch is simple, that is to say, it is made up of carbon and water, or carbon and the components of water, oxygen and hydrogen, but it contains no nitrogen, no earthy matters. From this it is evident that the nourishing power of starch, and of starchy articles of food gene- rally, is limited, that is to say, they cannot yield what they do not possess, nitrogen and earthy salts ; but as these are requi- site for the full nourishment of every por- tion of the frame, starchy food, either alone or in too great preponderance, cannot suffi- ciently nourish the body, particularly during the period of growth. This will bear out remarks made under articles " Arrow-root," " Bread," &c, which show that animals may be starved to death if fed on starch alone, or articles principally composed of starch, and that through ignorance of these facts infants and children 'have been seriously injured by the improper regulation of their food. But though starch, and such-like compounds, such as sugar, gum, &c, cannot build up bone and muscle, they can protect them, they can furnish respiratory aliment, or fuel, and also, when not thus required, assist largely in the formation of fat. Befer to Animal Food — Blood — Digestion, FEMORAL ARTERY.— The great arterj of the thigh. — See Artery. FEMUR.— The thigh-bone.— See Thigh- bone. FERMENTATION— Is a process of de- composition, or of change, in the relations of the various elements of fermentable bodies. For the action of this process of decomposition or of fermentation, it is in- dispensable that certain " azotized" sub- stances, named ferments, should be present. These substances all belong to the albumi- nous principles — bodies which in a moist condition putrefy and decompose sponta- neously. Thus, a solution of pure sugar will not ferment, however long it may be kept; but if a decomposing — putrefying — azotized ferment, either animal matter or vegetable albumen, or gluten, or yeast be added to the solution, the change quickly commences, and goes on until fermentation is complete. Vegetable juices, such as that of the grape and others, and even a solution of brown sugar, take on the process of fermentation spontaneously, because they contain sufficient azotized principles — ap- proaching the putrescible albuminous ani- mal matter in composition — to act as fer- ments. Milk also takes on a spontaneous process of fermentation for the same reason, but it is not the alcoholic ; no gas is evoked, and instead of spirit, a peculiar acid, the " lactic," is generated. Temperature, more- ever, exerts much influence upon the pro- cess of fermentation, and some juices yield either alcohol or lactic acid, according as the process is carried on under a low or high temperature. The acetous fermenta- tion, or that which results in the production of acetic acid, or vinegar, is carried on in a temperature of from 70° to 85° Fahr., and of course likewise requires the presence of a ferment. A certain amount of moisture and elevation of temperature are essential to the process of fermentation; dryness and cold alike stop the action. " The identity of composition of the chief constituents of blood, and of the nitrogenized constituents of vegetable food, has certainly furnished, in an unexpected manner, an ex- planation of the fact, that putrefying blood, white of egg, flesh, and cheese, produce the same effect in a solution of sugar as yeast or ferment." The explanation is simply this, that fer- ment or yeast is nothing but a vegetable principle, resembling these animal ones, in a state of decomposition. As it is only that modification of sugar, named grape- sugar, which is capable of being converted into alcohol, all fermentable substances, FER 247 FET ■whether containing cane-sugar, or starch, must be, and are, converted into grape- sugar, as the first step of the process. Anti- septics stop the process of fermentation. " The maturation, as it is called, or sweet- ening of winter fruits, when stored up for their preservation in straw, is the result of a true fermentation. Unripe apples and pears contain a considerable amount of starch, which becomes converted into sugar by the nitrogenous constituent of the juice passing into a state of decomposition, and transmitting its own mutations to the parti- cles of starch in contact with it."* Refer to Alcohol — Antiseptic — Vinegar — jiCClSt JxC FERMENTED LIQUORS— That is, beve- rages which have undergone the process of alcoholic fermentation, may almost be considered a natural product of warm cli- mates, from the readiness with which vege- table juices take on the process in these situations. The pure juice of the grape, if left to itself in a suitable tempera- ture, will ferment in a few hours ; and the palm-juice of Africa and other tropical countries, and the " pulque" of Mexico, are instances of the same thing. Ancient re- cords, including those of Scripture, all tend to show that fermented liquors have been known and used from the earliest periods. In the present day, the principal fer- mented liquors in use are — 1. Grape wines ; 2. Domestic or home-made wines, which are for the most part rendered fermentable by the addition of sugar ; 3. Liquors made from the fermented juice of the apple or pear ; 4. Malt liquors, from various grains, principally barley. For further information the reader is referred to the individual ar- ticles on the above subjects; also to Drinks, Food, $c. FERN, or Male Fern — Or, as it is called in botanical language, the " Aspidium filix mas," is a common native plant, noted principally as a remedy in tape-worm, but until lately too much neglected. It is pro- bable, that if given with the same care and precaution, it might not be found inferior to the now celebrated Eousso. The male fern (fig. lxviii.) grows chiefly on strong ground, in slightly-shaded situations ; no descrip- tion could guide an unprofessional and un- botanical person to gather it with certainty if it cannot be recognised from the figure, (lxviii ;) but perhaps the safest plan for any one wishing to use it, would be to have the plant either collected for him, or both it and its distinctive characters pointed out Liebig's Letters on Chemistry. Fig. lxviii. by some competent person. Dr. Christison gives the following directions: — '''The root, which is the part of the plant used, should be collected between the end of May and the middle of September. It should be cleared of foreign matters, root-fibres, and old or decayed tufts, but without being washed. It should then be dried quickly and thoroughly in the open air without heat, and in the shade ; these tufts, as well as the parts of the root-stock which are greenish internally, should alone be de- tached, and immediately reduced to pow- der ; and the powder must be kept in well- closed bottles." It should not be relied on when above one year old. The usual dose of the powdered root is from one to three drachms; but the' oil extracted by means of ether is the best preparation, the dose being eighteen drops given at night, either in pill, emulsion, or mixed with castor- oil, and repeated again in the morning. It is better to avoid much food just before taking the dose of either powder or oil, or during their operation ; and it is always requisite to follow the last dose taken with some aperient — castor-oil is perhaps the best — two or three hours afterward. The worms are discharged dead.f Eefer to Kousso — Worms, fyc. FERRUGINOUS.— Connected with iron. FETOR— Is a bad odour of any kind. In many cases it is the result of the process of putrefactive decomposition or fermentation, and may be developed either on the external or in the internal parts of the body. The use of chlorine or of chloric ether in various ways [or of the essential oil of camphor] f A case of tape-worm successfully treated by male fern is recorded hi the Lancet, for March 6th, 1S52. FE V 248 FEY is the best corrective. The mercurial fetor is a peculiar odour always acquired by the breath when the constitution is sensibly affected with mercury. Refer to Chlorine, Mercury, Sfc. FEVER — Is that condition of the body in which the pulse is quickened, the skin hotter than natural, thirst present, and the func- tions generally disordered. This feverish state of the system may arise from and be the concomitant of various local and other affections, but it may also constitute a dis- ease in itself, and it is to it in this light that the present article applies. Fever, properly so called, naturally di- vides itself into intermittent fever or ague, eruptive fever, such as small-pox or measles, hectic fever, remittent and common con- tinued fever. It is with the two last that we have to do at present ; the others will be considered under their own heads. Remittent fever may be regarded as an aggravated form of intermittent fever or ague, (see Ague) ; it has the regular succes- sion of hot, cold, and sweating stage, but the interval between the paroxysms is not characterized by the return to comparative health, as it is in the latter. Through most tropical countries, the principal type of fever is the remittent; but the complica- tions of the fever, and consequently its management, vary according to locality. Under these circumstances, it would answer no good end to devote more space to the subject at present, than to advise all who are about to reside in hot climates, to in- form themselves thoroughly on this as well as other matters connected with the pre- servation of health, and also on the nature and management of the diseases in and con- nected with their future home. Common continued fever is an affection of the whole system ; as described by a medical author of eminence, "it affects the head, the trunk of the body, and the extremities ; it affects the circulation, the absorption, and the nervous system ; it affects the skin, the muscular fibres, and the membranes ; it affects the body, and likewise the mind." By medical men this serious disease is subdivided into different varieties and types ; but it would serve no good purpose to enter into these here. The management of a disease so gravely im- portant as fever can never be legitimately undertaken by unprofessional persons, if medical assistance is procurable ; but as a provision for circumstances when this is absent, the less complicated the account both of the disease and its treatment, the more likely is it to be managed with ad- I vantage domestically. The first symptoms of incipient fever are usually displayed through the nervous system. The indi- vidual feels an unaccountable languor, and complains of headache and shivering, can- not exert his powers either in the duties or pleasures of life, is easily tired, sleep is dis- turbed, the appetite is impaired, the skin looks dusky and the eyes heavy, the pulse quickens, and at length the feeling of gene- ral illness drives the patient to bed. The attack, however, may commence much more suddenly — a shivering, or, as the people in many places call it, an "ague fit," may be the first symptom ; or severe headache, or vomit- ing, or fainting, or even convulsion may be the first symptom of the impending malady. When fever is fairly established, the pulse ranges above 100, the tongue is furred, probably brownish and dry, sleep is dis- turbed or supplanted by delirium, the mus- cular power is diminished and diminishing, and the mind indifferent to passing circum- stances ; dark incrustations collect about the teeth, the patient sinks down in bed, and perhaps passes the natural evacuations un- consciously, thus displaying the most evident signs of debility. This condition may in- crease till it terminates in death, or tends toward recovery, either by some marked crisis, such as profuse perspiration, or by an almost imperceptible amendment. Tranquil sleep, improved aspect of the countenance, the skin cooler and with more tendency to moisture, the tongue cleaning at the edges, and a natural desire for food, all give sign that the disease is passing away ; on the other hand, if a fatal issue is approaching, the general weakness increases, the patient slips down in the bed in consequence, and lies in a state of dreamy muttering; there is convulsive starting of the fingers or other parts of the body, picking at the bed- clothes, the insensibility to externaL impres- sions increases, and probably stupor closes life. Such are the general features of fever, whether simply continued, or when it runs on to the more serious forms of typhoid, or low, or nervous, or malignant fever. There are many other indications which occur, but which it would serve no good purpose to detail here ; all that is required is that the disease should be recognisable, so that its general management may be properly and intelligently conducted when it falls to the lot of an unprofessional person to have the direction. In the first place it must be remembered, that for continued fever we have no cure, that is, we have no medicine which we can FE V 249 FE V give with the tolerable certainty of remov- ing the disease, as quinine removes ague : it must be vanquished by the powers of the constitution, by the tendency to health, and our endeavour must be to place these powers in the most favourable condition possible for the struggle, and, where they appear to be insufficient, assist. Sometimes the constitutional power will throw off fever at the very onset. Probably few medical men have not experienced in their own persons, when attending fever patients, that they had contracted the disease, and that after all its symptoms had been in course of development for four- and- twenty, or even eight-and forty hours, it has been cast off, probably, by perspiration or diar- rhoea, and health restored. From this almost ephemeral attack, to the week after week of continued fever, the disease may be thrown off at any period of its course. A person attacked with fever ought to be placed in as roomy and well-aired a situa- tion as possible — better even in a barn than in a close or crowded room; the greatest cleanliness as regards every thing around must be observed, and perfect quietude ; if thirst is present, it should be liberally indulged with simple diluents ; if nourish- ment is taken, it should be given in mode- rate quantities, and consist principally of milk and farinaceous preparations ; grapes, oranges, and ripe fruits, if they do not create flatulence or diarrhoea, are allowable. If the skin is hot and dry, it should be sponged daily, or oftener, with water, and, indeed, this practice is beneficial, more or less, in most cases. By these simple means of management, almost without medicine, beyond some gentle aperient at intervals to keep the bowels perfectly free of their necessarily depraved contents, many a case of fever may be well conducted to a favour- able issue, with much more certainty than under a more meddlesome treatment — care being taken when signs of amendment show themselves, that there is not too great hurry in giving or permitting strong nourishment. In more serious forms of fever, the same principle of treatment must be kept in view, but more urgent symptoms may call for more active interference ; violent delirium may require the treatment pointed out under the article devoted to the subject; difficulty of breathing and cough may ren- der a blister on the chest desirable, or tenderness of the bowels on pressure, par- ticularly in the right iliac region, (see Ab- domen,) may call for the application of half a dozen leeches. Diarrhoea may require to be checked, (see Diarrhoea,) or constipa- tion removed by gentle aperients; eastor-oil or rhubarb or senna will generally be found safest and best, or by clysters. Sleepless- ness at night, with convulsive starting of the fingers, may require opium, (see Delirium ;) or the general sinking of the powers, the pulse becoming feeble and easily extin- guished, may call for the careful and measured administration of wine or brandy, or of camphor in milk, (see Camphor,) with strong meat-broth, or gravy, in frequently repeated small quantities. At this time care must be taken to observe whether urine is passed ; if there seems to be difficulty, a bag of hot bran on the lower part of the body will possibly make it easier ; if it dribbles away, means should be taken to protect the back and hips of the patient from being wetted with it. This may be done in various ways, either by waterproof material, or by constant renewal of dry cloths ; it is much better effected, however, by bags of bran, so placed as to absorb the urine as it comes away. If with every quart of bran, four ounces of the diluted sulphuric acid be mixed, it will neutralize the ammoniacal emanations which so quickly arise wherever urine collects. Very re- cently, bags filled with the powder of peat charcoal have been recommended for the same purpose ; and where this article can be procured, it will probably be superior to any other. All patients who lie long in fever become liable to bed-sores, or ulcerations on the prominent parts of the body which are subject to pressure as they lie; these are, especially, the back and hips, points of the shoulder-blades, back of the head, tips of the ears, &c. When these ulcerations form, they not only add materially to the suffer- ing of the patient, but may become the cause of a fatal termination to a case that might otherwise have recovered. They should, if possible, be prevented. The parts named above should be frequently examined, and on the slightest appearance of redness, the skin at the spot should be rubbed -with spirit — brandy — or a solution of camphor in spirit. When the skin has actually broken, it may be dressed with simple spermaceti ointment spread on linen; lead plaster spread on soft leather is often useful, or the white of egg beat up with alum. — See Alum. Both as a preventive and as a remedy after the sores have formed, the parts should be relieved from pressure as much as possible by various arrangements of cushions, &c. the elastic ones made for the purpose being the most suitable. — See Caoutchouc, Elas tic, §c. FIB 250 FIL Such are the general principles on which a case of fever is to be managed ; by attention to them an unprofessional person will be much more likely to do good than by meddlesome interfe- rence. Attention to the ventilation of the room, to the perfect cleanliness of the pa- tient and of every thing around — a free supply of diluent drinks, and care that the bowels are duly, but not forcibly relieved of their always depraved contents, ought to constitute the chief resources of the do- mestic management of fever. Again it is repeated, fever is not a disease to be cured, but to be guided to a safe ter- mination. If many of the symptoms which arise, or may arise, in fever, or if minutiae of treatment are here omitted, it is because either their enumeration would have been useless, or that a judicious reference to va- rious parts of this work will furnish ade- quate guidance. As regards the causes of fever, the first, " Contagion," has been fully treated of in its special article, and the rest are so fully pointed out in the various sani- tary articles, such as "Air" and "Atmo- sphere," "Bedroom," "Chlorine," "Disin- fectant," "Drainage," &c. &c. that it would involve needless repetition to go over them here. They may be summed up : Predispos- ing — whatever lowers, either temporarily or permanently, the standard of the gene- ral health ; and Direct — contagion and the products of animal or vegetable decompo- sition. Fever in children in this country [England] is more generally of a remittent character than it is in adults. This article cannot be closed without re- ference to the employment of fresh yeast in cases of fever, particularly of a low, malig- nant, or putrid tendency, in which it is most useful. It is given in tablespoonful doses, repeated every three or four hours. Refer to Ague — Bedroom — Contagion — Dis- infectant — Disease — Debility, §c. FIBRIN — Is that constituent of the blood which — along with the entangled globules — forms the clot. It also constitutes the fibre of flesh or muscle. It is identical in com- position with albumen, to which state it must be reduced in the process of digestion in the stomach, for the purposes of nutri- tion; but it is in a much more "vitalized* condition than the former substances ; in other words, is much more fit to become incorporated with the tissues of the living body. Refer to Albumen — Blood — Digestion — Food, §c. FIBULA.— The small bone of the leg. FIGS — The well-known fruit, contain a wholesome and somewhat aperient pulp, but the thick tough rind is indigestible, and should not be eaten. FILBERTS— Are liable to the objection to nuts generally, and are diflicult of di- gestion. FILTER — Is an agent for separating solid impurities from fluids. Filtering papers made for the purpose, or white blotting paper, are most usually used as medical filters, being supported by the well-known funnel or tundish, which ought to be of glass or porcelain, and ribbed inside, (fig. lxix.) To make a paper filter, the paper Fig. lxix. used must be square, (fig. lxx.) By the first fold the corners (1,1) are put together, at the next (2, 2) are put together, thus forming a triangle, (1, 3, 2;) 1 and 2 are next put together, making a triangle, (4, 3,2;) and one more fold (5, 3, 2) completes. The Fig. lxx. 1 4 ..-•* top being squared off, the filter is made, and may be opened out and placed inside the supporting tundish. In filtering through paper, it is always desirable to pass the first few ounces of the fluid through a second time, as a small amount of impurity gene- rally escapes at first. When the solids to be separated by filtration are not in very fine powder, the operation is more quickly done through linen or flannel. Of the va- rious filters sold for the purifaction of water, it is unnecessary here to speak. But as the purity of that element is one of the essentials for health, and as, in those situ- FIN 251 FIT ations and circumstances in which it is used in its greatest impurity, almost any kind of bought filter is unattainable, the following suggestion from the Proceedings of the British Association is most valuable : — Any common vessel with a hole below, such as a flower- pot, may be used. Its lower portion is to be filled with coarse pebbles, over which should be placed a layer of finer ones, and on these a layer of clean coarse sand ; on the top of this, a piece of burnt clay, perforated with small holes, should be put, and on this a stratum, three or four inches thick, of well- burnt pounded charcoal. A filter thus formed will last a long time, and not only separates solid impurities, but purifies the water, by means of the charcoal, from the putrescent and other noxious substances held in solu- tion, which cannot be separated by ordinary filtration. Refer to Water. FINGERS — From their constant exposure, are liable to many accidents and diseases — fractures, dislocations, whitlow, separation of the nail — all which are treated of under their respective articles. There is, however, one mishap which does not fall under any particular head. A ring which cannot be removed. — When this occurs, the use of cold to the finger and hand, the hand and arm being elevated at the same time, may cause sufficient shrinking to permit the removal. If this does not succeed, the following may : — A piece of fine pack-thread, or linen thread, is to be wrapped evenly and firmly round the finger, from the tip as far as the ring, through which its end is to be inserted, which being done, the packthread must be gradually unwound by means of the end thus placed. If this process does not suc- ceed, the ring should be filed off. It cannot remain without risk. FIRE.— See Heat. FISH — As an article of diet, is generally wholesome. It is neither so nutritive nor so heating as animal food, and on these ac- counts is often to be permitted when the latter is not. Fish are classed as fresh-water, salt- water, and shell-fish. Dr. Paris remarks, " Turbot, cod, whiting, haddock, flounder, and sole are the least heating of the more nutritive species ; and the flakiness of the fish, and its opaque appearance after being cooked, may be considered as true indica- tions of its goodness ; for when the muscles remain semi-transparent and bluish, after sufficient boiling, we may reject it as infe- rior in value, and not in season. When fish is in high perfection, there is also a layer of white curdy matter, resembling coagu- lated albumen, interposed between its flakes. The whiting ("the chicken of the sea") is well adapted for weak stomachs, on account of the little viscidity which it possesses. It is at the same time tender, white, and delicate, and conveys sufficient nutriment, with but little stimulus, to the system. The haddock is firmer in texture. Cod is not quite so digestible as the two former, but it is nutritious. Turbot is wholesome, without lobster sauce. Sole is tender, and yet suf- ficiently firm ; it is, therefore, easy of di- gestion, and affords proper nutriment to delicate stomachs. Salmon is very nutri- tious, but, being one of the oily fishes, is less digestible than many others — vinegar in some degree corrects the fault. Eels are always indigestible." From these observa- tions the value of fish may be appreciated, and the qualities which entitle them to election easily understood. [In the United States the rock-fish is most esteemed, but the shad, cat-fish, sun-fish, perch, pike, trout, and herring are also excellent articles of food.] Firmness of texture, whiteness of muscle, and the absence of oiliness and viscidity, are the circumstances which render them acceptable to weak stomachs. The flesh of fish contains kreatine. — See Kreatine. Shell- fish may, without exception, be considered as indigestible. Oysters eaten raw are un- doubtedly nutritive, but by some they are not easily digested. Many persons are lia- ble to cutaneous eruptions after the use of some descriptions of shell-fish, and some suffer from diarrhoea. In such places, as the coast of Norway and Sweden, where a diet of fish alone is habitual, the people are very liable to chro- nic cutaneous diseases. The most wholesome method of cooking fish is by boiling ; frying is not suitable for the invalid. It is well known that certain species of fish are poison at all times ; others appear to be so only occasionally, and under peculiar circumstances. Of these, the common mussel has proved more inju- rious than any others. The oily fishes also, such as salmon, herring, &c. when too long kept, have also given rise to symptoms of irritant poisoning. Refer to Mussels, §c. FISTULA — Is a canal or passage formed by disease, and healing with difficulty, which opens from the surface of the body. The word fistula, alone, is generally used popu- larly with reference to the disease when situated at the fundament. — See Rectum. FITS. — The term is applied popularly to any form of convulsion or spasm of the FIX 252 FOM voluntary muscles, such as Epilepsy, Hys- teria, and Convulsions generally, either in adults or children. To these heads the reader is referred. FIXED AIR. — The name given by Dr. Black to carbonic acid gas. FLANNEL — A woollen texture, is an ar- ticle of clothing which should be worn next the skin by every man, woman, and child in every country, notwithstanding its pro- hibition (!) by Preissnitz, amid other hy- dropathic regulations. Under the head of flannel is included, of course, woollen clothing generally. Wool being a bad con- ductor of heat, is, in consequence, the best protection against sudden vicissitudes of temperature, such as occur in most climates, and especially against chills, which may su- pervene upon the profuse perspiration in a warm one. Of course, the thickness of the woollen material worn next the skin may and ought to be varied, but wool it ought to be, if of no stronger texture than gauze. The experience of our military and naval sur- geons all tends to prove that there is no greater preservative from the dysenteric and febrile affections of hot climates than wool- len clothing next the skin, and every medi- cal man's experience in this country con- firms the fact of its protective power. Not- withstanding, it is astonishing how many carelessly neglect this indispensable article of clothing. Some few persons with extreme- ly irritable skin cannot wear flannel next it. In such cases, a dress of thin cotton [or silk] should be worn, with flannel over it. Flannel should be worn in summer, but of a thin texture. FLATULENCE— Or the collection of gas in the stomach and bowels, is very commonly the result of indigestion ; but it is often also the effect of nervous disorder. In the former case, it is probably chiefly due to the extrication of gas from the badly-di- gested food mass in a state of partial fer- mentation. In the latter, it is only possible to account for the enormous quantities of " wind" which are discharged by its forma- tion ("secretion") in the bowels. Toward the termination of fever, and other acute diseases, flatulent distention of the bowels, or " tympanitis," as it is called, is always an unfavourable symptom. Persons who suffer from flatulence require sedulously to avoid most kinds of vegetable food and fruits. Individual experience, how- ever, is the best guide on this head. When a severe attack of flatulence comes on, car- minative (see Carminatives) and stimulating remedies are generally resorted to, and often prove useful. But in many cases, particularly in nervous individuals, with pale tongue, the mineral acids will often be of more service — either twenty to thirty drops of dilute nitric acid in a wineglassful of infusion of orange-peel, or some other warm bitter ; or, better still, aromatic sul- phuric acid, in ten drop doses, in a wine- glassful of water. In general flatulence of the bowels, with difficulty of expulsion, the clysters of assafoetida or rue are most useful. Refer to Children — Clysters — Indigestion. FLESH. — The muscular substance of ani- mal bodies composed of fibrin. It is a po- pular error to suppose that flesh is merely present in the body "as flesh," and it is not understood that every particle of the sub- stance is muscle, and employed as such in the movements of the living body. Refer to Beef — Fibrin — Mutton, §c. FLESH-BRUSH.— A brush for brushing the skin. — See Skin. FLOODING. — Hemorrhage from the womb. — See Abortion — Childbed — Menstrua- tion, Sfc. FLOUR.— See Grains— Farina. FLOWERS op SULPHUR. — Sublimed sulphur. — See Sulphur. FLUCTUATION— In medical language, is the movement given to fluids in cavities (either natural or diseased) by the fingers of the medical man, while at the same time he endeavours to make himself acquainted with the various peculiarities which charac- terize the collection. Refer to Abscess. FLUOR ALBUS, [The Whites.]— See Menstruation. FLUX. -A An increased discharge from any of the passages of the body, such as the bowels, lined by a mucous membrane. The term has gone out of use. FOETUS.— The term is applied to the in- fant from the fifth month till the period of birth. FOMENTATION— Is a method of apply- ing heat and misture to any portion of the body. It is a most useful remedy, if well done, but is so often badly performed as to do more harm than good ; for this reason a bran-bag poultice, properly made (see Bran) is in most cases preferable. When fomenta- tion is to be performed, the bed or clothes should be guarded by some waterproof ma- terial if possible. Two good-sized pieces of coarse flannel are to be employed, one being in preparation while the other is in use. The flannel being wrung out of hot water, should be shaken up loosely, and laid upon the part under treatment. The size of the flannel must, of course, be propor^ FO M 253 FOO tioned to the case, but it should be ample. Simple warm water is generally sufficient for fomentation, but in some cases the de- coction of poppy capsules may be more soothing. Other additions are of no service beyond insuring the greater attention and confidence of many ignorant persons, who will not use, either with care or confidence, so simple an application as water. Refer to Bran — Heat — Poultice, §c. FOMITES.— See Contagion. FOOD— That by which the living body is nourished, in its widest sense, comprehends both liquid and solid aliment. In the fol- lowing article, the subject will be consider- ed chiefly with reference to the principles which regulate, or ought to regulate, the food of man, and on which, as far as ascer- tained, the nutriment of his material frame is conducted. Much special information connected with the subject is scattered through this work in the papers which treat of the individual articles used as nourish- ment ; and such papers as "Alimentary Canal," " Digestion," &c. bear directly up- on it. Water is not only the medium by means of which most of the operations which go on in living bodies are conducted, but it also enters so largely into the composition of these bodies, that it must be regarded as one of the alimentary principles, a due sup- ply of which is necessary, not only for health, but for life ; and this supply must be constant, in order to compensate for the loss of moisture which is continually going on from the surfaces, exterior and interior, of the living body. The food taken by man and animals has, or ought to have reference in its composi- tion to two distinct ends, the nourishment of the bodily tissues, and the maintenance of animal temperature. Milk is the only single article of diet which in itself con- tains this essential combination in properly balanced proportion. We know that it is capable, not only of sustaining, but of nourishing in growth the body of the young animal ; and thus we have plainly set before us, what He who made and sus- tains all things has provided as necessary for the sustenance of the creature, when that creature is confined to one means of nourishment solely. In addition to water and saline ingredients, milk contains three distinct sets of principles : the albuminous, represented by the curd; the saccharine, (in which is included the farinaceous,) repre- sented by the sugar, and the oleaginous, or fatty, by the cream. Of these, the albu- minous principles and salts are requisite for W the building up of the frame ; the saccha* rine and oleaginous for, so to speak, sup- plying it with fuel ; they are what has been called "respiratory food," because they chiefly furnish materials, carbon and hy- drogen, which may combine with the oxy- gen taken in from the air by the lungs, and burn, as it were, within the body by a slow and gentle process. It must not, however, be imagined that the saccharine and oleagi- nous principles are solely devoted to pur- poses of fuel, they also serve important ends in the nutrition of the body ; but as they contain no azote or nitrogen, it is evi- dent they cannot afford proper nutriment to tissues of which this element forms an essential component. They cannot, there- fore, form muscle ; but they can form fat, which contains no nitrogen, and requires none. In truth, the sugar, starch, and probably the fibre and gum of vegetables, must constitute the chief sources for the formation of fat in graminivorous or vege- table-feeding animals. The albuminous, the saccharine, and the oleaginous princi- ples must each be taken as the representa- tives of a peculiar class of substances. Under the head of albuminous principles falls the caseine, or curd of milk ; albumen, as we see it in the egg ; and fibrin, as it coagulates from blood, or forms part of animal muscle. These are principles all identical, or nearly so, in composition, but in different states of vital organization. They are composed of carbon, hydrogen, ni- trogen, and contain phosphorus and sulphur in small proportions. They are, therefore, adapted to afford due nourishment to such portions of the living animal body' as are similarly constituted. The milk curd is the only substance contained in that fluid from which the young animal can form its blood and its muscle. From the albumen of the egg alone all the tissues of the chick are constructed, and the carnivorous animal subsists upon the muscle (flesh) of its vic- tims. These principles are, therefore, in themselves capable of sustaining life. Not so the oleaginous and the saccharine, which represent, the one the fats and oils, and the other the starch or fecula, the sugar, and the gum. These being deficient in nitrogen, in sulphur, and phosphorus, cannot yield them, and, therefore, an animal fed upon them alone, will die of starvation, as regards certain essential components of its body at least. It was, for a long time, a paradox, how animals which lived on vegetable food, formed from it the albuminous principles contained within their bodies, because it was thought that in the vegetable kingdom FOO 254 FOO these azotized compounds did not exist. Chemistry of late years has solved the dif- ficulty, by proving that vegetables do contain albuminous principles answering to those found in animal substances ; not, it is true, in the same large proportion, but quite suf- ficient to afford all necessary nourishment, even to the muscular bull or the gigantic elephant. These principles, and indeed their own entire structure, plants elaborate " from carbonic acid, water, and ammonia ; that is, from the constituents of the atmo- sphere, with the addition of sulphur, and of certain constituents of the crust of the earth." Plants, therefore, may truly be said to produce the blood of animals. Certainly, animals which live upon vegetables have to consume a very much larger bulk of mate- rial than animals which live upon flesh ; but for this, their habits and the nature of their digestive organs have been arranged by the Creator. Vegetables, therefore, are the ori- ginal formers of these albuminous princi- ples, which they present ready prepared to the digestive organs of the vegetable-eating animal ; the latter have simply the task of fitting them for intermixture with the blood, previous to their becoming component con- stituents of the animal body. In the ani- mal, however, it must be evident that they exist in a much more compact condition than in vegetable substances, and that the flesh-eating animal will require to consume a much smaller proportion of its natural food than the vegetable feeder. Both classes of animals, however, breathe, that is, take in oxygen by the lungs, which, in main- taining their animal temperature, must com- bine with the respiratory elements, (carbon and hydrogen.) These the vegetable feeder receives in abundance, in the starch, the saccharine ingredients, the woody fibre, &c. which make up the mass of vegetable substance ; sources evidently not open to the animal living on flesh alone. This, it is true, will receive some amount of respira- tory food in the fat of its prey ; but it will also require to make more violent muscular exertion than the vegetable feeder, so that using up its muscle in so doing, it may obtain the carbon and hydrogen (which are contained in muscular substances as well as in other albuminous principles) for the pur- poses of animal fuel. In accordance with this, we find that the carnivorous animals expend much more muscular force in ob- taining their sustenance, (in hunting,) than the graminivorous animal. What is applicable to the food of animals is also true in that of man, as regards the nutrient principles ; the bodies of both stand upon the same level, but man has the will and the power to consume both vegetable and animal food, either mixed or singly, as may suit his habits. Existence upon animal flesh alone is not common, but it is practicable and practised by the Indians of the South American pampas, and by many people who live by hunting ; but all these, like the carnivorous animal, make long-con- tinued muscular exertion, without which, indeed, under the peculiar diet, they could not preserve health or life. Sir Francis Head relates, in his Journey over the Pampas, that while making immense exertions, he lived for months together exclusively on beef and water, this being the diet of the roamers over these immense plains, who spend most of their time in active exercise on horseback. Existence upon vegetable food alone is much more common than that upon ani- mal food alone ; and, indeed, is the rule with many nations and people, who un- questionably maintain high strength and vigour upon it. It is, in fact, only requisite to look at the grass-eating bull to feel con- vinced of the possibility of the fact, and did space permit, it would be easy to ci^e abundant confirmatory examples ; but if man lives on vegetables he must, like the vegetable-eating animal, consume a com- paratively large bulk to obtain sufficient nutriment; and so it is the Irishman and the Hindoo must eat seven or eight pounds of potatoes, or of rice, at a meal. These, however, are extreme instances, for potatoes and rice are comparatively non-nutritious, containing much starch and — especially the latter, when cooked — much water ; the cereal grains and pulses, on the other hand, pos- sess albuminous principles largely — the glu- ten of the former corresponding to the animal fibrin, and the caseine of the latter to the curd of milk. Those persons, there- fore, whose vegetable food is composed chiefly of the above, require, of course, to con- sume less, and there cannot be the slightest doubt that man may lead a most active and healthy life upon a grain diet alone, and especially if it be combined with milk. But what is possible may not always be expe- dient, nor suited to man's circumstances, and on this hinges the argument respecting the nature of food on which man ought to live. No physiologist would dispute, with those who maintain that man ought to live on vegetables alone, the possibility of his doing so, or that many might not be as well or better under such a system than any other ; but no physician acquainted with the requirements and constitutions of men FOO 255 FOO generally, who live according to the usages (certainly it may be allowed too artificial) — of this and other civilized countries, will allow that a vegetable diet could become the rule to the majority without serious injury. The healthy, active countryman, constantly exercised in the open air, will do well on a vegetable diet, under which the city artisan or man of business, the delicate female, the pale, perhaps scrofulous child, would be- come" diseased, or sink and die. Their organs of digestion and assimilation cannot extract from the vegetable mass sufficient blood-nourishment, neither do they receive sufficient stimulation from it. It may be contended that the evil is an artificial one, engendered by artificial life. That may or may not be the case, but so the question stands at present ; and, as man generally is circumstanced at the present day, he will best consult his own comfort, convenience, and usefulness, by using a mixed diet, the power to use which has been bestowed upon him by his Creator. He will, if possible, consume albuminous material, (animal food,) in quantity sufficient to supply the waste of his bodily, especially muscular, tissues ; but will mingle it with such respiratory food, that is, saccharine, or starchy, and oleaginous substances, as will supply the carbon and hydrogen requisite for animal temperature, without his being compelled to undergo the muscular exertion of the half savage hunter. In the consideration of the principles which ought to regulate man's food, and which do regulate the nourishment of his material animal body, there has been omit- ted — for the sake of avoiding confusion — all notice of an important and generally distributed component of the animal frame, the gelatinous, or jelly, principle. This, which enters mainly into the composition of the skin and tendons, and which forms the animal constituent of the bones, belongs to none of the principles already enume- rated, although it contains nitrogen, and is much simpler in composition than albumen. In the form of isinglass, gelatine, or glue, it is familiar to all. As gelatine enters largely into the constitution of the animal body, it must, of course, be a valuable, if it is not an essential, addition to its means of nutriment, when taken in the food, and especially as a substitute for albuminous nourishment, which must, in its absence, be used up in supplying nutriment to the azotized gelatinous tissues. The only other constituents of food it remains to notice are the mineral elements — salts of iron, potash, soda, lime, magnesia, &c, and with them sulphur and phosphorus ; these must be, and they generally are, afforded to the sys- tem, along with nutriment generally. To review the principles which regulate food and nourishment : — We have vegetables as the first agents for taking up the ele- mentary forms of matter, and combining and transforming them into such components as are suited to the digestive organs of the vegetable-subsisting animal which consumes them, and in which they are built up into the blood-filled animal frame, of muscle, nerve, and bone, ready for the consumption of the carnivora, or flesh-eaters, and to yield sustenance suited to the wants of man. We have these nutrient principles, consisting of albuminous compounds, fitted to nourish albuminous tissues, gelatinous to nourish gelatinous, and saccharine and farinaceous to supply the matter of fuel, and to take part in all the other operations of the system, or to be stored up as fat. Lastly, we have water, the aqueous prin- ciple, as the necessary medium without which these varied operations could not be carried out. To apply these principles to man, we find him so constituted as to be able to maintain health and life on animal food alone, or on vegetable food alone ; but we also find him fitted by organization to subsist on a mixed diet, such as is most in accordance with the habits and usages of all civilized communi- ties. In the selection of food, however, it is not sufficient that it contains the principles necessary for the nutriment of the body, but these principles must be reducible by the digestive powers. It matters not that wood fibre nearly approaches starch or gum in composition, or that horn contains albu- men largely, if the firm texture is not solu- ble in the stomach; and the same argument modified, applies to food generally — forms, indeed, that consideration with respect to it which comes under the designation Diet — that is, the facility or the reverse with which certain articles used as food are digested. To the strong and healthy, this is within certain limits a matter of com- parative indifference ; to those who suffer from weakened digestion — and they are very many — it becomes a matter of para- mount importance, as one on which com- fort and even life depends. The subject has engaged a large share of the attention of medical men, and is too extensive to be fully treated here. The aim of the author, therefore, is rather to point out the princi- ples on which diet should be regulated, than to descend to special minutise, and these he FOR 256 FRA is more willing to omit, from the fact that these minutise are greatly matters of indi- vidual peculiarity, which vary in each one ; and which must and ought to be matters of well-ascertained personal experience. Thus, we find that some stomachs are perfectly unable to cope with fatty matters, but do well with the acid or saccharine ; a certain class again seem quite at ease with milk, which throws others into a ferment ; even mutton, the most digestible of all meats, has, in a case within the author's knowledge, invariably produced vomiting when eaten, however disguised. It might be expected that something would be said as to the digestibility of various articles ; but this is sufficiently treated of under their individual heads, and the tables on the subject which have been drawn up are not to be depended upon. As a general rule, food is digested with more difficulty in proportion to the tena- ciousness of its structure, whether owing to natural conformation, or insufficient masti- cation, or faulty preparation or cooking. — See Boiling, Roasting, Sfc. Vegetables re- quire more digesting than animal substances, but they remain a shorter time in the stomach itself, undergoing a great portion of the pro- cess after they have passed from that organ, whereas animal food leaves it perfectly digested. This is partly the reason why a meal of animal food satisfies hunger longer than one composed of vegetables, but some- thing is also due to the position which the stomach holds with respect to the system generally. If the desire for food is sympa- thetic with the wants of the body at large, the animal food, which better supplies those wants, must do so for a longer period than the other. Variety in diet is requisite for health. A single article of nutriment, even though it contain all the requisite elements, can scarcely be long used exclusively as food, without injury to the digestive organs, or even danger to life. Brown bread with water is perhaps an exception. For further information upon food, the reader is re- ferred to the various articles in this work connected with the subject, the substance of which could not have been introduced here without needless repetition and occupation of space which cannot be spared. FOOT-BATH.— See Bath. FORCEPS — Are instruments used in ob- stetrical and surgical practice as substitutes for the hands or fingers, not only for the sake of cleanliness, but as being capable of introduction into positions where the hands or fingers cannot go. A pair of the com- mon dressing forceps (see fig. lxii., arti- cle Dressing) would be found useful for many purposes in domestic management, if for nothing else than taking off plasters, and it would be well if responsible persons generally, who reside at a distance from medical assistance, were provided with a pair of artery spring forceps. This instru- ment, which somewhat resembles the other in shape, is provided with a spring catch which keeps its points perfectly closed when required. In many cases of wounds involving the severance of an artery, an unprofessional person could not perhaps employ any means for stopping the bleeding with such probable certainty and ease. Refer to Hemorrhage — Artery. FORE-ARM.— The lower arm, between the elbow and the hand. It contains two bones, the radius (fig. lxxi., 1) and the Fig. lxxi. ulna, (2.) These are articulated or jointed at their upper extremity (3) to the single bone of the arm ; and at their lower extremi- ties to the small bones of the wrist. The bones of the fore-arm are very often broken, and in children are often bent by accident, without fracture. Refer to Fracture. FOWL.— See Poultry. FOX-GLOVE.— See Digitalis. FRACTURES op the Bones— Are acci- dents which, from their nature, can only be treated with certain efficiency and success by the educated surgeon; but on the other hand, from their frequent occurrence, par- ticularly in situations where no surgical assistance can be readily procured, it is highly desirable that unprofessional persona FR A 257 FR A should be able to manage them in some- thing like an intelligent manner. The existence of a fracture is, in some si- tuations, made out with difficulty, even by the skilful. This is particularly the case in the vicinity of joints, such as the ankle, hip, shoulder, &c; but in others, as in the middle of the long bones, such as those of the leg, thigh, forearm or arm, the fact is often too obvious to be overlooked by the most careless. The general symptoms of a fracture having occurred, are pain and loss of power over the injured limb, which is altered in shape or crooked, and probably swollen and shortened. Its lower ex- tremity hangs loosely, and is more mov- able than it ought to be; motion being generally accompanied with a sensation of grating, perceptible both to the sufferer and to the person handling the limb. The broken ends — generally the upper one — probably project against the skin, or, it may be, protrude entirely through it, con- stituting a compound fracture. Much of the displacement of the fractured ends of a bone is due to the contraction of some of the muscles of the limb, which are, from the nature of the injury, freed from the controlling counter-action of other muscles. This fact it is important to remember in the treatment, during which, when it can be done without sacrificing to too great an ex- tent other essential points, the injured limb should be placed in a position which allows the muscles generally %p be in a relaxed con- dition. In addition to these local signs, a person who has suffered from severe frac- ture is generally faint and depressed for some time after. In many cases of fractured bones, how- ever, the symptoms are far from being so plainly marked as described above. The fracture of a bone is, of course, in itself, a severe injury; but it is rendered infinitely more so, by the wounding and tearing of the soft parts of the limb by the generally ragged ends of the bone. This, therefore, it is desirable to prevent, as much as possible, both in removing the sufferer and afterward. It being ascertained that a fracture has occurred, if surgical assistance is not im- mediately at hand, the removal of the sufferer will probably be requisite. If the upper extremity be the part involved, it should in the mean time be well supported by a sling, and the sufferer will find walk- ing a much easier and less painful mode of locomotion than any other. Much injury and suffering are often inflicted upon persons who have fractured a lower ex- w2 17 tremity, by hasty and injudicious manage- ment in the removal ; the lower end of the limb being left entirely unsupported, or at best carried by some of those around, thus causing great pain, increasing the wound- ing of the soft parts within, or, it may be, occasioning the protrusion of the bone through the skin ; and thus, especially if the last should occur, diminishing greatly the chances of a good recovery. A person who has fractured the leg, if he be not already lying on the ground, should be placed there till a shutter, a door, or flat board of some kind can be procured ; this should be placed alongside, covered of course with coats or the like, and the sufferer gently slid, rather than lifted, upon it. On this he is to be hand-carried, even if the distance is considerable, as preferable either to cart or carriage conveyance. Before lifting him, however, the fractured limb should be secured from motion as much as possible, either by tying it to the sound one by means of handkerchiefs, or by straw or other material placed about it. In the ' mean while, a firm bed should be prepared for the patient ; a mattrass is most suitable, if procurable — if not, a board of sufficient length, passed under the ordinary bed, will do : the object of this is to prevent the sinking which inevitably occurs from a person lying long in one place in bed, a circumstance which interferes much both with comfort and treatment. The object in view in the treatment of a fractured bone is to preserve the broken ends in contact, in their proper relative po- sitions, as steadily and as exactly as possible, so that the curative and consolidating pro- cess may proceed without disturbance; and that when this is complete, the symmetry of the limb may be unaltered. In giving direc- tions as to the management of fractured bones by unprofessional persons, the author feels how difficult the task of conveying the information is to himself, and how much more difficult it must be to those unaccus- tomed to deal with such matters, to treat them at all satisfactorily from a written de- ' scription. At the same time cases do occur, in which the choice lies only between perfect ignorance and some amount of information of the methods to be adopted. For such cases this article is written; for certainly no sufferer from fracture, in his senses, would submit to, nor any unprofessional person undertake the treatment, if skilled assist- ance was in any way procurable. In ad- dition, the author would strongly advise any who are likely, in their course through life, to be thrown much in out-of-the-way Fit A 258 FEA circumstances, and who would wish to be useful, to see for themselves in some hospi- tal the mode of putting up fractured bones. A few hours, even, of observation, would teach them more than all written descrip- tions, though these might afterward refresh the memory. Either after or before the patient is placed in bed, the clothes must be removed, cut off the injured limb; of course by the seams if possible. The proper applications must meanwhile be got ready as quickly as may be. These are splints, such as are recommended in each particular form of accident, with their cushions and bandages. — See Bandage. Some surgeons delay the application of the splints for some days, till the swelling, which always occurs more or less after fracture, has subsided, and some cases may occur in which this is desirable ; but the majority of practitioners put the splints on as soon as possible after the acci- dent, and this is certainly the preferable practice. There almost always exists a tendency to spasmodic starting of a limb which has been fractured, for some time after the accident, and this constantly tends to displace the bones, and to increase the laceration and swelling of the soft parts ; this may in great measure be prevented by the early steadying of the whole limb by the splint, which, however, need not be bound tightly, and may be so applied as to be loosened at once if requisite.* A splint is simply an agent which can be bound to a fractured limb, and which will keep it in the straight position ; it may, therefore, be made of wood, iron, leather, or even straw. The variety of splints is very great, but as this article is written for use in situations where only the simplest means are supposed to be at hand, the sim- plest modes of management only will be ad- verted to. Moreover, fractures may be treated without splints, properly so called, as by starch bandages or the like, or by po- sition simply. As the continued contact of hard splints would occasion pain, they are usually cushioned or padded. This may be effected by any soft material, care being taken that the padding projects everywhere beyond the edges of the splint, to which it may, if convenient, be attached by tapes, (fig. lxxiii.) Lastly, all things being arranged, the setting of the fracture remains to be ef- fected. This, which is always painful, con- * The elastic split cushions of M. Bourjeaurd en- tirely obviate this objection. These are made of vul- canized India rubber, and are inflated with air, which can be increased or diminished, as required. sists in bringing the broken ends into con- tact, as much as possible in their proper re- lative position. In some few cases, as in the leg, it may happen that although there is fracture, there is no displacement ; but in the majority of instances the broken ends overlap one another, being drawn by the action of the muscles ; the main requisite, therefore, in the reduction of a fracture, is, by gentle but steady drawing down of the lower extremity of the limb — while the upper is fixed — to bring the ends to a level, and, if possible, place them one against the other. In the drawing down, however, the hand should not grasp the extremity of the fractured bone, but should be applied below the joint. Thus, in setting a fractured thigh, the surgeon grasps the leg, not the lower part of the thigh, &c. After a frac- ture has once been set, it should never, if possible, be disturbed again. This does not mean that the appliances are not to be removed, and the progress of the case in- spected ; for if this be not done, and if by any chance the proper position should have been disturbed, the bones may become so- lidly fixed in an improper manner, and deformity result, or the skin may become ulcerated. But the appliances should not be removed, if possible, before the end of the first week, and if all seems going on well, not moved again for ten days at least, unless for some special purpose. If a frac- ture is often disturbed or pulled about during the process of consolidation, it may chance that this will only be effected im- perfectly, and what is called a false joint formed ; that is, the broken part, instead of being firm, moves like a joint, and the limb is useless. It had better be crooked or shortened. Lastly, much care is always required that a limb which has been fractured is not used too soon after the accident ; otherwise it may be either snapped again, or it may be bent. The first advance toward the cure of a broken bone is the throwing out of a jelly-like matter around the ends; this FR A 259 PEA gradually becomes more solid, and, at last, is converted into a thick ring of bone ; but for this latter change the lapse of some months is requisite. Although, therefore, the uniting material, or "callus," as it is called, may be strong enough for ordinary purposes a considerable time before ossifi- cation has been effected, it will not bear extraordinary efforts. With respect to the general treatment of a person who has suffered from fracture, it is always advisable that for some little time after the accident the diet should be lowered, but that when the inflammatory stage is passed, the individual should return as much as possible to his ordinary food. Care must be taken, if the person has been accustomed to much alcoholic stimulant, that it is not unduly abstracted, otherwise the powers of the constitution will be so reduced that the reparative process can- not take place, and the fracture will re- main ununited. In fractures of the lower limbs, the use of a bed-pan and. urinal of some kind will be required, and attention must be given to the back, that it does not get sore. An elastic horse-shoe cushion (see Elastic) will be a great comfort in such cases. Fractures of the skull have been already alluded to under the article Brain. Fracture of the lower jaw is generally to- lerably evident. The simplest treatment is that recommended by Professor Fergusson. Two narrow wedges of cork, about an inch and a half long, a quarter thick at the base, and sloping away to a point, are placed be- tween the teeth, one on each side ; a piece of pasteboard softened in waimi water, or of gutta-percha, is then to be moulded round the jaw, and fixed, either by a bandage or hand- kerchief going over the crown of the head. By this method, space is left between the front teeth for the administration of liquid nourishment. The sufferer should rinse the mouth frequently with tincture of myrrh and water. Fracture of the bones of the spine is a rare accident. It may be suspected, when, after injury to the spine, loss of sensation in, or of power over the part, ensues below the site of the accident. In such a case, nothing could be done by unprofessional persons be- yond placing the sufferer in as easy a po- sition as possible. Fracture of the ribs is known by the pain which is felt at the injured spot in every motion of the body, even by breathing. The sufferer feels a grating sensation, which may be felt by another person laying the hand on the place. The chief risk involved in fractured ribs is from injury to the lungs by the sharp ends of the bone ; and when this occurs, it is apt to give rise to inflam- mation, which will require the usual treat- ment of this affection, from whatever cause arising. On this account, an individual who has suffered from fractured ribs should be especially careful, and for some little time after the accident should reduce his usual diet considerably. The application of the hot bran bag for some days after the accident will afford much relief, and it may be used over the usual bandage. When ribs on both sides of the chest are injured, this, with leeches if requisite, should be the sole application ; the patient being confined to bed for at least a fortnight or three weeks, in the posture found to be the easiest, which will probably be a half-sitting oue, sup- ported by pillows, or some other means. — See Bed. When the ribs on one side only are injured, less confinement is re- quired, but the chest should be encircled, as firmly as can be borne comfortably, with a band of stout calico, from eight to ten inches wide, and double; this should go once and a half round, and be sewed. A month will probably be required for the cure. Fracture of the collar-bone is a frequent accident, usually from falls on the shoulder. It is generally easily detected. As the use of the collar-bone is to keep the shoulder back, — the shoulder of the injured side falls forward when it is broken, pushing the broken ends over one another. The object of treatment, therefore, must be to keep back the shoulder by artificial means, until the bone has recovered its solidity. This might be done by keeping a person confined to bed, and in such a position that the weight of the shoulder falling backward would pull the bone into position without any other means being used ; few persons, however, will submit to the confinement necessary, and other methods are resorted to ; they are varied, but that recommended by the late Mr. Liston will most easily, and with best prospects of success, be adopted by the unprofessional. A wedge-shaped pad, of any firm material — (a pair of stock- ings folded will do) — is to be enveloped in the middle of a soft shawl or handkerchief of suitable size. The pad is then to be placed in the arm-pit of the injured side, (fig. lxxiii. 1 ;) the ends of the shawl must next be crossed over the opposite shoulder, (2,) and tied in the arm-pit, as represented, a folded cloth of some kind being interposed to prevent the chafing of the skin. Another handkerchief or band of some kind is next 260 to be applied (3) so as to bind the arm down to the side in such a manner that the pad in the arm-pit acts as a fulcrum, or gives such a "purchase" as allows the outer end of the broken collar-bone to be pulled outward, as the arm is bound to the side ; a sling enveloping the whole forearm is next to be applied, and completes the appa- ratus, which should be worn for a month at least. If carefully attended to, this appa- ratus will prove very effectual, and the means for it can always be procured. It should be understood that the principle of the treatment is extending the broken bone by means of the pad in the arm-pit. It is sometimes requisite to apply a bandage from the fingers upward to prevent swelling. Fractures and other injuries about the shoulder-joint are often so obscure that no uneducated person could distinguish them. The best management until surgical assist- ance can be procured, if it is far distant, will be perfect rest. Probably much com- fort may be derived from the use of the pad in the arm-pit, as recommended for broken collar-bone, and also of a sling supporting the forearm, wholly or only at the wrist, as may be most easy to the patient. The con- fining band (fig. lxxiii. 3) must not, how- ever, be used. In fracture of the shaft of the arm-bone it is better to put the whole limb in a sling at once, and if the person has to go to the surgeon, he will find it easier to walk than to ride in any conveyance. Confinement to bed will be requisite for some days at least after the accident. The injured limb being laid in an easy position on a pillow, if there is much swelling, it must be lightly band- aged from the fingers to the shoulder, and a couple of splints of wood or other firm material, two and a half inches wide, ap- plied one on each side of the limb (fig. lxxiv. 1) and secured with just sufficient firmness to prevent movement, by means of two or three looped bandages. This band- age (fig. Ixxv.) is made by taking a doubled length, sufficient for the purpose required, of the common roller bandage ; one end, or " tail," of the bandage (1) is passed through Fig. Ixxv. the looped extremity, (2,) and may then be tied to the other tail, (3.) This form of bandage has the great advantage of being easily loosened, if requisite, on account of swelling. After the first few days, when the swelling has subsided, the fracture of the arm may be put up more firmly and perma- nently. After bandaging the limb tole- rably firm, a splint of pasteboard or of gutta-percha, or leather, or indeed of any firm material, is to be put on each side of the limb, (fig. lxxiv.) These ought, however, to be shaped as represented by the dotted line 2, to come a little way along the fore- arm, and, having been previously shaped on the sound arm, instead of the looped band- age, should be well fixed by means of the common roller, which may be kept from slipping by the addition of starch or paste as it is put on. Instead of the splints, how- ever, the starch bandage alone, if the indi- vidual is not very muscular, may be used. But in this case, both the inner and outer bandage must be well saturated with strong starch, flour paste, or gum, or white of egg, and it is well to make the addition of strips of stout paper, pasted down over the inner bandage, and covered by the outer one, to give additional firmness. In this case, it FK A 261 FR A will be requisite to keep the arm very quiet till the paste has dried, or a wooden splint may be tied outside the bandages till this has taken place. A sling will be requisite to support the hand and wrist, but not the elbow, which should be allowed to hang, the weight tending to keep the bones straight. Fracture of the forearm is a very com- mon accident. In children the bones are most frequently partly broken and partly bent. In adults both bones or one only may be broken ; in the latter case, the sound bone acts as a splint to hold the other in place, and, should the accident be detected, a perfectly straight splint of light wood, applied to the inside of the arm, and ex- tending from the elbow to the tips of the fingers, fixed by a common roller, or by some looped bandages, is all that is re- quired; and, indeed, when both bones are broken, the same treatment will be suf- ficient, though some apply a splint on each side. After the lapse of a fortnight, in adults, the splints may be taken off, and a starch bandage used ; but in children who are liable to falls it is better to give them the protection of the wood for some time longer. In fracture of the forearm, the sling ought to give support from the elbow to the ends of the fingers, and the limb must, of course, be kept bent at the elbow during the period of cure. Fracture of the fingers is treated by a narrow, straight wood-splint, or by the starch bandage. Treatment of a fracture of the lower ex- tremity by an unprofessional person must be a most unfortunate contingency ; but the simpler the means used, the more likely will its management be conducted with some efiiciency. In a case of fracture of the thigh, the re- moval and preparation of the sufferer having been effected as already pointed out, the fol- lowing apparatus is such as an unprofes- sional person might, with a little care, ma- nage efficiently ; and the materials for its construction can scarcely ever fail to be pro- curable. Three pieces of wood, about three- eighths of an inch in thickness, will be required, the measurement as to length being made on the sound extremity. One of the pieces must be sufficiently broad to extend completely under the limb, and sufficiently long to extend from just above the middle of the thigh (fig. lxxvi., lxxvii., 1, 1) below the calf of the leg, being edged off at either end. The next piece, (2, 2,) to be fixed on the outer side of the under one, should extend from just above the hip to a little beyond the foot, and must be pierced Fig. lxxvi. Fig. lxxvii. with two holes at the upper end. The re- maining piece (fig. lxxvi. 3) should extend from about two-thirds up the thigh to a little beyond the foot, being fixed to the inner side of the under piece, and connected with the outer piece at the lower end (fig. lxxvi. 4). A slanting support for the sole of the foot, and about the same width, should also be fitted in, so that it will admit of the limb being extended to quite its full length, this being ascertained by measurement of the sound leg. The middle of the apparatus forms a kind of box. A soft handkerchief padded must now be placed between the thighs, (fig. lxxvii. 6, 6.) At this stage the limb must be set. One person should hold the body of the sufferer firmly at the hips, while another, grasping the leg just above the ankle, by a gentle and steady pull, straightens the in- jured limb to the same length as the sound one ; the broken ends of the bone being by this means brought into contact. The apparatus having been previously well padded with any soft material, (even chaff or dried leaves will do,) the broken limb, still kept on the stretch, should be gently placed in it. The foot must then be secured to the padded foot-board by means of a bandage or handkerchief, (fig. lxxvii. 7,) the heel being also well supported by the same or some similar application. The heel may be still further supported by means of a double tape sewed to the toe of a sock, pre- viously put upon the foot ; the tape being carried over the top of the foot-board, and tied to a nail or peg fixed to the back. The ends of the band (6, 6) passed be- tween the thighs are to be passed through the holes in the upper part of piece No. 2, and tied with sufficient firmness to keep the limb on the stretch. This is the essen- tial part of the treatment — the foot bound to the foot-board, and the band tied through the holes in the upper part of piece 2, act against one another, and keep the limb ex- tended. The upper end of 2 must next be secured by a band (8) passed round the FRA 262 FR A body, and the fixing of the apparatus is complete. It will be well, however, to fill up all the interstices between it and the limb, by means of some soft material stuffed in, and when this is done, as a further means of security, to fix one or two bandages or handkerchiefs (10, 10) round both the ap- paratus and limb. The above contrivance is a modification of the one most used by surgeons for the treatment of fractured thigh, but requires much less bandaging, and is, for this reason, preferable. In the usual form of long thigh splints, the entire efficiency of the arrange- ments depends upon the application of the bandage, and no unprofessional person is likely to put it on properly. The apparatus may be used for fractures of the upper part of the leg, as well as for the thigh. Another simple mode of treating fractures of the lower part of the thigh, or upper part of the leg, is by means of two pieces of wood similar 'to No. 2, fig. lxxvi., but shorter, and a large cloth, such as a table-cloth, in each side of which one of the pieces is to be folded up, until there is just space left to contain the limb, which being set, and placed in the space so left, the boards are to be tied up to it on each side by means of handkerchiefs, or stout tapes. Again, the sound limb may be made to act as a splint to the broken one. Pads of some soft ma- terial should be placed between the most prominent points of each, such as the knees, ankles, great toes, &c. ; and padded bands, two or three yards long, are to be wound round the legs as they are placed together, just above the ankle, and just below the knees. Or the broken thigh may be laid on a pillow, on its outer side, in the easiest po- sition for the patient. Under the former of the two last-men- tioned modes of treatment, a short splint, extending the length of the thigh, of wood, tree-bark, or any other firm material, may be applied on the outer side, and will give additional support. Under the last-men- tioned, such a short splint may be used on each side. In fractures of the leg, particularly of the lower portion of it, a different apparatus must be used, although in many respects the mode of management as regards pad- ding, &c. &c. is the same. In setting the limb, however, the -thigh must be grasped by one person, and the foot by the other. The easiest position for the limb will be with the knee bent, (figs, lxxviii. lxxix.,) and either of the contrivances figured may be easily constructed of any common wood. The upper one (lxxviii.) is merely a board Fig. lxxviii. Fig. lxxix. adapted to the size of the limb, with side- pieces (1) and foot-board (2) fastened to it, and slung by ropes from the corners, so that it can be suspended, as represented, from a rafter or any other convenient support. This is a very easy kind of apparatus, especially on board ship. The other apparatus (lxxix.) is also to be constructed from boards, as represented, with side-board and foot-board, (1 and 2.) In both these, it will be an ad- vantage to scoop out a hollow for the heel, and pad it as well as the whole con- trivance, with soft materials. Reference to the foregoing portions of this article, es- pecially that on fractured thigh, will suf- ficiently explain the general management of these cases. To recapitulate : the first removal of a patient who has suffered a fracture should always be conducted with the care enjoined in the first part of this article. The bed for a patient suffering from fracture must al- ways be a firm one. The adjustment and "putting up" of a fracture should be ef- fected as quickly after the accident as may be, allowance being made for swelling — and if this becomes extreme, loosening of the apparatus resorted to. In setting, the bones above and below the injured one, not the in- jured one itself, are to be grasped ; parts, such as the heel, &c. are to be relieved as much as possible from the effects of the con- tinued pressure which they must necessarily undergo during the treatment. It must always be borne in mind, that whatever ap- pliances are used in the treatment of frac- tures, they are all but different means to the one end — that of keeping the broken ex- tremities of the bone in continued steady contact, with as much ease to the patient as possible ; that when this has been done for three or four weeks, lighter applications PRE 263 FUR than those used at first may be employed, such as the starch bandage, &c. In conclusion, the foregoing article "will be of small benefit to those dwelling in the midst of civilization ; but its hints (and our space admits of but little more) may prove invaluable to those dwelling, or -who may be destined to dwell, in a thinly -peo- pled country, or in such situations as on board ship, in which fractures are far from being uncommon accidents. Even if proper assistance be ultimately procurable, the intelligent management of a case for the first few days may be of the highest importance ; and if it should happen, that throughout, it has been left to unprofes- sional management alone, even should a limb somewhat deficient in symmetry be the result, its cure is not likely to be more tardy or less painful, because those around are not in total ignorance of how it ought to be conducted. Compound fractures are those in which there is a wound through the skin, per- mitting access of the external air to the seat of the fracture. The contingency is a truly serious one to be without the assist- ance of a surgeon. Sometimes the bone protrudes considerably through the skin, and its end requires to be sawn off before it can be returned to its proper position. The great object is to heal the external wound as quickly as possible ; and probably as good a plaster as any will be a piece of linen soaked in the blood, [or in white of egg] and when this is separated by the dis- charge, the simple water dressing. FRECKLES — The well-known brown spots on the skin, are most frequent upon those parts exposed to the influence of light, such as the face, neck, hands, &c. r and in persons of fair complexion, espe- cially with red hair. Water, weakly acidi- fied with lemon-juice, is sometimes useful as a wash. Mr. Erasmus Wilson recom- mends the liniment of lime-water and oil, with the addition of a little ammonia. FRICTION— Or rubbing a portion of the body, either with the hand or with some interposed material, is of much importance as a curative agent. Applied to the skin by means of rough towels, hair-gloves, &c. it excites its nervous sensibility, and the circulation of blood through its capillary vessels. Friction with the hand in thicken- ings and congestion of parts beneath the skin is often of much service, and in none is its beneficial effect more obvious than where the breasts are painfully distended with milk after childbirth. The various oils, &c. used along with friction are gene- rally secondary in their effects to the me- chanical effect, and are chiefly serviceable in facilitating the movement of the hand : some, however, are really beneficial — the stimulant applications by exciting, and the anodyne by soothing. Moreover, some, such as codliver-oil, turpentine, &c. appear to ex- ert a specific effect. — Refer to Liniment, Sfc. FRIGHT.— See Fear. FROST.— See Cold. FRUITS. — See the individual articles up- on the various fruits. FRYING — Is a mode of cookery very ill- adapted for persons of weak digestion. FUMIGATION.— See Contagion, Disin- fectants, &c. FUNCTIONAL DISORDER.— See Dis- ease. FUNGI. — See Mushrooms. FUNIS.— The navel-cord. FUR — As an article of dress, maybe either extremely beneficial or the reverse, accord- ing to the manner in which it is used. When worn over other clothing in the open air, or as a regular fixed article of clothing in itself, the bad conducting power of fur renders it one of the most efficient pro- tectors against cold, or rather preservers of heat, we possess ; but when it is used as an occasional article of dress, it is a danger- ous one, and has proved so in the various forms in which it has been worn by females. When kept close to the skin — as of the neck or throat — for any length of time, it produces excited action and perspiration, which is liable to be suddenly checked the moment the boa or victorine is thrown back, and cold and sore-throat are the con- sequences. Very many cases of this kind occur ; and, the cause being unsuspected, is repeated again and again with the same effect, laying the foundation perhaps of serious disease by the improper use of the very means employed to guard against it. Many females liable to cold and sore-throat have been surprised to find how that liability has vanished with the laying aside of the use of fur round the throat. The change must, however, be made at first with caution. It is not, however, the fur which is at fault, but the uncertain mode of using it. More- over, its power of exciting the skin renders it a valuable agent when worn permanently next it, particularly upon the chest in win- ter, by persons with delicate lungs. It not only protects from cold but keeps up mild counter-irritation. A prepared hare or rabbit-skin, lined, makes as good a fur chest-protector as any other. Refer to Clothing, #c. FURUNCLE.— A boil— See Boil. GAL 264 GAL GALBANUM — One of the gum resins, is procured from an umbelliferous plant, and is brought chiefly from Persia and India. It is stimulant and carminative, but is not much employed in medicine at present. Its best preparations are the plaster, which is stimulating, and the compound galbanum- pill — dose, ten grains twice a day in nervous affections, flatulence, &c. GALL.— The bile. GALL-BLADDER— The receptacle for the bile, is situated beneath the right lobe of the liver, almost exactly at the boundary line between the epigastric and right hypo- chondriac region. — See Abdomen. It is pear- shaped, (fig. lxxx. 1;) from its smaller end Fig. lxxx. proceeds a duct, (2,) which shortly joins a similar duct from the liver, (3,) the two to- gether forming the common bile duct, (7,) which enters the duodenum (4) in its de- scending portion; [5 and 6 are arteries.] During its retention in the gall-bladder, the bile becomes thicker from the absorption of part of its water. GALL-STONES— Are concretions formed from the peculiar crystalline ingredient of the bile — the cholesterine. The concretions are of every variety in point of size, up to that of a walnut ; when small, the number, either passed by the patient or found in the gall-bladder after death, is often very great. These concretions may, and often do, exist in the gall-bladder, without giving rise to any unpleasant symptoms, their presence only being discovered on examination after death. But should one of them, from any cause, pass into the duct, it gives rise to most violent spasmodic pain, which con- tinues with little intermission until the stone has descended into the bowel through the ducts. The ordinary calibre of the gall-duct is about that of a goose-quill, and the stone is generally of much larger size ; the opera- tion, therefore, is often a protracted one. Symptoms of gall-stone often supervene suddenly. The person is seized with the most agonizing pain in the region of the gall-gladder ; probably, there is severe shi- vering and vomiting, and these do not dis- appear until the stone has passed. There may or may not be jaundice — probably not, as long as the obstruction does not pass into the common duct (2) and so stop the flow of bile from the liver. If jaundice comes on, the evacuations from the bowels become white and chalky in appearance. The fact of there being no fever present, and that the pain caused by a passing gall-stone is relieved, instead of aggravated, by pressure, is sufficiently indicative of the absence of inflammation. After the occurrence of the above symptoms, it is always proper to examine the evacuations from the bowels, to verify the disease by finding the cause. Gall-stones are easily detected in the eva- cuations, as they float upon water. When an individual is suddenly seized with symptoms of gall-stone, no time should be lost before making hot applications over the seat of the pain, or getting the sufferer into a warm bath. Opium ought to be given at once ; the first preparation at hand — probably laudanum — in full and repeated doses. If laudanum is used, thirty drops may be given immediately, and the dose repeated, by twenty drops at a time, every half-hour, or oftener, till the unbearable pain is subdued. As the retching is often severe, and liquids of every kind are vomit- ed as soon as taken, pills of solid opium — one grain each — are more likely to be re- tained, and are, therefore, preferable ; they may not, however, be at hand in an unex- pected attack. Persons who are liable to repeated attacks of gall-stone should keep these pills beside them. There is generally GAL 265 GAR much distressing acidity of stomach while a gall-stone is passing, and Dr. Prout's plan of giving full and frequently-repeated draughts of hot water, containing in each pint a full teaspoonful of carbonate of soda, affords much relief, whether vomited or not. Of course laudanum may be added to the soda solution if requisite. If the stomach will not retain the remedies, the opium must be administered by a clyster : as a pint or more of gruel, with forty drops of laudanum, re- peated if requisite. Mustard-plasters over the seat of the pain may be useful, but are much inferior as an application to the hot bran-poultice, on the surface of which lau- danum may be sprinkled. The suddenness of an attack of gall- stone and the agony of the pain, render it one of the diseases in which unprofessional persons may afford most valuable assistance by judicious management ; and, by follow- ing the above directions, they will certainly give relief, perhaps from many hours of suffering, if medical assistance is distant. A person who has once suffered from gall- stone, ought, of course, to be examined medically. Refer to Bile, §c. GALLS, or Gall-nuts — Are excrescences produced upon the twigs of a species of shrubby oak, by the prick of an insect for the purpose of depositing its eggs. They are brought from the shores of the Levant and from Asia. Galls are powerfully astrin- gent, owing to the tannin or astringent principle they contain, which, in its sepa- rated form, is now largely used in medical practice. Gall-ointment is a useful appli- cation in piles, in persons of relaxed or enfeebled constitution, but is quite the re- verse in those of full habit, in whom the piles are in a state of active inflammation. The best form of ointment is : Galls, in very fine powder, two drachms ; Opium, in powder, one drachm ; Lard, one ounce ; well rubbed up together. The infusion of galls is the best antidote to poisoning by tartrate of antimony. GALVANISM.— See Electricity. GAMBOGE.— See Camboge. GAME. — "Wild animals used as food, the flesh of which is for the most part easily digestible, and suited to many persons on account of the less proportion of fatty or oily substance which it contains. Of course, game, like other articles of food, may be rendered hurtful by sauces and modes of dressing. GANGLION — In anatomy, means an ag- gregation of nerve substance. In surgery, it is applied to the elastic swellings which X appear upon the. wrist or top of the foot, generally about the size of a hazel-nut. These may often be removed by bursting the small bag or cyst of which they con- sist, and thus effusing the contents — which resemble the white of egg — into the sur- rounding parts, a bandage being applied afterward. The case is best submitted to the surgeon. GANGRENE.— See Mortification. GAPING, or Yawning — Is a nervous af- fection, indicative of nervous exhaustion and depression of the circulation. Persons in health are, as is well known, liable to gape when tired ; like other nervous affections, it is apt to give rise to imitation in others. Gaping is, however, a not unfrequent symptom of disease — functional or organic — particularly of the chest. Attacks of hysteria accompanied with fainting, or of spasmodic asthma with depression of the action of the heart, are often ushered in by gaping. Persons who suffer from disease of the heart are also liable to "fits of gaping." GARGLES — Are liquid applications to the throat and upper part of the gullet, &c. used in affections of these parts. Gargles are too often used as astringents, particularly in the first stage of inflammation of the tonsils, &c. or sore-throat. In these cases, the warm water or gruel gargle is a much better remedy, with the addition of a small quantity of vinegar. The common domestic gargle *of "sage-tea and vinegar" answers very well. As a general rule, in the first stages of "sore-throat," it is better to use the simple soothing gargles, nearly as warm as can be borne ; in the latter stages, when there is often much stringy phlegm about the throat, the more stimulating and astiun- gent gargles will be useful. For the latter, from four to five drops of muriatic acid in the ounce of water is as good a form as any ; or the infusion of roses, with ten to fifteen drops of dilute sulphuric acid to the ounce. Another very useful gargle, in cases of relaxed sore-throat, is made with a drachm of alum, half an ounce of tincture of myrrh, and water sufficient to make up the pint. Cayenne-pepper infusion is also used as a gargle. — See Capsicum. In cases of chronic weakness of the throat, with tendency to frequent swelling and inflam- mation, a gargle of oak-bark decoction or of salt-water is of much service, used every morning for some time. Gargling is ef- fected by throwing the head back, and, con- sequently, the fluid back in the throat, and expelling the air through it from the lungs ; it is thus worked as it were into every part of the throat. GAR 266 GID GARLIC— See Onion. GAS — Is an elastic fluid, -which is per- manently aeriform in all ordinary tempera- tures, being distinguished from vapours, which are only temporarily elastic and aeriform. The gases alluded to in the course of this work are — Ammonia. Azote, or Nitrogen. Carbonic Acid, and Carburetted Hydrogen. Chlorine. Hydrogen, and Sulphuretted Hydrogen. Oxygen. Refer to separate articles. GASTRIC JUICE — Is the acid viscid fluid secreted in the stomach when that organ is excited by the presence of food ; the office of this peculiar secretion being the solution of the nutriment, or rather the reduction of its albuminous and gelatinous portions to a state in which they are fit for absorption into the system. Refer to Digestion — Food — Indigestion. GASTRITIS.— See Stomach, Inflamma- tion or. GELATINE, or Glue — Is an azotized component of animal bodies, of simpler constitution than the azotized albuminous compounds. — See Food. It may be ex- tracted from tendons, shin, &c. by long boiling, and from bones by dissolving out their earthy matter by acids: it occurs pure in many fishes, the air bladders of which are formed of gelatine ; isinglass, so well known as a jelly-making compound, being the prepared swimming or air bladders of the sturgeon, cod, ling, &c. The gelatine sold as such is generally prepared from bones. Many persons have a prejudice against this gelatine, and imagine it not so good as that which they extract from calves' feet, &c. As regards the amount of nutriment, it must be precisely the same, and as there is no reason to believe that the manufacture is otherwise than properly conducted, it is a pity that many should deprive themselves and others of so convenient an addition to sick cookery. — See Cookery, Food, §c. GENERAL HEALTH.— By this term is meant the state of the body and its functions collectively, in contradistinction to the con- dition of any special portion of the frame. The state of the general health is always an important consideration, with respect to local maladies, both as regards their treat- ment and ultimate prospects. The latter must always be more serious when the general health begins to suffer. GENTIAN ROOT— Is obtained from the Gentiana lutea, or yellow gentian, which is a native of the more elevated ranges of the Alps, Pyrenees, &c. The root is brown externally, irregular, knotty, ringed, and from half an inch to an inch in diameter ; it is yellow within. Like the gentians gene- rally, it is extremely bitter, and on account of this property it constitutes one of our most extensively used and most serviceable tonics and stomachics. The most useful medicinal preparations of gentian are the extract, the infusion, and the compound tincture. The extract is chiefly used in from five to ten grain (or more) doses, as an ingredient in tonic or aperient pills. The compound tincture may be taken in one or two teaspoonful closes, in water. The best preparation, however, for general use, is the infusion prepared in a concen- trated form, according to the following process: — To every ounce of sliced gentian- root add a quarter of an ounce of dried orange-peel, and infuse these (not boil) with successive quantities of boiling water poured over them, until their strength is en- tirely exhausted. The whole of the infu- sion thus made, being separated from the root and peel, must next be concentrated by boiling in a well-tinned or porcelain- lined saucepan, until the quantity is so far reduced that there is left half a pint of the concentrated infusion for every ounce of gentian used. To each half-pint of this concentrated infusion half an ounce of al- cohol is to be added. The effect of this addition of spirit is to coagulate a quantity of jelly-looking substance, which must be separated by straining through flannel. The infusion will thus be got clear, and will keep for a great length of time, the dose being one teaspoonful in an ounce of water. When the fresh infusion is required for im- mediate use, a quarter of an ounce of gentian-root sliced, with the addition of a little orange-peel, to the pint of water, will be a proper strength, if infused for an hour or two. GESTATION.— See Pregnancy. GIDDINESS — Dizziness — In medical language "vertigo," is a sensation of con- fusion, and loss of the power of balancing the body, which is frequently momentarily experienced even by persons in good general health, and is unquestionably often attribut- able to stomach derangement solely. Dis- order of the circulation of the blood in the head is a probable direct cause of giddiness, and this is most palpable after persons have been confined to bed or to the horizontal position for a short time : on first assuming the erect posture, giddiness is generally GIN 267 GOD experienced. Intoxication is an example ! to a certain extent of the same tiling. A mere passing giddiness is probably owing to some cause which a little attention to the state of the stomach will correct ; but repeated attacks, especially if accompanied with palpitation of the heart, or pain and heat about the head, require medical ex- amination without delay. GIN — The well-known liquor, also known as Geneva, or Hollands, contains oil of juni- per, and when first introduced was used simply as a diuretic medicine ; it ultimately, however, became an object of trade, and of general — too general — use. It certainly often increases the flow of urine in a marked degree. GINGER — This well-known spice, is the creeping root of a tropical plant. That used in Britain is chiefly brought from the East and West Indies. Two kinds of ginger are met with, the dark-coated and the pale- peeled ginger; the latter is the best. "The rhizomes, or root-pieces, of ginger of good quality, have no epidermis, or outer skin — are plump, of a whitish or faint straw color, soft and mealy in texture, with a short fracture, exhibiting a reddish resinous zone round the circumference : the taste should be hot and biting, but aromatic. The rhizomes of ginger of inferior quality are frequently coated with epidermis, are less full and plump, often contracted and shri- velled ; of darker colour, being of a brownish yellow ; of harder texture, termed flinty ; and more fibrous, while the taste is inferior and less aromatic." Ginger-root is chiefly adulterated by means of processes used to give the inferior quality the appearance of the best; for this purpose, whitewash, chlo- ride of lime, sulphur-fumes, &c. are used. As an aromatic, especially when added to medicines to correct their griping pro- perties, ginger is peculiarly useful. For persons of relaxed habit it is well suited as a spice, but by those of full habit, especially with tendency to the head, it should be sparingly used in diet. GLANDERS— The malignant disease to which the horse, the ass, and the mule are subject, is also capable of being communi- cated to man, certainly by inoculation, per- haps by simple contact with the skin. In the above animals, the disease is manifested by a yellowish, bloody, fetid, adhesive dis- charge from the nostrils, the lining mem- brane of which is ulcerated. Should any of this discharge come in contact with an abrasion of the skin, or even get lodged on the sound skin, as of the hands, or be snorted upon the nostrils or eyes of man, it is ca- pable of originating this horrible disease. In from two days to a week after inocula- tion, the attack is ushered in with fever symptoms, or by vomiting and diarrhoea ; small tumours which ulcerate and discharge form under the skin in various situations, and there is yellow viscid discharge from the nostrils, &c. Almost every case of this fearful disease has proved fatal. The object of mentioning it here is to impress caution upon ail who may be exposed to the con- tingency. The immediate destruction of an affected animal should, of course, be ef- fected, and its entire body at once buried. GLANDS — Are bodies situated in various parts of the animal frame, their office being either the alteration of some fluid or the separation of some secretion from the blood. Of the former, the mesenteric glands (see Absorbents, Digestion, Sfc.) are examples; of the latter, the liver, salivary glands, &c. GLAUBER SALTS, or Sulphate of Soda — See Soda. GLOBUS HYSTERICUS.— See Hysteria. GLOTTIS.— The superior opening of the larynx. — See Larynx. GLUTEN — Is an azotized principle which exists in the grains, and corresponds to the fibrin of animal bodies ; it is therefore highly nutritious. — See Fermentation, Food, §c. GLYCERIN— Is a product from fatty matter, and is obtained in the manufacture of lead-plaster. It is a fluid of thin syrupy consistence, very sweet taste, faint mawkish smell, and should be like pale sherry in colour, or even lighter. It is now a good deal used in medical practice on account of its powerful retention of moisture, either alone or mixed with other substances. In diseases of the skin, accompanied with harshness and dryness, a lotion composed of one part of glycerin to fifteen of water is very serviceable. The following lotion, as recommended by Mr. Startin, will be found very serviceable in chapped hands, &c. : — Take of pure glycerin half an ounce, borax two scruples, distilled water or rose water enough to make up half a pint. In deafness and affections of the ear it is also used. Refer to Cerumen — Ear, §c. GODFREY'S CORDIAL— Is one of the dangerous quack carminatives frequently given to children. It contains opium, and fatal consequences are often the result of its administration. In February of the pre- sent year (1852) one fatal case, at least, of poisoning by this compound was reported, and it was stated at the inquest that one teaspoonful of that used would contain five drops of laudanum. The remarks made GOI 268 GOU upon "Dalby's Carminative" apply equally to this legalized but dangerous compound. GOITRE.— See Bronchocele. GOOSE.— See Poultry. GOOSEBERRY.— One of our most whole- some fruits. It is aperient, and the seeds of ripe gooseberries add to this property, by their mechanical action upon the bowels. GOULARD'S EXTRACT— Is a saturated solution of sugar of lead, which, when di- luted, forms goulard-water. Refer to Lead. GOUT— Is a disease of the blood. Its exact nature is disputed, but it has been positively proved by Br. Garrod that the blood of a gouty patient contains an undue quantity of a peculiar acid named uric acid. This acid is contained in small proportion in healthy blood, but, in the disease in question, that proportion is found to be considerably increased. By some, the ex- cess of this uric acid is thought to be the effect, by others the cause, of the malady ; however that may be, the fact of its pre- sence is undoubted. Moreover, the proper outlet for this acid is by the kidneys, in the urine, which, as a rule, contains it in cer- tain proportions, but in greatly increased proportion in some peculiar conditions of the constitution, when it constitutes one form of gravel. It is even a matter of po- pular observation that gravel and gout are nearly connected. They often alternate with one another in the same person, and in the same family are found affecting the various individuals of it — the gout the males, the gravel the females. There is no disease, perhaps, the hereditary tendency of which is more thoroughly established than gout. Generally it occurs in persons of full habit, especially if they consume much stimulating food and drink, and take little exercise ; but it also shows itself in the weak and debi- litated. The attack is generally preceded by symptoms indicative of derangement of the general health, and particularly of the digestive organs. Br. Gairdner — one of the best authorities on the subject — enumerates dull pain in the side, headache, confined bowels, high-coloured urine, and scaly erup- tions on the skin, as among the most fre- quent warning symptoms. The attack itself generally comes on in the night, and the sufferer is awakened by the pain in the foot, having, perhaps, previous to awaking, passed through a night-mare, or "sugges- tive" dream, (see Dreams,) in which the scenes are connected with the uneasiness experienced. The ball of the great toe is the part most generally attacked, though not invariably ; the pain is very severe. A French author, in describing it, says — " Place your joint in a vice, and screw the vice up until you can endure it no longer ; that may represent rheumatism : then give the instrument another twist, and you will obtain a notion of the gout."* The part attacked by the gout becomes swollen, hot, red or bluish-red, and shining ; these symp- toms continue with more or less intensity for some days, and then subside. Along with the local symptoms there occurs more or less feverishness and disorder of the bowels and urine ; but when the attack has passed away, the individual is left in a better state of health than before. This fact has given rise to many erroneous ideas, and much erroneous practice in connection with gout, and by those subject to it*, re- garding it as a salutary affection, they have rather encouraged it than otherwise — the more so that the encouragement involves indulgence rather than self-denial — forget- ful that, although the outward manifesta- tion of a fit of gout may end in a salutary effect, from its being the disturbance occa- sioned by the constitution endeavouring to free itself from morbid matter, it must be far better if no such disturbing effort is re- quired at all ; and, further, it is certain that no constitution can be the subject of these repeated, violent perturbations, without its be- coming permanently weakened or wholly broken up. Let none, therefore, who have a gouty tendency, and are periodically renovated, as it were, lull themselves into security by the idea that they suffer no injury ; for the constitution cannot fail to be impaired by the repeated trials. Their only security rests with themselves, in avoiding those habits and modes of life which engender that state of system and blood that winds up with a fit of the gout. Moreover, al- though these fits may at first be more pain- ful than dangerous, this is far from being the case as life advances, and the constitu- tion suffers ; then gout may, and often does, attack some more important part than the great toe ; and the stomach, the heart, or brain are apt to become its seat, with fatal consequences. The most undoubted predisposing cause of gout is hereditary tendency, and it is one very widely distributed, though not always actively developed. The other causes are luxurious habits, the habitual consumption of a larger quantity of food — especially of animal food — than is required by the sys- tem, and undue consumption of wine and malt liquor, especially the former. These * Watson's Lectures. 00 u 269 GOU of themselves will develop gout in the predisposed: but if their use is coupled with deficient exercise in the open air, the exciting power becomes much increased. Moreover, the same acting causes give rise to attacks of red or uric acid gravel, that is, to the excretion of this from the blood, by the kidneys, in the urine, Hard malt liquor has a peculiar tendency to produce in those consuming it, this uric acid, even in spite of regular exertion in labour ; and the author has found brewery labourers, who often consume a considerable amount of hard ale, suffering from alternate attacks of gout and red gravel. In the country, gout is not a common disease, for the population generally, while they do not consume ex- cessive quantities of meat and malt liquor, have also the constant counteraction of plenty of fresh air and exercise. When gout is met with in the countiy, it is generally in those connected with inns and public- houses, who consume malt liquor largely, and take little exercise. From the above, it is evident how much any one with a liability to gout has it in his own power to prevent its occurrence. Malt liquor he should never touch, wine very sparingly, or if he must have some stimu- lant, though he is much better as a general rule without any, a little gin or brandy and water. Meat should be eaten sparingly, and only once a day ; never at night. Bread made with the bran in it, vegetables gene- rally, cooling fruits, and milk preparations, are the safest articles of diet for those predis- posed to gout ; but tea, and especially coffee, should not be taken strong. Further, early rising, attention to the condition of the skin by frequent washing, and regular daily exercise are the best adjuncts to temperate diet. It is, perhaps, not saying too much to affirm that persons predisposed to gout may almost wholly escape its attacks by attention to the above rules of health. In advising exercise, however, the caution must be given, that it is not violent and fitful ex- ertion which is recommended — this being, in fact, more likely to develop the disease than to prevent it. The regularity of a sufficient amount of daily exercise is the essential; indeed, not only does violent phy- sical exertion, especially of an unusual kind, tend to excite a fit of gout, but even strong mental emotion or violent passion has been known to do the same. Regarding the best treatment of gout during the existence of the attack, there is considerable diversity of opinion. Little is to be done to the inflamed part ; certainly cold applications, which have been recom- x2 mended and used, are dangerous ; but a piece of flannel, wrung out of warm water, laid lightly over the joint, and covered lightly with a piece of oiled-silk, will give relief ; or the lotion of sugar of lead and laudanum may be used warm : perfect rest it is almost superfluous to enjoin, as the pain makes that compulsory. As regards constitutional treatment, where the powers of the consti- tution are vigorous, a perfectly low diet should be observed. In some cases an ac- tive purgative answers well ; in others, but chiefly old standing cases, it so certainly aggravates the attack, that patients from their own experience will not resort to the remedy. Ten to fifteen grain doses of car- bonate of potash may be given three times a day, dissolved in half a tumblerful of water, either simply or made to effervesce by the addition of lemon-juice. The re- medy, however, for gout is colchicum. A medical man may, of course, give it more boldly than an unprofessional person; but still, should it so happen that the person suffering from gout is not under medical treatment, ten drops of colchicum-wine may be given safely three times in the twenty- four hours. The power of colchicum in subduing both the pain of gout and the disease itself is often most striking. The I following instance will exemplify it: — A I lady suffered from repeated attacks of se- j vere shooting pain through the region of I the heart, and was treated without relief; ! at length one of the joints of the forefinger ; became suddenly affected with gouty in- | flammation ; this gave an immediate clue ; ! colchicum-wine was prescribed in ten-drop ! doses twice a day, and before six doses were taken, both the pain at the heart and the inflamed joint were cured; the same thing has occurred repeatedly since in the same patient. It is undoubtedly better, safer, quicker, even in mild attacks of gout, for the case to be treated by a medical man ; but patients who know what the disease is will not always have recourse to his aid : in such cases, the perfect rest both of body and mind, the warm moist flannel, low diet, gentle regulation of the bowels, the cooling saline, and the small doses of colchicum will be the safest measures ; but safer still will be attention to those preventive mea- sures already pointed out, which any may follow by the aid of their own common sense — a faculty which ought to show the reason for and the reasonableness of such a course. Many persons who have suffered from repeated attacks of gout become af- fected with chalk-stones, (see Chalk-stones,) GE A 270 G KA which impede greatly the usefulness of the hands ; the constitution too gives way. In these cases, medical assistance ought never to be dispensed with, and there are few old sufferers from gout in whose power it is not to procure it of the best. A much less reduc- tion in diet will be required than in more recent cases and stronger subjects ; the medi- cines must be of a warmer character. Fifteen grains of calcined magnesia, ten of rhubarb, and forty drops of sal-volatile, in a wine- glassful of water, will form a draught which may be repeated twice a day. It may also be given with advantage with double the quantity of sal-volatile, and twenty or thirty drops of laudanum, iu the event of gout receding to the stomach, as evidenced by pain and other signs of disorder of the organ, and by the sympathetic faintness accompanying the attack. A glass of brandy may be substituted for the above with good effect; these stimulants, however, being given under the caution that no extreme tenderness, indicative of inflammation, ex- ists at the pit of the stomach. In addi- tion, in an attack of " retrocedent" gout, either to the stomach, or elsewhere, the feet should be immersed in hot water, with mustard, or a mustard-plaster should be applied to them, with a view of attracting the disease to its more usual site. These attacks of gout shifting to internal organs are often so quick in their seizure, and so rapid in their progress, that it is highly desirable that such measures should not only be understood, but thoroughly carried out. The aged and debilitated sufferer from gout must not at any time reduce much his usual mode of living. Gout has been, and is, confounded with rheumatism. The gene- ral distinctions are the occurrence of gout most frequently after the thirty-sixth year ; most often in males, especially those who live highly, affecting the small joints — generally but one at a time. Refer to Colchicum — Gravel — Rheumatism — Urine, fyc. GRAINS — Or, as they are sometimes called, the "cereals," are the seeds of plants which belong to the order of the grasses. They constitute a large proportion of the food consumed by the human race, and likewise form no inconsiderable amount of the nutriment of vegetable-feeding ani- mals generally. They are, perhaps, in one sense, the most direct link between the ani- mal and mineral kingdoms, for in them the nutrient compounds prepared by the vege- table from the mineral elements of the soil, and from the gaseous constituents of the atmosphere, are of such a nature, and are so compacted, that they are presented to the digestive organs and assimilating powers of animals in forms more fitted for affording direct nourishment to their tissues, and more direct support for their bodily func- tions, than any other kind of vegetable nu- triment, with the exception of that yielded by the pulses — beans, peas, &c. — which are not, however, so universally employed as food. The grains chiefly used by man are wheat, oats, barley, rye, millet, maize or Indian corn, and rice : the nutritive power of these, however, differs greatly. The nourishment afforded by the grains to animal bodies may be classed under three distinct heads — the azotized nourishment, represented by the gluten, which is adapted to build up and sup- ply the waste of the muscular, or fibrinous and albuminous tissues ; the non-azotized nourishment, represented by the starch, which goes to supply respiratory food, forms fat, &c. ; and the nourishment, principally phosphates of the alkalies and earths, which supplies the mineral elements to the bones, the nerves, and to the tissues generally. Upon the proportions, therefore, in which these different kinds of nourishment are contained in the grain, depends its nourish- ing power. Wheat, of all the grains, con- tains gluten most largely in proportion to its other constituents. Oats are next to wheat in this respect. Barley and rye are inferior to both wheat and oats, and maize and rice are very far below any of the above ; the former of the two not containing above 5 per cent, of azotized matter; the latter not above 3 or 4 per cent. Vice versa to the above, the starch constituents are in much larger pro- portion in rice and maize, than in wheat and oats. The mineral constituents of the grains vary considerably as regards proportional amount, but they consist chiefly of phos- phates, with oxide of iron. They are con- tained most largely in the seeds of the cereals and of the pulses, and appear to be no less necessary to the perfect formation of the seed, than they are to the blood of animals, which cannot be properly nou- rished, unless the food from which it is formed contains these mineral constituents in certain proportion — a beautiful instance of the harmony and universal adaptation of all things which prevails throughout the works of the Creator. The grains also contain a certain propor- tion of fatty or oily matter. Maize does so largely, and oats in very considerable pro- portion. The grains, therefore, from their consti- tution, are capable of supporting, with the GRA 271 GR A addition of water, the animal frame and functions. It is evident, however, from science, and experience confirms the fact, that a larger proportion of barley, and still more so of rice or maize, is required to sustain the muscular development, than of either wheat or oats, which contain a greater amount of the gluten, or nitrogenized, or plastic element of nutrition. For further information on these points refer to Blood, Digestion, Farina, Fecula, Food, Gluten, §c. The flour, or meal, prepared from grain, partakes of course of the characters of that from which it is formed, and is also modi- fied by the mode of preparation, whether ground fine or coarse, whether entirely de- prived of bran or not. — See Bran, Bread, Farina, $c. Under the microscope, the various kinds of flour, particularly their starch granules, present very different ap- pearances ; this agent therefore has become valuable as a means of detecting adulte- ration, which could not otherwise have been discovered with certainty. At pre- sent, owing to the abundance and cheap- ness of wheat and wheat flour, there is no temptation to its adulteration. — See Bread. May that temptation never be again in ac- tion ! Besides being ground into flour, some of the grains are otherwise prepared artifi- cially for food, as in the case of pearl-barley and groats formed from the oat. See Barley — Oat, $c. GRANULATIONS— Are the small red rounded points which-cover the surface of a healing sore. They are very vascular, and bleed easily. When the granulations are deficient, the sore is depressed, smooth, and glazed-looking, and is not healing well. When the granulations are excessive, they constitute what is called "proud flesh." In this state they are paler than they should be, and require depressing or astringing by some caustic or astringent agent, such as Lunar caustic, blue vitriol, &c. See Caustics, Ulcers, fyc. GRAPE.— The fruit of the vine, one of, if not the most wholesome of fruits. When ripe it contains sugar abundantly, vegetable jelly and mucilage, and the characteristic tartaric acid in combination with potassa ; also an azotized albuminous constituent, or gluten, on which depends its property of ready fermentation, in which respect the juice of the grape excels all other vegetable juices ; undergoing spontaneously the neces- sary change, and becoming converted into true wine by its own inherent power of fer- mentation. The juice, if kept a few hours, will spontaneously ferment. As a cooling article of diet, ripe grapes are most whole- some, and invaluable in many cases of ill- ness ; but must be forbid when their ape- rient properties may prove injurious. Of late years, what is called the "grape-cure" has been introduced into Germany ; the per- sons undergoing it living chiefly on grapes — of which they have to consume many pounds' weight per day — and bread. It is probable that in some states of constitution this cooling system of diet may be useful ; it has, however, at least one serious draw- back : the continued application of the acid of the fruit to the teeth completely dissolves off the enamel. Refer to Fermentation — Raisins — Wine, §c. GRAVEL.— See Urine. GRAVE-YARDS.— Receptacles for the dead, which are often so arranged in this country as to be a disgrace to a civilized community. Like the imperfect drainage, and the other deficient sanitary arrange- ments, the grave-yards of our large towns in the first half, at least, of the present cen- tury, will probably afford material for com- ment for its historians of a future age. It will be regarded as a curious anomaly, that the people of England could, in spite of warnings without number, continue to in- ter the corrupting remains of mortality in the midst of the abodes of the living — a practice in itself reprehensible, but doubly and trebly so, when the fearfully crowded condition of the grave-yards of large towns is considered. It would be difficult perhaps to estimate the amount of injury to the living which has resulted from the abomi- nable custom of city grave-yards, for which the only excuse, in times gone by, was igno- rance. This excuse, however, no longer ex- ists, and the investigations of Mr. Walker and of others have made the injurious and culpable nature of the practice sufficiently apparent. This reason might be enough to prevent interments in situations where they are likely to prove a source of disease and death to others ; but there is another reason, in the natural feeling which all must have toward the remains of those who have been near and dear to them, that they should be undisturbed — so long at least as they retain the semblance of the material body ; but un- disturbed they cannot be in the festering soil of some city burying-places. The words of Mr. Walker, not five years since, respect- ing one grave-yard in the heart of London, will best place this subject in its proper light. Of it he says — "Indecent, pestife- rous in every respect, because when a pro- portion of 3073 corpses are annually interred in an acre of land, it follows as an inevitable consequence that the bodies of the deceased GKR.E 272 GU A can remain in the ground only five months, instead of ten years. Hence the stacking of coffins in deep pits, the brutal dismem- berment of bodies, the consumption of coffin- wood in many localities, the absolute super- saturation of the soil, which can neither re- tain nor dissolve the putrescent matters with which it is loaded. Hence the daily scenes which outrage every moral and religious sentiment — hence the danger to mourners from attending funerals in such places — hence the insidious infection which poisons the at- mosphere ; and thus, by undermining health or begetting disease, hurries thousands to an untimely end." Here, surely, are arguments, both selfish and unselfish, sufficiently cogent to induce all to lay the remains of their friends where they will not be distui'bed, and where they cannot prove injurious to the living. Refer to Burial — Death, $c. GREEN-SICKNESS.— See Chlorosis. GREGORY'S POWDER, or Mixture.— A compound of two parts of rhubarb, four parts of calcined magnesia, and one part of ginger. It is taken either simply, in water, or with water along with some sti- mulant, such as a teaspoonful of sal-vola- tile : it is a good stomachic and gentle ape- rient ; but persons sometimes get in the habit of taking it regularly, and injure the tone of the stomach by the undue amount of magnesia. GRIPING — Is pain produced in some portion of the bowels, in consequence of irregular contraction of the muscular coat ; it is in fact a minor form of colic, or spasm, and is to be relieved by the management recommended under those heads. Some medicines are more liable to gripe than others, and some individuals are more than others susceptible of these griping proper- ties. The inconvenience is generally and successfully remedied by the addition of some carminative or aromatic, such as one of the essential oils — clove, cinnamon, &c. — or by ginger, &c. Pills which are apt to gripe are more effectually corrected by the addition of one or two grains of extract of henbane, when that medicine is admissible. Some medicines are rendered griping by faulty preparation. This is especially the case with senna. — See Senna. Refer to Colic — Spasm, §c. GRIPPE.— The French name for the epi- demic influenza. GROATS — Are oats deprived of the husks; "Embden groats," when they are bruised also. They are used and useful for making gruel, &c. GROWTH— Or increase of size of the body, as a whole, or of any part of it, is de- pendent, as a healthy process, first on o proper amount of nervous excitation, and second on a due supply of healthy blood. When any part, such as the arm of a work- man, is regularly and vigorously exercised, the nervous power and the flow of blood are directed to it in increased proportion, and it acquires additional substance, or grows ; but should the same arm become paralyzed, how quickly will it diminish in bulk ! Up to a certain period of life the body grows ; in animals this varies with the species ; in man, the process continues, generally, up to the twentieth 3 r ear, or even beyond. When growth ceases, it is not that new ma- terial ceases to be added to the body, for this is unceasingly being effected to supply the place of those constituents of the frame which are continually being used up ; but the balance between the food taken and as- similated, and the waste of the body, is equalized ; and after growth has ceased, this balance (with the exception of fatty de- posites) is, during health, maintained with but little variation during the years of life's prime. When old age comes on, that is, after the sixtieth year, the balance inclines the other way ; the waste now exceeds the reparative nutriment which it is in the power of the system to receive and elabo- rate, and the tissues all diminish in bulk, the stature, even, becoming less. Young persons require nutriment, not only to sustain the wasting processes of re- spiration, and of motor change or move- ment, but they require, also, sufficient to supply the growing tissues of their entire body with the various elements which go to perfect their composition. If these elements are not supplied, development is either ar- rested, or, the tendency to growth conti- nuing, the bones and tissues generally lengthen, without acquiring their healthy substance. As a rule, the appetite of a healthy, growing child for plain and whole- some food, ought never to be stinted. — See Children, Digestion, Food, §c. GRUEL.— See Cookery. . GUAIAC [Guiacum]. — The wood and gum resin of a tree which is a native of the West Indies. They are both used in medicine. The wood is extremely hard and tough, of a striped yellowish green colour ; the resin is a greenish brown. Guaiac, as a medicine, acts upon the skin, and is often extremely useful in chronic rheumatism. The most convenient form of administration is the tincture, which may be given in one or two teaspoonful doses at bedtime ; milk is the best vehicle for its administration ; when GUI 273 GUL taken in water, it must be drunk as soon as mixed, otherwise the resin separates and floats on the top. Guaiac sometimes occasions sickness, in which case is is better abandoned. GUINEA WORM— Is a parasitic, long, round worm, about the thickness of a violin string, which burrows beneath the skin, chiefly of the feet and calves of the legs. It is met with principally in tropical climates, particularly on the African west coast, but is sometimes brought to this country by indi- viduals who have resided in the tropics. The length of the animal varies from a few inches to five or six feet. After remaining under the skin for a longer or shorter time, the head protrudes through a small boil which forms on the skin. The only treat- ment is seizing the head when this occurs, and gradually, from day to day, winding out the worm, care being taken that it is not broken, for should this happen, the portion which remains is apt to occasion severe irritation. Persons native to the situations where these parasites prevail, will always be found skilled in the mode of extracting it. GULLET— The Gullet, or "CEsopha- Grs" — Is a tube which extends from the throat or fauces to the stomach. Down, or through it, the food is propelled by the ac- tion of the muscular fibres which form one of its coats. It is narrowest at its upper end, and it is here that choking from food most generally occurs... Choking may occur from various causes : either the gullet may be contracted from some cause or other at a particular point, or the morsel of food may be too large, or of such a hard irregular character that it cannot pass down easily, or the cause of the impediment may be spasm, more especially of an hysterical character. Impediment to swallowing from contraction of the gullet- tube is generally a serious matter ; the cause should, as soon as possible, be exa- mined by a medical man ; sometimes it fol- lows recent injury to the lining membrane, such as scratching by a sharp-pointed bone, or after poisoning by irritant agents. In a case under the author's care, it followed upon a damson-stone having been swallowed some months previously, scratching the throat in its descent; the power of swal- lowing, which was nearly lost, in conse- quence, probably, of thickening of the tis- sues immediately beneath the lining mem- brane, was restored by the administration of codliver-oil for a few weeks. When a large morsel of food gets fast in the gullet, it may occasion death by pressure upon the windpipe ; at all events, it causes much distress for the time. If at all within reach of the fingers, of course they may bo used for its extraction at once: if too far for this, a surgeon's assistance will be re- quired to push the morsel beyond the upper narrow portion of the gullet into the wider ; this he will effect by means of the probang, (fig. lxxxi.,) an instrument consisting of a Fig. lxxxi. piece of round whalebone about two feet long, to one end of which a portion of sponge, about the size of a large marble, is firmly attached, and which requires oiling or greasing before use. In passing the pro- bang, care has to be observed that it is kept well to the back of the throat, and the pa- tient's head well thrown back at the same time; it is then to be pushed steadily but quickly down till the obstruction is felt to pass readily before it, and away from it. These particulars are mentioned, not to induce unprofessional persons to attempt the operation when a medical man is procur- able ; but if he is not, an unprofessional operator and an extempore probang, made from an umbrella whalebone, a cane, or even a curved stick, with a small bunch of some soft material securely fastened to one end, would be preferable to choking en- tirely, or partially even, for any length of time. A few smart blows on the back will, in the case of children especially, often dislodge a morsel sticking in the upper part of the gullet. Sharp-pointed or irre- gular bodies, such as pins, fish-bones, or other bones, may get fixed in the throat, and it is generally in the upper part of it ; the fingers may be able to remove them, if not, a piece of bread, coarsely masticated and swallowed, will often, especially if fol- lowed by a draught of water, carry down the impediment. In some cases, an emetic may be useful. Frequently, after a sharp- pointed body has stuck in the gullet, and has scratched its lining membrane, the sen- sation of its still remaining may be felt for some time after it has passed away. It is well to keep this in mind, that continued unnecessary efforts to relieve may not be persevered in. If a sharp body remains fixed in the upper part of the gullet, press- ure at some point or other will almost cer- tainly cause a pricking sensation. The gullet is sometimes spasmodically affected, the food being either stopped in the passagi downward, or passed with pain and diffi- culty ; this affection falls partly under the head of Spasm and Hysteria, but it is some- IS GUM 274 GUM times the result of too great haste in eating and swallowing. As explained under article Digestion, the food does not simply fall into the stomach down the gullet-tube, but it is conveyed into the digestive organ by the regular action of the muscular fibres of the tube, which, while they propel forward, also close behind the morsel being swal- lowed. It must be evident, therefore, that if morsels follow one another in too quick succession, this action must be interfered with ; and if it is, spasmodic pain, at least, is produced, and not improbably choking. Choking, from things getting fixed in the gullet, must not be confounded with the sensation of suffocation produced by foreign bodies getting into and irritating the upper portions of the windpipe which lies in front of the gullet. — See Lungs. In the latter cases sudden, violent, spasmodic cough en- sues, and the appearance and dread of suf- focation is generally much more quickly and strongly marked. liefer to Alimentary Canal, and more espe- cially to Digestion — Lungs, §c. GUM ARABIC, or Gum Acacia— Is the produce of certain species of acacia, and is brought chiefly from Northern Africa, Egypt, Nubia, Barbary, &c. Gum is con- tained in greater or less proportion in the juice of most plants, and, by many, it is exuded in the form of round concrete drops or " tears," as they are called, such as the gums of cherry and plum trees, which are familiar to all. The gum of the acacia is, however, most generally used and esteemed as a demulcent in affections of the throat or air-passages, in irritations of the urinary organs, &c. When gum is dissolved in water the solution is named mucilage ; and, in this form, it is one of the most convenient vehicles for other medicines, particularly those which require some degree of suspen- sion in liquid, as, for instance, in the com- mon chalk mixture. It is also useful for facilitating the mixture of oils, camphor, &c. in watery mixtures ; but for this pur- pose milk is preferable. The powder of gum acacia, when genuine, is probably the best form for keeping, as it is dissolved in a few minutes, whereas gum in its ordinary form takes a considerable time, and, when made into mucilage, on the other hand, is very apt to spoil. Gum is nutritive in some degree, probably in the same degree as starch or sugar, and is used as an article of diet in the countries whence it is pro- cured. It is much more used in medical practice in France than in this country, both for its nutritive and its demulcent pro- perties. Gum tragacanth, another species of gun\ brought chiefly from Asia Minor, Persia, &c, is procured from a tribe of plants belong- ing, like the acacia, to the leguminous or pod-bearing family. It possesses many of the properties of acacia gum* but not being so soluble, is not nearly so convenient for use. Mucilage of gum acacia maybe conveniently made, by dissolving ten ounces of the gum in twenty fluid ounces of water, either by gentle heat or by suspending the gum — tied in a muslin-bag — in the water. GUMS. — The gums which closely invest, but do not adhere to the teeth, are com- posed of mucous membrane of a dense in- sensible character. In the investigation of disease, the gums frequently afford valuable information respecting general constitutional disorder. In sea-scurvy, the gums become spongy and swollen, extend over the teeth, and bleed easily: the symptom is always strongly corroborative of the bodily disor- der. In persons who have been long sub- jected to the action of lead, slowly intro- duced into the system, either in the course of their occupation, or, as sometimes occurs, from the ordinary drinking-water having become impregnated with the metal from lead pipes, a blue line is often observable along the edge of the gum. A pink line in the' same situation has also been pointed out as showing itself in persons affected with pulmonary consumption. In constitu- tional affection by mercury, it is well known that the gums become inflamed, sore, and spongy ; in some cases of disease affecting the mouth, the gums become dark or black in colour, and the breath is extremely fetid. Of course, in cases where the state of the gum is indicative of constitutional affection, that must be attended to, (see Scurvy,